The Peter Attia Drive Peter Attia, MD

In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into blood glucose and why it matters so much with respect to metabolic health and longevity. They explain the need to pay close attention to metrics like average blood glucose, glucose variability, and peak glucose numbers. Additionally, Peter explains why he encourages all his patients, even nondiabetics, to utilize a continuous glucose monitor (CGM) which gives important insights that traditional lab testing and metrics consistently miss.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #24 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

 

We discuss:
The problem with traditional blood tests and metrics for determining metabolic health [1:10]; The superior insights from a continuous glucose monitor [6:15]; Why lower is better than higher: average glucose, glucose variability, and glucose peaks [12:00]; Deep dive into average blood glucose and the importance of having the lowest average blood glucose possible [14:45]; Deep dive into glucose variability and why less variability is better [33:15]; Example of how HbA1c and traditional measures could catch metabolic issues too late [41:45]; Postprandial dips in blood glucose as a predictor of subsequent hunger and energy intake [43:00]; Exploring the idea that the suppression of fatty acids is actually causing hunger rather than a low blood glucose [49:45]; Deep dive into peak glucose and why lower peaks is better [57:15]; What the best rodent models tell us about the impact of peak glucose levels [1:06:25]; Why Peter encourages all his patients to wear a CGM [1:14:30]; and More.

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Amanda Grant Smith is a geriatric psychiatrist with decades of experience treating patients with dementia and Alzheimer's disease. In this episode, Amanda shares how she developed a passion for geriatric psychiatry as a means to support dementia patients. She explains how to recognize, define, and diagnose dementia—a process that still remains somewhat elusive. They also talk about the significance of ApoE genotype and compare the various forms of dementia including differentiating between Alzheimer’s disease and Lewy body dementia. They discuss the current landscape of clinical trials, the drug pipeline, and talk about a very promising monoclonal antibody directed at amyloid beta that has the potential to be a disease-modifying drug. They conclude with a discussion about how to define “healthy aging” and reflect on how understanding dementia can shape one’s life philosophy.
 

We discuss:
How Amanda developed a passion for geriatric psychiatry [3:15]; Defining and diagnosing dementia and Alzheimer’s disease [13:30]; Medical tests for dementia and their relationship to clinical symptoms [22:45]; The pathology of dementia, and the role of the tau and beta-amyloid protein in Alzheimer’s disease [33:15]; The significance of ApoE genotype, and differentiating Alzheimer’s disease from Lewy body dementia [43:15]; The evolution of Alzheimer’s disease prevention, care, and medications over the last 20 years [52:45]; Psychiatric support for dementia patients (and caregivers) with depression and anxiety [1:02:45]; Drug pipeline, clinical trials, and major challenges to overcome [1:13:45]; Redefining Alzheimer’s disease and designing effective trials [1:23:00]; The promise of monoclonal antibody treatments for Alzheimer’s disease [1:34:15]; How we should measure outcomes in dementia trials and define “healthy aging” [1:42:30]; How understanding dementia can reshape our life philosophy [1:53:45]; and More. Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/AmandaSmith

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Layne Norton is a physique coach, a natural professional bodybuilder and powerlifter, and holds a Ph.D. in nutritional sciences. In this episode, Layne explains how he became interested in weightlifting and fitness both professional and academically. He provides insights into preventing and managing injuries while using consistency and determination to boost his professional success in bodybuilding and powerlifting. Peter and Layne also review the science of body composition and what’s really driving muscle growth, including the role of nutrition, supplements, and a number of important and misunderstood hormones important to muscle protein synthesis. Furthermore, Layne stresses the importance of maintaining muscle mass even while losing fat for improving metabolic health and longevity and provides the keys to developing healthy habits. 
 

We discuss:
Layne’s childhood and why he gravitated towards weightlifting and bodybuilding [2:45]; Layne’s academic path, overcoming ADHD, and kicking Adderall [11:45]; Paradoxical observations about expertise, and Layne’s career transition to health and fitness [22:00]; The power of persistence and resilience in the face of setbacks [32:15]; Battling injuries, managing back pain, and setting lifting records [43:00]; Bodybuilding vs. powerlifting: comparing and contrasting the training approaches [57:15]; Cutting weight without losing muscle mass: exercise and dietary protocols, fasting, and a look at the literature [1:06:00]; Muscle protein synthesis and the importance of leucine [1:25:30]; Nitrogen balance and muscle protein synthesis, and the regulatory role of hormones for fat flux and muscle growth [1:37:00]; What’s really driving muscle growth: intrinsic vs. systemic factors, IGF, and hormone signaling [1:46:30]; The role of protein, carbohydrates and insulin on muscle growth and preservation, and the importance of context when interpreting study results [1:55:30]; Clarifying the role of cortisol—a misunderstood hormone [2:07:45]; The problem with studies trying to isolate one nutrient [2:15:00]; The important role of inflammation from exercise [2:19:25]; Keys to preserving muscle, and the value of habits, consistency, and resilience [2:23:30]; and More. Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/LayneNorton 

