The Metabolic Link

Ketosis in the Real World: Sardine Fasting, Low-Dose GLP-1s & Carb Addiction | Dr. Annette Bosworth, MD | The Metabolic Link Ep. 104

Join us for a FREE live Q&A with Dr. Boz on October 14 at 9:00 AM PT / 12:00 PM ET and ask her your questions directly. No membership required. Register here. What happens when an internist teaches ketogenic nutrition to 200 students at the same time and tracks every one of their glucose and ketone readings on shared dashboards? Dr. Annette Bosworth, MD, known to her audience as Dr. Boz, is an internal medicine physician and the author of ANYWAY YOU CAN and ketoCONTINUUM. After leaving corporate medicine she rebuilt her practice around ketone metabolic therapy, first with her own patients and now through a live 21-day class where small groups of ten work with coaches who have done the diet themselves. In this episode she walks Dom D'Agostino through what that model has taught her: why every student does a 72-hour sardine fast and the changes she has observed in morning glucose and ketone readings the day after, how she started a medically supervised group already in ketosis on 0.6 mg of tirzepatide once weekly (approximately one-quarter of the labeled 2.5 mg starting dose) and her report that roughly nine in ten stayed at that dose, and why she asks every participant to keep their own physician involved The conversation also covers the six-week ketogenic trial she ran with her mother during a leukemia recurrence, why she treats carbohydrate cravings the way she treated addiction in her clinic, and the free weekly support groups that classes from her first cohort still attend. Questions Answered in This Episode: What has Dr. Boz observed during her 72-hour sardine challenges? What did Dr. Boz observe when using low-dose tirzepatide in patients already in ketosis? What does "relief, not joy" reveal about carbohydrate addiction? Why can blood pressure medications require reassessment when starting a ketogenic diet? Why does she emphasize physician involvement when participants take prescription medications? Why does she combine group coaching with glucose and ketone tracking? Listeners and viewers will come away with a practical picture of ketone metabolic therapy as it is actually delivered: the protocol, the monitoring, the medication monitoring and reassessment, and the community structure that keeps people in it. Special thanks to the sponsors of this episode: ✅ Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here. ✅ Cowboy Colostrum: Get up to 25% off your entire order with code METABOLIC here. ✅ iRestore: Get the iRestore Elite helmet and Illumina face mask bundle at an exclusive discount with code LINK here. More Links Live Q&A with Dr. Boz, October 14, 9:00 AM PT / 12:00 PM ET (free, no membership): register here Dr. Boz's website: bozmd.com Dr. Boz on YouTube: @DoctorBoz Dr. Boz's books: ANYWAY YOU CAN and ketoCONTINUUM The Metabolic Initiative (expert lectures, CME, ad-free episodes, live Q&As; first 7 days free): membership.metabolicinitiative.com In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

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Metabolic Gynecology: Insulin, Inflammation, and the Uterus as an End Organ | Dr. Andréa Salcedo, DO | The Metabolic Link Ep. 103

Join us for a FREE live Q&A with Dr. Salcedo on September 10 at 9:00 AM PT / 12:00 PM ET and ask her your questions directly. Register here. What if the uterus is an end organ, responding to insulin and inflammation the same way the heart, kidneys, and liver do? Dr. Andréa Salcedo is a board-certified OBGYN (DO, MPH, FACOG) and associate professor at Loma Linda University School of Medicine whose research and clinical practice, which she calls conscious gynecology, examine gynecologic disease through a metabolic lens. In this episode she walks through the evidence that uterine fibroids share progenitor cells with atherosclerotic plaque, why she now teaches residents that fibroids are cardiovascular disease of the uterus, and how high insulin acts at the level of the brain stem to block ovulation. The conversation also covers her clinical observations on fasting insulin thresholds by body type, the renaming of PCOS to PMOS, what hormonal contraceptives do and do not treat, the role of chronic stress and adversity in gynecologic disease, and the four insulin-resistant transitions of a woman's life. Questions Answered in This Episode: Why are uterine fibroids being reframed as cardiovascular disease of the uterus? Can the menstrual cycle function as a metabolic vital sign? How does insulin, acting as a stress hormone, shut down ovulation? Is there an optimal fasting insulin for reproductive health, and does body type change the answer? What does the shift from PCOS to PMOS change for diagnosis and treatment? What happens to insulin resistance in perimenopause, and was the Women's Health Initiative misread? Viewers will come away with a physiological framework that treats heavy periods, fibroids, irregular cycles, and PCOS as early signals of metabolic dysfunction rather than isolated hormone problems. Special thanks to the sponsors of this episode: ✅ Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here. ✅ Cowboy Colostrum: Get 25% off your entire order with code METABOLIC here. ✅ Zocdoc: Find and instantly book a top-rated doctor here. ✅ fatty15: Get 15% off a 90-day starter kit with code METABOLICLINK here. More Links Live Q&A with Dr. Salcedo, September 10, 9:00 AM PT (free): register here Dr. Salcedo's website: consciousgynecology.com Dr. Salcedo on YouTube: @consciousgynecologist Dr. Salcedo on Instagram: @consciousgynecologist Paper: The uterus is an end organ: a preliminary study of the association between abnormal uterine bleeding and hyperinsulinemia (Menopause, 2025) Paper: Therapeutic Carbohydrate Restriction as a Metabolic Modality for the Prevention and Treatment of Abnormal Uterine Bleeding (Nutrients, 2023) Dr. Salcedo is speaking on chronic stress, adversity, and gynecologic health at the Ketogenic Foundation conference The Metabolic Initiative (expert lectures, CME, ad-free episodes, live Q&As; first 7 days free): membership.metabolicinitiative.com In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

