Ask Me Anything (AMA)

#370 – AMA #76: Peter evaluates longevity drugs, aspirin for CVD, and strategies to improve muscle mass — proven, promising, fuzzy, noise, or nonsense?

In this “Ask Me Anything” (AMA) episode, Peter revisits the “proven, promising, fuzzy, noise, nonsense” framework and applies it to a variety of popular topics. He begins with a refresher on what each category represents before classifying a range of interventions based on the strength of their supporting evidence. The conversation spans three main areas: drugs for geroprotection (including GLP-1 agonists, SGLT2 inhibitors, methylene blue, and telomere-lengthening supplements), the use of low-dose aspirin for cardiovascular disease prevention, and strategies to improve muscle mass through optimal protein intake and follistatin gene therapy. This episode provides a clear, evidence-based overview for listeners seeking to understand where these popular health and longevity interventions stand on the spectrum of scientific credibility.

• A framework for evaluating scientific claims: proven, promising, fuzzy, noise, or nonsense [A: 1:30, V: 0:10];
• Strong convictions, loosely held: the mindset that separates great scientists from the rest [A: 7:30, V: 6:30];
• GLP-1 agonists: are there benefits beyond improving metabolic health and promoting weight loss? [A: 12:45, V: 12:25];
• GLP-1 drugs and the brain: exploring the potential cognitive benefits [A: 18:45, V: 18:55];
• GLP-1 drugs and lifespan: examining the evidence for potential geroprotective effects [A: 23:00, V: 23:45];
• Rapamycin and geroprotection: why it remains in the “promising” category [A: 25:45, V: 26:50];
• SGLT2 inhibitors and their potential geroprotective effect [A: 27:30, V: 28:40];
• Methylene blue: examining the evidence of an anti-aging effect [A: 34:45, V: 37:00];
• Methylene blue’s potential neuroprotective effects: limited and inconsistent evidence in humans, and the challenges of dosing and safety [A: 41:15, V: 43:45];
• Telomeres: what they are, how they relate to aging, and why telomere-lengthening supplements lack credible scientific evidence [A: 43:45, V: 47:26];
• Does the idea of targeting telomere length to extend lifespan have scientific merit? [A: 50:15, V: 54:45];
• Low-dose aspirin for cardiovascular disease prevention: weighing its clot-prevention benefits against bleeding risks across different populations [A: 55:00, V: 1:00:05];
• Rethinking the protein RDA: why most people need twice the recommended amount for muscle health [A: 1:00:45, V: 1:06:40];
• Debunking the protein–cancer myth: why higher protein intake doesn’t promote tumor growth [A: 1:06:15, V: 1:12:40];
• The biology of follistatin and myostatin, and why follistatin gene therapy has become an emerging topic of interest for muscle growth [A: 1:13:15, V: 1:20:50];
• Follistatin gene therapy for muscle growth: state of the evidence in animals and humans, and the technical challenges and regulatory barriers [A: 1:17:00, V: 1:25:05];
• Why injectable follistatin is theoretically possible but impractical for real-world use [A: 1:23:15, V: 1:32:30]; and
• More.

#367 – Tylenol, pregnancy, and autism: What recent studies show and how to interpret the data

In this special episode of The Drive, Peter addresses the recent headlines linking acetaminophen (Tylenol) use during pregnancy to autism in exposed children. Recognizing the confusion these claims have sparked among patients, listeners, and the broader public, Peter uses this episode to provide a framework for thinking critically about complex conditions and the research related to them. He highlights the dramatic rise in autism diagnoses over recent decades, noting that multifactorial conditions rarely have a single cause, and emphasizes the importance of resisting oversimplified explanations. Peter also stresses that humans are not naturally wired for scientific thinking, making disciplined frameworks like the Bradford Hill criteria essential for evaluating causality in epidemiology. Ultimately, he uses this framework to explore the evidence surrounding acetaminophen use during pregnancy and its potential link to autism.

• Laying the groundwork for this discussion, the rise in autism rates, and the value in using frameworks [A: 1:00, V: 0:09];
• The FDA pregnancy drug categories, where Tylenol falls within that framework, and a structured method for evaluating scientific evidence and causality [A: 6:00, V: 5:33];
• What exactly are the claims being made about acetaminophen and autism? [A: 13:45, V: 14:13];
• The increase in autism rates and why so many things are being linked to autism: the multiple comparisons problem [A: 15:00, V: 15:27];
• Evaluating the review paper that triggered the recent concern over acetaminophen and autism [A: 21:45, V: 22:34];
• Breaking down the largest studies on prenatal Tylenol exposure and autism: is there a causal link? [A: 35:00, V: 36:20];
• Why observational studies can’t prove causality, the role of confounding variables, and the importance of frameworks like the Bradford Hill criteria [A: 43:30, V: 45:08];
• Applying the Bradford Hill criteria: testing the case for Tylenol and autism [A: 45:45, V: 47:48];
• Putting it all together to answer the question: Does acetaminophen use during pregnancy increase the risk of autism? [A: 56:15, V: 59:03];
• If autism risk is overwhelmingly genetic, what explains the dramatic rise in autism diagnoses? [A: 59:15, V: 1:02:09];
• Other risk factors for autism: parental age, maternal health, environment, and where Tylenol fits in [A: 1:09:15, V: 1:12:41];
• Medication use during pregnancy: balancing risks, benefits, and FDA categories [A: 1:15:15, V: 1:19:01];
• Considerations for taking Tylenol during pregnancy [A: 1:19:30, V: 1:23:48];
• Final thoughts: critical thinking, balanced risk assessment, and the importance of context when evaluating medications like Tylenol during pregnancy [A: 1:22:30, V: 1:26:53]; and
• More.

#364 – AMA #75: Diets: how to evaluate and implement any diet including keto, carnivore, vegan, Mediterranean, and more

In this “Ask Me Anything” (AMA) episode, Peter explores how to determine the right diet for yourself rather than searching for a universal “best” diet. He begins by laying out five non-negotiable criteria that any sustainable eating pattern must meet—energy balance, metabolic health, adequate protein, micronutrient sufficiency, and long-term adherence—before introducing a practical rubric for evaluating different diets. Using this framework, Peter walks through the ketogenic, carnivore, vegan, and Mediterranean diets, highlighting their strengths, ideal candidates for each, and common pitfalls such as micronutrient gaps or adherence challenges. He explains why this guidance is aimed at people who feel overwhelmed by diet choices, not zealots defending a single approach, and provides practical advice on using tools like DEXA scans, lab markers, continuous glucose monitors, and symptom tracking to assess whether a diet is truly working.

