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    #27 - David Sinclair, Ph.D.: Slowing aging – sirtuins, NAD, and the epigenetics of aging

    enNovember 05, 2018

    Podcast Summary

    • Exploring the Potential of Certuans in Aging ResearchOngoing research into certuans, NAD, and DNA repair is shedding light on potential ways to optimize human lifespan, but the idea that drinking wine can make you live longer is a misconception.

      The field of aging research is rapidly advancing, and Professor David Sinclair is at the forefront of these advancements. He is a pioneer in studying certuans, a class of molecules with potential implications for longevity. One of the most famous certuans is Resveratrol, found in grapes and wine. However, the idea that drinking wine can make you live longer is a misconception. The conversation explores the role of certuans, NAD, and DNA repair in the aging process. David's expertise in these areas sheds light on the potential benefits of orally administered precursors of NAD. Additionally, his personal use of Resveratrol, metformin, and NMM reveals his dedication to practicing what he preaches. This insightful discussion underscores the importance of ongoing research in the pursuit of understanding and potentially optimizing human lifespan.

    • The Passionate Pursuit of Extending Human LifespanProfessor David Sinclair's dedication to understanding and controlling aging, alongside collaboration with experts, has led to groundbreaking research and significant implications for improving human health and longevity.

      Aging and its control have been a lifelong passion for Professor David Sinclair. He recognized the potential of emerging technologies to extend human lifespan and saw the urgency in finding solutions for the millions of people who could benefit from them. He sought out the best minds in the field, including Lenny Guaranty from MIT, and collaborated with them on groundbreaking research. Through his expertise in molecular biology and yeast genetics, Sinclair contributed to the discovery of genes that control aging in yeast cells. This passion for understanding and manipulating the aging process has immense implications for the future of human health and longevity. Sinclair's dedication and pursuit of knowledge highlight the importance of addressing the fundamental aspects of aging to improve lives.

    • Overcoming Obstacles in Scientific ResearchThe story of David Sinclair illustrates the significance of perseverance and determination in the pursuit of a scientific career, emphasizing the necessity of unwavering passion and a strong desire to achieve goals in this field.

      Pursuing a career in scientific research requires tremendous determination and perseverance. David Sinclair's story highlights the obstacles he faced in joining a prestigious lab and obtaining funding. Despite being initially rejected and told to bring his own funding, he did not give up. He applied to different foundations and ultimately secured the necessary funds to continue his research. Sinclair's unwavering passion for understanding aging and longevity led him to fly across continents and sell his car for a five-minute interview. His dedication paid off as he was accepted into the lab and began making significant contributions to the field. This story emphasizes the importance of grit and a strong desire when pursuing one's goals in the scientific realm.

    • The Power of Unconventional Thinking in Scientific BreakthroughsPursuing unconventional paths and trusting innovative thinkers can lead to groundbreaking discoveries, as seen in David Sinclair's study of aging in yeast, which opened up a new field of biology. Persistence and embracing unconventional ideas are crucial in scientific exploration.

      Scientific breakthroughs often come from pursuing unconventional paths and trusting in the vision of innovative thinkers. David Sinclair's decision to study aging in yeast, despite initial skepticism from his peers, ultimately led to groundbreaking discoveries and a new understanding of the aging process. Lenny, the visionary behind the project, recognized the potential in studying aging genes and their connection to gene silencing. This unexpected finding opened up a whole new field of biology and sparked continuous research and publications. The conversation also highlights the rapid advancement of genetic knowledge during that time, with the discovery of introns and the use of PCR. Ultimately, this story emphasizes the importance of persistence, resilience, and embracing unconventional ideas in scientific exploration.

    • The Role of Sirtuins in Yeast Cells and Aging in HumansSirtuins, particularly the cert 2 protein, are essential for controlling mating and DNA repair in yeast cells. Distraction of sirtuins can lead to confusion in sex determination and sterility, similar to the aging process in yeast and humans. Additionally, sirtuins play a role in regulating various cellular processes, shedding light on the mechanisms of aging.

