Health & FitnessMedicineNutritionScienceLife Sciences

Fork U with Dr. Terry Simpson

Terry Simpson

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

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

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

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

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

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#145
Thursday · 15 min
The Fish that Built America
In our series about foods that built civilization, we talked a lot about grains, from wheat to corn to rice. Today, we are taking you to the ocean, with the civilizations that salmon built. From California to the interior of Alaska, salmon, a staple, allowed people to settle into villages, develop complex social networks, art, and trade routes. Those trade routes are as large as the ones in the Mediterranean. Some tribes built communal homes and developed complex art and language. Some were Seafaring tribes with canoes up to 60 feet long that traveled across oceans. All because there was a fish that would return in large numbers to streams and rivers, reliably, predictably. So predictable, the people could build their lives around salmon runs. So much so that some built a calendar not only with lunar cycles, but also with the return of the salmon. Civilizations have always gathered around food and water. The Mediterranean connected people who grew wheat and olives, giving people time to make wine, mine copper, build ships, trade with their neighbors, and occasionally go to war with them. Asia had rice and grain near the great river systems. The reliable calories from rice and grains allowed villages to become cities and to travel by water to trade. Today we are going to my home, from the Ventura River in California to my home state of Alaska. The Crop That Swam Home Different than the other civilizations, no one had to plant this crop. They didn’t have to tend the crop. It literally swam home every year. Different times for different types of salmon. When the first Europeans saw these fish, the river was so crowded they joked you could walk on their backs, crossing the river and never get wet. Ketchikan, The Salmon Capital of the World I grew up in Ketchikan, Alaska. A city founded upon salmon. Some say Ketchikan stands for smelly fish, apparently after the large spawn, as the fish died, it left quite an odor - you can only imagine thousands of dead salmon. Everyone has their favorite type of salmon. The large ones, the King Salmon, also called Chinook, typically start their run to the creeks and rivers in April. You could catch them reliably in late May and June, or even later. We had a King Salmon derby, usually in late May to early June. The record salmon was 79 pounds for that derby. The largest King I ever caught was 26 pounds, and I cannot imagine catching one larger. For a fish that was the livelihood of many of my neighbors, the stocks have become so low that the derby I grew up with was cancelled. Global warming has devastated salmon runs. The above totem is either an eagle or a man, depending on who you ask. The clam has caught it, and the tides roll in, and the man, or eagle, sings a song. Note the amazing carving, and a story as old as time itself. These are Chilkat blankets, or dancing blankets. They take up to five years to create. Made from a combination of inner cedar bark and mountain wool to make the foundation. The colors are mostly dyes of four natural pigments: black (hemlock bark/copper oxide), yellow (wolf moss), blue-green (copper soaked in urine), and the creamy white of natural undyed goat wool. Non-Nomadic People Because of the abundance, both in terms of the salmon runs, other marine mammals, and berries, they didn’t have to forage. So they were able to build villages with communal living - they were SF before SF was. An intense harvest in the late spring and summer led to a winter of art, ceremonies, and the potlatch. The potlatch is a giant party where the hosts not only display their wealth, but give it away. The richer you are, the more you would give, and that would be the nudge for the neighbor to do the same. Large villages and communal houses, when encountered by the first Europeans, weren’t something they were expecting. There was an entire civilization, clans, tribes, and alliances. People who made treaties, made war, and played games. In Ketchikan, these were rebuilt during the Depression. Here you can see my brother and I being kids - but it also gives you an idea of the large size of these communal homes and totems. They did travel through large canoes.
#144
September 10 · 20 min
The Three Sisters
Corn, beans, and squash, the three sisters, were the Native Americans’ crop, providing a stable source of calories, protein, and farming from Canada through South America. They allowed civilization to go from a hunting people to those who built cities that rivaled Europe and pyramids equal to the marvels seen in Egypt. The rise of civilizations has a pattern: grow a stable crop that allows people to survive, and go from nomads to develop complex societies. In our series of foods that built civilizations, we turn to the Americas before Europeans arrived. Long before Europeans arrived, civilizations in the Americas had developed writing, calendars, monumental architecture, cities, trade networks, irrigation systems, pottery, and sophisticated agriculture. Corn, or maize, fed the Maya, Inca, and Aztec worlds. In what is now the American Southwest, Pueblo peoples built multi-story communities in the desert, while Mississippian societies built towns and enormous earthworks along the great river valleys. It began with Corn, or Maze It all began with a grass called Teosinte (pronounced “tA-O-‘sin-tE”). Teosinte does not look like corn today, but the DNA shows they are alike, and it was this grass that Native Americans 10,000 years ago began to engineer. In fact it wasn’t until a few years, 2005, ago that modern molecular geneticists discovered that this grass, Teosinte, was the father of corn. For years, people who study plants, botanists, assumed the evolutionary predecessor had long since become extinct. And while Teosinte is widely spread throughout Central America, it was not even considered in the same family as corn. The original ear of Teosinte is 2-3 inches long with 5-12 kernels. The kernels were hard, and most human teeth would break trying to eat them. Teosinte is inedible for many people. Contrast Teosinte with modern corn with a cob. A cob is 12 inches long, with over 500 kernels. The coating on the kernel was selectively bred from the rock-hard protecting seed to, now, where corn has an easily chewable, paper-thin, but still indigestible membrane. This was breeding at its finest. Ten thousand years ago, there was no plant that anyone would recognize as corn. In fact, there was no corn. By 4500 years ago, corn was throughout all the Americas, with carbon dating of kernels in Arizona from over 3000 years ago, in Canada 700 years ago. Corn allowed the Mayan people to go from a people who foraged to a people who could stay and cultivate. You can see from the photos how, as time went on, corn changed: both Teosinte and corn have the same number of chromosomes, and they have the same genes that code for the same proteins. Teosinte and corn can be bred because they are so close genetically. The difference between the grass, Teosinte, and modern corn is about a few genes. Corn didn’t “evolve”; early Native Americans bred corn. Generation of corn after generation, they bred the crop that tasted better, chewed more easily, and survived well. In what is now El Salvador, some have said the Mayans discovered corn in the mountains of Chalatenango. Recently, a dam revealed a village in the area, which was one of the original four Lake Island villages of the Mayans. On this land, one can see the range of corn from the grass to the modern corn. If you hike there, you can see places where the Mayans would grow special crops, where they would harvest the Teosinte with the kernels they could eat, and over time, they would breed it and cross-breed it until they had an agricultural system based on this plant. So sacred was corn that they called it the “grain of the gods.” To this day, the people in Santa Ana, in western El Salvador, still plant little plots of primitive corn that they call something like “ulupiche”. This is not to eat, but simply to please the ancestors. It is from these Mayans that corn was selectively bred, or genetically engineered for better taste, different colors, and the ability to withstand pests. Corn moved quickly, finding its way to Mexico 7000 years ago, South America 6800 years ago, and to North America nearly 4000 years ago. Once Europeans arrived, corn spread even more rapidly through the rest of the world. The First Tupperware Party Edible Tupperware, that would bring new life into a product that seems to have gone the way of Department Stores and home parties hosted by your neighbor to get you to buy something. The first squash was probably used to carry water, food, and grain. Vessels such as these were radioactive-dated nearly 11,000 years ago in Honduras. These gourds were hard; the inside was bitter, but they were efficient to carry water, perhaps cook food, and store knick-knacks (the first junk drawer was a squash). But get hungry enough, and even bitter food can be tasty (not Brussels sprouts). The squash family (Cucurbitaceae) was domesticated about the same time. Those squashes were related to zucchini, yellow summer squash, acorn squash, delicata, many pumpkins, pattypan, and crookneck squash. And as much as zucchini feels Italian, these squash were grown and consumed in Mexico thousands of years before Rome existed. Multiple types of edible squash were cultivated in different geographic regions and ultimately traded. The Bean The last of the sisters was the bean. Indigenous peoples domesticated several species of beans in the Americas. The most familiar is Phaseolus vulgaris, the ancestor to black beans, kidney beans, pinto beans, and navy beans. But there wasn’t just one ancestor to all the beans. Indigenous farmers domesticated at least five species of Phaseolus. Today, we know their descendants. Besides the black and pinto beans. There was a different region that grew lima beans, and yet others were the scarlet runners and tepary beans. Europeans had been eating beans for thousands of years before Columbus. Original old-world beans included fava beans, peas, lentils, and chickpeas. From America, Europe obtained kidney beans, black beans, pinto beans, and cannellini beans. Yup, those favorite beans I put on Paella originally were groomed in America. The Three Sisters When the first European settlers arrived, they noted the agricultural habits of the Iroquois with the three sisters. The corn provided the pole, the beans fixed nitrogen into the soil, and the squash provided a ground cover that kept away pests. This works not only from the perspective of good land use, but also provides a complete protein. You do not have to eat corn and beans in the same bite to create a “complete protein.” But across a diet, their amino-acid profiles complement each other beautifully. Corn gives abundant energy and some protein. Beans add protein, particularly lysine. And, squash adds micronutrients through the seeds, fat, and additional protein. The agricultural system worked, and because it worked, it was copied throughout the Americas. The nutrition also worked, without a Registered Dietitian telling them. Civilizations We have historic records of what happened to some civilizations, which gave us written languages, weights, measures, amazing architecture, and Mayan calendars. The tragedy of the indigenous peoples of what is now North and South America has been well documented. We have no idea what we have lost. Yet what remains is the food. What always seems to remain is the food, and now, when you eat your tomato on the pizza, or have cannelloni beans on Paella, you are eating history from the major continents that all had their own civilizations whose contribution was great pizza, paella, and food. Every one of the ancient civilizations has disappeared. Their food remains. We read about the Greeks eating whole grains and pulses. We tour Machu Picchu. We marvel at the Code of Hammurabi. We look at the terracotta soldiers guarding the tomb near Xi’an. All while enjoying the food that allowed them to settle and make a civilization. Some monuments survived, but the food is still here. I still don’t know why we kept Brussels sprouts.
#143
September 3 · 12 min
Fear Not Rice: It Built a Civilization
If you spent time in the low-carb world, rice is about as welcome as a toxic waste dump. It is part of those dreaded whites: white flour, white sugar, and white rice. All a part of the reason we are fat, diabetic, and have every disease one can think of. But then, if you get out and see the world, you will realize that people eat rice daily, are thin as a rail, relatively healthy, and have some of the longest lives on the planet. Today, we will make sense of the madness of rice. While people in the Mediterranean were mostly illiterate, in Asia, they had developed writing, laws, philosophy, governments with elaborate testing for civil servants, and gunpowder. In addition, the evidence shows they circumnavigated the oceans, found a larva that could make silk cloth, and developed fine porcelain. They did this while we were drawing crude paintings in caves. Some of our ancestors looked east and even wrote about this “strange” but highly advanced civilization. This was all possible with grass, we call rice. Yangtze River Basin Along the basin of the Yangtze River, and elsewhere, was an edible grass that ultimately became rice. You can imagine it was simply gathered until someone learned how to plant it. Wild rice, then, would drop the edible seed as it matured. Replanting those that kept their seed on the plant longer meant the rice was easier to gather. Planting and gathering meant staying in one area, then, with abundance, one had to build storage, and eventually a civilization around rice. Weights, measures, laws, buildings. Once people can exchange for rice, you develop professions, art, philosophy. River basins have great soil, but the unpredictability of floods, so management of the river, canals, and all because of a simple grain. I realize carnivores like to hunt large game as their primal food, but chasing mammals doesn’t lead to a civilization or a brain beyond hunting. Also true today, although the hunting is reserved for determining which type of beef is better, and which store has better prices. Modern carnivore hunters prefer Costco beef, gyms, testosterone, and making fun of people who take statins. One needs a granary to build a civilization. Rice Roads The ability to grow rice led to the first trade routes, as rice and the dishes that accompany it. From Bryani, to Pilaf and Risotto, to Paella Rice, made its way through trade routes around the world. And with each region, their dishes were accompanied by rice. Spice roads developed on the trails originally made by rice traders, and one might think the spices were there to make the rice even better. Today, we all have our favorite rice dishes. Mine vary between sushi and paella. Every culture accepted rice and made its own dish. Some regions even claim their rice came not from the east, but locally. Rice and Medicine The first peer-reviewed diet for a chronic disease was the Rice and Fruit Diet, popularized by Walter Kempner out of Duke University. He developed the diet for malignant hypertension, the disease that President Roosevelt died of. This disease was almost uniformly fatal within six months of diagnosis. Kempner developed this low-sodium diet of white rice and fruit. In trials, it not only lowered blood pressure but also improved survival. In the 1960’s, the diet became popular for weight loss, and throughout the United States, “Rice Houses” became a place for weight loss. Many Hollywood celebrities swore by them. Vitamin B1 was arguably the first vitamin Today, we know that thiamine deficiency leads to Beriberi, which was a common and often fatal disease in the Japanese Navy. Kanehiro Takaki noticed sailors who preferred polished white rice, almost exclusively for food, developed beriberi. While officers eating a more varied diet generally did not. Hanehro Takati is credited with saving the Navy by changing its diet. Polished rice removes the husk and endosperm of the rice, which is the main source of fiber and nutrients. Vitamin A is also unavailable in polished white rice. Vitamin A deficiency remains a preventable cause of childhood blindness. The World Health Organization estimates that 250,000 to 500,000 vitamin-A-deficient children become blind every year, and about half die within twelve months of losing their sight. To overcome this, rice was genetically modified to produce a precursor of vitamin A. The rice takes on a deep yellow color, hence the name “golden rice.” Unfortunately, the objection to a genetically modified organism was brought to court and stopped golden rice from being used. While this sits in litigation, these children are still going blind and dying. Why not use brown rice? White rice is shelf-stable for years. Brown rice will quickly become rancid, so it has a limited shelf life. How to Eat Rice without Losing Your Mind - and Should You Buy the $400 Rice Cooker? When writing about rice, there is a lot of heat and not much light. Influencers warn about blood sugar levels, arsenic, while some claim brown rice is perfect and white rice is evil. Others, in an attempt to sound like they know science, refrigerate rice overnight and claim it is now transformed into perfection. Let’s go through those claims, as well as the fancy rice cookers I see on the market.
