Podcast Summary
Discussing benefits of lab tests, heart rate variability, and supplements: Exploring benefits of reference ranges for lab tests, importance of heart rate variability, and uses of supplements like statins, zetamib, and nicotinamide riboside. Emphasizing accurate information and team's role in ensuring it.
He discusses the benefits of using reference ranges for lab tests, the importance of heart rate variability, and the use of supplements and drugs like statins, zetamib, and nicotinamide riboside. He also addresses questions about women's health, medical training, and monetization of the podcast. Throughout the episode, Peter emphasizes the importance of accurate information and the value of his team in ensuring the information provided is correct. He encourages listeners to sign up for his weekly email and to review the podcast on Apple if they find it valuable. The episode is available in both audio and video format on the website.
Understanding optimal vs average reference ranges for health data: Dr. Peter Attia advocates for stricter lipid levels (triglycerides <100 mg/dL and LDL particle number <1000 animals per liter) for heart disease prevention, but optimal ranges can vary depending on individual health goals.
When it comes to interpreting health data from lab results, it's important to understand the difference between average and optimal reference ranges. During a live Q&A session, Dr. Peter Attia discussed his personal preferences for lipid levels, stating that he aims for triglycerides below 100 mg/dL and LDL particle number below 1000 animals per liter. He explained that these stricter standards are based on the prevalence of heart disease and atherosclerotic disease as the leading causes of death. However, it's crucial to recognize that reference ranges can change over time and may not represent optimal health for everyone. For instance, if someone is aiming for optimal performance in heavyweight rowing, they might choose a different range that falls outside the statistical norm. It's essential to remember that labs usually provide reference ranges based on population distributions, but these ranges may not be the best targets for individual health goals.
Unique lab result interpretation standards for healthcare professionals: Healthcare pros may prioritize lower values for small LDL particles, C-reactive protein, uric acid, ALT, AST, and stricter post-challenge glucose and insulin levels. They may also focus on specific ratios for thyroid function diagnostics.
The speaker, a healthcare professional, has unique standards for interpreting lab results that differ from typical reference ranges. They prioritize lower values for small LDL particles, C-reactive protein, uric acid, and liver enzymes ALT and AST. For glucose testing, they prefer stricter post-challenge glucose and insulin levels. For thyroid function, they look for specific ratios of TSH, free T3, and reverse T3. The professional acknowledges the complexity of hormone testing and diagnosis. They advocate for a more nuanced approach and possibly further discussion for a complete understanding.
Evaluating EPA and DHA levels and desmosterol in red blood cells: Desirable EPA and DHA levels in red blood cells are above 8.5%, but optimal levels depend on individual concerns. Desmosterol, a marker of cholesterol synthesis, should ideally be above 0.5%. IGF levels may benefit from cycling between high and low levels, influenced by amino acid intake, insulin levels, and exogenous hormones.
When evaluating EPA and DHA levels in red blood cells, a desirable range is above 8.5%, but optimal levels can vary depending on individual concerns, such as neurodegenerative or atherosclerotic risks. Additionally, the source of EPA and DHA is crucial. Desmosterol, a marker of cholesterol synthesis, should ideally be above 0.5%, as over-suppression of cholesterol synthesis can have individual health consequences. Regarding IGF levels, there is a shift in perspective towards cycling between high and low levels, rather than maintaining low levels at all times. Factors influencing IGF levels include amino acid intake, insulin levels, and exogenous hormones like growth hormone. It's important to remember that a single blood test provides a snapshot, and overall lifestyle and health are more representative of one's health status.
Understanding hormonal fluctuations beyond averages: IGF levels may not dip during tissue rejuvenation, and measuring hormones like GH and IGF-1 doesn't fully convey health status due to their pulsatile nature. Women's unique hormonal fluctuations during the menstrual cycle can significantly impact emotional and physical well-being.
