#411 ‒ AMA #90: Strong convictions, loosely held: how Peter's views on fasting, keto, metformin, rapamycin, whole-body MRI, and exercise have changed

Revisiting foundational positions after 400 episodes requires a "strong convictions, loosely held" framework, where scientific progress and clinical experience dictate shifts in perspective. Nutritional strategies, specifically ketogenic diets, have evolved from a focus on insulin suppression to an understanding of their role in managing energy intake and satiety. Similarly, the rationale for extended fasting as a longevity intervention—primarily driven by the potential for autophagy—has become more nuanced as data on the necessity and duration of these fasts emerge. Maintaining intellectual flexibility remains essential, as rigid adherence to past models hinders progress when faced with contradictory evidence from literature, patient outcomes, and expert insights. This reflective process ensures that health-related practices remain grounded in the most current, evidence-based understanding rather than relying on outdated assumptions.