Under Load Transistor (https://transistor.fm) https://feeds.transistor.fm/the-upward-arc Under Load is the weekly audio edition of Andre Heeg’s newsletter for senior leaders and business owners carrying heavy responsibility. Each episode examines how demanding work affects your health, energy, judgment, and life outside work. Andre draws on current research through the lens of his medical training and business experience. The result is practical guidance built for the reality of leadership. New episodes every Sunday. Read the full editions and supporting evidence at andreheeg.com. © 2026 Andre Heeg. All rights reserved. cf806740-9305-5681-a57d-aaf0b4059cbc yes en Sat, 26 Sep 2026 18:54:39 +0200 Sat, 26 Sep 2026 18:55:11 +0200 http://www.andreheeg.com https://img.transistorcdn.com/0DnD5__sLelwaFbzPD59BBU7aljCivwucsp5_HHMq-U/rs:fill:0:0:1/w:1400/h:1400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS8wODc1/MzQxYzZmMTk4MDBl/ODhhM2E4NWIwYTFj/OWExOC5wbmc.jpg Under Load http://www.andreheeg.com episodic Andre Heeg Under Load is the weekly audio edition of Andre Heeg’s newsletter for senior leaders and business owners carrying heavy responsibility. Each episode examines how demanding work affects your health, energy, judgment, and life outside work. Andre draws on current research through the lens of his medical training and business experience. The result is practical guidance built for the reality of leadership. New episodes every Sunday. Read the full editions and supporting evidence at andreheeg.com. Under Load is the weekly audio edition of Andre Heeg’s newsletter for senior leaders and business owners carrying heavy responsibility. executive health, longevity, performance Andre Heeg No No Midlife Career Change: Why Successful People Start Counting Backwards 9 9 Midlife Career Change: Why Successful People Start Counting Backwards full befd238e-22d1-414d-bef5-b90e52858aae https://share.transistor.fm/s/e0b61b5b "No one knows this yet." A friend I've known for more than fifteen years said it at lunch, just before the waiter arrived. Her career looked very solid. She was thinking about what comes next anyway. Within a few weeks, I heard almost the same question from five people who don't know each other.

None of them are in trouble, and none of them want to retire. They're still building, still have financial goals, and are asking in the middle of their careers: how many more years do I want to keep doing this, and how do I want to spend them?

This episode of Under Load looks at why that question arrives in midlife, and what it means for your health.

In 1968, the psychologist Bernice Neugarten described middle age as the point where life is restructured around the time left rather than the time since birth. Laura Carstensen's research at Stanford explains the mechanism: when time feels limited, we shift from collecting knowledge, contacts and status toward what matters emotionally. Her studies showed the shift depends on perceived time, not age. It appeared in older adults, in young adults in Hong Kong before the 1997 handover, and in young men living with HIV.

I argue that counting backwards is the same shift, applied to work. Age can move your horizon, and so can a health issue or an uncertain future. For me, it started with severe back pain and a summer evening on a terrace in 2024.

We also cover:

  • Why nobody says it out loud, and what psychologists call pluralistic ignorance, including a study of board directors who each doubted a failing strategy and stayed quiet.
  • What the "midlife crisis" data shows, and why the people aged 49 to 53 in one study described "shortened futures."
  • A German study of workers in their fifties: those who wanted to change profession but didn't had worse mental health.
  • Purpose in life and health, from a 2026 meta-analysis of nearly 490,000 people.
  • The honeymoon-hangover effect, and why a new job title rarely settles the question.
  • Why any answer has to cover the household first, and why years and healthy years are two different counts.

The episode closes with five things to try: the backwards count, the five-year test, a small real-world experiment, telling one trusted peer, and putting a number on the money fear.

Visit The Upward ARC and subscribe.

Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Capacity pillar: what you can still learn, the skills you build, and the reserves your mind and body carry into later life.

Key sources


]]> "No one knows this yet." A friend I've known for more than fifteen years said it at lunch, just before the waiter arrived. Her career looked very solid. She was thinking about what comes next anyway. Within a few weeks, I heard almost the same question from five people who don't know each other.

None of them are in trouble, and none of them want to retire. They're still building, still have financial goals, and are asking in the middle of their careers: how many more years do I want to keep doing this, and how do I want to spend them?

This episode of Under Load looks at why that question arrives in midlife, and what it means for your health.

In 1968, the psychologist Bernice Neugarten described middle age as the point where life is restructured around the time left rather than the time since birth. Laura Carstensen's research at Stanford explains the mechanism: when time feels limited, we shift from collecting knowledge, contacts and status toward what matters emotionally. Her studies showed the shift depends on perceived time, not age. It appeared in older adults, in young adults in Hong Kong before the 1997 handover, and in young men living with HIV.

I argue that counting backwards is the same shift, applied to work. Age can move your horizon, and so can a health issue or an uncertain future. For me, it started with severe back pain and a summer evening on a terrace in 2024.

We also cover:

  • Why nobody says it out loud, and what psychologists call pluralistic ignorance, including a study of board directors who each doubted a failing strategy and stayed quiet.
  • What the "midlife crisis" data shows, and why the people aged 49 to 53 in one study described "shortened futures."
  • A German study of workers in their fifties: those who wanted to change profession but didn't had worse mental health.
  • Purpose in life and health, from a 2026 meta-analysis of nearly 490,000 people.
  • The honeymoon-hangover effect, and why a new job title rarely settles the question.
  • Why any answer has to cover the household first, and why years and healthy years are two different counts.

The episode closes with five things to try: the backwards count, the five-year test, a small real-world experiment, telling one trusted peer, and putting a number on the money fear.

Visit The Upward ARC and subscribe.

Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Capacity pillar: what you can still learn, the skills you build, and the reserves your mind and body carry into later life.

Key sources


]]> Sat, 26 Sep 2026 18:54:37 +0200 Andre Heeg Andre Heeg 1033 "No one knows this yet." A friend I've known for more than fifteen years said it at lunch, just before the waiter arrived. Her career looked very solid. She was thinking about what comes next anyway. Within a few weeks, I heard almost the same question from five people who don't know each other.

None of them are in trouble, and none of them want to retire. They're still building, still have financial goals, and are asking in the middle of their careers: how many more years do I want to keep doing this, and how do I want to spend them?

This episode of Under Load looks at why that question arrives in midlife, and what it means for your health.

In 1968, the psychologist Bernice Neugarten described middle age as the point where life is restructured around the time left rather than the time since birth. Laura Carstensen's research at Stanford explains the mechanism: when time feels limited, we shift from collecting knowledge, contacts and status toward what matters emotionally. Her studies showed the shift depends on perceived time, not age. It appeared in older adults, in young adults in Hong Kong before the 1997 handover, and in young men living with HIV.

I argue that counting backwards is the same shift, applied to work. Age can move your horizon, and so can a health issue or an uncertain future. For me, it started with severe back pain and a summer evening on a terrace in 2024.

We also cover:

  • Why nobody says it out loud, and what psychologists call pluralistic ignorance, including a study of board directors who each doubted a failing strategy and stayed quiet.
  • What the "midlife crisis" data shows, and why the people aged 49 to 53 in one study described "shortened futures."
  • A German study of workers in their fifties: those who wanted to change profession but didn't had worse mental health.
  • Purpose in life and health, from a 2026 meta-analysis of nearly 490,000 people.
  • The honeymoon-hangover effect, and why a new job title rarely settles the question.
  • Why any answer has to cover the household first, and why years and healthy years are two different counts.

The episode closes with five things to try: the backwards count, the five-year test, a small real-world experiment, telling one trusted peer, and putting a number on the money fear.

Visit The Upward ARC and subscribe.

Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within the Capacity pillar: what you can still learn, the skills you build, and the reserves your mind and body carry into later life.

Key sources


]]> midlife career change, career change at 45, career change at 50, midlife transition, midlife crisis, what comes next, counting backwards, time left to live, second half of career, purpose and meaning at work, purpose in life, purpose and longevity, purpose and health, healthspan, healthy life expectancy, healthspan-lifespan gap, socioemotional selectivity theory, Laura Carstensen, Bernice Neugarten, perceived time, time horizon, pluralistic ignorance, board directors, career doubts, executive burnout, job satisfaction, honeymoon-hangover effect, changing jobs, portfolio career, multiple income streams, future of work, AI and jobs, World Economic Forum Future of Jobs, Generation X careers, high achievers, executive health, leadership, back pain and stress, job enjoyment and back pain, mental health at work, Capacity, lifelong learning, Under Load, The Upward ARC, Andre Heeg No Mobility after 40: Stretching, strength and everyday movement 8 8 Mobility after 40: Stretching, strength and everyday movement full cd443628-8166-4d27-b4cb-d11d55e9872c https://share.transistor.fm/s/9601a8e8 In a dusty square in Kathmandu, men waited for minibuses in a deep squat. I took those minibuses to the hospital, where I worked in traumatology, and began wondering why I rarely used that position myself.

Years later, during an hour's wait outside an embassy with my family, I was the only person in the queue squatting.

This episode of Under Load looks at mobility as we age, with a practical question for anyone whose working week involves a lot of sitting: which everyday movement do you want to keep being able to do?

