Fork U with Dr. Terry Simpson

Terry Simpson
  • 4.8 (105)
  • MEDICINE
  • UPDATED WEEKLY

Fork U(niversity) Not everything you put in your mouth is good for you. There’s a lot of medical information thrown around out there. How are you to know what information you can trust, and what’s just plain old quackery? You can’t rely on your own “google fu”. You can’t count on quality medical advice from Facebook. You need a doctor in your corner. On each episode of Your Doctor’s Orders, Dr. Terry Simpson will cut through the clutter and noise that always seems to follow the latest medical news. He has the unique perspective of a surgeon who has spent years doing molecular virology research and as a skeptic with academic credentials. He’ll help you develop the critical thinking skills so you can recognize evidence-based medicine, busting myths along the way. The most common medical myths are often disguised as seemingly harmless “food as medicine”. By offering their own brand of medicine via foods, These hucksters are trying to practice medicine without a license. And though they’ll claim “nutrition is not taught in medical schools”, it turns out that’s a myth too. In fact, there’s an entire medical subspecialty called Culinary Medicine, and Dr. Simpson is certified as a Culinary Medicine Specialist. Where today's nutritional advice is the realm of hucksters, Dr. Simpson is taking it back to the realm of science.

  1. Minnesota Starvation Experiment: Food Noise, Science

    2D AGO

    Minnesota Starvation Experiment: Food Noise, Science

    The Minnesota Starvation Experiment: What Hunger Does to the Human MindEvery few years, someone announces the solution to weight loss. Eat less. Fast longer. Cut carbs. Cut fat. Cut something. Naturally, the advice usually comes with a tone of moral certainty. If you are hungry, the implication goes, you simply lack discipline. However, long before social media, diet influencers, and the phrase food noise entered the modern vocabulary, scientists ran an extraordinary experiment that revealed something profound about hunger. Rather than speculate about appetite, they studied it directly. In the middle of World War II, researchers deliberately starved healthy young men. The results changed how we understand hunger forever. Why the Experiment HappenedDuring World War II, much of Europe faced severe food shortages. Cities were bombed, farms disrupted, and supply chains shattered. Consequently, millions of civilians were suffering from malnutrition and starvation. Yet another problem quickly emerged. Refeeding starving populations turned out to be complicated. If nourishment returned too quickly, dangerous metabolic complications could occur. Doctors needed to understand not only starvation but also recovery from starvation. Therefore, the U.S. government supported research designed to answer a simple but critical question: What happens to the human body and mind when calories are severely restricted for long periods? The scientist leading that effort was Dr. Ancel Keys at the University of Minnesota. Today, Keys is often remembered for his later work on diet and heart disease. Nevertheless, his wartime research produced one of the most remarkable studies ever conducted in nutrition science. The results were eventually published in a monumental two-volume work titled: “The Biology of Human Starvation.” This massive text, published in 1950, remains one of the most detailed examinations of hunger ever written. KEYS, ANCEL, JOSEF BROŽEK, AUSTIN HENSCHEL, OLAF MICKELSEN, HENRY LONGSTREET TAYLOR, Ernst Simonson, Angie Sturgeon Skinner, et al. The Biology of Human Starvation: Volume I. University of Minnesota Press, 1950. https://doi.org/10.5749/j.ctv9b2tqv. The VolunteersTo conduct the study, Keys recruited 36 conscientious objectors. These men had refused military service during World War II for moral or religious reasons. Nonetheless, they still wanted to contribute to the war effort. Participating in this experiment became their way of helping. Importantly, the volunteers were healthy young men. They had normal body weight, good physical fitness, and no significant psychological problems. In other words, they were ideal research subjects. Furthermore, they understood the risks. They would experience months of severe caloric restriction. Even more remarkable, the experiment took place beneath the University of Minnesota football stadium, turning an athletic facility into one of the most important laboratories in nutrition history. The Structure of the ExperimentThe study unfolded in three distinct phases. First came the baseline period. For several months, the men ate normally, consuming approximately 3,200 calories per day. Researchers measured body weight, metabolism, and psychological health to establish a stable starting point. Next came the central part of the experiment: six months of semi-starvation. During this period, calorie intake dropped to roughly 1,500 calories per day. That number may sound familiar because many modern diet programs recommend similar intake levels. The food itself resembled wartime rations. Participants ate simple meals consisting primarily of potatoes, bread, macaroni, turnips, and small amounts of dairy. Although the men remained physically active, their energy intake was cut in half. Finally, the experiment concluded with a refeeding phase designed to observe how the body recovers after prolonged starvation. The Unexpected Psychological EffectsResearchers expected weight loss. What surprised them was the dramatic change in the men’s relationship with food. Gradually, the volunteers became completely preoccupied with eating. First, they began collecting recipes. Soon afterward, they spent hours reading cookbooks. Remember that this was long before television cooking shows or the Food Network. Nevertheless, these men read cookbooks the way other people read novels. Additionally, food became the center of conversation. Participants talked about meals constantly. They debated cooking techniques and discussed ingredients in remarkable detail. Meanwhile, eating itself changed dramatically. Many men developed elaborate food rituals. Some cut meals into tiny pieces to make them last longer. Others chewed gum continuously to quiet hunger. Still others drank large amounts of water or coffee simply to fill their stomachs. Eventually, several participants reported dreaming about food every night. At that point, hunger had completely dominated their mental landscape. When Hunger Changes PersonalityAlongside this intense food focus came significant psychological changes. Participants became irritable. Mood declined. Social withdrawal increased. Furthermore, many men lost interest in hobbies and normal activities. Concentration dropped, and emotional resilience weakened. However, one topic continued to command their attention: Food. In modern terms, we might describe this state as persistent food noise—the constant internal dialogue about eating that many individuals with obesity describe today. The Minnesota experiment demonstrated something important: when the human body senses prolonged energy shortage, the brain amplifies signals related to food. That response is not weakness. Instead, it is survival. What Happened When Food ReturnedThe most striking results appeared during the recovery phase. Once calorie restrictions ended, participants were allowed to eat freely again. Unsurprisingly, many men consumed enormous amounts of food. Daily intake sometimes reached 5,000 to 10,000 calories. Importantly, this response was not driven by pleasure alone. Rather, the body was attempting to restore lost energy reserves and rebuild metabolic balance. Researchers observed that appetite remained elevated for months after the starvation phase ended. In some cases, normal appetite regulation took more than a year to return. Consequently, the study revealed that hunger leaves a lasting biological imprint. Lessons for Modern NutritionAlthough the Minnesota Starvation Experiment occurred more than eighty years ago, its lessons remain highly relevant. Modern weight-loss advice often emphasizes simple calorie restriction. People are told to eat less, ignore cravings, and rely on willpower. Yet the Minnesota study demonstrates that prolonged calorie restriction triggers powerful biological responses. Hunger intensifies. Food becomes mentally dominant. Motivation to eat grows stronger. In other words, the brain fights back. From an evolutionary perspective, this response makes perfect sense. Humans evolved in environments where food scarcity threatened survival. Therefore, the brain developed mechanisms to detect energy deficit and prioritize eating. Those mechanisms remain active today. Hunger, the Brain, and Food NoiseModern neuroscience offers further insight into what the Minnesota researchers observed. Several brain regions participate in appetite regulation. The hypothalamus monitors energy balance through hormones such as leptin, ghrelin, and insulin. Meanwhile, motivational circuits—including the nucleus accumbens—integrate metabolic signals with behavioral drive. When energy stores decline, these systems increase the motivational pull toward food. Consequently, thoughts about eating become more persistent and more difficult to ignore. This process resembles what many patients describe as food noise—a continuous internal signal urging them toward food. The Minnesota experiment showed that this phenomenon can arise even in healthy individuals when calories remain restricted long enough. A Modern Medical PerspectiveToday, treatments for obesity increasingly focus on restoring normal appetite regulation rather than relying solely on behavioral restraint. Medications known as GLP-1 receptor agonists offer one example. Patients using these therapies often report something striking. Many say that the constant mental chatter about food becomes quieter. Meals feel satisfying sooner, and cravings diminish. In other words, regulation returns. These observations reinforce an important idea: overeating may not reflect a lack of discipline. Instead, it may result from disrupted...

