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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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Dom D'Agostino is a neuroscientist and professor at the forefront of metabolic therapies, including ketogenic diets, exogenous ketones, and hyperbaric oxygen. In this episode, Dom breaks down nutritional versus supplemental ketosis, defines meaningful ketone thresholds, and outlines practical ways to achieve ketosis. He explains how a ketogenic diet can support metabolic health and weight loss, and advises on how to maintain adequate protein and avoid common mistakes. Dom surveys the growing landscape of exogenous ketones—from salts and esters to 1,3-butanediol—and effective pairings like caffeine, MCT oil, and alpha-GPC. He highlights the role of ketogenic therapy in cancer (particularly glioblastoma) and its promise for neurodegenerative diseases. The conversation also covers recommended hyperbaric oxygen protocols for brain injuries and cognitive function, situations where fasting or ketones offer cognitive and anti-inflammatory benefits, and touches on the carnivore diet as a ketogenic variant with potential relevance for autoimmune and metabolic conditions.
 
We discuss:
 
 • Dom and Peter's shared interest in ketosis, and Dom's scientific journey [2:30];
 • Dom's work for the Navy on oxygen toxicity [7:00];
 • Nutritional ketosis defined: physiology, biomarkers, and how fasting and diet generate therapeutic ketones [15:00];
 • The historical roots of ketogenic diets in epilepsy treatment, and evidence showing ketones reduce seizure activity and strengthen brain resilience [19:00];
 • Dom's personal experience on the ketogenic diet: tracking macros, getting enough protein, and monitoring ketone levels [24:15];
 • Using a ketogenic diet for weight loss: Dom's guidance on protein, fiber, calorie tracking, lipid monitoring, and more [31:00];
 • Protein on ketogenic diets: Dom's rationale for higher intake and muscle preservation [38:00];
 • Incorporating carbohydrates into keto: timing, high-fiber foods, and other considerations [41:30];
 • The carnivore diet: whether this diet induces ketosis, how it functions metabolically, and why it may help individuals with autoimmune conditions [44:15];
 • Early exogenous ketones: how 1,3-butanediol works, its liver toxicity risk, and why ketone esters replaced it [48:15];
 • The progression of exogenous ketones: why BHB monoesters and ketone salts emerged as better alternatives to 1,3-butanediol for ketone supplementation [59:30];
 • Ketone salts: easing the transition into ketosis, dosing, and how they compare to ketone esters [1:04:00];
 • The differences between D- and L-β-hydroxybutyrate, and how racemic mixtures may elevate ketones longer and offer unique biological effects [1:09:30];
 • How ketosis may boost NAD, and why NAD supplements have fallen short so far [1:16:30];
 • Emerging evidence for using a ketogenic diet to treat anorexia and other psychiatric disorders [1:20:30];
 • Potential cognitive and performance benefits of ketone supplementation, and why pushing ketones too high can be dangerous [1:23:45];
 • Applications for ketone esters, and why ketone salts or MCT-blended formulations may be safer and more practical for most people [1:29:15];
 • The role of a ketogenic diet in treating cancer [1:34:45];
 • The potential of a ketogenic diet for treating Alzheimer's disease [1:45:45];
 • Tools for cognitive enhancement: ketones, alpha-GPC, MCT, caffeine, strategic fasting, and more [1:53:45];
 • Hyperbaric oxygen therapy for concussion, TBI, PTSD, and cognitive function, including protocols and dosing approaches [1:55:30];
 • Peter's takeaways, recommended products, and additional resources to learn more [2:03:00]; and
 • More.
 
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#375 - Ketogenic diet, ketosis & hyperbaric oxygen: metabolic therapies for weight loss, cognition, Alzheimer's & more | Dom D'Agostino, Ph.D.