I discuss how flexibility, strength and balance contribute to getting into and out of a position. The LIFE trial gives us evidence about preserving walking ability in older adults with physical limitations. Stretching studies help estimate how much practice may be useful, although much of that evidence comes from younger adults.

The episode covers the estimated ten minutes of stretching per muscle group each week, why that estimate needs care, and what researchers mean by tissue stiffness and stretch tolerance. I also look at resistance training's effects on flexibility and the limits of the comparisons between different training intensities.

The practical section contains a supported squat, a hip-flexor stretch, a calf stretch and a supported one-leg stand. The sequence and starting amounts are my recommendation; the exact routine hasn't been tested as a package. I explain how to begin with support and observe progress without making every session harder.

The closing question is about the movement you've started avoiding. That gives the practice a purpose you can recognize outside an exercise session.

[Visit The Upward ARC and subscribe](https://www.andreheeg.com).

Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within Activate, with Capacity as the reason to continue.

Key sources:

- [Pahor et al., 2014, JAMA](https://doi.org/10.1001/jama.2014.5616): the LIFE randomized trial of structured physical activity and walking disability in older adults.
- [Guirguis-Blake et al., 2024, JAMA](https://doi.org/10.1001/jama.2024.4166): exercise interventions and falls in older adults.
- [Ingram et al., 2025, Sports Medicine](https://doi.org/10.1007/s40279-024-02143-9): static stretching dose and flexibility.
- [Oba et al., 2026, Sports Medicine – Open](https://doi.org/10.1186/s40798-026-01066-1): age and other characteristics in stretching adaptations.
- [Ingram et al., 2025, Sports Medicine](https://doi.org/10.1007/s40279-025-02204-7): possible mechanisms behind changes in range of motion.
- [Favro et al., 2025, Journal of Strength and Conditioning Research](https://doi.org/10.1519/JSC.0000000000005000): resistance training and flexibility.
- [NHS balance guidance](https://www.nhs.uk/live-well/exercise/balance-exercises/) and [strength guidance](https://www.nhs.uk/live-well/exercise/strength-exercises/): supported starting exercises and gradual progression.

Audio note

Andre reads the written newsletter, adapted for speech. Some figures are rounded and inline citations are omitted. The written edition contains the full references and exact reported figures.

Medical note

This episode provides general education. Adapt exercise to your health and current ability. Stop for pain, numbness or tingling. Recent surgery, restricted joint replacements or recurrent falls call for individual guidance from your clinician or physiotherapist.

]]> In a dusty square in Kathmandu, men waited for minibuses in a deep squat. I took those minibuses to the hospital, where I worked in traumatology, and began wondering why I rarely used that position myself.

Years later, during an hour's wait outside an embassy with my family, I was the only person in the queue squatting.

This episode of Under Load looks at mobility as we age, with a practical question for anyone whose working week involves a lot of sitting: which everyday movement do you want to keep being able to do?

I discuss how flexibility, strength and balance contribute to getting into and out of a position. The LIFE trial gives us evidence about preserving walking ability in older adults with physical limitations. Stretching studies help estimate how much practice may be useful, although much of that evidence comes from younger adults.

The episode covers the estimated ten minutes of stretching per muscle group each week, why that estimate needs care, and what researchers mean by tissue stiffness and stretch tolerance. I also look at resistance training's effects on flexibility and the limits of the comparisons between different training intensities.

The practical section contains a supported squat, a hip-flexor stretch, a calf stretch and a supported one-leg stand. The sequence and starting amounts are my recommendation; the exact routine hasn't been tested as a package. I explain how to begin with support and observe progress without making every session harder.

The closing question is about the movement you've started avoiding. That gives the practice a purpose you can recognize outside an exercise session.

[Visit The Upward ARC and subscribe](https://www.andreheeg.com).

Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within Activate, with Capacity as the reason to continue.

Key sources:

- [Pahor et al., 2014, JAMA](https://doi.org/10.1001/jama.2014.5616): the LIFE randomized trial of structured physical activity and walking disability in older adults.
- [Guirguis-Blake et al., 2024, JAMA](https://doi.org/10.1001/jama.2024.4166): exercise interventions and falls in older adults.
- [Ingram et al., 2025, Sports Medicine](https://doi.org/10.1007/s40279-024-02143-9): static stretching dose and flexibility.
- [Oba et al., 2026, Sports Medicine – Open](https://doi.org/10.1186/s40798-026-01066-1): age and other characteristics in stretching adaptations.
- [Ingram et al., 2025, Sports Medicine](https://doi.org/10.1007/s40279-025-02204-7): possible mechanisms behind changes in range of motion.
- [Favro et al., 2025, Journal of Strength and Conditioning Research](https://doi.org/10.1519/JSC.0000000000005000): resistance training and flexibility.
- [NHS balance guidance](https://www.nhs.uk/live-well/exercise/balance-exercises/) and [strength guidance](https://www.nhs.uk/live-well/exercise/strength-exercises/): supported starting exercises and gradual progression.

Audio note

Andre reads the written newsletter, adapted for speech. Some figures are rounded and inline citations are omitted. The written edition contains the full references and exact reported figures.

Medical note

This episode provides general education. Adapt exercise to your health and current ability. Stop for pain, numbness or tingling. Recent surgery, restricted joint replacements or recurrent falls call for individual guidance from your clinician or physiotherapist.

]]> Sat, 19 Sep 2026 15:56:53 +0200 Andre Heeg Andre Heeg 755 In a dusty square in Kathmandu, men waited for minibuses in a deep squat. I took those minibuses to the hospital, where I worked in traumatology, and began wondering why I rarely used that position myself.

Years later, during an hour's wait outside an embassy with my family, I was the only person in the queue squatting.

This episode of Under Load looks at mobility as we age, with a practical question for anyone whose working week involves a lot of sitting: which everyday movement do you want to keep being able to do?

I discuss how flexibility, strength and balance contribute to getting into and out of a position. The LIFE trial gives us evidence about preserving walking ability in older adults with physical limitations. Stretching studies help estimate how much practice may be useful, although much of that evidence comes from younger adults.

The episode covers the estimated ten minutes of stretching per muscle group each week, why that estimate needs care, and what researchers mean by tissue stiffness and stretch tolerance. I also look at resistance training's effects on flexibility and the limits of the comparisons between different training intensities.

The practical section contains a supported squat, a hip-flexor stretch, a calf stretch and a supported one-leg stand. The sequence and starting amounts are my recommendation; the exact routine hasn't been tested as a package. I explain how to begin with support and observe progress without making every session harder.

The closing question is about the movement you've started avoiding. That gives the practice a purpose you can recognize outside an exercise session.

[Visit The Upward ARC and subscribe](https://www.andreheeg.com).

Under Load is the Sunday edition of The Upward ARC, by Andre Heeg, MD, DDS, physician and reconstructive facial surgeon. This edition sits within Activate, with Capacity as the reason to continue.

Key sources:

- [Pahor et al., 2014, JAMA](https://doi.org/10.1001/jama.2014.5616): the LIFE randomized trial of structured physical activity and walking disability in older adults.
- [Guirguis-Blake et al., 2024, JAMA](https://doi.org/10.1001/jama.2024.4166): exercise interventions and falls in older adults.
- [Ingram et al., 2025, Sports Medicine](https://doi.org/10.1007/s40279-024-02143-9): static stretching dose and flexibility.
- [Oba et al., 2026, Sports Medicine – Open](https://doi.org/10.1186/s40798-026-01066-1): age and other characteristics in stretching adaptations.
- [Ingram et al., 2025, Sports Medicine](https://doi.org/10.1007/s40279-025-02204-7): possible mechanisms behind changes in range of motion.
- [Favro et al., 2025, Journal of Strength and Conditioning Research](https://doi.org/10.1519/JSC.0000000000005000): resistance training and flexibility.
- [NHS balance guidance](https://www.nhs.uk/live-well/exercise/balance-exercises/) and [strength guidance](https://www.nhs.uk/live-well/exercise/strength-exercises/): supported starting exercises and gradual progression.

Audio note

Andre reads the written newsletter, adapted for speech. Some figures are rounded and inline citations are omitted. The written edition contains the full references and exact reported figures.

Medical note

This episode provides general education. Adapt exercise to your health and current ability. Stop for pain, numbness or tingling. Recent surgery, restricted joint replacements or recurrent falls call for individual guidance from your clinician or physiotherapist.

]]> mobility after 40, mobility as you age, flexibility after 40, healthy aging, joint range of motion, static stretching, stretching dose, stretch tolerance, tissue stiffness, strength training, resistance training, balance exercises, fall prevention, walking ability, LIFE trial, deep squat, supported squat, hip mobility, hip flexor stretch, half-kneeling stretch, calf stretch, one-leg stand, chair rises, everyday movement, sedentary work, executive health, Kathmandu, Under Load, The Upward ARC, Andre Heeg No Hearing loss, listening effort, and dementia: a doctor's reading 7 7 Hearing loss, listening effort, and dementia: a doctor's reading full cfd5a6e7-4179-460c-a673-d8df812d9635 https://share.transistor.fm/s/5bdb2cc4 Karla said people were too loud. Everyday voices suddenly felt overwhelming after doctors put small tubes in her eardrums.

Our youngest had spent years struggling to hear us and tell us what she needed. She’s six now, and I’ve finally felt ready to write about it.

