Scientist Fact-Checks CONTROVERSIAL Medical Takes: Dr. Mike React (Kaeberlein vs. Topol)

#1

Counter’s to Eric Topol’s commentary:

Dr. Matt Kaeberlein reacts to controversial takes on supplements, MRIs, protein, and rapamycin from Dr. Eric Topol.

This video breaks down the evidence behind popular health trends, helping you separate science from hype.
0:00 - Setting the Stage: Expert Reaction
1:03 - Experts Selling Supplements: Credibility Lost?
2:30 - MRIs & CGMs: Lifesaving or Misleading?
7:16 - Protein “Overdose”: What’s the Real Risk?
11:11 - Rapamycin: Decoding the Data & Hype
21:00 - The Hard Truth About Supplements (Matt’s Take)
39:36 - Biological Age: Can We Really Measure It?
46:37 - CGMs: Powerful Tool or Just Trendy?

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#2

:yawning_face:

twenty characters

#3

AI Summary of the Podcast Discussion
Overview

The episode centers on a critical review of claims made by Dr. Eric Topol regarding longevity, supplements, diagnostics, and the work of Dr. Peter Attia. Dr. Mike and his guest react to Topol’s statements, highlighting both agreement and disagreement, and emphasizing the importance of nuance in medical debates.

Main Points of Discussion

Supplements and Credibility:
Topol asserts that anyone selling supplements while calling themselves a longevity expert loses credibility, since no supplement has been proven to reverse or slow aging. The hosts agree with this skepticism and stress that Attia does not directly sell supplements, though he has advisory roles with companies like AG1. They argue that Topol’s criticism may be misdirected, as more egregious examples exist in the field.

Diagnostics vs. Supplements:
Topol lumps diagnostics like full-body MRI and continuous glucose monitoring with supplements, calling their promotion problematic due to lack of evidence. The hosts counter that diagnostics do have proven utility (e.g., detecting disease), and it’s misleading to equate them with unproven supplements. They advocate for nuanced, individualized use rather than blanket acceptance or rejection.

Protein Intake:
Topol criticizes Attia’s recommendation of high protein intake, calling it an “overdose.” The hosts push back, noting there is no clear evidence that 1g protein per pound of body weight is harmful, and that optimal intake varies by individual context (diet quality, kidney function, etc.). They highlight the lack of definitive data and the need for scientific humility.

Rapamycin and Off-Label Use:
Topol warns about the safety and efficacy of off-label rapamycin use for longevity, claiming there’s no data supporting its benefits in humans. The hosts clarify that while there’s no conclusive evidence for lifespan extension, there is substantial safety data, and Attia only prescribes it to select patients. They criticize Topol for overstating the risks and for conflating cautious experimentation with irresponsible practice.

Medicine 2.0 vs. Medicine 3.0:
The discussion frames Topol as representing a more traditional, “reactive” medical mindset (Medicine 2.0), while Attia and others advocate a more proactive, personalized approach (Medicine 3.0). The hosts argue that waiting for perfect evidence can hinder innovation and patient care, especially when randomized trials are unlikely to be funded or completed soon.

Genetic and Preventive Testing:
The group discusses the value of genetic risk information (e.g., APOE4 for Alzheimer’s) and advanced diagnostics. They agree that such information can be empowering and actionable for some patients, but stress the need for careful communication to avoid unnecessary anxiety or over-testing.

Industry Problems:
The hosts and Topol agree that the supplement industry is rife with misleading marketing and lack of regulation, and that most people would benefit from a “supplement detox” unless medically indicated. They emphasize that most supplements lack robust evidence for broad health or longevity benefits.

Key Takeaways

There is broad agreement on the lack of evidence for most supplements and the need for skepticism in the longevity space.

Disagreements mainly concern the pace of innovation and the interpretation of incomplete evidence.

Nuance, context, and individualized care are essential; blanket statements and clickbait critiques do a disservice to patients and science.

The debate reflects a larger tension between traditional, evidence-based caution and a willingness to responsibly experiment when definitive data is lacking.

Quote Highlight

“Sometimes the areas of disagreement get blown out of proportion compared to the areas of agreement…tons of respect for both of these guys…where I criticize either of them it’s not coming from any place other than a difference of opinion or in some cases, you know, we all make mistakes when we get outside of our direct area of expertise.”

Bottom Line:
The episode is a nuanced critique of oversimplified skepticism in longevity medicine, calling for humility, precision, and balanced communication between innovation and evidence.

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#4

Gave it a quick skim watch, and I’ll use the AI summary as the bouncing off point for my opinions.

