Physician-Led Health Coaching

Why Your Fish Oil Supplement Isn’t Working (And What to Do Instead)

Dr. Ashori MD — Sun, 24 May 2026 16:05:46 GMT

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:

Large randomized trials in mostly healthy or well-managed patients show little to no reduction in major cardiovascular events.
Any benefit appears small, inconsistent, and often limited to very specific subgroups.
High-dose prescription EPA shows some benefit in very high-risk patients, but this may not apply to over-the-counter fish oil.

2018 study that showed no significant CVD benefits.

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

The VITAL trial also showed no benefit for CVD prevention.

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.

Know someone dealing with this? Send it to them.

#2. Inflammation & Joint Pain

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

What the evidence shows:

Small reductions in inflammatory markers.
Minimal effect on pain and joint movement.
Effects are too subtle to matter.

While there was some improvement, it was minimal.

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:

Some observational links between fish intake and cognition.
Omega-3 supplement trials show little to no cognitive benefit.
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.

The VITAL Study found no difference in annual rates of cognitive change in those taking Omega-3 vs placebo

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.
If you want help with this:

Book a coaching call

#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.

Someone you know taking Omega-3s?

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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4 Big Myths About HIV and AIDS That Still Show Up Today - Test Your Knowledge

Dr. Ashori MD — Sat, 23 May 2026 17:01:33 GMT

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.

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Are You and Your Doctor Speaking the Same Language?

Dr. Ashori MD — Thu, 14 May 2026 19:45:08 GMT

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.

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.

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7 Habits to Save Your Sleep and Sanity in Perimenopause

Dr. Ashori MD — Thu, 07 May 2026 14:06:24 GMT

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.

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.

2019 Study on Lifestyle Changes & Menopause Transition

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.

Lift weights.
Focus on big movements: squats, pushes, pulls.
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.

Keep a predictable sleep schedule.
Limit late-night stimulation.
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.

Switch away from refined carbs.
Increase fruits, vegetables, beans, & lean protein.
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.

Add vegetables, legumes, whole grains daily.
Build meals around fiber.
Experiment with beans, lentils, oats.

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.

Daily walking.
House chores that get you sweating.
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.

Create a daily “off switch”.
Walk, breathe, or step away from inputs.
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.

Track energy, sleep, weight trends.
Get your resting heart rate, heart rate variability.
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:

The 1–5 Scale I Use With Health Coaching Clients

Dr. Ashori MD — Tue, 05 May 2026 19:30:11 GMT

A symptom scale is not just a number. It is a way to communicate.

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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Why "Eating Healthy" Isn't Fixing Your Belly Fat

Dr. Ashori MD — Thu, 30 Apr 2026 14:02:24 GMT

Photo by Ehimetalor Akhere Unuabona on Unsplash

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.

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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.

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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:

13 Heart Health Markers That Matter (Beyond LDL)

Dr. Ashori MD — Thu, 16 Apr 2026 14:01:48 GMT

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.

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

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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.

Know someone dealing with this? Send it to them.

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.

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?

Disclaimer:

The 5 Drivers of Your Energy, Sleep, and Health

Dr. Ashori MD — Wed, 15 Apr 2026 21:27:24 GMT

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.

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.

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:

12 Ways to Calm Your Nervous System (And Feel Normal Again)

Dr. Ashori MD — Mon, 13 Apr 2026 18:46:22 GMT

Most people don’t realize their nervous system is stuck in “on” mode. They feel wired, but tired.

Sleep that once felt restorative is now anxiety-inducing.

And even trying to relax is no longer calming.

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:

Do you feel exhausted but too wired to rest?
Do you struggle to feel calm before bedtime?
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.

Thanks for reading Physician-Led Health Coaching! This post is public so feel free to share it.

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.

Download here

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.

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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10 Ways to Heal the Effect of Stress on the Body

Dr. Ashori MD — Mon, 06 Apr 2026 14:02:43 GMT

I’ve had a few major periods in my life when my body was overwhelmed by stress but I didn’t know I was stressed.

As a physician I was taught to ask my patients, “Are you stressed?” If the answer was no, I would take it at face value.

We feel the consequences of stress often before we recognize stress as an emotion in our body.

My Chaotic Gut

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.

But stress changes the way the intestines move and how enzymes are released to digest food.

