The Peter Attia Drive

Gary Taubes is an investigative science and health journalist and a best-selling author. In this podcast, Gary explains how he developed a healthy skepticism for science as he was transitioning from being a physics major to beginning as a science journalist. He talks about how he was particularly drawn to sussing out "pathologic science," telling the stories behind his books on the discovery of the W and Z bosons and cold fusion, emphasizing the need for researchers to perform a thorough background analysis. Gary then describes how his work came to focus on public health, nutrition, and obesity. He provides a great historic overview of obesity research and provides his explanation for why the conventional wisdom today is incorrect.We discuss:

• Gary's background in science and journalism, and developing a healthy skepticism for science [2:20];
• Gary's boxing experience, and the challenge of appreciating behavioral risk [8:40];
• How Gary developed his writing skills, and what the best science writers do well [16:45];
• Example of how science can go wrong, and the story behind Gary's first book, Nobel Dreams [25:15];
• Theoretical vs. experimental physicists: The important differentiation and the relationship between the two [36:00];
• Pathological science: research tainted by unconscious bias or subjective effects [40:30];
• Reflecting on the aftermath of writing Nobel Dreams and the legacy of Carlo Rubbia [49:45];
• Scientific fraud: The story of the cold fusion experiments at Georgia Tech and the subject of Gary's book, Bad Science [53:45];
• Problems with epidemiology, history of the scientific method, and the conflict of public health science [1:09:00];
• Gary's first foray into the bad science of nutrition [1:26:45];
• Research implicating insulin's role in obesity, and the story behind what led to Gary's book, Good Calories, Bad Calories [1:36:15]
• The history of obesity research, dietary fat, and fat metabolism [1:46:00]
• The evolving understanding of the role of fat metabolism in obesity and weight gain [1:55:15]
• Mutant mice experiments giving way to competing theories about obesity [2:04:00]
• How Gary thinks about the findings that do not support his alternative hypothesis about obesity [2:08:00]
• Challenges with addressing the obesity and diabetes epidemics, palatability and convenience of food, and other hypotheses [2:14:45];
• Challenging the energy balance hypothesis, and the difficulty of doing good nutrition studies [2:25:00]; and
• More.

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Dr. Patricia Corby is Associate Professor of Oral Medicine and Associate Dean of Translational Research at Penn Dental Medicine. Her work focuses on the importance of providing dental services alongside critical public healthcare services, like cancer treatment. In this episode, Pat provides an overview of dental anatomy, the importance of oral hygiene to overall health, and the association of poor oral health and systemic diseases like cancer and diabetes. She addresses tooth decay, oral hygiene in children, the utility of dental products, and ideal oral care regimens for different populations. She also discusses issues specific to immunocompromised patients and those with chronic illnesses as well as her own research with cancer patients undergoing radiation treatment.

We discuss:

• Anatomy of teeth and the purpose of the dental pulp—a highly vascularized and innervated region of the tooth [3:00];
• Types of teeth and the different purpose they serve [14:15];
• Anatomy of the oral cavity, bacteria in the mouth, and what a healthy mouth looks like [18:10];
• Pat's study demonstrating the importance of flossing [23:00];
• Detrimental effects of sugar and the importance of fluoride and oral hygiene [31:45];
• Oral health challenges for cancer patients and immunocompromised people [39:45];
• Pat's current research on cancer patients undergoing radiation treatment and the oral health risks associated with human papilloma virus (HPV) [50:00];
• Periodontal disease: caries and root canals [57:30];
• The relationship between poor oral health and systemic health diseases [1:11:00];
• Potential connection between oral hygiene and COVID-19 [1:17:45];
• Dry mouth leading to oral infections and ways to prevent it [1:22:30];
• What determines the appearance of teeth, methods of teeth whitening, and whether you should remove mercury fillings [1:27:30];
• Importance of fluoride for preventing tooth decay, and dental care for children [1:32:45];
• Useful dental products: floss, electrics toothbrushes, and more [1:39:15];
• Ideal oral care regimens [1:47:30]; and
• More.

