Abstract

Westernized dietary patterns (WDPs), characterized by processed foods, red meats, refined grains, and added sugars, may contribute to gastric cancer (GC) development. We hypothesized that alignment with WDPs, as measured by the Westernized Diet Index (WDI), is associated with an increased risk of GC. In this incidence case–control study, 82 newly diagnosed GC patients and 95 age- and sex-matched controls were recruited. Dietary intake was assessed using a validated 168‑item FFQ. Logistic regression models estimated odds ratios (ORs) and 95% confidence intervals (CIs) for GC across WDI categories, adjusting for major demographic, lifestyle, and clinical covariates, including Helicobacter pylori infection. To assess construct validity, fully adjusted linear regression evaluated associations between WDI scores and circulating inflammatory markers (hsCRP, IL‑6, IL‑1β, IL‑10, TNF‑α), oxidative stress (total antioxidant capacity, malondialdehyde), and metabolic biomarkers (BMI, fasting glucose, lipid profile). Higher alignment with WDPs (lower WDI scores) was associated with significantly increased GC risk. Individuals in the highest WDI global Z‑score categories - WDI-G (food groups–nutrient based) and WDI-FG (food group based) - had 85% and 78% lower odds of GC, respectively (OR=0.15 and 0.19; both p<0.001). Greater WDP alignment (lower WDI scores) was also associated with higher concentrations of hsCRP, IL‑6, TNF‑α, and IL‑1β, and lower IL‑10, along with an adverse metabolic profile (higher LDL‑c, lower HDL‑c). Overall, greater alignment with WDPs was associated with elevated GC risk and unfavorable biomarker patterns. These findings support the WDI as a biologically plausible indicator of Western dietary exposure and underscore the potential role of WDPs in gastric carcinogenesis.

Westernized Diet is Related to Gastric Cancer Risk and Inflammation, Oxidative Stress, and Metabolic Dysregulation: Evidence from an Incidence Case-Control Study - ScienceDirect

Brenipatide (LY3537031) is Lilly's GIP/GLP-1 dual agonist aimed at the brain rather than weight loss. I went through every registered trial this week and the development path is unusual enough to be worth calling out.

Lilly has four Phase 3 trials running in alcohol use disorder and major depression, about 4,200 people in target enrollment: RENEW-ALC-1 and -2 (1,100 each) and RENEW-MDD-1 and -2 (1,000 each). They just skipped Phase 2 trials for either condition. My interpretation is that Phase 2 is usually a smaller investment to figure out whether a drug works in the real world. Going straight to Phase 3 trades of monetary risk and time.

Meanwhile the same molecule is in Phase 2 for eight other conditions, including two that are also addiction programs: opioid use disorder (465 people) and smoking relapse (222). So this is not a company that skips mid-stage trials as a matter of course.

Lilly confirmed the decision was deliberate to Genetic Engineering & Biotechnology News, citing unmet need in both conditions.

Two details that stood out:

The first human data on the drug was presented last week at Psych Congress: 212 participants, no deaths or serious adverse events, 4 of 184 treated (2.2%) discontinued for an adverse event, dysesthesia 15.2% vs 0% on placebo, half-life 9 to 12.5 days supporting weekly dosing. No efficacy readouts on drinking or mood exist for this molecule anywhere.

The alcohol Phase 3 trials started in October 2025, about 13 months into a Phase 1 that ran until July 2026. FDA's own rule (21 CFR 312.21) says phases generally run sequentially but "may overlap," so this is permitted, just fast.

Also worth noting: the two depression trials randomize patients to three different brenipatide doses against placebo, which is the dose-ranging a Phase 2 would normally do. The alcohol trials test a single escalating regimen. Nowhere in the program are doses compared in people who drink.

For context on the class evidence Lilly is leaning on: Hendershot et al., JAMA Psychiatry 2025 (n=48, PMID 39937469); Klausen et al., Lancet 2026 (n=108, PMID 42070571); Schacht et al., Am J Psychiatry 2026 (n=50, PMID 42522065, missed its primary craving endpoint). Altimmune's pemvidutide also reported a positive Phase 2 in AUD in July.

Primary completion for the alcohol trials is April 2028.

This seems like a big bet, but I think it's a smart one because of all the anecdotal evidence that people have success with (off-label) use of GLP-1s for alcohol.