• Peter’s family chess battle [A: 3:00, V: 1:27];
• Framing the diet discussion: moving past tribalism to practical frameworks for evaluating various dietary strategies [A: 5:00, V: 3:45];
• Peter’s high-level nutrition framework [A: 11:00, V: 1:20];
• Why diet is such a uniquely polarizing subject [A: 14:15, V: 14:15];
• The five non-negotiables that apply to any diet [A: 17:45, V: 18:23];
• How to think about energy balance in the context of evaluating a specific diet [A: 20:15, V: 21:10];
• How diet can address metabolic health [A: 21:45, V: 22:56];
• Protein as a dietary foundation [A: 23:30, V: 25:15];
• Micronutrient essentials: avoiding deficiencies in restrictive and processed diets [A: 24:45, V: 26:36];
• Why adherence and sustainability are essential for diet success [A: 27:15, V: 29:21];
• Examining the standard American diet through the five non-negotiables [A: 31:00, V: 33:57];
• The evaluation framework for specific diets [A: 33:30, V: 37:00];
• The ketogenic diet: defining ketosis, clinical origins, modern uses, and potential health benefits [A: 35:00, V: 38:33];
• The main strengths and weaknesses of the ketogenic diet [A: 43:00, V: 48:00];
• How to avoid micronutrient deficiencies while on a ketogenic diet [A: 47:15, V: 52:49];
• Electrolytes and fiber and the ketogenic diet: preventing magnesium loss and maintaining digestive health [A: 49:15, V: 55:22];
• Adherence challenges of the ketogenic diet [A: 51:30, V: 58:00];
• The carnivore diet: definition, motivations, anecdotal benefits, and possible mechanisms [A: 53:15, V: 59:58];
• The main strengths and weaknesses of the carnivore diet [A: 57:30, V: 1:05:03];
• Plant exclusion on the carnivore diet: nutrient gaps, gut changes, and unanswered questions [A: 1:03:15, V: 1:12:38];
• Adherence challenges of the carnivore diet [A: 1:04:45, V: 1:14:28];
• The vegan diet: definition, core beliefs, and various motivations for this strategy [A: 1:05:45, V: 1:15:46];
• The main strengths and weaknesses of the vegan diet [A: 1:09:15, V: 1:20:15];
• Adherence to the vegan diet: social acceptance, edge cases, and personal sustainability [A: 1:13:15, V: 1:24:40];
• The Mediterranean diet: definitional challenges, traditional patterns, and its relatively strong evidence base [A: 1:15:15, V: 1:26:57];
• Limitations of the Mediterranean diet: loose definitions and indulgence risks [A: 1:19:30, V: 1:31:45];
• Measuring diet success: why setting clear goals and tracking outcomes matter [A: 1:21:00, V: 1:33:51];
• Tracking body composition using DEXA scans [A: 1:22:15, V: 1:35:27];
• Tracking metabolic health: key blood tests and advanced glucose monitoring tools [A: 1:22:45, V: 1:36:07];
• Using elimination diets to identify food sensitivities that may cause digestive problems, autoimmune symptoms, or low energy [A: 1:23:30, V: 1:36:45];
• Evaluating “anti-inflammatory diets”: confirming inflammation through symptoms and hs-CRP testing [A: 1:25:15, V: 1:38:54];
• Final takeaways: flexibility, structure, and avoiding dogma in dietary choices [A: 1:27:00, V: 1:40:49]; and
• More.

#361 – AMA #74: Sugar and sugar substitutes: weight control, metabolic effects, and health trade-offs

In this “Ask Me Anything” (AMA) episode, Peter explains how to evaluate sugar and its substitutes in the context of health. Peter explores the role of sweeteners in three common use-cases – beverages, protein supplements, and sweet treats – and breaks down how our evolutionary craving for sweetness now clashes with today’s food environment. He examines whether sugar is uniquely fattening, the hormonal effects of sugar consumption, and the significance of timing in sugar intake. The episode compares natural versus refined sugars, sugar in beverages versus in solid foods, and the pros and cons of popular sweeteners including saccharin, aspartame, sucralose, allulose, and sugar alcohols like erythritol and xylitol. With a focus on weight management, glycemic impact, gut health, and long-term safety, this episode offers a comprehensive guide to navigating the sweetener landscape with clarity and nuance.

• A quick tangent on chess and parenting [A: 2:30, V: 1:00];
• Overview of key scenarios for evaluating sugar and sweeteners [A: 6:15, V: 5:15];
• Why humans are hardwired to crave sweetness [A: 13:30, V: 13:15];
• Evaluating whether sugar is uniquely fattening or more harmful than other macronutrients under isocaloric conditions [A: 15:15, V: 15:15];
• Why sugar drives appetite: low satiety, insulin response, and reward system activation [A: 18:45, V: 19:15];
• How sugar type, liquid vs. solid form, and processing level influence appetite and metabolic impact [A: 20:15, V: 21:15];
• Addressing the common belief that natural sugars are healthier than refined sugars [A: 26:00, V: 27:45];
• How the timing of sugar consumption alters the body’s metabolic response [A: 29:15, V: 31:55];
• How Peter advises patients on sugar intake, factoring in metabolic health, insulin sensitivity, and activity level [A: 34:45, V: 38:00];
• The most common sugar substitutes, their sweetness relative to sugar, and their caloric content [A: 36:30, V: 40:20];
• Evaluating the role of sugar substitutes in weight control: efficacy vs. effectiveness and limitations in study design [A: 40:15, V: 44:30];
• Assessing the real-world impact of sugar substitutes on weight, and the role of sweetness without calories [A: 44:00, V: 48:50];
• The impact of sugar substitutes on glycemic control [A: 47:30, V: 52:50];
• Are microbiome changes from artificial sweeteners substantial enough to cause obesity and diabetes? [A: 50:30, V: 56:30];
• How Peter advises patients on the use of sugar substitutes across different contexts [A: 52:30, V: 58:45];
• Allulose—a sweetener with unique satiety and glycemic benefits and potential for weight control [A: 57:15, V: 1:04:30];
• Emerging evidence that stevia, monk fruit, and sugar alcohols may provide modest metabolic benefits compared to sugar [A: 1:03:00, V: 1:10:45];
• Sugar alcohols explained [A: 1:04:15, V:1:12:20];
• Xylitol’s dental health benefits and considerations for use [A: 1:05:00, V: 1:13:20];
• Artificial sweeteners and cancer risk: evaluating evidence, the aspartame controversy, and the role of dose in toxicology [A: 1:07:15, V: 1:15:55];
• Sugar substitutes and cardiovascular disease: assessing flawed studies and the absence of direct risk evidence [A: 1:11:00, V: 1:20:15];
• Why artificial sweeteners seem to attract so many negative headlines [A: 1:12:45, V: 1:22:05];
• Balancing benefits and risks of sugar substitutes: guidance for desserts, beverages, and protein products [A: 1:14:15, V: 1:24:00]; and
• More.

356 – AMA #73: Preserving brain health, optimizing exercise programming, improving body composition, and more

In this “Ask Me Anything” (AMA) episode, Peter addresses frequently requested topics, including brain health, exercise programming, and body composition. He explores the factors that influence dementia risk—including metabolic health, fitness, sleep, hearing, cholesterol levels, and more. He explains how to implement zone 2 training and VO₂ max intervals for cardiovascular fitness and also covers how to combine cardio modalities, how to stay in zone 2, and special considerations for women. Peter highlights the benefits of light movement after meals and offers strength training tips for those managing injuries. Additional insights include how to maintain fat loss, the truth about so-called “slow metabolisms,” and how to set appropriate daily protein goals while managing the trade-off between lean mass and body fat over time.

