Hemingway, Eichmann, Stranger in a Strange Land
Dylan, Berlin, Bay of Pigs invasion
Lawrence of Arabia, British Beatlemania
Ole Miss, John Glenn, Liston beats Patterson
Pope Paul, Malcolm X, British politician sex
JFK, blown away, what else do I have to say?

- Billy Joel, 1989

Not too long ago, I was sitting outside in the evening air, and staring into a crackling fire, the flames offering compensatory warmth against the mild chill brought on by an intermittent breeze. It was a lovely evening… from a perspective isolated to my backyard. I qualify it thus, because if you were to travel 4.2 miles due south, you would have encountered a chemical plant with a ruptured container, slowly releasing 7,000 gallons of methyl methacrylate. The toxic material was combustible, according to the refreshingly brief and forthcoming declaration from the Orange County Incident Commander Craig Covey:

"We are setting… in preparation for these two options: [The container] fails, or it blows up.”

Over 40,000 people were forced to leave their homes in consequence of this event, with my home perched on the northernmost boundary of the purported “blast zone” should that worst case scenario come to pass. Yet, the danger passed without incident, people returned to their homes, and the week of press covering this episode moved on to whatever next horrible thing was in progress.

I state all of this as a precedent to introduce a conversation I had with an evacuee who had taken shelter at our church. After my return from a supply run on her behalf, she and I sat in conversation where she listed off the numerous troubles on her watchlist, aside from the evacuation; limited home good supplies, multiple cat bites (from her… loving pet cats?), two bored and cooped up teenagers, and a blood sugar level too high.

I sat and listened with the hope that providing an outlet would help settle her mind and organize her thoughts. I was partly right, because as she spoke, the list of personal troubles and anxieties took shape and broadened into larger, more social problems that were still applied in a personal way. Concerns about property damage to her home became concerns about the statewide cost of rent and home prices. Worry about food spoilage turned to anxiety about the cost of food and insulin, and how teenagers are so distant these days, and people are so untrusting, and college will be so expensive for her kids, and on it went.

It was the rhetorical equivalent of watching a snowball set in motion downhill and slowly, steadily accrue mass and velocity with the question of where (and how) would it finally stop. She concluded with, “It’s just so hard out there everywhere. Things have just never been so bad.”

That poor woman’s final expression was uttered with equal parts exasperation and sincerity. An attempt to summarize the turmoil she perceived in her small corner of the world.

Now, I turn to you — the reader — and ask directly. Do you agree with her?

Whether or not you agree is a matter of your lifetime’s cumulative experiences, perceptions, and worldly observations, but for those who do agree, life can persistently feel heavy. I say this with mournful consideration, because I do believe that a growing number of people consider the very nexus of human existence, life itself, to be the greatest burden they carry.

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Whether or not this is you, I have words I would share.

Far be it from me to talk you out of the melancholy you’ve worked to develop, but, I would like to offer a counter-perspective to that evacuated woman’s statement, about how bad and demanding life feels upon everyone. I don’t agree with her conclusion, but I disagree in a way that may not make much sense. At least at first. That said, let me offer you my response in three short sentences.

It’s always been bad.

While it’s always been bad, it’s also somehow never been better.

Accept that it’s always been bad, but it’s also good, and then it will start to get better.

… Everybody got that? Well if not, here comes an expanded explanation with the help of Billy Joel.

It has always been bad

Listen to the song, “We Didn’t Start the Fire”. It was written and released by Billy Joel in response to a conversation between him and a younger acquaintance. The acquaintance in question was recently disenchanted with life itself (everyone has this moment at some point) as he came to the realization that life is often times an imperfect mess full of flawed individuals. Flawed as he himself is (at least, I presume).

Armed with this newfound knowledge, he proceeded to conversationally berate and blame Joel for the younger generation’s hardships. That didn’t sit well with Joel, who replied in the most artistic way possible. He wrote a song. Specifically, he wrote a song that was nothing more than a rapid-fire list of major headlines, disasters, and cultural events starting in 1949, the year he was born, going through 1989. His message was simple. History’s events and “fires” of world conflict had burned long before his generation’s arrival:

We didn't start the fire
It was always burning since the world's been turning
We didn't start the fire
No, we didn't light it, but we tried to fight it

I can’t exactly explain why, but I find catharsis every time I reflect on this settled fact; the world’s always been a mess.

Mankind’s lust for power, recognition, and greed have forever fueled hardships for one another, and yes, even weather patterns have long been inconsiderate a-holes to humanity. Perhaps this catharsis is nothing more than impish gratitude that I don’t suffer alone, but I like to believe it’s a settled perception that matches reality’s limitations. Said another way, I take life as it is, not how I want it to be. I seek progress, but from a established starting point. Nothing will augment misery faster than attempts to reconcile unrealistic expectations against reality’s backdrop.

Conflicts rage.

Innocents suffer.

Guilty go free.

No mortal man or woman alive can offer the assurance that clouds or storms will be kept at bay. Accept this. Once you do, you will be equipped to identify with the next great truth in the matter.

Even though it’s bad, it’s never been better

Of all the modern advances, benefits, and earmarks of modern living, there is something remarkable about unlimited pudding cups in a hospital.

Why on Earth is he talking about pudding cups…? Stay present for a moment, this will become clear. In almost any hospital across the country, men and women, guests or patients, have access to pudding cups. These small and scrumptious treats are offered at reasonable discretion for all to enjoy. True, there is a practical limit to how many you can take, but personal embarrassment would limit most before the hospital staff.

Delicious. Convenient. Practically “unlimited”. Nice perk while in a hospital.

Central to this point however is not the pudding cups themselves, but what allows for the existence of practical, infinite pudding cups; robust and thriving agricultural system, creative machinations of food enthusiasts, flexible policies within an otherwise restrictive system.

Well, pudding’s nice, but I’m sure most would trade free pudding for free healthcare… right you are, you hypercritical purist of social progress in an all-or-nothing paradigm!

I have another counter, however. Even though suffering and distress from health-induced financial difficulty is legitimate, what an incredible world it is where exist medical bills, insurance issues, and healthcare headaches to navigate in the first place? Not so long ago, none of these things existed. Merely slicing your hand on a blade could lead to infection and death, in the world without antibiotics. Being born without a functional SMN1 gene led to diaphragmatic collapse by age 2 and death, in a world without gene therapy. An aortic blockage of plaque caused limited blood flow and eventual death, in a world without surgery, statins, or lifestyle medicine.

Simply stated, death has always been a component of life, but in the modern era it is often less frequent and early in its arrival. How wonderful a thing it is to be able to argue about healthcare systems, because it means there are effective systems in the first place.

But it goes beyond life and death itself; from a material perspective, humanity is absolutely killin’ it, if you’ll forgive the phrase. You no longer have to drive to pick up your takeout or restaurant meal, someone can bring it to you. Bored with standard Oreos? No problem, there are dozens of flavors to choose from. Somewhere in between Amazon Prime and the 38 Marvel Cinematic Universe movies (God knows how many are planned), you realize that entertainment options outpace available hours in the day.

It’s not simply a matter of life being better, it’s also more convenient and entertaining. Even for those impoverished in the United States, life proceeds with a level of quality that exceeds that of emperors and rulers in bygone eras, and that’s without the use of slaves, monarchical power, or fiefdoms.

Yes, life still presents with difficulties, but, the difficulty setting has been adjusted in dramatic and life-extending ways.

That’s good, even though it’s still bad.

Accept that it’s always been bad, but it’s also good, and then it will start to get better

Let’s conclude the matter at hand with something anecdotal, and something empirical.

Our anecdote comes from an experience regarding an exchange between two parties during the 19th century. A group of educated individuals sat in discussion over a massive migration event from almost 50 years prior. The nature of the conversation was critical, highlighting the flaws and follies of the migration efforts and its leaders; leaving too late in the season, traveling under-supplied, lack of familiarity with the trek. This critique carried on until an elderly man, who had been a member of this same migration, asked everyone to stop discussing a matter which “they knew nothing about”, as he described it. It was a harsh, dangerous, and lethal journey, but it was a price he and all other participants were willing to pay because of what it had afforded them.

Now let’s consider something empirical, in one final push for the case about how to handle a world that’s always been bad.

In 2014, a study was published that reported results which I would not have believed had I not read the original manuscript, which you can find here. The study examined the effects and magnitude of acute psychological stress after the Boston Marathon bombings. Researchers surveyed 4,675 U.S. adults two to four weeks after the bombings, including participants from Boston, New York City, and the rest of the country. Key to this study and its design was the assessment of 1) proximity to the bombings (there when it happened, versus in the neighborhood, etc.), 2) hours per day of consuming bombing-related coverage through television, radio, print, online, and social media, and 3) acute stress symptoms reported. The researchers also accounted for factors such as prior mental health problems, typical television-viewing habits, demographics, and previous exposure to major traumatic events.

Now here’s the unbelievable part.

Media consumption had the strongest association with acute-stress symptom scores, not the actual bombing. When compared to people who consumed less than 1.5 hours/day of bombing-related media, those using media for 6 or more hours per day had a regression coefficient of b = 15.85, where ‘b’ is a comparison coefficient of acute-stress scores compared to other groups.

By comparison, people who were present at the actual bombing had a much smaller coefficient, with b = 6.17. That’s fully adjusted for confounders such as baseline mental health, hours of media consumption per day, proximity to the bombing, and even prior trauma.

Furthermore, if you consumed 6 or more hours of media, you were 9.6 times more likely to achieve the study's high acute-stress criteria compared with the minimal-exposure group. But direct bombing exposure? It was not significantly associated with that high-stress classification in the fully adjusted model.

Greater stress associated with media news consumption about the bombings, rather than the bombing.

This is complete speculation from here on out, but, I imagine that the people who consume that much traumatic-event media are likely the same people that will tell you, “It’s just never been so bad out there.”

There is a point of perspective within all of this, obviously, which allows each person to interpret the world and its calamities as they will. There is choice involved in how you internalize what you observe. And arguing that the world has always been bad is neither justification to let it continue as such, nor speak out against what is bad.

But, it is a great place to start for a healthier and more operable way to deal with that hardship. So perhaps the next time you hear the claim, “Things have just never been so bad”, what comes next? Will you reflect on the previous hardships the world has faced? Will you allow yourself a silver lining? Most importantly, will you allow yourself to experience happiness and joy, despite those hardships and whoever owns them?

Yes, things are bad. Yes, things have always been bad. But yes, things have somehow never been better. And perhaps accepting those truths all together may be part of how everything, for everyone, can ultimately start to get better.

The inaugural post of this newsletter was described an underutilized and desperately needed intervention in the realm of public health.

Fatherhood.

As a subject of social assessment, there is extensive research correlating absent or abusive fathers with a multiplicity of social ills (emphasis on the “multi” prefix). Economic hardship, low educational attainment, delinquency, criminality, justice-system involvement, mental health rates, substance use, and familial instability, to name a few.

While the research states that these associations are nothing more than, well, associations, considerable evidence and reason rightly categorize these relationships as causal. Missing fathers amplify social ills of various stripes. This is not to discount the irreplaceable need for women, but rather to highlight an overlooked chasm that few people are attempting to bridge.

That said, the ‘bridged chasm’ analogy may not be appropriate, as it implies that you can cross the chasm (i.e., missing fathers) using suitable material prompts. You can’t. What we need is to know where this chasm came from and how to reverse its growth. Instead, missing fathers are a symptom of interrupted or corrupted maturation on the way to manhood. This is inarguable, as evidenced by extremely grim statistics, such as how men are 4x more likely to commit suicide, or that men make up 92.7% of the state and federal prison population.

So if fatherhood is in demand vis-à-vie properly matured men, let’s be direct.

Men and young men everywhere. We need you. There is civilizational decay and fracture all around, but the life you choose to live can stand as a bulwark against that fracture.

It does not matter how much pain you carry. It does not matter what prior mistakes you have made. It doesn’t even matter how lonely or isolated you presently feel. The fact is, you can start on your way to becoming a more successful, attractive, and composed man if you just start cultivating three simple qualities.

Herein lies a brief, evidence-based three-step guide to absolutely crush it when it comes to being a man.

Be Kind

The quality that women find most attractive in a male partner, is kindness. Physical features, earning potential, and the ability to captivate attention are indeed short-term draws for women, but the quality that cements your attractiveness and worthiness is your ability to pour yourself — your words, your time, your talents, your actions — into the well-being of another.

Are you frustrated after a long and disappointing day, but able to set aside your irritation and ask your partner how her day went? Are you tired, but willing to “unwind” in the service of another by doing laundry, or loading the dishwasher? Do you sit in the living room and watch TV while your partner works in the kitchen, or do you proactively offer to help?

It stands to reason that one of the greatest expressions of kindness is the ability to serve, to give yourself to someone. Rather than an act of depletion, there is renewal, as the more of yourself you give, the more of yourself you find. You start to realize that externalized efforts are more satisfying and enriching than activities that are internalized and self-directed.

You can still take independent time, enjoy personal delights, and be resolute in personal defense. Kindness is not a distraction or deviation from any of this, but a pure upside that continuously delivers. If you are more honest, more trustworthy, and more restrained in moments where restraint is needed, your freedoms will expand and opportunities will abound.

How can you be a kind man? Perform acts of kindness. Trouble yourself with doing good rather than how to be good, and in due time, you will see the actions come to define the character.

Be Smart

Intellect is a difficult-to-measure construct, and nobody will master every topic out there. But as a wise man once said,

A man could lose everything. But what he carries in his head? Nobody can touch that.

So fill your head with consistent learning. You can accomplish this inside or outside a university.

Read. Find good books and read them. The classics, the currents, the hobbies, the interests. Learn something and apply yourself to crystallizing the knowledge in your head. A good education, as opposed to poor education, does not depend upon money paid or esteem of the attended learning institution, but on how you internalize your newfound knowledge. Done properly, education acts as a rising tide and lifts all of the boats that make up your personality. As neurons and mental maps take shape and enlarge, your character will be refined in the process.

How else do you explain how re-incarceration rates are cut dramatically for prisoners who work to complete or advance their education?

