Dr. Tom Rifai

11/17/2025

This story is emotionally compelling — but it’s also a classic example of fear-based marketing wrapped in pseudo-science.

A few quick realities for anyone feeling discouraged by posts like this:

1️⃣ People dramatically underestimate calorie intake — especially when relying on portion control instead of understanding calorie density.
This is not a character flaw. It’s human physiology. Decades of research (NIH, doubly-labeled water studies) show that self-reports can miss the mark by 30–50%. So “I ate 1,200 calories and gained weight” is almost never accurate, and it’s the first thing metabolic researchers look at — because it’s by far the most common explanation.

2️⃣ Your metabolism doesn’t “forget how to burn fat after 40.”
That is literally not how human bioenergetics works. Metabolic flexibility is real, but it’s not measured accurately by a handheld breath gadget. Carbohydrate vs. fat oxidation shifts all day long based on activity, meal timing, sleep, and hormones — not because a switch “breaks.”

3️⃣ The idea that a device can diagnose a “stuck metabolism” by one CO₂ breath test is scientifically unsupported.
CO₂ output = influenced by dozens of variables (sleep, stress, last meal, alcohol, exercise, even how deeply you inhale). It’s not a validated diagnostic for real metabolic dysfunction.

4️⃣ Weight gain after 40 is real — but the explanation is far more boring, far more humane, and far more fixable.
Lower muscle mass → lower resting energy needs.
Higher stress → more emotional eating.
Poor sleep → more hunger hormones.
Ultra-processed foods → higher calorie density.
Under-reporting intake → incredibly common.

Fixing these doesn’t require an expensive gadget. It requires evidence-based strategies that do work.

5️⃣ The emotional pain in the story is real — the “broken metabolism” narrative is not.
People don’t need to be scared into buying something. They need clarity, compassion, and science that actually holds up.

If anyone wants a trustworthy takeaway:
✔️ Eat more foods with high fiber + low calorie density
✔️ Prioritize resistance training to preserve lean mass
✔️ Track patterns, not a single number
✔️ Be skeptical of any device selling the idea that your metabolism is “broken”

You’re not broken.
You’re human — and humans are terrible at counting calories but excellent at responding to the right nutritional environment.

Fear sells. Science helps.

11/17/2025

The headlines about erythritol were definitely alarming. Yet the actual science is far more nuanced than how it was portrayed, including this post I’m sharing. As you can imagine, I believe it’s important not to - even unintentionally - scare people based on an oversimplified interpretation.

The key issue is this:

The study didn’t show that consuming erythritol causes heart attacks. It showed that people already at higher cardiometabolic risk tend to have higher blood levels of erythritol — and that elevation appears to come from internal production, NOT from using erythritol as a sweetener.

When we’re under metabolic stress (insulin resistance, inflammation, oxidative stress), the body increases production of certain polyols — including erythritol — as part of its internal metabolic pathways.

So high erythritol in the blood is more likely a MARKER of metabolic dysfunction, NOT a cause of it.

Several important clarifications:

• In controlled trials where people actually consume erythritol, it doesn’t raise glucose, insulin, or inflammatory markers.

• People with good metabolic health typically don’t show elevated endogenous erythritol production.

• If dietary erythritol were a major driver of clotting or cardiovascular risk, we would see it clearly in population data — and we don’t.

• The researchers themselves acknowledged that elevated blood erythritol is likely reflecting underlying metabolic impairment.

So the takeaway isn’t “erythritol causes heart disease.”

The takeaway is: metabolic dysfunction causes the body to produce more erythritol internally — and that’s what the study measured.

If someone is relying on a sweetener to avoid excess sugar, erythritol is still one of the safer options we have, especially when compared to refined sugar or high-fructose syrup, which we know drive metabolic disease.

I’m all for good science and staying cautious, but we should be careful not to overextend conclusions beyond what the research actually showed — especially when people may already feel confused or fearful about what’s safe to eat.

This topic deserves clarity, not fear.

New research has revealed a startling health risk: a common sweetener widely used in foods and beverages may damage the brain barrier, increasing the risk of stroke and other neurological problems. The brain barrier, also known as the blood‑brain barrier, is a critical defence system that protects the brain from harmful substances. When it is compromised even slightly, it can allow toxins and harmful molecules to enter the brain and cause long-term damage.

Scientists found that regular consumption of this sweetener can weaken the barrier over time, making the brain more vulnerable to inflammation, oxidative stress, and vascular damage. This discovery raises concerns about daily intake in sweetened drinks, snacks, and processed foods.

Health experts emphasise moderation and suggest seeking natural alternatives when possible. Protecting the brain barrier is essential not just for reducing stroke risk but also for maintaining overall cognitive health, memory, and long-term brain function.

With neurological diseases on the rise, awareness of hidden risks in everyday foods has never been more important. This finding is a wake-up call to monitor sweetener intake and make informed choices for long-term brain health.

