Dr. Tom Rifai

11/07/2025

TRUE or FALSE: To maintain muscle as he ages (now 57), Dr Tom takes testosterone, creatine and/or some other form of PED (performance enhancing drug) or supplement.

11/07/2025

In the world of “longevity medicine” there are many that are willing to take a single study in rodents and extrapolate that to meaning it is reasonable to try the drug in the human clinical world. Here’s why I don’t agree along with factual numbers behind why - all in 90 seconds.

11/07/2025

I’m beginning to feel like “Dr. Archie De-Bunker”. Anyway, here goes. And again, I really like Michael too. I’ve met him and he’s a great speaker, though he is a plant purist and I am a plant predominant flexitarian who doesn’t believe in absolutism or zero tolerance when it comes to food, because it too often leads to disordered eating and missed opportunities to mindfully enjoy life (ie occasional and well managed food in indulgences):

All that said, I believe Michael is directionally correct. But we don’t have to absolutely “cut out“ so-called “processed foods“ (the NOVA score system that we have been relying on to define so-called “ultra processed foods“, but thankfully are moving away from, is fatally flawed IMO, equating Greek yogurt with a touc highly processed jelly at the bottom to hot dogs and spam!).

As former medical director of the Pritikin Longevity Center (which Michael often touts as saving his grandmother and inspiring him to become a physician) I can attest to community wide complaints about no salt added foods “tasting like cardboard” at first, and in a very controlled environment like the Pritikin center it works because there’s no other choice (as well there is, but you really have to work for it by leaving the center) and by end of week one of your two weeks day, you are accommodating the natural flavors of foods much better. I personally love going to Pritikin (in Miami) to “detox“, if you will.

But “taste bud rehabilitation“ can occur by substantially, without absolutely, cutting back on CRRAHP foods. And it’s much more pleasurable and realistic to allow a “5% fun zone“.

I say this with the actual clinical experience Michael and many others don’t have in working with thousands of patients over tens of thousands of hours over decades in systems beyond Pritikin - ranging from Beaumont (now Corewell) Health to Trinity Health to Henry Ford Health system and Cleveland Clinic.

And let’s not oversimplify the dopamine issue please. Here’s the skinny on a more nuance to approach to thinking about dopamine:

🧠 1. Baseline dopamine tone vs. reward responsivity

Many people with obesity start out with — or develop — a lower baseline dopamine tone and/or reduced dopamine receptor availability (particularly D2 receptors in the striatum).

• This means they don’t get as much reward “signal” from ordinary stimuli (like a normal meal).

• So, hyper-palatable, calorie-dense foods (rich in sugar, fat, and salt) can temporarily “rescue” that low dopamine feeling by delivering a bigger dopamine burst.

This is similar to how addiction models describe a person chasing the dopamine hit they can’t easily get otherwise.

🔁 2. Chicken-and-egg problem: pre-existing vs. acquired

This low-dopamine responsivity can precede obesity (predisposing some people to seek more stimulation from food).

But, over time, chronic consumption of CRRAHP (calorie rich, refined hyper-palatable) foods also downregulates dopamine receptors further — creating a vicious cycle:

🧩 “Pre-existing low reward → more intake → further blunted dopamine response → even more intake.”

So, it’s both:
• partially innate or early-life trait (some people born with lower D2 receptor density or slower dopamine reuptake); and
• partially learned/adaptive due to repeated high-reward food exposure.


Cut out processed foods for a few weeks, and you’ll be amazed how good healthy foods can taste.
When switching to a low-salt diet, for example, everything might taste like cardboard at first.

But research shows that over the next several weeks, taste buds adapt.

✅ Participants started preferring the taste of salt-free soup over salty versions.
✅ They added less salt themselves the longer they stayed on a low-salt diet.
✅ By the end of the study, soup tasted just as salty to them—even with half the amount of salt.

If you've ever been on a sodium-restricted diet, you know how salted foods can start tasting too salty. You just naturally start favoring less salty food.

A similar thing can happen with fat, too.
➔ The less fat we eat, the more sensitive to fat our taste buds appear to become, which may lead to spontaneous reductions in butter, meat, dairy, and eggs.