I was kind of prepare to poo-poo Topol’s opinion, but I end up agreeing with a decent chunk. It’s good to have somebody more conservative/realistic IMO.

I agree with this almost 100%. Once you have that conflict of interest, it just makes it really hard to trust the advice you give. IMO it was a negative point against Bryan Johnson once he started shilling his own stuff. And I believe that Attia actually does sell protein bars, doesn’t he? So he’s not just an advisor to whatever companies, but he’s actively selling his own stuff now.

I guess that’s a bit of troll-bait, but I do understand Topol’s point here. I think a lot of people are somewhat tricked into thinking these things are necessary. Whole body MRI has never really been a great idea, but it’s a nice way for people to make money marketing it to health-conscious people.

However, a CGM costing like $50 for 2 weeks of data is really insightful IMO. Even just doing it once you actually learn a lot. My wife and I learned that we have VERY different responses to the same meal. I learned what happens to my glucose during my running or strength training exercise. I learned what my glucose does when I sleep. I even did a 72h fast. I believe it was worth it. But would I wear one all the time and obsess over every spike? No.

Disagree with Topol here. There’s no evidence that “high” protein is bad, especially if paired with exercise. IMO the source and quality of protein matters. A “high protein” diet can be bad in epidemiological studies because it correlates to KFC, hot dogs and processed foods. I find it very hard to believe that protein from meat, beans, soy etc is bad for you. And the bodybuilding literature consistently shows that you get better muscle growth and retention with doses up to 1g/lb or 1.6g/kg.

And if he doesn’t like extrapolating from animal to human studies, protein is another example of that, where low protein diets seem to benefit animals. However, the animals also don’t live in the real world where muscle loss, strength etc matter like they do to humans.

Doesn’t he take it himself?

I think most people with a working brain should agree with this one.

The other problem is that so many supplements simply don’t contain what they say they do, and there’s no guarantee of quality or efficacy. That “bergamot extract” might be from leaves from wherever, covered with fertiliser and pesticides, sat on a factory floor collecting cockroach poops, then processed with goodness knows what solvents, a bunch of bulking agents and fillers added, then sat around on various shelves for ages. Time and time again, those blind testing experiments reveal that many supplements are under-dosed, over-dosed, contaminants (sometimes deliberate, like “men health” supplements containing Tadalafil, SARMs or oral steroids). You have a market with massive competition, no regulation, and huge financial incentives because you market to health-conscious wealthy people. It’s rife for abuse.

I’ve dramatically cut my supplement intake, and prefer to use pharma interventions now. IMO there’s very little point messing around with red yeast rice, bergamot, berberine etc when statins, metformin etc exist and are cheap and good quality.

Edit: And FWIW, Dr Mike is a YouTuber non-expert and he’s playing towards his lay/uneducated audience. I wouldn’t really value his opinion on anything except for his actual specialty if I was his patient.

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#5

One of the main themes that emerges in the geoscience literature from mechanistic and animal studies is that raving up certain growth pathways is bad for longevity even perhaps good for short term health/fitness

Protein restriction / certain specified amino acid restrictions have many times been shown avoid raving those pro growth pathways up and help with longevity and related aging pathways

Search the forum for a lot of sources and discussion on those topics

#6

Yes, perhaps short term fitness - but how long do body builders live in a healthy state as they are and how long are their lives vs healthy, fit non bodybuilders?

#7

I don’t know what the right amount of protein is on average, I’d have to look at long-term cohort studies on aging, strength and muscle mass, fraility, ACM, CVD, kidneys, RCT’s, animal studies, etc…

A few questions:

(1) What is the maximal strength and muscle mass percentile that can be achieved and maintained on protein intakes at 0.8 g/kg or even lower intakes (protein restriction?) with strength training?
(2) Is it worse to do more strength training at a low protein diet than less strength training on higher protein diet if the maximal strength and muscle mass percentiles are higher at higher protein intakes and these lines would cross at some point?
(3) If it was the case that someone could have high percentile strength and muscle mass that is considered adequate for long term sarcopenia reserve at a lower protein intake with strength training, what is the curve of decline over time compared to someone with higher protein intake (and presumably higher maximal and maintained strength and muscle mass)?

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#8

Don’t worry, I’m well aware of the literature and discussions of the literature :stuck_out_tongue:

And yes, I do see the point. However, those are animal studies of BCAA, methionine, protein restriction, not human. So if Dr Topol wants to reject things like Rapamycin on that basis (i.e. only animals, only short term trials), it doesn’t make sense to be so ‘scared’ of protein. That’s especially the case when there’s a ton of (yes, shorter-term) data showing benefits of protein consumption.

