Health Journal Online

Category: Nutrition

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.
Source link
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.)

Source link

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.

Source link

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.)

Source link

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.)

Source link

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.

Source link

December 26, 2025
Can Vegan Fecal Transplants Lower TMAO Levels?

If the microbiome of those eating plant-based diets protects against the toxic effects of TMAO, what about swapping gut flora?

“Almost 2,500 years ago, Hippocrates stated that ‘All disease begins in the gut.’” When we feed our gut bacteria right with whole plant foods, they feed us right back with beneficial compounds like butyrate, which our gut bugs make from fiber. On the other hand, if we feed them wrong, they can produce detrimental compounds like TMAO, which they make from cheese, eggs, seafood, and other meat.

We used to think that TMAO only contributed to cardiovascular diseases, like heart disease and stroke, but, more recently, it has been linked to psoriatic arthritis, associated with polycystic ovary syndrome, and everything in between. I’m most concerned about our leading killers, though. Of the top ten causes of death in the United States, we’ve known about its association with increased risk of heart disease and stroke, killers number one and five, but recently, an association has also been found between blood levels of TMAO and the risks of various cancers, which are our killer number two. The link between TMAO and cancer could be attributed to the inflammation caused by TMAO, but it could also be oxidative stress (free radicals), DNA damage, or a disruption in protein folding.

What about our fourth leading killer, chronic obstructive pulmonary disease (COPD), like emphysema? TMAO is associated with premature death in patients with exacerbated COPD, though it’s suspected that it’s due to them dying from more cardiovascular disease.

The link to stroke is a no-brainer—no pun intended. It is due to the higher blood pressure associated with higher TMAO levels, as well as the greater likelihood of clots forming in those with atrial fibrillation. Those with higher TMAO levels also appear to have worse strokes and four times the odds of death.

Killer number six is Alzheimer’s disease. Can TMAO even get up into our brains? Yes, TMAO is present in human cerebrospinal fluid, which bathes the brain, and TMAO levels are higher in those with mild cognitive dysfunction and those with Alzheimer’s disease dementia. “In the brain, TMAO has been shown to induce neuronal senescence [meaning, deterioration with age], increase oxidative stress, impair mitochondrial function, and inhibit mTOR signaling, all of which contribute to brain aging and cognitive impairment.”

Killer number seven is diabetes, and people with higher TMAO levels are about 50% more likely to have diabetes. Killer number eight is pneumonia, and TMAO predicts fatal outcomes in pneumonia patients even without evident heart disease. Kidney disease is killer number nine, and TMAO is strongly related to kidney function and predicts fatal outcomes there as well. Over a period of five years, more than half of chronic kidney disease patients who started out with average or higher TMAO levels were dead, whereas among those in the lowest third of levels, nearly 90% remained alive.

How can we lower the TMAO levels in our blood? Because TMAO originates from dietary sources, we could limit our intake of choline- and carnitine-rich foods. They’re so widespread in foods,” though we’re talking about meat, eggs, and dairy. “Therefore, restriction of foods rich in TMA-containing nutrients may not be practical.” Can we just get a vegan fecal transplant? “Vegan donors provided the investigators with a fresh morning fecal sample…”

If you remember, if you give a vegan a steak, despite all that carnitine, they make almost no TMAO compared to a meat-eater, presumably because the vegan hasn’t been fostering steak-eating bugs in their gut. See below and at 3:40 in my video Can Vegan Fecal Transplants Lower TMAO Levels?.

Remarkably, even if you give plant-based eaters the equivalent of a 20-ounce steak every day for two months, only about half start ramping up production of TMAO, showing just how far their gut flora has to change. The capacity of veggie feces to churn out TMAO is almost nonexistent. Instead of eating healthier, what about getting some vegan poop?

In a double-blind, randomized, controlled trial, research subjects either got vegan poop or their own poop back through a hose snaked down their nose, and it didn’t work.

