The Peter Attia Drive

Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer's prevention.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, David Sinclair, Ph.D., a Professor in the Department of Genetics at Harvard Medical School and co-Director of the Paul F. Glenn Center for the Biological Mechanisms of Aging, returns to the podcast to discuss the content of his new book, Lifespan: Why We Age - and Why We Don't Have To. This conversation focuses on the biological mechanisms involved in what David terms the Information Theory of Aging which provides insights into the "clock" that determines our aging and to what degree it can be manipulated. Our discussion on aging of course leads us into interconnected topics of epigenetics, sirtuins, cellular senescence, as well as what compounds David is personally taking for his own longevity. Additionally, we discuss the most up to date information related to NAD and longevity by looking at the potential benefits (if any) of supplemental agents (NAD precursors, NR, NMR, etc.) that pose a promise of increasing NAD.

We discuss:

• SIR genes and cellular identity [8:45];
• Sirtuins regulate gene expression [14:30];
• DNA is methylated at the deepest layer of the epigenome [17:45];
• Methylation pattern and determining cellular age [20:15];
• Cellular reprogramming [33:45];
• Yamanaka factors to push cells "back in time" [41:00];
• Human cellular reprogramming viability [57:00];
• Measuring the rate of aging [1:02:45];
• Cellular reprogramming for longevity [1:14:45];
• Compounds David takes for his own longevity [1:29:15]
• NAD precursors (NR, NMN) and pterostilbene [1:40:00];
• The current field of sirtuin activators [2:03:15];
• David's artistic work [2:05:15] and;
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode:https://peterattiamd.com/davidsinclair2/ 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.

Today's episode of The Qualys is from podcast #27 – David Sinclair, Ph.D.: Slowing aging – sirtuins, NAD, and the epigenetics of aging.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Dr. Ronesh Sinha, a physician, author, and educator based in Silicon Valley, shares his many insights into metabolic illness that he has gleaned from his South Asian patient population. In this conversation we focus on hyperinsulinemia, insulin resistance, metabolic dysregulation, inflammation, blood pressure, obesity, etc. and ways to address them with nutrition, sleep, exercise, stress management, and more. We also take a deep dive into insulin resistant phenotypes, evolutionary theory and geographic determinants of insulin resistance which provides insight into the genetic architecture and pathophysiology of metabolic syndrome. Additionally, we discuss the surprisingly interrelated topic of stress, and how we might be inadvertently passing this on to our children, leading to mental and physical sickness down the road.

We discuss:

• How a stubborn case of insulin resistance connected Peter with Ronesh [7:15];
• Ronesh's clinical treatment focus of metabolic illnesses in South and East Asian patient populations [8:45];
• The distinction between visceral fat and subcutaneous fat stores [15:00];
• Shortcomings of a body mass index (BMI) calculator for evaluating metabolic disease risk [17:15];
• Cortisol and blood glucose variability [28:30];
• Insulin's role in elevated blood glucose: A symptom of metabolic syndrome [33:25];
• Mechanistic explanations of insulin resistance (there may be more than one) [35:15];
• Theories on origins and evolutionary reasons for insulin resistance [40:00];
• The inverse relationship between the amount of brown adipose tissue and rates of insulin resistance, and the role of climate in patterns and prevalence of insulin resistance [49:50];
• Vitamin D levels, hyperinsulinemia, and other effects [53:45];
• The evolutionary benefit of being able to turn fructose into fat (and the price we are now paying for it) [58:00];
• The VO2 max relationship to insulin resistance and familial metabolic health [59:30];
• Using zone 2 fitness test to evaluate mitochondrial performance [1:01:15];
• Exercise for long-term functional health [1:06:00];
• Lifestyle changes to improve insulin resistance and other metabolic phenotypes [1:14:00];
• Is PCOS a manifestation of insulin resistance? [1:21:00];
• The impact of stress on adiposity, and Peter's treatment regimen for overweight females resistant to typical nutritional approaches [1:23:45];
• How a culture of achievement and expectations can lead to undue stress, unhappiness, and health problems in our children (a Silicon Valley case study) [1:35:00];
• The negative impact of devices and social media on children [1:48:45];
• How you can help yourself, your family, and your community without being an MD or PhD [1:55:00]; and
• More.

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

Today's episode of The Qualys is from podcast #18 – Richard Isaacson, M.D.: Alzheimer's prevention.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Marty Makary, Johns Hopkins surgeon and NYT bestselling author, discusses his ambitious attempt to fix the broken U.S. healthcare system through educating the public, changing the lexicon, encouraging radical transparency in pricing, and more. We go in detail into the main drivers of inflated health care costs, the money games being played making it hard to understand, and the unfortunate system structure that has resulted in one in five Americans finding themselves in medical debt collections which can ruin the lives of people and families seeking basic medical care. Marty also shares some very practical advice and tips if you find yourself a victim of predatory pricing and stuck with an outrageous medical bill. In the end, despite the current state of the system, Marty discusses the many exciting trends gaining traction in healthcare and why he is very optimistic and hopeful about the future.

