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    #63 - AMA #7: Exercise framework, deadlifting, lower back pain, blood pressure, nootropics, CGM, and more

    enJuly 22, 2019

    Podcast Summary

    • AMA session with Peter Attia: Discussing note cards, managing studies, and exercisePeter Attia emphasizes organization, critical thinking, and access to exclusive content through his members-only podcast feed.

      During this AMA session, he discusses his note card system, managing scientific studies, obtaining a CGM without a prescription, and his current exercise routine, among other things. He also touches upon topics like blood pressure, concussions, and CTE. Throughout the episode, Peter emphasizes the importance of organization and critical thinking, drawing from his experiences working with top performers. He encourages listeners to subscribe to the members-only podcast feed for access to full AMA episodes, detailed show notes, and exclusive content.

    • Limit liquids before bedtime to reduce bathroom visitsAvoiding alcohol and controlling overall liquid intake near bedtime can minimize nighttime bathroom trips, contributing to better sleep and improved health.

      To prevent nighttime interruptions for using the bathroom, it's crucial to limit your liquid intake, especially alcohol, close to bedtime. Alcohol inhibits the anti-diuretic hormone (ADH), causing your body to produce more urine and increasing the frequency of bathroom visits. Therefore, avoiding alcohol consumption and being mindful of your overall liquid intake can significantly reduce the likelihood of getting up at night to use the bathroom. This advice not only applies to those seeking to prevent bedtime interruptions but also to individuals looking to avoid hangovers. So, in essence, practicing good hygiene around your beverage consumption, particularly alcohol, can lead to better sleep and improved overall health.

    • Avoid alcohol for optimal bladder healthAlcohol interferes with emptying the bladder, leading to frequent urination. Consult a doctor for proper diagnosis and treatment if this is a concern.

      For optimal bladder health, it's important to avoid drinking alcohol, especially the night before, as it can interfere with completely emptying the bladder. This can lead to increased urination both during the day and at night. To check if this is an issue, doctors can perform a post-void residual test, where they measure the amount of urine remaining in the bladder after urination. A normal result should show less than 30 cc of urine remaining. If you're experiencing frequent urination and suspect this could be the cause, it's recommended to consult a healthcare professional for proper diagnosis and treatment. Additionally, some people might consider taking vasopressin, a hormone that helps reduce urine production, to help alleviate the need to urinate frequently, but this should be discussed with a doctor first.

    • Using medications to stay awake and the dangers of excessive water intakeBe cautious with using medications to stay awake as excessive use can lead to hyponatremia, a dangerous condition. Excessive water intake during marathons or contests can also be harmful due to diluted sodium concentrations.

      The use of certain medications like DDAVP or vasopressin can help individuals stay awake and override their natural need to urinate, creating what some might call a "neat little trick" for those who absolutely don't want to get up to use the restroom. However, it's essential to be cautious with this method as excessive use can lead to a dangerous condition called hyponatremia, which occurs when sodium concentrations in the body get too low and create an osmotic mismatch, most troubling in the brain. This condition can be life-threatening and is a risk even for normal individuals taking small doses. It's important to note that this method should only be used under a doctor's prescription. Another interesting topic discussed was the dangers of excessive water intake during marathons or contests like "hold your wee for a week," which can lead to diluting sodium concentrations and potentially fatal consequences. Regarding the note card system mentioned, it's a personal organization method using three by five inch cue cards with different colors for various tasks. The first card is used for a daily list of things to accomplish. This system has been a long-term habit for the speaker, and they've been using the same leather pouch from Levenger for over a decade.

    • Using colored index cards for task managementUsing daily, weekly, and long-term task cards in different colors helps prioritize and manage tasks effectively, allowing for flexibility and cost savings

      The use of multiple colored index cards, each with specific purposes, can help manage daily, weekly, and long-term tasks effectively. The white card, used daily, holds tasks to be completed, while the pink card lists tasks due by the end of the week. Partially completed tasks are indicated with a half check, fully completed tasks with two checks. The orange card is reserved for patient-specific tasks, and the white card at the back of the pack is for long-term personal tasks. The system allows for flexibility, as tasks can be carried over to the next day or week if not completed, and the use of both sides of the cards saves money. Overall, this method provides a simple, cost-effective, and efficient way to organize and manage tasks.

    • Using a card system for effective time managementImplement a card system with a weekly pink list, green list, and unrelated tasks list for improved time management and productivity. Actively engage in reading and critical thinking for accurate understanding of health and disease studies.

      Effective time management involves using a card system to keep track of tasks and responsibilities. This system includes a weekly pink list for important tasks, a green list for completed tasks, and a list for unrelated, seemingly insignificant activities. The card system is highly modifiable and can be customized to fit individual needs. Additionally, to improve understanding of health and disease studies or media interpretations, one can engage in active reading and critical thinking, seek out reliable sources, and consider multiple perspectives. It's important to not just rely on headlines and to take the time to delve deeper into the research and underlying data.

