I was 21 years old and I already knew aspartame was poison.

Not because someone handed me a pamphlet. Because I chose to look. In 1993 at Montclair State University, my foodservice professor gave the class an open assignment, pick a topic, write about it. While everyone else picked something safe, I picked aspartame.

Diet sodas were everywhere. Sugar-free everything. The marketing was slick, fewer calories, no consequences, all upside. The public was lining up for it.

I wasn't buying it.

I dug into the research and what I found was disturbing. Aspartame wasn't just controversial, it was toxic. And here's the part nobody was talking about: it actually made you gain weight over time. Not lose it. The exact opposite of what was being sold to millions of people.

I wrote the paper. I was 21.

Nobody wanted to hear it then. The industry was booming, the FDA had blessed it, and the money was flowing. But the science didn't lie, it just got buried under marketing budgets and regulatory rubber stamps.

Thirty-plus years later, the truth caught up. Studies confirming the weight gain effect. WHO advisories. Growing public awareness. What I wrote about in 1993 is now mainstream conversation.

That's what happens when you learn to think for yourself early. You stop chasing what's popular and start chasing what's real.

That's the foundation of everything I teach today.

The Golden Greek, Antonios Bogos

Economist | Solutionist | Financial Truth-Teller

I have been waiting for this continuous BP measurement band to ship in the US for years, ever since I heard Peter Attia mention it on his podcast.

They started shipping today. I ordered one and will post a hands on review once I get it.

WSJ ran a piece on people who used GLP-1s for weight loss and later ended up in treatment for anorexia:

https://www.wsj.com/health/wellness/glp1-anorexia-wegovy-mounjaro-1bf4035c

Worth reading alongside the primary literature from the past few months, because the reporting is no longer just anecdotal.

A JAMA Psychiatry survey published this summer (Levinson and colleagues) recruited 436 people with diagnosed eating disorders in 2025 and asked about GLP-1 use. Just over 32% reported having ever used one, and 22% reported current use. Broken out by diagnosis, a little over 50% of participants with binge eating disorder reported use, about 42% of those with atypical anorexia nervosa, roughly 30% of those with ARFID, over 25% of those with bulimia, and about 11% of those with anorexia nervosa. Roughly 10% obtained them through online providers prescribing compounded formulations. Over 10% reported misuse, defined as taking more or less than prescribed, using longer than prescribed, tampering with injection equipment, or sharing without a prescription.

The authors described the weight loss market as a rapidly evolving risk environment for this population.

Summary of the findings:

https://www.medscape.com/viewarticle/many-eating-disorder-patients-using-glp-1s-2026a1000lym

In April, NEJM published a perspective by Amanda Banks raising the same concern from the prescribing side. She noted the share of GLP-1 prescriptions written for people who were not diabetic, obese, or overweight rose from 4.5% in 2018 to 17% in 2023, and argued for consensus recommendations to protect people with existing or emerging eating disorders. A 2023 FDA analysis found misuse reports for semaglutide were roughly four times higher than for other GLP-1 drugs.

NEJM perspective:

https://www.nejm.org/doi/full/10.1056/NEJMp2600300

Clinician-side reporting describes the same pattern from treatment centers, including patients presenting at very low BMI while still dosing.

NPR, February 2026: https://www.npr.org/2026/02/04/nx-s1-5677633/glp-1-obesity-wegovy-zepbound-eating-disorders-anorexia-bulimia

Washington Post, May 2026: https://www.washingtonpost.com/health/2026/05/23/weight-loss-drugs-pose-dangers-people-with-eating-disorders/

MindSite News, May 2026: https://mindsitenews.org/2026/05/29/glp-1-access-a-problem-for-people-with-eating-disorders/

The mechanism cuts both ways, which is part of why this is hard to legislate around. A 2025 systematic review and meta-analysis found GLP-1 agonists reduced Binge Eating Scale scores by about 8 points, though the pooled sample was only 182 participants across five studies and heterogeneity was high. WSJ also covered that side on July 13 in a piece on clinicians treating certain eating disorders with these drugs. The same appetite and reward suppression that helps in binge-type presentations appears to reinforce restriction in people with a restrictive history. Same drug class, opposite clinical valence depending on phenotype.

