#411 ‒ AMA #90: Strong convictions, loosely held: how Peter’s views on fasting, keto, metformin, rapamycin, whole-body MRI, and exercise have changed
Release Date: 10/12/2026
#412 ‒ The evolving science of cancer: emerging approaches to prevention and early detection, and the advances reshaping treatment | Siddhartha Mukherjee, M.D., Ph.D.
The Peter Attia Drive
In this episode, Peter welcomes back Dr. Siddhartha Mukherjee, a physician, oncologist, researcher, and the Pulitzer Prize-winning author of The Emperor of All Maladies. Fifteen years after the book was first published, Sid released an updated edition. This conversation examines what has changed in our understanding of cancer—not only in how we treat it, but in how we think about its causes, prevention, detection, and biology. Sid explores the contributions of genetics, environmental exposures, random mutations, and inflammation to cancer risk, including the emerging role of...
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#411 ‒ AMA #90: Strong convictions, loosely held: how Peter’s views on fasting, keto, metformin, rapamycin, whole-body MRI, and exercise have changed
The Peter Attia Drive
In this “Ask Me Anything” (AMA) episode, Peter looks back on 400 episodes of The Drive with another installment of “strong convictions, loosely held,” revisiting some of the positions he has taken over more than eight years of the podcast. He explains why changing one’s mind in response to new evidence, conversations with experts, and clinical experience is essential for practicing medicine well. Peter begins with nutrition, describing how his views on ketogenic diets, extended fasting, and the framework of dietary restriction, time restriction, and calorie restriction have...
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#410 ‒ The biology of pregnancy: physiologic adaptation, gestational diabetes, preeclampsia, childbirth, and long-term maternal health | Kathryn Gray, M.D., Ph.D.
The Peter Attia Drive
In this episode, Peter sits down with Dr. Kathryn (Katie) Gray, a physician-scientist, high-risk obstetrician, and maternal-fetal medicine specialist at the University of Washington School of Medicine. Katie begins by explaining the remarkable physiologic changes that occur during pregnancy and how the cardiovascular, metabolic, and hormonal systems adapt to support both mother and developing fetus. From there, the conversation turns to some of the most important complications that can arise. Katie explains how gestational diabetes is screened for and treated, and what a diagnosis may mean...
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#409 ‒ Inside modern drug development: the science, economics, and regulatory hurdles behind bringing new medicines to patients | Lloyd Klickstein, M.D., Ph.D.
The Peter Attia Drive
Lloyd B. Klickstein is a physician-scientist who has spent more than 20 years at the intersection of drug discovery, healthy aging, and preventive medicine. Drawing on his experience in academic medicine, translational research, and biotechnology, Lloyd walks through the full arc of modern drug development. He explains how scientists identify an unmet medical need and decide which diseases and therapeutic targets are worth pursuing. From there, he takes us through the process of engineering a drug, testing it in animals, and navigating clinical trials and regulatory approval. Using...
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#408 ‒ AMA #89: Thyroid health: interpreting symptoms, diagnosing and treating dysfunction, and navigating the gray zone
The Peter Attia Drive
In this "Ask Me Anything" (AMA) episode, Peter takes a deep dive into thyroid health and explains why diagnosing and managing thyroid dysfunction is unusually complex. He begins with the basic biology of the thyroid gland and three commonly measured hormones—free T4, free T3, and TSH. He explains how T4 is converted to the active hormone T3 and the important functions T3 performs throughout the body. He also explains what reverse T3 is and when it may be useful to measure it. Peter then breaks down thyroid blood tests and their limitations and provides a practical framework for evaluating...
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#407 ‒ Preventing cardiovascular and Alzheimer’s disease: lowering LDL early, APOE4, and promising new therapies | Michael Davidson, M.D.
The Peter Attia Drive
Michael Davidson is a world-renowned cardiologist, lipidologist, and the founding CEO of NewAmsterdam Pharma. He begins this episode by sharing how his family history shaped his interest in lipidology and primary prevention. He explains why prevention should focus on causal drivers of disease rather than near-term risk and examines the causal relationship between LDL and atherosclerotic cardiovascular disease. Michael then traces the complicated history of CETP inhibitors—from the original rationale that raising HDL would reduce cardiovascular risk to the failures of torcetrapib,...
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Blood pressure: how to measure, manage, and treat high blood pressure (AMA #48 rebroadcast)
The Peter Attia Drive
In this “Ask Me Anything” (AMA) episode, Peter delves into the critical subject of blood pressure, which is one of the three primary causes of atherosclerosis, along with high apoB and smoking. He begins by unraveling the nature of high blood pressure, its prevalence, and why it often goes undiagnosed. Peter describes in detail the proper way to accurately measure blood pressure and what determines a diagnosis. Next, Peter discusses the actionable steps one can take in response to high blood pressure, shedding light on the extent to which factors like weight loss, exercise, and...
