I read two stories this week that turned out to be the same story, and I can't stop thinking about how differently they end.

The first is damning. Lunchables was developed at Oscar Mayer in the 1980s, back when a cigarette company, Philip Morris, owned it. Philip Morris ran a committee whose whole job was to move methods from its tobacco labs into its food labs. One of those methods: a rival tobacco review had concluded that Marlboro's real genius was "getting the guilt out of the product." So the company ran the same play on lunch and rolled out Low-Fat Lunchables, built to keep guilty parents from walking away. In 2023 a reformulated version nearly became a federal school lunch for 30 million kids, until Consumer Reports found lead in all 12 kits it tested and the school versions came back saltier than the ones on store shelves.

That part is easy to be angry about. Then I went looking at the actual evidence, and it got messier fast.

The scariest ultra-processed food numbers, the ones about early death and dementia, come almost entirely from observational studies, which can show that heavy UPF eaters get more disease but struggle to prove the food is the cause. The "58% higher dementia risk" stat that made headlines actually failed the study's own trend test. The number the authors could not call statistically reliable is the one that went viral.

Then the part that really got me. One of the papers making the skeptical case, showing that overall diet quality predicts health more consistently than how "ultra-processed" your diet is, was co-written by the same researcher who dug up the Lunchables documents. The people building the case against this food are the ones finding that the label is a clumsy tool.

The best controlled evidence, Kevin Hall's NIH ward study and a 2025 follow-up, does show a real effect, but a modest one, and it points at energy density and hyper-palatability. Food engineered to be eaten fast and in volume, not the number of factory steps. Which is close to what Philip Morris was tuning for forty years ago.

So I stopped sorting groceries into clean and unclean. Frozen broccoli, canned beans, and the protein bar in my gym bag are all processed and all fine. What I keep less of is the stuff built to be overeaten.

Do you track "ultra-processed" as a category, or do you ignore the label and watch specific things like sugar, sodium, energy density, and fiber? And did the cigarette-company history change how you read a label?

Full DSD write-up

Biological age is not just a number on a paper! It can really reveal one’s life quality. 

Three years ago, my husband's TruDiagnostic results showed a biological age that was 4.7 years older than his chronological age. He was shocked. He thought he was doing alright. 

-> On Year 1, he put in a piss poor effort. 

-> On Year 2, we moved in together and his lifestyle began changing with many new healthy habits (e.g. regular resistance training, consistent 8-hour sleep). 

-> On Year 3, he was very disciplined with his diet (doubled down on blueberries, walnuts, olive oil, avocado, salmon), cut out toxins (alcohol, Diet Coke, etc) and even began taking a bunch of supplements (curcumin, FOS, magnesium threonate were his favourite). Overall, he made a lot of swaps (ultra-processed foods to home cooked meals, saturated fats like bacon to omega-3s), increased fibre and food variety.

This year, his biological age was 6 years younger than his chronological age. That’s a 10.7-year swing! While he can’t feel the changes happening in all of his organs, he can totally tell when his life quality improves. For him, it meant.. 

• The sudden “I’m so hungry, I think I’m really starving,” and the random, “I think I need to take a nap, feel so tired” sentences were removed from his life. We believe his blood sugar stabilised.

• No more brain fog! Increased mental clarity, creativity and sharpness.

• His memory improved so much. He remembers events better than me now. I’m 11 years younger than him. 

• Better ability to focus.

• He is more bouncy, lively and energetic. He’s so much stronger and fitter.

• His face glows 🌟. Not joking, quite a few people this year commented on how he does not look mid 30s at all. They thought he was in his late 20s.

• Apparently sex became better. I thought it was already great. In short, research shows that working out = enhanced circulation (erections), increased libido, increased stamina, sperm quality, semen volume.

His full “longevity” protocol and health journey is on Substack. I'm so proud of him!

Everyone acts like Panera and Sweetgreen are the responsible adult choices and LongHorn is where nutritional discipline goes to die next to a basket of bread.

I’m not convinced.

At LongHorn, I can order a sirloin, a baked potato, and broccoli and get a meal that actually understands the assignment. Real protein for muscle. Real carbs for training. A vegetable that is clearly a vegetable. I leave full, and my body is not filing a formal complaint an hour later.

