View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter Jason McCarthy is a former US Special Forces member and the founder of GORUCK, a company specializing in rucking equipment. In this episode, Jason recounts his journey from military service to navigating the challenging transition back into civilian life and ultimately embracing the mission of introducing rucking to the masses. Delving into the significance of rucking in military training and its applicability to the wider population, he discusses the mental and physical benefits of rucking as a mode of training, provides practical tips for beginners, and answers frequently asked questions about packs, weights, footwear, and more. We discuss:  Jason’s upbringing and what inspired him to join the military [3:15]; Jason’s path to becoming a Green Beret, his calling to serve, and staying true to oneself [10:30]; About the Green Berets: their role in the military, unique abilities, missions, and more [20:00]; The mental and physical challenges of special forces training and selection [25:00]; Rucking challenges as a Green Beret [37:00]; How Jason trained in his off-time and stayed mentally prepared [46:30]; Jason’s difficult decision to leave the army, and the challenges many veterans face returning to civilian life [51:30]; Jason’s struggles after leaving the army: loss of identity, feelings of shame, and the how he overcame a period of despair [57:15]; The origin of GORUCK [1:10:30]; The GORUCK Challenge [1:24:30]; The company's evolution from event organizer to manufacturing specialist, spurred by the growing interest in rucking as a form of training [1:35:30]; FAQs about rucking: packs, weight, rucksack vs. weighted vest, chest straps, and more [1:38:45]; Commemorating Normandy: GORUCK's plans for the 80th anniversary of the Normandy landings [1:51:30]; Footwear for rucking, and how GORUCK got into the footwear business [1:57:30]; How to avoid the most common injuries from rucking, and the benefits of rucking for VO2 max, strength, and sleep quality [2:05:00]; Advice for using rucking as a mode of training, and the advantages of rucking over other forms of training [2:12:45]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#292 ‒ Rucking: benefits, gear, FAQs, and the journey from Special Forces to founding GORUCK | Jason McCarthy

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Derek is a fitness educator, the entrepreneur behind More Plates More Dates, and an expert in exogenous molecules commonly used and misused by bodybuilders and athletes. In this episode, Derek returns to the podcast to explore the impact of exogenous molecules on male and female health. He covers testosterone, DHT, DHEA, progesterone, clomiphene (Clomid), hCG, and various peptides, alongside updates from the FDA affecting peptide use. Additionally, he addresses the recent hype around increasing muscle mass through myostatin inhibition via follistatin gene therapy and supplementation. Additionally, Derek discusses the various strategies that bodybuilders use for losing fat while preserving muscle, including insights on weight loss drugs. We discuss:  Testosterone and DHT: mechanisms of action, regulation of muscle growth, and influence on male and female characteristics [2:15]; TRT in women: the complexities and potential risks associated with testosterone use in women [9:00]; DHEA supplementation: exploring the benefits and risks for women, and the differing effects on men vs. women [22:00]; The role of progesterone in both men and women, pros and cons of supplementation, the importance of tailored doses, and more [28:00]; Measuring levels of free testosterone [37:15]; The trend towards earlier interest in TRT, and the risks of underground sources of testosterone [42:00]; The complexities and considerations surrounding the use of Clomid, E-Clomid, and hCG in TRT [46:00]; Low testosterone: diagnosis, potential causes, treatment options, and other considerations [53:45]; Growth hormone-releasing peptides: rationale and implications of the recent FDA categorization as high-risk substances [1:03:45]; Follistatin gene therapy and myostatin inhibition for increasing muscle mass: the recent hype online, human and animal data, and the need for more research [1:14:45]; Simple tips for lowering calorie intake and losing fat [1:32:30]; Methods of sustainable fat loss with muscle preservation: insights gleaned from bodybuilders [1:40:00]; Could prolonged fasting impact testosterone levels? [1:55:30]; High-protein ice cream [1:57:00]; Exploring fat loss supplements and drugs: L-carnitine, yohimbine, and more [2:02:15]; Potential remedies for individuals experiencing metabolic dysfunction due to hypercortisolemia [2:12:30]; The cornerstones of body composition improvement remain nutrition and exercise, even in the presence of exogenous testosterone [2:19:15]; The importance of approaching health advice found online with a critical eye and a healthy dose of skepticism [2:23:30]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#291 ‒ The role of testosterone in males and females, performance-enhancing drugs, sustainable fat loss, supplements, and more | Derek, More Plates More Dates Pt.2

