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Peter Attia

Expert insight on health, performance, longevity, critical thinking, and pursuing excellence. Dr. Peter Attia (Stanford/Hopkins/NIH-trained MD) talks with leaders in their fields.

The Peter Attia Drive

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Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav returns to dive deeper into his groundbreaking work as an endurance coach, exercise scientist, engineer, and physiologist. The discussion explores his data-driven approach to coaching, unpacking key performance metrics like functional threshold power, VO2 max, and lactate threshold, while emphasizing the importance of consistent testing protocols. Olav shares insights on how training methodologies differ across sports, the impact of nutrition on endurance performance, and the evolving strategies for carbohydrate metabolism in fueling athletes for races. Olav concludes with a discussion on the use of artificial intelligence for optimizing training insights and performance.
 
We discuss:
 
 • Olav’s unique, engineering-driven approach to endurance coaching [2:45];
 • Definitions and applications of key performance metrics: FTP, power, anaerobic threshold, and lactate threshold [4:45];
 • Lactate threshold: factors affecting lactate threshold, testing protocols, and how elite athletes' efficiency affects their performance and lactate profiles [14:15]
 • VO2 max: definition, testing, factors affecting its accuracy, and methods for optimizing oxygen utilization in elite athletes [22:15];
 • Testing VO2 max: common mistakes and key factors to consider—preparation, warm-up, timing, and more [34:00];
 • VO2 max testing continued: measuring instruments, testing protocols, and advanced insights gained from elite athletes [41:45];
 • The influence of supplements like beetroot concentrate and adaptogens on VO2 max and performance [49:45];
 • How respiratory quotient (RQ) reflects metabolic shifts during exercise, the challenges in measuring and interpreting RQ in elite athletes, and the physiological adaptations needed for prolonged endurance events [53:30];
 • Triathlon training: the challenge of maintaining elite performance across triathlon distances, metabolic efficiency, and swimming challenges [1:03:15];
 • How reducing drag in swimming could revolutionize performance and the role of biofeedback tools in optimizing efficiency across various endurance sports [1:07:00];
 • How endurance athletes prioritize effort regulation using RPE, heart rate, and power output, and the role of lactate in cardiac and athletic efficiency [1:20:00];
 • Lactate’s role as a fuel, buffering methods to combat lactic acidosis, and the variability in athlete response to bicarbonate supplementation [1:25:45];
 • The physiological mechanisms behind differences in performance between two elite athletes: lactate transport, cardiovascular efficiency, and compensatory systems [1:33:00];
 • Comparing interventions like acetaminophen to enhance performance in high-heat conditions versus natural adaptations to heat [1:37:15];
 • Advancements in nutrition science, changes in cyclist body composition, and the impact of fueling strategies on athletic performance and growth [1:39:30];
 • Optimizing endurance performance with utilization of carbohydrates, and the potential role of ketones [1:48:00];
 • Insights gained from elite performers in the 2020 and 2024 Olympics [1:58:30];
 • The use of artificial intelligence to optimizing training insights and performance [2:06:30]; and
 • More.
 
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#331 ‒ Optimizing endurance performance: metrics, nutrition, lactate, and more insights from elite performers | Olav Aleksander Bu (Pt. 2)