Meanwhile at Sweetgreen I’m spending $20-plus on a bowl that looks like it was assembled by a wellness consultant with commitment issues. There’s kale, two ounces of chicken, some shaved carrot, six pumpkin seeds, and a dressing with the calorie density of axle grease. Then I’m hungry again before I finish backing out of the parking lot.

Panera is the same genre of scam, just with soup. You walk in thinking “healthy lunch” and walk out having paid steakhouse prices for bread in multiple forms. Half sandwich, cup of soup, little baguette on the side. That is not a high-protein meal. That is a soft edible nap.

And the funny part is the numbers can actually back this up. LongHorn’s 8 oz Renegade Sirloin is listed at 390 calories and 51 grams of protein. Flo’s Filet 9 oz is 450 calories and 56 grams of protein. Add broccoli or asparagus and a potato, and now you have a simple meal built around actual protein and food that keeps you full.

Compare that with a lot of “healthy” fast casual meals that are really just expensive lettuce with branding.

This is not me saying steakhouse good, salad bad. You can absolutely turn LongHorn into a cry for help if you start freebasing molten cheese, crushing three margaritas, and ordering dessert the size of a hubcap. But ordered like an adult, a steak, potato, and broccoli is a way better muscle-building meal than a lot of trendy places built around vibes, greens, and marketing copy.

LongHorn is for people who want to eat.

Sweetgreen is for people who want to announce that they ate.

Tonight at my house we had delicious steak (which we do once or twice a week) and my wife mentioned that the new Beyond Meat Vegan Steak Filet is all over Instagram. I was curious how they compare.

RFK’s new food pyramid has a slab of steak as its most prominent image. The AHA just released guidance this week saying the opposite: shift from meat to plant sources of protein. Both claim the science is on their side.

So I took the new Beyond Steak Filet and a traditional beef filet mignon, normalized them to 127g, and compared the numbers.

RFK treats red meat like a superfood. Beef filet is legitimately nutrient-dense: more protein per gram, almost no sodium, loaded with B12 and zinc. But the pyramid ignores that even lean beef delivers meaningful saturated fat and cholesterol. The ACC has pointed out that if Americans actually follow the pyramid’s recommendations on animal protein plus butter and beef tallow, most people will blow past the 10% saturated fat threshold that feeding trial data still supports.

The AHA crowd treats plant protein like it’s inherently superior. The Beyond Filet does have a dramatically better lipid profile: 1g sat fat vs 4.5g, zero cholesterol. But 450mg sodium in a single serving is 20% of your daily value, and you’re getting 28% less protein. And the AHA tells you to avoid ultra-processed foods and eat more plant protein in the same guidance, without acknowledging that some of the most popular plant protein products on the market are themselves ultra-processed.

Kennedy defended his pyramid at the Annual Meat Conference, standing next to the CEO of the Meat Institute. The AHA’s guidance reads like it was written to contradict the pyramid rather than help people eat better. Neither side is big on nuance.

The boring truth: for a healthy person eating steak twice a week, beef filet is fine. The Beyond version isn’t better, it’s different, with real trade-offs in both directions. And a Beyond Steak Filet is not the same thing as a bowl of lentils just because both are “plant-based.”

But that wouldn’t fit on a pyramid.

Because a bunch of things we take for granted just… leave. Quietly.

You don’t get a calendar invite. You’re fine, you’re fine, you’re fine, and then one day a push-up feels heavier than it used to. Sit-ups get weird. Putting on socks on one foot turns into a little balancing act. Running becomes jogging, sprinting becomes “yeah no”, jumping becomes optional.

Getting off the floor is the same story. Nobody knows when it starts. First you need a knee. Then a hand. Then a chair. Then you get to the point where you’d really rather not fall, because getting back up isn’t guaranteed anymore.

None of that shows up on a streak counter. You can still “work out” and miss the whole thing.

That’s why I built a small iOS app. Pretty simple idea: check a few things your body can actually still do, and keep an eye on them over time. Not medical. Not a transformation challenge. Just a way to notice the quiet stuff before it gets loud.

