GLP-1s, Bryan Johnson's routine, and whether NAD is worth your money

The first episode. The four of us introduce ourselves and get into the three questions patients ask most right now.

What we covered

GLP-1s (semaglutide, tirzepatide, retatrutide). These drugs aren't new; Byetta and Bydureon were out 20 years ago with side effects patients couldn't tolerate. The change came when the once-weekly versions arrived and the drugs started being given to people who weren't diabetic. Between us we have several years of patient data: consistent fat loss, improving liver numbers, and lean mass holding up when patients lift and hit their protein. We don't all use them the same way. One approach is to add them after a year of lifestyle work hasn't moved the needle, with the behavior change pushed alongside. Another was to hold out for years, then watch the results in insulin-resistant patients who were already exercising and eating well. The cautious view at the table: blunted mood in some patients, slowed gut motility, and no good answer yet to how long people stay on them, so use a low dose as an assist and plan the exit.

Insulin, not weight, is the target. Why a fasting insulin that's still high 12 hours after eating makes fat loss close to impossible, and why the GLP-1s are an insulin treatment first. We disagreed on what happens to fasting insulin on the drugs: some of us see it fall as visceral fat falls; others see it run a little higher for the first year or two, probably from slowed stomach emptying. The open question: what does that mean for an insulin-sensitive person who takes it for a quick ten pounds?

Hemoglobin A1c is a calculation, not a measurement. It assumes red cells live 90 days. Real red cells live 66 to 120. Trends and a continuous glucose monitor tell you more than one number.

Gray-market retatrutide. Patients are buying it from research chemical suppliers. All four of us say don't: you don't know what's in the vial, the sterility, or the other chemicals. If you can't get most of the way there on semaglutide or tirzepatide from a real pharmacy, the problem isn't which drug you're on.

Bryan Johnson, Huberman, Attia, and the protocol problem. We read out Bryan Johnson's daily schedule. Our point: most of the loudest voices online don't manage patients, mouse studies don't translate, and an N of 1 with a billion dollars isn't a plan for a busy parent. Three tiers for any patient: fix what's broken, optimize what isn't, then extra credit like red light and hyperbaric oxygen if you want it. And the study that said diabetics lose three years: read it the other way too.

Extreme diets. Keto, carnivore, and the honeymoon phase every restrictive diet has. What happened to Robb Wolf after six months of it. One rule we all liked: eat food you cooked at home.

NAD. Split table. One of us stopped recommending it over the cancer question and prefers glutathione. One likes the concept, doesn't trust injected NAD to get where it needs to go, and also prefers glutathione. One was early on IV NAD and still thinks an occasional IV "top-off" makes more sense than daily pills, but hasn't needed one in a couple of years. Nobody has a lab test to tell who's deficient. What the infusion feels like, and the niacin-style flush from the injections.

Glutathione. Oral only works as S-acetyl glutathione; otherwise it's a shot, an IV, or sublingual. Three of the four of us take it.

The one thing. Our answers: there isn't one, it's the fundamentals; walk; nutrition first, then exercise; and read Atomic Habits so you learn how to build the habit, whatever the habit is.

Timestamps

• 00:00 Who we are
• 05:22 GLP-1s: four doctors, four takes
• 17:18 Why insulin is the real target
• 23:00 A1c is a calculation; use trends and a CGM
• 24:58 Gray-market retatrutide
• 27:50 Bryan Johnson's schedule and the influencer problem
• 33:03 Three tiers: broken, optimize, extra credit
• 36:48 Keto, carnivore, and the honeymoon phase
• 39:36 NAD: who takes it, who stopped
• 52:03 Glutathione and the pill burden
• 55:43 The one thing each of us would tell you

Mentioned

• Atomic Habits by James Clear
• The Miracle Morning by Hal Elrod
• Bryan Johnson's Blueprint protocol
• Robb Wolf and the paleo diet

A note on the disagreements

We didn't agree on fasting insulin on GLP-1s or on NAD, and we left it that way. That's the point of four doctors in a room.