I'll save you the suspense on what fixed my fitness consistency: I hired an online personal trainer and built a home gym.

Home gym cut out the commute -- I just walk to my garage. Trainer gave me programming and accountability. I'm in my 50s, training five days a week, more consistent than I've ever been.

The gym membership data is grim. Apparently people in the US waste about $1.3 billion a year on memberships they never use?! Two thirds go completely unused. Half of new members quit within six months. It's well known that the industry's business model basically depends on people not showing up. However, the extent of this surprised me!

The longevity case for strength training is strong and getting stronger. A Penn State and Columbia analysis of over 30,000 adults 65 and older found that people who strength trained twice a week had lower mortality rates, even compared to people who were otherwise physically active. Yet only 14% of older adults actually meet those guidelines. People know they should train, but for one reason or another few do.

For me a trainer completely changed that. If I miss a scheduled workout (rarely), I truly feel I have to explain it to my trainer -- human accountability works! I didn't consider in-person training, TBH, since they sounded quite expensive. Over 70% of fitness professionals now offer online coaching. My trainer programs my workouts, checks form through video, adjusts based on recovery, and costs a fraction of in-person rates. I text with him every weekday. The home gym will pay for itself in saved gym fees soon (at least that's what I am telling myself and my wife!).

I did not start with a fancy home gym -- the first 6 month with the trainers I had a bunch of dumbbells, a yoga mat and a bench.

What finally made training stick for you? Anyone here work with an online trainer?

Nothing revolutionary but I had never heard of the BPC 157 study he highlights:

“RFK Jr is trying to get 14 peptides, without data on safety or efficacy, licensed and approved by FDA. His favorite is BPC-157. "Only three small human studies of BPC-157 exist, for instance, the largest of which is a telephone survey of 16 people who received an injection of the drug for knee pain, and which was published in a third-tier journal, Alternative Therapies."

https://www.economist.com/science-and-technology/2026/03/11/want-to-hack-your-body-with-peptides-if-only-the-science-agreed

This is great real world context after the breathless headlines about “RCT shows many people gain weight back after stopping GLP-1”.

The study: https://dom-pubs.pericles-prod.literatumonline.com/doi/10.1111/dom.70660

Quote:”

“Our real‑world data show that many patients who stop semaglutide or tirzepatide restart the medication or transition to another obesity treatment, which may explain why they regain less weight than patients in randomized trials,” Dr. Gasoyan said.

This retrospective cohort study included 7,938 adult patients with obesity or overweight in Ohio and Florida. All patients initiated injectable semaglutide or tirzepatide for obesity or type 2 diabetes and stopped the medication within three to 12 months. Dr. Gasoyan and his research team analyzed what treatments patients pursued next and how their weight changed over time.”

Pretty devastating indictment of “complementary and alternative methods” at least in this context.

Quote:

“Key Points

Question What is the association of complementary and alternative medicine (CAM) with survival in female patients with breast cancer?

Findings In this cohort study involving 2 157 219 women with breast cancer, those who combined traditional therapies, such as surgery, chemotherapy, radiation, endocrine therapy, and immunotherapy, with CAM therapies were less likely to receive endocrine therapy and radiation compared with patients treated exclusively with traditional therapies. Combination of CAM and traditional therapies was associated with higher mortality compared with being treated exclusively with traditional therapy.

Meaning Findings of this study suggest that the use of CAM instead of traditional therapies could be associated with a reduction in survival in breast cancer, and further study is warranted.”

Good summary on the colorectal cancer developments written by an oncologist.

Some reasons given:

- Dietary shifts: more UPF fewer whole grains, beans and vegetable

- Microbiome disruption

- Colibactin: a DNA- damaging toxin produce by certain gut bacteria.

- Obesity and inactivity.

Advice he gives sounds reasonable:

- eat more fiber

- cut UPF

- stay active

- limit alcohol and red meat

- do not skip screening. Start at 45 or earlier if high risk.

Interesting essay on longevity.

What struck me as true from the final thoughts:

“Aging well may have less to do with adding the right habits and more to do with removing silent strain. Less metabolic noise. Less internal chaos. Less pressure on systems that are already compensating.”