Be humble, and recognize that the world around you is full of potential. Everyday there will be something new to learn or experience, and, coupled with your growing kindness, you will be able to express this intellect in numerous ways.

You’ll be funnier, more apt to engage in solving problems, and more informed about the hows and whys with which people concern themselves. All of this, by the way, further ups your attractiveness.

Be a Creator

Compared to women, men more often seem to like building things. If that describes you, consider the possibilities of what you could build. And remember, the act of creation is something that can extend beyond new buildings and structures.

If intellect matters (and it most assuredly does), than learn how to make things, and be expansive in how you apply this. We need buildings, cars, roads, and new technologies, but there is plenty more to build outside of these.

You can build a business, selling either a product or a service. You can build and maintain a community, either as a police officer, a maintenance worker, or a civil engineer. You can build other people as a manager and leader. Remember that good programs, service, or products matter, but these are secondary to the people they’re meant to serve. You can write software. You can craft stories for entertainment or instruction. You can build minds. You can build bodies.

And with all of this creation, don’t forget to build yourself. Whatever your current starting point, it is enough. But the world has a constant need for new creations and ongoing maintenance, so get busy. This will also be your greatest signal of your ability to procure resources.

Be kind. Be smart. Be a creator. These are the keys, backed by research, for you to win in department of manhood, and by extension, be attractive to the opposite sex.

These are the keys to help you unlock the greatest joys there are in life, and by extension, save civilization.

It starts with you. So get started.

There are few activities in this world that are more wholesome or uplifting than watching small children play with one another.

Despite the occasionally chaotic action or egocentricity driven by a limited worldview, the character of children possesses a purity and simplicity where every action is both intentional and without guile. When they play together, it is so they can play, together. When they hurt each other, by activity or accident, they remediate their differences and life carries on. They harbor neither grudge nor animus, and forgiveness is quickly rendered unconditionally, save for continued social engagement.

Wherever you go, whatever the culture, small children are all the same. Yet the passage of time eventually leads to the twilight of childhood innocence, ultimately replaced by a character constructed upon choice, experience, and perception. While preservation of those early virtues would be wonderful, there is an inescapable transition in adulthood. By comparison, adulthood is a complicated jumble of awareness and action. The world expands along with our emotions, complicating our once simplistic worldview. But despite that complexity, those emotions, most of them, can serve as a useful tool to shape, build, and guide the world we come to know.

Most of them. There is one amalgamated emotion — a blend of fear, disgust, and ruminated anger — that inhabits multiple contexts and erodes whatever it touches. To the soul that harbors it, it is both stimulant and venom. Everyone (eventually) is capable of it, and everyone who nurtures it, is eventually eaten by it. It promotes both survival and extinction. It is the antithesis of childlike virtue.

You know it more formally as hatred.

A New Epidemic

The present-day odium epidemic doesn’t marshal any scientific declarations, in part at least because there’s no real way to quantify it. Anger, we can and do measure using scales like the STAXI-2, or aggression, through the Buss-Perry Aggression Questionnaire. Hatred is more difficult to pin down given its complex makeup and contextual dependence. For simplicity’s sake, we can think of it as excessive and unrestrained anger.

Despite not having any fanfare, the odium epidemic is a very real phenomenon with potentially catastrophic ramifications on both a personal and social level. We may not be actively measuring it, but there are arguable changes in the American culture that point to something new. Boundaries appear to be realigning. The Overton window of public discourse admitting new dialogue that was once collectively dismissed. The world has frankly been full of suffering and pain, and even with the advent of technology allowing us to see more of this suffering at once, in real time, it feels as though something has broken.

There was once a time when the willful and malicious taking of an innocent life, meaning murder, was routinely disparaged. The details of the victim’s life were not evaluated for sympathy, and circumstances never permitted justification. Now, it may either be scrutinized for relevance, or even applauded.

When did an evaluation of a victim’s background become relevant in our condemnation of their murder?

A Personal Destruction

As public health takes interest in anything that alters outcomes in human health, it may come as no surprise that there is a rather extensive research examining the relationship between measured anger and health.

What may surprise you (or perhaps not) is that through repeated and rather robust measures, all the data report that anger kills you faster. Slowly, no doubt, but surely.

Here’s one example.

In a rather extensive meta-analysis that included data from 25 cohorts (totaling more than 70,000 people), researchers compared various levels of anger and hostility with reported new cases of coronary heart disease (CHD). Participants were followed for long periods of time, often longer than 10 years. Among otherwise healthy populations, individuals reported to consistently express anger or hostility more often had a 19% greater chance of being diagnosed with CHD by the end of the study period. Among those who were already ill, the effect was worse, at 24%.

It carries on, in various populations, for various conditions. In patients dealing with hypertension, those who reported the poorest anger control were 35% more likely to experience either a fatal or non-fatal cardiovascular incident. Over a 20-year period, being frequently angry meant you had a 17% greater chance of dying from heart disease, even when controlling for various confounders.

It brings new application to the phrase, “Poisoning the heart”.

A Social Decay

Anytime you have large groups of people living together, you are likely to experience additional threats to mortality. That’s not doom-predicting. It’s simple data. Each individual life carries on within its social circles, pursuing its own interests and engaging its communities. However, conflicts inevitably rise with so many distinct interests and personalities. People value different things, or pursue different ends, and sometimes these inevitably cross paths. At times our personal decisions will have effect on the collective, and when that happens, there will be tension that is either legal or cultural.

For example, consider the tension between an individual’s right to express their conscience, and how their communication influences the actions of others. In America, you are legally entitled to express your opinion without reprisal, so long as your expressions are not illegal calls to action or in violation of contractual agreements (such as may exist with employers). Indeed, you can hate someone, and tell them such. But such expressions would not exist in isolation.

Consider the recent attacks on religious minorities within the United States. We see religious organizations targeted because of their faith identity. Men, women, and even children, killed at the hands of someone whose hatred became their compass, the only crime of the victims being the worship of their God. Entire congregation sites lit up in flame, by someone convinced they were doing a public service.

How does that happen?

It happens because the relationship of anger and health extends into the relationship of anger and action. People are much more likely to cross the boundary dividing words and action, if you anger them, and rally them behind a preexisting prejudice, whether that be directed at a person, a group, or an idea. From that lens, you may find yourself less likely to follow the rallying cry that goes, “If you’re not angry, you’re not paying attention.” If someone wants you angry on their behalf, they want you as an object.

All this is to reiterate how, yes, a person readily sits within their rights to refer to religious minorities “demons,” or “filth,” and even “deserving of [spiritual] destruction.” But consider, what will the effect of such expressions be on individuals who already sit close to the line of action? People who simply need an excuse, a rationale to hurt others?

In the wake of such attacks, it seems we’re more invested in reinforcing what you can say, not what you should say. We think of the rights of those who express their hatred, but not of the religious observers who nervously glance up every time someone opens the door.

Perhaps the worst part of this epidemic, the most entrenching quality it possesses, is that everyone who participates feels empowered by it. Everyone. For every reason. Expressions of hatred are a stimulant, intoxicating the user with a sense of moral superiority, reduced ambiguity, and deactivated empathy. Hating another person, when done for the “right” reason, just feels so good. At least in the moment. Drug addiction by contrast may stimulate the soul, but it leaves one ashamed and reclusive. Such is not the case for hatred, where we are so proud of it we’ll take to media to publicize it, or publicize it from someone who expresses it better than us.

It’s such a strange personal perception, believing you can out-hate your enemy, or that we can wield our hatred as a tool. So many people completely miss the point that they are the tool, and hatred is what does the wielding. That wielding takes on different forms; othering, signaling a threat, mischaracterizations, digging a pit, etc.

What is to be done?

As a simple suggestion, read this speech, Lincoln’s second inaugural address. It’s a stunning series of statements delivered at the height of the Civil War, where a nation was pitted against itself over the question of extending or diminishing the human slave trade.

Observe how Lincoln describes his enemies:

With malice toward none with charity for all with firmness in the right as God gives us to see the right let us strive on to finish the work we are in to bind up the nation's wounds, to care for him who shall have borne the battle and for his widow and his orphan ~ to do all which may achieve and cherish a just and lasting peace among ourselves and with all nations

Consider the state of a nation which would appoint a leadership like this, which extends this much grace and exhibits this level of restraint. Herein you don’t find any clever quips, any focus on the soundbite. All you have is commitment to do good and give your enemy the benefit of the doubt.

We could use this. Again. Ultimately, the individual efforts which play out will continue to morph the culture, and whether or not the odium epidemic carries on as per usual is yet to be determined.

Just remember though. It does not have to. It doesn’t even require teaching or enforcing new laws or expectations.

It just requires us to remember something we all used to carry. Back when life was simpler, and the world was smaller to our vista. Where our actions were always sincere and our mercies quick to extend.

We did it once.

We can do it again.

The entertainment medium of the 90’s was unprecedented. Disney was dishing out the hits (now classics), Pokemon knowledge was a metric for social status among children, and Japanese anime became mainstream through show called “Sailor Moon”. The show featured the character Usagi Tsukino, who would transform into the titular heroine and fight evil alongside her fellow Sailor Guardians.

Aside from its endearing stories of kindness, bravery, and the banger-of-an-opening-intro (listen to it here), it had a character known as Tuxedo Mask, an ally of the Sailor Guardians. Rather than actually fight alongside the heroines, Tuxedo Mask would usually make dramatic entrances and talk to the Sailor Guardians at a safe distance from the actual battle. He’d offer obvious hindsight, make general commentary, and sometimes encourage the ladies. He never actually did anything, yet somehow he was always lauded as a mysterious and powerful figure within the show.

For reasons unclear, this sentiment felt familiar watching Wednesday’s White House press briefing for the release of the 2025-2030 Dietary Guidelines for Americans (DGAs).

Reaction to the new DGAs has been mixed. Among dietitians and most healthcare professionals, the commentary ranges from “a mess” to “contradictory”, while avid supporters of Health and Human Services Secretary Robert F Kennedy (RFK) Jr. were either ecstatic or disappointed.

Among the more thoughtful commentary about the new DGAs — the quinquennially released federal report that serves as the cornerstone on what and how to eat to promote health, prevent chronic disease, and meet nutrient needs across the lifespan — there has been minimal insight offered on the press briefing itself. While there’s plenty to glean from the 10-page 2025 DGAs (a major reduction from 2020’s 164 page report), or the 90-page science report… or its 418-page appendix, there is insight from both the press briefing as well as the reports.

Taken together, there are incongruous components of these DGAs which give rise to uncertainty regarding application, practicality, and approach to dietary implementation. There are indeed a few charming components, but there are also many questions regarding some of the more antithetical claims therein.

So first, the charm.

The most important, and likely under-appreciated (if noted at all) gem within these DGAs comes in the form of a 12-word statement:

… support American farmers, ranchers, and companies who grow and produce real food… [italics added']

It may well be that the most egregious oversight of all previous DGA reports is their failure to make this acknowledgement; the centrality of farmers and the work they do. There would not be dietary guidelines, nor the field of nutrition science at all, were it not for this fractious portion of the population that feeds everyone.

Previous reports which mentioned farmers treated them as downstream stakeholders, rather than central figures. That order is incorrect, and even though this nod of support is limited, it is explicit and extremely refreshing to see from the federal government.

Within the written text of the DGAs, there is plenty of material carried over from the 2020 version; similar guidance on fruit and vegetable intake, an emphasis on fiber-rich whole grains, and the regular consumption of dairy. They also detail how the advisable protein recommendation range is now 1.2 to 1.6 g/kg. Regarding this latter detail, that is welcome change. While data from national samples posit that most adults already consume at least 1.0 g/kg of protein, there is a strong case for an increase for the very range now advised within the DGAs, as described by researcher Stuart Philips within a piece published in The Conversation.

However, this is where the charm fades and the American public now wades into uncertainty and numerous questions given the report and press briefings inconsistencies, unusual assertions, and paradoxical positions.

So, thinking caps on.

During the press briefing, RFK Jr. is the first to formally introduce the new DGAs and he comes out swinging for the fences.

[We release] the most significant reset of federal nutrition policy in history. These guidelines replace corporate-driven assumptions with common sense goals and gold-standard scientific integrity.

As the notes progress, there are additional alluring details noted, such as the promise to invest more into nutrition science through the NIH, or the assertion to coordinate with private health organizations. However, as things progress, it starts to adopt a more melodramatic tone, including RFK’s assertion that if a foreign nation wanted to cripple our economy or weaken our national security, it would do so by addicting us to ultra-processed foods.

But he goes further, stating that the federal government of the past intentionally acted to drive these changes to worsen the health of American citizens, and that corporate interests played a role as well, allowing policy to determine the science, and not the other way around.

So the tone is set for the unveiling. A total reset, based on “gold-standard” science, without the consideration of corporate interests.

Then, we see the pyramid…

Now to truly appreciate this, you need an inside joke among dietitians. It is a fact that almost every dietitian will say the following phrases at some point in the course of the week; 1) “It depends”, 2) “Nutrition is individualized”, and 3) “No, we stopped using the food pyramid back in 2010”.

We may need a new inside joke.

Speaking of which, RFK Jr. then gets back to business and outlines the rest of the dietary guidelines, and trades with commentary from others in attendance. The summary is as follows,

…eat real food.

This phrase is repeated throughout the conference (and within the DGAs), along with admonitions to consume more meat, fruits, vegetables, and whole grains.

But we then veer into unusual statements and assertions.

For example, RFK Jr. claims that these DGAs are the first to address ultra-processed foods. However, there’s a glaring detail that contradicts this statement. Nowhere within the DGAs is there any mention of ultra-processed foods. Instead, you have reference to “highly-processed foods”, and while most nutrition professionals can read between the lines, this is an interesting contradiction, likely attributable to the HHS failing to settle on an actual definition of ultra-processed foods, as they attempted over the summer of 2025.

Amidst this great reset, there are many “Tuxedo Man” claims about how the current administration is finally advising against foods made up of refined grains or added sugar. But unless RFK Jr. intends for this great reset to be for 1980, the year the first DGAs were released, he is incorrect in his assertion because even back then with the limited data available, low sugar intake was advised (see item 5).

