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.

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:

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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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!

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.

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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:

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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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?

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.

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:

1. Fermentation (prebiotics & probiotics)

2. The dairy food matrix (all dairy often gets lumped together)

3. Protein creates natural satiety

4. Replacement of less healthy foods

5. 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.”

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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.

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

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:

1. Changes in gut bacteria

2. Increased bile acid excretion

3. Effects on cholesterol metabolism

4. Production of short-chain fatty acids

5. 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:

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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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.

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.

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.

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!

Leave a comment

Want to improve your cognitive capacity, I work with a small number of clients to figure out what’s actually going on behind their symptoms to build a plan that generates real results:

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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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When I was practicing family medicine, I noticed certain patterns on my cardiology rotations. Almost every patient sitting in an ICU bed after a heart attack said the exact same thing:

“But Dr. Ashori, I felt completely fine yesterday.”

No chest pain, no gasping for air. They went to work, ate their dinner with the family, and off to bed. Then they woke up in an ambulance.

When it comes to heart disease, the myth is that feeling good means you’re safe. Such is the passive nature of many of the silent killers we’ve come to know.

Plaque buildup in your arteries doesn’t have pain receptors. It accumulates without any signs over decades until it reaches a tipping point.

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.

When you ask ChatGPT or Google how to prevent a heart attack, you get a generic script that has little meaning: eat less fat, do 150 minutes of exercise, and lower your cholesterol.

But as a health coach, I look at the whole picture. I don’t treat lab values; I coach human beings to make meaningful changes that last. If generic advice worked, heart disease wouldn’t still be the number one killer.

If you are in your 30s or 40s and want to ensure you never end up in that ICU bed, we need to talk about what’s happening under the hood and what’s in your control right now.

Heart Disease Is Not a Plumbing Problem

Most picture an artery like a rusty pipe in an old house. They think cholesterol slowly stacks up inside the pipe until the opening gets too small, the blood stops, and boom, heart attack.

That is almost never how it happens.

If it were just a plumbing issue, we could see it coming easily. In reality, a heart attack is an inflammatory explosion.

I describe an artery wall like a layered sandwich. Cholesterol doesn’t passively sit on top of the wall; it gets trapped inside the wall. Your immune system tries to clean it up, creating a highly inflamed, pimple-like pocket of pus underneath the artery lining.

A heart attack happens when that “pimple” pops.

When it ruptures, the inside of your artery is exposed to raw inflammation. Your body tries to heal it by forming a massive, instant blood clot. That clot is what cuts off the blood flow in seconds.

Our goal isn’t just to stent open an artery or “lower numbers.” Our goal is to keep the artery lining strong and prevent the pimple from popping. Here is how we do that using root-cause lifestyle medicine.

1. Stop Chasing Cholesterol (Ask for ApoB)

Your standard annual physical includes a fasting lipid panel. It looks at your Total Cholesterol and your LDL cholesterol.

Half of all people who have heart attacks have “normal” LDL cholesterol numbers. But only 15% with a normal apoB will have an acute cardiac event.

• Next time you get labs, don’t just look at LDL-C. Ask your doctor for an apoB test (Apolipoprotein B). It counts the exact number of plaque-causing particles in your blood. It costs about $20, and it is a vastly superior crystal ball for your heart health.

• If you can’t get the apoB done in your country, take a look at your non-HDL-Cholesterol which can be a decent approximation for apoB.

2. Guard Your “Nocturnal Dipping”

Everyone talks about daytime blood pressure, but as a clinician, I care deeply about what your blood pressure does at night.

In a healthy body, your blood pressure should drop by 10%-20% at night. This gives your arteries a much-needed break from the constant internal pressure. If you are chronically stressed, having heavy meals, drinking alcohol before bed, or dealing with undiagnosed sleep apnea, your body stays in a fight-or-flight state all night. You become a “non-dipper.”

• If you use a wearable (like an Oura ring, Apple Watch, or Whoop), look at your resting heart rate curve. Does it hit its lowest point in the first half of the night? If it doesn’t drop until right before you wake up, your arteries are working a 24-hour shift without a break.

3. Build an “Exercise Floor,” Not a “Ceiling”

When people decide to get healthy, they say, “I’m going to hit the gym for an hour, 5 days a week.” Then life happens, they miss a week, feel guilty, and abandon the whole plan.

Your heart doesn’t care about a perfect workout; it cares about consistent movement. Every time your muscles contract, they suck glucose out of your blood and release nitric oxide, which dilates and relaxes your arteries.

• Forget the grueling workout plans. Build your exercise floor: the absolute minimum you will do even on your worst day. My favorite hack is the 10-minute post-meal walk. Walking for just 10 minutes immediately after dinner dramatically blunts your post-meal blood sugar spike.

• If you’re ready for more, build your aerobic capacity by extending your walks, hikes, rides, or swims. Go from 30 to 45 minutes, from 1 hour to 2 hours. Keep the effort low, aiming for a Zone 2 training level.

4. Viscous Fiber Shields Your Arteries

You’ve been told to eat fiber for your gut, but fiber is actually a major protector of your arterial lining.

Your liver uses cholesterol to make bile acids, which help you digest fat. After digestion, your body normally recycles that bile back to the liver. But when you eat viscous, soluble fiber, it turns into a thick gel in your digestive tract. This gel acts like velcro, trapping the bile and forcing your body to 💩 it out.

To make more bile, your liver has no choice but to pull LDL cholesterol out of your bloodstream to use as raw material.

• Don’t just eat “more fiber.” Focus on slimy, viscous fibers. Think oatmeal, chia seeds, brussels sprouts, and beans.

• If you are going to have a fun night out with a big pizza or pasta, have a tablespoon of psyllium husk in water as a clinical cheat code for protecting the lining of those delicate arteries.

Finally, Establish Your Baseline

If you are over 30, the absolute best thing you can do for your peace of mind is to stop guessing or following generic advice that may not apply to you.

Beyond an ApoB test, know your personal cardiovascular risk and what interventions will be the most effective in you.

Your cardiovascular system is highly resilient, but it requires maintenance. There usually is no check-engine light that’ll warn you ahead of time.

Ready to build a bulletproof heart?

If you want to move past generic medical advice and design a highly personalized strategy for longevity, energy, and metabolic health, let’s work together.

• Take my 3-Minute Healthy Aging Quiz

• Book a private 1-on-1 health coaching session with me

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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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.

TL;DR

• Omega-3 supplements rarely deliver the benefits people hope.

• Most would get more risk reduction from non-supplement options.

• Baseline risk matters more than supplement choice.

• Food, movement, sleep, and metabolic health outperform fish oil in most cases.

Omega-3’s Fame

Inside the human body, omega-3 fatty acids (EPA and DHA) have major roles in inflammation, cellular health, and lipid management.

Perhaps the biggest reason for its lasting success is that early observational studies showed that populations eating more fish had lower rates of heart disease.

Without any rigorous studies, the supplement industry ran with:

“Omega-3s protect your heart, your brain, and your joints.”

Where the Evidence Actually Lands

What I’ve heard from my patients is that they often take fish oil or other omega-3 supplements for these main reasons:

• Cardiovascular health

• Inflammation & joint pain

• Mood and mental health

• Neurocognitive protection

Let’s dive deep into the literature and see which of these hold up and which are supplement industry marketing.

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#1. Cardiovascular Disease Prevention

Claim: “Omega-3 supplements reduce heart attacks and strokes.”

What the evidence shows:

1. Large randomized trials in mostly healthy or well-managed patients show little to no reduction in major cardiovascular events.

2. Any benefit appears small, inconsistent, and often limited to very specific subgroups.

3. High-dose prescription EPA shows some benefit in very high-risk patients, but this may not apply to over-the-counter fish oil.

There are multiple other studies like these. The ASCEND trial is another one which was done in patients with diabetes.

Key problem:

Most people considering omega-3 supplements are already at low risk, so even if the supplements were effective, the result would be too small to matter.

Bottom line:

Omega-3 supplements are not a reliable heart-disease prevention strategy for the average person.

3 Alternatives I use in my practice to Lower CVD Risk:

• Improve waist size (waist-to-height ratio) and any insulin resistance.

• Improve muscle mass if you are undermuscled.

• Improve blood pressure.

#2. Inflammation & Joint Pain

Claim: “Omega-3s reduce inflammation and help arthritis.”

What the evidence shows:

1. Small reductions in inflammatory markers.

2. Minimal effect on pain and joint movement.

3. Effects are too subtle to matter.

Another study of 19,000 adults showed no improvement in chronic pain compared to placebo.

Fish oil supplementation also wasn’t effective for knee osteoarthritis.

Important nuance:

Lowering inflammatory markers doesn’t automatically mean that your health will improves. We don’t want to chase biomarkers.

Bottom line:

Omega-3s may slightly reduce inflammation, but the effect is too small to matter. If you don’t address the root cause of the inflammation, it will only get worse.

