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A patient sent a message through the portal. Attached was a PDF — several pages, color-coded, meticulously laid out — of data from his Oura ring. His deep sleep had been down for two weeks. He was tired. He snored, which his wife had been mentioning for years. He hadn’t thought much of any of it, separately. But the ring made it feel like a pattern. Like something worth bringing up.

He got a home sleep test. His apnea-hypopnea index came back at 16. He started CPAP. His sleep scores improved.

That’s one version of this story.

Here’s another. A patient called about ten days into a respiratory illness. She was still congested, still coughing, still blowing her nose. She was worried she’d developed a sinus infection. The reason she called? Her Oura ring, which had been quiet for several days, was now flagging “mild signs of stress” again — after starting the illness with “major signs of stress,” then settling down, then spiking again. The ring felt like confirmation that something was off.

Classic post-viral sinusitis symptoms, it turned out. She recovered without antibiotics.

Two patients. Same device. One case where the data nudged someone toward a real diagnosis they’d been avoiding. One case where the data may have prompted an unnecessary call about symptoms that didn’t require intervention.

This is the honest complexity behind a question a lot of people are asking right now: can a watch or a ring actually help us optimize our health?

The Claim

The pitch for consumer wearables — Oura Ring, Apple Watch, Fitbit, Garmin, and their many competitors — goes something like this: if you have enough data about your own body, you can use that data to make smarter decisions about your health. You can optimize your sleep, your activity, your recovery. You can catch something early, before it becomes a problem. The data doesn’t lie. And if you aren’t tracking, you might be missing something.

The marketing also carries a cultural implication: that traditional healthcare is reactive — waiting until you’re sick to do anything — while wearables represent a more personalized, proactive, precision approach. Continuous monitoring. Real-time feedback. A gold star at the end of the day if you closed your rings.

Why It’s Going Viral

The appeal makes sense on multiple levels.

There’s the very real cultural obsession with optimization right now. Wellness content is among the highest-performing content on every major platform. The idea that you could be doing more, tracking more, understanding your body more deeply — that’s in the water right now.

There’s also FOMO. Someone gets a device and starts sharing what it’s telling them about themselves, and suddenly you wonder: what might mine tell me? What am I missing?

And underneath both of those is something more serious — the fear of an unexpected health event. We all see the GoFundMe. The person who was seemingly fine. The diagnosis that came out of nowhere. If data could have caught it earlier, shouldn’t we have the data?

There’s also something worth naming that goes a little deeper: many of us have become genuinely disconnected from our own physical experience. So much of life is digital, virtual, mediated through screens. We’re flooded with notifications and input. We’ve been trained — by hustle culture, by demanding employers, by a healthcare system that requires documentation before you’re allowed to be sick — to push through, dismiss our symptoms, and not trust what our bodies are telling us. In that context, a wearable that delivers objective data about your own body can feel like permission. It can feel like proof. My ring says I’m stressed, so I’m allowed to acknowledge that I’m stressed.

That’s not silly. That’s a symptom of something bigger. And it helps explain why these devices have taken hold the way they have.

What the Science Shows

Step counting and activity tracking

This is the most basic use case, and the one with the most straightforward evidence.

Is it accurate? A comparison study of consumer wearables against a research-grade actigraph found that Apple Watch and Oura Ring were both within 10% of the gold standard for step counting, while Fitbit overestimated by about 18%. Moderate-to-vigorous activity measurement was more variable. Calorie burn estimates — the number that tells you how many calories you burned — showed the largest discrepancies, with Fitbit overestimating by over 139%. So: step count, reasonably accurate.

Does it matter? According to a large JACC review of consumer wearables in cardiovascular medicine, yes — there’s actually evidence that step counting helps people with cardiometabolic conditions (diabetes, cardiovascular disease, obesity) increase their physical activity and improve key health metrics over time. The accountability function is real.

Atrial fibrillation detection

Is it accurate? The Apple Heart Study enrolled over 400,000 participants to evaluate the Apple Watch’s irregular pulse notification algorithm. When participants received a notification, about 34% were confirmed to have atrial fibrillation on follow-up ECG patch. The positive predictive value was 0.84 — meaning when it flagged something, it was right about 84% of the time. That’s a reasonably strong signal.