Gone are the recommendations that offer objective metrics for assisting with intake patterns, such as keeping at least half of your grain intake from whole grains, or to restrict added sugars to no more than 10% of calories. Instead, we have statements about the priority for “fiber-rich whole grains”, or that “one meal should contain no more than 10 grams of added sugars.”

For context, 10 grams of sugar is the approximate amount you’ll find in a standard BBQ sauce, but don’t expect guidance on whether the protein content of grilled meats negates the need for that limitation.

Speaking of which, meat stands out as the definitive winner of the DGAs, with a general priority made for protein at every meal. While plant-based proteins are named within the DGAs, they seem noticeably absent within the new inverted pyramid graphic, save for two walnuts, an almond, and what appears to be a peanut. Meat, meat, meat, emphasizing these as nutrient-dense and high-quality, with no admonition regarding leanness of cuts, or fat content. At some point in the press conference, meat was mentioned so often it sounded as though an orc had prepared the secretary’s notes.

Plenty of other dietitians have also pointed out the incongruity of the new recommendation to consume full-fat dairy (high in saturated fat), promote butter and beef tallow (also high in saturated fat), but retain the recommended limit to consume less than 10% of your calories from saturated fats. Apparently, this was seen as betrayal by many of the keto/low-carb advocates, causing them to clutch at their hearts, but hopefully not due to soft plaque buildup.

In one more major reversal from previous DGAs, non-nutritive sweeteners are targeted and treated as similar to added sugars, with recommendation to avoid them. This flies in the face of data that clearly demonstrates how when replacing sugar-sweetened beverages, non-sugar sweetened beverages (such as diet sodas lead to improved health outcomes. The report stakes this claim on the basis of seven identified meta-analyses assessing non-sugar sweetened beverages and various health endpoints, stating that there was a significantly increased risk (of moderate grade certainty) for all-cause mortality, changes in BMI among children, and Alzheimer disease.

The scientific appendices cite that the evidence for their claim is weak, but since it matches the literature they read on added sugars in sodas, non-nutritive sweeteners were lumped in. This is an extremely poor read of the present literature, as researchers now know that early studies failed to control for individuals who had already been diagnosed with health conditions (heart disease, diabetes, etc.), and then started drinking non-nutritive sweeteners. Even one of the meta-analyses cited in the appendix admits as much.

It also may be worth noting that the “rigor” of scientific quality seems to fray here, with numerous errors in basic study details, such as claiming how a cited study evaluates the effects of artificial sweeteners, when in fact, that study does not actually evaluate artificial sweeteners, as noted in the screenshots below.

Finally, and perhaps strangest of all, was the decision to downgrade advice on restricting alcohol intake. The new DGAs still discourage alcohol, but removed the objective limits that were advised from the previous edition.

Dr. Oz fielded the question from the press about advisement on alcohol, and he responded with:

Well, alcohol is a social lubricant that brings people together. In the best case scenario, I don’t think you should drink alcohol, but it does allow people an excuse to bond and socialize, and there’s probably nothing healthier than having a good time with friends in a safe way.

Now to each their own, but the framing here hardly sounds negative. In fact, this rhetoric mimics talking points from alcoholic beverage lobbies. Industry messaging from these lobby organizations know they don’t have a scientific edge, so instead, they often promote their product cultural or social cues. The Beer Institute has launched entire campaigns on the sociality of beer.

The phrase “social lubricant” was even the headline of a major article in the World of Fine Wine.

Frankly, it is hard to know what to do with these DGAs. There are many contradictions. There are many ambiguities. Worst of all, there are antithetical statements and administrative actions that are decisively and totally at odds with one another.

You cannot decry corporate influence driving the decisions from previous DGAs and seek counsel from numerous individuals with potential conflicts of interest.

You cannot encourage consumption of saturated fat and tell people to restrict it to less than 10% of their calories.

You cannot create a visual graphic that minimizes grain intake and maintain the same whole grain serving amounts from previous DGAs.

You cannot encourage calorie restriction and discourage consumption of zero-calorie beverages.

You cannot claim to be the great reset and offer more limited, weaker dietary advice already provided 35 years ago.

You cannot demonize highly-processed foods and added sugars to the American public and publicly enjoy a meal that consists of highly-processed foods and sugars.

So, for any dietitians who observe these contradiction and are asking the question, “How are we supposed to use these?”, there is a simple and clear answer.

Don’t.

It’s not the bible. It’s a set of recommendations, and if those recommendations fall short or fail to meet an appropriate standard of evidence, don’t rely on them.

It is, yet again, an opportunity to show the public the capability and evidence-based care of the dietitian.

Our admonition as healthcare professionals is to follow the best available evidence, in line with good clinical judgment, adhering to the desires of the people we serve. If any organization or administration is failing to do that, than the responsibility falls upon us to carry on, ask good questions, and provide appropriate services.

The 2025 DGAs made their grand entrance, offered their rhetoric, but will retreat from the hard work of providing clear, consistent guidance. The fighting, IE, the interpretation of evidence, the navigation of contradictions, and the application of the complexity of nutrition science in the real world, still falls to you.

But don’t be discouraged. It has ever thus been.

To have more dietitians, the profession needs greater visibility, as more visibility will draw more talent. But greater visibility is easier typed than tackled…

Nothing enters this world in completed or perfect condition.

This is true of organizations, causes, cities, and even people. Each exists as an entity of tremendous potential, capable of good and worthwhile accomplishment that can only be met through elements of creation and construction. So if your goal is to build something and advance it towards a more perfect form, than all you need to do is identify the appropriate building blocks.

Picking up where we left off, what about trying to construct a cultural brand that’s recognized and respected on a national level? What are the building blocks for something like that, and more critically, what role do individual dietitians play in its development? Part one of this article outlined policy-applied, top-down measures, such as research funding, organizational cohesion, scope of practice, and tighter accreditation standards. But despite the meaningful assistance these would provide, policy measures can invoke a sense of individual futility. Policy discussions can lead those outside of the policy wheel to stop or limit personal action under the seemingly real yet inherently flawed belief that, this problem is beyond you.

Acting on such a belief would be a mistake. If you believe that enhancing the identity of dietetics is solely the responsibility of an external entity, than it will forever remain stagnated in both reach and impact. The expansion of the profession’s visibility is not enmeshed within cleverly devised policy, financial investiture, or external pressures. It will not be decided by vote, declared by monarchy, or broadcast via mandate.

It will be decided by the women and men of the profession and whether or not they lean into their humanity, develop social capital, and engage in the work of creation on a daily basis.

Among those three strategies, leaning into your humanity is perhaps the least intuitive, but a personal example can explain.

Not long ago, I was consulted for a patient recently diagnosed with kidney failure, meaning she would require hemodialysis three days a week for the foreseeable future. When I entered the room, she had a pleasant demeanor that initiated our discussion on friendly terms. Our conversation opened with her describing personal issues she was having at home, and before long, I heard a voice calling, “Sir?” on the other side of the room’s partition curtain. I ignored the first call, but a second came, more direct and pleading, so I gently held up a hand to signal a pause, and asked my patient if I could check on her roommate. She consented, and I stepped past the curtain to the other woman in the room.

“Can I help you, ma’am?” I asked.

“Can you please hand me the apple juice sitting on the white table?” she asked, a hint of annoyance in her voice. I looked around, seeing neither apple juice, nor a white table.

“Okay,” I replied. “Let me grab your nurse for you.”

“No!” the woman cried abruptly, annoyance washing over her. She waved her hand in aggravation. “Just… hand me my apple juice, it’s right there in the corner on the white table.”

I looked again and quickly set eyes on a cranberry juice container sitting on her patient tray, which was brown, for what it’s worth. “I don’t see any apple juice, but you have a cranberry juice here. Is this what you want want?”

“Yes,” she affirmed.

“Here, let me adjust your bed,” I said, elevating her headrest. She sat and moved upright as the bed adjusted, while I stole a quick glance at her board to make sure she wasn’t NPO or on fluid restriction. I peeled open the juice container, pulling the side open to be easier to drink from, and handed it to the woman.

“Anything else I can help you with?” I asked. She shook her head after pausing between slurps. All told, it was a fairly mundane encounter. An upset patient requesting juice, a dietitian who provided said juice. But when I stepped back over to my patient, she was already watching me with a faint smile on her face.

“What?” I asked, perplexed at her amusement. “You want a juice now, too?” I smirked, and we both laughed.

“It’s just,” she started, “probably six or seven people been in and outta this room the last hour, and that lady asked every one of them what she just asked you,” she said with emphasis. “But you did different,” she smirked. “You actually helped that poor woman out. That’s somethin’ special. That’s character.”

She paused, then pursed her lips and tilted her head as she rhythmically nodded some sort of tacit approval.

“I ain’t never heard of a dietitian before,” she said matter-of-factly. “But I sure know what one is now. So tell me, dear. What am I supposed to eat?”

What I draw from encounters like this is how healthcare is really just human care. Perhaps its more precise to call it the merger of your clinical knowledge and training with attempts to connect with and serve people. Humans in possession of a particular skillset, applied to other humans in need of that skill. That’s leaning into your humanity.

Unfortunately, it’s sometimes easier to treat medical problems than it is people. Medical problems are simple by comparison, and the busier you are, or the more you are berated by the ungrateful individuals, the easier it becomes to focus on the problem. My younger self was formulaic and focused on the science, more interested in the puzzle and problem of care. But my current self spends more time thinking about what I can give my patients. I can give them unhurried time (as opposed to hurried time). I can give them complete attention, even tears, as they describe their struggle with alcoholism or humiliation at their medical plight. I can give them a resilient yet compassionate target for their occasional frustrations. I can give them a chance to tell their story.

It’s not easy giving these things, but it is richly rewarding. And as an aside, it builds not only you, but your profession in the process.

And what of developing social capital?

Keeping things within the clinical setting, consider the following scenario. Most hospitals will have units or departments that set aside time for medical rounds, or length-of-stay meetings, where designated members of the care team discuss patients and the plan of care. In some hospitals, these meetings are not a mandatory requirement for dietitians to attend. If inundated with work, or not interested in attending, what is lost by not attending?

For the dietitian, nothing really. But for the care team, they lose your contribution. One could reason that if the meeting is optional, than whether or not the dietitian is present really does not make a difference. That is positively false, similar to arguing that removing fruit and vegetables from your diet really does not make a difference since the heart keeps beating. Healthcare will not collapse in on itself without a dietitian, of course, but healthcare misses a critical opportunity that only a dietitian can offer. This offering is frequently under-appreciated, and the only way to promote its value is, speaking figuratively, to show up to rounds. Be there when patient care is discussed. Ask questions. Make suggestions. Be unapologetically present with the firm and factual stance that your involvement matters in the outcomes of patient well-being.

That’s the trick with social capital. It’s development is neither sexy, nor does it require immense intuitive insight or specialization. It’s just work, and it’s not limited to the clinical realm. There are constant opportunities for promotion of health through the power of food. City initiatives, professional collaborations, community outreaches that employ a broad range of professionals and stakeholders, all of whom are potential friends and recipients of aid of the dietitian. They won’t know though, if dietitians don’t try.

For every occasion where a dietitian was proactively sought, there were probably five opportunities missed simply because nobody thought to ask.

A final thought. Everything, and I mean everything dietitians do is invested in what human beings ultimately consume. One could say that consumption is our ultimate interest and outcome.

Consumption really is important for the dietitians’ patient or clients, but creation is perhaps equally important to the name of the dietitian itself. If we really want to unlock the power of the world’s most under-valued and underutilized profession, we need to create things.

There are so many great things that dietitians are creating as they work to create lifelong healthier diets.

Research. Oh how we need more dietitians engaged in the work of research. Identifying gaps in knowledge or practice, targeted approaches to address said gaps, and amplification of their findings. Some are doing it. We need more.

Make yourself available to the up-and-coming professionals; the new generation of dietitians-to-be or those searching for the calling. Students may occasionally get sparks from their unique interests and personal histories, but flames are fanned by the example you will set.

Write, communicate, record… something. Your knowledge may be secondhand to you, but I assure you, it is a rare and previously unheard of treasure to many others out there. It does not matter the medium you select, make contributions where possible.

Perhaps most important, build relationships wherever you go. Seek out opportunities and work with professionals in medicine, psychology, exercise science, or agriculture. They may not think to ask, but you can think to offer. In can simple, or it can be large. At the present, I have a friend who is helping create the educational standards and requirements to launch the profession of dietetics in a populous Southeast Asian nation.

Take a look at what is around you, consider something that could make it better, and go create it.

Dietetics entered this world as a wonderful opportunity for humanity to expand and strengthen our connection to that most important material item on Earth, namely, the food we eat. It has advanced so far beyond those simple beginnings in 1917, but with all its advancement, there are far greater horizons still ahead.

Dietetics entered the world incomplete and full of potential, but it will steadily advance in impact, effectiveness, and reach throughout the world.

So the only question now is, what are you going to do today to help build it?

If you read this newsletter on the regular, you are likely familiar with the profession of dietetics.

If this newsletter has come across your feed, and you are not familiar with the profession of dietetics, then you honestly fit within most of mainstream America. As of October 20, 2025, there are 113,224 of us, with perhaps a few dozen more added in the past few days. Regardless, there are not many of us, so if you’re unfamiliar with our profession, you are part of a large club.

But beyond our limited visibility in the eye of the public, there’s another problem we face; an overwhelming demand of services spread amongst relatively thin ranks. There is 1 dietitian for every 3,060 Americans. On the physician side, that number is 1 per 332.

While there are plenty of competent professionals capable of offering nutrition-related services, none possess the clinical training, behavioral applications, ecological comprehension, or interdisciplinary abilities of the dietitian. We are a unique breed built to optimize human health through food and nutrition.

But there are too few of us. And there is such a need for our services, whether that’s enhancing food accessibility on a public scale, or providing individualized counseling and behavior modification.

At the moment, the United States is experiencing a cultural zeitgeist of health and nutrition, where every day more Americans gain conscious awareness of our food-related problems. Dietitians are prepared to meet this challenge, but in order to enact more of an impact, you need more dietitians.

