Physician-Led Health Coaching

My 5 Go-To Habits Despite Life's Chaos

Dr. Ashori MD — Mon, 05 Oct 2026 16:47:51 GMT

My routine definitely fell apart these past 3 weeks. I moved from Los Angeles to Anchorage, Alaska and a week later I was on a flight back to LA to babysit my goddaughter for a week.

I ate more packaged food because I couldn’t cook for myself. I didn’t have time or a car to go to my rock climbing gym. I fell asleep later and had to wake up much earlier.

Fortunately, our health doesn’t hold a grudge, it responds to long-term trends. Here are the habits that helped me maintain my immunity, blood pressure, and health these past 3 weeks.

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

1. My Go-To Meals

Store-bought low-fat hummus, 100% whole grain bread, tomatoes, and avocados. It doesn’t make for the best sandwich but it’s a meal I can always fall back on.

When things get hectic and unpredictable having that one go-to Meals (fruits, nuts, chilli) helps your digestion and metabolism, even if the other meals aren’t anything to brag about.

I buy fruits, nuts, and tofu when I’m in a new place. Even if I end up eating too much sugar, salt, and fat, I’ll have my nutrients.

2. I Walk

I tried to get to the airport early on each of my trips and just walked around. I also had my exercise band with which I did my deadlifts and shoulder presses while babysitting.

Even when your routine uncomfortably falls apart there’s always something you do that’ll make it easier to bounce back. It won’t be perfect but far better than full abandonment of your habits.

Even when it’s all chaos, I take my phone calls on a walk, I walk to the store, I walk with the stroller, and I walk to the gym.

3. Keeping up with Sleep

4:30 am wake-up and too much caffeine definitely didn’t help my sleep. But at least I set aside my night-time YouTube routine to get an extra 30 minutes of sleep.

When things get bad it’s natural to want to abandon all positive habits. After all, “What’s the point!” But every little bit matters. A nap on the plane, sleeping in a little more, avoiding anything that’ll interfere with your sleep quality (late meals, heavy meals, sugar, caffeine.)

Share this article if you know someone struggling with habits.

4. Making Room for Loved Ones

I felt very short on time, behind on work, wanting to spend more time on my laptop to catch up. But that’s the exact mindset that creates more stress and anxiety.

Instead, I relinquished control and spent time having a blast with this baby, hanging out with old friends, and catching up with my partner on the phone. I may have spent less time on my laptop but those few minutes were much more productive.

5. I Don’t Rush

This one is special for me. I don’t do well when I rush or multitask. I get stressed and anxious.

I say no to many more things and leave it up to others to accommodate my schedule, when possible. I scratch things off of my to-do list which makes me feel more lighthearted.

What Can You Keep During Your Hardest Week?

As a Physician Health Coach, the main priority for my clients is to help them avoid falling off the wagon. Every little bit helps.

The question is what’s the biggest driver of better health for you? Maybe it’s avoiding a cigarette, taking your medication on time, or keeping up with your running miles. You don’t need to do you weekly 30 miles, even 1 mile is your big win.

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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5 Ways to Know If Your Fatty Liver Is Actually Getting Better

Dr. Ashori MD — Tue, 29 Sep 2026 02:37:19 GMT

You were told you had fatty liver disease and you implemented some solid changes. But how do you know things are improving?

1. Weight & Waist Circumference

This is the cheapest and easiest one you can track at home.

And if you don’t like looking at the scale, the waist circumference will suffice. If you do weigh yourself, the number is less important than the trend.

No matter what weight you’re at, if you’re dealing with steatohepatitis then a 5% weight loss will meaningfully reduce your liver fat. Get to 7-10% and you’ll drop the accompanying inflammation.

Some data says that a drop of more than 10% will even improve fatty liver with fibrosis (a serious complication of fatty liver disease). The key of course, is to not lose your muscle mass. We’ll get to that later.

With your waist circumference, track your progress. Losing just 2 inches (5 cm) would translate into significant visceral fat loss. And while a DEXA scan is nice to have, it’s not an absolute must.

2. The Metabolic Drivers

Fatty liver disease, aka Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD), happens as a result of a bigger metabolic dysfunction. Fix the underlying metabolic problem and the liver is likely to improve.

When we talk about your metabolic health, we are referring to how your body is handling energy and fuel storage. And the way we can measure these is through your fasting blood sugar, triglycerides, HDL, blood pressure, and even fasting insulin.

I don’t just want someone’s ALT to come down. I want to know whether we’re reversing the process that caused fat to accumulate in the liver in the first place.

That’s why in my practice, at drashori.com, we use the TREND Method. T is for Testing, where we use appropriate biomarkers to assess things like metabolic health. REND stands for Relationships, Exercise, Nutrition, Downtime, which are the factors that we can manipulate to improve those test markers.

If your weight is going down, you’re exercising more, your resting heart rate is improving, and your fasting blood sugar or insulin are coming down, those can be encouraging signs that your metabolic health is moving in the right direction. That’s how connected these are.

Not sure which health markers are worth paying attention to?

My free Fatty Liver Fix Guide walks through the health markers, nutrition, weight, and exercise considerations that can be relevant when fatty liver is a concern.

I wrote more about what I would initially pay attention to in:

3. AST and ALT - Liver Enzymes

To assess if someone has any excess fat on the liver I look at the actual liver enzyme values, AST and ALT. Often labs won’t flag liver enzymes as abnormal until you are well into liver damage territory.

Many don’t know this but the flagging levels on labs are established for reporting purposes, not always for what’s normal and abnormal.

Liver enzyme trends are also important. In a healthy adult there’s no reason for the liver enzymes to be rising unless that person is accumulating more damage over time.

The classic scenario I see is an ALT of 22, followed by a rise to 38 (completely normal by lab standards), and eventually 68 a few years later. This last value is when the lab may finally flag the result as abnormal.

So, what did your doctor say about your most recent liver enzymes levels?

Could you have fatty liver disease with perfectly normal liver enzymes? Unfortunately, yes. That’s why we don’t just rely on one set of biomarkers when someone is at risk.

4. Liver Fat Imaging

Besides the blood test, many first find out that they have fatty liver disease because of a CT or Ultrasound. They do an ultrasound for the ovaries or kidneys and the radiologist comments on abnormal changes in the liver, maybe even fatty liver disease.

But an ultrasound isn’t always enough and it can miss fatty deposits in the liver. An MRI-PDFF (magnetic resonance imaging–proton density fat fraction) is a specialized MRI measurement that estimates the percentage of fat in the liver. It measures fat, not liver scarring; fibrosis requires a different imaging study.

