Fascia Episode
Peter, I’d like to suggest a podcast episode on fascia and its role in movement, resilience, and aging—highly aligned with the Centenarian Decathlon. Fascia is essential for force transfer, proprioception, elasticity, joint health, and movement efficiency. Unlike muscle, fascial decline appears driven less by age itself and more by reduced movement variability, elastic loading, hydration, and repetitive patterns. This often leads to stiffness, injury risk, and loss of movement confidence before strength meaningfully declines. An episode could cover what fascia is, how it functions as an integrated system, how it becomes disrupted with modern lifestyles and aging, and what the research suggests about maintaining or restoring fascial health. Practical discussion could include movement variability, end-range loading, elastic and rhythmic work, and why fascia may be a missing link between strength, mobility, and durable movement into advanced age. This feels directly relevant to living well into one’s 70s, 80s, and beyond. With Regards
What are we to make of the studies that find an association between Gabapentin and dementia?
This may be candidate for AMA or the Sunday email. I started intensive work with a psychologist who specializes in CBTI after your session with Ashley Mason. As part of the process, my sleep lab identified hundreds of Periodic Limb Movements in Sleep per night. My sleep doc recommended either Pramipexole or Gabapentin. Gabapentin worked well so I've been using it since June, starting at 100mg but found 600 mg the right dosage. I have been great sleep but a few days ago the WSJ did a scare piece that led me to find, on Consensus, a number of worrisome studies. I could discount them but they are also potentially credible. (The WSJ piece is here: https://www.wsj.com/health/gabapentin-painkiller-hidden-risks-603e6130?mod=hp_lead_pos7) I've stopped using Gabapentin and will talk with my doc but am now getting poor sleep. What's your assessment?
Very hot beverages and cancer link
Is there a proven causality between drinking very hot beverages and oesophageal cancer? I read this media report here: https://www.channelnewsasia.com/commentary/hot-drinks-gut-oesophagus-cancer-risk-5721351?cid=braze-cna_CNA-Morning-Brief_newsletter_28122025_cna
Tendon Healing in older adults
Quick background: I am a 69 yo male who is starting out late in my goal of better health span in my later years. I suffer from golfer's elbow in one arm and and a tendon injury to my brachioradialis from lifting a heavy picnic table by myself in 2011. These two injuries are dogging me and are very stubborn to heal despite exceedingly gentle eccentric and isometric exercises with 5 lb dumbells, and daily 20g of supplemental collagen. My dilemma is that I can't safely increase my dumbell weight to get stronger without risk of further injury. My muscles are more than willing, but my tendons are not. My question: How does a near 70 yo adult heal from tendon injuries? It would also be great to hear you speak about tendon injuries in general.
Nutrition and Metabolic Health
Is there any advantage to eating smaller portions throughout the day (say 4 or 5 meals) to match your total daily calories requirement, not from an energy expenditure point of view, but from insulin sensitivity and fat deposition, VLDL production or glycogen storage, looking from a metabolic pathway point of view?
How do I deal with long term nocturia?
I have been dealing with frequent nighttime urination for over 10 years. Numerous urologists have not been helpful. It may have been further affected by being treated for prostate cancer over a 3-year period, January 2022 through January 25. My ages during that period were 80-83. I stopped all treatments beginning in October 2024. My cancer was considered "cured". My PSA was .05 in August 2025 and my testosterone was 190 at the same time. I am currently 84. My urinary episodes at night have been at least 4, but there are some nights I have 6-8. I HAVE NO URINARY PROBLEMS WHATSOEVER DURING DAY TIME.
Reverse causation in exercise studies
A 2024 MR study that showed no causative effect of VO2max on longevity attributable to the genetic-causes of VO2max (which are substantial). https://pmc.ncbi.nlm.nih.gov/articles/PMC12012764/ This raises the possibility that much of correlations we see of VO2max and other fitness metrics with longevity could be mostly reverse-causal. That is, healthiness causes people to have higher VO2max, and perhaps also to exercise more, whereas poor health causes lower VO2max. Regardless, if VO2max is not causal, it raises real doubts as to whether it should be a target metric for longevity optimization. Please comment.
Advice for Younger Listeners
You talk a lot about health span and living well when you're older. I know you probably don't have many listeners in their 20s and 30s, but I'm in my late 20s and was wondering if you had advice on living well at this stage. Between depression and the state of the world and it makes it feel like I'll never actually make it far enough to take advantage of the advice you give for older people. Or like I'm suffering through doing stuff to make my life better later but not really enjoying my life the way it is now. Is there any advice you might have for living well as a young person in today's society?
Treatment options for spondyloarthritis and IBD
What is the best treatment for a person diagnosed with spondyloarthritis and IBD, having tested positive for the HLA-B27 antigen as well as Saccharomyces cerevisiae antibodies, but unable to take Sulfasalazine due to side effects affecting the liver? Can improvements in the gut microbiome reverse or suspend the effects of arthritis? What factors should be considered when weighing risk vs. reward with biologic drugs such as Humira?
Micro dosing GLP-1
Can micro dosing a GLP-1 help with adjusting composition to lower body fat? I’m 57, 186lbs, 15% body fat, exercise 6 days a week, 4 are sweat days (high zone 2), 30 min strength training 5 days per week, 185-210 grams protein daily. Read about it in a recent Men’s Health article.
Ketone Ester Clarification
I listened to Peter’s podcast with Dominic D’Agostino who likes a special keto salt (Ketostart) over ketone ester 1,3 Butanediol because the ketone ester could have negative impact on the liver if you take too much. But Dominic also said that some of the ketone esters were formulated differently. I have been experimenting with three different esters and tried to compare them with his cautions. The three products, Ketone-IQ, KetoneAid, and Kenetik all have R-1,3 Butanediol and KetoneAid and Kenetik also have D-BHB. I have tried all of these ketone esters and they raise my ketones above 1 but some taste better than others. I’m trying to determine if all are formulated ok or do any of them have the possible negative liver impacts if taking too many. It’s very confusing to try to sort this out based on the interview and show notes and the ingredients listed on the bottles.
Saturated fat, ApoE4 and ApoB/Lp a
Recent articles came out on how higher saturated fat was protective and it seemed like ApoE4 played a role. But if someone has high lp(a), and is on a statin to reduce overall risk through a preventative focus that includes diet and exercise, how should someone think about this data?
Blood test protocol for TRT patients
When is the best time to do a blood draw for someone on TRT (specifically SC injections)? How might it be different depending on frequency of injections? And how do you interpret the significant biomarkers from this blood draw in the context of when the blood is drawn relative to when the injections are happening?
Diabetes 1.5 LADA
I came across your podcast 2 years ago when I was diagnosed with pre-diabetes. I’m a cyclist and was only a little overweight. Despite doing all the right things, exercise, losing weight, carb restricted diet, I progressed to full diabetes and still couldn’t get my blood sugar under control over the last year while being on 4 diabetes medications. While switching insurance plans a month ago my wife was talking to the insurance broker about my meds etc to make sure they were covered and the insurance broker suggested I might have Diabetes 1.5 LADA (her son had type 1 and she was invoked with diabetes organizations). I had never heard of this before but I fit the profile. I took the GAD65 anti body test and was positive. I started insulin a few days ago and feel much better. It was frustrating that none of my doctors had ever mentioned this as a possibility. I listen to your podcast every week and you talk about diabetes a lot but you’ve never mentioned that there is another form that present like type 2 but is mechanistically more like type1. As a public service it might be worth at least mentioning its existence when also mentioning the more common forms just so listeners are aware of it. Thank you for your consideration.