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The Peter Attia Drive

The Peter Attia Drive

By: Peter Attia MD
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The Peter Attia Drive will feature guests and experts that will offer advice and insight to help you optimize performance, health, longevity, critical thinking, and life. It's hosted by Stanford M.D., TED speaker, and longevity expert Dr. Peter Attia, founder of Attia Medical, PC, a medical practice with offices in San Diego and New York City.Copyright © Peter Attia, MD Exercise & Fitness Fitness, Diet & Nutrition Hygiene & Healthy Living Physical Illness & Disease
Episodes
  • #398 ‒ AMA #86: GLP-1 RAs and muscle loss: new data, better questions, and how to preserve muscle during weight loss

    #398 ‒ AMA #86: GLP-1 RAs and muscle loss: new data, better questions, and how to preserve muscle during weight loss
    Jun 29 2026
    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 explores the effects of GLP-1 receptor agonists—including drugs such as Ozempic, Wegovy, and Zepbound—with a particular focus on their impact on muscle. He examines how much lean mass people actually lose during treatment and how those changes compare to weight loss achieved through other methods, while explaining why measurements of lean mass on DEXA scans can sometimes be misleading. Peter discusses the effects of these medications on bone mass, fracture risk, strength, and physical function, highlighting why functional outcomes may be more important than body composition metrics alone. He also explores how GLP-1–based therapies affect different fat depots throughout the body, identifies who may be most vulnerable to muscle loss, and outlines practical strategies for preserving muscle and bone health while using these medications. Finally, Peter reviews early insights into retatrutide, a next-generation weight-loss therapy, including what current evidence suggests about its effects on weight loss and muscle mass. 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 #86 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here. We discuss: The evolution of GLP-1 receptor agonists from diabetes drugs to breakthrough weight-loss therapies [1:45];Early concerns about lean mass loss with GLP-1 receptor agonists and the limitations of clinical trial data [3:45];How newer research has changed the understanding of lean mass loss on GLP-1 receptor agonists and why DEXA measurements can misrepresent muscle loss [6:15];Comparing lean mass loss across semaglutide, tirzepatide, and traditional weight-loss interventions [10:30];Comparing lean mass loss from GLP-1 receptor agonists with bariatric surgery, and whether these drugs cause muscle loss beyond normal expectations from substantial weight loss [13:15];The limited evidence regarding the timing of lean mass loss during GLP-1 therapy and the implications for exercise and nutrition strategies [16:00];Body composition changes after stopping GLP-1 receptor agonists: weight regain, fat regain, and lean mass recovery [17:45];Why lean mass measurements are an imperfect proxy for muscle health and function [21:45];The effects of GLP-1 receptor agonists on bone mineral density, fracture risk, and the importance of resistance training [23:00];Do GLP-1 receptor agonists directly cause muscle loss or simply mimic the effects of calorie restriction? [26:00];Why strength and physical function often improve despite lean mass loss on GLP-1 receptor agonists [28:00];Who is most at risk for lean mass loss during GLP-1–induced weight loss? [34:45];Intramuscular fat (IMAT), DEXA limitations, and the challenge of measuring true muscle loss [37:00];Preserving muscle while losing weight: resistance training, protein intake, and emerging research on preserving muscle during GLP-1–induced weight loss [39:00];Resistance-training principles for preserving lean mass during GLP-1–induced weight loss [43:45];Managing side effects and prioritizing protein intake while training on GLP-1 receptor agonists [46:15];Retatrutide: early evidence on its effects on weight loss, lean mass, and muscle function, as well as the limitations of the data being collected in ongoing clinical trials [48:00];The risks of using gray-market retatrutide before FDA approval [52:15];Key takeaways [54:30]; andMore. Connect With Peter on Twitter, Instagram, Facebook and YouTube
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    10 mins
  • #397 ‒ Endometriosis and adenomyosis: diagnosis, fertility, reproductive aging, and emerging treatments | Renato Tomioka, M.D., Ph.D.

