50 year overall health screening recommendation
Hello, I am turning 50 this year and beyond the regular blood work and I understand a colonoscopy/endoscopy is recommended for screening at this age, what else should I start to think about testing / monitoring? Thank you in advance.
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.
Cholesterol and Dementia
I have been on cholesterol medication for around 30 years and found that I experience significant "brain fog"/cognitive impairment on both statin medications and Zetia. I am at higher risk for Alzheimer disease (ApoE 4 heterozygous) and concerned that taking these medications increases my risk. Is there data that cholesterol medications affect dementia risk (other than by reducing inflammation?) and/or if so, is there another option to reduce CVD risk other than by lowering cholesterol?
How do I know when my insulin resistance is truly GONE?
Hi there, I have a very strong family hx of DMII, I had gestational diabetes (surprising my OB since my BMI was 22 when I got pregnant) that turned into a few months of pre-diabetes after I stopped breast feeding (5.9%). I quickly jumped into action. I lost 14 pounds of baby weight, my HbA1c is now 5.1%, my LFTs are down to teens (from 30s), my fasting insulin is 4.3, free fatty acids are 0.38. I'm an avid rower and cyclists and lift weights 2x per week. BUT, I still will occasionally have rebound hypoglycemia, typically triggered after a special high carb meal (big insulin bolus) followed by exercise a while later (when my BG is already on the downtrend but I still have too much insulin around). Outside of an insulin clamp, is there a test or constellation of tests to say insulin resistance is truly gone? Is this an indicator I still have insulin resistance or is it 'normal' to have a big insulin bolus to these high carb meals? My endocrinologist won't order me a OGTT with my HbA1c. I LOVED the talk with Dr. DeFronzo and was listening for an answer to this point, but was surprised it wasn't really addressed. Thank you! Lindsay
Neuroprotective supplements or behaviours for people with craniocervical instability
Specifically i was diagnosed with type 2b CCI by Dr Centeno in Colorado. Is there something i can take or do that is neuroprotective if my IJV is being compressed intermittently. I am waiting to get a Cerebrospinal fluid flow study done by scott rosa, and may also have diminished CSF flow.
Thank you and Another Request
Just wanted to say thanks. I recently requested something on caffeine and a premium article on caffeine went out today. I once requested Stephan Guyenet on the podcast and it came out the next day! So, us Peter Fans must be thinking alike, or else I'm the Wizard of Oz. I'm starting to think I have magical powers. Maybe a podcast on schizophrenia, bipolar disorder, etc.? The abnormal psychology episode. Thanks for being a source of health information that is unbiased and based on something other than hearsay, i.e., science.
Technical fabrics & BPA levels: Are you doing testing on yourself? How real is this risk?
Having read about unacceptable levels of BPA in infants from socks made from polyester spandex, I began wondering about sports bras - a piece of gear perfectly positioned to capture sweat and cause trouble. The CEH did testing on sports fabrics a year later https://ceh.org/latest/press-releases/new-testing-shows-high-levels-of-bpa-in-sports-bras-and-athletic-shirts/ which confirmed my concern. Given your exercise hours and probable sweat production, have you looked at this? Have you done testing on your own BPA levels, and if so - what have you found?
A2A2 beta-casein genotype
What is your opinion regarding the damage caused by milk not produced by A2A2 cows? The milk from cows type A1A2 and A1A1 contains beta-casein type A1. Beta-casein A1 promotes the formation of BCM-7 (beta-casomorphin-7) during gastrointestinal digestion, whereas the digestion of A2 results in little to no BCM-7. BCM-7 can increase intestinal permeability, allowing more substances to pass into the bloodstream. This can influence inflammatory processes and affect the brain. Altered intestinal permeability is linked to neurological and inflammatory diseases. Has this been proven? What is your opinion on this matter?
Multivitamins request
Your recent March 2025 podcast on supplements was excellent. I searched the podcast notes on multivitamins and which ones were suggested, but I could not find anything. Can you spend some time on this topic in the future and make a recommendation on a framework for assessing these? Many Americans take these as a foundation and as FOMO ( use them as a good enough solution). However, in other countries, this is not standard practice (Germany, France), and I think if we can get more information (pro/con) we can make a better decision on these. Thanks!
