(Obviously, lifestyle interventions are important as well but they are not the purpose of this section.)
Hypertension
If I were to choose a drug for hypertension, I would choose telmisartan over other antihypertensives. Telmisartan is an angiotensin receptor blocker (ARB). It has a long half-life and beneficial effects on metabolic health because of its off-target effects on PPAR-delta (a transcription factor involved in fatty acid metabolism). PPAR-delta modulators are banned by WADA because of their effects on endurance capacity. Unfortunately, most doctors choose ramipril or valsartan as their first-line antihypertensive – mostly because of historical reasons.
Dyslipidemia
If my ApoB levels were an issue, I would not even bother with lifestyle interventions (which do not do much for lipids anyway) but would immediately jump to 2.5mg of rosuvastatin (half of the lowest clinical dose) plus 10mg of ezetimibe. Ezetimibe blocks cholesterol reabsorption and is mostly without side effects. Rosuvastatin is a statin (blocking HMG-CoA-Reductase – one of the key enzymes in the synthesis of cholesterol) and at low doses it is mostly liver-targeted. Furthermore, it is very hydrophilic compared to other statins and the lack of lipophilicity keeps it mostly outside the blood brain barrier. 2.5mg of rosuvastatin is known to knock down ApoB levels by about 39%.
40mg of the drug only achieves about 55% despite being 16x the dosage (and therefore carries more non-hepatic systemic effects). Unfortunately, in the hospital I see 40mg of rosuvastatin given out all the time. A friend who is statin-intolerant, has capsules containing 1mg of rosuvastatin compounded for himself, which he can take without side effects (for reference: the lowest clinical dose is usually 5mg). Alternatively, for statin-intolerant people, bempedoic acid is an amazing drug, though unfortunately quite expensive and/or hard to get approved for.
I discuss my in-depth protocol for preventing atherosclerosis (heart disease) in more detail here.
Infections
Obviously, antibiotics are a huge spectrum and the “one-size-fits-all” antibiotics are broad-spectrum antibiotics (which is not good as they kill off most of the healthy flora). For most uncomplicated infections I think macrolide antibiotics are a great choice, particularly roxithromycin. Roxithromycin is dubbed “the doctor’s antibiotic” for a reason. It has a long half-life and needs to be taken only once daily. It targets intracellular bacteria as well (e.g., mycoplasma). Furthermore, it also kills senescent fibroblast and is, after dasatinib, perhaps one of the most powerful clinically available senolytic drugs. Furthermore, unlike penicillin and cephalosporine antibiotics, it is relatively narrow-spectrum and does not wreak havoc on the gut flora.
Doxycycline is also a great choice, as is minocycline, which has the additional advantage of inhibiting microglia, therefore helping with neuroinflammation (and potentially Long-COVID). Both are relatively easy on the gut microbiome. Furthermore, both antibiotics also kill off potential unrecognized co-inhabitants that for most people go unnoticed (such as symptom-free infections with intracellular parasites).
For fungal infections (e.g., yeast), first-line therapy is usually fluconazole. I prefer itraconazole over fluconazole because itraconazole does not penetrate well into the CNS because it is a substrate of p-glycoprotein. I prefer not to expose my brain to these kinds of drugs unless necessary.
Diabetes/metabolic syndrome
In my opinion, first-line drugs should be GLP-1 agonists, as they go to the core issue of diabetes. Firstly, they lead to weight loss and the loss of visceral adipose tissue increases insulin sensitivity. Secondly, they change insulin levels through acting on the hypothalamus (more specifically POMC/CART neurons), which has drastic effects on blood sugar levels through direct vagal control of the pancreas, liver, and other tissues.
SGLT-2 inhibitors are amazing drugs also. However, unlike GLP-1 agonists, they do not address the core of insulin resistance (visceral fat; faulty brain circuits) and are therefore inferior to GLP-1 agonists. I discuss my experience with SGLT-2 inhibitors in more detail here. Antidiabetics can also be used by “normal” people as metabolic enhancers – and there is quite some data that these drugs improve general health on many fronts (e.g., rates of atherosclerosis, cancer, or dementia decrease). I will post an in-depth article on my experience with metabolic drugs in the near future.
Hypnotics
Firstly, hypnotics should not be taken daily and the primary treatment of insomnia should be behavioral (How I Biohack My Sleep). But for occasional insomnia (whether it be issues with falling asleep vs. sleep maintenance) many doctors love to prescribe zolpidem, which, in my opinion, is a crappy molecule for a variety of reasons. A much better option, in my opinion, is eszopiclone. Both are Z-drugs but they “feel” very differently (and also produce quite different effects in EEGs).
In my experience and the experience of some friends, (es)zopiclone produces a restful sleep with no hangover whereas zolpidem kills my Oura data and is known to lead to all kinds of sleep-walking behavior. In fact, during my night shift two days ago, I had to send an older woman to a CT scan during the middle of the night because she fell out of bed hitting her head after having been given zolpidem by a colleague (even though it is common knowledge that zolpidem should never be given to old people!!). I discuss my experiences with a variety of hypnotics in more detail here.
Weekly observations
I share two Weekly Observations in my newsletter every week, similar to the one above. You can find the full archive here.
Disclaimer
The content available on this website is based on the author’s individual research, opinions, and personal experiences. It is intended solely for informational and entertainment purposes and does not constitute medical advice. The author does not endorse the use of supplements, pharmaceutical drugs, or hormones without the direct oversight of a qualified physician. People should never disregard professional medical advice or delay in seeking it because of something they have read on the internet.