Health & Fitness
**Fork U with Dr. Terry Simpson**

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Not everything you put in your mouth is good for you.

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

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

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

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

Latest Episodes:

Protein Panic: How Much Do You Really Need? Feb 19, 2026

Show notes

Protein Panic: How Much Do You Really Need?

Everywhere you look, protein has become a competition.

Scroll long enough and you will believe muscle disappears if you eat less than 150 grams a day. Meanwhile, influencers debate leucine thresholds like they’re trading baseball cards. As a result, ordinary meals now feel like math problems.

However, biology does not require panic.

Protein matters. Yet adequacy differs from excess. And importantly, most people eating real food already meet their needs.

So let’s slow down.

First, What Protein Actually Does

Protein builds and repairs tissue. In addition, amino acids support immune function and hormone signaling. Furthermore, specific amino acids such as leucine trigger muscle protein synthesis.

Nevertheless, once you reach the effective leucine threshold in a meal, adding more protein does not multiply muscle growth. Instead, your body oxidizes the excess.

Therefore, more does not always mean better.

How Much Is Enough?

For most healthy adults, about 0.8 grams per kilogram of body weight covers basic needs. Meanwhile, adults over 60 often benefit from 1.0 to 1.2 grams per kilogram to protect lean mass.

Notably, that recommendation does not require heroic intake. In fact, a 75–80 kilogram adult typically lands between 60 and 90 grams per day.

Consequently, many people hit those numbers without even trying.

Here’s What I Actually Do

I do not count protein. I never log grams. Moreover, I do not calculate leucine before breakfast.

Instead, I eat normal meals.

Most mornings, I have a shake. The recipe lives on terrysimpson.com. That shake provides roughly 25 grams of protein. Sometimes I add PB Fit. Occasionally, I include Greek yogurt. As a result, I increase protein slightly without thinking about it.

Later, I eat three to five ounces of chicken breast with Louisiana hot sauce. That adds another 25 grams.

Then at dinner, I often choose salmon and chickpeas. Together, they bring me to roughly 70–80 grams for the day.

Importantly, I have lost 50 pounds and preserved muscle mass. I track muscle periodically. I see no decline.

So what about leucine?

High-quality animal protein contains about 8–10% leucine. Therefore, a 25-gram protein meal delivers about 2 grams of leucine. That amount typically triggers muscle protein synthesis.

Thus, I hit the effective threshold at each meal without obsessing.

Now Let’s Bring In GLP-1

GLP-1 medications reduce appetite. Consequently, total intake drops. Because of that, protein intake can fall too.

So yes, people using GLP-1 should pay attention. However, they do not need 180 grams per day. Instead, they need adequacy and resistance training.

Lift something heavy. Spread protein across meals. Preserve lean mass.

Simple.

Here’s the Real Deficiency

Protein deficiency remains rare in the United States. By contrast, fiber deficiency remains common.

According to the National Institutes of Health, most adults fail to meet recommended fiber intake levels. In fact, average intake falls far below the 25–38 grams per day recommended for adults.

(Reference: NIH Office of Dietary Supplements – Fiber Fact Sheet)

Meanwhile, high-protein diets often crowd out legumes, whole grains, and vegetables.

So while people panic about protein, they quietly neglect fiber.

And fiber feeds the microbiome. Fiber improves glycemic control. Fiber lowers LDL cholesterol.

Protein builds muscle. Fiber protects metabolism.

Both matter.

Mediterranean Patterns Keep It Balanced

Mediterranean-style eating provides protein from fish, legumes, yogurt, and moderate poultry. At the same time, it supplies fiber from beans, vegetables, and whole grains.

Therefore, protein arrives packaged with micronutrients and fermentable substrate.

Unlike protein powders and bars, real food supports multiple systems at once.

Consequently, longevity patterns emphasize diversity, not maximal single-nutrient intake.

The Takeaway

Adequate protein preserves muscle. Resistance training drives adaptation. Fiber protects metabolic health.

So before you triple-scoop whey, pause.

Ask yourself whether you lack protein — or whether you lack plants.

Because protein matters.

Panic does not.

And once again, data beats dogma.

Mexican Food Is Healthy. The Taco Took the Blame. Feb 12, 2026

Show notes

Why Traditional Mexican Food Is Healthy — and How America Got It Wrong

Every time someone says Mexican food is unhealthy, I know exactly what they’re picturing.

They aren’t picturing Mexico.

They’re picturing an American taco: a hard shell or a fluffy white flour tortilla, fatty hamburger, sour cream, a thin smear of salsa that contributes almost nothing except salt, and a yellow substance legally allowed to be called cheese.

After eating that, they naturally conclude Mexican food is the problem.

That conclusion doesn’t come from biology. It comes from branding.

Traditional Mexican food looks nothing like that. More importantly, it behaves nothing like that once it hits your body.

So let’s slow down, take a breath, and do what we always do here—follow the evidence, not the vibes.

First, Let’s Talk About the Taco America Put on Trial

The American taco stacks the deck against itself.

It leads with saturated fat, piles on refined carbohydrates, and adds dairy on top of dairy. Meanwhile, it offers almost no fermentable fiber. The gut gets nothing to work with. Blood sugar spikes. Inflammation follows.

That taco doesn’t help anyone.

But here’s the key point: it isn’t Mexican food.

It’s ultra-processed American convenience food wearing cultural drag.

Now Let’s Look at a Real Taco

By contrast, a traditional taco starts very differently.

It starts with a corn tortilla, not refined flour. Then it adds beans. After that, it layers vegetables, real salsa, and often cabbage. Finally, it finishes with avocado. Sometimes it includes fish. Sometimes it doesn’t. Either way, the structure holds.

And structure matters.

Because when you look at how that meal behaves biologically, it stops looking indulgent and starts looking smart.

Corn Tortillas Aren’t the Villain — They’re the Foundation

First of all, traditional corn tortillas come from nixtamalized corn. That process treats corn with lime, and no, that isn’t trivia.

Instead, nixtamalization improves mineral absorption, improves protein quality, and preserves resistant starch.

As a result, resistant starch passes through the small intestine untouched. Then it reaches the colon, where gut bacteria ferment it. Consequently, those bacteria produce short-chain fatty acids, especially butyrate.

And here’s the important part: butyrate fuels the cells lining your colon. In addition it strengthens the gut barrier. It reduces inflammation. Finally, it improves metabolic signaling.

So no, this isn’t a carb disaster. On the contrary, it’s colon nutrition.

Beans Do the Heavy Lifting — And They Always Have

Next, add beans.

At that point, the conversation usually derails, so let’s keep it grounded.

A serving of beans delivers roughly ten grams of fiber. Not one kind — several kinds. Soluble fiber. Insoluble fiber. Resistant starch. Plus protein.

Because of that, beans slow digestion. They flatten glucose curves. They improve satiety. Most importantly, they feed gut bacteria that matter.

Specifically, bean fiber supports Akkermansia, a gut bacterium associated with better insulin sensitivity and a stronger gut barrier.

In other words, beans don’t fill space. Instead, they build infrastructure.

And yes, when you pair beans with rice, you get a complete amino acid profile. Humans figured that out centuries ago, long before protein powders and “ancestral” snack companies tried to monetize it.

Now Let’s Deal With Refried Beans — Because This Is Where People Panic

At this point, someone inevitably says, “But what about refried beans?”

So let’s clear that up.

First, frijoles refritos does not mean “fried twice.” It means well-fried or thoroughly cooked. Traditionally, people cooked beans, then lightly cooked them again, often mashing them for texture.

So yes — refried beans are traditional. Very traditional.

Moreover, mashing beans does not remove fiber. Cooking beans does not turn them into sugar. Beans remain beans.

So where did refried beans go wrong?

Fat choice.

