ApoE4/4 - Should I prioritize being in ketosis or prioritize protein consumption for muscle health?
Hi Dr. Attia - Thanks for all you do to get good, science-backed ideas into your listeners hands. I’m a 48 year old female who is ApoE4/4 (both my parents are alive and both have Alzheimers). I received my genetic status in mid-2019. I’m a life-long competitive athlete (swimming, running, triathlons, and mountain biking) who has always had an interest in health so I it did not take much for me to pivot to the behavior changes needed to support my longterm cognitive health. I began using time-restricted eating (16-18 hours/day fasting) and also shifted my diet so I am in ketosis most of the time. In the last year, I’ve really begun to see how my base of endurance training needs to be enhanced with regular strength training (not something I’ve ever prioritized). I know that I need to increase my protein to support muscular repair and growth, but I can’t increase my protein without kicking myself out of ketosis. I’m curious what you’d suggest — it is better for someone who is 4/4 to be in ketosis and not optimize around muscle strength? Or better to just keep sugar/carbs very low, not maintain ketosis, and eat enough protein? Or cycle in/out of ketosis around strength training days? I’ve been struggling with this for several months and I haven’t been able to find a satisfactory answer. Thank you!
Bone Health
In the book "Great Bones: Taking Control of Your Osteoporosis" by R. Keith McCormick, DC (March 2023) there are 13 pages explaining the 8 most common errors in the interpretation of bone Dexa scans. With such unreliability of those scans, wouldn't it be better to rely on the Bone Quality tests as well as the blood bone markers (CTX + PINP) in evaluating a person's bone health? So many doctors involved with treating osteoporosis or osteopenia seem unschooled in the complete picture of bone health.
Osteoporosis & Osteopenia
There are a fair number of postures and movements and exercises that are NOT good for those of us with osteoporosis (or osteopenia) that a podcast on the subject would be of value. It took me a full year to find help in that area (thanks to Margaret Martin, P.T). Stability & balance & knowledge of why certain postures & exercises are risky for those with questionable bone health are key and it would be great if a Drive podcast would cover the various aspects of it.
Total cholesterol and all-cause mortality by sex and age: a prospective cohort study among 12.8 million adults
There is a medical publication form 2019 which is cited often in the non-lipid hypothesis circles, which shows a U-shape for all cause mortality vs total cholesterol. Interestingly, the lowest hazard ratio is when TC is around 200-210, and reductions below this increased mortality. Can anyone point to if Peter has ever addressed this? or are there reliable unbiased Pubmed articles which discuss how this is possible? Here is the study: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367420/