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In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions on diverse topics such as aerobic efficiency and VO2 max with Olav Aleksander Bu; insulin resistance with Ralph DeFronzo; economics of the US healthcare system and cost-saving strategies with Saum Sutaria; diagnosis and treatment of autism, ADHD, and anxiety in children with Trenna Sutcliffe; and strength training with Mike Israetel. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these fascinating 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 #338 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • Overview of topics to be discussed [2:00];
 • Olav Aleksander Bu Pt.2 episode: metrics to track aerobic efficiency and insights about VO2 max, and the ability of increased carbohydrate consumption to boost performance [4:30];
 • The best practices for performing a VO2 max test, the differences between VO2 max training and all-out efforts, and the role of energy intake in endurance performance [14:45];
 • Ralph DeFronzo episode: the pathophysiology of insulin resistance and type 2 diabetes—how they impact different organs, flaws in conventional diabetes treatment, and more [24:30];
 • Understanding type 2 diabetes beyond the traditional triumvirate of features: the “ominous octet” describes changes in other organs [31:45];
 • Pharmacological treatments for insulin resistance and type 2 diabetes [41:30];
 • The importance of early detection and intervention in insulin resistance [50:30];
 • Saum Sutaria episode: the economic and systemic drivers of high healthcare costs in the U.S. [54:00];
 • Reducing health care costs: redefining health insurance, lowering drug prices while maintaining innovation, leveraging AI for efficiency, and more [1:07:15];
 • Trenna Sutcliffe episode: insights on autism, ADHD, and anxiety in children—definitions and diagnosis [1:11:45];
 • Exploring the rising prevalence of autism spectrum disorder [1:17:15];
 • Trenna’s views on caring for children with autism [1:21:15];
 • Misconceptions around vaccines and autism [1:26:00];
 • Mike Israetel episode: insights about strength training, minimum effective dose, troubleshooting plateaus, tips for beginners, and more [1:28:15];
 • Topics Peter is interested in exploring in future podcasts [1:40:15]; and
 • More.
 
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#338 ‒ Peter’s takeaways on aerobic exercise and VO2 max, insulin resistance, rising healthcare costs, treating children with autism and ADHD, and strength training | Quarterly Podcast Summary #4

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In this quarterly podcast summary (QPS) episode, Peter summarizes his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from his discussions with Jeff English on the journey to healing from trauma; Ashley Mason on improving sleep and CBT-I; Sanjay Mehta on misconceptions around radiation and its use in cancer therapy and treating inflammatory conditions (such as arthritis and tendonitis); Sean Mackey on understanding and treating acute and chronic pain; and Susan Desmond-Hellmann on insights from her extraordinary career that pertain to the use of AI in medicine, understanding cancer, and the development of cancer therapeutics. Additionally, Peter shares any behavioral changes he’s made for himself or his patients as a result of these fascinating 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 #347 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • Summary of episode topics [1:45];
 • Jeff English episode: how trauma shapes behavior and identity, and the value of understanding personal adaptations and working through unresolved emotional wounds [3:45];
 • Practical behavioral changes and emotional tools Peter has applied since the Jeff English episode [13:00];
 • Ashley Mason episode: treating insomnia using CBT-I and practical behavioral techniques for improving sleep quality [19:15];
 • When to seek professional care for sleep issues [30:30];
 • Sanjay Mehta episode: radiation therapy’s evolution, its underused potential in treating inflammatory conditions, and the cultural misconceptions surrounding radiation exposure [33:45];
 • Peter’s predictions and insights for the upcoming Formula 1 season [43:15];
 • Sean Mackey episode: the neuroscience, classifications, and treatment strategies for chronic pain, and the importance of personalized care [57:45];
 • Susan Desmond-Hellmann episode: how AI is revolutionizing medicine through advancements in drug development, biomarker discovery, and the potential of training models on private clinical data [1:05:45];
 • More from Susan Desmond-Hellmann: why cancer is so difficult to treat with drugs, the promise of immunotherapy, and the long-term hope for systemic treatments [1:14:00]; and
 • More.
 
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#347 – Peter’s takeaways on mastering sleep, dealing with chronic pain, developing breakthrough cancer drugs, transforming healthcare with AI, advancing radiation therapy, and healing trauma | Quarterly Podcast Summary #5

In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women's Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease, neurodegenerative disease, and osteoporosis, to name a few.
 
