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Category: Nutrition

Is Fasting an Effective Treatment for Diabetes?

By losing 15% of their body weight, nearly 90% of those who have had type 2 diabetes for less than four years may achieve remission.

Currently, more than half a billion adults have diabetes, and about a 50% increase is expected in another generation. I’ve got tons of videos on the best diets for diabetes, but what about no diet at all?

More than a century ago, fasting was said to cure diabetes, quickly halting its progression and eliminating all signs of the disease within days or weeks. Even so, starvation is guaranteed to lead to the complete disappearance of you if kept up long enough. What’s the point of fasting away the pounds if they’re just going to return as soon as you restart the diet that created them in the first place? Might it be useful to kickstart a healthier diet? Let’s see what the science says.

Type 2 diabetes has long been recognized as a disease of excess, once thought to afflict only “the idle rich…anyone whose environment and self-support does not require of him some sustained vigorous bodily exertion every day, and whose earnings or income permit him, and whose inclination tempts him, to eat regularly more than he needs.” Diabetes is preventable, so might it also be treatable? If we’re dying from overeating, maybe we can be saved by undereating. Remarkably, this idea was proposed about 2,000 years ago in an Ayurvedic text:

“Poor diabetic people’s medicine
He should live like a saint (Munni);
He should walk for 800–900 miles.
Or he shall dig a pond;
Or he shall live only on cow dung and cow urine.”

That reminds me of the Rollo diet for diabetes proposed in 1797, which was composed of rancid meat. That was on top of the ipecac-like drugs he used to induce severe sickness and vomiting. Anything that makes people sick has only “a temporary effect in relieving diabetes” because it reduces the amount of food eaten. His diet plan—which included congealed blood for lunch and spoiled meat for dinner—certainly had that effect.

Similar benefits were seen in people with diabetes during the siege of Paris in the Franco‐Prussian War, leading to the advice to mangez le moins possible, which translates to “eat as little as possible.” This was formalized into the Allen starvation treatment, considered to be “the greatest advance in the treatment of diabetes prior to the discovery of insulin.” Before insulin, there was “The Allen Era.”

Dr. Allen noted that there are clinical reports of even severe diabetes cases clearing up after the onset of a “wasting condition” like tuberculosis or cancer, so he decided to put it to the test. He found that even in the most severe type of diabetes, he could clear sugar from people’s urine within ten days. Of course, that’s the easy part; it’s harder to maintain once they start eating again. To manage patients’ diabetes, he stuck to two principles: Keep them underweight and restrict the fat in their diet. A person with severe diabetes can be symptom-free for days or weeks, but eating butter or olive oil can make the disease come raging back.

As I’ve said before, diabetes is a disease of fat toxicity. Infuse fat into people’s veins through an IV, and, by using a high-tech type of MRI scanner, you can show in real time the buildup of fat in muscle cells within hours, accompanied by an increase in insulin resistance. The same thing happens when you put people on a high-fat diet for three days. It can even happen in just one day. Even a single meal can increase insulin resistance within six hours. Acute dietary fat intake rapidly increases insulin resistance. Why do we care? Insulin resistance in our muscles, in the context of too many calories, can lead to a buildup of liver fat, followed by fat accumulation in the pancreas, and eventually full-blown diabetes. “Type 2 diabetes can now be understood as a state of excess fat in the liver and pancreas, and remains reversible for at least 10 years in most individuals.”

When people are put on a very low-calorie diet—700 calories a day—fat can get pulled out of their muscle cells, accompanied by a corresponding boost in insulin sensitivity, as shown below and at 4:43 in my video Fasting to Reverse Diabetes.

The fat buildup in the liver has then been shown to decrease substantially, and if the diet is continued, the excess fat in the pancreas also reduces. If caught early enough, reversing type 2 diabetes is possible, which would mean sustained healthy blood sugar levels on a healthy diet.

With the loss of 15% of body weight, nearly 90% of individuals who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels, whereas it may only be reversible in 50% of those who’ve lived with the disease for longer than eight years. That’s better than bariatric surgery, where those losing even more weight had lower remission rates of 62% and 26%, respectively. Your forks are better than surgeons’ knives. Indeed, most people who have had their type 2 diabetes diagnosis for an average of three years can reverse their disease after losing about 30 pounds, as you can see below and at 5:37 in my video.

Of course, an extended bout of physician-supervised, water-only fasting could also get you there, but you would have to maintain that weight loss. One of the things that has been said with “certainty” is that if you regain the weight, you regain your diabetes.

To bring it full circle, “the initial euphoria about ‘medicine’s greatest miracle’”—the discovery of insulin in 1921—“soon gave way to the realisation” that, while it was literally life-saving for people with type 1 diabetes, insulin alone wasn’t enough to prevent such complications as blindness, kidney failure, stroke, and amputations in people with type 2 diabetes. That’s why one of the most renowned pioneers in diabetes care, Elliott Joslin, “argued that self-discipline on diet and exercise, as it was in the days prior to the availability of the drug [insulin], should be central to the management of diabetes….”

Doctor’s Note

Check out Diabetes as a Disease of Fat Toxicity for more on the underlying cause of the disease.

For more on fasting for disease reversal, see:

Fasting is not the best way to lose weight. To learn more, see related posts below.

What is the best way to lose weight? See Friday Favorites: The Best Diet for Weight Loss and Disease Prevention.

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January 24, 2026
All About Allulose

Sugar and high fructose corn syrup are the original industrial sweeteners—inexpensive, filled with empty calories, and contributing to diseases such as obesity, type 2 diabetes, cavities, and metabolic syndrome. Artificial sweeteners, like NutraSweet, Splenda, and Sweet’N Low, are the second-generation sweeteners. They are practically calorie-free, but cautions have been raised about their adverse effects. Sugar alcohols, such as sorbitol, xylitol, and erythritol, are the third-generation sweeteners. They’re low in calories but carry laxative effects or even worse. What about rare sugars like allulose?

What Is Allulose?

Allulose is a natural, so-called rare sugar, present in limited quantities in nature. “Recent technological advances, such as enzymatic engineering using genetically modified microorganisms, now allow [manufacturers] to produce otherwise rare sugars” like allulose in substantial quantities.

