The Peter Attia Drive

• #355 – Skincare strategies, the science of facial aging, and cosmetic-intervention guidance | Tanuj Nakra, M.D. & Suzan Obagi, 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 Tanuj Nakra and Suzan Obagi, two leading experts in aesthetic medicine, join Peter to explore the science of facial aging and skin health as well as the responsibilities physicians face in the world of cosmetic procedures. In this episode, they examine the biological and hormonal drivers of facial aging, the evolutionary and psychological foundations of attractiveness, and the impact of modern media on beauty standards. They discuss the rise in cosmetic procedures among adolescents and the ethical responsibilities of physicians in these cases. The conversation then shifts to a practical, evidence-based guide to skin health—covering the use of mineral sunscreens, retinoids, vitamin C, and tailored skincare routines, as well as the management of acne and the psychology behind aesthetic consultations. The episode culminates in a candid, personal assessment of Peter’s own face, offering a revealing look at what aesthetic medicine can achieve and how to think critically about pursuing it. We discuss: Tanuj’s and Suzan’s training and expertise, and the evolving field of aesthetic medicine [4:00]; The biology of the aging face [10:45]; Why facial fat atrophies with age while body fat tends to accumulate [17:00]; How chronic stress accelerates facial aging [20:30]; The evolutionary biology of beauty, and how modern lifestyle, culture, and medicine interact with these ancient aesthetic instincts [25:30]; How social media and influencers have rapidly shifted aesthetic trends toward exaggerated features and unrealistic beauty standards [36:45]; The ethical challenges, financial incentives, and social pressures shaping modern aesthetic medicine [42:00]; The concerning trend of teenagers seeking cosmetic enhancements: the ethical and cultural impact of early beauty pressure [51:45]; Protecting the skin: UV damage and sunscreen recommendations [58:15]; Strategies for minimizing skin aging: retinoids, vitamin C, and evidence-based application methods [1:09:00]; Effective daily skincare routine: cleansing, antioxidants, retinoids, moisturization, and more [1:18:45]; The playbook for managing acne [1:31:00]; The 4 changes of aging and the complexities of aesthetic consultations including the anatomical, psychological, and ethical factors physicians must navigate [1:39:00]; The 5 R’s of rejuvenation [1:50:15]; A facial aging analysis and cosmetic strategy using Peter’s face as a real-time case study [1:53:00]; The decision-making process between fat grafting and dermal fillers for facial rejuvenation [1:56:30]; How self-image, eye aesthetics, and fleeting photos drive the desire for cosmetic enhancement [2:01:45]; Advice for wrinkles, causes of dark circles under the eyes, and the importance of facial symmetry [2:05:45]; Considerations that shape clinical decision making around fat grafting and other procedures to address the eye area [2:11:00]; The evolution of facial cosmetic surgery techniques, the serious risks involved, and how physician skill and procedure selection greatly impact outcomes [2:21:30]; How patients can make informed and safe choices when selecting a cosmetic surgeon [2:27:15]; A comparison of ablative versus non-ablative skin resurfacing treatments, laser vs. peels, and more [2:38:45]; How treatments are chosen and customized based on patient-specific factors [2:48:00]; The lifelong human desire to align physical appearance with self-identity [2:52:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #354 – What the dying can teach us about living well: lessons on life and reflections on mortality | BJ Miller, M.D. and Bridget Sumser, L.C.S.W.

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter BJ Miller, a hospice and palliative care physician, and Bridget Sumser, a licensed social worker specializing in serious illness and end-of-life care, join Peter to share insights from their decades of work supporting people at the end of life. In this episode, they explore the emotional and physiological processes of dying, the cultural barriers that prevent meaningful conversations about death, and how early engagement with mortality can lead to greater clarity and connection. The conversation highlights the distinctions between hospice and palliative care, the nature of suffering beyond physical pain, and the transformative role of honesty, forgiveness, and relational awareness in the dying process. Through stories and reflections, BJ and Bridget reveal what truly matters in the end—and how the dying can teach the living not only how to face death but how to live more fully. We discuss: The personal journeys of BJ and Bridget into end-of-life care, and the connection between living and dying [3:30]; What dying looks like: the physical, cognitive, and emotional realities at the end of life [13:15]; How historical perspectives on death contrast with modern experiences of dying [25:30]; The difference between palliative care and hospice care [30:45]; The systemic challenges surrounding hospice care: why patients often enter it too late to receive its full benefits [35:30]; How delayed hospice referrals and unspoken preferences often prevent patients from dying where and how they truly want [39:30]; The realities of home hospice: challenges, costs, and burdens placed of families [43:45]; How proactively engaging with the reality of death can avoid unnecessary suffering and promote a more peaceful ending [53:30]; How palliative care is misunderstood and underutilized—especially in cancer care [1:02:45]; Palliative care in the case of Alzheimer’s disease: emotional support, future planning, and family