GLP-1
Now that there is multi-year history and usage data on use of GLP-1 inhibitors for weight loss, is there an updated view on the overall risk-reward? The 2023 podcast had highlighted significant side-effects and seemed less keen on use of GLP-1 inhibitors for weight loss. Is there an updated view on the topic?
Kidney stone ama
Hi. I have reviewed the ama back catalog and cannot find an ama or guest episode dedicated to this topic. As a someone who has had multiple stones in the past and knowing the high prevalence of this issue, is Peter and the team willing to do an amazing job episode or guest discussion on this topic?
A Mystery No Doctor Has Solved For Me Yet - Lifelong High SHBG with Low Free T Despite Normal Total Testosterone
Hello Dr. Attia, I can't tell you how grateful I am for all the wisdom you have shared over the years. I've incorporated so much of your advice and have seen a dramatic improvement in my life so thank you! There is this one issue that I can't seem to solve and have been to several doctors over the years and it has stumped them all. I thought there may be other guys out there struggling with the same thing and don't recall you covering this topic in detail. I’m a 51-year-old man with a lifelong pattern of high SHBG and low free testosterone despite relatively normal total testosterone levels. This has been present throughout adulthood. Multiple doctors have been unable to identify a cause after ruling out the usual suspects (thyroid, liver, GH, medications, caloric restriction, etc.), and my bloodwork is otherwise normal. I had elevated cholesterol and ApoB (which I’m now successfully managing with Repatha). Could a genetic polymorphisms in the SHBG gene (e.g., rs6259 or TAAAA repeats) be plausible explanation for the constitutional high SHBG? What are your thoughts on this phenotype? How common is lifelong high SHBG with low free T in the absence of obvious secondary causes? In your experience, how do these patients respond to TRT versus other interventions (e.g., boron supplementation, thyroid optimization)? I want to avoid TRT due to the issues that could cause metabolic issues. I'm currently experimenting with Boron and will do bloodwork in a few months. Any specific management or monitoring nuances for someone with this hormone pattern + a history of high ApoB now on a PCSK9 inhibitor? Any additional tests or specialist referrals you would prioritize? Thank you so much for considering this topic that has driven me crazy for decades now.
Probiotic supplements
Following Dr Attia’s framework for determining which supplements are useful, what biomarker can be used to indicate when a probiotic supplement is needed, and if so what type, and ultimately whether the supplement is working? Hoping this can be addressed in a future AMA.
Updated Lipid guidelines--what do they mean?
I noticed that they American Heart Association updated their guidelines to include apoB testing. There also seems to be an emphasis of getting LDL-C under 100. The implication I see is that the disparity between ApoB and LDL-c is focused open ApoB being an indicator of risk when LDL is not. Is that disparity every applied the other way--ApoB indicating less risk?
Resistance cords for strength training
I have scanned your website but cannot find any specific comparisons of using elastic sport cords or bands for resistance training vs. machines (or free weights). Sport cords provide enormous benefits to access and setting up a home-based gym. I can even travel with them and use them in my hotel, which is often easier and more satisfying than dealing with the typical poorly maintained facilities in many hotels. I also use Airbnb a lot, and almost never have access to a gym in such cases. Can you suggest some guidance and information sources about selecting and using sport cords as well as an evaluation of their relative effectiveness?
High A1C in athletes
Hi! First, I want to say chin up. Keep doing your thing, you are helping lots of people. I am a fit 55-year-old with an A1C of 5.8. I have worn a CGM for a month a couple of times over the years, and despite elevated glucose in the morning (in the 90s), I didn't have high spikes and the glucose lowered as expected. Because of what I learned on The Drive, I asked for an OGTT, which was mostly normal. Researching this led me to Dr. Nicola Guess and his writing on prediabetes in athletes. I also found the Kraft Prediabetes Profile. You have repeatedly said that A1C is not a good metric and that OGTT is a much better indicator of metabolic health. I think talking about Dr. Guess' work and the Kraft interpretation might be helpful to your listeners who likely exercise a lot. My primary care doc is hyper-focused on A1C, I am sure I am in the same boat as a lot of other people.
muscle building
you have gone from muscle mass to muscle strength but strength is different from power and I th issue is power loss , dynapenia. I believe reversing dynopenia. which involves nerve speed, building the number of motor nevrve endplates and synchronizing the firings as in a building demolition. this all takes more specific training and longer training Thant building muscle mass or strength. so how to do this if this is correct.
HPV and Men
Great article about HPV, but I never see mention of *men*. What is the cancer risk for men from HPV? And is there a concern for the man if a partner/woman has been diagnosed with HPV and/or abnormal Pap with strains 16 or 18, should certain sexual activities be restricted until the infection clears?
Severe B12 deficiency
I listened to your podcast about genetics. I had a Complete DNA (formerly Nebula) test from Prophase Labs. It found 2 copies of an MTHFR gene. Following a methylation panel from Genova, I have been taking Homocysteine Resist and have maintained high levels of B12. However, my 56 year-old daughter had been complaining of increasing muscle cramps and tingling in her legs at all times. I asked her to test her B12 since she has at least 1 copy of my MTHFR variant. She did and found that she has a chronic, severe B12 deficiency. Since then she has had B12 shots and now takes folate supplements. She no longer has cramps but had some nerve damage. This is an example of an accidental finding on a whole genome DNA test that had important meaning for my daughter.
ECU breakthrough using DEXA for AAC detection using AI
Dear Peter and the team, I just came across the news that Australian ECU has made a breakthrough applying AI to detect and quantify abdominal aortic calcification (AAC) on lateral spine images captured by DEXA. Here are several links: https://www.heartfoundation.org.au/catalyst/aac-screening https://nhiri.ecu.edu.au/research/you-aorta-look-beyond-muscle-and-bone-for-falls-and-fracture-risk-new-ai-algorithm-identifies-high-risk-older-women/ It would be really interesting if Peter talks about this on one his AMAs to elucidate the subject.
Breast Cancer
Would love an updated podcast about Breast Cancer - it's been a few years since you've done one - and there have been so many advancements. Specially around women who have had breast cancer - especially early stages - that go through treatment - surgery, radiation, chemo - etc - but there are so many new hormone therapies that are about to come up - the SERD group - possibly replacing Tamoxifen and AIs. But - as a woman who had early stage breast cancer and is now on Tamoxifen - what lifestyle, supplement, nutrition information can you share to all me/us to go on to lead healthy lives?