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    #15 - Paul Conti, M.D.: trauma, suicide, community, and self-compassion

    enSeptember 17, 2018

    Podcast Summary

    • Empathy and Understanding: Insights on Mental Health from Doctor Paul ConteeDoctor Paul Contee emphasizes the importance of compassion and holistic approaches in addressing mental health, highlighting the interconnected nature of trauma, shame, depression, and suicide. His plan to write a book promises to enhance understanding in this field.

      Empathy and understanding of the human condition are crucial in the field of psychiatry. Despite experiencing personal tragedies that he does not openly discuss, Doctor Paul Contee remains one of the most empathetic and kind individuals. In the interview, he delves deep into the topics of trauma, emotional trauma, shame, depression, and suicide, all of which are interconnected. Although the conversation does not touch on technical aspects, it conveys the importance of addressing mental health issues in a compassionate and holistic manner. Doctor Contee's plan to write a book on these subjects is encouraging, as it will contribute to a better understanding of mental health and how to approach it. Overall, this episode offers valuable insights for anyone interested in the human mind and emotions.

    • The Power of Shared Struggle and Empathy in Medical School FriendshipsThe bond formed by a group of medical school classmates, based on shared experiences of struggle and personal growth, drives their pursuit of medicine and shapes their career choices.

      The bond and friendship formed by a group of medical school classmates was deeply influenced by their shared experiences of struggle and personal growth. Despite not being premeds and being slightly older than their peers, this group of seven individuals became inseparable from the first week of school. Their decision to pursue medicine was not just driven by ambition, but by a genuine search for truth and a desire to understand and heal their own wounds. The common thread of suffering and trauma allowed them to be open and honest with each other, forming strong bonds rooted in empathy and the shared pursuit of making a difference in the lives of others. These experiences shaped their career choices and drove them to embark on paths they may not have initially anticipated.

    • The Connection Between Helping Others and Personal FulfillmentHelping others is not separate from fulfilling our own needs; it is a means to explore and address our inner struggles, leading to personal fulfillment.

      There is no distinction between the things we do for others and the things we do for ourselves. It is a false dichotomy that follows Western logic. The best things we do for others often come from a search for healing and soothing within ourselves. This realization was part of the journey for the seven friends who went to medical school together, creating a strong bond among them. Prior to medical school, Paul Conti had pursued a career in finance, but he realized that he was not happy because he was missing the intensity of human interaction and struggle. By delving into understanding others and helping them, he discovered that it was a way to explore and address the things going on inside himself. It was not about being selfless or altruistic, but rather a way to find personal fulfillment.

    • Breaking the Silence: Overcoming the Challenges of expressing Vulnerabilities in SocietySociety must create a supportive environment that values mental health and encourages individuals to seek help and express their struggles without fear of judgment or shame.

      Society has structured itself in a way that makes it difficult for people to express their vulnerabilities and seek help. The inability to communicate one's struggles and emotions can be draining and even lead to death in extreme cases. Both suicide and a sense of desperate recklessness stem from unmet needs and a lack of support. This silent bravado and struggle often goes unnoticed, resulting in a functional death where individuals are physically alive but emotionally dead. The constant pressure to achieve and the pervasive influence of media further contribute to the suppression of vulnerability. It is crucial to create a space that encourages people to pause, reflect, and value themselves based on their own values rather than external markers of success. Society needs to prioritize mental health and provide avenues for genuine acknowledgment and assistance.

    • The Importance of Integrating Brain Biology and Psychology in PsychiatryA comprehensive understanding of both brain biology and psychology is crucial in psychiatry, as it allows psychiatrists to effectively help patients by considering the structural neurobiology of the brain and incorporating psychodynamic principles.

      A comprehensive understanding of both brain biology and psychology is crucial in the field of psychiatry. The speaker, Paul Conti, highlights the importance of being trained in both aspects to effectively help patients. He emphasizes that many psychiatrists lack sufficient knowledge in brain biology and fail to consider the structural neurobiology and neurochemistry of the brain when prescribing medications. On the other hand, he also stresses the significance of incorporating psychology, particularly psychodynamic principles, to truly understand and help individuals. Conti was fortunate to have split his training between Stanford and Harvard, where he gained a deep understanding of both brain biology and psychology. Ultimately, integrating these two disciplines provides psychiatrists with a broader skill set to assist patients effectively.

    • The Misinterpretation of Psychological ConceptsUnderstanding the true meanings of psychological terms is crucial in order to overcome defense mechanisms and establish genuine connections with ourselves and others, ultimately leading to happiness and authenticity.

      Our understanding of psychological concepts can often be hindered by the different interpretations of words and terms. For example, the Freudian concept of the ego refers to the whole self, the part of ourselves that is conscious and can address questions and issues. However, in modern usage, ego is often seen as a defense mechanism and a sense of self. This defense mechanism, built upon insecurities and the need for perfection, can lead to maladaptive behaviors and hinder genuine connections with ourselves and others. Psychotherapy and the use of psychedelics, in a controlled setting, can help break down these unhealthy defenses and allow us to experience our true selves, including our vulnerabilities and the things we may be ashamed of. Ultimately, prioritizing happiness and authenticity is essential, as longevity means little if we are miserable.