Allulose and Weight Loss

What happened when researchers evaluated the effect of allulose on fat mass reduction in people? As I discuss in my video Is Allulose a Healthy Sweetener?, more than a hundred individuals were randomized to a placebo control (0.012 grams of sucralose twice a day), a teaspoon (4 g) of allulose twice a day, or 1¾ teaspoons (7 g) of allulose twice a day for 12 weeks. Despite no changes in physical activity or calorie consumption in the groups, body fat significantly decreased following allulose supplementation. There weren’t any significant changes in LDL cholesterol levels in either of the allulose groups, though.

What about the purported anti-diabetes effects?

Does Allulose Help with Diabetes?

In a randomized, double-blind, placebo-controlled crossover experiment, people with borderline diabetes consumed a cup of tea containing either 1¼ teaspoons (5 g) of allulose or no allulose (control) with a meal. There was a significant reduction in blood sugar levels 30 and 60 minutes after consumption, but it was only about 15% lower compared to the control group and didn’t last beyond the first hour. To test long-term safety, the same researchers then randomized healthy people to a little over a teaspoon (5 g) of allulose three times a day with meals for 12 weeks. There didn’t appear to be any adverse side effects, but there weren’t any effects on weight or blood sugar levels either. So, it turns out the body fat data are mixed, as are the sugar data.

Another study found no effects of allulose on blood sugar levels in healthy participants tested up to two hours after consumption, though a similar study on individuals with diabetes did. And a systematic review and meta-analysis of all such controlled feeding trials suggested that the acute benefit on blood sugars was of “borderline significance.” It’s unclear whether this small and apparently inconsistent effect could translate into meaningful improvements in long-term blood sugar control. It may not be enough just to add allulose—you might also have to cut out junk food.

Is Allulose Good or Bad for You?

As I discuss in my video Does the Sweetener Allulose Have Side Effects?, unlike table sugar, allulose is safe for our teeth; it apparently isn’t metabolized by cavity-causing bacteria to produce acid and promote plaque buildup. It doesn’t raise blood sugar levels either, even in people with diabetes. Allulose is considered a “relatively nontoxic” sugar, but what does that mean?

How Much Allulose Is Too Much?

In one study, researchers gave healthy adults beverages containing gradually higher doses of allulose “to identify the maximum single dose for occasional ingestion.” No cases of severe gastrointestinal symptoms were noted until a dose of 0.4 g per kg of bodyweight was reached, which is about eight teaspoons for the average American. Severe symptoms of diarrhea were noted at a dose of 0.5 g per kg of bodyweight, or about ten teaspoons.

In terms of a daily upper limit given in smaller doses throughout the day, once participants reached around 17 teaspoons (1.0 g/kg bodyweight) a day, depending on weight, some experienced severe nausea, abdominal pain, headache, or diarrhea. So, most adults in the United States should probably stay under single doses of about 8 teaspoons (0.4 g per kg of bodyweight) and not exceed about 18 teaspoons (0.9 g per kg of bodyweight) for the whole day.

So, What’s the Verdict on Allulose?

Are rare sugars like allulose a healthy alternative for traditional sweeteners? Well, considering the variety of potentially beneficial effects of allulose “without known disadvantages from metabolic and toxicological studies, allulose may currently be the most promising rare sugar.” But how much is that saying? We just don’t have a lot of good human data. “As a result of the absence of these studies, it may be too early to recommend rare sugars for human consumption.” This is especially true given the erythritol debacle.

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January 21, 2026
Can Olive Oil Compete with Arthritis Drugs?

What happened when topical olive oil was pitted against an ibuprofen-type drug for osteoarthritis and rheumatoid arthritis?

Fifty million Americans suffer from arthritis, and osteoarthritis of the knee is the most common form, making it a leading cause of disability. There are several inflammatory pathways that underlie the disease’s onset and progression, so various anti-inflammatory foods have been put to the test. Strawberries can decrease circulating blood levels of an inflammatory mediator known as tumor necrosis factor, but that doesn’t necessarily translate into clinical improvement. For example, drinking cherry juice may lower a marker of inflammation known as C-reactive protein, but it failed to help treat pain and other symptoms of knee osteoarthritis. However, researchers claimed it “provided symptom relief.” Yes, it did when comparing symptoms before and after six weeks of drinking cherry juice, but not any better than a placebo, meaning drinking it was essentially no better than doing nothing. Cherries may help with another kind of arthritis called gout, but they failed when it came to osteoarthritis.

However, strawberries did decrease inflammation. In fact, in a randomized, double-blind, crossover trial, dietary strawberries were indeed found to have a significant analgesic effect, causing a significant decrease in pain. There are tumor necrosis factor inhibitor drugs on the market now available for the low, low cost of only about $40,000 a year. For that kind of money, you’d want some really juicy side effects, and they do not disappoint—like an especially fatal lymphoma. I think I’ll stick with the strawberries.

One reason we suspected berries might be helpful is that when people consumed the equivalent of a cup of blueberries or two cups of strawberries daily, and their blood was then applied to cells in a petri dish, it significantly reduced inflammation compared to blood from those who consumed placebo berries, as you can see below and at 2:02 in my video Extra Virgin Olive Oil for Arthritis.

Interestingly, the anti-inflammatory effect increased over time, suggesting that the longer you eat berries, the better. Are there any other foods that have been tested in this way?

Researchers in France collected cartilage from knee replacement surgeries and then exposed it to blood samples from volunteers who had taken a whopping dose of a grapeseed and olive extract. They saw a significant drop in inflammation, as shown below and at 2:30 in my video.

There haven’t been any human studies putting grapeseeds to the test for arthritis, but an olive extract was shown to decrease pain and improve daily activities in osteoarthritis sufferers. So, does this mean adding olive oil to one’s diet may help? No, because the researchers used freeze-dried olive vegetation water. That’s basically what’s left over after you extract the oil from olives; it’s all the water-soluble components. In other words, it’s all the stuff that’s in an olive that‘s missing from olive oil.

If you give people actual olives, a dozen large green olives a day, you may see a drop in an inflammatory mediator. But according to a systematic review and meta-analysis, olive oil—on its own—does not appear to offer any anti-inﬂammatory beneﬁts. What about papers that ascribe “remarkable anti-inflammatory activity” to extra virgin olive oil? Their evidence is from rodents. In people, extra virgin olive oil may be no better than butter when it comes to inflammation and worse than even coconut oil.

