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A medicine that quiets food noise, trims 15 to 20 percent of body weight, and even lowers the risk of heart events sounds like a fantasy—until you meet GLP-1 drugs. We dig into what makes semaglutide and tirzepatide so different, how they rewire satiety signals, and why their impact extends beyond the scale to blood sugar, blood pressure, and cardiovascular outcomes. Along the way, we get candid about the trade-offs: GI side effects, lean mass loss, and the reality that stopping often means regaining much of the weight.

To go deeper, we’re joined by Dr. David Rind, chief medical officer at the Institute for Clinical and Economic Review (ICER), to decode how “value” gets measured in health care. Together we explore how these medications can be a strong value for individuals at today’s negotiated prices, yet still strain the entire system when millions qualify. You’ll hear why real-world discontinuation is high, why strength training and adequate protein are non-negotiable, and how benefits like fewer heart attacks, fewer joint surgeries, and improved quality of life factor into the equation.

We also tackle the hard question: how do we pay for a breakthrough at population scale without crowding out everything else? From Netflix-style subscription models and dedicated funding to competitive pricing and rethinking our hyperpalatable food environment, we outline pragmatic paths that could expand access while protecting budgets. If you’ve wondered whether GLP-1s are miracle drugs or money pits, this conversation offers a grounded, evidence-based guide to the science, the economics, and the choices ahead.

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More of us are being seen by nurse practitioners (NPs) and physician associates/assistants (PAs); for routine care outcomes look similar to physician visits, but for complex, new, or worsening problems you should push to see the doctor and ask for clear oversight.

Key topics

• Why this is happening: Longer waits and rising demand meet a physician shortfall, so systems lean on NPs/PAs to expand access. New-patient waits average ~31 days, varying widely by city and specialty (AMN
  ). Fewer people have a usual source of care, pushing visits to urgent care/ER (Milbank Scorecard
  ).
• The scope shift: NP involvement in Medicare outpatient visits rose from 14% in 2013 to ~26% in 2019 (Harvard/Tradeoffs summary). Projections show rapid growth in NP and PA roles through 2030 (ValuePenguin analysis
  ).
• Training differences (at a glance): NPs typically complete a master’s/DNP with ~500–700 supervised clinical hours and, in many states, can practice independently; PAs complete a master’s with ~2,000 supervised hours and practice with physician collaboration; physicians complete medical school plus 3–5+ years of residency (~10,000+ hours) and broad rotations—critical for complex differential diagnosis (AJMC overview
  ).
• Quality of care, by the evidence: For common, protocol-driven issues, outcomes are generally similar. A Cochrane-summarized evidence base finds comparable results for blood pressure control, mortality, and patient satisfaction, with longer counseling time in NP visits (AJMC summary of RCTs
  ). Patients often feel PAs spend more time with them (JAAPA survey
  ). Diabetes care quality appears similar across clinicians (PubMed
  ); NPs tend to deliver more smoking-cessation counseling (AANP brief
  ).
• Where this works well: Routine follow-ups (blood pressure, cholesterol, diabetes), protocol-based care, minor acute concerns (UTI, simple URI), post-op checks when all is going well—especially with clear physician involvement.
• When to push for the doctor: New, unclear, or non-resolving problems (e.g., complex headaches, persistent back pain, ongoing fatigue or depression), multiple chronic conditions, many medications, or when a serious alternative diagnosis must be ruled out (e.g., “heartburn” vs. cardiac disease).
• Advocate for transparency: Ask in advance who you’ll see, whether your case will be reviewed with a physician, and how escalation works if you’re not improving.

Takeaways

• Access will keep driving NP/PA growth; use it to be seen sooner.
• For routine care, NPs/PAs are often a solid choice with similar outcomes and more counseling time.
• For complexity, insist on physician evaluation or documented oversight.
• You have the power to ask questions, confirm the plan, and request escalation when needed.

Links mentioned in this episode
AMN wait-time trends →

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Madrone Springs Ranch and Bed and Breakfast Website

Summary:
I share five lessons that shaped an unexpected path—from physician-scientist to entrepreneur, Ironman triathlete, podcaster, and ranch/inn owner—and how you can use the same principles to build a life you didn’t plan but absolutely love.