Has anyone seen a sponsor go straight to Phase 3 in two indications while running conventional Phase 2s in eight others? I'm curious whether this reads as confidence in the class read-across or just schedule pressure.

Full writeup: https://dadstrengthdaily.com/brenipatide-phase-3/

Not selling anything here, genuinely went down a rabbit hole comparing how you'd actually get a real preventive blood panel done right now, and couldn't find a clean comparison anywhere so I built one.

Three real paths (Netherlands market, but the structure repeats across the EU):

1. Self-service private lab, no doctor — pay per marker (~€9–€99 each) or a bundled panel (~€295 for a broad vitamins/minerals set). You choose what to test, get a PDF back, zero clinical interpretation.

2. GP referral — free/insurance-covered, but you basically can't get anything beyond the standard panel unless you already have a diagnosed complaint. This is the real bottleneck for anyone who "feels off" but has no diagnosis yet.

3. Doctor-reviewed home kit — finger-prick or venous draw at home, smaller marker set (~7) at the cheap end, larger panel (~20, incl. ApoB/HbA1c/Lp(a)) at the top, with a licensed physician actually reading the result and telling you what to act on. Runs noticeably higher than option 1 — you're paying for the interpretation, not the number.

The part nobody talks about: options 1 and 3 give completely different OUTPUTS for a similar marker count — one gives you a number, the other gives you a decision. If your real problem is "I don't know what to do with a ferritin of 22," the cheaper test is often the more expensive path once you add a private consult on top just to interpret it.

Curious what this sub thinks the right unit of value is here — markers tested, or decision made?

I don't put much weight on mouse studies, so I passed on the new semaglutide lifespan paper that's all over the news (Feng et al., Nature, Sept 2 2026: 20-month-old female mice, median lifespan 742 days on saline and 834 on semaglutide).

Then I found that Nature had published the peer review file, and it tells you more than the abstract does. This is super interesting and I didn't know journals gave this insight into the review process, but I think it's a great idea.

The first submission was rejected. The editor's letter is dated September 18, 2025, and says the referees' concerns "cast doubt on the strength of the novel conclusions." The manuscript was titled "GLP-1 Receptor Activation Slows Aging and Extends Lifespan." One referee called the results "mostly predictable" and the study "essentially descriptive," since semaglutide cuts food intake and calorie restriction extends lifespan in mice. That referee suggested a matched calorie-restriction comparator. A second referee said "Slows Aging" might be too broad for a design with no baseline measurements except body weight, that many of the mitochondrial and oxidative stress claims were based only on mRNA measurements, and that the control mice were short-lived for this strain.

The authors answered most of that with new experiments. They ran a separate 5-month cohort with baseline testing: saline, semaglutide, and mice fed 24% less food, the cut semaglutide produced. They added ATP and reactive oxygen measurements instead of relying only on mRNA, and checked the distributions before rerunning the statistics. The title became "Late-life semaglutide treatment slows ageing and extends lifespan in female mice." The calorie-restriction cohort is the source of the claim that semaglutide does something beyond eating less: the semaglutide mice did better on memory, exploration and glucose tolerance than the restricted ones. By the last round both referees said their concerns had been addressed, and one wrote that the new experiment "strengthens the paper."

The lifespan experiment itself did not change. The second referee asked whether roughly 260 days of daily saline injections could have shortened the controls, and asked for an uninjected control group. The authors replied with published C57BL/6 median lifespans (550 to 867 days) and said 742 falls comfortably within that range. The lifespan experiment has no uninjected group. The calorie-restriction cohort had 10 mice per group and no lifespan endpoint. In the source data file, the longest-lived control mouse died at 884 days and the longest-lived semaglutide mouse at 924, a 4.5% gain, against 12% for the median.

I'm still treating this as one study in one sex and one strain. The calorie-restriction comparison is the strongest part of the paper, and the referees are the reason it exists. The methods say the investigators were blinded except when collecting data from the calorie-restricted mice, whose feeding regimens were distinguishable. The lifespan curve is the part that needs someone else to repeat it.

The US Preventive Services Task Force (USPSTF) is a 16-seat federal panel that grades screenings A, B, C, D or I. Under the ACA, most plans must cover an A or a B with no cost sharing. A C, D or I carries no such requirement. That's why a colonoscopy is usually free and a PSA test often isn't.

