Paladin Family Practice

02/26/2026

I am guest hosting Walk with a Doc on Wednesday, March 11 from 11 A.M. to 12 P.M. at the Valley Health Wellness & Fitness Center.

Topic: Seasonal Allergies: What Helps and When to Get Checked

We will meet in the Fitness Center lobby and head outside for an easy group walk. Please arrive 10–15 minutes early to check in. The event is free and all are welcome.

02/25/2026

Finally. Someone is talking about the food supply like it actually matters.

Reuters reported that US health regulators are considering a petition to re evaluate the “generally recognized as safe” (GRAS) status for a long list of processed food ingredients, including certain refined carbohydrates and sweeteners like corn syrup. In plain language: some ingredients that have basically been treated as “safe by default” may soon face a higher bar, with more evidence required to keep them in our food. (I will include the Reuters link with this post.)

I see this as a step in the right direction. Refined carbohydrates and ultraprocessed foods are highly likely to be one of the biggest drivers of the US obesity epidemic and the downstream problems we all see: fatty liver disease, type 2 diabetes, hypertension, heart disease, and more. The US food environment is brutal. Cheap, hyper palatable, calorie dense food is everywhere, and it is engineered to be hard to stop eating. That reality fuels a massive portion of our healthcare spending.

When I was working in the hospital, this was impossible to ignore. Day after day, the majority of what we were treating traced back to preventable chronic disease, most often diet related illness, smoking, or both. You see the same patterns on repeat.

Artificial dyes deserve scrutiny too. They are not nutrition. They are marketing.

This will be a difficult battle. The food industry is extremely powerful and has a lot of money to throw around. Efforts like this will need more support to hold up over time. We all deserve to live in a healthier environment with better food options, not the current saturation of highly addictive processed foods in every store and drive throughs on every corner.

Practical takeaway (simple and effective): I like Michael Pollan’s advice.
• Shop the perimeter of the grocery store most of the time.
• Avoid or limit foods that need nutrition labels.
• If you do buy packaged food, keep it boring: short ingredient list, protein and fiber forward, minimal added sugar.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

The Food and Drug Administration will consider a petition to revoke the safety status of dozens of processed refined carbohydrates unless food companies can prove they are safe and not contributing to health issues and obesity, U.S. Health and Human Services Secretary Robert F. Kennedy Jr. said in r...

02/20/2026

We humans have only had widespread artificial light for a tiny slice of our history. Since Edison’s era in the late 1800s, electric light has been incredible for safety and productivity. But artificial light is not a replacement for sunlight, and it can also affect us most when it should be dark. We are still learning what constant indoor living, bright evenings, and screens at night do to our biology.

That is why I found this JAMA piece so interesting. The American Heart Association has now put out a formal scientific statement on “circadian health” and cardiometabolic risk. In plain terms: your body runs on a 24 hour clock, and the timing of light, sleep, meals, and exercise can influence things like weight, blood sugar, blood pressure, and long term heart risk. I will include the link with this post.

Practical takeaways that are realistic:
1. Get outdoor light early. A short walk in the morning does more than people think.
2. Dim the lights at night. If sleep is a struggle, cut bright screens for the last 30 to 60 minutes.
3. Keep sleep and wake times as consistent as you can, even on weekends.
4. Try to avoid heavy meals late at night.
5. Exercise is good at any time, but if evening workouts wreck your sleep, move them earlier.

None of this needs to be perfect. Small, consistent changes are usually enough to move the needle.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

This Medical News article discusses a new American Heart Association scientific statement on the importance of optimizing one’s circadian system to reduce the risks of obesity, hypertension, type 2 diabetes, and cardiovascular disease.

02/18/2026

This is fascinating. A new prospective cohort study in JAMA followed more than 130,000 adults for decades and looked at long term coffee and tea habits and later dementia outcomes. 

What stood out:
• Caffeinated coffee intake was linked with a lower risk of dementia and slightly better cognitive outcomes.
• Tea showed a similar pattern.
• Decaf coffee did not show the same association.
• The strongest signal was with moderate intake, roughly a couple cups a day, not extreme amounts. 

Important caveat: this is observational research. It shows an association, not proof that caffeine prevents dementia. But it is still a useful data point, especially because it separates caffeinated from decaf. 

Practical takeaway:
If you tolerate caffeine well, a moderate amount of coffee or tea can fit into a brain healthy lifestyle. I would not start caffeine just for this, and I would not push intake higher if it worsens sleep, anxiety, reflux, blood pressure, or palpitations. The big levers for brain health are still the basics: sleep, exercise, blood pressure control, diabetes prevention, not smoking, and staying socially and mentally active.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

This prospective cohort study investigates whether coffee and tea intake are associated with dementia risk and cognitive function in female participants from the Nurses’ Health Study and male participants from the Health Professionals Follow-up Study.

02/14/2026

Nearly everyone needs more hip mobility and here are some great hip focused movements.

02/12/2026

Getting started with exercise is one of the hardest parts. A lot of people feel like if they are not going all out, joining a gym, or training for something specific, it does not count. That mindset keeps people stuck.

A recent Nature article makes a simple point that I think is encouraging: going from doing nothing to doing something is where a lot of the benefit lives. Short bouts of movement, sometimes called “exercise snacks”, plus basic daily activity can meaningfully improve health over time. 

What that looks like in real life:
• Start small on purpose. Ten minutes counts. A brisk walk. A few flights of stairs. A short bike ride. Something you will actually repeat.
• Build toward a base: aim for about 150 minutes per week of Zone 2. That is the pace where you can talk in short sentences but you are breathing heavier. 
• Once you have that base, add a little intensity once a week to help your VO2 max. Example: 4 rounds of 4 minutes hard with 3 minutes easy between. Or 8 rounds of 1 minute hard with 1 to 2 minutes easy. Warm up first. Cool down after.
• If you are starting from zero, do not worry about perfect zones. Just move. Consistency wins.

