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    #305 ‒ Heart rate variability: how to measure, interpret, and utilize HRV for training and health optimization | Joel Jamieson

    enJune 10, 2024

    Podcast Summary

    • HRV assessmentHRV assessment provides insights into physiological status, revealing balance between sympathetic and parasympathetic nervous systems, crucial for health and performance. Tools like Morpheus Labs can help fine-tune training zones and optimize daily choices.

      Heart rate variability (HRV) is a valuable tool for understanding and optimizing one's health and fitness. Joel Jamieson, the founder of Morpheus Labs and 8 Weeks Out, shares his personal journey of discovery into HRV, which began with a chance encounter with a Russian scientist named Val. Val introduced Joel to the technology of HRV assessment, which provided insights into Joel's physiological status that were previously unavailable. HRV is a measure of the variation in heartbeats, reflecting the balance between the sympathetic and parasympathetic nervous systems. This balance is crucial for overall health and performance. HRV declines with age, but lifestyle choices can influence its level. Morpheus Labs' HRV technology helps individuals and trainers fine-tune training zones, providing valuable information for daily choices and performance optimization. Joel emphasizes that his recommendations for Morpheus are based on his belief in its efficacy, with no financial affiliation. Overall, HRV is an essential metric for understanding one's health and fitness, and tools like Morpheus can help individuals make informed decisions to improve their well-being.

    • HRV measurement techniquesHRV can be measured using an ECG for the highest accuracy, but chest straps and optical sensors on the wrist, forearm, or finger can also provide relatively accurate readings.

      Heart rate variability (HRV) has a rich history, dating back to the 1950s, with significant advancements made by the Russians, particularly in the realm of sports performance. HRV is measured by analyzing the time between heartbeats (R-R intervals) and is most accurately captured using an Electrocardiogram (ECG). The gold standard for HRV measurement is an ECG, which provides a clean and precise electrical signal of the heart's activity. However, chest straps and optical sensors on the forearm, wrist, or finger can also provide relatively accurate readings. The fidelity of these signals varies, with ECGs offering the highest resolution and chest straps coming in a close second. HRV is an essential metric for understanding an individual's autonomic nervous system function and overall health. It has been used for decades in sports performance and has evolved from a research-heavy medical system to widely available technology on phones and wearable devices.

    • HRV measurement accuracyOptical sensors on the forearm can provide accurate HRV measurements if placed correctly, while chest straps remain the most reliable option for heart rate and HRV measurement.

      While electrodes are the gold standard for measuring heart rate and heart rate variability (HRV), optical sensors like those found in wearable devices have become more accurate in the past few years. The location of the sensor plays a significant role in accuracy, with the forearm providing better results due to better blood flow and less movement. HRV is calculated by measuring the variation in time between heartbeats. At rest, a person's heart rate is typically around 60 beats per minute, with an average beat-to-beat interval of one second. However, there is natural variation in heart rate due to the body's autonomic nervous system. Optical sensors measure changes in blood volume beneath the skin to estimate heart rate and HRV. Accuracy can be affected by factors such as motion, skin tone, and sensor location. While chest straps remain the most accurate method for measuring heart rate and HRV, optical sensors on the forearm are a viable alternative if placed correctly. Some devices, like the Apple Watch, use algorithms to interpolate data and provide more accurate readings. It's important to note that even the most accurate devices may not be 100% reliable, especially during high-intensity activities.

    • Heart Rate VariabilityHeart Rate Variability (HRV) is a measure of heart rhythm variation, reflecting balance between the sympathetic and parasympathetic nervous systems. Resting HRV indicates vagal tone, revealing overall health, adaptability, and homeostasis.

      Heart Rate Variability (HRV) is a measure of the variation in time between heartbeats, reflecting the balance between the sympathetic and parasympathetic nervous systems. At rest, the parasympathetic nervous system, specifically the vagus nerve, plays a dominant role in regulating heart rhythm. Measuring HRV involves filtering raw ECG data, calculating various metrics like RMSSD, and assessing the resulting variability. This variability is indicative of vagal tone, which reflects the autonomic nervous system's responsiveness to internal and external stimuli. By analyzing HRV, we can gain insights into overall health, adaptability, and the body's ability to maintain homeostasis.

