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    #178 - Lance Armstrong: The rise, fall, and growth of a cycling legend

    enOctober 04, 2021

    Podcast Summary

    • Lance Armstrong's Journey: From Plano to the PelotonLance Armstrong's life story reveals lessons about redemption, personal growth, and the power of perseverance despite adversity.

      The Drive podcast, hosted by Peter Atia, delves into the story of Lance Armstrong's life, from his humble beginnings in Plano, Texas to his meteoric rise as a famous athlete, and ultimately his fall from grace due to performance enhancing drug use. This episode explores the details of his cancer diagnosis, the era he competed in, and the lessons he learned about himself and treatment of others. Despite any preconceived notions listeners may have, the episode offers insights into a complex story of redemption and personal growth. During the conversation, Lance answers yes or no questions about various topics, and they discuss his childhood in Plano, a city that has drastically changed since his time. Although he has mixed feelings about revisiting his past, the experience allows him to reflect on how far the city and himself have come.

    • Lance Armstrong's upbringing shaped him as a personLance Armstrong's unconventional family situation and adoption of swimming at a young age influenced his determination to succeed and became formative experiences in his life.

      Lance Armstrong's upbringing significantly influenced his life, particularly his adoption of swimming at a young age. Despite growing up with a non-biological father figure who was strict, Lance felt a sense of fatherly love towards him. However, his biological father, Eddie Gunderson, was largely absent from his life and passed away before they could potentially reconnect. Lance didn't excel in traditional sports and was encouraged to try swimming by his mother when he was 12. Despite initially struggling, Lance persevered and eventually became a successful swimmer. His experiences growing up, both good and bad, shaped him into the person he is today. Additionally, the stigma surrounding his non-traditional family situation may have fueled his determination to succeed in sports and prove himself to others.

    • Young Lance Armstrong's dedication to multiple sports and coachingDedication and hard work in youth can lead to success in various fields. Coaching played a crucial role in pushing Lance Armstrong to excel in swimming, running, and eventually triathlon.

      Dedication and hard work, even at a young age, can lead to success in multiple areas. Lance Armstrong's experience of swimming for both his high school team and a top age group team, while also running and training for track and cross-country, showcases this. His coaches played a significant role in pushing him to excel, and he thrived on the structure and discipline they provided. However, when he discovered his talent for triathlon, the freedom and excitement of the sport led him to turn professional at the age of 15. This decision was influenced by the opportunity for travel and prize money, but it also came from his natural ability and enjoyment of endurance events. Ultimately, Armstrong's success can be attributed to his unwavering commitment and passion for competition.

    • Swimming vs Cycling: Different Endurance Sports, Unique ExperiencesSwimming and cycling offer distinct experiences for athletes, with swimming's low-impact nature and potential for lifelong participation contrasting cycling's peloton mastery and Olympic competition opportunities.

      The experiences and challenges of different endurance sports like swimming, running, and cycling can vary greatly. For the interviewee, while swimming held a special place for its low-impact nature and the ability to continue the sport throughout life, cycling offered the potential for Olympic competition. Transitioning from triathlon to full-time cycling in the late 80s, the interviewee faced new challenges in mastering the peloton and race tactics. At the 1991 World Championships, despite being technically unprepared, competing against the best amateur cyclists was an invaluable experience. Ultimately, the unique aspects and demands of each sport create distinct experiences and growth opportunities for athletes.

    • Heart rate monitoring in early professional cyclingFormer cyclist shares experiences of heart rate focus during training and racing in the 1990s, including a fear of a VO2 max test and racing against Miguel Indurain.

      The early days of professional cycling relied heavily on heart rate monitoring for training and racing, with limited technology available for other metrics. The speaker, a former cyclist, shared his experience of being part of the Motorola team in the 1990s, where they primarily focused on heart rate during training and races. He also recalled an intriguing story about a VO2 max test he underwent as a young athlete, which he didn't complete due to fear of a rectal probe. The 1993 season was particularly notable for the dominance of Miguel Indurain, who won three consecutive Tours de France. The speaker reflected on the excitement of racing against Indurain during the World Championship road race and the unique racing calendar that allowed for a series of World Cup races after the Tour.

    • The 1991 Tour de France: A Turning Point for Performance-Enhancing Substances in Cycling?The 1991 Tour de France marked a turning point in cycling as Indurain rose to dominance following LeMond's unexpected decline. However, the use of substances like cortisone was common, and testing was not yet standard practice.

