The Peter Attia Drive

• #345 ‒ Chronic pain: pathways, treatment, and the path to physical and psychological recovery | Sean Mackey, M.D., Ph.D.

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Sean Mackey is a professor of pain medicine at Stanford University and the director of the Stanford Systems Neuroscience and Pain Lab, where his research explores the neural mechanisms of pain and the development of novel treatments for chronic pain. In this episode, Sean joins Peter for a wide-ranging discussion on the multifaceted nature of pain—as both a sensory and emotional experience—and its evolutionary purpose as a critical survival mechanism. He dives into how pain is transmitted through the nervous system, the different types of pain, and why different individuals perceive pain so differently. Sean shares insights into pain management strategies ranging from medications like NSAIDs and opioids to neuromodulation techniques such as transcutaneous electrical nerve stimulation (TENS). Additionally, this episode explores the interplay between sleep and chronic pain and the psychological and emotional dimensions of pain, and it includes a personal story from Peter about his own experience with pain and how Sean’s expertise helped him more than two decades ago. We discuss: The definition of pain, and how our understanding of pain has evolved from a simplistic body-mind separation to a nuanced biopsychosocial model [2:30]; The biological mechanisms behind how we perceive pain [9:30]; The role of consciousness in the perception of pain, and how nociception functions during unconscious states [14:30]; The four types of pain [22:00]; Using fMRI to identify objective biomarkers of pain in the brain [31:30]; The evolutionary role of pain in human behavior and survival [36:00]; How the brain processes and modulates pain signals, Gate Control Theory, the variability in individuals’ pain perception, and effectiveness of neuromodulation techniques like TENS [41:00]; The brain’s influence on pain: the role of emotion, beliefs, sleep, and individual differences in perception and tolerance [53:45]; Peter’s personal journey with chronic back pain, and how the emotional consequences of pain can be more distressing than the pain itself [1:04:30]; The pharmacology of common pain medications—NSAIDs, COX-2 inhibitors, and acetaminophen [1:09:30]; Muscle relaxants: benefits, drawbacks, and personalized strategies [1:20:30]; The definition of chronic pain [1:29:15]; The role of antidepressants in pain management [1:30:15]; Opioids: their controversial and nuanced role in pain management [1:33:45]; Alternative therapies: acupuncture and cannabis [1:54:15]; Fibromyalgia and chronic pain: clinical features, brain mechanisms, and emerging treatments like low-dose naltrexone [2:01:00]; Possible brain benefits of low-dose naltrexone (LDN) for people with mild cognitive impairment [2:15:00]; Peter’s recovery from severe chronic pain—how he went from immobility and high-dose opioids to full functionality [2:20:15]; Breaking the pain cycle: how physical rehabilitation and psychological recovery work together in chronic pain treatment [2:30:45]; Sean’s struggle with cluster headaches, and the value of knowledge, preparation, and empathy in both managing chronic pain and caring for patients [2:39:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #344 - AMA #70: Nicotine: impact on cognitive function, performance, and mood, health risks, delivery modalities, and smoking cessation strategies

