Dr. Tom Rifai

01/11/2026

Dr Archie De-Bunker with an RMS house call.

Dr Mercola, sadly, is well known for sensationalist claims. And here’s another (with a visual of someone’s hand over the opposite side of where their liver would be, ironically) on “hydrogen therapy”. Well, while these researchers explore, don’t wait. Here are some facts you need to know if you have MASLD (aka NAFLD) type fatty liver:

An important additional clarification—because delay matters here.

Metabolic dysfunction–associated steatotic liver disease (MASLD), formerly known as nonalcoholic fatty liver disease (NAFLD), is not a benign condition that can be “supported” indefinitely with supplements. In a meaningful subset of patients, prolonged fatty liver does progress—from simple steatosis to metabolic dysfunction–associated steatohepatitis, fibrosis, cirrhosis, and ultimately liver failure or hepatocellular carcinoma (primary liver cancer). This progression is often silent.

That’s why false reassurance is dangerous.

Milk thistle (silymarin) is frequently promoted as a liver “cure-all.” The reality is far more modest. While it has antioxidant properties and may improve liver enzyme levels, it has not been shown to reliably reduce liver fat, reverse fibrosis, or halt disease progression. Normalizing blood tests without addressing liver fat can create a false sense of security while underlying pathology continues.

The same caution applies to speculative approaches such as hydrogen-based therapies. Mechanistic hypotheses and early-phase studies do not substitute for robust, long-term clinical outcome data.

To be very clear:
The primary, evidence-based treatment for metabolic dysfunction–associated steatotic liver disease is intentional, sustained weight loss and metabolic improvement, leading to evacuation of fat from the liver. Even 5–10% reduction in body weight has been shown repeatedly to reduce liver fat, improve inflammation, and slow or reverse early disease.

Supplements and experimental therapies may one day play an adjunctive role. But they do not replace the urgency of addressing energy excess, insulin resistance, and visceral adiposity now.

Delaying effective treatment in favor of unproven “supportive” approaches risks allowing a reversible condition to become irreversible.

Bottom line:
Metabolic dysfunction–associated steatotic liver disease is common, serious, and treatable—but only if we act on what actually works. Clarity matters. Timing matters. Outcomes depend on it.

01/11/2026

A few important clarifications on protein rich powders, because several different issues are often conflated.

First, there is no credible long-term human evidence showing that clinically used protein-rich meal replacements increase cancer risk.

In fact, in the Look AHEAD trial—a large, well-conducted lifestyle intervention that did use protein-rich, powder-based meal replacements during the weight-loss phase—long-term follow-up showed no increase in cancer risk. On the contrary, participants in the intensive lifestyle group had lower incidence of obesity-related cancers, and those who achieved the greatest sustained weight loss had lower all-cause mortality nearly two decades later. That directly contradicts the idea that meal replacements used in a clinical metabolic intervention are inherently dangerous.

Second, heavy metals in some protein powders are a real but highly product-specific issue, not a category-wide indictment. This is critically important.

Independent testing has shown that some products—particularly some plant-based powders—can contain concerning levels of lead or other metals. That argues for better regulation, third-party testing, and informed product selection, not for demonizing all protein powders or medically formulated meal replacements.

Lumping high-quality, medically designed, clinically used products (eg Zpro25) together with poorly manufactured supplements is neither accurate nor helpful.

Third, claims about “protein powders disrupting the microbiome, producing toxins, and causing DNA damage” are being quite overstated.

Protein metabolism in general can produce different microbial byproducts depending on dose, background diet, fiber intake, and overall energy balance. That does not mean protein powders uniquely cause inflammation or DNA damage in humans, nor that their use in energy-restricted, medically supervised weight-loss programs is harmful.

Fourth, recent observational studies linking certain food preservatives to cancer risk need to be interpreted cautiously. These are associations, not proof of causations, and they reflect broader dietary patterns—not isolated, time-limited clinical use of meal replacements.

Finally, while the newest dietary guidelines emphasize whole and minimally processed foods, they do not state that protein shakes or meal replacements are categorically unsafe.