    • The Modern World: Opportunities and AvoidanceIn a world of abundance, it is crucial to pause and reflect on our vulnerabilities, personal needs, and aspirations to truly find fulfillment and contentment.

      The modern world has provided us with an abundance of opportunities, but it has also created a greater opportunity to avoid facing our vulnerabilities and insecurities. While these opportunities have allowed us to achieve and excel in various aspects of life, they have also fueled a constant desire for perfection and more accomplishments. As we strive for power and success, we often find ourselves running away from our own vulnerabilities and using external achievements as a shield. The modern world lacks clear guidance on what we should truly strive for and what it means to be fulfilled and content. It is important to recognize the impact of societal expectations and take time to reflect on our own personal needs and aspirations.

    • Understanding the Impact of Trauma on Mental HealthTrauma plays a significant role in mental health, affecting conditions that may seem unrelated. By recognizing trauma as a primary driver, practitioners can improve understanding and treatment for better mental health outcomes.

      Trauma is a pervasive and significant factor in the mental health of individuals and society as a whole. Paul Conti argues that approximately 80% of what he treats in his diverse psychiatric practice is trauma-related. Even conditions that may initially appear to be solely biologically determined, such as head injuries or addiction, are still influenced by the impact of trauma. Conti challenges the current approach in psychiatry that tends to categorize and diagnose people without truly understanding them. He believes that this categorization often misses the human aspect of individuals and their unique experiences. By acknowledging and addressing trauma as a primary driver of mental health issues, practitioners and patients can move towards a more comprehensive and effective understanding and treatment of mental health.

    • Neglecting Mental Health and Human Connection: A Recipe for TragedySociety's disregard for mental well-being and lack of human connection can lead to devastating consequences, including increased rates of suicide. It is crucial to address societal maladies and prioritize mental health to prevent profound and tragic outcomes.

      Society's tendency to isolate individuals and disregard their mental well-being can have devastating consequences, as evidenced by increasing rates of suicide. This not only impacts psychiatry's ability to help improve mental health, but it also permeates other aspects of society, leading to desperation and misery. The conversation highlights the importance of addressing societal maladies, such as the depersonalization caused by automated phone systems and a lack of genuine human connection. Peter Attia's approach to longevity also emphasizes the significance of understanding mortality trends, with suicide being a consistent top cause of death in every decade except the first. The conversation serves as a reminder that neglecting mental health and failing to prioritize human connection can have profound and tragic outcomes.

    • The Link Between Trauma, Mental Health, and Overall Well-beingRecognizing the impact of trauma on mental well-being is crucial to addressing underlying causes of distress and promoting healthier lives.

      Many deaths, while they may not be labeled as suicide, are ultimately the result of underlying trauma and a lack of mental well-being. The conversation highlights the importance of recognizing the role of trauma in shaping a person's life and the impact it can have on their overall health. It is suggested that factors such as depression, stress, and past traumatic experiences can contribute to various health issues, including cardiovascular disease, addiction, and even cancer. This conversation serves as a reminder to prioritize mental health and address the underlying causes of distress in order to promote healthier, longer lives. Overall, understanding the connection between trauma, mental health, and overall well-being is vital in providing comprehensive care to individuals.

    • Unseen scars: Understanding the lasting impact of traumaTrauma can have long-lasting effects on mental and emotional well-being, making it important to acknowledge and address these experiences for healing and growth.

      Trauma and its impact on individuals is often overlooked or minimized. People tend to ignore or downplay the effect of terrible experiences, such as assault or the loss of a loved one, on their inner lives. However, these experiences can symbolize deeper feelings of hopelessness, instability, or a constant struggle without any hope of progress. Many individuals may carry these experiences with them for years, repeatedly replaying them in their minds. It is crucial to recognize that trauma can manifest in various ways, including abuse, neglect, abandonment, measurement, and witnessing tragic events. Acknowledging and addressing trauma is vital for healing and overcoming the negative effects it can have on mental and emotional well-being.

    • Understanding the Emotional Impact of TraumaApproach discussions about trauma with empathy, as it can trigger deep-seated emotions. Understanding the impact of trauma helps support healing and positive growth.

      Traumatic experiences can have a significant impact on a person's emotions and reactions. It is important to approach discussions about trauma with empathy and understanding, as these experiences can trigger deep-seated emotions and bring up feelings of shame and fear. A skilled mental health clinician knows how to navigate these conversations gently and uncover the areas of pain and vulnerability. Trauma not only affects what happens to a person, but more importantly, it influences how they feel about themselves and the world around them. Understanding this can help us better support and empathize with individuals who have experienced trauma, allowing them to heal and move forward in a healthy and positive way.

    • The Unresolved Trauma Cycle: Understanding the Impact and Importance of HealingUnresolved trauma can have lasting effects on mental and physical well-being, and addressing and healing this trauma is essential for leading a healthier and happier life.

