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Health & Fitness

Fork U with Dr. Terry Simpson

Terry Simpson

Fork U(niversity)
Not everything you put in your mouth is good for you.

There’s a lot of medical information thrown around out there. How are you to know what information you can trust, and what’s just plain old quackery? You can’t rely on your own “google fu”. You can’t count on quality medical advice from Facebook. You need a doctor in your corner.

On each episode of Your Doctor’s Orders, Dr. Terry Simpson will cut through the clutter and noise that always seems to follow the latest medical news. He has the unique perspective of a surgeon who has spent years doing molecular virology research and as a skeptic with academic credentials. He’ll help you develop the critical thinking skills so you can recognize evidence-based medicine, busting myths along the way.

The most common medical myths are often disguised as seemingly harmless “food as medicine”. By offering their own brand of medicine via foods, These hucksters are trying to practice medicine without a license. And though they’ll claim “nutrition is not taught in medical schools”, it turns out that’s a myth too. In fact, there’s an entire medical subspecialty called Culinary Medicine, and Dr. Simpson is certified as a Culinary Medicine Specialist.

Where today's nutritional advice is the realm of hucksters, Dr. Simpson is taking it back to the realm of science.

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  • 20 episodes
  • Updated Yesterday

Episodes20

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  • Yesterday · 12 min

    The Benevolent Bean: Civilization's Forgotten Protein

    For years, beans have suffered from an image problem. They've been called "the poor man's meat," joked about for causing gas, and often relegated to the side of the plate. Yet for thousands of years, beans, lentils, chickpeas, and peas—collectively known as pulses—were among the most important foods on Earth. If bread supplied the calories that built cities, beans supplied much of the protein that sustained them. Long before protein powders and high-protein snack bars, civilizations from Rome to India relied on pulses as an everyday source of nourishment. The Roman laborer's bowl of puls—a hearty porridge often enriched with legumes—was far more representative of daily life than the lavish banquets of emperors. Across the Mediterranean, dishes like pasta e fagioli reflected a simple truth: grains and legumes together formed a remarkably nutritious meal. Modern science has largely caught up with what history already knew. Beans are rich in protein, but they're also packed with dietary fiber, resistant starch, folate, magnesium, potassium, and a remarkable collection of plant compounds that support both heart and metabolic health. Their fiber nourishes the trillions of bacteria living in our colon, producing short-chain fatty acids that help maintain the health of the intestinal lining and may reduce inflammation throughout the body. Perhaps most remarkable is that cultures around the world independently discovered the same dietary pattern. Italy has beans and pasta. India has dal with flatbread. Latin America combines beans with rice or corn. The Middle East gave us hummus. These weren't accidents. They were elegant nutritional solutions developed centuries before anyone knew what an amino acid was. Beans also improve the soil they grow in. Through a partnership with nitrogen-fixing bacteria living on their roots, legumes enrich the earth for future crops. Few foods nourish both the people who eat them and the land that produces them. Today, beans are enjoying a well-deserved renaissance. Heritage producers such as Rancho Gordo have reminded us that beans have flavor, texture, and personality. They're no longer just pantry staples—they're ingredients worthy of the center of the plate. In this week's Fork U podcast, we'll explore how one humble family of plants helped build civilizations, why modern nutrition keeps rediscovering their value, and why the "poor man's meat" may actually be one of the richest foods in human history. Sometimes the greatest superfoods aren't new discoveries. Sometimes they've been quietly simmering in the pot all along.

  • July 30 · 12 min

    Olive Oil: One of the First Medicines

    Olive Oil: The Original Superfood Before electricity lit our homes, olive oil did. For thousands of years, olive oil was far more than something people poured over bread. It fueled lamps, preserved food, moisturized skin, and was used in religious ceremonies. Long before it became a staple of the Mediterranean diet, it helped build civilization. Today, we think of olive oil as healthy. The fascinating part is that people believed it was medicinal long before they understood cholesterol, inflammation, or blood pressure. Sometimes medicine begins with observation. The science simply catches up later. More Than Just Fat When people hear "olive oil," they often think of fat. That's true, but not all fats behave the same way. Olive oil is rich in monounsaturated fat, the primary fat found in the Mediterranean diet. Rather than worrying about the chemistry, it is more useful to think about what happens inside the body. The real benefit comes from what olive oil replaces. Instead of cooking with butter or shortening, people sauté vegetables with olive oil. Olive oil is better than creamy dressings, and it is part of a delicious vinaigrette. And my favorite is, instead of spreading butter on bread, dipping it in olive oil. Those small substitutions can add up over time. The Science Is Impressive One of the first studies to grab the attention of cardiologists came from Lyon, France. Researchers enrolled people who had already suffered a heart attack and asked one group to adopt a Mediterranean-style diet rich in olive oil. The results surprised almost everyone. Those following the Mediterranean diet had dramatically fewer second heart attacks than those eating their usual diet. It was one of the studies that helped transform olive oil from a traditional food into a modern medical recommendation. Since then, researchers have followed hundreds of thousands of people around the world. Again and again, the same pattern appears. People who regularly consume olive oil tend to have lower rates of heart disease, lower rates of type 2 diabetes, and even lower mortality. Even better, randomized clinical trials such as the PREDIMED study showed that people at high cardiovascular risk reduced their chances of major cardiovascular events by following a Mediterranean diet supplemented with extra-virgin olive oil. Why Does It Work? Scientists think olive oil helps in several ways. When olive oil replaces butter and other saturated fats, LDL cholesterol usually falls. The natural polyphenols found in extra-virgin olive oil also appear to reduce inflammation and help blood vessels relax by improving nitric oxide production. In addition, studies suggest olive oil improves insulin sensitivity and helps protect LDL cholesterol from becoming oxidized, an important step in the formation of artery plaque. No single mechanism explains everything. Instead, several small benefits appear to work together. That is often how nutrition works. Not All Olive Oils Are the Same If you ask people where the best olive oil comes from, be prepared for a lively discussion. Some prefer the buttery oils from Liguria in Italy. Others enjoy the peppery oils of Lebanon, Greece, or Spain. I have favorites from Arizona, where I lived for years, and from California, where I live now. California also has some of the highest purity standards for olive oil in the world. While olive oil fraud has occurred in some parts of the world, California producers have built a reputation for careful quality control. That gives me confidence in what I'm pouring into my pan. A Small Change Worth Making Nutrition rarely comes down to one magical food. Instead, it comes from making better choices more often. Adding olive oil to your kitchen is one of those simple changes that is easy to enjoy. It makes vegetables taste better, encourages home cooking, and replaces less healthy fats without making meals feel restrictive. Sometimes the healthiest habits are also the most delicious. Olive oil first transformed civilization by lighting the night. Today, it may help illuminate a healthier future—one meal at a time.

  • July 23 · 17 min

    Cheese - Transforming Milk into Delicious

    Cheese: Humanity's Greatest Delicious Accident What if one of the world's favorite foods happened by accident? That's probably how cheese began. Nobody knows exactly who made the first cheese. Maybe it was a shepherd carrying milk in a bag made from a sheep's stomach. The milk warmed in the sun, natural rennet in the stomach lining began to separate the curds from the whey, and suddenly milk had become something entirely different. Instead of throwing it away, someone tasted it. Transforming Cheese Cheese is another example of one of humanity's greatest skills: transforming food. We didn't simply discover food—we learned how to make it safer, preserve it longer, and often make it taste even better. Then, over thousands of years, every culture added its own touch. The English gave us Cheddar. The French perfected Brie and Roquefort. Italy created Parmigiano Reggiano. Greece gave us Feta. Norway even created brown cheese by slowly caramelizing whey into a sweet, nutty delight. Each cheese tells the story of the people who made it. Then there's the science. For years, cheese was criticized because it contains saturated fat. However, modern nutrition research has taught us that cheese is far more complicated than a single nutrient. Cheese contains protein, calcium, beneficial bacteria from fermentation, and a unique food structure that scientists now call the dairy matrix. Interestingly, studies have found that eating cheese is generally neutral—and in many cases modestly protective—when it comes to heart disease. One of my favorite ironies involves Parmesan. People often warn about MSG while happily grating Parmesan over their pasta. Yet Parmesan is naturally rich in free glutamate, the compound responsible for the delicious savory flavor we call umami. Nature discovered that trick long before chemistry gave it a name. Like bread, soup, and cooking itself, cheese reminds us that humans became successful because we learned to transform food instead of wasting it. The next time you enjoy a piece of good cheese, remember you're tasting one of humanity's oldest scientific experiments. This week on FORK U, we'll explore the fascinating history of cheese, how it shaped civilization, why it's healthier than many people think, and why your charcuterie board has a much longer history than Instagram. And on my Substack later this week, we'll dive even deeper into the science behind cheese, fermentation, heart health, the Mediterranean diet, and why nutrition is always more interesting than social media makes it seem.

  • July 16 · 16 min

    Bread Built Civilization

    For years, bread has been the villain of social media. Scroll for a few minutes, and you'll find someone telling you bread causes obesity, diabetes, inflammation, or that humans were never meant to eat it. History tells a different story. Bread didn't weaken civilization. Bread helped build it. From Grass to Greatness Imagine the first person who looked at wild grass and wondered whether those tiny seeds could become food. Nobody knows exactly how bread was invented. Maybe someone mixed crushed grain with water and left it in the sun. Maybe wild yeast landed in the mixture, and it began to bubble. Maybe someone cooked it on a hot rock beside a fire. Whatever happened, one thing is certain. Someone noticed something new and tried it again. That's how science often begins—with curiosity. Bread Changed Everything Once people learned how to make bread, life changed. Grain could be stored for months. Families no longer had to search for food every day. Villages grew into towns, and towns became cities. Soon, people could become bakers, builders, teachers, physicians, and merchants because someone else was growing wheat. Bread didn't just feed people. It helped create civilization. Bread Fed Empires The ancient Egyptians depended on bread. Grain storage helped feed the workers who built the pyramids. The Romans knew that keeping bread available helped keep peace in the city. Even today, archaeologists find bakeries and loaves of bread preserved in Pompeii. Later, during the Klondike Gold Rush, my grandfather carried a sourdough starter into Alaska. Thousands of prospectors did the same. That's why experienced miners became known as "Sourdoughs." Bread traveled wherever people went. Then Bread Changed Over time, bread changed. Factories made bread softer, whiter, and able to last longer on grocery store shelves. It became convenient, but much of what made bread special disappeared. Then, during the 1960s and 1970s, people began baking bread at home again. Books like The Tassajara Bread Book encouraged Americans to rediscover whole grains, sourdough, and fresh bread. Sometimes progress means remembering what we forgot. What Does the Science Say? Not all bread is the same. Whole-grain bread contains fiber, vitamins, minerals, and plant compounds that refined white bread often lacks. Study after study has found that people who eat more whole grains tend to have lower rates of heart disease, type 2 diabetes, obesity, and colorectal cancer. That's one reason whole grains remain an important part of the Mediterranean diet. The question isn't whether bread is healthy. The question is: Which bread? Keep It Simple One of the simplest meals is still one of the best. Take a slice of whole-grain bread, add good extra-virgin olive oil, and enjoy it with a bowl of soup or a Mediterranean meal. It doesn't need to be complicated. Some foods have survived for thousands of years for a reason. Bread is one of them. This week in my Substack, I dive much deeper into the history of bread, how it helped build civilization, why whole grains continue to be recommended by nutrition research, and why bread has become one of the most misunderstood foods on social media. You can read the full article on drsimpson.com, and if you're looking for Mediterranean recipes—including homemade bread, soups, and healthy meals—you'll find them at terrysimpson.com.

