Podcast
Fork U with Dr. Terry Simpson
Hosted by Terry Simpson · EN
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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Diabetes, Weight Loss, Remission or Cure
6d ago00:17:55Tap to summarizeType 2 Diabetes, Bariatric Surgery, Fasting, and GLP-1s: What We Finally Learned About a Disease We Thought We UnderstoodFor 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 AloneOne 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 HypothesisRoy 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 WorksThis 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 EliminationThis 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 WellOne 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 mattersFiber matters.Satiety matters.Context matters.<p...
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The Science of Hangovers: Why Most “Cures” Fail
2w ago00:15:26Tap to summarizeThe Science of Hangovers: Why Your “Cure” Probably Doesn’t WorkYou 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 StorySocial 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” IndustryOver the last several years, social media has become flooded with products promising recovery, detoxification, or “support” for drinking.For example:Cheers RestoreZBioticsMyrklH-PROOFDHM DetoxDose for LiverFurthermore, 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 WaterPerhaps 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 LittleNow 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 HearingHere 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 ThoughtsUltimately, 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 ReadingFor 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.
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Why Food Became Engineered to Defeat You
3w ago00:12:42Tap to summarizeThe “Real Food” Protein BarThere 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 LectureTo 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 VegasFast 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 ProblemsBefore obesity became the dominant nutritional problem, the real challenge facing humanity was hunger.For most of history, people worried about:starvationfood spoilagecrop failurestransportationand simple calorie availabilityModern 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 ChangedHowever, in solving one problem, we slowly created another.Because once calories became:cheapportablestableand 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 EverythingMost 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:cerealcrackerscheese puffsprotein snacksbreakfast barsAnd 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 SelectionFood 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 EmotionalFood 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 ExperienceNow 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 FantasyThere 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:travelsurvive droughtssurvive warssurvive supply chain failuresand feed cities that no longer produce their own caloriesEngineered foods are not going away.Nor should they.Yes, Even on MarsWhen 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:efficientreproducibleresource-consciousand eventually taste just as goodThat future is not dystopian.It is practical.The Real Challenge NowThe 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—includin...
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What I Eat on a GLP-1 And Why It Changes
4w ago00:11:12Tap to summarizeLet’s Start With What Nobody Tells YouWhen 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 NoticingBefore 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 BeginsAfter 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 HappensFor 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 FoodAt 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 AfterthoughtOne 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 DifferentDinner 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 MattersEven 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 ThinkDessert 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 ChangeWhat 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 EatingThis 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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GLP-1 The First Month: Tips for the new user
Apr 3000:13:06Tap to summarizeIt’s not a straight line. It’s not a diet. And it’s definitely not what you expect.I started my journey on a GLP-1 in October 2024. While my doctor did what good doctors do—he gave me the warnings, the precautions, the usual advice about what to avoid and watch for—I quickly realized something was missing. No one really told me what it would feel like. More importantly, no one explained that this first month doesn’t unfold in one neat, predictable way, but instead moves along several paths depending on the person, their biology, their habits, and frankly, a bit of luck.So, as I’ve watched friends, patients, and many people start this same journey, I’ve come to understand that the first month is less about weight loss, and far more about discovery, adjustment, and occasionally confusion. While people expect something simple, they get instead of variation, and that variation can make them think something is wrong when everything is going exactly as it should.The Myth of the Straight LineMost people begin this process believing they will take the medication, lose their appetite, and watch the scale steadily drop. While that story is appealing, it simply isn’t how the body works, because biology rarely follows a script, and in this case, the first month is more like learning a new language than following a plan.What becomes clear quickly is that people fall into different patterns. While none of these patterns are right or wrong, understanding which one you are in can make all the difference in how you interpret the experience.The Three Paths of the First MonthSome people, myself included, are what we call hyper responders. Although we don’t fully understand why this happens, the effect can be dramatic. Within about twelve hours of my first dose, something shifted in a way I did not expect, as the constant chatter in my head about food—what we used to call head hunger—simply disappeared, and I didn’t even know it had been there until it was gone.During that first month, I lost twelve pounds, and while most of that was water and glycogen with some fat mixed in, the real change was not on the scale, but in my appetite. This dropped so noticeably that I found myself stretching out the