The Peter Attia Drive

In this episode, Mark and Chris Bell discuss their love of powerlifting, their unbelievable personal records, and what prompted the making of their now iconic film, Bigger, Stronger, Faster. They also very openly discuss steroid use, their tragic family history with addiction, the many inspirations that lead to their multifaceted success, and their dedication to having a positive impact on others in fitness and life.

We discuss:

• The impact of Bigger, Stronger, Faster, how it got made, and how it challenged Peter's set of beliefs regarding steroids [4:45];
• Chris's personal story of addiction and how he's using his experience to help others [17:30];
• Importance of sharing your struggle, and the danger of comparing yourself to others [28:00];
• Early life, their love of pro wrestling and what motivated Brothers Bell to be great? [33:45];
• How they got started lifting weights, powerlifting vs Olympic lifting, and personal records [43:30];
• Lifting weights: the importance of challenging yourself, how to avoid injury, monitoring progress, and staying motivated [1:02:30];
• Chris on how changing his diet changed his performance and life [1:09:15];
• Best resources for those wanting to get started lifting weights effectively and safely [1:14:00];
• Teaching kids strength training early in life, the negative impact of sitting and how we can minimize it [1:18:30];
• Benefits of bodybuilding, Mark's prep for his first competition, and the role of the ketogenic diet [1:27:15];
• The steroid controversy: Mark's use of them and Peter's perspective [1:42:15];
• Testosterone: Peter's approach to improving it in patients, and the impact of sleep, cortisol, and statins on production [1:51:00];
• Upcoming nutrition documentary [2:03:00];
• Parting advice from Mark [2:05:00];
• Kratom, a powerful plant with the potential to help opioid addiction and more [2:06:15];
• The many resources and ways to follow Mark and Chris [2:07:45]; and
• More.

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In this episode, David A. 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, provides insight into why we age and how to slow its effects based on his remarkable work on the role of sirtuins and NAD in health and diseases. He also presents the case that stabilizing the epigenetic landscape may be the linchpin in counteracting aging and disease.

We discuss:

• How and why David moved from Australia to Leonard Guarente's lab at MIT [7:30];
• Sirtuins and aging [15:00];
• A series of experiments elucidating the mechanisms of sirtuins [20:45];
• How are sirtuins activated? [25:30];
• NAD and sirtuin activation [31:00];
• Nicotinamide, sirtuin inhibition, andPNC1 [39:00];
• Resveratrol [43:00];
• The NIH/ITP studies on resveratrol [55:45];
• Does David take any compounds for longevity? [1:00:15];
• NAD precursors (NR, NMN) and pterostilbene [1:02:45];
• Female fertility and NAD precursors [1:14:45];
• A unifying theory of aging [1:20:30];
• Waddington's epigenetic landscape [1:23:00];
• If David had unlimited resources, what is the experiment he would do? [1:28:25];
• Testing combinations to extend lifespan [1:31:30];
• What made David aware of his mortality at such a young age? [01:33:45];
• What is David's book going to cover? [01:37:15]; and
• More.

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In this "Ask Me Anything" (AMA) episode, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter's head analyst, asks the questions.

This also marks the first video release of the podcast. You can find it on YouTube (https://youtu.be/kzs7GgxR_FQ) and the website (peterattiamd.com/ama03).

If you have any questions for the next AMA, please submit them to the AMA section on the website (peterattiamd.com).