We discuss:

• The science of delivering healthcare, how we need to do better as a system, and why no single person or entity fully to blame [10:15];
• The stories that prompted Marty to write his first book (Unaccountable) [19:15];
• The Surgery Checklist [26:15];
• The problem is with the system (not any one person or entity) and the misaligned interests of all the parties involved [28:15];
• Patients crave honesty and transparency, and the story of Peter's back surgery gone wrong [33:00];
• Today's med students and young doctors have less tolerance for predatory pricing and healthcare industry BS [44:30];
• Funny stories about John Cameron (legendary surgeon at Johns Hopkins) [48:00];
• How doctors are trained to internalize traumatic experiences which can result in a misunderstood form of "burnout" [57:40];
• The beat down of med students with traditional medical education and some exciting innovations to medical education [1:07:00];
• Exciting trends in healthcare and an optimistic view of the future [1:11:30];
• The Price We Pay (Marty's new book), an attempt to illuminate the blackbox that is the US healthcare system [1:21:00];
• Why it's not always in the best interest of the insurance company to negotiate the best price [1:28:30];
• Who is actually paying for medical costs, and Marty's frustration with the healthcare lexicon [1:32:00];
• Pros and cons of a single payer system [1:37:00];
• How to fight outrageous medical bills and predatory pricing (and make a dent in the wasteful healthcare spending for the country) [1:49:30];
• Disrupting the healthcare industry with private healthcare facilities with market demanded transparency [2:05:45];
• The people hurt the worst by the current US healthcare system, the sad breast cancer statistic, and the importance of knowing that medical bills are negotiable [2:09:30];
• The healthcare industry bubble [2:14:00];
• Increased costs from unnecessary tests and procedures [2:16:30];
• Malpractice concerns due to the litigious culture in America: What influence does it have on unnecessary testing, healthcare costs, and overall quality of treatment [2:22:00];
• Drug pricing, price gouging, middle-men money games, kickbacks, and other drivers of healthcare costs [2:27:45];
• How can we possibly fix the healthcare system? [2:34:30];
• Helpful resources [2:46:15]; and
• More.

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

Today's episode of The Qualys is from podcast #02 – Rhonda Patrick, Ph.D.: the performance and longevity paradox of IGF-1, ketogenic diets and genetics, the health benefits of sauna, NAD+, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

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. If you're a subscriber, you can now listen to this full episode on your private RSS feed. You can also watch (or listen) to this full episode on our website at the AMA #8 show notes page. Questions continue to be pulled from the AMA section on the website, and any subscriber is welcome to submit questions for future AMAs. We discuss:

• 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.

Learn more: https://peterattiamd.com/ Show notes page for this episode:http://peterattiamd.com/ama08 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.

Today's episode of The Qualys is from podcast #04 – AMA #1: alcohol, best lab tests, wearables, finding the right doc, racing, and more.

The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for "qualifying round," which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., "fast"), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

Learn more: https://peterattiamd.com/podcast/qualys/

Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/

Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD

In this episode, Dr. Vamsi Mootha, an expert in mitochondrial biology and investigator at the Howard Hughes Medical Institute, shares his breadth of knowledge on the mitochondrion organelle: its history, function, genome architecture, and his research of rare mitochondrial dysfunction. Vamsi is currently focused on finding clinical treatments for the 300-some identified rare disorders, but in this work there is a wealth of potential implications in the context of longevity and chronic disease. In this conversation, Vamsi elucidates how the latest research could give insight into conditions related to aging, including but not limited to Alzheimer's disease, Parkinson's disease, insulin resistance and type 2 diabetes, cancer, and much more. We also explore some of the most exciting potential therapies for mitochondrial diseases such as hypoxia (oxygen deprivation), how exercise affects the mitochondria, the use of hyperbaric chambers for cancer therapy, and the mechanisms by which Metformin might confer longevity benefits in a non-diabetic individual.

We discuss:

• The Broad Institute of MIT and Harvard [8:00];
• Vamsi's academic background [10:30];
• Advice for college students and med students considering a career in medicine and/or medical research [15:30];
• Vamsi's focus on mitochondria and mitochondrial disorders [20:00];
• The mitochondrial genome: Lineage, endosymbiosis, and reductive evolution [23:15];
• How many diseases can be attributed to mitochondrial mutations? [28:45];
• Nuclear DNA and mtDNA: Roles, interaction, communication, and biogenesis [31:30];
• Which cells have the most mitochondrial DNA? And how often does mitochondria turn-over in a cell? [37:30];
• Does ALL of your mitochondrial DNA come from your mother? [40:00];
• Mitochondria 101: The powerhouse of the cell, electron transport chain, and the NADH/NAD ratio [44:00];
• NAD and NADH: Role in the mitochondria, decline of NAD levels with age, and what it means to age at a mitochondrial level [51:30];
• Mitochondrial diseases Vamsi studies in his lab [55:15];
• Mitochondria and oxygen: Poor oxygen utilization and excess oxygen contributes to the pathology seen in some of the rare mitogenic diseases [1:02:00];
• What VO2 max can tell us about mitochondrial function, insulin resistance, type 2 diabetes, and more [1:10:00];
• Can studying mitochondrial disease provide insights into the common forms of aging? [1:18:45];
• Could muscle cell inflammation (a signature of aging) be caused by mtDNA damage being confused as foreign bacteria? [1:22:00];
• Exercise and mitochondrial health: Is there an optimal exercise strategy to slow the aging process? [1:27:00];
• What autophagy means in the context of mitochondria [1:36:15];
• Metformin's impact on exercise and lactate levels [1:40:15];
• How might metformin confer longevity benefits? [1:48:15];
• Hypoxia as a potential therapeutic option for mitochondrial disease [1:52:45];
• Cancer prevention and treatment: hyperbaric oxygen chambers, targeting single carbon metabolism of the mitochondria, and more [2:00:00];
• Chronic diseases have altered mitochondria: Evidence for mitochondrial dysfunction causing Parkinson's disease [2:04:30];
• Why Vamsi is very optimistic about the possibility of targeting mitochondrial proteins as therapies [2:09:30];
• Is it theoretically possible to genetically engineer a better functioning mitochondria? [2:14:30];
• Vamsi's fantasy experiment in an unconstrained world [2:20:15]; and
• More.

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