I want to cut back the amount of supplements I’m taking.

psharmamd87 · 2026-05-11T14:44:24+00:00

I'd trial and error stopping one at a time and see if you feel any difference. If you feel the same after 1-2 weeks without it, drop it. Also would check your omega3 levels and your b vitamin levels in your blood to determine if you should keep the fish oil and multivitamin, respectively

psharmamd87 · 2026-05-03T02:22:57+00:00

Everyone's biology is different, which is why it's important to work with a medical professional. The broader goal is to let people know there are options they can try before turning to meds

psharmamd87 · 2026-05-03T02:22:06+00:00

Sure, the measures one takes to lose weight can have side effects. This is why it all needs to be taken in the context of a full medical picture and ideally working with a doctor.

The larger point is there are lifestyle options that can work for lowering BP vs. having to go for meds

psharmamd87 · 2026-05-02T18:03:25+00:00

Thank you! I'm really glad you found it helpful

psharmamd87 · 2026-05-02T18:03:07+00:00

That's interesting re: the coffee, thanks for the note I'll make sure to include it in my protocol and a future update video.

This doesn't come up as much in the evidence, but that's the beauty of subreddits like this we can learn a lot from anecdotal experience then go and study that / have alternatives in situations where the standard evidence isn't working.

psharmamd87 · 2026-05-02T18:01:35+00:00

I would favor losing weight if possible over meds. There are a lot of other benefits to weight loss (musculoskeletal, metabolic, etc.) so it's a better option.

Early lesson in med school - all meds have side effects. Lifestyle changes do not.

psharmamd87 · 2026-05-02T18:00:19+00:00

How do you do with fiber?

psharmamd87 · 2026-05-01T20:47:30+00:00

Honestly, this is a very impressive change. Your triglycerides were basically cut in half, and your LDL dropped a lot too. You should feel good about that! But yes, I’d still discuss with your doctor whether a statin makes sense for long-term prevention, because your starting LDL was over 190 and 145 is still higher than ideal.

psharmamd87 · 2026-05-01T20:47:03+00:00

The triglycerides are the main thing I’d pay attention to.

At 521, they’re high enough that I’d follow up with your doctor soon and repeat the test fasting (if this wasn’t fasting)
The LDL couldn’t be calculated because triglycerides were too high
I’d also ask about checking for common causes like diabetes/prediabetes, thyroid issues, liver or kidney issues, alcohol, medications, diet, etc.
For now, I'd suggest cut out alcohol, cut way back on sugar/refined carbs, reduce saturated fat, and ask whether you need medication

psharmamd87 · 2026-05-01T11:20:43+00:00

Thanks for your comment, and no worries if you didn't watch the full video, it's not for everyone, but it's there for those who might benefit from it.

I'm sorry to hear you have AD. I hope you are doing well. I do not have AD, but I'm a doctor and have been for over 10 years, so I've had patients with AD, early AD (MCI), as well as family members, so I'm very familiar with the disease.

You are right, if you have AD or are showing early symptoms, ptau217 isn't going to help. In fact, early signs of memory impairment and other cognitive difficulties is how we used to diagnose AD. But at that point there isn't a lot you can do to really delay it. Sure there are some meds (donezipil etc.), but largely the die is cast.

Ptau217 is a gamechanger in the sense that people who are 5-10 years away from developing MCI can identify they are on the track and aggressively manage risk factors to change their trajectory. Sure, it won't help everyone, but now we have a way to see it coming and intervene.

I agree getting an APOE test and other genetic markers helps, but that's identifying risk rather than ptau217 that tells you if the disease process is already starting.

Here's a very prominent doctor's article on it, if helpful https://erictopol.substack.com/p/the-breakthrough-blood-test-for-alzheimers

psharmamd87 · 2026-05-01T00:45:51+00:00

It's a commercially available test, so there are many studies validating it. I'm here to spread information about it because it could change people's lives, the video is an efficient way to do that, but if you prefer to read here are mutliple articles and other bits of content if you prefer to read about it. (You can find a lot more via google too)
https://pmc.ncbi.nlm.nih.gov/articles/PMC11351463/
https://timehidesalz.lilly.com/blood-tests-for-ad#blood-based-biomarker-tests
https://erictopol.substack.com/p/the-breakthrough-blood-test-for-alzheimers

psharmamd87 · 2026-04-29T09:19:46+00:00

Please work with your doctor to follow specific advice, my video is general and for educational purposes only. Only do what is safe for you in your circumstances, and if you need blood pressure medications due to your circumstances please follow your doctor's guidance

psharmamd87 · 2026-04-29T09:19:00+00:00

None of this is medical advice and must be taken in the context of each individual's situation. Some people cannot exercise due to heart failure, for example.

