Dr Archie De-Bunker is back! The claim about arthritis below simply isn’t accurate. Arthritis is not caused “only by diet”, and age is a well-established risk factor, especially for osteoarthritis.
Osteoarthritis is strongly associated with aging because joints experience cumulative mechanical stress over time, cartilage gradually loses its ability to repair itself, and age-related cellular and structural changes occur within joint tissue. While symptoms can certainly appear earlier in life, the prevalence and severity of osteoarthritis rise markedly with age.
Inflammatory forms of arthritis, such as rheumatoid arthritis, psoriatic arthritis, and gout, are driven primarily by immune, genetic, and metabolic factors. Diet can influence inflammation and flare frequency, but it is not the sole cause of these conditions and does not explain their development on its own.
Now…nutrition does absolutely matter. Food quality, excess caloric intake, insulin resistance, and body weight all influence joint load and systemic inflammation, and improving these factors can meaningfully reduce symptoms and slow progression in many people. However, diet is only one modifiable contributor among many.
The bottom line is that arthritis reflects a combination of aging, genetics, biomechanics, prior injury, muscle strength, metabolic health, and lifestyle factors, including food. So, nutrition is important, but it is not the only driver, and age absolutely plays a role.
Age doesn’t inflame joints. Diet does.
12/18/2025
🩺 Big News on Weight-Loss Drug Costs in the U.S.
What happened:
The federal government announced agreements with major pharmaceutical companies Eli Lilly (maker of Zepbound/Mounjaro) and Novo Nordisk (maker of Ozempic/Wegovy) to significantly lower the cost of popular GLP-1 weight-loss and diabetes drugs. These agreements build on a broader policy initiative aimed at aligning U.S. drug prices with those in other wealthy countries. 
What it could mean for patients:
• Monthly prices for key GLP-1 drugs could drop from around $1,000–$1,350 to roughly $245–$350 for many patients when bought through the new TrumpRx platform and government programs. 
• Oral versions of these drugs (once approved) may be available at around $149/month for starter doses. 
• Medicare beneficiaries may see co-pays as low as $50/month for covered GLP-1 drugs. 
• Zepbound specifically has also seen price cuts on the LillyDirect platform even outside of the government program (e.g., ~$299/month for the lowest dose of injectable). 
How access could broaden:
Medicare and Medicaid coverage for certain obesity medications (like Wegovy and Zepbound) is expected to expand, potentially making them accessible to more patients with obesity and related health conditions. 
Note on context:
Some critics in Congress argue the details about consumer savings aren’t fully transparent yet and are pushing for more clarity on whether everyday patients will truly save money. 
⸻
💊 Personal Healthcare Disclaimer & My Perspective
As always, every reader of this post should discuss treatment decisions with their personal licensed healthcare provider. What works for one person may not work for another.
My bias:
Between the drugs commonly used for type 2 diabetes or weight loss, respectively (e.g., Ozempic/Wegovy vs Mounjaro/Zepbound), my personal tilt is toward Mounjaro/Zepbound. We generally see modestly more weight-loss results with tirzepatide (the active in Zepbound/Mounjaro) and generally modestly less, and for me personally particularly less, side-effects compared to semaglutide-based drugs like Ozempic/Wegovy. That said, everyone’s experience can differ, and individual risk profiles matter.
Full article link in comments section 
12/18/2025
Office holiday parties, “mandatory-ish” happy hours, endless treats on the counter…
For some people, this season isn’t relaxing — it’s extra emotional labor.
In Flex5, Mind Matters sits at the top not because it’s everything… but because it shapes how everything else is experienced.
Here’s the reframe:
✅ Mind Matters: Sometimes the healthiest choice is fewer things that require constant willpower.
✅ Environments: Design your surroundings to support your priorities.
✅ Accountability: Set boundaries without guilt.
You don’t have to push from a 5–10% fun zone into a 25–50% zone that leaves you depleted.
Protect your energy. Protect your priorities. Enjoy the holidays on purpose.
12/18/2025
Thoughtful and important study linking eating patterns consistent with The Flex5 Lifestyle’s maintenance phase as associated with less inflammation and with improved survival in advanced colon cancer.