      Unresolved trauma can have long-lasting effects on a person's mental and physical well-being. Paul Conti emphasizes that shame plays a significant role in perpetuating this trauma, making the individual feel at fault for their pain. Trauma triggers, such as a child reaching the age at which a traumatic event occurred, can reawaken these feelings of fear and vulnerability. The brain does not differentiate time when it comes to trauma, as it remains immediate and impactful regardless of how long ago the event took place. This unresolved trauma can lead to internal stress, which can contribute to various health problems like cardiovascular disease, cancer, autoimmunity, and ultimately reduce our healthy lifespan. It is crucial for individuals to address and heal their trauma in order to lead healthier and happier lives.

    • The Undeniable Impact of the Brain on the BodyEmotional trauma from the past can have a profound effect on physical health, highlighting the importance of addressing and healing internal struggles for overall well-being.

      The brain has a powerful impact on the body. This was evident in the case of the patient who was doing everything right in terms of nutrition and exercise, yet still struggled with inflammation and insulin resistance. It was discovered that a traumatic event in her past had a profound effect on her metabolic rate. This emphasizes the importance of addressing and healing emotional trauma for overall health and well-being. The brain's ability to shut off vision, movement to a limb, and even impact metabolism showcases the interconnectedness of mental and physical health. It is crucial for society to recognize and appreciate the significant influence that internal struggles can have on our overall functioning.

    • The Power of Our Inner VoicesUnderstanding the impact of negative self-talk and seeking support can lead to personal growth, fulfillment, and breaking free from destructive patterns.

      Our inner voices can have a profound impact on our well-being. The story highlights how trauma can manifest in the form of negative self-talk and deeply ingrained beliefs of inadequacy. These internalized messages can influence our thoughts, emotions, and physical health, ultimately hindering our ability to reach our full potential. It emphasizes the importance of understanding the origins of our negative self-perception and seeking support to challenge and change these destructive patterns. By addressing these internal struggles, we can create profound transformations in our lives, finding fulfillment, and breaking free from the endless cycle of self-doubt and striving for perfection. This story serves as a reminder to be compassionate towards ourselves and others, as we may never truly know the battles someone is fighting within.

    • Breaking the Cycle of Shame and TraumaUnderstanding and addressing the root causes of shame and trauma is crucial in preventing their transference to future generations and fostering healing.

      Understanding and addressing the underlying causes of shame and trauma is crucial in breaking the cycle and preventing the transference of these negative emotions to future generations. The impact of shame and trauma can manifest in different ways, often in a manner orthogonal to the original experience. This means that it is not necessary for the child of an abusive parent to become abusive themselves, but rather, the shame may find an alternative outlet in their lives. It takes multiple generations to work through and eliminate shame without proper intervention and understanding. Without addressing these root causes, human suffering and negative outcomes can persist silently, leading to a life of regrets and burdens. It is vital to educate ourselves and have open conversations about shame and trauma to break this cycle and foster healing.

    • The Illusion of Power and PerfectionTrue strength comes from embracing vulnerability and being honest about our struggles, rather than constantly striving for power and perfection. Success does not necessarily equal happiness or fulfillment.

      Our obsession with power and achievement can often lead to unhappiness and a lack of wholeness in our lives. Dr. Paul Conti questions why we feel the need to constantly be powerful and perfect, and why we are ashamed if we are not. He emphasizes that the belief that "what doesn't kill us makes us stronger" is a lie. In reality, the hardships we face can weaken us and cause long-lasting emotional pain if we don't acknowledge and address them. Dr. Conti argues that true strength lies in embracing vulnerability and being honest with ourselves and others about our struggles. He believes that achieving high levels of success may actually be a defense mechanism rather than a genuine indicator of happiness or fulfillment. Ultimately, we are all just individuals trying to navigate life and find our own sense of wholeness.

    • Embracing discomfort for personal growth and well-being.Confronting fears, opening up, and finding common ground can lead to personal growth and a sense of connection with others, while consistent support and self-reflection are crucial for maintaining progress.

      Making ourselves healthier often requires facing discomfort and exposing our vulnerabilities. The bridge, which is a trauma therapy program, embraces this philosophy by challenging individuals to confront their fears and open up about their struggles. The nickname "Camp misery" and "the crying factor" highlight the difficult and emotional journey involved in improving our well-being. Despite initial reservations, the speaker realizes the power of the program's approach, particularly the experience of having a roommate with whom he initially believed he had nothing in common. This experience taught him that regardless of our paths and backgrounds, we are all fundamentally the same. Additionally, attending 12-step meetings every night reinforced the importance of consistent support and self-reflection, even when emotionally exhausted.

    • Embracing vulnerability in group settings for personal growth and healing.Separating ourselves and feeling superior hinder personal development; embracing vulnerability and finding supportive communities fosters healing and growth.

      Vulnerability in a group setting can be a powerful antidote to shame. Peter Attia shares his experience in 12 step meetings where he found solace in the fact that nobody cared about his achievements or status. In these meetings, everyone was equal and there was no hierarchy. This allowed him to truly listen and be present without feeling the need to be the smartest or give advice. This lack of judgment and the focus on vulnerability created a safe space for healing and growth. The key lesson is that separating ourselves from others and feeling superior can hinder our personal development. Instead, we should strive to embrace vulnerability and find supportive communities where openness and empathy are valued.