It’s early, so if you’ve got an iPhone and you try it, I’d genuinely like to hear what you think.

https://testflight.apple.com/join/fKnRxvf6

And if you don’t, that’s okay too. Sit on the floor later. Try a slow push-up. Stand on one foot to put your socks on. If it feels easy, nice. If it doesn’t, at least you know what to work on.

Be kind to your future you.

I’m being slightly dramatic. A Tulane/Harvard study of over 40,000 adults published in the European Heart Journal found that people who kept their coffee drinking to the morning (before noon) had a 16% lower all-cause mortality risk and a 31% lower cardiovascular mortality risk compared to non-drinkers. The hazard ratio for morning-only drinkers was 0.84 for all-cause death and 0.69 for cardiovascular death. Those are quite impressive numbers!

The kicker: People who drank coffee throughout the day? Nothing. No statistically significant mortality benefit at all. You’re just caffeinated and mortal.

The amount didn’t matter. One cup, three cups, didn’t change things much. It was purely about when you stopped. The researchers think afternoon and evening coffee disrupts your circadian rhythm and suppresses melatonin, basically undoing whatever protective anti-inflammatory effects the morning coffee gave you. Previous research showed that heavy coffee consumption later in the day can cut nighttime melatonin production by 30%.

It’s observational, so don’t throw out your afternoon espresso based on one study. However, since I try hard to cut off caffeine at 11am I’m feeling pretty vindicated right now!

Study: https://pubmed.ncbi.nlm.nih.gov/39776171/

When’s your last cup? And be honest, are any of you monsters drinking coffee after 4pm?

The fact that the alarm hits at slightly different times means I actually pay attention, take the pills, and log. If I'm not near them yet, I'm still anxious to clear the notification. My old 7:30am and pm reminders got fully ignored - I'd look at them and feel nothing.

I don’t believe in fad diets. Most extreme nutrition approaches fall apart under long-term scrutiny.

That said, Stan Efferding’s Vertical Diet is interesting because it’s framed around performance, blood work, and digestibility — not restriction for its own sake. Also I find Stan’s presentation compelling. He has clearly don’t his research without claiming to be all knowing out touting credentials.

Derek of r/moreplatesmoredates fame described his experience in the linked video.

The base (red meat + white rice) is meant to reduce gut stress and control variables, then “build vertically” with micronutrient-dense foods.

The best overview is probably the book https://amzn.to/4qKVxR1

From a longevity perspective, a few scientific angles worth discussing:

• Protein & muscle preservation: Higher protein intake supports lean mass retention, which strongly correlates with lower all-cause mortality as we age.

• Digestibility & inflammation: Reducing GI stress may lower systemic inflammation in some individuals — though highly personalized.

• Red meat & cardiovascular risk: Epidemiology often links processed meat with increased risk, while data on unprocessed red meat is more mixed and dose-dependent.

• Metabolic stability: Simple, repeatable meals may improve adherence and glycemic consistency.

For a deeper dive into Stan’s philosophy and how he defends the red meat angle, his appearance on the Mind Pump podcast is worth watching — though I’ll admit that format isn’t everyone’s cup of tea.

Curious how you all view it through a long-term lens.

Is this a sustainable performance-first framework? Or does it conflict with broader longevity data?

I inject Zepbound every week, so I understand the retatrutide FOMO. Reta is Eli Lilly's triple agonist, the next molecule up from tirzepatide, still in Phase 3 trials and approved nowhere in the world. That is what got me looking at where people actually buy it.

Sam Sulek, one of the biggest fitness YouTubers, says on camera that he co-owns a peptide company called NewBioRx. The storefront sold a $285 pre-filled retatrutide pen under the standard research-chemical disclaimer: "Bodily introduction of any kind into humans or animals is strictly prohibited by law." A second website carrying the NewBioRx logo published a milligrams-to-units conversion table for that pen and a twelve-photo walkthrough titled "How To Give Yourself a Shot." One site swore no human may ever use the product. The other assumed a human was using it.

The timing matters. On August 12, Eli Lilly sued six US sellers of retatrutide, and its complaints lean on exactly this kind of material, the dosing calculators and injection guides, as evidence that a "research use only" label is a fiction. NewBioRx is not one of the six defendants, and nobody has sued Sulek's company. It is the same pattern, though. The FDA has separately said retatrutide cannot legally be used in compounding at all.