In clinical practice, these tools are often used strategically and temporarily to improve metabolic health, reduce insulin resistance, and support meaningful weight loss—followed by a transition to a plant-predominant, flexitarian whole-food pattern, exactly as we advocate.

Bottom line:
It is both inaccurate and potentially harmful to demonize meal replacements or protein powders wholesale. Product quality matters. Context matters. Clinical use matters. When used appropriately, in the right phase of a metabolic health journey, these tools have demonstrated safety and benefit, not increased cancer risk.

Nutrition and metabolic care deserve nuance—not fear-based generalizations.

01/10/2026

There is an incredible amount of misunderstanding around the term “Whole Foods.”

On one end of the spectrum, whole foods can mean a whole apple, a carrot, lentils, beans, peas, or intact whole grains — foods that are generally low in calorie density, high in fiber, and metabolically supportive for most people.

On the other end, the same label can be applied to a whole piece of steak from an animal that was corn-fed, rapidly fattened, and metabolically dysregulated long before slaughter — a product that may meaningfully worsen insulin resistance in many individuals.

Same label. Very different metabolic outcomes.

Conversely, some foods that are quickly demonized as “ultra-processed” — such as medically formulated meal replacements — have been used successfully in rigorous metabolic trials like LookAHEAD and DiRECT to induce remission of type 2 diabetes and achieve rapid metabolic control when urgency mattered.

By today’s common narratives, those tools would be dismissed outright — not because of outcomes, but because of slogans.

The truth is:
Metabolic nutrition cannot be reduced to bumper-sticker rules.

If nutrition really were as simple as “just eat whole foods” or “never eat ultra-processed foods,” we wouldn’t be facing the scale of cardiometabolic disease we see today.

Our problems are rooted much deeper — in a food system dominated by:
• Massive crop-land allocation toward corn and commodity crops
• Corn for cattle feed, high-fructose corn syrup, ethanol, and other industrial uses
• An overwhelming supply of CRRAHP foods (calorie-rich, refined, and hyper-palatable concoctions)

That context matters.

Even the tools we use to classify foods struggle with nuance.
The NOVA classification, for example, can place a Greek yogurt with a small amount of processed fruit in the same “ultra-processed” category as a hot dog — despite profoundly different nutritional and metabolic implications.

That imprecision is exactly why we developed the Flex5 Metabolic Nutrition Score — to move beyond labels and toward context, dose, pattern, and metabolic response.

In practice, this almost always leads people to a plant-predominant, flexitarian eating pattern that is:
• Non-extremist
• Metabolically powerful
• Ethnic-agnostic
• Highly personalizable
• Sustainable over the long term

Whole foods absolutely matter — especially when we’re talking about whole vegetables, whole legumes, intact whole grains, and minimally processed plant foods.

But slogans alone won't fix a complex problem.
That's why we focus on helping people find where Reality Meets Science - not dogma, not fear, and not false simplicity.

01/10/2026

Thank you, Phil, Longevity Technology and The Longevity Show. I’m honored. Full article link in comments.

01/10/2026

Dawn is a hero to me, as the person who coined ‘flexitarian’. Here was the comment I left to her question:

Good work Dawn! Respect to you for continuing to push the conversation forward thoughtfully. You genuinely tried to create a visual from the MACA (make America confused again) bunch that nevertheless helps us move toward a more plant-predominant, flexitarian, ethnic inclusive pattern of eating with your plate.

But we also eat out of bowls, boxes, cans, and handheld foods—so with respect, I’m personally OK with any depiction that meaningfully guides people towards foods that they love and can support a lifetime of health and happiness (which are sometimes a challenge to balance with immediate gratification often battled delayed gratification).

Yours plate helps, just as nearly any government plate or pyramid would if any critical mass of population actually ever followed any - since we’re comparing any to the notorious CRRAHP-SAD (calorie-rich, refined, and hyper-palatable Standard American Diet). So frankly, improving upon that baseline can be done on any individual level many ways.