We discuss:
 • The background of Carol and Avrum, and the impetus for writing Estrogen Matters [8:45];
 • The sad early history of hormone replacement therapy, treatments for prostate and breast cancer, and the difference between the treatment of women vs. men [14:00];
 • What hormones do, and why they drop off rapidly in women compared to gradually in men [20:15];
 • Mistreatment of women leading to great skepticism [23:45];
 • Breast cancer vs heart disease: Comparing the incidence and mortality in women [27:00];
 • Case studies of women suffering symptoms of menopause [30:00];
 • What are Carol and Avrum’s true motivations in this endeavor? [32:45];
 • The changing perceptions of HRT, the impact of the Women’s Health Initiative (WHI), and the problems with the WHI [37:45];
 • Is this one big conspiracy? The uncanny resemblance of the story of HRT and how the dietary guidelines were created [46:00];
 • Why people (falsely) think estrogen causes a 25% increase in breast cancer, and a lesson in absolute vs. relative risk [57:15];
 • The truth about progesterone and cancer risk, and the best types of estrogen and progesterone to be taking [1:09:00];
 • The Women’s Health Initiative: the reported findings, walking back their bold claims, and their hesitance to admit they were wrong [1:17:45];
 • Brain benefits of HRT, Alzheimer’s disease in women, and estrogen as a preventative treatment for AD [1:22:45];
 • The impact of HRT on heart disease, the ideal time to start HRT, and the risks associated with HRT [1:26:45];
 • The benefits of estrogen on bone health, and the incidence and mortality of hip fractures [1:33:15];
 • Colon cancer: Can HRT reduce the risk of colon cancer? [1:38:15];
 • Diabetes: Can HRT reduce the risk of developing diabetes? [1:40:30];
 • The downsides of hormone replacement therapy (HRT) [1:41:30];
 • How to approach your doctor who may already have a very strong point of view about HRT [1:42:15];
 • What kind of research needs to be done to answer the remaining questions about the benefits and risks of HRT? [1:48:30];
 • Cancer: Our evolving understanding and the future of treatment [1:59:15];
 • Welcoming the critics: Avrum and Carol want to start a conversation [2:02:00];
 • Are there racial differences in benefits and risks with HRT? [2:04:15];
 • The reactions to Estrogen Matters, and why it is a must read [2:09:15];
 • HRT after a diagnosis of breast cancer [2:13:45]; and
 • More.
 
 Learn more at www.PeterAttiaMD.com
 
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#42 - Avrum Bluming, M.D., and Carol Tavris, Ph.D.: Controversial topic affecting all women—the role of hormone replacement therapy through menopause and beyond—the compelling case for long-term HRT and dispelling the myth that it causes breast cancer

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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.
 
We discuss:
 
 • Heart rate variability (HRV): evolution, science, and practical applications of HRV in athletic training [4:00];
 • Methods of measuring HRV: EKG, wrist-based sensors, and more [11:30];
 • How HRV is calculated from the data [22:30];
 • The role of the autonomic nervous system (ANS) in regulating HRV [25:45];
 • The decline in HRV with age, and the mitigating effects of fitness and other lifestyle factors [33:30];
 • The role of genetics in HRV, the modifiability of HRV, and a comparison of VO2 max and HRV as predictors of mortality [37:00];
 • How aging affects HRV and sympathetic drive, and the importance of spontaneous movement and exercise in maintaining the body's adaptability [43:30];
 • How Morpheus measures HRV using RMSSD and normalizes it to a 100-point scale for easier interpretation [49:45];
 • The Morpheus system: development, integration with various metrics, and personalized daily training recommendations to optimize fitness and recovery [51:30];
 • The benefits of morning HRV readings for assessing daily readiness compared to overnight HRV measurements [1:03:00];
 • Why Morpheus recommends using a chest strap rather than an arm band [1:10:00];
 • The impact of consistent exercise, stress, alcohol, and other lifestyle factors on HRV [1:11:15];
 • Optimizing zone 2 training with Morpheus [1:18:15];
 • Using heart rate recovery (HRR) as an indicator of athletic conditioning and the balance between aerobic and anaerobic systems [1:22:45];
 • The importance of tracking HRV trends over time rather than focusing on data from a given day [1:29:00];
 • Effect of GLP-1 agonists on heart rate and HRV [1:34:45];
 • Where HRV belongs in the hierarchy of health metrics [1:42:00];
 • Parting thoughts [1:46:30]; and
 • More.
 
