Fork U with Dr. Terry Simpson

Terry Simpson
  • 4.8 (106)
  • 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. Menopause: Estrogen Effects Satiety

    5D AGO

    Menopause: Estrogen Effects Satiety

    Menopause, Hunger, and the Brain: Why It Feels DifferentMenopause changes more than temperature control. It reshapes how the brain handles hunger, fullness, and the quiet signals that guide eating. As a result, many women notice something unsettling. The same meals no longer satisfy. Hunger arrives sooner. Food feels louder. For years, we blamed metabolism. We told women their bodies were simply slowing down. While that explanation sounds scientific, it misses the most important part of the story. The brain has changed. A Pattern You Can’t IgnoreDuring my years performing weight loss surgery, about 80 percent of my patients were women. Over time, one pattern became impossible to overlook. When menopause or even perimenopause began, weight gain often followed. Some women had struggled with weight for years. Others had never given it much thought. Yet both groups described the same shift. They weren’t necessarily eating more. Instead, they felt hungrier, less satisfied, and more aware of food throughout the day. Meanwhile, the advice they received rarely evolved. Eat less. Move more. Try harder. However, that advice assumes the system regulating hunger still works the same way. In menopause, it doesn’t. Estrogen and the Appetite Control CenterTo understand what’s happening, we need to look at the hypothalamus. This small but powerful region of the brain regulates appetite, energy balance, and hormonal signaling. Under normal conditions, estrogen helps keep this system stable. Specifically, estrogen supports satiety signals and keeps hunger signals in check. In simple terms, it helps your brain recognize when you’ve had enough. As estrogen declines, that balance shifts. Hunger signals grow stronger. Fullness signals become less reliable. Consequently, the internal experience of eating begins to change. This shift explains why women often say, “I feel different around food,” even before their diet changes. Why Hunger Changes FirstInterestingly, appetite changes often appear before measurable increases in calorie intake. Women report thinking about food more often, feeling less satisfied after meals, and noticing hunger earlier in the day. At first glance, nothing looks different from the outside. Yet internally, the system has already shifted. Because of that, traditional advice falls short. Telling someone to eat less without addressing the change in signaling is like adjusting the thermostat while ignoring the wiring. More Than MetabolismAlthough metabolism does change with age, it does not fully explain the experience of menopause-related hunger. A slower metabolic rate might affect how calories are used, but it doesn’t explain why appetite feels louder or less controlled. Instead, the better explanation lies in the brain. The hypothalamus responds differently when estrogen levels fall. As a result, the signals that guide eating become less precise. In other words, this isn’t just about calories in and calories out. It’s about how the body decides when to eat—and when to stop. The Part We Should Have Addressed SoonerFor decades, menopause care focused on symptoms like hot flashes and bone health. Meanwhile, changes in appetite and weight were often attributed to lifestyle or willpower. Unfortunately, that approach overlooked a key fact. Estrogen plays a direct role in appetite regulation. Because of that, many women were told to push harder when their biology had already shifted. That message wasn’t just incomplete—it was unfair. Estrogen Replacement: A Broader RoleWhen clinicians discuss estrogen replacement, they often focus on symptom relief. However, estrogen also affects brain signaling related to hunger and satiety. In the right patient, hormone therapy may help restore some of that balance. It can improve how the brain responds to fullness and reduce the intensity of hunger signals. Importantly, hormone therapy does not inherently cause weight gain. That belief has persisted longer than the evidence supports. Still, therapy isn’t for everyone. Each patient requires an individualized discussion that considers risks, benefits, and goals. A New Layer: GLP-1 and Appetite ControlMore recently, GLP-1 receptor agonists have added another dimension to this conversation. These medications act on the same appetite centers in the brain, strengthening satiety and quieting hunger. Interestingly, estrogen appears to enhance the effectiveness of GLP-1 signaling. Therefore, menopause may not only reduce estrogen levels—it may also decrease the brain’s responsiveness to satiety cues. This interaction helps explain why some women experience such a dramatic shift in appetite during midlife. What Actually HelpsOnce you understand the biology, the approach changes. Rather than focusing solely on restriction, the goal becomes supporting satiety. Meals should include enough protein, fiber, and volume to sustain fullness. Additionally, sleep deserves attention, as poor sleep amplifies hunger signals. Medication reviews also matter, since some drugs can contribute to weight gain. For some women, hormone therapy or GLP-1 medications may play a role. For others, dietary structure and lifestyle adjustments provide meaningful improvement. In every case, the strategy should match the physiology. A Better Way ForwardMenopause is not a failure of discipline. It is a shift in how the brain regulates hunger. Once that shift is acknowledged, the conversation becomes more productive. Women can stop blaming themselves and start working with their biology. Ultimately, the goal isn’t to fight hunger. It’s to understand it. Final ThoughtMenopause doesn’t break the system—it changes the signal. And once you understand the signal, you can respond with clarity instead of frustration. Estrogen as a Key Regulator of Energy Homeostasis and Metabolic Health.Biomedicine & Pharmacotherapy = Biomedecine & Pharmacotherapie. 2022. Mahboobifard F, Pourgholami MH, Jorjani M, et al.