time between doses. Interestingly enough, my obstructive sleep apnea improved, which was not something I had anticipated, but certainly appreciated.At the same time, my doctor had warned me to drink more fluids, and that advice was critical, because much of the water we normally get comes from food, and when food intake drops, hydration must be a conscious effort. So I adjusted by adding a protein shake in the morning and increasing my iced tea throughout the day, and that simple change made a meaningful difference in how I felt. You can find my recipes for protein shakes on the recipe section of my site, terrysimpson.com.The Normal RespondersOn the other hand, most people do not have that kind of immediate response, and instead they fall into what I would call the normal responder group, where the changes are subtle at first, and because they are subtle, they are easy to miss, which leads many to think the medication isn’t working, especially when they compare themselves to others who seem to be losing weight quickly.What they don’t notice, however, is that they are snacking less, leaving a bit of food on their plate, and skipping that second helping more often than before, and while these changes may seem small, they add up over time, because when someone tells me they only lost four pounds in a month, I translate that into nearly fifty pounds in a year, and suddenly the perspective shifts from disappointment to possibility, because that is a sustainable path.The Strugglers - they need helpThen there is the third group, the strugglers, and these are the people who feel the effects right away but not in a pleasant way, because nausea, delayed gastric emptying, and an uncomfortable sense of fullness can make the experience feel miserable rather than helpful, and in these cases, intervention becomes important, since without adjustment, these individuals can run into real problems.What helps here is not complicated, but it does require attention, because smaller meals, avoiding fatty foods early on, focusing on liquids, and most importantly, never eating until full can turn things around, and more often than not, dehydration is the hidden issue, which is why something as simple as popsicles made from electrolyte solutions can provide both relief and hydration, and the key word for this group, more than anything else, is pacing.Food Noise and the Silence That FollowsBefore GLP-1 medications, we often described something called head hunger, which is that feeling of wanting food even when the body does not need it. The distinction between real hunger and head hunger is easier to understand than most people think. If you are truly hungry, something simple like a meatball will satisfy you, whereas if it is head hunger, you will find yourself reaching for cookies, candy, or snacks high in calories but low in nutrition.This is what we now call food noise, and for many people, it is constant, although they may not recognize it until it disappears, which is exactly what happens on a GLP-1, and that disappearance can feel both liberating and unfamiliar at the same time.I can always tell when mine starts to come back, and recently, I delayed my dose for a few days because I was celebrating my wife’s birthday, and the next day, before I resumed the medication, I found myself buying multiple boxes of ice cream bars, not because I needed them but because that voice had returned, quietly suggesting that I might want them, and once I took the dose again, that same voice faded, leaving me to wonder why I had bought them in the first place.That voice is persistent, not loud but steady, and it doesn’t shout like an alarm but instead calls like a siren from an old story, inviting you toward something you don’t need but think you want, and turning that down is one of the most profound changes this medication brings.What Changes Over the First Few WeeksAs the first month unfolds, the early days are often inconsistent because appetite may vary from one day to the next, and while some meals feel normal, others feel different, and this unpredictability can make people uneasy, especially if they expect immediate stability.Gradually, however, things begin to settle, and by the third or fourth week, satiety arrives earlier, meals become smaller without effort, and foods that once felt irresistible lose some of their pull, not because they are forbidden but because they are no longer as compelling.At that point, behavior starts to align with biology, and instead of forcing discipline, people find themselves responding to signals that finally make sense.What Actually Helps in the First MonthSuccess in the first month comes down to a few consistent themes, and while none of them are complicated, they are easy to overlook, because smaller meals tend to feel better, slower eating becomes natural, hydration proves essential, and real food often becomes more appealing, all while the pressure to eat disappears.In addition, forcing food when you are not hungry rarely ends well, and learning to stop earlier than you used to becomes one of the most important adjustments you can make.The Emotional Shift No One Talks AboutOne of the most surprising aspects of this process is not physical but emotional, because when the constant thinking about food quiets down, there is a sense of relief, yet at the same time, there can be a feeling of disorientation, as if something familiar has gone missing.For many people, food fills more than just hunger because it fills time, emotion, and habit, and when that changes, there is space to be filled in new ways, which can feel uncomfortable at first but ultimately becomes an opportunity.A Different Way to Think About the First MonthThe first month on a GLP-1 is not about rapid weight loss, and it is not about perfection, and it certainly is not about willpower, because what it really represents is a shift in how the body communicates and how the mind responds.Instead of fighting hunger, you begin to understand it, and instead of chasing food, you begin to choose it, and in that process, something changes that goes far beyond the number on a scale.One Final ThoughtIf you are considering this journey, it is worth finding a board-certified obesity specialist because they have the training and experience to guide you through these changes in a way that most physicians simply do not, and that guidance can make the difference between frustration and success.And as for that first month, it is less about what you lose and more about what you learn, because what you are really discovering is what it feels like to not be controlled by food for the first time in a very long time.