    • The balance between standing out and connecting with othersEmbracing our shared experiences and connecting with others is essential for avoiding isolation and finding healing.

      We often feel the need to stand out or differentiate ourselves because it helps us avoid feeling superior or ashamed. While this drive can lead to positive outcomes, such as expertise and being the focus in a room, it can also result in isolation and loneliness. We must be aware of when we are separating ourselves from the world, as this prevents us from experiencing our shared humanity and connecting with others. Trying to escape from our own issues by differentiating ourselves only guarantees loneliness. Instead, we should strive to be part of the humanity around us, relate to people, and understand that everyone suffers from human things. By recognizing our shared experiences, we can find places of openness and shared humanity that help us heal.

    • Embracing shared experiences and challenging societal assumptions to foster learning and self-acceptance.Everyone has something valuable to teach, regardless of their appearance or status. We should recognize the shared humanness in each individual and create spaces for mental health education and trauma acknowledgment.

      Everyone has something valuable to teach, regardless of their outward appearance or societal status. The story highlights the transformation of a young woman who has struggled in life and found her way to self-acceptance. She ends up teaching a neurosurgeon valuable lessons, challenging the assumption that knowledge and wisdom only come from those in positions of authority. This emphasizes the importance of recognizing the shared humanness in all individuals and the potential for learning from their unique experiences. Society needs to create spaces where mental health education and trauma acknowledgment are not rare occurrences but readily available resources. The story also underscores the power of shared experiences and the comfort it brings, defying the notion of perfection and shame.

    • The Pursuit of External Validation and its Impacts on HappinessTrue happiness cannot be found through material wealth or social status alone, but requires personal growth, purpose, and authentic connections with others.

      Our society often defines success and happiness in terms of material wealth, physical attractiveness, and social status. David Foster Wallace argues that we are all worshiping some form of "god," whether it be money, power, or intellect. However, he suggests that this pursuit of external validation ultimately leads to emptiness and dissatisfaction. Peter Attia reflects on his own experiences and those of his educated and privileged friends, who, despite having all the advantages, still feel profoundly sad. This highlights the disconnection between societal expectations and true fulfillment. It serves as a reminder that true happiness cannot be achieved through external achievements alone, but must also involve a deeper sense of purpose, personal growth, and authentic connection with others.

    • The Importance of Finding Meaning in LifeFinding purpose and meaning in our lives is essential for our overall happiness and fulfillment. Struggling can provide a sense of purpose, and reflecting on what truly matters helps us live a more meaningful life.

      The prevalence of suicide in our society raises questions about the meaning we find in our lives. Despite being wired to survive, many individuals in the current generation feel lost and disconnected. It seems that our expectations have increased while our happiness has declined. Struggle, however, can provide a sense of purpose and meaning. People who find meaning in survival, whether in war zones or personal battles, are more motivated to continue living. Without a sense of meaning, the desire to survive diminishes. We must reflect on how we value ourselves and what truly matters in our lives, going beyond external factors like success, wealth, or societal approval. Finding concrete meaning in our existence is crucial for a happier, more fulfilled life.

    • Finding Meaning in Struggle and Our ActionsFinding meaning in our struggles and actions is essential for our well-being, providing a sense of purpose and fulfillment in our lives.

      Finding meaning in struggle is essential for our well-being. When people go through difficult times, they often find the strength to persevere because they see the purpose and value in their struggle. However, when the struggle is over or when we're not actively facing challenges, we may struggle to value ourselves and understand our worth. This is especially true in modern society, where the complexities of life and the lack of a clear sense of community can make it difficult to find meaning. Without a sense of meaning, we may start questioning our purpose and the difference we are making. It is important to recognize the importance of finding meaning in our actions and helping others, as it can provide a sense of purpose and fulfillment in our lives.

    • Addressing Isolation and Building CommunityIt is alarming that something as simple as a medical bill can hinder someone's ability to provide food for themselves. This emphasizes the need to combat isolation and create a society that supports and uplifts everyone.

      There is a tremendous sense of isolation and lack of community in our society, which affects both those who have enough and those who don't. It's concerning to think that a $500 medical bill can prevent someone from putting food on the table. This highlights the struggles and vulnerabilities that many people face, even in a society with plenty of opportunity. The sense of isolation and lack of shared responsibility is a disease that needs to be addressed. While it may seem difficult to find a remedy, there are ways to make a difference and create a stronger sense of community. It's important to have dialogues and take actions that can truly help alleviate these struggles and build a more supportive society.

    • Building Community Support: A Solution to Society's Loneliness and IsolationPrioritizing community support and creating a sense of belonging can combat the prevalent loneliness and isolation in society, enhancing overall well-being and progress.

      Society has lost the sense of community and support that is crucial for individuals' well-being. Dr. Paul Conti highlights the need for places where people can come together, have shared experiences, and receive psychoeducation. He emphasizes the importance of building community support centers, which were once publicly funded and provided assistance to mentally ill individuals. Dr. Conti also criticizes the absurdity of society's priorities, where millions are spent on intensive care stays but basic needs are overlooked. To survive and progress as a society, we must prioritize mutuality and community support, recognizing that everyone has something to offer and benefit from. Creating tribes and fostering closeness, even in our busy lives, can help combat the loneliness and isolation prevalent in society today.