    • Heart Rate Variability and MortalityHRV declines with age and is associated with increased mortality risk, but the exact physiological mechanisms behind this decline are not fully understood, and both genetics and lifestyle factors influence HRV.

      Heart Rate Variability (HRV) is a measure of the variation in time between heartbeats, which can provide insights into an individual's overall health and autonomic nervous system function. Most commercial HRV measurements are calculated using the root mean square of successive differences between normal R-R intervals, but Apple Watch uses a different method called SDNN, which measures the standard deviation of normal R-R intervals over a 24-hour period. While both methods have their merits, the Apple Watch's method introduces more noise due to combining rest and activity periods. The relationship between HRV and all-cause mortality and disease-specific mortality has been established in research, and HRV declines significantly with age, reflecting a loss of resilience and adaptability. The exact physiological mechanisms behind this decline are not fully understood, but factors such as mitochondrial density, immune system function, and hormonal status are believed to play a role. Cardiovascular fitness and genetics also influence HRV, and the genetic component is estimated to be between 15-70%. HRV and VO2 max share similarities in that they are both influenced by genetics and modifiable through lifestyle factors, and they both provide valuable information about an individual's health status.

    • HRV vs VO2 max for mortality predictionVO2 max is a better indicator of fitness and mortality as it is more modifiable and has a stronger correlation with all-cause mortality compared to HRV, which is less predictive of mortality on its own but can provide valuable insights when used with other metrics and lifestyle factors.

      While Heart Rate Variability (HRV) is an important metric, it is less predictive of mortality compared to VO2 max. VO2 max, which measures the maximum amount of oxygen your body can use during intense exercise, is a better indicator of fitness and mortality as it is more modifiable and has a stronger correlation with all-cause mortality. HRV, on the other hand, is more genetically determined and less modifiable, making it a less reliable predictor of mortality on its own. However, when used in conjunction with other metrics like VO2 max and lifestyle factors, HRV can provide valuable insights into an individual's health and fitness. Ultimately, focusing on improving overall fitness through regular exercise and a healthy lifestyle is the most effective way to reduce the risk of mortality.

    • Autonomic Nervous System, Vagus NerveEffectively regulating the autonomic nervous system through relaxation, proper breathing, and regular exercise is crucial for emotional and physical well-being. Measuring heart rate variability (HRV) using tools like Morpheus can provide insights into the functioning of the autonomic nervous system and overall health status.

      Our autonomic nervous system, specifically the vagus nerve, plays a crucial role in our emotional and physical well-being. The ability to regulate this system effectively through relaxation, proper breathing, and regular exercise is essential for maintaining adaptability, emotional resilience, and overall health. As we age, we may lose the range and coordination of our autonomic nervous system, leading to decreased adaptability, emotional stress, and chronic pain. Measuring heart rate variability (HRV) can provide insights into the functioning of the autonomic nervous system, and tools like Morpheus can help normalize and interpret this data for a more complete understanding of an individual's health status. Morpheus, in particular, measures HRV and tracks other metrics like activity, sleep, and subjective markers to provide a more comprehensive view of an individual's recovery and readiness. It's important to note that various apps may interpret HRV data differently, and the accuracy and meaning of recovery or readiness scores can vary. Therefore, understanding the underlying physiological principles and using multiple tools for measurement can lead to a more informed and holistic approach to health and wellness.

    • Heart rate training appsThe Morpheus app offers a user-friendly and accurate approach to heart rate intensity training, personalizing zones based on individual fitness levels and autonomic nervous system responses.

      While there are various tools and methods to track training intensity, such as heart rate and lactate threshold, the accuracy and practicality of these methods can vary. The speaker shared his experience using the Morpheus app, which provides personalized heart rate zones based on individual fitness levels and autonomic nervous system responses. He was impressed by its accuracy in predicting zone 2 heart rates, which often correspond to the speaker's lactate threshold. The Morpheus app offers a more accessible and user-friendly approach to intensity training compared to traditional methods like lactate testing. The speaker also emphasized the importance of considering individual differences in response to training and the need for personalized guidance. Overall, the Morpheus app offers a valuable tool for individuals seeking to optimize their training intensity and improve their fitness.