      The world of professional cycling in the early 1990s was a grueling and demanding environment where the use of performance-enhancing substances was prevalent, even if not yet at the epidemic levels it would later reach. Greg LeMond's unexpected decline in performance during the 1991 Tour de France, which saw Indurain's rise to dominance, has been speculated to mark the beginning of the high-octane era in cycling. However, it's important to note that the use of substances like cortisone, which LeMond himself admitted to using, was common practice to help cyclists endure the grueling race. Testing for performance-enhancing drugs was not yet a standard practice, and the use of therapeutic use exemptions (TUEs) allowed cyclists to use certain substances under medical supervision. The environment of the late 1980s and early 1990s saw the use of various substances, from traditional painkillers to more sophisticated performance-enhancing drugs, as a means to cope with the demands of the race. Despite the physical toll the sport took on riders, the allure of winning the coveted rainbow jersey drove many to push their bodies to the limit, with or without the aid of performance-enhancing substances.

    • From Police Raids to Widespread Scandal in CyclingThe doping scandal in cycling expanded beyond just testing positive during competitions, with police raids revealing widespread use of performance-enhancing drugs. The shift from 1993 to 1994 marked a significant increase in usage, leading to increased scrutiny and a tragic wake-up call with the death of Fabio Casartelli.

      The doping scandal in cycling during the 1990s was not just about testing positive during competitions. The biggest busts, like the Festina case, often came from police raids. Athletes, including the speaker, believed they could compete and even win without the use of performance-enhancing drugs. However, the shift from 1993 to 1994 marked a significant change, with EPO and other banned substances becoming more widespread. The press eventually caught on, leading to widespread coverage and scrutiny. The tragic death of teammate Fabio Casartelli during the 1995 Tour de France served as a wake-up call, highlighting the dangers of the sport and the importance of taking ethical shortcuts.

    • Professional cyclist's emotional and physical journey during a race where a teammate tragically passed awayExperiencing a teammate's death during a race led the cyclist to unexpectedly win, while acknowledging the prevalence of performance-enhancing drugs during that era

      During a cycling race in the late 90s, the speaker, a professional cyclist, experienced an unexpected death of a teammate, Fabio Casartelli, during the race. This tragic event left a profound impact on him, and he felt an unexplained surge of energy and determination to win the race. He believes this experience gave him an extra boost, which helped him break away from the group and ultimately win the race. Additionally, the speaker discussed his use of EPO, a performance-enhancing drug, during his career. He started EPO use in 1995 and admits that it was widespread among cyclists during that time. He also mentions that there was some oversight in managing the drug but does not recall specific details, such as the target hematocrit level or the dosage. The speaker also shared some insights about his physical condition and performance during races. He mentions that his functional threshold power in 99 was 500 watts, and he first started using a power meter in 98. He also recalls experiencing symptoms of testicular pain and soreness before noticing any statistical signs of doping. Overall, the speaker's story highlights the emotional and physical challenges of professional cycling, the impact of team dynamics, and the prevalence of performance-enhancing drugs during that era.

    • Ignoring Symptoms Can Lead to Serious Health ConsequencesTaking symptoms seriously and not making excuses for them is crucial for maintaining good health. Delaying medical help can lead to more serious health issues.

      Ignoring symptoms and making excuses for them can lead to serious health consequences. The speaker in this conversation shared his experience of having testicular cancer, which he had ignored for years despite experiencing symptoms like headaches, visual changes, and a swollen testicle. He kept making excuses for these symptoms, such as blaming a headache on a concert or assuming blurry vision was due to needing glasses. It wasn't until he coughed up blood that he finally sought medical help, but even then, he downplayed the amount of blood to his doctor. This story highlights the importance of taking symptoms seriously and not making excuses for them, as it could have potentially saved the speaker from a more serious health crisis. Additionally, the lack of access to the internet in 1996 meant that the speaker had limited resources for researching his symptoms and seeking information, making it even more crucial for him to trust his instincts and seek medical help when something felt off.

    • A mother's belief and support during cancer treatmentBelief and support from loved ones can provide the strength to overcome adversity during cancer treatment

      Even during the most challenging times, having a strong support system and the determination to keep fighting can make a significant difference in overcoming adversity. Lance, who was diagnosed with a rare and aggressive form of testicular cancer, shares how his mother's unwavering confidence and belief in his ability to overcome the disease gave him the strength to keep going. Despite receiving a diagnosis with advanced and metastatic cancer, Lance's local oncologist recommended a more aggressive treatment plan at a renowned cancer center in Indiana. The experience there, although initially daunting, ultimately led to a successful treatment and recovery. Throughout his journey, Lance's focus on his progress and the support from his loved ones helped him stay positive and determined, ultimately leading to his survival.

