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. 4d ago

    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.

  2. 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.

  3. 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.

  4. 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.

  5. 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.

  6. Oct 1

    Does Omega-3 Reduce Inflammation?

    Everyone's heard the omega-6 to omega-3 ratio talked about like it tells you how inflamed you are right now. It doesn't — and the researcher who actually invented the real alternative test says so directly. This week I go through what the ratio actually measures, the real mechanisms behind omega-3's anti-inflammatory effects (including a gene-suppression pathway almost nobody covers), and then pressure-test the three major cardiovascular trials that somehow reached three different conclusions testing nearly the same intervention. I get into why REDUCE-IT's 25% risk reduction comes with a genuine, actively-debated methodological controversy, why the seemingly better-absorbed STRENGTH formulation failed completely while revealing a real atrial fibrillation signal, and how VITAL's "failed" headline buried a 28% reduction in heart attacks. I also walk through something genuinely uncomfortable: the original reasoning behind the 8-12% Omega-3 Index target hasn't held up as well under two decades of further research as most people assume. Finally, the practical part — what to eat, what to test, and the real gap between the UK's official guideline and what the research suggests actually matters. Sources: Harris WS, The Peter Attia Drive Ep. #83; Calder PC, Nutrients 2010; Bhatt DL et al., REDUCE-IT, 2019; Manson JE et al., VITAL, NEJM 2019; Marklund M et al., Circulation 2019; EFSA Scientific Opinion on EPA/DHA, 2010. 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. Sep 27

    The Growth Hormone Peptide That Got Shelved

    Two growth hormone peptides, built by two companies in the same city, at the same time, for the same condition, using the exact same natural hormone as their starting point. In July 2006, one company's trial was halted after a participant died. The other company's trial, treating the same disease, kept going. One became an FDA-approved medicine. The other is now a research-chemical bestseller that a federal safety panel formally rejected for pharmacy use just last year. This week I walk through how these peptides actually work, why two companies took completely different approaches to stabilising the same fragile hormone, and why that one event in 2006 sent them down permanently different paths. I get into why one of them became a tightly-controlled "biologic" and the other never could, what HIV-related fat redistribution actually is and why a growth-hormone peptide made genuine medical sense as a treatment for it, and the part most coverage skips: even the approved drug doesn't protect you if what you're actually buying never went anywhere near the trials that proved it works. I also cover the real physiology of how raising growth hormone affects blood sugar, and what the evidence shows if you're already starting from normal levels. Sources: Falutz et al., NEJM 2007 & JCEM 2010; Ionescu et al., JCEM 2006; FDA Pharmacy Compounding Advisory Committee, December 2024; Stanley et al., Lancet HIV 2019; Baker et al., Archives of Neurology 2012; Rudman et al., NEJM 1990. 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.

  8. Sep 24

    The Peptide Safety Checklist Nobody Follows

    Most people asking about a peptide want to know one thing: does it work. That's not actually the first question you should be asking — and this week I walk through the checklist that should come before it, the one almost nobody follows, including plenty of people already using these products. I cover the five questions worth asking before you put any peptide in your body, then spend most of the episode on what actually determines whether it's safe: how to read a Certificate of Analysis properly, why the two most-trusted names in peptide testing aren't accredited to any recognised standard, and why the pricing structure of this industry quietly rewards vendors for skipping the tests that matter most. I also get into a recent finding that changed how I think about sourcing entirely — some of the same manufacturers producing fentanyl precursors have been pivoting directly into the peptide supply chain. That's not a reason to panic about every vial, but it's exactly the kind of thing a purity percentage will never tell you. Sources: Peter Attia, MD, The Peter Attia Drive Ep. #387 (AMA #83); UKAS/A2LA/NATA accreditation standards; FDA 21 CFR Parts 210 & 211; ICH Q2(R2)/Q14; Axios, July 2026, on the fentanyl-to-peptide supply chain. Website for the testing I discussed- Janoshik.com 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
    30
  • Rating
    Clean
  • Copyright
    © lee
  • Show Website
    A Modern Pharmacist