The deeper challenge for population health is that CRRAHP will likely remain at ultra high levels as long as U.S. food policy and culture remain unchanged and we continue to drown in CRRAHP availability (almost being force-fed CRRAHP foods) —particularly while roughly 30% of arable land is dedicated to corn mostly for things like cattle feed, ethanol, HFCS, etc

America is ultimately a CRRAHP food making machine. And since we are what we eat and we collectively and inevitably eat what surrounds us, we’re screwed until we address root cause issues with changing the Farm Bill and food education from grade school to medical school. And do we really need every national pie day, ice cream day, pizza day and national hot dog eating contests (ie sanctioning and normalized binge eating)?

In fact, with the current system, we couldn’t even grow enough fruits and vegetables to provide every American with just five servings per day. So at some level, we’re all playing with margins until we seriously address the Farm Bill and broader food policy. Plates and pyramids—including even the Flex5 pyramid—can only go so far.

All said, anyone who cares about food systems, my recent conversation with NYU Prof. Marion Nestle and farmer-author Brian Reisinger (of “Land Rich, Cash Poor”) is honestly a must-watch.

Here’s the interview for anyone interested:
https://youtu.be/dbCVjZH_jKs?si=fl2goaQ8Fx9Rc6vz

I loved the MyPlate graphic. So using the new guidelines I made one.

"We don't put foods on a pyramid, we put foods on a PLATE."- Dawn Jackson Blatner, RDN

What do you think about this?

01/09/2026

Flex5 Friday Walk n Talk: Thoughts on the new US dietary guidelines

01/09/2026

Question at the end for you. But first, we can line up every food pyramid ever created—old, new, Harvard, USDA, or the Reality Meets Science® Flex5 pyramid - and debate the details.

But the truth is that the differences between these pyramids (or any “food plate” depiction) are small compared with the massive gap between any of them and what Americans actually eat.

This was the theme that my 2017 standing room only American College of Lifestyle Medicine presentation: “Diet Wars! A Tour of Duty from Vegan to Paleo”, pointing out that if healthy versions of any “healthy diet“ one chooses (or any blend of them as Flex5 supports), they are all relatively massive improvements over the calorie rich, refined and hyper palatable standard American diet (CRRAHP – SAD).

As just one case in point, no plate nor pyramid can succeed in a culture that normalizes hundreds of so-called “National Food Days” celebrating and incenting eating CRRAHP foods—Ice Cream Day, Donut Day, Hot Dog Day, Pizza Day, Candy Day, French Fry Day… etc., etc. with national food policies simultaneously flooding our environments with them.

This is a Dr. Jekyll & Mr. Hyde problem: dietary guidance on one side, Farm Bill–driven food economics on the other.

Until food policy, pricing, production, education, and cultural messaging align with nutrition science, we’ll keep debating and drowning pyramids while suffocating in nutrition driven metabolic disease.

So the real question is: do we want better diagrams—or a healthier food environment?

01/08/2026

Yesterday I had the privilege of being a guest teacher for my son’s school, talking with kids about the benefits of whole fruit—fresh and frozen—and how food can actually help our bodies thrive now and in the future!

I went in thinking I was giving something back.

Then today… this.

A handwritten thank-you card signed by every single student. Thoughtful notes. Joy. Pride. Connection.

AND… a kiwi on the front! Why?…because yes, we did an “eat a kiwi with the skin on” challenge, and they absolutely loved it 😂🥝
(Along with my classic line: “An apple a day keeps the doctor away.” So, nice combo, kids!).

As if donating my time to teach these kids about the power of whole fruit wasn’t enough… today they paid me back tenfold.

Moments like this are a reminder that giving back to the community may be an obligation—but more so, it’s a privilege. It’s also a reminder that our most precious resource isn’t technology, or innovation or healthcare systems.

It’s our children.

If we want a healthier future, this is where it starts: Curiosity. Joy. Real food. And showing up.

Grateful beyond words 🙏🏽🍎🥝💚🙏🏽🥰

01/08/2026

I’m recording a new YouTube educational video today om three food pyramids. Two reflect their eras and ends of a pendulum swing. One reflects the best blend of where Reality Meets Science® - lasting, evergreen and transcendent principles.

I’ll break down what the two government pyramids attempted, what they missed, and why neither fully serves those of us seeking long-term health.

And I’ll also explain how and why the Flex5 Food Pyramid was built (by popular demand,
notably) differently — grounded in the best blend of published evidence and decades of clinical experience in lifestyle-centered human health transformation.