A few clarifying thoughts I believe may help us ensure we interpret this literature in a way that best serves patients.
For instance, the article reports that physical activity attenuated the relationship between dietary inflammatory pattern and overall survival — an important reminder that diet does not act in isolation. Shared upstream drivers, additionally such as energy balance, insulin sensitivity and metabolic adiposity, likely mediate much of the observed benefit.
Dietary inflammatory indices (such as EDIP) are useful descriptive tools in observational cohorts, but they do not fully capture the dominant physiologic regulators of inflammation, particularly under conditions of medically monitored, intentional weight loss and resulting improved metabolic health.
This is why we see substantial reductions in inflammatory markers in intensive lifestyle, calorie lowered (vs patient baseline), interventions — even when early-phase strategies include medically formulated meal replacements that would score poorly on food-quality or “ultra-processed” food indices like NOVA.
From The Flex5 Lifestyle® perspective, this reflects the importance of phase-appropriate strategy rather than contradiction - for example patients in multidisciplinary intensive programs I have built in lead will go through three phases, generally speaking:
• Transformation phase (≈6–12 months): targeted calorie control to rapidly improve metabolic health and lower inflammation
• Transition phase (≈2–3 years): continued coaching to solidify habits and reduce relapse risk
• Maintenance phase: long-term adherence to a personalized, plant-predominant, non-extremist flexitarian eating pattern
Judging early-phase therapeutic tools as “toxic” simply because they are “ultra-processed” per NOVA (which has been shown in metabolic wards to lose its ability to distinguish foods risky for calorie overload once non-beverage calorie density and hyper palatability are controlled for) ignores the longitudinal reality of behavior change and metabolic healing.
Importantly, supporting so-called anti-inflammatory dietary patterns still makes sense for upstream reasons — e.g., higher potassium-to-sodium ratios for improved cardiometabolic health as CVD remains a leading cause of death among cancer survivors, including being the second most common cause of death in breast cancer survivors.
When Nutrition is integrated with Physical Activity, Mind Matters (ie psychology), Environments and Accountability - applied with appropriate timing and personalization - we move beyond limited distinctions and toward durable, real-world health transformation.
Reality Meets Science®
CHICAGO — Consuming a noninflammatory diet increased OS for patients with late-stage colon cancer, according to findings from a large, prospective cohort study presented at ASCO Annual Meeting.Of note, regular physical activity appeared to attenuate the association between diet and OS. Researc...
12/18/2025
I admire Dr Greger, I must be clear. But I must call things as I see them. And yes, he’s a non-animal food consuming, non-practicing physician with laudable ties to the Humane Society, while I’m a flexitarian practicing physician with over 20,000 hours of metabolic nutrition inclusive multidisciplinary care leadership experience. And while I’m no fan of confined animal feeding operations whatsoever and would phase them out as much and fast as reasonably possible if I were “king”, I am not a plant purist. Those cards on the table, here is the way I see the data and nutrition facts.
His overview below is well intentioned I believe, and many of these mechanisms are even biologically plausible…but a few important distinctions matter for accurate interpretation.
Acute post-meal changes in inflammatory biomarkers (e.g., IL-6 after a single meal) demonstrate physiologic responsiveness, not long-term disease causation. These short-term spikes are well known to occur after high-fat or high-glycemic meal loads (i.e., calorie-dense meals), and attenuation by berries, spices, or polyphenol-rich foods is expected. But this does not establish sustained reductions in chronic inflammation or mortality risk independent of energy balance.
When we examine longer-term interventions, the most consistent and largest reductions in inflammation (e.g., via CRP and IL-6) occur with weight loss and reductions in adiposity, regardless of dietary pattern.
Adipose tissue is itself a major source of inflammatory cytokines, so fat-mass loss dominates the effect size in most metabolically inflamed individuals.
Plant-based diets often improve inflammatory markers because they lower calorie density, promote weight loss, improve insulin sensitivity, and reduce CRRAHP (calorie-rich, refined, and hyper-palatable) food intake, with fiber, polyphenols, and phytochemicals playing supportive roles—but not as central as CRRAHP reduction and overall calorie reduction.