Historically, many refried beans used lard. That made sense when calories were scarce and undernutrition threatened survival. However, in a modern context, large amounts of lard mean large amounts of saturated fat.

Therefore, when refried beans swim in lard, then get buried under cheese, then land inside a refined flour tortilla, the problem isn’t the beans. The problem is the fat context.

Fortunately, this problem has an easy fix.

Use olive oil or another unsaturated fat. Add onions and garlic. Mash lightly, not into paste. Suddenly, refried beans snap right back into a Mediterranean-style pattern.

And yes — some commercially available refried beans already do this. Look for short ingredient lists. Look for beans, oil, onion, garlic, salt. Skip the lard. Skip the mystery fats. Your gut will notice.

Avocado Doesn’t Add Calories — It Unlocks Nutrition

Then comes avocado, which people love to blame for reasons that make no biological sense.

Avocado provides about five grams of fiber and a meaningful amount of monounsaturated fat — the same fat family as olive oil.

More importantly, fat enables absorption of fat-soluble vitamins: A, D, E, and K.

So when you add avocado to vegetables, you don’t ruin the meal. Instead, you make the nutrients available.

In other words, avocado doesn’t cancel vegetables. It activates them.

Salsa and Cabbage Quietly Do the Real Work

Meanwhile, real salsa brings tomatoes, onions, garlic, chilies, and cilantro to the table. That means fiber. That means polyphenols. That means fermentable substrate for gut bacteria.

Add corn to the salsa and you add more whole grains and more resistant starch.

Then add cabbage — raw or lightly dressed — and now you feed short-chain fatty-acid producers directly.

Nothing exotic. Nothing trendy. Just food that works.

Step Back — Because This Should Look Familiar

Now zoom out.

Traditional Mexican food emphasizes whole grains, legumes, vegetables, unsaturated fats, and fermentation. It stays naturally low in saturated fat. It supports the microbiome. It respects digestion.

In other words, it follows the Mediterranean pattern.

Not because it sits near the Mediterranean Sea — but because biology doesn’t care about geography.

The Mediterranean diet is a structure, not a destination.

Whether you eat it in Greece.

Or you eat it in Italy.

But you can eat it wrapped in a corn tortilla.

So What Actually Broke the Taco?

Processing.

Refining grains.

Deep-frying bases.

Replacing beans with beef.

Replacing water with sugar.

Turning cheese into a load-bearing wall.

Mexican food didn’t fail.

Industrial food did.

The Verdict

A traditional taco — corn tortilla, beans or properly made refried beans, vegetables, avocado, real salsa, maybe fish — fits squarely into one of the healthiest dietary patterns we know.

Different culture.

Same biology.

So the next time someone tells you Mexican food is unhealthy, remember this:

The taco was framed.

And once again — data beats dogma.

Keep Your Poop in a Group Feb 05, 2026

Show notes

Why Fiber Fails to Impress—and Why That’s the Point

Fiber has a public relations problem. Unlike supplements or extreme diets, fiber does not promise instant transformation. Instead, it works slowly, predictably, and quietly. Because of that, people rarely notice it when it’s doing its job well. However, that very boredom is precisely why fiber matters.

When fiber intake is adequate, digestion functions normally, blood sugar behaves more consistently, and bowel habits stay predictable. As a result, there is no drama to post on social media. Consequently, influencers move on. Meanwhile, the science stays exactly where it has been for decades: fiber lowers disease risk over time.

That kind of quiet effectiveness may not sell products, but it saves lives.

“Fiber Isn’t Essential”—Why That Argument Misses the Mark

Technically speaking, fiber is not an essential nutrient in the classic sense. In other words, there is no disease caused solely by a lack of fiber the way scurvy results from vitamin C deficiency. Because of this, critics often stop the conversation there.

However, medicine does not ask only whether you survive. Instead, it asks whether your risk of chronic disease rises or falls over time. On that front, fiber consistently lowers the risk of colon cancer, improves glucose regulation, reduces constipation, and supports cardiovascular health. Therefore, while you can live without fiber, you do not age particularly well without it.

Protein Gets the Spotlight While Fiber Does the Work

At the same time, nutrition conversations fixate on protein. Protein goals dominate podcasts, social media, and supplement aisles. Yet, in practice, true protein deficiency in the United States is rare, even among bariatric surgery patients.

In contrast, fiber deficiency is the norm. Roughly 92% of Americans fail to meet recommended fiber intake. As a result, constipation becomes common, long bathroom visits feel normal, and scrolling on a phone in the bathroom gets rebranded as “self-care.” Unfortunately, that normalization hides a real problem.

A Personal Lesson From Oats, Gas, and a Scorched Desk

Years ago, I learned a fiber lesson the hard way. After deciding to increase my fiber intake quickly, I started eating steel-cut oats every morning during a busy meeting week. At first, everything seemed fine. Soon, however, my digestive system made it clear that it had not been consulted in this decision.

By the second day, bloating appeared. By the third day, office etiquette became questionable. Consequently, I lit a candle at my desk. Unfortunately, I turned my back, and papers caught fire. Although the flames were extinguished quickly, the scorch mark stayed for years.

That stain served as a reminder: fiber works best when introduced gradually. Your gut adapts over time. Confidence without patience, on the other hand, leads to unnecessary consequences.

Not All Fiber Works the Same Way

Understanding fiber helps people stop fearing it. Soluble fiber, found in oats, barley, beans, lentils, psyllium, apples, and citrus, forms a gel in the gut. Because of this, it slows absorption, reduces glucose spikes, and lowers LDL cholesterol. Consequently, psyllium appears in clinical guidelines rather than influencer protocols.

Meanwhile, insoluble fiber focuses on mechanics. It adds bulk, speeds transit, and improves regularity. Importantly, this matters even more for people using GLP-1 medications, where slowed digestion often leads to constipation. In that setting, fiber is not optional—it is foundational.

Finally, fermentable fiber feeds gut bacteria. Beans, onions, garlic, asparagus, chicory root, and resistant starch nourish beneficial microbes. As these bacteria grow, they produce short-chain fatty acids, especially butyrate, which supports gut barrier function and immune regulation.

No, Butter Is Not a Shortcut to Butyrate

Despite what circulates online, butter does not meaningfully deliver butyrate to your colon. Although butter contains trace amounts of butyric acid, that fat is absorbed in the small intestine long before it reaches the colon. In contrast, the butyrate that protects colon health is produced by bacteria fermenting fiber directly in the colon.

Therefore, if butter were an effective therapy, gastroenterologists would prescribe croissants. They do not.

Supplements Help—but Food Still Wins

Fiber supplements can be useful. Psyllium and methylcellulose typically provide four to five grams of fiber, which helps people start. However, that amount represents only about ten percent of a reasonable daily target.

Personally, I use Loam, which provides around twelve grams of mixed fiber in a smoothie. Nevertheless, supplements act as bridges, not destinations. Ultimately, food does the heavy lifting.

IBS, FODMAPs, and Why We Avoid Diet Cosplay

Some people with IBS feel worse when fermentable fiber increases too quickly. Because fermentation produces gas, symptoms can flare initially. For that reason, clinicians use FODMAPs as a temporary elimination tool to identify triggers.

However, elimination is not the end goal. Instead, we reintroduce foods within a Mediterranean dietary pattern, which promotes diversity and tolerance. In contrast, Whole30 markets itself as elimination but functions primarily as low-carb restriction. That approach avoids symptoms rather than solving them.

What Eating Enough Fiber Actually Looks Like

People do not eat grams of fiber. They eat meals. A Mediterranean-style day, such as the 3-Day Mediterranean Diet at terrysimpson.com, delivers fiber incidentally.