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Being a Foodie on a GLP-1
Apr 2400:09:42Tap to summarizeWhy GLP-1 Made Me Love Food More—Not LessFrom beetroot pasta to backyard salsa, this wasn’t about eating less. It was about finally tasting more.I want to tell you about two people on a GLP-1.First, there’s me.I’ve been on a maintenance dose—7.5 mg of Zepbound—for a while now. And recently, I went to an incredible Michelin-star restaurant. Now, at one point during that meal, I said something that surprised even me.The beetroot pasta was one of the best dishes I had ever tasted.Now, let’s pause there—because this matters.I don’t like beets.In fact, I’ve always said I hate beets.And yet, there I was, enjoying beetroot pasta.So what changed?Well, not my opinion of beets.But absolutely my appreciation of flavor.Then, Something Unexpected HappenedDuring that same trip to Italy, I had one remarkable meal after another. For example, I ate at Ristorante Aroma, right next to the Colosseum. Then, I found a small, unforgettable place tucked away in Venice.Now, let me be clear—this is not a humble brag.Yes, the restaurants were fantastic. Yes, the trip was memorable.However, I’ve been to Europe before.And yet, this time was different.Because this time, I didn’t just eat the food.Instead, I tasted it.Moreover, I slowed down.In addition, I noticed the precision.And perhaps most importantly, I appreciated the flavors.Before, I think I liked good food.Now, I actually understand it.But Then There’s My FriendOn the other hand, there’s my friend.He’s also on a GLP-1. In fact, he weighs a bit less than I do. However, he told me something that stopped me in my tracks.“I don’t enjoy food anymore.”Now, that’s not discipline.And it’s certainly not success.Instead, that’s anhedonia.In his case, the dose was too high. As a result, appetite didn’t just quiet down—it disappeared. Furthermore, dehydration crept in. And on top of that, nutrition slipped just a bit.Consequently, food wasn’t enjoyable anymore.It was just… there.So, we made a small adjustment.We lowered the dose.Now yes, that can feel frightening. Naturally, people worry:“If I lower it, I’ll gain the weight back.”However, that didn’t happen.Instead, what came back was enjoyment.And Then There’s the Protein Bar ProblemNow, let’s shift gears—because this is where things get interesting.Every now and then, you need a snack. That’s normal. That’s life.However, when it comes to protein bars, I have to be honest.Most of them don’t taste like food.Instead, they taste like wet sawdust. Or, perhaps more accurately, dry particle board with a chocolate label slapped on it.Yes, they try. They add peanut butter flavor. They add cocoa.But still, the texture is off. The taste is off. And ultimately, your brain knows it.Now, to be fair, I do like some Aloha bars. They’re better than most.But even then…Recently, I skipped the bar.Instead, I had something entirely different:Tocino.A few bites.That’s all.And yet, those few bites delivered something protein bars rarely do:Flavor.Real flavor.Not engineered. Not simulated. Not “chocolate-adjacent.”Actual spices. Actual cooking. Actual food.And, frankly, it was fantastic.Meanwhile… the $32 Steak SnackOf course, I also tried one of those dried carnivore steak snacks.Thirty-two dollars.And honestly?Awful.Dry. Chewy. Completely joyless.At that point, you’re not eating—you’re making a statement to someone online.Instead, you’d be far better off flying to Spain and enjoying someJamón Ibérico.Because then, at least, you get flavor. And culture. And an experience.Now, Let’s Talk About BreakfastMost mornings, I have a smoothie.And it works.Specifically, I use oat milk, protein powder—this week I’m trying Ora pea protein—along with cocoa, coffee, blueberries, and a bit of banana.It’s quick. It’s consistent. And importantly, it fits into life.Especially when you’re stuck in California traffic.In fact, traffic moves so slowly here that I didn’t even have to get out of the car to move a snail off the road—he made it across before I got there.So yes, smoothies make sense.However, When I’m Home…Things change.Now, there’s nothing wrong with a bowl of Cinnamon Chex.It’s fine.But often, I want something more.So instead, I make:Poached eggsA splash of Louisiana Hot SaucePico de galloFresh tortillasBeansAnd, of course, real salsa.Not the jarred kind.Instead, the kind that takes an afternoon to make. The kind that improves overnight. The kind your neighbor brings over—and yes, you briefly consider paying her to keep making it, before realizing that might get a little awkward.So What’s Going On Here?At this point, you might think this is about “good food” versus “bad food.”But it’s not.Instead, it’s about awareness.Because much of what we eat today comes from a system designed for convenience.For example, extrusion—the process that creates cereals, protein bars, and many snack foods—makes food:Shelf-stableAffordableEasy to eatAnd importantly, easy to overeat.Because when food requires no effort…You don’t stop.But Here’s the Key PointThere is nothing wrong with food.Not with cereal. Not with protein bars. Not with convenience.However, GLP-1 changes something fundamental.It changes you.Specifically, it allows you—sometimes even forces you—to slow down.And because of that, you begin to:Notice flavorTake your timeActually enjoy what you eatBefore, I was filling my mouth before thinking.And I was swallowing before experiencing.Now?I taste.And That Changes EverythingBecause now, I can enjoy:The precision of fine diningThe bold flavors of the PhilippinesThe chunky salsa from my neighbor’s kitchenAnd suddenly, eating less becomes… more.More experience.More appreciation.More enjoyment.One Last ThingThere’s nothing wrong with Cinnamon Chex.But it’s not a morning habit anymore.Instead, it’s an every-now-and-then food.It’s interesting.But it’s not better.Because once you start tasting food the way it’s meant to be tasted…You don’t go back to eating it the way you used to.
