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#085 Dr. Peter Attia on Mastering Longevity – Insights on Cancer Prevention, Heart Disease, and Aging

Wed Dec 27 2023
preventative medicinecardiovascular diseasecholesterol managementexercisecancer screeninghormone replacement therapypersonalized care


Dr. Peter Atia discusses preventative medicine, cardiovascular disease, cholesterol management, exercise, cancer screening, hormone replacement therapy, and personalized care. Key takeaways include the importance of Apo B as a predictor of cardiovascular disease, the benefits of lifestyle changes in managing lipid levels, the role of mitochondrial function in health and aging, and the misconceptions surrounding hormone replacement therapy. The episode provides valuable insights into optimizing health and longevity.


Apo B is a better predictor of cardiovascular disease than LDL particle number.

Measuring Apo B levels can provide more accurate risk assessment for cardiovascular disease compared to LDL particle number.

Lowering triglyceride levels is an important step in managing insulin resistance and reducing Apo B.

Dietary interventions such as carbohydrate restriction can effectively lower triglyceride levels and improve metabolic health.

Exercise plays a crucial role in improving insulin sensitivity and glucose disposal.

Regular physical activity, including both aerobic and strength training exercises, can help lower blood sugar levels and reduce the risk of chronic diseases.

Early detection through screening is crucial for effective cancer treatment.

Regular screenings, such as mammograms and colonoscopies, can detect cancer at an early stage when it is more treatable and improve survival rates.

Hormone replacement therapy can be a safe and effective option for managing menopause symptoms.

Individualized hormone replacement therapy can help alleviate symptoms such as hot flashes, mood swings, and sleep disturbances associated with menopause.


  1. Preventative Medicine and Longevity
  2. Cardiovascular Disease and Atherosclerosis
  3. Measuring APOB and LDL Concentration
  4. Superiority of APO-B Over LDL-P
  5. Optimal APOB Levels and Causality
  6. LDL Regulation and Atherosclerosis Development
  7. Dietary Factors and Apo B Levels
  8. Response to Saturated Fat and Pharmacologic Tools
  9. Low Cholesterol and Cancer Outcome
  10. Cholesterol Absorption and Statins
  11. Mitochondrial Function and Exercise
  12. Zone Two Testing and Exercise Guidelines
  13. Cancer Screening and Prevention
  14. Alternative Treatments for Lipid Control
  15. New Approaches to Cholesterol Management
  16. Berberine and Glucose Regulation
  17. Glucose Disposal and Insulin Sensitivity
  18. Blood Pressure Control and Cardiovascular Health
  19. Exercise Guidelines and VO2 Max Training
  20. ERG Testing and VO2 Max Measurement
  21. Liquid Biopsies and Cancer Detection
  22. Breast Cancer Screening and Detection
  23. Screening Methods and Liquid Biopsies
  24. Hormone Replacement Therapy and Menopause
  25. Hormone Replacement Therapy Options
  26. Hormone Replacement Therapy for Menopause
  27. Bone Health and Hormone Replacement Therapy
  28. Vitamin D and Bone Health
  29. Testosterone Replacement Therapy in Women
  30. Testosterone Replacement Therapy in Men
  31. Hair Loss and Blood Pressure Control
  32. Blood Pressure Measurement and Prevention
  33. Personalized Medicine and Preventative Care
  34. Lifestyle Habits and Personal Routine
  35. Writing and Key Takeaways

Preventative Medicine and Longevity

00:00 - 07:32

  • Dr. Peter Atia is a respected expert in preventative medicine and longevity.
  • Apo B is a better predictor of cardiovascular disease than LDL particle number.
  • There are four main factors that elevate Apo B.
  • Apo B exists in humans but not in most species.
  • Low LDL may or may not be a risk factor for cancer.
  • Peter's opinion on ApoB reference ranges and the possibility of an ApoB level low enough to prevent death from atherosclerosis.
  • Certain dietary factors can increase ApoB levels.
  • The workings and side effects of statins and other lipid lowering pharmacotherapies, as well as alternatives to them.
  • Increased muscle mass helps lower blood sugar levels, reducing overall mortality.
  • Visceral fat correlates with increased cancer risk.
  • Aggressive cancer

