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#316 – AMA #63: A guide for hair loss: causes, treatments, transplants, and sex-specific considerations
- The impact of hair loss on emotional health [2:15];
- The prevalence, patterns, and causes of hair loss in men and women [5:15];
- The genetic and hormonal causes of hair loss, and the role of dihydrotestosterone (DHT) in androgenic alopecia [8:45];
- The visual differences in hair loss patterns between men and women, and the importance of consulting a specialist to rule out non-genetic causes of hair loss [13:30];
- How genetic predisposition influences the risk of androgenic alopecia, and how early detection through diagnostic tools and blood tests can help manage the risk more effectively [16:45];
- Ideal timing for starting treatment: why early treatment is crucial for effectively managing hair loss [19:30];
- The various FDA-approved treatments for androgenic alopecia, their mechanisms, and additional off-label treatments commonly used to manage hair loss [24:30];
- Topical minoxidil—the most commonly recommended starting treatment for hair loss [30:15];
- Oral vs. topical minoxidil: efficacy, ease of use, and potential side effects that must be considered [33:45];
- Finasteride for treating hair loss: efficacy, potential side effects on libido, and the need for careful PSA monitoring in men to avoid missing early signs of prostate cancer [37:15];
- Other effective hair loss treatments for women: boosting hair density with spironolactone gel and ketoconazole shampoo as part of a comprehensive strategy [41:30];
- Low-level laser therapy: effectiveness, costs, practicality, and a comparison of in-office treatments with at-home devices [49:00];
- Platelet-rich plasma (PRP) as an off-label treatment for hair loss: potential effectiveness, varying protocols, and significant costs [53:45];
- Hair transplant for advanced hair loss: criteria and considerations [58:00];
- Types of hair transplants: follicular unit transplantation (FUT) vs. follicular unit extraction (FUE) [1:02:00];
- The financial cost of hair transplant surgery, and what to consider when seeking affordable options [1:06:15];
- The potential risks and downsides of the various hair transplant procedures [1:09:30];
- Post-procedure care for hair transplants and whether the procedure must be repeated periodically [1:16:30];
- Combining different hair loss treatments: benefits, risks, and considerations [1:18:30];
- Emerging hair loss treatments with limited data [1:21:00];
- Key considerations for selecting the right treatment plan for hair loss [1:22:00];
- A summary of the different considerations for men and women facing hair loss [1:24:30];
- Practical advice on selecting the right specialist or treatment team [1:26:15]; and
- More.
- Overview of episode topics (and an important discussion on fanny packs) [2:00];
- Understanding uric acid: its role in metabolic processes, its association with gout and kidney stones, its impact on blood pressure, and more [6:00];
- Non-modifiable factors that influence uric acid levels [11:00];
- Modifiable factors that influence uric acid levels [14:15];
- Association between high uric acid levels and cardiovascular disease [20:00];
- Evidence suggesting a causal link between high uric acid levels and cardiovascular disease [24:00];
- Inconclusive evidence about the cardiovascular benefits of lowering uric acid pharmacologically [28:15];
- Exploring the potential risks of low uric acid levels in neurodegenerative diseases [37:00];
- Managing uric acid levels: dietary interventions and pharmacological approaches [42:00];
- The impact of protein on appetite and weight management [44:00];
- The consequences of insufficient protein on eating behaviors and satiety [52:15];
- The relationship between protein deficiency and obesity: exploring the “protein leverage hypothesis” [57:15];
- The impact of protein intake on energy expenditure [1:02:15];
- Determining optimal protein intake to avoid deficiency and support health [1:05:45];
- The role of different amino acids and protein sources in promoting satiety [1:08:15];
- Comparing the satiety effects of solid vs. liquid protein sources [1:10:30];
- Peter’s framework for incorporating protein intake into a strategy for controlling body weight [1:12:00]; and
- More.
- The impact of UV radiation on the skin [2:00];
- Understanding solar UV: from the electromagnetic spectrum to skin health [3:45];
- The role of sunlight in vitamin D production [8:30];
- Factors contributing to vitamin D deficiency: insufficient UV exposure, magnesium levels, and more [9:45];
- Sun exposure needs for different skin types, and the limitations of current studies in defining vitamin D deficiency [12:45];
- The acute and long-term effects of excessive UV exposure: sunburn, photoaging, and the increased risk of skin cancer [15:30];
- Types of skin cancer and associations with UV exposure [17:45];
- The complex relationship between melanoma and UV exposure [22:15];
- Why UV exposure alone doesn’t necessarily explain the risk for melanoma [25:15];
- Other risk factors for melanoma [29:15];
- Tanning beds and skin cancer risk [34:45];
- Balancing sun exposure: benefits and risks [38:15];
- Tattoos and sun exposure [40:30];
- The importance of regular skin checks, dermatologists, and emerging technologies showing promise for early detection of cancer [41:45];
- Self-skin checks: what to look for [46:30];
- Prevalence of skin cancer and the importance of early detection [49:30];
- Summary of the major risk factors for melanoma [54:15];
- The role of sunscreen in reducing skin cancer risk [55:45];
- How sunscreen works, the differences between chemical and mineral sunscreens, an explanation of SPF, and more [58:30];
- How to determine the appropriate sunscreen SPF to use based on the UV index [1:04:45];
- Choosing the right sunscreen for your individual needs [1:07:00];
- The impact of water and perspiration on sunscreen effectiveness [1:12:00];
- Chemical vs. mineral sunscreens: safety concerns and recommendations [1:14:00];
- Concerns about hormone effects from chemical sunscreens [1:19:15];
- Sunscreen summary: skin types, key considerations, recommended brands, and more [1:23:15]; and
- More.
- Overview of topics and episode format [1:40];
- Preventing cognitive decline [5:00];
- How to lower blood glucose and insulin [13:30];
- The relationship between lipids, CVD, and Alzheimer’s disease, and whether statins can increase the risk of neurodegenerative disorders and AD [23:15];
- Reducing apoB levels through exercise and diet [31:45];
- Pharmacological options for lowering apoB [38:00];
- How nutrition impacts longevity via metabolic health, muscle mass, BMD and more [40:15];
- How can someone determine the best diet for themselves? [43:45];
- Nutrition myth: All weight loss is good [46:45];
- Nutrition myth: Metabolic rates are dramatically different among individuals based on genetics [49:00];
- Nutrition myth: Losing weight after a brief period of overeating is impossible [53:45];
- Nutrition myth: GLP-1 agonists are a replacement for a healthy lifestyle [57:45];
- Nutrition myth: There is a single best diet for weight loss [1:03:00];
- Nutrition oversimplification: All calories are created equal [1:05:45];
- Daily step goals [1:06:45];
- The benefits of standing versus sitting throughout the day [1:10:45];
- How to identify the most impactful and easiest-to-implement ways to improve your health [1:12:30];
- The critical importance of emotional health [1:14:30];
- Why supplements should be considered as supportive aids rather than primary solutions in one’s strategy to improve longevity [1:18:00];
- Strategies for reducing high blood pressure [1:20:45];
- Peter’s biggest frustrations with “mainstream health advice” [1:28:00];
- Peter’s chaotic, yet cherished, morning routine [1:31:00]; and
- More.
#301 – AMA #59: Inflammation: its impact on aging and disease risk, and how to identify, prevent, and reduce it
- Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45];
- Acute vs chronic inflammation [8:00];
- The connection between chronic inflammation, aging, and age-related diseases [11:00];
- The impact of inflammation on metabolic health [18:30];
- Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00];
- Factors that contribute to low level chronic inflammation [28:00];
- Minimizing inflammation through diet [29:45];
- The important role of fiber for gut health and inflammation [33:45];
- A closer look at the impact of trans fats and saturated fats on overall health [34:45];
- Why Peter prefers dietary fiber from food sources over supplements [38:30];
- Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00];
- Is there any value in over-the-counter food inflammatory tests? [42:30];
- Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15];
- Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15];
- Dairy: the complex role of dairy on inflammation and individual responses [55:00];
- Wheat: the complexities and conflicting evidence around wheat’s inflammatory effects [57:45];
- How exercise influences inflammation [1:02:00];
- How sleep quality and duration impacts inflammation [1:07:00];
- The potential impact of chronic psychological stressors on inflammation [1:13:00];
- The impact of oral health on inflammation and overall well-being [1:15:00];
- The role of medications in managing chronic inflammation [1:18:15];
- Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15];
- Parting thoughts and takeaways [1:27:00]; and
- More.
#297 – AMA #58: Iron: its role in health, testing methods, and strategies for preventing and managing iron deficiency
- Overview of today’s topics and the importance of understanding iron levels in the body [1:45];
- The importance and ubiquity of iron in the body, and the role of the protein called ferritin [4:30];
- The processes of iron absorption, utilization, and transportation [9:30];
- Options for testing iron levels and how to interpret the results [13:45];
- What does it mean to be iron deficient and how is it different from anemia? [17:15];
- Symptoms of iron deficiency and/or anemia [22:15];
- How prevalent is iron deficiency and who is most susceptible? [24:30];
- The importance of consuming an adequate amount of iron daily to prevent deficiency [30:30];
- The best way to improve iron levels for someone who is deficient [34:45];
- Iron supplementation: various formulations and potential side effects [37:45];
- Intravenous iron infusion as an alternative to oral supplements — plus restless legs syndrome and other topics [42:00];
- Iron supplementation: who should and should not consider it [44:00];
- Peter’s approach to creatine and his pre- and post-workout supplements [50:15];
- Navigating sodium intake: effect on blood pressure, who should use precaution, and other considerations [54:45];
- Peter’s thoughts about the potential of writing another book [57:15]; and
- More.
