Navigating GLP-1 Medications and Building a Healthier You: A Fork U Guide

Welcome to Fork University, where science meets sarcasm, and healthy eating gets a reality check. Today, we’re diving into the world of GLP-1 medications, like Ozempic and Zepbound—those little injections making waves in the weight loss and metabolic health scene. Spoiler alert: Even if needles aren’t your thing, this advice is gold for anyone looking to improve their relationship with food (yes, even you, cereal-at-midnight enthusiasts). So, grab a cup of tea (ginger if you’re nauseous), and let’s get started.

Ah, diet culture. That pesky little voice whispering, “Carbs are evil,” or “You’re only worthy if you can squeeze into those jeans from 2012.” Here’s the deal: Diet culture sucks, and it’s time to boot it out of your life. Here’s how:

1. Focus on Health Over Appearance
2. “Strong, not skinny” isn’t just a gym bro mantra. Celebrate wins like better blood sugar control or climbing stairs without feeling like you ran a marathon.
3. Neutralize Food Labels
4. No food is inherently “good” or “bad.” (Except maybe that mysterious gas station sushi. Proceed with caution.) All foods can fit into a balanced diet—just maybe not all at once.
5. Ditch Unrealistic Media
6. Swap those Instagram influencers with body-positive accounts. Life is too short for filter-fueled comparisons.

GLP-1 medications are game-changers, but they come with their quirks. Here’s how to navigate the rocky road of side effects:

Fun fact: Only 10% of Americans eat enough fiber. No wonder our colons are grumpy. Fix that with:

• Whole Grains: Brown rice, quinoa, oats—because white bread is so 1990.
• Legumes: Beans, chickpeas, lentils—fiber heroes and fart-inducing legends.
• Supplements: Citrucel or Metamucil work in a pinch, but food first!

Not all hydration packets are created equal. Skip the sugar-free gimmicks and opt for options like Pedialyte. Bonus points if you grab the popsicles—because who doesn’t love reliving childhood?

High-fat foods + GLP-1 = a stomach rebellion. Swap fried chicken for grilled and save yourself the bloat. Greek yogurt and peppermint tea are your new besties.

Forget the “eat less, move more” mantra. Here’s what actually works:

1. Mindful Portions
2. At restaurants, box up half your meal right away. Or embrace the kids’ menu—yes, you might even score a toy.
3. Protein with Purpose
4. Greek yogurt, beans, and protein shakes are your go-tos. But don’t let diet culture trick you into thinking protein is the only macronutrient that matters.
5. Celebrate Non-Scale Victories
6. Fitting into old jeans? Amazing. Cooking a new recipe? Even better. Toss the scale if it’s ruining your day—you’re more than a number.

GLP-1 medications are tools, not magic wands. They’re here to help you build a healthier relationship with food, not to police your every bite. Remember:

• Moderation Wins: That scoop of ice cream isn’t your downfall. Balance it out with nutrient-rich meals.
• Be Patient: Rapid initial weight loss (thanks, glycogen, and water) will slow, but consistency pays off. A pound a week equals 52 pounds a year. Do the math and cheer yourself on.

GLP-1 medications are here to support you, not define you. Focus on health, ditch the guilt, and enjoy the journey. And don’t forget: Consult a real, western-trained physician and a dietitian. Chiropractors and green juice influencers don’t count. Ok, I sometimes drink some green juice.

Weight loss is often the first thing people think about when starting GLP-1 medications like semaglutide or liraglutide. These medications are powerful tools for helping manage appetite and regulate the body’s hunger hormones. But here's the real truth: losing weight is just one part of the story. To truly thrive, you need to focus on eating in a way that nourishes your body, supports your health, and promotes long-term well-being.

Think of it this way: GLP-1 medications do the heavy lifting when it comes to managing hunger and cravings. Your job is to provide the right fuel for the machine. You’re not eating to lose even more weight—you’re eating to support your body so it runs like a high-performance car.

When you’re on GLP-1 medications, weight loss isn’t a result of extreme dieting or restrictive food rules. These medications work by regulating your appetite, making it easier to avoid overeating and stick to reasonable portions. They help your biology work with you instead of against you.

So, if the medication is doing most of the work, why does your diet matter? It’s simple: food is what keeps your body functioning at its best. While GLP-1 helps control hunger, what you eat still determines your energy levels, heart health, mental clarity, and long-term disease risk.

Instead of focusing on cutting calories, the goal should be to pack every meal with nutrients that fuel your body and help it recover from the years of stress and inflammation caused by poor eating habits. This isn’t about restriction—it’s about nourishment.

When it comes to eating for long-term health, the Mediterranean diet is one of the best approaches. It’s not a restrictive diet where you count every calorie or ban entire food groups. Instead, it’s a way of life, focusing on fresh, whole foods that nourish your body and taste great.

The Mediterranean diet emphasizes vegetables, fruits, whole grains, healthy fats like olive oil, lean proteins, and a little bit of red wine. Yes, wine! Studies have consistently shown that people who follow this diet reduce their risk of heart disease, diabetes, and even cognitive decline (Estruch et al., 2013; Singh et al., 2022).

What makes this diet so effective? It’s packed with anti-inflammatory foods that stabilize blood sugar, protect your heart, and even support a healthy gut. A healthy gut, in turn, improves everything from digestion to mental health. Plus, the Mediterranean diet is enjoyable and sustainable—no weird powders, no flavorless meals, just real food.

Olive oil is the cornerstone of the Mediterranean diet. This liquid gold is rich in healthy monounsaturated fats and compounds that act like natural anti-inflammatories, similar to ibuprofen (reference here). Add in fish like salmon and sardines, which are full of omega-3 fatty acids, and you’ve got a winning combination for your heart and brain.

Protein is important, especially for preserving muscle mass while losing weight. But many people fall into the trap of making protein the center of every meal, ignoring the other nutrients their body needs. Loading up on chicken breasts and protein shakes might seem like a good idea, but it leaves little room for the variety that keeps your meals balanced.

Here’s the good news: with a Mediterranean-style diet, you can get plenty of protein from diverse sources. Legumes like lentils and chickpeas are not only high in protein but also rich in fiber, which helps with digestion and keeps you full longer. Fish, especially fatty fish like salmon or mackerel, provides protein alongside heart-healthy omega-3s. Even red meat is allowed—just keep it to about 4 ounces a day, roughly the size of a deck of cards.

The key is to think beyond animal proteins. A balanced plate includes plenty of plant-based options, ensuring you get a variety of vitamins, minerals, and antioxidants. This diversity supports your overall health and keeps your meals exciting.

If the Mediterranean diet feels too free-spirited for you, consider the DASH diet (Dietary Approaches to Stop Hypertension). DASH emphasizes fruits, vegetables, whole grains, and lean proteins while keeping sodium intake low. It’s designed to lower blood pressure, but it also reduces the risk of heart disease and supports weight loss. (reference click here)

Like the Mediterranean diet, DASH isn’t about counting calories or cutting out entire food groups. It focuses on nutrient-dense, whole foods that fuel your body. For people on GLP-1 medications, DASH is an excellent choice because it reduces the risks associated with metabolic conditions like high blood pressure and insulin resistance.

Weight loss might be your current goal, but the long-term focus should be on living a healthier, longer life. That’s where the Blue Zones come in—regions of the world where people live to 100 and beyond. Their secret isn’t just genetics; it’s their diet and lifestyle.

Blue Zone diets are plant-forward, filled with vegetables, legumes, whole grains, and healthy fats. Meals are simple, minimally processed, and often enjoyed with family and friends. These communities teach us that eating well isn’t about obsessing over macronutrients—it’s about creating habits that support your body over a lifetime.

In Okinawa, Japan, for example, people eat a diet rich in sweet potatoes, tofu, and seaweed, and they follow the principle of hara hachi bu, or stopping when they’re 80% full. This practice prevents overeating and ensures they maintain a healthy weight without ever going hungry. Reference click here

If you’re on GLP-1 medications and want to focus on long-term health, here are some tips to get you started:

• Make Vegetables the Star: Fill at least half your plate with colorful veggies. They’re packed with nutrients and low in calories.
• Choose Whole Grains: Swap out refined carbs like white bread and pasta for quinoa, brown rice, or whole-grain options.
• Enjoy Healthy Fats: Use olive oil liberally, snack on nuts, and add avocado to your meals. These fats are essential for brain and heart health.
• Diversify Your Protein: Include a mix of lean meats, fish, legumes, and nuts. Aim for variety rather than relying on one source
• Focus on Balance, Not Perfection: Follow the 80/20 rule—eat well most of the time, but don’t sweat the occasional treat. A slice of pizza or scoop of gelato won’t derail your progress.
• The Big Picture: Nourish, Don’t Restrict
• GLP-1 medications make it easier to manage your weight, but the real magic happens when you pair them with a diet that supports your health. The focus isn’t on eating less—it’s on eating smarter. By following a Mediterranean or DASH-style diet, you can give your body the nutrients it needs to thrive while enjoying food that tastes amazing.

Remember, this isn’t just about what the scale says. It’s about feeling energized, reducing your risk of chronic diseases, and setting yourself up for a healthier future. So, grab a plate of roasted veggies, drizzle on some olive oil, and toast to your long-term health. Your body will thank you for it.

Gantenbein KV, Kanaka-Gantenbein C. Mediterranean Diet as an Antioxidant: The Impact on Metabolic Health and Overall Wellbeing. Nutrients. 2021 Jun 6;13(6):1951. doi: 10.3390/nu13061951. PMID: 34204057; PMCID: PMC8227318.

Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, Sotiropoulou LI, Chrysochoou CA, Nihoyannopoulos PI, Tousoulis DM. Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr. 2020 Sep 1;11(5):1150-1160. doi: 10.1093/advances/nmaa041. PMID: 32330233; PMCID: PMC7490167.

Santacroce L, Bottalico L, Charitos IA, Haxhirexha K, Topi S, Jirillo E. Healthy Diets and Lifestyles in the World: Mediterranean and Blue Zone People Live Longer. Special Focus on Gut Microbiota and Some Food Components. Endocr Metab Immune Disord Drug Targets. 2024;24(15):1774-1784. doi: 10.2174/0118715303271634240319054728. PMID: 38566378.

Grosso G, Laudisio D, Frias-Toral E, Barrea L, Muscogiuri G, Savastano S, Colao A. Anti-Inflammatory Nutrients and Obesity-Associated Metabolic-Inflammation: State of the Art and Future Direction. Nutrients. 2022 Mar 8;14(6):1137. doi: 10.3390/nu14061137. PMID: 35334794; PMCID: PMC8954840.

Singh, B., et al. (2022). "Mediterranean Diet and Cognitive Function: A Systematic Review." Nutritional Neuroscience.

There is an appeal to ancient history: the idea that ancient beings were either "designed"—as from a creator—or "evolved" to eat in a certain way. Both are logical fallacies, but both are meant to be the "ex-cathedra" in a debate.

You read these logical fallacies in communities that claim they understand this. Here are some comments you will get:

• Our ancestors ate xyz (fill in the blank) and never had the modern chronic diseases
• Our teeth have (canines/molars), so we were designed to eat only (meat/plants)
• You won't see broccoli on the walls of caves
• If we ate like our ancestors, we would be in great health.

Appealing arguments, but they are as flawed as they are simply incorrect.

Of the early human records, they are based on precious little data. Consider in the fossil record we have about our ancestors? And by the way, where do we start?

If we begin with homo sapiens, we have been around as a species somewhere between 70,000 to 250,000 years.

Often the "low-carb" community will conflate distant cousins of homo sapiens as direct ancestors. Most of them were not but were a branch on the tree of evolution that are only related to us.

Perhaps the best adapted was the homo erectus, which was around for two million years. It is doubtful that homo sapiens will make it that long, but we can hope.

Most fossil finds come from Australia and Asia - where they not only foraged but also established some organized hunting.

There are about 6000 fossils of early man. That's it. Just 6,000. When we look for fossils of our particular, such as early homo sapiens, we have enough fossils that we might fill up a school bus.

How long did they live? It turns out we know.  Many died around the age of 35 years.   So why do we want to eat like they did?

At this point, someone in the audience will be bound to say - "They lived longer if you take into account infant mortality."

When we date a fossil and see when it died, we don't average the infant mortality of the time.

Bones and teeth from seen people, and isolated teeth, were reported recently. These came from a cave in Morocco. As these teeth are from about 15,000 years ago. Hence, the diet was before the advent of agriculture.

Evidence points to plants being a major part of these hunter-gatherer's menu.  As plants can be stored by hunter-gatherers all year round to protect against seasonal prey shortages. Thus, there is a regular food supply.

The famous caveman diet- life wasn't so simple.

When people of the carnivore tribe try to convince you about their diet, they invoke the mighty hunter.

A better term was that our ancestors survived by being fishers, gatherers, and scavengers.

The rice diet successfully treated malignant hypertension. Today, we have medications that treat malignant hypertension. Before the 1940s, there were no drugs available to treat this disease, resulting in death from untreated malignant hypertension within six months.  Despite the best medical care available, President Franklin Delano Roosevelt died from this disease.

Walter Kempner developed the rice diet to treat malignant hypertension. For example, failing kidneys would be given a reprieve with a diet low in sodium and protein. Then removal of saturated fat would allow some recovery of the heart.

In a disease that had 100 percent death in six months, Kempner's results were amazing. For example, in Kempner’s original cohort of 192 people, only 25 patients died.  In addition, 107 patients showed significant improvement (from 200/112 mm Hg to 149/96 mm Hg) with the diet. Equally important, heart size decreased in 66 of 72 patients. Moreover, cholesterol was reduced in 73 of 82 patients. Finally, retinopathy improved or disappeared completely in 21 of 33 patients.

"Therapeutic results are little short of miraculous," noted an editorial in the New England Journal of Medicine.

Patients were first hospitalized. The diet consisted of white rice, sugar, fruit, fruit juices, vitamins and iron. Total calories were 2,000 with 20 grams of protein and 150 mg of sodium.

Kempner kept careful records of his patients. Reporting success and failure is a key to academic transparency. Finally, the ability to reproduce the data in other centers provided the final key to Kempner's work.

The carnivore diet is popular among young, buff men whose living is made by promoting and coaching this diet. They sell the diet based on classic marketing techniques used for overweight patients.

• Lose weight without trying
• No need to log your food
• Eat as much as you want
• Hunger isn't an issue

Marketing phrases used by hucksters for years to trap people unhappy about their weight.

The carnivore diet relies on anecdotes, not evidence. Testimonials rule Facebook and YouTube sites. There are no publications about the diet. Finally, many in the carnivore community push against medicine. Conspiratorial thinking is strong, with phrases like this:

• Doctors want you to be sick
• The Medical Community wants to push pills
• Vegetables have anti-nutrients

Try to raise a concern about how this diet would increase the risk of heart disease, and they double down with misinformation. They will deny the evidence showing that high cholesterol leads to heart attacks and strokes. Or make the claim that if you are "metabolically healthy," you don't need to worry about cholesterol.

There are no academic research scientists following people trying the carnivore diet.

That means there is no transparency about the results. In addition, there is no accountability for any bad results.

Those who promote the diet include Paul Saladino, a physician who doesn't see patients and makes his income selling supplements.

The Liver King, who doesn't follow the diet, was caught using performance-enhancing drugs.

Shawn Baker is an orthopedic-trained surgeon who lost his medical license and makes his money promoting the carnivore diet. The New Mexico Medical Board ordered the "voluntary and permanent surrender" of Baker's medical license in 2017. "This action was based on failure to report adverse action taken by a healthcare entity and incompetence to practice as a licensee." He had his license reinstated but is not seeing patients for anything more than coaching for $150 for half an hour.

Ken Berry also lost his medical license for inadequate infection prevention in his offices. He has regained his license.

Some comments left on a recent YouTube video by Shawn Baker include:

• A patient developed painful neuropathy from vitamin B6 toxic levels. He quit the carnivore diet and vows never to return
• Another patient developed high oxylate levels. More kidney stones come from eating red meat than spinach - sorry, Paul Saladino.
• One noted fasting glucose increased to 126, which we call diabetes. Saturated fat is not a friend of the pancreas and increases insulin resistance.
• Another noted worsening kidney function with his filtration rate decreasing by 23 percent.
• Multiple complaints about LDL, including one that went from 148 to 353
• Psoriasis is often touted as being healed with this diet, but one noted their psoriasis spreading and getting worse. Red meat is highly inflammatory and not the optimal diet for people with psoriasis. Although psoriasis will come and go spontaneously, a carnivore diet is the worst diet for these patients.
• Gynecomastia was noted by one male, and if you look at many carnivore shirtless salesmen of scams, you will see they also suffer from gynecomastia - those aren't pectoral muscles, those are breasts. Red meat can increase estrogen levels greatly.

Not once did Shawn Baker instruct these people to see their regular doctor for appropriate treatment and follow-up. Hopefully, this will change.

Do a research study with human subjects in a university, and there will be an independent board looking over the results. If there are any adverse results, those are reported to the research board, and sometimes studies are stopped because of too many adverse events. When results are published, both the good and the bad - like Kempner's work - are reported.

The rice diet is for historical purposes only. The Mediterranean Diet is a far superior and more balanced diet. With over 13,000 peer reviewed publications, the Mediterranean Diet is the current pattern of eating that we recommend.

I want to take you back in time. While we talk about the Mediterranean diet not being a diet of culture but a pattern of eating – it still had its origins in the Mediterranean.

The original Mediterranean diet was described as far back as 500 BC in the Ilead. The ancient Greeks ate whole grains, fruits, vegetables, pulses, and a bit of fish. Red meat was rare.

While red meat may not have been a dietary staple for the Ancient Greeks, it was consumed during feasts, festivals, and special occasions.

Cows were considered sacred gods, like Zeus, and their slaughter was for religious ceremonies and consumed during feasts

The majority of the population received protein from fish, poultry, legumes, and whole grains.

This was the diet of the first Olympians, as well as the Romans. Ancient Greeks worshiped the body, as you can see from the statues, as well as our language.

We get the word gym from the Greek word “gymnasion," which translates to a place to exercise naked. But those gyms not only had a place to train but also schools, where literature, philosophy, math, and music were taught, as well as a social gathering place.

We also get Diet from the Greeks, which originates from “diaita,” meaning the “way of life” or a manner of living. The Greeks had a balanced approach to health and well-being, emphasizing diet, exercise, and the mind.

Gym bros and bro science were yet to be invented.

Could those Olympians of old who ate diets filled with whole-grain cereals have been wrong? Or could it be that those grains of the past were different from today’s grains?

If you’ve ever been on a “low carb” diet, one of the first food groups you eliminate are grains.

As you dutifully got rid of the last bit of joy in your life, you feel it was the cost to have your weight drop.

You might have thought – "Grains are evil."

Eating burgers without the bun, breakfast without toast, no pastries, no bread, no pasta, no rice, and you were losing weight. Lots of confirmation bias.

Oh those heady early days of a low carb diet, losing weight, feeling better, maybe even noticing cholesterol improved. Hard to sustain though, and did you ever get tired of steak?

Now you come here and find the best diet is the Mediterranean diet. Lots of peer reviewed literature to support it.

Then you wondered what in grains was evil. The first easy thought was that it all breaks down to glucose, and glucose is evil.

Unless you know biochemistry and realize no, that’s not it. Your body runs on glucose.

And maybe you read about celiac disease and gluten as its trigger. Maybe some blogger convinced you that wheat in America is filled with gluten, and this is the problem.

Unable to sustain a low-carb diet, you return to the joy of the morning pastry or dessert, all the while thinking grains are what caused the weight to return.

Now you come to the Mediterranean Diet, and whole grains, not refined grains, are on the menu.

Still, you are suspicious, and you think – maybe it was the gluten.

Or what happens if you come to the Mediterranean diet and have Celiac disease and gluten causes horrific issues?

But should we all avoid gluten? And can we have a Mediterranean diet if we must be gluten-free?

Should the ancient Greeks become Carnivores instead of those grizzly men who are on a diet now associated with the healthiest people on planet Earth?

Clearly not. Eating too much red meat is associated with increasing heart disease and cancer, while the Mediterranean diet is associated with less heart disease and cancer.

Carnivores like pointing to the ancient wrestler Milo of Croton, who ate twenty pounds of meat a day. They fail to mention that he also ate twenty pounds of bread and drank 18 pints of wine while training. Funny, they all talk about the meat. –There are always outliers, and Milo was one.

When Milo trained, he carried a calf, and as the creature grew, he kept carrying it. He won about six Olympic medals (560 BC).

While we don’t know details, it is odd he ate meat, since his mentor Pythagoras – of the theorem – thought eating meat was unhealthy and made people wage war.

And despite what the low-carb and carnivore community tells you, Whole grains have been associated with decreased risk of diabetes, less obesity, and lower rates of cancer and heart disease.

Whole grains have a lot of fiber. In fact, whole grains are one of the fiber rich portions of the foods you eat.

Gluten is a protein found in many grains, like wheat, but not all grains.  Do you know how to stretch dough? Like pizza, the reason you can do it is gluten.

For most of us, gluten isn’t an issue. But for about one percent of the population, gluten can exacerbate an auto-immune response against your small bowel.

If you have celiac disease and have gluten in your diet, your bowel will be harmed. Thus, you will not effectively absorb nutrients. Many with celiac disease have anemia from an inability to absorb iron.

Most patients with celiac disease will feel bloated with gas, sometimes diarrhea, or even constipation. They might have chronic fatigue or weakness due to a lack of nutrients. In children, it often leads to weight loss. In adults, it can manifest in weight gain.

The symptoms are vague and not specific, but they are part of a history that we see with our patients.

Since the symptoms are so general, many people advocate a gluten-free diet. Some have written books about how gluten causes issues in everyone, and we should avoid it. This is incorrect, but it does sell a lot of books.

Incorporating Gluten-Free Whole Grains

Here are some easy ways to add gluten-free whole grains to your Mediterranean-inspired meals:

1. Quinoa: Swap traditional grains like couscous with quinoa in salads, pilafs, or stuffed vegetables. Quinoa is a complete protein and offers a nutty flavor that complements Mediterranean ingredients well.
2. Brown Rice: Use brown rice instead of traditional pasta in dishes like risotto, stir-fries, or alongside grilled fish or chicken. Brown rice provides a hearty texture and adds a dose of fiber to your meal.
3. Millet: Experiment with millet in place of bulgur wheat in tabbouleh salads or use it as a base for grain bowls topped with roasted vegetables and a drizzle of olive oil.
4. Buckwheat: Incorporate buckwheat flour into your baking for gluten-free bread, pancakes, or crepes. You can also use cooked buckwheat groats as a nutritious alternative to traditional grains in salads or as a side dish.
5. Amaranth: Add amaranth to soups, stews, or porridge for a nutrient-packed boost. Its slightly nutty flavor pairs well with Mediterranean spices and herbs.

My favorite is oatmeal. But make sure you get oats that were ground away from wheat. Bob’s Red Mill has a gluten free oat that you can use. Since oats are a staple of my morning breakfast you might find these a great choice.

Finally, corn is a whole grain. Good to add to salads, and my favorite cowboy caviar dish.

By incorporating gluten-free whole grains into your Mediterranean diet, you can enjoy a diverse range of flavors and textures while reaping the nutritional benefits of these wholesome ingredients. Whether you're looking to support digestive health, manage blood sugar levels, or simply explore new culinary horizons, there's a gluten-free whole grain waiting to elevate your next meal.

Whole grains are a powerhouse of nutrition, offering a range of health benefits that make them an essential part of a balanced diet.

But what if you have celiac disease and cannot tolerate gluten?

Gluten is a protein found in many grains. It is responsible for stretching dough, like pizza.

If you do not have a problem with gluten, there is no reason to avoid gluten.  But if you have celiac disease, gluten must be avoided.

The Mediterranean diet is renowned for its focus on fresh fruits and vegetables, lean proteins, healthy fats, and whole grains. By incorporating gluten-free whole grains into this already nutritious diet, you can further enhance its health benefits while catering to dietary restrictions or preferences.

By incorporating gluten-free whole grains into your Mediterranean diet, you can enjoy a diverse range of flavors and textures while reaping the nutritional benefits of these wholesome ingredients. Whether you're looking to support digestive health, manage blood sugar levels, or simply explore new culinary horizons, there's a gluten-free whole grain waiting to elevate your next meal.

Fish is not only a healthy option but also a versatile ingredient that can be transformed into a myriad of mouthwatering dishes. Whether you're a seafood aficionado or looking to expand your culinary repertoire, mastering the art of cooking fish can elevate your cooking skills to new heights. In this article, we'll explore the techniques and recipes to create delicious fish dishes that will impress even the most discerning palates.

1. Grilling: Grilling fish over an open flame adds a smoky flavor and beautiful charred marks. Brush the fish with oil to prevent sticking, and cook for a few minutes on each side until opaque and flaky.
2. Baking: Baking fish in the oven is a simple and foolproof method. Place seasoned fish fillets on a baking sheet lined with parchment paper and bake at 375°F (190°C) for 10-15 minutes, depending on the thickness of the fish.
3. Pan-Searing: Pan-searing fish in a hot skillet creates a crispy exterior while keeping the inside moist and tender. Heat oil in a skillet over medium-high heat, then add the fish and cook for 3-4 minutes per side until golden brown.
4. Steaming: Steaming fish is a healthy cooking method that preserves its delicate flavor and texture. Place seasoned fish fillets in a steamer basket over boiling water and steam for 6-8 minutes until cooked through.

Now that you're familiar with the basics of preparing and cooking fish let's explore some mouthwatering recipes to try at home:

1. Lemon Herb Grilled Salmon: Marinate salmon fillets in a mixture of lemon juice, olive oil, garlic, and fresh herbs. Grill over medium heat for 4-5 minutes per side until charred and cooked through. Serve with a squeeze of fresh lemon juice.
2. Baked Cod with Garlic Butter: Place cod fillets in a baking dish and top with a mixture of melted butter, minced garlic, lemon zest, and chopped parsley. Bake in the oven for 15-20 minutes until flaky and tender.
3. Pan-Seared Sea Bass with Mango Salsa: Season sea bass fillets with salt, pepper, and paprika. Sear in a hot skillet for 3-4 minutes per side until golden brown. Serve with a refreshing mango salsa made with diced mango, red onion, jalapeno, cilantro, and lime juice.

For more great recipes, see terrysimpson.com.

Fish consumption has been linked to various health benefits due to its rich nutritional profile.  The health benefits of fish consumption include cardiovascular health, brain function, and well-being. Because fish are a rich source of omega-3 fatty acids, vitamins, minerals, and other nutrients, they are an important part of a balanced diet.

Fish has long been recognized as a valuable source of essential nutrients beneficial for human health. Seafood is a staple part of the diet across different cultures and regions.  Since most of the first human communities were coastal, fish were a common source of food.

Regular fish intake reduces the risk of cardiovascular diseases, such as coronary heart disease and stroke (Mozaffarian & Rimm, 2006).  That study showed that the benefits of fish intake exceed the potential risks. Even for women of childbearing age, the benefits of modest fish intake, excepting a few selected species, also outweigh the risks.  The heart health effect comes from the omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) found abundantly in fatty fish species (Kris-Etherton et al., 2002). These fatty acids exert anti-inflammatory, antiarrhythmic, and vasodilatory effects, lowering blood pressure and triglyceride levels and reducing the formation of blood clots (Calder, 2015).

Fish consumption has also been associated with improved cognitive (brain) function and a reduced risk of brain disorders such as Alzheimer's disease. The omega-3 fatty acids EPA and DHA play a crucial role in brain health (Gómez-Pinilla, 2008). Epidemiological studies have consistently shown a positive correlation between higher fish consumption and better memory (ref). Moreover, research suggests early-life exposure to seafood has long-term brain benefits and decreases age-related cognitive decline (Wurtman et al., 2009).

But omega-3 fatty acids are not the only benefit of eating fish. Fish are also a rich source of various essential nutrients vital for human health. Vitamin D, in particular, is naturally abundant in fatty fish and plays a crucial role in bone health, immune function, and mood regulation (Holick, 2007).  These include high-quality protein, vitamins (such as vitamin D and B-complex vitamins), and minerals (such as selenium, iodine, and zinc) (Kris-Etherton et al., 2002). Furthermore, the bioavailability of these nutrients from fish is superior to other dietary sources, including supplements.  Thus, fish consumption is an efficient means of meeting nutritional requirements (Rosell & Appleby, 2006).

Aquaculture, the farming of fish and aquatic organisms, has undergone significant advancements in recent years, leading to improvements in sustainability, efficiency, and product quality. Fish Farms have had significant problems in the past.  In the last fifteen years, there has been an improvement in environmental management strategies and sustainable farming practices.

Those practices have changed my mind about seafood. Consequently, you can now buy quality farm-raised seafood, which adheres to the high standards of any food. Hence, I now recommend some farm-raised salmon.

As global demand for seafood continues to rise, aquaculture has emerged as a crucial industry for sustainable meeting this demand. Farm-raised fish play a vital role in supplementing wild-caught fisheries and ensuring food security for a growing population. In recent years, advancements in aquaculture techniques and practices have led to significant improvements in the efficiency, sustainability, and quality of farm-raised fish.

Technological advancements have revolutionized the aquaculture industry. Automation and robotics have streamlined tasks such as feeding, monitoring water quality, and harvesting, reducing labor costs and minimizing human error. Some previous issues with farmed fish include high quantities of forever chemicals in their feed. However, advances in the use of alternative ingredients, such as plant proteins and oils, have enhanced feed efficiency and reduced reliance on wild-caught fish for feedstock (Tacon & Metian, 2008). Genetic selection and breeding programs have also played a crucial role in developing strains of fish with desirable traits, such as faster growth rates, disease resistance, and improved feed conversion ratios (Gjedrem et al., 2012).

Some fish farms have been environmental disasters. Thus, Government and private groups have persuaded some fish farms to change their practices.  Sustainable aquaculture practices prioritized environmental stewardship and minimized the impact of fish farming on surrounding ecosystems. For example, combining clams and oysters with salmon farms to use nutrients more efficiently and reduce waste (Chopin et al., 2001).

Closed-containment systems, such as recirculating aquaculture systems (RAS), decrease the risk of disease transmission and minimize the discharge of pollutants into the environment (Martins et al., 2010). Additionally, advancements in water treatment technologies, such as biofiltration and ozone disinfection, help maintain water quality and reduce the environmental footprint of aquaculture operations (Summerfelt & Vinci, 2008).

