🚨THREAD🚨

STRESS AND WEIGHT REGAIN While very few physicians have embraced it yet, our practice has been thriving on the use of remotely monitoring patient biometric data. In our clinic, almost all of our patients have smart equipment in their homes which wirelessly sync with our practice.

I have a serious problem with the term “pre-diabetes.”

The prefix “pre” is used to describe what comes before something.

In reality, “pre”-diabetes is actually AFTER or “post” 15 years of the high insulin levels & inflammation associated with the modern lifestyle. Prediabetes is usually diagnosed by checking an a1c level, which is the percentage of hemoglobin that binds to sugar as a percentage of normal hemoglobin.

If you a1c is between 5.7 and 6.4, you are considered to have “pre-diabetes”

Obesity doesn’t just “happen” to individuals… it spreads like an infectious disease.

🧵 Let me explain… A landmark NEJM study tracked 12,000+ people for 32 years. The shocking finding? If your friend became obese, your risk of becoming obese rose by 57%

Defund the American Academy of Pediatrics.
It’s not a neutral medical body… it’s a corporate mouthpiece. Here’s the proof 🧵 💊 Big Pharma
AAP takes money from pharma giants.
Their guidelines? Push GLP-1 injections and bariatric surgery for kids… but demonize reducing carbs and sugar. Profit over prevention.

After helping thousands of patients lose weight, here’s my advice for those looking for lifelong, sustainable life changes. These are the “5 MUSTS” anyone trying to lose weight lifelong NEEDS to do.

🧵/Thread Before you understand my “5 musts”, simply ask yourself -what are the side effects of your prior weight loss attempts- NOT your reasons, NOT what you want to happen, what went wrong, what made you stop?

There are 5 types of hunger that ideally should be taught to all patients with obesity

Without cultivating an awareness of appetite, hunger and cravings, a patient with obesity will not know what they are fighting against

So Let’s start! We are going to start with some easy ones…

The Cephalic phase response aka food cues - this is hunger stimulated when in presence of food.

These signals are deeply ingrained and can be conditioned

Think of Pavlov & commercials - these aren’t going away quickly or ever

1/
🧵 Can you reverse heart plaque?
Yes—and not just with meds.
Let’s walk through the top human trials showing how exercise, nutrition, and smart supplements can slow or even reverse plaque buildup.

A thread for your arteries… 🫀 2/
🏃‍♂️ CENIT Trial (2022)
Supervised HIIT (High-Intensity Interval Training)
📉 PAV shrank −1.2% per year
This isn’t casual walking—this is structured, high-effort cardio.
Result? Plaque regression.
Control group? No change.

💡NEW PAPER💡

Food addiction and binge eating symptoms can be improved without drugs or surgery using real food, real support, and virtual care.

Our new peer-reviewed study was just published:
🔗frontiersin.org/journals/psych…
💙 Like, repost, bookmark, or share this link to help spread awareness about the power of metabolic health and lifestyle changes.

🧵/ Here is what we found and why it matters. 👇 The intervention is called TOWARD:
📱 Text-based support
🌐 Online virtual care
🧠 Wellness coaching
📚 Asynchronous education
📊 Real-time biofeedback
🍳 Dietary change via TCR (Therapeutic Carbohydrate Reduction)

A real-world, fully-remote model.

Thread 🧵

...get started with low carb with these 5 simple steps Step One
Transform Breakfast...

Getting a breakfast filled with protein & healthy fats is imperative for lasting satiety & decreased appetite throughout the day.

How to INCREASE your low testosterone?

Thread 🧵 Testosterone is a steroid, anabolic hormone made in the testes and ovaries

1/
🧵 Can you reverse heart plaque?
Yes—and not just with meds.
Let’s walk through the top human trials showing how exercise, nutrition, and smart supplements can slow or even reverse plaque buildup.

A thread for your arteries… 🫀 2/
🏃‍♂️ CENIT Trial (2022)
Supervised HIIT (High-Intensity Interval Training)
📉 PAV shrank −1.2% per year
This isn’t casual walking—this is structured, high-effort cardio.
Result? Plaque regression.
Control group? No change.

1/
Most people don’t know the real results of the Minnesota Starvation Study…

Yes, the men lost weight.
But they also developed anxiety, depression, binge eating, low libido, cold intolerance, and obsession with food.

Caloric restriction isn’t benign.
Let’s dig deeper… 2/
A new review in Nature Reviews Endocrinology exposes what calorie restriction really does to the body.

While it may extend lifespan in rodents, the human data is less clear—and the downsides are serious.

Here’s what the science actually shows:

1/
🧵 Can you reverse heart plaque?
Yes—and not just with meds.
Let’s walk through the top human trials showing how exercise, nutrition, and smart supplements can slow or even reverse plaque buildup.