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#305 ‒ Heart rate variability: how to measure, interpret, and utilize HRV for training and health optimization | Joel Jamieson

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In this "Ask Me Anything" (AMA) episode, Peter dives deep into one of the most frequently discussed and often misunderstood topics: nutrition. From weight loss and maintenance to the intricate relationship between nutrition and exercise and body composition, Peter addresses the complexities of nutrition research and explores the perennial question of whether there is a "best diet." He provides practical insights on how to choose the right diet for your unique needs, discusses the role of protein and processed foods, and outlines the key questions to help you optimize your approach to eating.
 
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 #66 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • The key nutrition-related topics to be discussed [1:30];
 • Why Peter is not fond of discussing nutrition: limitations of nutrition research, the pitfalls of extreme certainty in dietary discussions, and the body's adaptability to varied diets [3:30];
 • Key health metrics to monitor to evaluate the effects of nutrition [9:30];
 • The relationship between nutrition and exercise as they relate to weight loss, maintenance, and gain [12:30];
 • How increased muscle mass from resistance training impacts calorie burn, body composition, glucose metabolism, and overall health benefits [19:45];
 • Comparing the impact of fitness and nutrition on lifespan and healthspan: data showing fitness to be a more significant predictor of mortality than nutrition [23:30];
 • The myth of a “best diet,” factors that determine the effectiveness of a diet, and data suggesting benefits of the Mediterranean diet [39:00];
 • How long to trial a new diet, the importance of measurable goals, and the appropriate timescales for observing meaningful changes [48:30];
 • The inherent challenges in nutrition research: variability in dietary exposures, limitations in study design, the body’s adaptive nature which dampen the effects, and more [51:15];
 • Nutritional approaches for chronic diseases like cardiovascular disease and type 2 diabetes [58:45];
 • Emerging studies on dietary interventions for non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) [1:02:45];
 • Practical considerations for individuals to identify the best diet for them: protein intake, energy balance, macronutrient adjustments, and micronutrient levels [1:06:00];
 • Understanding processed vs. ultra-processed foods [1:09:15];
 • The effects of ultra-processed foods on health [1:12:30];
 • Questions that someone should ask themselves if they’re looking to fine-tune their diet [1:18:15]; and
 • More.
 
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#328 - AMA #66: Optimizing nutrition for health and longevity: myth of a “best” diet, complexities of nutrition science, and practical steps for building a sustainable diet

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In this special episode of The Drive, Peter tackles a wide range of listener questions submitted over the past year. The discussion spans essential topics such as exercise—covering grip strength, traveling workouts, and why Peter doesn’t consider exercise an ideal weight-loss strategy—and the top biomarkers everyone should track. He also explores promising new longevity research, his evolving views on longevity, and frameworks like “objective, strategy, tactics” for personalized decision-making. The episode wraps up with insights on building good habits and a glimpse into Peter’s recent reading list.
 
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 Special AMA show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • Overview of episode topics (and Peter’s car stereo saga) [1:45];
 • The importance of grip strength and the best methods for training it effectively [3:45];
 • Exercise while traveling: strategies for staying active and maintaining an exercise routine [14:45];
 • Why women should prioritize strength training [18:00];
 • The limited role of exercise in weight loss and its greater importance in improving health, body composition, and insulin sensitivity [19:45];
 • The “top five most important biomarkers” for assessing health [22:45];
 • Promising developments in longevity research [28:15];
 • The development of Klotho as a neuroprotective drug: challenges, timelines of trials, and more [34:00];
 • Peter’s updated view on the potential of epigenome manipulation to restore aged cells to their youthful state [39:45];
 • How reversing age-related epigenetic changes in immune cells could revolutionize our approach to aging and disease [43:30];
 • The “objective, strategy, tactics” framework, and the importance prioritizing impactful lifestyle habits over less significant health trends [49:30];
 • Strategies for building and maintaining good habits [56:45];
 • How to think about drugs and supplements as part of a longevity toolkit [1:02:00];
 • Peter’s recent reading list [1:05:15]; and
 • More.
 
