Hey everyone, welcome to a sneak peek. Ask me, anything or am a episode of the drive podcast? I'm your host Peter, a TIA at the end of this short episode. I'll explain how you can access the AMA episodes in full along with a ton of other membership benefits. We've created or you can learn more now by going to Peter attea, m.com forward, slash
subscribe. So without further delay, here's today's sneak peek of the ask me. Anything episode. Welcome to another AMA. Episode of the drive. Today's episode will be the third of what we're calling. The quarterly podcast summary. The feedback again has been very positive on these so we're going to continue to do these. And in these conversations, what I do take the interviews that I've done over the preceding quarter and note the most important insights that I've
Gain personally from these interviews along with any changes that have resulted in my practices from these insights. So with all that said, these shouldn't be seen really as a replacement for listening to these but I hope they serve as both a primer, if you've listened to them or maybe they direct you to go back and listen to something that you missed. In today's episode, I'm going to cover interviews that I did with Anna Lemke, Phung Chang Belinda, Beck Erik Robinson, and Ted Schafer. In this discussion we speak about
Takes such as dopamine, addictions, crispr Gene, editing bone health, the importance of exercise at any age energy, balance, caloric, restriction, prostate cancer testosterone and much more. If you're a subscriber and you want to watch the full video this podcast, you can find it on the show notes page. If you're not a subscriber, you can watch a sneak peek of the video on our YouTube page. So, without further delay, I hope you enjoy this special quarterly podcast summary. Am a of the drive.
Peter, welcome to another quarterly podcast summary AMA which is a mouthful. How you doing?
Good? We have an abbreviation for
that. I think it's QPS 1 2 3. This is
3 Q. PS 3 a.m. a 60
something yeah. We're just going to keep throwing numbers at it until it sticks. That's definitely not confusing to The
Listener. Well, thank you for coming to Austin to do this one in.
Person.
Yeah, it's honestly weird to not. Look at you through a screen for one of
these. I feel the same way.
Yeah, I can't hide when I usually do behind the screen in this one. So, this is a much more serious episode. So for this one, as a reminder for people, because it's still relatively new, what we're doing with these quarterly podcast summaries is we're taking previous episodes and just going through them with your thoughts. And this came about because you take an insane amount of notes through the podcast. You have in front of you there.
So we would internally kind of go through these and we did a few of these and people really liked him and so what we're going to do is we'll go through we won't necessarily summarize them as much as you will talk about your big takeaways and then we'll kind of a conversation on how that's affected, either your behavior, how you deal with patients, anything of that nature. And so for today's episode, we're going to talk about dopamine through Anna's podcast. We have crispr which is super interesting through Fung's podcast, bone mineral density,
Density lifting and females, especially as you age with Belinda calorie restriction, with Eric, which is always of interest and then prostate cancer, which was kind of a special shorter episode we did with Ted. So I think it's really good and kind of a huge variety of things that will cover. But with that said, anything you want to say, before
we roll? No, just to reiterate. I'm sure I'll have said, this already in the intro, which I obviously haven't recorded yet that this is not a substitute for going back and listening to
Podcast, because I'm not even attempting to provide the full context of everything. What I'm really trying to do is capture what I'm taking away in real time as I'm having these discussions with people. What am I making notes on? That's effectively. The filter here is what is Peter pulling out of this as the most interesting stuff and sometimes that comes with an assumption that other content is understood and heard? So the hope is that you're listening to this after you've heard these podcasts or that you listen to these
and maybe go back and listen to a podcast that you skipped, because the inside is particularly
interesting. Yeah, definitely. Let's start with Anna's episode which covered dopamine. Great book. Super interesting episodes. Do you want to kind of start with what your main takeaways were from that episode?
Yeah, so I read an Olympic has book obviously before, interviewing her enjoyed it a lot and was kind of looking forward to talking about this and had a lot of questions about what really constitutes
And because I think the book is really about addiction more than it is about dopamine, right? Dopamine is kind of a heuristic, everybody's heard the term dopamine everybody understands what dopamine is, it's a neurotransmitter, it's one of the most important neurotransmitters in the reward system and therefore in the addiction system but it's not the only one. And so I think my interest was maybe even personally a little bit less in the nuts and bolts of dopamine and more around the science of addiction. We started with defining, the traditional aspects of what defines addiction so the sort of out.