#293 – AMA #57: High-intensity interval training: benefits, risks, protocols, and impact on longevity
- Common questions about high-intensity interval training (HIIT) [1:30];
- The origins of HIIT [3:15];
- Defining HIIT training and differentiating it from sprint interval training (SIT) [5:45];
- Why HIIT is often touted as a more efficient way to exercise [14:00];
- Navigating the nuances of HIIT research: understanding limitations and the importance of a blended exercise routine [20:30];
- The four pillars of exercise [24:15];
- Using HIIT to improve VO2 max [26:00];
- HIIT training for the untrained individual: impact on VO2 max and the interplay between exercise-induced adaptations and potential weight loss [33:00];
- Sprint interval training (SIT) vs. HIIT: comparing the relative improvements in VO2 max and the impact of longer duration intervals [40:00];
- Benefits and limitations of HIIT, drawbacks of overtraining with HIIT, and the importance of a diversified routine to increase total cardiorespiratory capacity [44:15];
- HIIT protocols Peter recommends [58:45];
- The risk of injury and other potential drawbacks of HIIT [1:02:15];
- The importance of incorporating a balance of continuous moderate-intensity cardio and HIIT when aiming for longevity [1:04:00]; and
- More.
#289 – AMA #56: Cancer screening: pros and cons, screening options, interpreting results, and more
- Why understanding cancer screening is crucial [2:45];
- The prevalence of cancer diagnosis and mortality rates [4:30];
- Why cancer screening and early detection is such an important part of the strategy to survive a cancer diagnosis [11:00];
- The data on how cancer screening impacts survivability of cancer [16:30];
- Inconsistencies between cancer screening trials regarding benefits to survival rates [25:45];
- What are some of the reasons why clinical trials don’t always improve cancer-specific mortality? [30:15];
- What are the arguments against population-level cancer screening? [42:00];
- Cancer screening outside the recommended guidelines: risks and benefits, interpreting results, and other considerations [46:00];
- Understanding sensitivity and specificity when reviewing screening results [52:30];
- Risks and complications associated with colonoscopies [55:45];
- Cancer screening modalities: options for cancer screening both within standard recommendations and beyond [58:30];
- The strengths and limitations of various types of cancer screening [1:02:15];
- Understanding positive and negative predictive value using sensitivity, specificity, and pretest probability [1:11:45];
- Factors that influence an individual’s pretest probability of cancer [1:13:45];
- How to interpret cancer screening results [1:18:15];
- The importance of having an advocate when considering out-of-guideline cancer screening tests [1:23:30];
- How stacking multiple cancer screening modalities can decrease the risk of false positives [1:29:30];
- Advice and guidance for making decisions related to cancer screening [1:31:15]; and
- More.
#285 – AMA #55: Exercise: longevity-focused training, goal setting, improving deficiencies, managing emotional stress, and more
- Overview of exercise topics [2:15];
- Importance of training with a goal in mind, the Centenarian Decathlon, and the natural decline of fitness with age [4:00];
- The four pillars of exercise [12:15];
- Measuring peak aerobic output with VO2max, and the importance of VO2max as a predictor of longevity [16:45];
- Measuring aerobic efficiency with zone 2 [25:45];
- Measuring and tracking muscle mass and strength [27:30];
- Case study of a fit person with a neglected pillar: why adding more training volume may not the best strategy [30:30];
- Periodization training: what it is and why it is beneficial [36:15];
- Periodization case study: high cardio fitness, lacking muscle and strength [40:00];
- Periodization case study: adequate muscle, low cardio fitness [44:45];
- Case study: significant improvement needed across all exercise pillars [48:45];
- Best ways to do zone 2 exercise and how to use relative perceived exertion (RPE) to find your zone 2 level [56:30];
- How the body responds to physical and emotional stress, its impact on training, and the consequences of chronic stress [1:01:00];
- The difference between “good” stress and “bad” or chronic stress [1:10:30];
- The complex relationship between exercise and stress, and the importance of adjusting exercise goals during high-stress periods [1:13:30];
- Clues that stress may be impacting your training [1:19:15];
- The use of wearables and devices for tracking trends and making decisions related to training [1:21:00];
- Parting thoughts regarding the importance of exercise for longevity and stress management [1:32:00]; and
- More.
#282 – AMA #54: Magnesium: risks of deficiency, how to correct it, supplement options, potential cognitive and sleep benefits, and more
- The important roles of magnesium in the body [2:45];
- How to determine if you might be deficient in magnesium [10:15];
- Addressing migraines related to low magnesium [14:45];
- The prevalence of magnesium deficiency [16:30];
- Various conditions and drugs that can negatively impact magnesium levels [21:30];
- Magnesium-rich foods and factors that impact absorption of magnesium [24:30];
- Daily targets for magnesium supplementation and whether it’s possible to take too much [30:15];
- The different forms of supplemental magnesium [34:00];
- How absorption of magnesium from food compares to absorption from supplements [36:15];
- Choosing the right magnesium supplements for optimal absorption [37:15];
- The unique ability of magnesium L-threonate to increase brain magnesium concentration [40:15];
- Potential cognitive benefits of magnesium [43:00];
- Potential sleep benefits of magnesium [48:45];
- Takeaways on magnesium and a look into Peter’s personal protocol [53:15];
- Peter’s new benchmarks related to exercise and age [58:30]; and
- More.
#279 – AMA #53: Metabolic health & pharmacologic interventions: SGLT-2 inhibitors, metformin, GLP-1 agonists, and the impact of statins
- 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.
#275 – AMA #52: Hormone replacement therapy: practical applications and the role of compounding pharmacies
- Why hormone replacement therapy is such an important topic [2:00];
- The onset of menopause: symptoms, blood tests, and when to consider HRT [6:00];
- Tests that may provide indications of perimenopause and their implications for fertility [9:15];
- Vasomotor symptoms: hormonal changes that cause hot flashes/night sweats, and HRT therapies that can help [13:45];
- The role of estrogen in menopausal HRT [17:30];
- The limited role of progesterone in HRT protocols [25:15];
- What is a “bioidentical” hormone? [28:30];
- Overview of the FDA-approved HRT formulations [31:45];
- Determining HRT dosing and considerations for perimenopausal women [37:45];
- Choosing the right HRT formulation: pros and cons [43:30];
- Examining the link between certain forms of estrogen and breast cancer [46:45];
- Changes in testosterone levels in women over time and why it matters [50:00];
- Recognizing low testosterone in women: common symptoms and diagnosis [53:45];
- Testosterone replacement therapy for women: options, considerations, and challenges [57:30];
- The long-term use of testosterone in women: examining the limited data [1:00:15];
- What is a compounding pharmacy? [1:09:30];
- Reasons to opt for a compounding pharmacy over a pharmacy that adheres to stricter regulations [1:16:00];
- The tragic incidents that heightened concerns about compounding pharmacies [1:20:45];
- Tips for finding a reputable compounding pharmacy [1:27:45]; and
- More
#271 – AMA #51: Understanding and improving your metabolic health
- Importance of metabolic health and a primer on metabolic disease [1:30];
- How poor metabolic health increases one’s risk for other chronic diseases [6:00];
- How useful is body weight and BMI for estimating metabolic health? [9:45];
- Overview of various tests and metrics used to understand metabolic health [12:15];
- Traditional biomarkers and how Peter’s point of view may differ from the guidelines [15:00];
- Lactate: insights into metabolic health through fasting and resting lactate levels [17:00];
- Zone 2 output: an important functional test of metabolic health [20:00];
- Cardiopulmonary exercise testing (CPET) [25:45];
- Visceral adipose tissue (VAT): what is VAT and how does it impact health? [27:00];
- Oral glucose tolerance test (OGTT): how it works and why it is such an important metric for assessing metabolic health [32:15];
- The utility of a continuous glucose monitor (CGM) [40:45];
- Liver function and NAFLD [42:15];
- Sleep as an intervention [46:00];
- Exercise as an intervention [53:15];
- Diet and nutrition [59:00];
- How reducing stress can improve metabolic health [1:05:15]; and
- More
#266 – AMA #50: Genetics: how they impact disease risk, what you can do about it, testing, and more
- Defining the term “genetics” and why it’s important [2:15];
- What is DNA, and how does it impact our biology and traits? [5:45];
- How are genetics passed down from parent to child? [8:45];
- How much do genes vary across individuals? [13:00];
- Which traits are determined by genetics versus experience or environmental factors? [17:00];
- Reasons for genetic testing [22:30];
- What exactly is being measured by a genetic test? [29:15];
- Testing for monogenic disorders [35:15];
- Understanding polygenic risk [39:30];
- Is genetic testing more important for someone who doesn’t know their family history? [40:45];
- What does it mean to be positive for a particular variant? [43:00];
- What does it mean to be negative for a particular variant? [45:45];
- How does someone get genetic testing through their healthcare provider, and how are these tests performed? [48:15];
- The financial cost of various genetic tests [54:30];
- Could having a risk allele for a disease result in an increase in one’s insurance premium? [57:15];
- Other risks associated with genetic testing [59:00];
- How do commercial, direct-to-consumer genetic tests compare to the information one might receive from clinical genetic testing? [1:01:45];
- Are certain direct-to-consumer tests better than others? [1:03:45];
- How long until whole genome sequencing becomes genuinely useful? [1:16:00];
- How useful are personalized dietary recommendations based on genetics? [1:18:15];
- Final thoughts and advice regarding genetic testing [1:20:00]; and
- More
#262 – AMA #49: Heart rate recovery, strength training, rucking, kidney function, and brain health
- Topics: exercise, kidneys, and brain health [1:30];
- Rucking: advice for beginners, proper load, packs, and shoes [4:30];
- Rucking for women, bone health, using a treadmill, zone 2, and more [11:45];
- Building vs. maintaining: when and how to transition from the goal of building muscle and strength to focusing on maintenance [16:00];
- Should you lift weights before or after a cardio session? [24:00];
- Heart rate recovery: defining heart rate recovery and how it relates to cardiovascular fitness [28:45];
- How to measure heart rate recovery, and what is considered a “good” heart rate recovery [33:15];
- How kidney health and function typically measured [42:30];
- Differentiating between creatine and creatinine [48:15];
- The cystatin C blood test as a practical way to assess kidney health [52:45];
- How kidney function impacts lifespan and the five stages of kidney disease [59:15];
- Slowing the decline of kidney function [1:08:15];
- The main drivers of kidney disease [1:11:15];
- The importance of managing homocysteine levels for brain health [1:14:00];
- The relationship between alcohol consumption and brain health [1:21:30]; and
- More
#258 – AMA #48: Blood pressure—how to measure, manage, and treat high blood pressure
- Blood pressure and other risk factors for cardiovascular disease [2:30];
- Defining blood pressure and the purpose and meaning of a blood pressure measurement [5:45];
- The implications of high blood pressure and the importance of maintaining an optimal level [10:30];
- The importance of accurate measurements of blood pressure and how Peter approaches the care of patients at the very top range of “normal” [21:45];
- The prevalence of high blood pressure—a hidden epidemic? [24:30];
- The consequences of high blood pressure on cardiovascular health, brain health, kidneys, and more [24:45];
- Low blood pressure: symptoms and consequences [35:30];
- How to properly measure blood pressure [37:45];
- Daily variance in blood pressure and the transient changes in blood pressure during exercise [48:00];
- Primary hypertension vs. secondary hypertension: what to look for [51:45];
- Lifestyle factors impacting blood pressure: weight loss, exercise, and sodium [57:45];
- Impact of insulin resistance and type 2 diabetes on blood pressure [1:04:45];
- How sleep impacts blood pressure [1:06:45];
- Pharmacologic options for managing blood pressure [1:08:00]; and
- More.
