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In this "Ask Me Anything" (AMA) episode, Peter takes a deep dive into the liver and its central role in metabolic health. He explains why the liver can serve as a "canary in the coal mine" for metabolic dysfunction and explores how insulin resistance, visceral fat, alcohol consumption, genetics, and hormones contribute to liver disease, along with how increasing muscle mass can benefit liver health. Peter provides a framework for understanding the progression of liver disease, highlighting which stages are reversible and why early detection matters. He explains why normal liver enzymes can provide false reassurance, which labs he uses to assess liver health, and the tools available for detecting fibrosis and more advanced disease. Peter then breaks down the interventions that can meaningfully improve liver health once risk or disease is identified, ranging from diet and exercise to GLP-1–based therapies and other medications. Finally, he examines popular claims around liver "detoxification" and supplements, separating what is supported by evidence from what is unlikely to meaningfully improve liver health.

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We discuss:

• Why the liver is the "canary in the coal mine" for metabolic dysfunction, and an overview of what the liver does [2:00];
• The relationship between the liver and blood sugar control [6:30];
• A framework for understanding how metabolic disease affects the liver [9:15];
• Chronic caloric surplus and insulin resistance as drivers of liver disease [11:00];
• Liver diseases that result from metabolic dysfunction and the difference between steatosis and fibrosis [15:15];
• How visceral fat affects liver health [20:00];
• The importance of lifestyle interventions for liver and metabolic health: resistance training, not drinking calories, and the impact of fructose [22:00];
• Why alcohol-associated liver disease is more common than we give it credit for [26:30];
• Genetic and hormonal risks for liver disease [31:45];
• Labs that objectively measure liver health and the FIB-4 score [35:30];
• FibroScan: non-invasive imaging of the liver [44:30];
• The resiliency of the liver: an organ that can heal itself [47:00];
• Fibrosis staging and its impact on mortality and cancer risk [49:15];
• Interventions for someone with MASLD: weight loss and GLP-1s [52:00];
• Other medications used to treat metabolic liver disease [57:00];
• The role of exercise in treating metabolic liver disease: caloric deficit and building muscle [59:45];
• The myth of liver detoxes and cleanses, and a few supplements that may benefit the liver [1:01:15];
• A practical summary: how to assess your risk and the levers that reverse the disease [1:08:00]; and
• More.

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In this episode, Peter sits down with Dr. Linus Abrams, a psychiatrist with nearly 35 years of clinical experience specializing in mood disorders and psychopharmacology, to explore how our understanding of mental health is evolving beyond the traditional neurotransmitter model. After decades in practice, Linus began questioning many of the assumptions underlying modern psychiatry, leading him to investigate how hormones, metabolism, inflammation, circadian biology, and the endocrine system shape mood and cognition. Together, Peter and Linus examine why psychiatric care should aim not only to reduce symptoms but also to restore the full human experience. They discuss how psychiatric medications work, where they fall short, and why distinguishing bipolar disorder from unipolar depression is essential for effective treatment. The conversation also explores the growing mental health burden of social isolationn associated with digital devices and social media, along with the biological factors—nutrition, exercise, sleep, and chronic stress—that influence resilience and distress tolerance. Linus explains the powerful roles of estrogen, progesterone, testosterone, and thyroid hormone in regulating mood and cognition across the lifespan. Finally, Peter and Linus review the promise and limitations of ketamine and psychedelic therapies, and why the future of psychiatry may lie in integrating neuroscience, endocrinology, and whole-body physiology to better understand, diagnose, and treat mental illness.

We discuss:

• Linus's passion for understanding his patients and going beyond traditional psychiatry [2:45];
• A short primer on the different classes of drugs used in psychiatry [12:45];
• Evaluation of a patient with bipolar disorder [26:00];
• An evolutionary perspective on depression [33:30];
• Changes in the modern world triggering mental health problems [41:00];
• An evolutionary perspective on insomnia [48:15];
• Peter's window analogy to understand distress tolerance and irritability [49:45];
• The impact of foundational biological factors on psychiatry: nutrition, exercise, sleep, and endocrinology [52:30];
• The effect of estradiol on neurotransmitters in the brain [58:15];
• Options for increasing testosterone in men, and why clomiphene is inferior to exogenous testosterone [1:11:00];
• The rapid drop in progesterone is linked to both premenstrual dysphoric disorder (PMDD) and postpartum depression [1:14:30];
• Treatment of postpartum depression [1:18:00];
• Hypothyroidism presenting as depression: how Linus makes the diagnosis and what he uses for treatment [1:26:00];
• The link between hyperarousal and chronically elevated cortisol [1:39:30];
• A case where the menopause transition uncovers bipolar disorder [1:44:15];
• Ketamine as a tool to treat recalcitrant depression, and concerns about its recreational use [1:49:15];
• Case study: an Alzheimer's patient who improved after psilocybin, and why Linus is cautious about drawing conclusions from it [1:55:15];
• Peter's experience with psychedelics, and the myth that estrogen is bad for men [2:00:30];
• The therapeutic potential of psychedelics in psychiatry [2:11:00]; and
• More.

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In this episode, Peter returns to the topic of peptides, offering a clear and accessible guide to a field surrounded by both genuine scientific promise and widespread misinformation. Peptides are increasingly marketed for everything from injury recovery and muscle growth to longevity and improved appearance, often with claims that extend far beyond the available evidence. Rather than promoting or dismissing peptides as a category, Peter presents a practical framework for evaluating any peptide: what it is, how it is supposed to work, and where the science is strong, weak, or simply absent. He then applies this framework to a specific example before examining the risks of gray-market products, concerns about sourcing and quality, and where the field may be headed—ultimately helping listeners distinguish legitimate therapies from hope that has been packaged and sold without sufficient evidence.

We discuss:

• What peptides are and why they must be evaluated individually [3:15];
• A five-question framework for evaluating peptides and other drugs [5:30];
• A three-tier system for classifying the scientific evidence behind peptides [10:00];
• Evaluating BPC-157: unclear mechanisms, absent human evidence, and unknown risks [14:00];
• Why BPC-157's expanding claims do not indicate a broad mechanism [20:45];
• CJC-1295: biological activity versus meaningful clinical benefit [23:30];
• Why testimonials about peptide benefits cannot establish the effectiveness of peptides [27:30];
• The placebo effect, and the importance of controlled trials for evaluating peptides [31:00];
• What FDA approval provides when evaluating peptide safety and effectiveness [34:45];
• Why prescriptions from doctors, compounding pharmacies, and third-party testing do not validate unapproved peptides [38:30];
• Approved peptides sold on the gray market: why evidence for an approved peptide does not automatically extend to gray-market versions [40:45];
• Addressing the claim that pharmaceutical companies ignore effective natural peptides because they cannot be patented [43:00];
• The promise of peptide science, and the risks of the gray-market wellness industry [46:30];
• Why peptide claims must be falsifiable and why evidence should precede widespread use rather than be expected to catch up later [49:00]; and
• More.

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