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Peter Attia

Expert insight on health, performance, longevity, critical thinking, and pursuing excellence. Dr. Peter Attia (Stanford/Hopkins/NIH-trained MD) talks with leaders in their fields.

The Peter Attia Drive

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In this special episode of The Drive, Peter addresses the recent headlines linking acetaminophen (Tylenol) use during pregnancy to autism in exposed children. Recognizing the confusion these claims have sparked among patients, listeners, and the broader public, Peter uses this episode to provide a framework for thinking critically about complex conditions and the research related to them. He highlights the dramatic rise in autism diagnoses over recent decades, noting that multifactorial conditions rarely have a single cause, and emphasizes the importance of resisting oversimplified explanations. Peter also stresses that humans are not naturally wired for scientific thinking, making disciplined frameworks like the Bradford Hill criteria essential for evaluating causality in epidemiology. Ultimately, he uses this framework to explore the evidence surrounding acetaminophen use during pregnancy and its potential link to autism.
 
We discuss:
 
 • Laying the groundwork for this discussion, the rise in autism rates, and the value in using frameworks [1:00];
 • The FDA pregnancy drug categories, where Tylenol falls within that framework, and a structured method for evaluating scientific evidence and causality [6:00];
 • What exactly are the claims being made about acetaminophen and autism? [13:45];
 • The increase in autism rates and why so many things are being linked to autism: the multiple comparisons problem [15:00];
 • Evaluating the review paper that triggered the recent concern over acetaminophen and autism [21:45];
 • Breaking down the largest studies on prenatal Tylenol exposure and autism: is there a causal link? [35:00];
 • Why observational studies can’t prove causality, the role of confounding variables, and the importance of frameworks like the Bradford Hill criteria [43:30];
 • Applying the Bradford Hill criteria: testing the case for Tylenol and autism [45:45];
 • Putting it all together to answer the question: Does acetaminophen use during pregnancy increase the risk of autism? [56:15];
 • If autism risk is overwhelmingly genetic, what explains the dramatic rise in autism diagnoses? [59:15];
 • Other risk factors for autism: parental age, maternal health, environment, and where Tylenol fits in [1:09:15];
 • Medication use during pregnancy: balancing risks, benefits, and FDA categories [1:15:15];
 • Considerations for taking Tylenol during pregnancy [1:19:30];
 • Final thoughts: critical thinking, balanced risk assessment, and the importance of context when evaluating medications like Tylenol during pregnancy [1:22:30]; and
 • More.
 
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#367 - Tylenol, pregnancy, and autism: What recent studies show and how to interpret the data

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Joe Liemandt is a software entrepreneur turned education reformer who left Stanford in 1989 to found Trilogy, a highly profitable private software company, before pivoting to transforming K-12 learning. In this episode, Joe shares how he transitioned from leading a global software enterprise to becoming principal of Alpha School, where his focus is building a mastery-based, individualized education model that leverages AI as the missing infrastructure for large-scale change. He details the shortcomings of traditional K-12 education, explains how Alpha replaces conventional seat time with focused academics, and outlines the role of AI tutors and human coaches in helping students accelerate through material. Joe also discusses early results, the data-driven systems that track progress, and his ambitious plan to reach a billion children in the next 20 years by combining cutting-edge technology with proven learning science.
 
We discuss:
 