Salt may override this effect, so it may be helpful to cut down on fat and salt simultaneously.

There is a brain component to this, too.
➔ People who regularly eat ice cream (which contains sugar and fat) have a dulled dopamine response when drinking a milkshake. Once we’ve dulled our dopamine response, we may then overeat in an effort to achieve the degree of satisfaction previously experienced.
➔ In contrast, diets rich in whole plant foods don’t lead to a deadened dopamine response––even with the same number of calories. So, they help us achieve natural satisfaction without overeating.

The longer we eat healthier, whole foods, the better they taste. Don’t believe us? Go ahead and put it to the test!

See the video “Changing Our Taste Buds” at https://bit.ly/2MmG0aV to learn more.
PMID: 3728360, 21757270, 26708735, 22338036

11/07/2025

I have to respectfully disagree with being “afraid” or “fearful“ of eating any food. This includes unsaturated fat rich seed oils, which despite their ultra high calorie density, when controlled for calories (key!), certainly have plenty of data to support that they can be part of a healthy eating pattern.

Caution? Mindfulness? Considering “calculated risks” (such as cake on a special occasion like your daughter’s wedding), of course.

But “fear“? Never.

Without question one of the healthiest rock stars out there aside from Paul McCartney is Paul Stanley of KISS and of Phantom of the Opera fame.

Search YouTube for a two minute video “Paul Stanley on growing old“. He conveys an excellent balance of discipline without extremism and certainly without “fear“ of occasional non-negotiable indulgences. His answer to a physician with whom he was discussing his family history of high cholesterol when that physician said Paul S. could “never“ eat ice cream again is classic.

As a metabolic health and lifestyle medicine physician, and past Medical Director of the Pritikin Longevity Center, I have shared that video with hundreds of physicians who are missing the boat if they don’t understand that when they talk about food in terms of fear, conversations like Mr. Stanley’s go on behind their back afterwards more often than not.

Most patients and the mass of public, even those interested in healthy eating - don’t want to hear about “fearing” food. food fear leads to disordered eating. Even oils and occasional calorie rich, refined and hyper-palatable (CRRAHP) food concoctions can fit in what we call a “5% fun zone”.

Blue Zones have calculated risky eating (note how Sardinians indulge in the celebration of Easter). Bolivian Tsimané (who have the lowest rates of heart disease ever recorded) have them (see my YouTube interview of one of the two main researchers of the tribe, Prof. Michael Gurven).

The problem is when we’re running on a “55 to 75% Fun Zone” like so much of America - we are banking on a balloon mortgage against our healthspans.

Sadly it’s difficult to avoid because we have saturated ourselves in food environments with businesses serving and exposing us to overwhelming amounts of CRRAHP food concoctions.

As such, we are collectively losing 10 to 15 years of health. See my YouTube interview of Professor Marion Nestle, Prof. food politics and nutrition NYU, as well as Farmer and best selling author of “land rich, cash poor“, Brian Reisinger on “saving America’s metabolic health by saving our family farms“.

11/07/2025

This page got almost 2,000 reactions on its posts last week! Thanks everyone for your support! 🎉
Please continue to share with friends and family 🙏🏽

11/07/2025

I don’t categorically disagree with Dan here. But I do subtly. And it’s important nuance. Now I love Dan - a brother from another mother. We appeared in the PBS documentary “the embrace of aging” together. 

But it’s actually both: ie a combo of NEAT (non-exercise activity time… which is the “blue zone’s style” physical activity to which he is referring) - which I would agree is the cake - plus small, much more manageable (and certainly not gym requiring) regular small bouts of “brisk physical activity that is scheduled on a daily regular and consistent basis” (ie “exercise“).

The combo of NEAT topped off with sustainable regular bouts of exercise is the sweet spot for modern, non-blue zone, areas .

NEAT is the cake, “exercise is the icing”.

Something Dan didn’t mention: exercising regularly but then sitting all day long, is also occurring in many of the people that are exercising regularly. And regular exercise and the time spent the rest of the day in secondary behaviors are two different issues.