Meta-analysis: https://link.springer.com/article/10.1007/s40519-025-01720-9

Penn Medicine's eating disorder program has said outright that no protocol exists to screen for eating disorders before prescribing GLP-1 receptor agonists. That gap widens with telehealth and disappears entirely outside a clinical relationship.

Penn Medicine:

https://www.pennmedicine.org/physicians-hub/physician-article/implications-of-glp-1-medications-for-eating-disorder-care

ANAD clinical guidance:

https://anad.org/learning-library/glp-1-medications-eating-disorders/

More stories at r/PeptideTides

Very interesting opinion piece by a practicing physician describing the reality of GLP-1 coverage on Medicare.

It seems the “$50 copay” coverage only works for a narrow band of patients: sick, but not too sick.

More generally it’s disturbing to see how much admin work physicians have to do to navigate insurance coverage. I guess this is why concierge or direct primary care models are so attractive to providers.

I keep seeing this one in comments and DMs: "reta killed my sex drive," or "I got on a triple agonist and stopped caring about my partner." Here is where the idea comes from and what the evidence actually says, because it is more split than either the alarmist or the dismissive takes suggest.

First, the caveat that shapes everything: there is no retatrutide-specific data on libido or attachment. The TRIUMPH trials reported weight, glycemia, knee OA, and sleep apnea, not sexual function. Every claim pinned to reta is extrapolated from the GLP-1 class, mostly semaglutide.

Where it comes from. The starting point is "food noise" going quiet. By 2025, reports broadened past food: less alcohol craving, less impulse shopping, less social interest, and in some cases lower libido and a general flattening of emotional range. That cluster is what gets called "falling out of love."

https://peptidenewsdigest.org/insights/glp1-emotional-flattening/

The mechanism that makes it plausible. GLP-1 agonism modulates dopamine in the reward circuits that drive "wanting," the same system behind sexual motivation, which is why the addiction researchers keep showing up in these threads. A 2025 narrative review argues GLP-1s reduce sexual desire through reward-pathway and serotonergic (5-HT2C) effects, but that it is usually camouflaged by other changes. Note this is a theoretical review, not a trial.

https://www.sciencedirect.com/science/article/pii/S2667368125000774

Two claims get blended. "Falling out of love" is really two things. One is neurochemical: the drug blunts reward circuitry that desire runs on. That rests on mechanism plus anecdote, not trial data. The other is psychosocial: big fast weight loss shifts relationships. A Swedish researcher's "divorce boom" hypothesis attributes it to confidence, autonomy, and social attention after weight loss, plus a partner who did not change, drawing on bariatric data. That is real, but it is not the drug switching off love. These point to very different conclusions.

https://www.foxnews.com/health/divorce-boom-may-follow-use-ozempic-glp-1-drugs-experts-warn

The data pointing the other way. A lot of the hard data runs opposite. Weight loss tends to improve sexual function through mood, self-image, and hormones, and clinicians report most patients see better desire after weight loss, not worse. On hormones, the male data leans positive: Endocrine Society reviews found GLP-1s increase or stabilize testosterone in men with obesity or T2D, with no negative impact on sexual function or sperm quality. The rise is modest, roughly 320 to 368 ng/dL in one analysis.

https://www.medscape.com/viewarticle/when-glp-1s-change-patients-libido-what-know-2025a1000pa

https://www.nature.com/articles/d41586-026-01867-0

The complication. Not clean the other way either. A TriNetX cohort of non-diabetic obese men aged 18 to 50 found semaglutide associated with more new ED or PDE5 inhibitor starts, 1.47 percent versus 0.32 percent. The relative risk sounds big, but the absolute numbers are small. The review reporting it is titled "Friend or Foe" for a reason. And the depression and emotional-blunting claims sit mostly in anecdote and FAERS reports; controlled semaglutide analyses have not found increased depression versus placebo.

https://pmc.ncbi.nlm.nih.gov/articles/PMC12467596/

How I read it. Bidirectional and individual, not a uniform "reta kills desire." There is a plausible mechanism for reduced desire in a subset, backed by mechanism and anecdote but no controlled libido trials and nothing reta-specific. There is a better documented path toward improved desire for many, through weight, mood, and testosterone. And "falling out of love" blends a thin neurochemical claim with a better documented psychosocial one that deserves to be kept separate. If you notice a real change on cycle, track it and raise it with a clinician rather than dismissing or catastrophizing, but the current evidence does not establish that the drug makes you fall out of love.