3 Alternatives for Inflammation & Joint Health:

• Daily movement helps lower inflammatory markers.

• Targeted resistance training helps rebuild damaged joints.

• Sleep consistency and stress reduction reduce HS-CRP.

#3. Brain Health & Neurodegeneration

Claim: “Omega-3s protect the brain and prevent dementia.”

Evidence shows:

1. Some observational links between fish intake and cognition.

2. Omega-3 supplement trials show little to no cognitive benefit.

3. Dementia is not prevented or slowed with omega-3.

Why this matters:

Brain health is influenced by sleep, insulin resistance, vascular health, hearing, movement, and social engagement, not a single nutrient. And, of course, genetics.

To prevent dementia, here are real lifestyle changes you can start today.

Bottom line:

Omega-3 supplements have not demonstrated ‘neuroprotection’ in the better clinical trials.

3 Alternatives to improve neurocognition:

• Optimize sleep timing and duration.

• Improve cardiorespiratory fitness.

• Stabilize your blood sugars.

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.
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#4. Mood, Depression, and Anxiety

Claim: “Omega-3s improve depression and mental health.”

In research, some depressed patients have been found to have lower omega-3 levels.

Evidence:

• Small mood benefit in some studies, but it’s not consistent.

• Higher EPA content fish oil was slightly more effective.

Consider:

Omega-3s are sometimes framed as a low-risk “natural antidepressant.”

But that’s not true. Sunlight is a better antidepressant than omega-3 supplements.

Bottom line:

Omega-3s may help a few patients, but they likely won’t outperform proper mental health therapy and social support.

I would consider offering a patient higher EPA omega-3 supplements if they are improving with therapy but don’t quite need a prescription medication.

The Industry Bias Problem

Omega-3 supplements benefit from:

• Heavy marketing

• “Heart healthy” labeling

• Celebrity doctors and wellness figures overexplaining its mechanism

Some clinicians speak positively about omega-3s, often focusing on biological plausibility. But I care about hard endpoints like fewer major heart attacks, strokes, or cancer (a potential cause of excess inflammation).

The Question That Matters Most

“Will this meaningfully change my risk? Is there a more effective alternative I should consider?”

For most people, the answer with omega-3 supplements is that there likely are better options.

When Omega-3 Supplements Might Make Sense

• Very low fish intake and

• High baseline cardiovascular risk and

• Lifestyle options already maxed out

Even then, the results from the supplement would be modest.

The Takeaway

Omega-3 supplements are overpromised but they have their place in a small subset of patients.

My approach to any supplement is to dive deep into the research. Then I identify the existing biases. For each patient I ask, “What will have the biggest impact on their health?” If it’s exercise, then that’s what we’ll focus on. If it’s a supplement, we’ll start with that first.

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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We grew up hearing a lot of confusing stories about HIV. This should be an easy read and help clear up a few of those myths.

Article Summary:

• HIV is not transmitted through casual contact, saliva, or sharing food.

• Modern treatment can make HIV undetectable, which means it is untransmittable.

• The virus is treatable and manageable, and people live long, healthy lives with it.

1. What I Learned Growing Up

I started medical school in 2001, long after the scariest times of HIV. But the way we managed the disease back then is worlds apart from now.

The goal now is to keep people’s viral loads undetectable which means that the virus can’t be transmitted. This is such an incredible breakthrough.

2. Myth 1 = HIV Spreads Through Casual Contact

Not just in the US but especially in other countries, the fear of transmission still shows up in families, workplaces, and dating. It keeps the stigma alive, even though casual contact can’t spread the virus.

HIV is not transmitted through saliva, sweat, or touch. It requires specific body fluids and specific routes.

3. Myth 2 = People With HIV Always Look or Feel Sick

Many don’t get tested because they don’t ‘look sick.’ Even in 2025, this myth continues to exist. The only chance at a good life with HIV is getting tested and treated early.

Treatment today suppresses the virus and it’s much more affordable than ever before. People can live long, healthy lives with HIV, raising families, working, aging, and living well.

Undetectable means untransmittable. When the virus is suppressed to an undetectable level, it cannot be passed to a partner.

4. Myth 3 = HIV Is Rare Today, So You Don’t Need To Worry

The virus is less common than in past decades, but not rare. Adults in their 30s to 50s should still know how transmission works, and how PrEP (pre-exposure prophylaxis) protects people.

5. Myth 4 = Oral Sex & Kissing is How People Catch HIV

Kissing, even with small cuts, is considered extremely low risk. It’s a common ‘what if’ situation people bring up to me in my clinic.

As for oral sex, the risk isn’t zero but I have never had a patient who contracted HIV through oral sex. The risk is higher with sores, bleeding, or if your partner has a very high viral load of HIV.

How To Think About Your Own Risk

Regular STI screening and asking your partners to get screened is very important. Using a condom lowers your risk immensely. PrEP exists.

Send Your Questions

I’m preparing a follow-up piece based on questions from the community. If you want to stay private, you can reply directly to this email or message me privately. If you prefer to comment publicly, you can drop your question below.

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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You walk into your doctors office or login to your telehealth app and pretty quickly you get a sense about your doctor. They ask you specific questions that may sometimes feel a bit rehearsed, they give you a few options, tell you what will happen next, and that’s the appointment.

Each physician is both a healthcare professional and a patient - a consumer of healthcare services, much like yourself. This person has certain viewpoints and biases in regards to nutrition, exercise, and clinical medicine.

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.

What’s Health Philosophy

Do you believe in medications for everything or a lifestyle approach first? That’s your personal health philosophy.

Health philosophy is how a person thinks about health and healing. What information they use to come up with their heuristic to make health decisions for themselves, their patients, and loved ones.

My health philosophy as a physician is that health is a constantly evolving phenomenon. It’s the ebb and flow of the way your body responds to external conditions.

Clinical information is shaped by the research that we do in Western Medicine but the decisions I make for my patients are done in a cooperation together and not something that I rain down on them from a pulpit.

What’s Health?

There is no single definition of health. Each of us has our own unique definition of it. For one person it’s having normal blood tests, for another it’s feeling energetic, vibrant, and recovering well from disease.

What’s your definition of health? What tools are you comfortable using to achieve it?

Sharing Your Doctor’s Health Philosophy

Some doctors have a more fluid health philosophy and they adjust it readily for each patient. I like this approach because it keeps the conversation going without leaving the patient feeling judged.

This doctor’s goal is to figure out how you define health and what’s important to you. They see their role as an expert to help you achieve your ideal health (not theirs.)

When you and your doctor both have the same health philosophy it’s like two old friends talking about health over some coffee or beer. The conversation is often deeper, nuanced, and you both learn from each other.

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Defining Your Own Health Philosophy

My health philosophy has definitely evolved over time but at its core I believe that we have the ability to affect our health with the daily decisions we make.

The goal is to make daily small decisions that help our bodies heal, recover, and rebuild. A process that’s different for each person.

1. Maximalist or Minimalist?

Back when I worked in the urgent care, I would have someone walk in with 24 hours of a miserable cough, runny nose and congestion. They wanted everything thrown at this thing: cough syrup, steroid injection, antibiotics, and inhalers. This is a maximalist.

I would also have someone walk in with chest pain, sweating, shortness of breath and an ominous EKG. But they didn’t want to go to the ER or take medication unless their life was in danger. That’s a minimalist.

Most of us are somewhere in the middle. My wife makes fun of me for refusing to take NSAIDs for a sprain or even a topical anti-inflammatory unless absolutely necessary.

When you know yourself well enough and are okay with the consequences of a decision, you become an empowered consumer of healthcare. You gain expertise and confidence.

2. Empowered or Authority Driven?

Some of my patients prefer to let their doctor make all the important health decisions. They have agency and often quite knowledgeable but they don’t want to have to make all of their health decisions.

Others prefer to do the research on their own, have lengthy discussions with their doctor, and then make their final health decisions.

If you’re the latter, you need the kind of doctor who’ll spend hours with you discussing all the consequences and upsides of a health decision. They’ll share their experience and help you look around the corner.

3. Lifestyle or Treatment?

When that cholesterol level gets past a certain level will you reach for medication or change your lifestyle?

The maximalist may do both and the minimalist may not even believe in the consequences of an elevated lipid level.

But lifestyle changes aren’t always easy to implement, especially if you don’t know which has the highest chance of success in you.

4. Biohacker or Evidence-Based?

Are you the person who lines up for the newest peptide or supplement? You do the sauna and light therapy and have your own ozone machine?

Or perhaps you prefer to have at least 10 years of evidence before trying a new treatment.

Your doctor doesn’t have to believe in peptides to know how to help manage your health. But they should be inquisitive enough to want to learn and know what potential side effects to monitor for.

5. Contrarian or Mainstream?

The contrarian may believe that Western Medicine is inherently evil and vaccines are harmful. They don’t trust treatments and may overly rely on ‘natural’ treatments.

