The Peter Attia Drive - Qualy #52 - Insights about berberine

Episode Date: November 1, 2019

Today's episode of The Qualys is from podcast #26 – AMA #3: supplements, women’s health, patient care, and more. The Qualys is a subscriber-exclusive podcast, released Tuesday through Friday, and published exclusively on our private, subscriber-only podcast feed. Qualys is short-hand for “qualifying round,” which are typically the fastest laps driven in a race car—done before the race to determine starting position on the grid for race day. The Qualys are short (i.e., “fast”), typically less than ten minutes, and highlight the best questions, topics, and tactics discussed on The Drive. Occasionally, we will also release an episode on the main podcast feed for non-subscribers, which is what you are listening to now. Learn more: https://peterattiamd.com/podcast/qualys/   Subscribe to receive access to all episodes of The Qualys (and other exclusive subscriber-only content): https://peterattiamd.com/subscribe/  Connect with Peter on Facebook.com/PeterAttiaMD | Twitter.com/PeterAttiaMD | Instagram.com/PeterAttiaMD 

Welcome to the Qualies, a subscriber exclusive podcast. Qualies is just a shorthand slang for a qualification round, which is something you do prior to the race, just a little bit quicker. Qualies podcast features episodes that are short, and we're hoping for less than 10 minutes each, which highlight the best questions, topics, tactics, et cetera, discussed on previous episodes of the drive. We recognize many of you as new listeners to the podcast may not have the time to go back and listen to every episode, and those of you who have already listened may have forgotten. So the new episodes of the quality is going to be released Tuesday through Friday,

and they're going to be published exclusively on our private subscriber-only podcast feed. Now occasionally, we're going to release quality episodes in the main feed, which is what you're about to hear now. If you enjoy these episodes and if you're interested in hearing more, as well as receiving all of the other subscriber exclusive content, which is growing by the month, you can visit us at pteratia-md.com-forward-slash- subscribe. So without further delay, I hope you enjoy today's quality. So without further delay, I hope you enjoy today's quality. In sights about Burbering. So Burbering is a plant-derived extract that has two properties, one of which it gets a lot of attention for, one of which it might not be as well known.

The first is that it is a weak AMP kinase activator. And for those of you that have shown an interest in what Metformin does, that's sort of the, that's probably the secret sauce of Metformin, is its AMPK activation. So Burberine, when taken at, you know, sort of recommended OTC doses, which I, I don't remember the doses anymore, I think it's like a, it might be actually a comparable dose to Metformin. It might be like either 500 twice a day or a thousand twice a day. It does have some of that weak AMPK activation.

And what the net effect of that is it decreases hepatic glucose output. So it's upregulating AMPK is telling the liver hay you can make less glucose. So send less glucose out of the body. And so in that sense, it's a poor man's version of metformin. I don't find that that interesting. I prefer to just use metformin. If we're going to go down that path, like let's do it pharmacologically with potent drugs that we understand that are consistent from batch to batch that have a much higher sort of oversight of regulation and that kind of stuff. The other thing about burberry, and this is that this is when I still do use it in clinical practice,

is it is also a weak inhibitor of the enzyme PCSK9, which any listener of this podcast is going to be very well up to speed on what PCSK9 is. The word on the street is it probably only works in a subset of people who overexpress PCS K9. So PCS K9 is a protein that degrades LDL receptors. So if you overexpress this enzyme, you're going to really degrade LDL receptors. You're going to have a higher LDL particle number and probably a higher LDL cholesterol. If you take that subset of patients, they seem to respond quite nicely to burbrine.

Now the question is, how do you know that? I don't think there's a test anymore to measure that. Athrotech, which I think might have got absorbed into VAP or something like that. I think you used to have a test, but in the end, I was like, why am I going to do some test on somebody to see if they overexpress PCS can I and before I give them burberry? I'll just give them burberry and make no other change.

And see, if there's not a significant enough difference in their LDL, I don't care. And every once in a while, you just, you look like a rock star. You get this patient who's LDL is really high and you check your boxes, like they don't have, their triglycerides aren't that high, their phytosterols are not that high triglycerides, aren't that high, their phytosterols are not that high, their stannels are not that high, their dysmosporols are not

that high. Hey, they clearly have defective LDL clearance. Maybe they overexpress PCS-K9, which would be one of a thousand reasons you could have hot. Like literally, there are 2,000 genetic mutations that can lead to an inability to clear LDL or something, because this is like one of them, but this one amounts to about 5% of them. And so in that patient, you hit them with burberry and all of a sudden, like, pff, everything's fixed. Do you see that with metformin at all?

No. No, I don't think that formin possesses that piece of what burberryin has. I hope you enjoyed today's quality. Now sit tight for that legal disclaimer. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. And note, no doctor-patient relationship is formed.

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