    12 min
  2. From Gila Monster to GLP-1 Revolution

    FEB 26

    From Gila Monster to GLP-1 Revolution

    Meanwhile, in a LaboratoryIn 1990, researchers isolated a peptide from Gila monster venom. Two years later, work from the Bronx VA Medical Center described exendin-4, a molecule that resembled human GLP-1 but lasted far longer in circulation. Human GLP-1 survives only minutes before the body breaks it down. Exendin-4 resisted that breakdown. That difference changed everything. Soon afterward, the first GLP-1 receptor agonist reached patients under the brand name Byetta. At the time, physicians used it to treat diabetes. No one called it a weight-loss drug. No one predicted it would reshape obesity medicine. And yet, the foundation was already in place. While I Was OperatingAt the Phoenix Indian Medical Center, I performed weight loss surgery in a population with some of the highest rates of type 2 diabetes in the world. Researchers there studied metabolism intensely. The “thrifty gene” hypothesis gained traction in that environment. Scientists asked whether efficient energy storage, once protective in scarcity, became harmful in abundance. At the same time, I watched something remarkable in the operating room. After gastric bypass, patients’ blood sugars often improved within days, before meaningful weight loss occurred. Hormones were shifting. Physiology was driving outcomes. Meanwhile, GLP-1 drugs evolved. Researchers lengthened their half-lives. Chemists modified their structures so they bound albumin and stayed active for days rather than minutes. Clinical trials expanded. Safety data accumulated. Eventually, semaglutide showed average weight loss approaching fifteen percent of body weight in obesity trials. Then tirzepatide, now marketed as Zepbound for obesity, exceeded 20 percent weight reduction in higher-dose studies. In addition, cardiovascular outcome trials demonstrated reductions in major adverse cardiac events in high-risk patients. These were not cosmetic results. These were metabolic and cardiovascular outcomes. Food NoisePatients rarely talk about receptors. They talk about noise. Food noise. The constant internal dialogue about eating. The mental pull toward the pantry. The background chatter that never quite stops. GLP-1 receptors exist in appetite-regulating areas of the brain, including the hypothalamus and brainstem. These medications act through vagal signaling and through regions where the blood-brain barrier is more permissive. As a result, they modulate satiety and reward pathways. Consequently, many patients report something simple but profound: the noise quiets. Not disappears. Quiet. That distinction matters. Diet Culture PushbackPredictably, not everyone celebrates this shift. Diet culture thrives on the belief that weight reflects character. Some coaches insist the solution is fewer calories. Others argue for more beef, more butter, more fiber, or stricter discipline. Entire industries depend on the idea that trying harder solves everything. However, biology does not negotiate with virtue. Obesity is a chronic, relapsing, neurohormonal disease. No one worked harder at weight loss than many of my surgical patients. Likewise, I do not lack willpower. And I practice culinary medicine. Preaching and eating a Mediterranean diet. Nevertheless, effort alone does not silence dysregulated signaling. Calling GLP-1 therapy “cheating” misunderstands the science. These medications restore signaling. They amplify satiety. They reduce excess reward drive. They support physiology. That is treatment, not moral compromise. My Parallel UniverseWhen I began my career, I weighed about 185 pounds. Years later, hospital cafeterias, exhaustion, and irregular meals pushed me to 225. I understood obesity clinically. Then I understood it personally. In one version of my career, revision surgery remains the answer for weight regain. In this version, I reached for GLP-1 therapy instead. Today, I weigh what I weighed when Nixon was president. I am both surgeon and patient. And your reporter. A Necessary CautionGLP-1 medications carry risks as well as benefits. Nausea can occur. Gastric emptying slows. Gallbladder disease risk may increase, although obesity itself already raises that risk substantially. Physicians must monitor dosing carefully. Therefore, if you consider GLP-1 therapy, work with a trained physician who understands obesity medicine. Avoid quick online scripts. Seek supervision. Demand follow-up. Metabolic medicine deserves serious care. The Desert Was the BeginningI once thought Phoenix was punishment. The heat felt relentless. Even Satan might choose a cooler vacation. Only Canadians brave July—and who can blame them? However, what felt like exile turned out to be preparation. In that same desert, I learned surgery. Researchers debated the thrifty gene. A venomous lizard carried a peptide that would become the basis of modern metabolic therapy. I thought I had been sent to hell. But I found beauty in the desert, and by the time I left Arizona, I missed it terribly. Little did I know I was sent to the future in Arizona.