So, should we just stick to olives? Sadly, a dozen olives could take up nearly half your sodium limit for the entire day, as you can see below and at 3:47 in my video.

When put to the test, extra virgin olive oil did not appear to help with fibromyalgia symptoms either, but it did work better than canola oil in alleviating symptoms of inflammatory bowel disease. Unfortunately, I couldn’t find any studies putting olive oil intake to the test for arthritis. But why then is this blog entitled “Can Olive Oil Compete with Arthritis Drugs?” Because—are you ready for this?—it appears to work topically.

Topical virgin olive oil went up against a gel containing an ibuprofen-type drug for osteoarthritis of the knee in a double-blind, randomized, clinical trial. Just a gram of oil, which is less than a quarter teaspoon, three times a day, costing less than three cents a day, worked! Topical olive oil was significantly better than the drug in reducing pain, as you can see below and at 4:37 in my video.

The study only lasted a month, so is it possible that the olive oil would have continued to work better and better over time?

Is olive oil effective in controlling morning inflammatory pain in the fingers and knees among women with rheumatoid arthritis? The researchers went all out, comparing the use of extra virgin olive oil to rubbing on nothing and also to rubbing on that ibuprofen-type gel, and, evidently, the decrease in the disease activity score in the olive oil group beat out the others.

Doctor’s Note

For more on joint health, see related posts below.

What about eating olive oil? See Olive Oil and Artery Function.

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January 16, 2026
The Hidden Costs of Bariatric Surgery

Weight regain after bariatric surgery can have devastating psychological effects.

How Sustainable Is the Weight Loss After Bariatric Surgery? I explore that issue in my video of the same name. Most gastric bypass patients end up regaining some of the fat they lose by the third year after surgery, but after seven years, 75% of patients followed at 10 U.S. hospitals maintained at least a 20% weight loss.

The typical trajectory for someone who starts out obese at 285 pounds, for example, would be to drop to an overweight 178 pounds two years after bariatric surgery, but then regain weight up to an obese 207 pounds. This has been chalked up to “grazing” behavior, where compulsive eaters may shift from bingeing (which becomes more difficult post-surgery) to eating smaller amounts constantly throughout the day. In a group of women followed for eight years after gastric bypass surgery, about half continued to describe episodes of disordered eating. As one pediatric obesity specialist described, “I have seen many patients who put chocolate bars into a blender with some cream, just to pass technically installed obstacles [e.g., a gastric band].”

Bariatric surgery advertising is filled with “happily-ever-after” fairytale narratives of cherry-picked outcomes offering, as one ad analysis put it, “the full Cinderella-romance happy ending.” This may contribute to the finding that patients often overestimate the amount of weight they’ll lose with the procedure and underestimate the difficulty of the recovery process. Surgery forces profound changes in eating habits, requiring slow, small bites that have been thoroughly chewed. Your stomach goes from the volume of two softballs down to the size of half a tennis ball in stomach stapling and half a ping-pong ball in the case of gastric bypass or banding.

As you can imagine, “weight regain after bariatric surgery can have a devastating effect psychologically as patients feel that they have failed their last option”—their last resort. This may explain why bariatric surgery patients face a high risk of depression. They also have an increased risk of suicide.

Severe obesity alone may increase the risk of suicidal depression, but even at the same weight, those going through surgery appear to be at a higher risk. At the same BMI (body mass index), age, and gender, bariatric surgery patients have nearly four times the odds of self-harm or attempted suicide compared with those who did not undergo the procedure. Most convincingly, so-called “mirror-image analysis” comparing patients’ pre- and post-surgery events showed the odds of serious self-harm increased after surgery.

About 1 in 50 bariatric surgery patients end up killing themselves or being hospitalized for self-harm or attempted suicide. And this only includes confirmed suicides, excluding masked attempts such as overdoses classified as having “undetermined intention.” Bariatric surgery patients may also have an elevated risk of accidental death, though some of this could be due to changes in alcohol metabolism. When individuals who have had a gastric bypass were given two shots of vodka, their blood alcohol level surpassed the legal driving limit within minutes due to their altered anatomy. It’s unclear whether this plays a role in the 25% increase in prevalence of alcohol problems noted during the second postoperative year.

Even those who successfully lose their excess weight and keep it off appear to have a hard time coping. Ten years out, though physical health-related quality of life may improve, general mental health can significantly deteriorate compared to pre-surgical levels, even among those who lost the most weight. Ironically, there’s a common notion that bariatric surgery is for “cheaters” who take the easy way out by choosing the “low-effort” method of weight loss.

Shedding the weight may not shed the stigma of prior obesity. Studies suggest that “in the eyes of others, knowing that an individual was at one time fat will lead him/her to always be treated like a fat person.” And there can be a strong anti-surgery bias on top of that—those who chose the scalpel to lose weight over diet or exercise were rated more negatively (for example, being considered less physically attractive). One can imagine how remaining a target of prejudice even after joining the “in-group” could potentially undercut psychological well-being.

There can also be unexpected physical consequences of massive weight loss, like large hanging flaps of excess skin. Beyond being heavy and uncomfortable and interfering with movement, the skin flaps can result in itching, irritation, dermatitis, and skin infections. Getting a panniculectomy (removing the abdominal “apron” of hanging skin) can be expensive, and its complication rate can exceed 50%, with dehiscence (rupturing of the surgical wound) one of the most common complications.

“Even if surgery proves sustainably effective,” wrote the founding director of Yale University’s Prevention Research Center, “the need to rely on the rearrangement of natural gastrointestinal anatomy as an alternative to better use of feet and forks [exercise and diet] seems a societal travesty.”

In the Middle Ages, starving peasants dreamed of gastronomic utopias where food just rained down from the sky. The English called it the Kingdom of Cockaigne. Little could medieval fabulists predict that many of their descendants would not only take permanent residence there but also cut out parts of their stomachs and intestines to combat the abundance. Critics have pointed out the irony of surgically altering healthy organs to make them dysfunctional—malabsorptive—on purpose, especially when it comes to operating on children. Bariatric surgery for kids and teens has become widespread and is being performed on children as young as five years old. Surgeons defend the practice by arguing that growing up fat can leave “‘emotional scars’ and lifelong social retardation.”

