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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 tackles a wide range of listener questions submitted over the past year. The discussion spans essential topics such as exercise—covering grip strength, traveling workouts, and why Peter doesn’t consider exercise an ideal weight-loss strategy—and the top biomarkers everyone should track. He also explores promising new longevity research, his evolving views on longevity, and frameworks like “objective, strategy, tactics” for personalized decision-making. The episode wraps up with insights on building good habits and a glimpse into Peter’s recent reading list.
 
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 Special AMA show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • Overview of episode topics (and Peter’s car stereo saga) [1:45];
 • The importance of grip strength and the best methods for training it effectively [3:45];
 • Exercise while traveling: strategies for staying active and maintaining an exercise routine [14:45];
 • Why women should prioritize strength training [18:00];
 • The limited role of exercise in weight loss and its greater importance in improving health, body composition, and insulin sensitivity [19:45];
 • The “top five most important biomarkers” for assessing health [22:45];
 • Promising developments in longevity research [28:15];
 • The development of Klotho as a neuroprotective drug: challenges, timelines of trials, and more [34:00];
 • Peter’s updated view on the potential of epigenome manipulation to restore aged cells to their youthful state [39:45];
 • How reversing age-related epigenetic changes in immune cells could revolutionize our approach to aging and disease [43:30];
 • The “objective, strategy, tactics” framework, and the importance prioritizing impactful lifestyle habits over less significant health trends [49:30];
 • Strategies for building and maintaining good habits [56:45];
 • How to think about drugs and supplements as part of a longevity toolkit [1:02:00];
 • Peter’s recent reading list [1:05:15]; and
 • More.
 
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#329 ‒ Special AMA: Peter on exercise, important labs, building good habits, promising longevity research, and more

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This is part two of a two-part mini-series on fertility and reproductive health. Paula Amato is a leading expert in female reproductive health and infertility, widely recognized for her contributions to advancing fertility treatment and research. In this episode, which follows last week's conversation on male fertility, Paula explores the biology of female fertility, including how hormonal changes regulate the menstrual cycle and ovulation, what those patterns reveal about fertility potential, and why both partners should be evaluated early in infertility workups. She discusses the role of the fallopian tubes, the causes of miscarriage, the impact of age and lifestyle on fertility, and treatment options for conditions like PCOS—including the emerging use of GLP-1 agonists. The episode also covers the evolution of IVF, advances in pre-implantation genetic testing, egg freezing, and the promise and limitations of next-generation reproductive technologies.
 
We discuss:
 
 • The finite nature of a woman’s egg reserve, how it changes over time, and the basic process of ovulation and fertilization [3:00];
 • How hormones influence egg selection, and how and why chromosomal errors lead to most miscarriages [5:30];
 • The full journey of conception—from hormonal cues triggering ovulation, to fertilization, embryo development, implantation, and early pregnancy risks [16:30];
 • How infertility is defined and diagnosed, and the broader trends contributing to rising infertility rates [25:15];
 • Fallopian tube damage: how STDs and scarring impact fertility and raise ectopic pregnancy risk [31:30];
 • Unexplained infertility: how doctors evaluate ovulation and cycles—and why more research on women’s health is needed [41:00];
 • The defining symptoms of polycystic ovary syndrome (PCOS), its hormonal characteristics, and its relationship with insulin resistance [44:00];
 • Managing PCOS without pregnancy: cycle regulation, androgen suppression, and insulin resistance treatment [46:00];
 • The treatment approach for women with PCOS who are trying to conceive: GLP-1 use, ovulation induction, and timing protocols [49:45];
 • Barriers to getting informed fertility care for PCOS: limited provider knowledge and access, insurance gaps, and next steps when ovulation treatments don’t lead to pregnancy [55:45];
 • Fertility treatment for women with unexplained infertility, risk of multiple pregnancies with superovulation, and more [1:03:00];
 • Intrauterine insemination (IUI): process, success rates, and when in vitro fertilization (IVF) becomes the better option [1:07:00];
 • The history of in vitro fertilization (IVF), and how access and acceptance have evolved over time [1:16:45];
 • The step-by-step process of IVF [1:19:30];
 • The IVF lab process: egg retrieval, fertilization, embryo culture, and freezing [1:26:30];
 • Genetic testing and embryo selection in IVF: aneuploidy screening, polygenic traits, and ethical concerns [1:41:15];
 • Embryo transfer in IVF: timing, uterine preparation, and implantation support [1:47:30];
 • Egg donation in IVF: indications, donor guidelines, and other considerations [1:50:45];
 • How to choose the right IVF clinic [1:54:45];
 Innovations in fertility on the horizon, advice about freezing eggs, and more [2:02:00]; • Optimizing fertility through lifestyle: diet, stress management, sleep, exercise, and supplementation [2:07:45];
 • Promising areas of fertility research [2:15:45]; and
 • More.
 
