A Modern Pharmacist

lee
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Most of what gets called healthy is just normal. Normal is not the same as optimal. I am Lee, a prescribing pharmacist working in the NHS. I also live with diabetes, so this is not theory for me. Every week I break down the tests, numbers and decisions that actually move the needle on long term health. The biomarkers I run on myself. The tests I cannot order on the NHS but wish I could. What it is really like navigating the health system as both the person prescribing and the person managing a condition every day. No fluff. Just evidence, from a clinician who holds himself to the same standard

  1. 2d ago

    How to Reverse Insulin Resistance: What the Evidence Shows

    Insulin resistance can develop for years while your blood sugar still looks normal, quietly raising your risk of type 2 diabetes and heart disease. In this episode I focus on what actually reverses and prevents it, with numbers from the studies. I start with a quick recap: insulin resistance is largely a problem of fat building up in the wrong places, the liver and muscle, where it blocks insulin’s signal. I explain why that raises heart risk, through small dense LDL, ApoB and damage to the nitric oxide pathway, and how to test for it, including fasting insulin, HOMA-IR and the triglyceride-to-HDL ratio. Then the practical part. Losing just 5% of your weight cut liver fat by 40% in one trial. Combining cardio and weights beats either alone, and working muscle can take in glucose without insulin. Each 10% more muscle is linked to 11% lower insulin resistance. I explain what “low carb” actually means in grams, why a 2-minute walk every 20 minutes lowers your glucose and insulin by about a quarter, and why sleeping 6 hours instead of 7.5 raised insulin resistance by around 15%. I finish with stress, cortisol and the role of medication. Sources: DeFronzo (Diabetes, 2009), Magkos et al. (Cell Metabolism, 2016), Diabetes Prevention Program (NEJM, 2002), DiRECT (The Lancet, 2018), HART-D (JAMA, 2010), Srikanthan & Karlamangla (JCEM, 2011), Goldenberg et al. (BMJ, 2021), Dunstan et al. (Diabetes Care, 2012), Zuraikat et al. (Diabetes Care, 2023), Petersen & Shulman (Physiological Reviews, 2018). This is informational purposes only, not medical advice. If you can’t get seen by your own physician, by all means do so, but always speak to your own healthcare provider.

  2. 5d ago

    Sleep Explained: Stages, Efficiency and How to Sleep Better

    Sleep takes up a third of our lives, and despite leaving us vulnerable for all those hours, it’s something we’ve never evolved our way out of. In this episode I explain why sleep matters and how to improve it. I start with what happens in each stage of sleep: N2 for skills and learning, deep sleep (N3) for long-term memory and physical recovery, and REM for dreaming, emotional processing and connecting ideas. I explain why sleeping 6 hours instead of 8 costs you far more than a quarter of your REM sleep. Then chronotype: whether you’re a morning lark or a night owl, how much is genetic, and how it changes with age. The second half is practical. I cover the difference between time in bed and actual sleep, what sleep efficiency means, and why falling asleep instantly can signal sleep debt. Then how to improve your sleep, from consistent wake times and morning daylight to a cool room and a warm bath, and what to avoid: alcohol, late caffeine, and relying on sleeping tablets instead of CBT-I. Sources: AASM sleep staging, Horne & Östberg (1976), Jones et al. (Nature Communications, 2019), Haghayegh et al. (Sleep Medicine Reviews, 2019), Kripke et al. (BMJ Open, 2012), NICE insomnia guidance, NHS caffeine guidance, The Peter Attia Drive #221. This is informational purposes only, not medical advice. If you can’t get seen by your own physician, by all means do so, but always speak to your own healthcare provider.