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You Asked, Ben Bikman Answered: GLP-1 Muscle Loss, Ketone Targets & Cancer Metabolism | The Metabolic Link Ep. 102

Today we are doing something we have never done before. Once a month, members of The Metabolic Initiative get an hour to put their own questions directly to the scientists and clinicians at the forefront of metabolic health. Those sessions stay inside the platform. This one does not. After Dr. Ben Bikman joined us for episode 100, the questions kept coming. So we invited him back to sit with Dr. Dominic D'Agostino and MHI co-founder Victoria Field for a live member Q&A, and for the first time we are releasing the full session publicly. What came out of it: GLP-1 medications and the muscle loss debate, and how Ben's own position on these drugs has shifted. Insulin resistance and ceramides. Exogenous ketones, and when they may actually be useful. Metabolic approaches to cancer and the glucose ketone index. Exercise timing. Type 1 diabetes. Cortisol and fat distribution. Supplements. Questions Answered in This Episode: The muscle loss debate around GLP-1s has become polarized. Should clinicians be worried about muscle loss, muscle function, or neither? If you were diagnosed with cancer, are there any metabolic therapies you would start immediately? How long can it take for ceramides in adipose tissue to resolve — and insulin resistance to improve? Bioidentical D-BHB exogenous ketones are substantially more expensive. What is the value proposition over other forms? GLP-1 receptor agonists consistently raise resting heart rate. Is that something to be concerned about? Are there any emerging approaches to improving the management of type 1 diabetes? What happens metabolically, and to fat cells, glucose and ketones, when taking corticosteroids? This is the kind of conversation we host every month inside The Metabolic Initiative, alongside expert presentations from our conferences and a library built entirely around metabolic health and therapy, with CME credit available on eligible content for healthcare providers. If you want to be in the room for the next one, the first seven days are free. membership.metabolicinitiative.com Special thanks to the sponsors of this episode: Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here. Cowboy Colostrum: Get up to 25% off with code METABOLIC here. More Links Dr. Ben Bikman's website: benbikman.com Insulin IQ: insuliniq.com YouTube: youtube.com/@benbikman Instagram: @benbikmanphd In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

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Implementation of Ketogenic and Low Carbohydrate Therapies for Metabolic Disease | Franziska Spritzler, RD, CDE | The Metabolic Link Ep. 101

Ketogenic and low-carbohydrate diets often focus on a specific carbohydrate target: keep your net carbs under 30 grams. But as registered dietitian and certified diabetes educator Franziska Spritzler demonstrates in this presentation from Metabolic Health Summit, a carbohydrate target is not a therapy. Effective implementation means a full assessment of medical history, medications, labs, food preferences, lifestyle, and the motivation that will carry a patient through year one and beyond. Spritzler specializes in low-carbohydrate and ketogenic nutrition and has extensive experience helping people use these approaches to improve metabolic health. The creator of lowcarbdietitian.com, she walks through the practical decisions clinicians face: when a ketogenic diet is warranted versus a more flexible low-carbohydrate approach, why she recommends 1.2 to 1.8 grams of protein per kilogram rather than the RDA's 0.8, how to manage medication adjustments for patients at risk of hypoglycemia or hypotension, and how to handle electrolytes, carbohydrate counting, sweeteners, and plant-based variations without losing the patient along the way. Questions Answered in This Episode: • What actually separates a ketogenic diet from a low-carbohydrate diet, and when does the difference matter? • Why is the protein RDA too low for long-term metabolic health, and what range does Spritzler recommend instead? • Who should avoid ketogenic diets entirely, and why are most contraindications manageable with closer supervision? • How should medications be monitored and adjusted when a patient begins carbohydrate restriction? • Should patients count net carbs or total carbs, and why are packaged "net carb" labels unreliable? • Can a ketogenic diet be done as a vegetarian or vegan? A practice-tested blueprint for turning carbohydrate restriction from a prescription into a therapy patients can sustain. Special thanks to the sponsors of this episode: ✅ Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here. ✅ iRestore: Get a special discount on the iRestore Illumina Face Mask with code LINK here. ✅ fatty15: Get an additional 50% off a 90-day subscription starter kit with code METABOLICLINK. ✅ Zocdoc: Find and instantly book a top-rated doctor here. More Links • Franziska's website: lowcarbdietitian.com • The Metabolic Initiative (expert lectures, CME, ad-free episodes, live Q&As; first 7 days free): membership.metabolicinitiative.com In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

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Ben Bikman, PhD | Rethinking Metabolic Health: Insulin, Ketones, and What Comes Next | The Metabolic Link Ep. 100

Join us for a live Q&A with Dr. Ben Bikman here. For the 100th episode of The Metabolic Link, Ben Bikman, PhD, professor of cell biology and physiology at Brigham Young University and author of Why We Get Sick, returns for a milestone conversation with co-hosts Dominic D’Agostino, PhD, and Victoria Field. Together, they examine what clinicians are measuring, what conventional approaches may be missing, and how the science of metabolic health continues to evolve. Bikman argues that the clinical picture of metabolic health remains glucose-centric and lipid-heavy while the earliest signal, elevated insulin, goes unmeasured. He explains why women stay insulin sensitive at far higher body fat than men and what menopause takes away, why visceral fat is misunderstood, and how a fatty liver can be miscounted as lean mass on a DEXA scan. That last point is why he now says he was wrong about GLP-1 drugs, and why he thinks they should be prescribed as something other than weight loss medication. Questions Answered in This Episode: • Why does standard bloodwork detect metabolic dysfunction so late? • Why are women more insulin sensitive than men at the same or higher body fat? • What actually changes metabolically during menopause? • Is visceral fat inherently dangerous, or is something else going on? • Why did Dr. Bikman change his position on GLP-1 medications? • Should GLP-1 drugs be prescribed as weight loss drugs at all? This milestone episode offers a rigorous, physiology-first look at where metabolic science stands today, and what researchers and clinicians may need to examine next. Thank you for listening, watching, sharing these conversations, and helping us reach 100 episodes. We’re incredibly grateful to have you as part of this community. Special thanks to the sponsors of this episode: Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here. Cowboy Colostrum: Get up to 25% off with code METABOLIC here. iRestore: Get a special discount on the iRestore Illumina face mask with code LINK here. More Links Dr. Ben Bikman's website: benbikman.com Insulin IQ: insuliniq.com YouTube: youtube.com/@benbikman Instagram: @benbikmanphd Featured study: White Matter Lipids as a Ketogenic Fuel Supply in Aging Female Brain: Implications for Alzheimer's Disease In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

