Melatonin: Stay the Course

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As we continue to examine the results that appeared to suggest that the chronic use of melatonin in people diagnosed with insomnia could result in an increased risk of a diagnosis of heart failure, heart failure hospitalizations, and death from all causes, let’s put the unreviewed abstract in perspective. One correction from Tuesday. The researchers did not track the subjects for five years; the gathered data from the past five years. That’s an important difference

The simplest way to is to convert the percentage of risk into real percentages. The study reported that the risk of developing heart failure was over 90%. That’s true, but it’s based on the percentage of insomniacs that didn’t use melatonin at 2.7% versus 4.6% in those that did use melatonin. The same logic was used for hospitalizations (19.0% vs. 6.6%), and mortality (7.8% vs. 4.3%). It still seems like a significant risk, but there’s one more number that’s important: the total number of subjects in the study.

Insomnia: The Numbers

In the United States, the average number of adults that are diagnosed with insomnia is 12%. With 268 million adults in the U.S., that means that 32.2 million people have chronic insomnia. The percentage diagnosed is about the same in all high-income countries around the world. The researchers used a database that claims to have 150 million de-identified electronic medical records in its database, so how did the number of subjects get to only 120,000? It should have been at least 15 million.

Yes, the subjects were matched for a variety of criteria including age, gender, medications, and other factors but still, that’s an awful lot of lost subjects. Even without the diagnosis of insomnia, other diagnoses such as depression and other mental health diagnoses result in insomnia. They can also predispose people to heart failure as well. Those subjects would also have been lost.

The most significant information that was not collected was any data on over-the-counter melatonin use. To their credit, they do cite that as an issue, but there are no data as to how much melatonin was actually used by the subjects who took melatonin. There’s no record of melatonin use by people in the non-melatonin group if they didn’t report it as a supplement they use to their physician. There are more questions, but that’s enough to call the results into question.

The Bottom Line

Perhaps after the peer-review process, the data collection will be more clear. But as for right now, the best thing that could be said is that they distributed a great press release that caused a lot of concern. But as for actual research evidence? There’s no reason to modify melatonin use at this point. However, it’s always a good idea for you to report any supplements you’re taking to your healthcare provider.

What are you prepared to do today?

        Dr. Chet

Reference: American Heart Association Scientific Sessions 2025, Abstract MP2306

Melatonin: CVD Risk?

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Medical conferences are always a great source of controversy; studies are presented that haven’t been peer reviewed but have great press releases to advertise them. The American Heart Association met last week, and the Scientific Sessions didn’t disappoint. The abstract that caught my attention was based on an analysis of a large database of subjects from a variety of countries that demonstrated that melatonin used to treat insomnia could lead to an increased risk of cardiovascular disease (CVD) and hospitalization.

Researchers chose subjects who were diagnosed with insomnia and took melatonin for at least a year based on their medical charts. They were matched with control subjects on a variety of characteristics including age, height, weight, and many more variables, who were also diagnosed insomniacs but did not report melatonin use. They were tracked for five years.

The abstract stated that there was a 90% greater risk of CVD diagnosis in the melatonin group. Further, there was a 350% increased risk of being hospitalized in the melatonin group and a 100% increased risk of dying from all causes as well.

Is it time to throw out the melatonin? I’ll give you some perspective on this study on Saturday.

Tomorrow night is the Insider conference call and, wow, there is a lot to talk about! If you become an Insider by 8 p.m. tomorrow night, you can join in on the call. Protein intake. Creatine. Bike paths and medical costs. And even more.

What are you prepared to do today?

        Dr. Chet

The Pink Salt Diet

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As I meander through social media to get a sense of what’s going on out there in the health field, I happened upon something called the pink salt diet. Sure enough, I got a question asking me about it a short time later.

After research, I’d say the only thing you may get from the pink salt diet is high blood pressure if you’re sensitive to sodium.

The diet consists of Himalayan pink salt at varying amounts, lemon or lime, sometimes sugar or honey and water. You’re supposed to drink the concoction 30 minutes before eating. Something magical is supposed to happen that acts like a GLP-1 agonist—maybe even better than that because it’s all natural. Sounds to me like the Margarita diet, and if you drink one before every meal, you’ll probably eat less. But…

This reminds me of the old Stillman water diet; you were supposed to drink water with lemon several times per day. Oh, and you weren’t supposed to eat more than 500 calories per day. What do you think really helped you lose the weight? The water or the 500 calories per day?

There’s some research to suggest that drinking an 8-ounce glass of water before you eat may help you eat less. I would think mixing in a teaspoon of fiber might be an even better approach, but there are no short cuts to losing weight and keeping it off: eat less, eat better, move more. For life. Salt your food if you want to and enjoy your Margarita, but it’s not a weight loss plan.

What are you prepared to do today?

        Dr. Chet

Vote!

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I’m an election inspector here in Michigan, so I’m spending today verifying that voters are registered to vote in this election. Paula and I already voted via drop-off ballot. My only message is to vote in any election that’s conducted in your area today.

