#336 – AMA #68: Fasting, well-balanced diets, alcohol, exercise for busy people, wearables, emotional health, assessing cardiovascular health, and more

We discuss:

• Episode format: overview of common health topics based on listener questions [1:30];
• How to accurately assess your cardiovascular health [3:00];
• The impact of fasting, time-restricted eating, and dietary restriction on metabolic health [9:00];
• Alcohol: health risks of consumption, limitations of research, and how to weigh the risks against social and personal enjoyment [13:45];
• Principles of a well-balanced diet: macronutrients, micronutrients, protein, energy balance, and more [23:45];
• The benefits and drawbacks of ketogenic diets: impact on satiety, metabolic health, athletic performance, lipid levels, and more [29:15];
• Protein: best sources for muscle growth, total intake, PDCAAS scoring system, and getting adequate amounts on plant-based diets [36:15];
• Creating an effective fitness routine that fits into a busy schedule [41:45];
• The role of rest and recovery in a workout routine [46:00];
• How to track fitness progress beyond just weight on a scale [48:30];
• The best low-impact exercises for individuals with joint issues [52:00];
• Wearables: insight vs. compliance, and how to use them effectively [54:45];
• How to evaluate the risks and benefits of medical interventions: procedural risks, complication rates, and asking informed questions [59:00];
• Sleep: impact on metabolic and cognitive health, and tips for improving sleep quality [1:03:45];
• How to identify and address emotional health challenges [1:08:30]; and
• More.

Episode format: overview of common health topics based on listener questions [1:30]

• This AMA episode compiles listener-submitted questions gathered over the past three years from the AMA portal on the website.
• The questions cover a wide range of health topics in a structured yet broad manner.
  • Diseases and health conditions
  • Nutrition and fasting
  • Exercise and fitness strategies
  • Other general wellness topics

How Listeners Can Participate in Future AMAs

• The AMA portal allows listeners to submit questions at any time.
• Questions can be related to:
  • Past podcast episodes
  • Newsletters
  • Personal health concerns

Episode Format & Experimentation

• This AMA will feature more questions with shorter answers, mimicking how Peter would respond in casual conversations (e.g., at a party).
• If listeners enjoy this style, Peter suggests doing quarterly AMAs with a mix of general Q&A and specific listener-submitted questions.
• Possibility of acknowledging specific individual submissions in future episodes.
• Goal: Test if this approach resonates with the audience and adjust accordingly.

How to accurately assess your cardiovascular health [3:00]

The Importance of Cardiovascular Health

• Cardiovascular disease (CVD) is the leading cause of death worldwide.
• Many people are curious about their current cardiovascular risk and how to properly assess it.

Key Tools for Assessing Cardiovascular Risk

Family History as a Primary Indicator

• One of the most overlooked yet critical aspects of risk assessment.
• It’s not enough to just know how long relatives lived; it’s important to understand:
  • What conditions they had (e.g., high cholesterol, high blood pressure).
  • Whether they took medications for cholesterol or hypertension.
  • If they required cardiovascular procedures (e.g., stents, bypass surgery, revascularization).
• Early cardiovascular events in family members suggest potential heritable causes, such as:
  • Elevated Lipoprotein(a) [Lp(a)]
    • Podcast: #07 – Deep Dive: Lp(a) — what every doctor, and the 10-20% of the population at risk, needs to know
    • Podcast: #210 – Lp(a) and its impact on heart disease | Benoît Arsenault, Ph.D.
    • Podcast: #238 – AMA #43: Understanding apoB, LDL-C, Lp(a), and insulin as risk factors for cardiovascular disease
  • Familial Hypercholesterolemia (FH)
    • Podcast: #255 ‒ Latest therapeutics in CVD, APOE’s role in Alzheimer’s disease and CVD, familial hypercholesterolemia, and more | John Kastelein, M.D., Ph.D.
    • More resources

Calcium Scan (CAC) for Assessing Arterial Damage

• A CAC scan helps determine the extent of arterial calcification, which indicates advanced disease.
  • Article: Coronary artery calcium scan
  • Podcast: #247 ‒ Preventing cardiovascular disease: the latest in diagnostic imaging, blood pressure, metabolic health, and more | Ethan Weiss, M.D.
  • Podcast: #203 – AMA #34: What Causes Heart Disease?
• Key points about CAC:
  • An ideal score is zero, meaning no calcification.
  • However, a score of zero is not always definitive, as 15% of cases can have soft plaque not detected by CAC.
  • In these cases, a CT angiogram (CTA) can provide a clearer picture but exposes the patient to radiation and contrast dye risks.
  • Calcification itself is a protective mechanism, but its presence suggests an underlying cardiovascular process that could indicate broader risks.

Lipid Profile and Blood Markers

• ApoB and Lp(a) are the two most critical markers.
  • More on apoB:
    • Podcast: #229 ‒ Understanding cardiovascular disease risk, cholesterol, and apoB
    • Article on apoB: Measuring cardiovascular disease risk and the importance of apoB
    • Podcast: #238 – AMA #43: Understanding apoB, LDL-C, Lp(a), and insulin as risk factors for cardiovascular disease
• LDL cholesterol, HDL cholesterol, and non-HDL cholesterol are less relevant once ApoB and Lp(a) are known.
• Triglycerides are important only when extremely elevated (>400 mg/dL), which can indicate metabolic issues requiring intervention.

Blood Pressure as a Major Risk Factor

• Hypertension is a significant predictor of cardiovascular disease and is often under-monitored.
• Key blood pressure considerations:
  • Ideal blood pressure is below 120/80 mmHg.
  • 130/85 mmHg, previously considered normal, is now known to increase risk.
  • Doctors often measure blood pressure incorrectly—proper technique includes:
    • Sitting still for five minutes before measurement.
    • Ensuring the arm is positioned at heart level.
    • Using a properly fitting cuff and avoiding crossed legs.
    • Checking multiple readings (duplicate or triplicate measurements).
  • Monitoring at home twice daily for two weeks once a year provides a better assessment.
• Resources:
  • Article: All things blood pressure: from measurement to management
  • Podcast: #258 – AMA #48: Blood pressure—how to measure, manage, and treat high blood pressure

Lifestyle and Metabolic Factors

• Smoking significantly increases CVD risk.
• Metabolic health plays a critical role, including:
  • Hyperinsulinemia
  • Insulin resistance
  • Type 2 diabetes
• Addressing metabolic dysfunction is crucial for long-term cardiovascular health.

Tests and Metrics Not Considered as Useful

• Carotid Intima-Media Thickness (CIMT)
  • Peter does not find CIMTs particularly useful for assessing cardiovascular risk.
  • The data does not support CIMT as a superior tool compared to the aforementioned tests.

The impact of fasting, time-restricted eating, and dietary restriction on metabolic health [9:00]

Defining Fasting vs. Time-Restricted Eating

• Common misconception: People often use the terms fasting and intermittent fasting interchangeably.
• Peter’s distinction:

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