Promoters of preventive medicine may argue that bariatric surgery is the proverbial “ambulance at the bottom of the cliff.” In response, proponents of pediatric bariatric surgery have written: “It is often pointed out that we should focus on prevention. Of course, I agree. However, if someone is drowning, I don’t tell them, ‘You should learn how to swim’; no, I rescue them.”

A strong case can be made that the benefits of bariatric surgery far outweigh the risks if the alternative is remaining morbidly obese, which is estimated to shave up to a dozen or more years off one’s life. Although there haven’t been any data from randomized trials yet to back it up, compared to non-operated obese individuals, those getting bariatric surgery would be expected to live significantly longer on average. No wonder surgeons have consistently framed the elective surgery as a life-or-death necessity. This is a false dichotomy, though. The benefits only outweigh the risks if there are no other alternatives. Might there be a way to lose weight healthfully without resorting to the operating table? That’s what my book How Not to Diet is all about.

Doctor’s Note

My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your library or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

This is the final segment in a four-part series on bariatric surgery, which includes:

This blog contains information regarding suicide. If you or anyone you know is exhibiting suicide warning signs, please get help. Go to https://988lifeline.org for more information.

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January 14, 2026
Progress on added sugar, protein hype, saturated fat contradictions • The Nutrition Source
The 2025–2030 Dietary Guidelines for Americans (DGAs) were released this week with the tagline “eat real food,” and a stronger stance on limiting added sugars and highly processed foods.

But it also brought the return of a pyramid-like graphic—this time flipped on its head, emphasizing foods like steak, full-fat milk, and butter. The visual prominence of such options might have you thinking saturated fat limits were tossed out with the MyPlate graphic, but the actual Guidelines retain the longstanding upper limit of 10% of total daily calories.

“I think the new Guidelines move in the right direction by reinforcing the importance of reducing added sugars and cutting back on refined grains and other highly processed foods,” said Frank Hu, professor of nutrition and epidemiology and chair of the Department of Nutrition at the Harvard T.H. Chan School of Public Health. “However, there appear to be several contradictions within the DGAs and between the DGAs and the new pyramid. The mixed messages surrounding saturated-fat-rich foods such as red meat, butter, and beef tallow may lead to confusion and potentially higher intake of saturated fat and increased LDL cholesterol and cardiovascular risk.”

While the other largest section of the pyramid is sensibly composed of vegetables and fruits, Dr. Hu did flag the relatively smaller depiction of whole grains in the pyramid despite the Guidelines’ recommendation of 2-4 servings per day.

These details matter, as images and taglines may be more memorable than the nuanced details and underlying text. It’s one of the reasons why we created our Healthy Eating Plate (and the Healthy Eating Pyramid before that).

Below we unpack some key changes in this newest edition of the DGAs, considering both its written guidance and the “New Food Pyramid.”

Calling out “highly processed” foods

While previous DGAs have emphasized whole foods while minimizing added sugar and sodium, this edition is the first to call out a broader category of “highly processed foods.” Although this terminology is somewhat vague on the surface (food processing is a spectrum after all), the text recommends avoiding sugar-sweetened beverages as well as salty or sweet packaged snacks and ready-to-eat foods (even the illustrated yogurt container in the pyramid specifies “unsweetened”). The guidance on grains prioritizes whole, fiber-rich options while calling for a significant reduction in highly processed, refined carbohydrates, such as white bread.

Further reductions on added sugar

The new DGAs take an overall strict position on sweets, noting that “no amount of added sugars or non-nutritive sweeteners is recommended or considered part of a healthy or nutritious diet.” In practice, it recommends no one meal should contain more than 10 grams of added sugars (although meals aren’t generally how people track added sugar in their diet). This is reduction from the previous DGAs’ limit of 10% of daily calories (e.g., 50 grams of added sugar each day in a 2,000-calorie diet). It also now calls for children to avoid added sugars until age 10—a jump from age 2. The DGAs are clear on avoiding added sugar, but far less clear on how these recommendations can be implemented in everyday life.

Contradictory guidance on healthy fats

When it comes to dietary fat and long-term health outcomes, what’s most important is the type of fat you eat—reducing saturated fat and replacing it with sources of unsaturated fat. As mentioned, the DGAs maintained existing consensus that saturated fat consumption should not exceed 10% of total daily calories.

What’s confusing is that the “healthy fat” guidance groups animal-based foods higher in saturated fat—such as meats and full-fat dairy—with plant-based foods lower in saturated fat. There is no mention as to which of these foods should be chosen more or less often to help stay within the upper limit. And on the pyramid, steak, cheese, whole milk, and butter seem to play a prominent role.

Saturated fat math

What does this guidance look like in daily practice? Let’s take a 2,000-calorie diet where the 10% limit equates to roughly 22 grams of saturated fat. In the DGAs’ guidance on daily servings by calorie level, 3 servings of dairy are recommended daily. If full fat versions are selected for the examples given [one 8-oz cup of whole milk (5 grams saturated fat); ¾ cup of full-fat Greek yogurt (6 grams); 1 ounce of cheddar cheese (6 grams)], you are already at 17 grams of saturated fat. If you were to add a single tablespoon of butter (7 grams) or beef tallow (6 grams)—both suggested cooking fat options—you’re over the limit. And this isn’t even considering other foods consumed throughout the day, including some of the recommended protein options (more on that below).

While olive oil is visualized in the pyramid and suggested as a healthy fat, it is referenced as an option with “essential fatty acids.” While olive oil is a healthy choice lower in saturated fat (2 grams per tablespoon), Dr. Hu explains how there are better sources when consuming essential fatty acids is the goal:

“Olive oil contains mostly oleic acid, but relatively small amounts of essential fatty acids such as alpha-linolenic acid and linoleic acid compared with other oils that are rich sources of these fatty acids, such as soybean oil and canola oil. Importantly, all these plant oils have been shown to lower LDL cholesterol and cardiovascular risk compared with animal fats such as butter or tropical fats such as coconut oil and palm oil.”

Hype around protein quantity

The new DGAs suggest that adults consume 1.2 to 1.6 grams of protein per kilogram of body weight per day, 50-100% more than what was previously recommended for minimum intake. Certainly, protein needs are highly variable—and wider ranges have been set by groups like the National Academy of Medicines—but these needs are best determined by a healthcare provider or a registered dietitian, as consuming excess protein can still be converted to fat in the body and lead to weight gain. What’s also missing from the Guidelines is clarity on the quality of different protein foods, especially when many in the U.S. are consuming more than enough protein.

