Are Vegetables BS?

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

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

Toxins in Vegetables

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

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

List of the "Toxins"

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

What the literature says

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

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

Who to believe?

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

Fiber as an essential nutrient

Fiber

The most abundant solid ingredient in breast milk is a fiber. That fiber is human milk...

Inflammation and the Mediterranean Diet

The Mediterranean Diet is the most anti-inflammatory diet studied.

The inflammatory response is the body's mechanism to fight infection, repair itself and rid itself of cancer.  Inflammation is a coordinated response to trauma, infection, and cancer. Without inflammation, we would be dead within twenty-four hours.

Too little or too much

Too much inflammation results in wanton destruction of tissues, pain, fevers, and misery. It is associated with heart disease, cancer, aging. It is that delicate balance of inflammation we need.

Does diet play a role with inflammation? The answer is "sort of."

Short Course about Inflammation

Inflammation is involved in:

• Wound healing, removing dead cells - breaking them down into components so they can be recycled
• Removing and destroying bacteria
• Inactivating and eliminating viruses
• Destroying cells that have changed into cancer cells
• Repairing injury from infection
• Destroying parasites
• Removes toxic chemicals
• The immune system is one branch of the inflammatory response.

Five Signs of Inflammation

The five signs of acute inflammation and their Latin names:

• Redness - in Latin this is called rubor.
• Swelling - in Latin this is called tumor.
• Fever - in Latin this is called calor
• Pain - in Latin this is called dolor
• Secretion - in Latin this is called fluor

Medical school teaches inflammation as one of the first series of lectures.

Simple Inflammation

Your finger was hit with a hammer. You have an injury to your finger. Some cells are injured. The cells send a distress signal, and immediately white blood cells begin to swarm into the area to help the injured cells.  All that extra blood flowing to the area will lead to redness (rubor) and swelling (tumor). Soon, the finger will feel a bit hot (calor) and will have pain (dolor).

Some cells are so badly injured that they are no longer viable. Your inflammatory reaction breaks down these cells, removes the debris, and recycles the parts to create new tissue in the area.

Unwanted Inflammation

I love nature walks but like to avoid Poison Ivy.

Sometimes, we want to decrease the immune response. Inflammation is the response of our skin to poison ivy.  We reduce the immune response by reducing hives and itching.

Rheumatoid arthritis is another example of unwanted inflammation.  Rheumatoid arthritis is an auto-immune disease.  The resulting inflammation leads to pain, fever, and joint destruction. The aim of the treatment is to reduce the inflammatory response that saves joints and improves well-being.

The inflammatory response of COVID, influenza, or the common cold is reduced by the use of non-steroidal anti-inflammatory drugs, such as aspirin or Motrin.

Acute Disease and Inflammation

Heart disease is partially the result of inflammation. When you have a heart attack, the coronary arteries are blocked. As a result, a part of your heart muscle is without oxygen. The cells send out inflammatory signals, and you begin to feel pain (dolor). If the blood flow is restored, your cells can heal, but if it takes too long, some of those cells will die. Then your body will get rid of those dead cells and replace them with scar tissue. The result is that your heart becomes less effective.

Cardiovascular disease and inflammation

Plaque formation in the arteries is the result of genetics,

In Vino, Veritas – or In Wine, Truth – by Pliny the Elder

When the Holy Roman Empire was forming Charlemagne gave lands to the monks in order for them to plant vineyards to make wine for the Eucharist. Those first vineyards, planted by Benedictine monks, make some of the classic wines of all time.  Wine was in France centuries prior to Charlemagne, but it was those monks that we have a provenance of today’s wine. It was also from those Monks that we got the concept of terroir.

Today terroir is the “in” thing that wine sommeliers will talk about. One of the myths is that you can taste the soil of the wine.  This traces back to those monks who would taste the soil in order to determine where the best wines would come from. What those monks didn’t know was that the vines get their ingredients from carbon dioxide and sunlight.

Wine geology is complex, and recently Alex Maltman, a distinguished professor emeritus of geology, published a book about the geology of wine.  His book: Vineyards, Rocks, and Soils The Wine Lover’s Guide to Geology is a reference guide for those who want to know more about the geology of the wines they are drinking.

Dr. Maltman was also a guest on the podcast where we talked about wine geology and dispelled the myth about tasting the soil.

Dr. Maltman notes that the chalk of Champagne is the soil, and the soil is important to drainage of the vine, but the plant doesn’t take up chalk (which is a silicate compound), and when the inorganic compounds of chalk are broken down, and some of those minerals are taken up they are tasteless.

What people taste are the many organic compounds that the plant makes from the carbon from carbon dioxide through photosynthesis and coded on the vineyards DNA. You also taste the byproducts of fermentation – as those compounds are put through yeast, bacteria. Where the confusion lies is that some of the organic compounds of the soil smell like some of the products of fermentation of the wine.

The monks didn’t know about photosynthesis, nor did they know about DNA encoding for the proteins and organic chemicals, nor did they understand the complex chemistry of fermentation. They just knew wine is delicious- and sometimes the soil tastes a bit like the wine, so they assumed that the vine took up the soil and put it into the grape (the wine takes up the water, not the soil).

Today Sommeliers everywhere love to talk about the geology of where the wine you are buying came from. They love telling you a story – because we love stories about our food. As Maltman points out, we love to know the provenance of our food, and in an era of large multinational corporations, wine is one of the few places you can know about where a grape was grown, harvested, what were the conditions that year, what is the makeup of the land – even what side of the mountain that wine came from.

But what you cannot taste, is the soil from the rocks. That, my friends, is not only impossible because of how and what the plant takes from the soil (water and ionic forms of inorganic compounds, as Maltman points out in his book) but ignores the most glorious and complex part of wine.

In our conversation, Maltman talks about the grapes that no one has heard of that are making a comeback in Greece, Croatia, and Eastern Europe.

Oh, and we bust the myths of resveratrol and people who want to add this as a supplement for weight loss, long life, etc.

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Fork U is part of the Your Doctors Orders network of podcasts and is hosted by noted physician and surgeon Dr. Terry Simpson.

• Follow Dr. Terry Simpson on TikTok for bite-sized...

The Cyclical Nature of Autoimmune Diseases: A Huckster's Playground

Autoimmune diseases are notoriously difficult to manage because they don’t follow a linear progression. Patients often experience periods of remission, where symptoms lessen or disappear, followed by flare-ups, where symptoms return, sometimes worse than before. This cyclical nature gives the illusion that certain "treatments" or lifestyle changes are working when, in reality, the disease is simply following its natural course.

Hucksters exploit this ebb and flow, offering unproven solutions and claiming credit for any improvements that coincide with the natural remission phase. When symptoms return during a flare-up, they may shift the blame to the patient, suggesting they didn’t follow the regimen properly or need to try an even more restrictive approach.

In many cases, these alternative therapies center around the idea that gut issues cause autoimmune diseases, particularly leaky gut syndrome. The pitch is simple: repair the gut, and the immune system will stop attacking the body. Unfortunately, the science doesn’t back this up.

Why the Gut Isn’t the Root Cause of Autoimmune Disease

It's true that there is a connection between the gut and the immune system. In fact, about 70% of the immune system resides in the gut, and gut bacteria (the microbiome) play a role in regulating immune responses. However, autoimmune diseases are far more complex than just a gut issue.

Genetic predispositions primarily drive Autoimmune diseases, environmental triggers, and immune system dysregulation. While diet and gut health can influence immune responses, there’s no evidence that simply "healing" the gut will reverse the course of autoimmune diseases. The immune system in these conditions has gone awry in ways that are not fully understood, and current medical treatments focus on suppressing overactive immune responses and managing symptoms—not on gut health alone.

Myasthenia Gravis (MG) is an autoimmune disease where medical treatment significantly outperforms dietary interventions.

MG is characterized by autoantibodies targeting the neuromuscular junction, leading to fluctuating muscle weakness and fatigability. The primary treatment modalities for MG involve immunosuppressive therapies and precision medicine approaches.

Current treatment guidelines, as discussed by Cavalcante et al., highlight the use of immunosuppressive therapies such as corticosteroids, azathioprine, and mycophenolate mofetil to control symptoms and improve muscle strength. (reference here)

Additionally, novel biological drugs targeting B cell activation, antibody recycling, and complement system-mediated neuromuscular junction damage have shown efficacy and safety in clinical trials. These precision medicine approaches are tailored to the patient's specific immunopathogenic mechanisms, offering a more targeted and effective treatment strategy.

In contrast, dietary interventions have not demonstrated significant efficacy in managing MG. While general nutritional support is important for overall health, there is no specific diet that can modulate the autoimmune mechanisms underlying MG to the same extent as pharmacological treatments.

In summary, medicine does better than diet in managing Myasthenia Gravis, with immunosuppressive therapies and precision medicine approaches being the cornerstone of treatment.[1]

Here’s why relying on gut health as the sole solution is like using a garden hose to fight a forest fire:

A. The Complexity of Autoimmune Dysregulation

Autoimmune diseases involve dysregulation at multiple levels of the immune system. In...

Canola Oil is Healthy and Inexpensive

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

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

The Logical Fallacy of Ancestral Diets / and Humans

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

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

Canola Oil Podcast Transcript

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

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

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

Today on Fork U

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

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

Fork University

Where we make sense of the madness

Bust a few myths

And teach you a little bit about food as medicine.

What is Canola Oil?

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

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

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

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

Erucic Acid

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

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

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

Rapeseed Oil as a lubricant

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

Canadians Hybrids

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

Beyond the Scale: Eating for Long-Term Health, Not Just Weight Loss

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

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

GLP-1 Medications Take the Lead; Your Diet Supports the Process

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

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

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

The Mediterranean Diet: A Gold Standard for Health

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

Why the Mediterranean Diet Works

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

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

The Science Behind Olive Oil and Omega-3s

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

Don’t Get Stuck on Protein

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

Here’s the good news: with a Mediterranean-style diet, you can get plenty of protein from diverse sources. Legumes like lentils and chickpeas

In recent years, GLP-1 agonists have gained significant attention as effective treatments for obesity and type 2 diabetes. However, emerging research suggests these medications may also influence brain function and behaviors related to reward and addiction. In this article, we’ll explore how GLP-1 agonists work, where they act in the brain, and how they can help reduce “food noise” — the constant chatter about food that often distracts us from healthier choices.

Understanding GLP-1 Agonists

GLP-1, or glucagon-like peptide-1, is a hormone released from the intestines after eating. It plays a crucial role in regulating appetite and glucose metabolism. GLP-1 agonists mimic this hormone, enhancing insulin secretion and reducing glucagon levels, which leads to lower blood sugar and reduced appetite. Popular medications in this class include semaglutide (Ozempic, Wegovy) and liraglutide (Saxenda).

How GLP-1 Agonists Affect the Brain

Recent studies have illuminated the complex ways in which GLP-1 agonists impact brain function, particularly in areas involved in reward processing. Researchers have found GLP-1 receptors in key brain regions such as:

Hypothalamus: This area regulates appetite and energy balance.

Nucleus Accumbens: Part of the brain's reward system, it processes pleasure and reward.

Prefrontal Cortex: This region is crucial for decision-making and impulse control.

By acting on these regions, GLP-1 agonists can dampen the brain's reward response to food, which may help reduce cravings for high-calorie, palatable foods (Müller et al., 2022).

GLP-1 Agonists and Food Noise

“Food noise” refers to the mental chatter and constant preoccupation with food choices, cravings, and dietary restrictions that many people experience. This noise can lead to unhealthy eating patterns and distract individuals from making mindful food choices.

GLP-1 agonists appear to quiet this food noise. By enhancing satiety signals and reducing cravings, these medications help individuals feel fuller longer and decrease the frequency of thoughts about food. Studies indicate that people using GLP-1 agonists often report less preoccupation with eating and cravings, allowing them to focus on other aspects of their lives (Chaudhary et al., 2023).

Implications for Other Addictions

Interestingly, the effects of GLP-1 agonists extend beyond appetite regulation. Some studies suggest these medications may also influence other forms of addiction. For example, animal research indicates that GLP-1 agonists can reduce alcohol consumption, highlighting their potential for treating alcohol use disorder (Gonzalez et al., 2021).

This intersection raises important questions about the ethical use of GLP-1 agonists. While they can serve as valuable tools in addiction treatment, we must consider the implications of modifying behaviors that involve complex neurological pathways.

It even appears to change one's reaction to stress.

Conclusion

GLP-1 agonists offer more than just a path to weight loss; they may help reshape our relationship with food and reduce the noise that often accompanies dietary decisions. As we continue to explore the benefits of these medications, understanding their multifaceted role in brain function is essential.

Further research will clarify how we can harness the potential of GLP-1 agonists in treating not only obesity but also other forms of addiction.

References

Chaudhary, N., et al....

LiverKing Falls From Grace

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

The Rise of LiverKing

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

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

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

But his rise was anything but an accident.

Powering up the Media

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

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

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

Guess who his partner was in supplements?

The Supplement Industry

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

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

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

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

Supplements can kill.

But so can their diet.

The Diet They Don't Eat

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

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

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

Wait, can I get sick from too much Vitamin A?

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

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

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

The Maple Syrup and Hormone Diet

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

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

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

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Produced by Simpler Media

The idea of Blue Zones—those rare places where people supposedly live longer, healthier lives—has become nutritional gospel. From best-selling books to Netflix specials, Blue Zones have been painted as longevity utopias we can mimic if we just eat more beans and nap more often.

But here’s the thing: Blue Zones aren’t science—they’re storytelling.

In this post, we take an unfiltered look at the Blue Zones concept, explore recent controversies, and compare it with something backed by actual peer-reviewed data: the Mediterranean Diet.

What Are Blue Zones?

Coined by journalist Dan Buettner and popularized through National Geographic, Blue Zones refer to five regions with high numbers of centenarians:

• Okinawa, Japan
• Sardinia, Italy
• Nicoya, Costa Rica
• Ikaria, Greece
• Loma Linda, California

These regions reportedly share key habits: plant-forward diets, natural movement, strong social bonds, and low stress.

While these are certainly positive lifestyle features, the problem is how this information was collected. The Blue Zones model is observational, not scientific. It’s a patchwork of ethnographic notes, anecdotes, and assumptions—not randomized trials or controlled cohort studies.

The Blue Zones Controversy

In recent years, the Blue Zones concept has come under scrutiny:

• Okinawa’s longevity claims have declined in newer data; life expectancy has dropped, and obesity and chronic diseases are on the rise.
• Record inaccuracies in places like Okinawa and Ikaria have been found, making claims of centenarian density questionable.
• Survivorship bias skews the picture—we hear from those who lived long, not those who didn’t.
• Westernization has eroded the very habits that supposedly defined these zones.

