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?
APOE4 monozygous systemic effects
What are the systemic effects on cholesterol and insulin resistance for people who have 2 APOE4 alleles? I ask because I have 2 and have unusually high cholesterol, both LDL and HDL, and ongoing insulin resistance regardless of lifestyle measures. I think it is because of this as I have had genetic testing to rule out everything else. I have read studies that suggest having the APOE4 alleles are much more systemic and complicated than just effects are brain tissue but there isn't much mainstream on the topic and I am not by an means an expert on reading and understanding research studies. So I was hoping you might consider a focuses discussion on systemic effects. Thank you.....and not to butter up the request but I have been a member for a while and am part of the Early program. :) Hey its worth a try.
MD vs PhD Pathways in Translational Physiology and Longevity Research
I’m a PhD student in Human Performance and Movement Science with interests in integrative physiology, cardiometabolic disease, and aging-related mechanisms, and I’m trying to decide whether pursuing an MD (vs staying PhD-only) meaningfully improves one’s ability to do translational work in this space. In your experience, does clinical training materially change the kind of research questions, impact, or credibility one can have in longevity and physiology-focused work? Or can a PhD-driven path be equally effective for doing the kind of work you do?
blood transfusion science
This is more a suggestion for a topic, rather than a question. Having worked in a diagnostic lab, I often think the science behind blood transfusions is vastly underappreciated. Only 1 blood group system is widely known (ABO), but there are >25 that can affect compatibility. Crossmatching blood can be challenging and stressful for lab staff, especially when a patient is 'bleeding out' or a mass trauma event has occurred. Emergency blood can only be given in limited amounts and a sample of the patient's blood must be taken beforehand so they can be typed to ensure subsequent units are compatible (not always easy practically or given priority by doctors). Whether or not the patient is female and of childbearing age must be considered. I realise this is somewhat outside Peter's main topics, but relevant to longevity because transfusions show science directly saving life and a relatable real world topic, especially since it relies on donated blood (it is hard to envisage synthetic blood products ever being invented). The rationale for athletes having transfusions is also interesting. The frenetic activity inside a diagnostic lab is never seen by patients which is a shame since scarcely any medical decision is made without reference to tests results and blood transfusions are a crucial part of modern medicine with a fascinating history.
Hunting special
Hello Peter and the team! I wonder if you would consider making an episode about hunting. I'm always intrigued when it is mentioned. Perhaps "how to start" or "how to experience". I'm curious what sort of skills, knowledge and fitness a person needs to gain to be able to try to go hunting with a guide or on their own. Thanks for consideration!
Joint Health
I'm curious to hear a science based analysis of the impact of running and weight lifting on joint health. Are there studies that show the impact of running on long term joint health. Also interested in any other data on the specific health benefits or drawbacks of marathon training. Love the show.
MACE prevention post-elevated CAC CT Score
Let's say you've received an elevated CAC CT Score that places you in the moderate risk category. What now? Essentially the same as you've already recommended for prevention? Or are there additional considerations or goals that should be met to drive down future risk? Can future risk still be mitigated?
Zepbound by the vial
Many patients now take Zepbound by the vial and dispense their own shots. In the online community many patients take the whole vial, not just the 5mg in the vial. There is about 6.4mg in the vial. Thus the actual dosage taken by the patients can be more than the prescribed amount. Do we know of any dangers associated with this common practice?
Testosterone for breast cancer survivors (while also taking Letrozole)?
I've been listening to the podcast for perhaps 5 years. You've done a great job talking about HRT and testosterone and how women can minimize the negative effects of menopause. But for many women who have survived hormone-positive breast cancer (admittedly a minority of the population but still a sizable group), HRT isn't on the table. For these women, besides vaginal creams like estradiol, is there nothing they can do to combat the consequences of menopause? For example, pt had breast cancer when she was 39. Her dr recommended that her ovaries be removed. She has basically been in menopause for years and is now in late forties. Her sex drive is essentially zero, though she doesn't want it to be. Her doctor won't give her testosterone because the dr is afraid it will convert to estrogen. But she takes Letrozole. I saw a recent NIH study that suggests perhaps Aromatase inhibitors (like Letrozole) could be used to mitigate this fear. Do you have any thoughts on that? Is that something these patients can take or is it just too risky?
Zone 2 Heart Rate
Hi, I am a 56 year old male, pretty fit (I can run at least 3km in 12 minutes => VO2max 56+). My maximum observed heart rate is around 165, maybe 170 if really pushed. Based on Peter's RPE guidance, I can be in Zone 2 and conversing well up to 145, maybe even 150bpm. This seems a very high % of maximum HR (85%+) compared to everything I see online. Is this realistic?
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.