 • Joe’s early interest in AI and the story of how he quit school to build Trilogy [4:45];
 • Joe’s first encounter with Alpha School and how it sparked his journey into education innovation [8:15];
 • America’s declining K-12 performance and the hidden power of mastering fundamentals [13:00];
 • How traditional time-based grade progression undermines later learning, and how mastery-focused instruction can transform student achievement [20:30];
 • Motivation as the key to high-level learning: how Alpha School fosters motivation with its “Timeback” model and leverages AI to accelerate learning [28:45];
 • Core principles of learning: how high standards, mastery-based instruction, and supportive struggle foster both academic excellence and personal growth [35:45];
 • Breaking down self-imposed limitations with foundational skills, defined time requirements, and a mastery model [41:15];
 • Using short-term extrinsic rewards to help students overcome limiting beliefs and ignite lasting intrinsic motivation [46:45];
 • $100 for 100: a simple but powerful incentive system that helps students fill academic gaps and master fundamentals [53:45];
 • How AI is the pivotal technology that can finally allow proven learning science to scale and unlock unprecedented student potential [57:45];
 • The emergence of generative AI that catalyzed Joe’s billion-dollar investment in education [1:09:45];
 • The path and obstacles to integrating Alpha’s AI-powered model into mainstream education [1:12:00];
 • Reimagining schooling from the ground up across five key dimensions [1:22:30];
 • The potential of this educational approach to reduce inequality in academic success [1:30:00];
 • Why the biggest challenge to scaling Alpha’s AI-driven education is cultural adoption and systemic redesign [1:34:00];
 • Peter’s daughter’s experience at Alpha School [1:38:30];
 • Alpha School’s expansion plans and need for people and resources for maximum impact [1:42:30]; and
 • More.
 
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#366 ‒ Transforming education with AI and an individualized, mastery-based education model | Joe Liemandt

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In this special episode of The Drive, Peter hosts a strength and conditioning roundtable with three experts in the field—Gabrielle Lyon, Jeff Cavaliere, and Mike Boyle. Together they explore why maintaining muscle mass, strength, and power is essential for healthspan and longevity, and examine how resistance training supports metabolic resilience and injury prevention across the lifespan. The conversation covers practical strategies for getting started and staying consistent, the importance of a protein-centered diet tailored to age and activity level, and approaches to resistance training for peri- and post-menopausal women—including tendon care and optimal programming. They debate single-leg training versus heavy bilateral lifts, share knee-friendly lower-body options, and highlight exercises that belong in the “graveyard” due to poor risk-reward ratios. Finally, the group discusses youth sports specialization, emphasizing the long-term value of variety for developing lifelong athletes.
 
We discuss:
 
 • Personal career journeys and philosophies of each guest that shaped their approaches to strength, conditioning, and lifelong health [3:30];
 • Why so few people engage in resistance training despite its proven health benefits [8:30];
 • Mike’s low-stress, high-consistency method for training beginners to resistance training [18:45];
 • How resistance training enhances metabolic health and body composition even in lean, highly active endurance athletes [25:30];
 • The dominant role of nutrition in shaping physique and achieving low body fat, the synergistic effect of resistance training, and the unrealistic expectations about muscle growth and fat loss [28:30];
 • Why Jeff advocates for five meals a day, and why meal timing matters less than overall protein intake and caloric consistency [38:00];
 • Optimizing protein for every stage of life: quality, quantity, and guidelines for diverse diets and body types [44:15];
 • The advantages of unilateral lower-body training over heavy bilateral lifts: impact on strength, athleticism, recovery, and functional movement [51:45];
 • Rethinking heavy squats and deadlifts: risk-reward, aging bodies, and the case for reverse lunges and other single-leg alternatives [1:01:15];
 • Adapting with age: Gabrielle on injuries, hip dysplasia, and the shift to smarter training [1:10:15];
 • Exercises that belong in the “iron graveyard”: unnecessarily risky exercises and their safer alternatives [1:19:15];
 • The downside of early sports specialization in children and the long-term benefits of encouraging kids to play multiple sports [1:25:00];
 • Advice for preventing an Achilles injury: calf strength, ankle mobility, and listening to pain signals [1:33:15];
 • Shoulder pain: how to keep training the upper body when shoulder pain limits pressing movements [1:40:45];
 • Effective strength training strategies for women before, during, and after the menopausal transition [1:43:15];
 • Best practices for strength training and athletic development in children, and the pitfalls of early sports specialization [1:50:30];
 • How to foster healthy habits and an interest in fitness beyond playing sports [2:00:00];
 • Something each guest has changed their mind about in the last five years [2:04:00]; and
 • More.
 