    • HRV measurementsMorning HRV measurements inform daily training decisions, while overnight HRV measurements offer insights into long-term trends and adaptation

      Heart Rate Variability (HRV) measurements in the morning provide valuable insights into our body's recovery and readiness for daily activities. These measurements help us understand our body's response to the previous day's activities and inform us about the most appropriate training zones for the day. However, there are limitations to morning HRV measurements, such as potential influence from factors like urination or previous evening activities. Overnight HRV measurements, on the other hand, provide a more comprehensive picture of our body's stress and recovery cycle, as they capture the entire process of sleep and recovery. The choice between morning and overnight HRV measurements depends on individual preferences and goals, with morning measurements being more convenient and useful for daily training decisions, and overnight measurements offering a more detailed view of long-term trends and adaptation. Ultimately, both types of measurements can provide valuable information when used in conjunction with each other.

    • HRV measurementUsing a chest strap for HRV measurements provides better data compared to armbands and lifestyle choices significantly impact HRV, with cardiovascular fitness being a significant contributor.

      For accurate heart rate variability (HRV) measurements, using a chest strap is recommended over an armband, as it provides better data and eliminates confusion. HRV is influenced by genetics, fitness, and lifestyle factors, with cardiovascular fitness being a significant contributor. Lifestyle choices, such as eating well, getting enough sleep, managing mental stress, and building aerobic fitness, can positively impact HRV. Alcohol consumption and excessive stress can negatively impact HRV, and overnight HRV tests can provide valuable insights into these effects. For athletes, normal morning HRV ranges from the low to mid eighties, but stressors like finals week can cause significant drops in HRV. Overall, while workouts contribute to HRV, the rest of one's life and lifestyle choices also play a significant role.

    • Heart Rate Variability AnalysisConsistently collecting and analyzing HRV data every morning can provide valuable insights into fitness level, training effectiveness, and overall health, even with missing data. Maximizing workout efficiency and avoiding overtraining are key benefits.

      Collecting and analyzing heart rate variability (HRV) data consistently every morning can provide valuable insights into an individual's fitness level and training effectiveness, even if some data is missing. The output of this data, such as heart rate, heart rate variability, sleep duration, and soreness, is crucial for understanding an athlete's current readout state and making informed decisions about their training. While some may argue that collecting too much data can be overwhelming, for those with limited time for training, having access to as much information as possible can help maximize the efficiency and effectiveness of their workouts. Additionally, as individuals age, the importance of accurately understanding their body's dynamic changes becomes even more significant. By using HRV data to determine the optimal volume and intensity of training, individuals can avoid wasting time or overtraining, leading to better results and improved overall health.

    • Heart rate variabilityHeart rate variability is a crucial metric for assessing the body's response to exercise and stress. Faster heart rate recovery post-workout indicates better balance between sympathetic and parasympathetic systems and improved aerobic fitness.

      Heart rate variability (HRV) is an essential metric for understanding the body's response to exercise and stress. During high-intensity workouts, such as VO2 max intervals, the sympathetic nervous system is activated, leading to increased heart rate and decreased HRV. However, the balance between the sympathetic and parasympathetic systems plays a crucial role in heart rate recovery. The faster the heart rate drops post-exercise, the more aerobically driven the workout was, indicating a better balance between the two systems. Athletes, especially those in high-performance sports, can benefit from monitoring heart rate recovery between rounds or intervals to assess their conditioning and readiness for competition. Furthermore, HRV provides insight into the body's response to stress and can help identify periods of increased stress or fatigue. By analyzing HRV trends over time, individuals can gain a better understanding of their body's response to various stimuli and make informed decisions about training, recovery, and overall health.

    • Heart rate variability and stressHeart rate variability drops during stress and recovers, influenced by factors like workout intensity, fitness levels, alcohol, mental stress, sleep, and certain drugs like GLP-1 agonists and dual agonists, which can increase resting heart rate and decrease HRV, potentially impacting the parasympathetic-sympathetic balance, and requiring careful consideration of benefits and risks.

