: Steve talks about growing up in Tampa and playing sports as a kid.

: Dawn asks Steve about his decision to attend Florida State after high school.

: Dawn comments on how Steve bounced between medicine, business, and psychology before finally deciding to major in psychology. She asks if having two parents who were also psychologists played a role in his decision.

: Ken asks about Steven’s experience pursuing his Ph.D. at the University of Florida.

: Dawn brings up that Steve became a fellow of behavioral medicine at the Pennington Biomedical Research Center in Baton Rouge, La. She mentions that Pennington has one of the nation’s premier programs in obesity metabolism and diabetes. She asks if that was the reason he decided on Pennington.

: Dawn asks what prompted Steve to return to the University of Florida.

: Ken asks what is driving the increased prevalence of metabolic syndrome that’s associated with advanced age.

: Dawn brings up how hospitals have tried to promote health and wellness programs for decades, but notes how hospitals are designed to treat people who are sick and injured rather than delivering lifestyle interventions. She asks if Steve can give a summary of what he has learned in looking at ways to deliver interventions.

: Dawn mentions that the traditional treatment and management approaches for type 2 diabetes are relatively ineffective and only reverse the disease in about one percent of the cases.

: Ken mentions that Jeff Volek, STEM-Talk Guest on episode 43, has been a pioneer in researching type 2 diabetes.

: Dawn points out that she and Ken had an in-depth conversation with Dr. Mark Matson about autophagy on episode seven of STEM-Talk. Matson also discussed fasting, and intermittent energy restriction and how it promotes autophagy, which is often described as the body’s innate recycling system. Dawn asks if Steve can elaborate a little on this process.

: Dawn mentions that Steve has written about muscle quality and body composition and the risk of metabolic diseases and functional decline. She asks about the relationship between muscle quality, body fat and health.

: Dawn asks if Steve can talk about how the age-related loss of muscle function and mass often lead to sarcopenia, and how this condition effects the individual and society.

: Ken asks for Steve’s thoughts on the group of people who could be classified as having “pre-sarcopenia.” Ken mentions his interest in this group given that dietary and exercise intervention can still make a huge difference in their lives.

: Dawn brings up the point of how testosterone tends to decline as men age, which is associated with a number of adverse health problems, including: cardiovascular and metabolic disease, sexual dysfunction, and mood disorders. Dawn asks about Steve’s study on the effects of testosterone supplementation in older men, and about the risks and benefits of supplementation.

: Dawn asks if Steve can describe the difference between muscle quality and quantity, and if there is an easy way we can track and measure muscle quality.

: Ken asks how we should be thinking about pharmaceutical therapies in these conditions as the field goes forward; given that so many new pharmaceuticals are in various stages of development, and that many of the currently available pharmaceutical approaches to age-related muscle loss have, to date, been effective at increasing muscle mass but not necessarily function.

: Dawn asks what exercise methods Steve recommends for optimal, long-term health.

: Dawn mentions that in 2016 a team of Spanish and Italian researchers published an article in the prestigious journal, Nature, showing that autophagy is a critical regulator of stem-cell fate and has implications for fostering muscle regeneration and sarcopenia as well as other disorders. She goes on to mention that autophagy typically declines with age, and this may be because stem cells start to lose their “steminess,” and become senescent (the loss of a cell’s power of division and growth). She goes on to ask about fasting and ketogenic diets, and how both interventions increase autophagy and could account for the common benefits we see in both of those interventions.

: Dawn asks about the emerging concept of normal-weight obesity.

: Ken asks about the consequences and challenges of sarcopenic obesity.

: Dawn mentions that a growing body of evidence strongly indicates that chronic systemic low-grade inflammation plays a significant role in contributing to sarcopenia and associated functional decline. She goes on to say that preserving muscle and mobility is essential to maintaining a high quality of life as we age. She asks Steve what promising therapeutic approaches are out there that can potentially help avert systemic inflammation that’s associated with aging.

: Dawn asks what the connection is between body fat and inflammation.

: Dawn asks about the phenomenon that inflammation seems to be central to many lifestyle-related chronic diseases.

: Dawn mentions that exercise has anti-inflammatory effects and asks if we should be considering anti-inflammatory intervention strategies as a starting point.

: Ken mentions that Steve has a paper published in the obesity journal titled “Flipping the Metabolic Switch,” a study which looked at intermittent fasting and suggested that the metabolic switch into ketosis represents an evolutionary conserved trigger point that shifts metabolism to the mobilization of fat through fatty-acid oxidation and fatty-acid derived ketones. This mobilization shows that intermittent fasting regimes that induce ketosis have the potential to improve body composition in overweight individuals. He asks how the review was designed and what was learned.

: Ken comments on how this whole discussion of intermittent fasting and the resulting elevated level of ketone bodies leads one to wonder whether exogenous ketones such as esters would recapitulate some of the effects of fasting or the ketogenic diet.

: Dawn mentions that from religious to medical practices, fasting has been performed for thousands of years, dating back to the Greeks, Romans, and Chinese. She asks if Steve could give an overview of the history of fasting and also why so many researchers and scientists today are taking a renewed interest in episodic caloric restriction.

: Ken asks if Steve could talk about the role of resistance training in maintaining muscle mass, function and quality as we age. Ken also asks what Steve has learned in examining exercise-based interventions as well as the combination of exercise and dietary interventions.

: Ken mentions that poor muscle quality and functional decline are associated with the loss of type-two muscle fibers, and increased intramuscular fat. Going on to mention that these same changes are regularly seen in endurance athletes. He asks if these adaptations might become maladaptive as these athletes age.

: Dawn asks if there is an upper limit of benefit, in terms of muscle gain, and a lower limit in terms of optimal body fat, when it comes to longevity. Inquiring as to whether there is a point of diminishing returns or increasing harm when it comes to gaining muscle or losing fat.

: Dawn mentions another one of Steve’s major review studies that looked at the effects of popular diets on weight loss. Steve examined the evidence for the diets that were listed in the 2016 U.S. News & World Report’s rankings of the best weight-loss diets, which ranged from the Mediterranean to Atkins to Ornish to the Paleo diets. She goes on to say that the review found the Atkins diet to have the most evidence in producing meaningful short-term and long-term weight loss.

: Dawn asks what Steve’s diet and exercise routine look like.

: Dawn mentions how it is not the lack of knowledge on the biology of disease, and what interventions will be effective for different individuals, but rather the implementation and adherence at a population level. Given his background in psychology, Dawn asks Steve what his thoughts are on ways to help people implement these interventions into their lives.

: Ken mentions how calorie restriction is a controversial strategy to enhance longevity. Some say that it is the only strategy that has worked consistently, across species, to extend lifespan. Ken mentions that there is also evidence from multiple meta-analysis that shows only about 50% of rodent studies result in a longevity benefit. When one accounts for the quality of the food given to primates, the situation becomes even more unclear as to whether or not calorie restriction has a longevity benefit. Ken asks Steve if the same could apply to humans.

: Dawn mentions that she understands Steve persuaded his 72-year-old father to try intermittent fasting, and that his father has become a great testimonial for Steve.