Physician-Led Health Coaching

Traditional Medicine Treats You as an Equation

Dr. Ashori MD — Wed, 19 Aug 2026 14:32:08 GMT

If you’ve ever gone to the doctor and blanketly told that you need a medication because of a number in your chart then you got the short end of the clinical stick.

Far too often, Western Medicine treats people the same without discussing the subtleties of each case. Without diving deeper and having a truly informed discussion.

But this isn’t because your doctor is bad, you have some responsibility here as well. Trying to reduce clinical medicine to an online equation or a 50 second video clip can be harmful.

Welcome to the Physician-Led Health Coaching weekly newsletter. I’m Dr. Ashori, a board-certified physician & health coach. I help people fix brain fog, fatigue, and stubborn weight before they turn into real disease.

High Blood Pressure

Imagine you are in your mid 30s and noticed a few high blood pressure readings. Your doctor checks it and confirms it’s too high at 150/92. They cite the JNC8 Guidelines and recommend you start treatment with a medication.

But that’s not how high blood pressure works. It doesn’t exert the same effect on every body the same. The reason we treat your blood pressure is to decrease your baseline risk.

What is your baseline risk? If it’s very high, the medication is likely a life-saver. This might apply to 20% of the population. If you have no family history of heart disease, kidney disease, strokes, or other complications from high blood pressure then your baseline risk is really low. Adding a blood pressure medication would lower your miniscule risk by a tiny amount.

Elevated A1C

Almost every primary care doctor will order an A1C test on every patient annually. It’s meant to pick up a signal that your blood sugars are too high and you should do something.

A high A1C means there could be a potential risk for diabetes in the future. The problem is that we don’t know which patient will end up developing diabetes.

My mother is nearly 80, thin, exercises daily, and it’s a mostly plant-based, minimally processed diet. I’d consider her healthy - whatever that might mean. But her A1C is 6.0. Her doctor even recommended a medication to treat it.

So, my mother at 98 lbs is being treated the same as someone who eats fast food daily, doesn’t exercise, and carries 50 extra lbs.

Paroxysmal Atrial Fibrillation

Most of my patients are in their 30s-50s, but I have a few patients I take care of in their 70s and 80s. One of my 75-yo patients was just told that he needs life-long blood thinner treatment because his watch notified him that he might have Atrial Fibrillation.

He’s active, low-stress, drank alcohol only occasionally, exercises, and has a healthy weight, and no other medical problems. In fact, the only bout of Afib he got once he wore a rhythm monitor was because he had some Tequila.

The cardiologist plugged his age into a calculator and it said he needs to be treated, so that was the decision. This is bad medicine. Because if he was 100 lbs overweight, sedentary, drank alcohol daily. and had high blood sugars, he’d be given the same recommendation.

But blood thinners, just like meds for diabetes and hypertension, aren’t without harm and risk.

Obesity

Now imagine you have an extra 15 lbs and your doctor (or social media) recommends a GLP1. You’re otherwise quite healthy and a DEXA scan confirms that most of your extra weight is subcutaneous fat.

What’s the benefit of this medication? What’s the benefit of you even losing this 15 lbs but lowering your calorie intake? Not much, that’s the answer.

There is a risk when you carry extra weight. But it’s not the same for everyone. If your baseline risk is incredibly low then decreasing that weight won’t add anything to you. If you have $1M in the bank and I give you 1 penny, nothing happened.

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Back Pain

The harm of overtreatment with back pain could be called an epidemic. Okay, I’m exaggerating but I can think of so many of my patients who had back pain, got an MRI, then told they have a herniated disc and needs surgery.

There’s no time in traditional medicine to really put you through an intensive physical therapy program, reassess your pain, tease out whether it’s truly damage to the nerves or just back spasms.

The equation here is that you had a herniated disc on an MRI = surgery. But the reality is that most herniated discs resolve on their own. It’s worth a try.

The Role the Patient Plays

I’m just a Family Medicine doctor. I’m not a specialist, certainly not a cardiologist. When I push back on the recommendation of lifelong anticoagulation for paroxysmal AFib I’m told by the cardiologist in no uncertain terms that they are the expert.

My patient, too, will push back and say, hey look, you’re a Family Medicine doctor, the cardiologist knows better. I disagree. The cardiologist knows some things better, not all things. She’s perfect for a complicated AFib case but not for a borderline case.

If you just put your head down and go along with whatever an expert says then you risk getting swept up with guideline-based medicine. Yes, your specialist is an expert but you should always verify what you’re being told.

Disclaimer:

Dr. Mohammad Ashori is a U.S.-trained family medicine physician. The content shared here is for education and general guidance. It is not personal medical advice, diagnosis, or treatment, and it does not create a doctor-patient relationship. Humans are complicated and your personal details matter. Your healthcare team is your best resource before making medical decisions, changing medications, or managing symptoms. This information is to help you add more depth to those conversations.

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7 Things to Fix Before You Try a Peptide

Dr. Ashori MD — Fri, 14 Aug 2026 17:23:50 GMT

You’ve now heard at least a dozen people tell you what a miracle they experienced because they injected BPC-157 or Ipamorelin. You’re curious but you’ve also heard a few horror stories from the biohacking community.

I don’t have a horse in the peptide race. It seems to work swimmingly for some and I have had as many patients who experienced no benefits or just side effects. But I’ve collected 7 learning points from my patients that you can try before you dial your local peptide dude.

1. You’re Not Recovering Like You Used to

This is one of the most popular reasons to reach for a peptide like BPC-157 and TB500. They promise to regenerate your tissues, help you heal faster, and get back to your best self.

But chances are you are doing too many things back to back without adequate rest. In my TREND Method D stands for downtime. You need this downtime/recovery to regenerate tissue, to have more parasympathetic tone on your blood vessels and heart.

2. You Can’t Process Information

Semax and Selank are the popular stack for those who are experiencing brain fog, slow processing speeds, or poor concentration.

The likely problem is that you’re constantly draining your brain without allowing it time to refuel. Try setting a time for heavy mentally taxing work - say, from 9 am until 2 pm. After that, only do lighter work. And turn off your processor after 5 pm. This allows your brain to come back online fresh by 9 am the next morning.

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3. You’re in Bed But Not Sleeping

This is the sleep data from one of my patients. She’s convinced she’s getting 8 hours but 2 separate devices confirmed that her sleep apnea and some other health issues are preventing her from actually getting sleep.

Ipamorelin and CJC-1295 are another popular combo stack people take right before bed. Instead, address the quality of your sleep. Maybe your body is retaining too much water which makes you get up to pee a lot or your mind races too much to fall back asleep during the midnight awakenings.

4. Your Energy is Zapped

MOTS-c and Elamipretide are used separately or together to supposedly put the mitochondria in hyperdrive. But that’s only a quick fix. The 2 main problems I see in my practice are excessive calorie restriction and constant low-grade stress.

If you’re trying to control your weight by focusing on more protein and less carbs chances are you’re going to be hungry a lot. Maybe you’re in the 25% of the population who feels great satiety from animal proteins but the other 75% need complex carbs for the nutrients.

Before You Optimize, Get the Foundations Right

Peptides may be getting most of the attention right now, but the fundamentals of good health haven’t changed. Sleep, nutrition, movement, recovery, and metabolic health are still where I want most people to start.

I put together my 6 Healthy Aging Habits eBook to help you focus on the evidence-based habits that matter before getting distracted by the latest health trend.

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5. Your Insulin Needs a Break

Retatrutide and 5-Amino-1MQ are used to improve insulin balance in the body. At least Reta is in the pipeline to be a future pharmaceutical drug, which allows us to have more transparency - not perfect, but better than a completely unregulated space.

I have a patient right now whose fasting insulin is nearly 20. A1C is nearly in the diabetes range. And his cholesterol is quite high. All of this means that his pancreas and liver are just not getting a break from glucose.

Switch from simple carbs to complex carbs. Add more lean protein to your diet (tofu, beans, tempeh, fish, eggs, meat.) The goal is to give the pancreas a break so that your body can get rid of all the excess insulin receptors.

6. Your Muscles Aren’t Activated

We have lots of important receptors on the muscles and to express them we have to use them. How much? It depends on your genetics. Some people just have to walk but others need to lift weights regularly for those proteins to be activated.

Biohackers take IGF-1 LR3 and Tesamorelin are both used to increase muscle synthesis. But they act on the IGF-1 and Growth Hormone pathways, which are both very delicate and potentially harmful to manipulate.

Stretch your muscles before going to bed and go for daily walks. If you are still having trouble with your blood pressure or blood sugars, add in some resistance band training - start with 5 minutes a day.

7. Skin & Hair Are Thin or Sagging

GHK-Cu and Epitalon are injected for anti-aging and collagen remodeling. But we know that collagen breakdown accelerates with low-grade inflammation, excessive UV exposure, inadequate hydration, stress, and high-glycemic-index diet.

Try to oxygenate your tissues more and don’t be afraid of the sun. Use a sun exposure calculator to get the right amount of sun and vitamin D. If your fasting insulin is high, work on bringing it down which will help avoid damage to the skin and hair follicles.

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Why Your Waist Circumference Won't Budge

Dr. Ashori MD — Mon, 10 Aug 2026 14:30:47 GMT

You read that visceral fat is bad so you’ve been on a mission to get your waist number down. Let’s first make sure you’re taking the right measurement and then we’ll tackle stubborn weight around the belly.

A recent article in 2026 showed that visceral fat is a stronger predictor than BMI:

1. Are You Taking the Correct Measurement?

You’re 6’ tall and you read that a 32-34” waist is ideal but you’re hovering around 36.

You probably are measuring your waist circumference when you’re bloated, which naturally will give you a larger measurement. The best measurement is after you haven’t eaten for 12 hours and you haven’t eaten anything too bloat inducing.

Measure at the midpoint between the bottom of your lowest rib and the top of your hip bone (iliac crest). Keep the tape horizontal to the ground and take your measurement.

2. Abdominal Wall Laxity

You have a natural corset which is called the transverse abdominis. If your core is weak or you have some tissue laxity then it’s normal for abdominal content to protrude more, making a waist measurement less accurate.

In this case, your measurement will be falsely elevated. You may have no excess visceral fat.

3. Forward Tilting Pelvis

Anterior pelvic tilt increases the arch in the lower back and makes your belly stick out more, inflating your waist circumference numbers.

Before taking a measurement line up your pelvis. You can do this by slightly drawing your pelvis up. You don’t want to flex your abdominal muscles too much, but enough to line things up.

Now, what if you don’t have any of these issues but having trouble losing your stubborn belly fat.

Oh, and don’t slouch. Stand up straight when you take the measurement.

4. You Need More Time

You’ve eaten a perfect diet, exercised, cut out the alcohol, and getting plenty of sleep, but it’s only been 1 year. That’s not enough to fat redistribution and not enough for the fat to leave the belly.

If you’re in your 20s, yes, it’ll happen very fast. Past your 30s, it can take 12-30 months. The majority of the fat melted off but the last stubborn bit will also disappear if you stick to your plan.

5. Hyperinsulinemia

Insulin is the fat-storage hormone. If it hasn’t come down enough then it might continue to signal for more belly fat.

It can be a really stubborn hormone in some people but we’ve been able to get it down on almost everyone in my practice.

6. Excess Cortisol

There are a lot of cortisol receptors on deep visceral fat compared to subcutaneous fat. Unless this changes it’s hard to lose the last bit of excess belly fat.

Stress and chronic inflammation will keep the fat alive. You’ll constantly pull fat from under skin and mobilize it to the belly area.

7. Alcohol Consumption

For some people alcohol isn’t a problem but some adults have a different enzyme composition in the liver and this organ will prioritize processing alcohol over all other metabolic tasks.

When the liver can’t metabolize fats, they’ll land in the bloodstream and get deposited not just into visceral fat but also into the liver. Try experimenting with zero alcohol and see if that changes things.

8. Not Enough Muscle

Muscles are the best way to get rid of excess glucose in the bloodstream. If you don’t have enough then the extra blood sugar will get turned into triglycerides which will be deposited in the belly area, increasing visceral fat.

Finally, remember that your measurement is a crude metric for belly fat. If you want to know for sure then consider getting a DEXA scan, MRI, or even a bioimpedance measurement.

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Top 10 Ways to Fix Your Prediabetes A1C

Dr. Ashori MD — Sat, 08 Aug 2026 18:25:51 GMT

You were just told that your A1C is creeping up and you’ve done your online research, you’ve ordered your supplements, and been down the keto rabbit hole. Now, are you ready to embrace the evidence and do what’s been proven to work?

This comes from the archives of the many patients with high A1Cs in my practice who have reversed their prediabetes and even diabetes.

Western Medicine doesn’t want us to use the term “reverse”, they prefer “remission.” Whatever you want to call it, what I care about is that my patient’s metabolic health is repaired.

The Heart of Prediabetes

At the core of prediabetes is liver and pancreas fat. It’s not being able to properly use the insulin in your body, which negatively affects your blood sugar.

The problem with prediabetes is that it causes many of the problems you’ll have with diabetes - fatigue, infections, skin and eye damage, higher dementia risk, and joint degeneration.

Fix your metabolic health and you’ll reverse your diabetes risk.

Top 10 Actions in Descending Order

90% of adults only need to do the top 3. That’s it. The other 7 are for very resistant cases or the hardcore dedicated.

1. Fix Body Composition

A DEXA scan is the best place to start. We have tons of data on this, so it’s easy to look at your DEXA Body Composition report and see if you’re lacking muscle and/or too much visceral fat.

Most will achieve this by cutting back on calories and losing weight. But remember that prediabetes is very different from person to person; one having a more dietary issue and another from lack of movement.

2. Increase Your Glucose Transporters

You need many more cell transporters that take the glucose in your blood and store it in your liver and muscle.

The best way is with working out your muscles. Lifting weights or calisthenics works really well. Cardio does too but you’ll have to experiment to see which is best for you.

3. Increase Gut’s SCFAs

Your gut bacteria need fiber to create short chain fatty acids (SCFA) to help improve your body’s ability to manage glucose.

Fiber also blocks some glucose absorption. It won’t block a Coca Cola but if you’re having a healthy meal, the fiber will block any excess glucose from the veggies and scratches from getting absorbed.

4. Drop Your Post-Meal Glucose

Right after eating your body will see the highest spikes of glucose. Lower it by going for a walk right after your meal.

You don’t need a CGM, here. If you’re having prediabetes then you are definitely getting either glucose spikes or long-hauls of elevated glucose. Walk it off.

5. Decrease Fasting Insulin + 2-Hr OGTT

A1C is a very crude marker. If you’re going to do a blood test then do a fasting insulin and a fasting 2-hour glucose tolerance test. This tells you whether your metabolic system is moving in the right direction.

If it’s not then you might need to change the macro composition of your meals or adjust your activity level. Usually it’s the former.

6. Shift Your Calorie Timing

Most of us eat the heaviest meal at night. Don’t worry, you don’t have to starve.

Try having most of your calories early in the day and have larger volume food (read, more fiber) later in the day.

7. Drop Your Cortisol

Cortisol and insulin are fairly proportional for most people. Lowering cortisol helps lower your insulin which is a good thing for your blood glucose because it fights insulin resistance.

Stressed? Meditate or strategize good stress coping mechanisms.

Not getting enough sleep or ruining it with sleep apnea? Bock more time for sleep and wind down your cabeza in the evening.

8. Review Your Medications

There are a few medications that interfere with your metabolism which are worth discussing with your doctor. Any LLM these days can tell you whether your meds are or aren’t a problem and fortunately there are lots of alternatives available for most.

9. Cut Out Your Supplements

Supplements cause more harm than good. That’s what the evidence shows. Try stopping them for 6 months and see how your insulin, OGTT, and A1C respond.

10. Improve Glycogen Storage

We all have glucose in our blood stream but it needs to be tightly regulated. It’s okay to have a giant birthday cake as long as your body can stash that glucose away.

Having a cake right after a tough workout often repletes your glycogen stores which means less sugar floating around in the bloodstream causing damage.

Meds are also great for this. There are lots of options available from metformin to GLP1s. But they won’t rebuild your metabolic system. The other 9 options above will.

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Why Your Weight Fluctuates 5 lbs in a Day

Dr. Ashori MD — Tue, 04 Aug 2026 14:32:37 GMT

When you’re on a weight loss journey nothing is more demoralizing than seeing your weight jump up by 5 lbs in a day. It feels like failing but it’s actually all about osmosis.

I forget his name now, but a few years ago I saw a patient in the urgent care regularly for various health problems related to obesity. He’d weigh in at 385 one day and 360 just two day later.

#1. Water Retention

Women understand this much more intuitively because a menstrual cycle creates bloating due to fluid retention.

Progesterone blocks aldosterone receptors, which increases salt retention, and then estrogen drives thirst, which increases water retention.

Even without hormonal influences your thirst may be affected by temperature, humidity, exercise, and whether you’d had plain water versus fruits and vegetables.

#2. Salt is Powerful

Salt hides in plain sight everywhere these days. I had oatmeal the other day and the chef told me how much salt he puts in. Wow! No wonder it was so good.

Bread, pasta, pastries, canned foods, and restaurant foods hide a lot of salt as well. While you should be able to excrete it through the kidneys, your body can handle only so much.

There’s only so much extra sodium your body can filter through the kidneys and excrete in the urine.

#3. Food & Waste Build up

Your intestines can hold an impressive amount of mass. You would think that it should protrude by quite a bit if it’s holding on to an extra 5 pounds of food and waste. But you have a lot of “space” in the gastrointestinal tract and any excess weights will get tucked into your pelvis.

That’s why some people develop urinary obstruction, pelvic pressure, pelvic organ prolapse, and other pelvic problems when they aren’t able to evacuate their bowels adequately.

#4. Stress Affect Hormones

Most hormones have some downstream effect on water and sodium balance. And it’s not immediate. Your poor sleep on Monday may have you retaining water all the way through Friday.

Sympathetic activation, the RAAS system, vasopressin, and cortisol are affected by your stress and sleep quality.

Focus on Your Weekly Average

So, are you tracking your weight in hopes of improving your body composition? Focus on your average weekly numbers and less on daily values.

If I notice a lot of weight fluctuations in my patients I like to look at their salt intake, stress levels, and hydration. Usually we discover the source somewhere here.

I wrote this article for one of my health coaching clients who has been really frustrated with his yo-yo-ing weight. Once I explained this to him he stopped weighing himself weekly. That’s success.

And the only reason excess body weight fluctuations are important to me is that there is data to show that a lot of weight fluctuations could increase health risk. This mostly became apparent once someone’s body weight fluctuated by more than 7%.

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Are You Fit?

Dr. Ashori MD — Mon, 03 Aug 2026 20:01:52 GMT

Maybe you’re getting to that age when you’re wondering if you’re still fit. You ran in high school or played competitive sports but now you lost a step. So, are you still fit in all the categories that matter?

To be fit means you’ll recover faster from illnesses, avoid many diseases, and if you ever need a serious treatment for something like a heart attack, sepsis, or cancer you’ll fare much better than the average person.

My 3 Fitness Categories

In my practice we assess each patient’s fitness across strength, endurance, and power. You don’t need to be perfect in any of them but chances are your body type will naturally be better at one.

1. Strength

This is how effective your muscles are at moving objects. And it’s not just muscles, you’ll need nerve recruitment as well.

Without adequate baseline endurance, you can’t improve your strength. Because if you tire out by the 2nd set in the gym, then you can never do the necessary 3rd set to improve your strength.

2. Endurance

This is aerobic fitness and needs to be trained at very low levels. In sports physiology the sweet spot is training in your Zone 2.

My best friend from high school who’s dealing with a lot of health problems can’t walk more than a block right now. He gets short of breath, back starts hurting, feet cramp, and he gets lightheaded.

3. Power

I don’t have anyone in my circle of friends who train power but I’ve convinced most of my patients to train power. It’s the #1 category that declines after your 20s.

It helps you prevent falls, catch your stumbles, and heavily involves your reflexes, nerves, and antagonistic muscles. Think, medicine ball slams, kettlebell swings, box jumps.

Testing Your Fitness Level

First, why are you testing it? The best reason is that you want to make sure you are on track to age well and stay healthy. It doesn’t matter what John’s fitness level is, only yours.

I’ve provided 3 options for each test. And there are links to websites and apps that help you calculate your results to compare to existing standards.

A. Testing Your Strength

We want to know your 1-Repetition-Maximum, which the cool kids call your 1-Rep-Max.

Option 1: Pick your favorite compound movement like a squat or bench press and keep adding weights until you can only complete a single repetition, with perfect form. Use an online calculator to assess your level.

Option 2: Handgrip dynamometers are cheap and your gym might have one. It’s a great stand-in for your overall strength.

Option 3: If you consider 1 rep max too risky to test, you can do your 5-rep-max (lifting to technical failure by repetition #5) and use the Brzycki equation to calculate your 1-Rep-Max.

B. Testing Your Endurance

We want to know how efficient and effective your body is at using oxygen and how much stamina your muscles have.

Option 1: You can measure your VO2Max directly in a lab or estimate it using your wearable or calculate it using the Bruce Treadmill Test or YMCA Submaximal Cycle Test.

Option 2: The McGill Core Endurance Battery is a great test to measure your muscular endurance. It correlates well with your overall aerobic capacity.

Option 3: The ACSM push-up test measures the max number of continuous, proper-form reps of push-ups you can complete without resting.

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C. Testing Your Power

We want to know how explosively your neuromuscular system can create force in a short amount of time.

Option 1: The Vertical Jump Test is more of a lower body measurement but translates well to the whole body. You can shoot a video of yourself doing it and upload it to a website or use an app.

Option 2: The Medicine Ball Chest Pass is tough! You throw a heavy ball horizontally from chest level and measure how far you can throw it. More upper body, which won’t translate well to lower body.

Option 3: You’ll need an accelerometer (or a phone app) to measure your Bar Speed. It’s how fast you can move a bar with 50-70% weight of your 1-rep-max.

You Don’t Need Perfection

No matter when you’re at right now, the goal is to maintain or make improvements. Chances are you already know if your stamina is lacking or you don’t feel strong.

Numbers can be really helpful for tracking. If you can deadlift 100 lbs but don’t feel strong, aim for 125 lbs over the next 6-12 months. That’s a win.

How to Train Each Category

Having a personal trainer has been a game changer for me. If you can afford a good one, I highly recommend one.

A. Training Your Strength

To train your strength you need to follow the core principle of progressive overload. If you beat batter as a chef by hand, over time you’re going to beat the batter faster and beat more batter. You’ll get some really big forearms.

Add more weight
Complete more repetitions
Improve your execution (form)

2-3 times per week is usually sufficient. Rest 2-3 minutes between sets. The number of sets and reps will depend on your endurance, but 3-4 sets with 5-8 reps is a great start for strength. Keep good form and leave 1-2 reps left in the tank.

Aim for a squat, chest press, and deadlift. Here are versions we use in my practice:

Goblet Squat: This loads the weight more in the front, keeping the torso upright, reducing stress on the lower back.
Neutral-Grip Dumbbell Bench Press: Great for anyone with shoulder pains or impingement.
Trap Bar Deadlift: Keeps the load centered, minimizing lubar stress but still loading your legs effectively.

B. Training Your Endurance

We are trying to build your aerobic base by increasing mitochondrial density and those tiny capillary networks. The goal is to avoid metabolic fatigue which is hard to recover from.

Aim for 3-4 days per week, easily combined with your strength days. Ideally a continuous session of 30-45 minutes.

Stationary Incline Walking: Low impact on joints. You can track your Zone 2 HR on your phone or watch or just measure manually.
Stationary Ergometer Cycling: Low-impact and easy on the tush. Switch to regular cycling if you prefer.
Elliptical Trainer: It’s a full-body workout that’s still easy on the knees. Replace with a rower if you prefer.

C. Training Your Power

This is what I’m focusing on right now with my trainer. In rock climbing, you need power to get through complex moves without tiring out. We want quality + speed, not grinding + fatigue.

Aim for 1-2 days a week with a lot of rest between sets.

Kettlebell Swings: Trains explosive hip extension and safe on the back as long as you keep the weight low, focus on form, and speed.
Medicine Ball Slams: Improves upper body power. You can do chest passes instead if the slamming is too loud in your gym.
Box Jumps: Builds that explosiveness in the lower body. You don’t need a tall box. Focus on form and speed.

Disclaimer:

I Polled My Patients - Here Are 10 Things They Taught Me

Dr. Ashori MD — Fri, 31 Jul 2026 14:32:08 GMT

You’ve tried everything, but haven’t yet succeeded. This is the collective trial-and-error of my practice which might just offer a shortcut.

1. Stress

Acknowledging the source but not obsessing over it
Having a therapist or close friend to talk to about the source

Stress often can’t be avoided but we can cope or manage well with it. It should never be about becoming better at tolerating an unhealthy situation.

More sleep, magnesium, and ashwagandha didn’t offer long-lasting fixes. The goal is to gain enough clarity and headspace to address the root-cause.

2. Sleep

Tiring yourself physically but not mentally/emotionally during the day
Perfecting common triggers like sleep apnea, caffeine, sugar, pain, and anxiety
Not trying to perfect sleep, just improving it

Yoga nidra, melatonin, and Ambien might be effective tools but most of my patients ditched them as standalone strategies.

3. Weight Loss

More fiber for long-term weight loss
Setting eating windows for those who love snacking
Carbonated water, tea, decaf coffee, and fruits for the snackers

I’ve had quite a few people in my practice who couldn’t tolerate GLP1s. I’m surprised when I read about the blatantly positive responses others seem to have online. While weight loss medications remains a great tool, they don’t address the root cause of weight loss.

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4. Fatigue

Making active time for recovery
More exercise (counterintuitively)
Taking iron

Taking iron supplementation came up a few times so I included it. But I’ve not found it to be particularly helpful.

Fatigue often happens because we don’t have enough downtime from daily stressors and the exercise we do is too intense.

5. Unfocused/Brain Fog

More sleep + better sleep quality
Reducing mental overload (most learned to delegate more)
More nutrition, fewer calories

Stimulants and ADHD medications were effective for some people in the beginning. But they often cause tolerance, requiring higher dosages which comes with side effects.

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6. Bloating/Constipation & IBS

Identifying food triggers (cold foods, fruits, bread)
Playing around with the type of and amount of fiber.
Stress management

In #3 my patients taught me that more fiber helped them with long-term weight loss. But not everyone responds well to fiber. It needs a thoughtful and gradual approach.

7. Acne and Eczema

Simplifying skin care routines (fewer products, fewer treatments)
Sticking with the same treatment even when there are occasional flares
Completely cutting out added sugar and refined carbs

I wrote about rosacea before and what I learned from my older patients with that condition.

While medications were very effective for both acne and eczema, they also had plenty of side effects.

8. Hair Loss

Identifying why you’re having the hair loss
Sticking with one treatment long enough to see results
Poor nutrition + iron deficiency had huge wins in men + women

Many started with complicated regimens, peptides, meds, and over time they didn’t have long-term results. It seems that simplifying the treatment once the underlying cause is identified had the best results.

9. Back Pain

Almost always muscles or tight fascia (not herniated disc or sciatic issues)
Improving strength and mobility
Rebuilding confidence and cultivating the belief that you can be pain-free

After surgeries, injections, and meds many of my patients realized that their back pain was from some tight structure, a weak muscle somewhere, or inadequate overall strength.

10. Metabolic Health

DEXA scan to help guide weight management
Walking, more so than other exercises
Less refined carbs.

I know these seem intuitive but many of my patients believed they were eating healthy, unrefined diets until we recorded each meal for 2 weeks.

Most of my patients tried so many different things. Some tried them not long enough to see results. And many got caught up with medication, surgeries, and complicated regimens with few results.

The theme is that you have to try different things but consistency matters most. Don’t give up if you don’t see results right away (hair), and don’t assume you’ll never improve (back pain + acne.)

Disclaimer:

The Big Guns in Medicine

Dr. Ashori MD — Thu, 30 Jul 2026 14:30:05 GMT

There’s some health risk you’re facing that might be keeping you up at night. Maybe you were told it’s the prediabetes that could turn into diabetes or the small nodule in the lung that could become cancer.

Many believe that Western Medicine has a big pocket of cures, ready to be doled out once the right diagnosis is made. That’s why we read headlines like “This Big Name Hospital Missed a Major Diagnosis.”

As if all that’s needed is the right diagnosis and you’ll be cured.

This isn’t what doctors believe. We know this is just what the healthcare industry is trying to sell people.

Joint Replacement Surgery

Many patients in primary care talk about “waiting for their new hip.” They are dealing with some nagging pains with the hip and watching it gradually worsen.

At some point, they’ll be ready to pull the trigger to have that him replaced. It’s a “routine” surgery. In fact, it’s called an elective surgery. Most surgeons will tell you that they’ve done hundreds/thousands of them and you should be fine.

And without a doubt, most of my patients have done really well. But quite a few didn’t do well. And once you are that 1% statistic, you are 100% affected.

Joint preservation should be on every adult’s mind. I know it’s not sexy but whatever you can do to keep your knee, hip, back, and shoulder healthy will help you prevent such a surgery.

Prostatectomy

An enlarged prostate is something many men deal with over their lifetime. Sometimes it’s bad enough that medications aren’t enough and a full removal of the entire prostate is necessary.

It’s a major surgery but also considered fairly routine. It’s the bread and butter of many urologists.

But prostate enlargement tends to follow a certain trend in older men. We know there are steps you can take to prevent it.

And while there’s nothing wrong with waiting until it’s bad enough that you’ll need surgery, the surgery isn’t without risk. And the decade leading up to that surgery is riddled with sleepless nights and medication side effects - something the surgery won’t give you back.

Check out this article on preventing prostate enlargement:

IV Antibiotics for Sepsis

One of the main reasons to end up in a hospital these days is for a fever. Without a doubt you’ll be started on empiric antibiotics. This is to help prevent or treat a possible early sepsis.

One one hand, this is the magic cure of Western Medicine in this modern age. On the other, it’s creating the antibiotic resistance tidal wave we all have to face some day.

There’s nothing more effective at combating sepsis than a healthy immune system. The proper nutrition, sleep, stress, and all the other boring things that make up “Lifestyle Medicine” help prevent an organism from taking over the bloodstream.

Downplaying the Heavy Toll of “Normal” Side Effects

Some patients view joint replacement, pelvic surgery, or IV antibiotics as a reset button. They don’t realize that even a successful procedure will have many lasting consequences.

Many will need repeat procedures, revisions, and follow-up for ongoing pain or recurrences. Some will have to be on medications for a long time after such interventions - even if all goes well.

The Big Guns Are Becoming Routine

We are so fortunate to have these big guns and some will unfortunately need them even if they did everything “right.”

Rheumatoid Arthritis can destroy joints and some may end up needing a joint replacement. Or a severe car accident or infection may destroy a joint enough that it has to be replaced.

Someone who eats well, has controlled their weight, and is active may still develop an enlarged prostate. But the good news is that they may never need a total prostatectomy if they can keep it from getting worse.

And while many of us will develop pneumonia or UTI at some time in our lives, the kind of immune system we cultivate now may prevent it from spreading to the bloodstream.

Know someone dealing with this? Send it to them.

Healthcare Can’t Keep up

The healthcare system in almost every country is overwhelmed, understaffed, and way over budget.

We live in a world with finite resources. The best thing we can do for each other as human beings is to protect precious finite resources. Whatever I can do to keep myself healthier will free up resources for someone else who more desperately needs treatment.

We also can no longer rely on ‘routine’ treatments to be routine. In an overwhelmed healthcare system the same simple procedure may have many more complications.

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Top 5 Ways to Get the Most out of Your Wearable Health Tech

Dr. Ashori MD — Tue, 28 Jul 2026 20:46:42 GMT

Every week, I have a new patient proudly display their wearable health data on a screen. The problem is they are often overwhelmed by the information and haven’t made a meaningful change despite the gadgetry.

My method is that we use the right tool for the right amount of time to give us the exact answer we’re looking for. Then the device goes offline until it’s needed again.

1. What Problem Are You Trying to Solve?

We use wearables quite a lot in my practice. But the first question is what problem we’re trying to solve. Most of the time the answer won’t come from a wearable.

In fact, stopping the use of a wearable has often decreased anxiety, relieved stress, and helped my patients become more in-tune with how they feel, instead of what shows up on their app.

A patient was wearing a CGM because he was worried about glucose spikes. He was noticing them when he’d eat watermelon. So he cut out the watermelon. The problem is that he was also replacing it with more candy and pastries. This made his A1C go up.

Not Sure What to Focus on First? Your wearable can give you plenty of data. The harder part is knowing what actually deserves your attention. I created the free Healthy Aging Type Quiz to help you identify which area sleep, nutrition, recovery, or your daily routine, may be getting in the way of your progress.

Take The Healthy Aging Type Quiz Now

2. Increasing Your Daily Movement

By far the most supported evidence comes from using a wearable to help you get more steps in. The number of steps doesn’t matter. What matters is that you get more steps.

Many underestimate how many steps they get doing chores in the house. Just as many overestimate their activity levels.

A patient who was wearing his Oura Ring told me he’s getting close to 10K daily just doing house chores. We looked up the numbers and his 2 week average was 4,280.

3. Controlling the Dose of Exercise

How much exercise does your body need? At what intensity? How frequently and at what duration?

Most adults need more time in moderate-intensity exercise, often called Zone 2. But most are getting too much training in higher zones in short bursts, essentially not getting any good results.

Higher zones ≠ better training. In fact, you’ll need more time to recover, suffer more injuries, and won’t burn off the necessary fat through fat oxidation.

A patient’s Polar Chest Strap showed that she’s mostly in Zone 3-4 when exercising. We dropped her down to Zone 2 and she enjoyed better sleep, better recovery, and lost that stubborn weight she was battling.

4. Improve Your Duration

It’s not the sleep quality that improves with a wearable. The amount of Deep Sleep, Light or REM, or frequent awakenings are less valuable than your total sleep duration.

Almost any vetted wearable device can give you Polysomnography-level accuracy on the total time you were asleep.

You’ll start noticing a trend that with late meals, alcohol, arguments, or too much screen time you’ll spend fewer hours in bed. That’s one of the easiest sleep problems to remedy.

5. Heart Rate Data

The most important ones here are: resting heart rate, heart rate recovery, and exercise-level heart rates.

I didn’t mention HRV or the estimated VO2Max because they just aren’t that accurate and vary a lot based on genetics. Sure, if you see an upward or downward trend over time, it’s a valuable signal but the actual numbers don’t tell us much.

However, I want most of my patients to enjoy a low resting heart rate and I don’t want light-to-moderate exercise to spike up their HR too much. And for HR recovery, I want them to drop 20-30 beats in the first minute.

My patient’s Whoop Device showed that he only dropped 10-15 beats after an intense session. We dropped his hard workouts, switched him do more endurance training, had him to some breathing exercises and foam rolling of his ribs before a session and we got him up to ~30 BPM drop. Use this handy calculator for your next exercise session.

Know someone using a wearable? Send it to them.

Looking for the best health tracker?

Of course, it matters what question you’re answering. The goal with health techn isn’t to make you dependent on tech but to have you become more in-tune with your body.

Until next week,

Disclaimer:

The Danger of Chasing Biomarkers

Dr. Ashori MD — Sat, 25 Jul 2026 21:28:54 GMT

The biggest risk to your health these days might be the lab test which you should have never gotten in the first place.

I have 2 patients in my practice with confusing lab numbers. Both came to me because their doctors were treating the lab values, not the patient.

80 Yo Active Woman

Meet H., an active 80 yo woman living on her own. She does regular exercises, goes for walks, cooks her own meals, and takes good care of herself.

Her A1C, a marker for diabetes, was going up, so her doctor recommended a dietary change. She was even diagnosed with prediabetes and offered meds.

45 Yo Sedentary Man

Meet M., a 420 lb man who had been trying to lose weight for a few years. Other than his weight, his labs were perfect. His total cholesterol was under 150. His A1C was 5.2. Never had a problem with his blood pressure.

He assumed this meant great health. And, in fact, his doctors were treating the lab values and only advised him on weight loss.

Treating a Lab Value

Even as medical students we learned to not get fooled by normal or abnormal lab values. I’m certain that wasn’t training unique to our medical school at UCLA.

If someone’s blood sugar is going up but they have no risk for diabetes, what’s the value of taking any action? A high A1C doesn’t cause diabetes.

A better question is why someone was checking this 80 yo’s A1C.

In fact, she suffered a lot from that dietary change. She developed severe diarrhea, then a bout of rectal bleeding, which needed an extensive workup. After nearly a year of chasing symptoms, she switched back to her previous diet. And she’s back to normal.

Understanding Root Causes

You don’t just keep repainting your ceiling when you see water stains from the rain. Your contractor will recommend repairing or replacing your roof.

With health, addressing the root cause is even more important because you can’t replace your roof and patch jobs rarely are successful.

M.’s doctors told him to lose weight because his lab values were normal, it wasn’t urgent. But it actually was - and not just urgent, emergent.

He ended up in the emergency room with several serious issues related to his weight. Not only did he end up needing emergency surgery, but because of that his entire lifestyle will need to change moving forward.

Know someone dealing with this? Send it to them.

The Value of a Lab Result

A popular trend right now is the 200-point lab tests that many companies advertise. Patients book a call with me to go over these fancy printouts. There’s almost always something abnormal.

Even during your annual physical it’s quite likely that your doctor will order a CBC, CMP, A1C, Lipid panel, and TSH.

Unfortunately, such screening tests cause so much havoc for patients. They’ll have to chase each abnormal result and perhaps start a medication. After all, you can’t unsee a high LDL-C or a high liver enzyme.

But just because someone’s liver enzymes are high it doesn’t mean something is wrong with their liver. Lots of benign things can raise your liver enzymes. And it’s quite unlikely that your 10-minute primary care appointment will tease that out. So, off to the hepatologist you go.

Frustrated by one-size-fits-all advice? I take on a limited number of 1-on-1 coaching clients to dive deep into your unique health history, identify your physiological triggers, and design a sustainable plan to help you feel your best.

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Knowing When to Order a Test

Both of these patients are doing much better. H. is back to her old lifestyle and feeling great. And M. is on track to lose a lot of weight, albeit it’ll take a while to get there.

The right time to get a blood test is when the current information is not enough. When you’ve exhausted all available knowledge and you still suspect a risk, that’s when you order a very specific test.

If I’m suspecting a blood sugar problem in H. I’m not going to get an A1C which is very non-specific in someone of her ethnic background and age. I would instead get a fasting insulin. Which, in fact, was normal for her.

Step 1: Define risk first, don’t think about the test.
Step 2: Look at the person, not just the wall of numbers on a page.
Step 3: Ask your doctor, “Okay, so what?”

Disclaimer:

5 Signs Your Blood Sugar May Be Causing Your Brain Fog

Dr. Ashori MD — Mon, 20 Jul 2026 23:36:10 GMT

Perhaps you’ve found yourself mentally clear in the morning but struggling after lunch. Or you can’t concentrate well when you go too long without eating.

It’s often sugar and caffeine that temporarily make you feel normal again. Which isn’t a major problem but things are getting worse. And your labs aren’t showing anything obviously wrong.

Welcome to the Physician-Led Health Coaching weekly newsletter. I’m Dr. Ashori, a board-certified physician turned health coach. I help people fix brain fog, fatigue, and stubborn weight before they turn into real disease.

Blood sugar does not need to reach the diabetic range to affect how alert, focused, or mentally steady someone feels. Sudden rises and fast falls affect your cognitive function even with normal fasting glucose or A1C.

1. Your Brain Fog After Meals

The classic situation I see in my practice is you eat breakfast or lunch and feel sleepy, unfocused, or mentally slower 1-3 hours later.

Meals dominated by refined carbohydrates can cause glucose to rise quickly. The subsequent drop may leave some people feeling tired or foggy, especially when the meal contains little fiber, lean proteins, or healthy fats.

The classic examples are:

Cereal and juice
A bagel by itself
Pastries or sweetened coffee
A large portion of white rice or pasta without veggies to slow their absorption

Pay attention to how you feel after a refined-carbohydrate meal with how you feel after a meal containing adequate fiber, proteins, and fats. Jot down some times in the day or week when your brain fog feels most pronounced.

2. Irritable, Shaky, or Headachy When You Eat Late

Missing lunch shouldn’t make you feel anxious, irritable, weak, headachy, or unable to think clearly. Hungry, yes, but it shouldn’t affect your baseline brain function.

A rapid glucose decline, combined with stress hormones such as adrenaline, can produce similar symptoms even when glucose has not fallen into a medically dangerous range.

Ask yourself, does the problem predictably appear when meals are delayed and improve soon after eating?

The best strategy here is to have consistent meal timing and more substantial meals rather than constant snacking. Each meal should have adequate fiber (to slow glucose absorption), protein (satiation), and fats (absorb nutrients.)

3. Rapidly Crashing Energy & Concentration

Most of us alternate between feeling productive and struggling with work. But with adequate rest and proper nutrition, you should be able to enjoy productivity without being hindered by less taxing work.

A common pattern might be:

Clear in the morning
Sluggish after breakfast or lunch
Better after coffee or something sweet
Foggy again a few hours later

Mental performance usually should not rise and fall dramatically based on the last snack or cup of coffee. Large swings may indicate that meals, sleep, caffeine, stress, and glucose regulation are interacting poorly.

Track your meals, energy, and concentration for 1 week. You don’t need a glucose monitor.

A simple record could include:

What you ate (take a photo)
When the fog started
Whether you were hungry, shaky, or craving sugar
What made the symptoms improve

Blood sugar is only one possible contributor to brain fog. Sleep quality, stress, medications, nutrient deficiencies, hormones, and several other patterns can cause similar symptoms. If some of these signs sound familiar, my free Brain Fog Reset Guide will help you look at the bigger picture and decide where to start.

Get your free copy here

The Brain Fog Reset Guide contains:

The most common overlooked causes of brain fog
A simple self-assessment
Practical changes readers can begin immediately
The exclusive health-coaching gift included with the campaign

4. Depending on Sugar or Caffeine to Feel Normal

Coffee or the occasional sweet treat should be a treat for the taste buds but not a crutch for the brain to function daily.

Sugar temporarily raises glucose, while caffeine temporarily masks fatigue. Neither addresses the root cause of why energy & concentration are crashing.

Needing morning coffee (me!) is not proof of a blood-sugar problem. But needing repeated rescue throughout the day might be. This is one of the reasons I’ve cut back by caffeine intake and feel better overall.

Do you need something sweet each afternoon?
Does caffeine briefly improve your brain fog?
Are cravings strongest after less-balanced meals?

The right strategy is to improve the overall meal structure and not necessarily cutting out the caffeine. Once the metabolic system is repaired, the occasional sweet treat will be a welcomed treat, not a crutch for your brain.

5. Other Signs of Poor Metabolic Health

Metabolic health is at the heart of preventing heart disease, diabetes, strokes, dementia, liver disease, and joint degeneration. We have a few strong clues to recognize it.

Possible accompanying clues

Increasing waist circumference
High LDL-C or apoB or triglycerides
Elevated fasting glucose or insulin
A history of gestational diabetes or polycystic ovary syndrome
A strong family history of type 2 diabetes
Sleep apnea
Increasing blood pressure

While no individual indicator confirms that blood sugar levels trigger brain fog, a metabolic connection becomes increasingly likely when multiple signs appear in tandem.

I don’t rely on a normal blood glucose or A1C to tell me what my patient’s metabolic health is up to. Because it’s so prevalent and easy hide, I often go digging with some of the tests mentioned above.

Summary: Look for the Pattern, Not One Symptom

Brain fog is not always caused by blood sugar, but it also should not automatically be dismissed as stress, aging, or a lack of motivation.

The Brain Fog Reset Guide covers the other common contributors and provides the next step you can take to regain your focus and energy.

Download the guide here

Disclaimer:

Top 4 Ways to Decrease Overall Mortality

Dr. Ashori MD — Fri, 17 Jul 2026 21:00:17 GMT

Ever wondered what increases your risk of having a major adverse health event? In medicine we call that mortality, also morbidity.

After reading this article by Dr. Cifu I thought about digging into the research. As with all research, there’s no clear answer, but this list is quite an accurate, though likely not precise list.

For an average, generally healthy 30- to 40-year-old who does not smoke or use illicit drugs, here’s the most defensible descending order.

Top 10 Ways to Reduce Your Risk of Dying Early

The top 4 on this list is what I promised and are the most effective strategies. But what matters more is knowing what you are at risk for. Then set out to mitigate your individual risk.

For example, I’m a rock climber. My biggest risk isn’t #1 or 2, it’s #3.

1. Build or Maintain Physical Fitness

Regular aerobic exercise, resistance training, and daily movement have the broadest reach across cardiovascular disease, cancer, diabetes, mental health, and functional aging.

Meeting both aerobic and strength-training guidelines has been associated with roughly 40% lower all-cause mortality compared with doing neither. (British Journal of Sports Medicine)

If you can’t do any of that above, just walk every day. It’ll get you 90% there.

2. Know and Control Your Blood Pressure

High blood pressure progressively increases the risk of heart disease, stroke, kidney disease, and premature death. Even “high-normal” blood pressure in early and middle adulthood predicts greater long-term cardiovascular risk. (New England Journal of Medicine)

Every 10 mmHg increase in systolic blood pressure was associated with an unadjusted 17% higher relative risk of death from cardiovascular disease, according to that study above.

“Among the six populations we studied, the relative increase in long-term mortality due to CHD for a given increase in blood pressure is similar, whereas the absolute risk at the same level of blood pressure varies substantially.”

3. Take Injury Prevention Seriously

Wear a seatbelt, use an appropriate helmet (especially when rock climbing), avoid distracted or impaired driving, and practice safe firearm storage.

Unintentional injuries remain the leading cause of death through age 44, although drug poisoning accounts for a significant portion of that category. (CDC)

For you, it might be getting on your ladder to work on your roof or swimming in the ocean. Know your biggest risk and mitigate it.

4. Avoid Heavy and Binge Drinking

The important distinction is not simply “drink or do not drink.” It is avoiding intoxication, binge drinking, impaired driving, and cumulative heavy use.

Excessive alcohol contributes to injuries, violence, cancer, liver disease, cardiovascular disease, and approximately 178,000 US deaths annually. (CDC)

5. Know and Control Your LDL-C, ApoB, or Non-HDL-C

Someone can exercise and feel healthy while carrying substantial long-term cardiovascular risk from high atherogenic particles or inherited lipid disorders.

Lipoprotein measured in young adulthood predicts cardiovascular disease decades later. (New England Journal of Medicine)

“Our study focused on five modifiable risk factors for which strict control could potentially prevent 57.2% of all cases of cardiovascular disease in women and 52.6% of all cases in men globally.”

6. Prevent Visceral-fat Gain and Metabolic Dysfunction

Waist gain, insulin resistance, fatty liver, hypertension, and rising glucose often develop together.

Maintain a favorable waist size, body composition, glucose regulation, and metabolic profile while preserving muscle and fitness. (British Journal of Sports Medicine)

“Our analyses found that those classified as fit, regardless of BMI status, showed no statistically significant increase in CVD or all-cause mortality risk compared with normal weight-fit individuals.”

7. Eat a Consistently High-Quality Diet

Prioritize minimally processed foods, vegetables, legumes, fruit, whole grains, nuts, seeds, and appropriate protein.

Limit excess sodium, refined carbohydrates, processed meats, and heavily processed calorie-dense foods.

Diet works partly by improving blood pressure, lipids, glucose, weight, and cancer risk, rather than through one supposedly perfect food. (World Health Organization)

“A healthy diet comprises a combination of different foods... Eating a variety of foods and consuming less salt, sugars and saturated and industrially-produced trans-fats, are essential for healthy diet.”

Book a 1-Hour Call With Dr. Ashori

8. Protect Your Mental Health and Respond Early

Suicide is already one of the leading causes of death in this age group. Persistent depression, escalating alcohol use, hopelessness, severe anxiety, and suicidal thinking deserve the same urgency as significant physical symptoms. (JAMA Psychiatry)

“Although the pooled effect size for suicidal ideation was small, the 30% lower risk of suicide attempts associated with both direct and indirect treatments can be considered clinically relevant, given the severity of such events.”

9. Get Adequate Sleep & Evaluate Possible Sleep Apnea

Chronic short sleep is associated with higher all-cause and cardiovascular mortality.

Snoring, witnessed breathing pauses, morning headaches, unexplained hypertension, and excessive daytime sleepiness should not be dismissed simply because someone is young or productive. (PubMed)

“Short sleep duration (< 7 h per night) was associated with a 14% increase in mortality risk compared to the reference of 7-8 h.”

10. Use Preventive Medicine Appropriately

Stay current on recommended vaccines, complete age- and risk-appropriate cancer screening and prevention, protect your skin from excessive UV exposure, and discuss earlier screening when family history warrants it. (uspreventiveservicestaskforce.org)

“The USPSTF recommends offering or referring adults with cardiovascular disease risk factors to behavioral counseling interventions to promote a healthy diet and physical activity.”

Disclaimer:

The Mystery Pill in Your Cabinet

Dr. Ashori MD — Thu, 16 Jul 2026 17:49:06 GMT

Staring at a bottle of imported Ayurvedic herbs or a random wellness powder, it’s easy to wonder what’s actually inside. Standard label regulations don’t guarantee purity.

Consumers have two options: look for the gold-standard independent trust seals, or in high-risk cases, hire industrial forensic labs for private, out-of-pocket analysis.

Standard retail testing kits only look for specific pre-determined elements like lead or mercury. But what if you want the full blueprint? What if you need to rule out undeclared pharmaceuticals, harmful fillers, or complete botanical substitution?

19 Yo With Liver Failure

10 years ago I was working in the Urgent Care when I saw a 19 yo with a few vague complaints. A few basic labs revealed that he was in liver failure.

He wasn’t drinking alcohol, taking no medication, no family history of it … but he was taking an over-the-counter weight-gain supplement. Long story short, after the State forensics got involved, it turned out that there was hepatotoxic impurity in that popular supplement.

He recovered well but it took months and it’s hard to know the long-term consequences.

The First Line of Defense: The Big 3 Quality Seals

Before you spend hundreds of dollars on custom chemical analyses, the FDA and physicians recommend looking for independent, third-party certification seals.

These organizations audit manufacturing facilities, review label accuracy, and run random test batches. If your bottle has one of these verified seals, the heavy lifting has already been done for you:

1. USP (U.S. Pharmacopeia) Verified Mark

The USP mark is the gold standard of pharmaceutical and dietary supplement verification.

A USP-verified product guarantees that the supplement actually contains the exact ingredients in the listed potency, has zero harmful levels of heavy metals or microbes, and is formulated to break down and absorb efficiently in your system.

2. NSF Certified / NSF Certified for Sport

NSF International conducts strict toxicological reviews, audits GMP (Good Manufacturing Practices), and checks for physical contaminants.

For athletes, their “Certified for Sport” seal is the absolute baseline, testing against 280+ substances banned by major athletic organizations.

3. ConsumerLab.com (CL) Approved Quality Seal

Unlike other groups, ConsumerLab buys products directly off the shelves from retail stores instead of accepting samples from manufacturers.

They are famous for maintaining the strictest purity requirements, often setting heavy-metal limits up to 40 times lower than competitors or federal standards.

The Problem With “Quality Seals”

These seals are a pay-to-play agreement. As a supplement manufacturer you have to pay a lot and once you pay that money to these organizations, they want to keep you happy.

This also means that smaller companies won’t be able to afford these seals even if they have better manufacturing practices.

Finally, many of these supplement companies may claim on their website that they are “USP/NSF Certified” - but that’s only for one of their product lines, not the rest of their supplements.

The Ultimate Option: Independent Forensic Labs

If your supplement doesn’t carry these seals, or if it is an imported, traditional preparation like a bhasma (metal-processed Ayurvedic powder) with high contamination risk, you can pay out of pocket for high- precision, untargeted testing to identify every chemical structure inside.

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Option A: Measurlabs (Helsinki/Global)

When my patient can afford it and is adamant about a particular supplement, we get it tested.

For US clients, the first option is Measurelabs, best suited for direct, user-friendly testing.

Their “Identification of an Unknown Substance” panel is specifically structured to identify both organic active herbs and hidden chemical structures in a mystery sample.

Estimated Cost: Typically $500 - $1,500+, depending on sample complexity.
Turnaround Time: 10 - 15 business days.
Best For: Clear, highly guided process for individual out-of-pocket payers.

Option B: Analytical Research Laboratories (ARL)

ARL is an ISO 17025 accredited, FDA-registered scientific powerhouse based in Oklahoma.

While they primarily serve compounding pharmacies and manufacturers, they accept individual private pay.

Estimated Cost: Starting around $300 for basic HPLC (chromatography) potency, scaling to $1,000+ for untargeted chromatography screens.
Turnaround Time: 5 - 10 business days.
Best For: Industry-grade, legally-defensible purity and potency reports.

Making a Better Decision: The 3-Step Framework I Use

Do you want to know if a product is safe (requires a heavy metals/microbiology screen, $100-$200) or what it actually is (requires an untargeted GC-MS screen, $500+)?
Prioritize testing for formulations with high historical risk, such as heavy-metal-vulnerable Ayurvedic or athletic supplements prone to synthetic drug adulteration.
Save money by purchasing brands pre-certified by NSF, USP, or ConsumerLab.

Disclaimer:

12 Rosacea Habits That May Calm Redness and Flares

Dr. Ashori MD — Wed, 15 Jul 2026 22:41:04 GMT

If you’ve been dealing with skin redness and rosacea flares, this article is for you. Lifestyle changes are huge to help you manage it but sometimes you just need medications or laser to really calm things down.

This is the cumulative knowledge of several individuals who’ve lived with rosacea whom I’ve polled in my medical practice.

The reason I’m including rosacea in my newsletter is because of the strong association between it and both metabolic syndrome and cardiovascular disease.

Historically, rosacea was treated strictly as a localized cosmetic skin issue. However, contemporary research views it as a systemic, chronic inflammatory disorder.

1. Stop Overdoing Skincare

A lot of people said their skin improved when they stopped multiple products and simplified everything.

Some people even stopped morning face washing, stopped double-cleansing, stopped serums/toners, or used only water.

Avoiding all the chemical-laden skin care products has had a lot of other health benefits for my patients.

2. Get Diagnosed Properly

Several people said the real turning point was seeing a dermatologist and realizing it was rosacea, not adult acne. They can really look alike.

With the right diagnosis, you get the right treatment:

Metronidazole, ivermectin/Soolantra/Rosiver, doxycycline, azelaic acid, compounded “triple cream,” low-dose minocycline, Rhofade, and sometimes low-dose Accutane.

3. Ivermectin is Popular

This was probably one of the most repeated medication mentions. And there’s good data to back it up.

Pubmed

People described it as a “game changer,” especially for type 2 papulopustular rosacea. Some said it took weeks, one person said it took 8 months for full clearance.

4. Doxycycline Helped Some Dramatically

Several mentioned low-dose doxycycline helping pustules, painful flushing, or type 2 symptoms.

Doxy for rosacea

Some said symptoms returned when they tried to stop.

5. Sunscreen, Especially Tinted or Zinc

Daily sunscreen was another major theme.

People mentioned tinted sunscreen because it both protects and visually softens redness.

Zinc/mineral sunscreens came up repeatedly. Some specific products mentioned included La Roche-Posay Anthelios, Australian Gold tinted, Dr. G Green Mild Up, ISDIN, and La Roche-Posay tinted SPF.

Book a 1-Hour Call With Dr. Ashori

6. Alcohol Avoidance

Multiple people said stopping alcohol made a big difference, even if they only drank occasionally.

Other dietary triggers mentioned: sugar, dairy, chili/spicy foods, high-fructose corn syrup, red meat, greasy food, caffeine, and high-histamine foods.

7. Temperature Control

A lot of people focused on heat and temperature swings.

Common tips: Avoid hot showers. Use cool or tepid water. Do not wash face in the shower. Avoid letting shower water hit the face. Stay warm enough in winter to avoid cold-triggered rebound flushing.

8. Exercise Had Mixed Reports

Some people said cardio before a meal or event helped them “get the flush out of the way” and stay calmer afterward.

Others said cardio or gardening made them stay flushed for hours. So this seems very individual.

I always start exercise in my rosacea patients slowly, especially when outdoors. Almost always, more exercise improves symptoms.

9. Omega-3s

A few users said omega-3 supplements helped redness, type 2 symptoms, or ocular rosacea.

Some discussed algae-based EPA/DHA versus flax oil. One person reported improvement after about 6 weeks.

I’ve not had a lot of success with omega-3s but I still recommend people try it.

6 daily habits that decrease inflammation and improve metabolic health:
Download the free guide!

10. Sulfur Soap/Wash

Several people mentioned sulfur soap or sulfur wash, sometimes as a second cleanser or short mask.

One of my patients used a cheap 10% sulfur bar and noticed less cheek redness within about a week. N=1.

I’d clear this with your dermatologist first because it can worsen reactions.

11. Lasers and Light Treatments

Vbeam and IPL were mentioned as helpful for redness/flushing, especially when topicals did not fix the vascular redness.

One person said Vbeam required 4 rounds initially and then yearly maintenance. Another said IPL greatly reduced weekly flares after 2 sessions.

12. Look for Overlapping Conditions

Several people mentioned that their “rosacea” was partly something else or overlapping with something else.

Examples mentioned: Seborrheic dermatitis. Allergies. SIBO. Ocular rosacea. Demodex-related symptoms.

Disclaimer:

What's Your Body Composition?

Dr. Ashori MD — Fri, 10 Jul 2026 19:39:43 GMT

Have you noticed how there’s a sweet spot for your weight? It’s number when you feel the best in your body.

Interestingly, it’s not always the same. The 172 lbs of 2024 now feels too much or too little. It’s because what matters much more than your weight is your body composition.

Your body composition is the most sensitive way to assess your physical overall health. It’s more granular than weight, and much less crude than your BMI.

InBody Body Composition Analysis

This is the report that this $10,000 machine gives you. It takes less than 2 minutes and it’s basically a body impedance device, which is different from a DEXA Scan that uses imaging.

As a physician, the most important data I want to know from this are:

SMI - which is the same as ALMI, or total muscle mass relative to height
PBF - percent body fat
Grip strength

You get a few other interesting calculations and numbers:

Basal metabolic rate - how many calories you burn at baseline
Estimation of your visceral fat
ECW/TBW ratio - guesstimate of excess fluid or inflammation

Weight and BMI Are Crude Metrics

Modern food technology unfortunately has created normal BMIs but very unhealthy fat distribution. That’s why it’s not a good metric for most of us.

High protein intake and exercise has made weight also a less useful metric. That’s why in my practice we rarely talk about weight but care more about someone’s body composition.

I’m not sponsored by InBody and there are lots of great alternatives but if you’re looking to get yours done, check out their map here.

Grip Strength

There’s a lot of hype about grip strength and leg muscles. I consider them to be more correlative and less causative.

My grip strength is quite high at 99.9 lbs because I’m a rock climber. I’m sure if you measured my VO2Max it wouldn’t be that impressive. But that’s the problem with measurements like this - they tell us what someone has maximized in their life, not optimized.

Segmental Analysis

I usually don’t care much about the breakdown of muscle mass in relation to the body part. But in certain age groups and medical conditions it’s really important.

I like to see a good correlation between right and left. Discrepancies often indicate that someone may benefit from a better exercise form to avoid loading a joint more on one side.

Muscle-Fat Analysis

You’ve heard of skinny fat or sarcopenic or metabolically healthy obese. I’m not a fan of these terms because they are rarely backed by data.

I’ve had many patients referred to my practice who were convinced they are in tip-top shape but their scans revealed quite a bit of fatty liver disease, as I’ve discussed in this article below.

Given your frame, it’s good to know how much skeletal muscle mass vs body fat you have. Of course, what also matters is where this fat is located.

Visceral fat hides around the organs. Subcutaneous fat is less problematic and sits under the skin. This is a very simplistic way of describing fat but it’s fine for this discussion.

A DEXA scan with the right software or an MRI can give much more accurate values. Then again, you can use biomarkers like Tg/HDL ratio, waist-to-height ratio, or fasting insulin to determine if visceral fat is present.

I work with a small number of clients to get to the root cause behind their symptoms and build a plan that works.

Book a 1-Hour Call With Dr. Ashori

Disclaimer:

How to Reverse Fatty Liver Disease Without Medication

Dr. Ashori MD — Mon, 06 Jul 2026 23:48:38 GMT

I’m Dr. Ashori, family medicine physician and health coach.

If you have ever been told your liver enzymes are “just a little elevated,” or if you are carrying stubborn weight around your midsection, you might be dealing with fatty liver disease.

According to global epidemiological data published in The Lancet Gastroenterology & Hepatology, Steatotic Liver Disease now affects an estimated 1.7 billion adults worldwide. It has officially become the fastest-growing chronic liver disease on Earth.

Most adults have no idea because, just like high blood pressure and diabetes, it’s usually completely silent.

Fatty Liver Disease in Mainstream Medicine

In standard medical practice, a fatty liver is often caught incidentally on an ultrasound or dismissed if routine lab markers like AST and ALT are “within the normal reference range.”

But as a physician, I am here to tell you that “normal” labs do not always equal optimal health. Early-stage hepatic steatosis routinely flies under the diagnostic radar.

Left unchecked, this fat accumulation can trigger a cascade of systemic issues, progressing to inflammation, scarring (cirrhosis), and severe metabolic dysfunction.

But the empowering news is that the liver is one of the most resilient, regenerative organs in the human body. Unlike many progressive chronic conditions, a fatty liver can be completely halted and entirely reversed without a single prescription medication.

Here is the exact 4-step protocol I use with my patients to reverse fatty liver disease naturally.

What Actually Causes a “Fatty” Liver?

A common misconception is that eating dietary fat causes a fatty liver. It doesn’t.

Instead, a fatty liver is primarily driven by an intrahepatic process called de novo lipogenesis (DNL). When your body is flooded with excess carbohydrates, specifically refined sugars and starches, your pancreas secretes high levels of insulin. Insulin acts as a storage hormone, instructing your liver to take those excess sugars and pack them away. When the liver’s glycogen storage tanks are completely full, it is forced to convert those sugars directly into fat molecules.

Think of your liver like a busy airport luggage carousel. If more bags (sugars) keep dropping onto the belt than passengers can take off, the bags eventually spill over and pile up in the middle of the room. That “pile-up” is hepatic steatosis. To fix it, we have to stop overloading the belt and turn on the body’s natural fat-clearing systems.

The 4-Step Evidence-Based Reversal Protocol

1. Eliminate Fructose and Liquid Carbs

If there is a public enemy number one for liver health, it is dietary fructose, specifically in the form of high-fructose corn syrup (HFCS) found in sodas, sports drinks, condiments, and processed foods.

And while most of my patients swear they don’t have anything with HFCS, once I inspect their food logs, it always shows up. Always.

Unlike glucose, which can be used by every single cell in your body for energy, fructose can only be metabolized by the liver. When you consume a heavy load of liquid fructose, the liver is suddenly overwhelmed, and it rapidly converts that fructose straight into fat via that lipogenesis we talked about.

Evidence:

A comprehensive review published in Nutrients highlighted that while hypercaloric diets of any kind are problematic, artificially added fructose (not fruit) is a uniquely potent inducer of fatty liver disease.

Try this:

Completely eliminate liquid sugars. Swap out sodas, sweet teas, and heavily commercialized fruit juices for water, seltzer, or unsweetened green tea.
If it comes in a box or a bottle and lists HFCS, sucrose, or added agave, keep it out of your GI tract.

2. Optimize Your Eating Window

To get your liver to burn off its trapped fat, you must give your digestive system a prolonged break.

When you enter a fasted state, your body runs through its circulating glucose and stored liver glycogen. Once those primary energy reserves are depleted, your metabolic machinery flips a switch. It enters a state of lipolysis, mobilizing stored triglycerides out of the liver cells to be used as fuel.

Evidence:

A 12-month randomized clinical trial published in JAMA Network Open tracked patients with obesity and NAFLD. The researchers found that an 8-hour time-restricted eating window (eating only between 8:00 AM and 4:00 PM) successfully reduced intrahepatic fat.

Try this:

Limit your daily eating window to 8 hours (e.g., 10:00 AM to 6:00 PM) and fast for the remaining 16 hours. This consistent fasting window gives your liver the uninterrupted time it desperately needs to clean house.

Know someone wanting to reverse their fatty liver disease? Share this with them.

3. Increase Cruciferous Vegetables and Choline

Reversing a fatty liver isn’t just about what you take out of your diet; it’s also about what you put in. Your liver requires specific micronutrients to safely pack up fat and ship it out of the liver tissue.

The most critical nutrient for this process is choline. Choline is required to synthesize phosphatidylcholine, a vital component of Very Low-Density Lipoproteins (VLDL). Think of VLDL as the delivery trucks that transport fat out of your liver and into the rest of the body for energy. If you are deficient in choline, the delivery trucks can’t be built, and fat gets trapped inside your liver cells.

Try this:

Prioritize nutrient-dense whole foods such as cruciferous vegetables like broccoli, Brussels sprouts, and kale. These veggies contain glucosinolates and choline, compounds that stimulate the liver’s natural detoxification pathways and protect hepatic cells from oxidative stress.
Eat high-quality, wild-caught fish, soybeans, nuts, seeds, and eggs.

4. Zone 2 Exercise For Liver Turnover

Physical activity clears liver fat directly. But you don’t need to perform grueling, high-intensity workouts that leave you utterly exhausted. All you need for liver health is Zone 2 Cardio.

Zone 2 exercise is a steady, low-intensity aerobic effort, think of a brisk walk, a light jog, or an easy bike ride where you can maintain a conversation but your heart rate is elevated (roughly 60–70% of your max heart rate). At this exact intensity, your body relies almost entirely on mitochondrial aerobic metabolism, utilizing fat as its primary fuel source rather than burning through carbohydrates.

Evidence:

Clinical data emphasizes that consistent aerobic training significantly reduces visceral and intrahepatic fat. By working out in Zone 2, you drastically improve mitochondrial density and systemic insulin sensitivity.

Try this:

Aim for 3 one-hour Zone 2 cardio sessions per week. This can be broken down into a 30-minute brisk walk or cycle session. Keep the pace comfortable, sustainable, and consistent.

Unlock Your Complete Liver-Optimizing Protocol

While these 4 pillars give you the foundation, executing them perfectly requires specific data and tools. You shouldn’t have to guess your ideal heart rate zone or argue with your insurance company about which lab panels to order.

To help you execute this protocol flawlessly, I have put together an exclusive resource:

Download the Free Fatty Liver Fix Guide

Inside this guide, you will get:

The exact, cutting-edge blood panels you should request from your doctor (and how to interpret them for optimal ranges, not just “normal” ranges).
A complete 12-week anti-inflammatory, choline-rich meal plan designed to minimize De Novo Lipogenesis.
The FibroScan Translator, exactly how to request this specialized ultrasound and interpret your score.
A step-by-step framework to calculate your exact Zone 2 heart rate range.
Knowing precisely when to recheck your bloodwork to visualize your liver’s healing progress.

Ready to Take Action?

I’ve put together the Liver-Optimizing & Healing Blueprint to give you the exact framework I use in my practice, including lab interpretation, specific meal plans, and heart rate math.

Download the Liver Guide Here

Disclaimer:

The Lean Person’s Guide to Sleep Apnea - Keeping Your Airway Open Tonight

Dr. Ashori MD — Fri, 19 Jun 2026 00:42:13 GMT

The Uncommon Sleep Apnea Patient

We assume sleep apnea only happens in someone with obesity or thick, short neck. It’s incredibly frustrating to be lean and waking up exhausted because you couldn’t get enough oxygen at night.

For skinny individuals, OSA is usually a structural or muscle-tone issue, not a weight issue.

The good news is that you can help your neck and facial muscles function much more effectively. A few specific exercises and some lifestyle changes for a few minutes a day is all you need.

1. The Physics of Sleep Apnea

When you sleep on your back, gravity pulls your tongue and soft palate down, blocking your airway. So, avoiding falling asleep on your back is a good place to start.

Actionable Steps:

You can tape or sow a tennis ball to the back of your PJs or shirt. There are lots of variations to this Tennis Ball Technique. Give it a try.
You can also invest in a wedge pillow to elevate the head of the bed by 4 to 6 inches.

Pro-Tip: If you want to get techy, smart wearables or positional buzzers can vibrate when you flip onto your back.

If this resonated with you, I work with a small number of clients to figure out what’s actually going on behind their symptoms to build a plan that works for them.
If you want help with this:

Book a coaching call

2. Sabotaging Airway Relaxants

Certain substances chemically force your throat muscles to go completely slack, triggering collapses.

The Culprits:

Alcohol - Establish a strict “no drinking 4–6 hours before bed” rule.
Medications - Muscle relaxants, anti-anxiety meds, or sedatives are all culprits. You’d be amazed how many of your meds fall into this category.
Sleep Deprivation - There’s a paradox where being too tired makes your muscles relax too much during deep rebound sleep, collapsing your airway.

3. Myofunctional Therapy - Exercising the Tongue

Just like hitting the gym builds biceps, specific exercises build upper airway tone so it doesn’t collapse under negative pressure (when you suck air in).

Actionable Steps:

Try 2-3 quick daily exercises, like pressing the tongue firmly against the roof of the mouth for 10 seconds, or repeating vowel sounds loudly.
You can also press the tongue against the side of the cheek to improve tongue tone.

Clinical data shows this can reduce mild-to-moderate apnea severity by up to 50%. This rivals some sleep apnea machines!

Know someone dealing with this? Send it to them.

4. Nasal Blockage & Aging

A stuffed or congested nose forces mouth breathing. Mouth breathing naturally drops the jaw backward, narrowing the airway.

Actionable Steps:

Tackle your allergies by using saline rinses, nasal sprays, or nasal dilator strips.
Smoking/vaping increases airway inflammation in some people, creating a blockage.

Airway tone naturally decreases with age, meaning consistency with these habits matters more as we age.

You Might Be Aging Faster Than You Think
Do you know Your Healthy Aging Score?
Find out which area is holding you back and what to do next.

Check My Score

Your Next Steps

Lifestyle changes are incredibly powerful tools to lower your “apnea score” (AHI), but they are adjuncts to clinical solutions, not always replacements.

Be sure to get proper testing if you suspect you have sleep apnea. There are lots of effective and affordable ways to get this done.

You don’t need to start all of these steps all at once. What do you think is the biggest driver for you? Start there. Adjust as needed.

Disclaimer:

The Curious Case of Yogurt and Heart Health Compared to Other Dairy

Dr. Ashori MD — Mon, 08 Jun 2026 14:31:09 GMT

Why does “Greek Yogurt” or dairy yogurt in general keep coming out ahead of other dairy? Here’s a bit of a deep dive I did when one of my patients asked me if she can have yogurt for breakfast.

And if regular yogurt is good for you, is low-fat yogurt better?

Why might it be bad? Dairy fat contains saturated fat. Saturated fat can raise LDL cholesterol. LDL cholesterol matters for heart disease risk. But we know that nutrition is never this simple.

In research, yogurt often looks neutral to beneficial for cardiovascular health. But is that because of healthy-user bias? Is it because of the fermentation?

My Overall Topic Summary:

Plain yogurt appears to be a reasonable cardiometabolic food for many people. The benefit is probably due to a combination of:

Fermentation (prebiotics & probiotics)
The dairy food matrix (all dairy often gets lumped together)
Protein creates natural satiety
Replacement of less healthy foods
Healthy-user bias may be a big driver

The biggest practical benefit comes from consuming more plain fermented yogurt versus sweetened yogurt, dairy desserts, butter, cream, and refined snack foods.

1. All Dairy is Not the Same - Ice Cream vs Cream

A common mistake in nutrition is reducing a food down to one core ingredient, in the case of yogurt, saturated fat.

Yogurt is a fermented food. It contains protein, calcium, bacterial cultures, fermentation byproducts, and a complex structure researchers often call the “dairy matrix.”

The same amount of saturated fat may have different effects depending on whether it comes from butter, cheese, yogurt, meat, or an ultraprocessed dessert.

A Danish study showed that when people replaced a daily serving of yogurt with an equivalent amount of butter, their risk of ischemic stroke significantly increased.

2. Yogurt And Cardiovascular Risk?

Observational studies generally show that yogurt intake is neutral to moderately favorable for cardiovascular disease risk.

A 2018 analysis in people with hypertension found that higher yogurt intake was associated with lower cardiovascular disease risk, especially when yogurt was eaten as part of an overall heart-healthy dietary pattern.
A 2020 meta-analysis of fermented dairy foods found that fermented dairy intake was associated with lower cardiovascular disease risk. In subgroup analysis, yogurt and cheese both showed favorable associations.
A 2022 review also concluded that fermented dairy foods, including yogurt, tend to look more favorable than some other dairy categories.

But we should be careful. These are not the same as randomized trials proving that yogurt prevents heart attacks. People who eat yogurt regularly may also be more likely to exercise, eat fruit, avoid smoking, have higher income, and follow healthier dietary patterns overall - aka, healthy-user bias.

So, the data does not show that “Yogurt prevents heart disease,” but that “Yogurt tends to show up as part of dietary patterns associated with better cardiometabolic health.”

You Might Be Aging Faster Than You Think
Do you know Your Healthy Aging Score?
Find out which area is holding you back and what to do next.

Check My Score

3. Low-Fat vs Full-Fat Yogurt

If yogurt’s benefit were simply about avoiding saturated fat, then low-fat yogurt should consistently look better than full-fat yogurt. But that’s not what the research shows exactly.

Some studies and reviews suggest that full-fat fermented dairy, especially yogurt and cheese, does not worsen blood lipids, blood pressure, insulin sensitivity, or cardiovascular risk the way we might predict based only on their saturated fat content.

That does not mean full-fat yogurt is always better. It means the fat content is not the only variable that matters.

This basically comes down to a substitution issue. What is this yogurt replacing in the diet? If it’s full-fat yogurt vs low-fat sweetened yogurt, the former wins.

4. Yogurt vs. Butter

Butter and yogurt both come from milk, but they are not metabolically identical foods. Butter is mostly dairy fat. Yogurt is a fermented food that contains protein, minerals, and live cultures. This may influence digestion, fat absorption, bile acid metabolism, cholesterol handling, appetite hormones, and inflammation.

When saturated fat is packaged inside yogurt or cheese, the body may respond differently than when that fat comes from butter, cream, or processed desserts.

This does not mean saturated fat is irrelevant. If someone has a high apoB, high LDL-C, familial hypercholesterolemia, or is a strong LDL responder to saturated fat, I would still individualize the advice. That’s why I’m constantly tracking my patient’s biomarkers instead of just guessing.

But on a population level, plain full-fat yogurt does not deserve to be placed in the same category as butter.

Book a coaching call

5. Fermentation

Remember, this is only a theory - there’s no way to prove this with our current approach to clinical research.

Yogurt is made through bacterial fermentation. That process may produce bioactive compounds and alter how the food interacts with the gut. Some probiotic yogurt trials show modest reductions in total cholesterol and LDL cholesterol, especially in people with mild to moderate hypercholesterolemia.

The effect is not dramatic. Yogurt is not a statin. It is not a replacement for proven lipid-lowering therapy when someone needs it.

But fermentation gives yogurt a plausible mechanism beyond just “calcium and protein.”

Potential mechanisms include:

Changes in gut bacteria
Increased bile acid excretion
Effects on cholesterol metabolism
Production of short-chain fatty acids
Modest anti-inflammatory effects

The evidence certainly wouldn’t urge me to prescribe yogurt to anyone. But it’s an interesting enough theory to consider when it comes to dairy choices.

6. Healthy-User Bias

People who eat plain yogurt may simply be healthier to begin with. Their sugar cravings obviously are low enough that they’re choosing an unsweetened dairy option instead of ice cream or sweetened yogurt.

They may also eat more fruit, nuts, and whole grains. They may exercise more. They may smoke less. They may be more educated or more health-conscious. They may be using yogurt as part of a Mediterranean-style or DASH-style diet.

My Practical Recommendation

For most people, plain yogurt can be part of a heart-healthy diet.

The best choices are usually:

Plain Greek yogurt (strained to remove whey and lactose)
Plain regular yogurt (less strained)
Plain low-fat yogurt (if there are no additives)
Unsweetened kefir, if tolerated

Again, I wouldn’t add yogurt into your diet for any supposed benefits. Unless it’s replacing something less favorable like pancakes, waffles, or a breakfast pastry.

How To Build A Better Yogurt Bowl

Have your yogurt if you enjoy it. But remember that what the yogurt is carrying is probably much more beneficial to your health than the yogurt:

Plain yogurt
Berries or chopped fruit
Walnuts, almonds, chia, or ground flax
Cinnamon

A bowl with sweetened yogurt, sugary granola, chocolate chips, and syrup may taste great, but metabolically it is closer to dessert.

Disclaimer:

Why Brain Fog Today May Be Dementia Tomorrow

Dr. Ashori MD — Fri, 05 Jun 2026 14:31:36 GMT

When was the last time you walked into a room and completely forgot why you were there? Or misplaced your keys for the third time in a week? Or found yourself in the middle of a conversation, but couldn’t find the right words?

Most of the time, we chalk this brain slips up to a bad night’s sleep, a hectic week, or just stress. But they may also be early signals worth paying attention to.

June is Alzheimer’s Awareness Month. As a family medicine doctor turned health coach, I want to share something that is neglected by traditional medicine: dementia is one of the most preventable conditions we face. But to prevent it, we have to completely change when we start paying attention.

Dementia Isn’t a Disease of the Elderly

Most adults in their 30s and 40s view dementia as a distant problem, something that only happens in your 60s, 70s, or 80s. It’s something you screen for when you’re retired and something you have little control over.

Dementia is actually a complex longitudinal process that progresses slowly over decades, long before a diagnosis. The changes in the brain that lead to Alzheimer’s often begin in your 30s and 40s. It’s not frank memory loss or not being able to drive, it’s more subtle changes you may have noticed:

Midday energy crashes
Poor sleep & groggy mornings
Stubborn weight that won’t budge
Difficulty focusing on complex tasks
Shortened attention spans

Whatever is happening to your metabolism is translating directly to your brain. When your brain is deprived of optimal oxygenation and can’t clear toxic metabolites, or starved of the precise nutrients it needs over a period of 20-30 years, a stage is set for cognitive decline.

This review paper in 2025 explains the molecular mechanics of how simple sugars cause sharp glucose fluctuations that damage cognitive clarity, whereas complex carbohydrates and dietary fiber provide a sustained energy release.

Think of your brain like a high-performance engine. When you experience chronic metabolic stress from modern life, it’s like the fuel lines are getting crimped. The fuel is there, but the engine is sputtering.

When your brain cells can’t access energy, the engine begins to misfire. That is why you feel exhausted after a deep conversation, experience brain fog after a long presentation, or find yourself losing common words. These are the early symptoms of metabolic brain strain.

Know someone worried about their cognition? Share this article with them.

Dr. Ashori’s 3 Core Pillars for Brain Regeneration

I don’t believe in cookie-cutter health advice. In my practice, I work individually with each client to map out their unique risks and create a highly customized strategy.

However, there are 3 non-negotiable tenets that form the foundation of brain healing and cognitive resilience. You can start implementing these today:

1. Protect Your Brain Fuel (The Morning Routine)

Brain health starts the moment you wake up. To keep your brain steady and avoid the midday “sputter,” avoid high-simple-carbohydrate or high-sugar breakfasts that spike your blood sugar.

The Fix: Start your day with plenty of fiber to stabilize blood sugar.
Dr. Ashori’s Favorites: A warm bowl of steel-cut oats with nuts, or a whole-egg omelet loaded with spinach.

2. Prioritize Cellular Regeneration (Deep Sleep)

Your brain cannot repair itself when it’s constantly going. It requires deep sleep to heal from the trauma of a stressful week or back-to-back executive meetings. To protect this critical repair window, you must give your brain a little runway before bedtime.

This 2026 RCT paper provides the first direct, causal evidence in humans showing that normal, undisrupted sleep actively clears these Alzheimer's-linked biomarkers out of the brain parenchyma and into the bloodstream. Of course, this is just a surrogate marker, but it’s the closest data we have.

The Fix: For 2-3 hours before sleep, avoid caffeine, heavy meals, chocolate, alcohol, and high-stress work or conversations. Otherwise, your deep sleep window gets cut short, and your brain misses its cleanup cycle.

3. Implement the Daily Reset

You cannot run a high-performance engine at redline all day without consequences. If you engage in mentally taxing work, you need to deliberately reset your nervous system.

The Fix: Break up your day with intentional, restorative pauses. Take a 15-minute walk in the sunlight, read a book chapter, meditate, or simply practice deep breathing. This allows your brain cells to reset and function at the highest possible level.

6 daily habits that improve energy, sleep, and long-term health:
Download the free guide!

Where Traditional Family Medicine Left Off

I spent years practicing traditional family medicine, but I ultimately chose to leave it behind.

I was tired of managing Alzheimer’s dementia after it was already too late. I was tired of prescribing medications to patients who were already suffering, who could no longer dress themselves, and who could no longer manage their own bank accounts. At that stage, my work was just a band-aid.

My mission now is to step in before the damage is done. I want to partner with high-agency individuals who have the health literacy to dictate the quality of their future.

You have the power to develop a brain that functions sharply and serves you well into your oldest years. You just need the right roadmap.

I want to hear from you: Do you have a family member who has suffered from dementia? Are you worried about your own cognitive trajectory? What is one thing you are doing today to protect your brain for the future? Let me know in the comments below!

Disclaimer:

No-Measure Seeded Whole Grain Bread

Dr. Ashori MD — Thu, 04 Jun 2026 01:02:17 GMT