The Peter Attia Drive

Peter Attia, MD
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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.

  1. 5D AGO

    Peter’s takeaways on navigating HRT, rejuvenating the face, understanding the biology of aging, optimizing fertility, and learning to live well from the dying | Quarterly Podcast Summary #6

    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 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 Paul Turek and Paula Amato on male and female fertility; Rachel Rubin on menopause and hormone replacement therapy; Brian Kennedy on the biology of aging; Tanuj Nakra and Suzan Obagi on facial aging and skin rejuvenation; and BJ Miller and Bridget Sumser on lessons we can learn from the dying about how to live. Peter highlights the most important insights from each episode and 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 #358 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Summary of episode topics [1:15]; Episodes on fertility with Paul Turek and Paula Amato: insights on all things male and female fertility [4:45]; How men can optimize fertility [20:15]; How women can optimize fertility [26:00]; Rachel Rubin episode: insights on women’s sexual health, menopause, and HRT [31:45]; How women can prepare for menopause: proactive care, evidence-based HRT, and more [41:45]; Brian Kennedy episode: understanding aging, role of inflammation and mTOR, and current limitations of aging clocks and biomarkers [46:30]; Advice from Brian Kennedy on testing longevity interventions [56:45]; Tanuj Nakra/Suzan Obagi episode: causes of facial aging and practical strategies for prevention and treatment [57:30]; Skincare: making sense of the wide range of skin resurfacing treatments [1:06:45]; How to create a realistic, sustainable skincare routine [1:12:30]; The dangers of following unqualified aesthetic advice online and the importance of getting professional medical guidance for cosmetic treatments [1:18:00]; BJ Miller/Bridget Sumser episode: lessons about living from the dying [1:21:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

    12 min

  2. JUL 21

    A new era of longevity science: models of aging, human trials of rapamycin, biological clocks, promising compounds, and lifestyle interventions | Brian Kennedy, 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 Brian Kennedy is a renowned biologist, leader in aging research, and director of the Center for Healthy Longevity at the National University of Singapore. In this episode, Brian shares insights from ongoing human aging studies, including clinical trials of rapamycin and how dosing strategies, timing, and exercise may influence outcomes. He presents two key models of aging—one as a linear accumulation of biological decline and the other as an exponential rise in mortality risk—and explains why traditional models of aging fall short. He also explains why most current aging biomarkers lack clinical utility and describes how his team is working to develop a more actionable biological clock. Additional topics include the potential of compounds like alpha-ketoglutarate, urolithin A, and NAD boosters, along with how lifestyle interventions—such as VO2 max training, strength building, and the use of GLP-1 and SGLT2 drugs—may contribute to longer, healthier lives. We discuss: Brian’s journey from the Buck Institute to Singapore, and the global evolution of aging research [2:45]; Rethinking the biology of aging: why models like the hallmarks of aging fall short [9:45]; How inflammation and mTOR signaling may play a central, causal role in aging [14:15]; The biological role of mTOR in aging, and the potential of rapamycin to slow aging and enhance immune resilience [17:30]; Aging as a linear decline in resilience overlaid with non-linear health fluctuations [22:30]; Speculating on the future of longevity: slowing biological aging through noise reduction and reprogramming [33:30]; Evaluating the role of the epigenome in aging, and the limits of methylation clocks [39:00]; Balancing the quest for immortality with the urgent need to improve late-life healthspan [43:00]; Comparing the big 4 chronic diseases: which are the most inevitable and modifiable? [47:15]; Exploring potential benefits of rapamycin: how Brian is testing this and other interventions in humans [51:45]; Testing alpha-ketoglutarate (AKG) for healthspan benefits in aging [1:01:45]; Exploring urolithin A’s potential to enhance mitochondrial health, reduce frailty, and slow aging [1:05:30]; The potential of sublingual NAD for longevity, and the combination of NAD and AKG for metabolic and exercise enhancement [1:09:00]; Other interventions that may promote longevity: spermidine, 17𝛼-estradiol, HRT, and more [1:17:00]; Biological aging clocks, clinical biomarkers, and a new path to proactive longevity care [1:23:15]; Evaluating rapamycin, metformin, and GLP-1s for longevity in healthy individuals [1:32:15]; Why muscle, strength, and fitness are the strongest predictors of healthspan [1:37:30]; Why combining too many longevity interventions may backfire [1:39:30]; How increased funding and AI integration could accelerate breakthroughs in aging research [1:41:45]; The research Brian is most excited about, and the need to balance innovation with safety in longevity clinics [1:47:00]; Peter’s reflections on emerging interventions and the promise of combining proven aging compounds [1:54:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