• Overview of episode topics on brain health, cardiovascular training strategies, and body composition [2:15];
• Understanding dementia risk: modifiable vs. non-modifiable contributors to cognitive decline [5:00];
• The causality between metabolic health and dementia [9:45];
• How diet and exercise influence brain health: energy balance and exercise as key preventative tools [13:30];
• Why combining aerobic, resistance, and cognitively engaging activities offers the most comprehensive benefits for preventing cognitive decline [17:00];
• Additional lifestyle factors that influence dementia risk: smoking, head trauma, alcohol, and sleep [19:45];
• The link between hearing loss and dementia: dose-dependent risk and the case for correction [25:15];
• How poor oral hygiene may contribute to neuroinflammation and dementia risk [23:30];
• Supplements for brain health: which ones matter and when they’re worth considering [28:45];
• Low LDL cholesterol and brain health: debunking the myth of cognitive risk [33:45];
• How to approach zone 2 training: the importance of staying in zone 2 and tailoring intensity based on your time and goals [38:00];
• Lactate testing for zone 2: clinical protocols and at-home approaches [43:00];
• Combining modalities in zone 2 training: balancing enjoyment and efficiency [47:00];
• Zone 2 training for women: addressing the misconception that zone 2 training is unnecessary or ineffective for postmenopausal women [49:30];
• Effective strategies for VO₂ max training: short vs. long intervals [51:45];
• The benefits of post-meal walking for glucose management, and why spikes in glucose during exercise aren’t harmful [56:45];
• The role of stability training in supporting resistance work and healthy aging [1:00:15];
• Adapting strength training to manage chronic back injuries and train for longevity [1:02:00];
• The role of aerobic exercise (like zone 2) in fat loss, metabolic health, and weight maintenance [1:06:30];
• Debunking the “fast vs. slow metabolism” myth: why energy balance and protein matter most for fat loss [1:09:45];
• Lean mass vs. body fat: why both matter for health and longevity [1:12:15];
• How protein intake impacts muscle mass and why pairing it with resistance training is significantly more effective [1:15:15]; and
• More.

#353 – AMA #72: Fasting: benefits for body composition and disease prevention, potential risks, and Peter’s updated practical framework

In this “Ask Me Anything” (AMA) episode, Peter revisits the topic of fasting, sharing how his thinking has evolved over time. The episode explores fasting-related terminology and common types of fasting, as well as the various reasons individuals might choose to fast. Peter explores potential benefits including improvements in body composition, metabolic health, lifespan extension, cardiovascular disease, cancer prevention and treatment, neurodegenerative conditions such as Alzheimer’s and Parkinson’s, and autoimmune symptoms like arthritis. He also examines the risks and potential downsides of fasting and offers a practical framework to help assess when and how fasting may be most appropriately applied.

• Why the topic of fasting is being revisited [1:45];
• The importance of being open to changing one’s opinion in science and medicine as new evidence emerges [4:15];
• Defining fasting and how it fits in the framework of dietary restriction, time-restricted feeding, and calorie restriction [7:30];
• The most common types of fasting [11:45];
• Why someone might choose fasting over continuous caloric restriction [19:00];
• The biochemical effects of fasting: fuel partitioning, autophagy, and more [21:00];
• Autophagy: a cellular cleanup process stimulated by fasting and energy depletion [26:00];
• Comparing the physiological effects of a ketogenic diet to those of long-term fasting [27:45];
• How long fasting takes to induce ketosis and boost autophagy, and how autophagy is measured [29:45];
• At-home tests for ketones [33:45];
• Reducing senescent (“zombie”) cells and inflammation through autophagy [35:00];
• Examining the evidence for the long-term health benefits of fasting beyond short-term metabolic effects [37:15];
• The common health claims associated with fasting across metabolic, neurological, oncological, autoimmune, and longevity domains [40:30];
• The impact of fasting on body weight and body composition [42:00];
• Weight regain and potential metabolic consequences of fasting [44:00];
• The risk of lean mass loss with fasting and how to mitigate it [47:15];
• A practical framework for using fasting as a strategy to improve body composition [52:15];
• How extended fasting compares to caloric restriction in improving insulin sensitivity in people with insulin resistance or type 2 diabetes [54:00];
• Is there any evidence that fasting can extend lifespan? [55:45];
• Examining whether fasting improves cardiovascular disease risk beyond the effects of weight loss and calorie reduction [58:15];
• Exploring whether prolonged fasting can reduce cancer risk [59:45];
• The potential benefits of fasting or fasting-mimicking diets during cancer treatment: emerging evidence and practical considerations [1:02:15];
• Fasting for protection against neurodegenerative diseases: early evidence of therapeutic benefit and open questions [1:10:45];
• Various fasting methods for autoimmune diseases: potential symptom relief with cautious application [1:14:00];
• Fasting and type 1 diabetes: risks, evidence, and careful dietary alternatives [1:16:45];
• Fasting and gut disorders: potential benefits outside of flare-ups [1:18:45];
• The primary risks and downsides associated with fasting [1:19:45];
• The essential vitamins and minerals to supplement during prolonged fasting [1:21:30];
• Who should avoid fasting and why [1:22:15];
• Fasting’s role in health: where it shows promise and where it likely offers no distinct advantage over caloric restriction [1:23:45]; and
• More.

#349 – AMA #71: Building strength and muscle mass: how to optimize training, nutrition, and more for longevity

In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of muscle mass and strength, examining their essential roles in both lifespan and healthspan. Drawing from over 30 hours of prior discussions with experts including Layne Norton, Andy Galpin, and Mike Israetel, this episode distills the most important insights into one comprehensive and up-to-date conversation. Peter explores why muscle matters for longevity, metabolic health, and injury prevention, and clarifies the differences between muscle mass and strength, including which is more vital for aging well. He breaks down practical strategies for building muscle safely and effectively, including progressive overload, training intensity, rep ranges, and the importance of explosive power. Peter also covers key nutrition strategies—like protein intake, timing, and creatine supplementation—and offers practical advice for everyone from beginners to seasoned lifters on building and maintaining muscle safely and sustainably.

• Peter’s humorous experience talking nutrition with a second grader [2:30];
• Overview of topics, episode structure, and reasoning for focus on muscle mass and strength [6:00];
• Defining key terms: muscle mass, strength, hypertrophy, power, and more [8:15];
• The importance of muscular strength, muscle mass, and cardiorespiratory fitness for longevity [10:30];
• Grip strength as a simple yet powerful predictor of all-cause mortality [16:45];
• Is muscle strength causal or just a marker of health? [20:00];
• Why VO2 max, strength, and muscle mass are powerful health markers: a reflection of long-term consistent effort [22:30];
• How muscle mass and strength enhance healthspan by supporting metabolic health, inflammation control, recovery from illness, mobility, and fall prevention [23:45];
• How muscle mass and strength decline with age, and why it’s essential to act early to slow decline and preserve function later in life [30:30];
• The foundational principles of building muscle strength and size through resistance training [35:30];
• How to apply “progressive overload” for long-term strength and muscle gains [39:30];
• The difference between concentric and eccentric muscle contractions and how each impacts strength, hypertrophy, and injury prevention [44:45];
• The differences between muscle fiber types, and how aging disproportionately affects fast-twitch fibers responsible for power [50:15];
• How to effectively train for power [52:00];
• Training intensity: the benefits and safety of using the “reps in reserve” method [53:00];
• How to balance compound and isolation exercises in a workout routine, and why compound lifts are foundational [55:45];
• Can bodyweight exercises build muscle as effectively as weight training? [57:45];
• How women can effectively build strength and muscle: key considerations [59:15];
• Effective methods for tracking progress in strength [1:01:15];
• Effective methods for tracking progress in muscle mass, and how to interpret results from a DEXA scan [1:04:30];
• How to balance workout frequency with recovery for optimal results [1:06:45];
• How to recognize signs of overtraining and when to consider taking rest days [1:10:15];
• Avoiding injury: how beginners or returning lifters can start resistance training safely [1:15:15];
• Protein: recommended intake, quality sources, timing of consumption, and more [1:17:30];
• How fasting and calorie restriction affect muscle mass and what can be done to minimize muscle loss [1:24:15];
• Key nutritional factors beyond protein that support muscle growth: hydration, creatine, and recovery [1:27:45];
• The impact of hormones, sleep, stress, and consistency on muscle building and recovery [1:28:45];
• How to structure an effective workout routine for a younger person that is new to resistance training [1:31:30];
• How to modify beginner resistance training programs for older individuals to prioritize safety and gradual progress [1:35:30];
• Should beginners start with machines or free weights when resistance training? [1:36:30];
• How experienced lifters should modify their training to support healthspan and performance in later life [1:38:00]; and
• More.