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The Peptide Bazaar: Real Medicine vs. Vials from the Internet
Apr 1600:10:13Tap to summarizeThe word “peptide” is doing too much workLet’s start with the simplest truth.A peptide is just a chain of amino acids—like pearls on a necklace. That’s it. Nothing mystical. Nothing magical.However, structure matters. Sequence matters. Biology cares deeply about both.Because of that, some peptides are extraordinarily powerful. Others are biologically interesting. And a growing number are simply… marketed.That last category is where things get messy.Before the hype, there was a miracleNow rewind to a hospital ward in Toronto in the early 1920s.Children with diabetes were dying. Not slowly improving. Not plateauing. Dying.Then Frederick Banting and Charles Best walked in with something crude and experimental.Insulin.They injected it.The children woke up.Not metaphorically. Not in a graph. They woke up. Families watched death reverse in real time.That is what a peptide can do when it actually works.Then came the desert and the lizardFast forward a few decades.Out in the Southwest—near where I started my first job as a bariatric surgeon in Phoenix—lives the Gila monster. Not exactly a creature you expect to change medicine.Yet inside its venom was a peptide that led, eventually, to drugs like:SemaglutideThat discovery didn’t go straight to Instagram.Instead, it went through:receptor biologypharmacologyclinical trialsoutcomes researchAnd the results were real:lower blood sugarmeaningful weight lossreduced cardiovascular riskSo yes, peptides can be extraordinary.But only when the science is finished.And then we lost the plotNow, enter the modern peptide market.Suddenly, everything is a peptide. Everything promises:healingrecoveryfat lossanti-agingYou’ve seen the names:BPC-157TB-500CJC-1295IpamorelinMOTS-cAOD-9604Meanwhile, they are sold in places that should make you pause immediately.Gyms.Wellness clinics.Online “research chemical” shops.Rarely, if ever, through the same channels as actual medicine.BPC-157: the peptide that does everything… on paperStart with the most famous one.BPC-157 is marketed as a cure-all:tendon healinggut repairanti-inflammatoryaccelerated recoveryThe claims are sweeping. The confidence is impressive.But then you look at the evidence.Animal studies? Yes.Human randomized trials? No.Long-term safety? Also no.That gap matters.Because when something claims to stimulate healing broadly, it raises an uncomfortable question:What else might it stimulate?The answer, at this point, is simple.We don’t know.TB-500: recovery without receiptsNext comes TB-500.It is sold as a recovery peptide. It promises faster healing and improved flexibility.The biology is plausible. The mechanism sounds reasonable.Yet human evidence for those claims is lacking.Even so, it thrives in:bodybuilding circlesperformance clinicsonline forumsIn other words, environments where anecdote travels faster than data.Hormone peptides: changing numbers vs. changing outcomesNow we get to the hormone crowd.CJC-1295 and Ipamorelin are sold as a stack. They stimulate growth hormone release.That part is real.What comes next is not.Because increasing a hormone level is not the same as improving health.We do not have strong evidence for:long-term outcomessafety over yearsmeaningful clinical benefitsStill, they are marketed as anti-aging therapies.That leap—from signal to certainty—is where the trouble begins.Melanotan II: the one that proves the ruleMelanotan II is different.It actually does something.It increases pigmentation. It affects melanocortin receptors.And with that comes:nauseablood pressure changesmole darkeningdocumented toxicitySo here is the lesson.When a peptide truly works, you don’t get silence. You get side effects.The absence of side effects in marketing should never reassure you.It should make you suspicious.AOD-9604 and MOTS-c: the fantasy layerAt the far end of the spectrum are peptides like AOD-9604 and MOTS-c.They promise:targeted fat lossexercise-like metabolic effectslongevityThe evidence?Mostly cells and animals.Yet they are already being sold, injected, and promoted.At this point, we are not even pretending to wait for human data.Where these actually come fromNow let’s talk about the vial.Because this is where things shift from questionable to concerning.Many of these peptides are:manufactured overseasshipped in bulkrepackagedrelabeledThey are often sold as:“research chemicals”“wellness therapies”Independent testing has found:incorrect dosingcontaminationinconsistent puritySo when someone says they are taking a specific peptide, the real answer is uncertain.They hope they are.Why this is suddenly in the newsRecently, Robert F. Kennedy Jr. has pushed to expand access to peptides restricted by the