#240 Dr. Spencer Nadolsky on Repatha, ApoB Targets, and What Actually Matters in Lipidology

Dr. Mike Hart sits down with Dr. Jessica Peatross to explore the overlooked factors that may contribute to unexplained health symptoms, from blood sugar fluctuations that resemble anxiety to disrupted cortisol rhythms that affect sleep and energy. They discuss how meal timing, fasting, and hormone balance influence overall well-being, along with the relationship between gut health, histamine intolerance, and mast cell activation syndrome (MCAS). Dr. Jess explains why she questions conventional food sensitivity testing, how she evaluates potential liver dysfunction and mold exposure, and why certain probiotics and supplements may not work for everyone. The conversation also covers environmental toxins, breast implant illness, genetic variations such as MTHFR and COMT, and the importance of tailoring health interventions to individual needs. Dr. Jessica Peatross, also known as Dr. Jess, is a medical doctor and former hospitalist who spent nearly seven years practicing conventional medicine before transitioning toward a more holistic, individualized approach to patient care. Her work focuses on identifying underlying contributors to chronic health concerns through detailed patient histories, symptom patterns, laboratory assessments, and personalized treatment strategies. She emphasizes nervous system regulation, nutritional support, and understanding how environmental and biological factors influence individual health responses. Beyond her clinical practice, she shares educational content through her Wellness+ platform and serves as a supplement formulator for Aegis Formulas. Her philosophy encourages patients to look beyond symptom management while recognizing the essential role of conventional medicine, particularly in emergencies.

In this solo Hart2Heart Podcast episode (focused on male androgenetic alopecia), Dr. Mike Hart reviews hair-loss treatments, emphasizing that regrowth is harder if follicles are gone after 12–18 months. He highlights minoxidil (topical or oral), noting similar efficacy between 2.5 mg and 5 mg oral dosing, comparable results between oral 5 mg and topical 5% twice daily, and that adding 0.01% tretinoin may allow once-daily topical use; combining oral and topical is unstudied but not necessarily dangerous. He advises avoiding systemic DHT blockers due to side effects, favoring 0.05% topical dutasteride for minimal blood DHT reduction, and recommends weekly microneedling (~0.75 mm) without applying products immediately after. As growth-factor adjuncts, he prioritizes PRP or placental exosomes, discusses limited evidence for ketoconazole shampoo and copper peptides, warns DHT-derived anabolic steroids won't be helped by dutasteride, and reviews emerging anti-androgen options and their systemic-risk concerns.

Dr. Mike Hart and Dr. Ira Price explore how medicine is adapting as patients gain greater access to emerging treatments, health information, and tools once limited to physicians. They discuss unapproved peptides and GLP-1 drugs, the growing shift toward personalized and patient-centered care, and the challenges doctors face when evidence and regulation lag behind real-world use. The conversation expands into Canada's opioid crisis, drug decriminalization, fentanyl and medetomidine contamination, emergency-room strain, physician burnout, and broader problems within the Canadian healthcare system. They also examine medical cannabis, CBD and lesser-known cannabinoids, psychedelic medicine, sleep, longevity, and the importance of balancing individual choice with evidence, clinical judgment, and responsible medical guidance. Dr. Ira Price is an emergency physician, sports medicine specialist, and longtime cannabinoid-medicine practitioner whose work sits at the intersection of acute care, emerging therapeutics, and patient-centered medicine. Over nearly two decades working with cannabinoids and years on the front lines of emergency care, he has developed a strong focus on helping patients navigate treatments that often move faster than traditional medical guidelines. His approach emphasizes collaboration rather than gatekeeping, encouraging physicians to remain lifelong learners while helping patients critically evaluate evidence, understand risks and benefits, and make more informed decisions about their health. He brings a practical perspective shaped by emergency medicine, sports medicine, cannabinoid research and clinical practice, and firsthand experience with the evolving challenges facing modern healthcare.

Dr. Mike Hart discusses how oral peptides can still have biological effects despite limited or no systemic absorption, using examples including KPV, BPC-157, linaclotide (Constella), oral semaglutide, and cyclosporine. He explains protein digestion into dipeptides/tripeptides and the PEPT1 transporter that moves some small peptides into enterocytes for local cellular effects, noting that KPV can act in intestinal cells without entering circulation and that carnosine is another PEPT1-absorbed example. He outlines multiple local mechanisms (acting in the gut lumen, on the enterocyte surface, inside enterocytes, and in nearby gut tissue) and contrasts these with systemic absorption examples like semaglutide formulated with SNAC (only 0.4–1% reaches blood yet remains effective) and cyclosporine's unusual properties. He notes exceptions like glutathione and discusses theories for BPC-157's oral effects, emphasizing regulated products and upcoming discussion on GLP-1s and obesity with Dr. Spencer Nadolsky.

In this episode, Dr. Mike Hart and OB-GYN Dr. Salome Masghati examine how common hormone interventions can affect women far beyond pregnancy prevention or symptom relief. They discuss the risks and tradeoffs of different birth control options, possible effects on mood, libido, testosterone, and attraction, and why individual responses can vary significantly. The conversation then explores when to consider HRT, the roles of estrogen, progesterone, and testosterone, thyroid testing beyond TSH, and how shifting hormones may contribute to mast cell symptoms during perimenopause. The episode provides a practical framework for making more informed and personalized decisions about hormone care. Dr. Salome Masghati is a board-certified OB-GYN and functional gynecologist whose work focuses on individualized hormone care for women throughout their reproductive years, perimenopause, and menopause. Her approach combines symptoms, menstrual patterns, comprehensive laboratory testing, metabolic markers, and treatment response to understand each patient's complete health picture rather than relying on a single test or standardized protocol. She works with bioidentical and rhythmic hormone strategies, thyroid care, sexual wellness, and root-cause assessment, emphasizing informed choices, careful monitoring, and helping patients move beyond temporary symptom control toward better long-term health and function.