We also have FibroScan with CAP that measures liver stiffness, evaluating for fibrosis (scar tissue). The “CAP” is a specific ultrasound that measures steatosis (fat).

Before you consider these tests, ask yourself how the result would impact what you do. Getting a test for the sake of a test often results in unnecessary spending and health anxiety.

Want the bigger fatty liver framework?

I put together a free Fatty Liver Fix Guide covering the health markers, nutrition, weight, exercise, and other factors worth understanding.

5. Fibrosis Risk

Among those with fatty liver disease, 33% progressed to worsening liver fibrosis. About 8% of Americans with MASLD already had advanced fibrosis on the initial scan.

Liver fat matters because the whole goal is to avoid liver fibrosis. In fact, I’m okay keeping someone’s fatty liver at bay even if I can’t get rid of it as long as I can prevent progression to irreversible liver fibrosis.

What’s your fibrosis risk? You can calculate it using FIB-4 formula. Current liver guidelines commonly use it as the first-line noninvasive fibrosis assessment in adults with MASLD, taking into account your age, AST, ALT, and platelet count.

The main reason for all of this extra testing is to answer one question: Has the fatty liver progressed to a stage that poses greater long-term risk?

How to Use All This Information

It’s never a good idea to take a protocol and blindly paste it into your life.

First: Establish your baseline liver status.

Second: Make a meaningful change in your lifestyle and habits.

Third: Repeat the measurements that answer your most important health question.

An example might be that your weight/waist is trending up over time. So the best adjustment is first to address nutrition/exercise behavior. And if you’re struggling then you want to know your liver enzyme numbers and metabolic markers. Now, calculate your fibrosis risk and restart your lifestyle efforts. Consider imaging if you’re still not making progress.

What if the numbers don’t improve?

If your fatty liver markers are staying the same or getting worse, then you want to be a scientist when it comes to your nutrition and exercise. Not just guessing calories or steps walked, but really measuring it.

How much exact weight did you lose? Was it muscle or fat?
How much did your alcohol intake change?
What’s your exact level of insulin resistance or metabolic status?
Could something else other than fatty liver explain the liver issues?
What else can you try if what you’ve tried hasn’t worked?

You don’t need every available liver test. You need the right initial basic testing, a real intervention, and a plan for reassessment.

One lab marker shouldn’t declare success or failure because this is a long-term game and it takes years before real damage sets in.

Look at the trend across metabolic health, liver enzymes, liver fat, and fibrosis risk. If those are moving in the right direction, you’re building much stronger evidence that the liver is improving.

Not Sure What You Should Follow?

If you’ve been told you have fatty liver and aren’t sure what deserves your attention first, I put together a free Fatty Liver Fix Guide that goes deeper into the health markers, nutrition, weight, and exercise considerations I think are worth understanding. The goal is to help you better understand what may be relevant so you can have a more informed conversation with your healthcare team.

Get the Fatty Liver Fix Guide

You’re Sleeping 8 Hours, So Why Are You Tired & Foggy Brained?

Dr. Ashori MD — Wed, 23 Sep 2026 16:22:41 GMT

You might be one of the most diligent people when it comes to sleep. In bed by 10, getting your 8 hours, and avoiding noise and blue light. But even someone with perfect sleep habits can wake up tired and struggle with memory and concentration throughout the day.

Enough sleep is critical but recovering throughout the day (and night) is also important.

1. 8 Hours ≠ Good Sleep

When it comes to sleep, it’s about quality and quantity. Without at least 6.5-7 hours it’s hard to recover. And once you’ve had a tough work day or ate late at night or got into an argument with your partner, you’ll need closer to 8.

Then there’s sleep quality. If you wake up a lot or never get deep into Deep Sleep or you wake up before you’ve had enough REM sleep, quality will suffer. That’s true even if your Oura Ring shows that you’ve had enough bed-time.

The best barometer is to gauge how well you’re functioning the next day.

If you’re getting enough hours but regularly waking up in the middle of the night, I wrote more about why you might be waking up around 2 a.m. and what to look at here:

2. How Do You Feel When You Wake Up?

Let’s keep it simple:

Do you feel tired when you wake up?

Do you immediately need coffee to start functioning?

Do you wake up with headaches or feel foggy-headed?

Do you feel noticeably better on weekends or vacations?

Sometimes you notice the pattern when your routine changes. If you feel noticeably better on vacation, I’d want to understand what’s different.

I talked more about that here:

What Vacation Reveals About Brain Fog

Does your energy change when you get to sleep in?

Caffeine & sugar are great examples of what can affect sleep quality. But it can also signal a pattern or a clue as to what could have happened the day before.

Nothing wrong with starting your day with coffee but if you can’t function without it (or sugar) then I want to understand why.

What happens on days when you don’t need as much? Did you sleep differently? Eat differently? Have fewer meetings? Exercise? Have less stress?

3. Brain Fog Is a Symptom, Not a Disease

Over the years practicing as a physician, people have described brain fog as: difficulty concentrating, poor memory, slow recall, losing your train of thought, mental fatigue, and struggling to find words.

But brain fog describes what you’re experiencing. It doesn’t necessarily explain why you’re experiencing it.

Poor sleep can affect how you function during the day. But sleep isn’t the only thing I want to know about.

What are you eating?
How stressed are you?
Did anything change with your medications?
How’s your energy?
Your exercise?
Your mood?
Your health markers?

The more in-tune you can get with how you’re feeling and what patterns you are experiencing the easier it gets to solve this brain fog mystery.

Blood sugar is one pattern I sometimes think about when brain fog seems connected to meals or changes in energy. I wrote more about what that pattern can look like here:

4. Sleep Is Only 50% of Recovery

I’m 48, running a medical practice and working with a team while still wanting time to rock climb, exercise, cook, and have a life outside of work. I want to meet up with friends, hang out with my wife, go on hikes and travel.

I log many days with more than enough sleep but my body and brain don’t feel recovered. Maybe it was too many back-to-back meetings, emails, deadlines, or even too much exercise.

When I talk about recovery, I don’t mean there’s one recovery score we need to optimize. I’m thinking more broadly about the demands you’re placing on yourself and whether you’re giving yourself enough opportunity to recover from them.

8 hours of sleep can’t compensate for a day with very little opportunity to mentally or physically recover.

I think this is particularly relevant for busy doctors, lawyers, entrepreneurs, and working parents who are constantly juggling work, family, health, and other responsibilities while trying to perform at a high level.

You can still be productive, exercise, and get your work done. But if it’s taking more effort than before, that’s something worth paying attention to.

Dealing with brain fog and not sure what’s contributing to it?