What you’ll learn:

• Why it’s smart to seek counsel—but essential to trust your own judgment.
• How pairing medicine and business created a career at the intersection of evidence, incentives, and impact.
• A simple way to identify your superpower (and your kryptonite) so you can build the right team around you.
• The “big picture → incremental steps” approach that carried me from daily core work to marathons to Ironman.
• How to move forward when you don’t have a master plan—just take the next best step.
• The power of focusing on strengths and designing work (and life) around what you do best.
• Why my podcast exists: translating rigorous evidence into accessible, agenda-free guidance.

Key moments:

• Choosing medicine vs. business—and discovering it was never either/or.
• Reframing a PhD: deliver peer-reviewed papers, not a door-stop dissertation.
• From “don’t look old” to four full Ironmans and 15 70.3s—one step at a time.
• Building Madrone Springs Ranch by following curiosity, not a 10-year plan.
• Accepting getting "older": prioritize durability and finishing over speed.
• The “Chief Beauty Officer” principle—surround yourself with complementary strengths.
• Why I launched Live Long & Well: evidence first, no hype, no conflicts.

Takeaways:

• Ask for advice, but trust yourself.
• Know your superpower—and your kryptonite.
• If you have a vision, work backward into small, consistent steps.
• If you don’t, take the next best step and let the path reveal itself.
• Build your life around what you’re genuinely good at.

Try this this week:

• Write down one decision where your gut disagrees with the chorus—what is it telling you?
• Make two columns: strengths and weaknesses. Identify one task to delegate or drop.
• Pick one small step that moves your long-term vision—or your curiosity—forward.

If this episode helped you, share it with a friend who’s between Point A and Point B. And if you’re new here, follow the show so you don’t miss what’s next.

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Summary: I separate cold-season fact from folklore so you know what truly prevents colds, what (slightly) shortens them, what eases symptoms—and what to skip. Save money, feel better, and keep it simple.

What we cover

• How common colds are and how long they last (2–3 per year on average; usually 5–7 days; cough can linger).

Prevention audit: 

• Vitamin C doesn’t prevent colds in the general population (Cochrane), though it helped in physically stressed groups; 
• handwashing probably helps (Cochrane) 
• echinacea doesn’t pan out (Cochrane) 
• garlic didn’t reduce colds but modestly reduced severity in one RCT (trial)
•  gargling showed a very small signal (trial)
• 
  

Grandma’s wisdom check: 

• Short sleep (<6 hours) quadrupled cold risk in a viral-challenge study (study) 
• cold exposure might matter (foot-chilling RCT: more colds in the chilled group, study
• lab data suggest colder noses weaken first-line defenses (mechanism)

Shortening a cold: 

• Vitamin C doesn’t shorten it when started after symptoms (Cochrane
• zinc lozenges can trim 1–2 days if started within 24 hours (≈100 mg/day elemental zinc in trials, meta-analysis
• chicken soup has plausible lab effects on white blood cells (study

Symptom relief: 

• Oral phenylephrine doesn’t work; the FDA voted 16–0 that it’s ineffective (FDA review
• Pseudoephedrine (the “real” Sudafed, behind the pharmacy counter) reduces congestion with meaningful effect sizes (evidence
• Honey 30 minutes before bed improved cough and sleep in kids (not for <1 year) and is supported by a broader review (RCTsystematic review 
• Humidifiers didn’t show clear benefit in trials (Cochrane
• Voice myth: Whispering actually stresses the vocal cords more for many people—so speak softly instead (study
• Flu vs. cold: Tamiflu is only for influenza and must be started within ~48 hours.

Takeaways

• To avoid colds: prioritize sleep and handwashing; keeping warm may help.
• To shorten a cold: consider zinc (start early). Chicken sou

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Summary: I walk you through the proposed shift away from universal newborn hepatitis B vaccination at birth, why it matters, what the evidence shows, and how parents can make a calm, informed choice—without reigniting every vaccine debate.