    • The Importance of Nurturing FriendshipsMaintaining meaningful connections with friends is crucial for a fulfilling life, despite the challenges of busy schedules and prioritizing work. Strive to spend quality time with friends to meet emotional needs and strike a balance in life.

      Maintaining meaningful connections with friends becomes increasingly difficult as life gets busier. Many people go months, even years, without truly connecting with those who are important to them. This automaticity in prioritizing work and responsibilities over relationships often stems from insecurities and fears of missed opportunities or lower success. However, it is crucial to recognize the value and importance of nurturing these friendships. Despite having spouses or partners, there are certain needs that can only be met by friends of the same gender. As we age, have families, and pursue careers, it is easy to lose touch with these friends, but it is essential to make the effort to spend quality time with them. Striking a balance between work, relationships, and personal well-being is vital for a fulfilling life.

    • Rethinking Romantic Expectations and Embracing ConnectionSociety's pressure for one person to fulfill all our needs in a romantic relationship is unrealistic. Embracing diverse relationships and seeking therapy can provide the support and growth we need.

      Societal expectations of romantic relationships often lead to unrealistic and unhealthy pressures on individuals to be everything to their partners. This belief that one person can fulfill all our needs is a fallacy that disregards the inherent complexity of human connection. Instead, we should recognize the value of diverse relationships and communities that offer different types of support and connection. By embracing a communal way of living, we can find balance, avoid negative consequences such as cult-like affiliations, and fulfill our natural need for connection and variety. Additionally, it is crucial to be aware of our internal dialogue and question the repetitive thoughts that may reinforce damaging beliefs about ourselves. Seeking therapy and exploring trauma-based treatment options can provide invaluable support for those seeking healing and personal growth.

    • The Importance of Understanding Ourselves and Connecting with OthersOpen communication, seeking professional help, and engaging with literature are essential for personal growth and well-being. Fostering self-compassion is crucial for overcoming shame and seeking help when necessary.

      Developing a better understanding of ourselves and connecting with those around us is essential for personal growth and well-being. Paul Conti emphasizes the importance of open communication with trusted individuals and seeking professional help when needed. He suggests that therapy is beneficial for everyone, as it allows us to gain insight into our thoughts and emotions without feeling like a burden to others. Additionally, Conti highlights the significance of literature in understanding our shared humanity. He recommends Albert Camus' "The Plague" as a reflection on how we navigate life's challenges, and Catherine Mansfield's short stories for their portrayal of subtle nuances in human interaction. Ultimately, fostering self-compassion is crucial for overcoming shame and seeking help when necessary.

    • The Importance of Mental Health for a Fulfilling LifePrioritizing mental health is essential for a fulfilling life, as it underpins overall well-being and happiness. It is crucial to address mental health issues to improve the quality of people's lives.

      Mental health is a crucial aspect of living a good life. Paul Conti emphasizes the importance of addressing mental health from a holistic perspective, as it undergirds our ability to lead fulfilling lives. Peter Attia commends Conti for bringing insights on topics such as depression, suicide, trauma, and shame, which are near and dear to everyone's hearts. They both acknowledge the significance of prioritizing happiness and rectifying unhappiness, stating that it makes little sense to focus solely on extending lifespan if individuals are not content. By recognizing mental health as an essential component of overall well-being, this exchange highlights that addressing mental health issues is vital for improving the quality of people's lives.

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    • The importance of tracking HRV trends over time rather than focusing on data from a given day [1:29:00];
    • Effect of GLP-1 agonists on heart rate and HRV [1:34:45];
    • Where HRV belongs in the hierarchy of health metrics [1:42:00];
    • Parting thoughts [1:46:30]; and
    • More.

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    The Peter Attia Drive
    enJune 10, 2024

    #304 – NEW: Introducing quarterly podcast summaries - Peter shares his biggest takeaways on muscle protein synthesis, VO2 max, toe strength, gut health, and more

    #304 – NEW: Introducing quarterly podcast summaries - Peter shares his biggest takeaways on muscle protein synthesis, VO2 max, toe strength, gut health, and more

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    In this quarterly podcast summary (QPS) episode, Peter introduces a new format aimed at summarizing his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as protein and muscle building with Luc van Loon, toe strength with Courtney Conley, VO2 max with Olav Aleksander Bu, liquid biopsies for cancer with Alex Aravanis, gut health and probiotics with Colleen Cutcliffe, and road safety with Mark Rosekind. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions.

