Dr. Tom Rifai

01/25/2026

January is RMS HealthyHER month. Heart disease is still the #1 killer - of women as well.
And too often, we miss it - starting with the language we use.

For decades, cardiovascular research focused primarily on men. As a result, women’s most common heart-related symptoms were labeled “atypical”.

That’s rubbish. There is nothing atypical about symptoms that relate to over half the population on earth.

Calling them “atypical” may delay recognition, diagnosis, and treatment.

Women experiencing heart disease are more likely to (i.e., commonly - opposite of “atypical”) report:
• Unusual or overwhelming fatigue
• Shortness of breath
• Nausea or indigestion
• Jaw, neck, or upper back discomfort
• Lightheadedness or dizziness
• Sleep disruption
• Anxiety or a vague sense that “something isn’t right”

Here’s the part that often surprises people — including some clinicians:

👉 In a large proportion of coronary artery disease cases, the first manifestation is sudden cardiac death due to a sudden plaque rupture that only moments prior was not blocking blood flow enough to cause symptoms - and this applies all human beings, irrespective of sex/gender.

Further:
Many dangerous plaques that do not cause major blockages prior to rupture:
• Do not show up on standard stress tests
• Can remain silent for years

That is why we should discuss tests like Coronary Calcium Scoring by CT (usually

01/25/2026

I’ve taught Nutrition Label Reading to thousands of people from patients to executives, and clinicians. Recorded at the beautiful Oakland University in Metro Detroit, this is consistently a game-changer for anyone trying to improve healthspan.

Take your time with it and add time to your healthspan with it!

Link: https://youtu.be/x9NlnOyRpdE?si=NUgmjHCVrlA66R8L

In this lesson, you’ll learn how to decode a nutrition label using the most powerful principles in metabolic nutrition:

🔹 Calorie Density — the #1 driver of satiety, weight control, and metabolic health - differentiating beverage calories (including how meal replacements work for metabolic health) from food based calories

🔹 Protein and Natural (vs processed, added) Fiber Quality & Quantity — including the exclusive RMS PF10-to-Cal Ratio for assessing longevity-supportive protein

🔹 Sodium Density — how to spot stealth sodium’s cardiometabolic risk easily

🔹Saturated Fat and where Dietary Cholesterol still matters for avoided cholesterol laden vascular plaques.

🔹 Hidden Traps — comparing when there are serving size discrepancies

You’ll walk away with the exact framework I use in clinic to help patients:
✔ improve metabolic health
✔ lower cardiovascular risk
✔ manage weight without deprivation
✔ gain real food intelligence
✔ make confident decisions in and beyond any grocery store

This video is taken directly from the Flex5 Masterclass, where we combine:
🧠 Mind Matters/Psychology
🍎 Nutrition
🏃‍♂️ Activity
🌿 Environments
🤝 Accountability

…into a holistic framework designed for sustainability and real-world transformation.

If this helps you, please LIKE, SUBSCRIBE, and COMMENT — it makes a huge difference and helps others discover science-based longevity guidance.

01/25/2026

October 2011 — Sardinia (Blue Zone)
Never before shared.

We are what we eat.
And we eat what surrounds us.

Our movement, too, is deeply shaped by our environment — often far more than by motivation, willpower, or even intention.

In the Blue Zones, this isn’t talked about as a “strategy.”
It’s simply life.

• Food is visible, seasonal, local, and close to its source
• Movement is built into daily living — walking, tending, harvesting, carrying
• Eating and moving aren’t separate “events”; they’re woven into the day

That’s the real lesson.

Most of us don’t live in the mountains of Sardinia — but we can borrow the principles and apply them where we are.

A few basics I often share:

• Put the healthiest foods front and center in your home (fruit on the counter, vegetables visible in the fridge)
• Make the less helpful options inconvenient, not forbidden
• Arrange your space to encourage natural movement — standing more, walking more, carrying more
• Look for NEAT opportunities (non-exercise activity time): stairs, chores, errands, daily routines that keep you moving without calling it “exercise”
• Design your environment so the default choice is the better one

This isn’t about perfection.
It’s about alignment.

The more your environment works with you instead of against you, the less you have to rely on constant discipline.

Blue Zones didn’t discover a secret.
They simply built lives where healthy behaviors were the path of least resistance.

That’s a lesson worth bringing home.

01/24/2026

Stone fruit 🍑 🎸 (singing this to the melody of Jimi Hendrix’s “Stone Free“)🤣

01/24/2026

Dr Archie De-Bunker returns for a post on YouTube “influencer”, non-practicing (he gave up medicine to be an influencer - and no, I’m not kidding on this) Dr Nick Norwitz.

Nick’s time away from medicine to comment on it has paid off in some great video production skills. Too bad his content isn’t as impressive as his marketing. Nothing unique. There’s a ton of self-appointed nutrition gurus out there with literally zero actual clinical experience in metabolic medicine and nutrition

Here’s was my complete and honest reply to Nick on his YouTube:

Nick — I watched the video and read your pinned comment, including the publicly available portion of your paywalled Substack where you state that the Minnesota Coronary Experiment (MCE) showed the group that lowered cholesterol “died more often,” and that lower cholesterol was associated with higher mortality.

