The Peter Attia Drive

In this episode, Richard Isaacson, a neurologist and director of the Alzheimer's Prevention Clinic at Weill Cornell Medicine and NewYork-Presbyterian, discusses strategies for staving off Alzheimer's disease. Richard shares a wealth of insight for people who want to know more about Alzheimer's and what you can do to help yourself and your loved ones – starting today and continuing throughout the entire lifespan.

• Richard's fun-facts (and alter egos): "bling" phones, Doogie Howser, and DJ Rush [8:00];
• Richard's impetus to focus on Alzheimer's disease: Uncle Bob [18:20];
• Starting an Alzheimer's Prevention Clinic [27:00];
• How Alzheimer's is diagnosed [30:00];
• Short-term memory, processing speed, executive function and how they're tested [35:45];
• Prevention vs reduction of Alzheimer's [44:00];
• What is the prevalence of Alzheimer's in America? [49:30];
• How do people actually die from Alzheimer's or dementia? [51:30];
• How can people do everything right and still get Alzheimer's? It's all about AGE [55:15];
• The APOE gene [58:15];
• Why is the risk of Alzheimer's higher for women? [1:13:00];
• How many different paths lead to Alzheimer's? [1:15:45];
• What role does MTHFR play in Alzheimer's? [1:19:45];
• What are the "ABCs" of Alzheimer's prevention? [1:26:45];
• Baptists, Tauists, Syners, and Apostates [1:36:30];
• Concerns with statin use for high-risk patients [1:45:00];
• The use of Theracurmin [1:48:45];
• What are the five actionable things one can do to reduce the risk for Alzheimer's today? [1:54:30];
• The cognitive reserve [2:14:15]; and
• More.

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In this episode, ultra-endurance athlete and entrepreneur, Mike Trevino, discusses the lessons he's learned from his remarkable athletic feats, and the training required to reach them. Not only is Mike's advice practical for those looking to take their endurance training to the next level, but his lessons and insight are extraordinarily applicable to living everyday life.

We discuss:

• Mike's background, his crazy birthday tradition, and his transition from power to endurance [6:30];
• Mike's breakthrough year: setting a course record, and completing the Badwater 135 [16:00];
• Race Across America (RAAM), perseverance, and extreme sleep deprivation [25:30];
• Mindset, nutrition, fasting, and other advice from Mike for those looking to take the next step in their training [49:00];
• What getting a parasite taught Mike about fasting [59:45];
• The risks involved with cycling [1:03:00];
• Mike setting the trans-Iowa (RAGBRAI) record [1:10:15];
• PEDs, stimulants, and their effect on performance [1:15:00];
• What motivates Mike (and others) to do this extreme stuff? What led him to eventually pull back? [1:22:00];
• Life-lessons learned from training, and how to impart them to his kids, and others [1:35:30];
• The greatest beer in the world remains a mystery [1:46:15]; and
• More.

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In this bonus episode, Peter and med school colleague (and brilliant psychiatrist) Paul Conti reminisce on their favorite moments in Formula 1 history, their deep admiration for the late Ayrton Senna, and the remarkable careers of their all-time favorite drivers. Paul also helps to illuminate the psychological components that made the luminary drivers great, and the cautionary lessons we can take from their incredible lives.

We discuss:

• Ayrton Senna [3:45];
• How Senna's death changed the sport [9:50];
• The 80s & 90s: a remarkable era of Formula 1 [12:55];
• Hypothesizing what caused Senna's fatal crash [17:45];
• Comparing Stewart and Senna, their incredible bravery, and what lessons we can learn from them [23:30];
• Best documentaries on racing, and some of Senna's best moments [31:00];
• Gilles Villeneuve, Stefan Bellof, and some of the other greats [39:15];
• Why Senna is widely acknowledged as the best of all time [46:15];
• Great rivalries and personalities [49:30];
• Rendezvous, a high-speed drive through Paris [56:50]; and
• More.

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In this episode, psychiatrist Paul Conti, M.D. discusses the impact of untreated trauma, the rising rate of suicide, and the influence of modern society on mental health, to name a few important topics covered. Paul also talks about how to deal with these challenges for yourself, your loved ones, and the community at large.

