The Peter Attia Drive

• #365 ‒ Training for longevity: A roundtable on building strength, preventing injury, meeting protein needs, guidance for women and youth athletes, and more | Gabrielle Lyon, Mike Boyle, Jeff Cavaliere

  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 special episode of The Drive, Peter hosts a strength and conditioning roundtable with three experts in the field—Gabrielle Lyon, Jeff Cavaliere, and Mike Boyle. Together they explore why maintaining muscle mass, strength, and power is essential for healthspan and longevity, and examine how resistance training supports metabolic resilience and injury prevention across the lifespan. The conversation covers practical strategies for getting started and staying consistent, the importance of a protein-centered diet tailored to age and activity level, and approaches to resistance training for peri- and post-menopausal women—including tendon care and optimal programming. They debate single-leg training versus heavy bilateral lifts, share knee-friendly lower-body options, and highlight exercises that belong in the “graveyard” due to poor risk-reward ratios. Finally, the group discusses youth sports specialization, emphasizing the long-term value of variety for developing lifelong athletes. We discuss: Personal career journeys and philosophies of each guest that shaped their approaches to strength, conditioning, and lifelong health [3:30]; Why so few people engage in resistance training despite its proven health benefits [8:30]; Mike’s low-stress, high-consistency method for training beginners to resistance training [18:45]; How resistance training enhances metabolic health and body composition even in lean, highly active endurance athletes [25:30]; The dominant role of nutrition in shaping physique and achieving low body fat, the synergistic effect of resistance training, and the unrealistic expectations about muscle growth and fat loss [28:30]; Why Jeff advocates for five meals a day, and why meal timing matters less than overall protein intake and caloric consistency [38:00]; Optimizing protein for every stage of life: quality, quantity, and guidelines for diverse diets and body types [44:15]; The advantages of unilateral lower-body training over heavy bilateral lifts: impact on strength, athleticism, recovery, and functional movement [51:45]; Rethinking heavy squats and deadlifts: risk-reward, aging bodies, and the case for reverse lunges and other single-leg alternatives [1:01:15]; Adapting with age: Gabrielle on injuries, hip dysplasia, and the shift to smarter training [1:10:15]; Exercises that belong in the “iron graveyard”: unnecessarily risky exercises and their safer alternatives [1:19:15]; The downside of early sports specialization in children and the long-term benefits of encouraging kids to play multiple sports [1:25:00]; Advice for preventing an Achilles injury: calf strength, ankle mobility, and listening to pain signals [1:33:15]; Shoulder pain: how to keep training the upper body when shoulder pain limits pressing movements [1:40:45]; Effective strength training strategies for women before, during, and after the menopausal transition [1:43:15]; Best practices for strength training and athletic development in children, and the pitfalls of early sports specialization [1:50:30]; How to foster healthy habits and an interest in fitness beyond playing sports [2:00:00]; Something each guest has changed their mind about in the last five years [2:04:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #364 – AMA #75: Diets: how to evaluate and implement any diet including keto, carnivore, vegan, Mediterranean, 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 explores how to determine the right diet for yourself rather than searching for a universal “best” diet. He begins by laying out five non-negotiable criteria that any sustainable eating pattern must meet—energy balance, metabolic health, adequate protein, micronutrient sufficiency, and long-term adherence—before introducing a practical rubric for evaluating different diets. Using this framework, Peter walks through the ketogenic, carnivore, vegan, and Mediterranean diets, highlighting their strengths, ideal candidates for each, and common pitfalls such as micronutrient gaps or adherence challenges. He explains why this guidance is aimed at people who feel overwhelmed by diet choices, not zealots defending a single approach, and provides practical advice on using tools like DEXA scans, lab markers, continuous glucose monitors, and symptom tracking to assess whether a diet is truly working. 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 #75 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Peter’s family chess battle [3:00]; Framing the diet discussion: moving past tribalism to practical frameworks for evaluating various dietary strategies [5:00]; Peter’s high-level nutrition framework [11:00]; Why diet is such a uniquely polarizing subject [14:15]; The five non-negotiables that apply to any diet [17:45]; How to think about energy balance in the context of evaluating a specific diet [20:15]; How diet can address metabolic health [21:45]; Protein as a dietary foundation [23:30]; Micronutrient essentials: avoiding deficiencies in restrictive and processed diets [24:45]; Why adherence and sustainability are essential for diet success [27:15]; Examining the standard American diet through the five non-negotiables [31:00]; The evaluation framework for specific diets [33:30]; The ketogenic diet: defining ketosis, clinical origins, modern uses, and potential health benefits [35:00]; The main strengths and weaknesses of the ketogenic diet [43:00]; How to avoid micronutrient deficiencies