This episode follows her progress, our doubts about a bilingual kindergarten, and the conversations I want people to be able to follow at work and at home. My wrestling ears make an appearance too, along with an expensive pair of custom earphones that finally stayed in.

### In this episode

- Karla’s glue ear and the long wait for answers.
- A study of middle-aged adults with normal standard hearing tests, and what their pupils suggested about effort after listening in noise.
- The difference between hearing-related fatigue and the need to recover from a working day.
- What employees with hearing loss said made video meetings easier to follow.
- The ACHIEVE trial’s overall result and its often-quoted 48% subgroup result, with the comparison and limitations explained.
- Practical questions for a hearing appointment, and Karla starting first grade.

### Written edition and subscription

Find Under Load and subscribe at [andreheeg.com](https://www.andreheeg.com).

All 16 references are included in the written edition.

Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS, on executive health, longevity and sustained performance.

### Key sources

- [NICE guidance on glue ear in children](https://www.nice.org.uk/guidance/ng233/chapter/Recommendations) and [adult hearing assessment and care](https://www.nice.org.uk/guidance/ng98/chapter/recommendations).
- [MacKeith and colleagues, 2023](https://doi.org/10.1002/14651858.CD015215.pub2): the Cochrane review of ventilation tubes for children with glue ear.
- [Zink and colleagues, 2025](https://doi.org/10.7554/eLife.102823): listening effort in adults with normal standard hearing tests.
- [Holman and colleagues, 2021](https://doi.org/10.1177/23312165211052786), [van Leeuwen and colleagues, 2022](https://doi.org/10.1097/AUD.0000000000001127), and [Gussenhoven and colleagues, 2017](https://doi.org/10.1177/2331216517692304): fatigue and recovery outcomes across different study designs.
- [Marsja and colleagues, 2026](https://doi.org/10.1177/10519815251398498): interviews about access to video meetings for employees with hearing loss.
- [Ferguson and colleagues, 2026](https://doi.org/10.1002/14651858.CD012023.pub3): hearing aids for adults with mild to moderate hearing loss. [Ohlenforst and colleagues, 2017](https://doi.org/10.1097/AUD.0000000000000396) reviewed the separate outcome of listening effort.
- [Lin and colleagues, 2023](https://doi.org/10.1016/S0140-6736(23)01406-X): ACHIEVE, which tested hearing care against health education in older adults.
- [Cantuaria and colleagues, 2024](https://doi.org/10.1001/jamaoto.2023.3509): the observational Danish study of hearing loss and later dementia.
- [NIDCD guidance on noise-induced hearing loss](https://www.nidcd.nih.gov/health/noise-induced-hearing-loss).

### About the audio

Andre reads the written newsletter, adjusted for speech. Reference numbers are omitted from the recording; the written edition carries the citations.

AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.

This episode is general information and does not replace an assessment by your own clinician. If your hearing suddenly worsens over three days or less, seek medical assessment within 24 hours. [NICE guidance](https://www.nice.org.uk/guidance/ng98/chapter/recommendations).

]]> Karla said people were too loud. Everyday voices suddenly felt overwhelming after doctors put small tubes in her eardrums.

Our youngest had spent years struggling to hear us and tell us what she needed. She’s six now, and I’ve finally felt ready to write about it.

This episode follows her progress, our doubts about a bilingual kindergarten, and the conversations I want people to be able to follow at work and at home. My wrestling ears make an appearance too, along with an expensive pair of custom earphones that finally stayed in.

### In this episode

- Karla’s glue ear and the long wait for answers.
- A study of middle-aged adults with normal standard hearing tests, and what their pupils suggested about effort after listening in noise.
- The difference between hearing-related fatigue and the need to recover from a working day.
- What employees with hearing loss said made video meetings easier to follow.
- The ACHIEVE trial’s overall result and its often-quoted 48% subgroup result, with the comparison and limitations explained.
- Practical questions for a hearing appointment, and Karla starting first grade.

### Written edition and subscription

Find Under Load and subscribe at [andreheeg.com](https://www.andreheeg.com).

All 16 references are included in the written edition.

Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS, on executive health, longevity and sustained performance.

### Key sources

- [NICE guidance on glue ear in children](https://www.nice.org.uk/guidance/ng233/chapter/Recommendations) and [adult hearing assessment and care](https://www.nice.org.uk/guidance/ng98/chapter/recommendations).
- [MacKeith and colleagues, 2023](https://doi.org/10.1002/14651858.CD015215.pub2): the Cochrane review of ventilation tubes for children with glue ear.
- [Zink and colleagues, 2025](https://doi.org/10.7554/eLife.102823): listening effort in adults with normal standard hearing tests.
- [Holman and colleagues, 2021](https://doi.org/10.1177/23312165211052786), [van Leeuwen and colleagues, 2022](https://doi.org/10.1097/AUD.0000000000001127), and [Gussenhoven and colleagues, 2017](https://doi.org/10.1177/2331216517692304): fatigue and recovery outcomes across different study designs.
- [Marsja and colleagues, 2026](https://doi.org/10.1177/10519815251398498): interviews about access to video meetings for employees with hearing loss.
- [Ferguson and colleagues, 2026](https://doi.org/10.1002/14651858.CD012023.pub3): hearing aids for adults with mild to moderate hearing loss. [Ohlenforst and colleagues, 2017](https://doi.org/10.1097/AUD.0000000000000396) reviewed the separate outcome of listening effort.
- [Lin and colleagues, 2023](https://doi.org/10.1016/S0140-6736(23)01406-X): ACHIEVE, which tested hearing care against health education in older adults.
- [Cantuaria and colleagues, 2024](https://doi.org/10.1001/jamaoto.2023.3509): the observational Danish study of hearing loss and later dementia.
- [NIDCD guidance on noise-induced hearing loss](https://www.nidcd.nih.gov/health/noise-induced-hearing-loss).

### About the audio

Andre reads the written newsletter, adjusted for speech. Reference numbers are omitted from the recording; the written edition carries the citations.

AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.

This episode is general information and does not replace an assessment by your own clinician. If your hearing suddenly worsens over three days or less, seek medical assessment within 24 hours. [NICE guidance](https://www.nice.org.uk/guidance/ng98/chapter/recommendations).

]]> Sat, 12 Sep 2026 13:00:42 +0200 Andre Heeg Andre Heeg 892 Karla said people were too loud. Everyday voices suddenly felt overwhelming after doctors put small tubes in her eardrums.

Our youngest had spent years struggling to hear us and tell us what she needed. She’s six now, and I’ve finally felt ready to write about it.

This episode follows her progress, our doubts about a bilingual kindergarten, and the conversations I want people to be able to follow at work and at home. My wrestling ears make an appearance too, along with an expensive pair of custom earphones that finally stayed in.

### In this episode

- Karla’s glue ear and the long wait for answers.
- A study of middle-aged adults with normal standard hearing tests, and what their pupils suggested about effort after listening in noise.
- The difference between hearing-related fatigue and the need to recover from a working day.
- What employees with hearing loss said made video meetings easier to follow.
- The ACHIEVE trial’s overall result and its often-quoted 48% subgroup result, with the comparison and limitations explained.
- Practical questions for a hearing appointment, and Karla starting first grade.

### Written edition and subscription

Find Under Load and subscribe at [andreheeg.com](https://www.andreheeg.com).

All 16 references are included in the written edition.

Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS, on executive health, longevity and sustained performance.

### Key sources

- [NICE guidance on glue ear in children](https://www.nice.org.uk/guidance/ng233/chapter/Recommendations) and [adult hearing assessment and care](https://www.nice.org.uk/guidance/ng98/chapter/recommendations).
- [MacKeith and colleagues, 2023](https://doi.org/10.1002/14651858.CD015215.pub2): the Cochrane review of ventilation tubes for children with glue ear.
- [Zink and colleagues, 2025](https://doi.org/10.7554/eLife.102823): listening effort in adults with normal standard hearing tests.
- [Holman and colleagues, 2021](https://doi.org/10.1177/23312165211052786), [van Leeuwen and colleagues, 2022](https://doi.org/10.1097/AUD.0000000000001127), and [Gussenhoven and colleagues, 2017](https://doi.org/10.1177/2331216517692304): fatigue and recovery outcomes across different study designs.
- [Marsja and colleagues, 2026](https://doi.org/10.1177/10519815251398498): interviews about access to video meetings for employees with hearing loss.
- [Ferguson and colleagues, 2026](https://doi.org/10.1002/14651858.CD012023.pub3): hearing aids for adults with mild to moderate hearing loss. [Ohlenforst and colleagues, 2017](https://doi.org/10.1097/AUD.0000000000000396) reviewed the separate outcome of listening effort.
- [Lin and colleagues, 2023](https://doi.org/10.1016/S0140-6736(23)01406-X): ACHIEVE, which tested hearing care against health education in older adults.
- [Cantuaria and colleagues, 2024](https://doi.org/10.1001/jamaoto.2023.3509): the observational Danish study of hearing loss and later dementia.
- [NIDCD guidance on noise-induced hearing loss](https://www.nidcd.nih.gov/health/noise-induced-hearing-loss).

### About the audio

Andre reads the written newsletter, adjusted for speech. Reference numbers are omitted from the recording; the written edition carries the citations.

AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.

