The Peter Attia Drive

In part 2 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the preponderance of evidence linking poor sleep to cardiovascular disease, cancer, and sexual function. He also details the impact of cortisol on our nervous system contributing to sleep disturbances and insomnia as well as the efficacy and risks associated with the most common sleeping pills. Matthew also describes the sleep needs of teenagers and urgently lays the case that we should reconsider school start times. We also get into the effect of electronics at night, the efficacy of napping, the general impact of modern society on our sleep habits, and what changes we can make to course correct.

We discuss:

• Sleep and cardiovascular disease [6:00];
• Fuel partitioning and dieting while sleep deprived [16:45];
• Sleep and the reproductive function: testosterone, sperm count, FSH, menstrual cycles, and fertility [19:45];
• The biological necessity of sleep, the lack of a "safety net", sleep debt, and ways to course correct sleep problems [23:45];
• Fighting cancer and improving immune function with sleep [34:30];
• The medical profession: A culture that devalues sleep [47:30];
• The sleep needs of children, the travesty of early school start times, electronics at night, and advice for parents [1:04:45];
• How exposure to light affects sleep, and how modern society has changed our sleep habits [1:26:15];
• Is napping helpful? [1:36:00];
• The effect of cortisol levels on sleep [1:41:15];
• Are sleeping pills doing more harm than good? [1:52:15]; and
• More.

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In part 1 of this 3 part series, Matthew Walker, professor of neuroscience at UC Berkeley and expert on sleep, describes the different stages and cycles of sleep, including what he calls the 4 pillars of sleep, and how they contribute to memory consolidation and numerous important pathways to mental health. We also get into the dangers of chronic sleep deprivation, such as the development of dementia, and the more acute dangers of sleep deprivation like fatal car crashes which are most often caused by drowsy driving. We also discuss the different and important roles of REM vs. non-REM sleep, and the impact that bad sleep habits can have specifically on those sleep stages.

We discuss:

• Matthew's background and interest in sleep [6:03];

• Sleep and Alzheimer's disease, and the 4 pillars of sleep [12:18];

• Stages of sleep, sleep cycles, and brain waves [41:18];

• Memory and sleep, and the risk of insufficient REM sleep [55:48];

• Evolutionary reasons to sleep [1:02:03];

• The early riser vs. the night owl, and tips for overcoming jet lag [1:10:18];

• Is there one type or stage of sleep that is most important? [1:17:33];

• The dangers of drowsy driving [1:28:48];

• The timeliness of Matthew's book, and how the conversation of sleep has changed over the past several years [1:35:18]; and

• More.

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In this episode, Chris Masterjohn, entrepreneur, independent researcher, and doctorate in nutrition, elucidates the latest research on the risk and benefits of NAD supplements, and shares his personal intuition on the topic. We also dive deep into choline deficiency and its role in the rising prevalence of nonalcoholic fatty liver disease. From there, Chris enlightens us on the importance of methylation, a simple yet profoundly important biochemical process affecting our physical and mental health. He also describes the variations of the genes MTHFR and COMT, enzymes which play important roles in methylation and which have profound impacts on our well-being.

We discuss:

• Chris's background, falling in love with biochemistry, and decision to pursue research over medicine [7:45];
• Choline: what it is, why it is important, and how a deficiency can cause non-alcoholic fatty liver disease [11:45];
• NAFLD: increasing prevalence and potential causes [25:00];
• TMAO: Should we be worried about the TMAO content in choline and our foods? [39:15];
• Types of fatty acids: How they may predispose us to different types of illnesses [53:30];
• Why don't we see low VLDL in patients with NAFLD? [59:45];
• Understanding flux, and how machine learning may affect medicine in the near future [1:03:15];
• NAD: How it works, supplements, sirtuins, and the central role of the liver [1:09:30];
• Intravenous NAD [1:33:00];
• Oral NR: Is it the optimal way to get more NAD? [1:38:30];
• What is the possible harm of taking an NAD precursor? [1:47:15];
• The MTHFR gene [1:49:45];
• The methylation pathway [1:58:15];
• The COMT gene [2:04:30];
• Creatine: The uses and benefits and its important role in methylation [2:10:15];
• Dietary strategies for MTHFR: choline, creatine, folate, and glycine [2:16:45];
• How to mitigate the negative effects of NAD supplements [2:23:45];
• A case study of a person with high homocysteine [2:28:00];
• What is the level of evidence that you need to take action? [2:32:15];
• Does Chris supplement with NAD precursors? And can it improve symptoms of rosacea? [2:35:45];
• Decision making in the face of inconclusive data, and trying to disentangle the placebo effect [2:39:00];
• What does Chris believe to be true that very few people would agree with him about? [2:43:15];
• How to follow Chris's work [2:48:45]; and
• More.