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Carole Hooven is a human evolutionary biologist whose research centers on testosterone, sex differences, and behavior. In this episode, she explores how prenatal testosterone orchestrates male development in the body and brain, how early hormonal surges shape lifelong behavioral tendencies, and what rare natural experiments—such as 5-alpha-reductase deficiency—reveal about the biology of sex differentiation. She discusses distinct male and female aggression styles through an evolutionary lens, how modern environments interact with ancient competitive drives, and the implications of attempting to suppress them. The conversation also covers testosterone across the lifespan, the role of hormone therapy in both men and women, and Carole's own experience after surgical menopause, culminating in a broader discussion of masculinity, cultural narratives, and the consequences of denying biological sex differences.
 
We discuss:
 
 • How Carole became interested in exploring the biological and evolutionary roots of sex differences and the role of testosterone [2:30];
 • How testosterone and other hormones influence sex differences in aggression and behavior across species [9:45];
 • How chromosomes, the SRY gene, and early hormones direct embryonic sexual differentiation [12:15];
 • A stark contrast of male social bonding compared to females, and evolutionary parallels in chimpanzees [19:30];
 • How hormones like DHT shape sexual differentiation, and how 5⍺-reductase deficiency reveals the distinct roles of these hormones [22:45];
 • How sex chromosomes and prenatal testosterone shape early brain development and explain sex differences in childhood behavior [31:30];
 • How gamete differences shape reproductive strategies, energetic costs, and sex-specific behavior [42:30];
 • How evolutionary biology shapes sex differences in play, aggression, and conflict resolution (and how modern environments and cultural messaging can disrupt those patterns) [49:00];
 • Why males commit disproportionately more violent crime, and how cultural and environmental forces shape aggression [1:01:00];
 • Why females evolved different behavioral strategies: nurturing, risk aversion, and the cultural norms that override biology [1:04:00];
 • Whether male aggression is still necessary in modern society, why the underlying biological drives persist, and how modern society redirects these drives [1:06:30];
 • How testosterone levels naturally shift to support fatherhood and caregiving [1:13:30];
 • How testosterone shapes male mating strategies, and why long-term pair-bonding persists even when reproduction is no longer at stake [1:18:30];
 • The distinct roles of estrogen in male development, mood, libido, and muscle [1:25:00];
 • How evolution, health, lifestyle, and androgen receptor biology shape modern testosterone replacement therapy (TRT) [1:34:15];
 • Carole's experience with hormone replacement therapy (HRT), and the risks associated with TRT in younger men [1:45:15];
 • How Carole rebuilt after controversy: leaving academia and recommitting to scientific honesty [1:51:30,];
 • Carole's next book: examining masculinity, cultural narratives, and the cost of denying biological sex differences [1:57:30]; and
 • More.
 
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#374 - The evolutionary biology of testosterone: how it shapes male development and sex-based behavioral differences, | Carole Hooven, Ph.D.

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Walter Green is a remarkable philanthropist, mentor, author of This Is the Moment!, and founder of the impactful "Say It Now" movement. In this episode, Walter delves into the unique insights gained from his challenging upbringing, discusses embracing mortality, and highlights the mindset of "finishing strong." He shares insights on intentionality, thinking in reverse, saying "no," prioritizing relationships, and the essence of focusing on others. The conversation focuses on the "Say It Now" movement, which stresses the importance of expressing sentiments to loved ones well before the end of life.
 
We discuss:
 
 • How Peter and Walter met through Ric Elias [3:30];
 • The unique perspectives and life lessons provided by Walter's challenging childhood [6:00];
 • Walter's harrowing experience with a sudden mental breakdown and his subsequent recovery with the help of therapy [12:15];
 • A diverse professional journey ending in great success [19:15];
 • The birth of a movement: celebrating friendships through public tributes and expressing gratitude to those who have shaped your life's journey [23:30];
 • Intentionality, thinking in reverse, saying "no", and other guiding principles for Walter [30:45];
 • Walter's global journey of gratitude on his 70th birthday, visiting friends, and creating memorable experiences [40:15];
 • The profound impact of acknowledging and expressing gratitude for the people who contribute to our lives [47:15];
 • The key elements for creating meaningful connections and cultivating deep, authentic friendships [53:15];
 • The "Say It Now" movement: the inspiration behind the remarkably impactful initiative [59:15];
 • What "finishing strong" means to Walter [1:08:15];
 • Finding peace at the end of life through expressing gratitude and finding purpose in serving others [1:16:45];
 • Resources to learn about "Say It Now" [1:27:00]; and
 • More.
 