    • Sharing experiences and raising awareness for young cancer patientsCreating support systems and addressing practical needs beyond research are crucial for cancer patients' well-being and recovery.

      The experience of undergoing intensive cancer treatment, such as VIP protocol, can be isolating and physically taxing. The speaker, who went through this treatment for testicular cancer, shares how he felt the need to create awareness and support for those dealing with the disease, especially young men who might be reluctant to seek help due to stigma. He also emphasizes the importance of addressing the practical needs of cancer patients beyond research, as these areas often receive less funding. The speaker's foundation, which started as a modest effort, grew to raise over half a billion dollars and inspired other organizations to address various cancer-related challenges.

    • Lance Armstrong's advocacy work for cancer researchArmstrong's strong brand and strategic advocacy led to significant investments in cancer research despite his health challenges. Perseverance and belief in abilities allowed him to continue advocacy and competition.

      Lance Armstrong's advocacy work for cancer research, funded through strategic lobbying and partnerships, led to significant investments in research and prevention, despite his personal health challenges. This demonstrates the power of a strong brand and strategic advocacy in creating meaningful change, even when resources seem limited. Additionally, Armstrong's determination to return to professional cycling after his diagnosis and recovery faced numerous obstacles, but ultimately led him to secure a contract with the Postal team, driven by his history and relationships within the sport. Despite setbacks and self-doubt, Armstrong's perseverance and belief in his abilities allowed him to continue pursuing his goals in both advocacy and competition.

    • Lance Armstrong's Challenging Return to CyclingDespite facing challenges with team disorganization, unpaid salaries, and personal health, Lance Armstrong's determination and knowledge of the race helped him return to competitive cycling with the support of his team and new leadership.

      Lance Armstrong's recovery from cancer and return to professional cycling involved the support of friends and teammates, as well as the use of performance-enhancing drugs like EPO and cortisone. During his absence, his team was disorganized, and he faced challenges with unpaid salaries and lack of support. After finishing fourth in various races in 1998, Armstrong decided to fully commit to his comeback in 1999 and hired a new director sportif, Johan Bruyneel. Despite the challenges, Armstrong's determination and knowledge of the race helped him navigate the difficult situation and ultimately return to competitive cycling. However, his use of performance-enhancing drugs was a significant part of his success during this period.

    • Lance Armstrong's Doping Era in US Postal TeamLance Armstrong, during his time in the US Postal team, won the prologue of the Tour de France using EPO before testing existed, while team manager Johan Bruyneel predicted his success. This era of cycling remains a topic of controversy due to the widespread use of performance-enhancing drugs.

      The US Postal cycling team during Lance Armstrong's era was accused of doping at an industrial level due to the systematic nature of their practices. Armstrong was approached to join a cycling union but instead chose to become the team's director. He had previously worked with physiologist Dr. Ferrari, who guided all of his training. Armstrong placed fourth in the world championships, which was his first indication that he could win the Tour de France. When Armstrong joined the team, team manager Johan Bruyneel predicted that he would finish on the podium in 1999, which was a bold claim considering the previous winners, Pantani and Ulrich, were not present due to doping scandals. The prologue, a short time trial at the beginning of the Tour de France, was crucial for assessing a rider's condition against their competitors. In Armstrong's case, he won the prologue and earned his first yellow jersey. However, during this tour, Armstrong was using EPO without the testing for it yet, and he maintained his hematocrit level around 47 to avoid detection. This era of cycling remains a controversial topic, with debates surrounding the extent of doping and the impact on the sport's integrity.

    • The Era of Doping in Professional CyclingFrom the late 1990s to early 2000s, professional cycling was marked by rampant use of performance-enhancing drugs, particularly EPO, with many top athletes, including Lance Armstrong, participating. This era was characterized by a lack of transparency and accountability, and even those closest to the athletes often turned a blind eye.