#142
August 27 · 41 min
Beer, Bread, Cheese — and Penicillin
When we talk about the microbiome, people think about the colon and trillions of microorganisms. Have you ever considered that humans have other interactions with microbiomes that occur with our cooking? On this week’s episode of FORK U, we continue with our series “Food That Made Civilization.” The topic is Fermentation. How Fermentation Built Civilization We were selecting a microbiome without knowing it. Bacteria, yeast, and molds. Feed the ones that worked, keep the conditions they liked, and do it again. Your grandmother may have kept the bowl that made better bread. She saved some of yesterday’s dough to start tomorrow’s. Others learned that milk mixed with a bit of salt and kept in a goat’s stomach became yogurt or cheese instead of something that had to be thrown away. In Asia, they salted cabbage, put it into a jar, and buried it, which allowed them to survive the winter. And perhaps in what is modern-day Iran, they learned that when they crushed grapes, stored them in special containers, they made wine. And in Mesopotamia (now Iraq), ancient Sumerians left written recipes of barley brewing dating back over 5,000 years, which was probably beer. There were no microscopes or bacterial cultures. We didn’t know that yeast metabolized sugar into alcohol and carbon dioxide, or that lactic-acid bacteria changed the chemistry of cabbage and milk. But what they didn’t see was a colony of bacteria, yeast, and mold, creating environments in which organisms thrived, and transformed foods into something more edible and even stable for preservation. Those microorganisms gave us bread, beer, wine, cheese, kimchi, vinegar, and eventually penicillin. What Did Ancient Beer Taste Like? We are fascinated by what people before us ate and drank. From the Midas Tomb in ancient Phrygia, now Turkey, they discovered that people had made a fermented drink from barley, grapes, and honey. It was probably beer, wine, and mead in the same cup. Based on a chemical analysis of these vessels, Dogfish Head Brewery used modern yeast to make a beer called Midas Touch. But I wished we could have cultured the yeast and bacteria from one of those vessels? As much effort as Dogfish used to reproduce the ingredients on the basis of chemical analysis, the beer is not the same. The barley, grapes, and even the water are different. Some of those grape varieties may not even exist anymore. The temperature and storage conditions we are guessing at best. And the microbes undoubtedly changed over the three thousand years while waiting to resume their shift. Dogfish Head analyzed ingredients from pottery in China. That 9000-year-old pottery once held a fermented beverage made from rice, honey, and fruit. This was being drunk years before the Great Wall was built. Which makes me think, the Great Wall was the velvet rope, seeing if your name was on the list for the rice wine party. But consider it like this: even pizza lovers from New York will tell you that without the NY water, or coal-fired oven, you cannot make a true NY pizza. The yeast we use now are descendants of those used by our ancestors. But the microbiome changes, they reproduce, mutate, mix with other organisms from the flour, the grain, the fruit, the hands, and the environment. Yeast today are more different from their ancestors than we are from ours. But we are never drinking the exact same beer. We are drinking what became of that ancient experiment. Just like you never step in the same river twice. Then We Finally Saw Them Then came Antonie van Leeuwenhoek, who developed the first microscope. He was not a physician. He was not a professor of microbiology. There was no microbiology. He was a fabric salesman with an obsession for making good lenses. When he put those lenses together, he saw a world no one knew existed. He pointed it at everything: water, tooth scrapings, and eventually beer. He saw tiny living things moving around in a world humans had never seen. Leeuwenhoek called them animalcules, little animals. He even looked under his microscope at wine and beer. France Has a Wine Problem By the middle of the nineteenth century, France had been through revolution, empire, monarchy, another revolution, republic, and empire again. The country had plenty of political problems. But there was one problem that could unite almost any Frenchman. They didn’t know why sometimes their wine would spoil. Yes, there is the occasional bottle that is “corked,” and that is an inconvenience. But losing the entire batch is a disaster. Louis Pasteur, a chemist, was commissioned to help solve this problem. Leeuwenhoek could see them. Pasteur wanted to know what the hell they were doing. They were doing chemistry. The yeast was associated with alcoholic fermentation. Other organisms were associated with lactic fermentation. Different microorganisms produced different outcomes. And suddenly, all those odd instructions from your grandmother made sense. Use this bowl. Save some of that dough. Keep a little from the good batch. Don’t use that barrel again. Pasteur found that gently heating wine could prevent some of these microbial problems without boiling or ruining the wine. This gives us one of my favorite historical details: pasteurization was developed for wine before it was used for milk. The raw-milk crowd should put that on the T-shirt. My Great-Great-Uncle Changed Surgery James Young Simpson — my grandfather’s uncle — helped transform surgery with chloroform anesthesia. Anesthesia meant surgeons could finally operate without four people holding the patient down. Unfortunately, patients could survive the operation and still die several days later from infection. That is where Joseph Lister enters the story. Lister read Pasteur’s work on fermentation and putrefaction, and wondered if microorganisms could spoil wine; perhaps they could also spoil wounds. Fermenting grapes can be wonderful. Fermenting wounds, not so much Lister began using carbolic acid to treat wounds, instruments, and surgical infection rates fell. That became the start of modern, safe surgical technique. Pasteur was worried about spoiled wine. Lister was worried about dead patients. In your kitchen, you practice microbiology.
#141
August 20 · 25 min
Salt: From the Roman Legion to Your Electrolyte Packet
Salt: From the Roman Legion to Your Electrolyte Packet You've probably heard that Roman soldiers were paid in salt—and that this is where we get the word salary. It's a great story. It's also almost certainly not true. The Romans had money. We find Roman coins throughout the former empire, including around military forts such as those along Hadrian's Wall, and we have evidence that Roman soldiers were paid in money. What we do have is an ancient linguistic connection between the Latin sal, meaning salt, and salarium, which eventually gives us salary. Somewhere along the way, that became the much better story that a legionary went to the quartermaster and collected his wages at the imperial salt lick. But the fact that the story sounds believable tells us something important: salt really was extraordinarily valuable. Long before Rome, humans sought salt just as other animals do. Animals travel to mineral licks, and humans learned to exploit saline springs, coastal deposits, and eventually salt mines. Nobody needed to measure a serum sodium to discover salt. We had two very good reasons to want it: salt tastes good, and salt preserves food. That second property changed civilization. Meat and fish could be salted and dried. Vegetables could be fermented. Milk could be transformed into cheese, concentrating its nutrition and allowing it to last far longer than fresh milk. Salt helped food survive winter, travel aboard ships, and provision armies. The Egyptians even used natron—a mixture of sodium salts rather than ordinary table salt—to dry and preserve their dead. Hence the mummy. Or occasionally, presumably, the daddy. Once everyone wanted salt, governments discovered the next obvious thing to do: tax it. Salt became a source of state revenue in ancient China, traveled along trade routes in Rome, was burdened by the French gabelle, and eventually became the focus of Gandhi's famous Salt March against British rule in India. Then something changed. We got very good at producing salt, and we invented refrigeration. One of the principal reasons humans had consumed large quantities of salt—preserving food—became much less important. Unfortunately, we didn't stop liking the taste. Modern food manufacturers discovered that salt was cheap, improved flavor and texture, and could be added to almost everything. Today, the problem is rarely finding enough sodium. It's avoiding too much of it. There was, however, one particularly clever moment when public health took advantage of our universal salt habit. Iodine deficiency once produced enormous numbers of goiters and, more importantly, could impair fetal and childhood brain development. In 1924, iodized salt appeared on grocery shelves in Michigan as part of the American effort to combat endemic iodine deficiency. The idea was beautifully simple: everybody eats salt, so put iodine in the salt. Salt iodization became an extraordinarily effective way to prevent iodine-deficiency disorders, and it remains recommended by the World Health Organization. Which makes today's fascination with expensive “mineral” salts particularly amusing. Celtic sea salt, Himalayan pink salt, and other specialty salts contain magnesium, calcium, and other minerals—but in trace amounts. If you like their taste or texture, wonderful. I have fancy salts in my kitchen too. That's cuisine, not cardiology. If you want magnesium, eat some nuts. And then buy Morton's. We have performed a similar trick with hydration. There are people who genuinely need extra sodium: athletes exercising for hours, people working in extreme heat, and people experiencing substantial fluid losses. The development of sports drinks was a reasonable response to athletes losing both water and electrolytes during prolonged exercise. Somehow, that became the idea that everyone needs mango-flavored electrolytes simply because they own a water bottle. Most of us don't. Sodium is essential, but essential doesn't mean unlimited. The WHO currently recommends adults consume less than 2,000 mg of sodium per day—about 5 grams of salt—and notes that average global sodium intake is more than twice that amount. Most dietary sodium isn't necessarily coming from the salt shaker. Processed meats, breads, sauces, prepared foods, restaurant meals, cheese, and other frequently consumed foods can contribute substantial amounts. That doesn't mean your food needs to be bland. Cook vegetables. Eat legumes. Have fish. Use olive oil, herbs, spices, lemon, and vinegar—and use enough salt to make good food taste good. Just don't confuse seasoning your dinner with adding unnecessary sodium to an already sodium-rich diet. Salt helped build civilizations. It preserved food, provisioned armies, generated taxes, helped make cheese possible, and eventually became a vehicle for preventing iodine deficiency. We spent thousands of years figuring out how to get enough of it. Now we've become so good at it that we're paying extra to put more of it in our water. Listen to this episode of FORK U for the story of salt, and head over to drsimpson.com for the deeper dive into sodium, blood pressure, vascular health, salt sensitivity, gastric cancer, electrolytes, and what the science actually says about how much salt we should be eating.
