Nitric Oxide
I would love it if you did a deep dive into nitric oxide. I did a stem cell injection in my wrist and the Doctor Who performed it had me taking nitric oxide tablets that are like lozenges and dissolving your mouth daily in the morning and the evening. I noticed a couple things, one was at my blood pressure came down. I was kind of prehypertensive. The other thing I noticed is that my athletic performance was significantly better. After noticing the changes, I read a book by Dr. Nathan Bryan. Pre-fascinating.
What to do once you have cancer?
Hi folks. Dr. Attia has done a ton on cancer prevention and there’s now some scattered stuff throughout many interviews and AMAs on things to do if you receive a cancer diagnosis. It might be useful to pull all of that together into a single AMA, sort of a “what would Peter tell a patient or a loved one to do if they recently received a cancer diagnosis”? I realize there are many different types of cancer, and the staging would matter, but you all have managed equally complex topics in past AMAs so I think he could pull it off.
Is the best diet for you influenced by your genes?
See this testing website https://nutrigenomix.com/ "Evidence shows that one-size-fits-all nutrition recommendations are inefficient and often ineffective. Peer-reviewed, published research confirms that DNA-based dietary advice increases motivation and enhances compliance compared to population-based recommendations." If the best nutrition for you isn't one sized fits all is it trial and error to get biomarkers in check/what feels good?
Disclosure for Dom D'Agostino Podcast is Not Correct
The disclosure says "Dom is not involved financially with this company [Ketostart], though his wife advises them" His wife is listed as the "Founder and CEO" of the company, so he definitely has a much stronger financial interest than is suggested by "his wife advises them."
What are your thoughts about reversible MAO-B inhibitors for the treatment of brain inflammation-related diseases?
Hi Peter Attia, During my Masters' in Biomedical Sciences I did my colloquium about the role of astrocytes in high-fat diet (HFD)-induced obesity and found something really cool that I think is worth sharing with you. As it turns out, astrocytes do play a huge role in HFD-induced obesity in mice. A HFD can cause astrocytes to become inflamed and reactive, impairing its function in energy balance regulation. After chronic HFD consumption, reactive astrocytes in the hypothalamus (specifically the lateral hypothalamic area, or LHA) upregulate the enzyme monoamine oxidase B (MAO-B), that can turn fatty acids (FAs) in the brain into GABA. This astrocytic GABA decreases the firing rate of GABRA5+ neurons, that normally stimulate thermogenesis and lipolysis. Hence, increased GABA production in response to chronic HFD feeding increases fat storage in white adipose tissue (WAT), promoting obesity (Sa et al., 2023). However, inhibiting the MAO-B enzyme with a reversible inhibitor (KDS2010) prevents this astrocytic GABA synthesis in the LHA, and prevents fat storage in WAT and promotes fat loss. Interestingly, irreversible MAO-B inhibitor Selegiline (approved by the FDA for Parkinson's disease) does not have this effect, possibly because of compensatory mechanisms via diamine oxidase (DAO) (Park et al., 2019). The most exciting thing for me about this line of research is that this fat loss was not accompanied by reductions in cumulative food intake, like we typically see with GLP-1 receptor agonists. To reiterate: KDS2010 resulted in significant weight loss without reductions in food intake, but instead by promoting lipolysis in WAT and thermogenesis in BAT! Next to effects on HFD-induced obesity, reversible MAO-B inhibition by KDS2010 was also investigated in Alzheimer's disease (AD), another brain inflammation-related disorder that could show improvement in learning and memory (Park et al., 2019). Although the research on reversible MAO-B inhibition in humans to promote weight loss is only in phase2a of its clinical trials (NCT07009171), I think this is one of those studies worth following over the coming years (results are expected in 2027). I would love to hear your thoughts on the potential of these drugs in humans. Best References Park, J. H., Ju, Y. H., Choi, J. W., Song, H. J., Jang, B. K., Woo, J., Chun, H., Kim, H. J., Shin, S. J., Yarishkin, O., Jo, S., Park, M., Yeon, S. K., Kim, S., Kim, J., Nam, M. H., Londhe, A. M., Kim, J., Cho, S. J., Cho, S., … Park, K. D. (2019). Newly developed reversible MAO-B inhibitor circumvents the shortcomings of irreversible inhibitors in Alzheimer's disease. Science advances, 5(3), eaav0316. https://doi.org/10.1126/sciadv.aav0316 Sa, M., Yoo, E. S., Koh, W., Park, M. G., Jang, H. J., Yang, Y. R., Bhalla, M., Lee, J. H., Lim, J., Won, W., Kwon, J., Kwon, J. H., Seong, Y., Kim, B., An, H., Lee, S. E., Park, K. D., Suh, P. G., Sohn, J. W., & Lee, C. J. (2023). Hypothalamic GABRA5-positive neurons control obesity via astrocytic GABA. Nature metabolism, 5(9), 1506–1525. https://doi.org/10.1038/s42255-023-00877-w
Is taking care of our Gut Biome the answer?