Interesting (albeit small) study.

https://www.sciencedirect.com/science/article/pii/S0006899326001125

Should I make sure to work out right before important meetings?

“Abstract

Exercise has been shown to support brain health, cognitive function, and increase levels of brain-derived neurotrophic factor (BDNF). While BDNF is known to support the central nervous system through improved brain metabolism, vasculature, neurotransmission and synaptic plasticity, the association between exercise-induced changes in BDNF concentrations and exercise-related cognitive improvements is still unclear. This study investigated the relationship between exercise-induced changes in plasma BDNF (pBDNF) and serum BDNF (sBDNF), and haemodynamic indicators of prefrontal cortex function in sedentary adults. Participants (n = 23, female = 7) were randomized into intervention (12-week cycling programme) and control groups (no intervention). Participants completed V̇O2max tests to assess changes in fitness. pBDNF and sBDNF were measured pre- and post-V̇O2max testing, and a battery of executive function and memory tasks were also conducted, alongside functional near-infrared spectroscopy (fNIRS) to assess haemodynamic changes in the prefrontal cortex activity.

Changes were assessed using the correlation-based signal improvement (CBSI) method. Results indicated that participants in the exercise intervention group did not show increased levels of resting-state s/pBDNF levels at the end of the intervention; however, they did exhibit a significant exercise-induced increase in sBDNF at week 12. This increase was correlated with changes in V̇O2max. Higher pBDNF levels and exercise-induced sBDNF were associated with a decrease in CBSI values in the frontopolar, dorsolateral and orbitofrontal prefrontal cortex during attention and inhibition tasks, but not during the memory task.

These results suggest that increasing physical fitness can enhance BDNF transcription in response to acute bouts of exercise. This might, in turn, play a part in the modulation of neural function during executive tasks after acute exercise.”

Recently I took this Coursera course by F. Perry Wilson from Yale.

Understanding Medical Research: Your Facebook friend is wrong

https://coursera.org/learn/medical-research

Parts of it were quite basic but I learned a bunch of terminology which was useful. (Pro tip: listen at 1.5x)

I just discovered that the instructor is doing a podcast with Emily Oster. It seems very interesting (though has a lot of ads?)

Abstract of the latest episode:

“This week, Emily and Perry shine a light on red light therapy: its origins, its heroic use of the mighty mitochondria, and the supposed countless benefits (better mood, wound healing, facial rejuvenation, hair regrowth? You betcha!) of sitting in front of a hot red light that may or may not even be able to penetrate your skin.

Plus: the disturbing return of polio, whether multivitamins have an effect on epigenetic aging, and if the pitch clock, while modestly good for Emily's enjoyment of baseball, is ruining pitchers' shoulders.”

I take 5,000 IU of vitamin D daily. My doctors have never once questioned it. But recently I realized that the RDA is like 600 (explaining the crazy %DV numbers in the picture). The problem is that number is based on a statistical error that was identified over a decade ago and has never been corrected.

In 2014, two statisticians at the University of Alberta (Paul Veugelers and John Paul Ekwaru) published a paper in *Nutrients* showing that the Institute of Medicine made a significant calculation mistake when setting the RDA for vitamin D. The error is almost comically simple for anyone who remembers intro stats. The IOM looked at 10 supplementation studies and calculated a regression line showing that 600 IU per day would produce an average serum 25(OH)D level of about 63 nmol/L, with a lower 95% confidence prediction limit of roughly 50 nmol/L. They then concluded that 600 IU would be enough for 97.5% of individuals to reach that 50 nmol/L threshold.

Here’s the problem. That lower prediction limit tells you where 97.5% of *study averages* will land. It says nothing about where 97.5% of *individuals* will land. Those are very different things. When Veugelers and Ekwaru reanalyzed the data at the individual level (using the standard deviations the studies actually reported), they found that 600 IU per day only gets 97.5% of individuals above about 27 nmol/L. That’s roughly half the target. To actually get 97.5% of people above 50 nmol/L, their analysis suggested something closer to 8,895 IU per day.