      Sirtuins, specifically the cert 2 protein, play a crucial role in controlling mating and DNA repair in yeast cells. When the cert 2 protein is distracted by other cellular processes, such as DNA repair, it cannot perform its gene silencing function, leading to confusion in yeast cells regarding their sex and ultimately causing sterility, which is a hallmark of aging in yeast. This distraction of sirtuins is also observed in the aging process of humans. Furthermore, sirtuins, including the cert 2 protein, are not only involved in histone control but also in regulating signaling and metabolism by targeting various proteins in the cell, including those in the nucleus and mitochondria. These findings shed light on the intricate mechanisms of aging and cellular processes controlled by sirtuins.

    • Insights on Premature Aging from YeastDNA breaks in unstable genome regions are the underlying cause of premature aging, and the cert 2 gene plays a crucial role in DNA repair and genomic stability.

      Studying the SGS 1 gene in yeast provided valuable insights into the universal process of premature aging. By working on the yeast homologue of SGS 1, David Sinclair and his team were able to observe accelerated aging and sterility in the yeast cells, similar to what happens in humans. This model helped them understand that the underlying cause of premature aging is DNA breaks and recombination occurring in the most unstable regions of the genome. Furthermore, they discovered that knocking out the cert 2 gene resulted in increased genomic instability and decreased DNA repair, leading to accelerated aging. On the other hand, overexpressing the cert 2 gene in yeast cells increased genomic stability and extended their lifespan. These findings open the door to the development of compounds that can mimic the effects of cert 2 without the need for genetic mutations.

    • The Role of Sirtuin Genes in Extending Lifespan and Promoting Survival Mechanisms.Sirtuin genes are crucial for mimicking the benefits of calorie restriction and promoting longevity by controlling gene expression and aiding in survival mechanisms.

      The gene called sirtuin plays a crucial role in mimicking the effects of calorie restriction, which is known to extend lifespan. This gene family is not only necessary but also sufficient in providing the benefits of calorie restriction when expressed. Knocking out the sirtuin gene leads to the loss of these benefits. Interestingly, there are multiple sirtuin genes, and they work together as a family. In yeast, for example, knocking out one gene can be compensated by others. These sirtuin genes evolved billions of years ago in response to biological stressors such as DNA damage, temperature changes, or nutrient deprivation. They help organisms adapt and survive by controlling gene expression and promoting survival mechanisms.

    • Conservation of Longevity Pathways and the Potential for Human Lifespan ExtensionExtending the lifespan of yeast, worms, and mice could hold promise for extending human lifespan, but safety and regulatory considerations must be addressed. Understanding the biology of aging and its connections to NAD, sirtuins, and calorie restriction is essential.

      The longevity pathways involved in survival during adversity are surprisingly conserved across different organisms, from yeast to mice. Manipulating just one gene or using a single drug can extend lifespan in these organisms. This discovery is significant because it suggests that if we can successfully extend the lifespan of yeast, worms, and mice, we have a strong chance of doing the same for humans. The challenge lies in ensuring safety and adhering to regulatory agencies, but the biology underlying aging is ancient and well-preserved. The connection between NAD and sirtuin activity, as well as the link to calorie restriction, further adds to our understanding of the mechanisms involved in longevity.

    • The Importance of NAD in Cellular Function and SurvivalNAD is crucial for cellular processes and its levels fluctuate, impacting aging and DNA repair. NAD levels in mitochondria are especially critical, and new technologies aid in measuring them.

      NAD (nicotinamide adenine dinucleotide) plays a crucial role in our survival. Without NAD, our cells would not be able to function properly and we would die within seconds. It was previously believed that NAD levels were constant and any changes could be fatal. However, research has shown that NAD levels actually fluctuate and are important for various cellular processes, including aging and repairing DNA damage. Interestingly, it has been discovered that NAD levels in the mitochondria, the powerhouse of the cell, are even more critical for survival than in the cytoplasm. Measuring NAD levels in the mitochondria is a challenging task, but new technologies like mass spectrometry have been helpful in this regard.

    • The Importance of NAD in Cellular Functions and Potential Methods to Increase NAD LevelsNAD is a crucial molecule in cellular functions, and researchers are exploring ways to increase NAD production within cells to address limitations and enhance cellular processes.