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#406 ‒ Migraine, cluster headache, and tension headache: symptoms, causes, prevention, and treatment | Brian Grosberg, M.D.
The Peter Attia Drive
Brian Grosberg is a world-renowned headache specialist who joins Peter to provide a master class on the diagnosis and treatment of headache disorders. In this episode, Brian explains the distinction between primary and secondary headaches and breaks down the defining features of the "big three" primary headache types (migraine, cluster, and tension headache)—highlighting how often they are misdiagnosed and how they are treated. He explores the epidemiology of headaches, describing migraine as an invisible disease affecting about 12% of the population, disproportionately affecting women,...
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#405 ‒ AMA #88: Metabolic liver health: how to assess risk, catch dysfunction early, and prevent or reverse liver disease
The Peter Attia Drive
In this "Ask Me Anything" (AMA) episode, Peter takes a deep dive into the liver and its central role in metabolic health. He explains why the liver can serve as a "canary in the coal mine" for metabolic dysfunction and explores how insulin resistance, visceral fat, alcohol consumption, genetics, and hormones contribute to liver disease, along with how increasing muscle mass can benefit liver health. Peter provides a framework for understanding the progression of liver disease, highlighting which stages are reversible and why early detection matters. He explains why normal liver enzymes can...
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#404 ‒ Mental health beyond neurotransmitters: the role of hormones in psychiatry, why symptom reduction isn't enough, and the future of psychedelic therapies | Linus Abrams, M.D.
The Peter Attia Drive
In this episode, Peter sits down with Dr. Linus Abrams, a psychiatrist with nearly 35 years of clinical experience specializing in mood disorders and psychopharmacology, to explore how our understanding of mental health is evolving beyond the traditional neurotransmitter model. After decades in practice, Linus began questioning many of the assumptions underlying modern psychiatry, leading him to investigate how hormones, metabolism, inflammation, circadian biology, and the endocrine system shape mood and cognition. Together, Peter and Linus examine why psychiatric care should aim not only...
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In this “Ask Me Anything” (AMA) episode, Peter looks back on 400 episodes of The Drive with another installment of “strong convictions, loosely held,” revisiting some of the positions he has taken over more than eight years of the podcast. He explains why changing one’s mind in response to new evidence, conversations with experts, and clinical experience is essential for practicing medicine well. Peter begins with nutrition, describing how his views on ketogenic diets, extended fasting, and the framework of dietary restriction, time restriction, and calorie restriction have evolved. He explains why he no longer takes metformin for longevity and discusses his growing uncertainty around rapamycin despite compelling animal data. Peter also revisits his views on cancer screening, including whole-body MRI and liquid biopsies for early detection. On exercise, Peter explains how his approach to cardiorespiratory training and the 80/20 Zone 2 framework has changed, particularly for people with limited time to train. He also shares why he has moved away from heavy barbell squats and deadlifts and how he now thinks about balancing benefit and injury risk. Throughout the episode, Peter emphasizes the importance of focusing on durable principles, strong foundations, and sustainable practices rather than chasing optimizations that provide marginal gains.
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We discuss:
- Strong convictions, loosely held: changing opinions as evidence, expert conversations, and clinical experience evolve [2:00];
- Nutrition: Peter’s evolving view of ketogenic diets, energy balance, and dietary dogmatism [5:30];
- Extended fasting, autophagy, lean-mass loss, and who may benefit from prolonged fasting [12:00];
- The dietary restriction, time restriction, and calorie restriction framework—and why GLP-1 agonists are tipping the balance toward calorie restriction [20:15];
- Why Peter no longer views metformin as geroprotective for metabolically healthy people [24:45];
- Rapamycin for longevity: compelling animal data, unresolved human dosing, and Peter’s growing uncertainty [29:15];
- The importance of early cancer detection, declining whole-body magnetic resonance imaging (MRI) quality, and more targeted alternatives [41:30];
- Liquid biopsies for cancer screening: the NHS-Galleri trial, why early-stage rather than late-stage detection is what actually matters, and why the technology remains "fuzzy" [53:30];
- Evolving exercise goals, the limitations of the 80/20 Zone 2 framework, and programming cardio at lower training volumes [1:00:00];
- Exercise prescriptions for limited time, building a training habit, and becoming less dogmatic about forcing workouts [1:05:00];
- Moving away from heavy squats and deadlifts, alternative exercises, and deliberate risk management [1:13:00];
- Prioritizing principles, foundations, and sustainable practices over marginal optimization [1:21:30]; and
- More.
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