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    #275 - AMA #52: Hormone replacement therapy: practical applications and the role of compounding pharmacies

    enOctober 16, 2023

    Podcast Summary

    • Challenging the Stigma of Hormone Replacement TherapyHormone replacement therapy is a valuable option for perimenopausal and postmenopausal women in improving their health, and it is essential to promote informed discussions and support for its use.

      Hormone replacement therapy (HRT) has been unfairly demonized in the mainstream medical community. The misinterpretation of the women's health initiative has led to a gross injustice for perimenopausal and postmenopausal women seeking hormone therapy. This topic is not only relevant for women but also for men who care about women's health. It is important to pay attention to discussions on HRT as it can help not only women but also those who support them. Additionally, the conversation around HRT also sheds light on the use of compounding pharmacies, which can be beneficial for those in need of custom prescriptions. Overall, this discussion aims to provide practical applications and insights for the use of HRT in women's healthcare.

    • Diagnosing Menopause and Tracking Hormone LevelsBlood tests, particularly measuring FSH and LH levels, can indicate the onset of menopause or provide insight into inconsistent periods. It is important to note that women still having periods are not in menopause.

      To confirm the onset of menopause, a clinical diagnosis requires 12 months of amenorrhea without any other obvious cause. However, there are blood tests that can indicate the approaching menopause or be useful in cases of inconsistent periods. The main hormone to look at is follicle stimulating hormone (FSH), which provides a sense of where a woman is in her trajectory towards menopause. FSH levels can be measured along with luteinizing hormone (LH). It is important to note that women who are still having periods, even if they are infrequent due to factors like the use of an IUD, are not considered to be in menopause yet. To gain a better understanding of female reproductive hormones and their changes throughout a cycle, watching the provided video on the subject can be helpful.

    • Measuring hormone levels for menopause diagnosis and fertility planning.FSH and LH levels around 20-25 indicate menopause, but diagnosis considers symptoms. AMH levels help with reproductive planning.

      Measuring FSH, LH, and estradiol levels on day 5 can provide valuable information about menopause. When FSH and LH levels rise to around 20 or 25, it indicates that a woman is in menopause. However, it's important to note that menopause is not solely diagnosed based on these hormone levels, but also takes into account other symptoms and medical evaluations. The most common symptoms experienced by women before menopause include hot flashes and night sweats. Other symptoms, such as vaginal dryness and loss of bone density, may occur later. Additionally, for those concerned about fertility, the anti-malaria hormone (AMH) can be indicative of ovarian reserve. Knowing AMH levels and their rate of decline can provide insights for reproductive planning.

    • Hormone Levels and Menopause: Understanding the ImplicationsMonitoring hormone levels, such as FSH, LH, and AMH, can help predict the timing of menopause and guide decisions on fertility and hormone replacement therapies.

      The levels of FSH, LH, and AMH play crucial roles in understanding menopause and its implications. Five years before menopause, FSH and LH are low, while AMH is high. As menopause approaches, AMH levels drop suddenly within a year or two, while FSH and LH rise. This graph displays these changes in hormone concentrations. Studies suggest that an AMH level below 0.2, combined with being over 40 years old, indicates a high probability of entering menopause within the next five years. FSH is also valuable in determining the timing of menopause. On the other hand, an AMH level above 1.5 suggests that menopause is at least six years away, making it helpful for those considering fertility options. Understanding these hormone changes can aid in managing menopausal symptoms and deciding on hormone replacement therapies.

    • Exclusive Member Benefits: Accessing a Wealth of Knowledge and ResourcesBy becoming a member, gain exclusive access to comprehensive show notes, monthly Q&A episodes, premium newsletters, private podcast feed, and valuable highlight reels. Peter values providing more value than the subscription price.

      Peter Attia is committed to providing valuable content without relying on paid ads. He achieves this through the support of his members, who receive exclusive member-only benefits. These benefits include comprehensive podcast show notes, monthly Ask Me Anything episodes, a premium newsletter with in-depth research, access to a private podcast feed, and a highlight reel of previous episodes. By subscribing, members gain access to a wealth of additional knowledge and resources beyond what is available for free. It's clear that Peter's goal is to ensure that the value provided to members far exceeds the price of the subscription. However, it's important to note that the information shared is not a substitute for professional medical advice, and users should consult their healthcare professionals for any specific medical conditions.

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    • The promising potential of klotho for Alzheimer’s disease treatment, and the importance of philanthropy for funding research [1:58:00]; and
    • More.