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#365 ‒ Training for longevity: A roundtable on building strength, preventing injury, meeting protein needs, guidance for women and youth athletes, and more | Gabrielle Lyon, Mike Boyle, Jeff Cavaliere

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In this “Ask Me Anything” (AMA) episode, Peter explores how to determine the right diet for yourself rather than searching for a universal “best” diet. He begins by laying out five non-negotiable criteria that any sustainable eating pattern must meet—energy balance, metabolic health, adequate protein, micronutrient sufficiency, and long-term adherence—before introducing a practical rubric for evaluating different diets. Using this framework, Peter walks through the ketogenic, carnivore, vegan, and Mediterranean diets, highlighting their strengths, ideal candidates for each, and common pitfalls such as micronutrient gaps or adherence challenges. He explains why this guidance is aimed at people who feel overwhelmed by diet choices, not zealots defending a single approach, and provides practical advice on using tools like DEXA scans, lab markers, continuous glucose monitors, and symptom tracking to assess whether a diet is truly working.
 
If you’re not a subscriber and are 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 or our website at the AMA #75 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • Peter’s family chess battle [3:00];
 • Framing the diet discussion: moving past tribalism to practical frameworks for evaluating various dietary strategies [5:00];
 • Peter’s high-level nutrition framework [11:00];
 • Why diet is such a uniquely polarizing subject [14:15];
 • The five non-negotiables that apply to any diet [17:45];
 • How to think about energy balance in the context of evaluating a specific diet [20:15];
 • How diet can address metabolic health [21:45];
 • Protein as a dietary foundation [23:30];
 • Micronutrient essentials: avoiding deficiencies in restrictive and processed diets [24:45];
 • Why adherence and sustainability are essential for diet success [27:15];
 • Examining the standard American diet through the five non-negotiables [31:00];
 • The evaluation framework for specific diets [33:30];
 • The ketogenic diet: defining ketosis, clinical origins, modern uses, and potential health benefits [35:00];
 • The main strengths and weaknesses of the ketogenic diet [43:00];
 • How to avoid micronutrient deficiencies while on a ketogenic diet [47:15];
 • Electrolytes and fiber and the ketogenic diet: preventing magnesium loss and maintaining digestive health [49:15];
 • Adherence challenges of the ketogenic diet [51:30];
 • The carnivore diet: definition, motivations, anecdotal benefits, and possible mechanisms [53:15];
 • The main strengths and weaknesses of the carnivore diet [57:30];
 • Plant exclusion on the carnivore diet: nutrient gaps, gut changes, and unanswered questions [1:03:15];
 • Adherence challenges of the carnivore diet [1:04:45];
 • The vegan diet: definition, core beliefs, and various motivations for this strategy [1:05:45];
 • The main strengths and weaknesses of the vegan diet [1:09:15];
 • Adherence to the vegan diet: social acceptance, edge cases, and personal sustainability [1:13:15];
 • The Mediterranean diet: definitional challenges, traditional patterns, and its relatively strong evidence base [1:15:15];
 • Limitations of the Mediterranean diet: loose definitions and indulgence risks [1:19:30];
 • Measuring diet success: why setting clear goals and tracking outcomes matter [1:21:00];
 • Tracking body composition using DEXA scans [1:22:15];
 • Tracking metabolic health: key blood tests and advanced glucose monitoring tools [1:22:45];
 • Using elimination diets to identify food sensitivities that may cause digestive problems, autoimmune symptoms, or low energy [1:23:30];
 • Evaluating “anti-inflammatory diets”: confirming inflammation through symptoms and hs-CRP testing [1:25:15];
 • Final takeaways: flexibility, structure, and avoiding dogma in dietary choices [1:27:00]; and
 • More.
 
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#364 – AMA #75: Diets: how to evaluate and implement any diet including keto, carnivore, vegan, Mediterranean, and more

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Edward Chang is a neurosurgeon, scientist, and a pioneering leader in functional neurosurgery and brain-computer interface technology, whose work spans the operating room, the research lab, and the engineering bench to restore speech and movement for patients who have lost these capabilities. In this episode, Edward explains the evolution of modern neurosurgery and its dramatic reduction in collateral damage, the experience of awake brain surgery, real-time mapping to protect critical functions, and the split-second decisions surgeons make. He also discusses breakthroughs in brain-computer interfaces and functional electrical stimulation systems, strategies for improving outcomes in glioblastoma, and his vision for slimmer, safer implants that could turn devastating conditions like ALS, spinal cord injury, and aggressive brain tumors into more manageable chronic illnesses.
 