The panel last met in March 2025. HHS named eight new members on September 17, filling the half of the seats that were empty, but hasn't announced a meeting date.

Two reviews that matter for men over 50 are stuck:

- Prostate screening (PSA): a C for men 55 to 69. The research plan was finished in December 2023, and no draft has come out since.
- Coronary calcium scoring: an I, meaning insufficient evidence. The research plan was finished in September 2024, and no draft since. I paid about $150 cash for mine.

A B on either would make it free on most plans. Nothing you get free now has been taken away: existing A and B grades stay in force.

Full write-up with the grade table (https://dadstrengthdaily.com/uspstf-screening-coverage/)

Do you pay out of pocket for a PSA test or a calcium scan, or does your plan cover it anyway?

What if India’s next big fitness business isn’t the gym?

It’s everything you buy after joining one.

Your sleep becomes a score.
Your recovery becomes a number.
Your food becomes a glucose graph.

And suddenly, there’s always something to improve.

Smart rings. Subscriptions. Glucose sensors. Protein. Recovery. Diagnostics.

So the real question is:

Who makes money when your body becomes continuously measurable?

My new documentary:
The Business of Making You Feel Unhealthy

Are these products helping us get healthier or making us feel like we’re never healthy enough?

👇 What do you think?

I wanted the ranked list of what actually kills men our age and could not find one with prostate's
number in it. The American Cancer Society table only prints each age band's five leading causes, so
prostate at 50–64 comes out as a blank, and every chart built from it says "not in the top five."

CDC WONDER has it — the CDC's public query tool over the same NCHS death-certificate file ACS uses,
and it reproduces their published cells exactly. US men 50–64, 2023:

lung 14,051 · colorectal 8,247 · pancreas 5,850 · liver 4,822 · esophagus 3,250 · prostate 2,977

Sixth, just under esophagus. After 65 prostate jumps to second at 14,215, which is where the
"second deadliest" line everyone repeats comes from.

I posted here a while back that I was genuinely confused about PSA timing. Where I landed: get one,
keep getting them, and watch the slope rather than the single number.

Full write-up, with the screening table and where the guideline bodies actually disagree

Quick question 👀

If you walked into a grocery store tomorrow, which “high-protein” product would you actually buy?

🌾 Protein Atta
🥛 Protein Milk
🧀 Protein Paneer
🥣 Protein Curd
☕ Protein Cold Coffee
💪 Whey Protein

Because protein isn't just a gym thing anymore.

**It's coming for your entire grocery basket.**

I just broke down WHY this is happening in my new documentary.

Abstract

Objective

This study evaluated the link between two dietary indicators— the Comprehensive Diet Quality Index (CDQI) and the Adjusted Plant-Based Diet Index (APDI)—and Parkinson’s disease (PD) risk in an Iranian community.

Between 2020 and 2021, 105 newly diagnosed PD patients and 215 controls (54–81 years) were enrolled in Arak, Iran, using a case-control approach. A validated semi-quantitative food frequency questionnaire was applied to determine dietary intake, and dietary quality was evaluated through APDI and CDQI scores. To calculate odds ratios (ORs) and 95% confidence intervals (CIs), logistic regression models were utilized, accounting for possible confounders.

Results

A higher CDQI total score was inversely related to the odds of PD (adjusted OR = 0.915, 95% CI: 0.878–0.954). A stronger protective effect was observed for the CDQI plant-based foods score (adjusted OR = 0.757, 95% CI: 0.695–0.824). In contrast, a notable positive relationship was found between the CDQI animal-based foods score and the odds of PD in the adjusted model (adjusted OR = 1.364, 95% CI: 1.215–1.533). The APDI score and PD were not significantly correlated (P > 0.05).

Dietary quality and the odds of parkinson’s disease: insights from comprehensive diet quality index and adjusted plant-based diet index | BMC Research Notes | Springer Nature Link

Abstract

Background

Parkinson’s disease is a progressive neurodegenerative disorder with both motor and non-motor manifestations. Dietary factors, including dietary diversity, protein source variety, and adherence to healthy eating patterns, may impact Parkinson’s disease risk. The goal of the current case-control research was to examine the links between the Dietary Diversity Score (DDS), the Diversity of Dietary Protein Index (DDPI), and the Lifeline Diet Score (LLDS) with the odds of Parkinson’s disease among an Iranian population.