#344 – AMA #70: Nicotine: impact on cognitive function, performance, and mood, health risks, delivery modalities, and smoking cessation strategies

In this “Ask Me Anything” (AMA) episode, Peter dives deep into nicotine—a topic increasingly debated both scientifically and publicly. He clarifies the critical differences between nicotine and tobacco, highlighting why nicotine alone isn’t primarily responsible for smoking’s severe health consequences. Peter examines the specific risks associated with nicotine use, including addiction, sleep disruption, cardiovascular concerns, and effects on mood and anxiety. He evaluates various nicotine delivery methods, from traditional cigarettes to gums, pouches, and synthetic alternatives, ranking them according to their relative safety. Additionally, Peter explores nicotine’s potential positive and negative impacts on physical performance, cognitive function, fertility, and its interactions with other stimulants like caffeine. Finally, he provides practical guidance for minimizing risks with nicotine use and offers thoughtful strategies for smoking cessation and effective nicotine replacement therapies.

• Revisiting the previous AMA on microplastics: low-effort, high-impact changes to significantly reduce microplastic exposure [1:45];
• Overview of episode topics related to nicotine [3:30];
• The current landscape of nicotine research [4:45];
• Addressing the common misconception that nicotine itself is the primary cause of tobacco-related health risks [6:45];
• Peter’s Marlboro-branded apparel is a nostalgic tribute to the Formula One era and not a sign of support for smoking [10:00];
• The limitations of current research on the health risks of nicotine itself [12:15];
• The most common side effects of nicotine [18:15];
• The impact of nicotine on sleep [21:30];
• Nicotine and mood: how nicotine can have both anxiety-inducing and calming effects based on genetics and dosage [25:00];
• The addictive properties of nicotine: factors influencing addiction risk, and why certain people may struggle more than others [29:15];
• The various nicotine products and nicotine delivery methods available: effects, absorption rates, and potential risks [33:45];
• The relative risks of various nicotine products: how differences in nicotine concentration, absorption rates, and presence of contaminants impact their safety [37:00];
• How nicotine exposure during adolescence can negatively impact brain development [47:45];
• Nicotine’s potential to prevent or slow neurodegenerative diseases [50:45];
• Nicotine’s impact on memory, learning, and attention [52:45];
• The interaction between nicotine and other stimulants, particularly caffeine [55:15];
• Nicotine’s potential impact on physical performance [57:15];
• The potential effects of nicotine on fertility, and the challenges of distinguishing the impact of nicotine itself from the effects of smoking [58:30];
• Considerations for people curious about using nicotine for its cognitive benefits [1:01:30];
• How to think about nicotine: weighing cognitive claims, addiction risks, and personal tolerance [1:03:15];
• The prevalence of smoking, the health risks it poses, and the substantial long-term benefits of quitting [1:05:45];
• Effective strategies for smoking cessation including the use of nicotine replacement therapies [1:09:00];
• The reasons behind weight gain after quitting smoking, the role of nicotine in appetite suppression, and strategies to manage weight [1:15:30]; and
• More.

#340 – AMA #69: Scrutinizing supplements: creatine, fish oil, vitamin D, and more—a framework for understanding effectiveness, quality, and individual need

In this “Ask Me Anything” (AMA) episode, Peter explores the complex world of supplements by introducing a practical framework for evaluating their effectiveness and relevance to individual health needs. Rather than providing a simple list of recommendations, Peter aims to equip listeners with the tools to critically assess supplements on their own. He then applies this framework to discuss research on several popular supplements, including creatine, fish oil, vitamin D, B vitamins, and ashwagandha. Additionally, he covers key factors in assessing supplement quality, helping listeners develop a deeper understanding of how to make informed decisions based on their personal health goals.

• Overview of episode topics [1:45];
• How Peter evaluates patients’ supplement regimens, and common misconceptions about supplements vs. pharmaceuticals [3:00];
• A framework for evaluating supplements [6:15];
• Evaluating creatine: purpose of supplementation, dosing, and mechanism of action [10:00];
• Creatine: proven benefits for muscle performance, potential cognitive benefits, and why women may benefit more [15:15];
• Creatine: risk vs. reward, kidney concerns, and choosing the right supplement [18:45];
• Evaluating fish oil: its primary purpose as a supplement and how to track levels [20:45];
• Fish oil: how omega-3s impact inflammation, heart health, and brain function, and the strengths and limitations of current research [26:30];
• Fish oil: the risks of supplementation, guidance on selecting high-quality products, and how to determine whether supplementation is appropriate [37:30];
• Evaluating vitamin D: understanding deficiency and optimal levels [45:15];
• Vitamin D: role in bone health, immune function, potential longevity impact, and biomarker limitations [51:15];
• Vitamin D: efficacy, safety, and balancing risk vs. reward [58:15];
• Evaluating B vitamins: function, consequences of deficiency, and key biomarkers to assess whether supplementation is necessary [1:02:15];
• B vitamins: risks for CVD and dementia associated with deficiency, and limited evidence for general population supplementation [1:07:15];
• Evaluating ashwagandha: background, uses, and mechanism of action [1:15:30];
• Ashwagandha: current evidence for its effects on sleep, stress, and anxiety [1:19:15];
• Ashwagandha: evaluating supplement quality, safety profile, and the risk-reward balance [1:22:15];
• The importance of using a structured evaluation framework to assess any supplement [1:26:30]; and
• More.

#336 – AMA #68: Fasting, well-balanced diets, alcohol, exercise for busy people, wearables, emotional health, assessing cardiovascular health, and more

In this “Ask Me Anything” (AMA) episode, Peter tackles a diverse set of listener-submitted questions, covering a wide range of health and performance topics. He dives into assessing cardiovascular health, discussing key biomarkers and risk factors, and breaks down various fasting approaches, including time-restricted eating and prolonged fasting. The conversation also explores the impact of alcohol on health and disease risk, fundamental principles of nutrition, and optimal protein intake. Additionally, he examines the pros and cons of ketogenic and low-carb diets, strategies for building effective exercise routines, and the role of wearables in tracking health metrics. The episode concludes with insights on emotional health, making this a well-rounded discussion packed with practical takeaways for anyone looking to optimize their well-being.

• Episode format: overview of common health topics based on listener questions [1:30];
• How to accurately assess your cardiovascular health [3:00];
• The impact of fasting, time-restricted eating, and dietary restriction on metabolic health [9:00];
• Alcohol: health risks of consumption, limitations of research, and how to weigh the risks against social and personal enjoyment [13:45];
• Principles of a well-balanced diet: macronutrients, micronutrients, protein, energy balance, and more [23:45];
• The benefits and drawbacks of ketogenic diets: impact on satiety, metabolic health, athletic performance, lipid levels, and more [29:15];
• Protein: best sources for muscle growth, total intake, PDCAAS scoring system, and getting adequate amounts on plant-based diets [36:15];
• Creating an effective fitness routine that fits into a busy schedule [41:45];
• The role of rest and recovery in a workout routine [46:00];
• How to track fitness progress beyond just weight on a scale [48:30];
• The best low-impact exercises for individuals with joint issues [52:00];
• Wearables: insight vs. compliance, and how to use them effectively [54:45];
• How to evaluate the risks and benefits of medical interventions: procedural risks, complication rates, and asking informed questions [59:00];
• Sleep: impact on metabolic and cognitive health, and tips for improving sleep quality [1:03:45];
• How to identify and address emotional health challenges [1:08:30]; and
• More.