We discuss:
 
 • The evolution of neurosurgery and the shift toward minimally invasive techniques [2:30];
 • Glioblastomas: biology, current treatments, and emerging strategies to overcome its challenges [10:45];
 • How brain mapping has advanced from preserving function during surgery to revealing how neurons encode language and cognition [16:30];
 • How awake brain surgery is performed [22:00];
 • How brain redundancy and plasticity allow some regions to be safely resected, the role of the corpus callosum in epilepsy surgery, and the clinical and philosophical implications of disconnecting the hemispheres [26:15];
 • How neural engineering may restore lost functions in neurodegenerative disease, how thought mapping varies across individuals, and how sensory decline contributes to cognitive aging [39:15];
 • Brain–computer interfaces explained: EEG vs. ECoG vs. single-cell electrodes and their trade-offs [48:30];
 • Edward’s clinical trial using ECoG to restore speech to a stroke patient [1:01:00];
 • How a stroke patient regained speech through brain–computer interfaces: training, AI decoding, and the path to scalable technology [1:10:45];
 • Using brain-computer interfaces to restore breathing, movement, and broader function in ALS patients [1:28:15];
 • The 2030 outlook for brain–computer interfaces [1:34:00];
 • The potential of stem cell and cell-based therapies for regenerating lost brain function [1:38:00];
 • Edward’s vision for how neurosurgery and treatments for glioblastoma, Parkinson’s disease, and Alzheimer’s disease may evolve by 2040 [1:42:15];
 • The rare but dangerous risk of vertebral artery dissections from chiropractic neck adjustments and high-velocity movements [1:44:45];
 • How Harvey Cushing might view modern neurosurgery, and how the field has shifted from damage avoidance to unlocking the brain’s functions [1:46:15]; and
 • More.
 
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#363 ‒ A new frontier in neurosurgery: restoring brain function with brain-computer interfaces, advancing glioblastoma care, and new hope for devastating brain diseases | Edward Chang, M.D.

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Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine.
 
We discuss:
 
 • Peter’s experience with debilitating back pain [3:00];
 Anatomy of the back: spine, discs, facet joints, and common pain points [14:15]; • Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:30];
 • Why the majority of back injuries happen around the L4, L5, and S1 joints [30:45];
 • How the spine responds to forces like bending and loading, and how it adapts to different athletic activities [36:00];
 • The pathology of bulging discs [43:00];
 • The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [45:45];
 • The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:00];
 • The significance of strength and stability in preventing injuries and preserving longevity [1:08:00];
 • Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:15];
 • Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:29:45];
 • Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:38:30];
 • When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:30];
 • Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:15];
 • Tarlov cysts: treatment and surgical considerations [2:00:00];
 • The evolution of patient assessments and the limitations of MRI [2:02:00];
 • Pain relief related to stiffness and muscle bulk through training [2:06:45];
 • Advice for the young person on how to keep a healthy spine [2:14:00];
 • Resources for individuals dealing with lower back pain [2:25:15]; and
 • More.
 
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Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D. (#287 rebroadcast)

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Josh Spitalnick is a clinical and research psychologist with expertise in treating a variety of anxiety conditions with cognitive-behavioral therapy (CBT) and other evidence-based approaches. In this episode, Josh unpacks the four layers of anxiety—psychological, emotional, cognitive, and behavioral—highlighting why avoidance is the key feature that transforms ordinary worry into disorder. He explains why he continues to treat OCD and PTSD as anxiety conditions despite their DSM-5 reclassification, and he draws important distinctions between worries versus worrying and thoughts versus thinking. The discussion explores health anxiety, illness anxiety, and the impact of modern contributors such as wearables, social media, and the COVID era, while weaving in real-world case studies and Josh’s structured assessment approach. Josh also breaks down evidence-based treatments, from exposure therapy and cognitive-behavioral therapy (CBT) to acceptance and commitment therapy (ACT), along with the role of medication, lifestyle factors, and how shifting from avoidance to committed action can build long-term resilience.
 