FDA.The argument is framed as freedom.The FDA’s concern is simpler:lack of safety datarisk of contaminationunknown long-term effectsIn other words, we do not yet know enough to call these safe.That is not obstruction.That is the job.GLP-1: the difference data makesNow compare all of that to GLP-1 drugs.They don’t just sound scientific.They are scientific.They:improve blood sugarreduce weightlower cardiovascular riskMost importantly, they do this consistently, predictably, and measurably.That is what happens when research goes the distance.The bottom linePeptides are not the problem.Peptides gave us insulin.Peptides gave us GLP-1.At their best, they are among the most elegant tools in medicine.But the current peptide market is not built on finished science.Instead, it is built on possibility, dressed up as certainty.And that difference matters.Because the gap between “interesting biology” and “safe, effective therapy” is where patients get hurt.Final thoughtThe difference between a child waking up in a Toronto hospital…and a vial purchased online…is not the molecule.It is the evidence.
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Fat Shaming and GLP-1 - It's Biology
Apr 900:07:34Tap to summarizeThe Chorus of “Just Eat Less”Spend a few minutes on social media, and you will hear it. On Bill Maher's podcast the other day, I heard it. Two people who know less about GLP-1 drugs than almost anyone, opining about how GLP-1s are horrific.Bill Maher says, “Just eat less.”Jillian Michaels warns that GLP-1 medications are dangerous. Did she even graduate from college?Meanwhile, a rotating cast of gym bros, coaches, and influencers insists that anyone using these medications is taking the easy way out.At first glance, these seem like different voices. A comedian, a fitness personality, a group of online trainers.However, they are all saying the same thing.If you are overweight, this is your fault.If you need help, you are weak.If you use medication, you are cheating.That message travels well. It is simple. It fits into a tweet. It sounds like common sense. Science shows us that fat shaming doesn't work (reference).It is also wrong.Who Is Doing the Shaming—and WhyThe fitness industry has something to lose here, and that part is easy to understand. Entire businesses are built on the idea that weight loss is a matter of discipline. Follow the plan, buy the program, track the macros, and success will follow. If it doesn’t, the explanation is built in.You didn’t try hard enough.However, the criticism does not stop there.When someone like Bill Maher reduces obesity to “just eat less,” it is not about selling a diet plan. Instead, it reflects something else entirely. A kind of cultural impatience with complexity. A belief that if a problem can be described simply, it must also be solved simply.And when that belief meets a condition like obesity, the result is dismissal.If I don’t struggle with this, then it must not be real.If you do struggle, then you must be doing something wrong.That is not analysis.That is a failure of imagination.The Problem with Simple AnswersMedicine has a long history of being wrong in simple ways.We once believed ulcers were caused by stress alone. Then came Helicobacter pylori and antibiotic treatment. We once thought hypertension was simply a matter of salt intake and personality. Then we developed therapies that addressed the underlying physiology.Obesity has followed a similar path, except we have been slower to let go of the old explanation.“Eat less, move more” is not incorrect.It is incomplete.Because it ignores the system that determines how much you want to eat, how often you think about food, and how your body responds when you try to lose weight.The Part I Didn’t AdmitFor years, I saw the damage this thinking caused.I ran support groups for patients struggling with weight. I watched them come in carrying not just pounds, but shame. They believed they were weak, that they lacked discipline, that something about them was broken.We worked to change that.We talked about biology. About appetite regulation. About how the body defends weight. We tried to replace blame with understanding.And yet, I quietly held myself to a different standard.I didn’t blame my patients.I blamed myself.The Surgeon Who Thought He Could Outwork BiologyIf anyone should be able to power through something, it is a surgeon. That is the job. Endure long hours. Stay focused. Push through fatigue. Delay gratification.So I assumed I could do the same with weight.I tried diets. I cleaned things up. I ate vegetables, cut back on certain foods, and experimented with structure. And like many people, I saw results.At first.Weight loss is not the mystery.Weight maintenance is.Because over time, the same thing happened again and again. The body adapted. Hunger