    1h 57m

  3. JUL 14

    AMA #73: Preserving brain health, optimizing exercise programming, improving body composition, 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, Peter addresses frequently requested topics, including brain health, exercise programming, and body composition. He explores the factors that influence dementia risk—including metabolic health, fitness, sleep, hearing, cholesterol levels, and more. He explains how to implement zone 2 training and VO₂ max intervals for cardiovascular fitness and also covers how to combine cardio modalities, how to stay in zone 2, and special considerations for women. Peter highlights the benefits of light movement after meals and offers strength training tips for those managing injuries. Additional insights include how to maintain fat loss, the truth about so-called “slow metabolisms,” and how to set appropriate daily protein goals while managing the trade-off between lean mass and body fat over time. 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 #73 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Overview of episode topics on brain health, cardiovascular training strategies, and body composition [2:15]; Understanding dementia risk: modifiable vs. non-modifiable contributors to cognitive decline [5:00]; The causality between metabolic health and dementia [9:45]; How diet and exercise influence brain health: energy balance and exercise as key preventative tools [13:30]; Why combining aerobic, resistance, and cognitively engaging activities offers the most comprehensive benefits for preventing cognitive decline [17:00]; Additional lifestyle factors that influence dementia risk: smoking, head trauma, alcohol, and sleep [19:45]; The link between hearing loss and dementia: dose-dependent risk and the case for correction [25:15]; How poor oral hygiene may contribute to neuroinflammation and dementia risk [27:30]; Supplements for brain health: which ones matter and when they’re worth considering [28:45]; Low LDL cholesterol and brain health: debunking the myth of cognitive risk [33:45]; How to approach zone 2 training: the importance of staying in zone 2 and tailoring intensity based on your time and goals [38:00]; Lactate testing for zone 2: clinical protocols and at-home approaches [43:00]; Combining modalities in zone 2 training: balancing enjoyment and efficiency [47:00]; Zone 2 training for women: addressing the misconception that zone 2 training is unnecessary or ineffective for postmenopausal women [49:30]; Effective strategies for VO₂ max training: short vs. long intervals [51:45]; The benefits of post-meal walking for glucose management, and why spikes in glucose during exercise aren’t harmful [56:45]; The role of stability training in supporting resistance work and healthy aging [1:00:15]; Adapting strength training to manage chronic back injuries and train for longevity [1:02:00]; The role of aerobic exercise (like zone 2) in fat loss, metabolic health, and weight maintenance [1:06:30]; Debunking the “fast vs. slow metabolism” myth: why energy balance and protein matter most for fat loss [1:09:45]; Lean mass vs. body fat: why both matter for health and longevity [1:12:15]; How protein intake impacts muscle mass and why pairing it with resistance training is significantly more effective [1:15:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

    17 min

  4. JUL 7

    Navigating bone health: early life influences and advanced strategies for improvement and injury prevention (#214 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 episode from July 2022, Peter dives deep into the topic of bone health and explains why this is an important topic for everyone, from children to the elderly. He begins with an overview of bone mineral density, how it’s measured, how it changes over the course of life, and the variability between sexes largely due to changes in estrogen levels. From there he provides insights into ways that one can improve bone health, from exercise to nutrition supplements to drugs. Additionally, Peter discusses what happens when one may be forced to be sedentary (e.g., bedrest) and how you can work to minimize the damage during these periods. While this original episode is an AMA, it is available in full to all listeners as a special rebroadcast. We discuss: Overview of bone health topics to be discussed [2:30]; Bones 101: bone function, structure, and more [6:15]; Bone mineral density (BMD), minerals in bone, role of osteoblasts and osteoclasts, and more [9:30]; The consequences of poor bone health [14:30]; The devastating nature of hip fractures: morbidity and mortality data [18:00]; Where fractures tend to occur in the body [23:45]; Defining osteopenia and osteoporosis [25:30]; Measuring BMD with DEXA and how to interpret scores [28:00]; Variability in BMD between sexes [35:15]; When should people have their first bone mineral density scan? [37:45]; How BMD changes throughout the life and how it differs between men and women [40:15]; How changes in estrogen levels (e.g., menopause) impact bone health [45:15]; Why HRT is not considered a standard of care for postmenopausal bone loss [49:00]; Factors determining who may be at higher risk of poor bone health [52:00]; Common drugs that can negatively impact BMD [55:45]; How children can optimize bone health and lay the foundation for the future [59:30]; Types of physical activity that can positively impact bone health [1:03:30]; How weight loss can negatively impact bone health and how exercise can counteract those effects [1:12:15]; Nutrition and supplements for bone health [1:16:00]; Pharmaceutical drugs prescribed for those with low BMD [1:18:45]; Impact of extreme sedentary periods (e.g., bedrest) and how to minimize their damage to bone [1:23:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