Does it matter? Importantly, it doesn’t tell us how often the watch misses cases, because no follow-up was done on the unnotified participants. Another notable finding: 57% of notified participants contacted a healthcare provider outside of the study. That’s a lot of people entering the healthcare system because of a wrist notification — some of whom needed to, and some of whom may not have.

Heart rate variability

Is it accurate? This is one of the most commonly asked-about metrics — and one of the most confusing. HRV is a measure of how much variation exists between heartbeats, used as a proxy for autonomic nervous system health and recovery from stress. Higher HRV generally indicates better cardiovascular fitness, lower stress, and better sleep. Lower HRV is associated with illness, poor recovery, chronic stress, aging, and being female (for reasons that aren’t fully understood).

Does it matter? Consumer wearables have mean absolute percentage errors of 29–31% compared to ECG-based measurement, and they’re least accurate when you’re moving. More fundamentally, there are no validated clinical norms for HRV. There’s no number you “should” have. What has potential value is your own trend over time — a sustained drop for you, relative to your baseline, may indicate something worth paying attention to. But the absolute number is not clinically interpretable, and there’s no “good” or “bad” HRV score to compare yourself against.

Sleep tracking

Is it accurate? A study comparing the Oura Ring Gen 3, Fitbit Sense 2, and Apple Watch Series 8 against polysomnography — the gold-standard sleep study — found that all three devices were reasonably accurate at distinguishing sleep from wakefulness (sensitivity over 95%), and similar to the gold standard in estimating total sleep duration. The Oura Ring performed best at estimating sleep stages. The Fitbit and Apple Watch showed more variability — the Apple Watch underestimated deep sleep by 43 minutes.

Does it matter? One clinically relevant development: a Samsung smartwatch feature received FDA authorization in 2023 to detect signs of moderate-to-severe sleep apnea. Sensitivity was 82.7% and specificity 91% — not bad for a screening tool. It’s not a diagnosis, can’t replace a polysomnography, and only flags moderate to severe cases. But it’s the first consumer wearable feature with FDA authorization for this purpose.

Who’s actually using these devices — and who benefits most

This is a critical piece of context from the same JACC review: only about 30% of US adults use wearable devices, and adoption is concentrated among younger, wealthier, more educated, and already-healthier individuals who are already exercising regularly. In other words, the people most likely to benefit — those with cardiometabolic risk, those who are sedentary — are the least likely to be wearing these devices. And importantly, the evidence suggests that wearable interventions are significantly more effective when paired with face-to-face clinical conversations rather than used in isolation.

Clinical Nuance

None of this means wearables are useless, or that the patients using them are being naive. It means the picture is genuinely complicated.

There are clinical situations where these devices have real value. A patient who’s been snoring for years and keeps dismissing their spouse’s concerns might finally get a sleep study because their ring flagged something. A patient at risk for atrial fibrillation might catch an asymptomatic episode earlier than they would have otherwise. A patient with diabetes who’s been sedentary might find that step-count tracking gives them the accountability nudge they needed. These aren’t trivial benefits.

But there are also real risks. The psychological burden of constant data can be significant — and it’s underrecognized. For patients with anxiety, OCD, eating disorders, or perfectionistic tendencies, wearables can become a source of distress rather than reassurance. The compulsion to close every ring, even when sick. The spiral that begins when a metric drops. The notification that arrives at 11pm telling you your HRV is low. These are not benign side effects.

There’s also the cascade effect. False positive notifications don’t just cause anxiety — they trigger healthcare contact. And primary care providers are already working in a system that estimates it would take 26.7 hours per day for a single physician to provide all recommended adult preventive care for a panel of 2,500 patients. Every portal message with a screenshot of wearable data is one more thing that needs a response — sometimes warranted, sometimes not.

Finally, there’s the question of false reassurance. A person who can’t access or afford traditional healthcare, who uses a wearable as a substitute for evidence-based screening, may feel like they’re covered when they’re not. These devices don’t check your blood pressure in a clinically meaningful way. They don’t screen for diabetes or thyroid disease. A “clean” Oura ring readout does not replace a screening mammogram or colonoscopy.

The most useful framework may be: these devices can be a bridge — to motivation, to a conversation, to taking something seriously that was previously being dismissed. They are not a destination.