To have more dietitians, the profession needs greater visibility, as more visibility will draw more talent. But greater visibility is easier typed than tackled. On a policy level, there are four primary approaches that would improve this situation. And yes, these all functionally mimic how physicians rose to mainstream prominence.

Number one. You tighten the profession’s entry standards by raising the requirements of education. As of 2024, dietitians could not enter practice unless they had a graduate degree. While this was a controversial maneuver by the profession’s leadership — which did not offer a significant ROI — it was probably a good move. In the early 20th century, the early American Medical Association used Abraham Flexner’s report on school standards to shut down a significant number of medical schools in the nation, specifically those which did not meet the new educational standards.

Tighter standards are simply a magnet for credibility.

Number two. Establish an exclusive scope of practice laws, IE, only dietitians are allowed to provide and charge for specified medical nutrition therapy services. Dietetics has made some headway in this, but it has a ways to go.

Number three. Branding a unified credential that is buttressed by a strong professional body. Dietitians are, for the most part, extremely “type A” individuals who are also very comfortable with independent work. Only a small percentage of dietitians are members of our professional organization. There are many reasons to why that is, but it’s a significant barrier.

Number four. As painful as this is to say, we simply do not invest the funding requisite of the professional advancement of human nutrition. It’s easy to forget that nutrition is a relatively young science, and the professional enactment and development of the sciences will always require funding, be it private or public. This is especially the case for nutrition science that carries many complexities which are atypical of other biological sciences. But challenges aside, it would absolutely be a worthwhile investment.

In the years following World War II, there was an explosion of biomedical research, specialization, and public funding in the United States. It arguably helped further cement the physician and medical services in worldwide esteem. New services were developed, new treatments made available, new enterprises launched that were all visible to the public eye and built traction behind trust in the medical field.

Today however, public investment of research of any field is increasingly limited. Even within the federal government’s grotesquely bloated $6.75 trillion dollar budget, only about 2% of that is appropriated for research — about $135 billion. Certainly not chump change by my metric, but that is split among all fields of study. You can read more about funding issues outlined in this piece from Dr. Kevin Klatt.

From a public angle, there are certainly amenable options for helping the profession of dietetics to grow and gain visibility. However, in sharing these suggestions, there is a temptation to surrender the visibility battle to a higher organizational power, or at least, to someone else.

But what about you? What efforts are possible from the solitary dietitian making rounds in their hospital, or producing content on social media? While publicly organized fronts as described above could move the public needle, it’s a petty trap to fall into thinking that all change must come from the top, or that any meaningful change must be widespread and acclaimed.

There is something that individual dietitians can do about this. There is untapped potential. There is an escape from the self-limiting acceptance of shadow and public isolation. That begins with tapping into what may be our most undervalued, under-appreciated asset.

If you’re not familiar with what that is, I suppose you’ll have to await next week’s follow-up to this discussion.

Until then.

The world is changing:
I feel it in the water,
I feel it in the earth,
and I smell it in the air.
- J.R.R. Tolkien, 1954

How is public health expected to promote life and well-being if consumed by a culture incapable of unilaterally condemning murder, or simply seeking power? Forget about funding, or competence, or policy-making in general; none of that bears any meaning if malice is permitted to continue its persistent encroachment.

Something has changed. Something, that was once collectively dismissed to the fringes has crept forward. It’s difficult to discern when and how this change occurred, but we have arrived at a cultural milestone that marks the border of barren and unforgiving territory. We do not want to be here, and the longer we stay, the more we risk.

Two weeks ago, during a morning Mass attended by students and faculty of Minneapolis’s Annunciation Catholic School, a gunman opened fire on attendees. Two young boys, named Fletcher Merkel (8) and Harper Moyski (10), were murdered. 21 others were injured.

In another incident, this one occurring the week before, a young woman named Iryna Zarutska was murdered while riding the light-rail train in Charlotte. She was a refugee from the Ukrainian war. Her assailant, without any provocation, pulled out a knife and stabbed her multiple times from behind. The attack was over in seconds, and while Iryna initially sat stunned in the aftermath, she quickly passed out as she lost blood. Despite being surrounded by witnesses, nobody stepped forward to assist her. She bled out and died from her wounds.

Then there was Wednesdays’s events; the assassination of Charlie Kirk. The 31-year-old founder of Turning Point USA was fatally shot on stage while speaking to a crowd at Utah Valley University.

I’m just so tired of seeing people hurt. So now, I speak frankly.

I cannot remember the last time I was this disgusted and sickened by a news notification. I watched the video of Kirk take the bullet in his neck, and I was off social media. But even considering my intentional avoidance of the topic, I already know what everyone is saying. Stop me when this rings familiar.

“I don’t condone political violence, but…

• a few weeks ago, someone from another political organization was killed and you didn’t care about that.

• what goes around comes around.

• I totally understand why someone would do that.

• its too bad he was opposed to gun control.

• you people only seem to care about this level of violence when its a [insert racial background of choice].

If you have uttered anything akin to these phrases, turn around, because you’ve wandered beyond the milestone marker. If you are incapable of expressing unconditional repudiation of premeditated and willful taking of innocent life, you are lost. We cannot esteem life and then casually express tacit acceptance for when it is taken. The crowd who refuses to celebrate the death, but still manages to express their disdain, is still transmitting the message that murder is permissible… as long as it’s the “right person”.

Regarding this violence, what are we to do about it? Everywhere I look, it seems as though very little is offered by way of solution. I whole-heartedly reject that there is nothing we can do about it, but consequently, I have sufficient brain power to discern that this is more than a material issue. Even if it were possible to magically remove every firearm from the planet, I would be quite unsettled in knowing that there are still people who consider murder a viable action to their problems.

In fact, I would bet that others share my fear. Maybe that’s why gun sales surge every time a maniac picks up a weapon to have his way with others. It’s simply a primal truth in how everyone is entitled to defend themselves. What you’re seeing is simply a collective declaration to one another that, “I’ll give up my gun… when you give up yours.”

Furthermore, given the abhorrent nature of this violence, why is public attention to it so intermittent? Why does a mass shooting bring a chaotic eruption of communication which gradually fades, while singular shootings occur without fanfare every week in Baltimore, D.C., Los Angeles, Chicago, or St. Louis?

If you’re not sure what I mean, I’m referring to the fact that every weekend in major cities across the United States, there are murders occuring in rates which dwarf the casualties witnessed at Annunciation Catholic School. In Baltimore alone, in 2024, the passage of two weeks (the time since the shooting at Annunciation) there were 8 murders. If those victims follow similar demographics, most of them were young men, under the age of 30.

One city. Two weeks. Why does that figure not receive the same level of coverage as the efforts of one mass shooter? Are we less outraged about these murders because we expect them to occur, because we’ve accepted that for some places in America, murder is just a part of life?

Perhaps there simply isn’t enough outrage to spare, assuming it’s actually outrage on display, and not performative bait-switching. A mad grab for attention or a means to self-promote. But that’s my fear and concern about public health today; that it’s become an institution less concerned with the protection of life and more concerned with the procurement of power.

I’ve previously argued that there is tremendous folly in attempting to solve human problems through either a deluge of material interventions, or a binary vote cast by people completely removed from the problems. But that’s exactly what we see from so many people in public health.

It’s a tempting, albeit soul-crushing perspective to believe that human beings are simply walking meat bags, or specimens in a petri-dish wherein if conditions are tailored just right (by those smart enough to do so), you can engineer them to the proper function. What a burden it must be to think that humans are nothing more than an extension of their circumstances. To the lost soul who believes such, it makes complete sense that money would be an amenable answer to most of life’s problems. I frequently hear complaints from a Congress, operating a budget of 6.5 trillion dollars, that with just a little more, they can make everything right.

“Give us the budget we need.”

“Let us have control over this.”

I wish people who talk like this would just outrightly say what they actually mean — “Give us the power, this is beyond you.”

What is a person to do in these circumstances? In this uncertainty? I don’t have anything to offer by way of policy, but here is what I plan on doing tomorrow. I’m pursuing life. I will arise early in the morning, pray to my God, and thank Him for the blessings of another day.

I will wake my children, prepare them for school, and not allow one ounce of my temporary pain to be transmitted to them. That they are entitled to their era of innocence from the brokenness of the world around them is something I will defend to my last breath. The day may bring hardship, or limitation, or challenge, or more pain, but I will meet it and choose life for my wife, my children, and my community.

I will not mistake overcast cloud cover for general darkness.

[Theoden] - The fortress is taken. It is over.

[Aragorn] - You said this fortress would never fall while your men defend it! They still defend it. They have died defending it!

…

[Theoden] - So much death. What can men do against such reckless hate?

[Aragorn] - Ride out with me. Ride out and meet them.

[Theoden] - For death and glory?

[Aragorn] - For Rohan. For your people.

(The Two Towers, 2002)

Brian Johnson is not well, and his online activity gives me serious pause to consider whether or not this whole “social media” invention was in fact, a mistake. I know that sounds a bit dramatic, but if you’ll consider some source material, perhaps you’ll understand my perspective.

If you are fortunate enough to be unfamiliar with the story and public image of Brian Johnson, here is a quick primer. Brian Johnson is the health and wellness influencer behind the personal brand labeled “The Liver King”, and presents as a bearded, over-bearing, demi-brute who built an online empire around what he calls “the ancestral lifestyle”.

None of what follows here should be construed as an invested deconstruction of Johnson’s life and teachings, nor is it an attempt to derive meaning from his motives or character. Altogether, I’ve probably devoted only two hours of my life to watching or reading his content. These are simply casual observations and comments from someone who works in the field of evidence-based health advice.

Speaking of advice, what a great place to start. Personally, I have a deep love for scientific communication; taking complex and contextually-dependent science, and repackaging it as useable and practical material for consumers. But if I was faced with either exile or fact-check Johnson’s content, I would immediately turn to my accusers and request 30 minutes to pack my things.

Decoding and communicating Johnson’s content is not a challenge of absurdity (there’s plenty of that), nor is it one of nuance (there’s very little of that). It is simply this.

Majority of the time, I don’t understand what this man is trying to say or what he believes.

He sells crap, he talks (or grunts) into a camera, and loosely connects it all to his “ancestral lifestyle.” This, claims Johnson, is a caveman-inspired way of living built on nine tenets that are: sleep, eat, shield, move, connect, cold, sun, bond, and fight. Attempting to fact check Johnson would probably be a bit like shoveling sand on the beach, into its adjacent ocean. Time-intensive and laborious for certain, but with no clear purpose. The man just talks; about himself, about his products, about his “ancestral lifestyle”, and the tenets he makes soundbites for.

What does any of that mean? Don’t know.

How is a general description of general human activities supposed to offer sage insight on the state of the human condition? Don’t know.

So why do people watch this? That’s a fairly simple answer. It’s entertaining. A short while ago I was sitting in a lobby with a few dietitian friends, and somehow, Johnson’s brand came up. At his name, one of my friends bemoaned the state of affairs that allows a person like Johnson to accrue such a following. Why, she asked, do so many people watch a person like this for information about their health? I offered that it’s not about information, it’s just spectacle.

Unintended or not, Johnson’s entire brand is entertainment. Not facts, not health, not even lifestyle. Majority of people who follow his socials do so for the same reason that people would tune in to watch MTV’s “Jackass”. Personal spectacle is fun to watch. A man cosplaying as a caveman (heavy emphasis on the word “cosplay”) who also looks like a GI Joe action figure, makes that all the more alluring.

And that allure is fortunate for Johnson, as there’s hardly a self-proclaimed alpha-male out there more starved for public attention and validation. Ironic. But it’s a fact. You don’t sit down to consume a bowl of cream and raw organ meat because you enjoy it. You do that because people will watch it with the same macabre anticipation as when Steve-O snorts a line of wasabi powder. I remember watching a video posted years ago, where Johnson was standing in a kitchen and talking about the foods he eats. Naturally (… naturally), one of these foods was a raw bull testicle. With clear reluctance etched on his, he bit into the organ, chewing with all the enthusiasm of a teenager having his license taken away. At one point, he quickly looks off camera at someone, snorts, and takes another bite. Brand manager giving orders, or on-set aides flashing thumbs-up of encouragement? You decide.

And now, we find ourselves in the era of Johnson’s rebrand. You see, in 2022, emails were leaked sharing Johnson’s correspondence which confirmed his expensive habit of using performance-enhancing drugs. That was somewhat out-of-tune with Johnson’s all-natural caveman persona. Johnson posted an apology, but it seemed a fairly short time thereafter that he again began posting content, later releasing a Netflix documentary. Regarding that documentary, high marks to the producers for attempting to spin Johnson as a contrite prodigal, but, you simply see too much of the same behavior.

However, I don’t think the rebrand is going quite so well given Johnson’s recent arrest after challenging Joe Rogan (Yes, that Joe Rogan) to a fight:

Joe Rogan, I’m calling you out. My name’s Liver King. Man to man, I’m picking a fight with you… I have no training in jiu-jitsu, you’re a black belt, you should dismantle me. But I’m picking a fight with you. Your rules, I’ll come to you, whenever you’re ready.

It’s worth pointing out that Johnson issues this challenge shirtless… he’s always shirtless, wearing a fur headdress and wielding two gold plated rifles. Understandably, Rogan called the cops when Johnson arrived in Austin, the latter being promptly arrested by police in his hotel room.

Go watch that video. Watch how Johnson acts, interacts with his family, addresses the police, demands the cameras keep rolling. I watch that and come away with one conclusion.

Brian Johnson is not well. All of this *gesturing broadly* is abnormal human behavior.

Johnson seems less a man who influences, more a man absolutely captured by the need to put his life on display, for no major end other than attention. A manufactured sense of self, propped by an artificial lodestar of purpose. It is pitiful, and I fear there is still plenty of Earth between Johnson and some big, impenetrable rock. The best thing anyone close to Johnson could do for him would be to take his phone away, delete his socials, and encourage a life hidden away from the public.

It's a poetic twist of circumstance, but if Johnson actually acted like a caveman, his life would improve dramatically.

Last week, a story was published about the Environmental Working Group (EWG) hosting a webinar that featured Andrew Zimmern, a celebrity chef well known for his television personality on the Travel Channel’s “Bizarre Foods”. I loved that show. It was my original point of immersion into the world of food and culture, setting me up for appreciation of the various eats available to mankind.