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The impact of gratitude, serving others, embracing mortality, and living intentionally | Walter Green (#288 rebroadcast)

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Antonio Bianco is a world-renowned physician-scientist and expert in thyroid physiology and metabolism. In this episode, Antonio explores the complex biology of thyroid hormone production, conversion, and regulation—highlighting how deiodinase enzymes modulate hormone activity at the tissue level and why that matters for interpreting lab results. He discusses the shortcomings of relying solely on TSH as a marker of thyroid function, the ongoing debate around combination therapy with T3 and T4 versus standard T4 treatment, and how genetics, tissue sensitivity, and individual variability influence thyroid hormone metabolism. The conversation also examines how hypothyroidism affects energy, mood, cognition, and longevity; why some patients remain symptomatic despite "normal" labs; and how future research could reshape treatment paradigms.
 
We discuss:
 
 • How the thyroid produces, stores, and activates hormones like T4 and T3 to finely regulate thyroid activity [2:45];
 • How fasting alters thyroid hormones to conserve energy [12:45];
 • Action of the deiodinases: how D1, D2, and D3 enzymes control the activation and inactivation of thyroid hormones [19:15];
 • The normal function of thyroid hormone and the roles of the hypothalamus, pituitary gland, and deiodinases in maintaining hormonal balance [23:30];
 • Why understanding thyroid physiology is essential for proper diagnosis and treatment of hypothyroidism [33:45];
 • Testing for thyroid hormones: understanding free vs. total levels, the limitations of current T3 assays, best practices, and more [36:00];
 • Genetic and sex-based variability in thyroid hormone regulation and their limited clinical significance [43:45];
 • Hyperthyroidism: causes, symptoms, diagnosis, and treatment options [46:00];
 • Hypothyroidism: diagnosis and autoimmune causes of hypothyroidism [56:30];
 • More on hypothyroidism: diagnostic biomarkers, antibody patterns, and non-autoimmune presentations [1:05:00];
 • Thyroid hormone replacement therapy [1:15:15];
 • More on thyroid replacement strategies: exploring the evidence gaps, mortality signals, effects on lipids, and more [1:28:00];
 • Hypothyroidism basics: causes, antibody implications (including pregnancy), and how to make the diagnosis before choosing therapy [1:35:15];
 • Thyroid medication: compounded controlled-release T3, brand name versus generic, and what Antonio prescribes to newly diagnosed hypothyroid patients [1:42:45];
 • Redefining treatment success: why normalizing TSH isn't always enough for patients with hypothyroidism [1:54:45];
 • Case studies: analysis of two unusual cases of thyroid disease [1:57:00];
 • Dangers of supplementing with high levels of iodine, and female-specific risk of thyroid disease [2:05:45];
 • Case study of a patient who presents with elevated TSH but no symptoms [2:09:30];
 • How future research could reshape treatment, and Antonio's new book called "Rethinking Hypothyroidism" [2:13:15]; and
 • More.
 
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#373 – Thyroid function and hypothyroidism: why current diagnosis and treatment fall short for many, and how new approaches are transforming care | Antonio Bianco, M.D., Ph.D.