Of control compulsive use the Cravings, the continued use despite consequences, and then the tolerance to the stimulus and then ultimately, withdraw when it's removed. So again, if you view that through the traditional lens of how people think of an addiction, like alcohol, all of those things clearly check, check, check, check check. But of course, there are behavioral things that show up here as well. Everything from gambling to sex, to workaholism many of these things can constitute an addiction. Now, one of the things I took away from this that I found interesting was the idea
What are the factors that influences particularly wanted to really understand how heritable addiction was meaning? How much is this written into the genetic code turned out quite a bit? According to the heritability data. Now again, you'll often hear us talk about these. This came up in the podcast with Karl deisseroth where we talked about eating disorders, depression schizophrenia. The typical way that these conjoined twin studies are done. Is they look at the prevalence of a certain condition in identical twins that
were raised apart. That's really the best tool we have to understand how much of a role did genes play. You take two people with identical genes raised in a completely different environment and based on that Anna said that addiction is about 50 to 60 percent heritable. That's a huge amount obviously but it's a big enough amount that it can't be ignored but it's not so big an amount that the die is cast meaning just because you come from a line of people who have an addiction to one thing or another,
Doesn't mean that you are fate is sealed. So what are the other two things that play a role in this? And she described them as nature/nurture neighborhood nature jeans, nurture how you're raised and neighborhood meeting the environment you're in. Now she wasn't able to provide or at least if she was I missed it. What the percent is for nurture versus neighborhood. But again, if heritability is 50 to 60 percent, we're going to say 40 to 50 percent. Comes from how you were.
Raised and I don't just mean like the obvious things, but I also mean the subtle things. So we're you raised around people that are engaging in a certain Behavior. Do you have experiences in life, for example, trauma that might predispose you to certain addictive, behaviors, this idea of neighborhood is very important and I think it really has a lot to do with anybody who's ever considered trying to break a bad habit. So if you struggle with gambling, it's really hard to break a gambling habit. If all your friends are gamblers, you either have to get a bunch of new friends or somehow.
Decide you're going to hang out with a bunch of people who gamble but not do it yourself. Very difficult. Another topic that I just found incredibly fascinating and I don't think we know the answer is the takeaway is why do some people have a certain lock and key configuration for certain addictions? So why is it? I use myself as an example. I think, in the podcast I really enjoy alcohol. Like it's not like I'm repulsed by the taste of alcohol. I quite enjoy it. Like, literally enjoy the taste. I just don't think I could be an
Alcoholic. If I tried in other words, if you surrounded me with alcoholics, it would never appealed to me, to drink in the morning or to drink in a manner that would lead to excessive use. So why is that? It's clearly not moral superiority. That's not what I'm trying to say. It's that there is something in my brain that doesn't get enough of that cycle from alcohol, that it just doesn't work for me. That way. The same is true with gambling. I was in Vegas. Remember giving a talk a little while ago had to walk through a casino like 25 times 2 and from where I was
Going and again, I don't say this to be disparaging of the people that are in casinos, at seven in the morning, but I just couldn't imagine. Like if you said to me Peter, we have a job for you. You just have to sit in the casino and play Blackjack and we'll pay you a million dollars a month to do this and cover all your losses and you can keep all the winnings I couldn't do it. I couldn't imagine something less appealing and yet, there are obviously people who can ruin their lives doing this. Why? And by the way, there are things that I'm addicted to that. Most people would look at and say who could do that this. Why question? I don't think we have an
Answer to yet, and yet it totally fascinates me, to me. That's the most interesting question in this space. How does Anna work with clients? She's a psychiatrist. One of the first steps that she thinks about, and I think this is valuable for any of us that are trying to cope with our own addictions. Is she does a four-week dopamine fast, which means a four-week total abstinence from the behavior. That one is trying to rid themselves of. She said that 80% of her clients or patients will feel better,
After the four-week fast. Now she also noted, some of those people need medications to help them through that. So for example, if a person is trying to do a dopamine fast around alcohol, they may actually require benzodiazepines medically to help with that transition. Of course, that's not always the case. She also talked I think my camera this was in her book or we talked about it, but I think we also discussed a woman that was basically smoking pot 24/7. And was doing it because of her
Anxiety but of course turned out she was having all the anxiety because you're smoking all the poppet. This wasn't realized until she was able to sort of abstain from it. Okay. Another thing that I found just interesting sort of nuance was around pain and pleasure. One of the examples we used was that of cold plunging. So people have heard me talk a lot about cold plunging. I'm a huge fan of it. Although I still firmly maintain it has no longevity benefit. There's no gyro protective benefit of cold plunging. So 12 the bio hackers out there. I'm just
Sorry but I don't think it's going to make you live longer but I do think there are two distinct benefits. I think one is a reduction in inflammation and muscle soreness and I think the other for select people is an improvement in mood and I talked about how she's tried cold plunging many times and has never experienced an improvement in mood and I was like, oh, that's super interesting. I've heard many people say that, but I've heard just as many people share my experience, which is no matter what mood I'm in, no matter how foul it is.