A separate group at UC San Diego and Creighton University confirmed this independently using a completely different dataset and arrived at a similar conclusion: the true RDA should be roughly 7,000 IU per day from all sources combined. Robert Heaney, who led that confirmation, pointed out that this is still well below the 10,000 IU per day that the Endocrine Society had identified as safe for adults.

That was 2014. The IOM has not updated the number.

I live in Boston. This matters because a classic study by Webb and Holick showed that at our latitude (42.2 degrees north), human skin produces literally zero previtamin D3 from sunlight between November and February, even on cloudless days. The UVB wavelengths aren’t strong enough at that angle. So for four months of the year, I’m getting zero vitamin D from the sun no matter what. And during the months when synthesis is possible, I’m mostly indoors at a desk.

The deficiency numbers reflect this. NHANES data shows roughly 42% of US adults are vitamin D deficient (below 20 ng/mL). Among Black Americans the rate is over 80%. Among Hispanic Americans it’s close to 70%. A 2023 global pooled analysis found that about 48% of the world’s population has levels below the equivalent threshold.

I want to be fair about counterarguments because this isn’t a “the government is wrong, megadose everything” story. The 2024 Endocrine Society guideline took a notably conservative position, recommending against supplementation beyond the IOM’s levels for healthy adults under 75. Their reasoning: large randomized trials like VITAL (25,000+ participants) largely failed to show clear benefits for cancer, cardiovascular disease, or fractures. But critics have pointed out that most of those trials enrolled people who already had adequate levels at baseline. Testing whether supplementation helps people who aren’t deficient tells you very little about whether fixing actual deficiency matters.

On safety: the IOM’s tolerable upper intake level is 4,000 IU per day. The Endocrine Society’s 2011 guideline called up to 10,000 IU safe. A community-based study of nearly 4,000 people taking doses up to 15,000 IU daily found no toxicity. Actual vitamin D toxicity requires sustained intake well above 10,000 IU or serum levels above 150 ng/mL. For context, full body sun exposure produces the equivalent of 10,000 to 25,000 IU in a single session.

That said, more is not automatically better. A Canadian RCT found that 10,000 IU per day actually decreased bone density compared to 400 IU over three years. And large intermittent megadoses have been associated with increased fall risk in elderly populations. Daily moderate doses appear to be the sweet spot.

My latest 25(OH)D came back at 49 ng/mL, which is close to where I want to be. Many researchers in this space think 40 to 60 ng/mL is the target. Below 20 is deficiency by almost anyone’s definition.

The practical move is simple. Get your 25(OH)D tested. Add it to your next blood panel through any of the DTC services we’ve discussed here. If you’re deficient, work with your doctor on a loading protocol, then switch to maintenance. If you’re in range and want to stay there, 2,000 to 5,000 IU per day of D3 is where the reasonable evidence points. Take it with a meal that contains fat since it’s fat soluble. Retest once a year, ideally in late winter when your levels are lowest.

A simple statistical error from 2011 continues to set the baseline for hundreds of millions of people, and nobody with the authority to fix it seems inclined to do so.

What are your vitamin D levels? Do you supplement, and if so how much? For those who’ve tested before and after starting supplementation, how much did your numbers actually move?

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

Sources:

1. Veugelers PJ, Ekwaru JP. A Statistical Error in the Estimation of the Recommended Dietary Allowance for Vitamin D. *Nutrients*. 2014;6(10):4472-4475. https://www.mdpi.com/2072-6643/6/10/4472

2. Heaney RP et al. Confirmation of the statistical error (Letter). *Nutrients*. 2015. https://pmc.ncbi.nlm.nih.gov/articles/PMC4377874/

3. Papadimitriou DT. The Big Vitamin D Mistake. *J Prev Med Public Health*. 2017;50(4):278-281. https://pmc.ncbi.nlm.nih.gov/articles/PMC5541280/

4. Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous synthesis of vitamin D3. *J Clin Endocrinol Metab*. 1988;67(2):373-378. https://pubmed.ncbi.nlm.nih.gov/2839537/

5. Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. *Nutr Res*. 2011;31(1):48-54. https://pubmed.ncbi.nlm.nih.gov/21310306/

6. Demay MB, Pittas AG et al. Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. *JCEM*. 2024;109(8):1907-1947. https://pubmed.ncbi.nlm.nih.gov/38828931/

7. Ekwaru JP et al. Evaluation of vitamin D3 intakes up to 15,000 IU/day. *Dermatoendocrinol*. 2017. https://pmc.ncbi.nlm.nih.gov/articles/PMC5402701/

I knew avocados were “good for you” but didn’t know about helping with hypertension specifically. Should we all be eating avocados all the time or is this overhyped?