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Type 1 Diabetes on a Ketogenic Diet: What a 1,000-Mile Bike Ride Revealed | Dr. Ian Lake | The Metabolic Link Ep. 99

What can 21 days of continuous glucose and ketone data, recorded during a 1,000-mile cycling journey, reveal about managing type 1 diabetes on a ketogenic diet? Dr. Ian Lake is a UK-based primary care physician who has lived with type 1 diabetes for more than 30 years. After two decades of conventional high-carbohydrate management, he adopted a very low-carbohydrate, ketogenic approach and began examining insulin not simply as a glucose-lowering medication, but as a metabolic hormone whose requirements are influenced by nutrition, exercise, sleep, circadian rhythm, hydration, and stress. His new book, Shifting Gears, documents the ride and the lessons he took from it. Dr. Lake treated the journey as a 21-day personal experiment, wearing continuous glucose and ketone monitors while consuming roughly 20 grams of carbohydrate per day. In this conversation with Dr. Dominic D’Agostino, he shares what his data showed: an average ketone level near 1.2 mmol/L, daily insulin requirements declining from the mid-20s of units to around 16, and an episode in which glucose and ketones rose together after he had taken too little insulin. Dr. Lake describes how, in his case, one unit of insulin brought his ketones from approximately 3.0 to 0.9 mmol/L within about 20 minutes. He and Dr. D’Agostino use the experience to explore the distinction between nutritional ketosis and diabetic ketoacidosis, the essential role of adequate insulin, and why ketone readings must always be interpreted alongside glucose levels and clinical context. They also discuss insulin sensitivity during prolonged exercise, the practical challenges of adjusting insulin during endurance activity, and research suggesting that fat-adapted athletes may sustain high rates of fat oxidation at relatively high exercise intensities. Questions Answered in This Episode What did 21 days of continuous glucose and ketone monitoring reveal during a ketogenic, 1,000-mile cycling journey? How did prolonged endurance exercise affect Dr. Lake’s daily insulin requirements? How is nutritional ketosis different from diabetic ketoacidosis, and what role does insufficient insulin play in DKA risk? What did Dr. Lake observe when his glucose and ketones began rising at the same time? How might fat adaptation influence fuel use and endurance performance? What are the practical limitations of continuous glucose and ketone monitoring for real-time insulin decisions? This conversation offers a rare look at 21 consecutive days of glucose, ketone, insulin, nutrition, and exercise data, while also emphasizing that Dr. Lake’s experience is an individual case, not a substitute for personalized medical supervision. More Links: Shifting Gears, Dr. Lake’s book, on Amazon Type1Keto, Dr. Lake’s site featuring the book and the Zero Five 100 project Special thanks to the sponsors of this episode: ✅ Zocdoc: Find and instantly book a top-rated doctor here. ✅ fatty15: Get an additional 50% off a 90-day subscription starter kit with code METABOLICLINK. ✅ Toups and Co: Get 25% off your first order with code METABOLIC. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

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Ozempic, Insulin Resistance, and Type 2 Diabetes: What Are We Missing? | Dr. Mariela Glandt | The Metabolic Link Ep. 98

Attend a Live Q&A with Dr. Glandt. Reigster here. What if the way we treat type 2 diabetes is fundamentally backwards? Dr. Mariela Glandt is an endocrinologist and obesity medicine specialist who spent 15 years practicing conventional medicine before concluding, in her words, that how we treat diabetes “is actually upside down.” As co-founder of OwnaHealth, she focuses on addressing the insulin resistance underlying type 2 diabetes, not only the elevated blood sugar it eventually causes. In this episode, she walks through the science of that shift: why fasting insulin may reveal metabolic dysfunction before A1C becomes abnormal, why a laboratory “normal” range running up to 20 can be misleading, and why she believes repeatedly escalating insulin can contribute to weight gain, reduced insulin responsiveness, and worsening metabolic health. She also shares what she has learned bringing low-carbohydrate and ketogenic therapy to underserved communities in the South Bronx, where patients may be navigating severe diabetes alongside financial pressure, cultural food traditions, psychiatric illness, chronic stress, and conflicting medical advice. Her work shows that these therapies can succeed even in communities facing significant barriers to care. Dr. Glandt also breaks down what GLP-1 medications actually do, where they can help, and what they may leave unresolved—including the risks of muscle loss, inadequate protein intake, and relying on medication without addressing the patient’s broader metabolic health. Questions Answered in This Episode: • What key mindset shifts do conventionally trained physicians need to make when transitioning to a more integrated approach to medicine? • How does reframing diabetes as insulin resistance change the way a doctor practices? • What are the earliest signs of metabolic dysfunction that many clinicians miss? • Can ketogenic metabolic therapy succeed in underserved communities? • What do GLP-1 medications actually solve, and what do they leave untouched? • Where can ketogenic therapy and GLP-1 medications work together? • What has Dr. Glandt observed in patients living with both metabolic and psychiatric illness? • Where does endocrinology most need to change course? Viewers will come away with a different lens on metabolic disease, one that looks beyond glucose and weight to the biological, social, and practical factors shaping a patient’s health. More links: For Richer, for Poorer: Low-Carb Diets Work for All Incomes OwnaHealth: Reverse the course of chronic disease — for everyone. Special thanks to the sponsors of this episode: ✅ Toups and Co – Get 15% off your first order with code METABOLIC here. ✅ iRestore – Get a huge discount on the Elite and the Illumina bundle with the code LINK here. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Treating PTSD When Standard Care Falls Short: A Hyperbaric Oxygen Protocol | Dr. Keren Doenyas-Barak, MD | The Metabolic Link Ep. 97