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Sarah Hallberg is the Medical Director at Virta Health and a physician who has spent nearly two decades treating patients with obesity and type 2 diabetes. In the first half of this episode, Sarah discusses how she became a huge believer in the efficacy of carbohydrate restriction for the treatment of type 2 diabetes through her research and clinical experience. Sarah challenges the common beliefs about the role of dietary fat and carbohydrate on the plasma makeup of fatty acids and triglycerides. She also expresses the importance of understanding early predictors of metabolic illness—highlighting one particular fatty acid as the most important early predictor—before finishing with a discussion about how doctors might be able to personalize patients’ metabolic management in the future. In the second half of this episode, Sarah tells the personal story of her own lung cancer diagnosis. She talks about dealing with her grief, deciding to continue her work while prioritizing her family, and how she devised a plan to extend her survival as long as possible.  
 
We discuss:
How Sarah discovered the profound impact of carbohydrate restriction for reversing obesity and type 2 diabetes [3:15]; Prediabetes and metabolic syndrome: prevalence, early signs, and the importance of treating early [16:00]; Overview of fatty acids, how they are metabolized, and understanding what you see in a standard blood panel [29:15]; The relationship between diet composition and metabolic markers [35:15]; Why palmitoleic acid is such an important biomarker [48:15]; The best early indicators of metabolic disease [1:00:00]; Personalized management of metabolic illness [1:07:00]; Sarah’s cancer diagnosis and the beginning of her journey [1:15:15]; The emotional impact of a devastating diagnosis [1:27:15]; Sarah’s plan to extend survival [1:36:45]; Sarah’s aggressive treatment plan [1:47:30]; Life-threatening complications and the return of her cancer [1:59:00]; Sarah’s reflections on her approach to life with chronic cancer and balancing her time [2:11:00]; and More. Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/SarahHallberg 

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In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into nicotine, a complicated and interesting molecule that has effects on both the brain and the body. They analyze the results of the studies that describe nicotine’s cognitive benefits and potential for inducing weight loss. They talk about a smoking cessation technique called nicotine replacement therapy and give a full breakdown of the various routes of administration, dosing, and safety. Finally, they explore the fascinating and counterintuitive observation that cigarette smokers are less likely to get a severe case of COVID-19.

If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #23 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:


How Peter first became interested in the potential benefits of nicotine [1:15];
Untangling nicotine from tobacco [6:00];
Nicotine replacement therapy (NRT) for quitting smoking: products, protocols, and a review of the literature [9:30];
The cognitive benefits of nicotine: Overview of the literature [15:50];
Where nicotine has the most positive impact on cognition [30:30];
Possible mechanisms conferring the benefits of nicotine [37:00];
How modafinil and other nootropics compare to nicotine [47:15];
How nicotine may induce weight loss [54:00];
Relationship between smoking and COVID-19: Analyzing the observation that smoking appears protective against COVID-19 [1:01:45];
Breakdown of the various nicotine replacement therapies: route of administration, dosing, and safety [1:11:30];
Concluding thoughts on nicotine: use cases, addictive properties, and more [1:19:45]; and
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Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee evaluating COVID-19 vaccines. In this episode, Paul’s second appearance on The Drive, he provides an update on all the SARS-CoV-2 vaccines currently deployed, explains why the concerns raised around the mRNA vaccines are not legitimate, and offers his view on the prospects and timeframe of reaching herd immunity. He also takes a deep dive into immunology, explaining the short-term and long-term immune response to both natural infection and vaccination and how these two can function together to provide durable immunity. Additionally, they discuss the theories on the origins of this virus, what impact the new COVID-19 variants might have, and the recent pausing of the J&J vaccine. Finally, they discuss how we can be better prepared for an inevitable future outbreak of a novel virus. This episode was originally recorded on April 14, 2021.
We discuss:
Overview and current status of the SARS-CoV-2 vaccine strategies [4:10];
Addressing concerns about mRNA vaccines [9:00];
How the failure to make an effective HIV vaccine aided the development of a COVID-19 vaccine [16:45];
Where SARS-CoV-2 falls on the spectrum of its ability to mutate and what that means for immunity and vaccination [21:30];
How the combination of short-term and long-term immune response to SARS-CoV-2 work together to provide durable immunity [28:00];
Importance of understanding relative vs. absolute risk reduction [38:15];
Implications of pausing the J&J vaccine due to reports of blood clotting in the brain [42:45];
What constitutes herd immunity and the concerns of rising vaccine hesitancy [47:45];
When we might reach herd immunity, future vaccines for children, and long-term outlook for maintaining population immunity [58:45];
Theories about the origins of SARS-CoV-2 [1:07:00];
Preparing for the possibility of a future pandemic and how we can learn from our mistakes [1:10:40]; and
More.
Learn more: https://peterattiamd.com/

Show notes page for this episode: https://peterattiamd.com/pauloffit2 

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