#332 – AMA #67: Microplastics, PFAS, and phthalates: understanding health risks and a framework for minimizing exposure and mitigating risk

In this “Ask Me Anything” (AMA) episode, Peter tackles a topic that’s been dominating headlines and sparking widespread concern: microplastics and plastic-associated chemicals, including BPA, PFAS, and phthalates. Peter explores the science behind these substances including how and why they’ve become so prevalent, the extent of our exposure, and the potential risks to our health. Most importantly, he provides a practical framework for understanding microplastics and plastic-associated chemicals and minimizing exposure while distinguishing genuine risks from exaggerated concerns.

We discuss:

• The complexity of the topic of microplastics and associated chemicals [1:30];
• Definitions: microplastics, BPA, PM2.5, phthalates, and more [6:30];
• The reasons behind the increase in microplastics in our environment and the surge in interest in them [12:00];
• The various ways that humans are exposed to microplastics and nanoplastics [14:00];
• Volume of plastic consumed by humans, and how the body eliminates or absorbs microplastics [16:00];
• How microplastics accumulate in the body, the variability in tissue accumulation, and the challenges in studying their long-term health effects [21:30];
• Limitations of blood tests for microplastics, and the importance of reliable biomarkers for guiding behavior and interventions [26:30];
• The speculative health risks of microplastics, the limitations of current research, and the need for more robust studies [29:15];
• The challenges of measuring microplastics in human tissues, the need for better methodologies, and the importance of critically evaluating study relevance and claims [39:45];
• If it’s unclear whether microplastics actually cause harm, should we still be concerned about exposure? [42:15];
• Strategies to minimize microplastic exposure [45:00];
• The financial cost and effort involved in various microplastic exposure mitigation strategies [51:00];
• The role of airborne microplastics in total exposure and accumulation [1:03:00];
• Chemicals associated with plastics, their role as endocrine disruptors, and the challenges in linking exposure to specific health outcomes [1:04:00];
• BPA: role in plastic production, and its potential developmental risks [1:05:45];
• BPA’s potential health risks: pregnancy, fertility, obesity, and diabetes, and the socioeconomic confounders in the data [1:08:30];
• Regulatory limits on BPA exposure, and practical considerations for reducing exposure [1:12:45];
• The prevalence of BPA in modern products and how to identify it [1:17:15];
• PFAS: chemical structure and purpose in products [1:18:30];
• Why PFAS are considered endocrine disruptors [1:19:45];
• The main sources of PFAS exposure, and practical steps to reduce exposure [1:21:30];
• The potential health risks of PFAS exposure [1:24:00];
• Phthalates: role in making plastics flexible, and presence in personal care products [1:24:45];
• Why phthalates are considered endocrine disruptors [1:25:15];
• The main sources of phthalate exposure, and how manufacturing practices are evolving to reduce exposure [1:26:45];
• Practical strategies to reduce exposure to phthalates in food, air, water, and personal care products [1:28:30];
• Navigating microplastics and associated chemicals: a framework for personalized risk reduction [1:29:30]; and
• More.

#329 ‒ Special AMA: Peter on exercise, important labs, building good habits, promising longevity research, and more

In this special episode of The Drive, Peter tackles a wide range of listener questions submitted over the past year. The discussion spans essential topics such as exercise—covering grip strength, traveling workouts, and why Peter doesn’t consider exercise an ideal weight-loss strategy—and the top biomarkers everyone should track. He also explores promising new longevity research, his evolving views on longevity, and frameworks like “objective, strategy, tactics” for personalized decision-making. The episode wraps up with insights on building good habits and a glimpse into Peter’s recent reading list.

We discuss:

• Overview of episode topics (and Peter’s car stereo saga) [1:45];
• The importance of grip strength and the best methods for training it effectively [3:45];
• Exercise while traveling: strategies for staying active and maintaining an exercise routine [14:45];
• Why women should prioritize strength training [18:00];
• The limited role of exercise in weight loss and its greater importance in improving health, body composition, and insulin sensitivity [19:45];
• The “top five most important biomarkers” for assessing health [22:45];
• Promising developments in longevity research [28:15];
• The development of Klotho as a neuroprotective drug: challenges, timelines of trials, and more [34:00];
• Peter’s updated view on the potential of epigenome manipulation to restore aged cells to their youthful state [39:45];
• How reversing age-related epigenetic changes in immune cells could revolutionize our approach to aging and disease [43:30];
• The “objective, strategy, tactics” framework, and the importance prioritizing impactful lifestyle habits over less significant health trends [49:30];
• Strategies for building and maintaining good habits [56:45];
• How to think about drugs and supplements as part of a longevity toolkit [1:02:00];
• Peter’s recent reading list [1:05:15]; and
• More.

328 – AMA #66: Optimizing nutrition for health and longevity: myth of a “best” diet, complexities of nutrition science, and practical steps for building a sustainable diet

In this “Ask Me Anything” (AMA) episode, Peter dives deep into one of the most frequently discussed and often misunderstood topics: nutrition. From weight loss and maintenance to the intricate relationship between nutrition and exercise and body composition, Peter addresses the complexities of nutrition research and explores the perennial question of whether there is a “best diet.” He provides practical insights on how to choose the right diet for your unique needs, discusses the role of protein and processed foods, and outlines the key questions to help you optimize your approach to eating.

We discuss:

• The key nutrition-related topics to be discussed [1:30];
• Why Peter is not fond of discussing nutrition: limitations of nutrition research, the pitfalls of extreme certainty in dietary discussions, and the body’s adaptability to varied diets [3:30];
• Key health metrics to monitor to evaluate the effects of nutrition [9:30];
• The relationship between nutrition and exercise as they relate to weight loss, maintenance, and gain [12:30];
• How increased muscle mass from resistance training impacts calorie burn, body composition, glucose metabolism, and overall health benefits [19:45];
• Comparing the impact of fitness and nutrition on lifespan and healthspan: data showing fitness to be a more significant predictor of mortality than nutrition [23:30];
• The myth of a “best diet,” factors that determine the effectiveness of a diet, and data suggesting benefits of the Mediterranean diet [39:00];
• How long to trial a new diet, the importance of measurable goals, and the appropriate timescales for observing meaningful changes [48:30];
• The inherent challenges in nutrition research: variability in dietary exposures, limitations in study design, the body’s adaptive nature which dampen the effects, and more [51:15];
• Nutritional approaches for chronic diseases like cardiovascular disease and type 2 diabetes [58:45];
• Emerging studies on dietary interventions for non-alcoholic fatty liver disease (NAFLD) and metabolic dysfunction-associated steatotic liver disease (MASLD) [1:02:45];
• Practical considerations for individuals to identify the best diet for them: protein intake, energy balance, macronutrient adjustments, and micronutrient levels [1:06:00];
• Understanding processed vs. ultra-processed foods [1:09:15];
• The effects of ultra-processed foods on health [1:12:30];
• Questions that someone should ask themselves if they’re looking to fine-tune their diet [1:18:15]; and
• More.