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#329 ‒ Special AMA: Peter on exercise, important labs, building good habits, promising longevity research, and more

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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.
 
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Building & Changing Habits | James Clear (#183 rebroadcast)

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Trenna Sutcliffe is a developmental behavioral pediatrician and the founder and medical director of the Sutcliffe Clinic in the San Francisco Bay Area, where she partners with families to provide care for children facing behavioral challenges, developmental differences, and school struggles. In this episode, Trenna shares her journey into developmental and behavioral pediatrics, including her pioneering work at Stanford and her expertise in autism, ADHD, and anxiety—the "three As." She explores the diagnostic processes, the overlap and comorbidities of these conditions, and the importance of personalized treatment plans that address both medical and environmental factors. Trenna offers valuable insights into the changing prevalence of autism, the impact of evolving diagnostic criteria, and the range of therapies and medications available to support children and their families. She also discusses the challenges in accessing care and the critical need for a holistic approach that bridges healthcare and education.
 
We discuss:
 
 • Trenna’s passion for developmental-behavioral pediatrics (DBP), and the process of diagnosing anxiety, ADHD, and autism [3:15];
 • Understanding anxiety and ADHD: assessing impairment and self-esteem and identifying anxiety and emotional well-being in young patients [9:45];
 • The evolving diagnosis of autism: understanding the spectrum and individual needs [16:30];
 • The dramatic rise in autism spectrum disorder (ASD): genetics, environment, expanded diagnostic criteria, and more [25:45];
 • Exploring epigenetics and the potential multigenerational impact of environment exposures on susceptibility to certain disorders [37:15];
 • The evolution of autism classifications, and the particular challenges for children with level 1 (mild) autism due to a lack of support [41:15];
 • The broadening of the autism spectrum: benefits and risks of expanded diagnostic criteria and the need for future frameworks to focus on better outcomes [48:00];
 • The overlap between ASD, ADHD, and anxiety [57:15];
 • Understanding oppositional defiant disorder, and the importance of understanding the “why” behind a behavior when creating treatment plans [1:00:45];
 • Defining developmental-behavioral pediatrics (DBP), and Trenna’s professional journey [1:07:00];
 • Updated methods of ABA (applied behavioral analysis) therapy: evolution, controversies, challenges of scaling autism care, and the need for tailored interventions [1:13:45];
 • Advice for parents trying to find and evaluate care for children with autism, ADHD, or anxiety [1:22:45];
 Tailored treatments for ADHD: balancing stimulant medications with behavioral training [1:28:30]; • The interplay between medication, behavioral therapy, and neuroplasticity in managing ADHD, and the potential to grow out of the need for medication [1:39:45];
 • Using medication to treat anxiety and other symptoms in kids with autism without ADHD [1:44:45];
 • FAQs about medicating children with ADHD: benefits, side effects, dosage, and more [1:46:30];
 • The “superpowers” associated with level 1 autism [1:48:45];
 • The next steps to increase support for children with ASD, anxiety, and ADHD [1:50:45]; and
 • More.
 
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#330 – Autism, ADHD, and Anxiety: Understanding the rise in autism and a multidisciplinary approach to diagnosis and treatment of each condition in children | Trenna Sutcliffe, M.D.

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In this “Ask Me Anything” (AMA) episode, Peter tackles a topic that's been dominating headlines and sparking widespread concern: microplastics and plastic-associated chemicals, including BPA, PFAS, and phthalates. Peter explores the science behind these substances including how and why they've become so prevalent, the extent of our exposure, and the potential risks to our health. Most importantly, he provides a practical framework for understanding microplastics and plastic-associated chemicals and minimizing exposure while distinguishing genuine risks from exaggerated concerns.
 
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 #67 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.
 