“Substantially raising overall protein intake without distinguishing between different protein sources may have unintended long-term health implications,” says Dr. Hu. “Evidence continues to suggest that plant-based proteins and fish are associated with more favorable health outcomes than diets high in red meat.”

When we eat foods for protein, we also eat everything that comes alongside it: the different fats, fiber, sodium, and more. It’s this protein “package” that’s likely to make a difference for health. While the Guidelines recommend a “variety of protein foods” from both animal and plant sources, there’s no clear messaging about which options should be chosen more regularly. Given the DGAs’ stated saturated fat limits, this is an important consideration depending on what other foods are consumed throughout the day. For example:
- A 4-ounce broiled sirloin steak is a significant source of protein—about 33 grams worth. But it also delivers about 5 grams of saturated fat.
- A cup of cooked lentils provides about 18 grams of protein and 15 grams of fiber, and it has virtually no saturated fat.
“Less” Alcohol

On alcohol, the DGAs offer a vague message to “consume less alcohol for better health,” Without concrete limits, it’s hard for people to know what “less” actually means.

Still no consideration of environmental impacts

Another concern is that the DGAs do not consider the environmental and socioeconomic impact of dietary recommendations. This omission is problematic because food choices significantly affect the environment, and in turn are strongly shaped by socioeconomic and cultural factors.

Bottom line

Despite stronger positions on added sugars and highly processed foods, and technical alignment with the scientific consensus on saturated fat limits, certain aspects of the 2025 Guidelines send mixed signals. The New Food Pyramid graphic itself is particularly puzzling, given the visual emphasis on animal products high in saturated fat. Although DGAs are typically launched as policy documents, this edition appears more consumer-friendly, given its shorter length, associated graphics, and interactive website. Historically, research finds that Americans do not follow the dietary guidelines, so it remains to be seen if this edition will be any different. However, if you find yourself confused by some of the conflicting messaging, we recommend checking out the Healthy Eating Plate, or consulting a registered dietitian for more personalized guidance.

Related: A different road to this year’s DGAs

Every five years, the DGAs are updated by the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) for use by federal nutrition program operators, policy makers, and healthcare providers. But first, the Dietary Guidelines Advisory Committee—an independent group of nutrition science experts—summarizes the current state of nutrition science without influence from government or food industry. Members are vetted through extensive background checks, undergo ethics training, and scientific committee meetings are livestreamed. The public is also given opportunities to submit comments. After two years of evidence review and synthesis, the Committee released their Scientific Report to USDA and HHS.

But this time around, the Committee’s report was ultimately rejected by the current administration. Instead, a supplemental scientific analysis was conducted by a group of individuals selected through a “federal contracting process.” Although the supplemental document notes that “evidence was evaluated based solely on scientific rigor” and underwent “internal quality checks” with external peer review, some have raised concern over the lack of transparency in their process. In an Q&A with Harvard Chan News, Deirdre Tobias, assistant professor in the Department of Nutrition who served on the 2025-2030 Dietary Guidelines Advisory Committee, noted:

“As of today, there has not been transparency in who wrote the new DGAs. Although there are documents included in the appendices by named scientists, there is no transparency in the methodology and rigor that was employed, or why certain topics were selected to be relitigated. The reviews themselves, as well as their overall presentation and integration, deviate significantly from the rigorous process that the HHS developed for the DGAs to ensure the evidence base and its committees’ conclusions were replicable, unbiased, transparent, and free from non-scientific influences.”

Others have also flagged reviewers’ financial ties to the beef and dairy industries (which is disclosed in the supplemental analysis), given the prime placement of meat and dairy products in the DGAs.
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January 10, 2026
Is Surgery Necessary to Reverse Diabetes?

Losing weight without rearranging your gastrointestinal anatomy carries advantages beyond just the lack of surgical risk.

The surgical community objects to the characterization of bariatric surgery as internal jaw wiring and cutting into healthy organs just to discipline people’s behavior. They’ve even renamed it “metabolic surgery,” suggesting the anatomical rearrangements cause changes in digestive hormones that offer unique physiological benefits. As evidence, they point to the remarkable remission rates for type 2 diabetes.

After bariatric surgery, about 50% of obese people with diabetes and 75% of “super-obese” diabetics go into remission, meaning they have normal blood sugar levels on a regular diet without any diabetes medication. The normalization of blood sugar can happen within days after the surgery. And 15 years after the surgery, 30% remained free from their diabetes, compared to a 7% remission rate in a nonsurgical control group. Are we sure it was the surgery, though?

One of the most challenging parts of bariatric surgery is lifting the liver. Since obese individuals tend to have such large, fatty livers, there is a risk of liver injury and bleeding. An enlarged liver is one of the most common reasons a less invasive laparoscopic surgery can turn into a fully invasive open surgery, leaving the patient with a large belly scar, along with an increased risk of wound infections, complications, and recovery time. But lose even just 5% of your body weight, and your fatty liver may shrink by 10%. That’s why those awaiting bariatric surgery are put on a diet. After surgery, patients are typically placed on an extremely low-calorie liquid diet for weeks. Could their improvement in blood sugar levels just be from the caloric restriction, rather than some sort of surgical metabolic magic? Researchers decided to put it to the test.

At a bariatric surgery clinic at the University of Texas, patients with type 2 diabetes scheduled for a gastric bypass volunteered to stay in the hospital for 10 days to follow the same extremely low-calorie diet—less than 500 calories a day—that they would be placed on before and after surgery, but without undergoing the procedure itself. After a few months, once they had regained the weight, the same patients then had the actual surgery and repeated their diet, matched day to day. This allowed researchers to compare the effects of caloric restriction with and without the surgical procedure—the same patients, the same diet, just with or without the surgery. If there were some sort of metabolic benefit to the anatomical rearrangement, the patients would have done better after the surgery, but, in some ways, they actually did worse.

The caloric restriction alone resulted in similar improvements in blood sugar levels, pancreatic function, and insulin sensitivity, but several measures of diabetic control improved significantly more without the surgery. The surgery seemed to put them at a metabolic disadvantage.