While as a clinician I do not routinely use VLCD protein-sparing modified fasts via zero-fiber meal-replacement shakes, there is no question they have been published and show dramatic inflammation reduction—underscoring the dominant role of energy balance rather than fiber per se.
Indices such as the Dietary Inflammatory Index reflect diet-composition scores, not direct measures of biologic inflammation, and should not be conflated with causal biomarker changes.
In fact, randomized trials comparing healthy vegan, healthy Mediterranean, healthy low-fat (e.g., Pritikin), and other diets show overlapping improvements in CRP and IL-6 when weight loss occurs, and inconsistent differences when weight is held constant.
Thus, attributing anti-inflammatory effects primarily to the elimination of animal products risks over-interpreting association as causation.
To me, and I think most fair to all, a more precise conclusion is that metabolic context matters more than dietary ideology: diets that reduce excess energy intake and metabolic stress tend to reduce inflammation, whether plant-pure or not.
References for consideration:
Nicklas et al., Journal of Nutrition, 2004: Demonstrated that reductions in CRP were driven primarily by weight loss, not macronutrient composition.
Klement and Pazienza, Nutrients, 2019: Comprehensive review showing adiposity reduction as the dominant determinant of systemic inflammation across dietary patterns.
Calder et al., British Journal of Nutrition, 2011: Clarifies the difference between acute post-prandial inflammation and chronic inflammatory disease risk.
Tom M. Rifai MD FACP DipABLM
Past President, US National Board of Physician Nutrition Specialists
12/17/2025
Dr Archie De-Bunker is back for a “Gross exaggeration alert!”: In the spirit of Einstein’s philosophy that science should be explained “as simply as possible, but not simpler”, here’s what the ACC reviews have actually emphasized: context and replacement, not carte blanche endorsement.
Specifically:
Sat fats are not essential for adults nor children. PUFAs are.
Replacing saturated fat with REFINED carbs (liquid sugar sources, white flour based foods, other fiber removed refined grains etc) does not improve outcomes - this is where much confusion arises.
Yes, certain dairy with an milk-fat-globule membrane (MFGM) compounds may modestly attenuate lipid effects, but this is very different from endorsing butter, beef tallow, or refined saturated fats as “health foods”, as they do not have MFGM features.
Spoiler for Robert and MACA (Make Americans Confused Again): The ACC continues to recommend limiting saturated fat as part of an overall cardioprotective dietary pattern, especially when it displaces healthier unsaturated fats. Simpleton statements like “saturated fat is fine” are irresponsible. But they will go on. C’est la vie.
Reality Meets Science®
'The recommendation to limit dietary saturated fatty acid (SFA) intake has persisted despite mounting evidence to the contrary.'
Chiming in…Whole milk is not a nutritional villain, but it’s also not nutritionally essential.
There is reasonable evidence that dairy fat behaves differently than isolated saturated fat, in part due to the milk fat globule membrane (MFGM). This structure appears to attenuate adverse lipid effects compared with butter or other refined saturated fat sources, and fermented or whole-food dairy is consistently associated with neutral or modestly favorable cardiometabolic outcomes in observational studies. And yes, observational is not proof, I understand. But it’s notable.
That said, saturated fat is not an essential nutrient for adults nor for school-aged children. Children do not require saturated fat for growth or development. Modest amounts are not existentially dangerous, but from a nutritional standpoint, whole milk primarily adds non-essential fat calories. 1% is probably the best balance on a population health level. But c’est la vie. This isn’t the worst thing coming from the MACA (make America confused again) movement and as such the recent House-passed bill allowing whole milk back into schools is not our most pressing school-nutrition problem.
A greater concern is the directional shift being signaled at HHS, where enthusiasm appears stronger for heavy butter, heavy beef tallow, and other refined saturated-fat sources. These are saturated fat sources with far less protective food matrices and stronger associations with adverse cardiometabolic risk - especially when they replace unsaturated fats or sources of minimally processed, high intrinsic fiber associated carbohydrates (think beans, peas, lentils and minimally processed whole grains).
Equally concerning is the relative lack of attention to high amounts of added sodium, which remains one of the most robust, modifiable drivers of hypertension across the lifespan, including in children.