This episode is general information and does not replace an assessment by your own clinician. If your hearing suddenly worsens over three days or less, seek medical assessment within 24 hours. [NICE guidance](https://www.nice.org.uk/guidance/ng98/chapter/recommendations).

]]> hearing loss, listening effort, speech in noise, glue ear, otitis media with effusion, ear tubes, child speech development, bilingual children, hearing aids, hearing-related fatigue, recovery after work, video meetings, executive health, sustained performance, midlife hearing, cognitive decline, dementia, ACHIEVE trial, custom earphones, noise protection, The Upward ARC, Andre Heeg No Intermittent Fasting: What a Doctor Tells People Who Ask 6 6 Intermittent Fasting: What a Doctor Tells People Who Ask full fed92436-9719-4352-86ba-8fd84ea0512a https://share.transistor.fm/s/d7211405 I knocked a boiled egg against the table, and the crack cut through the silence.


We were at a hotel for a week of leadership training. The morning session started at eight o'clock, and so did my eating window, so I came in from the breakfast buffet with eggs and started breakfast in front of everyone.


I understand why the rule appeals. Pick your hours, and you have fewer decisions to make. The problem is expecting that one rule to deliver everything you have heard about fasting.


Two people asked my opinion in the last fortnight. My answer always starts with their goal, and this episode is that answer in full.


In this episode:


Why a year-long trial that gave everyone the same calorie target found the eating window worth an extra one point eight kilos, and why that number did not survive the statistics. I explain what the P value actually means, in plain language, because it is the part most coverage skips.


The trial that settled the timing question more directly, by handing both groups the same food for twelve weeks. The early ten-hour window produced no extra weight loss and no better blood sugar.


The stronger result almost nobody talks about. Four normal eating days a week, three days at about twenty percent of normal intake, and after a year, nearly three kilos more weight lost than daily calorie cutting. It is the version of fasting with the best evidence behind it, and it is the version nobody asking me about 16:8 has in mind.


Autophagy, which is why I came back to fasting in the first place. What the 2016 Nobel Prize was actually awarded for, what has been measured in human white blood cells since 2017, and why the hour figure in your fasting app has no human study underneath it.


What Krista Varady, who runs these trials for a living, says about the hours. It is the most honest sentence in the whole field.


Making weight at sixteen. Weeks of cutting calories, then broth, then nothing, then the sauna to sweat off the last kilogram. It worked. It also belongs to a part of wrestling's history that killed three healthy college wrestlers in the winter of 1997, and I say why that is a different thing from restricting the hours you eat.


Why my priorities changed. An unstable shoulder that has dislocated even after surgery, a back that complains when I skip two weeks of lifting, and what I now put ahead of any eating schedule.


How to read a claim about fasting and muscle, including the difference between a scan's fat-free mass and actual muscle, and why that distinction changes what a well-known twelve-month trial can tell you.


The afternoon crash, the workday test, and the three signs that mean you should stop running a window regardless of what the research says.


What the evidence really supports about finishing dinner before bed, including the trial that hit one of its two main outcomes and missed the other.


The correction. In May 2025 I was too sure about preserving lean mass, and I left out a mortality finding that was already sitting in my research notes. This episode gives the full picture.


Three things to try today, sorted by what you actually want.


Every study mentioned is fully referenced in the written edition at https://www.andreheeg.com

]]> I knocked a boiled egg against the table, and the crack cut through the silence.


We were at a hotel for a week of leadership training. The morning session started at eight o'clock, and so did my eating window, so I came in from the breakfast buffet with eggs and started breakfast in front of everyone.


I understand why the rule appeals. Pick your hours, and you have fewer decisions to make. The problem is expecting that one rule to deliver everything you have heard about fasting.


Two people asked my opinion in the last fortnight. My answer always starts with their goal, and this episode is that answer in full.


In this episode:


Why a year-long trial that gave everyone the same calorie target found the eating window worth an extra one point eight kilos, and why that number did not survive the statistics. I explain what the P value actually means, in plain language, because it is the part most coverage skips.


The trial that settled the timing question more directly, by handing both groups the same food for twelve weeks. The early ten-hour window produced no extra weight loss and no better blood sugar.


The stronger result almost nobody talks about. Four normal eating days a week, three days at about twenty percent of normal intake, and after a year, nearly three kilos more weight lost than daily calorie cutting. It is the version of fasting with the best evidence behind it, and it is the version nobody asking me about 16:8 has in mind.


Autophagy, which is why I came back to fasting in the first place. What the 2016 Nobel Prize was actually awarded for, what has been measured in human white blood cells since 2017, and why the hour figure in your fasting app has no human study underneath it.


What Krista Varady, who runs these trials for a living, says about the hours. It is the most honest sentence in the whole field.


Making weight at sixteen. Weeks of cutting calories, then broth, then nothing, then the sauna to sweat off the last kilogram. It worked. It also belongs to a part of wrestling's history that killed three healthy college wrestlers in the winter of 1997, and I say why that is a different thing from restricting the hours you eat.


Why my priorities changed. An unstable shoulder that has dislocated even after surgery, a back that complains when I skip two weeks of lifting, and what I now put ahead of any eating schedule.


How to read a claim about fasting and muscle, including the difference between a scan's fat-free mass and actual muscle, and why that distinction changes what a well-known twelve-month trial can tell you.


The afternoon crash, the workday test, and the three signs that mean you should stop running a window regardless of what the research says.


What the evidence really supports about finishing dinner before bed, including the trial that hit one of its two main outcomes and missed the other.


The correction. In May 2025 I was too sure about preserving lean mass, and I left out a mortality finding that was already sitting in my research notes. This episode gives the full picture.


Three things to try today, sorted by what you actually want.


Every study mentioned is fully referenced in the written edition at https://www.andreheeg.com

]]> Sat, 05 Sep 2026 22:41:22 +0200 Andre Heeg Andre Heeg 923 I knocked a boiled egg against the table, and the crack cut through the silence.


We were at a hotel for a week of leadership training. The morning session started at eight o'clock, and so did my eating window, so I came in from the breakfast buffet with eggs and started breakfast in front of everyone.


I understand why the rule appeals. Pick your hours, and you have fewer decisions to make. The problem is expecting that one rule to deliver everything you have heard about fasting.


Two people asked my opinion in the last fortnight. My answer always starts with their goal, and this episode is that answer in full.


In this episode:


Why a year-long trial that gave everyone the same calorie target found the eating window worth an extra one point eight kilos, and why that number did not survive the statistics. I explain what the P value actually means, in plain language, because it is the part most coverage skips.


The trial that settled the timing question more directly, by handing both groups the same food for twelve weeks. The early ten-hour window produced no extra weight loss and no better blood sugar.


The stronger result almost nobody talks about. Four normal eating days a week, three days at about twenty percent of normal intake, and after a year, nearly three kilos more weight lost than daily calorie cutting. It is the version of fasting with the best evidence behind it, and it is the version nobody asking me about 16:8 has in mind.


Autophagy, which is why I came back to fasting in the first place. What the 2016 Nobel Prize was actually awarded for, what has been measured in human white blood cells since 2017, and why the hour figure in your fasting app has no human study underneath it.


What Krista Varady, who runs these trials for a living, says about the hours. It is the most honest sentence in the whole field.


Making weight at sixteen. Weeks of cutting calories, then broth, then nothing, then the sauna to sweat off the last kilogram. It worked. It also belongs to a part of wrestling's history that killed three healthy college wrestlers in the winter of 1997, and I say why that is a different thing from restricting the hours you eat.


Why my priorities changed. An unstable shoulder that has dislocated even after surgery, a back that complains when I skip two weeks of lifting, and what I now put ahead of any eating schedule.


How to read a claim about fasting and muscle, including the difference between a scan's fat-free mass and actual muscle, and why that distinction changes what a well-known twelve-month trial can tell you.


The afternoon crash, the workday test, and the three signs that mean you should stop running a window regardless of what the research says.


What the evidence really supports about finishing dinner before bed, including the trial that hit one of its two main outcomes and missed the other.


The correction. In May 2025 I was too sure about preserving lean mass, and I left out a mortality finding that was already sitting in my research notes. This episode gives the full picture.


Three things to try today, sorted by what you actually want.


Every study mentioned is fully referenced in the written edition at https://www.andreheeg.com

]]> intermittent fasting, time-restricted eating, 16:8, autophagy, 4:3, fasting, alternate-day fasting, executive health, longevity, weight loss, muscle preservation, protein intake, meal timing, fasting and muscle, metabolic health, evidence-based medicine, No Cortisol Tests, Recovery, and Burnout: A Doctor Reads the Evidence 5 5 Cortisol Tests, Recovery, and Burnout: A Doctor Reads the Evidence full 2abec819-50f1-4900-b86f-b5de3196e3e8 https://share.transistor.fm/s/23edbe58 I slid twenty kilos onto each side of the bar and stepped under it.

Sixty kilos with the bar. Ten reps at that weight is a warm-up for me, the set I do without thinking about it. I got to five and had to rack it.

Nothing had gone wrong. I had slept badly, so I told myself that was the reason. Then it happened again the next week, and the week after.

I am a physician, so my first move was to go looking for a number that would explain it. That search is what this episode is about, and it ended somewhere I did not expect.

