AMA
Fruits & vegetables—everything you need to know
#211 – AMA #36: Fruits & vegetables—everything you need to know
In this “Ask Me Anything” (AMA) episode, Peter discusses the nutritional profiles of various fruits and vegetables as a means of assessing their relative value. He explains the difference between eating them vs. drinking them, how processing fruits and vegetables can change their properties, and how one’s current state of health affects nutrition strategy when it comes to fruits and vegetable consumption. Additionally, Peter explains the potential benefits and negative effects of certain phytochemicals found in produce and concludes with a discussion of supplementing with green powders, multivitamins, and more.
- The limitations of nutritional data and challenges of making broad recommendations [2:00];
- How one’s current state of health impacts their “optimal” diet [11:30];
- Defining “metabolic health” [14:45];
- The wide-ranging nutrition profiles of various fruits and vegetables [16:30];
- The benefits of fiber [20:45];
- Eating whole fruits vs. drinking fruit juice or smoothies [22:30];
- Drinking alcohol: metabolic effects, calories in alcohol, and more [28:30];
- Can excess fruit consumption lead to insulin resistance? [30:30];
- Glycemic impact of different fruits, using CGM data to assist decision making, and how fruit is fundamentally different from what we evolved to eat [31:30];
- Dietary approaches for people with a carbohydrate tolerance disorder (TD2, NAFLD, etc.), and when it makes sense to restrict fruit consumption [34:30];
- Nutrition profile of select vegetables: sugar content, micronutrients, and more [40:00];
- Phytochemicals in produce: potential positive health impacts on inflammation, cardiovascular (CV) risk, and cancer [44:30];
- Phytochemicals with potential negative health impacts [50:45];
- Nightshades and inflammation [53:15];
- How important is it to eat organic foods? [56:00];
- How necessary is it to wash fruits and vegetables? [1:00:45];
- How does food preparation change the nutritional composition? [1:03:45];
- Considerations when eating canned and frozen food, and paying attention to processed food additives [1:04:45];
- Supplementing vitamins and nutrients as an alternative to eating whole fruits and vegetables [1:06:15];
- Green powder supplements [1:11:15];
- Important takeaways [1:16:00]; and
- More.
AMA
"Anti-Aging" Drugs — NAD+, metformin, & rapamycin
#207 – AMA #35: “Anti-Aging” Drugs — NAD+, metformin, & rapamycin
In this “Ask Me Anything” (AMA) episode, Peter is joined by special guest, Dr. Matt Kaeberlein. Together they answer many questions around the field of aging with an emphasis on three specific molecules—NAD, metformin, and rapamycin—and their purported geroprotective qualities. They first discuss aging biomarkers and epigenetic clocks before breaking down the advantages and limitations of the most common experimental models being used today to study aging and pharmacological possibilities for extending lifespan. Next they dive deep into NAD and the much-hyped NAD precursors, nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN). They compare data from NAD precursors to studies on metformin and rapamycin, assessing how they stack up against each other and using the comparison as an opportunity to illustrate how to make sense of new experimental data and make smart decisions about how to approach future research.
- Logic behind comparing NAD precursors to rapamycin and metformin [3:40];
- Aging biomarkers: current state, usefulness, and future promise [7:00];
- Epigenetic clocks: definition, use case, and limitations [14:45];
- Advantages and limitations of studying aging in non-humans and the strengths and weaknesses of different model systems [26:30];
- Aging studies: importance of control lifespans and the problems with reproducibility [34:15];
- Intro to NAD, potential role in aging, relationship to sirtuins, and more [48:15];
- NAD precursors (NR and NMN): current data [1:10:00];
- Human studies with NAD precursors [1:25:45];
- Comparing NAD lifespan data to data from metformin and rapamycin [1:28:30];
- Defining a “clean drug” and a “dirty drug” [1:38:00];
- Reason for the lack of rapamycin studies in humans compared to NAD and metformin [1:41:00];
- Ranking the geroprotective molecules in terms of risk and reward [1:48:00]; and
- More.
AMA
What Causes Heart Disease?
#203 – AMA #34: What Causes Heart Disease?
In this “Ask Me Anything” (AMA) episode, Peter dives deep into the topic of atherosclerotic cardiovascular disease (ASCVD)—the number one killer in the developed world. Peter argues for the importance of paying attention to and understanding ASCVD given its ubiquity and inevitability. He goes into great detail about the development of atherosclerosis and how it can take hold at a very early age, the role of cholesterol, and the causal factors of ASCVD that determine prevention strategies. Additionally, he discusses the important metrics and biomarkers found in blood work, as well as diagnostic tests such as coronary artery calcium scores (CAC) and CT angiograms which help to determine the level of arterial damage present. Finally, Peter lays out the keys to understanding and interpreting calcium scores before wrapping up the conversation with his key takeaways regarding prevention.