When it comes to understanding hormonal levels, particularly Insulin-like Growth Factor (IGF), it's important to consider the cycling nature of these hormones rather than just averages. IGF levels may not reach low points during tissue rejuvenation or regeneration. Additionally, while measuring hormones like Growth Hormone (GH) and Insulin-like Growth Factor-1 (IGF-1) can provide valuable insights, their pulsatile nature makes it challenging to infer complete health status. In women's health, the least studied areas often revolve around unique female experiences, such as hormonal fluctuations during the menstrual cycle. These fluctuations can significantly impact women's emotional and physical well-being, and understanding these hormonal changes can help women better manage their health.
Women's hormonal changes and their health impacts: During reproductive years, testosterone dominates, but in menopause, estrogen, progesterone, and testosterone levels drop, leading to various symptoms and health issues. Doctors often overlook these symptoms, and multiple pregnancies can affect thyroid function, emphasizing the need for more research on women's health.
Women's hormonal changes during their reproductive years and menopause have significant impacts on their health. During their reproductive years, women experience high levels of testosterone relative to estrogen, making testosterone a dominant hormone. However, in their fifth decade, women experience a sudden loss of estrogen, progesterone, and testosterone, leading to various symptoms and health issues. Unfortunately, many doctors disregard these symptoms and refuse to prescribe hormones, leading to further health complications. Another overlooked issue is the impact of multiple pregnancies on women's thyroid function. These issues highlight the importance of understanding the unique differences between male and female bodies and the need for more research on women's health.
The Importance of Understanding Gender Differences in Health: Thalidomide highlights the need to consider gender in medical research. Women's unique physiology, such as menstruation and hormonal fluctuations, can impact disease risk and response to treatments. Fasting or ketosis may affect fertility in women due to hormonal changes.
The story of Thalidomide serves as a reminder of the importance of understanding the ramifications of medical discoveries and potential gender differences in health. While women generally tend to get less cardiovascular disease than men when all factors are equal, the protective effect may be related to lower iron levels due to menstruation. The gender disparity in Alzheimer's disease prevalence also warrants further investigation. Regarding women and fasting or ketosis, it's essential for women trying to conceive to be cautious, as high ketone levels may suppress fertility hormones. The differences in FGF21 levels between males and females in response to ketosis provide evidence for this.
Understanding the role of ketosis in pregnancy: While ketosis may have been beneficial in times of famine, modern contexts require individualized approaches to pregnancy and conception, considering each person's unique medical history, lifestyle, and health conditions.
While women have evolved to give birth in a state of ketosis, it doesn't necessarily mean it's the optimal state for pregnancy or trying to conceive. During periods of famine, it may have been beneficial for women to stop reproducing and for men to maintain high testosterone levels to hunt and gather food. However, in modern times, the context matters, and restricting carbohydrates to the point of ketosis may not be the best strategy for everyone, especially for those with conditions like gestational diabetes. Medical students and residents should focus on gaining a deep understanding of each patient's unique context and individual needs, rather than relying on general rules or bumper sticker solutions. It's essential to consider each person's medical history, lifestyle, and specific health conditions when providing advice or treatment. Additionally, gaining practical experience early on, such as through internships or research opportunities, can help students optimize their time in medical school and prepare for their future careers.
Explore passions in college beyond pre-med: Deepen your knowledge in college and help others during challenging times to maintain motivation in your medical journey
Before embarking on a pre-medical track, it's essential to explore areas of deep passion in college instead of solely focusing on acing the MCAT. The speaker emphasizes that the foundational knowledge gained in college will be only a surface-level introduction to the subjects, and medical school will require a much more in-depth understanding. Additionally, during challenging times in medical school or residency, it's beneficial to help others and remind oneself of the privilege of being in that position. By sharing knowledge and expertise, one can rediscover the enthusiasm and motivation that led them to pursue their goals in the first place.
Balancing learning and self-care in medical school: Engage in self-care activities, interact with patients, align decisions with goals, and explore monetization options for podcast sustainability.
Finding a balance between learning and self-care is crucial for personal growth and success, especially during rigorous academic periods like medical school. Over-focusing on studies can lead to burnout, and it's essential to engage in activities that replenish and bring joy. Interacting with patients is an essential part of medical education, as it offers a unique opportunity to make a difference in people's lives and understand the privilege and responsibility of the profession. When making decisions, it's essential to consider whether they align with our goals and bring us excitement and fulfillment, as the challenges of medical school can test our commitment. Regarding monetizing the podcast, exploring various options, such as sponsorships, merchandise, or premium content, can help ensure its sustainability.