increased. Energy dipped. The system pushed back.And eventually, the weight returned.What the Data Shows (and Why It Matters)When you look beyond personal stories and examine long-term studies, the pattern becomes clear.In the Diabetes Prevention Program, participants lost weight early, then gradually regained some of it. In the Look AHEAD trial, an intensive lifestyle intervention produced initial success, but the gap narrowed over time.Observational data suggest that only a small percentage of people—often cited around 3 to 5 percent—maintain significant weight loss at five years.That number should change the conversation.Because it tells us this is not a widespread failure of discipline.It is a predictable outcome of a biological system.The Loop We Keep IgnoringWeight gain does not happen in isolation. It is part of a loop.Sleep worsens, which increases appetite. Movement becomes uncomfortable, so activity declines. Food becomes more rewarding, not less, because it offers relief.Then intake increases.Then the cycle repeats.And yet, into that loop, we continue to insert the same advice.Try harder.What Finally ChangedFor years, I thought I just needed to try harder myself.I was wrong.Today, I am down fifty pounds.Not because I discovered a better diet, but because something changed in the system itself.I started a GLP-1–based medication.The effect was immediate in ways I did not expect. My sleep improved. My snoring stopped. That alone changed my appetite and energy. Then something else happened.The noise went away.That constant pull toward food, the background awareness that shapes decisions throughout the day, quieted.From there, everything else followed.I began moving more. I returned to yoga, not out of obligation, but because it felt good. Because my body allowed it.This was not about replacing lifestyle.It was about finally being able to live it.What the Critics MissWhen critics say this is the “easy way out,” they misunderstand what is happening.There was nothing easy about fighting biology for years.What these medications do is change the biology so that effort becomes effective.That is not cheating.That is treatment.The Future of Coaching (and Who Will Adapt)The fitness world is not going away.However, it is going to change.The coaches who succeed will not be the ones shaming people for using medication. Instead, they will be the ones who understand how to work with it. They will help people build muscle, improve movement, and develop sustainable eating patterns once appetite is regulated.Mediterranean and DASH-style diets still matter. They remain among the best-supported dietary patterns for long-term health. What changes is the ability to follow them.When the biology shifts, adherence becomes possible.Eating Without FearOne of the most striking changes is how food feels.You no longer need to treat eating as a constant negotiation. You can eat real food. Greek yogurt, eggs, vegetables, and fruit.You can enjoy it.You can eat a peach without worrying about whether you have broken a rule.That is what happens when the noise quiets.Where I Was Wrong—and What Comes NextFor a long time, I believed that effort alone would solve this.I was wrong.Not because effort doesn’t matter, but because effort without the right biology is not enough.Science moves forward by showing us where we were incomplete. In this case, we were incomplete in how we understood obesity.Now we are beginning to correct that.And as we do, the conversation should change.Less blame.More understanding.Less shame.More treatment.Because this was never about character.It was always about biology.
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Menopause: Estrogen Effects Satiety
Apr 200:06:56Tap to summarizeMenopause, Hunger, and the Brain: Why It Feels DifferentMenopause changes more than temperature control. It reshapes how the brain handles hunger, fullness, and the quiet signals that guide eating. As a result, many women notice something unsettling. The same meals no longer satisfy. Hunger arrives sooner. Food feels louder.For years, we blamed metabolism. We told women their bodies were simply slowing down. While that explanation sounds scientific, it misses the most important part of the story.The brain has changed.A Pattern You Can’t IgnoreDuring my years performing weight loss surgery, about 80 percent of my patients were women. Over time, one pattern became impossible to overlook. When menopause or even perimenopause began, weight gain often followed.Some women had struggled with weight for years. Others had never given it much thought. Yet both groups described the same shift. They weren’t necessarily eating more. Instead, they felt hungrier, less satisfied, and more aware of food throughout the day.Meanwhile, the advice they received rarely evolved. Eat