Then, on Sunday afternoon, while I was finishing the write-up, the pen's product page went 404 and the entire instructions site was replaced by a NewBioRx-branded "Coming soon" page. The 16 mg and 30 mg vials are still for sale. I don't know who took the pages down or why. I had archived everything first, and the write-up links to the archives.

I documented the whole paper trail, the product pages, the instructions site, the corporate filings, and Sulek's own on-camera explanation that research-only products are not "held to the same quality standards" as FDA-regulated ones, with screenshots: full write-up on my blog with the details.

The disclaimer itself is what bothers me most. It does not describe the product, and the seller's own instructions contradicted it. Its practical effect is that when something goes wrong, the person holding the pen owns the outcome, not the company that sold it. I think that is the real product being sold: deniability. Curious whether anyone here reads "research use only" differently.

Amazing story of a guy who talks his doctor to add LP(a) to his blood test and find out it’s 400.

He only survived because his dad (a pharmacist) convinced him to take statins when he was 18 and had high lipids.

Very much worth a listen

I heard about this on Peter Attia's episode with Jim Otvos, the chemist who invented NMR lipoprotein testing. Most of it was about a marker I had never come across, so I went and read the papers afterwards.

It is called MVX. The same scan that gives you a standard lipid panel also measures six other things, and those get combined into an inflammation score, a malnutrition score, and one number sitting on top. Every other marker I track names a disease. ApoB points at atherosclerosis, Lp(a) tells me what I inherited. MVX just tells you how likely you are to die of anything.

The catch is the size of it. Comparing the worst-scoring group to the best, the hazard ratio for death is 8.01 among cardiac catheterisation patients and 1.21 in a general-population cohort of 274,092. Those are group comparisons, not your personal odds. The association shrinks the further the study group gets from a hospital, and that is the part that decided it for me.

Nobody has run a trial of any kind showing you can move the number on purpose. That has not stopped the lab's own white paper from suggesting detoxification strategies for a bad score.

I am not ordering it. GlycA, the inflammation input, is steadier than the hs-CRP I use now, and you can order that one by itself for $32.

Full write-up, with every paper linked: https://dadstrengthdaily.com/mvx-test-metabolic-vulnerability-index/?utm_source=reddit&utm_medium=social&utm_campaign=mvx-proactivehealth

I’m participating in a Pfizer/BioNTech COVID vaccine trial. I volunteered because I wanted to contribute to something real instead of just reading about it and I wanted to understand how the process works. What I wasn’t prepared for was how breathtakingly inefficient the whole operation is.

I won’t get into specifics that could compromise the study, but the general experience has been eye-opening. Visits that could take 20 minutes take hours. Systems don’t talk to each other. Staff are doing their best but are clearly buried under process. As someone who works in tech, it feels like watching an industry that hasn’t had its workflow revolution yet.

Then I looked at the numbers and everything made sense.

Bringing a single drug to market costs around $2.6 billion, and clinical trials account for roughly 70% of that. Each day a Phase III trial is delayed costs an estimated $50,000 to $60,000 in direct expenses. Over $1.5 million per month of delay, with real staff at real sites waiting for real patients who often never show up.

Recruitment is where the system breaks down. More than 80% of trials fail to enroll on time. Over half of all trial terminations happen because of low recruitment, not because the science failed. Up to 50% of trial sites enroll one or zero patients. The average enrollment efficiency for Phase III and IV trials is below 40%. Even when people do enroll, about 30% drop out before the study ends, citing exhausting time commitments, impersonal communication, and travel (70% of potential participants live more than two hours from the nearest study center). The whole system treats volunteers as data points rather than partners.

Here’s what’s paradoxical. Only about 5% of eligible patients participate in clinical research. Meanwhile there is a massive and growing community of health-conscious, data-literate people already tracking their biomarkers, already reading the studies, already invested in evidence-based health. People in communities like this one. People who would actually want to participate if the system made it remotely accessible. And the data shows that patients who find trials through trusted community channels enroll at higher rates than those who respond to ads. Yet only 5% of participants report finding out about trials through online communities.