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Alex Aravanis is a leader in research and development of technologies and clinical tests utilizing the latest tools in DNA analysis and data science. In this episode, Alex delves into two interconnected topics: liquid biopsies and epigenetics. He begins by tracing the trajectory of genome sequencing and tumor sequencing, setting the stage for a detailed exploration of liquid biopsies as an early cancer detection method. The discussion encompasses key concepts such as cell-free DNA, DNA methylation, sensitivity, specificity, and the predictive values associated with liquid biopsies. Transitioning to epigenetics, Alex examines the intricate interplay of DNA methylation and aging biology and explores the possibility of using cellular reprogramming to reverse epigenetic changes that occur with aging. We discuss:  Alex’s background in applying engineering to problems in medicine [3:15]; A primer on human genetics, and the history and current landscape of DNA sequencing [11:00]; The advent and evolution of liquid biopsies for early detection of cancer [23:15]; The role of cell-free DNA in cancer detection: how incidental findings in non-invasive prenatal testing led to the development of liquid biopsies [40:15]; The development of a universal blood test for cancer detection and a discussion of specificity of tests [46:00]; Advancements in cell-free DNA analysis and development of a multi-cancer screening test at GRAIL [51:00]; DNA methylation explained [58:15]; Optimizing cancer detection with methylation analysis of cfDNA in small blood samples [1:02:45]; The importance of understanding sensitivity, specificity, positive predictive value, and negative predictive value in cancer screening [1:08:00]; The performance of the GRAIL Galleri test and its ability to detect various types and stages of cancer [1:21:00]; Do early cancer detection methods, like liquid biopsies, translate to improvement in overall survival? [1:27:45]; The role of epigenetics in aging [1:39:30]; How cell-free DNA methylation patterns can help identify a cancer’s tissue of origin [1:45:30]; Cellular and epigenetic reprogramming and other exciting work in the field of aging [1:52:30]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#290 ‒ Liquid biopsies for early cancer detection, the role of epigenetics in aging, and the future of aging research | Alex Aravanis, M.D., Ph.D.

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, the conversation focuses on cancer screening, a topic often shrouded in confusion yet crucial to understand given that early identification of a cancer is an essential part of survival strategy. Peter examines the arguments both for and against cancer screening, including addressing why some trials may show no benefit to screening. He then delves into the various screening modalities available for different cancers, highlights the pros and cons associated with each, and explains how to interpret the results. Additionally, Peter provides guidance for navigating outside of the relatively narrow and confined screening guidelines for various types of screening tests. 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 #56 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:  Why understanding cancer screening is crucial [2:45]; The prevalence of cancer diagnosis and mortality rates [4:30]; Why cancer screening and early detection is such an important part of the strategy to survive a cancer diagnosis [11:00]; Data on how cancer screening impacts survivability of cancer [16:30]; Inconsistencies between cancer screening trials regarding benefits to survival rates [25:45]; What are some of the reasons why clinical trials don’t always improve cancer-specific mortality? [30:15]; What are the arguments against population-level cancer screening? [42:00]; Cancer screening outside the recommended guidelines: risks and benefits, interpreting results, and other considerations [46:00]; Understanding sensitivity and specificity when reviewing screening results [52:30]; Risks and complications associated with colonoscopies [55:45]; Cancer screening modalities: options for cancer screening both within standard recommendations and beyond [58:30]; The strengths and limitations of various types of cancer screening [1:02:15]; Understanding positive and negative predictive value using sensitivity, specificity, and pretest probability [1:11:45]; Factors that influence an individual's pretest probability of cancer [1:13:45]; How to interpret cancer screening results [1:18:15]; The importance of having an advocate when considering out-of-guideline cancer screening tests [1:23:30]; How stacking multiple cancer screening modalities can decrease the risk of false positives [1:29:30]; Advice and guidance for making decisions related to cancer screening [1:31:15]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#289 - AMA #56: Cancer screening: pros and cons, screening options, interpreting results, and more

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter Walter Green is a remarkable philanthropist, mentor, author of This Is the Moment!, and founder of the impactful “Say It Now” movement. In this episode, Walter delves into the unique insights gained from his challenging upbringing, discusses embracing mortality, and highlights the mindset of “finishing strong.” He shares insights on intentionality, thinking in reverse, saying “no,” prioritizing relationships, and the essence of focusing on others. The conversation focuses on the “Say It Now” movement, which stresses the importance of expressing sentiments to loved ones well before the end of life. We discuss:  How Peter and Walter met through Ric Elias [2:45]; The unique perspectives and life lessons provided by Walter’s challenging childhood [5:30]; Walter’s harrowing experience with a sudden mental breakdown and his subsequent recovery with the help of therapy [11:15]; A diverse professional journey ending in great success [18:15]; The birth of a movement: celebrating friendships through public tributes and expressing gratitude to those who have shaped your life’s journey [22:30]; Intentionality, thinking in reverse, saying “no”, and other guiding principles for Walter [30:00]; Walter’s global journey of gratitude on his 70th birthday: visiting friends and creating memorable experiences [39:15]; The profound impact of acknowledging and expressing gratitude for the people who contribute to our lives [46:15]; The key elements for creating meaningful connections and cultivating deep, authentic friendships [52:15]; The “Say It Now” movement: the inspiration behind the remarkably impactful initiative [58:30]; What “finishing strong” means to Walter [1:07:30]; Finding peace at the end of life through expressing gratitude and finding purpose in serving others [1:16:00]; Resources to learn about “Say It Now” [1:26:15]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#288 ‒ The impact of gratitude, serving others, embracing mortality, and living intentionally | Walter Green

