Should You Worry About Forever Chemicals?

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Per- and polyfluoroalkyl substances (PFAS for short) are found in water to the extent that 100% of the population has measurable PFAS in their blood. PFAS are synthetic chemicals that are used in many products such as fire and heat retardants and oil- and stain-resistant products. Teflon coating in cookware is the best example of the use of PFAS and why getting rid of that cookware is a good idea. Because they are chemically stable, they are called forever chemicals.

The problem is that there are known health issues associated with exposure to PFAS. Among them are a reduction in immune response and increased risk of infections of the liver and kidney damage, increased risk of cholesterol and high blood pressure, as well as issues related to reproductive health. There may be more specific issues with other organs and organ systems. Research will continue.

The question is this: if they are forever chemicals, will they stay in the body forever? There is no known detoxification system that directly eliminates PFAS from the liver, but there may be hope based on a few recent studies. We’ll take a look at those on Saturday.

In tomorrow’s Insider Conference Call, I’ll discuss a variety of topics related to vaccinations as well as whether the COVID infection impacts the health of arteries. If you become an Insider by 8 p.m. tomorrow, you can participate and get your questions answered.

What are you prepared to do today?

        Dr. Chet

Reference: https://bit.ly/3VhB612

Artificial Sweeteners—Still Your Choice

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The use of artificial sweeteners is always a contentious topic in the health field. Some people hate them, other people love them. I use them occasionally, but when it comes to benefits versus harms, I stick to the research. In this case, it’s what wasn’t stated in the headlines about the study that is important, but we can make a decision based only on what we read. This was an abstract of a presentation at a conference, so some details may have been left out that were included in the study.

The Rest of the Story

The authors established an increased risk of diabetes with artificially sweetened drinks and saccharin in any form, but there were no statistically significant diabetes symptoms linked with total intake of artificial sweeteners, sucralose, or aspartame in all foods. That means that artificial sweeteners used in other foods didn’t raise the risk of diabetes, such as added to coffee, used in ice cream or other dairy products, or used in baking. You have to wonder why it had no apparent impact.

It may be that the specific food delivery system has some impact on why it does or does not have an effect. One possibility is that if the sweetener reaches the gut bacteria, it’s modified in some way so that it doesn’t impact blood sugar or blood sugar release.

It seems odd that they used markers of diabetes as their criteria rather than physician diagnosis. They looked for fasting glucose of 126 mg/dl or more; oral glucose tolerance test 2-hour glucose of 200 mg/dl or more; hemoglobin A1C of 6.5% or more; or use of diabetes medications. The last one makes sense, because you don’t get the meds unless you have a diagnosis, but still, odd language.

FFQ—Again!

Even though the food frequency questionnaire is still a good assessment tool when used with interviews, I checked the validation studies. The correlations with food diaries and interviews for the food frequency questionnaire developed specifically for the CARDIA study were no better than 0.5, indicating a moderate positive relationship—maybe it did, maybe it didn’t. That’s much worse than other correlations used in large studies. Also, the first two nutritional assessments couldn’t have assessed sucralose because it wasn’t available until after they took place; I don’t know why sucralose was included when it wasn’t available for almost half the follow-up period.

The Bottom Line

The debate on artificial sweeteners will go on, because people love them or hate them. Based on the results of this observational study, nothing of worth has really been added to the knowledge base. The researchers called for more research to examine how artificial sweeteners impact glucose metabolism. We don’t know that it does from anything done in this study, but that doesn’t mean well-designed studies shouldn’t be done in the future. Until then, it’s up to you whether to use artificially sweetened drinks or not. Maybe a better idea is to give up the mega-burger and fries instead.

What are you prepared to do today?

        Dr. Chet

Reference:  Cur Devel in Nutr  https://doi.org/10.1016/j.cdnut.2025.107034

Artificial Sweeteners—Again

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“I’ll have the jumbo mega-burger with extra cheese, a large order of fries, and a diet cola.” Have you ever heard that when you’re standing in line? Have you maybe ordered that yourself? That’s what I thought of when I read the health headlines about the dangers of artificial sweeteners contributing to the development of diabetes.

The Coronary Artery Risk Development in Young Adults (CARDIA) study began in the early 1980s by recruiting and tracking young adults to determine which factors are associated with the development of heart disease. Nutrition was one of the primary factors that was tracked using a food frequency questionnaire with dietician interview. They tested the subjects at the beginning of the study, at year 7 of follow-up, and year 20 of follow-up.

After tracking the subjects for almost 25 years, they found that 14.8% of subjects developed metabolic changes that indicated diabetes. Comparing the highest quintile of artificially sweetened drink use with the lowest quintile, there was a 129% increased risk for developing diabetic symptoms in the highest quintile. The use of saccharin was also associated with 120% increased risk of developing diabetes.

Is there more to this study that wasn’t highlighted in the headlines? I’ll cover that in Saturday’s Memo.

What are you prepared to do today?

        Dr. Chet

Reference:  Cur Devel in Nutr  https://doi.org/10.1016/j.cdnut.2025.107034

Why You Need a Plan

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I recently watched a documentary about a weight loss game show that was very popular about 25 years ago and lasted for 17 seasons. The show was one Paula and I watched for a number of seasons, but eventually we lost interest as the show became more bizarre and unrealistic. The documentary was challenging to watch for a variety of reasons; from the brutality of the trainers, the absurd challenges that demeaned the contestants as human beings, and the constant conflicts between contestants, it was not enjoyable.

According to the documentary, after the winner was announced, the people who had lost hundreds of pounds were left to fend for themselves. They essentially had left reality behind to live on less than 1,000 calories per day and to be able to exercise up to six hours or more a day for close to a year—then, nothing. No plan for how to transition to a normal life again. No explanation from dieticians or trainers how to adapt to maintain their weight loss.

In reality, it’s happening again right now with people who are using GLP-1 RA injections to control blood sugar and lose weight. If you’re going to try it, you should plan an exit strategy well before you’re done losing the weight, the same planning as what the weight loss contestants should have been provided.

How can you do that on your own if the healthcare professional doesn’t? Remember when I wrote about the physician who lost weight by eating the same portions as his wife was eating? I saw him again a week or so ago, and he’s maintained his weight loss well. The plan was to eat like his wife ate, and it has worked.

The Bottom Line

No matter what program or strategy you have to lose weight and get fit, you’ll be more successful at maintaining your weight loss if you work on the exit strategy before you’re even done losing the weight.

  • Are you willing to eat the same foods you ate during the process, or have you been depriving yourself of things you know you want to eat again? How can you fit your favorite foods into your new eating plan? The worst thing you can do is go back to your old way of eating.
  • Have you been doing extra exercise to get there? What are you willing to continue after you’re done? If you go back to your old way of life, you’ll probably go back to your old weight.

Whatever your strategy will be, it has to be something you’re willing to do for the rest of your life. You have the chance to plan ahead. That plan may change as you progress, but it’s easier to adjust a plan you’ve already worked out than to come up with one out of thin air. As the saying goes, “Failing to plan is planning to fail.”

What are you prepared to do today?

        Dr. Chet

Is Cold Pasta Healthier?

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Our grandson Riley has loved pasta since he started eating solid food (that’s him digging into his pasta at two; if his ear looks orange, it’s because his imaginary cell phone rang during dinner), and he often eats it cold. I mean refrigerator cold; he’ll eat it warm if we go out to a restaurant, but he prefers it cold. I don’t mean macaroni salad—I mean cold pasta, preferably with Riley sauce. The Riley sauce is my recipe created for him with a base of a marinara sauce; I grind up onions, garlic, mushrooms, carrots, zucchini, and beef with the grinding attachment for Paula’s KitchenAid mixer and add them to the base along with some additional spices. Then I slow cook it for a couple of hours. He eats that with a spoon (cold, of course) and doesn’t realize all the veggies he’s getting.

But it’s really the cold pasta that may be healthier for him. Why?  Doesn’t pasta increase blood sugar rapidly? Sure, if it’s hot. But when pasta is put in the refrigerator for a day or more, a process called retrogradation happens. As the pasta loses water, the remaining molecules lose their original structure and form a new structure. Those turn some of pasta’s sugar molecules into a resistant starch that passes through the body without being digested in the same way. When eaten cold like Riley does, that starch resists digestion until it gets down to the probiotics. There it can be turned into short-chain fatty acids instead of sugar molecules. Those fatty acids are much better for us for a variety of reasons.