I created a free Brain Fog Reset Guide to help you look at some of these patterns and identify what may deserve your attention first.

Get the Free Brain Fog Reset Guide

5. Be a Detective of the Patterns

I can’t fix anyone’s brain fog unless I understand when it’s happening. This is what we call patterns in clinical medicine.

At first, you might say it’s always bad or it’s random. In my experience, it’s rarely that unpredictable.

When is it worst?
How do you feel when you wake up?
Does it happen after certain meals?
Does it get worse during stressful weeks?
Do you feel different on vacation?
What seems to make it better?
What else changed around the same time?

This just needs a journal and some time to reflect. Do it on your own or with your medical team. For a week, pay attention to your sleep, meals, caffeine, stress, exercise, and when your brain fog acts up.

Don’t just assume it’s aging or stress. Always discuss something that’s persistent or getting worse with your medical team.

6. You Don’t Need to Fix Everything

Perhaps you discovered a pattern of long work hours or lack of exercise leading to worsened recovery, leaving you with more brain fog for the whole week. And you also discovered that eating pastries really makes your brain crash.

Don’t start changing everything all at once, you’ll burn out. Instead, see if you can be more present and feel the anxiety or worry when your work creeps into your personal life. Sometimes when you start addressing the elephant in the room, the craving for pastries takes care of itself.

Start with one simple daily change and track how you feel.

Still dealing with brain fog and not sure what’s contributing?

If you’ve already tried improving your sleep, nutrition, stress, or routine and you’re still struggling with brain fog, you may need a more individualized look at what’s going on.

Learn About Brain Fog Health Assessment

Disclaimer:

Fact Checking the Health Claims of GLP1 and Other Incretin Drugs

Dr. Ashori MD — Thu, 17 Sep 2026 15:00:22 GMT

These popular incretin drugs certainly aren’t merely cosmetic weight-loss drugs but they also have no evidence to reverse heart disease, cure diabetes, prevent dementia, or even suppress inflammation.

Large trials certainly show that these drugs reduce major cardiovascular events, kidney disease, prevent worsening heart failure, and delay diabetes progression. But this is what we call the total treatment effect which may be due to the weight loss, the improved blood glucose, lowering of the visceral fat, and blood pressure.

“Reversing Heart Disease”

Unsupported. No large definitive randomized human trial as demonstrated reversal of atherosclerosis. These drugs can reduce events in high-risk groups but the same can be said about exercise, diet, and nutrition changes.

Everyone mentions the SELECT trial (semaglutide) but this was done in a cohort with established cardiovascular disease. And cardiovascular death was not significantly reduced.

There were lots of other problems with the SELECT trial such as inadequate cardiovascular therapy of participants. Had their blood pressure and LDL-C been adequately controlled, would we still see a 1.5% drop in cardiovascular disease rates?

Instead of trying to reverse heart disease, the biggest wins come from preventing its progression. Control blood pressure, improve cardiorespiratory fitness, and lose excess weight.

“They Reverse Heart Failure”

Equivocal. Symptoms and morbidity improved in obesity-related HFpEF but we didn’t see a mortality benefit.

The SUMMIT trial (small) used tirzepatide vs placebo showed fewer heart failure events in those with HFpEF. But the LIVE trial, liraglutide did not improve ejection fraction and cardiac deaths were more frequent. In FIGHT trial we didn’t see any improvement in symptoms in those hospitalized for HFrEF.

When it comes to heart failure, drugs are incredibly important. Just as important are exercise, blood pressure, and good quality sleep.

“Reverses Diabetes”

Unsupported. When you take glucose lowering drugs it lowers your diagnostic criteria for diabetes. This isn’t so much reversal of the disease as disease management.

An international consensus defines type 2 diabetes remission as A1C below 6.5% for at least 3 months without taking glucose-lowering medication. A person with a normal A1C while taking semaglutide or tirzepatide has controlled diabetes, but is not in remission.

To improve your diabetes the goal is to lose visceral fat, improve your fasting HOMA-IR, and put on enough muscle to counteract the high glucose.

“Reverses Kidney Disease”

Unproven. There’s no evidence to show that by taking a GLP you will reverse kidney disease or even halt it.

The FLOW trial is a frequently cited study in adults with type 2 diabetes and CKD who took semaglutide or placebo. Again, we know that if we improve blood sugar numbers and blood pressure we can slow down kidney disease. But does an incretin have other means of achieving the same?

If you have or are at risk for kidney disease: improve your blood pressure, exercise, and keep an ideal blood sugar.

“Prevents dementia”

Unproven. Some cognitive signals in diabetes trials were observed but two large phase 3 Alzheimer trials failed to show benefit in early Alzheimer’s.

In the EVOKE trials semaglutide vs placebo did not show slower clinical decline. We have no other data to show that these medications will prevent dementia in otherwise healthy adults.

Want to prevent dementia? We know 14 evidence-based ways of living that show a decreased risk of dementia.

“Increases Longevity or Slows Aging”

Unsupported. Some studies showed fewer deaths but that’s related to disease management. No human trial has been done that shows decreased aging or longer lifespan in healthy people.

I’ll add that this would be a very tough one to prove even if that was the intention. If you goal is longer life, I have no data or evidence to offer you. Which is why I’m not a longevity doctor.

The only way I can help someone not die prematurely is by helping them prevent preventable diseases. Might sound obvious but only 50% of adults on this track.

Whether you’re dealing with inflammation or metabolic issues, the liver is at the heart of it. Worried about fatty liver disease? Download my free Liver Fix Guide here:

I want to repair my fatty liver

“Lowers Inflammation”

Unsupported. Semaglutide usage was associated with a lower hsCRP but we also know that weight loss and improved diets do the same.

So the question is whether direct, weight-independent anti-inflammatory clinical benefit can be proven. Not yet. The CRP reduction we noticed in some trials correlated closely to weight changes.

Want to lower your hsCRP? Consider improving your body composition. Improve your diet and avoid excess calories.

“Treats Addiction”

Unsupported. There are phase 2 trials underway that are showing some decrease alcohol usage but that’s not the same thing as “it treats alcohol use disorder.” We have no studies that show a decrease in gambling, smoking, shopping, and opioid use disorder.

We’ve all been incredibly excited about phase 2 trials just to be let down by the final outcome. We can remain hopefully but we don’t have any evidence yet to hang our hats on.

Addiction is too broad to address here. But a holistic approach seems to be the most successful. It’s important to address emotional, mental, and physical aspects.

Disclaimer:

4 Things I’d Focus on After Being Told I Have Fatty Liver

Dr. Ashori MD — Sat, 12 Sep 2026 14:31:04 GMT

Chances are you only discovered your fatty liver on a scan. Otherwise you’re feeling great, working, exercising, and leading a healthy lifestyle.