If I get into a 40-degree bathtub bury myself to my neck for 10 minutes, I feel insanely good after that. And again, it's not unlike the issue we discussed earlier of why do some people have the key go in the lock for alcohol? And it's like, both thumbs up. Other people don't have it. What it really comes down to is endogenous dopamine production from pain. So and I talked about how we live in a state of
Of homeostasis. This is obviously a factor spread across all of biology. So when it comes to maintaining regular glucose levels, when it comes to maintaining a regular pH body temperature, all of the core things that allow us to live, require homeostasis, and the body has remarkable tools for adjusting up and down to keep us in that window. And dopamine is no exception. And so when we do something, that is difficult that induces pain. And the two examples that she gave
We're cold immersion and exercise. The body has to offset that pain somehow and it does so by increasing the endogenous production of dopamine what's different about this is one, it's not a huge rush of dopamine that you get for free. It's this dopamine that you kind of had to work for to offset something you're doing that's actually causing pain. So when you remove the pain you painful stimulus. IE when you get out of the cold plunge, when you stop the workout you have this lingering effect of
Of that heightened dopamine. But again, it's a physiological level and it hasn't been sort of a hijacked level. There is a line in Anna's book that she credits to the person who said it. And I can't remember who that was, but I loved it. Our brains are like cactuses that now reside, in rainforests. So we evolved in an environment where stimulation was relatively modest and our brains had normal tools for coping with the up.
Downswings of dopamine and now we live in the most stimulating environment imaginable and obviously, we just didn't have enough time to adapt. Anybody can sort of follow the logic there. And so I think that makes a lot of sense. And it probably speaks to kind of what I think of as the big takeaways from this. So the big takeaways here, especially if you're a parent is to sort of ask the question, what are we doing to prevent our kids brains from being hijacked by this?
So even the world you and I grew up in more than 10 years older than you, but whether your group in the 70s or the 80s, we still grew up in a relatively stimulation, free world. I mean, the most stimulating thing in my life was a cheap cathode ray tube TV, watching reruns of Happy Days. Like that was the Pinnacle of stimulation in my life and today forgot about it. Kids wouldn't even know what that is if they saw it. So everything is in Technicolor and two things. She said
Really probably stand out one is social media. The other is pornography, again, I think I brought up the example of when I was a kid. Pornography was a Playboy magazine today. It's VR literally, all of this stuff. There's just no way around it, as a parent. I think you just have to be the one that's in charge of saying, we're going to absolutely minimize avoid these things to the best of our ability. I don't think there's much. I would add here because so much of this is advice. I think everybody already kind of knows about
Out how much you limit, smartphones, social media, all of those things, those are the big takeaways from this podcast,
a few follow-up questions. Their first is on the heritability piece so about 56 percent which is large and I know we've talked to other podcasts about the importance of like family history and taking a detailed family history, typically as it relates to diseases, cardiovascular disease Alzheimer's, things of that nature, cancer soon. When you're having patience and new patients do family, histories. Are you now having?
Also include addictions in there. Have you always done that?
Yeah, it's a good question. So we don't have dedicated questions around it but usually we we almost always come up with it just through the detailed questioning around everything else. And the reason is, it's very difficult for a person to struggle with an addiction to alcohol or drugs and not have a creep into their health. So it's very common that we hear, Uncle Jimmy, he died of heart disease when he was 60, but
Truth be told he had a real drinking problem and that is so yeah, we usually emerge from the family history, knowing full well, but I actually think it's a good point. I think we could be more deliberate about it and we obviously pay just a lot of attention to this when it comes to mental health as well. Because when you go through the family history and you see the number of family members with mental illness, you just realize that there's a greater susceptibility as well.