The same food I ate 2 years later weren’t causing any problems.

Appetite Skyrocketed

Stress puts the body in the fight and flight mode. We want to constantly get simple carbs in us to quench anxiety.

I developed a binge eating problems sometime around the first year of medical school but it didn’t really bloom until my third year.

If I ate enough, I would eventually settle down. The food would overfill my stomach, signal my parasympathetic system, and my stress hormones would crash.

My Mood Crashed

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

I experienced this again a few years later when I was dealing with a medical board investigation. On the surface I was still cooking, exercising, and socializing. But my internal processing of signals was overamped.

These days, when I feel irritable I know I have to check in to see what my stress level is. The stress bypasses our ability to calmly assess a situation. Our presentness gets hijacked and we lose our ability to process.

Energy & Stamina Were Rock Bottom

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.

Cognition Couldn’t Keep up

The ability to focus, process information, and form new memories is highly dependent on our stress levels.

There are lots of studies, such as the 2009 Lupien et al, that track how adults with higher cortisol levels often have lower cognitive function.

Currently, in my practice, stress management is our top priority for any health coaching client experiencing cognitive difficulties.

Worse Aches & Pains

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.

I was fortunate to work with a great personal trainer who showed me that I had excess tension in the paralumbar muscles. Once I got a handle on my stress, the pain disappeared.

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.

Blood Pressure Was Super High

We have a lot more data on stress and blood pressure. And my system certainly wasn’t naive to it.

In 2016, during my career transition, my blood pressure was routinely in the 170s/100s range. It wouldn’t have made sense to take a blood pressure medication because I would have just masked the problems.

I still tried a blood pressure medication but it crashed really bad. Fortunately, as soon as I made the career move my BP was down to 90/60s, like usual. This was the biggest ah-ha moment for me.

10 Things I’ve Since Learned About Stress

1. Breathing is one of the most effective ways to lower stress.

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

2. Natural sunlight protects against stress.

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

3. “Release” stress by going for a walk or doing a hard workout.

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

4. Don’t ignore the constant, low-level stress.

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

5. More sleep time is needed because stress dampens sleep.

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

6. Stretching your muscles lowers your stress hormones.

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 bosy, negatively affecting sleep.

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.

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.

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.

Taking New Health Coaching Clients!

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:

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

Catch Metabolic Disease a Decade Before It Shows up on Standard Labs

Dr. Ashori MD — Wed, 01 Apr 2026 22:29:35 GMT

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.

Medical Biochemistry Page

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:

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

10 Signs Your Testosterone Is Low (And What to Do About It)

Dr. Ashori MD — Tue, 31 Mar 2026 14:03:05 GMT

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:

Slowly Losing Your Health Without Realizing It?

Dr. Ashori MD — Mon, 30 Mar 2026 19:33:49 GMT

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

10 Habits That Prevent Diabetes, According to the ADA

Dr. Ashori MD — Thu, 26 Mar 2026 18:38:02 GMT

38% of adults have prediabetes. And 25% of those with diabetes don’t know they have it.

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.

Gemini: 3 mediterranean dishes. The last one has the best balance of gut-friendliness.

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.

Know someone dealing with this? Send it to them.

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?

Book a coaching call

Disclaimer:

7 Ways to Prevent Diabetes, Even If It Runs in Your Family

Dr. Ashori MD — Tue, 24 Mar 2026 15:23:07 GMT

If you’ve watched your parents suffer the steady decline of type 2 diabetes, you may wonder if you’re bound to end up with the same disease.

Type 2 diabetes has a strong genetic component. But genes alone aren’t enough. You can design a lifestyle plan for yourself to avoid it.

Genetics ≠ Diabetes.

Welcome to the Healthy Aging Newsletter, a free publication translating trustworthy medical research into simple habits to age well, free of chronic disease. I’m Dr. Ashori, a family medicine doctor turned health coach.

Subscribe now

Factors Most Likely to Lead to Diabetes

I only have one grandmother who developed diabetes late in life. But even without a family history, anyone can develop diabetes, given the right factors.

Back in the day, genes that raised the risk of type 2 diabetes conferred survival advantages. But since we no longer live in those calorie-starved environments these genes are more of a liability.

1. Visceral Fat

Visceral fat is the enemy here. With enough of it, the pancreas and liver will have a hard time functioning properly.