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#352 ‒ Female fertility: optimizing reproductive health, diagnosing and treating infertility and PCOS, and understanding the IVF process | Paula Amato, M.D.

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In this “Ask Me Anything” (AMA) episode, Peter revisits the topic of fasting, sharing how his thinking has evolved over time. The episode explores fasting-related terminology and common types of fasting, as well as the various reasons individuals might choose to fast. Peter explores potential benefits including improvements in body composition, metabolic health, lifespan extension, cardiovascular disease, cancer prevention and treatment, neurodegenerative conditions such as Alzheimer’s and Parkinson’s, and autoimmune symptoms like arthritis. He also examines the risks and potential downsides of fasting and offers a practical framework to help assess when and how fasting may be most appropriately applied.
 
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 #72 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • Why the topic of fasting is being revisited [1:45];
 • The importance of being open to changing one's opinion in science and medicine as new evidence emerges [4:15];
 • Defining fasting and how it fits in the framework of dietary restriction, time-restricted feeding, and calorie restriction [7:30];
 • The most common types of fasting [11:45];
 • Why someone might choose fasting over continuous caloric restriction [19:00];
 • The biochemical effects of fasting: fuel partitioning, autophagy, and more [21:00];
 • Autophagy: a cellular cleanup process stimulated by fasting and energy depletion [26:00];
 • Comparing the physiological effects of a ketogenic diet to those of long-term fasting [27:45];
 • How long fasting takes to induce ketosis and boost autophagy, and how autophagy is measured [29:45];
 • At-home tests for ketones [33:45];
 • Reducing senescent (“zombie”) cells and inflammation through autophagy [35:00];
 • Examining the evidence for the long-term health benefits of fasting beyond short-term metabolic effects [37:15];
 • The common health claims associated with fasting across metabolic, neurological, oncological, autoimmune, and longevity domains [40:30];
 • The impact of fasting on body weight and body composition [42:00];
 • Weight regain and potential metabolic consequences of fasting [44:00];
 • The risk of lean mass loss with fasting and how to mitigate it [47:15];
 A practical framework for using fasting as a strategy to improve body composition [52:15]; • How extended fasting compares to caloric restriction in improving insulin sensitivity in people with insulin resistance or type 2 diabetes [54:00];
 Is there any evidence that fasting can extend lifespan? [55:45]; • Examining whether fasting improves cardiovascular disease risk beyond the effects of weight loss and calorie reduction [58:15];
 • Exploring whether prolonged fasting can reduce cancer risk [59:45];
 • The potential benefits of fasting or fasting-mimicking diets during cancer treatment: emerging evidence and practical considerations [1:02:15];
 • Fasting for protection against neurodegenerative diseases: early evidence of therapeutic benefit and open questions [1:10:45];
 • Various fasting methods for autoimmune diseases: potential symptom relief with cautious application [1:14:00];
 • Fasting and type 1 diabetes: risks, evidence, and careful dietary alternatives [1:16:45];
 • Fasting and gut disorders: potential benefits outside of flare-ups [1:18:45];
 • The primary risks and downsides associated with fasting [1:19:45];
 • The essential vitamins and minerals to supplement during prolonged fasting [1:21:30];
 • Who should avoid fasting and why [1:22:15];
 • Fasting’s role in health: where it shows promise and where it likely offers no distinct advantage over caloric restriction [1:23:45]; and
 • More.
 