Fewer than 40% of people with PTSD respond to standard care. For the intrusive symptoms at the core of the disorder, response rates may be lower than 15%. So what options remain for patients who have not responded to existing treatments? Dr. Keren Doenyas-Barak, director of the PTSD program at the Sagol Center for Hyperbaric Medicine and Research and a faculty member at Tel Aviv University, has treated close to 1,000 civilian and military patients and led sham-controlled trials that are helping reshape how hyperbaric medicine is studied. She walks host Dr. Dominic D'Agostino through the protocol her clinic uses—60 sessions over 12 weeks, with oxygen cycled at two atmospheres—the 35% CAPS-score improvement associated with continued progress after treatment ends, and the reported two-year outcomes, including improved occupational function, roughly double the proportion of patients living with a partner, and sharp drops in benzodiazepine and cannabis use. She also details the convincing sham control her team engineered after concluding that earlier placebo arms may have delivered a physiologically active dose. Questions Answered in This Episode: What hyperbaric protocol is best supported for treatment-resistant PTSD? What does a 35% reduction in CAPS score predict about long-term recovery? Which outcomes beyond symptom scores changed most for patients? How did the team build a hyperbaric sham that patients genuinely could not detect? Which safety measures are non-negotiable in a hyperbaric PTSD clinic? Does a patient's baseline metabolic fitness predict their response to HBOT, and can the treatment affect cardiometabolic risk? A rigorous, frontline examination of what responsible hyperbaric medicine actually requires, led by a clinician helping to build its evidence base. Special thanks to the sponsors of this episode: ✅ Toups and Co – Get 15% off your first order with code METABOLIC here. ✅ iRestore – Get a huge discount on the Elite and the Illumina bundle with the code LINK here. ✅ MudWtr – Get up to 43% off + free shipping and a free rechargeable frother with code METABOLICLINK here. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Inflammation and Glycation: The Two Heads of Chronic Disease | Dr. Paul Reynolds, PhD | The Metabolic Link Ep. 96

Dr. Paul Reynolds has spent his career studying what he calls “two heads of the same beast”: inflammation and glycation — two interlocking processes that may help explain why so many chronic diseases are connected, even when they are treated as separate conditions. Dr. Reynolds is a professor and research scientist at Brigham Young University whose NIH-funded research program studies inflammation, lung biology, glycation, and the AGE/RAGE receptor system that links metabolic and environmental stressors to disease throughout the body. In this episode, Dr. Reynolds traces the glycation cascade from early sugar-protein reactions to advanced glycation end-products, or AGEs, and explains how the RAGE receptor can act as a self-perpetuating accelerant for inflammation. He also breaks down why the brain may be uniquely vulnerable to glucose dysregulation, how diesel exhaust and tobacco smoke can create AGE-like structures that bind the same inflammatory receptors, and how the glyoxalase defense system helps neutralize damage before it becomes permanent. Questions Answered in This Episode: Can breathing polluted air trigger some of the same inflammatory pathways as excess sugar exposure? Is browned food a real glycation concern, or is the bigger issue what happens inside the body when glucose stays elevated? Why is the brain especially vulnerable to glucose dysregulation? How does fasting help the body reduce glycation and inflammatory burden? What do people need to understand about sugar substitutes like allulose and xylitol when it comes to glycation? How should we approach kids’ nutrition if glycation and inflammation can begin early in life? Is glycation damage reversible, and where does the body draw the line? This conversation offers a mechanistic map connecting cardiovascular disease, neurodegeneration, metabolic dysfunction, environmental exposures, and visible aging back to two upstream processes many patients never hear named in a clinical visit. Find the Meet Consumption and Cognitive Health paper here. Sign up for his upcoming Q&A on The Metabolic Initiative here. Find Dr. Reynolds online: Instagram Facebook X.com Youtube LinkedIn TikTok Special thanks to the sponsors of this episode: ✅ Toups and Co – Get 15% off your first order with code METABOLIC here. ✅ Fatty15 – Get 15% off a 90-day Starter Kit with code METABOLICLINK here ✅ ZocDoc - Find and instantly book a top-rated doctor here In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Metabolic Psychiatry in Clinical Practice: Brain Energy, Common Pitfalls, & Precision Nutrition | Dr. Bret Scher, MD | The Metabolic Link Ep. 95