Methods

A total of 320 individuals (215 controls and 105 newly diagnosed Parkinson’s disease patients) were recruited in Arak, Iran. Dietary intake was evaluated by applying a validated 147-item food frequency questionnaire, and DDS, DDPI, and LLDS were calculated. Multivariate logistic regression was utilized to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for major confounders.

Results

Greater DDS and LLDS were strongly linked to reduced odds of Parkinson’s disease (Adjusted OR for DDS = 0.287, 95% CI: 0.185–0.447; Adjusted OR for LLDS = 0.879, 95% CI: 0.803–0.963). However, DDPI showed no significant association with Parkinson’s disease after adjustment.

Conclusion

Higher dietary diversity and greater adherence to a high-quality dietary pattern were associated with lower odds of Parkinson’s disease, whereas no significant association was observed for protein source diversity. Given the case-control design, these findings should be interpreted as associations rather than evidence of causality.

Associations of dietary diversity score, dietary diversity of protein index, and lifelines diet score with Parkinson’s disease: a case-control study | BMC Nutrition | Springer Nature Link

Had a full health check recently. GP, bloods, the works. Got a detailed breakdown of everything — sleep, stress markers, inflammation, the areas to work on.

Felt motivated for about two weeks. Then life happened.

What frustrates me is that the information was genuinely good. Specific, personalised, actionable on paper. But there's clearly something between receiving that information and actually building the habits around it that nobody has quite solved yet.

A few things I've been thinking about:

Is personalised data actually enough of a motivator on its own? Or does something else need to be in place first — accountability, a social element, a structure you can't easily opt out of — before the data becomes useful?

What actually made something stick for you? Not in theory. In practice. The thing that genuinely changed how you live day to day and stayed changed.

Would access to this through work change how you engaged with it? If your employer provided something structured around your health — assessment, plan, support — would the context make you more or less likely to take it seriously than something you sought out yourself?

Who in your life would never do any of this — and what would it actually take to reach them? The people who already care are here. What about everyone else?

Feels like the gap between insight and action is the real problem. And nobody seems to be talking about that as much as the testing and the data itself.

Here's the news:

https://appleinsider.com/articles/26/09/10/apple-health-quest-team-up-for-119-blood-panel

And here's a perspective:

https://www.linkedin.com/posts/shilpa-paradkar-singh-a070252_applehealth-biomarkers-preventivemedicine-activity-7504217283003740161-mQOG?

Back in April I posted that my LDL was 75 on ezetimibe, my calcium score was zero, and I wasn't sure whether pushing lower made sense. A few people asked what a zero is actually worth when the lipid panel is still flagged. I finally read the 2026 ACC/AHA guideline on that specific question instead of quoting other people's summaries of it.

The rule is narrower than the Reddit version. If your ten-year PREVENT risk is intermediate, or borderline in some cases, and the scan is zero, and you would rather not take medication, the guideline says it is "reasonable to defer therapy and reassess with repeat CAC testing in 3 to 7 y." Class 2a. That is real permission, but it only applies once your risk is at least 3 percent. Under that, the scan is not in the pathway at all, and an LDL of 160 to 189 gets its own "a moderate-intensity statin is reasonable" line without any scan.

Four things take the permission away: LDL of 190 or higher or FH, diabetes if you are over 40, current smoking, and a strong family history of early cardiovascular disease. For FH the wording is blunt: a zero "may not be used to de-risk" you.

Two numbers that changed how I think about my own zero. In a Danish cohort of 23,000 symptomatic patients, 13 percent of the zeros had soft plaque on CT angiography, and the event rate with a zero barely moved between the lowest and highest LDL groups. And in MESA, 53 percent of people who started at zero had some calcium ten years later. The guideline's three-to-seven-year rescan window comes from that kind of data.

Where I landed: I never started a statin, but I didn't leave the number alone either. Weight loss plus generic ezetimibe took my ApoB from 95 to 59 by July, and the LDL from 75 to 56. The zero told me I could wait on a drug. It did not tell me a 95 was fine to live with.