involvement [1:12:15]; The importance of having an advance directive: defining what matters most before it’s too late [1:23:00]; The differences between how young and old individuals experience dying from cancer [1:30:15]; The difference between pain and suffering, role of medicine in pain relief, and why emotional healing is essential at the end of life [1:35:45]; Dying well: the power of self-honesty and human connection at the end of life [1:47:00]; How psychedelics like psilocybin can unlock emotional breakthroughs and deepen connection for patients near the end of life [1:55:15]; Lessons from the dying on how to live well [1:57:30]; The physical process of active dying, and the emotional and practical considerations for loved ones [2:09:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #353 - AMA #72: Fasting: benefits for body composition and disease prevention, potential risks, and Peter’s updated practical framework

  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 revisits the topic of fasting, sharing how his thinking has evolved over time. The episode explores fasting-related terminology and common types of fasting, as well as the various reasons individuals might choose to fast. Peter explores potential benefits including improvements in body composition, metabolic health, lifespan extension, cardiovascular disease, cancer prevention and treatment, neurodegenerative conditions such as Alzheimer’s and Parkinson’s, and autoimmune symptoms like arthritis. He also examines the risks and potential downsides of fasting and offers a practical framework to help assess when and how fasting may be most appropriately applied. 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 #72 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Why the topic of fasting is being revisited [1:45]; The importance of being open to changing one's opinion in science and medicine as new evidence emerges [4:15]; Defining fasting and how it fits in the framework of dietary restriction, time-restricted feeding, and calorie restriction [7:30]; The most common types of fasting [11:45]; Why someone might choose fasting over continuous caloric restriction [19:00]; The biochemical effects of fasting: fuel partitioning, autophagy, and more [21:00]; Autophagy: a cellular cleanup process stimulated by fasting and energy depletion [26:00]; Comparing the physiological effects of a ketogenic diet to those of long-term fasting [27:45]; How long fasting takes to induce ketosis and boost autophagy, and how autophagy is measured [29:45]; At-home tests for ketones [33:45]; Reducing senescent (“zombie”) cells and inflammation through autophagy [35:00]; Examining the evidence for the long-term health benefits of fasting beyond short-term metabolic effects [37:15]; The common health claims associated with fasting across metabolic, neurological, oncological, autoimmune, and longevity domains [40:30]; The impact of fasting on body weight and body composition [42:00]; Weight regain and potential metabolic consequences of fasting [44:00]; The risk of lean mass loss with fasting and how to mitigate it [47:15]; A practical framework for using fasting as a strategy to improve body composition [52:15]; How extended fasting compares to caloric restriction in improving insulin sensitivity in people with insulin resistance or type 2 diabetes [54:00]; Is there any evidence that fasting can extend lifespan? [55:45]; Examining whether fasting improves cardiovascular disease risk beyond the effects of weight loss and calorie reduction [58:15]; Exploring whether prolonged fasting can reduce cancer risk [59:45]; The potential benefits of fasting or fasting-mimicking diets during cancer treatment: emerging evidence and practical considerations [1:02:15]; Fasting for protection against neurodegenerative diseases: early evidence of therapeutic benefit and open questions [1:10:45]; Various fasting methods for autoimmune diseases: potential symptom relief with cautious application [1:14:00]; Fasting and type 1 diabetes: risks, evidence, and careful dietary alternatives [1:16:45]; Fasting and gut disorders: potential benefits outside of flare-ups [1:18:45]; The primary risks and downsides associated with fasting [1:19:45]; The essential vitamins and minerals to supplement during prolonged fasting [1:21:30]; Who should avoid fasting and why [1:22:15]; Fasting’s role in health: where it shows promise and where it likely offers no distinct advantage over caloric restriction [1:23:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #352 ‒ Female fertility: optimizing reproductive health, diagnosing and treating infertility and PCOS, and understanding the IVF process | Paula Amato, 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 This is part two of a two-part mini-series on fertility and reproductive health. Paula Amato is a leading expert in female reproductive health and infertility, widely recognized for her contributions to advancing fertility treatment and research. In this episode, which follows last week's conversation on male fertility, Paula explores the biology of female fertility, including how hormonal changes regulate the menstrual cycle and ovulation, what those patterns reveal about fertility potential, and why both partners should be evaluated early in infertility workups. She discusses the role of the fallopian tubes, the causes of miscarriage, the impact of age and lifestyle on fertility, and treatment options for conditions like PCOS—including the emerging use of GLP-1 agonists. The episode also covers the evolution of IVF, advances in pre-implantation genetic testing, egg freezing, and the promise and limitations of next-generation reproductive technologies. We discuss: The finite nature of a woman’s egg reserve, how it changes over