The Peter Attia Drive Peter Attia, MD

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Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan, as well as a previous guest on The Drive. In this episode, Rich provides an update on the exciting work of the Interventions Testing Program (ITP), an initiative designed to assess potential life-extending interventions in mice. Rich covers the notable successes like rapamycin, 17⍺-estradiol, and acarbose as well as notable failures like nicotinamide riboside, metformin, and resveratrol, providing valuable lessons about the intricacies of the aging process. Rich delves deep into aging biomarkers and aging rate indicators, unraveling crucial insights into the science of geroprotective molecules. Additionally, Rich discusses some surprising successes of recent molecules tested by the ITP and concludes with an optimistic look at future frontiers, including bridging the gap from mice to humans.
We discuss:
An overview of the Interventions Testing Program (ITP) [3:45]; How the mice used by the ITP are superior for research relative to mouse models used in most research [11:15]; Design of ITP studies, outcomes tested, and metrics of interest [19:00]; The process and challenges of drug formulation for mice [30:00]; Four drugs identified by the ITP that extends the lifespan of mice [36:30]; The success of rapamycin and what it tells us about the biology of aging [43:15]; Other measures of healthspan evaluated by the ITP in stage 2 studies [50:45]; Distinguishing aging rate indicators from biomarkers of aging [57:30]; Aging rate indicators identified through the examination of slow-aging mice [59:15]; Why proteomics are essential to understand changes in the cell [1:12:15]; Unraveling aging rate indicators: dose-effect, duration, and future frontiers [1:21:45]; A closer look at aging rate indicators: bridging the gap from mice to humans [1:27:00]; What do laboratory mice die from? [1:38:45]; Distinguishing between a drug that improves an age-sensitive outcome and a drug that improves all aspects of aging [1:42:00]; The ITP study of 17⍺-estradiol: mechanisms of life extension and surprising sex differences [1:43:30]; Unsuccessful drugs studied by the ITP: resveratrol, metformin, and nicotinamide riboside [1:51:30]; Over-the-counter successes in the ITP: meclizine and astaxanthin [2:01:00]; A senolytic drug, fisetin, fails to extend lifespan [2:07:00]; Can targeting senescent cells slow aging? [2:13:00]; Optimism about future findings [2:16:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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Arthur Brooks is a social scientist, professor at Harvard University, columnist for The Atlantic, and bestselling author. In this episode, Arthur returns to the podcast to discuss his new book, Build the Life You Want. He delves into the nuanced concept of happiness, differentiating between momentary feelings and overall wellbeing. He explains the importance of understanding one’s personality pattern with respect to positive and negative emotions in order to better self-manage emotions. He delves into the three key elements of happiness, offering practical strategies for enhancing those specific domains through methods such as metacognition, transcendent experiences, discipline, minimizing self-focus while directing attention outward, and more. Through personal examples, Arthur demonstrates that one can actively track well-being levels and take intentional steps to cultivate happiness and enhance overall well-being.
We discuss:
Happiness vs. happy feelings, and how happiness and unhappiness can coexist [4:30]; The six fundamental emotions [8:00]; The evolution and heritability of happiness, and the four personality patterns with respect to positive and negative emotions [17:30]; Navigating relationships: the power of complementarity over compatibility [23:30]; The importance of self-managing your mental habits [25:30]; Enjoyment: one of the three macronutrients of happiness [32:00]; Satisfaction: one of the three macronutrients of happiness [43:45]; The reverse bucket list, metacognition, and other techniques to protect yourself from your limbic system [51:00]; Meaning: one of the three macronutrients of happiness [57:30]; The four quarters of your life and how that relates to the meaning of your life [1:05:00]; Putting metacognition into practice [1:09:00]; What might explain the societal downdrift in happiness over the last few decades? [1:17:00]; Taking charge of your happiness: discipline, transcendent experiences, and other deliberate actions for happiness [1:30:30]; Tracking happiness: biomarkers and micronutrients behind the macronutrients of happiness [1:42:00]; The value in minimizing the self and looking outward [1:49:45]; How Arthur surprised himself with his ability to improve his happiness [1:54:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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To support Tom’s mission and work, please visit: https://africanmissionhealthcare.org/donation/catena/.
 
In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast to the ubiquity of chronic disease and self-harm in the West, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who, despite their suffering, live so harmoniously, happily, and resiliently.
We discuss:
Background, medical training, and early days of missionary work in Africa [5:15]; Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [12:30]; Learning surgery on the job and earning the trust of the community [37:00]; The amazing people of Nuba, and why Nuba feels like home to Tom [47:45]; NY Times article about Tom’s work, and Tom’s new venture on the board of the Aurora Prize Foundation, raising awareness and funds for other missionaries [59:45]; Tom’s mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:12:00]; The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:19:45]; The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:30:00]; The logistical challenge of helping Tom’s hospital, and what Tom really needs [1:35:15]; Diseases in the adult population [1:38:30]; Living without possessions, finding meaning, and being a missionary [1:55:45]; Happiness, sense of purpose, and suicide: contrasting the US with Nuba [2:07:15]; Other than donations, is there a way people can help Tom and other similar causes? [2:15:15]; The food in Nuba [2:18:30]; Tom’s annual bout of malaria [2:23:45]; Patients Tom will never forget [2:26:00]; Resources for people wanting to get involved in helping Tom’s work [2:31:00]; Peter tells a story that defines Tom [2:32:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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In this “Ask Me Anything” (AMA) episode, Peter explores various pharmacologic tools commonly utilized to improve metabolic health and treat diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. He examines the available data on these drugs, assessing their comparative effectiveness and their potential in the context of lifestyle interventions. Additionally, he offers insights into whether SGLT2 inhibitors hold promise as geroprotective agents beyond their effects on glycemic control. Next, Peter analyzes the relationship between statin usage and the risk of developing insulin resistance and type 2 diabetes, investigating possible causal pathways and providing insights into strategies for risk reduction. He offers insights on monitoring adverse statin effects and evaluating the need for adjustments, ultimately weighing the trade-off between the risk to overall metabolic health against the benefits of reducing apoB levels through statin use.