The Antidote

For Patients

(Things you can remind yourself when your wearable is making you anxious, confused, or compulsive)

• I am allowed to trust how I feel without needing a device to confirm it.

• A low HRV score or a rough sleep readout is not a diagnosis. It’s one data point.

• The goal of tracking is to support my wellbeing — not to add another thing to optimize or feel bad about.

• If this device is adding to my anxiety rather than reducing it, I’m allowed to take it off.

• The best version of caring for my health includes actual conversations with my doctor — not a substitute for them.

• I can bring my wearable data to my appointment and talk through what it does and doesn’t mean.

• More information is not always the same as better information.

For Clinicians

(Language you can borrow, tweak, or make your own)

• “What about this device has been most helpful for you? Has it shown you anything that caused you stress or confusion?”

• “Heart rate variability doesn’t have a clinical normal range — what matters more is your own trend over time, not comparing it to a number online.”

• “This is one piece of information. It doesn’t replace the conversation we’re having about how you’re actually feeling.”

• “For some of my patients, trackers are a really useful nudge toward activity or sleep habits. For others, they become a source of anxiety. I want to make sure it’s doing the first thing for you, not the second.”

• “If your watch flags an irregular rhythm, that’s worth bringing to me — but it doesn’t mean something dangerous is happening. Let’s talk about what follow-up actually makes sense.”

• “Wearable data can be a great conversation starter. It can’t replace the actual evaluation.”

Sources and Further Reading

• Miwa T, Mii K, Chatani R, Sugitani Y. Comparison of consumer-grade wearable devices with a research-grade instrument for measuring physical activity in a free-living setting. PLoS One. 2026 Feb 23;21(2):e0342543. doi: 10.1371/journal.pone.0342543. PMID: 41729926; PMCID: PMC12928483.

• Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation (Apple Heart Study). NEJM. 2019.

• Petek BJ, Al-Alusi MA, Moulson N, Grant AJ, Besson C, Guseh JS, Wasfy MM, Gremeaux V, Churchill TW, Baggish AL. Consumer Wearable Health and Fitness Technology in Cardiovascular Medicine: JACC State-of-the-Art Review. J Am Coll Cardiol. 2023 Jul 18;82(3):245-264. doi: 10.1016/j.jacc.2023.04.054. PMID: 37438010; PMCID: PMC10662962.

• Promises and Perils of Consumer Mobile Technologies in Cardiovascular Care: JACC Scientific Statement. 2024.

• Robbins R, Weaver MD, Sullivan JP, Quan SF, Gilmore K, Shaw S, Benz A, Qadri S, Barger LK, Czeisler CA, Duffy JF. Accuracy of Three Commercial Wearable Devices for Sleep Tracking in Healthy Adults. Sensors (Basel). 2024 Oct 10;24(20):6532. doi: 10.3390/s24206532. PMID: 39460013; PMCID: PMC11511193.

• FDA De Novo Classification Request for Samsung Sleep Apnea Feature. 2023.

• Hodkinson A, Kontopantelis E, Zghebi SS, Grigoroglou C, McMillan B, Marwijk HV, Bower P, Tsimpida D, Emery CF, Burge MR, Esmiol H, Cupples ME, Tully MA, Dasgupta K, Daskalopoulou SS, Cooke AB, Fayehun AF, Houle J, Poirier P, Yates T, Henson J, Anderson DR, Grey EB, Panagioti M. Association Between Patient Factors and the Effectiveness of Wearable Trackers at Increasing the Number of Steps per Day Among Adults With Cardiometabolic Conditions: Meta-analysis of Individual Patient Data From Randomized Controlled Trials. J Med Internet Res. 2022 Aug 30;24(8):e36337. doi: 10.2196/36337. PMID: 36040779; PMCID: PMC9472038.

• Porter J, Boyd C, Skandari MR, Laiteerapong N. Revisiting the Time Needed to Provide Adult Primary Care. J Gen Intern Med. 2023 Jan;38(1):147-155. doi: 10.1007/s11606-022-07707-x. Epub 2022 Jul 1. PMID: 35776372; PMCID: PMC9848034.

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A patient came in recently having already ordered a multi-cancer blood test through another clinician. She brought in the result — clean, unambiguous, two words: cancer signal not detected.