Bottom line: Whole milk in schools is a somewhat secondary issue. The real risk lies in broader policy signals that downgrade unsaturated fats, ignore sodium, and elevate refined saturated fats, all while missing the bigger opportunity: improving overall food quality, balance, and long-term cardiometabolic health.
How about some work on Farm Bill policies that would bring fruits and vegetable prices down?
Yesterday, the Whole Milk for Healthy Kids Act, legislation we have long opposed, passed the House. The bill will likely soon be enacted into law by President Trump.
The science is clear: dietary saturated fat increases heart disease risk, the leading cause of death in the U.S. Despite this, the bill allows full fat (whole) and reduced fat (2 percent) milk to be served in schools and exempts milk’s saturated fat content from counting towards the weekly, science-based saturated fat limits school meals follow. Eighty-four to 91 percent of children consume too much saturated fat. This bill thus leaves even more room for excess saturated fat, making this bill the exact opposite of what is needed to improve health outcomes and a clear handout to the dairy industry at the expense of our kids’ health.
We appreciate Congressman Bobby Scott and all representatives who voted “No” for putting our kids’ health first. But we are disappointed that Congress, instead of prioritizing access to and funding for school meals and other child nutrition programs, chose to undermine evidence-based nutrition standards that were designed to protect kids’ health.
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Photo credit: Kristina Blokhin - stock.adobe.com
12/16/2025
Tabouli at a restaurant with no salt added? Only at the phoenicia_resturant! ❤️
12/16/2025
How shall we interpret this study funded by the Australian egg industry re nuance and cardiovascular context?🥚🧠❤️
The headline advice has barely changed in 40 years:
“One egg a day is OK”, despite we’ve learned far more about cardiovascular risk heterogeneity, apoB particle containing biology, and dietary patterns used to reverse heart disease (e.g. Medicare-approved intensive cardiac rehabilitation programs like Ornish and Pritikin).
So here’s my nuance:
🔹 I don’t support a blanket recommendation that everyone should eat one whole egg per day, especially individuals with established ASCVD or very high cardiometabolic risk. Egg whites are a different story - being an option in both of the heart disease reversal programs aforementioned - as they contain no saturated fat or cholesterol.
🔹 For high cardiovascular risk individuals, adding dietary cholesterol has not been shown to provide benefit—but does add risk. If a cell needs cholesterol, it synthesizes it intracellularly. Circulating levels beyond physiologic need are not required (newborns arguably have the highest building demands of any humans and have very low levels of circulating cholesterol).
🔹 That said, if eggs are a “non-negotiable” for someone, a compromise approach (e.g., ~2–3 egg yolks per week) keeps average dietary cholesterol
12/16/2025
Nutrition frameworks come and go. Biology does not.
“The Portfolio Diet” functions as a therapeutic nutrition strategy built around specific cholesterol-lowering tools. Those tools are valuable — and importantly, they are compatible with broader lifestyle frameworks like Flex5, which takes a slightly different — and more complete, human-centered — approach.
Why? Because Flex5 is not a “diet” (we intentionally avoid that word). It is a holistic lifestyle, both in terms of philosophy and clinical methodology, integrating nutrition with psychology, behavior change and maintenance skills, and real-world sustainability.
Where Flex5 aligns — and where it intentionally, necessarily, goes further:
Like other evidence-based eating patterns, Flex5 principles overlap with approaches shown to:
• Lower apoB-containing lipoproteins
• Reduce systemic inflammation
• Improve insulin sensitivity
• Lower blood pressure
• Stabilize atherosclerotic plaque
This matters because cardiovascular events don’t occur only because plaque exists (which is necessary, to be sure, but not sufficient) — they occur when plaque becomes inflamed, unstable, and ruptures, triggering thrombosis (blood clot blocking blood flow to heart or brain).
But where Flex5 clearly distinguishes itself is in how it addresses human behavior.
The 5% Fun Zone is not a “loophole” — it is a very intentional, preemptive and reality accepting, feature:
Flex5 explicitly includes a “5% Fun Zone”, and this is not a concession to weakness. It is acknowledgment of strategic resting, human agency and calculated risk acceptance. It is also optional and can be forgone, if one wishes - which can often be temporarily the case, but we rarely see that lasting. And Flex5 is about long lasting lifestyle. 

