The Peter Attia Drive

Paul Offit is a pediatrician specializing in infectious diseases and an expert in virology and vaccine development. He currently serves on the FDA committee overseeing and evaluating COVID-19 vaccines. In this episode, Paul discusses the strategies and major companies pursuing a vaccine against the SARS-CoV-2 virus. He gets into the nuances of the vaccine approval process and its implications for COVID-19 vaccine outlook. Paul also explains potential risks, reveals his own confidence level in safety, and gives insight into protection against reinfection with vaccination. Please note that this episode was recorded 11/05/2020, prior to the 11/09/2020 news release of the Pfizer vaccine update. We discuss:

• How Paul's experience as a child in a chronic care hospital as child informed his path in pediatrics and vaccine development (3:30);
• Addressing the anti-vaccination sentiment and explaining the fraudulent origins of the anti-vaccination movement (8:00);
• Lessons and insights from 26 years studying rotavirus and creating a successful rotavirus vaccine (17:00);
• Developing a new vaccine: the different phases of clinical trials, overall timeline, and financial costs (27:15);
• Operation Warp Speed: the expedited process of creating a coronavirus vaccine (32:30);
• Various vaccine strategies—RNA, DNA, virus vector—and the challenges associated (35:00);
• The Moderna and Pfizer mRNA vaccines: strategy, timeline, and Emergency Use Authorization (41:15);
• Paul's confidence level in the safety of the first coronavirus vaccines (48:30);
• The risks associated with different types of vaccines, and updates on the Johnson & Johnson and Astrazeneca coronavirus vaccines (52:15);
• What we know about the coronavirus vaccines approved in Russia and China (55:45);
• The latest on the Merck coronavirus vaccine (57:15);
• The recombinant/purified protein vaccine approach for coronavirus—big players, risks, and the best vaccine for the elderly (57:45);
• Attenuated and inactivated vaccine strategies for coronavirus (1:02:00);
• The genetic drift of SARS-CoV-2: Impacts for protection and vaccine development (1:02:30);
• Paul's take on the hypothesis that a previous coronavirus infection offers protection against the novel COVID-19 (1:06:45);
• Addressing the concern that antibodies fade over time (1:09:15);
• Blood type and protective against coronavirus (1:13:00);
• Distribution: the challenge of prioritizing the limited doses of vaccines after approval (1:13:15);
• Paul's perspective on COVID-19 vaccine safety (1:16:15);
• Considerations regarding vaccinating children for coronavirus and the role of a fever immune response (1:21:45);
• Why vaccine development can be challenging and risks of current COVID-19 strategies (1:29:45); and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/pauloffit 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 discuss different methods to evaluate body composition. They explore ways of measuring body fat, delineating between subcutaneous and visceral fat, and go over best strategies for improving body composition and optimizing health. They also discuss insulin resistance using a patient case study that highlights interventions capable of reversing the condition. Finally, Peter addresses his level of concern about a recent Consumer Report finding that Topo Chico had the highest levels of a class of synthetic chemicals (PFAS) of all the carbonated bottled waters tested. Peter concludes by sharing if the finding will change his consumption habits. 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 #17 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:

• 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.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama17 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.

BJ Miller is a hospice and palliative care specialist on a quest to reframe our relationship with death. In this episode, BJ begins with how his own brush with death radically shifted his perspective and ultimately forged his path towards palliative care and helping patients integrate and understand their life in a meaningful way. BJ recounts several moving stories from his patients, which reveal important lessons about overcoming the fear of death, letting go of regret, and what's most important in life. He discusses the major design flaws of a "death phobic" healthcare system. Furthermore, he makes the case that seeing death as a part of life allows us to live well, as opposed to living to evade death itself. He concludes with a discussion around physician-assisted death as well as his hopes around the use of psychedelics to reduce suffering in end-of-life care. We discuss:

• BJ's accident leading to the loss of his limbs and his experience inside a burn unit [3:00];
• Coping with his amputations—being tough, the grieving process, and the healing properties of tears [14:30];
• Going from art history to medical school: the value of a diverse background in medicine [28:15];
• How BJ's new body liberated him [40:00];
• How losing his sister to suicide and his disillusionment with medicine altered his path [47:15];
• Discovering his path of palliative care—distinct from hospice—in medicine [55:30];
• Our complicated relationship with death, and how acknowledging it can release its grip and improve living [1:02:15];
• The different distinctions around the fear of death, and how BJ helps his patients negotiate fears [1:10:00];
• The major design flaws of a "death phobic" healthcare system [1:14:15];
• Common regrets, the value of time, and other insights from interactions with patients in their final moments of life [1:23:00];
• The story of Randy Sloan—a case study of playing life out [1:33:45];
• Physician-assisted dying: Legality and considerations [1:39:45];
• The use of psychedelics in end-of-life care, and what BJ is most excited about going forward [1:45:45]; and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/bjmiller 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.