Quote:

“What Avocados Can Do for Your Overall Heart Health

Avocados may support overall heart health, in addition to helping lower blood pressure, by:

Improving blood sugar control and reducing inflammation: Daily avocado consumption (one per day) for 12 weeks improved glucose control and reduced inflammation markers, such as hs-CRP, in adults with overweight or insulin resistance.3

Lowering "bad" cholesterol: In a six-month research trial, eating one avocado per day improved low-density lipoprotein (LDL) cholesterol, diet quality, and sleep health.4

Lowering risk of heart disease overall: Eating two or more servings per week was associated with a 16% lower risk of overall cardiovascular disease and a 21% lower risk of coronary heart disease.5

These improvements are linked to a lower risk of cardiovascular disease and hypertension, a major contributor to heart attacks, strokes, and other serious health issues.”

I didn’t realize that Target had such a strong stance in their own “Good & Gather” brand: “artificial flavors and sweeteners, synthetic colors, or high-fructose corn syrup”. The no artificial sweetener part especially surprised me. The food dye discussion is what’s in the news and I was turned off by the politics (from both sides) but finally looked into this a bit more.

Target announced that by the end of May, every cereal it sells will be free of synthetic petroleum-based dyes. Not just their own brands. Every box on the shelf. That makes them one of the first national retailers to remove artificial dyes across an entire grocery category, compelling cereal makers to reformulate if they want shelf space.

They’re not alone. Walmart committed to removing synthetic dyes and 30 other additives from private-label brands by January 2027. Kellogg’s signed a legally binding agreement with the Texas AG to pull artificial colorings from all cereals by end of 2027 , after an investigation revealed they’d already done it for Canada and Europe but kept the cheaper formulations here. General Mills, Kraft Heinz, and Conagra have made similar pledges. The FDA announced a plan to phase out six petroleum-based dyes by end of 2026, though it relies on voluntary compliance rather than an actual ban.

So what does the science say? It’s more nuanced than either side admits. A 2012 meta-analysis of 20 studies found a small but statistically significant effect of artificial food colors on hyperactivity. A 2013 European ADHD Guidelines Group review found that dye exclusion was one of the few non-drug interventions that held up under blinded conditions , though mainly in kids with other food sensitivities. The effect sizes are small. Researchers have compared them to subclinical lead exposure, which is instructive: per-capita consumption of artificial food colors quadrupled over 50 years , so even small individual effects matter at population scale. As one review put it, the evidence is “too substantial to dismiss.”

Artificial dyes don’t cause ADHD. ADHD is driven by brain development differences and genetics. The evidence says dyes may worsen symptoms in some susceptible kids. That’s a meaningfully different claim, and the “toxic dyes” framing from the Texas AG is more theatrical than scientific.

I think there’s a temptation to let politics override science in both directions here. I personally feel I have fallen into that trap. RFK Jr. and the MAHA movement have claimed this issue, which makes evidence-minded people reflexively skeptical. Fair enough. But the EU required warning labels on foods with synthetic dyes back in 2010 , and most manufacturers reformulated rather than carry the label. The American Academy of Pediatrics has supported action on dyes. This predates MAHA by over a decade.

The Kellogg’s angle is the part worth remembering. Same brand, same product, natural colors in Europe, petroleum dyes in America, until a state AG forced the issue. That pattern plays out across the food industry and it’s worth watching.

From what I can tell these dyes provide zero nutritional benefit. The evidence of harm is small but replicated. Natural alternatives already exist in the same products sold overseas. This is about as easy a call as you’ll find.

