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

The Secret Ingredient

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The paper on the physics of fluids was interesting, although the math was way beyond my ability. Researchers from four European countries took part in the research study on Cacio e Pepe to find the precise texture of the pasta, starch content of the water, and temperature of the water to get the perfect sauce from cheese and pasta water (the starchy water in which the pasta’s been cooking).

It all comes down to something called phase separation. That is the critical point where the starchy pasta water emulsifies the cheese so that it becomes creamy instead of separating into a lumpy mess. The scientists called the clumping the mozzarella stage. Not everyone has an Italian grandmother that they can watch and learn from, and nonnas didn’t use fancy instruments to test the water starch content—they knew from experience after making the dish hundreds of times.

If you’ve never thought about the physics of cooking, I’m with you on that. But the interaction of the starch being released from the pasta and visually assessing the starch content to get it right is just that: physics. The number of attempts the scientists used with varying starch content, water temperature, and cheese, and the resultant mathematical calculations to get to a solution were amazing. They actually came up with the correct recipe, but believe me, it’s too complicated to just post because it requires so much explanation. So they looked for another way to prepare the cheese sauce.

The Secret to Cheese Sauce: Sodium Citrate

The scientists came up with a natural solution: a natural substance, sodium citrate, that helps with the emulsification of the cheese. That’s the step the physicist chef talked about on the podcast. At the point where the starchy water is added to the cheese, a pinch of sodium citrate will help the emulsification process and instead of goo, you’ll get a creamy and smooth sauce. When I try it, I’ll let you know how it went.

Sodium citrate will add some tartness, but it’s also good for you if you’re not sodium sensitive. The citrate is a natural anticoagulant as well as emulsifier. The stumbling block may be the amount of sodium citrate. The recipe called for a pinch, which is usually an eighth of a teaspoon, but in the amount of pasta for two persons, the scientists used 5 grams, which is almost a teaspoonful.

So even after all the science that went into it, it’s still going to come down to trial and error. But you now have a solution for homemade cheese sauces. Ever try to make your own mac and cheese and end up with clumps? If it works for Cacio e Pepe, it should work for other cheese sauces that may separate.

The Bottom Line

What’s the point to all of this? Cooking enhances the flavor of the simplest ingredients. I would wager that if people knew how to cook better, they would use healthier ingredients. I think we can all relate to hating Brussel sprouts, but when baked with a little cheese and bacon, they’re amazing (check out the recipe on the Health Info page at drchet.com). We can argue whether a three-ingredient pasta dish is healthy, but if cooked properly, we may be satisfied with less, while vegetables cooked properly may mean we eat a little more. Remember, no one ever said that vegetables, fruits, and whole grains had to taste bad. The goal is to eat better. If cooked well, we may eat less.

What are you prepared to do today?

        Dr. Chet

Reference: Physics of Fluids 37, 044122 (2025)

Cheesy Pasta: My Gooey Mess

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Last Saturday I said that with all the heavy health news going on, it was time to change it up and talk about something a little lighter. Nothing could be lighter than cooking with just three ingredients to get a magnificent pasta dish. The dish is called Cacio e Pepe (Cheese and Pepper in English), and all you need is pasta, fresh ground pepper, and pecorino cheese although Parmesan also works. What you may not realize is that you also need to watch an Italian nonna cook it about 100 times before you even try to cook it.

When done correctly, the sauce is delicious. I’ve tried making it twice. The first ended up with the cheese reformulating and making a gooey mess. The second was the same but was inedible because I put in way too much pepper, together with the gooey instead of smooth and glistening sauce. I wasn’t going to threaten the creations of Italian nonnas any time soon. (By the way, we thought Nonnas was a fun movie.)