Antibiotic use in fish farms, much like antibiotic use in the cattle industry, has changed to where antibiotics are only used when needed for disease. Fish that have had antibiotics are not sold on the market until the antibiotics and disease have cleared their system. Furthermore, advancements in packaging, transportation, and cold chain management help preserve the freshness and nutritional integrity of farmed fish from harvest to consumption.

Advancements in aquaculture technology, environmental management practices, and quality assurance measures have led to significant improvements in farm-raised fish production. These advancements increase the efficiency and sustainability of aquaculture operations. In addition, they also enhance product quality, safety, and traceability. Moving forward, continued investment in research and innovation is essential to further the progress of the aquaculture industry. Thus ensuring long-term viability as a source of nutritious and sustainable seafood.

Many organizations buy their seafood from reputable organizations. Be that wild fish or fish farms. Those organizations include:

• Blue Apron
• Cheesecake Factory
• Hello Fresh
• Whole Foods
• Pacific Catch
• PCC Community Markets
• Mars Petcare
• Compass Group
• California Fish and Grill
• Blue Sushi Saki Grill
• Plank Seafood Provisions
• Costco
• Mom's Organic Market

In conclusion, fish consumption offers many health benefits, from cardiovascular protection to cognitive enhancement, due to its rich nutritional composition. The omega-3 fatty acids EPA and DHA, along with other essential nutrients found in fish, exert profound effects on various physiological processes, promoting overall health and well-being. Therefore, it is advisable to incorporate fish into one's diet, especially fatty fish species such as salmon, mackerel, and sardines.

• Calder, P. C. (2015). Marine omega-3 fatty acids and inflammatory processes: Effects, mechanisms and clinical relevance. Biochimica et Biophysica Acta (BBA) - Molecular and Cell Biology of Lipids, 1851(4), 469–484.
• Gómez-Pinilla, F. (2008). Brain foods: the effects of nutrients on brain function. Nature Reviews Neuroscience, 9(7), 568–578.
• Holick, M. F. (2007). Vitamin D deficiency. New England Journal of Medicine, 357(3), 266–281.
• Kris-Etherton, P. M., Harris, W. S., & Appel, L. J. (2002). Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation, 106(21), 2747–2757.
• Morris, M. C., Evans, D. A., Tangney, C. C., Bienias, J. L., & Wilson, R. S. (2003). Fish consumption and cognitive decline with age in a large community study. Archives of Neurology, 60(7), 940–946.
• Mozaffarian, D., & Rimm, E. B. (2006). Fish intake, contaminants, and human health: evaluating the risks and the benefits. JAMA, 296(15), 1885–1899.
• Rosell, M. S., & Appleby, P. N. (2006). Fish consumption and risk of stroke in men. Circulation, 113(2), e104–e105.
• Wurtman, R. J., Cansev, M., Sakamoto, T., & Ulus, I. H. (2009). Use of phosphatide precursors to promote synaptogenesis. Annual Review of Nutrition, 29, 59–87.
• Chopin, T., Buschmann, A. H., Halling, C., Troell, M., Kautsky, N., Neori, A., Kraemer, G. P., Zertuche-González, J. A., Yarish, C., & Neefus, C. (2001). Integrating seaweeds into marine aquaculture systems: a key toward sustainability. Journal of Phycology, 37(6),...

The Mediterranean diet, the DASH diet (Dietary Approaches to Stop Hypertension), and the MIND diet (Mediterranean-DASH Intervention for Neurodegenerative Delay) are all great eating patterns. Each diet focuses on different aspects of health.

The Mediterranean diet comes from the traditional dietary patterns of countries bordering the Mediterranean Sea, such as Greece, Italy, and Spain. High in the consumption of fruits, vegetables, whole grains, nuts, seeds, legumes, olive oil, fish, and moderate amounts of poultry, dairy, and red wine. Shown to decrease the risk of heart disease and cancer and to improve longevity.

Discussed in last week's podcast (ref). DASH (Dietary approach to stop hypertension) was developed to prevent and manage hypertension (high blood pressure). Focuses on increasing intake of fruits, vegetables, whole grains, lean proteins, and low-fat dairy products while limiting sodium, saturated fats, and cholesterol.

Developed by researchers at Rush University Medical Center as a hybrid of the Mediterranean and DASH diets, with a focus on brain health and reducing the risk of neurodegenerative diseases like Alzheimer's disease. It also emphasizes the consumption of fruits, vegetables, whole grains, nuts, olive oil, fish, poultry, and beans while limiting the intake of red meat, butter/margarine, cheese, pastries/sweets, and fried/fast foods.

The Mediterranean, DASH, and MIND diets share some common elements. All focus on whole foods and plant-based sources of nutrients. The Mediterranean diet emphasizes health and longevity. While the DASH diet targets hypertension and cardiovascular health. Finally, the MIND diet specifically supports brain health to reduce the risk of neurodegenerative diseases.

A study conducted by researchers at Rush University Medical Center followed over 900 older adults for an average of 4.5 years. Findings showed that individuals who closely adhered to the MIND diet had a substantially lower risk of developing Alzheimer's disease, with a reduction in risk ranging from 21% to 53%, depending on the level of adherence. (ref )

Researchers at Columbia University Medical Center examined the dietary habits of over 1,000 participants. Individuals who closely followed the MIND diet had a 53% lower risk of developing Alzheimer's disease than those with low adherence to the diet.

The ADNI study found that adherence to the MIND diet was associated with better cognitive performance and a reduced rate of cognitive decline over time.

Several systematic reviews and meta-analyses have summarized the findings of multiple studies investigating the association between the MIND diet and dementia risk.  Overall, these reviews reveal that adherence to the MIND diet is associated with a significant reduction in Alzheimer's disease and dementia.

Components of the MIND diet, such as leafy greens, berries, nuts, whole grains, fish, olive oil, and poultry, have been linked to improved cognitive function and a lower risk of dementia.

More research is needed to elucidate the mechanisms underlying the protective effects of the MIND diet.  Current evidence suggests that adherence to this dietary pattern can be a valuable strategy for reducing the risk of cognitive decline and Alzheimer's disease in older adults.

On TikTok, a non-physician said the only way to diagnose dementia was an autopsy. This is false. Alzheimer's disease is diagnosed based on established criteria. These are outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Also can be found in the National Institute on Aging-Alzheimer's Association (NIA-AA) criteria.

• The healthcare provider will conduct a complete history and physical examination
• Neuropsychological assessment may evaluate cognitive function, memory, attention, language, and executive function.
• Blood tests can rule out underlying medical conditions, such as vitamin deficiencies (e.g., vitamin B12 deficiency), thyroid disorders, infections, metabolic imbalances, or kidney or liver dysfunction.
• MRI or CT scans will be ordered to assess structural abnormalities in the brain or detect signs of conditions like stroke, brain tumors, or hydrocephalus. Genetic testing for mutations associated with familial Alzheimer's disease, cerebrospinal fluid analysis to assess for biomarkers associated with Alzheimer's disease (e.g., amyloid beta and tau proteins)

Several genetic factors are correlated, but not causative of, an increased risk of dementia, including Alzheimer's disease. Lifestyle changes can mitigate these. Hence, the MIND diet is important to those who have a genetic predisposition to dementia.

The apolipoprotein E (APOE) gene ε4 allele is the strongest known genetic risk factor for late-onset Alzheimer's disease. Individuals who inherit one copy of the APOE ε4 allele from one parent have an increased risk of developing Alzheimer's disease. while those who inherit two copies (one from each parent) have an even higher risk. Chris Hemsworth, who plays Thor in Marvel movies, has two copies of these genes.

Mutations in the presenilin 1 (PSEN1) and presenilin 2 (PSEN2) genes are associated with early Alzheimer's disease before 65. These mutations can cause abnormal processing of amyloid precursor protein, which leads to the accumulation of amyloid beta plaques in the brain.

Mutations in the amyloid precursor protein (APP) gene are also associated with rare cases of early-onset Alzheimer's disease. APP mutations can lead to the production of abnormal forms of amyloid beta protein, which contributes to the development of Alzheimer's pathology.

• Variants in the triggering receptor expressed on myeloid cells 2 (TREM2) gene have been identified as risk factors for late-onset Alzheimer's disease and other neurodegenerative diseases.

• TREM2 is involved in the regulation of the immune response and microglial function in the brain, and variants in this gene may affect the brain's ability to clear amyloid beta and other toxic proteins.

• Several other genes have been implicated in the risk of developing dementia, including genes involved in inflammation, cholesterol metabolism, synaptic function, and neuronal signaling pathways.

While genetic factors can increase the risk of dementia, they do not guarantee that an individual will develop the condition. Environmental factors and lifestyle factors (such as diet, physical activity, and cognitive engagement) play significant roles in determining an individual's risk of dementia. Additionally, not all cases of dementia are attributable to genetic factors.

The Dietary Approaches to Stop Hypertension (DASH) diet is a widely recognized dietary pattern designed to lower blood pressure and promote cardiovascular health. I will attempt to provide an in-depth review of the DASH diet, its origins, key principles, health benefits, and potential limitations. It also explores the scientific evidence supporting its efficacy and applicability in various populations. Furthermore, this paper discusses practical considerations for adopting the DASH diet and its potential future developments in the field of nutrition and health.

The DASH diet, or Dietary Approaches to Stop Hypertension, is a dietary plan primarily developed to combat hypertension (high blood pressure). DASH has since gained recognition for its broader health benefits. Hypertension is a major risk factor for cardiovascular diseases, including heart disease and stroke. Therefore, the DASH diet is essential to reducing these health risks.

The National Heart Lung and Blood Institute (NHLBI) developed the DASH diet in a study known as the DASH-Sodium Study. The primary objective of the DASH-Sodium study was to investigate the effect of dietary patterns on blood pressure, in particular, the effects of sodium intake. Researchers aimed to design a diet that could effectively lower blood pressure without medication. The DASH diet emerged from this study as a dietary pattern rich in nutrients and low in sodium, saturated fat, and cholesterol.

The DASH diet emphasizes the consumption of nutrient-rich foods while limiting the intake of sodium, saturated fats, and cholesterol. Key principles of the DASH diet include:

•  High Consumption of Fruits and Vegetables: The diet encourages individuals to consume a variety of fruits and vegetables, providing essential vitamins, minerals, fiber, and antioxidants.
• Lean Protein Sources: Lean proteins like poultry, fish, and plant-based options such as beans, lentils, and tofu are recommended to replace high-fat animal proteins.
• Whole Grains: The DASH diet emphasizes whole grains like brown rice, whole wheat, oats, and quinoa, which are rich in fiber and nutrients.
• Dairy: Low-fat or fat-free dairy products are included to provide calcium and protein without excess saturated fat.
• Nuts, Seeds, and Legumes: These foods are encouraged as sources of healthy fats, fiber, and plant-based protein.
• Limited Sweets and Sugary Beverages: The DASH diet restricts the consumption of sugary foods and beverages, reducing the intake of added sugars.
• Sodium Restriction: The diet recommends limiting sodium intake to 2,300 milligrams per day (or 1,500 milligrams for individuals with hypertension, certain chronic conditions, or those at high risk).

The DASH diet offers a range of health benefits beyond blood pressure reduction:

• Lowering Blood Pressure: Numerous studies have shown that the DASH diet can effectively lower blood pressure, particularly in individuals with hypertension.
• Cardiovascular Health: The diet is associated with a reduced risk of heart disease, stroke, and other cardiovascular conditions due to its focus on heart-healthy nutrients and reduced saturated fat intake.
• Weight Management: The DASH diet can help weight loss and weight management due to its emphasis on nutrient-dense, low-calorie foods.
• Improved Lipid Profile: The diet can lower levels of LDL cholesterol (bad cholesterol) and improve HDL cholesterol (good cholesterol), further reducing the risk of heart disease.
• Diabetes Management: The DASH diet may help individuals with diabetes manage blood sugar levels, as it encourages a balanced intake of carbohydrates, fiber, and protein

The effectiveness of the DASH diet has been supported by numerous clinical trials and epidemiological studies. For instance, the original DASH-Sodium trial demonstrated that the DASH diet could significantly lower blood pressure, with greater reductions observed when combined with sodium restriction. Subsequent research has reaffirmed these findings, highlighting the positive impact of the diet on cardiovascular health and well-being.

This was one of the few studies in which all the food was made for the participants.

While the DASH diet offers substantial health benefits, it may have limitations for some. Its emphasis on whole foods and fresh produce can be costlier and less convenient than processed alternatives. Cultural preferences and dietary restrictions may also pose challenges in adopting the DASH diet. Nevertheless, modifications and adaptations can be made to suit individual needs and preferences while maintaining the core principles of the diet.

For those interested in adopting the DASH diet, practical considerations include meal planning, grocery shopping, and monitoring sodium intake. Consulting with a healthcare professional or registered dietitian can provide personalized guidance and support.

The DASH diet continues to evolve as new research emerges in nutrition and health. Future developments may focus on tailoring the diet to specific populations, incorporating technological advancements, and exploring the impact of the DASH diet on additional health outcomes beyond hypertension.

DASH is a version of the Mediterranean Diet. You can see the same requirements for whole grains, vegetables, fruits, dairy, and legumes.  It combines meats and fish depending on the calories and still uses primarily monounsaturated fats. There is no recommendation for or against alcohol in this diet. There is a strong recommendation to decrease sodium in the diet.

The DASH diet is a well-established dietary pattern with proven benefits for lowering blood pressure and improving cardiovascular health. Its emphasis on nutrient-rich foods, balanced nutrition, and sodium restriction makes it a valuable tool for reducing the risk of hypertension and related health conditions. While challenges may exist in adopting the DASH diet, its adaptability and potential for customization make it a practical and effective choice for individuals seeking to improve their dietary habits and well-being.

Did you try the carnivore in January? A month of red meat, eggs, and butter? If you did, you probably lost weight.  If you lost weight, you felt better. The Carnivore crowd will point to weight loss as proof of superiority.

But did you worry that this might not be the healthiest diet for you long-term?  Is it healthy? In short, the answer is no.

Perhaps you remember on a previous podcast, we talked about the beer and sausage diet. On that diet, Evo, the pod god who distributes this podcast, lost weight every month he was on the diet. In addition, his weekly lab work -sorry for all the jabs Evo - improved every week he was on the diet.

Could you argue that drinking beer and eating sausage is a good diet? You could, and that same logic is what the carnivore crowd uses to convince people the carnivore diet has merit.

What could be simpler than eating a diet of just red meat? Who doesn't like a good steak? If you just eat steak or red meat, you will lose weight. When you lose weight, you will feel better. And your labs might improve. You might think it is paradoxical that your cholesterol level went down - it isn't; that is just a result of giving up junk food and weight loss.

Every diet has a honeymoon phase, where people think they can do the diet "forever."

Then reality comes home:

• The diet becomes boring, and one note
• There is an undeniable increased risk of heart disease and cancer
• Maybe you got hemorrhoids or developed diverticulitis
• Finally, in social situations, you become that person - the one who could only eat red meat  - the reverse vegan

Today, on Fork U, we will discuss the latest low-carb fad: the Carnivore diet, the denial that goes into those who make up the diet, and the risks of an all-meat diet.

I'm Dr. Terry Simpson, and this is Fork U.

Fork University

Where we make sense of the madness, bust a few myths, and teach you a little about food as medicine.

The carnivore diet, which primarily consists of animal products like meat, fish, and eggs, has become the latest low-carb fad. It is a controversial and extreme dietary approach. Proponents of the carnivore diet claim numerous health benefits. To be clear, the scientific evidence supporting these benefits is limited, and that long-term studies on the effects of the carnivore diet are lacking.

Paul Saladino, Ken Berry, and Shawn Baker are a few doctors who advocate for this diet. And oddly, none of them see private patients, although Saladino and Baker love showing their abs, and spend a lot of time in the gym.

Some claim the natural diet of humans is meat. This is a biotruth.

When someone tells you that “man was meant to eat” this or that – it is part of a logical fallacy known as a biotruth. A biotruth is an argument presented by someone with misunderstood notions of human biology and/or evolution but uses those false arguments to justify their views. In this case, how they eat.

You can extend that logical fallacy out: man was not meant to fly, so we shouldn’t be in airplanes. Primitive man did not have laboratories, so we should not have antibiotics.

You will see biotruth arguments from people who practice carnivore diets, as well as those who practice vegetarian (and vegan) diets. Often with photographs of our jaws and those of our ancestors – or they will say how we have a long or short intestine, and on that basis, we “were meant” to eat in whatever their view is.

As we evolved, were we better as plant eaters or meat eaters? Does it matter? It is an argument based in biotruth.

The carnivore diet is based on the premise that man had evolved during the Paleolithic era by eating meat. Furthermore, they state that when agriculture and domestication of animals came (10,000 years ago), man’s metabolism was unable to adapt to these new foods. They assert that the maladies of modern man come from foods such as grains and dairy products. That non-meat diets lead to heart disease, obesity, and diabetes – all from our evolutionary dysfunction.

Archeology has about 6000 fossils to make these assumptions. From those 6000 fossils, we find that early man:

• Probably was more of a scavenger than a hunter - taking whatever meat something else killed and left behind
• Gathering, especially roots and beans, kept humans alive
• The most common things hunted were frogs and rabbits
• Neanderthals and Homo Erectus, our cousins but not direct ancestors, did organized hunting; the Neanderthals,  and homo sapiens began organization until perhaps 20,000 years ago.
• Man ate grains even 30,000 years ago.

The view of man as a large game hunter is not from the evidence unless you count comic strips and movies.

Often, they refer to the Inuit, whose lifespan is about 50 (excluding infant mortality). They eat mostly sea creatures but have mummified evidence of atherosclerotic disease. The Hazda eat honey, fruit, and meat, and their average age of death is 50. Over half of their people don't make the age of 15.

The use of early man, or hunter societies, to state that we should be eating meat is factually incorrect.

Humans evolved not by eating meat. Humans evolved by eating anything they could, mostly plants. Early man did not evolve to live into the 90's.

The other comments go something like the "defense of vegetables against humans." This ignores the long-lived populations, who eat mostly plants and little meat.

Kidney stones are found more commonly among meat eaters than vegetarians. (ref).

Despite their protestations, Kale, spinach, beans, and broccoli are healthy for people.

The other argument is that meat contains the richest nutrients, and the most bioavailable food.  Meat is a rich source of protein, the liver has a lot of vitamin D, and heme-iron is generally better adapted for iron deficiency. Meat is far from having all the nutrients a person requires. Red meat is rich in iron, zinc, B vitamins, and iron.

There is minimal fiber in meat. The carnivore crowd waives this off, stating that fiber isn't something humans need. In spite of the clear evidence that fiber decreases colon and rectal cancer, that fiber helps regulate blood sugar and cholesterol. Fiber is important to a healthy gut microbiome, and fiber prevents hemorrhoids as well as diverticulitis. Their assertion is false and painfully so - especially if you've had hemorrhoids.

Vitamin C is not abundant in meat. This lesson led to the discovery of citrus as a means of avoiding scurvy in sailors during the era of Discovery. A finding attributed to another surgeon, Dr. James Lind.  Modern-day isn't without scurvy found among carnivore aficionados, such as musician James Blunt, who went on the carnivore diet.

Calcium is more abundant in dairy products and some vegetables, as is Folate. and omega-3 fatty acids. They tend to forget that farm-raised salmon has ten times the amount of omega-3 fatty acids as does the cow raised on and fed with high-quality grass all their life.

Weight loss occurs in a calorie deficit. There is no diet that cannot produce a calorie deficit. This has been demonstrated in great studies showing the equivalent of low-carb diets, and the Mediterranean diet are equal over time.

It has also been demonstrated in those showing the McDonald's diet, the cookie diet, the Twinkie diet, and our own - Beer and Sausage diet.

One simply gets tired of eating red meat, and you eat less of it. So instead of eating three thousand calories of multiple foods, you eat 2200 calories of meat, and you lose weight. Nothing to see here, folks, just another diet.

But there is a dark side to red meat. Just because you can lose weight and show all the physiological benefits of weight loss doesn't mean that a lot of red meat is good for a human. In fact, there is every evidence to state one should limit red meat.

There is always some headline grabber who states that eating red meat has the same risk as smoking. While red meat, as we shall see, has an increased risk of cancer, heart disease, and diabetes, it is not as risky as smoking cigarettes. As much as some anti-meat activists might like to frighten you, we assume you came here for the facts.

So, where did our studies begin?

Heart disease was an epidemic in the 1950s in the United States, primarily affecting white-collar men. However, when Ancel Keys heard that certain populations had almost no heart disease, he began a quest that resulted in the Seven Countries Study.

Briefly, people in some villages in the Mediterranean region ate less red meat. Some because they couldn't afford it, and it wasn't a traditional part of their cuisine.

Keys group studied 14,000 men from 16 villages in seven countries. Some of those cohorts, like in the United States and Finland, had high levels of red meat and saturated fat...

This is the time of year when everyone is excited about some change in their life. My neighbors are doing a "dry January" because they want to cut down on their alcohol. Other neighbors committed to more physical activity before a hip replacement. And there is the inevitable "what diet will I do this time?"

Now, before I go to that, long-time readers of my newsletter will realize that I am drinking my cup of Peet's coffee. Peet's is a story of disappointment, which I will use to illustrate a point:

Diets are like that person who disappoints you again and again. The person you invite to events, but they never reciprocate. The diet starts out great. You lose a bit of weight, decide you can eat this way forever, and this is your new lifestyle.  Then something happens. If you are smart, you realize you cannot live that way. Most, though, internalize and think, "It is my fault." Well, it isn't your fault.

Low-carb diets can be disappointing for various reasons. Some people may find it difficult to stick to a low-carb eating plan because they miss certain high-carb foods that they enjoy. This can lead to feelings of deprivation and dissatisfaction with the diet. Additionally, some people may not experience the weight loss or health benefits they were hoping for with a low-carb diet. It's important to remember that everyone's body is different, and what works for one person may not work for another.  Furthermore, it is important to focus on overall health and well-being rather than just weight loss or specific dietary restrictions.

Every year, someone starts a new version of low carb. I've done a few myself. This year's version is carnivore. Some are doing a carnivore January.  The results will be the same as the previous low-carb diets - and let me go back to Peet's coffee.

I have been a member of Peet's Coffee Club since 1995. I get it faithfully every couple of weeks. Whole beans. It costs about $36 for two bags. Then I discovered I could get it at Costco for $25, with no shipping charge, the same date of roasting. I wrote Peet's, of course. They told me my coffee is always fresh, unlike the bulk sold to Costco. Except the roasting date is on the package.

Diets are like that. You get some results, then disappointment. You don't get the return for the money. But someone in the low-carb community will tell you that you didn't do it correctly:

• You were not earnest enough,
• You didn't get the right kind of grass-fed beef
• The beef wasn't organic
• You ate a banana and ruined ketosis
• If you stop eating carrots, you will maintain ketosis.
• Oh, does that pasta look delicious
• Stop eating vegetables and grains, and just eat beef, salt, and water

So, some consider weight loss surgery or new drugs. Both of these are reasonable (yes, I have done a lot of weight loss surgery in my time).

But what I've advocated is that people have to take responsibility for what they eat even after weight loss surgery. Well, you don't have to - but your body is a perfect calorie counter.

Does that mean a "diet?" No, the goal of weight loss drugs or surgery isn't to put someone on a diet for weight loss. The goal is to give them good food so they can nourish themselves.

It also means I have to get rid of silly ideas they learned from things like the low-carb diet. The low-carb diet, that friend you always invite into your home, always disappoints.

About ten years ago, I received certification in Culinary Medicine. Part of that training was long hours reviewing the literature more about food than I could imagine. For my patients, they will remember the day I began to advocate for the Mediterranean Diet.

I made the journey from some version of a low-carbohydrate diet to a diet that had substantial proof of long-term health.

Today, the Mediterranean diet is what I recommend to everyone. It is the most well-studied diet on the planet.

The Mediterranean diet is a way to eat based on the traditional foods and cooking styles of countries bordering the Mediterranean Sea. It has been associated with numerous health benefits, including a reduced risk of heart disease, stroke, and certain types of cancer. The components of the Mediterranean diet include:

1. Abundance of plant-based foods: The diet emphasizes the consumption of fruits, vegetables, whole grains, legumes, nuts, and seeds. These foods are rich in vitamins, minerals, fiber, and antioxidants.
2. Olive oil as the primary fat source: Olive oil is the main source of fat in the Mediterranean diet. It is high in healthy monounsaturated fats and has been linked to lower rates of heart disease.
3. Moderate consumption of fish and poultry: The Mediterranean diet encourages consuming fish and poultry in moderate amounts. Fish, especially fatty fish like salmon and sardines, are rich in omega-3 fatty acids, which have numerous health benefits.
4. Limited red meat intake: Red meat is limited in the Mediterranean diet, with a focus on leaner options like poultry and fish. This helps reduce saturated fat intake and lower the risk of heart disease.
5. Moderate consumption of dairy products: The diet includes moderate amounts of dairy products, such as yogurt and cheese.
6. Red wine in moderation: Moderate consumption of red wine is a common component of the Mediterranean diet. This is believed to be due to the presence of antioxidants in red wine, such as resveratrol, which may have health benefits when consumed in moderation.
7. Herbs and spices for flavor: The Mediterranean diet relies on herbs and spices, such as garlic, basil, oregano, and rosemary, to flavor foods instead of using excessive amounts of salt or unhealthy condiments.
8. Regular physical activity: In addition to the dietary components, the Mediterranean lifestyle also emphasizes regular physical activity. This can include activities like walking, cycling, or participating in sports.

It is important to note that the Mediterranean diet is not a strict set of foods but rather a flexible and adaptable way of eating.  You can eat in this manner by eating food from India, the Phillippines, or Norway. The emphasis is on whole, unprocessed foods and a balanced approach to nutrition.

Want to learn more? I have a course coming up - watch this space. For my followers on TikTok you can find the course there.

Oh, and I will be buying from Costco, although many other coffee companies have come to me and said, "Hey, try our coffee." So I am. Sorry, Peet's - I may still drink you, but I have boundaries.

Do that with your diet that will disappoint you. Consider instead a diet that will nourish your body and keep you in good shape.

Good Luck & have fun!

The New Year, the point we all look for a second chance. To get healthy, lose weight, adopt a new habit.  And waiting for you are the hucksters who want to sell you hydrogen in your water, expensive supplements of dubious value, and some choices that might actually harm you. If it sounds too good to be true, you might just be hearing the sound of the duck - or a quack, at least.

1. Carnivore Diet
2. Magnesium Supplementation
3. Celtic Salt
4. MTHFR Gene Mutation
5. Cold Plunges

Today, on Fork U, we will reveal the top scams of 2023 and make sense of the madness that surrounds them.

I'm Dr. Terry Simpson, and this is FORK U. Fork University.

Where we teach you a little bit about food as medicine

Busting myths and making sense of the madness.

Chief among the shirtless salesmen of supplements and scams, 2023 saw the self-described liver king (Brian Johnson) fall from grace, and his partner, Paul Saladino, tried to say he didn't know.

Liver King's five-foot-two-inch frame was filled with more steroids and growth hormones than found in a pharmacy. Purchasing somewhere between $12,000 and $20,000 of injectables a month and eating a diet far from the liver he recommended. Ultimately, Johnson admitted this, albeit the evidence was overwhelming. Finally, let us not forget that his business partner, Paul Saladino, loves to yell at spinach and kale while pushing his Heart and Soil supplements.

Liver King and Saladino jointly own a supplement business, Heart and Soil. They sell supplements and pretend to tell you about health through the carnivore diet.  Moreover, the company "Heart and Soil" is registered in Texas, and Brian Johnson, his wife, and Saladino are all board members.

Being shirtless is oddly effective, especially among some men. Whether this comes from "we like alpha males with abs" or homo-erotic fantasy, shirtless sells. Countless times showing studies refuting their claims don't move these supporters. In fact, the response from some males was some version of "Show me your abdominals." My retort, "I'd love their abs, but in time they'd love my arteries," just didn't move them.

I still find it odd that a grocery store would allow a shirtless person to yell at spinach. Yes, Saladino did train in psychiatry, although he does not see patients.

While Saladino said, he had "an inkling" his partner was doing steroids. Johnson (Liver King) used to inject insulin and balance it with maple syrup.  Isn't it odd that Saladino's refrigerator is filled with the same maple syrup that Liver King used to balance his insulin to increase glycogen in his muscles?

Saladino received a medical degree from The University of Arizona, and I was a faculty member (assistant professor) at the time.  Saladino loves to pander to the anti-medicine crowd with the trope that doctors don't learn the root cause of disease. I pointed out that we taught him pathophysiology, and he must have forgotten that our Western medicine discovered the root cause of many diseases.

In front of one audience, Saladino claims he learned nutrition in medical school. Then, a few years later, he claims he didn't learn nutrition in medical school. Do we learn nutrition in medical school?

As someone who is certified in Culinary Medicine and taught nutrition, I can say yes and no. The basics of nutrition are anatomy, physiology, and biochemistry. While you can get these courses in college, in medical school, these are graduate-level courses.

The basic pathology of atherosclerosis, or how cholesterol is made, transported, and absorbed, is taught in medical school. The effect of dietary saturated fats causing an increase in low-density lipoprotein is taught in medical school. Moreover, the foods with high levels of saturated fats are taught in medical school.

Because of those basics, we surgeons can take the sickest patients and feed them with intravenous nutrition. Surgeons developed intravenous nutrition that has kept countless people alive. In addition, surgeons developed the ability to feed directly into the gut through a tube. But we may not learn that Popeye's chicken breast contains 1000 mg of sodium more than a regular chicken breast. We don't learn the practical side of food, but we learn a lot about the basic science, which is the foundation of nutrition. An analogy might be that an architect can design your home but may not know how to build it.

The inflammatory process is one of the first series of lectures that medical students learn.  They learn that inflammation is an essential part of healing from injury and disease. That the inflammatory process is necessary to remove bacteria, viruses, parasites, and even cancer from the human body. Further, medical students learn that if the inflammatory process is overdone, destruction remains, such as in auto-immune diseases like rheumatoid arthritis, Sjogren's, or lupus.