while on a ketogenic diet [47:15]; Electrolytes and fiber and the ketogenic diet: preventing magnesium loss and maintaining digestive health [49:15]; Adherence challenges of the ketogenic diet [51:30]; The carnivore diet: definition, motivations, anecdotal benefits, and possible mechanisms [53:15]; The main strengths and weaknesses of the carnivore diet [57:30]; Plant exclusion on the carnivore diet: nutrient gaps, gut changes, and unanswered questions [1:03:15]; Adherence challenges of the carnivore diet [1:04:45]; The vegan diet: definition, core beliefs, and various motivations for this strategy [1:05:45]; The main strengths and weaknesses of the vegan diet [1:09:15]; Adherence to the vegan diet: social acceptance, edge cases, and personal sustainability [1:13:15]; The Mediterranean diet: definitional challenges, traditional patterns, and its relatively strong evidence base [1:15:15]; Limitations of the Mediterranean diet: loose definitions and indulgence risks [1:19:30]; Measuring diet success: why setting clear goals and tracking outcomes matter [1:21:00]; Tracking body composition using DEXA scans [1:22:15]; Tracking metabolic health: key blood tests and advanced glucose monitoring tools [1:22:45]; Using elimination diets to identify food sensitivities that may cause digestive problems, autoimmune symptoms, or low energy [1:23:30]; Evaluating “anti-inflammatory diets”: confirming inflammation through symptoms and hs-CRP testing [1:25:15]; Final takeaways: flexibility, structure, and avoiding dogma in dietary choices [1:27:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #363 ‒ A new frontier in neurosurgery: restoring brain function with brain-computer interfaces, advancing glioblastoma care, and new hope for devastating brain diseases | Edward Chang, 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 Edward Chang is a neurosurgeon, scientist, and a pioneering leader in functional neurosurgery and brain-computer interface technology, whose work spans the operating room, the research lab, and the engineering bench to restore speech and movement for patients who have lost these capabilities. In this episode, Edward explains the evolution of modern neurosurgery and its dramatic reduction in collateral damage, the experience of awake brain surgery, real-time mapping to protect critical functions, and the split-second decisions surgeons make. He also discusses breakthroughs in brain-computer interfaces and functional electrical stimulation systems, strategies for improving outcomes in glioblastoma, and his vision for slimmer, safer implants that could turn devastating conditions like ALS, spinal cord injury, and aggressive brain tumors into more manageable chronic illnesses. We discuss: The evolution of neurosurgery and the shift toward minimally invasive techniques [2:30]; Glioblastomas: biology, current treatments, and emerging strategies to overcome its challenges [10:45]; How brain mapping has advanced from preserving function during surgery to revealing how neurons encode language and cognition [16:30]; How awake brain surgery is performed [22:00]; How brain redundancy and plasticity allow some regions to be safely resected, the role of the corpus callosum in epilepsy surgery, and the clinical and philosophical implications of disconnecting the hemispheres [26:15]; How neural engineering may restore lost functions in neurodegenerative disease, how thought mapping varies across individuals, and how sensory decline contributes to cognitive aging [39:15]; Brain–computer interfaces explained: EEG vs. ECoG vs. single-cell electrodes and their trade-offs [48:30]; Edward’s clinical trial using ECoG to restore speech to a stroke patient [1:01:00]; How a stroke patient regained speech through brain–computer interfaces: training, AI decoding, and the path to scalable technology [1:10:45]; Using brain-computer interfaces to restore breathing, movement, and broader function in ALS patients [1:28:15]; The 2030 outlook for brain–computer interfaces [1:34:00]; The potential of stem cell and cell-based therapies for regenerating lost brain function [1:38:00]; Edward’s vision for how neurosurgery and treatments for glioblastoma, Parkinson’s disease, and Alzheimer’s disease may evolve by 2040 [1:42:15]; The rare but dangerous risk of vertebral artery dissections from chiropractic neck adjustments and high-velocity movements [1:44:45]; How Harvey Cushing might view modern neurosurgery, and how the field has shifted from damage avoidance to unlocking the brain’s functions [1:46:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• Lower back pain: causes, treatment, and prevention of lower back injuries and pain | Stuart McGill, Ph.D. (#287 rebroadcast)

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Stuart McGill is a distinguished professor emeritus at the University of Waterloo and the chief scientific officer at Backfitpro where he specializes in evaluating complex cases of lower back pain from across the globe. In this episode, Stuart engages in a deep exploration of lower back pain, starting with the anatomy of the lower back, the workings of the spine, the pathophysiology of back pain, and areas of vulnerability. He challenges the concept of nonspecific back pain, emphasizing the importance of finding a causal relationship between injury and pain. Stuart highlights compelling case studies of the successful treatment of complex cases of lower back pain, reinforcing his conviction that nobody needs to suffer endlessly. He also covers the importance of strength and stability, shares his favorite exercises to prescribe to patients, and provides invaluable advice for maintaining a healthy spine. We discuss: Peter’s