Fat can also make its way into the muscle and prevent glucose balance. Think of that prized marbled beef - it’s a cow with metabolic disease. It’s not what we want for our own muscles.

What we do in my practice:

We build moderate intensity exercises to maintain a high aerobic capacity which burns fat. This forces visceral fat to melt off. We confirm it with a DEXA scan and/or Waist-to-Height Ratio.

2. Break up Sedentary Stretches

If you have any diabetes risk, it’s more important to avoid being sedentary rather than just getting workouts in. Exercise is important, but constant low-level movement may matter more.

It is also possible that the same thrifty genes that raise diabetes risk make maintaining high activity levels more difficult in today’s low-demand environment.

We do this in my practice:

We want our patients to maintain regular activity by breaking up long sitting. 2 hours of watching Netflix should be 30 minutes at a time, with a break to go and do some dishes. Try a walk after heavier meals.

3. High Cortisol Levels

It may be the cortisol hormone or how stress affects our appetite for calorie-dense foods. Stress can’t be avoided but we can build strong coping techniques.

Today is Friday and I have a long list of things to hand off to my team before the weekend. But I try to keep my focus on what I’m doing in the moment. I don’t think about the growing to-do list.

We do this:

We teach meditation to our patients - even those with experience meditating. Time is finite and the more you squeeze into one day the more stress you’ll feel. You have much less control over your life than you realize. This is liberating.

4. Calorie-Dense vs. Nutrient-Dense Eating

A bowl of broccoli tastes bland. Sprinkled with some olive oil and we’re getting somewhere. Covered in Sriracha Mayo and now we’re talking.

Your diabetes genes are clever and crave something calorie-dense. I’ve seen it over and over again with my patients. It’s just that we no longer live in those food-scarce environments.

We do this:

Trick your body with healthy high-volume food instead of calorie-density. This is going to need a little habit formation. More fiber added to your meals will leave you more satiated. Fill up with some nuts, hummus, and fruits if you still need to satisfy your calorie cravings.

5. Functional Musculature

Muscles are a great way to dampen the glucose spikes from meals. You don’t need large muscles but functional ones.

As we age we lose some muscle. We also lose it when we are sedentary. And the times we are at peak muscle activity is right after a heavy exercise. This is the time to have your highest-carb meals.

We do this in my practice:

We time sweet foods like dessert after your fiber-rich meals or after a good hike. It’s not to say that you can’t have it at other times. But when you understand the inner workings of your physiology you have a leg up.

Need help designing a custom lifestyle plan? Don’t wait until you have borderline high blood sugars. Being proactive here means that you’ll save yourself decades of financial and physical headaches. You’re not alone in this.

Book a call with Dr. Ashori today!

Disclaimer:

The 10 Habits That Protect Your Memory

Dr. Ashori MD — Thu, 19 Mar 2026 19:41:46 GMT

Several large scientific reviews have tried to answer a simple question: What protects memory as we age?

One of the most influential efforts is the 2024 Lancet Commission on Dementia Prevention, which analyzed decades of research on preventing memory loss with age.

Their conclusion is quite encouraging. It proves that a large portion of memory decline risk is preventable.

10 Habits That Improve Memory - Supported by Evidence

1. Protect Your Sleep

Deep sleep is when the brain consolidates memories and clears metabolic waste. Without this step you can’t form or recall memories.

Poor sleep impairs learning the next day and increases long term dementia risk.

You don’t need perfect sleep. You don’t even always need restful sleep. But if you know you have to wake up early the next day, you simply can’t afford to go to bed late.

2. Exercise Regularly

Aerobic exercise improves blood flow to the brain and increases brain derived neurotrophic factor (BDNF), which improves neuron health.

You don’t need a gym membership. Being active at home (chores) or going for daily walks is considered aerobic exercise.

3. Improve Your Metabolic Health

Insulin resistance, fatty liver disease, and metabolic syndrome are strongly linked to cognitive decline.

The amount of visceral fat you have, how much you move daily, and the foods which spike your blood sugar are all factors in how your body’s metabolism functions.

4. Lower Your Blood Pressure

High blood pressure damages small brain vessels and is one of the strongest drivers of vascular cognitive impairment.

Just as it’s the main driver for kidney and heart disease, it also can wear down your sensitive nerves.