  3. Oct 23

    AMA: Statins, Creatine, Cholesterol and Protecting Your Heart

    In this Ask Me Anything episode I answer seven questions on heart health, metabolic health, medication and training: the ones I get asked most often, plus two sent in on Instagram. I start with the vitamin stack question and why testing beats guessing, with one UK exception: vitamin D in autumn and winter. Then why being young and fit doesn't mean you can skip a cholesterol check, including ApoB and Lp(a), a genetic risk factor you only need to test once. I go through the evidence on statin side effects, including the SAMSON trial, where 90% of symptoms also appeared on placebo, and a meta-analysis of over 150,000 people showing only about 1 in 15 muscle complaints in the first year were caused by the statin. I also cover whether creatine is safe and why it can make your kidney blood tests look worse than they are, whether to prioritise cardio or weights if you only have three hours a week, and how to check your blood pressure properly at home. Finally, the big one: what you can do now to protect your heart for the future. Sources: CTT Collaboration (The Lancet, 2022), SAMSON (NEJM 2020; JACC 2021), StatinWISE (BMJ, 2021), EAS Lp(a) consensus (2022), HEART UK (2019), NICE NG136 and NG203, UK vitamin D guidance. This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider.

  4. Oct 18

    Iron Explained: Why It Matters, Testing and Treatment

    Iron is one of the most important minerals in your body, yet most people only find out they're low once they're anaemic, and that's one of the last signs to appear. In this episode I give a general overview of iron, from why it matters to how to test and treat it. I start with what iron does: 6.5% of the body's enzymes depend on it, it sits at the centre of haem in haemoglobin, and the body uses zinc instead when iron runs short. Then how much you need: we lose 1–2 mg a day and absorb only about 10% of what we eat, and needs differ for men, menstruating women and pregnancy. I cover the best food sources and the symptoms of low iron, including restless legs and craving ice. Next, testing: why a full blood count isn't enough, what ferritin, transferrin saturation and TIBC tell you, and why inflammation can make ferritin look normal. Finally, treatment: finding the cause first, why once-daily or alternate-day dosing works better because of hepcidin, why a 65 mg tablet is repaying a debt rather than overshooting, and when IV iron is needed. Sources: NHS iron guidance, NICE CKS, British Society of Gastroenterology guidelines (Gut, 2021), AGA guidelines (2020), Moretti 2015 (Blood), von Siebenthal 2023, The Peter Attia Drive AMA #58. This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider.

  5. Oct 15

    Is Microdosing GLP-1s Backed by Any Evidence?

    Around 1 in 7 people on GLP-1s say they've tried microdosing, so in this episode I look at whether any of it is backed by evidence. I start with what microdosing actually means. There's no official definition, and I cover why it took off, from cost to side effects to claims about inflammation, longevity and the brain. Then how people do it: using the "golden dose" left in the pen, and stretching out the gap between injections. Next, the evidence. The lowest-dose trial we have used daily semaglutide, adding up to 0.35 mg a week, which gave 6% weight loss at 52 weeks vs 2.3% on placebo. That's still above the licensed starting dose. SURMOUNT-1 shows weight loss rising with dose, and SURMOUNT-MAINTAIN compares staying on the top dose, dropping to 5 mg, and stopping, along with what happened to side effects. I also cover EVOKE, where full-dose semaglutide didn't slow Alzheimer's. Finally, the MHRA warnings on fake pens, and why you can't know what's in an unlicensed vial. My verdict: below licensed doses, microdosing remains unstudied. Sources: O'Neil 2018 (The Lancet), SURMOUNT-1 (NEJM, 2022), SURMOUNT-MAINTAIN (The Lancet, 2026), EVOKE/EVOKE+ (Novo Nordisk, 2025), Eli Lilly UK Medical Information, MHRA falsified Mounjaro alert, STAT News (2026). This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.

  6. Oct 11

    Is VO2 Max More Important Than Strength?

    I come from lifting, so I wanted the answer to be strength. In this episode, I go through the biggest studies on fitness, strength and mortality to answer one question: if you could only train one, which matters more for living longer? I start with what VO2 max really measures, and why a MET is based on the resting oxygen use of one man. Then the cardio evidence: the Cleveland Clinic study of 122,007 people, where elite fitness was linked to an 80% lower risk of death than low fitness, and why "being unfit is worse than smoking" misreads it. Then the case for strength, from Ruiz's bench and leg press data to grip strength across 1.9 million people. The UK Biobank head-to-head brings both together, and I finish with Generation 100, the largest exercise RCT on mortality, and why its result isn't as clean as it looks. My verdict: cardio edges it, but the lowest risk belongs to people who have both. Sources: Mandsager 2018 (JAMA Netw Open), Lang 2024 (BJSM), Ruiz 2008 (BMJ), García-Hermoso 2018 (Arch Phys Med Rehabil), UK Biobank 2018 (Eur J Epidemiol), Generation 100 (BMJ, 2020), Byrne 2005 (J Appl Physiol), UK CMO Physical Activity Guidelines 2019. This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.