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#353 - AMA #72: Fasting: benefits for body composition and disease prevention, potential risks, and Peter’s updated practical framework

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In this "Ask Me Anything" (AMA) episode, Peter dives deep into one of the most frequently discussed and often misunderstood topics: nutrition. From weight loss and maintenance to the intricate relationship between nutrition and exercise and body composition, Peter addresses the complexities of nutrition research and explores the perennial question of whether there is a "best diet." He provides practical insights on how to choose the right diet for your unique needs, discusses the role of protein and processed foods, and outlines the key questions to help you optimize your approach to eating.
 
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 #66 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • The key nutrition-related topics to be discussed [1:30];
 • Why Peter is not fond of discussing nutrition: limitations of nutrition research, the pitfalls of extreme certainty in dietary discussions, and the body's adaptability to varied diets [3:30];
 • Key health metrics to monitor to evaluate the effects of nutrition [9:30];
 • The relationship between nutrition and exercise as they relate to weight loss, maintenance, and gain [12:30];
 • How increased muscle mass from resistance training impacts calorie burn, body composition, glucose metabolism, and overall health benefits [19:45];
 • Comparing the impact of fitness and nutrition on lifespan and healthspan: data showing fitness to be a more significant predictor of mortality than nutrition [23:30];
 • The myth of a “best diet,” factors that determine the effectiveness of a diet, and data suggesting benefits of the Mediterranean diet [39:00];
 • How long to trial a new diet, the importance of measurable goals, and the appropriate timescales for observing meaningful changes [48:30];
 • The inherent challenges in nutrition research: variability in dietary exposures, limitations in study design, the body’s adaptive nature which dampen the effects, and more [51:15];
 • Nutritional approaches for chronic diseases like cardiovascular disease and type 2 diabetes [58:45];
 • Emerging studies on dietary interventions for non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) [1:02:45];
 • Practical considerations for individuals to identify the best diet for them: protein intake, energy balance, macronutrient adjustments, and micronutrient levels [1:06:00];
 • Understanding processed vs. ultra-processed foods [1:09:15];
 • The effects of ultra-processed foods on health [1:12:30];
 • Questions that someone should ask themselves if they’re looking to fine-tune their diet [1:18:15]; and
 • More.
 
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#328 - AMA #66: Optimizing nutrition for health and longevity: myth of a “best” diet, complexities of nutrition science, and practical steps for building a sustainable diet

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James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the “Four Laws of Behavioral Change.” In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one’s self-identity. Finally, James breaks down his “Four Laws of Behavioral Change” and how to use them to create new habits, undo bad habits, and make meaningful changes in one’s life.
 
We discuss:
 
 • Why James became deeply interested in habits [2:00];
 • Viewing habits through an evolutionary lens [6:15];
 • The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:30];
 • The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:45];
 • How finding one’s passion can cultivate perseverance and discipline [23:30];
 • Advantages of creating systems and not just setting goals [29:30];
 • The power of habits combined with self-identity to induce change [36:45];
 • How a big environmental change or life event can bring on radical behavioral change [50:45];
 • The influence of one’s social environment on their habits [54:30];
 • How and why habits are formed [1:00:45];
 • How to make or break a habit with the “Four Laws of Behavior Change” [1:09:45];
 • Practical tips for successful behavioral change—the best strategies when starting out [1:16:30];
 • Self-forgiveness and getting back on track immediately after slipping up [1:30:45];
 • Law #1: Make it obvious—Strategies for identifying and creating cues to make and break habits [1:40:00];
 • Law #2: Make it attractive—examples of ways to make a new behavior more attractive [1:48:00];
 • Law #3: Make it easy—the 2-minute rule [1:59:00];
 • Law #4: Make it satisfying—rewards and reinforcement [2:03:45];
 • Advice for helping others to make behavioral changes [2:06:15]; and
 • More.
 