James O'Keefe is a preventative cardiologist and bestselling author of The Forever Young Diet and Lifestyle. In this episode, James discusses cardiac physiology and what makes the human heart susceptible to disease. He provides evidence for what supports his approach to exercise--elucidating both positive and negative kinds of exercise for heart health. He also discusses the role of nutrition, specific nutrients, and pharmacological interventions to support heart and brain longevity.

We discuss:

• James' background and why he favors a preventative approach to cardiology [3:15];
• Understanding atherosclerosis and the misconception that it's a "plumbing problem" [10:15];
• The danger in excessive exercise—a reverse J-shaped mortality curve [21:15];
• The story of Micah True—A case study of excessive exercise [49:15];
• The best kinds of exercise for longevity—The Copenhagen City Heart Study [53:00];
• Being a more balanced athlete and finding the right exercise intensity [58:45];
• Heart rate during exercise, resting heart rate, and other important metrics [1:04:00];
• Nutrition for cardiovascular health [1:09:45];
• Important nutrients: Magnesium, potassium, calcium, sodium, and collagen [1:19:30];
• SGLT2 inhibition for diabetes, cardio-protection, and general longevity [1:24:15];
• GLP-1 agonists for weight loss and reducing cardiovascular risk [1:34:15];
• Statins—Mechanism of action, safety, and useful alternatives [1:37:25];
• A 40-year view on cardiovascular risk, and the possibility of reversing arterial calcification [1:45:45];
• Evidence for high dose EPA and DHA for the reduction of cardiovascular disease risk [1:53:30];
• The impact of omega-3, curcumin, and other compounds on mental health and dementia [1:59:00];
• James' focus beyond cardiology [2:02:15]; and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/JamesOKeefe 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.

Vinay Prasad is a practicing hematologist-oncologist who doubles as a "meta-researcher," studying the quality of medical evidence, health policy, and clinical trials. In this episode, Vinay discusses the differences in clinical treatment from the existing medical evidence, often leading to useless, or even harmful, outcomes for patients. With a focus in oncology, he takes a deep dive into the field's structural problems, which include the disconnect between progress and funding, drug costs, and financial conflicts of interest. He concludes with his "six hallmarks of successful cancer policy" as a potential roadmap to sustained progress against cancer and a way to avoid repeating the policy and practice mistakes of the past.

We discuss:

• Vinay's background and unique perspective [3:15];
• Medical reversal—the disconnect between research findings and clinical applications in medicine [10:15];
• The uniquely challenging field of oncology [22:45];
• The importance of bedside manner with cancer patients [30:00];
• Structural problems in oncology—Problem #1: Huge costs for small improvements [37:00];
• Structural problems in oncology—Problem #2: Medical reversal—when medical practices are adopted based on low levels of evidence [40:15];
• Structural problems in oncology—Problem #3: Slow progress in cancer research (despite all the hype and propaganda) [45:00];
• Structural problems in oncology—Problem #4: The burden of payment is not matched with those making treatment decisions [54:45];
• "No-brainer" moves in oncology [1:06:45];
• "Fool's gold" treatments in oncology [1:09:30];
• The six hallmarks of successful cancer policy [1:16:00];
• Cancer policy hallmark #1: Independence [1:18:00];
• Cancer policy hallmark #2: Evidence [1:28:15];
• Cancer policy hallmark #3: Relevance [1:31:30];
• Cancer policy hallmark #4: Affordability [1:32:00];
• Cancer policy hallmark #5: Possibility [1:47:00];
• Cancer policy hallmark #6: Agenda [1:52:00];
• Tumor genome sequencing and liquid biopsies [1:54:30];
• Vinay's clinical philosophy, being skeptical without being too contrarian, and practicing medicine without perfect information [2:03:30]; and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/VinayPrasad 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 explore the quality of evidence for hot and cold therapy. In the discussion, they evaluate the safety, efficacy, and opportunity costs of various hot and cold therapy protocols, and Peter ultimately considers the addition of dry sauna to his longevity toolkit. Once again, Bob Kaplan, Peter's head of research, will be asking 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. 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 #16 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

• 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.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama16/ 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.

Renowned social psychologists Carol Tavris and Elliot Aronson are the co-authors of Mistakes Were Made (But Not By Me), a book which explores the science of cognitive biases and discusses how the human brain is wired for self-justification. In this episode, Carol and Elliot discuss how our desire to reconcile mental conflicts adversely affects many aspects of society. The two give real-world examples to demonstrate the pitfalls in attempts to reduce mental conflict, or dissonance. The examples reveal that no one is immune to dissonance reduction behavior, how intellectual honesty can be trained and lastly, how to think critically in order to avoid engaging in harmful dissonant behaviors.

