The Peter Attia Drive

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Abbie Smith-Ryan is a leading researcher in exercise physiology whose work focuses on how training and nutrition influence body composition, metabolism, cardiovascular health, and women's health across the lifespan, with particular attention on perimenopause and post-menopause. In this episode, Abbie explains how early exercise and play help build the foundation for bone health, muscle development, and cardiorespiratory fitness in girls, as well as how puberty and menstruation shape athletic performance, motivation, and recovery. She also explores how women can tailor training and nutrition across the menstrual cycle through smart fueling, hydration, and inflammation management; examines the evidence behind supplements such as creatine, omega-3s, and magnesium; and unpacks the metabolic and body composition changes that accompany the transition into perimenopause and menopause. Finally, she covers practical exercise programming for busy women, training and nutrition considerations during pregnancy and postpartum, and the evolving role of hormone therapy alongside lifestyle-based, evidence-driven approaches that help women better advocate for their health. We discuss: Abbie's background in distance running and her interest in studying women's health around exercise [3:00]; The role of early-life exercise in building lifelong bone, muscle, and cardiovascular health in girls [4:00]; Training principles for premenstrual girls, the risks of early specialization and delayed puberty from intense training, and how youth sport participation can shape bone and spinal health [7:15]; Nutrition as fuel in young female athletes: supporting training, growth, and performance [11:00]; Training and recovery across the menstrual cycle: recovery, nutrition, supplements, and practical strategies for performance support [16:00]; The benefits of creatine supplementation and importance of protein intake across the menstrual cycle [27:15]; How women should approach training intensity and volume across the menstrual cycle [33:00]; How to identify and monitor the perimenopausal transition and why this phase represents a critical window for exercise and nutrition interventions [37:15]; Case study: time-efficient exercise program for a busy, perimenopausal woman [42:00]; Why improving body composition is a better goal than weight loss, and how to set realistic fat-loss targets in midlife women [53:30]; How to preserve muscle and bone while using GLP-1 medications: resistance training, protein intake, and more [58:15]; Designing a three-hour-per-week training plan for sustainable body recomposition [1:03:30]; Abbie's insights from her 20+ years of self-tracking: nutrient timing, injury prevention, excessive training, bone health, and more [1:07:15]; How pregnancy and the postpartum period affect body composition, and how consistent exercise and intentional nutrition can prevent a permanent shift in body fat or muscle mass [1:13:30]; Changes in muscle quality and metabolic flexibility during perimenopause and menopause, and how exercise may counteract hormonally driven sarcopenia [1:21:45]; The biggest open questions about women's health: combining menopause hormone therapy with exercise, GLP-1 drugs, minimizing injury risk, and more [1:32:00]; How the training response differs between men and women, and the importance of type IIa muscle fibers [1:39:15]; Training advice for the hypothetical 70-year-old woman who has never exercised deliberately [1:47:00]; Misinformation about exercise and nutrition for women, injury risk, supplement hype, and the need for more nuanced messaging around hormones, recovery, and midlife training [1:53:30]; Benefits of hormone therapy in midlife women and its interaction with exercise and lifestyle interventions [2:00:15]; Peter's overall take on how women should approach exercise volume and intensity at various life phases and time constraints [2:03:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter James Clear is the author of the New York Times bestseller Atomic Habits. His extensive research into human behavior has helped him identify key components of habit formation and develop the "Four Laws of Behavioral Change." In this episode, James provides insights into how both good and bad habits are formed, including the influence of genetics, environment, social circles, and more. He points to changes one can make to cultivate more perseverance and discipline and describes the profound impact habits can have when tying them into one's self-identity. Finally, James breaks down his "Four Laws of Behavioral Change" and how to use them to create new habits, undo bad habits, and make meaningful changes in one's life. We discuss: Why James became deeply interested in habits [1:45]; Viewing habits through an evolutionary lens [6:00]; The power of immediate feedback for behavior change, and why we tend to repeat bad habits [9:15]; The role of genetics and innate predispositions in