Nowadays, Zimmern has expanded far beyond the realm of kitchen’s and culinary shows. At some point, he became involved in food policy activism, aligning himself with organizations and initiatives which call for improvements to food access and the elimination of global hunger. So it came as no surprise to see Zimmern acting in his role as a team member of the EWG, offering remarks and critiques of the current food system.

Here however, is where I find myself conflicted as a dietitian and public health expert. I’m grateful for Zimmern’s engagement and interest in feeding the world, but I was greatly disappointed by the inaccuracies and mischaracterizations embedded throughout his address. He demonstrated great zeal and passion for nutritious food, but it was undermined by minimal or erroneous knowledge of public health and nutrition science. It’s a hard lesson; no amount of zeal can replace the value of factual knowledge.

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But at the very least, here is what Zimmern got right.

There is rampant chronic disease plaguing the United States. While we have improved treatments that reduce mortality, we see more cases than ever before for conditions such as heart disease, cancer, kidney disease, and diabetes. Each of these illnesses are driven by lifestyle, and that includes the food we eat, and since food is the primary driver of obesity, more people are asking questions about our food system. The fact is widespread obesity is a (relatively) new phenomenon. Starting in the 1970’s, the obesity rate, then only about 15% of the population, started to trend upward. This trend continued to present time where we now observe a rate of 41.9% of the population.

Say what you will about the limitations of body mass index as a metric; this nation has collectively gotten heavier. And this extra weight we carry is invariably connected to our dietary patterns, lifestyles, and externally constructed environments. Dietitians know this, and despite our efforts and success for treating individual cases, collectively, we’re simply not moving the needle of obesity prevalence on our own.

But back to Zimmern; once he leaves the peripheries of the chronic illness epidemic, his remarks occasionally fall into recitations of tropes and hackneyed talking points reflective of the webinar’s host. In some instances, you could argue and disagree with his perspective, while in others, he was simply incorrect.

For example, he argued that the current Dietary Guidelines for American’s (DGA’s) reflect profit motives. It is for this reason, according to Zimmern, that the guidelines have always downplayed the role of sugar, salt, and ultra-processed foods.

So herein we have three claims…

1. The DGAs are profit-driven

2. The DGAs are not concerned with sugar, or salt, or ultra-processed foods

3. The DGAs do not improve health outcomes

To that first point, I’m certain Mr. Zimmern has absolutely no idea from where or how the DGAs are written. So here is a quick recap.

Every five years, the USDA and the DHHS call for an independently selected and appointed panel of experts, the Dietary Guidelines Advisory Committee (DGAC). These people are vetted for their qualifications, experience, and any potential conflicts of interest. The committee reviews the latest nutrition science, public health data, and comments from the public to make evidence-based recommendations, filing a large report submitted to the USDA and HHS who publish the official findings in consideration of federal priorities and feasibility.

I invite anyone to identify where and how a member of the DGAC is compromised in this process, shoehorning in their brand or food of choice. And please, spare yourself the embarrassment of pointing out how some of these highly trained nutrition scientists previously worked with brands or commodities. If you are surprised that companies will seek the guidance of scientists for improving their products or messaging, who would you rather they turn to?

As for that second point, about the DGAs not concerning themselves with sugar, salt, or ultra-processed foods, please turn your eyes to the screenshot below:

What you see are the original DGAs, first published in 1980. I know it’s hard to discern amidst the miasma of text, but if you look carefully, you can readily make out explicit advice to avoid large quantities of salt and sugar. Why weren’t ultra-processed foods included on this list, you ask? Well that’s probably because the term “ultra-processed foods” was not popularized until the development of the NOVA food classification system, in 2009.

As to the third, tacit claim about the DGAs and their effects on health, the data simply doesn’t agree with Zimmern. When you adhere to the DGAs, you are less likely to die. From everything. That’s what the research shows us.

Honestly though, if misinterpretation of the DGAs were the worst of it, I don’t think this piece would be worth writing. After all, he’s a chef, not a nutrition scientist, and you can easily forgive him for mistaking the two. While there is much more he covers in his webinar, I feel compelled to respond to two particular items.

First, where he states…

I think the last thing I would add is that corporate capture of our dietary guidelines is not some abstract policy concern. It’s the reason the public gets nutrition advice written with a food lobbyist pen. It couldn’t be more obviously wrong. So, until we firewall government agencies from industry money, we’re not going to be getting dietary guidance [italics added]

That is a bold assertion, and I hope he does not take personal the fact that I do not take him seriously on this matter. I can’t. You simply cannot tell me that you are in complete opposition to corporate lobbying, while you are delivering a webinar on behalf of an organization that does an awful lot of corporate lobbying.

For those uninitiated, please see the EWG’s subsidiary organization, the EWG Action Fund, a 501(c)(4) organization.

But perhaps this is justified under the adage of “It’s only bad if someone else does it!”. Perhaps Zimmern considers himself or his webinar host, the EWG, to be moral arbiters of food activism, and thereby entitled to participate in corporate lobbying.

Well, again, I would disagree. More than that, I would say that for the sake of humanity, we would all be better off if the EWG were to shrivel into a compacted mass, fall into a flooded gutter, ride the current until falling in between the metal slats of a storm drain, where it would then be carried into the city’s drainage system and forever lost to mankind.

I have rewritten that previous paragraph several times now, and that is the kindest way I can phrase my sentiments about the EWG.

The absolute gall of an organization that lies directly to consumers, right on their webpage. Dear ladies and gentlemen, organic crops also use synthetic pesticides. Buying more expensive organic produce does not change that fact.

Regarding the use of pesticides, or other agrochemicals, I could go on about the rigorous testing, the evaluations for safety, the complexity of approving their commercial use, the required residue limits, and so on, but instead I’ll opt for a slightly more emotive, yet factual statement.

If organic agriculture became the law of the land, or pesticides and other agrochemicals were set to limited terms of which the EWG approves, there would be a famine in this country. If you desire a robust food system that feeds hundreds of millions of people, you need pesticides, and fungicides, and agrochemicals. If you think otherwise, ask Sri Lanka how their experiment of going organic fared.

And there is one last thing I would say to Andrew Zimmern should he ever take interest. Please avoid denigrating yourself and millions of American’s by adopting one of RFK Jr.’s favorite phrases from his days as an environmental lawyer. The phrase of “industrial agriculture”, also sometimes referred to as “factory farming”.

In short, leave farmers alone.

My role as a dietitian, and Zimmern’s role as a chef, are bound by the common tie of being luxury professions whose existence depends upon the modern food system. I would not have patients to counsel, policies to encourage, science to conduct, were it not for a robust food supply. Zimmern’s culinary skills and outright advocacy for expanded access would not exist were it not for so much food being produced in the first place.

We owe a great debt of gratitude to those men and women, far better than simply reducing them to corporate schlubs. Our efforts would be feckless exercises were it not for this less than 2% of the nation that feeds everyone else.

Lastly, I have an invitation to anyone that carries the zeal and passion of Zimmern but lacks the technical know-how and scientific basis.

Just ask us. We’re ready to talk. In fact, we love to talk about it. Food, food policy, health, good dietary behaviors, improved food access; there’s a good group of us out there, and we’ve been talking about this stuff for a long time.

We also know better than most how zeal does not translate into authority, or accuracy, or effectiveness. And of course, I’m certain there are items we can learn from you, whatever your course or current training.

Bring your passion, bring your skill, bring your experience, but above all, bring your determination to find how zeal and evidence can work together to make sure we build a food system that nourishes us all.

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The human soul is a precious, complex creature. Consider the internal drive, judgment, assessment, and executive function, all of which operate within a lifetime of accrued experience. That can make for some unexpected outcomes.

But whatever the outcome, human complexity scales up dramatically as you add more and more people to the mix. In public health, it is this complexity that drives a multi-pronged problem which, although exacerbated by recent events, actually began many years ago. If you’re unfamiliar with this problem, you’ll be properly introduced once you’re acquainted with Nic’s story. Nic is a redacted name, but the story is very real.

Nic was born and raised in Southern California, where he currently resides with his wife and youngest son. His two older sons are adults, out in the world and serving new communities, guided under the values and principles of the home in which they were raised. Nic and his wife are upstanding individuals who raised their sons in love, warmth, and support. The home they figuratively built was grounded upon the values of their faith, where each boy grew to manhood esteeming honor, work ethic, kindness, and growth.

This humble family, in their seemingly ordinary life, takes a turn into the extraordinary when you consider how Nic’s home of today is an inverse reflection of his own childhood, which was devoid of the very love Nic now gives his own children. Nic’s father was an alcoholic, and rarely present at home or in company. His mother was equally disconnected, content with the meager living that life afforded. Abuse was normative. Meals often consisted of materials purchased at a gas station. One bright spot of hope in this situation was an adult relative who, as Nic describes him, was the father Nic needed. He set boundaries, punished poor behavior, maintained standards of conduct, and connected Nic to an alternative community that afforded new opportunities for meaningful relationships. In this setting, Nic saw the potential for a better life, despite his destitution. It was here that Nic met his future wife, a woman raised in the very sort of home that Nic would one day create.

Poverty. Addiction. Violence. Food insecurity. All of these exist within the realm of public health’s purview, each a social ill that shortens life and deteriorates standards of living. Yet somehow, here is a man who experienced it all, yet was moored by relationships, an alternative community, hope, and progression through personal discipline. Nic created beauty out of pain.

Now. Here is the problem.

How do you solve Nic’s problem with a yes-or-no vote, cast in a chamber housed many miles away, by hundreds of strangers who have never met him?

This is the crux of public health’s present dilemma: An empirically grounded, yet altogether incoherent argument that you can resolve human complexity with a binary vote.

It’s Always Political

“I just don’t like it when it gets political” is a refrain on public health, that public health officials have heard more than once over the years. Setting aside any introspection of that statement, there is a simple and appropriate response as to why public health is always political.

The three core functions of public health include:

1. Assessment of a population’s health

2. Policy development to improve the population’s health

3. Assurance of competent, consistent health services to the public

It is that 2nd core function which affirms the political necessity of public health’s nature. Policy is a function of the legislature. The legislature is a branch of the federal government. The business of the government is to operate within its prescribed powers to manage public affairs, and maintain public good and stability.

Stated more succinctly, the business of government is politics. So before going any further in the problem of public health, we should first justify the necessity and relevance of policy development for the health of human beings.

Individual agency is a gift which operates in the milieu of environment, circumstance, and opportunity. People choose, and choices are affected by our environment. This is an inarguable position. If I surround an individual with apples, intermixed with one or two bags of chips, that individual is overwhelmingly more likely to eat more apples than a person existing in the opposite scenario; surrounded by chips with a few apples here and there. Nudge theory, choice architecture, and human psychology can offer relevant predictions for how people will behave given certain circumstances.

But all predictions aside, how do you explain someone like Nic? Everything we know about public health predicts that Nic should have followed in his father’s footsteps. He is a statistical outlier, to be clear, so if we corrected the poverty, addiction, crime, and food insecurity, would we get more outcomes like his? Simple logic suggests that yes, we would. So there’s the rub. How do you correct these systemic social ills? What is the solution?

The Price of Engineering Humanity

It’s difficult to discern a precise number, but there is good evidence to suggest that appropriations bills — the allocation of federal funds — make up a sizable portion of congressional votes. Investing in public infrastructure, social welfare programs, defense, education, research and so forth all arguably provide for the maintenance and improvement of civilization.

Recently, the 119th Congress passed H.R.1, more informally referred to as “The One Big Beautiful Bill Act”. This is not the place to dissect the bill, but simply stated, it grants Congress permission to spend money in some areas, and cut spending in others. The cuts represent reversals on the goals of previous administrations, and the new expenditures bolster controversial topics. It has ever been thus. Congresses come and go, and spend money in ways which follow the cultural stream.

But at the end of the day, money is spent. Lots of it. The federal budget for fiscal year 2024 was 6.75 trillion… with a ‘t’… dollars. The scale of that amount defies most human imaginations. For instance, if you were written a check for a million dollars, what would you buy? What could you buy?

Now imagine you have $10 million to spend. What then?

Now you have $100 million. If you spent $100 million every day, it would take you a little more than 27 years to spend $1 trillion dollars.

If we presume that human health outcomes merely require paying the proper fiscal amount, however that manifests, what does that figure look like? How much exactly do we need to pay before we start seeing the desired outcomes?

At the very least, we know the answer is not $36.6 trillion, the current debt of the United States as of today.

Before anyone argues, “We’ve not been spending money on the right measures,” it’s worth asking if you know where the United States spends, and historically has spent most of its budget. The top four expenses of the federal government are

1. Social security - 21%

2. Medicare - 14%

3. Interest (on our growing national debt) - 14%

4. Health - 13%

We are spending 48% of our budget on items that directly related to public health. So one more time, the question.

How much money do we need to spend before we start to see improvement in this arena?

The Policy of Engineering Humanity

The issue is not merely the money, as Congress is also involved in regulation of industry, passage of new laws, and development of departmental policy which trickles down and influences citizenry.

But back to Nic. What law, or series of laws, would Congress need to pass that would have prevented the circumstances of his childhood? The question is intentionally designed to think about the circumstance of Nic’s life. Whereas most public health officials would see his problem as an issue of poverty, that is not what initiated his father’s alcoholism, nor his mother’s laissez-faire approach to life and family.

Had someone stepped in, showed up to Nic’s childhood door with a suitcase full of $100,000 in cash as a gift, or declared alcoholism to be illegal… it does not take much imagination to reasons that these offerings would have been useless gestures at best, and gasoline on a fire at worst.

But we need laws, and policies, and improvements to social systems that increase the likelihood of bad things happening. It’s horrible to consider, but if murder were not illegal, there would be more murders. If there were no speed limits, there would be more motor vehicle accidents. If drugs and alcohol are more rampant, addiction will increase.

But the alternative perspective to this is a chilling prospect.

There are people who choose not to murder, simply because it would get them in trouble. I’d much rather live with people who don’t need a consequence to never consider murder.