That framing goes beyond what the data can legitimately support.

The MCE was conducted in institutionalized populations (nursing homes and mental hospitals), with extreme participant turnover and short exposure for many subjects. It was never designed or powered to assess mortality. Even the recovered-data reanalysis does not demonstrate that lowering LDL or replacing saturated fat with polyunsaturated fat caused harm.

The mortality association you emphasize comes from post-hoc subgroup observations and is highly vulnerable to reverse causation and frailty bias — especially in older, institutionalized cohorts where declining cholesterol often reflects underlying illness and proximity to death. That phenomenon is well described in epidemiology and does not establish causality.

Even the original investigators cautioned against drawing mortality conclusions from these data. At most, the trial showed that lowering cholesterol did not clearly reduce mortality in that specific setting — not that cholesterol lowering increased death risk.

For additional context, Walter Willett has addressed the misinterpretation of the Minnesota data and the 2016 BMJ reanalysis, noting that it represents an interesting historical footnote but does not overturn the broader evidence base linking apoB lowering and reduced cardiovascular risk:
https://nutritionsource.hsph.harvard.edu/2016/04/13/diet-heart-ramsden-mce-bmj-comments/

The BMJ reanalysis itself does not conclude that cholesterol lowering caused death - as it would such a blatantly irresponsible contention, only that the intervention lowered cholesterol without demonstrating a mortality benefit in THAT trial:
https://www.bmj.com/content/353/bmj.i1246

A broader methodological critique explaining why mortality associations in this trial cannot be interpreted causally is available here:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4836695/

As for the suggestion that the study was “buried”? Please be real. We know you’ve a very personal and vested interest in and bias towards Keto and your choice for a LMHR states. But a simpler explanation is that it failed to demonstrate the hypothesized benefit and was not considered particularly informative even at the time. Not every null or inconclusive study represents conspiratorial “suppression”; many simply don’t meaningfully advance science.

If the claim is uncertainty or lack of demonstrated benefit in that specific trial, that’s fair enough.

But presenting the MCE as evidence that lowering cholesterol or replacing saturated fat is dangerous is a dangerous misinterpretation itself — and it conflicts with the broader body of far higher-quality randomized trials, mechanistic data, and causal evidence.

Honestly Nick, perspectives tend to evolve after one has the honor you’ve chosen against, caring and longitudinally following thousands of patients through intensive, multidisciplinary metabolic health programs — with structured nutrition, behavior change, accountability, and long-term outcomes staring you in the face. Without that clinical ballast, it’s far easier to drift toward elegant narratives, empty rabbit holes, and wishful thinking. Real-world metabolic medicine has a way of clarifying what actually holds up over time.

And that matters when communicating to a broad public audience, many of whom still trust that MD titles mean extensive clinical experience as an attending, practicing and board certified physician.

01/24/2026

15 years ago yesterday, my #1 health hero from childhood—Jack LaLanne—passed at his home.

Jack lived to nearly 97, moved his body every single day until almost the very end, and did so despite a sobering family history—his father died of a massive heart attack at 50.

Jack chose a different path and spent a lifetime proving that vitality is a daily practice, rather than being a genetic victim. After all, genetics may load the proverbial gun, but behaviors largely control the trigger.

His message was beautifully simple and radically empowering: “Just move.”

And yes—he backed it up with legendary feats of physicality. This wasn’t to suggest we should copy him at all, but rather to make movement feel possible, joyful, and human—and to show what the body can do when it’s treated with respect and consistency.

He’s been my top health hero since before I was 10 (I’m coming up on 58 now), and his influence on how I think about health, aging, and vitality has only deepened with time. He is highlighted in The Flex5 Lifestyle masterclass Accountability module based on a life story LaLa confirmed was true when I met her.

Yes, I had the absolute joy and honor of meeting his wife, Elaine (“LaLa”), when Jack was honored posthumously—and she in full, vibrant person—by the American College of Lifestyle Medicine with their Lifetime Achievement Award. A true Godfather and a true Godmother of fitness and vitality!

LaLa is still amazing and thriving today at ~99. Let that sink in (and let’s thank Jack for convincing LaLa to quit smoking decades ago when they met).

Today, and every day we can, in their honor and the spirit of vitality at every age, let’s “just move” 🙏🏽

01/23/2026

Reality Meets Science® intentionally limits “before-and-after” photos - and when we do it is cases that do not include use of GLP nor bariatirc surgery and are long term maintainers. Vote to be clear I have helped to manage hundreds of patients have had bariatric surgery and use GLP as well. But those are always just adjunct, turbo charges if you will add it to the engine of The Flex5 Lifestyle - our unique, cutting edge, ethnic inclusive, age and gender diagnostic methodology for human health transformation and maintenance of vitality and healthy aging.

Not because change didn’t happen—but because the wrong thing gets measured far too often.

What you see in these photos isn’t about a number on a scale.
It’s about vitality, function, confidence, movement, clarity, and healthy aging.