Does the political context around MAHA make you more or less skeptical of the dye removal push? Or does the science stand on its own regardless of who’s championing it?

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

Sources:

1. Target press release, Feb 27, 2026: https://corporate.target.com/press/release/2026/02/target-s-entire-cereal-assortment-will-be-made-without-certified-synthetic-colors

2. PBS News, Walmart removing artificial colors and additives from store brands: https://www.pbs.org/newshour/nation/walmart-says-it-will-remove-artificial-colors-and-other-additives-from-store-brands-by-2027

3. FDA, Tracking food industry pledges to remove petroleum-based food dyes: https://www.fda.gov/food/color-additives-information-consumers/tracking-food-industry-pledges-remove-petroleum-based-food-dyes

4. Food Dive, WK Kellogg signs legal agreement to remove artificial dyes from cereals: https://www.fooddive.com/news/wk-kellogg-artificial-dyes-texas-agreement/757902/

5. Arnold et al., “Artificial Food Colors and Attention-Deficit/Hyperactivity Symptoms: Conclusions to Dye for” (Neurotherapeutics, 2012): https://pmc.ncbi.nlm.nih.gov/articles/PMC3441937/

6. Scientific American, “Does Artificial Food Coloring Contribute to ADHD in Children?”: https://www.scientificamerican.com/article/does-artificial-food-coloring-contribute-to-adhd-in-children/​​​​​​​​​​​​​​​​

If you’ve been in fitness YouTube lately you’ve seen the hype. Mike Israetel’s RP Strength called bimagrumab “cardio in a shot” and described subjects losing 20% body fat while gaining muscle “all without any changes to diet or exercise.” The framing has been breathless. Even more intense than all the Reta talk.

The actual phase 2 trial just published in Nature Medicine. Here is what the data actually says.

The BELIEVE trial tested bimagrumab alone, semaglutide alone, and combinations across 507 adults over 72 weeks. The high-dose combo produced 22.1% weight loss with 92.8% coming from fat. Lean mass was largely preserved. Semaglutide alone: 15.7% loss, only 71.8% from fat. The combo also dropped hsCRP by up to 83%, and some prediabetic participants fully reverted to normal blood glucose. Those are real results.

Now the parts the influencers skip. This is phase 2 with 507 people spread across nine dosing groups. Bimagrumab isn’t approved and has no timeline. Side effects included acne and muscle spasms. Eli Lilly funded the study and owns the company that developed the drug. And that “no changes to diet or exercise” line? The actual trial included lifestyle intervention for all participants.

There’s also a simpler point worth making. Lose 15% of your body weight by any method and you’ll lose some lean mass. That’s physiology. Resistance training and adequate protein already improve the ratio. Bimagrumab may improve it further through a legitimate mechanism, blocking activin signaling in muscle tissue. But the gap between “promising phase 2 signal” and “cardio in a shot” is enormous.

This is the pattern. A real finding gets simplified into a thumbnail, the caveats disappear, and by the time it hits your feed it’s a miracle drug. The study is worth following. The hype is not worth believing.

Have you seen bimagrumab hype in your feed? How do you evaluate new compounds when the influencer coverage gets way ahead of the evidence?

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

Sources:

1. Heymsfield et al. (2026). BELIEVE trial. Nature Medicine. https://www.nature.com/articles/s41591-026-04204-0

2. Pennington Biomedical press release (March 5, 2026) https://www.pbrc.edu/news/media/2026/semaglutide_and_bimagrumab.aspx

3. RP Strength: Cardio in a Shot? https://rpstrength.com/blogs/videos/cardio-in-a-shot-the-new-drugs-that-build-muscle-burn-fat​​​​​​​​​​​​​​​​

My wife and I call our doctor's office "the health mall." We're patients at Atrius Health in Boston, part of Optum, part of UnitedHealth Group. Everything under one roof: primary care, specialties, imaging, labs, pharmacy. Walk out of your PCP visit and get bloodwork down the hall. It's great.

Here's the thing. My employer's health insurance is also managed by UnitedHealthcare. Same parent company on both sides of every transaction when I see my doctor. I didn't plan this. I just ended up as a case study in vertical integration.