I’ve written about blood pressure management a lot. It’s been one of my most successful tools in managing hypertension without medications.

5. Protect Your Hearing

Untreated hearing loss is one of the largest modifiable dementia risk factors.

The explanation is simple - without the right stimulus to the brain, it begins to atrophy. Your vision, sense of touch, taste, and most other senses are just as important as your hearing.

6. Stay Mentally Active

Learning new skills builds cognitive reserve.

Play the piano, learn a new language, find a new sport. This is how complex neural networks are formed in the brain.

Nowadays our attention is much shorter. If you can’t finish a complicated book or sit down and write a long article, you’d benefit greatly from more deep work.

7. Stay Socially Connected

Social interaction stimulates multiple cognitive systems simultaneously.

All your senses come alive and you have to handle multiple conversations and your emotions all at the same time. This is the best workout for your brain.

8. Limit Your Alcohol

Alcohol interferes with memory formation and sleep architecture.

Alcohol is the thing you can have when everything is working perfectly fine in your body.

9. Eat Nutrient-Dense Foods

Patterns similar to Mediterranean diets appear protective for brain health. That’s because they are more nutrient-dense and less calorie-dense.

10. Manage Your Stress

Chronic stress elevates cortisol which impairs hippocampal function.

You don’t need to avoid your stress but you should learn ways of coping with it.

When I know that I can’t cope with stress, I try to avoid it whenever possible.

Reducing Risk of Dementia

These habits don’t improve your memory but they also reduce dementia risk.

If you need help structuring these into your daily routine, reach out below.

Book a 1-hour Call with Dr. Ashori

Disclaimer:

Lowering Your Cholesterol: Lifestyle Changes Recommended in the Newest 2026 AHA/ACC Lipid Guidelines

Dr. Ashori MD — Mon, 16 Mar 2026 00:40:53 GMT

The new American Heart Association/American College of Cardiology 2026 dyslipidemia guideline still treats lifestyle as the foundation of lipid management, even when medications are used.

The guideline emphasizes that lifestyle changes should begin before medication and continue alongside it. However, in practice, it’s rare for lifestyle changes to precede medications.

If you want a lower lifetime risk of heart attacks, stroke, heart failure, and atrial fibrillation, this is what the science says.

1. Dietary Pattern (Most Important Intervention)

The new March 2026 guideline emphasizes overall dietary pattern, not a single nutrients.

Sorry, protein, despite what the marketers and influencers say, having more protein doesn’t seem to make you healthier.

Recommended eating patterns:

Mediterranean diet
DASH-style diet
Plant-forward diet

At its core, the goal is to increase the following items in your food, assuming you have a mostly Westernized (aka, American) diet.

vegetables
fruits
legumes
whole grains
nuts
seeds
fish
unsaturated fats (olive oil)

Most Americans will also need to reduce their intake of:

saturated fat (dairy, meats)
ultraprocessed foods (packaged junk food)
refined carbohydrates (white rice, white flour)
added sugars
processed meats

Saturated fat target

The health conscious American look at chicken or beef and sees protein. They are trying to eat more protein as recommended to them by perhaps well-intentioned health influencers.

But this kind of diet comes at the risk of excess saturated fat.

I know, I know, “Saturated fat doesn’t cause heart disease, it’s sugar!” This is the keto camp argument. And it’s a strong argument. But right now, we’re focusing on the guidelines.

The goal is to keep saturated fats under <7-10% of daily calories, depending on your individual risk.

2. Fiber Intake

The guideline strongly highlights soluble fiber. This is the kind that dissolves in water and becomes gel-like.

Fiber blocks cholesterol absorption and binds bile acids, both lowering overall serum lipids.

Examples include, oats, barley, beans, lentils, fruits, vegetables.

And even though the guideline recommends psyllium husk as a supplement, I highly recommend against it if your goal is better cardiovascular health. Though it does lower your cholesterol.

Recommended target:

25–30 g/day total fiber
5–10 g/day soluble fiber

In my opinion, this is too low. I know this because when I’ve bumped up fiber goals my patients have felt better. But of course there are exceptions.

3. Body Weight Reduction

Weight loss is recommended when BMI or visceral adiposity is high.

This is easily measured with a DEXA scan or bioimpedence or a good old measuring take for a waist to height ratio.