In this episode:

What the largest review of sleep loss and physical performance actually found, and the reason it could not explain my own morning. The review left out exactly the situation most working adults are in, which is worth knowing before you read the headline.

The 2003 study that changed how I think about my own judgment. People restricted to four or six hours in bed continued to see their performance decline for two straight weeks, while their sense of how tired they felt stopped changing. The researchers said they were largely unaware of it.

The drive home I have told almost nobody about. My wife asleep in the passenger seat, an hour of fighting to stay awake, and the ten or twenty seconds I do not remember.

Why I ordered a saliva cortisol test, and what a review of 190 studies says about whether cortisol can tell you anything about burnout.

Adrenal fatigue, and what two endocrinologists found when they went through fifty-eight studies looking for it.

You can now buy a cortisol curve as a stress score, and this is the part I want people to hear. The lab work behind those kits is real. Doctors use saliva cortisol to screen for Cushing's syndrome. The problem sits somewhere else entirely, and there is one question you can ask any company selling you a number.

Psychological detachment, which is the ordinary business of your mind leaving work the way your body does, and what the workplace data shows about who manages it and who does not.

The morning in our Berlin hallway when I could not put on my own socks, and what my wife said when I asked for help.

Why I would write The Upward ARC differently now than I did in May 2025. Activate, Recover, Capacity works as a loop rather than a list, and the difference matters more than I realized when I first published it.

The three kinds of capacity, and which one tends to go first.

Five things to try, including the one I do that no study has ever tested, clearly labeled as such.

If you have ever answered a bad stretch by adding more effort, this one is for you.

---

Read the written edition, with all 10 references:
https://www.andreheeg.com

Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.

Subscribe: https://www.andreheeg.com

---

Studies and sources discussed in this episode are listed in full in the written edition. Key ones:

Craven et al. (2022), Sports Medicine: effects of acute sleep loss on physical performance
Van Dongen et al. (2003), Sleep: the cumulative cost of additional wakefulness
Watson et al. (2015), Journal of Clinical Sleep Medicine: recommended amount of sleep for a healthy adult, AASM and Sleep Research Society consensus
Rothe et al. (2020), Neuroscience and Biobehavioral Reviews: cortisol in major depressive disorder and burnout
Cadegiani and Kater (2016), BMC Endocrine Disorders: adrenal fatigue does not exist
Norton et al. (2023), Comprehensive Psychoneuroendocrinology: reliability of diurnal salivary cortisol metrics
Wendsche and Lohmann-Haislah (2017), Frontiers in Psychology: antecedents and outcomes of detachment from work
Meeusen et al. (2013), Medicine and Science in Sports and Exercise: ECSS and ACSM joint consensus on overtraining syndrome
Albulescu et al. (2022), PLOS ONE: efficacy of micro-breaks for well-being and performance
Holt-Lunstad et al. (2010), PLOS Medicine: social relationships and mortality risk

---

This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.

AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.

Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor. If you are exhausted, sleeping badly, in pain, or worried about burnout, take it to your clinician rather than to a newsletter. If you are fighting to stay awake at the wheel, stop driving.

]]> I slid twenty kilos onto each side of the bar and stepped under it.

Sixty kilos with the bar. Ten reps at that weight is a warm-up for me, the set I do without thinking about it. I got to five and had to rack it.

Nothing had gone wrong. I had slept badly, so I told myself that was the reason. Then it happened again the next week, and the week after.

I am a physician, so my first move was to go looking for a number that would explain it. That search is what this episode is about, and it ended somewhere I did not expect.

In this episode:

What the largest review of sleep loss and physical performance actually found, and the reason it could not explain my own morning. The review left out exactly the situation most working adults are in, which is worth knowing before you read the headline.

The 2003 study that changed how I think about my own judgment. People restricted to four or six hours in bed continued to see their performance decline for two straight weeks, while their sense of how tired they felt stopped changing. The researchers said they were largely unaware of it.

The drive home I have told almost nobody about. My wife asleep in the passenger seat, an hour of fighting to stay awake, and the ten or twenty seconds I do not remember.

Why I ordered a saliva cortisol test, and what a review of 190 studies says about whether cortisol can tell you anything about burnout.

Adrenal fatigue, and what two endocrinologists found when they went through fifty-eight studies looking for it.

You can now buy a cortisol curve as a stress score, and this is the part I want people to hear. The lab work behind those kits is real. Doctors use saliva cortisol to screen for Cushing's syndrome. The problem sits somewhere else entirely, and there is one question you can ask any company selling you a number.

Psychological detachment, which is the ordinary business of your mind leaving work the way your body does, and what the workplace data shows about who manages it and who does not.

The morning in our Berlin hallway when I could not put on my own socks, and what my wife said when I asked for help.

Why I would write The Upward ARC differently now than I did in May 2025. Activate, Recover, Capacity works as a loop rather than a list, and the difference matters more than I realized when I first published it.

The three kinds of capacity, and which one tends to go first.

Five things to try, including the one I do that no study has ever tested, clearly labeled as such.

If you have ever answered a bad stretch by adding more effort, this one is for you.

---

Read the written edition, with all 10 references:
https://www.andreheeg.com

Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.

Subscribe: https://www.andreheeg.com

---

Studies and sources discussed in this episode are listed in full in the written edition. Key ones:

Craven et al. (2022), Sports Medicine: effects of acute sleep loss on physical performance
Van Dongen et al. (2003), Sleep: the cumulative cost of additional wakefulness
Watson et al. (2015), Journal of Clinical Sleep Medicine: recommended amount of sleep for a healthy adult, AASM and Sleep Research Society consensus
Rothe et al. (2020), Neuroscience and Biobehavioral Reviews: cortisol in major depressive disorder and burnout
Cadegiani and Kater (2016), BMC Endocrine Disorders: adrenal fatigue does not exist
Norton et al. (2023), Comprehensive Psychoneuroendocrinology: reliability of diurnal salivary cortisol metrics
Wendsche and Lohmann-Haislah (2017), Frontiers in Psychology: antecedents and outcomes of detachment from work
Meeusen et al. (2013), Medicine and Science in Sports and Exercise: ECSS and ACSM joint consensus on overtraining syndrome
Albulescu et al. (2022), PLOS ONE: efficacy of micro-breaks for well-being and performance
Holt-Lunstad et al. (2010), PLOS Medicine: social relationships and mortality risk

---

This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.

AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.

Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor. If you are exhausted, sleeping badly, in pain, or worried about burnout, take it to your clinician rather than to a newsletter. If you are fighting to stay awake at the wheel, stop driving.

]]> Sat, 29 Aug 2026 16:50:48 +0200 Andre Heeg Andre Heeg 963 I slid twenty kilos onto each side of the bar and stepped under it.

Sixty kilos with the bar. Ten reps at that weight is a warm-up for me, the set I do without thinking about it. I got to five and had to rack it.

Nothing had gone wrong. I had slept badly, so I told myself that was the reason. Then it happened again the next week, and the week after.

I am a physician, so my first move was to go looking for a number that would explain it. That search is what this episode is about, and it ended somewhere I did not expect.

In this episode:

What the largest review of sleep loss and physical performance actually found, and the reason it could not explain my own morning. The review left out exactly the situation most working adults are in, which is worth knowing before you read the headline.

The 2003 study that changed how I think about my own judgment. People restricted to four or six hours in bed continued to see their performance decline for two straight weeks, while their sense of how tired they felt stopped changing. The researchers said they were largely unaware of it.

The drive home I have told almost nobody about. My wife asleep in the passenger seat, an hour of fighting to stay awake, and the ten or twenty seconds I do not remember.

Why I ordered a saliva cortisol test, and what a review of 190 studies says about whether cortisol can tell you anything about burnout.

Adrenal fatigue, and what two endocrinologists found when they went through fifty-eight studies looking for it.

You can now buy a cortisol curve as a stress score, and this is the part I want people to hear. The lab work behind those kits is real. Doctors use saliva cortisol to screen for Cushing's syndrome. The problem sits somewhere else entirely, and there is one question you can ask any company selling you a number.

Psychological detachment, which is the ordinary business of your mind leaving work the way your body does, and what the workplace data shows about who manages it and who does not.

The morning in our Berlin hallway when I could not put on my own socks, and what my wife said when I asked for help.

Why I would write The Upward ARC differently now than I did in May 2025. Activate, Recover, Capacity works as a loop rather than a list, and the difference matters more than I realized when I first published it.

The three kinds of capacity, and which one tends to go first.

Five things to try, including the one I do that no study has ever tested, clearly labeled as such.

If you have ever answered a bad stretch by adding more effort, this one is for you.

---

Read the written edition, with all 10 references:
https://www.andreheeg.com

Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.

