Discordant LDL-C and ApoB w/ Medication - Healthy 34 yr old Male
Hi - have been a long time listener, want to say thank you for all the help and info you have provided over the years. I used to have high LDL and have been on a statin / Ezetimibe regiment for several years which lowered ApoB to 60-70 range and LDL-C to about 73. I recently had an annual blood test and LDL dropped (65) but ApoB rose to 104. I probably have started to eat more saturated fat in the past year (moved near a regenerative farm and have been eating a lot of the beef cuts) but otherwise no real change. I exercise daily, high Vo2, all other labs looked normal, normal weight, no metabolic issues I know of (though haven’t done an OGTT). Do I need to be on a PCSK9i? Could an increase in dietary saturated fat really drive that much discordance between LDL and ApoB? Any help or thoughts would be great! Thanks
Dementia in the family - should I test?
Given a family history of dementia (my mother and her brother), but no current cognitive symptoms myself, would you recommend APOE genotyping or broader preventive genomic testing as part of a longevity strategy? More specifically, how do you decide when genetic risk information is actionable enough to justify testing, and how would a positive APOE4 result actually change prevention, monitoring, or treatment decisions? Male of 75 in good physical and mental health.
Follow Up on Peptides
Would love for you to address the discrepancy between your take on BPC-157 and SS-31 and what other folks are saying. You make a powerful case that BPC-157 has no value at all, yet Rogan, Peter Diamandis, Bryan Johnson talk about these peptides like they are wonder drugs. As an aside, I feel you are being totally singled out for a handful comments in a few emails, when folks like Reid Hoffman were WAY more involved with Epstein. Personally, I would love to see you take the gloves off - especially on some of the nonsense spewed by Bryan Johnson. I love a lot of what he does, but it would be great to see him held accountable for some of his more reckless claims on psychedelics, gene therapy, and so on. Hang in there. Not sure if yo see these questions, but if you don't, whoever reads these please convey to Peter there is at least one person 100 percent on his side.
Bone density and protein
Is there a biochemical explanation with excessive protein in the diet leading to a decrease in bone density? Does excessive protein in the diet lead to acidic blood and leaching of calcium from the skeletal system that leads to a decrease in bone density? Are there societies such as Eskimo's where there primary source of nutrition is protein leading to low bone density?
Endurance athletes and the need to train smart
Would your team be willing to do an episode about cardiac health or harm occurring in 40plus endurance athletes? There is a growing number of articles about this and many of your subscribers fit in this category and have had cardiac issues without underlying family history of ASCVD.
Full body MRI
Peter recommends aggressive and early cancer screenings. And for the appropriate patient will order full body MRIs. Over the last several years several companies have made this type of testing more widely available at a cheaper cost (prenuvo, Ezra/Function, etc). However most of these scans are not quite the same as an MRI you’d receive in a hospital, they have larger fields of view, and I believe likely have a much lower sensitivity. Are any of these companies worth it, especially if they are the only option for most people? If not, are there alternatives? How can middle class viewers approach early cancer screening?
Salt sensitivity
My husband has sleep apnea and wears COAP machines regularly. He has hypertension as well and takes BP medication (spartan 25 mg) but his BP is still not within 120/80 hence we are seeking combination therapy/meds. Meantime I have noticed he is super sensitive to salt and BP shoots up by eating out. Why and what should we do?