- The importance of understanding atherosclerosis early in life [2:15];
- Defining atherosclerotic cardiovascular disease (ASCVD), its causes, and the role of cholesterol [9:00];
- The process of developing ASCVD, part 1 [15:00];
- The process of developing ASCVD, part 2 [24:00];
- The process of developing ASCVD, part 3 [32:45];
- How early in life ASCVD can start to develop [40:30];
- Case studies of atherosclerosis and figures showing real pathology [43:00];
- Coronary artery lesions present in autopsies of different age groups [49:15];
- The causal factors of ASCVD that determine prevention strategies [52:15];
- Labs to identify biomarkers of ASCVD [59:00];
- Diagnostic tests to determine the level of arterial damage present—CAC, CTA, CIMT, and more [1:00:30]
- Calcium scores: keys to understanding and interpreting a CAC score and/or CTA results [1:05:15];
- Is there a risk from cholesterol levels being too low? [1:13:00];
- Key takeaways regarding prevention [1:15:45];
- More.
AMA
Hydration—electrolytes, supplements, sports drinks, performance effects, and more
#200 – AMA #33: Hydration—electrolytes, supplements, sports drinks, performance effects, and more
In this “Ask Me Anything” (AMA) episode, Peter discusses all things related to hydration, starting with how water is distributed in the body and the important concept of tonicity. He explains the difference between dehydration and volume depletion and their respective health consequences and implications. He describes the different conditions which affect our daily water needs, as well as the signs of dehydration and how it can affect performance. Next, he discusses all the ways in which we can rehydrate and when it makes sense to add electrolytes, glucose—or a combination of both—to rehydration fluids. Additionally, Peter gives his take on the plethora of sports drinks on the market and which ones stand out from the rest. Finally, he concludes with some key takeaways related to hydration.
- Peter’s incident leading to a renewed interest in hydration [3:15];
- Water in the human body: percentage, location, and implications [6:00];
- Defining tonicity—isotonic, hypotonic, and hypertonic [11:45];
- Defining dehydration and volume depletion [19:00];
- The health consequences of dehydration and volume depletion [21:45];
- How do we actually lose water? [25:30];
- How much water do we need every day? [28:00];
- Signs of dehydration during exercise and how it can affect performance [32:45];
- Is it possible to be overhydrated? [43:15];
- Electrolytes: benefits and when to include them in rehydration fluids [47:00];
- Glucose: benefits and when to include it in rehydration fluids 51:15];
- The ability of glucose to improve absorption of sodium [58:45];
- The type of carbohydrates in drinks than actually impact performance [1:02:00];
- Sodium during workouts: is there an optimal ratio of carbohydrate to sodium? [1:05:00];
- Pros and cons of sports drinks and which ones stand out [1:09:15];
- How much hydration comes from the food we eat? [1:14:30];
- Is there a downside to drinking electrolytes throughout the day even without exercise? [1:15:15];
- Key takeaways related to hydration [1:18:15]; and
- More.
AMA
Exercise, squats, deadlifts, BFR, and TRT
#196 – AMA #32: Exercise, squats, deadlifts, BFR, and TRT
In this “Ask Me Anything” (AMA) episode, Peter shares his current workout regimen and how he incorporates blood flow restriction (BFR). He walks through the mechanics and fundamentals of some of his favorite lifts including squats, deadlifts, and hip thrusters and stresses the relative importance of each in the context of longevity. He touches on the relative importance of muscle size vs. muscle strength and discusses the impact of fasting on muscle mass and the potential tradeoffs during aging. Peter then dives into the topic of testosterone replacement therapy (TRT) for both men and women, starting with a clinical discussion around how he actually replaces testosterone in patients. He explains the targets of this therapy as well as the risks and benefits, and he gives his interpretation of current data on the association between TRT and heart disease.
- Peter’s current exercise routine [2:25];
- How Peter incorporates blood flow restriction (BFR) into his workouts [5:45];
- Relative importance of muscle size vs. muscle strength [16:45];
- Comparing squats to deadlifts and why both are important [22:00];
- Squatting technique and fundamentals [31:15];
- Important cues to look for while lifting weights [38:30];
- Proper mechanics of a deadlift [42:00];
- Hip thrusters as an alternative to the squat or deadlift [44:00];
- Split-leg work for simulating activities of daily living [47:00];
- The impact of fasting/calorie restriction on muscle mass and the potential tradeoffs to consider [49:45];
- Testosterone replacement therapy: Considerations when contemplating TRT and Peter’s approach with patents [54:30];
- Data on the association between TRT and heart disease [1:04:15];
- TRT for women—risks and benefits [1:06:45];
- Impact of fasting on testosterone levels [1:13:45]; and
- More.