Notably, the issues addressed by manageable exercise (and that certainly doesn’t include CrossFit or marathons, levels of exercise they could ultimately even increase heart arrhythmia risk as they go beyond the bell curve of exercise benefits) is not about managing obesity.

There is a much wider picture when one opens the aperture as it relates to the KPI’s for exercise, including mood, blood pressure, bone health, muscle maintenance and insulin sensitivity.

Since we don’t live in the nudging environments of blue zones (and I’ve been to the mountains of Sardinia and deep into the forest of Nicoya), we really have to accommodate whatever non-exercise activity time we can fit in in our highly mechanized worlds but top it off with bits of exercise to help blow out the carbon.

Now, if one was forced to choose between NEAT and “75 or 150 minutes of brisk or moderate, respectively, minutes of exercise per week“. NEAT is the way to go. On that, I agree with Dan.

11/06/2025

Worth sharing. As many you might remember, Professor Stuart Phillips was a guest on the Reality Meets Science podcast, and we actually discussed protein and muscle as it relates to menopausal health. 

We can all do everyone a big favour on here and help each other with truthful and transparent communication. I believe honesty will win the day. So here's some honesty around the data that's recent been WAY overhyped as proof MHT 'causes' anything disease-wise, and notice the lack of a crusading saviour complex message. It's a sign when someone claims to come to save your health and crusade. There's enough of that kind of rhetoric going on in politics right now. So let's get the those that are trained to know better to deliver real messages to women about their health! Thanks for keeping it real!

11/06/2025

Helping the public understand the difference between observational data and prospective human randomized control data is one of the biggest challenges we have regarding public health discourse. Add the over extrapolation from animal-based studies and the push to conclusions with “biological plausibility“ and we have a maddening mixture of misinformation and over exaggeration that is so attractive to marketers from social to mainstream media who are looking for clicks and views more than the public benefit. 

This is a brief snippet from the senior author of the work that many influencers have said is evidence that shows a 60% reduction in risk as causal. Folks, observation is not causation. It's good news to be sure, but not enough to make the claim that MHT is THE reason why women saw an association with reduced risk for certain chronic diseases.

11/06/2025

🔥 The “Twinkie Diet” — a real-world reminder that physics still applies to biology.

Body:
A Kansas State nutrition professor once lost 27 pounds in 10 weeks eating mostly junk food — Twinkies, Doritos, Oreos.

How? He applied the first law of thermodynamics — energy balance. He ate fewer calories than he burned. Period. Full stop. And this isn’t the first time this type of self experiment has been done whether it’s with McDonald’s or CRRAHP (calorie rich, refined and hyper palatable) sweets etc.

Of course, that doesn’t mean eating purely CRRAHP food is healthy in the long run.” Far from it. But it does highlight a key truth that often gets buried in nutrition tribalism: calorie control drives weight control.

Now, as for his improved cholesterol — it’s not mysterious. When you cut total calories that drastically, you also usually cut saturated fat and dietary cholesterol. Combine that with the weight loss itself, and you’ll see lipid improvements even on a nutrient-poor diet.

Bottom line:
✅ Calories matter for weight.
✅ Quality matters for health and longevity.
✅ Both matter for life span and health span.

If you’d like me to discuss this further, like this post and/or make a comment as such below.

Full article link in the first comment 👇

📊 

11/06/2025

This was just posted by physician on LinkedIn. Would you like me to discuss it? If so, what additional questions would you like to bring to the table?

11/05/2025

Sigh…Just got this email notice from one of my kids’ schools.

I’m not “against“ kids having an occasional hotdog or chicken tenders or whatever is inexorably and inevitably flying at them at breakneck speed and tsunami forces. I’m a realist.

But when the hard core of food choices served to the children in our schools are CRRAHP (calorie rich, refined and hyper palatable), we simply have a LONG way to go.

And it starts at home. Am I wrong?

PS: I’m not blaming Public Schools. They are operating inside a matrix of a food system designed to fail our long term metabolic health at the expense of big food inc profit. Check out my YouTube on saving our country’s metabolic health by saving our family farms.

11/04/2025

One of the best independent product review resources available is consumerlab_. And no, they do not pay me to tell you this. It’s simply based on my opinion from experience.