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Building & Changing Habits | James Clear (#183 rebroadcast)

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Trenna Sutcliffe is a developmental behavioral pediatrician and the founder and medical director of the Sutcliffe Clinic in the San Francisco Bay Area, where she partners with families to provide care for children facing behavioral challenges, developmental differences, and school struggles. In this episode, Trenna shares her journey into developmental and behavioral pediatrics, including her pioneering work at Stanford and her expertise in autism, ADHD, and anxiety—the "three As." She explores the diagnostic processes, the overlap and comorbidities of these conditions, and the importance of personalized treatment plans that address both medical and environmental factors. Trenna offers valuable insights into the changing prevalence of autism, the impact of evolving diagnostic criteria, and the range of therapies and medications available to support children and their families. She also discusses the challenges in accessing care and the critical need for a holistic approach that bridges healthcare and education.
 
We discuss:
 
 • Trenna’s passion for developmental-behavioral pediatrics (DBP), and the process of diagnosing anxiety, ADHD, and autism [3:15];
 • Understanding anxiety and ADHD: assessing impairment and self-esteem and identifying anxiety and emotional well-being in young patients [9:45];
 • The evolving diagnosis of autism: understanding the spectrum and individual needs [16:30];
 • The dramatic rise in autism spectrum disorder (ASD): genetics, environment, expanded diagnostic criteria, and more [25:45];
 • Exploring epigenetics and the potential multigenerational impact of environment exposures on susceptibility to certain disorders [37:15];
 • The evolution of autism classifications, and the particular challenges for children with level 1 (mild) autism due to a lack of support [41:15];
 • The broadening of the autism spectrum: benefits and risks of expanded diagnostic criteria and the need for future frameworks to focus on better outcomes [48:00];
 • The overlap between ASD, ADHD, and anxiety [57:15];
 • Understanding oppositional defiant disorder, and the importance of understanding the “why” behind a behavior when creating treatment plans [1:00:45];
 • Defining developmental-behavioral pediatrics (DBP), and Trenna’s professional journey [1:07:00];
 • Updated methods of ABA (applied behavioral analysis) therapy: evolution, controversies, challenges of scaling autism care, and the need for tailored interventions [1:13:45];
 • Advice for parents trying to find and evaluate care for children with autism, ADHD, or anxiety [1:22:45];
 Tailored treatments for ADHD: balancing stimulant medications with behavioral training [1:28:30]; • The interplay between medication, behavioral therapy, and neuroplasticity in managing ADHD, and the potential to grow out of the need for medication [1:39:45];
 • Using medication to treat anxiety and other symptoms in kids with autism without ADHD [1:44:45];
 • FAQs about medicating children with ADHD: benefits, side effects, dosage, and more [1:46:30];
 • The “superpowers” associated with level 1 autism [1:48:45];
 • The next steps to increase support for children with ASD, anxiety, and ADHD [1:50:45]; and
 • More.
 
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.

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Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav returns to dive deeper into his groundbreaking work as an endurance coach, exercise scientist, engineer, and physiologist. The discussion explores his data-driven approach to coaching, unpacking key performance metrics like functional threshold power, VO2 max, and lactate threshold, while emphasizing the importance of consistent testing protocols. Olav shares insights on how training methodologies differ across sports, the impact of nutrition on endurance performance, and the evolving strategies for carbohydrate metabolism in fueling athletes for races. Olav concludes with a discussion on the use of artificial intelligence for optimizing training insights and performance.
 