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    The Peter Attia Drive
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    Julia Wattacheril is a physician scientist and director of the Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) program at Columbia University Irving Medical Center. In this episode, Julia delves deep into the complex world of liver health, beginning with a foundational overview of liver physiology. She provides an in-depth look at how alcohol impacts liver function, breaking down the metabolism of ethanol and its detrimental effects. Julia then shifts the focus to understanding liver function tests and optimal enzyme levels, providing a detailed explanation of AST and ALT and elucidating why fluctuations in these levels may or may not be concerning. She provides a primer on the four major stages of liver disease, discussing risk and emphasizing the importance of early diagnosis. Julia highlights the role of liver disease in increasing the risk of cancer and cardiovascular disease and covers in detail the various strategies for diagnosing, treating, and preventing the progression of liver disease.

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    • The poisonous nature of ethanol to the liver [40:30];
    • Varied responses to alcohol, damaging effects of alcohol beyond the liver, and the process of advising patients on their alcohol consumption [47:15];
    • Understanding liver enzymes AST and ALT—interpreting levels, lifestyle factors that affect them, and diagnostic approaches [58:30];
    • Interpreting liver function tests for fatty liver disease, and the challenges of diagnosing liver pathologies, particularly in children versus adults [1:13:15];
    • Comprehensive liver health assessments via imaging and various diagnostic tools to prevent overlooking potential liver pathologies [1:18:45];
    • Potential impact of recreational drugs, statins, and other medications on liver function test results [1:26:45];
    • Shifting nomenclature from NAFLD to MASLD to reflect accuracy in the underlying pathophysiology and understanding of liver diseases [1:30:30];
    • Pathophysiology of MASLD, the need for proactive screening, and the significance of liver fat percentage as an indicator of metabolic health [1:36:30];
    • The importance of screening for rare conditions alongside common metabolic diseases associated with fatty liver accumulation [1:42:45];
    • Practical strategies for managing MAFLD [1:45:30];
    • The impact of fructose consumption on liver health and the challenges of disentangling its effects from other factors like obesity and insulin resistance [1:52:45];
    • The potential of GLP-1 agonists for the treatment of MASLD [1:57:45];
    • How the four stages of liver disease have evolved [2:00:30];
    • Increased cancer and heart disease risk associated with early-stage MAFLD [2:05:15];
    • Emerging drugs and therapies for addressing fat accumulation and fibrosis related to MAFLD [2:12:15];
    • Peter’s major takeaways [2:18:45]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enMay 20, 2024

    #301 - AMA #59: Inflammation: its impact on aging and disease risk, and how to identify, prevent, and reduce it

    #301 - AMA #59: Inflammation: its impact on aging and disease risk, and how to identify, prevent, and reduce it

    View the Show Notes Page for This Episode

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    In this “Ask Me Anything” (AMA) episode, Peter delves into the often misunderstood concept of inflammation. He first defines inflammation and differentiates between acute inflammation and chronic inflammation, the latter of which is linked to aging and a plethora of age-related diseases. Peter breaks down the intricate relationship between chronic inflammation, obesity, and metabolic health, and highlights the signs that might suggest someone may be suffering from chronic inflammation. From there, the conversation centers on actionable advice and practical steps one can take to manage and minimize chronic inflammation. He explores how diet plays a crucial role, including the potential benefits of elimination diets, and he examines the impact of lifestyle factors such as exercise, sleep, and stress management. Additionally, he discusses the relevance of food inflammatory tests and concludes by examining the potential benefits and drawbacks of drugs and supplements in managing inflammation.

    If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #59 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45];
    • Acute vs chronic inflammation [8:00];
    • The connection between chronic inflammation, aging, and age-related diseases [11:00];
    • The impact of inflammation on metabolic health [18:30];
    • Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00];
    • Factors that contribute to low-level chronic inflammation [28:00];
    • Minimizing inflammation through diet [29:45];
    • The important role of fiber for gut health and inflammation [33:45];
    • A closer look at the impact of trans fats and saturated fats on overall health [34:45];
    • Why Peter prefers dietary fiber from food sources over supplements [38:30];
    • Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00];
    • Is there any value in over-the-counter food inflammatory tests? [42:30];
    • Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15];
    • Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15];
    • Dairy: the complex role of dairy on inflammation and individual responses [55:00];
    • Wheat: the complexities and conflicting evidence around wheat's inflammatory effects [57:45];
    • How exercise influences inflammation [1:02:00];
    • How sleep quality and duration impacts inflammation [1:07:00];
    • The potential impact of chronic psychological stressors on inflammation [1:13:00];
    • The impact of oral health on inflammation and overall well-being [1:15:00];
    • The role of medications in managing chronic inflammation [1:18:15];
    • Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15];
    • Parting thoughts and takeaways [1:27:00]; and
    • More.

    Connect With Peter on TwitterInstagramFacebook and YouTube

    The Peter Attia Drive
    enMay 13, 2024

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