The mainstream individual believes that as long as it has the seal of approval from the AMA or Western Medicine, it’s legitimate.

I’ve taken care of both patients on both sides of the spectrum. What matters to me is that that each person develops a more nuanced perspective after enough visits with me. I’m not trying to change their mind - just nuance.

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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Every woman will go through this natural physiologic change somewhere in their 30s-40s.

What we don’t know is how it will affect you, individually.

Some barely notice it. Others feel like their body changed overnight.

The science says that women have a lot more say over how this transition happens. Let’s dive into the details.

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.

It’s Not Just Hormones That Change

Women can begin to experience perimenopause symptoms up to 10 years before their final period - usually in their mid-30s.

Despite what you may have heard, estrogen, testosterone, and FSH levels aren’t what matter most. It’s how your body reacts to the changes and how your lifestyle adapts during the menopause trasition. There are estrogen and progesterone receptors all over the body.

The classic set of changes I see in my practice is a woman who starts gaining weight or unable to lose it. She will have sudden increase in belly fat and her sleep will be chaotic.

On the blood panels, cholesterol and liver function test goes up and sometimes we see the inflammatory markers go up.

Unfortunately, like many women’s health issues, it’s diminished to stress or ‘normal’ aging.

Perimenopause is a true metabolic shift. And if you can prepare for it, your body will thank you. Your symptoms will be milder and the negative health effects negligible.

The Important Systems That Change

During the menopause transition, women experience a 10-15% increase in LDL cholesterol and a 10-12% loss of bone density over those years.

There are a few systems that almost always get affected:

• Metabolism

• Bone health

• Cardiovascular health

• Sleep & recovery

• Mood & stress response

There are advantages to this transition and your lifestyle choices today will have a big impact of how your body’s systems respond.

The Earliest Signs Often Ignored

Compared to premenopausal women, during midlife there’s a 3x higher risk of high blood pressure, excess body fat, and insulin resistance.

One of the earliest signs I’ve seen in my patients is stubborn weight, even with a healthy lifestyle.

Body fat - This is also the time that subcutaneous fat starts redistributing to the belly area, causing the unwanted belly fat.

Mood - Stress, anxiety, and low mood are often associated with a primary mood disorder. And this is often incorrectly treated with antidepressants, instead of the necessary lifestyle changes to help rebalance hormones.

Heart Health - It’s also cardiometabolic changes, such as a rising cholesterol lab panel. This is especially important when your diet, exercise, and weight haven’t changed meaningfully.

Energy & Sleep - Finally, sleep problems, such as being wide awake in the middle of the night and crashing in the early afternoon are potential signs of perimenopause.

It Feels Harder Than Expected

Approximately 45% to 85% of women report bothersome symptoms during the transition, yet a staggering 75% of women who seek help for these symptoms do not receive adequate treatment.

In 2026, women in their 30s and 40s are more accomplished and busier than ever before.

They are raising kids, growing careers, managing a household, budgeting, exercising, and taking care of elderly parents.

Even without any hormonal changes women in this stage of their lives have higher stress, less time to recover, increased hunger, and a dropping metabolism.

You finally have the physical fitness you’ve worked so hard for but now several aspects of your health seem to not be in your control.

We Don’t Want to “Fix” Perimenopause

Going through menopause is as natural as puberty. But the transition doesn’t have to wreak havoc on your lifestyle.

I’ve seen it over and over again; my patients who choose specific lifestyle habits tend to fair much better during this hormonal change.

We have solid evidence to show that this transition can feel much better for most women. Symptoms will be milder and more predictible. Life will be less disrupted and overall health outcomes will be better.

And in some cases, barely noticeable. This is huge - knowing that you can affect how it feels inside you is empowering.

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7 Habits With The Biggest Impact

Clinical data suggests that women lose approximately 3-8% of their muscle mass per decade after age 30, which accelerates during perimenopause and directly impacts metabolic rate.

1. Use Your Muscles to Your Advantage

The Evidence: Resistance Training and Bone Mineral Density in Postmenopausal Women

High-intensity resistance training is proven to not only stop muscle loss but significantly increase bone density in the femoral neck and spine, directly counteracting the menopause-related osteopenia and osteoporosis.

Muscle is the main way metabolism is managed. It stabilizes weight (mitochondria), improves insulin sensitivity (insulin receptors), and supports long-term health.

1. Lift weights.

2. Focus on big movements: squats, pushes, pulls.

3. Progress slowly.

2. Be Intentional With Sleep

The Evidence: Sleep Trajectories and the Final Menstrual Period: SWAN Sleep Study

Landmark data shows that “waking up frequently” is specifically tied to the hormonal shift of menopause, making targeted sleep habits a critical tool for quality of life.

Sleep affects hormones, mood, appetite, and recovery. Better sleep means a better hormonal transition.

1. Keep a predictable sleep schedule.

2. Limit late-night stimulation.

3. Avoid late night heavy meals.

3. Nutrient-Rich > Calorie-Rich Foods

The Evidence: Nutrient Intake and Menopausal Symptoms

Clinical evidence confirms that women with higher intakes of vitamins and antioxidants through whole foods report improves symptoms compared to those eating calorie-dense, nutrient-poor diets.

Because of the stronger hormone drive during this hormone transition, most women get the majority of their calories from refined carbs.

1. Switch away from refined carbs.

2. Increase fruits, vegetables, beans, & lean protein.

3. Eat more frequently if hunger demands it.

4. Increase Fiber, A Lot

The Evidence: Dietary Fiber Intake and Mood

Increasing fiber intake is shown to significantly lower the risk of metabolic syndrome and insulin resistance, which can rise 3x during the transition.

Fiber supports gut health and helps regulate cholesterol and blood sugar. It’ll keep you satiated more than it seems.

You might eat more but you’ll absorb fewer simple carbs.

1. Add vegetables, legumes, whole grains daily.

2. Build meals around fiber.

3. Experiment with beans, lentils, oats.

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

5. Move Consistently

The Evidence: Impact of Exercise on Perimenopausal Syndrome: A Systematic Review of Randomized Controlled Trials

This 2025 review shows that exercise reduces the total burden of perimenopausal symptoms. Specifically irritability, muscle pain, and physical fatigue by approximately 15.7%.

Even if exercise isn’t in the cards right now, get regular movement.

1. Daily walking.

2. House chores that get you sweating.

3. Avoid long gaps between movement.

6. Address Your Stress

The Evidence: Cognitive behavioural treatment for women who have menopausal symptoms after breast cancer treatment

This landmark randomized controlled trial demonstrated that 6 weeks of group Cognitive Behavioral Therapy significantly reduced the distress and “problem rating” of hot flashes and night sweats, with improvements in mood and sleep.

Stress amplifies everything: sleep issues, weight gain, mood changes.

1. Create a daily “off switch”.

2. Walk, breathe, or step away from inputs.

3. Keep it simple and repeatable.

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7. Don’t Rely Just on Labs

Your symptoms and how you feel will often change before your labs do.

I have countless examples of women who had in-depth lab testing done to show their FSH, estradiol, and testosterone were all normal. But they had all the classic symptoms of perimenopause.

1. Track energy, sleep, weight trends.

2. Get your resting heart rate, heart rate variability.

3. Notice patterns early with a journal.

If You Need Help Preparing

This is exactly where physician-led health coaching helps.

Without overcomplicating it, the goal is to:

• Create a stable routine.

• Identify what’s changing.

• Adjust before things get out of hand.

Health coaching isn’t about more information. It’s best for creating a sustainable habit and seeing real results. It helps with structure when you need it most.

Book a coaching call

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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Most people have been asked some version of this question: “What is your pain on a scale of 1 to 10?”

But this kind of scale is often too confusing. A patient may say their pain is a 12 because they feel like they can no longer function. A doctor may hear that number differently. That gap can make people feel dismissed, misunderstood, or rushed into the wrong solution.

In this episode, I explain why health scales are really a grammar for communication.

I also walk through the 1–5 energy scale I use with health coaching clients:

• A 1 means your energy is so low that you can barely get out of bed.

• A 3 means your energy is steady and functional for most of your day.

• A 4 means you have extra energy to spare, but you may crash if you stay there too long.

• A 5 is not the goal. It can feel jittery, scattered, and unsustainable.

This matters because many people say their energy is “bad,” but they have lost the ability to sense what their baseline really is.

When you describe your symptoms more clearly, your doctor, health coach, dietitian, nutritionist, or trainer can help you more effectively.

The goal is to understand what your body is actually trying to tell you.

--------------------------

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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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Over 1 in 3 adults have excess abdominal fat despite a good diet and exercise routine.

It’s almost never as simple as calories or going vegan or keto.

The way your body manages its hormones is unique to you. Stress, sleep, and blood sugars are a few signals we can use to troubleshoot stubborn belly fat but it’s still not the whole story.