What do you think about Dr. Jamnadas's work with Gut Biome (Cardiovascular surgeon, Lecturer with Florida State University, Cardiovascular Institute Florida, Aristotle Education, the Galen Institute and has various youtube channels). I am particularly interested in the links to inflammation and mental health. Can you heal the gut lining. Can you actually get better from diabetes? Why haven't you had him on your show yet? He is all about health, wellbeing, health span and longevity. I'd love to know whether you think he is right.
#369 hottub vs sauna
I think you said a hottub at 104 degrees neck down for 20 mins has similar benefits to a sauna. Is that true? I have both (hottub and sauna) but I don’t sweat in the sauna even when I workout before and wear clothes. I get very hot in the hottub so it’s easier and a much more efficient use of my time.
Neurodiverse Docs
Your guest episode this week about ketogenic diets and exogenous ketones answered a question I sent in a month ago perfectly, thank you! Last year you featured a guest who focused on pediatric autism and you delved into the complex world of the changes in definition of ASD and then ABA therapy. Tonight, I received an email pointing me to a resource called neurodiversedocs.com which looks at ways to recognize and support a myriad of different learning and function styles in physicians - ASD, ADHD, Anxiety, etc. I have no affiliation with this site, or with Krystal Sodaitis who operates the site, but this topic may be of interest to many of the 20-25% of physicians in your audience (noted from the episode before Thanksgiving on hypothyroidism).
Biotin Interference with Thyroid Assays
In the episode with Antonio Bianco, MD, PhD, I was surprised there was no discussion of how biotins interference with thyroid function testing. Having Hashimoto's for over 20years, I was starting to feel symptomatic after 15 years of stable symptoms. My PCP was running tests (my endocrinologist had retired and I just haven't made an appt. with a new endo), and she kept telling me was actually hyperthyroid, which I knew couldn't be possible. As a zebra a medicine, I drove into the literature. I didn't realize my creatine supplement at biotin in it even though I stopped my multivitamin before blood work. We repeated my labs two weeks later after going off all supplements, and my thyroid labs were in the opposite direction in line with my symptoms. Happy to share screen shots to show now dramatic this difference was using the same lab/assays, but most physicians don't know about biotin issues in labs. I am sure it is leading to many incorrect or delayed diagnosis given the prevalence of biotin in supplements at very high dosages. Additionally, it is possible to have both Hashimoto's and Graves at the same time. While extremely rare, it can be a reason why labs and symptoms don't add up, or responses people seems to swing back and forth between symptom profiles. My friend and aunt have both conditions. I can't underscore enough that taking T4 and T3 can be life altering. Cytomel changed my life, and I hope more MDs considering prescribing it. It did take some work to get the dose correct, but it's worth the effort. Sorry, these are not questions, but I hope additional information can be provided to people either in an AMA, the qualys, and/or follow-up guests. I have been a follower for years, and my thyroid health has both ruined my life, and when functioning, giving me a normal life.
HRT and Breast Cancer
There’s a recent article that said research is now showing that up to 1 in 4 breast cancers are occurring in women under age 50. This flies in the face that HRT causes breast cancer, yet the narrative is still strong. So, what are the likely reasons for the increase in breast cancer occurrence in young women? Any possible relation to the fact that many, many Americans are very/significant overweight? Are there any studies on obesity and cancers?
How do I get energy??
I am 66 years old and have struggled with low energy for decades I think. I am healthy, take vitamins and minerals (B, C, D, multivitamin,magnesium glycinate, ubiquinol and coQ10) and exercise regularly. I am 5’6” and weigh 132 lbs, I take medication for hypothyroidism and I am on estrogen and progesterone under the care of my naturopath (all meds are evaluated regularly) and eat a balanced diet including about 70g of protein a day and lift as heavy as I can at the gym. My blood work shows I have basically no testosterone in my body but when I have taken it in the past, my hair starts falling out so I stop. I don't know if that is a factor or not. Where do people get all their energy? I do a good job at work and maintaining a household, but I always feel like I’m running at half-speed. Every once in a while, probably every few months, I will have several hours where I feel I am on top of the world, feeling good and being my best self. But I can't tie that feeling to any specific behavior before that. I would love to hear any suggestions you may have.
Exercise speed and progressive overload
isn’t the concept of progressive overload somewhat negated by the fact that you get faster at doing the exercise? For example, if you can do five reps in 20 seconds and then six months from now you can do 15 reps in 20 seconds is this one way to approach it where you don’t have to think about adjusting and increasing your weight until you’re literally doing it at a pace that is unreasonable? If that is true, should you use a specific time such as 30 seconds or one minute and then once you do a certain number within that timeframe increase your weight and use time based progressive overload or do you suggest weight based progressive overload? Thanks.