Caloric restriction works by first mobilizing fat out of the liver. Type 2 diabetes is thought to be caused by fat building up in the liver and spilling over into the pancreas. Everyone may have a “personal fat threshold” for the safe storage of excess fat. When that limit is exceeded, fat gets deposited in the liver, where it can cause insulin resistance. The liver may then offload some of the fat (in the form of a fat transport molecule called VLDL), which can then accumulate in the pancreas and kill off the cells that produce insulin. By the time diabetes is diagnosed, half of our insulin-producing cells may have been destroyed, as seen below and at 3:36 in my video Bariatric Surgery vs. Diet to Reverse Diabetes. Put people on a low-calorie diet, though, and this entire process can be reversed.

A large enough calorie deficit can cause a profound drop in liver fat sufficient to resurrect liver insulin sensitivity within seven days. Keep it up, and the calorie deficit can decrease liver fat enough to help normalize pancreatic fat levels and function within just eight weeks. Once you drop below your personal fat threshold, you should then be able to resume normal caloric intake and still keep your diabetes at bay, as seen below and at 4:05 in my video.

The bottom line: Type 2 diabetes is reversible with weight loss, if you catch it early enough.

Lose more than 30 pounds (13.6 kilograms), and nearly 90% of those who have had type 2 diabetes for less than four years can achieve non-diabetic blood sugar levels (suggesting diabetes remission), whereas it may only be reversible in 50% of those who’ve lived with the disease for eight or more years. That’s by losing weight with diet alone, though. For people with diabetes, losing more than twice as much weight with bariatric surgery, diabetes remission may only be around 75% of those who’ve had the disease for up to six years and only about 40% for those who’ve had diabetes longer, as seen below and at 4:41 in my video.

Losing weight without surgery may offer other benefits as well. Individuals with diabetes who lose weight with diet alone can significantly improve markers of systemic inflammation, such as tumor necrosis factor, whereas levels significantly worsened when about the same amount of weight was lost from a gastric bypass.

What about diabetic complications? One reason to avoid diabetes is to avoid its associated conditions, like blindness or kidney failure requiring dialysis. Reversing diabetes with bariatric surgery can improve kidney function, but, surprisingly, it may not prevent the occurrence or progression of diabetic vision loss—perhaps because bariatric surgery affects quantity but not necessarily quality when it comes to diet. This reminds me of a famous study published in The New England Journal of Medicine that randomized thousands of people with diabetes to an intensive lifestyle program focused on weight loss. Ten years in, the study was stopped prematurely because the participants weren’t living any longer or having any fewer heart attacks. This may be because they remained on the same heart-clogging diet but just in smaller portions.

Doctor’s Note

This is the third blog in a four-part series on bariatric surgery. If you missed the first two, check out The Mortality Rate of Bariatric Weight-Loss Surgery and The Complications of Bariatric Weight-Loss Surgery.

My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

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January 9, 2026
Top 10 NutritionFacts.org Videos of 2025

We create more than a hundred new videos every year. They are the culmination of countless hours of research. We comb through tens of thousands of scientific papers from the peer-reviewed medical literature so busy people like you don’t have to.

In 2025, I covered a wide variety of hot topics. I released an extensive series on Ozempic, updates on vitamin B12, and, of course, a lot on aging and anti-aging based on my research for How Not to Age. Which videos floated to the top last year?

#10 How Much Vitamin B12 Do We Need Each Day?

How are the recommended daily and weekly doses of vitamin B12 derived?

#9 The Best Way to Boost NAD+: Supplements vs. Diet (webinar recording)

This webinar wrapped up the pros and cons of all the NAD+ supplements and the ways to naturally boost NAD+ with diet and lifestyle. (Did you know we now offer a growing library of on-demand webinars for CME credits? To learn more and to register, visit us on the LearnWorlds platform.)

#8 How to Improve Your Heart Rate Variability

A healthy heart doesn’t beat like a metronome.

#7 The Best Foods for Your Skin

Greens, apples, tomato paste, and grapes are put to the test as edible skin care candidates.

#6 Friday Favorites: Foods That Cause Inflammation and Those That Reduce It

This is a popular combination of two earlier videos, exploring which foods are the worst when it comes to triggering inflammation within hours of consumption and what an anti-inflammatory diet looks like?

#5 The Healthiest Way to Drink Coffee

Why do those who drink filtered coffee tend to live longer than those who drink unfiltered coffee?

#4 Is One Egg a Day Too Much?

*Spoiler alert*: Meta-analyses of studies involving more than 10 million participants confirm that greater egg consumption confers a higher risk of premature death from all causes.

#3 Do Not Eat Pawpaws

Pawpaw fruits, like soursop, guanabana, sweetsop, sugar apple, cherimoya, and custard apple, contain neurotoxins that may cause a neurodegenerative disease.

#2 The Highest Antioxidant: Apple, Bean, Berry, Lentil, or Nut?

Remember these kinds of videos from way back when? I brought them back! Of course, the best apple, bean, berry, lentil, and nut are the ones you’ll eat the most of, but if you don’t have a strong preference, which ones have the highest antioxidant power?

#1 How to Slow Cancer Growth

The fact that this video was so popular is validation for my plan to take on cancer after How Not to Hurt, my upcoming book on lifestyle approaches to pain management, which should be out in (fingers crossed) December 2026. This video explains how, at this very moment, many of us have tumors growing inside our bodies, so we cannot wait to start eating and living more healthfully.

Thank you for being a part of this community. We gained more than 170,000 new subscribers on YouTube in 2025, and the number of people we can reach with this life-saving, life-changing information continues to grow.

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January 7, 2026
Bariatric Surgery: Risks in the OR and Beyond

The extent of risk from bariatric weight-loss surgery may depend on the skill of the surgeon.

After sleeve gastrectomy and Roux-en-Y gastric bypass, the third most common bariatric procedure is a revision to fix a previous bariatric procedure, as you can see below and at 0:16 in my video The Complications of Bariatric Weight-Loss Surgery.

Up to 25% of bariatric patients have to go back into the operating room for problems caused by their first bariatric surgery. Reoperations are even riskier, with up to 10 times the mortality rate, and there is “no guarantee of success.” Complications include leaks, fistulas, ulcers, strictures, erosions, obstructions, and severe acid reflux.