  7. Oct 8

    Heart Disease Starts Long Before the Heart Attack

    Heart disease has taken another member of my family, and it's the reason I've put so much of my career into prevention. This is a more personal episode, but I didn't want it to be just my story. I wanted you to leave with something you can actually use. I start with why heart disease is still the world's biggest killer, and why most of the risk comes down to things we can change. Then I go through the autopsy evidence. Young soldiers killed in war, and teenagers who died in accidents, already had disease in their arteries. Early changes have even been found before birth. I explain how plaque builds up while the artery quietly grows outwards to hide it, which is why a normal test doesn't always mean you're clear. Finally, I go through what actually moves your risk: lowering LDL and blood pressure, getting fitter and stronger, losing weight, stopping smoking, and checking the things people miss, like family history and Lp(a). You'll leave with a simple checklist of what to know and what to test. Sources: INTERHEART (Lancet, 2004), BHF UK CVD Factsheet (2026), Enos et al. (JAMA, 1953), Bogalusa Heart Study (NEJM, 1998), PDAY (JAMA, 1999), Tuzcu et al. (Circulation, 2001), Ference et al. (JACC, 2012), CTT (Lancet, 2010), SPRINT (NEJM, 2015), Kodama et al. (JAMA, 2009), PURE (Lancet, 2015). This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week. Follow so you don't miss the next one.

  8. Oct 4

    The Steroid User Waiting for a New Heart

    At 41, after taking steroids continuously since he was 18, this patient has an ejection fraction of 15% and is on the waiting list for a heart transplant. In this episode I talk through his case and use it to separate two things that often get lumped together: anabolic steroid abuse and properly diagnosed, monitored testosterone replacement therapy. I cover how supraphysiological androgens damage the heart directly through androgen receptors on heart muscle, fibrosis, RAAS activation, fluid retention, raised blood pressure, crashed HDL and a higher tendency to clot, and why his high haematocrit was only part of the story. I go through the Baggish weightlifter study, where steroid users averaged an ejection fraction of 52% against 63% in non-users, and what the TRAVERSE trial does and doesn't tell us about TRT, heart attacks, stroke and prostate cancer. We also get into haematocrit monitoring, Virchow's triad, why testosterone switches off sperm production, and the dilemma of a man whose own testosterone is unlikely to ever recover. Sources: Baggish et al. (Circulation, 2017); Marsh et al. (Circulation, 1998); Fadah et al. (Front Cardiovasc Med, 2023); HAARLEM study (Smit et al., 2021); TRAVERSE (NEJM, 2023) and prostate safety analysis (JAMA Netw Open, 2023); Bhasin et al. (Am J Physiol, 2001); Endocrine Society guideline (JCEM, 2018); Ajayi et al. (Circulation, 1995); Travison et al. (JCEM, 2017). This is informational purposes only, not medical advice. If you can't get seen by your own physician, by all means do so, but always speak to your own healthcare provider. New episodes every week.

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About

Most of what gets called healthy is just normal. Normal is not the same as optimal. I am Lee, a prescribing pharmacist working in the NHS. I also live with diabetes, so this is not theory for me. Every week I break down the tests, numbers and decisions that actually move the needle on long term health. The biomarkers I run on myself. The tests I cannot order on the NHS but wish I could. What it is really like navigating the health system as both the person prescribing and the person managing a condition every day. No fluff. Just evidence, from a clinician who holds himself to the same standard

Information

  • Creator
    lee
  • Years Active
    2026
  • Episodes
    33
  • Rating
    Clean
  • Copyright
    © lee
  • Show Website
    A Modern Pharmacist