AMA
Heart rate variability (HRV), alcohol, sleep, and more
#193 – AMA #31: Heart rate variability (HRV), alcohol, sleep, and more
In this “Ask Me Anything” (AMA) episode, Peter and Bob first answer a variety of questions related to heart rate variability (HRV): what it means, why it matters, and how to measure, interpret, and potentially elevate it. Next, they dive deep into the topic of alcohol, beginning with a discussion on the negative impact that it can have on sleep. They then break down the confusing body of literature suggesting potential health benefits to moderate levels of drinking compared to complete abstinence and point out the limitations of these studies. Finally, they conclude by analyzing data on the impact of moderate and heavy drinking on the liver and on risk for Alzheimer’s disease and dementia.
- What is heart rate variability (HRV), and why do we measure it? [2:10];
- The association between low HRV and mortality risk [10:00];
- What high and low HRV means and why athletes strive for a high HRV [15:30];
- Factors that can raise or lower HRV [18:00];
- How and when to measure HRV, and the best wearables [19:15];
- Interpreting your personal HRV number and why there’s so much individual variation [23:15];
- How Peter’s morning HRV reading impacts his decision to train [28:30];
- Alcohol’s impact on sleep [31:30];
- Metrics to track the impact of alcohol on your sleep [34:00];
- Alcohol’s impact on the need to urinate during the night [39:00];
- Alcoholic fatty liver disease (AFLD) [41:30];
- Individual differences in the way people metabolize and react to alcohol consumption [44:15];
- Analysis of epidemiology studies suggesting moderate alcohol consumption lowers mortality risk [52:00];
- Alcohol consumption and Alzheimer’s disease [1:05:15];
- Heavy alcohol consumption and risk of dementia [1:08:30];
- Chronic effects of alcohol on the liver [1:17:45];
- The relationship between alcohol, sleep, and automotive deaths [1:20:45]; and
- More.
AMA
How to Read and Understand Scientific Studies
#188 – AMA #30: How to Read and Understand Scientific Studies
In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into all things related to studying studies to help one sift through all the noise to find the signal. They define the various types of studies, how a study progresses from idea to execution, and how to identify study strengths and limitations. They explain how clinical trials work, as well as the potential for bias and common pitfalls to watch out for. They dig into key factors that contribute to the rigor (or lack thereof) of an experiment, and they discuss how to measure effect size, differentiate relative risk from absolute risk, and what it really means when a study is statistically significant. Finally, Peter lays out his personal process when reading through scientific papers.
- The ever changing landscape of scientific literature [2:15];
- The process for a study to progress from idea to design to execution [4:15];
- The various types of studies and how they differ [7:30];
- The different phases of a clinical trial [19:15];
- Observational studies and the potential for bias [26:30];
- Experimental studies: Randomization, blinding, and other factors that make or break a study [44:00];
- Power, p-values, and statistical significance [56:15];
- Measuring effect size: Relative risk vs. absolute risk, hazard ratios, and “Number Needed to Treat” [1:07:45];
- How to interpret confidence intervals [1:17:30];
- Why a study might be stopped before its completion [1:23:45];
- Why only a fraction of studies are ever published and how to combat publication bias [1:31:30];
- Why certain journals are more respected than others [1:40:30];
- Peter’s process when reading a scientific paper [1:43:45]; and
- More.
AMA
GLP-1 Agonists - The Future of Treating Obesity?
#184 – AMA #29: GLP-1 Agonists – The Future of Treating Obesity?
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to GLP-1 agonists—a class of drugs that are gaining popularity for the treatment of obesity. They cover the discovery of these peptides, their physiology, and what it is they do in their natural state. Next, Peter and Bob break down a recently published study which showed remarkable results for weight loss and other metabolic parameters using a once-weekly injection of the GLP-1 agonist drug semaglutide, also known as Ozempic, in overweight and obese patients. Finally, they compare results from the semaglutide study to results from various lifestyle interventions and give their take on the potential future of GLP-1 agonists.
- Remarkable results of a recent study in overweight adults [2:15];
- Key background on insulin, glucagon and the incretin effect to appreciate the effects of semaglutide [4:00];
- What is GLP-1 and how does it work? [16:30];
- 2021 semaglutide study: remarkable results, side effects, and open questions [30:00];
- Semaglutide vs. lifestyle interventions: comparing results with semaglutide vs. lifestyle interventions alone [44:00];
- Closing thoughts and open questions on the therapeutic potential of semaglutide [47:30]; and
- More.