There are people who choose not speed, because they don’t want to lose money or driving privileges. I’d much rather live among people who impose restrictions upon themselves, for fear of how it would potentially harm others.

The perspective that you personally adopt — the internal locus of drive, or the external locus of force — probably rests with whether or not you believe you can engineer people to always make the right choice.

What a prospect. Here, then, are a few a concluding points.

The heart of public health may reside in our public systems, but the soul of health forever resides in people.

Nic’s story reminds us that lives are not shaped solely by funding formulas or statutes. They are shaped in kitchens, in churches, in gyms and classrooms and recovery centers, driven constantly by the choice of human beings to invest in themselves and other human beings. And yet, we cannot abandon systems because they are a natural part of the cultures we create, a method to scale our lives in a way that helps the exceptional become more common.

Public health, then, should not be viewed as the science of “fixing” people. Exaggerated faith in a binary vote’s ability to rectify all that is unfair about life is a doomed prospect. Rather, it is the art of building environments where bad behavior can become good, and good behavior can become better. It requires the promotion of qualities and beliefs that have no fixed cost, including purpose, character, and sacrifice. It requires a more involved citizenry, perhaps even more so than those who are elected to write and pass laws.

That is the tension. That is the cost. That is the task, complex as it may seem.

But considering the value of the human soul, it is worth it.

Welcome to the Public Health Blast Out, an end-of-the-month compilation of recent research, trends in public health, messages for men and women, meal prep ideas, and much more!

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Hello Friends,

Greetings to each of you. Just popping in with a quick note here. You may notice that this month’s blastout newsletter is a little… sparse. Well, it’s been a rather busy month as I find myself adjusting to a very different schedule. Simply said, with all of the other projects I’m working on it’s difficult to set aside time to fill up this blastout page, compared to working on my regular newsletter pieces.

That said, I plan to continue this 3rd newsletter each month, but something will change about the format and offered content. I’ve been teasing around with a few ideas, but, if there is something you’d like to see, or something that would be of value to you, I’m open to suggestions.

Anyways, please have a happy upcoming 4th of July. May you make it through the holiday, along with each of your fingers on both hands.

Dustin (AKA, Public Health Dad)

It’s time to consider the lilies. Or in this case, flowers in general.

It’s been a short while since an agriculture-related topic was discussed in this newsletter, so a chance encounter with the following LinkedIn post offered an intriguing opportunity to evaluate a specified research question. Here’s the question, solicited by the post’s author:

Can rows of wildflowers really replace pesticides? Turns out, yes.

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Public Health Dad is a newsletter dedicated to scientific communication, public health discussions, and broadcasting ideas about how people can live a good and healthy life. Sometimes these topics are complex, winding, and difficult to condense. But other times, like today, the topics trend on the simple side.

Today’s topic actually revolves around the definition of a single word.

That word is “poison”.

In the current health zeitgeist of the United States, the word poison is thrown around rather flippantly, being used and applied in ways it was never meant to be used. Case in point: Rob Schneider accused the Kelce brothers of “endorsing poison for our nation’s children!!”

Schneider’s whole post and tone were alarmist, filled with uppercase letters and exclamation marks, which I interpret as sincerity. And to be honest, were he referencing some new children’s product — Cyanide Snaps, Hemlock Gummies, Mercury Mints — I would be the first person to stand in defense of our children.

But Schneider was not referring to any of these imaginary items (at least I hope they’re imaginary…). He was referring to common breakfast cereals; Reese’s Puffs, Lucky Charms, Cinnamon Toast Crunch. The Kelce brothers partnered with General Mills to create a unique cereal blend that included their childhood favorites, and promoted the mix through their “Cereal Training Camp” marketing campaign.

Frankly, I expected public outrage over the noticeable absence of Taylor Swift from the campaign. Instead, we saw accusations lobbed against the Kelce brothers, with Calley Means, a current senior advisor to DHHS and former food lobbyist, declaring that the brothers were “sponsoring food that destroys kids' metabolic health.”

Unpack that for a moment.

A former food lobbyist with no medical training or scientific education accusing the Kelce brothers, Superbowl champions who grew up eating breakfast cereals, of harming children’s health.

Means is not alone in his accusations, as this cult of anti-sugar has numerous acolytes who promote similar messages on all sorts of media. These individuals come from all walks of life; wellness influencers, fitness trainers, suburban moms, suburban dads, actors, and everyone in between. Induction into this special club requires neither training nor critical thought. It simply requires adoption of a singular mantra.

“Sugar is poison”.

Wherever sugar rears its head, be that soda, ice cream, fruit, or cookies, the mantra is chanted.

For the sake of simplicity, sanity, and a few good laughs, here is a point-by-point breakdown of why this is a nonsense phrase. Simple logic, a little data, and a few reasonable questions.

Let us begin.

1) The Basics of Poison

There is no standalone definition of the term “poison” that is universally adopted by all organizations. Instead, they operate under the principles of toxicology which identify a poison as “any substance that can cause harm to the body.”

So here is lesson number one: “poison” is a dynamic term that depends on the dose, the circumstance, and the subject.

Three simple examples can demonstrate this.

Water is essential to life, but if you consume too much within a short time, it causes water intoxication and can kill a human being. That’s a DOSE problem.

Snake venom is cytotoxic and can kill a human being if injected into the bloodstream, but is harmless if swallowed. That’s an issue of CIRCUMSTANCE.

Theobromine is a compound found in chocolate, harmless to humans, but lethal if ingested by dogs. That’s a matter of the SUBJECT.

2) The Basics of Sugar

Let’s talk about the single-unit simple sugars, also called monosaccharides, also called the basic chemical units of carbohydrates.

Monosaccharides are 6-carbon units, typically made up of the chemical formula C₆H₁₂O₆. There are only three that human beings consume and metabolize. Glucose, Fructose, and galactose, and that foremost glucose is king among these within the human body.

Why is glucose the king? Three simple reasons.

1. There is a biochemical pathway embedded into every human being called gluconeogenesis. This pathway produces some glucose for survival when there are insufficient levels detected.

2. Glucose is the primary source of energy for the cells of the human body.

3. All other monosaccharides can be metabolically converted into glucose inside the human body. Hail to the king.

Sugar, the common name for the disaccharide sucrose, is the product of a glucose and fructose molecule bonded together. Most the sucrose consumed in the United States is produced from two crops; sugarcane and sugar beets. Together, high fructose corn syrup (a blend of fructose and glucose) and sucrose are the two most commonly consumed added sugars in the United States.

All sugars used for food are digested down to their monosaccharide form and absorbed into the bloodstream. Galactose and some fructose is converted into glucose, and these simple sugars are picked up by cellular GLUT transporters which carry them into the cells.

3) The Basics of Comparisons

A little while back I heard a clip from an episode of Mike Rowe’s podcast where he hosted Vinnie Tortorich, a self-proclaimed fitness and nutrition expert. You can see the full episode here, but the piece I heard was an exchange where Rowe went back and forth with Tortorich as follows:

What’s killed more people? Alcohol or sugar? [Rowe]
Sugar. [Tortorich]

Fentanyl or sugar? [Rowe]
Sugar. [Tortorich]

Heroin or sugar? [Rowe]
Sugar. [Tortorich]

Cocaine or sugar? [Rowe]
Sugar. [Tortorich]

That is a remarkable claim. Tortorich, as far as I can perceive, is serious in his assertions.

Here is my counter-claim: Sugar, when ingested, has never killed anyone. Ever.

We can compare my claim with Tortorich’s by making practical contrasts between each product mentioned and a sugary beverage. To accomplish this, we’ll use the now discontinued 24-ounce Unicorn Frappuccino from Starbucks, which boasted an astounding 76 grams of sugar, more than twice the daily recommended limit.

Alcohol is a neuro-depressant which slows communication between neurons, impairs judgment, coordination, and memory, and alters mood and behavior. Every year, 178,000 people die from excessive alcohol use, usually from a motor vehicle crash or alcohol poisoning.

How many people do you think ever crashed their vehicle or lethally impaired their brain activity after consuming a Unicorn Frappuccino?

My reasonable guess is, zero.

Fentanyl is a synthetic opioid, where 1 gram is capable of killing up to 500 people within one hour of ingestion by shutting down their respiratory system.

How many people do you think ever stopped breathing after consuming a Unicorn Frappuccino?

My guess is, again, zero.

Heroin works similar to fentanyl, is highly addictive, and attributed to 9,200 overdose deaths each year. Again, I don’t think Unicorn Frappuccinos have ever done that.

Last but not least, cocaine. Cocaine is a stimulant derived from the coca plant, and despite limited medical uses, is highly addictive and can trigger heart attacks. It kills 24,000 people each year.

Broken record over here, but I don’t think Unicorn Frappuccinos can do this.

The irony to this is how it’s not even the most nonsensical thing Tortorich has claimed. That anti-sugar cult honor of distinction goes to this declaration:

Millions and millions have died at the hands of the sugar industry. Industry knows what it is doing yet continues to do it… A mass murderer, driven by the big exec’s want for economic gain.

…

Right now, at this very moment, there are doomsday preppers who have stockpiled 15 years worth of freeze-dried beef, taught their children Morse code, and recycle their own urine, all in anticipation of a climactic end to humanity, and if presented with this statement they would respond by saying, “Okay… that’s a bit dramatic.”

4) The Basics of Exposure

Let me offer a steelman of the position that sugar can be a poison. It would go something like this.

Excessive added sugar consumption contributes to excess energy, which contributes to obesity, a major driver of chronic diseases like type 2 diabetes, heart disease, and fatty liver, conditions that all together cause millions of preventable deaths worldwide each year.

The problem of added sugar intake is one of association, not direct causation. Sugar is not poison because in an acute setting, all it does is elevate blood sugar. Nobody has ever been killed by consuming too much sugar on one occasion, but the same cannot be said of alcohol, fentanyl, cocaine, or heroin.

The worst thing you can attribute to sugar intake is how persistent and excess doses represent a long-term lifestyle risk factor.

For example, there is strong evidence in support of how high sugar intake, most commonly from sugar-sweetened beverages, is associated with an increased risk of developing type 2 diabetes. Despite this, the relationship is complex, because a large amount of that risk is attributed to excess calorie consumption and weight gain, NOT from any unique effect of the sugar itself.

Furthermore, evidence suggests that excessive added sugar intake serves as a proxy indicator for an unhealthy lifestyle. It’s not simply the added sugar, but a host of other lifestyle behaviors — smoking, poor sleep habits, unmanaged stress, low physical activity — that help contribute to the risk of mortality.

Consider it this way. Who is more likely to die from drowning? An adult who spends every day indoors, or an adult who likes to go to the beach? The beach-goer, of course.

Similar scenario. Who is more likely to die from drowning? An adult who goes to the beach once a year, or an adult who goes to the beach 6 times a month? The one who goes more often, because they are exposed to the possibility of drowning more. Does this mean the beach is “poison” to the frequent beach-goer? No. It’s simply a matter of exposure and association.

As a thought to close this out, here is one more question. Do members of this anti-sugar cult actually believe what they say, that sugar is a poison, a weapon of mass destruction?

If not, why say it? Personally, I would venture two suggestions. First, it’s a rhetorical tool, a use of emotionally charged language meant to assert authority and eliminate discourse. After all, who can argue against the claim that we don’t want our children poisoned? Second, it’s a sale pitch to promote the presumed virtue and scientific authority of the speaker. Human beings often associate virtue with absence or elimination of a practice, so sugar serves as a sweetly self-righteous declaration.

If you’ve made it this far, you now possess more toxicological literacy than half of social media. The anti-sugar cult may decry “metabolic destruction”, but reality steps in with something far less cinematic: sugar is energy.

So go forth, choose your battles wisely, and remember, not every sweet thing is a threat to civilization. Sometimes, it’s just a cookie.

Welcome to the Public Health Blast Out, an end-of-the-month compilation of recent research, trends in public health, messages for men and women, meal prep ideas, and much more!

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If there were a singular universal quality shared among all good parents, it would probably be the desire to see their children succeed. We raise our children in circles of love, instruction, and protection, yearning for a future in which each one can make their own way, overcome their own challenges, and build their own families in joy.

Of course, this desire for success can sometimes take a more focused and archetypal form, like the father who dreams of his children growing up to become professional athletes. This long-standing tradition has many cultural manifestations, but one of my favorites is a story meant more as a joke:

A father signs his kid up to participate in every sport possible, from the beginning to the end of the school year. Whether its football in fall, baseball in the spring, golf in summer, and karate in between, the child’s life revolves around a sport. “You never know which one he’ll go pro in,” chimes the dad. But by high school, the child has become a prodigy—not in athletics, but in productivity. His insight becomes the topic of TED Talks and consultant meetings. Everyone wants to hear from the kid who mastered the concept of “time management under duress.”

It may not be true, but it’s a funny story, and I thought of it when a friend asked me about a supplement I’d never heard of. The seller of this supplement was the company TruHeight, and its products are uniquely focused on youth. Specifically, the supplements they promote are labeled as “growth capsules” and their proprietary “growth protein shake”. All of this was fairly run-of-the-mill for supplements, except for some fairly bold and assertive claims about the product’s ability to promote and accelerate growth in children. Then, I saw that their product had been the subject of a peer-reviewed, randomized clinical trial that allegedly supported these claims.

According to the website

In our study, children who took TruHeight® experienced a remarkable 43.91% higher level of Collagen X. Collagen X is more than just a marker; it plays a central role in the growth process, reflecting real-time bone growth rates.

First, I will say that it is commendable anytime an organization subjects their specially-formulated products to peer-reviewed clinical research. That does not mean the product is automatically validated, but it does merit an investigation into the research.

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Years ago, while living with my parents and attending a local community college, I was hired and began working for a business I referred to as “the machine shop”. In reality, it was an aerospace parts factory. It housed industrial-grade milling machines, programmed to craft specially designed metal bolts and slips which were then sold to companies that would use them to build planes and jets.

Complex and technical as it sounds, my job was simple grunt work. The machines did all the heavy-lifting. For guys working the floor, our job included replacing chipped cutting instruments, washing oil off prepared parts, removing burrs from threaded screws, and taking measurements to make sure the parts were in spec. As a young man, it was a pretty sweet gig; most coworkers were friends, the pay was exceptionally good, and every day we ate either Chinese food or Subway.