First of all, the vegans recruited for the study started out making TMAO themselves, in contrast to the other study, where they didn’t make any at all. This may be because the earlier study required the vegans to have been vegan for at least a year, and this study didn’t. So, there wasn’t much of a change in TMAO running through their bodies two weeks after getting the vegan poop, but the vegan poop they got seemed to start out with some capacity to produce TMAO in the first place.

So, the failure to improve after the vegan fecal transplant “could be related to limited baseline microbiome differences and continuation of an omnivorous diet” after the vegan-donor transplant. What’s the point of trying to reset your microbiome if you’re just going to eat meat? Well, the researchers didn’t want to switch people to a plant-based diet since they knew that alone can change our microbiome, and they didn’t want to introduce any extra factors. The bottom line is that it seems there may not be any shortcuts. We may just have to eat a healthier diet.

Doctor’s Note

Want to become a donor? Find out How to Become a Fecal Transplant Super Donor.

For more on TMAO, check out related posts below.

See the microbiome topic page for even more.

Source link

December 24, 2025
Is Aflatoxin a Concern?

Is “toxic mold syndrome” a real thing? What do we do about toxic mold contamination of food?

In recent years, mold has been blamed for all sorts of “vague and subjective” symptoms, but we have little scientific evidence that mold should be implicated. However, this “concept of toxic mold syndrome has permeated the public consciousness,” perpetuated by disreputable predatory practices of those making money testing homes for mold spores or testing people’s urine or blood. But all these tests are said to “further propagate misinformation and inflict unnecessary and often exorbitant costs on patients desperate for a clinical diagnosis, right or wrong, for their constellation of maladies…The continued belief in this myth is perpetuated by those charlatans who believe that measles vaccines cause autism, that homeopathy works, that fluoride in the water should be removed….”

Mold toxin contamination of food, however, has emerged as a legitimate issue of serious concern, and mycotoxins are perhaps even more important than other contaminants that might make their way into the food supply. Hundreds of different types have been identified, but only one has been classified as a known human carcinogen, and that’s aflatoxin. The ochratoxin I’ve previously discussed is a possible human carcinogen, but we know aflatoxin causes cancer in human beings. In fact, aﬂatoxins are amongst the most powerful known carcinogens.

It has been estimated that about a fifth of all liver cancer cases may be attributable to aflatoxins. “Since liver cancer is the third-leading cause of cancer deaths worldwide, and mortality rapidly follows diagnosis, the contribution of aflatoxins to this deadly cancer is significant.” And once aflatoxin makes it into the food, there is almost nothing we can do to remove it. Cooking, for example, doesn’t help. Indeed, as shown below and at 1:50 in my video Should We Be Concerned About Aflatoxin?, once it makes it into crops or into the meat, dairy, and eggs from animals consuming those crops, it’s too late. So, we have to prevent contamination in the first place, which is what we’ve been doing for decades in the United States. Because of government regulations, “companies in developed countries…are ‘always sampling’ for aflatoxin,” resulting in nearly $1 billion in losses every year. That may get even worse if climate change exacerbates aflatoxin contamination in the Midwest Corn Belt.

So, on a consumer level, it is more of a public health problem in the less industrialized world, such as in African countries, where conditions are ripe and farmers can’t afford to throw away $1 billion in contaminated crops. Aflatoxin remains a public health threat in Africa, Southeast Asia, and rural China, affecting more than half of humanity. This explains why the prevalence of liver cancer in those areas may be 30 times higher, yet it is not a major problem in the United States or Europe.

Only about 1% of Americans have detectable levels of aflatoxins in their bloodstream. Why not 0%? The U.S. Food and Drug Administration works to ensure that levels of exposure to these toxins are kept as low as practical, not as low as possible. In California, for instance, there has been an increase in “unacceptable aflatoxin levels” in pistachios, almonds, and figs. Unacceptable in Europe, that is, so it affects our ability to export, but not necessarily unacceptable for U.S. consumers, as we allow twice as much aflatoxin contamination.