AMA
All things testosterone and testosterone replacement therapy
#180 – AMA #28: All things testosterone and testosterone replacement therapy
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to testosterone: what happens when testosterone levels are low, and the potential benefits and risks of testosterone replacement therapy (TRT). They explain the physiology of testosterone, how it works, and how its level changes over the course of a person’s life. They have a detailed discussion about existing literature, which reveals vast potential structural, functional, and metabolic benefits of testosterone replacement therapy. They also take a very close look at potential risks of this therapy, with a focus on the controversial effects on cardiovascular disease and prostate cancer.
- A primer on the hormone testosterone and how it influences gene expression [3:30];
- How the body naturally regulates testosterone levels [11:30];
- The defining threshold for “low testosterone,” how low T impacts men, and why free testosterone is the most important metric [16:15];
- When it makes sense to treat low testosterone [26:00];
- The structural and metabolic benefits of testosterone replacement therapy [29:15];
- Body composition changes with TRT [45:30];
- Changes in bone mineral density with TRT [48:15];
- The metabolic impact of TRT: glucose, insulin, triglycerides, and more [52:30];
- A study investigating testosterone replacement therapy for prevention or reversal of type 2 diabetes [59:30];
- The impact of TRT on metabolic parameters and body composition—A study comparing results from continuous vs. interrupted treatment [1:07:15];
- The controversy over TRT and cardiovascular disease [1:21:45];
- Two flawed studies that shaped perceptions of risks associated with TRT [1:44:15];
- The controversy over TRT and prostate cancer [1:56:45];
- Other potential risks with testosterone replacement therapy [2:02:15]; and
- More
AMA
The importance of muscle mass, strength, and cardiorespiratory fitness for longevity
#176 – AMA #27: The importance of muscle mass, strength, and cardiorespiratory fitness for longevity
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss the longevity benefits from greater cardiorespiratory fitness (CRF) and greater muscle mass and strength. Conversely, they dive deep into the literature showing a rapid increase in morbidity and mortality risk as fitness levels decline with age. They also try to tease out the relative contributions of CRF, muscle mass, and strength. Additionally, they discuss the impact of fasting on muscle mass, the potential tradeoffs to consider, and finish by discussing why it’s critical to maximize your fitness level.
- VO2 max and its association with cardiorespiratory fitness [2:45];
- Changing mortality risk based on VO2 max and cardiorespiratory fitness [7:45];
- The profound impact of improving cardiorespiratory fitness [15:15];
- Muscle mass, function, and loss with aging: how it’s defined, measured, and the cutoff points for sarcopenia [25:00];
- Increasing mortality risk associated with declining muscle mass and strength [40:00];
- Muscle size vs. strength—which has the bigger impact on mortality risk? [58:00];
- Evaluating the cumulative impact of cardiorespiratory fitness and muscular strength on mortality risk when put together [1:03:30];
- Investigating the rising incidence in deaths from falls, and what role Alzheimer’s disease might play [1:09:00];
- The impact of fasting on muscle mass and the potential tradeoffs to consider [1:14:30];
- The critical importance of working to maintain muscle mass and strength as we age [1:20:30]; and
- More.
AMA
Continuous glucose monitors, zone 2 training, and a framework for interventions
#173 – AMA #26: Continuous glucose monitors, zone 2 training, and a framework for interventions
In this “Ask Me Anything” (AMA) episode, Peter and Bob answer numerous follow-up questions to recently discussed deep-dive topics such as the use of continuous glucose monitors and getting the most from zone 2 exercise. They also discuss the incredible feats of cyclists in the Tour de France through the lens of the amazing performance physiology required from these athletes. Additionally, Peter ties the conversation together by sharing his foundational framework when considering different interventions, even in the absence of data from a randomized controlled trial.
- Peter’s foundational framework when considering different interventions [1:30];
- Applying Peter’s framework to the idea of using a CGM [8:00];
- Why certain fruits have a bigger impact on glucose, and the limitations of a CGM can tell you [16:00];
- Importance of paying attention to insulin, and the prospects of a continuous monitor for insulin levels [20:00];
- How exercise impacts glucose and peak glucose numbers to stay under [24:15];
- Impact of anxiety on stress on glucose, and why it’s important to calibrate your CGM [26:30];
- The five main tools for managing blood glucose numbers [33:45];
- Benefits of moving or exercising after a meal, and where ingested carbohydrates get can be stored [37:15];
- How to make decisions about an action or intervention in the absence of data from a rigorous, randomized controlled trial [40:30];
- The incredible athletic feats of Tour de France cyclists [48:30];
- Different modalities for doing zone 2 exercise: running, rowing, cycling, and more [1:00:15];
- Proxies for knowing your in zone 2 short of using a lactate monitor [1:07:30];
- Monitoring lactate for zone 2 exercise [1:10:00]; and
- More.