    • Stay informed with Dr. Peter Attia's resourcesExplore Dr. Peter Attia's website, subscribe to his email list, follow him on social media for updates on longevity, science, performance, and sleep.

      Dr. Peter Attia encourages listeners to stay informed about longevity, science, performance, and sleep through his various platforms. His website, PeterAtiaMD.com, hosts podcast show notes, readings, and links. Subscribing to his weekly email is another option to receive updates on his research and interests. Dr. Attia is active on social media, particularly Twitter, for interaction with his audience. However, his podcast and other resources are for informational purposes only and do not constitute medical advice. Listeners should consult their healthcare professionals for any medical concerns. Dr. Attia also discloses his conflicts of interest on his website.

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    View the Show Notes Page for This Episode

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    In this “Ask Me Anything” (AMA) episode, Peter delves into two topics that have generated a lot of questions over the years: skin cancer and sunscreen. He begins by exploring the basics of UV radiation, discussing its effects on vitamin D conversion, photoaging, and its role in skin cancer. He examines various skin types, discussing their implications for sun exposure and vitamin D levels, as well as how to determine where you fall on the skin type scale. He then delves into the various types of skin cancer, with a particular emphasis on melanoma, exploring its complex relationship with UV exposure and other contributing risk factors. Additionally, he covers tanning beds, the importance of early skin cancer detection through regular skin checks, and the often confusing topic of sunscreen. He explains how sunscreen affects UV radiation and skin cancer risk, what SPF levels to choose, the differences between organic and mineral sunscreens, and what to consider when selecting the best sunscreen for your needs.

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    #307 ‒ Exercise for aging people: where to begin, and how to minimize risk while maximizing potential | Peter Attia, M.D.

    View the Show Notes Page for This Episode

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    In this special episode, Peter addresses the common questions about starting or returning to an exercise routine over the age of 50. Individuals in this age group have frequently reached out with questions about whether it's too late to start exercising and often express concern over a lack of prior training, a fear of injury, or uncertainty about where to begin. Peter delves into the importance of fitness for older adults, examining all four pillars of exercise, and provides practical advice on how to start exercising safely, minimize injury risk, and maximize potential benefits. Although this conversation focuses on people in the “older” age category, it also applies to anyone of any age who is deconditioned and looking to ease into regular exercise.

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    The Peter Attia Drive
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    #306 - AMA #60: preventing cognitive decline, nutrition myths, lowering blood glucose, apoB, and blood pressure, and more

    View the Show Notes Page for This Episode

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    Sign Up to Receive Peter’s Weekly Newsletter

    In this “Ask Me Anything” (AMA) episode, Peter provides insights on a broad range of important topics. He delves into the prevention of cognitive decline, the link between cardiovascular disease and Alzheimer's disease, and methods to lower blood glucose, insulin, and apoB. He also addresses nutrition-related queries, exploring the impact of dietary habits on weight loss and longevity, how a person can identify the best diet for themselves, and common nutrition myths. Additional discussions include optimal blood pressure, daily step goals, the benefits of standing versus sitting desks, and much more.

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    View the Show Notes Page for This Episode

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    Joel Jamieson is a conditioning expert who developed Morpheus to give people a smarter way to build their conditioning regimen and improve their recovery. In this episode, Joel dives deep into the world of heart rate variability (HRV), explaining its scientific foundation, how it measures the balance between the sympathetic and parasympathetic nervous systems, the various methods of measurement, and how it can guide healthier lifestyle choices and improved training performance. He explores the nuances of HRV calculation, the impact of aging on HRV, and the roles of genetics, exercise, and other lifestyle factors in this process. He also covers Morpheus, the innovative training tool that won Peter over after his initial skepticism, highlighting its practicality and effectiveness in guiding training and optimizing fitness outcomes.

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    The Peter Attia Drive
    enJune 10, 2024

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

    View the Show Notes Page for This Episode

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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:

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    Connect With Peter on TwitterInstagramFacebook and YouTube

    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.

    View the Show Notes Page for This Episode

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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:

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    • 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];
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    • The interaction between the KL-VS genetic variant and APOE4 and how it impacts risk of Alzheimer’s disease [1:34:45];
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    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    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.

    View the Show Notes Page for This Episode

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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:

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    • 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];
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    • Potential impact of recreational drugs, statins, and other medications on liver function test results [1:26:45];
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    • 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];
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    • The potential of GLP-1 agonists for the treatment of MASLD [1:57:45];
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    • 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.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    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

    View the Show Notes Page for This Episode

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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?

    View the Show Notes Page for This Episode

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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.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    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

    View the Show Notes Page for This Episode

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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.

    Connect With Peter on TwitterInstagramFacebook and YouTube

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