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

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

We discuss:

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

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama24/ Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

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

We discuss:

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

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/AmandaSmith Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

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

We discuss:

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

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/LayneNorton Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Sarah Hallberg is the Medical Director at Virta Health and a physician who has spent nearly two decades treating patients with obesity and type 2 diabetes. In the first half of this episode, Sarah discusses how she became a huge believer in the efficacy of carbohydrate restriction for the treatment of type 2 diabetes through her research and clinical experience. Sarah challenges the common beliefs about the role of dietary fat and carbohydrate on the plasma makeup of fatty acids and triglycerides. She also expresses the importance of understanding early predictors of metabolic illness—highlighting one particular fatty acid as the most important early predictor—before finishing with a discussion about how doctors might be able to personalize patients' metabolic management in the future. In the second half of this episode, Sarah tells the personal story of her own lung cancer diagnosis. She talks about dealing with her grief, deciding to continue her work while prioritizing her family, and how she devised a plan to extend her survival as long as possible.

We discuss:

• How Sarah discovered the profound impact of carbohydrate restriction for reversing obesity and type 2 diabetes [3:15];
• Prediabetes and metabolic syndrome: prevalence, early signs, and the importance of treating early [16:00];
• Overview of fatty acids, how they are metabolized, and understanding what you see in a standard blood panel [29:15];
• The relationship between diet composition and metabolic markers [35:15];
• Why palmitoleic acid is such an important biomarker [48:15];
• The best early indicators of metabolic disease [1:00:00];
• Personalized management of metabolic illness [1:07:00];
• Sarah's cancer diagnosis and the beginning of her journey [1:15:15];
• The emotional impact of a devastating diagnosis [1:27:15];
• Sarah's plan to extend survival [1:36:45];
• Sarah's aggressive treatment plan [1:47:30];
• Life-threatening complications and the return of her cancer [1:59:00];
• Sarah's reflections on her approach to life with chronic cancer and balancing her time [2:11:00]; and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/SarahHallberg Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

In this "Ask Me Anything" (AMA) episode, Peter and Bob dive deep into nicotine, a complicated and interesting molecule that has effects on both the brain and the body. They analyze the results of the studies that describe nicotine's cognitive benefits and potential for inducing weight loss. They talk about a smoking cessation technique called nicotine replacement therapy and give a full breakdown of the various routes of administration, dosing, and safety. Finally, they explore the fascinating and counterintuitive observation that cigarette smokers are less likely to get a severe case of COVID-19. If you're not a subscriber and listening on a podcast player, you'll only be able to hear a preview of the AMA. If you're a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #23 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:

• How Peter first became interested in the potential benefits of nicotine [1:15];
• Untangling nicotine from tobacco [6:00];
• Nicotine replacement therapy (NRT) for quitting smoking: products, protocols, and a review of the literature [9:30];
• The cognitive benefits of nicotine: Overview of the literature [15:50];
• Where nicotine has the most positive impact on cognition [30:30];
• Possible mechanisms conferring the benefits of nicotine [37:00];
• How modafinil and other nootropics compare to nicotine [47:15];
• How nicotine may induce weight loss [54:00];
• Relationship between smoking and COVID-19: Analyzing the observation that smoking appears protective against COVID-19 [1:01:45];
• Breakdown of the various nicotine replacement therapies: route of administration, dosing, and safety [1:11:30];
• Concluding thoughts on nicotine: use cases, addictive properties, and more [1:19:45]; and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama23 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee evaluating COVID-19 vaccines. In this episode, Paul's second appearance on The Drive, he provides an update on all the SARS-CoV-2 vaccines currently deployed, explains why the concerns raised around the mRNA vaccines are not legitimate, and offers his view on the prospects and timeframe of reaching herd immunity. He also takes a deep dive into immunology, explaining the short-term and long-term immune response to both natural infection and vaccination and how these two can function together to provide durable immunity. Additionally, they discuss the theories on the origins of this virus, what impact the new COVID-19 variants might have, and the recent pausing of the J&J vaccine. Finally, they discuss how we can be better prepared for an inevitable future outbreak of a novel virus. This episode was originally recorded on April 14, 2021.