We discuss:

• Paul's background, and what drove him to psychiatry [5:00];
• How silent bravado and incessant striving can lead to a functional (and actual) death, and why Paul is critical of the current state of psychiatry [14:45];
• Psychedelics, psychotherapy and the dissolution of the ego [20:30];
• How current society may be contributing to the increasing amount of suffering [25:00];
• The ubiquity and impact of untreated trauma [31:45];
• The rising rate of suicide, parasuicide, and "accidental" death [35:30];
• Types of trauma, why we minimize it, and Peter's introduction to Bridge to Recovery [44:00];
• Triggering shame and fear, childhood trauma, and why trauma doesn't care about time [48:00];
• The impact of the brain on the body, and overcoming trauma with self-awareness [55:00];
• How to recognize and stop the cycle of shame transference [1:04:30];
• Peter's profound experience at Bridge to Recovery, and the importance of finding shared experiences with others [1:11:15];
• How to identify and deal with our own personal trauma [1:19:00];
• Finding meaning in struggle, why we are less happy than ever, and the impact of an isolated society [1:25:30];
• What steps can we take as a society to make an appreciable impact on the rising sense of desperation and misery? [1:43:15];
• Resources, book recommendations, and things you can do [1:56:15]; and
• More.

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In this episode, Rob Lustig — a researcher, an expert in fructose metabolism, and a former pediatric endocrinologist — discusses what's wrong with the current food environment, and what we can do to reduce our chances of becoming part of the obesity, diabetes, metabolic syndrome, and nonalcoholic fatty liver disease (NAFLD) epidemics. Rob recently earned a Master of Studies in Law because he believes that educating people about sugar from a scientific standpoint is only half the equation: the other half involves changing policy, which he explains in this episode.

We discuss:

• What's the difference between glucose and fructose? [7:00];
• Do we have biomarkers that can give us some indication of average exposure to fructose over a given period of time? [14:20];
• What's the difference between ALT and AST? [18:45];
• Inflammation, endothelial function, and uric acid [21:30];
• Is there something that fructose does better than glucose? [23:45];
• For children that undergo a remarkable shift from metabolic health to metabolic derangement, is there a concern that these kids suffer an epigenetic hit that makes it harder for them later in life? [26:15];
• How many times do you have to introduce a savory food vs a sugary food to an infant before they will accept it? [29:30];
• How are alcohol and fructose similar in how they affect the brain? [33:51];
• Advice for parents and kids for creating a sustainable environment that's going to prevent them from running into metabolic problems [40:30];
• Why do some populations have a higher risk for NAFLD? [45:42];
• What causes NAFLD? [48:45];
• Is insulin resistance the result of NAFLD or is NAFLD the result of insulin resistance? [56:00];
• HRV, cortisol, and norepinephrine [1:00:30];
• What are the actual mechanisms that links metabolic syndrome, insulin resistance, fatty liver, and type 2 diabetes? [1:03:00];
• Is the food industry still saying that all calories contribute equally to adiposity and insulin resistance? [1:09:00];
• What is the difference between soluble and insoluble fiber and why do you need both? [1:13:00];
• How can we change the food system when 10 companies control almost 90 percent of the Calories we consume in the US? [1:15:00]; and
• More.

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This episode explores the question of how we can maintain a naturally youthful look as we get older. Brett — a New York City oculofacial plastic surgeon who specializes in both non-surgical and surgical cosmetic and reconstructive procedures of the eyes and face — shares some remarkably practical advice on everything from the most extensive procedural options, down to the simple steps one can do themselves, starting today, that can make a tremendous impact. Brett also discusses how to pick a provider you trust while you're sorting through the ever-growing list of facial treatments and cosmetic procedures.

We discuss:

• History of medical training that led to Brett's current interests [5:00];
• What changes occur that make skin look older over time? [8:00];
• How to avoid the "unnatural" look associated with cosmetic surgery [17:00];
• Facial augmentation, fixing eye-bags, and picking the right provider [22:15];
• Common botox mistakes, and how to do it right [37:30];
• Protect and rejuvenate your skin with these 3 main tools [46:30];
• Latest trends in cosmetic industry, botox, cryolipolysis, the various forms of facials, and PRP [1:05:00];
• Importance of picking a provider you trust, rather than a device you want [1:31:30];
• Future of the cosmetic field [1:33:00]; and
• More.

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Corey and Peter met when they visited North Kern State Prison in California together as volunteers for Defy Ventures. Peter was moved by Corey's remarkable story, who is a former inmate himself, and realized he had to have him on the podcast to share his experiences with a wider audience. You'll almost assuredly take away something very important from listening to this episode. Understanding how your experiences can define you, what forgiveness means of both yourself and others, and how good people can do bad things, are just a few of the takeaways.