Breakfast often includes oats, berries, and nuts. Lunch typically features vegetables, legumes, whole grains, and olive oil. Snacks rely on fruit, nuts, or hummus. Dinner centers on vegetables, whole grains like farro, and fish or poultry. Over the course of a day, fiber naturally reaches 25–40 grams without spreadsheets or stress.

Start Slowly, Then Stay Consistent

If you currently eat little fiber, the solution is simple but not dramatic. Increase intake gradually. Drink water. Give your microbiome time to adapt. Although you are not fragile, abrupt change can still cause discomfort.

The Bottom Line

Fiber does not need hype. Instead, it needs consistency. It works quietly, steadily, and reliably. If bathroom visits require entertainment, the issue is not age—it is fiber.

How GLP-1 Quiets Food Noise Jan 29, 2026

Show notes

Food Noise Isn’t Hunger — and Why Broccoli Never Fixed the Brain

Food noise does not announce itself politely. Instead, it hums in the background, persistent and exhausting. For years, patients tried to describe it. Meanwhile, medicine largely ignored it. Recently, however, GLP-1 receptor agonists forced the conversation into the open.

I did not understand food noise myself until it stopped.

About twelve hours after my first GLP-1 injection, I stood in my kitchen waiting for baked salmon to finish cooking. Nothing dramatic happened. No emotional moment followed. Still, something felt different. The internal commentary was gone. The negotiations disappeared. For the first time, my brain felt quiet.

At that moment, I finally understood what patients had been telling me for years.

First, Define the Problem Clearly

Food noise is not hunger. Hunger serves a biological purpose. In contrast, food noise describes persistent, intrusive thoughts about food that occur regardless of energy needs. People experience rumination, preoccupation, cravings, and mental fatigue—even when they are physiologically full.

Importantly, this phenomenon is now measurable. The Food Noise Questionnaire validates what patients already knew. Specifically, it assesses the frequency of food thoughts, difficulty controlling them, interference with daily activities, emotional distress, and craving intensity. In other words, food noise exists independently of willpower.

Consequently, advice that targets hunger alone inevitably fails.

Next, Address the Broccoli Myth

I eat vegetables. Nevertheless, I have never liked broccoli.

Frankly, if broccoli is air-fried to the edge of carbonization, I will tolerate it. That concession, however, does not transform broccoli into a neurological intervention. Fiber increases fullness. Protein improves satiety. Vegetables slow digestion. None of those actions quiet the reward centers of the brain.

Put simply, broccoli fills the stomach. Food noise lives elsewhere.

Because of that distinction, the “just eat for satiety” argument collapses under scrutiny.

Then, Follow the Science Where It Leads

Food noise arises from heightened food-cue reactivity. Visual cues, smells, availability, and anticipation activate reward pathways long before food reaches the stomach. Ultra-processed foods amplify this response. Their engineered combinations of refined carbohydrates, fats, salt, and flavor compounds reliably stimulate the mesolimbic dopamine system.

As a result, ultra-processed foods increase wanting rather than liking.

However—and this matters deeply—removing ultra-processed foods does not automatically restore normal appetite signaling. Once reward circuitry becomes dysregulated, dietary virtue alone cannot reset it. At that stage, telling someone to “just eat whole foods” resembles telling someone with tinnitus to “enjoy the silence.”

Therefore, ultra-processed foods contribute to the problem, but they do not explain it entirely.

Now, Enter GLP-1 Receptor Agonists

GLP-1 receptor agonists act centrally and peripherally. While many people fixate on gastric emptying, the central mechanisms explain the lived experience.

In the hypothalamus, GLP-1 receptor agonists activate satiety-promoting POMC/CART neurons while inhibiting hunger-promoting NPY/AgRP neurons. This dual action reduces homeostatic hunger. Meanwhile, in the brainstem—particularly the nucleus tractus solitarius—GLP-1 signaling integrates gut-brain communication and sustains appetite suppression.

More importantly, GLP-1 receptor agonists modulate reward circuitry. In regions such as the ventral tegmental area and nucleus accumbens, these agents dampen dopamine signaling. Consequently, food becomes less compelling rather than forbidden.

Functional imaging studies confirm this effect. After GLP-1 treatment, brain responses to food cues decrease in the insula, amygdala, orbitofrontal cortex, and related regions. The brain still recognizes food. It simply stops obsessing.

As a Result, Behavior Changes Without Force

Once food noise quiets, people do not suddenly become disciplined saints. Instead, they become selective.

In my own case, wine lost its appeal. I did not swear it off. I simply stopped wanting it. Eventually, I quit five wine clubs. When a glass tastes mediocre, I put it down and choose iced tea. That behavior reflects altered reward signaling, not moral growth.

Similarly, food choices shift without struggle. People stop eating things merely because they are available. They stop drinking because something is poured. The absence of compulsion creates space for intentional eating.

That distinction explains why GLP-1 therapy feels different from appetite suppression.

Finally, Place Diet Back Where It Belongs

The Mediterranean diet improves health. I recommend it. I eat it. Still, it does not cure food noise.

Diet supports metabolic health once interference disappears. GLP-1 therapy removes that interference. Together, they work better than either alone. Pretending otherwise leads to fat shaming disguised as nutritional advice.

Obesity is a disease. GLP-1 receptor agonists treat that disease. Food then becomes nourishment rather than negotiation.

So, What Actually Matters

Ultra-processed foods worsen food noise, yes. Yet removing them does not repair dysregulated reward circuitry. Satiety fills the stomach. GLP-1 therapy quiets the brain. Once the noise fades, nutrition finally has a fair chance.

In the end, broccoli keeps my mother from returning from the grave. GLP-1s keep my brain quiet. Both have their place. Only one treats the disease.

REFERENCES:

1. Medications for Obesity: A Review.

The Journal of the American Medical Association. 2024. Gudzune KA, Kushner RF.

2. The Arcuate Nucleus Mediates GLP-1 Receptor Agonist Liraglutide-Dependent Weight Loss.

The Journal of Clinical Investigation. 2014. Secher A, Jelsing J, Baquero AF, et al.

3. Direct and Indirect Effects of Liraglutide on Hypothalamic POMC and NPY/AgRP Neurons - Implications for Energy Balance and Glucose Control.

Molecular Metabolism. 2019. He Z, Gao Y, Lieu L, et al.

4. On the Pleiotropic Actions of Glucagon-Like Peptide-1 in Its Regulation of Homeostatic and Hedonic Feeding.

International Journal of Molecular Sciences. 2025. Sayers S, Wagner E.New

5. Glucagon-Like Peptide 1 (GLP-1) Action on Hypothalamic Feeding Circuits.

Endocrinology. 2025. Hwang E, Portillo B, Williams KW.New

6. GABA Neurons in the Nucleus Tractus Solitarius Express GLP-1 Receptors and Mediate Anorectic Effects of Liraglutide in Rats.

Science Translational Medicine. 2020. Fortin SM, Lipsky RK, Lhamo R, et al.

7. GLP-1 Receptor Activation Modulates Appetite- And Reward-Related Brain Areas in Humans.

Diabetes. 2014. van Bloemendaal L, IJzerman RG, Ten Kulve JS, et al.

8. Glucagon-Like Peptide 1 and Its Analogs Act in the Dorsal Raphe and Modulate Central Serotonin to Reduce Appetite and Body Weight.

Diabetes. 2017. Anderberg RH, Richard JE, Eerola K, et al.

9. of GLP-1 Therapies for Addiction and Mental Health Comorbidities—Quo Vadis?.

JAMA Psychiatry. 2026. Farokhnia M, Leggio L.New

10. GLP-1 and Weight Loss: Unraveling the Diverse Neural Circuitry.

American Journal of Physiology. Regulatory, Integrative and Comparative Physiology. 2016. Kanoski SE, Hayes MR, Skibicka KP.

11. Mechanisms of GLP-1 Receptor Agonist-Induced Weight Loss: A Review of Central and Peripheral Pathways in Appetite and Energy Regulation.