In short: Blue Zones are more about a moment in time than a repeatable formula.

So What Does the Data Say?

If you're looking for longevity strategies backed by evidence—not just folklore—consider the major cohort studies:

• Nurses’ Health Study
• Adventist Health Study
• EPIC-Oxford

These studies have followed hundreds of thousands of people for decades. The data consistently shows that people who live longer:

• Eat more whole, plant-based foods
• Limit ultra-processed foods and added sugars
• Exercise regularly
• Maintain strong social connections
• Get adequate sleep
• Manage stress
• Don’t overeat

No magic. Just measurable habits.

Mediterranean Diet: The Gold Standard

Unlike Blue Zones, the Mediterranean Diet is a defined, evidence-based dietary pattern. And it’s been rigorously studied in over 13,000 peer-reviewed publications.

Core Features:

• High intake of fruits, vegetables, legumes, whole grains
• Olive oil as the main fat
• Moderate fish and poultry
• Minimal red meat and sugar
• Moderate wine, usually with meals
• Emphasis on community and shared meals

Evidence Highlights:

• PREDIMED Trial (2013): A randomized controlled trial of over 7,000 participants in Spain found that the Mediterranean Diet reduced the risk of cardiovascular events by 30% compared to a low-fat diet.
• Reference: Estruch R, et al. N Engl J Med. 2013;368(14):1279-1290.
• Link
• Spanish Cohort Study (2022): A population-based study of 1.5 million adults found that greater adherence to the...

Apple Watch vs. Oura, Whoop, and Withings

Health wearables have exploded in popularity, promising better sleep, fitness, and recovery tracking. But with so many options—Apple Watch, Whoop, Withings, Oura, and Ultrahuman Rings—which one is actually worth your money?

More importantly, do these devices improve your health, or are they just expensive digital trophies?

In this breakdown, we’ll compare features, accuracy, HRV (Heart Rate Variability) and “strain” tracking, battery life, hidden costs, and privacy concerns—so you can make the best choice for your lifestyle.

We have come a long way since the pedometer - which I used to buy and give to my post op surgery patients to encourage them to walk.

What Do These Devices Track?

Most modern wearables track heart rate, sleep, HRV, activity levels, and even blood oxygen and temperature. More than just steps - which they all track, but each device has its strengths:

• Apple Watch – Tracks HRV, ECG (FDA-cleared for atrial fibrillation), and fall detection. However, cellular models require a monthly subscription for full use, and it no longer tracks blood oxygen (SpO2) due to a patent dispute.
• Whoop – Focuses on recovery, strain, and sleep—but requires a costly subscription and has no screen.
• Oura Ring – A discreet ring tracking sleep stages, HRV, and body temperature.
• Withings – The only one besides Apple to be FDA-cleared for atrial fibrillation detection, with a focus on medical-grade tracking (smart scales, blood pressure monitors, and sleep mats). Unlike Apple, Withings still tracks blood oxygen (SpO2). Withings also tracks heart rate continuously during sleep, and thanks to its long battery life, it can be worn at night for weeks without interruption. No subscription required.
• Ultrahuman Ring – A newer ring with a focus on metabolic tracking and recovery.

Scientific Insight:

A 2020 Nature Digital Medicine study found that wrist-based devices overestimate activity but underestimate calories burned, while rings tend to be more reliable for sleep and HRV.

HRV and Strain: What Do These Metrics Really Mean?

What is HRV (Heart Rate Variability)?

HRV is the variation in time between heartbeats—a measure of how well your autonomic nervous system is functioning.

• Higher HRV = Better recovery, lower stress, and improved cardiovascular health.
• Lower HRV = Fatigue, overtraining, stress, or even illness.

However, HRV is highly variable based on factors like hydration, sleep, and time of day.

How Wearables Measure HRV:

• Apple Watch, Whoop, Oura, Withings, and Ultrahuman all track HRV, but accuracy depends on when and how it’s measured.
• Whoop and Oura measure HRV during deep sleep, which is considered more stable than spot-checks.
• Apple Watch and Withings measure HRV periodically throughout the day, which may be less reliable due to external...

Losing Weight With Apps

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

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

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

Episode Sponsor: Modifyhealth.com

What the Studies Show

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

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

Blood Pressure, Cholesterol, and Calories

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

The Proliferation of Apps

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

Many Apps With Poor Quality

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

What About Noom

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

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

Another article used Noom data for their references.

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

References:

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

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

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

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

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

Turmeric: It can kill you

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

Supplements

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

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

Contrast with Aspirin

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

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

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

Turmeric and Liver Injury

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

Liver injury due to turmeric appears to be increasing in the United States, perhaps reflecting usage patterns or increased combination with black pepper. (2)

Turmeric and Cooking

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

Tumeric belongs in the cabinet, not in a capsule.

TEXT FROM THE PODCAST

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

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

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

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

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

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

FORK U

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

Fork University

Where we make sense of the madness

Bust a few myths!

And teach you a little bit about food as medicine.

Inflammation

Inflammation is a complex biochemical, physiological, and even pathological process. Inflammation is the basis of our immune system, and acute inflammation allows us to rid our bodies of cancer, viruses, bacteria, yeasts, mold, and parasites. Without the inflammatory process, we would end up being a pile of goo in twenty-four hours – dead as dead can be. Inflammation allows us

Ever since the YouTube video of Dr. Lustig and the evils of fructose went viral in 2010, many have advocated that fructose is the single most common cause of obesity in the United States.

The video had metabolic pathways that had the hypothesis that most fructose either becomes fat in the liver, or that it might go down a pathway to cause joint issues, leaky gut, and inflammation causing obesity.

Here are the two chemical structures of glucose, also known as the "good sugar" and fructose, or the bad sugar. I cannot help but thinking of the good witch and the bad witch on the Wizard of Oz.

Dr. Lustig's hypothesis was based on studies done in mice and rats. In those studies, published two years before the viral video, found that high fructose diets in mice lead to increased "gut leak" and led to liver damage (1). This was even confirmed with a small study of 8 men (2) who had their complex carbohydrates replaced by fructose and fed normal caloric diets - meaning, these eight men had increased liver fat, more de novo fat formation (de novo lipogenesis) .

This all makes that logical sense since sugar-sweetened beverages are associated with chronic inflammation and these days everything to do with chronic inflammation increases the risk of obesity, diabetes, heart disease, and aging.

Then came a double-blinded, randomized, crossover study where a group of people were fed a standard diet but drank 25% of their calories as either fructose (the evil sugar), or glucose (the good one) or a high fructose corn syrup sweetened beverage. Oddly, there was no difference in any of those groups with regard to markers of inflammation, intestinal permeability, or inflammation in the fat tissue.

To quote from the study: "Excessive amounts of fructose, HFCS, and glucose from SSBs consumed over 8 d did not differentially affect low-grade chronic systemic inflammation in normal-weight to obese adults." SSB = sugar sweetened beverages.

There have been a number of human trials looking at sugar-sweetened beverages and inflammation, and the results are not consistent. Even finding that people who drink large amounts of either glucose of fructose didn't find changes in inflammation or visceral fat.

Mice are not men, and the link between gut permeability, leading to systemic and chronic inflammation, occurs in mice, but not men. And while in mice fructose can lead to inflammation and liver issues, this doesn't happen in human beings. (4)

The key may not be fructose itself, but increased caloric intake.  If you eat more, you will increase in weight, but it is not fructose alone. It is, in fact, high caloric intake combined with sugars. Meaning, that great tasting snack with the high levels of sugars and fats act in concert with the increased calories consumed to give you that portly look.

To be fair, all of the studies were short term, less than a couple of weeks. Fructose, over the long term, may still be a bad actor.

What about fruit? It is exceedingly difficult to eat enough whole fruits to make this a problem. To eat the excess amount in some of these studies you would have to eat several pounds of apples, and most people simply cannot do that in a day. And whole fruit consumption, as a part of the Mediterranean diet reduces the burden of cardiovascular disease, diabetes, and even erectile dysfunction.(5)

In fact less than 10% of most Western dieters have adequate levels of fruit (6) leading to a serious threat to human health. Maybe a couple of apples a day will keep the doctor away.

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Fork U is part of the Your Doctors Orders network of podcasts and is hosted by noted physician and surgeon Dr. Terry Simpson.

The Benefits of Whole Grains in Your Diet

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

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

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

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

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

The First Olympics

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

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

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

Gym bros and bro science were yet to be invented.

Ancient Grains

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

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

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

You might have thought – "Grains are evil."

Low Carb Life Without Grains

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

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

Finding Joy in the Mediterranean Diet

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

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

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

It's the Gluten

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

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

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

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

Celiac Disease

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

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

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

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

Carnivore's Take

Carnivores like pointing to the ancient...

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

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

Vitamin B1 and Beriberi

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

White Rice and Beriberi

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

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

Beriberi in Mid-1800’s Japan

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

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

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

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

Eastern Traditional Cures for Beriberi

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

Kanehiro’s training

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

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

The Bitter Truth: Why Bitterness Matters More Than You Think

Have you ever taken a sip of black coffee and immediately regretted it? Or maybe you’ve bitten into a grapefruit and felt like your tongue was under attack? If so, you’re not alone. Bitterness is one of the most misunderstood flavors, but it plays a huge role in our health and survival. From keeping us from eating toxic foods to helping digestion, bitterness has a bigger impact on our bodies than most people realize. So, let’s dive into the bitter truth—why some people hate it, why your stomach can actually taste it, and how it has been used as medicine for centuries.

Why Do Some Foods Taste Bitter?

To begin with, bitterness exists for a reason. In nature, many poisonous plants contain bitter compounds. Long ago, humans who could detect bitterness had a survival advantage. In other words, their ability to taste bitterness kept them from eating something deadly. As a result, our bodies evolved to be extra sensitive to bitter flavors.

However, not all bitter foods are dangerous. Many are incredibly healthy. Take kale, dark chocolate, and turmeric, for example. These foods may taste strong or even unpleasant to some people, but they are packed with antioxidants and nutrients that support overall health.

So, why do some people love bitter foods while others can’t stand them? The answer lies in our genes. Scientists have discovered that a gene called TAS2R38 determines how sensitive we are to bitterness. If you are a super-taster, bitter foods might seem unbearably strong. On the other hand, if you are a non-taster, you may barely notice the bitterness at all.

Your Stomach Can "Taste" Bitterness Too

Interestingly, your tongue isn’t the only part of your body that detects bitterness. Your stomach can taste it as well. But how does that work? Well, your stomach has bitter taste receptors that serve a very important function.

First, these receptors help control digestion. When bitter foods enter your stomach, the receptors slow down gastric emptying. In simpler terms, they make food stay in your stomach longer. As a result, you feel full for a longer period. This is one reason why bitter greens like arugula or dandelion leaves can help with weight management.

Second, these bitter receptors act as bodyguards for your digestive system. If your stomach detects a bitter substance that shouldn’t be there—like a potential toxin—it delays digestion to prevent harmful substances from moving too quickly into your intestines. This process gives your body extra time to neutralize any potential threats.

Bitters: From Medicine to Cocktails

Because of their digestive benefits, bitter herbs have been used in medicine for centuries. In the past, people took bitters—herbal mixtures containing bitter plant extracts—to help with digestion, bloating, and nausea. Some of the most common bitter herbs include:

• Gentian root – A powerful bitter used to stimulate digestion.
• Dandelion – Helps with liver function and gut health.
• Wormwood – Historically used for digestive problems and gut health.
• Burdock – Supports digestion and has anti-inflammatory properties.

Over time, bitters made their way from medicine cabinets to cocktail bars. During the 1800s, bitters became a key ingredient in alcoholic drinks, including the Old Fashioned and the Manhattan. In fact, some of today’s most famous bitters, like Angostura and Peychaud’s, were originally marketed as health...

The term "microplastics" was originally described in 2004 for plastic particles that are less than 5 millimeters in diameter, originally being seen on beaches. But everywhere scientists have looked on planet earth, they have been found. From fruit, vegetables, nuts, beer, baby bottles, in the air, in our water.

Some have estimated that we ingest 100,000 microplastic particles per day or the equivalent of a credit card of microplastic in a year. That number will only increase, as we are producing over 400 million tons of plastics a year, and we have over 5 billion tons of plastics in landfills. Plastic degrades over time, from sunlight, from ocean water, from wind. Some of those plastics become so small they cross the blood-brain barrier in humans.

These plastics come in all shapes and sizes. As they are exposed to the environment and degrade, they become smaller and smaller. They come with different types of plastics with different reactions, but mostly we don't know.

The problem is we don't know what these plastics are doing to us. We don't know what the toxic levels of microplastics are. We don't know what, if any, physiological systems that microplastics would interfere with. We don't know if they increase cancer, heart disease, auto-immune disease, dementia, liver cirrhosis - we just don't know. We don't know if they inhibit the growth of children if they cause the loss of fetuses in women who are pregnant.

We do know on larger levels; plastics cause issues with marine mammals. Shopping bags in the water look like the turtle's favorite feast, a jellyfish, and they will consume those, and those plastics become stuck in the turtle's digestive system clogging up their intestines and leading to their death. Most have seen the turtle whose nose was stuffed with a plastic straw. What we don't know is what happens when the small microplastics enter into cells, or cross the blood-brain barrier, or land in our lungs. Those finds led to the laws to decrease plastic one-use bags and plastic straws, but that is just the tip of what might be a more serious problem.

We know that mice fed microplastics had lower sperm counts, smaller offspring, but again, mice are not men. We also don't know what the different types of microplastics will do - one type might be harmful, another type might be benign.

Some plastics might pass through us like fiber, indigestible matter that has no consequence other than moving stool along.

What can you do if you are worried? If you feed your child formula, use bottles instead of plastic. If you use your microwave, don't reheat food in plastic containers. Try not to use plastic containers for storage, and don't dispose of them so quickly. Water bottles - well, time to use reusable water bottles made of metal or glass.

For now, we can do a small part, but it isn't the entire part. It is a problem that may be a larger problem or less of a problem. But it probably is an issue. We already know that some plastics do cause endocrine disruption, and those products have been outlawed.

But it isn't just a marine problem; whether you are a vegan, pescatarian, vegetarian, omnivore, or carnivore, there will be plastics in everything you eat.

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Fork U is part of the Your Doctors Orders network of podcasts and is hosted by the noted physician and surgeon Dr. Terry Simpson.

• Follow Dr. Terry Simpson on TikTok for bite-sized content on  healthy eating
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Decreasing cholesterol: drugs and diet

There is a persistent belief that lifestyle can take care of all cholesterol problems. Lifestyle can make things worse, but once things are worse, it cannot make things better.

