#085 Dr. Peter Attia on Mastering Longevity – Insights on Cancer Prevention, Heart Disease, and Aging
Podcast Notes Playlist: Fitness
The Benefits of Hormone Replacement Therapy for Women
This chapter discusses the potential benefits of hormone replacement therapy (HRT) for reducing the risk of Alzheimer's disease, heart disease, and cancer. It explores the impact of HRT on bone mineral density (BMD) and the need for further research. The speakers also touch upon the importance of personalized treatment and the potential use of an FDA approved intranasal testosterone spray for women's libido.
Key Takeaways
- “The healthier an individual is, the more they can rely on their mitochondria for ATP generation under increasing demands of the cell. This is one of the hallmarks of health.” – Dr. Peter Attia
- Spend good time training in Zone 2; this means a rate you can hold a conversation and form sentences at, but really don’t want to
- For many, rate of perceived exertion is an accurate measure
- Maffetone heart rate is a helpful target: take 180-age for target HR
- Four things are causal risk factors for atherosclerotic cardiovascular disease: (1) ApoB; (2) insulin resistance; (3) hypertension; (4) smoking
- Statin use is inexpensive, accessible, and effective but “If money were no issue, you’d probably just be on PCKS9 inhibitors, ezetimibe, and bempedoic acid.” – Dr. Peter Attia
- Tip: don’t skip your eye exams! By looking at the retina and capillaries at the back of the eye, diabetes can be detected earlier
- “Exercise is probably the single most important thing we have at our disposal to increase insulin sensitivity.” – Dr. Peter Attia
- Sleep, energy balance, hormone balance are key as well
- To optimize cardiovascular health and mitochondrial efficiency: start with how much time you’re willing to exercise – then divide that into 80/20 with 80% at zone 2 and 20% at VO2 max
- VO2 max sweet spot is 3-8 minutes with 1:1 ratio of rest to recovery – it takes some time to find how much effort you can put out in this time; it’s slower than a Tabata (20 on/10 off x 8 rounds) but by no means endurance
- “Exercise is probably the single most important thing we have at our disposal to increase insulin sensitivity.” – Dr. Peter Attia
- The difference between normal glucose and type 2 diabetes is just a teaspoon of blood glucose – muscle is the sink for glucose disposal
- Smoking and obesity are the greatest modifiable risk factors for cancer
- Why obesity? It’s not actually the amount of fate cells; it’s likely the inflammatory environment that comes with obesity –the excess fat that spills into areas where fat accumulation is harmful like around organs, in muscle
- Tip: don’t rely on mammograms exclusively, especially if you’re high risk – combine with ultrasound or MRI
- “There has been no greater disservice brought by the medical community onto anyone, in particular in this case women, than the abject failure of the Women’s Health Initiative.” – Dr. Peter Attia
- Hormone replacement therapy started at the onset of menopause will help most women
- Testosterone replacement therapy in men should be based on bloodwork in combination with symptoms – but be conservative, there are side effects for individuals at risk (hair loss, slightly elevated risk of cardiovascular events, acne)
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Peter Attia, MD is a highly respected expert in preventive medicine, focused on the crucial subject of longevity and cardiovascular health. He's also the author of the NY Times best selling book Outlive - which I highly recommend if you have not read it already. Peter's philosophy transcends the conventional goal of merely extending lifespan; it's about enriching the quality of every year, ensuring that each stage of life is lived with optimal health and vitality.
In this episode, we discuss:
- (00:00) Introduction
- (07:36) Defining cardiovascular disease
- (09:43) Coronary plaque and fatality risk
- (13:34) How ApoB predicts heart disease
- (21:34) Factors elevating ApoB
- (27:23) Does high ApoB cause cardiovascular disease
- (37:01) ApoB thresholds for ASCVD prevention
- (40:27) Dietary factors raising ApoB
- (49:33) Genetics of ApoB and LDL
- (53:24) Does low LDL increase cancer?
- (56:19) Cholesterol-lowering drugs
- (59:59) Statins, uses, and side effects
- (1:03:12) Are statins toxic to mitochondria?
- (1:09:56) Ubiquinol for statin-induced muscle soreness
- (1:11:09) How to train in zone 2
- (1:17:09) Statins and neurodegenerative disease risk
- (1:21:54) Cholesterol synthesis in the brain (desmosterol role)
- (1:25:58) Statin alternatives
- (1:36:49) Berberine for CVD Risk Reduction?
- (1:39:36) Muscle as a glucose sink
- (1:51:38) Hemoglobin A1C Levels and Mortality Data
- (1:55:35) 80/20 Zone 2/VO2 Max Training Protocol
- (2:02:12) Insights from VO2 max testing data
- (2:12:17) How obesity increases cancer risk
- (2:15:03) Cancer screening
- (2:40:32) Menopause – hormonal shifts and health effects
- (2:45:13) Hormone replacement therapy (HRT)
- (2:58:57) Perimenopause diagnosis with hormone levels
- (3:02:04) HRT's impact on dementia, cancer, and heart disease risk
- (3:07:42) Vitamin D
- (3:16:24) Testosterone replacement for women's sexual function
- (3:18:47) HRT safety 10 years post-menopause
- (3:23:05) Testosterone & TRT
- (3:32:33) Blood pressure
- (3:45:30) Peter's longevity optimization routines
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