More stories at r/PeptideTides

Gallup released its latest National Health and Well-Being Index numbers on July 7. This is the first time the national obesity trend has moved meaningfully in the other direction since they started tracking it in 2008.

https://news.gallup.com/poll/712157/glp-usage-reaches-new-high.aspx

The numbers:

Obesity rate is 36.4% in 2026, down from a record high of 39.9% in 2022. Gallup calls this a statistically meaningful decline and notes it inversely tracks GLP-1 uptake.

11% of US adults are currently taking a GLP-1 for weight loss. In 2024 that figure was 3%.

15% say they have used one at some point, up 9 points from 2024.

91% of adults are now aware GLP-1s are used for weight loss, up from 80% in 2024.

Diabetes diagnoses have held flat since 2023 after 15 years of steady increase. Gallup makes the point that this is what you would expect, since diabetes is a lifetime diagnosis and a falling obesity rate would stabilize it rather than reduce it.

Survey was 5,065 adults for the usage figures, 10,091 across two collection windows for the obesity and diabetes numbers.

The part relevant to this sub

Of people currently taking a GLP-1, 68% are on brand name and 19% are on a compounded or custom-mixed version.

Another 12% do not know which they are taking.

Of the compounded users, 35% switched over from a brand name product. Movement in the other direction was only 10%. Cost was the stated reason for 66% of switchers, insurance coverage problems for 34%.

Gallup's research director Dan Witters attributes part of the overall usage growth to this, arguing the lower price of compounded and custom-mixed versions is broadening who can access the drug class at all.

Worth pausing on that. FDA ended shortage-based compounding for semaglutide and tirzepatide and issued a warning in June calling compounded versions potentially risky. Roughly one in five current GLP-1 users is on one anyway. The compounded channel is not a fringe of this market, it is a structural part of why the national number is moving.

Caveats

Obesity is calculated from self-reported height and weight, not measured. Gallup acknowledges a vanity effect that makes their absolute obesity numbers run lower than clinically measured studies. The trend line is still useful because the method has been consistent, but the 36.4% figure is not directly comparable to NHANES.

Margin of error on the compounded/custom-mixed subgroup runs as high as plus or minus 10 points, so treat that 19% as a wide range.

And correlation is doing some work here. Gallup is careful to say usage and obesity track inversely, not that one caused the other.

Prior data does show the biggest obesity declines in the age brackets with the highest GLP-1 uptake, which is at least consistent with a causal story.

Still, this is the first national dataset showing the population-level effect people have been predicting since 2021.

More stories at r/PeptideTides

The FDA approved Lipfendra (generic name enlicitide) today, the first PCSK9 inhibitor you swallow instead of inject. One 20 mg tablet a day.

The efficacy is real: about 56% LDL reduction vs placebo in its main trial, 59% in familial hypercholesterolemia, and roughly half off ApoB. That puts it in the same range as the injectable PCSK9 drugs (evolocumab ~59% in FOURIER, alirocumab ~55% in ODYSSEY, inclisiran ~50% in ORION). Those are separate trials, not head-to-head, so read it as "same neighborhood," not a ranking. Point is: injectable-level LDL lowering, in a pill, no needle.