Once you have disease, or cholesterol is higher, you need treatment often beyond lifestyle management.

This distresses many people, who wish to have control over their fate.

High cholesterol is one of the main causes of heart attacks, strokes, and peripheral vascular disease. You can lower cholesterol through diet and exercise by as much as 15 percent. Lifestyle changes are the first choice to decrease cholesterol. Modern drugs, however, will lower cholesterol levels far more than diet or exercise.

The progressive changes of a vessel

The normal artery, as shown below, is a free-flowing blood vessel. When a person is in their late teens, there is already fatty formation on the inside of the vessel wall.

As more fat is deposited in the vessel wall, blood flow decreases, leading to ischemia in the end organ.

Angina, or heart pain, occurs when there is insufficient blood flow to the heart secondary to an artery narrowed by plaque.

Factors contributing to atherosclerotic plaque formation

Damage to the blood vessel begins the process of

• Smoking
• Hypertension
• High blood sugars
• Diets rich in saturated fats and refined grains

However, the lower the level of LDL, the less risk those factors become, as you shall see.

Anatomy of the Blood Vessel

If you examine the autopsy specimen of the coronary artery above, the blood flows through that lumen. The inner wall, the wall the blood comes into contact with, is called the endothelium. There are three layers to the wall of an artery:

1. Tunica intima
2. Tunica Media
3. Tunica Adventicia

Atherosclerosis begins when the cholesterol transport protein enters the wall of the tunica media, whose first layer is the endothelium.

Discovery of LDL

In 1954, Dr. John Gofman reported the discovery of LDL and HDL. These were the particles found when he separated plasma cholesterol-carrying lipoproteins with an ultracentrifuge. Gofman was the first to note that heart attack patients had high LDL levels. The correlation of high LDL and heart attacks has been called “one of the most profound epidemiologic correlations in all of medicine.”

High LDL levels have been shown to correlate with atherosclerosis in all species studied.

High LDL and Atherosclerosis

The higher the LDL level, the faster atherosclerosis develops. Factors that increase atherosclerosis are those which injure blood vessels: smoking, hypertension, hyperglycemia, and genetic factors that predispose endothelium to early injury.

High LDL levels can lead to heart attacks in children as young as 6 years old. This rare form of homozygous familial hypercholesterolemia inspired Brown and Goldstein to elucidate the genetic defect in the receptor for LDL.

Discovery of the LDL receptor defect

Alcohol and the Mediterranean Diet

Alcohol consumption is controversial.  No one disputes that excess alcohol consumption leads to dire consequences. But what about moderate alcohol consumption? Can we define moderate alcohol consumption? Is there a safe and therapeutic level of alcohol consumption?

Alcohol is a component of the Mediterranean Diet. However, the consumption is limited to 10 ounces of red wine for men, which translates to 14 grams of alcohol. Half that amount for women. In a number of articles, this amount of alcohol is beneficial.

Bias from Authors

Confirmation bias is ingrained in all humans.  Treatment programs for alcohol addiction teach that there is no safe level of alcohol consumption.  Fundamentalist Christians, Muslims, and other organized religions have taboos regarding alcohol consumption. Finally, consumers of alcohol will be biased against abstinence.

Components of Wine

In their article, Wine, Polypenols and Mediterranean Diet, the authors note that one can get polyphenols from other sources in the diet, and thus the alcohol may be unnecessary.  They conclude that moderate consumption is likely an important component of a mechanistic as well as social norm.

Dose Dependent Effects of Polyphenols on the Body

• Decreased risk of cardiovascular disease
• Dose-dependent reduction of LDL-C
• Increase HDL-C and decrease triglycerides in patients with diabetes
• Reduction of Blood Pressure
• Increase production of nitric oxide (NO), which increases blood flow and reduces blood pressure
• Improve LDL/HDL ratio
• Resveratrol inhibition of pro-inflammatory agents
• lower risk of type 2 diabetes
• Resveratrol improves glucose homeostasis
• Modulate gut microbiota
• Improvement in blood vessel wall function (endothelial function)
• Reduction of drugs in diabetic patients

Mechanistic vs Holistic

The issue with the Mediterranean Diet is always those who approach from a mechanistic view versus those who approach nutrition and lifestyle from a holistic view. The original data from the Mediterranean Diet came from the Seven Countries Study. This was a holistic examination, not only of their diet but also their lifestyle.

Alcohol Toxicity is in the Dose

A bit of wine is good, a lot of wine is not.

If you look at every improvement in human physiology with alcohol listed above, the opposite effect happens when the dose is beyond about 50 grams of alcohol.

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Produced by Simpler Media

It turns out that the juice from beets may lower blood pressure in a sustained and lovely manner. Beets, you see, besides being a colorful vegetable, contain a high level of Nitrate (NO3-). And this is absorbed by the body and converted into nitric oxide. Nitric oxide is that amazing molecule that relaxes blood vessels and improves blood flow.

How Your Body Gets Nitric Oxide

The conversion of nitrate into nitrite, which is then converted into nitric oxide is a fun pathway.

When you eat your greens (yes even lettuce has nitrates) your intestines absorb it and then it is secreted back into saliva where those bacteria in your mouth digest the nitrate (NO3-) into nitrite (NO2-) <-- for you chemistry major nerds. It is that nitrite that is converted to nitric oxide in the body as it needs it - and often it needs it.

This particular study gave volunteers 250 ml of beet juice (what happens if you say that three times and fast?) - 34 of whom were on blood pressure medicine and 34 who were not (four people dropped out of the study).

These people were randomized to receive, daily, one cup (250 ml) of beetroot juice (same as beet juice) daily, or the placebo which was nitrate free beet juice. No one could tell the difference in taste. BMI was constant in both groups, about 25-26. They measured, besides blood pressure, nitrates.

What happened?

There was a large increase in NOX (nitrates and nitrites) and cGMP (the signaling molecule ) but more importantly there was a sustained and real drop in blood pressure by 7.7 mm of Hg which was NOT seen in the nitrate free beet juice.

The drop in systolic blood pressure was seen after the first week and the ultimate reduction of 8.1/3.6 Hg reduction was not altered by a change in heart rate.

Two weeks after stopping this regimen the blood pressure returned to normal.

Did you know that every increase of systolic blood pressure by 2 mm of Hg increases mortality of heart disease and stroke by about ten percent? This showed a reduction of 7.7 mm of Hg in systolic blood pressure.

Dietary Implications

Nitrates are not only found in beets, but also in many other vegetables. One of the clearest and classic papers for the use of the DASH diet showed that the adoption of this diet lead to blood pressure reduction in adults. While this diet was using salt as the major effector, it is clear that the increased use of vegetables with their high nitrate component is an additional determinant in nitrates and blood pressure reduction.

[caption id="attachment_9737" align="aligncenter" width="640"]

All vegetables, even the green ones have nitrates[/caption]

It may be that the increase in vegetable servings in the DASH diet may be a secondary and important factor for blood pressure reduction in both the DASH and Mediterranean Diets. For a review of the diet and hypertension click here.

But what is even more impressive is if we look back at people who have increasing vegetable intake with ultimate cardiovascular disease. The Danish report looked at this and concluded, " Moderate vegetable nitrate intake was associated with 12%, 15%, 17% and 26% lower risk of ischemic heart disease, heart failure, ischemic stroke and peripheral artery disease hospitalizations respectively." - see the reference below or click here.

This goes against the Carnivore diet where they state there is no need for vegetables. Showing that vegetables are needed and produce improved quality of life.

REFERENCES:

Kapil V, Khambata RS, Robertson A, Caulfield MJ, Ahluwalia A. Dietary nitrate provides sustained blood pressure

Seed Oils: Toxic or Not?

Today, the low-carb/carnivore community has a new enemy. It is seed oils. Here is their argument:

• There were no seed oils in ancient lands
• Seed oils are highly inflammatory
• Seed oils are extracted with hexane, a cancer-causing agent
• The rise of seed oils correlates with the rise of obesity
• Seed oils are high in omega-6 fatty acids, which are inflammatory

That is the summary of their logic. Now, let's get to the science.

What are Seed Oils?

See those beautiful seeds, in them are bits of oil. This is the rapeseed plant, which we have covered before. From rapeseed came canola oil. And this has been used as a source of oil starting about 4000 years ago. A much misunderstood oil, please see our previous podcast.

Seed Oils

Every seed has oil. Nuts are a type of seed, and their caloric density comes from oil. Oddly, low carb/keto types tend to eat nuts, the carnivore crowd avoids them.

Seed oils are another name for vegetable oils, and they are used often in cooking because they have a neutral taste and high smoke point. The more common ones include corn, peanuts, sunflowers, grapes, and others.

Seed Oils and Ancient Humans

 Besides the logical fallacy about what ancient humans ate, seed oils have been cultivated and used for the whole of written humanity. Ancient Egyptians used oils for cooking and perfume. Even the Bible talks about the use of oils, including the gifts sent to the birth of Jesus. To summarize, humans have recorded the use of oils from seeds through all recorded history.

Components of Seed Oils

There is no one "oil" that can chemically be called a "seed oil." Rather, every seed contains different compositions of oils, and it is how the body uses those particular oils that makes us interested in them. Thus, seed oils as a term is silly. I wonder why the carnivore/keto crowd decided to use "seed oils" instead of vegetable oils? After all, they don't call beef tallow "meat oil."

Oleic Acid: Olives to Butter

Oleic acid is the main fatty acid in olive oil (55-85% of the oil).  This is a mono-unsaturated fatty acid, which everyone seems to agree is heart healthy. Hence, the more oleic acid in something, the better.

• Peanut oil 48%
• Canola oil 65%
• Palm oil 39%
• Soybean oil 23%
• Coconut oil 7%
• Beef Tallow 47%
• Butter 24%

But are Vegetable Oils Inflammatory?

The short answer is no. To be inflammatory, they would have to elicit an inflammatory response. This means that inflammatory markers in the blood would be elevated for those who use vegetable oils over meat oils. In contrast, there is no increase in inflammatory markers of those who use vegetable oils.

Want to see the data? Take a look at this paper where they look at foods, like vegetable oils, with high ratios of omega-6 fatty acids. What didn't they find? Higher levels of inflammatory markers. Thus, seed oils are not inflammatory.

Atherosclerosis and Seed Oils

Do vegetable oils increase your risk of atherosclerosis, or do they decrease it? If the carnivore crowd is correct, they have not been yet, then their view of the vegetable oils is that it would increase your risk of atherosclerosis

REFERENCES:

Courville AB, Majchrzak-Hong S, Yang S, Turner S, Wilhite B, Ness Shipley K, Horneffer Y, Domenichiello AF,

Erythritol and Heart Attacks: Is It Hype?

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

The article abstract can be found here.

Erythritol is an artificial sweetener

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

The case for artificial sweeteners

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

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

But your body makes erythritol

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

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

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

The case against artificial sweeteners

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

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

How much we make

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

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

It's not hype - the study

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

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

This episode originally aired for the holidays in 2018. But it's solid advice, so we're playing it again, Sam!

Diet season is soon upon us, but what happens if we have a system where you can lose weight during the times when you are most vulnerable: holidays, vacations, new relationships.

Not a “lifestyle” or “long term” diet - but a simple ten-day plan to lose weight during the times when you need it.

Full details: https://www.yourdoctorsorders.com/2018/12/10-day-holiday-diet/

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Produced and distributed by Simpler Media

Follow Dr. Terry Simpson on Twitter

In science, we don’t look to confirm what we know; we want to find out something that we don’t know. We love it when science proves us wrong.

If your doctor told you that you have heart disease, were pre-diabetic, or said you should eat healthier, they likely will tell you to follow the Mediterranean Diet.

When I introduce the Mediterranean Diet to my patients I get a response like this:

“Sounds great!  Who doesn’t love red wine, olive oil, and fresh Italian tomatoes?”

This is followed by asking for a recommendation of a book of recipes from the Mediterranean.

The Mediterranean Diet seems to invoke sitting on a rooftop restaurant in Positano sipping wine while munching on fruit and waiting for pasta. The food and wine are part of the lifestyle, as is relaxing and breathing in the surroundings. You might not be on a rooftop restaurant in Positano (lucky if you are). You might be looking in your yard and seeing a squirrel or rabbit or flowers, and taking in that time to breathe and relax and maybe the glass of wine and thus transporting that lifestyle to your home.

Which do you think is better for your heart and your brain: rushing home from a stressful day at work, grabbing a martini and letting the alcohol calm you or going outside, taking a deep breath of fresh air, maybe having a glass of wine?

In the original Greek, the word “diata” was used to describe how one should live, what one should eat, how to maintain a healthy body. It is from diata that our word “diet” derives. There is no doubt what you eat impacts your health.

While the origin of the Mediterranean Diet is what ‘some’ people in the Mediterranean ate, but that isn’t what we (doctors, scientists, registered dieticians) mean today.   Over the last fifty years over 150 foods have been studied to see their effect on humans, for better or for ill.  

Years of research, studied on millions of people, and yet most people have the view of the Mediterranean lifestyle as hummus and fish. So let me introduce this diet, and this lifestyle to you, and why it may be the most important lifestyle you should understand.

In spite of all the noise on the internet about low carb/keto, vegan, or other diets/lifestyles you will find that the Mediterranean Diet is consistently ranked as the number one or two diet in the United States. 

That is based on many studies showing how the diet leads to a decrease in heart disease, lower blood pressure, better control of diabetes, fewer strokes, and lowering the risk of dementia.

The Mediterranean diet is neither low carbohydrate (it is about 50% carbohydrate) nor low fat (it is about 30% fat). It is not high protein (it is about 20% protein). Improvement in your health comes from eating certain foods, and not from counting macros (proteins, carbs, fats, and alcohol). Weight loss and better health are both touted from those who profess “low carb” or “low fat” and yet weight loss with the Mediterranean lifestyle is equal to or better than the low fat or low carb “diets”.

Those who claim low-carbohydrate diets are the best for diabetes are often stunned that the Mediterranean diet provides superior long-term results for diabetes and insulin resistance. While they rightly point out that a diet rich in whole grains and fruits, will produce transient spikes in blood glucose levels, the long-term results from the Mediterranean lifestyle are superior to avoiding those foods – providing better control for diabetes.

Back to those categories: Vegetables, Fruit and nuts, legumes, whole grains, meats, dairy, fats and oils, fish, and alcohol.

Each one of those categories is worth a point, so you have a chance to get nine points total. For some categories, you get a point for eating a given quantity of food (more for some, less for others). We determine adherence to the diet based on how many points a day a person gets on...

Was Ancel Keys responsible for the modern epidemic of obesity?

If you have read any low carb blog lately, you would think so.