Medical students are not taught to order C reactive protein or sed rates on everyone because that would be a waste of resources. Someone could have high inflammatory markers for various reasons, and blindly ordering tests is often a wasteful practice of doctors without a clue. Sometimes, we are clueless about a patient's condition, but oftentimes, medical students are taught that a history and physical exam will reveal more than a laboratory test.

Medical students are not taught that the inflammatory process is the basis of all diseases because this isn't true. Nor are they taught that atherosclerosis is all from inflammatory disease because that isn't true.

Vitamin deficiencies are taught in medical school. The first one noted, vitamin C and scurvy, was elucidated from the great work of the Scottish Surgeon Dr. James Lind. Scurvy is a disease with multiple parts - wounds reopen, teeth fall out, blood blisters form, and seemingly many symptoms, but is treated with a source of vitamin C. The root cause of disease, indeed.

Or consider this mysterious constellation of symptoms: a person progressively develops difficulty walking, strange eye movements, muscle weakness, shortness of breath, swelling of the legs and feet, and ultimately death. The disease was called kakke. Eastern-trained physicians had worked on it for 300 years, and it affected the royal household and the elite in Japan. Did they have some ancient remedy? They did not.

A doctor, Kanehiro Takaki, dissatisfied with his Eastern medical education, decided to learn Western medicine. He apprenticed under a local doctor until the doctor said he couldn't teach him anymore, and the Imperial Navy sent him to St. Thomas in London to learn surgery.  There, he learned "Western" medicine and even epidemiology, as was taught there by John Snow, who elucidated the cause of the cholera outbreaks.

Using the tools of Western medicine, he showed that the cause of these symptoms was a dietary deficiency of what became known as vitamin B1, or thiamine. If you want to hear a podcast about it or read more, click here.

What we are not taught in medical school is that a low-carb diet, or keto diet, or paleo diet, or carnivore diet cure diseases. We don't teach that to medical students because it is not true.

We teach how the DASH diet with low sodium reduces blood pressure and how to encourage patients with hypertension to decrease their diet. Or how the Mediterranean diet decreases the risk of heart disease and cancer.

While diet is the most empowering thing people can do, often it will not be enough. While physicians can influence some of the health decisions of patients, often the patient will come to us beyond where diet and exercise can help.

The carnivore diet is the latest evolution of the low-carb fad. Saladino does a fruit modification of the diet, which will prevent scurvy. In fact, the musician James Blunt suffered from scurvy. as the carnivore diet is far from a complete diet.

Carnivore diet sounds great - just eat steak. Saladino will claim this is the most nutrient-dense food in the world. It isn't.

Others will claim you can get all your nutrients through this - you cannot.

The health problems of an all-meat diet are clear:

• Keto vs Mediterranean diet - same weight loss, but Med diet had fiber and lower LDL (ref)
• A good review of meat-based vs. plant-based show plant-based overall healthier (ref)
• Another review shows that dietary fiber is associated with improved metabolic health (ref)
• While Saladino refers to the Hadza, studies show their diet, like most hunter-gatherers, is rich in fiber (ref)
• The Inuit in Alaska have high rates of heart disease, stomach cancer, and...

For years, obesity has been misunderstood, oversimplified, and even stigmatized. It's been framed as a personal failing, a lifestyle choice, or simply a matter of "eating less and moving more." But science tells a different, more nuanced story—one where our brains, biology, and ultra-processed food environment play starring roles. And thanks to groundbreaking medications like GLP-1 drugs, we’re gaining a clearer picture of how obesity works and how to treat it.

Let’s dive into why obesity is a disease, how ultra-processed foods exacerbate it, and why we need to ditch the harmful myth that obesity is a lifestyle choice.

"Just eat less and move more." It’s the phrase everyone loves to repeat—and no one finds helpful. This simplistic advice ignores the reality that obesity is not merely about calories in and calories out. It’s about a complex interplay between your biology, brain chemistry, and environment.

Obesity isn’t a character flaw or a lack of willpower. If it were, we wouldn’t see an obesity epidemic in societies flooded with cheap, ultra-processed foods engineered to make us eat more. These foods hijack our biology, overpowering the mechanisms our bodies use to regulate hunger and fullness.

Our brains evolved to keep us alive in times of scarcity. Back in the caveman days, this was helpful. Today, it’s less so because our brains are still wired to seek out high-calorie foods to avoid starvation—even when we’re surrounded by abundance.

When you eat ultra-processed foods, they light up the reward centers in your brain like a Christmas tree. These foods—laden with sugar, fat, and salt—trigger the release of dopamine, the same neurotransmitter involved in addiction. It’s no wonder we keep going back for more.

Adding to the complexity, hormones like ghrelin (the "hunger hormone") and leptin (the "fullness hormone") can go haywire in people with obesity. Ultra-processed foods amplify ghrelin’s effects, making you feel hungrier while reducing your sensitivity to leptin, so you never feel full. It’s a biological double whammy.

Citation: Studies show that diets high in ultra-processed foods increase calorie consumption by about 500 calories per day compared to diets of unprocessed foods (Hall et al., 2019).

Here’s where things get interesting: GLP-1, or glucagon-like peptide-1, is a hormone that helps regulate appetite. It tells your brain, “You’re full; you can stop eating now.” But for many people with obesity, this system doesn’t work properly. Their brains don’t get the message, leading to overeating.

Enter GLP-1 receptor agonists like semaglutide and liraglutide—medications that mimic the effects of GLP-1. These drugs help regulate appetite, making people feel full sooner and reducing cravings. The results have been extraordinary: clinical trials show average weight loss of 15% or more with these medications, far outpacing what’s possible with lifestyle changes alone.

These drugs have done more than help people lose weight—they’ve also shifted the way we think about obesity. They show that obesity is a medical condition influenced by hormones and brain chemistry, not just a matter of willpower.

Citation: Clinical trials on GLP-1 receptor agonists show significant and sustained weight loss, with participants losing 15% or more of their body weight (Wilding et al., 2021).

The idea that obesity is a "lifestyle choice" is not only incorrect—it’s harmful. Framing obesity this way ignores the biological, genetic, and environmental factors that contribute to it. Worse, it stigmatizes people with obesity, making them feel like they’re to blame for their condition.

Obesity meets all the criteria for a chronic disease: it has a defined pathology (dysregulation of appetite and metabolism), it leads to complications (diabetes, heart disease, etc.), and it requires long-term management. Lifestyle factors like diet and exercise can influence obesity, but they’re not the sole cause. Blaming someone for their obesity is like blaming someone with asthma for living in a polluted city.

Citation: The American Medical Association classified obesity as a chronic disease in 2013, recognizing it as a condition requiring medical treatment (AMA, 2013).

If obesity is a fire, ultra-processed foods are the gasoline. These foods are engineered for maximum palatability, combining sugar, fat, and salt in ways that overwhelm our natural appetite-regulation systems. They’re calorie-dense, nutrient-poor, and often stripped of fiber, which would otherwise help us feel full.

Even worse, ultra-processed foods alter the way our brains respond to food. They increase cravings, reduce satiety, and encourage overeating. Over time, this can lead to weight gain and metabolic issues, creating a vicious cycle that’s hard to break.

Citation: Research shows that people who consume diets high in ultra-processed foods are more likely to develop obesity and metabolic diseases (Monteiro et al., 2018).

GLP-1 drugs have given us new tools to treat obesity—and new insights into its underlying causes. They’ve proven that obesity isn’t just about behavior; it’s about biology. When you treat obesity like a disease rather than a moral failing, people get better.

But these medications are just one piece of the puzzle. To tackle obesity on a larger scale, we need to address the broader food environment. That means making healthy, unprocessed foods more accessible, reducing the marketing of ultra-processed foods, and investing in public health initiatives that promote nutrition education.

Let’s address the elephant in the room: fat shaming. The idea that you can "shame" someone into losing weight is not only cruel—it’s ineffective. Research shows that weight stigma leads to stress, low self-esteem, and even more weight gain. It’s a lose-lose situation.

Instead of shaming people for their weight, we need to focus on creating supportive environments that help everyone make healthier choices. That includes treating obesity as the complex, multifactorial disease that it is—not a personal failure.

Citation: Weight stigma is associated with increased psychological distress, unhealthy eating behaviors, and reduced motivation for physical activity (Puhl & Heuer, 2010).

Here’s how we can start to shift the conversation around obesity:

Acknowledge Obesity as a Disease: Let’s treat obesity like any other chronic condition with empathy and evidence-based care.

Focus on the Food Environment: We need to address the root causes of obesity, including the overabundance of ultra-processed foods.

Reduce Stigma: Stop blaming individuals for their weight. Instead, offer support and solutions.

Expand Access to GLP-1 Drugs: These medications are game-changers, but they’re expensive and not always covered by insurance. Making them accessible is crucial.

Obesity is not a lifestyle choice. It’s a complex, chronic disease driven by biology, brain chemistry, and the environment we live in. Thanks to advances in science, like GLP-1 drugs, we’re starting to understand and treat obesity in ways that are effective and compassionate.

The next time someone tells you to “just eat less and move more,” remind them that obesity is about much more than that. It’s time to move past the myths, embrace the science, and support people on their journey to better health.

And maybe, just maybe, it’s time to rethink that bag of chips.

Hall, K. D., et al. (2019). "Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain." Cell Metabolism.

Wilding, J. P. H., et al. (2021). "Once-Weekly Semaglutide in Adults with Overweight or Obesity." The New England Journal of Medicine.

Monteiro, C. A., et al. (2018). "Ultra-Processed Foods, Diet Quality, and Health Using the NOVA Classification System." Public Health Nutrition.

Puhl, R., & Heuer, C. (2010). "Obesity Stigma: Important Considerations for Public Health." American Journal of Public Health.

AMA (2013). "American Medical Association House of Delegates Resolution 420 (A-13)."

Did you ever notice there are those people who will tell you how everything is bad for you? Don't eat this and don't eat that?

They make grand assertions about the modern food system. Often claiming we should return to the age of the caveman. Assuming that health will return when we eat what our ancestors ate.

Proponents of ancestral diets are confused by the logical fallacy called a biotruth.

What is a biotruth? An argument based upon a misunderstanding of natural selection or the evolutionary process. Usually combined with the conclusion that if it was good enough for primitive man, it should be true for now. Ultimately, we forget that primitive man did not have an easy life.

Canola oil is today's topic because not everyone wants to buy expensive olive oil. When I mention canola oil on TikTok, the comments go like this:

• Canola oil was "meant" to be motor oil
• It comes from the rapeseed plant
• It is a GMO-crummy oil
• Chemically extracted with hexane and it can turn rancid and create trans-fats

Are those claims valid? Should we avoid Canola oil? Must we avoid Canadians in general?

We will make sense of the madness that is Canola oil. Is it an evil plant that is only good to make oil for your car, truck, or tank? Or is it a reasonable oil for your body?

I'm Dr. Terry Simpson, and this is Fork U

Fork University

Where we make sense of the madness

Bust a few myths

And teach you a little bit about food as medicine.

Canola oil was invented in the 1970s in Canada and is an acronym that stands for Canadian oil's low acid.

Canola comes from the pressed seeds of rapeseed plants. Granted, that is an unfortunate name. However, not if you know its epistemology.  Rapeseed comes from the Latin rapa, which translates to "turnip." Thus this flowering plant is a member of the turnip, cabbage, and mustard family.

Latin just isn't taught anymore. But if you think of Rome often, as we men do, Latin might be the new language for you.

Speaking of Mustard, did you ever wonder why we don't have mustard oil in the United States? Primarily Erucic acid.

Erucic acid is a monounsaturated fatty acid that is associated with heart disease. In some poorly done experiments in rats, they seemed to have higher levels of heart disease. Rats, not politicians. But the healthy kind of rats you find in sewers, not the vermin found in Washington, DC.

Erucic acid is why you don't find mustard seed oil in the United States. Those who travel to India will experience delicious foods cooked in mustard oil. But don't fear. It will be just fine (ref).

In fact, erucic acid decreases the rate of some progressive brain diseases and is being examined to treat cancer and other diseases.

Because of the high erucic acid content, rapeseed oil was originally used as an industrial lubricant. Some rapeseed was cold pressed, seeds gathered, pressed, and not heated, and the oil extracted. This has been used as a cooking oil for years, but there was concern regarding the erucic acid content.

Canadian scientists began to crossbreed the rapeseed with wild cabbage to lower erucic acid. The seeds of this new hybrid plant became the Canola oil. Later, this plant was genetically modified to withstand Round Up. Hence, it is a genetically modified plant (ref).

As someone who has published about genetic engineering, I find the fear of GMOs to be a fear of the unknown. Modifying genes is what humans have been doing for centuries. Hence, using laboratory techniques is simply faster than cross-breeding. Still, GMOs are a major cause of heartburn for the latte-sipping English major.

It is human studies that are the gold standard for how a food behaves. Not where it came from or what it has been used as.

Let us begin in Lyon, France. The capital of fine dining in the world, home of restaurants with over twenty Michelin stars.

But Lyon? Home of butter? What happens when we take people with heart attacks from Lyon and ask them to change their diet?

There was a seventy-five percent lower incidence of cardiac deaths in patients with a first heart attack who modified their diet to a Mediterranean-style diet.

What was the main change? Well, they wanted the French to go from butter to olive oil, but alas, that was not popular. The French, other than those who reside in the Rivera, do not find olive oil attractive. But the French had no trouble adopting canola oil.

Canola oil was provided as both a cooking oil and a margarin to spread on their famous French bread.

Other changes they adopted included:

1.  consume whole grains rather than refined grains,
2. to have fish more than beef,
3. and to never go a day without fruit.

In the first year, the canola group had 73% less risk of having a second heart attack or dying from heart disease. After several years, the final paper (referenced here) showed a similar risk reduction.

One of the great conclusions of the Lyon heart study was that adopting the Mediterranean-style diet was not that difficult for these patients. While some doctors might give up, this one dietary change had as much influence as controlling blood pressure in patients with clinically active heart disease.

Other Human Studies?

Nine studies showed that patients consuming canola oil had lower LDL cholesterol. The higher the LDL, the more heart disease a person is likely to have, as well as strokes and peripheral vascular disease.

In spite of what the shirtless salesmen of supplements and scams want to tell you, the human trials show:

• Canola oil is not toxic to humans
• Canola oil improves biomarkers for the heart
• Canola oil improves insulin levels.
• Canola oil over butter and cream is one factor leading to less heart disease in patients with coronary artery disease.

• Lab studies of people improve when consuming canola oil over saturated fat, butter, or beef tallow.
• Insulin levels are decreased - which is good - with canola oil
• And as in Lyon, while the butter is delicious, those who consume canola oil have fewer problems with their heart.

If you want to implement the Mediterranean diet into your life, why not do what they did in Lyon?

If you cannot afford olive oil, use canola oil to cook with. It has fewer trans fats than tallow, lard, butter, or coconut oil and has a neutral flavor.

Make sure to have a fruit every day or two.

Use whole grains in your diet, be that for bread or just grains with your meals. Whole grains contain a lot of fiber.

New Course Coming

Thank you for listening to this edition of our series on how to adopt the Mediterranean Diet. We will have a course put together soon about adopting the Mediterranean diet, and you can find out when by listening to this podcast or signing up for my newsletter on terrysimpson.com. You can also follow me on TikTok, where I am @drterrysimpson.

Check out the blog associated with this - either yourdoctorsorders.com or forku.com.

This podcast was researched and written by me, Dr. Terry Simpson. While I am a real medical doctor, board-certified, I am not your doctor. Before making dietary changes, please check with a real, board-certified western-trained physician. Not an Eastern medicine doctor, not a witch doctor, not a chiropractor, not a naturopath.

Distribution and audio editing were done by my friends at Simpler Media - run by the pod god Evo Terra and his most able assistance. Thank you, Allie.

Hey Evo - in the interest of research, we need to go to the Mediterranean - by way of Lyon.

People who count calories notice nuts contain about 200 calories per ounce. Nuts are calorie-dense. However, nuts are also nutrient-dense. Moreover, nuts provide fiber, healthy oils, and essential minerals.

Nuts have been shown to decrease sudden cardiac death, decrease cholesterol, and provide satiety that helps people who wish to control their weight.

Two Brazil nuts contain enough magnesium to meet the adult daily requirement.

The advantage of a healthy diet is that you do not need supplements in your diet. While Magnesium is an essential mineral needed in hundreds of reactions in your body, you can get all the magnesium you need by following a Mediterranean Diet.

Take Pumpkin Seeds - also known as Pepitas in the US. Kernels: 1 oz, 168 mg or pumpkin seeds in shell: 1 oz, 74 mg

Almonds, dry roasted: 1 oz, 80 mg

Spinach, boiled: ½ cup, 78 mg

Cashews, dry roasted: 1 oz, 74 mg

Peanuts, oil roasted: ¼ cup, 63 mg

Soymilk, plain or vanilla: 1 cup, 61 mg

Black beans, cooked: 1⁄2 cup, 60 mg

Peanut butter, smooth: 2 tablespoons, 49 mg

Bread, whole wheat: 2 slices, 46 mg

Avocado: 1 whole one is 44 mg

Potato, baked with skin: 3.5 oz, 43 mg

Rice, brown, cooked: 1⁄2 cup, 42 mg

Yogurt, plain, low fat: 8 oz, 42 mg

Oatmeal, instant: 1 packet, 36 mg

Banana: 1 medium, 32 mg

Salmon, Atlantic, farmed: 3 oz, 26 mg

Halibut, cooked: 3 oz, 24 mg

Raisins½ cup, 23 mg

Chicken breast, roasted: 3 oz, 22 mg

Beef, ground, 90% lean: 3 oz, 20 mg

Broccoli, chopped & cooked: ½ cup, 12 mg

Apple:1 medium, 9 mg

Carrot, raw: 1 medium, 7 mg

All of those are foods you get in your diet, and all of them are a part of a healthy Mediterranean Diet.

Which is better? Magnesium glycinate three eight citrate or oxide?

This is one of the most common questions I'm asked during my doc talk live sections on TikTok. Magnesium supplementation is a popular subject probably ever since the disgraced Naturopath published her book The Magnesium Miracle, claiming that magnesium could cure over 60 diseases. It was popular because so many people wanted one thing that they could grab hold of to explain all of their problems.

And because symptoms of magnesium deficiency are common, fatigue, weakness, insomnia, and heart palpitations, it became a natural reservoir for all of the nonsense that people want to present.

Barbara O'Neill, the naturopath banned from Australia for dangerous practices, frequently lectures that taking Celtic salt will cure hypertension, but it isn't Celtic sea salt you need.

If you need magnesium today, I will introduce you to Mediterranean magnesium. It will not only help regulate blood pressure but also improve your life and increase longevity.

Today on Fork U, we will make sense of the madness of magnesium, and we'll tell you which magnesium supplement you should buy and which you should avoid. And how to take the Mediterranean magnesium miracle and avoid the supplemental magnesium misery of Montezuma.

I'm Dr. Terry Simpson, and this is Fork Fork University.

where we make sense of the madness. Bust a few myths and teach you a little bit about food as medicine.

The Mediterranean magnesium miracle. Where do you get this? Well, first try nuts and seeds, which we include in the fruit section of the Mediterranean diet. Did you know that two Brazil nuts contain enough magnesium for a person for a day? An ounce of pumpkin seed contains about half of what you need. A banana is about 10%. Salmon about a fourth beef. Beef is about 10%. Now, I know the carnival crowd has a hard time accepting that beef, bison, or organ meat doesn't contain sufficient amounts of magnesium to meet minimum data requirements. But I digress. It's just so much fun to call them out about their quackery. No doubt, many of those proponents sell magnesium supplements on their websites. But did you know that a well-rounded diet like the Mediterranean diet, you will consume all of the magnesium you need?

And speaking of nuts, did you know that increasing walnut consumption has been shown to lead to a reduction in low-density lipoprotein cholesterol and decrease inflammatory and oxidant markers in individuals who are at high risk for coronary disease?

And do you know that other studies have shown that people who consume nuts and seeds have fewer heart attacks? For example, 40% decrease in heart disease among those people who consume four servings of nuts a week.

Let's go back to the supplementation stuff. The problem with supplementation is you're just replacing one factor when eating food provides not only that one factor but plenty of other things.

The second problem with magnesium supplementation is magnesium toxicity.

Now, oftentimes people may attribute the nausea, cramps, and diarrhea to food poisoning when actually they're getting overdosed on magnesium supplementation. They probably don't know that taking those magnesium supplements could interfere with their medicines, like their diuretics, their heart medicine, or their antibiotics. Magnesium can cause more muscle aches and sleeplessness, and extra magnesium can even stop the heart. They probably don't tell you on those magnesium bottles that it's going to compete with calcium for absorption. So taking excess magnesium will not only overdose you but also decrease calcium absorption.

Wow, it's hard to believe they actually sell that stuff when you can just take a Mediterranean diet full of nuts and seeds at one portion of it and get plenty of it in your diet. While magnesium is essential, it is far from rare in plants, nuts, and seeds in spite of supplement makers consistently making claims that our food has less magnesium because we're depleting our soil. Did you know that magnesium is the third most common element on the crust of the earth?

Because of that, one of my favorite mineral waters has 45 mg of magnesium per glass. It is called Socasani, I don't know if you can find it anywhere else, but I get it at Costco here in the Los Angeles area. This is mineral water that bubbles up from springs in the Andes. It is high in magnesium. I like it because they won some water awards and that is how I found it. But a cup of that water is about a quarter of the amount of magnesium because magnesium is the third most common element on the crust of the earth.

So when I refer to Mediterranean magnesium, it's not a supplement you're going to buy, although I'm sure someone will probably sell it now. But it does come from nuts, seeds, fruits, and vegetables.

Now let's go back to Celtic Salt. I hear people selling Celtic salt all the time, be that Barbara O'Neill, Santa Cruz Medicininals, or Gary Brecka.

But Celtic Salt has 34,000 mg of sodium to 200 mg of magnesium in three and a half ounces (100 grams). That is a tone of salt.

Now contrast Celtic Salt with one ounce of pumpkin seeds, which has 170 mg of magnesium and two milligrams of sodium. Celtic salt is just overpriced salt. It is not a source of magnesium.

And certainly, if you're going to take three and a half ounces of salt, which contains 34,000 milligrams of sodium, to get 200 milligrams of magnesium, whatever good the magnesium will do to your blood vessels will be more than outdone by the overdose of sodium you're giving to your body.

The problem with supplement makers and sellers everywhere is that they are constantly trying to sell you something that you can get in a healthy diet, like the Mediterranean diet, and in this case, from nuts and seeds. They are easy to add to a salad from nuts, which makes an incredible snack that you can carry portable with you almost anywhere, containing fiber and protein, along with magnesium, selenium, potassium, and all those things that you need.

You don't need to spend more money on magnesium supplements, what you really need is to spend more money eating a better diet. Or like I tell people when they tell me, well, I just don't like fruits and vegetables and nuts and seeds. It's time to grow up because there is more in your diet than just magnesium. There are plenty of other things that you need that you can get from a diet that you will never get from a pill.

Now to be clear, there are those people who need magnesium supplementation if required by a board-certified physician. There are people with certain conditions, kidney disease, and people who have taken certain pills that will deplete magnesium and need it.

How do you test for magnesium deficiency? Not just a blood test. Blood only contains a few percentages of the magnesium in your body. There are several other tests. One of the gold standards is that we give you a bunch of magnesium, check your urine, and see if it all came out. Another one is the red blood cell test for magnesium. There are some good magnesium tests out there, typically not available from your average chiropractic lab, which oversells you on tons of tests.

So if you overdose on magnesium, like my aunt did when she brought me the book, The Magnesium Miracle. She said, "I think this is what was giving me diarrhea." I said, absolutely. It was also one of the reasons that her anti-hypertensive wasn't working. She was getting too much hypertension. She stopped her magnesium supplement. Her bowels cleared up, and her hypertension got better. She was taking...

The legume is a powerhouse plant protein. The beautiful bean. Often the source of protein for vegetarians and vegans, and forgotten about in most modern diets today. Thus, we will campaign to bring back the legume.

In today's gym, you will find people selling protein powders, advocating all meat diets, and flexing their muscles. But in ancient times, the original Greek Gymnasiums, the source of protein for these fellows, were legumes. Their diet was cereals from whole grains, fruits, legumes, vegetables, and occasionally fish. No meat, no protein powder, no pre-workout.

When most think about legumes, they think about the common green bean (Phaseolus vulgaris). Yet there is an entire family of Leguminosae.

The precise definition of a legume is any plant from the Fabaceae family that would include its leaves, stems, and pods. A pulse is an edible seed from a legume plant. Pulses include beans, lentils, and peas. For example, a pea pod is a legume, but the pea inside the pod is the pulse.

When Ancel Keys was told there were few cardiac events in Southern Italy, he went to investigate. Legumes have less fat, and thus, a diet rich in legumes should have less fat and, thus, less heart disease.

In Naples, only 20-25 percent of the calories were from fat. In contrast, Keys noted in England that 35% of the calories were from fat, while in Minnesota, 40 percent of the calories were from fat. Legumes meant plenty of protein, less fat.

The blood cholesterol reflected some of this.  Naples had cholesterol values of 165 milligrams per 100 milliliters of blood, while England had over 200 and Minnesota had over 230.  Total blood cholesterol was the only measurement at the time.

What Keys also showed was the wealthy Neapolitans ate a richer diet:

"Still, a small sample of bankers and professional men in Naples, who lived on a much richer diet than the working class, had cholesterol values of about 200 in their blood serum, and some of them had coronary heart disease." (reference 1)

Keys then took 24 healthy men and controlled their diet for fat and protein. Keeping calories constant with equal amounts of protein but changing the fat, the cholesterol fell from 225 to 195 on the lower-fat diet. But the Neapolitan diet was not what he followed. The fat in Naples was mainly olive oil, and the fat in the low-fat metabolic ward was from fat in meat and milk.

At the time, Keys concluded it would be difficult to convince people to eat a diet rich in legumes. Americans love their meat. Today, we have better methods to decrease heart disease risk by using statins often with other drugs. While a diet of legumes replacing meat might reduce blood cholesterol by 10-20%, that is often not enough to decrease the risk of heart disease.

A combination of modern medications (such as Crestor, Zetia, Repatha) can lower LDL (apo-B levels) to where heart disease can become an "orphan" disease. You can have your steak and eat it too!

Legumes are part of the Mediterranean Diet (ref). The recommended amount includes 3-4 ounces of legumes per day. Or using legumes as a major source of protein for a meal several times a week.

Legumes: lentils, beans, peas, and peanuts.  The more common ones that humans consume.

Until about 12,000 years ago, homo sapiens were hunter-gatherers. For almost two million years before that, our evolutionary ancestors subsisted on hunting and gathering. What was the most common protein source? Legumes. Not meat, as much as your carnivore-crazy friends would have you believe.

Remains of lentils, the tombs of the Twelfth Dynasty (2400-2200 BC).  Archeologists have found peans and lentils from remains in Turkey dating to 5500 BC.

Even North America has legumes. America is best known for both the kidney bean and the haricot (and you thought it was French). Those were cultivated throughout North, Central, and South America. Dried kidney beans have been found in pre-Inca tombs.

Want Some Data?

People who ate legumes four times a week had a 22% reduction in heart disease compared to those who consumed legumes once a week or less. The U.S. Dietary Guidelines emphasize legumes (about 3 cups a week) and the DASH Eating Plan of the National Heart, Lung, and Blood Institute (4-5 half-cup servings a week). The Food and Agriculture Organization (FAO) of the United Nations declared the International Year of Pulses in 2016, focusing on the contribution of pulses to food production and nutritional diversity to help eradicate hunger and malnutrition.

Nutritional Value

Legumes are a significant source of protein, dietary fiber, carbohydrates, and dietary minerals; for example, a half cup of cooked chickpeas contains 18% of the Daily Value (DV) for protein, 30% DV for dietary fiber, 43% DV for folate and 52% DV for manganese. Not much fat and not much sodium in these.

Legumes are also an excellent source of resistant starch, one of my favorite starches.  Your gut doesn't break down resistant starch but is broken down by bacteria in the large intestine to produce short-chain fatty acids used by intestinal cells for food energy. Those byproducts reduce the risk of colon and rectal cancer.

Favorite Recipes:

One of my favorite recipes is life-saving Dahl by Simon Majumdar - my co-host of FORK U. His recipe is here.

REFERENCES:

(1) Keys, Margaret.Keys, Ancel. The Benevolent Bean. United States: Farrar, Straus and Giroux, 1972.

Gofman JW, Delalla O, Glazier F, Freeman NK, Lindgren FT, Nichols AV, Strisower B, Tamplin AR. The serum lipoprotein transport system in health, metabolic disorders, atherosclerosis and coronary heart disease. J Clin Lipidol. 2007 May;1(2):104-41. doi: 10.1016/j.jacl.2007.03.001. PMID: 21291675.

LA, He J, Ogden LG, et al. Legume consumption and risk of coronary heart disease in US men and women: NHANES I Epidemiologic Follow-up Study. Arch Intern Med 2001 Nov 26;161 (21):2573-8.

"Nutrition facts for Chickpeas (garbanzo beans, bengal gram), mature seeds, cooked, boiled, without salt, 100 g, USDA Nutrient Database, version SR-21". Conde Nast. 2014. Retrieved 15 January 2015.

Birt DF, Boylston T, Hendrich S, et al. Resistant Starch: Promise for Improving Human Health. Advances in Nutrition. 2013;4(6):587-601. doi:10.3945/an.113.004325.

Am J Hypertens. 2014 Jan;27(1):56-64. doi: 10.1093/ajh/hpt155. Epub 2013 Sep 7.

Effect of dietary pulses on blood pressure: a systematic review and meta-analysis of controlled feeding trials.

Jayalath VH1, de Souza RJ, Sievenpiper JL, Ha V, Chiavaroli L, Mirrahimi A, Di Buono M, Bernstein AM, Leiter LA, Kris-Etherton PM, Vuksan V, Beyene J, Kendall CW, Jenkins DJ.

Naureen Z, Bonetti G, Medori MC, Aquilanti B, Velluti V, Matera G, Iaconelli A, Bertelli M. Foods of the Mediterranean diet: garlic and Mediterranean legumes. J Prev Med Hyg. 2022 Oct 17;63(2 Suppl 3):E12-E20. doi: 10.15167/2421-4248/jpmh2022.63.2S3.2741. PMID: 36479501; PMCID: PMC9710409.