Subscribe: https://www.andreheeg.com

---

Studies and sources discussed in this episode are listed in full in the written edition. Key ones:

Craven et al. (2022), Sports Medicine: effects of acute sleep loss on physical performance
Van Dongen et al. (2003), Sleep: the cumulative cost of additional wakefulness
Watson et al. (2015), Journal of Clinical Sleep Medicine: recommended amount of sleep for a healthy adult, AASM and Sleep Research Society consensus
Rothe et al. (2020), Neuroscience and Biobehavioral Reviews: cortisol in major depressive disorder and burnout
Cadegiani and Kater (2016), BMC Endocrine Disorders: adrenal fatigue does not exist
Norton et al. (2023), Comprehensive Psychoneuroendocrinology: reliability of diurnal salivary cortisol metrics
Wendsche and Lohmann-Haislah (2017), Frontiers in Psychology: antecedents and outcomes of detachment from work
Meeusen et al. (2013), Medicine and Science in Sports and Exercise: ECSS and ACSM joint consensus on overtraining syndrome
Albulescu et al. (2022), PLOS ONE: efficacy of micro-breaks for well-being and performance
Holt-Lunstad et al. (2010), PLOS Medicine: social relationships and mortality risk

---

This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.

AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.

Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor. If you are exhausted, sleeping badly, in pain, or worried about burnout, take it to your clinician rather than to a newsletter. If you are fighting to stay awake at the wheel, stop driving.

]]> cortisol, cortisol test, salivary cortisol, cortisol curve, adrenal fatigue, burnout, burnout biomarker, stress test, chronic stress, sleep deprivation, sleep debt, sleep and performance, recovery, overtraining, psychological detachment, work stress, executive health, longevity, evidence-based medicine, wearables, health tracking, The Upward ARC, Andre Heeg No Glucose Monitors Without Diabetes: A Doctor Reads the Evidence 4 4 Glucose Monitors Without Diabetes: A Doctor Reads the Evidence full fb00bc2b-16e3-4eaa-a70b-b41c16d88803 https://share.transistor.fm/s/64abf75a I walked up to the booth at CES ready to buy a glucose monitor.


Bright lights, shiny counters, staff handing out little treats and packets of electrolyte powder. Six figures of trade-show budget, probably more, and it showed.


I had just come from the panel. Two people I respect had talked about wearing one of these, and after three years of doubt I was ready to try it and later speak from experience.


So I asked the person selling it one question. What does this do for a healthy person with no blood sugar problem?


I never got an answer I could use. I left with the electrolyte powder and no monitor.


Then I went and read the evidence.


In this episode:


The study that changed how I think about this whole category. Eighteen experts in continuous glucose monitoring were handed twenty reports from adults without diabetes and asked a simple question: would you call this person back? All eighteen agreed on three of the twenty.


What the same authors said about interpreting these reports in people who do not have diabetes, which is the sentence that should give any healthy buyer pause.


How much time a genuinely healthy adult spends above the line your app calls a spike. The number surprised me, and it reframes what the alert on your phone is actually telling you.


Why the device may be reading high in the first place, what a smoothie company has to do with that finding, and why I still find that sentence funny.


Where this technology genuinely earns its place, because it does. A review published in JAMA Internal Medicine three weeks before this episode is clear about the patients who benefit, and I am not interested in pretending otherwise.


Prediabetes, which is a real exception rather than a hedge, and where the evidence points differently.


The strongest argument for wearing one, taken seriously, and what twenty-five randomized trials found when they tested it.


My own numbers, the tablet I take every morning, and why I am comfortable measuring one thing and not the other. That is the whole test, and I apply it to myself before I apply it to anyone else.


And a colleague's unopened blister of patches on a shared desk, which is the shortest version of this entire argument.


If you are weighing whether to buy one of these, there is a four-item test near the end that will take you about five minutes and may save you the money.


---


Read the written edition, with all 16 references:


https://www.andreheeg.com


Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.


Subscribe: https://www.andreheeg.com


---


Studies and sources discussed in this episode are listed in full in the written edition. Key ones:


Dower et al. (2026), JAMA Internal Medicine: continuous glucose monitoring in type 2 diabetes and beyond


Spartano et al. (2025), Journal of Diabetes Science and Technology: expert interpretation of CGM reports from people without diabetes


Spartano et al. (2025), Journal of Clinical Endocrinology and Metabolism: defining CGM time in range in a community cohort without diabetes


Shah et al. (2019), Journal of Clinical Endocrinology and Metabolism: CGM profiles in healthy nondiabetic participants


Hutchins et al. (2025), American Journal of Clinical Nutrition: continuous glucose monitor overestimates glycemia


Liao et al. (2026), European Journal of Medical Research: CGM in non-diabetic populations


Richardson et al. (2024), International Journal of Behavioral Nutrition and Physical Activity: CGM as a behaviour change tool


Hall et al. (2020), Journal of General Internal Medicine: thiazide diuretics and fasting plasma glucose


U.S. Food and Drug Administration (2024), 510(k) K233655: Lingo Glucose System


---


This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.


AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.


Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor. If you have diabetes, prediabetes, symptoms, or another metabolic risk, take this question to your clinician rather than to a newsletter.


]]> I walked up to the booth at CES ready to buy a glucose monitor.


Bright lights, shiny counters, staff handing out little treats and packets of electrolyte powder. Six figures of trade-show budget, probably more, and it showed.


I had just come from the panel. Two people I respect had talked about wearing one of these, and after three years of doubt I was ready to try it and later speak from experience.


So I asked the person selling it one question. What does this do for a healthy person with no blood sugar problem?


I never got an answer I could use. I left with the electrolyte powder and no monitor.


Then I went and read the evidence.


In this episode:


The study that changed how I think about this whole category. Eighteen experts in continuous glucose monitoring were handed twenty reports from adults without diabetes and asked a simple question: would you call this person back? All eighteen agreed on three of the twenty.


What the same authors said about interpreting these reports in people who do not have diabetes, which is the sentence that should give any healthy buyer pause.


How much time a genuinely healthy adult spends above the line your app calls a spike. The number surprised me, and it reframes what the alert on your phone is actually telling you.


Why the device may be reading high in the first place, what a smoothie company has to do with that finding, and why I still find that sentence funny.


Where this technology genuinely earns its place, because it does. A review published in JAMA Internal Medicine three weeks before this episode is clear about the patients who benefit, and I am not interested in pretending otherwise.


Prediabetes, which is a real exception rather than a hedge, and where the evidence points differently.


The strongest argument for wearing one, taken seriously, and what twenty-five randomized trials found when they tested it.


My own numbers, the tablet I take every morning, and why I am comfortable measuring one thing and not the other. That is the whole test, and I apply it to myself before I apply it to anyone else.


And a colleague's unopened blister of patches on a shared desk, which is the shortest version of this entire argument.


If you are weighing whether to buy one of these, there is a four-item test near the end that will take you about five minutes and may save you the money.


---


Read the written edition, with all 16 references:


https://www.andreheeg.com


Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.


Subscribe: https://www.andreheeg.com


---


Studies and sources discussed in this episode are listed in full in the written edition. Key ones:


Dower et al. (2026), JAMA Internal Medicine: continuous glucose monitoring in type 2 diabetes and beyond


Spartano et al. (2025), Journal of Diabetes Science and Technology: expert interpretation of CGM reports from people without diabetes


Spartano et al. (2025), Journal of Clinical Endocrinology and Metabolism: defining CGM time in range in a community cohort without diabetes


Shah et al. (2019), Journal of Clinical Endocrinology and Metabolism: CGM profiles in healthy nondiabetic participants


Hutchins et al. (2025), American Journal of Clinical Nutrition: continuous glucose monitor overestimates glycemia


Liao et al. (2026), European Journal of Medical Research: CGM in non-diabetic populations


Richardson et al. (2024), International Journal of Behavioral Nutrition and Physical Activity: CGM as a behaviour change tool


Hall et al. (2020), Journal of General Internal Medicine: thiazide diuretics and fasting plasma glucose


U.S. Food and Drug Administration (2024), 510(k) K233655: Lingo Glucose System


---


This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.


AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.


Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor. If you have diabetes, prediabetes, symptoms, or another metabolic risk, take this question to your clinician rather than to a newsletter.


]]> Sat, 22 Aug 2026 11:59:15 +0200 Andre Heeg Andre Heeg 1020 I walked up to the booth at CES ready to buy a glucose monitor.


Bright lights, shiny counters, staff handing out little treats and packets of electrolyte powder. Six figures of trade-show budget, probably more, and it showed.


I had just come from the panel. Two people I respect had talked about wearing one of these, and after three years of doubt I was ready to try it and later speak from experience.


So I asked the person selling it one question. What does this do for a healthy person with no blood sugar problem?


I never got an answer I could use. I left with the electrolyte powder and no monitor.


Then I went and read the evidence.


In this episode:


The study that changed how I think about this whole category. Eighteen experts in continuous glucose monitoring were handed twenty reports from adults without diabetes and asked a simple question: would you call this person back? All eighteen agreed on three of the twenty.


What the same authors said about interpreting these reports in people who do not have diabetes, which is the sentence that should give any healthy buyer pause.


How much time a genuinely healthy adult spends above the line your app calls a spike. The number surprised me, and it reframes what the alert on your phone is actually telling you.


Why the device may be reading high in the first place, what a smoothie company has to do with that finding, and why I still find that sentence funny.


Where this technology genuinely earns its place, because it does. A review published in JAMA Internal Medicine three weeks before this episode is clear about the patients who benefit, and I am not interested in pretending otherwise.


Prediabetes, which is a real exception rather than a hedge, and where the evidence points differently.


The strongest argument for wearing one, taken seriously, and what twenty-five randomized trials found when they tested it.


My own numbers, the tablet I take every morning, and why I am comfortable measuring one thing and not the other. That is the whole test, and I apply it to myself before I apply it to anyone else.