I would reiterate that quality of life matters too. Human frailty is a very big deal. Everybody loses muscle with age. Nobody wants to be too weak to get out of a chair. Injury is also a big deal and sufficient muscle and strength is really important for injury prevention.

I am not sure whether we have those data. But natural ‘bodybuilders’ (i.e. lifting weights, not using cocktails of hormones and drugs to gain excessive size, nor going to extremes to diet for competitions) are pretty damn healthy IMO.

I think it all needs to be taken into context. If you’re exercising, you can most likely make better use of the protein than if you’re sedentary. But if a person is sedentary, they probably have bigger worries than the grams of methionine per day they consume IMO.

#9

Yeah, that’s from aging and sarcopenia, which I think @Neo is expecting a lower rate of decline in strength and muscle mass with lower rather than higher protein intakes?

We have the “sarcopenia reserve”, which is basically a buffer where if its high to begin with, even if your rate of decline is equal to the average person, you’ll end up at a higher point because your base value is higher. If you have 10% more muscle mass you’ll end up with 10% muscle mass in later life if the rate is the same. But isn’t it strength that matters ultimately and isn’t neural adaptations really important for this as well (take a look at really thin olympic weightlifters)?

So based on a meta analytic summation of like 30 non-significant studies on short term muscle mass growth from strength training we know to grow under that period the best protein amount is maybe 1.6 g/kg.

So you might grow your base value a lot, but how does that impact the rate? Is it the same, better, worse? If you can change the rate, maybe that’s better as it also impacts other systems?

I might be opening a can of worms here but it seems more complicated than just believing in 1.6 g/kg. Of course it’s different for the elderly or those with sarcopenia already, and other situations.

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#10

On the broader protein question I tend to agree it is the overall intake that matters. If it is biased towards protein then I don’t think there is much to complain about.

#11

All great questions, and would probably be a good study to try and sum all of those together.

Regarding protein and muscle gains, I think that’s quite comprehensively answered by Greg Nuckols, here: Protein Science Updated: Why It's Time to Move Beyond the “1.6-2.2g/kg” Rule • Stronger by Science

Short version is, the muscle gains (with training) seem to keep going beyond 1.6g/kg:

However, my best accounting of this body of research suggests that the most likely breakpoint (if one exists) is at around 2.0g/kg, with a plausible range for the breakpoint spanning from 1.7-2.35g/kg. So, if you distilled it down in the same way, you’d recommend that lifters should aim to consume between 2.0g/kg and 2.35g/kg of protein.

And also interesting is:

The RDA (Recommended Dietary Allowance) for protein of 0.8g/kg came from an analysis of nitrogen balance studies. These studies suggested that the average protein intake required for people in the general population to achieve nitrogen balance was 0.66 ± 0.085 grams of protein per kilogram of body mass. An RDA is supposed to cover the needs of 95% of individuals, so to calculate an RDA, you add two standard deviations to the average requirement. Thus, the RDA for protein was calculated to be 0.83g/kg, which the USDA rounded down to 0.8g/kg (the World Health Organization also adopted a similar approach).

However, IAAO studies in the general population generally find that the average protein intake requirement is around 0.92g/kg, and the protein intake required to cover the needs of 95% of individuals is around 1.2g/kg. So, nitrogen balance studies likely underestimated protein requirements in the general population by ~40-50%! There’s every reason to suspect that the aforementioned nitrogen balance studies in lifters also underestimated protein requirements to a similar degree.

So basically, the RDA is probably too low, and most people in the general population eat more than the RDA anyway. (Again, safe to assume the general quality of their high protein diet is not great.)

If that is the assumption, I can’t wrap my head around that. Being in negative nitrogen balance and shutting off those pro-growth pathways is the fastest way to lose muscle.

And yes, neural adaptations (and practice) are super important for strength. But muscle mass itself (at reasonable, naturally-achievable levels) also helps tremendously.

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#13

In addition to the protein bars, Attia is involved with Maui Nui venison sticks. All his podcast bro friends now advertise those as well.

He drones on and on about how he takes them to meet his goals…

Now, I’m not against Attia, but even if these products are high quality and help people, and even if he is correct in his protein advice, it diminishes his credibility on the topic, greatly. He’s no longer in a position to be objective.

Perhaps this is also what Topol is referring to as a ‘supplement”?

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#15

Ha! I didn’t know this was your thing, nor did I know about Neo’s or Rapadmin’s :).

