The Peter Attia Drive

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.

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, Rick Doblin, founder and executive director of MAPS, discusses MDMA, a molecule that has (at a minimum) revolutionary therapeutic benefits for PTSD, but arguably could have, at the highest order, a lasting impact on humanity's ability to peacefully coexist. Rick details the history of MDMA, what lead to its unfortunate criminalization, and his lifelong work trying to protect MDMA (and other psychedelics) from criminalization (and his subsequent attempt to decriminalize it). Through his founding of MAPS, Rick has made enormous progress in debunking many of the exaggerated risks being claimed against MDMA (neurotoxicity, memory loss, depression, Parkinson's, etc.), and is very close to getting FDA approval for a psychotherapy technique using MDMA. Additionally, in this discussion, you will learn about the history of LSD, psilocybin, and other psychedelics and how the combination of the misunderstanding of them with the crackdown on drug use in the 1970s lead to their designation of schedule 1 substances. But it's important to note that you will also realize from this discussion just how different MDMA is compared to the average psychedelic. We end this discussion with a message of hope: there are going to be many people who are going to wonder what can they do to receive this MDMA therapy. We talk about what those clinical trials look like, what the enrollment looks like, and perhaps more importantly, what a compassionate use license would look like, such that if there are patients who are in need of this therapy (prior to its approval) they can have an understanding of the legal paths to doing just that.

We discuss:

• Discovering MDMA, how Rick learned about it and his first experiences with it [9:45];
• The timeline of MDMA's evolution, the reinvention in the 1970s, "ecstasy", the criminalization of MDMA [21:10];
• Explaining the different "schedules" of drugs [30:55];
• Rick's fight to protect it for therapeutic uses, losing to the DEA despite winning in the court, the scientific community, and the media [38:25];
• The risks involved with taking MDMA [42:30];
• An incredible MDMA-LSD case study: Rick's story of healing a treatment-resistant PTSD patient in the 1980s [44:45];
• How and why MDMA was declared illegal on an emergency basis going against the judge's recommendation after hearing Rick's compelling case (and multiple appeals) in court [57:15];
• Rick's decision to study politics to affect change from the inside out, and the recent progress being made with the DEA [1:07:00];
• Debunking the exaggerated risks of MDMA (e.g., neurotoxicity) [1:16:30];
• Rick's unbelievable ability to play the long game [1:28:45];
• Which patients would not be good candidates for MDMA from a safety perspective? [1:34:30];
• How MDMA is different from all other psychedelics, the importance of the setting, and Peter's experiences with MDMA [1:36:30];
• MDMA studies which lead to the crucial designation as a "breakthrough therapy" [1:40:30];
• How someone with PTSD can get treated now through "expanded access for compassionate use" [1:46:00];
• Rick's ultimate goal and long term vision for psychedelic clinics [1:50:30];
• Trip of Compassion documentary, and how psychedelics could change the world [1:52:30];
• Rick's early life: Resisting the draft, his feeling of wanting to change the world, and his profound experiences with LSD and other psychedelics [1:55:30];
• The history of LSD and psilocybin, and the CIA's interest in psychedelics [2:10:45];
• Timothy Leary and the Good Friday Experiment [2:22:00];
• Rick's follow up study to the Good Friday Experiment, and his criticism (and praise) of Tim Leary [2:33:50];
• Peter's experience taking psilocybin [2:44:30];
• The Concord Prison Experiment, and Rick's follow up study 34 years later [2:47:00]; and
• More.

Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/rickdoblin/ 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 episode, board-certified plastic surgeon, Zol Kryger, enlightens us about the frighteningly loose laws regulating the industry of plastic surgery, paving the way for a majority of cosmetic procedures being performed by doctors that are not board-certified plastic surgeons. We talk about some of the very serious complications that can occur even in "minimally invasive" procedures, where the incidence rate is only increased by the flood of non-certified doctors who want to offer these procedures to augment their income. Fortunately, Zol provides listeners with a very specific list of important questions to ask a surgeon when considering any of the many cosmetic procedures available. We then go into the specifics of the most common procedures and the risk of complications for each of them, including breast augmentation, tummy tucks, liposuction, Brazilian butt lifts, botox and fillers, facial peels and lasers, and more. By the end of this episode, you'll have a really clear understanding of what these risks are and how you can go about reducing those risks by choosing the right physician.