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In this "Ask Me Anything" (AMA) episode, Peter breaks down the science of dietary fiber, moving beyond the blanket advice to "eat more fiber" to uncover what it actually does in the body and where its benefits are truly supported by evidence. He explains how different types of fiber—soluble, insoluble, viscous, and fermentable—affect digestion, satiety, weight management, and glycemic control, and compares their impact to other, more potent metabolic tools. Peter also examines how certain fibers influence lipid metabolism and cardiovascular risk, evaluates the strength of evidence for fiber's role in colorectal cancer prevention, and highlights why some individuals may not tolerate specific fibers well. The discussion concludes with practical guidance on moving past generic fiber targets toward a more strategic and personalized approach that maximizes the true benefits of fiber.
 
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 #77 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • Why it's time to re-examine the evidence behind dietary fiber recommendations [2:00];
 • Why it's hard to isolate fiber's true effects on health: the limits of nutritional epidemiology [5:45];
 • Defining dietary fiber: what it is, how it's digested, and why different types have different effects [8:15];
 • Understanding fiber properties: how solubility, viscosity, and fermentability shape its effects in the body [11:15];
 • Resistant starches explained: types, food sources, and how cooking and cooling influence their benefits [16:30];
 • A framework for evaluating each of the major health claims linked to fiber [19:15];
 • How fiber can support weight loss: mechanisms, realistic expectations, and its complementary role to broader dietary strategies [20:30];
 • How fiber modestly improves glycemic control by reducing glucose spikes and insulin demand [26:15];
 • How fiber modestly lowers LDL cholesterol and supports cardiovascular health [34:30];
 • How fiber compares to other available tools and strategies for managing lipids, blood sugar, and weight [42:00];
 • Fiber's role in colon cancer prevention: mechanisms, evidence, and limitations [45:30];
 • Is fiber necessary for colon cancer prevention in otherwise healthy individuals? [53:30];
 • Why some people have adverse reactions to certain types of fiber, and how to manage them [56:00];
 • A general strategy for dietary fiber: combine multiple fiber types through whole foods and supplements [58:45];
 • Why total fiber intake is more important than the ratio of soluble-to-insoluble fiber [1:02:45];
 • The optimal timing and context for consuming fiber to maximize blood sugar control and metabolic benefits [1:05:00];
 • How food processing affects the functional properties of fiber, the differences between supplement forms and natural sources, and why whole foods generally remain the best option [1:06:45];
 • Fiber's potential to interfere with medication absorption [1:09:30];
 • How to safely increase fiber intake: ramp up gradually and stay hydrated [1:12:00];
 • Final takeaway on fiber: modest benefits, strong rationale, low downside [1:13:00];
 • Peter's carve-out: lessons and inspiration from the Acquired podcast [1:14:30]; and
 • More.
 
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#372 - AMA #77: Dietary fiber and health outcomes: real benefits, overhyped claims, and practical applications

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Sally Greenwald is an OB-GYN who specializes in women's sexual health from a hormonal and physiologic perspective, with expertise spanning desire, arousal, pelvic floor function, contraception, and menopause care. In this episode, she explains why sexual health is a vital component of overall well-being, exploring topics such as the drivers of desire, the anatomy of sexual function, myths and realities around orgasm, and the role of hormones in perimenopause and menopause. She also covers vaginal and pelvic health, pain with sex, evidence-based therapies for low desire and arousal, how contraception and medications can affect sexual function, and practical strategies for enhancing sexual satisfaction and maintaining intimacy across life stages. This episode offers a comprehensive, evidence-based discussion with immediate real-world relevance for women as well as for men who want to better understand their partners.
 
We discuss:
 