The 5% Fun Zone is a deliberate, science-informed design choice rooted in psychology (what we call “Mind Matters”) and acceptance.
Flex5 avoids the self-sabotage of:
• Zero-tolerance extremism
• Food moralization (“cheat” days, “guilty” pleasures)
• The naive illusion that lifelong adherence comes from denial
Instead, Flex5 acknowledges a biological and psychological truth:
The dose makes the poison — and pretending non-negotiables don’t exist leads to failure.
No other metabolic health or longevity-focused eating framework more directly faces reality:
• Some foods are non-negotiable for some people
• Enjoyment, when accepted, intentional, and bounded, is not the enemy
• Suppression breeds rebound; acceptance breeds control
This mirrors what we see in real-world longevity populations like ‘blue zones’ and the Tsimané tribe of the Bolivian Amazon.
CRRAHP foods are kept to a very dull roar — but not treated as “forbidden” and to be associated with shame. They are enjoyed rarely, intentionally and mindfully - including a “moment of silence“ to focus on the rare pleasure, and without guilt (e.g., Sardinian Easter celebrations), not framed as “rule-breaking”.
That is where Reality Meets Science® as I’ve seen over 20,000 hours of human health transformation coaching and multidisciplinary clinical experience.
The Flex5 Lifestyle® from RMS doesn’t rely on ideology — it relies on science blended with wide ranging, real-world, human experience .
Through the Flex5 Lifestyle and its accompanying education, objective biomarkers act as early warning signals, not moral judgments:
• Rising blood pressure → salt or calorie creep
• Worsening lipids / apoB → saturated fat or excess energy
• Declining insulin sensitivity → metabolic overload
When the biology speaks, we plan, track, adjust, re-assess and optimize.
It’s not rocket science. But it darn well is science driven.
Bottom line:
Flex5 belongs to a universe of human health transformation approaches, compatible with therapeutic nutrition strategies like Portfolio — but it distinguishes itself by integrating biology, behavior, acceptance, and objective feedback into a sustainable whole.
Different paths.
Same biology.
Better adherence.
Better outcomes.
Reality Meets Science®.
12/15/2025
Yes — even at starbucks you can eat for health (and a little comfort too). ☕️🥣
My go-to order: oatmeal, simplified.
✔️ Toppings: mixed nuts + blueberries only
✔️ Swap water → steamed nonfat milk
✔️ One packet of Stevia or Splenda
…and you’re good to go.
Simple, satisfying, and surprisingly aligned with metabolic health — proof we can still eat out and make smart choices on the road.
Special thanks to Dr. Walter Willett (Michigan State, University of Michigan, Harvard) for helping inspire options like this to exist at scale. If you haven’t heard it yet, ask me for the podcast episode I recorded with Walter and I’ll drop the link in the comments.
Discipline without extremism. Reality meets science.
12/15/2025
Flex5 – Mind Matters | Processing Tragedy Without Surrendering Our Humanity
The past couple of days have brought deeply troubling news — senseless violence, innocent lives lost, families forever changed. My sincerest condolences go out to the Reiner family, to the families and community affected by the tragic events at Brown University, and to those grieving after the horrific loss of life in Australia. Our hearts are with you.
It’s human to feel shock, sadness, anger, and even fear. Acknowledging that matters.
At the same time, how we process these events matters just as much.
In Flex5 – Mind Matters, we often return to the three levels of control:
1️⃣ What we can control
Our thoughts, our behaviors, how we show up for our families, patients, colleagues, and communities. We can choose compassion over hatred, presence over paralysis, and purpose over despair.
2️⃣ What we can influence
How we speak to one another. How we support those who are hurting. How we advocate for safer environments, healthier systems, and healthier societies — while remaining grounded rather than reactive.
3️⃣ What we cannot control
The existence of violent acts committed by others. Pretending otherwise only amplifies suffering.
Part of healthy processing also includes situational awareness — being present in our surroundings, trusting our instincts, and embracing the simple principle of “see something, say something.” Awareness is not fear; it is responsibility.