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro Inc. where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine. We discuss:  Peter’s experience with debilitating back pain [3:30]; Anatomy of the back: spine, discs, facet joints, and common pain points [14:45]; Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:45]; Why the majority of back injuries happen around the L4, L5, and S1 joints [31:00]; How the spine responds to forces like bending and loading, and how it adapts do different athletic activities [36:15]; The pathology of bulging discs [43:15]; The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [46:00]; The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:15]; The significance of strength and stability in preventing injuries and preserving longevity [1:08:15]; Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:30]; Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:30:00]; Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:39:00]; When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:45]; Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:30]; Tarlov cysts: treatment and surgical considerations [2:00:15]; The evolution of patient assessments and the limitations of MRI [2:02:15]; Pain relief related to stiffness and muscle bulk through training [2:07:00]; Advice for the young person on how to keep a healthy spine [2:14:15]; Resources for individuals dealing with lower back pain [2:25:30]; and More.  Connect With Peter on Twitter, Instagram, F

#287 ‒ Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D.

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter Andrew Huberman, professor of neurobiology at Stanford University and host of the Huberman Lab podcast, returns for another special journal club episode. Andrew introduces an observational study investigating the influence of light exposure on circadian clock regulation and its link to mental health, while Peter covers a phase III clinical trial employing immune checkpoint inhibitors for the treatment of metastatic cancer. They delve into the essential findings of their respective papers, elucidate the reasons for their enthusiasm, and tackle potential limitations and unanswered questions. Additionally, they provide valuable insights into their approaches for comprehending research studies, aiding listeners in independently navigating this process. We discuss:  The intricate relationship between light exposure, circadian rhythms, and mental health [3:30]; The importance of low solar angle sunlight, and other types of light needed for optimal mental and physical health [12:00]; Promising new lightbulb technology that simulates low solar angle sunlight [17:45]; The significance of both darkness and the need for direct light exposure to the eyes, specifically [20:00]; Some tips and advice regarding optimizing light exposure, blue blockers, and effects on circadian rhythm [22:15]; Andrew presents a paper which suggests avoiding light at night and seeking light during the day is associated with better mental health [25:45]; Examining the data: the negative impact of increasing nighttime light exposure and the positive effects of daytime light exposure [34:30]; Statistical analysis: the importance of focusing not only on statistical significance but also clinical relevance, power analysis, error bar range, and more [45:45]; Takeaways from the study of daytime and nighttime light exposure [49:45]; The practicalities of minimizing light exposure and screen time at night, the use of sleep trackers, and overall challenge of modern, indoor lifestyles [55:15]; Potential limitations of the light exposure study, reverse causality, and the complex interplay of variables in epidemiological studies [1:06:00]; A tangent on diet soda and sugar substitutes as an example of reverse causality [1:13:15]; Andrew and Peter’s take on the causality vs. correlation of light exposure to mental health, the damage of circadian disruption, and the interpretation of observational data [1:17:30]; A primer on the immune system as background for the paper Peter chose [1:25:00]; Background on cancer: causes, how it evades the immune system, and the logic behind immune checkpoint inhibitor therapy [1:35:45]; Peter presents a paper on immune checkpoint inhibitor therapy in cancer patients [1:50:15]; Unpacking the results of the checkpoint inhibitor trial [1:59:45]; Other noteworthy observations, including the differing results between males and fem

#286 ‒ Journal club with Andrew Huberman: the impact of light exposure on mental health and an immunotherapy breakthrough for cancer treatment

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial topic of exercise, starting with the importance of having a goal in training, including how and why Peter uses the goal of training for the “Centenarian Decathlon” when structuring his training plans. Peter elaborates on how to identify deficient areas within the four pillars of exercise and guides listeners on incorporating periodization training for optimal improvement and training variety. The episode explores diverse case studies, offering insights into tailored workouts for individuals of various training backgrounds, from seasoned enthusiasts to complete beginners. Additionally, Peter tackles the universal issue of emotional stress and its impact on training, as well as how exercise can help manage stress and how to determine when training should be adjusted during a high-stress period. 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 #55 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:  Overview of exercise topics [2:15]; Importance of training with a goal in mind, the Centenarian Decathlon, and the natural decline of fitness with age [4:00]; The four pillars of exercise [12:15]; Measuring peak aerobic output with VO2max, and the importance of VO2max as a predictor of longevity [16:45]; Measuring aerobic efficiency with zone 2 [25:45]; Measuring and tracking muscle mass and strength [27:30]; Case study of a fit person with a neglected pillar: why adding more training volume may not the best strategy [30:30]; Periodization training: what it is and why it is beneficial [36:15]; Periodization case study: high cardio fitness, lacking muscle and strength [40:00]; Periodization case study: adequate muscle, low cardio fitness [44:45]; Case study: significant improvement needed across all exercise pillars [48:45]; Best ways to do zone 2 exercise and how to use relative perceived exertion (RPE) to find your zone 2 level [56:30]; How the body responds to physical and emotional stress, its impact on training, and the consequences of chronic stress [1:01:00]; The difference between “good” stress and “bad” or chronic stress [1:10:30]; The complex relationship between exercise and stress, and the importance of adjusting exercise goals during high-stress periods [1:13:30]; Clues that stress may be impacting your training [1:19:15]; The use of wearables and devices for tracking trends and making decisions related to training [1:21:00]; Parting thoughts regarding the importance of exercise for longevity and stress management [1:32:00]; and More.  Connect With Peter on Twitter, Instagram