#254 – AMA #47: Cold therapy: pros, cons, and its impact on longevity
- Overview of discussion on cold therapy (and a Formula 1 tangent) [1:45];
- The most common cold exposure therapies [5:45];
- Potential benefits of cold water immersion: a look at the data [9:30];
- Comparing the effects of cold water immersion with whole-body cryotherapy [18:30];
- The potential impact of cold exposure on mood and as a treatment for depression [20:45];
- How do cold showers compare to cold water immersion? [28:15];
- Cold exposure and the activation of brown adipose tissue (BAT) [34:15];
- Exercising in cold temperatures: impact on exercise performance [38:30];
- Potential downsides of cold therapy and its impact on hypertrophy, strength, and recovery [44:45];
- Are the blunting effects of cold on hypertrophy due to the effects on inflammation? [50:45];
- Does cold exposure offer any potential geroprotective benefits? [53:15];
- Cold therapy protocols for delayed onset muscle soreness (DOMS) [56:30];
- Summarizing the data and takeaways from Peter [1:01:00]; and
- More.
#251 – AMA #46: Optimizing brain health: Alzheimer’s disease risk factors, APOE, prevention strategies, and more
- Diagnosing Alzheimer’s disease [2:45];
- Biomarkers for Alzheimer’s disease, the C2N test, and other tools for diagnosis [7:30];
- Genetic component of Alzheimer’s disease: genes that confer risk [12:45];
- Understanding your APOE status and why it’s important to know [17:15];
- The prevalence of Alzheimer’s disease and other forms of dementia, and who is at higher risk [21:15];
- Can the risk of Alzheimer’s disease be decreased with behavioral changes? [24:15];
- Overview of modifiable behaviors that potentially play a role in risk reduction of neurodegeneration [30:15];
- Things that clearly impact brain health: smoking, alcohol, sleep, head injuries, blood pressure, and more [34:15];
- How nutrition impacts brain health: common diets, metabolic health, energy balance, and more [46:15];
- Comparing common diets: data showing the association between the incidence of Alzheimer’s disease and specific diets [59:45];
- Supplements: EPA and DHA, vitamin D, and B vitamins [1:13:00];
- Supplements: theracurmin, cocoa flavonols, and magnesium L-threonate [1:25:15];
- Impact of exercise on brain health, minimum effective dose, and the most important types of exercise [1:33:00];
- Challenging the mind with brain games—does it impact neurodegeneration? [1:43:00];
- The data on sauna and brain health [1:49:45];
- Oral health and its association with brain health [1:52:45];
- How reducing lipids can improve brain health and prevent neurodegeneration [1:55:30];
- The potential impact of hearing loss on brain health and neurodegeneration [2:04:30]; and
- More.
#246 – AMA #45: Pros and cons of GLP-1 weight loss drugs and metformin as a geroprotective agent
- The hype around semaglutide, tirzepatide, and other GLP-1 agonists for weight loss [2:30];
- Overview of GLP-1 agonists and why these drugs are getting so much attention [6:15];
- Defining the term “geroprotective” [11:30];
- Semaglutide: background, brand names, indications, and more [15:15];
- Tirzepatide: background, brand names, indications, and more [19:15];
- How semaglutide and tirzepatide compare in their efficacy in terms of weight loss and other metabolic health metrics [23:45];
- Data showing sustained weight loss and improved metabolic metrics with after more than a year of using semaglutide and tirzepatide [29:00];
- What happens to body weight when a patient discontinues the medication? [34:45];
- Noteworthy side effects of GLP-1 agonists and similar classes of drugs [40:45];
- Increased resting heart rate and other concerning trends in patients using GLP-1 agonists [45:15];
- Changes in body composition (body fat and lean muscle) in patients on GLP-1 agonists [50:45];
- Possible reasons for the loss of lean muscle mass and tips for protecting lean mass [59:00];
- GLP-1 agonists and thyroid cancer [1:01:30];
- Who might be a candidate for GLP-1 agonists? [1:03:45];
- The large financial cost of this class of drugs [1:08:30];
- Metformin as a geroprotective drug: origin of the idea that metformin could be a longevity agent even for non-diabetic patients [1:11:30];
- A 2022 study on metformin sheds more light on the question of whether metformin should be used for “geroprotection” in non-diabetics [1:21:00];
- Peter’s current approach with metformin for his patients [1:25:15]; and
- More
#242 – AMA #44: Peter’s historical changes in body composition with his evolving dietary, fasting, and training protocols
- DEXA scans and other methods for tracking body composition [2:30];
- Importance of tracking data over time to see trends [10:15];
- DEXA scans in 2011: swimming, lifting, and a carb-restricted diet [12:45];
- DEXA scans 2012-2014 during Peter’s time on a strict ketogenic diet [18:30];
- Blood biomarkers for evaluating metabolic health [25:15];
- DEXA scan in 2020 after several years of regularly engaging in time-restricted feeding and prolonged fasting protocols [28:45];
- DEXA scan in 2021: shifting focus to adding muscle, high-protein diet, and more strength training [40:00];
- DEXA scan in early 2022: eating additional calories and adding blood flow restriction (BFR) to his workouts [44:45];
- DEXA scan in late 2022: a dramatic change following shoulder surgery, and the impact of stress [48:30];
- Peter’s approach moving forward following his most recent DEXA scan [59:15];
- A rundown of the various nutritional methods of energy restriction [1:06:15];
- Current thoughts on fasting and key takeaways [1:09:45]; and
- More.
#238 – AMA #43: Understanding apoB, LDL-C, Lp(a), and insulin as risk factors for cardiovascular disease
- A racecar analogy for understanding atherosclerotic cardiovascular disease [2:00];
- Defining and differentiating apoB and LDL-C [10:00];
- The interrelated nature of insulin levels, apoB, triglycerides, and ASCVD parameters [13:00];
- Another way that hyperinsulinemia plays a role in endothelial dysfunction [18:00];
- Why Peter uses the oral glucose tolerance test (OGTT) with all patients [20:15];
- Is there any evidence that hyperinsulinemia is an independent contributor to ASCVD? [23:00];
- Thinking through risk in the context of high-fat diets resulting in improved metabolic metrics but with an elevation of apoB/LDL-C [27:30];
- Thinking through risk in the context of low apoB but higher than normal triglyceride levels [32:15];
- The importance of lowering apoB for reducing ASCVD risk [38:15];
- Data on men and women with familial hypercholesterolemia that demonstrates the direct impact of high apoB and LDL-C on ASCVD risk [47:45];
- Importance of starting prevention early, calcium scores, and explaining causality [52:30];
- Defining Lp(a), its impact on ASCVD risk, and what you should know if you have high Lp(a) [56:30];
- Lp(a) and ethnic differences in risk [1:00:30];
- Why someone with elevated Lp(a) should consider being more aggressive with apoB lowering strategies [1:05:00];
- Addressing the common feeling of hesitancy to taking a pharmacologic approach to lower ASCVD risk [1:07:15];
- Peter’s take on the 2022 Formula 1 season and thoughts on 2023 [1:15:15]; and
- More.
#233 – AMA #42: Optimizing sleep – bedtime routine, molecule regimen, sleep trackers, sauna, & more
- Peter’s current pre-bedtime routine [3:30];
- Sauna: Peter’s routine, sleep benefits, and tradeoffs [10:45];
- Importance of keeping an open mind as new information arrives [16:15];
- Importance of reducing stimulation leading up to bedtime [19:30];
- Medications that can enhance sleep: mechanisms of action, contraindications, risks, and Peter’s regimen [20:30];
- Why medications can enhance sleep, but should not replace good sleep habits [34:45];
- Sleep supplements: mechanisms of action, contraindications, and Peter’s regimen [37:30];
- Temperature during sleep, cooling devices, mattresses, and more [53:00];
- A tip to help avoid straining your back in the morning [59:15];
- Contrasting polysomnography with wearable sleep trackers [1:00:45];
- Sleep tracking wearables: interpreting metrics, and the pros and cons of trackers [1:04:30];
- Final takeaways on sleep [1:16:30]; and
- More
#231 – AMA #41: Medicine 3.0, developments in the field of aging, healthy habits in times of stress, and more
- The evolution of medicine and the transition to “Medicine 3.0” [3:00];
- Peter’s unorthodox career arc and what led him to this point [11:45];
- What does Peter consider to be his superpowers? [22:15];
- How Peter thinks about risk and explains it to his patients when making medical decisions [26:45];
- The advantage of using frameworks for decision-making [37:00];
- What advice would Peter give his 30-year old self? [42:15];
- Why longevity is such a hard problem to solve [42:30];
- The most impactful developments in the field of longevity and aging in the last 5 to 10 years [46:15];
- What is Peter most excited to see develop in the health and longevity space in the next few years? [51:30];
- Prioritizing healthy habits while navigating the stresses of life and time constraints [53:45];
- How Peter navigates periods of high stress [58:00];
- What fitness watch did Peter recently purchase? [1:03:45];
- Potential benefits of cold plunging [1:05:15];
- Advice for someone beginning an exercise program [1:07:30];
- Strategies and tactics to lower apoB levels [1:09:00];
- Interesting studies and books Peter has recently read [1:11:30]; and
- More.