We discuss:

• How Corey and Peter met through Defy Ventures [4:00];
• How Corey's prison experience has shaped his life story [13:30];
• Corey's early life, and the traumatic event that changed everything [16:00];
• Early adolescence years, beginnings of addiction, and overwhelming shame [23:00];
• The 5 ways to classify wounds, and the relationship between trauma and addiction [39:00];
• Turbulent high school years, the struggle of parenting a troubled child, and more trauma further shaping the self-narrative [46:00];
• Post high school years, spiraling out of control, and giving up on himself [1:02:00];
• Navigating prison life, and why a desire to change often isn't enough to make it happen [1:19:00];
• The turning point and eventual road to recovery [1:48:00];
• 12 step programs: Pros and Cons [1:54:00];
• Final days in prison, getting released, and routines Corey has kept [1:54:00]
• Corey's new perspective on life, takeaways from the visit to Kern prison [2:12:30]; and
• More.

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Consider this episode a cross between an ask me anything (AMA) and a show-and-tell. Peter discusses his fasting experiment in great detail and answers questions from listeners and readers.

We discuss:

• Why Peter did a one-week fast and the rationale for front- and back-ending it with a week-long ketogenic diet [6:30];
• What Peter's typical diet, exercise, sleep, stress management, and supplementation looks like [11:00];
• What labs (e.g., glucose, ketones, lipids, inflammation and oxidation markers, thyroid- and sex hormones) Peter checked for the experiment [22:00];
• Peter's results after a week on a ketogenic diet [29:30];
• Peter's results after a week on a water-only fast [48:45];
• Peter's results after a week on a ketogenic diet following a week of fasting [58:30];
• Peter's "Top 6" surprises from the fasting experiment [1:08:30];
• Different fasting-mimicking diet (FMD) protocols [1:29:20];
• What is the optimal protocol, frequency, and duration for fasting? [1:33:00];
• How to break a fast without GI distress? [1:38:00];
• "Am I breaking the fast if…?" [1:41:30]; and
• More.

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Matt is someone who is deeply interested in understanding the biology of aging. Why do we age? What happens to us as we age? What are the things we can do to slow the aging process? How can we delay or prevent the onset of age-related diseases? These are all questions that Matt thinks deeply about, and explores these questions with his research at the University of Washington. He is currently investigating many of these questions through the Dog Aging Project and the compound rapamycin—the only known pharmacological agent to extend lifespan all the way from yeast to mammals—across a billion years of evolution. We talk about cancer, heart disease, Alzheimer's disease, healthspan, lifespan, and what we can do to provide longer, healthier lives for both people and dogs.

We discuss:

• Matt's early years and his a-ha moment on aging [4:00];
• Studying dogs [6:30];
• Dogs, rapamycin, and its effects on lifespan and healthspan [15:30];
• An unexpected finding in presumably healthy dogs [36:00];
• Rapamycin in cancer treatment [50:00];
• Why isn't there a rapamycin trial for Alzheimer's disease (AD)? [1:01:30];
• If Matt could do a definitive study on life extension in dogs, with resources not being a concern, what does that experiment look like? [1:16:00]; and
• More.

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In this episode, my good friend David Sabatini delves into his extensive work with the mechanistic target of rapamycin—better known as mTOR—and rapamycin. The compound rapamycin is the only known pharmacological agent to extend lifespan all the way from yeast to mammals—across a billion years of evolution. David, a professor of biology and a member of the Whitehead Institute at MIT, shares his remarkable journey and discovery of mTOR in mammalian cells and its central role in nutrient sensing and longevity. Fasting, rapamycin, mTOR, autophagy, gedankenexperiments: having this conversation with David is like being the proverbial kid in the world's greatest candy store.

We discuss:

• mTOR and David's student years [4:30];
• Rapamycin and the discovery of mTOR [8:15];
• The connection between rapamycin, mTOR, and longevity [30:30];
• mTOR as the cell's general contractor [34:45];
• The effect of glucose, insulin, and amino acids on mTORC1 [42:50];
• Methionine sensing and restriction [49:45];
• An intermittent approach to rapamycin [54:30];
• Rapamycin's effects on cancer, cardiovascular disease, and neurodegeneration [57:00];
• Gedankenexperiment: couch potatoes on rapamycin vs perfectly behaved humans [1:03:15];
• David's dream experiment with no resource constraints [1:07:00]; and
• More.

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