Their revisionist history is broken down to this:

• Ancel Keys was an influential scientist who thought fat was to blame for heart disease
• He did a study of diet and correlated fat and heart disease in those people of the seven countries
• But Dr. Keys left out countries that would have proven his hypothesis wrong
• The influence of Dr. Keys work turned the US away from saturated fat and to sugar
• Sugar causes obesity and all the lifestyle illness of the world
• Dr. Keys brought us snackwells instead of pork rinds and we are all obese with diabetes

You will find versions of this in blogs, books, and videos.  Low-carb bloggers plagiarize one another. Nor have they never the primary source material.

The Mediterranean Diet Founder and the Study

Keys is the founder of the Mediterranean Diet. He was a pioneer physiologist, one of the first to show that diet was an important component of heart disease.

In the 1950's few considered diet an important component of heart disease.

Rich People and Diets

"In 1952 when Margaret and I were making surveys in Naples and then Madrid. It seemed quite clear that there was some relationship between diet and the incidence of coronary heart disease. Rich people had different diets and different blood cholesterols, and they had the only heart attacks in town. When those findings were written up and presented at a meeting in Amsterdam, some people were impressed and some didn't believe anything about it. " - Ancel Keys

This early observation by Keys  was the impetus for  the Seven Country Study.

That diet was responsible for heart disease was contrary to the prevailing theory: in the 1950's heart disease was hypothesized to be phenomenon of aging.  Dr. Keys meticulous research revealed the strong correlation between heart disease and a diet rich in saturated fat.

The First Graph

The graph below is a result of looking at macro dietary statistics of a country compared with death rates from heart disease. Keys presented this data at a WHO meeting in the early 1950's. The conclusion about fat and heart disease,  was met with a great deal of skepticism. Diet was not considered a factor in heart disease.

While this data points to a potential cause, to examine this hypothesis one must perform a cohort study.

Some assume that Keys collected country wide data about diet and heart disease, but he did not. Bloggers probably assume this based on this graph, as well as the name, Seven Countries Study. But the Seven Country Study was far more precise. The Study was a Cohort type study.

Cohort Studies

A cohort study follows subjects for a long period of time. The Seven Countries Study followed over 12,000 men for nearly 50 years.

Following these men involved yearly physical examinations, blood work, hospital and death records, as well as very specific dietary follow up.

Of all the factors examined, saturated fat and blood cholesterol were most correlated with  heart disease.

One of the more common myths about the Seven Country Study was that sugar was not examined. In fact, sugar was examined as an independent dietary factor. Sugar was not an primary variable for heart disease, unless combined with saturated fat.

Testing both low and high fat countries

The low-carb bloggers assume that Keys only tested those countries whose diet was rich in carbs, and low in fat. Keys chose his cohorts based on different diets, from those who were low fat, to high fat. Total fat, as it turns out, was not a factor for heart disease. Greeks

Apolipoprotein B (apoB) is the causative agent in atherosclerosis. If your apoB is low, you will not develop atherosclerosis. However, if your apoB is high, you could die young.

We know this because of genetic studies of people with different levels of apoB and their health outcomes.

What is Atherosclerosis of the heart?

Atherosclerosis is a progressive laying down of "plaque" in the wall of the coronary arteries.  Since the coronary arteries feed the heart, this can lead to three outcomes:

1. The plaque impinges on the artery. Thus, the plaque will decrease blood flow to the heart. This can lead to angina or a poorly working cardiac muscle.
2. The plaque can rupture (burst) into the artery. Next the body repairs this by clotting the blood. Thus,  the blood flows to that portion of the heart is stopped. Without blood flow, the heart muscle starves, and if the flow isn't restored, that part of the heart will die. This is a heart attack or myocardial infarction.
3. The plaque can have no result.  Meaning, it isn't stopping blood flow to lead to angina, and it doesn't occlude the artery.

What is in the plaque?

In the above artery, you can see the yellow cholesterol in the wall. This is a "soft" plaque, like porridge.

The plaque is not inside the vessel. The artery is lined by a layer called the intima. So how does cholesterol get from the inside of the blood vessel to behind the layer?

The Process of Atherosclerotic Plaque Formation

Lipoprotein Entry into the Arterial Wall: The process begins when ApoB-containing lipoproteins pass through the endothelial layer of arteries. Normally, this layer acts as a barrier, but factors like high blood pressure or inflammation can make it more permeable, allowing these particles to accumulate beneath the endothelial cells.

Retention and Modification: Once inside the arterial wall, ApoB lipoproteins are trapped by proteoglycans (components of the extracellular matrix). These retained lipoproteins undergo modifications, such as oxidation, which makes them more likely to trigger inflammatory responses.

Inflammatory Response: The modified lipoproteins activate endothelial cells and attract immune cells like monocytes. These monocytes enter the arterial wall and transform into macrophages. Macrophages engulf the modified lipoproteins, turning into foam cells, which are a hallmark of early atherosclerotic plaque.

Plaque Development: Over time, foam cells accumulate, leading to the formation of fatty streaks in the arterial wall. Smooth muscle cells migrate into the intimal layer of the artery, contributing to the formation of a fibrous cap that covers the plaque. This cap consists of connective tissue, calcium, and cholesterol deposits.

Progression and Complications: As the plaque grows, it narrows the artery and restricts blood flow. If the fibrous cap ruptures, it can lead to the formation of a blood clot (thrombus), which may block the artery entirely, causing a heart attack or stroke.

Preventing Plaque Formation

Understanding how ApoB-containing lipoproteins contribute to atherosclerosis underscores the importance of managing blood cholesterol levels. Lifestyle changes such as diet, exercise, and medications like statins can reduce LDL levels, lowering the risk of plaque formation and subsequent cardiovascular events.

Atherosclerosis is a gradual process that starts with the seemingly harmless entry of ApoB lipoproteins into arterial walls. By addressing the risk factors that promote lipoprotein retention and inflammation, the progression of atherosclerosis can be slowed or prevented.

LDL particle size

LDL particles can...

From Starving to Stuffed: The Evolution of Obesity in America

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

1970s: Setting the Stage for Ultra-Processed Foods

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

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

1980s: Ultra-Processed Foods Take Center Stage, and Obesity Rates Start to Climb

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

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

About 15 years ago physician came to me telling me that she was opening a new venture, distributing plant-based bioidentical hormones, and surgically implanting those hormones as pellets. She wanted me to send her all of my patients who presented in menopause because "with bioidentical hormones they won't need weight loss surgery." She went on to say how every woman would be tested for their hormones and then a compounding pharmacy would make up the exact hormones to replace the ones the person was not producing enough of. This would, "almost reverse aging and cause weight loss." In fact, those bioidentical hormones cause weight gain.

Bioidentical hormones, from whatever source, cause weight gain, not weight loss (reference) . In spite of a number of "advertisement" from providers who wish to provide you with "compounded" bioidentical hormones that propose they will cause weight loss - they don't.  This physician was not an Ob-Gyn, nor was she a board certified endocrinologist, in fact her specialty was about as far from treatment of complex menopausal hormone replacement or obesity as one could imagine.

The red flags for this clinic were (a) proposing weight loss (b) associating with a compound pharmacy (c) offering anti aging treatments (d) a provider that is not an expert in the field of endocrinology or gynecology.

Bioidentical hormones made by any compounding pharmacies do not meet rigorous FDA standards. In fact, compounded forms of bio-identical hormones are similar to supplements, and have the same issues that supplement industries have had that we have outlined previously.

Menopausal Hormone Replacement is Medicine, Compounded bioidentical hormones are ?

With every scam there is a separation of the chaff from the wheat. Here is the current evidence about hormones and changes that occur as women enter menopause. Accepted sources for this information include The Menopause Society as well as The American College of Obstetrics and Gynecology.

Women undergoing menopause they decrease their production of certain hormones. This can lead to severe symptoms of menopause that hormone replacement therapy can alleviate. Symptoms of menopause such as hot flashes, sleep disturbances, joint aches and pains, mood changes, vaginal dryness. That is undisputed and the improvement in quality of life is why many seek hormone replacement therapy. There is also potential benefit to decreasing risk of cardiovascular disease, if started within ten years of symptoms and before the age of 60 years.

The major concern of hormone replacement therapy came from the study published in 2002, the Women’s Health Initiative, showing that hormone replacement, with the most commonly prescribed medicine, Prempro, led to an increase in heart attacks, strokes, deep venous thrombosis and pulmonary embolism as well as breast cancer.

The concern among gynecologists led to a rapid decrease in the prescription of Prempro by nearly 70%. This also led to a decrease in the quality of life by women going through menopause. Some gynecologists and endocrinologists continued to prescribe hormone replacement therapy.

Compound Pharmacies Filling the Gap

Bioidentical hormones made by any compounding pharmacies do not meet rigorous FDA standards. In fact, compounded forms of bio-identical hormones are similar to supplements, and have the same issues that supplement industries have had that we have outlined

The Scams and Quacks of the Year

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

TOP SCAMS OF THE YEAR

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

FORK U

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

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

Where we teach you a little bit about food as medicine

Busting myths and making sense of the madness.

The Liver King and Paul Saladino

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

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

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

The Shirtless Salesmen of Supplements and Scams

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

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

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

The Carnivore Diet - or - Doctors Don't Learn Nutrition in Medical School

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

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

Do Doctors Learn Nutrition in Medical School?

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

The Mediterranean Diet: Why It’s Still #1 in 2025

When it comes to choosing the best diet for overall health, the Mediterranean diet has topped the

Bird Flu, Flu Season, and Protecting Your Health: What You Need to Know

While I typically focus on food and your health, pressing medical updates demand attention. Today, we’re tackling two critical topics: the latest on bird flu (avian influenza) and the rise in seasonal respiratory illnesses, including flu and COVID-19.

With public communication from federal agencies temporarily paused, it’s vital to stay informed. Here’s a comprehensive overview of what’s happening, what it means for you, and how to protect yourself and those around you.

Respiratory Illness Trends: Seasonal Flu on the Rise

As of January 24th, 2025, respiratory illnesses are driving more people to seek healthcare. Here’s what we’re seeing:

• Seasonal flu: Elevated and rising in some areas.
• COVID-19: Most regions report a decline in cases.
• RSV: Also trending downward.

Locally, we’re seeing these same trends, with flu activity increasing significantly.

Bird Flu: A Persistent Global Concern

Since 1997, HPAI A(H5N1) virus infections have been reported in over 925 people, with an alarming 50% case fatality rate. Early outbreaks included 20 cases and 7 deaths in Hong Kong between 1997 and 2003, and since November 2003, more than 900 cases across 24 countries have been documented (CDC).

Symptoms and Severity

HPAI A(H5N1) infections can range from mild to severe, including:

• Mild symptoms: Upper respiratory tract issues like a runny nose or sore throat.
• Severe symptoms: Pneumonia, respiratory failure, acute respiratory distress syndrome (ARDS), and multi-organ failure.
• Neurological impact: Some cases report encephalitis, a dangerous brain inflammation.

Since 2016, sporadic cases have been reported globally, and while rare, they highlight the virus’s ability to persist.

Notable Cases and Strains

A Sobering Case from Louisiana

A recent case in Louisiana reminds us of the risks associated with bird flu. A man died after handling wild birds infected with HPAI A(H5N1). This tragic event underscores how deadly the virus can be in humans.

Other Strains to Watch

• HPAI A(H5N6): Over 90 cases have been reported in China since 2014, with one additional case in Laos in 2021. This strain has a case fatality rate exceeding 50% (WHO).
• HPAI A(H5N8): Russia reported the first asymptomatic human case in a poultry worker in 2020 (CDC).

Testing and Monitoring

Hospitals now test anyone hospitalized with severe flu symptoms for bird flu. Public health officials use several tools to monitor these trends:

• Wastewater surveillance
• Emergency department visit data
• Lab-confirmed cases

These measures provide early warnings of emerging threats, helping to guide public health responses.

Protecting Yourself: Key Preventive Measures

1. Avoid...

Fuel, Don’t Fad: How to Eat for Health, Not Hype

If you’ve ever fallen for a fad diet, you’re not alone. They promise quick results, make bold claims, and usually leave you hungry, cranky, and disappointed. But here’s the truth: fad diets don’t work in the long run. What does work? Fueling your body with the right foods. In this blog, we’ll break down why fad diets fail, how to rebuild your relationship with food, and the best way to fuel your body for health, happiness, and energy.

Why Fad Diets Fail (Every Single Time)

Fad diets sound tempting. They promise you’ll drop 10 pounds in a week, detox your body, or gain endless energy. But they always have a catch—and that catch is why they fail so miserably.

1. Fad Diets Demonize Food

Carbs are evil. Fats are the enemy. Fruits have too much sugar. If you’ve heard any of these, you’ve encountered a fad diet. These diets love to turn food into the villain, leaving you afraid to eat the things your body actually needs.

2. They Set You Up for Yo-Yo Dieting

You lose weight quickly at first, but as soon as you eat normally, the weight comes rushing back. This cycle is not just frustrating—it’s harmful to your health and metabolism.

3. They Ignore Science

Many fad diets rely on gimmicks instead of facts. For example, “Don’t eat after 7 PM because your metabolism goes to sleep.” Spoiler alert: your metabolism doesn’t have a bedtime.

Unhealthy Relationships with Food

Fad diets don’t just fail—they mess with your mind. They teach you to fear food, label meals as “good” or “bad,” and disconnect you from your body’s natural hunger and fullness cues.

Stop Labeling Food as the Enemy

Food isn’t good or bad. It’s just food. Sure, a salad has more nutrients than a slice of cake, but both can fit into a balanced diet. When you stop assigning moral value to food, you’ll stop feeling guilty about what you eat.

Trust Your Body’s Hunger Signals

Your body knows when it’s hungry and when it’s full. Fad diets train you to ignore these signals, but you can retrain yourself. Start listening to your body—it’s smarter than any diet app.

How to Fuel Your Body the Right Way

Now that we’ve covered what doesn’t work, let’s talk about what does. Fueling your body means giving it the energy and nutrients it needs to thrive. Forget restriction—focus on addition.

Fruits: Nature’s Candy

Aim for 9 ounces of fruit per day or about two servings. Fruits provide vitamins, antioxidants, and natural sweetness. Plus, they’re portable and easy to snack on.

• Snack idea: Slice an apple and pair it with peanut butter.
• Breakfast tip: Add berries to your oatmeal or yogurt.

Vegetables: The Foundation of Your Plate

Like fruits, aim for 9 ounces of vegetables per day. Vegetables are low in calories but high in nutrients, fiber, and flavor.

• Quick tip: Roast a tray of veggies with olive oil, garlic, and herbs.
• Sneaky trick: Add spinach to your smoothies—you won’t taste it, but your body will love it.