Nutrition and American Food Products questions
Hi Dr Attia, Sorry, this is less a question than a request. Can you focus more on how our food products are made and packaged here in America, and whether they are better or worse than those in other countries? You say that smoking is one of the biggest own-goals you can do, but can you say the same for American packaged foods? Are pre-packaged foods good/bad for us? Can you shine light on studies and guest speakers that have used science-based approaches to support or dispel these fears? Thank you
Overtraining syndrome, Low LDL, low glucose with Sglt2i and metformin.
Hi! could you do a deep dive on overtraining? until 8 years ago, I suffered severe bouts of overtraining syndrome, but not due to really excessively training, but rather a combination of stress, training and low T. I had low cortisol and was unable to exercise for months. When I had finally recovered, found myself succumbing to it again, without that much warning, though I followed Oura and Elite HRV metrics. As I started TRT, my overtraining symtoms gradually stopped. I got my vo2max to 47 and was exercising up to 15 hours a week, with 5 hours of zone 2, 2-3 gym exercises and rest being zone 1 walks, cycling etc. Felt great. Then I discovered 70% LAD stenosis and started Repatha, Forxiga 5 mg. and metformin to really limit my risk. One year later I again succumbed to overtraining syndrome. Took some 6 months with almost no exercise to recover. Now after getting my vo2max back to 45, I succumbed again. Low cortisol and taking 5-10mg hydrocortisone, helps a lot, but can't do it more than 3 days in a row, to be safe. Sparred with chatgpt and it said my extremely low LDL of 28 mg/dl could be interfering with cortisol synthesis and possibly my low glucose due to sglt2i and metformin could make things worse. Now I think that this really could be the case. Could you expand on this topic, as I think you have also suffered some. over training and you also have very low LDL and glucose. My Ac1 is 5.3, so not that low.
Right Bundle Branch Block
What precautions or considerations should a person over 60 with Right Bundle Branch Block (RBBB) consider when engaging in high-intensity workouts? Do you have specific heart‑rate zones or intensity thresholds that you should observe (or avoid) during high‑intensity workouts?
Should you minimize mTOR stimulation through leucine after cardio?
I'm wondering if stimulating the mTOR pathway through a high leucine meal should be avoided after zone 2 training sessions, as this would downregulate the AMPK pathway, as I understand? I know this is only temporary, but it still seems to make most sense to confine whey protein shakes etc to post resistance training sessions, and to focus on promoting the cardio-specific adaptations post zone 2 and VO2max sessions (still high protein but not quite as high; no whey protein; potentially less calories, whereas I try to be in a slight caloric surplus after resistance training for building muscle).
Preventing muscular disuse atrophy during bedrest due to sickness (rather than joint immobilization)
I'm wondering after which amount of bedrest due to illness we have to worry about disuse atrophy? From the studies on joint immobilization, this seems to occur within 1-2 days; but at the same time we know that resistance training even once a week is enough to make gains, which implies that it should take (much) more than 7 days from the last resistance training session before atrophy occurs. The only way to explain this discrepancy seems to be that even the moderate amount of movement during daily living is enough to prevent atrophy, which makes me wonder: At what point do I have to worry about atrophy during bedrest, where the joint is not immobilized? The challenge here is that, if the sickness is accompanied by a fever, real resistance training is probably not a good idea. But would it be advisable to still try to stimulate all muscle groups with low intensities (in particular the arms and shoulders, as the legs may get enough stimulation through walking)? Maybe isometrics would be easier on the body? And of course BFR seems like a good option, but that can not target all muscle groups. Or would this not be worth the risk of interfering with recovery from the illness, thereby delaying the next resistance training session? I guess the answer to these questions will also depend on how easily reversible the loss in muscle mass is (which seems to depend on age)?
Protocol for Preventing Glioblastoma Recurrence
My father (age 71 and also a member!) had glioblastoma in a location that they were able to laser it via surgery. He then went through radiation and chemo. 1 year later he's currently having clean scans but we know it's very aggressive so we want to do whatever we can. What protocols (diet, exercise, supplements, etc.) would you recommend for him to prevent recurrence? He was on Rapamyacin before he was diagnosed but he is unsure if he should restart it. Thank you!