      NAD, or nicotinamide adenine dinucleotide, is a crucial molecule that plays a role in various cellular functions. It cannot be moved in and out of plasma and cells; it is made de novo within the cell. NADP and NADH, although similar to NAD, do not activate certain cellular switches like NAD does. Additionally, high doses of vitamin B3, or nicotinamide, inhibit sirtuins, which are enzymes involved in aging and metabolism. This inhibition occurs due to a negative feedback loop that measures nicotinamide levels. To address this limitation and increase NAD levels, researchers are exploring methods to enhance NAD production within cells.

    • The role of gene PNC 1 in activating NAD production and sirtuins, and its potential for lifespan extension.Gene PNC 1 acts as a sensor in the environment, activating defense pathways and potentially extending lifespan. Understanding genetic pathways is crucial for aging research and drug development.

      The gene PNC 1 plays a crucial role in activating NAD production and sirtuins, and it can mimic the effects of caloric restriction in increasing NAD availability. PNC 1 is not only activated by caloric restriction but also by stressors such as heat, low amino acids, and high salt. This gene acts as a sensor in the environment and activates defense pathways. The conversation also highlights the discovery of molecules, initially not resveratrol, that can activate the Sirtuin enzyme and potentially extend lifespan. This discovery was made through a collaborative effort and provides a promising avenue for drug development in the field of aging. The significance of understanding genetic pathways and their activation in lifespan extension is emphasized.

    • The discovery and testing of lifespan extension molecules through a genetics-first approach and the crucial role of Resveratrol.Resveratrol, discovered through a genetics-first approach, has shown promising results in extending lifespan in organisms with the Sirtuin gene, sparking public interest and boosting wine sales.

      The pathway of discovering and testing lifespan extension molecules can vary. In the case of Resveratrol, the scientists followed a genetics-first approach, identifying a molecule and then testing it on organisms. This approach allowed them to find a highly conserved mechanism that could be targeted for longevity. They also found that a specific amino acid, E230, played a crucial role in the activation of Resveratrol. Their experiments in yeast, worms, and flies showed that the compounds extended lifespan only in organisms with the Sirtuin gene. This brought attention to their research, especially when the mouse paper in 2006 showed promising results. The discovery of Resveratrol's potential impact on longevity sparked public interest and even led to a boost in wine sales.

    • Resveratrol's Potential Impact on Lifespan and HealthResveratrol, even at lower doses, has shown promising effects on extending lifespan. Combining Resveratrol with caloric restriction may further enhance its benefits, but more research is needed to fully understand its mechanisms and potential synergies.

      Resveratrol, when administered to mice on a high fat, high sugar diet, extended their lifespan by approximately 25%. This effect was observed in mature mice, equivalent to middle-aged humans. The dose of Resveratrol used was relatively high - 200 milligrams per kilogram per day. However, lower doses have also shown positive effects on longevity. It is important to note that Resveratrol activates multiple pathways, including the AMP kinase metformin-related pathway. The combination of Resveratrol and caloric restriction showed even greater benefits, suggesting that Resveratrol enhances the response to caloric restriction. Further research is needed to understand the specific mechanisms and potential synergies of Resveratrol with other substances like metformin.

    • Enhancing the Absorption of Resveratrol for Optimal Health BenefitsConsuming resveratrol with fatty food increases its absorption, potentially improving its health benefits. Despite its low potency and solubility, further research is exploring ways to enhance its absorption.

      The absorption of resveratrol, a molecule with potential health benefits, is enhanced when consumed with fat. Resveratrol is not very soluble, which means it doesn't reach high levels in the blood unless accompanied by fatty food. This finding was observed in both mice and humans. It is speculated that the Western diet, which often includes more fat, leads to better absorption of resveratrol compared to a low-fat diet. Despite resveratrol's low potency and solubility issues, overexpressing certain genes like sirtuins still show potential for extending lifespan. Clinical trials have been conducted to explore the effects of resveratrol on humans and to find ways to improve its absorption in the body.

    • The Potential and Challenges of Resveratrol in Clinical TrialsResveratrol did not meet expectations in clinical trials, but research continues to develop more potent variants. David Sinclair personally takes resveratrol and believes it may offer cardiovascular protection, along with the use of metformin for its potential anti-aging properties.