 • How sexual health influences physical health, emotional well-being, and relationships [3:15];
 • Understanding the physiology of the female orgasm, sexual comfort and satisfaction, and the disparity between men and women [12:45];
 • Foreplay, the science of desire, and methods to help women cultivate arousal and connection [19:00];
 • The physiology and sources of female lubrication, the role of clitoral nerve anatomy in pleasure, and the use of lubricants and vibrators to enhance comfort and sexual health [23:45];
 • Understanding female anatomy and what is needed for orgasm [31:15];
 • Understanding sexual desire, how to cultivate it, the role of hormones, and testosterone therapy in women [41:15];
 • Personalizing perimenopause care: how desire for ovulation guides the choice between contraception and menopausal hormone therapy [49:30];
 • Considerations for choosing contraceptives and hormonal therapies during perimenopause [59:45];
 • Factors negatively affecting desire, and why female libido persists with age and fluctuates across the menstrual cycle [1:11:00];
 • How sexual trauma and physical pain can affect sexual health, and evidence-based strategies for recovery [1:15:15];
 • Vaginal care routine: lubricants, moisturizers, topical hormones, and other approaches for vaginal health [1:19:15];
 • Tips for sexually satisfying your female partner [1:25:45];
 • The pharmacology of arousal: various treatments for low sexual desire in women [1:30:30];
 • Sex during and after pregnancy: impact on arousal, safety of sex, and how to manage postpartum recovery and pain [1:37:45];
 • How Sally would redesign sex education [1:42:15];
 • Sally's optimism about a new era in women's sexual health [1:49:00]; and
 • More.
 
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#371 – Women's sexual health: desire, arousal, and orgasms, navigating perimenopause, and enhancing satisfaction | Sally Greenwald, M.D., M.P.H.

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In this special episode, Peter provides a comprehensive introduction to longevity, perfect for newcomers or those looking to refresh their knowledge. He lays out the foundational concepts of lifespan, healthspan, and the marginal decade. Additionally, Peter discusses the four main causes of death and their prevention, as well as detailing the five key strategies in his longevity toolkit to improve lifespan and healthspan. Detailed show notes provide links for deeper exploration of these topics, making it an ideal starting point for anyone interested in understanding and improving their longevity.
 
We discuss:
 
 • Key points about starting exercise as an older adult [2:45];
 • Overview of episode topics and structure [1:45];
 • How Peter defines longevity [3:45];
 • Why healthspan is a crucial component of longevity [11:15];
 • The evolution of medicine from medicine 1.0 to 2.0, and the emergence of medicine 3.0 [15:30];
 • Overview of atherosclerotic diseases: the 3 pathways of ASCVD, preventative measures, and the impact of metabolic health [26:00];
 • Cancer: genetic and environmental factors, treatment options, and the importance of early and aggressive screening [33:15];
 • Neurodegenerative diseases: causes, prevention, and the role of genetics and metabolic health [39:30];
 • The spectrum of metabolic diseases [43:15];
 • Why it's never too late to start thinking about longevity [44:15];
 • The 5 components of the longevity toolkit [46:30];
 • Peter's framework for exercise—The Centenarian Decathlon [47:45];
 • Peter's nutritional framework: energy balance, protein intake, and more [58:45];
 • Sleep: the vital role of sleep in longevity, and how to improve sleep habits [1:08:30];
 • Drugs and supplements: Peter's framework for thinking about drugs and supplements as tools for enhancing longevity [1:13:30];
 • Why emotional health is a key component of longevity [1:17:00];
 • Advice for newcomers on where to start on their longevity journey [1:19:30]; and
 • More.
 
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Longevity 101: a foundational guide to Peter's frameworks for longevity, and understanding CVD, cancer, neurodegenerative disease, nutrition, exercise, sleep, and more (re-broadcast)

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In this "Ask Me Anything" (AMA) episode, Peter revisits the "proven, promising, fuzzy, noise, nonsense" scale and applies it to a variety of popular topics. He begins with a refresher on what each category represents before classifying a range of interventions based on the strength of their supporting evidence. The conversation spans three main areas: drugs for geroprotection (including GLP-1 receptor agonists, SGLT2 inhibitors, methylene blue, and telomere-lengthening supplements), the use of low-dose aspirin for cardiovascular disease prevention, and strategies to improve muscle mass through optimal protein intake and follistatin gene therapy. This episode provides a clear, evidence-based overview for listeners seeking to understand where these popular health and longevity interventions stand on the spectrum of scientific credibility.
 