#140
August 13 · 30 min
Coffee Woke Civilization
How a tiny seed changed the way we work, think, meet, and start the day Bread gave civilization calories. Beans gave it protein. Olive oil gave it light. Coffee gave civilization somewhere to meet—and a reason to stay awake. Coffee came late to Western civilization. The Greeks didn't have it. The Romans didn't have it. Even Galileo had to stay awake at night looking through his telescope without the help of an espresso machine. Historians no longer like the old idea of the “Dark Ages,” and for good reason. But I have my own definition: the Dark Ages were simply the time before Western civilization discovered coffee. Coffee Started as a Fruit First, coffee isn't really a bean. What we call the coffee bean is the seed of a fruit, often called a coffee cherry. Coffee plants originated in Africa, especially Ethiopia, where we get the wonderful legend of a goat herder named Kaldi. He supposedly noticed that his goats became unusually energetic after eating the red fruit from a coffee tree. The goats danced, Kaldi tried the fruit, and eventually the local monks discovered it helped them stay awake for evening prayers. It's a great story, although there isn't much evidence that Kaldi actually existed. The history becomes more reliable by the 1400s, when we know people were drinking coffee in Yemen. From there, coffee traveled along trade routes through the Middle East and into the Ottoman Empire. Somewhere along the way, something important happened: coffee stopped being simply a drink and became a reason for people to gather. Coffeehouses Woke People Up By the 1500s, coffeehouses were appearing in the Ottoman world. People came to drink coffee, but they stayed to talk about business, politics, religion, news, and probably their neighbors. Coffee eventually moved west, and by the 1600s, coffeehouses were spreading across Europe. London's first coffeehouse is generally dated to 1652. Some of these coffeehouses became known as “penny universities.” For the price of a cup of coffee, you could sit, listen, argue, and perhaps learn something. Coffee did not cause the Enlightenment, but it certainly provided a convenient place for people to discuss it. Unlike the tavern, the main drug being served made people more alert instead of less. The Swedes Took Coffee Seriously Then there were the Swedes. After losing to Russia in 1709, King Charles XII of Sweden spent several years in Ottoman territory. While there, he and his companions developed quite an affection for coffee. When the Swedes eventually returned home, that affection came with them, and coffee became deeply rooted in Swedish culture. Today, the Swedes have fika, which is much more than a coffee break. You stop what you are doing, sit down, usually have something to eat, and most importantly, talk to another person. In other words, coffee provides an excuse to stop working long enough to remember that there are other human beings around you. That sounds remarkably familiar to me. Coffee in Rainy Alaska I grew up in Ketchikan, Alaska, one of the wettest cities in America. Some years, the rainfall can approach 200 inches, and this isn't always the lovely rain that gently falls outside while you read a book beside the fireplace. In Ketchikan, the rain sometimes blows sideways. Many women of my mother's generation had moved to Alaska because their husbands brought them there. Their families might be thousands of miles away, winter days were short, and sometimes it seemed as though the rain would never stop. This was before SSRIs, but there was always coffee. My mother and her friends would gather at someone's house, sit around the kitchen table, drink coffee, and talk. Looking back as a physician, I think those gatherings served an important purpose. Not because coffee treats depression—it doesn't—but because friendship, conversation, and human connection matter. When the rain was blowing sideways, and you had had enough of your own house, you could always go to Betty's house for a cup of coffee. Of course, there were standards. In our part of Alaska, coffee meant Hills Bros. If Betty served something else, everyone would still drink it gratefully, but it would certainly be discussed. Coffee could generate more conversation than differences in religion. In a town where you could still hear Norwegian spoken on the streets, coffee sometimes seemed like our national beverage. Admittedly, Ketchikan also had far more bars than churches, but that's another story. We Still Meet Over Coffee That social role of coffee never disappeared. In many parts of the world, you don't begin a business meeting with business. First comes coffee. You make introductions, ask about family, talk about where you are from, and get to know one another. Then you conduct business. We Americans have made the process more efficient. We pick up a paper cup from the espresso bar, carry it into a conference room, open the laptop, and get right to work. We've kept the coffee, but perhaps we've lost a little of the ritual. Still, coffee shops are thriving, while alcohol use, particularly among younger adults, has been declining. For generations in America, meeting someone often meant, “Let's get a drink.” Increasingly, that drink might be coffee. From a health standpoint, replacing some alcohol with coffee is probably a pretty good trade: a healthier drink and a brighter mind. Even first dates now happen over coffee. Some people think a proper first date should involve dinner, but I'm not convinced. If I'm going to spend two hours discovering whether I like someone, wouldn't I rather find out after they've occupied a few of their adenosine receptors? Give them an espresso, and let's hear their interpretation of Hume. What Coffee Does to Your Brain Which brings us to caffeine. Caffeine doesn't actually give you energy. Instead, it blocks receptors for adenosine, a chemical involved in the feeling of sleep pressure. As you've been awake longer, adenosine signaling helps tell your brain that you're tired. Caffeine interferes with that message, which is why you feel more alert. My first scientific encounter with caffeine wasn't coffee at all. In the organic chemistry laboratory at the University of Chicago, we isolated caffeine from tea by brewing what may have been the world's strongest cup. It looked completely undrinkable, which was fine because we weren't making afternoon tea; we were doing chemistry. Years later, my friend Simon Majumdar introduced me to proper British builder's tea. Suddenly, I understood the British a little better. Builder's tea is one step removed from containing enough caffeine to keep you awake through one of my podcasts. Do You Really Have to Wait 90 Minutes? You may have heard the popular claim that you should wait 90 minutes after waking before drinking coffee because of cortisol. There is a little real physiology behind the claim. Caffeine can temporarily increase cortisol, and cortisol normally changes around the time we wake up. However, that doesn't prove the 90-minute rule. People who regularly consume caffeine develop substantial tolerance to some of its cortisol effects, and we don't have clinical trials showing that people who wait exactly 90 minutes have better health, better sleep, or better alertness. This is an important lesson that goes well beyond coffee. A biological mechanism is not automatically a medical rule. If waiting 90 minutes makes you feel better, then wait. If you've been drinking coffee shortly after waking for thirty years, sleep well, and enjoy your morning cup, there isn't good evidence that you need to stand beside the coffee maker holding a stopwatch. Coffee Is More Than Caffeine For years, medicine tended to think about coffee mainly in terms of caffeine. Caffeine stimulates us and can temporarily increase blood pressure, so it seemed reasonable to worry that coffee might be bad for the heart. Then researchers began looking at what actually happened to people who drank coffee over many years, and the story became much more interesting. Coffee contains hundreds of compounds, including chlorogenic acids, which are polyphenols. It also contains other compounds created or changed during roasting. In other words, coffee isn't simply caffeine dissolved in brown water. Large observational studies have found that moderate coffee consumption is associated with lower rates of several health problems, including type 2 diabetes and cardiovascular disease. Some of the most consistent findings involve the liver, where coffee drinking has been associated with lower risks of chronic liver disease, cirrhosis, and liver cancer. Interestingly, some health associations also appear in people who drink decaffeinated coffee. That tells us caffeine cannot be the entire story. Of course, these studies don't prove that coffee prevents disease, and coffee isn't medicine. But they certainly make the old idea that coffee must be bad for us much harder to defend. How You Make Coffee Matters Even the way we brew coffee changes what ends up in the cup. Coffee contains compounds called cafestol and kahweol, and cafestol can raise LDL cholesterol. Boiled and unfiltered coffee retains more of these compounds, while a paper filter removes many of them. That makes a simple invention from 1908 surprisingly important. A German woman named Melitta Bentz wanted a cleaner cup of coffee without grounds and began experimenting with paper filtration. More than a century later, we know that her filter didn't just change the taste and texture of coffee; it changed its chemistry. The Chemex, introduced in 1941, took paper filtration and turned it into an object that looks as though someone walked out of a chemistry laboratory and decided the glassware would make a lovely coffee pot. As someone who spent time in chemistry labs, I approve. Meanwhile, Italians went another direction. The early espresso machines arrived around the turn of the twentieth century, the Bialetti Moka Express appeared in 1933, and later machines gave us the pressure and crema we associate with modern espresso. Americans largely decided that what coffee really needed was a bigger cup and someone in a diner who would keep refilling it until you surrendered. Why We Drink It I have been drinking coffee for most of my life. Since about 1995, my first cup has usually been Peet's Major Dickason's Blend, and since 2005, most of those cups have been made by a Jura. I'm now on my second machine, so between them, they have probably made tens of thousands of cups. For years, I also traveled with an AeroPress because I was willing to trust a hotel with my bed, towels, and the structural integrity of the building, but apparently not with my morning coffee. Today, I even have a Nespresso machine in my bedroom because some mornings I would rather stay there, drink coffee, and read for another half hour before civilization requires my participation. But I don't drink coffee because of chlorogenic acids, and neither did my mother. The women sitting around those kitchen tables in Ketchikan weren't discussing polyphenols. The Swedes weren't measuring cortisol during fika, and the people in the old coffeehouses weren't worrying about whether 90 minutes had passed since they woke up. They drank coffee because it tasted good, because it helped them wake up, and because someone else was often sitting across the table. When the rain was blowing sideways in Ketchikan, there was Betty's house. There was coffee. And there was someone to talk to. Bread gave civilization calories. Beans gave it protein. Olive oil gave it light. Coffee gave civilization a reason to sit down together—and enough caffeine to get back up again. Coffee woke civilization.
#139
August 6 · 12 min
The Benevolent Bean: Civilization's Forgotten Protein
For years, beans have suffered from an image problem. They've been called "the poor man's meat," joked about for causing gas, and often relegated to the side of the plate. Yet for thousands of years, beans, lentils, chickpeas, and peas—collectively known as pulses—were among the most important foods on Earth. If bread supplied the calories that built cities, beans supplied much of the protein that sustained them. Long before protein powders and high-protein snack bars, civilizations from Rome to India relied on pulses as an everyday source of nourishment. The Roman laborer's bowl of puls—a hearty porridge often enriched with legumes—was far more representative of daily life than the lavish banquets of emperors. Across the Mediterranean, dishes like pasta e fagioli reflected a simple truth: grains and legumes together formed a remarkably nutritious meal. Modern science has largely caught up with what history already knew. Beans are rich in protein, but they're also packed with dietary fiber, resistant starch, folate, magnesium, potassium, and a remarkable collection of plant compounds that support both heart and metabolic health. Their fiber nourishes the trillions of bacteria living in our colon, producing short-chain fatty acids that help maintain the health of the intestinal lining and may reduce inflammation throughout the body. Perhaps most remarkable is that cultures around the world independently discovered the same dietary pattern. Italy has beans and pasta. India has dal with flatbread. Latin America combines beans with rice or corn. The Middle East gave us hummus. These weren't accidents. They were elegant nutritional solutions developed centuries before anyone knew what an amino acid was. Beans also improve the soil they grow in. Through a partnership with nitrogen-fixing bacteria living on their roots, legumes enrich the earth for future crops. Few foods nourish both the people who eat them and the land that produces them. Today, beans are enjoying a well-deserved renaissance. Heritage producers such as Rancho Gordo have reminded us that beans have flavor, texture, and personality. They're no longer just pantry staples—they're ingredients worthy of the center of the plate. In this week's Fork U podcast, we'll explore how one humble family of plants helped build civilizations, why modern nutrition keeps rediscovering their value, and why the "poor man's meat" may actually be one of the richest foods in human history. Sometimes the greatest superfoods aren't new discoveries. Sometimes they've been quietly simmering in the pot all along.
#138
July 30 · 12 min
Olive Oil: One of the First Medicines
Olive Oil: The Original Superfood Before electricity lit our homes, olive oil did. For thousands of years, olive oil was far more than something people poured over bread. It fueled lamps, preserved food, moisturized skin, and was used in religious ceremonies. Long before it became a staple of the Mediterranean diet, it helped build civilization. Today, we think of olive oil as healthy. The fascinating part is that people believed it was medicinal long before they understood cholesterol, inflammation, or blood pressure. Sometimes medicine begins with observation. The science simply catches up later. More Than Just Fat When people hear "olive oil," they often think of fat. That's true, but not all fats behave the same way. Olive oil is rich in monounsaturated fat, the primary fat found in the Mediterranean diet. Rather than worrying about the chemistry, it is more useful to think about what happens inside the body. The real benefit comes from what olive oil replaces. Instead of cooking with butter or shortening, people sauté vegetables with olive oil. Olive oil is better than creamy dressings, and it is part of a delicious vinaigrette. And my favorite is, instead of spreading butter on bread, dipping it in olive oil. Those small substitutions can add up over time. The Science Is Impressive One of the first studies to grab the attention of cardiologists came from Lyon, France. Researchers enrolled people who had already suffered a heart attack and asked one group to adopt a Mediterranean-style diet rich in olive oil. The results surprised almost everyone. Those following the Mediterranean diet had dramatically fewer second heart attacks than those eating their usual diet. It was one of the studies that helped transform olive oil from a traditional food into a modern medical recommendation. Since then, researchers have followed hundreds of thousands of people around the world. Again and again, the same pattern appears. People who regularly consume olive oil tend to have lower rates of heart disease, lower rates of type 2 diabetes, and even lower mortality. Even better, randomized clinical trials such as the PREDIMED study showed that people at high cardiovascular risk reduced their chances of major cardiovascular events by following a Mediterranean diet supplemented with extra-virgin olive oil. Why Does It Work? Scientists think olive oil helps in several ways. When olive oil replaces butter and other saturated fats, LDL cholesterol usually falls. The natural polyphenols found in extra-virgin olive oil also appear to reduce inflammation and help blood vessels relax by improving nitric oxide production. In addition, studies suggest olive oil improves insulin sensitivity and helps protect LDL cholesterol from becoming oxidized, an important step in the formation of artery plaque. No single mechanism explains everything. Instead, several small benefits appear to work together. That is often how nutrition works. Not All Olive Oils Are the Same If you ask people where the best olive oil comes from, be prepared for a lively discussion. Some prefer the buttery oils from Liguria in Italy. Others enjoy the peppery oils of Lebanon, Greece, or Spain. I have favorites from Arizona, where I lived for years, and from California, where I live now. California also has some of the highest purity standards for olive oil in the world. While olive oil fraud has occurred in some parts of the world, California producers have built a reputation for careful quality control. That gives me confidence in what I'm pouring into my pan. A Small Change Worth Making Nutrition rarely comes down to one magical food. Instead, it comes from making better choices more often. Adding olive oil to your kitchen is one of those simple changes that is easy to enjoy. It makes vegetables taste better, encourages home cooking, and replaces less healthy fats without making meals feel restrictive. Sometimes the healthiest habits are also the most delicious. Olive oil first transformed civilization by lighting the night. Today, it may help illuminate a healthier future—one meal at a time.