    13 min
  3. Protein Panic: How Much Do You Really Need?

    FEB 19

    Protein Panic: How Much Do You Really Need?

    Protein Panic: How Much Do You Really Need?Everywhere you look, protein has become a competition. Scroll long enough and you will believe muscle disappears if you eat less than 150 grams a day. Meanwhile, influencers debate leucine thresholds like they’re trading baseball cards. As a result, ordinary meals now feel like math problems. However, biology does not require panic. Protein matters. Yet adequacy differs from excess. And importantly, most people eating real food already meet their needs. So let’s slow down. First, What Protein Actually DoesProtein builds and repairs tissue. In addition, amino acids support immune function and hormone signaling. Furthermore, specific amino acids such as leucine trigger muscle protein synthesis. Nevertheless, once you reach the effective leucine threshold in a meal, adding more protein does not multiply muscle growth. Instead, your body oxidizes the excess. Therefore, more does not always mean better. How Much Is Enough?For most healthy adults, about 0.8 grams per kilogram of body weight covers basic needs. Meanwhile, adults over 60 often benefit from 1.0 to 1.2 grams per kilogram to protect lean mass. Notably, that recommendation does not require heroic intake. In fact, a 75–80 kilogram adult typically lands between 60 and 90 grams per day. Consequently, many people hit those numbers without even trying. Here’s What I Actually DoI do not count protein. I never log grams. Moreover, I do not calculate leucine before breakfast. Instead, I eat normal meals. Most mornings, I have a shake. The recipe lives on terrysimpson.com. That shake provides roughly 25 grams of protein. Sometimes I add PB Fit. Occasionally, I include Greek yogurt. As a result, I increase protein slightly without thinking about it. Later, I eat three to five ounces of chicken breast with Louisiana hot sauce. That adds another 25 grams. Then at dinner, I often choose salmon and chickpeas. Together, they bring me to roughly 70–80 grams for the day. Importantly, I have lost 50 pounds and preserved muscle mass. I track muscle periodically. I see no decline. So what about leucine? High-quality animal protein contains about 8–10% leucine. Therefore, a 25-gram protein meal delivers about 2 grams of leucine. That amount typically triggers muscle protein synthesis. Thus, I hit the effective threshold at each meal without obsessing. Now Let’s Bring In GLP-1GLP-1 medications reduce appetite. Consequently, total intake drops. Because of that, protein intake can fall too. So yes, people using GLP-1 should pay attention. However, they do not need 180 grams per day. Instead, they need adequacy and resistance training. Lift something heavy. Spread protein across meals. Preserve lean mass. Simple. Here’s the Real DeficiencyProtein deficiency remains rare in the United States. By contrast, fiber deficiency remains common. According to the National Institutes of Health, most adults fail to meet recommended fiber intake levels. In fact, average intake falls far below the 25–38 grams per day recommended for adults. (Reference: NIH Office of Dietary Supplements – Fiber Fact Sheet) Meanwhile, high-protein diets often crowd out legumes, whole grains, and vegetables. So while people panic about protein, they quietly neglect fiber. And fiber feeds the microbiome. Fiber improves glycemic control. Fiber lowers LDL cholesterol. Protein builds muscle. Fiber protects metabolism. Both matter. Mediterranean Patterns Keep It BalancedMediterranean-style eating provides protein from fish, legumes, yogurt, and moderate poultry. At the same time, it supplies fiber from beans, vegetables, and whole grains. Therefore, protein arrives packaged with micronutrients and fermentable substrate. Unlike protein powders and bars, real food supports multiple systems at once. Consequently, longevity patterns emphasize diversity, not maximal single-nutrient intake. The TakeawayAdequate protein preserves muscle. Resistance training drives adaptation. Fiber protects metabolic health. So before you triple-scoop whey, pause. Ask yourself whether you lack protein — or whether you lack plants. Because protein matters. Panic does not. And once again, data beats dogma.

    8 min
  4. Mexican Food Is Healthy. The Taco Took the Blame.

    FEB 12

    Mexican Food Is Healthy. The Taco Took the Blame.

