Watch the full episode and view show notes here: https://bit.ly/3z5JsNM Become a member to receive exclusive content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Josh Rabinowitz is a Professor of Chemistry and Integrative Genomics at Princeton University, where his research focuses on developing a quantitative, comprehensive understanding of cellular metabolism through the study of metabolites and their fluxes. In this episode, Josh focuses the discussion on three main topics: metabolomics, NAD (and its precursors), and cancer metabolism. The metabolomics discussion starts with a broad definition of metabolism, metabolites, and fluxomics before diving deep into glucose metabolism, lactate as a fuel, movement of lactate, and the regulation of these substrates. He then gives a detailed explanation of the electron transport chain and Krebs cycle and their implications with respect to both drugs and nutrition while also explaining how NAD is central to the process of energy generation. He then discusses the age-related decline in NAD and what current literature says about efforts to increase NAD through intravenous or oral supplementation with the precursors NMN and NR, including whether doing so provides any advantage to lifespan or healthspan. Finally, Josh ends the conversation talking about cancer metabolism and how one particular intersection between cancer metabolism and immunotherapy might provide a hopeful outlook on the future of cancer treatment. We discuss: 0:00:00 - Intro 0:00:08 - Josh’s background and unique path to becoming a research scientist at Princeton 0:09:11 - What sparked Josh’s early interest in metabolism 0:14:59 - Metabolomics 101: defining metabolites and how they are regulated 0:25:42 - Fluxomics: Metabolism as a system in action 0:34:43 - The Randle Hypothesis: glucose and fatty acids compete as substrates for oxidation 0:37:44 - The important role of lactate as an alternate fuel 0:50:09 - Fasting lactate levels as a potential early indicator of metabolic dysfunction 0:57:17 - The beauty of the Krebs cycle and the role of NAD in energy production 1:10:46 - How the drug metformin acts on complex I of the electron transport chain 1:15:30 - The difference between NADH and NADPH 1:17:45 - NAD levels with age, and the efficacy of supplementing with intravenous NAD 1:31:44 - The usefulness of restoring NAD levels and efficacy of oral supplementation with NAD precursors NR and NMN 1:43:59 - Exploring the hypothesis that boosting NAD levels is beneficial 1:51:25 - Cancer metabolism and the intersection with immunotherapy 2:00:17 - Making cancer a chronic disease: exploiting the metabolic quirks of cancer, augmenting the immune system, and more 2:05:06 - The challenge of treating pancreatic cancer 2:12:07 - Epithelial cancers that might respond to metabolic approaches to therapy 2:14:50 - Josh’s hopeful outlook on the future of cancer treatment 2:16:39 - Nutritional approaches to cancer attenuation 2:23:26 - What makes Princeton University special ------- About: The Peter Attia Drive is a weekly, ultra-deep-dive podcast focusing on maximizing health, longevity, critical thinking…and a few other things. With over 45 million episodes downloaded, it features topics including fasting, ketosis, Alzheimer’s disease, cancer, mental health, and much more. Peter is a physician focusing on the applied science of longevity. His practice deals extensively with nutritional interventions, exercise physiology, sleep physiology, emotional and mental health, and pharmacology to increase lifespan (delay the onset of chronic disease), while simultaneously improving healthspan (quality of life). Learn more: https://bit.ly/3bjxpEG Connect with Peter on: Facebook: http://bit.ly/PeterAttiaMDFB Twitter: http://bit.ly/PeterAttiaMDTW Instagram: http://bit.ly/PeterAttiaMDIG Subscribe to The Drive: Apple Podcast: http://bit.ly/TheDriveApplePodcasts Overcast: http://bit.ly/TheDriveOvercast Spotify: http://bit.ly/TheDriveSpotify Google Podcasts: http://bit.ly/TheDriveGoogle Disclaimer: This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit my website where I keep an up-to-date and active list of such companies.