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

As 2025 comes to an end, it’s the perfect moment to reflect on what truly advanced longevity medicine this year — not in mice, not in theory, but in real humans. Here are the developments that meaningfully shape how we age going into 2026 and beyond. 1. Hormone Therapy for Women Was Finally Set Free On November 10, 2025, the FDA and HHS removed the long-standing boxed warning from many menopause-related hormone therapy products. For more than 20 years, this warning frightened

A recently released study has raised eyebrows in the medical community: long-term use of melatonin (3 - 10 mg in this study) was associated with a significantly increased risk of heart failure, hospitalizations, and even all-cause mortality in adults with chronic insomnia. While the study was observational (meaning it found an association, not causation), it’s still an important reminder of something I’ve seen repeatedly in my practice: melatonin is a hormone, not a vitamin,

For millions of women, hormone replacement therapy (HRT) was once a key part of vitality. But for more than two decades, fear has overshadowed its benefits, until now. November 10, 2025, marks a historic milestone in women’s health: the day the FDA officially removed the black box warning on hormone replacement therapy. This decision, now being referred to as “Menopause Liberation Day,”  signals a new era of science-based empowerment for women navigating midlife and beyond. A

Many of my patients know that I’m always looking for practical, evidence-based ways to reduce disease risk and extend healthy lifespan. One of the simplest tools for protecting your skin may already be sitting on the pharmacy shelf: vitamin B3 , also known as nicotinamide (or niacinamide ). A new study from Vanderbilt University Medical Center and the U.S. Veterans Affairs system looked at more than 33,000 veterans and found that those taking nicotinamide had a significantly

When BBC News recently reported on a blood test that can detect more than 50 types of cancer, it made global headlines. The Galleri test identifies subtle methylation patterns in circulating DNA fragments, the biological “whispers” that reveal the presence and origin of cancer long before imaging or symptoms appear. To many, this represents the future of medicine. To my patients, it’s already standard practice. For over two years, I’ve integrated Galleri into a deeper philoso

When most people think about hormones and aging, testosterone, estrogen, and maybe DHEA come to mind. But there’s another hormone that quietly sits at the top of the cascade, influencing nearly everything else: pregnenolone. Sometimes called the “mother hormone,” pregnenolone is the building block from which many other hormones are made — including progesterone, DHEA, estrogen, testosterone, and cortisol. Like most hormones, pregnenolone levels are high in youth and decline s

I’ve always focused on prevention, vitality, and optimizing health at every age. Today, I’m excited to announce that I’m now offering Hormone Replacement Therapy (HRT) — for both women and men — as part of my commitment to supporting your health span, not just your lifespan. Why Hormones Matter Hormones are powerful messengers that regulate nearly every system in the body — from energy levels and mood to metabolism, muscle strength, brain function, and sexual health. As we ag

This morning, I had a realization that stopped me in my tracks. In Romanian, the common way to ask someone’s age is “Câți ani ai făcut?” —which literally translates to: “How many years have you created?” Not “How old are you? ”Not “How many years have passed?” But how many years you’ve created. It’s a subtle shift in language—but a profound one. This phrase doesn’t imply deterioration or decline. Instead, it implies authorship . It suggests that your age isn’t something that