She was relieved. And honestly, the simplicity of it was understandably appealing. No prep, no procedures, no waiting rooms, no ambiguous imaging findings with follow-up recommended in six months. Just a blood draw, a clear answer, and a sense that something had been done.

This is the promise of multi-cancer early detection blood tests, or MCEDs — a category that includes products like Galleri ($949) and CancerGuard ($689), and one that is expanding fast. You may have seen them advertised online, heard about them from a friend, or been asked about them by a patient who found an urgent care clinic with a sign in the window that just says: “Blood test for 50 cancers. Get it done today.”

Underneath that marketing is a genuinely compelling scientific idea, and underneath that idea are some numbers that deserve a real conversation. So let’s have it.

The Claim

If you spend time on social media — or drive past certain urgent care clinics — you’ve probably encountered this pitch: a single blood draw can now screen for 50 or more cancers simultaneously. These multi-cancer early detection tests promise to find tumors before they cause symptoms, at the stages when they’re most treatable, including cancers for which no standard screening currently exists. The marketing language is evocative. CancerGuard’s website declares: “Your cells have a story. We’re listening.” Results, they promise, will be “negative or positive. That’s it.” No jargon. Just clarity.

The appeal is obvious, especially for anyone who has sat through an indeterminate mammogram result or tried to make sense of what “we’d like to take another look” actually means. The idea that one clean yes-or-no answer could replace all of that is deeply, emotionally attractive.

And these tests are not fringe technology. They are actively being studied by major health systems. One of them is currently the subject of the first randomized controlled trial of its kind, funded by the NHS. They are real. They are scientifically grounded. And they are not ready to be used the way they are being marketed.

Why It’s Going Viral

The pandemic changed how a lot of people relate to their health. There was a heightened awareness of mortality that didn’t fully go away when the acute crisis did. And in the years since, social media feeds have been full of stories about young, seemingly healthy people receiving devastating cancer diagnoses. Celebrities. Friends of friends. The colleague who ran marathons. These stories aren’t wrong to share, but they’re not representative, and they do something particular to our sense of risk: they make the statistically unlikely feel close and personal and inevitable.

At the same time, there’s a growing cultural narrative — one that has real traction for real reasons — that what you receive through the traditional healthcare system is barely the minimum. That standard screenings are a starting point, not a finish line. That proactive people do more. For patients who have felt dismissed, rushed, or under-served, this narrative lands hard. And for anyone who has watched a loved one diagnosed late with a cancer that might have been caught earlier, it is impossible to dismiss.

The companies building these products understand this. “Is CancerGuard right for you?” their website asks, and then lists: “You are proactive about your health. You have a family history of cancer. You have increased risk factors such as smoking, alcohol use, or obesity.” That is not a list of specific criteria. That is a description of most adults who are paying attention to their health at all.

And the contrast with standard cancer screening is striking. A colonoscopy requires a day off work, a prep that no one enjoys, a procedure where you are mildly sedated while someone inserts a camera into your colon, and then a wait for results that are often not perfectly clear. A blood draw takes ten minutes. The emotional math is not hard to do.

What the Science Shows

The science behind these tests is real and interesting. All cells — including tumor cells — shed fragments of their DNA into the bloodstream as they turn over. These fragments are called cell-free DNA, and when they come from a tumor, they’re called circulating tumor DNA. What MCED tests do is look at the methylation patterns on that cell-free DNA — epigenetic modifications that serve as a kind of fingerprint for where the DNA originated and whether it came from a cancer cell. AI models trained on thousands of these patterns can then flag abnormal signals and estimate which tissue or organ the signal may have come from. It is genuinely sophisticated technology.

But here is where the numbers get complicated.

The largest validation study on Galleri, published in Annals of Oncology, enrolled over 5,000 participants with known cancers and without. The overall sensitivity — meaning the test’s ability to correctly identify true cancer cases — was 51.5%. That sounds reasonable until you look at where that number comes from. For stage I cancers (the early ones these tests are most hoping to catch), sensitivity dropped to 16.8%. For stage IV cancers (metastatic, often already clinically apparent), sensitivity was 90.1%. In other words: this test is best at finding the cancers that are already the hardest to miss, and least good at finding the ones it claims to catch.

