#085 Dr. Peter Attia on Mastering Longevity – Insights on Cancer Prevention, Heart Disease, and Aging
Podcast Notes Playlist: Fitness
00:00
CT Angiogram for Assessing Plaque Accumulation
The chapter discusses the use of CT angiogram as a method to assess plaque accumulation in arteries and the vascular system. The speaker explains that the decision to order a CT angiogram should be based on whether the test results would change the management of the patient.
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Found My Fitness - Rhonda Patrick
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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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