#227 – AMA #40: Body composition, protein, time-restricted feeding, fasting, DEXA scans, and more
- Interpreting DEXA scans: important metrics, radiation levels, and more [2:15];
- DEXA metrics: Bone mineral density (BMD) [12:00];
- DEXA metrics: Visceral adipose tissue (VAT) [14:30];
- DEXA metrics on lean tissue: appendicular lean mass index (ALMI) and fat-free mass index (FFMI) [20:45];
- Concerning trends in BMD, VAT, & muscle mass revealed through DEXA scans [24:15];
- Muscle and lean tissue loss with age and how to overcome anabolic resistance [29:15];
- Female patient case studies: DEXA scan results and prescribed interventions [35:00];
- Male patient case studies: DEXA scan results and prescribed interventions [42:45];
- Protein consumption: recommended daily intake, Peter’s personal approach, timing around workouts, and more [48:15];
- What to look for with protein supplements [53:15];
- Protein intake: optimal timing and how it should be divided throughout the day [55:30];
- Time-restricted feeding (TRF): Peter’s updated perspective [57:45];
- Three strategies for reducing energy intake in over-nourished patients [1:03:15];
- Prolonged fasting: potential benefits and tradeoffs [1:07:15];
- A protein-supplemented version of time-restricted feeding (TRF) [1:09:30];
- Theories about time-restricted feeding (TRF) and its positive influence on sleep and circadian rhythm [1:12:00]; and
- More.
#223 – AMA #39: The Centenarian Decathlon, zone 2, VO2 max, and more
- Exercise topics to be discussed [1:45];
- Peter’s exercise goals, and the Centenarian Decathlon [4:00];
- Peter’s exercise framework, and how he tracks his MET hours [8:30];
- How to partition your time between low and high intensity exercise to optimize results [13:15];
- Zone 2 exercise: ideal training methods and how to determine your zone 2 level [23:15];
- Rucking as a versatile mode of exercise [31:45];
- Zone 5 exercise: modalities of training, time per week, and other considerations [34:30];
- The importance of knowing your VO2 max, and methods for estimating it [38:15];
- Training methods for improving VO2 max, and realistic targets for improvement [46:00];
- Relationship of VO2 max with age and the required fitness levels for daily life activities and exercise [52:30];
- The training necessary to maintain an elite VO2 max throughout life [58:45];
- The value in starting early: the compounding nature of fitness [1:01:45]; and
- More
#218 – AMA #38: Can you exercise too much?
- How exercise reduces risk for all-cause mortality [2:30];
- Defining the metric called “MET” and how it’s useful for evaluating different exercises [7:45];
- The challenge in determining the optimal dose of exercise and the limitations of methods used to study the effect of exercise [13:30];
- Using VO2 max as a proxy for fitness to better predict mortality risk [19:00];
- Reviewing data which support the theory of a “J-curve” relationship between exercise and longevity [24:45];
- Importance of understanding p-values and statistical significance [33:30];
- Deconstructing the studies that show a J-curve: major limitations and how one could be misled [36:45];
- Peter’s takeaways on the theoretical “J-curve” relationship between exercise and longevity [51:15];
- Risk of sudden cardiac death from vigorous physical exertion [53:45];
- Atrial fibrillation associated with extreme levels of exercise [1:00:00];
- Parting thoughts: benefits of exercise far outweigh the risks [1:04:00]; and
- More
#214 – AMA #37: Bone health—everything you need to know
- Overview of bone health topics to be discussed [1:45];
- Bones 101: bone function, structure, and more [5:15];
- Bone mineral density (BMD), minerals in bone, role of osteoblasts and osteoclasts, and more [8:30];
- The consequences of poor bone health [13:30];
- The devastating nature of hip fractures: morbidity and mortality data [17:00];
- Where fractures tend to occur in the body [23:00];
- Defining osteopenia and osteoporosis [24:30];
- Measuring BMD with DEXA and how to interpret scores [27:00];
- Variability in BMD between sexes [34:15];
- When should people have their first bone mineral density scan? [36:45];
- How BMD changes throughout the life and how it differs between men and women [39:00];
- How changes in estrogen levels (e.g., menopause) impacts bone health [44:00];
- Why HRT is not considered a standard of care for postmenopausal bone loss [47:30];
- Factors determining who may be at higher risk of poor bone health [50:30];
- Common drugs that can negatively impact BMD [54:15];
- How children can optimize bone health and lay the foundation for the future [57:45];
- Types of physical activity that can positively impact bone health [1:02:30];
- How weight loss can negatively impact bone health and how exercise can counteract those effects [1:10:45];
- Nutrition and supplements for bone health [1:14:15];
- Pharmaceutical drugs prescribed for those with low BMD [1:17:15];
- Impact of extreme sedentary periods (e.g., bedrest) and how to minimize their damage to bone [1:22:00]; and
- More
#211 – AMA #36: Fruits & vegetables—everything you need to know
- The limitations of nutritional data and challenges of making broad recommendations [2:00];
- How one’s current state of health impacts their “optimal” diet [11:30];
- Defining “metabolic health” [14:45];
- The wide-ranging nutrition profiles of various fruits and vegetables [16:30];
- The benefits of fiber [20:45];
- Eating whole fruits vs. drinking fruit juice or smoothies [22:30];
- Drinking alcohol: metabolic effects, calories in alcohol, and more [28:30];
- Can excess fruit consumption lead to insulin resistance? [30:30];
- Glycemic impact of different fruits, using CGM data to assist decision making, and how fruit is fundamentally different from what we evolved to eat [31:30];
- Dietary approaches for people with a carbohydrate tolerance disorder (TD2, NAFLD, etc.), and when it makes sense to restrict fruit consumption [34:30];
- Nutrition profile of select vegetables: sugar content, micronutrients, and more [40:00];
- Phytochemicals in produce: potential positive health impacts on inflammation, cardiovascular (CV) risk, and cancer [44:30];
- Phytochemicals with potential negative health impacts [50:45];
- Nightshades and inflammation [53:15];
- How important is it to eat organic foods? [56:00];
- How necessary is it to wash fruits and vegetables? [1:00:45];
- How does food preparation change the nutritional composition? [1:03:45];
- Considerations when eating canned and frozen food, and paying attention to processed food additives [1:04:45];
- Supplementing vitamins and nutrients as an alternative to eating whole fruits and vegetables [1:06:15];
- Green powder supplements [1:11:15];
- Important takeaways [1:16:00]; and
- More.
#207 – AMA #35: “Anti-Aging” Drugs — NAD+, metformin, & rapamycin
- Logic behind comparing NAD precursors to rapamycin and metformin [3:40];
- Aging biomarkers: current state, usefulness, and future promise [7:00];
- Epigenetic clocks: definition, use case, and limitations [14:45];
- Advantages and limitations of studying aging in non-humans and the strengths and weaknesses of different model systems [26:30];
- Aging studies: importance of control lifespans and the problems with reproducibility [34:15];
- Intro to NAD, potential role in aging, relationship to sirtuins, and more [48:15];
- NAD precursors (NR and NMN): current data [1:10:00];
- Human studies with NAD precursors [1:25:45];
- Comparing NAD lifespan data to data from metformin and rapamycin [1:28:30];
- Defining a “clean drug” and a “dirty drug” [1:38:00];
- Reason for the lack of rapamycin studies in humans compared to NAD and metformin [1:41:00];
- Ranking the geroprotective molecules in terms of risk and reward [1:48:00]; and
- More.
#203 – AMA #34: What Causes Heart Disease?
- The importance of understanding atherosclerosis early in life [2:15];
- Defining atherosclerotic cardiovascular disease (ASCVD), its causes, and the role of cholesterol [9:00];
- The process of developing ASCVD, part 1 [15:00];
- The process of developing ASCVD, part 2 [24:00];
- The process of developing ASCVD, part 3 [32:45];
- How early in life ASCVD can start to develop [40:30];
- Case studies of atherosclerosis and figures showing real pathology [43:00];
- Coronary artery lesions present in autopsies of different age groups [49:15];
- The causal factors of ASCVD that determine prevention strategies [52:15];
- Labs to identify biomarkers of ASCVD [59:00];
- Diagnostic tests to determine the level of arterial damage present—CAC, CTA, CIMT, and more [1:00:30]
- Calcium scores: keys to understanding and interpreting a CAC score and/or CTA results [1:05:15];
- Is there a risk from cholesterol levels being too low? [1:13:00];
- Key takeaways regarding prevention [1:15:45];
- More.
#200 – AMA #33: Hydration—electrolytes, supplements, sports drinks, performance effects, and more
- Peter’s incident leading to a renewed interest in hydration [3:15];
- Water in the human body: percentage, location, and implications [6:00];
- Defining tonicity—isotonic, hypotonic, and hypertonic [11:45];
- Defining dehydration and volume depletion [19:00];
- The health consequences of dehydration and volume depletion [21:45];
- How do we actually lose water? [25:30];
- How much water do we need every day? [28:00];
- Signs of dehydration during exercise and how it can affect performance [32:45];
- Is it possible to be overhydrated? [43:15];
- Electrolytes: benefits and when to include them in rehydration fluids [47:00];
- Glucose: benefits and when to include it in rehydration fluids 51:15];
- The ability of glucose to improve absorption of sodium [58:45];
- The type of carbohydrates in drinks than actually impact performance [1:02:00];
- Sodium during workouts: is there an optimal ratio of carbohydrate to sodium? [1:05:00];
- Pros and cons of sports drinks and which ones stand out [1:09:15];
- How much hydration comes from the food we eat? [1:14:30];
- Is there a downside to drinking electrolytes throughout the day even without exercise? [1:15:15];
- Key takeaways related to hydration [1:18:15]; and
- More.