    7 min
  2. Henry VIII, the Brain, and the Obesity

    MAR 26

    Henry VIII, the Brain, and the Obesity

    The Madness of King Henry VIII—and What We Got Wrong About ObesityThe King We ForgotThere is a moment in history that most of us think we understand. King Henry VIII—large, immobile, temperamental—has become almost a caricature of excess. We picture a man who simply ate too much, moved too little, and paid the price. It is a tidy story. Unfortunately, it is also likely the wrong one. Before the 1530s, Henry was something very different. He was athletic, charismatic, and energetic. He hunted, he jousted, he played sports, and he carried himself like the Renaissance ideal—educated, capable, and physically impressive. His armor, still preserved today, tells that story clearly. Narrow waist. Broad chest. Built for motion. The Fall That Changed EverythingThen everything changes. In January of 1536, Henry was thrown from his horse during a jousting match. The horse fell on him. He was reportedly unconscious for hours. Not minutes—hours. Even by modern standards, that is a significant traumatic brain injury. Soon after, in May of that same year, Anne Boleyn was arrested and executed. She was accused not only of adultery but also of witchcraft. That detail matters. Prior to this period, Henry was not known for superstition. He was a rational thinker. Yet suddenly, accusations of witchcraft become part of the story. It is tempting to say this was political theater. It may have been. Still, the timing is difficult to ignore. Meanwhile, his body begins to change. The Story We Told OurselvesAt first, historians explained this in simple terms. He ate more. He exercised less. Calories in, calories out. That explanation sounds neat. It fits what we like to believe. Even so, the math does not hold up. To gain over 200 pounds, you need a massive and sustained excess of calories. A reduction in physical activity alone does not explain that. We measure activity in METS—metabolic equivalents—and even a dramatic drop in activity would not account for that level of weight gain. In other words, you cannot outrun the math. Yet every January, gyms fill with people who are told exactly that. Move more. Try harder. Burn it off. By February, most of those gyms are empty again. If exercise alone solved obesity, we would not still have the problem. The Organ in ChargeSo what did we miss? The answer sits deep in the brain, in a small but powerful structure called the hypothalamus. It regulates hunger, satiety, hormones, and stress. When it works, eating feels normal. You get hungry, you eat, you stop. No drama. No constant thinking. However, when the hypothalamus is disrupted—by injury, disease, or chronic metabolic stress—that quiet system becomes loud. Hunger no longer behaves like a signal. It becomes a drive. This is not theory. Modern medicine has a name for it: acquired hypothalamic obesity. After traumatic brain injury, some patients develop rapid weight gain, persistent hunger, and changes in impulse control. Studies show that nearly half of patients with significant brain injury gain weight over time. The strongest predictor is not inactivity. It is hyperphagia—an abnormal increase in appetite. In simpler terms, the problem is not how much people move. It is what their brain is telling them to do. What Patients Taught MeThat pattern feels familiar if you have ever sat with patients. I have. Years ago, working with former NFL players, we noticed something striking. The players who struggled most with weight often had long histories of concussions. Not all of them gained weight. Yet those who did described the same experience—something they had never felt before. Food noise. Not hunger. Noise. A constant suggestion that does not go away. At first, I understood that as a physician. Later, I understood it as a person. When the World Went QuietAbout twelve hours after my first injection of Zepbound, something changed. The world became quiet. For the first time, I realized how much of my thinking had been shaped by that background noise. It did not disappear dramatically. It simply stopped. Since then, I have lost fifty pounds. More interesting than the weight loss is what happens between doses. As the medication wears off, the noise returns—subtly at first. A thought here. A reminder there. Even my stress levels rise slightly, something I can see on my WHOOP device. Then, a few hours after the next injection, it quiets again. That experience changes how you see patients. It changes how you see history. Looking Back at HenryBecause now, when we look back at Henry, we are not just looking at excess. We are looking at a possible disruption of the system that regulates behavior itself. There are hints of this even in his own time. A French ambassador noted that Henry’s chronic leg pain troubled him often and that he compensated by eating and drinking more. Later reconstructions suggest large meals, heavy in meat, along with substantial alcohol intake. Those numbers are estimates, not precise measurements. Even so, the pattern is clear. Something was driving the behavior. Decline, Not IndulgenceBy the end of his life, Henry could barely move. Mechanical devices were needed to help him stand. He lost close allies, including Thomas Wolsey and Thomas More. His body deteriorated. His mood worsened. This was not simply indulgence. It was decline. What We Can Do NowToday, we have tools that speak directly to that system. GLP-1 medications do not give people discipline. They restore control. Patients do not say they are stronger. They say it is quieter. That distinction matters. Because obesity was never just about calories. It was about signaling and about biology. It was about a system that, once disrupted, can push behavior in ways that are very difficult to resist. The Real LessonSo when we look at Henry VIII, we should be careful before we judge him as a man who simply lacked restraint. We may not know exactly how much he ate. Nevertheless, we know something was driving it. And when we ignore that truth today, we do more than misunderstand the disease. We blame the patient for having it. References Argente J, Farooqi IS, Chowen JA, Kühnen P, López M, Morselli E, Gan HW, Spoudeas HA, Wabitsch M, Tena-Sempere M. Hypothalamic obesity: from basic mechanisms to clinical perspectives. Lancet Diabetes Endocrinol. 2025 Jan;13(1):57-68. doi: 10.1016/S2213-8587(24)00283-3. Epub 2024 Nov 12. Erratum in: Lancet Diabetes Endocrinol. 2025 Jan;13(1):e1. doi: 10.1016/S2213-8587(24)00368-1. PMID: 39547253.

