This one is a quickie. And a bit philosophical.

It starts with a question.

What are you doing today?

Or as poet Mary Oliver once asked?

“Tell me, what is it you plan to do with your one wild and precious life?”

And don’t forget about one of PrimalMD’s guiding principles, Memento Mori.

In his Meditations—Marcus Aurelius opined, “You could leave life right now. Let that determine what you do and say and think.”

Yes. Memento Mori. We all will eventually pass. And we don’t know when.

Which brings us to Dolly Parton, the country music icon who sadly passed this week at the not so old age of 80.

Yesterday, PrimalRD and I were driving along I-95 in Connecticut and we saw not 1, not 2, but 3 billboards bidding farewell to Dolly Parton.

Farewell Dolly. Goodbye Dolly.

Which led to a conversation. Not so much about Dolly, but about the contributions WE make to ourselves and others. Each and every day. What actions deplete us. And what repletes us.

Now to be clear, I am not a country music buff. I’m more of a 70’s Classic Rock guy. But it was interesting to read about Dolly the past few days, and her accomplishments. And the doors she helped to open. She was a ‘connector’ for millions of folks. Humble. A ‘rags-to-riches, or as she would say, ‘rags-to-wishes’ story. A voice for gender-equality in the workplace. Philanthropic. And over the years, a unifying spirit, much needed in these partisan, divisive times.

So I was thinking about Dolly on my morning run. Her story is compelling and motivating. But I am sure she, like us all, had flaws. I listened to some of her music. As much as I can’t help singing out loud to ‘Islands in the Stream,’ the lyrics of ‘Backwoods Barbie’ stood out. How she perhaps is judged and misunderstood by others based on her story or appearance. I wondered what internal story made her embrace that appearance? And how that inspired her to pursue the altruistic life for which she is remembered.

Where am I going with all of this?

We ALL have responsibilities. Things we have to do. Things we MUST do. Some are boring. Repetitive. Soul-sucking. Yet obligatory.

Not everyone is fortunate to be retired, or privileged enough to do whatever they want whenever they want.

They’re doing the sh*t. And getting sh*t done because they have to. That job may not specifically be from 9 AM-5 PM. But I trust you get the metaphor.

9-5 is what you HAVE to do.

No matter what we HAVE to do as living, breathing, functioning adults in this world, there is always time to do, or at least try to, do some stuff we WANT to do. The stuff we CHOOSE to do.

That is YOUR 5-9.

The hours outside of your obligations.

The time to give VALUE and MEANING to your one wild and precious life.

Let’s face it. We are all imperfect beings. Imperfect in mind, body, and spirit. And unless we are truly narcissistic, we all recognize that there is an opportunity for improvement.

An opportunity for creativity. For restoration. For living with intention.

To not just drift through your days, but to give each and every day purpose and meaning.

For some, your ‘9-5’ may blend with your ‘5-9.’ Your day job or daily obligations may be spiritually ‘nutrient-dense.’ That’s a bonus.

But for others, we recognize that although some of our hours are depletive, and drain our energy and spirit, your 5-9 is a chance to reclaim and replete that energy.

Your opportunity to decide what REALLY matters.

The passing of a cultural figure is just a moment in time. Every day, another one passes. Another reminder.

Heck, the very next day, Tim Curry passed. For those of a certain age, he is forever remembered as Dr. Frank-N-Furter from the Rocky Horror Picture Show.

Those billboards on I-95 are a reminder.

That song you hear on your next walk or run is a reminder.

THIS post is a REMINDER.

Not everyone will make an impact on popular culture like Dolly. But we all want to have some impact, hopefully positive on ourselves and loved ones.

I submit that by remembering the words of Marcus Aurelius , that our impermanence should inform and direct what we do or say, is a useful heuristic. A PrimalMed philosophy.

The impact you have on your self-esteem and sense of self-worth, and the impact you have on others, as a mentor, guide, or hero, may very well come from what you do and create AFTER your ‘9-5’ is done. It’s what you do in those after hours, in that ‘5-9’ that may have those most meaningful impact on yourself and others.

- PrimalMD 2026

So today’s PrimalMed Prescription? A Call to action!

Just do ONE thing today.

For yourself. Something creative or constructive.

For me?

Heck, I’m gonna ask my friends if anyone is up for a road trip to Dollywood!

If not now, when?

So here’s to Dolly. A reminder to all that our days are short. Our story is short. But you are the main character in that story and you get to decide the narrative.

Be like Dolly.

And lastly for those Boomers who fondly remember The Rocky Horror Picture Show. Remember…practice your ‘hop, skip and jump,’ so you can do the Time Warp again!

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on the PrimalMed website.

Let me ask you a question:

When was the last time you ‘hopped?’

When was the last time you ‘skipped?’

When was the last time you ‘jumped?’

If you are 8 years old, the answer is pretty easy… TODAY!

But for our average PrimalMed subscriber (between 25 and 95), the answer might be…’Hmmm, when I was 8?”

Now what does a hop, skip, and a jump have to do with being PrimalMed approved?

A lot.

Remember the PrimalMed secret of longevity? DON’T FALL!

Or at the very least…try NOT to fall, trip or stumble!

But we are human and as such, accidents and missteps WILL happen.

And when you do find yourself in the middle of a stumble, the question becomes…”What now?” Can you CATCH yourself so that stumble doesn’t land you in the ER?

Here’s a scenario. Let’s break it down:

Let’s say you catch your foot on some uneven sidewalk. Or you miss that last step. Or you step in a pothole.

Perhaps you lunge for the ball on the tennis or pickleball court and you can’t decelerate smoothly.

You trip.

You, or actually your brain and muscles, have about a second or two to figure it out and I’m telling you, you can’t consciously think or reason your way to a good outcome. You either land on your outstretched hand or your hip and earn a trip to your friendly orthopedic surgeon…

OR your sturdy sea legs rise to the occasion, you stick the landing, and you emerge injury free. Shaken but not stirred.

What’s going on?

You see, your brain was designed, from an evolutionary perspective, to sniff out any danger, protect you, and ensure your survival. And we have developed a pretty incredible and quite elegant feedback loop between our brain and our muscles.

You see. You hear. You smell. Your senses are on-guard to protect.

Now for those of you who still remember your middle school biology, you know that there are these tiny little guys in your inner ear called the Semicircular Canals. They are part of the vestibular (balance) system.

When you stumble, the semicircular canals act like a highly sensitive angular-motion sensor for your head. They don’t detect your foot catching the ground directly - they detect the sudden rotation/acceleration of your head that follows. Fluid in the canals and tiny crystals shift, sensory hairs bend, and signals are sent via a nerve, to your eyes, other balancing systems, and your legs and feet!

This sends your brain positional information (called proprioception) and the brain issues a system alert!

“Attention! I’m falling! All hands on deck! I am hereby calling on all muscles in my legs and core to steady the ship, stay upright and catch me!”

SO….do you have the POWER to react and produce the necessary force to decelerate, contract your muscles with sufficient strength and coordination so that you remain upright?

Do you still have the intact neuromuscular pathways needed to send the message to generate that power?

Message is sent. BUT can YOU handle the message?

I was thinking of this last week. PrimalRD and I were with some friends on vacation. So of course, we went on an adventure! Look closely. Beautiful waterfalls. A scenic view from the top with a walking bridge over the falls.

Do you see the steps in this picture?

There are 487 STEPS up to the top of the Montmorency Falls outside of Quebec City. Yup. 487. I counted each and every one. Interesting observation. Some folks were running up the steps. Bounding. Nary a care in the world. Others were gripping the handrail. Slow. Unsteady.

And on the way down? Some folks running DOWN the steps. Jumping down two at a time! A bounce and pep in their step. But some I noticed were not so confident. Going DOWN steps is a helluva lot more challenging. Especially wet, slick steps. It requires eccentric strength. It’s as if you need to master a quick controlled FALL. Your muscles absorb force, stabilize your joints and react instantly to every step. We need that skill.

BUT

Absorbing force is a skill we lose as we age. And if you don’t have the strength, and power and confidence to briskly or even slowly descend? Well, that’s an accident waiting to happen.

Going UP…yep, that’s strength.

Going DOWN…that’s a bit different. It’s about muscular power and control.

PRE-HAB beats RE-HAB. We want to prevent or actually rehearse for an accident.

Rehearse for an accident? YES.

We actually can practice reactive responses by training our nervous system to act in a way to prevent a stumble from becoming a fall!

And how do we practice these reactive responses?

By reacquainting ourselves with the HOP, SKIP, and JUMP!

In a word, power and plyometric training. Not familiar with the term plyometrics? No worries. Keep reading. I gotcha.

First. The foundations. Cardio and Resistance Training. We have talked about this before.

#1 Low-level easy CARDIO like walking, jogging, biking, rowing for aerobic endurance. This is the baseline. 80% of your workouts. It is a non-negotiable.

#2 RESISTANCE training is also a non-negotiable. Muscle is the ENGINE that helps drive your metabolic machine. Working, active muscle secretes hormones called myokines that can cross the blood brain barrier, and help preserve cognition and support neuroplasticity. Muscle can act as a glucose sink, and soak up blood glucose thus preventing excessive Insulin secretion. Another topic…. BUT I posted on this way back in February 2024. See link below and take a journey to the PrimalMed archives!

Muscle Counts!

The missing link?

#3 BALANCE and POWER.

Miss a step? Need to jump over a pothole or a puddle? Quickly accelerate to catch the elevator? Can you land on one foot?

There comes a time when you can’t take this for granted. As you age, muscle mass and strength fades. That’s called sarcopenia. You can SEE this. Look in the mirror.

But what fades first, and what you can’t readily see, is loss of muscular POWER, called DYNAPENIA.

So we need to TRAIN for POWER. We need to train our neuromuscular systems to react and respond fast. To accelerate and decelerate. And to train our muscles, tendons, and ligaments to absorb these landing forces.

We need to stave off and delay the onset of DYNAPENIA.

If you lose this skill, you WILL fall, and you WILL get injured. Ugh.

At PrimalMed, we ask: How do we go from knowing to doing?

How do we train for POWER and harness this power?

Well it’s time to introduce PrimalMed Plyometrics!

What are plyometrics? (See, I told you I’d get to this).

Plyometrics are exercises that train your nervous system, muscles, and tendons to rapidly absorb, control, and redirect force - the physical skill you need when you jump, change direction, stumble, or catch yourself from a fall.

Think HOP, SKIP, and JUMP!

Every hop, skip, and jump teaches your brain and muscles to communicate faster. Every controlled landing is practice for the unexpected.

Cardio and Classic Resistance training WILL NOT accomplish this.

When you think of plyometrics, or jumping and leaping exercises, you might have a vision for some Cross-Fit gym bro jumping on and off a 24” box or some parkour ninja leaping on and off tables and benches. And if you are a 20-something kiddo, by all means jump and leap to your hearts content.

But for us mere mortals, it’s time to turn back the clock and hop, skip, and jump in a sensible progression to retrain our brains and muscles. At any level, this can be done. The brain can adapt to new stimuli. And it can develop new neuromuscular pathways. This is called neuroplasticity.

Your body will adapt, slowly, to these new, imposed demands. This is the SAID principle (Specific Adaptations to Imposed Demands).

Here’s the way to do it. The PrimalMed way:

You need to have the necessary STRENGTH on board BEFORE you start plyometric training. If you don’t have the requisite calf or quad strength, you will tweak your achilles or patellar, or quad tendons. Respect the process.

Don’t be Stupid.

Don’t rush in full speed, say by entering a jumping rope contest without proper warm up or training. You will wind up with a tendon or meniscal injury. This I know from personal experience. You must go SLOW. Know your limits and respect your limits.

Start with easy stuff.

Essential movements like squats, deadlifts and step-ups. You can do sit-to-stands from a chair. Come back down. That’s a squat.

You can walk up and DOWN stairs slowly with intention and slow control. That’s a step-up and step-down!

And calf raises. Slow up and slower back down. With knees straight (works the gastrocnemius calf muscles) and knees bent (works the deeper soleus muscles).

Equally important is BALANCE. Can you balance on one foot for 30 seconds? Can you balance yourself, one leg at a time and descend the stairs slowly and with control? No hands? Start there. And PRACTICE.

Basic strength and balance are the course prerequisites before proceeding with plyometric training.

This baseline level of balance and strength will allow you to absorb impact forces when you land.

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Now comes the PLYOMETRICS.

And remember, although I am an MD, I am NOT YOUR MD. So if you are uncertain about any moves, then ask your health care provider or physical therapist.

Start with EASY plyometric moves.

No rigid rules or protocols here. That’s where you get hurt.

HOP:

• Start with easy POGO hops. Stand up. Hold on to a chair or counter if you need to and just hop up and down on the balls of your feet…maybe 1-2”. Do it once. Pause. Then twice. Then a few times. (And then make believe you are on a POGO stick).

• After the hop, you gotta land, right? So land soft and light. Let the knees bend and your quads absorb the force. Then pop up again. Make believe your calves and quad are coiled springs.

• Now, after say 5-10 hops, land with that slight knee bend and hold your landed position for 2 seconds. Contract the quads to steady the ship. That’s called ‘Sticking the landing.’ Just like an Olympic gymnast as he/she/they lands with two feet as they fly off the balance beam or pommel horse.

• Then POGO some more. Make believe you are holding on to an imaginary jump rope and swing your wrists. Knees soft. Land soft. You must TEACH your brain and legs to LAND soft and absorb impact.

Remember you are reawakening the elasticity of your aging tendons.

Your brain will get the message and soon, landing soft will become second nature.

Time to progress!

Hop a little more. Progress to Jumping Jacks. Easy. Controlled. Pick up the cadence if you want. Or not.

SKIP:

Remember how to skip? It took me a little while to relearn the move. Sing ‘Skip to my Lou’ if you want.

JUMP:

Now it’s time to progress to JUMPS. Not herculean leaps! You are NOT Spiderman.

Make believe there’s a puddle. Any size. Jump over it. Two feet together. Then one at a time. Bend, coil, jump, land softly. Even if it’s only 6”. And hold the landing. Teach the brain the movements. Rehearse now and you’ll instinctively be ready to jump when it’s show-time.

Bonus moves: Practice playing Hopscotch. Forward/Backward or side-to-side with rotations. Or you can try my favorite plyometric move…the ‘Skater Hop.’

Let’s say you have KNEE or HIP issues. Perhaps you can't or shouldn’t be doing the same ‘hop, skip or jump’ moves.

Have no fear…PrimalMed plyos without jumping are here!

You don’t have to leave the ground to train the nervous system to react quickly.

Start with rapid weight shifts:

Take an athletic stance. Shuffle left/right. Steady and stabilize. Then do it quicker and stabilize or ‘stick’ that landing. Then try one brisk step forward, lateral or diagonal THEN plant and stick the landing and hold 2 seconds.

You can progress to alternating quick steps, low step-ups (2-4”) with a controlled 2 second landing, or try toe taps to different targets.

Remember, we are really training the RECOVERY RESPONSE. That can be done with plyometric power moves that do not require jumping.

NOTE: You may FEEL fit, confident and ready to progress BEFORE your tendons and muscles ARE actually ready. Your cardiovascular system conditions faster than your tendons, soft tissues, fascia and muscles. Remember, we are focusing on that elastic recoil and bounce. Increasing the elasticity in your tendons takes time. So be patient and curb your enthusiasm.

If you are going to do any challenging plyometric training, 1-2 sessions/week should suffice. Give those tendons some downtime. If you are doing little hops and pops as 1-2 minute exercise snacks, then you can do them more frequently.

TL;DR

Remember what we are trying to accomplish.

We are training to prevent a stumble from becoming a FALL.

To catch ourselves when falling.

And improve our reactive strength…to allow us to stop quickly without crumbling.

That’s the goal of plyometric and power training. And that is why it deserves a place in your training regimen.

Teaching your brain and body to rediscover the reactive strength you took for granted when you were a youngster will pay dividends! Especially on the Pickleball or Tennis courts!

Master that hop, skip, and jump…so you don’t snap, crackle, and pop!

AND NOW…IT’S MUSIC TIME…

Remember: Accidents WILL happen.

AND you will find yourself Stumblin’ In.

The message goes to your BRAIN and MUSCLES:

So we must TRAIN to ‘Stick the Landing.’

And practice your plyometric hops and bops to this 90’s one hit wonder!

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on the PrimalMed website.

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A question that comes up often with clients is... “What can I pack for a snack?”

The real question is... “Do you need that snack?”

For most healthy adults, snacking is usually unnecessary. If you’re eating nourishing meals with enough protein, healthy fats and whole-food, fiber-rich carbohydrates, your body will have enough fuel to comfortably last until your next meal.

One of the greatest misconceptions in nutrition is that our body needs a constant supply of food, to be used as fuel, throughout the day.

But first, in order to understand the concept of snacking, we need to understand where our body gets its fuel.

What are your body’s fuel sources?

• Glucose - readily available fuel
  Glucose circulating in the bloodstream provides a readily available source of energy. Much of it comes from the digestion of carbohydrate-containing foods and can be used by cells for immediate energy.
  

• Glycogen - short-term stored fuel
  Glucose that is not immediately needed is stored in the form of glycogen, primarily in the liver and muscles. Glycogen releases glucose as needed as an available energy reserve between meals and especially during bouts of exercise.
  

• Fat - long-term stored fuel
  Body fat is our largest energy reserve. Stored fat releases fatty acids which are used for energy. Fat generally contributes a greater proportion of fuel during periods between meals, overnight, and for lower intensity activities.
  

• Protein - not a significant source of energy
  Dietary protein is broken down into amino acids, used to build and repair tissues, and produce other essential compounds throughout the body. Although not the body’s preferred energy-storage system, amino acids can contribute to energy production when needed.

In reality, our bodies are designed to alternate between using incoming energy from food when we eat, and drawing on stored energy between meals and during periods of fasting.

This is called Metabolic Flexibility.

Metabolic flexibility is your body’s ability to adjust the mixture of fuels it uses - particularly carbohydrate and fat, according to what you’ve eaten, your activity level, and your energy needs.

A metabolically flexible body doesn’t simply flip a switch from ‘burning glucose’ to ‘burning fat.’ Instead, the body generally uses a mixture of fuels, continually adjusting the proportion of glucose and fat used for energy based on what and when you last ate, insulin levels, activity intensity and duration, and overall metabolic health.

Think of your body like a hybrid car, which draws from both gasoline and electricity, and automatically adjusts the combination according to driving conditions. Cruising may require one mix of fuel, while accelerating or climbing a steep hill requires another.

Similarly, during prolonged or higher-intensity exercise, the body relies more heavily on carbohydrate, particularly stored muscle glycogen. During rest, between meals, and with lower-intensity activity, fat generally provides a greater proportion of energy.

