Hand Osteoarthritis Ouch!
Hi Peter I am a big fan of yours and so I want to thank you first for all I have learned from you! To be honest you have turned my life around in many ways. So I am a psychotherapist by day and a sculpture, guitar player, hands on person the rest of the time. My way of balancing things I guess. I am sure over the years I have over done working with my hands. When I was in a band I built a dining room table in the shape of a guitar. Lots of using tools in my studio. But I have recently been diagnosed with Osteoarthritis in my right thumb, base of thumb towards wrist. Im told it is severe loss of cartilage and that it will only get worse as I age. I have been very active but now can't do weight training without worrying I am making this worse. I got a shot which didn't work. I am seeing a hand OT but keep getting the news there isn't much we can do with this. I read that both Metformin and Berberine help but only if you are willing to chance losing muscle growth as a side effect. I don't want to do surgery because it can lower range of motion and maybe something better will come down the pike. Radiation? Where should I go. Would you do recommend this? Seems like everything else can be replaced but not your hands. I do hand exercises but it doesn't help much. I have been told to stop yoga because downward dog/ push ups are bad for the place that is where my thumb meets my wrist. I am really looking for some hope so when I do exercise and use my hands I don't have to worry that while I am making my arm muscles stronger I am making use of my hands worse in the future. I have been carrying 10 -15 lb kettlebells when I walk the dog for about 20 mins every other day. I also walk with a ruck pack which doesn't hurt my hands. I am a very motivated person but not sure what to do next. I am working on improving my metabolic health as my sugar is at prediabetic level which is why I thought Metformin might help. Is it worth he trade off of possibly losing other muscle growth. I am following my sugar on a GCM. I get mixed messages but not sure if I get my sugar down will my arthritis go away or change at all. My hand hurts often and I try not to take Ibuprofen very often. I guess I am fearful this will only get worse. Everything else I study seems to have clear outlines on what to do to help. Like knee arthritis. But this one seems to not get addressed much and the news doesn't seem very promising. I mostly want to know what you would do if you were me? Thank you again
Processing and interaction of Supplements (especially Magnesium)
My initial question is how fat is processed, where in the body it ends up and interacts with other substances – in the stomach, the bloodstream or in cells – and how long it stays in each place and is available for such interactions. I´m talking about normal daily processing, not superfluous fat resulting in weight gain. I´m trying to find out how fat helps in the absorbtion of various elements and compounds, particularly vitamin D, which is fat soluble rather than water soluble. How soon after eating a fatty substance may one still get the benefit from it for absorbing Vitamin D? Does vitamin D from sunlight mean we don´t have to worry about fat? How much sun exposure would be necessary? I have read that it doesn´t have to be bright sun, that even on cloudy days one can get the necessary light exposure. Lets say its a cloudy winter day and someone walks 20 minutes each way to school or work. Only their face will be exposed. Is this enough? I am concerned about absorbtion/metabolizing of vitamin D because I understand that it is required for the absorbtion of both Calcium and Magnesium (in fact the calcium pills I take at the instruction of my doctor also contain vitamin D). However, I have also read that magnesium is required for metabolizing vitamin D, and that calcium can prevent the proper absorbtion of magnesium – and vice versa. Yet there are pills which contain both magnesium and calcium. Which, if either, of these statements is accurate? In what relative order and at what times should I take these supplements to get maximum advantage from them? With or without food? Likewise, internet sources say both that L-theonine works with caffeine to increase concentration and that it 'cancels out´ the stimulant effects of caffeine. Which is correct? Does it have any experimentally supported effects? Related questions Does vitamin C and/or citric acid influence on any of the above? I tend to get vitamin C in the form of fizzy tablets which contain citric acid – but maybe that´s what vitamin C is? Would it be preferable to eat, say, a red or green pepper or some cantelope? Calcium – is said to decrease stomach acid so should not be eaten with meals as it causes problems with digestion. In fact, the bottle says to take it with food. Which is correct? I have been taking it with meals forever with no problems. 