Cardiovascular Disease and Atherosclerosis

07:04 - 14:18

  • Cardiovascular disease, specifically atherosclerotic cardiovascular disease (ASCVD), is the leading cause of death in the United States and globally.
  • ASCVD refers to the disease of coronary arteries that leads to reduced blood flow to key parts of the heart muscle, resulting in ischemia.
  • The majority of deaths from cardiovascular disease are caused by plaque formation inside coronary arteries.
  • Sudden death is a common first symptom of coronary artery disease, although it now occurs in less than 50% of cases.
  • Cholesterol is essential for cell fluidity and the production of important hormones like estrogen, progesterone, and cortisol.
  • Lipoproteins are used to transport cholesterol throughout the body via the bloodstream.
  • Apolipoprotein B100 (ApoB100) is an important structural protein found on

Measuring APOB and LDL Concentration

13:49 - 20:45

  • Intermediate density lipoproteins (IDLs) and very low density lipoproteins (VLDLs) are part of the family of high density lipoproteins (HDLs).
  • Total cholesterol concentration in lipoproteins was loosely correlated with cardiovascular outcomes, but only at extremes.
  • Low density lipoprotein (LDL), a subset of total cholesterol, is a stronger predictor of risk for cardiovascular disease.
  • The concentration of all APOB particles is a better way to predict risk than measuring cholesterol within LDL.
  • There are two ways to measure APOB: using an equation called the Friedewald equation or directly measuring LDL concentration.
  • Most labs still use the Friedewald equation to estimate LDL cholesterol.
  • Direct measurement of LDL concentration is superior to estimating it using the

Superiority of APO-B Over LDL-P

20:18 - 26:58

  • The speaker switched from NMR to IMMOTILITY for LDLP testing, but ultimately switched to APO-B because it was superior in accuracy and standardization across different labs.
  • ApoB is favored over LDL-P because it encompasses the total atherogenic burden, including high VLDL levels that can be missed by LDLP or LDLC testing.
  • Small dense LDL particles are harder to clear and pose a higher risk of atherosclerosis, which is why ApoB captures this risk better than other metrics.
  • Elevated ApoB can be caused by factors such as cholesterol synthesis, cholesterol reabsorption, triglyceride burden, and clearance issues related to the LDL receptor on the liver.
  • Drugs used to treat LDL indirectly or directly impact the LDL receptor and clearance.
  • ApoB allows for

Optimal APOB Levels and Causality

26:30 - 33:23

  • The reference lab used in the podcast considers an ApoB level below 80 to be wonderful, as it is the 20th percentile of the population.
  • The lab categorizes ApoB levels between 80 and 100 as intermediate risk, and levels above 120 as very high risk.
  • The speaker believes that understanding the causality of APOB is crucial, as it is not just associated with cardiovascular disease but causally linked to it.
  • The analogy of cigarettes and lung cancer is used to emphasize that when there is a causal driver of a disease, it should be eliminated immediately.
  • Atherosclerosis takes decades to progress, and Apop is one of its biggest drivers along with high blood pressure, smoking, and insulin resistance.
  • Lowering ApoB levels sooner rather than later has

LDL Regulation and Atherosclerosis Development

32:55 - 39:46

  • LDLR regulation involves a combination of conformational changes and reduced presence over time.
  • ApoB is not necessary for most species, as they can transport everything with HDL.
  • LDL plays a major role in reverse cholesterol transport, bringing cholesterol back to the liver.
  • Evolutionarily, humans prioritize having a lot of cholesterol due to its labor-intensive production process.
  • Physiologic levels of LDL cholesterol and ApoB in children are typically below 20 milligrams per deciliter without negative consequences.
  • Clearance reduction and additional LDL needs occur during teenage years and twenties.
  • APOB level below 30 milligrams per deciliter may prevent atherosclerosis development.
  • Lowering APOB to 30 requires aggressive intervention for most people.
  • Risk of dying from atherosclerosis depends on

Dietary Factors and Apo B Levels

39:34 - 46:45

  • High levels of Apo B, a protein associated with increased risk of atherosclerosis, can be influenced by lifestyle and dietary factors.
  • Insulin resistance and high triglyceride levels are major contributors to elevated Apo B.
  • Lowering triglyceride levels is an important step in managing insulin resistance and reducing Apo B.
  • Carbohydrate restriction, particularly refined and starchy carbohydrates, is effective in lowering triglycerides.
  • Saturated fat consumption can directly impact cholesterol synthesis and inhibit LDL receptors, leading to higher Apo B levels.
  • The impact of saturated fat on Apo B varies among individuals due to genetic differences.
  • Swapping saturated fat with monounsaturated or polyunsaturated fats may help improve Apo B levels for some individuals.