We discuss:

• What references ranges does Peter consider too broad on lab tests? [5:30];
• What aspect of women's health is the least studied/understood? [21:15];
• What are your thoughts on fasting and ketosis for females? [31:30];
• Advice for medical students and residents, how to get through it, and optimize their time while in med school [38:00];
• What is Peter's opinion on the best way to monetize a podcast to make it sustainable? [47:45];
• What are you looking to achieve and monitor with your blood glucose monitor? [57:15];
• Thoughts on lithium supplementation? [1:08:15];
• Insights about berberine? [1:16:00];
• Why does Peter take a baby aspirin? What does the science say? [1:19:20];
• How do you use HR variability as a metric in your practice and/or in your own personal use? Sleep, pre/post exercise, pre/post eating, every morning readiness? [1:23:25];
• With the emergence of "the coconut oil is pure poison" article, can you shed some light on saturated fat in the literature and the types of studies done specifically on coconut oil? [1:38:45];
• Would you discuss the recent meta studies that claim that moderate carbohydrate intake may be best for health? [1:40:45];
• What is the number one recommendation/habit you would suggest every person add to their daily regimen (besides physical activity) for wholesome health? [1:42:45];
• What does it mean if your body has a harder time getting into ketosis via fasting than it used to (testing using a Precision Xtra)? [1:44:15];
• Why are you taking Zetia and Lipitor? Are you mitigating risk based on your APOE4? Or is there something else going on? [1:46:10];
• What will your book be about and what is the expected release date? [1:47:45];
• What are your thoughts on nicotinamide riboside supplementation for longevity? [1:49:30];
• Which brand of supplements have you found to be effective? [1:54:30];
• Are you currently accepting new patients? And how do I find a 'Peter Attia clone' in my area? [1:56:20];
• Bob's personal experience with Peter as a doctor [1:58:45];
• Can you tell us more about the latest and best of APOE4? [2:06:15]; and
• More.

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We discuss:

• How Scott and Peter met [3:45];
• Scott's tragic family story that shaped his life and altered his trajectory [8:00];
• High school years, rebellion, and music [30:30];
• Life as a club promoter, drug use, soul-searching, and a change of heart [41:30];
• Mercy Ships [1:15:00];
• The amazing transformations of Mercy Ships and the parallels to his own transformation [1:28:00];
• Leveraging the art of storytelling to raise money and awareness while fighting temptations to fall into his previous life [1:33:30];
• Discovering the water crisis that lead to charity: water [1:46:45];
• How the lack of trust in nonprofits can cripple charities [1:54:00];
• The four pillars of charity: water that helped it overcome the stigma of nonprofits and become successful [2:01:00];
• Where to learn more about Scott's work and charity: water [2:12:30];
• Scott's book recommendations [2:14:30]; and
• More.

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In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part V, Peter and Tom talk about inflammation, endothelial health, and oxidative stress as they pertain to cardiovascular disease, and our attempts to monitor them using biomarkers. They also discuss a couple of very important risk factors that too few people (and doctors) know about. Tom closes the five-part series with a tragic story about his good friend that is likely all-too-common for many practicing physicians, that both haunts and motivates Dr. Dayspring to learn as much as he can about the number one killer in the United States.

We discuss:

• Lp(a) [2:30];
• Inflammation [17:15];
• Oxidative stress markers: Lp-PLA2 and oxLDL [20:45];
• Endothelial health markers: ADMA and SDMA [34:30];
• Remnants [43:45];
• Omega-3 fatty acids (EPA and DHA) and apoC-III [55:30];
• Red blood cells and cholesterol transport [1:07:45];
• Tom's friend Earl [1:10:00];
• Peter's friend JP [1:18:15]; and
• More.

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In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part IV, Peter and Tom review the history and current use of drugs to prevent cardiovascular disease. They also discuss why some drugs appear to be more effective than others, an in-depth conversation about niacin, cholesterol and brain health, and the futility of using CKs (creatinine kinase) and liver function tests to identify adverse effects in statins, to name a few topics in this episode.

We discuss:

• Bile acid sequestrants and statins [2:00];
• Ezetimibe (Zetia) [15:00];
• PCSK9 inhibitors [27:30];
• Fibrates [41:00];
• Fish oil, DHA, and EPA [1:01:00];
• Niacin [1:05:15];
• PCSK9 inhibitors [1:23:45];
• Cholesterol, statins, and the brain [1:30:00];
• Elevated creatine kinase (CK) and liver function tests (LFTs) on statins [1:50:30]; and
• More.