And a colleague's unopened blister of patches on a shared desk, which is the shortest version of this entire argument.


If you are weighing whether to buy one of these, there is a four-item test near the end that will take you about five minutes and may save you the money.


---


Read the written edition, with all 16 references:


https://www.andreheeg.com


Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.


Subscribe: https://www.andreheeg.com


---


Studies and sources discussed in this episode are listed in full in the written edition. Key ones:


Dower et al. (2026), JAMA Internal Medicine: continuous glucose monitoring in type 2 diabetes and beyond


Spartano et al. (2025), Journal of Diabetes Science and Technology: expert interpretation of CGM reports from people without diabetes


Spartano et al. (2025), Journal of Clinical Endocrinology and Metabolism: defining CGM time in range in a community cohort without diabetes


Shah et al. (2019), Journal of Clinical Endocrinology and Metabolism: CGM profiles in healthy nondiabetic participants


Hutchins et al. (2025), American Journal of Clinical Nutrition: continuous glucose monitor overestimates glycemia


Liao et al. (2026), European Journal of Medical Research: CGM in non-diabetic populations


Richardson et al. (2024), International Journal of Behavioral Nutrition and Physical Activity: CGM as a behaviour change tool


Hall et al. (2020), Journal of General Internal Medicine: thiazide diuretics and fasting plasma glucose


U.S. Food and Drug Administration (2024), 510(k) K233655: Lingo Glucose System


---


This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.


AI assisted with research, drafting and adapting this piece for different formats. I chose the argument and examples, reviewed the evidence, edited the final text and take responsibility for every published claim.


Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor. If you have diabetes, prediabetes, symptoms, or another metabolic risk, take this question to your clinician rather than to a newsletter.


]]> continuous glucose monitor, CGM, glucose monitor, blood sugar, glucose spike, Lingo, Dexcom, FreeStyle Libre, Abbott, wearables, biosensors, metabolic health, prediabetes, HbA1c, fasting glucose, glycemic index, quantified self, health tracking, evidence-based medicine, nutrition science, longevity, executive health, JAMA Internal Medicine, Framingham No Seed Oils: I Read Both Sides, Including the Trials Nobody Quotes 3 3 Seed Oils: I Read Both Sides, Including the Trials Nobody Quotes full 0a2db054-0b29-4e8e-b04f-8421c4141895 https://share.transistor.fm/s/ec03dbca I drank butter for breakfast for two years. Two tablespoons, blended into coffee, standing at the kitchen counter before anyone else was awake.


I have a medical degree and a dental one. I did it because someone on a podcast explained the science, and it made sense to me at the time.


These things always seem to make sense at first. That is the real problem.


After butter came MCT oil, then coconut, then ghee, then olive. Five phases over fifteen years, each with its own expert, its own mechanism, and a fat I was told to avoid. The current villain is seed oils, and lately more executives have asked me about them than about anything else.


So I read both sides properly, including the arguments I expected to disagree with.


In this edition:


Why the critics are right about the biology. Linoleic acid really is stored in your cell membranes and your body fat, and its share of American adipose tissue roughly doubled between 1959 and 2008. That part is not in dispute.


Where the chain breaks. The one time anyone tested the DNA claim in living people, and what they actually found.


The omega-6 to omega-3 ratio, and why the study everybody cites points somewhere other than where they think it does.


The two randomized trials that should trouble anyone who believes this question is settled, including the one where more of the intervention group died. I do not soften it, and I explain why the margarine explanation the internet reaches for was rejected by the trial's own authors.


Why the cohort studies and the randomized trials disagree with each other, and what each design can and cannot tell you. This is the part of clinical training that transfers to reading any study.


Two of my own phases that turned out badly, including the one where I made things more concentrated while believing I had made them lighter.


And a hallway outside a wrestling dormitory, which is where this piece actually starts, and where it ends.


If you have ever thrown out a bottle of oil because of something you heard, there is a section on where cooking fat actually sits in your diet that will probably annoy you.


---


Read the written edition, with all 16 references:

https://www.andreheeg.com


Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.


Subscribe: https://www.andreheeg.com


---


Studies and sources discussed in this episode are listed in full in the written edition. Key ones:


Guyenet & Carlson (2015), Advances in Nutrition: the rise in adipose linoleic acid across 37 studies

de Kok et al. (2003), Food and Chemical Toxicology: the human trial of linoleic acid and oxidative DNA damage

Zhang et al. (2024), eLife: omega-6, omega-3 and mortality in 85,425 UK Biobank adults

Hooper et al. (2018), Cochrane Database of Systematic Reviews: omega-6 fats and cardiovascular disease

Ramsden et al. (2016), BMJ: recovered data from the Minnesota Coronary Experiment

Ramsden et al. (2013), BMJ: recovered data from the Sydney Diet Heart Study

Zhang et al. (2025), JAMA Internal Medicine: butter, plant oils and mortality

Hall et al. (2019), Cell Metabolism: the inpatient ultra-processed food trial


---


This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.


I use AI to research and pressure-test the science. The thinking, the conclusions, and the writing are always mine.


Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor.

]]> I drank butter for breakfast for two years. Two tablespoons, blended into coffee, standing at the kitchen counter before anyone else was awake.


I have a medical degree and a dental one. I did it because someone on a podcast explained the science, and it made sense to me at the time.


These things always seem to make sense at first. That is the real problem.


After butter came MCT oil, then coconut, then ghee, then olive. Five phases over fifteen years, each with its own expert, its own mechanism, and a fat I was told to avoid. The current villain is seed oils, and lately more executives have asked me about them than about anything else.


So I read both sides properly, including the arguments I expected to disagree with.


In this edition:


Why the critics are right about the biology. Linoleic acid really is stored in your cell membranes and your body fat, and its share of American adipose tissue roughly doubled between 1959 and 2008. That part is not in dispute.


Where the chain breaks. The one time anyone tested the DNA claim in living people, and what they actually found.


The omega-6 to omega-3 ratio, and why the study everybody cites points somewhere other than where they think it does.


The two randomized trials that should trouble anyone who believes this question is settled, including the one where more of the intervention group died. I do not soften it, and I explain why the margarine explanation the internet reaches for was rejected by the trial's own authors.


Why the cohort studies and the randomized trials disagree with each other, and what each design can and cannot tell you. This is the part of clinical training that transfers to reading any study.


Two of my own phases that turned out badly, including the one where I made things more concentrated while believing I had made them lighter.


And a hallway outside a wrestling dormitory, which is where this piece actually starts, and where it ends.


If you have ever thrown out a bottle of oil because of something you heard, there is a section on where cooking fat actually sits in your diet that will probably annoy you.


---


Read the written edition, with all 16 references:

https://www.andreheeg.com


Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.


Subscribe: https://www.andreheeg.com


---


Studies and sources discussed in this episode are listed in full in the written edition. Key ones:


Guyenet & Carlson (2015), Advances in Nutrition: the rise in adipose linoleic acid across 37 studies

de Kok et al. (2003), Food and Chemical Toxicology: the human trial of linoleic acid and oxidative DNA damage

Zhang et al. (2024), eLife: omega-6, omega-3 and mortality in 85,425 UK Biobank adults

Hooper et al. (2018), Cochrane Database of Systematic Reviews: omega-6 fats and cardiovascular disease

Ramsden et al. (2016), BMJ: recovered data from the Minnesota Coronary Experiment

Ramsden et al. (2013), BMJ: recovered data from the Sydney Diet Heart Study

Zhang et al. (2025), JAMA Internal Medicine: butter, plant oils and mortality

Hall et al. (2019), Cell Metabolism: the inpatient ultra-processed food trial


---


This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.


I use AI to research and pressure-test the science. The thinking, the conclusions, and the writing are always mine.


Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor.

]]> Thu, 13 Aug 2026 16:57:40 +0200 Andre Heeg Andre Heeg 1104 I drank butter for breakfast for two years. Two tablespoons, blended into coffee, standing at the kitchen counter before anyone else was awake.


I have a medical degree and a dental one. I did it because someone on a podcast explained the science, and it made sense to me at the time.


These things always seem to make sense at first. That is the real problem.


After butter came MCT oil, then coconut, then ghee, then olive. Five phases over fifteen years, each with its own expert, its own mechanism, and a fat I was told to avoid. The current villain is seed oils, and lately more executives have asked me about them than about anything else.


So I read both sides properly, including the arguments I expected to disagree with.


In this edition:


Why the critics are right about the biology. Linoleic acid really is stored in your cell membranes and your body fat, and its share of American adipose tissue roughly doubled between 1959 and 2008. That part is not in dispute.


Where the chain breaks. The one time anyone tested the DNA claim in living people, and what they actually found.


The omega-6 to omega-3 ratio, and why the study everybody cites points somewhere other than where they think it does.


The two randomized trials that should trouble anyone who believes this question is settled, including the one where more of the intervention group died. I do not soften it, and I explain why the margarine explanation the internet reaches for was rejected by the trial's own authors.


Why the cohort studies and the randomized trials disagree with each other, and what each design can and cannot tell you. This is the part of clinical training that transfers to reading any study.


Two of my own phases that turned out badly, including the one where I made things more concentrated while believing I had made them lighter.