  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 dives deep into nicotine—a topic increasingly debated both scientifically and publicly. He clarifies the critical differences between nicotine and tobacco, highlighting why nicotine alone isn't primarily responsible for smoking's severe health consequences. Peter examines the specific risks associated with nicotine use, including addiction, sleep disruption, cardiovascular concerns, and effects on mood and anxiety. He evaluates various nicotine delivery methods, from traditional cigarettes to gums, pouches, and synthetic alternatives, ranking them according to their relative safety. Additionally, Peter explores nicotine's potential positive and negative impacts on physical performance, cognitive function, fertility, and its interactions with other stimulants like caffeine. Finally, he provides practical guidance for minimizing risks with nicotine use and offers thoughtful strategies for smoking cessation and effective nicotine replacement therapies. 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 #70 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: Revisiting the previous AMA on microplastics: low-effort, high-impact changes to significantly reduce microplastic exposure [1:45]; Overview of episode topics related to nicotine [3:30]; The current landscape of nicotine research [4:45]; Addressing the common misconception that nicotine itself is the primary cause of tobacco-related health risks [6:45]; Peter’s Marlboro-branded apparel is a nostalgic tribute to the Formula One era and not a sign of support for smoking [10:00]; The limitations of current research on the health risks of nicotine itself [12:15]; The most common side effects of nicotine [18:15]; The impact of nicotine on sleep [21:30]; Nicotine and mood: how nicotine can have both anxiety-inducing and calming effects based on genetics and dosage [25:00]; The addictive properties of nicotine: factors influencing addiction risk, and why certain people may struggle more than others [29:15]; The various nicotine products and nicotine delivery methods available: effects, absorption rates, and potential risks [33:45]; The relative risks of various nicotine products: how differences in nicotine concentration, absorption rates, and presence of contaminants impact their safety [37:00]; Potential cognitive benefits of nicotine: short-term benefits and impact of chronic use [44:45]; How nicotine exposure during adolescence can negatively impact brain development [47:45]; Nicotine's potential to prevent or slow neurodegenerative diseases [50:45]; Nicotine’s impact on memory, learning, and attention [52:45]; The interaction between nicotine and other stimulants, particularly caffeine [55:15]; Nicotine's potential impact on physical performance [57:15]; The potential effects of nicotine on fertility, and the challenges of distinguishing the impact of nicotine itself from the effects of smoking [58:30]; Considerations for people curious about using nicotine for its cognitive benefits [1:01:30]; How to think about nicotine: weighing cognitive claims, addiction risks, and personal tolerance [1:03:15]; The prevalence of smoking, the health risks it poses, and the substantial long-term benefits of quitting [1:05:45]; Effective strategies for smoking cessation, including the use of nicotine replacement therapies [1:09:00]; The reasons behind weight gain after quitting smoking, the role of nicotine in appetite suppression, and strategies to manage weight [1:15:30]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #343 – The evolving role of radiation: advancements in cancer treatment, emerging low-dose treatments for arthritis, tendonitis, and injuries, and addressing misconceptions | Sanjay Mehta, 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 Sanjay Mehta is a radiation oncologist with over 25 years of experience, and is currently the president of Century Cancer Centers in Houston, Texas (drsanjaymehta.com). In this episode, Sanjay explores the rapidly evolving field of radiation oncology, addressing common misconceptions about radiation exposure. He delves into radiation’s critical role in modern oncology, examining recent advancements that precisely target tumors while minimizing damage to surrounding healthy tissues and reducing side effects, with specific insights into breast, prostate, and brain cancers. Sanjay discusses fascinating international practices involving low-dose radiation therapy for inflammatory conditions such as arthritis, tendonitis, and sports injuries, highlighting its effectiveness and potential for wider adoption in the United States. Wrapping up on a lighter note, Peter and Sanjay discuss their mutual passion for cars and reveal how this shared interest first brought them together. We discuss: How radiation oncology became a distinct, rapidly evolving medical specialty [2:45]; Defining radiation, ionizing vs. non-ionizing, and common misconceptions about radiation exposure [5:30]; How radiation doses are measured, real-world examples of radiation exposure, and safety practices [9:00]; Radiation doses from common medical imaging tests, and why benefits of routine imaging outweigh risks [14:15]; Therapeutic radiation oncology: the evolution of breast cancer treatment toward less invasive surgery combined with targeted radiation [23:30]; Modern radiation oncology treatments for breast cancer—minimizing risks and maximizing patient comfort and outcomes [27:15]; How advances in radiation dosing, technology, and treatment precision have significantly reduced side effects [39:45]; How breast implants affect radiation treatment [44:45]; Radiation therapy for prostate cancer: advancements in precision, effectiveness, and patient selection criteria [48:00]; Radiation therapy options for inoperable prostate cancer or those seeking alternatives to surgery, and a remarkable patient case study [55:15]; How patients can effectively evaluate and select a high-quality radiation oncologist [1:05:45]; Radiation therapy for brain cancer: the shift toward precise, targeted techniques that minimize cognitive side effects, and remaining challenges [1:08:30]; The origins of radiophobia and how it influenced perceptions of radiation use in medicine [1:18:00]; Treating chronic inflammatory conditions such as tendinitis, arthritis, and more with very low-dose radiation [1:23:45]; Using low-dose radiation to treat spine injuries, scar tissue, fibrosis, keloids, and more [1:30:00]; The current barriers preventing widespread adoption of low-dose radiation therapy for inflammatory conditions [1:35:45]; The durability and versatility of low-dose radiation therapy in treating chronic inflammatory and arthritic conditions [1:40:45]; Sanjay’s talent as a drummer [1:44:45]; Peter and Sanjay’s shared passion for cars and racing [1:47:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #342 ‒ Aging well: Peter shares strategies for improving longevity with residents at a senior living center