#137
July 23 · 17 min
Cheese - Transforming Milk into Delicious
Cheese: Humanity's Greatest Delicious Accident What if one of the world's favorite foods happened by accident? That's probably how cheese began. Nobody knows exactly who made the first cheese. Maybe it was a shepherd carrying milk in a bag made from a sheep's stomach. The milk warmed in the sun, natural rennet in the stomach lining began to separate the curds from the whey, and suddenly milk had become something entirely different. Instead of throwing it away, someone tasted it. Transforming Cheese Cheese is another example of one of humanity's greatest skills: transforming food. We didn't simply discover food—we learned how to make it safer, preserve it longer, and often make it taste even better. Then, over thousands of years, every culture added its own touch. The English gave us Cheddar. The French perfected Brie and Roquefort. Italy created Parmigiano Reggiano. Greece gave us Feta. Norway even created brown cheese by slowly caramelizing whey into a sweet, nutty delight. Each cheese tells the story of the people who made it. Then there's the science. For years, cheese was criticized because it contains saturated fat. However, modern nutrition research has taught us that cheese is far more complicated than a single nutrient. Cheese contains protein, calcium, beneficial bacteria from fermentation, and a unique food structure that scientists now call the dairy matrix. Interestingly, studies have found that eating cheese is generally neutral—and in many cases modestly protective—when it comes to heart disease. One of my favorite ironies involves Parmesan. People often warn about MSG while happily grating Parmesan over their pasta. Yet Parmesan is naturally rich in free glutamate, the compound responsible for the delicious savory flavor we call umami. Nature discovered that trick long before chemistry gave it a name. Like bread, soup, and cooking itself, cheese reminds us that humans became successful because we learned to transform food instead of wasting it. The next time you enjoy a piece of good cheese, remember you're tasting one of humanity's oldest scientific experiments. This week on FORK U, we'll explore the fascinating history of cheese, how it shaped civilization, why it's healthier than many people think, and why your charcuterie board has a much longer history than Instagram. And on my Substack later this week, we'll dive even deeper into the science behind cheese, fermentation, heart health, the Mediterranean diet, and why nutrition is always more interesting than social media makes it seem.
#136
July 16 · 16 min
Bread Built Civilization
For years, bread has been the villain of social media. Scroll for a few minutes, and you'll find someone telling you bread causes obesity, diabetes, inflammation, or that humans were never meant to eat it. History tells a different story. Bread didn't weaken civilization. Bread helped build it. From Grass to Greatness Imagine the first person who looked at wild grass and wondered whether those tiny seeds could become food. Nobody knows exactly how bread was invented. Maybe someone mixed crushed grain with water and left it in the sun. Maybe wild yeast landed in the mixture, and it began to bubble. Maybe someone cooked it on a hot rock beside a fire. Whatever happened, one thing is certain. Someone noticed something new and tried it again. That's how science often begins—with curiosity. Bread Changed Everything Once people learned how to make bread, life changed. Grain could be stored for months. Families no longer had to search for food every day. Villages grew into towns, and towns became cities. Soon, people could become bakers, builders, teachers, physicians, and merchants because someone else was growing wheat. Bread didn't just feed people. It helped create civilization. Bread Fed Empires The ancient Egyptians depended on bread. Grain storage helped feed the workers who built the pyramids. The Romans knew that keeping bread available helped keep peace in the city. Even today, archaeologists find bakeries and loaves of bread preserved in Pompeii. Later, during the Klondike Gold Rush, my grandfather carried a sourdough starter into Alaska. Thousands of prospectors did the same. That's why experienced miners became known as "Sourdoughs." Bread traveled wherever people went. Then Bread Changed Over time, bread changed. Factories made bread softer, whiter, and able to last longer on grocery store shelves. It became convenient, but much of what made bread special disappeared. Then, during the 1960s and 1970s, people began baking bread at home again. Books like The Tassajara Bread Book encouraged Americans to rediscover whole grains, sourdough, and fresh bread. Sometimes progress means remembering what we forgot. What Does the Science Say? Not all bread is the same. Whole-grain bread contains fiber, vitamins, minerals, and plant compounds that refined white bread often lacks. Study after study has found that people who eat more whole grains tend to have lower rates of heart disease, type 2 diabetes, obesity, and colorectal cancer. That's one reason whole grains remain an important part of the Mediterranean diet. The question isn't whether bread is healthy. The question is: Which bread? Keep It Simple One of the simplest meals is still one of the best. Take a slice of whole-grain bread, add good extra-virgin olive oil, and enjoy it with a bowl of soup or a Mediterranean meal. It doesn't need to be complicated. Some foods have survived for thousands of years for a reason. Bread is one of them. This week in my Substack, I dive much deeper into the history of bread, how it helped build civilization, why whole grains continue to be recommended by nutrition research, and why bread has become one of the most misunderstood foods on social media. You can read the full article on drsimpson.com, and if you're looking for Mediterranean recipes—including homemade bread, soups, and healthy meals—you'll find them at terrysimpson.com.
#135
July 9 · 17 min
Soup: The Mediterranean Diet in a Bowl
Soup: The Mediterranean Diet in a Bowl Over the past few weeks, many of us have been looking at our refrigerators a little differently. News about Cyclospora, E. coli, and other foodborne outbreaks has made people nervous about fresh vegetables and herbs. At the same time, grocery stores are filled with expensive electrolyte drinks, protein broths, and wellness beverages promising to keep us healthy. However, there is a much simpler solution that has been around for thousands of years. Make soup. It may sound almost too simple, but soup remains one of the healthiest meals we can prepare. In fact, if someone asked me to build the perfect meal using what we know today about nutrition, I'd probably start with a pot of soup. Add onions, garlic, beans, tomatoes, leafy greens, herbs, perhaps a little chicken or fish, a drizzle of olive oil, and serve it with a slice of whole-grain sourdough. You've just created what I like to call the Mediterranean diet in a bowl. And to prove you can do that from any cuisine, my favorite soup is Dahl - and click here for the recipe. The First Food Safety More importantly, soup has always been much more than comfort food. Throughout history, people discovered that boiling food made it easier to digest and often safer to eat, even though they had no idea bacteria or parasites existed. Today, we know that proper cooking destroys organisms such as Cyclospora and many harmful bacteria, making soup not only delicious but also one of humanity's oldest food safety techniques. Furthermore, soup is one of the best ways to reduce food waste. We all have that refrigerator drawer that starts out as a crisper and eventually becomes what I call the "future soup drawer." A few carrots, some celery that's lost its crunch, half an onion, spinach that's beginning to wilt, or herbs that are no longer picture-perfect can all become tomorrow's lunch instead of tomorrow's compost. Rather than throwing them away, let them contribute their flavors to a pot of soup. Another reason I love soup is that it naturally brings together many of the foods we should be eating more often. Beans provide fiber and plant protein. Vegetables add vitamins, minerals, and phytochemicals. Herbs contribute remarkable flavors without relying on excess salt. A little olive oil adds healthy fats, while broth provides hydration along with naturally occurring electrolytes. Unlike many products marketed as "wellness foods," soup doesn't need fancy packaging or celebrity endorsements. It has been quietly doing its job for thousands of years. Better with Age - like me Then there's one final reason soup deserves a place in every kitchen. It gets better. Few foods improve overnight the way soup does. The flavors continue to develop, the broth becomes richer, and somehow the entire pot tastes more complete the next day. That's one reason soup has always been one of the original meal-prep foods. Long before social media was teaching us how to prepare lunches for the week, families simply made one large pot of soup and enjoyed it for several meals. Of course, every family develops its own favorites. In our house, taco soup is always a winner. It starts with onions, garlic, olive oil, canned beans, tomatoes, cumin, coriander, and chili spices before being finished with fresh lemon juice, avocado, and crushed whole-grain tortilla chips. It's hearty, inexpensive, packed with fiber, and it disappears quickly whenever I make it. Perhaps that's why every civilization eventually invented soup. It stretches ingredients, reduces waste, nourishes families, hydrates naturally, and transforms simple foods into something extraordinary. Sometimes the oldest ideas remain the smartest ones. This week on Fork U, we're diving into the remarkable history and science of soup, including why every civilization created its own version, why soup may be the Mediterranean diet in a bowl, why it often tastes better the next day, and even why a proper French consommé is one of the greatest achievements in culinary science. For the full story, listen to this week's episode of Fork U at drsimpson.com. And if you'd like some of my favorite soup recipes—including taco soup, Mediterranean-inspired soups, and other healthy meals—you'll find them at terrysimpson.com.
#134
July 2 · 12 min
How Cooking Made Us Human
Fire didn't just change dinner. It changed us. If I asked you what made us human, you might say language. Or tools. Maybe agriculture. All of those changed our species, but I think one discovery came even earlier—and it may have been the most important of all. Fire. Not because it kept us warm. Not because it frightened predators. But because it cooked dinner. At first glance, that might seem like an odd claim. After all, cooking is something we do every day without much thought. However, when you look at the science and the history together, cooking becomes one of the most remarkable innovations in human evolution. More importantly, it changed far more than the taste of our food. For more in-depth discussion, go to my Substack channel at DrSimpson.com Cooking Changed the Food We Ate Before humans learned to control fire, food was difficult work. Raw meat is tough. Many roots are fibrous. Grains are nearly impossible to eat without processing, and many plants lock away their nutrients behind tough cell walls. Then everything changed. Cooking unfolds proteins, softens connective tissue, gelatinizes starches, and breaks down plant cell walls. As a result, our digestive system has less work to do, and we gain access to more of the calories and nutrients already present in the food. In other words, cooking didn't create nutrition. It unlocked it. Then Cooking Made Food Safer However, the story doesn't stop with nutrition. Long before anyone understood bacteria or parasites, early humans discovered something through observation. Food cooked over a fire made people sick less often. Today we know why. Heat destroys many harmful bacteria. It kills many parasites. It reduces the risk of foodborne illness. Consequently, cooking likely became one of humanity's earliest public health tools. Groups that regularly cooked their food would have lost fewer children to severe diarrheal disease, had healthier adults, and retained more of the calories they worked so hard to obtain. That is a tremendous evolutionary advantage. Flavor Matters More Than You Think There is another benefit that often gets overlooked. Cooking made food taste better. That may sound obvious, yet it is incredibly important. Humans don't simply eat because food contains nutrients. We eat because food is enjoyable. Cooking creates hundreds of new flavor compounds through browning reactions that simply don't occur in raw food. Think about the smell of fresh bread. Or grilled steak. Or roasted coffee. Those aromas are products of cooking. Likewise, a cooked potato bears little resemblance to a raw one. The texture changes. The flavor changes. Even the way our bodies digest the starch changes. Fire didn't just feed us. It invited us back for another meal. The Real Lesson from Evolution Unfortunately, some people oversimplify this fascinating story. They argue that because meat was important during human evolution, the ideal modern diet must consist almost entirely of meat. The science doesn't support that conclusion. Cooking improved meat. It also improved roots. Cooking made tubers tasty. Then cooking softened grains. And finally, it made legumes digestible The evolutionary advantage wasn't eating one perfect food. Instead, it was becoming adaptable enough to thrive on many foods by transforming them with fire. That is a much more interesting story—and one much better supported by the evidence. Why This Still Matters Today Even in modern kitchens, we continue using the same principles our ancestors discovered thousands of years ago. We cook food to improve digestibility. And we cook food to improve safety. We cook food because it tastes better. Most importantly, we gather around meals because cooking has always been about more than calories. It has always been about family, community, and sharing stories. Perhaps civilization didn't begin with the first city. Perhaps it began around the first campfire.