We discuss:

• Why Zol chose plastic surgery [7:30];
• The shockingly high percentage of plastic surgery being done by non-board certified doctors, and the laws that allow it to happen [11:20];
• 10 Questions to Ask Your Cosmetic Surgeon (PDF Download) [21:00];
• Complications: Why you must ask your doctor about potential complications and how they would deal with them [24:20];
• Zol's first complication, how he dealt with it, and how having a partner to check your work is great for the doctor and patient [32:30];
• Breast augmentation: What you need to know—types of implants, complication rates, and Zol's summary of the safest and most effective way to do it [39:10];
• Breast reconstruction following a mastectomy [1:06:30];
• Tummy tuck: How it's done, biggest risks involved, scarring, and how it can address hernias and diastasis [1:13:00];
• Liposuction: How it works, the potential complications and risks involved, and the importance of choosing the right doctor in the "wild west" of liposuction [1:26:45];
• Butt lifts: Rising popularity, major risks, the frighteningly loose laws regulating the industry, and how the butt lift industry is eerily similar to the subprime mortgage crisis [1:37:00];
• What is it about plastic surgery (and not other segments of medicine) that compels (and allows for) untrained doctors to offer these procedures? [1:49:45];
• Peter asks Zol if he ever feels emotionally conflicted working in an industry that sometimes can feed off the vanity and insecurity of people [1:56:25];
• Does Zol ever turn down patients? [2:02:45];
• The risks involved with botox, fillers, facial peels, and laser treatments [2:07:45]; and
• More.

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

We discuss:

• What can I do to prevent/reduce interruptions in sleep due to needing to get up to urinate at night? [3:00];
• Peter's note card system for organizing his to-do lists [7:15];
• 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? [11:15];
• 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.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, Keith Flaherty, director of clinical research and targeted cancer therapy at Massachusetts General Hospital, shares his vast wealth of knowledge in cancer starting with the history of treatment from chemotherapy to radiation to surgical therapy and where those methodologies seemed to have leveled off. He also walks us through the timeline of advancements (and lack there of) from when the War on Cancer was declared in the 1970s, through the sequencing of the entire human genome, and all the way to today. Keith dives into the topic of immunotherapy, probably the most exciting recent development in cancer therapy, and also provides us a rundown of his notion of a different approach to cancer that attacks all the essential pillars of cancer growth and survival. Finally, we talk a little bit about liquid biopsies, we discuss the roles of CRISPR and other potentially over-hyped therapies with respect to cancer. We also touch on stem cell therapy a bit, as well as some other common cancer-related questions such as the role of vitamin D and sun exposure in melanoma, and much more.

We discuss:

• Growing up around medicine, and finding a career that you love [7:30];
• Medicine as a career, limitations of the med school teaching approach, and the dynamic and accelerating field of medicine and technology [16:30];
• Explaining chemotherapy, radiation, and how a cancer develops [23:45];
• Surgical oncology, cure rate of solid tumors, and survival rate after tumor removal [33:15];
• 25 years after the War on Cancer is declared, gene sequencing, and why Keith's was fascinated by the HIV case study [37:15];
• Cancer immunotherapy: History, how it works, and why some cancers respond and others don't [46:00];
• MHC complexes, and cancer cloaking mechanisms [56:00];
• Comparative biology of cancer: Why some cancer can evade immune detection better than others [1:03:00];
• What we learned from the Cancer Genome Atlas Project [1:07:00];
• Defining targeted therapy, HER2 breast cancer, chronic leukemia, and the translocation of chromosomes [1:12:00];
• Tumor protein P53, the most famous tumor suppressor gene and its ubiquity in cancer [1:17:45];
• Activated oncogenes, the RAS pathway, PI3 kinase, RAF gene, and Keith's "aha moment" [1:24:15];
• Advice for starting your career as a scientist/clinician [1:37:00];
• Fusion-driven cancers, targeted therapy, and the Bcr-Abl/chronic myelogenous leukemia case study [1:39:45];
• Targeted therapy for fusion-driven solid tumors, adjuvant systemic therapy, and the HER2 breast cancer example [1:53:00];
• Advancing melanoma treatment, survival, and cure rates with BRAF-MEK combo therapy [1:59:15];
• The fundamental pillars of cancer growth and survival, and the toolkit we need to attack cancer from all angles [2:02:40];
• Peter's clinical framework for thinking about cancer and how Keith might improve it, and how the biotech environment is hampering our ability to put together novel cancer treatments [2:05:00];
• How useful is CRISPR in terms of tumor suppressing? [2:16:15];
• Liquid biopsies as a therapeutic monitoring tool [2:18:00];
• Stem cell therapy: The efficacy and potential risks [2:25:15];
• Aging and cancer: Is cancer inevitable? [2:28:45];
• Vitamin D supplements, sun exposure, melanoma, and exercise [2:32:30];
• How and why Keith has straddled the line between science/research and industry/drug companies, and the importance of getting more voices of practitioners at the table [2:42:00]; and
• More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this episode, radiologist/engineer, Raj Attariwala, explains how he was able to apply his engineering background to create a unique MRI scanner that is capable of constructing whole-body images with a resolution that is unmatched in the industry. Peter and Raj discuss the implications of such a robust, radiation-free imaging tool on the early detection of cancer. They dive deep into cancer screening and define terms such as sensitivity and specificity that are necessary to really understand this complex space. They then describe the biggest risks involved in this type of screening (false positives) and how Raj's unique technology and process might drive down this risk substantially. But before that, they discuss all the common imaging technology from X-ray, to CT scan, to PET scans, to ultrasound, to MRI, and more. They touch on the history of each, how they work, the usefulness and limitations of each of them, as well as the varying risks involved such as radiation exposure. If you are interested in cancer screening and/or you've ever wondered how any radiology tool works, this episode is for you.