    12 min
  3. The Carnivore Priesthood

    MAR 19

    The Carnivore Priesthood

    When Beef Becomes Belief: The Carnivore PriesthoodNutrition debates rarely begin with money. Yet money almost always explains how they spread. That fact explains much of the modern carnivore movement. At first glance, the carnivore diet appears to be a radical nutritional idea: eat beef, organs, and animal fat while avoiding vegetables, grains, legumes, and most fruits. Advocates often present the idea as a return to ancestral eating. According to the story, prehistoric humans thrived on meat, and modern illness appeared only after plants and processed foods entered the menu. However, once you look past the rhetoric, another pattern appears. The carnivore movement did not grow out of decades of clinical research. Instead, it grew out of a very modern ecosystem: social media, podcasts, influencer culture, and supplement companies. And once that ecosystem forms, the incentives become clear. First, someone declares that conventional nutrition science has misled the public. Next, they present a dramatically simple solution. Afterward, they build a community around that solution. Eventually, products appear—supplements, coaching programs, special meat boxes, laboratory panels, and branded lifestyle advice. In other words, the diet becomes the marketing engine. And beef becomes the sacrament. Why Simplicity SellsExtreme diets succeed for a reason. Complexity frustrates people, while simplicity reassures them. “Eat a balanced diet rich in vegetables, whole grains, legumes, fish, and moderate meat” may represent excellent advice supported by decades of research. Unfortunately, that advice does not travel well on social media. By contrast, statements such as “plants are poison” or “fiber is unnecessary” spread rapidly. Bold claims generate engagement. Engagement produces followers. Followers create revenue streams. Consequently, the carnivore diet does not function only as a nutritional recommendation. It functions as a brand. Once someone builds that brand, they must defend it. The Prophets: The Case of the Liver KingEvery belief system eventually develops its prophets, and the carnivore world found one in a man who called himself Liver King. He appeared online with an enormous beard, an even larger physique, and a simple message: modern men had grown weak because they had abandoned the practices of their prehistoric ancestors. According to his message, people should eat raw organs, train like cavemen, reject modern foods, and adopt “ancestral living.” Conveniently, the ancestral lifestyle also included supplements he sold through his company. The marketing proved effective. The image of a muscular barbarian rejecting modern science attracted millions of followers and produced a supplement business worth tens of millions of dollars. Unfortunately, the story collapsed in 2022 when leaked emails revealed the Liver King spent more than $10,000 per month on anabolic steroids and other performance-enhancing drugs. Shortly afterward, he admitted publicly what physicians suspected from the beginning. Raw liver did not build that physique. Pharmacology did. Nevertheless, the episode illustrates the economic logic of the carnivore movement. First comes the doctrine. Then comes the identity. Finally, come the products. The Theologians: Paul SaladinoMovements rarely survive on prophets alone. They also require theologians—people who explain the doctrine with intellectual confidence. Within the carnivore community, one of the most prominent interpreters has been Paul Saladino, a physician originally trained in psychiatry who later rebranded himself as Carnivore MD. For several years, his message remained uncompromising. Plants contained toxins. Vegetables acted as chemical weapons. Humans thrived best on meat, organs, and animal fat. His book The Carnivore Code argued that modern civilization misunderstood nutrition and that health required a return to meat-centered eating. However, the human body eventually entered the conversation. After spending years on a strict carnivore diet, Saladino described several physiological problems: poor sleep, heart palpitations, muscle cramps, and hormonal changes. Consequently, the diet evolved. Fruit appeared. Honey appeared. Raw dairy appeared. Today, the diet carries a new label—an “animal-based diet.” In practice, that means meat accompanied by carbohydrates from fruit and honey. In other words, the diet rediscovered sugar. This pattern appears frequently in nutrition movements. Early stages emphasize purity and certainty. Later stages quietly reintroduce flexibility when biology refuses to cooperate. Also, Paul is partners with Liver King. The Economic EngineThe economic component remains impossible to ignore. Carnivore influencers rarely restrict themselves to books and podcasts. Instead, they build supplement companies that sell freeze-dried organs, nutrient capsules, and other “ancestral” products. The marketing narrative follows a familiar path. Modern food supposedly lacks essential nutrients. Ancient diets supposedly provided them. Supplements conveniently deliver them. When followers adopt the diet, they often purchase the products associated with it. Over time, they invest not only money, but identity in the movement. As a result, they defend the doctrine aggressively, particularly when new treatments threaten the narrative. The GLP-1 ConflictThis dynamic explains the hostility many carnivore influencers display toward GLP-1 medications, such as semaglutide and tirzepatide. GLP-1 drugs reduce appetite, improve metabolic health, and produce significant weight loss in clinical trials. For many patients, they represent the most effective medical treatment for obesity ever developed. However, GLP-1 therapy undermines the core promise of the carnivore movement. Influencers claim that diet alone solves metabolic disease. Pharmaceutical treatments challenge that claim. Moreover, if people lose weight and improve their health through medical therapy, they may no longer feel compelled to purchase expensive supplements or coaching programs. Consequently, the drugs become ideological enemies. Carnivore influencers often portray GLP-1 medications as dangerous, unnatural, or morally suspect. Their followers repeat these arguments across social media platforms, especially on X (formerly Twitter), where the debate frequently resembles a religious dispute, not a scientific discussion. Within this worldview, GLP-1 therapy resembles a rival faith. And rival faiths provoke rebellion. The Cave Painting ArgumentCarnivore advocates occasionally invoke another argument that sounds persuasive until examined closely. If humans historically consumed vegetables, they ask, why do cave paintings rarely depict them? The answer lies in the purpose of cave art. Prehistoric artists painted dramatic events—hunts, animals, danger, survival. These images celebrated moments that mattered in a world where food sometimes fought back. Nobody returned from hunting mammoths and announced, “Let us commemorate this carrot.” Cave art told stories. It did not document grocery lists. Moreover, the absence of broccoli in cave paintings has an obvious explanation. Broccoli did not exist during the Paleolithic era. Mediterranean farmers cultivated it from wild brassica plants thousands of years later, likely beginning with the Etruscans. Using cave paintings to prove humans were carnivores resembles using medieval paintings to argue that humans never drank coffee. Humans Have Always Been OmnivoresAnthropology provides a far more realistic picture. Scientists studying ancient bones, tools, and coprolites—preserved human feces—consistently find evidence of diverse diets that included roots, tubers, fruits, seeds, fish, and meat. Geography shaped these diets. Arctic populations consumed more animal foods, while equatorial societies relied heavily on plants. However, no civilization in human history survived entirely on beef. Flexibility—not purity—allowed our species to thrive. The Culinary ProblemCarnivore advocates rarely discuss another drawback of the diet. It is monotonous. Human cuisine represents one of the great achievements of civilization. Across cultures, people combine vegetables, grains, spices, and animal foods into extraordinary traditions that reflect geography and history. Reducing that diversity to an endless rotation of ribeye steaks diminishes both nutrition and culture. Beef remains delicious. I enjoy it myself. Growing up on a small island in Alaska, I rarely saw beef because it cost too much to ship. Consequently, it felt special when it appeared at the table. Yet eating beef every day does not create cuisine. It creates repetition. Is the Carnivore Diet Safe?Many readers ask a simple question: Is the carnivore diet safe? Short-term, some people lose weight on a carnivore diet because they eliminate ultra-processed foods and increase protein intake. However, long-term health outcomes remain far less reassuring. Diets that exclude vegetables, legumes, fruits, and whole grains remove important sources of fiber, phytonutrients, and micronutrients that support gut health, metabolic regulation, and cardiovascular protection. Large population studies consistently associate dietary patterns rich in plant foods—such as the...

    12 min
  4. Minnesota Starvation Experiment: Food Noise, Science

    MAR 5

    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
  5. 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
  6. 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
  7. 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
  8. 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
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About

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
    124
  • Rating
    Clean
  • Copyright
    © Copyright 2026 Terry Simpson
  • Show Website
    Fork U with Dr. Terry Simpson

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