    Why Traditional Mexican Food Is Healthy — and How America Got It WrongEvery time someone says Mexican food is unhealthy, I know exactly what they’re picturing. They aren’t picturing Mexico. They’re picturing an American taco: a hard shell or a fluffy white flour tortilla, fatty hamburger, sour cream, a thin smear of salsa that contributes almost nothing except salt, and a yellow substance legally allowed to be called cheese. After eating that, they naturally conclude Mexican food is the problem. That conclusion doesn’t come from biology. It comes from branding. Traditional Mexican food looks nothing like that. More importantly, it behaves nothing like that once it hits your body. So let’s slow down, take a breath, and do what we always do here—follow the evidence, not the vibes. First, Let’s Talk About the Taco America Put on TrialThe American taco stacks the deck against itself. It leads with saturated fat, piles on refined carbohydrates, and adds dairy on top of dairy. Meanwhile, it offers almost no fermentable fiber. The gut gets nothing to work with. Blood sugar spikes. Inflammation follows. That taco doesn’t help anyone. But here’s the key point: it isn’t Mexican food. It’s ultra-processed American convenience food wearing cultural drag. Now Let’s Look at a Real TacoBy contrast, a traditional taco starts very differently. It starts with a corn tortilla, not refined flour. Then it adds beans. After that, it layers vegetables, real salsa, and often cabbage. Finally, it finishes with avocado. Sometimes it includes fish. Sometimes it doesn’t. Either way, the structure holds. And structure matters. Because when you look at how that meal behaves biologically, it stops looking indulgent and starts looking smart. Corn Tortillas Aren’t the Villain — They’re the FoundationFirst of all, traditional corn tortillas come from nixtamalized corn. That process treats corn with lime, and no, that isn’t trivia. Instead, nixtamalization improves mineral absorption, improves protein quality, and preserves resistant starch. As a result, resistant starch passes through the small intestine untouched. Then it reaches the colon, where gut bacteria ferment it. Consequently, those bacteria produce short-chain fatty acids, especially butyrate. And here’s the important part: butyrate fuels the cells lining your colon. In addition it strengthens the gut barrier. It reduces inflammation. Finally, it improves metabolic signaling. So no, this isn’t a carb disaster. On the contrary, it’s colon nutrition. Beans Do the Heavy Lifting — And They Always HaveNext, add beans. At that point, the conversation usually derails, so let’s keep it grounded. A serving of beans delivers roughly ten grams of fiber. Not one kind — several kinds. Soluble fiber. Insoluble fiber. Resistant starch. Plus protein. Because of that, beans slow digestion. They flatten glucose curves. They improve satiety. Most importantly, they feed gut bacteria that matter. Specifically, bean fiber supports Akkermansia, a gut bacterium associated with better insulin sensitivity and a stronger gut barrier. In other words, beans don’t fill space. Instead, they build infrastructure. And yes, when you pair beans with rice, you get a complete amino acid profile. Humans figured that out centuries ago, long before protein powders and “ancestral” snack companies tried to monetize it. Now Let’s Deal With Refried Beans — Because This Is Where People PanicAt this point, someone inevitably says, “But what about refried beans?” So let’s clear that up. First, frijoles refritos does not mean “fried twice.” It means well-fried or thoroughly cooked. Traditionally, people cooked beans, then lightly cooked them again, often mashing them for texture. So yes — refried beans are traditional. Very traditional. Moreover, mashing beans does not remove fiber. Cooking beans does not turn them into sugar. Beans remain beans. So where did refried beans go wrong? Fat choice. Historically, many refried beans used lard. That made sense when calories were scarce and undernutrition threatened survival. However, in a modern context, large amounts of lard mean large amounts of saturated fat. Therefore, when refried beans swim in lard, then get buried under cheese, then land inside a refined flour tortilla, the problem isn’t the beans. The problem is the fat context. Fortunately, this problem has an easy fix. Use olive oil or another unsaturated fat. Add onions and garlic. Mash lightly, not into paste. Suddenly, refried beans snap right back into a Mediterranean-style pattern. And yes — some commercially available refried beans already do this. Look for short ingredient lists. Look for beans, oil, onion, garlic, salt. Skip the lard. Skip the mystery fats. Your gut will notice. Avocado Doesn’t Add Calories — It Unlocks NutritionThen comes avocado, which people love to blame for reasons that make no biological sense. Avocado provides about five grams of fiber and a meaningful amount of monounsaturated fat — the same fat family as olive oil. More importantly, fat enables absorption of fat-soluble vitamins: A, D, E, and K. So when you add avocado to vegetables, you don’t ruin the meal. Instead, you make the nutrients available. In other words, avocado doesn’t cancel vegetables. It activates them. Salsa and Cabbage Quietly Do the Real WorkMeanwhile, real salsa brings tomatoes, onions, garlic, chilies, and cilantro to the table. That means fiber. That means polyphenols. That means fermentable substrate for gut bacteria. Add corn to the salsa and you add more whole grains and more resistant starch. Then add cabbage — raw or lightly dressed — and now you feed short-chain fatty-acid producers directly. Nothing exotic. Nothing trendy. Just food that works. Step Back — Because This Should Look FamiliarNow zoom out. Traditional Mexican food emphasizes whole grains, legumes, vegetables, unsaturated fats, and fermentation. It stays naturally low in saturated fat. It supports the microbiome. It respects digestion. In other words, it follows the Mediterranean pattern. Not because it sits near the Mediterranean Sea — but because biology doesn’t care about geography. The Mediterranean diet is a structure, not a destination. Whether you eat it in Greece. Or you eat it in Italy. But you can eat it wrapped in a corn tortilla. So What Actually Broke the Taco?Processing. Refining grains. Deep-frying bases. Replacing beans with beef. Replacing water with sugar. Turning cheese into a load-bearing wall. Mexican food didn’t fail. Industrial food did. The VerdictA traditional taco — corn tortilla, beans or properly made refried beans, vegetables, avocado, real salsa, maybe fish — fits squarely into one of the healthiest dietary patterns we know. Different culture. Same biology. So the next time someone tells you Mexican food is unhealthy, remember this: The taco was framed. And once again — data beats dogma.