350 mg. caplets of magnesium glycinate seem to have caused a certain amount of stomach gas. Could I cut them in half and/or dissolve them in water, which I would then drink at two different times, say with breakfast and dinner? I want to minimize liquid intake after about 7 PM to avoid waking up to pee in the middle of the night. I have read that, in any case, it is best to get properly hydrated within the first ten hours after waking, so I tend to drink a lot of water early in the day. I note in passing that taking magnesium seems to result in a thickening of nasal mucus. It this a recognized side-effect? What about caffeine? Coffee, tea, pepsi? Which really has more caffeine, green tea or black? And alcoholic drinks - beer, wine, stronger stuff? Can one take one‘s supplements with these instead of water? (Don´t laugh, please. Relaxing with a glass of wine or beer at the end of the day might be the perfect occasion for one supplement or another. With a bit of cheese if one needs the fat for vitamin D absorbtion.) I am particularly concerned that my caffeine consumption, 3-5 cups of coffee or the equivalent in tea of pepsi, before noon, may cancel out the effects of the magnesium or calcium I would take at breakfast and/or lunch time. Also I understand that caffeine ‚cancels out‘ vitamin C consumed at the same time – so it is pointless to drink orange juice at breakfast if one is going to drink coffee at the same time. Please also comment on other factors that may be relevant. Gender or age, for example. I´m a 72 year old female. I´m not looking to extend longevity, I simply want to be able to be enjoy whatever time I have left. I´m looking for quality, not quantity! And a final post-script. I have heard that various substances in coffee, and also L-theonine in tea, are quite good for you in certain ways – but then there´s the caffeine! Decaf coffee and tea will have much less caffeine (but, I understand, not absolutely zero.) How do they get the caffeine out? Is it a chemical process that may result in even worse problems? I´m going to send these questions to Chat GBT, but am sending them to you because the best computer by far is still the (knowledgeable) human brain. Here´s the summary: I want to get the maximum advantage from magnesium (350 mg) and calcium (2 tablets, 600 mg. plus 20 mcg of vitamin D ) supplements. When, how, and how often would it be best to take these supplements, and why? Please provide bibliography.
CBTI (cognitive behavioral therapy) - Ashely Mason podcast.
The podcast with Dr. Ashley Mason was terrific, but could we have a follow-up - Part 2? As Dr. Mason noted, she has gone through the behavioral part of CBTI in detail but not so much the ‚therapy‘ part – changing one´s mindset with regard to sleep – nor how to prevent relapses. The book she recommended is also skewed in this direction. Following the behavioral guidelines she and it suggest is indeed brutal but can be done . . . but for how long? Where does one go from there if one is still (for example) waking up for two hours in the middle of the night after three weeks? How DOES one prevent relapses? (After confining my bed-time to a total of 6 hours, I did not end up sleeping for 5.5, but only 3.5-4.5, for a period of about 2 weeks. I don´t live in California but my wait for a therapist is also going to be long.)
Protein - science re impact of quantity
Can Peter discuss studies showing the impact of eating a gram of protein per pound of body weight each day, on maintaining or adding muscle? I’ve heard him say it many times, but what is the science behind it? This is important for a lot us us on Tirzepitide who have trouble maintaining muscle as we lose weight combined with decreased appetite that makes eating enough protein more difficult.
Why doctors don’t recommend Exenatide for type 2 diabetes (See Ralph Defronzo episode 337).
Similar to my question for the same episode (#337) wrt Actos/Pioglitazone Ralph did not address reports that there have been published reports linking exenatide with Pancreatic Cancer. Has the science wrt the safety of exenatide for type 2 diabetes become for settled than it was in 2020?
Doctor reluctance to prescribe Actos, aka pioglitazone, not completely addressed by Ralph Defronzo in Episode 337
In Episode 337 Ralph Defronzo claimed to be mystified about doctors’ reluctance to prescribe Actos (aka pioglitzone). Today I asked my Primary Care Physician why I was not put on a combination regimen like the one described by DeFronzo. My doctor mentioned two concerns: 1) fluid retention - which Ralph addressed and 2) cancer risk which I feel Ralph ignored. A quick google search shows that while the science may not been settled there are reports going back to 2009 of a concern that pioglitzone was connected to an increase in bladder cancer and that the relationship was both strength of dose and length of treatment dependent. More interesting is that Ralph himself is listed as an author of a 2019 article entitled: “Pioglitazone: The forgotten, cost-effective cardioprotective drug for type 2 diabetes” (Diab Vasc Dis Res. 2019 Mar;16(2):133-143. doi: 10.1177/1479164118825376. Epub 2019 Feb 1.) In that paper, the authors claim that a large study showed no relationship between the drug and bladder cancer. At the same time acknowledging, that, nevertheless, the FDA was still promulgating a warning to prescribing physcians. I am assuming that there must be liability risks for Doctors when they decide to ignore a warning from the FDA. Has the science behind the risk of Actos aka pioglitazone become more settled than it was in 2019?