The American Journal of Medicine. 2025. Moiz A, Filion KB, Tsoukas MA, et al.New

12. GLP-1 Physiology and Pharmacology Along the Gut-Brain Axis.

The Journal of Clinical Investigation. 2026. Beutler LR.New

Whole Milk Isn’t the Fix—Feeding Kids Is Jan 22, 2026

Show notes

Whole Milk Is Back in Schools

But Hungry Kids Are Still the Real Problem

Whole milk is back in school cafeterias.

As a result, a lot of people are celebrating. Some are calling it a victory for nutrition. Others are calling it common sense. Meanwhile, a few are even calling it a breakthrough.

However, that excitement misses the point.

Because the biggest problem facing kids in school today is not milk fat.

Instead, the real problem is hunger.

First, Let’s Start With the Obvious

Before we talk about milk, fat, or nutrients, we need to start with something very basic.

Hungry kids do not learn well.

In fact, hunger affects attention, memory, and behavior. As a result, students who do not eat enough struggle to focus. Over time, that struggle shows up as lower academic performance.

Because of that, no change to milk will ever fix an empty stomach.

Therefore, if we want better outcomes, we have to start with food access.

Next, What Actually Changed With Milk

Despite what many people believe, whole milk was not removed from schools in the past.

Instead, schools continued to offer low-fat and fat-free milk.

Importantly, those options provided the same essential nutrients:

protein
calcium
potassium
iodine
vitamin B12

In addition, vitamin D was added through fortification, regardless of milk fat level.

So, children did not lose vital nutrients.

What they lost was milk fat.

Now, Why Milk Fat Is Not Essential

Milk fat is made mostly of saturated fat.

That matters because saturated fat is not an essential dietary nutrient.

If the human body needs saturated fat, it can make it on its own. In other words, there is no requirement to eat it for normal growth or brain development.

As a result, adding more saturated fat to a child’s diet is not necessary.

Then, Let’s Talk About the Brain

Here is where biology matters.

The brain is built largely from polyunsaturated fats, not saturated fats.

These polyunsaturated fats keep cell membranes flexible. Because of that flexibility, brain cells can signal, adapt, and learn.

In contrast, saturated fat is rigid. It plays only a small structural role in membranes. If membranes contained too much saturated fat, they would become stiff. When that happens, signaling does not work well.

For that reason, biology uses saturated fat sparingly.

Therefore, less saturated fat in the diet of growing children is actually better for long-term brain and cardiovascular health.

Meanwhile, What Kids Are Really Missing

If there is one nutrient that most children lack, it is fiber.

Fiber supports gut health. In addition, it improves insulin sensitivity. Over time, it also reduces cardiovascular risk.

Milk fat does none of those things.

So, if nutrition is the concern, fiber deserves more attention than nostalgia for saturated fat.

At the Same Time, Food Access Is Shrinking

While milk is being discussed, something else is happening quietly.

Food assistance programs are being reduced.

That matters because programs like SNAP do more than help families buy groceries. They also help children qualify for free school meals.

When eligibility is reduced, fewer children qualify. As a result, schools receive less funding for lunch programs. Consequently, some schools serve fewer meals. In certain communities, programs disappear entirely.

Therefore, the outcome is simple: fewer kids eat at school.

In Contrast, Feeding Kids Actually Works

Some states have shown a different approach.

When children receive meals consistently, attendance improves. At the same time, concentration improves. Over the long term, educational outcomes improve as well.

This result has been seen repeatedly.

Because of that, feeding kids is not charity. Instead, it is an investment in education, health, and future productivity.

So, Let’s Put This Together

Whole milk is fine.

If families enjoy it, they can drink it. If schools offer it, that is acceptable.

However, whole milk is not an innovation.

Feeding children is.

Ultimately, school meals should not be treated as a budget line to debate each year. Instead, they should be treated as part of what a functioning society does for its kids.

One Reference on Brain Fat and Cell Membranes

For readers who want the science behind membrane fats and brain function, this review explains it clearly:

Stillwell W, Wassall SR.

Docosahexaenoic acid: membrane properties of a unique fatty acid.

Chemistry and Physics of Lipids. 2003;126(1):1–27.

This paper explains why polyunsaturated fats keep membranes flexible and why saturated fats play only limited roles.

Food Pyramid Blues: Influencers are not Scientists Jan 15, 2026

Show notes

When Influencers Replace Scientists, Everyone Loses

Every few years, nutrition gets a makeover.

First comes a new graphic.

Then comes a new slogan.

Soon after, we hear claims that this time, someone finally figured it all out.

Recently, that makeover arrived in the form of a “reverse food pyramid” and the cheerful phrase “Eat Real Food.” On the surface, that message sounds reasonable. In fact, many doctors have said the same thing for decades.

However, the real problem isn’t the slogan.

Instead, the problem lies in who is now shaping nutrition advice—and who is not.

Yes, Some of the Advice Is Right

To be clear, let’s start with agreement.

Eating real food helps health.

Limiting added sugar makes sense.

Reducing ultra-processed foods improves outcomes.

Importantly, none of this is new.

Doctors, dietitians, and public-health researchers have said these things for years. Because of that, when influencers now say, “See, we were right,” a serious issue appears.

They didn’t discover this information.

They copied it.

The Real Risk Isn’t Agreement

At first glance, agreement sounds harmless.

Nevertheless, agreement becomes dangerous when it turns into ownership.

Once someone believes they have discovered basic nutrition truths, they often assume they can rewrite everything else. As a result, bad ideas slip in quietly, wrapped in confidence instead of evidence.

That shift matters.

Scientists and Influencers Are Not Interchangeable

At this point, we need to say something clearly.

We cannot afford to replace scientists with influencers.

Nutrition science didn’t come from podcasts or social media. Instead, it came from metabolic ward studies, long-term population research, and randomized trials. Moreover, real scientists accept uncertainty. They change their minds when the data changes.

By contrast, influencer culture rewards certainty.

Even worse, confidence often replaces humility.

There is no “Mediterranean diet influencer community.”

Likewise, there is no “DASH diet movement.”

Those dietary patterns exist because scientists studied them, tested them, and measured outcomes over time.

On the other hand, a loud low-carb and carnivore influencer ecosystem does exist. That ecosystem includes brands, supplements, coaching programs, and a strong contrarian identity. Because of that structure, influence—not evidence—often drives the message.

Fiber Versus Saturated Fat: A Telltale Sign

If you want to know whether someone understands nutrition science, ask a simple question:

Which matters more—fiber or saturated fat?

Influencers often say, “Fiber isn’t an essential nutrient.”

Technically, that statement is true in the narrowest sense.

However, context matters.

Fiber supports a healthy gut microbiome.

Additionally, fiber improves insulin sensitivity.

Furthermore, fiber lowers cardiovascular risk.

Finally, fiber supports colon health.

Because fiber feeds beneficial gut bacteria, entire fields of microbiome research depend on it.

Now compare that with saturated fat.

Saturated fat is truly non-essential.

Your body can make all it needs.

No deficiency disease exists from avoiding it.

Even more importantly, excess saturated fat raises LDL cholesterol and worsens artery health. Over time, that increases cardiovascular risk.

So ask yourself this:

Why dismiss fiber as optional while quietly promoting saturated fat?

That choice reflects ideology, not biology.

The Brain Doesn’t Care About Trends

Here’s another reality check.

Your brain—the most important organ you own—relies heavily on polyunsaturated fats. These fats support cell membranes, nerve signaling, and blood flow.

Ironically, these same fats often get labeled “seed oils” and dismissed.

Meanwhile, saturated fat does not belong in high amounts in brain tissue. Worse still, saturated fat can clog the arteries that supply the brain.

Biology does not respond to marketing.