    1h 32m

  5. JUN 30

    Skincare strategies, the science of facial aging, and cosmetic-intervention guidance | Tanuj Nakra, M.D. & Suzan Obagi, M.D.

    View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Tanuj Nakra and Suzan Obagi, two leading experts in aesthetic medicine, join Peter to explore the science of facial aging and skin health as well as the responsibilities physicians face in the world of cosmetic procedures. In this episode, they examine the biological and hormonal drivers of facial aging, the evolutionary and psychological foundations of attractiveness, and the impact of modern media on beauty standards. They discuss the rise in cosmetic procedures among adolescents and the ethical responsibilities of physicians in these cases. The conversation then shifts to a practical, evidence-based guide to skin health—covering the use of mineral sunscreens, retinoids, vitamin C, and tailored skincare routines, as well as the management of acne and the psychology behind aesthetic consultations. The episode culminates in a candid, personal assessment of Peter’s own face, offering a revealing look at what aesthetic medicine can achieve and how to think critically about pursuing it. We discuss: Tanuj’s and Suzan’s training and expertise, and the evolving field of aesthetic medicine [4:00]; The biology of the aging face [10:45]; Why facial fat atrophies with age while body fat tends to accumulate [17:00]; How chronic stress accelerates facial aging [20:30]; The evolutionary biology of beauty, and how modern lifestyle, culture, and medicine interact with these ancient aesthetic instincts [25:30]; How social media and influencers have rapidly shifted aesthetic trends toward exaggerated features and unrealistic beauty standards [36:45]; The ethical challenges, financial incentives, and social pressures shaping modern aesthetic medicine [42:00]; The concerning trend of teenagers seeking cosmetic enhancements: the ethical and cultural impact of early beauty pressure [51:45]; Protecting the skin: UV damage and sunscreen recommendations [58:15]; Strategies for minimizing skin aging: retinoids, vitamin C, and evidence-based application methods [1:09:00]; Effective daily skincare routine: cleansing, antioxidants, retinoids, moisturization, and more [1:18:45]; The playbook for managing acne [1:31:00]; The 4 changes of aging and the complexities of aesthetic consultations including the anatomical, psychological, and ethical factors physicians must navigate [1:39:00]; The 5 R’s of rejuvenation [1:50:15]; A facial aging analysis and cosmetic strategy using Peter’s face as a real-time case study [1:53:00]; The decision-making process between fat grafting and dermal fillers for facial rejuvenation [1:56:30]; How self-image, eye aesthetics, and fleeting photos drive the desire for cosmetic enhancement [2:01:45]; Advice for wrinkles, causes of dark circles under the eyes, and the importance of facial symmetry [2:05:45]; Considerations that shape clinical decision making around fat grafting and other procedures to address the eye area [2:11:00]; The evolution of facial cosmetic surgery techniques, the serious risks involved, and how physician skill and procedure selection greatly impact outcomes [2:21:30]; How patients can make informed and safe choices when selecting a cosmetic surgeon [2:27:15]; A comparison of ablative versus non-ablative skin resurfacing treatments, laser vs. peels, and more [2:38:45]; How treatments are chosen and customized based on patient-specific factors [2:48:00]; The lifelong human desire to align physical appearance with self-identity [2:52:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

    2h 57m

  6. JUN 23

    What the dying can teach us about living well: lessons on life and reflections on mortality | BJ Miller, M.D. and Bridget Sumser, L.C.S.W.