Over the years, I’ve had the privilege of working with people who wanted:
• To move better, not just weigh less
• To feel stronger, more capable, and more alive
• To reduce disease risk while actually enjoying their lives

That work ultimately led me to write an article for Consultant360:

“5 Keys to Optimal Wellness, Weight Loss, and Disease Prevention”

It outlines a simple but powerful framework built around five interdependent domains:
• Nutrition
• Activity
• Mind Matters
• Environments
• Accountability

Not as rigid rules.
Not as extremes.
But as skills that compound over time—especially as we age.

If you’d like a copy of the article, I’m happy to share it.

👉 Drop your email here (or DM me) and I’ll send it to you.

No spam. No gimmicks.
Just evidence-based guidance on how to build healthspan, not just chase weight loss.

Because in the end, the goal isn’t just to look younger. It’s to live better—and when you do that as primary - then our odds of living healthier longer go up remarkably.

01/23/2026

Look, I don’t want to demonize the MAHA movement, so I wouldn’t have added some of the commentary this RD, PhD did. But she’s not entirely wrong. Worth a watch and a listen.

01/23/2026

I have tremendous respect for former UFC welter and middleweight champion, Georges St-Pierre — I’ve met him, and he’s the real deal. An extraordinarily disciplined, highly trained athlete with years of physiological resilience built through elite training.

That said, elite outliers should never be used as population models.

A highly trained individual like GSP may appear to tolerate multi-day water fasting while preserving muscle and performance because of:
• years of resistance training
• high baseline lean mass
• favorable hormonal and metabolic adaptations
• meticulous recovery and stress management

That does not make the practice benign — and it certainly doesn’t make it safe for the general public.

For most people, unsupervised 72-hour water fasting carries real risks, including hypoglycemia (especially with insulin or other glucose-lowering meds), hypotension with BP meds, electrolyte disturbances that can trigger arrhythmias, and over time, loss of muscle and bone — outcomes that directly conflict with healthy aging.

What concerns me most is the absence of clear caveats when this is promoted on social media. Context matters. Physiology matters. Selection bias matters.

If people are genuinely interested in fasting from a scientific standpoint, I’d strongly recommend following the work of Courtney Peterson (Harvard-trained, leading published researcher in this space). I had the pleasure of interviewing her on YouTube, where we discuss time-restricted eating and fasting approaches that are evidence-based, safer, and far more applicable to real humans living real lives.

Longevity and metabolic health aren’t built through extreme interventions — they’re built through durable behaviors that preserve lean tissue, stability, and quality of life.

https://youtu.be/h3HngMS-Zsk?si=6wDwuD6EnKbRUJ4j

01/22/2026

Prof. Stuart Phillips, Ph.D. is the gold standard when it comes to physical activity science and, isn’t it notable and very Reality Meets Science how well walking (via NEAT or exercise) does for longevity. Totally consistent with Flex5 and Blue Zones.

New study on physical activity and longevity. A few thoughts worth sharing.

https://bmjmedicine.bmj.com/content/5/1/e001513

A large BMJ Medicine paper followed tens of thousands of adults for decades to examine the types and variety of physical activity and their association with the risk of death.

The clear wins
• Being physically active is associated with lower mortality across most activity types.
• Doing a variety of activities seems to add benefit, even after accounting for total activity.
• Walking shows the most consistent and robust relationship with lower risk across outcomes. Simple, accessible, and powerful.

Where we should slow down and think
Some of the dose–response curves look strange. Cycling is a good example, where the curve can look W-shaped: a little helps, some harms, then a lot helps again. That pattern makes little biological sense and is far more likely due to noisy data at higher activity levels and overfitting flexible curves.

When most of the confidence interval sits below 1.0, it is hard to argue that there is real harm. These shapes should be questioned, especially when they contradict better-powered studies showing broadly monotonic benefits of physical activity.

Quick explainer
A MET is a unit of energy cost relative to resting.
About 5 MET-hours per week is roughly 40–45 minutes of easy cycling, or about 75 minutes of brisk walking.

Bottom line
Move more. Walk often. Mix your activities. The BIG picture is the reduction in risk for multiple diseases… if that were a drug, we’d be falling over ourselves to take it!

And be cautious about over-interpreting squiggly curves from observational data when common sense, biology, and stronger evidence point in the same direction.

Feel free to share if this helps keep the conversation grounded in evidence.

01/22/2026

Blood pressure. One of the most powerful health numbers we have—and one of the most overlooked.

If you’re just getting started, I recommend checking your blood pressure at least 3 times per week for one month, missing no more than two total readings (minimum of 10). Each measurement should be a true resting blood pressure:

• Seated with both feet flat on the floor
• Back against backrest with arm supported at heart level
• Proper cuff size
• Rested quietly for at least 2 minutes (up to 5 if you have the time)

Guideline targets—always to be discussed with your clinician—are generally

01/21/2026

Ok - here’s my post responding to Facebook’s prompt to “make a post for national cheese lovers day”. We all, including myself, eat enough cheese as it is! As if we need a “special day” for it! 🤣 sheesh… what do they want next from me? To promo the national hot dog eating contest? 🤦‍♂️