Metabolic flexibility is this ability to efficiently adjust fuel use as circumstances change.

And just as a hybrid car doesn’t need to stop for fuel every few miles, a metabolically flexible body doesn’t necessarily need a constant supply of food - it can draw upon stored energy between meals when needed.

As the hours pass after a meal, digestion and absorption continue, blood glucose generally settles toward its usual range, and insulin levels decline. As this happens, the body gradually shifts the balance of fuel use away from recently consumed nutrients and toward stored energy. It may draw upon glycogen, the body’s short-term carbohydrate reserve, while also increasing its use of stored fat for energy.

This ‘quiet time’ between meals is a normal part of human physiology.

Eventually, hunger gradually returns.

How do we apply this physiology to real life client situations?

Many find eating three nourishing, balanced, protein rich meals are fine. Some find eating a larger breakfast and lunch and smaller dinner works best. Some may even have 2 meals/day - a later breakfast and ‘Linner’ (lunch/dinner) to satisfy needs.

If after a meal, there are no increased energy needs for a few hours, and you’re feeling comfortably full, then you most likely don’t need a snack.

Light activity such as an easy walk, yoga or a casual bike ride less than 60 minutes? You most likely don’t need a snack.

Water is often enough.

Moderate exercise (60-90 min) such as a brisk hike, moderate run, strength training or a pickleball session - again may not need a snack if a meal was eaten 2-3 hours prior. But if feeling hungry - truly hungry beforehand, a small whole food snack may be fine.

Endurance Exercise (90+ minutes) such as long-distance cycling, half-marathon training, mountain hiking, long trail runs, is different. Muscles begin using significant amounts of glycogen (stored glucose). A snack prior or during the activity often becomes beneficial to maintain energy, delay fatigue, support performance and improve recovery afterwards.

But when do you truly need a snack?

• Genuinely physically hungry - rather than eating in response to boredom, stress, emotion, convenience, or habit.

• Energy needs are higher than usual, such as pregnancy, heavy physical labor, or other circumstances that increase nutritional requirements.

• Preparing for prolonged or strenuous exercise or completed a vigorous workout and need to support recovery.

• Previous meal wasn’t substantial i.e. insufficient protein, healthy fats and whole-food, fiber rich carbohydrates.

• It has been five or more hours since your last meal...don’t snack, have your next meal!

  ---

Special Snacking Scenarios:

Should you snack if trying to lose weight?

No, a snack is not necessary.

Every snack is a bolus of fuel. Every time we eat, the body responds to the nutrients in the meal. Carbohydrates generally have the greatest effect on blood glucose and insulin, while protein can also stimulate insulin to a lesser degree; fat has little direct effect.

Frequent eating—especially foods high in refined carbohydrates and added sugars—can contribute to repeated rises and falls in blood glucose. For some people, these fluctuations may increase hunger and cravings, making it easier to reach for more carbohydrate- or sugar-rich foods.

Insulin also signals the body to store excess energy as body fat and suppress the release of stored fat while insulin levels are elevated. Between meals, as insulin levels fall, the body can more readily access stored energy.

If you want to lose weight, predominantly adipose tissue (body fat), then eat nourishing meals and don’t snack. To be clear, insulin is a necessary hormone for many important bodily functions. We just don’t need it activated all the time.

Should you snack if trying to gain weight?

Perhaps... and in this case nutrients should support a healthy weight gain, ideally muscle gain. Rather than grazing, focus on protein-rich nourishing meals and planned, nutrient-dense snacks.

An ideal snack is to pair quality protein with a whole-food carbohydrate and/or healthy fat to provide nourishment, sustained energy, and greater satiety.

When adding in exercise, small energy dense snacks can be strategically placed to support performance and help meet higher energy needs. Use the list above as starting points, but keep portions small, particularly in the pre-exercise window. This post-exercise snack can provide protein for muscle repair and carbohydrate to replenish glycogen.

Why do some people seem to snack frequently without gaining weight?

Nutrition is not one-size-fits-all. Each individual has their own unique physiology, metabolism, activity level, and nutritional needs. We all differ in our daily energy expenditure.

Daily energy expenditure comes from several places:

• Resting metabolism: Energy required simply for body function - breathing, circulating blood, maintaining body temperature, brain activity, cellular processes, organ function, etc. This is typically the largest component of daily energy expenditure, about 1200 calories/day

• Thermic effect of food (TEF): Energy needed to eat, digest, absorb, transport, and metabolize nutrients. Protein has the highest thermic effect of the macronutrients.

• Non-exercise activity thermogenesis (NEAT): Energy used for movement outside planned exercise - standing, walking around the house, fidgeting, doing chores, taking stairs, gardening, and so forth.

Some people have genetic and hormonal variances that results in increased energy expenditures. In these cases, snacking doesn’t impact weight gain.

Now that we have covered the ‘science of snacking,’ let’s talk behavior.

Why am I snacking?

Am I responding to true hunger—or simply following a routine?

Am I fueling with purpose—or simply feeding a habit?

Ask the Four questions:

1. Hunger: Am I truly physically hungry?

True hunger usually develops gradually and is regulated by a network of hormones and brain signals, rather than by one single hunger hormone. (i.e. ghrelin and leptin).

If hunger returns soon after eating, consider your last meal. Did it contain enough protein, fiber, healthy fat, and overall nourishment? A protein-rich meal combined with fiber and healthy fats generally provides greater satiety than a meal dominated by refined carbohydrates.

Mild hunger between meals is a normal physiological signal. If you’re unsure, drink some water, take a short walk, and wait 15–20 minutes. If hunger remains and nourishing food still sounds appealing, eat.

Repeated shakiness, sweating, lightheadedness, or difficulty concentrating deserves closer attention, particularly for those with diabetes or taking glucose-lowering medications.

The goal is not to ignore or suppress hunger, but to recognize true hunger and respond appropriately.

2. Habits: Am I eating because it’s what I always do?

Not every desire to eat means your body needs fuel. A 3:00 p.m. snack time, TV snack, or after-dinner treat can become automatic, where the situation itself becomes the cue to eat - whether you’re hungry or not.

The goal is to pause and ask: Does my body need fuel, or is my brain responding to a routine? Feed hunger, not habit.

3. Cravings: Am I seeking comfort and feeding my emotions?

Cravings often appear more suddenly and specifically as a desire for something sweet, salty, or crunchy. Stress, boredom, fatigue and emotions can all trigger snacking behavior providing comfort and pleasure, i.e. dopamine hits. Some cravings may be due to sleep deprivation, and hormonal shifts.

If you’re unsure if it’s a craving or habit, change activities, drink some water, take a short walk, or simply wait a few minutes and see if the urge passes.

The goal is to pause and reassess: can you recognize and identify what may be driving your craving? Feed hunger, not emotions.

4. High Performance: Am I Fueling for Activity or Recovery?

Is this a desk day - or a long hike, bike ride, run, or demanding workout day?

Fuel according to the body’s demands.

So, getting back to my client’s question.

Is packing that snack PrimalMed approved?

It depends. Context matters. Understand why you need that snack.

A snack becomes purposeful fuel when your body has a reason for it. Otherwise, it’s just filler.

And remember…sometimes the smartest snack choice is realizing you don’t need one at all.

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

In a recent Nutrition Counseling session, a client shared how much he enjoyed his Greek yogurt – and asked if I had opinions on the many different types of Greek yogurt he encountered at the supermarket.

“Greek yogurt? Funny you should ask, as I just returned from a family vacation to Greece.”

What started as a simple question about Greek yogurt, turned into an exploration about traditional Greek yogurt – from Greece, and how it transformed to something quite different in the U.S.

So, let’s dive in...

Real Greek yogurt, made in Greece, bears little resemblance to what most Americans know as ‘Greek yogurt.’ Rich, tangy, and naturally creamy, it varies in flavor and texture depending on the milk used (often sheep or goat) and its use of traditional straining methods. It is not marketed as a ‘protein product.’ It’s simply a traditional food, topped with honey and nuts, or used in classic dishes like tzatziki.

Walk down a supermarket aisle here in the U.S. and you’ll find rows of ‘Greek Yogurt.’ It is a modern nutrition category, marketed for protein, consistency and dietary trends.

But first, what exactly is yogurt - and what makes yogurt ‘Greek’?

Regular yogurt is made by heating milk, then adding live bacterial cultures. It is this process of fermentation – in which beneficial bacteria convert lactose (milk sugar) into lactic acid, that gives yogurt its thick texture and tangy flavor. Although some lactose remains, yogurt typically contains less lactose than the milk from which it was made.

Greek yogurt begins the same way as Regular yogurt:

Milk + live cultures → fermentation → yogurt

Then comes one additional step:

Milk + live cultures → fermentation → straining → Greek yogurt

Straining, where much of the liquid whey is removed (along with water and some lactose), leaves behind a thicker, creamier yogurt.

But one may ask...if the removed liquid whey contains protein, how does Greek yogurt end up higher in protein?

The answer is concentration. Much like reducing a sauce, straining whey liquid removes liquid and reduces volume, leaving the remaining nutrients more concentrated.

While some whey protein is lost during straining, another milk protein, casein, becomes more concentrated. As noted earlier, during fermentation, bacteria convert some lactose into lactic acid. This causes casein proteins to coagulate and form the gel-like structure of yogurt. Straining further concentrates this casein network, creating Greek yogurt’s characteristic thickness and increasing the amount of protein per spoonful compared to regular yogurt.

In Greece, traditionally made yogurt—often called strained yogurt, or straggisto, is a staple of the Mediterranean diet. Through repeated straining, excess whey is removed, creating a thicker texture, concentrating protein, reducing lactose, and intensifying flavor.

That’s it. No secret ingredients. No special country requirement.
No industrialized standardization.
Minimal ingredients used, usually just milk and cultures.
Protein content may vary naturally.

Full-fat versions are common.
Stabilizers and other added ingredients are uncommon.

Whole milk is sometimes blended together - from sheep or goat.
Milk is naturally strained using cloth bags.

In Greece, ‘Greek yogurt’ isn’t a marketing category - it is simply a traditional food.

They just call it…yogurt.

For decades, regular yogurt sold in the United States was marketed primarily as a sweetened snack, digestive aid or diet food, often containing added sugar.

That began to change in the early 2000s as nutrition trends shifted toward higher protein and lower sugar content - especially appealing during the Atkins-era diet boom.

Manufacturers quickly realized that Greek-style yogurt could be produced on an industrial scale using ultrafiltration, centrifugation and other standardized processing methods. These technologies created a thicker texture, longer shelf life, and consistent flavor while increasing protein concentration. In some products, protein levels were further boosted with milk solids, milk protein concentrate, whey protein concentrate, or other dairy proteins, allowing manufacturers to achieve targeted protein levels on nutrition labels. Any added dairy proteins, such as milk protein concentrate or whey protein concentrate, must be listed separately on the ingredient label and cannot be hidden under the term ‘milk.’

Stabilizers such as guar gum, locust bean gum, tapioca starch, pectin, gelatin or modified food starch are commonly used to improve texture, maintain consistency, and reduce whey separation. Regulatory agencies consider these ingredients safe when used as approved. Depending on the brand, flavors, sweeteners and fruit preparations may also be added.

As production expanded, Greek yogurt evolved from a traditional food rooted in Greek culinary culture into a major commercial category marketed for protein, convenience and health. Grocery store dairy aisles reorganized around Greek yogurt, brands competed on ‘protein per serving,’ and consumers increasingly viewed it as a health food associated with weight management, fitness and sports nutrition.

The name ‘Greek’ remained the same, but the product evolved to meet different consumer expectations.

Greek yogurt in Greece: shaped by culture and food history. Rich sensory experience, moderate-high protein, less engineered consistency, usually sheep milk. Straining, the primary driver, removes whey and water and concentrates existing milk protein. A tradition, not a marketing label.

Greek yogurt in the U.S.: shaped by macros, labels, and modern health trends. More controlled protein levels using milk protein concentrates or powders, often higher protein per serving, more industrial consistency, standardized for consistent nutrition labels.

Many mainstream supermarket brands in the U.S. are formulated to achieve specific nutrition targets, texture and flavor.

However, there are still a handful of U.S. brands that closely resemble traditional Greek yogurt, primarily on straining to remove whey, with simple ingredients—typically just milk and live cultures. Their protein content comes largely from the straining process itself, without the addition of milk protein concentrates or other dairy proteins. Texture depends largely on the milk’s natural fat content.

Ultimately, a yogurt choice comes down to personal preference: Do you prefer a traditional yogurt made from milk and cultures alone, or a yogurt product formulated to deliver higher protein, a certain flavor and consistent texture?

So... what should you look for when shopping for Greek yogurt?

Start with the Ingredients

Begin with the ingredient list— it tells you what is in the container. Move past the marketing claims. Keep it simple, milk and live cultures. Organic and grass-fed labels provide additional information about farming and feeding practices.

As a general rule, the more ingredients added for sweetness, texture, flavor, or protein enhancement, the further the product moves away from its traditional fermented-food roots.

Understand Where the Protein Comes From

Greek yogurt’s higher protein content can be achieved in several ways.

Traditional straining (removing whey after fermentation), ultrafiltration of milk before fermentation, or the addition of dairy protein ingredients such as milk protein concentrate (MPC), milk protein isolate (MPI), whey protein concentrate, or nonfat dry milk.

These latter ingredients are processed dairy proteins, not harmful additives. They increase protein content and improve consistency, but they are not necessary to make traditional Greek yogurt.

If dairy protein ingredients are added, they must appear on the ingredient list by name. That high protein number you see on the Nutrition Facts label does not tell you how the protein amount was achieved - it may come from any combination of traditional straining, ultrafiltration, and added dairy proteins.

Watch for Added Sugars

Many flavored Greek yogurts contain significantly more sugar than their plain counterparts. A single serving may contain 10–20 grams of added sugar - and sometimes even more in dessert-style varieties.

Don’t assume ‘fruit-on-the-bottom’ means just fruit. The fruit layer is often a sweetened fruit preparation that can substantially increase the yogurt’s sugar content.

Don’t assume ‘sugar-free’ means unsweetened - these products often contain non-nutritive sweeteners, which may cause GI upset in some people.

So...start with plain Greek yogurt and add your own fruit and berries, or even walnuts or a drizzle of honey…as they do in Greece!

Consider Stabilizers and Texture Agents

Many yogurts include ingredients that improve texture, consistency, and shelf stability, such as pectin, gelatin, guar gum, locust bean gum, tapioca starch, and modified food starch.

These ingredients help reduce whey separation, improve creaminess, and create a more uniform product from batch to batch.

From a manufacturing perspective, they are functional and generally recognized as safe. However, some consumers may experience mild digestive symptoms (bloating and gas) from ingredients such as guar gum and locust bean gum.

Live Cultures vs. Probiotics

All yogurt contains live bacteria because bacteria are required for fermentation. These traditional starter cultures convert milk into yogurt and create its characteristic texture and tangy flavor.

Some yogurts may contain additional bacterial strains marketed as probiotics. These strains are selected for potential health benefits beyond the fermentation process and are often studied for their effects on gut health and digestion.

In other words: All probiotic yogurts contain live cultures. Not all yogurts with live cultures contain added probiotic strains.

What About Organic Yogurt?

Like the United States, Greece and the rest of the European Union have conventional and organic dairy farming systems. Greece follows EU regulations, so the rules governing pesticides, additives, organic certification and food safety are largely established at the EU level, not by Greece independently.

Unless any farm is certified organic, its milk and yogurt are considered conventional by default. Many smaller European dairy producers do not pursue organic certification because of the costs, paperwork, inspections, and ongoing administrative requirements involved. In local markets, certification may provide little additional value when consumers already know and trust the producer.

The European Union and the United States approach agricultural regulation differently.

The European Union generally follows a more precautionary approach, sometimes restricting certain agricultural chemicals or additives when scientific uncertainty exists.

The United States tends to use a more risk-based approach, allowing products that are considered safe within established exposure limits.

As a result, farming practices and its use of pesticides face greater restrictions in the European Union than in the United States.

What about grass-fed yogurt?

In Greece and much of the EU, sheep, goats, and cows often graze on pastures, especially in rural and mountainous regions. However, this does not mean all Greek yogurt is ‘grass-fed.’ Unless a producer specifically states its feeding practices, the animal diet is usually not disclosed. In the EU, pasture-based feeding is often more of a default system shaped by climate and tradition rather than a marketing label. In the U.S., ‘grass-fed’ is more commonly used as an explicit marketing claim with defined labeling standards.

What about Greek yogurt vs Greek-style?

‘Greek-style’ typically means the thickness comes from formulation techniques, such as added milk proteins or stabilizers, rather than traditional straining after fermentation.

In Summary...

Traditional Greek yogurt emerged from a culture of fermentation and straining.

Modern American Greek yogurt evolved within a food system focused on protein and consistency.

They both reflect different priorities.

Some American manufacturers will produce Greek yogurt in the most traditional sense.

Many others will continue to modify existing Greek yogurt formulations to adhere to modern trends, supporting a culture that continues to want protein and consistency.

And my client? He learned what to look for when choosing Greek yogurt.

And in addition, he learned how traditional yogurt from Greece was transformed into an American food product…

…but our conversation was a very condensed version!

He then asked THE most important question...

“Is Greek yogurt PrimalMed approved”?

PrimalRD said...

“It depends...look for plain Greek yogurt with a short ingredient list - milk and live cultures. Probiotics are a bonus. PrimalMed approved!

Added sugars, artificial sweeteners, and fruit on the bottom? Not PrimalMed approved. Better to control your own added ingredients…frozen berries, or chopped fruit. That ‘fruit on the bottom’ is often a sugar-filled puree or juice concentrate.

Added stabilizers? Not always harmful but not really necessary. A good Greek yogurt has fewer added ingredients and can be thick and creamy on its own.

Protein concentrates? Not inherently bad if trying to achieve higher protein goals, however, a well-made Greek yogurt can achieve good protein content through quality milk and straining alone. PrimalMed approves foods that naturally contain protein rather than added engineered products.

Sheep milk yogurt is often closest to traditional Greek yogurt - richest and most nutrient dense, and naturally higher in beneficial fats and certain minerals. Goat milk yogurt is another great option, and many find it easier to digest due to its different protein structure. Both are PrimalMed approved.

I prefer full-fat yogurt - it’s closest to its natural form, contains beneficial fatty acids and naturally carries the fat-soluble vitamins A, D, E, and K. Full fat is often most satiating. However, non-fat or low-fat varieties may align with your preferences and nutrition goals.

And try to choose organic and grass fed dairy if concerned how the feed was grown and what the animal ate.

I do believe you are what you eat ... ate!”

Lastly, my client then asked... “so where do I find this best Greek yogurt?”

I smiled.

“Go to Greece.”