    10 min
  5. Keep Your Poop in a Group

    FEB 5

    Keep Your Poop in a Group

    Why Fiber Fails to Impress—and Why That’s the PointFiber has a public relations problem. Unlike supplements or extreme diets, fiber does not promise instant transformation. Instead, it works slowly, predictably, and quietly. Because of that, people rarely notice it when it’s doing its job well. However, that very boredom is precisely why fiber matters. When fiber intake is adequate, digestion functions normally, blood sugar behaves more consistently, and bowel habits stay predictable. As a result, there is no drama to post on social media. Consequently, influencers move on. Meanwhile, the science stays exactly where it has been for decades: fiber lowers disease risk over time. That kind of quiet effectiveness may not sell products, but it saves lives. “Fiber Isn’t Essential”—Why That Argument Misses the MarkTechnically speaking, fiber is not an essential nutrient in the classic sense. In other words, there is no disease caused solely by a lack of fiber the way scurvy results from vitamin C deficiency. Because of this, critics often stop the conversation there. However, medicine does not ask only whether you survive. Instead, it asks whether your risk of chronic disease rises or falls over time. On that front, fiber consistently lowers the risk of colon cancer, improves glucose regulation, reduces constipation, and supports cardiovascular health. Therefore, while you can live without fiber, you do not age particularly well without it. Protein Gets the Spotlight While Fiber Does the WorkAt the same time, nutrition conversations fixate on protein. Protein goals dominate podcasts, social media, and supplement aisles. Yet, in practice, true protein deficiency in the United States is rare, even among bariatric surgery patients. In contrast, fiber deficiency is the norm. Roughly 92% of Americans fail to meet recommended fiber intake. As a result, constipation becomes common, long bathroom visits feel normal, and scrolling on a phone in the bathroom gets rebranded as “self-care.” Unfortunately, that normalization hides a real problem. A Personal Lesson From Oats, Gas, and a Scorched DeskYears ago, I learned a fiber lesson the hard way. After deciding to increase my fiber intake quickly, I started eating steel-cut oats every morning during a busy meeting week. At first, everything seemed fine. Soon, however, my digestive system made it clear that it had not been consulted in this decision. By the second day, bloating appeared. By the third day, office etiquette became questionable. Consequently, I lit a candle at my desk. Unfortunately, I turned my back, and papers caught fire. Although the flames were extinguished quickly, the scorch mark stayed for years. That stain served as a reminder: fiber works best when introduced gradually. Your gut adapts over time. Confidence without patience, on the other hand, leads to unnecessary consequences. Not All Fiber Works the Same WayUnderstanding fiber helps people stop fearing it. Soluble fiber, found in oats, barley, beans, lentils, psyllium, apples, and citrus, forms a gel in the gut. Because of this, it slows absorption, reduces glucose spikes, and lowers LDL cholesterol. Consequently, psyllium appears in clinical guidelines rather than influencer protocols. Meanwhile, insoluble fiber focuses on mechanics. It adds bulk, speeds transit, and improves regularity. Importantly, this matters even more for people using GLP-1 medications, where slowed digestion often leads to constipation. In that setting, fiber is not optional—it is foundational. Finally, fermentable fiber feeds gut bacteria. Beans, onions, garlic, asparagus, chicory root, and resistant starch nourish beneficial microbes. As these bacteria grow, they produce short-chain fatty acids, especially butyrate, which supports gut barrier function and immune regulation. No, Butter Is Not a Shortcut to ButyrateDespite what circulates online, butter does not meaningfully deliver butyrate to your colon. Although butter contains trace amounts of butyric acid, that fat is absorbed in the small intestine long before it reaches the colon. In contrast, the butyrate that protects colon health is produced by bacteria fermenting fiber directly in the colon. Therefore, if butter were an effective therapy, gastroenterologists would prescribe croissants. They do not. Supplements Help—but Food Still WinsFiber supplements can be useful. Psyllium and methylcellulose typically provide four to five grams of fiber, which helps people start. However, that amount represents only about ten percent of a reasonable daily target. Personally, I use Loam, which provides around twelve grams of mixed fiber in a smoothie. Nevertheless, supplements act as bridges, not destinations. Ultimately, food does the heavy lifting. IBS, FODMAPs, and Why We Avoid Diet CosplaySome people with IBS feel worse when fermentable fiber increases too quickly. Because fermentation produces gas, symptoms can flare initially. For that reason, clinicians use FODMAPs as a temporary elimination tool to identify triggers. However, elimination is not the end goal. Instead, we reintroduce foods within a Mediterranean dietary pattern, which promotes diversity and tolerance. In contrast, Whole30 markets itself as elimination but functions primarily as low-carb restriction. That approach avoids symptoms rather than solving them. What Eating Enough Fiber Actually Looks LikePeople do not eat grams of fiber. They eat meals. A Mediterranean-style day, such as the 3-Day Mediterranean Diet at terrysimpson.com, delivers fiber incidentally. Breakfast often includes oats, berries, and nuts. Lunch typically features vegetables, legumes, whole grains, and olive oil. Snacks rely on fruit, nuts, or hummus. Dinner centers on vegetables, whole grains like farro, and fish or poultry. Over the course of a day, fiber naturally reaches 25–40 grams without spreadsheets or stress. Start Slowly, Then Stay ConsistentIf you currently eat little fiber, the solution is simple but not dramatic. Increase intake gradually. Drink water. Give your microbiome time to adapt. Although you are not fragile, abrupt change can still cause discomfort. The Bottom LineFiber does not need hype. Instead, it needs consistency. It works quietly, steadily, and reliably. If bathroom visits require entertainment, the issue is not age—it is fiber.