Lowering excess visceral fat reduces triglycerides and increases HDL. It also improves insulin sensitivity.

The guideline emphasizes waist circumference and visceral fat as key cardiometabolic drivers.

Need help with your health? Book a private health coaching session:

1 hr - $169

4. Physical Activity

The dose of exercise really depends on the individual and their unique risk factor.

The recommended minimum is 150–300 minutes/week moderate activity (aka, zone-2)
or 75–150 minutes/week vigorous activity.

Moderate activity means that my 47-yo self would need to get my heart rate up to 130-ish and maintain it for at least 30 minutes.

The guideline also recommends 2 resistance training sessions/week.

When my patients have high triglycerides, one of the best ways to lower it is to have them do more zone-2 training and resistance training.

5. Alcohol Reduction

Alcohol raises triglycerides and contributes to metabolic dysfunction.

If you have no metabolic problems and at a very low risk of heart disease, reducing your alcohol may not do much for these arenas.

Guideline recommendation:

Limit alcohol as such:

≤1 drink/day women
≤2 drinks/day men

In patient with high triglyerides:

avoid alcohol completely.

Personally, 2 drinks per day is a LOT of alcohol if you’re dealing with any cardiometabolic problems. But, don’t kill the messenger, this is directly from the guidelines.

6. Smoking Cessation

Smoking affects lipid metabolism and vascular biology.

Some of you read this and say, “Come on! Who still smokes?”

Quite a lot of my patients. That’s who.

The benefits are that stopping smoking will increase your HDL, lower inflammation, and reduce plaque buildup.

7. Sleep Health

The guideline newly acknowledges that sleep duration, circadian rhythm, and metabolic syndrome are important factors when it comes to heart disease risk.

Poor sleep is associated with:

higher triglycerides
insulin resistance
weight gain.

The guidelines recommend getting 7–9 hours/night. Of course, that’s total sleep time. If you take an hour to fall asleep and are awake for another 1.5 hours randomly throughout the night, you’ll need a minimum of 9.5 hours in bed to get your 7 of sleep.

Important Guideline Philosophy

The guideline explicitly states that lifestyle is necessary even when medications are used.

The reason I love this is because we’ve seen so many patients who are on medication but are still suffering all the ill consequences of a less-ideal lifestyle.

Medications reduce LDL (and apoB), but lifestyle changes address:

inflammation
insulin resistance
triglycerides
obesity
endothelial dysfunction

All of which contribute to ASCVD risk beyond LDL.

Conflicts of Interest

Well, my main conflict of interest is that I’m trying to sell you my health coaching services to help you fight fatigue, poor sleep, stubborn weight, and your risk of heart disease, cancer, or dementia.

The conflict of interest of the ladies and gents who created this guideline is a bit longer:

Research funding from pharmaceutical companies, institutional research grants for lipid-lowering drug trials, consulting fees from lipid drug manufacturers, advisory board membership for cardiovascular drug development, participation in pharmaceutical scientific advisory committees, speaker honoraria from pharmaceutical educational programs, participation in industry-sponsored continuing medical education programs, lecture fees from drug manufacturers, stock ownership in biotechnology or pharmaceutical companies, equity holdings in cardiovascular diagnostics companies, stock options in pharmaceutical or biotech firms, royalties from medical textbooks or guideline-related publications, intellectual property related to lipid metabolism or cardiovascular therapeutics, patents related to cardiovascular diagnostics or lipid treatment, participation in clinical trial steering committees sponsored by industry, data safety monitoring board membership for pharmaceutical trials, trial investigator roles in industry-sponsored lipid-lowering drug trials, consulting for PCSK9 inhibitor manufacturers, consulting for statin manufacturers, consulting for omega-3 lipid therapy companies, consulting for cardiovascular diagnostics companies, consulting for medical device manufacturers involved in cardiovascular care, advisory board participation for pharmaceutical pipeline development, honoraria for participation in guideline or policy panels funded by medical societies with industry sponsorship, reimbursement for travel to speak at educational conferences sponsored by industry, research collaboration agreements between academic institutions and pharmaceutical companies, grant funding from nonprofit cardiovascular research foundations that receive industry support, board membership in nonprofit cardiovascular research organizations with industry funding, editorial board roles in journals receiving pharmaceutical advertising revenue, leadership roles in professional societies with industry partnerships, consultancy for biomarker testing companies, consultancy for lipid diagnostic laboratory companies, consulting for companies developing cardiovascular risk algorithms, consulting for companies developing lipid-lowering biologic therapies, consulting for companies producing cholesterol-lowering monoclonal antibodies, participation in industry-funded cardiovascular registries, involvement in pharmaceutical sponsored epidemiologic studies, consulting for companies developing RNA-based lipid therapies, consulting for companies developing antisense therapies targeting lipoprotein pathways, consulting for companies developing gene-based lipid treatments, consulting for companies producing cholesterol absorption inhibitors, consulting for companies producing triglyceride-lowering therapies, advisory board participation for companies developing cardiovascular prevention drugs, consulting for companies developing inflammation-targeting cardiovascular therapies, consulting for companies producing cardiovascular imaging technologies used in atherosclerosis research.

I sure hope you’re not getting your medication advice from this guideline. But the lifestyle advice is solid. I vouch for it.

Got a loved one dealing with high cholesterol?

Disclaimer:

Motivation Comes After You Start a Health Habit

Dr. Ashori MD — Sat, 14 Mar 2026 16:22:00 GMT

In this episode, motivation is explained not as something you find, but as something that develops after consistent action.

Motivation is often the side effect of doing something long enough to see results.

When daily habits start producing real changes, better energy, better health markers, better physical fitness, motivation begins to grow naturally.

The episode I explores:

Why excitement is often mistaken for motivation
How journaling and reflection help uncover your actual priorities
Why consistency is more important than inspiration
How positive feedback loops create long-term motivation

Download my free 6 Healthy-Aging Habits ebook: https://drashori.com/ebook/longevity-habits/

Book a health coaching session: https://drashori.com/health-coaching/

Follow me on Instagram: https://www.instagram.com/DrAshoriMD

Join me on Facebook: https://www.facebook.com/DrAshoriMD

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

Disclaimer:

6 Reversible Causes of Memory Loss

Dr. Ashori MD — Mon, 09 Mar 2026 18:00:47 GMT

UPDATED: March 27th, 2026

Welcome to Beyond the Labs, a weekly deep-dive into untangling your health mysteries. I help adults in their 30s and 40s crack the code on brain fog, fatigue, and stubborn weight gain, so they can reclaim their energy and focus.. I’m Dr. Ashori, a board-certified MD. I look Beyond the Labs through virtual Direct Primary Care in California and personalized health coaching for professionals worldwide.

A 38 year old entrepreneur came to see me because her memory was failing even though she felt that she was living a healthy lifestyle.

She ran a successful business, exercised regularly and labs were all “normal.” But she was forgetting conversations, had to reread emails, and would lose words during a meeting.

While she was worried about dementia, it was clear that something in her routine was affecting her cognitive abilities. We eventually pinpointed it to her late-night eating, worsening insulin resistance, and very interrupted sleep patterns.

This isn't a one-off story in my practice. As a health coach, I often see people who experience dramatic improvements after making a few subtle lifestyle changes. That's exactly what happened with this businesswoman - she's now back to her old self.

Memory Problems

Memory problems worry people of every age. Adults in their 30s and 40s often notice distraction, stress, and poor sleep affecting their memory. Adults in their 60s and 70s worry about looming dementia.

This guide is a goldmine for troubleshooting memory issues. It's crucial to distinguish between brain fog and mild cognitive impairment, which is the stepping stone to dementia.

Memory Formation & Recall

Memory is the brain’s ability to encode, store, and retrieve information.

The 3 main stages:

Encoding to take in information.
Storage to safeguard the information over time.
Retrieval to access the information effectively.

If any of these steps fail, you experience a memory problem. For example, you never encoded the information because you were distracted. Or, as in the case of the businesswoman, she stored it poorly because of sleep deprivation and she couldn’t retrieve it because of her high level of stress.

In your 30s and 40s, attention problems are at the source of most memory problems.

Don’t Underestimate Memory

Without good memory your day is so much harder. You’ll have to do double duty to get the same amount of work done. Frustration accumulates, your sleep will be affected, and your stress hormones rise.