  • July 9 · 17 min

    Soup: The Mediterranean Diet in a Bowl

    Soup: The Mediterranean Diet in a Bowl Over the past few weeks, many of us have been looking at our refrigerators a little differently. News about Cyclospora, E. coli, and other foodborne outbreaks has made people nervous about fresh vegetables and herbs. At the same time, grocery stores are filled with expensive electrolyte drinks, protein broths, and wellness beverages promising to keep us healthy. However, there is a much simpler solution that has been around for thousands of years. Make soup. It may sound almost too simple, but soup remains one of the healthiest meals we can prepare. In fact, if someone asked me to build the perfect meal using what we know today about nutrition, I'd probably start with a pot of soup. Add onions, garlic, beans, tomatoes, leafy greens, herbs, perhaps a little chicken or fish, a drizzle of olive oil, and serve it with a slice of whole-grain sourdough. You've just created what I like to call the Mediterranean diet in a bowl. And to prove you can do that from any cuisine, my favorite soup is Dahl - and click here for the recipe. The First Food Safety More importantly, soup has always been much more than comfort food. Throughout history, people discovered that boiling food made it easier to digest and often safer to eat, even though they had no idea bacteria or parasites existed. Today, we know that proper cooking destroys organisms such as Cyclospora and many harmful bacteria, making soup not only delicious but also one of humanity's oldest food safety techniques. Furthermore, soup is one of the best ways to reduce food waste. We all have that refrigerator drawer that starts out as a crisper and eventually becomes what I call the "future soup drawer." A few carrots, some celery that's lost its crunch, half an onion, spinach that's beginning to wilt, or herbs that are no longer picture-perfect can all become tomorrow's lunch instead of tomorrow's compost. Rather than throwing them away, let them contribute their flavors to a pot of soup. Another reason I love soup is that it naturally brings together many of the foods we should be eating more often. Beans provide fiber and plant protein. Vegetables add vitamins, minerals, and phytochemicals. Herbs contribute remarkable flavors without relying on excess salt. A little olive oil adds healthy fats, while broth provides hydration along with naturally occurring electrolytes. Unlike many products marketed as "wellness foods," soup doesn't need fancy packaging or celebrity endorsements. It has been quietly doing its job for thousands of years. Better with Age - like me Then there's one final reason soup deserves a place in every kitchen. It gets better. Few foods improve overnight the way soup does. The flavors continue to develop, the broth becomes richer, and somehow the entire pot tastes more complete the next day. That's one reason soup has always been one of the original meal-prep foods. Long before social media was teaching us how to prepare lunches for the week, families simply made one large pot of soup and enjoyed it for several meals. Of course, every family develops its own favorites. In our house, taco soup is always a winner. It starts with onions, garlic, olive oil, canned beans, tomatoes, cumin, coriander, and chili spices before being finished with fresh lemon juice, avocado, and crushed whole-grain tortilla chips. It's hearty, inexpensive, packed with fiber, and it disappears quickly whenever I make it. Perhaps that's why every civilization eventually invented soup. It stretches ingredients, reduces waste, nourishes families, hydrates naturally, and transforms simple foods into something extraordinary. Sometimes the oldest ideas remain the smartest ones. This week on Fork U, we're diving into the remarkable history and science of soup, including why every civilization created its own version, why soup may be the Mediterranean diet in a bowl, why it often tastes better the next day, and even why a proper French consommé is one of the greatest achievements in culinary science. For the full story, listen to this week's episode of Fork U at drsimpson.com. And if you'd like some of my favorite soup recipes—including taco soup, Mediterranean-inspired soups, and other healthy meals—you'll find them at terrysimpson.com.

  • July 2 · 12 min

    How Cooking Made Us Human

    Fire didn't just change dinner. It changed us. If I asked you what made us human, you might say language. Or tools. Maybe agriculture. All of those changed our species, but I think one discovery came even earlier—and it may have been the most important of all. Fire. Not because it kept us warm. Not because it frightened predators. But because it cooked dinner. At first glance, that might seem like an odd claim. After all, cooking is something we do every day without much thought. However, when you look at the science and the history together, cooking becomes one of the most remarkable innovations in human evolution. More importantly, it changed far more than the taste of our food. For more in-depth discussion, go to my Substack channel at DrSimpson.com Cooking Changed the Food We Ate Before humans learned to control fire, food was difficult work. Raw meat is tough. Many roots are fibrous. Grains are nearly impossible to eat without processing, and many plants lock away their nutrients behind tough cell walls. Then everything changed. Cooking unfolds proteins, softens connective tissue, gelatinizes starches, and breaks down plant cell walls. As a result, our digestive system has less work to do, and we gain access to more of the calories and nutrients already present in the food. In other words, cooking didn't create nutrition. It unlocked it. Then Cooking Made Food Safer However, the story doesn't stop with nutrition. Long before anyone understood bacteria or parasites, early humans discovered something through observation. Food cooked over a fire made people sick less often. Today we know why. Heat destroys many harmful bacteria. It kills many parasites. It reduces the risk of foodborne illness. Consequently, cooking likely became one of humanity's earliest public health tools. Groups that regularly cooked their food would have lost fewer children to severe diarrheal disease, had healthier adults, and retained more of the calories they worked so hard to obtain. That is a tremendous evolutionary advantage. Flavor Matters More Than You Think There is another benefit that often gets overlooked. Cooking made food taste better. That may sound obvious, yet it is incredibly important. Humans don't simply eat because food contains nutrients. We eat because food is enjoyable. Cooking creates hundreds of new flavor compounds through browning reactions that simply don't occur in raw food. Think about the smell of fresh bread. Or grilled steak. Or roasted coffee. Those aromas are products of cooking. Likewise, a cooked potato bears little resemblance to a raw one. The texture changes. The flavor changes. Even the way our bodies digest the starch changes. Fire didn't just feed us. It invited us back for another meal. The Real Lesson from Evolution Unfortunately, some people oversimplify this fascinating story. They argue that because meat was important during human evolution, the ideal modern diet must consist almost entirely of meat. The science doesn't support that conclusion. Cooking improved meat. It also improved roots. Cooking made tubers tasty. Then cooking softened grains. And finally, it made legumes digestible The evolutionary advantage wasn't eating one perfect food. Instead, it was becoming adaptable enough to thrive on many foods by transforming them with fire. That is a much more interesting story—and one much better supported by the evidence. Why This Still Matters Today Even in modern kitchens, we continue using the same principles our ancestors discovered thousands of years ago. We cook food to improve digestibility. And we cook food to improve safety. We cook food because it tastes better. Most importantly, we gather around meals because cooking has always been about more than calories. It has always been about family, community, and sharing stories. Perhaps civilization didn't begin with the first city. Perhaps it began around the first campfire.

  • June 25 · 12 min

    The Bank of Muscle: Your Retirement Account Isn't Your 401(k)

    The Bank of Muscle: Why Your Real Retirement Account Isn't Your 401(k) I used to think retirement planning was all about money. Put enough away, let compound interest do its thing, and someday you'll enjoy the rewards. As I've gotten older, however, I've come to appreciate another form of savings that may be just as important. It's your muscle. Nobody reaches eighty-five and wishes they had less of it. Instead, people wish they could get out of a chair more easily. They wish they could carry groceries, travel, garden, and play with grandchildren. In other words, they wish they had more reserves. That's really what muscle buys us. Dad's First Retirement Account I was fortunate. My father lived nearly ninety-nine years old, and he didn't simply survive. He lived. At eighty-five, Dad was walking three and a half miles every day. That's remarkable. Many people half his age don't walk that much. He had survived several heart attacks over the years, but he had reserves. Looking back, I realize that making it to eighty-five is one thing. Reaching eighty-five healthy enough to begin the sprint into your nineties is something else entirely. Dad didn't do anything exotic. He wasn't biohacking. He wasn't chasing supplements. He wasn't optimizing every laboratory value. He walked. And my mother cooked. Their meals weren't complicated. They enjoyed meat, potatoes, vegetables, soups, and desserts. They enjoyed life together. In hindsight, Dad was making deposits into his Bank of Muscle every day without ever calling it that. Then Life Changed As my mother's dementia slowly progressed, things began to fall apart. Dad stopped walking, not because he wanted to, but because he didn't want to leave Mom alone. He worried she might wander. At the same time, Mom stopped cooking. Breakfast became something out at a diner. Lunch might be a sandwich. Dinner often became cereal. I watched them both lose weight. Then I got the phone call no child wants. "Dad's in the hospital. He fell and couldn't get up." The fall wasn't the problem. Falls happen. What concerned me was that Dad no longer had enough reserve. After a couple of weeks in rehabilitation, I convinced him to move into an assisted living center close to our house. He wasn't thrilled with the idea, but something remarkable happened. Once Mom entered memory care and Dad had regular meals again, he began to thrive. He complained constantly about the food while gaining seventeen pounds. But he made friends and was always talking to someone or another. I would drive by and see him talking to anyone, from former Supreme Court Justice Sandra Day O'Connor, who lived there, and had a crush on my dad. My dad was making sure his neighbor got the newspaper, and yet he continued to complain about the food. All while gaining 17 pounds the first year. Twice a week, I would take Dad to dinner, and we would split a steak. The waitresses had a standing joke. They would ask him whether he wanted the kale salad. Dad would smile and say, "I grew up in an orphanage in Alaska. We grew kale, but we fed it to the cows. I'll eat the cow." He charmed every waitress in town. Eventually, after Mom died, Dad moved back home to Oregon and lived independently again. Visiting Angels helped with meals and companionship, but he was back in his own house. Looking back, I learned two things. Food matters. Muscle matters. Frailty Is the Enemy We spend a lot of time talking about heart disease, cancer, cholesterol, and blood pressure. Those are important. However, frailty is another great enemy of aging. Frailty steals independence. One broken hip can change everything. A fall that would have been a nuisance at sixty can become life-changing at eighty-five. Muscle gives us reserve, and reserve allows us to recover. My father didn't avoid every setback. He survived them. That's what reserve does. Protein Helps, But It Isn't Magic The supplement industry would love us to believe that a powder is all we need. Unfortunately, muscles didn't get the memo. Protein matters, especially as we age. Most experts recommend older adults consume about 1.2 to 1.5 grams of protein per kilogram of body weight each day, spread throughout the day rather than eaten all at once at dinner. For many people, that means aiming for twenty-five to thirty grams of protein at each meal.¹ However, protein alone isn't enough. A large meta-analysis found that protein supplementation without resistance exercise had limited effects on strength and muscle mass. In contrast, combining protein with resistance exercise produced meaningful improvements.² In other words, muscles need both building blocks and a reason to keep existing. Exercise Doesn't Have To Be Fancy When people hear "resistance exercise," they often picture bodybuilders. That's not what the science requires. Walking hills counts. Gardening counts. Resistance bands count. Swimming counts. Carrying groceries counts. Yoga counts. For me, yoga became the answer. I'm not a gym person. Exercise isn't my hobby. I don't wake up every morning excited to work out. I do yoga because I know future Terry will appreciate it. I'm not training for the Olympics. I'm training for my eighties. Real Food Still Works Whey protein is probably the most studied supplement because it's rich in leucine, an amino acid that helps stimulate muscle protein synthesis. As we age, muscles become less sensitive to that signal, which is why getting enough leucine becomes increasingly important.¹ Fortunately, you don't need expensive powders. Eggs, fish, dairy products, soy, beans, chicken, and meat all provide excellent protein. Personally, whey protein and I are not close friends. I've had lactose intolerance for years, and the slower gut that comes with GLP-1 therapy has made me even less tolerant of many whey products. Add stevia, sugar alcohols, and various flavorings, and my intestines politely object. Instead, I use egg protein or plant proteins. I avoid stevia because it tastes like electrical tape to me, and I don't need a chemistry experiment in a shaker bottle. Still, I recognize supplements have a role. If you're on a GLP-1 medication and eating less, or if you're simply busy, a protein shake or bar can be a useful tool. They aren't magic. They're convenient. A Father's Wisdom After Mom died, Dad came to live with me in California. By then, I had discovered yoga. Dad teased me about it at first. Then one day, he looked at me and said something I've never forgotten. "I think you doing yoga is great. You're the right age. Doing this now is important. If yoga is what you like, buy all the spandex you want and keep doing it." Those words stayed with me. You're the right age. Doing this now is important. If you're lucky, your parents give you wisdom throughout your life. When you're young, you roll your eyes. Later, you realize those words become part of who you are. Money gets spent. Wisdom gets carried. Dad wasn't telling me to do yoga. He was telling me to keep moving. Make Deposits Every age has different priorities. At twenty-five, you may be building a career. At forty-five, you may be raising children. At sixty-five, you may be protecting your muscle. At eighty-five, you may simply want enough reserve to get out of a chair and go to dinner with your family. The body doesn't really care whether those deposits come from yoga, barbells, swimming, pickleball, or walking. It only cares that you keep making deposits. Because someday you'll need to make a withdrawal. Life guarantees that. When that day comes, you'll be grateful for every walk, every stretch, every protein-rich meal, and every little thing you did, not because you loved doing them, but because they built reserve. Healthy aging isn't about dying young as slowly as possible. It's about building enough reserve so that when life knocks you down, you still have enough strength to get back up. And that may be the most important retirement account you'll ever own. References Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14(8):542-559. Liao CD, Tsauo JY, Wu YT, et al. Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: a meta-analysis. American Journal of Clinical Nutrition. 2017;106(4):1078-1091. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 2019;48(1):16-31.

  • June 19 · 13 min

    Did the Food Pyramid Make America Fat?