    12 min
  6. How GLP-1 Quiets Food Noise

    JAN 29

    How GLP-1 Quiets Food Noise

    Food Noise Isn’t Hunger — and Why Broccoli Never Fixed the BrainFood noise does not announce itself politely. Instead, it hums in the background, persistent and exhausting. For years, patients tried to describe it. Meanwhile, medicine largely ignored it. Recently, however, GLP-1 receptor agonists forced the conversation into the open. I did not understand food noise myself until it stopped. About twelve hours after my first GLP-1 injection, I stood in my kitchen waiting for baked salmon to finish cooking. Nothing dramatic happened. No emotional moment followed. Still, something felt different. The internal commentary was gone. The negotiations disappeared. For the first time, my brain felt quiet. At that moment, I finally understood what patients had been telling me for years. First, Define the Problem ClearlyFood noise is not hunger. Hunger serves a biological purpose. In contrast, food noise describes persistent, intrusive thoughts about food that occur regardless of energy needs. People experience rumination, preoccupation, cravings, and mental fatigue—even when they are physiologically full. Importantly, this phenomenon is now measurable. The Food Noise Questionnaire validates what patients already knew. Specifically, it assesses the frequency of food thoughts, difficulty controlling them, interference with daily activities, emotional distress, and craving intensity. In other words, food noise exists independently of willpower. Consequently, advice that targets hunger alone inevitably fails. Next, Address the Broccoli MythI eat vegetables. Nevertheless, I have never liked broccoli. Frankly, if broccoli is air-fried to the edge of carbonization, I will tolerate it. That concession, however, does not transform broccoli into a neurological intervention. Fiber increases fullness. Protein improves satiety. Vegetables slow digestion. None of those actions quiet the reward centers of the brain. Put simply, broccoli fills the stomach. Food noise lives elsewhere. Because of that distinction, the “just eat for satiety” argument collapses under scrutiny. Then, Follow the Science Where It LeadsFood noise arises from heightened food-cue reactivity. Visual cues, smells, availability, and anticipation activate reward pathways long before food reaches the stomach. Ultra-processed foods amplify this response. Their engineered combinations of refined carbohydrates, fats, salt, and flavor compounds reliably stimulate the mesolimbic dopamine system. As a result, ultra-processed foods increase wanting rather than liking. However—and this matters deeply—removing ultra-processed foods does not automatically restore normal appetite signaling. Once reward circuitry becomes dysregulated, dietary virtue alone cannot reset it. At that stage, telling someone to “just eat whole foods” resembles telling someone with tinnitus to “enjoy the silence.” Therefore, ultra-processed foods contribute to the problem, but they do not explain it entirely. Now, Enter GLP-1 Receptor AgonistsGLP-1 receptor agonists act centrally and peripherally. While many people fixate on gastric emptying, the central mechanisms explain the lived experience. In the hypothalamus, GLP-1 receptor agonists activate satiety-promoting POMC/CART neurons while inhibiting hunger-promoting NPY/AgRP neurons. This dual action reduces homeostatic hunger. Meanwhile, in the brainstem—particularly the nucleus tractus solitarius—GLP-1 signaling integrates gut-brain communication and sustains appetite suppression. More importantly, GLP-1 receptor agonists modulate reward circuitry. In regions such as the ventral tegmental area and nucleus accumbens, these agents dampen dopamine signaling. Consequently, food becomes less compelling rather than forbidden. Functional imaging studies confirm this effect. After GLP-1 treatment, brain responses to food cues decrease in the insula, amygdala, orbitofrontal cortex, and related regions. The brain still recognizes food. It simply stops obsessing. As a Result, Behavior Changes Without ForceOnce food noise quiets, people do not suddenly become disciplined saints. Instead, they become selective. In my own case, wine lost its appeal. I did not swear it off. I simply stopped wanting it. Eventually, I quit five wine clubs. When a glass tastes mediocre, I put it down and choose iced tea. That behavior reflects altered reward signaling, not moral growth. Similarly, food choices shift without struggle. People stop eating things merely because they are available. They stop drinking because something is poured. The absence of compulsion creates space for intentional eating. That distinction explains why GLP-1 therapy feels different from appetite suppression. Finally, Place Diet Back Where It BelongsThe Mediterranean diet improves health. I recommend it. I eat it. Still, it does not cure food noise. Diet supports metabolic health once interference disappears. GLP-1 therapy removes that interference. Together, they work better than either alone. Pretending otherwise leads to fat shaming disguised as nutritional advice. Obesity is a disease. GLP-1 receptor agonists treat that disease. Food then becomes nourishment rather than negotiation. So, What Actually MattersUltra-processed foods worsen food noise, yes. Yet removing them does not repair dysregulated reward circuitry. Satiety fills the stomach. GLP-1 therapy quiets the brain. Once the noise fades, nutrition finally has a fair chance. In the end, broccoli keeps my mother from returning from the grave. GLP-1s keep my brain quiet. Both have their place. Only one treats the disease. REFERENCES:1. Medications for Obesity: A Review. The Journal of the American Medical Association. 2024. Gudzune KA, Kushner RF. 2. The Arcuate Nucleus Mediates GLP-1 Receptor Agonist Liraglutide-Dependent Weight Loss. The Journal of Clinical Investigation. 2014. Secher A, Jelsing J, Baquero AF, et al. 3. Direct and Indirect Effects of Liraglutide on Hypothalamic POMC and NPY/­AgRP Neurons - Implications for Energy Balance and Glucose Control. Molecular Metabolism. 2019. He Z, Gao Y, Lieu L, et al. 4. On the Pleiotropic Actions of Glucagon-Like Peptide-1 in Its Regulation of Homeostatic and Hedonic Feeding. International Journal of Molecular Sciences. 2025. Sayers S, Wagner E.New 5. Glucagon-Like Peptide 1 (GLP-1) Action on Hypothalamic Feeding Circuits. Endocrinology. 2025. Hwang E, Portillo B, Williams KW.New 6. GABA Neurons in the Nucleus Tractus Solitarius Express GLP-1 Receptors and Mediate Anorectic Effects of Liraglutide in Rats. Science Translational Medicine. 2020. Fortin SM, Lipsky RK, Lhamo R, et al. 7. GLP-1 Receptor Activation Modulates Appetite- And Reward-Related Brain Areas in Humans. Diabetes. 2014. van Bloemendaal L, IJzerman RG, Ten Kulve JS, et al. 8. Glucagon-Like Peptide 1 and Its Analogs Act in the Dorsal Raphe and Modulate Central Serotonin to Reduce Appetite and Body Weight. Diabetes. 2017. Anderberg RH, Richard JE, Eerola K, et al. 9. of GLP-1 Therapies for Addiction and Mental Health Comorbidities—Quo Vadis?. JAMA Psychiatry. 2026. Farokhnia M, Leggio L.New 10. GLP-1 and Weight Loss: Unraveling the Diverse Neural Circuitry. American Journal of Physiology. Regulatory, Integrative and Comparative Physiology. 2016. Kanoski SE, Hayes MR, Skibicka KP. 11. Mechanisms of GLP-1 Receptor Agonist-Induced Weight Loss: A Review of Central and Peripheral Pathways in Appetite and Energy Regulation. The American Journal of Medicine. 2025. Moiz A, Filion KB, Tsoukas MA, et al.New 12. GLP-1 Physiology and Pharmacology Along the Gut-Brain Axis. The Journal of Clinical Investigation. 2026. Beutler LR.New