    View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter BJ Miller, a hospice and palliative care physician, and Bridget Sumser, a licensed social worker specializing in serious illness and end-of-life care, join Peter to share insights from their decades of work supporting people at the end of life. In this episode, they explore the emotional and physiological processes of dying, the cultural barriers that prevent meaningful conversations about death, and how early engagement with mortality can lead to greater clarity and connection. The conversation highlights the distinctions between hospice and palliative care, the nature of suffering beyond physical pain, and the transformative role of honesty, forgiveness, and relational awareness in the dying process. Through stories and reflections, BJ and Bridget reveal what truly matters in the end—and how the dying can teach the living not only how to face death but how to live more fully. We discuss: The personal journeys of BJ and Bridget into end-of-life care, and the connection between living and dying [3:30]; What dying looks like: the physical, cognitive, and emotional realities at the end of life [13:15]; How historical perspectives on death contrast with modern experiences of dying [25:30]; The difference between palliative care and hospice care [30:45]; The systemic challenges surrounding hospice care: why patients often enter it too late to receive its full benefits [35:30]; How delayed hospice referrals and unspoken preferences often prevent patients from dying where and how they truly want [39:30]; The realities of home hospice: challenges, costs, and burdens placed of families [43:45]; How proactively engaging with the reality of death can avoid unnecessary suffering and promote a more peaceful ending [53:30]; How palliative care is misunderstood and underutilized—especially in cancer care [1:02:45]; Palliative care in the case of Alzheimer’s disease: emotional support, future planning, and family involvement [1:12:15]; The importance of having an advance directive: defining what matters most before it’s too late [1:23:00]; The differences between how young and old individuals experience dying from cancer [1:30:15]; The difference between pain and suffering, role of medicine in pain relief, and why emotional healing is essential at the end of life [1:35:45]; Dying well: the power of self-honesty and human connection at the end of life [1:47:00]; How psychedelics like psilocybin can unlock emotional breakthroughs and deepen connection for patients near the end of life [1:55:15]; Lessons from the dying on how to live well [1:57:30]; The physical process of active dying, and the emotional and practical considerations for loved ones [2:09:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

    2h 16m

  7. JUN 16

    AMA #72: Fasting: benefits for body composition and disease prevention, potential risks, and Peter’s updated practical framework

    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 revisits the topic of fasting, sharing how his thinking has evolved over time. The episode explores fasting-related terminology and common types of fasting, as well as the various reasons individuals might choose to fast. Peter explores potential benefits including improvements in body composition, metabolic health, lifespan extension, cardiovascular disease, cancer prevention and treatment, neurodegenerative conditions such as Alzheimer’s and Parkinson’s, and autoimmune symptoms like arthritis. He also examines the risks and potential downsides of fasting and offers a practical framework to help assess when and how fasting may be most appropriately applied. 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 #72 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Why the topic of fasting is being revisited [1:45]; The importance of being open to changing one's opinion in science and medicine as new evidence emerges [4:15]; Defining fasting and how it fits in the framework of dietary restriction, time-restricted feeding, and calorie restriction [7:30]; The most common types of fasting [11:45]; Why someone might choose fasting over continuous caloric restriction [19:00]; The biochemical effects of fasting: fuel partitioning, autophagy, and more [21:00]; Autophagy: a cellular cleanup process stimulated by fasting and energy depletion [26:00]; Comparing the physiological effects of a ketogenic diet to those of long-term fasting [27:45]; How long fasting takes to induce ketosis and boost autophagy, and how autophagy is measured [29:45]; At-home tests for ketones [33:45]; Reducing senescent (“zombie”) cells and inflammation through autophagy [35:00]; Examining the evidence for the long-term health benefits of fasting beyond short-term metabolic effects [37:15]; The common health claims associated with fasting across metabolic, neurological, oncological, autoimmune, and longevity domains [40:30]; The impact of fasting on body weight and body composition [42:00]; Weight regain and potential metabolic consequences of fasting [44:00]; The risk of lean mass loss with fasting and how to mitigate it [47:15]; A practical framework for using fasting as a strategy to improve body composition [52:15]; How extended fasting compares to caloric restriction in improving insulin sensitivity in people with insulin resistance or type 2 diabetes [54:00]; Is there any evidence that fasting can extend lifespan? [55:45]; Examining whether fasting improves cardiovascular disease risk beyond the effects of weight loss and calorie reduction [58:15]; Exploring whether prolonged fasting can reduce cancer risk [59:45]; The potential benefits of fasting or fasting-mimicking diets during cancer treatment: emerging evidence and practical considerations [1:02:15]; Fasting for protection against neurodegenerative diseases: early evidence of therapeutic benefit and open questions [1:10:45]; Various fasting methods for autoimmune diseases: potential symptom relief with cautious application [1:14:00]; Fasting and type 1 diabetes: risks, evidence, and careful dietary alternatives [1:16:45]; Fasting and gut disorders: potential benefits outside of flare-ups [1:18:45]; The primary risks and downsides associated with fasting [1:19:45]; The essential vitamins and minerals to supplement during prolonged fasting [1:21:30]; Who should avoid fasting and why [1:22:15]; Fasting’s role in health: where it shows promise and where it likely offers no distinct advantage over caloric restriction [1:23:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