Whole Grains: Your Sturdy Sidekick

Whole grains give you the energy that lasts. They’re rich in fiber, which keeps you full and your digestion happy. Aim for 9 ounces of whole grains per day.

• Breakfast idea: Enjoy a bowl of oatmeal with fruit and nuts.
• Dinner option: Serve quinoa, brown rice, or whole-grain pasta as a base for your meals.

Fish: Brain...

Implementing the Mediterranean Diet: Vegetables

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

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

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

How Much is a Serving?

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

Meal Ideas

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

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

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

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

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

Supplements Are Not the Same

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

There is no supplement that can replace vegetables.

Do Vegetables Have Anti-nutrients?

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

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

Lectins

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

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

Oxalates

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

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

We Love Legumes

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

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

What is a Legume or Pulse?

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

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

Rediscovering the Bean

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

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

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

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

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

Beans and Lower Cholesterol

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

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

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

Legumes and the Mediterranean Diet

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

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

Ancient Peoples and Legumes

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

Remains of lentils, the tombs of the Twelfth...

The US Preventative Task Force updated their recent recommendations about vitamins and supplements in The Journal of the American Medical Association - reference here.

Their conclusion was: "Conclusions and Relevance Vitamin and mineral supplementation was associated with little or no benefit in preventing cancer, cardiovascular disease, and death, with the exception of a small benefit for cancer incidence with multivitamin use. Beta carotene was associated with an increased risk of lung cancer and other harmful outcomes in persons at high risk of lung cancer."

We have published about how misleading labels of supplements are before - click here.

The appeal of vitamins and supplements is the ability to extract the vital chemicals (like vital amines) antioxidants, and anti-inflammatory ingredients, place them into a pill so you can avoid having a healthy diet. Trust me, a healthy diet is clinically proven to work but it is a lot easier to eat a burger and pop a pill than to remember to eat some vegetables (I like Habit Burger).

[caption id="attachment_9745" align="aligncenter" width="640"]V Yes, I do love a good burger - Habit is my favorite[/caption]

But let's go back in history for a second and let you know that surgeons love vitamins. If you haven't listened to one of my favorite stories- listen to this about the first vitamin - click here. And let us not forget that the first evidence based study in the history showed that citrus fruits prevented scurvy - who was that person that showed that - was it a "nutritionist" or was it a surgeon? Oh yes, it was Dr. James Lind - a surgeon.

Why the appeal of vitamins, besides my fantasy about eating burgers and popping a pill?

First there is the "natural" fallacy - I don't know, I think natural is more eating fruits and vegetables than pills. People tend to think of vitamins as "good" or healthy, and they are. They seem to think of a vitamin as "natural" even though they were brought to us from the golden age of biochemistry. It is clear that the vitamin and supplement companies have taken advantage of that and use terms like "support gut health" or "support immune function" or "good for cardiovascular health, " - even if those statements are meaningless.

Second, it is easier to think of things we believe we understand. Heart disease and cancer are complex topics (not that the true chemistry of vitamins aren't but they seem easy). We want to make things easy - like take vitamins and supplements for prevention or cure of cancer or heart disease, because if we start talking about scary statins or chemotherapy not only are there real side-effects but bad press. Of course with vitamins and supplements there can be real side effects - check here. My aunt's son, a Ph.D. in nuclear physics, died after taking a supplement that was to help him be "fit."

But the simple truth is this: however the polychemistry there is in fruits, vegetables, legumes, whole grains, as well as balancing dairy, meats, fats and alcohol has proven effect - we call that the Mediterranean Diet (for more see

Abstract:

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

1. Introduction

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

2. Origins and Development

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

 3. Key Principles of the DASH Diet

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

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

4. Health Benefits of the DASH Diet

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

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

5. Scientific...

The Beer and Sausage Diet

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

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

Episode Sponsor: Modifyhealth.com

I'm The Doctor

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

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

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

Careful Supervision

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

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

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

There are advantages to beer and sausages

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

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

We added vitamins and fiber to his regimen.

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

Science Wins

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

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

It didn't happen.

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

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

His cholesterol went down.

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

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

Conclusions:

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

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

Health Benefits of Fish Consumption

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

Fish, the Most Ancestral Food

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

Cardiovascular Health Exceeds Risk

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

Brain Function

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

Nutrient Profile, Such as Vitamin D

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

Fish Farms

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

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

Don't Fear the Fruit, Enjoy It

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

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

Eating fruit and Living Longer

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

Now, dad enjoys a mixed bit of fruit.

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

Each serving of fruit

8% less risk of heart disease

3% lower risk of cancer

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

Even the Low Carb Community is coming around

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

What 5 servings looks like

Breakfast with 1/2 cup of blueberries

Morning snack of one medium banana

Lunch with one apple

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

Evening snack of 1 clementine

Don't forget the tomato

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

Other Benefits of Fruit

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

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

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Produced by Simpler Media

Leaky Gut: Facts and Fads

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

A Surgeon's View

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

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

The Non-Surgical Emergency or Chronic Leaky Gut

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

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

Emulsifiers and Obesity

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

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

Non-Humans and Leaky Gut

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

Functional Medicine and Leaky Gut

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

Disease States and Leaky Gut

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

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

Non-Controversial Causes of Leaky Gut

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

Gut Barrier Anatomy and Function

The small bowel's purpose is primarily for the absorption...

Salt: Toxicity is in the Dose

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

Salt Toxcity Deniers

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

Salt and Hypertension

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

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

Salt and Cholesterol

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

The DASH diet showed no significant impact at all.

More of "The Salt Fix" Misinformation

• Our ancestors ate more salt
• The primitive argument for which there is no proof. Since our ancestors ate mostly plants and no processed foods, this is easily debunked. Meat eaters know that a one-pound chicken contains about 150 mg of salt. A double patty of hamburger has 500 mg. He makes up numbers that don't make sense.
• He states our ancestors ate from salt licks, but there are few in Africa (he makes up stuff)
• Other countries have higher salt intake and lower heart disease
• He cites Korea (which has 50% hypertension or pre-hypertension), Japan (highest incidence of stomach cancer related to salt), and France (hypertension is high, but low levels of heart disease related to the Mediterranean diet practiced by most).
• Salt doesn't lower blood pressure by a significant amount and makes food bland.
• The DASH diet studies show significant reductions in blood pressure, and the food is not bland.
• Lower salt leads to increased death.
• The opposite has been shown. Increased levels of sodium in the diet show increased levels of death.
• Lower salt leads to lower iodine levels.
• Iodized salt was introduced in the US because of the low iodine

Obesity: Not Just About Forks and Willpower

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

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

The Myth of "Just Eat Less and Move More"

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

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

The Hungry Brain: Why You Can’t Stop Eating

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

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

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

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

GLP-1: The Game-Changing Hormone

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

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

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

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

Why Obesity Is a Disease, Not a Lifestyle Choice

The idea that...

Mediterranean Diet after weight loss surgery

Success after weight loss surgery doesn't end with an operation. It just gets started.

The most recalcitrant people to diets are those who undergo weight loss surgery. Weight loss surgery patients were on multiple diets prior to surgical intervention.  The Mediterranean Diet is the best post-operative diet one can have.

Weight Loss and the Mediterranean Diet

The Med Diet is favorable for health. Multiple studies have shown decreased risk of cardiovascular disease, cancer, and autoimmune disease. What about weight loss? Systematic reviews have shown the Med Diet is equal or superior to other diets for weight loss. However, we found no post-operative program to adopt the Med Diet after weight loss surgery.

Preoperative Med Diet

We began coaching patients with the Med Diet before surgery. Many insurance companies require a preoperative, physician-supervised diet. In 2010, we began to use the Mediterranean Diet as a template for our patients using the 9-point scale.  Contrary to weight loss plans, our emphasis was learning the Med Diet.

Weight Loss Surgery Protocol Liquid Phase

The immediate post-operative diet emphasized soups and smoothies rich in legumes, vegetables, and fruits. Modular, unflavored protein supplements (whey or pea-based) were used to augment the protein content during this time, as were standard chewable vitamins.  Thus, the beginning of the post-operative plan was already a rich Mediterranean-style diet.

Early Solid Food Phase

Legumes and fish were emphasized during the early solid food phase, which were universally easy to digest. One of the favorite Mediterranean-style foods were tacos.  Contrary to popular belief, the Med Diet is not foods commonly eaten in the Mediterranean. Instead, it consists of foods rich in whole grains (corn tacos), fruits (homemade salsa), legumes (lentils), some dairy products (cheese), and fish.

We noted lettuce was problematic for some in the early phase, but spinach was easy to digest. Thus salads were based upon spinach rather than lettuce.

Later Solid Food Phase

As the stomach continued to heal, we stressed the increase in food with multiple fiber types.  We de-emphasized red meats, cautioned against excess alcohol, and worked on olive oil as the primary source for fats.

Follow up

Cooking classes were a constant feature of our support group, often bringing in guest chefs from the area and the Food Network. We emphasized the importance of patients learning to cook.  Many of our patients believed that cooking was the most important aspect of their postoperative care. We found that those who learned to cook their meals had better weight loss than those who did not.

Validated Food Frequency Questionnaires (FFQ) were used to follow a group of patients. The FFQ were validated using dietary logs during follow-up with patients.

Getting in that quantity of food

Stomach capacity after weight loss surgery is limited. How, then, does one get in the required amount of food? It is not difficult.

All food is measured pre-cooked. Take broccoli. If you take nine ounces of broccoli and bake it, you end up with a small amount of volume but still have the one Mediterranean Diet point.

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

Food increases over time

Food volume increases over time with both the Gastric Sleeve, Lap-Band, and RNY gastric bypass. The answer is not to eat less or take more protein shakes. The...

Adherence to the Mediterranean Diet decreases the risk of cardiovascular disease. The Seven Country Cohort Study clearly showed this.

But what about cancer? Does the Mediterranean Diet impact cancer or cancer prevention? To study this, another cohort study began called the EPIC study. Uniquely, the EPIC showed not only a decreased risk of cancer but also mortality from cancer.

All vegetables, even the green ones, have nitrates. It turns out that the components of The Mediterranean Diet decreases the risk of cancer, decreases the risk of cancer recurrence, improves survival from cancer, and decreases overall mortality.

EPIC Study

The European Prospective Investigation into Cancer and Nutrition (EPIC) is a large cohort study involving over 521,000 individuals from 23 centers from ten countries.

Adherence to the Mediterranean Diet and Longevity

The EPIC researchers developed a simple scoring system to determine adherence to the Mediterranean Diet.  Greater adherence to the Mediterranean Diet was associated with longevity.

The Scoring System

The Mediterranean Diet is scored on a scale of one to nine. Nine being a perfect Mediterranean Diet Score, and zero being poor. Great adherence to the Mediterranean Diet is a score of seven points or more.

Eating more of these foods gives you points

The Mediterranean diet is rich with vegetables, legumes, fruits and nuts, whole grains, and fish.

• You get a point for consuming 9 ounces or more of vegetables a day. If you consume less than nine ounces, you get a score of zero.
• Legumes will net you a point if you consume two ounces or more per day.
• Fruits and nuts are one point for nine ounces or more.
• Likewise, whole grains are worth a point for nine ounces or more.
• Fish is an average of an ounce a day, or two main meals per week. Thus,  by consuming a diet rich in these five components can score five points.

The weight is based on pre-cooked food.

Lentils are a legume, and if you consume more than 2 ounces per day, you will score one Mediterranean Diet point. They are high in protein and fiber and low in saturated fat.

Eat Less for More

People from the Mediterranean didn't eat much meat or dairy.  By consuming less of these, you can achieve Mediterranean Diet points.

• Eating less than  4 ounces of meat a day  is worth one point
• Consuming 1.5 ounces of hard cheese a day or LESS is worth one point
• Consuming less than 8 ounces of dairy is worth one point (mostly consume yogurt).

Thus by eating less dairy and meat, or none, you can score two additional points.

You might think that 6-ounce burger is small, but if you eat less than four ounces of meat a day, you get one Mediterranean Diet point. Eat more than four ounces, and you get zero points.

Alcohol

Alcohol is a component of the Mediterranean Diet but in moderation.

For ethanol, a value of 1 was assigned to men who consumed between 10 and 50 g per day and to women who consumed between 5 and 25 g per day. This corresponds to 5 ounces of wine for women or 10 ounces for men.

Olive Oil

Olive oil is an important component of the Mediterranean Diet. The type of fat in olive oil is mainly monounsaturated. The ideal ratio of olive oil or monounsaturated fats to saturated fats should be at least 60%.

The best olive oils come from the US.

Interventions in the Mediterranean Diet

Increasing the score in the Mediterranean Diet by two points in the Mediterranean diet led to...

What Are Ultra-Processed Foods?

Ultra-processed food (UPF) might sound like something concocted in a secret laboratory, but it simply refers to foods that are significantly altered from their original state. These often contain additives like emulsifiers, preservatives, and stabilizers—ingredients you wouldn’t typically find in a home kitchen.

This category includes everything from convenience-store hot dogs to plant-based meat alternatives. Yes, even your favorite vegan nuggets fall into this group.

Common Myths About Ultra-Processed Foods

Myth #1: They’re Toxic and Will Kill You Instantly

If ultra-processed foods were as lethal as some claim, most of us wouldn’t have survived past childhood. While some contain high amounts of salt, sugar, and fat, they aren’t inherently poisonous. The key is moderation. A diet loaded with neon-colored cheese puffs and soda? That’s a health disaster. But an occasional indulgence won’t do you in.

Myth #2: Twinkies Last Forever

Twinkies have a long shelf life, but they aren’t immortal. The idea that they’ll outlast civilization comes from misunderstood experiments on old snack cakes. In reality, they’ll go stale and unappetizing over time—just like any other food.

Myth #3: If You Can’t Pronounce an Ingredient, It Must Be Bad

Complicated words don’t necessarily mean something is harmful. For example, cyanocobalamin is just vitamin B12, an essential nutrient for your nervous system. Even dihydrogen monoxide sounds ominous—but it’s just water.

The Real Issue with Ultra-Processed Foods

Many ultra-processed foods are designed to be hyper-palatable, meaning they activate your brain’s reward system. Ever wonder why it’s so easy to eat an entire bag of chips in one sitting? It’s not just about willpower—these foods are engineered to be irresistible.

Additionally, ultra-processed foods tend to be calorie-dense but nutrient-poor. They can crowd out healthier, more nutrient-rich options, leading to deficiencies over time.

Can You Eat Ultra-Processed Foods and Stay Healthy?

Absolutely! The key is balance. If 80% of your diet consists of whole foods—fruits, vegetables, lean proteins, and whole grains—you can enjoy processed indulgences in moderation. The problem arises when ultra-processed foods dominate your meals.