experience with debilitating back pain [3:00]; Anatomy of the back: spine, discs, facet joints, and common pain points [14:15]; Lower back injuries and pain: acute vs. chronic, impact of disc damage, microfractures, and more [24:30]; Why the majority of back injuries happen around the L4, L5, and S1 joints [30:45]; How the spine responds to forces like bending and loading, and how it adapts to different athletic activities [36:00]; The pathology of bulging discs [43:00]; The pathophysiology of Peter’s back pain, injuries from excessive loading, immune response to back injuries, muscle relaxers, and more [45:45]; The three most important exercises Stuart prescribes, how he assesses patients, and the importance of tailored exercises based on individual needs and body types [56:00]; The significance of strength and stability in preventing injuries and preserving longevity [1:08:00]; Stuart’s take on squats and deadlifting: potential risks, alternatives, and importance of correct movement patterns [1:19:15]; Helping patients with psychological trauma from lower back pain by empowering them with the understanding of the mechanical aspects of their pain [1:29:45]; Empowering patients through education and understanding of their pain through Stuart’s clinic and work through BackFitPro [1:38:30]; When surgical interventions may be appropriate, and “virtual surgery” as an alternative [1:46:30]; Weakness, nerve pain, and stenosis: treatments, surgical considerations, and more [1:55:15]; Tarlov cysts: treatment and surgical considerations [2:00:00]; The evolution of patient assessments and the limitations of MRI [2:02:00]; Pain relief related to stiffness and muscle bulk through training [2:06:45]; Advice for the young person on how to keep a healthy spine [2:14:00]; Resources for individuals dealing with lower back pain [2:25:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #362 ‒ Understanding anxiety: defining, assessing, and treating health anxiety, OCD, and the spectrum of anxiety disorders | Josh Spitalnick, Ph.D., A.B.P.P.

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Josh Spitalnick is a clinical and research psychologist with expertise in treating a variety of anxiety conditions with cognitive-behavioral therapy (CBT) and other evidence-based approaches. In this episode, Josh unpacks the four layers of anxiety—psychological, emotional, cognitive, and behavioral—highlighting why avoidance is the key feature that transforms ordinary worry into disorder. He explains why he continues to treat OCD and PTSD as anxiety conditions despite their DSM-5 reclassification, and he draws important distinctions between worries versus worrying and thoughts versus thinking. The discussion explores health anxiety, illness anxiety, and the impact of modern contributors such as wearables, social media, and the COVID era, while weaving in real-world case studies and Josh’s structured assessment approach. Josh also breaks down evidence-based treatments, from exposure therapy and cognitive-behavioral therapy (CBT) to acceptance and commitment therapy (ACT), along with the role of medication, lifestyle factors, and how shifting from avoidance to committed action can build long-term resilience. We discuss: Josh’s professional background and his holistic approach to treating anxiety [3:00]; Definition of anxiety and changes in the DSM-5 [5:00]; The psychological and cognitive aspects of anxiety [10:45]; Breaking down anxiety symptoms: triggers, fears, and hidden mental rituals [17:00]; Thoughts versus thinking and worries versus worrying: what constitutes dysfunction [20:15]; Health anxiety and the limits of medical reassurance: understanding illness anxiety and somatic symptom disorder [24:30]; Triggering events for health anxiety, symptom fixation, heritability, and the role of nature versus nurture [36:30]; Historical and modern shifts in health anxiety, from HIV/AIDS in the 1980s to today’s heightened fears of cancer [45:30]; Modern factors and recent events that have amplified societal anxiety levels [47:15]; Josh’s approach to patients with excessive health-related rituals and/or OCD using CBT and exposure therapy [54:30]; Hypothetical example of treating a person with a fear of flying: assessment, panic disorder, and the role of medication and exposure therapy [1:03:15]; The four types of exposure therapy and the shift from habituation to inhibitory learning [1:14:00]; Treating people with OCD that manifests in disturbing and intrusive thoughts, and why therapy focuses on values over reassurance [1:21:00]; Acceptance and commitment therapy (ACT): reorienting patients toward values-driven living rather than symptom elimination [1:31:45]; Mindfulness as a tool to cultivate presence, awareness, and healthy engagement with life [1:36:30]; Hallmarks of successful therapy and red-flags that therapy is not going well [1:38:15]; The relationship between anxiety and substance use, and the therapeutic challenges it creates [1:44:45]; Anxiety’s overlap with ADHD, OCD, autism, and physical health conditions [1:49:45]; Debunking the harmful myth that health anxiety is a “made up” condition [1:51:30]; Prevalence, severity, and evolving treatments for health anxiety and OCD [1:54:45]; Treating health anxiety is about providing patients with skills to improve quality of life—a discussion on how to address symptoms often attributed to long COVID [2:01:30]; Balancing the benefits of abundant health information with the risks of fueling health anxiety [2:06:30]; Advice for finding a telehealth provider with expertise in health anxiety [2:11:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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