    9 min
  7. Whole Milk Isn’t the Fix—Feeding Kids Is

    JAN 22

    Whole Milk Isn’t the Fix—Feeding Kids Is

    Whole Milk Is Back in SchoolsBut Hungry Kids Are Still the Real ProblemWhole milk is back in school cafeterias. As a result, a lot of people are celebrating. Some are calling it a victory for nutrition. Others are calling it common sense. Meanwhile, a few are even calling it a breakthrough. However, that excitement misses the point. Because the biggest problem facing kids in school today is not milk fat. Instead, the real problem is hunger. First, Let’s Start With the ObviousBefore we talk about milk, fat, or nutrients, we need to start with something very basic. Hungry kids do not learn well. In fact, hunger affects attention, memory, and behavior. As a result, students who do not eat enough struggle to focus. Over time, that struggle shows up as lower academic performance. Because of that, no change to milk will ever fix an empty stomach. Therefore, if we want better outcomes, we have to start with food access. Next, What Actually Changed With MilkDespite what many people believe, whole milk was not removed from schools in the past. Instead, schools continued to offer low-fat and fat-free milk. Importantly, those options provided the same essential nutrients: proteincalciumpotassiumiodinevitamin B12 In addition, vitamin D was added through fortification, regardless of milk fat level. So, children did not lose vital nutrients. What they lost was milk fat. Now, Why Milk Fat Is Not EssentialMilk fat is made mostly of saturated fat. That matters because saturated fat is not an essential dietary nutrient. If the human body needs saturated fat, it can make it on its own. In other words, there is no requirement to eat it for normal growth or brain development. As a result, adding more saturated fat to a child’s diet is not necessary. Then, Let’s Talk About the BrainHere is where biology matters. The brain is built largely from polyunsaturated fats, not saturated fats. These polyunsaturated fats keep cell membranes flexible. Because of that flexibility, brain cells can signal, adapt, and learn. In contrast, saturated fat is rigid. It plays only a small structural role in membranes. If membranes contained too much saturated fat, they would become stiff. When that happens, signaling does not work well. For that reason, biology uses saturated fat sparingly. Therefore, less saturated fat in the diet of growing children is actually better for long-term brain and cardiovascular health. Meanwhile, What Kids Are Really MissingIf there is one nutrient that most children lack, it is fiber. Fiber supports gut health. In addition, it improves insulin sensitivity. Over time, it also reduces cardiovascular risk. Milk fat does none of those things. So, if nutrition is the concern, fiber deserves more attention than nostalgia for saturated fat. At the Same Time, Food Access Is ShrinkingWhile milk is being discussed, something else is happening quietly. Food assistance programs are being reduced. That matters because programs like SNAP do more than help families buy groceries. They also help children qualify for free school meals. When eligibility is reduced, fewer children qualify. As a result, schools receive less funding for lunch programs. Consequently, some schools serve fewer meals. In certain communities, programs disappear entirely. Therefore, the outcome is simple: fewer kids eat at school. In Contrast, Feeding Kids Actually WorksSome states have shown a different approach. When children receive meals consistently, attendance improves. At the same time, concentration improves. Over the long term, educational outcomes improve as well. This result has been seen repeatedly. Because of that, feeding kids is not charity. Instead, it is an investment in education, health, and future productivity. So, Let’s Put This TogetherWhole milk is fine. If families enjoy it, they can drink it. If schools offer it, that is acceptable. However, whole milk is not an innovation. Feeding children is. Ultimately, school meals should not be treated as a budget line to debate each year. Instead, they should be treated as part of what a functioning society does for its kids. One Reference on Brain Fat and Cell MembranesFor readers who want the science behind membrane fats and brain function, this review explains it clearly: Stillwell W, Wassall SR. Docosahexaenoic acid: membrane properties of a unique fatty acid. Chemistry and Physics of Lipids. 2003;126(1):1–27. This paper explains why polyunsaturated fats keep membranes flexible and why saturated fats play only limited roles.