      Resveratrol, a compound that was once believed to have potential health benefits, did not meet expectations in clinical trials. Although massive doses of resveratrol were initially used due to concerns about its bioavailability, there were no clear signs of toxicity in regular individuals. However, the trial with cancer patients revealed some cases of renal failure, leading to the discontinuation of the study. Although resveratrol was not deemed a viable drug by a large pharmaceutical company, further research focused on developing more potent variants of the compound. Despite inconclusive evidence, the speaker, David Sinclair, personally continues to take resveratrol and believes it may offer some cardiovascular protection. Additionally, he mentioned taking metformin, a medication commonly used to treat type 2 diabetes, which has also gained interest for its potential anti-aging properties.

    • Combining Molecules for Health and Longevity: A Cautionary ApproachWhen combining molecules for health benefits, start with a low dose, monitor well-being, and consult experts. Consider including NAD precursors for enhanced effectiveness and choose supplements carefully due to lack of regulation.

      Combining molecules like Resveratrol and AMPK activators can potentially have additive effects on health and longevity. It is important to tread carefully in unknown territory and avoid overdosing on these combinations. Starting with a reasonable low dose based on available data, monitoring one's well-being and consulting experts is crucial. The discussion also highlights the inclusion of molecules like Toro still being with NAD precursors to enhance their effectiveness. While there may be conflicts between different pathways and ego involved, the ultimate goal is to make significant contributions to human health. The choice between supplements and pharmaceuticals depends on personal experiences and timeframes. The regulatory environment for supplements remains largely unregulated, emphasizing the need for caution and quality control.

    • Lack of evidence on the effectiveness of supplements like Elysium's Basis or ChromaDex's NR in humansThe benefits of supplements like Elysium's Basis or ChromaDex's NR in humans are uncertain and require further investigation through human clinical trials.

      There is a lack of concrete evidence regarding the effectiveness of supplements like Elysium's basis or ChromaDex's NR in humans. While these supplements may have shown promising results in mice studies, it is uncertain whether they provide similar benefits to humans. Many individuals claim to have experienced positive outcomes, such as improved exercise tolerance, after taking these supplements. However, these anecdotal stories cannot be considered as scientific proof and may be influenced by a placebo effect. To address these uncertainties, human clinical trials are necessary. Additionally, there is an ongoing debate in the scientific community about the transportation of molecules like NR, which adds to the complexity of understanding how these supplements work in the body.

    • Stability and transportation of NMM and NR are still under study, with NMM appearing more stable. Transport into cells is unclear, but both compounds increase NAD levels.Ongoing research using NMR and tracer studies will reveal how NMM and NR are transported and utilized in different tissues. Blood measurements may not provide definitive conclusions due to active utilization and recycling by the body.

      The stability and transportation of NMM and NR, which are compounds that raise energy levels in the body, are still subjects of ongoing studies. While NMM appears to be more stable than NR, it is not clear how they are transported into cells. There is evidence of an NR transporter, but both compounds effectively raise NAD levels in the body. As these studies are being conducted using whole cells from blood or PBMCs, it is important to note that NMM and NR are actively utilized and recycled by the body, making it difficult to draw definitive conclusions from blood measurements. Ongoing research using techniques like NMR and tracer studies will provide a clearer understanding of where these compounds are preferentially taken up in different tissues.

    • Promising Effects of NAD Precursors on Female Infertility and Low FertilityNAD precursors show potential in improving egg quality and fertility in women, while further research is required for male fertility. Be cautious of unauthorized products claiming to be endorsed by David Sinclair or Harvard.

      David Sinclair's research on NAD precursors has shown promising effects on female infertility and low fertility. The molecules being developed by companies like Metro Biotech and Jumpstart Fertility have demonstrated improved bioavailability, stability, and efficacy compared to publicly available options. These molecules target a protein called Babara 1, which regulates spindle quality in eggs. Low levels of NAD in the ovary and egg may contribute to infertility, and providing NAD precursors to eggs has resulted in healthier, more numerous eggs that are better suited for fertilization and healthy pregnancies. While there is potential for male fertility opportunities, further research is needed. It's important to note that products with David Sinclair's name that are available over the counter are not authorized by him or Harvard.