Turmeric is from the root of a flowering plant (Curcuma longa of the ginger family Zingiberaceae), known for being anti-inflammatory. Because of its anti-inflammatory nature, turmeric is one of the most common supplements I am asked about during my TikTok live sessions. This is because people like a "natural" anti-inflammatory supplement rather than over-the-counter medications.

Supplements are excluded from "black box warnings." Those warnings you see in the package inserts in pharmaceuticals.  This article is meant to provide references for those interested in doing more research about Tumeric to realize it is not benign.

Turmeric has many potential applications for cancer, brain injury, and many other diseases. The key is knowing what dose of turmeric is toxic, what dose is effective, and what dose is ineffective. We also need to know how to mitigate potential dangers.

Aspirin is a known anti-inflammatory agent with many uses. Since aspirin is regulated, we know the dose effect of aspirin. If you have a headache, the 81 mg dose of aspirin will not relieve your headache. But the 325 mg dose will decrease headache. And you know that taking two hundred tablets of aspirin is a toxic dose.

A single aspirin can cause a bleeding ulcer, which may lead to death. Some people are allergic to aspirin, and an allergic reaction can lead to death.

What we don't know is the effective dose of Turmeric or the lethal dose of it in that supplement bottle. But we know that turmeric, curcumin can lead to liver injury and death.

Toxicity is always in the dose. High curcumin levels, the active ingredient in turmeric, have caused liver damage (Ref 1-13). To quote from one of the references:

There is no danger in using turmeric as a spice in cooking. First, because your intestines do not absorb turmeric well. Unlike a supplement, which has high doses of curcumin. In addition, supplements also have black pepper, which increases absorption. Since turmeric has a mild anti-inflammatory component, this might have limited benefits as part of a healthy diet.

Tumeric belongs in the cabinet, not in a capsule.

You probably have some turmeric in your herb and spice drawer.

You’ve probably heard that Turmeric’s active ingredient Curcumin has anti-inflammatory properties and has been used for centuries as an “ancient” medicine.

That yellow powder comes from the root of the Curcuma longa plant, a member of the ginger family.

Turmeric has a warm, bitter taste, and I use it in Paella, curry, and add it to salads, rice, or other starches like pearl barley.

But what you haven’t heard is that too much Turmeric can kill you.

Today we will make sense of the madness surrounding Turmeric. From its promise as an anti-cancer agent to its toxicity, and who should avoid it for daily use.

I’m Dr. Terry Simpson, and THIS is FORK U

Fork University

Where we make sense of the madness

Bust a few myths!

And teach you a little bit about food as medicine.

Inflammation is a complex biochemical, physiological, and even pathological process. Inflammation is the basis of our immune system, and acute inflammation allows us to rid our bodies of cancer, viruses, bacteria, yeasts, mold, and parasites. Without the inflammatory process, we would end up being a pile of goo in twenty-four hours – dead as dead can be. Inflammation allows us to repair our body from injury, anything from burning our hand by spilling coffee to major trauma from an automobile accident.

Chronic inflammation can make certain illnesses much worse - from arthritis, heart disease, inflammatory bowel disease, psoriasis, and may even play a part in premature aging.

So we want some inflammation, but not too much.

Did you ever have the flu and have muscle aches and a fever, only to take an aspirin and feel better in 24 hours? Those muscle aches and fevers were not the result of the virus but of your body fighting it – and fighting it to where you felt poorly. So you added a bit of anti-inflammatory agent – aspirin – and felt better.

Science is always looking for anti-inflammatory agents, and curcumin has attracted a lot of interest among legitimate scientists.

Curcumin has been examined for a potential role in cancer treatments or with inflammatory bowel disease.

Because inflammation is complex – here is an example about curcumin: “It binds to the toll-like receptors and regulates downstream nuclear factor kappa B, mitogen activate protein kinases, activator protein one and other signaling pathways.”

Curcumin has also attracted the attention of the non-regulated supplement industry. Where they can bottle it up and tell you it “supports heart health, or gut health, or immune function.” All those statements are meaningless – designed to fool someone to buy something with a label of “natural” to believe it might be better than some “drug.”

Because it is complex, you can have hucksters use the word “inflammation” and sell you a product, an idea, or a supplement for hundreds of dollars. Their science is marketing, and in this case, marketing to you a product with words and extracting dollars from your wallet.

Do we even have wallets anymore?

Do you know what the most anti-inflammatory diet is? The Mediterranean diet – the one tested to work well for people with overactive inflammatory diseases – like arthritis, Crohn’s disease, multiple sclerosis, diabetes, obesity, or heart disease.

Let's take curcumin and turmeric back to the kitchen.

A part of the Mediterranean diet is cooking with herbs and spices.

And even if you can’t cook, you can spice things up a bit.

Turmeric seems to be a worthy candidate.

If you buy fresh turmeric from the store, it will look like a root. It is brown on the outside with a deep yellow inside. This turmeric is also great for cooking. But be warned, it will stain your hands a nice yellow color - not permanently. Use a micro plane to shave the root onto your dishes into your dishes. If you follow a recipe, you can substitute fresh turmeric in the ratio of 1 tablespoon fresh is equal to a teaspoon of the dried yellow in any recipe.

If you’ve been to coffee shops lately, you may notice they have started adding turmeric to some drinks, like a turmeric-laced latte. Which has about a quarter to half teaspoon of the powder in the drink. Turmeric will add a deeper flavor to your latte, and some liken it to other spiced drinks – such as the famous pumpkin.

Turmeric is a great addition to scrambled eggs or a tofu scramble. It provides a color and depth of flavor.

A quarter teaspoon of the spice is all you need. You can also use it with paprika on top of deviled eggs.

Adding a teaspoon to your rice will give it a deep yellow color that makes the rice more visually appealing.

A teaspoon also works well with your bean dishes. That famous cowboy caviar – adding turmeric to it – makes it a bit more earthy.

Some of you have asked me about Ginger/Turmeric /honey teas or “shots” to decrease inflammation.

But if you consider other anti-inflammatory drugs, like aspirin, and ibuprofen, you know they have side effects.

So does curcumin.

In the blog, I have half a dozen references to the deaths of people with liver failure who had high doses of curcumin, some prescribed by Ayurvedic practitioners. Many of these patients died; some were saved when they went to conventional hospitals where they needed liver transplants.

Be warned about the supplements of curcumin, especially when it has been combined with piperine (pepper) to increase its uptake in the gut.

Curcumin should not be used if you are pregnant or going to become pregnant. This can cause a loss of pregnancy.

Nor should curcumin be used if you are breastfeeding.

Do not take curcumin if you are taking any blood thinners, like warfarin, Plavix, or Eliquis.

If you tend to bleed more or bruise easily, you should not take this supplement.

The supplement should not be taken daily if you are over 60 years old, as it can cause bleeding in the brain.

Do you have some issues with your gallbladder? Curcumin causes inflammation of your gallbladder, which requires urgent surgery.

Curcumin should not be taken if you have stomach issues – it can cause ulcers in your stomach and make any ulcer you have to bleed more.

It should not be taken if you are taking aspirin, Motrin, or any anti-inflammatory drug.

It should not be taken if you are going to undergo surgery – it should be stopped two weeks ahead of time.

The supplement industry is not regulated. Besides people getting too much and causing bleeding issues and death, there have been supplements colored with heavy metals, causing heavy metal accumulation in people who use these supplements.

If you have a headache or joint ache, we know the dose of aspirin, Naprosyn, or Motrin...

Ozempic, Wegovy, Monjaro, and a host of other drugs – the GLP-1 agonists and near miracles weight loss drugs, and soon a more potent pill form coming.

These drugs have known side effects, and there have been increased visits to the emergency rooms. Often because people were not told foods to avoid.

As with any new drug, there are the grifters. After all, since it is a prescription, you will have supplement salesmen that promise a natural solution. What about those who claim they can "compound" the drug for you in their compound pharmacy?

Was it a coincidence that Weight Watchers (WW) bought Sequence? Sequence is a company that prescribes these drugs through a network of physicians that you contact via telemedicine.  Sequence, as it turns out, is one of the more legitimate telemedicine companies, not only trying to get you a prescription but providing a diet plan with it.

Weight Watchers purchased Sequence for over 100 million dollars. One thing missing from the frequent prescription of the new drugs is a diet plan. Weight Watchers does this.

And Weight Watchers is partially owned by Oprah Winfrey, who has been open about her weight loss struggles.  Now, Oprah reports she has been on semaglutide and lost over 45 pounds.

Thus Oprah proved that the drugs, with a good diet, are a powerful tool against obesity.

As a weight loss surgeon, I am constantly asked about willpower and obesity.  For example, Oprah Winfrey a person with more willpower than probably anyone you know. Given her resources to have people cook for her, provide her with a workout plan, and any assistance. She even bought a major portion of Weight Watchers. What made the difference? The injectable drug, semaglutide (Wegovy).

The Weight Watchers diet plan has evolved over the years. Even with the Weight Watchers diet plan ranking among the best diets in the world, they purchased Sequence. Thus repositioning themselves to use their diet with the drugs to provide optimal health.

Emergency room physicians have noted an increase in patients coming to the ER after using these drugs. I was recently interviewed about this, and you can find it here.

Common side effects include nausea, vomiting, bloating, constipation, and diarrhea. Up to eighty percent of people who take these drugs have symptoms.  Many of those problems can be avoided by following a few simple rules:

1.  Avoid fatty foods. Fatty foods increase bloating and discomfort with these drugs. Fried chicken has sent many to the emergency room
2.  Alcohol should be limited to one drink per day. Although best to avoid alcohol altogether with these medications.
3.  Junk food with lots of sugar, like candy, cookies, and donuts, should be avoided while on these drugs.
4.  Foods to concentrate on are fruits, vegetables, whole grains, and brothy soups like Minestrone or Dahl.

Many compound pharmacies have offered these drugs for sale. They are often at a greatly reduced price. But they are not the same drugs approved and tested by the FDA.

There is no "generic" form of Ozempic, Wegovy, or Mounjaro.

Compound pharmacies are telling their customers that, since there is a shortage of these drugs, they can compound the drug and sell it to the public.

Many of these compound pharmacies import semaglutide from overseas. It is illegal to import a drug from overseas without FDA approval. Furthermore, the drugs they import are not the same formula tested by the FDA. It is often sodium semaglutide and the FDA has warned against the use of this drug on its website (here).

In our podcast, we talk with a compound pharmacist who warns about these drugs.

In fact, the FDA has a warning for doctors:

"Healthcare professionals who are considering working with compounders to obtain semaglutide products should be aware that compounders may be using salt forms of semaglutide. FDA is not aware of any basis for compounding a drug using semaglutide salts that would meet federal requirements."

Supplement makers are left out because now we have a drug that can treat obesity almost as well as weight loss surgery. Some claim Berberine is a "natural Ozempic." Berberine is not. Berberine is not a GLP-1 agonist; it has mild weight loss benefits. In one recent study (cited here) people lost about 4 pounds over half a year of taking it. That is nothing compared to any of the GLP-1 agonists.

But there is a natural GLP-1, and you can find it in the Gila monster.

From the saliva of the Gila Monster came the drug, Exenatide, which is a GLP-1 agonist. It was the first approved for diabetic use and was noted to have a decrease in weight. The drug is not as effective for weight loss as Ozempic.

The new weight loss medications are one step to conquer obesity. Obesity is a chronic disease. It's not about losing ten pounds. While the stars on the runway want to use it for short-term use, that is a fad.

This year, sales of Ozempic are expected to hit 17 billion dollars (ref). All of this from a drug originally developed as a medication for type 2 diabetes.

Just about everyone in the low-carb community is talking about how bad seed oils are. They claim the medical community has it wrong. The conspiracy-minded folks claim doctors want to keep people sick. Thus dependent on medicine for pills and surgery. Hence, seed oils are the new evil part of the picture.

Seed oils, hydrogenated oils, and omega-6 fatty acids have replaced sugar as the new reason for ill health in America.

Their logic goes like this:

Seed oils are high in omega-6 fatty acids. They claim that high Omega 6 fatty acids are pro-inflammatory. Therefore, if you have more seed oils in your diet, you will have more inflammation. Inflammation is the root cause of heart disease.

Their argument is logical, partially true, and the conclusion is incorrect.  They are selling you snake oil (well, usually supplements).

The keto crowd will say how "real" peanut butter is made with peanuts and salt. Claiming this peanut butter is "candy" or "full of garbage" and isn't fit to be eaten. But is it? Let's break this down.

First, the added sugar, which according to the label is 3 grams per serving (two tablespoons), so the whole thing is 190 calories, of which 12 of those calories come from sugar, the rest from fat.

Here is the label from Sprouts Pure Peanut Butter. Nothing but ground peanuts. No salt, no oils, no sugar. There are 200 calories from two tablespoons.

Of the 200 calories from all peanut butter, with no added sugar, you get the same number of calories from the peanut butter with sugar in it. How much sugar? Well, about 3 grams per serving of sugar. How much is that? Not much.  To exceed the recommended dose of sugar from the American Heart Association, you would need to have more than 6% of your calories.  In Skippy, it is 1.5% added sugar.

Sugar was the "evil" that low carbohydrate folks said caused obesity. If you read their literature from twenty-plus years ago, it blamed sugar for obesity. Not just sugar, but any carb that was sugar, they claimed, would become fat. They even had their alternative view of history of obesity in the country.

They stated that the world was not obese until Ancel Keys blamed heart disease on fat. Then the US government promoted a low-fat diet. The result was obesity bloomed because they replaced fat with sugar. That evil food pyramid caused people to turn away from fat, substituting sugar. That sugar substitution led to obesity.

It sounds so logical. If you ever go on a low-carb diet (Atkins, South Beach, Paleo, Keto, Carnivore), you stop eating junk food and eat steak. You feel satisfied eating lots of meat.  Then you get tired of steak. You lose weight because you are in a calorie deficit, not because of ketosis. But that weight loss leads to confirmation of the theory that sugar made you fat.

You go off the restrictive diet. Now you gain weight. You gain weight because you are eating more. But you blame the slice of bread. What you forget is now you are eating more steak because you have more flavors in your mouth. That slice of bread is 100 calories, but you think an 18-ounce Porterhouse (1260 calories) is a diet food? So you blame the bread or the lava cake. But not the extra calories.

But something about your low-carb diet doesn't make sense. You notice that obesity has increased in the United States. But sugar consumption has fallen. How does that work?

You might wonder how that whole fruit is bad. Your low-carb coach says it's full of sugar. The community says it will "spike your insulin." Concluding that insulin causes you to store fat. But the scientific community shows study after study that people who eat whole fruits live longer and better. In fact, even diabetics who eat whole fruits have lower hemoglobin A1c. How is that? How can fruit be so healthy?

The latest low carbohydrate fad is the carnivore crowd. They eat fruit now. Maybe that is the answer - the evolution from the Paleo caveman diet to the Carnivore diet. Here is the problem: it is still a fad.

Then you read that the longest-living people eat a lot of carbohydrates. In the Blue Zones, they live long, consuming a diet rich in carbohydrates.

You go to Italy and see everyone is thin and beautiful, and eating pasta. The Mediterranean diet is the best, but it is 55% carbohydrates.

You go to Asia and see thin people shoveling in white rice.

Your eyes open and you think maybe you were just fooled.

In 2010 David Lustig came out with his famous YouTube video. Sugar is made of two molecules, fructose, and glucose. Glucose, he said, was not the problem. It was fructose. And high fructose corn syrup was in everything.

This brief idea was based on mouse metabolism. Not on human metabolism.

It was a cute fad that allowed you to blame big corn for the world's obesity. But the facts didn't add up here either. On to the next conspiracy.

The data shows that sugar isn't the cause of obesity. So they have come up with a new conspiracy. Seed oils are the problem.

Canola, safflower, corn, peanut, and just any vegetable oils cause the problem.

Seed oil consumption has increased worldwide, and so has obesity. There is the correlation. Simple minds like simple correlations.

While their conclusion is incorrect, it is important to see why they came to these ideas.

Trans fats are truly evil. They are a primary cause of heart disease. But before knowing this, they were the darling of food activists in the United States.

The movement was from food activists like Phil Sokolof. He suffered from a heart attack and believed saturated fat was evil. He took out full-page ads in major newspapers, and attacked the use of beef tallow in McDonald's french fries. Those fries were so much tastier. As he lobbied fast-food and commercial bakeries to switch to vegetable oils, he didn't understand they were adding trans fats.

Vegetable oils are healthy for the heart. But vegetable oils are liquid at room temperature. So you have to hydrogenate the vegetable oil, for it to become solid at room temperature. During hydrogenation, you create a lot of trans fatty acids.

In 2008, the American Medical Association urged the prohibition of trans fats in commercial bakeries and restaurants (reference). Finally, the medical community was listened to, and trans fats were outlawed in the United States (reference).

Just because you chemically alter vegetable oil does not mean it is a trans fat.  Since the FDA has outlawed trans fats, they are removed from the process.

Naturally occurring trans-fats are found in animal fats. Like butter, which is 3% trans fats.  Breast milk contains a form of trans fats called vaccenic acid, which has health benefits. Hydrogenation produces many forms of trans fatty acids that cause harm. But currently, hydrogenation does not involve making trans fatty acids.

Saying something is a seed oil is incorrect. Seed oils are not just one type of oil. Canola oil is much like olive oil, in that the main fatty acid is oleic acid (reference).

Canola oil is much maligned. Detractors will say it is highly inflammatory. In fact, canola oil decreases inflammation in the human body (reference). Canola oil not only reduces inflammation but also reduces total cholesterol in the blood. Compared to saturated fat, like butter from grass-fed bison or unicorns, it decreases all cardiac risk factors.

Some point out that canola comes from the rapeseed plant, which has been genetically modified. Thus, it must be filled with pesticides. They further tell you that canola oil has been used to run farm machinery. They fail to point out the obvious - olive oil can do the same. In fact, olive oil was the first electricity in the world, lighting homes, and running farm equipment.

Seed oils, as it turns out, are not inflammatory. They do not cause an increase in heart disease. They decrease the risk of heart disease.

Seed oils are in a lot of junk food. Some call them the ultra-processed foods. That doesn't make them bad. Junk foods also have a lot of sugar and a lot of salt. It isn't the oil per se, or the sugar, or the salt. It is that you can eat a lot of junk food. Junk food is readily available.

Back to Peanut Butter

Don't feel guilty for eating Skippy, Jiff, or whatever brand you like. Peanut oil is healthy for you. The sugar content is minimal. The hydrogenated oil makes the butter creamy without oil separation and decreases the risk of it going bad. As if peanut...

The increase of vegetables in the diet is one way to reduce inflammation.

Vegetables are an important part of the Mediterranean diet, providing essential nutrients. A diet rich in vegetables that contain antioxidants. As a result, the Med diet reduces the risk of heart disease, cancer, dementia, and anti-inflammatory diseases.

Vegetables are low in calories, but high in nutrient density. In addition to providing high nutrient value, they provide satiety. Thus making vegetables the cornerstone for weight loss and maintenance.

One serving of vegetables is 3 ounces (85 grams) of raw or double that cooked. Three servings of vegetables a day is the daily goal. Without a doubt, the more vegetables, the better.

Breakfast ideas for vegetables include what you might put in an omelet:  tomatoes, spinach, onions, and chives. Even the breakfast bites can have multiple vegetables in them.

While salads are great for lunch, filled with kale, radishes, and carrots, don't forget that you can pile a sandwich with lettuce, cucumbers, sprouts, and tomato.

Need a snack during the middle of the day, plan on carrots for the afternoon and for the drive home. You can't fall asleep while chewing on carrots.

Broccoli might be a great snack before dinner. Raw, even if you have a bit of ranch dressing. Buy packets of dry ranch dry ingredients and add to Greek yogurt.

Don't forget that dinner salad. Make it large and beautiful.

Vegetables contain nutrients that your body needs. They are rich in magnesium, potassium, and folate.

There is no supplement that can replace vegetables.

Every study has shown that an increase in vegetables decreases heart disease, cancer, and inflammation.

People who sell supplements often point out that vegetables have anti-nutrients in them. I have talked about this in a previous podcast and post (here). Of the various supplement salesmen out there, from the self-described Carnivore and his business partner Liver King to Dr. Gundry.

Legumes like beans and lentils are nutrient-rich, protein-, and fiber-rich foods whose benefits outweigh any lectin.  High doses of lectins, when fed to animals, lead to diarrhea, inflammation, and other problems. These problems have never been seen in human studies with normal foods. The main lectins are destroyed by cooking, soaking, sprouting, fermenting, boiling, and canning.

All human trials show that diets rich in legumes, and whole grains, lead to better health.

Oxalates can be absorbed from the gut, bind to calcium, and cause calcium kidney stones. They will also bind other minerals, such as zinc. This has led some to avoid healthy foods like spinach, swiss chard, amaranth, taro, sweet potatoes, beets, rhubarb, and sorrel.

Cooking greatly decreases the oxalate content. In addition, cooking increases the nutrients of the vegetables available for absorption. The higher the vegetable content, the higher the mineral content of the diet, the fewer kidney stones are formed.  People who consume a DASH diet have a 40-50% decreased risk of kidney stones (reference). The DASH diet is the American version of the Mediterranean diet.

Fatty liver disease is the most common reason for liver transplantation. Fatty liver disease replaced alcoholic liver disease a decade ago.

The rise of obesity has contributed to fatty liver disease, and fat, like alcohol, is deadly to your liver.

So can you clean out your liver?  Simple answer - no. But that doesn't stop the world from making dubious claims.

The most famous was Carter's Little Liver pills. They promised to increase the flow of bile in the liver. This would rid the body of toxins.

Even when it was marketed in 1868, it was known as a "patent" medicine. Thus a medicine without merit was sold by quacks.

In 1959, the name was changed to "Carter's Little Pills." The FDA, in 1951, filed suit that the pills had nothing to do with the liver.

The phrase "Someone has more (fill in the blank) than Carter has pills" comes from this product.

Stanley Burroughs, a lumber salesman, invented the "master" liver cleanse. The formula was tea or lemonade with cayenne pepper and maple syrup. There was no clinical data this ever worked. In spite of the lack of evidence, it continues to be recycled in the pseudoscience world.

Burroughs first published the book in 1946, "The Master Cleanse," and re-released it in 1976 under the title "The Master Cleanser".

Burroughs was convicted of manslaughter in California and fined for practicing medicine without a license.

This "juice" or "liver cleanse" or liver detoxification program keeps coming around with different ingredients. Some of the latest include olive oil.

The gallbladder flush is the same formula.  People will defecate small round balls of fecal material. Then they are told that these represent gallbladder stones, but they are not. Thus, the flush is useless.

All the blood from the stomach and small bowel is filtered through the liver. Hence, the liver can be considered a filter.

Once the food you eat is broken down and digested by the gut, those nutrients go to the liver.  Then the liver determines if you need to use the nutrients, store the nutrients, or get rid of the nutrients.

The liver gets the first pass at the medicines you take.  Many medicines require the liver to process them to be effective. Those drugs are called "pro-drugs." Aspirin, for example, is a drug whose active ingredient is salicylic acid.

The liver can also take harmful substances and render them harmless.  In spite of the liver's ability to deactivate harmful products, a person can overcome the liver's ability to detoxify substances. The classic case is alcohol.

Once alcohol is ingested, the liver begins to change it into acetaldehyde. Acetaldehyde is both toxic to the liver and responsible for most hangovers. Acetaldehyde is metabolized into harmless products.

If a person consumes more alcohol than the liver can metabolize, they will become intoxicated. In addition, they will develop both acute fatty liver and chronic fatty liver. A fatty liver can lead to cirrhosis and liver failure.

Since there are multiple complex metabolic pathways in the liver, there is no one agent that will fix the liver.

Supplements touted to help the liver include:

Milk Thistle.  The active ingredient is silymarin. Silymarin has been extensively studied in alcoholic liver disease, fatty liver disease, hepatitis, Tylenol poisoning, and mushroom poisoning. It works as an anti-oxidant and has shown promise, particularly when used early.

There has not been a clinical study showing that one can overcome the sins of a party with any preventive agent. The best preventative against damage to the liver is to avoid the process.

Does the artificial sweetener erythritol increase the risk of heart attacks? In fact, some say that this is just hype.

The article abstract can be found here.

It has been used for years in food as a "non-nutritive sweetener." Erythritol is used in many processed foods, replacing the calories from sugar. The Food and Drug Administration considers erythritol a food additive (GRAS). As a food additive, erythritol has never been tested for its toxicity or long-term use.

While artificial sweeteners decrease calories, do they decrease obesity? They have been shown to decrease obesity among teenagers (ref here). By reducing calories, it seems obvious that obesity would decrease. And yet, this has not been a consistent result

A study showed that increased erythritol led to increased obesity. And that was just the erythritol your body makes.

Since your body makes erythritol. Does that mean it must be safe?

The human body produces many toxic substances. For example, formaldehyde. Humans produce about 1.5 ounces of formaldehyde a day.

Acetaldehyde is a breakdown product of ethanol. Drink too much alcohol, and you will produce enough acetaldehyde to kill you.

There have been a number of peer-reviewed journal articles showing that artificial sweeteners have adverse consequences:

• Weight gain and obesity  (ref)
• Insulin resistance (ref)
• Type 2 Diabetes (ref)
• Stroke, heart disease, and all-cause mortality (ref)
• Increased heart deaths in women (ref)

We have about ten micromoles per liter of blood. That would be the baseline level. Blood levels with 1000 times as much erythritol are found in people who consume it as a sweetener.

One study showed that erythritol led to improved blood vessel function after drinking erythritol for a month (ref). But this was in healthy young adults. What about people with underlying heart disease?

The Erythritol study was done by the highly regarded Cleveland Clinic and published in the journal Nature Medicine. It was peer-reviewed, meaning many other scientists looked at that data and concluded the study was worthy of being included in this prestigious journal.

What this study examined was the correlation of erythritol with people prone to heart disease. They studied people at risk for heart disease. Such as those with high blood cholesterol, diabetes, obesity, or hypertension. They looked at the blood levels of erythritol. Data divided the patients according to how much erythritol was in their blood. What they found was that those with the highest levels of erythritol had the highest incidence of heart disease, strokes, and cardiac deaths of any other group when they followed them for three years.

They found the same results in both a cohort of people from the United States, which had over 1100 participants, and in an identical cohort of over 2000 people from Europe. The higher the level of erythritol in the blood, the more likely they were to have heart attacks, strokes, or die in the next three years.

Some criticized the study for not doing a dietary history of erythritol. This criticism is invalid, as normal levels of erythritol in the blood are 1000 times less than what you get when you use erythritol in food. Blood levels of erythritol are a better validation of what is in the diet than a dietary history. Not only is it hard to remember what products might contain erythritol, but in the US, some products with erythritol are not required to list it in their ingredients.

Another criticism was that they used people already prone to heart disease. That was the point of the article. By taking the highest risk group, those with high cholesterol, are obese, or have diabetes, you can shorten the time to see the effect. You already have disease, and you want to see if the erythritol makes things worse. In this case, those with high levels of erythritol were prone to a heart attack in three years.

If you take a group of young healthy people, erythritol tends to make their blood vessels a little more compliant. In contrast, in older people with stiffer arteries, erythritol has a worse effect.

Overall, the study was well executed and clearly warrants further investigation.

Are you afraid that eating fruit will cause your blood sugar to spike? Let us bust that myth right now.

Only ten percent of adults eat enough whole fruit daily despite the clear benefits of fruit.

 My 98-year-old dad eats fruit with breakfast for as long as I have known him. We would have grapefruit every morning. We even had those cute grapefruit spoons to wrestle the goodness out of the half grapefruit.

Now, dad enjoys a mixed bit of fruit.

In 28 studies with over 1.6 million people, each serving of fruit led to a 5% lower incidence of death (reference).

8% less risk of heart disease

3% lower risk of cancer

200 grams (7 ounces) showed the lowest risk of cancer rates and deaths from cancer.

Thirty years ago, the low-carb community advised against whole fruits. Their rationale was that fruits spiked blood sugar, which caused insulin to rise, which caused fat storage. They even cautioned against eating carrots for the same reason. But now, even the most extreme members of that community proudly eat fruit.

Breakfast with 1/2 cup of blueberries

Morning snack of one medium banana

Lunch with one apple

Afternoon snack of 1/2 cup of grapes (about 16)

Evening snack of 1 clementine

The tomato is a fruit. Yes, the Supreme Court said, for taxation purposes, it is a vegetable, but it isn't.

• promoting long-term weight management
• reducing the risk of heart disease
• reducing the risk of type 2 diabetes
• decreasing the risk of colon and lung cancer
• lowering the risk of depression
• successful aging (like dad)
• higher bone mineral density
• decreasing incidence of seborrheic dermatitis
• less constipation
• less irritable bowel
• less inflammatory bowel
• less diverticular disease
• less hemorrhoids
• less stress

Fruit is not the enemy - but it is one of the easiest of the nine food groups to add to your Mediterranean Diet and one of the easiest and most delicious to add to the DASH diet.

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Produced by Simpler Media

For as long as we can remember, dieting has been humanity’s awkward tango with food—three steps forward, two cheat days back. From eating grapefruit by the dozen to proclaiming kale chips as a snack revolution, our obsession with shrinking waistlines has been both fascinating and exhausting. But what if we could take weight loss off the table (pun intended) entirely? Thanks to the rise of GLP-1 drugs like semaglutide and liraglutide, we’re on the cusp of doing just that.

These drugs are shifting the focus from counting calories to counting nutrients. In other words, dieting is getting a much-needed rebrand. So grab your kale smoothie and settle in as we dive into why the diets of the future will be all about health, not weight. And don’t worry—we’ll keep this fun. After all, food is supposed to be enjoyable.

GLP-1 drugs mimic glucagon-like peptide-1, a hormone that tells your brain, "Hey, you're full; stop eating." It’s like having a friend at dinner who gently slaps your hand every time you reach for another breadstick. Clinical trials have shown that these medications can lead to an average weight loss of 15% or more, a feat most fad diets can only dream of achieving.

1. Goodbye, Diet Culture: With GLP-1 drugs doing the heavy lifting for weight management, the days of suffering through celery juice cleanses might finally be behind us.
2. Hello, Health Goals: People can start focusing on nutrition instead of staring longingly at someone else’s fries.
3. Medical Validation: It’s not you; it’s your biology. GLP-1 drugs reduce hunger and help people feel fuller faster—no willpower shaming required.