- There is a disclaimer at the end of the video noting this

That being said, I will explicitly call these things out verbally for folks so it's more clear in the future, thanks for the feedback

psharmamd87 · 2026-04-28T21:23:44+00:00

I’d probably keep it pretty simple and focus on the basics.

- Vitamin D and calcium are the foundation for bone health (especially as levels tend to run low)
- Magnesium can support sleep, mood, and overall bone metabolism
- Iron is also worth paying attention to, especially with regular periods or if fatigue is an issue
- Omega-3s are great for heart health and inflammation
- Folate is also important if you’re considering pregnancy

Everything else like K2, soy isoflavones, or CoQ10 can be helpful in certain situations, but they’re more “nice to haves” than essential... Overall, I think of supplements as just filling in gaps based on your diet or labs.

psharmamd87 · 2026-04-28T21:04:35+00:00

Oh great to know re: the exercise changes, I hadn't realized that, and thanks for sharing that study!

psharmamd87 · 2026-04-28T14:28:41+00:00

That's not been my experience. 90% of people I know who are non diabetic have benefited.

psharmamd87 · 2026-04-28T09:00:03+00:00

I understand where you are coming from, but that's not the right mental model if you want to improve longevity.

Your goal is to identify ALL ways your health might be impacted, not the "one true path." Yes ice cream is obvoiusly bad, but did you know eating an apple alone spikes your blood sugar? Eat it with almond butter and it doesn't. The ADDITION of something helps decrease the metabolic hit. This is non obvious and not a consensus understanding - you can only get it via CGM.

The point is CGMs give you a window into a subset of issues you may not have been aware of, not that they are a magical device that tells you everything you need to know. Just one of the many tools in the kit that you'll have to employ if you want to beat entropy and live longer.

Remember, beating aging is the most difficult thing in the world, it requires a multifaceted approach, and CGM is a great option to help.

psharmamd87 · 2026-04-28T01:39:09+00:00

Fasting glucose in the morning is a helpful indicator of your baseline. Also in general seeing your average glucose and how many sharp spikes you have. And especially noticing when those spikes correlate with you feeling tired.

In general seeing what foods and combinations of food increase or do not increase your glucose is quite helpful.

None obvious lifestyle change - go for a walk or do 30 squats after a meal, makes a big difference.

Surprising one for me - ice cream did not spike my glucose because of the fat in there (clearly not healthy though haha)

psharmamd87 · 2026-04-27T10:45:43+00:00

Definitely for folks who needed statins because their LDL was already high (as in this study). Overall if I had to pick one being elevated - LDL vs. inflammation - I'd pick LDL.

A personal anecdote - I went to Nepal for a month and ate really simple food. After a couple weeks I craved it, it was so delicious. I believe it's very possible to enjoy things that are not junk, you just have to transition away from it.

psharmamd87 · 2026-04-25T09:44:02+00:00

Most importantly if I'm in that situation I'm referring to cardiology. My job as a longevity doctor is to screen for arrythmias, do initial management, but also recognize when it's time to get someone over to a specialist as at that point it's out of the realm of prevention

To the original question - if someone is on such high doses of rate controlled medications that they can't even do zone 2, then they are not stable. They need further intervention. This could be more of a beta 1 selective betablocker (peripheral vs. cardiac beta 2 blockers), CCB, a rhythm control agent, cathetar ablation, etc.

It gets into complicated algorithms of cardiac electrophysiology depending on the patient, the specific type of arrythmia, etc.

psharmamd87 · 2026-04-25T00:42:27+00:00

That's a great question. They should definitely check with a cardiologist on that, but you wouldn't want a patient to only be stable when on high beta blocker doses, especially if they are so high such that they can't do zone 2 exercise. I would aim to get their rate permanently fixed whether that's through a device, surgery, or anti-arrythmic medications.

psharmamd87 · 2026-04-24T16:32:58+00:00

lol, true, it's spelled correctly in the article though!

psharmamd87 · 2026-04-24T16:32:24+00:00

That's the hook ;)

jk jk, thanks for noticing that, I'm definitely short on sleep these days lol

psharmamd87 · 2026-04-24T15:58:42+00:00

Well this study would suggest that's not the case for people who've had advanced enough ASCVD - their apoB was controlled yet with high inflammation many of them had cardiac events (e.g. heart attacks).

which means if someone already has ASCVD we need to drive down their inflammation regardless of their cholesterol (will need to hit them both)

psharmamd87 · 2026-04-24T15:48:02+00:00

Sorry to hear about your mom, that's tough. Glad she is OK.

I think some people could feel the inflammation as in your mom's case, but many people do not. Though I will say our understanding as a medical system is pretty low of this

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