The Peter Attia Drive

In this episode, Chris Masterjohn, entrepreneur, independent researcher, and doctorate in nutrition, elucidates the latest research on the risk and benefits of NAD supplements, and shares his personal intuition on the topic. We also dive deep into choline deficiency and its role in the rising prevalence of nonalcoholic fatty liver disease. From there, Chris enlightens us on the importance of methylation, a simple yet profoundly important biochemical process affecting our physical and mental health. He also describes the variations of the genes MTHFR and COMT, enzymes which play important roles in methylation and which have profound impacts on our well-being.   We discuss: Chris’s background, falling in love with biochemistry, and decision to pursue research over medicine [7:45]; Choline: what it is, why it is important, and how a deficiency can cause non-alcoholic fatty liver disease [11:45]; NAFLD: increasing prevalence and potential causes [25:00]; TMAO: Should we be worried about the TMAO content in choline and our foods? [39:15]; Types of fatty acids: How they may predispose us to different types of illnesses [53:30]; Why don’t we see low VLDL in patients with NAFLD? [59:45]; Understanding flux, and how machine learning may affect medicine in the near future [1:03:15]; NAD: How it works, supplements, sirtuins, and the central role of the liver [1:09:30]; Intravenous NAD [1:33:00]; Oral NR: Is it the optimal way to get more NAD? [1:38:30]; What is the possible harm of taking an NAD precursor? [1:47:15]; The MTHFR gene [1:49:45]; The methylation pathway [1:58:15]; The COMT gene [2:04:30]; Creatine: The uses and benefits and its important role in methylation [2:10:15]; Dietary strategies for MTHFR: choline, creatine, folate , and glycine [2:16:45]; How to mitigate the negative effects of NAD supplements [2:23:45]; A case study of a person with high homocysteine [2:28:00]; What is the level of evidence that you need to take action? [2:32:15]; Does Chris supplement with NAD precursors? And can it improve symptoms of rosacea? [2:35:45]; Decision making in the face of inconclusive data, and trying to disentangle the placebo effect [2:39:00]; What does Chris believe to be true that very few people would agree with him about? [2:43:15]; How to follow Chris’s work [2:48:45]; and More. Learn more at  .

In this “Ask Me Anything” (AMA) episode, the first subscriber-only edition, Peter answers a wide range of questions from readers and podcast listeners. Bob Kaplan, Peter’s head of research, asks the questions. As a reminder, AMAs are for subscribers only. If you want to subscribe, you can learn more about the benefits at  .

In this episode, Jeremy Schaap, preeminent journalist at ESPN, discusses two of the most incredible upsets in boxing history, both of which Jeremy has expertly covered during his illustrious career, most recently culminating in the 30 for 30 special, 42 to 1. We also discuss his infamous Bobby Knight interview, his coverage of the doping scandals in baseball and cycling, as well as the pressures of following in his father’s enormous footsteps who taught him the importance of fairness in journalism. Additionally, we discuss the deeper meaning of sports, what it teaches us, and how he uses sports as a platform to bring light to greater societal issues.    We discuss: Jeremy and Peter’s shared obsession with boxing history [5:15]; Cinderella Man: The incredible upset of Max Baer by James Braddock, and the rise of the great Joe Louis [9:00]; 42 to 1: Buster Douglas beats Mike Tyson for one of the most unlikely upsets in the history of sports [23:30]; Contrasting fighting styles from “destroyers” to “artists”, and comparing the auras of the all-time greats [36:30]; Mike Tyson’s take on the Douglas fight, what went wrong for Buster Douglas following his victory, and other incredible upsets in sports history [45:30]; Ranking the greatest boxers since the 1960s [54:00]; Jeremy’s famous Bobby Knight interview: A career defining moment [57:00]; The pressures of following his father’s career path, and what it means to be a fair journalist [1:01:30]; The meaning of sports: how it brings us together and gives us a platform for bigger discussions [1:11:00]; Jeremy’s biggest regret in reporting, the 1998 home run chase, and the doping scandals of baseball and cycling [1:17:30]; The biggest and most underreported stories in sports [1:26:45]; Best 30 for 30 episodes: Jeremy and Peter pick their favorites [1:31:30]; Baseball: Steroids and the hall of fame [1:34:30]; Final thoughts on what makes sports so special [1:37:45]; and More. Learn more at  .