    If you read some low-carb sites, or Gary Taub's books, you will find the contention that the food pyramid - the last one being in 2011 - put America into a low fat, high carb diet responsible for today's obesity. That the government food pyramid misled a generation of people, and because we faithfully follow it, we became fat. The problem is, that isn't the case, but I want to go back in time and see why we have those government issued guidelines, and see where we are today. Dietary Recommendations The first major food guide appeared in 1943. It wasn't even a pyramid. It was called the Basic Seven. Created to prevent malnutrition and maintain stamina during World War II, it categorized foods into seven groups and served as the precursor to the modern food pyramid: 1: Green and Yellow Vegetables (e.g. leafy greens, green beans, carrots). 2: Oranges, Tomatoes, Grapefruit (or other raw greens high in Vitamin C). 3: Potatoes and Other Vegetables/Fruits (e.g., apples, potatoes, beets). 4: Milk and Milk Products (e.g. fluid milk, evaporated milk, cheese). 5: Meat, Poultry, Fish, or Eggs (as well as plant-based proteins like dried beans and nuts). 6: Bread, Flour, and Cereals (focusing on whole grain or enriched varieties). 7: Butter and Fortified Margarine (specifically noted to provide necessary calories and Vitamin A during rationing). The Basic Four These came out in 1956 to help a growing America. doctors worried about malnutrition and vitamin deficiencies. Diseases such as pellagra, rickets, and scurvy were still being treated. A breakdown of the 4 food groups and how they currently fit into a balanced, healthy routine: 1. Fruits & Vegetables 🥦Focus: Whole forms (fresh, frozen, or canned without added sugars).Benefits: Packed with essential vitamins, minerals, and dietary fiber.Goal: Aim to make half your plate fruits and vegetables at meal times. 2. Grains 🌾Focus: Whole grains (oats, brown rice, whole-wheat bread).Benefits: Provides vital carbohydrates and fiber for sustained energy.Goal: Make at least half your daily grains "whole" to get the most nutritional value. 3. Protein 🥩Focus: Lean proteins like poultry, fish, eggs, legumes (beans/peas), nuts, and seeds.Benefits: Builds muscle mass, repairs tissues, and keeps you full.Goal: Include a portion of protein with every meal to keep metabolism regulated. 4. Dairy 🥛Focus: Milk, yogurt, and cheeses (or calcium-fortified plant alternatives).Benefits: Crucial source of calcium and vitamin D for strong bones and teeth.Goal: Opt for low-fat or unsweetened varieties whenever possible to limit excess sugar 1979 What to Avoid Directly after the Basic Four, the USDA introduced the Hassle-Free Daily Food Guide (1979). The Hassle-Free Daily Food Guide (1979–1984) What changed: It kept the core Basic Four, but added a fifth group: Fats, Sweets, and Alcohol. Purpose: This was the first time a group was explicitly highlighted for the public to consume only in moderation. The transition away from the Basic Four marked a major shift in government policy: instead of just telling Americans to eat enough nutrients to avoid deficiencies, the focus changed to preventing chronic illnesses by telling people what to limit. The Food Guide Pyramid (1992–2005) The first guide to feature highly specific daily serving sizes across six distinct categories. Grains formed the massive base (6–11 servings), followed by fruits and vegetables, then dairy and meat, with fats/sweets resting at the tiny top peak. Fair Criticisms of the Food Pyramid None of this means the Food Pyramid was perfect. In fact, there are several reasonable criticisms. First, the pyramid did not do a great job distinguishing between whole grains and refined grains. A bowl of steel-cut oats is different from a sugary breakfast cereal, but both could look similar on a simple graphic. Likewise, the pyramid often treated fats as a single category when we now know that olive oil, nuts, and fish are different from trans fats and highly processed shortening. In addition, agriculture and food industry groups had influence over the process. That should not surprise anyone. Food policy has always involved scientists, government agencies, farmers, food manufacturers, and politicians. As a result, some recommendations reflected compromises rather than perfect science. That is a fair criticism, and it is one reason nutrition advice continues to evolve. However, we should also be honest about today's environment. While many criticize the influence of industry on older food guides, we now live in an age where nutrition advice often comes from influencers, supplement companies, podcasters, social media personalities, and people selling books, courses, or products. In other words, we have not eliminated outside influences. We have simply changed who those influences are. Therefore, the challenge today is the same as it has always been: separating evidence from marketing. Most importantly, the biggest problem facing Americans today is not that we are following an outdated Food Pyramid. Instead, it is that inexpensive, highly processed, calorie-dense foods surround us that require little preparation and are available everywhere. At the same time, portion sizes have increased, sugary beverages have become common, restaurant meals have grown larger, and fewer people cook regularly at home. As a result, we consume more calories than previous generations, while often moving less. The Real Reason We Became Heavier The Food Pyramid did not make America fat. That story is appealing because it is simple, but simple stories are not always true. The reality is that obesity developed while most Americans were not following the Food Pyramid at all. Instead, we were eating larger portions, drinking more calories, consuming more ultra-processed foods, dining out more often, and cooking less frequently. At the same time, our food environment changed dramatically. Food became cheaper, more convenient, and available nearly everywhere. Consequently, it became much easier to consume excess calories without even noticing it. The real lesson is not that one graphic ruined America's health. Rather, the lesson is that every generation faces new food challenges and tries to solve them with the best knowledge available at the time. Some recommendations age well, while others do not. Yet one message has remained remarkably consistent for decades: eat more fruits and vegetables, include beans and whole grains, enjoy fish and other healthy proteins, cook when you can, and share meals with people you care about. That advice may not fit neatly into a pyramid, but it has stood the test of time.

  • June 11 · 13 min

    The Scientists Who Built the Modern Snack

    How We Eat Most of us think we know what we eat. However, nutrition researchers have learned a frustrating lesson over the years: asking people what they ate yesterday is often less accurate than anyone would like. Although food diaries and surveys can provide useful information, memories are imperfect, snacks are easily forgotten, and portion sizes tend to grow smaller in retrospect. Consequently, some of the most important nutrition research takes place in a setting that is both expensive and surprisingly simple—a metabolic ward, where every meal is prepared, every serving is weighed, and every leftover bite is measured. That approach is exactly what researcher Kevin Hall and his colleagues used in a landmark study at the NIH. Participants were given two different diets, one based largely on ultra-processed foods and another built around minimally processed foods. Importantly, the volunteers could eat as much as they wanted. Nobody instructed them to count calories, restrict portions, or lose weight. Nevertheless, participants consumed about 500 more calories per day when eating the ultra-processed diet. The same people, living in the same environment, produced dramatically different results simply because the food changed. Obesity in the US and Ultra-Processed Foods As a result, the study raised an intriguing question. If ultra-processed foods can influence calorie intake to that degree, why isn't everyone obese? After all, ultra-processed foods make up a large portion of the modern food supply. Grocery stores are filled with them, convenience stores specialize in them, and many restaurants depend on them. Yet despite widespread exposure to the same food environment, some people seem relatively unaffected while others struggle with appetite, cravings, and weight gain. Prego and Vanishing Calories To understand how we arrived here, it helps to step back a few decades. During the latter half of the twentieth century, food companies increasingly turned to scientists, statisticians, and sensory researchers to understand consumer behavior. One of the most influential figures was Howard Moskowitz, a researcher who discovered that there was no single perfect food. Instead, he found that consumers tended to cluster into different preference groups. Some people preferred sweeter products, others wanted more texture, and still others favored stronger flavors. As a result, food manufacturers stopped searching for one ideal product and began creating multiple versions designed to appeal to different consumers. Meanwhile, another researcher, Steven Witherly, focused on a different question. Rather than asking what people preferred, he explored why certain foods were so rewarding. His work highlighted the importance of texture, aroma, crunch, temperature, and mouthfeel. In other words, food is not simply taste. Instead, it is a complex sensory experience involving multiple signals that influence how satisfying a meal feels. One of Witherly's most memorable concepts is known as vanishing caloric density. Certain foods, particularly puffed snacks, dissolve quickly in the mouth and create the sensation that they have almost disappeared. Although the calories remain, the physical experience of eating them can feel surprisingly brief. Consequently, these foods may be easier to consume in larger quantities before the body's normal satiety signals fully catch up. While that does not make such foods inherently bad, it does help explain why some snacks seem to empty themselves once the bag is opened. Ultra-Processed Foods and GLP-1 At the same time, the modern food environment has become remarkably effective at attracting attention. Food manufacturers optimize texture, flavor, aroma, and convenience, while consumers encounter those products virtually everywhere. Therefore, the challenge is not simply one of personal responsibility. Biology, environment, culture, sleep, stress, and genetics all influence how people respond to food. Some individuals appear naturally protected, whereas others experience stronger reward signals and greater susceptibility to cravings. Interestingly, the recent rise of GLP-1 medications has provided another perspective on appetite. Many patients describe a quieter relationship with food, noting that foods which once demanded attention suddenly seem less compelling. The food itself has not changed; rather, the brain's response to it has shifted. Consequently, these medications have highlighted something obesity researchers have suspected for years: appetite is not merely a matter of willpower. Instead, it reflects a complex interaction between biology and an increasingly sophisticated food environment. Ultimately, Kevin Hall's study gave us an important clue about what happens when people are exposed to different types of food. Howard Moskowitz showed how companies learned to identify consumer preferences, while Steven Witherly helped explain why certain foods are so appealing in the first place. Together, their work offers a fascinating glimpse into the science behind modern eating and raises a question that may be more interesting than why some people gain weight. Perhaps the real mystery is why some people seem largely unaffected by an environment that was designed to capture our attention. For a deeper discussion of food engineering, the bliss point, vanishing caloric density, and what this means for appetite in the era of GLP-1 medications, listen to this week's episode of Fork U.

  • June 4 · 12 min

    Taste Buds Everywhere: Your Body's Hidden Food Sensors

    Taste Isn't What You Think It Is Most people believe taste happens on the tongue. That idea seems obvious because food enters the mouth, the tongue recognizes flavors, and the brain decides whether something tastes good or bad. However, modern science has revealed a much more fascinating story. Taste receptors are scattered throughout the body, including the stomach, intestines, airways, pancreas, and even tissues associated with the nervous system. Consequently, what we call taste is actually part of a much larger surveillance system that helps us detect nutrients, toxins, microbes, and potential threats before they become serious problems. Before we explore those hidden taste receptors, though, we need to separate taste from smell. Most people use the words interchangeably, yet they are remarkably different systems. In fact, if you've ever had a bad cold, you've already experienced the difference firsthand. Why Expensive Wine Tastes Like Grape Juice With a Stuffy Nose Imagine spending a fortune on a bottle of Screaming Eagle wine. A sommelier describes notes of blackberry, cedar, tobacco, leather, and dark cherry while swirling the glass dramatically. Now pinch your nose shut and take a sip. Suddenly, those elegant descriptions become much harder to appreciate, and the wine starts tasting suspiciously like grape juice. The reason is simple. Your tongue detects only a handful of basic categories: sweet, salty, sour, bitter, and umami. Meanwhile, your nose identifies the thousands of aromatic compounds that make strawberries taste different from cherries or Cabernet different from Merlot. Therefore, much of what we casually call taste is actually smell working behind the scenes. Without smell, a wine tasting becomes a costly visit to a Welch's grape juice stand. This distinction matters because it helps explain why taste receptors throughout the body are not there for pleasure. Instead, they exist to gather information. Sweet Means Calories, and Your Body Pays Attention For most of human history, finding calories was difficult. As a result, sweet flavors became associated with survival. A ripe fruit, a handful of berries, or a cache of honey represented valuable energy in a world where starvation was a constant threat. Because of that evolutionary pressure, the body developed specialized receptors to detect sweetness and rapidly prepare for incoming fuel. The story becomes even more interesting once food reaches the intestine. Sweet receptors known as TAS1R receptors help stimulate the release of incretin hormones such as GLP-1 and GIP. Consequently, eating sugar creates a different physiologic response than receiving glucose through an IV. The tongue detects sweetness, the gut begins releasing hormones, the pancreas prepares insulin, and the brain activates reward pathways. In contrast, intravenous glucose raises blood sugar, but skips much of the sensory experience that evolution spent millions of years refining. Warm apple pie and an IV bag may deliver similar sugar molecules. Nevertheless, your body treats them as entirely different events. Umami: The Taste the Japanese Taught the World While sweet and bitter flavors are easy to recognize, umami remained poorly understood until Japanese scientists formally described it in the early twentieth century. The term refers to a savory, rich taste associated with glutamate and certain amino acids. Soy sauce, mushrooms, Parmesan cheese, tomatoes, broths, and many fermented foods owe much of their appeal to umami. From an evolutionary standpoint, umami serves an important purpose. Protein is essential for growth, repair, reproduction, and survival, so recognizing protein-rich foods provided a significant advantage. Consequently, the body evolved receptors specifically designed to detect those compounds. Modern scientists call them TAS1R1 and TAS1R3 receptors. Our ancestors simply recognized them as signs that dinner was likely worth pursuing. Growing up in Ketchikan, Alaska, I had a slightly different perspective on some of these foods. The first time somebody enthusiastically explained sushi to me, my immediate reaction was, "That's bait." Fortunately, the Japanese had grander plans for raw fish than I did. Why Children Hate Broccoli Parents often assume children reject vegetables because they are stubborn. Evolution suggests another explanation. Many toxic plant compounds are bitter, and bitterness frequently serves as nature's warning label. Therefore, children are generally more sensitive to bitter flavors than adults. Their bodies are essentially operating a heightened food safety program. As people age, repeated exposure teaches the brain that many bitter foods are safe and even beneficial. Coffee, tea, dark chocolate, kale, Brussels sprouts, and beer all require overcoming an instinctive caution signal. Adulthood, in many ways, involves learning which bitter things deserve a second chance. Moreover, many of those foods contain nutrients, fiber, and bioactive compounds associated with better health. This is one reason I smile whenever someone declares kale is poison. The statement may reveal more about the speaker's bitter receptors than about kale itself. Babies, Honey, and a Healthy Fear of Food Infants face a different challenge. During the first months of life, stomach acid production is lower than in adults. Consequently, babies are more vulnerable to certain organisms that older children and adults can handle without difficulty. This difference explains one of the most important feeding rules in pediatrics: do not give honey to infants under one year of age. Honey can contain spores of Clostridium botulinum. In adults, stomach acid and a mature intestinal environment generally prevent those spores from causing problems. However, infants lack many of those defenses. Therefore, infant botulism remains a genuine concern, despite honey's reputation as a natural food. Once again, evolution reminds us that caution often exists for a reason. The Stomach: Bouncer, Judge, and Executioner One of the most surprising discoveries in recent years is that the stomach contains bitter taste receptors known as TAS2Rs. These receptors do not evaluate flavor. Instead, they help assess what has arrived and determine how aggressive the digestive system should respond. When bitter compounds appear, gastric emptying may slow, giving stomach acid additional time to destroy microbes and process potentially hazardous material. I learned this lesson personally during a trip to Tijuana. Someone handed me a Clamato loaded with raw shellfish. At the time, it tasted wonderful. Several hours later, however, my stomach conducted a thorough review of the situation. The acid weighed in, the receptors filed their reports, and the immune system apparently demanded immediate action. The resulting decision was swift, unanimous, and memorable. Evolution does not care about dignity. Survival remains the only vote that counts. Your Sinuses Listen to Bacteria Perhaps the strangest discovery involves bitter receptors in the airways and sinuses. Researchers have found that certain receptors can detect chemical signals used by bacteria to communicate. In other words, cells lining your sinuses may effectively eavesdrop on microbial conversations before those microbes establish a significant foothold. Once those signals are detected, defensive mechanisms begin activating. Nitric oxide production increases, antimicrobial responses strengthen, and mucus clearance accelerates. Consequently, these receptors function less like taste buds and more like security personnel monitoring suspicious activity. The fact that a system originally associated with tasting food can also help defend against infection highlights how versatile these ancient sensors have become. The Real Story of Taste For generations, we assumed taste existed primarily for enjoyment. While pleasure certainly plays a role, the larger story is far more interesting. Taste receptors help identify calories, protein, toxins, bacteria, and environmental threats. Furthermore, many of these receptors appear to have evolved as general chemical sensors long before they became associated with dining. The next time you enjoy a slice of pie, a bowl of sushi, a glass of wine, or even a serving of broccoli, remember that your tongue is only one participant in the conversation. Your stomach is paying attention. Your intestines are paying attention. Even your sinuses may be paying attention. Long before nutrition labels, food influencers, and restaurant reviews existed, the body developed its own remarkably sophisticated system for deciding what was worth eating and what should be avoided. That's not just taste. That's survival.

