AMA #53: Metabolic health & pharmacologic interventions: SGLT-2 inhibitors, metformin, GLP-1 agonists, and the impact of statins

**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.
Welcome to Ask Me Anything, AMA number 53 I'm joined once again by my cohost, Nick Stenson. In today's episode, we'll discuss two different topics. First, we'll have a follow up to AMA 51, where we focused on metabolic disease. One thing we didn't really cover in that AMA, which we cover in much more detail in this AMA, are the various pharmacologic tools that we have at our disposal to improve an individual's metabolic health. These include a discussion around SGLT2 inhibitors, which are also of interest for their potential geroprotective benefits, along with Metformin, GLP-1 agonists, and other drugs that can improve one's metabolic health. From there, we shift our discussion to look very specifically at the relationship between perhaps the most prescribed class of drugs out there, statins, and their relation to insulin resistance. This is a topic we get a lot of questions on.
In fact, so many that we decided that it was worth half an AMA. So we cover all of the issues here and all of the data around statins and not just the relationship to type 2 diabetes, which is generally recognized as a small issue with certain statins, but much more broadly around the relationship between statins and metabolic health. And of course, we put this in the broader context of net benefit versus net harm. So if you're a subscriber and you want to watch the full video of this podcast, you can find it on the show notes page. If you're not a subscriber, you can watch a sneak peek of the video on our YouTube page.
So without further delay, I hope you enjoy AMA number 53

**Nick Stenson** (2:15)
Hey! Peter, welcome to another AMA. How you doing?

**Peter Attia** (2:18)
Doing very well.

**Nick Stenson** (2:19)
How's that toothpick treating you?

**Peter Attia** (2:21)
Very well. Love me some toothpicks.

**Nick Stenson** (2:23)
Do you ever tell the story about how you ended up with so many?

**Peter Attia** (2:26)
I think I have shared that story. In fact, I know I've shared that story, because when I meet strangers sometimes, they've asked me if they can have some of those toothpicks.

**Nick Stenson** (2:35)
Are they still, to this date, the best toothpicks you've ever had?

**Peter Attia** (2:38)
No, I would actually say my toothpick game has evolved a little bit, and I have started to like other types of toothpicks. Those toothpicks are still remarkable, but I don't think I could call them the single best toothpick in the history of dentition.

**Nick Stenson** (2:53)
Well, maybe a future AMA, if there's enough demand, we can break out the different types of toothpicks and pros and cons of each.
But not today. So today, we are gonna talk kind of in follow up for the first part to AMA 51, which was on metabolic disease. And metabolic disease is one of your four horsemen that you talk about in the book and talk about on podcasts, the other three being cardiovascular disease, neurodegenerative disease, cancer.
In that AMA, we talked about how metabolic disease feeds those other types of diseases. We went into insane detail and how to measure and know where you're at and how your metabolic health is. And then we talked about some lifestyle factors that you can do to improve your metabolic health.
The one thing that was missing from that AMA, which we get a lot of questions on, is what about the pharmacological options for people to improve their metabolic health? So the first part of this AMA, we'll talk about that. That will include SGLT-2 inhibitors, metformin, GLP-1, and a few others. And on some of those drugs, such as SGLT-2 inhibitors, we'll also cover if there's potentially a geroprotective benefit to those, because we also see questions from people who may be in good metabolic health, but based on some study results are curious on that. Part two, we're gonna cover something we get asked about an insane amount, and that is the relationship between statins and insulin resistance. And we see a lot of questions come through, and so we pulled all of them for that. We'll get to those here. All that said, before we get started, anything you wanna add?

**Peter Attia** (4:33)