We discuss:

• Raj's road from engineering to radiology [7:45];
• How X-ray works, the risk of radiation exposure, and the varying amounts of radiation associated with the different imaging technologies [18:00];
• Computed tomography scans (CT scans): The history of CT, how it works, and why we use contrast [27:45];
• Ultrasound: Benefits and limitations, and a special use for the heart [40:45];
• Detecting breast cancer with mammography: When is works, when you need more testing, and defining 'sensitivity' and 'specificity' [51:15];
• Magnetic resonance imaging (MRI): How it works, defining terms, and looking at the most common types of MRI [1:03:45];
• Brain aneurysms: Using MRI to find them and save lives [1:23:45];
• Raj's unique MRI technology [1:30:00];
• The risk of false positives in cancer detection, and how Raj's MRI can reduce the number of false positives (i.e., increase specificity) [1:43:40];
• The unique software Raj created to pair with his MRI machine [1:51:15];
• Comparing the radiation exposure of a whole-body PET-CT to Raj's equipment (DWIBS-MRI) [1:53:40];
• How diffusion-weighted magnetic resonance imaging (DW-MRI) has revolutionized cancer screening [1:55:15];
• Why a DW-MRI is still not a perfect test [1:59:00];
• The potential for advancing MRI technology: Where does Raj think it could improve in the next 5-10 years? [2:03:00];
• Are there any commercially available scanners that can match the resolution of Raj's images? [2:06:00];
• Machine learning: When and where might machine learning/AI impact the field of radiology? [2:08:40]; and
• More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

In this anniversary episode, Olivia, Peter's daughter who initially kicked off The Drive podcast with her sneak peek episode, returns to ask Peter the tough questions on how the podcast is going, what he has learned along the way (and how he plans to make it better), what exciting things are in store for the future, and plenty more.

In this episode, former World Series of Poker champion and author, Annie Duke, explains how poker is a pertinent model system for decision making in the real world, a system which blends imperfect information with some unknown percentage of both luck and skill. We go through the decision-making matrix, and how we spend most of our energy focusing on just one of the four quadrants at the expense of the learning opportunities that come from the other 75% of situations. Annie also shares how this evaluation of only the bad outcomes (and our tendency to judge others more harshly than ourselves in the face of a non-status quo decision), leads individuals, leaders, and teams to avoid bad outcomes at all costs. This avoidance is at the cost of the types of decisions which lead to progress and innovation both personally, and societally, across many realms from poker to sports to business to medicine. We also dive deep into a framework for learning, and the levels of thought required to rise to the top of a given domain. Finally, we talk about something that resonated deeply with me in terms of how I think about extending healthspan, which is the concept of "backcasting".

We discuss:

• Annie's background, favorite sports teams, and Peter's affinity for Belichick [7:30];
• Chess vs. poker: Which is a better metaphor for decision making in life (and medicine)? [12:30];
• Thinking probabilistically: Why we aren't wired that way, and how you can improve it for better decision making [18:15];
• Variable reinforcement: The psychological draw of poker that keeps people playing [25:15];
• The role of luck and skill in poker (and other sports), and the difference between looking at the short run vs. long run [38:00];
• A brief explanation of Texas hold 'em [47:00];
• The added complexity of reading the behavior of others players in poker [53:15];
• Why Annie likes to "quit fast", and why poker is still popular despite the power of loss aversion [58:30];
• Limit vs. no limit poker, and how the game has changed with growing popularity [1:01:00];
• The advent of analytics to poker, and why Annie would get crushed against today's professionals [1:10:30];
• The decision matrix, and the 'resulting' heuristic: The simplifier we use to judge the quality of decisions —The Pete Carroll Superbowl play call example [1:16:30];
• The personal and societal consequences of avoiding bad outcomes [1:27:00];
• Poker as a model system for life [1:37:15];
• How many leaders are making (and encouraging) status-quo decisions, and how Bill Belichick's decision making changed after winning two Super Bowls [1:41:00];
• What did we learn about decision making from the Y2K nothingburger? And how about the D-Day invasion? [1:46:30];
• The first step to becoming a good decision maker [1:48:45];
• The difference between elite poker players and the ones who make much slower progress [1:55:30];
• Framework for learning a skill, the four levels of thought, and why we hate digging into our victories to see what happened [1:58:15];
• The capacity for self-deception, and when it is MOST important to apply four-level thinking [2:06:15];
• Soft landings: The challenge of high-level thinking where there is subtle feedback and wider skill gaps [2:16:45];
• The benefits of 'backcasting' (and doing pre-mortems) [2:19:30];
• Parting advice from Annie for those feeling overwhelmed (and two book recommendations) [2:28:30]; and
• More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