#133
June 25 · 12 min
The Bank of Muscle: Your Retirement Account Isn't Your 401(k)
The Bank of Muscle: Why Your Real Retirement Account Isn't Your 401(k) I used to think retirement planning was all about money. Put enough away, let compound interest do its thing, and someday you'll enjoy the rewards. As I've gotten older, however, I've come to appreciate another form of savings that may be just as important. It's your muscle. Nobody reaches eighty-five and wishes they had less of it. Instead, people wish they could get out of a chair more easily. They wish they could carry groceries, travel, garden, and play with grandchildren. In other words, they wish they had more reserves. That's really what muscle buys us. Dad's First Retirement Account I was fortunate. My father lived nearly ninety-nine years old, and he didn't simply survive. He lived. At eighty-five, Dad was walking three and a half miles every day. That's remarkable. Many people half his age don't walk that much. He had survived several heart attacks over the years, but he had reserves. Looking back, I realize that making it to eighty-five is one thing. Reaching eighty-five healthy enough to begin the sprint into your nineties is something else entirely. Dad didn't do anything exotic. He wasn't biohacking. He wasn't chasing supplements. He wasn't optimizing every laboratory value. He walked. And my mother cooked. Their meals weren't complicated. They enjoyed meat, potatoes, vegetables, soups, and desserts. They enjoyed life together. In hindsight, Dad was making deposits into his Bank of Muscle every day without ever calling it that. Then Life Changed As my mother's dementia slowly progressed, things began to fall apart. Dad stopped walking, not because he wanted to, but because he didn't want to leave Mom alone. He worried she might wander. At the same time, Mom stopped cooking. Breakfast became something out at a diner. Lunch might be a sandwich. Dinner often became cereal. I watched them both lose weight. Then I got the phone call no child wants. "Dad's in the hospital. He fell and couldn't get up." The fall wasn't the problem. Falls happen. What concerned me was that Dad no longer had enough reserve. After a couple of weeks in rehabilitation, I convinced him to move into an assisted living center close to our house. He wasn't thrilled with the idea, but something remarkable happened. Once Mom entered memory care and Dad had regular meals again, he began to thrive. He complained constantly about the food while gaining seventeen pounds. But he made friends and was always talking to someone or another. I would drive by and see him talking to anyone, from former Supreme Court Justice Sandra Day O'Connor, who lived there, and had a crush on my dad. My dad was making sure his neighbor got the newspaper, and yet he continued to complain about the food. All while gaining 17 pounds the first year. Twice a week, I would take Dad to dinner, and we would split a steak. The waitresses had a standing joke. They would ask him whether he wanted the kale salad. Dad would smile and say, "I grew up in an orphanage in Alaska. We grew kale, but we fed it to the cows. I'll eat the cow." He charmed every waitress in town. Eventually, after Mom died, Dad moved back home to Oregon and lived independently again. Visiting Angels helped with meals and companionship, but he was back in his own house. Looking back, I learned two things. Food matters. Muscle matters. Frailty Is the Enemy We spend a lot of time talking about heart disease, cancer, cholesterol, and blood pressure. Those are important. However, frailty is another great enemy of aging. Frailty steals independence. One broken hip can change everything. A fall that would have been a nuisance at sixty can become life-changing at eighty-five. Muscle gives us reserve, and reserve allows us to recover. My father didn't avoid every setback. He survived them. That's what reserve does. Protein Helps, But It Isn't Magic The supplement industry would love us to believe that a powder is all we need. Unfortunately, muscles didn't get the memo. Protein matters, especially as we age. Most experts recommend older adults consume about 1.2 to 1.5 grams of protein per kilogram of body weight each day, spread throughout the day rather than eaten all at once at dinner. For many people, that means aiming for twenty-five to thirty grams of protein at each meal.¹ However, protein alone isn't enough. A large meta-analysis found that protein supplementation without resistance exercise had limited effects on strength and muscle mass. In contrast, combining protein with resistance exercise produced meaningful improvements.² In other words, muscles need both building blocks and a reason to keep existing. Exercise Doesn't Have To Be Fancy When people hear "resistance exercise," they often picture bodybuilders. That's not what the science requires. Walking hills counts. Gardening counts. Resistance bands count. Swimming counts. Carrying groceries counts. Yoga counts. For me, yoga became the answer. I'm not a gym person. Exercise isn't my hobby. I don't wake up every morning excited to work out. I do yoga because I know future Terry will appreciate it. I'm not training for the Olympics. I'm training for my eighties. Real Food Still Works Whey protein is probably the most studied supplement because it's rich in leucine, an amino acid that helps stimulate muscle protein synthesis. As we age, muscles become less sensitive to that signal, which is why getting enough leucine becomes increasingly important.¹ Fortunately, you don't need expensive powders. Eggs, fish, dairy products, soy, beans, chicken, and meat all provide excellent protein. Personally, whey protein and I are not close friends. I've had lactose intolerance for years, and the slower gut that comes with GLP-1 therapy has made me even less tolerant of many whey products. Add stevia, sugar alcohols, and various flavorings, and my intestines politely object. Instead, I use egg protein or plant proteins. I avoid stevia because it tastes like electrical tape to me, and I don't need a chemistry experiment in a shaker bottle. Still, I recognize supplements have a role. If you're on a GLP-1 medication and eating less, or if you're simply busy, a protein shake or bar can be a useful tool. They aren't magic. They're convenient. A Father's Wisdom After Mom died, Dad came to live with me in California. By then, I had discovered yoga. Dad teased me about it at first. Then one day, he looked at me and said something I've never forgotten. "I think you doing yoga is great. You're the right age. Doing this now is important. If yoga is what you like, buy all the spandex you want and keep doing it." Those words stayed with me. You're the right age. Doing this now is important. If you're lucky, your parents give you wisdom throughout your life. When you're young, you roll your eyes. Later, you realize those words become part of who you are. Money gets spent. Wisdom gets carried. Dad wasn't telling me to do yoga. He was telling me to keep moving. Make Deposits Every age has different priorities. At twenty-five, you may be building a career. At forty-five, you may be raising children. At sixty-five, you may be protecting your muscle. At eighty-five, you may simply want enough reserve to get out of a chair and go to dinner with your family. The body doesn't really care whether those deposits come from yoga, barbells, swimming, pickleball, or walking. It only cares that you keep making deposits. Because someday you'll need to make a withdrawal. Life guarantees that. When that day comes, you'll be grateful for every walk, every stretch, every protein-rich meal, and every little thing you did, not because you loved doing them, but because they built reserve. Healthy aging isn't about dying young as slowly as possible. It's about building enough reserve so that when life knocks you down, you still have enough strength to get back up. And that may be the most important retirement account you'll ever own. References Bauer J, Biolo G, Cederholm T, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc. 2013;14(8):542-559. Liao CD, Tsauo JY, Wu YT, et al. Effects of protein supplementation combined with resistance exercise on body composition and physical function in older adults: a meta-analysis. American Journal of Clinical Nutrition. 2017;106(4):1078-1091. Cruz-Jentoft AJ, Bahat G, Bauer J, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age and Ageing. 2019;48(1):16-31.
#132
June 19 · 13 min
Did the Food Pyramid Make America Fat?
If you read some low-carb sites, or Gary Taub's books, you will find the contention that the food pyramid - the last one being in 2011 - put America into a low fat, high carb diet responsible for today's obesity. That the government food pyramid misled a generation of people, and because we faithfully follow it, we became fat. The problem is, that isn't the case, but I want to go back in time and see why we have those government issued guidelines, and see where we are today. Dietary Recommendations The first major food guide appeared in 1943. It wasn't even a pyramid. It was called the Basic Seven. Created to prevent malnutrition and maintain stamina during World War II, it categorized foods into seven groups and served as the precursor to the modern food pyramid: 1: Green and Yellow Vegetables (e.g. leafy greens, green beans, carrots). 2: Oranges, Tomatoes, Grapefruit (or other raw greens high in Vitamin C). 3: Potatoes and Other Vegetables/Fruits (e.g., apples, potatoes, beets). 4: Milk and Milk Products (e.g. fluid milk, evaporated milk, cheese). 5: Meat, Poultry, Fish, or Eggs (as well as plant-based proteins like dried beans and nuts). 6: Bread, Flour, and Cereals (focusing on whole grain or enriched varieties). 7: Butter and Fortified Margarine (specifically noted to provide necessary calories and Vitamin A during rationing). The Basic Four These came out in 1956 to help a growing America. doctors worried about malnutrition and vitamin deficiencies. Diseases such as pellagra, rickets, and scurvy were still being treated. A breakdown of the 4 food groups and how they currently fit into a balanced, healthy routine: 1. Fruits & Vegetables 🥦Focus: Whole forms (fresh, frozen, or canned without added sugars).Benefits: Packed with essential vitamins, minerals, and dietary fiber.Goal: Aim to make half your plate fruits and vegetables at meal times. 2. Grains 🌾Focus: Whole grains (oats, brown rice, whole-wheat bread).Benefits: Provides vital carbohydrates and fiber for sustained energy.Goal: Make at least half your daily grains "whole" to get the most nutritional value. 3. Protein 🥩Focus: Lean proteins like poultry, fish, eggs, legumes (beans/peas), nuts, and seeds.Benefits: Builds muscle mass, repairs tissues, and keeps you full.Goal: Include a portion of protein with every meal to keep metabolism regulated. 4. Dairy 🥛Focus: Milk, yogurt, and cheeses (or calcium-fortified plant alternatives).Benefits: Crucial source of calcium and vitamin D for strong bones and teeth.Goal: Opt for low-fat or unsweetened varieties whenever possible to limit excess sugar 1979 What to Avoid Directly after the Basic Four, the USDA introduced the Hassle-Free Daily Food Guide (1979). The Hassle-Free Daily Food Guide (1979–1984) What changed: It kept the core Basic Four, but added a fifth group: Fats, Sweets, and Alcohol. Purpose: This was the first time a group was explicitly highlighted for the public to consume only in moderation. The transition away from the Basic Four marked a major shift in government policy: instead of just telling Americans to eat enough nutrients to avoid deficiencies, the focus changed to preventing chronic illnesses by telling people what to limit. The Food Guide Pyramid (1992–2005) The first guide to feature highly specific daily serving sizes across six distinct categories. Grains formed the massive base (6–11 servings), followed by fruits and vegetables, then dairy and meat, with fats/sweets resting at the tiny top peak. Fair Criticisms of the Food Pyramid None of this means the Food Pyramid was perfect. In fact, there are several reasonable criticisms. First, the pyramid did not do a great job distinguishing between whole grains and refined grains. A bowl of steel-cut oats is different from a sugary breakfast cereal, but both could look similar on a simple graphic. Likewise, the pyramid often treated fats as a single category when we now know that olive oil, nuts, and fish are different from trans fats and highly processed shortening. In addition, agriculture and food industry groups had influence over the process. That should not surprise anyone. Food policy has always involved scientists, government agencies, farmers, food manufacturers, and politicians. As a result, some recommendations reflected compromises rather than perfect science. That is a fair criticism, and it is one reason nutrition advice continues to evolve. However, we should also be honest about today's environment. While many criticize the influence of industry on older food guides, we now live in an age where nutrition advice often comes from influencers, supplement companies, podcasters, social media personalities, and people selling books, courses, or products. In other words, we have not eliminated outside influences. We have simply changed who those influences are. Therefore, the challenge today is the same as it has always been: separating evidence from marketing. Most importantly, the biggest problem facing Americans today is not that we are following an outdated Food Pyramid. Instead, it is that inexpensive, highly processed, calorie-dense foods surround us that require little preparation and are available everywhere. At the same time, portion sizes have increased, sugary beverages have become common, restaurant meals have grown larger, and fewer people cook regularly at home. As a result, we consume more calories than previous generations, while often moving less. The Real Reason We Became Heavier The Food Pyramid did not make America fat. That story is appealing because it is simple, but simple stories are not always true. The reality is that obesity developed while most Americans were not following the Food Pyramid at all. Instead, we were eating larger portions, drinking more calories, consuming more ultra-processed foods, dining out more often, and cooking less frequently. At the same time, our food environment changed dramatically. Food became cheaper, more convenient, and available nearly everywhere. Consequently, it became much easier to consume excess calories without even noticing it. The real lesson is not that one graphic ruined America's health. Rather, the lesson is that every generation faces new food challenges and tries to solve them with the best knowledge available at the time. Some recommendations age well, while others do not. Yet one message has remained remarkably consistent for decades: eat more fruits and vegetables, include beans and whole grains, enjoy fish and other healthy proteins, cook when you can, and share meals with people you care about. That advice may not fit neatly into a pyramid, but it has stood the test of time.