Episode highlights

• I explain why hepatitis B is uniquely risky for babies: if infected early, up to 90% develop lifelong infection with later risks of cirrhosis and liver cancer. I also clarify that exposures aren’t only from mom at delivery—household contact and tiny blood exposures matter.
• We review what happened after the U.S. moved to a universal newborn dose in 1991: childhood hepatitis B plunged dramatically, with no new safety concerns emerging from hundreds of millions of doses.
• I outline the new proposal: keep the birth dose for babies of mothers who are positive or whose status is unknown; consider delaying to two months when mom tests negative—via shared decision-making with the pediatrician.
• I describe why many pediatric and public health experts still favor the birth dose: it protects against documentation errors and early exposures, and it avoids added “friction” that can reduce on-time vaccination.
• I address autism concerns with empathy and evidence: large studies and reviews have not found a link between vaccines—including hepatitis B—and autism.
• My take: I would keep the universal birth dose because it’s safe, simple, and highly effective. But if parents delay, they should commit to the 2-month visit and rely on their clinician—not social media.

Key takeaways

• The risk window is small but meaningful. Early-life infection can have lifelong consequences; the birth dose is a safety net.
• Process vs. evidence matters. Policy shifts should be driven by strong data, not ideology or committee turnover.
• If you delay, have a plan. Put the two-month appointment on the calendar now and follow through.
• Know your status. Make sure maternal hepatitis B testing is done and documented correctly.

Resources mentioned (for deeper reading)

• Hepatitis B clinical overview and long-term risks (CDC): cdc.gov/hepatitis-b/hcp/clinical-overview
  
  
• U.S. policy history and early childhood burden pre-1991: PubMed 11694691
  
  
• Impact of infant hepatitis B vaccination (MMWR): mmwrhtml/mm5125a3.htm
  
  

CTA: If this episode helped, share it with an expecting parent or grandparent. To get my weekly note on practical, evidence-supported longevity and preventive health, join me at DrBobbyLiveLongAndWell.com.

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Summary: Microplastics are showing up in our water, food, air—and in human tissues. In this episode, I unpack what the best studies actually show (and don’t), why risk is plausible but not proven, and the realistic steps you can take today without panic. 

In this episode, I cover:

• What microplastics are and why they’re everywhere—from packaging and clothing to tire dust—and why production is still projected to rise ~70% by 2040 (OECD).
  OECD+2
  OECD+2
• The signal that caught my attention: patients with microplastics in carotid artery plaque had a markedly higher 3-year risk of heart attack, stroke, or death (NEJM). Association, not proof—but concerning.
  The Guardian+3
  New England Journal of Medicine+3
  PubMed+3
• What’s turning up in the brain: autopsy work suggests rising microplastic loads in brain tissue, though causality remains unknown (Nature Medicine coverage).
  Nature+2
  Nature+2
• Everyday exposure: a liter of bottled water can contain ~240,000 plastic particles—mostly nanoplastics—using newer detection methods (NIH Research Matters).
  TIME+3
  National Institutes of Health (NIH)+3
  NCBI+3
• Indoor vs. outdoor air: estimates suggest we inhale tens of thousands of microplastic particles daily, with higher indoor concentrations (PLOS One).
  PLOS+1

My takeaways for you (progress, not perfection):

• Respect the signal without catastrophizing. Human data are early, but cardiovascular and neurologic signals merit attention.
  New England Journal of Medicine+1
• Make the easy swaps: store food in glass, don’t microwave plastic, favor loose-leaf tea over plastic-based tea bags, and replace plastic cutting boards with wood or glass. (These trim exposure; they don’t eliminate it.) 
• Air matters: consider a HEPA purifier for main living/sleeping areas and vacuum regularly; natural-fiber clothing sheds fewer synthetic particles. 
• Water choices: where safe, use tap water with a quality home filter and a reusable (non-plastic) bottle—especially given the nanoplastic findings in some bottled waters.
  National Institutes of Health (NIH)

Listener corner: You asked for more quick-hit myth busters (yes, we’ll do “Does chicken soup speed recovery?”), and thanks for the reminder to wear a

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Exercise is the most powerful longevity tool we have, but after 50 the recovery curve, injury risk, and bone/muscle changes mean the smartest plan blends strength, power, impact, and slightly more recovery—so you can train hard without derailing progress.