Physiology does not care about popularity.

The “You’re On Your Own” Problem

Another issue deserves attention.

After influencers step into the spotlight and claim credit for old science, they often step away from responsibility. Then they tell the public to “figure it out.”

That approach ignores reality.

Many Americans live in food deserts.

Even more rely on school meals.

Lots of Americans work multiple jobs.

Many lack time, money, or kitchens.

Public health exists because willpower alone does not scale. Without system-level support, advice turns into abandonment.

Agreement Does Not Equal Expertise

Recently, debates around nutrition have highlighted this pattern clearly.

Some influencers argue that because they agree with basic nutrition advice, they deserve authority over the rest of the science. Unfortunately, agreement does not grant expertise.

Copying conclusions does not mean you earned them.

Science rewards method, not confidence.

The Bottom Line

Yes, eat real food.

And clearly, limit added sugar.

Most definitely, reduce ultra-processed foods.

Doctors have said this for years.

However, flipping a pyramid does not change biology.

Likewise, sidelining scientists does not improve health.

Finally, promoting saturated fat while dismissing fiber misleads the public.

People do not fail diets.

Systems fail people.

When we trade evidence for influence, health suffers.

A Final Note

This article provides general education, not personal medical advice. Always talk with your healthcare professional about individual nutrition needs.

At Your Doctor’s Orders, we believe data matter more than dogma, and evidence matters more than trends.

Because when it comes to health, confidence without science is not bold.

It’s risky.

Ultra-Processed Food The Enemy Jan 08, 2026

Show notes

Ultra-Processed Food: Making Sense of the Madness

Ultra-processed food has become the villain of modern nutrition.

Scroll through social media, and you’ll hear that it’s poisoning us, wrecking our gut, and driving the obesity epidemic all by itself.

At the same time, other voices dismiss the entire idea as fear-mongering.

According to them, processing doesn’t matter at all.

Neither extreme tells the full story.

So instead of slogans, let’s talk about what ultra-processed food actually means, why people want to blame it, where the science is strong, and where it starts to drift into storytelling.

Why We’re Looking for Something to Blame

The obesity epidemic is real.

Rates have climbed for decades, and people understandably want answers.

Human biology didn’t suddenly change in the 1980s.

Willpower didn’t vanish overnight.

Something in our environment shifted.

Food is an obvious suspect.

Because food changed, many people assume there must be a single culprit hiding in the ingredient list.

That belief leads to bold claims.

Some say Europe bans certain additives and therefore avoids obesity.

In reality, obesity rates continue to rise across Europe as well.

Others argue that specific ingredients damage the gut, letting in more calories or triggering metabolic chaos.

Those ideas sound scientific, especially when they involve complex biology.

However, when a problem is large and complicated, humans naturally want a cause that feels simple and controllable.

Blaming one ingredient feels easier than confronting patterns of eating, stress, time pressure, and convenience.

Biology, unfortunately, rarely offers cinematic villains.

What “Ultra-Processed” Actually Means

To understand the debate, definitions matter.

Researchers use the NOVA classification system to describe food processing.

NOVA does not rate healthfulness.

Instead, it categorizes food by how manufacturers produce it.

The system includes four groups.

First come whole or minimally processed foods, such as vegetables, beans, eggs, and fish.

Next are culinary ingredients like oil, sugar, salt, and flour.

Then come processed foods, including bread, cheese, yogurt, and canned vegetables.

Finally, NOVA defines ultra-processed foods as industrial formulations.

These products often combine refined ingredients with additives, stabilizers, emulsifiers, and flavor systems that home cooks rarely use.

Here’s the crucial point.

Ultra-processed food is defined by how it is made, not by what it does in the body.

That distinction often gets lost.

As a result, soda and whole-grain bread can fall into the same category, even though they behave very differently nutritionally.

Why Ingredient Blame Falls Short

At this point, many discussions take a wrong turn.

Instead of asking how people eat, the conversation focuses on what to ban.

Ingredients become the enemy.

Yet most claims about additives rely on animal studies using doses far higher than what humans consume.

Human data remains limited and inconsistent.

Meanwhile, the bigger picture often gets ignored.

Ultra-processed food correlates with stress, long work hours, poor sleep, and limited time for cooking.

Those factors influence eating behavior regardless of ingredients.

When people feel rushed and overwhelmed, they don’t just eat differently.

They eat faster, snack more often, and rely on foods that require little effort.

That context matters.

The Simple Question That Changed the Conversation

Instead of chasing villains, one researcher asked a much simpler question.

Do people eat more when food is ultra-processed, even when nutrition looks the same on paper?

That question led to the most important experiment in this entire debate.

What Kevin Hall Actually Found

At the National Institutes of Health, Kevin Hall conducted a tightly controlled feeding study.

Participants lived in a metabolic ward.

Researchers controlled the environment, the meals, and the measurements.

Each participant ate two diets.

One diet consisted mostly of ultra-processed foods.

The other relied on minimally processed foods.

Importantly, researchers matched calories, protein, fat, carbohydrates, sugar, and salt.

People could eat as much as they wanted.

The result surprised almost everyone.

On the ultra-processed diet, participants consumed about 500 extra calories per day.

Yet, they didn’t report more hunger.

They didn’t feel less full.

However, they simply ate more.

This finding matters because it avoids speculation.

No ingredient theories appear here.

No gut damage claims drive the conclusion.

Ultra-processed food made it easier to eat more calories without noticing.

Sometimes the most powerful answers are also the least dramatic.

Why a Book Made This Go Viral

That study helped fuel widespread interest, including the success of Ultra-Processed People: The Science Behind Food That Isn't Food by Chris van Tulleken.

Van Tulleken, a British physician, took a personal approach.

He ate a diet dominated by ultra-processed foods and documented the effects.

Weight gain followed.

Hunger became harder to regulate.

Energy and mood shifted.

The book resonated because it made an abstract concept feel personal.

It also highlighted how modern foods often prioritize shelf life, softness, and convenience.

Stories like this help people recognize patterns they already sense in daily life.

However, a compelling narrative does not replace careful interpretation.

Where the Story Goes Too Far

Ultra-processed food is not one thing.

It does not act through a single mechanism.

The research faces several challenges.

First, heterogeneity clouds interpretation.

Grouping soda and yogurt together creates confusion rather than clarity.

Second, confounding remains a major issue.

People who eat more ultra-processed food often face structural barriers that affect health in many ways.

Third, additive panic oversimplifies biology.

Mouse data cannot stand in for long-term human outcomes.

Ultra-processed food may contribute to health problems, but it rarely acts alone.

A Better Way to Think About Food

Rigid rules tend to fail.

Real eating happens in real life.

Instead of asking whether a food qualifies as ultra-processed, better questions help guide choices.

Does the food contain fiber?

How will it contribute protein or micronutrients?

Finally, will it replace a balanced meal or help create one?

Can you eat it mindfully and stop when satisfied?

Foods like yogurt, tofu, olive oil, canned beans, and frozen vegetables often break simplistic rules.

Yet they support healthy eating patterns when used well.

Processing did not ruin our food.

Confusion did.

The Bottom Line

People want a villain because villains feel actionable.

Science, however, often points toward behavior rather than ingredients.

Ultra-processed foods encourage faster eating, softer textures, and higher calorie intake.

That pattern explains a great deal without invoking conspiracies.

Understanding that reality empowers better choices than fear ever could.

Reference

Hall KD, Ayuketah A, Brychta R, et al. Ultra-Processed Diets Cause Excess Calorie Intake and Weight Gain: An Inpatient Randomized Controlled Trial. Cell Metabolism. 2019;30(1):67–77.e3.

Willpower Is B.S.: A Surgeon on Zepbound Jan 01, 2026

Show notes

Willpower Is B.S.: Food Noise, Healthspan, and What Actually Changed My Life

For decades, I started every New Year the same way.

