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The Peter Attia Drive

The Peter Attia Drive

Podcast The Peter Attia Drive
Podcast The Peter Attia Drive

The Peter Attia Drive


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  • #186 - Patrick Radden Keefe: The opioid crisis—origin, guilty parties, and the difficult path forward
    Patrick Radden Keefe is an award-winning staff writer at The New Yorker and the bestselling author of Empire of Pain: The Secret History of the Sackler Dynasty. In this episode, Patrick tells the story of the Sackler family and Purdue Pharma - makers of the pain management drug OxyContin, providing the backdrop for the ensuing opioid epidemic and public health crisis. He reveals the implicit and sometimes explicit corruption of all parties involved in the development, approval, and marketing of OxyContin, leading to a cascade of unintended consequences including addiction and death. He explains the unfortunate lack of accountability for the current crisis, as well as what it all means for those with legitimate pain management needs. Finally, he examines the difficult path ahead towards finding a solution. We discuss: Patrick’s investigation into distribution and use of drugs in our society [3:55]; The scale of the opioid crisis [9:15]; The Sackler brothers: family life, career in the pharmaceutical industry, and role in the current crisis [11:45]; Purdue Pharma: origins, early years, and move towards pain management drugs [17:30]; The development of OxyContin: its conception, marketing, and the controversy around the FDA approval process [25:30]; Early reports of OxyContin addiction and unintended consequences and how Purdue Pharma sidestepped responsibility [40:45]; The many paths to addiction and abuse of OxyContin and the ensuing downfall of Purdue Pharma [47:15]; Peter’s personal experience with OxyContin [57:00]; Pain—the “fifth vital sign,” how doctors are trained in pain management, and the influence of money [1:08:00]; Other players that helped facilitate the eventual opioid crisis [1:16:15]; Lack of accountability following the investigation and prosecution of Purdue and the Sackler family [1:23:30]; Legacy of the Sackler family and their disconnect from reality [1:34:45]; Patrick’s views on the regulation and use of pain management drugs [1:42:15]; The difficult path forward [1:44:45]; and More. Learn more: Show notes page for this episode:  Subscribe to receive exclusive subscriber-only content: Sign up to receive Peter's email newsletter: Connect with Peter on Facebook | Twitter | Instagram.
  • #185 - Allan Sniderman, M.D.: Cardiovascular disease and why we should change the way we assess risk
    Allan Sniderman is a highly acclaimed Professor of Cardiology and Medicine at McGill University and a foremost expert in cardiovascular disease (CVD). In this episode, Allan explains the many risk factors used to predict atherosclerosis, including triglycerides, cholesterol, and lipoproteins, and he makes the case for apoB as a superior metric that is currently being underutilized. Allan expresses his frustration with the current scientific climate and its emphasis on consensus and unanimity over encouraging multiple viewpoints, thus holding back the advancement of metrics like apoB for assessing CVD risk, treatment, and prevention strategies. Finally, Allan illuminates his research that led to his 30-year causal model of risk and explains the potentially life-saving advantages of early intervention for the prevention of future disease. We discuss: Problems with the current 10-year risk assessment of cardiovascular disease (CVD) and the implications for prevention [4:30]; A primer on cholesterol, apoB, and plasma lipoproteins [16:30]; Pathophysiology of CVD and the impact of particle cholesterol concentration vs. number of particles [23:45]; Limitations of standard blood panels [29:00]; Remnant type III hyperlipoproteinemia—high cholesterol, low Apo B, high triglyceride [32:15]; Using apoB to estimate risk of CVD [37:30]; How Mendelian randomization is bolstering the case for ApoB as the superior metric for risk prediction [40:45]; Hypertension and CVD risk [49:15]; Factors influencing the decision to begin preventative intervention for CVD [58:30]; Using the coronary artery calcium (CAC) score as a predictive tool [1:03:15]; The challenge of motivating individuals to take early interventions [1:12:30]; How medical advancement is hindered by the lack of critical thinking once a “consensus” is reached [1:15:15]; PSK9 inhibitors and familial hypercholesterolemia: two examples of complex topics with differing interpretations of the science [1:20:45]; Defining risk and uncertainty in the guidelines [1:26:00]; Making clinical decisions in the face of uncertainty [1:31:00]; How the emphasis on consensus and unanimity has become a crucial weakness for science and medicine [1:35:45]; Factors holding back the advancement of apoB for assessing CVD risk, treatment, and prevention strategies [1:41:45]; Advantages of a 30-year risk assessment and early intervention [1:50:30]; More. Learn more: Show notes page for this episode:  Subscribe to receive exclusive subscriber-only content: Sign up to receive Peter's email newsletter: Connect with Peter on Facebook | Twitter | Instagram.
  • Rick Johnson, M.D.: Metabolic Effects of Fructose (Ep. #87 Rebroadcast)