      The use of performance-enhancing drugs in professional cycling during the late 1990s and early 2000s was rampant, with many top athletes, including Lance Armstrong, using EPO to maintain high hematocrit levels and improve their performance. This era, which included the infamous Tour de France teams of US Postal and Mapei, was marked by a lack of transparency and accountability, with team doctors and trainers facilitating the use of these drugs. Armstrong's dominance during this period, including his wins in the 1999 Tour de France where he won all three individual time trials, brought intense scrutiny and raised questions about his performances. Despite the pressure, Armstrong denied any wrongdoing, and his teammates and support system helped him maintain his denial. The culture of doping in professional cycling during this time was pervasive, and even those closest to the athletes often turned a blind eye to it. One of Armstrong's biggest regrets was his interaction with Marco Pantani during the 2000 Tour de France, where he attempted to give Pantani the win in the Von 2 stage. This era of professional cycling would later be exposed through various investigations, leading to a major shift in the sport's culture and a renewed commitment to clean competition.

    • Lance Armstrong's Regrets: Focusing on Every Race and Admiring Jan UllrichArmstrong regrets not focusing on every race, especially the Vuelta a España, and deeply admired Jan Ullrich as his greatest rival.

      During his cycling career, Lance Armstrong believed he made a mistake by not focusing on winning every race, specifically the Vuelta a España (Von 2). He admired Jan Ullrich greatly, viewing him as his biggest rival and greatest talent, despite their similar upbringings. Armstrong's best physical tour was in 2001, where he put out around 500 watts for 30 minutes, and he believes his wattage would have been 10% lower without the use of performance-enhancing drugs. The infamous "look" photo during the 2001 Tour de France was not a deliberate attempt to intimidate Ullrich, but rather a check to ensure a teammate was nearby. Armstrong's hematocrit levels dropped significantly after the 1999 Tour, leading to the use of transfusions from 2000 onwards, starting with one bag at the halfway point.

    • Lance Armstrong reflects on his doping allegations and memorable moments in his cycling careerDespite admitting some doping in his cycling career, Lance Armstrong emphasizes the importance of not losing sight of the bigger picture and expresses frustration over sensationalized media coverage.

      That despite the numerous investigations and allegations, Lance Armstrong acknowledges that some elements of his cycling career were tainted with doping, but he also believes that much of the public narrative was filled with misinformation and sensationalism. He expressed frustration over the focus on insignificant details, such as the supposed engine in his bike or the switch in his shorts, while ignoring the larger context. During the 2003 Tour de France, Armstrong was under immense pressure from his rival, Jan Ullrich, who was closing the gap. The stress was compounded by Ullrich's superior performance in the first time trial, which took two minutes out of Armstrong's lead. Despite this, Armstrong managed to maintain his composure and eventually secured his victory. One of the most memorable moments from the 2003 Tour was Armstrong's narrow escape from a crash caused by a rider's tire hitting hot tar. In the split second that he made the decision to swerve into a nearby field, a path appeared, saving him from a potentially career-ending accident. Armstrong's reflections on his career reveal a mix of acceptance, frustration, and awe at the twists and turns of his public image. He acknowledges the truth of the doping allegations but also emphasizes the importance of not losing sight of the bigger picture.

    • Lance Armstrong's Unexpected Challenges and Tough DecisionsDespite facing unexpected challenges and making tough decisions, Lance Armstrong remained committed to his goals in his cycling career, ultimately overcoming doping allegations and returning to competition in 2009.

      Lance Armstrong's cycling career was marked by unexpected challenges and tough decisions. One such instance was when he encountered a ditch during the 2003 Tour de France, which led him to question the reliability of the route. Another incident involved a handlebar collision that resulted in a snapped chainstay, but Jan Ullrich waited for him, showcasing their mutual respect. Armstrong retired at the end of 2005, citing a desire to focus on his foundation and spend more time with his family. However, Jean-Marie LeBlanc, a Tour director, wrote an open letter urging him not to return, fearing the negative impact of his past doping allegations. Despite the resistance, Armstrong felt a sense of responsibility to the foundation and the sponsors, and he returned to the sport in 2009, building a new team and placing third. Throughout his career, Armstrong faced numerous challenges and made difficult decisions, ultimately choosing to stay committed to his goals despite the risks and criticisms.

    • Lance Armstrong's interview with Oprah Winfrey: Confession and RedemptionLance Armstrong confessed to using PEDs during his career, lost sponsors, but maintained an open relationship with his children, ultimately learning valuable lessons from his mistakes.