We discuss:
 
 • Josh’s professional background and his holistic approach to treating anxiety [3:00];
 • Definition of anxiety and changes in the DSM-5 [5:00];
 • The psychological and cognitive aspects of anxiety [10:45];
 • Breaking down anxiety symptoms: triggers, fears, and hidden mental rituals [17:00];
 • Thoughts versus thinking and worries versus worrying: what constitutes dysfunction [20:15];
 • Health anxiety and the limits of medical reassurance: understanding illness anxiety and somatic symptom disorder [24:30];
 • Triggering events for health anxiety, symptom fixation, heritability, and the role of nature versus nurture [36:30];
 • Historical and modern shifts in health anxiety, from HIV/AIDS in the 1980s to today’s heightened fears of cancer [45:30];
 • Modern factors and recent events that have amplified societal anxiety levels [47:15];
 • Josh’s approach to patients with excessive health-related rituals and/or OCD using CBT and exposure therapy [54:30];
 • Hypothetical example of treating a person with a fear of flying: assessment, panic disorder, and the role of medication and exposure therapy [1:03:15];
 • The four types of exposure therapy and the shift from habituation to inhibitory learning [1:14:00];
 • Treating people with OCD that manifests in disturbing and intrusive thoughts, and why therapy focuses on values over reassurance [1:21:00];
 • Acceptance and commitment therapy (ACT): reorienting patients toward values-driven living rather than symptom elimination [1:31:45];
 • Mindfulness as a tool to cultivate presence, awareness, and healthy engagement with life [1:36:30];
 • Hallmarks of successful therapy and red-flags that therapy is not going well [1:38:15];
 • The relationship between anxiety and substance use, and the therapeutic challenges it creates [1:44:45];
 • Anxiety’s overlap with ADHD, OCD, autism, and physical health conditions [1:49:45];
 • Debunking the harmful myth that health anxiety is a “made up” condition [1:51:30];
 • Prevalence, severity, and evolving treatments for health anxiety and OCD [1:54:45];
 • Treating health anxiety is about providing patients with skills to improve quality of life—a discussion on how to address symptoms often attributed to long COVID [2:01:30];
 • Balancing the benefits of abundant health information with the risks of fueling health anxiety [2:06:30];
 • Advice for finding a telehealth provider with expertise in health anxiety [2:11:00]; and
 • More.
 
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#362 ‒ Understanding anxiety: defining, assessing, and treating health anxiety, OCD, and the spectrum of anxiety disorders | Josh Spitalnick, Ph.D., A.B.P.P.

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In this “Ask Me Anything” (AMA) episode, Peter explains how to evaluate sugar and its substitutes in the context of health. Peter explores the role of sweeteners in three common use-cases – beverages, protein supplements, and sweet treats – and breaks down how our evolutionary craving for sweetness now clashes with today’s food environment. He examines whether sugar is uniquely fattening, the hormonal effects of sugar consumption, and the significance of timing in sugar intake. The episode compares natural versus refined sugars, sugar in beverages versus in solid foods, and the pros and cons of popular sweeteners including saccharin, aspartame, sucralose, allulose, and sugar alcohols like erythritol and xylitol. With a focus on weight management, glycemic impact, gut health, and long-term safety, this episode offers a comprehensive guide to navigating the sweetener landscape with clarity and nuance.
 