      Our body responds to stress by dropping heart rate variability (HRV) and then recovering it, eventually returning to normal. This process is influenced by factors such as workout intensity, individual fitness levels, and other external factors like alcohol, mental stress, and sleep. A notable exception to this pattern are certain drugs like GLP-1 agonists and dual agonists, which can predictably increase resting heart rate and decrease HRV. While this may be a byproduct of appetite suppression, it's unclear whether these drugs are significantly impacting the parasympathetic-sympathetic balance. It's important to note that these drugs may have benefits for some individuals, but there are potential risks, especially for those taking them for cosmetic reasons or to lose a small amount of weight. Overall, understanding the complex relationship between heart rate, HRV, and stress can help us make informed decisions about our health and well-being.

    • Weight loss drugs and heart rate variabilityThe use of certain weight loss drugs, such as semaglutide and tirzepatide, may negatively impact heart rate variability, which could potentially indicate an artificial adjustment to the autonomic nervous system. Long-term studies on their impact on HRV are lacking, and individuals using these drugs should monitor their HRV closely.

      The use of certain weight loss drugs, such as semaglutide and tirzepatide, may have negative effects on heart rate variability (HRV), which could potentially indicate an artificial adjustment to the autonomic nervous system. These drugs are popular due to their ability to help people lose weight and improve blood markers, but long-term studies on their impact on HRV are lacking. The suppression of HRV could have costs in the long run, especially if used for extended periods. It's important for individuals using these drugs to be aware of this potential side effect and to monitor their HRV closely. HRV is an important metric to consider in overall health, as it can provide daily feedback on one's health status and help inform decisions. A consistently low HRV could be a warning sign and may indicate a need for adjustments in training or lifestyle. Additionally, extremely high or sudden changes in HRV could also indicate a medical concern, such as an arrhythmia.

    • HRV and health outcomesHRV technology, like Morpheus, can help individuals understand their unique physiology and biology, leading to better health outcomes by identifying anomalies related to arrhythmia, medications, or COVID symptoms. Using data from HRV and sleep monitors, individuals can become their own coaches and gain valuable insights.

      Using heart rate variability (HRV) technology, like Morpheus, can help individuals understand their own physiology and biology, leading to better health outcomes. Anomalies in HRV data can indicate various factors, including arrhythmia, medications, or even COVID-related symptoms. While some tools may seem attractive for copying others' workouts or diets, truly understanding one's own response to training, diet, and food intake is essential for long-term success. By using data from HRV and sleep monitors, individuals can become their own coaches and gain valuable insights into their unique physiology. The Drive podcast, led by Peter Attiam, provides comprehensive content on this topic and offers member-exclusive benefits for those who subscribe, including detailed podcast show notes, monthly AMA episodes, and access to a private podcast feed. Remember, it's crucial to consult healthcare professionals for any medical concerns and not rely solely on podcast content for medical advice.

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    • How to lower blood glucose and insulin [13:30];
    • The relationship between lipids, CVD, and Alzheimer’s disease, and whether statins can increase the risk of neurodegenerative disorders and AD [23:15];
    • Reducing apoB levels through exercise and diet [31:45];
    • Pharmacological options for lowering apoB [38:00];
    • How nutrition impacts longevity via metabolic health, muscle mass, BMD and more [40:15];
    • How can someone determine the best diet for themselves? [43:45];
    • Nutrition myth: All weight loss is good [46:45];
    • Nutrition myth: Metabolic rates are dramatically different among individuals based on genetics [49:00];
    • Nutrition myth: Losing weight after a brief period of overeating is impossible [53:45];
    • Nutrition myth: GLP-1 agonists are a replacement for a healthy lifestyle [57:45];
    • Nutrition myth: There is a single best diet for weight loss [1:03:00];
    • Nutrition oversimplification: All calories are created equal [1:05:45];
    • Daily step goals [1:06:45];
    • The benefits of standing versus sitting throughout the day [1:10:45];
    • How to identify the most impactful and easiest-to-implement ways to improve your health [1:12:30];
    • The critical importance of emotional health [1:14:30];
    • Why supplements should be considered as supportive aids rather than primary solutions in one’s strategy to improve longevity [1:18:00];
    • Strategies for reducing high blood pressure [1:20:45];
    • Peter’s biggest frustrations with "mainstream health advice" [1:28:00];
    • Peter’s chaotic, yet cherished, morning routine [1:31:00]; and
    • More.

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    The Peter Attia Drive
    enJune 17, 2024

    #305 ‒ Heart rate variability: how to measure, interpret, and utilize HRV for training and health optimization | Joel Jamieson

    #305 ‒ Heart rate variability: how to measure, interpret, and utilize HRV for training and health optimization | Joel Jamieson

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    Joel Jamieson is a conditioning expert who developed Morpheus to give people a smarter way to build their conditioning regimen and improve their recovery. In this episode, Joel dives deep into the world of heart rate variability (HRV), explaining its scientific foundation, how it measures the balance between the sympathetic and parasympathetic nervous systems, the various methods of measurement, and how it can guide healthier lifestyle choices and improved training performance. He explores the nuances of HRV calculation, the impact of aging on HRV, and the roles of genetics, exercise, and other lifestyle factors in this process. He also covers Morpheus, the innovative training tool that won Peter over after his initial skepticism, highlighting its practicality and effectiveness in guiding training and optimizing fitness outcomes.

    We discuss:

    • Heart rate variability (HRV): evolution, science, and practical applications of HRV in athletic training [4:00];
    • Methods of measuring HRV: EKG, wrist-based sensors, and more [11:30];
    • How HRV is calculated from the data [22:30];
    • The role of the autonomic nervous system (ANS) in regulating HRV [25:45];
    • The decline in HRV with age, and the mitigating effects of fitness and other lifestyle factors [33:30];
    • The role of genetics in HRV, the modifiability of HRV, and a comparison of VO2 max and HRV as predictors of mortality [37:00];
    • How aging affects HRV and sympathetic drive, and the importance of spontaneous movement and exercise in maintaining the body's adaptability [43:30];
    • How Morpheus measures HRV using RMSSD and normalizes it to a 100-point scale for easier interpretation [49:45];
    • The Morpheus system: development, integration with various metrics, and personalized daily training recommendations to optimize fitness and recovery [51:30];
    • The benefits of morning HRV readings for assessing daily readiness compared to overnight HRV measurements [1:03:00];
    • Why Morpheus recommends using a chest strap rather than an arm band [1:10:00];
    • The impact of consistent exercise, stress, alcohol, and other lifestyle factors on HRV [1:11:15];
    • Optimizing zone 2 training with Morpheus [1:18:15];
    • Using heart rate recovery (HRR) as an indicator of athletic conditioning and the balance between aerobic and anaerobic systems [1:22:45];
    • The importance of tracking HRV trends over time rather than focusing on data from a given day [1:29:00];
    • Effect of GLP-1 agonists on heart rate and HRV [1:34:45];
    • Where HRV belongs in the hierarchy of health metrics [1:42:00];
    • Parting thoughts [1:46:30]; and
    • More.

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    The Peter Attia Drive
    enJune 10, 2024

    #304 – NEW: Introducing quarterly podcast summaries - Peter shares his biggest takeaways on muscle protein synthesis, VO2 max, toe strength, gut health, and more

    #304 – NEW: Introducing quarterly podcast summaries - Peter shares his biggest takeaways on muscle protein synthesis, VO2 max, toe strength, gut health, and more

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    In this quarterly podcast summary (QPS) episode, Peter introduces a new format aimed at summarizing his biggest takeaways from the last three months of guest interviews on the podcast. Peter shares key insights from each episode, covering diverse topics such as protein and muscle building with Luc van Loon, toe strength with Courtney Conley, VO2 max with Olav Aleksander Bu, liquid biopsies for cancer with Alex Aravanis, gut health and probiotics with Colleen Cutcliffe, and road safety with Mark Rosekind. Additionally, Peter shares any personal behavioral adjustments or modifications to his patient care practices that have arisen from these engaging discussions.