We discuss:
 
 • Olav’s unique, engineering-driven approach to endurance coaching [2:45];
 • Definitions and applications of key performance metrics: FTP, power, anaerobic threshold, and lactate threshold [4:45];
 • Lactate threshold: factors affecting lactate threshold, testing protocols, and how elite athletes' efficiency affects their performance and lactate profiles [14:15]
 • VO2 max: definition, testing, factors affecting its accuracy, and methods for optimizing oxygen utilization in elite athletes [22:15];
 • Testing VO2 max: common mistakes and key factors to consider—preparation, warm-up, timing, and more [34:00];
 • VO2 max testing continued: measuring instruments, testing protocols, and advanced insights gained from elite athletes [41:45];
 • The influence of supplements like beetroot concentrate and adaptogens on VO2 max and performance [49:45];
 • How respiratory quotient (RQ) reflects metabolic shifts during exercise, the challenges in measuring and interpreting RQ in elite athletes, and the physiological adaptations needed for prolonged endurance events [53:30];
 • Triathlon training: the challenge of maintaining elite performance across triathlon distances, metabolic efficiency, and swimming challenges [1:03:15];
 • How reducing drag in swimming could revolutionize performance and the role of biofeedback tools in optimizing efficiency across various endurance sports [1:07:00];
 • How endurance athletes prioritize effort regulation using RPE, heart rate, and power output, and the role of lactate in cardiac and athletic efficiency [1:20:00];
 • Lactate’s role as a fuel, buffering methods to combat lactic acidosis, and the variability in athlete response to bicarbonate supplementation [1:25:45];
 • The physiological mechanisms behind differences in performance between two elite athletes: lactate transport, cardiovascular efficiency, and compensatory systems [1:33:00];
 • Comparing interventions like acetaminophen to enhance performance in high-heat conditions versus natural adaptations to heat [1:37:15];
 • Advancements in nutrition science, changes in cyclist body composition, and the impact of fueling strategies on athletic performance and growth [1:39:30];
 • Optimizing endurance performance with utilization of carbohydrates, and the potential role of ketones [1:48:00];
 • Insights gained from elite performers in the 2020 and 2024 Olympics [1:58:30];
 • The use of artificial intelligence to optimizing training insights and performance [2:06:30]; and
 • More.
 
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#331 ‒ Optimizing endurance performance: metrics, nutrition, lactate, and more insights from elite performers | Olav Aleksander Bu (Pt. 2)

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In this “Ask Me Anything” (AMA) episode, Peter tackles a topic that's been dominating headlines and sparking widespread concern: microplastics and plastic-associated chemicals, including BPA, PFAS, and phthalates. Peter explores the science behind these substances including how and why they've become so prevalent, the extent of our exposure, and the potential risks to our health. Most importantly, he provides a practical framework for understanding microplastics and plastic-associated chemicals and minimizing exposure while distinguishing genuine risks from exaggerated concerns.
 
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 #67 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • The complexity of the topic of microplastics and associated chemicals [1:30];
 • Definitions: microplastics, BPA, PM2.5, phthalates, and more [6:30];
 • The reasons behind the increase in microplastics in our environment and the surge in interest in them [12:00];
 • The various ways that humans are exposed to microplastics and nanoplastics [14:00];
 • Volume of plastic consumed by humans, and how the body eliminates or absorbs microplastics [16:00];
 • How microplastics accumulate in the body, the variability in tissue accumulation, and the challenges in studying their long-term health effects [21:30];
 • Limitations of blood tests for microplastics, and the importance of reliable biomarkers for guiding behavior and interventions [26:30];
 • The speculative health risks of microplastics, the limitations of current research, and the need for more robust studies [29:15];
 • The challenges of measuring microplastics in human tissues, the need for better methodologies, and the importance of critically evaluating study relevance and claims [39:45];
 • If it’s unclear whether microplastics actually cause harm, should we still be concerned about exposure? [42:15];
 • Strategies to minimize microplastic exposure [45:00];
 • The financial cost and effort involved in various microplastic exposure mitigation strategies [51:00];
 • The role of airborne microplastics in total exposure and accumulation [1:03:00];
 • Chemicals associated with plastics, their role as endocrine disruptors, and the challenges in linking exposure to specific health outcomes [1:04:00];
 • BPAs: role in plastic production, and its potential developmental risks [1:05:45];
 • BPA's potential health risks: pregnancy, fertility, obesity, and diabetes, and the socioeconomic confounders in the data [1:08:30];
 • Regulatory limits on BPA exposure, and practical considerations for reducing exposure [1:12:45];
 • The prevalence of BPA in modern products and how to identify it [1:17:15];
 PFAS: chemical structure and purpose in products [1:18:30]; • Why PFAS are considered endocrine disruptors [1:19:45];
 • The main sources of PFAS exposure, and practical steps to reduce exposure [1:21:30];
 • The potential health risks of PFAS exposure [1:24:00];
 • Phthalates: role in making plastics flexible and presence in personal care products [1:24:45];
 • Why phthalates are considered endocrine disruptors [1:25:15];
 • The main sources of phthalate exposure, and how manufacturing practices are evolving to reduce exposure [1:26:45];
 • Practical strategies to reduce exposure to phthalates in food, air, water, and personal care products [1:28:30];
 • Navigating microplastics and associated chemicals: a framework for personalized risk reduction [1:29:30]; and
 • More.
 