  • May 28 · 17 min

    Diabetes, Weight Loss, Remission or Cure

    Type 2 Diabetes, Bariatric Surgery, Fasting, and GLP-1s: What We Finally Learned About a Disease We Thought We Understood For years, I watched something happen in bariatric surgery that made very little sense, according to the medical textbooks of the time. Patients with type 2 diabetes would undergo surgery, and within days, their blood sugars would improve dramatically. Some would leave needing far less insulin. Others would stop insulin entirely. Many of them would eventually remain off diabetes medications for years. Now here is the important part: They had not yet lost significant weight. That observation mattered enormously. Because if diabetes improvement were simply the result of fat disappearing from the body over time, then blood sugar should improve slowly over months as weight comes off. But that was not what we saw. Instead, patients barely eating — sipping broth and protein shakes while recovering from surgery — were suddenly metabolically different almost immediately. At the time, we knew it worked. What we did not fully understand was why. And honestly, that story tells you something important about medicine and science: sometimes clinical medicine notices the truth before biology fully explains it. For decades, type 2 diabetes was often taught in very mechanical terms. You gained weight. You became insulin-resistant. The pancreas worked harder and harder until it “burned out.” Then you needed insulin. That explanation was not entirely wrong. However, it was incomplete. Furthermore, it encouraged a kind of fatalism around type 2 diabetes, as though progression were inevitable and irreversible for everyone. Then, bariatric surgery complicated the narrative. Meanwhile, researchers like Professor Roy Taylor at Newcastle University began developing a much more dynamic understanding of what was actually happening inside the liver and pancreas. And suddenly, many of the strange things bariatric surgeons had observed for years started making sense. The Problem May Not Be Sugar Alone One of the most common mistakes in nutrition discourse is assuming that blood sugar itself is the disease. It is not. Blood sugar is often the visible signal of a much larger metabolic problem involving: the liver, the pancreas, adipose tissue, appetite signaling, inflammation, gut hormones, and the brain itself. Now, to be fair, refined carbohydrates and ultra-processed foods absolutely can worsen insulin resistance and glucose control. Sugary beverages, highly refined starches, and hyperpalatable processed foods create enormous metabolic stress for many people. However, reducing the entire disease of type 2 diabetes to “sugar is poison” oversimplifies what is actually a highly complex biological system. If carbohydrates alone caused diabetes, then traditional Mediterranean populations consuming beans, lentils, intact grains, and fruit would have universally developed severe metabolic disease. Yet many of those populations historically had some of the best cardiovascular and metabolic outcomes in the world. Similarly, bariatric surgery would not improve diabetes before substantial fat loss occurred. Something deeper was happening. Roy Taylor and the Twin Cycle Hypothesis Roy Taylor’s Twin Cycle Hypothesis is one of the most elegant modern explanations for type 2 diabetes. The theory proposes that type 2 diabetes develops through two interconnected metabolic cycles, involving excess fat accumulation in organs not designed to store large amounts of fat. First comes the liver. When caloric intake chronically exceeds what the body can safely store in adipose tissue, fat begins accumulating in the liver. Eventually, the liver becomes insulin-resistant. Now the liver starts misbehaving metabolically. Instead of calming down glucose production when insulin is present, the liver continues to release glucose into the bloodstream. At the same time, it exports excess triglycerides and fat particles into circulation. This creates a vicious cycle: more liver fat, more insulin resistance, higher insulin levels, more glucose production. Then comes the second cycle. Those excess fat particles eventually accumulate in the pancreas itself. And that is where the beta cells begin struggling. The Beta Cell Is Not Simply “Burned Out” For years, we talked about the pancreas as though it simply became exhausted. However, newer biology suggests something more complicated — and more hopeful. Beta cells produce insulin, which is a protein. Proteins must be folded properly inside the cell before they can be packaged and secreted. Under chronic metabolic stress — high glucose levels, elevated fatty acids, inflammation, oxidative stress — the protein-folding machinery inside the beta cell begins malfunctioning. Some insulin molecules become misfolded. Now imagine a factory assembly line where defective products begin to accumulate faster than workers can remove them. The system clogs. The beta cell experiences what is called endoplasmic reticulum stress, or ER stress. In simple terms, the protein-processing machinery becomes overloaded. At first, the cell adapts. It slows production. And the cell will activate repair systems. To clear damaged proteins. But if the stress continues long enough, the machinery begins failing. Some beta cells become dysfunctional. As a result, some become metabolically suppressed. They stop making insulin. Some dedifferentiate, meaning they stop functioning normally. And eventually some undergo apoptosis: programmed cell death. That distinction matters enormously. Because it suggests that not every beta cell is permanently destroyed early in the disease. Some are simply overwhelmed. Why Fasting Sometimes Works This may help explain why fasting improves type 2 diabetes in some patients. Fasting reduces metabolic demand. Less glucose enters the system. Less insulin is required. The liver produces less glucose. The pancreas experiences less pressure. In effect, fasting may temporarily reduce the metabolic traffic jam overwhelming the beta cells. Now, some people online treat fasting almost like a mystical cure for diabetes. I think that is an exaggeration. The body is not achieving enlightenment because somebody skipped breakfast. The likely benefit is much more practical: Reduced metabolic overload allows stressed systems to recover function. And clinically, we do see this. Some patients improve dramatically with fasting or aggressive caloric restriction. However, fasting is not universally successful because not all patients have the same remaining beta-cell reserve. Some patients have substantial recoverable function left. Others have experienced years of apoptosis and structural loss. That is one reason newly diagnosed patients often respond far better than patients with decades of poorly controlled diabetes. Duration matters. Furthermore, what happens after the fasting matters enormously. If someone fasts aggressively, but then returns immediately to hyper-palatable ultra-processed food, liquid calories, and chronic overnutrition, the same metabolic stress returns. Which brings us to an important point. The Real Goal Is Not Carb Elimination This is where I part ways somewhat with the more absolutist low-carb community. Low-carb diets help many patients reduce caloric intake and improve glucose control. That part is real. However, when you look at the broader evidence, the deeper lesson is probably not: “Carbohydrates are evil.” The deeper lesson is: eat less, eat better, and create a sustainable metabolic environment that the body can actually manage long term. And this is where Mediterranean-style dietary patterns continue to shine. Why the Mediterranean Diet Works So Well One of the strangest developments in modern nutrition culture is the fear surrounding whole grains and legumes. Beans somehow became suspicious. Oatmeal became controversial. Meanwhile, the modern industrial food environment quietly engineered ultra-processed calorie delivery systems powerful enough to overwhelm normal satiety pathways entirely. Perspective matters. After bariatric surgery, once patients had healed from the immediate postoperative phase, many naturally transitioned toward what was essentially a Mediterranean-style eating pattern. Not because it was trendy. Because clinically it worked. But because patients tolerated it well. Their weight stabilized more successfully. In addition, cardiovascular risk factors improved. And perhaps most importantly, they could sustain it. That last point matters more than anything else in nutrition. The Mediterranean diet works because it aligns well with human physiology: high fiber, intact foods, lower caloric density, reduced ultra-processed food burden, improved satiety, favorable effects on the microbiome, and long-term sustainability. Importantly, carbohydrates behave differently from rapidly absorbed refined starches and sugary beverages. Food structure matters Fiber matters. Satiety matters. Context matters. A bowl of lentils with olive oil, vegetables, and fish is metabolically different from ultra-processed food engineered to bypass normal fullness signaling. Whole grains are not the apocalypse. GLP-1 Drugs and Bariatric Surgery Are Teaching the Same Lesson GLP-1 medications work so well because they address biology directly. They: reduce appetite, slow gastric emptying, improve satiety, decrease caloric intake, lower liver fat, and reduce metabolic demand. In many ways, these medications reproduce medically some of the metabolic effects bariatric surgeons observed years ago. Importantly, they help patients sustain the physiologic state required for remission. And this is where the conversation about obesity often becomes deeply unfair. For decades, medicine and society moralized obesity, while underestimating how aggressive biology defends body weight. Hunger increases with weight loss. Energy expenditure decreases. Food reward intensifies. The environment constantly pushes hyperpalatable calories. This is not weakness. It is biology. Remission Is Still a Victory One of the more frustrating debates online revolves around the word “cure.” I understand why people want to use it. Remission sounds less dramatic. Less triumphant. However, remission is actually an extraordinarily hopeful concept. It means the disease process can improve substantially. But also, it means biology is more dynamic than we once believed. Finally, it means the pancreas retains recoverable function in many patients. But remission also recognizes reality: Some beta cells are permanently lost, Relapse can occur, weight regain matters, disease duration matters, and long-term susceptibility often remains. That is not pessimism. That is biological honesty. The real breakthrough here is not that type 2 diabetes was fake all along. The breakthrough is that we finally understand it as a far more dynamic, reversible, and biologically complex disease than we once believed. And perhaps the most important lesson of all is this: Bariatric surgery, fasting research, Mediterranean diets, and GLP-1 science are not actually telling completely different stories. They are all pointing toward the same underlying truth: The human body functions well when chronic metabolic overload is reduced long enough for normal signaling systems to recover. The tragedy of type 2 diabetes is not merely that millions have developed it. But that for decades, we blamed patients morally, while barely understanding the biology ourselves. Then, patients stopped eating after surgery, and their diabetes improved before the sutures had healed. Biology was trying to teach us something. Eventually, science listened.