AMA
Navigating the complexities and nuances of cancer screening
#170 – AMA #25: Navigating the complexities and nuances of cancer screening
In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into cancer screening, including why it’s important, what you need to know about a test, and Peter’s approach with patients. They specifically discuss various screening methods, explain important terms like sensitivity and specificity, and how layering and stacking different tests in tandem can improve predictive values. They conclude with a discussion on one of the more exciting screening tools, diffusion-weighted MRI, and how it’s changing the cancer screening landscape.
- The importance of cancer screening [1:15];
- Cancer screening terms: sensitivity, specificity, false positives, and false negatives [8:25];
- Cancer screening terms: positive and negative predictive value [17:00];
- Improving predictive value by layering tests, and the predictive values of mammograms [25:45];
- How smoking impacts the predictive value of cancer screening [30:45];
- Liquid biopsies for ruling out cancer and the blind spots of common cancer screening tests [33:00];
- The difference between cancer originating from inside versus outside the body [41:15];
- How diffusion-weighted MRI is changing cancer screening [45:15];
- Summary of Peter’s approach to cancer screening [53:45]; and
- More.
AMA
Deep dive into blood glucose: why it matters, important metrics to track, and superior insights from a CGM
#165 – AMA #24: Deep dive into blood glucose: why it matters, important metrics to track, and superior insights from a CGM
In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into blood glucose and why it matters so much with respect to metabolic health and longevity. They explain the need to pay close attention to metrics like average blood glucose, glucose variability, and peak glucose numbers. Additionally, Peter explains why he encourages all his patients, even nondiabetics, to utilize a continuous glucose monitor (CGM) which gives important insights that traditional lab testing and metrics consistently miss.
- The problem with traditional blood tests and metrics for determining metabolic health [1:10];
- The superior insights from a continuous glucose monitor [6:15];
- Why lower is better than higher: average glucose, glucose variability, and glucose peaks [12:00];
- Deep dive into average blood glucose and the importance of having the lowest average blood glucose possible [14:45];
- Deep dive into glucose variability and why less variability is better [33:15];
- Example of how HbA1c and traditional measures could catch metabolic issues too late [41:45];
- Postprandial dips in blood glucose as a predictor of subsequent hunger and energy intake [43:00];
- Exploring the idea that the suppression of fatty acids is actually causing hunger rather than a low blood glucose [49:45];
- Deep dive into peak glucose and why lower peaks is better [57:15];
- What the best rodent models tell us about the impact of peak glucose levels [1:06:25];
- Why Peter encourages all his patients to wear a CGM [1:14:30]; and
- More.
AMA
All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action
#161 – AMA #23: All Things Nicotine: deep dive into its cognitive and physical benefits, risks, and mechanisms of action
In this “Ask Me Anything” (AMA) episode, Peter and Bob dive deep into nicotine, a complicated and interesting molecule that has effects on both the brain and the body. They analyze the results of the studies that describe nicotine’s cognitive benefits and potential for inducing weight loss. They talk about a smoking cessation technique called nicotine replacement therapy and give a full breakdown of the various routes of administration, dosing, and safety. Finally, they explore the fascinating and counterintuitive observation that cigarette smokers are less likely to get a severe case of COVID-19.
- How Peter first became interested in the potential benefits of nicotine [1:15];
- Untangling nicotine from tobacco [6:00];
- Nicotine replacement therapy (NRT) for quitting smoking: products, protocols, and a review of the literature [9:30];
- The cognitive benefits of nicotine: Overview of the literature [15:50];
- Where nicotine has the most positive impact on cognition [30:30];
- Possible mechanisms conferring the benefits of nicotine [37:00];
- How modafinil and other nootropics compare to nicotine [47:15];
- How nicotine may induce weight loss [54:00];
- Relationship between smoking and COVID-19: Analyzing the observation that smoking appears protective against COVID-19 [1:01:45];
- Breakdown of the various nicotine replacement therapies: route of administration, dosing, and safety [1:11:30];
- Concluding thoughts on nicotine: use cases, addictive properties, and more [1:19:45]; and
- More.
AMA
Losing fat and gaining fat: the lessons of fat flux
#157 – AMA #22: Losing fat and gaining fat: the lessons of fat flux
In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into fat flux. They define the major players that impact the flow of fat entering and exiting a fat cell, which determines how much fat a person carries. They discuss the significant influence that insulin has on the net fat balance and explore common strategies, such as fasting and low-carb diets, that have efficacy in the liberation and oxidation of fat from fat cells. Additionally, Bob explains his research process and how he seeks answers to Peter’s challenging questions.