Podcast experiment turned into enjoyable experience: Host aims to cover costs, fund research projects, and potentially generate revenue through podcast
The podcast project started as an experiment but has turned into an enjoyable experience for the host, who gets to interview knowledgeable guests and delegate most of the work to others. However, the podcast comes with a significant cost of around $2,500 per episode, and the host aims to cover these expenses and even fund research projects by potentially generating revenue through the podcast. The host's goal is to expand the research team and contribute to projects that could benefit from unrestricted funding, such as identifying metabolic signatures for autophagy. The podcast could potentially fund these projects and even generate additional capital for investment. The host expressed a preference against selling ads and is exploring other potential revenue streams.
Monetizing a podcast through advertising: Balancing integrity and finances: Speaker aims to monetize podcast by 2019, likely through membership model or advertising, while maintaining integrity and genuine product recommendations.
Monetizing a podcast through advertising is a complex issue with potential risks and benefits. The speaker values his integrity and fears the influence of advertisers on his content. He also acknowledges the financial limitations of relying solely on listener support. Another option is creating a membership model, but it comes with the loss of potential listeners. Ultimately, the speaker aims to monetize the podcast by 2019, likely through one of the latter two approaches. Despite the challenges, he intends to continue sharing his genuine recommendations for products he loves.
Real-time health data from CGMs and wearables improves health management: Access to real-time health data from CGMs and wearables enables informed decisions, leading to improved behavior and better health outcomes.
Having access to real-time health data through tools like continuous glucose monitors (CGMs) and wearable technology can significantly improve behavior and overall health management. The speaker shared their personal experience with the G6 CGM, expressing how it has become an essential part of their daily life due to its accuracy and ability to provide immediate feedback. This data helps the speaker make informed decisions about their diet and physical activity, ultimately leading to better health outcomes. The speaker also highlighted the competitive nature that drives them to maintain optimal glucose levels and avoid spikes. They expressed hope for the future of these technologies becoming more affordable and accessible to consumers, beyond their current status as medical devices.
Limited real-time insulin monitoring with CGMs due to insulin assay challenges: Despite limitations, CGMs provide real-time glucose data for more precise diabetes management, and ongoing research aims to develop real-time insulin monitoring.
The FDA currently regulates Continuous Glucose Monitors (CGMs) in a way that limits their real-time and accurate functionality for clinical use. This is due to the challenge of measuring insulin in real-time, as insulin assays require complex chemical reactions that cannot be performed quickly at the point of care. As a result, CGMs are primarily used as a proxy for insulin levels, with low glucose levels and low glucose variability indicating a lower insulin profile. Despite the limitations, there is ongoing research to develop real-time insulin monitoring, and some companies are exploring using CGM data to impute insulin changes. However, this would require a significant amount of data and accurate calibration. The A1C test, which measures average glucose levels over the past 2-3 months, is often used as a diagnostic tool for diabetes management. However, it has limitations as it relies on the assumption that a red blood cell lives for 90-120 days. Any deviation from this range can lead to inaccurate results. In contrast, CGM provides real-time glucose data, allowing for more precise and personalized diabetes management. Overall, while there are challenges to real-time insulin monitoring, the use of CGMs as a proxy for insulin levels and the ongoing research in this area hold promise for improving diabetes management and ultimately, improving patient outcomes.
Person with beta thalassemia trait has high A1C levels despite normal blood glucose: Despite normal blood glucose levels, a person with beta thalassemia trait can have high A1C levels due to long-lived red blood cells, indicating potential prediabetes. Future tests may focus on continuous glucose monitoring instead.