In people with severe depression and cognitive decline, brain glucose metabolism has been shown in some studies to decline measurably. Ketone metabolism, by contrast, appears relatively preserved. That single observation is reshaping how researchers think about psychiatric illness. In this episode, Dominic D'Agostino sits down with Bret Scher, a cardiologist who pivoted to metabolic psychiatry and now leads clinical education and content for Metabolic Mind at the Baszucki Group. Dr. Scher brings a rare dual perspective: deep training in conventional cardiology paired with three years embedded in the research and clinical practice exploring metabolic approaches in psychiatry. The conversation covers brain energy dysfunction as a potential unifying mechanism across psychiatric disorders, the preserved ketone metabolism documented in work by researchers like Stephen Cunnane, the recently published Delphi consensus paper on metabolic psychiatry, why four-week randomized trials may be inadequate for nutritional interventions, and the case for future diagnostic categories like metabolic depression and metabolic bipolar disorder. Questions Answered in This Episode: Are we underestimating brain energy dysfunction as a potential unifying mechanism across psychiatric disorders? What are the two biggest clinical mistakes patients make when starting ketogenic therapy for mental illness? Should ketogenic therapy ever be positioned as a first-line intervention for psychiatric disorders? What is the single biggest bottleneck preventing wider clinical adoption of ketogenic therapy? What has been the most unexpected challenge in moving metabolic psychiatry into the mainstream? What does precision, personalized, prescriptive ketone metabolic therapy actually look like in clinical practice? This conversation reframes psychiatric illness as a question of brain energy alongside neurotransmitter signaling and other biological mechanisms, with implications for how the next decade of research and clinical training will unfold. Join the Live Q&A with Dr. Bret Scher. Bring your questions directly to Dr. Scher on May 29 at 10:00 a.m. Pacific / 1:00 p.m. Eastern. Register here. Where to Find Dr. Bret Scher Online: Metabolic Mind Coalition for Metabolic Health Special thanks to the sponsors of this episode: ✅ Toups and Co – Get 15% off your first order with code METABOLIC here. ✅ iRestore – Get a huge discount on the Elite and the Illumina bundle with the code LINK here. ✅ MudWtr – Get up to 43% off + free shipping and a free rechargeable frother with code METABOLICLINK here. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Inuit Metabolism Revisited: Ketosis, Omega-3s, & the CPT1A Arctic Variant | Dr. Gideon Mailer & Nicola Hale | The Metabolic Link Ep. 94

A gene mutation that reduces ketone production in the fasted state is associated with sudden infant death in modern populations. But in the ancestral context where it evolved alongside an omega-3-rich diet, it may have been part of what kept infants alive. Dr. Gideon Mailer and Nicola Hale join The Metabolic Link to present their hypothesis that the CPT1A L479 Arctic variant is not anti-ketogenic but pro-metabolic flexibility, conserving glucose by upregulating ketosis at the fed-state threshold. Their work explains why SIDS rates are dramatically elevated in modern Inuit communities no longer eating the ancestral Inuit diet, and how omega-3 fatty acids counteract the downregulation the mutation produces. The clinical picture extends beyond infancy. Modern carriers of the variant show lower triglycerides, lower VLDL, slightly higher HDL, and a "healthy obesity" phenotype with favorable fat distribution. But the health advantages seen in traditional Inuit populations disappear with Western diet adoption, as cardiovascular disease and diabetes rates rise to match the general population. Questions Answered in This Episode: How is the mutation associated with SIDS, and why is there a detrimental effect in modern populations? How prevalent is the CPT1A Arctic variant in the U.S. population, and does partial Inuit ancestry carry metabolic consequences? How do omega-3 fatty acids physically upregulate CPT1A activity and concentration within cell membranes? What metabolic markers distinguish carriers of the L479 variant from non-carriers? What happens to cardiovascular disease rates in Inuit populations that adopt Western diets? What should people take away from the Arctic variant story for their own metabolic health? A sobering case study in what happens when ancestral genetic adaptations collide with modern dietary environments, and what can be recovered when they are realigned. Special thanks to the sponsors of this episode: ✅ Toups and Co – Get 15% off your first order with code METABOLIC here. ✅ Fatty15 – Get 15% off a 90-day Starter Kit with code METABOLICLINK here ✅ ZocDoc - Find and instantly book a top-rated doctor here In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Understanding Female Metabolism: PCOS, Postpartum, and Menopause | Madison Kackley, PhD | The Metabolic Link

In a 12-week clinical trial at The Ohio State University, every woman with PCOS who completed the intervention experienced a change in her menstrual status. One participant, who had never had a period in her life, began menstruating within a week. Another saw spotting after five years of amenorrhea while taking only a ketone supplement without adopting a ketogenic diet. These are among the earliest controlled findings linking ketogenic interventions directly to reproductive hormone restoration. Dr. Madison Kackley is an Assistant Professor of Kinesiology at The Ohio State University and Director of the SHE Is Laboratory. Her work focuses on how hormonal fluctuations shape metabolic flexibility and resilience in women across the lifespan. In this episode, she explains why a single fasting glucose or insulin measurement is misleading without knowing where a woman is in her cycle, how the luteal phase creates a state of increased energy expenditure and insulin resistance that conventional carb-loading advice may worsen, and why perimenopausal women who jump into intermittent fasting and high-intensity exercise without prior fat adaptation can end up in a high-cortisol catabolic spiral. She also introduces the Renew study, which examines ketone supplementation alongside group exercise for postpartum depression, a condition she frames as an energy-availability problem rather than a purely psychological one. Questions Answered in This Episode: What will we look back on in ten years and realize we got fundamentally wrong about women's health? Why are women more susceptible to dementia than men, and what does it have to do with reproductive energy? Why might long-term hormonal birth control contribute to infertility, metabolic syndrome, and type 2 diabetes? Why can women in perimenopause feel exhausted and still not be able to sleep? Should weaning be understood as its own distinct hormonal event, separate from postpartum? For clinicians, researchers, and women navigating these transitions, this conversation previews the evidence-based framework that female metabolic health has been waiting for. Special thanks to the sponsors of this episode: ✅ Toups and Co – Get 15% off your first order with code METABOLIC here. ✅ iRestore – Get a huge discount on the Elite and the Illumina bundle with the code LINK here. ✅ MudWtr – Get up to 43% off + free shipping and a free rechargeable frother with code METABOLICLINK here. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Vagal Nerve Stimulation, TBI, and Brain Health: Rethinking Neurological Care | Dr. Michael Hoffman, MD | The Metabolic Link Ep. 92