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#332 - AMA #67: Microplastics, PFAS, and phthalates: understanding health risks and a framework for minimizing exposure and mitigating risk

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In this special episode of The Drive, Peter introduces a brand-new roundtable format. Joined by three renowned experts in longevity science—Steven Austad, Richard Miller, and Matt Kaeberlein—the group explores the rapidly evolving field of geroscience. Together, they dive deep into topics like the relationship between healthspan and lifespan, evaluating interventions like rapamycin and senolytics, the role of epigenetic changes in aging, and whether GLP-1 receptor agonists hold geroprotective potential. They also tackle major challenges in funding and public acceptance of longevity research including how geroprotective interventions might be tested in humans. Packed with nuanced debate, humor, and groundbreaking insights, this episode is a must-listen for anyone fascinated by the science of aging.
 
We discuss:
 
 • The recent rise in public interest in longevity, misconceptions, and the link between healthspan and lifespan [3:45];
 • Redefining healthspan, the US healthcare paradox, and separating longevity science from commercial hype [12:30];
 • The need to redirect medical research from disease-specific models to aging-focused approaches [21:30];
 • Proactive healthcare: rethinking health, disease, and the role of aging [30:00];
 • Biologic age versus chronologic age, and the limitations and potential of epigenetic clocks [35:00];
 • The utility and drawbacks of the “hallmarks of aging” as a framework for research and funding [49:30];
 • The role of epigenetic changes in aging and the challenges of proving causality [56:45];
 • The translational challenges of moving aging research from preclinical studies to human applications [1:03:45];
 • Distinguishing between a biomarker of aging and aging rate indicators [1:17:15];
 • The difficulties of translating longevity research in mice to humans, and the difficulties of testing interventions in humans [1:21:15];
 • Exercise, aging, and healthspan: does exercise slow aging? [1:35:45];
 • Are GLP-1 receptor agonists geroprotective beyond caloric restriction effects? [1:41:00];
 • The role of senescent cells in aging, challenges with reproducibility in studies, and differing views on the value of current research approaches [1:46:15];
 • How funding challenges and leadership in NIH and other institutes impact the advancement of aging-related research [2:00:15];
 • Metformin: geroprotective potential, mechanisms, and unanswered questions [2:02:30];
 • Canagliflozin and rapamycin as geroprotective molecules: mechanisms, dosing strategies, and longevity potential [2:10:45];
 • Resveratrol and NAD precursors—a lack of evidence for anti-aging effects [2:22:45];
 • The potential of parabiosis and plasmapheresis to slow aging, the challenges in translating mouse studies to humans, and possible design for human studies [2:29:45]; and
 • More.
 