    Today’s episode of The Drive is a rebroadcast of the conversation with Rick Johnson (originally released January 6th, 2020). This episode was one of the most popular discussions to-date and is a prelude to an upcoming follow-up discussion which will be coming out in February 2022 along with the release of Rick’s new book. In this episode, Rick Johnson, professor of nephrology at the University of Colorado, explains how his research into the causes of blood pressure resulted in a change of research direction to focus more on how fructose has such profound metabolic effects. Rick begins by talking about the relationship between salt and high blood pressure, then provides a masterclass into uric acid, and then expertly reveals the mechanisms and pathways by which sugar (specifically fructose) can profoundly impact metabolic health. From there, he explains how he applies this information to real life patients as well as touches on some of the most promising ideas around pharmacotherapy that are being developed in response to the epidemics of fatty liver, insulin resistance, diabetes, and obesity. Furthermore, Rick gives his take on artificial sweeteners compared to real sugar, discusses cancer’s affinity for fructose, and much more. We discuss: The connection between blood pressure and fructose that shifted Rick’s professional focus [3:00]; The relationship between salt and blood pressure (and the role of sugar) [4:45]; Defining fructose, glucose, and sugar [18:30]; An ancient mutation in apes that explains why humans turn fructose into fat so easily [22:00]; The problems with elevated uric acid levels, and what it tells us about how sugar causes disease [30:30]; How sugar causes obesity—explaining the difference in glucose vs. fructose metabolism and the critical pathway induced by fructose [39:00]; Why drinking sugar is worse than eating it [49:00]; Unique ability of sugar to drive oxidative stress to the mitochondria, insulin resistance, and diabetes [53:00]; Why cancer loves fructose [59:20]; The many areas of the body that can use fructose [1:04:00]; Fructokinase inhibitors—a potential blockbuster? [1:06:15]; Treating high uric acid levels—Rick’s approach with patients [1:09:00]; Salt intake—what advice does Rick give his patients? [1:15:30]; How excess glucose (i.e., high carb diets) can cause problems even in the absence of fructose [1:20:00]; Artificial sweeteners vs. real sugar—which is better? [1:28:15]; Umami, MSG, alcohol, beer—do these have a role in metabolic illness? [1:32:45]; Fructose consumption—Is any amount acceptable? Is fruit okay? Where does Rick draw a hard line? [1:37:45] How does Rick manage the sugar intake of his young kids? [1:42:00]; and More. Learn more: Show notes page for this episode:  Subscribe to receive exclusive subscriber-only content: Sign up to receive Peter's email newsletter: Connect with Peter on Facebook | Twitter | Instagram.
  • #184 - AMA #29: GLP-1 Agonists—The Future of Treating Obesity?
    In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to GLP-1 agonists—a class of drugs that are gaining popularity for the treatment of obesity. They cover the discovery of these peptides, their physiology, and what it is they do in their natural state. Next, Peter and Bob break down a recently published study which showed remarkable results for weight loss and other metabolic parameters using a once-weekly injection of the GLP-1 agonist drug semaglutide, also known as Ozempic, in overweight and obese patients. Finally, they compare results from the semaglutide study to results from various lifestyle interventions and give their take on the potential future of GLP-1 agonists. If you’re not a subscriber and 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 on our website at the AMA #29 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Remarkable results of a recent study in overweight adults [2:15]; Key background on insulin, glucagon and the incretin effect [4:00]; What is GLP-1 and how does it work? [16:30]; 2021 semaglutide study: remarkable results, side effects, and open questions [30:00]; Semaglutide vs. lifestyle interventions: comparing results with semaglutide vs. lifestyle interventions alone [44:00]; Closing thoughts and open questions on the therapeutic potential of semaglutide [47:30]; and More Learn more: Show notes page for this episode:  Subscribe to receive exclusive subscriber-only content: Sign up to receive Peter's email newsletter: Connect with Peter on Facebook | Twitter | Instagram.
  • #183 - James Clear: Building & changing habits
    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 [1:45]; Viewing habits through an evolutionary lens [6:00]; The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:15]; The role of genetics and innate predispositions in determining one’s work ethic and success in a given discipline [14:30]; How finding one’s passion can cultivate perseverance and discipline [23:15]; Advantages of creating systems and not just setting goals [29:15]; The power of habits combined with self-identity to induce change [36:30]; How a big environmental change or life event can bring on radical behavioral change [50:30]; The influence of one’s social environment on their habits [54:15]; How and why habits are formed [1:00:30]; How to make or break a habit with the “Four Laws of Behavior Change” [1:09:30]; Practical tips for successful behavioral change—the best strategies when starting out [1:16:15]; Self-forgiveness and getting back on track immediately after slipping up [1:30:30]; Law #1: Make it obvious—strategies for identifying and creating cues to make and break habits [1:39:45]; Law #2: Make it attractive—ways to make a new behavior more attractive [1:47:45]; Law #3: Make it easy—the 2-minute rule [1:58:45]; Law #4: Make it satisfying—rewards and reinforcement [2:03:30]; Advice for helping others to make behavioral changes [2:06:00]; More. Learn more: Show notes page for this episode:  Subscribe to receive exclusive subscriber-only content: Sign up to receive Peter's email newsletter: Connect with Peter on Facebook | Twitter | Instagram.

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