High protein intake and association with incident CKD
Hi Peter, I listened with great interest to your conversation in Ep. 224. The association of high protein intake (> 1.5g/kg/d) and the development of CKD has been bantered about for many years. A recent paper in JSON highlights these observations. The major purported mechanism being glomerular hyperfiltration over long periods of time. It's difficult to discern what the signal/noise ratio is with these papers. The largest cofounder of course would be that increased lean muscle equates to high endogenous creatinine and thus an underestimate of true GFR. I know you use Cystatin-C, but I am curious if in your practice you've addressed this potential outcome and/or if you have found significant disparity in the standard CKD-EPI measurement vs. with Cystatin-C in your high protein intake patients? Have you employed a radiolabeled urinary clearance method at all? It would be interesting to get a sense of what you're seeing here. If there's any validity to this association, population based recommendations could have significant public health outcomes. Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7460905
ADHD stimulants
I can’t seem to find anything about this in any of your content so far— but I am curious what your position is on stimulants. There is one exception in an excerpt with Huberman where you said something very vague about it. Even if your opinion is boilerplate, it would be interesting to hear what you are thinking about on this topic.
Lipid Lowering Medication / Repatha
Hi Peter, you mention that Repatha has no side effects but some people I know do get severe side effects which seems to be supported by repatha reviews https://www.drugs.com/comments/evolocumab/repatha-for-hyperlipidemia.html. Could you please elaborate on the side effects of lipid lowering medications and especially Repatha. Thanks!
CGM strategy
It would be interesting to hear how you use the different features of a CGM , specifically things like the alert ranges, targets for the Time in range and GMI. Also wondering if there are ways of dealing with different abnormalities in the charts out of clarity. As an example I know you work to keep people below 140. What are the things we can try. I imagine assuming we are non-diabetic, just trying to fix screwed up metabolisms