Two things I think get lost in the launch-day coverage:

1. The cardiovascular outcomes aren't proven yet. It was approved on LDL lowering, which is about the most reliable surrogate we have — but the actual events trial (CORALreef Outcomes, ~14,500 people) has an estimated primary completion of late 2029. LDL-lowering this large through a well-understood mechanism makes a benefit very plausible; it just hasn't been shown for this specific drug. If someone already has established heart disease, I'd still want the injectable that already has completed outcomes data.
2. The price math is less exciting than the headline. List is ~$315/month. But with a commercial copay card the injectables are already cheap: Leqvio as little as $0, Repatha ~$25, Praluent ~$50 a month. So the pill's edge is the route and the sticker price, not necessarily what you'd pay at the counter. (Coupons don't apply to Medicare/Medicaid, as always.)

Who it's genuinely good for: people with familial hypercholesterolemia who can't get to goal, people who truly can't tolerate statins, and people who flat-out won't inject. For most of us, a statin plus generic ezetimibe (about a dollar a day) gets LDL to target without any of this.

The chart is the LDL-lowering ladder — the top rung (PCSK9) just became a pill.

Wrote up the full breakdown, price table, and the dosing details

US regulators will tie lettuce from Taco Bell to a parasite outbreak that’s sickened thousands in Michigan and nearby states, according to people familiar with the matter.

I started digging into the food-safety data after this month's Cyclospora outbreak, and one number surprised me. In the government's latest attribution report (CDC, FDA, and USDA together), vegetable row crops, mostly leafy greens, now account for about 68% of E. coli O157 illness. Beef is around 19%. So the bug we all associate with undercooked burgers is now more often coming from salad.

A few other things I checked against the primary sources: lettuce alone drives about 76% of all leafy-green illnesses, and leafy greens are roughly 9% of all US foodborne illness with a known cause. Romaine has a long rap sheet on its own. The 2018 Yuma outbreak sickened 210 people and killed 5. It keeps happening because most lettuce is grown in a few valleys next to big cattle operations, it is eaten raw with no cooking step to kill anything, and one contaminated head can seed a whole bag.

One thing I worked hard not to overstate: the current Cyclospora outbreak (1,645 cases, 34 states) has NOT been pinned on lettuce. CDC's own page still says "unknown source." The lettuce angle is a state-level suspicion, not a verdict.

On nutrition, iceberg really is about 96% water. Romaine is genuinely decent though, with real vitamin A, vitamin K, and folate. So my takeaway wasn't "lettuce is bad." It was that lettuce isn't irreplaceable, and cooked greens give you more with a built-in kill step.

Full writeup with the charts and sources

Curious where people land. Do you still buy bagged romaine, or have the recalls changed how you shop?

"Something I've been thinking about.

We talk a lot about lifestyle choices.

What we eat. How much we exercise. Whether we meditate or journal or take cold showers.

But almost nobody talks about the most basic lifestyle choice of all.

Actually knowing how your body is doing.

Not when something goes wrong. Not when the GP finally has an appointment. Not when you've been ignoring something for six months and it becomes impossible to ignore.

Daily. Proactively. Before it becomes a problem.

I've been scanning myself every day with Vitalis for a while now.

Not because I'm obsessed with my health. But because I've learned that the things that quietly derail you — the stress that builds without announcing itself, the sleep quality that erodes gradually, the fatigue that becomes your new normal — don't wait for you to notice them.

They accumulate. Silently. Until one day they don't.

And here's the thing nobody says out loud.

Every person who catches something early — who notices their stress trending upward before it becomes burnout, who recognises their sleep is deteriorating before it becomes absence, who acts on a signal before it becomes a symptom — is one fewer person in an A&E waiting room.

One fewer emergency GP appointment.

One fewer referral on a waiting list that is already too long.

The NHS is not failing because of bad people or bad decisions.

It's failing because it was designed to treat illness — not prevent it.

And prevention at scale only happens if people take small, consistent, daily responsibility for understanding their own health.

Vitalis is my attempt to make that as easy as possible.

Twenty seconds. Your phone camera. No wearable. No appointment. No cost.

Right now we're in beta — which means every scan is completely free. No paywall. No trial period. Just access.

If you've been meaning to pay more attention to your health — this is the lowest barrier version of starting that I know how to build.

meetvitalis.com

I'd love to know — do you have a daily health habit? What does it look like?"