#196 – AMA #32: Exercise, squats, deadlifts, BFR, and TRT
- Peter’s current exercise routine [2:25];
- How Peter incorporates blood flow restriction (BFR) into his workouts [5:45];
- Relative importance of muscle size vs. muscle strength [16:45];
- Comparing squats to deadlifts and why both are important [22:00];
- Squatting technique and fundamentals [31:15];
- Important cues to look for while lifting weights [38:30];
- Proper mechanics of a deadlift [42:00];
- Hip thrusters as an alternative to the squat or deadlift [44:00];
- Split-leg work for simulating activities of daily living [47:00];
- The impact of fasting/calorie restriction on muscle mass and the potential tradeoffs to consider [49:45];
- Testosterone replacement therapy: Considerations when contemplating TRT and Peter’s approach with patents [54:30];
- Data on the association between TRT and heart disease [1:04:15];
- TRT for women—risks and benefits [1:06:45];
- Impact of fasting on testosterone levels [1:13:45]; and
- More.
#193 – AMA #31: Heart rate variability (HRV), alcohol, sleep, and more
- What is heart rate variability (HRV), and why do we measure it? [2:10];
- The association between low HRV and mortality risk [10:00];
- What high and low HRV means and why athletes strive for a high HRV [15:30];
- Factors that can raise or lower HRV [18:00];
- How and when to measure HRV, and the best wearables [19:15];
- Interpreting your personal HRV number and why there’s so much individual variation [23:15];
- How Peter’s morning HRV reading impacts his decision to train [28:30];
- Alcohol’s impact on sleep [31:30];
- Metrics to track the impact of alcohol on your sleep [34:00];
- Alcohol’s impact on the need to urinate during the night [39:00];
- Alcoholic fatty liver disease (AFLD) [41:30];
- Individual differences in the way people metabolize and react to alcohol consumption [44:15];
- Analysis of epidemiology studies suggesting moderate alcohol consumption lowers mortality risk [52:00];
- Alcohol consumption and Alzheimer’s disease [1:05:15];
- Heavy alcohol consumption and risk of dementia [1:08:30];
- Chronic effects of alcohol on the liver [1:17:45];
- The relationship between alcohol, sleep, and automotive deaths [1:20:45]; and
- More.
#188 – AMA #30: How to Read and Understand Scientific Studies
- The ever changing landscape of scientific literature [2:15];
- The process for a study to progress from idea to design to execution [4:15];
- The various types of studies and how they differ [7:30];
- The different phases of a clinical trial [19:15];
- Observational studies and the potential for bias [26:30];
- Experimental studies: Randomization, blinding, and other factors that make or break a study [44:00];
- Power, p-values, and statistical significance [56:15];
- Measuring effect size: Relative risk vs. absolute risk, hazard ratios, and “Number Needed to Treat” [1:07:45];
- How to interpret confidence intervals [1:17:30];
- Why a study might be stopped before its completion [1:23:45];
- Why only a fraction of studies are ever published and how to combat publication bias [1:31:30];
- Why certain journals are more respected than others [1:40:30];
- Peter’s process when reading a scientific paper [1:43:45]; and
- More.
#184 – AMA #29: GLP-1 Agonists – The Future of Treating Obesity?
- Remarkable results of a recent study in overweight adults [2:15];
- Key background on insulin, glucagon and the incretin effect to appreciate the effects of semaglutide [4:00];
- What is GLP-1 and how does it work? [16:30];
- 2021 semaglutide study: remarkable results, side effects, and open questions [30:00];
- Semaglutide vs. lifestyle interventions: comparing results with semaglutide vs. lifestyle interventions alone [44:00];
- Closing thoughts and open questions on the therapeutic potential of semaglutide [47:30]; and
- More.
#180 – AMA #28: All things testosterone and testosterone replacement therapy
- A primer on the hormone testosterone and how it influences gene expression [3:30];
- How the body naturally regulates testosterone levels [11:30];
- The defining threshold for “low testosterone,” how low T impacts men, and why free testosterone is the most important metric [16:15];
- When it makes sense to treat low testosterone [26:00];
- The structural and metabolic benefits of testosterone replacement therapy [29:15];
- Body composition changes with TRT [45:30];
- Changes in bone mineral density with TRT [48:15];
- The metabolic impact of TRT: glucose, insulin, triglycerides, and more [52:30];
- A study investigating testosterone replacement therapy for prevention or reversal of type 2 diabetes [59:30];
- The impact of TRT on metabolic parameters and body composition—A study comparing results from continuous vs. interrupted treatment [1:07:15];
- The controversy over TRT and cardiovascular disease [1:21:45];
- Two flawed studies that shaped perceptions of risks associated with TRT [1:44:15];
- The controversy over TRT and prostate cancer [1:56:45];
- Other potential risks with testosterone replacement therapy [2:02:15]; and
- More
#176 – AMA #27: The importance of muscle mass, strength, and cardiorespiratory fitness for longevity
- VO2 max and its association with cardiorespiratory fitness [2:45];
- Changing mortality risk based on VO2 max and cardiorespiratory fitness [7:45];
- The profound impact of improving cardiorespiratory fitness [15:15];
- Muscle mass, function, and loss with aging: how it’s defined, measured, and the cutoff points for sarcopenia [25:00];
- Increasing mortality risk associated with declining muscle mass and strength [40:00];
- Muscle size vs. strength—which has the bigger impact on mortality risk? [58:00];
- Evaluating the cumulative impact of cardiorespiratory fitness and muscular strength on mortality risk when put together [1:03:30];
- Investigating the rising incidence in deaths from falls, and what role Alzheimer’s disease might play [1:09:00];
- The impact of fasting on muscle mass and the potential tradeoffs to consider [1:14:30];
- The critical importance of working to maintain muscle mass and strength as we age [1:20:30]; and
- More.
#173 – AMA #26: Continuous glucose monitors, zone 2 training, and a framework for interventions
- Peter’s foundational framework when considering different interventions [1:30];
- Applying Peter’s framework to the idea of using a CGM [8:00];
- Why certain fruits have a bigger impact on glucose, and the limitations of a CGM can tell you [16:00];
- Importance of paying attention to insulin, and the prospects of a continuous monitor for insulin levels [20:00];
- How exercise impacts glucose and peak glucose numbers to stay under [24:15];
- Impact of anxiety on stress on glucose, and why it’s important to calibrate your CGM [26:30];
- The five main tools for managing blood glucose numbers [33:45];
- Benefits of moving or exercising after a meal, and where ingested carbohydrates get can be stored [37:15];
- How to make decisions about an action or intervention in the absence of data from a rigorous, randomized controlled trial [40:30];
- The incredible athletic feats of Tour de France cyclists [48:30];
- Different modalities for doing zone 2 exercise: running, rowing, cycling, and more [1:00:15];
- Proxies for knowing your in zone 2 short of using a lactate monitor [1:07:30];
- Monitoring lactate for zone 2 exercise [1:10:00]; and
- More.
#170 – AMA #25: Navigating the complexities and nuances of cancer screening
- The importance of cancer screening [1:15];
- Cancer screening terms: sensitivity, specificity, false positives, and false negatives [8:25];
- Cancer screening terms: positive and negative predictive value [17:00];
- Improving predictive value by layering tests, and the predictive values of mammograms [25:45];
- How smoking impacts the predictive value of cancer screening [30:45];
- Liquid biopsies for ruling out cancer and the blind spots of common cancer screening tests [33:00];
- The difference between cancer originating from inside versus outside the body [41:15];
- How diffusion-weighted MRI is changing cancer screening [45:15];
- Summary of Peter’s approach to cancer screening [53:45]; and
- More.
#165 – AMA #24: Deep dive into blood glucose: why it matters, important metrics to track, and superior insights from a CGM
- 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.
#161 – AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action
- 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
- More.
#157 – AMA #22: Losing fat and gaining fat: the lessons of fat flux
- The two main ways to reduce fat mass (1:30);
- Explaining fat flux—how fat enters and exits a fat cell (9:15);
- What fat balance looks like (21:15);
- What net fat influx looks like, and the impact of insulin in lipolysis (24:30);
- What net fat efflux looks like, and the benefits of fasting for breaking the hyperinsulinemic cycle (28:30);
- Exploring why most people with excess body fat will lose fat mass when reducing carbohydrates or eating a ketogenic diet (32:45);
- Why being in nutritional ketosis does not automatically translate to negative fat flux (fat loss) (42:40);
- Bob’s approach to scientific research (47:00);
- The importance of curiosity and a desire to learn (58:30);
- Bob’s tips and tricks for answering a scientific question in a time-crunch (1:00:00); and
- More.
#153 – AMA #21: Deep dive into olive oil, high-intensity exercise, book update, and more
- The early history of olive oil and the Mediterranean diet (2:15);
- The three broad categories of fats: SFA, MUFA, and PUFA (6:25);
- Exploring the hypothesis that olive oil is healthy (10:30);
- Comparing olive oil to the makeup of other common oils (30:00);
- Defining “extra virgin” olive oil, what to look for when purchasing, and Peter’s favorite brand (34:30);
- Update on Peter’s book (47:15);
- Zone 5 training: Peter’s approach to zone 5 training, and other anaerobic training protocols (49:30);
- Advantages of using a standing desk compared to sitting (55:30);
- Lactate meters and strips (57:45);
- Electrolyte supplementation during fasting and keto, and why uric acid may increase (59:30);
- The usefulness of massage guns, foam rollers, and professional massage for muscle pain and tightness (1:01:30); and
- More.