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on the PrimalMed website.

In May 2026, an intrepid team of Metabolic Health nerds set out on a journey. A journey that took them to the shores of the Aegean Sea. They first landed in Athens, Greece.

They were in search of a prized artifact treasured by the ancients Greeks dating back to 500 BCE.

Gleaning clues found while scouring the pages of ancient Stoic scriptures, they first searched the ruins of the Parthenon.

But no luck.

Their quest then took them to the island of Paros and a search along the ancient Byzantine Road, a 1000 year old marble and stone path connecting the villages of Lefkes and Prodromos.

Again, no luck. The team was dismayed, but not discouraged.

Under the watchful eyes of Zeus and Athena, they continued on. Like Odysseus, King of Ithaca and war hero, they would not be denied in their quest. The Gods of Ancient Greece were by their side.

Their odyssey then took them to the volcanic isle of Thira, also known to us mortals as Santorini.

And there, while hiking the rocky, jagged paths along the volcanic caldera and under the watchful eyes of Athena, the discovery was made.

Between two stones, wedged up against the retaining wall…

The sought after ancient instrument that had guided the people of ancient Greece since 500 BCE.

The PrimalMed pen!

But is this JUST a pen? What does it represent?

The pen is a tool.

A tool for Zeno, the father of Stoicism. A tool he used to script the philosophy that would guide ancient Greeks and subsequent generations.

But for us, it is a tool we take with us on OUR journeys, that reminds us to reconnect with our ancestral past, slow down and OBSERVE how we connect with our environment.

For PrimalMD and RD, our trip to Greece represents our way of ‘going home’…re-connecting with the inputs that matter MOST when thinking about our Metabolic Health.

With apologies to Thomas Wolfe, I submit that you CAN go home again. Odysseus would agree. His long journey was ultimately a quest to rediscover what mattered most. Returning home. Returning to his faithful wife Penelope. For 20 years he persisted. Battling Poseidon. Thwarting the evil Cyclops. Resisting the allure of the bewitching song of the Sirens.

So easy to get distracted by the lure of our modern day Sirens…

Namely, the iPhone. The iPad. The constant barrage of information that often does not have our best interests in mind, The marketing. The ultra-processed food. The daily onslaught of advice from ‘Wellness Influencers’ that really have THEIR best interests in mind. The Wellness-Industrial complex is not your friend.

The PrimalMed Pillars of Metabolic Health, namely diet (nutrition), exercise (movement), stress mitigation, sleep, and community are NOT found in a supplement bottle, a magical red-light device, or a myopic focus on individual labs values or restrictive eating patterns championed on YouTube or Instagram.

PrimalRD spoke of this in her recent post! You are what you scroll! Resist the Sirens! And ‘go home’ and go back to paying attention to the ‘obvious’ BEFORE running towards the ‘esoteric.’

So what did WE learn? And HOW can our observations translate to a meaningful message to you, our faithful readers?

It all starts with OBSERVATION. This may seem so very obvious right? But DO we really take the time to slow down, and make observations about us and our surroundings? About our inputs?

Our food. Our movement patterns. Our social and family connections. This may be why many take a ‘vacation.’ To slow down and disconnect.

When we toured the Parthenon, I was enthralled by the symmetry of the columns. As a Radiologist, I was trained to first OBSERVE, before making a conclusion or diagnosis. And I observed that these pillars looked perfectly straight. From every angle. But they are not. Our guide explained…

The Greek architects observed. And they knew that human perception is deceiving. The guide explained that the Greek engineers utilized a design concept known as entasis, with the columns subtly swelling in the middle. From far, the illusion is perfect symmetry. And that’s what I saw!

AND, they used the PrimalMed pen to scribe their calculations and observations (or so the legend goes).

Learn all about how the Parthenon was built!

and

here too!

After Athens, we ventured on to the island of Paros, and walked the Byzantine Road. I was really only concerned with not tripping on the jagged, rocky stones…but our guide taught us to go SLOW and OBSERVE. The thyme growing between the stones. The scent of oregano. The herbs used by the locals for centuries to enhance and complement their dishes. No food dyes or additives here!

We walked this path down to Prodromos, much like merchants had done over the past 1000 years.

And we finished with a traditional Greek mezze-style lunch in a small Taverna. Sitting around a table were 5 old villagers. All in similar white shirts, with sleeves rolled up. Enjoying pork gyros, fava beans and dolmas stuffed with all sorts of minced meats. A bit of local wine. Laughing and sharing stories in a communal experience. Our guide told us that this crew was here every afternoon. And so were the legions of stray cats congregating about our table.

Something about cats and Greece? If you know…leave a comment!

SO

What did we OBSERVE at this small Greek Taverna?

Community. Laughter. And eating real, whole, traditional foods served in small plates and portions.

Now THAT is PrimalMed approved!

Same thing in Santorini. OBSERVATION. They say Santorini is the MOST beautiful island. It is. The whole island is volcano! White and blue homes and churches built INTO the volcanic slopes. In harmony with Mother Nature.

Our hike around the caldera, from Fira to Oia was a 4 hr, 10 km. exercise in focus and observation. What did we observe? Apparently, there are NO flat roads or paths in Santorini. Hills. Hills. And more hills. But the PrimalMed team conquered the rocky and silty terrain. No trips or spills (or as I call it…’losing my footing.’)

And steps. Lots of steps.

Wide steps. Narrow steps. Steps built up on rocks.

Smooth steps. Slippery steps. Even steps with chicken pox.

A nod to the Pillar of meaningful, sensible movement and EXERCISE: Walking. And varied terrain. Climbing and descending steps COUNTS as concentric and eccentric resistance training! And not falling required attention to our balance and core stability.

Much of what we do starts with OBSERVATION. We just might not recognize it as such.

In our Metabolic Health space, we OBSERVE what happens when people eat real food. What happens when they incorporate resistance training and build muscle. What happens when they eat in alignment with their circadian rhythms and walk after meals. Easy stuff, right? Obvious, right?

Look in the mirror and OBSERVE.

What you eat, how much you eat, when you eat.

How you move. How often. With sensible effort and intensity.

What you read. What frames your thoughts and beliefs. Doom scrolling vs. embracing community with friends and family.

“You’d be surprised what you see, when you take the time to look.”

- PrimalMed 2026

If you are so inspired, pick up Homer’s Odyssey, or at least a modern reinterpretation. Sit on your porch with an espresso and observe the stillness around you. If you can do it while overlooking the hills of Santorini, so much the better.

TL;DR:

This post may fall into the ‘No sh*t Sherlock’ or ‘this is so obvious category.’

Or is ‘going home’ to our basic PrimalMed principles just the right message for today?

“Embrace the Obvious before chasing the Esoteric.”

- PrimalMed 2026

I admit that I am feeling a bit introspective after this trip, so please indulge my philosophical musings. I’m sure Zeno and Aristotle would approve.

And as always…enjoy these reflective tunes for your pleasure. Going Home Again…The Carole King classic and an under the radar gem from Sir Elton.

And to bring it up a notch, I had to include this ‘Greek’ inspired rager that was THE FRAT anthem from 1980.

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on the PrimalMed website.

The other day, I was chatting with a PrimalMed reader. She mentioned how you can start off reading about food on social media and the next thing you know, you are pulled into a steady stream of content that slowly reshapes how you think about that food.

The content? Most are not generally centered around healthy foods.

They emphasize, and OVER emphasize a ‘low calorie’ approach to weight loss.

Many will follow this dietary mindset, not because it feels healthy, but because they are told it performs.

This is why the social media model works. Exactly as intended. Grabbing one’s attention and reinforcing the idea that trendy diets and ‘diet foods’ are the answer to weight loss.

So, what do we see on these social media platforms?

Quick clips of ‘low calorie foods’

Persuasive images of ‘low calorie swaps’

Engaging reels of ‘what I eat in a day’

Over time, the cumulative effect on some readers is subtle but real. Repeated exposure to these messages rewires how we think about food. Calorie counting is convenient, easy to implement, and feels like the most rational way to stay in control.

Is Diet culture a new phenomenon?

No, it’s been around for decades.

Pre-internet exposure came through TV commercials and magazine ads.

The low-fat diet obsession that started in the ‘80’s and 90’s, and continues today, drove home the message that FAT was the enemy. 100-calorie snack packs became the darlings of the diet-conscious food companies. And the smart phone brought us constant engagement with calorie-counting apps.

And then…the exponential rise of the newest social media apps changed the delivery system entirely!

Instagram and TikTok turned food into entertaining visual content, and then, dramatically turned that visual content into influence. Visual appeal and calorie counting took center stage and often outweighed the true role of sensible nourishment. Within the last few years, we’ve seen more and more posts, algorithmically tailored to the viewer and curated with simple hooks that offer the promise of fast, calorie-driven weight loss.

Content creators and influencers learned that low-calorie focused messaging drove engagement. Reader engagement drove… Ka-Ching, Ka-Ching...

The medium was feeding us a ‘diet’…but nutrient dense, it was not.

The result was a growing disconnect from genuine hunger signals. The body’s own feedback system was masked by external cues.

So why does this Diet Culture content work so well on social media?

Weight loss sells. Algorithms reward content that is extreme, simple, and promises fast, visible results. Who wants to work so hard for the delayed gratification of achieving long term nourishment?

Calorie models are easy to market. A single number, a calorie count, is easy to package into a short digestible clip. Who wants to sift through the complex topics of the gut microbiome, hormone signaling and metabolic health?

Influencers are incentivized. Sponsorships, coaching programs and affiliate deals often reward this quick weight-loss, focused content. But why focus on restriction and quick results? Because it sells. Ka-Ching!

But we missed the BIGGER picture.

Food is nourishment, the information that supports cellular health. It is not a calorie target.

Our reader was right on. ‘Diet culture’ as emphasized on social media was focusing on calorie targets, not nutrient quality.

A more grounded approach doesn’t necessarily ignore calories. It just puts them in context. It’s not just how much you’re eating, but also what your body is able to do with that food.

Food Quality matters.

Focusing on calories alone isn’t the answer. Two meals can have the exact same calorie count yet affect your body in completely different ways.

A 500-calorie meal made from ultra-processed ingredients can be engineered and marketed as ‘light’ by using artificial sweeteners and removing fat, while adding refined starches, emulsifiers and fillers. But despite the calorie count, that meal may still spike blood sugar, blunt satiety hormones and fail to provide the nutrients your cells need to function well.

A 500-calorie meal built from quality protein, healthy fats, and fiber-rich vegetables does the opposite – it provides the raw materials for stable blood sugar, muscle maintenance, hormone balance and cellular repair.

In other words, two meals can have the same calories, but produce completely different physiologic outcomes.

Over time, a diet centered on calorie cutting, ‘sugar-free’ products, and ultra-processed low-nutrient foods, mostly engineered for profit and taste, can dull hunger and satiety signals.

Despite your best intentions, you may find yourself beset with fatigue, increased cravings, and blood sugar swings that are not failures of willpower.

They are signs that the body craves nourishment.

What does the body actually need to function well?

The PrimalMed Perspective:

A model built on nutrient sufficiency, not caloric deficiency.

A model built around sound physiology, not caloric ideology.

A model built around slow, sustainable goals, not quick wins.

🌱 In other words, a meal plan that emphasizes the relationship of the nutrient-dense, minimally processed macro and micronutrients your body efficiently utilizes to function, adapt and thrive.

Protein → builds and repairs muscle and tissues; supports enzymes and immune function and helps regulate satiety signals

Healthy fats → support hormone production, brain and nervous system health, cell structure and provide long-lasting energy

Complex carbohydrates (including fruits, vegetables, whole grains) → primary energy source for the body and brain; fiber supports digestion, gut health, and helps stabilize blood sugar

Vitamins & minerals (micronutrients) → act as cofactors that enable thousands of biochemical reactions that are vital for cellular health.

Water → essential for nearly every bodily process: digestion, circulation, temperature regulation, nutrient transport, and cellular function

Remember, the food you eat is information for your cells. It is a signal that allows your cells to activate the messenger hormones (insulin, cortisol, thyroid, leptin) and peptides (GLP-1) that will either contribute to or detract from your health.

Understanding this perspective, the PrimalMed model, yields the best long-term results with my most successful clients.

Social media is simply a medium.

Depending on context it can have a positive or negative message. What you do with the medium, is what counts. Social media content can certainly be an avenue for learning and engagement. But understand that it also functions as a product with flashy hooks and financial incentives that may not be fully aligned with your best interests.

Remember the next time you see that engaging Instagram reel...

Stop. Think twice.

Does the information support achievable, sustainable habits?

You are what you scroll. Consume this information with a new wise perspective…

The PrimalMed Perspective.

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on the PrimalMed website.

Couldn’t resist.

So who here has a case of wonky knees? Can I see a show of hands?

Hmmm…more than just a few.

And when our knees ache…it’s only natural to blame the knee. We touch, poke and prod at and around the joint, hoping for relief.

But instead of pointing our fingers to the actual knee joint as the only culprit…perhaps we should consider that it’s not JUST the knees.

I humbly submit that WEAK glutes and hips and hamstrings are the accomplices!

Wonky knees? Think upstream. Look north to the glutes!

Do NOT underestimate the importance of strong and functional buttocks.

Kramer knows this. And so should you.

As a refresher, I urge you to read my post from October 2022. Click link below and enjoy some of PrimalMD’s earliest works.

Wonky knees? Today’s PrimalMed Prescription from Oct 2022

Here’s the backstory (pun intended).

A few months ago, Primal RD and I were at a Metabolic Health Conference. Four straight days of lectures. I sat. A lot. My OCD self needed to compensate for my sloth. So every morning at 6 AM it was an espresso fueled aggressive gym workout complete with kettle bell squats and jumping rope. In no short time...my knees were sore. But more than sore. The chronically torn cartilage (medial meniscus) in my right knee became uber-angry and I had a nasty flare! Swollen knee. Stairs became difficult. The knee doth betray me. It was wonky, wobbly, and weak.

All of a sudden!

But was it really ‘all of a sudden?’ Or were underlying muscle weaknesses that had been brewing over the past few months the ingredients that made this pot boil over?

Weakness that did not allow my leg to absorb the stressful impact of overzealous exercise.

Alas poor knee I knew ye well.

So I paid a visit to my friendly physical therapist.

I lamented about my puffy, angry knee.

She told me to hop up on exam table and lie down flat on my stomach.

“Now contract your Right butt cheek,” she said.

“What about my knee?” I asked.

“We’ll get to that in due time,” she replied. “Now squeeze that glute!”

I tried, and as I did, noticed my Rt knee and thigh had lifted off the table.

“Now try it again, but focus on keeping your knee and leg down on the table. I want you to isolate and contract ONLY your glute.

Couldn’t do it.

“You Sir… have a case of Dead Butt Syndrome.” she proclaimed.

Read more here!

And read about it in the NY Times!

You see, if you sit on your arse too much, the butt muscles shut off. And if the muscles in your butt…namely the Gluteus Maximus, Medius, and Minimus, are dormant or don’t fire up properly, the burden and strain on the downstream leg muscles like your quads and hamstrings are amplified. (Quads= front of the thigh. Hamstrings=back of the thigh).

And if THOSE are weak, then your knees bear the brunt of the applied forces when you stand, squat, or climb or descend stairs.

The knee is simply a hinge joint. The cartilage, and tendons and ligaments in and around the joint provide cushioning and control the hinge motion in a stable, safe and secure fashion.

“But it all starts with the GLUTES,” she explained.

Those muscles need to be awake and fire properly so the chain of command is obeyed. The GLUTES give the marching orders so to speak and the quads and hamstrings fall in line. Any weak link, and the knee takes the hit.

“So what do I do?” I asked.

“We gotta turn ‘em on. We gotta take those glutes and turn the lights back on.”

This is how I think of it…

The POWER in your leg comes from above…the glutes, hip muscles and the hamstrings and quads.

The SPRING or bounce comes from below…the calf muscles and the achilles tendon.

You want both. You need both. Power AND Spring.

And if you ignore the power and the spring, your healthy knee soon becomes your wonky knee.

Let’s start with the glutes. Yo butt.

GLUTES: The glutes are composed of 3 muscles. The large one you feel when you squeeze your cheeks is the gluteus MAXimus.

When you step, squat, and walk or run and your foot plants, the thigh bone rotates inward. And if the glutes are weak, it rotates too much and your kneecap (patella) doesn’t track quite straight. The cartilage underneath the kneecap can get irritated. And when the kneecap is angry, some fluid builds up (that’s called a joint effusion). Fluid build up can prevent the joint from hinging smoothly. The tissue that creates the fluid (the synovium) also gets irritated. Irritated synovium then releases (or secretes) inflammatory molecules called prostaglandins. And voila… your knee hurts!

HIPS: How about the hip muscles? Well let’s focus on the gluteus MEDius. It is the smaller sibling of MAXimus and sits deeper. If you lie on your side, you can sorta feel it as a dimple or pit near the hip when you lift your leg.

If your glute medius is weak, then your hip caves in a bit when you run or walk, and that also transmits too much force on the inside of the knee.

HAMSTRINGS: Now along the back of your thigh lives the HAMSTRING muscles. The hamstrings are interesting (at least to me) because they cross both the hip and knee joint. They help to flex the knee AND stabilize the shin. If your hips or hamstrings are weak or ‘turned off,’ then they lose the power and ability to absorb impact. They lose their ability to counterbalance your quads. This in turn creates an unequal pull on the patella and transmits increased force in to the knee joint.

CALF: Weak calf muscles? The achilles tendon loses its spring and you can’t absorb impact forces as well. The knee takes the hit.

It is always better to pay attention to these muscles and keep ‘em strong and resilient with some mobility and strength training, SO you don’t wind up on the PT’s table, prone, and glute-deficient!

Now, this puzzle is far from complete, as there are other players;

The iliotibial band (the IT band), the shin muscles, the quads as well as the connective tissue that overlies the entire leg called the fascia.

These all play a role re: how the knee absorbs impact and functions.

But today we are laser-focused on the glutes. If your glutes are sleepy, then everything else suffers.

PRE-HAB beats RE-HAB. Every time.

So at PrimalMed, we ask…How do we go from KNOWING to DOING?

What moves can we do to address those sleepy glutes?

First, my disclaimer.

Now, although I am an MD, I am not YOUR MD. Nor am I a licensed physical therapist. So if you are acutely injured, and your knee is wonky, painful or even worse, locked and of limited mobility, then see your friendly PT or orthopedist.

The goal of this post is to educate. To stress the importance of training and ‘pre-habbing’ the posterior chain muscles, and in particular, the GLUTES, so your knees can remain functional and pain-free.

And comprehensive rehab includes an assessment of not only the glutes, but everything from the feet and ankles all the way to your core and back and shoulders!