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#333 ‒ Longevity roundtable — the science of aging, geroprotective molecules, lifestyle interventions, challenges in research, and more | Steven Austad, Matt Kaeberlein, Richard Miller

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Tom Dayspring is a world-renowned expert in clinical lipidology and a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis and why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men and women. He examines how the disease develops from a pathological perspective and discusses key risk factors, including often-overlooked contributors such as insulin resistance and chronic kidney disease. He breaks down the complexities of cholesterol and lipoproteins—including LDL, VLDL, IDL, and HDL—with an in-depth discussion on the critical role of apolipoprotein B (apoB) in the development of atherosclerosis. Additionally, he covers the importance of testing various biomarkers, the impact of nutrition on lipid levels, and the vital role of cholesterol in brain health, including how cholesterol is synthesized and managed in the brain, how it differs from cholesterol regulation in the rest of the body, and how pharmacological interventions can influence brain cholesterol metabolism.
 
We discuss:
 
 • Defining atherosclerotic cardiovascular disease (ASCVD): development, risks, and physiological impact [2:45];
 • The pathogenesis of ASCVD: the silent development over decades, and the importance of early detection for prevention of adverse outcomes [10:45];
 • Risk factors versus risk markers for ASCVD, and how insulin resistance and chronic kidney disease contribute to atherosclerosis [17:30];
 • How hyperinsulinemia elevates cardiovascular risk [24:00];
 • How apoB-containing lipoproteins contribute to atherosclerosis, and why measuring apoB is a superior indicator of cardiovascular risk compared to LDL cholesterol [29:45];
 • The challenges of detecting early-stage atherosclerosis before calcification appears [46:15];
 Lp(a): structure, genetic basis, and significant risks associated with elevated Lp(a) [55:30]; • How aging and lifestyle factors contribute to rising apoB and LDL cholesterol levels, and the lifestyle changes that can lower it [59:45];
 • How elevated triglycerides, driven by insulin resistance, increase apoB particle concentration and promote atherosclerosis [1:08:00];
 • How LDL particle size, remnant lipoproteins, Lp(a), and non-HDL cholesterol contribute to cardiovascular risk beyond apoB levels [1:21:45];
 • The limitations of using HDL cholesterol as a marker for heart health [1:29:00];
 • The critical role of cholesterol in brain function and how the brain manages its cholesterol supply [1:36:30];
 • The impact of ApoE genotype on brain health and Alzheimer's disease risk [1:46:00];
 • How the brain manages cholesterol through specialized pathways, and biomarkers to track cholesterol health of the brain [1:50:30];
 • How statins might affect brain cholesterol synthesis and cognitive function, and alternative lipid-lowering strategies for high-risk individuals [1:57:30];
 • Exciting advancements in therapeutics, diagnostics, and biomarkers coming in the next few years [2:09:30];
 • Recent consensus statements on apoB and Lp(a) from the National Lipid Association (NLA) [2:12:30]; and
 • More.
 
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#334 - Cardiovascular disease, the number one killer: development, biomarkers, apoB, cholesterol, brain health, and more | Tom Dayspring, M.D.

Pronounced, el-pee-little-a, this lipoprotein is simply described as a low density lipoprotein (LDL) that has an apoprotein “a” attached to it...but Lp(a) goes far beyond its description in terms of its structure, function, and the role that it plays in cardiovascular health and disease. Affecting about 1-in-5 people, and not on the radar of many doctors, this is a deep dive into a very important subject for people to understand.
 
 • A quick primer on lipoproteins [7:30];
 • Intro to Lp(a) [11:00];
 • Lab tests for Lp(a) and reference ranges [20:00];
 • The physiologic functions of Lp(a) [31:00];
 • The problems associated with high Lp(a) [34:15];
 • Lipid-lowering therapies of Lp(a) [44:45];
 • Lp(a) modification through lifestyle intervention [1:00:45];
 • High LDL-P on a ketogenic/low-carb-high-fat diet [1:05:30]; and
 • More
 
 Learn more at www.PeterAttiaMD.com
 
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#07 - Deep Dive: Lp(a) — what every doctor, and the 10-20% of the population at risk, needs to know

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