#149 – AMA #20: Simplifying the complexities of insulin resistance: how it’s measured, how it manifests in the muscle and liver, and what we can do about it
- Explaining the format of this AMA: Extracting insights from Gerald Shulman’s masterclass on insulin resistance (2:00);
- The basics of insulin, defining insulin resistance (IR), and gold-standard methods of quantifying IR in the muscle (7:15);
- Practical ways to test for insulin resistance in a normal clinical setting (15:45);
- How insulin resistance manifests in the muscle (23:00);
- The biochemical block in glycogen synthesis—drivers and mechanisms resulting in insulin resistance in the muscle (30:45);
- The disparity in fat oxidation between insulin-sensitive and insulin-resistant individuals (44:45);
- The fate of the ingested carbohydrate in someone who is insulin resistant (51:00);
- The prevalence and clinical phenotype of insulin resistance (1:00:15);
- The role of exercise in mitigating and reversing insulin resistance (1:05:00);
- How insulin resistance manifests in the liver (1:09:15);
- Biggest takeaways: what we can do to mitigate and prevent insulin resistance (1:20:45); and
- More.
#145 – AMA #19: Deep dive on Zone 2 training, magnesium supplementation, and how to engage with your doctor
- Defining zone 2 exercise (3:30);
- The most effective ways to engage in zone 2 exercise (14:00);
- The process of training a deconditioned individual with zone 2: Dosage, frequency, and metrics to watch (19:45);
- Training for health vs. performance, and the importance dedicating training time solely to zone 2 (25:00);
- Why Peter does his zone 2 training in a fasted state (31:30);
- Improving mitochondrial density and function with zone 2 training (34:00);
- Metrics to monitor improving fitness levels from zone 2 training (36:30);
- Advice for choosing a bicycle for zone 2 exercise at home (42:30);
- Comparing the various equipment options for aerobic training: Rowing machine, treadmill, stairmaster, and more [48:15];
- Back pain and exercise, and Peter’s stability issues as a consequence of previous surgeries (51:45);
- A deep dive into magnesium supplementation, and Peter’s personal protocol (55:30);
- Advice for engaging with and questioning your doctor (1:03:15); and
- More.
#141 – AMA #18: Deep dive: sugar and sugar substitutes
- Delineating the various forms of “sugar” (2:00);
- Added sugar vs. naturally occurring sugar (12:30);
- Important variables related to sugar consumption: Density, volume, and velocity (17:00);
- Alternatives to sugar: Non-nutritive sweeteners (22:30);
- Alternatives to sugar: Alcohol sugars (34:15);
- Alternatives to sugar: Allulose (39:00);
- Contextualizing risk when it comes to sugar substitutes (45:00);
- Why some people report feeling better when eliminating non-nutritive sweeteners from their diet (46:30);
- The impact of sweetness—Cephalic insulin response and the metabolic drive to eat more (49:45); and
- More.
#136 – AMA #17: Body composition methods tour de force, insulin resistance, and Topo Chico
- Body mass index (BMI) vs. body fat percentage (BF%) (1:45);
- Methods of assessing body fat—Magnetic Resonance Imaging (MRI) (6:25);
- The different types of body fat (9:00);
- Methods of assessing body fat—Computed Tomography (CT Scan) (12:00);
- Methods of assessing body fat—Dual-Energy X-ray Absorptiometry (DEXA) (14:30);
- Methods of assessing body fat—Hydrostatic/Underwater Weighing (19:25);
- Methods of assessing body fat—Air Displacement (Bod Pod) (22:25);
- Methods of assessing body fat—Skinfold measurement (23:55);
- Methods of assessing body fat—Total Body Water (27:15);
- Methods of assessing body fat—Bioelectrical Impedance (BIA) (28:45);
- The optimal body fat percentage, muscle mass, and the best strategy to improve body composition (31:30);
- Defining insulin resistance and the steps to reverse it (40:15);
- Patient case study: Reversing insulin resistance (49:00);
- Addressing the recent finding of high levels of PFOA in Topo Chico (58:25); and
- More.
#132 – AMA #16: Exploring hot and cold therapy
- How stress can show up as physical pain, and tips for changing time zones [1:45];
- Literature overview of heat and cold therapy [7:15];
- Cold therapy for delayed onset muscle soreness (DOMS) [12:00];
- Quality of evidence for cold therapy for depression or immune enhancement [19:30];
- Cold therapy and brown adipose tissue (BAT) [21:15];
- Weighing the safety, efficacy, and opportunity cost of cold therapy [28:45];
- An overview of heat therapy benefits [40:00];
- Longevity benefits of sauna—reviewing the studies [41:30];
- Limitations in the sauna literature—Where might we be fooled? [54:30];
- Possible mechanisms conferring the longevity benefits of sauna, and how it compares to exercise [1:02:15];
- Parting thoughts on sauna, opportunity costs, and Bob’s personal regimen [1:06:30]; and
- More.
#127 – AMA #3 with sleep expert, Matthew Walker, Ph.D.: Fasting, gut health, blue light, caffeine, REM sleep, and more
- Matt’s framework for changing his mind when faced with new information [1:30];
- Blue light—How Matt shifted his thinking [5:45];
- Caffeine—How Matt has adjusted his hypothesis [12:00];
- REM sleep—Why Matt is more bullish on the importance of dream sleep [16:30];
- How to increase REM sleep [27:30];
- Sleep tracking wearables—criteria for evaluation, and why Matthew favors Oura [35:00];
- Does the electromagnetic force of devices have any impact on sleep? [40:15];
- The relationship between fasting and sleep [46:15];
- Restless leg syndrome [58:10];
- Magnesium supplementation as a sleep aid [1:03:00];
- The relationship between sleep deprivation and gut health [1:08:30];
- The next evolution in sleep science and technology [1:16:30];
- Questions Matt would like to explore if money was no issue [1:24:15]; and
- More.
#124 – AMA #15: Real-world case studies—metabolic dysregulation, low testosterone, menopause, and more
- Should you stop taking supplements before getting a lab test? [2:45];
- Family history—Questions to ask and what to look for [5:30];
- The purpose of an oral glucose tolerance test (OGTT) [12:15];
- Case study—Insufficient muscle mass for proper glucose disposal [17:15];
- Why hemoglobin A1c is a relatively unhelpful metric [24:00];
- Case study—Exceeding carbohydrate tolerance [26:30];
- Case study—Metabolic dysfunction and a framework for metabolic health [33:30];
- Peter’s ideal tracking of metabolic health for all his patients [43:30];
- Contrasting presentations of hypogonadism—Low free testosterone [45:00];
- How sleep, exercise, and alcohol affect testosterone levels? [56:20];
- Case study—Surprisingly fast onset of menopause [59:25];
- Case study—Hypothyroidism and high cholesterol [1:07:00];
- Case study—Elevated uric acid and hypertension [1:10:55]; and
- More.
AMA with Dom D’Agostino, Ph.D., Part II of II: Ketosis for cancer and chronic disease, hyperbaric oxygen therapy, and the effect of ketosis on female health
- Update on Dom’s Press-pulse therapeutic strategy for the metabolic management of cancer [2:05];
- Potential role for vitamin C in cancer treatment [12:45];
- Glutamine targeting in cancer therapy—evidence that the mitochondria in cancer are damaged? [17:45];
- Can a ketogenic diet lessen the toxicity of cancer therapies? [24:45];
- 3BP—a promising agent in cancer therapy [26:45];
- The relationship between cancer and ketogenic diets [29:30];
- Hyperbaric oxygen therapy (HBOT)—primer, protocols, and therapeutic uses [33:30];
- Is there a potential role for HBOT in treating COVID-19 patients? [44:15];
- Non-cancer applications of HBOT [47:30];
- The inverse relationship between glucose and ketones [50:30];
- Is a ketogenic diet appropriate for type 1 diabetics? [54:00];
- How ketosis may reduce the risk for Alzheimer’s disease and Parkinson’s disease [1:00:30];
- Ketosis for females—considerations, fertility, performance, and the latest research [1:11:00];
- Low-carb diets during pregnancy and postpartum [1:17:00];
- A high-protein diet to counteract common hormonal issues associated with the ketogenic diet [1:21:15];
- Nutritional tips for remaining metabolically flexible [1:22:45];
- What is one belief Dom has changed his mind about? [1:26:45];
- In utero experiments, and other interesting questions Dom wants to explore [1:29:45];
- The anti-catabolic effect of ketones, cancer cachexia, and nutritional interventions for cancer patients [1:38:30];
- What is the one interesting experiment Dom would do if money and time were no barrier? [1:46:25]; and
- More.