    20 min

  8. JUN 9

    Female fertility: optimizing reproductive health, diagnosing and treating infertility and PCOS, and understanding the IVF process | Paula Amato, M.D.

    View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter This is part two of a two-part mini-series on fertility and reproductive health. Paula Amato is a leading expert in female reproductive health and infertility, widely recognized for her contributions to advancing fertility treatment and research. In this episode, which follows last week's conversation on male fertility, Paula explores the biology of female fertility, including how hormonal changes regulate the menstrual cycle and ovulation, what those patterns reveal about fertility potential, and why both partners should be evaluated early in infertility workups. She discusses the role of the fallopian tubes, the causes of miscarriage, the impact of age and lifestyle on fertility, and treatment options for conditions like PCOS—including the emerging use of GLP-1 agonists. The episode also covers the evolution of IVF, advances in pre-implantation genetic testing, egg freezing, and the promise and limitations of next-generation reproductive technologies. We discuss: The finite nature of a woman’s egg reserve, how it changes over time, and the basic process of ovulation and fertilization [3:00]; How hormones influence egg selection, and how and why chromosomal errors lead to most miscarriages [5:30]; The full journey of conception—from hormonal cues triggering ovulation, to fertilization, embryo development, implantation, and early pregnancy risks [16:30]; How infertility is defined and diagnosed, and the broader trends contributing to rising infertility rates [25:15]; Fallopian tube damage: how STDs and scarring impact fertility and raise ectopic pregnancy risk [31:30]; Unexplained infertility: how doctors evaluate ovulation and cycles—and why more research on women’s health is needed [41:00]; The defining symptoms of polycystic ovary syndrome (PCOS), its hormonal characteristics, and its relationship with insulin resistance [44:00]; Managing PCOS without pregnancy: cycle regulation, androgen suppression, and insulin resistance treatment [46:00]; The treatment approach for women with PCOS who are trying to conceive: GLP-1 use, ovulation induction, and timing protocols [49:45]; Barriers to getting informed fertility care for PCOS: limited provider knowledge and access, insurance gaps, and next steps when ovulation treatments don’t lead to pregnancy [55:45]; Fertility treatment for women with unexplained infertility, risk of multiple pregnancies with superovulation, and more [1:03:00]; Intrauterine insemination (IUI): process, success rates, and when in vitro fertilization (IVF) becomes the better option [1:07:00]; The history of in vitro fertilization (IVF), and how access and acceptance have evolved over time [1:16:45]; The step-by-step process of IVF [1:19:30]; The IVF lab process: egg retrieval, fertilization, embryo culture, and freezing [1:26:30]; Genetic testing and embryo selection in IVF: aneuploidy screening, polygenic traits, and ethical concerns [1:41:15]; Embryo transfer in IVF: timing, uterine preparation, and implantation support [1:47:30]; Egg donation in IVF: indications, donor guidelines, and other considerations [1:50:45]; How to choose the right IVF clinic [1:54:45]; Innovations in fertility on the horizon, advice about freezing eggs, and more [2:02:00]; Optimizing fertility through lifestyle: diet, stress management, sleep, exercise, and supplementation [2:07:45]; Promising areas of fertility research [2:15:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

    2h 23m
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4.7
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About

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.

Information

  • Creator
    Peter Attia, MD
  • Years Active
    2018 - 2025
  • Episodes
    405
  • Rating
    Explicit
  • Copyright
    Copyright © Peter Attia, MD
  • Show Website
    The Peter Attia Drive

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