HRT for women over 60
For women in their 60s who were denied HRT because of the flawed women's health initiative study, could starting hormone therapy now (10+ years post-menopause) confer some of the same heart and bone health and cognitive benefits? The research seems mixed, and suggests it’s okay for women who have no risk factors - but is that interpretation also flawed? For women who eat well, maintain a healthy weight, and exercise regularly (including weights) but still are starting to see their cholesterol, A1c and blood pressure creep up above normal, while Dexa scans and brain fog get worse, could HRT still be protective and potentially slow or reverse these trend lines? If a patient over 60 with elevated LDL (low 100s) and blood pressure is able to improve her cholesterol and bp to normal with medication, would HRT then be potentially safe for her? Given the elevated DVT risk suggested in the research, would the answer change if we know the patient does not have the factor V Leiden gene? What other tests might need to be run to help make the decision? What type of HRT at what dose would provide the best benefit-risk?
Protein
Can you post several days worth of your actual meals to give us a sense of how you are getting in your protein daily? Not looking to copy a nutrition plan. Looking for examples of how you specifically achieve your protein intake. Alternatively, can you recommend how someone can achieve daily intake if they are on a budget? Thank you!
Muscular/ structural flexibility: how important, how to practice it, pitfalls..
Where does structural flexibility fit into Peters framework for health? In sports and in PT flexibility of major leg muscles,, shoulders hips..has always been emphasized. How does Peter think about it: when is it helpful or harmful, does he stretch himself?
Integrating Genetic, Glycan, and Inflammatory Biomarkers: Can Precision Testing Extend Both Lifespan and Healthspan?
As both a technology executive and an amateur endurance (mountain bike) and combat sports athlete (BJJ), I’ve been working to optimize my longevity and performance through evidence-based interventions. I currently rely on a series of advanced diagnostic tests, including GlycanAge, 23andMe (genetic data), a sports genetics and nutrition analysis, and ImuPro (type III food allergy and inflammation profiling). My question is: How effective and reliable are these genetic and immunological tests — such as 23andMe, Glycanage, ImuPro, and DNA performance analyses — in guiding interventions for longevity (lifespan and healthspan)? Specifically, how valuable is their insight into traits like inflammation markers, caffeine metabolism, medication response, and micronutrient deficiencies (magnesium, zinc, etc.)? In your view, how should these datasets be integrated — or weighed — in a comprehensive longevity protocol for someone who trains and competes regularly, but supplements only when clinically indicated by diagnostic evidence? And are there other, more validated or emerging genetic or molecular assays you would recommend that could meaningfully impact long-term health outcomes? THank you
Integrating Genetic, Glycan, and Inflammatory Biomarkers: Can Precision Testing Extend Both Lifespan and Healthspan?
As both a technology executive and an amateur endurance (mountain bike) and combat sports athlete (BJJ), I’ve been working to optimize my longevity and performance through evidence-based interventions. I currently rely on a series of advanced diagnostic tests, including GlycanAge, 23andMe (genetic data), a sports genetics and nutrition analysis, and ImuPro (type III food allergy and inflammation profiling).
Integrating Genetic, Glycan, and Inflammatory Biomarkers: Can Precision Testing Extend Both Lifespan and Healthspan?
As both a technology executive and an amateur endurance (mountain bike) and combat sports athlete (BJJ), I’ve been working to optimize my longevity and performance through evidence-based interventions. I currently rely on a series of advanced diagnostic tests, including GlycanAge, 23andMe (genetic data), a sports genetics and nutrition analysis, and ImuPro (type III food allergy and inflammation profiling). My question is: How effective and reliable are these genetic and immunological tests — such as 23andMe, Glycanage, ImuPro, and DNA performance analyses — in guiding interventions for longevity (lifespan and healthspan)? Specifically, how valuable is their insight into traits like inflammation markers, caffeine metabolism, medication response, and micronutrient deficiencies (magnesium, zinc, etc.)? In your view, how should these datasets be integrated — or weighed — in a comprehensive longevity protocol for someone who trains and competes regularly, but supplements only when clinically indicated by diagnostic evidence? And are there other, more validated or emerging genetic or molecular assays you would recommend that could meaningfully impact long-term health outcomes? Thank you
Repatha effect on body composition
Hello, Background: I am a 120lb, low body fat, 59yo F with rather significant ASCVD and have been taking Repatha (after experiencing near rhabdomyolysis with Atorvastatin) since July 2025. I have also been taking hormone therapy since December 2024 in an effort to delay further bone loss. I have been a lifelong moderate exerciser (running, biking) and added consistent weight training in the Fall of 2024. I purchased a HUME body scanner in March 2025 to better track my progress. It reflected consistent increases in muscle mass and slight decrease/constant body fat month to month UNTIL July 2025, when I started Repatha. Since then, the numbers have inverted (body fat up, muscle mass down) each time I step on the HUME. In fact, it seems that my strength is actually decreasing despite rest days, not being “overtrained”… Is there a correlation between Repatha and body composition? I am beginning to feel defeated due to the fact my ApoB was 113 without Repatha and I clearly need something. My physicians are not concerned about body composition and have no answers. Thank you.
Heart Rhythm
I would love to learn more about arrhythmias. We cover cholesterol and heart health often. Maybe I’ve missed it but what causes arrhythmias and how to correct them. Personally, I have a SVT’s and PVC’s, no Afib - I take an absurd amount (I think absurd anyhow) (500mg) of magnesium (Dr. prescribed) and still get them. Thank you!
Role of sleep apnea in cardiovascular health, sleep quality
I'm curious about the rise in sleep apnea diagnoses as a whole. It seems that so many people I know, both obese, and not, are being diagnosed with sleep apnea and getting prescribed CPAP machines. This seems to be much more prevalent in the last 5-10 years. What are the different types of sleep apnea? What is the pathophysiology? Can you prevent sleep apnea? Are there other treatments besides CPAP/BIPAP? Does it actually improve sleep quality? I've heard many people report that it interferes with their sleep. What is the implication for cardiovascular health and the other 4 horsemen?
Normal ApoB with high LDL-C
I finally convinced my pcp to order an ApoB with my lipid panel. I was surprised to find that my ApoB was normal despite my LDL-C level being elevated. Can you help me to understand why this discordance happens and if I should be concerned either by the elevated LDL-C or by whatever mechanism causes this discordance? Thank you
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.