In January, I promised myself this would be the year.

By February, I tried harder.

Every spring, I adjusted the plan.

And by summer or fall, the weight crept back.

That cycle repeated not because I lacked knowledge, discipline, or effort. Instead, it repeated because I misunderstood biology — at least when it came to myself.

This year is different.

For the first time since Ronald Reagan was first elected, weight loss is not at the top of my New Year’s resolution list. Not because I stopped caring, but because I lost 45 pounds with the help of Zepbound over the last year. More importantly, however, I learned something that reshaped how I think about obesity, healthspan, and shame.

Before anything else, let me be clear: this is not medical advice. This is a story. Anecdotes are not evidence, even when the anecdote is from a physician. Nevertheless, stories help us understand science when data alone fails to move us.

And this story matters.

I Had Willpower. That Wasn’t the Problem.

For years, people told me — and millions of others — the same thing: move more and eat less. At first glance, that advice sounds logical. After all, calories matter. Energy balance matters.

However, reality is more complicated.

To begin with, I am a surgeon. Surgical training requires extraordinary willpower. Moreover, I’ve logged food meticulously, cooked Mediterranean-style meals, exercised consistently, and followed every evidence-based recommendation I’ve ever given patients.

Meanwhile, Oprah has willpower. Olympic athletes have willpower. Yet obesity persists.

Sure, willpower works briefly. In fact, go on a liquid protein diet, and the weight will fall off quickly. Unfortunately, the food noise remains. Eventually, biology wins. Always.

In the same way you cannot positive-think your way out of hypertension, cholesterol, diabetes, cancer, or heart disease, you cannot willpower your way out of obesity. Obesity is a disease. It is not a moral failure.

Ironically, I knew this intellectually. Nevertheless, I failed to apply it to myself. We have a name for that: cognitive dissonance.

Food Noise Was the Missing Concept

The real turning point did not come from reading another study. Instead, it came from listening to people I trusted.

One colleague quietly lost weight on a GLP-1. Another friend told me something more striking: the food noise stopped. Alcohol lost its appeal. Smoking no longer called.

That phrase — food noise — suddenly explained decades of struggle.

To illustrate, think of sleeping near Lake Shore Drive in Chicago. At first, traffic noise dominates your awareness. Eventually, it fades into the background. Only when you leave the city do you realize how loud it was.

Food noise works the same way.

When GLP-1 therapy quieted that background signal, eating slowed naturally. Meals ended without effort. Desire changed without rules. Biology shifted.

Notably, calories did not lower my stress. Calories did not improve my sleep. Calories did not stop snoring. Biology did.

The Unexpected Early Benefits

Interestingly, weight loss was not the first change I noticed.

Sleep improved almost immediately. Stress dropped dramatically. Commutes that once registered hours of physiologic stress now barely registered minutes. Appetite normalized. Eating slowed.

These changes matter because sleep and stress directly affect inflammation, metabolic health, appetite signaling, and long-term disease risk. In other words, healthspan improved before the scale reflected anything meaningful.

That observation alone reframed the entire experience.

Why Support Groups Matter More Than Diet Rules

Along the way, something else happened.

Friends noticed.

Predictably, they asked the same question everyone asks: What diet is working? After I answered honestly, several started their own journeys.

Soon enough, we formed an informal support group. People texted. Others called. Questions surfaced: Is this normal? Should I eat this? Does this feeling pass?

Support did not mean coaching. Rather, support meant context. Shared experience reduced anxiety. Honest conversations prevented unnecessary panic.

Not surprisingly, patterns emerged. People still loved great food. Wine interest decreased naturally. Travel did not end. Joy remained intact.

Support mattered because isolation amplifies shame.

Vitamins, Bowels, and the Things No One Mentions

Equally important, practical realities surfaced.

Eating less means needing micronutrients, not fewer of them. Unfortunately, some vitamins fail when appetite drops. In fact, the only time I vomited was after taking a vitamin on an empty stomach. That lesson mirrored decades of bariatric follow-up experience.

For me, AG1 worked. No sponsorship exists here. Nevertheless, cost raises questions. With a background in culinary medicine, developing a better formulation makes sense. Thiamine deficiency, for example, causes devastating neurologic consequences. This is not theoretical.

Similarly, bowel habits change. Less intake means less output. Fewer bowel movements do not equal constipation. Fiber still matters. Mediterranean-style eating naturally solves most of this problem.

Understanding physiology prevents fear.

Why I’m Writing Another Book

At some point, frustration turned into obligation.

Recently, a physician who has never used a GLP-1 published a book about eating on GLP-1 therapy. That bothered me more than it should have.

Given my background — weight-loss surgery, culinary medicine, and lived experience — I realized I had to write this book. Not to sell diets, but to explain reality.

The working title?

Willpower Is B.S.

Subtlety has never been my strength.

This book will focus on biology, food ideas, micronutrients, behavior, and healthspan. Above all, it will remove shame from the conversation.

Incidentally, my literary agent retired long ago. Therefore, if you know someone who understands medicine, food, and honesty, I’m back in the market.

Why the Mediterranean Healthspan Cruise Exists

At the same time, conversations kept expanding beyond weight loss.

Healthspan matters more than thinness. Longevity depends on sleep, stress, nutrition, social connection, and movement. Accordingly, the Mediterranean Healthspan Cruise was born.

This is not a weight-loss cruise. Instead, it’s a learning experience. We will discuss food, medicine, science, and aging. Yes, there will be a GLP-1 support session. Equally, there will be conversations for everyone.

Learning works best in a community.

This Is Only Part One

As I write this, I’m preparing to inject my 7.5 mg dose of Zepbound. I still hate needles. Some things never change.

Nevertheless, this is only part one of the journey.

Science progresses when we admit what we got wrong.

This time, I listened.

References

Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide Once Weekly for the Treatment of Obesity. N Engl J Med. 2022 Jul 21;387(3):205-216. doi: 10.1056/NEJMoa2206038. Epub 2022 Jun 4. PMID: 35658024.
Rubino F et al. Joint international consensus statement for ending stigma of obesity. Nature Medicine, 2020.

Is Whoop Predicting My Death? Dec 25, 2025

Show notes

Is Your Watch Predicting Your Death?

What Biologic Age Really Means — and What It Doesn’t

My Whoop tells me I’m eight years older than I actually am.

Naturally, that raises a question.

Does that mean I’m going to die eight years sooner?

Is my watch quietly chiseling a new date onto my tombstone?

Fortunately, the answer is no.

Still, confusion around biologic age has exploded.

Wearables promise insight.

Apps offer scores.

Some even whisper about your future health, as if destiny lives on your wrist.

So let’s slow this down and talk about what biologic age really is — and why it matters far less than you think.

The Two Numbers and the Dash

Every tombstone has two numbers.

One marks when you were born.

The other marks when you died.

However, the most important part isn’t either number.

It’s the dash in between.

That dash represents your life.

It reflects your health, mobility, independence, and curiosity.

When we talk about longevity, we shouldn’t obsess over the second number.

Instead, we should focus on making those two numbers far apart — and keeping the dash strong for as long as possible.

That’s healthspan.

Why Biologic Age Sounds Scarier Than It Is

Biologic age is not a prophecy.

It isn’t a death clock.

It doesn’t predict how long you’ll live.

Instead, biologic age is a model.

It estimates how your body is functioning right now based on things like:

resting heart rate
heart-rate variability
sleep duration and consistency
activity and recovery patterns
sometimes weight or blood pressure

Different devices use different inputs.

As a result, they often give different answers.

In other words, biologic age reflects recent stress and behavior, not your destiny.

Think of it as feedback — not fate.

Why Your Watch Isn’t Measuring “Real” Aging

Earlier in the Fork U longevity series, we talked about telomeres.