If you’re not a subscriber and are 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 or our website at the AMA #74 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • A quick tangent on chess and parenting [2:30];
 • Overview of key scenarios for evaluating sugar and sweeteners [6:15];
 • Why humans are hardwired to crave sweetness [13:30];
 • Evaluating whether sugar is uniquely fattening or more harmful than other macronutrients under isocaloric conditions [15:15];
 • Why sugar drives appetite: low satiety, insulin response, and reward system activation [18:45];
 • How sugar type, liquid vs. solid form, and processing level influence appetite and metabolic impact [20:15];
 • Addressing the common belief that natural sugars are healthier than refined sugars [26:00];
 • How the timing of sugar consumption alters the body’s metabolic response [29:15];
 • How Peter advises patients on sugar intake, factoring in metabolic health, insulin sensitivity, and activity level [34:45];
 • The most common sugar substitutes, their sweetness relative to sugar, and their caloric content [36:30];
 • Evaluating the role of sugar substitutes in weight control: efficacy vs. effectiveness and limitations in study design [40:15];
 • Assessing the real-world impact of sugar substitutes on weight, and the role of sweetness without calories [44:00];
 • The impact of sugar substitutes on glycemic control [47:30];
 • Are microbiome changes from artificial sweeteners substantial enough to cause obesity and diabetes? [50:30];
 • How Peter advises patients on the use of sugar substitutes across different contexts [52:30];
 Allulose—a sweetener with unique satiety and glycemic benefits and potential for weight control [57:15]; • Emerging evidence that stevia, monk fruit, and sugar alcohols may provide modest metabolic benefits compared to sugar [1:03:00];
 • Sugar alcohols explained [1:04:15];
 • Sugar alcohols and GI issues [1:05:00];
 • Xylitol’s dental health benefits and considerations for use [1:06:30];
 • Artificial sweeteners and cancer risk: evaluating evidence, the aspartame controversy, and the role of dose in toxicology [1:07:15];
 • Sugar substitutes and cardiovascular disease: assessing flawed studies and the absence of direct risk evidence [1:11:00];
 • Why artificial sweeteners seem to attract so many negative headlines [1:12:45];
 • Balancing benefits and risks of sugar substitutes: guidance for desserts, beverages, and protein products [1:14:15]; and
 • More.
 
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#361 - AMA #74: Sugar and sugar substitutes: weight control, metabolic effects, and health trade-offs

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Charles Duhigg is a Pulitzer Prize-winning journalist and best-selling author known for distilling complex neuroscience and psychology into practical strategies for behavior change, performance, and decision-making. In this episode, Charles explores the neuroscience behind habit formation, including how cue-routine-reward loops drive nearly half of our daily actions and why positive reinforcement is far more effective than punishment. He explains how institutions like the military and Alcoholics Anonymous engineer environments to change behavior at scale, as well as discussing the limits of willpower and how to preserve it by shaping context. The conversation also covers the real timeline of habit formation, how to teach better habits to kids, the role of failure and self-compassion in lasting change, and the power of social accountability. Charles further discusses how cognitive routines enhance productivity and creativity, how to gamify long-term goals through immediate rewards, why identity and purpose are often the strongest forces behind sustainable behavior change, and the potential of AI to power habit change.
 
We discuss:
 
 • How Charles’s background in journalism and personal experiences led to his interest in habit formation [3:15];
 • The science behind reinforcement: why positive rewards outperform punishment in habit formation [10:15];
 • How the military uses habit science to train soldiers using cues, routines, and rewards [17:15];
 • Methods for creating good habits and eliminating bad ones: environmental control, small wins, rewards-based motivation, and more [24:00];
 • How parents can teach kids to build habits and strengthen willpower [32:15];
 • How adults experience changes in motivation and cue effectiveness over time, and why willpower must be managed like a finite resource [34:30];
 • Keys to successful habit change: planning for relapse, learning from failure, and leveraging social support [38:00];
 • Advice for parents: praise effort, model habits, and normalize failure [47:45];
 • The time required for making or breaking a habit [50:45];
 • The different strategies for creating new habits vs. changing existing ones, and the crucial role of cues and reward timing [55:15];
 • How to create habits around long-term goals when the rewards are delayed (like saving money) [1:01:45];
 • How to stick with good habits that offer no immediate reward: designing reinforcements and identity-based motivation [1:11:15];
 • The potential for AI to provide social reinforcement [1:16:45];
 • Mental habits: how thought patterns and contemplative routines shape deep thinking, innovation, and high-stakes performance [1:23:30];
 • How cognitive routines boost productivity and habit formation but may stifle creativity [1:35:15];
 • Contemplative routines: using stillness to unlock deeper productivity and creativity [1:40:45];
 • How habits reduce decision fatigue and enable deep, high-quality productivity [1:44:15];
 • New research that reveals the power of environment and social feedback in habit formation [1:49:45];
 • How AI may transform work, identity, and our sense of purpose [1:53:45];
 • The potential of AI-powered habit change, and the essential—but often lacking—element of motivation [2:02:30]; and
 • More.
 