The extent of risk may depend on the skill of the surgeon. In a study published in The New England Journal of Medicine, bariatric surgeons voluntarily submitted videos of themselves performing surgery to a panel of their peers for evaluation. Technical proficiency varied widely and was related to the rates of complications, hospital readmissions, reoperations, and death. Patients operated on by less competent surgeons suffered nearly three times the complications and five times the rate of death.

“As with musicians or athletes, some surgeons may simply be more talented than others”—but practice may help make them perfect. Gastric bypass is such a complicated procedure that the learning curve may require 500 cases for a surgeon to master the procedure. Risk for complications appears to plateau after about 500 cases, with the lowest risk found among surgeons who had performed more than 600 bypasses. The odds of not making it out alive may be double under the knife of those who had performed less than 75 compared to more than 450, as seen below and at 1:47 in my video.

So, if you do choose to undergo the operation, I’d recommend asking your surgeon how many procedures they’ve done, as well as choosing an accredited bariatric “Center of Excellence,” where surgical mortality appears to be two to three times lower than non-accredited institutions.

It’s not always the surgeon’s fault, though. In a report entitled “The Dangers of Broccoli,” a surgeon described a case in which a woman went to an all-you-can-eat buffet three months after a gastric bypass operation. She chose really healthy foods—good for her!—but evidently forgot to chew. Her staples ruptured, and she ended up in the emergency room, then the operating room. They opened her up and found “full chunks of broccoli, whole lima beans, and other green leafy vegetables” inside her abdominal cavity. A cautionary tale to be sure, but perhaps one that’s less about chewing food better after surgery than about chewing better foods before surgery—to keep all your internal organs intact in the first place.

Even if the surgical procedure goes perfectly, lifelong nutritional replacement and monitoring are required to avoid vitamin and mineral deficits. We’re talking about more than anemia, osteoporosis, or hair loss. Such deficits can cause full-blown cases of life-threatening deficiencies, such as beriberi, pellagra, kwashiorkor, and nerve damage that can manifest as vision loss years or even decades after surgery in the case of copper deficiency. Tragically, in reported cases of severe deficiency of a B vitamin called thiamine, nearly one in three patients progressed to permanent brain damage before the condition was caught.

The malabsorption of nutrients is intentional for procedures like gastric bypass. By cutting out segments of the intestines, you can successfully impair the absorption of calories—at the expense of impairing the absorption of necessary nutrition. Even people who just undergo restrictive procedures like stomach stapling can be at risk for life-threatening nutrient deficiencies because of persistent vomiting. Vomiting is reported by up to 60% of patients after bariatric surgery due to “inappropriate eating behaviors.” (In other words, trying to eat normally.) The vomiting helps with weight loss, similar to the way a drug for alcoholics called Antabuse can be used to make them so violently ill after a drink that they eventually learn their lesson.

“Dumping syndrome” can work the same way. A large percentage of gastric bypass patients can suffer from abdominal pain, diarrhea, nausea, bloating, fatigue, or palpitations after eating calorie-rich foods, as they bypass your stomach and dump straight into your intestines. As surgeons describe it, this is a feature, not a bug: “Dumping syndrome is an expected and desired part of the behavior modiﬁcation caused by gastric bypass surgery; it can deter patients from consuming energy-dense food.

Doctor’s Note

This is the second in a four-part series on bariatric surgery. If you missed the first one, see The Mortality Rate of Bariatric Weight-Loss Surgery.

Up next: Bariatric Surgery vs. Diet to Reverse Diabetes and How Sustainable Is the Weight Loss After Bariatric Surgery?.

My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local library, or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

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January 2, 2026
Bariatric Weight-Loss Surgery and Mortality

Today, death rates after weight-loss surgery are considered to be “very low,” occurring in perhaps 1 in 300 to 1 in 500 patients on average.

The treatment of obesity has long been stained by the snake-oil swindling of profiteers, hustlers, and quacks. Even the modern field of bariatric medicine (derived from the Greek word baros, meaning “weight”) is pervaded by an “insidious image of sleaze.” Beguiled by advertising for fairy tale magic bullets of rapid, effortless weight loss, people blame themselves for failing to manifest the miracle or imagine themselves metabolically broken. On the other end of the spectrum are overly pessimistic practitioners of the opinion that “people who are fat are born fat, and nothing much can be done about it.” The truth lies somewhere in between.

The difficulty of curing obesity has been compared to learning a foreign language. It’s an achievement virtually anyone can attain with a sufficient investment of energies, “but it always takes a considerable amount of time and trouble.” And, of those who do stick with it, most will regain much of the weight lost. To me, this speaks to the difficulty, rather than the futility. It may take smokers an average of 30 attempts to finally kick the habit. Like quitting smoking, curing obesity is just something that has to be done. As the chair of the Association for the Study of Obesity put it, it doesn’t take “will power” to do essential tasks like getting up at night to feed a baby; it’s just something that has to be done.

Our collective response doesn’t seem to match the rhetoric or reality. If obesity is such a “national crisis” reaching alarming proportions, dubbed by the post-9/11 Surgeon General as “every bit as devastating as terrorism,” why has our reaction been so tepid? For example, governments meekly suggest the food industry take “voluntary initiatives to restrict the marketing of less healthy food options to children….” Have we just given up and ceded control?

Our timid response to the obesity epidemic is encapsulated by a national initiative promulgated by a Joint Task Force of the American Society for Nutrition, Institute of Food Technologists, and International Food Information Council: the “small-changes approach.” Since “small changes are more feasible to achieve,” suggestions include “using mustard instead of mayonnaise” and “eating 1 rather than 2 doughnuts in the morning.” Seems a bit like bringing a butter knife to a gunfight. Proponents of the small-changes approach lament that, unlike other addictions—for example, alcohol, cocaine, gambling, or tobacco—we can’t counsel our obese patients to give up the addictive element completely, as “[n]o one can give up eating.” But just because we have to breathe, doesn’t mean it has to be through the end of a cigarette. And just because we have to eat doesn’t mean we have to eat junk.