Response to Saturated Fat and Pharmacologic Tools

46:27 - 53:04

  • Shifting from high saturated fat to high monounsaturated fat can fix hyper response to saturated fat for about half of the people.
  • Excessively restrictive low-fat diets can lead to insulin resistance and other issues.
  • Using nutrition to solve lipid problems may not be the best solution, as there are effective pharmacologic tools available for managing blood pressure and lipids.
  • ApoB and LDLC levels are highly genetic, supported by epidemiologic data, clinical trial data, and Mendelian randomization studies.
  • People with familial hypercholesterolemia have extremely high LDL cholesterol levels, while those with hypofunctioning PCSK9 gene have very low LDL cholesterol levels.
  • PCSK9 is a protein that degrades LDL receptors.

Low Cholesterol and Cancer Outcome

52:39 - 59:17

  • Some people have a hyperfunctioning PCSK9 gene, which leads to high LDL cholesterol levels but no increase in the incidence of other diseases.
  • Studies that show low cholesterol is associated with higher all-cause mortality may be biased because they sample a subset of high-risk individuals who are being aggressively treated.
  • Mendelian randomization studies have shown that low LDL cholesterol does not have any bearing on cancer outcome.
  • Pharmacological interventions, such as PCSK9 inhibitors, can effectively lower apo B levels.
  • The first drug used to lower lipids, Triperinal, turned out to be harmful despite lowering cholesterol levels.
  • Bile acid sequestrants are another class of drugs that lower cholesterol by reducing its reabsorption in the gut.

Cholesterol Absorption and Statins

58:51 - 1:05:21

  • Cholesterol absorption in the body is regulated by various steps, including the excretion of unesterified cholesterol through ATP binding cassette.
  • Bile acid sequestrants were an early class of drugs used to lower cholesterol but had limited success and significant side effects.
  • The development of statins in the late 1980s revolutionized the pharmacological approach to treating ASCVD (atherosclerotic cardiovascular disease).
  • Statins work by inhibiting cholesterol synthesis, primarily in the liver, leading to increased LDL receptors and decreased LDL cholesterol levels.
  • Common side effects of statins include muscle aches (in about 7% of people) and insulin resistance (in a small subset, around 0.4%).
  • Monitoring markers like hemoglobin A1C, fasting insulin and glucose levels, and

Mitochondrial Function and Exercise

1:05:00 - 1:12:07

  • Mitochondrial function is an important indicator of health and aging.
  • Functional tests, such as zone two testing, are crucial in measuring mitochondrial function.
  • Zone two testing involves putting a person under controlled physical demand while sampling lactate levels to assess ATP generation.
  • Metformin, a drug that impairs complex one of the mitochondria, has been shown to reduce zone two output and increase fasting resting lactate levels.
  • Statins, on the other hand, do not appear to have the same effect on mitochondrial function as metformin.
  • Clinical trials on supplementing ubiquinol with statin users have not shown significant differences in muscle soreness.
  • While there may be no harm in taking ubiquinol with statins, it is unclear if it offsets any potential negative effects on mitochondrial function.

Zone Two Testing and Exercise Guidelines

1:11:51 - 1:18:32

  • There are different ways to estimate zone two output without using lactate testing.
  • Rate of perceived exertion (RPE) is a valuable tool for exercising in zone two and is especially useful for out-of-shape individuals.
  • The talk test can be used to determine if someone is in zone two during exercise. They should be able to speak, but it should be uncomfortable.
  • Heart rate guidance can also be used, such as the formula 180 minus age. However, the fitter you are, the less relevant this becomes.
  • HRV (heart rate variability) can be measured using apps like Morpheus to predict zone two heart rate. This prediction may vary based on factors like sleep quality and soreness.
  • For someone starting out, RPE and 180 minus age are sufficient guidelines for exercising