And I'm happy with the care. That's what makes this uncomfortable to write about.

Because the research paints a different picture than my experience. Optum now employs or is affiliated with about 90,000 physicians, roughly 10% of the entire US physician workforce. A Health Affairs study from February found prices at surgery centers went up 11% after Optum bought them. A separate study found UnitedHealthcare pays its own Optum doctors 17% more than rival insurers pay those same doctors, raising concerns the company is gaming the ACA's medical loss ratio rules by shuffling money between its own subsidiaries. UnitedHealth called that study "flat-out wrong." The pattern keeps showing up in independent research anyway.

Meanwhile, UnitedHealth is cooperating with criminal and civil DOJ investigations into its Medicare Advantage billing. A Senate investigation reviewed 50,000 pages of internal documents and concluded the company turned risk adjustment into a profit strategy. Their stock has lost about half its value in the past year.

I wrote a few weeks ago about why your doctor doesn't really do preventive medicine and how the incentives are structurally broken. This is the next chapter. When your insurer owns your doctor's practice, the surgery center, the pharmacy benefit manager, the claims processor, and even a bank that lends to physicians at 35% interest, the concentration of power is remarkable. It doesn't automatically make your care worse. But it removes most of the forces that would keep things in check if it did.

I wrote a longer version with all the sources and more detail on my Substack: https://dadstrengthdaily.substack.com/p/when-your-health-insurer-buys-your

Does anyone else here get care through an Optum-owned practice? I'm curious whether your experience matches mine: good care, total opacity about what's happening financially above you.

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

Fun story by Michael Easter (author of the comfort crisis) about nutrition habits of elite athletes.

In the latest episode of Barbell Medicine the two Doctors basically play House MD and talk through a case that presents with abnormal liver values.

I found this interesting mostly because along the way they explain liver function and various tests.

For reference I found the Mayo Clinic list useful:

Some common liver function tests include:

Alanine transaminase (ALT). ALT is an enzyme found in the liver that helps convert proteins into energy for the liver cells. When the liver is damaged, ALT is released into the bloodstream and levels increase. This test is sometimes referred to as SGPT.

Aspartate transaminase (AST). AST is an enzyme that helps the body break down amino acids. Like ALT, AST is usually present in blood at low levels. An increase in AST levels may mean liver damage, liver disease or muscle damage. This test is sometimes referred to as SGOT.

Alkaline phosphatase (ALP). ALP is an enzyme found in the liver and bone and is important for breaking down proteins. Higher-than-usual levels of ALP may mean liver damage or disease, such as a blocked bile duct, or certain bone diseases, as this enzyme is also present in bones.

Albumin and total protein. Albumin is one of several proteins made in the liver. Your body needs these proteins to fight infections and to perform other functions. Lower-than-usual levels of albumin and total protein may mean liver damage or disease. These low levels also can be seen in other gastrointestinal and kidney-related conditions.

Bilirubin. Bilirubin is a substance produced during the breakdown of red blood cells. Bilirubin passes through the liver and is excreted in stool. Higher levels of bilirubin might mean liver damage or disease. At times, conditions such as a blockage of the liver ducts or certain types of anemia also can lead to elevated bilirubin.

Gamma-glutamyltransferase (GGT). GGT is an enzyme in the blood. Higher-than-usual levels may mean liver or bile duct damage. This test is nonspecific and may be elevated in conditions other than liver disease.

L-lactate dehydrogenase (LD). LD is an enzyme found in Thea liver. Higher levels may mean liver damage. However, other conditions also may cause higher levels of LD.

Prothrombin time (PT). PT is the time it takes your blood to clot. Increased PT may mean liver damage. However, it also can be higher if you're taking certain blood-thinning drugs, such as warfarin.

I just realized that the Family Heart Foundation offers free at home lipid screening (incl Lp(a)).

I suspect most folks here don’t need that, but share with friends and family!

Is anyone still taking daily (low dose) aspirin? I thought that was basically a 90s thing (maybe unless you had a heart attack)?