At some point, demand for operations reached a fever pitch, so the owners decided to hire a floor supervisor to buttress operations. I was uninterested, but several of my friends vied for the role. The person they selected was Jason* (*not his real name). To all of us, Jason seemed like a reasonable choice. He was a smooth talker, experienced with different jobs on the factory floor, and was well regarded by most everyone at the shop.

However, that all seemed to change shortly after his promotion. Jason, to our befuddlement, was fairly inept in his role as floor supervisor. He would fumble important tasks, workflow became more complicated, and anytime something went wrong he was consistently, oddly, never responsible. At least, that’s what he told us.

Jason went from being capable, to incompetent, and a bit of a jerk when confronted with his ineptitude. What happened? Well, to provide a simple answer, Jason was promoted past his level of competence, displaying a classic example of the “Peter Principle” in action.

The Peter Principle was a term coined by Canadian psychologist Dr. Laurence Peter who in 1969, wrote and published a book called The Peter Principle: why things always go wrong. Removed from the banal managerial texts of the time, the work was a piece of satire that explored dysfunctions within organizational hierarchies, especially when it came to leadership.

In his book, he explains how people are easily promoted based on performance in a current role, rather than on abilities that are required or relevant to a new role. If not moored in principled hiring practices, incompetence may be advanced just as quickly as a career. A once capable person quickly becomes incapable, because the skills required for success in one role will not by necessity grant success in the new role. The new role may require different and more complex skills, and once confronted with a new challenge, the mismatch becomes apparent.

Now that we’re all familiar with the Peter Principle and its effort to explain the promotion of incompetence, we can turn our sights to the latest relevant case study found in one Casey Means, nominated to the role of Surgeon General.

The Call to Arms

Last week, Google search engines saw a sharp uptick in the phrases, “Who is Casey Means” and “What does the Surgeon General do?”, the trigger point for these online search phrases being Trump’s nomination of Casey Means for the office of the Surgeon General.

At the time of her appointment, Trump himself admitted to never having met Means, and that he relied entirely on the advice of his Health and Human Services Secretary, Robert F. Kennedy Jr. (RFK Jr):

“Bobby really thought she was great. I don’t know her… I listened to the recommendation of Bobby. I met her yesterday and once before. She’s a very outstanding person. A great academic, actually. So I think she’ll be great.”

Many healthcare individuals, both those who are inside and outside of President Trump’s favorable social circle, were critical of nomination. To get a brief glimpse of Means, here is a condensed timeline of her career:

2009-2014 - Means earned her medical degree from Stanford University.

2014-2018 - Means begins residency in Otolaryngology Head and Neck Surgery at Oregon Health & Science University, but leaves six months before completion due to what she described as “disillusionment with the healthcare system”.

2019 - A big year for Means. She sets up a functional medicine practice in Portland Oregon, and months later, co-founds Levels, a health technology company aimed at providing continuous glucose monitoring to people without diabetes. This same year, her medical license shifts to inactive status.

2024 - She co-authors the book "Good Energy: The Surprising Connection Between Metabolism and Limitless Health" with her brother, Calley Means.

My first introduction to the Means siblings was the senate roundtable hearing back in September of 2024. At the time, I don’t recall being impressed by what Means presented, though you could certainly argue she was passionate on the subject of chronic illness.

Passions aside, Means is utterly inept for the role she was offered. The office of the Surgeon General may not offer much in terms of legislative power, but it is a highly influential position.

The Nation’s Doctor

The Surgeon General is colloquially referred to as “the nation’s doctor”, so right off the bat, Means dispossession of an active medical license comes across as a federal faux pas. While being a medical doctor is not a necessity, the office has typically been filled by people with extensive experience in the healthcare field. In reverse chronological order, the role has seen a nurse officer, a physician and founder of Doctors for America, a nurse practitioner, an anesthesiologist and vice admiral, a nurse officer and rear admiral, and a physician with dual residency in family medicine and dermatology.

Means, for all intents and purposes, is an entrepreneurial wellness influencer.

Surgeon Generals are spokespersons. Nobody actually knows what they do, but everyone has heard of the role. The Surgeon General advises the government and the public on urgent health issues and shares evidence-based information to help people live healthier lives. They are vocal on everything that affects health, from chronic disease prevention, to mental health, to pandemics, to vaccinations.

They are also in charge of the U.S. Public Health Service Commissioned Corps, a team of about 6,000 public health professionals. This is the president’s personal medical army, deployed during natural disasters, disease outbreaks, and other emergencies to support community health efforts across the country.

You don’t know the Surgeon General, but you have probably heard their work.

In 1964, Dr. Terry released the first official report linking smoking to cancer and heart disease, which led to the use of cigarette warning labels.

In 1986, during the height of the AIDS crisis, Dr. Koop sent a public information pamphlet on HIV/AIDS to every American household, something that had never previously been done.

In 2016, Dr. Murthy published a massive report on addiction which attempted to frame the nature of addiction outside of moral failure. He’s the same man who in 2023 discussed effects of social media on youth, calling for better protections and more research.

The office does not write law, but it is significant. You want someone who is a good communicator, but, that communication needs to be evidence-based.

Unfit for Office

Consider the following from Casey Mean’s book, Good Energy:

There is a better way, and it starts with understanding that the biggest lie in health care is that the root cause of why we’re getting sicker, heavier, more depressed, and more infertile is complicated. (Means, 2024, IX) [Italics added]

More on that comment about “the biggest lie” in a minute. She also wrote:

Depression, anxiety, acne, infertility, insomnia, heart disease, erectile dysfunction, type 2 diabetes, Alzheimer’s disease, cancer, and most other conditions that torture and shorten our lives are actually rooted in the same thing. And the ability to prevent and reverse these conditions — and feel incredible today — is under your control and simpler than you think. (Means, 2024, IX)

You could cover a circus tent with the red flag required when any medical professional attributes all human suffering to one thing. I cannot for the life of me understand how anyone earns a medical degree and carries on with a perception that the human body is that simplistic.

Worse than this however, is the practice of morally condemning the entire medical profession; decrees of personal escapes in order to “tell the truth”. RFK Jr. seems completely on board with this sentiment, as he publicly expressed:

The attacks that Casey is unqualified because she left the medical system completely miss the point of what we are trying to accomplish with MAHA. Casey is the perfect choice for Surgeon General precisely because she left the traditional medical system—not in spite of it.

Said another way, Means and RFK Jr. do not claim experience and practice as their professional qualifiers. Rather, they rely on a self-asserted quasi-virtue. Unfortunately, this self-proclaimed virtue is grey, fuzzy in its distinction, and relies entirely on collective dismissal and condemnation.

In other words, it’s not virtue. It is immoral, useless pablum whose only achievement is grandstanding the official from which it originates.

But here’s the rub. Means is clearly an intelligent woman. She is clearly a good communicator. She has the ability to foster sentiments that somehow sound both independent and obsequious. She knows enough about human physiology to sound educated and experienced. She is resourceful, capable of launching a successful business brand. She’s also a talented story-teller.

According to Means, she left medicine when she perceived the healthcare system to be broken and exploitative.

According to her former residency chair, Dr. Paul Flint, who offered Means a three month leave of absence during her residency, it was stress and burnout:

She was under so much stress… She did that [took the leave of absence], came back and decided she wanted to leave the program. She did not like that level of stress.

If that is the case, Means managed to successfully reinvent her residency dropout, as it has now put her front and center for a big promotion. But as we learn from Dr. Laurence Peter, your ability to excel with a specified skillset will not necessarily afford you success in another arena.

A final word on this, and the Peter Principle. For all its pervasiveness, incompetence in hiring is not an inevitability. Rather, it highlights the need for skills-based promotion. As people are naturally promoted it should be fueled by a track record of success, and supported through a system of mentorship, professional development, and performance evaluation.

Following the logic of the Peter Principle, you can quickly see how any organization can quickly become top-heavy with incompetence over time. I still remember a quote from undergraduate that stated, “Mediocrity knows nothing beyond itself, but talent instantly recognizes genius.” Incompetent people, who do not perceive their incompetence, will surround themselves with like-minded incompetents.

A fellow dietitian on LinkedIn noted this irony behind Mean’s nomination:

The irony of this administration saying they are doing away with DEI and going based on merit, when not a single person has the merit for the position they hold.

Hiring and rewarding incompetence did not start with the current administration, but at present, it is leading towards ill-advised destinations. Casey Means seems charismatic, a good communicator, and quite convicted in her positions.

Even assuming best intentions, that is not good enough. Our nation needs, desperately, competence in practice.

Welcome to the Public Health Blast Out, an end-of-the-month compilation of recent research, trends in public health, messages for men and women, meal prep ideas, and much more!

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The Fireside Topics

• 100 men versus 1 gorilla. Men… what are you really trying to tell us?

• The low-carb high-fat zealotry continues to undermine itself

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Articles in the news hardly ever seem to get it right when it comes to reporting nutrition research studies. It seems outlets most often select research that is receiving a lot of fanfare, presenting with some shock value, or reporting conclusions that run contrary to conventional scientific wisdom. I remember reading a case study in college, where the story headline reported, “Garlic Likely Does Not Promote Better Health.” For the 98% of the world’s population that enjoys garlic, that was a rather disappointing headline, but, a simple analysis of the study on which the story was based revealed that the selected title was a dramatic oversimplification. In brief, the study was a randomized controlled trial evaluating how blood pressure was affected by one of two treatments — the one group consuming lots of garlic for four weeks, while the control group was given… an ACE inhibitor (AKA, blood pressure medication). Not exactly reasonable comparisons, if you think about it.

I suppose the world of fast-paced, high-strung, and high-demand news can hardly spare the time required for a critical analysis that would reveal the more common study limitations; no comparison group, limited generalizability, poor interpretation of data, or conclusions drawn outside of the study’s design and scope.

So if news stories are unable to capture details like that, how on Earth are they supposed to identify study findings that are outright deceptive or unethical in their presentation of their data? In short, I don’t think they can, as evidenced by this recent headline — “New Study Shakes Up Heart Disease Theory: High Cholesterol May Not Mean High Risk”. The study which generated this headline, and numerous others, is misleading through omission, unfaithful to its proposed objective, and belying the outright unprincipled bias of the researchers who produced it.

The study in question is titled, Plaque Begets Plaque, ApoB Does Not: Longitudinal Data From the KETO-CTA Trial, a non-randomized, observational study looking at a highly exclusive population, known as the lean mass hyper-responders (LMHR). This classification is reserved for subjects who typically present with a low-BMI and lean figure, along with the trifecta of the following:

1. Elevated low-density lipoprotein cholesterol (LDL-C)

2. Elevated High-density lipoprotein cholesterol (HDL-C)

3. Low serum triglycerides

These particular characteristics are most commonly observed in individuals who are carb-restricted, commonly following a ketogenic diet pattern; inordinately high fat and protein intake, and less than 50 grams of carbohydrate per day, or the amount you would get in three slices of bread.

To the study’s credit, and there is little of that to be found, the screening criteria was explicit in identifying LMHRs to include for analysis, even verifying adherence to the ketogenic diet via daily b-hydroxybutyrate (bHB) measures, a lab value that indicates nutritional ketosis.

Why would the researchers bother with such an exclusive study group? What did they hope to achieve with such a methodologically constrained study design? Before we answer that, a quick lesson is needed on two specific biochemical markers in the human body, and their relationship to heart disease; Apolipoprotein B (ApoB) and LDL-C.

Each LDL particle contains one molecule of ApoB, so ApoB is used as a direct measure of the number of LDL particles in the bloodstream. LDL are responsible for transporting cholesterol throughout the body, and this figure is captured by LDL-C, or, the amount of cholesterol carried by LDL. To keep it simple, both LDL-C and ApoB are measures of cardiovascular disease (CVD) risk, and inform us on two different components of that risk; number of particles and amount of cholesterol. The progression of CVD involves the accumulation of LDL particles inside the arterial walls, ultimately creating plaques which narrow the arteries. These plaques grow in size as they come in contact with cholesterol and other materials, and in time, this can lead to a full blockage. Typically, while both ApoB and LDL-C predict CVD risk, ApoB is considered the more accurate predictor.

Extraordinarily high-fat diets are recognized as a risk factor for atherosclerosis (a form of CVD), so the authors, wishing to challenge this premise via their LMHR population, set the purpose of the study to evaluate progression of arterial plaques within 100 of these participants over one year. Does this hyper-specific population of lean and highly lipidized individuals disrupt everything we know about CVD risk and plaque progression? Would ApoB and LDL-C fail to contribute to those plaque formations?

In both instances, the answer was no, but the authors did everything they could to spin another story. Let’s consider the study.

A key detail that immediately stands out is the paper’s blatant omission of numerical values for non-calcified plaque volume (NCPV). This outcome, measured in cubic millimeters, tells us how much soft plaque has developed on arterial walls.

Why should we care for or presume inclusion of NCPV in this study? Well, because it was the primary outcome listed in the study’s preregistration protocol. These values are never presented in the study, instead, we are presented with a figure that omits any numerical data:

From looking at that figure, I see no discernible way to actually identify the percent change of NCPV from baseline to one year. I’m given lines which appear to indicate a general increase, but it’s impossible to discern what numbers or their significance those numbers actually represent.

Imagine you are in France and ask for the address of the Louvre museum, and instead, the person hands you a globe and points to France. That’s what it feels like, looking at this figure.

So the primary outcome, the measurement upon which the entire study was constructed to test, is omitted in the final results. Thanks to pressure from the scientific community, the lead author, Adrian Soto-Mota, finally admitted in a post on X that the “… numerical pooled NCPVchange value, it is: p50=18.8 mm³.”

What does that value mean?

For comparison, in another study evaluating a healthy population of people who did not have any coronary events or risk factors, the change in NCPV was 4.9 mm3. So the LMHR participants within this study developed plaque in their arteries at nearly four times the rate of a healthy population.