But for me… it was a case of the sleepy butt.

So here’s the first rule in medicine…’First Do No Harm.’

So with respect to any exercise:

If something hurts, don’t do it.

If something feels off or wrong, don’t do it.

But if it feels OK, here are some basic and popular moves to help wake up those glutes. Moves to turn ‘em on again.

Glute Bridges: Lie with your back on the floor, knees bent, close up to your butt. Try to drive your hips to the ceiling and squeeze those glutes! Can do one leg at a time or both legs together.

Hip-hinge squats: Not your usual squat. You sorta start to sit back and push your hips back and then bend your knees, keeping your shins vertical and your knees behind your toes (like sitting on a chair). Heck, doing ‘sit to stands’ with your butt back really can make the glutes burn. You may feel the quads on this one, so if you can push back a bit more, you’ll hit the glutes.

Reverse lunges: Doing a lunge, stepping back rather than forward loads the glutes and hips with less pressure on the knee. In my experience, the classic forward lunge puts too much pressure on the knee.

Clamshells: This targets the outer hips and glute medius. Lie on your side, knees bent on top of each other with feet together, then contract the butt to raise the top knee away from the bottom knee (visualize opening a clamshell).

Now… these are just a few. These are all done with your own bodyweight. Some PTs like to use stretchy bands as well. You can go on YouTube to see the tutorials. And please work within your own limitations.

If it hurts. Don’t do it. PAIN = NO GAIN.

BUT if you are in pain, of course you can turn to the usual therapies of heat, compression sleeves or even some pain relievers. But they are band-aids that mask the underlying muscular dysfunction. I am not a fan of NSAIDS or Steroids unless absolutely necessary. Excessive use of NSAIDS can cause gut and kidney issues.

Using Turmeric as an anti-inflammatory, as a more holistic approach, requires caution as too much may cause liver issues. Same with Tylenol. So if you need that band-aid, I would say, use the most minimal dose, and speak to your MD.

TL;DR:

Here’s the deal; If you sustain an acute injury like an ACL or meniscus tear from trauma or sport…then it’s time for professional orthopedic evaluation and treatment.

If your knee is chronically wonky or achy, don’t assume it is only a KNEE problem.

To really fix the issue, you MUST address the root cause.

Pay heed to the supporting upstream muscles. Strong and functional glutes are your secret weapon!

Sublime buttocks ARE PrimalMed approved !!!

So PrimalMed readers…do you have sleepy glutes from sitting on your TUSH a bit too much?

Say goodbye to ‘Dead Butt’ syndrome.’ And wake up those glutes.

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on the PrimalMed website.

to this?

Have you heard about the latest health trend for 2026?

It’s called ‘Fibermaxxing!’

Wha? Adding gobs of fiber and fiber powders to everything?

Thanks to Tik-Tok and Reddit and Instagram and the need for quick hits and solutions for the health-curious, every year deserves a new cataloging of what will be trending. Get with it man. Get on board the fibermaxx train!

Butter coffee? That is SO 2018. Last year it was all about PROTEIN. Sure it is important, but protein donuts? Protein added to everything? It’s all a money grab, right? Marketing. The protein thing was probably aimed at the GLP-1 market.

Fibermaxxing? Do we really NEED to feed in to these fiber fanatics?

That’s what the influencers say. Add fiber powders and chia and flax to EVERYTHING! But will that make you healthier? Perhaps this year’s trend is sponsored by BIG FIBER. I don’t know.

Here’s the deal. Fiber has been around since…well, forever. Even Nana knew about prunes and a healthy bowl of steel-cut oats to help the ‘muggin.’ (That is yiddish. IYKYK… and for those who don’t, look it up).

So what’s up with Fiber? What is it? And why is it important? OR.. is it really that important? And if so, do we need a little, a lot, or do we take it to the MAXX!

Is there more to fiber than just colon health and voluminous poops?

I posit that there is indeed MORE to fiber than meets the eye. There is a Metabolic Health angle here. Of course there is!

So let’s dig in.

First, a back story, and then a discussion of the potential benefits.

And then a counterpoint, seen through the lens of the Carnivore/Keto/Low Carb folks, who call out the fiber frenzy as ‘The Fiber Fallacy.’

So the whole ‘Fiber is good’ mantra really started in the late 1960’s and early 70’s, the result of the observations of a British surgeon, a one Dr. Denis Burkitt. He travelled to Africa and Uganda, doing research on colon health and noticed that the native rural Ugandans, who had a diet of grains, tubers, vegetables, etc. produced voluminous, soft, frequent stools… or as some might say…EPIC! Transit time… or time from mouth to anus, was about 40 hours, not 60-70 hours like those on the Western diet.

And he noticed that these folks were free of or at least had lower incidences of colon cancer, diverticulosis, hemorrhoids and inflammatory bowel diseases. Hmmmm he thought… Rapid transit. Epic stools. No bowel disease?

It MUST BE the Fiber! ( Or fibre.. since he was a Brit.)

Here is the link to the back story.

The story of Dr Burkitt and Fibre

So he ran with it… lectured, published books and helped shape dietary guidelines and policy in the 70’s in England. It really was just a hypothesis based on his observations. But what started as a hypothesis soon turned into an accepted truth. You needed your fiber! Bring on the psyllium husk and Metamucil!

But here’s the thing:

From a PrimalMed perspective, including fiber is important for it’s downstream metabolic effects…NOT necessarily for epic sh*ts:

The first thing you gotta know is that there are 2 types of fiber.

There is SOLUBLE and INSOLUBLE fiber. This topic and its importance in various diets is more in PrimalRD’s wheelhouse, so I’ll be basic…

SOLUBLE fiber dissolves in to a viscous gel when taken or eaten with water. Sorta forms a protective mesh in your bowel and colon. So that’s a good thing.

Think oats, legumes, beans, nuts, flaxseed, fruit, psyllium husk. This fiber feeds the bacteria in your colon (For science geeks, the fiber is known as a PRE-biotic and the gut bacteria that feed on the fiber are the PRO-biotics. These bacteria then produce or ferment these molecules and produce POST-biotics, namely short-chain fatty acids such as butyrate. More on butyrate soon).

INSOLUBLE fiber does NOT dissolve. It helps form the bulk in your stool. Think wheat bran, raw vegetable skin, parts of whole grains and yes…celery! This is the secret sauce that speeds things along, IF you drink plenty of water, otherwise, it can clog up the highway…traffic jam on the Van Wyck if you will.

So here is the science, the metabolic health angle that I feel is important and supports the inclusion of soluble fiber.

Here the main points:

Cholesterol management, blood sugar control, and short chain fatty acid production…namely butyrate. Remember that one…BUTYRATE.

Cholesterol: IF your goal is to reduce your total cholesterol and LDL, then soluble fiber can play a role. Fiber such as oats (that contain Beta-glucans) and barley bind to bile acids in the small bowel. The bile acids are excreted. The liver, which MAKES cholesterol, now has a new job and then uses its manufactured cholesterol to make new bile acids, thus taking some LDL cholesterol out of circulation. LDL goes down. That’s my 10 second summary.

Blood sugar: Keep your blood sugar and insulin under control. Soluble fiber as a viscous gel slows absorption of glucose after a meal. It may impede the digestion of some starches. It helps mitigate the glucose spike, and the insulin response that follows may be more muted.

Butyrate: MY favorite topic. Butyrate is one of 3 short chain fatty acids that are produced by the bacteria in your colon. It is important:

Butyrate serves as a source of fuel for the colonocytes (the cells that line the colon). It signals the cells to make GLP-1, which can help curb hunger and has a host of other metabolic effects. The fuel supports these colonocytes and firms up the tight junctions (thus helping to prevent intestinal permeability or ‘leaky gut.’)

And, most importantly, in my opinion, is the role of butyrate as an epigenetic signaling molecule. It acts as an HDAC inhibitor (which stands for Histone Deacetylase.) HDAC inhibitors act at the level of the DNA to influence gene expression towards normal cell differentiation. Abnormal cell differentiation is not a good thing ( think cancer, inflammation and cellular aging).

This is a low-level discussion of the above, as my editor has told me to keep it short! But for those platinum PrimalMed readers, here is a worthy high level discourse on the epigenetic properties of butyrate:

Read more on butyrate here!

Counterpoint: Some (but not all) folks, especially in the keto/carnivore/low carb space think all of this hoopla on fiber is BS.

Here are some of their points:

• Fiber is not an essential nutrient. You don’t need fiber to live. The macronutrients protein and fat ARE essential. Omega 3 and 6 fatty acids ARE essential. Many carnivores eschew all veggie and fruits and take perfectly respectable poops.

• If you have acute inflammatory bowel disease, such as colitis, loading up on fiber may actually make your symptoms worse. Speak to your doctor.

• If you are constipated, logic would say to go hard and load up on fiber. But sometimes the opposite holds true. Here is the link to a recent study where the researchers took constipated patients, had them DECREASE overall fiber intake, and their symptoms such as straining, bloating and abdominal pain IMPROVED!

LESS fiber improved symptoms

While some research points to an associated benefit of fiber intake and decreased incidence of breast cancer incidence, the purported beneficial effect on colon cancer and adenoma formation, part of Burkitt’s original hypothesis, does not always hold up. Here is a link to that study from the New England Journal of Medicine.

Fiber and Colon cancer

Burkitt’s original observations?…perhaps the rural Africans eating traditional diets in the 1960s were not just eating more fiber. Context matters! They were eating fewer processed foods, less refined sugar, less industrial seed oil, fewer preservatives, and living more physically active lives. And maybe THAT was why they had less incidence of the GI afflictions that plague us today.

What about butyrate? The keto/carnivore folks say you can get that from full fat dairy and butter. I am on board with that! Bring on the cottage cheese and manchego.

It is hard to go from observation, correlation and hypothesis to definite CAUSE and irrefutable dogma. As with everything in science, especially nutritional science, things can get messy. There is room for disagreement and cordial discussion. Some folks in the low-carb world do support the inclusion of fiber in the diet.

“Feed the gut” they say. I tend to agree.

So at PrimalMed, we always ask… “how do we go from knowing to doing?”

TL;DR

Fiber is getting a lot of attention these days. Perhaps too much attention? Ignore the Fibermaxxing influencers. You don’t need to go crazy.

What you need is the PrimalMed perspective:

Dietary fiber IS PrimalMed approved.

Include fiber in your diet. It is not an essential nutrient. But try to include some. I do. And don’t forget to drink plenty of water.

How?

Eat a sensible whole foods diet. Remember, we don’t just eat fiber, we eat whole foods that contain fiber. Eat like an adult, with fewer ultra-processed foods, refined sugars and starches etc. Whether you eat (or prioritize) plants and some animals, or eat animals and some plants…you’ll get plenty.

Sorry influencers…the fiber frenzy is not necessary. More is not always better. And too much could actually irritate your gut.

I’m not going to get into recommended doses and grams/day etc. That is not the focus of this post. That’s for your Nutrition Expert.

Because each case is different. And some cases do require a bit of sensible supplementation.

Regardless of the counterpoints made by some in the Ancestral health space, I believe the benefits of soluble fiber with respect to cholesterol levels and blood sugar management are valid. And the role of butyrate, as stated above, seems to play a key role in GLP-1 production and act as a signal to support cellular health. I went from butyrate-curious to a butyrate believer.

So if you want to have your Steel-cut oats with berries in the morning, go at it. Avocado toast? Plenty of fiber. You’ll be fine.

And if you choose to include butter and full fat dairy to get your daily dose of butyrate, you too will be just fine.

But remember…too much can lead to a serious case of Colon Blow!

Music Time!

If you are a little backed up and yearn for some encouragement:

But if you are like those rural Ugandans, and have delivered like a champ:

Our goal is to educate and hopefully be a wee bit engaging. Not every post is short and some are a bit dense and long. But there is always a few chuckles thrown in and a song or two or three at the end.

According to the great philosopher Billy Joel… “if you wanna have a hit, you gotta make it fit, so I cut it down to 3:05.”

Maybe next time…

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on the PrimalMed website.

For the first time in decades, the 2025–2030 Dietary Guidelines finally got it right, aligning with The PrimalMed Prescription…

Eat. Real. Food.

The root cause of chronic diseases, such as diabetes and obesity may lie in our food choices. The new dietary guidelines clearly promote eating patterns that aim to prevent these diet-related chronic diseases.

The message is simple: Prioritize protein, include healthy fats, and limit added sugar. In short, focus on minimally processed foods.

Since 1980, federal nutrition policy has promoted low-fat, high-carb diets, along with subsidized ultra-processed food.

Remember the 1990’s? Americans were told that ‘fat made you fat’ and excessive carbohydrates were overemphasized.

Low-fat everything, grains at the base of the pyramid, and protein took a back seat.

The result?

Increased incidence of obesity, type-2 diabetes, fatty liver disease, early onset of metabolic disease and diet-driven chronic illness.

The biggest shift in the new 2025 guidelines?

Emphasizing quality, variety and real food sources, which supports both healthy eating and metabolic health.

What we eat matters... I have written about this again and again.

A step in the right direction.

For the first time, federal policy names the real drivers of metabolic disease:

• Chemical additives, emulsifiers, artificial sweeteners, dyes

• Refined, industrially produced carbohydrates

• Added sugars

The previous guidelines didn’t fail because Americans ignored it.

The previous guidelines failed us; it allowed ultra-processed foods to be deeply embedded in our food system. You could include all the food groups, stay within your calorie limits, and still wind up eating mostly ultra-processed crap.

• Artificially flavored yogurt counted as dairy

• Refined sugary cereal counted as grains

• Processed seed oils counted as fats

The new Guidelines fix that, focusing on food quality, not just food groups.

What was most impressive in the new guidelines?

Protein is back!

At the center of the plate...and that matters.

Recommendations increased to support satiety, glucose regulation, healthy aging. (1.2–1.6 g/kg body weight; 1 kg = lbs/2.2)

PrimalMed approved!

• Preserves muscle, as lean muscle is our most powerful metabolic organ

• Improves satiety, reducing overeating

• Stabilizes blood sugar (glucose regulation)

• Supports metabolic flexibility and healthy aging

You don’t need to eat rib-eye steaks every night. Lean meats, poultry, eggs and even beans are all perfectly fine sources of protein. Some have criticized the challenge to keep saturated fat at or below 10% of total calories, while emphasizing diets inclusive of animal products. However, both animal and plant proteins are explicitly included in the guidelines.

Whether a diet is animal-based or plant-based, it can still support health - as long as essential nutrients are provided in adequate amounts and deficiencies are addressed. Real food is the foundation of any healthy diet. Supplementation is simply a tool to fill gaps when dietary patterns fall short.

REAL FOOD is in sync with your body’s biology:

Real food provides the nutrients your body recognizes to optimize your key metabolic markers.

Another meaningful shift in the new guidelines?

Full-fat dairy is back.

Because full-fat foods contain saturated fat, staying within the 10% saturated fat limit may be challenging with higher animal protein intake. The new guidelines, however, do move away from fear-based language and toward food-based patterns. The food matrix matters, and saturated fat in the context of healthy carbs and fiber is not inherently harmful. Risk comes from refined carbs + ultra-processed foods promoting insulin resistance.

• Full-fat dairy is no longer automatically off-limits

• Cardiometabolic risk is contextual, framed in patterns, not single nutrients

A deeper dive is below, for those Gold and Platinum readers:

Full fat products have been demonized for decades, but it was the saturated fat that was framed as the villain - largely based on the diet–heart hypothesis, which assumed:

Saturated fat → higher LDL → heart disease.

While LDL cholesterol is an important factor in the discussion of cardiovascular health, it is not the sole indicator of risk.

Often referred to as the ‘bad cholesterol’, LDL (low-density lipoprotein) carries cholesterol through the bloodstream and may, in some circumstances, contribute to plaque buildup in arteries.

However, not all LDL cholesterol levels indicate the same risk for heart disease.

A comprehensive assessment that includes the following, provides an understating of an individual’s true cardiovascular risk.

1. Cholesterol Subclasses: Cholesterol isn’t just ‘good’ (HDL) or ‘bad’ (LDL). LDL comes in different sizes and types. LDL subclasses are often grouped into ‘patterns’:

• Pattern A → mostly large, buoyant LDL particles (LDL-A) → lower cardiovascular risk

• Pattern B → mostly small, dense LDL particles (LDL-B) → higher cardiovascular risk

Pattern B means greater arterial risk. Measuring these subclasses can reveal hidden risk even if total LDL appears normal.

Why does saturated fat get a bad rap? Because in some people, it may cause a rise in their LDL. So you need to measure your LDL subtype on your next blood draw.

BUT context also matters.

Recognizing the person’s metabolic health status may play a role in the type of LDL (Pattern A vs B) they express.

2. Metabolic Health: Additional markers and factors may also play significant roles: Insulin resistance, inflammation, high triglycerides, low HDL, elevated blood pressure, and decreased muscle mass all contribute to poor metabolic health. And your LDL will most likely express Pattern B (more atherogenic with an increased risk of atherosclerotic cardiovascular disease).

3. Plaque Burden: The presence of plaque in arteries is a stronger predictor of future cardiovascular events than LDL levels alone. Obtaining a baseline is crucial for assessing risk. I’ll let PrimalMD tackle that in his next post!

https://aarr.org/heart-health-myths-cholesterol-role/ Heart Health Myths: Cholesterol’s Role Under Scrutiny

https://pubmed.ncbi.nlm.nih.gov/30198808/ LDL-C does not cause cardiovascular disease: a comprehensive review of the current literature (published in 2018!)

What else does PrimalMed like about the new Dietary Guidelines?

Less emphasis on refined grains and added sugars.

The new guidelines increasingly favor:

• Carbohydrate sources from predominantly whole, intact foods

• Fiber from vegetables, legumes, and minimally processed plants

• Reduced added sugars across age groups

This also aligns with PrimalMed’s core stance:

Carbohydrates are not inherently harmful; however, highly processed carbohydrate sources (factory made, in a bag or box, with a bar code) are associated with poorer metabolic health.

The guidelines acknowledge metabolic reality. For the first time, the guidelines acknowledge that some individuals with chronic disease may benefit from lower - carbohydrate diets, a major departure from decades of carbohydrate-centric advice. Type 2 diabetes, metabolic syndrome, and insulin resistance aren’t calorie problems - they’re hormonal and carb-intolerance problems, affecting a huge portion of the population.

The new guidelines allow for personalization, addressing age and life stage, for example higher protein needs to support healthy aging.

Social determinants of health are noted - income, access, education and environment - as limits on food choice. These barriers are recognized. Solutions have not yet been met, but awareness has improved.

Are the 2025 Dietary Guidelines perfect? No.