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.

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Q: Why is all my fat going to my stomach?

Fat deposit happens when you have excess calories coming than what you’re burning.

But even if your calorie balance is neutral, your body can take subcutaneous fat and deposit it around the belly and organs. Aka, visceral fat.

Late night eating, stress, and skipping meals can send ghrelin, insulin, and cortisol swinging wildly. This is how undesirable fat redistribution happens.

Q: Why am I not losing belly fat even when I eat healthy?

“Healthy” is a broad term. What your body needs isn’t always what you or your doctor might consider healthy.

One of my patients was convinced that his vegan diet was the healthiest diet he’s ever had. But his liver, DEXA scan, and inflammatory markers told a very different story.

Snacking on high-carb or calorie-dense foods and winging it on weekends is all it takes to signal weight retention in the belly area.

You don’t have to be perfect, but you have to have a balance. The more you build in reserves, the more cheat days you can enjoy.

Q: Could belly fat just be hormonal?

Hormones play a major role in where your body stores fat.

Insulin, cortisol, and sex hormones all influence whether fat is stored under the skin or deeper, around the organs.

But hormones alone aren’t enough to cause stubborn belly fat.

When insulin stays elevated from frequent eating or excess carbs, your body is more likely to store fat rather than burn it. That’s why patients with type 2 Diabetes usually develop rapid fat gain once they start insulin.

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Q: Can stress alone cause belly fat?

Stress doesn’t directly add calories. But how your body deals with excess calories affects where the fat ends up.

When stress is high, cortisol rises, as does insulin. This shifts your body toward storing fat, especially in the abdominal area.

The same stress also drives behaviors like snacking, poor sleep, and less movement, which all compound the issue.

For those dealing with a lot of stress or a schedule that’s completely out of their hand, we design a custom nutrition and activity plan that’s sustainable and fights off belly fat.

Q: I sleep enough so no way that’s an issue with my big belly, right?

Being in bed for 8 hours isn’t the same as getting 8 hours of sleep. The body needs a combo of light + deep sleep to balance out hormones, curb hunger, and recover our tissues.

Disrupted sleep increased hunger hormones like ghrelin, and satiety signals decrease. This makes it easier to overeat without realizing it.

It takes just 1 night of bad sleep for your body to deposit a lot more fat even if you eat the same calories as before. That’s because your insulin levels will be much higher that day.

Q: What’s the best exercise to melt away my belly fat?

There isn’t one specific exercise that targets belly fat. A better way to think about it is figuring out how your body best burns fat.

It’s not gonna be the same as my body’s.

Consistent movement, especially walking and lower-intensity cardio, helps your body burn fat more efficiently. The magical “zone 2” training zone is incredibly effective at fat burning.

If you are drastically undermuscled, some strength training will lower your average blood sugar, making belly fat loss much easier.

The least effective exercise is high intensity exercise. At least, for most of us.

Q: I read that the calorie theory of fat loss has been debunked.

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Calorie balance is one of the most important drivers of losing belly fat. But it’s not the only thing.

2 people can eat the same number of calories and have very different results depending on sleep, chewing, stress, activity levels and food quality.

Highly processed foods almost always mean that you’ll eat more calories during the day. That’s because they raise your hunger cues.

Meal timing, food composition, and consistency all influence how your body stores or burns energy.

Q: I eat perfectly, exercise, sleep well, and have no stress, so why can't I lose belly fat?

Bloating is not the same as belly fat. But if you are dealing with belly fat, it’s one of these 4 factors that need adjustment:

• nutrition

• activity levels

• sleep

• stress

Even as testosterone and estrogen drops in men and women with age, it takes one of the factors above to maintain or gain belly fat.

It’s not about having a perfect lifestyle. Even the perfect lifestyle could be hurting you. It’s about having the right diet, activity level, sleep, and stress-coping mechanisms to help you achieve your ideal body composition goals.

Q: How can I tell whether it’s belly fat or visceral fat?

The most scientific way is to get an MRI or DEXA body composition test. But a tape measure is just as effective. If your Waist-to-Height Ratio is above goal, you likely have excess belly fat in form of visceral fat.

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

Q: Which is better, exercise or diet?

There’s no one-size-fits-all approach. I’ve had patients who didn’t see any change with exercise and some who saw no change with diet.

You need a competent clinician who can review your lifestyle and identify which factors are likely contributing to the stubborn belly fat.

Then you create a 3-month plan and see which strategy is the most effective.

If I had to pick one, I’d pick diet over exercise. Few of us can exercise at the right (low) capacity level long enough to see meaningful fat loss.

Q: How quickly can I expect to see results?

Improving your health is a marathon, not a sprint.

Visceral fat around the belly can be lost but the tissue may remain puffy for some time. It takes on average 3 months of a consistent plan to see real changes.

I always remind my patients that if they are doing the right things for their health, the benefits are inevitable.

Q: Do weight loss supplements and drugs work?

Yes, but usually with many side effects.

Supplements may increase your metabolism or decrease your appetite.

Prescription medications usually will curb your appetite. This may result in belly fat loss but if you’re not eating a healthy diet, you’ll trade one health problem for another.

Q: I’ve had a big belly for 30 years, is it too late?

My dad had a big belly from age 38 until 68. Then he decided to curb his white rice, eggs, cheese, and butter. He lost all his belly fat in under a year.

He’s also maintained it for the past decade.

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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Most people think heart health comes down to one number, LDL cholesterol.

If that number looks “normal,” they assume they’re fine.

But cardiovascular disease is a much more complex process.

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.

Main Contributors to CVD

Cardiovascular disease (CVD) isn’t a single process. That’s why some people with high cholesterol don’t develop a heart attack or stroke. While another with normal lipids, does.

The main contributors are:

• Lipoprotein burden

• Metabolic disease

• Endothelial damage

• Inflammation

• Thrombogenicity

1. Metabolic Health

One of the biggest drivers of elevated LDL-C is poor metabolic health. Yes, even more so than saturated fat intake.

You can have a lot of dangerous lipoproteins floating in the blood, but they may not be able to penetrate the endothelium and deposit as plaque if your metabolic health is optimal.

The biomarkers you can track are:

• Tg/HDL ratio

• 2-hour OGTT

• Liver ALT

• Uric acid

Why it matters:
If your metabolic health is healthy, your chance of developing insulin resistance and arterial plaque is much lower.

2. Lipoproteins

The particles that actually form into plaque are called lipoproteins which can be measured directly.

These are the lipoprotein biomarkers to track:

• ApoB

• non-HDL cholesterol

• HDL-C

Why it matters:
These measure particle burden, so they are much more accurate than serum cholesterol.

3. Inflammation & Damage

Most of us will have some degree of plaque in our coronary and cerebral arteries. But how stable is that plaque? High inflammation means higher chance of plaque rupture.

Biomarkers for inflammation:

• hs-CRP

• Homocysteine

Why it matters:
Plaque doesn’t just form. It forms in an inflammatory environment and its stability is affected by inflammation.

4. Body Composition

I mostly care about visceral fat these days. It seems that for most adults subcutaneous fat isn’t as concerning.

Biomarkers to track:

• DEXA scan (or MRI)

Why it matters:
Two people can weigh the same and have completely different risks.

5. Cardiovascular Function

How healthy are your mitochondria, muscles, and your aerobic capacity?

Biomarkers to track:

• VO2 max (or the Cooper Test)

• HRV (heart rate variability)

• RHR (resting heart rate)

• Blood pressure

Why it matters:
Should you ever have a plaque rupture, how resilient is your heart and blood flow? This makes all the difference between angina and sudden cardiac death.

What I Don’t Routinely Track (And Why)

Lipoprotein(a)

The evidence is still evolving. And while the AHA recently recommended it, the data is still quite weak.

It may matter in specific cases. And when it’s indicated, I order it on such patients.

But for most people, it doesn’t change what we actually do. That’s because the other risk factors paint 99% of the picture.

Coronary Artery Calcium scan (CAC)

Popular and cheap. It tells you if calcified plaque is already there.

It doesn’t tell you if you have soft plaque. And it doesn’t tell you if your plaque is unstable or stable.

The problem with adding more tests is that you don’t know when to stop.

There are endless tests available to assess the cardiovascular system:

• CT angiogram

• Echo

• EKG

• Troponin

• BNP

At some point, you’re no longer improving health. You’re just collecting data.

In my practice, I’m not trying to find disease easier. My goal is to prevent it long before anything can show up on a test.

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

Quick Self-Check

Ask yourself:

• How’s my energy throughout the day?

• How’s my stamina?

• Is my sleep restful?

• Is my body composition good?

If these are off, your cardiovascular system is already under stress.

Even if your labs look “normal.”

What are your favorite tests to track your heart health?

Leave a comment

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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Most people think their health problems are separate.

• Low energy.

• Weight gain.

• Poor sleep.

