#52 - Ethan Weiss, M.D.: A masterclass in cardiovascular disease and growth hormone - two topics that are surprising interrelated

The Peter Attia Drive podcast is listener-supported, rather than relying on ad revenue. The host, Peter Attia, believes that trust and honesty are important in their relationship with listeners, and he's more enthusiastic about sharing information on products or topics that he truly believes in. Members receive additional benefits such as exclusive show notes, access to Ask Me Anything episodes, and discounts on products that Attia loves. The podcast remains free to all, but Attia hopes that many listeners will find enough value in the content to support the production directly. Attia also announced that this week's episode features a discussion with Dr. Ethan Weiss about cardiovascular disease and the role of growth hormone and IGF in disease. Weiss, a cardiologist, provides unique insights on both topics.

Dr. Ethan Weiss, a renowned medical professional trained at Hopkins and UCSF, has a wide range of expertise in various aspects of medicine, including cardiovascular disease and endocrinology. During their conversation, they delved into the complexities of interventional radiology, calcium scores, and CT angiograms. However, what stood out most to the host was Dr. Weiss's passion for endocrinology, specifically growth hormone and its effects on the liver and brain. They had an engaging discussion on this topic, which could almost be considered a separate podcast. Additionally, Dr. Weiss recently started a company called Keto, a breath analyzer for acetone, which provides feedback during fasting or following a ketogenic diet. Overall, the podcast offers valuable insights into both cardiovascular disease and endocrinology, with detailed show notes and diagrams to aid understanding.

Even if something seems out of reach financially, taking a chance and bidding the minimum can lead to acquiring a cherished item. The speaker's story of purchasing a Wayne Gretzky hockey jersey despite initial doubts demonstrates this idea. The jersey holds significant sentimental value due to the speaker's early memories of wanting it as a child and the effort put into obtaining it. The conversation piece now brings joy and serves as a conversation starter for visitors. Additionally, the shared passion for hockey and Hopkins University between the speaker and the interlocutor highlights the importance of cherishing personal experiences and connections.

Personal experiences and unexpected circumstances can significantly influence career choices. The speaker grew up around medicine but didn't initially plan to pursue it due to his academic performance. However, a transformative science course in college sparked his interest, and he eventually attended medical school at Johns Hopkins. Despite initially struggling due to the competitive environment, he found it inspiring and went on to do his residency there. The speaker's story highlights the importance of embracing challenges and discovering one's strengths in unexpected places.

Personal experiences and opportunities, beyond just academic rankings, played a significant role in shaping one's decision to attend a particular medical school. The speaker, who ultimately chose Stanford over Hopkins, highlighted the impact of growing up in California and having memorable experiences during medical school, such as Sunday school with renowned surgeons. Medical residencies in the 90s were demanding, with long hours and frequent call shifts, but the speaker looked back on these experiences fondly. The speaker's interest in cardiology was sparked during medical school by encountering patients with myocardial infarctions who had no apparent risk factors. These experiences, combined with family background and personal preferences, influenced the speaker's decision to pursue cardiology.

The speaker's experience in a neuroscience lab during his formative years played a significant role in shaping his career path towards adult cardiology. The debate around the cause of heart attacks was ongoing in the past, with some believing that clots were present before death and others believing they were formed after. It wasn't until the late 1970s and early 1980s that Michael Davies' research proved that clots were the primary cause of most heart attacks, leading to the development of treatments like aspirating clots using a suction catheter. The speaker emphasizes the importance of understanding the history of cardiology to appreciate the advancements made in the field. In summary, the speaker's personal experience and the historical context of cardiology research contributed to his career choice and deepened his understanding of the field.

The cause of a heart attack is not the plaque buildup itself, but the exposure of a protein called tissue factor carried by macrophages, which triggers the clotting cascade. This was a groundbreaking discovery that happened in the late 1980s, and it revolutionized our understanding of heart attacks. Prior to this, it was believed that the contents of the plaque, such as lipids and inflammatory cells, were the direct cause of heart attacks. However, it is the interaction between the tissue factor and the blood that leads to the formation of a clot. The body has a delicate balance between pro-coagulant and anti-coagulant factors to prevent excessive clotting and maintain the health of the circulatory system. Understanding this evolutionary perspective provides valuable insights into the complex mechanisms of heart attacks and the importance of maintaining this balance.