AMA with Dom D’Agostino, Ph.D., Part I of II: Ketogenic diet, exogenous ketones, and exercise
- Dom’s recent and ongoing projects [3:00];
- Benefits of a ketogenic diet for an otherwise healthy person [7:00];
- Book recommendations for getting knowledgeable on the ketogenic diet [11:30];
- Best devices for measuring ketones [13:45];
- Genetic factors that influence how someone responds to the ketogenic diet [24:45];
- Ketogenic diet for those with the APOE e4 allele [28:15];
- Impact of long-term ketogenic diets on thyroid function [34:25];
- Low-carb and ketogenic diets for appetite control and weight management [39:00];
- Ketogenic diet and the microbiome [43:00];
- Comparing monounsaturated fat versus saturated fat on the ketogenic diet [45:55];
- Implications of long-term genetic and epigenetic adaptations to a ketogenic diet [47:45];
- Why some people see a rise in LDL-C and LDL-P when on a ketogenic diet and what they can do about it [50:15];
- Should someone with familial hypercholesterolemia consider the ketogenic diet? [55:00];
- Exogenous ketones—benefits, therapeutic uses, and ketone supplements that Dom has tested [56:45];
- Ketogenic protocols for management of traumatic brain injuries [1:06:00];
- Comparing the benefits and therapeutic uses of various medium-chain fatty acids—caprylic acid (C8), capric acid (C10), MCT oil, and coconut oil [1:08:45];
- Nootropics, caffeine, and other stimulants [1:16:15];
- Supplemental use of testosterone, DHEA, and creatine for muscle growth and performance [1:23:45];
- Impact of fasted-state training on strength and performance [1:30:15];
- Stacking exogenous ketones with MCTs for optimal effectiveness [1:33:30];
- BCAA supplements during a fast for muscle preservation [1:35:45];
- What app is Dom using for tracking his macros? [1:42:00];
- Getting enough micronutrients while on a ketogenic diet [1:47:15];
- Ideal macros for staying in ketosis while getting enough protein for strength training [1:48:15];
- Pros, cons, and ideal macros of one meal a day [1:51:15];
- Dom’s take on “carb backloading” [1:54:45];
- Dom’s take on “carb up” days for ketogenic dieters [2:01:00];
- Dom’s thoughts on the carnivore diet and the paleolithic ketogenic diet [2:05:30];
- Advantage of the ketogenic diet for extreme endurance athletes [2:10:30];
- Impact on strength, power, and performance of the adaptation period to the ketogenic diet [2:14:00];
- Fasted-state elevation in growth hormone and its impact on training [2:17:45];
- Is it possible to build muscle on a ketogenic diet? [2:23:30];
- Why Dom took a year off from weight training [2:28:00];
- What does Dom do for cardio exercise? [2:30:45];
- Protocols for hard training recovery [2:33:15];
- Dom’s personal approach to fasting, time-restricted eating, and sleep [2:35:45];
- People, books, and other resources that shaped Dom’s training and nutrition [2:38:45]; and
- More
AMA #14: What lab tests can (and cannot) inform us about our overall objective of longevity
- Important lab tests and reference ranges [2:35];
- How lab testing fits into the overall objective of longevity [4:25];
- A healthcare system set up to react to a disease rather than prevent it [8:00];
- The four pillars of chronic disease, and the three components of healthspan [14:30];
- Atherosclerosis—How much can labs tell us about risk? [18:00];
- Coronary calcium score (CAC)—interpreting results based on your age [24:15];
- Cancer—what lab work can tell you, and the future of liquid biopsies [28:00];
- Alzheimer’s disease—what’s driving Alzheimer’s disease, and what labs can tell you about your risk [33:15];
- Healthspan and the physical body—where lab testing fits, the endocrine system, and zone 2 testing [39:00];
- Summarizing the usefulness of lab testing—where it gives great, reasonable, or lousy insight [43:15];
- Patient case study—elevated Lp(a): Understanding ApoB, and how cholesterol levels get reduced [45:30];
- Patient case study—familial hypercholesterolemia [59:30];
- Coming up on a future AMA [1:10:30]; and
- More.
AMA #13: 3-day fasting, exogenous ketones, autophagy, and exercise for longevity
- Peter’s observations since switching from a 7-day to a 3-day fasting regimen [1:25];
- Ketone measuring devices—blood and breath [7:40];
- Can zero-calorie sweeteners affect ketone production? [10:40];
- Will there be a continuous insulin monitor anytime soon? [11:55];
- Exogenous ketones—Role in fasting and ketogenic diets and their effect on insulin, blood glucose, and autophagy [14:10];
- 5 tips to help you get through a multi-day fast [25:55];
- Relationship between BHB levels, glucose levels, and autophagy—Are high levels of ketones enough to produce autophagy? [34:10];
- Why is measuring blood insulin so much harder than blood glucose? [36:55];
- Advice and resources for people wanting to stay up to date on developments related to health and longevity (and how to quickly sift through all the bad science) [40:10];
- Advice for those looking to fit exercise for longevity into their busy life [51:10]; and
- More.
AMA #12: Strategies for longevity (which don’t require a doctor)
- The five levers you can pull to affect longevity [1:15];
- Nutritional biochemistry: Framework, 3 nutritional interventions, and how to approach your goals, and what you should be tracking [4:30];
- Exercise for brain health, and the 4 components of exercise [20:45];
- Exercise component—Stability [24:30];
- Exercise component—Strength [29:00];
- What is Peter optimizing for with his exercise? [30:30];
- Exercise components—Zone 2 and zone 5 training [33:15];
- More about DNS, and why we need to be careful with rushing kids through neuromuscular development stages [45:00];
- Sleep: How to improve quantity and quality [48:15]
AMA #11: All things fasting
- Defining the various fasting protocols [1:00];
- Why Peter plans to switch to a 3-day fast once per month in 2020 [11:00];
- How Peter uses his CGM to gain insights into the depth of fast [13:15];
- Peter’s supplement protocol during fasting, and why he eats a ketogenic diet leading up to a prolonged fast [17:00];
- Peter’s exercise regimen during a fast [23:30];
- Peter’s hunger levels during a typical 7-day fast [26:45];
- Fasting observations—Core body temperature and thyroid hormone [30:30];
- Fasting observations—Glucose, BHB, and hunger levels [33:15];
- Peter’s sleep protocol during a fast [40:15];
- Does Peter observe any differences between men and women in their ability to fast? [47:00];
- How Peter prefers to break a long fast [50:15];
- Importance of community support while fasting, and is there a perfect fasting protocol? [52:00]
AMA #10: Low testosterone, hypothyroidism, building muscle (and preserving it while fasting)
- Does testosterone supplementation impact longevity? [2:40];
- Under what conditions does Peter decide to treat patients who have low testosterone? [8:50];
- Are there risks involved with testosterone replacement therapy? [17:10];
- How does Peter diagnose and treat hypothyroidism? [21:30];
- How might someone do time-restricted feeding while also adding muscle mass? [26:30];
- If building muscle requires higher levels of IGF-1, should we be concerned about longevity? [34:45];
- How to preserve muscle mass while fasting [41:45];
- Is it possible to simultaneously lose fat and add muscle mass? [46:30]
Celebrity AMA with Apolo Ohno and Sasha Cohen: Fasting, rapamycin, performance vs. longevity, and more
- Apolo’s questions begin [1:45];
- Why women may have a harder time fasting, and tips for those who are struggling [2:10];
- Is there any place for fasting as part of a nutritional strategy in adolescents? [6:15];
- Tips for learning and retaining large amounts of new information (and the best nutritional approach) [9:15];
- Must read books of 2019 [14:45];
- If you could only keep a few watches for the rest of your life which would they be? [16:45];
- What workout would Peter do inside a hotel room? [22:15];
- What is Peter’s ultimate gorge meal? [23:45];
- How do you foresee fasting as a mechanism for performance in athletes? [25:30];
- What is driving Peter to strive for excellence? [33:30];
- Sasha’s questions begin [38:40];
- What are you most excited about in the longevity space? [38:45];
- At what point do you see enough data or proof that a new drug, or type of fasting is worth trying it out for yourself? [41:30];
- Is it possible to obsess so much about your health that it becomes a negative stressor? [46:45];
- Which tests are worth doing if you want to be proactive about your health? [48:15];
- Are there any supplements Peter things are beneficial to be taking? [55:15];
- How does Peter’s training differ when optimizing for performance versus longevity? [56:30];
- How does taking testosterone and growth hormone affect performance versus longevity? [59:15]; and
- More.
AMA #9: NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more
- The story of how Peter almost worked for Theranos [2:00];
- The trend of lower testosterone and higher estrogen in men: Why is it happening and what to do about it? [10:00];
- Takeaways from Peter’s recent hunting trip in Hawaii [14:45];
- What books are you currently reading/listening to? [21:30];
- What advice would you give to the 25 year-old Peter? [24:00];
- What is your emergency protocol if you start getting sick? [27:45];
- How have your thoughts changed on NAD precursors, and also on metformin, in the past year or so? [30:30];
- What are your thoughts on “fat burning” zones for cardio workouts? — A lesson in relative vs. absolute fat combustion [34:15];
- What mental models do you use and how do you go about solving problems and approaching difficult questions? [49:00];
- Creatine supplementation—Yay or nay? Why? [49:30]
AMA #8: DNA tests, longevity genes, metformin, fasting markers, salt, inflammation, and more
- Do DNA kits provide actionable info for cancer, CVD, diabetes, Alzheimer’s, nutrition, or exercise? [1:45];
- What genes increase longevity? And do those genes show up on genetic tests like 23andMe? [12:00];
- Who are some people that Peter would like to have as guests on The Drive? [15:00];
- Inflammation: Is CRP a useful marker? What can one do to reduce it? And what other inflammatory markers can I look at to gauge health? [18:30];
- What lipid test does Peter now use on his patients? What are the three best cardiovascular laboratories? [28:00];
- Metformin for longevity: What considerations should one think about before doing taking metformin for longevity purposes? [32:30];
- What is Peter’s take on salt and its role in things like high blood pressure and stomach cancer? [40:00];
- What markers does Peter find most interesting (and surprising) during his quarterly fasts? [47:30]
AMA #7: Exercise framework, deadlifting, lower back pain, blood pressure, nootropics, CGM, and more
- What can I do to prevent/reduce interruptions in sleep due to needing to get up to urinate at night? [2:15];
- Peter’s note card system for organizing his to-do lists [6:15];
- How do I get smarter at reading/understanding the studies (or the media’s interpretation of them) that get the headlines on health and/or disease? [10:30];
- How can I obtain a continuous glucose monitor (CGM) as a non-diabetic individual? [11:55];
- What is the most effective way to bring blood pressure down? [15:00];
- Does Peter use any nootropics? [28:10];
- Peter’s thoughts pertaining to concussions and head trauma [33:00];