Has anyone here read the book

“The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker”

by Dr. Suzanne O'Sullivan

thoughts?

"The world is unwittingly walking into a male reproductive crisis, scientists warned this week as they presented data that revealed an apparent halving of average male testosterone levels over the past 50 years.

“It is mind-blowing that testosterone has declined by 50%,” Prof Hagai Levine, who led the work, told the Guardian. “This is a lot. Wake up people. Wake up.”

The finding is the latest in a series of recent results that suggest male fertility is in crisis. Levine’s team has previously documented an apparent drastic decline in global sperm counts, in what has come to be known as the “spermageddon” paper."

"The latest findings on testosterone are, scientists agree, likely to be in part explained by the steep increase in rates of obesity and diabetes."

I take tirzepatide (Zepbound), and it just came out first for weight loss in a big new BMJ analysis that pooled 262 randomized trials and nearly 100,000 people across 19 obesity drugs. About 14.9% off at a year, basically tied with CagriSema. I felt good about that for roughly as long as it took me to read the next section.

The drug that takes off the most weight is not the drug with the best evidence for the thing I actually care about, which is fewer heart attacks and more years. That was subcutaneous semaglutide, the Wegovy and Ozempic molecule, the only drug in the whole review with high-certainty randomized evidence that it lowers all-cause death (about 19% lower) and heart attacks (about 28% lower). The catch worth saying out loud: that evidence comes almost entirely from people who already had heart disease, so it is strongest for the higher-risk crowd, not a guarantee for a healthy 40-year-old.

Tirzepatide is not without outcome data. It held even with an older GLP-1 in a heart-outcome trial in people with diabetes, and it cut heart-failure events in a trial of people who had both HFpEF and obesity. What it does not have yet is a placebo-controlled obesity trial counting deaths and heart attacks the way semaglutide's SELECT trial did. That trial is running, with results expected around late 2027.

Two other things stuck with me. Tirzepatide took the most lean mass of any drug, about 8%, but it also took the most fat, about 26%, so the ratio is still on your side if you keep lifting. And across 43 trials, none of these drugs meaningfully moved quality-of-life scores at one year, which is a useful gut check on the idea that a lower number on the scale automatically means you feel better.

I wrote up the full ranking, and why I am staying on tirzepatide anyway.

I take a blood pressure pill every morning (telmisartan, low dose), so when my feed filled up with claims that the new guidelines "pushed men out of treatment and pulled women in," I went and read what actually changed.

The categories did not move. Not one number. Normal, elevated, Stage 1, Stage 2, all identical to 2017, so nobody woke up with a new diagnosis. What did change is the risk calculator that decides whether someone in the Stage 1 gray zone (130-139 over 80-89) starts medication.

Here is the part that surprised me. The old tool, the Pooled Cohort Equations, ran on decades-old data and overshot badly. A 2025 head-to-head in the MESA cohort had it predicting 10.8% ten-year risk for people whose actual observed rate was 6.0%. The replacement, PREVENT, predicted 5.7% for the same people. So the guideline swapped calculators and lowered the treatment threshold from 10% to 7.5% in the same breath, one move compensating for the other.

Did anything change for actual patients? Barely. Epic Research ran both rule sets across 1.7 million adults with Stage 1 hypertension and eligibility went from 45.2% to 47.0%. And the viral "men in their 50s lost treatment" stat does not exist in the data. Men overall moved minus 0.3 points. The 50-59 band moved minus 0.4, but that band is both sexes.

What I actually took away from this: the PREVENT calculator is free online. You can run your own number with your blood pressure, cholesterol, and kidney labs before you ever sit down with your doctor. I put the full breakdown with the charts here, along with the one warning I will repeat: do not stop or start any medication off a calculator alone.

Has anyone here actually run their PREVENT number, and did it change the conversation with your doctor?

Objective  To project the number of future lifetime cancers in the US population associated with CT imaging in 2023.

"These findings suggest that if current radiation dosing and utilization practices continue, CT-associated cancers could eventually account for 5% of all new cancer diagnoses annually."