Final Thoughts: Should You Fear the French Fry?

No. Fear misinformation more than the occasional processed snack. The goal isn’t to live on a diet of raw kale and regret—it’s about making informed choices.

Enjoy your guilty pleasures in moderation, but don’t let them replace nutrient-dense foods. Science, not fear, should guide your eating habits.

For more food science insights, follow me on TikTok and Instagram at @drterrysimpson. And remember—eat smart, not scared!

Diets. They work for some, but not for others. "You're just not on the right diet," purveyors of the latest trend will tell you. "You're just not on the right diet for your blood type, ethnicity, age, hair color," says another set of true believers.

So what's right and what's wrong?

Today on Fork U, a conversation between Dr. Terry Simpson, weight loss physician, and Dr. Bill Lagakos, nutritional biochemist and physiologist, where they expose the truth behind diets and why they may, and may not, work for you.

And check out Bill's book, The Poor Misunderstood Calorie.

TRANSCRIPT:

Terry Simpson: Bill, there are a lot of weight loss programs out there. The one that I'm hearing the most about most often is the Keto movement, which says that they're going to cure everything from heart disease and cancer.

Bill Lagakos: I think from a 30,000-foot view, Keto works for a lot of people. So does low fat. I like some of the recent work, the studies showing it's more about the level of processing of the food.

So you can have a vegan diet or you can have a Ketogenic diet and as long as it is excluding a lot of processed foods, it tends to not be over eaten. And people that tout the magical benefit effects of any of these diets, 99% of the time it's due to weight loss.

Terry Simpson: We actually had an experiment with Evo, who you met. He uhh did it several years, three or four years in a row for one month, Evo would go on a beer and sausage diet, rigorously kept his calories to 1500. We measured his liver function tests, his lipid panel.

Every year he lost weight, kept it off, and every year his liver function was fine, surprising with the number of beers he had a day, which was limited to six. But it was, he had weight loss and he had sustained weight loss over the year with a, kind of this funky diet we sort of made up.

Bill Lagakos: Well, that's terrific. And that's an awesome diet. I'm jealous.

But, uh, yeah, that, that basically proves the point. I mean, even if it's not a lot of weight he lost, I think a weight loss is a major driver in a lot of the health improvements that people like to attribute to particular dietary trends.

Terry Simpson: There doesn't seem to be a lot of long-term data in these diets. When I look at the sort of metadata, I see that if you eat really high on the low-fat side, you have a little lower lifespan. If you eat really high on the high-fat side, you have a little lower lifespan. If you have your carbs at about 55%, you seem to have a little longer lifespan.

Is there much good data saying one diet versus another, other than the Mediterranean, has great long-term results?

Bill Lagakos: I don't think so. I don't think it comes down to macros at all. I think that there's the confounding in those studies is so deep that I don't think the macronutrient composition of your diet is going to be what kills you in the end.

Terry Simpson: Part of your job is helping people lose weight. What are sort of the big messages you try and get through to people?

Bill Lagakos: One of the biggest things is the importance of adherence, which is why I try to say, you know, what do I know that, that you can adhere to 100%? It's what you've been doing because you've been doing it. So let's try and find the lowest hanging fruit that we can change so it doesn't turn your whole world upside down, which is something that would probably never work.

Terry Simpson: So in other words, you're not going to change a Keto into a vegan or a vegan into a Keto....

The Carnivore diet is the most extreme of the low-carbohydrate diets, with its expressed point that humans did great on a diet of flesh and evolved to eat a diet high in fats.

While we cannot make up what people ate in the past, we can see about the diet of the Yupik’s of Alaska.  These people have been studied extensively by the Center for Alaska Native Health Research (CANHR) at the University of Alaska in Fairbanks who partnered with Genetics of Coronary Artery Disease in Alaska Native people.

First the CANHR found that Alaska Natives who ate processed meats (hot dogs, lunch meat, fried chicken) had higher triglycerides. Those Yupik’s who consumed lots of omega-3 fatty acids and ate lots of meats with saturated fats developed coronary artery disease. As much as we like to get our omega-3 fatty acids from the sources, and few in the world eat as many as the Yupik’s, that cannot protect you from coronary artery disease in the presence of the over-consumption of saturated and trans fatty acids. It further showed that, at least for the Yupik’s, consuming processed meats, and meats high in saturated fats like beef, pork, lamb and chicken with skin was not healthy for the Alaska Natives.

The Carnivore diet excludes greens and berries, however sea greens and berries are a large part of the traditional Yupik diet. The diet that they have is high in marine mammals, fish, game animals, greens and berries that provide high levels of fat soluble vitamins (A,D,E, and K) as well as iron.

The Biotruth of the Carnivore Diet:

A biotruth is a logical fallacy, usually found to be a misunderstanding of evolution. In this case the idea that early human ancestors were meat eaters and that the adaptation of cultivation of crops led to chronic disease.

When CT scans were looked at from 137 mummified remains from four geographical regions, ancient Egypt, Peru, the Pueblo, and Unangan from the Aleutian Islands were examined they found atherosclerosis in all of them. 

“Interpretation: Atherosclerosis was common in four preindustrial populations including preagricultural hunter-gatherers. Although commonly assumed to be a modern disease, the presence of atherosclerosis in premodern human beings raises the possibility of a more basic predisposition to the disease.”

It should be noted that those were diverse diets from those who ate primarily marine mammals and fish to those whose diet was composed primarily of vegetation with little meat.

The Myths of LDL

The low carbohydrate community propose that LDL isn’t an issue with heart disease. This flies in the face of the recent article in JAMA looking at 34 clinical trials and finding that lowering LDL-C not only decreased the risk of heart disease, but all causes of mortality. While the low-carb crowd likes to point out how sugar indeed has a role in development of heart disease, they quietly forget to point out that diets rich in meats are overwhelmingly an issue.

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Fork U is part of the Your Doctors Orders network of podcasts and is hosted by noted physician and surgeon Dr. Terry Simpson.

• Follow Dr. Terry Simpson on TikTok for bite-sized content on  healthy eating
• Visit TerrySimpson.com for additional details on Dr. Simpson

Scientists and dieticians consistently  rank The Modern Mediterranean Diet (MED diet) as the diet most recommended.  But often people don't know what the MED diet is. This post will  define the Med diet.

Critics of the Med Diet

Critics  argue that there is no uniform MED diet. They make these assertions based on one of these three arguments:

1. That there is no uniform diet of the Mediterranean Region. There are over 20 countries on the 26,000 miles of coastline of the Mediterranean Sea. Each country with their own unique diets. Many of which have adopted a more modern American style diet.
2. The diet is simply made up and therefore should be ignored.
3. Finally some point out that there are many Med Diets as the literature.

Heart disease and Diet

Ancel Keys is the scientist most responsible for not only the Med diet but the relationship of heart disease to diet. In the 1950's, heart disease was thought to be a disease of aging, and smoking but not diet or lifestyle.

In the 1950's, much like today, heart disease was the number one cause of death among of middle aged executives. While there was a clear association between smoking and heart disease, there were far more deaths than could be explained from smoking.  Then an Italian scientist told Dr. Keys about the low incidence of cardiovascular deaths of men in Naples.

Heart Disease and Diet in Europe

Keys confirmed this claim when he took a sabbatical in Oxford in 1952.  Keys found there was a difference of heart disease between the poor and the executives of Italy. He developed the hypothesis that diet might explain difference  between the two groups.  To confirm this Keys, and his wife, then traveled throughout Europe catalog different diets and rates of heart disease.

In 1955 Keys presented his data to the World Health Organization, concluding  that diet played a significant role in heart disease.  Many members of the WHO mocked his  "diet-heart theory."  Keys then organized the seven countries study (click here).

Seven Countries Study

The seven countries study was an observational study looking at biomarkers, lifestyles and their relationship to heart disease.  Those countries were Greece, Italy, former Yugoslavia, Finland, The Netherlands, Japan, and the United States. The cohorts were chosen because of diverse diets, lifestyle, and risk factors. Dietary and lifestyle influence on cardiovascular disease was unknown at the time.

The seven country study was to answer the question about dietary influence and heart disease.

The French Paradox

Low-carb bloggers accuse the seven country study of leaving out France. They cite the French Paradox, that the French eat a diet high in saturated fat but have a low incidence of heart disease.

However, France was not left out of the study.  French investigators were present at the original pilot study in Nicotera Italy, but ultimately decided not to participate in the study.  France was recovering from World War 2 and simply didn't have the resources to commit to such a study.

In fact, The French Paradox was "coined" in the 1980s, over twenty years after the  start of the seven country study. The investigators didn't have access to that data, or the term. Low-carb bloggers  didn't read the seven country study or the French...

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

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

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

Weight Watchers and Sequence

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

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

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

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

It is More Than Willpower - Ask Oprah

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

Obesity Management is more than a diet - ask Weight Watchers

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

Keeping you out of the Emergency Room - Side Effects of the New Drugs

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

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

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

Compound Pharmacies and "generic Ozempic"

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

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

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

Many of these compound pharmacies import semaglutide from overseas. It is illegal to import a drug from overseas without FDA approval. Furthermore, the drugs they import are not the same formula...

Common Collagen Claims (taken from actual websites selling collagen supplements):

• “improves skin elasticity,”
• “support bone and joint health,”
• “strengthen hair, skin, and nails,”
•  “may benefit the bodies cellular structure,”
• “support healthy skin, bone, and joints.”
• “will feed your skin health”
• “will improve nail appearance and strength”
• “lead to a noticeable hair thickness”

Collagen as a supplement is not regulated by the Drug division of The Food and Drug Administration

If you look at the bottom of the websites, or on the bottles, you will see a disclaimer that the claims “have not been evaluated by the U.S. Food and Drug Administration. ” More telling is “these products are not intended to treat, diagnose, cure, or prevent any disease.” Such a disclaimer is provided by the lawyers because if one claims to cure, treat, or diagnose an actual medical condition then it must have passed a rigorous FDA approval. To be clear, there have been no FDA studies that show collagen as a supplement treats any disease.

Supplements commonly will use “support xyz health” – where you can fill in the blank with hair, nails, joints, skin – in the case of collagen.

One of the main issues with supplements is “If the composition and quality of ingredients cannot be reliably ensured, the validity of research on dietary supplements is questionable. Moreover, the health of the US public is put at risk.”

Starr RR. Too little, too late: ineffective regulation of dietary supplements in the United States. Am J Public Health. 2015;105(3):478-485. doi:10.2105/AJPH.2014.302348

As such, even when you look at the studies which promote collagen, or collagen byproducts, they do not meet the most basic of studies which are done to evaluate pharmaceuticals. In order to have an evaluation of a pharmaceutical you must have three phases in the trial:

• phase one is determining the dose for safety. While the supplement industry is happy if you think all supplements are good and all pharmaceuticals are evil – everything, every drug, every chemical from water to salt to formaldehyde has a toxic dose
• phase two is to test the drug for efficacy and side effects. Some people will react poorly to a supplement just as they will a drug. WE need to know what those side effects are. With a supplement people who don’t feel well often just stop it – or, like my cousin, die (yes, I had a cousin who died from a supplement).
• phase three testing is to determine if there is truly efficacy, what is the effectiveness and what is the safety.
• phase four is post-marketing surveillance in the public because even though you have gone through trials with a number of phases and under strict supervision when a drug is released to the public you have the chance to see millions of reactions.

Thalidomide, for example, was released in Europe and even had two drug trials in the United States but was NEVER approved in the United States by the FDA because of insufficient data.

Vioxx was a drug used worldwide and was taken off the market in 2004 because of the risk of a fatal heart attack, but was taken off after it had passed multiple drug tests previously.

FDA testing is rigorous and specific, with the highest standards in the world. Collagen has NEVER had such rigorous testing performed. These tests have not risen to the level and in 2022 one report noted “More research is needed to establish knowledge of the effects and physiologic mechanism of collagen supplementation. Dermatologists should be aware of the unsubstantiated proclamations of collagen made by companies and in social media, as well as what evidence is established thus far, to be equipped to discuss collagen supplementation with patients.”

Rustad AM, Nickles MA,...

Nuts and Seeds, or Supplements

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

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

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

Food Works, Supplements May Not

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

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

Other Foods That Work:

Almonds, dry roasted: 1 oz, 80 mg

Spinach, boiled: ½ cup, 78 mg

Cashews, dry roasted: 1 oz, 74 mg

Peanuts, oil roasted: ¼ cup, 63 mg

Soymilk, plain or vanilla: 1 cup, 61 mg

Black beans, cooked: 1⁄2 cup, 60 mg

Peanut butter, smooth: 2 tablespoons, 49 mg

Bread, whole wheat: 2 slices, 46 mg

Avocado: 1 whole one is 44 mg

Potato, baked with skin: 3.5 oz, 43 mg

Rice, brown, cooked: 1⁄2 cup, 42 mg

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

Oatmeal, instant: 1 packet, 36 mg

Banana: 1 medium, 32 mg

Salmon, Atlantic, farmed: 3 oz, 26 mg

Halibut, cooked: 3 oz, 24 mg

Raisins½ cup, 23 mg

Chicken breast, roasted: 3 oz, 22 mg

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

Broccoli, chopped & cooked: ½ cup, 12 mg

Apple:1 medium, 9 mg

Carrot, raw: 1 medium, 7 mg

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

TEXT FROM PODCAST:

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

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

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

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

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

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

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

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

The Mediterranean magnesium miracle. Where do you get this? Well, first try nuts and seeds, which we include in the fruit section of the Mediterranean diet. Did you know that two Brazil nuts contain enough magnesium for a person for a day? An ounce of pumpkin

Seed Oils, Omega 6, and Inflammation

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

The New Sugar Conspiracy

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

Their logic goes like this:

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

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

It is Peanut Butter

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

Added Sugar

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

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

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

Low Carb Sugar Conspiracy

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

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

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

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

Where It Falls Apart

But something about your low-carb diet doesn't make sense. You notice that obesity has increased in the United States. But...

Whole Grains Reduce Obesity

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

The difference

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

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

The Bran

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

Fiber is Essential

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

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

The Microbiome

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

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

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

Interesting Functions of Gut Bacteria

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

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

How much to eat?

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

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

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

Did You Try the Carnivore Diet?

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

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

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

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

Simplicity, is Thy Name Carnivore?

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

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

Then reality comes home:

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

FORK U

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

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

Fork University

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

Carnivore Diet

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

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

The Biotruth of Evolution

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

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

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

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

As we evolved, were we better...

Learn to Cook Fish

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

Cooking Methods:

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

Delicious Fish Recipes:

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

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

For more great recipes, see terrysimpson.com.