A veteran walks into the clinic with a persistent migraine. Four minutes of vagal nerve stimulation later, the migraine is gone. This is not a one-off result. It is what Dr. Michael Hoffman has been observing for over seven years in the VA hospital system, using non-invasive devices he considers severely underutilized. Dr. Hoffman is a stroke and cognitive-behavioral neurologist who trained at Columbia University, spent 14 years in the VA system, and has evaluated an estimated 10,000 stroke patients across his career. He now practices at the University of Central Florida, where he integrates ketogenic nutrition, advanced imaging, vagal nerve stimulation, and hyperbaric oxygen into his neurological care. In this episode, Dr. Hoffman walks through what he calls the "five brain fitness rules," the specific, measurable lifestyle prescriptions he gives every patient, and explains why standard cognitive screening tools like the MoCA and Mini Mental miss the most dramatic behavioral syndromes caused by brain injury. He also discusses why PET scans and diffusion tensor imaging should be used far more often, and why post-TBI hormonal evaluation is critical but routinely overlooked. Questions Answered in This Episode: What are the five brain fitness rules every neurological patient should follow? Why do standard cognitive tests fail to detect some of the most severe brain injury syndromes? How is vagal nerve stimulation treating migraines, and why is it so underutilized outside the VA? What clinical changes would most improve neurological care today? Does the evidence support hyperbaric oxygen therapy for traumatic brain injury? Could fungal infections contribute to some long-standing Alzheimer's diagnoses? What is the surprising decade when your brain's cognitive function peaks? Dr. Hoffman makes a case that the gap between what we know about the brain and what we do in clinical practice has never been wider, and that closing it starts with giving clinicians the time and tools to actually examine their patients. Learn more about Dr. Hoffman on his website here. Special thanks to the sponsors of this episode: ✅ Fatty15 – Get 15% off a 90-day Starter Kit with code METABOLICLINK here ✅ Troscriptions – Get 10% off your first order with code METABOLICLINK here ✅ ZocDoc - Find and instantly book a top-rated doctor here ✅ MudWtr – Get up to 43% off + free shipping and a free rechargeable frother with code METABOLICLINK here In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

What's in Your Tap Water? Contaminants, Filtration, and How to Test It | Johnny Pujol | The Metabolic Link Ep. 91

You could have elevated levels of contaminants like uranium or arsenic in your drinking water—and not know it. Many of these compounds are colorless, odorless, and undetectable without testing. Johnny Pujol is a water chemist and the founder of Tap Score, a drinking water testing platform supported by a network of roughly 270 specialized laboratories. His path from electrochemistry research to consumer water testing was driven by a simple realization: the chemistry inside what looks like a clear glass of water is far more complex than most people realize. In this episode, Dr. Dominic D’Agostino and Johnny break down what’s actually in drinking water, how regulatory standards are set, and where they may lag behind emerging research. They also discuss how chronic exposure to certain contaminants may intersect with metabolic health and long-term disease risk. Johnny also shares insights from Tap Score’s forthcoming research comparing contaminant profiles in unfiltered tap water, bottled water, and filtered tap water. Questions Answered in This Episode: Why does the EPA action level for lead differ from the ideal target of zero? Can certain filtration systems introduce unintended issues, like microbial growth, if not properly maintained? How can environmental factors like rainfall impact private well water quality? What's the difference between a "first draw" sample and a "representative" sample, and why does it matter? Is the health risk from showering in contaminated water meaningful compared to drinking it? Why do some water tests cost $600 to $800 while others cost a fraction of that? Understanding your drinking water starts with recognizing the difference between what’s legally permitted and what may be considered optimal from a health perspective. This conversation explores that gap, and what individuals can do to better assess their own water quality. Learn more here: https://mytapscore.com/ Special thanks to the sponsors of this episode: ✅ Troscriptions – Get 10% off your first order with code METABOLICLINK here. ✅ Toups and Co – Get 15% off your first order with code METABOLIC here. ✅ iRestore – Get a huge discount on the Elite and the Illumina bundle with the code LINK here. ✅ MudWtr – Get up to 43% off + free shipping and a free rechargeable frother with code METABOLICLINK here. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Rethinking Cognitive Decline: Stimulus, Exercise, and the Aging Brain | Dr. Tommy Wood, MD, PhD | The Metabolic Link Ep. 90