What we cover

• Why this matters now: record-setting older endurance athletes (and I’m racing at 69) show what’s possible—if we train wisely.
• The “aging triad”: loss of muscle (especially fast-twitch/power), bone density shifts (sharpest around menopause), and rising osteoarthritis risk.
• The injury paradox: the fitter you are, the more a single layoff can cost; preventing setbacks is a longevity strategy.
• A practical framework: build strength, protect fast-twitch fibers, add tolerable impact for bone, and consider an extra rest day after hard sessions.

Evidence, in plain English (linked)

• Muscle changes: We preferentially lose type-2 (power) fibers with age; quads are especially affected. Training can target this. Review
  .
• Women & men both lose muscle mass percentage-wise; patterns differ but loss is universal. Same review
  .
• Bone density: Women can lose ~2–3%/yr at the spine around menopause; men decline more gradually. CDC data brief
  .
• Running & knees: Long-term cohorts show no higher knee OA in runners vs. non-runners (Stanford cohort
  ; systematic review, ~14k people
  ), and even runners with established OA didn’t worsen—and reported less pain. Prospective OA cohort
  .
• Strength at any age: Even adults 85+ can add ~10% quad size and ~40% leg strength in 12 weeks; heavy strength work is safe when programmed well. Overview
  .
• Power/fast-twitch support: Short (30–120 s) high-intensity efforts and plyometrics can improve type-2 fiber function and neuromuscular drive in older adults. Narrative review
  .
• Bones respond to signal: In 80 trials (5,500 postmenopausal women), combined resistance + impact training improved spine and hip BMD regardless of menopause timing or baseline status. Meta-analysis
  .
• Recovery with age: Some data show more soreness and temporarily lower strength 24–72h post-lifting in middle-aged vs. young adults—supporting a touch more recovery after hard days. Study
  .

Practical takeaways

• Lift twice weekly
• Add brief power: 20–30-second hard intervals or controlled mini-hops/step-downs; keep impact tolerable.
• Build bones: pair resistance work with  impact (jog/jump rope as tolerated). If you have osteopenia/osteoporosis, get your plan cleared first.
• Recover like it matters: if a session is truly hard, consider one extra easy/recovery day.
• Audit risk: dial back higher-risk activities that would sideline you for weeks; prevention preserves gains.

If this episode helped, please rate the show and share it with a friend. To get my newsletter with practical, evidence-backed steps for living long and well, visit DrBobbyLiveLongandWell.com.

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Be honest—have you ever rescued a French fry from the floor? In this bite-size myth episode, I test the famous “5-second rule.” I walk through what actually transfers to your food (fast), when that matters, and why a little microbial exposure isn’t always the villain—while drawing a hard line for high-risk settings and situations.

Key Topics & Takeaways

• The verdict meter: The 5-second rule is false—bacteria can transfer in <1 second. In a Rutgers lab study, juicy foods like watermelon picked up the most, gummies the least; tile/steel transferred more than carpet (Applied and Environmental Microbiology / PubMed
  ).
• Foodborne illness is common: ~48M illnesses/year in the U.S., ~128k hospitalizations, ~3k deaths. Usual suspects include Salmonella, E. coli, Campylobacter, Listeria, and norovirus. Symptoms are typically GI, but severe cases occur—especially in the very young, elderly, pregnant, or immunocompromised (CDC overview
  ).
• Context matters: Moisture and surface trump “time.” High-moisture foods collect more microbes; visibly dirty or high-traffic floors (think convenience stores) raise risk—regardless of seconds.
• When to skip the floor food—no debate: If you’re immunocompromised, pregnant, very young/elderly, or you’re in a hospital/clinical setting, don’t eat it. Full stop.
• Nuance: Are microbes always bad? Early, diverse exposure to benign environmental microbes associates with more resilient immunity. Farm-exposed kids had lower asthma/atopy rates (≈20–40%) versus city peers (NEJM
  ). Greening urban daycare yards (adding soil/plant matter) increased skin/gut microbial diversity and shifted immune markers in a favorable direction (Science Advances
  ). This doesn’t mean “eat off the floor”—it means the bigger story is about exposure diversity and context.
• My practice: At home, I don’t stress over a quick drop on a clean surface; out in public or medical settings, I pass.