Ok, I love that you brought this up… it reminds me of what I often forget…

When I was in Kenya, we would go on hikes up to the top of some hilltops… It was no surprise that I couldn’t keep up, but the ultra fit American men we were with were waaaaayyy behind the Kenyans.

The local guides were wearing their old ratty sandals with the unfastened straps dangling on the ground… they were going up these hills with such ease my jaw was on the ground… they made goats look bad.

They ate relatively little protein… and yes, they all looked just Iike the guys in your photo :).

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#16

No supplements, unbalanced nutrition (?), no hormone replacement, etc.
Makes me wonder what the hell are we doing.

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#17

Adaptation. People underestimate how specific are body adaptations. I’ve been jogging for years incorporating HIIT sprints. I can jog for hours if needed, with little effort. But when I started to hike uphill in the local canyons over the weekend, I was quite winded. After a few hiking sessions however, I could bound up the hills with little effort. I’ve been doing squats for years, with a weight vest 45lbs, ass to grass, 32 minutes at a stretch incorporating 5 minute jumping squat intervals. I was watching a yt video of a fitness influencer who was far more muscled than I am and considerably younger, and he was showing how to do bodyweight squats - he did half-squats (only to thighs parallel), and remarked how challenging it was to do 100 such squats. I could do bodyweight squats literally for hours nonstop, and used to regularly do 1000 at a time. Yet I have no doubt that he could lift three times more than I could.

When you train, you become “fit” within that specific range, and it doesn’t necessarily translate into other ranges. The body is extremely economical, and adapts only to what it absolutely has to. Cardiovascular fitness does have spillover adaptations to other modes of CV challenges (hence health benefits of CV fitness), but there’s also the neuromuscular entrainment of specific muscle pathways - if you lift, your neuromuscular adaptations will be along that line. And don’t forget the brain sets its own limits having little to do with actual muscle capacity or CV fitness. The brain will signal extreme “stop immediately” fatigue in an unfamiliar activity long before actual muscle exhaustion - a protective mechanism. Training involves the gradual easing of brain restraints on muscle capacity with an increasingly familiar activity - your muscle capacity was already there, now your brain is granting the permission to use more if it.

To sum up - I bet those fit Americans in the hills of Kenya had the fitness to keep up with the natives, but their brains were not letting them. Plus they lacked some very easy to come by adaptations they could grab within days.

The brain in particular is a funny thing. I do some isometric exercises. It’s amazing how that works - if my exercise involves 6 minutes, then the last 30 seconds I feel like I can just about manage before collapsing. But if it involves the exact same exercise for 10 minutes, I easily blow through the 6 and again it’s the last 30 seconds that are a bear. Same for most other time periods, it’s always the last 30 seconds. Btw. same with pushups and pullups - almost no matter how few or many you do in a session, it’s the last ones that are hard. Because the brain controls when you feel exhausted, not the muscles (within limits of course).

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#18

@desertshores Ha, indeed… and don’t forget, no gyms!!!

@CronosTempi that was all very interesting, especially in light of the fact that when I whine to my voodoo witch doctor (aka, my PT who trains me) that I caaaannnn’t do that, his answer, on repeat, is it’s my brain that is stopping me.

and WOW on all you can do!

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#19

Beautifully said, and I totally agree. You see a lot of strong people (let’s say 140kg+ squat) who can’t do seemingly basic things (single leg pistol squat), but then you see people doing amazing stuff (huge box jumps) who are comparatively weak (< 100kg squat).

I think what you say about neural control is also what defines a great athlete. I’m always impressed by the strongmen like Eddie Hall and Brian Shaw. Obviously they’re huge and strong, but the skill of learning something, controlling their body, making quick adaptations etc is really impressive. There’s a bunch of Youtube videos of them trying sports for the first time, and it’s shocking how quickly they can adapt, presumably from very superior neural control.

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#20

I know that is not your quote, but from the video.

Is reversing and slowing aging the only benefit that matters?..

Since there are no “drugs” that reverse or slow aging, (except maybe Rapa) should we stop using pharmaceuticals as well?

Both drugs and supplements can address specific conditions, some related to age, many related to individual conditions, hereditary, environmental, life style, etc.

The whole fixation on “proven to reverse or slow aging” seems to introduce a significant amount of bias into discussions. Since we have no way to extend human life span, increasing health span, today, is more important and has a bigger payback today than the search for the Fountain of Youth.

If the Fountain of Youth is the gold standard for any intervention, they will all fail that test.

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