In this episode, Alan Bauman, certified hair transplantation surgeon and hair restoration expert, discusses both male and female pattern hair loss, the science behind what drives it, and what that tells us about prevention and restoration. Having treated over 20,000 patients, Alan shares his invaluable insights into what works and what doesn’t in terms of the non-surgical treatment options. We also go into great detail about the more invasive approaches like PRP, and of course, hair transplantation, a procedure which Alan has refined over the years into a proprietary method that seems to produce unbelievable results. Additionally, Alan provides tips for maintaining scalp health, which is vital for hair growth, as well as the importance of choosing a hair specialist who has the tools, expertise, and patience to develop a compassionate and encompassing approach to hair restoration.    We discuss: Alan’s unique path, and how he became interested in hair transplantation [7:15]; The prevalence of hair loss, types of hair loss, and the different patterns in men vs. women [15:45]; The role of genetics in hair loss, and when does it start [19:00]; Female hair loss: the role of hormones, pregnancy related hair loss, and what it means to have thinning and shedding [22:30]; Primary drivers of male hair loss, finasteride as a treatment, and the potential side effects [26:15]; Common treatments - Proscar, Propecia, Rogaine, and more - how they all came about and what you need to know [29:45]; Primary drivers of female hair loss, potential treatments, and the different types of hair follicles [33:15]; What are some of the unproven/snake oil methods of hair treatments being pushed to the public? [37:15]; Preventative steps to take if you’re worried about future hair loss [42:00]; Medications that may negatively affect hair quality [45:30]; The importance of seeing a hair specialist [47:15]; Impact of scalp health and inflammation on hair growth, how to pick and apply shampoo and conditioner, and how to avoid and treat hair breakage [50:15]; Treatment options - finasteride, minoxidil, laser caps - how they work and what you need to know [57:15]; PRP treatment: How it works, details of the procedure, and Alan’s proprietary protocol [1:11:45]; The hair transplant procedure [1:29:30]; Risks involved with a hair transplant procedure [1:44:00]; Is a donor hair susceptible to the forces of the implant site that caused the hair loss? Can a hair follicle grow anywhere on the body? [1:47:45]; Age appropriate procedures, how far the field has come, and why Alan loves his work [1:51:45]; and More. Learn more at  .

In this episode, Avrum Bluming, hematologist, medical oncologist, and emeritus clinical professor at USC and Carol Tavris, social psychologist and author of Mistakes Were Made (But Not By Me), discuss their collaboration on their recent book, Estrogen Matters. Their book takes on the very polarizing and confusing topic of hormone replacement therapy for women suffering with symptoms of menopause. In many ways, the story and history of HRT is in striking parallel to the bad science that led up to the dietary guidelines being set forth in 1980. Carol and Avrum make a compelling case that most women benefit greatly from being on postmenopausal hormone replacement therapy, and can do so without increasing their risk of breast cancer. We also cover the history of HRT, the impact of the Women's Health Initiative, and take a deep dive into each of the clinical conditions for which HRT should be considered, such as cardiovascular disease, neurodegenerative disease, and osteoporosis, to name a few. We discuss: The background of Carol and Avrum, and the impetus for writing Estrogen Matters [8:45]; The sad early history of hormone replacement therapy, treatments for prostate and breast cancer, and the difference between the treatment of women vs. men [14:00]; What hormones do, and why they drop off rapidly in women compared to gradually in men [20:15]; Mistreatment of women leading to great skepticism [23:45]; Breast cancer vs heart disease: Comparing the incidence and mortality in women [27:00]; Case studies of women suffering symptoms of menopause [30:00]; What are Carol and Avrum’s true motivations in this endeavor? [32:45]; The changing perceptions of HRT, the impact of the Women’s Health Initiative (WHI), and the problems with the WHI [37:45]; Is this one big conspiracy? The uncanny resemblance of the story of HRT and how the dietary guidelines were created [46:00]; Why people (falsely) think estrogen causes a 25% increase in breast cancer, and a lesson in absolute vs. relative risk [57:15]; The truth about progesterone and cancer risk, and the best types of estrogen and progesterone to be taking [1:09:00]; The Women’s Health Initiative: the reported findings, walking back their bold claims, and their hesitance to admit they were wrong [1:17:45]; Brain benefits of HRT, Alzheimer’s disease in women, and estrogen as a preventative treatment for AD [1:22:45]; The impact of HRT on heart disease, the ideal time to start HRT, and the risks associated with HRT [1:26:45]; The benefits of estrogen on bone health, and the incidence and mortality of hip fractures [1:33:15]; Colon cancer: Can HRT reduce the risk of colon cancer? [1:38:15]; Diabetes: Can HRT reduce the risk of developing diabetes? [1:40:30]; The downsides of hormone replacement therapy (HRT) [1:41:30]; How to approach your doctor who may already have a very strong point of view about HRT [1:42:15]; What kind of research needs to be done to answer the remaining questions about the benefits and risks of HRT? [1:48:30]; Cancer: Our evolving understanding and the future of treatment [1:59:15]; Welcoming the critics: Avrum and Carol want to start a conversation [2:02:00]; Are there racial differences in benefits and risks with HRT? [2:04:15]; The reactions to Estrogen Matters, and why it is a must read [2:09:15]; HRT after a diagnosis of breast cancer [2:13:45]; and More. Learn more at  .