      The interview with Oprah Winfrey was a pivotal moment for Lance Armstrong, not only for his personal confession of using performance-enhancing drugs (PEDs) but also for his desire to clear his reputation and tell the truth. He believed that if he was going to give a deposition, he might as well do it on his terms. However, his honesty came at a cost, as none of his sponsors reached out to thank him for his past contributions to their success. Despite this, Armstrong maintained an open-door policy with his children, encouraging them to ask questions about his life and decisions. The family has remained close throughout the ordeal. The moment of truth came when Armstrong read Tyler Hamilton's book and realized the extent of the doping culture in professional cycling. He acknowledged his mistake and faced the consequences, ultimately learning valuable lessons from the experience.

    • Reflecting on Past Mistakes and Moving ForwardLance Armstrong values his past mistakes as lessons for growth, acknowledges the importance of apologizing, and understands that some relationships may not be restored.

      Lance Armstrong acknowledges the importance of both reflecting on past mistakes and moving forward. After his public fall from grace following the Oprah interview in 2013, he reached out to some but not all of those he had wronged, including Emma O'Reilly, who he had pursued during his competitive cycling years. He values the lessons learned from his past, recognizing that the mistakes made, even those played out on a public stage, contribute to his current growth. Armstrong also emphasizes the importance of having a rearview mirror to remember past mistakes, but not letting them consume him. He believes that the person he is today is a result of his past experiences, both good and bad. Additionally, he acknowledges that some relationships, like those with Floyd Landis and Tyler Hamilton, may not be rekindled.

    • Factors influencing public perception of athletes' falls from graceSocietal factors, including media, organizers, and public perception, significantly impact how athletes are treated after scandals, with some receiving more compassion than others.

      The line between a "good" and "bad" is not always clear-cut in sports or in life. The interview discussed the case of Lance Armstrong, who faced intense criticism for using performance-enhancing drugs and treating people poorly. However, another athlete, who expressed regret for past actions but valued the lessons learned, received more compassionate responses. The speaker questioned why some athletes, despite similar transgressions, faced different outcomes. He suggested that societal factors, including the media, organizers, and public perception, play a significant role in shaping the narrative around athletes' falls from grace. Ultimately, the speaker expressed frustration with the hypocrisy and lack of support for athletes struggling with their demons, which can lead to tragic outcomes.

    • Lance Armstrong's fall from grace and redemptionLance Armstrong learned to prioritize health, family, and one-on-one help after falling from grace, emphasizing the importance of balance in life to avoid similar downfalls.

      Lance Armstrong's fall from grace was a stark reminder of the harsh realities of fame and the dangers of losing sight of what truly matters in life. Despite his past controversies, including a public falling out with his neighbor and a period of reclusion, Armstrong has since rebuilt his life, focusing on his health, family, and cycling. He has also learned to prioritize helping individuals in need on a one-on-one basis, rather than through large public events. The societal fascination with watching public figures rise and fall is a complex issue that Armstrong finds frustrating, and he emphasizes the importance of maintaining a healthy balance in life to avoid similar downfalls. While his legacy is still unfolding, Armstrong remains proud of his accomplishments and is committed to making amends for past mistakes.

    • Reinventing oneself and building success through perseverance and self-relianceDespite facing adversity, the speaker is proud of his ability to build a successful podcast without external support, recognizing the importance of perseverance, self-reliance, and personal growth. Past traumas have shaped him, both positively and negatively, and while he wishes he had started reflecting earlier, it's never too late to learn and grow.

      Perseverance and self-reliance are valuable assets, even in the face of adversity. The speaker is proud of his ability to reinvent himself and build a successful podcast without external support, a feat that wouldn't have been possible in the past. He values his family, his audience, and the trust of those who have invested in him. Looking back, he recognizes that traumatic experiences shaped him, both positively and negatively, and that some of these experiences may have been easier to navigate with guidance earlier in life. However, the speaker acknowledges that some character traits, including resilience and competitiveness, are deeply ingrained and may have been present even before he was consciously aware of them. While he wishes he had started the process of unpacking past traumas earlier, he understands that it's never too late to reflect and grow.

    • Lessons from past strugglesPast struggles shape us, leading to personal growth and introspection. Embrace them for a happier, more fulfilling life.