Specificity was high at 99.5%, suggesting a false positive rate of only 0.5%. But here is where a critical statistical nuance applies. Because cancer is relatively rare in the general population, even a high specificity does not protect against a meaningful number of false positives in absolute terms. The positive predictive value — the probability that a “cancer signal detected” result actually reflects a true cancer — was 44.4%. That means that in the validation population, more than half of people who received a positive result did not have cancer.

The PATHFINDER study, published in The Lancet in 2023, looked at over 6,000 adults 50 and older across seven U.S. health systems. Cancer signal was detected in 1.4% of participants. Of those, only 38% were ultimately diagnosed with a cancer within the 12-month follow-up period. The other 62% had no cancer diagnosis, but what they did have was an average of 79 days of diagnostic workup: labs, imaging, and in 49% of cases, at least one procedure. One patient underwent an inguinal orchiectomy — testicle removal — based on findings that turned out not to be cancer. During the 12-month study period, 122 cancers were diagnosed in the full cohort. Only 35 of those were detected by the MCED test. The rest were found through standard screening, incidental findings, or clinical symptoms.

There is also an NHS-funded randomized controlled trial underway — the first RCT on an MCED test, with 142,000 participants tested annually for three years. Preliminary data, shared in a brief PDF circulated by the company, shows a favorable trend toward fewer late-stage diagnoses but no statistically significant reduction in the combined rate of stage III and IV cancers. The primary endpoint has not been met. No published data yet demonstrates that performing this screening in any population reduces the risk of death from cancer.

Clinical Nuance

None of this means these tests are a scam. The technology is real, the studies are ongoing, and the landscape is evolving rapidly. What the data shows today may look different in 2027 or 2030. We are at an early and genuinely uncertain moment.

But here is what we want patients to understand: this test cannot replace standard cancer screening. The Galleri website says so clearly in its own fine print. A breast cancer sensitivity of 30.5% does not supplement a mammogram’s 70-90% sensitivity — it does not come close. A normal result does not clear you. A positive result does not diagnose you. And the workup that follows a positive result can be extensive, expensive, emotionally taxing, and in some cases, physically risky.

When someone brings this up in a clinical conversation, it is worth slowing down to ask what is really driving the question. Sometimes it is health anxiety. Sometimes it is a family history that hasn’t been fully explored — and that might qualify the patient for genetic testing that could actually change their management. Sometimes it is a sense that they haven’t been getting enough from the healthcare system, which may or may not be true, but is worth exploring. Sometimes patients who are overdue on a colonoscopy or a mammogram are asking about this instead, and that shift in attention deserves a gentle redirect.

There are specific clinical scenarios where this type of testing becomes a more reasonable part of the conversation: a patient with a strong family history, negative genetic testing, elevated pretest probability for a specific cancer, or a situation where conventional workup would involve meaningful procedural risk. In those cases, shared decision-making might include this as one option. But for the general population, the American Cancer Society’s guidance is right: this should involve explicit informed consent about high specificity but limited early-stage sensitivity, the potential for false positives requiring extensive workup, the absence of mortality data, and the out-of-pocket cost.

And if someone brings it up and ultimately decides to move forward after a full conversation, that is a reasonable outcome. People have the right to spend their money on optional tests. What they deserve is an honest account of what those tests can and cannot do.

The Antidote

For Patients

(Gentle reminders and affirmations)

• Wanting to know if I have cancer is not irrational. It is human.

• The fear I feel when I hear about young, healthy people getting cancer diagnoses makes sense. Those stories are real — and they are not representative of what is most likely to happen to me.

• A blood test that screens for cancer is not the same as a blood test that rules out cancer.

• If this test says “cancer signal detected,” that does not mean I have cancer. It means more investigation is needed.

• If this test says “cancer signal not detected,” that does not mean I am free of cancer. It has significant limitations in detecting early-stage disease.

• This test does not replace my mammogram, my colonoscopy, my Pap smear, or other recommended screenings.

• I deserve a real conversation about what this test can and cannot do — not just a confident-looking result.

• There may already be screenings or genetic testing I qualify for that I haven’t explored yet. That conversation is worth having with my doctor.

For Clinicians

(Language you can borrow, tweak, or make your own)

• “I’m really glad you brought this up. These tests are real technology — not fringe — and they’re actively being studied. Let’s talk about what the data shows.”