That is until I listened to a podcast that mentioned the physics of cooking pasta. A guest on the podcast, a chef with a PhD in physics, mentioned the elusiveness of cooking this recipe. That caught my attention and led me to read a paper titled “Phase behavior of Cacio e Pepe sauce” in the journal Physics of Fluids. Not only did I find out a lot about how pasta loses starch, but I also found out about a secret ingredient that makes the sauce work—and it may be good for you as well! That’s Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

Reference: Physics of Fluids 37, 044122 (2025)

Folinic Acid and Autism

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The other news related to autism was talk about the potential benefits of a pharmacological form of folate called folinic acid, an active form of vitamin B9; it’s being described as a cure for autism. In fact, the new CDC administration is fast-tracking a change in label use for the drug so it can be prescribed more often. Here’s why I think that would be a mistake.

While doing background research on an updated webinar on pregnancy, I found a paper that discussed the potential impact of mutations of the methylenetetrahydrofolate reductase (MTHFR) gene of the mother on the development of the baby. If the mother had both mutated genes, her body wouldn’t process folate very well, resulting in the over production of homocysteine as well as other issues. That could be related to the development of neurological disorders in their babies, including autism spectral disorders and ADHD.

Folinic acid is a pharmacological form of folate that has been prescribed for use with chemotherapy patients. Some forms of chemo block the MTHFR gene, and folinic acid helps ameliorate the problems related to the chemotherapy. It seemed obvious to me that it could potentially help pregnant women with the mutated MTHFR genes and thus maybe prevent the neurological disorders in the baby. That’s where it ended because there’s not enough research to suggest it will work. The research has to happen now. Simply changing the uses for the drug based on small studies and testimonials isn’t good enough without research to support it.

As far as a treatment for autism, the same holds true. We don’t know whether the impact is dependent on, or independent of, the MTHFR mutation. Perhaps in people without the gene mutation it wouldn’t be effective, or worse, detrimental in some way that is not apparent right now.

I hope reason rules the day, as exciting as the potential seem to be, but treatments should not be based on a few case studies or worse, solely on potential. We need at least some conventional proof.

Next week, I’ll turn to a couple of cooking topics to lighten things up a little.

What are you prepared to do today?

        Dr. Chet

Acetaminophen and Pregnancy

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There have been statements circulating in the health news related to autism in the past couple of weeks, and I want to provide some perspective on both. Today it’s about a link between autism and acetaminophen, the generic name for Tylenol, also known in other countries as paracetamol. Acetaminophen is also an ingredient in OTC meds such as Nyquil, Alka-Seltzer Plus, Theraflu, Goody’s Powder, Pamprin, and so on.

The controversy surrounds a recently published study that concluded pregnant women should use acetaminophen with caution under the supervision of a physician for short periods of time—which is exactly what the major medical associations already recommend.

The researchers used a statistical technique called navigation guide analysis. Essentially, it’s a meta-analysis typically used to assess environmental toxins; whether it should be used in a pharmacological analysis is not clear. In addition, there’s always the risk of bias when selecting studies for inclusion in any meta-analysis, and this is no different.

It’s especially difficult to ignore bias when three of the four researchers have provided expert evidence for plaintiffs in prior lawsuits against acetaminophen manufacturers. Even if that were not a concern, the methodology for assessing acetaminophen use depended on recall questionnaires from the mothers-to-be or their healthcare providers—not medical records. We know how well that works in Food Frequency Questionnaires, so let’s go: Did you take any pain meds in the last year? Which ones? Don’t remember? I’m not surprised—neither would I expect a woman who’s busy growing another person to remember every OTC med she took.

One more thing? Acetaminophen has been recommended for pain since the 1950s. If it were directly linked to the risk of autism or other neurological issues, it would have become apparent before this, some 75 years later. It doesn’t mean research shouldn’t continue, but for now, acetaminophen appears to be safe when taken as recommended for short periods of time under the direction of a physician. Pregnancy comes with a host of worries—which diapers, which car seat, which baby vitamins—but I’d take acetaminophen off that list.

On Saturday: is there a new treatment for autism?

What are you prepared to do today?

        Dr. Chet

Reference: Environmental Health (2025) 24:56