less. Move more. Try harder.However, that advice assumes the system regulating hunger still works the same way. In menopause, it doesn’t.Estrogen and the Appetite Control CenterTo understand what’s happening, we need to look at the hypothalamus. This small but powerful region of the brain regulates appetite, energy balance, and hormonal signaling. Under normal conditions, estrogen helps keep this system stable.Specifically, estrogen supports satiety signals and keeps hunger signals in check. In simple terms, it helps your brain recognize when you’ve had enough.As estrogen declines, that balance shifts. Hunger signals grow stronger. Fullness signals become less reliable. Consequently, the internal experience of eating begins to change.This shift explains why women often say, “I feel different around food,” even before their diet changes.Why Hunger Changes FirstInterestingly, appetite changes often appear before measurable increases in calorie intake. Women report thinking about food more often, feeling less satisfied after meals, and noticing hunger earlier in the day.At first glance, nothing looks different from the outside. Yet internally, the system has already shifted.Because of that, traditional advice falls short. Telling someone to eat less without addressing the change in signaling is like adjusting the thermostat while ignoring the wiring.More Than MetabolismAlthough metabolism does change with age, it does not fully explain the experience of menopause-related hunger. A slower metabolic rate might affect how calories are used, but it doesn’t explain why appetite feels louder or less controlled.Instead, the better explanation lies in the brain. The hypothalamus responds differently when estrogen levels fall. As a result, the signals that guide eating become less precise.In other words, this isn’t just about calories in and calories out. It’s about how the body decides when to eat—and when to stop.The Part We Should Have Addressed SoonerFor decades, menopause care focused on symptoms like hot flashes and bone health. Meanwhile, changes in appetite and weight were often attributed to lifestyle or willpower.Unfortunately, that approach overlooked a key fact. Estrogen plays a direct role in appetite regulation.Because of that, many women were told to push harder when their biology had already shifted. That message wasn’t just incomplete—it was unfair.Estrogen Replacement: A Broader RoleWhen clinicians discuss estrogen replacement, they often focus on symptom relief. However, estrogen also affects brain signaling related to hunger and satiety.In the right patient, hormone therapy may help restore some of that balance. It can improve how the brain responds to fullness and reduce the intensity of hunger signals.Importantly, hormone therapy does not inherently cause weight gain. That belief has persisted longer than the evidence supports.Still, therapy isn’t for everyone. Each patient requires an individualized discussion that considers risks, benefits, and goals.A New Layer: GLP-1 and Appetite ControlMore recently, GLP-1 receptor agonists have added another dimension to this conversation. These medications act on the same appetite centers in the brain, strengthening satiety and quieting hunger.Interestingly, estrogen appears to enhance the effectiveness of GLP-1 signaling. Therefore, menopause may not only reduce estrogen levels—it may also decrease the brain’s responsiveness to satiety cues.This interaction helps explain why some women experience such a dramatic shift in appetite during midlife.What Actually HelpsOnce you understand the biology, the approach changes.Rather than focusing solely on restriction, the goal becomes supporting satiety. Meals should include enough protein, fiber, and volume to sustain fullness. Additionally, sleep deserves attention, as poor sleep amplifies hunger signals. Medication reviews also matter, since some drugs can contribute to weight gain.For some women, hormone therapy or GLP-1 medications may play a role. For others, dietary structure and lifestyle adjustments provide meaningful improvement.In every case, the strategy should match the physiology.A Better Way ForwardMenopause is not a failure of discipline. It is a shift in how the brain regulates hunger.Once that shift is acknowledged, the conversation becomes more productive. Women can stop blaming themselves and start working with their biology.Ultimately, the goal isn’t to fight hunger. It’s to understand it.Final ThoughtMenopause doesn’t break the system—it changes the signal.And once you understand the signal, you can respond with clarity instead of frustration.Estrogen as a Key Regulator of Energy Homeostasis and Metabolic Health.Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2022. Mahboobifard F, Pourgholami MH, Jorjani M, et al.
