Nick Sterling, MD, PhD

Most people think pre-diabetes is just a waiting room for Type 2 diabetes — something you manage, not something you fix. Turns out, that thinking is out of date. Brand new data published in one of medicine's most respected journals shows that people who reversed their pre-diabetes had about half the rate of heart attacks, heart failure, and cardiovascular death over the following decades. In t...

In this episode, we cover a practical system ER doctors use to lead through high-pressure, high-stakes moments. I walk through a high-pressure scenario and break it into repeatable steps: checking your own pulse, clearing cognitive load, committing, prioritizing with the Eisenhower Matrix, executing safely (“slow is smooth, smooth is fast”), and cycling back to reevaluate and verify. We also talk...

In this episode, we cover why early atherosclerosis is essentially universal by young adulthood and tests that tell us about cardiovascular risk—beyond a standard lipid panel. We walk through ApoB (and why it can outperform LDL-C in some circumstances), Lp(a) and the case for checking it at least once, inflammation markers like hs-CRP and GlycA, the triglyceride–HDL relationship and TG/HDL ratio,...

Spotting Metabolic Dysfunction Early: LP-IR, Waist-to-Hip, Uric Acid & More. In this episode, we cover practical ways to spot early metabolic dysfunction. We walk through the LP-IR (lipoprotein insulin resistance) index and what changing lipid particle patterns reveal, then show how to measure waist-to-hip ratio correctly and interpret risk thresholds. We also touch on where magnesium fits (and it...

In this episode, we cover the highest-yield lab tests to spot insulin resistance early—often years before routine screening would. I walk through how insulin works, why insulin resistance can be silent for a decade, and which metrics actually move the needle for long-term metabolic health. We dig into fasting glucose and A1C, fasting insulin, and combined indices like HOMA-IR and QUICKI. I also ex...

Scientific knowledge of the gut microbiome has increased exponentially over the last decade. Recently, several studies have suggested that specific strains of bacteria, including Akkermansia muciniphila, are key to supporting the environmental conditions required for other related bacterial strains that facilitate healthy metabolic health. In this video, Colleen Cutcliffe, PhD, co-founder and CEO...

Insulin resistance is a major risk factor for conditions like heart disease, stroke, and diabetes, yet its causes are not always well understood. This video explores the role of magnesium deficiency in insulin resistance and metabolic dysfunction, highlighting its impact on glucose metabolism, insulin signaling, and pancreatic function. We discuss how common magnesium deficiency is, why standard b...

What are some common side effects of medications like Ozempic and Wegovy? From the front lines of healthcare, we explore adverse effects of these medications based on real-world visits to the emergency department. Learn about common side effects such as nausea, dehydration, and muscle wasting, as well as lesser-known risks like starvation ketosis and mood changes. Chapters 0:00 - Introduction to &...

In this episode, we explore how ketamine, a dissociative anesthetic with a long history in medical use, is now being investigated for its rapid and sustained effects on depression, anxiety, and PTSD. We discuss its role in promoting neuroplasticity—rewiring the brain's structure to counteract stress-induced atrophy—and review the evidence from clinical trials, including a landmark 2023 meta-analys...

In this episode, we talk about a recent study from Nature Aging that suggests aging may not progress in a straight line. Using data from thousands of biological measurements, researchers identified key ages—44 and 60—where changes in aging appear to accelerate. We review what this means for our understanding of aging, how it affects multiple systems in the body, and the potential implications for...

Can we slow the speed of aging? In this episode, Dr. Varun Dwaraka, Head of Bioinformatics at TruDiagnostic, walks us through through the science of measuring "biological age" using epigenetic markers, such as DNA methylation. We discuss how epigenetics (i.e. DNA methylation), may provide biomarkers of biological age, the rate at which aging occurs, and potentially early markers of disea...

Why do humans get cardiovascular disease and how can we prevent it? These are critical processes to understand for anyone who is interested in living a longer and healthier life. I'm very honored to talk with Dr. Tom Dayspring, a world-renowned clinical lipidologist and physician whose topic expertise is unparalleled. We discuss the underlying process of atherosclerosis & the formation of...

In this episode, I had the pleasure of sitting down with Nicolas Verhoeven of Physionic. We focus our attention on metabolic health and, specifically, the energy-related, cellular, and nutritional mechanisms of insulin resistance. Nicolas reviews evidence pertaining to the reversal of insulin resistance and dietary clinical trials demonstrating remission of type 2 diabetes. Nicolas also highlights...

In this episode, we discuss polarized training, which includes high-volume low intensity training and high-intensity training. We review the scientific literature pertaining to endurance performance, mechanisms of recovery debt, adaptations to various exercise modalities, and developing training programs around polarized training. MAF-180: https://philmaffetone.com/180-formula/ #ultra #ironman #en...

Does muscle loss occur in people taking GLP-1 receptor agonists such as semaglutide (marketed as "Ozempic" and "Wegovy") or combined GLP-1/GIP agonists like tirzepatide (marketed as "Mounjaro")? In this episode, we discuss current evidence regarding these next-generation weight loss drugs and muscle wasting, as well as principles of preventing muscle loss in weight lo...

How do drugs like Ozempic (semaglutide) cause weight loss? In this episode, we discuss how these drugs (GLP-1 receptor agonists) target specific areas in the brain to suppress appetite and facilitate weight loss. We also discuss clinical trials data suggesting that these drugs and/or the weight loss that they facilitate may have cardioprotective effects. Lastly, we will also examine evidence regar...

Highly processed foods have been shown to lead to weight gain and are thought to drive intake through several mechanisms. Recent research suggests that the effect of combining fats and carbs on appetite might be more than the sum of their individual effects. Highly processed foods, accordingly, might simulate increased intake via the ratio of macronutrients. Link to episode on neuroscience of appe...

Growing scientific evidence suggests that highly processed foods are associated with increased risk of disease. Until recently, scientists were unable to study directly the effects of highly processed foods on humans. In this episode, we review one of the first highly controlled scientific trials demonstrating that ultra-processed foods lead to weight gain.  Neuroscience of appetite regulatio...

In this episode, we discuss how overeating can lead to inflammation and neuron dysfunction in specific parts of the brain that control appetite and energy regulation. We review the neuroscience of appetite regulation, energy expenditure, and body fat regulation. Topics include hypothalamic dysfunction of body fat regulation, leptin resistance, neuro-inflammation, and physical changes in the hypoth...

Is it possible to be metabolically healthy and overweight or obese? In this episode, we discuss the science of what makes fat healthy or unhealthy. We discuss how metabolic dysfunction in fat tissue can affect the rest of the body. We also review evidence pertaining to the "obesity paradox" and explore explanations for the associations of body mass index (BMI) and changes in the risk of disease co...

In this episode, we discuss fat through the lens of performance and survival, and what happens when we push our energy systems to their limits. We also talk about how our bodies make adaptations via exercise to improve our ability to "burn" fat for fuel, and how our bodies conserve fuel during times of negative energy balance. Lastly, we preview the role of fat as an endocrine organ and the import...

This is our first episode on weight gain and weight loss. In this episode, we describe how, as an industrialized nation, our food supply and environment have changed in a way that, in many cases, is mismatched with our biology as humans. We explore how these changes can lead to disease and metabolic dysfunction. We discuss how the replacement of whole foods with processed foods, as well as the add...