#285 - AMA #55: Exercise: longevity-focused training, goal setting, improving deficiencies, managing emotional stress, and more

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Bestselling author Michael Easter returns to The Drive to discuss his new book, Scarcity Brain. In this episode, Michael explores the evolutionary backdrop that molded human beings, a setting characterized by scarce food, limited information, and few possessions. He contrasts that with the modern era, marked by abundance and comfort, and the ensuing repercussions on our physical and mental well-being. Michael introduces the concept of the “scarcity loop,” a three-part behavior cycle which helps explain modern challenges such as overeating, addiction, gambling, and materialism, and offers practical strategies to break free from its cycle. The episode culminates in a thought-provoking exploration of happiness, drawing on Michael's experiences with monks and underscoring the value of boredom, exploration, and discomfort as transformative elements that elevate awareness, presence, and the will to live. We discuss:  Inspiration for Michael’s latest book, Scarcity Brain [2:15]; Evolutionary adaptations to the scarcity of food contrasted with the modern obesity crisis [4:00]; Lessons learned about diet and nutrition from living with hunter-gatherers [9:30]; The impact of ultra-processed foods on energy balance [20:30]; Michael’s experience with attempting the hunter-gatherer diet at home [27:30]; The roots of excess: factors that contribute to overeating and the varied vulnerabilities among individuals [34:00]; The scarcity loop: how components of the scarcity loop are illustrated in gambling and addiction [39:45]; Using knowledge of the scarcity loop to break the cycle [50:45]; The evolutionary drive to acquire material possessions [58:15]; The benefits of boredom and value of exploration [1:07:00]; The consequences of an attention economy driven by negativity bias [1:16:30]; Navigating the world of endless information and the value in “slow information” [1:23:00]; Defining happiness, and the downward trend in reports of happiness [1:33:00]; Purpose, austerity, self-reliance and other missing elements of happiness gleaned from the study of monks [1:38:30]; The value in uncomfortable activities that increase your awareness, presence, and will to live [1:48:45]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#284 ‒ Overcoming addictive behaviors, elevating wellbeing, thriving in an era of excess, and the scarcity loop | Michael Easter, M.A.

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

James Clear: Building & Changing Habits (#183 rebroadcast)

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter Colleen Cutcliffe is an expert in molecular biology and co-founder of Pendulum Therapeutics, a company working to develop treatments for a variety of diseases by targeting the microbiome. In this episode, Colleen delves into the complexity of the microbiome, how it is tested, and how it changes over time. She explores how probiotics, prebiotics, and postbiotics affect the gut and makes a compelling case that well-developed products have the potential not only to enhance gut health but also to positively influence overall metabolic well-being. Colleen emphasizes the significance of a high-fiber diet in sustaining a thriving gut microbiome, shares insights on minimizing microbiome damage during antibiotic use, provides tips for fostering and preserving a healthy gut, and much more. We discuss:  Colleen’s background and current focus [4:45]; The basics of the microbiome [7:15]; The study of the human microbiome [15:15]; Categories of bacteria, and the implications on health of the rapid evolution of bacteria [19:45]; Methods for measuring and understanding the microbiome, and key indicators of microbiome health [28:30]; The important role of fiber for promoting gut health through the production of butyrate [38:30]; The case for manipulating gut bacteria via fecal microbiota transplant (FMT) [45:00]; Dynamics of the microbiome: the gut-brain connection and how antibiotics, nutrition, stress, and more impact the microbiome's diversity and function [50:15]; Factors that influence the vaginal microbiome [55:15]; The effect of gut microbes on obesity and challenges with fecal transplants in people [58:45]; Beneficial strains of gut bacteria and strains commonly found in probiotics [1:01:15]; The difference between a probiotic and prebiotic, and how CFUs are a measure of the “active ingredient” [1:09:45]; Considerations about how probiotic strains are produced, and more on the meaning of CFU [1:14:15]; Mitigating the effect of antibiotics on the microbiome [1:22:30]; What do we know about the effect of artificial sweeteners on the gut microbiome? [1:30:00]; Why Akkermansia is a keystone strain with implications for metabolic health and an individual’s response to dietary interventions [1:36:15]; The essential steps necessary to develop a robust probiotic for optimal health support [1:45:45]; How Akkermansia helps control blood glucose, and potential implications of Akkermansia in weight loss, diabetes management, and more [1:48:45]; Pendulum Therapeutics’ commitment to rigorous product develop [2:06:30]; Details about the probiotic “Glucose Control” and other probiotics developed by Pendulum Therapeutics [2:13:00]; Further studies of Akkermansia that have been proposed or are underway [2:20:30]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#283 ‒ Gut health & the microbiome: improving and maintaining the microbiome, probiotics, prebiotics, innovative treatments, and more | Colleen Cutcliffe, Ph.D.

