#390 ‒ AMA #84: Family health history, preventing heart disease, metabolic health, strength training efficiency, dementia risk reduction, NAD supplements, and hydration

**Peter Attia** (0:10)
Hey everyone, welcome to a sneak peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com/subscribe.
So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Welcome to Ask Me Anything AMA episode 84 In today's AMA, I answer listener questions across a wide range of topics. Less about deep dives and more about how I think through real world trade-offs and apply the science and practice. In today's episode, we're going to discuss how to build and analyze a meaningful family health history. How risk tolerance changes decisions around testing and treatment. Why heart disease remains so poorly prevented despite the tools we already have. Whether someone can carry excess body fat and still remain metabolically healthy. The minimum effective dose for strength training for people who don't have a lot of time. The habits and interventions that may matter most for reducing dementia risk. What would need to change for me to reconsider my point of view on the supplements that boost NAD, such as NR and NMN.
And when hydration and electrolytes matter, and when they're mostly overkill. So without further delay, I hope you enjoy AMA number 84

**SPEAKER_1** (1:46)
Peter, welcome to another AMA. Today's AMA is going to be another mixed bag of topics covering a variety of things. Again, these aren't meant to be deep dives on the science. The focus is more how you talk with patients, how you think about decisions, how you weigh trade-offs for yourself and for others. And so we'll move across a variety of topics. This will include conversations around family history, what it is, when it's more useful than genetic testing, how you use it with patients, and how people should think about it.
How you think about various people's different feelings around taking risks as it relates to their health and how that affects their decision. Look at cardiovascular disease prevention, ideas around can someone be metabolically healthy while still being overweight and what that looks like? We'll talk about strength training. What is the potential minimum effective dose and how do you prioritize different exercises for people who are busy, which is the vast majority of people listening to this. We'll also look around dementia risk, any updated thoughts on NAD boosters such as NMN, NR, hydration, electrolytes and more.
So all that said, I think we'll get into it with talking about family history. So we've talked about family history before as something that you find very insightful, and sometimes, if not often, even more insightful than genetic tests. So before we get into the best way for someone to collect and analyze their family history, do you want to just kind of talk about why you think family history is such a valuable and often underutilized tool that people have?

**Peter Attia** (3:34)
Well, there's no doubt that genetics play a role in disease. But the truth of the matter is that most conditions arise from a polygenic backdrop, right? So it's easy to think about the examples of a single gene gone awry leading to a disease.
But the reality of it is that's the exception and not the rule. So when someone says, you know, heart disease runs in my family or cancer runs in my family, it's usually not going to be tied to a single gene. And even if you do genetic testing, you're unlikely to see exactly what's causing it. So instead, what we want to do is look at the family history, because the other thing that's a little confusing about genes is they don't always reach what's called the same degree of penetration. So again, in extreme cases, we know that there's complete penetration of a gene. So if you have the gene, you have the condition. But again, it becomes much more nuanced when you start to think about the big ticket items like diabetes, heart disease, and cancer.
So that's really the reason that we think that there's actually more fruit to be had in doing a very thorough assessment of a family history when the data are available. Obviously, there are going to be situations where that's not the case, if a person is adopted or estranged from their family. But in our experience, most people have access to enough information that we can start to hone in on risks. And then of course, that doesn't mean we're opposed to using genetic testing as a way to sharpen that lens. Again, I think that there are certain cancer panels, cancer genetic panels, that is, that can add a little bit more light around certain types of cancer, such as breast cancer. But I just think that the more information you can have here, the better.