At some point your bloodwork or an ultrasound comes back and someone mentions fatty liver. And the advice you receive is some version of:

“Lose weight and eat better.”

That may be reasonable advice, but it’s not much of a plan and it certainly isn’t helpful.

If this were me, I’d want to understand 4 things before making a specific recommendation:

1. What’s happening with the rest of my metabolic health?

The liver isn’t the problem. Some type of metabolic process is happening all over the body and the liver is the first one to show signs of it.

I’d want appropriate context around weight, waist circumference, glucose/A1C, lipids, blood pressure, alcohol intake and other relevant health information.

Most of what drives fatty liver disease is a rising fasting insulin, fasting cortisol, a drop in sex hormones, then eventually elevated fasting glucose and A1C, lipids, and eventually blood pressure.

2. What am I eating and drinking?

The modern high-protein, high-refined-carb diet crowds out a lot of nutrients. Without choline and glucosinolates it’s hard for the liver to heal. With a constant influx of excess calories the fat storage overflows, destroying the functioning parts of the liver.

The solution is obvious to almost everyone but the reason most have a hard time doing something about it is because the strategy with nutrition is missing. Again, it’s not about a lack of information, it’s about a lack of a sustainable plan.

If you’ve been told you have fatty liver and aren’t sure what to change first, I put together a free Fatty Liver Fix Guide that walks through the labs, nutrition, exercise, and other factors worth paying attention to.

Get the Fatty Liver Guide

3. How much am I moving?

Walking, resistance training and aerobic activity can all be relevant pieces of the bigger metabolic picture. There’s no minimum dose because it depends on what your body needs in the moment.

I break exercise down to “mobility, stamina, and strength.” A healthy balance between these 3 seems to be necessary for improved metabolic health. In fact, many times I’ve been able to reverse someone’s fatty liver disease with just the right dose of aerobic training.

4. How will I know whether things are moving in the right direction?

If I change my habits, what are we following? When are we reassessing? Which measurements matter most?

I don’t want to make 6 changes and simply hope something happens. That’s where data is really helpful. In my TREND Method, I track the effect of an intervention. Then we adjust accordingly.

Fatty liver is a good reminder that you don’t necessarily need to feel sick for something to deserve your attention.

Not sure where to start?

If you’ve been told you have fatty liver and aren’t sure what deserves your attention first, I put together a free Fatty Liver Fix Guide to help.

It walks through the bigger picture, including the health markers, nutrition, weight, and exercise that can be relevant when fatty liver is a concern.

Inside the guide:

Health markers and labs worth discussing with your healthcare team
Nutrition changes that can support metabolic and liver health
The role of weight loss and body composition
Exercise and movement
A practical way to start making changes you can actually maintain.

Get the Fatty Liver Guide

Disclaimer:

The Anatomy of Afternoon Brain Fog

Dr. Ashori MD — Wed, 09 Sep 2026 14:31:38 GMT

You’re getting through your workday, you’re still productive, but focusing takes a lot more effort. Maybe you lose your train of thought in meetings. You reread the same paragraph and names or words don’t come to you as quickly.

By early afternoon, doing focused work feels considerably harder than it did in the morning.

People often describe all of this as brain fog. A condition that we don’t diagnose in Western Medicine.

To understand brain fog I need to know a few things.

1. What does “brain fog” mean to you?

It’s different from person to person. One is worried that they are losing their mind. Dementia. Another is frustrated that they can’t concentrate.

Memory and recall are terrible to deal with in a busy workplace, while mental fatigue and word finding just leaves you exhausted. Maybe even dreading work.

Your definition of brain fog is what matters. There’s no universal definition.

2. When does it happen?

For most adults it happens later in the day but some deal with it constantly. They wake up with it and go to bed with it.

But maybe you’ve noticed that it’s worse after meals. Worse in the afternoon? Maybe better on your vacation but bad when you’re under a lot of pressure.

The pattern alone doesn’t diagnose the problem. But it tells us what lifestyle factors are affecting your mental performance.

3. What does sleep look like?

I’ve been practicing medicine for 2 decades and have become an expert in brain fog over the last 5 years. Sleep keeps coming up as a major contributor, though not always causal factor.

For many busy professional, eventually, “tired” starts feeling normal. Getting back to the basics of sleep is a helpful way to rule out sleep-related brain function.

Dealing with brain fog?

I created a free guide to help you take a closer look at the patterns that may be affecting your focus, energy, and mental clarity.

Get the Free Brain Fog Guide here

4. What are you asking your brain to do all day?

I’m 48 and running a busy medical practice and a big team to help with my online clinic workflow. I often have back-to-back meetings, notifications, emails, deadlines, and I still want time to rest, rock climb, cook.

Whenever your downtime decreases, you’re left with no room for recovery. Both physical and mental recovery matter for us adults. Less so when you’re a teenager, of course.

I don’t think we can discuss focus without considering the environment we’re expecting the brain to perform in.

5. What else is changing?

It’s rare that brain fog is the only problem. How is your energy, weight, exercise, nutrition? Are you taking new supplements, meds? How’s your mood and emotional state?

I need to know relevant health markers to assess someone’s overall health. Often a medical history is very telling but it’s helpful to know contributing factors.

Your brain isn’t operating separately from the rest of your body. That’s why I prefer looking for patterns before randomly changing 5 things.

If you’ve been dealing with brain fog and aren’t sure what deserves your attention first, I created a free Brain Fog Reset Guide to help.

It will help you take a closer look at the patterns around your focus, energy, sleep, and daily habits so you have a better idea of where to start.

Inside the guide:

Common contributors to brain fog worth paying attention to
A simple self-assessment to help you spot patterns
Practical changes you can start trying
A simple way to decide what to focus on first

Get the Brain Fog Guide here

Still not sure what may be contributing to your brain fog?

If brain fog is starting to affect your work, responsibilities, or how you feel during the day, you don’t have to keep guessing at what to change first.

In a 1-hour Health Assessment, I’ll look at the bigger picture with you, your brain fog, energy, sleep, daily habits, health history, and priorities and help you figure out where it makes sense to start.

Book Your Health Assessment

Disclaimer:

$1,500 a Month Won't Prevent a Heart Attack

Dr. Ashori MD — Fri, 04 Sep 2026 14:30:51 GMT

You’re paying $1,500 a month for your health insurance, giving you a feeling of health security. “Should anything happen, I’m covered.” But what really happens that day when you have a scare and are whisked up to the hospital?