determining one's work ethic and success in a given discipline [14:30]; How finding one's passion can cultivate perseverance and discipline [23:15]; Advantages of creating systems and not just setting goals [29:15]; The power of habits combined with self-identity to induce change [36:30]; How a big environmental change or life event can bring on radical behavioral change [50:30]; The influence of one's social environment on their habits [54:15]; How and why habits are formed [1:00:30]; How to make or break a habit with the "Four Laws of Behavior Change" [1:09:30]; Practical tips for successful behavioral change—the best strategies when starting out [1:16:15]; Self-forgiveness and getting back on track immediately after slipping up [1:30:30]; Law #1: Make it obvious—Strategies for identifying and creating cues to make and break habits [1:39:45]; Law #2: Make it attractive—examples of ways to make a new behavior more attractive [1:47:45]; Law #3: Make it easy—the 2-minute rule [1:58:45]; Law #4: Make it satisfying—rewards and reinforcement [2:03:30]; Advice for helping others to make behavioral changes [2:06:00]; More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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 presents a curated "best of" conversation with bestselling author and previous guest Arthur Brooks, organized around four core themes: happiness itself, the forces that undermine it, the tools and practices that help cultivate it, and the courage required to live and love well. The episode brings together the most meaningful moments from two past interviews into a single, focused discussion that distills Brooks' most insightful ideas and offers practical takeaways for building a life that's both successful and deeply happy. We discuss: Happiness vs. happy feelings, and how happiness and unhappiness can coexist [2:15]; The six fundamental emotions [5:30]; The three main "macronutrients" of happiness [15:00]; Enjoyment: one of the three macronutrients of happiness [22:45]; Satisfaction: one of the three macronutrients of happiness [30:45]; Sense of purpose: one of the three macronutrients of happiness [38:45]; Fame: one of the traps that hijack our happiness [46:30]; Success addiction, workaholism, and their detriment to happiness [49:15]; The reverse bucket list: one of Arthur's tools and practices he recommends for moving past the traps that hijack our happiness [59:15]; Metacognition: one of Arthur's tools and practices he recommends for moving past the traps that hijack our happiness [1:01:00]; Taking charge of your happiness: discipline, transcendent experiences, and other deliberate actions for "happier-ness" [1:11:30]; Tracking happiness: the biomarkers and micronutrients behind the macronutrients of happiness [1:22:45]; The value of minimizing the self and looking outward [1:30:45]; How Arthur surprised himself with his ability to improve his happiness [1:34:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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 tackles a wide-ranging set of listener questions spanning lifespan interventions, exercise, cardiovascular risk reduction, time-restricted eating, blood pressure management, hormone therapy, diagnostics, and more. Peter reveals the single most important lever for extending healthspan and lifespan, and explains how he motivates midlife patients using the Centenarian Decathlon framework. He discusses the importance of addressing high apoB and cholesterol even in metabolically healthy individuals with calcium scores of zero, how to manage high blood pressure, and how to accurately evaluate metabolic health beyond HbA1c. Additional topics include time-restricted eating, practical considerations around ultra-processed foods, nuanced approaches to HRT for women and TRT for men, and why early and expanded screening for chronic disease—colonoscopy, PSA, coronary imaging, low-dose CT—can be lifesaving. He also offers insights into treating prediabetes, crafting exercise programs for those short on time, and safely incorporating high-intensity training in older adults. 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 #78 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Introducing a wide-ranging AMA: practical perspectives on lifespan interventions, metabolic health, diet, hormones, diagnostics, and more [2:45]; Why exercise is the most powerful single intervention for lifespan and healthspan [4:15]; How Peter motivates midlife patients to prioritize exercise [6:00]; Why lifespan and healthspan should not be treated as competing priorities and how choosing sustainable interventions benefits both [9:30]; Why high apoB deserves treatment even in a metabolically healthy patient with a CAC score of zero [14:00]; Managing hypertension: ideal targets for blood pressure, lifestyle levers, and why early pharmacology matters [18:15]; Assessing metabolic health beyond HbA1c: fasting insulin, triglycerides, lactate, zone 2, and more [23:30]; How to avoid common self-sabotaging patterns by choosing