Strategies and Tools for Achieving Medicine 3.0

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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Show notes are available by clicking here

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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