    10 min
  8. Food Pyramid Blues: Influencers are not Scientists

    JAN 15

    Food Pyramid Blues: Influencers are not Scientists

    When Influencers Replace Scientists, Everyone LosesEvery few years, nutrition gets a makeover. First comes a new graphic. Then comes a new slogan. Soon after, we hear claims that this time, someone finally figured it all out. Recently, that makeover arrived in the form of a “reverse food pyramid” and the cheerful phrase “Eat Real Food.” On the surface, that message sounds reasonable. In fact, many doctors have said the same thing for decades. However, the real problem isn’t the slogan. Instead, the problem lies in who is now shaping nutrition advice—and who is not. Yes, Some of the Advice Is RightTo be clear, let’s start with agreement. Eating real food helps health. Limiting added sugar makes sense. Reducing ultra-processed foods improves outcomes. Importantly, none of this is new. Doctors, dietitians, and public-health researchers have said these things for years. Because of that, when influencers now say, “See, we were right,” a serious issue appears. They didn’t discover this information. They copied it. The Real Risk Isn’t AgreementAt first glance, agreement sounds harmless. Nevertheless, agreement becomes dangerous when it turns into ownership. Once someone believes they have discovered basic nutrition truths, they often assume they can rewrite everything else. As a result, bad ideas slip in quietly, wrapped in confidence instead of evidence. That shift matters. Scientists and Influencers Are Not InterchangeableAt this point, we need to say something clearly. We cannot afford to replace scientists with influencers. Nutrition science didn’t come from podcasts or social media. Instead, it came from metabolic ward studies, long-term population research, and randomized trials. Moreover, real scientists accept uncertainty. They change their minds when the data changes. By contrast, influencer culture rewards certainty. Even worse, confidence often replaces humility. There is no “Mediterranean diet influencer community.” Likewise, there is no “DASH diet movement.” Those dietary patterns exist because scientists studied them, tested them, and measured outcomes over time. On the other hand, a loud low-carb and carnivore influencer ecosystem does exist. That ecosystem includes brands, supplements, coaching programs, and a strong contrarian identity. Because of that structure, influence—not evidence—often drives the message. Fiber Versus Saturated Fat: A Telltale SignIf you want to know whether someone understands nutrition science, ask a simple question: Which matters more—fiber or saturated fat? Influencers often say, “Fiber isn’t an essential nutrient.” Technically, that statement is true in the narrowest sense. However, context matters. Fiber supports a healthy gut microbiome. Additionally, fiber improves insulin sensitivity. Furthermore, fiber lowers cardiovascular risk. Finally, fiber supports colon health. Because fiber feeds beneficial gut bacteria, entire fields of microbiome research depend on it. Now compare that with saturated fat. Saturated fat is truly non-essential. Your body can make all it needs. No deficiency disease exists from avoiding it. Even more importantly, excess saturated fat raises LDL cholesterol and worsens artery health. Over time, that increases cardiovascular risk. So ask yourself this: Why dismiss fiber as optional while quietly promoting saturated fat? That choice reflects ideology, not biology. The Brain Doesn’t Care About TrendsHere’s another reality check. Your brain—the most important organ you own—relies heavily on polyunsaturated fats. These fats support cell membranes, nerve signaling, and blood flow. Ironically, these same fats often get labeled “seed oils” and dismissed. Meanwhile, saturated fat does not belong in high amounts in brain tissue. Worse still, saturated fat can clog the arteries that supply the brain. Biology does not respond to marketing. Physiology does not care about popularity. The “You’re On Your Own” ProblemAnother issue deserves attention. After influencers step into the spotlight and claim credit for old science, they often step away from responsibility. Then they tell the public to “figure it out.” That approach ignores reality. Many Americans live in food deserts. Even more rely on school meals. Lots of Americans work multiple jobs. Many lack time, money, or kitchens. Public health exists because willpower alone does not scale. Without system-level support, advice turns into abandonment. Agreement Does Not Equal ExpertiseRecently, debates around nutrition have highlighted this pattern clearly. Some influencers argue that because they agree with basic nutrition advice, they deserve authority over the rest of the science. Unfortunately, agreement does not grant expertise. Copying conclusions does not mean you earned them. Science rewards method, not confidence. The Bottom LineYes, eat real food. And clearly, limit added sugar. Most definitely, reduce ultra-processed foods. Doctors have said this for years. However, flipping a pyramid does not change biology. Likewise, sidelining scientists does not improve health. Finally, promoting saturated fat while dismissing fiber misleads the public. People do not fail diets. Systems fail people. When we trade evidence for influence, health suffers. A Final NoteThis article provides general education, not personal medical advice. Always talk with your healthcare professional about individual nutrition needs. At Your Doctor’s Orders, we believe data matter more than dogma, and evidence matters more than trends. Because when it comes to health, confidence without science is not bold. It’s risky.

    8 min
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Fork U(niversity) Not everything you put in your mouth is good for you. There’s a lot of medical information thrown around out there. How are you to know what information you can trust, and what’s just plain old quackery? You can’t rely on your own “google fu”. You can’t count on quality medical advice from Facebook. You need a doctor in your corner. On each episode of Your Doctor’s Orders, Dr. Terry Simpson will cut through the clutter and noise that always seems to follow the latest medical news. He has the unique perspective of a surgeon who has spent years doing molecular virology research and as a skeptic with academic credentials. He’ll help you develop the critical thinking skills so you can recognize evidence-based medicine, busting myths along the way. The most common medical myths are often disguised as seemingly harmless “food as medicine”. By offering their own brand of medicine via foods, These hucksters are trying to practice medicine without a license. And though they’ll claim “nutrition is not taught in medical schools”, it turns out that’s a myth too. In fact, there’s an entire medical subspecialty called Culinary Medicine, and Dr. Simpson is certified as a Culinary Medicine Specialist. Where today's nutritional advice is the realm of hucksters, Dr. Simpson is taking it back to the realm of science.

Information

  • Creator
    Terry Simpson
  • Years Active
    2018 - 2026
  • Episodes
    121
  • Rating
    Clean
  • Copyright
    © Copyright 2026 Terry Simpson
  • Show Website
    Fork U with Dr. Terry Simpson

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