#131
June 11 · 13 min
The Scientists Who Built the Modern Snack
How We Eat Most of us think we know what we eat. However, nutrition researchers have learned a frustrating lesson over the years: asking people what they ate yesterday is often less accurate than anyone would like. Although food diaries and surveys can provide useful information, memories are imperfect, snacks are easily forgotten, and portion sizes tend to grow smaller in retrospect. Consequently, some of the most important nutrition research takes place in a setting that is both expensive and surprisingly simple—a metabolic ward, where every meal is prepared, every serving is weighed, and every leftover bite is measured. That approach is exactly what researcher Kevin Hall and his colleagues used in a landmark study at the NIH. Participants were given two different diets, one based largely on ultra-processed foods and another built around minimally processed foods. Importantly, the volunteers could eat as much as they wanted. Nobody instructed them to count calories, restrict portions, or lose weight. Nevertheless, participants consumed about 500 more calories per day when eating the ultra-processed diet. The same people, living in the same environment, produced dramatically different results simply because the food changed. Obesity in the US and Ultra-Processed Foods As a result, the study raised an intriguing question. If ultra-processed foods can influence calorie intake to that degree, why isn't everyone obese? After all, ultra-processed foods make up a large portion of the modern food supply. Grocery stores are filled with them, convenience stores specialize in them, and many restaurants depend on them. Yet despite widespread exposure to the same food environment, some people seem relatively unaffected while others struggle with appetite, cravings, and weight gain. Prego and Vanishing Calories To understand how we arrived here, it helps to step back a few decades. During the latter half of the twentieth century, food companies increasingly turned to scientists, statisticians, and sensory researchers to understand consumer behavior. One of the most influential figures was Howard Moskowitz, a researcher who discovered that there was no single perfect food. Instead, he found that consumers tended to cluster into different preference groups. Some people preferred sweeter products, others wanted more texture, and still others favored stronger flavors. As a result, food manufacturers stopped searching for one ideal product and began creating multiple versions designed to appeal to different consumers. Meanwhile, another researcher, Steven Witherly, focused on a different question. Rather than asking what people preferred, he explored why certain foods were so rewarding. His work highlighted the importance of texture, aroma, crunch, temperature, and mouthfeel. In other words, food is not simply taste. Instead, it is a complex sensory experience involving multiple signals that influence how satisfying a meal feels. One of Witherly's most memorable concepts is known as vanishing caloric density. Certain foods, particularly puffed snacks, dissolve quickly in the mouth and create the sensation that they have almost disappeared. Although the calories remain, the physical experience of eating them can feel surprisingly brief. Consequently, these foods may be easier to consume in larger quantities before the body's normal satiety signals fully catch up. While that does not make such foods inherently bad, it does help explain why some snacks seem to empty themselves once the bag is opened. Ultra-Processed Foods and GLP-1 At the same time, the modern food environment has become remarkably effective at attracting attention. Food manufacturers optimize texture, flavor, aroma, and convenience, while consumers encounter those products virtually everywhere. Therefore, the challenge is not simply one of personal responsibility. Biology, environment, culture, sleep, stress, and genetics all influence how people respond to food. Some individuals appear naturally protected, whereas others experience stronger reward signals and greater susceptibility to cravings. Interestingly, the recent rise of GLP-1 medications has provided another perspective on appetite. Many patients describe a quieter relationship with food, noting that foods which once demanded attention suddenly seem less compelling. The food itself has not changed; rather, the brain's response to it has shifted. Consequently, these medications have highlighted something obesity researchers have suspected for years: appetite is not merely a matter of willpower. Instead, it reflects a complex interaction between biology and an increasingly sophisticated food environment. Ultimately, Kevin Hall's study gave us an important clue about what happens when people are exposed to different types of food. Howard Moskowitz showed how companies learned to identify consumer preferences, while Steven Witherly helped explain why certain foods are so appealing in the first place. Together, their work offers a fascinating glimpse into the science behind modern eating and raises a question that may be more interesting than why some people gain weight. Perhaps the real mystery is why some people seem largely unaffected by an environment that was designed to capture our attention. For a deeper discussion of food engineering, the bliss point, vanishing caloric density, and what this means for appetite in the era of GLP-1 medications, listen to this week's episode of Fork U.
#130
June 4 · 12 min
Taste Buds Everywhere: Your Body's Hidden Food Sensors
Taste Isn't What You Think It Is Most people believe taste happens on the tongue. That idea seems obvious because food enters the mouth, the tongue recognizes flavors, and the brain decides whether something tastes good or bad. However, modern science has revealed a much more fascinating story. Taste receptors are scattered throughout the body, including the stomach, intestines, airways, pancreas, and even tissues associated with the nervous system. Consequently, what we call taste is actually part of a much larger surveillance system that helps us detect nutrients, toxins, microbes, and potential threats before they become serious problems. Before we explore those hidden taste receptors, though, we need to separate taste from smell. Most people use the words interchangeably, yet they are remarkably different systems. In fact, if you've ever had a bad cold, you've already experienced the difference firsthand. Why Expensive Wine Tastes Like Grape Juice With a Stuffy Nose Imagine spending a fortune on a bottle of Screaming Eagle wine. A sommelier describes notes of blackberry, cedar, tobacco, leather, and dark cherry while swirling the glass dramatically. Now pinch your nose shut and take a sip. Suddenly, those elegant descriptions become much harder to appreciate, and the wine starts tasting suspiciously like grape juice. The reason is simple. Your tongue detects only a handful of basic categories: sweet, salty, sour, bitter, and umami. Meanwhile, your nose identifies the thousands of aromatic compounds that make strawberries taste different from cherries or Cabernet different from Merlot. Therefore, much of what we casually call taste is actually smell working behind the scenes. Without smell, a wine tasting becomes a costly visit to a Welch's grape juice stand. This distinction matters because it helps explain why taste receptors throughout the body are not there for pleasure. Instead, they exist to gather information. Sweet Means Calories, and Your Body Pays Attention For most of human history, finding calories was difficult. As a result, sweet flavors became associated with survival. A ripe fruit, a handful of berries, or a cache of honey represented valuable energy in a world where starvation was a constant threat. Because of that evolutionary pressure, the body developed specialized receptors to detect sweetness and rapidly prepare for incoming fuel. The story becomes even more interesting once food reaches the intestine. Sweet receptors known as TAS1R receptors help stimulate the release of incretin hormones such as GLP-1 and GIP. Consequently, eating sugar creates a different physiologic response than receiving glucose through an IV. The tongue detects sweetness, the gut begins releasing hormones, the pancreas prepares insulin, and the brain activates reward pathways. In contrast, intravenous glucose raises blood sugar, but skips much of the sensory experience that evolution spent millions of years refining. Warm apple pie and an IV bag may deliver similar sugar molecules. Nevertheless, your body treats them as entirely different events. Umami: The Taste the Japanese Taught the World While sweet and bitter flavors are easy to recognize, umami remained poorly understood until Japanese scientists formally described it in the early twentieth century. The term refers to a savory, rich taste associated with glutamate and certain amino acids. Soy sauce, mushrooms, Parmesan cheese, tomatoes, broths, and many fermented foods owe much of their appeal to umami. From an evolutionary standpoint, umami serves an important purpose. Protein is essential for growth, repair, reproduction, and survival, so recognizing protein-rich foods provided a significant advantage. Consequently, the body evolved receptors specifically designed to detect those compounds. Modern scientists call them TAS1R1 and TAS1R3 receptors. Our ancestors simply recognized them as signs that dinner was likely worth pursuing. Growing up in Ketchikan, Alaska, I had a slightly different perspective on some of these foods. The first time somebody enthusiastically explained sushi to me, my immediate reaction was, "That's bait." Fortunately, the Japanese had grander plans for raw fish than I did. Why Children Hate Broccoli Parents often assume children reject vegetables because they are stubborn. Evolution suggests another explanation. Many toxic plant compounds are bitter, and bitterness frequently serves as nature's warning label. Therefore, children are generally more sensitive to bitter flavors than adults. Their bodies are essentially operating a heightened food safety program. As people age, repeated exposure teaches the brain that many bitter foods are safe and even beneficial. Coffee, tea, dark chocolate, kale, Brussels sprouts, and beer all require overcoming an instinctive caution signal. Adulthood, in many ways, involves learning which bitter things deserve a second chance. Moreover, many of those foods contain nutrients, fiber, and bioactive compounds associated with better health. This is one reason I smile whenever someone declares kale is poison. The statement may reveal more about the speaker's bitter receptors than about kale itself. Babies, Honey, and a Healthy Fear of Food Infants face a different challenge. During the first months of life, stomach acid production is lower than in adults. Consequently, babies are more vulnerable to certain organisms that older children and adults can handle without difficulty. This difference explains one of the most important feeding rules in pediatrics: do not give honey to infants under one year of age. Honey can contain spores of Clostridium botulinum. In adults, stomach acid and a mature intestinal environment generally prevent those spores from causing problems. However, infants lack many of those defenses. Therefore, infant botulism remains a genuine concern, despite honey's reputation as a natural food. Once again, evolution reminds us that caution often exists for a reason. The Stomach: Bouncer, Judge, and Executioner One of the most surprising discoveries in recent years is that the stomach contains bitter taste receptors known as TAS2Rs. These receptors do not evaluate flavor. Instead, they help assess what has arrived and determine how aggressive the digestive system should respond. When bitter compounds appear, gastric emptying may slow, giving stomach acid additional time to destroy microbes and process potentially hazardous material. I learned this lesson personally during a trip to Tijuana. Someone handed me a Clamato loaded with raw shellfish. At the time, it tasted wonderful. Several hours later, however, my stomach conducted a thorough review of the situation. The acid weighed in, the receptors filed their reports, and the immune system apparently demanded immediate action. The resulting decision was swift, unanimous, and memorable. Evolution does not care about dignity. Survival remains the only vote that counts. Your Sinuses Listen to Bacteria Perhaps the strangest discovery involves bitter receptors in the airways and sinuses. Researchers have found that certain receptors can detect chemical signals used by bacteria to communicate. In other words, cells lining your sinuses may effectively eavesdrop on microbial conversations before those microbes establish a significant foothold. Once those signals are detected, defensive mechanisms begin activating. Nitric oxide production increases, antimicrobial responses strengthen, and mucus clearance accelerates. Consequently, these receptors function less like taste buds and more like security personnel monitoring suspicious activity. The fact that a system originally associated with tasting food can also help defend against infection highlights how versatile these ancient sensors have become. The Real Story of Taste For generations, we assumed taste existed primarily for enjoyment. While pleasure certainly plays a role, the larger story is far more interesting. Taste receptors help identify calories, protein, toxins, bacteria, and environmental threats. Furthermore, many of these receptors appear to have evolved as general chemical sensors long before they became associated with dining. The next time you enjoy a slice of pie, a bowl of sushi, a glass of wine, or even a serving of broccoli, remember that your tongue is only one participant in the conversation. Your stomach is paying attention. Your intestines are paying attention. Even your sinuses may be paying attention. Long before nutrition labels, food influencers, and restaurant reviews existed, the body developed its own remarkably sophisticated system for deciding what was worth eating and what should be avoided. That's not just taste. That's survival.