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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.

As a reminder, AMAs are for subscribers only. If you want to subscribe, you can learn more about the benefits at https://peterattiamd.com/subscribe. If you are a subscriber, you can watch or listen to this in full on the show notes portion of our website. If you are listening to this on a podcast player, you will hear a sneak peek of this AMA and then will have to finish listening or watching on the website.

All questions are pulled from the AMA section on the website (https://peterattiamd.com/ask-me-anything/). Any subscriber is welcome to submit questions.

We discuss:

• 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.

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In this episode, Jeremy Schaap, preeminent journalist at ESPN, discusses two of the most incredible upsets in boxing history, both of which Jeremy has expertly covered during his illustrious career, most recently culminating in the 30 for 30 special, 42 to 1. We also discuss his infamous Bobby Knight interview, his coverage of the doping scandals in baseball and cycling, as well as the pressures of following in his father's enormous footsteps who taught him the importance of fairness in journalism. Additionally, we discuss the deeper meaning of sports, what it teaches us, and how he uses sports as a platform to bring light to greater societal issues.

We discuss:

• Jeremy and Peter's shared obsession with boxing history [5:15];
• Cinderella Man: The incredible upset of Max Baer by James Braddock, and the rise of the great Joe Louis [9:00];
• 42 to 1: Buster Douglas beats Mike Tyson for one of the most unlikely upsets in the history of sports [23:30];
• Contrasting fighting styles from "destroyers" to "artists", and comparing the auras of the all-time greats [36:30];
• Mike Tyson's take on the Douglas fight, what went wrong for Buster Douglas following his victory, and other incredible upsets in sports history [45:30];
• Ranking the greatest boxers since the 1960s [54:00];
• Jeremy's famous Bobby Knight interview: A career defining moment [57:00];
• The pressures of following his father's career path, and what it means to be a fair journalist [1:01:30];
• The meaning of sports: how it brings us together and gives us a platform for bigger discussions [1:11:00];
• Jeremy's biggest regret in reporting, the 1998 home run chase, and the doping scandals of baseball and cycling [1:17:30];
• The biggest and most underreported stories in sports [1:26:45];
• Best 30 for 30 episodes: Jeremy and Peter pick their favorites [1:31:30];
• Baseball: Steroids and the hall of fame [1:34:30];
• Final thoughts on what makes sports so special [1:37:45]; and
• More.

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In this episode, Alan Bauman, certified hair transplantation surgeon and hair restoration expert, discusses both male and female pattern hair loss, the science behind what drives it, and what that tells us about prevention and restoration. Having treated over 20,000 patients, Alan shares his invaluable insights into what works and what doesn't in terms of the non-surgical treatment options. We also go into great detail about the more invasive approaches like PRP, and of course, hair transplantation, a procedure which Alan has refined over the years into a proprietary method that seems to produce unbelievable results. Additionally, Alan provides tips for maintaining scalp health, which is vital for hair growth, as well as the importance of choosing a hair specialist who has the tools, expertise, and patience to develop a compassionate and encompassing approach to hair restoration.