#326 – AMA #65: Red light therapy: promising applications, mixed evidence, and impact on health and aging

In this “Ask Me Anything” (AMA) episode, Peter dives into the world of red light therapy in response to frequent questions from listeners. Peter provides a comprehensive exploration, starting with the basics of red light therapy and why it’s getting so much attention. The conversation examines the latest data on various applications, including aging, skin health, acne, wound healing, hair loss, eye health, exercise performance, metabolic health, weight loss, inflammation, injury recovery, and menstrual cramps. Peter analyzes the scientific literature on each use case and concludes with a summary table that provides an easy-to-follow breakdown of the potential benefits of red light therapy across these areas.

We discuss:

• Overview of topics and the motivation behind exploring red light therapy [1:45];
• The basic science of red light therapy [3:15];
• The unique penetration properties of red light [6:00];
• What happens when tissue is exposed to red light [9:30];
• Exploring red light therapy’s potential to combat aging [11:00];
• Red light therapy for treating acne [13:00];
• Red light therapy for aiding in wound healing [18:45];
• Red light therapy for hair loss: promising benefits and practical advice [24:15];
• Analyzing the evidence of a positive or negative effect of red light therapy on the eyes [28:00];
• Red light therapy’s impact on performance and recovery [30:30];
• Red light therapy’s impact on metabolic health: analyzing the limited evidence for improved glucose metabolism [32:45];
• Red light therapy for weight loss and targeted fat reduction [36:45];
• Red light therapy for inflammation, chronic pain, and injury rehabilitation [41:00];
• Red light therapy as a treatment for menstrual cramps [43:45];
• Summary: promising applications of red light therapy, unsupported claims, and costs to consider [46:45]; and
• More.

#320 – AMA 64: New insights on GLP-1 agonists (Ozempic, Wegovy, Mounjaro) – efficacy, benefits, risks, and considerations in the rapidly evolving weight-loss drug landscape

In this “Ask Me Anything” (AMA) episode, Peter dives back into the increasingly popular topic of GLP-1 agonists, such as Ozempic and Mounjaro, which have garnered widespread attention for their ability to promote weight loss. Peter covers the latest findings in this rapidly evolving landscape, including new insights into their long-term efficacy, side effects, and what happens when the drug is discontinued. Peter also explores their impact on body composition and how resistance training interacts with these treatments. Additionally, he compares different GLP-1 receptor agonists and discusses promising new drugs in the pipeline. Finally, Peter addresses questions about the role of compounding pharmacies in the GLP-1 agonist market, compares oral vs. injectable options, and provides key considerations for anyone deciding whether to use a GLP-1 agonist for weight loss.

• The rapidly evolving landscape of GLP-1 agonists [2:15];
• The mechanism of GLP-1 agonists, their origin as diabetes treatments, and how they evolved into weight-loss drugs [6:45];
• Overview of the new data and open questions related to the benefits and risks of GLP-1 agonists [10:30];
• New insights into the long-term safety of GLP-1 agonists, side effects, and more [16:45];
• The long-term efficacy of GLP-1 agonists, financial barriers, and more [19:45];
• The mechanisms behind GLP-1 agonists’ ability to promote weight loss [22:00];
• New data on body weight changes after discontinuing the drug [26:00];
• Effects of GLP-1 agonists on lean mass and body composition, and the role of protein and resistance training in preserving muscle [31:30];
• Semaglutide vs. tirzepatide: comparing benefits and side effects [36:30];
• How compounding pharmacies affect availability of GLP-1 drugs and the types of formulations that are available [39:15];
• How do oral formulations of GLP-1 drugs compare to injectable formulations? [44:15];
• How do sublingual (under tongue) formulations of GLP-1 drugs compare to injectable formulations? [46:15];
• Guidance for using compounding pharmacies to purchase GLP-1 agonists [47:15];
• Data on retatrutide—a promising new triple receptor agonist in the pipeline [50:15];
• Can GLP-1 agonists be beneficial for sleep apnea and immune function? [57:00];
• Potential neuroprotective benefits of GLP-1 agonists: impact on dementia risk [1:00:45];
• Exploring why GLP-1 agonists may reduce the risk of cancer, kidney disease, and cardiovascular disease [1:04:00];
• How GLP-1 agonists might boost fertility in women [1:10:15];
• Early indications that GLP-1 agonists may help treat substance abuse disorders [1:12:00];
• Potential health risks of GLP-1 agonists: addressing thyroid cancer concerns and the unknowns due to lack of data [1:14:00];
• Examining the potential link between GLP-1 agonists and increased depression or suicidal ideation [1:16:00];
• Major remaining questions: the effects of cyclic use, rebound appetite, impact on adolescents’ development, and more [1:19:30];
• Key considerations when deciding whether to use a GLP-1 agonist for weight loss [1:23:45]; and
• More.

#316 – AMA #63: A guide for hair loss: causes, treatments, transplants, and sex-specific considerations

In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of hair loss, exploring its relationship with aging and its impact on quality of life. The conversation focuses on androgenic alopecia, the most common form of hair loss in both men and women, and covers the differences in patterns and causes between the sexes. Peter delves into the right timing for treatment, breaking down various options such as minoxidil and finasteride, low-level laser therapy, platelet-rich plasma injections, and more. Additionally, Peter outlines the pros and cons of the two primary hair transplantation methods and concludes with practical advice on selecting the right specialist or treatment team for those facing hair loss.

• The impact of hair loss on emotional health [2:15];
• The prevalence, patterns, and causes of hair loss in men and women [5:15];
• The genetic and hormonal causes of hair loss, and the role of dihydrotestosterone (DHT) in androgenic alopecia [8:45];
• The visual differences in hair loss patterns between men and women, and the importance of consulting a specialist to rule out non-genetic causes of hair loss [13:30];
• How genetic predisposition influences the risk of androgenic alopecia, and how early detection through diagnostic tools and blood tests can help manage the risk more effectively [16:45];
• Ideal timing for starting treatment: why early treatment is crucial for effectively managing hair loss [19:30];
• The various FDA-approved treatments for androgenic alopecia, their mechanisms, and additional off-label treatments commonly used to manage hair loss [24:30];
• Topical minoxidil—the most commonly recommended starting treatment for hair loss [30:15];
• Oral vs. topical minoxidil: efficacy, ease of use, and potential side effects that must be considered [33:45];
• Finasteride for treating hair loss: efficacy, potential side effects on libido, and the need for careful PSA monitoring in men to avoid missing early signs of prostate cancer [37:15];
• Other effective hair loss treatments for women: boosting hair density with spironolactone gel and ketoconazole shampoo as part of a comprehensive strategy [41:30];
• Low-level laser therapy: effectiveness, costs, practicality, and a comparison of in-office treatments with at-home devices [49:00];
• Platelet-rich plasma (PRP) as an off-label treatment for hair loss: potential effectiveness, varying protocols, and significant costs [53:45];
• Hair transplant for advanced hair loss: criteria and considerations [58:00];
• Types of hair transplants: follicular unit transplantation (FUT) vs. follicular unit extraction (FUE) [1:02:00];
• The financial cost of hair transplant surgery, and what to consider when seeking affordable options [1:06:15];
• The potential risks and downsides of the various hair transplant procedures [1:09:30];
• Post-procedure care for hair transplants and whether the procedure must be repeated periodically [1:16:30];
• Combining different hair loss treatments: benefits, risks, and considerations [1:18:30];
• Emerging hair loss treatments with limited data [1:21:00];
• Key considerations for selecting the right treatment plan for hair loss [1:22:00];
• A summary of the different considerations for men and women facing hair loss [1:24:30];
• Practical advice on selecting the right specialist or treatment team [1:26:15]; and
• More.