Memory allows us to:

Learn and improve skills
Build meaningful relationships
Make important decisions
Maintain independence as we age

Memory is the canary in the coal mine. It is also one of the earliest brain functions affected by poor neurological function.

I repeat this phrase a lot to my clients, “Most memory complaints in midlife are not dementia.”

You don’t have years to wait for “normal” labs to finally catch up to how you feel. Let’s fast-track your cognitive recovery with a personalized plan tailored to your unique biology.

Work with me 1:1

Brain Fog vs Memory Loss

What many label as a memory problem is often an attention problem. If you never properly stored a memory because of inattention, you can’t recall it.

Brain fog is usually a problem with attention and focus. I’ve written about it in the following articles:

The symptoms of brain fog are:

Difficulty concentrating
Slower thinking
Trouble finding words
Needing to reread things
Feeling mentally exhausted

With brain fog, the brain often never encoded the information clearly in the first place. If information is never encoded, it cannot be remembered later.

Memory loss is different. Here, the person is doing everything right to consolidate the memory but is unable to and therefore can’t recall it.

Symptoms of memory loss are:

Repeating the same stories or questions.
Forgetting recent conversations completely.
Getting lost in familiar places.
Difficulty managing medications or finances.

This type of memory problem may be associated with conditions such as mild cognitive impairment or dementia. The reassuring reality is that most memory complaints in adults in their 30s and 40s are brain fog, not neurodegeneration.

It’s never too late to catch early symptoms of dementia. I’ve written about strong evidence on it here:

Current Evidence on Improving Memory

Large reviews from groups such as the Lancet Commission on Dementia Prevention (2020) and recent WHO consensus statements consistently highlight the same modifiable factors.

Evidence‑supported habits that protect memory include:

Improving neurovascular circulation.
Improving quality of slow-wave sleep.
Addressing sensorineural deficits early.
Addressing any cardiometabolic disease.
Improving cognitive skills.
Increasing social engagement.
Limiting neurotoxic substances.

These factors influence both day‑to‑day memory performance and long‑term dementia risk.

6 Reversible Causes of Memory Problems

1. Multitasking Overload

Modern work and lifestyles are an assault on the senses. Attention is like cooking, you can’t shortcut it, or else information never gets encoded into memory.

Classic inattention is forgetting what you just read, walking into rooms and forgetting why, or re‑reading the same email several times.

What you can do to improve focus and attention:

Single‑task whenever possible. This trains your focus and memory.
Turn off notifications.
Write things down to address later.

2. REM Sleep Disruption

Memory consolidation happens during sleep, especially REM sleep. This happens later in the night, so if you get up early or have too much noise in the house you’ll miss out on it.

REM problems show up as forgetting conversations, trouble recalling recent information, brain fog, decreased creativity, slow thinking, and irritability.

Protect your sleep architecture:

Aim for a consistent sleep schedule and protect the last 90 minutes of your sleep.
Reduce or avoid alcohol, especially close to bedtime.
Screen for sleep apnea.
Look for potential REM disruptor medications.

3. Chronic Stress

The hippocampus is at the core of memory formation and recall. If it’s overloaded with cortisol, it can’t do its job.

Common symptoms are losing words mid sentence, forgetting familiar names, and inability to stay concentrated.

In my TREND framework I talk about D, which stands for downtime. You need a break from thinking and stress the same way you need a break from exercise. And what better break than exercising! Another great tool is breathing exercises.

4. Too Many Stimulants

Caffeine, sugar, supplements and some medication can improve alertness but worsen memory if you’re already overloaded.

This might show up as racing thoughts, feeling jittery or overly stimulated, trouble focusing on a task long enough to get anything done, and feeling wired later in the evening.

5. Alcohol

It might have been okay in your 20s and 30s but now in your 40s or 70s - not so much. But it’s always worth testing because you might not be affected by alcohol at all.

We know that alcohol suppresses glutamate, a neurotransmitter involved in memory. We just don’t know how sensitive each person is to fluctuating glutamate levels.

I love a good IPA but I have to deal with 2 days of bad sleep, anxiety, and terrible exercise recovery. Maybe it’s my Middle Eastern genes or just age.

6. Medical Problems

Several medical conditions impair memory. They require closer management to improve memory.

Examples include sleep apnea, thyroid disorders, hormone decline, vitamin deficiencies (rare), mood disorder like depression, and side effects from medications like beta blockers, benzodiazepines, and even certain antidepressants.