Health insurance went from a risk mitigation service to a carte blanche for the healthcare system. They’ll run the tests they want, make the diagnoses they need, and scare the health consumer into a procedure or treatment without really offering informed consent.

But you might not be too worried because you know that you can always sue your clinical team if something goes wrong. Except, I’ve never had a happy patient who was in a lawsuit. When you are stuck on lifetime dialysis, even $100 million won’t add much to the quality of your life.

Paying for What Matters

In the US you likely won’t die from a mosquito bite, Typhoid, severe diarrhea, or other major public health disasters. The biggest killers are the factors that lead to chronic disease.

I’m 48 and my biggest risks are heart disease, diabetes, cancer, autoimmune disease, and dementia. Most of these are preventable according to science.

And since for most adults money is a finite resource, the question is whether the health insurance premium is protecting you. While it doesn’t have to be an either-or, the money you spend on health insurance is the money you’re not spending on prevention.

This Is What Will Keep You Healthy

Here is a breakdown of areas worth spending money so that you can avoid needing to use your health insurance in the first place.

The implication is that relying on the health insurance system is actually a risk to your health. How do we know? Lots of data shows that defensive medicine, profit-motivated health decisions, and medical errors place your health at risk.

1. High-Value Lab Tests - $75

Annual TSH, CBC, and cholesterol? What’s the point if you just keep getting them without taking action?

ApoB
HOMA-IR
Liver function panel
hs-CRP
TG/HDL ratio

These aren’t labs that I just get willy nilly. Before obtaining them, I have a long discussion (my appointments are 1-hour long in my practice) with each patient and we decide what action we’d take based on what the results are.

Waiting for an LDL-C of 160 or an A1C of 6.7 is like waiting for the tornado to hit your home before you evacuate it.

2. Blood Pressure Cuff - $35

I don’t have to say too much about high blood pressure. I’ll just add that waiting for your annual blood pressure reading at your doctor’s office won’t tell you what your cardiovascular system is doing. It’s like taking a random photo at a wedding and hoping the bride/groom are in it.

Know your blood pressure and know what affects it. Ideally, know what it does overnight as well. Make adjustments to keep it in a healthy range. Don’t assume that a blood pressure medication will fix the underlying issue.

Struggling with Brain Fog? Consider enrolling in my Brain Fog Reset program.

Book your spot now!

3. Glucometer - $40

An A1C is a very crude metric and a CGM is far too granular. But a glucometer is cheap, safe, and effective. It’ll tell you how your body responds to different stimuli.

For some adults it’s stress, poor sleep, something sweet, or being sedentary and they’ll see their blood sugar spike up. Of course, so will exercise. It’s not to say that something that raises your blood sugar is bad for you - that’s where all the longevity gurus miss the mark.

4. Body Composition - $90

Whether you do a DEXA scan, MRI ($500), or InBody ($50), it doesn’t matter. You’ll get a solid idea of your body’s muscle, fat, and bone composition.

If you’re Asian, Indian, Middle Eastern, or a woman you’re at far higher risk to have “Normal Weight Obesity.” You may look great in the mirror but a lot could be brewing underneath.

There are lots of other ways to glean this information but what I’ve learned after 2 decades of practice is that nobody wants to bother with a tape measure and a calculator to check their waist-to-height ratio. They want a digital printout. So if a WtHR isn’t convincing enough, start with a DEXA.

5. Fitness Test - $100

You can do a fitness test at home, on a treadmill, on a hill, on a bike, in a pool or you can pay $300 and have a lab test for your VO2Max.

You’ll need a heart rate monitor so I added $100 for the cost. Knowing what your max heart rate, resting heart rate, and oxygen capacity is will help you decide what changes to make with your health.

Using the Information

The list above assumes that you know what to do with the information and that you actually implement the necessary changes. Believe me, this is far more important than you realize.

Most adults have plenty of data to paint a clear picture of their current and future health. Taking action on this data is what makes all the difference. It might seem overwhelming at first but if you break it down it’s quite doable.

Follow this 5-point method to help you achieve better health than most of your peers:

What data do you already have?
What important data points are missing?
What does the data say about your current and future health?
What are the top 3 things you could do today that would have a major impact?
How can you measure your progress?

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

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What It Takes to Keep Climbing for Decades

Dr. Ashori MD — Tue, 01 Sep 2026 14:29:39 GMT

10 years into climbing, a terrible pain started in my right hand. Soon, it traveled up my arm. Eventually, I couldn’t even sleep. 3 surgical consults and 1 hand surgery later, I was facing not being able to continue something I loved.

What does it take to keep climbing for decades? Or playing any sport you love long into the future?

Know More About What I Do

Why Climbing Has Become Personal to Me

The first time I climbed indoors I fell in love with the problem solving, the feeling of your entire body against gravity. It’s a sport that hooks people and never leaves them.

To climb well, you have to train. It’s not the kind of sport where you can just climb, perhaps because it’s not always easy on the body.

It was never easy for me to know when I was overtraining or whether my gym training was climbing-specific enough. But that’s exactly what makes all the difference in sport longevity.

Health and climbing have so much in common. To enjoy your health you have to do some training for it and sometimes it’s a sacrifice while other times it’s pleasurable. And just like training for climbing you can overdo it, suffering from side effects or other burnout.

Why I Appeared on The Nugget Climbing Podcast

Steven Dimmitt is a fantastic climber who started a well-rounded podcast related to climbing. He interviews the best climbers, coaches, and random people who’ve fallen in love with the sport over the years.

I reached out to Steven because of my own personal passion for long-term health and longevity in climbing. We threw around a few ideas for a podcast we could record together and finally settled on “The 5 Things That Will Keep You Climbing for Decades.”

What We Talked About

Climbing creates muscles but what kind of muscles do we need to climb for decades to come?
Had I spent more time letting my body recover from my hand injury I wouldn’t have ended up needing a major hand surgery. How does one intentionally structure recovery?
Nutrition and metabolic health is of course at the heart of my Physician-Led Health Coaching but it’s also what every athlete needs for growth and recovery. So, of course, we covered specifics of sports nutrition.
We talked about the right kind of cardio for adequate aerobic capacity so you can train harder.
My TREND Method is centered around “Testing.” I want useful data to know what actions to take for my patients and coaching clients. But we have high level data and less useful data. Check out our discussion about Steven’s A1C and LDL results.

What I Didn’t Expect Us to Cover

We talked at length about evidence in medicine and the US healthcare system.

It’s fascinating that two adults from very different backgrounds have come to overlapping conclusions regarding health.

Listen to the Full Conversation

Whether you're a dedicated athlete or just looking to safeguard your baseline health against aging, this episode is for you. Listen to the full conversation.