• “The sensitivity for early-stage cancers — which is what we’re most hoping to catch — is about 17% for stage I disease. That’s meaningfully lower than standard screening tools for many cancer types.”

• “If this test comes back positive, it doesn’t diagnose you with cancer. It triggers a workup. In studies, more than half of positive results didn’t end up being cancer. But that workup — labs, imaging, sometimes procedures — takes time, money, and often comes with real anxiety.”

• “This is a test you can add on top of your standard screening, but it cannot replace it.”

• “Before we talk about this, I want to make sure we’ve covered everything you already qualify for — are you up to date on your colonoscopy and mammogram? And based on your family history, I want to ask about whether you might qualify for genetic testing.”

• “I’m not opposed to this if you’ve thought it through and understand the limitations. What I want for you is a decision you’ve made with full information.”

Sources and Further Reading

• Blood-based tests for multicancer early detection (PATHFINDER): a prospective cohort study. The Lancet. 2023.

• Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. Annals of Oncology. 2021.

• Sensitive and specific multi-cancer detection and localization using methylation signatures in cell-free DNA. Annals of Oncology. 2020.

• Multicancer early detection testing: Guidance for primary care discussions with patients. 2024.

• American Cancer Society: Multi-Cancer Early Detection Tests — patient resource.

• NHS-Galleri trial: Talking points for healthcare providers (preliminary data PDF).

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She came in carrying a printed list of questions. She had PCOS, prediabetes, high cholesterol. She’d struggled with her weight since puberty, developed an eating disorder in middle school, and had spent years seeing doctors who told her, in one form or another, to lose weight. The most recent one had said it within the first five minutes of meeting her — before any labs were reviewed, before her history was taken — and had recommended a GLP-1.

She wasn’t sure she wanted it. She’d seen it all over social media — the before-and-afters and the warnings. She’d seen celebrities who suddenly looked completely different, and she’d seen people online saying that GLP-1s were destroying people’s relationships with food. She didn’t know who to believe.

This is a story we hear almost every week, in some variation. And it’s the story that made us want to do this episode.

Because GLP-1 medications are genuinely, legitimately revolutionary — and also genuinely complicated in ways that the current conversation doesn’t always make room for.

The Claim

If you’ve spent any time on social media in the last few years, you’ve encountered at least one of these narratives. GLP-1s are a miracle drug that will end obesity and metabolic disease as we know it. Or: GLP-1s are dangerous and full of scary side effects that your doctor isn’t telling you about. Or: people who use them are lazy, cheating, and setting themselves up for lifelong dependence on a pharmaceutical company. Or: GLP-1s are deepening fat phobia and will cause a wave of eating disorders. Or, maybe most cynically: doctors who prescribe them are bought by Big Pharma.

None of these framings is quite right. And most of them leave out the thing that actually matters: context.

Why It’s Going Viral

These drugs came of age during a very particular cultural moment. Semaglutide (Wegovy) was approved in 2021 — peak COVID, peak social media usage, peak collective health anxiety. At the same time, direct-to-consumer drug marketing was evolving rapidly from generic TV commercials into influencer marketing, where real people who had used these medications were being paid to talk about their results to audiences who trusted and felt connected to them. That’s a fundamentally different kind of persuasion.

Then came the celebrity photographs. People who had publicly struggled with their weight for years suddenly looked dramatically different. And a medication that had been quietly used for diabetes management became a cultural phenomenon almost overnight.

The result was enormous demand, significant drug shortages, a boom in compounding pharmacies, asynchronous telehealth platforms offering prescriptions without any real clinical relationship, and a lot of very strong opinions being formed on very incomplete information.

Meanwhile, for people who have spent years feeling dismissed by a healthcare system that told them to simply eat less and move more — or who have metabolic conditions that diet and exercise alone couldn’t adequately address — the appeal of an effective medication is not irrational. It’s completely understandable. And that’s exactly why this conversation matters.

What the Science Shows

Let’s start with what these medications actually are. GLP-1 stands for glucagon-like peptide-1, and GLP-1 receptor agonists have been around since 2005 — long before Wegovy became a household name. They work by slowing gastric emptying, reducing glucose levels by increasing insulin and decreasing glucagon, and acting on brain regions associated with appetite and reward. Some newer formulations, like tirzepatide (Mounjaro/Zepbound), also target a second receptor called GIP, giving them dual action.