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 #76 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • A scale for evaluating scientific claims: proven, promising, fuzzy, noise, or nonsense [1:30];
 • Strong convictions, loosely held: the mindset that separates great scientists from the rest [7:30];
 • GLP-1 receptor agonists: are there benefits beyond improving metabolic health and promoting weight loss? [12:45];
 • GLP-1 drugs and the brain: exploring the potential cognitive benefits [18:45];
 • GLP-1 drugs and lifespan: examining the evidence for potential geroprotective effects [23:00];
 • Rapamycin and geroprotection: why it remains in the "promising" category [25:45];
 • SGLT2 inhibitors and their potential geroprotective effect [27:30];
 • Methylene blue: examining the evidence of an anti-aging effect [34:45];
 • Methylene blue's potential neuroprotective effects: limited and inconsistent evidence in humans, and the challenges of dosing and safety [41:15];
 • Telomeres: what they are, how they relate to aging, and why telomere-lengthening supplements lack credible scientific evidence [43:45];
 • Does the idea of targeting telomere length to extend lifespan have scientific merit? [50:15];
 • Low-dose aspirin for cardiovascular disease prevention: weighing its clot-prevention benefits against bleeding risks across different populations [55:00];
 • Rethinking the protein RDA: why most people need twice the recommended amount for muscle health [1:00:45];
 • Debunking the protein–cancer myth: why higher protein intake doesn't promote tumor growth [1:06:15];
 • The biology of follistatin and myostatin, and why follistatin gene therapy has become an emerging topic of interest for muscle growth [1:13:15];
 • Follistatin gene therapy for muscle growth: state of the evidence in animals and humans, and the technical challenges and regulatory barriers [1:17:00];
 • Why injectable follistatin is theoretically possible but impractical for real-world use [1:23:15]; and
 • More.
 
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#370 - AMA #76: Peter evaluates longevity drugs, aspirin for CVD, and strategies to improve muscle mass — proven, promising, fuzzy, noise, or nonsense?

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Rhonda Patrick is a scientist, health educator, and host of the FoundMyFitness podcast whose work explores the intersection of nutrition, aging, and disease prevention. In this episode, Rhonda joins Peter for part two of his deep dive on protein, continuing last week's discussion with David Allison and expanding the conversation to include creatine supplementation and sauna use. She discusses why the current RDA for protein is insufficient, how much more is needed to maintain muscle mass and prevent frailty, how activity level and aging influence protein requirements through mechanisms such as anabolic resistance, and how to determine optimal protein intake. The conversation also covers creatine's proven effects on strength, endurance, and performance; its overlooked benefits for cognition and brain health; and the optimal dosing for different populations. Rhonda closes with the science behind sauna use, including its cardiovascular and cognitive benefits, the role of heat shock proteins, and practical guidance on temperature and duration.
 
We discuss:
 
 • Why the current protein RDA is too low, and why maintaining sufficient amino acid intake is vital for muscle preservation and health [3:30];
 • The case for raising the protein RDA by at least 50% [9:45];
 • Anabolic resistance: why inactivity—more than aging—blunts the body's response to protein, and how resistance training restores it [14:00];
 • How sarcopenia develops, the profound effect of frailty on quality of life, and why it's crucial to build and maintain muscle early [20:00];
 • Finding the optimal protein dose [25:00];
 • Why aiming higher is smarter: the case for targeting 2g of protein per kg of body weight in the real world [32:15];
 • Protein needs for pregnant women and growing adolescents [37:30];
 • Why higher protein intake is crucial when trying to lose fat while preserving or gaining muscle [39:45];
 • GLP-1 drugs: protein needs, muscle preservation, dosing strategies, evidence of broader health impacts, and more [43:45];
 • How overweight individuals should calculate protein needs based on target body weight [50:45];
 • Unpacking a misunderstood topic: the relationship between protein intake, mTOR activation, and longevity [52:00];
 • Why it's unclear whether rapamycin is geroprotective in humans, and how misinterpreted animal data have fueled misconceptions about protein or mTOR activation being harmful [1:00:45];
 • The unmatched longevity benefits of exercise, its synergy with higher protein intake, and
 • Peter's recommended protein intake [1:06:15];
 • How Rhonda became fascinated with creatine—a well-studied, safe, and effective supplement for improving exercise performance [1:09:00];
 • Creatine for the brain: how higher doses may enhance cognition under stress and support resilience against aging and disease [1:16:30];
 • Optimal creatine use: dosing for adults and teens, safe product selection, debunking kidney myths, and more [1:25:45];
 • Sauna: how deliberate heat exposure mimics exercise, boosts cardiovascular and brain health, and shows promise for improving mood and mental resilience [1:32:15];
 • The benefits of sauna for reducing risk of dementia, and why hotter may not be better [1:41:15];
 • The FoundMyFitness podcast [1:45:30]; and
 • More.
 