  • Vote if the only thing on the ballot is a millage issue for schools or public projects.
  • Vote if it’s a governor’s or state official’s race.
  • Vote if it’s for a position on the county or local commission.
  • Vote if it’s for a position on the school board.
  • Volunteer as an election worker; the pay isn’t a lot, but the company is great!

There are two things we value in the U.S.: one is freedom and the other is the right to vote. Today is the day to demonstrate both. If you want a workout, walk to your polling location if it’s a reasonable distance; drive if it’s not. Today is a day to do your job as a citizen.

Vote. And if you don’t like any of the candidates, find a candidate you can work for—or you could run yourself next time. Democracy is the ultimate do-it-yourself project.

What are you prepared to do today?

        Dr. Chet

By Any Means Necessary

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The second discussion was between a tech expert and a finance expert—neither one in the healthcare field. The tech expert shared a story of how a nurse who weighed over 300 pounds was using a GLP-1 agonist to get to a more reasonable weight so she could participate in more activities with her family. That really touched the tech expert.

But that story lit up the finance expert. The GLP-1 agonists are offered at a fraction of the price around the world compared to the U.S. price; Americans pay $936 to $1,396 per month compared to the next highest price of $169 to $319 per month in Japan.  He went on to say that if we were really serious about addressing obesity and health, the price of the GLP-1 agonists should drop to an affordable level of about $50 per month. The pharmaceutical companies would end up increasing sales overall and reduce the number of overweight and obese citizens from 70% by half or more.

That would have an effect of saving about half a trillion dollars in healthcare costs or more per year. That would help around 100 million people and probably save even more than his estimate. More than that, the population would be healthier as long as they were also trained on how to make better food choices, cook better, and exercise on a regular basis to maintain the weight loss.

Why This Approach?

Would I prefer to not even mention a medication when the solution is really simple at its core? Of course. But in the 35 years I’ve been doing what I do, I can’t say that anything else has really worked to help people eat less, eat better, and move more for life. I’ve had challenges myself; I’m still not at my ideal weight for height. That shouldn’t prevent me from giving you every approach to help yourself get there. If you have insurance that can cover the cost of the GLP-1 agonist, have a discussion with your physician about whether it’s right for you.

The Bottom Line

“By any means necessary!” I don’t usually quote Malcolm X but in this case, it fits. Getting to and maintaining a normal weight for height is important to live better and maybe live longer. Using the medications available, together with planning what to do when you stop the medication to maintain the weight loss, may be the solution for you as long as you can tolerate any side effects. For me, I’m modifying the Optimal Performance program slightly to achieve my goals including eating more protein, a challenge that seems to burden everyone over the age of 50. Whatever you decide to do, I’ll finish with a phrase that everyone seems to scream all the time: Let’s go!

What are you prepared to do today?

        Dr. Chet

Same Problem, Different Solution

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Close to 70% of all adult Americans, as well as an increasing number of children, are overweight or obese. The solution for society has been as elusive as it is simple: eat less. Eat better. Move more. But there’s one more part that’s the problem: for life. We could review the reasons why, but let’s look at alternative solutions.

I recently listened to a couple of podcasts that were completely unrelated but talked about the same subject: GLP-1 agonists. To review, GLP-1 receptor agonists are medications that allow the manufacture of the hormone GLP-1. Without getting technical, GLP-1 helps the body release insulin which can lower hemoglobin A1c (HbA1c) levels in diabetics. It also functions to increase satiety so users don’t eat as much and thus lose weight. GLP-1 agonists aren’t a panacea. The come with side effects, but most are manageable. With that in mind, here is a recap of the conversations.

In the first discussion, a physician stated that he puts his overweight patients on a low dose of a GLP-1 agonist to help get their appetite under control. The objective is to help the individual reduce hunger while transitioning to a higher protein diet. It’s using the pharmaceutical the way it was designed. The result helps the patient lose weight with an exit strategy of adopting a new lifestyle of eating less and moving more. Of course, that depends on whether they can afford the medication.

I’ll talk about the second podcast on Saturday. It’s all about the money.

What are you prepared to do today?

        Dr. Chet

Mystery Ingredients

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One of the oft-repeated comments by many nutritional experts goes something like this: “If you can’t say it, don’t eat it.” A further expansion of that is “If there are ingredients you don’t recognize on the nutrition label, don’t eat that food.”

The idea is that the longer the list of ingredients with more difficulty to pronounce the names, the more likely it’s highly processed and could be an ultra-processed food. I understand that concept, so let’s test it out. I’ll stick to the list of ingredients.

Guess the Mystery Food

The serving size is 3.3 ounces. Ingredients: Sugar (fructose, glucose), ascorbic acid, phylloquinone, homogalacturonans and rhamnogalacturonans, hemicellulose, betaine, cyanidin-3-galactoside

beta-cryptoxanthin, chlorogenic acid, coumaric acid, caffeic acid, phloridzin, and ash. (I didn’t include every ingredient.)

How many could you pronounce? How many did you recognize? Sugar, for sure. Probably ascorbic acid as a preservative, another name for vitamin C. But the rest?