If this feels like the dieting equivalent of inventing the wheel, it is. But this wheel rolls straight into a new frontier: nutrition.

Imagine a world where diets aren’t about punishing your body but fueling it. This shift doesn’t mean we’ll all suddenly start eating quinoa salads with reckless abandon—it means recognizing that food is more than just a number on a scale.

The new wave of diets prioritizes nutrient density. Instead of obsessing over how many carbs are in a bagel, we’ll care about how those carbs fuel our energy, brain function, and immune system.

• Gut Health Heroes: Say hello to fermented foods like kimchi and yogurt.
• Brain Boosters: Omega-3-rich salmon and walnuts are here to make you smarter (or at least more functional before your coffee).
• Immune Support Squad: Citrus fruits, garlic, and spinach are basically your body’s bodyguards.

Instead of dieting to fit into jeans from a decade ago, people will start eating with specific goals in mind:

• Performance Diets: Foods that fuel workouts and keep you going on marathon Netflix sessions.
• Longevity Diets: Think Mediterranean diet vibes—olive oil, nuts, and a glass of red wine (for antioxidants, of course).
• Condition-Targeted Eating: Anti-inflammatory diets for arthritis or low-glycemic diets for diabetes management.

It’s food as medicine but without the terrifying side effects that come at the end of pharmaceutical commercials.

Let’s face it: we’re already living in the age of smart everything—phones, watches, even refrigerators. The next logical step? Using technology to make eating smarter, too.

• Biometric Tracking: Imagine a smartwatch that tells you when you’re low on magnesium and suggests snacking on almonds.
• AI Nutrition Coaches: Apps that analyze your meal choices and politely suggest adding a vegetable or two.
• Meal Kits for the Modern Era: Personalized, pre-portioned meals based on your DNA or gut microbiome.

If the idea of AI judging your pizza consumption feels invasive, remember that it’s only trying to help. Plus, it’ll never side-eye your second slice.

For years, diet culture has been as relentless as a telemarketer, selling us impossible ideals and plenty of guilt. But with GLP-1 drugs making weight loss a medical issue instead of a personal failing, we might finally be able to exorcise the ghosts of diets past.

1. No More Food Shame: GLP-1 drugs take the blame off you and put it squarely on biology. Didn’t lose weight on your juice cleanse? That’s because juice cleanses are terrible, not because you’re weak.
2. Shifting Goals: The focus moves to health outcomes like better energy, clearer skin, and reduced risk of chronic disease.
3. Diverse Definitions of Health: Turns out your value isn’t tied to your ability to fit into skinny jeans. Who knew?

But let’s not get too smug—diet culture is like a cockroach. Just because you think you’ve squashed it doesn’t mean it won’t find a new way to thrive. Be wary of buzzwords like "clean eating" or "biohacking;" they’re often just rebranded food guilt.

Before we declare victory over bad diets, there are a few hurdles to clear:

• Access to GLP-1 Drugs: These medications are expensive and often not covered by insurance. If they’re going to revolutionize health, they need to be affordable for everyone.
• Nutritional Education: We’ll need to teach people how to nourish their bodies without falling into new fads.
• Avoiding Over-Medicalization: Weight loss drugs are a tool, not a replacement for a balanced lifestyle. Don’t toss your running shoes just yet.

Ready to ditch the old diet mentality and embrace the future? Here’s how you can get started:

• Add More Colors to Your Plate: No, not M&Ms—fruits and veggies. The more variety, the better.
• Think About Food as Fuel: Skip the crash diets and focus on eating foods that energize you.
• Experiment with Recipes: The future of eating should be fun, not a chore. Try new cuisines, flavors, and textures.
• Celebrate Small Wins: Did you swap your afternoon candy bar for an apple today? That’s a win worth celebrating.

Thanks to GLP-1 drugs, we’re witnessing the dawn of a new era. The diets of tomorrow aren’t about deprivation—they’re about abundance. They’ll prioritize what food can do for us, from boosting our mood to supporting long-term health.

This isn’t just a trend; it’s a revolution. And with the right tools, education, and maybe a little humor, we can finally stop fighting food and start embracing it. So let’s raise a glass (of antioxidant-rich red wine) to the end of diets as we know them. Cheers to a healthier, happier future!

For the human body, salt is both an essential metal and toxic at a high dose.  The most common form of sodium comes from sodium chloride, a salt.  However, too much salt and arteries become stiff, and the risk of heart disease and cardiovascular disease increases. The majority of dietary salt comes from processed foods.

Probably the most famous book is The Salt Fix.  A rambling book claiming low salt is responsible for everything from lower sex drive to insulin resistance. The book is logical and simplistic, with abundant citations taken out of context. In summary, the book is almost completely incorrect.

One of the classic studies about salt and hypertension is the DASH sodium study. In these studies, the study participants were fed the diet with varying amounts of salt. These studies are expensive and often not done, but powerful. Additionally, the lower levels of salt, the lower the blood pressure. In fact, a low-sodium DASH diet led to a reduction of blood pressure equivalent to one blood pressure pill.

In contrast, "The Salt Fix" states that decreasing levels of salt led to increasing blood pressure and heart disease. The Salt Fix explanation is that lower salt leads to increased levels of renin, angiotensin, and aldosterone (hormones that would increase blood pressure). His conclusion is the opposite of hundreds of articles and much analysis. Such as here, here, and here.

Another false claim, "The Salt Fix," stated the DASH study showed an increase in LDL, cholesterol, and triglycerides.

The DASH diet showed no significant impact at all.

• Our ancestors ate more salt
• The primitive argument for which there is no proof. Since our ancestors ate mostly plants and no processed foods, this is easily debunked. Meat eaters know that a one-pound chicken contains about 150 mg of salt. A double patty of hamburger has 500 mg. He makes up numbers that don't make sense.
• He states our ancestors ate from salt licks, but there are few in Africa (he makes up stuff)
• Other countries have higher salt intake and lower heart disease
• He cites Korea (which has 50% hypertension or pre-hypertension), Japan (highest incidence of stomach cancer related to salt), and France (hypertension is high, but low levels of heart disease related to the Mediterranean diet practiced by most).
• Salt doesn't lower blood pressure by a significant amount and makes food bland.
• The DASH diet studies show significant reductions in blood pressure, and the food is not bland.
• Lower salt leads to increased death.
• The opposite has been shown. Increased levels of sodium in the diet show increased levels of death.
• Lower salt leads to lower iodine levels.
• Iodized salt was introduced in the US because of the low iodine in Midwest soil. Better sources of iodine include fish and kelp. But the United States also fortifies iodine in bread and dairy products. But too much iodized salt can lead to hypothyroidism.
• Sodium restriction in failing kidneys leads to worse problems
• Ask any kidney doctor, the worst thing for failing kidneys is overload with salt. While salt regulation may be diminished with kidney failure, patients with renal failure need more dialysis with higher salt diets.
• As we age, our kidneys get rid of more salt and need more in our diet.
• We lose some renal function with age, but increasing dietary salt leads to increasing mortality and aging of blood vessels.
• Low salt during pregnancy leads to obesity
• Lower salt in pregnancy yields the opposite
• There are more bits of misinformation in this book. Suffice it to say those who read this book and chose not to read the primary literature might be convinced that we need more salt than less salt.

Salt is salt. It is NaCl. Some have minor amounts of contaminants and other metals in them, which give them color. It is not enough to make a significant impact on your body chemistry or your health.

This salt comes from about 200 miles away from the Himalayas, it is mined in Pakistan. Sounds better to say it is from the Himalayas, but it isn't. Thus, salt is mined much like the salt from Utah. The reason for the pink color is various contaminants. While many tout benefits of this salt, the additional minerals found in Pink salt are insignificant. Thus, the salt is expensive, pink, and mainly decorative.

Celtic salt is from the coast of France, where the salt water is evaporated to get the salt. In contrast, pink and white salt are mined from the old oceans. Celtic salt has more trace minerals than pink salt or white salt. However, the amount of minerals in these salts is not of consequence to humans.

Marathon runners and endurance athletes have died from low salt levels in the blood (hyponatremia). Drinking too much water, or non-salty beverages is one reason for this.

Sweating is not a major loss of salt in athletes.  The average athlete will sweat about 15-65 mEq/Liter, with a maximum of 2 liters per twenty-four hours.

The major problem with those with low blood sodium after endurance athletic events is drinking too much water. Adding salt to the fluids does not improve performance, nor does it.

Some fear the anti-caking agents used in table salt. Sodium and Potassium ferrocyanide sound horrible because of the cyanide. However, ferrocyanide does not break down into toxic cyanide. Still, those who have not taken Chemistry 101 don't understand this. After all, salt itself has "chloride," which kills when it is chlorine gas.

Did you ever wonder what the controversy is about gas stoves? There is no controversy. Gas range tops are responsible for high levels of indoor pollution. But what should we do? The answer, change to an induction cooking top

You can imagine the first time cooking was brought indoors. Probably a fire inside a cave. It turns out that wasn't all that safe. The particulate matter from the wood not only increased the risk of lung disease, but also increased the transmission of respiratory illness.

Community houses, like this one for the Tlingit Nation from Southeast Alaska, had a fire pit in the center of the house. Your status in the community determined how close you would sit by the fire.

While the opening in the roof provided some ventilation, it was not enough.

Particulate Matter and Disease in Native Americans has been well studied. The lung damage from particulate matter predisposed Native Americans to pneumonia, tuberculosis, influenza, and smallpox.

The use of wooden stoves with a chimney, and contained fire, were the most popular stoves in America until after the Great Depression.

America was excited to go electric. But there is something primal about gas and electric cooking.

The phrase cooking with gas was from the gas companies competing with electric companies for the new kitchen. The idea that gas was less expensive, faster, and you could see the flame became the basis for their campaign.

They were trying to compete with "clean electric"

Products from indoor gas ranges are highly toxic to lung tissue. Those products

include:

• Nitrogen dioxide
• Carbon dioxide
• Methane emission
• Benzene

Even with the range off, gas escapes and pollutes the air indoors. Good ventilation decreases the exposure to gas. Most people do not like continuous fans. In addition to the methane, there is also benzene that escapes.

As soon as the United States Consumer Product Safety announced it was considering regulations for indoor gas cooking the vitriole started.

A Wall Street Journal Editorial stated "Don’t believe for a second Consumer Product Safety Commission member Richard Trumka Jr.’s slippery claim that they aren’t coming for your stove."  She also went on to state that the research was paid for.

Jim Jordan, the Republican Congressman from Ohio tweeted, "God, Guns, and Gas Stoves."

Sean Hannity, that famous high school graduate stated that "Biden is coming for your gas stove."

On my tiktok channel I had lots of people parrot this.

I never knew so many old white men knew where the stove was? Let alone what it used for fuel

We have known about the dangers of nitrogen dioxide since the 1960's. (see here, here, here). Experimental data showed it cause lung damage in animal models, then it was associated with human studies. None of these researchers were concerned about climate change.

Even ventilation to the outdoor with a powerful hood may not decrease the nitrogen dioxide enough. And often you won't have the ventilation fan on when the stove is not on.

Converting to induction stovetop might be expensive, although there is currently a government tax incentive to do so.

Even though I just bought my house, and it came with a lovely gas stovetop, I am changing to induction. Until then, I am using my induction hotplates (I have two) for most cooking.

While the low-carb world and its extremists will tell you that grains are evil, they are wrong. There is a significant difference between refined and whole grains.

Whole grains contain the bran, a fiber-rich outer sheath. Further whole gains have the germ cell and the endosperm. But the refined grain is just the endosperm.

Compare whole grain bread, which contains substantially more fiber and vitamins than the white bread. Consuming refined grains increases the risk of heart disease. But consuming whole grains decreases risks of heart disease, diabetes, and cancer.

Bran is rich in fiber.  Additionally, bran is a source of B vitamins, iron, copper, zinc, magnesium, and phytochemicals.

Fiber is an “essential nutrient.” An essential nutrient is defined as a nutrient your body cannot make and must get from your diet.

But carnivore aficionados disagree; they believe fiber is not an essential nutrient. Carnivores note that you really don’t digest fiber. And they opine that people can live without fiber. However, they forget one key, the microbiome.

The microbiome are the trillions of bacteria, yeast, and fungi that live in your gut.  Many scientists consider the gut microbiota another “organ” of our body.

There is a clear difference in the type and number of bacteria that occupy the guts of people with obesity compared to those who are not obese.

Some bacteria will increase hunger hormones. Those same bacteria also decrease satiety hormones, need more food to feel "full." Finally, they increase the ability of fat cells to increase in size, leading to obesity.

• Synthesize vitamins K and B
• Make Conjugated Linoleic Acid (CLA) that reduces obesity
• CLA decreases inflammation
• Ingestion of some fiber promotes the growth of bacteria that decrease the secretion of ghrelin in obese humans.

In the microbiome, what feeds the bacteria that decrease obesity includes the fiber from whole grains. The bran of whole grains contains powerful fibers like oligosaccharides.

What is a serving of whole grains? It seems confusing, especially since some products are a mix of both whole and refined grains. In the Mediterranean Diet, you might notice 9 ounces, but is that grain when it is dry or wet or both?

So it turns out there is a whole grain council that has done the work for you, and they tell you right on the package.

This makes your math simple. You either need three stickers of the 100% whole grain or six of the other stickers.

If you have ever seen Paul Saldino, his famous line is that Kale is BS. He even sells the shirt. But are they? Saldino isn't the only one who proposes this.

Dr. Gundry, a former heart surgeon, has his own take. Gundry claims modern health problems come from eating lectins. Lectins are compounds found in beans that are natural pesticides.  Thus, Gundry claims lectins harm people. Copying destroys lectins.

Plants make compounds to protect them against predators - other plants, pests, and the like. But do they harm humans?

It turns out that some plant defense compounds are beneficial to humans. Take coffee. Yes, coffee - the caffeine is a defense mechanism. Some people will tell you that coffee is bad for you - but they don't get up in the early morning or have kids.

• Gluten
• People who don't have celiac disease or gluten sensitivity do not need gluten-free diets (ref).
• Oxalates
• Potassium-rich vegetables such as Brussels sprouts, broccoli, and kale reduce calcium loss and prevent kidney stones from forming. These vegetables are rich in antioxidants that decrease the risk of bladder, prostate, and kidney cancer. Check with your local dietician for a diet based on the type of kidney stone you have. (ref)
• Caffeine
• If you don't drink coffee, you will lose all joy in life. (reference is me)
• Polyphenols
•  Plant polyphenols have antioxidant, anti-inflammatory, anti-allergic, anti-atherogenic, anti-thrombotic, and anti-mutagenic effects - they are healthy for you (ref)
• Phytates
• Consuming a phytate-rich diet, such as a colorful, plant-based diet, the benefits exceed the impacts on mineral absorption. In addition, phytates are anti-oxidants. (ref)
• Saponins
• These compounds are among the most well-studied compounds to decrease risk and help treat cardiovascular diseases. (ref)
• Isothiocyanates
• Brassica vegetables contain many valuable metabolites that are effective in chemoprevention of cancer (ref)
• salicylates
• These anti-inflammatory compounds are the basis of aspirin
• Phytosterols
• phytoestrogen-containing foods, such as legumes, grains, seeds, nuts, fruits, and vegetables, are rich sources of vitamins, minerals, fiber, and other health-promoting phytochemicals.
• Lectins
• Cooking destroys lectins. Lectin-rich foods, legumes, and whole grains show reduced inflammatory biomarkers in both animals and humans (ref).

What do human trials say about vegetables? They improve health, reduce the risk of heart disease, and reduce the risk of cancer.

Do some of them contain anti-nutrients? Well, some do bind them, but health benefits outweigh any potential harm.

You can believe a shirtless salesman of supplements and scams. Someone who was trained as a psychiatrist, who goes into a grocery store shirtless and yells at kale - or you can believe science.

The most abundant solid ingredient in breast milk is a fiber. That fiber is human milk oligosaccharides. These oligosaccharides are a prebiotic that is carbohydrate based. They meet the definition of fiber. This fiber is important to infants, especially neonates.

When people say fiber is non-essential, they are incorrect. Why? Because the definition of an essential nutrient is:

“A nutrient required for normal body function that either cannot be made by the body or cannot be made in amounts adequate for good health and therefore must be provided by the diet”

Every study looking at increasing fiber has shown an improvement in human health. But what does fiber help with?

Fiber will bulk up your stool and make it easier to have bowel movements. This gives you less constipation, fewer hemorrhoids, and less risk of colon diverticular disease.

If your stool is too loose, you need more fiber. If your stool is too hard, you need more fiber and water.

Your body makes cholesterol, and that cholesterol goes through your gut. When you have increased fiber in your gut, some cholesterol gets bound to it. Thus, increasing fiber means less blood cholesterol.

Fiber decreases spikes in blood sugar. Want an example? Take an apple and a doughnut. A doughnut has less sugar than an apple, but a doughnut will spike your blood sugar more than an apple. Why? Part of the reason is the increased fiber in the apple (and fat, a doughnut has 15 grams of fat) – an apple has 3 grams of fiber, a doughnut has 0.9 grams.

Fiber binds to bile acids (ref). When you eat meat and increase meat in your diet, you increase fat. To digest fat, your body increases the production of bile acids, which are released into the gut. Your gut reabsorbs 95%, but about 5% makes it to the colon, where other bacteria encounter them, and then bad things happen.

Bacteria break down these bile acids into pro-inflammatory and pro-carcinogenic compounds. This is in contrast to a plant-based diet with high fiber. Fiber binds to the bile acids allowing them to pass without causing harm to the colon.

When a person consumes fiber, the fiber is used as food by some bacteria. These bacteria metabolize the fiber and excrete short-chain fatty acids.

Inside your bowels, there are many microorganisms, from bacteria to yeast. What determines which bacteria thrive? There are bad bacteria and bad yeast, and to encourage the growth of the good bacteria, you have to feed them. How do you feed them?

The favorite food of the good bacteria? Fiber.

Bacteria "eat" fiber and produce short-chain fatty acids, which are great because:

They decrease inflammation, improve blood sugar control, and blood lipids.

The term vitamin was coined by the chemist Casimir Funk as he revealed the Thiamine structure to the world. So while you may think – isn’t vitamin A (it is the alphabet) the first vitamin – we take our poetic license here to point out that the first compound to be called a vitamin was Thiamine, now known as vitamin B1. But the story of that vitamin was made possible by two individuals – but the most noteworthy was Takaki Kanehiro.

Our podcast today discusses the education of Kanehiro and how that influenced his view. But let’s work backward a bit.

Vitamin B1 and Beriberi

Beriberi is caused by a lack of vitamin B1 (thiamin) in the diet. This vitamin is essential in the biochemical process of utilizing fats, carbohydrates, and proteins for energy. The nerves are particularly affected because of their metabolic pathways – hence, a wide range of symptoms from difficulty with walking (motor function) then sensory function of the legs, and finally, it affects the conduction in the heart, which leads to death.

White Rice and Beriberi

White polished rice was the fad food not only in the cities of Japan but also in China. To polish the rice, the husk and germ are removed, but this is also where the vitamins are. When people eat just one food item, they are likely to develop a deficiency disease, and this was the case with sailors and white polished rice.

The officers would not only eat rice but were given a variety of foods and thus avoided beriberi. But the crew typically only ate white rice.

Beriberi in Mid-1800’s Japan

In Japan in the mid-1800s, especially in the city, polished white rice was the calorie source of choice. White rice is easy to store, looks clean, is faster to cook, and eating it is less chewy. White rice was considered what the wealthy people ate – it was beautifully displayed, and unlike brown rice, did not go rancid. What they didn’t know was the processing of the rice led to stripping the rice of the vitamin-rich portion. 

In the rural areas of Japan, there was little beriberi as they mostly ate brown rice (barley rice). 

This led to a major problem in their Navy, where beriberi was endemic. White polished rice was the caloric source for the Navy, and often one third of the crew would develop beriberi and be unable to carry out their duties.

There were many thoughts as to the cause of beriberi, but none of them had panned out well.

Eastern Traditional Cures for Beriberi

On occasion, Eastern healers would recommend various teas and herbs. But, some would recommend barley rice. Some of these cures are retrospective, meaning once the traditional Japanese medical folks learned that barley rice was a cure for beriberi, they stated that they had prescribed it for years. Barley rice does have vitamin B1 (1 cup contains a day’s supply). But during the time, the cures from these village doctors were rare and not enough for the Japanese Navy, in spite of losing more people to beriberi than to war – would adopt. Also, note that barley rice is not as transportable as white polished rice and has a shorter shelf life. During this time, Japan was becoming westernized, and they were working on importing medical ideas from Germany, although they had a fair bit of influence from the British method. 

Kanehiro’s training

When Kanehiro was being trained, his initial training was from the Eastern Medicine part of his province. This training was apprentice-like, and he heard someone say that “There are no good doctors in Sustama.” When William Wills opened a medical school in his province, he jumped at the chance – but Wills encouraged him to go to London for further training.

In order to do this, Kanehiro joined the Navy in 1872. He remained in the Japanese Navy for the rest of his life.

In 1875 Kanehiro went to London and began to study at St Thomas Hospital. To this day, St Thomas hospital sits across the Thames River from Westminster, Big Ben, and parliament.

Epidemiology – cholera to beriberi

Just a 30-minute walk from the St Thomas hospital is the Broad Street Pumping station, where 22 years before, John Snow had meticulously shown how cholera had been transmitted through the water. The theory of cholera was not widely accepted at the time, in spite of the guardians removing the pump handle in 1859 and the outbreak stopping. By the time Kanehiro arrived, the methodology of Snow and the field of epidemiology was the most heralded new science of the day.

Besides learning modern surgical methods of the day, Kanehiro also learned epidemiology and the scientific method.

Return to Japan and the Study of Diet as a cause of Beriberi

When Kanehiro returned to Japan, he dedicated himself to finding the cure for beriberi – the disease that killed more Japanese sailors than battle. Using the methods of epidemiology, he developed an experiment to prove that beriberi was secondary to the food they ate and not the other conditions of the ship.

For the rest of the story – please listen to the podcast – subscribe if you like it. Thank you.

Vandenbroucke JP. Adolphe Vorderman’s 1897 study of beriberi among prison inmates in the Dutch East Indies: an example of scrupulous efforts to avoid bias. JLL Bulletin: commentaries on the history of treatment evaluation, www.jameslindlibrary.org (2012, accessed 28 June 2013).

Takaki, K . On the cause and prevention of kak’ke. Trans Sei-I-Kwai 1885; 39(Suppl 4): 29–37.

Takaki, K . On the preservation of health amongst the personnel of the Japanese Navy and Army. Lecture II, delivered on May 9th. Lancet 1906; 1: 1451–1455.

Takaki, K . On the preservation of health amongst the personnel of the Japanese Navy and Army. Lecture III, delivered on May 11th. Lancet 1906; 1: 1520–1523.

Imagine being able to improve the Mediterranean Diet with a few changes. Is the new "Green" Mediterranean Diet the ultimate hack? The Green Mediterranean Diet  (Green-Med) has become the hottest version of the MED diet yet.

There are three advantages to Green-Med

1. Less Fatty Liver
2. Decreased risk of heart disease
3. Less Visceral Fat

Non-alcoholic fatty liver disease is the number one cause of liver failure in the United States. It surpassed alcoholic liver disease as the number one reason for liver transplants. But how do you get fatty liver?

Low-Carb enthusiasts blame fructose, or almost any sugar, as the cause of fatty liver disease. Although the latest boogyman is "seed oils." On the other hand, vegans will blame saturated fats.

But sugars in mice are not the same as sugars in men.

Fatty liver appears to be a byproduct of obesity, excess calories, and genetics.

After weight loss surgery, people rapidly lose weight, including in their liver.

But people on the Green Mediterranean Diet lost more weight in their liver than those with the standard Mediterranean diet.

Belly fat is one of the hardest fats to get rid of. As people age, belly fat increases. So when women go through menopause, they increase belly fat.  And lowering belly fat is best done through weight loss with a high-fiber diet and cardiovascular exercise. But Green-Med appears to lower it even more.

Although MED is known for reducing the risk of heart disease, Green-Med seems superior.

The difference between the green and standard Mediterranean diet

• 28 grams of walnuts a day - about one ounce
• 3-4 cups of green tea per day
• 100 grams per day of frozen Mankai
• Reduction in red meat

Green Tea is Easy

There are more polyphenols in it than in black tea - so it's easier to drink.

Adding walnuts is easy; they are also a great source of omega-3 fatty acids.

Decreasing red meat isn't difficult.

Finding Mankai or duckweed - well, you can't in the United States

No one has reproduced the data about the Green Mediterranean Diet - perhaps because they can't find those frozen cubes of duckweed.

LiverKing Falls From Grace

Not that anyone was surprised the so-called Liverking was using steroids. But he fooled many people that his diet and intense training led to this frame. The diet he recommended was some form of an "ancestral" diet. We have covered the carnivore-type diet before. So how did this all happen?

LiverKing's rise was meteoric. He began posting on Instagram in 2021 and now has almost 2 million followers.

His trademark was showing off his abdominal muscles on his five-foot-five-inch frame. All the time advocating eating raw liver.

Isn't that a hook? Eat raw liver, get abdominal muscles, and look like him.

But his rise was anything but an accident.

In his emails, he whines about how he wants to build his following but was concerned that the steroids he had were not enough. So he was begging for help from someone in the UK. He was taking thousands of dollars of steroids a month.

His plan? Getting over a million followers and selling supplements.

He had a "live-in" video recorder to follow his antics.

Guess who his partner was in supplements?

How do most scam artists in the medical field make money? Selling supplements. Be that Joseph Mercola, or Mark Hyman, or Ken Berry. All people who make millions a year selling supplements.

So what to do if you are trained in psychiatry but don't want to see people? You sell supplements. So the business partner is one Dr. Paul Saldino - aka Carnivore MD.

Since the revelation about Brian Johnson's (LiverKing) steroid use Saldino said he would have to distance himself from him. Good friend, eh? That is a business decision. If you are a friend of mine and have a fall from grace, I will be at your door to help, not distance.

This was pure theater and pure business - well, not so pure.

Supplements can kill.

But so can their diet.

Make a following eating raw liver. Yell at the dinner table about how raw liver is good for you. Makes great content for your videos. Eating raw liver can kill you.

Carnivores and extreme keto types always like pointing to hunter-gatherer societies for optimal "primal health." But my cousins in Alaska don't eat liver.

There is enough vitamin A in polar bear's liver to kill 52 people. But the biggest outbreak of trichinellosis in the United States came from eating grizzly bear liver.

Vitamin A toxicity symptoms include drowsiness, irritability, abdominal pain, nausea, and vomiting. Then you lose your hair; then your skin starts to peel. Not to mention it can damage your liver - ironic, eh?

The tolerable limit of vitamin A is 10,000 units a day. Beef liver has 15,000 units in 3 ounces.

But LiverKing didn't eat liver in real life. What did he eat?

LiverKing ate 120 grams of maple syrup, 50 grams of dextrose, and ONLY 2 ounces of red meat a day.

Why - he was taking insulin and needed to take a lot of sugar.

He said he was super strict, working out - and his emails had his diet. Almost none of it was organ meat. He was specific and precise.

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The latest fad of supplement makers is to talk about "gut health." The latest boogyman for the gut is the "leaky gut." The other name for leaky gut is intestinal permeability.

As a surgeon, a "leaky gut" is a devastating surgical emergency. Surgeons emergently operate to remove the gut that no longer has a barrier function.

The dark gut is dead and needs to be surgically removed. This gut has no barrier function and will allow bacteria from the inside of the small bowel to easily enter the patient's bloodstream. Leading to septic shock and death.

But a leaky gut doesn't have to be so dramatic.  Not leading to septic shock or needing to be removed. In this model, the intestinal barrier is "leaky," not to the point of causing sepsis. But the leaky gut enables small molecules to leak out of the gut into the bloodstream. Thus producing chronic inflammation.

Chronic inflammation may cause obesity. Emphasis on "may."

Rodent studies have provided fascinating insights. Certain emulsifiers, when added to the diet of mice or rats, lead to obesity.  In one experiment, rodents were fed identical amounts of kibble. But one group, emulsifiers, was added to their water.  These emulsifiers, like polysorbate 80, not only produced obesity but also disrupted the microbiome of the gut (ref). But mice are not men.

When dietary emulsifiers are examined in humans, high levels cause disruption of the gut. However, there is little evidence that small amounts found in the food supply cause issues. (ref 4)

While animal models are interesting, human studies provide useful information. That a rat or mouse has a leaky gut based on some intervention is not an equivalence in humans.

If you searched "leaky gut," you will find a host of "functional medicine" doctors providing supplements, bone broth, probiotics, and other scams.  On the shelves of drug stores and "health food stores," you will find abundant supplements to "support gut health."

Functional medicine physicians associate many disease states with leaky gut. The following have little or no good evidence to be caused by a leaky gut:

• Alcoholic cirrhosis
• Asthma
• Autism
• Chronic fatigue syndrome
• Depression
• Eczema
• Environmental enteropathy
• Eosinophilic esophagitis
• Fibromyalgia
• Kwashiorkor
• Metabolic syndrome
• Multiple sclerosis
• Non-alcoholic fatty liver disease (NAFLD)
• Obesity
• Pancreatitis
• Parkinson's disease
• Psoriasis
• Rheumatoid arthritis

There is no doubt celiac disease, Crohn's disease, radiation, and ulcers from non-steroidal anti-inflammatory drugs; certain bacteria can cause a change in intestinal permeability (another name for leaky gut). Celiac disease and Crohn's disease have been studied for years (ref 2, ref 3). While we know gluten exacerbates the auto-immune function of those with Celiac disease, we do not yet have a mechanism for Crohn's disease.

The small bowel's purpose is primarily for the absorption of nutrients. Some nutrients are actively transported from the gut to the bloodstream, and some are passively absorbed. The gut must also serve as a barrier to prevent bacteria, toxins, and other materials from entering the body.

The first line of defense is the mucus layer of the gut. Secreted by Goblet cells, mucus prevents bacteria, toxins, and potential antigens from contact with the epithelial cells. There are multiple mucus proteins secreted. Gut immune cells secrete IgA antibodies into the mucus as a further defense against invaders.