Click this link to take you to your favorite podcast app.

If you want to start taking a more intentional approach to your health, learn more about my Physician-Led Health Coaching program.

Disclaimer:

“So, what did your doctor say?”

Dr. Ashori MD — Wed, 26 Aug 2026 14:31:26 GMT

75 yo man new to my practice who’s accumulated his wealth and taken care of his health, hoping to live a great life. Except, health problems are starting to add up.

He has great health insurance and has been seeing his PCP. He asked me to review his labs because we have a few friends in common. While his doctor has done a good job taking care of him, I don’t think they have communicated well together.

Fatty Liver Disease

When your liver enzymes start creeping up, especially your ALT, as a family medicine physician I always want to know why. I usually start with a liver ultrasound and eventually get a FibroScan.

We combed through his old tests and he had an ultrasound which showed fatty liver disease but nothing was done. My question is why the doctor didn’t say anything or why the patient didn’t hear him. The other question is why the patient didn’t review his imaging results?

That’s okay, some good learning points. Let’s move on.

The liver is at the heart of metabolic health. Worried about fatty liver disease? Download my free Liver Fix Guide here:

I want to repair my fatty liver

Rising Blood Sugars - A1C

His A1C was 5.5, then 5.7, then 5.9 and eventually 6.1. His doctor said that they’ll keep watching it. But what are you watching for? If there’s a signal, what are you doing about it?

A squeaky brake could just be the pad wearing against the caliper but it could also be a sign that you need a new pad or even rotor. You don’t wait and see, you inspect. And just like your A1C, you don’t need a mechanic to inspect what’s going on.

A rising A1C is enough information to take action. What action? There are a finite options, ranking like this:

Start resistance training
Add aerobic exercise
Change your diet around

But we don’t just ignore a health signal, we take an action and retest. That’s what my TREND Method is all about. T stands for Testing. The REND are the parameters we adjust: relationships, exercise, nutrition, downtime.

Worsening Liver Enzymes

This patient was started on cholesterol lowering medications. Since then his liver enzymes have been slowly creeping up. A problem? Usually not, as long as the benefits outweigh the harm.

But he didn’t really have a lot of risk factors for heart disease to justify the cholesterol lowering medication. If he did, in my practice we would recommend a different class of medications without the liver risk.

His doctor said it’s okay, it’s not a problem. But if it’s not a problem why monitor the liver enzymes so closely? I think it is a problem and if nothing else it warrants a thorough discussion with the patient.

Obesity & Lifestyle

Again, I place equal burden on the doctor as the patient. Any great patient-doctor relationship requires both parties to be fully vested. The problem here is that this patient’s weight was never discussed.

Not being very tall, 180 lbs (82 kg) was too much. His doctor didn’t say anything but this new patient of mine was also not concerned. He assumed it was par for aging. Not so.

A healthy body composition is a strong predictor of long-term health. You don’t have to have the perfect body composition but carrying extra fat around your liver is not ideal.

After some talking, my patient admitted that the doctor mentioned a few things about a better lifestyle and even offered a nutrition consult. Who knows, maybe the doctor didn’t want to be pushy or the patient didn’t want to know more details.

Take Signals Seriously

The gist of this article is that any signal in health should have some sort of action plan. After all, you step on a scale for a reason. What are you planning on doing with the information?

We are fortunate to have lots of medication options, so that if one is causing an issue, the relief batter is ready to go.

You as the patient have to be the most proactive. Trust your doctor and appreciate them but vet everything they say. I certainly hope that nobody in my practice is following my advice blindly.

Two adults who are engaged and open, vulnerable, and inquisitive will have the best chance at creating a meaningful patient-doctor relationship.

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Disclaimer:

“All doctors are going concierge, what gives?”

Dr. Ashori MD — Mon, 24 Aug 2026 18:37:33 GMT

You went for follow-up with your gynecologist and were told that now there’s an annual fee of $350 just to be a part of this practice. You’ll still pay your copay, you’ll still pay for labs, you’ll still have insurance denials to deal with, but you’ll also be responsible for this fee.

This is happening in primary care, pediatrics, cardiology, and in many other specialties. So why is this happening and is it good or bad for you?

“The Doctor is Getting Rich”

Most of these practices are called Concierge Clinics. They aren’t on Rodeo and they don’t have an all-glass facade. They are concierge because they operate as a hybrid model - a monthly or annual cash free along with the insurance reimbursement.

The practice started out with a mix of commercial insurance, Medicaid, and Medicare. But the doctor was taking home only $150K a year, half of what she could get if she worked for a large mega-corp. And she loves her practice but can’t cover her overhead.

She can’t force the third party payers to reimburse her more so she’ll either have to see more patients, offer subpar care, or turn to her patients for the difference.

If she had 2,500 patients in her practice and went concierge, she’ll likely have 1,500 patients stay and accept the concierge fee: $525,000/yr.

Now she can spend more time per patient, spend more time on claim denials and prior authorizations. She can hire an extra staff member, upgrade to better software, and improve customer service.

In the end, she’ll keep an extra $100K, at most, from this new concierge fee. It will be enough to keep her from joining the nearby mega hospital system.

Hybrid Clinics Are Problematic

I personally find hybrid clinics problematic. As a physician you have to cater to the insurance company because they are the ones paying you - not the patient. The patient pays you a small amount of sometimes no copay at all. But the majority of your income is paid by the insurance company, as long as you do things exactly the way they say.

Then you have this cash-based part of the practice where the patient is paying you directly. Let’s face it, it’s really a membership fee. A membership to keep your current doctor. It’s not really pleasant for anyone to be told,

“Hey, I’ve been your doctor for a few years, and we’ve built rapport, if you want to keep me and avoid the headaches of starting all over again, you have to pay me extra.”

Even though they are a problem, I haven’t found a better solution for someone who is already in a practice.

My practice is cash-only. I can’t fathom having an insurance company tell me what I can and can’t do for a patient. But that’s because I built it from the ground up as a cash-based, out-of-network practice.

“I Can’t Afford It”

This is a very valid statement for someone who simply can’t come up with an extra $350. But in our modern society “afford” is used in more creative ways.

If you are paying $1,000 a month for health insurance it’s not really feasible to say you can’t afford $30 a month for better medical care (assuming the extra time and attention would translate into better care.)

The science says that prevention and early screening improves health outcomes. If this is correct then spending extra money now would help you stay healthier longer, prevent suffering, and add more productive years to your life.

Health insurance will only go up in price. Yes, eventually a catastrophic plan will be added once enough people opt out of insurance and go to the ER for their care, but for now everyone is held hostage to whatever price hikes come our way.