Flex5 is designed for extending not only health, but happiness, which no lifestyle does better than The Flex5 Lifestyle®

Flex5 isn’t a reaction. It’s a revolution.

If your goal is health that lasts and a life you enjoy living, this conversation matters.

01/07/2026

Today was one of those days that fills your heart. ❤️

I was invited to speak in my child’s public school science classroom about nutrition — focusing on fruit and why we’ve all heard the saying “an apple a day keeps the doctor away.”

We talked about how healthy eating helps:
• make our bones strong
• help our brains think and learn better
• protect our hearts
• and even help our bodies fight infections

But the BEST part?
The kids’ questions. Thoughtful, curious, and genuinely impressive. The teachers too — incredible partners in making science fun and meaningful.

These are the moments that remind me why early education around food and health matters so much. 🍎
So proud of these students and grateful to be part of their learning today.

01/07/2026

HealthyHER Month 💚 Finding where acceptance meets clarity.

Women’s bodies are diverse — and that diversity deserves respect. At the same time, good science matters.

It’s true that women who tend to store fat in the hips and thighs (“pear-shaped”) often have lower cardiometabolic risk compared with those having more central (abdominal) fat accumulation. That association is real and well described, true enough…

…But here’s the important nuance we shouldn’t lose:

🔹 Relative risk is not immunity
Being more pear-shaped does not eliminate risk for insulin resistance, T2 diabetes, heart disease, stroke nor dementia. It may modify or delay risk — not erase it. And having more genetic tendency towards an “apple shape” does not whatsoever “condemn” one to having metabolic disease.

🔹 Fat gain is never the goal
We can’t honestly frame body fat accumulation in the hips as protective. And nevertheless, we - women and men - don’t get to choose where our fat is stored. And for women, bodies naturally change across pregnancy, perimenopause, menopause.
Caveat: we do have some influence. Alcohol, in particular, increases the likelihood of abdominal fat accumulation, especially when consumed regularly.

🔹 Muscle — not fat — is the strongest protector
The most consistent metabolic benefit comes from lower-body muscle mass and strength, not thigh fat itself. Strong legs improve glucose uptake, insulin sensitivity, blood pressure, triglycerides, balance, and long-term independence — without requiring weight gain.

🔹 Shape is not a health strategy
Pear-shaped is not a free pass.
Apple-shaped is not a moral failure.
Neither replaces the fundamentals of metabolic health.

The HealthyHER takeaway:
👉 Respect your body
👉 Build strength
👉 Reduce visceral fat risk (be esp careful of alcohol)
👉 Focus on function, not labels

This is where acceptance and honesty coexist — and where Reality Meets Science®

01/07/2026

📌 Thoughtful take on protein and longevity from Prof. Stuart, who’s been on my YouTube channel — worth reading (link to full article in comments).

There’s been a lot of protein chatter recently. Here’s how I see it:

✅ Protein is essential — especially when paired with resistance training — for maintaining muscle mass, strength, metabolic function, and overall quality of life as we age. That’s exactly what long-time protein researcher Prof Stuart Phillips emphasizes in his work on healthy aging and muscle health. 

⚠️ Longevity concerns about high protein intake stem largely from specific observational data and mechanistic pathways like IGF-1 signaling. Some older population studies suggest that very high protein — particularly from animal sources — may correlate with higher mortality in mid-life, potentially mediated through growth pathways linked to cancer or disease risk. 

🎯 But here’s the nuance many miss:
• The relationship between protein, IGF-1, and longevity in humans is not linear — in fact, both very low as well as very high IGF-1 levels are associated with higher mortality risk, suggesting a “Goldilocks” zone (aka “U shaped curve”) rather than a one-size-fits-all rule. 

• In older adults (65+), higher protein intake is often associated with lower mortality and better muscle preservation, which is critical for maintaining independence and healthspan.

• Protein source matters — plant-forward or mixed protein patterns tend to show more favorable outcomes in longevity research than diets heavy in flesh, esp. processed red meats. 

💡 Bottom line:
Protein isn’t a longevity villain — but its amount, source, timing, and the individual’s age and activity level absolutely matter. Moderation + context > blanket rules.