Cancer Screening and Prevention

1:18:11 - 1:25:28

  • There has never been a study that directly links the use of statins to the incidence of Alzheimer's disease or dementia as a primary outcome.
  • Multiple studies have found no significant impact of statin use on the incidence of dementia or Alzheimer's disease, including vascular dementia and Parkinson's disease.
  • There is no difference in the outcomes between hydrophobic and hydrophilic statins.
  • The highest incidence of diabetes is associated with atorvastatin, but this may be because it is widely used.
  • Four statins are considered worth prescribing: rosuvastatin (Crestor), atorvastatin (Lipitor), pitavastatin (Livalo), and sometimes pravastatin (Pravachol).
  • Desmosterol levels can be used as a proxy for

Alternative Treatments for Lipid Control

1:24:59 - 1:31:43

  • Statins are not the only option for controlling lipids and there is no reason to take unnecessary risks with them.
  • PCSK9 inhibitors are highly effective and safe alternatives to statins, but they can be expensive and insurance coverage may be limited.
  • Azetamide is a less potent but relatively inexpensive alternative to statins that increases LDL receptors on the liver by impairing cholesterol reabsorption.
  • Patients with defective ATP binding cassettes in their gut may respond well to azetamide treatment.
  • High levels of phytosterols, which are cholesterol from plants, can indicate a defective ATP binding cassette and may be more atherogenic than cholesterol itself.
  • Using phytosterols as an over-the-counter treatment to lower cholesterol can lead to increased absorption of phytosterols in patients with defective ATP

New Approaches to Cholesterol Management

1:31:16 - 1:38:13

  • Bettmendoc acid is a drug that inhibits cholesterol synthesis in the liver without impacting other cells like statins do.
  • CT angiogram is considered the best way to assess plaque accumulation in arteries and the vascular system.
  • Ordering a CT angiogram should only be done if the results would change patient management.
  • Positive findings in young people or negative findings in old people from a CT angiogram can lead to different actions.
  • Biomarkers of interest should be tracked to assess risk, especially for younger individuals.
  • Berberine has been found to have beneficial effects on clearing plaque and lowering LDL cholesterol levels. It is also a mitochondrial toxin.

Berberine and Glucose Regulation

1:37:49 - 1:44:42

  • Berberine has been shown to lower LDL cholesterol and may also have a mitochondrial toxin effect.
  • Berberine is considered a poor man's metaphor and has potential benefits for metabolic health.
  • Studies have shown that berberine can lower the side effects of statin myopathy and reduce the effective dose of statins needed to lower LDL cholesterol.
  • Glucose disposal is an important aspect of glucose regulation in the body, involving the interplay between the endocrine system, liver, and muscles.
  • A fasting blood glucose level of 100 milligrams per deciliter is considered on the cusp of being too high.
  • The majority of glucose in the body is stored in the liver and muscles, with only a small amount circulating in the blood.
  • The brain primarily relies on glucose from circulation, while other

Glucose Disposal and Insulin Sensitivity

1:44:22 - 1:51:52

  • Glucose disposal in the muscle is primarily insulin-dependent, where insulin triggers glucose transporters to bring glucose into the muscle cells.
  • People who are fit and do a lot of cardio training can also have an insulin-independent system where exercise itself promotes glucose transport across the muscle.
  • Elevated levels of glucose can be toxic and lead to chronic damage, affecting protein function and narrowing blood vessels, particularly in microvascular areas like the eyes.
  • Elevated levels of insulin can be damaging to larger blood vessels in the heart, kidneys, and brain.
  • Chronic elevation of glucose leads to increased insulin production as a solution to resistance at the cell level.
  • Exercise is crucial for increasing insulin sensitivity and improving glucose disposal. Other factors that affect this system include energy balance, sleep disruptions, hormonal changes (such as reduced estrogen and testosterone), hyperc

Blood Pressure Control and Cardiovascular Health

1:51:28 - 1:58:39

  • Normalizing post-prandial glucose levels through exercise can be beneficial, even for individuals not on a low carb diet.
  • Lower average blood glucose levels are generally better for overall health, even outside the range of diabetes.
  • Hemoglobin A1c data suggests that an average blood glucose level of 100 is better than 115.
  • Metrics such as post-prandial spikes, standard deviation, and exceeding threshold values can provide indirect insights into insulin secretion.
  • Certain activities like high-intensity interval training (HIIT) can temporarily spike glucose levels but are not necessarily harmful in the short term.
  • Metabolic flexibility refers to the ability to switch between using glucose and fatty acids as energy sources.
  • Training in zone two (80% cardio training time) helps improve metabolic flexibility by expanding mitochondrial capacity to utilize fatty acids