The speaker, who has beta thalassemia trait, has a high A1C level due to the long lifespan of their red blood cells. Despite having an average blood glucose level within the normal range as indicated by continuous glucose monitoring, their A1C levels are consistently higher, making them essentially prediabetic. The speaker expresses hope that in the future, hemoglobin A1C tests may no longer be ordered and instead, continuous glucose monitoring will be the standard for assessing blood sugar levels. The speaker also discusses the potential correlation between groundwater lithium levels and better mental health, referring to it as "tier two epidemiology," but acknowledges that further research is needed to determine if there is a clear causal relationship and to consider potential confounding factors. The speaker also shares their personal decision to try taking lithium to potentially stabilize their mood after conducting extensive research.
Personal experiment with high doses of lithium and Berberine: Taking high doses of lithium and Berberine can have noticeable effects on mental health, but come with significant risks and potential side effects. Personal experiences should not replace proper medical advice.
Taking high doses of lithium, even under closely monitored conditions, can have noticeable effects on mental health, but comes with significant risks and potential side effects. The speaker shared his personal experiment of taking 600 milligrams of lithium a day for a year, which led to a decrease in his "assholeness," as noticed by his wife. However, he also experienced side effects such as nausea and noticed the effects were less noticeable when he returned to a lower dose. The speaker also mentioned Berberine, a plant extract with two properties, one of which is its weak AMP kinase activation, similar to Metformin. The speaker did not claim definitive evidence of the effectiveness or side effects of taking high doses of lithium or Berberine, but shared his personal experience as an anecdote. It's important to note that taking high doses of lithium without proper medical supervision can be dangerous and even fatal.
Berberine acts like Metformin and inhibits PCSK9: Berberine reduces hepatic glucose output and inhibits PCSK9, benefiting those with LDL clearance issues, while baby aspirin's heart health benefits are now under debate due to unreliable aspirin works test and potential side effects.
Berberine, when taken at recommended doses, acts similarly to Metformin by decreasing hepatic glucose output through weak AMPK activation. However, Berberine also inhibits the enzyme PCSK9, which may benefit a subset of people who overexpress this enzyme and have defective LDL clearance. As for baby aspirin, it has historically been taken to reduce the risk of heart disease, particularly for those with a family history and positive aspirin works test. However, recent science suggests that the aspirin works test may not be reliable, and the decision to take baby aspirin should be based on individual risk assessment and consideration of potential side effects.
Baby aspirin's preventative benefits questioned: Recent studies suggest minimal risk reduction from baby aspirin for low-risk populations, potentially leading to less prescribing. Intuitive practices like taking aspirin on flights may not be backed by data. Consider heart rate variability for health assessment and personalized recommendations.
The use of baby aspirin for preventative health measures, particularly for low-risk populations, may not be as effective as previously believed based on recent studies. The risk reduction is minimal, making it a "wash." This finding may lead to a change in clinical practice, with doctors being less inclined to prescribe baby aspirin for low-risk patients. Additionally, intuitive practices, such as taking baby aspirin on long flights to reduce the risk of blood clots, may not be supported by clinical trial data. Furthermore, heart rate variability is a metric that can be used in clinical practice and personal health management to assess overall health and wellbeing. This metric, which measures the variation in heartbeats, can provide insights into sleep quality, stress levels, and overall health. Heart rate variability can be measured using various devices and techniques, and its analysis can help inform personalized health recommendations.
Understanding Heart Rate Variability and its Impact on Health: Heart rate variability (HRV) measures the variation in time between heartbeats, reflecting autonomic nervous system function and overall health. Two leading companies, HeartMath and FirstBeat, provide accessible HRV analysis using proprietary algorithms, revealing insights into stress levels, emotional well-being, and fitness.
Heart rate variability (HRV) is an essential measure of the variation in time between heartbeats, which can provide insights into an individual's autonomic nervous system function and overall health. HRV is typically measured in milliseconds and can be influenced by various factors, including heart rate, respiratory rate, and stress levels. Traditionally, HRV analysis required specialized equipment and complex mathematical algorithms, but advancements in technology have made it more accessible. Two leading companies, HeartMath and FirstBeat, have developed proprietary algorithms for analyzing HRV data. The data obtained from these analyses can reveal important information about an individual's parasympathetic and sympathetic nervous system activity, offering insights into their stress levels, emotional well-being, and fitness. By monitoring HRV, individuals can gain a better understanding of their body's response to various stimuli and make informed decisions to improve their health and wellness.