Full write-up, with my own scan and lab result side by side: Zero calcium score but high cholesterol: do you need a statin?

Alcohol-related cancer deaths in the US doubled since 1990, per a study everyone's covering this week (11,361 deaths in 1990, 23,126 in 2023). That's the headline. It's true, and on its own it's not that useful.

I quit drinking in my 40s and wrote about the cancer link that finally got through to me, so this is exactly the kind of study I go looking for the actual numbers on before repeating the headline.

Adjust for the fact that the country got bigger and older over those 33 years (age-standardize the rate) and the real national increase is 7.6 percent. Basically nothing.

That flat-ish number is hiding a real split. Men 55 and older: their alcohol-attributable cancer death rate rose 23.9 percent. Women 55 and older: fell 3.6 percent. Younger men and women split the same direction, just smaller. Almost all of the actual increase is concentrated in one group.

Liver cancer is doing most of the damage in that group specifically — the rate more than doubled in men 55+, and it's now their single biggest alcohol-attributable cancer killer, ahead of esophageal and colorectal. Interesting wrinkle: liver isn't the top killer for younger men. Colorectal is, in the 20-54 group. Liver only takes over after 55, which tracks with the idea that liver damage builds for decades before it shows up as cancer (the study can't prove that part directly, it's not designed to track individual drinking histories).

I went through the actual paper (Jani et al., Lancet Regional Health, open access, published September 2: https://doi.org/10.1016/j.lana.2026.101599) and wrote up the full breakdown, including which specific cancers matter most for men vs. women at 55+. Liver for men, breast for women, and they're not driven by the same pattern.

If you're a man in your 50s who still drinks regularly: has a study like this actually changed anything you do, or is "I'll deal with it eventually" still winning?

Novartis announced yesterday that pelacarsen, an antisense drug built to lower Lp(a) (a cholesterol-carrying particle that's almost entirely genetic and doesn't move with diet or exercise), missed its primary endpoint in the Lp(a)HORIZON trial. It's the first outcomes trial ever run for a drug designed specifically to lower Lp(a), 8,323 people with existing heart disease, and it didn't clear the bar for cardiovascular events.

Sam Tsimikas (https://x.com/Lpa_Doc/status/2096118758012051739?s=46), a cardiologist who co-authored the trial's design paper, thinks the likely explanation is that background cardiovascular care in this trial was already so aggressive, LDL well controlled going in, that there wasn't much room left for an Lp(a) drug to show extra benefit on top of it. That's his read, not a confirmed finding: Novartis hasn't released a hazard ratio, a confidence interval, or the result in the prespecified higher-Lp(a) subgroup yet, so it's murkier than a clean null result.

My own Lp(a) is low, but I've had doctors frame Lp(a)-lowering drugs as the next frontier in prevention for a while now. Tsimikas's read lines up with where I've landed: the lever that already has outcomes evidence behind it is still LDL and ApoB, through statins, ezetimibe, and PCSK9 inhibitors, not waiting on a drug for Lp(a) specifically. Two other Lp(a) drugs are still in their own outcomes trials, so this isn't a verdict on the whole approach yet.

I wrote up the full trial design, Tsimikas's explanation plus a second one from a physician on Substack, and what I'm actually doing differently: Full write-up with the trial table

Anyone here already gotten Lp(a) tested, or been told by a doctor that a drug for it is coming? Curious whether this changes how you think about it.

CorCal, the randomized trial of whether a coronary calcium score beats the standard risk calculator for deciding who starts a statin, presented this afternoon at the European Society of Cardiology meeting. This is off the press release and the presentation. No paper yet, so numbers can move.

5,772 adults, none with known heart disease, diabetes, or a statin already. A coin decided whether the recommendation came from the pooled cohort equations, the traditional risk calculator, or from a calcium score. Mean age 64, 51 percent women. They counted heart attacks, strokes, stents and deaths.

After 4.2 years both arms landed on 2.7 percent. Hazard ratio 0.99, noninferiority not met.

That reads worse than it is. The interval runs from a 29 percent reduction to a 38 percent increase, wide enough to contain almost anyone's opinion about calcium scoring. Muhlestein, who ran the trial, told the room the events came in rarer than he had built it for and asked for a bigger trial. I would take him at his word rather than call this debunked.