Exercise Guidelines and VO2 Max Training

1:58:13 - 2:05:01

  • Most people cannot sustain a power output of 330 to 340 watts for one minute, but some athletes can do it for hours while keeping their lactate levels low.
  • The concept of 80/20 training is based on achieving the highest VO2 max and metabolic flexibility.
  • To build a strong cardio respiratory engine, it is important to have a broad aerobic base (zone 2 efficiency) and a high peak (VO2 max).
  • Doing too much high-intensity training without a solid aerobic base can lead to inefficiency in mitochondria.
  • A balanced approach with both low-intensity and high-intensity training is recommended for optimal results.
  • VO2 max training involves slightly longer intervals than traditional HIIT, with rest periods equal to the work periods.
  • The sweet spot for generating VO2 max is

ERG Testing and VO2 Max Measurement

2:04:34 - 2:11:43

  • The podcast discusses an exercise test called ERG, which is different from Peloton because the computer determines the wattage based on pedaling speed.
  • During the ERG test, the resistance and wattage increase over time, and it's important to maintain a high RPM (80-100) to avoid test failure.
  • The tech conducting the test measures VO2 (ventilation rate of oxygen), VCO2 (ventilation rate of CO2), and the ratio of VCO2 to VO2 (respiratory quotient or RQ).
  • The respiratory quotient indicates how much fat is being oxidized versus carbohydrates. A ratio of 0.7 means 100% fat oxidation, while a ratio above 1 means no fat oxidation.
  • It's recommended to request both a summary and raw data from the

Liquid Biopsies and Cancer Detection

2:11:18 - 2:18:29

  • The grail test is used to detect cancer that has spread or shed its DNA outside its site of origin.
  • The sensitivity of the grail test for breast cancer is low, but the specificity is high.
  • For early-stage ERPR negative breast cancers, the sensitivity of the grail test is 75-80%.
  • Triple positive ERPR positive, her two new breast cancers have low sensitivity and specificity on the grail test.
  • Indolent breast cancers are less likely to be detected early by the grail test, while aggressive ones are more likely to be detected early.
  • Liquid biopsies combined with other morphology types of screens may be a useful approach in cancer detection.
  • CT scans are not recommended as a screening method due to their high radiation levels, except for former or current smokers at

Breast Cancer Screening and Detection

2:18:01 - 2:25:25

  • Mammograms are good at detecting calcified lesions but not non-calcified lesions, while MRIs are the opposite.
  • Combining multiple tests can increase the accuracy of screening for breast cancer.
  • Colonoscopy is a highly sensitive and safe procedure for detecting colon cancer, but it carries physical risks.
  • Recommendations for colonoscopy frequency depend on factors such as family history and findings from previous screenings.
  • For younger individuals, starting mammograms at 40 and doing ultrasounds every six months may be recommended based on risk factors.
  • Early detection of breast cancer greatly improves survival rates, with stage one being non-fatal and stage four being uniformly fatal.
  • Liquid biopsies can detect cancer by analyzing

Screening Methods and Liquid Biopsies

2:24:58 - 2:32:15

  • Mammograms should not be relied upon exclusively for breast cancer screening and should be combined with ultrasound or MRI.
  • There is fear surrounding the amount of radiation involved in ultrasounds and MRIs.
  • A test called molecular breast imaging (MBI) used to be done before the utility of MRIs, but it is no longer performed.
  • Liquid biopsies are effective for detecting blood cancers such as leukemia and myeloma.
  • The cost of liquid biopsies is typically around $900 to $1000, and they may require a doctor's order.
  • Women experience hormonal changes during menopause, including a decline in estrogen, progesterone, and testosterone levels.
  • Vasomotor symptoms like hot flashes and night sweats are common during menopause.
  • Other symptoms include brain fog, sleep

Hormone Replacement Therapy and Menopause

2:45:01 - 2:52:36

  • The interpretation of the Women's Health Initiative study in 2001, which suggested that hormone replacement therapy (HRT) increases the risk of breast cancer, was completely misinterpreted.
  • Over 20 million women have been deprived of hormones due to this misinterpretation, resulting in unnecessary lives lost.
  • There is still a misunderstanding among some women that HRT increases the risk of dying from breast cancer when it actually does not.
  • The Women's Health Initiative study had major flaws, including not clarifying the difference between estrogen plus progestin (MPA) and estrogen alone groups.
  • Estrogen alone group had a lower incidence and mortality rate of breast cancer compared