Many have criticized the New 2025 Dietary Guidelines, noting that their messaging is open to misinterpretation: Critics ask if there is too much protein, too much saturated fat and no clear limit on alcohol? Critics also note that healthy eating as per the guidelines may be cost prohibitive.

Institutional and federally funded food programs such as SNAP and WIC, school lunch programs, and even the military stand to benefit from these guidelines. If implemented as intended, they could meaningfully improve the metabolic health of these populations.

The real question is whether they can be implemented effectively, and at a sustainable cost.

Are the 2025 Dietary Guidelines a step in the right direction? Yes.

Just Eat Real Food. Highly processed foods are discouraged. Prioritize proteins, incorporate healthy fats and limit added, refined sugary carbs.

Here is the NEW Pyramid:

Over the past 45 years, our metabolic health as a nation has steadily declined.

Here is the OLD Food Guide Pyramid from the 1990’s.

In 2011, MyPlate was introduced to emphasize portion proportion.

But our health, as a nation, continued to decline. Time to re-introduce the Pyramid graphic and turn it upside down, to reflect updated nutritional science.

The new guidelines recognize the changes needed to be made to improve our health.

It will take work. The new guidelines reflect progress and a long overdue meaningful pivot. A pivot from old nutrient dogma, away from fat fear, away from carb-heavy defaults.

What do we need?

We need education - real food nutrition, how to read a label, how to identify unhealthy ingredients and how to recognize marketing ploys.

We need accountability - large food companies to phase out artificial ingredients. California is already banning certain dyes, and many other states are likely to follow.

We need reform - aligning subsidies with nutrient density, reforming school and federal food programs and expanding accessible tools for personalized nutrition.

We need personalized nutritional guidance - addressing individual needs to support optimal health-span.

Turning the food pyramid upside down? Yes!

See the South Park take on the food pyramid here:

Turn it upside down!

South Park may have had it right all along.

So maybe I’ll rewatch a few episodes and see what the future holds.

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

Oops, I did it again. And again.

Britney wasn’t singing about nutrition - but she could have been.

Are you repeating behaviors and bad habits you promised yourself you’d stop?

…again and again.

As another new year begins, do you default to old resolutions?

“This year I’ll start the diet.”
“This year I’ll go to the gym.”

What’s new for 2026?

This past year has seen a surge in the use of GLP-1 receptor agonists. The clinical data and benefits are well documented.

GLP-1 (glucagon-like peptide-1) is a hormone naturally produced in the gut that plays a key role in appetite regulation, glucose-dependent insulin secretion and gastric emptying.

GLP-1 receptor agonist medications mimic these hormone effects, resulting in reduced appetite, weight loss and improvements in metabolic and cardiovascular risk factors, with emerging data on brain and gut health.

Documented benefits include:

• Improved blood sugar regulation

• Appetite and weight regulation

• Cardiovascular risk reduction

• Neurobehavioral effects

• Gut and liver benefits

• Anti-inflammatory and hormonal effects

But important clinical questions remain:

• How long should someone stay on these medications?

• Should we continue to suppress our natural hunger cues?

• What do we know about long-term use?

GLP-1’s are a tool - not a replacement for foundational habits.

As discussed in a previous PrimalMed post, the satirical film Sleeper reminds us that scientific ‘truth’ is often a moving target. ‘The Science’ is fluid and constantly evolving.

In Nutrition, recommendations and guidelines shift repeatedly, often in response to new research and data.

• Are eggs good or bad?

• Is fat the enemy – or sugar?

• Red meat? Dairy? Plants or Animals or both?

Pharmaceutical interventions, like the GLP-1s are no different.

Should these medications be thought of as a quick fix? Or a revolutionary metabolic intervention? -PrimalMD

Quick fixes may work short term. New habits work long term.

For many, GLP-1 medications work.

However, when stopped, especially after rapid weight loss, biological adaptations may be triggered:

• Leptin (satiety hormone) decreases

• Ghrelin (hunger hormone) increases

• Resting metabolic rate may decline

• Thyroid signaling may shift

• Lean muscle mass may be lost if protein intake and resistance training are inadequate

This is not a failure of discipline.
It is biology - adaptive physiology, and not human weakness.

These adaptive mechanisms often drive a return of hunger unless nutrition, psychology and physiology are addressed, in conjunction with medical treatment.

Earlier in my career, I was referred patients preparing for bariatric surgery. They were required to meet with a Registered Dietitian before their surgery.

This wasn’t optional - it was foundational.

Long-term success was most likely achieved when patients were supported by learning and incorporating good habits – addressing nutrition, psychological drivers and physiological changes related to surgery.

From years of working with clients, I’ve seen that sustainable success begins with nutrition education - the foundational knowledge of food and nutrients. However, education and meal planning alone are not enough; addressing the psychological and physiological aspects of eating are equally important.

Lasting habits yielding successful outcomes requires an understanding of:

• Nutrition Education

• The Psychological “why” behind old habits

• The Physiology related to an individual’s medical history

So how do I start with clients to help them build successful habits?

The PrimalMed Nutrition Framework

Step 1: Define the goal

For many patients, their stated goal is simply weight loss.

For others, their goal might be improving metabolic health conditions such as hypertension, pre-diabetes, non-alcoholic fatty liver disease…

And I tell my patients…

Get healthy first, metabolically healthy, by learning new habits.

The weight loss (if needed) and improved metabolic health parameters will follow.

Step 2: Are you ready?

Find your compelling reason…why you want to reach your goal

There is never a perfect time
Change is a mindset, not a calendar date

Step 3: Assess

We discuss typical eating and movement patterns
We discuss history, labs, current meds and supplements
And we discuss…what has changed over time

Step 4: Create the meal and lifestyle plan - together

Nutrition Education:

Focus on balanced nutrient intake (protein, healthy fats, fiber) - whole foods over ultra-processed foods

Prioritize protein to preserve lean muscle mass

Include fiber rich carbs: vegetables, fruits, beans, whole grains

Understand food labels and avoid marketing ploys

Establish meal timing and frequency that supports efficient metabolism

In fact, PrimalMed nutrition education is so encompassing, I could go on and on for hours… it’s a post on its own!

Psychology:

Identify your intrinsic motivation by finding your “why” beyond weight or appearance

Normalize hunger and fullness cues

Recognize behavioral triggers by noticing patterns and environments that influence food choices

Create a repeatable structure that focuses on consistency, not rigid rules

Set up your environment for healthy choices by keeping nutritious foods visible, planning meals and limiting exposure to temptation

Allow flexibility without guilt

Stop eating when no longer hungry

Assess how your clothing fits

Use apps or journals as tools to track cravings, progress and set measurable goals

Avoid ‘All or Nothing’ thinking: Think in ranges, not rigid rules. No foods are truly forbidden, but frequency and portions matter

…and practice patience since setbacks are part of the process

Physiology:

Engage in consistent movement and resistance training

Prioritize sleep, rest days, and active recovery

Address functional movement - mobility, posture, strength and balance

Maintain or improve health markers

Consider metabolic factors - age, muscle mass, and hormonal shifts

Understand how medications or medical conditions affect appetite, weight, energy and metabolism (i.e., diabetes, thyroid issues, hormonal changes)

Morning sunlight and respecting circadian rhythms

Step 5: Support

Ongoing education

Apps as tools, not crutches

Professional check-ins, group support

Step 6: Reassess and evaluate at 3 months

Making progress? It often comes down to reassessing these three interconnected areas:

Nutrition: Are your improved food choices and habits supporting your goals?

Psychology: Are your old habits, cravings or emotional connections to food still influencing your decisions?

Physiology: Are your medications, medical conditions or your body’s physical response affecting your ability to make or sustain change?

First address the foundations.

If a pharmaceutical intervention, such as a GLP-1 medication is being considered, that decision should be made in collaboration with your healthcare provider.

However, habits matter.

Medications like GLP-1s are most effective when paired with sound nutrition and an understanding of the psychological and physiological factors that influence habits.

To start the New Year, begin with one question...

What habits can you change to strengthen your foundation?

Start with just ONE new habit. Every day.

• Drink a glass of water before meals

• Eat at least a serving of protein per meal

• Walk at least a block after each meal

• Write down a new victory you had today
  

For this new year, it’s about un-learning old habits that never worked for you.

And start with new and improved habits that will work for you…again and again!

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

The days are finally getting longer and 2026 is a-knockin at our door.

Thank you to all of our readers who joined us on our Metabolic Health Journey. Feel free to revisit all of our posts for a refresher. Each post does try to sprinkle in a bit of humor and some carefully curated musical selection or two at the end. Making it fun. Making it engaging. Having a conversation.

At year’s end, we take stock of what we discussed and what we hope to cover in the coming year. How can YOU make 2026 your best year ever?

That’s a tall order, for sure, but I suspect that we all would want to be and strive to be…just little bit better than yesterday. And whether it’s focusing on your mindset or your mitochondria, there are always ways to improve.

Three topics come to mind, as I embrace my own stream of consciousness.

One is the topic of CREATION.

Personal CREATION, and exploring your creativity, can, in my opinion, bring one a sense of happiness, and contentment. And a sense of control and purpose.

What gives us a sense of control and inner peace? And purpose?

Start by accepting this nugget:

Know what in your life is IN your control, what is NOT, and having the wisdom to distinguish between the two.

“Serenity Now!”

And WHAT is in your control? According to the Stoics, only your THOUGHTS and BELIEFS. And those thoughts drive your RESPONSE. Your actions and behaviors.

And WHAT frames your thoughts and beliefs?

Your inputs. What you watch, what you see, what you hear, what you read…in short, what you CONSUME.

Your information diet. So choose your media input wisely.

And your friends, and community. Choose your company wisely.

Balance input (consumption) with your output. Your CREATION.

I submit that we can achieve happiness and a sense of relevance and PURPOSE when we create, for ourselves and for others. When we contribute.

• CREATE goals and challenges for yourself.

Stalled? Finding resistance? Failing? That’s what my dad used to call ‘paying tuition.’ Mistakes are simply ‘teaching moments.’

• CREATE for others. Can you be a role model? A mentor to help others become a hero in their own personal story.

Remember, every day you are the author of your own story. The main character. And you get to write that story every day. The ‘Hero’s Journey’ is a time honored theme in books, and movies as one moves from Victim to Hero, with the help of a Guide (just ask Luke Skywalker in Star Wars IV…. the OG version).

Oh and BTW, if you are interested, I recommend ‘Hero on a Mission,’ by Donald Miller. It is a short book from 2022, that illustrates the intertwining roles we play as victim, villain, hero and guide, every day, as we search for a path to a meaningful life.

Focus more on the ‘CREATE and CONTRIBUTE’…rather than the ‘CONSUME’.

And that will help you find, what the Japanese call ‘Ikigai,’ your own sense of purpose.

Read more on Ikigai

The second topic is:

WRITING.

Writing, like music or any art form, is a sense of self-expression. A chance to share thoughts, stories, and memories.

And, a chance to educate and advocate. A chance to help others. To be a guide. To help others on their own personal ‘hero’s journey.’

For Your PrimalMed Prescription, it is our hope that we can be YOUR GUIDE. Helping you navigate the conflicting media messages on health and wellness topics and become a hero in your own metabolic health journey.

AND we promise to continue to write, as we learn, in the most AUTHENTIC voice possible.

Reality check…AI can write blogs and stories, legal briefs, medical summaries and journal entries at light speed. And perhaps even better than us mere mortals.

Will writing become obsolete?

NO WAY. Nothing, I think, replaces the message that is crafted with an authentic human touch.

And at PrimalMed, we pride ourselves on AUTHENTICITY and that HUMAN TOUCH.

You see those occasional spelling errors, typos, and grammar glitches? Yep. That’s us being authentic and human.

So for 2026..try this.

WRITE. Write anything. Anywhere. Jot down some thoughts on your iPad or on an actual sheet of paper. Then delete it or throw it in the trash if you want (also known as your sh*tty first draft). But you may be pleasantly surprised to see what you are able to create.

And if you don’t write, then READ.

READ some authentic human stuff. Not some AI generated slop.

Ryan Holiday, in his recent book, ‘Wisdom takes Work,’ discusses the importance of reading. Read something. Anything. One page. One book. Everyday. Fiction or Non-fiction. You gain the insight and wisdom and experience of others. The lessons of the past usually ring true today.

You’ll be a whole lot smarter and a whole lot more interesting by year’s end.

Don’t believe me? Just ask Primal Ida, 90 years young, voracious reader and…the most interesting person in Tucson!

And the third topic is MUSIC.

Writing music? A form of artistic expression. Listening to music? A conduit to the primal pleasure centers living deep in our brains. Good music sets the mood. It creates the moment. It can be a vessel of pure pleasure unbridled by the complications of rational thought. A good song can turn a sh*tty day upside down.

Every post has some music at the end. And it is not random. Each song is carefully curated and selected specifically to relate to the post.

PrimalMed reader FloridaMan RL once asked me…”Where do you get your ideas for your posts? What’s your inspiration?”

Many times, the song itself, heard in the car or on a run, is the MUSE that sparks the flame. The creative flow…that results in words on paper and a blog in your INBOX.

So for 2026: Take some time to think less, and live more, with MUSIC. Play it loud. Sing it loud. You’ll feel a whole lot better.

Today’s TL;DR:

Your action list for 2026:

• CREATE. Something, Anything. A new memory. A new story or narrative. It will give you a sense of relevance and agency. It will allow you to focus on what is in your control and tune out what is not. And allow you to he the hero in your story. Creation is the path to purpose.

• WRITE: Putting words on paper helps solidify your thoughts and emotions. And READ printed copy. Written by humans. AI is here. And it will affect what is written and what you read. BUT, the ART of writing is not dead. AI will not replace the raw, genuine and imperfect voice of a real live human. And you get to choose WHAT you read. Your inputs. Choose wisely.

• LISTEN: And not just to yourself and others. I implore you to let loose and LISTEN TO THE MUSIC. Put aside your worries and embrace your ancestral and primal groove. If you wanna sing out, sing out!

“Will we still be writing, in approaching years?”

“Will the things we wrote today, sound as good tomorrow?”

John/Taupin 1975

The PrimalMed 2025 Playlist is on Spotify! Featuring songs from our posts …and a few bonus tracks…What’s your favorite?

Comment below!

So get your groove on. Like this guy…. Rock on Primal-J!

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

Who else but Woody Allen can send a sheepish health nut named Miles Monroe into the future only to discover that everything he thought about health was wrong? Of course, Sleeper (1973) is a satire, but it hammers home the point that, for most health claims…we just don’t know.

To Miles, eating nuts and berries and being organic everything was his way. The right way.

But the experts 200 years in the future enlightened him. Meat, heavy cream and pleasure seeking dopaminergic activities were encouraged.

In Sleeper, people no longer engaged in critical thought, but rather succumbed to the power of the almighty ‘orb.’ A device that provided all the dopamine hits one desired. So prescient, since today, we all clutch our iPhones and rely on the easily digestible answers created by ChatGPT and other AI algorithms.

What we read, and what we see is often determined by the echo chamber in which we reside. This can get VERY messy and discouraging, not just in creating divisive partisan politics, but divisive, partisan opinions about medicine and nutrition, much of which is based on misinformation and pseudo-science.

It’s like 50% of what we read and hear is bullsh*t, but we just don’t know which of that information is the 50%.

The 24/7 onslaught of information, and conflicting messages is here and is not going away. There are rarely clear answers. One day, we read that eggs are bad, the next day, we read that eggs are good. Eating saturated fat? Man, don’t get me started since that topic has morphed in to a political football.

Does anything have to be good or bad or does context matter? HOW the message is sent matters. What makes sense and what is BS? See below, as seen recently in the Wall Street Journal.

NEED to eat saturated fats? The picture above conflates gluttony with evil saturated fats. BUT, in a whole food matrix without the bread and cheese-whiz, and in a sensible portion, they need not be vilified. Now, context matters. How is the research done? On what population? If you are obese, diabetic, sedentary and a smoker, it would seem to make sense to limit the saturated fat since what travels WITH the saturated fat makes the difference.

Cheese has saturated fat. But here is a collection of recent mainstream sources reporting that high-fat cheese is good!

And the MIND diet, supposedly the best diet for dementia prevention? Cheese is BAD, yet conflicting studies say otherwise. (These above and below infographics are credited to Nick Norwitz, MD, PhD from his recent StayCuriousMetabolism Substack post).

Read below link: Bring on the Gouda!

Cheese is brain food!

So science is MESSY and the future, and in particular, 2026, promises to BE MESSY.

So why am I talking about ‘Sleeper?’

‘Sleeper’ allows us to question scientific dogma and recognize that ‘The Science’ is fluid and a moving target. It’s funny. It’s satire. But satire always points to uncomfortable truths. And, as in Sleeper, when people choose not to think critically (and succumb to the ‘Orb,’ the giver of the quick fix and the easy answer), is it too easy to look past the foundations of metabolic health in search of a quick fix? Are we sacrificing our personal agency and responsibility?

The above example on ‘cheese health’ illustrates how nutritional information is still fluid and a moving target in the media.

And pharmaceutical interventions and drugs are no different.

Case and point: The GLP-1 Receptor Agonists.

In select patients, are certain ‘quick fixes’ a necessary component to get many people on the path to achieving optimal metabolic health? Should these medications be thought of as a quick fix? Or a revolutionary intervention?

A question to ponder…

So what’s in store for 2026?

Prediction: THE story that will dominate the medical and nutrition science newsfeeds is…

The GLP-1 Receptors Agonists.

We usually default to the OG term, Ozempic, but there are many variations, some for diabetics and some targeted to treat obesity and metabolic health conditions. The medical terms you may have heard are Semaglutide and Tirzepatide (Ozempic and Mounjaro) but compounded, even more potent combinations are on the horizon. Glucagon-like peptide-1 receptor agonists are paired with peptides such as GIP and amilyn, which are part of the incretin family of hormones.

Are GLP-1s a great medical miracle? Or a quick-fix band-aid for those looking to drop a quick 10 lbs?

Like all things in science, IT DEPENDS. Things aren’t good or bad. That relates to food and drugs. CONTEXT MATTERS.

To be clear: I am NOT an obesity medicine specialist or endocrinologist. The clinical aspects of prescribing these powerful and effective metabolic therapeutics is the bailiwick of these specialists. But I am a radiologist who interprets images of the manifestations of obesity and sees scans of patients in the ER and hospital on the GLP-1s. (And of course, as PrimalMD, continuing my studying and training in the field of Metabolic Health).

Disclaimer aside, what was first thought of (like in 2021 and 2022) simply as a weight loss shot for the lazy and vain are now being understood as a potent therapy targeting the gut, brain, and pancreas in a way that coordinates metabolic function and improves inflammation, insulin sensitivity and cardiovascular risk parameters BEFORE weight loss occurs or even independent of weight loss.

My thinking has evolved, as the data evolves.