#129
May 28 · 17 min
Diabetes, Weight Loss, Remission or Cure
Type 2 Diabetes, Bariatric Surgery, Fasting, and GLP-1s: What We Finally Learned About a Disease We Thought We Understood For years, I watched something happen in bariatric surgery that made very little sense, according to the medical textbooks of the time. Patients with type 2 diabetes would undergo surgery, and within days, their blood sugars would improve dramatically. Some would leave needing far less insulin. Others would stop insulin entirely. Many of them would eventually remain off diabetes medications for years. Now here is the important part: They had not yet lost significant weight. That observation mattered enormously. Because if diabetes improvement were simply the result of fat disappearing from the body over time, then blood sugar should improve slowly over months as weight comes off. But that was not what we saw. Instead, patients barely eating — sipping broth and protein shakes while recovering from surgery — were suddenly metabolically different almost immediately. At the time, we knew it worked. What we did not fully understand was why. And honestly, that story tells you something important about medicine and science: sometimes clinical medicine notices the truth before biology fully explains it. For decades, type 2 diabetes was often taught in very mechanical terms. You gained weight. You became insulin-resistant. The pancreas worked harder and harder until it “burned out.” Then you needed insulin. That explanation was not entirely wrong. However, it was incomplete. Furthermore, it encouraged a kind of fatalism around type 2 diabetes, as though progression were inevitable and irreversible for everyone. Then, bariatric surgery complicated the narrative. Meanwhile, researchers like Professor Roy Taylor at Newcastle University began developing a much more dynamic understanding of what was actually happening inside the liver and pancreas. And suddenly, many of the strange things bariatric surgeons had observed for years started making sense. The Problem May Not Be Sugar Alone One of the most common mistakes in nutrition discourse is assuming that blood sugar itself is the disease. It is not. Blood sugar is often the visible signal of a much larger metabolic problem involving: the liver, the pancreas, adipose tissue, appetite signaling, inflammation, gut hormones, and the brain itself. Now, to be fair, refined carbohydrates and ultra-processed foods absolutely can worsen insulin resistance and glucose control. Sugary beverages, highly refined starches, and hyperpalatable processed foods create enormous metabolic stress for many people. However, reducing the entire disease of type 2 diabetes to “sugar is poison” oversimplifies what is actually a highly complex biological system. If carbohydrates alone caused diabetes, then traditional Mediterranean populations consuming beans, lentils, intact grains, and fruit would have universally developed severe metabolic disease. Yet many of those populations historically had some of the best cardiovascular and metabolic outcomes in the world. Similarly, bariatric surgery would not improve diabetes before substantial fat loss occurred. Something deeper was happening. Roy Taylor and the Twin Cycle Hypothesis Roy Taylor’s Twin Cycle Hypothesis is one of the most elegant modern explanations for type 2 diabetes. The theory proposes that type 2 diabetes develops through two interconnected metabolic cycles, involving excess fat accumulation in organs not designed to store large amounts of fat. First comes the liver. When caloric intake chronically exceeds what the body can safely store in adipose tissue, fat begins accumulating in the liver. Eventually, the liver becomes insulin-resistant. Now the liver starts misbehaving metabolically. Instead of calming down glucose production when insulin is present, the liver continues to release glucose into the bloodstream. At the same time, it exports excess triglycerides and fat particles into circulation. This creates a vicious cycle: more liver fat, more insulin resistance, higher insulin levels, more glucose production. Then comes the second cycle. Those excess fat particles eventually accumulate in the pancreas itself. And that is where the beta cells begin struggling. The Beta Cell Is Not Simply “Burned Out” For years, we talked about the pancreas as though it simply became exhausted. However, newer biology suggests something more complicated — and more hopeful. Beta cells produce insulin, which is a protein. Proteins must be folded properly inside the cell before they can be packaged and secreted. Under chronic metabolic stress — high glucose levels, elevated fatty acids, inflammation, oxidative stress — the protein-folding machinery inside the beta cell begins malfunctioning. Some insulin molecules become misfolded. Now imagine a factory assembly line where defective products begin to accumulate faster than workers can remove them. The system clogs. The beta cell experiences what is called endoplasmic reticulum stress, or ER stress. In simple terms, the protein-processing machinery becomes overloaded. At first, the cell adapts. It slows production. And the cell will activate repair systems. To clear damaged proteins. But if the stress continues long enough, the machinery begins failing. Some beta cells become dysfunctional. As a result, some become metabolically suppressed. They stop making insulin. Some dedifferentiate, meaning they stop functioning normally. And eventually some undergo apoptosis: programmed cell death. That distinction matters enormously. Because it suggests that not every beta cell is permanently destroyed early in the disease. Some are simply overwhelmed. Why Fasting Sometimes Works This may help explain why fasting improves type 2 diabetes in some patients. Fasting reduces metabolic demand. Less glucose enters the system. Less insulin is required. The liver produces less glucose. The pancreas experiences less pressure. In effect, fasting may temporarily reduce the metabolic traffic jam overwhelming the beta cells. Now, some people online treat fasting almost like a mystical cure for diabetes. I think that is an exaggeration. The body is not achieving enlightenment because somebody skipped breakfast. The likely benefit is much more practical: Reduced metabolic overload allows stressed systems to recover function. And clinically, we do see this. Some patients improve dramatically with fasting or aggressive caloric restriction. However, fasting is not universally successful because not all patients have the same remaining beta-cell reserve. Some patients have substantial recoverable function left. Others have experienced years of apoptosis and structural loss. That is one reason newly diagnosed patients often respond far better than patients with decades of poorly controlled diabetes. Duration matters. Furthermore, what happens after the fasting matters enormously. If someone fasts aggressively, but then returns immediately to hyper-palatable ultra-processed food, liquid calories, and chronic overnutrition, the same metabolic stress returns. Which brings us to an important point. The Real Goal Is Not Carb Elimination This is where I part ways somewhat with the more absolutist low-carb community. Low-carb diets help many patients reduce caloric intake and improve glucose control. That part is real. However, when you look at the broader evidence, the deeper lesson is probably not: “Carbohydrates are evil.” The deeper lesson is: eat less, eat better, and create a sustainable metabolic environment that the body can actually manage long term. And this is where Mediterranean-style dietary patterns continue to shine. Why the Mediterranean Diet Works So Well One of the strangest developments in modern nutrition culture is the fear surrounding whole grains and legumes. Beans somehow became suspicious. Oatmeal became controversial. Meanwhile, the modern industrial food environment quietly engineered ultra-processed calorie delivery systems powerful enough to overwhelm normal satiety pathways entirely. Perspective matters. After bariatric surgery, once patients had healed from the immediate postoperative phase, many naturally transitioned toward what was essentially a Mediterranean-style eating pattern. Not because it was trendy. Because clinically it worked. But because patients tolerated it well. Their weight stabilized more successfully. In addition, cardiovascular risk factors improved. And perhaps most importantly, they could sustain it. That last point matters more than anything else in nutrition. The Mediterranean diet works because it aligns well with human physiology: high fiber, intact foods, lower caloric density, reduced ultra-processed food burden, improved satiety, favorable effects on the microbiome, and long-term sustainability. Importantly, carbohydrates behave differently from rapidly absorbed refined starches and sugary beverages. Food structure matters Fiber matters. Satiety matters. Context matters. A bowl of lentils with olive oil, vegetables, and fish is metabolically different from ultra-processed food engineered to bypass normal fullness signaling. Whole grains are not the apocalypse. GLP-1 Drugs and Bariatric Surgery Are Teaching the Same Lesson GLP-1 medications work so well because they address biology directly. They: reduce appetite, slow gastric emptying, improve satiety, decrease caloric intake, lower liver fat, and reduce metabolic demand. In many ways, these medications reproduce medically some of the metabolic effects bariatric surgeons observed years ago. Importantly, they help patients sustain the physiologic state required for remission. And this is where the conversation about obesity often becomes deeply unfair. For decades, medicine and society moralized obesity, while underestimating how aggressive biology defends body weight. Hunger increases with weight loss. Energy expenditure decreases. Food reward intensifies. The environment constantly pushes hyperpalatable calories. This is not weakness. It is biology. Remission Is Still a Victory One of the more frustrating debates online revolves around the word “cure.” I understand why people want to use it. Remission sounds less dramatic. Less triumphant. However, remission is actually an extraordinarily hopeful concept. It means the disease process can improve substantially. But also, it means biology is more dynamic than we once believed. Finally, it means the pancreas retains recoverable function in many patients. But remission also recognizes reality: Some beta cells are permanently lost, Relapse can occur, weight regain matters, disease duration matters, and long-term susceptibility often remains. That is not pessimism. That is biological honesty. The real breakthrough here is not that type 2 diabetes was fake all along. The breakthrough is that we finally understand it as a far more dynamic, reversible, and biologically complex disease than we once believed. And perhaps the most important lesson of all is this: Bariatric surgery, fasting research, Mediterranean diets, and GLP-1 science are not actually telling completely different stories. They are all pointing toward the same underlying truth: The human body functions well when chronic metabolic overload is reduced long enough for normal signaling systems to recover. The tragedy of type 2 diabetes is not merely that millions have developed it. But that for decades, we blamed patients morally, while barely understanding the biology ourselves. Then, patients stopped eating after surgery, and their diabetes improved before the sutures had healed. Biology was trying to teach us something. Eventually, science listened.
#128
May 21 · 15 min
The Science of Hangovers: Why Most “Cures” Fail
The Science of Hangovers: Why Your “Cure” Probably Doesn’t Work You wake up thirsty. Then, almost immediately, you realize your head hurts. Your stomach feels unstable. The room is too bright. Your mouth tastes like regret and old wine corks. Furthermore, your intestines suddenly decided today is the day they become extremely efficient. In other words, you have a hangover. Now, hopefully, this is not a regular occurrence. Nevertheless, most adults eventually experience one. The evening starts innocently enough: good friends, great conversation, maybe a cocktail before dinner. Then, however, another bottle arrives. Someone orders dessert drinks. Suddenly, what seemed like sophisticated socializing turns into next-morning negotiations with your nervous system. And that raises the obvious question: What actually causes a hangover? More importantly, why do so many supposed “cures” fail so spectacularly? First, Alcohol Is Not Just “Dehydration” Many people think a hangover is simply dehydration. Certainly, dehydration matters. Alcohol suppresses vasopressin, the hormone that helps your kidneys conserve water. As a result, you urinate more frequently. Consequently, you lose fluid and electrolytes. However, dehydration is only part of the story. In fact, hangovers are far more complicated. Alcohol irritates the stomach lining. Additionally, it disrupts blood sugar regulation. Furthermore, it interferes with inflammatory pathways, sleep architecture, hormone signaling, and neurotransmitters involved in mood and alertness. So while dehydration contributes to the misery, it does not fully explain why you feel like a Victorian ghost haunting your own apartment. Moreover, alcohol affects sleep in a particularly cruel way. It helps many people fall asleep quickly. However, it fragments restorative sleep later in the night. Therefore, you may technically be unconscious for eight hours while still waking up exhausted. You passed out. You did not recover. Then There’s Acetaldehyde — But It’s Not the Whole Story Social media wellness culture loves one word: Acetaldehyde. This is the toxic metabolite created when your liver breaks down alcohol. And yes, acetaldehyde contributes to flushing, nausea, headache, and inflammation. Nevertheless, modern marketing often exaggerates its role because it creates a simple story. “If acetaldehyde is bad, then a supplement that lowers acetaldehyde must solve hangovers.” Unfortunately, biology is rarely that convenient. Hangovers are not caused by one molecule acting alone. Instead, they are the result of multiple overlapping physiologic stresses happening simultaneously. In other words, there is no single “off switch.” And that is exactly where the supplement industry enters the picture. The Rise of the “Hangover Cure” Industry Over the last several years, social media has become flooded with products promising recovery, detoxification, or “support” for drinking. For example: Cheers Restore ZBiotics Myrkl H-PROOF DHM Detox Dose for Liver Furthermore, many of these products use similar language: “supports liver health,” “helps metabolize alcohol,” “promotes recovery,” or “supports detoxification.” Notice the wording carefully. Most companies avoid explicitly claiming to “cure” hangovers because proving that scientifically would require strong clinical evidence. And, unfortunately for marketing departments everywhere, that evidence largely does not exist. So Do These Products Work? The honest answer is: Probably not very well. Now, to be fair, some ingredients are biologically plausible. For instance, DHM — dihydromyricetin — has shown interesting effects in animal studies involving alcohol metabolism and GABA signaling. Likewise, some probiotics may influence acetaldehyde metabolism in the gut. Meanwhile, antioxidants and electrolytes may help support recovery in limited ways. However, plausible does not mean proven. That distinction matters enormously. Most studies on hangover products are: small, poorly standardized, company-funded, or focused on surrogate laboratory markers rather than meaningful real-world outcomes. Consequently, the evidence remains weak. And that is why most medical reviews conclude the same thing: there is no strong evidence that popular hangover cures reliably work as advertised. Meanwhile, IV Clinics Are Mostly Selling Expensive Salt Water Perhaps nothing captures modern wellness culture better than the rise of the “hangover IV.” Now, certainly, IV fluids can help with dehydration. Additionally, anti-nausea medications may temporarily improve symptoms. Nevertheless, many hangover IV clinics market themselves almost like detox spas. And that language becomes misleading very quickly. Your liver already detoxifies alcohol. In fact, that is literally its job. Moreover, your liver clears alcohol at a relatively fixed rate. Therefore, no vitamin infusion dramatically speeds the process. So while IV hydration may help some symptoms, it does not reverse toxicology. It is mostly expensive supportive care with mood lighting. What Actually Helps? Unfortunately, the most effective hangover treatments are also the least exciting. First, hydration genuinely matters. Water, electrolyte drinks, broth, and even fruit juice can help restore fluid balance and blood sugar. Second, bland foods often help settle the stomach. For example: toast, rice, crackers, eggs, or soup. Interestingly, pho may actually be one of the better hangover foods because it combines fluids, sodium, carbohydrates, and easy digestion. Third, sleep matters enormously. Alcohol damages sleep quality. Therefore, recovery sleep becomes critical afterward. Meanwhile, pain relievers should be used carefully. Ibuprofen or aspirin may help with headaches. However, they can worsen stomach irritation. And acetaminophen deserves special caution. Alcohol stresses liver metabolism. Acetaminophen also relies heavily on liver pathways. Consequently, combining large amounts of alcohol with Tylenol can become dangerous. Some Supplements May Help a Little Now this is where nuance matters. A few supplements do show modest signals in limited studies. For example: Prickly pear extract has shown some reduction in inflammatory hangover symptoms. Red ginseng has demonstrated modest improvement in some small trials. Siberian ginseng and combination antioxidant products have shown scattered positive findings. However, none of these products “cures” hangovers. Furthermore, the studies are small and inconsistent. Most importantly, they are not permission slips for binge drinking. The Part Nobody Likes Hearing Here is the uncomfortable reality. Even intermittent heavy drinking may have long-term consequences. Many people believe occasional binge drinking is harmless because they are still functioning professionally and socially. However, alcohol remains neurotoxic. Repeated episodes of heavy alcohol exposure are associated with changes in cognition, mood regulation, sleep quality, memory, and brain structure over time. And importantly, aging reduces the brain’s ability to compensate for injury. Therefore, the “weekend warrior” approach to alcohol may not be as biologically benign as people hope. Meanwhile, our culture often treats alcohol very differently from other health risks. People obsess over processed foods, seed oils, artificial dyes, or gluten. Yet somehow, repeated alcohol poisoning became normalized in adulthood with appetizers. That contradiction is worth thinking about. So What Is the Best Prevention? Unfortunately, prevention is boring. And yet boring works. Drink less. Drink slower. Eat before drinking. Alternate alcohol with water. Avoid “catch-up drinking.” Prioritize sleep afterward. And, additionally, lower-congener drinks like vodka or gin may produce fewer hangover symptoms than whiskey, bourbon, or brandy. Not because they are healthy. Simply because they contain fewer additional fermentation compounds. Final Thoughts Ultimately, the science of hangovers is less glamorous than the internet wants it to be. There is no miracle cure. There is no magical probiotic that allows unlimited tequila without consequences. There is no gummy that outperforms biology. Instead, a hangover is your body responding to inflammation, dehydration, toxic exposure, disrupted sleep, and metabolic stress. In other words, it is not a vitamin deficiency. It is a receipt. Outside Reading For a good evidence-based overview of hangovers and the limited science behind hangover remedies, see the review from the Cleveland Clinic on hangover cures and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) overview of hangovers.
