HDL Cholesterol Uptake Efficiency/Efficacy
I admit to being a bit of an Attia junkie - I started during the depths of Covid trying to find a practical voice between the extreme positions, and I subscribed when I realized how much I could learn without going back to school for an MD. My latest path started with your latest AMA on coronary heart disease and an almost side comment you made about HDL efficacy being the true test of if a given HDL level was good or bad. Are you aware of a test provider offering the following test (or something of similar complexity/cost) to quantify HDL Uptake Efficiency/Efficacy? https://phys.org/news/2017-07-function-hdl-carrier-good-cholesterol.html (By way of background, I started taking statins in my 30’s and graduated over time to better and better statins and higher doses. Now at 40 mg of Rosuvastatin, and while my LDL dropped a good amount, my HDL remained abysmal (low 30’s). Fenofibrate really didn’t work but Niacin not only improved HDL-C but greatly improved both LDL-P and HDL-P. I was one of the people whose LDL-C was good and my early PCPs thought was under control until my last PCP tested particle count via NMR. I know of potential risk of insulin resistance with Niacin, but that has remained the regimen for the last 4+ years. Mitigating that risk via Vitamin K, cinnamon, and ~10/14 IF (you sound less sold on IF save for impact of calorie restriction, but my own CGM testing seemed to show a positive impact on glucose metabolism) Now looking to test ApoE thanks to you. My calculated ApoE based on formulas in literature is below 5th percentile but I want to see how well my HDL is working and whether my HCL-C of 87 is a sign of goodness, or masking a continuing problem due to HDL uptake inefficacy. Would love to know what tests exist and are best to test how well HDL is scrubbing cholesterol from the lumen, etc.… Thanks.)
Peak vs Average vs AUC Glucose, Inflammation, and CVD
It's well known that a higher average glucose increases your risk of cardiovascular disease (CVD). I'm presuming this is due to inflammatory damage on the endovascular wall, but haven't found an adequate explanation of the biochemical pathway in which sugar causes inflammation. Do you have one? Furthermore, is it peak glucose levels (or a glucose over X amount) that causes this inflammation, the average glucose, or the glucose Area Under the Curve (AUC) which better tracks with this inflammation? The AUC would correlate best with total sugars consumed, but would mean that the glycemic index of the food item is irrelevant. Thanks in advance for your response.
Diteary/Lifestyle changes in dyslipidemia
First, I want to say thank you for the plethora of information relating to cardiovascular disease. Your in depth and well-thought-out interviews are excellent, even for those with limited medical knowledge. My question is related to treatment and prevention. You often discuss, in depth, how statins and other meds are used to treat dyslipidemia and how they work. However, I cannot find any information on what you recommend to patients in regard to dietary and nutritional changes to make before introducing medications. Is there a standard plan you ask patients to adhere to, and how long do you allow before you expect results and test lipids again? Thank you!
Prescription stimulant use and longevity
Peter, what are your thoughts on long-term prescription stimulant use in the context of longevity? For many, these medications are life-changing, but it seems likely long-term use would result in cardiovascular complications down the line. Do you have any patients on these medications, and how are they managed?
LONGEVITY OF THE SKIN
Hi Peter I thoroughly enjoyed a recent podcast on the ageing eye and thought the topic of ageing skin and what measures are known to preserve the skin's integrity would also be useful. As a pharmacist of 40 years I have had many elderly patients and their main complaint regarding ageing is the management of their deteriorating skin : thinning skin easily injured, ulcers, shingles rashes that are slow to resolve, skin cancers, itchiness, etc. Have there been any recent studies for improving this feature of longevity?