They act to restore and improve insulin signaling and metabolic function in patients and the weight loss follows. We always say to clients…you don’t lose weight so you can get healthy, but rather, focus on getting metabolically healthy, so weight loss is a sustainable side effect.

I know many people on the GLP-1s. One person I know has lost 40 lbs and, under the supervision of his MD, tapered off his blood pressure medications. He’s out of his stretchy pants, and back to his size 32 Levis. BUT, he does find the weekly injections irritating.

For the RIGHT patient, in the right clinical setting and UNDER proper medical supervision, these medications can be game changers.

The GLP-1s act by suppressing appetite and delaying gastric emptying. They shut off the ‘food noise’ that clouds many peoples minds. And they reduce food reward signaling.

I know one person, who told me “I am not hungry and I just don’t care about food or eating.” But is it wise to shut off hunger long term? Hunger is a signal, not a problem. It is part of our ancestral DNA. To be hungry. To hunger, if you will.

We are still in the first inning of this game. The science is NEW. What will the next 10 years show? Remember, every intervention, EVERY one, has DOWNSTREAM consequences. BUT, at this point, we just don’t know.

Let’s talk side effects. Weight loss is preferentially MUSCLE more than fat. Loss of lean mass is a problem. Remember, that muscle is the organ of longevity. You gotta pair the GLP-1s with increasing protein intake AND incorporating resistance training.

Nausea and vomiting are real side effects. BUT, there are new drugs on the horizon to counter this, and thus allow better patient compliance.

And if you don’t eat, what about nutritional deficiencies? Are we creating patients that are thin but metabolically fragile?

Many questions.

What do we find in clinical practice?

Sustainable fat loss is BEST achieved through first addressing and changing HABITS.

Addressing your WHY. Your motivation.

That’s the foundation. If you don’t couple the GLP-1s with lifestyle changes (yes, nutrition and movement are the foundational interventions), then the intervention will fail. Side effects may dominate. And in many, the weight WILL come back. As fat. Not muscle.

So, is the future soon the future now?

Buckle up people, because I believe that 2026 will be the YEAR of the GLP!

The ORAL GLPs are coming!

Eli Lilly has orforglipron. Novo Nordisk has an oral type of Wegovy. Viking Therapeutics is developing a pill (VK2735) as a combo incretin to address obesity, diabetes, and MASLD (what we used to call fatty liver or NASH).

And don’t forget the mighty Pfizer, who just acquired Metsera for a tidy 10 billion dollars. The cash-grab has begun.

Pfizer acquires Metsera

Once these are prescribed as pills and not injections, I suspect use will skyrocket. Medicare will cover it. Simply being overweight is now being referred to as ‘Pre-Obesity.’ Not sure how that will play out, but labelling overweight as a disease may in the future allow for more insurance coverage.

Now, this is not necessarily a bad thing, as I am all about people being metabolically healthy. Decreasing the incidence of Metabolic Syndrome and obesity related diseases in the population will perhaps drive down healthcare costs in the future. Now that is a GOOD thing.

As with cheese, eggs, and saturated fat…framing anything as ‘good or bad’ really depends on who is writing the paper, why they are writing the paper, and what conflicts of interest abound. Many think GLPs are BAD, ripe for abuse. Many think GLP-s are GREAT. A metabolic intervention. A lever to pull to help millions of people become healthier.

GLP-1s are just a medication.

As the data continues to show, they can be GREAT for many, when used responsibly, as prescribed by a medical professional.

BUT they can also be ripe for misuse and abuse, driven by profit and misinformation.

PrimalMD and RD, on a recent walk down Beverly Blvd in Los Angeles, saw signs in the windows of Wellness Clinics offering not only infrared sauna and Vitamin C infusions BUT also, get this… Skinny Shots! Off label compounded GLP-1’s. Dose? Who knows? Safety? Buyer beware.

We still get VAL-PAK in the mail and recently included were coupons beckoning us to ‘slim down’ for the holidays with CyberDeals on GLP-1 Injections with free overnight shipping.

NOW…

When the oral GLPs are approved, and this might happen VERY soon, you can bet this horse will not only be out of the barn, but off to the races.

And I suspect off label and compounded pills will be available online as soon you can say “Apple Pay accepted.”

WHAT could possibly come next?

You heard it here first:

OZEMPIC gummies! Now they may be called some other name, but heck, if Viagra and Cialis, as well as CBD with a hint of THC can be packaged in to a gummy, then why not a little micro-dose of a GLP-1? Who doesn’t want to be rock-solid ready to go, skinny, and half-baked, thanks to a berry flavored chew?

(Note: This is conjecture and a bit of hyperbole and satire…)

Crazy?

Let me know a year from now.

At PrimalMed, we ask, “How do we go from knowing to doing?”

Look at your HABITS. Look at your WHY. And see what makes sense.

Our best success with clients comes from addressing foundational interventions: diet, proper movement and exercise to include strength training, and sleep optimization BEFORE resorting to pharmaceutical interventions.

Releasing ourselves to the authority of the ORB as a solution for our ills (as in Sleeper), is no different than us releasing ourselves from the personal responsibility of appropriate and sensible lifestyle choices.

Beware the rise of online scams and promises, which will become more and more prevalent in the future.

GLP-1s and the newer oral and injectable metabolic therapeutics CAN be life saving and game changing interventions, when used for the right reasons.

For the right patient with appropriate medical supervision, complementary dietary and lifestyle interventions, and appropriate plans to ‘off ramp’ the medication.

Speak to your licensed medical professional.

We used to say “You can’t outrun a bad diet” and I would say “ You can’t outrun bad habits with an Ozempic Gummy!” Be smart.

So…what is PrimalMed doing? Reading the literature and the randomized controlled studies. Going to conferences, speaking with the experts. We value DATA over DOGMA. The science is evolving, every day. Our goal is to learn and incorporate the new and changing data to Your PrimalMed Prescription and report back to you!

Oh, and I’m going to eat more cheese!

“And all this science, I don’t understand. It’s just my job 5 days a week.”

John/Taupin 1972

And here’s a tune about the future. Enjoy!

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

What’s my muse? What gets me thinking about my next post and HOW it fits in to the PrimalMed template of optimizing metabolic health, and by extension, our health span?

Usually, it’s a song or current event that sparks my interest, and then I work backwards and retrofit it to the PrimalMed blueprint.

And this past Sunday, October 19th, which happened to coincide with the birthday of my Mom and myself, a team of jewel thieves in Paris pulled off an ‘old-school’ heist. These intrepid fellows were able to, with planning and precision, enter the Louvre, climb into a second floor window in broad daylight and in 4 minutes, get in and get out!

And then escaping on scooters with the sounds of euro-police Citroens wailing behind.

Almost as cool as the mini-cooper chase in the Italian Job (The 1969 original!)

Here’s a link to the Louvre jewel heist story.

The Jewel Heist!

In at 9:34 AM and out at 9:38 AM. 4 minutes!

SO…what can YOU do in 4 minutes?

How about a type of sprint workout?

The PrimalMed Tabata!

The Tabata workout is an intermittent type of workout known to many of our loyal PrimalMed readers (I’m lookin’ at you Florida Man RL).

It is a short but intense intermittent effort:

20 second bursts, each followed by 10 seconds of rest, repeated 8 times.

Let me explain what this is all about:

It’s back to the Japanese!

Izumi Tabata, who developed this type of workout in 1996 and wrote a comprehensive review in 2019, wanted to create an energetically efficient workout. Why? Well, the goal of Tabata and his team of researchers was to optimize the performance of the Japanese speed-skating team! Of course…how could you NOT know that?

In past posts, we have discussed interval training, where we go pretty fast for 3 minutes or so, then slow it down for 3 minutes of so… remember Japanese walking from a few posts ago?

Walk this Way!

And way, way back, I wrote a post on the importance of building your foundation with the introduction of VO2 max workouts, where you row or cycle or run pretty hard for 4 minutes, go slow for 3 minutes and repeat 4 times.

Build your Foundation!

These interval type trainings certainly help build your cardiorespiratory fitness, more so, I believe, than a long, steady pace run for an hour.

Long, slow cardio IS important for most of the time, but varying your pace with intervals sends your body the signals it needs to make your foundation rock solid.

By drawing on the principals of minimal effective dose for maximum results, Tabata and his team developed a short, but intense type of workout that taxed both the aerobic and anaerobic energy systems and thus was able to best stimulate metrics like Maximum Accumulated Oxygen Deficit (MAOD) and Maximum Oxygen Uptake (V02 Max). You get a metabolic boost during and after the workout!

And Tabata stressed that you REST for those 10 seconds, rather than just slow down. This way you gave 100% effort each rep. All the way to rep #8.

Only downside is it can be challenging and exhausting!

The original workouts or Tabata high-intensity workouts were done on an exercise bike.

Here is the link to his original work in 1996

Tabata HIIT training

But incorporating any intermittent intense stimulus, such as squats, burpees, sprints, even jumping jacks works, it’s just that purists like to call that ‘Tabata-style training.’

20 seconds effort, 10 seconds REST. Repeat 8 times.

Warm up first, for about 10 minutes.

Go as hard as you safely can for 20 seconds. Maybe build up that effort if you need. But for the workout to be effective, according to Tabata, you gotta be winded and a huffin and a puffin by the 7th or 8th rep.

Here is a link to an updated perspective.

PrimalMed Gold and Platinum readers…this one’s fer you!

More Tabata.

Occasional sprinting in various forms all improve cardio metabolic fitness, and a Tabata style workout is only 4 minutes long.

Tabata workouts for YOU!

And for those that want to revisit my post from July 2024, this link’s for YOU.

PrimalMed sprints.

NOW, and this is a big NOW…Tabata style workouts are not for everyone.

Not everyone has the necessary fitness to go super-hard on the spin bike or do super-fast jumping jacks and burpees till you are winded. We are not military recruits and certainly not trying out for the Japanese Olympic Speed Skating team.

And remember that although I am an MD, and I am not YOUR MD, so if you have cardiac issues or physical limitations, speak to YOUR MD.

The bottom line is that maintaining and building on your fitness is a journey that never ends…Tabata style workouts (very short intermittent bursts, a form of cardio), and other higher intensity interval type trainings, such as interval walking and V02 max workout - are important components to overall fitness, However, one needs to include low level cardio such as walking, everyday movement and strength training ( bodyweight/resistance bands/free weights).

Are Tabatas Primalmed approved? Of course.

But for many, just starting with a walk is PrimalMed approved!

(And don’t forget strength training, 2-3X/week).

Here it is…

the TL;DR:

4 minutes! What can YOU do in 4 minutes?

Just look at that recent jewel heist in Paris. In and out in 4 minutes!

Certainly, you can muster the motivation for 4 minutes right!

So… CAN 4 minutes of any exercise really make a difference? According to Tabata and the Japanese Speed-skaters, YES.

But as PART of a balanced training plan.

WHAT: Go hard 20 seconds. REST 10 seconds. Repeat x 8. That’s 4 minutes.

WHY: Tabatas work aerobic and anerobic systems and give you maximum cardio-respiratory benefits with minimal time, provided you give it 100%.

MODIFICATIONS: If those Tabatas aren’t for you, any intermittent exercise will do the trick. PrimalMed Walks, Get-Ups, and Pumps!

We may not be as fit as the Japanese Olympic Skaters, but I am certain Dr. Tabata would approve of AND applaud our efforts.

In honor of Dr. Tabata, other 4 minute enthusiasts, and saxophone players from Mt. Kisco all the way to Malibu, here’s a jazzy riff:

and if you have a 5th minute to spare:

Back to October 19th. This past Sunday, the Great Louvre Jewel Heist went down in Paris, but back here across the pond, we all celebrated the joint birthdays of my mom and myself. Here’s to you PrimalEv. Always in our hearts.

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or on the PrimalMed website.

I am certain some of the PrimalMed readers will recognize this gent in the photo. And if you don’t, no worries. Today’s post is short and sweet. No complex chemistry or linked studies on creatine or collagen or your mitochondria.

Today I want to focus on the ‘mindset’ component of the PrimalMed Prescription.

”How do we go from KNOWING to DOING?”

TR was a man of action. A man dedicated to improvement and GSD ( gettin’ sh*t done).

And he didn’t much care for his nickname.

Many celebrated the High Holidays this past week. The Jewish New Year. The Day of Atonement. And all religions do incorporate times of ‘looking inward’ and self reflection. A time to look back on the past year, on your life… and atone.

And recalibrate your path going forward.

So in April, 1910, TR, (no longer President, 1901-1909) gave a speech in France, possibly as criticism to the inaction and his perceived haplessness of the Taft Administration. It is commonly referred to as ‘The Man in the Arena’ speech.

So as I was on a recent run, I pondered this quote and it’s relevance in today’s world.

We all, at some time, look in the mirror. Perhaps when you are brushing our teeth or shaving, or applying your tallow-based moisturizer.

No one else is around. Just you and your thoughts.

How are you doing. Are you just ‘THERE?’ Are you floating about? What is your direction? Are you ‘on task’ and gettin’ sh*t done? Are you creating meaning in your life and the life of your family?

Or are you just ‘consuming?’

Do you stand on the side lines, criticize and complain, or do you step in to ‘arena’ with the risk of failure or disappointment, as you ACT, and go from ‘knowing to doing?’

“THE CREDIT BELONGS TO THE MAN who is actually in the arena, whose face is marred by dust and sweat and blood.”

These are all lofty considerations, but I think it serves us well to take stock of ourselves and our path at least once a year.

The PrimalMed philosophy dictates that you ARE the ‘Man’ in the Arena. You are making your personal choices that take you from a place from ‘knowing to doing.’

And by Arena, I mean your OWN PERSONAL experience. The Arena is YOU.

We can learn all about how to improve our metabolic health as a path towards improving our health span and staving off the chronic diseases that I so often discuss.

But you gotta do the work. You gotta look in the mirror and commit to stepping in to YOUR personal arena.

I am not saying you HAVE to drink your Matcha with Creatine, go do some Japanese walking, and follow it with a breakfast of grass fed bison and pasture raised eggs (although to me that is perfect Sunday morning)!

I am saying that credit will go to YOU… when you look in the mirror and decide to do something, anything, that marks you as a person of action, rather than a person that stands on the outside, and points, as TR notes, how “the strong man stumbles.”

TR had another quote: “Comparison is the thief of joy.”

It is based on the Japanese philosophy of Oubairori, that posits that we, like trees, all bloom on our own personal timeline. What we do on our journey towards achieving our best life, or optimal health span is unique to ourselves.

There will always be someone who runs that race faster. Someone who will be leaner or taller or happier.

If you own a mansion and yacht, know that there will always be someone down the street with a bigger mansion and a yacht. (Thank you Elmer J. Fudd for that analogy)!

No need to compare yourself to others. YOUR arena is YOUR business. It does not need to be shared, posted and liked. You know, deep down, how you are doing and what you are doing.

You do you. N=1.

Comparison is futile.

TL;DR

Being the ‘Man in the Arena’ IS PrimalMed approved.

Do one thing, anything, today, that places you in that arena. And when you look in the mirror, you can be proud, knowing that you are channeling the energy and mindset of Teddy Roosevelt, a man of action and determination.

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

September 29th is National Coffee Day!

Now for me, and those PrimalMed approved java junkies, EVERYDAY is National Coffee Day. But before you head out to Starbucks, or Dunkin for your morning fix, take a pause, and consider WHAT you are putting in your coffee.

When I was growing up, there was only one way to enjoy your coffee. BLACK.

Maybe, just maybe, my mom would throw in a hint of 99% fat free Trim ‘n Tasty ultra skim. Ugh. Dad was straight black. Always.

And that was it. Cream? No way! Not in the fat-phobic 1970’s.

Sugar? Also no way… although I do think there were a few packets of Splenda hanging around. Blasphemy!

But fast forward to 2025, and it seems that there is no shortage of stuff people are adding to their coffee…making a super drink into a super duper drink. (or a super duper dud).

Protein coffee? Butter Coffee? And don’t get me started on all those artificial creamers that turn your magical elixir in to a chemical sh*tstorm. And how ‘bout those plant based milk-like substances made from Oats, and Almonds and Cashews? You may find some with clean ingredients.

Beware that many are replete with all sorts of factory made oils and stabilizers…ugh.

At the recent Metabolic Health Symposium, conversations revolved around WHAT we were stirring in our coffee. Should we just bring it back to black? OR, can we look at some additions to our morning brew that actually might be, from a metabolic health perspective, beneficial.

You can’t beat a black demitasse. Breakfast of champions. Coffee, Caffeine and Chlorogenic Acid.

Caffeine is our most studied ergogenic chemical. As stated before in many posts, it’s stimulant activity comes from preventing fatigue (by blocking receptors for a molecule called adenosine.)

Chlorogenic Acid is the main polyphenol found in coffee with a myriad of antioxidant properties. It is also found in Matcha and Green Tea.

PrimalMed Pivot! Please indulge my nostalgic interlude.

When I was a wee lad, my parents had the ‘No Secrets’ album and loved Carly Simon. My mom, in particular, loved her lyrics and poetry. I mean, Carly was able to rhyme yacht, apricot and gavotte! All in the first minute of the song! But it was the metaphor she used…’clouds in my coffee’ that stuck with me.

What’s with all the white stuff people are blending into their precious java?

Good, bad, or meh?

Here are some ‘clouds’ that come to mind. And they all begin with the letter ‘C.’

Creatine, Collagen, Coconut Oil, Colostrum, and Cream. I could include Cinnamon, and Celtic Salt. They do indeed start with ‘C’ but they don’t quite qualify as ‘clouds.’

Carly created quite a stir with this 1972 album cover, but what about today’s stir-in? Are these ‘stir-ins’ PrimalMed approved?

CREATINE:

It seems that the power of the Internet algos can suddenly and mysteriously elevate any mundane topic to the level of ‘darling’ status. And that brings us to Creatine. Seems that 2025 is the year of Creatine (just behind Japanese walking). The lay press seemingly just can’t get enough of Creatine as a supplement.

What is Creatine actually? Is it a performance enhancing substance favored by gym bros and Hans and Franz wanna-bes? Is it a steroid? Is it banned? Will it wreck your kidneys and make you bloat and gain water weight?

Here’s the deal:

Creatine is not a steroid. It is a molecule produced in the body from the amino acids: Methionine, Glycine, and Arginine. It stores energy, that enables the cell to produce MORE ATP, which is the primary carrier of energy in our body. (Science geek alert: It actually accelerates converting ADP back to ATP by donating a phosphate group, thus quickly replenishing cellular energy stores)

So if you need to crank out some more ATP, in situations that require higher amounts of energy, creatine comes to the rescue. We have always known that for athletic endeavors like power or resistance training, adding creatine can add to your gains. It boost energy availability to our skeletal muscles.