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We discuss:
Pharmacologic tools for improving metabolic health, and the relationship between statins and insulin resistance [2:00]; SGLT-2 inhibitors: how they work and help to manage type 2 diabetes [4:15]; The history of SGLT2 inhibitors – from discovery to the current state [10:15]; Comparing the various FDA-approved SGLT2 inhibitors [15:00]; Other beneficial effects of SGLT2 inhibitors outside of glycemic control [20:15]; Exploring SGLT2 inhibitors as potential geroprotective molecules [22:45]; The side effects and risks associated with SGLT2 inhibitors [31:45]; Medications, lifestyle interventions, and other considerations for treating diabetes and improving metabolic health [37:45]; Metformin as a tool for pre-diabetics, and how metformin compares to lifestyle interventions [44:00]; How GLP-1 agonists compare to metformin and SGLT2 inhibitors in terms of glycemic control and weight loss [49:15]; Exploring the relationship between statin use and the risk of developing insulin resistance and type 2 diabetes [52:30]; Possible mechanisms of statin-induced insulin resistance and diabetes, and potential mitigation strategies [1:04:30]; How to monitor for adverse effects of statin use and assess the need for adjustments [1:11:45]; Weighing the benefits and risks of statin use: does the diabetes risk outweigh the benefits of lowering apoB with a statin? [1:15:30]; Parting thoughts [1:20:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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Harold (Hal) Burstein is an internationally renowned breast cancer expert. In this episode, Hal discusses a broad range of topics related to breast cancer, starting with the intricacies of breast anatomy and the endocrinological factors at play. He covers the spectrum of breast cancer, from precancerous lesions to invasive breast cancer, classifying these conditions into a helpful framework. He delves into various screening methods, including self-exams, mammograms, ultrasounds, and MRIs, and addresses the ongoing debate surrounding early screening and detection. Hal provides insights into the latest advancements in cancer treatment, offering valuable guidance for individuals to understand their unique circumstances within the three primary categories of breast cancer. Finally, Hal delves into the role of genetics in breast cancer and brings attention to the less commonly addressed issue of male breast cancer.
We discuss:
The prevalence and mortality rate of breast cancer in women [4:15]; The anatomy of the breast and the complex factors behind breast cancer development [6:30]; The three main categories of breast cancer [16:45]; Breast cancer risk: the impact of menopause, estrogen, breast density, obesity, and more [21:15]; Finding and evaluating lumps in the breast [25:30]; Identifying and treating precancerous lesions like ductal carcinoma in situ (DCIS) [31:00]; Post-lumpectomy for DCIS: standard of care, future risk of cancer, and pros and cons of radiation and other preventative options [41:15]; Lobular carcinoma in situ (LCIS): how it differs from DCIS in terms of treatment and future risk of invasive cancer [55:00]; Breast cancer screening: mammography, ultrasound, MRI, and more [1:03:45]; Invasive breast cancer: pathology report, surgery, and survival [1:11:00]; The argument for aggressive screening for breast cancer [1:22:15]; Advances in the treatment of breast cancer, adjuvant therapy, and neoadjuvant therapy [1:27:00]; The use of hormone replacement therapy in women who are in remission from breast cancer [1:41:15]; The role of genetics in breast cancer [1:44:45]; The importance of multidisciplinary care delivered by cancer centers [1:53:15]; Breast cancer in men [2:03:30]; Parting thoughts and takeaways [2:05:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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Kari Nadeau is a physician scientist with expertise in treating food allergies. In this episode, Kari first explains the fascinating workings of the immune system, exploring how it adeptly defends against bacteria and viruses but how the same system can lead to food allergies. She proceeds to explore the complexities of food allergies, detailing their typical developmental patterns, underscoring the significance of preventative approaches like early exposure, and highlighting the potentially life-threatening nature of severe food allergies. Kari illuminates the latest advancements in immunotherapies that not only mitigate allergy severity but also hold the potential to completely cure the patient. Additionally, Kari shares her concerns about the increasing levels of air pollution, elucidating its adverse effects on health while providing valuable suggestions for reducing exposure.
We discuss:
Kari’s motivation to study food allergies [4:00]; Overview of the immune system and the family of immunoglobulins [9:00]; How our immune system fights viruses, bacteria, or fungi, and some exceptions to the rule [13:00]; Why our immune system is generally better at fighting viruses than bacterial infections [18:45]; Differentiating a food sensitivity from a food allergy, and a discussion about celiac disease [25:30]; How food allergies develop, why they can be lethal, and factors contributing to the uptrend in food allergies [35:45]; The role of environmental factors in the onset of food allergies and strategies for prevention [50:15]; How immunotherapy helps to overcome, and even cure, food allergies [1:04:15]; Can immunotherapy work for environmental allergens like pollen? [1:24:00]; Air pollution: impact on health and tips for reducing your risk [1:25:30]; Resources for those wanting to learn more or find clinical trials related to food allergies [1:40:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube