Longevity risk of ADHD stimulants?
Many people take stimulants like Adderall, Vyvanse, Ritalin, Modafinil. I think you can even get a prescription for low-dose methamphetamine, although I doubt many doctors are willing to write it anymore. Many people will be on them for decades, or a lifetime. Can you discuss exactly how these work in the body and brain, what chemicals or hormones they increase or decrease, and the potential downsides of long-term use? Obviously it’s a problem if they chronically elevate your blood pressure past 120/80, but do they introduce other risks to brain health, cardiovascular health, the kidney, or the HPA axis? I’m surprised how little information about this is available, but not sure if that’s because we don’t know, or because the people who know don’t want to talk about it. Related: It would be fascinating to know if there are other commonly used or prescribed drugs that might have overlooked detriments to your pillars of longevity. NSAIDs or other drugs’ impact on the kidney, steroid impact on bone health, etc.
Deeper Dive on hyper-insulinemia?
You’ve said a lot about blood sugar and insulin resistance, so you may be surprised that anyone could have further questions. However, hyper-insulinemia seems like an adjacent yet separate condition from type 2 diabetes in the sense that you can have great glucose control with very high insulin levels. I believe Nir Barzilai said high glucose causes micro-vascular problems while high insulin tends to cause more macro-vascular problems—and those problems (cancer / heart attack) may kill a person before they even develop diabetes. Can you please elaborate on that? Specifically: What do we really know about the role of insulin in cancers and other health problems? At what level does insulin create problems acutely (i.e. how high can insulin "spikes" be before causing damage and how many do there have to be) and what level of insulin is considered "chronically" elevated and what type of damage does that cause? What parts of the body are most impacted? It seems like there has been less focus on it than on other endocrine or metabolic issues. Where are the knowledge gaps? How accurate are insulin tests (both fasting and OGTT), and what might yield inaccurate results—e.g. acutely high cortisol on the morning you do the OGTT, or estrogen / the birth control pill etc. How might it impact the test if you fast for 8 hours vs. 12 hours-16 hours before the test? That raises a related question—should we test insulin in isolation, or would other hormones (cortisol, sex hormones, IGF-1 / HGH…) give a fuller picture? Have there been developments in at-home insulin testing or other ways to test insulin more easily than browbeating your doctor into writing a lab order, or driving from NY to a state that has a more enlightened view on self-order tests? I’ve listed your preferred Glucose / Insulin ranges below from your AMA case studies several years ago—has your thinking changed since then? And are the ranges different for women than for men? Fasting Glucose less than 100 but ideally less than 90; Fasting Insulin less than 6 30 minutes Glucose at 130-140; Insulin 30-40 60 minutes Glucose at 120-130; Insulin can be peaking at 60 min but hopefully not higher than 30-40 90 minutes Glucose coming back toward 100; Insulin at no more than 2x the fasting rate Please do more case studies! Very helpful and interesting. Thank you--
APOE
I'm a 58 yo female. I just found out have the genotype of E3/E4 and I'm freaking out. My LDLC and LDL particle count have been climbing steadily over the past 2 years (LDLC-146/LDLP-1905), and APOb-105. Actually, LDLC has always been on the higher side. All other markers, HDL, Tri's, A1C, CRP, Calcium score (0), weight is 123 and I'm 5'4", I've always been active and, as an adult, a competitive athlete. I eat well and just started eating red meat about a year ago (only locally, grass-finished, humanely raised & processed - so, I don't eat a lot of it). Now, my dr is suggesting that I consider a vegan diet for the genotype. This goes against everything I've learned about protein and, specifically, regeneratively raised animal protein. I'm looking for an AMA episode that does a deep dive on this test and can give some direction as to next steps. For someone who lives a pretty, damned healthy lifestyle (of course, not perfect), I don't expect to worry about CVD or Alzheimers and am at a loss for what else I can do. I know it's not a death sentence but, all the lifestyle recommendations don't seem to be moving the needle in the right direction. And, yes, I'm on the lower carb side of nutrition but I eat at least 100g/day. And, I'm not a fat-seeker, I just don't shy away from it. Dr. Attia, please help me sort this out. Thank you
Cheat Sheets for the Lazy Listener/Reader
I just finished your book, well done! There were surprises and new stories, even for a pretty consistent podcast listener. I was hoping for cheatsheets at the end of the book or a link (so it can change as the science advances) describing: your preferred lab ranges, minimum exercise and training types and amounts per week. I realize that this information is spread across many podcasts and throughout the book, but it would be really nice for readers and/or subscribers to have this information in one easy spot and updated as your recommendations shift.