BUT recent studies over the past few years are showing that creatine has beneficial effects on COGNITIVE performance. Increased levels of this peptide may help reduce mental fatigue, aid in memory, reduce symptoms of depression and stave off cognitive decline. Makes sense, since all body systems would benefit from increases in cellular energy. The brain would seem to benefit most since it the most ‘energy-hungry’ organ in our bodies.

Creatine is one of the most studied supplements out there. It is well tolerated by most people, the major reported side effects might be some GI discomfort. Creatine is excreted in the kidneys, so if you have underlying renal disease, or take other medications that might affect the kidneys, I would speak with your doctor.

Minor side effects might include weight gain, but that is really just water weight, as water is drawn into your muscle, and increases the pump, or volume in the muscle. And that is temporary, as your body adjusts and recalibrates.

In the past, people talked about loading creatine at 20 grams, then taking smaller maintenance doses, but, after reading the literature, it seems that you can simply take a scoop, which usually is 5 grams, anytime during the day. Only caveat, is to pair it with fluids… water, smoothies… or even coffee!

I was once told that since coffee is a diuretic, you would NOT want to pair Creatine with your coffee. You want to ADD water and fluids with creatine, not pair it with a diuretic.

Some have opined that caffeine and creatine can somewhat counteract each other, so, if you are looking specifically for muscle and athletic performance gains, then have your coffee first, then maybe supplement with creatine added to water, or other liquids around your workouts (before or after).

For most of us, I think it’s probably OK to just add a scoop to your coffee.

Here’s a layman’s overview from the AARP:

The AARP on creatine

and a more scientific reference on creatine supplementation for bone and muscle strength in seniors:

Creatine for seniors

and

All about Creatine

Can Creatine make you smarter?

If you are looking for the cognitive benefits, as I think most boomers and even millennials should, then just get your 5g in anytime during the day. You CAN add it to coffee. But it’s not necessary to add it to the coffee.

And the dose that the studies claim that is needed to really move the needle for cognitive improvements is in the 10-20g range.

Creatine for brain health

Here’s the next question and one that opens the door to an even more nuanced topic:

Do you really NEED to supplement?

Here’s the deal. Creatine is naturally found in animal meats, eggs, and fish.

Animal products.

If you eat those and get your protein from animal sources, then supplementing is not critical but can be beneficial. I think this is of value to those older folks, who want to preserve and increase muscle mass as well as stave off cognitive decline or impairment. If you do not eat animal products, then you may consider supplementing. There is some creatine in soy foods, nuts and legumes, but not much. Your body will be able to make some.

Buyer beware: Anything that is made in a lab and sold as a powder can be tainted, and contain heavy metals and pesticides. So buy from a reputable source. Brands with Creatine Monohydrate or the label Creapure are best. Those are actually made in Germany. I don’t list specific brands here, since I have no affiliation with any product, but privately message me and we can have a conversation.

So, is this ‘CLOUD’ in your coffee PrimalMed approved?

Creatine in general is a yes. It’s always best to get it in FOOD. But adding 5g, especially for boomers, is probably a good idea. If you don’t eat animal products, then I would say supplementing is a good idea.

But please note, that even though I am an MD, I am not your MD.

N=1. Each person is an individual, with their own medical history. Speak with your personal MD.

For me, I have mixed Creatine in my coffee but actually prefer mixing it into my Greek yogurt, or adding it to a smoothie after my runs and workouts.

COLLAGEN:

Collagen peptides are another internet ‘darling.’ and have been elevated to superfood status most recently, thanks to those internet algos.

But my Nana and I bet your Nana knew all about collagen. Simmer some bones in a stew or make some gelatin? Collagen!

Collagen is a structural peptide. It makes up about one-third of the protein found in our bodies. Where? Think bones, joints, cartilage, and skin. Collagen is like the scaffolding or backbone in these structures. Your body can make it or you can supplement with food or collagen peptide powders.

Collagen is NOT a complete protein…it is mostly made up of the amino acids glycine, proline and hydroxyproline. These amino acids do not contribute to the protein requirements we need for muscle support and repair.

To stave off sarcopenia or muscle loss, you need to incorporate the key amino acids leucine, isoleucine and valine. (These are not in collagen.)

Most collagen supplements are from bovine (cow) hide or marine sources. Some claim that collagen sourced from chicken trachea and scapula are more bioavailable. And some collagen peptide products pair it with Vitamin C, which aids in the uptake of collagen.

But you gotta get it from animal sources, since plants do not produce collagen.

AND, there are many different types of collagen, depending on the structure and individual amino acid composition. For us mortals, most important are

• Type I - skin health

• Type II - joint cartilage health

• Type III - wound healing

But is this all hype? Does that scoop of collagen really make its way in to your meniscal cartilage or do you just pee it out? I think the studies are mixed, with some improved outcomes in small studies.

The recent studies on this focus on the effects in post-menopausal women and fracture risk:

Collagen supplementation in Post-menopausal women

I always think that getting your amino acids through real food is best! We can’t all eat nose-to-tail or eat organ meats or gelatin (which are a great source of glycine). I don’t see much down-side other than cost. Full disclosure, I DO use collagen powders as a supplement, most every day, and usually add it to my yogurt rather than my coffee.

My personal experience is that it never blends well with the coffee and it imparts a gritty taste and texture. I take my morning cup of joe WAY too seriously to mess with my moment of Zen.

Now…does collagen help my joints and cartilage and bone structure? Who knows? I have never done a bone biopsy or biochemical immunofluorescence staining study on myself to PROVE that the collagen winds up in my joints or skin. However I did tear a knee meniscus in October 2022 and then supplemented with collagen peptides with positive results.

That’s my N=1; therefore, I err on the side of ‘maybe supplementation helps.’

The literature does point in that direction.

Collagen supplementation? Does it help?

As with any powder made in a lab… buyer beware. Some cheap brands may contain pesticides or heavy metals. I prefer collagen peptides from grass fed cows, although I recently began using a product made with trachea and scapula.

And…as a source of the important amino acid found in collagen, glycine, organ meats like liver and heart (mixed with bison as a meatball for palatability), are also included in my diet.

I’ll go quick on the last three:

Colostrum? Would you add this to your coffee? Colostrum is a protein found in breast milk. Yep. That’s right. Bovine ‘first milk” providing immunoglobulins and growth factors to the newborn. Do WE adults need it? Not sure. Colostrum can provide immunoglobulins that MAY help with gut health and immunity but I don’t believe that has been proven in humans. It probably can’t hurt. But I don’t think it moves the needle, especially in your coffee.

Coconut Oil? Would you add this to your coffee? Fatty coffee was quite popular a few years ago, when Bulletproof Coffee (blended with grass-fed butter), was all the rage.

Medium chain triglycerides, MCT, found in coconut oil, can provide some quick energy as caprylic acid, a C:8 saturated fat. The C:8 fats act as a source of ketones, which as a signaling molecule has some beneficial metabolic properties and can promote lean body mass. It can promote satiety so you basically eat less. Coconut Oil can increase your HDL which is good. And as a bonus, it contains C:12 fatty acid (lauric acid) which has antibacterial and antimicrobial properties.

BUT...drinking fat adds a lot of calories, and can spike LDL in some people. Too much coconut oil can cause GI upset, which can lead to an urgent trip to the lavoratory. If you are not quick… you may experience the medical condition known as ‘disaster pants.’

Cream? Man, foam up some whipping cream or half and half and my cuppa cappucino is singing! Cream is full of the soluble vitamins A,D,E, and K. And I sometimes add a light dusting of Ceylon Cinnamon (which actually has polyphenolic properties and lowers blood sugar). BUT, to some folks, cream is an addition of liquid fat and calories, so go slow here. Enjoy… but be sensible.

So at PrimalMed, we ask, “HOW do we go from knowing to doing?”

What’s the TL;DR? How is all of this information practical?

Black coffee: PrimalMed approved! Caffeine and Chlorogenic Acid. Can improve mood, energy and has powerful antioxidant properties.

The white stuff or ‘Clouds” in your coffee?

Creatine: I think Creatine, especially for the possible cognitive benefits is PrimalMed approved. It just doesn’t have to be in your coffee. 3-5g in a scoop for muscle strength, support and endurance. Higher doses up to 20g/day may help with cognition. But the safety and science on these higher doses is still being studied.

Collagen peptides? Also PrimalMed approved. It may contribute (and I believe probably does) to joint, skin and bone health. I prefer it in my other drinks or yogurt as well as my coffee.

Colostrum? Hmm. Probably not essential.

Coconut Oil? Maybe. But not essential. I think the addition of MCT and ketones has merit but I always say it is best to INCLUDE healthy fats in your diet and EAT them, not drink them. And no need to ADD extra fat.

Cream? If you are concerned about saturated fat, and added calories, go slow. For me, I might add a tablespoon at most (or add goat milk) and I stick to sensible portions.

The bottom line is that PrimalMD likes his coffee black or with some cream as a flat white, cortado or cappuccino. I do add creatine and collagen to my yogurt and post workout smoothies.

So today on National Coffee Day, and every day, let’s raise a mug to our metabolic health and those ‘clouds’ in our coffee.

Enjoy the music, and the lyrics. Question? Who is this song about? And which rock icon sings backup? Let’s see what you know without referring to your favorite AI source! And please do leave some comments and let us know what YOU put in your coffee.

Let’s add to our cuppa joe by stirring in some JT! Enjoy song #2.

But if you are an OG purist.. then Song #3 is for YOU!

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

You may have noticed a recent theme. The PrimalMed ‘Get Up’, then the Primalmed ‘Walk’, and now…. the PrimalMed ‘Pump’. What’s up with that?

The overarching theme of Your PrimalMed Prescription, and one that we try to consistently address, is that we can increase and improve our health-span by focusing on making our metabolism more efficient. When our cells are working at full capacity, then we thrive.

Metabolism, at its core, is really how we, as humans, take our inputs, such as food, water, and oxygen (add in micronutrients and movement patterns) and create energy, at the level of our cells (mitochondria).

Imagine yourself as a well-oiled machine, (like a 2003 Toyota Sienna with 100,000 miles that just won’t quit…rear mounted 6 CD changer optional). Equip YOUR engine with the best inputs possible and apply the PrimalMed principles we speak of, and I think you’ll have a better than average chance of thriving and staving off the dreaded chronic diseases that we have discussed in posts prior. Get that Sienna up to 200,000 miles!

OK…so where does this PrimalMed Pump fit in?

What is it? Why is it relevant? How does it work? Is it sustainable?

What is it?

I have been reading about the SPU, or Soleus Push-Up lately. The soleus is one of your calf muscles. The Gastrocnemius gets all the glory, since you can see it. Stand up on your tippy toes and look at the back of your calves in the mirror. See those 2 muscle bellies pop out? Those are the gastrocs.

But the soleus, which is the deeper muscle beneath the gastrocs is the unsung hero in this story! Building the deep soleus muscles not only adds volume to the calf and makes you a better walker and runner (each step is an act of forced braking, and the soleus helps you absorb the impact), but ALSO has a very unique role in regulating blood sugar, cholesterol and energy metabolism.

The soleus goes ‘low and slow.’ It is built for endurance, not speed or explosive movements like jumps or sprints. It can stay active for hours, purring along at slow speeds (like that Toyota Sienna), and acts as a major pump…getting blood to return to the heart.

So instead of standing and doing those all to familiar calf raises, the soleus push-up is just a SEATED calf-raise. You SIT, in a chair with your hips and knees at about 90 degrees and raise your heels. You give ‘em a pump.

It’s easy, like REALLY easy. And do it for 50-100 times. Speed is not important. The PrimalMed Pump incorporates variety, so we do them 10 slow, then 10 fast and alternate. Mix it up at your discretion.

Why is it relevant?

The root cause of many chronic diseases, in my opinion, comes down to having a dysfunctional metabolism, at the level of the cell and mitochondria, which is characterized by chronic inflammation and prolonged or too frequent glucose spikes (and the ability of your body to create an appropriate insulin response).

I always say, “Think like a diabetic!” even if you are not. Given that close to 70% of Americans are obese, near obese, or significantly overweight, It think it is reasonable to surmise that there is a lot of undiagnosed pre-diabetes and insulin resistance in that population and the incidence of chronic diseases linked to the obesity and diabetes in that population will only continue to rise.

So if we can employ easy and actionable interventions that are sustainable and can improve our metabolic health, then THAT…my dear friends, is how we go…from KNOWING to DOING.

The PrimalMed pump, along with the walk and get-up fits the bill!

How does it work?

Let’s look at the literature!

Researchers at the University of Houston, led by Hamilton, MT et al, in 2022, found that performing the soleus pushup ( SPU) elevated muscle metabolism for hours, even while sitting. But let’s parse the details.

For the science geeks out there, the SPU sustained oxidative metabolism, or the ability to burn and utilize incoming fuel for hours, as long as the subjects performed the contractions. The soleus muscle selectively uses free fatty acids and free glucose from the bloodstream and spares muscle glycogen stores, as you exercise.

These researchers found a 52% improvement in glucose utilization with 60% less insulin required for over 3 hours after a glucose drink (challenge), as those subjects pumped and activated their soleus for up to 3 hours!

More efficient glucose use while needing less insulin when doing the SPU’s?That’s a big win!

They also found that during periods of NOT eating, triglycerides and a type of lipoprotein called VLDL were reduced. Again, the subjects needed to pump the calves… but it is an easy maneuver with very little fatigue.

We all can’t pump our soleus for hours at a time, but we can sneak in those pumps throughout the day.

Credit to Hamilton and his team for this original research!

Read study here

A recent study from Aug 2025 showed that the Soleus Push-Up had positive effects on lipid profiles with decreased LDL and increased HDL values in the exercise groups.

Read here about blood lipid improvements

And a recent study from 2024 looked at blood glucose levels after meals after subjects with pre-diabetes incorporated the soleus push ups. 32% lower glucose levels!

Read study here

Yes indeed. It seems that the biochemical properties of the soleus muscle (with a predominance of Type I slow-twitch fibers) allow it to act as a metabolic superstar!

This muscle makes up a very small percentage of our total body mass, yet it’s activation is responsible for the robust metabolic benefits mentioned above.

Talk about the Pareto principle at work, right in your very own calf!

Is it sustainable?

You betcha! And no one has to see you pumping away under the table. We LOVE the post meal walk, as well as doing the PrimalMed walk during the day BUT sometimes, you just can’t get outside. If it is too dark after dinner and the bears and coyotes are out and about, please stay safe. Do those PrimalMed Pumps from the comfort of your home.

Bored at work or stuck at the desk? Bang out 50-100 pumps. Alternate slow and fast to keep you engaged. Music always helps. Or, if so inclined, whistle a happy tune, so no one will suspect…you are improving your metabolic health! (Bonus points to readers who get the reference).

TL;DR

The Soleus Push-Up is hereby called ‘The PrimalMed Pump!’ (At least in our tribe). Unlike walking or standing , the activation of the soleus muscle is particularly unique in that it can deliver whole body metabolic benefits while you are sitting and activating that muscle.

And…it’s pretty hard to fatigue. You can always do more.

SO, at PrimalMed, we ask…How do we go from KNOWING to DOING?

Simple. I showed you the science. Are you sitting down now? Then you can easily bang out some seated calf-raises. Did you do 50? After lunch? Then, congrats, you are PrimalMed approved! Now go do another 50.

But note: the ‘Pump’ isn’t a magical elixir on its own. And it only works when and if you do the actual pumps! Ya gotta do the work.

Think of it as an additional arrow in your quiver. I would say you should be walking as much as you can, as well as all of the other PrimalMed approved movements. But it’s nice to know there’s a special little muscle out there that can lend a helping hand.

So get Pumped! It’s PrimalMed approved!

Nothing says 1978 like Elvis Costello. This one is Hi-Octane for sure.

BUT, I know some PrimalMed readers crave a more old school ‘get-up and dance’ vibe.

And for those ancient souls who got the trivial reference buried in the post…

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

I’ve been thinking about this since the beginning of the year, when I first read about the topic of Interval Walking Training, or as it has been called…’Japanese Walking.’

When I think of walking, it seems to me to be the most basic, primal, essential movement. It is the foundational movement that defines us from an evolutionary perspective.

Walking is, of course, PrimalMed approved!

So… do we REALLY NEED to formalize it into a curated, regimented training program? Or, as Mark Sisson, master of primal and ancestral wisdom says in his recent book, ‘Born to Walk,’ we should “just f*ckin walk!”

So… as I am thinking deep thoughts on the topic of walking, I see that last month marked the 50th anniversary of Springsteen’s opus, ‘Born to Run.’ I then glanced up at my bookcase and saw Christopher McDougall’s 2009 ‘Born to Run,’ the bestseller that sparked the whole barefoot running boom.

So… are we Born to Run? Or are we Born to Walk, as that most accurately aligns with our genetic imperatives. That’s a lot of ‘Born to…this and that.’ We are also Born to be Wild, Born to be Alive, Born this Way, and Born Free. (Check out Spotify for these gems). Maybe we are just Born to Move.

But for now, a big shout out to Mark Sisson and Brad Kearns, for their latest book, as it highlights the perils of chronic cardio and how excessive cardio at too fast a pace can lead to increased hunger, weight gain, mental burn out, physical injury, suppressed immunity and cardiovascular issues.

But if we are Born to Walk, must we do it in a specific codified way?

In 2025, it seems I could NOT open my iPad without seeing another article or link or Apple News feed on Japanese Walking!

Verywell, June 4, 2025 ‘Japanese Walking’ May improve Blood Pressure…

ScienceAlert, June 7, 2025 The ‘Japanese Walking’ Fitness Trend…”

Washington Post, July 13, 2025 ‘Just 30 minutes a day of ‘Japanese Walking…’

NY Times, July 31, 2025…”Japanese Walking’ is a Fitness trend!

GQ, August 7, 2025…”Should You Try the Japanese Walking Method?”

Verywell, August 7, 2025…”Japanese Walking vs. Running…”

and a pretty good article in the lay press:

Women’s Health July 21, 2025

Whoa! Is there something new out there? The Japanese gave us the Magic of Matcha Tea, the concept of hara hachi bu (eat until you are 80% full) and walking those 10,000 steps! And now…a new way of walking !?!?!?

I mean, I think I know HOW to walk, right? Why did this concept seem to explode in the summer of 2025. Were the AI algorithms taking over?

I don’t know…but I do know this…

It was time to go to the source literature.

The original research came from Japan in 2007 by a team of researchers led by Hiroshi Nose, MD, PhD. I did the deep dive and read the research and the follow up papers. See the below link.

Interval Walking Training!