What you’re looking at is the ingredients in an apple—if they actually put the ingredients on the label of apples. Those are the names of the fibers, prebiotics, and the phytonutrients found in just about every type of red apple. I think we should probably eat more of them whether we can pronounce the ingredients or not.

The Bottom Line

I’m not discounting the advice attributed to Michael Pollan about pronouncing ingredients, but oversimplification isn’t the answer either. They just become talking points for media gurus and wannabe influencers. Much of the time they get it wrong. Remember the ruckus about maltodextrin? They want to get noticed to get more clicks. The truth doesn’t always matter.

Their true challenge is to prove that any ingredient deemed as “Generally Regarded As Safe” is not—not with testimonials or research on animals, but with research that connects ingredients with disease. That would be helpful. Otherwise, it’s just tangential commentary that serves only the purpose of the person doing the talking.

What are you prepared to do today?

        Dr. Chet

Everybody’s a Critic

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In the past couple of weeks, I’ve been listening to a variety of health-related podcasts. One just went from one topic to another about the benefits of the ketogenic diet; no matter the issue, it was going to be part of the solution one way or another. Another simply criticized any research that had to do with losing weight or what could be termed ultra-processed foods. Then I found one that was so science-driven, it was a real snoozer unless you had a strong interest in the topic. That’s the one that caught my attention.

Two scientists were discussing the state of health information. They said that one thing or another was pitched as a villain: carbohydrates, seed oils, fats in general, protein, food additives, and on and on. One health influencer starts off a critique, and everyone jumps in. I relate to that one because I often am asked my opinion on these topics. One of the scientists said a group of researchers came to this conclusion:

Only three things matter when it comes to nutrition or any research; the data, the methodology used to collect the data, and the logic connecting the data to the conclusions being made. Everything else is tangential.

There’s always something to criticize about any type of nutrition research, from the methods to the statistics to the logic used in the formation of and the conclusions of the study. Those can be irrelevant to the actual study and are just someone’s pet peeve this week. Everybody’s a critic, and I’ll give you a precise example on Saturday.

What are you prepared to do today?

        Dr. Chet

Zeaxanthin: More Than Eye Health

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Zeaxanthin is a carotenoid we know contributes to eye health, but recent research has shown that it may be beneficial in boosting the right immune cells that will interfere with tumor growth.

Researchers examined the effect of zeaxanthin in mice getting immunotherapy for cancer treatment. While the immunotherapy worked, its effect was enhanced in the mice getting the zeaxanthin supplements by slowing tumor growth. The researchers took it one step further. They examined the impact on human tumor cells enhanced with specific traits. The results were that the carotenoid enhanced the cancer-cell-killing ability in several forms of cancer.

This is basic science research to find the next potential beneficial treatments for disease or to enhance the current treatments so they are more effective. This is how science is supposed to work. The head researcher has been studying this topic for years before this breakthrough. There’s a lot more research to go before we may see the results of studies like I reviewed this week.

The Bottom Line

I think these two studies illustrate the benefit of nutrition for health and as a potential aid to recover from disease. Just keep in mind the concept of food first, then add supplements to enhance impact if necessary. Remember, the first study examined one amino acid, cysteine, found in healthy protein from animal and plant sources. The second used zeaxanthin as a supplement, but foods are the source of that carotenoid. I think that eating better may be the way to get healthier and beat conditions before they become a problem. If you try to eat a dark-green vegetable frequently, then add some yellow and orange fruits and veggies, you’ll get your zeaxanthin, plus lots of other good nutrients.

What are you prepared to do today?

        Dr. Chet

References:
1. Nature (2025). https://doi.org/10.1038/s41586-025-09589-5
2. https://doi.org/10.1016/j.xcrm.2025.102324

Cysteine for Gut Health

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The science behind the treatments of tomorrow lies with basic research today. There have been a couple of studies published recently that use building blocks of food to treat specific conditions. Let’s take a look at the first one today.

Researchers at MIT conducted a study to see if a specific amino acid could help the digestive system recover after damage due to radiation therapy for cancer. They tested 20 amino acids and found that cysteine stimulated the healing process in mice. They found that a high-cysteine diet increased the production of intestinal stem cells. While the actual biochemical process is very complex, it’s ready for human trials.

Why so quickly? Cysteine is a natural substance the body needs. Putting people on a high-cysteine diet for a time would provide no harm and may provide a boost to gut repair. In looking at the references, this approach is also being looked at for people with Crohn’s disease and irritable bowel syndrome.

How do you get a high-cysteine diet? Meat, dairy, legumes, and nuts are all high in cysteine, and it’s also available as a dietary supplement. If you have such issues, talk with your physician about giving the diet a try to see if it will help. Zeaxanthin is the next nutrient we’ll look at on Saturday.

Tomorrow night is the Insider Conference Call. I’m going to be answering Insider questions as well as discussing a couple of success stories for people who used GLP-1 RA to lose weight. Become an Insider by 8 p.m. tomorrow night and you can join us.

What are you prepared to do today?

        Dr. Chet

Reference: Nature (2025). https://doi.org/10.1038/s41586-025-09589-5