Do You Need A Liver Cleanse?

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

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

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

History of Liver Scams

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

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

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

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

The Master Cleanser

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

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

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

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

Gallbladder Flush

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

The Liver's Job

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

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

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

Liver and Alcohol

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

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

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

Milk Thistle and The Liver

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

Supplements touted to help the liver include:

Milk Thistle.  The active ingredient is silymarin. Silymarin has been extensively studied in alcoholic liver disease, fatty liver disease, hepatitis, Tylenol poisoning, and...

Sorry It Didn't Work

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

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

Diet Disappointment

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

Low Carb Disappointment

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

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

Coffee and Diets

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

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

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

Now What?

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

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

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

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

My Journey to Culinary Medicine

About ten years ago, I received certification in Culinary Medicine. Part of that training was long hours reviewing the literature...

Rice and Fruit or Carnivore

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

History of the Rice Diet

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

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

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

The Rice Diet

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

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

Contrast the Carnivore Diet

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

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

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

No Science in the Carnivore Diet

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

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

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

No Academic Researchers

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

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

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

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

Shawn Baker is an orthopedic-trained surgeon who lost his medical license and makes his money promoting the carnivore diet. The New Mexico Medical Board ordered the "voluntary and permanent...

Dietary Myths vs. Nutritional Science: Why the Mediterranean Diet Reigns Supreme

As an Athabascan physician and culinary medicine expert, I'm often amused by the dietary myths perpetuated online, particularly those championed by keto and carnivore diet enthusiasts. Today, let's debunk some of these myths—Inuit diets, Hong Kong longevity, Maasai heart health, and the so-called French paradox—and explain why decades of robust nutritional science firmly support the Mediterranean diet.

Myth 1: The Inuit Diet

Low-carb proponents love pointing to the traditional Inuit diet as evidence of the supposed superiority of carnivorous diets. Yes, Inuit diets are traditionally high in marine mammals like whales, seals, and fish, providing ample vitamin C from sources such as muktuk (whale skin and blubber) and seal liver. Yet, archaeological evidence clearly shows ancient Inuit mummies suffered from vascular disease, challenging the claim that their diet was protective (Fodor et al., 2014). Additionally, Inuit diets historically incorporated plant-based foods such as berries, seaweed, and tubers during summer months—a fact conveniently overlooked by keto advocates.

Myth 2: The Hong Kong Longevity Claim

Another popular keto narrative incorrectly attributes Hong Kong's impressive longevity statistics to high meat consumption. But research shows elderly individuals in Hong Kong typically eat less meat and adhere closely to diets resembling the Mediterranean style, rich in vegetables, seafood, and whole grains (Woo et al., 2001). Again, context is key—and frequently missing from keto claims.

Myth 3: Maasai Immunity to Heart Disease

The Maasai, often cited as proof that diets rich in saturated fats don't cause heart disease, actually demonstrate the opposite. Recent studies confirm significant atherosclerosis and cardiovascular issues among Maasai populations, underscoring that even "warrior" genetics don't provide immunity from saturated fat-related diseases (Mann et al., 1972).

Myth 4: The French Paradox

Ah, the French Paradox—the idea that French populations consume diets high in saturated fats yet experience low heart disease rates. The reality is simpler: the French eat plenty of vegetables, fruits, olive oil, seafood, and emphasize portion control and mindful eating. France was initially included in the famous Seven Countries Study but was ultimately excluded due to funding constraints—not dietary irregularities (Kromhout et al., 2017). It's sensible eating, not paradoxical magic.

Solid Science: The Mediterranean Diet

Contrary to these dietary myths, extensive nutritional science consistently supports the Mediterranean diet. Two landmark studies illustrate this clearly:

• Seven Countries Study: Spanning 50 years and involving over 14,000 men, this research demonstrated clearly superior cardiovascular outcomes for individuals following Mediterranean-style diets rich in vegetables, fruits, whole grains, legumes, fish, and olive oil compared to higher-fat diets (Keys et al., 1986).
• EPIC Study: Following over half a million Europeans, the European Prospective Investigation into Cancer and Nutrition showed that diets emphasizing plant foods and limiting red and processed meats significantly reduce cancer risks (

The Green Mediterranean Diet

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

Advantages of the Green Mediterranean Diet

There are three advantages to Green-Med

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

Fatty Liver

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

Is fatty liver caused by sugar or fat or both?

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

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

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

Reducing fatty liver

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

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

Visceral Fat

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

Cardiovascular Risk Factors

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

Implementing the green Mediterranean Diet

The difference between the green and standard Mediterranean diet

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

Green Tea is Easy

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

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

Decreasing red meat isn't difficult.

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

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

The Great Egg Redemption: How Science Saved Breakfast (But Not Your Wallet)

For decades, the humble egg was treated like a ticking time bomb for your arteries. Nutrition guidelines told us to avoid them, doctors warned us about cholesterol, and many Americans swapped their morning omelet for a sad bowl of processed cereal. But here’s the kicker—those recommendations weren’t based on strong science. Instead, industry interests heavily influenced them, outdated theories, and a lot of fear-mongering.

Now, eggs are back on the menu. Science has finally caught up, and experts agree that dietary cholesterol isn’t the villain it was made out to be. But just when we thought we could enjoy eggs guilt-free, bird flu struck, prices skyrocketed, and suddenly, eggs became the new luxury item. So, how did we get here? Let’s crack open the truth.

The Food Pyramid: A Big Business, Not Big Science

If you grew up in the 90s, you probably remember the Food Pyramid. It told us to eat 6-11 servings of bread, pasta, and cereal every day, while foods like eggs, meat, and fats were placed at the top—basically labeled "Eat Sparingly."

But was this pyramid built on solid science? Not exactly.

The grain industry played a huge role in shaping these guidelines. In the 1970s and 80s, low-fat diets became the gold standard for heart health. The idea was simple: eating fat leads to heart disease, so cutting out fat would make us healthier. Unfortunately, that’s not what happened.

Instead, food companies removed fat from products and replaced it with sugar and processed carbs—because, let’s face it, fat-free food tastes terrible without something to make it palatable. As a result, Americans ended up eating way more refined carbs and sugar, leading to a spike in obesity and type 2 diabetes (Ludwig et al., 2018).

Meanwhile, eggs—one of nature’s most nutrient-dense and affordable foods—were put on the naughty list.

The War on Eggs: How a Bad Idea Became Dietary Dogma

The real egg panic began in 1968 when the American Heart Association (AHA) declared that dietary cholesterol was a major cause of heart disease. They recommended eating no more than three eggs per week (Kritchevsky, 1999).

But here’s the problem—this recommendation wasn’t based on strong human studies. Instead, it was based on:

1. Animal Studies – Scientists fed cholesterol to rabbits, which are naturally herbivores, and (shocker!) their cholesterol went up. But rabbits process cholesterol differently than humans (McNamara, 2000).
2. Epidemiological Correlations – Early studies linked high cholesterol intake to heart disease, but they didn’t separate it from other factors like saturated fat, smoking, or lack of exercise (Hu et al., 1999).
3. Clinical Studies With Unrealistic Diets – Some studies tested cholesterol intake using six eggs per day—which is way more than most people eat (Fernandez, 2006).

Meanwhile, many scientists already knew that dietary cholesterol had minimal impact on blood cholesterol for most people. Our bodies naturally regulate cholesterol production—when we eat more cholesterol, the liver produces less to balance it out (Griffin & Lichtenstein, 2013).

But by the time the science caught up, the damage was done. Food companies had already flooded the market with...

On my tiktok channel (@drterrysimpson or terrysimpson309) putting up a review of red meat the comments are reflective of the polarization that makes politics look like gentle disagreements.

Nutrition is nuanced - meaning, it is rare that something is good or bad for us, except for Death Cap Mushrooms, they will kill you, although I hear they are delicious. The same is true for red meat. What we have are rarely the types of nutrition studies where we feed people precise amounts of food and see the results (the DASH diet studies were great with this -ref 1 ). Instead we rely on what people tell us, which can be accurate, or not - and we look at markers for disease instead of the disease itself (looking at end points of heart disease we look at LDL, cholesterol, C-reactive protein, and rather non-specific markers.

Red Meat and Glycemic Control and Inflammation

In this study (ref 2) they examined the premise that red meat's has an effect on inflammatory markers and glycemic control. So the study  was a meta analysis of randomized control of glycemic control and inflammatory markers.

Adults that were studied were given various quantities of red meats and then checked for glycemic control and inflammation. The end result "Total red meat consumption, for up to 16 weeks, does not affect changes in biomarkers of glycemic control or inflammation for adults free of, but at risk for, cardiometabolic disease. "

Does this put this to bed - not really, but the proposed ill effect of red meat is not something that is seen in these studies.  Here are the markers they studied: glucose, insulin levels, HOMA-R, Hemoglobin A1c, C-reactive protein, IL-6, and TNF-alpha.

This was a group of studies that went to about 16 weeks (four months) so any longer term issues with red or even red processed meats, were not seen. But there were clearly no indication found in these studies.

What about other markers for heart disease?

So the next question is the effect of red meat on lipids, lipoproteins and blood pressure(ref 3)? It turned out that increasing red meat did not affect those variables for heart disease.

What if you check not just red meat, but "red meat with diets that replaced red meat with a variety of foods. We stratified comparison diets into high-quality plant protein sources (legumes, soy, nuts); chicken/poultry/fish; fish only; poultry only; mixed animal protein sources (including dairy); carbohydrates (low-quality refined grains and simple sugars, such as white bread, pasta, rice, cookies/biscuits); or usual diet. We performed random-effects meta-analyses comparing differences in changes of blood lipids, apolipoproteins, and blood pressure for all studies combined and stratified by specific comparison diets."- from ref 4.  They found that changing red meat for plant protein had a minimal effect, and yet other studies (ref 2) found that plant protein had no significant difference at all.

Those short term studies, which are clear changes with specific amounts over a short period of time, appear to contrast with the studies of various groups where they look at the risk of type 2 diabetes and red meat consumption. Take reference 5, where they looked at the increase of diabetes in different groups based on self-reporting of red meat intake. These studies are not as powerful as the controlled trials above, and they are confounded by other variables - people who eat more red meat have higher caloric intake and more obesity, they also tend to drink more and to smoke more. It is not easy to isolate, statistically, those variables out and this is always the issue with large cohort studies.

Take the many studies of the Seventh Day Adventist group, who are considered America's Blue Zone in Loma Linda, California. They don't eat meat, they live longer -- but there is more, that group tends to exercise more, they do not

Welcome to Fork U, the latest podcast from Dr. Terry Simpson.

If you enjoyed the previous episodes of Culinary Medicine and Your Doctors Orders, you'll love these quick, impactful bits of information that are easily digestible. (See what I did there?)

No need to adjust your podcast or subscribe to anything new, you are already here!

With that, here is the first episode of the new podcast, Fork U, where you can learn a bit about food and medicine.

Why you should ditch your gas stove

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

Types of Indoor Cooking

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

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

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

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

Wooden Stoves

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

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

Cooking with Gas

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

They were trying to compete with "clean electric"

Indoor pollutants with gas range tops

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

include:

• Nitrogen dioxide
• Carbon dioxide
• Methane emission
• Benzene

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

Culture Wars

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

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

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

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

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

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

Research

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

What can you do?

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

Converting to induction stovetop might be...

Three Great Diets

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

Mediterranean Diet

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

DASH Diet

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

MIND Diet

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

Three Diets are Branches of the Same Tree

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

1. Rush Memory and Aging Project:

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

2. Columbia University Medical Center Study:

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

3. Alzheimer's Disease Neuroimaging Initiative (ADNI):

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

4. Systematic Reviews and Meta-Analyses:

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

5. Mechanisms of Action:

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

More research is needed to elucidate the mechanisms underlying the protective effects of the MIND diet.  Current evidence suggests that...

Bird Flu: What You Need to Know About Risks, Realities, and Readiness

Bird flu, or highly pathogenic avian influenza (HPAI), has far-reaching effects on public health, the food supply, and even the global economy. While human-to-human transmission hasn’t occurred, its potential to mutate poses significant concerns. Understanding how bird flu impacts us today — and how science is working to mitigate its risks — is essential.

In this blog post, we’ll explore the realities of bird flu, its effects on food prices, the role of vaccines, and practical tips to stay safe. Let’s break it down into manageable pieces so you’re fully informed.

What Is Bird Flu, and Why Should You Care?

Bird flu primarily affects birds, especially poultry, like chickens and turkeys. However, certain strains, such as H5N1, have occasionally infected humans. While these cases are rare, they carry a high mortality rate of over 50%, making the virus particularly dangerous if contracted.

Why Human-to-Human Transmission Matters

Here’s the good news: Bird flu isn’t currently spreading from person to person. The bad news? Experts worry about a process called reassortment, where bird flu and human flu viruses could mix in someone infected with both. This could result in a highly contagious and deadly strain capable of causing a pandemic.

Despite some conspiracy theories, no laboratory is working on gain-of-function research to make bird flu more transmissible. These myths are counterproductive, distracting from real medical efforts to monitor and control the virus.

Rising Prices: How Bird Flu Impacts Your Wallet

If you’ve noticed higher prices at the grocery store, bird flu is partly to blame. The virus has disrupted the poultry industry and the broader food supply chain.

Egg Prices Soar

When bird flu outbreaks occur, millions of chickens are culled to prevent the virus from spreading. This reduction in supply causes egg prices to skyrocket, leaving many of us paying more for our morning omelets.

Dairy Costs Climb

Bird flu also affects dairy products. The demand for poultry feed drives up costs for dairy farmers, who often rely on the same feed. Additionally, in rare cases, parts of the bird flu virus have been detected in raw milk. This is yet another reason to avoid raw, unpasteurized milk and stick to pasteurized dairy products for safety.

The Role of Vaccines: Science in Action

Vaccines are at the heart of our response to bird flu, but they serve different purposes for birds and humans.

Vaccines for Poultry

Scientists are developing vaccines for poultry to control the virus in bird populations. These vaccines could:

• Reduce the need for mass culling.
• Lower the economic impact on the poultry industry.
• Decrease the risk of the virus spilling over into humans or other animals.

While these efforts are promising, it will take time before poultry vaccines are widely implemented.

Vaccines for Humans

For humans, H5N1 vaccines are available for at-risk workers like poultry farmers and wildlife handlers. However:

• These vaccines are strain-specific and may not protect against a mutated strain.
• They are not available to the general public.
• In the event of a pandemic, new vaccines would need to be developed, which takes time.

Seasonal Flu Vaccines:...