So they try to fix each problem separately, not realizing they are interconnected.

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.

A Common Health Mistake

Many treat their symptoms like isolated problems, often without ideal results. This has become the pitfall of mainstream medical care.

Since the advent of labs, clinicians and patients have mistakenly focused on specific biomarkers without considering the big picture of health.

The 5 Systems That Control Your Health

After reviewing the best-performing health framework, this is the one I use with every health coaching client. It’s called the TREND framework.

• T - Testing.

• R - Relationships.

• E - Exercise.

• N - Nutrition.

• D - Downtime.

1. Testing - To Guide Better Decisions

Before making any decisions we should have an objective test to help guide us.

And it should be a test that we can keep rechecking to make sure that our actions are having a real impact on our health.

• Your energy after a meal.

• The quality of your sleep.

• Specific labs that answer specific questions.

• Your VO2Max.

2. Relationships - What Shapes Your Daily Habits

This is the one almost everyone ignores. Your environment shapes your habits.

Improving this category makes it much easier to see results in another category.

• Stress from your environment.

• How you feel about yourself.

• The people who are around you.

• Your support systems.

If those are off, everything else gets harder.

3. Exercise - To Maintain Functioning

You need consistency much more than the perfect exercise plan.

Just one week of missing a workout and you'll have lost most of the cardiovascular protection.

Most people can get the majority of benefits from simple daily movement:

• Walking.

• Basic strength work.

• Chores around the house.

• Calisthenics.

• Hiking.

Once you build the activity floor you can add in the intensity ceiling. But that comes later.

4. Nutrition - To Support Energy and Metabolism

Before focusing on macros, it’s important to know what you healthy goals are.

What’s your biggest health risk and how is your current diet helping or hurting you?

The goal is to make your nutrition intake:

• Consistent.

• Sustainable.

• Not overly processed.

• Nutrient dense.

• Not calorie-dense.

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

5. Downtime - To Restore Energy and Focus

Once you’ve done all the hard work to improve other aspects, you now need enough rest and recovery to reap the benefits.

No recovery → no progress.

The key factors in recovery are:

• Don’t push yourself when tired.

• Protect your sleep.

• Structure downtime for your mind, not just body.

All Parts Are Interconnected

Health is an ecosystem that is interdependent. You can’t really focus on just heart health and assume your brain will do well.

They feed into each other.

That’s why focusing on one thing rarely works. But when you’re troubleshooting, you can focus on the highest yield actions.

Ask yourself

• Do I actually know what’s working for me, or am I guessing?

• Is my routine consistent enough to produce results, or just occasional?

• Am I relying on intensity instead of consistency?

• Is my recovery helping my progress, or holding it back?

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.

Follow me on:
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Sleep that once felt restorative is now anxiety-inducing.

And even trying to relax is no longer calming.

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.

Meditation as a Tool

If you’ve been frustrated with traditional meditation or your own past experiences, here are 12 different methods to try.

If you’re an athlete, it’ll help you recover faster. If you are over age 50, this is one of the most effective dementia prevention strategies.

When you can tap into your calmness, you’ll make better decisions, experience less stress, and apparently live longer. (Schneider et al, 2006, Stress reduction & mortality.)

• Improve metabolic health.

• Reduce inflammation.

• Improve digestion.

• Improve mood.

Quick Check:

1. Do you feel exhausted but too wired to rest?

2. Do you struggle to feel calm before bedtime?

3. Do you wake up anxious or exhausted?

12 Simple Alternatives to Traditional Meditation

The main goals:

• Slow down breathing.

• Lower your heart rate.

• Improve circulation.

1. Breath-Focused Meditation

This is the “compound lift” of the meditation world. Focus on only your breath (nostrils, chest, or belly). When your mind wanders, you simply return to the breath.

• Best for: Busy minds, anxiety, and beginners.

• The Goal: Train attention like a muscle. Notice the drift, return gently, repeat.

• How: Feel the air through your nostril, your ribs expanding, your belly moving.

2. Mindfulness Practice (My personal favorite)

Instead of hyperfocusing on one thing (breathing), you become an objective observer of everything. You watch thoughts, sensations, and emotions arise without trying to change them.

• Best for: Emotional regulation and obsessive thinking.

• The Goal: You’re not trying to stop or change thoughts; you’re practicing not getting swept up by them.

• How: Search with your mind for 5 sounds, 4 sights, 3 touches, 2 tastes, and 1 smell.

3. Body Scan (I do this at night)

You move your attention slowly from head to toe, noticing sensations like tingling, heat, tension, pain, pressure, lightness, and heaviness.

• Best for: Insomnia and chronic pain.

• The Goal: Reconnect the brain-to-body link and manually downshift the nervous system.

• How: Feel the fabric on your sock, glasses on your nose, and air on your forehead.

You can actually change blood flow to a certain part of the body by focusing on it. Try it when you have cold hands/feet.

4. Loving Kindness

You internally repeat phrases of goodwill toward yourself and others (“May I be safe… may you be well…”).

• Best for: Self-criticism and relationship stress.

• The Goal: Practice emotional stability.

• How: Silently or out loud you repeat, I’m okay. Everything is okay. Nothing of value can be taken away.

Say anything long enough and you’ll eventually believe it.

5. Tapping into Compassion

When you feel hate or anger then you come up with an image or thought that is loving about the person or situation.

• Best for: Caregivers, burnout, and parents.

• The Goal: Learning that you can care deeply without carrying everyone else’s weight.

6. Mantra

You repeat a word, phrase, or sound to anchor your attention.

• Best for: People who dislike breath focus or a rigid structure.

• The Goal: Give the mind one single sound to hold onto, leaving fewer places for it to run wild.

• How: Hum gently or purse your lips and vibrate it.

  

This is the Pavlovian concept where your mind associates a phrase or word with a feeling.

7. Guided Visualization (I use this for pain)

I imagine myself walking into a thick, mossy forest. I descend hidden, stony stairs into a light fog. Then appears a healing figure, showering me with love (It’s actually Dr. Weil - he’s so warm and fuzzy to me.)

• Best for: High stress, insomnia, pain, and performance anxiety.

• The Goal: Use your imagination to adjust the dial on your nervous system.

• How: Find an enchanted image and take yourself there. Immerse yourself in the sounds and smells of that place with as much detail as possible.

8. Walking Meditation

Slow or normal-paced walking with total attention on your steps, the contact with the ground, and your environment.

• Best for: People who feel restless sitting, those with ADHD traits, or a post-meal reset.

• The Goal: Meditation for people who say they “can’t” meditate.

• How: Listen to all sounds, the pressure on your feet, the wind, sun, and movement of your limbs.

9. Movement-Based Mindfulness (Yoga/Tai Chi)

Slow, intentional movement combined with breath and focused attention. The importance is the synchrony of breath and movement.

• Best for: Physical stiffness, stress, and “older” beginners who want to combine mind-body work.

• The Goal: Some nervous systems open easier through movement than through sitting still.

10. Labeling Practice

You gently “label” your experiences as they happen: “thinking,” “planning,” “tension,” “hearing.”

• Best for: Rumination, intrusive thoughts, and feeling emotionally overwhelmed.

• The Goal: “Name it to tame it.” The labels create space between you and the thoughts.
  

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, you can learn more here:

Book a coaching call

11. Self-Inquiry

Practices that ask deep questions like “Who am I?” or “Who is the one observing?”

• Best for: Experienced meditators or those drawn to philosophical/existential approaches.

• The Goal: Less “doing,” more “seeing.”

• How: Ask the question but the answer isn’t important. Just reflect.

12. Mind-Body Connection

30–90 seconds of downshifting: 3 slow breaths, unclench the jaw, relax the shoulders, and a long exhale.

• Best for: People who are “too busy” and workplace stress.

• The Goal: Consistency beats intensity. Five 1-minute resets per day can be more powerful than one 20-minute session you never do.

Which one resonates with you?

If you’re feeling that midlife[ fatigue or brain fog, I challenge you to pick one of these and try it for 3 minutes right now. Your nervous system will thank you.

Leave a comment

To your health,

-Dr. Ashori, MD

Disclaimer:

Dr. Mohammad Ashori is a U.S.-trained family medicine physician turned health coach. The content shared here is for education and general guidance only. It is not personal medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Humans are complicated and context matters. Always talk with your own healthcare team before making medical decisions, changing medications, or ignoring symptoms. This information is to help you add more depth to those conversations.

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Putting up With Stress

In my second year of medical school I was bloated, had acid reflux, bouts of diarrhea and constipation. I assumed it was what I ate.

Most of the time my mood was fine. But it took very little to overwhelm me or make me irritated.

Just a few months ago I was onboarding new team members in my practice and the first thing I noticed was that my stamina in the gym was lower. I hadn’t changed anything else.

My amygdala was likely firing constantly with no way for me to override it. This crashed my nervous system, unable to make my muscles fire the way I wanted.

Crashing Focus

The 2009 Lupien et al study tracked how adults with higher cortisol levels often have lower cognitive function. This isn’t dementia but it would certainly feel that way to you.

That’s why stress management is our top priority for any health coaching client experiencing brain fog.

Chronic Pain

Our body has a natural way of suppressing excess pain signals. But chronic stress lowers the brain’s ability to mute pain. This was demonstrated in Pola et al, 2024.

I felt this in my lower back in 2016. I was slowly transitioning out of the insurance-based world and launching my own medical practice came with stress. No matter what I did, I felt pain in my back.

Immune System Couldn’t Recover

Between 2010-2012 I was always sick. I was a full-time physician at Kaiser Permanente in the family medicine department, I picked up shifts in the urgent care and in pediatrics, and I had way too many hobbies outside of medicine.

High catecholamines suppress immune cells such as NK cells and increase inflammatory molecules like IL6. This combination crashes the immune system, which is needed not just for fighting off infections but fighting off cancer cells.

Segerstrom et al reviewed 300 articles to show that while fight-or-flight stress can improve the immune system temporarily, chronic stress caused global suppression of it.

10 Things I Teach My Patients About Stress

1. Perform breath techniques to lower stress (and blood pressure).

You can try the box breathing method below. My personal favorite is the 4-7-8 breath.

The Ma, X. et al (2017) study showed that diaphragmatic breathing reduces cortisol levels and improve negative effects of stress.

2. Get natural sunlight.

While many fear skin cancer, we forget all the benefits from the sun. It’s not just about vitamin D but also mood.

Mead (2008) showed how solar radiation affects the body through non-visual pathways, boosting serotonin to alleviate stress.

3. Go for a walk or perform an intense workout.

I do my health coaching meetings when I go for a walk. It’s better than sitting behind a computer screen.

The Mikkelsen et al. (2017) clinical review demonstrated that regular physical activity significantly lowers subjective anxiety, panic disorders, and perceived psychological stress.

4. Journaling is like talking to a therapist.

If there’s something bothering you, talk about it, journal about it, or at least do some mindfulness to avoid obsessing over it.

The Glass et al. (2019) trial showed that regular expressive writing and emotional journaling significantly relieve psychological burden, ordering associated thoughts to decrease perceived distress.

5. Plan for more sleep after stressful days.

When stressed, the same 8 hours in bed will be more like 6. So add a little more bedtime if possible.

The Hirotsu et al. (2015) study confirmed that high psychological stress increases nighttime cortisol and impairs the deep, restorative sleep phases.

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

6. Stretching your muscles lowers your stress hormones.

If you don’t like to work out at least consider getting on the ground and stretching your joints.

Eda et al measured salivary stress hormones and showed that stretching decreased cortisol and increased testosterone.

7. Caffeine is the enemy of stress (and sleep.)

During high-stress days, it’s best to cut back on caffeine. It’ll take longer to get cleared from the body, negatively affecting sleep. Switch to half-caff coffee for a while.

The Richards and Smith (2015) cross-sectional study established that higher caffeine consumption is strongly linked to elevated anxiety and higher stress scores.

8. Socializing can be frustrating when stressed, but it’s therapeutic.

When I’m stressed I don’t want to socialize. But if I can do it in a supportive space, it’s healing.

The Ozbay et al. (2013) clinical trial demonstrated that high social support alters neurobiological pathways to suppress cortisol spikes during acute stress.

9. High-intensity exercise during stress is as bad as caffeine.

I’ve learned from my patients that intensity has to go down when stress levels are high.

The Budde et al. (2015) study showed that high-intensity workouts elicit a sharp physiological stress response that can amplify existing mental burnout.

10. Stress is physiological, not cognitive. You can’t think your way out of it.

Overanalysis, repetitive thinking, and having internal dialogues often are more harmful than helpful.

The Zainal and Newman (2021) clinical study proved that chronic cognitive overanalysis and worry disrupt basic autonomic recovery systems, trapping the body in a prolonged stress loop.

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.

Follow me on:
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Cancer, diabetes, fatty liver disease, and autoimmune diseases have a higher risk if there’s underlying metabolic disease. And since there’s no one test that can check for it, this is the approach we take in my practice.

TL;DR

• Start with insulin, not glucose.

• Look at how your body responds to glucose/stress.

• Measure fat distribution, not just weight or BMI.

• Liver fat is an important metabolic signal.

• Simple tests like waist measurement still matter.

1. Fasting Insulin (HOMA-IR)

Insulin levels change before glucose does. That’s because major glucose spikes can be dampened by secreting more insulin.

You can get your fasting insulin and glucose done separately and calculate a HOMA-IR score using an online calculator. Ideally this should be ~1.5, not much higher.

Note: Fasting, exercise, or a late-night high-carb meal can all affect your HOMA-IR score. We follow a strict protocol when measuring this to avoid noise.

2. OGTT

This is the oral glucose tolerance test. Think of it as the treadmill stress test for your metabolism. This is how your body handles a hefty glucose load.

For an added layer of accuracy, you can get this test done with both glucose and insulin levels.

In our practice, we look at the curve but also how the person feels after ingesting the Glucose Drink. We check at 30, 60, and 120 minutes.

Note: If you’re keto, fasting, or slept bad, your numbers won’t be accurate.

3. Visceral Fat

I like DEXA scan because it’s cheap and easy. But MRI’s are becoming more popular.

Bioimpedance devices do a good job of overall fat but they can’t localize it to the fat that accumulates around the organs.

Note: DEXA/MRI are accurate but not 100%. If you’re borderline, follow up with other tests. Trends matter more than absolute numbers here.

4. Liver Fat (ALT)

You can’t have a normal cardiometabolic system without a healthy liver. Your liver’s ALT enzyme is one of the more accurate tests for this.

We still get a liver scan to be sure but if someone has a high ALT and it drops with the right lifestyle changes, no need to check further.

Note: You can have fatty liver disease with normal ALTs. And exercise, statins, and other drugs can falsely elevate your ALT.

5. Waist-to-Height Ratio

I don’t know any other practice that uses this. I’ve never met a patient who’s calculated their WtHR. It’s not sexy but it has incredibly solid evidence behind it.

All you need is a tape measure. More than 50% and your risk is high. Lower, and chances are your metabolic health isn’t too bad.

Strong Secondary Markers for Metabolic Disease

Many don’t know that your lipid numbers are often an accurate reflection of your metabolic health. Poor metabolic health will lower your HDL, raise your Triglycerides and your LDL.

• Triglyceride / HDL ratio

• ApoB

• Uric acid

• High-sensitivity CRP

• Blood pressure

Who We Test

If your diet, exercise, stress, and sleep aren’t optimized, testing is a good idea.

Before any testing we ask: “What changes can we or are we willing to undergo if the result is abnormal?”

The Goal of Testing

I test for metabolic disease early because if we intervene then we potentially prevent:

• Diabetes

• Heart disease

• Cancer

• Autoimmune disease

We test so that we have data to take action on. But we don’t obsess over absolute values and instead focus on how to get the results to trend lower over time.

Taking New Health Coaching Clients!

If you’ve been looking for a partner to help you solve a health mystery, this is your chance. If you’ve been looking for a partner to help you solve a health mystery, this is your chance. Below are 3 ways to work with me to help you feel better:

1. One-Time Deep Dive (60 minutes)
   This is a focused session to review your symptoms, labs, and lifestyle. In this physician-led health coaching hour you can pick my brain. I’ll share my experience and the latest research relevant to you.

2. Monthly Coaching
   Ongoing support with one live session per month plus direct messaging.
   This is best for making steady progress with accountability.

3. Weekly Coaching
   This is much more hands-on, with weekly live 1-hour sessions and close guidance.
   Ideal if you want faster and more structured change.

Find out more at https://drashori.com/health-coaching/

Disclaimer:

Dr. Mohammad Ashori is a U.S.-trained family medicine physician turned health coach. The content shared here is for education and general guidance only. It is not personal medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Humans are complicated and context matters. Always talk with your own healthcare team before making medical decisions, changing medications, or ignoring symptoms. This information is to help you add more depth to those conversations.

Follow me on:
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Facebook
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What Does Low Testosterone Feel Like in Men?

From the European Male Aging Study and the HIM Study by Mulligan, we know exactly what symptoms show up when testosterone drops below necessary levels.

This testosterone decline usually happens right after age 30, when most men are at the peak of their careers. They have stress, weight gain, less exercise, and less focus on their health. Which can all be confused for low testosterone.

• Reduced libido

• Erectile dysfunction

• Reduced morning erections

• Low energy

• Reduced physical strength

• Depressed mood

• Reduced motivation

• Poor concentration

• Sleep disturbances

• Increased body fat

It’s important to differentiate ‘normal’ stress from hypogonadism. Of course, these are just symptoms and lab tests are helpful to differentiate the real underlying cause.

1. Low Sexual Desire

When it comes to decreased sexual desire related to low testosterone, we’re not comparing you to your 18-yo self, but how you were 1-2 years ago.

What to look for:

• Noticeable drop compared to prior baseline

• Less spontaneous desire

• Less mental preoccupation with sex

Of course, this could also be due to thyroid, blood sugar, or various other medical issues. Your doctor will know how to rule out all potential conflicting diagnoses.

2. Reduced Morning Erections

Men with healthy testosterone levels typically wake with erections several times per week. More noticeable when your bladder is full.

A biologic sign of testosterone decline includes a progressive decline in:

• Frequency

• Firmness

• Duration

3. Reduced Drive/Motivation

There is male go-getter-ness that perhaps you had when you were in your 20s and early 30s. It’s a natural inclination towards competitiveness.

When T levels drops it’s common to experience:

• Less motivation

• Less drive to pursue goals

• Feeling “flat” or blunted

4. Increased Visceral Fat

Without adequate testosterone levels your waist starts expanding. It’s a 2-way street with a poor lifestyle which drives and is driven by low testosterone.

• A bigger belly

• Growing love handles

• Softer muscle tone

More fat → more aromatization → lower T → more fat.

5. Reduced Muscle Recovery

If you work out regularly then you know it takes a certain amount of time to recover. Both to feel fresh again and to prevent injuries.

• Slower strength gains

• More soreness

• Harder to maintain muscle mass

6. Depressed Mood/Irritability

No desire to do anything fun? Especially if it shows up with irritability then it’s likely related to hormonal changes.

It’s really important to differentiate between major depressive disorder (MDD) and hormone related changes to mood:

• Low energy

• Low desire to do fun things

• Not suicidal, still able to get out of bed

7. Increased Fatigue & Energy Crash

This is crashing by 3 pm and not having any energy to do anything else. It’s not likely that your energy will recovery later in the evening.

• Not able to pick yourself up

• Crashing towards the end of the day

• Not better with rest

8. Sleep Fragmentation

Low testosterone and poor sleep reinforce each other. If you’re not able to adequately exert yourself throughout the day, it’s unlikely that you’ll get restful sleep.

• Snoring

• Mild sleep apnea

• 2-3 am awakenings

• Not feeling rested after adequate sleep

9. Gynecomastia

It might not be dramatic breast tissue like many boys develop during puberty. But there will be excess fat and tissue accumulations around the breasts.

• Puffy areola

• Softer chest contour

• Softer muscle mass overall

10. Abnormal Metabolic Functions

If you’re doing everything right but you notice increasing A1C, higher Triglycerides, higher blood sugars and insulin levels, that could point to testosterone problems.

• Lower HDL

• Higher HOMA-IR score

• Increasing LDL-C or apoB

It’s Not in Your Head

If a doctor has ever dismissed your symptoms as “it’s in your head” or “psychosomatic”, you have my permission to push back.

In my practice, I rarely see any value in telling someone it’s in their head. If you’re feeling something new with your health, it’s real. The goal is to figure out what you can do to help you feel better. That’s what I do as a health coach.

5 Ways to Improve Your Testosterone Levels

Now that we covered what symptoms you’ll experience if your testosterone levels get too low, here’s what you can do about it.

The current narrative is that if your T is low, you need testosterone replacement. That’s false for most men. The first things you need and can do are:

1. Lose Visceral Fat

Subcutaneous fat won’t matter. Visceral fat:

• Increases aromatase activity (T to E)

• Suppresses the hypothalamic-pituitary pathway

All you need is around a 5% reduction and you’ll see better sleep, more energy, and better mood.

2. Lift Hard or Very Hard

Of course, you’ll have to work up to this gradually. But the act of lifting weights or just exerting yourself physically stimulates testosterone production directly.

• Compound lifts

• Larger muscle groups involved

• Progressive overloading

Once you master the correct form, my favorite exercises are:

• Squats

• Pull ups

• Push ups

• Deadlifts

3. Get More Restful Sleep

10 hours in bed after caffeine, alcohol, and a heavy meal will give you at best 6 hours of halfway decent sleep.

Testosterone is produced primarily during sleep.

Even one week of 5-hour sleep can drop testosterone 10–15%.

Key issues in 30s–40s men:

• Late screen use

• Alcohol at night

• Sleep apnea

• Irregular schedule

4. Focus on Fuel

There’s no “heart diet”, just as there’s no “testosterone diet.” You need enough food to fuel your body, not more, not less.

In my TREND framework, N = nutrition. We need the right amount of calories and nutrients to keep this body functioning. If you need help figuring it out for yourself:

Book a private session

5. Replace the Stress

If you do stressful things, you’ll experience higher cortisol. It’s not easy to get away from it but spending more time with friends, outdoors, exercising, and leisurely reading can help a lot.

Disclaimer:

Dr. Mohammad Ashori is a U.S.-trained family medicine physician turned health coach. The content shared here is for education and general guidance only. It is not personal medical advice, diagnosis, or treatment, and it does not create a doctor–patient relationship. Humans are complicated and context matters. Always talk with your own healthcare team before making medical decisions, changing medications, or ignoring symptoms. This information is to help you add more depth to those conversations.

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UPDATED: April 13th, 2026

Welcome to Physician-Led Health Coaching, a weekly newsletter troubleshooting your health mysteries. I help adults solve brain fog, fatigue, and stubborn weight to age well and avoid the common chronic diseases of modern life. I’m Dr. Ashori, a board-certified MD turned health coach, offering personalized health coaching for professionals worldwide.

I keep seeing a similar pattern in people in their 30s and 40s.
They feel mostly fine, but something is off.

Energy is lower. Sleep is inconsistent. And their weight is creeping up.

Their labs are “normal.” But they don’t feel normal.

I chose to pursue medicine because I was fortunate to grow up with it. I wanted others to enjoy the same health.

Growing up and living in Iran, Germany, Spain, and now the US, I’ve seen health from so many different angles.

If Medical School Taught Health Care

The Krebs cycle, the renal glomeruli, and the connective tissue between fascia and muscle are what were taught. They are the building blocks of the human body doctors learn to take care of.

Health, however, is a personal definition, not defined by an elite group of physicians on a guideline panel. It’s what I needed to learn to define for myself when in training, so that I could one day tease it out from my patients.

I learned pharmaceutical names, prescription guidelines, how to interpret research studies, anatomy, physiology, psychology, and pathology. But never getting close enough to the health I recall having definitely before, certainly not during medical school.

The Medical Care Complex

The sterile clinic of today is the battle ground where the doctor attempts to sell the patient on a new diagnosis, accompanied by related drugs, treatments, and lab testing.

The patient attempts and very quickly gives up because the propaganda of clinical medicine is so powerful. From the cellular to the magnetic imaging, it’s really tough to stand up against this convincing behemoth.

The patient goes in every 3 months, stripped of their autonomy, showered with acronyms and latin words, leaving with a lighter pocket after their final visit to the pharmacy.

The are often waiting for the next symptom to show up, desperately hoping to never have to go through the same phone tree, talk to yet another new receptionist, or, much worse, see yet a new clinician whom they’ve never met before. NP, PA, or was it a DO this time?

The Diseases That Compete With Health

Now, 2 decades and 100,000 patient visits later, I know what health is. I’ve defined it for myself but need to define it over and over every time I enroll a new patient in my medical practice.

The 20 year old often coasts on the great genetics most of us have in our first two decades. There’s resilience, easy recovery, and sleep will happen even if you don’t want it to. Alcohol, weed, and fast food go down easily, rarely making you feel like you’re on fire.

It’s in the 30s and 40s when you need caffeine to avoid the headaches, the purple pill for the reflux, the yellow powder for constipation, the red bottle for aches and pains. These are the convenient OTC solutions until they become our gateway drugs to the prescription bottles.

It’s diabetes, hypertension, cancer, dementia, and autoimmune diseases that eventually take us down. The over the counter runs won’t do it anymore. It’s time to go sit on an exam table, half naked, with an middle-aged, white-coated person standing over you.

Lost Health

It was just a few years ago that you were doing bunny hops on your bike and taking dives off your surfboard into the waves. What changed? You haven’t done a thing different than your early 20s.

And, honestly, you don’t feel as bad as this wrinkled white coat is making it out to be. The last thing you want is to be on a bunch of meds. The dropped faces of those waiting in line at the pharmacy are enough to keep you from ever going back.

Not Joe Rogan, Peter Attia, Andrew Huberman, or Rhonda Patrick actually care about your health. You figured that out because the $2,900 red light therapy device didn’t do anything. Your $349 Oura ring just made you more anxious. And the creatine, magnesium, and 10,000 milligrams of vitamin D or, was it E, just made you bloated.

But there’s no lying - that LCD screen is definitely showing 148/92. The Quest lab says you’re in the prediabetes range at 5.9. And these were the good numbers you’re using to make yourself feel better.

