Managing ADT
You have mentioned in several pieces on prostate cancer how debilitating ADT is. For those of us who are on it and have no choice, what are the best practices to minimize those complications? Please include the psychological, sexual loss including orgasm (which no one addresses), bone loss, muscle loss, metabolic risk, emotional sensitivity, hot flashes - all of it. Are these changes progressive with the duration of ADT? Is there ever an equilibrium when it doesn't get worse? Also how long does it take for these to become manifest and what recovery can a man expect and what options are available if recovery is insufficient. I know parts of this are addressed among your various podcasts, but I don't think all of it has been brought together in one coherent piece. It would help. Thank you
When Risk Markers Disagree, How Should Statin Timing Be Approached
Dear Dr. Attia, I’ve been listening to your podcast and reading your work for several years and deeply appreciate your emphasis on data-driven decision-making in a space often filled with noise. Your discussions have meaningfully shaped how I think about longevity and cardiovascular risk. I’m hoping you might address the following question: I’m a 52-year-old female (5’1”, 115 lb) with lifelong, genetically elevated cholesterol. I’ve exercised consistently my entire adult life (strength training, cardio, and more recently VO₂ max work), eat a very clean diet, track intake carefully, keep saturated fat low, and have no major health issues. Despite this, my LDL climbs higher over the years. Historically, my physicians have deferred statin therapy because my triglycerides are low and my CAC score has been zero. This year, I checked ApoB for the first time and rechecked CAC with the results below: Current labs: Total cholesterol: 258 LDL-C: 187 HDL-C: 56 VLDL: 15 Triglycerides: 89 ApoB: 138 CAC score: 0 My question is: What do you think about timing of initiating statin therapy in overall healthy, active individuals with elevated ApoB and LDL but other good scores such as mine—particularly in midlife women? Thank you for the clarity you bring to these conversations.
Sleep - Cumulative versus Continuous?
8 hours of sleep. Is there a difference (good/bad) between getting 8 hours of continuous sleep versus 8 hours cumulative overnight? I currently find myself waking up at 3am. If I don't go back asleep within 30 minutes (while still in bed), I get up and usually go back to sleep around 5am. Netting a total of 8 hours of sleep. I've read that Cristiano Ronaldo sleeps in 90 minutes shifts as a strategy for his body to recover and sustain. This made me wonder if two four hour sleep shifts might be preferable?
Age, GLP1, creatine recommendation & exercise
Dr. Attia, As a recent subscriber, I find your podcasts fascinating! Thank you. I’m 67 y/o, I was physically fit about 20 years ago, not now. I have just started taking Tirzepitide compounded with B6 and have lost a few pounds but 50 lbs. would be ideal. I’d like to know how to find a good brand of creatine & if yoga and Pilates are good forms of exercise to start.
Specific exercises to start weight training
Could you name several specific weight training exercises to do when I go to the gym to do weight training? You talk about it all the time but for 1+ year I haven't started higher weight training because I don't know where to start, and I'm guessing I'm not alone. Something simple would be great, e.g. start with this machine and 5 pounds, then if you have no pain, go up a pound every few days as you can, then go to these next 4 machines and do the same thing, increasing weight as your body tells you its ok. I'm a 65 year old with a thin frame and weak upper body (legs are fine per a recent InBody scan). I've got a 12 pound weight vest (per MC Haver) and walk with that regularly, and I do a strength class twice a week with 5-6 pound weights, but per your podcasts that isn't enough weight. I am so very shy about the gym that I believe a starting recipe (with advice re how to ramp up) would help me out immensely. I've figured out what to do with VO2 max and Z2, but this continues to elude me, even though I've looked at many articles/podcasts on your website. I read Outlive and listen to all of your podcasts, which started my path toward healthier living, and I thank you for that. I'm just stuck re weight training. Thank you for considering this.
How do I know if my children are at genetic risk of heart disease?