And that research did indeed find that walking in a specific way, namely a 30 minute walk with 3 minutes at a brisk pace and 3 minutes at a slow pace, repeated for 30 minutes was beneficial and effective in improving mood, lowering blood pressure and improving overall muscular strength.

And... get this, the improvements in these metrics was greater in the interval walkers than those who did a high intensity power walk for the full 30 minutes! No burn out or fatigue in the interval walkers. The body seemed to respond better to an intermittent stimulus.

And many studies since then have confirmed these findings, re: improvements in physical fitness, body composition, glycemic control and blood pressure reductions and mood! See links below for Platinum readers:

Great 2024 review by Nose, et.al

Interval Walking training in Diabetics

And here!

But the researchers focused on specific metrics. The studies specified that the interval walkers had to repeat 5 cycles at speeds greater than 70% V02 Max, and slow to 40% V02 Max. And it had to be 3 minute intervals.

Hmm, that may be too much for us PrimalMed readers/walkers/athletes to incorporate and think about on a daily basis 😬

And why intervals? Why not just power-walk?

Who remembers the 1980s and 90’s? It seems that power-walking was then the latest and greatest fitness trend. Throw on some ankle weights or perhaps power-walk in the mall. Why not just bust out a 30 minute vigorous walk, arms a-pumping? I mean, that’s good but…

Here’s the PrimalMed perspective:

It seems our bodies do best when we expose it to intermittent stress, followed by recovery. We can achieve the same or even greater metabolic benefits by shorter more intense challenges done in a safe and sensible manner, the real magic occurring by allowing our body to recover.

And not everyone can bust out that power-walk. Less fit folks or those with limitations will need to vary the intervals in a way that makes SENSE to them. We want our efforts to be fun, and safe and effective. Let’s get the max, or close to max benefits with the minimal effective dose of input and train our way up. And feel refreshed to repeat the exercise later in the week.

If you are fit and in good shape… walk as often and as fast as your body permits. Slow jogging, and running, (when done sensibly and not excessively) are always encouraged.

Slow long walks are great too, as they boost overall fitness as well as creativity! I do my best thinking when I am out on a walk!

But throwing in some more intense intervals will reap additional metabolic health benefits.

At Primalmed, we ask, “How do we go from knowing to doing?”

Introducing…

’The PrimalMed Walk.’

Yes, I’m giving it a name! And it’s not even on Tik-Tok…yet.

It does not have be quantified, codified and data-fied. As long as it’s not specifically the 3 minute ‘Japanese Walk,’ we can call it anything we want!

And here it is:

First.. a field test: .

Since I always ‘Walk the walk,’ I did an experiment. We have a 2 mile hilly loop in my neighborhood that PrimalRD and I walk almost every day. Takes about 35 minutes.

I did it once as Power-Walk…but 35 minutes straight of arms swinging with a purposeful pace was fatiguing. Could I do that every day? I would need to train.

Then I tried 3 minutes fast with 3 minutes slow with a timer…too stressful. I kept wondering when the damn timer would beep. And sometimes, I wanted to keep going after the beep.

So I just let my feet do their thing.

I jammed to some tunes! I picked some upbeat songs, some a bit shorter than 3 minutes, some a bit longer. (‘Walk Like an Egyptian’ by the Bangles is about 3:23). When the song was over, I took it down to a stroll. Then picked up the pace again. No hard or fast rules.

But whether it’s 2:50 or 3:10 or even 4 minutes, those faster intervals MUST be done with intensity. You can’t just kinda sorta do it. You need to tighten those glutes and core and yes, pump your arms.

Don’t worry, you WILL NOT look silly! If you think that your walk is silly, just compare yourself to Monty Python’s ‘The Silly Walk.’

YOUR pace is your own business! Don’t stress out about your V02 max! You’ll know if you are a huffin’ and a puffin’ or you can’t keep a conversational pace.

One caveat… if you’re taking a post dinner walk…take it slow. This is NOT the time to power it up. Take it easy and allow yourself to digest your meal.

The beauty of the PrimalMed walk is that it embraces the Japanese research done by Nose, et. al in 2007 backing the principles of intervals, but is done in a fun way without strict timing or metrics.

TL;DR

Q: Is Interval Walking Training PrimalMed approved!

A: YES

• Do your PrimalMed walk for 10, 20, 29, 31, or 40 minutes. Who cares?

• Ensure that there is an element of intensity followed by recovery.

• Incorporate the ‘PrimalMed Walk’ to your daily walking routines a few times each week to reap the maximum metabolic benefits of interval walking training.

• Combine it with your PrimalMed pushups, squats, planks and get-ups and variations each week as your foundational bodyweight movements!

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And of course…curated songs for your PrimalMed walks: One fast and one slow. Send me your suggestions in the comments so I can build a playlist!

NOW if you think you look silly when you pump those arms, I invite you to take a trip to the Ministry of Silly Walks and enjoy the comic genius of Monty Python. I’m sure some readers will remember this gem.

The Ministry of Silly Walks

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

Picture this. Strolling through a quaint New England town. A perfect summer day. A HOT summer day.

We were thirsty. VERY thirsty. Water? Too boring.

We popped into shops and cafes – looking for thirst quenching drinks!

Rows of cans and bottles - plastic, aluminum, glass, lined the shelves.

100% Natural, Gluten-Free, Caffeine-free, Cold-pressed, Probiotics, Collagen boosting, Vegan, Kosher...For Energy, For Focus, For Recovery...you name it.

The Seltzer slogan...“Why be flat when you can sparkle?”

The front of the label is marketing; the back is the truth – the ingredient list.

The Seltzer ingredients were short and simple, ‘Sparkling water, natural flavor’.

RED FLAG…NATURAL FLAVOR

Yes, I am a label reader and look at ALL the ingredients – especially if it comes in a box, a bag, a bottle.

But what do ‘natural flavors’ really mean?

Natural flavors are derived from real food sources - plants (fruits, vegetables, herbs, spices) or animal products (dairy, meat, seafood).

However, here’s where it gets complicated.

The source of the flavor may be grown with pesticides or come from genetically modified crops such as corn and soy.

The processing methods of such flavors are rarely disclosed. Synthetic solvents (propylene glycol, hexane, acetone), synthetic carriers (polysorbates), emulsifiers, preservatives (BHT, BHA), and other ‘incidental additives’ which can make up 80% of the formulation.

These ‘flavors’ are added by food manufacturers to enhance taste - not nutritional value.

‘Natural’ is misleading. It creates a positive impression, believing a product is healthy. Many ‘natural’ flavors are highly processed and may be quite similar to ‘artificial’ flavors’. We’ll get into that later.

Complex mixtures of ‘natural flavors’ are created by trained food chemists known as Flavorists.

In the United States, the Flavor and Extract Manufacturers Association (FEMA), a primary trade group of scientists, evaluate and approve the safety of flavor additives as Generally Recognized as Safe (GRAS). U.S. laws regarding flavor additives, however, have been criticized as lax, and FEMA has faced scrutiny from nutrition experts and the public. Furthermore, the FDA does not require labeling of the individual ingredients used to create these complex formulations, which may include dozens of chemicals.

For instance, a flavor that mimics strawberry may be highly processed during extraction, preservation, stabilization, yet still come from a plant source, so it is called a ‘natural’ flavor. A misleading label – the end product is processed despite originating from a natural source. Sounds healthy… but is it really?

One of the primary concerns of ‘natural flavor’ labeling, is the lack of transparency. Companies are not required to disclose the specific plant/animal source used in the natural flavors - a problem for vegans or vegetarians that may have ethical or religious restrictions to avoid animal products.

Furthermore, companies do not have to disclose what chemicals, nor how much of each chemical, may have been part of the natural flavor mixture – solvents, carriers or preservatives – a problem for those on special diets or with allergies (e.g., soy, dairy, gluten, MSG-like compounds).

Is this harmful?

Many experts suggest these additives are not harmful in small amounts, as Generally Recognized as Safe (GRAS) health and safety standards are met.

However, from an RD perspective, and my own personal view, there is always the question of uncertainty. Aside from the ethical restrictions, there is the question of allergies and sensitivities of undisclosed compounds - even in minute amounts. What about gut issues or effects on the gut microbiome? It is no surprise that some people tolerate unflavored sparkling waters but given fruit flavored varieties, experience digestive discomfort.

These compounds generally do ‘trick’ the palate and the brain, to want more, to overeat - mostly processed foods. Sweet drinks and salty chips go well together.

And what are the long-term effects of flavorings? Will our experience be similar to that seen with artificial sweeteners…ill effects on our Metabolic Health?

Read about artificial sweeteners here

So, to review: Natural flavors originate from compounds isolated from natural sources – plants or animals, often processed, refined, and altered in a lab with solvents, preservatives, emulsifiers. Ethical, dietary, and health issues are always a concern.

What about ‘artificial flavors’...

What’s the difference between ‘natural’ vs ‘artificial’ flavors?

Artificial flavors are made from synthetic chemicals in labs, designed to mimic natural taste molecules. Fully man-made, petroleum derivatives or other chemical precursors are often used. These flavorings are more consistent and cheaper to produce... but again, unknown compounds are in the mix.

Natural and artificial flavors are in many ways, quite similar. The main difference is the source. Natural flavors originate from plants or animals, whereas artificial flavors are made in the lab.

Vanilla for example, may come from natural vanilla beans or artificial petroleum derived compounds, but the end products may be quite similar. Different source, but both may be heavily processed.

Again, as in natural flavors, artificial flavors need to be approved as Generally Recognized as Safe (GRAS). However, both lack transparency. Both do not require companies to disclose ingredient lists.

But wait, there’s more...what about Organic natural flavors?

How does ‘Organic natural flavor’ differ from ‘natural flavor’?

Organic natural flavors are derived from organic plants or animals – there are no synthetic pesticides, fertilizers, GMOs, or irradiation allowed. Such flavors don’t always mean it comes from a whole food, like vanilla bean or lemon peel directly – it’s often an extracted compound or blend.

Organic approved solvents are used (e.g., organic ethanol, CO₂, or water).
Organic approved carriers or stabilizes are used (e.g., organic alcohol, organic glycerin).

The flavor must be made with at least 95% organic ingredients.

Any non-organic components used must be on the USDA’s National List of Allowed Substances.

As an example:

Natural lemon flavor → could come from lemon oil extracted with solvents.

Organic natural lemon flavor → must come from organically grown lemons, extracted using approved organic methods (like CO₂ or alcohol) and made from organic-compliant ingredients and processes. ‘Organic natural lemon flavor’ and ‘organic lemon flavor’ mean the same thing—both are originally sourced from organically grown lemons, and all organic flavors must be natural, sourced from a plant (as in this case) or an animal.

But wait…there’s EVEN more:

Extracts and Essences are both from plant or animal sources.

An extract is a concentrated substance often made using solvents like alcohol, water, or oil to isolate compounds (i.e. vanilla and lemon extract). Some may involve additional processing with synthetic solvents such as hexane.

An essence is a more refined, highly concentrated flavoring, typically obtained through distillation, condensation, or similar processes, which may also use chemical aids.

The key difference is the method and concentration used to intensify flavor. Not all extracts and essences are fully ‘clean’ or organic, as chemicals may be involved.

Organic extracts and essences must meet USDA standards (at least 95% organic ingredients) using only approved solvents and no synthetic additives, though this does not guarantee they are solvent-free or unprocessed. For the cleanest option, products that are 100% organic will say so explicitly.

So where does that leave us? Let’s Re-think Our Drink.

It does seem healthier to choose foods and drinks with added natural flavors and avoid those with artificial flavors. But in terms of chemical composition, these are quite similar. A flavor is derived naturally or synthetically – but the end products may be quite similar….highly processed.

Essences and Extracts may be less processed, perhaps a better choice, but recognize they may not be organic. Solvents may still be used.

Going Organic seems to be the best bet but are not always available when your thirst needs quenching!

SO…Are ANY added flavors on the label, PrimalMed approved?

It all depends on the dose…how much and how often.

Reality - we can’t always know what type of flavoring has been added to our foods and beverages, especially when dining out.

Practical - allow yourself to enjoy eating and drinking, but use the knowledge learned to make the best choices for you, the smart consumer.

If you prefer organic sourcing and stricter, ‘safer’ processing methods - as we do - choose foods or drinks with ‘organic flavors’ or ‘organic natural flavors.’

Our opinion:

PrimalMed Go: Plain sparkling water preferred! Then sparkling water with lemon/lime (lowest calories). Next best is anything organic - natural flavoring, essence or extracts

Sparkling water with added lemon or lime, however, does contain citric acid, which may cause dental erosion if consumed frequently, especially with repeated sipping. Drinking with meals reduces this risk, since food stimulates saliva - a natural acid buffer. Using a straw can help protect teeth!

Sparkling water with 100% fruit juice as an ingredient, will add a few calories, but no added flavors, sweeteners or solvents… and is less likely to cause enamel erosion than drinks higher in citric acid.

PrimalMed Slow: Everything else. Depends on the dose…how much and how often.

PrimalMed No: Added artificial sweeteners like Aspartame and Sucralose.

And so, after months with a client, we cleaned up her diet and removed foods and drinks with ‘natural flavors’ from her shopping lists!

All was good until she showed me her latest supplement - her Magnesium powder…filled with…

RED FLAG...NATURAL FLAVOR

Re-think your drink and your food…and your supplements.

PrimalMed® says: Don’t be fooled by the flavor.”

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

Longevity, Longevity, Longevity! Seems that every day, there’s a new article, YouTube, or blog on how to achieve a long, happy, and healthy life filled with vim, vigor and joy.

Here at PrimalMed, we’ve talked about how best to add ‘life’ to your years (health-span) rather than just focusing on adding ‘years’ to your life (lifespan). There was even an article in the New York Times back in July on…get this…’Joy-span’ or maximizing years of joy and happiness.

I get it. Who wants to spend the last 30 years of their life on a first-name basis with their friendly pharmacist at Walgreens? I don’t care if you are 30, 60 or 90, I suspect we all want to be able to hoist our Away Bigger Carry-On luggage bag up to the storage bin without sheepishly asking for assistance.

SO… how are you doing? If you want to know where you stand in the game of ‘Don’t Die…at least right now…’ there are many objective tests that have been described that purportedly predict how long you will live:

Hand Grip strength, Walking speed, The 40 push-up challenge, and The sit-to-stand ( Also known as the Sit to Rise test). At the end of the day, they all are markers of frailty.

And some of the objective metrics seem arbitrary to me. I mean, I can only do 39 pushups. Does that mean the guy who does 41 will live longer? Not necessarily.

There may be something to the walking speed metric, since my Nana, who lived until 95, walked at olympic speeds up and down the hills of Dartmouth Street and Yellowstone Blvd. I confess that I am a bit of a stroller, so I’ll be trying to improve on my walking pace ( hint…wait for the next PrimalMed post).

And the ‘Sit to Rise’ Test? That is a metric used by the medical community to gauge patients muscular strength and endurance. Here is the link to the CDC infographic.

Sit to Stand info…link here!

and

More on the Sit to Stand test!

So what does this all mean? How do these objective metrics stack up when we live in a subjective world where random events dictate our lives and we are all our own N=1 experiment?

The best advice I ever heard, addressing this topic, I believe is attributed to famed investor Charlie Munger. He was a fountain of pithy aphorisms on investing and life. He did live until the ripe age of 99 so I’ll hear him out.

How to live a long life?

Find out WHERE you are going to die and DON”T go there.

The PrimalMed answer? ”DON’T FALL!”

I see so many CT scans, everyday, from the ER, of people who have fallen and could not get up. People too weak from sarcopenia and poor cardio metabolic fitness to brace themselves during the fall.

And hip fractures in the elderly, directly related to a 3X risk of mortality.

Hip fractures in the elderly… link here!

So if random events occur and we will ALL eventually take a tumble, it is imperative to be able to brace ourselves, lessen the impact and most importantly...GET UP!

Or as the great philosopher James Brown intoned…’Get up offa that thing!”

Introducing…The Primalmed Get-Up

How can we mortals improve our ability to not fall and then be able to get up?

Practice, practice, practice.

There are many on-line blogs and longevity tests and challenges that translate how easily you can get up from a seated position without using your hands or knees or any object for assistance as a predictor of longevity.

When I fall, I don’t really care about how many points I’ll get with an unassisted effort. I just wanna ‘get up offa that thing.’

We need to train our entire body to be aware of the subtle cues of what it is like to fall and how we can expect our bodies to move as we get up.

The PrimalMed Get-Up relies on this principle: Maximum derived benefit from minimum input.

And it takes only 3 minutes!

It’s a total body functional movement. It combines leg strength, core stability, balance and coordination. Heart rate rises, breathing efforts increase. It’s a cardio workout that also builds strength and resilience.

Here’s HOW you do it:

Stand up. Sit down on the floor. Get up. I don’t care if you need to use your arm or knee. I don’t care if you need to lean on a chair. I don’t care if you need your pet goat for assistance. Just get up and stand up.

Then repeat…AND repeat. AND repeat. For 3 full minutes. Set a timer. Or listen to a song. Take as many breaks as need. Huff and puff if you must. And write your results down. How’ ya do? 5, 10, 50 times?

Whatever. See how you feel and see if you can improve each week. That’s it.

At PrimalMed, we ask…”how do we go from knowing to doing?”

Incorporate the PrimalMed Get-up into your fitness routine.

Start with seeing how you do with the Sit to Stand. If you are motivated and adventurous (I’m looking at you Primalmed Jr.)... go hard and go Turkish, with the Turkish Get-Up, a structured advance move that combines it all. You can do half get ups, or full get ups with bodyweight or dumbbells.

And as a real treat…you get to see yours truly, walking the walk as I talk the talk! Authentically done with one take. No edits.

Don’t forget to comment and share this post! Teach the PrimalMed Get-Up to friends and family. They too can subscribe for free!

And now… for some tunes! PrimalMed approved for your walk, drive or next workout. Enjoy!

No one says 1990’s like REM!

If you are fan of the funky Mr. James Brown, then this is your jam.

And lastly, if the Reggae Vibe is your thing mon…

Ted Metzger, MD is a practicing board certified Radiologist as well as founder and owner of PrimalMed, LLC. PrimalMed educates and advocates on Metabolic Health and Wellness, as seen through the lens of a curious radiologist.

Ellen Metzger MS, RD - the other half of the PrimalMed team, is an Integrative Registered Dietitian, addressing ancestral and primal nutrition principles as drivers of metabolic health and wellness.

The information in this article is designed for educational purposes only and is not intended to be a substitute for informed medical advice or care. This information should not be used to diagnose or treat any health problems or illnesses without consulting a doctor. Consult with a health care practitioner before relying on any information in this article or at PrimalMed.com.

Hello PrimalMed readers! Converse and connect over cappuccino! We often get follow-up questions about topics and posts. Here’s your chance to chime in!

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