We discuss:

• Overview and current status of the SARS-CoV-2 vaccine strategies [4:10];

• Addressing concerns about mRNA vaccines [9:00];

• How the failure to make an effective HIV vaccine aided the development of a COVID-19 vaccine [16:45];

• Where SARS-CoV-2 falls on the spectrum of its ability to mutate and what that means for immunity and vaccination [21:30];

• How the combination of short-term and long-term immune response to SARS-CoV-2 work together to provide durable immunity [28:00];

• Importance of understanding relative vs. absolute risk reduction [38:15];

• Implications of pausing the J&J vaccine due to reports of blood clotting in the brain [42:45];

• What constitutes herd immunity and the concerns of rising vaccine hesitancy [47:45];

• When we might reach herd immunity, future vaccines for children, and long-term outlook for maintaining population immunity [58:45];

• Theories about the origins of SARS-CoV-2 [1:07:00];

• Preparing for the possibility of a future pandemic and how we can learn from our mistakes [1:10:40]; and

• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/pauloffit2 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Peter Hotez is an internationally recognized physician-scientist in neglected tropical diseases and vaccine development. In this episode, they first follow up on the podcast episode (#158) with Brian Deer (the investigative journalist who exposed the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism) with a broader discussion about the origin and evolution of the anti-vaccine movement. They explore some of the specific claims being made around vaccine additives, the timing of when vaccines are given, and claims about issues with the HPV vaccine specifically. Next, Dr. Hotez shares his own journey as a parent of an autistic child and speaks of the challenges of diagnosing autism, what could account for the seeming increase in the prevalence, and whether there is any support for the notion that environmental triggers play a role. They close out with a discussion on the state of affairs with respect to COVID-19 vaccination, comparing the various vaccines as well as the challenges that emerging variants of the virus may present. This episode was originally recorded on April 2, 2021.

We discuss:

• The stubborn persistence of anti-vaccine sentiment (3:00);
• A closer look at claims about thimerosal and vaccine spacing causing autism (12:00);
• The Hib vaccine: An example of the profound difference a vaccine can make (23:30);
• The controversy surrounding the human papillomavirus (HPV) vaccine (30:45);
• The growing anti-science sentiment, COVID vaccine hesitance, and the basis of the anti-vaxx movement (39:00);
• The origins of autism, and Hotez's personal story as a parent of an autistic child (1:02:45);
• The challenge of diagnosing autism, increasing prevalence, and a potential parallel to Alzheimer's disease (1:14:15);
• Comparing the various COVID-19 vaccines and the impact of emerging variants of the virus (1:30:00);
• Global vaccination challenges and "vaccine diplomacy" (1:40:45); and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/PeterHotez3 Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Brian Deer is an award-winning investigative journalist best known for his coverage of the pharmaceutical industry. In this episode, he and Peter discuss the content of his book, The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines, which exposes the complex and disturbing story behind the infamous 1998 Lancet paper by Andrew Wakefield linking the MMR vaccine and autism. Brian explains how doctors led by Wakefield, a lawyer, and an anti-vaccination parents' group worked together on a study to validate their preconceived belief that the MMR vaccine caused autism. He reveals what happened behind the scenes as the study was carried out, explains problems in the lab, and discusses inconsistencies in the analysis. In the end, this is a story that serves as a cautionary tale about the consequences of science driven by an agenda rather than by a spirit of open inquiry.

We discuss:

• How Andrew Wakefield's flawed approach to scientific research led to the belief that vaccines cause autism (3:25);
• The importance of following the scientific method, and how Wakefield twisted the science to link measles virus to Crohn's disease (14:15);
• The backstory behind Andrew Wakefield's infamous 1998 Lancet paper linking the MMR vaccine and autism (26:45);
• The many flaws and disturbing aspects of Wakefield's study: suffering children and failure to do strain-specific sequencing (45:15);
• The epicenter of fraud: Bogus PCR testing furthering the belief that measles virus from the MMR vaccine caused autism (1:00:00);
• Additional issues that contaminated the study results (1:22:15);
• Discovering the misrepresented medical records for the kids involved in the study leading to the retraction of the Lancet paper and Wakefield losing his license (1:31:00);
• The resurgence of the anti-vaccination movement, Brian's motivation to write the book, and parting thoughts (1:36:45); and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/BrianDeer Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.