Register for a live Q&A with Dr. Tommy Wood on Wednesday, March 25th. Decreased glucose uptake in the brain is often considered a hallmark of Alzheimer's disease. But Dr. Tommy Wood asks whether part of that metabolic signature may reflect how little cognitive demand we place on the brain. He sits down with Dr. Dominic D'Agostino for a nuanced conversation on metabolic health and cognitive function.. Dr. Wood is a neuroscientist, neonatal brain injury researcher, and author of The Stimulated Mind. This episode follows the metabolic thread through every stage of brain health. Pre-diabetes and type 2 diabetes as predictors of cognitive decline. Neurovascular coupling as the reason heart disease risk factors double as brain disease risk factors. Lactate crossing the blood-brain barrier to drive BDNF production where it actually matters. Creatine as a brain energy distributor that most people still only associate with muscle. Dr. Wood lays out his Three S Model — Stimulus, Supply, Support — and makes the case that cognitive demand drives glucose uptake into the brain the same way muscular contraction drives it into skeletal muscle. Questions Answered in This Episode: Does the brain respond to energy demand the same way skeletal muscle does? What role does creatine play in brain energy distribution, and what do the clinical trials show? Can heavy resistance training produce the same brain-relevant lactate response as HIIT? How should exercise be dosed after a concussion or traumatic brain injury? Is cognitive decline in your 50s, 60s, and 70s actually inevitable, or is that a statistical artifact? Why are pre-diabetes and metabolic syndrome among the strongest predictors of dementia? The mechanistic throughline here is demand-driven metabolism. Dr. Wood makes the case that the same principles governing glucose uptake in skeletal muscle apply to the brain — and the conversation gets into what that means for how we interpret FDG-PET data, design lifestyle interventions, and think about neurodegeneration itself. Find more at DrTommyWood.com Special thanks to the sponsors of this episode: ✅ Fatty15 – Get 15% off a 90-day Starter Kit with code METABOLICLINK here ✅ Troscriptions – Get 10% off your first order with code METABOLICLINK here ✅ Toups and Co – Get 15% off your first order with code METABOLIC here ✅ ZocDoc - Find and instantly book a top-rated doctor here In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Journal Club: Five Papers Pushing the Boundaries of Metabolic Therapy | The Metabolic Link Ep. 89

Get free access to our new Ketogenic Metabolic Therapy ebook here. Could changing your metabolism reduce alcohol cravings, ease psychiatric symptoms, and even make cancer immunotherapy more effective? The science is pointing to yes, and the mechanisms are fascinating. In this Journal Club episode, co-hosts Victoria Field, Dr. Dominic D'Agostino, and Dr. Angela Poff break down five peer-reviewed papers from their newly released Ketogenic Metabolic Therapy ebook (Volume 4). From a French preclinical study showing ketogenic diet enhances PD-L1 immunotherapy response in kidney cancer, to an NIH/UPenn trial using machine-learning-derived fMRI signatures to measure reduced alcohol cravings during ketosis, to Stanford's pilot trial demonstrating notable metabolic and psychiatric improvements in schizophrenia and bipolar disorder, this episode covers the cutting edge of metabolic therapy research. Questions Answered in This Episode: Why does the brain crave alcohol in people with alcohol use disorder, and how might ketones help? How might a ketogenic diet affect a tumor’s response to immunotherapy? Can insulin resistance in the brain contribute to psychiatric symptom severity? How does the ketogenic diet compare to the Mediterranean diet for autoimmune inflammation? Does timing of ketogenic diet initiation matter for chronic pain relief? Is it realistic for people with serious mental illness to adhere to a ketogenic diet? Whether you're a clinician, researcher, or someone looking to understand the latest science, this episode reveals just how far-reaching ketogenic metabolic therapy has become, spanning oncology, psychiatry, addiction, autoimmune disease, chronic pain, and much more! In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Mitochondria, Muscle, & Aging: What Longevity Drugs Miss | Dr. Mark Tarnopolsky | The Metabolic Link Ep. 88

Dr. Mark Tarnopolsky's VO2 max was once 87.6 ml/kg/min — an elite-level mark few humans have reached. He's competed at three world championships in three different sports. He's also had three cardiac ablation surgeries, bled from his bowels after races, and watched his vision tunnel to a speck crossing a finish line. His story is a master class in where the line falls between peak performance and self-destruction. Now 63, Tarnopolsky is a neurologist, neuromuscular disease specialist, and supplement formulator who has channeled decades of elite athletic experience and hundreds of published studies into the idea that keeping metabolic throughput high is what protects us as we age. In this conversation with Dom D'Agostino, he shares practical strategies anyone can apply: why resistance training three times per week is non-negotiable after 50, why post-exercise nutrient timing improved performance in a simulated training camp with identical calories, why he says creatine belongs in nearly everyone's regimen, and why he personally takes his mitochondrial supplement stack situationally after hard efforts rather than daily. Questions Answered in This Episode: What is the only intervention proven to extend human lifespan — and by how much? At what point does endurance exercise become pro-aging — and what are the warning signs? What simple nutrient timing strategy improved performance with zero extra calories? How did a bodybuilder bar conversation lead to a published discovery about growth hormone and collagen? What muscle and bone costs of Ozempic aren't getting enough attention? Why did elite endurance athletes need nearly as much dietary protein as bodybuilders — and why were bodybuilders massively overconsuming? This conversation reframes the longevity debate around what's actually been proven in human clinical trials — not Petri dishes, not animal models, and not social media influencers. Special thanks to the sponsors of this episode: ✅ Troscriptions – Get 10% off your first order with code METABOLICLINK here. ✅ Toups and Co – Get 15% off your first order with code METABOLIC here. ✅ iRestore – Get a huge discount on the Elite and the Illumina bundle here. ✅ MudWtr – Get up to 43% off + free shipping and a free rechargeable frother with code METABOLICLINK here. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Trauma, Inflammation, and Neurodegeneration: A New Framework for Alzheimer's | Dr. Caesar Hernandez, MS, PhD | The Metabolic Link Ep. 87