• Comparing scientific disciplines: Medicine and biology versus physics [7:25];
• The limitations of evidence-based medicine [12:30];
• Early signs of metabolic disease: How specializing kidney disease gives Jason a unique insight into early indications of illness [20:50]
• Insulin resistance, hyperinsulinemia, and the overflow paradigm [29:30];
• Why the common treatments for type 2 diabetes seem to make things worse [42:30];
• How hyperinsulinemia (not insulin resistance) drives metabolic syndrome [53:15];
• Insulin and weight gain, and using fasting to empty the cells of glucose [59:30];
• The two step process of developing type 2 diabetes and how they are both manifestations of hyperinsulinemia [1:03:15];
• NAFLD and hyperinsulinemia: A vicious cycle [1:08:30];
• Are the features and symptoms of diabetes actually protective? [1:12:15];
• Is obesity causing insulin resistance or is it the other way around? [1:17:30];
• What role does inflammation play in obesity? [1:21:45];
• CVD and cancer: Diseases of too much growth? [1:27:30];
• How to reduce proliferation with rapamycin, nutrition, exercise, fasting, and manipulating hormones [1:32:45];
• Getting patients to fast: How Jason and Peter utilize fasting in their practice, and how their approach differs [1:40:15];
• Comparing bariatric surgery to fasting as a treatment for type 2 diabetes [1:48:00];
• Why people think that fasting is bad for you [1:55:15];
• Time-restricted feeding and intermittent fasting: Defining terms, and how Jason applies them in his practice [1:58:30];
• A fasting case study: A diabetic patient with a non-healing foot ulcer [2:04:00];
• Keys to a successful fast [2:12:45];
• Muscle loss during fasting, and why Jason isn't worried [2:24:45];
• Will fasting help a healthy person live longer? [2:31:30];
• Does fasting cause gallstones? [2:38:45]; and
• More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.

• Matthew's TED Talk, and his favorite public speakers [7:45];
• How good are the current sleep trackers like Oura, Fitbit, etc.? [10:45];
• Is it bad to eat food too close to bedtime? [15:30];
• How does exercise impact sleep? [17:30];
• How is appetite affected by our sleep quality? [21:30];
• Anxiety, cortisol, and weight gain: An awful feedback loop of sleep deprivation [23:30];
• How to optimize your wind down routine: lights, temperature, & relaxation [26:10];
• How alcohol disrupts sleep (and contributes to Alzheimer's disease) [46:00];
• Sleep's impact on sex hormones, and romantic relationships [50:00];
• Performance, accuracy, and minimizing the damage of shift work [55:30];
• Bed partners: How to sleep in separate beds and retain a good relationship [59:30];
• Can we use sound machines and electrical stimulation to improve sleep? [1:02:40];
• Will we ever be able to "supercharge" our sleep stages using technology? [1:08:30];
• Why sleep is the best insurance policy for lifespan and healthspan [1:11:45];
• Melatonin: How (and how not) to use it for sleep improvement [1:19:00];
• The dangers of sleeping pills, useful alternatives, and cognitive behavioral therapy for insomnia [1:28:30];
• Can CBD and THC be used for sleep? [1:43:30];
• Why haven't we been able to develop a really effective sleeping aid? [1:50:40];
• Can you get too much sleep? [1:55:50];
• What to do (and not do) immediately following a terrible night of sleep? [2:09:15];
• Why a consistent wake up time is king [2:14:30];
• Does poor sleep speed up the aging process? [2:16:00];
• Can different people be more (or less) resilient to sleep deprivation? [2:22:50];
• Finding your optimal sleep schedule and determining your sleep chronotype [2:27:45];
• Defining sleep efficiency and how to improve it [2:33:25];
• Correcting insomnia: A counterintuitive approach [2:35:45];
• How can parents improve the sleep of their kids? [2:41:30]; and
• More.

Learn more at www.PeterAttiaMD.com Connect with Peter on Facebook | Twitter | Instagram.