We discuss:

• Carol and Elliot's respective background, collaboration history, and their decision to write Mistakes Were Made (But Not By Me) [4:00];
• The theory of cognitive dissonance, and real examples of dissonance reduction in action [11:15];
• How Elliot advanced the theory of cognitive dissonance [23:00];
• The evolutionary reason for dissonance reduction, and cultural differences in what causes cognitive dissonance [30:30];
• The great danger of smart, powerful people engaging in dissonance reduction [35:15];
• Two case studies of cognitive dissonance in criminal justice [39:30];
• The McMartin preschool case study—The danger in making judgements before knowing all the information [43:30];
• How ideology distorts science and public opinion [56:30];
• How time distorts memories [58:30];
• The downside of certainty [1:05:30];
• Are we all doomed to cognitive dissonance?—How two people with similar beliefs can diverge [1:09:00];
• Cognitive dissonance in the police force [1:21:00];
• A toolkit for overcoming cognitive dissonance [1:27:30];
• Importance of separating identity from beliefs, thinking critically, & and the difficulty posed by political polarity [1:30:30];
• How to impart the lessons from their work into future generations [1:48:00]; and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/caroltavris-elliotaronson/ 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.

World-renowned lipidologist Tom Dayspring returns to give an update on the current thinking in lipidology as a follow-up to his 2018 five-part podcast series. In this episode, Tom discusses the growing consensus that atherogenic lipoproteins are essential drivers of atherosclerotic vascular disease. Tom further emphasizes apolipoprotein B (apoB) and lipoprotein(a) (Lp(a)). He provides insights into risk assessment, including which lab metrics to use, how to interpret them, and the appropriate therapeutic targets. Additionally, Tom discusses the most recent developments in lipid-lowering drug therapies—from the continued evolution of PCSK9 inhibitors, to the latest understanding of EPA and DHA, and the most recent addition of bempedoic acid to the list of therapeutic agents.

We discuss:

• The latest in the field of lipidology and cardiovascular disease [3:45];
• Apolipoproteins—the key to understanding lipid biology [9:30];
• ApoB as a preferred metric over LDL-P [16:30];
• Therapeutic goals for apoB concentration [21:45];
• Drivers of atherosclerosis [34:15];
• Overview and current thinking on high density lipoproteins (HDLs)—Is it a useful metric? [37:00];
• Lipoprotein(a)—the most dangerous particle you've never heard of [55:00];
• Are low density lipoprotein triglycerides (LDL-TGs) a useful metric? [1:13:15];
• Tom's preferred lab measurements [1:17:45];
• The latest in lipid-lowering therapies [1:21:30];
• The different pathways among various lipid-lowering drugs [1:30:45];
• The latest on EPA and DHA [1:38:15];
• Fibrates—an underappreciated treatment for hypercholesterolemia [1:49:45] and;
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/tomdayspring6 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.

Irene Davis is the founding Director of the Spaulding National Running Center at the Harvard Medical School. In this episode, Irene describes how her research of biomechanics and clinical work with running injuries, as well as research by others, has shaped her views on maintaining body alignment and foot health. Irene discusses her argument for the role of modern footwear in running-related injuries and how minimalist footwear helps resolve the subsequent biomechanical issues.

We discuss:

• Irene's path to her Ph.D., her entry into physical therapy, and her interest in biomechanics [3:20];
• How Irene's thinking about the use of orthotics has changed [7:15];
• The evolution of the human foot and the transition from walking to running [10:30];
• The evolution of shoes and its impact on running injuries [17:30];
• An overview of running injuries [26:00];
• Cushioned running shoes, heel striking and impact forces [29:30];
• Shin splints [33:45];
• How heel strike patterns promotes knee stress through rate of loading [35:30];
• The critical importance of exercise [42:15];
• Impact forces and injury potential [45:45];
• How shoe cushioning alters impact forces despite forefoot striking [49:00];
• An overview of minimalist shoes [52:30];
• Irene's protocol for transitioning people out of orthotics [58:45];
• Transitioning to minimalist shoes and a forefoot strike [1:05:30];
• Foot muscle volume, minimalist shoes, and orthotics [1:07:00];
• The recognition of the importance of foot strength in podiatry [1:09:45];
• Minimalist shoes across the lifespan—from children to adults [1:12:30];
• Why learning to forefoot strike on soft surfaces is not the best approach [1:20:00];
• Knee valgus and factors related to knee injury [1:21:45];
• IT band syndrome [1:28:30];
• Physics and ground reaction forces [1:33:15];
• Irene's approach to retraining a runner's gait [1:36:00];
• Case study—How the transition to minimalist shoes decreased injury and improved performance [1:42:15];
• Importance of proper movement patterns and the negative influence of our modern environment [1:45:30]; and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/irenedavis 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 special episode, Matthew Walker returns for his third AMA episode to provide his expert insight into numerous sleep-related questions directly from listeners. He explains how he adjusted his hypotheses on topics like blue light and caffeine, and why he is more bullish on the importance of REM sleep. Matt also answers questions about sleep wearables, how fasting affects sleep, how sleep deprivation impacts gut health, and magnesium as a sleep aid. Finally, Matt reveals what he believes is the next evolution in sleep science and technology. If you're a subscriber, you can now listen to this full episode on your private RSS feed or on our website on the show notes page.

We discuss:

• 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.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/matthewwalkerama3 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.