Living Well

On Reddit people say how terrible these doctors are. Gaslighters, patronistic, condescending, rude, and dismissive long white coats. These doctors are making money on ordering MRIs but never tell you to lose weight, sleep better, or exercise.

Back when I used to work as a family medicine doctor at Kaiser Permanente, I wondered why we’re doing what we’re doing. Then again, everyone, including the president, was praising what a great example KP was as a healthcare system. All the while, I’d escalate prescription dosages, add new meds and new ICD 10 codes to their member’s charts.

The only 2 people I recall in my decade-long stint at KP who escaped my clutches were 52 year old CP and 83 year old EM. He got tired of more and more diagnoses and didn’t want to end up like his dad, a pulmonologist who had a pharmacy on his nightstand and lived at the hospital dialysis center. She had retired 2 decades prior and completely disconnected from society but wasn’t about to start her first prescription and decided to reverse her diabetes and high blood pressure with her plate and feet.

They are both still alive. Both doing well. But no longer my patient.

A Life Coach You Didn’t Want

Nor Aetna or Cigna are going to pay me to talk about exercise, diet, stress, and sleep. At least not when someone’s numbers are in the red. If I didn’t fear the insurance companies denying my claims I had to fear the lawyers coming after my medical license for not forcing a statin down my throat’s patient.

My mechanic wants to explain to me that the error code is coming from one of the 3 computers my car has. I just don’t want to hear it. I don’t speak wrench - please just fix it and tell me where to tap my phone. Just as my patients don’t want to hear about the glucose transporter on their myocites. So we all just talk at each other but don’t know what the other person is saying.

While the 3rd computer is replaceable, your coronaries aren’t. So I decided to test a hypothesis of preventing over treating. If I can keep your vessels clear, your liver lean, and your muscle cells working, maybe you wouldn’t get sick. You wouldn’t be in a doctor’s office or the long pharmacy line.

It worked. Blood pressures and cholesterol and CRPs came down because I health coached more than I doctored. People felt better because they had a life coach who wasn’t bound by clinical conflicts of interest. They got their 20s back in their 40s. And now they knew what health was. They didn’t need me much because they were empowered.

No more bamboozled by the banker turned carnivore dietician. Free from the clutches of the supplement dealer. And no more having to listen to someone who’s on an ACE-I, statin, and injectable testosterone who’s telling you how to stay healthy. The freedom!

It Starts Here

As long as we’re in these human bodies we’ll need ER, ICU, and rheumatology doctors. But it turns out that even ICU stays and aortic dissections are preventable. It starts by knowing that they are preventable.

Smart, caring, dedicated doctors don’t believe that. Because their paychecks depend on them believing their training. We are, after all, human. My biases are as colorful as yours. Except I’ve been fortunate to question my clinical biases and my health coaching clients are reaping the reward.

UCLA, the Cleveland Clinic, JAMA, nor the AHA aren’t about to turn on this dime. They certainly aren’t dying on their hill. Their disciples are building them mansions on top of them. From PBMs to vertically integrated healthcare systems, you only need to go in for acid reflux and you’ll come out with a prostate cancer diagnosis.

It starts with knowing what’s at steak. Your Health. And who actually cares about it. You. And who is on your team to help you achieve your definition of health vs. try to convince you that they have the solution to your health safely stashed behind the counter.

https://drashori.com

The good news is that it’s a completely preventable condition. Think of it like a car accident - if you don’t speed and drive attentively, you’ll avoid a crash.

The Early Symptoms

For most adults it starts with your energy dipping down in the afternoon. You feel like crashing after some meals - especially lunch. And you start craving something sweet to get through the day.

But this isn’t just about your energy or appetite. There’s a hormone problem brewing that also affects your hair, skin, sleep, blood vessels, and tendons. All of this is happening with perfectly normal standard lab results.

The goal is not to wait until your labs signal a metabolic problem. We want to catch it years ahead and prevent diabetes in the first place.

Insulin & Your Muscles + Liver

Your muscles are the largest place your body can store glucose (70-80%). If you’re not using your muscles, you can’t store the glucose, which means it’ll float around in your vessels.

Over time, your body has to produce more insulin to push the glucose into the muscles and the liver - that’s the second best place to safely store glucose (10-20%).

But the more insulin your body releases, the more insulin resistant you become. And that won’t show up on a fasting glucose or an A1C test. We’re still a decade out from that.

Are You At Risk?

We are all at risk. That’s because our bodies are meant to prioritize glucose absorption for survival.

As I’m sitting here, intensely focused on writing this article, my body is freeing up glycogen to feed my typing fingers and my revving brain. That means that my glycogen stores are running low.

Our sedentary lives, stress, interrupted sleep, refined foods, and even prescription medications are all contributing to higher blood sugars. This is the risk we all face.

The 10 Habits That Protect Against Type 2 Diabetes

My mom is nearly 80 and went to her doctor and told that her A1C is nearing diabetes. She doesn’t carry a gram of extra weight on her. She eats well and exercises.

But with time, our pancreas, liver, and muscles slow down their function. The good news is that even if she develops diabetes, she’ll have pushed it far into her future. It won’t be happening anytime soon.

Here are the habits my mom and my patients have learned to avoid or delay diabetes for as long as possible.

1. Walk After Your Heaviest Meals

My wife and I had some Cubano sandwiches. This is the perfect definition of a carb/fat bomb going off in our bodies.

The good news is that your body can handle this, as long as everything else is going well. And right after this delicious food, we went for a walk.

As the refined carbs in the bread get absorbed into the bloodstream, the flexing muscles during our walk are transporting the glucose into the muscle and storing it as glycogen.

2. Build Your Muscles 2x/Week

My mom started doing resistance training in her late 60s. It has helped her avoid falls, improve her resting tremor, and get her thyroid levels back to normal.

You don’t need much - 2x/week of a structured resistance program is more than enough. Do it without weights (body exercises) or do resistance bands.

Focus on big muscles and compound movements like squats, pushups, and pullups.

3. Switch from Refined Carbs to Complex Carbs

Me and my wife don’t have a lot of risk factors for diabetes but we still avoid refined carbs. High-carb foods like that cubano sandwich is something we’ll have very rarely.

If your health is solid, a little refined carbs timed properly shouldn’t be an issue. For everyone else it’s a food that your body will really struggle with.

4. Protect Your Sleep

There’s no such thing as perfect sleep but there’s always something you can do to protect it. If I eat after 6pm then I’ll be tossing and turning until the wee hours.

If you’re someone who wakes up in the middle of the night and can’t go back to sleep, check out this article:

5. Feed Your Gut Bacteria

Your gut bacteria make the short chain fatty acids that lower inflammation and improve your metabolism. They also make vitamin K2, certain B vitamins, and about 90% of the serotonin you need for your mind-body connection to function properly.

Your gut bacteria subsist on fiber. With a healthier gut flora you’ll slow down sugar absorption, lowering your chance of diabetes.

6. No Liquid Calories

In my health coaching practice, liquid calories are a non-negotiable. I’ve tried to be lenient with it in the past, only to see the blood sugars and cholesterol shoot up suddenly.

Liquid calories are mostly juices and soda. But they include alcohol and some shakes. Soups aren’t in this category.

7. Lower Cortisol

Stress is unavoidable and one could say that stress can lead to growth. But how your body responds to stress is something you can improve over time.

High cortisol releases more insulin and also increases inflammation. While meditation, breathing exercises, and relaxing activities can help lower it.

8. Maintain a Healthy Waist Size

Visceral fat is the enemy of insulin resistance, prediabetes, and diabetes. To lose it you must engage in aerobic activities and consume fewer calories than you burn.

The good news is that your body is a master/mistress at burning off visceral fat. You just need to give it a chance to do so.

9. Limit Late-Night Eating

As I shared above, eating late at night terribly disrupts my sleep. Without enough deep sleep, I can’t recover, which means more inflammation. And more inflammation means worse metabolic health.

Our heart rate stays higher longer with late-night meals, our temperature regulation worsens, and it’s generally harder for digestion to take place.

If you eat late, just set it back by 1 hour. That will already make a big difference.

10. Stay Consistent, Not Perfect

When I sign on a new health coaching client, we focus on small habits they can do consistently. We never aim for perfection because that’s a recipe for failure.

Small, daily, consistent habits have the benefit of compounding over time.

The TREND Method for Better Health

My TREND method focused on testing (T) to determine what we need to focus on. Using the following metrics I determine if someone is at risk for diabetes or having early signs of insulin resistance:

• HOMA-IR

• Tg/HDL ratio

• Oral Glucose Tolerance Test

Then we pick one small habit from the other categories to change and keep consistent:

• R - relationships

• E - exercise

• N - nutrition

• D - downtime

If you’re dealing with any fatigue or health issues related to your metabolic health, what are some challenges you’ve faced?

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

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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