BHRT and the Nay-Sayers
Today, 10 Nov 2025, the FDA lifted the black box warning on BHRT. Kudos to Dr. Marty Makary. Yet…YET… there are still nay sayers out there and I’m seeing them pop up all over the place. Can you go over why the so called “natural” remedies are about as useless as snake oil when it comes to protecting bone, heart, and brain health. I think this has to stay in the forefront because the crazies out there exist who insist that natural is the way to go.
Being a prescriber
I am a primary care physician who is trying my best. I totally understand the frustration of patients who feel that their doctors may not be adequately educated on the kinds of topics you cover. I agree that the limitations of medical education and poor physician mentorship play a role for many. However I think that the “system” is a big part of it as well. Let’s use Hcg as an example; I would be interested in learning to prescribe that for my patients as an alternative for young hypogonadal men who are interested in preserving fertility. However, on the insurance that my patients have, hcg is just not covered or available in any form, and I don’t know how to order it for my patients even if I really wanted to. How did you learn to get around these kinds of issues? Could you do an episode that helps physicians (or prescribers) learn how to navigate this system to help their patients, even when things like insurance and EHRs don’t make it easy? Are you using compounding pharmacies? These just aren’t things we are taught, and so it is difficult to even know where to start. Thank you
Is peter aware of our research about excess folic acid contributing to neurodevelopmental issues in the offspring
Hi Peter, I recently listened to your podcast where you discussed autism and its potential causes. I appreciated the depth of your analysis and wanted to share some lesser-known but emerging research that may be of interest to you. I’m a PhD candidate at the University of Technology Sydney, currently finalizing my thesis on MTHFR, excess folic acid, and recurrent pregnancy loss. Your summary leaned toward autism being primarily genetic, which is certainly a major component. However, animal studies dating back to 1998—and more recent human data—suggest that excess folic acid may play a significant role in neurodevelopmental outcomes, including autism. We’ve just published two papers on this topic, which I’ve linked below. The evidence points to excess folic acid creating epigenetic changes that affect fetal neurodevelopment. While this isn’t genetic in the traditional sense, it does have profound implications for gene expression and long-term health. Importantly, while folic acid has been instrumental in preventing neural tube defects, we now know that more is not necessarily better. Our research suggests that 400 mcg/day is likely the optimal intake. Intakes above this—common in many U.S. prenatal supplements (often 800 mcg or more)—may increase risks for pregnancy loss, gestational diabetes, and neurodevelopmental disorders such as autism, especially in individuals with genetic variants like MTHFR that affect folate metabolism. Unfortunately, many public health guidelines still rely on outdated research from 2012, despite significant advancements in our understanding since then. I’m part of a research group focused exclusively on folate metabolism, and we believe it’s time to redefine what constitutes “excess” folic acid in light of current evidence. Here are the links to our recent publications: https://www.mdpi.com/2072-6643/14/13/2715 https://www.sciencedirect.com/science/article/pii/S147264832500447X Thanks for all the work you do to bring science to the public in such an accessible way.
Optimizing recovery from joint replacement surgery.
What is the optimal nutrition and or supplements for post-joint replacement surgery? Is there any evidence to support increased calcium, magnesium, phosphorus, or Vit D intake for quicker recovery or better function? Is there any evidence to support increased Leucine intake or other EAA? This could also apply to fracture healing in the older age group or sports injuries in the younger age group.
Endothelial Dysfunction
Hi Peter, I recently had a EndoPAT that revealed that I have endothelial dysfunction. It’s disheartening news as I exercise regularly, eat a heart healthy diet etc. I am very health conscious. I’m female and 58 yrs old. The doctor told me that because I am otherwise fit and healthy, it must be related to COVID and this is common in women. He said to keep up the aerobic exercise as that is the only treatment. So, my question is if it is caused by COVID, will I ever get back to normal? Can exercise improve it as I do exercise a lot already and I still have it. Wondering if there are a lot of people with this issue now following COVID and if I am doing everything I can do improve it. I am on HRT and a low dose statin for a tiny amount of soft plaque in carotid. I have a zero coronary calcium score. Would be grateful for your thoughts. Thank you.
Night Cramps
First I am not speaking of exercise induced cramps. I frequently have intense lower leg/foot cramps that will cause me to awake from sleep. Duration is 5 to 10 minutes. No position or stretch reduces the cramp. It simply must run its course. This does not seem to be uncommon as I speak to others. What are possible causes? What are potential treatments to reduce and/or eliminate the issue? Thank you.
Sleeping 7-9 hours
I always hear sleep 7-9 hours, pretty sure that’s what Dr. Walker said as well. Yes I seem to usually hear Peter say “be in bed 8 hours, as most people need 7-8 hours of sleep per night” as he said in his Masterclass and elsewhere. Does Peter think more than 8 hours has no or merely modest benefits? Thanks!
Impact of loss and return of menses during breast cancer treatment and survivorship
Treatment for breast cancer often results in the loss and then return of menses for premenopausal patients. I would love to hear a discussion of the ongoing research on the impact that both the loss of and return of menses during breast cancer treatment and survivorship has on patients. How to the physiological and hormonal changes affect mood, energy, exercise tolerance, sleep, appetite, digestion, cognitive, and sexual health? What impact may all of this have on social and professional life? And how can we better integrate awareness of and care for these issues into breast cancer care?
Heavy Metals
I've recently been seeing a lot about heavy metals and how we may have them inherited from our mothers and are exposed to them via various toxins we come in contact with..... and how important it is to detox from heavy metals. Can you explain this? Is this legitimate? Is this something that everyone should be checking into?
Is Lisdexamfetamine worth the blood pressure increase?
I have been diagnosed with adult ADHD and I am taking Lisdexamfetamine. It has helped my attention and productivity at work but it does raise my blood pressure to right as the normal level or slightly above (118-122/78-82), while normally i sit below. How damaging is the increase in blood pressure if you are still around normal range? I'm trying to weigh the benefits of the increased productivity vs the long-term risk of an elevated blood pressure.