Equally important is respecting the rights of individuals to legally defend themselves and their loved ones in ways consistent with the law. Preparedness, when rooted in responsibility and restraint, is not aggression — it is stewardship.
This is one reason I’m personally committed to ensuring my children become deeply knowledgeable in self-defense and martial arts — not to instill fear or violence, but to build confidence, discipline, respect, and the ability to protect themselves if ever truly necessary.
Holding space for grief and concern is not weakness — it’s humanity. But allowing fear or despair to dominate our lives is something else entirely. When violence succeeds in stopping us from living fully, loving deeply, and moving forward, it grants power to those who seek destruction.
The most compassionate response is not denial — it is resolve.
Resolve to live well.
Resolve to care for one another.
Resolve to continue building health, meaning, and connection — especially in dark moments.
Life does go on. And choosing to live it with intention, courage, and compassion is not disrespectful to those lost — it honors them.
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Dr Tom Rifai is a physician expert in the areas of lifestyle medicine and metabolic health coaching for wellness, weight loss and disease prevention. He has worked with countless patients to reverse or substantially improve their type 2 and prediabetes, heart disease and unparalleled skills in healthy, sustainable weight management. Many physicians claim to be expert in metabolic health, lifestyle medicine and weight management. Exceedingly few have Dr. Rifai's well established experience at the highest levels of multidisciplinary care nor his personal insights as a recovering binge eater (see link at bottom). His evidence based training and clinical approach is one of "lifestyle first, medications only if necessary". Dr Rifai has been elected a Fellow of the American College of Physicians for his leadership in education of physicians and medical students in lifestyle medicine and type 2 diabetes prevention. He recently served as Regional Medical Director of Metabolic Health and Weight Management for the world renown Henry Ford Health System of Metro Detroit, Michigan - helping make unprecedented strides in standardizing and integrating multiple different program offerings throughout the system to one based on a solid, unified curriculum based on his Reality Meets Science® based 5 Keys to optimal wellness, weight loss and disease prevention: 1. Understanding Nutrition 2. Understanding Activity 3."Mind Matters" (psychological and spiritually related issues) 4. Environments (e.g., food, social) and 5. Accountability (e.g., whether to a program like RMS, a hospital based program or even self-monitoring tools like food and fitness apps or groups).
Dr Rifai is founder and President of his health education and wellness company Reality Meets Science® LLC (aka RMS), the mission of which is to translate lifestyle science into powerful, yet practical and sustainable applications for the every day person (tag line: "Lifestyle Science for YOU"). The 5 RMS Keys of healthy lifestyle helps busy, hard working people break down the otherwise challenging process of life saving lifestyle changes into manageable areas of focus. As they operate together when one Key area improves, it typically helps benefit other Key areas of healthy lifestyle (an interdependent superstructure of the most critical distilled components of health and well-being)
Dr Rifai has also been distinguished as a Harvard Medical School continuing medical education (CME) online course director of Lifestyle Medicine on the urgent topic of prevention of type 2 diabetes (course title: "Nutrition and the Metabolic Syndrome" Weblink - CMEonline.Med.Harvard.Edu/Info/Nutrition) Rifai's Harvard CME course educated thousands of health care providers since its release in 2009 and has been in the top quintile of most popular online Lifestyle Medicine CME courses through Harvard Medical School. The course guides and educates doctors and health care providers on evidence based motivational interviewing techniques, practical, achievable but effective and lifesaving lifestyle changes as well as the type 2 diabetes prevention drug Metformin, where evidence justifies its use and potential benefit as an add-on to (not as an alternative to) lifestyle change.
In all of this, Dr. Rifai is not only an expert in the area of therapeutic lifestyle change, but also a patient himself. As aforementioned, he has spent years challenged with depression, binge and nighttime eating. The experiences and journey through such, while maintaining great health thanks to all the blessings in life he has to motivate him to "battle on!" has given him great insight, and humbling modesty, in his becoming an elite lifestyle and health coach. He provides not only great sympathy, but great empathy with the clients and patients he serves. His story on becoming a lifestyle medicine doctor was recently published through the American College of Lifestyle Medicine: https://www.lifestylemedicine.org/page-1863534
DISCLOSURE:
Reports financial relationships with his business, Reality Meets Science LLC.