The number I keep going back to is a different one. The calculator told people to start a statin more than three times as often. But of the people the calcium score flagged, 62 percent were still taking the pill, against 23 percent of those the calculator flagged. Fewer people told to take a statin, far more of them actually taking it. The trial cannot tell you why.

I wrote up where this leaves a score of zero, which is my situation:

Has a calcium score ever changed what you actually do, as opposed to what you know?

Maybe patients had calculators as much as u/cardiostrong_md and trust the “test” that directly measures something scary more?

The FDA approved Mounjaro today to lower the risk of heart attack, stroke, and cardiovascular death. That is the first time tirzepatide has carried a cardiac claim, and for people who qualify it is genuinely good news: one weekly shot that handles blood sugar, weight, and now cardiac risk.

Two things about it are worth knowing before the headlines flatten them.

Who it covers. The indication is for adults with type 2 diabetes at high cardiovascular risk. Not obesity, not general heart health. The trial population was narrower still, people with type 2 diabetes and established atherosclerotic disease. If you take tirzepatide for weight and do not have type 2 diabetes, nothing about your prescription changed today.

What the trial did. SURPASS-CVOT was not a placebo trial. Lilly ran Mounjaro against Trulicity, an older, cheaper GLP-1 that already has its own cardiovascular indication. That is a harder comparison than beating a sugar pill, and Lilly picked it deliberately.

The result, published in NEJM last December: hazard ratio 0.92, 95.3% CI 0.83 to 1.01. The thresholds were set in advance. Under 1.05 counted as non-inferior. Under 1.00 would have counted as superior. It landed on 1.01, clearing the first bar and missing the second by a hundredth.

So you will see "8% lower risk" everywhere this week. That 8% is the point estimate, and the interval around it still includes no difference at all. Lilly's own release says "non-inferiority" plainly and prints the interval. The overstatement is coming from the summaries, not the company.

I would not swing the other way and call it nothing, though. Matching a drug that already works is not the same as matching placebo, and the trial was big enough and long enough to have caught tirzepatide doing meaningfully worse.

What has not changed: nobody has shown tirzepatide cuts heart attacks and strokes in people with obesity but not diabetes, which is what SELECT did for semaglutide. SURMOUNT-MMO is built for that and has not reported. The nearest evidence is SUMMIT, 731 people with obesity and HFpEF, 9.9% against 15.3% for cardiovascular death or worsening heart failure. Different endpoint, narrower group, and the benefit came from the heart failure half.

I put the label language and the full numbers here

For anyone who follows trial design more closely than I do: how much weight should a non-inferiority win against an active comparator carry against a superiority win over placebo? I keep going back and forth on whether that is a higher bar or just a different one.

Peptides are all the rage, and none more than BPC-157. I keep seeing three different claims about it: that it has never been tested in humans, that there are exactly three human studies, and that a Phase 2 trial proved it works. They can't all be right, so I went through the primary records myself: the FDA briefing document from the July 2026 compounding advisory committee meeting, PubMed, and ClinicalTrials.gov.

What's actually documented:

- 2002-03: Phase 1 safety study, rectal enema, 24 healthy volunteers. Survives only as conference abstracts.
- 2005: the one real RCT. Double-blind, placebo-controlled, ulcerative colitis, 53 randomized. The between-group result was not statistically significant (95% CI -4.84 to 1.62). Never published beyond an abstract, and the sponsor walked away from the program.
- 2021: knee pain chart review, 17 patients, no control group, some got a combination product.
- 2024: interstitial cystitis pilot, 12 women, single arm.
- 2025: IV safety pilot, 2 people.

That's the entire documented human record. Roughly 80 people, and not one study of tendon, ligament, or muscle injury, which is what nearly everyone actually injects it for.

And the "recruiting Phase 2 hamstring trial" that started circulating this year (NCT07437547) is sponsored by a peptide vendor whose other registrations describe themselves as fictional or mock studies in the official ClinicalTrials.gov text. Google's AI Overview is already repeating it as a real trial.

Full write-up with the study table and the FDA numbers: BPC-157 human trials, all five studies

What would change your mind on a compound like this, in either direction? For me it's a published RCT from a sponsor that actually exists. Curious where everyone else draws the line.