Hormone Replacement Therapy Options

2:58:49 - 3:06:00

  • Women nowadays have options for taking progesterone, such as bioidentical micronized oral progesterone or a progesterone-coated IUD.
  • Some women don't respond well to progesterone and may use a progesterone uncoded IUD instead.
  • Estrogen did not drive the incidence of breast cancer or mortality associated with breast cancer in this study.
  • Oral estrogen is no longer used, and bioidentical estrogens are preferred.
  • Bioidentical estrogens include estradiol and/or estryol, but there is no FDA-approved estryol product.
  • Estradiol can be turned into estrone (E1) and estrol (E3), but E3 cannot be turned into E2 or E1.
  • The four hydroxy

Hormone Replacement Therapy for Menopause

3:05:39 - 3:12:02

  • Perimenopause is a transitional phase before menopause, and the dose of hormone therapy for women in perimenopause is low relative to their pre-menopausal levels.
  • Estradiol and FSH levels are measured on day five of the menstrual cycle to determine if a woman is transitioning to perimenopause.
  • Rising FSH levels indicate that menopause is approaching, and symptoms may start appearing at this stage.
  • AMH levels can provide insight into fertility and the number of eggs or follicles remaining.
  • Treatment for perimenopause typically begins when symptoms occur, and lower doses of hormones can be effective.
  • In full-fledged menopause, estrogen doses are given to reduce FSH levels to around 25, which helps manage symptoms and preserve bone density.
  • Hormone replacement therapy (HRT)

Bone Health and Hormone Replacement Therapy

3:11:41 - 3:18:04

  • The chemical transduction system in our bones turns force into bone building.
  • Estrogen plays a crucial role in promoting bone growth by converting force into a chemical signal for osteoblasts and osteoclasts.
  • Removing estrogen from a woman post-menopause leads to rapid bone decline, but starting estrogen therapy later can still be beneficial.
  • Bisphosphonates are not as effective as estrogen for treating bone mineral density (BMD) and can only be used for a limited time.
  • Even if the protection from hormone replacement therapy (HRT) is lost and there is a slight increase in risk, the overall risk of falling may still make HRT neutral or beneficial.
  • Lifestyle factors like resistance training and muscle mass can contribute to better bone health.
  • Vitamin D deficiency may also impact bone metabolism and have

Vitamin D and Bone Health

3:17:43 - 3:24:52

  • Going above 60 nanograms per milliliter of vitamin D is still associated with lower all-cause mortality.
  • High doses of vitamin D can lead to increased absorption of dietary calcium and phosphorus, which can cause problems.
  • Most people are not supplementing excessively with vitamin D, but some individuals may need higher doses due to genetic factors.
  • Vitamin D trials often use low doses and do not measure blood levels adequately, leading to flawed results.
  • There is a lack of reliable randomized controlled trial (RCT) data on the optimal vitamin D level for health benefits.
  • Avoiding deficiency is important, but the ideal vitamin D level is still uncertain.
  • There may be potential interactions between estrogen and vitamin D levels that require further study.
  • Testosterone replacement in women post-menopause is an area that is being

Testosterone Replacement Therapy in Women

3:24:28 - 3:31:38

  • Testosterone is being used more liberally in women for various purposes, including maintaining muscle mass as they age.
  • The goal is to restore women's testosterone levels to what they were in their 30s and 40s, which is about 1/10th the dose that men take for physiologic replacement.
  • Initiating hormone replacement therapy (HRT) in women who are 10 years post-menopause is challenging and handled on a case-by-case basis due to potential risks.
  • Risk assessment for AD, AS-CVD, and breast cancer helps determine the suitability of HRT for individual women.
  • The use of testosterone alone without estrogen and progesterone is not yet fully understood and requires further study.
  • Hormone replacement therapy is personalized and tailored to each woman's needs, taking into account