Chest pain is a serious symptom that can indicate a heart attack. During a heart attack, a ruptured plaque can lead to a clot, blocking blood flow and causing damage to the heart muscle. The diagnosis of a heart attack used to be based on the presence or absence of a Q-wave on an electrocardiogram (ECG), which indicates transmural cell death. However, not all heart attacks present with a Q-wave, and the diagnosis in such cases was based on chest pain and positive biomarkers, such as creatine kinase (CK), in the blood. The ECG remains a fundamental tool in diagnosing and treating heart attacks, and while diagnostic criteria have evolved, it continues to play a crucial role in healthcare.

Stable angina and unstable angina differ in their underlying pathophysiology. Stable angina is caused by an imbalance between myocardial oxygen supply and demand, specifically due to the inability to dilate the target lesion and increase blood flow to the affected area during periods of increased demand. Unstable angina, on the other hand, is caused by plaque rupture and incomplete blood flow blockage. The symptoms of stable angina, such as chest pain and shortness of breath, are relieved with rest or medication, while unstable angina can lead to more serious complications, including heart attack. It's important to note that most Western adults will have some degree of coronary disease by the age of 50, but the majority of them will not experience symptoms until the blockage reaches approximately 70% diameter stenosis. This is also the point where stress tests can begin to detect coronary disease. Understanding the differences between stable and unstable angina is crucial for effective diagnosis and treatment.

The presence of a Q wave or ST elevation in an EKG does not definitively predict the severity or imminent danger of a heart attack. The evolution of diagnostic terminology over the past few decades has led to the distinction between ST elevation myocardial infarction (STEMI) and non-ST elevation acute coronary syndrome (NSTE-ACS), but these categories may overlap. Michael Davies' research showed that fatal plaque ruptures could occur in arteries with less than 50% stenosis, and someone with a 95% stenosis is not necessarily at imminent risk. The ability to predict which plaque will rupture and cause a fatal heart attack remains a challenge, and advancements in diagnostic tools are needed to improve risk assessment. The standard of care for STEMI is to open the affected artery as soon as possible through a combination of pharmacology and manual intervention, while NSTE-ACS is managed with medications and close monitoring. The distinction between these categories is important for determining the appropriate treatment, but the overall prediction of which patient will have a fatal heart attack remains elusive.

The presence or absence of ST elevation in an Electrocardiogram (ECG) is crucial in determining the severity and response to treatment for Acute Coronary Syndromes (ACS). ST elevation indicates a more severe condition, such as ST elevation Myocardial Infarction (STEMI), which requires immediate intervention, including activating the cath lab and administering medications like heparin, aspirin, and clopidogrel. On the other hand, non-ST elevation ACS, which can present with depressed ST segments or other abnormalities, may not trigger an immediate response but still requires careful evaluation and treatment. The focus on expediting care, as demonstrated in trials like the Timmy trials, has led to improvements in door-to-balloon times and overall patient outcomes. When a patient arrives at the hospital with suspected STEMI, the ER or even paramedics can make the initial call to activate the cath lab team, significantly reducing delays and potentially saving lives.

The process of angioplasty and stenting to treat heart conditions is a mechanical solution that involves threading a catheter through the body to reach the blocked artery, then using various tools like balloons and stents to open the artery and keep it from collapsing again. This process is more precise and effective than using chemical solutions like clot-dissolving drugs, which can have unintended consequences by disrupting clots in other parts of the body. The development of stents in the 1990s was a significant improvement in maintaining artery openings and reducing the risk of recurring blockages. However, it's important to note that these procedures have limitations and are not always the best solution for every patient or situation. The choice between mechanical and chemical interventions depends on the specific condition and individual patient factors.

During the 1990s, a major issue with the use of coronary stents was the problem of restenosis, or the re-narrowing of the arteries after the stent was implanted. This was caused by the body's reaction to the injury of the stent deployment, resulting in the formation of scar tissue. To address this issue, researchers turned to drugs that inhibit mTOR, a protein known for its role in cell growth and proliferation. By painting the outside of the stent with these drugs, they were able to block the proliferative process of cells making scar tissue, effectively eliminating the problem of restenosis for the most part. However, in the early 2000s, drug-eluting stents were briefly taken off the market due to concerns about their safety and delivery, but they eventually returned and resumed their market dominance. Another major issue during this time was the clotting of stents, which was a significant problem in the early 1990s and led to various trials using blood thinners like aspirin and warfarin to prevent this issue. Despite these challenges, the development and refinement of drug-eluting stents marked a major advancement in the field of interventional cardiology.

The use of medications like aspirin and warfarin, which act on different parts of the blood clotting process, revolutionized interventional cardiology by making it safer to perform stent procedures. However, these early treatments had limitations and risks, leading to the development of newer drugs like ticlopidine and clopidogrel (Plavix). These drugs, known as thienopyridines, work by blocking a receptor on platelets and making them less sticky, reducing the risk of stent clotting. This discovery was transformative, but it also led to new challenges, such as subacute and late stent thrombosis. These complications occurred when patients stopped taking their medication, and they could be life-threatening. Research later revealed that these drugs also inhibit the growth of endothelial cells, which are essential for preventing blood clotting. The body naturally regenerates endothelial cells around the stent, but if this process is disrupted, it can lead to dangerous complications. Today, patients receive a year's supply of Plavix after getting a stent to minimize the risk of these complications. Understanding the complex interplay between these medications, their mechanisms of action, and their potential risks and benefits is crucial for providing optimal care for patients undergoing stent procedures.

Effective communication about the importance of taking prescribed medications, particularly Plavix after a stent procedure, is crucial for preventing complications like stent thrombosis. In the past, the understanding of interventional cardiology and the best course of action for patients with stable angina was less clear. In the 1980s, patients were given nitric glycerin and beta blockers, but these were not ideal solutions. With the advent of stents in the mid-1990s, the focus shifted towards revascularization, and the use of bypass surgery, specifically Lima to LAD (left internal mammary artery to left anterior descending artery), became a more durable and effective option. However, it was only suitable for a specific subset of patients, and the survival benefit was not universal. The development of newer generation drug-eluting stents with a longer duration of effectiveness and fewer complications has led to the general consensus that taking Plavix for six months after a stent procedure is essential. Effective communication about this necessity is vital to prevent potentially life-threatening complications.

During the mid-90s, the cardiology community considered rotarooter procedures, which aimed to open up blocked arteries instead of bypassing them, as a reasonable hypothesis based on the success of bypass surgery. However, it's essential to define the intended benefit: symptom relief versus mortality extension. While some procedures showed mortality benefits, most were used for symptom relief. The advent of stents and statins coincided during this era, and interventions that improved quality of life, even without extending life, were considered valuable. When diagnosing a heart attack, STEMI patients with ST segment elevation and chest pain require immediate hospitalization, while non-STEMI patients with chest pain, positive troponin, and normal EKGs are managed medically or through interventional cardiology, depending on hemodynamic stability. Complicated non-STEMI patients, who are hemodynamically unstable, may also go to the cath lab. In essence, the focus should be on providing relief from symptoms and improving quality of life, even if it doesn't extend life, as these benefits can significantly impact a patient's daily life. The stent era's arrival, along with statins, emphasized this idea.

The ORBITA trial, published in 2017, challenged the long-held belief that opening blocked arteries through stenting provides additional heart benefit beyond symptom relief for patients with stable angina. The trial, which was designed to compare maximum medical therapy to stenting, did not find a significant difference in heart outcomes between the two groups. This shift in understanding adds complexity to decision-making in managing stable angina patients, emphasizing the importance of aggressive medical therapy and individualized treatment plans.

A landmark study from 2007 called COURAGE challenged the widespread use of coronary artery stents for stable angina patients. The study showed no difference in hard outcomes between patients who received stents and those who received optimal medical therapy alone. This was a significant shift in cardiology, as stenting was a common practice at the time, even for asymptomatic patients. The study led to a reevaluation of the role of stents in symptom management and emphasized the importance of optimizing medical therapy before considering invasive procedures. Ten years later, a study called ORBIT was conducted to investigate whether stents were actually reducing symptoms in patients. ORBIT was the first sham-controlled, randomized, blinded trial in virtual cardiology. The trial demonstrated that stents did not provide any additional symptom relief compared to optimal medical therapy alone. These findings further emphasized the importance of medical therapy in managing stable angina and reaffirmed the role of stents as a secondary option for symptom relief when medical therapy fails.

The design and power of clinical trials play a crucial role in determining their outcomes. The discussion centered around a small study that investigated the effectiveness of optimized medical therapy versus a stent for managing angina. The trial was criticized for being underpowered, leading to conflicting conclusions. While some reported that stents didn't reduce symptoms or risk of heart attack, others emphasized the importance of medical therapy. The study highlighted the significance of designing trials with appropriate power based on expected outcomes. It also underscored the importance of medical therapy in managing angina symptoms before considering invasive procedures like stenting.

The use of stents and related medications is a complex process with ongoing implications. As a cardiologist, it's our responsibility to optimize the use of these treatments, but we must also be prepared to adapt if necessary. The nature of science means that facts and knowledge are constantly evolving, and we must stay humble and open to new information. For patients, this can mean that what we recommend today may change tomorrow. It's essential to understand that this uncertainty is a natural part of the scientific process, and it's what makes it so exciting. In the context of cardiology, this means staying informed about the latest research and advancements, such as the ongoing debate around calcium scores versus CT angiograms and heart flow. Ultimately, the goal is to provide the best possible care, balancing the need for aggressive intervention with the potential risks of over-management.

As a preventive cardiologist, making individualized decisions for patients based on their specific risk factors and needs can be challenging, as current tools and clinical trials often focus on averages. The speaker emphasizes the importance of remaining humble and open to new information, incorporating new tests, and considering the context of each patient's unique situation. Evidence-informed medicine, which takes into account both clinical evidence and individual circumstances, may be a more effective approach for making complex preventive healthcare decisions.

Being a preventive cardiologist involves making judgement calls based on both science and art, as there is often a lack of clear outcomes unless there is failure. The use of tests like CAC and CTA can help inform decisions, but their role in screening is still controversial. These tests are most appropriate for individuals in the intermediate risk category, and their utility in low and high-risk populations is less clear. The goal is to include patients as partners in making these decisions and to communicate effectively. The science and art of preventive cardiology require a balance between following guidelines and being open to individualized approaches based on patient history and anecdotal experiences.

Coronary artery calcium scans, also known as SCORE, provide valuable information for determining the aggressiveness of medical therapy, particularly for individuals in the intermediate risk category. The scan quantitatively measures the amount of calcium in the arteries, which is an indicator of plaque buildup. A calcium score of zero does not necessarily mean perfect arteries, especially for younger individuals. Conversely, a zero score in older adults can be quite informative. The test is most valuable for young people with calcification and older adults without calcification, as it provides important context for assessing heart attack risk. Age is the greatest risk factor for heart disease, and a calcium scan can help provide additional information beyond traditional risk factors. Ultimately, the scan helps doctors make informed decisions about the use of statins and other medical interventions.

While traditional risk factors like family history, lipid levels, and age are important indicators of cardiovascular disease risk, there are some patients whose stories and additional tests like calcium scores reveal a higher risk that may not be captured by these factors alone. These patients, who may not even be in the 80th percentile by traditional metrics, can still be at the 99th percentile in terms of risk. The calcium score, while helpful, can be difficult to interpret due to the lack of clear age cohorts in studies. CT angiograms, on the other hand, provide both anatomic detail and information on soft plaque or injury to the artery that hasn't yet reached the point of calcification. In the field of primary prevention, these tests add valuable information, but the interpretation of the data remains more art than science.

CT angiograms and calcium scores provide valuable information for assessing cardiovascular health, but their utility and cost vary. CT angiograms offer detailed images of the heart and blood vessels, allowing for the detection of plaque buildup and narrowing, even before it significantly affects blood flow. On the other hand, calcium scores indicate the amount of calcium deposits in the walls of the arteries, serving as a predictor of future cardiovascular events. The combination of both tests can provide a more comprehensive understanding of a patient's cardiovascular health. However, the cost of CT angiograms is significantly higher than calcium scores, and their coverage by insurance may vary. While the radiation exposure is a concern, it is relatively low compared to historical levels. Ultimately, the decision to undergo these tests depends on the individual's risk factors, age, and the judgment of their healthcare provider.

Non-invasive heart flow analysis, offered by companies like HeartFlow, is a promising tool for measuring the severity of coronary artery blockages using CT scans. This technology, which is based on the idea that velocity across a narrowed artery increases and creates a pressure gradient, can help inform decisions about whether or not to perform invasive procedures like angiograms and stent placements. The technique was first developed using invasive methods, such as intravascular ultrasound and fractional flow reserve (FFR), which measure pressure before and after blockages. Large studies, like FAME and FAME 2, have shown that using FFR to determine the degree of blockages can improve patient outcomes by guiding the use of stents. However, these methods require invasive procedures, making non-invasive alternatives, like heart flow analysis, attractive. By analyzing CT scans, heart flow analysis can provide a non-invasive FFR (CTFFR) measurement, allowing for more convenient and less invasive decision-making. Despite some controversy and ongoing research, this technology has the potential to significantly impact cardiology practice by reducing the need for invasive procedures and improving patient care.

The addition of heart flow studies to preventative cardiology may not be a significant game changer at present. The value it brings to individual patients or doctors is unclear, and the business argument for cost savings through reduced catheterizations is not convincing. However, the conversation pivoted to an intriguing discussion about sex differences in cardiology. Men and women may have evolved differently regarding the clotting system due to their respective roles in hunter-gatherer society. Women, who historically carried pregnancies and had menstruation, may have evolved to prioritize protection over their offspring, resulting in a lower immune response, lower inflammatory response, and a lower prothrombotic response. This could explain why women are less susceptible to cardiovascular disease, despite having lower blood pressure and less iron. These findings, which were supported by research in mouse genetic models, suggest an exciting area for further exploration in preventative cardiology.

The sexual dimorphism of gene expression in the liver of mammals, including humans, is not driven primarily by sex hormones but rather by a dimorphic pattern of growth hormone secretion. Males have a more pulsatile pattern, resulting in longer intervals between growth hormone pulses, while females have a more continuous secretion. This difference in growth hormone secretion can be reversed by administering exogenous growth hormone, leading to a change in gene expression signature. This discovery was made by studying the regulatory mechanisms of sexually dimorphic gene expression in the liver, which led to the identification of growth hormone as the primary driver. This finding challenges the common belief that sex hormones are the primary determinants of sexually dimorphic gene expression and opens up new avenues for understanding the complex interplay between growth hormone and sex hormones in regulating physiological processes.

The liver's production and export of triglycerides are regulated by growth hormone and insulin-like growth factor one (IGF-1). Specifically, growth hormone signaling in hepatocytes leads to the production of IGF-1, which circulates in the blood and acts as a biosensor for growth hormone levels. When growth hormone signaling is blocked, IGF-1 levels fall, leading to increased growth hormone secretion and acromegaly, but selective growth hormone resistance in the liver. This resistance results in an accumulation of fat in the liver, leading to non-alcoholic fatty liver disease. The discovery of this relationship was made through the observation that knocking out Jack two, a key component of the growth hormone signaling pathway, led to a complete shutdown of circulating IGF-1 and a 25-fold increase in liver fat. This finding highlights the importance of understanding the complex interplay between hormones and metabolic pathways in the regulation of liver function.

The effects of growth hormone on fat accumulation in the liver are not just about high growth hormone levels, but also about those levels acting on peripheral tissues. Researchers discovered that a molecule called CD36, which facilitates fat uptake, was upregulated in animals where they knocked out JAK2 in hepatocytes. By blocking both JAK2 and CD36, they were able to nearly normalize the fat accumulation. However, they also found that blocking the growth hormone signaling pathway in adipocytes reduced lipid in the liver, suggesting that the defect is in turning off endogenous glucose production from the liver, rather than an insulin sensitivity issue. This discovery led to a long-term research journey into how growth hormone regulates insulin sensitivity and insulin glucose homeostasis through the adipose tissue. A historical figure who inspired this research was Bernardo Houssay, the first Latin American to win the Nobel Prize, who made remarkable contributions to the field in the 1930s.

Growth hormone and insulin, two seemingly distinct hormones, have a complex interplay in regulating blood sugar levels. Early experiments showed that removing the pituitary gland in animals made them more insulin sensitive but prone to hypoglycemia, while removing the pancreas made them better tolerate hyperglycemia. Later studies confirmed this relationship in humans, leading to the use of pituitary removal as a treatment for brittle type 2 diabetes, despite the risks and complications. The ultimate cause of this effect is believed to be the convergence of the insulin and growth hormone signaling pathways at the mTOR molecule. IGF-binding proteins, which are also produced in the liver, play a role in this regulation but add an extra layer of complexity to the relationship between IGF, insulin, and growth hormone, making the study of their effects on longevity a topic of ongoing research and debate.

The relationship between Insulin-like Growth Factor-1 (IGF-1) and health is complex. While IGF-1 has been linked to increased longevity and reduced risk of certain diseases like Alzheimer's and cardiovascular disease, it also increases the risk of other diseases such as cancer. The human genetics and animal studies suggest that excess GH signaling, including the absence of GHR in the liver, can lead to increased lifespan but also comes with health issues like being short and having a high body fat percentage. On the other hand, individuals with Loraine Syndrome, who have a decrease in GH signaling, have a decreased risk of metabolic diseases like type 2 diabetes despite having a high body fat percentage. The protection conferred to these individuals is thought to be due to improved insulin sensitivity. The paradox lies in the fact that these individuals have normal glucose levels but are highly insulin sensitive, which is still not fully understood. Ultimately, the role of IGF-1 in health and longevity is a complex one, and further research is needed to fully understand its effects.