    #397 ‒ Endometriosis and adenomyosis: diagnosis, fertility, reproductive aging, and emerging treatments | Renato Tomioka, M.D., Ph.D.
    Jun 22 2026
    View the Show Notes Page for This Episode Become a Member to Receive Exclusive Content Sign Up to Receive Peter's Weekly Newsletter View our full terms of use Renato Tomioka is a leading expert in reproductive medicine and gynecologic surgery whose unique skills allow him to diagnose and treat some of the most impactful yet frequently overlooked conditions affecting women's health. In this episode, Renato explores endometriosis and adenomyosis, explaining what these conditions are, why they often go undiagnosed for years despite affecting millions of women worldwide, and how advances in MRI and specialized ultrasound are transforming diagnosis beyond traditional surgical laparoscopy. He discusses the decision-making process behind hormonal therapy versus surgery, how treatment strategies change when fertility preservation is a priority, and where IVF fits into the care pathway for women with endometriosis, adenomyosis, or age-related fertility decline. Renato also examines the profound effects of female age on egg quality and quantity, including the accelerating rise in chromosomal abnormalities after age 35, highlights common mistakes in both surgical and fertility management, and shares promising developments on the horizon for treating these conditions and preserving fertility. Follow Dr. Tomioka's work: Instagram: @dr.renatotomioka; Website: Renato Tomioka, M.D., Ph.D. We discuss: 0:00:00 - Intro0:00:11 - Endometriosis: definition, prevalence, infertility risk, and theories of disease development0:09:03 - The biology of endometriosis: estrogen dependence, progesterone resistance, and tumor-like growth mechanisms0:13:25 - Adenomyosis explained: how it differs from endometriosis, why it develops, and its impact on reproductive health0:18:52 - Recognizing endometriosis and adenomyosis: the "6 Ds" of endometriosis and key differences in clinical presentation0:22:09 - Uterine fibroids: classification, symptoms, and the importance of fibroid location for bleeding and fertility0:24:09 - Understanding endometriosis pain: lesion-driven pain, nerve involvement, central sensitization, and the importance of early treatment0:28:26 - Endometriosis in young women: rising prevalence, delayed diagnosis, and barriers to care0:33:11 - Modern diagnosis of endometriosis: specialized ultrasound, MRI, and the decline of diagnostic laparoscopy0:45:52 - Clinical case example #1: Managing endometriosis in a young woman seeking pain relief while preserving future fertility0:54:10 - Clinical case example #2: Comparing treatment strategies for symptom control versus fertility1:01:24 - Endometriosis and fertility: the roles of age, embryo quality, IVF, and surgery1:11:50 - Clinical case example #3: Managing adenomyosis after failed IVF transfers to improve implantation and pregnancy outcomes1:20:51 - The funding gap in endometriosis research: disease burden, economic impact, and growing awareness1:22:01 - Clinical case example #4: Surgical decision-making in endometriosis—balancing pain relief, fertility preservation, and common treatment pitfalls1:27:43 - Common misconceptions about fertility: maternal age, embryo aneuploidy, the inefficiency of human reproduction, and the limits of IVF1:34:23 - Elective egg freezing: timing, success rates, the fertility funnel, and the tradeoffs of fertility preservation1:45:49 - Emerging fertility technologies: mitochondrial replacement, ovarian tissue preservation, stem-cell-derived eggs, and current limitations1:55:10 - The future of endometriosis treatment: new guidelines, biologic therapies, and unanswered questions about IVF1:58:30 - Why earlier diagnosis matters: reducing years of suffering from endometriosis and adenomyosis Connect With Peter on Twitter, Instagram, Facebook and YouTube
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    1 hr and 59 mins
  • #396 ‒ Breast cancer screening: understanding risk, deciding when to start and how often to screen, and choosing the right imaging strategy

    #396 ‒ Breast cancer screening: understanding risk, deciding when to start and how often to screen, and choosing the right imaging strategy
    Jun 15 2026

    View the Show Notes Page for This Episode

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    In this episode, Peter explores the critical topic of breast cancer screening, examining why thousands of women continue to die from breast cancer each year despite the availability of effective screening tools. He explains the strengths and limitations of current screening strategies, reviews the recommendations from major medical organizations, and discusses why screening guidance can often seem confusing or contradictory. Peter outlines a practical framework for understanding breast cancer risk and personalizing screening decisions, including when to begin screening, how frequently to screen, and which imaging modalities may be most appropriate based on an individual's risk profile. Throughout the episode, he emphasizes that while population-based guidelines provide an important foundation, optimizing outcomes requires a more personalized approach aimed at helping women make informed screening decisions that can improve the chances of early detection and successful treatment.

    We discuss:

    • Why women still die from breast cancer: the benefits of screening, the problem of under-screening, and the need for risk-based screening strategies [1:45];
    • Current screening recommendations, why they differ between organizations, and the importance of personalized screening decisions [6:30];
    • A framework for personalizing screening [8:45];
    • Assessing baseline breast cancer risk: genetics, family history, breast density, lifestyle factors, and the role of risk calculators in personalized screening [9:30];
    • Balancing cancer detection and false positives: how breast cancer risk influences screening intensity and imaging choices [17:45];
    • Mammography as the foundation of breast cancer screening: detecting ductal carcinoma in situ (DCIS) and the advantages of 3D versus 2D mammography [21:00];
    • MRI for high-risk women: the benefits of supplemental screening, abbreviated MRI, and the emerging role of contrast-enhanced mammography [23:00];
    • The role of ultrasound: supplemental cancer detection, diagnostic evaluation, and limitations compared with mammography and MRI [26:00];
    • Choosing the right breast cancer screening strategy: imaging modality selection, screening hierarchies, and the importance of imaging center quality [28:00];
    • How often should you screen for breast cancer? [30:15];
    • At what age should you start screening? [37:30];
    • Breast cancer in younger women: aggressive tumor biology, BRCA-related risk, breast density, and individualized decisions about when to begin screening [41:45];
    • Inflammatory breast cancer, the limitations of screening mammography for symptomatic disease, and the importance of promptly evaluating new breast symptoms in both women and men [44:45];
    • From risk assessment to personalized screening: a practical framework for reducing breast cancer mortality through earlier and more effective detection [46:30]; and
    • More.

    Connect With Peter on Twitter, Instagram, Facebook and YouTube
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    50 mins
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really loved the limitless series so listening to this podcast was great. getting more of Chris and peters insights was very interesting

loved limitless

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The title of this review is not an understatement. Listening to Peter has transformed my life in all ways. I never really grasped the importance of exercise until Attia and have gone from being an exercise avoider to loving exercise and exercising for a minimum of 7+ hours a week. After a life time of serial yo yo dieting, I lost circa 45 pounds which I've maintained for over 2 years. I credit being weight stable at a very healthy weight to understanding it's exercise that is even more crucial to health than nutrition. Thank you Peter.

Peter Attia has transformed my life

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Important information that makes me reflect on my liffe and becoming more mindfully of the world around me that will make me live longer and learn.

Usefull insight on how to live a better life

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Excellent up to date content backed by solid research papers. Delivered in an informative manner but accepting that some content requires some chewing over and repetition to comprehend adequately.

Pushing Boundaries

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