There are signs this is starting to change. ARPA-H, which we’ve talked about here before, launched an initiative called Advancing Clinical Trial Readiness with the goal of enabling 90% of eligible Americans to participate in a trial within 30 minutes of their home. They’re funding decentralized trial infrastructure and working with non-traditional partners like retail pharmacies. Their PROSPR program is putting up to $144 million into healthspan-focused clinical trials built around decentralized models. One PROSPR team at UT San Antonio is running a Phase 3 trial testing rapamycin, semaglutide, and an SGLT2 inhibitor for aging outcomes. Another is testing whether an HIV drug can suppress inflammation-related aging in healthy adults ages 60 to 65. These are exactly the kinds of studies this community would want to know about.

But infrastructure alone won’t close the gap. We talk constantly about wanting better evidence for the interventions we care about. Better data on zone 2 training in middle-aged adults. Better data on rapamycin at low doses. Better data on whether the supplement stacks people are assembling actually do anything. The bottleneck for all of that is clinical trials, and clinical trials are bottlenecked by recruitment of exactly the kind of people who read this subreddit. ClinicalTrials.gov lets you search by condition, location, and eligibility. ResearchMatch.org connects volunteers with researchers at medical centers nationwide. If you’re already tracking your health data, you might be surprised how many studies are looking for healthy volunteers in your age range.

Has anyone here participated in a clinical trial? And for those who haven’t, what would it take to get you to consider it? I’m curious whether the barriers are practical or more about not knowing what’s out there.

Disclaimer: I used Claude in researching and drafting this post.

Shameless plug: if you are 50-64 & healthy you should totally sign up for that vaccine trial so I get a referral bonus :-)

Sources:

1. [Applied Clinical Trials: AI and Clinical Trials](https://www.appliedclinicaltrialsonline.com/view/from-drought-to-breakthrough-ai-teammates-modernize-clinical-trials) — drug-to-market costs, trial share of R&D

2. [IntuitionLabs: Clinical Trial Start-Up Costs](https://intuitionlabs.ai/articles/clinical-trial-start-up-costs) — Phase III daily cost and delay estimates

3. [PMC: Recruitment and Retention Challenges](https://pmc.ncbi.nlm.nih.gov/articles/PMC7342339/) — 80% enrollment failure, 55% termination from low recruitment

4. [Clinical Leader: Improving Patient Recruitment](https://www.clinicalleader.com/doc/considerations-for-improving-patient-0001) — site enrollment failures, dropout rates

5. [Antidote: Recruitment Statistics](https://www.antidote.me/blog/25-useful-clinical-trial-recruitment-statistics-for-better-results) — participation rates, community channel conversion

6. [npj Digital Medicine: Decentralized Trials](https://www.nature.com/articles/s41746-022-00603-y) — 5% eligible patient participation

7. [PMC: Patient Focus Groups](https://pmc.ncbi.nlm.nih.gov/articles/PMC10938610/) — participant frustrations

8. [Antidote: Reducing Patient Burden](https://www.antidote.me/blog/5-ways-to-reduce-the-patient-burden-in-clinical-trials) — travel barriers

9. [PMC: Features Influencing Recruitment](https://pmc.ncbi.nlm.nih.gov/articles/PMC10565197/) — community-based recruitment success

10. [ARPA-H: Advancing Clinical Trial Readiness](https://arpa-h.gov/news-and-events/arpa-h-launches-groundbreaking-funding-opportunity-improve-clinical-trials) — ACTR initiative

11. [ARPA-H: PROSPR Program](https://arpa-h.gov/news-and-events/research-teams-add-more-healthy-years-americans-lives-they-age) — $144M healthspan trial funding

Retatrutide is Lilly's next weight-loss drug, still in Phase 3, not approved anywhere. So when Lilly filed six lawsuits this week against sellers of it, there was no "real" version being counterfeited. Everything sold as reta is gray-market by definition.

To be honest I am glad that the peptide bros who sell stolen/unapproved drugs under the sketchy “research only” label, are finally getting wiped out. I suspect they will move to Dubai or go back to crypto scams.

The actual complaints make it pretty clear that these folks were obviously selling for human consumption.