Figs are unique since they’re “allowed to fully ripen and semidry on the tree.” This makes them “particularly susceptible to aﬂatoxin production.” It would be interesting to know about the fig-consuming habits of the 1% of Americans who were positive for the toxin. If figs were to blame, I’d encourage people to diversify their dried fruit consumption, but nuts are so good for us that we really want to keep them in our diets. The cardiovascular health beneﬁts we get from nuts outweigh their carcinogenic effects; nut consumption prevents thousands of strokes and heart attacks for every one case of liver cancer. “Thus, the population health beneﬁts provided by increased nut consumption clearly outweigh the risks associated with increased aﬂatoxin B1 exposure.”

So, we’re left with aflatoxin being mostly a problem in the developing world, and, because of that, it “remains a largely and rather shamefully ignored global health issue….” Where attention has been paid, it has been largely driven by the need to meet stringent import regulations on mycotoxin contamination in the richer nations of the world, rather than to protect the billions of people exposed on a daily basis.

Doctor’s Note

This is the last video in a four-part series on mold toxins. If you missed the others, check the related posts below.

Source link

December 19, 2025
Are the Effects of Ochratoxin Concerning?

The overall cost-benefit ratio for mycotoxins depends on which food is contaminated.

Ochratoxin has been described as toxic to the immune system, developing fetus, kidneys, and nervous system, as well as being carcinogenic, but that is in animal studies. Ochratoxin “causes kidney toxicity in certain animal species, but there is little documented evidence of adverse effects in humans.” That’s why it’s only considered a possible human carcinogen.

Big Ag assures that current ochratoxin levels are safe, even among those who eat a lot of contaminated foods. The worst-case scenario may be young children eating a lot of oat-based cereals, but, even then, “their lifetime cancer risk is negligible.” Individuals arguing against regulatory standards suggest we can eat more than 42 cups of oatmeal a day and not worry about it. Where do they get these kinds of estimates?

They determine the so-called benchmark dose in animals—the dose of the toxin that gives a 10% increase in pathology—then, because one would want to err on the side of caution, divide that dose by 500 as a kind of safety fudge factor to develop the tolerable daily intake. For cancer risk, you can find the tumor dose—the dose that increases tumor incidence in lab animals by 5%—and extrapolate down to the ”negligible cancer risk intake,” effectively incorporating a 5,000-fold safety factor, as seen below and at 1:28 in my video Should We Be Concerned About the Effects of Ochratoxin?.

It seems kind of arbitrary, right? But what else are you going to do? You can’t just intentionally feed people the stuff and see what happens—but people eat it regularly. Can we just follow people and their diets over time and see if those who eat more whole grains, like oats, for example, are more likely to have cancer or live shorter lives?

What is the association between whole grain intake and all-cause, cardiovascular, and cancer mortality? Every additional ounce of whole grains eaten a day is associated with not only a lower risk for cancer mortality but also a lower risk of dying from all causes put together. Below and at 2:05 in my video are findings from all the big cancer studies. Every single one trended towards lower cancer risk.

The bottom line is that you don’t find adverse effects confirmed in these population studies. This is not to say ochratoxin is necessarily harmless, but “any such risk does not outweigh the known beneﬁts of wholegrain consumption.” In fact, healthy constituents of the whole grains themselves, like their antioxidants, may directly reduce the impacts of mycotoxins by protecting cells from damage. So, eating lots of fruits and vegetables may also help. Either way, “an overall healthy diet can play a signiﬁcant role in mitigating the risk of contaminants in grain.”

In summary, healthy foods like whole grains are good, but just not as good as they could be because of ochratoxin, whereas less healthful foods, like wine and pork, are worse because of the mycotoxin, as shown below and at 2:52 in my video. Ochratoxin was detected, for example, in 44% of tested pork.

Doctor’s Note

This is the third video in a four-part series on mold toxins. If you missed the first two, see Ochratoxin in Breakfast Cereals and Friday Favorites: Ochratoxin and Breakfast Cereals, Herbs, Spices, and Wine.

Should We Be Concerned About Aflatoxin? is coming up next.

Source link

December 17, 2025
Mold Toxins in Cereals, Herbs, Spices, and Wine

Most crops are contaminated with fungal mycotoxins, but some foods are worse than others.