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#360 ‒ How to change your habits: why they form and how to build or break them | Charles Duhigg, M.B.A

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Eric Verdin is a physician-scientist and the CEO of the Buck Institute for Research on Aging whose career has centered on understanding how epigenetics, metabolism, and the immune system influence the aging process. In this episode, Eric traces his scientific journey from studying viruses and histone deacetylases (HDACs) to leading aging research at the Buck Institute, offering insights into how aging impairs immune and nervous system function—including thymic shrinkage, chronic inflammation, and reduced vaccine response—and how these changes impact lifespan. He explores the metabolic underpinnings of aging, such as oxidative stress and insulin and IGF-1 signaling, and he discusses practical tools like zone 2 cardio, ketogenic diets, and GLP-1 drugs. The conversation also covers declining NAD levels with age, the roles of NAD-consuming enzymes such as sirtuins and CD38, and what current NAD-boosting strategies (like NMN, NR, and IV NAD) can and can’t accomplish. Eric weighs in on promising longevity interventions including rapamycin, growth hormone for thymic regeneration, and anti-inflammatory therapies, while also examining the promise and limitations of current biological age tests and the potential of combining epigenetic, proteomic, and organ-specific metrics with wearables to guide personalized longevity care.
 
We discuss:
 
 • Eric’s scientific journey from virology to the field of geroscience [2:45];
 • How dysfunction in the immune system and central nervous system can drive aging throughout the body [5:00];
 • The role of metabolism and oxidative stress in aging, and why antioxidant strategies have failed to deliver clear benefits [8:45];
 • Other aspects of metabolism linked to aging: mitochondrial efficiency, fuel utilization, and glucose-modulating drugs [16:30];
 • How inefficient glucose metabolism drives insulin, IGF-1 signaling, and accelerates aging [21:45];
 • The metabolic effects of GLP-1 agonists, and the need to move beyond crude metrics like BMI in favor of more precise assessments of metabolic health [27:00];
 • The case for immune health as a “fifth horseman” [36:00];
 • How the innate and adaptive immune systems work together to build immune memory [39:45];
 • Why vaccines lose effectiveness with age: shrinking of the thymus gland and diminished T-cell diversity [44:15];
 • Exploring growth hormone, thymic regeneration, and the role of exercise in slowing immune aging [48:45];
 • The challenges of identifying reliable biomarkers for immune function, and the potential of rapamycin analogs to enhance vaccine response in older adults [57:45];
 • How rapamycin’s effects on the immune system vary dramatically by dosage and frequency [1:03:30];
 • The limitations of mouse models in aging research and the need for cautious interpretation of rapamycin’s benefits in humans [1:08:15];
 • NAD, sirtuins, and aging: scientific promise amid commercial hype [1:15:45];
 • How CD38 drives age-related NAD decline, influences immune function, and may impact longevity [1:23:45];
 • How NMN and NR supplementation interact with CD38 and NAD metabolism, and potential risks like homocysteine elevation and one-carbon cycle depletion [1:31:00];
 • Intravenous NAD: limited evidence and serious risks [1:37:00];
 • Interleukin-11 (IL-11) as a new target in immune aging, the dual role of chronic inflammation in aging, and the need for better biomarkers to guide interventions [1:43:00];
 • Biological aging clocks: types of clocks, promise, major limitations, and future outlook [1:48:30];
 • The potential of proteomics-based aging clocks for detecting organ-specific decline and frailty [2:00:45]; and
 • More.
 
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#359 ‒ How metabolic and immune system dysfunction drive the aging process, the role of NAD, promising interventions, aging clocks, and more | Eric Verdin, M.D.

Welcome to a special sneak peek of The Peter Attia Drive. The Peter Attia Drive will feature guests and experts that will offer advice and insight to help you optimize performance, health, longevity, critical thinking, and life. It’s hosted by Stanford M.D., TED speaker, and longevity expert Dr. Peter Attia, founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City.
 
Learn more at www.PeterAttiaMD.com
 Connect with Peter on Facebook | Twitter | Instagram.

#00 - Sneak Peek: The Peter Attia Drive

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