Starting TRT, Heart Disease, Longevity, Nootropics, Menopause And F1 - Peter Attia

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Dec 4, 2024

Peter Attia, a physician specializing in preventative medicine and longevity, shares intriguing insights on aging and genetic factors. He dives into the role of epigenetics and methylation, discussing their impact on health and how personalized medicine can revolutionize treatment. He also tackles the complexities of testosterone replacement therapy and hormone optimization, particularly for women. Attia amusingly intertwines these discussions with Formula 1, reflecting on the dynamics of the racing season and personal anecdotes, blending serious health topics with a bit of racing fun.

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INSIGHT

Epigenetics and Aging

Epigenetics, specifically methylation, plays a crucial role in gene expression and cell differentiation.
Methylation patterns change with age and disease, raising questions about their causal role in aging.

INSIGHT

MTHFR and Methylation

MTHFR gene polymorphisms, while common, are often overemphasized in their impact on methylation.
It's more clinically relevant to treat elevated homocysteine levels directly, regardless of genotype.

ADVICE

Target LDL-C Levels

Aim for LDL-C levels in the 20-30 mg/dL range to minimize ASCVD risk, even with other risk factors.
This 'physiologic level' is similar to that of infants and supports normal cholesterol transport.

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🕑 Timestamps:

0:00:00 - 0:13:37 – Epigenetics, Methylation, And Aging

0:13:37 - 0:19:02 – Books That Have Dramatically Impacted Peter’s Life. His Current Career Goals.

0:19:02 - 0:22:42 – Sponsor: Eight Sleep (The Most Impactful Sleep Enhancing Device I Have Ever Used)

0:22:44 - 0:29:50 – AI, And Why Peter Typically Doesn’t Find Tests That Look For Early ASCVD Valuable

0:29:50 - 0:32:12 – Is There An APOB Level That Guarantees No Risk Of Atherosclerosis?

0:32:12 - 0:33:27 – For Those With Hypofunctioning PCSK9 And Extremely Low LDL-C, What Is Their Average Age Of Death, And What Are They Dying From?

0:33:27 - 0:35:06 – How Much Cholesterol Is Needed For Brain Development?

0:35:06 - 0:36:22 – How Lipid Managing Medications Work

0:36:22 - 0:41:16 – How Peter Evaluates The Best Strategy For Managing APOB For Each Patient

0:41:16 - 0:42:39 – Can You Trust Grocery Store Olive Oil?

0:42:39 - 0:44:09 – Is Olive Oil Healthier Than Eating Less?

0:44:09 - 0:47:56 – If You’re Thriving With Bad Lipids, What Should You Do?

0:47:56 - 0:49:34 – Are Statins Evil?

0:49:34 - 0:53:00 – Tests For Targeted Lipid Management

0:53:00 - 0:56:28 – Bempedoic Acid Vs. Statins

0:56:28 - 1:00:03 – Peter’s Multipronged Approach To Lipid Managing Pharmacology

1:00:03 - 1:05:22 – Sponsor: Marek Health (Preventive Medicine, HRT, & Rigorous Blood Work)

1:05:22 - 1:06:45 – Liver Toxicity And NAFLD

1:06:45 - 1:08:57 – Which Statins Are The Most Likely To Cause Side Effects?

1:08:57 - 1:10:49 – Repatha

1:10:49 - 1:14:04 – Will Obicetrapib Obliterate Atherosclerosis?

1:14:04 - 1:17:47 – Medications That Lower Lp(a)

1:17:47 - 1:25:01 – If Someone Has High Lp(a), But Excellent Metabolic Health, Can They Still Develop Premature Heart Disease?

1:25:01 - 1:26:50 – The Reason Why We Develop Plaque In Arteries, But Not Veins

1:26:50 - 1:27:33 – Maintain ≤ 120/80 Blood Pressure To Smash Your Risk Of Heart Disease And Dementia

1:27:33 - 1:28:34 – Is Lower Than 120/80 Better?

1:28:34 - 1:31:49 – How To Fix High Blood Pressure

1:31:49 - 1:34:12 – DEXA Scans And What A “Good” FFMI Is

1:34:12 - 1:36:24 – Is There Any Way To Verify Endothelial Damage?

1:36:24 - 1:38:16 – How Helpful Is A CT Angiogram?

1:38:16 - 1:40:06 – Can You Accurately Detect Plaque Accumulation In Yearly Intervals With CT Angiography?

1:40:06 - 1:43:47 – Why You Can Have No Detectable Inflammation In Bloodwork, But Still Develop Raging Atherosclerosis

1:43:47 - 1:51:24 – Why Peter Is Starting HRT, And What His Protocol Will Be

1:51:24 - 2:00:47 – Women’s Birth Control Options

2:00:47 - 2:05:42 – When Should Women Start HRT?

2:05:42 - 2:15:48 – Optimizing Women’s HRT Protocols

2:15:48 - 2:18:51 – The Prevalence Of Hypothyroidism

2:18:51 - 2:22:09 – When Should You Treat Inflammation With Supplements Or Medications?

2:22:09 - 2:24:48 – Will Cold Plunge Pre-Workout Inhibit Muscle Growth?

2:24:48 - 2:25:43 – Cold Plunge Increases Dopamine As Much As Coke!?

2:25:43 - 2:30:54 – Peter’s Use Of Modafinil, Nicotine, Caffeine, And What He Thinks The Best Nootropic Is

2:30:54 - 2:33:29 – How To Properly Dose Omega-3 Supplements

2:33:29 - 2:38:30 – Sponsor: Gorilla Mind (Innovative Pre-Workout, Nootropic, Performance & Health Supporting Formulations)

2:38:30 - 2:42:33 – What Actually Causes Brain Fog?

2:42:33 - 2:46:36 – How Obesity Impacts Mitochondrial Function

2:46:36 - 2:48:38 – Ideal Daily Magnesium Intake

2:48:38 - 2:51:42 – What Are The Most Important Sleep Metrics?

2:51:42 - 3:22:27 – F1 Talk

3:22:27 - 3:30:26 – Reconnecting Peter Attia With His Long-Lost Obsession... Tearing Phone Books!

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