11/17/2025

🌱 Autophagy, Fasting, Exercise & Longevity — What Really Matters (Real Talk)

If you’ve heard people online talking about autophagy — your body’s cellular “cleanup” system — it’s easy to think you need extreme fasting to be healthy or “live longer.”

Here’s the science-based truth ⬇️

⸻

1️⃣ Exercise is the #1 safest and most reliable way to boost autophagy.

Not 48-hour fasts.
Not starvation windows.

Walking, strength training, interval training — they all activate your body’s repair systems.

Movement > everything else.

⸻

2️⃣ Fasting can deepen autophagy… but it comes with real risks.

Fasting isn’t harmless for everyone.

It can:
• Trigger overeating or binge–restrict cycles
• Increase anxiety around food
• Affect sleep and hormones
• Reduce lean muscle if overdone

Fasting should never be a punishment, a weight-loss shortcut, or something you feel pressured into.

⸻

3️⃣ Eating fewer calories is NOT the same as fasting.

Even small meals shut off autophagy because of insulin and amino-acid signaling.
So calorie reduction can improve health — but it doesn’t trigger deep “cellular cleanup” the way fasting does.

And that’s okay.

⸻

4️⃣ Metformin helps a little… but it doesn’t replace fasting or exercise.

Metformin can support some of the same pathways (like AMPK activation), but it cannot mimic the full physiology of fasting or the mitochondrial benefits of exercise.

It’s a support tool, not a replacement for healthy habits.

⸻

5️⃣ So… do you NEED deep autophagy to improve longevity?

No.

You can dramatically improve your healthspan — your years of feeling well — without intense fasting.

The biggest drivers of long-term health are:
• Daily movement
• Strength training
• Nutritious whole foods
• Good sleep
• Stress management
• Supportive habits

Autophagy is one piece of the puzzle, not the whole picture.

⸻

💡 The RMS / Flex5 Takeaway

You do not need extreme fasting or rigid rules to live longer and better.

You do need:
• Sustainable habits
• Behavioral balance
• A healthy relationship with food
• Consistent movement
• Whole-person wellbeing

Longevity isn’t about suffering.
It’s about creating a body and mind that work — for life.

11/16/2025

Walk n Talkin’ in Saudi..

11/16/2025

SEE comments for a RARE opportunity!

11/16/2025

The new VESALIUS-CV trial (NEJM) is a major step forward: high-risk adults without prior MI or stroke saw a ~25% reduction in cardiovascular events with evolocumab, lowering LDL-C to a median ~45 mg/dL.

Solid science and good news.

But several unmeasured domains make it hard to understand why some still had events despite very low LDL, and why others in the placebo group did not.

These blind spots matter for prevention, longevity, and real-world clinical care:

🔍 Missing cardiometabolic variables

• No non-HDL-C reporting — despite its strength in diabetes/mixed dyslipidemia.
• No apoB reporting — the most direct measure of atherogenic particle burden.
• No blood pressure data — this is a “wow”. Hard to interpret outcomes without one of the strongest causal drivers.

⸻

🔍 Missing anatomical & biological context

• No CAC distribution — we don’t know who had CAC = 0 vs 400+.
• No plaque biology (CLEERLY/CCTA) — no soft plaque, total burden, or 5-yr progression.
• No Lp(a) characterization — PCSK9 inhibitors reduce it ~20–25%, but we cannot assess its contribution.
• No inflammatory/metabolic profiling — no hsCRP, IL-6, insulin resistance, visceral fat, activity, or sleep data.

These gaps leave the “event despite LDL ~45” vs “no event despite higher LDL” patterns unexplained.

⸻

🔍 Not to get on a soapbox here but…sigh…No intensive lifestyle or behavior-change intervention

As in most cardiology trials, VESALIUS-CV did not include a USPSTF-grade lifestyle program (>12–24 sessions focused on nutrition, activity, sleep/stress, and accountability).

Thus, major drivers of residual risk — BP, insulin resistance, inflammation, stress load, sleep quality, movement patterns, and food environments — were largely unaddressed.

Both arms should’ve received serious intensive lifestyle intervention. It’s not only gold standard science, it’s gold standard ethics.

⸻

🧠 The Flex5 Lifestyle® / Reality Meets Science® interpretation

LDL-lowering works but isn’t monolithic nor holistic.

Whole-person prevention is transformative.

Within Flex5, emphasized are all 5 critical domains of health and wellbeing:
• Nutrition that lowers apoB and improves BP, glycemic control, and insulin sensitivity.
• Activity that enhances vascular function and metabolic flexibility.
• Psychology for stress, sleep and substance management as well as emotional resilience.
• Environments engineered so the default choice at home, work, and travel supports health span and when not, how to best manage.
• Accountability to support consistency, make change durable, personalized, and measurable.

Cardiovascular and overall health live in multiple domains, not a single biomarker.

⸻

🌱 Bottom line

VESALIUS-CV shows how powerful LDL-lowering can be. It also shows how much opportunity remains when key risk drivers are unmeasured and, likely, suboptimally treated.

