Happy Thanksgiving!

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All of us in the Zelasko household wish you and your family a happy Thanksgiving. I’m grateful for all of you who support my business. May your travels be safe, the family fellowship be fun, and the food be delicious. Be back with you next week.

Sodium Citrate Works!

Last month, I talked about the fluid physics of pasta for making Cacio e Pepe, a three ingredient pasta dish. Researchers analyzed the best way to get the pasta to the right temp and starch level of the water. Then they used sodium citrate to compensate for the experience of an Italian grandmother who knew exactly when to add the pasta water.

Paula ordered sodium citrate, and I finally tried it. I used fresh chopped basil instead of pepper and added a teaspoon of sodium citrate as I added the cheese. No lumps in the sauce for the first time—smooth and silky—delicious! You can use the sodium citrate to make any cheese sauce smooth and not grainy or lumpy. Think about that Thanksgiving macaroni and cheese or some other recipe that requires cheese; you could even add a gravy boat of cheese sauce to encourage young (and older) guests who hate vegetables. Peas with cheese? Yes, whatever works.

The sodium citrate isn’t going to help with the turkey gravy, but for anything with a cheese sauce, like the nachos you’re going to serve as an appetizer or a snack during the game, you might find it’s a whole lot more popular this year if you use the sodium citrate trick. Leave it to physicists who love pasta to come up with the solution to clumpy cheese! That’s one more reason to be thankful.

What are you prepared to do today?

        Dr. Chet

Research Update: Peanut Allergies

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Peanut allergies can result in some of the most severe allergic reactions including anaphylactic shock; it’s especially horrible when it happens to children. While research continues on how to overcome a present allergy to peanuts, the best option is to prevent the allergy from occurring. Recent research has shown that’s possible.

Peanut Exposure Early

Researchers decided to find out why Jewish children raised in Israel had fewer peanut allergies than children raised in the United Kingdom or the United States. In the Learning Early About Peanut Allergy (LEAP) trial, researchers used 680 babies with allergies to one of two groups based on their reaction to a peanut pin-prick test. One group was given peanuts snacks beginning at 4 to 11 months old, and members of the other group were not exposed to peanuts. They tracked the children for five years and found that 13.7% of the children who weren’t exposed to peanuts developed peanut allergies, while only 1.7% who were exposed to peanuts early developed peanut allergies. This falls into the category of being a landmark study.

The guidelines for exposure to peanuts were changed in 2016 to encourage peanut exposure earlier in life.

Recent Research

Researchers followed groups of children in the U.S. diagnosed with atopic dermatitis from birth through three years old over two time frames: before the peanut exposure guidelines were introduced for one to two years and after the peanut guidelines were changed for one to two years. They used medical records for diagnoses and blood markers that indicate peanut sensitivity. There was a significant decrease in peanut allergy diagnoses in the follow-up period after the guidelines were introduced compared to before the guidelines. In plain language, when applied to the entire population of children in the U.S., that means thousands of children may never develop severe allergies to peanuts.

The Bottom Line

We want to protect our children, and especially their health. One possible way to protect them is to make sure they’re exposed to a varied diet. Before the Guidelines were changed, the objective was to limit their exposure to anything that might cause problems, but the LEAP study demonstrated that could be a mistake. Discuss potential allergies with your pediatrician if your child shows any signs of allergic reactions, including something relatively simple like a rash. Get their opinion on the best course of action related to food sensitivities. If a little exposure now prevents more serious issues later, that seems like the best course of action. But you have to do what you believe is in the best interest of your children—I wouldn’t make this change without consulting our pediatrician, and I hope you wouldn’t either.

One final note: this only applies to very young children. If they have already been diagnosed with severe peanut allergies, that’s a different issue. Make sure you follow procedures that your physician has recommended, and never leave the house without an EpiPen.

What are you prepared to do today?

        Dr. Chet

References:
1. N Engl J Med 2015;372:803-813
2. Pediatrics (2025) 156 (5): e2024070516.

Lectin: Hidden Danger?

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This week will be about beans and nuts, a tired ad campaign, and some exciting new research.

Let’s begin with the advertising retread. A retired pediatric cardiologist started talking about the dangers of lectins in foods, especially beans and nuts, years ago. They were the reason you had bloating and other digestive issues. That turns out to be partially true, but fire comes to the rescue.

Lectins are proteins found in the beans and nuts but also in a whole array of foods. These proteins bind to carbohydrates with varying results in the body. Some lectins found in beans cannot be absorbed, cause gastric distress, and may even compromise the immune system. Other lectins help boost the immune system, such as wheat lectins, and still others, like mushroom lectins, may have a positive neurological benefit.

Where does the fire come in? If the plants are cooked or roasted, the lectins become neutralized and cause little to no gastric distress. No country in the world suggests eating beans without thoroughly cooking them first. That eliminates most of the issues with lectins. That doesn’t mean that some people aren’t sensitive to them, but it’s not the gut-expanding problem the ads indicate. Time to retire that approach.

However, there is some exciting news when it comes to nuts. We’ll take a look on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://doi.org/10.1016/j.heliyon.2024.e39471

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