#313 – AMA #62: Protein’s impact on appetite and weight management, and uric acid’s link to disease and how to manage levels

In this “Ask Me Anything” (AMA) episode, Peter dives into two important health topics: uric acid and protein, examining them from unique perspectives. For uric acid, he explores its metabolic role and connection to various diseases, focusing on the potential causal link with cardiovascular disease. He also discusses factors influencing uric acid levels, such as diet, genetics, and lifestyle, providing practical tips for effective management. Shifting to protein, Peter delves into its role in appetite and weight management, the consequences of insufficient protein, and the “protein leverage hypothesis” linking protein deficiency to obesity. He covers optimal protein intake and its impact on energy expenditure, and he compares the satiety effects of solid versus liquid protein. Finally, Peter shares his strategy for incorporating protein into a comprehensive weight management plan.

• Overview of episode topics (and an important discussion on fanny packs) [2:00];
• Understanding uric acid: its role in metabolic processes, its association with gout and kidney stones, its impact on blood pressure, and more [6:00];
• Non-modifiable factors that influence uric acid levels [11:00];
• Modifiable factors that influence uric acid levels [14:15];
• Association between high uric acid levels and cardiovascular disease [20:00];
• Evidence suggesting a causal link between high uric acid levels and cardiovascular disease [24:00];
• Inconclusive evidence about the cardiovascular benefits of lowering uric acid pharmacologically [28:15];
• Exploring the potential risks of low uric acid levels in neurodegenerative diseases [37:00];
• Managing uric acid levels: dietary interventions and pharmacological approaches [42:00];
• The impact of protein on appetite and weight management [44:00];
• The consequences of insufficient protein on eating behaviors and satiety [52:15];
• The relationship between protein deficiency and obesity: exploring the “protein leverage hypothesis” [57:15];
• The impact of protein intake on energy expenditure [1:02:15];
• Determining optimal protein intake to avoid deficiency and support health [1:05:45];
• The role of different amino acids and protein sources in promoting satiety [1:08:15];
• Comparing the satiety effects of solid vs. liquid protein sources [1:10:30];
• Peter’s framework for incorporating protein intake into a strategy for controlling body weight [1:12:00]; and
• More.

#308 – AMA #61: Sun exposure, sunscreen, and skin health: relationship between sun exposure and skin cancer, vitamin D production, and photoaging, how to choose a sunscreen, and more

In this “Ask Me Anything” (AMA) episode, Peter delves into two topics that have generated a lot of questions over the years: skin cancer and sunscreen. He begins by exploring the basics of UV radiation, discussing its effects on vitamin D conversion, photoaging, and its role in skin cancer. He examines various skin types, discussing their implications for sun exposure and vitamin D levels, as well as how to determine where you fall on the skin type scale. He then delves into the various types of skin cancer, with a particular emphasis on melanoma, exploring its complex relationship with UV exposure and other contributing risk factors. Additionally, he covers tanning beds, the importance of early skin cancer detection through regular skin checks, and the often confusing topic of sunscreen. He explains how sunscreen affects UV radiation and skin cancer risk, what SPF levels to choose, the differences between organic and mineral sunscreens, and what to consider when selecting the best sunscreen for your needs.

• The impact of UV radiation on the skin [2:00];
• Understanding solar UV: from the electromagnetic spectrum to skin health [3:45];
• The role of sunlight in vitamin D production [8:30];
• Factors contributing to vitamin D deficiency: insufficient UV exposure, magnesium levels, and more [9:45];
• Sun exposure needs for different skin types, and the limitations of current studies in defining vitamin D deficiency [12:45];
• The acute and long-term effects of excessive UV exposure: sunburn, photoaging, and the increased risk of skin cancer [15:30];
• Types of skin cancer and associations with UV exposure [17:45];
• The complex relationship between melanoma and UV exposure [22:15];
• Why UV exposure alone doesn’t necessarily explain the risk for melanoma [25:15];
• Other risk factors for melanoma [29:15];
• Tanning beds and skin cancer risk [34:45];
• Balancing sun exposure: benefits and risks [38:15];
• Tattoos and sun exposure [40:30];
• The importance of regular skin checks, dermatologists, and emerging technologies showing promise for early detection of cancer [41:45];
• Self-skin checks: what to look for [46:30];
• Prevalence of skin cancer and the importance of early detection [49:30];
• Summary of the major risk factors for melanoma [54:15];
• The role of sunscreen in reducing skin cancer risk [55:45];
• How sunscreen works, the differences between chemical and mineral sunscreens, an explanation of SPF, and more [58:30];
• How to determine the appropriate sunscreen SPF to use based on the UV index [1:04:45];
• Choosing the right sunscreen for your individual needs [1:07:00];
• The impact of water and perspiration on sunscreen effectiveness [1:12:00];
• Chemical vs. mineral sunscreens: safety concerns and recommendations [1:14:00];
• Concerns about hormone effects from chemical sunscreens [1:19:15];
• Sunscreen summary: skin types, key considerations, recommended brands, and more [1:23:15]; and
• More.

#306 – AMA #60: preventing cognitive decline, nutrition myths, lowering blood glucose, apoB, and blood pressure, and more

In this “Ask Me Anything” (AMA) episode, Peter provides insights on a broad range of important topics. He delves into the prevention of cognitive decline, the link between cardiovascular disease and Alzheimer’s disease, and methods to lower blood glucose, insulin, and apoB. He also addresses nutrition-related queries, exploring the impact of dietary habits on weight loss and longevity, how a person can identify the best diet for themselves, and common nutrition myths. Additional discussions include optimal blood pressure, daily step goals, the benefits of standing versus sitting desks, and much more.

• Overview of topics and episode format [1:40];
• Preventing cognitive decline [5:00];
• How to lower blood glucose and insulin [13:30];
• The relationship between lipids, CVD, and Alzheimer’s disease, and whether statins can increase the risk of neurodegenerative disorders and AD [23:15];
• Reducing apoB levels through exercise and diet [31:45];
• Pharmacological options for lowering apoB [38:00];
• How nutrition impacts longevity via metabolic health, muscle mass, BMD and more [40:15];
• How can someone determine the best diet for themselves? [43:45];
• Nutrition myth: All weight loss is good [46:45];
• Nutrition myth: Metabolic rates are dramatically different among individuals based on genetics [49:00];
• Nutrition myth: Losing weight after a brief period of overeating is impossible [53:45];
• Nutrition myth: GLP-1 agonists are a replacement for a healthy lifestyle [57:45];
• Nutrition myth: There is a single best diet for weight loss [1:03:00];
• Nutrition oversimplification: All calories are created equal [1:05:45];
• Daily step goals [1:06:45];
• The benefits of standing versus sitting throughout the day [1:10:45];
• How to identify the most impactful and easiest-to-implement ways to improve your health [1:12:30];
• The critical importance of emotional health [1:14:30];
• Why supplements should be considered as supportive aids rather than primary solutions in one’s strategy to improve longevity [1:18:00];
• Strategies for reducing high blood pressure [1:20:45];
• Peter’s biggest frustrations with “mainstream health advice” [1:28:00];
• Peter’s chaotic, yet cherished, morning routine [1:31:00]; and
• More.

#301 – AMA #59: Inflammation: its impact on aging and disease risk, and how to identify, prevent, and reduce it

In this “Ask Me Anything” (AMA) episode, Peter delves into the often misunderstood concept of inflammation. He first defines inflammation and differentiates between acute inflammation and chronic inflammation, the latter of which is linked to aging and a plethora of age-related diseases. Peter breaks down the intricate relationship between chronic inflammation, obesity, and metabolic health, and highlights the signs that might suggest someone may be suffering from chronic inflammation. From there, the conversation centers on actionable advice and practical steps one can take to manage and minimize chronic inflammation. He explores how diet plays a crucial role, including the potential benefits of elimination diets, and he examines the impact of lifestyle factors such as exercise, sleep, and stress management. Additionally, he discusses the relevance of food inflammatory tests and concludes by examining the potential benefits and drawbacks of drugs and supplements in managing inflammation.