Even one of the study’s secondary outcomes, buried in supplemental materials, alluded to this increase in plaque. Percentage Atheroma Volume (PAV), is a measure similar to NCPV, but instead provides the proportion of the blood vessel wall occupied by any type of plaque. It doesn’t capture narrowing of the artery like NCPV, but it still gives an idea of plaque progression. The authors reported a change in PAV of 0.8% from the start to end of the study.

For comparison, a recent retrospective analysis of 205 individuals reported that among those classified as “rapid progressors” for arterial plaques, there was an annual change of 0.46%, nearly half the rate of change within the LMHR participants in this study.

Why were these findings relegated to the shadows of this paper? It’s not difficult to devise why. Each of the study authors, along with the Citizen Science Foundation that funded the paper have a vested interest in promoting the keto-carnivore dietary pattern. Each believes that all of humanity has gotten it wrong, that elevations in a person’s LDL-C and ApoB are not risk factors for the development of heart disease. The findings of this paper report exactly the opposite, as these LMHRs with exceedingly high LDL-C are developing arterial plaques at rates which are magnitudes higher than the general population.

But the lack of ethics becomes even more glaring as the authors try to conclude how:

… a 1-year prospective study of 100 persons exhibiting extreme carbohydrate restriction-induced elevations in LDL-C and ApoB, changes in and baseline levels of ApoB were not associated with changes in noncalcified plaque volume or total plaque score as measured by [coronary computed tomography angiography]. — Brackets added.

This is an asinine conclusion for a simple reason — there was no variability of exposure in LDL-C and ApoB with regards to plaque development. The average reported LDL-C among these LMHRs was 254 mg/dL, more than 2.5 times the recommended cutoff for CVD risk.

In epidemiological or clinical research, detecting associations between exposure and outcome requires variation in exposure — you need to have some people with high exposure, some with low exposure, or ideally a range in between. Since everyone in this study had sky-high LDL levels, you can’t compare outcomes between different exposure levels, making it impossible to determine whether the exposure is associated with the outcome. You would need a low-level LDL control group to do that. To analogize this, imagine trying to figure out if sunlight exposure causes sunburns, but, you perform the study in a place where everyone is exposed to intense sunlight. If no one is ever in the shade, you can’t compare the sunburn rates between the sun-exposed and shade-exposed people.

It is difficult to conclude that these omissions and presentations of data were made in good faith or by oversight. Such is confirmed by a physician who walked away from the research project over ethics violations. Dr. Nadolsky, commenting on the conduct of the study team in a reel produced by Dr Idrees Mughal declared:

Yes they are some of the most dishonest “researchers” out there. As the guy who created the original protocol and left the study team, I can tell you this team is about as bad as it comes. Thank you for spreading awareness that they are spinning this to fit their narrative.

Ultimately, this study serves less as a contribution to our scientific understanding and more as a cautionary tale about what happens when research is co-opted for dogmatic agendas. Some time long ago, for reasons known only to themselves, these authors decided to follow a conclusion in spite of any evidence to the contrary. The fruits of that decision are easily identified by selective reporting of results, omitting key outcomes, and presenting misleading conclusions that obscure rather than clarify the risks associated with extreme dietary patterns.

By positioning themselves and their ideological commitments at the center of the work, the researchers have drawn attention not to the science, but to themselves—and in doing so, have performed a disservice to the scientific method. A substitution of solid science for ego-driven storytelling that co-opted the language of data.

In a time where public health experts and researchers are trying to revive a population’s trust, this sort of theatre is just another poison pill.

Spit it out, and demand better.

In the faint recesses of my mind, there is a small file titled “Randomcommercials_childhood”, and it possesses exactly the content the name describes; old commercials I watched as a child, which I inexplicably committed to memory through the years. Gone are the trumpet lessons, dissipated are the memories of childhood pets, and not even a young Indiana Jones could find that treasure box I buried in my parent’s backyard. But somehow, I remember each jingle for Cocoa Krispies.

One of these commercials portrayed a young man driving down an open highway, radio music blasting, a smile on his face, and the sun shining at full strength. He passes a series of highway signs, the first of which congratulates him (the driver) for having recently graduated high school. His smile beams, but then falters as the next reads, “Work ahead…,” and then looks utterly dismayed as the last sign says, “… for the next 60 years.” The upbeat radio music drags, then dies out. Our young protagonist quickly pulls off the road and that’s where my memory goes blank.

The commercial’s setting depicts the fairly sobering reality of how a life, especially a good life, requires work. Not simply the generic effort of time, energy, and skill, but the long-term arc of how to focus and apply that effort — a career, if you will. A sizeable portion of a person’s life will be committed to a career, or work in general. Like it or not, your occupation serves as a social determinant of health, the non-medical factors that affect our health and include conditions into which we are born or live.

Normally, it is the matters of compensation, workplace environments, and career opportunities that usually fall center-stage in the discussion of work. Jobs provide income, income provides resource access.

But put that on the shelf for a minute and come along for a different kind of discussion on work and careers.

What do you want from your life?

Does work provide you with a paycheck to pursue a meaningful life, or is your work a component of that meaning?

What kind of career will help shape you — your character, your habits, your perceptions — to be the kind of person you want to become?

Right now, there are millions of bright-eyed college and trade school students who harbor career aspirations. There are millions of working adults who found their “dream job”, or, who are miserable with their jobs, or, eager for the next step in their career. How many are currently content with where they are and what is the difference between them and everyone else?

The Definition of Work

At some point, everyone has heard the utterance, “When are you going to get a real job?” My 18-year-old self would turn his nose up at the question, indignant at the idea that you could classify someone’s job as either contrived or inferior.

Then, along came the Kardashians.

All of us, some less willing than others, became acquainted with their reality TV show presence. I never watched an episode, but I was knew that millions of my fellow Americans obsessed over this family for… reasons; mindless entertainment, parasocial bonding, an exemplary case study in personal branding.

Focus on the crown jewel icon of the family for a minute; Kim. Prior to her entrepreneurships, what would you say was the job of Kim Kardashian? You would see her making headlines, attending fashion shows, and living the high life, but, what was the job? Seems it was little more than to provide celebrity allure or curate drama into a cultural black hole, the sort of thing that can only find audience in a content-hungry culture.

What was built? What was the contribution? What became edified because of her reality TV show?

If I’m going to take a lesson from Dr. Martin Luther King Jr on this one, I would draw from his declaration that:

All labor that uplifts humanity has dignity and importance and should be undertaken with painstaking excellence.

That’s the key. Work, or a “real job” is something that should uplift humanity. And frankly, a lot of work that gets done does not actually contribute anything useful, merely simulates productivity, or degrades social interaction.

Ever heard of mukbang? It originated in South Korea, and depicts people filming themselves eat large quantities of food—often while they talk to a live audience. Performers use studio level lighting, answer questions, and even incorporate autonomous sensory meridian response (ASMR, for short). It draws a large crowd, and as a result, some people make a lot of money from this. Mukbang itself is completely useless, and the people who promote it breed an unhealthy sense of community.

Think this is sounding judgmental? Hold that thought.

How often is a corporate consultant brought in to tell a company something it already knows, and then be paid an obscene amount of money for the effort?

The world of today now boasts the high-frequency trader, who makes a profit by exploiting tiny price gaps in the market using ultra-fast algorithms. They don’t invest to add company value or boost its capital production. They hold assets for mere seconds and sell it off for profit, adding no real value to the economy.

How many jobs are created simply to justify another job, like a compliance enforcer overseeing a process created by another compliance enforcer?

“Health influencers” who discourage conventional medicine and hock their proprietary supplements?

Not all work is worthwhile work, and this is not determined by how lucrative, authoritative, or culturally prestigious the role is. There are indeed “real jobs”, defined by asking what they build, however small. That’s the next arena where people trip up, is when they fail to realize that a real job’s value may not always be imminently apparent.

The Value of Work

California was one of the states that served as ground zero back in 2018 for the “Fight for $15” campaign, a labor protest calling for a raise in the state’s minimum wage to $15 an hour.

One of the catch slogans used during this campaign, as well as in previous labor campaigns throughout the state was, “We’re worth it.” It’s a simple justification based on individuals identifying with their jobs, thereby esteeming their personal worth as a rationale for wage elevation.

I have some problems with that reasoning.

If you are going to say that a job is worth more because the job is powered by a human soul, why are you stopping at $15/hour? Why not $20, or, in the religious context, place infinite value on the worth of the job? There is a significant problem you bump into by equating the worth of a job with that of a human being.

Not all jobs are of equal worth. Everyone can agree to that. The skill, responsibility, and stakes of operating a deep fryer, or a car wash, or the booth at an entrance gate simply do not compare with those required to fly an airplane, or practice law, or conduct scientific evaluation.

Now trade that scenario for a human being. Are some human beings worth more than others? If presented with two children from different nations, all other features similar, is one worth more than the other?

Given that scenario, seems like unwise practice to equate a job with that of a human life. So how do you determine the value of a job? At the end of the day, it’s probably better to allow economists and markets to make that determination. Even then, it’s hard to imagine the dollar amount providing an accurate capture of the true value. I know a lifeguard who saved more than a dozen children from drowning, and he did this while making $13 an hour. The most important and challenging job in the world, that of being a parent, doesn’t pay anything.

Culturally, we sometimes equate personal perception and prestige with the value of a job, and this brings us neatly along to the subject of a “dream job”. Some people seem born with or quickly develop a fixed determination for what they want to do for a career, and this is their dream job. LinkedIn has recently seen people employ a template post, wherein they sit down with and have a discussion with their younger self. The younger self asks if they achieved their dream job, and the present-day self gets to describe what they have accomplished.

Personally, my conversation with myself would be brief, as my younger self did not have an answer to that question. He’d probably ask me something trivial, like, how many World Series do the Dodgers win?

For any who achieve their dream job, I am truly happy on their behalf. For any who have not (yet) achieved their dream job, I hope they eventually do. But what about everyone who doesn’t have a dream job, not because of any failure on their part, but because they simply don’t know what that is?

In college, I was frequently asked, “What’s your dream job?” or “What’s a job you would love so much you would never work a day in your life?” Personally, I knew I wanted to be a dietitian, but the where and how for applying the talents acquired from this role were always a mystery. I never fretted much about it, but I had friends who would lose sleep. School was hard enough without attempting to envision a desired future for which they knew neither the route nor directions.

Everyone wants to be paid well. Everyone wants to do something they love. Everyone wants to be happy with their work.

But who says only one job can fulfill that role? Even if there is one thing you want to do, one dream title you wish to carry, there is no reason to be believe that’s truly the end of your options for meaning and satisfaction.

So for those uncertain, set aside your perceived value of the work, and consider instead the purpose.

The Purpose of Work

One more story, this one from the apocrypha of the United States.

In 1961, not long after President John F. Kennedy had announced the ambitious goal of sending an American to the moon and back by decade’s end, the president paid a visit to a military installation in Cape Canaveral, Florida, which would eventually become the Space Center given his namesake.

While touring the facility and getting a layout for the future plans, Kennedy and company came across a janitor working in one of the hallways. Curious and personable, Kennedy greeted the man, and asked what he was doing. The janitor responded:

"Well, Mr. President, I'm helping put a man on the moon.

Teleology hearkens to the Greek word telos, meaning "end," "purpose," or "goal." The concept itself refers to an idea that things have an inherent purpose, or when properly applied will achieve a certain end.

Everyone is always quick to use the word “passion” as it relates to their job, but purpose hardly ever receives mention. Why? Passions are inherently fleeting, offering sparks and glimmers that can fade in and out according to the temperament of human nature. Some days, you wake up and you simply don’t feel like doing anything. Ultimately, the fervor of passion depends upon mood, and moods can be a fickle thing.

But purpose is something different. Purpose is not characterized by an emotion, but a belief that what you are doing matters. The person who is driven by purpose knows that behind the colors and titles and salaries, they are creating something good, accomplishing something that brings order — however small it may seem — into an entropic and uncaring universe.

Who thrives at work? It is not the people paid the most, though honestly, who wouldn’t want to be paid more?

Time and again, research demonstrates how task identity, autonomy, and meaningful work promote thriving. The greater the sense of meaning derived, the stronger the work engagement.

Granted, plenty of other factors can derail a person’s satisfaction with their job, such as an unsupportive work environment, bad managers, or adversarial relationships. But a job or manager who can 1) foster connection with a community and 2) offer a purposive sense of service to that community can moderate so much of what would otherwise be undesirable.

And here, seeing the job as a social determinant of health becomes increasingly apparent. Thriving is associated with positive health outcomes, reduced burnout, and enhanced subjective well-being.

Keeping a sense of purpose for what a job is for, and not for, goes a long way in helping to establish a healthy career and life.

A job should not be the place you go to for love.

A job should not be a distraction from the life you want to live.

A job should not serve as a personal means to ingratiate yourself through the accumulation of titles, prestige, and power.

At the end of the day, the job’s contribution may not seem like much, but if it’s putting food on the table and creating or maintaining something that is good, that’s a worthwhile job.

One more quote, another from MLK Jr in a speech delivered in 1967 to the students at Barratt Junior High School in Philadelphia:

"If a man is called to be a street sweeper, he should sweep streets even as Michelangelo painted, or Beethoven composed music, or Shakespeare wrote poetry. He should sweep streets so well that all the hosts of heaven and earth will pause to say, ‘Here lived a great street sweeper who did his job well.’"

If you find yourself at present dissatisfied with your job, or fearful, uncertain of what comes next, maybe this is a good starting point. Perhaps right now there is a task or service that is neither glamorous, lucrative, or conventional by your perceptions, but still needed.

Whether you are designing a rocket, sweeping streets, teaching students, or working in the background, the real question is whether or not the work leaves the world just a bit more whole than it was before.

Don’t ask yourself, what’s the dream job. Don’t ask how much you can advance therein, or how many people it would affect, or how much attention it would garner.

If you can look at what you do — today, this week, this year — and say with quiet confidence, I do something that matters, you can count yourself in good fortune.

And maybe that’s how you know it’s a “real job” after all.

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Public Health Fireside

(Come sit by the fire for a discussion on recent trends, research, and current events)

This month’s fireside chat was all about aeronutrients and those beef tallow fries over at Steak n’ Shake. Grab your snacks, grab your drink, and cozy up by the fire.

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