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

Introduction: The Revolution Starts Here

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

Breaking Free from Diet Culture: Goodbye, Guilt

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

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

Taming Side Effects: Fiber, Hydration, and the Art of Not Overeating

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

Constipation: The Fiber Fix

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

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

Hydration: Sugar-Free Isn’t Always Your Friend

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

Nausea: Avoid the Grease Trap

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

Building Healthy Habits: Small Steps, Big Wins

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

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

Long-Term Success: Sustainable, Not Perfect

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

Ancestral Diets and Logical Fallacies

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

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

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

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

What Do We Know About Early Humans?

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

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

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

Homo Erectus

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

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

Fossil Records

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

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

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

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

Recent Discoveries

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

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

Hunter-Gatherers

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

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

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

If you don’t have diabetes, should you even consider a blood glucose monitor? Well, here is the science behind this new tiktok trend and why these Continuous Blood Glucose Monitors (CGM) are here to stay and what we know about them.

The device

First, the device – a continuous blood glucose monitor is a device that you place on your body and it measures the blood glucose level and reports that data typically to an application on your phone. The first blood glucose monitors were used to help patients with type 1 diabetes regulate their blood sugar. They were revolutionary, but expensive, not covered by many insurance companies, and cumbersome. As the technology has improved, the price has decreased, the comfort level has improved, and the accuracy of the monitoring has improved. As with most technology, blood glucose monitors are now less expensive, better, and widely available.

You can read more about the history of the blood glucose monitor here.

Most diabetics use a fingerstick to see what their blood glucose is, and use that information to determine the medicine they need to help regulate their blood glucose. The CGM allows real-time data which can be checked against food logs to allow a person to see impact of their diet on their regulation of food. As the epidemic of diabetes grows, about 55 million predicted with diabetes by 2030, we know that the less variability in glucose, the better long-term outcome (reference here) and here.

Variability in blood glucose with non-diabetics

It turns out that even people who are not diabetic, have wide variations of blood glucose (reference here). Further, the variations in blood glucose have real time effects and we should care about those effects.  For example, high glucose spikes lead to inflammation of the arteries, even in non-diabetics, which lead to atherosclerosis, heart disease, strokes and peripheral vascular disease (click here). A study published in Journal of the American Medical Association (here) concluded “Providing individuals with tools to manage their glycemic responses to food based on personalized predictions of their PPGRs may allow them to maintain their blood glucose levels within limits associated with good health.”

What is best?

Avoiding the large variability in blood glucose is clearly important to health whether one has diabetes or not. Trying to predict what variability will be based on fasting blood glucose or hemoglobin A1C cannot be done.

Using a healthy diet like the Mediterranean or DASH diet – this has been found in studies with CGM on young people with type 1 diabetes (reference ) 

Even variations of the Mediterranean Diet and CGM have found improvement in glucose variability.

Economies of...

The Future of Diets: From Weight Loss to Nutrition, Thanks to GLP-1 Drugs

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

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

The GLP-1 Revolution: Shedding Pounds Without Shedding Tears

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

Why This Changes Everything

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

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

Citation: Clinical trials on GLP-1 drugs have shown sustained weight loss for a majority of participants (Wilding et al., 2021).

From Weight Loss to Wellness: The New Role of Diets

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

1. Nutrition Over Numbers

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

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

Fun Fact: Your brain is about 60% fat, so eating healthy fats can actually make you a better thinker. Finally, an excuse for avocado toast!

2. Functional Foods

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

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

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

Mediterranean Diet - Fats

Perhaps the most important part of the Mediterranean Diet is this plant.

Olive oil is the single ingredient most associated with the Mediterranean Diet. It is the one single food substitution you can do that will improve your health immediately and have great consequences. But not all olive oil is the same.

Olive oil and your heart

There are many types of fat that you can find in your diet. Saturated fat will raise your LDL level, increasing your risk of heart disease and stroke. Olive oil, which is unsaturated, decreases the risk of heart disease.

Types of Fat

Fats are confusing. You will hear saturated, poly unsaturated, monounsaturated, and trans fats. First, we won't look at the chemical structure of fats. Second, we will look at the evidence that the food is associated with fat and how it influences our bodies. Finally, we will dismantle some bad arguments against certain fats.

Saturated Fats - it's the source, not the ingredient

Sources: butter, red meat, dairy.

What the Mediterranean Diet showed us what that the total diet mattered more than the individual ingredient. In spite of the revolutionary approach to using cohort studies with complete diets, many have insisted on pulling that apart to find out if one ingredient is "bad." For years, saturated fat was considered the "bad" part of what we ate. The American Heart Association recommended limiting saturated fat to just ten percent of what you eat.  The AHA recommended changing from saturated fat to polyunsaturated fat or monounsaturated fat. There has never been a question about olive oil, but a few concerns have been raised about some polyunsaturated fat.

But it isn't as simple as the saturated fat molecule. We don't eat pure saturated fat, it turns out we eat food containing that fat. Depending on the food, it depends on how saturated fat affects you.

Dairy and Fish vs Red Meat

Adding more fish and dairy to your diet decreases the risk of heart disease. Adding more red meat to your diet increases your risk of heart disease. This study, from the EPIC group, was impressive in its size, and its ability to factor out other issues that might increase heart disease. Once again, cohort studies show it isn't as important.

Cheese

Besides heart disease, cheese decreased the risk of dementia among a cohort of Finnish men followed for 22 years.

Perhaps the greatest snack of all time (my opinion - not science).

Another cohort study found that cheese was associated with a lower risk of pre-diabetes. Other forms of dairy products did not have this same benefit. This flies in the face of some vegans, who insist diabetes comes from saturated fat.

Finally, non-dairy cheese is not a great source of nutrients. I know my fellow vegans want to find a good alternative for cheese, but there simply isn't one.

Proving again that the whole food is greater than its parts, fish.

Fatty fish have been shown to decrease not only cardiovascular mortality, but all causes of mortality. But...

Should I eat bread?

The low carbohydrate movement has demonized bread.  But is bread fattening? Does it cause inflammation? And if so, why do we call bread the Staff of Life?

The Staff of Life

Imagine calling white bread the staff of life. And yet bread is more responsible for humans ending a nomadic existence. The cultivation of wheat and barley, both in the Nile and in the Euphrates/Tigris rivers, led to civilization.

Calendars, Art, Religion

Not having to forage meant there was time to build a more permanent shelter. It also meant a steady supply of food.

This also meant a calendar was needed because when is the optimal time to plant?

The calendar helped predict when the rivers would swell and recede. The bottom land, with its rich topsoil, is ideal for growing crops.

When you don't need to spend time looking for food, you have time to develop other things:

• Make a religion around grains - the god of the weather, of the earth of the river
• Grain can become the first currency, facilitating trade
• Art because you spend less time seeking food
• Storage systems to overcome times of famine.
• Mathematics, weights, and measures are needed to buy and sell grain
• Writing to make contracts and facilitate trade of the grain
• A government is needed to settle disputes

Storage Systems

Harvested grain can be stored. Storing grain in Egypt was easier because of the dry climate.  Joseph, of the Hebrew Bible, prophesied to the Pharoh of an upcoming famine. As a result, the Pharoh built silos and stored a portion of each harvest.  Seven years later, the harvest failed.  But

The silo system was complex. Filling from the top and arranged in a way that winds would keep the grains cool.  Where did Egyptians get the idea for such an invention? From bees. You can see the bees' natural ventilation system here:

Bees were the symbol of royalty in ancient Egypt. Their honey was tears from the sun god. Bee architecture was copied for the ventilation system for the silos storing grain.  Thus, the storage of grain allowed society to thrive during the time of famine.

Bronze Age to Iron Age

Bread was portable. Served as currency. Allowed armies to march. Facilitated trade between city states. The grain rich regions of the Nile produced grain traded with Mycennians for olive oil and wine.

The Roman emperors gave bread to the poor as welfare. Part of the bread and circus program to keep Romans happy. Bread was imported to Rome, and ultimately, Roman citizens were given "their daily bread."

Rome fell, but bread continued to be important.

Bread until 1920

Grains, including bread, were the major source of calories for most of Europe. From the fall of Rome through the Middle Ages, bread was the main source of calories, along with other grain products.

Bread in the Industrial Age

White bread was considered pure, hygienic, the whiter the better. Brown bread could be contaminated. The ability of mills to separate wheat from chaff, and to make bread without a human hand touching it was irresistible. Industrial bread slicing resulted in "best thing since sliced bread."

White bread became the preferred style of bread from the 1920s until 2009.

Fortification of bread with vitamins in the 1940s made bread a health food.  Pellagra (vitamin B 3 deficiency) and beriberi  (thiamine deficiency) had sadly become common in the US and were eliminated by fortification. So it was indeed revolutionary, but calling it a health food? Even the Federal Trade Commission had issues with this "12 ways campaign" and sued Wonder Bread. The Feds lost.

Age of Aquarius Beats Bread

In spite of the world loving white bread,

Implementing the Med Diet - Part One

Do you think you eat enough plants in your diet? How many plants do you eat in a week? Not refined grains, but plants. You can cook them, boil, bake, microwave, roast them or even eat them raw. How many? Further, it's not just eating more volume of plants, it's diversity.

Mediterranean Diet and Plants

Adherence to the Mediterranean diet depends more on plants.

• Vegetables
• Fruits, Tree Nuts, Seeds
• Legumes
• Whole Grains
• Olive oil

When it comes to plants, more is better. But not just in quantity of plants, but also diversity.

Think about this: there is no one plant that can provide all the micronutrients and macronutrients a person needs. We tell vegetarians to use several plant sources for complete proteins, the same is true for any nutrient.

Gut Bugs and Plants

Your gut contains a trillion bugs. There are more of them than of us. But what do they eat? It turns out, most of what they eat are the things we don't. Gut bugs eat plant parts. Without them eating those plant parts, we would be far worse off. Thus, the gut microbiome is an exciting research field.

Guts break down fiber to chemicals shown to:

• Decrease the risk of colon cancer
• Lower cholesterol
• Decrease blood sugar spikes
• Decrease depression
• Allow absorption of polyphenols

Fiber is an Essential Nutrient

Plants provide vitamins, minerals, macro and micronutrients. A single source of plants cannot provide the nutrients a person requires, which has been the main reason we recommend a diversified diet. Fiber is also a nutrient, an essential nutrient, one that humans cannot make, but without it there is clearly an increase in disease. While those on the extreme of low-carb diets will disagree, the literature is unambiguous.

Myth

Fiber supplements are not a substitute. Some are expensive, one selling for over $150 a month. But no supplement gives you the diversity of nutrients that you can get from your diet. Mother Nature gives you a better deal. So, eat your fiber, don't buy a supplement.

Now begin to chart your diversity

Today's assignment is simple: begin to chart the diversity in your diet, so that you increase the sources of your plants. One of my favorite dieticians, Dr. Megan Rossie, suggests a person has 30 plant-based foods per week. Sound impossible? Let's try it using the Meditereanean Diet.

Why 30?

It isn't that difficult to implement, but consider that you want to consume the vitamins, minerals, antioxidants, and other nutrients, and there is no one plant that does this. But many will.

Vegetables:

One Mediterranean diet point is achieved by consuming 9 ounces of vegetables per day.  Run through the list of vegetables that you can add to your diet in any given week.

1. Asparagus
2. Beets
3. Bok Choi
4. Broccoli
5. Brussels...

Fish oil is the bomb - Greenland Yupik and the rise of fish oil

Fish oil first became a "hot topic" when a 1980 publication showed that Yupik in Greenland had a lower incidence of cardiovascular disease.

Their paper concluded, "The rarity of ischemic heart disease in Greenland Eskimos may partly be explained by the antithrombotic effect of the long-chained polyunsaturated fatty acids, especially eicosapentaenoic acid prevalent in diets rich in marine oils." (Bang HO, Dyerberg J, Sinclair HM. The composition of the Eskimo food in north western Greenland. Am J Clin Nutr. 1980 Dec;33(12):2657-61. doi: 10.1093/ajcn/33.12.2657. PMID: 7435433).

This led to more scientific bodies looking at the evidence for fish oil, and ultimately omega 3 fatty acids, and if it did reduce the incidence of cardiovascular disease. And even 22 years after the publication of that study, the American Heart Association put out a statement that fish oil was protective against cardiovascular disease. (Kris-Etherton PM, Harris WS, Appel LJ; American Heart Association. Nutrition Committee. Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease. Circulation. 2002 Nov 19;106(21):2747-57. doi: 10.1161/01.cir.0000038493.65177.94. Erratum in: Circulation. 2003 Jan 28;107(3):512. PMID: 12438303)

The other predictable tract this led on was the inevitable marketing of fish oils in the supplement industry trying to sell fish oil capsules, from whatever source, as a "must take" to prevent the number one killer in the United States. As with most supplements, being unregulated, they would make claims that their oil was better than others - because it came from krill, or it was vegan-based, or from cod, or pick something that sounds like it can be marketed. Some would claim their fish oil was more pure omega 3 fatty acids. Radio and television spots were secured, and when it was confirmed that the "good cholesterol" or HDL was indeed raised by omega 3 fatty acids it raised their game and intensity of marketing.

Back in the world of science, testing continued and the results that came back didn't match the conclusions.

Some papers would conclude that fish oil didn't produce a significant decrease in first time cardiac events but might help prevent secondary cardiac events (Yokoyama M, Origasa H, Matsuzaki M, Matsuzawa Y, Saito Y, Ishikawa Y, Oikawa S, Sasaki J, Hishida H, Itakura H, Kita T, Kitabatake A, Nakaya N, Sakata T, Shimada K, Shirato K; Japan EPA lipid intervention study (JELIS) Investigators. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomized open-label, blinded endpoint analysis. Lancet. 2007 Mar 31;369(9567):1090-8. doi: 10.1016/S0140-6736(07)60527-3. Erratum in: Lancet. 2007 Jul 21;370(9583):220. PMID: 17398308).

In 2004 the Cocharane database looked at 48 randomized controlled trials and concluded that taking fish oils did not reduce mortality from cardiovascular disease. It also concluded that it didn't matter where the fish oil came from, fish or plant sources, or other sources. This, as you might imagine, throws a monkey wrench into the statement by the American Heart Association that fish oils were good for you, especially coming two years later.

Marketing moves faster than medicine, so while doctors and scientists were working to find out why there were inconsistent results, the marketing of fish oils continued to expand. Given that there was no regulation in the supplement industry, they continued to market the "benefits" of their product. By 2020 the sales of over-the-counter fish oil products became to a SIX BILLION dollar industry, (https://www.grandviewresearch.com/industry-analysis/omega-3-supplement-market).

Scientists worked at looking at the different components of dietary, or essential fatty acids. Because the literature was confusing, and the American Heart...