#127
May 14 · 12 min
Why Food Became Engineered to Defeat You
The “Real Food” Protein Bar There may be no phrase in modern nutrition more ridiculous than this: “Real food protein bar.” And yet, somehow, we are expected to nod seriously when someone says it. Recently, internet nutrition personality Paul Saladino introduced what he described as his best “real food” protein bar. While I have nothing personal against the man. I admire the confidence required to sell twelve protein bars for forty-four dollars while talking about ancestral living. Because let’s be honest for a moment. Protein bars are the modern candy bar. They simply come wrapped in better branding, cleaner fonts, and enough wellness language to make people feel virtuous while eating what is essentially an expensive Snickers bar with a podcast sponsorship. Now, before the internet declares me anti-protein-bar, let me clarify something immediately. I actually like Aloha bars. They’re expensive, but they say the right words to me. More importantly, they taste better than most compressed drywall products pretending to be nutritious. At the same time, real life exists, and sometimes convenience matters because airports happen, traffic happens, and long clinic days happen. Still, pretending industrial engineering somehow untouches these foods is a bit like pretending woodland elves handcrafted a Tesla. Breakfast Used to Be a Moral Lecture To understand how we got here, we need cereal, because cereal tells the entire story of modern food in one aisle. The first cereals in America were essentially granolas—dense grain mixtures that required chewing, preparation, and a bit of commitment. While nobody was exactly dreaming about them at night, they solved an important problem because they stored well, traveled well, and provided calories in an expanding industrial society. Then along came John Harvey Kellogg. Now, Kellogg was brilliant, strange, deeply moralistic, and profoundly suspicious of pleasure. He believed rich foods, spicy foods, meat, and almost anything enjoyable stimulated dangerous passions, and among those passions, he was particularly terrified of masturbation, which he viewed as one of the great threats to civilization. So his answer was blandness. Very blandness. Little sugar. Little excitement. Little stimulation. The original breakfast cereal movement was not designed around pleasure. Instead, it was designed around suppression. In many ways, those cereals were crunchy moral discipline. Then the Cereal Aisle Became Las Vegas Fast forward a hundred years, and the cereal aisle becomes the exact opposite of Kellogg’s vision. Sugar increases dramatically. Crunch becomes engineered. Colors explode across the box. Mascots arrive to recruit children before they can read. Eventually, breakfast stops being a health intervention and slowly transforms into dessert with vitamins sprinkled on top. And importantly, none of this happened because someone woke up wanting to destroy public health. That’s the part people often misunderstand. Food Engineering Solved Real Problems Before obesity became the dominant nutritional problem, the real challenge facing humanity was hunger. For most of history, people worried about: starvation food spoilage crop failures transportation and simple calorie availability Modern food engineering changed that reality. Shelf-stable foods mattered. Affordable calories mattered. Transportation mattered. Refrigeration mattered. And honestly, millions upon millions of lives have been improved because of those advances. It is very easy for people with stocked refrigerators and grocery delivery apps to romanticize the past, but the past involved a tremendous amount of malnutrition, uncertainty, and hunger. So modern food systems were not evil. They were revolutionary. The Problem Changed However, in solving one problem, we slowly created another. Because once calories became: cheap portable stable and endlessly available …the challenge was no longer finding enough food. The challenge became stopping. And this is where modern biology collides with the modern grocery aisle. Our brains evolved in environments where calorie-dense food was rare and valuable. Suddenly, within just a few generations, we found ourselves surrounded by foods engineered to be affordable, repeatable, and highly rewarding. That mismatch matters. Extrusion Changed Everything Most people have never heard the word extrusion, even though it may be one of the most important food technologies in modern life. The process is simple. Take starches, grains, or protein powders. Apply heat and pressure. Force them through machinery. Suddenly, you have: cereal crackers cheese puffs protein snacks breakfast bars And here is the important part: extrusion changes texture, and texture changes satiety. When food crunches perfectly, dissolves quickly, and slides down effortlessly, people consume more of it before fullness has time to register. That is not a conspiracy. It is simply biology interacting with engineering. The Grocery Store Became Natural Selection Food companies did not necessarily set out to create hyper-palatable foods. Instead, they followed what sold. And what sold was what people returned to again and again. So over time, the grocery aisle became a form of natural selection. Products survived because they triggered pleasure effectively. Foods that didn’t simply disappear. And I will confidently say something controversial: Reese's sells better than Brussels sprouts. I will die on that hill. Now, yes, Brussels sprouts can be delicious roasted with olive oil and balsamic, and somewhere at this exact moment, a chef in Brooklyn is shaving them raw onto handmade pottery while explaining their emotional complexity. Still, Reese’s triggers something primal. Sweetness. Fat. Salt. Texture. And your brain immediately says: “Yes. More of that.” Food Is Emotional Food is not just chemistry. Food is memory. It is also culture. What we eat is comfort. For some people, comfort food is a tamale. For others, it’s lefse. Meanwhile, many people find that comfort in peanut butter cups or a Dove Bar. The grocery aisle evolved around those emotional realities much faster than human biology evolved to manage them. And that matters, because modern eating is not simply about willpower. It is about environment. Cooking Changes the Experience Now compare all that to actual cooking. Not content-creator cooking. Real cooking. A stew simmering slowly. A roast chicken filling the kitchen with aroma. A tagine building layers of flavor from preserved lemon, apricots, and warm Moroccan spices. That kind of food slows you down. You smell it before you eat it. You notice texture. You experience layers of flavor. And interestingly enough, you often need less of it to feel satisfied. That is one of the great ironies of modern eating. As food became more engineered for efficiency, it often became less satisfying experientially. The Wellness Fantasy There is another uncomfortable reality that nobody on wellness Instagram likes to admit. In order to feed a hungry planet, we cannot all live on pasture-raised beef, farm-fresh eggs gathered from cheerful backyard chickens, and organic kale harvested by a local poet-farmer wearing linen. That is not a food system. That is a lifestyle catalog. The modern world has eight billion people. Food has to: travel survive droughts survive wars survive supply chain failures and feed cities that no longer produce their own calories Engineered foods are not going away. Nor should they. Yes, Even on Mars When human beings eventually colonize Mars, we are not putting cattle on the rocket ship. Nobody is building a space ranch outside Olympus Mons. Likewise, we are not stocking the moons of Jupiter with artisanal grass-fed herds wandering peacefully beneath methane clouds. Instead, we will use engineered foods and lab-grown proteins, because they will be: efficient reproducible resource-conscious and eventually taste just as good That future is not dystopian. It is practical. The Real Challenge Now The challenge facing us today is very different from the challenge facing humanity a century ago. We no longer live in a world where most people fear starvation. Instead, we live in a world where many people are simultaneously overfed and undernourished. Calories are abundant. Satiety is not. And that is where medications like GLP-1 are helping many people—including me—regain a sense of balance and reality in a food environment that our brains were never designed to navigate. Food Is Not the Enemy Food is not evil. Engineering is not automatically bad. Convenience matters, and sometimes a protein bar is perfectly fine. However, pretending that heavily processed convenience foods become “real food” because someone added collagen and an Instagram strategy does not help anyone understand the real issue. The goal is not perfection. The goal is awareness. We need food systems that: reduce malnutrition prevent shortages improve satiety and avoid creating environments where obesity becomes the default outcome of modern life Because feeding humanity was one of civilization’s greatest achievements. Now we simply have to figure out how to do it without overwhelming the biology that got us here in the first place.
#126
May 7 · 11 min
What I Eat on a GLP-1 And Why It Changes
Let’s Start With What Nobody Tells You When people start a GLP-1, they are told what to avoid. What side effects to expect, and sometimes how much protein they should be eating. While that information has its place, it misses the part that actually changes your day-to-day life. Because what really shifts is not just how much you eat, but also how you experience it. At first, that change can feel subtle, almost easy to miss. Because nothing dramatic happens overnight. Although for me it did. In addition, over the course of a few days and weeks, you begin to notice that foods you used to reach for automatically no longer have the same pull, and simultaneously, foods you barely thought about before start to feel more interesting, more satisfying, and more worth your attention. So instead of asking what you should eat, a better question becomes what you actually want to eat. Because that answer starts to change. The Old Way: Eating Without Noticing Before this, eating was often fast, automatic, and driven by something that wasn’t quite hunger. Most meals were about filling up rather than tasting anything. Once the plate was in front of you, it didn’t take long for it to disappear. In many cases, food was less about enjoyment and more about reaching that point of fullness where the urge to eat finally quieted. Which meant convenience foods made sense, large portions felt normal, and finishing everything was exactly what you did. As a result, you weren’t really tasting food; you were processing it. And that difference matters more than people realize. Then the Shift Begins After starting a GLP-1, the signal changes. While it doesn’t happen the same way for everyone, it shows up quickly enough that you notice it in small ways. Because you slow down without trying, you pause between bites without thinking, and you stop earlier than you used to. That pause is important because it gives you a moment to notice what you’re eating. Once you notice, you start making choices that feel different from before, not because you are forcing yourself to be disciplined, but because your body is guiding you in a new way. Gradually, eating becomes less about quantity and experience, and that shift changes everything. Lunch: Where Real Life Happens For most people, lunch is not a carefully planned event, and that’s exactly why it’s a good place to see what actually works. On many days, I keep it simple because simple is reliable. A chicken breast heated up in the morning with a bit of hot sauce does the job without much effort. while a couple of apples and some grapes can carry me through the late morning and early afternoon without feeling like I need a full sit-down meal. Plus, if I am driving, eating slices of apples and grapes keeps me awake. At the same time, I don’t force structure onto it, because grazing a bit throughout the day often fits better than trying to recreate the old idea of a formal lunch, and that flexibility makes things easier rather than harder. On other days, I might grab a sandwich, and while it could be like a triple-decker club. The difference now is not what I order, but how much I eat, because stopping halfway feels natural instead of forced. Whatever is left has a way of disappearing quickly once my son gets home from school. Eating out follows the same pattern, because one or two tacos are usually enough. While fried foods sometimes feel heavier than they used to, grilled or ceviche-style options bring out flavor without that weight, making the experience better without trying to optimize anything. Simple Food Becomes Better Food At some point, you realize that simple foods start to feel more satisfying than they used to. And something like a good tuna, mixed with yogurt, lemon, and a bit of mustard, becomes a meal that you actually look forward to. Rather than something you eat because you think you should. Bread becomes optional, not forbidden, and sometimes a bowl or a few crackers is all you need, which removes the sense that meals must follow a certain format. Seasonal fruit fits into that pattern. Because when something tastes good, you eat it, and when it doesn’t, you move on, which is a different mindset from trying to force certain foods into your day. Even something as simple as peanut butter and jelly can feel satisfying again, because the experience of eating it has changed. Hydration Stops Being an Afterthought One thing that becomes more noticeable is how important drinking fluids actually is because when you eat less, you naturally take in less water from food, and that means you have to be more intentional about it. For me, iced tea works because it adds a bit of flavor without adding much else. Making it overnight in a pitcher means it’s ready when I need it, which turns hydration into a habit instead of something I forget about. That small shift makes a bigger difference than most people expect, because feeling off is often just a sign that you need to drink more. Dinner Becomes Something Different Dinner changes in a way that feels less structured and more creative. Because instead of trying to build a large meal, you start thinking about what would actually be enjoyable. Cooking becomes more interesting, not because you are trying harder, but because you have the space to pay attention. Dishes like salmon, pasta with a well-made sauce, or even something new from a meal kit can feel like something you are exploring rather than something you are consuming. At the same time, there is more room for variety, because you are not relying on volume to feel satisfied, and that allows you to try different things without needing to make them large. Still Paying Attention Matters Even with all these changes, I still track what I eat using Noom. Because awareness doesn’t go away just because the biology works differently. And that habit keeps things grounded without turning it into something rigid. Going out to eat is still part of life, and in many ways, it becomes more enjoyable because you can focus on what you like rather than how much you can eat, and sharing a meal or splitting something becomes a natural part of the experience. Dessert Tells You More Than You Think Dessert is where you can see the shift. Most of the time, I don’t think about it, and that alone is different, because it used to be automatic. Every now and then, especially when I’m getting close to my next dose, I’ll notice that I want something sweet, and I might have an ice cream bar, and that’s enough. That moment says more than any rule ever could. It shows the drive is lower, not gone, and that you can respond to it without being controlled by it. The Real Change What has changed is not complicated, but meaningful. I go for flavor instead of volume. Timing, now I take my time tasting instead of rushing. Choosing where and what to eat depends on whether it is worth it, not whether it is popular or convenient. Food is not the enemy. It never was. Some days, I am simply not interested in dinner, and if lunch was larger, I might just have a protein shake and move on, because eating is no longer something I have to do on a schedule. A Different Way of Eating This is not a diet. It is not a plan. It is not about perfection. Instead, it is about eating in a way that matches how your body now works, which means paying attention, making choices, and allowing yourself to enjoy food without relying on it for everything else. Before, I filled my mouth before thinking, and swallowing before experiencing. Now, I taste.

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