There are DPCs (direct primary care doctors) and DSC (direct specialty care) and there are health-sharing companies like Zion and CrowdHealth. In fact, this is the combo my wife and I are using right now and we’re both doctors.

There are '“experts” who say that DPC is not a viable model and crowd-sourced or health-sharing plans are a scam. But my wife and I, both physicians, disagree. Just like any service or subscription, you have to go in informed. It’s not what I’m recommending, it’s just what we’re using at this time.

More Diseases, More Treatments, More Complexity

If you’ve been going to your doctor for the past 10 years here’s what’s change in the last decade:

there are more diseases in the ICD10 code system
more medications in our repertoire
you probably have more health conditions
more vaccine options to sort through
more imaging technology to choose from
more specialties or topic experts to refer to
higher rate of malpractice cases to deal with
a more complex credentialing system for doctors

With all of this added on, not to mention inflation, most private practice doctors can’t stay in business. They’ll need to hire more staff and subscribe to more software to keep their practice running.

So Why Bother With Private Practice

This is a valid point. Most adults are part of large hospital-based medical groups. They get everything in one place. Easy referrals and all of their data is readily shared between the different tentacles of the medical group.

And that’s exactly the problem. That large hospital-based medical group is also quite busy analyzing your health data to see how they can squeeze a few more health dollars from you and your insurance company.

They have your best interest in mind, no doubt, but it’s just under their own best interest, which is profits.

We could say the same for the private practice doctor. I certainly wouldn’t stay in practice if I didn’t get paid. But I could get paid far more working for that same large medical group. So, obviously profits aren’t my main motivation.

Maybe this is exactly why many private practice doctors may be a better fit for most patients; because their first priority is practicing medicine the way they see fit, followed by making a decent living, followed by their patient’s best interest. Don’t be offended by this, I’m a patient myself and I would never go to a medical practice that has no sustainable business model and only cares about my health. That’s because they wouldn’t be around for too long.

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So What Can You Do?

1. The good news is that there are lots of practices that haven’t and likely won’t go concierge. But you’ll wait a long time to see your doctor, wait a long time for referrals, and get frustrated waiting for your refills. Your clinician, though, will genuinely care about you, same with their staff.

2. You can pay the concierge fee knowing that it will make the practice run smoother and help improve your health along with it. Expect to pay $200 - $50,000 per year.

3. Go to a DPC/DSC practice. You’ll pay a small fee every month ($75-150) and never have to worry about the conflict of interest with the insurance company. But it’s advisable to keep your health insurance to pay for the really big things like emergencies.

4. Invest in your health literacy because no matter what system you use, you never want to be at the mercy of the healthcare system. You want the advice and guidance from your clinician that you can vet yourself.

5. Sign up for a health sharing ministry like Zion or CrowdHealth. But you’ll want to read the fine print. Many things are not covered but big unexpected bills usually are.

Disclaimer:

5 Ways to Halt and Reverse Osteoarthritis Pain

Dr. Ashori MD — Mon, 24 Aug 2026 14:31:22 GMT

You’ve been dealing with a nagging knee pain for years and the last time you had x-rays your doctor said that you’ll need a knee replacement. The good news is that there’s a lot you can do about the knee pain.

While reversing actual joint damage isn’t as feasible, it’s also not the main goal. We don’t go to the orthopedist because we are worried about the shape of our cartilage, we go there because of pain or decreased mobility.

1. Offload Mechanical Stress

If you’re carrying extra weight, as little as 10 lbs can take as much as 40 pounds of mechanical force off of your knees. With each step you’ll feel less pain and stiffness, allowing your tissues to get more oxygenations and blood flow.

If you don’t have arthritis yet, a healthy weight will help prevent it. There are some studies to also show that extra weight, especially visceral fat, may increase total body inflammation.

2. Calming Systemic Inflammation

I did a recent blood test on a patient and his inflammatory markers were through the roof. We didn’t expect it but it so happens that he’s been dealing with a lot of arthritis in his knees.

But blood tests aren’t always enough. Even though there are lots of ways to test for inflammation it can still evade most tests. It’s better to think about the kind of lifestyle that naturally decreases inflammation:

Diet rich in plants, fruits, whole grains
Cutting out highly processed sugary foods
Improving your stress and sleep

Whether you’re dealing with inflammation or metabolic issues, the liver is at the heart of it. Worried about fatty liver disease? Download my free Liver Fix Guide here:

I want to repair my fatty liver

3. Protecting the Mechanics of the Joint

The last thing you want to do when you have knee or hip osteoarthritis pain is exercise. But that’s exactly what will reverse the pain, decrease inflammation, and protect the joint from further damage.

Strengthening the muscles surrounding a joint provides improved shock absorption, stability, and mobility. For the knee arthritis it’s usually the thigh muscles, for the hip it’s the glutes and lower back.

This is the best time to partner with a physical therapist who is an expert in joint biomechanics.

4. Daily Movement

We used to tell adults that running would ruin their knees. Now we know better. Regular physical activity actually helps lubricate joints and prevents muscle loss with age.

If you stop moving, such as after an injury, you lose muscles at different rates in different parts of the leg. Then when you go to walk again you create immense pressure in certain parts of the joint which may damage the cartilage leading to arthritis.

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5. It’s Okay to Reach for a Crutch

Sometimes lifestyle treatments aren’t enough and the data clearly shows that some local anti-inflammatories (or systemic ones like ibuprofen) and some walking aids or even joint braces may help.

The goal is to calm a severe flare-up. Once the joint calms down it’s easier to resume normal activities or targeted physical therapy.

Disclaimer:

Traditional Medicine Treats You as an Equation

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

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

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

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

High Blood Pressure

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

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

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

Elevated A1C

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

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

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

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

Paroxysmal Atrial Fibrillation

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

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

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

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

Obesity

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

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

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

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Back Pain

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

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

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

The Role the Patient Plays

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

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

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

Disclaimer:

7 Things to Fix Before You Try a Peptide

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

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

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

1. You’re Not Recovering Like You Used to

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

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

2. You Can’t Process Information

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

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

Struggling with Brain Fog? Consider enrolling in my Brain Fog Reset program.

Know more about the program

3. You’re in Bed But Not Sleeping

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

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

4. Your Energy is Zapped

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

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

Before You Optimize, Get the Foundations Right

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

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

Download your eBook

5. Your Insulin Needs a Break

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

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

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

6. Your Muscles Aren’t Activated

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

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

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

7. Skin & Hair Are Thin or Sagging

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

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

Want a practical place to start?
Download my free 6 Healthy Aging Habits eBook and focus on the foundations before chasing the latest health trend.