As you celebrate the last summer holiday this weekend, keep in mind that pasta might be a dish best served cold. Have a fun Labor Day weekend, and please be safe if you’re traveling anywhere this weekend.

What are you prepared to do today?

        Dr. Chet

Lithium: It’s The Amount That Matters

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I received a question from a long-time reader the other day. They asked, “What is the difference between lithium orotate and the lithium in batteries?” The short answer is simply that they are the same metal. Given the history of lithium batteries and their tendency to overheat and sometimes explode, I’ll go into a little more detail.

Lithium is the lightest metal on the Periodic Table. It is a soft, lustrous metal and, while it is found in quantity in mines, it is everywhere. As an element, it can be toxic. What makes it less so is that it can naturally bind to so many other elements. Depending on what it binds to, that can determine whether it’s safe to use.

Lithium orotate is an organic salt and far supersedes the efficacy of other organic salts and inorganic salts such as lithium carbonate. In batteries, the value of lithium is its ability to freely give up ions that can result in the production of energy, but there’s about 38.4 mcg of elemental lithium contained in 1 mg of lithium orotate. That’s at least 1,000 times less than found in a single AA lithium battery and without the toxic solvents necessary to make the battery work.

Another reader asked about the highest sources of lithium in the food supply. That’s something I would have included, but it all depends on the water supply and whether the soil has lithium in it. For now, there is no way to provide a list. Eat them all!

I hope that clarifies things. On Friday: why the way Riley eats pasta might just be best for gut health.

What are you prepared to do today?

        Dr. Chet

Lithium: A Hopeful Discovery

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You may recognize lithium as a treatment for some mental health issues such as bipolar disorder. That would require a pharmacological dose of 600–1,800 mg of lithium per day; levels that high can create severe side effects. But prior research showed that people who were treated with lithium had lower rates or delayed onset of cognitive impairment. The next step in the study was what form of lithium and what amount could help reverse the cognitive impairment and potentially be used to prevent mild cognitive impairment and Alzheimer’s disease.

Forms of Lithium

Researchers examined a variety of organic and inorganic salts to find the form which prevented or reduced the sequestration of lithium in amyloid plaque. Lithium carbonate, the inorganic salt form most used in pharmacological doses, did not prevent the pathology in low-dose supplemental form. An organic form called lithium orotate was successful in amounts consistent with dietary intake. Over a period of weeks, the mice drinking lithium orotate in their water reversed the cognitive impairment and other negative effects.

What’s Next?

The first thing you may be thinking is, “I gotta get me some of that!” Slow down. Remember, these were tested in mice—there are no human trials yet. While there are tests for assessing lithium levels, they’re generally reserved for patients with mental disorders. With such a small range found within the blood, testing requires medical interpretation, and we don’t really know what that level may be in someone with mild cognitive impairment.

Before this becomes a supplement you want to take, a couple of good human trials should be done to determine the proper dosage and any potential side effects. Tremors and nausea are routine side effects when lithium is used to treat mental conditions, but at normal food and water intake levels—1 to 3 mg per day—there should be none. There are many lithium orotate products in the marketplace that range from 1 to 5 mg, but let’s not get ahead of the science.

The Bottom Line

I think there are still questions to be answered before we all start supplementing with lithium orotate. While there is no RDA for lithium, there is a provisional target of 1 mg per day from diet. However, because the amount of lithium in water and food can be so variable, taking 1 to 5 mg per day of lithium orotate seems like a reasonable thing to do if you are over 50 years and are starting to experience memory issues beyond the normal where-are-my-keys problems.

It will take a while before we have the results of human trials. It would also help if you eat better, drink water, and get some exercise; those also help reduce the development of amyloid plaque. When I know more, so will you.

What are you prepared to do today?

        Dr. Chet

Reference: Nature. https://doi.org/10.1038/s41586-025-09335-x

Lithium and Brain Health

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The health field has been buzzing about a study that was recently published related to Alzheimer’s disease markers and the mineral lithium, a soft, silvery-white alkali metal. Got lithium? You can use it in batteries, nuclear reactions, and many other industries; it’s also used in medications to stabilize mood.