- The two main ways to reduce fat mass (1:30);
- Explaining fat flux—how fat enters and exits a fat cell (9:15);
- What fat balance looks like (21:15);
- What net fat influx looks like, and the impact of insulin in lipolysis (24:30);
- What net fat efflux looks like, and the benefits of fasting for breaking the hyperinsulinemic cycle (28:30);
- Exploring why most people with excess body fat will lose fat mass when reducing carbohydrates or eating a ketogenic diet (32:45);
- Why being in nutritional ketosis does not automatically translate to negative fat flux (fat loss) (42:40);
- Bob’s approach to scientific research (47:00);
- The importance of curiosity and a desire to learn (58:30);
- Bob’s tips and tricks for answering a scientific question in a time-crunch (1:00:00); and
- More.
AMA
Deep dive into olive oil, high-intensity exercise, book update, and more
#153 – AMA #21: Deep dive into olive oil, high-intensity exercise, book update, and more
In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into olive oil. They explore the history of olive oil, discuss observational data that led to the hypothesis that olive oil is a healthier alternative to many other fats, and they explain the classification of olive oil types —including what to look for in a high-quality “extra virgin” olive oil. Peter and Bob round out the discussion with a “two-minute drill,” in which Peter answers questions from subscribers. They cover zone 5 training, an update on Peter’s book, lactate meters, standing desks, massage guns, electrolyte supplementation, and more.
- The early history of olive oil and the Mediterranean diet (2:15);
- The three broad categories of fats: SFA, MUFA, and PUFA (6:25);
- Exploring the hypothesis that olive oil is healthy (10:30);
- Comparing olive oil to the makeup of other common oils (30:00);
- Defining “extra virgin” olive oil, what to look for when purchasing, and Peter’s favorite brand (34:30);
- Update on Peter’s book (47:15);
- Zone 5 training: Peter’s approach to zone 5 training, and other anaerobic training protocols (49:30);
- Advantages of using a standing desk compared to sitting (55:30);
- Lactate meters and strips (57:45);
- Electrolyte supplementation during fasting and keto, and why uric acid may increase (59:30);
- The usefulness of massage guns, foam rollers, and professional massage for muscle pain and tightness (1:01:30); and
- More.
AMA
Simplifying the complexities of insulin resistance: how it's measured and what we can do about it
#149 – AMA #20: Simplifying the complexities of insulin resistance: how it’s measured, how it manifests in the muscle and liver, and what we can do about it
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss all things related to insulin resistance by revisiting the important points made in the fascinating, yet quite technical, episode of The Drive with Gerald Shulman. They devote the entire discussion to understanding the condition known as insulin resistance, how it’s measured, how it manifests in the muscle and liver, and ultimately, what we can do about it.
- Explaining the format of this AMA: Extracting insights from Gerald Shulman’s masterclass on insulin resistance (2:00);
- The basics of insulin, defining insulin resistance (IR), and gold-standard methods of quantifying IR in the muscle (7:15);
- Practical ways to test for insulin resistance in a normal clinical setting (15:45);
- How insulin resistance manifests in the muscle (23:00);
- The biochemical block in glycogen synthesis—drivers and mechanisms resulting in insulin resistance in the muscle (30:45);
- The disparity in fat oxidation between insulin-sensitive and insulin-resistant individuals (44:45);
- The fate of the ingested carbohydrate in someone who is insulin resistant (51:00);
- The prevalence and clinical phenotype of insulin resistance (1:00:15);
- The role of exercise in mitigating and reversing insulin resistance (1:05:00);
- How insulin resistance manifests in the liver (1:09:15);
- Biggest takeaways: what we can do to mitigate and prevent insulin resistance (1:20:45); and
- More.
AMA
Zone 2 training, magnesium supplementation, and how to engage with your doctor
#145 – AMA #19: Deep dive on Zone 2 training, magnesium supplementation, and how to engage with your doctor
In this “Ask Me Anything” (AMA) episode, Peter and Bob take a deep dive into zone 2 training. They begin with a detailed definition of zone 2 and continue by discussing the importance of adding it to your exercise regimen. They talk about how to program zone 2 training, including intensity, frequency, and duration, and metrics for tracking improvement. Additionally, they provide a detailed overview of all things related to magnesium supplementation. The two conclude with insights about how to effectively engage with your doctor in the pursuit of getting your questions answered and considerations for finding a physician that’s right for you.