Those shorten slowly over decades, one cell division at a time.

Your wearable isn’t tracking that.

Instead, devices like Whoop measure physiology, not DNA.

They detect how hard you’ve been living lately, not how much time you have left.

A bad week of sleep, travel, stress, or alcohol can push your biologic age higher.

A calm, consistent routine can bring it back down.

That’s not aging.

That’s load management.

A Simple Experiment That Tells the Whole Story

Here’s a trick I tried.

I told Whoop I was younger than I actually am.

Guess what happened?

Suddenly, my biological age dropped below my real age.

That alone tells you everything.

Whoop isn’t predicting where you’re going.

It’s comparing how you’re doing relative to the age you told it you are.

Once again, that’s feedback — not destiny.

Why I Prefer Withings

I use multiple devices because, frankly, I’m a nerd.

However, I tend to prefer Withings for one simple reason.

They don’t try to scare you.

Instead of telling you how old you “really” are, Withings focuses on things that actually improve your life today:

blood pressure trends
body weight and composition
heart rhythm
sleep duration
long-term consistency

More importantly, they ask better questions.

Are you sleeping better?

Is your blood pressure improving?

Are your habits trending in the right direction?

That’s medicine.

Not numerology.

And no — Withings didn’t pay me to say that.

The Biggest Mistake People Make

Many people treat biologic age like a grade.

Others see it as a moral judgment.

When the number drops, they feel virtuous.

When it rises, they panic.

That framing misses the point.

The only question that matters is this:

Is it moving in the right direction over time?

One bad week doesn’t define you.

One good week doesn’t either.

Trends matter.

Moments don’t.

What No Device Can Tell You

No wearable can tell you:

when you’ll die
whether you’ll get cancer
if you’ll have a stroke
how many years you have left

Anyone claiming otherwise is selling fear — or subscriptions.

Technology can guide behavior.

It cannot predict destiny.

New Year’s Resolutions That Actually Improve Healthspan

If you want to improve your biologic age — and more importantly, your healthspan — start here:

Sleep better and more consistently.

Build and maintain muscle.

Move your body every day.

Eat a Mediterranean-style diet.

Lower stress where you can.

Spend time with people you enjoy.

Do those things, and most metrics improve on their own.

The Bottom Line

Your watch is not your destiny.

Chronological age is fixed.

Healthspan is not.

Biologic age is adjustable, responsive, and reversible.

Use it as feedback.

Ignore it as prophecy.

And remember — the goal isn’t to beat time.

The goal is to live well while time keeps moving.

References

Levine ME. Modeling the rate of senescence: Can estimated biological age predict mortality more accurately than chronological age? J Gerontol A Biol Sci Med Sci. 2013.
Belsky DW, et al. Quantification of biological aging in young adults. Proc Natl Acad Sci USA. 2015.
Blackburn EH, Epel ES, Lin J. Human telomere biology: A contributory and interactive factor in aging, disease risks, and protection. Science. 2015.
WHOOP Team. Understanding Recovery, HRV, and Physiological Load.
Withings Health Institute. Longitudinal tracking of cardiometabolic health markers.

GLP-1 Drugs, the Mediterranean Diet, and the Science of Living Longer Dec 18, 2025

Show notes

GLP-1 Drugs, the Mediterranean Diet, and the Science of Living Longer

For years, anti-aging has been hijacked by supplements, hacks, and promises that never hold up. Meanwhile, real science has quietly moved forward. Today, the most compelling anti-aging story does not come from a powder, a cold plunge, or a fasting app. Instead, it comes from metabolism.

A class of medications called GLP-1 receptor agonists started as diabetes drugs. Over time, clinicians discovered something bigger. These medicines now play a major role in obesity treatment, and they produce effects that reach far beyond the scale. Because obesity shortens lifespan and damages nearly every organ system, it makes sense that drugs that treat obesity could also improve healthspan—the years you live with strength, clarity, and independence.

However, weight loss alone does not explain what researchers are seeing. These drugs reduce inflammation, protect the heart, lower biological stress, and may even delay cognitive decline. Importantly, many of these effects occur independent of weight loss. That fact has forced scientists to ask a serious question: could GLP-1 drugs represent a new class of anti-aging medicine?

Even longevity-focused clinicians, such as Peter Attia, have publicly discussed using GLP-1 drugs at lower doses in select patients—not for weight loss, but for metabolic health and long-term disease prevention.

Why Metabolism Matters for Aging

Aging is not just about time. Instead, it reflects how well your body regulates key systems over decades. Blood sugar control, inflammation, oxidative stress, and cellular repair all shape how fast—or how slowly—you age.

GLP-1 receptor agonists influence all these pathways. Originally designed to mimic a gut hormone that signals fullness, these drugs turned out to do much more. Research shows they lower systemic inflammation, improve mitochondrial function, and reduce oxidative stress. As a result, organs function better for longer.

In simple terms, when metabolism runs smoothly, cells behave younger.

Retatrutide and the Next Generation of GLP-1 Drugs

Newer drugs have taken this concept even further. Retatrutide, a triple-agonist medication, targets three hormonal pathways simultaneously: GLP-1, GIP, and glucagon.

In Phase 3 trials, participants lost nearly 29% of their body weight, or more than 70 pounds on average. Yet weight loss only tells part of the story. Retatrutide also lowered inflammation, improved blood pressure, improved lipid profiles, and reduced joint pain.

Each hormone plays a role. GLP-1 reduces appetite and inflammation. GIP improves insulin sensitivity and nutrient handling. Glucagon increases energy expenditure and fat oxidation. Together, these pathways keep metabolism active, not slowing down during weight loss.

That combination does more than shrink waistlines. It restores metabolic flexibility, which declines with age.

Inflammation: The Engine of Aging

For decades, scientists blamed aging on simple wear and tear. Modern research tells a different story. Chronic, low-grade inflammation—often called inflammaging—drives many diseases of aging.

Heart disease, stroke, arthritis, fatty liver disease, and cognitive decline all share this inflammatory background. In clinical trials, GLP-1 drugs reduced markers such as C-reactive protein, triglycerides, and blood pressure. These changes signal reduced biological aging risk, not just better lab numbers.

When inflammation falls, fewer senescent cells accumulate. Blood vessels stay healthier. Organs function longer.

Heart Disease and Longevity

Nothing ages a person faster than a heart attack. Because of that reality, cardiovascular protection matters deeply for longevity.

Multiple cardiovascular outcome trials show that GLP-1 receptor agonists reduce major adverse cardiovascular events in people with type 2 diabetes and high cardiovascular risk. Across studies, researchers observed a 13% reduction in cardiovascular death and a 9% reduction in nonfatal heart attacks compared with other treatments.¹²

The LEADER trial demonstrated that liraglutide reduced cardiovascular mortality by 22%.⁶ Similar benefits appeared with semaglutide, dulaglutide, and albiglutide.²⁷ Because of this evidence, the FDA approved several GLP-1 drugs for cardiovascular risk reduction in adults with diabetes and established heart disease.⁸

These benefits do not come from glucose control alone. GLP-1 drugs lower blood pressure, reduce inflammation, improve endothelial function, decrease oxidative stress, and reduce RAAS activity.³⁴ At the cellular level, they protect heart muscle cells from multiple forms of cell death while enhancing autophagy and mitophagy.⁵

Although GLP-1 drugs do not strongly reduce heart failure hospitalizations, meta-analyses suggest a modest benefit.³⁷ Most importantly, they safely reduce atherosclerotic risk. Preventing a heart attack remains one of the most powerful anti-aging interventions available.

Dementia: Prevention, Not Cure

Brain health deserves careful discussion. GLP-1 drugs do not reverse dementia. They do not improve cognition once dementia is established. Recent trials in patients with Alzheimer’s disease showed no meaningful cognitive improvement.