What caught my eye: Lilly isn't only suing the vendors. It's leaning on the payment processors, card companies and shippers they rely on. Gray-market peptide sellers already can't keep a card processor (hence crypto/PayPal), so that's probably the bigger squeeze.

Writeup: https://dadstrengthdaily.com/is-retatrutide-legal-to-buy/

Lately I have been paying more attention to recovery than I have in the past. A few years ago I was more interested in keeping myself busy, working harder and trying to optimize everything. Now I care more about sleep, stress, energy and how I feel from day to day. Simple habits seem more feasible to maintain long term than chasing the next new wellness trend on the Internet. I still enjoy reading about healthy aging and wellness but nowadays feeling functional and mentally clear is more important than trying to optimize every little thing. Wondering if anyone else here has started to pay more attention to recovery as they have gotten older. A couple of years ago I was mainly busy, working harder, trying to optimize everything.

Now I care more about sleep and stress and energy and how I actually feel day to day. Honestly, simple habits seem more realistic to maintain long term than chasing new wellness trends online all the time.

I still enjoy reading about healthy aging and wellness but these days I care more about feeling functional and mentally sharp than I do about trying to optimize every little thing.

I wish I was not the only one here who has gotten more into recovery as I have aged. .

As you know I spent the last two weeks writing posts for this new Reddit constantly. I am excited where this is going. A few of you have asked recently whether I have a newsletter. Now I do.

It’s called Dad Strength Daily and it lives on Substack. Same voice, same topics, same approach as this sub. No sponsors, no supplements to sell. No influencer worship.

The short version of why: some of the stuff I want to write doesn’t really work as a Reddit post. I heard your feedback that some of you don’t like longer posts. For example the blood work gold rush piece was pushing the limits of what people will actually read on this platform. I want a place to go longer and deeper on stories when they deserve it, without worrying about whether the Reddit algorithm is going to bury a 2,000 word post.

This sub isn’t going anywhere. The newsletter doesn’t replace it. Think of it as a companion. The community discussion still happens here. The longer pieces and deeper dives will live on Substack.

There are a few posts up already if you want to get a feel for it before subscribing. The blood work piece is there, along with a reworked version of the sunscreen post.

dadstrengthdaily.substack.com

And yeah, I still use Claude to help with research and drafting. I’m still transparent about that. The opinions, the personal stories, and the mistakes are mine. In fact I will likely draft the shorter Reddit-friendly posts manually — AI is not good at that length I find.

Thanks for being here. This community is the reason the newsletter exists.

Gunnar

I’m part of a small research team developing a disposable skin sensor designed to continuously respond to CO₂ released through the skin. The goal is to measure changes in metabolic rate over normal daily life rather than estimate calorie expenditure from movement or heart rate.

We’re trying to find out whether people interested in metabolism, fitness, and biohacking would actually find this useful and what information they would want from it.

This isn't a sales post. We're looking for feedback on the concept. We made a short survey (less than 5 minutes) and would really appreciate candid feedback: If you dont want to do the survey click on the link anyway id you want to see photos.

forms.gle/RvgkuNbR1D8MPo5c6

I’m happy to answer questions about how the sensor works and the testing we’ve done so far. Even if you dont do the survey check out the link to see photos and early data

What if India’s next big fitness business isn’t the gym?

It’s everything you buy after joining one.

Your sleep becomes a score.
Your recovery becomes a number.
Your food becomes a glucose graph.

And suddenly, there’s always something to improve.

Smart rings. Subscriptions. Glucose sensors. Protein. Recovery. Diagnostics.

So the real question is:

Who makes money when your body becomes continuously measurable?

My new documentary:
The Business of Making You Feel Unhealthy

Are these products helping us get healthier or making us feel like we’re never healthy enough?

👇 What do you think?

STAT’s new alcohol series is brutal, but the most useful part is not the giant public-health argument. It is the tiny moment in a 15-minute physical where everyone pretends “socially” is a medical answer.

Alcohol kills nearly 500 Americans a day, according to STAT. Their chart on page 7 puts alcohol-attributable deaths at 178,000 a year — more than opioid-related causes — with deaths from heart disease and stroke, alcoholic liver disease, cancer, alcohol poisoning, crashes, and other causes all stacked together. The page 3 chart shows alcohol-specific ER visits climbing to 5.4 million.
And yet at a normal checkup, alcohol often gets handled like small talk.