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Prefer watching? I also broke down why I think people can fall into “The Peptide Trap” and what I'd look at before trying one.

Watch the Youtube Video

Already using peptides or considering them?

If you’d like physician-led guidance that takes your health history, goals, lifestyle, and overall health picture into account, you can learn more about my Initial Health Assessment.

Disclaimer:

Why Your Waist Circumference Won't Budge

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

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

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

1. Are You Taking the Correct Measurement?

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

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

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

2. Abdominal Wall Laxity

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

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

3. Forward Tilting Pelvis

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

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

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

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

4. You Need More Time

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

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

5. Hyperinsulinemia

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

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

6. Excess Cortisol

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

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

7. Alcohol Consumption

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

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

8. Not Enough Muscle

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

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

Disclaimer:

Top 10 Ways to Fix Your Prediabetes A1C

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

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

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

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

The Heart of Prediabetes

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

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

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

Top 10 Actions in Descending Order

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

1. Fix Body Composition

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

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

2. Increase Your Glucose Transporters

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

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

3. Increase Gut’s SCFAs

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

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

4. Drop Your Post-Meal Glucose

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

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

5. Decrease Fasting Insulin + 2-Hr OGTT

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

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

6. Shift Your Calorie Timing

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

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

7. Drop Your Cortisol

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

Stressed? Meditate or strategize good stress coping mechanisms.

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

8. Review Your Medications

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

9. Cut Out Your Supplements

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

10. Improve Glycogen Storage

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

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

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

Disclaimer:

Why Your Weight Fluctuates 5 lbs in a Day

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

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

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

#1. Water Retention

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

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

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

#2. Salt is Powerful

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

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

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

#3. Food & Waste Build up

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

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

#4. Stress Affect Hormones

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

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

Focus on Your Weekly Average

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

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

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

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

Disclaimer:

Are You Fit?

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

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

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

My 3 Fitness Categories

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

1. Strength

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

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

2. Endurance

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

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

3. Power

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

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

Testing Your Fitness Level

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

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

A. Testing Your Strength

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

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

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

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

B. Testing Your Endurance

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

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

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

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

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C. Testing Your Power

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

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

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

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

You Don’t Need Perfection

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

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

How to Train Each Category

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

A. Training Your Strength

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

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

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

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

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

B. Training Your Endurance

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

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

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

C. Training Your Power

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

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

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

Disclaimer:

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

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

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

1. Stress

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

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

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

2. Sleep

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

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

3. Weight Loss

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

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

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4. Fatigue

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

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

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

5. Unfocused/Brain Fog

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

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

Struggling with Brain Fog? Fix it with my Brain Fog Reset program.

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6. Bloating/Constipation & IBS

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

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

7. Acne and Eczema

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

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

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

8. Hair Loss

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

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

9. Back Pain

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

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

10. Metabolic Health

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

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

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

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

Disclaimer:

The Big Guns in Medicine

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

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

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

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

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

Joint Replacement Surgery

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

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

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

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

Prostatectomy

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

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

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

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

Check out this article on preventing prostate enlargement:

IV Antibiotics for Sepsis

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

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

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

Downplaying the Heavy Toll of “Normal” Side Effects

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

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

The Big Guns Are Becoming Routine

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

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

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

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

Know someone dealing with this? Send it to them.

Healthcare Can’t Keep up

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

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

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

You Might Be Aging Faster Than You Think
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Disclaimer:

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

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

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

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

1. What Problem Are You Trying to Solve?

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

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

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

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

Take The Healthy Aging Type Quiz Now

2. Increasing Your Daily Movement

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

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

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

3. Controlling the Dose of Exercise

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

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

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

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

4. Improve Your Duration

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

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

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

5. Heart Rate Data

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

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

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

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

Know someone using a wearable? Send it to them.

Looking for the best health tracker?

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

Until next week,

Physician-Led Health Coaching

My 5 Go-To Habits Despite Life's Chaos

1. My Go-To Meals

2. I Walk

3. Keeping up with Sleep

4. Making Room for Loved Ones

5. I Don’t Rush

What Can You Keep During Your Hardest Week?

Disclaimer:

5 Ways to Know If Your Fatty Liver Is Actually Getting Better

1. Weight & Waist Circumference

2. The Metabolic Drivers

3. AST and ALT - Liver Enzymes

4. Liver Fat Imaging

5. Fibrosis Risk

How to Use All This Information

What if the numbers don’t improve?

Related Reading:

Disclaimer:

You’re Sleeping 8 Hours, So Why Are You Tired & Foggy Brained?

1. 8 Hours ≠ Good Sleep

2. How Do You Feel When You Wake Up?

3. Brain Fog Is a Symptom, Not a Disease

4. Sleep Is Only 50% of Recovery

5. Be a Detective of the Patterns

6. You Don’t Need to Fix Everything

Disclaimer:

Fact Checking the Health Claims of GLP1 and Other Incretin Drugs

“Reversing Heart Disease”

“They Reverse Heart Failure”

“Reverses Diabetes”

“Reverses Kidney Disease”

“Prevents dementia”

“Increases Longevity or Slows Aging”

“Lowers Inflammation”

“Treats Addiction”

Disclaimer:

4 Things I’d Focus on After Being Told I Have Fatty Liver

1. What’s happening with the rest of my metabolic health?

2. What am I eating and drinking?

3. How much am I moving?

4. How will I know whether things are moving in the right direction?

Not sure where to start?

Disclaimer:

The Anatomy of Afternoon Brain Fog

1. What does “brain fog” mean to you?

2. When does it happen?

3. What does sleep look like?

4. What are you asking your brain to do all day?

5. What else is changing?

Still not sure what may be contributing to your brain fog?

Disclaimer:

$1,500 a Month Won't Prevent a Heart Attack

Paying for What Matters

This Is What Will Keep You Healthy

1. High-Value Lab Tests - $75

2. Blood Pressure Cuff - $35

3. Glucometer - $40

4. Body Composition - $90

5. Fitness Test - $100

Using the Information

Disclaimer:

What It Takes to Keep Climbing for Decades

Why Climbing Has Become Personal to Me

Why I Appeared on The Nugget Climbing Podcast

What We Talked About

What I Didn’t Expect Us to Cover

Listen to the Full Conversation

Disclaimer:

“So, what did your doctor say?”

Fatty Liver Disease

Rising Blood Sugars - A1C

Worsening Liver Enzymes

Obesity & Lifestyle

Take Signals Seriously

Disclaimer:

“All doctors are going concierge, what gives?”

“The Doctor is Getting Rich”

Hybrid Clinics Are Problematic

“I Can’t Afford It”