Longevity Playbook When Chronic Disease Starts Setting In
Generic - “Peter, I’m a 57-year-old South Asian male and I feel I’m entering the phase where chronic disease is beginning to set in, not as a distant possibility but as an active trajectory. From a longevity perspective, what should the playbook be at this stage? How would you prioritise fat loss, glucose control, lipid lowering, sleep, exercise, and cardiovascular screening, and when is it time to move beyond lifestyle alone into a more aggressive prevention strategy?” Specific - “Peter, I’m a 57-year-old South Asian male with a history of previously reversing diabetes through lifestyle, but I now seem to be drifting back toward metabolic dysfunction despite renewed effort. My recent markers show HbA1c around 6.3%, fasting glucose about 104 mg/dL, fasting insulin about 14.8 µU/mL, LDL around 118 mg/dL, triglycerides around 144 mg/dL, hs-CRP around 3.15 mg/L, vitamin D insufficiency, mild TSH elevation, excess body weight, and concern about cardiovascular risk. I’m already working on nutrition, walking, strength work, stress reduction, breathwork, and sleep, but progress is incomplete. In a South Asian male like me, how would you prioritise the next 6–12 months: body composition first, glucose control first, lipid lowering first, sleep repair first, or deeper cardiovascular testing first? And how do you decide when someone has reached the limit of lifestyle-only progress and should escalate to therapies such as GLP-1s, metformin, LDL-lowering treatment, or more aggressive cardiac evaluation?”
Vitamin C and Dr. Linus Paulings research.
Are we the only mammals that DON'T produce Vitamin C (except rhesus monkey and fruit bat) and shouldn't we be absolutely supplementing correlative to body weight and stress. 150 lb goat produces 8 grams per day but chase the goat around he field (stress) 11 grams. It's been a long time since I studied this so.... Thank you. M. Galt
Recent American Heart Association dietary guidelines
The recent announcement (3-31-26) cites it is “based on decades of science.” As usual, that “science” is not referenced nor are the studies it is based on referenced. Could this be addressed in a future AMA as the American Heart Association influence on our population is significant and knowing the basis for the “science” is critical for individuals to make good decisions.
Fat Gripz
I found out that there are special add-ons for barbells, dumbbells, high bar, kettle bells, pretty much anything where a hand needs to grip in order to engage in an activity - Fat Gripz. The hype out there is massive. Peter, could you please decipher this add-on whether it is worth an investment, how it works, how it should be used properly, who it is recommend for, what brands would you recommend, so we don't end up hurting our wrists with poor quality Fat Griptz, would sets/reps need to be adjusted? Thank you!
Exercise for woman over 70 years old
Dr. Attia - I have always exercised - HILT, running, and strength training. I do not have diabetes, NO high blood pressure, nor any other chronic diseases. I attribute a significant portion of my fitness to all the exercise I’ve done since my early twenties. Since turning 70, however, exercise is becoming more painful - meaning, more muscle soreness, especially in the legs; tightness in the hip, and other joint-related pain. I do not want to stop exercising. Is there an exercise you recommend that one can do and be in Zone 2 without it becoming a source of pain? Thank you.
Calcium supplementation and cardiovascular disease risk
We have been giving calcium supplements to women with osteopenia and osteoporosis as standard of care for years. There are studies that show increased MI risk due transiently high serum calcium from bolus dosing and that the calcium supplementation does not decrease risk of fragility fracture, but there is a lot of noise as well. Can you summarize the state of the data in this area and what we should be telling patients about calcium supplementation?
Validity/Potential of the cartilage building recent publication
Potential? Researchers have developed a new method for monitoring iron flux — the movement and rate at which cells take in, store, use and release iron — in stem cells known as mesenchymal stromal cells (MSCs). The system can provide insights within a minute about a cell’s ability to grow cartilage tissue for cartilage repair. The breakthrough offers a promising pathway toward more consistent and efficient manufacturing of high‑quality MSCs for regenerative therapies to treat joint diseases such as osteoarthritis, chronic joint degeneration conditions, and cartilage injuries. The work was led by researchers from the Critical Analytics for Manufacturing Personalized-Medicine (CAMP) group within the Singapore-MIT Alliance for Research and Technology (SMART), and was supported by the SMART Antimicrobial Resistance (AMR) research group, in collaboration with MIT and the National University of Singapore (NUS). A paper describing the work, “Cellular iron flux measurement by micromagnetic resonance relaxometry as a critical quality attribute of mesenchymal stromal cells,” was published in February in the journal Stem Cells Translational Medicine.