Practical takeaway: you do not need a perfect plan to get real benefits. Start with small, repeatable movement, then gradually build. Over time, improving VO2 max and maintaining it later in life is one of the best investments you can make in long term health and independence.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

https://www.nature.com/articles/d41586-026-00237-0

02/10/2026

Screen time, including smartphone use, is an area of ongoing research, and we are learning more every year. As a dad, I know it can be a contentious topic at home. I also think most of us have to work on using screens in a way that helps our lives instead of quietly draining our attention. I try to keep up with the data, and I found this new JAMA study published in January 2026 interesting. 

Researchers used objective phone tracking from a large US teen study (not self reported estimates) and looked at phone use during school hours. The headline: many teens are still spending about an hour a day on their phones at school, and a big chunk of that time is social media, with video and games also showing up. 

Why it matters: attention is a limited resource. If it is getting pulled away repeatedly during the school day, learning is harder, stress goes up, and it is tough to build good habits.

Practical takeaway for families:
• Make the rule simple: phone away during class, period.
• Use Focus or downtime settings to block the biggest distraction apps during school hours.
• Explain the “why” to your kid in plain language: less stress, better grades, more freedom after school.
• Start small and be consistent. Consistency beats intensity.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

https://jamanetwork.com/journals/jama/fullarticle/2843506?guestAccessKey=338edf15-28ca-460a-a073-5d184373bab2&utm_medium=email&utm_source=postup_jn&utm_campaign=article_alert-jama&utm_content=etoc-tfl_&utm_term=020326

02/04/2026

I came across a fascinating case and I wanted to share the story.

An 81 year old endurance runner just set a world record in the 50K for his age group. Two weeks later, researchers brought him into the lab to see what was under the hood. The headline was not “youthful luck” or some secret supplement. It was years of steady training that preserved a surprisingly strong aerobic engine, plus muscles that were still very good at using oxygen efficiently. In plain terms, his fitness held up because he kept building it, and he kept showing up.

The takeaway for the rest of us is simple and encouraging. VO2 max is not just for elite athletes. It matters for health, stamina, and long term independence, and it can be preserved much later in life than most people assume.

A practical way to train it:
1. Build your base with about 150 minutes per week of Zone 2. That is the pace where you can talk in short sentences, breathe heavier, and still keep going. Brisk walking, incline walking, cycling, rowing, and light jogging all count.
2. Add one hard session per week once your base is consistent. Examples: 4 rounds of 4 minutes hard with 3 minutes easy between, or 8 to 10 rounds of 1 minute hard with 1 to 2 minutes easy. Warm up first, cool down after.
3. Start where you are. Consistency beats intensity when you are getting rolling. If you have heart or lung disease, or you have been inactive, talk with your clinician before pushing intervals.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

Aging is associated with declines in cardiorespiratory fitness and endurance performance, but this association is usually confounded by age-related declines ...

02/03/2026

I have been keeping an eye on the metformin and aging conversation, and I wanted to share a quick update with you.

This is not brand new, but I recently came across a 2024 study in Cell (link I am sharing). Researchers gave metformin to older male macaque monkeys and found signs of slower biological aging, especially in the brain, plus better performance on memory type tasks. Interesting, but it is still animal research, so it is not proof for humans.

What about people: metformin has a long track record in type 2 diabetes, and a lot of studies have linked it to better outcomes and sometimes lower mortality compared with other diabetes treatments. But we do not yet have solid proof that it helps healthy people live longer. That is what future longevity focused trials are trying to answer.

Practical takeaway: if you have prediabetes, diabetes, insulin resistance, or fatty liver, metformin may be a useful tool when it fits your situation. If you are healthy and thinking about longevity, the fundamentals still matter more than any pill: strength training, daily movement, waistline control, sleep, protein, fiber, and limiting alcohol. It is possible that in the future, metformin (or a related medication) ends up with a role in anti aging care, but we are not there yet.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

https://www.sciencedirect.com/science/article/pii/S0092867424009140

01/30/2026

A new JAMA study looked at people with atrial fibrillation who were having their heart rhythm reset with a cardioversion. Everyone in the study already drank coffee, and they were assigned to either keep drinking caffeinated coffee (at least about a cup a day) or avoid coffee and caffeine for six months. The group that kept drinking coffee had fewer returns of their abnormal rhythm over the next six months (47% vs 64%), and there was no meaningful difference in side effects between groups. The takeaway: for many people, moderate coffee does not appear to be harmful for atrial fibrillation and may even be helpful in some situations, but if caffeine clearly triggers your palpitations, trust your body and skip it.

Disclaimer: This post is for general information only and is not medical advice. If you have symptoms or questions about your health, talk with your clinician.

01/28/2026

Big congratulations to Dr. Sara Kepple. I am grateful for her support and guidance as I started Paladin Family Practice. She was generous with her time, honest about what works and what does not, and always encouraged me to stay focused on a patient first approach. Warrenton is lucky to have her.

Dr. Sara Kepple offers affordable primary care – without a deductible.

01/15/2026

GLP 1 meds like semaglutide are becoming a lot more common for weight loss, and they can be very effective. One issue people worry about is losing muscle along with fat. 

Big takeaway from this Mass General review: protect your lean mass by pairing these meds with a high protein diet and consistent exercise, especially resistance training. 

My general rule of thumb is to avoid “crash” loss and keep the pace to about 2 pounds per week max.

This is general education, not medical advice. Talk with your physician about what is right for you.

In a Grand Rounds presentation, Mass General Brigham researchers reviewed data on the impact of weight loss paradigms, including GLP-1 medication, on body composition and fat mass.