  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 joins a unique conversation inspired by his daughter’s volunteer experience at a senior care center, where she formed meaningful relationships with residents curious about healthspan, lifespan, and strategies for living well as they age. Peter engages directly with the residents, covering critical topics like the profound impact of exercise—particularly strength training— for maintaining mobility, preventing falls, and preserving independence later in life. He also discusses the importance of nutrition, emphasizing adequate protein intake, along with strategies for sleep optimization and preservation of brain health. Peter also underscores the importance of emotional wellness, purpose, and social connections in healthy aging, provides advice on staving off chronic disease, and much more. We discuss: Peter’s definition of longevity [2:30]; Why it’s never too late to invest in your longevity [5:30]; The importance of adding “life to years” rather than just “years to life” [7:45]; The "four horsemen"—heart disease, cancer, neurodegenerative diseases, and metabolic conditions [9:15]; Advice for those managing chronic diseases later in life [11:30]; Why balance declines and falls become increasingly common with age, and how to prevent them [13:30]; Why strength training is essential (and effective) for older adults [18:30]; The five tools in Peter’s longevity toolkit [21:00]; Practical ways older adults can safely begin exercising despite physical limitations or health issues [23:00]; Principles of good nutrition, and the importance of adequate protein intake [24:00]; The importance of sleep for cognitive health, and effective sleep-improvement strategies for seniors [27:30]; How emotional health, social connections, and a sense of purpose significantly impact quality of life and longevity [32:00]; Why Peter decided to focus his work on longevity [33:45]; Protein intake recommendations should be based on ideal body weight (not current weight) [34:45]; The potential of klotho as a therapy for improving cognitive function and combating aging-related cognitive decline [35:30]; The best types of protein supplements to consider [36:45]; The APOE gene's influence on Alzheimer's disease risk, and why everyone should proactively address brain health, regardless of genetics [38:15]; How falls can accelerate cognitive decline, and the importance of staying physically and mentally active [40:45]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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• #341 - Overcoming insomnia: improving sleep hygiene and treating disordered sleep with cognitive behavioral therapy for insomnia | Ashley Mason, Ph.D.

  View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter’s Weekly Newsletter Ashley Mason is a clinical psychologist and an associate professor at UCSF, where she leads the Sleep, Eating, and Affect (SEA) Laboratory. In this episode, Ashley provides a masterclass on cognitive behavioral therapy for insomnia (CBT-I), detailing techniques like time in bed restriction, stimulus control, and cognitive restructuring to improve sleep. She explains how to manage racing thoughts and anxiety, optimize sleep environments, and use practical tools like sleep diaries to track progress. She also offers detailed guidance on sleep hygiene; explores the impact of temperature regulation, blue light exposure, and bedtime routines; and offers guidance on finding a CBT-I therapist, along with sharing practical steps you can take on your own before seeking professional help. We discuss: Defining insomnia: diagnosis, prevalence, and misconceptions [3:00]; How insomnia develops, and breaking the cycle with cognitive behavioral therapy for insomnia (CBT-I) [7:45]; The different types of insomnia, and the impact of anxiety, hydration, temperature, and more on sleep [11:45]; The core principles of cognitive behavioral therapy (CBT) and how CBT-I is used to treat insomnia [20:00]; Implementing CBT-I: time in bed restriction, sleep scheduling, and the effect of napping [29:45]; Navigating family and partner sleep schedules, falling asleep on the couch, sleep chronotypes, and more [39:45]; Key aspects of sleep hygiene: temperature, light exposure, and circadian rhythm disruptions [44:45]; Blue light and mental stimulation before bed, and the utility of A-B testing sleep habits [52:45]; Other simple interventions that may improve sleep [57:30]; Ashley’s view on relaxation techniques and mindfulness-based practices [1:02:30]; The effectiveness of CBT-I, the role of sleep trackers, and best practices for managing nighttime awakenings [1:04:15]; Guidance on intake of food and alcohol for good sleep [1:16:30]; Reframing thoughts and nighttime anxiety to reduce sleep disruptions [1:18:45]; Ashley’s take on sleep supplements like melatonin [1:21:45]; How to safely taper off sleep medications like benzos and Ambien [1:26:00]; Sleep problems that need to be addressed before CBT-I can be implemented [1:38:30]; The importance of prioritizing a consistent wake-up time over a fixed bedtime for better sleep regulation [1:40:15]; Process S and Process C: the science of sleep pressure and circadian rhythms [1:45:15]; How exercise too close to bedtime may impact sleep [1:47:45]; The structure and variability of CBT-I, Ashley’s approach, and tips for finding a therapist [1:50:30]; The effect of sauna and cold plunge before bed on sleep quality [1:56:00]; Key takeaways on CBT-I, and why no one should have to suffer from insomnia [1:58:15]; and More. Connect With Peter on Twitter, Instagram, Facebook and YouTube

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