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter tackles essential questions about magnesium, beginning with the important roles it plays in the body and why maintaining proper levels is crucial. Peter discusses the harms of magnesium deficiency, how to determine if you're deficient, potential causes of deficiency, and how diet and supplementation can be used to increase magnesium levels. Peter unravels the confusion surrounding magnesium supplementation, discussing the optimal forms and recommended daily intake while addressing concerns about excess consumption. He also explores the potential cognitive and sleep benefits associated with magnesium supplementation. Finally, Peter concludes with a look into his recent experimentation with new exercises to serve as benchmarks to assess his progress and fitness levels as he navigates the aging process. 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 #54 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:  The important roles of magnesium in the body [2:45]; How to determine if you might be deficient in magnesium [10:15]; Addressing migraines related to low magnesium [14:45]; The prevalence of magnesium deficiency [16:30]; Various conditions and drugs that can negatively impact magnesium levels [21:30]; Magnesium-rich foods and factors that impact absorption of magnesium [24:30]; Daily targets for magnesium supplementation and whether it’s possible to take too much [30:15]; The different forms of supplemental magnesium [34:00]; How absorption of magnesium from food compares to absorption from supplements [36:15]; Choosing the right magnesium supplements for optimal absorption [37:15]; The unique ability of magnesium L-threonate to increase brain magnesium concentration [40:15]; Potential cognitive benefits of magnesium [43:00]; Potential sleep benefits of magnesium [48:45]; Takeaways on magnesium and a look into Peter’s personal protocol [53:15]; Peter’s new benchmarks related to exercise and age [58:30]; and The potential impact of hearing loss on brain health and neurodegeneration [2:04:30]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#282 - AMA #54: Magnesium: risks of deficiency, how to correct it, supplement options, potential cognitive and sleep benefits, and more

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter Richard Miller is a professor of pathology and the Director of the Center for Aging Research at the University of Michigan, as well as a previous guest on The Drive. In this episode, Rich provides an update on the exciting work of the Interventions Testing Program (ITP), an initiative designed to assess potential life-extending interventions in mice. Rich covers the notable successes like rapamycin, 17⍺-estradiol, and acarbose as well as notable failures like nicotinamide riboside, metformin, and resveratrol, providing valuable lessons about the intricacies of the aging process. Rich delves deep into aging biomarkers and aging rate indicators, unraveling crucial insights into the science of geroprotective molecules. Additionally, Rich discusses some surprising successes of recent molecules tested by the ITP and concludes with an optimistic look at future frontiers, including bridging the gap from mice to humans. We discuss:  An overview of the Interventions Testing Program (ITP) [3:45]; How the mice used by the ITP are superior for research relative to mouse models used in most research [11:15]; Design of ITP studies, outcomes tested, and metrics of interest [19:00]; The process and challenges of drug formulation for mice [30:00]; Four drugs identified by the ITP that extends the lifespan of mice [36:30]; The success of rapamycin and what it tells us about the biology of aging [43:15]; Other measures of healthspan evaluated by the ITP in stage 2 studies [50:45]; Distinguishing aging rate indicators from biomarkers of aging [57:30]; Aging rate indicators identified through the examination of slow-aging mice [59:15]; Why proteomics are essential to understand changes in the cell [1:12:15]; Unraveling aging rate indicators: dose-effect, duration, and future frontiers [1:21:45]; A closer look at aging rate indicators: bridging the gap from mice to humans [1:27:00]; What do laboratory mice die from? [1:38:45]; Distinguishing between a drug that improves an age-sensitive outcome and a drug that improves all aspects of aging [1:42:00]; The ITP study of 17⍺-estradiol: mechanisms of life extension and surprising sex differences [1:43:30]; Unsuccessful drugs studied by the ITP: resveratrol, metformin, and nicotinamide riboside [1:51:30]; Over-the-counter successes in the ITP: meclizine and astaxanthin [2:01:00]; A senolytic drug, fisetin, fails to extend lifespan [2:07:00]; Can targeting senescent cells slow aging? [2:13:00]; Optimism about future findings [2:16:30]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#281 ‒ Longevity drugs, aging biomarkers, and updated findings from the Interventions Testing Program (ITP) | Rich Miller, M.D., Ph.D.

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter Arthur Brooks is a social scientist, professor at Harvard University, columnist for The Atlantic, and bestselling author. In this episode, Arthur returns to the podcast to discuss his new book, Build the Life You Want. He delves into the nuanced concept of happiness, differentiating between momentary feelings and overall wellbeing. He explains the importance of understanding one’s personality pattern with respect to positive and negative emotions in order to better self-manage emotions. He delves into the three key elements of happiness, offering practical strategies for enhancing those specific domains through methods such as metacognition, transcendent experiences, discipline, minimizing self-focus while directing attention outward, and more. Through personal examples, Arthur demonstrates that one can actively track well-being levels and take intentional steps to cultivate happiness and enhance overall well-being. We discuss:  Happiness vs. happy feelings, and how happiness and unhappiness can coexist [4:30]; The six fundamental emotions [8:00]; The evolution and heritability of happiness, and the four personality patterns with respect to positive and negative emotions [17:30]; Navigating relationships: the power of complementarity over compatibility [23:30]; The importance of self-managing your mental habits [25:30]; Enjoyment: one of the three macronutrients of happiness [32:00]; Satisfaction: one of the three macronutrients of happiness [43:45]; The reverse bucket list, metacognition, and other techniques to protect yourself from your limbic system [51:00]; Meaning: one of the three macronutrients of happiness [57:30]; The four quarters of your life and how that relates to the meaning of your life [1:05:00]; Putting metacognition into practice [1:09:00]; What might explain the societal downdrift in happiness over the last few decades? [1:17:00]; Taking charge of your happiness: discipline, transcendent experiences, and other deliberate actions for happiness [1:30:30]; Tracking happiness: biomarkers and micronutrients behind the macronutrients of happiness [1:42:00]; The value in minimizing the self and looking outward [1:49:45]; How Arthur surprised himself with his ability to improve his happiness [1:54:00]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#280 ‒ Cultivating happiness, emotional self-management, and more | Arthur Brooks Ph.D.

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter To support Tom’s mission and work, please visit: https://africanmissionhealthcare.org/donation/catena/.   In this episode, Tom Catena, a missionary physician who runs Mother of Mercy Hospital in the Nuba Mountains in Sudan, describes some of his extraordinary work as the only doctor in a remote, war-torn region of Africa. In terms of individual lives saved, you could argue that there is no other person on the front lines doing more than Tom. Additionally, we explore the manner in which the Nuba people die, which is in striking contrast to the ubiquity of chronic disease and self-harm in the West, despite the extreme poverty and unimaginable suffering experienced by the Nuba people. Lastly, we discuss the lessons to be gleaned from the Nuba people, who, despite their suffering, live so harmoniously, happily, and resiliently. We discuss:  Background, medical training, and early days of missionary work in Africa [5:15]; Tom arrives at Mother of Mercy Hospital in the Nuba Mountains of Sudan, civil war breaks out, and his staff evacuates [12:30]; Learning surgery on the job and earning the trust of the community [37:00]; The amazing people of Nuba, and why Nuba feels like home to Tom [47:45]; NY Times article about Tom’s work, and Tom’s new venture on the board of the Aurora Prize Foundation, raising awareness and funds for other missionaries [59:45]; Tom’s mind-blowing ability to deal with chaos while seeing hundreds of patients per day [1:12:00]; The most afraid Tom has ever been, and how he copes with the emotional trauma of his daily experiences [1:19:45]; The basic tools, technologies, and medicines that Tom is lacking that could save many lives [1:30:00]; The logistical challenge of helping Tom’s hospital, and what Tom really needs [1:35:15]; Diseases in the adult population [1:38:30]; Living without possessions, finding meaning, and being a missionary [1:55:45]; Happiness, sense of purpose, and suicide: contrasting the US with Nuba [2:07:15]; Other than donations, is there a way people can help Tom and other similar causes? [2:15:15]; The food in Nuba [2:18:30]; Tom’s annual bout of malaria [2:23:45]; Patients Tom will never forget [2:26:00]; Resources for people wanting to get involved in helping Tom’s work [2:31:00]; Peter tells a story that defines Tom [2:32:00]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

The world’s most important doctor to millions in the war-torn and remote villages of Sudan | Tom Catena, M.D. (#40 rebroadcast)

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter In this “Ask Me Anything” (AMA) episode, Peter explores various pharmacologic tools commonly utilized to improve metabolic health and treat diabetes, including SGLT-2 inhibitors, metformin, and GLP-1 agonists. He examines the available data on these drugs, assessing their comparative effectiveness and their potential in the context of lifestyle interventions. Additionally, he offers insights into whether SGLT2 inhibitors hold promise as geroprotective agents beyond their effects on glycemic control. Next, Peter analyzes the relationship between statin usage and the risk of developing insulin resistance and type 2 diabetes, investigating possible causal pathways and providing insights into strategies for risk reduction. He offers insights on monitoring adverse statin effects and evaluating the need for adjustments, ultimately weighing the trade-off between the risk to overall metabolic health against the benefits of reducing apoB levels through statin use. 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 #53 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:  Pharmacologic tools for improving metabolic health, and the relationship between statins and insulin resistance [2:00]; SGLT-2 inhibitors: how they work and help to manage type 2 diabetes [4:15]; The history of SGLT2 inhibitors – from discovery to the current state [10:15]; Comparing the various FDA-approved SGLT2 inhibitors [15:00]; Other beneficial effects of SGLT2 inhibitors outside of glycemic control [20:15]; Exploring SGLT2 inhibitors as potential geroprotective molecules [22:45]; The side effects and risks associated with SGLT2 inhibitors [31:45]; Medications, lifestyle interventions, and other considerations for treating diabetes and improving metabolic health [37:45]; Metformin as a tool for pre-diabetics, and how metformin compares to lifestyle interventions [44:00]; How GLP-1 agonists compare to metformin and SGLT2 inhibitors in terms of glycemic control and weight loss [49:15]; Exploring the relationship between statin use and the risk of developing insulin resistance and type 2 diabetes [52:30]; Possible mechanisms of statin-induced insulin resistance and diabetes, and potential mitigation strategies [1:04:30]; How to monitor for adverse effects of statin use and assess the need for adjustments [1:11:45]; Weighing the benefits and risks of statin use: does the diabetes risk outweigh the benefits of lowering apoB with a statin? [1:15:30]; Parting thoughts [1:20:45]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#279 - AMA #53: Metabolic health & pharmacologic interventions: SGLT-2 inhibitors, metformin, GLP-1 agonists, and the impact of statins

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter Harold (Hal) Burstein is an internationally renowned breast cancer expert. In this episode, Hal discusses a broad range of topics related to breast cancer, starting with the intricacies of breast anatomy and the endocrinological factors at play. He covers the spectrum of breast cancer, from precancerous lesions to invasive breast cancer, classifying these conditions into a helpful framework. He delves into various screening methods, including self-exams, mammograms, ultrasounds, and MRIs, and addresses the ongoing debate surrounding early screening and detection. Hal provides insights into the latest advancements in cancer treatment, offering valuable guidance for individuals to understand their unique circumstances within the three primary categories of breast cancer. Finally, Hal delves into the role of genetics in breast cancer and brings attention to the less commonly addressed issue of male breast cancer. We discuss:  The prevalence and mortality rate of breast cancer in women [4:15]; The anatomy of the breast and the complex factors behind breast cancer development [6:30]; The three main categories of breast cancer [16:45]; Breast cancer risk: the impact of menopause, estrogen, breast density, obesity, and more [21:15]; Finding and evaluating lumps in the breast [25:30]; Identifying and treating precancerous lesions like ductal carcinoma in situ (DCIS) [31:00]; Post-lumpectomy for DCIS: standard of care, future risk of cancer, and pros and cons of radiation and other preventative options [41:15]; Lobular carcinoma in situ (LCIS): how it differs from DCIS in terms of treatment and future risk of invasive cancer [55:00]; Breast cancer screening: mammography, ultrasound, MRI, and more [1:03:45]; Invasive breast cancer: pathology report, surgery, and survival [1:11:00]; The argument for aggressive screening for breast cancer [1:22:15]; Advances in the treatment of breast cancer, adjuvant therapy, and neoadjuvant therapy [1:27:00]; The use of hormone replacement therapy in women who are in remission from breast cancer [1:41:15]; The role of genetics in breast cancer [1:44:45]; The importance of multidisciplinary care delivered by cancer centers [1:53:15]; Breast cancer in men [2:03:30]; Parting thoughts and takeaways [2:05:45]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#278 ‒ Breast cancer: how to catch, treat, and survive breast cancer | Harold Burstein, M.D., Ph.D.