Oats can be thought of as “uniquely nutritious.” One route by which they improve human health is by providing prebiotics that “increase the growth of beneficial gut microbiota.” There are all manner of oats, ranging from steel-cut oats to, even better, intact oat groats (their form before being cut), all the way down to highly processed cereals, like Honey Nut Cheerios.

“Rolling crushes the grain, which may disrupt cell walls and damage starch granules, making them more available for digestion.” This is bad because we want the starch to make it all the way down to our colon to feed our good gut bacteria. Grinding oats into oat flour to make breakfast cereals is even worse. When you compare blood sugar and insulin responses, you can see significantly lower spikes with the more intact steel-cut oats, as shown below and at 0:54 in my video Ochratoxin in Certain Herbs, Spices, and Wine.

What about ochratoxin? As seen here and at 1:01 in my video, oats are the leading source of dietary exposure to this mold contaminant, but they aren’t the only source.

There is a global contamination of food crops with mycotoxins, with some experts estimating as much as 25% of the world’s crops being affected. That statistic is attributed to the Food and Agriculture Organization of the United Nations, but it turns out the stat is bogus. It isn’t 25%. Instead, it may be more like 60% to 80%. “The high occurrence is likely explained by a combination of the improved sensitivity of analytical [testing] methods and the impact of climate change.”

Spices have been found to have some of the highest concentrations of mycotoxins, but because they are ingested in such small quantities, they aren’t considered to be a signiﬁcant source. We can certainly do our part to minimize our risk, though. For instance, we should keep spices dry after opening sealed containers or packages.

What about dried herbs? In “Mycotoxins in Plant-Based Dietary Supplements: Hidden Health Risk for Consumers,” researchers found that milk thistle–based supplements had the highest mycotoxin concentrations. It turns out that humid, wet weather is needed during milk thistle harvest, which is evidently why they get so moldy. “Considering the fact that milk thistle preparations are mainly used by people who suﬀer from liver disease,” such a high intake of compounds toxic to the liver may present some concern.

Wine sourced from the United States also appears to have particularly high levels. In fact, the single highest level found to date around the world is in a U.S. wine, but there’s contamination in wine in general. In fact, some suggest that’s why we see such consistent levels in people’s blood—perhaps because a lot of people are regular wine drinkers.

Ochratoxin is said to be a kidney toxin with immunosuppressive, birth defect–causing, and carcinogenic properties. So, what about ochratoxin decontamination in wine? That is, removing the toxin? Ideally, we’d try to prevent the contamination in the first place, but since this isn’t always practical, there is increased focus on finding effective methods of detoxification of mycotoxins already present in foods. This is where yeast enters as “a promising and friendly solution,” because the mycotoxins bind to the yeast cell wall. The thought is that we could strain out the yeast. Another approach is to eat something like nutritional yeast to prevent the absorption.

It works in chickens. Give yeast along with aflatoxin (another mycotoxin), and the severity of the resulting disease is diminished. However, using something like nutritional yeast as a binder “depends on stability of the yeast-mycotoxin complex through the passage of the gastrointestinal tract.” We know yeasts can remove ochratoxin in foods, but we didn’t have a clue if it would work in the gut until 2016. Yeast was found to bind up to 44% of the ochratoxin, but, in actuality, it was probably closer to only about a third, since some of the bindings weren’t stable. So, if you’re trying to stay under the maximum daily intake and you drink a single glass of wine, even if your bar snack is popcorn seasoned with nutritional yeast, you’d still probably exceed the tolerable intake. But what does that mean? How bad is this ochratoxin? We’ll find out next.

Doctor’s Note

This is the second video in a four-part series on mold toxins. The first one was Ochratoxin in Breakfast Cereals.

Stay tuned for Should We Be Concerned About the Effects of Ochratoxin? and Should We Be Concerned About Aflatoxin?. You can also check: Friday Favorites: Should We Be Concerned About Ochratoxin and Aflatoxin?.

Source link

December 12, 2025