Assessing Health with Real-time Heart Rate Variability Data: Heart rate variability (HRV) data from wearable tech offers real-time insights into sleep quality, recovery, and overall health. Modern wearables make it convenient to collect and analyze daily HRV data, allowing individuals to adjust lifestyle factors for better health and performance.
Heart rate variability (HRV), derived from wearable technology, is a valuable metric for assessing sleep quality, recovery, and overall health. The advantage of continuously monitoring HRV is that it provides real-time feedback, enabling individuals to make adjustments to their lifestyle and habits based on the data. For instance, factors like alcohol consumption, unhealthy food, and poor sleep hygiene can negatively impact HRV, which in turn affects sleep quality and recovery. However, the challenge with earlier devices was low compliance due to the inconvenience of long-term use and data transmission. Modern wearables, such as Aura Ring and Whoop, offer more user-friendly solutions, allowing for daily data collection and analysis. HRV is an essential parameter for evaluating readiness and determining optimal performance levels. By monitoring HRV, individuals can identify patterns and make adjustments to their training regimens, meal timing, and other lifestyle factors to improve overall health and well-being. In summary, HRV is a crucial metric for understanding individual health and optimizing lifestyle choices. Real-time feedback from wearable technology enables individuals to make informed decisions and improve their overall health and wellness.
Impact of intense workouts and fasting on recovery and sleep: Intense workouts can negatively affect recovery, especially endurance activities. Deep sleep improves during fasting, with stable heart rate and decreasing respiratory rate.
The Aura Ring, a device used to monitor recovery and sleep quality, shows that intense workouts, especially those involving high calorie expenditure, can lead to a dip in recovery scores. This effect seems to be more pronounced with endurance activities like cycling or running. The ring also indicates that deep sleep improves during fasting, with respiratory rate decreasing and heart rate remaining stable. The speaker believes that nutritional epidemiology, which often relies on food frequency questionnaires, is not a reliable source of information. He also thinks that the case against saturated fat, such as coconut oil, may be overstated but not completely without merit. The speaker suggests that the optimal consumption of saturated fat varies from person to person. During their conversation, they discussed the possibility of doing a speed round, answering questions within 90 seconds, but they didn't get to it in their conversation.
Considering Absolute Risks in Nutrition and Health Studies: Don't just focus on relative risks in nutrition studies, consider absolute risks instead. Be skeptical of one-size-fits-all recommendations, prioritize sleep, and understand your unique circumstances.
When it comes to nutrition and health studies, it's important to consider the absolute risks and not just the relative risks. The speaker argues that some recent meta studies suggesting moderate carbohydrate intake may be best for health suffer from the usual problems of epidemiology and additional issues specific to nutritional epidemiology. He advises against relying on such studies and instead encourages individuals to understand the underlying biomarkers that impact health outcomes. The speaker also emphasizes the importance of sleep, stating that while it may not be the most important factor for health, it is the one that people will suffer from the quickest if they lack it. Additionally, he suggests being skeptical of number one recommendations and encourages individuals to consider their unique circumstances when making health-related decisions.
Variability in ketone production and measurement: Managing lipid levels and inflammation are important for longevity. Speaker's personal experience with using Lipitor and Zetia. Writing a book on shepherding, potential release during election cycle. Nicotinamide riboside for longevity discussed but not fully explored.
The body's production and utilization of ketones can vary greatly from person to person, and measuring ketone levels through urine tests may not necessarily reflect optimal health. Another key point discussed was the importance of managing lipid levels and inflammation for longevity, and the speaker's personal experience with using Lipitor and Zetia to do so. The speaker also shared that they are writing a book about their experiences as a shepherd and hoped to have the manuscript completed by the end of the year, but acknowledged the challenges of releasing it during an election cycle. Lastly, the topic of nicotinamide riboside supplementation for longevity was brought up, but the speaker acknowledged that a full discussion on the subject would require more time than was available.