- Defining zone 2 exercise (3:30);
- The most effective ways to engage in zone 2 exercise (14:00);
- The process of training a deconditioned individual with zone 2: Dosage, frequency, and metrics to watch (19:45);
- Training for health vs. performance, and the importance dedicating training time solely to zone 2 (25:00);
- Why Peter does his zone 2 training in a fasted state (31:30);
- Improving mitochondrial density and function with zone 2 training (34:00);
- Metrics to monitor improving fitness levels from zone 2 training (36:30);
- Advice for choosing a bicycle for zone 2 exercise at home (42:30);
- Comparing the various equipment options for aerobic training: Rowing machine, treadmill, stairmaster, and more [48:15];
- Back pain and exercise, and Peter’s stability issues as a consequence of previous surgeries (51:45);
- A deep dive into magnesium supplementation, and Peter’s personal protocol (55:30);
- Advice for engaging with and questioning your doctor (1:03:15); and
- More.
AMA
Deep dive: sugar and sugar substitutes
#141 – AMA #18: Deep dive: sugar and sugar substitutes
In this “Ask Me Anything” (AMA) episode, Peter and Bob talk all about sugar and sugar substitutes and provide a way to think about sugar consumption. The conversation begins by defining the various forms of sugar, delineating between added sugar and naturally occurring sugar, and describing the important variables that determine the potential for metabolic damage from consumption. They then take a dive deep into three main categories of sugar substitutes—non-nutritive sweeteners, alcohol sugars, and leaving allulose, in a class by itself—including the safety profile of each, impact on blood sugar and insulin, side-effects, taste preferences, and more.
- Delineating the various forms of “sugar” (2:00);
- Added sugar vs. naturally occurring sugar (12:30);
- Important variables related to sugar consumption: Density, volume, and velocity (17:00);
- Alternatives to sugar: Non-nutritive sweeteners (22:30);
- Alternatives to sugar: Alcohol sugars (34:15);
- Alternatives to sugar: Allulose (39:00);
- Contextualizing risk when it comes to sugar substitutes (45:00);
- Why some people report feeling better when eliminating non-nutritive sweeteners from their diet (46:30);
- The impact of sweetness—Cephalic insulin response and the metabolic drive to eat more (49:45); and
- More.
AMA
Body composition methods tour de force, insulin resistance, and Topo Chico
#136 – AMA #17: Body composition methods tour de force, insulin resistance, and Topo Chico
In this “Ask Me Anything” (AMA) episode, Peter and Bob discuss different methods to evaluate body composition. They explore ways of measuring body fat, delineating between subcutaneous and visceral fat, and go over best strategies for improving body composition and optimizing health. They also discuss insulin resistance using a patient case study that highlights interventions capable of reversing the condition. Finally, Peter addresses his level of concern about a recent Consumer Report finding that Topo Chico had the highest levels of a class of synthetic chemicals (PFAS) of all the carbonated bottled waters tested. Peter concludes by sharing if the finding will change his consumption habits.
- Body mass index (BMI) vs. body fat percentage (BF%) (1:45);
- Methods of assessing body fat—Magnetic Resonance Imaging (MRI) (6:25);
- The different types of body fat (9:00);
- Methods of assessing body fat—Computed Tomography (CT Scan) (12:00);
- Methods of assessing body fat—Dual-Energy X-ray Absorptiometry (DEXA) (14:30);
- Methods of assessing body fat—Hydrostatic/Underwater Weighing (19:25);
- Methods of assessing body fat—Air Displacement (Bod Pod) (22:25);
- Methods of assessing body fat—Skinfold measurement (23:55);
- Methods of assessing body fat—Total Body Water (27:15);
- Methods of assessing body fat—Bioelectrical Impedance (BIA) (28:45);
- The optimal body fat percentage, muscle mass, and the best strategy to improve body composition (31:30);
- Defining insulin resistance and the steps to reverse it (40:15);
- Patient case study: Reversing insulin resistance (49:00);
- Addressing the recent finding of high levels of PFOA in Topo Chico (58:25); and
- More.
AMA
Exploring hot and cold therapy
#132 – AMA #16: Exploring hot and cold therapy
In this “Ask Me Anything” (AMA) episode, Peter and Bob explore the quality of evidence for hot and cold therapy. In the discussion, they evaluate the safety, efficacy, and opportunity costs of various hot and cold therapy protocols, and Peter ultimately considers the addition of dry sauna to his longevity toolkit. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions. If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA.
- How stress can show up as physical pain, and tips for changing time zones [1:45];
- Literature overview of heat and cold therapy [7:15];
- Cold therapy for delayed onset muscle soreness (DOMS) [12:00];
- Quality of evidence for cold therapy for depression or immune enhancement [19:30];
- Cold therapy and brown adipose tissue (BAT) [21:15];
- Weighing the safety, efficacy, and opportunity cost of cold therapy [28:45];
- An overview of heat therapy benefits [40:00];
- Longevity benefits of sauna—reviewing the studies [41:30];
- Limitations in the sauna literature—Where might we be fooled? [54:30];
- Possible mechanisms conferring the longevity benefits of sauna, and how it compares to exercise [1:02:15];
- Parting thoughts on sauna, opportunity costs, and Bob’s personal regimen [1:06:30]; and
- More.