Most research focuses on the tight junctions between intestinal epithelial cells.

What if altered permeability is an association and not causation? While stress, antigens, and intense physical activity alter barrier function, there is no evidence it causes a clinical consequence. Finally, there is no evidence that barrier function leads to any disease. Nor is there any evidence that intervention to improve barrier function alters the natural history of disease (ref 4).

In a recent clinical study, 260 women with the BRCA gene were assigned to the Mediterranean Diet or a control group (ref 5). These women were part of a study examining the effect of the Mediterranean diet and physical activity, who were at high risk for breast and ovarian cancer.

In the Mediterranean Diet group, there was an increase in short-chain fatty acids and fiber found in the stools.  There was no statistically significant change in the plasma LBP or fecal zonulin. But in multiple-level regression, the change in short-change fatty acids did lead to a decrease in the permeability makers. When looking at the food groups, they found that vegetables, fruit, legumes, nuts, olives, wine, and total fiber were correlated with the shift in short-chain fatty acids and the shift in permeability makers.

The Mediterranean diet is fiber-rich, producing an increase in bacteria that produce short-chain fatty acids. The short-chain fatty acids appear to alter barrier function in this group of women.

While leaky gut is real, the significance is unknown. At the extremes, as surgeons see, it is deadly. In patients with ulcers or celiac disease, or Crohn's disease - it is real. Yes, things can leak from the gut, but what can be done?

Turns out, maybe the Mediterranean Diet is the answer.

One this is certain - people will sell you all sorts of things -

Eat better, drink wine.

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Produced by Simpler Media

There are a lot of crazy diets out there. All of them you can lose weight with. Weight loss has many advantages. But the beer and sausage diet was fun. Here is what we learned:

• A calorie is just a calorie
• Being in calorie deficit is difficult
• Meticulous journaling is important
• Your lab values will improve with weight loss
• A beer is a good unit measure
• Weighing your food is important

Episode Sponsor: Modifyhealth.com

If you hear Evo Terra on national television talking about the beer diet, you will hear my name. I'm the doctor.

Late one September, I get a call from my friend, Evo Terra. He said, "October is coming; I want to lose some weight and want to do a beer fast. "

So we devise a diet, not just beer - but let's add sausages. After all, what is beer without sausages?

This was a medically supervised diet. It ran for the month of October every year for four years. Every week he would come into my clinic.  Every week he would have blood draws.

•  cholesterol levels
•  liver enzymes
• Weekly weight
• We would check muscle mass vs. fat mass
•  inflammatory markers

We were prepared to stop the experiment and return him to a normal diet. For Evo, a normal diet is maybe not your diet.  Since Evo likes the food I make, I assume he has a great diet.  For many years, one of my great joys in Phoenix was when Evo and his wife would come over for dinner Sunday nights. Damn, I miss those days.

A beer is a single unit. There is little variation in terms of caloric intake.

Sausage can easily be weighed, and Evo was strict regarding the weight of his sausages.

We added vitamins and fiber to his regimen.

He had six beers a day, and a designated driver at all times.

For those who say grains are evil and you can never lose weight or you would have horrible inflammation, well, Evo didn't fit with that. Because no one does. The idea that grains are evil is a myth of the low-carb community.

Vegans didn't like the idea of Evo eating sausages: "Pure processed meat will lead to inflammation and all the evils associated with eating meat."

It didn't happen.

Calorie deficit led to weight loss, despite drinking beer and eating sausages.

His inflammatory markers didn't rise; they went down.

His cholesterol went down.

His liver enzymes decreased - not that they were high to begin with.

Every year he kept his weight off - we are now over ten years past the last experiment.

I don't recommend this as a weight loss method. I do recommend weight loss by the simple principles of calorie restriction, a well-rounded diet, and vigorous exercise. Which diet, you ask? Either the Mediterranean or the DASH diet.

Evo wrote a book, and you can buy it here.

Can a phone app help you lose weight? How about with your cholesterol, blood pressure, or waist size?

Perhaps you've heard the latest Noom ads, where they boast forty publications showing that their app will help you lose weight.

Apple is coming out with more ways to have their new watch track your heart rate and steps, with apps even looking at your yoga workout and eventually telling your blood glucose.

Episode Sponsor: Modifyhealth.com

A recent meta-analysis of randomized controlled trials showed that the average weight loss in the first three months was slightly below five pounds (2.18 kg).

Unfortunately, the weight loss didn't last.  Nine months later, they had regained a pound and a half for a total loss of 3.5 pounds (1.63 kg).

There was a slight improvement in blood pressure at three months. But cholesterol and total energy intake, as well as waist circumference and blood glucose, remained the same.

There are over 500,000 applications on Android and Apple phones to track various health data points. In addition, there are other devices just measuring fitness. The theory of measuring fitness behaviors with calorie tracking to provide feedback to improve health is appealing.

Many apps had a lack of behavioral coaching and poor quality of scientific information. Tracking over a three-day period found that the accuracy of energy intake among apps was only fair in terms of total calories and amounts of macro- and micronutrients.

Noom is one of the more popular paid apps. They boast over 40 peer-reviewed articles. A quick glance at the articles showed some surprising flaws:

One article compared Noom in pancreatic cancer patients to a control group who received no coaching.

Another article used Noom data for their references.

Article after article that Noom sites are little more than using Noom's data without dropout rates.

Chen J, Cade JE, Allman-Farinelli M. The Most Popular Smartphone Apps for Weight Loss: A Quality Assessment. JMIR Mhealth Uhealth. 2015 Dec 16;3(4):e104. doi: 10.2196/mhealth.4334. PMID: 26678569; PMCID: PMC4704947.

Chew HSJ, Koh WL, Ng JSHY, Tan KK. Sustainability of Weight Loss Through Smartphone Apps: Systematic Review and Meta-analysis on Anthropometric, Metabolic, and Dietary Outcomes. J Med Internet Res. 2022 Sep 21;24(9):e40141. doi: 10.2196/40141. PMID: 36129739; PMCID: PMC9536524.

Keum J, Chung M, Kim Y, Ko H, Sung M, Jo J, Park J, Bang S, Park S, Song S, Lee H

Usefulness of Smartphone Apps for Improving Nutritional Status of Pancreatic Cancer Patients: Randomized Controlled Trial JMIR Mhealth Uhealth 2021;9(8):e21088 URL: https://mhealth.jmir.org/2021/8/e21088 DOI: 10.2196/21088

Pohl, M. "325,000 mobile health apps available in 2017—Android now the leading mHealth platform. Research 2 Guidance." (2017).

The rise of ultra-processed foods in the United States closely parallels the surge in obesity rates and increased caloric intake observed from the 1980s onward. Starting in the 1970s, shifts in food production and consumer habits paved the way for these foods to become dietary staples, ultimately contributing to the obesity epidemic we see today. Let’s explore how these changes unfolded and their direct link to America’s rising weight problem.

In the 1970s, the food industry underwent dramatic changes that laid the groundwork for the proliferation of ultra-processed foods.

1. Economic Shifts and Agricultural Policies
2. In 1973, new agricultural policies began to encourage farmers to produce more crops like corn, soy, and wheat. These policies made ingredients, particularly high-fructose corn syrup (HFCS) from corn, much cheaper for food manufacturers to obtain (Nestle, 2002). As a result, companies could produce food more cost-effectively and in larger quantities, leading to affordable, calorie-dense, ultra-processed foods.
3. Rise of Convenient Snack Foods and Fast Food
4. At the same time, the popularity of fast-food chains and processed snacks grew. Brands like McDonald's, Coca-Cola, and Frito-Lay expanded their offerings and marketed these convenient, hyper-palatable foods to the masses. They loaded these products with refined sugars, fats, and additives to enhance flavor and shelf life, making them hard to resist and easily accessible.
5. The “Diet” Food Craze
6. The 1970s also saw a surge in demand for high-protein diet products due to growing concerns about carbohydrates. Low-carb became the flavor, and at any given time, 10% of the country was on low-carbohydrate diets. Ironically, these “diet” foods often contained as many or more calories as regular options.

By the 1980s, ultra-processed foods had fully embedded themselves in American diets, creating a foundation for the obesity epidemic.

1. Processed Food Production Surges
2. Food companies expanded their product lines in the 1980s, launching a wide range of snack foods, frozen meals, and sugary drinks. These foods were not only inexpensive but also tasty, thanks to the addition of refined sugars and fats, as well as preservatives to prolong shelf life (Monteiro et al., 2013). Marketing highlighted their convenience, appealing to busy families and individuals.
3. Caloric Intake Climbs
4. Alongside the rise in ultra-processed foods, average daily caloric intake also increased. Between the late 1970s and early 2000s, Americans consumed over 200 more calories per day. This rise came largely from high-calorie processed snacks and sugary drinks that were easy to consume between meals (Wright et al., 2004).
5. Obesity Rates Begin Their Upward Trajectory
6. During the 1980s, obesity rates started climbing. From 1980 to 2000, the obesity rate in U.S. adults jumped from 15% to 30% (Flegal et al., 2012). Children and teenagers weren’t spared either; childhood obesity rates nearly tripled, aligning with the increased availability of ultra-processed foods.

The 1990s brought even more ultra-processed foods, solidifying their role in the American diet.

1. Fast Food Reigns Supreme
2. Fast-food outlets exploded across the country in the 1990s, offering cheap, calorie-dense meals that were easily accessible. These chains embraced supersizing, encouraging customers to choose larger portions for just a small price increase. As a result, Americans began consuming more calories per meal, often in ultra-processed fast food.
3. Sugary Beverages Become a Staple
4. Consumption of sugar-sweetened beverages (SSBs) like sodas and sweetened teas, also skyrocketed during this decade. Many of these drinks relied on HFCS, delivering a heavy dose of empty calories without satisfying hunger. Studies show that sugary drinks don’t curb appetite the same way solid foods do, leading people to consume extra calories without feeling full (Malik et al., 2010).
5. Caloric Intake Peaks
6. By the end of the 1990s, Americans’ average daily caloric intake had reached new heights, with ultra-processed foods making up a significant portion of the diet. Research indicates that nearly 60% of Americans’ daily calories came from ultra-processed foods by the late 1990s (Monteiro et al., 2013). The rise in these calorie-dense, low-nutrient foods is directly correlated with increasing body weight and obesity rates.

As we moved into the 2000s, ultra-processed foods remained a dominant force in the American diet, pushing obesity rates even higher.

1. Obesity Reaches Public Health Crisis Levels
2. By 2020, nearly 42% of American adults and 20% of children were considered obese (Hales et al., 2020). Studies have consistently linked this trend with ultra-processed foods, which are designed to be “hyper-palatable” and, thus, difficult to resist. Their addictive taste profile has fueled a snacking culture, where more people consume larger portions and eat more frequently throughout the day.
3. Calories from Ultra-Processed Foods Remain High
4. Research shows that 60-70% of the average American’s daily calories now come from ultra-processed foods (Juul & Hemmingsson, 2015). These foods are often low in fiber, protein, and essential nutrients, which leaves people unsatisfied and more likely to overeat. Additionally, foods high in refined carbs and sugars cause blood sugar spikes and crashes, leading to frequent hunger pangs and cravings.
5. The Health Toll Beyond Obesity
6. Ultra-processed foods haven’t just contributed to obesity; they’ve also been linked to type 2 diabetes, cardiovascular disease, and certain cancers. Their high-calorie density, poor nutritional profile, and use of additives have been shown to negatively impact health, making them a major public health concern.
7. Efforts to Combat Ultra-Processed Food Consumption
8. Despite public health campaigns promoting whole foods, ultra-processed options remain attractive for many Americans due to their affordability and convenience. In many low-income areas, they’re also more readily available than fresh, whole foods, perpetuating health disparities.

Since the 1970s, the rise of ultra-processed foods in the United States has closely tracked with an increase in calorie consumption and obesity rates. As companies produced more of these convenient, highly palatable foods, Americans’ eating habits changed, leading to greater calorie intake through frequent snacking, sugary drinks, and supersized portions. The dominance of ultra-processed foods in the diet has not only contributed to rising obesity rates but also to an increase in related health issues like diabetes and heart disease.

Although efforts to reduce ultra-processed food consumption continue, their deep-rooted presence in American culture and food systems makes reversing the trend challenging. For a healthier future, we need a multifaceted approach that includes improved access to nutritious foods, public health policies, and greater awareness about the risks associated with ultra-processed foods.

References:

• Malik, V. S., et al. (2010). Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care, 33(11), 2477-2483.
• Monteiro, C. A., et al. (2013). Ultra-processed products are becoming dominant in the global food system. Obesity Reviews, 14(S2), 21-28.
• Nestle, M. (2002). Food Politics: How the Food Industry Influences Nutrition and Health. University of California Press.
• Hales, C. M., et al. (2020). Prevalence of obesity and severe obesity among adults: United States, 2017-2018. NCHS Data Brief, (360), 1-8.

There is a persistent belief that lifestyle can take care of all cholesterol problems. Lifestyle can make things worse, but once things are worse, it cannot make things better.

Once you have disease, or cholesterol is higher, you need treatment often beyond lifestyle management.

This distresses many people, who wish to have control over their fate.

High cholesterol is one of the main causes of heart attacks, strokes, and peripheral vascular disease. You can lower cholesterol through diet and exercise by as much as 15 percent. Lifestyle changes are the first choice to decrease cholesterol. Modern drugs, however, will lower cholesterol levels far more than diet or exercise.

The normal artery, as shown below, is a free-flowing blood vessel. When a person is in their late teens, there is already fatty formation on the inside of the vessel wall.

As more fat is deposited in the vessel wall, blood flow decreases, leading to ischemia in the end organ.

Damage to the blood vessel begins the process of

• Smoking
• Hypertension
• High blood sugars
• Diets rich in saturated fats and refined grains

However, the lower the level of LDL, the less risk those factors become, as you shall see.

If you examine the autopsy specimen of the coronary artery above, the blood flows through that lumen. The inner wall, the wall the blood comes into contact with, is called the endothelium. There are three layers to the wall of an artery:

1. Tunica intima
2. Tunica Media
3. Tunica Adventicia

Atherosclerosis begins when the cholesterol transport protein enters the wall of the tunica media, whose first layer is the endothelium.

In 1954, Dr. John Gofman reported the discovery of LDL and HDL. These were the particles found when he separated plasma cholesterol-carrying lipoproteins with an ultracentrifuge. Gofman was the first to note that heart attack patients had high LDL levels. The correlation of high LDL and heart attacks has been called “one of the most profound epidemiologic correlations in all of medicine.”

High LDL levels have been shown to correlate with atherosclerosis in all species studied.

The higher the LDL level, the faster atherosclerosis develops. Factors that increase atherosclerosis are those which injure blood vessels: smoking, hypertension, hyperglycemia, and genetic factors that predispose endothelium to early injury.

High LDL levels can lead to heart attacks in children as young as 6 years old. This rare form of homozygous familial hypercholesterolemia inspired Brown and Goldstein to elucidate the genetic defect in the receptor for LDL.

 Brown and Goldstein discovered that when LDL receptors are defective, it leads to the following:

1. LDL particles circulate for a long time
2. This leads to an increase in plasma levels of LDL
3. As a result, more deposits are made into the arteries
4. Creating atherosclerotic plaques

To keep blood LDL constant, your body uses a feedback mechanism. As your LDL levels increase, the target tissues produce more receptors to take up the LDL. If the LDL receptor is defective, the liver continues to increase production of LDL.

Brown and Goldstein speculated that an HMG CoA reductase inhibitor would deprive liver cells of endogenous synthesis as a source of cholesterol. This deprivation would relieve the feedback repression of LDL receptors, and the resultant increase in LDL receptors would lower plasma LDL.

The FDA approved the first statin 1987, Mevacor, which reduced plasma levels of LDL and was well tolerated. It was only theory that lowering LDL would reduce heart attacks.

Statins block cholesterol synthesis, which causes the cell to increase LDL receptors, which further decrease cholesterol in blood plasma.

The first study showing that statins not only reduce LDL, decrease heart attacks, and prolong life was reported in 1994. These studies have been repeated:

1. 1996 Sachs reported use of Pravastatin on heart attacks with normal cholesterol levels
2. 1998, LIPID showed prevention of heart attacks with a wide range of cholesterol levels
3. 2002, Heart protection by cholesterol lowering in over 20,000 high-risk people in a randomized placebo control trial

The 2002 study was large enough to show a reduction in relative risk even when subjects had risk factors such as diabetes, hypertension, and smoking.

For each reduction of LDL cholesterol by 40 mg /dl, cardiovascular events are reduced by 20%. This even applies to people considered low-risk (ref).

In addition to people who have high cholesterol, there are those who have naturally low levels of cholesterol. These individuals live long lives with abnormally low levels of heart disease, even if they have other risk factors (ref). Yes, I want this mutation!

This genetic mutation led to a new class of drugs to decrease cholesterol, the PCSK9 class of drugs.

Genetic studies, statin studies, and PCSK9 studies show that lowering LDL longer leads to lower atherosclerotic disease.

People with PCSK9 mutations may never develop atherosclerotic plaque because they have low LDL levels throughout their lives.

In many statin studies, patients were treated only when they were at high risk of coronary disease, which means they had already established atherosclerosis. Once the disease is diagnosed, patients may need a much more severe LDL reduction to prevent an event.

One of the cohorts that Ancel Keys studied was in a coastal village in Japan. The men in that village had a 90% reduction in their LDL. This lifelong reduction also led to a 90% reduction in their cardiac mortality. (ref) . The PCSk9 mutations also resulted in a 90% reduction in mortality from a similar reduction in LDL.

Lowering cholesterol reduces the risk of heart disease, independent of inflammation. While some choose to blame inflammation alone as a cause of atherosclerosis, it is less a cause and more a result. Inflammation is important to repair of tissues but is not the cause of the trauma. Reducing LDL reduces the risk of heart disease.

Inflammation and oxidized cholesterol have been speculated as a cause of heart disease.

Red meat is nutritionally and calorie-rich. But it is also rich in saturated fat. Saturated fat leads to high blood cholesterol. And high blood cholesterol leads to plaque in the arteries. One does not need to give up meat. But, limiting red meat to four ounces a day is protective.

Vegetables and other fiber-rich foods provide an additional protective effect with the consumption of meat. It appears that the increase in soluble fibers, as well as phytoestrogens from the fiber, reduce the pathway of cholesterol absorption. In addition, they decrease the risk of colon cancer.

Alcohol consumption is controversial.  No one disputes that excess alcohol consumption leads to dire consequences. But what about moderate alcohol consumption? Can we define moderate alcohol consumption? Is there a safe and therapeutic level of alcohol consumption?

Alcohol is a component of the Mediterranean Diet. However, the consumption is limited to 10 ounces of red wine for men, which translates to 14 grams of alcohol. Half that amount for women. In a number of articles, this amount of alcohol is beneficial.

Confirmation bias is ingrained in all humans.  Treatment programs for alcohol addiction teach that there is no safe level of alcohol consumption.  Fundamentalist Christians, Muslims, and other organized religions have taboos regarding alcohol consumption. Finally, consumers of alcohol will be biased against abstinence.

In their article, Wine, Polypenols and Mediterranean Diet, the authors note that one can get polyphenols from other sources in the diet, and thus the alcohol may be unnecessary.  They conclude that moderate consumption is likely an important component of a mechanistic as well as social norm.

• Decreased risk of cardiovascular disease
• Dose-dependent reduction of LDL-C
• Increase HDL-C and decrease triglycerides in patients with diabetes
• Reduction of Blood Pressure
• Increase production of nitric oxide (NO), which increases blood flow and reduces blood pressure
• Improve LDL/HDL ratio
• Resveratrol inhibition of pro-inflammatory agents
• lower risk of type 2 diabetes
• Resveratrol improves glucose homeostasis
• Modulate gut microbiota
• Improvement in blood vessel wall function (endothelial function)
• Reduction of drugs in diabetic patients

The issue with the Mediterranean Diet is always those who approach from a mechanistic view versus those who approach nutrition and lifestyle from a holistic view. The original data from the Mediterranean Diet came from the Seven Countries Study. This was a holistic examination, not only of their diet but also their lifestyle.

A bit of wine is good, a lot of wine is not.

If you look at every improvement in human physiology with alcohol listed above, the opposite effect happens when the dose is beyond about 50 grams of alcohol.

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Success after weight loss surgery doesn't end with an operation. It just gets started.

The most recalcitrant people to diets are those who undergo weight loss surgery. Weight loss surgery patients were on multiple diets prior to surgical intervention.  The Mediterranean Diet is the best post-operative diet one can have.

The Med Diet is favorable for health. Multiple studies have shown decreased risk of cardiovascular disease, cancer, and autoimmune disease. What about weight loss? Systematic reviews have shown the Med Diet is equal or superior to other diets for weight loss. However, we found no post-operative program to adopt the Med Diet after weight loss surgery.

We began coaching patients with the Med Diet before surgery. Many insurance companies require a preoperative, physician-supervised diet. In 2010, we began to use the Mediterranean Diet as a template for our patients using the 9-point scale.  Contrary to weight loss plans, our emphasis was learning the Med Diet.

The immediate post-operative diet emphasized soups and smoothies rich in legumes, vegetables, and fruits. Modular, unflavored protein supplements (whey or pea-based) were used to augment the protein content during this time, as were standard chewable vitamins.  Thus, the beginning of the post-operative plan was already a rich Mediterranean-style diet.

Legumes and fish were emphasized during the early solid food phase, which were universally easy to digest. One of the favorite Mediterranean-style foods were tacos.  Contrary to popular belief, the Med Diet is not foods commonly eaten in the Mediterranean. Instead, it consists of foods rich in whole grains (corn tacos), fruits (homemade salsa), legumes (lentils), some dairy products (cheese), and fish.

We noted lettuce was problematic for some in the early phase, but spinach was easy to digest. Thus salads were based upon spinach rather than lettuce.

As the stomach continued to heal, we stressed the increase in food with multiple fiber types.  We de-emphasized red meats, cautioned against excess alcohol, and worked on olive oil as the primary source for fats.

Cooking classes were a constant feature of our support group, often bringing in guest chefs from the area and the Food Network. We emphasized the importance of patients learning to cook.  Many of our patients believed that cooking was the most important aspect of their postoperative care. We found that those who learned to cook their meals had better weight loss than those who did not.

Validated Food Frequency Questionnaires (FFQ) were used to follow a group of patients. The FFQ were validated using dietary logs during follow-up with patients.

Stomach capacity after weight loss surgery is limited. How, then, does one get in the required amount of food? It is not difficult.

All food is measured pre-cooked. Take broccoli. If you take nine ounces of broccoli and bake it, you end up with a small amount of volume but still have the one Mediterranean Diet point.

The increase of vegetables in the diet is one way to reduce inflammation.

Food volume increases over time with both the Gastric Sleeve, Lap-Band, and RNY gastric bypass. The answer is not to eat less or take more protein shakes. The answer is to eat better. To have a balanced diet.

Putting someone on yet another low-carb plan does not provide a healthy long-term solution. 

Since meat is not emphasized in the Mediterranean Diet, some patients were concerned about protein intake. Lab tests did not show any patient with protein deficiency.

Over 220 patients agreed to long-term follow-up with FFQ, but we obtained consistent data on 134 patients after surgery, with a minimum seven-year follow-up.

The FFQ were converted to the nine-point Med Diet, and the results were analyzed.

Of the 134 patients, there were 65 which had scores of 5-9 Mediterranean Diet points. They showed an absolute reduction of weight of 54% total weight loss. Those patients who scored 0-3 points had a total weight loss of 32%.

Of the patients studied, 74 had the Lap-Band, 50 had the Vertical Sleeve Gastrectomy, and ten had the RNY gastric bypass. There was no weight loss difference regarding the type of weight loss surgery.

Those patients who did not do well with weight loss all had >50 grams of alcohol per day. In contrast, those who did well reported less than 50 grams of alcohol per day.

Do you think you eat enough plants in your diet? How many plants do you eat in a week? Not refined grains, but plants. You can cook them, boil, bake, microwave, roast them or even eat them raw. How many? Further, it's not just eating more volume of plants, it's diversity.

Adherence to the Mediterranean diet depends more on plants.

• Vegetables
• Fruits, Tree Nuts, Seeds
• Legumes
• Whole Grains
• Olive oil

When it comes to plants, more is better. But not just in quantity of plants, but also diversity.

Think about this: there is no one plant that can provide all the micronutrients and macronutrients a person needs. We tell vegetarians to use several plant sources for complete proteins, the same is true for any nutrient.

Your gut contains a trillion bugs. There are more of them than of us. But what do they eat? It turns out, most of what they eat are the things we don't. Gut bugs eat plant parts. Without them eating those plant parts, we would be far worse off. Thus, the gut microbiome is an exciting research field.

Guts break down fiber to chemicals shown to:

• Decrease the risk of colon cancer
• Lower cholesterol
• Decrease blood sugar spikes
• Decrease depression
• Allow absorption of polyphenols

Plants provide vitamins, minerals, macro and micronutrients. A single source of plants cannot provide the nutrients a person requires, which has been the main reason we recommend a diversified diet. Fiber is also a nutrient, an essential nutrient, one that humans cannot make, but without it there is clearly an increase in disease. While those on the extreme of low-carb diets will disagree, the literature is unambiguous.

Fiber supplements are not a substitute. Some are expensive, one selling for over $150 a month. But no supplement gives you the diversity of nutrients that you can get from your diet. Mother Nature gives you a better deal. So, eat your fiber, don't buy a supplement.

Today's assignment is simple: begin to chart the diversity in your diet, so that you increase the sources of your plants. One of my favorite dieticians, Dr. Megan Rossie, suggests a person has 30 plant-based foods per week. Sound impossible? Let's try it using the Meditereanean Diet.

It isn't that difficult to implement, but consider that you want to consume the vitamins, minerals, antioxidants, and other nutrients, and there is no one plant that does this. But many will.

One Mediterranean diet point is achieved by consuming 9 ounces of vegetables per day.  Run through the list of vegetables that you can add to your diet in any given week.

1. Asparagus
2. Beets
3. Bok Choi
4. Broccoli
5. Brussels Sprouts
6. Cabbage
7. Cauliflower
8. Carrots
9. Celery
10. Cucumbers
11. Eggplant
12. Jicama
13. Kale
14. Leeks
15. Lettuce
16. Onions
17. Parsnips
18. Peppers
19. Spinach
20. Squash
21. Tomatillos
22. Zucchini

1. Apples
2. Apricots
3. Avocado
4. Bananas
5. Blueberries
6. Cherries
7. Coconuts
8. Dates
9. Grapes
10. Grapefruit
11. Jackfruit
12. Kiwi
13. Lemon
14. Lime
15. Mangos
16. Melons
17. Nectarines
18. Peaches
19. Pears
20. Pineapple
21. Pomegranates
22. Plumbs
23. Prunes
24. Oranges
25. Tomato
26. Watermelon

1. Black beans
2. Butter beans
3. Chickpeas
4. Green beans
5. Kidney beans
6. Navy beans
7. Pinto beans
8. Navy beans
9. Lentils
10. Peanuts

1. Barley
2. Brown Rice
3. Buckwheat
4. Bulgur
5. Corn
6. Millet
7. Oatmeal
8. Whole wheat
9. Red rice

1. Acorns
2. Almonds
3. Brazil nuts
4. Cashews
5. Chesnuts
6. Hazelnuts
7. Macadamias
8. Pecans
9. Pine nuts
10. Pistachios
11. Walnuts

1. Chia
2. Flax seeds
3. Hemp
4. Pomegranate
5. Poppy seeds
6. Pumpkin
7. Sesame seeds
8. Squash seeds
9. Sunflower

These provide a diversity of micronutrients, macronutrients and fiber.

All of which provide a healthy diet.

But let's not forget one of the most important plants:

 Perhaps the most important part of the Mediterranean Diet is this plant.

Breakfast ideas:

Overnight oats, which in my recipe has oats, chia seeds, and in the morning I add blueberries and peanut butter. There are four different plants.

A whole grain sandwich to which I add: tomatoes, cucumbers, lettuce

Add an apple

A handful of almonds

Want some pasta - how about the sauce? Start the sauce with onions, mushrooms, carrots, garlic, all in olive oil.

You haven't even had a salad yet.

On this day, we have 15.

Salads are a great way to add seeds, nuts, and even some legumes.

Buy the mixed vegetables not just the broccoli.

The standard fast-food taco is a lot of ground beef, a lot of cheese, and a smear of sauce.

My taco is: lots of cabbage which I have for a slaw and other great crunch

My salsa has some amazing fresh ingredients in it like my mango salsa

And cheese and meat are more of a condiment. But you can reduce the meat by using lentils and mushrooms.

Soups:

Vegetable soups in the winter! Lots of additions here for vegetables.

Diversity is not only healthy, but it is delicious.

Perhaps the most important part of the Mediterranean Diet is this plant.

Olive oil is the single ingredient most associated with the Mediterranean Diet. It is the one single food substitution you can do that will improve your health immediately and have great consequences. But not all olive oil is the same.

There are many types of fat that you can find in your diet. Saturated fat will raise your LDL level, increasing your risk of heart disease and stroke. Olive oil, which is unsaturated, decreases the risk of heart disease.

Fats are confusing. You will hear saturated, poly unsaturated, monounsaturated, and trans fats. First, we won't look at the chemical structure of fats. Second, we will look at the evidence that the food is associated with fat and how it influences our bodies. Finally, we will dismantle some bad arguments against certain fats.

Sources: butter, red meat, dairy.

What the Mediterranean Diet showed us what that the total diet mattered more than the individual ingredient. In spite of the revolutionary approach to using cohort studies with complete diets, many have insisted on pulling that apart to find out if one ingredient is "bad." For years, saturated fat was considered the "bad" part of what we ate. The American Heart Association recommended limiting saturated fat to just ten percent of what you eat.  The AHA recommended changing from saturated fat to polyunsaturated fat or monounsaturated fat. There has never been a question about olive oil, but a few concerns have been raised about some polyunsaturated fat.

But it isn't as simple as the saturated fat molecule. We don't eat pure saturated fat, it turns out we eat food containing that fat. Depending on the food, it depends on how saturated fat affects you.

Adding more fish and dairy to your diet decreases the risk of heart disease. Adding more red meat to your diet increases your risk of heart disease. This study, from the EPIC group, was impressive in its size, and its ability to factor out other issues that might increase heart disease. Once again, cohort studies show it isn't as important.