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Henry VIII, the Brain, and the Obesity
Mar 2600:11:53Tap to summarizeThe Madness of King Henry VIII—and What We Got Wrong About ObesityThe King We ForgotThere is a moment in history that most of us think we understand. King Henry VIII—large, immobile, temperamental—has become almost a caricature of excess. We picture a man who simply ate too much, moved too little, and paid the price. It is a tidy story. Unfortunately, it is also likely the wrong one.Before the 1530s, Henry was something very different. He was athletic, charismatic, and energetic. He hunted, he jousted, he played sports, and he carried himself like the Renaissance ideal—educated, capable, and physically impressive. His armor, still preserved today, tells that story clearly. Narrow waist. Broad chest. Built for motion.The Fall That Changed EverythingThen everything changes.In January of 1536, Henry was thrown from his horse during a jousting match. The horse fell on him. He was reportedly unconscious for hours. Not minutes—hours. Even by modern standards, that is a significant traumatic brain injury.Soon after, in May of that same year, Anne Boleyn was arrested and executed. She was accused not only of adultery but also of witchcraft. That detail matters. Prior to this period, Henry was not known for superstition. He was a rational thinker. Yet suddenly, accusations of witchcraft become part of the story. It is tempting to say this was political theater. It may have been. Still, the timing is difficult to ignore.Meanwhile, his body begins to change.The Story We Told OurselvesAt first, historians explained this in simple terms. He ate more. He exercised less. Calories in, calories out. That explanation sounds neat. It fits what we like to believe. Even so, the math does not hold up.To gain over 200 pounds, you need a massive and sustained excess of calories. A reduction in physical activity alone does not explain that. We measure activity in METS—metabolic equivalents—and even a dramatic drop in activity would not account for that level of weight gain. In other words, you cannot outrun the math.Yet every January, gyms fill with people who are told exactly that. Move more. Try harder. Burn it off. By February, most of those gyms are empty again. If exercise alone solved obesity, we would not still have the problem.The Organ in ChargeSo what did we miss?The answer sits deep in the brain, in a small but powerful structure called the hypothalamus. It regulates hunger, satiety, hormones, and stress. When it works, eating feels normal. You get hungry, you eat, you stop. No drama. No constant thinking.However, when the hypothalamus is disrupted—by injury, disease, or chronic metabolic stress—that quiet system becomes loud. Hunger no longer behaves like a signal. It becomes a drive.This is not theory. Modern medicine has a name for it: acquired hypothalamic obesity. After traumatic brain injury, some patients develop rapid weight gain, persistent hunger, and changes in impulse control. Studies show that nearly half of patients with significant brain injury gain weight over time. The strongest predictor is not inactivity. It is hyperphagia—an abnormal increase in appetite.In simpler terms, the problem is not how much people move. It is what their brain is telling them to do.What Patients Taught MeThat pattern feels familiar if you have ever sat with patients. I have. Years ago, working with former NFL players, we noticed something striking. The players who struggled most with weight often had long histories of concussions. Not all of them gained weight. Yet those who did described the same experience—something they had never felt before.Food noise.Not hunger. Noise. A constant suggestion that does not go away.At first, I understood that as a physician. Later, I understood it as a person.When the World Went QuietAbout twelve hours after my first injection of Zepbound, something changed. The world became quiet. For the first time, I realized how much of my thinking had been shaped by that background noise. It did not disappear dramatically. It simply stopped.Since then, I have lost fifty pounds. More interesting than the weight loss is what happens between doses. As the medication wears off, the noise returns—subtly at first. A thought here. A reminder there. Even my stress levels rise slightly, something I can see on my WHOOP device. Then, a few hours after the next injection, it quiets again.That experience changes how you see patients. It changes how you see history.Looking Back at HenryBecause now, when we look back at Henry, we are not just looking at excess. We are looking at a possible disruption of the system that regulates behavior itself.There are hints of this even in his own time. A French ambassador noted that Henry’s chronic leg pain troubled him often and that he compensated by eating and drinking more. Later reconstructions suggest large meals, heavy in meat, along with substantial alcohol intake. Those numbers are estimates, not precise measurements. Even so, the pattern is clear.Something was driving the behavior.Decline, Not IndulgenceBy the end of his life, Henry could barely move. Mechanical devices were needed to help him stand. He lost close allies, including Thomas Wolsey and Thomas More. His body deteriorated. His mood worsened. This was not simply indulgence. It was decline.What We Can Do NowToday, we have tools that speak directly to that system. GLP-1 medications do not give people discipline. They restore control. Patients do not say they are stronger. They say it is quieter.That distinction matters.Because obesity was never just about calories. It was about signaling and about biology. It was about a system that, once disrupted, can push behavior in ways that are very difficult to resist.The Real LessonSo when we look at Henry VIII, we should be careful before we judge him as a man who simply lacked restraint.We may not know exactly how much he ate.Nevertheless, we know something was driving it.And when we ignore that truth today, we do more than misunderstand the disease.We blame the patient for having it.ReferencesArgente J, Farooqi IS, Chowen JA, Kühnen P, López M, Morselli E, Gan HW, Spoudeas HA, Wabitsch M, Tena-Sempere M. Hypothalamic obesity: from basic mechanisms to clinical perspectives. Lancet Diabetes Endocrinol. 2025 Jan;13(1):57-68. doi: 10.1016/S2213-8587(24)00283-3. Epub 2024 Nov 12. Erratum in: Lancet Diabetes Endocrinol. 2025 Jan;13(1):e1. doi: 10.1016/S2213-8587(24)00368-1. PMID: 39547253.
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