sustainable habits over extreme health interventions [26:00]; Time-restricted eating: minimal effect beyond calorie control, implications for protein intake, and practical considerations for implementing it [28:00]; Ultra-processed foods: definitions, real-world risks, and practical guidelines for smarter consumption [30:30]; How women should prepare for menopause and think about hormone replacement therapy: early planning, symptom awareness, and guidance on HRT [36:45]; Testosterone replacement for aging men: indications, benefits, and safe clinical management [39:45]; Why Peter recommends earlier and more aggressive screening tests than guidelines suggest: colonoscopies, coronary imaging, PSA, Lp(a), and low-dose CT scans, and more [43:30]; Full-body MRI screening: benefits, limitations, potential false positives, and the importance of physician oversight [47:15]; Prediabetes: individualized treatment strategies using tailored combinations of nutrition, sleep, and training interventions [51:00]; Time-efficient training plans for people with only 30 minutes per day to exercise [53:00]; How to safely introduce high-intensity exercise for older adults [55:00]; Timed dead hangs and ripping phone books: a playful look at Peter's early attempts to impress his wife [57:15]; Peter's carve out: The Four Kings documentary about a golden era of boxing [1:01:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter Dom D'Agostino is a neuroscientist and professor at the forefront of metabolic therapies, including ketogenic diets, exogenous ketones, and hyperbaric oxygen. In this episode, Dom breaks down nutritional versus supplemental ketosis, defines meaningful ketone thresholds, and outlines practical ways to achieve ketosis. He explains how a ketogenic diet can support metabolic health and weight loss, and advises on how to maintain adequate protein and avoid common mistakes. Dom surveys the growing landscape of exogenous ketones—from salts and esters to 1,3-butanediol—and effective pairings like caffeine, MCT oil, and alpha-GPC. He highlights the role of ketogenic therapy in cancer (particularly glioblastoma) and its promise for neurodegenerative diseases. The conversation also covers recommended hyperbaric oxygen protocols for brain injuries and cognitive function, situations where fasting or ketones offer cognitive and anti-inflammatory benefits, and touches on the carnivore diet as a ketogenic variant with potential relevance for autoimmune and metabolic conditions. We discuss: Dom and Peter's shared interest in ketosis, and Dom's scientific journey [2:30]; Dom's work for the Navy on oxygen toxicity [7:00]; Nutritional ketosis defined: physiology, biomarkers, and how fasting and diet generate therapeutic ketones [15:00]; The historical roots of ketogenic diets in epilepsy treatment, and evidence showing ketones reduce seizure activity and strengthen brain resilience [19:00]; Dom's personal experience on the ketogenic diet: tracking macros, getting enough protein, and monitoring ketone levels [24:15]; Using a ketogenic diet for weight loss: Dom's guidance on protein, fiber, calorie tracking, lipid monitoring, and more [31:00]; Protein on ketogenic diets: Dom's rationale for higher intake and muscle preservation [38:00]; Incorporating carbohydrates into keto: timing, high-fiber foods, and other considerations [41:30]; The carnivore diet: whether this diet induces ketosis, how it functions metabolically, and why it may help individuals with autoimmune conditions [44:15]; Early exogenous ketones: how 1,3-butanediol works, its liver toxicity risk, and why ketone esters replaced it [48:15]; The progression of exogenous ketones: why BHB monoesters and ketone salts emerged as better alternatives to 1,3-butanediol for ketone supplementation [59:30]; Ketone salts: easing the transition into ketosis, dosing, and how they compare to ketone esters [1:04:00]; The differences between D- and L-β-hydroxybutyrate, and how racemic mixtures may elevate ketones longer and offer unique biological effects [1:09:30]; How ketosis may boost NAD, and why NAD supplements have fallen short so far [1:16:30]; Emerging evidence for using a ketogenic diet to treat anorexia and other psychiatric disorders [1:20:30]; Potential cognitive and performance benefits of ketone supplementation, and why pushing ketones too high can be dangerous [1:23:45]; Applications for ketone esters, and why ketone salts or MCT-blended formulations may be safer and more practical for most people [1:29:15]; The role of a ketogenic diet in treating cancer [1:34:45]; The potential of a ketogenic diet for treating Alzheimer's disease [1:45:45]; Tools for cognitive enhancement: ketones, alpha-GPC, MCT, caffeine, strategic fasting, and more [1:53:45]; Hyperbaric oxygen therapy for concussion, TBI, PTSD, and cognitive function, including protocols and dosing approaches [1:55:30]; Peter's takeaways, recommended products, and additional resources to learn more [2:03:00]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube