<div><span> As a follow up to</span> <a href="https://peterattiamd.com/ama14/" rel="noopener noreferrer" target="_blank">AMA #14</a><span> where Peter explained his framework for analyzing labs, this "Ask Me Anything" (AMA) episode focuses on a number of real-world case studies exploring metabolic dysregulation, low testosterone, menopause, hypothyroidism, elevated uric acid, and more. From the examples discussed, you can follow along how our clinical team goes about interpreting diagnostic measures and applying relevant research findings. Once again, Bob Kaplan, Peter's head of research, will be asking the questions. If you're a subscriber, you can now listen to this full episode on your </span><a href="https://peterattiamd.com/members/private-podcast-feed/" rel="noopener noreferrer" target="_blank">private RSS feed</a><span> or on our website at the </span><a href="http://peterattiamd.com/ama15" rel="noopener noreferrer" target="_blank">AMA #15 show notes page</a><span>.</span></div> <div> <p>We discuss:</p> <ul type="disc"> <li>Should you stop taking supplements before getting a lab test? [2:45];</li> <li>Family history—Questions to ask and what to look for [5:30];</li> <li>The purpose of an oral glucose tolerance test (OGTT) [12:15];</li> <li>Case study—Insufficient muscle mass for proper glucose disposal [17:15];</li> <li>Why hemoglobin A1c is a relatively unhelpful metric [24:00];</li> <li>Case study—Exceeding carbohydrate tolerance [26:30];</li> <li>Case study—Metabolic dysfunction and a framework for metabolic health [33:30];</li> <li>Peter's ideal<span style="color: #ff0000;"><span style="text-decoration: line-through;"> </span></span>tracking of metabolic health for all his patients [43:30];</li> <li>Contrasting presentations of hypogonadism—Low free testosterone [45:00];</li> <li>How sleep, exercise, and alcohol affect testosterone levels<s>?</s> [56:20];</li> <li>Case study—Surprisingly fast onset of menopause [59:25];</li> <li>Case study—Hypothyroidism and high cholesterol [1:07:00];</li> <li>Case study—Elevated uric acid and hypertension [1:10:55]; and</li> <li>More.</li> </ul> <p>Learn more: <a href="https://peterattiamd.com/">https://peterattiamd.com/</a><br /> <br /> Show notes page for this episode: <a href="https://peterattiamd.com/ama15">https://peterattiamd.com/ama15</a><br /> <br /> Subscribe to receive exclusive subscriber-only content: <a href="https://peterattiamd.com/subscribe/">https://peterattiamd.com/subscribe/</a><br /> <br /> Sign up to receive Peter's email newsletter: <a href="https://peterattiamd.com/newsletter/">https://peterattiamd.com/newsletter/</a><br /> <br /> Connect with Peter on <a href="http://Facebook.com/PeterAttiaMD"><u>Faceboo</u></a><u>k</u> | <a href="http://Twitter.com/PeterAttiaMD"><u>Twitter</u></a> | <a href="http://Instagram.com/PeterAttiaMD"><u>Instagram</u></a>.</p> </div>
Actionable Insights
1. Consult Healthcare Professionals
Do not use the information from this podcast as a substitute for professional medical advice, diagnosis, or treatment. Always consult your healthcare professionals for any medical conditions you have, as this podcast is for general informational purposes only and does not constitute medical advice.
2. Gather Detailed Family History
Collect extensive family history information for your mother, father, both sets of grandparents, all aunts, uncles, and siblings, focusing on cardiovascular disease (blood pressure, cholesterol, stroke, heart attack), dementia, cancer, and metabolic disease (diabetes). This provides far more insight than genetic data like 23andMe and helps identify patterns and genetic predispositions.
3. Contextualize Family Health History
When gathering family history, always ask ‘second order questions’ to understand the context of health events (e.g., if a relative with cancer was a heavy smoker, or if a relative with an early heart attack had other risk factors like alcoholism or heavy smoking). This prevents misinterpreting genetic predispositions when lifestyle factors were significant contributors.
4. Prepare Family History Template
If seeking medical advice, prepare a detailed family history template in advance of your first meeting with a doctor, as gathering this information requires significant time and effort, often involving many phone calls and research into deceased relatives. This ensures you can provide comprehensive data for a thorough assessment.
5. Continue Supplements Before Labs
Unless specifically instructed to stop, continue taking your supplements as usual before scheduled lab tests. Doctors often want to track biomarkers while you are on supplements, and will postpone tests if you’ve run out or forgotten to take them, to avoid misleading results.
6. Know Intervention Effect Timeline
Be aware of the time it takes for an intervention (whether a supplement or medication) to show its full effect on biomarkers. Testing too soon can lead to misinterpretations, such as thinking a supplement isn’t working or isn’t dosed high enough, when it simply hasn’t had enough time to assimilate.
7. Interpret Labs with Family History
Use detailed family history to interpret the severity and implications of lab findings, such as elevated LP(a). A strong family history of early cardiovascular events combined with elevated LP(a) warrants aggressive intervention, whereas the same elevated LP(a) with no family history of early events might suggest a less aggressive approach is acceptable.
View initial lab tests not as definitive answers, but as starting points that often lead to more questions and require further investigation beyond the initial set of results. This detective-like approach helps uncover deeper insights into your health.
9. Consider OGTT with Insulin
Consider undergoing an Oral Glucose Tolerance Test (OGTT) with frequent sampling of both glucose and insulin, as it provides a much deeper insight into insulin sensitivity and metabolic health compared to just fasting blood glucose or glucose-only OGTTs, despite being a more cumbersome test.