Besides heart disease, cheese decreased the risk of dementia among a cohort of Finnish men followed for 22 years.

Perhaps the greatest snack of all time (my opinion - not science).

Another cohort study found that cheese was associated with a lower risk of pre-diabetes. Other forms of dairy products did not have this same benefit. This flies in the face of some vegans, who insist diabetes comes from saturated fat.

Finally, non-dairy cheese is not a great source of nutrients. I know my fellow vegans want to find a good alternative for cheese, but there simply isn't one.

Fatty fish have been shown to decrease not only cardiovascular mortality, but all causes of mortality. But not fish oil.

Who doesn't love a good salmon?

Fish consumption has been associated with a lower risk of heart disease. Further, fatty fish decreases the risk of all-cause mortality.

Fatty fish contain high quantities of omega-3 fatty acids.  Our body cannot make these fats, we must get them from our diet. Here are the fish that are high in omega-3 fatty acids:

• salmon
• sardines
• mackerel
• herring
• lake trout
• canned light tuna

Even tilapia has some omega-3 fatty acids, in fact, it has about four times as much omega-3 fatty acids as grass-fed beef. However, tilapia has ten times less omega-3 fatty acid as salmon. Some have discouraged the consumption of tilapia, but it remains an inexpensive, sustainable type of fish. Just for reference, tilapia has the same amount of omega-3 fatty acid as cod, scallops, shrimp, and wild lobster.

There are two kinds of omega-3 fatty acids in fish — eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA).  One of the few supplements that all physicians recommend are DHA for pregnant women. This is essential to the brain of the child.

 Yes, he is a smart kid - was it genetics or the DHA his mother took during pregnancy?

• They are anti-inflammatory
• They are extracted with hexane
• They are healthy
• There is less hexane if you consumed from your diet for a year than one whiff of the gas you put into your automobile

• You can cook with it, this is the only oil used in cooking in most homes in Italy and Greece
• Extra Virgin Olive oil standards are the highest from those produced in the United States
• Over 80% of the Extra Virgin Olive oil imported is contaminated with other oils
• The smoke point is around 400, but up to 475 F when you used "refined" olive oil
• My favorite olive oil is from the US, but the tastiest is from Liguria in Italy (my opinion)

Olive oil, balsamic vinegar, sardines all provide elements of taste - the sour, salty, and savory, combine with bread - the sweet and you have a perfect balance.

The Mediterranean Diet is the most anti-inflammatory diet studied.

The inflammatory response is the body's mechanism to fight infection, repair itself and rid itself of cancer.  Inflammation is a coordinated response to trauma, infection, and cancer. Without inflammation, we would be dead within twenty-four hours.

Too much inflammation results in wanton destruction of tissues, pain, fevers, and misery. It is associated with heart disease, cancer, aging. It is that delicate balance of inflammation we need.

Does diet play a role with inflammation? The answer is "sort of."

Inflammation is involved in:

• Wound healing, removing dead cells - breaking them down into components so they can be recycled
• Removing and destroying bacteria
• Inactivating and eliminating viruses
• Destroying cells that have changed into cancer cells
• Repairing injury from infection
• Destroying parasites
• Removes toxic chemicals
• The immune system is one branch of the inflammatory response.

The five signs of acute inflammation and their Latin names:

• Redness - in Latin this is called rubor.
• Swelling - in Latin this is called tumor.
• Fever - in Latin this is called calor
• Pain - in Latin this is called dolor
• Secretion - in Latin this is called fluor

Medical school teaches inflammation as one of the first series of lectures.

Your finger was hit with a hammer. You have an injury to your finger. Some cells are injured. The cells send a distress signal, and immediately white blood cells begin to swarm into the area to help the injured cells.  All that extra blood flowing to the area will lead to redness (rubor) and swelling (tumor). Soon, the finger will feel a bit hot (calor) and will have pain (dolor).

Some cells are so badly injured that they are no longer viable. Your inflammatory reaction breaks down these cells, removes the debris, and recycles the parts to create new tissue in the area.

I love nature walks but like to avoid Poison Ivy.

Sometimes, we want to decrease the immune response. Inflammation is the response of our skin to poison ivy.  We reduce the immune response by reducing hives and itching.

Rheumatoid arthritis is another example of unwanted inflammation.  Rheumatoid arthritis is an auto-immune disease.  The resulting inflammation leads to pain, fever, and joint destruction. The aim of the treatment is to reduce the inflammatory response that saves joints and improves well-being.

The inflammatory response of COVID, influenza, or the common cold is reduced by the use of non-steroidal anti-inflammatory drugs, such as aspirin or Motrin.

Heart disease is partially the result of inflammation. When you have a heart attack, the coronary arteries are blocked. As a result, a part of your heart muscle is without oxygen. The cells send out inflammatory signals, and you begin to feel pain (dolor). If the blood flow is restored, your cells can heal, but if it takes too long, some of those cells will die. Then your body will get rid of those dead cells and replace them with scar tissue. The result is that your heart becomes less effective.

Plaque formation in the arteries is the result of genetics, diet, and inflammation. The increased cholesterol, either from the genetics or from a diet high in saturated fat, is deposited in the arteries.  When cholesterol enters the artery wall, the body's inflammatory response tries to get rid of it, causing inflammation in the arteries. Did you know that 18-year-olds already have signs of early plaque formation in their arteries?

Chronic inflammation is when your body continues to send inflammatory signals, even when there is no acute injury or danger. This is what happens in rheumatoid arthritis, lupus, long Covid, and is involved in diabetes, obesity, dementia, and premature aging.

It is easy to obtain calories in western societies. In human history, we have gone from people on the verge of starvation to being overfed. We have also increased lifespan because of sanitation, vaccination, clean water, availability of food, and modern medicine. Living longer means seeing more chronic diseases. The role of diet in those diseases has never been in doubt since Hippocrates said, "Let thy food be thy medicine." The result has been an increase in inflammatory diseases

Contrary to the Mediterranean diet, the typical US diet has changed to a diet rich in fats. Fat consumption has risen by 11% at the expense of healthy carbohydrates.

Refined sugars have increased from 18 pounds a year in 1800 to over 180 pounds per year in 1999. Since 1999 sugar consumption has been decreasing in the United States.

The typical western diet has decreased in the amounts of fruits, nuts, seeds, vegetables, legumes, and fish. All while increasing meats, ultra-processed foods, dairy, and alcohol.

Diseases caused by inflammation have increased in the United States. Obesity is now considered an inflammatory disease. But other diseases of inflammation have increased:

• Inflammatory Bowel Disease
• Rheumatoid arthritis, lupus, and other auto-immune diseases
• Hidradenitis suppurativa and other skin diseases
• Food allergies, such as allergies to peanuts
• Dementia, Alzheimer's, and Vascular dementia, as well as cognitive decline with age
• Asthma
• Diabetes, both type 1 and type 2
• Multiple Sclerosis and Amyotrophic Lateral Sclerosis
• Diabetic complications, such as neuropathy, cardiovascular disease, kidney disease

Diet contributes to inflammatory conditions. If inflammation is like a fire, then some dietary components are adding kindling to the fire of inflammation. The Mediterranean diet has led to reduced inflammation and improved quality of life.

Antiinflammatory components of the Mediterranean Diet include anti-oxidants, polyphenols, omega 3 fatty acids, vitamins, potassium, magnesium, zinc, fiber, and lower sodium and saturated fat consumption.

Tsigalou C, Konstantinidis T, Paraschaki A, Stavropoulou E, Voidarou C, Bezirtzoglou E. Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases. An Overview. Biomedicines. 2020 Jul 8;8(7):201. doi: 10.3390/biomedicines8070201. PMID: 32650619; PMCID: PMC7400632.

Malesza IJ, Malesza M, Walkowiak J, Mussin N, Walkowiak D, Aringazina R, Bartkowiak-Wieczorek J, Mądry E. High-Fat, Western-Style Diet, Systemic Inflammation, and Gut Microbiota: A Narrative Review. Cells. 2021 Nov 14;10(11):3164. doi: 10.3390/cells10113164. PMID: 34831387; PMCID: PMC8619527.

Obesity Society. (2014, November 4). U.S. adult consumption of added sugars increased by more than 30% over three decades. ScienceDaily. Retrieved August 27, 2022 from www.sciencedaily.com/releases/2014/11/141104141731.htm

Drews G, Krippeit-Drews P, Düfer M. Oxidative stress and beta-cell dysfunction. Pflugers Arch. 2010 Sep;460(4):703-18. doi: 10.1007/s00424-010-0862-9. Epub 2010 Jul 23. PMID: 20652307.

Joseph A, Ackerman D, Talley JD, Johnstone J, Kupersmith J. Manifestations of coronary atherosclerosis in young trauma victims--an autopsy study. J Am Coll Cardiol. 1993 Aug;22(2):459-67. doi: 10.1016/0735-1097(93)90050-b. PMID: 8335815.

Saltiel AR, Olefsky JM. Inflammatory mechanisms linking obesity and metabolic disease. J Clin Invest. 2017 Jan 3;127(1):1-4. doi: 10.1172/JCI92035. Epub 2017 Jan 3. PMID: 28045402; PMCID: PMC5199709.

Ng SC, Shi HY, Hamidi N, Underwood FE, Tang W, Benchimol EI, Panaccione R, Ghosh S, Wu JCY, Chan FKL, Sung JJY, Kaplan GG. Worldwide incidence and prevalence of inflammatory bowel disease in the 21st century: a systematic review of population-based studies. Lancet. 2017 Dec 23;390(10114):2769-2778. doi: 10.1016/S0140-6736(17)32448-0. Epub 2017 Oct 16. Erratum in: Lancet. 2020 Oct 3;396(10256):e56. PMID: 29050646.

Raghupathi W, Raghupathi V. An Empirical Study of Chronic Diseases in the United States: A Visual Analytics Approach. Int J Environ Res Public Health. 2018 Mar 1;15(3):431. doi: 10.3390/ijerph15030431. PMID: 29494555; PMCID: PMC5876976.

D'Antona S, Caramenti M, Porro D, Castiglioni I, Cava C. Amyotrophic Lateral Sclerosis: A Diet Review. Foods. 2021 Dec 17;10(12):3128. doi: 10.3390/foods10123128. PMID: 34945679; PMCID: PMC8702143.

Yarla NS, Polito A, Peluso I. Effects of Olive Oil on TNF-α and IL-6 in Humans: Implication in Obesity and Frailty. Endocr Metab Immune Disord Drug Targets. 2018;18(1):63-74. doi: 10.2174/1871530317666171120150329. PMID: 29165098.

Esposito S,...

Adherence to the Mediterranean Diet decreases the risk of cardiovascular disease. The Seven Country Cohort Study clearly showed this.

But what about cancer? Does the Mediterranean Diet impact cancer or cancer prevention? To study this, another cohort study began called the EPIC study. Uniquely, the EPIC showed not only a decreased risk of cancer but also mortality from cancer.

All vegetables, even the green ones, have nitrates. It turns out that the components of The Mediterranean Diet decreases the risk of cancer, decreases the risk of cancer recurrence, improves survival from cancer, and decreases overall mortality.

The European Prospective Investigation into Cancer and Nutrition (EPIC) is a large cohort study involving over 521,000 individuals from 23 centers from ten countries.

The EPIC researchers developed a simple scoring system to determine adherence to the Mediterranean Diet.  Greater adherence to the Mediterranean Diet was associated with longevity.

The Mediterranean Diet is scored on a scale of one to nine. Nine being a perfect Mediterranean Diet Score, and zero being poor. Great adherence to the Mediterranean Diet is a score of seven points or more.

The Mediterranean diet is rich with vegetables, legumes, fruits and nuts, whole grains, and fish.

• You get a point for consuming 9 ounces or more of vegetables a day. If you consume less than nine ounces, you get a score of zero.
• Legumes will net you a point if you consume two ounces or more per day.
• Fruits and nuts are one point for nine ounces or more.
• Likewise, whole grains are worth a point for nine ounces or more.
• Fish is an average of an ounce a day, or two main meals per week. Thus,  by consuming a diet rich in these five components can score five points.

The weight is based on pre-cooked food.

Lentils are a legume, and if you consume more than 2 ounces per day, you will score one Mediterranean Diet point. They are high in protein and fiber and low in saturated fat.

People from the Mediterranean didn't eat much meat or dairy.  By consuming less of these, you can achieve Mediterranean Diet points.

• Eating less than  4 ounces of meat a day  is worth one point
• Consuming 1.5 ounces of hard cheese a day or LESS is worth one point
• Consuming less than 8 ounces of dairy is worth one point (mostly consume yogurt).

Thus by eating less dairy and meat, or none, you can score two additional points.

You might think that 6-ounce burger is small, but if you eat less than four ounces of meat a day, you get one Mediterranean Diet point. Eat more than four ounces, and you get zero points.

Alcohol is a component of the Mediterranean Diet but in moderation.

For ethanol, a value of 1 was assigned to men who consumed between 10 and 50 g per day and to women who consumed between 5 and 25 g per day. This corresponds to 5 ounces of wine for women or 10 ounces for men.

Olive oil is an important component of the Mediterranean Diet. The type of fat in olive oil is mainly monounsaturated. The ideal ratio of olive oil or monounsaturated fats to saturated fats should be at least 60%.

The best olive oils come from the US.

Increasing the score in the Mediterranean Diet by two points in the Mediterranean diet led to an 8% reduction in mortality.

Imagine a simple dietary intervention leading to a decrease in mortality.

In a recent update of the Mediterranean Diet they found a higher consumption of fruits and vegetables combined led to a decrease in colorectal cancers. But just eating fruits alone or just vegetables alone didn't do it.  Proving again, the entire dietary pattern is important.

A Mediterranean Diet score of 6-9 led to an 11% decrease risk of colorectal cancer!

If you eat a lot of red meat but eat a lot of vegetables, your risk of colon cancer decreases.

The  Mediterranean Diet was found to protect against breast cancer. In addition, it improved overall survival of those who developed breast cancer.

Alcohol consumption increases the risk of breast cancer. While the Mediterranean Diet is a low in alcohol consumption, it is still a factor.  Thankfully, coffee consumption is protective against breast cancer. Of interest, sugar-sweetened and artificially sweetened beverages were not associated with an increase in breast cancer.

Whole grains, fruits, and vegetables were associated with less risk of lung cancer.  Smokers decreased their risk of breast cancer with increasing vegetable consumption. Lung cancer even decreased with higher consumption of apples and pears.

There was no association with meat or fish consumption and lung cancer.  Alcohol was also not associated with an increased risk of lung cancer.

Adherence to the Mediterranean Diet lowers the risk of cancer, cancer recurrence, and improves survival from cancers.  The Mediterranean diet leads to a lower risk of many cancers:

• colorectal
• lung
• breast
• stomach
• pancreas
• prostate
• liver
• head and neck cancers

In contrast, there is not much evidence that the keto diet has a positive impact on cancers. The number of clinical studies have been small and unimpressive. While it clearly has proponents, clinical outcomes in humans are lacking.

Cancer isn't fixed from a  diet. But a healthy diet is the only empowering thing that many cancer patients have.

Augmenting conventional treatment with a healthy Mediterranean diet provides a powerful defense against cancer.

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Produced by Simpler Media

Was Ancel Keys responsible for the modern epidemic of obesity?

If you have read any low carb blog lately, you would think so.

Their revisionist history is broken down to this:

• Ancel Keys was an influential scientist who thought fat was to blame for heart disease
• He did a study of diet and correlated fat and heart disease in those people of the seven countries
• But Dr. Keys left out countries that would have proven his hypothesis wrong
• The influence of Dr. Keys work turned the US away from saturated fat and to sugar
• Sugar causes obesity and all the lifestyle illness of the world
• Dr. Keys brought us snackwells instead of pork rinds and we are all obese with diabetes

You will find versions of this in blogs, books, and videos.  Low-carb bloggers plagiarize one another. Nor have they never the primary source material.

Keys is the founder of the Mediterranean Diet. He was a pioneer physiologist, one of the first to show that diet was an important component of heart disease.

In the 1950's few considered diet an important component of heart disease.

Rich People and Diets

"In 1952 when Margaret and I were making surveys in Naples and then Madrid. It seemed quite clear that there was some relationship between diet and the incidence of coronary heart disease. Rich people had different diets and different blood cholesterols, and they had the only heart attacks in town. When those findings were written up and presented at a meeting in Amsterdam, some people were impressed and some didn't believe anything about it. " - Ancel Keys

This early observation by Keys  was the impetus for  the Seven Country Study.

That diet was responsible for heart disease was contrary to the prevailing theory: in the 1950's heart disease was hypothesized to be phenomenon of aging.  Dr. Keys meticulous research revealed the strong correlation between heart disease and a diet rich in saturated fat.

The graph below is a result of looking at macro dietary statistics of a country compared with death rates from heart disease. Keys presented this data at a WHO meeting in the early 1950's. The conclusion about fat and heart disease,  was met with a great deal of skepticism. Diet was not considered a factor in heart disease.

While this data points to a potential cause, to examine this hypothesis one must perform a cohort study.

Some assume that Keys collected country wide data about diet and heart disease, but he did not. Bloggers probably assume this based on this graph, as well as the name, Seven Countries Study. But the Seven Country Study was far more precise. The Study was a Cohort type study.

A cohort study follows subjects for a long period of time. The Seven Countries Study followed over 12,000 men for nearly 50 years.

Following these men involved yearly physical examinations, blood work, hospital and death records, as well as very specific dietary follow up.

Of all the factors examined, saturated fat and blood cholesterol were most correlated with  heart disease.

One of the more common myths about the Seven Country Study was that sugar was not examined. In fact, sugar was examined as an independent dietary factor. Sugar was not an primary variable for heart disease, unless combined with saturated fat.

The low-carb bloggers assume that Keys only tested those countries whose diet was rich in carbs, and low in fat. Keys chose his cohorts based on different diets, from those who were low fat, to high fat. Total fat, as it turns out, was not a factor for heart disease. Greeks had 40% of their dietary calories from fat but a low heart disease rate.Most of their fat came from monounsaturated fat,  olive oil.

The Finland cohort was chosen precisely because of their high fat diet:

"Loggers’ lunches, even today, are things of wonder, unsurpassed in caloric density: Large hunks of meat are suspended in congealed fat, enveloped in a dark bread loaf fully permeated by fat. The whole – at 250 grams of fat and well over 2,000 calories – is packaged in aluminum foil and tied with a ribbon. This hefty fare is preceded by a breakfast of fish soup, containing fifty percent butter fat calories and several grams of salt. The evening meal provides the rest of the 6,000 calories the logger needs to work outdoors all day." - Henry Blackburn

Finland had a high level of coronary heart disease. The Fins also have a very active lifestyle, which didn't prevent them from the ravages of atherosclerosis.

"Though the picture in Finland confirms the major causal hypothesis about the role of dietary saturated fatty acids, a basic issue remains, as exposed in a practical dietary experiment completed some years ago. Can the picture be changed? East Finns were placed on an Italian diet and Italian farmers on a Finnish diet. As in the black and white prisoners that Keys and John Brock of Capetown studied in Southern Africa forty years before; the groups rapidly approached the blood lipid characteristics of those in the adopted eating pattern." - Henry Blackburn

Dietary intervention, having a group of Fins eat a more Mediterranean diet, changed their lipid profile. Italians were placed on a high saturated fat diet and their blood lipid levels became worse. This was one of the first reported dietary interventions showing the benefits of the Mediterranean diet.

The Fins remind me of the Cross-Fit types: young, seemingly healthy and eating a lot of fat. Then struck down by heart disease as a result of poor dietary choices.

Does the French Paradox refute the work of The Seven Country Study and Dr. Keys?  The paradox is that France has a low rate of heart disease and a high consumption of saturated fat.

The accusation that France was not included in the Seven Country Study was dismissed based upon three facts: First, France was invited to participate. They were at the initial pilot study. Second, France chose not to participate because they lacked funding. Third, later studies from France did confirm the conclusions from the Seven Country Study.

The French Paradox makes great debate, but isn't supported by the data. Finally, the  French diet was essentially Mediterranean through the mid 1970's, not a diet high in saturated fat.

No country was excluded from the investigation of heart disease and diet.

The diets of the US and Finish cohorts showed there was more than just correlation between diet and heart disease.

Did Keys cherry pick the data? Knowing that countries that didn't agree with his thesis, did Keys exclude those countries?

Here is data from 22 counties regarding diet and disease published in 1957 (reference).  Many low-carb bloggers have reproduced this graph. They conclude that Keys left out countries whose data would be contrary to his hypothesis. They also conclude that this graph, does not show correlation between fat and heart disease.  In fact, both assumptions are incorrect.

No country was left out of the study. In fact, some cohorts were studied precisely because they had high fat diets. High fat diet combined with an active lifestyle (today we call this "metabolically healthy") did not decrease heart disease. The data from Finland showed as "metabolically healthy" as the loggers were, they suffered from an alarming rate of sudden death from cardiovascular disease.

The Seven Country study WAS NOT a study of  broad dietary habits of people from those seven countries. Rather, it was a study of specific cohorts, from villages in those countries.

Studying those cohorts involved meticulously recording their diet (even weighing portions), taking blood samples, physical examinations, and recording their lifestyle. The result was the strong correlation between saturated fat and blood cholesterol to heart disease.

No country was excluded from involvement.

Cohorts were chosen because they had different dietary patterns. This demonstrated the effect of diet on the heart health over time.

Sugar was studied as an independent variable and was not found to be associated with an increased risk of heart disease. Sugar combined with saturated fat was found to be impactful.

In 1977 the United States guidelines for diet stated "consume only as much energy as you expend, eat more naturally occurring sugars, consume more fruits and vegetables and go easy on eggs and butter. "  The 1980 guidelines admonished people to cut down on saturated fat and sugars. Were those guidelines were followed the United States would not have an obesity epidemic.

Low Carb bloggers plagiarize one another freely. But those bloggers clearly do not read the primary sources.

Mediterranean Diet Today

The diet that provides optimal cardiovascular health continues to be

Scientists and dieticians consistently  rank The Modern Mediterranean Diet (MED diet) as the diet most recommended.  But often people don't know what the MED diet is. This post will  define the Med diet.

Critics of the Med Diet

Critics  argue that there is no uniform MED diet. They make these assertions based on one of these three arguments:

1. That there is no uniform diet of the Mediterranean Region. There are over 20 countries on the 26,000 miles of coastline of the Mediterranean Sea. Each country with their own unique diets. Many of which have adopted a more modern American style diet.
2. The diet is simply made up and therefore should be ignored.
3. Finally some point out that there are many Med Diets as the literature.

Heart disease and Diet

Ancel Keys is the scientist most responsible for not only the Med diet but the relationship of heart disease to diet. In the 1950's, heart disease was thought to be a disease of aging, and smoking but not diet or lifestyle.

In the 1950's, much like today, heart disease was the number one cause of death among of middle aged executives. While there was a clear association between smoking and heart disease, there were far more deaths than could be explained from smoking.  Then an Italian scientist told Dr. Keys about the low incidence of cardiovascular deaths of men in Naples.

Keys confirmed this claim when he took a sabbatical in Oxford in 1952.  Keys found there was a difference of heart disease between the poor and the executives of Italy. He developed the hypothesis that diet might explain difference  between the two groups.  To confirm this Keys, and his wife, then traveled throughout Europe catalog different diets and rates of heart disease.

In 1955 Keys presented his data to the World Health Organization, concluding  that diet played a significant role in heart disease.  Many members of the WHO mocked his  "diet-heart theory."  Keys then organized the seven countries study (click here).

The seven countries study was an observational study looking at biomarkers, lifestyles and their relationship to heart disease.  Those countries were Greece, Italy, former Yugoslavia, Finland, The Netherlands, Japan, and the United States. The cohorts were chosen because of diverse diets, lifestyle, and risk factors. Dietary and lifestyle influence on cardiovascular disease was unknown at the time.

The seven country study was to answer the question about dietary influence and heart disease.

Low-carb bloggers accuse the seven country study of leaving out France. They cite the French Paradox, that the French eat a diet high in saturated fat but have a low incidence of heart disease.

However, France was not left out of the study.  French investigators were present at the original pilot study in Nicotera Italy, but ultimately decided not to participate in the study.  France was recovering from World War 2 and simply didn't have the resources to commit to such a study.

In fact, The French Paradox was "coined" in the 1980s, over twenty years after the  start of the seven country study. The investigators didn't have access to that data, or the term. Low-carb bloggers  didn't read the seven country study or the French paradox.

Two factors explain the French Paradox.

The high fat diet was not widely adopted by the French prior to the mid 1970's. It  takes time for a  habit to have an effect on cardiovascular disease. For example, one doesn't develop heart disease after the first cigarette. The primary French diet in the 1950's through 70's was a Mediterranean Diet.  Thus, the effect of the high fat diet would not be evident for twenty plus years after it was adopted.

The second explanation is that French physicians consistently underreported heart disease. Of note, Wine consumption has been the most studied aspect of the French Paradox. Red wine sales increased dramatically after the airing of the "French Paradox" on Sixty Minutes.  Wine is an important component of the Med diet.

From 1958 to 1970  over 12,000 men were tracked for diet, weight, smoking, physical activity, vital signs, cholesterol, and lung capacity. During that time there were about 2300 deaths, 27% from heart disease. Different countries had different rates of deaths from heart disease: USA 50%, Northern Europe 40%, Southern Europe 17%, Japan 5%.  The dietary pattern that was identified in this study became the basis of what Keys would call The Mediterranean Diet. Key's book became a bestseller, describing not only the first version of the Mediterranean Diet, but providing healthy recipes for a country trying to fight the number one killer. Keys even wrote a best selling cookbook with his wife touting the benefit of the diet.

Adopting the Mediterranean Diet

Keys died shortly before his 101'st birthday. There are a number of great articles written about Keys, but the obituary here is one of the finest.

The first scoring system for the Med diet was proposed in 1995 (here). Other studies began to arise to determine the Med diet for cancer, autoimmune diseases, longevity, dementia, and other disease states.

One of the more famous was a meta analysis of twelve studies looking at longevity. Greater adherence in this scale also showed lower incidence of Parkinson's disease, Alzheimer's disease as well as cardiovascular mortality.

This scale gave points for increased consumption of vegetables, fruits, legumes, cereals, fish, and moderate red wine consumption. While those who had "above the median" of red and processed meats and dairy were given zero points. Ultimately this was refined further with the use of monounsaturated fatty acids (olive oil) as the primary fat (60% or greater).

Trichopoulou, and her colleagues began the European Prospective Investigation into Cancer and Nutrition (EPIC) study in 1994 after the pilot study in 1991. The study enrolled more than 521,000 participants from 23 centers in 10 western European countries, detailing diet, lifestyle, medical history, and vital signs.

They used a validated food frequency questionnaire of over 150 foods commonly consumed in Greece. "For this analysis, we focused on nine nutritional variables: vegetables, legumes, fruits and nuts, dairy products, cereals, meat and meat products, fish and seafood, monounsaturated to saturated lipid ratio, and ethanol." (11).

A two point increase in the Mediterranean diet score  led to a decrease in mortality of 14%.

Diet pyramids were common in the 1990's . One of the more famous was from Oldways where they developed a pyramid in 1994 to describe the Mediterranean Diet. (12). This pyramid was based primarily on the diet from the Island of Crete and southern Italy from the 1960's.

Diet pyramids are of little use in scientific studies, as they don't quantify the amounts of foods consumed. Some argue that diet pyramids are a useful way to display the data.

The Lyon heart study was a randomized secondary trial testing the Mediterranean Diet against the French Prudent diet. After 46 months there were 1.24 per one hundred patients who had either a cardiac death or nonfatal infarction. This compared to 4.07 per one hundred who had the standard cardiac diet. They also noted that most patients, after a few years, were still following the Mediterranean Diet, showing that adoption and compliance was not difficult.

The Mediterranean Diet is useful not only for disease, but for weight management. The latest drugs for obesity are GLP-1 agonists (Wegovy, Ozempic) there is a clear benefit from polyunsaturated fatty acids (PUFA) and raising GLP-1. While obese patients have lower GLP-1 response to glucose than non-obese, the PUFAs in the Mediterranean diet provide an increase in GLP-1.

Further the polyphenolic compounds of the Mediterranean Diet provide another benefit. People with the highest intake of polyphenols (especially the flavonoids) were associated with...

If you don’t have diabetes, should you even consider a blood glucose monitor? Well, here is the science behind this new tiktok trend and why these Continuous Blood Glucose Monitors (CGM) are here to stay and what we know about them.

The device

First, the device – a continuous blood glucose monitor is a device that you place on your body and it measures the blood glucose level and reports that data typically to an application on your phone. The first blood glucose monitors were used to help patients with type 1 diabetes regulate their blood sugar. They were revolutionary, but expensive, not covered by many insurance companies, and cumbersome. As the technology has improved, the price has decreased, the comfort level has improved, and the accuracy of the monitoring has improved. As with most technology, blood glucose monitors are now less expensive, better, and widely available.

You can read more about the history of the blood glucose monitor here.

Most diabetics use a fingerstick to see what their blood glucose is, and use that information to determine the medicine they need to help regulate their blood glucose. The CGM allows real-time data which can be checked against food logs to allow a person to see impact of their diet on their regulation of food. As the epidemic of diabetes grows, about 55 million predicted with diabetes by 2030, we know that the less variability in glucose, the better long-term outcome (reference here) and here.

Variability in blood glucose with non-diabetics

It turns out that even people who are not diabetic, have wide variations of blood glucose (reference here). Further, the variations in blood glucose have real time effects and we should care about those effects.  For example, high glucose spikes lead to inflammation of the arteries, even in non-diabetics, which lead to atherosclerosis, heart disease, strokes and peripheral vascular disease (click here). A study published in Journal of the American Medical Association (here) concluded “Providing individuals with tools to manage their glycemic responses to food based on personalized predictions of their PPGRs may allow them to maintain their blood glucose levels within limits associated with good health.”

What is best?

Avoiding the large variability in blood glucose is clearly important to health whether one has diabetes or not. Trying to predict what variability will be based on fasting blood glucose or hemoglobin A1C cannot be done.

Using a healthy diet like the Mediterranean or DASH diet – this has been found in studies with CGM on young people with type 1 diabetes (reference ) 

Even variations of the Mediterranean Diet and CGM have found improvement in glucose variability.