That limitation matters.

However, prevention tells a different story. Large observational studies show that GLP-1 receptor agonists are associated with 33–45% lower dementia risk compared with other glucose-lowering drugs in people with type 2 diabetes.¹² A 2025 JAMA Neurology study involving nearly 34,000 patients found a 33% lower risk of Alzheimer’s disease and related dementias among GLP-1 users.¹

Randomized trial evidence shows a more modest, but still significant effect. A 2025 JAMA Neurology meta-analysis found that GLP-1 drugs reduced dementia risk, while SGLT2 inhibitors did not.³ This finding suggests a class-specific effect, rather than a glucose-only explanation.

Mechanistically, GLP-1 drugs reduce neuroinflammation, improve insulin signaling in the brain, promote neurogenesis, and may reduce amyloid-β and tau pathology.⁵⁶ They also improve vascular health, which strongly influences cognitive aging.

Age appears to matter. A 2025 target-trial emulation showed weaker effects in adults over 75, but stronger protection in younger patients.⁷ The takeaway remains clear: earlier prevention works better.

The goal is not to cure dementia. Instead, the goal is to delay its onset long enough that many people never reach it.

Ultra-Processed Food and Brain Aging

Diet still matters. Ultra-processed foods damage the same systems that GLP-1 drugs try to repair.

These foods hijack dopamine reward pathways, increase cravings, and weaken satiety signals. Soft textures and engineered flavors allow rapid overconsumption. High intake links to higher inflammation, worse metabolic health, reduced gray-matter density, and faster brain aging.

Additives and emulsifiers disrupt the gut microbiome and the gut-brain axis. As a result, insulin signaling in the brain worsens. GLP-1 drugs often counteract damage caused by this food environment, but prevention works better than repair.

The Mediterranean Diet and Alcohol

Here is the empowering part. People can act today.

The Mediterranean diet remains the dietary pattern with the strongest evidence for protecting both the heart and the brain. Vegetables, legumes, fruit, whole grains, olive oil, fish, and minimal ultra-processed food form its foundation. This pattern reduces inflammation, improves vascular health, supports the microbiome, and slows cognitive decline.

Think of it this way: GLP-1 drugs quiet the metabolic noise. The Mediterranean diet keeps it quiet.

Alcohol also matters. Earlier beliefs about alcohol and brain protection did not hold up. Even moderate drinking increases dementia risk, worsens sleep, raises inflammation, and damages the hippocampus. If cognitive protection matters, less alcohol helps, and none works best.

What This Means for Healthspan

Aging is not about adding years. Aging is about protecting systems.

GLP-1 drugs support metabolic health. The Mediterranean diet supports biology. Avoiding alcohol protects the brain. Movement and sleep reinforce everything else.

If heart disease, dementia, and disability are delayed long enough, many people will never experience them. That outcome does not represent immortality. Instead, it represents success at healthspan.

References

Ussher JR, Drucker DJ. Glucagon-Like Peptide 1 Receptor Agonists: Cardiovascular Benefits and Mechanisms of Action. Nat Rev Cardiol. 2023;20(7):463–474.
Nauck MA, et al. Cardiovascular Actions and Clinical Outcomes With GLP-1 Receptor Agonists. Circulation. 2017;136:849–870.
Pop-Busui R, et al. Heart Failure: An Underappreciated Complication of Diabetes. Diabetes Care. 2022;45:1670–1690.
Wu Q, et al. Glucose-Independent Cardiovascular Mechanisms of GLP-1 RAs. Biomed Pharmacother. 2022;153:113517.
Boshchenko AA, et al. Cardioprotective Signaling of GLP-1 Receptor Agonists. Int J Mol Sci. 2024;25:4900.
Marso SP, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2016;375:311–322.
Honka H, et al. Therapeutic Manipulation of Myocardial Metabolism. J Am Coll Cardiol. 2021;77:2022–2039.
FDA Orange Book.
Tang H, et al. GLP-1RA Medications and Dementia Risk. JAMA Neurol. 2025;82:439–449.
Seminer A, et al. Cardioprotective Glucose-Lowering Agents and Dementia Risk. JAMA Neurol. 2025;82:450–460.
Au HCT, et al. GLP-1 and Neurodegenerative Pathology. Neurosci Biobehav Rev. 2025;173:106159.
Inoue K, et al. GLP-1 RAs and Dementia Incidence in Older Adults. Ann Intern Med. 2025.

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Fork U with Dr. Terry Simpson

Protein Panic: How Much Do You Really Need?

First, What Protein Actually Does

How Much Is Enough?

Here’s What I Actually Do

Now Let’s Bring In GLP-1

Here’s the Real Deficiency

Mediterranean Patterns Keep It Balanced

The Takeaway

Why Traditional Mexican Food Is Healthy — and How America Got It Wrong

First, Let’s Talk About the Taco America Put on Trial

Now Let’s Look at a Real Taco

Corn Tortillas Aren’t the Villain — They’re the Foundation

Beans Do the Heavy Lifting — And They Always Have

Now Let’s Deal With Refried Beans — Because This Is Where People Panic

Avocado Doesn’t Add Calories — It Unlocks Nutrition

Salsa and Cabbage Quietly Do the Real Work

Step Back — Because This Should Look Familiar

So What Actually Broke the Taco?

The Verdict

Why Fiber Fails to Impress—and Why That’s the Point

“Fiber Isn’t Essential”—Why That Argument Misses the Mark

Protein Gets the Spotlight While Fiber Does the Work

A Personal Lesson From Oats, Gas, and a Scorched Desk

Not All Fiber Works the Same Way

No, Butter Is Not a Shortcut to Butyrate

Supplements Help—but Food Still Wins

IBS, FODMAPs, and Why We Avoid Diet Cosplay

What Eating Enough Fiber Actually Looks Like

Start Slowly, Then Stay Consistent

The Bottom Line

Food Noise Isn’t Hunger — and Why Broccoli Never Fixed the Brain

First, Define the Problem Clearly

Next, Address the Broccoli Myth

Then, Follow the Science Where It Leads

Now, Enter GLP-1 Receptor Agonists

As a Result, Behavior Changes Without Force

Finally, Place Diet Back Where It Belongs

So, What Actually Matters

REFERENCES:

Whole Milk Is Back in Schools

But Hungry Kids Are Still the Real Problem

First, Let’s Start With the Obvious

Next, What Actually Changed With Milk

Now, Why Milk Fat Is Not Essential

Then, Let’s Talk About the Brain

Meanwhile, What Kids Are Really Missing

At the Same Time, Food Access Is Shrinking

In Contrast, Feeding Kids Actually Works

So, Let’s Put This Together

One Reference on Brain Fat and Cell Membranes

When Influencers Replace Scientists, Everyone Loses

Yes, Some of the Advice Is Right

The Real Risk Isn’t Agreement

Scientists and Influencers Are Not Interchangeable

Fiber Versus Saturated Fat: A Telltale Sign

The Brain Doesn’t Care About Trends

The “You’re On Your Own” Problem

Agreement Does Not Equal Expertise

The Bottom Line

A Final Note

Ultra-Processed Food: Making Sense of the Madness

Why We’re Looking for Something to Blame

What “Ultra-Processed” Actually Means

Why Ingredient Blame Falls Short

The Simple Question That Changed the Conversation

What Kevin Hall Actually Found

Why a Book Made This Go Viral

Where the Story Goes Too Far

A Better Way to Think About Food

The Bottom Line

Reference

Willpower Is B.S.: Food Noise, Healthspan, and What Actually Changed My Life

I Had Willpower. That Wasn’t the Problem.

Food Noise Was the Missing Concept

The Unexpected Early Benefits

Why Support Groups Matter More Than Diet Rules