Researchers decided to find out the relationship between markers for Alzheimer’s such as types of amyloid structures in the brain. There have been associations with reduced lithium intake and mild cognitive impairment in prior studies, so researchers decided to examine how mice on a reduced-lithium diet would respond. They measured several other minerals as well, but the only one associated with an increase in amyloid structures was lithium. It seems that when there’s not enough lithium in the diet, the brain cannot function as normal and sequesters the lithium in the amyloid bodies; brain function decreases further as lithium levels drop, including cognitive impairment.

The normal amount of lithium found in the diet suggests we get 0.6 to 3 mg per day, mostly from water and food. That amount is able to sustain the 7 mg typically found in an adult human. The next question would be how much it would take to reverse cognitive impairment. I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Nature. https://doi.org/10.1038/s41586-025-09335-x

When It Comes to Carbs, Quality Matters

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You probably guessed right after reading Tuesday’s Memo that there are benefits from the quality of carbohydrates a person eats on a low-carb diet. In fact, one might say that because the carb intake is very low, every decision matters. Before getting into the results, let’s use the definition to identify the carbohydrate quality used in the study.

Good Carbs, Bad Carbs

High-quality carbohydrate diets are characterized by higher intakes of whole grains, non-starchy vegetables, whole fruits, nuts, and legumes, with correspondingly higher dietary fiber.

Lower quality carbohydrate diets are characterized by higher intakes of refined grains, sugar-sweetened beverages, baked desserts, and other sweet snacks.

The Results

While there were numerous statistical applications used, when comparing the lowest quintile of high-quality carbohydrates with the highest, as the percentage of high-quality carbohydrates increased, the markers of inflammation decreased.

When comparing the lowest quintile of low-quality carbohydrates with the highest quintile, the markers of inflammation increased as the percentage intake increased.

Understand that the high-quality carb eaters ate low-quality carbs as well, just not as much as the low-quality carb eaters. That means you don’t have to eat only one way. I’ve been developing a carb theory, one that goes along with the 80/20 rule: if you can eat well 80% of the time, you can loosen up 20% of the time, at least when it comes to carbohydrate quality.

The Bottom Line

This was not the be-all, end-all study; they used food frequency questionnaires, and I’ve talked ad nauseum about why I think they’re not much better than no info at all. But it was a practical approach to establishing that eating better most of the time can have benefits and may even reduce the risk of disease. We’ll see if there are future papers that track morbidity and mortality in the same group of subjects. Until then, eat less, eat better, and move more.

What are you prepared to do today?

        Dr. Chet

Reference: Current Developments in Nutrition. 2025. https://doi.org/10.1016/j.cdnut.2025.107479

Lower Carb Diet: Does Quality Count?

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The Framingham Study began in 1948 and focused on monitoring nutrition and cardiovascular disease among other conditions. The purpose was to monitor the dietary and health habits as well as the health outcomes of a large group of people over time. Much of what we know about diet and cardiovascular disease comes from the longitudinal data collected; that study continues today with a focus on the children whose parents were part of the original study. Study participants have regularly scheduled physicals and blood work as well as dietary intake assessed by a food frequency questionnaire.

The researchers wanted to study the effect of high-quality carbohydrate intake versus low-quality carbohydrate intake on markers of inflammation in those people following a lower carbohydrate diet. These were not hard-core ketogenic diet followers; the average carbohydrate intake was about 41% instead of the typical 50% to 60%. Subjects had similar intakes of percentage of protein and fat intake. They were compared by the quality of the carbohydrates that they ate.

The subjects were followed for over six years to see if there were any changes in inflammatory markers, because inflammation is related to an increased risk of many diseases and conditions including cardiovascular disease. Was it beneficial to eat better carbs? I’ll let you know on Saturday along with comments about the significance of this study.

Tomorrow night is the Insiders conference call. If you want to participate and get your questions answered, become an Insider by 8 p.m. ET tomorrow night; I’ll include you in the call or you can listen to the replay.

What are you prepared to do today?

        Dr. Chet

Reference: Current Developments in Nutrition. 2025. https://doi.org/10.1016/j.cdnut.2025.107479