Yeah, let's talk a little bit more about cold therapy so you do that. You mentioned for you in particular for mood. You said, that's not the case for everyone. But there
Good amount of people who get that benefit. And so, do you find for yourself? It's more of a if you routinely do cold plunges, it's kind of like a consistent benefit, or do you ever have days where you're like, I'm in a terrible mood. Like I need to just step away from the computer jump in. Do you kind of use it both ways or how do you think about that?
I occasionally do use it as the total reset. And by the way, I don't know that that even needs to be done in the most
Extreme version of a cold plunge. Like I really think that having your face dipped in a bowl of cold water. I've talked about this in the past, can stimulate the mammalian dive reflex. Do you have a big enough Bowl? You put your head into it just even just covering your face that can in theory I suppose at least trigger an autonomic response that up regulates the parasympathetic system via the vagus nerve and that can tone down the sympathetic system actually. This is a great example of coming back to a previous podcast.
So the one with Joel Jameson where we talk about HRV, I think he did a very good job in that podcast explaining that you don't want to think about one system being on one system being off between parasympathetic and sympathetic. You just really want to think about them. Always both being on, and it's just a question of the balance, or you revving one up more than the other.
You mentioned that in addition to cold therapy, Anna talked about exercise can also be a mood stabilizer for people. Do you see that for
you? Yeah, yeah. I mean, if you deprive me from exercise,
It's noticeable within a
day when you work with patients, how do you think? Because there's obviously a huge spectrum of this. Some of it can be as simple as I'm just not going to look at my phone and how hour before bed, other can be deep addictions. And so, how do you think in your work with patients of, when you're starting to recommend? Hey, let's just try these behaviors verse. Let's go see a specialist to work on this in a more nuanced detailed manner.
I think, for the most part, we
Like to see people try to solve this on their own using neighborhood as the tool. So what do I mean by that? If I'm sitting around holding my phone, I'm looking at it frequently, there's no two ways about it and by the way, I can be very good about not looking at social media, but it's also because I don't really like social media, but the truth of it is if I'm sitting around and my phone is on my lap or it's in my pocket.
I'm going to be checking email, I'm going to be checking text, I'm going to be reading news quite often. So if I want to avoid that, I have to come up with an alternative and that's where my bat phone is a good alternative, right? If I'm going somewhere where I need a phone to make phone calls but I don't want to have anything to do. I just bring my second phone, my bat phone which doesn't have email on it. I don't even know the phone number. Nobody Knows the phone number so it never gets a text message. It's
Basically just a device that makes calls and has podcasts on it if I want to listen to a podcast. So that's something that I'm just going to look at last because I fixed the neighborhood in a sense. And so I think that's sort of generally what I try to get patients to think about is, yeah, like, how do you not have your phone in your room? How do you not have your phone with you for an hour before bed? Not because you're white-knuckling it, but because you've come up with another thing in your routine, that wouldn't have a phone with you. So if you go and do a Sonic old,
Orange before bed, it's easy to displace the phone. But if I say, I want you to sit there and stare at the wall but not have your phone, that's a tougher
ask you do archery every now and then you go hunting and when you do it's basically like being off the grid. So you're hiking, you're deep in the woods, it's not like you're kind of sitting around your house. There's no TVs. So during those periods of time, those handful of days. Do you find that? Not being on your phone? Not having technology when you come back to the world? Do you use it last?
Is that kind of like a natural dopamine fast or
no? I wouldn't say so because I don't think it's long enough. I do enjoy that. I just came back from a trip a little while ago where we were bowhunting in a very very remote area. So there was no Wi-fi there's no cell service, my phone didn't work once except for the one place where one guy had one of those little starlink things once or twice a day. You could make a phone call or something. Yeah, everything about that is cool. What you don't have to be hunting to do it that you could just be camping.
The right spot but everything about waking up super, super early going to bed. Once the sun goes down and not being inundated with anything was great. And so I don't think that would constitute a fast because at least in my case, it's not nearly long enough but it's enjoyable, nonetheless. It also probably maybe made me feel a bit better and knowing that I guess I don't have an addiction to that, at least because I also didn't experience withdrawal. I was like quite happy to not have the
device. Awesome. Let's move on to
To the next one, which is Fung's, podcasts, heavily on crispr Gene editing, really interesting episode, Pretty technical at times, but also, it's a topic. I feel as talked about so much you here, crisper your Gene and mean we've written about pcsk9 Gene editing and how that can have an impact and cardiovascular disease. So do you want to talk about your biggest, take aways inside you. Learn from that.
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