    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 episode #304 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • How Peter keeps track of his takeaways from each podcast episode [5:15];
    • Luc van Loon episode: fat utilization, muscle protein synthesis, dietary protein, aging and inactivity, and more [8:45];
    • Behavioral changes that have come about from the conversation with Luc van Loon [23:45];
    • Courtney Conley episode: importance of toe strength and the impact of dedicated foot training [26:45];
    • Olav Aleksander Bu episode: the importance of VO2 max for lifespan, and the practicalities of measuring and improving VO2 max [36:45];
    • Behavioral changes that have come about from the conversation with Olav [56:00];
    • Alex Aravanis episode: liquid biopsies for cancer detection [1:01:30];
    • Colleen Cutcliffe episode: the importance of gut bacteria balance, and the potential therapeutic uses of probiotics, particularly Akkermansia [1:16:45];
    • Mark Rosekind: the significant issue of road fatalities and injuries, their causes, and practical safety measures to reduce risks [1:27:00]; and
    • More.

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    The Peter Attia Drive
    enJune 03, 2024

    #303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D.

    #303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D.

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    Dena Dubal is a physician-scientist and professor of neurology at UCSF whose work focuses on mechanisms of longevity and brain resilience. In this episode, Dena delves into the intricacies of the longevity factor klotho: its formation and distribution in the body, the factors such as stress and exercise that impact its levels, and its profound impact on cognitive function and overall brain health. Dena shares insights from exciting research in animal models showing the potential of klotho in treating neurodegenerative diseases as well as its broader implications for organ health and disease prevention. She concludes with an optimistic outlook for future research in humans and the potential of klotho for the prevention and treatment of Alzheimer’s disease.

    Disclosure: Peter is an investor in Jocasta Neuroscience, a company working to develop klotho as a therapy for people with Alzheimer’s disease.

    We discuss:

    • Dena’s fascination with aging and how she came to study klotho [3:30];
    • Biological properties of klotho: production, regulation, decline with age, and factors influencing its levels [11:45];
    • Potential benefits of klotho on brain health [22:00];
    • The relationship between soluble klotho protein, platelet factors, and cognitive enhancement [33:45];
    • The role of platelet factor 4 (PF4) and it’s interaction with GluN2B in mediating cognitive enhancement [46:45];
    • Benefits of klotho observed in a mouse model of Parkinson’s disease [55:45];
    • Benefits of klotho observed in a mouse model of Alzheimer’s disease [1:03:00];
    • Promising results of klotho in primate models, and the importance of finding an appropriate therapeutic dose before moving to human trials [1:08:00];
    • Speculating why a single klotho injection has such long-lasting effects [1:25:30];
    • Potential cognitive benefits of klotho in humans, the impact of the KL-VS genetic variant on klotho levels, and the need for human trials to confirm these effects [1:27:45];
    • The interaction between the KL-VS genetic variant and APOE4 and how it impacts risk of Alzheimer’s disease [1:34:45];
    • The significance of klotho levels: studies linking lower levels to increased mortality and the broader implications for organ health and disease prevention [1:47:15];
    • Measuring klotho levels and determining an individual’s KL-VS status [1:52:15];
    • The promising potential of klotho for Alzheimer’s disease treatment, and the importance of philanthropy for funding research [1:58:00]; and
    • More.

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    The Peter Attia Drive
    enMay 27, 2024

    #302 - Confronting a metabolic epidemic: understanding liver health and how to prevent, diagnose, and manage liver disease | Julia Wattacheril, M.D., M.P.H.

    #302 - Confronting a metabolic epidemic: understanding liver health and how to prevent, diagnose, and manage liver disease | Julia Wattacheril, M.D., M.P.H.

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    Julia Wattacheril is a physician scientist and director of the Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) program at Columbia University Irving Medical Center. In this episode, Julia delves deep into the complex world of liver health, beginning with a foundational overview of liver physiology. She provides an in-depth look at how alcohol impacts liver function, breaking down the metabolism of ethanol and its detrimental effects. Julia then shifts the focus to understanding liver function tests and optimal enzyme levels, providing a detailed explanation of AST and ALT and elucidating why fluctuations in these levels may or may not be concerning. She provides a primer on the four major stages of liver disease, discussing risk and emphasizing the importance of early diagnosis. Julia highlights the role of liver disease in increasing the risk of cancer and cardiovascular disease and covers in detail the various strategies for diagnosing, treating, and preventing the progression of liver disease.

    We discuss:

    • Julia’s training, the importance of liver health, and the challenges and innovations of hepatology [3:15];
    • The complex and crucial functionality of the liver, its four most essential functions, and more [8:45];
    • Liver injuries: historical and evolving understanding of causal factors, and the progression to liver diseases and cancer [13:15];
    • How the liver metabolizes nutrients and what happens in the presence of excess calories or alcohol [24:45];
    • Methods of diagnosing liver disease and how insights guide treatment and management strategies [33:30];
    • The poisonous nature of ethanol to the liver [40:30];
    • Varied responses to alcohol, damaging effects of alcohol beyond the liver, and the process of advising patients on their alcohol consumption [47:15];
    • Understanding liver enzymes AST and ALT—interpreting levels, lifestyle factors that affect them, and diagnostic approaches [58:30];
    • Interpreting liver function tests for fatty liver disease, and the challenges of diagnosing liver pathologies, particularly in children versus adults [1:13:15];
    • Comprehensive liver health assessments via imaging and various diagnostic tools to prevent overlooking potential liver pathologies [1:18:45];
    • Potential impact of recreational drugs, statins, and other medications on liver function test results [1:26:45];
    • Shifting nomenclature from NAFLD to MASLD to reflect accuracy in the underlying pathophysiology and understanding of liver diseases [1:30:30];
    • Pathophysiology of MASLD, the need for proactive screening, and the significance of liver fat percentage as an indicator of metabolic health [1:36:30];
    • The importance of screening for rare conditions alongside common metabolic diseases associated with fatty liver accumulation [1:42:45];
    • Practical strategies for managing MAFLD [1:45:30];
    • The impact of fructose consumption on liver health and the challenges of disentangling its effects from other factors like obesity and insulin resistance [1:52:45];
    • The potential of GLP-1 agonists for the treatment of MASLD [1:57:45];
    • How the four stages of liver disease have evolved [2:00:30];
    • Increased cancer and heart disease risk associated with early-stage MAFLD [2:05:15];
    • Emerging drugs and therapies for addressing fat accumulation and fibrosis related to MAFLD [2:12:15];
    • Peter’s major takeaways [2:18:45]; and
    • More.

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    The Peter Attia Drive
    enMay 20, 2024

    #301 - AMA #59: Inflammation: its impact on aging and disease risk, and how to identify, prevent, and reduce it

    #301 - AMA #59: Inflammation: its impact on aging and disease risk, and how to identify, prevent, and reduce it

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    In this “Ask Me Anything” (AMA) episode, Peter delves into the often misunderstood concept of inflammation. He first defines inflammation and differentiates between acute inflammation and chronic inflammation, the latter of which is linked to aging and a plethora of age-related diseases. Peter breaks down the intricate relationship between chronic inflammation, obesity, and metabolic health, and highlights the signs that might suggest someone may be suffering from chronic inflammation. From there, the conversation centers on actionable advice and practical steps one can take to manage and minimize chronic inflammation. He explores how diet plays a crucial role, including the potential benefits of elimination diets, and he examines the impact of lifestyle factors such as exercise, sleep, and stress management. Additionally, he discusses the relevance of food inflammatory tests and concludes by examining the potential benefits and drawbacks of drugs and supplements in managing inflammation.

    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 #59 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45];
    • Acute vs chronic inflammation [8:00];
    • The connection between chronic inflammation, aging, and age-related diseases [11:00];
    • The impact of inflammation on metabolic health [18:30];
    • Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00];
    • Factors that contribute to low-level chronic inflammation [28:00];
    • Minimizing inflammation through diet [29:45];
    • The important role of fiber for gut health and inflammation [33:45];
    • A closer look at the impact of trans fats and saturated fats on overall health [34:45];
    • Why Peter prefers dietary fiber from food sources over supplements [38:30];
    • Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00];
    • Is there any value in over-the-counter food inflammatory tests? [42:30];
    • Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15];
    • Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15];
    • Dairy: the complex role of dairy on inflammation and individual responses [55:00];
    • Wheat: the complexities and conflicting evidence around wheat's inflammatory effects [57:45];
    • How exercise influences inflammation [1:02:00];
    • How sleep quality and duration impacts inflammation [1:07:00];
    • The potential impact of chronic psychological stressors on inflammation [1:13:00];
    • The impact of oral health on inflammation and overall well-being [1:15:00];
    • The role of medications in managing chronic inflammation [1:18:15];
    • Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15];
    • Parting thoughts and takeaways [1:27:00]; and
    • More.

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    The Peter Attia Drive
    enMay 13, 2024

    #300 - Special episode: Peter on exercise, fasting, nutrition, stem cells, geroprotective drugs, and more — promising interventions or just noise?

    #300 - Special episode: Peter on exercise, fasting, nutrition, stem cells, geroprotective drugs, and more — promising interventions or just noise?

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    In this special edition celebrating 300 episodes of The Drive, Peter discusses a variety of popular topics and health interventions and classifies them based on their level of evidence and relevance using the following categories: proven, promising, fuzzy, noise, and nonsense. Peter first delves into the topic of geroprotective molecules, covering rapamycin, metformin, NAD and its precursors, and resveratrol. Next, he explores the significance of metrics like VO2 max and muscle mass, as well as emerging concepts like blood flow restriction and stem cells. The conversation extends to nutrition, addressing questions surrounding long-term fasting, sugar consumption, sugar substitutes, and the contentious role of red meat in cancer. Peter not only provides his current stance on each topic—most of which have been covered in great detail in the previous 300 episodes—but also reflects on how his opinion may have evolved over the years.

    We discuss:

    • Defining the categories of “proven, promising, fuzzy, noise, and nonsense” [3:15];
    • Rapamycin [9:30];
    • Metformin [17:00];
    • NAD and its precursors [24:30];
    • Resveratrol [32:45];
    • The importance of VO2 max, muscle mass, and muscular strength for lifespan [38:15];
    • Blood flow restriction (BFR) training [44:00];
    • Using stem cells to treat osteoarthritis or injury [51:30];
    • Fasting as a tool for longevity (and why Peter stopped his fasting protocol) [55:45];
    • The energy balance theory [1:06:30];
    • The idea that sugar is poison [1:12:00];
    • The idea that sugar substitutes are dangerous [1:22:15];
    • The debate on red meat and cancer [1:28:45]; and
    • More.

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    Special episode with Dax Shepard: F1 and the 30th anniversary of Ayrton Senna’s death

    Special episode with Dax Shepard: F1 and the 30th anniversary of Ayrton Senna’s death

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    This is a special episode of The Drive with Peter’s friend and fellow car enthusiast Dax Shepard. In this podcast, which commemorates the 30th anniversary of the death of Brazilian Formula One legend Ayrton Senna, Dax sits down with Peter to better understand what made Senna so special and why Peter remains an enormous fan. This conversation focuses on Senna’s life, the circumstances of his death, and his lasting impact and legacy on the sport of F1.

    We discuss:

    • Peter’s interest in motorsports began as a child [2:30];
    • The drama and dangers of F1 [6:00];
    • What made Senna special [13:00];
    • What Senna meant to Brazilians [24:00];
    • The cause of the fatal crash [28:15];
    • Why Peter is obsessed with Senna [40:30];
    • Being the best versus having the best record [43:30];
    • Senna’s unique driving style and incredible intuition about automotive engineering [46:30];
    • Back to the day of the dreadful race [53:00];
    • What Peter believes caused the crash [1:02:45];
    • Views on dying young, in the prime of life [1:13:00];
    • Senna lives on in his foundation and in safety changes adopted by F1 [1:21:00];
    • Statistics aren’t enough for fandom, and why people like who they do [1:24:15];
    • The biggest difference between F1 today and F1 in the 80s [1:28:30];
    • Senna’s driving superpower [1:30:30];
    • The fastest drivers currently in F1 [1:38:30];
    • Current F1 obsessions [1:45:00];
    • How hard it is to do what the top F1 drivers do [1:50:15];
    • Dax’s love of motorcycles and his AMG E63 station wagon [1:52:15];
    • Awesome Senna mementos from Etsy [2:01:15];
    • What makes specialists interesting, and Max’s devotion to F1 [2:10:15];
    • What Senna might have done if he had not died that day [2:14:00];
    • Michael Schumacher and Max Verstappen are also top F1 drivers [2:17:30];
    • Interlagos in Sao Paulo Brazil is always an incredible experience [2:18:45]; and
    • More.

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    #299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D.

    #299 ‒ Optimizing muscle protein synthesis: the crucial impact of protein quality and quantity, and the key role of resistance training | Luc van Loon, Ph.D.

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    Luc van Loon is an internationally renowned expert in skeletal muscle metabolism. In this episode, Luc starts with an exploration of the roles of insulin and triglycerides in endurance exercise, highlighting their impact on skeletal muscle metabolism, and he offers profound insights into the significance of protein in this context. He elucidates how different protein types and forms influence muscle protein synthesis rates, exploring the nuances of protein absorption, digestibility, amino acid quality, and their implications for performance and recovery. Delving deeper, he differentiates between animal and plant protein sources, unraveling the distinctive properties of various protein types, from the differences between whey and casein to the emerging trends in collagen protein supplementation. Moreover, Luc dissects the intricate connections among physical activity, lean muscle mass, muscle protein synthesis induced by resistance training, and dietary protein.

    We discuss:

    • Luc’s background and insights about fuel selection during exercise [3:30];
    • Fuel utilization during endurance exercise [9:30];
    • Fat metabolism, intramuscular lipids, and the nutritional dynamics of endurance sports [17:15];
    • The optimal window for replenishing intramuscular fat stores and glycogen post-exercise [25:15];
    • Luc’s interest in protein metabolism and exploration of amino acids' dual role as building blocks and signaling molecules in driving muscle protein synthesis [32:15];
    • How protein metabolism differs between sedentary individuals and those engaged in predominantly strength training or endurance training [38:45];
    • The basics of how proteins are digested and absorbed, and how muscle protein synthesis is measured [50:30];
    • How factors like food texture, cooking methods, and protein composition impact muscle protein synthesis, and the importance of protein distribution throughout the day [59:45];
    • Differences in whey and casein proteins, and the ability of ingested protein to stimulate muscle protein synthesis [1:03:30];
    • Dietary protein distribution and quantity for the maximization of muscle protein synthesis [1:09:00];
    • Muscle loss with age and inactivity and the importance of resistance exercise to maintain type II muscle fibers [1:17:15];
    • Differences between whey and casein proteins, and the importance of both quantity and quality of protein sources [1:28:30];
    • Optimizing muscle protein synthesis: exercise, timing of protein intake, protein quality, and more [1:37:00];
    • How to preserve muscle while trying to lose weight [1:46:00];
    • Anabolic resistance and overcoming it with physical activity [1:55:45];
    • Importance of protein intake and physical activity in hospitalized patients [2:06:30];
    • Reviewing the efficacy of collagen supplements [2:13:30];
    • Plant-based diets: how to ensure a balance of amino acids, and other considerations [2:20:30];
    • Future research: understanding protein metabolism in the brain [2:23:45]; and
    • More.

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