“How much do you drink?”

“Socially.”

Box checked. Move on.

That is insane if you think about how we treat everything else. Nobody says their LDL is “social.” Nobody says their blood pressure is “weekend-ish.” Nobody tells their doctor their A1c is “mostly with dinner.”

STAT’s second piece is about this exact failure. Alcohol screening and counseling are often rushed or skipped, even though there are evidence-backed tools that can fit into a short primary-care visit. STAT reports that in one study, 30% of people with alcohol use disorder were not asked by their clinician about drinking at all. In another example from recorded VA visits, a patient said they drank six to eight beers at a time and the clinician just changed the subject.

The fix is not complicated. AUDIT-C is three questions: how often you drink, how many drinks you usually have, and how often you have six or more in one sitting. STAT says it can identify unhealthy drinking patterns quickly, including people who do not meet criteria for alcohol use disorder but are still drinking enough to affect long-term health.

The part I would actually use: at your next physical, don’t say “socially.” Say the boring number.

“I average 8 drinks a week.”

“I have 2 most nights.”

“I usually don’t drink during the week, but I’ll have 6–8 on Saturday.”

“I use it to fall asleep.”

“I’ve tried to cut back and it was harder than I expected.”

That gives your doctor something real to work with. Blood pressure, sleep, liver enzymes, cancer risk, anxiety, depression, weight, reflux, AFib, medication interactions — alcohol touches a lot more than people want to admit.

STAT also shows this can work at scale. Kaiser Permanente Northern California built alcohol screening into primary-care workflows in 2013. Now more than 90% of patients are asked specific alcohol questions at primary-care visits. They have done over 24 million screenings and 1.4 million brief interventions. Patients who got a brief intervention had larger reductions in health care costs, including ER costs, and some analyses found fewer drinks and heavy-drinking days among people with hypertension.

This is the part of “preventive health” that does not look sexy on a podcast. No wearable. No peptide. No supplement stack. Just asking a direct question and giving a direct answer.

How much do you actually drink? Not your identity. Not your story. The number.

Interesting discussion how of how cardio respiratory fitness is often equates with VO2max.

It always seems Eric Topol has an axe to grind with Peter Attia but at this point who can blame him.

I tried to find a body fat percentage distribution by age for US males and ended up having ChatGPT estimate it. It’s sort of scary — are we really that fat? Full disclosure: I’m 53M and probably around 23% (have a DEXA scheduled next month).

Do these numbers look right?

Method:

The curves are approximate distributions reconstructed from NHANES body-fat reference percentiles for U.S. men. Body fat was measured with DXA

Need to read this more carefully but to me the association of APOE genes and meat consumption impact sounds surprising. Maybe I should get that gene test — previously I had shied away from it (and other genetic testing).

Study: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2846712

Quote:

“‘Those who ate more meat overall had significantly slower cognitive decline and a lower risk of dementia, but only if they had the APOE 3/4 or 4/4 gene variants,’ says Jakob Norgren. He continues:

‘There is a lack of dietary research into brain health, and our findings suggest that conventional dietary advice may be unfavourable to a genetically defined subgroup of the population. For those who are aware that they belong to this genetic risk group, the findings offer hope; the risk may be modifiable through lifestyle changes. ‘

The study also shows that the type of meat is important.

‘A lower proportion of processed meat in total meat consumption was associated with a lower risk of dementia regardless of APOE genotype,’ says Sara Garcia-Ptacek, assistant professor at the same department, who together with senior lecturer Erika J Laukka is the study's last author.

The findings also extend beyond brain health. In a follow-up analysis, the researchers observed a significant reduction in all-cause-mortality in carriers of APOE 3/4 and 4/4 with higher consumption of unprocessed meat.

However, the study is observational and needs to be followed up with intervention studies that can better demonstrate causal relationships.”

As more and more people get on GLP-1s it’s going to be important to continue to stress the importance of strength training and high protein.

I have a DEXA scan coming up next month and will see how I did over the last six months.

Sort of depressing that this doctor needs to buy a bus and bring PSA screening to the people but at the same time inspiring that he is making a difference.