    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 episode #304 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

    We discuss:

    • How Peter keeps track of his takeaways from each podcast episode [5:15];
    • Luc van Loon episode: fat utilization, muscle protein synthesis, dietary protein, aging and inactivity, and more [8:45];
    • Behavioral changes that have come about from the conversation with Luc van Loon [23:45];
    • Courtney Conley episode: importance of toe strength and the impact of dedicated foot training [26:45];
    • Olav Aleksander Bu episode: the importance of VO2 max for lifespan, and the practicalities of measuring and improving VO2 max [36:45];
    • Behavioral changes that have come about from the conversation with Olav [56:00];
    • Alex Aravanis episode: liquid biopsies for cancer detection [1:01:30];
    • Colleen Cutcliffe episode: the importance of gut bacteria balance, and the potential therapeutic uses of probiotics, particularly Akkermansia [1:16:45];
    • Mark Rosekind: the significant issue of road fatalities and injuries, their causes, and practical safety measures to reduce risks [1:27:00]; and
    • More.

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    The Peter Attia Drive
    enJune 03, 2024

    #303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D.

    #303 - A breakthrough in Alzheimer’s disease: the promising potential of klotho for brain health, cognitive decline, and as a therapeutic tool for Alzheimer's disease | Dena Dubal, M.D., Ph.D.

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    Dena Dubal is a physician-scientist and professor of neurology at UCSF whose work focuses on mechanisms of longevity and brain resilience. In this episode, Dena delves into the intricacies of the longevity factor klotho: its formation and distribution in the body, the factors such as stress and exercise that impact its levels, and its profound impact on cognitive function and overall brain health. Dena shares insights from exciting research in animal models showing the potential of klotho in treating neurodegenerative diseases as well as its broader implications for organ health and disease prevention. She concludes with an optimistic outlook for future research in humans and the potential of klotho for the prevention and treatment of Alzheimer’s disease.

    Disclosure: Peter is an investor in Jocasta Neuroscience, a company working to develop klotho as a therapy for people with Alzheimer’s disease.

    We discuss:

    • Dena’s fascination with aging and how she came to study klotho [3:30];
    • Biological properties of klotho: production, regulation, decline with age, and factors influencing its levels [11:45];
    • Potential benefits of klotho on brain health [22:00];
    • The relationship between soluble klotho protein, platelet factors, and cognitive enhancement [33:45];
    • The role of platelet factor 4 (PF4) and it’s interaction with GluN2B in mediating cognitive enhancement [46:45];
    • Benefits of klotho observed in a mouse model of Parkinson’s disease [55:45];
    • Benefits of klotho observed in a mouse model of Alzheimer’s disease [1:03:00];
    • Promising results of klotho in primate models, and the importance of finding an appropriate therapeutic dose before moving to human trials [1:08:00];
    • Speculating why a single klotho injection has such long-lasting effects [1:25:30];
    • Potential cognitive benefits of klotho in humans, the impact of the KL-VS genetic variant on klotho levels, and the need for human trials to confirm these effects [1:27:45];
    • The interaction between the KL-VS genetic variant and APOE4 and how it impacts risk of Alzheimer’s disease [1:34:45];
    • The significance of klotho levels: studies linking lower levels to increased mortality and the broader implications for organ health and disease prevention [1:47:15];
    • Measuring klotho levels and determining an individual’s KL-VS status [1:52:15];
    • 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
    enMay 27, 2024

    #302 - Confronting a metabolic epidemic: understanding liver health and how to prevent, diagnose, and manage liver disease | Julia Wattacheril, M.D., M.P.H.

    #302 - Confronting a metabolic epidemic: understanding liver health and how to prevent, diagnose, and manage liver disease | Julia Wattacheril, M.D., M.P.H.

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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.

    We discuss:

    • Julia’s training, the importance of liver health, and the challenges and innovations of hepatology [3:15];
    • The complex and crucial functionality of the liver, its four most essential functions, and more [8:45];
    • Liver injuries: historical and evolving understanding of causal factors, and the progression to liver diseases and cancer [13:15];
    • How the liver metabolizes nutrients and what happens in the presence of excess calories or alcohol [24:45];
    • Methods of diagnosing liver disease and how insights guide treatment and management strategies [33:30];
    • 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.

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    The Peter Attia Drive
    enMay 20, 2024