time, and the basic process of ovulation and fertilization [3:00]; How hormones influence egg selection, and how and why chromosomal errors lead to most miscarriages [5:30]; The full journey of conception—from hormonal cues triggering ovulation, to fertilization, embryo development, implantation, and early pregnancy risks [16:30]; How infertility is defined and diagnosed, and the broader trends contributing to rising infertility rates [25:15]; Fallopian tube damage: how STDs and scarring impact fertility and raise ectopic pregnancy risk [31:30]; Unexplained infertility: how doctors evaluate ovulation and cycles—and why more research on women’s health is needed [41:00]; The defining symptoms of polycystic ovary syndrome (PCOS), its hormonal characteristics, and its relationship with insulin resistance [44:00]; Managing PCOS without pregnancy: cycle regulation, androgen suppression, and insulin resistance treatment [46:00]; The treatment approach for women with PCOS who are trying to conceive: GLP-1 use, ovulation induction, and timing protocols [49:45]; Barriers to getting informed fertility care for PCOS: limited provider knowledge and access, insurance gaps, and next steps when ovulation treatments don’t lead to pregnancy [55:45]; Fertility treatment for women with unexplained infertility, risk of multiple pregnancies with superovulation, and more [1:03:00]; Intrauterine insemination (IUI): process, success rates, and when in vitro fertilization (IVF) becomes the better option [1:07:00]; The history of in vitro fertilization (IVF), and how access and acceptance have evolved over time [1:16:45]; The step-by-step process of IVF [1:19:30]; The IVF lab process: egg retrieval, fertilization, embryo culture, and freezing [1:26:30]; Genetic testing and embryo selection in IVF: aneuploidy screening, polygenic traits, and ethical concerns [1:41:15]; Embryo transfer in IVF: timing, uterine preparation, and implantation support [1:47:30]; Egg donation in IVF: indications, donor guidelines, and other considerations [1:50:45]; How to choose the right IVF clinic [1:54:45]; Innovations in fertility on the horizon, advice about freezing eggs, and more [2:02:00]; Optimizing fertility through lifestyle: diet, stress management, sleep, exercise, and supplementation [2:07:45]; Promising areas of fertility research [2:15:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #351 ‒ Male fertility: optimizing reproductive health, diagnosing and treating infertility, and navigating testosterone replacement therapy | Paul Turek, 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 This is part one of a two-part mini-series on fertility and reproductive health, with next week's guest, Dr. Paula Amato, focusing on the female side of the equation. Paul Turek is a world-renowned expert in male fertility and reproductive health, the founder and medical director of the Turek Clinic, and host of the Talk with Turek podcast. In this episode, Paul explores the topic of male fertility, offering a detailed look at the complex and highly coordinated process of conception and the many challenges sperm face on their journey to fertilizing an egg. He shares fascinating insights into how sperm work together to navigate the female reproductive tract, how environmental factors like heat, stress, and toxins impact sperm quality, and what men can do to improve their reproductive health. Paul also dispels common myths about testosterone replacement therapy and its effects on fertility, providing strategies for preserving fertility while on TRT. The episode also highlights cutting-edge advances in reproductive medicine, from genetic testing and sperm sorting to emerging treatments for infertility. We discuss: The incredibly complex and hostile journey sperm must take to fertilize an egg [3:00]; How sperm are made: meiosis, genetic variation, and the continuous renewal influenced by environmental factors [9:00]; The built-in filter that weeds out genetically abnormal sperm [14:45]; How sperm are finalized in form and function: tail formation, energy storage, and chemical sensing abilities [18:30]; How to optimize conception through the timing of sex, ejaculation frequency, and understanding the sperm lifecycle [26:30]; Male infertility and Paul’s diagnostic approach: detailed history, a physical exam, and identifying red flags [33:30]; Viral infections that can affect the testes and potentially lead to sterility [40:30]; Semen analysis: morphology, motility, and hormonal clues to male fertility [45:45]; Effects of medication, microplastics, stress, and exercise on fertility [57:15]; Testosterone replacement therapy (TRT) and male fertility [1:06:00]; Restoring fertility after prolonged use of exogenous testosterone [1:25:00]; Effects of heat and cold exposure on fertility and sperm quality [1:36:00]; How different levels of exercise—especially cycling—affect male fertility [1:41:45]; How alcohol, marijuana, and nicotine affect male fertility [1:46:00]; Why type 2 diabetes is a risk factor for male infertility [1:50:00]; How varicoceles—a common cause of male infertility—are diagnosed and treated [1:51:15]; Genetic factors that affect fertility [1:54:00]; The impact of lifestyle and environmental exposures on fertility [1:56:30]; The evidence (or lack thereof) behind stem cell and PRP therapies for male infertility, and how lifestyle and non-invasive interventions often lead to successful conception [2:00:30]; Considerations for sperm banking, and how paternal age impacts fertility planning and offspring health [2:05:00]; Semen quality as a biomarker: linking male fertility, longevity, and preventative health through Medicine 3.0 and epigenetics [2:14:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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