• Defining inflammation (and the cultural impact of Napoleon Dynamite) [1:45];
• Acute vs chronic inflammation [8:00];
• The connection between chronic inflammation, aging, and age-related diseases [11:00];
• The impact of inflammation on metabolic health [18:30];
• Understanding and diagnosing chronic inflammation: blood tests and other approaches, and challenges with measurement [20:00];
• Factors that contribute to low level chronic inflammation [28:00];
• Minimizing inflammation through diet [29:45];
• The important role of fiber for gut health and inflammation [33:45];
• A closer look at the impact of trans fats and saturated fats on overall health [34:45];
• Why Peter prefers dietary fiber from food sources over supplements [38:30];
• Debunking “superfoods”: emphasizing proven methods over marketing claims for reducing inflammation [39:00];
• Is there any value in over-the-counter food inflammatory tests? [42:30];
• Food elimination diets: how they work, symptoms and markers to watch, challenges and limitations [45:15];
• Identifying dietary triggers for gut-related symptoms through low-FODMAP diets like the “carnivore diet” [51:15];
• Dairy: the complex role of dairy on inflammation and individual responses [55:00];
• Wheat: the complexities and conflicting evidence around wheat’s inflammatory effects [57:45];
• How exercise influences inflammation [1:02:00];
• How sleep quality and duration impacts inflammation [1:07:00];
• The potential impact of chronic psychological stressors on inflammation [1:13:00];
• The impact of oral health on inflammation and overall well-being [1:15:00];
• The role of medications in managing chronic inflammation [1:18:15];
• Supplements: evaluating the efficacy of various anti-inflammatory supplements [1:22:15];
• Parting thoughts and takeaways [1:27:00]; and
• More.

#297 – AMA #58: Iron: its role in health, testing methods, and strategies for preventing and managing iron deficiency

In this “Ask Me Anything” (AMA) episode, Peter delves into the crucial yet often overlooked topic of iron and iron deficiency. He explores why iron is indispensable for the body, explains the repercussions of iron deficiency, and sheds light on the prevalence of this issue and who is most susceptible. Peter outlines strategies for increasing iron levels, covering dietary iron, supplementation, and infusion options, while also discussing the suitability of each approach for different individuals. Shifting gears, Peter tackles rapid-fire questions on creatine and sodium, as well as inquiries related to his book. 

• Overview of today’s topics and the importance of understanding iron levels in the body [1:45];
• The importance and ubiquity of iron in the body, and the role of the protein called ferritin [4:30];
• The processes of iron absorption, utilization, and transportation [9:30];
• Options for testing iron levels and how to interpret the results [13:45];
• What does it mean to be iron deficient and how is it different from anemia? [17:15];
• Symptoms of iron deficiency and/or anemia [22:15];
• How prevalent is iron deficiency and who is most susceptible? [24:30];
• The importance of consuming an adequate amount of iron daily to prevent deficiency [30:30];
• The best way to improve iron levels for someone who is deficient [34:45];
• Iron supplementation: various formulations and potential side effects [37:45];
• Intravenous iron infusion as an alternative to oral supplements — plus restless legs syndrome and other topics [42:00];
• Iron supplementation: who should and should not consider it [44:00];
• Peter’s approach to creatine and his pre- and post-workout supplements [50:15];
• Navigating sodium intake: effect on blood pressure, who should use precaution, and other considerations [54:45];
• Peter’s thoughts about the potential of writing another book [57:15]; and
• More.

#293 – AMA #57: High-intensity interval training: benefits, risks, protocols, and impact on longevity

In this “Ask Me Anything” (AMA) episode, Peter delves into the topic of high-intensity interval training (HIIT), starting with addressing some common misunderstandings around this type of exercise and breaking down what HIIT truly entails. He examines the correlation between HIIT and VO2 max, a vital metric for overall health and longevity, and describes the beneficial impact of HIIT on longevity when incorporated properly. Additionally, he emphasizes the importance of building a wide base of cardiovascular fitness, reveals the optimal protocols for incorporating HIIT into a balanced routine, and discusses the risk of injury and other potential drawbacks of HIIT. 

• Common questions about high-intensity interval training (HIIT) [1:30];
• The origins of HIIT [3:15];
• Defining HIIT training and differentiating it from sprint interval training (SIT) [5:45];
• Why HIIT is often touted as a more efficient way to exercise [14:00];
• Navigating the nuances of HIIT research: understanding limitations and the importance of a blended exercise routine [20:30];
• The four pillars of exercise [24:15];
• Using HIIT to improve VO2 max [26:00];
• HIIT training for the untrained individual: impact on VO2 max and the interplay between exercise-induced adaptations and potential weight loss [33:00];
• Sprint interval training (SIT) vs. HIIT: comparing the relative improvements in VO2 max and the impact of longer duration intervals [40:00];
• Benefits and limitations of HIIT, drawbacks of overtraining with HIIT, and the importance of a diversified routine to increase total cardiorespiratory capacity [44:15];
• HIIT protocols Peter recommends [58:45];
• The risk of injury and other potential drawbacks of HIIT [1:02:15];
• The importance of incorporating a balance of continuous moderate-intensity cardio and HIIT when aiming for longevity [1:04:00]; and
• More.

#289 – AMA #56: Cancer screening: pros and cons, screening options, interpreting results, and more

In this “Ask Me Anything” (AMA) episode, the conversation focuses on cancer screening, a topic often shrouded in confusion yet crucial to understand given that early identification of a cancer is an essential part of survival strategy. Peter examines the arguments both for and against cancer screening, including addressing why some trials may show no benefit to screening. He then delves into the various screening modalities available for different cancers, highlights the pros and cons associated with each, and explains how to interpret the results. Additionally, Peter provides guidance for navigating outside of the relatively narrow and confined screening guidelines for various types of screening tests.

• Why understanding cancer screening is crucial [2:45];
• The prevalence of cancer diagnosis and mortality rates [4:30];
• Why cancer screening and early detection is such an important part of the strategy to survive a cancer diagnosis [11:00];
• The data on how cancer screening impacts survivability of cancer [16:30];
• Inconsistencies between cancer screening trials regarding benefits to survival rates [25:45];
• What are some of the reasons why clinical trials don’t always improve cancer-specific mortality? [30:15];
• What are the arguments against population-level cancer screening? [42:00];
• Cancer screening outside the recommended guidelines: risks and benefits, interpreting results, and other considerations [46:00];
• Understanding sensitivity and specificity when reviewing screening results [52:30];
• Risks and complications associated with colonoscopies [55:45];
• Cancer screening modalities: options for cancer screening both within standard recommendations and beyond [58:30];
• The strengths and limitations of various types of cancer screening [1:02:15];
• Understanding positive and negative predictive value using sensitivity, specificity, and pretest probability [1:11:45];
• Factors that influence an individual’s pretest probability of cancer [1:13:45];
• How to interpret cancer screening results [1:18:15];
• The importance of having an advocate when considering out-of-guideline cancer screening tests [1:23:30];
• How stacking multiple cancer screening modalities can decrease the risk of false positives [1:29:30];
• Advice and guidance for making decisions related to cancer screening [1:31:15]; and
• More.