- Does Peter structure his exercise plan for lifespan or healthspan? [36:45];
- How did Peter rebuild his lower back strength after his devastating injury during med school? [38:15];
- Peter’s approach to deadlifting with a bad lower back [43:25];
- Did Peter cave and buy a dog? [51:50]
AMA #2 with sleep expert, Matthew Walker, Ph.D.: short sleep mutants, optimal sleep environment, sleep apnea, & rapid fire questions
- DEC2—A genetic mutation that produces a short sleeping phenotype [11:00];
- What is the best position to sleep in? [22:45];
- Should you consider a “sleep divorce” with your partner? [27:00];
- The challenge of kids wanting to sleep in bed with their parents [28:45];
- Is there an ideal type of pillow? [32:30];
- Any data on hammock sleeping? Should adults be rocked to sleep like a baby? [34:45];
- The optimal room temperature and body temperature for the best sleep [38:30];
- Do humidifiers help? [50:40];
- How do high altitudes affect sleep? [53:15];
- What is the data on weighted blankets (e.g., the Gravity blanket)? [57:00];
- Caffeine—How much, and in what way, does it affect sleep? [58:15];
- How does sexual activity relate to sleep quality? [1:04:00];
- Should we be sleeping in two phases? First sleep & second sleep? [1:06:30];
- Napping—Is there ideal duration? Should we be napping or not? [1:08:30];
- Advice for new parents dealing with sleep deprivation [1:12:00];
- Understanding your sleep chronotype [1:16:15];
- If you drink too much alcohol in a given night, is there anything you can do to make sure your sleep isn’t wrecked? [1:20:45];
- How postmenopausal women can manage their sleep problems with (and without) hormone replacement therapy [1:23:00];
- Could a daily practice of Wim Hof’s breathing method help or hinder quality of sleep? [1:29:15];
- Why do some people paradoxically feel more tired the more they sleep? [1:31:15];
- Sleep apnea—How to know if you have it, the different types, the causes, and helpful resources [1:33:15];
- Is there such a thing called “sleep eating”? [1:45:00];
- If Matt was “sleep czar”, what changes would he make to society to improve sleep? [1:46:15];
- Catch up sleep: Explaining the difference between retrospective damage and prospective benefit [1:48:45];
- Does poor sleep really speed up the aging process? [1:50:30];
- Is medicated sleep better than no sleep? [1:53:00];
- Does vivid dreaming disrupt the sleep cycle? [1:56:45];
- Is there potential benefit to using “binaural beats” or some type of sound to induce better sleep? [1:57:45];
- How is sleep affected by fasting and time-restricted eating? [1:59:45];
- Is there any evidence that polyphasic sleep (e.g., “Uberman”) works? [2:03:30]
AMA with sleep expert, Matthew Walker, Ph.D.: Strategies for sleeping more, sleeping better, and avoiding things that are disrupting sleep
- Matthew’s TED Talk, and his favorite public speakers [3:40];
- How good are the current sleep trackers like Oura, Fitbit, etc.? [6:45];
- Is it bad to eat food too close to bedtime? [11:40];
- How does exercise impact sleep? [13:15];
- How is appetite affected by our sleep quality? [17:30];
- Anxiety, cortisol, and weight gain: An awful feedback loop of sleep deprivation [19:30];
- How to optimize your wind down routine: lights, temperature, & relaxation [22:10];
- How alcohol disrupts sleep (and contributes to Alzheimer’s disease) [42:00];
- Sleep’s impact on sex hormones, and romantic relationships [46:00];
- Performance, accuracy, and minimizing the damage of shift work [51:30];
- Bed partners: How to sleep in separate beds and retain a good relationship [55:30];
- Can we use sound machines and electrical stimulation to improve sleep? [57:40];
- Will we ever be able to “supercharge” our sleep stages using technology? [1:03:30];
- Why sleep is the best insurance policy for lifespan and healthspan [1:07:45];
- Melatonin: How (and how not) to use it for sleep improvement [1:15:00];
- The dangers of sleeping pills, useful alternatives, and cognitive behavioral therapy for insomnia [1:24:30];
- Can CBD and THC be used for sleep? [1:39:30];
- Why haven’t we been able to develop a really effective sleeping aid? [1:46:40];
- Can you get too much sleep? [1:51:50];
- What to do (and not do) immediately following a terrible night of sleep? [2:04:15];
- Why a consistent wake up time is king [2:10:30];
- Does poor sleep speed up the aging process? [2:12:00];
- Can different people be more (or less) resilient to sleep deprivation? [2:18:50];
- Finding your optimal sleep schedule and determining your sleep chronotype [2:23:45];
- Defining sleep efficiency and how to improve it [2:29:25];
- Correcting insomnia: A counterintuitive approach [2:31:45];
- How can parents improve the sleep of their kids? [2:37:30]
AMA #6: Fasting framework, vitamin supplementation, antioxidants, time management, problem-solving, and more
- Vitamin supplementation: Is it necessary if you eat a balanced diet? [2:00];
- Antioxidants: What does current science have to say about antioxidants in food and supplements? [9:00];
- How do you break a fast of more than three days? [17:15];
- Does a morning black coffee break a fast? In other words, does black coffee raise insulin levels? [22:15];
- When intermittent fasting, does the placement of the “feeding window” matter? [25:30];
- Is it better to fast before or after a planned food binge (e.g., Thanksgiving)? [28:30];
- Fasting protocol: Do you have a specific protocol to recommend? [31:30];
- Time management: How do you manage your time between work, family, and your many personal interests? [35:45];
- Problem solving: Can you breakdown your process of problem-solving? [46:45];
- For those looking to gain a better understanding of biochemistry, pharmacology, etc., do you have any good textbooks or (online) resources to recommend? [49:00];
- What are some of your favorite podcasts that you listen to? [51:15];
- What is your favorite animal? [54:45]
AMA #5: calcium scores, Centenarian Decathlon, exercise, muscle glycogen, keto, and more
- Coronary calcium score: what it means and how to interpret your results [1:15];
- How to train for the “Centenarian Decathlon” [18:00];
- Explaining the blood glucose response to various types of exercise [35:30];
- The Tabata protocol [43:15];
- Exercising on a ketogenic (or low-carb) diet: performance, muscle glycogen, adaptation, and more [49:30];
- The work of Dr. Gabor Maté and its impact on Peter [54:15];
- What’s the best book you’ve read in the past year? [55:45];
- What is “pattycakes?” [59:00];
- What is the latest and greatest of egg boxing [59:30]
AMA #4: sleep, jet lag protocol, autophagy, metformin, and more
- Blue light blockers and how they improve sleep [1:30];
- How to minimize jet lag and sleep disruption while traveling [6:45];
- How to treat symptoms of PMS, the female hormone cycle, testosterone in women, and estrogen in men [15:45];
- Autophagy: what it is, why it matters, and how can we enhance it [26:15];
- The two-minute drill (and a bonus Patriots and Tom Brady tangent) [41:15];
- Has Peter thought about having CME accredited content for people in the medical field? [44:15];
- How does one find good doctors that are somewhat up to date on the latest research, primary care, etc.? [45:45];
- What values would Peter be interested in monitoring continuously if the tech existed? [47:15];
- How to annoy Peter [49:15];
- If I’m interested in longevity, should I do a Ph.D. or M.D.? [50:00]
AMA #3: supplements, women’s health, patient care, and more
- What references ranges does Peter consider too broad on lab tests? [5:30];
- What aspect of women’s health is the least studied/understood? [21:15];
- What are your thoughts on fasting and ketosis for females? [31:30];
- Advice for medical students and residents, how to get through it, and optimize their time while in med school [38:00];
- What is Peter’s opinion on the best way to monetize a podcast to make it sustainable? [47:45];
- What are you looking to achieve and monitor with your blood glucose monitor? [57:15];
- Thoughts on lithium supplementation? [1:08:15];
- Insights about berberine? [1:16:00];
- Why does Peter take a baby aspirin? What does the science say? [1:19:20];
- How do you use HR variability as a metric in your practice and/or in your own personal use? Sleep, pre/post exercise, pre/post eating, every morning readiness? [1:23:25];
- With the emergence of “the coconut oil is pure poison” article, can you shed some light on saturated fat in the literature and the types of studies done specifically on coconut oil? [1:38:45];
- Would you discuss the recent meta studies that claim that moderate carbohydrate intake may be best for health? [1:40:45];
- What is the number one recommendation/habit you would suggest every person add to their daily regimen (besides physical activity) for wholesome health? [1:42:45];
- What does it mean if your body has a harder time getting into ketosis via fasting than it used to (testing using a Precision Xtra)? [1:44:15];
- Why are you taking Zetia and Lipitor? Are you mitigating risk based on your APOE4? Or is there something else going on? [1:46:10];
- What will your book be about and what is the expected release date? [1:47:45];
- What are your thoughts on nicotinamide riboside supplementation for longevity? [1:49:30];
- Which brand of supplements have you found to be effective? [1:54:30];
- Are you currently accepting new patients? And how do I find a ‘Peter Attia clone’ in my area? [1:56:20];
- Bob’s personal experience with Peter as a doctor [1:58:45];
- Can you tell us more about the latest and best of APOE4? [2:06:15]
AMA #2: the Nothingburger — results from Peter’s week-long fast between two weeks of nutritional ketosis — and answering questions on all things fasting
- Why Peter did a one-week fast and the rationale for front- and back-ending it with a week-long ketogenic diet [6:30];
- What Peter’s typical diet, exercise, sleep, stress management, and supplementation looks like [11:00];
- What labs (e.g., glucose, ketones, lipids, inflammation and oxidation markers, thyroid, sex hormones) Peter checked for the experiment [22:00];
- Peter’s results after one week on a ketogenic diet [29:30];
- Peter’s results after a week on a water-only fast [48:45];
- Peter’s results after a week on a ketogenic diet following a week of fasting [58:30];
- Peter’s “Top 6” surprises from the fasting experiment [1:08:30];
- Different fasting-mimicking diet (FMD) protocols [1:29:20];
- What is the optimal protocol, frequency, and duration for fasting? [1:33:00];
- How to break a fast without GI distress? [1:38:00];
- “Am I breaking the fast if…?” [1:41:30]
AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more
- What are my thoughts on alcohol consumption and health? [4:00]
- What are the best lab tests to request from your PCP, and what are the best markers for longevity? [14:00]
- What are the best wearables and why, and why do I use a continuous glucose monitor? [35:00]
- How does one select the right physician as a patient? [47:00]
- Why do I race cars and what’s the hardest thing to learn as a new driver? [54:30]
- What is my current exercise regimen and what are my thoughts on exercise for improving lifespan and healthspan? [1:20:15]
- What is my strategy for learning something deeply? [1:33:00]
- What is my process for forming my beliefs? [1:53:30]
- What does my diet look like these days? [1:57:45]