    • Targeting Rare Diseases and Fertility: A Closer Look at Life Bioscience's ResearchDavid Sinclair's company, Life Bioscience, is focusing on targeting rare diseases and conducting fertility trials, while exploring the central tenants of aging and potential connections to the Sirtuin story in yeast.

      David Sinclair's company, Life Bioscience, is focusing on targeting rare diseases with high unmet needs. They are also conducting trials in fertility, specifically in IVF clinics next year. Peter Attia highlights the challenge of longevity research and the difficulty of making claims in humans due to the lengthy testing process. In contrast, other companies like Restore Bio are targeting very specific indications that are testable in shorter periods of time. When discussing the central tenants of aging, Sinclair mentions epigenetic change, cellular health communication, inflammation, senescent cells, protein misfolding, telomere loss, genomic instability, metabolic changes, and responses to nutrient inputs. Sinclair believes that there is a unifying theory that explains why these pathways go awry during aging, and he hints at a connection to the Sirtuin story in yeast. However, these findings have not been published yet.

    • The Loss of Epigenetic Information and Aging ProcessThe loss of epigenetic information during the aging process leads to cells losing their identity and functioning improperly, highlighting the need for further research to achieve significant changes in human longevity.

      The aging process is heavily influenced by the loss of epigenetic information, which leads to the cells losing their identity and functioning improperly. The genome itself remains largely intact in old individuals, but the pattern of gene expression, which is analog information, deteriorates over time. This analog information is constantly adapting to various factors such as diet, exercise, and sleep. However, due to the fragility of analog systems, this information doesn't last long and results in a loss of gene regulation. This loss of regulation causes cells to behave differently and lose their specialized functions. While the field of longevity research has made significant progress, there is still much to learn and discover in order to achieve step function changes in human longevity.

    • Aging and Gene Expression: Finding Ways to Access InformationAs we age, the proteins responsible for DNA repair and gene expression prioritize repair over deactivation, potentially disrupting gene programming. Finding ways to trigger cells to access and utilize information could have significant benefits in terms of longevity and cost savings.

      As we age, the proteins responsible for DNA repair and gene expression become distracted from their deactivation function and focus more on the repair function. This response to stresses and DNA breaks is beneficial when we are young, but as we get older, it can disrupt the structure of our chromatin and affect gene programming. However, the exciting news is that the information is still present and accessible. The challenge is to find ways to trigger cells to access and utilize this information at the right time. To accelerate our knowledge, an ideal experiment would involve giving a group of 5000 people certain medications and monitoring their mortality rate over a few years. The potential benefits of such an experiment are immense, both in terms of longevity and cost savings.

    • Exploring the Potential of Molecules and Genes to Extend Lifespan and Combat Aging-related IssuesDavid Sinclair's lab has achieved promising results in extending lifespan in mice through the use of natural molecules and genetic modifications. This research offers hope for addressing age-related decline and improving overall wellness in older individuals.

      There is great potential to extend lifespan and combat aging-related issues through experiments and combinations of different molecules and genes. David Sinclair discusses the promising results obtained in his lab, where they have been able to extend the lifespan of mice even when starting later in life. They have been using natural molecules, such as NMM, and are now exploring better molecules to achieve even better outcomes. Additionally, Sinclair highlights the ability to genetically modify adult mice quickly and efficiently, which allows for faster experiments and testing of combinations of genes and molecules. The focus is on NAD precursor space and activating all seven sirtuins to replenish what's lost over time. This research offers hope for addressing the age-related decline in NAD and improving overall wellness in older individuals.

    • Understanding Children's Understanding of DeathChildren between the ages of four and seven go through a natural process of understanding death, which remains buried in their subconscious until later in life. Discussing mortality with children can be challenging for parents.

      Children go through a natural process of understanding and accepting the concept of death between the ages of four and seven. Initially, they may be in denial and believe that only certain adults will die while others will not. However, by the age of seven, they come to realize that everything around them, including themselves, will eventually die. Interestingly, this understanding is buried deep in their subconscious and does not often resurface until they reach their fifties or encounter significant signs of aging. The conversation also highlights the challenges parents face when discussing mortality with their children, as it can be traumatic and overwhelming for them. Ultimately, at different stages of life, individuals may have varying levels of awareness and contemplation about their own mortality.