Bottom Line
Microbes hop on fast; the “rule” doesn’t save you. But danger depends on what fell, where, and who is eating it. Be smart, especially if you or your environment are higher risk.

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Summary: I unpack why medicine sometimes reverses course—and how you can tell sound evidence from shiny anecdotes—with physician-author Dr. Adam Cifu of the University of Chicago and co-author of Ending Medical Reversal
.

Key topics & takeaways

• Why medicine “flips”: Plausible theories + observational data → premature guidelines; true answers require randomized trials. Classic examples: menopausal hormone therapy, early peanut avoidance, and stents for stable angina (LEAP trial
  , COURAGE
  
  
• Open-minded skepticism: Ask, “What’s the human outcomes evidence?” Cool mechanisms and moving testimonials aren’t proof.
• Hype outside the clinic: Mitochondria “rechargers,” microbiome panaceas, and biological age tests are intriguing—but not ready for prime time.
• Nutrition sanity:  For supplement evidence summaries, I like Examine
  .
• When AI helps (and when it doesn’t): Tools can orient you to established topics; they’re weaker on breaking studies. Look for linked primary sources.
• N-of-1 experiments: When evidence is uncertain and the outcome is measurable (sleep, blood pressure, pain), test on yourself—track a baseline, try the change, measure again, and, if possible, stop-start to confirm. Use symptom diaries, validated scales, or wearables.
• Humility is a signal: Trust sources that sometimes conclude “we don’t know.” I often check Cochrane Reviews
  for balanced syntheses.

About my guest
Adam Cifu, MD is a professor of medicine at the University of Chicago, author of 140+ peer-reviewed papers, and co-author of Ending Medical Reversal. He writes at Sensible Medicine.

Call to action
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.

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I unpack what “ultra-processed” really means, why these foods are so easy to overeat, what the best evidence shows (including metabolic-ward studies), and how I personally navigate them without fear or perfectionism. 

Key topics & evidence (in plain English):

• What counts as “ultra-processed”? I walk through the NOVA system—useful, not perfect—and where borderline items (frozen meals, boxed mixes) fit. See an overview of NOVA classifications here
  . 
• How we got here: post-WWII abundance of refined flour, cheap sugars, oils, and a cultural push for convenience—now ~60% of the U.S. diet comes from UPFs (study
  ). 
• Additives: stabilizers, emulsifiers, preservatives, and colors are generally recognized as safe (GRAS). I explain why, on their own, they’re probably not the main health issue. 
• The bigger problem: UPFs are energy-dense, engineered for bliss (fat/sugar/salt + perfect texture), and easy to eat quickly—driving higher calorie intake.
   • Metabolic-ward crossover trial: +~508 kcal/day when participants ate UPFs vs minimally processed (Cell 2019
  ).
  • Overweight adults in a crossover design: +~814 kcal/day on the UPF week (PubMed
  ).
  • Another recent crossover RCT reports ~300 kcal/day higher on UPFs (Nature Medicine 2025
  ). 

What I recommend (and what I do):

• Prioritize whole foods most of the time; shop the perimeter; cook when you can. Canned tomatoes/beans and frozen fruits/peas are fine helpers. 
• If weight, diabetes, or blood pressure are concerns, be extra cautious with UPFs—they’re designed to be irresistible and calorie-dense. 
• Moderation wins: I enjoy favorites (yes, even boxed mac ’n’ cheese and crunchy peanut butter) without letting them dominate my plate. 

Takeaways you can use today:

1. Build meals around minimally processed proteins, veggies, fruits, and beans; let convenience items support—not star—in your diet. 
2. Watch “calorie-dense + easy to overeat” combos (chips, sweets, fast food). If you have them, portion once, then put the package away. 
3. If symptoms or inflammation are puzzling you, try a short UPF-light experiment (2–4 weeks) and see how you feel. 

If this episode helped, please follow and leave a quick review—and share it with a friend who’s curious about UPFs. For my newsletter and resources, visit drbobbylivelongandwell.com.