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In this episode from July 2022, Peter dives deep into the topic of bone health and explains why this is an important topic for everyone, from children to the elderly. He begins with an overview of bone mineral density, how it’s measured, how it changes over the course of life, and the variability between sexes largely due to changes in estrogen levels. From there he provides insights into ways that one can improve bone health, from exercise to nutrition supplements to drugs. Additionally, Peter discusses what happens when one may be forced to be sedentary (e.g., bedrest) and how you can work to minimize the damage during these periods.

While this original episode is an AMA, it is available in full to all listeners as a special rebroadcast.

We discuss:

• Overview of bone health topics to be discussed [2:30];
• Bones 101: bone function, structure, and more [6:15];
• Bone mineral density (BMD), minerals in bone, role of osteoblasts and osteoclasts, and more [9:30];
• The consequences of poor bone health [14:30];
• The devastating nature of hip fractures: morbidity and mortality data [18:00];
• Where fractures tend to occur in the body [23:45];
• Defining osteopenia and osteoporosis [25:30];
• Measuring BMD with DEXA and how to interpret scores [28:00];
• Variability in BMD between sexes [35:15];
• When should people have their first bone mineral density scan? [37:45];
• How BMD changes throughout the life and how it differs between men and women [40:15];
• How changes in estrogen levels (e.g., menopause) impact bone health [45:15];
• Why HRT is not considered a standard of care for postmenopausal bone loss [49:00];
• Factors determining who may be at higher risk of poor bone health [52:00];
• Common drugs that can negatively impact BMD [55:45];
• How children can optimize bone health and lay the foundation for the future [59:30];
• Types of physical activity that can positively impact bone health [1:03:30];
• How weight loss can negatively impact bone health and how exercise can counteract those effects [1:12:15];
• Nutrition and supplements for bone health [1:16:00];
• Pharmaceutical drugs prescribed for those with low BMD [1:18:45];
• Impact of extreme sedentary periods (e.g., bedrest) and how to minimize their damage to bone [1:23:30]; and
• More.

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Tanuj Nakra and Suzan Obagi, two leading experts in aesthetic medicine, join Peter to explore the science of facial aging and skin health as well as the responsibilities physicians face in the world of cosmetic procedures. In this episode, they examine the biological and hormonal drivers of facial aging, the evolutionary and psychological foundations of attractiveness, and the impact of modern media on beauty standards. They discuss the rise in cosmetic procedures among adolescents and the ethical responsibilities of physicians in these cases. The conversation then shifts to a practical, evidence-based guide to skin health—covering the use of mineral sunscreens, retinoids, vitamin C, and tailored skincare routines, as well as the management of acne and the psychology behind aesthetic consultations. The episode culminates in a candid, personal assessment of Peter’s own face, offering a revealing look at what aesthetic medicine can achieve and how to think critically about pursuing it.

We discuss:

• Tanuj’s and Suzan’s training and expertise, and the evolving field of aesthetic medicine [4:00];
• The biology of the aging face [10:45];
• Why facial fat atrophies with age while body fat tends to accumulate [17:00];
• How chronic stress accelerates facial aging [20:30];
• The evolutionary biology of beauty, and how modern lifestyle, culture, and medicine interact with these ancient aesthetic instincts [25:30];
• How social media and influencers have rapidly shifted aesthetic trends toward exaggerated features and unrealistic beauty standards [36:45];
• The ethical challenges, financial incentives, and social pressures shaping modern aesthetic medicine [42:00];
• The concerning trend of teenagers seeking cosmetic enhancements: the ethical and cultural impact of early beauty pressure [51:45];
• Protecting the skin: UV damage and sunscreen recommendations [58:15];
• Strategies for minimizing skin aging: retinoids, vitamin C, and evidence-based application methods [1:09:00];
• Effective daily skincare routine: cleansing, antioxidants, retinoids, moisturization, and more [1:18:45];
• The playbook for managing acne [1:31:00];
• The 4 changes of aging and the complexities of aesthetic consultations including the anatomical, psychological, and ethical factors physicians must navigate [1:39:00];
• The 5 R’s of rejuvenation [1:50:15];
• A facial aging analysis and cosmetic strategy using Peter’s face as a real-time case study [1:53:00];
• The decision-making process between fat grafting and dermal fillers for facial rejuvenation [1:56:30];
• How self-image, eye aesthetics, and fleeting photos drive the desire for cosmetic enhancement [2:01:45];
• Advice for wrinkles, causes of dark circles under the eyes, and the importance of facial symmetry [2:05:45];
• Considerations that shape clinical decision making around fat grafting and other procedures to address the eye area [2:11:00];
• The evolution of facial cosmetic surgery techniques, the serious risks involved, and how physician skill and procedure selection greatly impact outcomes [2:21:30];
• How patients can make informed and safe choices when selecting a cosmetic surgeon [2:27:15];
• A comparison of ablative versus non-ablative skin resurfacing treatments, laser vs. peels, and more [2:38:45];
• How treatments are chosen and customized based on patient-specific factors [2:48:00];
• The lifelong human desire to align physical appearance with self-identity [2:52:45]; and
• More.

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BJ Miller, a hospice and palliative care physician, and Bridget Sumser, a licensed social worker specializing in serious illness and end-of-life care, join Peter to share insights from their decades of work supporting people at the end of life. In this episode, they explore the emotional and physiological processes of dying, the cultural barriers that prevent meaningful conversations about death, and how early engagement with mortality can lead to greater clarity and connection. The conversation highlights the distinctions between hospice and palliative care, the nature of suffering beyond physical pain, and the transformative role of honesty, forgiveness, and relational awareness in the dying process. Through stories and reflections, BJ and Bridget reveal what truly matters in the end—and how the dying can teach the living not only how to face death but how to live more fully.

We discuss:

• The personal journeys of BJ and Bridget into end-of-life care, and the connection between living and dying [3:30];
• What dying looks like: the physical, cognitive, and emotional realities at the end of life [13:15];
• How historical perspectives on death contrast with modern experiences of dying [25:30];
• The difference between palliative care and hospice care [30:45];
• The systemic challenges surrounding hospice care: why patients often enter it too late to receive its full benefits [35:30];
• How delayed hospice referrals and unspoken preferences often prevent patients from dying where and how they truly want [39:30];
• The realities of home hospice: challenges, costs, and burdens placed of families [43:45];
• How proactively engaging with the reality of death can avoid unnecessary suffering and promote a more peaceful ending [53:30];
• How palliative care is misunderstood and underutilized—especially in cancer care [1:02:45];
• Palliative care in the case of Alzheimer’s disease: emotional support, future planning, and family involvement [1:12:15];
• The importance of having an advance directive: defining what matters most before it’s too late [1:23:00];
• The differences between how young and old individuals experience dying from cancer [1:30:15];
• The difference between pain and suffering, role of medicine in pain relief, and why emotional healing is essential at the end of life [1:35:45];
• Dying well: the power of self-honesty and human connection at the end of life [1:47:00];
• How psychedelics like psilocybin can unlock emotional breakthroughs and deepen connection for patients near the end of life [1:55:15];
• Lessons from the dying on how to live well [1:57:30];
• The physical process of active dying, and the emotional and practical considerations for loved ones [2:09:30]; and
• More.

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