  • May 21 · 15 min

    The Science of Hangovers: Why Most “Cures” Fail

    The Science of Hangovers: Why Your “Cure” Probably Doesn’t Work You wake up thirsty. Then, almost immediately, you realize your head hurts. Your stomach feels unstable. The room is too bright. Your mouth tastes like regret and old wine corks. Furthermore, your intestines suddenly decided today is the day they become extremely efficient. In other words, you have a hangover. Now, hopefully, this is not a regular occurrence. Nevertheless, most adults eventually experience one. The evening starts innocently enough: good friends, great conversation, maybe a cocktail before dinner. Then, however, another bottle arrives. Someone orders dessert drinks. Suddenly, what seemed like sophisticated socializing turns into next-morning negotiations with your nervous system. And that raises the obvious question: What actually causes a hangover? More importantly, why do so many supposed “cures” fail so spectacularly? First, Alcohol Is Not Just “Dehydration” Many people think a hangover is simply dehydration. Certainly, dehydration matters. Alcohol suppresses vasopressin, the hormone that helps your kidneys conserve water. As a result, you urinate more frequently. Consequently, you lose fluid and electrolytes. However, dehydration is only part of the story. In fact, hangovers are far more complicated. Alcohol irritates the stomach lining. Additionally, it disrupts blood sugar regulation. Furthermore, it interferes with inflammatory pathways, sleep architecture, hormone signaling, and neurotransmitters involved in mood and alertness. So while dehydration contributes to the misery, it does not fully explain why you feel like a Victorian ghost haunting your own apartment. Moreover, alcohol affects sleep in a particularly cruel way. It helps many people fall asleep quickly. However, it fragments restorative sleep later in the night. Therefore, you may technically be unconscious for eight hours while still waking up exhausted. You passed out. You did not recover. Then There’s Acetaldehyde — But It’s Not the Whole Story Social media wellness culture loves one word: Acetaldehyde. This is the toxic metabolite created when your liver breaks down alcohol. And yes, acetaldehyde contributes to flushing, nausea, headache, and inflammation. Nevertheless, modern marketing often exaggerates its role because it creates a simple story. “If acetaldehyde is bad, then a supplement that lowers acetaldehyde must solve hangovers.” Unfortunately, biology is rarely that convenient. Hangovers are not caused by one molecule acting alone. Instead, they are the result of multiple overlapping physiologic stresses happening simultaneously. In other words, there is no single “off switch.” And that is exactly where the supplement industry enters the picture. The Rise of the “Hangover Cure” Industry Over the last several years, social media has become flooded with products promising recovery, detoxification, or “support” for drinking. For example: Cheers Restore ZBiotics Myrkl H-PROOF DHM Detox Dose for Liver Furthermore, many of these products use similar language: “supports liver health,” “helps metabolize alcohol,” “promotes recovery,” or “supports detoxification.” Notice the wording carefully. Most companies avoid explicitly claiming to “cure” hangovers because proving that scientifically would require strong clinical evidence. And, unfortunately for marketing departments everywhere, that evidence largely does not exist. So Do These Products Work? The honest answer is: Probably not very well. Now, to be fair, some ingredients are biologically plausible. For instance, DHM — dihydromyricetin — has shown interesting effects in animal studies involving alcohol metabolism and GABA signaling. Likewise, some probiotics may influence acetaldehyde metabolism in the gut. Meanwhile, antioxidants and electrolytes may help support recovery in limited ways. However, plausible does not mean proven. That distinction matters enormously. Most studies on hangover products are: small, poorly standardized, company-funded, or focused on surrogate laboratory markers rather than meaningful real-world outcomes. Consequently, the evidence remains weak. And that is why most medical reviews conclude the same thing: there is no strong evidence that popular hangover cures reliably work as advertised. Meanwhile, IV Clinics Are Mostly Selling Expensive Salt Water Perhaps nothing captures modern wellness culture better than the rise of the “hangover IV.” Now, certainly, IV fluids can help with dehydration. Additionally, anti-nausea medications may temporarily improve symptoms. Nevertheless, many hangover IV clinics market themselves almost like detox spas. And that language becomes misleading very quickly. Your liver already detoxifies alcohol. In fact, that is literally its job. Moreover, your liver clears alcohol at a relatively fixed rate. Therefore, no vitamin infusion dramatically speeds the process. So while IV hydration may help some symptoms, it does not reverse toxicology. It is mostly expensive supportive care with mood lighting. What Actually Helps? Unfortunately, the most effective hangover treatments are also the least exciting. First, hydration genuinely matters. Water, electrolyte drinks, broth, and even fruit juice can help restore fluid balance and blood sugar. Second, bland foods often help settle the stomach. For example: toast, rice, crackers, eggs, or soup. Interestingly, pho may actually be one of the better hangover foods because it combines fluids, sodium, carbohydrates, and easy digestion. Third, sleep matters enormously. Alcohol damages sleep quality. Therefore, recovery sleep becomes critical afterward. Meanwhile, pain relievers should be used carefully. Ibuprofen or aspirin may help with headaches. However, they can worsen stomach irritation. And acetaminophen deserves special caution. Alcohol stresses liver metabolism. Acetaminophen also relies heavily on liver pathways. Consequently, combining large amounts of alcohol with Tylenol can become dangerous. Some Supplements May Help a Little Now this is where nuance matters. A few supplements do show modest signals in limited studies. For example: Prickly pear extract has shown some reduction in inflammatory hangover symptoms. Red ginseng has demonstrated modest improvement in some small trials. Siberian ginseng and combination antioxidant products have shown scattered positive findings. However, none of these products “cures” hangovers. Furthermore, the studies are small and inconsistent. Most importantly, they are not permission slips for binge drinking. The Part Nobody Likes Hearing Here is the uncomfortable reality. Even intermittent heavy drinking may have long-term consequences. Many people believe occasional binge drinking is harmless because they are still functioning professionally and socially. However, alcohol remains neurotoxic. Repeated episodes of heavy alcohol exposure are associated with changes in cognition, mood regulation, sleep quality, memory, and brain structure over time. And importantly, aging reduces the brain’s ability to compensate for injury. Therefore, the “weekend warrior” approach to alcohol may not be as biologically benign as people hope. Meanwhile, our culture often treats alcohol very differently from other health risks. People obsess over processed foods, seed oils, artificial dyes, or gluten. Yet somehow, repeated alcohol poisoning became normalized in adulthood with appetizers. That contradiction is worth thinking about. So What Is the Best Prevention? Unfortunately, prevention is boring. And yet boring works. Drink less. Drink slower. Eat before drinking. Alternate alcohol with water. Avoid “catch-up drinking.” Prioritize sleep afterward. And, additionally, lower-congener drinks like vodka or gin may produce fewer hangover symptoms than whiskey, bourbon, or brandy. Not because they are healthy. Simply because they contain fewer additional fermentation compounds. Final Thoughts Ultimately, the science of hangovers is less glamorous than the internet wants it to be. There is no miracle cure. There is no magical probiotic that allows unlimited tequila without consequences. There is no gummy that outperforms biology. Instead, a hangover is your body responding to inflammation, dehydration, toxic exposure, disrupted sleep, and metabolic stress. In other words, it is not a vitamin deficiency. It is a receipt. Outside Reading For a good evidence-based overview of hangovers and the limited science behind hangover remedies, see the review from the Cleveland Clinic on hangover cures and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) overview of hangovers.

  • May 14 · 12 min

    Why Food Became Engineered to Defeat You

    The “Real Food” Protein Bar There may be no phrase in modern nutrition more ridiculous than this: “Real food protein bar.” And yet, somehow, we are expected to nod seriously when someone says it. Recently, internet nutrition personality Paul Saladino introduced what he described as his best “real food” protein bar. While I have nothing personal against the man. I admire the confidence required to sell twelve protein bars for forty-four dollars while talking about ancestral living. Because let’s be honest for a moment. Protein bars are the modern candy bar. They simply come wrapped in better branding, cleaner fonts, and enough wellness language to make people feel virtuous while eating what is essentially an expensive Snickers bar with a podcast sponsorship. Now, before the internet declares me anti-protein-bar, let me clarify something immediately. I actually like Aloha bars. They’re expensive, but they say the right words to me. More importantly, they taste better than most compressed drywall products pretending to be nutritious. At the same time, real life exists, and sometimes convenience matters because airports happen, traffic happens, and long clinic days happen. Still, pretending industrial engineering somehow untouches these foods is a bit like pretending woodland elves handcrafted a Tesla. Breakfast Used to Be a Moral Lecture To understand how we got here, we need cereal, because cereal tells the entire story of modern food in one aisle. The first cereals in America were essentially granolas—dense grain mixtures that required chewing, preparation, and a bit of commitment. While nobody was exactly dreaming about them at night, they solved an important problem because they stored well, traveled well, and provided calories in an expanding industrial society. Then along came John Harvey Kellogg. Now, Kellogg was brilliant, strange, deeply moralistic, and profoundly suspicious of pleasure. He believed rich foods, spicy foods, meat, and almost anything enjoyable stimulated dangerous passions, and among those passions, he was particularly terrified of masturbation, which he viewed as one of the great threats to civilization. So his answer was blandness. Very blandness. Little sugar. Little excitement. Little stimulation. The original breakfast cereal movement was not designed around pleasure. Instead, it was designed around suppression. In many ways, those cereals were crunchy moral discipline. Then the Cereal Aisle Became Las Vegas Fast forward a hundred years, and the cereal aisle becomes the exact opposite of Kellogg’s vision. Sugar increases dramatically. Crunch becomes engineered. Colors explode across the box. Mascots arrive to recruit children before they can read. Eventually, breakfast stops being a health intervention and slowly transforms into dessert with vitamins sprinkled on top. And importantly, none of this happened because someone woke up wanting to destroy public health. That’s the part people often misunderstand. Food Engineering Solved Real Problems Before obesity became the dominant nutritional problem, the real challenge facing humanity was hunger. For most of history, people worried about: starvation food spoilage crop failures transportation and simple calorie availability Modern food engineering changed that reality. Shelf-stable foods mattered. Affordable calories mattered. Transportation mattered. Refrigeration mattered. And honestly, millions upon millions of lives have been improved because of those advances. It is very easy for people with stocked refrigerators and grocery delivery apps to romanticize the past, but the past involved a tremendous amount of malnutrition, uncertainty, and hunger. So modern food systems were not evil. They were revolutionary. The Problem Changed However, in solving one problem, we slowly created another. Because once calories became: cheap portable stable and endlessly available …the challenge was no longer finding enough food. The challenge became stopping. And this is where modern biology collides with the modern grocery aisle. Our brains evolved in environments where calorie-dense food was rare and valuable. Suddenly, within just a few generations, we found ourselves surrounded by foods engineered to be affordable, repeatable, and highly rewarding. That mismatch matters. Extrusion Changed Everything Most people have never heard the word extrusion, even though it may be one of the most important food technologies in modern life. The process is simple. Take starches, grains, or protein powders. Apply heat and pressure. Force them through machinery. Suddenly, you have: cereal crackers cheese puffs protein snacks breakfast bars And here is the important part: extrusion changes texture, and texture changes satiety. When food crunches perfectly, dissolves quickly, and slides down effortlessly, people consume more of it before fullness has time to register. That is not a conspiracy. It is simply biology interacting with engineering. The Grocery Store Became Natural Selection Food companies did not necessarily set out to create hyper-palatable foods. Instead, they followed what sold. And what sold was what people returned to again and again. So over time, the grocery aisle became a form of natural selection. Products survived because they triggered pleasure effectively. Foods that didn’t simply disappear. And I will confidently say something controversial: Reese's sells better than Brussels sprouts. I will die on that hill. Now, yes, Brussels sprouts can be delicious roasted with olive oil and balsamic, and somewhere at this exact moment, a chef in Brooklyn is shaving them raw onto handmade pottery while explaining their emotional complexity. Still, Reese’s triggers something primal. Sweetness. Fat. Salt. Texture. And your brain immediately says: “Yes. More of that.” Food Is Emotional Food is not just chemistry. Food is memory. It is also culture. What we eat is comfort. For some people, comfort food is a tamale. For others, it’s lefse. Meanwhile, many people find that comfort in peanut butter cups or a Dove Bar. The grocery aisle evolved around those emotional realities much faster than human biology evolved to manage them. And that matters, because modern eating is not simply about willpower. It is about environment. Cooking Changes the Experience Now compare all that to actual cooking. Not content-creator cooking. Real cooking. A stew simmering slowly. A roast chicken filling the kitchen with aroma. A tagine building layers of flavor from preserved lemon, apricots, and warm Moroccan spices. That kind of food slows you down. You smell it before you eat it. You notice texture. You experience layers of flavor. And interestingly enough, you often need less of it to feel satisfied. That is one of the great ironies of modern eating. As food became more engineered for efficiency, it often became less satisfying experientially. The Wellness Fantasy There is another uncomfortable reality that nobody on wellness Instagram likes to admit. In order to feed a hungry planet, we cannot all live on pasture-raised beef, farm-fresh eggs gathered from cheerful backyard chickens, and organic kale harvested by a local poet-farmer wearing linen. That is not a food system. That is a lifestyle catalog. The modern world has eight billion people. Food has to: travel survive droughts survive wars survive supply chain failures and feed cities that no longer produce their own calories Engineered foods are not going away. Nor should they. Yes, Even on Mars When human beings eventually colonize Mars, we are not putting cattle on the rocket ship. Nobody is building a space ranch outside Olympus Mons. Likewise, we are not stocking the moons of Jupiter with artisanal grass-fed herds wandering peacefully beneath methane clouds. Instead, we will use engineered foods and lab-grown proteins, because they will be: efficient reproducible resource-conscious and eventually taste just as good That future is not dystopian. It is practical. The Real Challenge Now The challenge facing us today is very different from the challenge facing humanity a century ago. We no longer live in a world where most people fear starvation. Instead, we live in a world where many people are simultaneously overfed and undernourished. Calories are abundant. Satiety is not. And that is where medications like GLP-1 are helping many people—including me—regain a sense of balance and reality in a food environment that our brains were never designed to navigate. Food Is Not the Enemy Food is not evil. Engineering is not automatically bad. Convenience matters, and sometimes a protein bar is perfectly fine. However, pretending that heavily processed convenience foods become “real food” because someone added collagen and an Instagram strategy does not help anyone understand the real issue. The goal is not perfection. The goal is awareness. We need food systems that: reduce malnutrition prevent shortages improve satiety and avoid creating environments where obesity becomes the default outcome of modern life Because feeding humanity was one of civilization’s greatest achievements. Now we simply have to figure out how to do it without overwhelming the biology that got us here in the first place.