We discuss:

• Alan's unique path, and how he became interested in hair transplantation [7:15];
• The prevalence of hair loss, types of hair loss, and the different patterns in men vs. women [15:45];
• The role of genetics in hair loss, and when does it start [19:00];
• Female hair loss: the role of hormones, pregnancy related hair loss, and what it means to have thinning and shedding [22:30];
• Primary drivers of male hair loss, finasteride as a treatment, and the potential side effects [26:15];
• Common treatments - Proscar, Propecia, Rogaine, and more - how they all came about and what you need to know [29:45];
• Primary drivers of female hair loss, potential treatments, and the different types of hair follicles [33:15];
• What are some of the unproven/snake oil methods of hair treatments being pushed to the public? [37:15];
• Preventative steps to take if you're worried about future hair loss [42:00];
• Medications that may negatively affect hair quality [45:30];
• The importance of seeing a hair specialist [47:15];
• Impact of scalp health and inflammation on hair growth, how to pick and apply shampoo and conditioner, and how to avoid and treat hair breakage [50:15];
• Treatment options - finasteride, minoxidil, laser caps - how they work and what you need to know [57:15];
• PRP treatment: How it works, details of the procedure, and Alan's proprietary protocol [1:11:45];
• The hair transplant procedure [1:29:30];
• Risks involved with a hair transplant procedure [1:44:00];
• Is a donor hair susceptible to the forces of the implant site that caused the hair loss? Can a hair follicle grow anywhere on the body? [1:47:45];
• Age appropriate procedures, how far the field has come, and why Alan loves his work [1:51:45]; and
• More.

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In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women's Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease, neurodegenerative disease, and osteoporosis, to name a few.

We discuss:

• The background of Carol and Avrum, and the impetus for writing Estrogen Matters [8:45];
• The sad early history of hormone replacement therapy, treatments for prostate and breast cancer, and the difference between the treatment of women vs. men [14:00];
• What hormones do, and why they drop off rapidly in women compared to gradually in men [20:15];
• Mistreatment of women leading to great skepticism [23:45];
• Breast cancer vs heart disease: Comparing the incidence and mortality in women [27:00];
• Case studies of women suffering symptoms of menopause [30:00];
• What are Carol and Avrum's true motivations in this endeavor? [32:45];
• The changing perceptions of HRT, the impact of the Women's Health Initiative (WHI), and the problems with the WHI [37:45];
• Is this one big conspiracy? The uncanny resemblance of the story of HRT and how the dietary guidelines were created [46:00];
• Why people (falsely) think estrogen causes a 25% increase in breast cancer, and a lesson in absolute vs. relative risk [57:15];
• The truth about progesterone and cancer risk, and the best types of estrogen and progesterone to be taking [1:09:00];
• The Women's Health Initiative: the reported findings, walking back their bold claims, and their hesitance to admit they were wrong [1:17:45];
• Brain benefits of HRT, Alzheimer's disease in women, and estrogen as a preventative treatment for AD [1:22:45];
• The impact of HRT on heart disease, the ideal time to start HRT, and the risks associated with HRT [1:26:45];
• The benefits of estrogen on bone health, and the incidence and mortality of hip fractures [1:33:15];
• Colon cancer: Can HRT reduce the risk of colon cancer? [1:38:15];
• Diabetes: Can HRT reduce the risk of developing diabetes? [1:40:30];
• The downsides of hormone replacement therapy (HRT) [1:41:30];
• How to approach your doctor who may already have a very strong point of view about HRT [1:42:15];
• What kind of research needs to be done to answer the remaining questions about the benefits and risks of HRT? [1:48:30];
• Cancer: Our evolving understanding and the future of treatment [1:59:15];
• Welcoming the critics: Avrum and Carol want to start a conversation [2:02:00];
• Are there racial differences in benefits and risks with HRT? [2:04:15];
• The reactions to Estrogen Matters, and why it is a must read [2:09:15];
• HRT after a diagnosis of breast cancer [2:13:45]; and
• More.

