#268 - The truths about obesity, skinny fat, TOFI & why thin people can be unhealthy | Dr. Robert Lustig & Mike Haney

Heart disease is the leading cause of death, but it’s also one of the most preventable. Decades of research have established a strong causal role for LDL and other ApoB-containing particles in atherosclerosis, and we now have multiple proven ways to lower them. The harder question is how to turn that evidence into a decision for an individual person. Mike Haney talks with Johns Hopkins cardiologist Dr. Seth Martin, a co-author of the new 2026 dyslipidemia guidelines, about what the latest evidence says we should actually measure and act on. The throughline is pragmatic: lower exposure to atherogenic particles earlier and for longer, use additional tests when they can change a decision, and distinguish interesting new measurements from ones that have actually been shown to improve outcomes.

Most of NextLevel starts with a measurement problem: we can see more biology than ever, but we still have to figure out what to do with it. Bioelectronic medicine flips that sequence. We already know how to send electrical signals into the nervous system to change biology, including an FDA-approved vagus nerve treatment for rheumatoid arthritis, even though we still can’t map or read most of the individual nerve fibers carrying those signals.

Most health decisions happen before the science is settled. A study points one way, another points somewhere else, experts disagree about what matters, and even strong population-level evidence may not tell you what will happen to you.

Most medical imaging happens after a symptom, injury, or abnormal test gives a clinician a reason to look. But what changes if imaging becomes a more routine measurement, creating a record of the body before something goes wrong? In this episode of Next Level, Mike Haney talks with Dr. Daniel Durand, chief medical officer at Prenuvo, about whole-body MRI as a test case for a broader shift from episodic medicine toward longitudinal health data. Whole-body MRI is controversial, and Durand is clearly an advocate. The conversation takes the skepticism seriously, then asks a larger question: as measurement gets cheaper, more frequent, and increasingly visible to patients themselves, how should medicine decide what is worth knowing?

Alcohol has spent the last 40 years bouncing between two health narratives: a little is good for your heart, or any amount is dangerous. The science doesn’t really support either slogan. Dr. Tim Naimi has spent decades studying the health effects of alcohol and, just as importantly, why the research is so difficult to interpret. His read of the evidence is less dramatic but more useful: there’s no good reason to start drinking for your health, very low intake may carry little measurable added risk, and risk rises as consumption does. Understanding why earlier studies made moderate drinking look protective helps explain a lot of the whiplashing headlines.