  • May 7 · 11 min

    What I Eat on a GLP-1 And Why It Changes

    Let’s Start With What Nobody Tells You When people start a GLP-1, they are told what to avoid. What side effects to expect, and sometimes how much protein they should be eating. While that information has its place, it misses the part that actually changes your day-to-day life. Because what really shifts is not just how much you eat, but also how you experience it. At first, that change can feel subtle, almost easy to miss. Because nothing dramatic happens overnight. Although for me it did. In addition, over the course of a few days and weeks, you begin to notice that foods you used to reach for automatically no longer have the same pull, and simultaneously, foods you barely thought about before start to feel more interesting, more satisfying, and more worth your attention. So instead of asking what you should eat, a better question becomes what you actually want to eat. Because that answer starts to change. The Old Way: Eating Without Noticing Before this, eating was often fast, automatic, and driven by something that wasn’t quite hunger. Most meals were about filling up rather than tasting anything. Once the plate was in front of you, it didn’t take long for it to disappear. In many cases, food was less about enjoyment and more about reaching that point of fullness where the urge to eat finally quieted. Which meant convenience foods made sense, large portions felt normal, and finishing everything was exactly what you did. As a result, you weren’t really tasting food; you were processing it. And that difference matters more than people realize. Then the Shift Begins After starting a GLP-1, the signal changes. While it doesn’t happen the same way for everyone, it shows up quickly enough that you notice it in small ways. Because you slow down without trying, you pause between bites without thinking, and you stop earlier than you used to. That pause is important because it gives you a moment to notice what you’re eating. Once you notice, you start making choices that feel different from before, not because you are forcing yourself to be disciplined, but because your body is guiding you in a new way. Gradually, eating becomes less about quantity and experience, and that shift changes everything. Lunch: Where Real Life Happens For most people, lunch is not a carefully planned event, and that’s exactly why it’s a good place to see what actually works. On many days, I keep it simple because simple is reliable. A chicken breast heated up in the morning with a bit of hot sauce does the job without much effort. while a couple of apples and some grapes can carry me through the late morning and early afternoon without feeling like I need a full sit-down meal. Plus, if I am driving, eating slices of apples and grapes keeps me awake. At the same time, I don’t force structure onto it, because grazing a bit throughout the day often fits better than trying to recreate the old idea of a formal lunch, and that flexibility makes things easier rather than harder. On other days, I might grab a sandwich, and while it could be like a triple-decker club. The difference now is not what I order, but how much I eat, because stopping halfway feels natural instead of forced. Whatever is left has a way of disappearing quickly once my son gets home from school. Eating out follows the same pattern, because one or two tacos are usually enough. While fried foods sometimes feel heavier than they used to, grilled or ceviche-style options bring out flavor without that weight, making the experience better without trying to optimize anything. Simple Food Becomes Better Food At some point, you realize that simple foods start to feel more satisfying than they used to. And something like a good tuna, mixed with yogurt, lemon, and a bit of mustard, becomes a meal that you actually look forward to. Rather than something you eat because you think you should. Bread becomes optional, not forbidden, and sometimes a bowl or a few crackers is all you need, which removes the sense that meals must follow a certain format. Seasonal fruit fits into that pattern. Because when something tastes good, you eat it, and when it doesn’t, you move on, which is a different mindset from trying to force certain foods into your day. Even something as simple as peanut butter and jelly can feel satisfying again, because the experience of eating it has changed. Hydration Stops Being an Afterthought One thing that becomes more noticeable is how important drinking fluids actually is because when you eat less, you naturally take in less water from food, and that means you have to be more intentional about it. For me, iced tea works because it adds a bit of flavor without adding much else. Making it overnight in a pitcher means it’s ready when I need it, which turns hydration into a habit instead of something I forget about. That small shift makes a bigger difference than most people expect, because feeling off is often just a sign that you need to drink more. Dinner Becomes Something Different Dinner changes in a way that feels less structured and more creative. Because instead of trying to build a large meal, you start thinking about what would actually be enjoyable. Cooking becomes more interesting, not because you are trying harder, but because you have the space to pay attention. Dishes like salmon, pasta with a well-made sauce, or even something new from a meal kit can feel like something you are exploring rather than something you are consuming. At the same time, there is more room for variety, because you are not relying on volume to feel satisfied, and that allows you to try different things without needing to make them large. Still Paying Attention Matters Even with all these changes, I still track what I eat using Noom. Because awareness doesn’t go away just because the biology works differently. And that habit keeps things grounded without turning it into something rigid. Going out to eat is still part of life, and in many ways, it becomes more enjoyable because you can focus on what you like rather than how much you can eat, and sharing a meal or splitting something becomes a natural part of the experience. Dessert Tells You More Than You Think Dessert is where you can see the shift. Most of the time, I don’t think about it, and that alone is different, because it used to be automatic. Every now and then, especially when I’m getting close to my next dose, I’ll notice that I want something sweet, and I might have an ice cream bar, and that’s enough. That moment says more than any rule ever could. It shows the drive is lower, not gone, and that you can respond to it without being controlled by it. The Real Change What has changed is not complicated, but meaningful. I go for flavor instead of volume. Timing, now I take my time tasting instead of rushing. Choosing where and what to eat depends on whether it is worth it, not whether it is popular or convenient. Food is not the enemy. It never was. Some days, I am simply not interested in dinner, and if lunch was larger, I might just have a protein shake and move on, because eating is no longer something I have to do on a schedule. A Different Way of Eating This is not a diet. It is not a plan. It is not about perfection. Instead, it is about eating in a way that matches how your body now works, which means paying attention, making choices, and allowing yourself to enjoy food without relying on it for everything else. Before, I filled my mouth before thinking, and swallowing before experiencing. Now, I taste.

  • April 30 · 13 min

    GLP-1 The First Month: Tips for the new user

    It’s not a straight line. It’s not a diet. And it’s definitely not what you expect. I started my journey on a GLP-1 in October 2024. While my doctor did what good doctors do—he gave me the warnings, the precautions, the usual advice about what to avoid and watch for—I quickly realized something was missing. No one really told me what it would feel like. More importantly, no one explained that this first month doesn’t unfold in one neat, predictable way, but instead moves along several paths depending on the person, their biology, their habits, and frankly, a bit of luck. So, as I’ve watched friends, patients, and many people start this same journey, I’ve come to understand that the first month is less about weight loss, and far more about discovery, adjustment, and occasionally confusion. While people expect something simple, they get instead of variation, and that variation can make them think something is wrong when everything is going exactly as it should. The Myth of the Straight Line Most people begin this process believing they will take the medication, lose their appetite, and watch the scale steadily drop. While that story is appealing, it simply isn’t how the body works, because biology rarely follows a script, and in this case, the first month is more like learning a new language than following a plan. What becomes clear quickly is that people fall into different patterns. While none of these patterns are right or wrong, understanding which one you are in can make all the difference in how you interpret the experience. The Three Paths of the First Month Some people, myself included, are what we call hyper responders. Although we don’t fully understand why this happens, the effect can be dramatic. Within about twelve hours of my first dose, something shifted in a way I did not expect, as the constant chatter in my head about food—what we used to call head hunger—simply disappeared, and I didn’t even know it had been there until it was gone. During that first month, I lost twelve pounds, and while most of that was water and glycogen with some fat mixed in, the real change was not on the scale, but in my appetite. This dropped so noticeably that I found myself stretching out the time between doses. Interestingly enough, my obstructive sleep apnea improved, which was not something I had anticipated, but certainly appreciated. At the same time, my doctor had warned me to drink more fluids, and that advice was critical, because much of the water we normally get comes from food, and when food intake drops, hydration must be a conscious effort. So I adjusted by adding a protein shake in the morning and increasing my iced tea throughout the day, and that simple change made a meaningful difference in how I felt. You can find my recipes for protein shakes on the recipe section of my site, terrysimpson.com. The Normal Responders On the other hand, most people do not have that kind of immediate response, and instead they fall into what I would call the normal responder group, where the changes are subtle at first, and because they are subtle, they are easy to miss, which leads many to think the medication isn’t working, especially when they compare themselves to others who seem to be losing weight quickly. What they don’t notice, however, is that they are snacking less, leaving a bit of food on their plate, and skipping that second helping more often than before, and while these changes may seem small, they add up over time, because when someone tells me they only lost four pounds in a month, I translate that into nearly fifty pounds in a year, and suddenly the perspective shifts from disappointment to possibility, because that is a sustainable path. The Strugglers - they need help Then there is the third group, the strugglers, and these are the people who feel the effects right away but not in a pleasant way, because nausea, delayed gastric emptying, and an uncomfortable sense of fullness can make the experience feel miserable rather than helpful, and in these cases, intervention becomes important, since without adjustment, these individuals can run into real problems. What helps here is not complicated, but it does require attention, because smaller meals, avoiding fatty foods early on, focusing on liquids, and most importantly, never eating until full can turn things around, and more often than not, dehydration is the hidden issue, which is why something as simple as popsicles made from electrolyte solutions can provide both relief and hydration, and the key word for this group, more than anything else, is pacing. Food Noise and the Silence That Follows Before GLP-1 medications, we often described something called head hunger, which is that feeling of wanting food even when the body does not need it. The distinction between real hunger and head hunger is easier to understand than most people think. If you are truly hungry, something simple like a meatball will satisfy you, whereas if it is head hunger, you will find yourself reaching for cookies, candy, or snacks high in calories but low in nutrition. This is what we now call food noise, and for many people, it is constant, although they may not recognize it until it disappears, which is exactly what happens on a GLP-1, and that disappearance can feel both liberating and unfamiliar at the same time. I can always tell when mine starts to come back, and recently, I delayed my dose for a few days because I was celebrating my wife’s birthday, and the next day, before I resumed the medication, I found myself buying multiple boxes of ice cream bars, not because I needed them but because that voice had returned, quietly suggesting that I might want them, and once I took the dose again, that same voice faded, leaving me to wonder why I had bought them in the first place. That voice is persistent, not loud but steady, and it doesn’t shout like an alarm but instead calls like a siren from an old story, inviting you toward something you don’t need but think you want, and turning that down is one of the most profound changes this medication brings. What Changes Over the First Few Weeks As the first month unfolds, the early days are often inconsistent because appetite may vary from one day to the next, and while some meals feel normal, others feel different, and this unpredictability can make people uneasy, especially if they expect immediate stability. Gradually, however, things begin to settle, and by the third or fourth week, satiety arrives earlier, meals become smaller without effort, and foods that once felt irresistible lose some of their pull, not because they are forbidden but because they are no longer as compelling. At that point, behavior starts to align with biology, and instead of forcing discipline, people find themselves responding to signals that finally make sense. What Actually Helps in the First Month Success in the first month comes down to a few consistent themes, and while none of them are complicated, they are easy to overlook, because smaller meals tend to feel better, slower eating becomes natural, hydration proves essential, and real food often becomes more appealing, all while the pressure to eat disappears. In addition, forcing food when you are not hungry rarely ends well, and learning to stop earlier than you used to becomes one of the most important adjustments you can make. The Emotional Shift No One Talks About One of the most surprising aspects of this process is not physical but emotional, because when the constant thinking about food quiets down, there is a sense of relief, yet at the same time, there can be a feeling of disorientation, as if something familiar has gone missing. For many people, food fills more than just hunger because it fills time, emotion, and habit, and when that changes, there is space to be filled in new ways, which can feel uncomfortable at first but ultimately becomes an opportunity. A Different Way to Think About the First Month The first month on a GLP-1 is not about rapid weight loss, and it is not about perfection, and it certainly is not about willpower, because what it really represents is a shift in how the body communicates and how the mind responds. Instead of fighting hunger, you begin to understand it, and instead of chasing food, you begin to choose it, and in that process, something changes that goes far beyond the number on a scale. One Final Thought If you are considering this journey, it is worth finding a board-certified obesity specialist because they have the training and experience to guide you through these changes in a way that most physicians simply do not, and that guidance can make the difference between frustration and success. And as for that first month, it is less about what you lose and more about what you learn, because what you are really discovering is what it feels like to not be controlled by food for the first time in a very long time.