Potassium and high blood pressure
Peter has said he tends to use ACE inhibitors and ARBs first for patients in treating high blood pressure. I'm interested how he thinks about hyperkalemia as a side effect, which is common. All references to potassium I can find in show notes are about increasing it, but on these medications, it can often add to risk of CVD events.
Chronic Sarcoidosis
A very good friend of mine has the auto-immune disease Sarcoidosis. Much longer than 2 years already so its chronic. Had a lot of medication like prednison and Humira (adalimumab). Nothing seems to help him and the research centre in Holland says they got no options left to treat him anymore but still has a lot of symptoms like tiredness, muscle and bone pains, low energy etc. He doesn't take any medications anymore. He only eats food from the farm like raw cheese, eggs, meat and yoghurt. Do you have any research on how to lower these symptoms to improve his healthspan and quality of life? Is strength training beneficial (no activity pas years) or not because of more inflammation. Does he needs more protein also? If you need more information please let me know
Blood pressure monitors
Dr. Attia describes in detail how to measure the blood pressure correctly. My question is if the blood pressure varies so much so one has to sit down for five minutes not talk and not check their phone and be in a certain position to measure it correctly, does that mean that our blood pressure is constantly elevated at all other times? Simply because during a normal day no one sits for five minutes in this particular position in order to measure their blood pressure . Does that also mean that all other devices for continuous blood pressure monitoring such as Aktiia , which I’m planning to buy ( I live in the UK ) are not going to reflect the correct blood pressure as this is a wearable , which means that people are going to be doing their normal daily activities while it’s measuring their blood pressure . Many thanks for your time. I think Dr Attia is one of the most credible doctors in this field and I would like to thank him for making a difference to people’s lives. He certainly has made a big difference to my life in terms of preventative medicine.
APOB reduction vs. elevated ALT/AST liver enzymes
With a family history of cardiovascular disease I have been disciplined about working hard to reduce my long term risk of ASVCD along with the other three horsemen. I'm in good physical condition for my age (53); consistent exercise along with low dose Crestor (5mg) and ezetimibe (10mg) reduced my APOB from 114 to 60. However, my ALT/AST enzymes went from low 20's to low 30's. To test whether Crestor was causal in my elevated ALT/AST I recently started the PSCK9i Repatha and stopped Crestor/Ezetimibe while holding other lifestyle factors constant (best I can figure anyway). APOB went up to 88 while ALT/AST reduced to 21/21. My goal for APOB is <60 and I'm sure I can achieve that with Repatha and low dose Crestor but I'm trying to understand the tradeoff between APOB reduction and ALT/AST elevation. Is there any data or generally accepted thinking around the tradeoffs between reduced APOB and elevated liver enzymes? My (unsubstantiated) hunch is that low 30's ALT/AST is a worthwhile tradeoff to achieve sub-60 APOB, but how do those factors trade off with each other across 30+ years? Thanks so much. I've learned so much from you and your team over the past several years.
Two Questions
Slightly philosophical these ones . . . 1) What is good communication in the modern world? How to communicate in different settings, with adults, with children, with seniors, on the Internet, on Social Media, in relationships, etc. 2) What have been the major events in your life that have made the biggest differences in your changing from a "boy" to a "man?" This could be rites of passage, or psychological or philosophical revelations, relationships, etc.
Zone 2 Exercise and fasted state
This article: https://peterattiamd.com/guide-to-zone-2-training/?_gl=1*nuft6m*_up*MQ..*_ga*ODcyNTY1MjQ0LjE3NDU2MTg5NjE.*_ga_1CG74LFGNE*MTc0NTYxODk2MS4xLjEuMTc0NTYxOTAwNC4wLjAuMA.. discusses the advantage of doing Zone 2 in a fasted state, or after consumption of a high-ft mail, as fatty acids in circulation will be abundant. My question: Do I need to do Zone 2 actually fasted (for a few hours or more), or is it sufficient to wait long enough after a high or mixed-carb meal for the subsequent insulin level to come back down from its post-meal spike. I used a CGM for a month recently, so I have a pretty good idea of how long the spike lasts for me, until I'm back down to baseline.