AMA
Real-world case studies—metabolic dysregulation, low testosterone, menopause, and more
#124 – AMA #15: Real-world case studies—metabolic dysregulation, low testosterone, menopause, and more
As a follow up to AMA #14 where Peter explained his framework for analyzing labs, this “Ask Me Anything” (AMA) episode focuses on a number of real-world case studies exploring metabolic dysregulation, low testosterone, menopause, hypothyroidism, elevated uric acid, and more. From the examples discussed, you can follow along how our clinical team goes about interpreting diagnostic measures and applying relevant research findings. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions.
- Should you stop taking supplements before getting a lab test? [2:45];
- Family history—Questions to ask and what to look for [5:30];
- The purpose of an oral glucose tolerance test (OGTT) [12:15];
- Case study—Insufficient muscle mass for proper glucose disposal [17:15];
- Why hemoglobin A1c is a relatively unhelpful metric [24:00];
- Case study—Exceeding carbohydrate tolerance [26:30];
- Case study—Metabolic dysfunction and a framework for metabolic health [33:30];
- Peter’s ideal tracking of metabolic health for all his patients [43:30];
- Contrasting presentations of hypogonadism—Low free testosterone [45:00];
- How sleep, exercise, and alcohol affect testosterone levels? [56:20];
- Case study—Surprisingly fast onset of menopause [59:25];
- Case study—Hypothyroidism and high cholesterol [1:07:00];
- Case study—Elevated uric acid and hypertension [1:10:55]; and
- More.
AMA
What lab tests can (and cannot) inform us about our overall objective of longevity
#111 – AMA #14: What lab tests can (and cannot) inform us about our overall objective of longevity
In this “Ask Me Anything” (AMA) episode, Peter explains his framework for understanding what lab tests can (and cannot) inform us as it pertains to overall longevity, with a specific focus on atherosclerosis, cancer, Alzheimer’s disease, and the physical body. Additionally, Peter shares details into two patient case studies around cardiovascular disease, including how the lab results influenced his diagnosis and treatment plan for the patients. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions.
- Important lab tests and reference ranges [2:35];
- How lab testing fits into the overall objective of longevity [4:25];
- A healthcare system set up to react to a disease rather than prevent it [8:00];
- The four pillars of chronic disease, and the three components of healthspan [14:30];
- Atherosclerosis—How much can labs tell us about risk? [18:00];
- Coronary calcium score (CAC)—interpreting results based on your age [24:15];
- Cancer—what lab work can tell you, and the future of liquid biopsies [28:00];
- Alzheimer’s disease—what’s driving Alzheimer’s disease, and what labs can tell you about your risk [33:15];
- Healthspan and the physical body—where lab testing fits, the endocrine system, and zone 2 testing [39:00];
- Summarizing the usefulness of lab testing—where it gives great, reasonable, or lousy insight [43:15];
- Patient case study—elevated Lp(a): Understanding ApoB, and how cholesterol levels get reduced [45:30];
- Patient case study—familial hypercholesterolemia [59:30];
- Coming up on a future AMA [1:10:30]; and
- More.
AMA
Fasting, exogenous ketones, autophagy, and exercise for longevity
#108 – AMA #13: 3-day fasting, exogenous ketones, autophagy, and exercise for longevity
In this “Ask Me Anything” (AMA) episode, Peter explains some observations he’s noticed since switching to a 3-day fasting regimen, the various things he’s measuring, and some helpful tips for getting through a prolonged fast. He also discusses the role of exogenous ketones in fasting and ketogenic diets as well as their impact on autophagy, specifically. Finally, Peter provides some practical advice for those looking to fit exercise for longevity into their busy life. Once again, Bob Kaplan, Peter’s head of research, will be asking the questions.
- Peter’s observations since switching from a 7-day to a 3-day fasting regimen [1:25];
- Ketone measuring devices—blood and breath [7:40];
- Can zero-calorie sweeteners affect ketone production? [10:40];
- Will there be a continuous insulin monitor anytime soon? [11:55];
- Exogenous ketones—Role in fasting and ketogenic diets and their effect on insulin, blood glucose, and autophagy [14:10];
- 5 tips to help you get through a multi-day fast [25:55];
- Relationship between BHB levels, glucose levels, and autophagy—Are high levels of ketones enough to produce autophagy? [34:10];
- Why is measuring blood insulin so much harder than blood glucose? [36:55];
- Advice and resources for people wanting to stay up to date on developments related to health and longevity (and how to quickly sift through all the bad science) [40:10];
- Advice for those looking to fit exercise for longevity into their busy life [51:10]; and
- More.
