Beta Blockers and vo2 Max
Hi Dr. Attia. Do you take beta blockers into consideration when determining a patient's vo2 Max and/or make adjustments to the results? Apple added a "feature" to their Watch asking if a user takes a beta blocker or calcium channel blocker. If one of those are checked off, it lowers the vo2 Max estimate substantially. I know it's not a real test but if a beta blocker caused your HR to lower as much at 20 bpm than without, would you leave that setting on or turn it off? Thank you
SGLT-2 Inhibitors and Lactate Threshold
I am a 73 year old male who does 3 x week weights and swim 2300 M every other day. I try desperatly to stay in zone 2, but it is hard. I end up north of there regulary, despite trying to keep my HR down. I have HFpVF (6 years on Chemotherapy) but still manage to stay quite active in the pool, lake, cross country skiing and Mountain biking. I am working hard to stay in zone 2. Somewhere around 120 my lactate readings surge above 2.0. I am on Dapagiflozin. I think this affects the lactate threshold but am not able to find any references regarding that. It is referenced for Metformin but not Dapagiflozin. Does the use of SGLT-2 inhibitors alter lactate threshold values? As I tread my way through the science of all this, I find your experience and scientific basis extraordinary. You have only truth and curiosity to stimulate us. Thank you
Estrogen-dominance in the HPG axis, AI in TRT, Letrozole/Anastrazole Monotherapy for Testosterone Increase
Is it still TRT if one sees estrogenic side effects and has to use an aromatase inhibitor? While the actual assay result might not be "supraphysiologic", its "supraphysiologic" in the context of a specific individual as even in their teens - they are unlikely to have had such testosterone levels as their hypothalamus would've shut off GnRH due to sufficient estradiol. Thoughts on using Letrozole/Anastrazole to tap into testicular reserve (slack in LH) to boost T while keeping E2 constant / minor attenuation. Thoughts on using Anastrazole in obese individuals taking a GLP1 agonist to "hide body fat"(i.e reduce aromatization / virtually carve out an endocrine environment seen in lean individuals from an obese one). Why are trials pursuing myostatin inhibitors over this?
Hope for apoe4 carriers
Hi Dr. Attia, I'm wondering what your perspective is on this article: https://www.apollohealthco.com/a-holy-grail-for-apoe4/ Has your outlook changed in recent times on the promise of Alzheimer’s prevention (and specifically for apoe4 carriers?) Is there any reason to be hopeful? Thank you so much.