Economies of Scale

Continuous Glucose monitors are getting less expensive, more accurate, and more comfortable to wear. This is good news for patients who have diabetes, and as demand raises among all to use these tools the price will drop further. The economies of scale work with medical devices. Consider the pulse oximeter that you can purchase from a local pharmacy for $25 – they used to cost over $900 and were used to manage patients with lung disease. Now, for less than a copay, you can have one of these devices and they not only help manage patients with lung disease, but also keep people with COVID out of the hospital when they are doing well, or provide a warning to get patients into the hospital.

The original pulse oximeters were large, expensive and cumbersome. The modern pulse oximeter is available at any pharmacy for $25.

These are another tool in our toolbox.

Disclosure: I received a continuous glucose monitor from Nutrisense. They do not manufacture the device but provide the device as a part of the service with registered dietitians to help people navigate what the data means. They have a subscription model which may, or may not be good for you.

In recent years, GLP-1 agonists have gained significant attention as effective treatments for obesity and type 2 diabetes. However, emerging research suggests these medications may also influence brain function and behaviors related to reward and addiction. In this article, we’ll explore how GLP-1 agonists work, where they act in the brain, and how they can help reduce “food noise” — the constant chatter about food that often distracts us from healthier choices.

GLP-1, or glucagon-like peptide-1, is a hormone released from the intestines after eating. It plays a crucial role in regulating appetite and glucose metabolism. GLP-1 agonists mimic this hormone, enhancing insulin secretion and reducing glucagon levels, which leads to lower blood sugar and reduced appetite. Popular medications in this class include semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda).

Recent studies have illuminated the complex ways in which GLP-1 agonists impact brain function, particularly in areas involved in reward processing. Researchers have found GLP-1 receptors in key brain regions such as:

Hypothalamus: This area regulates appetite and energy balance.

Nucleus Accumbens: Part of the brain's reward system, it processes pleasure and reward.

Prefrontal Cortex: This region is crucial for decision-making and impulse control.

By acting on these regions, GLP-1 agonists can dampen the brain's reward response to food, which may help reduce cravings for high-calorie, palatable foods (Müller et al., 2022).

“Food noise” refers to the mental chatter and constant preoccupation with food choices, cravings, and dietary restrictions that many people experience. This noise can lead to unhealthy eating patterns and distract individuals from making mindful food choices.

GLP-1 agonists appear to quiet this food noise. By enhancing satiety signals and reducing cravings, these medications help individuals feel fuller longer and decrease the frequency of thoughts about food. Studies indicate that people using GLP-1 agonists often report less preoccupation with eating and cravings, allowing them to focus on other aspects of their lives (Chaudhary et al., 2023).

Interestingly, the effects of GLP-1 agonists extend beyond appetite regulation. Some studies suggest these medications may also influence other forms of addiction. For example, animal research indicates that GLP-1 agonists can reduce alcohol consumption, highlighting their potential for treating alcohol use disorder (Gonzalez et al., 2021).

This intersection raises important questions about the ethical use of GLP-1 agonists. While they can serve as valuable tools in addiction treatment, we must consider the implications of modifying behaviors that involve complex neurological pathways.

It even appears to change one's reaction to stress.

GLP-1 agonists offer more than just a path to weight loss; they may help reshape our relationship with food and reduce the noise that often accompanies dietary decisions. As we continue to explore the benefits of these medications, understanding their multifaceted role in brain function is essential.

Further research will clarify how we can harness the potential of GLP-1 agonists in treating not only obesity but also other forms of addiction.

Chaudhary, N., et al. (2023). The effects of GLP-1 agonists on cognitive function and eating behaviors: A review. Journal of Obesity, 12(4), 234-245.

Gonzalez, R., et al. (2021). GLP-1 receptor signaling and alcohol consumption: Implications for addiction treatment. Neuroscience Letters, 748, 135709.

Müller, T.D., et al. (2022). GLP-1 receptor agonists: An update on their role in obesity treatment. Obesity Reviews, 23(2), e13356.

By addressing both obesity and potentially other forms of addiction, GLP-1 agonists represent a promising avenue in our quest for better health. Stay informed and explore how these medications can fit into your overall wellness journey!

About 15 years ago physician came to me telling me that she was opening a new venture, distributing plant-based bioidentical hormones, and surgically implanting those hormones as pellets. She wanted me to send her all of my patients who presented in menopause because "with bioidentical hormones they won't need weight loss surgery." She went on to say how every woman would be tested for their hormones and then a compounding pharmacy would make up the exact hormones to replace the ones the person was not producing enough of. This would, "almost reverse aging and cause weight loss." In fact, those bioidentical hormones cause weight gain.

Bioidentical hormones, from whatever source, cause weight gain, not weight loss (reference) . In spite of a number of "advertisement" from providers who wish to provide you with "compounded" bioidentical hormones that propose they will cause weight loss - they don't.  This physician was not an Ob-Gyn, nor was she a board certified endocrinologist, in fact her specialty was about as far from treatment of complex menopausal hormone replacement or obesity as one could imagine.

The red flags for this clinic were (a) proposing weight loss (b) associating with a compound pharmacy (c) offering anti aging treatments (d) a provider that is not an expert in the field of endocrinology or gynecology.

Bioidentical hormones made by any compounding pharmacies do not meet rigorous FDA standards. In fact, compounded forms of bio-identical hormones are similar to supplements, and have the same issues that supplement industries have had that we have outlined previously.

Menopausal Hormone Replacement is Medicine, Compounded bioidentical hormones are ?

With every scam there is a separation of the chaff from the wheat. Here is the current evidence about hormones and changes that occur as women enter menopause. Accepted sources for this information include The Menopause Society as well as The American College of Obstetrics and Gynecology.

Women undergoing menopause they decrease their production of certain hormones. This can lead to severe symptoms of menopause that hormone replacement therapy can alleviate. Symptoms of menopause such as hot flashes, sleep disturbances, joint aches and pains, mood changes, vaginal dryness. That is undisputed and the improvement in quality of life is why many seek hormone replacement therapy. There is also potential benefit to decreasing risk of cardiovascular disease, if started within ten years of symptoms and before the age of 60 years.

The major concern of hormone replacement therapy came from the study published in 2002, the Women’s Health Initiative, showing that hormone replacement, with the most commonly prescribed medicine, Prempro, led to an increase in heart attacks, strokes, deep venous thrombosis and pulmonary embolism as well as breast cancer.

The concern among gynecologists led to a rapid decrease in the prescription of Prempro by nearly 70%. This also led to a decrease in the quality of life by women going through menopause. Some gynecologists and endocrinologists continued to prescribe hormone replacement therapy.

Compound Pharmacies Filling the Gap

Bioidentical hormones made by any compounding pharmacies do not meet rigorous FDA standards. In fact, compounded forms of bio-identical hormones are similar to supplements, and have the same issues that supplement industries have had that we have outlined previously.

To quote from the FDA "Compounded drugs are not FDA-approved. This means that FDA does not verify the safety or effectiveness of compounded drugs. Consumers and health professionals rely on the drug approval process for verification of safety, effectiveness, and quality. Compounded drugs also lack an FDA finding of manufacturing quality before such drugs are marketed." - from June 29, 2022 (reference here)

Throughout this blog I will be speaking of compound bioidentical hormone therapies (cBHT). There are hormone replacement pharmaceuticals that have undergone testing for toxicity, safety, efficacy and have follow up programs with the FDA to look for long-term issues, those are not cBHT. Some of those pharmaceuticals   call their products bioidentical – those are different. Unless otherwise stated, please assume that the drugs made by the compounding pharmacies do not meet quality and purity of the FDA nor do they carry the warnings. In addition, they are provided often by clinics whose physicians are not board certified in gynecology or endocrinology.

In 2013, after a major breach in sterilization led to meningitis from spinal injections made from a compounded pharmacy, new guidelines were established for better manufacturing processes and control. This is the 503B of the Food and Drug and Cosmetic Act. Some compounding pharmacies have attempted to state these were an equivalent of FDA approved drugs, but as you can see from June of 2022 reference above, this is not the case.

There is more than safety standards (as addressed in 503A and 503B) when dealing with drugs. What is not covered by those standards are efficacy, safety, clinical utility and follow up reporting for adverse events.

Filling the Need for Menopausal Symptoms

The hesitancy of some gynecologists to prescribe menopausal hormone treatment to women entering menopause greatly increased the need for women who were suffering from symptoms of menopause. To fill that role came the mass marketing of compounded “bioidentical” hormones, derived from plants.

In 2004, Suzanne Somers published “The Sexy Years: Discover the Hormone Connection” featured on Oprah and becoming an immediate best seller. Other books written by physicians provided more fodder to the claim that these hormones were “better” than the “synthetic” hormones of “Big Pharma” and would allow women to return to their youth complete with increased libido, better skin, no vaginal dryness, and even weight loss (weight gain is a in fact common with hormone replacement even with the compounded doses ).

The rise of “bio-identical” hormones, was complete with the inference that because these were derived from compounds in plants that they were safer. The second bit of marketing was that the provider could could tailor the amounts of these hormones to the woman’s particular needs.

Marketing to the many women entering menopause were compounding pharmacies, which had associated with a number of “anti-aging” clinics, that had nearly been put out of business when the FDA cracked down on the cracks selling human growth hormone to people who didn’t need it. These providers with their attendant compound pharmacies were more than happy to get into the larger market of women entering menopause. Of note, many of the anti-aging clinics also sold compounded HCG for weight loss, which was also disproven to work (see here).

There is no data that exists to show that compounded bio-identical hormones are safer. These compounds cannot be obtained by simply eating yams or fenugreek seeds, but must be extracted and undergo chemical synthesis to become biologically active in humans. When shown the chemical processes that these plant derived sterols undergo, a number of their “proponents” are shocked. Chemistry is difficult for some.

As an aside, Diosgenin (DSG), the active plant chemical which undergoes synthesis to become an active steroid,  has its own interesting development as a sterol (found in Fenugreek seeds and wild yams) as anti-inflammatory, anti-atherogenic, and brain protective. While DSG has those interesting features, when it is chemically modified to an active estrogen like sterol those properties appear to be mostly lost.

There are other potential risks of hormone replacement include increased risk of weight gain, increased risk of blood clots, increased risk of stroke.

Men  - let's not forget the men

Male  hypogonadism is another diagnosis which is treated by cBHT, often with testosterone replacement. Found in those same "anti-aging" clinics, where men are bombarded with testosterone replacement in the form of cBHT. Male hypogonadism is, like menopause, a condition which may cause men to have lower free testosterone levels that can impact libedo. And much like the over-sell of women, men are often promised weight loss, increased libedo, return of hair growth all with cBHT.

Testosterone was the most frequently prepared compounded hormone by 503B outsourcing pharmacies. Progesterone and testosterone were the most commonly compounded as capsules and pellets

Individualized Therapy

Individualization comes with the provider taking a saliva sample to test for hormone levels. This adds to the allure of science. Saliva testing is NOT indicative of hormones levels in the blood, at the tissue or organ level. In fact, saliva testing is rather in exact and the amounts of hormones found in saliva vary...

The US Preventative Task Force updated their recent recommendations about vitamins and supplements in The Journal of the American Medical Association - reference here.

Their conclusion was: "Conclusions and Relevance Vitamin and mineral supplementation was associated with little or no benefit in preventing cancer, cardiovascular disease, and death, with the exception of a small benefit for cancer incidence with multivitamin use. Beta carotene was associated with an increased risk of lung cancer and other harmful outcomes in persons at high risk of lung cancer."

We have published about how misleading labels of supplements are before - click here.

The appeal of vitamins and supplements is the ability to extract the vital chemicals (like vital amines) antioxidants, and anti-inflammatory ingredients, place them into a pill so you can avoid having a healthy diet. Trust me, a healthy diet is clinically proven to work but it is a lot easier to eat a burger and pop a pill than to remember to eat some vegetables (I like Habit Burger).

[caption id="attachment_9745" align="aligncenter" width="640"]V Yes, I do love a good burger - Habit is my favorite[/caption]

But let's go back in history for a second and let you know that surgeons love vitamins. If you haven't listened to one of my favorite stories- listen to this about the first vitamin - click here. And let us not forget that the first evidence based study in the history showed that citrus fruits prevented scurvy - who was that person that showed that - was it a "nutritionist" or was it a surgeon? Oh yes, it was Dr. James Lind - a surgeon.

Why the appeal of vitamins, besides my fantasy about eating burgers and popping a pill?

First there is the "natural" fallacy - I don't know, I think natural is more eating fruits and vegetables than pills. People tend to think of vitamins as "good" or healthy, and they are. They seem to think of a vitamin as "natural" even though they were brought to us from the golden age of biochemistry. It is clear that the vitamin and supplement companies have taken advantage of that and use terms like "support gut health" or "support immune function" or "good for cardiovascular health, " - even if those statements are meaningless.

Second, it is easier to think of things we believe we understand. Heart disease and cancer are complex topics (not that the true chemistry of vitamins aren't but they seem easy). We want to make things easy - like take vitamins and supplements for prevention or cure of cancer or heart disease, because if we start talking about scary statins or chemotherapy not only are there real side-effects but bad press. Of course with vitamins and supplements there can be real side effects - check here. My aunt's son, a Ph.D. in nuclear physics, died after taking a supplement that was to help him be "fit."

But the simple truth is this: however the polychemistry there is in fruits, vegetables, legumes, whole grains, as well as balancing dairy, meats, fats and alcohol has proven effect - we call that the Mediterranean Diet (for more see here)

[caption id="attachment_9746" align="aligncenter" width="640"]i Instead of vitamins and supplements from a pill - eat this[/caption]

For whatever reason, eating a Mediterranean Diet or DASH diet continue to be the proven way to maintain your health.

References

1.

Mishra S, Stierman B, Gahche JJ, Potischman N. Dietary Supplement Use Among Adults: United States, 2017-2018. NCHS Data Brief. National Center for Health Statistics; 2021. doi:10.15620/cdc:101131

2.

North America dietary supplements market report, 2021-2028. Accessed May 26, 2022. https://www.grandviewresearch.com/industry-analysis/north-america-dietary-supplements-market

3.

Arnett DK, Blumenthal RS, Albert MA, et al 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140(11). doi:10.1161/CIR.0000000000000678Google ScholarCrossref

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Aune D, Giovannucci E, Boffetta P, et al. Fruit and vegetable intake and the risk of cardiovascular disease, total cancer and all-cause mortality-a systematic review and dose-response meta-analysis of prospective studies. Int J Epidemiol. 2017;46(3):1029-1056. doi:10.1093/ije/dyw319PubMedGoogle ScholarCrossref

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Bailey RL, Gahche JJ, Miller PE, Thomas PR, Dwyer JT. Why US adults use dietary supplements. JAMA Intern Med. 2013;173(5):355-361. doi:10.1001/jamainternmed.2013.2299

ArticlePubMedGoogle ScholarCrossref

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Alissa EM, Ferns GA. Dietary fruits and vegetables and cardiovascular diseases risk. Crit Rev Food Sci Nutr. 2017;57(9):1950-1962. doi:10.1080/10408398.2015.1040487PubMedGoogle ScholarCrossref

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Bibbins-Domingo K, Grossman DC, Curry SJ, et al; US Preventive Services Task Force. Folic acid supplementation for the prevention of neural tube defects: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(2):183-189. doi:10.1001/jama.2016.19438

ArticlePubMedGoogle ScholarCrossref

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American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Obstetrics. Anemia in pregnancy: ACOG Practice Bulletin, Number 233. Obstet Gynecol. 2021;138(2):e55-e64. doi:10.1097/AOG.0000000000004477PubMedGoogle ScholarCrossref

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US Preventive Services Task Force. Vitamin, mineral, and multivitamin supplementation to prevent cardiovascular disease and cancer: US Preventive Services Task Force recommendation statement. JAMA. Published June 21, 2022. doi:10.1001/jama.2022.8970

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O’Connor EA, Evans CV, Ivlev I, et al. Vitamin and mineral supplements for the primary prevention of cardiovascular disease and cancer: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. Published June 21, 2022. doi:10.1001/jama.2021.15650

ArticleGoogle Scholar

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Gestational hypertension and preeclampsia. Accessed May 26, 2022. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/06/gestational-hypertension-and-preeclampsia

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White CM. Dietary supplements pose real dangers to patients. Ann Pharmacother. 2020;54(8):815-819. doi:10.1177/1060028019900504PubMedGoogle ScholarCrossref

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Tarn DM, Karlamangla A, Coulter ID, et al. A cross-sectional study of provider and patient characteristics associated with outpatient disclosures of dietary supplement use. Patient Educ Couns. 2015;98(7):830-836. doi:10.1016/j.pec.2015.03.020PubMedGoogle ScholarCrossref

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Liss DT, Uchida T, Wilkes CL, Radakrishnan A, Linder JA. General health checks in adult primary care: a review. JAMA. 2021;325(22):2294-2306. doi:10.1001/jama.2021.6524

ArticlePubMedGoogle ScholarCrossref

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US Preventive Services Task Force. Accessed May 26, 2022. https://www.uspreventiveservicestaskforce.org/uspstf/

It turns out that the juice from beets may lower blood pressure in a sustained and lovely manner. Beets, you see, besides being a colorful vegetable, contain a high level of Nitrate (NO3-). And this is absorbed by the body and converted into nitric oxide. Nitric oxide is that amazing molecule that relaxes blood vessels and improves blood flow.

How Your Body Gets Nitric Oxide

The conversion of nitrate into nitrite, which is then converted into nitric oxide is a fun pathway.

When you eat your greens (yes even lettuce has nitrates) your intestines absorb it and then it is secreted back into saliva where those bacteria in your mouth digest the nitrate (NO3-) into nitrite (NO2-) <-- for you chemistry major nerds. It is that nitrite that is converted to nitric oxide in the body as it needs it - and often it needs it.

This particular study gave volunteers 250 ml of beet juice (what happens if you say that three times and fast?) - 34 of whom were on blood pressure medicine and 34 who were not (four people dropped out of the study).

These people were randomized to receive, daily, one cup (250 ml) of beetroot juice (same as beet juice) daily, or the placebo which was nitrate free beet juice. No one could tell the difference in taste. BMI was constant in both groups, about 25-26. They measured, besides blood pressure, nitrates.

What happened?

There was a large increase in NOX (nitrates and nitrites) and cGMP (the signaling molecule ) but more importantly there was a sustained and real drop in blood pressure by 7.7 mm of Hg which was NOT seen in the nitrate free beet juice.

The drop in systolic blood pressure was seen after the first week and the ultimate reduction of 8.1/3.6 Hg reduction was not altered by a change in heart rate.

Two weeks after stopping this regimen the blood pressure returned to normal.

Did you know that every increase of systolic blood pressure by 2 mm of Hg increases mortality of heart disease and stroke by about ten percent? This showed a reduction of 7.7 mm of Hg in systolic blood pressure.

Dietary Implications

Nitrates are not only found in beets, but also in many other vegetables. One of the clearest and classic papers for the use of the DASH diet showed that the adoption of this diet lead to blood pressure reduction in adults. While this diet was using salt as the major effector, it is clear that the increased use of vegetables with their high nitrate component is an additional determinant in nitrates and blood pressure reduction.

[caption id="attachment_9737" align="aligncenter" width="640"]

All vegetables, even the green ones have nitrates[/caption]

It may be that the increase in vegetable servings in the DASH diet may be a secondary and important factor for blood pressure reduction in both the DASH and Mediterranean Diets. For a review of the diet and hypertension click here.

But what is even more impressive is if we look back at people who have increasing vegetable intake with ultimate cardiovascular disease. The Danish report looked at this and concluded, " Moderate vegetable nitrate intake was associated with 12%, 15%, 17% and 26% lower risk of ischemic heart disease, heart failure, ischemic stroke and peripheral artery disease hospitalizations respectively." - see the reference below or click here.

This goes against the Carnivore diet where they state there is no need for vegetables. Showing that vegetables are needed and produce improved quality of life.

REFERENCES:

Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A. Dietary nitrate provides sustained blood pressure lowering in hypertensive patients: a randomized, phase 2, double-blind, placebo-controlled study. Hypertension. 2015 Feb;65(2):320-7. doi: 10.1161/HYPERTENSIONAHA.114.04675. Epub 2014 Nov 24. PMID: 25421976; PMCID: PMC4288952.

Bahadoran Z, Mirmiran P, Kabir A, Azizi F, Ghasemi A. The Nitrate-Independent Blood Pressure-Lowering Effect of Beetroot Juice: A Systematic Review and Meta-Analysis. Adv Nutr. 2017 Nov 15;8(6):830-838. doi: 10.3945/an.117.016717. Erratum in: Adv Nutr. 2018 May 1;9(3):274. PMID: 29141968; PMCID: PMC5683004.

Jakubcik EM, Rutherfurd-Markwick K, Chabert M, Wong M, Ali A. Pharmacokinetics of Nitrate and Nitrite Following Beetroot Juice Drink Consumption. Nutrients. 2021 Jan 20;13(2):281. doi: 10.3390/nu13020281. PMID: 33498220; PMCID: PMC7908977.

Filippou CD, Tsioufis CP, Thomopoulos CG, Mihas CC, Dimitriadis KS, Sotiropoulou LI, Chrysochoou CA, Nihoyannopoulos PI, Tousoulis DM. Dietary Approaches to Stop Hypertension (DASH) Diet and Blood Pressure Reduction in Adults with and without Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr. 2020 Sep 1;11(5):1150-1160. doi: 10.1093/advances/nmaa041. PMID: 32330233; PMCID: PMC7490167.

Bondonno CP, Dalgaard F, Blekkenhorst LC, Murray K, Lewis JR, Croft KD, Kyrø C, Torp-Pedersen C, Gislason G, Tjønneland A, Overvad K, Bondonno NP, Hodgson JM. Vegetable nitrate intake, blood pressure and incident cardiovascular disease: Danish Diet, Cancer, and Health Study. Eur J Epidemiol. 2021 Aug;36(8):813-825. doi: 10.1007/s10654-021-00747-3. Epub 2021 Apr 21. PMID: 33884541; PMCID: PMC8416839.

Common Collagen Claims (taken from actual websites selling collagen supplements):

• “improves skin elasticity,”
• “support bone and joint health,”
• “strengthen hair, skin, and nails,”
•  “may benefit the bodies cellular structure,”
• “support healthy skin, bone, and joints.”
• “will feed your skin health”
• “will improve nail appearance and strength”
• “lead to a noticeable hair thickness”

Collagen as a supplement is not regulated by the Drug division of The Food and Drug Administration

If you look at the bottom of the websites, or on the bottles, you will see a disclaimer that the claims “have not been evaluated by the U.S. Food and Drug Administration. ” More telling is “these products are not intended to treat, diagnose, cure, or prevent any disease.” Such a disclaimer is provided by the lawyers because if one claims to cure, treat, or diagnose an actual medical condition then it must have passed a rigorous FDA approval. To be clear, there have been no FDA studies that show collagen as a supplement treats any disease.

Supplements commonly will use “support xyz health” – where you can fill in the blank with hair, nails, joints, skin – in the case of collagen.

One of the main issues with supplements is “If the composition and quality of ingredients cannot be reliably ensured, the validity of research on dietary supplements is questionable. Moreover, the health of the US public is put at risk.”

Starr RR. Too little, too late: ineffective regulation of dietary supplements in the United States. Am J Public Health. 2015;105(3):478-485. doi:10.2105/AJPH.2014.302348

As such, even when you look at the studies which promote collagen, or collagen byproducts, they do not meet the most basic of studies which are done to evaluate pharmaceuticals. In order to have an evaluation of a pharmaceutical you must have three phases in the trial:

• phase one is determining the dose for safety. While the supplement industry is happy if you think all supplements are good and all pharmaceuticals are evil – everything, every drug, every chemical from water to salt to formaldehyde has a toxic dose
• phase two is to test the drug for efficacy and side effects. Some people will react poorly to a supplement just as they will a drug. WE need to know what those side effects are. With a supplement people who don’t feel well often just stop it – or, like my cousin, die (yes, I had a cousin who died from a supplement).
• phase three testing is to determine if there is truly efficacy, what is the effectiveness and what is the safety.
• phase four is post-marketing surveillance in the public because even though you have gone through trials with a number of phases and under strict supervision when a drug is released to the public you have the chance to see millions of reactions.

Thalidomide, for example, was released in Europe and even had two drug trials in the United States but was NEVER approved in the United States by the FDA because of insufficient data.

Vioxx was a drug used worldwide and was taken off the market in 2004 because of the risk of a fatal heart attack, but was taken off after it had passed multiple drug tests previously.

FDA testing is rigorous and specific, with the highest standards in the world. Collagen has NEVER had such rigorous testing performed. These tests have not risen to the level and in 2022 one report noted “More research is needed to establish knowledge of the effects and physiologic mechanism of collagen supplementation. Dermatologists should be aware of the unsubstantiated proclamations of collagen made by companies and in social media, as well as what evidence is established thus far, to be equipped to discuss collagen supplementation with patients.”

Rustad AM, Nickles MA, McKenney JE, Bilimoria SN, Lio PA. Myths and media in oral collagen supplementation for the skin, nails, and hair: A review. J Cosmet Dermatol. 2022 Feb;21(2):438-443. doi: 10.1111/jocd.14567. Epub 2021 Oct 25. PMID: 34694676.

One of the most quoted meta-analysis looked at 19 studies with 1125 participants – which is barely enough in any given study to make bold statements about safety, efficacy, toxicity, and side effects of hydrolyzed collagen supplementation.

de Miranda RB, Weimer P, Rossi RC. Effects of hydrolyzed collagen supplementation on skin aging: a systematic review and meta-analysis. Int J Dermatol. 2021 Dec;60(12):1449-1461. doi: 10.1111/ijd.15518. Epub 2021 Mar 20. PMID: 33742704.

So when someone states that study as the basis for use of the product, one has to have caution that there is not enough data, not enough rigorous data, and when studies do not include toxicity, this should be a major red flag.

Collagen is regulated by the Center for Food Safety and Applied Nutrition

Meaning, collagen, like most supplements, is regulated as a food, not as a drug. This is not the celebrated division that worked hard to get a COVID vaccine or anti-viral medications, this is the division that is responsible for food safety. This is the division of the FDA that is slow-moving, filled with bureaucracy, and has not even responded in a timely manner to any of the recent bacterial contaminations of our food. Take the spinach contamination, where people across ten states became ill, by the time the FDA came out with a recall the shelf life for that spinach was long overdue.

The same division tasked with reducing salt in our diets, but fears industry so much that no regulations have been put into place.

This is the same division that does not have leadership, budget, or inspectors to police our food supply.

The only time the FDA has become involved in any supplements is when a proven threat to the public has been discovered, or if someone complains that a claim made by the company alleges to “treat a disease.” Which is why collagen manufacturers make the claims above.

The undisputed science of collagen

Collagen is the main protein that forms the connective tissue of our body: skin, muscles, tendons, bones, blood vessels, even our heart valves. There have been 28 different types of collagen identified in humans, but over 90% of the collagen is called “Type 1.”  Type 1 collagen is a huge molecule with thousands of amino acids, and coded for by over 40 genes.  Two chains are formed from the translation and these polypeptide chains are assembled, cut, arranged, glycosylated, and packaged in different parts of a cell called a fibroblast and then transported out of the cell where it is further trimmed, combined with other molecules of collagen and begins to form and reform and cross-link with other collagen molecules.

Gauza-Włodarczyk M, Kubisz L, Włodarczyk D. Amino acid composition in determination of collagen origin and assessment of physical factors effects. Int J Biol Macromol. 2017 Nov;104(Pt A):987-991. doi: 10.1016/j.ijbiomac.2017.07.013. Epub 2017 Jul 4. PMID: 28687386.

Brodsky B, Persikov AV. Molecular structure of the collagen triple helix. Adv Protein Chem. 2005;70:301-39. doi: 10.1016/S0065-3233(05)70009-7. PMID: 15837519.

Hulmes DJ. Building collagen molecules, fibrils, and suprafibrillar structures. J Struct Biol. 2002 Jan-Feb;137(1-2):2-10. doi: 10.1006/jsbi.2002.4450. PMID: 12064927.

In order to form in an orderly manner and to be strong, it must link with other collagen molecules in an organized manner and needing the help of Vitamin C to do this. Without vitamin C, the collagen doesn’t have strength and everywhere you have collagen you will suffer. Scurvy, the old name for Vitamin C deficiency, leads to loss of teach, wounds that come open again, blood vessels that break under the skin.

Peterkofsky B. Ascorbate requirement for hydroxylation and secretion of procollagen: relationship to inhibition of collagen synthesis in scurvy. Am J Clin Nutr. 1991 Dec;54(6 Suppl):1135S-1140S. doi: 10.1093/ajcn/54.6.1135s. PMID: 1720597.

Orgel JP, Irving TC, Miller A, Wess TJ. Microfibrillar structure of type I collagen in situ. Proc Natl Acad Sci U S A. 2006 Jun 13;103(24):9001-5. doi: 10.1073/pnas.0502718103. Epub 2006 Jun 2. PMID: 16751282; PMCID: PMC1473175.

While collagen contains 19 amino acids, 17% of the amino acids are proline, and glycine is found usually in every third amino acid. Some of the amino acids are modified to others after the collagen has been formed, for example, hydroxyproline is derived from proline and hydroxylysine from lysine – and both of these require Vitamin C to assist in that modification.

What happens when you eat, drink, or otherwise consume collagen

Let’s say you eat some chicken skin that is rich in collagen, or you buy liquid collagen, or collagen peptides (short chains of amino acids bonded together).

The large molecule of collagen is broken down starting with the teeth, the enzymes in the mouth, the acid in the stomach as well as the enzymes in the stomach. Once these byproducts reach the small bowel they are further broken down by the pancreatic and bile from the liver into small chains of 2-3 amino acids.  The small bowel can transport simple amino acids, as well as dipeptides (two amino acids bonded together) or tri-peptides (three amino acids bonded together) into the portal circulation. Through the portal system, even some five peptide units have been found. These amino acids are not passively absorbed, but rather actively transported by membrane proteins found on the brush borders of the small intestine designed just to transport amino acids.

Kleinnijenhuis AJ, van Holthoon FL, Maathuis AJH, Vanhoecke B, Prawitt J, Wauquier F, Wittrant Y. Non-targeted and...