While growth hormone is known to have negative effects on metabolic diseases, cardiovascular disease, and cancer from a metabolic standpoint, its role in neurotrophic functions is less clear. The condition Laurent Syndrome, which results in less GH production, has been linked to a decreased risk of these diseases, but it's unclear why these patients don't experience a survival advantage. The connection between insulin and IGF, which are also pro-oncologic or pro-tumor, and their neurotrophic roles is complex and not well understood. The ongoing debate about the role of insulin in cardiovascular disease and the use of growth hormone, particularly in athletes, highlights the need for further research into the complex regulation of these hormones. Ultimately, while there is evidence suggesting that too much GH can be harmful, the full picture is much more nuanced, and the potential benefits and risks of manipulating these hormones warrant careful consideration.

While Growth Hormone (GH) therapy may help improve physical appearance and muscle mass, there is currently no conclusive evidence that it increases longevity. For those considering GH therapy, it's essential to understand the potential risks and benefits. The speaker suggests that further investigation is needed, particularly in the area of cognitive impairment and IGF levels. IGF levels can be significantly affected by nutritional interventions, such as fasting or a ketogenic diet. During a water-only fast, IGF levels can drop below normal levels and take about six weeks to return to normal. The relationship between GH and IGF during fasting and their impact on longevity is still an open question. The speaker also mentions the possibility of selective GH resistance in the liver and other tissues, which could explain the apparent paradox of increased GH levels and decreased IGF levels during fasting. Overall, more research is needed to fully understand the role of GH and IGF in the context of fasting and their impact on aging and health.

Communicating the excitement and importance of science effectively to people, especially at a young age, is crucial for increasing scientific literacy and understanding. The lack of scientific training among lawmakers and the trend towards early specialization in education are concerns that highlight the need for making science more accessible and interesting. Scientists have a responsibility to communicate complex concepts in an engaging way, and initiatives like podcasts and educational videos can help achieve this goal. Additionally, providing opportunities for individuals to experience science firsthand, regardless of their intended career path, can broaden their understanding and appreciation of scientific concepts. By addressing these challenges, we can foster a more scientifically literate society, enabling individuals to make informed decisions and navigate the world around them.

The current education system in medical and graduate studies has led to a lack of understanding of physiology and medicine among students, particularly medical students. This lack of foundational knowledge may hinder their ability to work in research labs later in life. The speaker, who didn't have a strong scientific background but developed a successful career in both clinical work and entrepreneurship, emphasized the importance of understanding behavioral science and behavioral economics in addressing health issues like obesity. The speaker also shared his experience starting a company to provide real-time, actionable information to help people change their behavior and make healthier choices. Overall, the conversation highlighted the need for a more holistic education system that emphasizes both scientific knowledge and practical application.

A new company named K-E-Y-T-O is revolutionizing the health industry by providing individuals with a portable, accurate ketone sensor and accompanying app to help guide and reinforce behaviors related to the ketogenic diet. The sensor aims to replace some of the human intervention required in programs like Verda, making it more economically feasible. The company's mission goes beyond just the ketogenic diet, offering information and resources to help individuals succeed. The sensor, which went from prototype to market in just three months, is a fun and exciting new venture for the founder, who has spent the last ten years combining clinical work and lab research at UCSF. Follow K-EY-T-O on Twitter @ETH and @JYs for updates.

Social media platforms like Twitter can be valuable tools for increasing scientific literacy and staying informed about research in various fields. Dr. Peter Attia shared his personal experience of using Twitter to engage with experts, learn about new studies, and connect with like-minded individuals. He emphasized the importance of curating a network of trusted sources to filter through the noise and stay updated on relevant information. Despite the negative public perception of Twitter due to issues with politics and fake news, Dr. Attia finds the platform more positive than negative in his own experience. He encourages listeners to use social media responsibly and seek professional medical advice for any health concerns. Additionally, Dr. Attia invites listeners to follow him on Twitter, Instagram, and Facebook, and sign up for his weekly email newsletter for updates on his work and interesting papers related to longevity, science, performance, and sleep.