We discuss:
 
 • The complexity of the topic of microplastics and associated chemicals [1:30];
 • Definitions: microplastics, BPA, PM2.5, phthalates, and more [6:30];
 • The reasons behind the increase in microplastics in our environment and the surge in interest in them [12:00];
 • The various ways that humans are exposed to microplastics and nanoplastics [14:00];
 • Volume of plastic consumed by humans, and how the body eliminates or absorbs microplastics [16:00];
 • How microplastics accumulate in the body, the variability in tissue accumulation, and the challenges in studying their long-term health effects [21:30];
 • Limitations of blood tests for microplastics, and the importance of reliable biomarkers for guiding behavior and interventions [26:30];
 • The speculative health risks of microplastics, the limitations of current research, and the need for more robust studies [29:15];
 • The challenges of measuring microplastics in human tissues, the need for better methodologies, and the importance of critically evaluating study relevance and claims [39:45];
 • If it’s unclear whether microplastics actually cause harm, should we still be concerned about exposure? [42:15];
 • Strategies to minimize microplastic exposure [45:00];
 • The financial cost and effort involved in various microplastic exposure mitigation strategies [51:00];
 • The role of airborne microplastics in total exposure and accumulation [1:03:00];
 • Chemicals associated with plastics, their role as endocrine disruptors, and the challenges in linking exposure to specific health outcomes [1:04:00];
 • BPAs: role in plastic production, and its potential developmental risks [1:05:45];
 • BPA's potential health risks: pregnancy, fertility, obesity, and diabetes, and the socioeconomic confounders in the data [1:08:30];
 • Regulatory limits on BPA exposure, and practical considerations for reducing exposure [1:12:45];
 • The prevalence of BPA in modern products and how to identify it [1:17:15];
 PFAS: chemical structure and purpose in products [1:18:30]; • Why PFAS are considered endocrine disruptors [1:19:45];
 • The main sources of PFAS exposure, and practical steps to reduce exposure [1:21:30];
 • The potential health risks of PFAS exposure [1:24:00];
 • Phthalates: role in making plastics flexible and presence in personal care products [1:24:45];
 • Why phthalates are considered endocrine disruptors [1:25:15];
 • The main sources of phthalate exposure, and how manufacturing practices are evolving to reduce exposure [1:26:45];
 • Practical strategies to reduce exposure to phthalates in food, air, water, and personal care products [1:28:30];
 • Navigating microplastics and associated chemicals: a framework for personalized risk reduction [1:29:30]; and
 • More.
 
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#332 - AMA #67: Microplastics, PFAS, and phthalates: understanding health risks and a framework for minimizing exposure and mitigating risk

In this five-part series, Thomas Dayspring, M.D., FACP, FNLA, a world-renowned expert in lipidology, and one of Peter's most important clinical mentors, shares his wealth of knowledge on the subject of lipids. In Part III, Peter and Tom dig into HDL, why "reverse cholesterol transport" is a lot more nuanced than what most of us are taught, lipid transport, apolipoproteins, and more. In addition, this episode highlights the complexity of HDL and a discussion about the CETP inhibitor trials.
 
We discuss:
 
 • Reverse cholesterol transport [1:40];
 • Lipid transportation, apolipoproteins, VLDL, IDL, and LDL particles [11:00];
 • Remnant lipoproteins and apoC-III [16:45];
 • Particles having sex: lipid exchange [28:00];
 • Cholesteryl Ester Transfer Protein (CETP) and CETP inhibitors [40:45];
 • 2006 CETP inhibitor trial: torcetrapib (Pfizer) [54:45];
 • 2012 CETP inhibitor trial: dalcetrapib (Hoffmann–La Roche) [56:15];
 • 2017 CETP inhibitor trials: evacetrapib (Eli Lilly) and anacetrapib (Merck) [58:00]; and
 • More.
 
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#22 - Tom Dayspring, M.D., FACP, FNLA – Part III of V: HDL, reverse cholesterol transport, CETP inhibitors, and apolipoproteins

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