      Despite past regrets and hardships, they shape us into who we are today, and we couldn't undo them even if we wanted to. Lance Armstrong shared his experiences of total destruction and the desire to take it all back, but he realized that these events led him to deep introspection, realignment, and growth. He no longer focuses on being the fastest or using technology to measure his performance, but instead finds happiness in riding alone and mostly on a mountain bike. He acknowledges the importance of maintaining his fitness, not for appearance, but for mental sanity. Interestingly, many former pro athletes struggle to maintain their active lifestyle once it's no longer a job requirement. Armstrong shared a story about being served salmon and okra, two foods he dislikes, and how he found joy in the unexpected meal. Overall, Armstrong's takeaway is that even though past experiences may be difficult, they are essential for personal growth and should be embraced.

    • Unexpected dislike of okra and podcast membership program discussionThe speaker shared his personal experience of an unexpected dislike for okra during a meal and discussed the benefits of The Drive podcast membership program, emphasizing the importance of seeking professional medical advice.

      The speaker had an unexpected aversion to okra during a meal, despite appearing to enjoy it. He was open about his dislike and was ready to face any potential consequences. The conversation then shifted to the topic of the membership program for the podcast, The Drive, which offers exclusive content and benefits for subscribers, including comprehensive show notes, access to a private podcast feed, discounts on recommended products, and more. The speaker emphasized that the content of the podcast is for general informational purposes only and does not constitute medical advice. He also disclosed potential conflicts of interest and encouraged listeners to seek professional medical advice for any health concerns.

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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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    Related Episodes

    Episode 8: Lance Armstrong Part 2 (Doping Boogaloo)

    Episode 8: Lance Armstrong Part 2 (Doping Boogaloo)

    As we discussed in the previous episode of Controversial Figures, American Lance Armstrong had just announced his 2nd retirement in 2011 at the age of 33. This was after winning a record breaking seven consecutive Tour de France races as a recent cancer survivor, and having only recently returned from his previous retirement. It was a shock that such a talented and successful athlete would suddenly announce his retirement.

     

    But the revelations that would occur soon after Lance's retirement would be even more shocking. And would explain his abrupt departure.

     

    Today, if you look at Lance Armstrong's Wikipedia page, under Career Achievements, there is a hidden section labeled "Voided results from August 1998 onward". When the hidden section is expanded, it shows the more than 40 professional cycling races Lance Armstrong no longer has credited to his name. Let's get into what lead to Lance losing all of his achievements from 1998 to 2010 and his complete ban from the sport of cycling on part 2 of the Lance Armstrong episode today on the Controversial Figures Podcast.


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    Tour de Francia 🇫🇷 2023 Previa

    Tour de Francia 🇫🇷 2023 Previa

    Empieza La Grande Boucle, con salida en Bilbao este año y con los equipos llenos de motivación y objetivos. 
    Todos esperamos a que será un duelo entre Jonás Vingegaard y Tadej Pogaçar, pero realmente será así? 
    Víctor Hugo y Johan nos dan sus opiniones sobre cómo ellos creen que se desarrollará la carrera, quien tiene el mejor equipo y que podemos esperar a lo largo de las próximas 3 semanas.

    Tour de Francia 🇫🇷 2023 Etapa 19

    Tour de Francia 🇫🇷 2023 Etapa 19

    La última oportunidad para muchos ciclistas y equipos de ganar una etapa hoy y que increíble etapa pudimos vivir.
    Una multitud de escapadas y intentos de escapadas hasta que por fin se formó un grupo grande del cual en los últimos 20 kms se fueron Kasper Asgreen, Matej Mohorič y Ben O’Connor por delante y se disputaron la victoria del día entre ellos. 
    En un sprint muy ajustado fue el esloveno Matej Mohorič quien se adjudicó la victoria. 
    Jonás Vingegaard y su equipo Jumbo no tuvieron problemas para defender el maillot amarillo.

    THEMOVE: 2023 Tour de France Stage 8

    THEMOVE: 2023 Tour de France Stage 8

    Lance, JB, and George break down Mads Pedersen's impressive sprint victory ahead of Jasper Philipsen and Wout van Aert on a difficult uphill finish in Limoges. The loss leaves Van Aert, who had two stage wins at this point in the race last year, with little to show for the immense amount of work he has already put into the race. 

    The crew also discuss Mark Cavendish’s devastating mid-stage crash, which forced him out of the race and ended his chances, at least for 2023, of breaking the all-time Tour de France stage win record. They wrap up the show by discussing Simon Yates and Mikel Landa’s late crashes, and ensuing time losses, before previewing what to expect on tomorrow’s historic, and brutal, finish atop Puy de Dôme.

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