My husband died recently of Ischeamic Heart Disease, aged 56. It was sudden and unexpected. A postmortem revealed he had severe heart disease. He was Indian, his father had a quadruple bypass in his late 50s and all of his father’s 5 siblings died of complications from late onset diabetes ( amputations and infection) not specifically HD. I am Caucasian and am not aware of any family history other than my mother suffered from pneumonia, bronchitis, emphysema and finally died of COPD at 72 after heavy smoking since age of 9. I am 57 and healthy, love exercise and have a VO2 max of 46 and have had no health problems that I’m aware of. My questions is related to my two sons aged 26 and 20 - how do I find out if they are at genetic risk and how often should they be tested if so. They are both athletes, the eldest an ultra athlete but they are young and I’m now all too aware that HD moves secretly and slowly. I live in the UK. Thank you Michelle
IBIS risk assessment for breast cancer and the role of risk reducing surgery for people without a germline mutation
I would be interested to hear your thoughts on the IBIS tool for breast cancer risk assessment. For women with extremely dense breasts, a family history and/or biopsies showing hyperplasia (or a combination of these factors), the IBIS will often calculate lifetime risk to be in the 40-60% range. I would be interested to hear your take on the accuracy of the model, and how to use this model to guide decision making, particularly around the role of risk reducing mastectomy in patients without a germline mutation. If the 40-60% lifetime risk is real, this would certainly be reason to consider surgery (similar to the risk of patients with Lynch Syndrome for endometrial cancer, and we recommend hyst/BSO for those patients). Risk reducing mastectomy has not been discussed much outside of the BRCA+ population, but it would seem like a rational option for a well informed patient/good surgical candidate if their risk was truly in that range. Would be very interested to hear your take and potentially a deeper dive on the IBIS model and its accuracy.
Fascia Episode
Peter, I’d like to suggest a podcast episode on fascia and its role in movement, resilience, and aging—highly aligned with the Centenarian Decathlon. Fascia is essential for force transfer, proprioception, elasticity, joint health, and movement efficiency. Unlike muscle, fascial decline appears driven less by age itself and more by reduced movement variability, elastic loading, hydration, and repetitive patterns. This often leads to stiffness, injury risk, and loss of movement confidence before strength meaningfully declines. An episode could cover what fascia is, how it functions as an integrated system, how it becomes disrupted with modern lifestyles and aging, and what the research suggests about maintaining or restoring fascial health. Practical discussion could include movement variability, end-range loading, elastic and rhythmic work, and why fascia may be a missing link between strength, mobility, and durable movement into advanced age. This feels directly relevant to living well into one’s 70s, 80s, and beyond. With Regards
What are we to make of the studies that find an association between Gabapentin and dementia?
This may be candidate for AMA or the Sunday email. I started intensive work with a psychologist who specializes in CBTI after your session with Ashley Mason. As part of the process, my sleep lab identified hundreds of Periodic Limb Movements in Sleep per night. My sleep doc recommended either Pramipexole or Gabapentin. Gabapentin worked well so I've been using it since June, starting at 100mg but found 600 mg the right dosage. I have been great sleep but a few days ago the WSJ did a scare piece that led me to find, on Consensus, a number of worrisome studies. I could discount them but they are also potentially credible. (The WSJ piece is here: https://www.wsj.com/health/gabapentin-painkiller-hidden-risks-603e6130?mod=hp_lead_pos7) I've stopped using Gabapentin and will talk with my doc but am now getting poor sleep. What's your assessment?
Very hot beverages and cancer link
Is there a proven causality between drinking very hot beverages and oesophageal cancer? I read this media report here: https://www.channelnewsasia.com/commentary/hot-drinks-gut-oesophagus-cancer-risk-5721351?cid=braze-cna_CNA-Morning-Brief_newsletter_28122025_cna
Tendon Healing in older adults
Quick background: I am a 69 yo male who is starting out late in my goal of better health span in my later years. I suffer from golfer's elbow in one arm and and a tendon injury to my brachioradialis from lifting a heavy picnic table by myself in 2011. These two injuries are dogging me and are very stubborn to heal despite exceedingly gentle eccentric and isometric exercises with 5 lb dumbells, and daily 20g of supplemental collagen. My dilemma is that I can't safely increase my dumbell weight to get stronger without risk of further injury. My muscles are more than willing, but my tendons are not. My question: How does a near 70 yo adult heal from tendon injuries? It would also be great to hear you speak about tendon injuries in general.
Nutrition and Metabolic Health
Is there any advantage to eating smaller portions throughout the day (say 4 or 5 meals) to match your total daily calories requirement, not from an energy expenditure point of view, but from insulin sensitivity and fat deposition, VLDL production or glycogen storage, looking from a metabolic pathway point of view?
How do I deal with long term nocturia?
I have been dealing with frequent nighttime urination for over 10 years. Numerous urologists have not been helpful. It may have been further affected by being treated for prostate cancer over a 3-year period, January 2022 through January 25. My ages during that period were 80-83. I stopped all treatments beginning in October 2024. My cancer was considered "cured". My PSA was .05 in August 2025 and my testosterone was 190 at the same time. I am currently 84. My urinary episodes at night have been at least 4, but there are some nights I have 6-8. I HAVE NO URINARY PROBLEMS WHATSOEVER DURING DAY TIME.