A thread for your arteries… 🫀 2/
🏃‍♂️ CENIT Trial (2022)
Supervised HIIT (High-Intensity Interval Training)
📉 PAV shrank −1.2% per year
This isn’t casual walking—this is structured, high-effort cardio.
Result? Plaque regression.
Control group? No change.

THREAD: 🧵

CGMs - continuous glucose monitors

Having looked at 10,000+ CGMs let me tell you what you will learn...

1/9 Lesson 1: Hidden carbs are everywhere
- you will find hidden sugar & carbs everywhere.

You didnt know you could find carbs/sugar but you will:
hotdogs, sausage, beef jerky, spices, condiments, sauces, soups, broths, basically everywhere you didnt look.

2/9

🔔 Where did Ozempic & Monjauro come from? 🤔

Bookmark, save, and follow along 🦎 The Gila monster (Heloderma suspectum), a unique lizard known for its binge-eating behavior, produces the hormone exenatide, the basis for diabetes medications such as Ozempic and Mounjaro.

When I entered medicine, it was deeply personal. My family’s struggles with obesity and metabolic disease were my driving force. I watched my brothers reach 400 to 500 pounds, and our family was plagued by diabetes, hypertension, and more. I thought becoming a doctor would give me the tools to help, but what I found was a system that often prioritized profit over patient outcomes. In the early 2010s, I began noticing issues with the CMS reimbursement structure. The payment model seemed designed to incentivize procedures and chronic disease management rather than prevention. Spending time with patients to address root causes wasn’t valued. Instead, quick fixes like medications were prioritized.

If you want to tackle your weight or diet-related disease, you need to pick a side.

Let’s talk about food addiction!

🧵 /thread 2 paths, you much choose one:

One path: Acknowledge that your identity is shifting and that your relationship with food needs to change. If you recognize that certain foods are addictive and damaging, then commit—either abstain or harm-reduce with intention. If this is your path, you must fully own it.

🚨 NEW PAPER 🚨

Making America Healthy and reversing obesity, without drugs & injections

By focusing only on metabolic health, patients lost 15.5% of their weight while STOPPING unnecessary medications

👇🏻👇🏻

50 patients
⬇️43lbs on average ‼️
💥~15.5% weight loss at one year💥
🤔 Majority of patients KEPT losing weight even after stopping GLP1
🤔 Even at 1 year, 76% of patients were STILL losing weight - BUSTING THE MYTH that “patients can’t adhere to diets longterm”

I’ll walk you through why some of this is REALLY important

This paper looks at the 1 year weight loss results from our virtual metabolic health program with CGMs, smart equipment, an app and virtual coaches.

Paper linked:
frontiersin.org/journals/nutri…

Please RT, bookmark & share this link 🔗 to spread awareness so doctors know the power of metabolic health and lifestyle changes NOT only pushing medications 💊

🧵/THREAD 🤌Allow me to set the stage.

The current accepted truths in medicine is that GLP1 meds have unprecedented results and there is no other options because “all diets fail”

But have medical teams actually tried to help patients adhere ? 🤔

They haven’t. Why? Because it’s easier to prescribe injection weight loss drugs than to promote & inspire lifestyle change

But the sad reality is many patients cannot tolerate the injection drugs due to side effects while many others don’t actually need it.

If every patient with obesity and diabetes goes on these injection drugs corporate America and Medicare will go bankrupt from the trillion dollar burden it would cost.

So our clinic aimed for better.

A completely new care model called TOWARD

And how did we do?

🚨 THREAD 🚨

GALLSTONES & GALLBLADDER DISEASE

Everything you need to know about gallstones as it relates to diet and dietary composition.

👇🏻👇🏻👇🏻👇🏻👇🏻 In the obese during rapid weight loss from a very low-calorie diet, a relatively high fat intake could prevent gallstone formation, probably by maintaining an adequate gallbladder emptying, which could counterbalance lithogenic mechanisms

nature.com/articles/08006…

🚨We are officially changing the name 🚨

Have you heard of “lean mass hyper-responders” or LMHR… it may soon be called “Lean Mass Hyper-ABSORBERS”

Cc: @AdrianSotoMota @nicknorwitz @realDaveFeldman

🤯

Let me present some data from our clinic that we shared at @TheSMHP - that you may find interesting

🧵 Several weeks ago I put a poll asking people to guess what caused this?

So let’s dig in and find out:

We presented this case series of ~10 patients

I have a serious problem with the term “pre-diabetes.”

The prefix “pre” is used to describe what comes before something.

In reality, “pre”-diabetes is actually AFTER or “post” 15 years of the high insulin levels & inflammation associated with the modern lifestyle. Prediabetes is usually diagnosed by checking an a1c level, which is the percentage of hemoglobin that binds to sugar as a percentage of normal hemoglobin.

If you a1c is between 5.7 and 6.4, you are considered to have “pre-diabetes”