AMA #15: Real-world case studies—metabolic dysregulation, low testosterone, menopause, and more

**Peter Attia** (0:11)
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 forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Hey everyone, welcome to Ask Me Anything or AMA episode number 15
Now in May, we released the first part of our AMA focusing on my framework for analyzing labs. But in that episode it took me a little longer to get to some of the actual labs and we weren't able to cover as much as I wanted. So this is a follow up to that greatly appreciated episode. People had a lot of really kind things to say about it. They really wanted more. And so it was a pretty easy decision to follow up and go a lot deeper because in that episode we really only got to cardiovascular labs. In this episode, we kick it off with some of the stuff around insulin sensitivity, getting into some oral glucose tolerance tests.
We get into testosterone replacement. We talk about menopause and female sex hormones, thyroid hormone, other metabolic stuff that can be gleaned from labs. Overall, I found this to be a really fun episode and I'm really glad we did it. And also there were a couple other pretty cool nuggets that Kaplan threw in here based on some questions from the previous one. So before we start, of course, I need to remind everyone through the obligatory legal disclaimer that this podcast is for general informational purposes only. It does not constitute the practice of medicine, including the giving of medical advice. The use of this information and the materials linked to the podcast is at the user's own risk. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they have.
And with all of that said, and without further delay, I hope you enjoy AMA number 15

**Bob Kaplan** (2:22)
Welcome back to another AMA. We may consider this one a part two. I think it was back in May we had let's call it part one, where a lot of questions came in about what lab test should I be getting? And I think that turned into, well, it depends and actually it's more of how does Peter think about labs. And we got into some really interesting case studies or patient cases on cardiovascular and I think that we wanted to get into more cases and didn't have enough time. So we're going to come back and discuss a few more patient cases.
But first, we had some feedback from the first part 1 AMA, where we got a couple of really interesting questions that I think we should address up top. And so the first question that I have for you, Peter, is this one. When a patient is going in for their labs, how long before the lab should they cease taking any supplements if they're taking any?
And should they stop taking supplements for labs at all?

**Peter Attia** (3:18)
So, I mean, I think it really depends on what the supplement is and what's the purpose of the test. But almost without exception in our practice, it's the opposite. We'll check in with patients a month before a scheduled test to be sure that they are on their supplements, and if they are not, we'll postpone the lab test until they resume them.
For most supplements, there's some biomarker that we would track. For example, if we care about a person's homocysteine level as the metric we're tracking, then that's why we might be giving them methylated B vitamins. So if we find out, hey, I ran out a month ago and I forgot to refill it, it wouldn't make a lot of sense to repeat the information we already know, which is, hey, when you're not taking a methylated B vitamin, lo and behold, your homocysteine is high. I'm trying to think of an example of when I want someone to stop a supplement or a medication outside of when I want to actually know how they look without it.
But I think the more important point here is you need to know how long it takes to see the effect of the intervention.
And so, for example, one of the longer tail things is looking at, for example, the omega quant test that we use to measure EPA and DHA index. So this is a test that looks at the red blood cell membranes and measures the amount of EPA and DHA, which are omega-3 fatty acids. We spoke about this on a podcast with Bill Harris some time ago. That's a test that you use to assess either how much fish a person is getting through their diet, like how much fish oil is coming in naturally, or in the case of most people, through supplementation. But you have to know that it can take up to three months to fully assimilate the change you make to see that. So if you gave somebody that supplement and then tested them a month later, you could be misled into thinking you're not giving them enough. Whereas other things work very quickly. For example, a drug like Rapatha, probably within two doses, which is given over the course of two weeks, would be sufficient to know if the drug is working or not. So whether we're talking about drugs or supplements, the real question is knowing what the period of time is it takes to see an effect and making sure that you're being thoughtful about that. And again, I think the bigger issue is making sure that the patient didn't run out or didn't forget to take it so that you're not scratching your head. And this happens to us still, despite all our checks and balances, this still happens to us where we get labs back and we think, oh, this can't make any sense.