Exercise depleted sleep....
I'm a strength and conditioning coach and I usually start work at 7am, to facilitate my bike training I rise at 4am 5/day a week, walk my dog and then hop on my stationary bike for at least 30mins for a HITT & Hills ride. Even with going to sleep at 9, after having dinner and spending time with my family, I rarely hit the 6hr mark of quality sleep. My question is should I prioritize sleep over exercise(which would be very hard for me to do, LOL) or assume the reason for me not getting enough sleep by exercising outweighs the detrimental effect of being moderately sleep deprived? Thanks for your input! I've been a long time admirer & subscriber and heading into my 73rd year, so every little thing I do that can make my healthspan better I'm all in!
Living at Altitude
Hi Peter, I've really enjoyed your discussions on altitude, particularly Episode #77 on sleep at altitude, Episode #85 with Iñigo San Millán on "live high, train low," and Episode #199 with Ryan Hall, where he described growing up at altitude, training at sea level twice a week, and later sleeping at 9,400 feet in Crested Butte while preparing for marathons. I live year-round at 9,200 feet in Colorado and travel to Dallas frequently for work, so I unintentionally follow a similar "live high, train low" approach. I'm a recreational endurance athlete, running several 10Ks and a couple of half marathons each year, with an occasional marathon. Like you've discussed, I consistently see lower overnight oxygen saturation at home, my sleep feels less restorative, and my hematocrit runs around 50%. My resting heart rate and HRV often improve when I'm at lower elevation, although not always. The performance benefits of altitude seem clear, but I'm less certain about the long-term health implications. If your primary goal were maximizing healthspan rather than athletic performance, would you choose to live at 9,200 feet or at sea level for the next 30 years? How do you personally think about the tradeoff between the cardiovascular and performance benefits of chronic altitude exposure versus the potential downsides of poorer sleep, chronic nocturnal hypoxia, increased hematocrit, and sympathetic activation? Are there specific biomarkers or tests you would monitor in someone like me to know whether altitude is helping or hurting long-term health? As a second question, many friends and family from lower elevations struggle when they visit us. Even climbing a flight of stairs can be surprisingly difficult for the first day or two. We've found that hydration, pacing themselves, and even canned oxygen seem to provide some temporary relief, and I've personally found that Excedrin helps with altitude headaches. What evidence-based advice do you have for people visiting high elevations like 9,200 feet? Are there interventions—such as acetazolamide, supplemental oxygen, specific supplements, hydration strategies, or other approaches—that you think are genuinely effective, and which commonly recommended remedies are mostly placebo?
You keep mentioning progressive overload. What is it?
For someone who is 70+ what does progressive overload mean? Supposing that I can just manage 3 X15 with a weight (say 35lbs). Does that mean that I should go up to 40lb and try to do 3X10? I can certainly exhaust myself by trying 3 X16 at the old weight. So how does one manage the number of reps vs weight?
Aging Athlete- Bradycardia & heart health
I am a 57 year old female and have a low resting heart rate (50 and dips into 40s when sleeping) combined with low blood pressure 105/60. These have been my vitals for the past 10+ years as a result of cardio training (which I continue to do but not as long or vigorous as when I was younger. I do lift weights as well). I’ve read that bradycardia from athletic training can lead to afib as you age. Is that true? Are there other potential heart conditions tied to bradycardia that I should pay attention to as I age?
Adjunctive lifestyle care for people already diagnosed with cancer
Adjunctive lifestyle care for people already diagnosed with cancer is so poorly addressed: using exercise, nutrition, muscle preservation, and carefully supervised metabolic interventions to improve treatment tolerance, quality of life, recurrence risk, and longevity. can you provide some guidance in this area. It would be valuable to so many.
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.