The proprotein convertase subtilisin–kexin type 9 (PCSK9) inhibitor evolocumab reduces the risk of major adverse cardiovascular events (MACE) among patients with a previous myocardial infarction, s...

11/15/2025

Ask and you shall receive! Here’s a video link to the video YOU asked for on bone health. The, by FAR, number one voted topic: https://youtu.be/NqXdLwwpOfU?si=069cDO1C9YFocxc2

Voted this week as the top topic from my Facebook community, my thoughts on bone health and a bit on the relationship between "bones n (kidney) stones". ...

11/15/2025

Flex5 students, show your skills: What is the PF10™/calorie ratio of this 460 cal flexitarian meal?

FYI: contents include broccoli, beets, cantaloupe, pear, Chia seeds, fat-free Greek yogurt and 2 ounces of chicken breast + a touch of masala sauce.

11/15/2025

Please follow me on X too (if you can tolerate it, if not, I don’t blame you). I’ll be “throwing myself” into some important conversations re cholesterol/lipid management, metabolic health and Longevity/Lifestyle Medicine there

11/15/2025

Are car air-fresheners or perfumes dangerous?
Short answer: Not in the way social-media fear posts suggest. But like many things in health, the truth lives in the middle — and that’s where Reality Meets Science® comes in.

You may see influencers warning that “chronic fragrance exposure” will cause massive harm. Let’s clear the air (yes, pun intended).

✅ What science actually shows

Air-fresheners and strong fragrances can release small amounts of volatile organic compounds (VOCs). In heavy, chronic exposure — like a rideshare or taxi driver sitting for hours in a tightly closed car filled with strong scented products — these can cause irritation (eyes, throat, lungs) or headaches in some people.

This is real, but also very manageable.

❌ What the click-bait doesn’t tell you

There is no solid evidence that normal, everyday fragrance exposure causes serious disease.
Most studies show:
• Effects depend on dose + time
• A car with windows cracked or AC pulling fresh air dramatically reduces exposure
• Occasional use is not something people need to panic about
• Symptoms tend to be reversible when the fragrance source is removed

In other words: context matters.

🧭 Practical RMS/Flex5 Environments guidance

If you’re a driver or someone who spends long hours in a vehicle:
• Keep ventilation flowing (windows cracked or AC pulling outside air)
• Use softer scents, or take breaks from them
• Avoid heavy aerosol sprays in small spaces
• If you get headaches or irritation, reduce or remove the product — that’s your body giving feedback

For everyone else scrolling past fear-posts:
You don’t need to worry about normal exposure. Just stay mindful, not fearful.

💡 Bottom line

Fragrances aren’t “silent killers,” and they’re not harmless magic either. They’re simply environmental exposures we can manage with common sense — not panic.

That’s where Reality Meets Science® always lands:
Balanced. Evidence-based. Calm.

For references, please see comment section. 

11/14/2025

Dr Tom MD (aka Dr Archie De-Bunker) here again reporting on doctor of chiropractic, Eric Berg.  here was my reply to his scaremongering and partial truth mixed with misinformation post.

Be careful, whether me, Dr Berg or anyone else, and do your own homework. At the very least, consider credentials and experience:

 What happened was that many of these remedies either proven to be useless or even harmful. That doesn’t mean we shouldn’t be focusing on lifestyle as medicine or see the value in some natural remedies that have data to Back them, including omega-3, vitamin D, absorb forms of magnesium etc..

But don’t associate “natural remedies“ with prescribing Lifestyle Medicine including healthy eating, physical activity, healthy psychology, environment management and accountability.

A mistake or disingenuous to conflate the two, hopefully the former.

Yes of course we should be prescribing lifestyle as medicine. That is my career for the record. I’ve treated thousands of patients and taught thousands of healthcare providers in Lifestyle Medicine.

But just for example - cod liver oil for tuberculosis? Come on. Cod liver oil was historically used in TB treatment, but only with anecdotal reports of benefit. It was never shown to cure TB and has no modern evidence supporting its use as therapy. If any benefit was likely due to vitamin D, not a specific anti-tuberculosis effect and certainly not worth the risk of vitamin A toxicity.

There are immensely wiser choices for omega-3 and vitamin D than cod liver oil.

And niacin? Please familiarize yourself with two large population, placebo controlled, randomized control trials that put the nail in the coffin niacin as a therapy for lipids.

If not, do yourself a favor and get up-to-date with the results from AIM-HIGH and HPS2-THRIVE.

I could go further but I don’t have the time. I do suggest that people think critically rather than taking information at face value, whether chiropractic Dr Berg or me as an MD internal medicine physician and past president of the national board of physician nutrition specialists. Do your homework for your health.

We simply cannot scroll our way to health. 

11/14/2025

Flex5 friends! Please pick which hot topic next:
A. Bone health 
B. Saturated fat vs seed oils
C. Plant predominant vs plant pure

Or type your choice for topic in comments below