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202 - Peter on nutrition, disease prevention, and more — looking back on the last 100 episodes

View show notes for this episode here: https://bit.ly/3joiRnA Become a member to receive exclusive content: https://bit.ly/374SCzS Sign up to receive Peter's email newsletter: https://bit.ly/3rdT8Th In this second edition of the “Strong Convictions, Loosely Held” episode, Peter discusses topics on which his thoughts have evolved as a result of his interviews with podcast guests and other information he’s gained since episode 100. Peter covers topics including cancer therapy and screening, as well as prevention strategies for cardiovascular disease and Alzheimer’s disease. He also describes changes in his perspectives on time-restricted feeding and protein consumption and on the therapeutic use of psychedelics, and he discusses some sleep supplements with remarkable efficacy. He ends with a special discussion on all things Formula 1 racing. We discuss: 0:00:00 - Intro 0:03:10 - The concept of “strong convictions, loosely held” [3:10]; 0:08:33 - Update on Peter’s upcoming book [8:30]; 0:14:20 - Cancer: the promise of immunotherapy [14:15]; 0:24:30 - Cancer: how aggressive screening for gastrointestinal cancers could save lives [24:30]; 0:31:39 - Cardiovascular disease: how early and aggressive lowering of apoB could change the course of ASCVD [31:30]; 0:40:16 - Alzheimer’s disease: genes that modify risk associated with the APOE4 variant [40:15]; 0:44:02 - Time-restricted feeding: where the benefit comes from, and when this practice can be problematic [44:00]; 0:51:37 - The common problem of protein underconsumption [51:45]; 0:54:27 - The tremendous impact of exercise on lifespan and healthspan [54:45]; 1:00:00 - Peter’s shoulder surgery [1:00:15]; 1:06:02 - An uninspiring viewpoint on NAD precursors as a longevity tool [1:06:15]; 1:09:18 - Psychedelics: a powerful therapeutic tool in the right setting [1:09:30]; 1:12:54 - Sleep: updated thoughts on blue light and a remarkable drug for aiding sleep quality [1:13:15]; 1:20:32 - Book recommendation from Peter [1:20:45]; 1:21:48 - Formula 1: the 5 variables that determine the winner [1:22:00]; 1:25:48 - F1: the drivers [1:26:00]; 1:27:17 - F1: the tires [1:27:30]; 1:31:47 - F1: the engine and chassis [1:32:00]; 1:33:58 - F1: rule changes around cars [1:34:15]; 1:40:55 - F1: importance of qualifying races [1:41:15]; 1:47:22 - F1: racing strategy [1:47:30]; 1:50:47 - F1: season outlook and predictions [1:51:00]; and More. -------- About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 40 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://bit.ly/3xlXKut Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle

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Apr 11, 20221h 57mWatch on YouTube ↗

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WHAT IT’S REALLY ABOUT

Peter Attia revisits changed views on health, longevity, and Formula 1

Attia frames the episode around 'strong convictions, loosely held,' arguing that updating beliefs with new evidence is a strength and explaining why that makes him lukewarm about publishing a book.
On disease, he has become more aggressive about immunotherapy's promise, early and frequent GI cancer screening, lowering apoB early and deeply, and genes that modify APOE4 risk in Alzheimer's.
On nutrition and exercise, he now believes most time-restricted feeding benefit comes from eating less, that protein is under-consumed, and that cardiorespiratory fitness and strength carry an outsized effect on lifespan and healthspan.
He is unimpressed by NAD precursors, cautions that psychedelics work best paired with psychotherapy, plays down blue light, and now favors trazodone for sleep after Phenibut became hard to get.
The episode ends with a Formula 1 primer covering the five determinants of winning, the 2022 rule changes, qualifying, tire strategy, and season predictions.

IDEAS WORTH REMEMBERING

5 ideas

Changing your mind is a feature, not a flaw

Attia borrows the phrase from a hedge fund friend and argues that science and medicine, like investing, require updating positions as new information arrives, though people tend to dig in.

Designer immunotherapies may treat most metastatic solid cancers

Attia notes that 80% of patients have neoantigens recognized by the immune system, which makes him predict that in about 10 years engineered cell therapies could be out of trials, though insurance coverage may lag.

Screen for colon cancer much earlier and more often

He argues nobody should die of colon cancer because polyps are visible and removable. His practice starts colonoscopy at 40 and he suspects every one to three years is better than the current five to ten.

Lower apoB early and deeply

Citing infantile levels of 30 to 40 mg/dL and Mendelian randomization data, he now favors treating early and keeping apoB below roughly 60, with ceiling at about the fifth percentile.

Time-restricted feeding mostly works through fewer calories

He sees no magic in the fasting window itself, and warns that aggressive restriction with low protein can cost lean mass while adding fat, as seen on DEXA scans.

WORDS WORTH SAVING

5 quotes

Nobody should ever die from colon cancer, and I would add the same for esophageal and stomach.

— Peter Attia

I really think that in 10 years we're going to basically be using designer-based immunotherapies to eradicate most solid organ metastatic cancers. That's a bold-ass statement.

— Peter Attia

The good news is this tool called exercise, which is broad, includes a lot of things, it's not just one thing, so by definition it needs to be multimodal, it has an unbelievable impact on your lifespan and healthspan, probably bigger than anything else, and it's available to everyone.

— Peter Attia

I think the RDA is predicated on how much protein you need to, like, live versus how much protein you need to thrive.

— Peter Attia

Two years ago I was kind of like meh, and now I'm three levels below meh.

— Peter Attia

Strong convictions, loosely heldImmunotherapy and GI cancer screeningAggressive apoB lowering for ASCVDAPOE4 modifier genes in Alzheimer'sTime-restricted feeding and protein intakeExercise, VO2 max, and grip strengthSleep, trazodone, and Formula 1 strategy

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