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter Kari Nadeau is a physician scientist with expertise in treating food allergies. In this episode, Kari first explains the fascinating workings of the immune system, exploring how it adeptly defends against bacteria and viruses but how the same system can lead to food allergies. She proceeds to explore the complexities of food allergies, detailing their typical developmental patterns, underscoring the significance of preventative approaches like early exposure, and highlighting the potentially life-threatening nature of severe food allergies. Kari illuminates the latest advancements in immunotherapies that not only mitigate allergy severity but also hold the potential to completely cure the patient. Additionally, Kari shares her concerns about the increasing levels of air pollution, elucidating its adverse effects on health while providing valuable suggestions for reducing exposure. We discuss:  Kari’s motivation to study food allergies [4:00]; Overview of the immune system and the family of immunoglobulins [9:00]; How our immune system fights viruses, bacteria, or fungi, and some exceptions to the rule [13:00]; Why our immune system is generally better at fighting viruses than bacterial infections [18:45]; Differentiating a food sensitivity from a food allergy, and a discussion about celiac disease [25:30]; How food allergies develop, why they can be lethal, and factors contributing to the uptrend in food allergies [35:45]; The role of environmental factors in the onset of food allergies and strategies for prevention [50:15]; How immunotherapy helps to overcome, and even cure, food allergies [1:04:15]; Can immunotherapy work for environmental allergens like pollen? [1:24:00]; Air pollution: impact on health and tips for reducing your risk [1:25:30]; Resources for those wanting to learn more or find clinical trials related to food allergies [1:40:45]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#277 ‒ Food allergies: causes, prevention, and treatment with immunotherapy | Kari Nadeau, M.D., Ph.D.

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter In this special episode of The Drive, Peter discusses a variety of topics, breaking away from the typical deep-dive format to explore a wide range of common questions submitted by listeners. Peter tackles subjects like the viability of living to 120 and beyond, addressing some of the optimistic theories regarding achievement of this remarkable feat. Peter then shares his drug and supplement regimen while emphasizing how individualized these protocols need to be. The conversation also touches on lowering apoB, the long-term use of statins, the myth of good vs. bad cholesterol, the complexities of nutrition research, the quest for the ideal diet, and Peter's strategies for hitting daily protein goals. Peter finishes with a discussion about his favorite health-tracking wearables, the role of CGM in non-diabetics, and more. We discuss:  Overview of topics and previous episodes of a similar format [2:45]; The viability of living to 120 and beyond: some optimistic theories [4:45]; The potential of mTOR inhibition as a mid-life intervention, and longevity potential for the next generation [13:30]; A framework for thinking about geroprotective drugs and supplements in the context of a lack of aging biomarkers [17:00]; Supplements Peter takes and how his regimen has changed in the last year [26:15]; Pharmacologic strategies to lower ASCVD risk, the limitations of statins, nutritional interventions, and more [36:15]; Misnomers about cholesterol [48:00]; Why nutritional research is so challenging, some general principles of nutrition, and why Peter stopped doing prolonged fasts [50:45]; Optimizing protein intake [59:45]; Wearables for sleep and exercise, continuous glucose monitors (CGM), and a continuous blood pressure monitor on the horizon [1:04:45]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

#276 ‒ Special episode: Peter answers questions on longevity, supplements, protein, fasting, apoB, statins, and more

View the Show Notes Page for This Episode  Become a Member to Receive Exclusive Content  Sign Up to Receive Peter’s Weekly Newsletter In this "Ask Me Anything" (AMA) episode, the discussion zeroed in on the practical application of hormone replacement therapy in women. Peter walks through the signs, symptoms, and hormonal changes in women approaching – and going through – menopause. He provides an overview of the FDA-approved HRT formulations and explains how women might go about choosing the right option for themselves. Peter also describes the significant changes in testosterone levels in women over time and the options, as well as the considerations and challenges of testosterone replacement therapy (TRT) for women. Lastly, Peter highlights the necessary role of compounding pharmacies in HRT, underscores concerns regarding the quality and sterility of compounded drugs, and offers guidance on locating a trustworthy pharmacy. 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 #52 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss:  Why hormone replacement therapy is such an important topic [2:00]; The onset of menopause: symptoms, blood tests, and when to consider HRT [6:00]; Tests that may provide indications of perimenopause and their implications for fertility [9:15]; Vasomotor symptoms: hormonal changes that cause hot flashes/night sweats, and HRT therapies that can help [13:45]; The role of estrogen in menopausal HRT [17:30]; The limited role of progesterone in HRT protocols [25:15]; What is a “bioidentical” hormone? [28:30]; Overview of the FDA-approved HRT formulations [31:45]; Determining HRT dosing and considerations for perimenopausal women [37:45]; Choosing the right HRT formulation: pros and cons [43:30]; Examining the link between certain forms of estrogen and breast cancer [46:45]; Changes in testosterone levels in women over time and why it matters [50:00]; Recognizing low testosterone in women: common symptoms and diagnosis [53:45]; Testosterone replacement therapy for women: options, considerations, and challenges [57:30]; The long-term use of testosterone in women: examining the limited data [1:00:15]; What is a compounding pharmacy? [1:09:30]; Reasons to opt for a compounding pharmacy over a pharmacy that adheres to stricter regulations [1:16:00]; The tragic incidents that heightened concerns about compounding pharmacies [1:20:45]; Tips for finding a reputable compounding pharmacy [1:27:45]; and More.  Connect With Peter on Twitter, Instagram, Facebook and YouTube

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