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In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part III, Peter and Tom dig into HDL, why "reverse cholesterol transport" is a lot more nuanced than what most of us are taught, lipid transport, apolipoproteins, and more. In addition, this episode highlights the complexity of HDL and a discussion about the CETP inhibitor trials.

We discuss:

• Reverse cholesterol transport [1:40];
• Lipid transportation, apolipoproteins, VLDL, IDL, and LDL particles [11:00];
• Remnant lipoproteins and apoC-III [16:45];
• Particles having sex: lipid exchange [28:00];
• Cholesteryl Ester Transfer Protein (CETP) and CETP inhibitors [40:45];
• 2006 CETP inhibitor trial: torcetrapib (Pfizer) [54:45];
• 2012 CETP inhibitor trial: dalcetrapib (Hoffmann–La Roche) [56:15];
• 2017 CETP inhibitor trials: evacetrapib (Eli Lilly) and anacetrapib (Merck) [58:00]; and
• More.

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In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part II, Tom provides a 101 on lipids and lipoproteins. Tom and Peter also discuss the history and techniques used to measure lipoproteins, and more. We discuss:

• Lipoprotein basics [1:30];
• Gofman and the ultracentrifuge [5:15];
• Lipoprotein structure, function, metabolism [6:45];
• Lipoprotein and cholesterol measurement, and NMR technology [15:15];
• LDL-C vs LDL-P and apoB [30:45];
• Sterols and cholesterol synthesis [39:45]; and
• More.

Learn more at www.PeterAttiaMD.com

Connect with Peter on Facebook | Twitter | Instagram.

In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. Part I serves as an introduction to Tom, his work, and an overview of lipid terminology.

We discuss:

• Tom's recent and remarkable physical transformation [6:30];
• The moving stories behind Tom's obsessions: firefighting, hockey, and, of course, lipids [20:30];
• Tom's medical background [39:30];
• Producing some of the most accessible diagrams on lipids [50:00];
• What are the different kinds of lipids, what do they do, and how are they transported? [57:15]; and
• More.

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In this episode, Dave Feldman, discusses his journey from software engineer to n=1 experimenter, his experience with low-carbohydrate diets, and his hypothesis that cholesterol levels are influenced by energy metabolism.

We discuss:

• Peter's synthesis of Dave's energy model [5:00];
• Dave's journey from software engineer to cholesterol enthusiast [15:00];
• Standard blood panels, sterol panels, and what moves the needle when it comes to particle numbers [18:30];
• Hyper-responders [20:00];
• Lipoprotein transport [33:45];
• The lean mass hyper-responder phenotype [47:30];
• The progression of atherosclerosis, CAC, and CIMT [52:30];
• Testing for oxidized LDL [55:30];
• All-cause mortality and clinical endpoints [1:01:15];
• What does "LDL as causal" mean? [1:05:15];
• Dave's low carb cholesterol challenge and drug & genetic study qualifications [1:13:15];
• If all other markers are in an healthy range, but LDL-P is high, is the patient at risk? A couple of case studies, and a self-experiment [1:27:30];
• Peter's three-day exercise and ketosis experiment [1:41:00];
• What are remnant lipoproteins? [1:45:00];
• What might cause lean mass hyper-responders to have higher LDL particle numbers? [1:53:30];
• A case study from Dave of a lean mass hyper-responder [1:56:30];
• Mass balance and cholesterol flux [2:05:30];
• Can a higher degree of cholesterol explain the lean mass hyper-responder phenotype? [2:10:00];
• Peter's LDL during his keto-fast-keto experiment [2:13:30];
• Does substituting saturated fats with monounsaturated fats lower LDL-P and LDL-C? [2:15:45];
• Dave's carb-swap experiments [2:22:15];
• Dave's carotid intima-media thickness tests [2:41:15];
• Looking for studies that stratify for high HDL-C and low TG alongside low and high LDL-C [2:53:00]; and
• More

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