  • April 24 · 9 min

    Being a Foodie on a GLP-1

    Why GLP-1 Made Me Love Food More—Not Less From beetroot pasta to backyard salsa, this wasn’t about eating less. It was about finally tasting more. I want to tell you about two people on a GLP-1. First, there’s me. I’ve been on a maintenance dose—7.5 mg of Zepbound—for a while now. And recently, I went to an incredible Michelin-star restaurant. Now, at one point during that meal, I said something that surprised even me. The beetroot pasta was one of the best dishes I had ever tasted. Now, let’s pause there—because this matters. I don’t like beets. In fact, I’ve always said I hate beets. And yet, there I was, enjoying beetroot pasta. So what changed? Well, not my opinion of beets. But absolutely my appreciation of flavor. Then, Something Unexpected Happened During that same trip to Italy, I had one remarkable meal after another. For example, I ate at Ristorante Aroma, right next to the Colosseum. Then, I found a small, unforgettable place tucked away in Venice. Now, let me be clear—this is not a humble brag. Yes, the restaurants were fantastic. Yes, the trip was memorable. However, I’ve been to Europe before. And yet, this time was different. Because this time, I didn’t just eat the food. Instead, I tasted it. Moreover, I slowed down. In addition, I noticed the precision. And perhaps most importantly, I appreciated the flavors. Before, I think I liked good food. Now, I actually understand it. But Then There’s My Friend On the other hand, there’s my friend. He’s also on a GLP-1. In fact, he weighs a bit less than I do. However, he told me something that stopped me in my tracks. “I don’t enjoy food anymore.” Now, that’s not discipline. And it’s certainly not success. Instead, that’s anhedonia. In his case, the dose was too high. As a result, appetite didn’t just quiet down—it disappeared. Furthermore, dehydration crept in. And on top of that, nutrition slipped just a bit. Consequently, food wasn’t enjoyable anymore. It was just… there. So, we made a small adjustment. We lowered the dose. Now yes, that can feel frightening. Naturally, people worry: “If I lower it, I’ll gain the weight back.” However, that didn’t happen. Instead, what came back was enjoyment. And Then There’s the Protein Bar Problem Now, let’s shift gears—because this is where things get interesting. Every now and then, you need a snack. That’s normal. That’s life. However, when it comes to protein bars, I have to be honest. Most of them don’t taste like food. Instead, they taste like wet sawdust. Or, perhaps more accurately, dry particle board with a chocolate label slapped on it. Yes, they try. They add peanut butter flavor. They add cocoa. But still, the texture is off. The taste is off. And ultimately, your brain knows it. Now, to be fair, I do like some Aloha bars. They’re better than most. But even then… Recently, I skipped the bar. Instead, I had something entirely different: Tocino. A few bites. That’s all. And yet, those few bites delivered something protein bars rarely do: Flavor. Real flavor. Not engineered. Not simulated. Not “chocolate-adjacent.” Actual spices. Actual cooking. Actual food. And, frankly, it was fantastic. Meanwhile… the $32 Steak Snack Of course, I also tried one of those dried carnivore steak snacks. Thirty-two dollars. And honestly? Awful. Dry. Chewy. Completely joyless. At that point, you’re not eating—you’re making a statement to someone online. Instead, you’d be far better off flying to Spain and enjoying some Jamón Ibérico. Because then, at least, you get flavor. And culture. And an experience. Now, Let’s Talk About Breakfast Most mornings, I have a smoothie. And it works. Specifically, I use oat milk, protein powder—this week I’m trying Ora pea protein—along with cocoa, coffee, blueberries, and a bit of banana. It’s quick. It’s consistent. And importantly, it fits into life. Especially when you’re stuck in California traffic. In fact, traffic moves so slowly here that I didn’t even have to get out of the car to move a snail off the road—he made it across before I got there. So yes, smoothies make sense. However, When I’m Home… Things change. Now, there’s nothing wrong with a bowl of Cinnamon Chex. It’s fine. But often, I want something more. So instead, I make: Poached eggs A splash of Louisiana Hot Sauce Pico de gallo Fresh tortillas Beans And, of course, real salsa. Not the jarred kind. Instead, the kind that takes an afternoon to make. The kind that improves overnight. The kind your neighbor brings over—and yes, you briefly consider paying her to keep making it, before realizing that might get a little awkward. So What’s Going On Here? At this point, you might think this is about “good food” versus “bad food.” But it’s not. Instead, it’s about awareness. Because much of what we eat today comes from a system designed for convenience. For example, extrusion—the process that creates cereals, protein bars, and many snack foods—makes food: Shelf-stable Affordable Easy to eat And importantly, easy to overeat. Because when food requires no effort… You don’t stop. But Here’s the Key Point There is nothing wrong with food. Not with cereal. Not with protein bars. Not with convenience. However, GLP-1 changes something fundamental. It changes you. Specifically, it allows you—sometimes even forces you—to slow down. And because of that, you begin to: Notice flavor Take your time Actually enjoy what you eat Before, I was filling my mouth before thinking. And I was swallowing before experiencing. Now? I taste. And That Changes Everything Because now, I can enjoy: The precision of fine dining The bold flavors of the Philippines The chunky salsa from my neighbor’s kitchen And suddenly, eating less becomes… more. More experience. More appreciation. More enjoyment. One Last Thing There’s nothing wrong with Cinnamon Chex. But it’s not a morning habit anymore. Instead, it’s an every-now-and-then food. It’s interesting. But it’s not better. Because once you start tasting food the way it’s meant to be tasted… You don’t go back to eating it the way you used to.

  • April 16 · 10 min

    The Peptide Bazaar: Real Medicine vs. Vials from the Internet

    The word “peptide” is doing too much work Let’s start with the simplest truth. A peptide is just a chain of amino acids—like pearls on a necklace. That’s it. Nothing mystical. Nothing magical. However, structure matters. Sequence matters. Biology cares deeply about both. Because of that, some peptides are extraordinarily powerful. Others are biologically interesting. And a growing number are simply… marketed. That last category is where things get messy. Before the hype, there was a miracle Now rewind to a hospital ward in Toronto in the early 1920s. Children with diabetes were dying. Not slowly improving. Not plateauing. Dying. Then Frederick Banting and Charles Best walked in with something crude and experimental. Insulin. They injected it. The children woke up. Not metaphorically. Not in a graph. They woke up. Families watched death reverse in real time. That is what a peptide can do when it actually works. Then came the desert and the lizard Fast forward a few decades. Out in the Southwest—near where I started my first job as a bariatric surgeon in Phoenix—lives the Gila monster. Not exactly a creature you expect to change medicine. Yet inside its venom was a peptide that led, eventually, to drugs like: Semaglutide That discovery didn’t go straight to Instagram. Instead, it went through: receptor biology pharmacology clinical trials outcomes research And the results were real: lower blood sugar meaningful weight loss reduced cardiovascular risk So yes, peptides can be extraordinary. But only when the science is finished. And then we lost the plot Now, enter the modern peptide market. Suddenly, everything is a peptide. Everything promises: healing recovery fat loss anti-aging You’ve seen the names: BPC-157 TB-500 CJC-1295 Ipamorelin MOTS-c AOD-9604 Meanwhile, they are sold in places that should make you pause immediately. Gyms. Wellness clinics. Online “research chemical” shops. Rarely, if ever, through the same channels as actual medicine. BPC-157: the peptide that does everything… on paper Start with the most famous one. BPC-157 is marketed as a cure-all: tendon healing gut repair anti-inflammatory accelerated recovery The claims are sweeping. The confidence is impressive. But then you look at the evidence. Animal studies? Yes. Human randomized trials? No. Long-term safety? Also no. That gap matters. Because when something claims to stimulate healing broadly, it raises an uncomfortable question: What else might it stimulate? The answer, at this point, is simple. We don’t know. TB-500: recovery without receipts Next comes TB-500. It is sold as a recovery peptide. It promises faster healing and improved flexibility. The biology is plausible. The mechanism sounds reasonable. Yet human evidence for those claims is lacking. Even so, it thrives in: bodybuilding circles performance clinics online forums In other words, environments where anecdote travels faster than data. Hormone peptides: changing numbers vs. changing outcomes Now we get to the hormone crowd. CJC-1295 and Ipamorelin are sold as a stack. They stimulate growth hormone release. That part is real. What comes next is not. Because increasing a hormone level is not the same as improving health. We do not have strong evidence for: long-term outcomes safety over years meaningful clinical benefits Still, they are marketed as anti-aging therapies. That leap—from signal to certainty—is where the trouble begins. Melanotan II: the one that proves the rule Melanotan II is different. It actually does something. It increases pigmentation. It affects melanocortin receptors. And with that comes: nausea blood pressure changes mole darkening documented toxicity So here is the lesson. When a peptide truly works, you don’t get silence. You get side effects. The absence of side effects in marketing should never reassure you. It should make you suspicious. AOD-9604 and MOTS-c: the fantasy layer At the far end of the spectrum are peptides like AOD-9604 and MOTS-c. They promise: targeted fat loss exercise-like metabolic effects longevity The evidence? Mostly cells and animals. Yet they are already being sold, injected, and promoted. At this point, we are not even pretending to wait for human data. Where these actually come from Now let’s talk about the vial. Because this is where things shift from questionable to concerning. Many of these peptides are: manufactured overseas shipped in bulk repackaged relabeled They are often sold as: “research chemicals” “wellness therapies” Independent testing has found: incorrect dosing contamination inconsistent purity So when someone says they are taking a specific peptide, the real answer is uncertain. They hope they are. Why this is suddenly in the news Recently, Robert F. Kennedy Jr. has pushed to expand access to peptides restricted by the FDA. The argument is framed as freedom. The FDA’s concern is simpler: lack of safety data risk of contamination unknown long-term effects In other words, we do not yet know enough to call these safe. That is not obstruction. That is the job. GLP-1: the difference data makes Now compare all of that to GLP-1 drugs. They don’t just sound scientific. They are scientific. They: improve blood sugar reduce weight lower cardiovascular risk Most importantly, they do this consistently, predictably, and measurably. That is what happens when research goes the distance. The bottom line Peptides are not the problem. Peptides gave us insulin. Peptides gave us GLP-1. At their best, they are among the most elegant tools in medicine. But the current peptide market is not built on finished science. Instead, it is built on possibility, dressed up as certainty. And that difference matters. Because the gap between “interesting biology” and “safe, effective therapy” is where patients get hurt. Final thought The difference between a child waking up in a Toronto hospital… and a vial purchased online… is not the molecule. It is the evidence.

