#334 - Cardiovascular disease, the number one killer: development, biomarkers, apoB, cholesterol, brain health, and more | Tom Dayspring, M.D.
Release Date: 02/03/2025
#335 ‒ The science of resistance training, building muscle, and anabolic steroid use in bodybuilding | Mike Israetel, Ph.D.
The Peter Attia Drive
Mike Israetel is a sports physiologist, competitive bodybuilder, and co-founder of Renaissance Periodization, where he coaches athletes and professionals in diet and weight training. In this episode, Mike shares his journey from powerlifting to academia, breaking down the core principles of resistance training, including exercise selection, volume, intensity, and frequency. He debunks common misconceptions about strength training, explains how to structure an effective program for beginners and advanced lifters, and provides candid insights into his experience with anabolic steroids,...
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#334 - Cardiovascular disease, the number one killer: development, biomarkers, apoB, cholesterol, brain health, and more | Tom Dayspring, M.D.
The Peter Attia Drive
Tom Dayspring is a world-renowned expert in clinical lipidology and a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis and why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men and women. He examines how the disease develops from a pathological perspective and discusses key risk factors, including often-overlooked contributors such as insulin resistance and chronic kidney disease. He breaks down the complexities of cholesterol and lipoproteins—including LDL, VLDL, IDL, and HDL—with an in-depth...
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#333 ‒ Longevity roundtable — the science of aging, geroprotective molecules, lifestyle interventions, challenges in research, and more | Steven Austad, Matt Kaeberlein, Richard Miller
The Peter Attia Drive
In this special episode of The Drive, Peter introduces a brand-new roundtable format. Joined by three renowned experts in longevity science—Steven Austad, Richard Miller, and Matt Kaeberlein—the group explores the rapidly evolving field of geroscience. Together, they dive deep into topics like the relationship between healthspan and lifespan, evaluating interventions like rapamycin and senolytics, the role of epigenetic changes in aging, and whether GLP-1 receptor agonists hold geroprotective potential. They also tackle major challenges in funding and public acceptance of longevity...
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#332 - AMA #67: Microplastics, PFAS, and phthalates: understanding health risks and a framework for minimizing exposure and mitigating risk
The Peter Attia Drive
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...
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#331 ‒ Optimizing endurance performance: metrics, nutrition, lactate, and more insights from elite performers | Olav Aleksander Bu (Pt. 2)
The Peter Attia Drive
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...
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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.
The Peter Attia Drive
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...
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Building & Changing Habits | James Clear (#183 rebroadcast)
The Peter Attia Drive
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...
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#329 ‒ Special AMA: Peter on exercise, important labs, building good habits, promising longevity research, and more
The Peter Attia Drive
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...
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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
The Peter Attia Drive
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...
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#327 - Choices, costs, and challenges in US healthcare: insurance intricacies, drug pricing, economic impacts, and potential reforms | Saum Sutaria, M.D.
The Peter Attia Drive
Dr. Saum Sutaria is the Chairman and CEO of Tenet Healthcare and a former leader in McKinsey & Company’s Healthcare and Private Equity Practices, where he spent almost two decades shaping the field. In this episode, Saum unpacks the complexities of the U.S. healthcare system, providing a detailed overview of its structure, financial flows, and historical evolution. They delve into topics such as private insurance, Medicare, Medicaid, employer-sponsored coverage, drug pricing, PBMs and the administrative burdens impacting the system. Saum’s insights help connect healthcare spending...
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Tom Dayspring is a world-renowned expert in clinical lipidology and a previous guest on The Drive. In this episode, Tom explores the foundations of atherosclerosis and why atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death worldwide for both men and women. He examines how the disease develops from a pathological perspective and discusses key risk factors, including often-overlooked contributors such as insulin resistance and chronic kidney disease. He breaks down the complexities of cholesterol and lipoproteins—including LDL, VLDL, IDL, and HDL—with an in-depth discussion on the critical role of apolipoprotein B (apoB) in the development of atherosclerosis. Additionally, he covers the importance of testing various biomarkers, the impact of nutrition on lipid levels, and the vital role of cholesterol in brain health, including how cholesterol is synthesized and managed in the brain, how it differs from cholesterol regulation in the rest of the body, and how pharmacological interventions can influence brain cholesterol metabolism.
We discuss:
- Defining atherosclerotic cardiovascular disease (ASCVD): development, risks, and physiological impact [2:45];
- The pathogenesis of ASCVD: the silent development over decades, and the importance of early detection for prevention of adverse outcomes [10:45];
- Risk factors versus risk markers for ASCVD, and how insulin resistance and chronic kidney disease contribute to atherosclerosis [17:30];
- How hyperinsulinemia elevates cardiovascular risk [24:00];
- How apoB-containing lipoproteins contribute to atherosclerosis, and why measuring apoB is a superior indicator of cardiovascular risk compared to LDL cholesterol [29:45];
- The challenges of detecting early-stage atherosclerosis before calcification appears [46:15]; Lp(a): structure, genetic basis, and significant risks associated with elevated Lp(a) [55:30];
- How aging and lifestyle factors contribute to rising apoB and LDL cholesterol levels, and the lifestyle changes that can lower it [59:45];
- How elevated triglycerides, driven by insulin resistance, increase apoB particle concentration and promote atherosclerosis [1:08:00];
- How LDL particle size, remnant lipoproteins, Lp(a), and non-HDL cholesterol contribute to cardiovascular risk beyond apoB levels [1:21:45];
- The limitations of using HDL cholesterol as a marker for heart health [1:29:00];
- The critical role of cholesterol in brain function and how the brain manages its cholesterol supply [1:36:30];
- The impact of ApoE genotype on brain health and Alzheimer's disease risk [1:46:00];
- How the brain manages cholesterol through specialized pathways, and biomarkers to track cholesterol health of the brain [1:50:30];
- How statins might affect brain cholesterol synthesis and cognitive function, and alternative lipid-lowering strategies for high-risk individuals [1:57:30];
- Exciting advancements in therapeutics, diagnostics, and biomarkers coming in the next few years [2:09:30];
- Recent consensus statements on apoB and Lp(a) from the National Lipid Association (NLA) [2:12:30]; and
- More.
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