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#369 ‒ Rethinking protein needs for performance, muscle preservation, and longevity, and the mental and physical benefits of creatine supplementation and sauna use | Rhonda Patrick, Ph.D.

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David Allison is a world-renowned scientist and award-winning scientific writer who has spent more than two decades at the forefront of obesity research. In this episode, David joins for his third appearance on The Drive to bring clarity to one of the most contentious topics in modern nutrition—protein. He explores the historical pattern of demonizing macronutrients, the origins and limitations of the RDA for protein, and what the evidence really says about higher protein intake, muscle protein synthesis, and whether concerns about harm are supported by actual data. He also discusses the challenges of conducting rigorous nutrition studies, including the limits of epidemiology and crossover designs, as well as conflicts of interest in nutrition science and why transparency around data, methods, and logic matter more than funding sources. The episode closes with a discussion on processed and ultra-processed foods, the public health challenges of tackling obesity, and whether future solutions may depend more on drugs like GLP-1 agonists or broader societal changes. This is part one of a two-part deep dive on protein, setting the stage for next week's conversation with Rhonda Patrick.
 
We discuss:
 
 • The cyclical pattern of demonizing different macronutrients in nutrition and why protein has recently become the latest target of controversy [3:15];
 • The origin and limits of the protein RDA: from survival thresholds to modern optimization [6:30];
 • Trust vs. trustworthiness: why data, methods, and logic matter more than motives in science [13:30];
 • The challenges of nutrition science: methodological limits, emotional bias, and the path to honest progress [17:15];
 • Why the protein RDA is largely inadequate for most people, and the lack of human evidence that high protein intake is harmful [30:30];
 • Understanding the dose-response curve for muscle protein synthesis as protein intake increases [45:15];
 • Why nutrition trials are chronically underpowered due to weak economic incentives, and how this skews evidence quality and perceptions of conflict [48:15];
 • The limitations and biases of nutrition epidemiology, and the potential role of AI-assisted review to improve it [56:15];
 • The lack of compelling evidence of harm with higher protein intake, and why we should shift away from assuming danger [1:04:15];
 • Pragmatic targets for protein intake [1:09:30];
 • Defining processed and ultra-processed foods and whether they are inherently harmful [1:16:15];
 • The search for a guiding principle of what's healthy to eat: simple heuristics vs. judging foods by their molecular composition [1:25:00];
 • Why conventional public health interventions for obesity have largely failed [1:38:15];
 • Two ideas from David for addressing the metabolic health problem in society [1:42:30];
 • The potential of GLP-1 agonists to play a large role in public health [1:46:30]; and
 • More.
 
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#368 ‒ The protein debate: optimal intake, limitations of the RDA, whether high-protein intake is harmful, and how to think about processed foods | David Allison, Ph.D.

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.
 
 Learn more at www.PeterAttiaMD.com
 
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#23 - Tom Dayspring, M.D., FACP, FNLA – Part IV of V: Statins, ezetimibe, PCSK9 inhibitors, niacin, cholesterol and the brain

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