AMA
What lab tests can (and cannot) inform us about our overall objective of longevity
#111 – AMA #14: What lab tests can (and cannot) inform us about our overall objective of longevity
In this “Ask Me Anything” (AMA) episode, Peter explains his framework for understanding what lab tests can (and cannot) inform us as it pertains to overall longevity, with a specific focus on atherosclerosis, cancer, Alzheimer’s disease, and the physical body. Additionally, Peter shares details into two patient case studies around cardiovascular disease, including how the lab results influenced his diagnosis and treatment plan for the patients. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions.
- 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
Fasting, exogenous ketones, autophagy, and exercise for longevity
#108 – AMA #13: 3-day fasting, exogenous ketones, autophagy, and exercise for longevity
In this “Ask Me Anything” (AMA) episode, Peter explains some observations he’s noticed since switching to a 3-day fasting regimen, the various things he’s measuring, and some helpful tips for getting through a prolonged fast. He also discusses the role of exogenous ketones in fasting and ketogenic diets as well as their impact on autophagy, specifically. Finally, Peter provides some practical advice for those looking to fit exercise for longevity into their busy life. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions.
- 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
Strategies for longevity (which don't require a doctor)
#92 – AMA #12: Strategies for longevity (which don’t require a doctor)
In this “Ask Me Anything” (AMA) episode, Peter explains the various levers one can pull to affect longevity with a specific focus on the strategies and tactics one can implement that do not require the help of a physician. This episode heavily features insights into nutrition, exercise physiology, and sleep physiology. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions.
- 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]; and
- More.
AMA
All things fasting
#89 – AMA #11: All things fasting
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of fasting-specific questions from subscribers. Peter starts by defining the various fasting protocols, details his own personal fasting regimen, explains his revised plan for 2020, and provides a ton of value to anyone interested in fasting. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions.
- 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]; and
- More.
AMA
Low testosterone, hypothyroidism, building muscle (and preserving it while fasting)
#84 – AMA #10: Low testosterone, hypothyroidism, building muscle (and preserving it while fasting)
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.
- 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]; and
- More.
AMA
NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more
#73 – AMA #9: NAD & metformin, fat-burning zone, creatine, estrogenization of men, emergency kit for cold & flu, and more
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.
- 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]; and
- More.
AMA
DNA tests, longevity genes, metformin, fasting markers, salt, inflammation, and more
#67 – AMA #8: DNA tests, longevity genes, metformin, fasting markers, salt, inflammation, and more
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.
- 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]; and
- More.
AMA
Exercise framework, deadlifting, lower back pain, blood pressure, nootropics, CGM, and more
#63 – AMA #7: Exercise framework, deadlifting, lower back pain, blood pressure, nootropics, CGM, and more
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from subscribers. Bob Kaplan, Peter’s head of research, asks the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.
- 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]; and
- More.
AMA
Fasting framework, vitamin supplementation, antioxidants, time management, problem-solving, and more
#53 – AMA #6: Fasting framework, vitamin supplementation, antioxidants, time management, problem-solving, and more
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions. If you’re listening on a podcast player, you’ll be able to hear a preview of the AMA.
- 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]; and
- More.
AMA
Calcium scores, Centenarian Decathlon™, exercise, muscle glycogen, keto, and more
#50 – AMA #5: calcium scores, Centenarian Decathlon™, exercise, muscle glycogen, keto, and more
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions. If you’re listening on a podcast player, you’ll be able to hear a preview of the AMA.
- 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]; and
- More.
AMA
Sleep, jet lag protocol, autophagy, metformin, and more
#45 – AMA #4: sleep, jet lag protocol, autophagy, metformin, and more
In this “Ask Me Anything” (AMA) episode, the first subscriber-only edition, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions.
- 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]; and
- More.
AMA
Supplements, women’s health, patient care, and more
#26 – AMA #3: supplements, women’s health, patient care, and more
In this “Ask Me Anything” (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head analyst, asks the questions.
- 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]; and
- More.
AMA
The Nothingburger — results from Peter’s week-long fast between two weeks of nutritional ketosis — and answering questions on all things fasting
#11 – AMA #2: the Nothingburger — results from Peter’s week-long fast between two weeks of nutritional ketosis — and answering questions on all things fasting
Consider this episode a cross between an ask me anything (AMA) and a show-and-tell. Peter discusses his fasting experiment in great detail and answers questions from listeners and readers.
- 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]; and
- More.
AMA
Alcohol, best lab tests, wearables, finding the right doc, racing, and more
#04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more
In the first “Ask Me Anything” episode, I answer a wide range of questions from podcast listeners and the Twittersphere. Bob Kaplan, my head analyst, playing the role of Mike Wallace, asks, and follows up on, the hard-hitting questions submitted via Twitter.
- 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]
- And more.