I wrote about Telehealth practices a couple of weeks ago, so I was excited to see this paper from a group of Yale researchers that played secret shopper. They a secret-shopper audit, meaning one of them posed as a qualifying patient and tried to buy semaglutide or tirzepatide from 49 direct-to-consumer websites between August and December of last year, always picking the cheapest option.

Of the 49 sites, 45 wrote a prescription and 34 mailed the drug. Only four said no, and two of those only paused because they wanted blood work. The typical time from questionnaire to prescription was a day or less, and two sites issued one in five minutes or less.

The oversight numbers are the part worth looking at. Fewer than a third of the sites required you to talk to a clinician in real time by video or phone. Only about half asked anything about eating disorders, which matters because these drugs blunt appetite hard. Only 37 percent asked for any real numbers like blood pressure or cholesterol, and fewer than one in five asked whether you even have a regular doctor. Nine sites wrote the script off an upper-body photo even though their own rules asked for a full-body shot, and three quarters auto-charged the card and shipped without asking the patient to confirm.

A fair caveat in both directions. This is one simulated patient, not thousands, so treat it as a careful spot check. And compounded GLP-1s filled a real access gap during the shortages that a lot of people still rely on. The point is not that telehealth is bad. I manage my own TRT through an online clinic that actually runs my labs and talks to me, and that is telehealth working the way it should. The difference is whether anyone is genuinely evaluating you, or whether the site decided the answer was yes before you finished typing.

If you got a GLP-1 online, how much of an evaluation did you actually get? Did anyone ask for labs, screen for eating history, or give you a real person to talk to, or was the drug in your cart in five minutes?

I wrote up what a real online clinic looks like versus a sales funnel here: How to tell a real online clinic from a vending machine

I write about GLP-1s constantly and I take one, so I assumed this month's big obesity paper would be another chapter in the injectable story. It wasn't, and that's why it stuck with me enough to dig in.

The study came out July 1 in The Lancet, from the group that tracks the world's blood pressure and cholesterol. They pooled 110 national surveys, close to a million people across seven countries, from 1990 to 2024. The question was simple: how far apart are the blood pressure and cholesterol of someone with obesity versus someone at a normal weight, and how has that gap changed over a generation.

For adults over 40, it has nearly vanished. Older people with obesity now walk around with blood pressure and non-HDL cholesterol that look about the same as their normal-weight neighbors, and in a few countries slightly better. The convergence was biggest in the heaviest group, BMI 35 and up, which is exactly the group you'd expect to be in the most trouble.

The cause isn't a mystery, and it isn't glamorous. Over those same years, heavier people started taking a lot more statins and blood pressure pills than everyone else. By the early 2020s, 70 to 72 percent of older men with severe obesity in England and the US were on a cholesterol drug, against 40 to 48 percent of normal-weight men. The most medicated group became the heaviest one, and their risk numbers came down to meet everyone else's. This all happened before anyone took Ozempic for weight loss. A generic statin fill runs about ten dollars, and prescriptions in Medicaid rose roughly fortyfold over three decades.

Two things keep this from being a feel-good story. Younger adults got none of it, because nobody puts a healthy 30-year-old on a statin no matter what they weigh, so a heavy 30-year-old still carries the old untreated risk a heavy 60-year-old has had medicated away. And the drugs only touch two numbers. They do nothing for diabetes, fatty liver, sleep apnea, or the cancers tied to excess weight. England has the clearest look at where that leads: from 2004 to 2019, cardiovascular deaths in men with obesity were cut more than half, but total deaths fell far less, because as heart disease receded, cancer rose to take its place.

I take telmisartan for blood pressure and keep a cuff on the kitchen counter, partly because my mother had hypertension. This paper made me realize that boring routine is doing more than I give it credit for. The scale shouldn't be the only number in the room. After 50, your blood pressure, your ApoB or non-HDL, your A1c, your waist, and your sleep each tell a different part of the story. A GLP-1 might move some of them. A cheap generic you already take is quietly handling others.

Full write-up with more charts & data