I keep an eye on a number most people have never heard of: how much COVID virus is showing up in Wake County’s sewage. It is the most honest early-warning signal we have. If the virus is moving through the community, it shows up in the wastewater first, usually a week or two before I see it in the office. That number is going up. In early July, the largest treatment plant serving Raleigh was reading close to zero. By the end of August it had climbed roughly forty-fold, and ev

Every week a woman in my office asks me some version of the same question. Her mother has dementia. She is fifty-two, she is miserable, and she wants to know whether hormone therapy will protect her brain or ruin it. For twenty years the answer has been that dementia is a risk of hormone therapy. This month we got the most interesting piece of evidence in a long time. What They Found A Stanford group published an autopsy study in Neurology on August 12. They pulled 258 women

A new patient in her early fifties came to see me a few months ago, already six months into estrogen and progesterone and frustrated. The hot flashes were gone. The sleep was better. But she described herself as flat. She was lifting three days a week and getting nothing back for it. Her drive was gone, at work and at home. She told me she felt like a competent, tired stranger doing an impression of herself. She had a thick chart. Thyroid, iron, B12, vitamin D, a full metabol

A man in his late thirties sat in my office last month, complaining of being tired all day, flat in his mood, thicker around the middle than he used to be, and losing interest in things he used to want. He assumed it was work, or age, or that he simply needed to try harder. His total testosterone came back at 310. Technically normal. Fifty years ago, that number in a man his age would have raised eyebrows across the room. I have been having a version of that conversation more

If you spend any time on social media, you have probably seen the breathless posts about a parasite outbreak in North Carolina. Take a breath. Let me offer you the thing the internet almost never does: perspective, and a calm plan. Yes, we are having a busier-than-usual season of cyclosporiasis, a stomach bug you can catch from certain fresh produce. The state has confirmed more than 700 cases so far in 2026, with a little over half of them here in Wake County. That sounds li

A 30-year study just published in the British Journal of Sports Medicine tracked 147,000 adults for three decades and measured one thing: who lived, and who did not. The answer might surprise you. In the largest and longest study of its kind, people who combined regular cardio with resistance training cut their risk of death by up to 58 percent compared to people who did neither. What the Data Says The study found that 90 to 120 minutes of strength training per week was assoc

Travel season is here, and for many of us, it brings the inevitable compromise: the trade-off between the excitement of a new destination and the high-risk environment of modern transit. In my practice, we don't just "hope" for health; we anticipate challenges and optimize our defenses. Travel is, by definition, a long-duration, high-exposure event. You are in a pressurized cabin or a crowded terminal, and despite rigorous hand hygiene or masking, you are inhaling the same re

My recent series on plastics worried a lot of you. I know, because you told me. The question: okay — so what do I actually do? Here's my answer: You don't need to overhaul your entire life this week. You need to start with one thing. And if you start with one thing, start with your water. Why water first You drink it every day. Your kids drink it every day. It is the single largest, most repeated exposure you have real control over — far more than the occasional plastic-wrapp

If you have not read Parts 1 , 2 , and 3 , I encourage you to do so before continuing. What follows will mean more if you understand what came before it. Part 1 was about what plastic is doing inside your body. Part 2 was about what you can do about it. Part 3 was the hardest thing I have ever written — a reckoning with what plastic is doing to our species, our fertility, and the generations that will follow us into a world we have permanently altered. I ended Part 3 with two

Why I Wrote Part 3 My job is to help you live better. Longevity medicine is about understanding the forces that degrade human vitality and doing everything in our power to slow them down. I want to tell you what started this research. Over the past year I began noticing a pattern in my practice that I could not ignore: young healthy men in their early twenties coming in with low testosterone. By the time I saw the sixth one, I knew something was wrong that went beyond the usu

Right on schedule, a new COVID variant has arrived. And right on schedule, the headlines are coming. "New COVID Variant Detected in 25 States." "75 Mutations May Evade Immunity." ... The Facts BA.3.2 is a new Omicron subvariant first identified in South Africa in November 2024. As of this month, it has been detected in 23 countries and found in wastewater samples from 25 U.S. states. Those two sentences are going to generate a month's worth of alarming chyrons. Wastewater sur

Last week I told you something that I cannot stop thinking about. I told you that the plastic water bottle you discarded today will still exist in 500 years. I told you that a single liter of bottled water contains 240,000 nanoplastic fragments, and that if you drink a liter a day, you are ingesting 87.6 million of them per year from that single source alone. I told you that the so-called blood-brain barrier — one of the body's most trusted defenses — cannot stop these partic

You eat well. You exercise. You take your supplements. You do everything right. And yet, right now, invisible particles of plastic are circulating in your bloodstream, lodging in your arteries, and quietly disrupting the hormones that govern your metabolism, your brain, and your heart. Yes, it is happening inside your body right now as you are reading this. Microplastics have now been detected in human blood, lungs, liver, kidneys, cancer, placenta, breast milk, and even brai

Every spring, I start hearing the same things: "My eyes are itchy and I can't stop sneezing." "I wake up feeling like I didn't sleep at all." "I feel exhausted and I can't think straight." If that sounds familiar, you are not imagining it. Allergy season is here, it is already running ahead of schedule, and here in the Triangle, we are dealing with one of the most aggressive pollen environments in the country. Why Allergies Are So Bad in the Triangle The Pollen Trifecta Most

Over the past few weeks, many of you have asked me about measles. Some of you are vaccinated. Some of you are not. Many of you are simply unsure what to think. When several of you bring up the same concern, I pay attention. So I reviewed the CDC surveillance data myself. What the Data Shows Confirmed measles cases in the United States have increased compared to recent years. Early 2026 case counts are already significantly higher than typical early-year baselines from prior o

When people think about longevity, they usually think about cholesterol, blood pressure, blood sugar, supplements, or the latest medication trending on social media. Very few people think about muscle. But muscle is one of the strongest predictors of how long we live and, just as importantly, how well we live. Muscle Is Not Just for Movement Skeletal muscle is often viewed as a mechanical tissue that helps us walk, lift, and move. Muscle functions more like a metabolic and en

What a New Metformin Study Reveals About Aging Joints Osteoarthritis is often described as a simple consequence of aging, with joints wearing out, cartilage breaking down, and inevitable pain. But if osteoarthritis were purely a mechanical problem, we would expect it to progress at roughly the same pace in everyone. In reality, we see enormous variability. Some patients remain active and relatively pain free well into older age, while others develop significant joint pain and

Why many women are being told to stop hormones, and what modern evidence actually shows For many women, hormone therapy has felt confusing, or even frightening ever since large studies from more than 20 years ago raised concerns about its safety. Recently, several of my own patients told me they were advised during routine gynecologic visits to stop hormone therapy immediately due to fears of stroke, heart attack, blood clots, or cancer. That understandably created anxiety. T

Every January, people pause and reflect on where they are and where they want to go. Some call these resolutions. Others see them as a continuation of work they have already been doing for years. Either way, the new year creates a natural opportunity to recommit. Longevity is not built on motivation. It's built on repeatable systems that respect human physiology over decades, not weeks. Longevity Is Boring for a Reason When people hear that longevity work is "boring," they of

As we head into Christmas week, many of you are traveling, hosting family, or attending large gatherings. I want to briefly address the new circulating flu strain—commonly referred to in the media as the “K variant,” and medically classified as Influenza A (H3N2)—that we are seeing this season, and more importantly, what it means practically for you and your family over the next 10 days. What’s different about this flu season? The term “K variant” refers to a subclade within