Thanks for reading Dr. Ashori - Beyond the Labs! This post is public so feel free to share it.

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What Doctors Do When Your Case Is Too Complicated

Dr. Ashori MD — Fri, 06 Mar 2026 23:02:06 GMT

Every doctor eventually encounters a case that stops them in their tracks.

Maybe it’s a rare autoimmune disease.
Maybe an unusual infection.
Maybe a complication that doesn’t show up in textbooks.

Medicine is too large for any one physician to master completely.

That’s where Figure1 comes in.

Most patients have never heard of it because the platform is designed for healthcare professionals. Think of it as a global clinical forum where physicians post difficult cases and get input from colleagues across specialties and countries.

Unlike large language models like OpenEvidence, Figure1 is not an AI tool. It’s a community of human physicians sharing real-world experience to help solve difficult clinical problems.

And sometimes that collective knowledge can make all the difference for a patient.

Solving Hard Cases

Imagine you have a really complicated rheumatology case, such as a retroperitoneal fibrosis.

There isn’t much literature on it and the world’s leading experts on the topic are busy being leading experts - so you have to manage it yourself.

While many believe that LLMs have the answers, personally I’ve mostly gotten bad or biased advice from them when managing my patients.

But perhaps that’s a user error.

Fortunately, I can take a case like that and post it on Figure1 and get the input from doctors all over the world, from all different specialties.

Time Needed to Post

The average U.S. doctor has less than 15 minutes with a patient.

The rest of the time goes to documentation, prior authorizations, and care coordination.

To make a post you have to collect all the right information, get the patient’s consent, formulate the right question, add the right images, post your case, and engage with replies.

The doctors who are doing this are not your average doctor.

But sometimes you need someone who is not average.

Patient Consent & Protected Health Information

Most of the Electronic Health Records are constantly collecting patient data and sharing it with third-party companies to figure out how to squeeze more money out of each patient.

This isn’t a fringe opinion.

Electronic health records were supposed to improve care coordination. In reality, many have become billing and documentation machines.

So, what about that xray of the patient’s foot? Well, it belongs to the patient, no doubt. Your data should be your data. But the problem is that it’s not, right? Large medical group and insurance companies are using it without your expressed permission.

When I take your foot x-ray and post it to get clinical feedback, that’s considered disclosing protected health information. Even if the intention is good, I need direct patient consent.

This makes the work much harder. Because now I am exposed to risk and have to find my patient and not only get their permission but I have to get permission from my medical group to use the image which was taken on their premises.

It’s messy and it’s hurting patients. And it doesn’t need to be.

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Learning From International Doctors

When is that last time you read about treating leishmaniasis or MDR malaria? Or how to manage a cancer patient when you don’t have access to an MRI?

The cumulative knowledge of 10 doctors is a very powerful force when it comes to patient care.

Sometimes you have to turn to other countries because your patient can’t afford a CT scan or a certain medication.

How do they do it?
How do they choose when they don’t have all the necessary information?

Figure1 vs. LLMs

LLMs = pattern recognition from literature.
Figure1 = real physicians discussing real cases.

Figure1 has been around a lot longer than LLMs. But LLM AIs have penetrated healthcare so easily. Hardly anyone has batted an eye.

Patients are being recorded, their data is being scraped by AI, and AI is even making diagnoses in the EHR.

The reason LLMs have won over case forums like Figure1 is that LLMs are considered unbiased and aren’t humans.

An AI will digest information from a patient’s chart and it won’t go disclosing that data to another person.

But it will take the information and use it as training data (for free) and also aggregate that data to help make better financial decisions when it comes to patient care.

I guess, I would want things to be more equitable, more fair. Let LLMs rise but don’t silence far better existing tools under the pretence that we’re protecting sensitive patient information.

How Does Your Doctor Expand Their Reach?

The next time you feel chummy with your MD, ask them what they do when they have a tough case. Perhaps they nudge a colleague or present the case in a grand round.

Working in a silo will prevent me from becoming the best doctor I can be. I won’t grow and I’ll only be semi-effective for my patients.

Of course, we first need to develop the vulnerability with our patients to honestly answer such a question. But hopefully you have that kind of relationship with your doctor. If not, it’s worth it to start forming that.