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In this episode, Jake Kushner, pediatric endocrinologist specializing in helping people with type 1 diabetes, discusses the best strategies to live and thrive with T1D, especially as it relates to diet and exercise. We also discuss why many patients who control their blood sugar with high amounts of exogenous insulin are at a substantially higher risk than people who can control their blood sugar at lower levels of insulin. This concept has great implications for non-diabetics as well considering the increasing prevalence of diseases related to insulin resistance. We also cover some of the basics, the history, the increasing prevalence of type 1 diabetes, and more importantly, what we can do to help kids with this disease, and their families. We discuss:

• How Jake became interested in type 1 diabetes [5:30];
• The pathophysiology of type 1 diabetes, the increase in prevalence, and the role of beta cells [17:00];
• The role of body weight and BMI in the risk of developing T1D [27:00];
• Genetics of T1D and the risk of inheritance [32:00];
• Hemoglobin A1c [36:15];
• Insulin: the amazing story of its discovery, its effect on cellular metabolism and IGF-1, and why the hell it's so expensive [39:15];
• Diabetes Control and Complication Trial: blood glucose and the complications associated with diabetes [54:45];
• Cognitive impairment, epigenetic changes, and other dangers associated with high, peak blood glucose, and big swings in blood glucose levels [1:09:15];
• Depression, anxiety, and other challenges of living with T1D [1:15:30];
• Jake's realization that the current standard of care of T1D is inadequate [1:26:15];
• Managing diabetes with exercise [1:30:15];
• The Bernstein method, and protein's impact on glucose and insulin [1:36:15];
• Jake radically changes his approach to treating patients [1:45:00];
• What other tools are there for controlling T1D? [1:49:45];
• Is the ketogenic diet appropriate for those with T1D? [1:52:45];
• The most important lessons that can be applied by the non-diabetic population [1:59:00];
• The two dream measurements Peter wishes were available [2:04:00]; and
• More.

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In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast the ubiquity of chronic disease and self-harm in the west, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who despite their suffering, live so harmoniously, happily, and resiliently. To support Tom's mission please visit www.amhf.us.

We discuss:

• Background, medical training, and early days of missionary work in Africa [9:00];
• Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [15:45];
• Learning surgery on the job and earning the trust of the community [40:45];
• The amazing people of Nuba, and why Nuba feels like home to Tom [51:30];
• NY Times article about Tom's work, and Tom's new venture on the board of Aurora Prize Foundation bringing awareness and funding to other missionaries doing great work [1:03:30];
• Tom's mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:15:45];
• The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:23:30];
• The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:33:30];
• The logistical challenge of helping Tom's hospital, and what Tom really needs [1:39:15];
• Diseases in the adult population [1:42:30];
• Living without possessions, finding meaning, and being a missionary [1:59:30];
• Sense of purpose, happiness, and suicide: Contrasting the US with Nuba [2:11:00];
• Other than donations, is there a way people can help Tom and other similar causes? [2:19:15];
• The food in Nuba [2:22:30];
• Tom's annual bout of malaria [2:27:30];
• Patients that Tom will never forget [2:29:45];
• Resources for people wanting to get involved in helping Tom's work [2:34:45];
• Peter tells a story that defines Tom [2:36:00]; and
• More.

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In this episode, Ted Schaeffer, Professor and Chair of the Department of Urology at Northwestern (youngest chairman in the country), presents the roadmap for the best way to screen for, and treat, prostate cancer. We also get into the "mass screening" controversy and all the risks involved with treatment. In addition, we discuss our evolving understanding of cancer and the most exciting areas of research to come.

We discuss:

• Ted's unique path to get his PhD [5:15];
• The exciting transition in science during Ted's PhD in the 1990s [15:30];
• Ted's advice to MD-PhD students, and why he choose urology and Johns Hopkins [23:45];
• History of prostate surgery, and Pat Walsh's legendary work in prostate cancer [36:15];
• Prostate surgery and the risks involved with treatment [53:00];
• Screening for prostate cancer [58:00];
• The "mass screening" controversy [1:12:45];
• Biopsies and MRI: important things to know [1:25:30];
• Why urology such a great field of medicine, and why Peter wants a goat [1:34:45];
• Ted's work with Ben Stiller [1:39:00];
• Gleason grading system [1:43:45];
• Testosterone, DHT and the prostate cancer controversy [1:53:15];
• The metabolism of the prostate [2:03:00];
• The most exciting areas of research in prostate cancer [2:08:00];
• Benign issues involving the prostate: pelvic pain, infections and treatments [2:11:15];
• Video of Ted's surgeries, the latest technology, and males contraceptive options [2:18:00];
• Watches and cars [2:23:30]; and
• More.

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