    • Embracing Change and Continuous LearningThe evolving nature of knowledge calls for humility, adaptability, and the willingness to continuously update and revise information in order to stay informed and relevant.

      Knowledge and information are constantly evolving. Both Peter Attia and David Sinclair express their understanding of the changing nature of facts and the need for ongoing updates and revisions. They acknowledge that what is known today may not be entirely true tomorrow. This realization requires humility and a willingness to adapt. Sinclair shares his struggle with perfectionism, constantly updating his book and PowerPoint slides even after submitting them. However, he also recognizes the value of getting information down on paper and being able to address burning questions from readers. The conversation highlights the importance of staying open-minded and continuously learning in order to stay informed and relevant.

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    The Peter Attia Drive
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    #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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    Everybody grows old. Everyone dies. But is this scientific fact? Or is it merely a story based on history and our current understanding of biology? What if we instead consider aging as a disease? This begs the question: what is the cure? Welcome to the mind of David Sinclair, PhD, one of the world’s leading scientific authorities on longevity, aging and how to slow its effects. A professor in the Department of Genetics at Harvard Medical School and co-Director of the Paul F. Glenn Center for the Biological Mechanisms of Aging, David obtained his Ph.D. in Molecular Genetics at the University of New South Wales, Sydney in 1995 and worked as a postdoctoral researcher at M.I.T. where, among other things, he co-discovered the cause of aging for yeast. The co-founder of several biotechnology companies, David is also co-founder and co-chief editor of the journal Aging. His work has been featured in a variety of books, documentaries, and media, including 60 Minutes, Nightline and NOVA. He is an inventor on 35 patents, has been lauded as one of the Top 100 Australian Innovators, and made TIME magazine’s list of the 100 most influential people in the world. In addition, David is the author of the forthcoming book, Lifespan: The Revolutionary Science of Why We Age — and Why We Don't Have To* which hits bookstores on Sept. 10 and is currently available for pre-order here*. This is an absolutely fascinating conversation on all things human lifespan, aging and longevity. We begin with the specific scientific mechanisms that contribute to biological degeneration. Then we dive deep into the hard science David and his peers are examining to better understand what contributes to aging and how to prevent it. According to David, the prospect of living to 200+ is not a pipe dream, but a very possible reality. If humans could indeed double lifespan, how would this change how you live? And what does this mean for the future of humanity? This conversation travels deep into the scientific weeds. Perfect for the geeks among us. But it's also grounded in practical takeaways for all of us — because David's work isn't just about extending lifespan. It's about learning how to live as vibrantly and energetically as possible for as long as possible. It’s an honor and a privilege this brilliant man’s pioneering work and wisdom with you today. Plus he's a lovely guy. If you enjoyed my episode with Dr. Valter Longo (RRP #367), a fellow brilliant warrior in the longevity space, then I’m fairly confident you’re going to love this one. So break out that pen and paper, because you're going to want to take notes on this one. I sincerely hope you enjoy the episode. Peace + Plants, Rich

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    Rhonda and I go on a Nerd Safari into the jungle of health, nutrition, fitness, performance, and longevity. We visit IGF-1 and whether there’s a tradeoff of having high or low levels. We discuss the PPARs (receptor proteins) and genetic polymorphisms. Does Rhonda think there’s any benefit in a NAD+ booster for health and longevity? Can saunas lower the risk of heart disease, dementia, and all-cause mortality? 

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    We discuss:

    • What Rhonda believes differently today than she did a few years ago [5:40];
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    • The role of PPAR in fat metabolism and ketogenic diets [23:00];
    • The possible genetic explanations for why some patients don’t respond well to a ketogenic diet [31:00];
    • The health benefits of heat and cold exposure [1:12:30];
    • NAD+ [1:32:45];
    • And more.

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    Friday Five: Bio-hacking to live well for longer, with Ed van Harmelen

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    The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race cardone before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive.

    Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now.

    Learn more: https://peterattiamd.com/podcast/qualys/  

    Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/ 

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