  • April 9 · 7 min

    Fat Shaming and GLP-1 - It's Biology

    The Chorus of “Just Eat Less” Spend a few minutes on social media, and you will hear it. On Bill Maher's podcast the other day, I heard it. Two people who know less about GLP-1 drugs than almost anyone, opining about how GLP-1s are horrific. Bill Maher says, “Just eat less.” Jillian Michaels warns that GLP-1 medications are dangerous. Did she even graduate from college? Meanwhile, a rotating cast of gym bros, coaches, and influencers insists that anyone using these medications is taking the easy way out. At first glance, these seem like different voices. A comedian, a fitness personality, a group of online trainers. However, they are all saying the same thing. If you are overweight, this is your fault. If you need help, you are weak. If you use medication, you are cheating. That message travels well. It is simple. It fits into a tweet. It sounds like common sense. Science shows us that fat shaming doesn't work (reference). It is also wrong. Who Is Doing the Shaming—and Why The fitness industry has something to lose here, and that part is easy to understand. Entire businesses are built on the idea that weight loss is a matter of discipline. Follow the plan, buy the program, track the macros, and success will follow. If it doesn’t, the explanation is built in. You didn’t try hard enough. However, the criticism does not stop there. When someone like Bill Maher reduces obesity to “just eat less,” it is not about selling a diet plan. Instead, it reflects something else entirely. A kind of cultural impatience with complexity. A belief that if a problem can be described simply, it must also be solved simply. And when that belief meets a condition like obesity, the result is dismissal. If I don’t struggle with this, then it must not be real. If you do struggle, then you must be doing something wrong. That is not analysis. That is a failure of imagination. The Problem with Simple Answers Medicine has a long history of being wrong in simple ways. We once believed ulcers were caused by stress alone. Then came Helicobacter pylori and antibiotic treatment. We once thought hypertension was simply a matter of salt intake and personality. Then we developed therapies that addressed the underlying physiology. Obesity has followed a similar path, except we have been slower to let go of the old explanation. “Eat less, move more” is not incorrect. It is incomplete. Because it ignores the system that determines how much you want to eat, how often you think about food, and how your body responds when you try to lose weight. The Part I Didn’t Admit For years, I saw the damage this thinking caused. I ran support groups for patients struggling with weight. I watched them come in carrying not just pounds, but shame. They believed they were weak, that they lacked discipline, that something about them was broken. We worked to change that. We talked about biology. About appetite regulation. About how the body defends weight. We tried to replace blame with understanding. And yet, I quietly held myself to a different standard. I didn’t blame my patients. I blamed myself. The Surgeon Who Thought He Could Outwork Biology If anyone should be able to power through something, it is a surgeon. That is the job. Endure long hours. Stay focused. Push through fatigue. Delay gratification. So I assumed I could do the same with weight. I tried diets. I cleaned things up. I ate vegetables, cut back on certain foods, and experimented with structure. And like many people, I saw results. At first. Weight loss is not the mystery. Weight maintenance is. Because over time, the same thing happened again and again. The body adapted. Hunger increased. Energy dipped. The system pushed back. And eventually, the weight returned. What the Data Shows (and Why It Matters) When you look beyond personal stories and examine long-term studies, the pattern becomes clear. In the Diabetes Prevention Program, participants lost weight early, then gradually regained some of it. In the Look AHEAD trial, an intensive lifestyle intervention produced initial success, but the gap narrowed over time. Observational data suggest that only a small percentage of people—often cited around 3 to 5 percent—maintain significant weight loss at five years. That number should change the conversation. Because it tells us this is not a widespread failure of discipline. It is a predictable outcome of a biological system. The Loop We Keep Ignoring Weight gain does not happen in isolation. It is part of a loop. Sleep worsens, which increases appetite. Movement becomes uncomfortable, so activity declines. Food becomes more rewarding, not less, because it offers relief. Then intake increases. Then the cycle repeats. And yet, into that loop, we continue to insert the same advice. Try harder. What Finally Changed For years, I thought I just needed to try harder myself. I was wrong. Today, I am down fifty pounds. Not because I discovered a better diet, but because something changed in the system itself. I started a GLP-1–based medication. The effect was immediate in ways I did not expect. My sleep improved. My snoring stopped. That alone changed my appetite and energy. Then something else happened. The noise went away. That constant pull toward food, the background awareness that shapes decisions throughout the day, quieted. From there, everything else followed. I began moving more. I returned to yoga, not out of obligation, but because it felt good. Because my body allowed it. This was not about replacing lifestyle. It was about finally being able to live it. What the Critics Miss When critics say this is the “easy way out,” they misunderstand what is happening. There was nothing easy about fighting biology for years. What these medications do is change the biology so that effort becomes effective. That is not cheating. That is treatment. The Future of Coaching (and Who Will Adapt) The fitness world is not going away. However, it is going to change. The coaches who succeed will not be the ones shaming people for using medication. Instead, they will be the ones who understand how to work with it. They will help people build muscle, improve movement, and develop sustainable eating patterns once appetite is regulated. Mediterranean and DASH-style diets still matter. They remain among the best-supported dietary patterns for long-term health. What changes is the ability to follow them. When the biology shifts, adherence becomes possible. Eating Without Fear One of the most striking changes is how food feels. You no longer need to treat eating as a constant negotiation. You can eat real food. Greek yogurt, eggs, vegetables, and fruit. You can enjoy it. You can eat a peach without worrying about whether you have broken a rule. That is what happens when the noise quiets. Where I Was Wrong—and What Comes Next For a long time, I believed that effort alone would solve this. I was wrong. Not because effort doesn’t matter, but because effort without the right biology is not enough. Science moves forward by showing us where we were incomplete. In this case, we were incomplete in how we understood obesity. Now we are beginning to correct that. And as we do, the conversation should change. Less blame. More understanding. Less shame. More treatment. Because this was never about character. It was always about biology.

  • April 2 · 6 min

    Menopause: Estrogen Effects Satiety

    Menopause, Hunger, and the Brain: Why It Feels Different Menopause changes more than temperature control. It reshapes how the brain handles hunger, fullness, and the quiet signals that guide eating. As a result, many women notice something unsettling. The same meals no longer satisfy. Hunger arrives sooner. Food feels louder. For years, we blamed metabolism. We told women their bodies were simply slowing down. While that explanation sounds scientific, it misses the most important part of the story. The brain has changed. A Pattern You Can’t Ignore During my years performing weight loss surgery, about 80 percent of my patients were women. Over time, one pattern became impossible to overlook. When menopause or even perimenopause began, weight gain often followed. Some women had struggled with weight for years. Others had never given it much thought. Yet both groups described the same shift. They weren’t necessarily eating more. Instead, they felt hungrier, less satisfied, and more aware of food throughout the day. Meanwhile, the advice they received rarely evolved. Eat less. Move more. Try harder. However, that advice assumes the system regulating hunger still works the same way. In menopause, it doesn’t. Estrogen and the Appetite Control Center To understand what’s happening, we need to look at the hypothalamus. This small but powerful region of the brain regulates appetite, energy balance, and hormonal signaling. Under normal conditions, estrogen helps keep this system stable. Specifically, estrogen supports satiety signals and keeps hunger signals in check. In simple terms, it helps your brain recognize when you’ve had enough. As estrogen declines, that balance shifts. Hunger signals grow stronger. Fullness signals become less reliable. Consequently, the internal experience of eating begins to change. This shift explains why women often say, “I feel different around food,” even before their diet changes. Why Hunger Changes First Interestingly, appetite changes often appear before measurable increases in calorie intake. Women report thinking about food more often, feeling less satisfied after meals, and noticing hunger earlier in the day. At first glance, nothing looks different from the outside. Yet internally, the system has already shifted. Because of that, traditional advice falls short. Telling someone to eat less without addressing the change in signaling is like adjusting the thermostat while ignoring the wiring. More Than Metabolism Although metabolism does change with age, it does not fully explain the experience of menopause-related hunger. A slower metabolic rate might affect how calories are used, but it doesn’t explain why appetite feels louder or less controlled. Instead, the better explanation lies in the brain. The hypothalamus responds differently when estrogen levels fall. As a result, the signals that guide eating become less precise. In other words, this isn’t just about calories in and calories out. It’s about how the body decides when to eat—and when to stop. The Part We Should Have Addressed Sooner For decades, menopause care focused on symptoms like hot flashes and bone health. Meanwhile, changes in appetite and weight were often attributed to lifestyle or willpower. Unfortunately, that approach overlooked a key fact. Estrogen plays a direct role in appetite regulation. Because of that, many women were told to push harder when their biology had already shifted. That message wasn’t just incomplete—it was unfair. Estrogen Replacement: A Broader Role When clinicians discuss estrogen replacement, they often focus on symptom relief. However, estrogen also affects brain signaling related to hunger and satiety. In the right patient, hormone therapy may help restore some of that balance. It can improve how the brain responds to fullness and reduce the intensity of hunger signals. Importantly, hormone therapy does not inherently cause weight gain. That belief has persisted longer than the evidence supports. Still, therapy isn’t for everyone. Each patient requires an individualized discussion that considers risks, benefits, and goals. A New Layer: GLP-1 and Appetite Control More recently, GLP-1 receptor agonists have added another dimension to this conversation. These medications act on the same appetite centers in the brain, strengthening satiety and quieting hunger. Interestingly, estrogen appears to enhance the effectiveness of GLP-1 signaling. Therefore, menopause may not only reduce estrogen levels—it may also decrease the brain’s responsiveness to satiety cues. This interaction helps explain why some women experience such a dramatic shift in appetite during midlife. What Actually Helps Once you understand the biology, the approach changes. Rather than focusing solely on restriction, the goal becomes supporting satiety. Meals should include enough protein, fiber, and volume to sustain fullness. Additionally, sleep deserves attention, as poor sleep amplifies hunger signals. Medication reviews also matter, since some drugs can contribute to weight gain. For some women, hormone therapy or GLP-1 medications may play a role. For others, dietary structure and lifestyle adjustments provide meaningful improvement. In every case, the strategy should match the physiology. A Better Way Forward Menopause is not a failure of discipline. It is a shift in how the brain regulates hunger. Once that shift is acknowledged, the conversation becomes more productive. Women can stop blaming themselves and start working with their biology. Ultimately, the goal isn’t to fight hunger. It’s to understand it. Final Thought Menopause doesn’t break the system—it changes the signal. And once you understand the signal, you can respond with clarity instead of frustration. Estrogen as a Key Regulator of Energy Homeostasis and Metabolic Health. Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2022. Mahboobifard F, Pourgholami MH, Jorjani M, et al.

  • March 26 · 11 min

    Henry VIII, the Brain, and the Obesity

    The Madness of King Henry VIII—and What We Got Wrong About Obesity The King We Forgot There is a moment in history that most of us think we understand. King Henry VIII—large, immobile, temperamental—has become almost a caricature of excess. We picture a man who simply ate too much, moved too little, and paid the price. It is a tidy story. Unfortunately, it is also likely the wrong one. Before the 1530s, Henry was something very different. He was athletic, charismatic, and energetic. He hunted, he jousted, he played sports, and he carried himself like the Renaissance ideal—educated, capable, and physically impressive. His armor, still preserved today, tells that story clearly. Narrow waist. Broad chest. Built for motion. The Fall That Changed Everything Then everything changes. In January of 1536, Henry was thrown from his horse during a jousting match. The horse fell on him. He was reportedly unconscious for hours. Not minutes—hours. Even by modern standards, that is a significant traumatic brain injury. Soon after, in May of that same year, Anne Boleyn was arrested and executed. She was accused not only of adultery but also of witchcraft. That detail matters. Prior to this period, Henry was not known for superstition. He was a rational thinker. Yet suddenly, accusations of witchcraft become part of the story. It is tempting to say this was political theater. It may have been. Still, the timing is difficult to ignore. Meanwhile, his body begins to change. The Story We Told Ourselves At first, historians explained this in simple terms. He ate more. He exercised less. Calories in, calories out. That explanation sounds neat. It fits what we like to believe. Even so, the math does not hold up. To gain over 200 pounds, you need a massive and sustained excess of calories. A reduction in physical activity alone does not explain that. We measure activity in METS—metabolic equivalents—and even a dramatic drop in activity would not account for that level of weight gain. In other words, you cannot outrun the math. Yet every January, gyms fill with people who are told exactly that. Move more. Try harder. Burn it off. By February, most of those gyms are empty again. If exercise alone solved obesity, we would not still have the problem. The Organ in Charge So what did we miss? The answer sits deep in the brain, in a small but powerful structure called the hypothalamus. It regulates hunger, satiety, hormones, and stress. When it works, eating feels normal. You get hungry, you eat, you stop. No drama. No constant thinking. However, when the hypothalamus is disrupted—by injury, disease, or chronic metabolic stress—that quiet system becomes loud. Hunger no longer behaves like a signal. It becomes a drive. This is not theory. Modern medicine has a name for it: acquired hypothalamic obesity. After traumatic brain injury, some patients develop rapid weight gain, persistent hunger, and changes in impulse control. Studies show that nearly half of patients with significant brain injury gain weight over time. The strongest predictor is not inactivity. It is hyperphagia—an abnormal increase in appetite. In simpler terms, the problem is not how much people move. It is what their brain is telling them to do. What Patients Taught Me That pattern feels familiar if you have ever sat with patients. I have. Years ago, working with former NFL players, we noticed something striking. The players who struggled most with weight often had long histories of concussions. Not all of them gained weight. Yet those who did described the same experience—something they had never felt before. Food noise. Not hunger. Noise. A constant suggestion that does not go away. At first, I understood that as a physician. Later, I understood it as a person. When the World Went Quiet About twelve hours after my first injection of Zepbound, something changed. The world became quiet. For the first time, I realized how much of my thinking had been shaped by that background noise. It did not disappear dramatically. It simply stopped. Since then, I have lost fifty pounds. More interesting than the weight loss is what happens between doses. As the medication wears off, the noise returns—subtly at first. A thought here. A reminder there. Even my stress levels rise slightly, something I can see on my WHOOP device. Then, a few hours after the next injection, it quiets again. That experience changes how you see patients. It changes how you see history. Looking Back at Henry Because now, when we look back at Henry, we are not just looking at excess. We are looking at a possible disruption of the system that regulates behavior itself. There are hints of this even in his own time. A French ambassador noted that Henry’s chronic leg pain troubled him often and that he compensated by eating and drinking more. Later reconstructions suggest large meals, heavy in meat, along with substantial alcohol intake. Those numbers are estimates, not precise measurements. Even so, the pattern is clear. Something was driving the behavior. Decline, Not Indulgence By the end of his life, Henry could barely move. Mechanical devices were needed to help him stand. He lost close allies, including Thomas Wolsey and Thomas More. His body deteriorated. His mood worsened. This was not simply indulgence. It was decline. What We Can Do Now Today, we have tools that speak directly to that system. GLP-1 medications do not give people discipline. They restore control. Patients do not say they are stronger. They say it is quieter. That distinction matters. Because obesity was never just about calories. It was about signaling and about biology. It was about a system that, once disrupted, can push behavior in ways that are very difficult to resist. The Real Lesson So when we look at Henry VIII, we should be careful before we judge him as a man who simply lacked restraint. We may not know exactly how much he ate. Nevertheless, we know something was driving it. And when we ignore that truth today, we do more than misunderstand the disease. We blame the patient for having it. References Argente J, Farooqi IS, Chowen JA, Kühnen P, López M, Morselli E, Gan HW, Spoudeas HA, Wabitsch M, Tena-Sempere M. Hypothalamic obesity: from basic mechanisms to clinical perspectives. Lancet Diabetes Endocrinol. 2025 Jan;13(1):57-68. doi: 10.1016/S2213-8587(24)00283-3. Epub 2024 Nov 12. Erratum in: Lancet Diabetes Endocrinol. 2025 Jan;13(1):e1. doi: 10.1016/S2213-8587(24)00368-1. PMID: 39547253.