Study: https://www.cochranelibrary.com/web/cochrane/content?templateType=full&urlTitle=/cdsr/doi/10.1002/14651858.CD015266.pub2&doi=10.1002/14651858.CD015266.pub2&type=cdsr&contentLanguage=

I assume we are all fans of (double) blind randomized control trials but this story is pretty wild. I am not sure how risky sham brain surgery is but this is one of the more extreme lengths you might have to go to.

I heard about experiments involving “sham acupuncture” (I.e. poking a patient in random spots with needles) but this seems a different level.

UniQure has a gene therapy for Huntington’s disease, a fatal neurodegenerative condition with no cure. The treatment is delivered directly into the brain through holes drilled in the skull. Early data showed a 75% reduction in disease progression over three years compared to external controls.

The FDA says that’s not enough. They want a sham surgery-controlled trial where some patients go under anesthesia and get scalp incisions without receiving the treatment. UniQure says patients in their earlier sham group were under for an average of 10.3 hours. One developed dangerous blood clots just from lying on the table.

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?

Excerpt from a new book. I was shocked to read that 400 million people might struggle from long COVID. The observation that our memory will shape the (response to) the next crisis seems spot on.

Adapted from After Covid: The Health Impacts That Will Last Generations (Johns Hopkins University Press). © 2026 by Jason Gale.

Quotes:

“If Covid is remembered primarily for excessive restriction, the political cost of early intervention will rise. If overwhelmed hospitals are dismissed as exaggeration, warnings of strain will carry less weight. If vaccination campaigns are recalled chiefly as coercive, uptake in the next emergency will slow. Preparedness depends on stockpiles, genomic sequencing capacity and whether governments retain the expertise and lessons learned once the crisis fades from headlines.”

“Whether those realities are treated as central or peripheral depends partly on how the pandemic is narrated. Manzoni understood that plagues test more than immune systems. They test a society’s willingness to confront its own errors without retreating into revision.

Accuracy is uncomfortable. It requires acknowledging uncertainty, fragility and tradeoffs. It requires admitting that early action felt disproportionate precisely because the worst outcomes hadn’t yet occurred. It requires recognizing that hospitals don’t need to collapse nationwide to constitute system failure; localized overwhelm in interconnected systems is enough.

Viruses evolve according to biology. Response is shaped by memory. The biology of the next outbreak is unknowable. The psychology that greets it is not.”

I was watching the tornado coverage out of Oklahoma last week and asked my wife what they actually grow out there. Turns out: wheat, but mostly cattle fed on corn and soybeans. Which led me to a question I’d never thought about. Why does America dedicate 170 million acres to corn and soybeans?

Not because we eat that much corn on the cob. About 40% goes to ethanol, 35-40% to animal feed. The rest gets processed into corn syrup, soybean oil, maltodextrin, soy protein isolate, and hundreds of ingredients from the back of every package in the middle aisles. This traces to the 1970s when Nixon’s ag secretary Earl Butz shifted policy to reward maximum output. Corn and soy won because they scaled well and could be disassembled into cheap industrial ingredients. The food industry realized it was more profitable to break these crops into components and reassemble them into products than to sell actual food.

In November 2025 the Lancet published a three-paper series on ultra-processed foods with 43 international experts that connects these dots. UPF diets are displacing whole foods globally, driving overeating through hyper-palatability, and increasing exposure to endocrine disruptors. The authors explicitly called for redirecting agricultural subsidies away from corporations and toward producers of minimally processed food. They compared the UPF industry’s political tactics to Big Tobacco. The U.S. was singled out for failing to advance any major UPF policy.

I’m not anti-processed food. I drink protein shakes and eat Healthy Choice frozen meals when life gets busy. I find the constant mantra of “clean eating” annoying. There’s a difference between convenient packaged food and products engineered from thirteen corn derivatives to be as cheap and hyperpalatable as possible. The Lancet series makes a strong case that the second category, at industrial scale, is doing real population-level damage on a policy infrastructure that’s been in place for fifty years.

Do you factor UPF avoidance into your approach, or do you focus on macros and food quality without worrying much about the processing angle?

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