Roughly 90% of Alzheimer's patients develop neuropsychiatric symptoms including anxiety, persistent fear, and an inability to recognize safety — but little research is being done to investigate why. New data connecting PTSD, trauma, and accelerated brain aging may hold the answer. Dr. Caesar Hernandez is a behavioral, molecular, and circuit neuroscientist and assistant professor in the Division of Gerontology, Geriatrics & Palliative Care at the University of Alabama at Birmingham. His research program seeks to identify modifiable mechanisms that drive vulnerability to age-related cognitive decline and Alzheimer's disease. In this conversation with Dr. Dominic D'Agostino, Dr. Hernandez walks through epidemiological evidence linking PTSD to increased Alzheimer's risk, the comorbidity cluster of metabolic syndrome, gut permeability, and neuropsychiatric disorders observed in veteran populations, and why ketogenic interventions may offer a unique therapeutic angle — reducing neuroinflammation and anxiety while making the brain more receptive to rewiring traumatic memories. Questions Answered in This Episode: Could addressing PTSD in midlife meaningfully reduce the risk of cognitive decline and dementia later in life? Why do veteran populations show such high comorbidity between PTSD, metabolic syndrome, and dementia? Could ketogenic therapy serve a similar function to pharmacologically-assisted psychotherapy for PTSD? How does the amygdala - the brain's "fear center" - play a role in Alzheimer's disease? What is the single biggest unanswered question driving Alzheimer's research right now — and why does it go beyond genetics and biochemistry? Dr. Hernandez's driving question — why are negative life experiences associated with an increased the risk of neurodegeneration? — reframes brain aging as something shaped not just by genes and biology, but by the lives we live and the stress we carry. Find more of Dr. Caesar Hernandez online: University of Alabama Birmingham LinkedIn Special thanks to the sponsors of this episode: ✅ Genova Connect – Get 15% off any test kit with code METABOLICLINK here. ✅ Fatty15 – Get 15% off a 90-day Starter Kit with code METABOLICLINK here. ✅ Troscriptions – Get 10% off your first order with code METABOLICLINK here. ✅ ZocDoc - Find and instantly book a top-rated doctor here. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

The Metabolic Roots of Cardiovascular Disease: A Vascular Surgeon's Perspective | Dr. Lily Johnston | The Metabolic Link Ep. 86

What if the sequence we've always assumed—plaque causes arterial stiffness—is actually backwards? Dr. Lily Johnston proposes that impaired nitric oxide signaling may stiffen arteries first, creating the endothelial injury that then promotes plaque formation. Dr. Lily Johnston is a board-certified vascular surgeon and newly certified obesity medicine physician who bridges the operating room and metabolic medicine. After years of scraping plaque from arterial walls, she began questioning why surgical outcomes remain so modest—and discovered that what she was treating might represent the end stage of multiple distinct disease phenotypes, not a single condition. In this episode, Dr. Johnston shares her forest fire analogy for understanding LDL risk, explains why tissue surrounding diseased arteries shows profound inflammation even in first-time surgeries, and reveals why 80–90% of the operations she performs could potentially be prevented with upstream metabolic intervention. Questions Answered in This Episode: Do metabolically healthy people with elevated LDL need the same treatment as those with active disease? Why might someone with "great" biomarkers still have significant plaque burden? What will individualized cardiovascular treatment look like in 20 years? To what extent is vascular disease a metabolic disease—and is this accepted in vascular surgery? Where do you stand on the LDL particle number vs. metabolic context debate? What percentage of vascular surgeries could have been avoided with earlier metabolic intervention? A surgeon's-eye view of what happens when metabolic dysfunction goes unaddressed for decades—and a practical framework for intervening before the fire starts. Find more of Dr. Johnston online: Live Q&A Youtube channel LinkedIn Coresight Health Special thanks to the sponsors of this episode: ✅ Genova Connect – Get 15% off any test kit with code METABOLICLINK here. ✅ Toups and Co – Get 15% off your first order with code METABOLIC here. ✅ Troscriptions – Get 10% off your first order with code METABOLICLINK here. ✅ MudWtr – Get up to 43% off + free shipping and a free rechargeable frother with code METABOLICLINK here. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Ultra-Processed Food and Nutrition Policy: What We're Getting Wrong | Dr. David Ludwig | The Metabolic Link Ep. 85

The term “ultra-processed food” appeared nearly 100 times in the White House’s Make America Healthy Again report. But questions remain about whether the concept is precise enough to guide effective policy. Dr. David Ludwig—Harvard endocrinologist, obesity researcher, and author of Always Hungry—joins Dr. Dominic D'Agostino to dismantle the ultra-processed food framework from the inside out. Ludwig reveals why the NOVA classification system lumps protein bars with soda, why the FDA admitted they can't define what they're trying to regulate, and why the famous studies showing ultra-processed foods cause overeating may be fundamentally flawed. This conversation cuts through the noise to identify what actually matters: the mechanistic difference between processing carbohydrates, fats, and proteins—and why that distinction should reshape nutrition policy. Questions answered in this episode: Can ultra-processed foods be "fixed" through reformulation? What's the most overrated "healthy" food in supermarkets? Should omega-3 levels be part of standard blood work? Are GLP-1 drugs a metabolic reset or a lifelong crutch? If you could pass one food policy law, what would it be? Why did the low-fat diet era make obesity worse? Dr. Ludwig argues that "ultra-processed food" is a compelling marketing term without mechanistic grounding—and that precise, actionable targets like highly processed carbohydrates and demonstrably harmful additives would do far more to improve public health. Where to find more of Dr. Ludwig's work online: Blog on UPF NEJM paper on UPF Problems with short diet trials Carbohydrate-insulin model Website Special thanks to the sponsors of this episode: ✅ Fatty15 – Get 15% off a 90-day Starter Kit with code METABOLICLINK here. ✅ Troscriptions – Get 10% off your first order with code METABOLICLINK here. ✅ iRestore - Get a huge discount on the iRestore Illumina Face Mask when you use the code METABOLICLINK here. ✅Genova Connect – Get 15% off any test kit with code METABOLICLINK here. In every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in! You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel! Find us on social: Instagram Facebook YouTube LinkedIn Please keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.