] Dawn opens the interview welcoming Peter back to the show. Dawn mentions that a lot has happened since she and Ken last interviewed Peter and points out that Peter is in the process of writing a book.

] Ken asks Peter if it’s true that he does his best writing on long flights.

] Dawn mentions that in 2014 Peter created Attia Medical, which is a practice with offices in San Diego and New York City, where he focuses on the applied science of longevity and optimal performance. Peter gives an overview of his practice and how he works to improve people’s healthspan and lifespan.

] Ken asks Peter to explain the difference between a strategy and a tactic in the domain of optimization of performance and healthspan.

] Dawn mentions that back on episode one of STEM-Talk that Peter talked about his eight drivers of longevity. Dawn asks Peter if his thinking over the past three years has changed in terms of the eight drivers.

] Dawn asks what are some of the best lab tests in terms of longevity that people should request from their primary care physician.

] Ken asks how Peter goes about determining optimal reference ranges to target in his patients, noting that the guidelines constituting normal are based on a sick overall population.

] Dawn talks about how every year a new secret to longevity comes out with the force of hype behind it, but that rarely does the new so-called secret deliver. In contrast, she mentions how Peter encourages people to keep things simple and focus on nutrition, exercise and sleep. Peter explains how these three things can have the biggest impact on a person’s physical health.

] Dawn explains that optimizing health span can be expensive, often costing upwards of $100,000 a year in tests and devices and off-label medications. She asks if Peter has any thoughts on if there is becoming a class divide in the world of healthspan and lifespan.

] Ken explains that a primary inhibitor of BDNF is HDAC, and BHB is a powerful inhibitor of HDAC, which leads one to think that one of the mechanisms of exercise to increase BDNF is the elevation of BHB.

] Ken mentions that the area under the curve for insulin is one of Peter’s favorite longevity markers, and asks him to talk about the concept of insulin area under the curve.  In addition to blood tests and glucose monitoring, Ken asks Peter what would be the next item of greatest interest in terms of longevity markers.

] Dawn mentions that Peter wears an Oura Ring to monitor his sleep, and a glucose monitor to measure his blood sugar in real time. Dawn asks Peter to talk about the benefits of continuous monitoring versus short-term use for the purpose of building future behavior.

] Dawn asks if Peter uses any other wearables besides the ones she just mentioned.

] Dawn points out that Peter traveled to Easter Island with some friends, including David Sabatini, a guest on episode 70 of STEM-Talk. Dawn asks Peter to talk about the trip which was set up to explore first-hand the place where a group of Canadian researchers first discovered rapamycin.

] Ken mentions that Peter is on record saying, “For me personally nothing is more interesting than rapamycin.” Peter explains what he has been learning about rapamycin and why it is so fascinating.

] Ken says that in one of Peter’s podcasts, Peter mentioned he had been taking 5 mg of rapamycin. Ken asks what it was that informed that choice. Ken also asks Peter how he has been tracking rapamycin’s effects, and if he has any thoughts for listeners considering rapamycin.

] Dawn asks if we are any closer to being able to accurately measure biological signals, such as mTOR activity and autophagy, than we were three years ago.

] Peter explains his thoughts on muscle loss and fasting, and the amino acids that are important in muscles affected during a fast.

] Ken mentions that there are a lot of misconceptions about protein consumption, particularly in the context of ketogenic diets. He mentions Valter Longo’s opinion that a diet high in protein is as bad as smoking. Peter explains his thoughts on the role of protein in health and performance.

] Ken makes the point that the strongest viewpoints in science that have the most passion and anger behind them are often the ones with the largest error bars.

] Dawn mentions the importance of IGF-1 and its related molecules on metabolism. She asks about the paradox when it comes to IGF-1 in terms of performance and longevity.

] Ken mentions that the Annals of Internal Medicine published a study that made the point that eating red meat poses minimal health risks. Peter gives his thoughts on this.

] Ken states that in addition to rapamycin and fasting, he and Peter share an interest in sauna, a practice with growing evidence for its benefits. Ken asks Peter’s opinion on the difference between infrared and traditional sauna.

] Dawn mentions that in 2016 the Dong et al paper in Nature suggested that the limit of human longevity has been reached, and that Barbi et all published a paper in Science in 2018 that said that the mortality curve for humans flattens out once the age of 105 is reached. Peter shares his thoughts on just how long humans can live.

] Ken mentions that a recent study from the Miller Lab suggested that metformin might inhibit mitochondrial adaptation in older adults, and that an even more recent paper out of the University of Kentucky and the University of Alabama reported that metformin significantly blunts muscle hypertrophy in response to resistance training. Peter gives his thoughts on this and why he stopped taking metformin.

] Peter shares his concerns about generic metformin, as well as his recent interview with Katherine Eban about the fraud in the generic drug industry.

] Ken mentions that Peter is a proponent of fasting, and is involved with the Zero app. Ken asks if the benefits of fasting can be thought of in relationship to ApoB levels.

] Ken asks Peter to describe what he sees as the most interesting question he doesn’t yet have an answer to, but believes is eventually possible to know.

] Dawn ends the interview by asking Peter if there is one thing that he did not believe three years ago that he now thinks is likely to be true.