Only the liver can effectively utilize oral NAD+ precursors: Oral NAD+ precursors like NR and NMN may not increase cellular NAD levels throughout the body, as only the liver can utilize them to produce NAD. Intravenous doses may be necessary for therapeutic effects.
Taking NAD+ precursors such as NR and NMN orally, like supplements or infusions, may not effectively increase cellular NAD levels throughout the body, as only the liver can utilize these precursors to produce NAD. Therefore, intravenous doses may be the only effective way to increase cellular NAD levels. This information comes from a recent study by Josh Rabinowitz and his team, which used a tracer to track NAD intermediaries and precursors in various cells. The study showed that only the liver could take up oral NR or NMN and convert them into NAD. The implication is that oral supplementation may be a waste of money, and intravenous administration may be necessary for therapeutic effects. It's essential to note that this information may not be popular with companies selling oral NAD+ precursors, but it's crucial for consumers to make informed decisions based on scientific evidence.
Trustworthy Supplement Companies and Doctors: Dr. Peter Attia advocates for reliable supplement companies and doctors who share similar health principles. He recommends JRO, Pure Encapsulations, Nordic Naturals, Carlson's, and Thorne for supplements and Berberine respectively.
Dr. Peter Attia emphasizes the importance of reliable supplement companies like JRO and Pure Encapsulations for his personal use. He also mentions Nordic Naturals and Carlson's for EPA and DHA. He recommends Thorne for Berberine due to different regulations for pharmaceuticals. Currently, his practice is not accepting new patients, and he suggests seeking out doctors who share similar principles as a potential solution for patients looking for a doctor like him. Despite the challenges of geography and endorsement, he expresses interest in creating a doctor-patient matchmaking service as a solution to this common request. Overall, Dr. Attia's emphasis is on finding trustworthy sources for health information and care.
Creating a patient-generated questionnaire for doctors: Patients seek comprehensive care and doctors can't always provide it. A patient-generated questionnaire could help match patients with doctors who align with their desired level of care, inspired by the quick feedback and immersive experience in critical care medicine.
Patients want comprehensive and deliberate care from their doctors, but they often feel that their current doctors may not be able to provide that level of attention. To address this issue, a suggestion was made to create a patient-generated questionnaire for doctors to answer and post online, allowing patients to find doctors who match their desired level of care. The speaker also shared their personal experience of observing doctors in an ICU setting and learning the value of quick feedback and immersive experience in medicine. Ultimately, the short feedback cycle in critical care medicine makes it an interesting and teachable field, and the level of care provided in critical care units can be compared to the level of care in other medical practices.
The Importance of Healthcare Professionals Behind the Scenes: Engaged patients reap the most benefits from healthcare, requiring consistent effort and attention, with doctors and researchers working together to improve health outcomes.
The impressive work in healthcare often goes unseen by patients. Doctor-patient interactions are just the tip of the iceberg, with a whole team of researchers and professionals working behind the scenes. Patients who are deeply engaged with their health and numbers get the most value from healthcare providers. Being an active participant in one's health journey is crucial, and it requires consistent effort and attention. In the upcoming podcast, Dr. Peter Attia will interview neurologist Dr. Richard Isaacson about Alzheimer's prevention and APOE. Stay tuned for more insights on this topic. Remember, you can sign up for Dr. Attia's email list or follow him on social media for updates on his work and related topics. Always consult with healthcare professionals for medical advice.
Transparency and Ethical Conduct in Investing: Investors and advisors should disclose conflicts of interest and maintain a clear separation between personal and professional interests to build trust and foster long-term relationships.
Transparency and ethical conduct are crucial in the investment industry. Peter Aitamurto emphasizes the importance of disclosing conflicts of interest and encourages investors and advisors to maintain a clear separation between their personal and professional interests. He believes that this approach builds trust and fosters long-term relationships. You can learn more about Peter's approach to investing and disclosures by visiting his website, peteratiamd.com, and exploring the "About" section. Ultimately, by prioritizing transparency and ethical conduct, investors and advisors can create a foundation for successful and sustainable business relationships.