Testosterone Replacement Therapy in Men

3:31:08 - 3:37:55

  • Testosterone replacement therapy (TRT) may not be as helpful as believed due to variations in androgen receptors and the difficulty in accurately measuring testosterone levels.
  • Symptoms such as reduced libido, energy, mood, insulin resistance, difficulty gaining muscle mass, and exercise recovery can indicate a need for TRT.
  • The decision to start TRT depends on the individual's testosterone levels and symptoms. Incremental increases are recommended to assess effectiveness.
  • Injections are preferred over gels for TRT due to more consistent absorption. Twice-weekly injections at lower doses provide a steadier testosterone level.
  • TRT does not increase the risk of prostate cancer but may potentially increase benign prostatic hypertrophy (BPH), hair loss, and acne in susceptible individuals.
  • Strategies like taking five-alpha reductase inhibitors can help mitigate

Hair Loss and Blood Pressure Control

3:37:33 - 3:44:12

  • Hair loss concerns can be addressed with strategies such as taking five-alpha reductase inhibitors to block the conversion of testosterone to dihydrotestosterone.
  • Some patients prioritize hair over testosterone and choose not to take testosterone.
  • Testosterone may slightly increase the risk of cardiovascular events in susceptible individuals due to an increase in blood pressure, but this risk diminishes over time.
  • Aggressive blood pressure control is important, with a target of 120/80 or better.
  • Blood pressure is a significant risk factor for cardiovascular disease and can often be improved through lifestyle interventions such as weight loss and exercise.
  • Sauna or hot tub use may indirectly affect blood pressure by impacting cortisol levels.
  • Exercise, diet, and donating blood have been observed to help normalize high blood pressure in some individuals with hemochromatosis.

Blood Pressure Measurement and Prevention

3:43:45 - 3:50:29

  • A patient's blood pressure improved after implementing lifestyle changes and logging measurements at home.
  • Homocysteine levels can impair the clearance of ADMA and SDMA, which indirectly inhibit nitric oxide synthase and are associated with poor outcomes in cardiovascular disease.
  • Coca flavanols can lower homocysteine levels and increase nitric oxide synthase activity, potentially leading to a reduction in blood pressure.
  • The Sprint trial established the gold standard for measuring blood pressure using an automated cuff, emphasizing the importance of accurate readings and avoiding stimulation during measurement.
  • Patients are advised to check their blood pressure twice a day for two weeks to obtain an average reading, rather than relying on a single measurement at the doctor's office.
  • To achieve aggressive prevention in healthcare, individuals can become informed consumers of their own healthcare information

Personalized Medicine and Preventative Care

3:50:08 - 3:56:52

  • The speaker discusses a panel at Boston Hart that provides comprehensive results for personalized care.
  • The goal is to have a critical mass of people and physicians who want to practice this type of medicine.
  • Physicians need to be re-educated in order to practice this way, which is why the speaker has invested time in building a program.
  • Medicine 3.0 focuses on highly preventive, super early, personalized care.
  • The speaker emphasizes the importance of sleep and having a consistent bedtime and wake-up time.
  • The speaker uses an eight sleep mattress cover for cooling during sleep.
  • Before bed, the speaker avoids looking at anything that will activate them, such as email or social media.
  • The speaker has a separate phone with limited functions to avoid temptation before bed.
  • Brushing and flossing teeth before using the sauna

Lifestyle Habits and Personal Routine

3:56:23 - 3:59:01

  • The speaker focuses on getting 40 to 50 grams of protein four times a day, with some meals consisting solely of protein.
  • They make sure to stop eating at least three hours before bed to improve sleep quality.
  • While they believe there are no biochemical benefits to alcohol, they acknowledge the prosocial benefits and consume around seven or eight drinks per week, usually with dinner.
  • Exercise is the most important aspect of their routine, including zone two workouts, strength training sessions, and recreational activities like rucking.
  • Mental health is also crucial, with therapy sessions and journaling playing a significant role in improving their quality of life.
  • The speaker has a podcast called "Drive" available on various platforms and a book titled "Outlive."
  • They have websites where people can sign up for newsletters and access additional content

Writing and Key Takeaways

3:56:23 - 3:59:01

  • Writing sharpens your thinking and helps you get clear on what you're saying.
  • Some people may not fully understand your message from a podcast, so writing a book could be beneficial.
  • The conversation with Dr. Peter Atia was enjoyable and there is potential for future discussions.
  • A free evidence-based blueprint is available for download at, focusing on improving cognitive function and delaying brain aging.
  • The blueprint includes protocols for exercise, nutrition, supplementation, and Ronda's specific strategies for cognitive and neuroprotective impact.