What about bringing a scalpel to the gunfight instead? The use of bariatric surgery has exploded from about 40,000 procedures noted in the first international survey in 1998 to hundreds of thousands performed now every year in the United States alone. The first technique that was developed, the intestinal bypass, involved carving out about 19 feet of intestines. More than 30,000 intestinal bypass operations were performed before we recognized “catastrophic” and “disastrous outcomes” resulted from these procedures. This included protein deficiency-induced liver disease, “which often progressed to liver failure and death.” This inauspicious start is remembered as “one of the dark blots in the history of surgery,” as I discuss in my video The Mortality Rate of Bariatric Weight-Loss Surgery.

Today, death rates after bariatric surgery are considered “very low,” occurring on average in perhaps 1 in 300 to impacting 1 in 500 patients. The most common procedure is stomach stapling, also known as sleeve gastrectomy, in which most of the stomach is permanently removed. Only a narrow tube of the stomach is left so as to restrict how much food people can eat at any one time. It’s ironic that many patients choose bariatric surgery convinced that, “for them, ‘diets do not work,’” when, in reality, that’s all the surgery may be—an enforced diet. Bariatric surgery can be thought of as a form of internal jaw wiring.

Gastric bypass, known as Roux-en-Y gastric bypass, is the second most common bariatric surgery. It combines restriction—stapling the stomach into a pouch smaller than a golf ball—with malabsorption by rearranging one’s anatomy to bypass the first part of the small intestine. It appears to be more effective than just cutting out most of the stomach, resulting in a loss of about 63% of excess weight compared to 53% with a gastric sleeve. But gastric bypass carries a greater risk of serious complications. Many are surprised to learn that new “surgical procedures…do not require premarket testing and approval by the Food and Drug Administration (FDA)” and are largely exempt from rigorous regulatory scrutiny.

Doctor’s Note

I didn’t know there wasn’t some kind of approval process for new surgical procedures!

This is the first video in a four-part series on bariatric surgery. Coming up are:

My book How Not to Diet is focused exclusively on sustainable weight loss. Check it out from your local public library or pick it up from wherever you get your books. (All proceeds from my books are donated to charity.)

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December 31, 2025
How Healthy Are Baruka Nuts?

How do barukas, also known as baru almonds, compare with other nuts?

There is a new nut on the market called baru almonds, branded as “barukas” or baru nuts. Technically, it isn’t a nut but a seed native to the Brazilian Savannah, known as the Cerrado, which is now among the most threatened ecosystems on the planet. Over the last 30 years, much of the Cerrado’s ecosystem has been destroyed by extensive cattle ranching and feed crop production to fatten said cattle. If it were profitable not to cut down the native trees and instead sell baru nuts, for example, that could be good for the ecosystem’s health. But what about our health?

“Although baru nuts are popular and widely consumed, few studies report on their biological properties.” They do have a lot of polyphenol phytonutrients, presumably accounting for their high antioxidant activity. (About 90% of their phytonutrients are present in the peel.) Are they nutritious? Yes, but do they have any special health benefits—beyond treating chubby mice?

Researchers found that individuals fed baru nuts showed lower cholesterol, supposedly indicating the nuts “have great potential for dietary use” in preventing and controlling cholesterol problems. But the individuals were rats, not humans, and the baru nuts were compared to lard. Pretty much everything lowers cholesterol compared to lard. Nevertheless, there haven’t been any reports about the effect of baru nut consumption on human health, until this: A randomized, controlled study of humans found that eating less than an ounce a day for six weeks led to a 9% drop in LDL cholesterol. Twenty grams would be about 15 nuts or a palmful.

Like many other nut studies, even though the research subjects were told to add nuts to their regular diets, there was no weight gain, presumably because nuts are so filling that we inadvertently cut down on other foods throughout the day. How good is a 9.4% drop in LDL? It’s the kind of drop we can get from regular almonds, though macadamias and pistachios may work even better, but those were at much higher doses. It appears that 20 grams of baru nuts work as well as 73 grams of almonds. So, on a per-serving basis or a per-calorie basis, baru nuts really did seem to be special.

There are lower-dose nut studies that show similar or even better results. In this one, for instance, people were given 25 grams of almonds for just four weeks and got about a 6% drop in their LDL cholesterol. In another study, after consuming just 10 grams of almonds a day, or just seven individual almonds a day, study participants got more like a 30% drop in LDL during the same time frame as the baru nuts. Three times better LDL at half the dose with regular almonds, as you can see below and at 2:47 in my video Are Baruka Nuts the Healthiest Nut?.

The biggest reason we are more confident in regular almonds than baru almonds is that studies have been done over and over in more than a dozen randomized controlled trials, whereas in the only other cholesterol trial of baru nuts, researchers found no significant benefit for LDL cholesterol, even at the same 20-gram dose given for even longer—a period of eight weeks.

That’s disappointing, but it isn’t the primary reason I would suggest choosing other nuts instead of baru nuts. I would do so because we can’t get raw baru nuts. They contain certain compounds that must be inactivated by heat before we can eat them. The reason raw nuts are preferable is because of advanced glycation end-products (AGEs), so-called glycotoxins, which are known to contribute to increased oxidative stress and inflammation.

Glycotoxins are naturally present in uncooked animal-derived foods, and dry-heat cooking like grilling can make things worse. The three highest recorded levels have been in bacon, broiled hot dogs, and roasted barbecued chicken skin—nothing even comes close to that, not even Chicken McNuggets, as you can see below and at 3:50 in my video.

However, any foods high in fat and protein can create AGEs at high enough temperatures. So, although plant foods tend to “contain relatively few AGEs, even after cooking,” there are some high-fat, high-protein plant foods. But, again, AGEs aren’t a problem at all with most plant foods. See the AGE content in boiled tofu (in a soup, for instance), broiled tofu, a raw apple, a baked apple, a veggie burger—I was surprised that veggie burgers are so low in AGEs, even when baked or fried—and nuts and seeds, which are up in tofu territory, especially when roasted, which is why I would recommend raw nuts and seeds and nut and seed butters whenever you have a choice. See below and at 4:33 in my video.

Doctor’s Note

In my Daily Dozen checklist, I recommend eating a quarter cup of nuts or seeds or two tablespoons of nut or seed butter each day. Why? See related posts below.

For those unfamiliar with advanced glycation end-products (AGEs), check out the first two videos I did on them way back when: Glycotoxins and Avoiding Glycotoxins in Food.

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December 26, 2025