And a hallway outside a wrestling dormitory, which is where this piece actually starts, and where it ends.


If you have ever thrown out a bottle of oil because of something you heard, there is a section on where cooking fat actually sits in your diet that will probably annoy you.


---


Read the written edition, with all 16 references:

https://www.andreheeg.com


Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.


Subscribe: https://www.andreheeg.com


---


Studies and sources discussed in this episode are listed in full in the written edition. Key ones:


Guyenet & Carlson (2015), Advances in Nutrition: the rise in adipose linoleic acid across 37 studies

de Kok et al. (2003), Food and Chemical Toxicology: the human trial of linoleic acid and oxidative DNA damage

Zhang et al. (2024), eLife: omega-6, omega-3 and mortality in 85,425 UK Biobank adults

Hooper et al. (2018), Cochrane Database of Systematic Reviews: omega-6 fats and cardiovascular disease

Ramsden et al. (2016), BMJ: recovered data from the Minnesota Coronary Experiment

Ramsden et al. (2013), BMJ: recovered data from the Sydney Diet Heart Study

Zhang et al. (2025), JAMA Internal Medicine: butter, plant oils and mortality

Hall et al. (2019), Cell Metabolism: the inpatient ultra-processed food trial


---


This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.


I use AI to research and pressure-test the science. The thinking, the conclusions, and the writing are always mine.


Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor.

]]> seed oils, linoleic acid, omega-6, omega-3, canola oil, olive oil, coconut oil, ghee, saturated fat, cholesterol, Paul Saladino, ultra-processed food, nutrition science, evidence-based medicine, longevity, executive health, UK Biobank, Cochrane review No BPC-157: The Peptide I Almost Injected 2 2 BPC-157: The Peptide I Almost Injected full d51d934d-6ca7-4b01-9c2f-977c8750736e https://share.transistor.fm/s/4dd5abca In August 2024 I was at the worst point of eighteen months of back pain. My wife was putting my socks on for me. I was half-listening to a podcast when I heard a Stanford neuroscientist mention a compound called BPC-157.


That afternoon I was on a vendor's website with a bank transfer form open.


I never bought it, and the reason is embarrassing rather than admirable. This episode is about what happened next, and about why nobody can answer the question I now get asked every week: are peptides safe?


In this edition:


Why "peptide" is a measurement rather than a category of medicine, and how a line drawn at 40 amino acids decides paperwork instead of safety. Insulin is a peptide. So is Ozempic. So is the compound in that vial.


What the FDA advisory panel actually did on July 23, and why the answer is closer to nothing than the headlines suggested.


What the human evidence for BPC-157 really consists of, and why almost all of it comes from one laboratory in Zagreb whose founder has never published a key part of his own work.


The trials registry problem, where searching for evidence today returns Phase 2 studies marked "recruiting" that state inside their own records that they are fictional.


The stacks, the marketing, and what a physician sees when a bundle of untested compounds gets named after a comic book character.


And a section I did not plan to write, about the prescriptions I refuse to sign, and what years of operating on cancers of the mouth taught me about the phrase "at your own risk."


If you are already taking something, there is one part I would want you to hear before the rest. It is about blood vessels.


---


Read the written edition, with all 25 references:

https://www.andreheeg.com


Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.


Subscribe: https://www.andreheeg.com


---


Studies and sources discussed in this episode are listed in full in the written edition. Key ones:


Vasireddi et al. (2025), HSS Journal — systematic review of BPC-157 in orthopaedic sports medicine

Józwiak et al. (2025), Pharmaceuticals — literature and patent review, and the published exchange with Sikirić

Talpos, S. (2026), Undark Magazine — reporting on the unpublished parent sequence

Ashraf et al. (2024), Journal of Medical Internet Research — quality analysis of semaglutide bought from online sellers

Huberman Lab (June 2026) — Peptides: The Science, Uses & Safety, with Dr. Abud Bakri


---


This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.


I use AI to research and pressure-test the science. The thinking, the conclusions, and the writing are always mine.


Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor.

]]> In August 2024 I was at the worst point of eighteen months of back pain. My wife was putting my socks on for me. I was half-listening to a podcast when I heard a Stanford neuroscientist mention a compound called BPC-157.


That afternoon I was on a vendor's website with a bank transfer form open.


I never bought it, and the reason is embarrassing rather than admirable. This episode is about what happened next, and about why nobody can answer the question I now get asked every week: are peptides safe?


In this edition:


Why "peptide" is a measurement rather than a category of medicine, and how a line drawn at 40 amino acids decides paperwork instead of safety. Insulin is a peptide. So is Ozempic. So is the compound in that vial.


What the FDA advisory panel actually did on July 23, and why the answer is closer to nothing than the headlines suggested.


What the human evidence for BPC-157 really consists of, and why almost all of it comes from one laboratory in Zagreb whose founder has never published a key part of his own work.


The trials registry problem, where searching for evidence today returns Phase 2 studies marked "recruiting" that state inside their own records that they are fictional.


The stacks, the marketing, and what a physician sees when a bundle of untested compounds gets named after a comic book character.


And a section I did not plan to write, about the prescriptions I refuse to sign, and what years of operating on cancers of the mouth taught me about the phrase "at your own risk."


If you are already taking something, there is one part I would want you to hear before the rest. It is about blood vessels.


---


Read the written edition, with all 25 references:

https://www.andreheeg.com


Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.


Subscribe: https://www.andreheeg.com


---


Studies and sources discussed in this episode are listed in full in the written edition. Key ones:


Vasireddi et al. (2025), HSS Journal — systematic review of BPC-157 in orthopaedic sports medicine

Józwiak et al. (2025), Pharmaceuticals — literature and patent review, and the published exchange with Sikirić

Talpos, S. (2026), Undark Magazine — reporting on the unpublished parent sequence

Ashraf et al. (2024), Journal of Medical Internet Research — quality analysis of semaglutide bought from online sellers

Huberman Lab (June 2026) — Peptides: The Science, Uses & Safety, with Dr. Abud Bakri


---


This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.


I use AI to research and pressure-test the science. The thinking, the conclusions, and the writing are always mine.


Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor.

]]> Wed, 05 Aug 2026 13:35:39 +0200 Andre Heeg Andre Heeg 1228 In August 2024 I was at the worst point of eighteen months of back pain. My wife was putting my socks on for me. I was half-listening to a podcast when I heard a Stanford neuroscientist mention a compound called BPC-157.


That afternoon I was on a vendor's website with a bank transfer form open.


I never bought it, and the reason is embarrassing rather than admirable. This episode is about what happened next, and about why nobody can answer the question I now get asked every week: are peptides safe?


In this edition:


Why "peptide" is a measurement rather than a category of medicine, and how a line drawn at 40 amino acids decides paperwork instead of safety. Insulin is a peptide. So is Ozempic. So is the compound in that vial.


What the FDA advisory panel actually did on July 23, and why the answer is closer to nothing than the headlines suggested.


What the human evidence for BPC-157 really consists of, and why almost all of it comes from one laboratory in Zagreb whose founder has never published a key part of his own work.


The trials registry problem, where searching for evidence today returns Phase 2 studies marked "recruiting" that state inside their own records that they are fictional.


The stacks, the marketing, and what a physician sees when a bundle of untested compounds gets named after a comic book character.


And a section I did not plan to write, about the prescriptions I refuse to sign, and what years of operating on cancers of the mouth taught me about the phrase "at your own risk."


If you are already taking something, there is one part I would want you to hear before the rest. It is about blood vessels.


---


Read the written edition, with all 25 references:

https://www.andreheeg.com


Under Load is the Sunday edition of The Upward ARC, written by Andre Heeg, MD, DDS. Evidence-led writing on executive health, longevity and performance under load, for people carrying real responsibility.


Subscribe: https://www.andreheeg.com


---


Studies and sources discussed in this episode are listed in full in the written edition. Key ones:


Vasireddi et al. (2025), HSS Journal — systematic review of BPC-157 in orthopaedic sports medicine

Józwiak et al. (2025), Pharmaceuticals — literature and patent review, and the published exchange with Sikirić

Talpos, S. (2026), Undark Magazine — reporting on the unpublished parent sequence

Ashraf et al. (2024), Journal of Medical Internet Research — quality analysis of semaglutide bought from online sellers

Huberman Lab (June 2026) — Peptides: The Science, Uses & Safety, with Dr. Abud Bakri


---


This episode is me reading the written newsletter, adjusted for the spoken word. Figures are rounded and citations are left out; everything is fully referenced in the written edition.


I use AI to research and pressure-test the science. The thinking, the conclusions, and the writing are always mine.


Nothing here is medical advice, and it is not a substitute for a conversation with your own doctor.

]]> BPC-157, peptides, TB-500, GLP-1, semaglutide, tirzepatide, FDA, compounding pharmacy, longevity, executive health, Andrew Huberman, Joe Rogan, gray market, sports medicine, evidence-based medicine No I Couldn't Remember My Password. That Was the Best News of the Trip. 1 1 I Couldn't Remember My Password. That Was the Best News of the Trip. full f58b28e7-5f33-47f3-bd41-5f192863bcf9 https://share.transistor.fm/s/4e2927f0 Sat, 01 Aug 2026 22:44:05 +0200 Andre Heeg Andre Heeg 975 executive health, longevity, performance No