The benefits, for the right patients, are real and well-documented.

For people with type 2 diabetes, these medications have been genuinely transformative — offering improvements in blood sugar control that were not possible with older drugs. For high-risk patients with existing cardiovascular disease or diabetes, a meta-analysis of nearly 100,000 patients found significant reductions in all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events. There are also documented benefits for chronic kidney disease in people with diabetes, and for metabolic-associated fatty liver disease (previously called non-alcoholic fatty liver disease). A 2025 meta-analysis of 25 randomized controlled trials found meaningful improvements in liver inflammation and liver fat, with tirzepatide showing particularly robust effects.

Weight loss, in large trials, ranges from about 6% with some formulations to nearly 18–25% with newer agents. But weight loss as a standalone “benefit” warrants careful framing. The critical caveat is sustainability. A 2025 study from Vanderbilt University found that weight cycling — the lose-regain-lose pattern that many patients experience — was associated with a nearly 30% increased risk for conditions like sleep apnea, fatty liver disease, and type 2 diabetes, and a more than 50% increased risk of heart failure, compared to weight stability at any body size. This means the question isn’t just whether a medication causes weight loss. It’s whether that weight loss can be sustained — and what happens if it isn’t.

The risks are also real. GI side effects (nausea, diarrhea, constipation, vomiting) are the most common and are usually dose-dependent and time-limited, though not trivial. Gallbladder events, including gallstones, are increased by about 26%. Loss of lean muscle mass and bone density are meaningful concerns, particularly at higher doses — though research suggests exercise can significantly mitigate both. The thyroid cancer signal, which carries a black-box warning, appears primarily relevant to people with specific rare genetic conditions (MEN2), and the biological plausibility for risk in humans is generally considered low. A 2024 study found that GLP-1 use was actually associated with reduced overall cancer incidence across most obesity-associated cancer types, though a possible signal for kidney cancer warrants further study.

The mental health picture is more nuanced. Initial pharmacovigilance data raised concerns about depression and suicidality, but subsequent meta-analyses did not show a statistically significant direct drug effect — pointing instead to the underlying psychiatric burden in populations who are already navigating weight stigma, weight cycling, and inadequate care. However, signals for eating disorder-related adverse events with all three major GLP-1 medications have not been similarly resolved. This is particularly important given that many people who might be candidates for these medications have a history of disordered eating, whether recognized or not.

Clinical Nuance

The biggest clinical risk in the current moment is extrapolation: applying the findings of a cardiovascular outcomes trial in people with existing heart disease to someone who is otherwise metabolically healthy but wants to lose weight. The populations are not the same, and the risk-benefit calculation is not the same.

Thoughtful prescribing means starting with the question: what are we actually treating? If there is a diagnosable metabolic condition — diabetes, fatty liver disease, sleep apnea, cardiovascular disease — the data is more straightforward. If the primary indication is weight loss in an otherwise healthy person just because of their BMI (a metric known to be flawed and not designed to be used to define an individual person’s health), the conversation needs to be much more careful and individualized, including a frank discussion of what stopping the medication might mean long-term.

It also means screening for disordered eating before prescribing. Most primary care providers have never received formal training in eating disorder screening, and the rates of disordered eating in this population are high. Brief, validated tools like the SCOFF or the Eating Disorder Screen for Primary Care (ESP) can be administered quickly in clinical practice. What you find should shape whether, how, and at what dose you proceed.

There is also a real concern about access and equity. These medications are expensive — $149–499 per month out of pocket, and increasingly being dropped from insurance coverage. When patients can’t sustain access, they stop. And stopping, without a plan, is a clinical event. Compounded formulations present additional safety concerns: variable sourcing, inadequate regulation, salt forms that are not pharmacologically identical to the approved drugs, and, in some cases, outright fraud. The FDA has documented counterfeit compounded products listing pharmacies that don’t exist. This is the environment in which many patients are obtaining these medications.

Finally, it is worth sitting with the societal dimension of this moment. These medications have, in some corners of the internet, been framed as eliminating any excuse for a larger body size. That framing is harmful. It amplifies weight stigma. It ignores the complexity of why people’s bodies are the sizes they are. And it can make already-vulnerable patients feel that their choices about their own bodies are being made for them by cultural pressure rather than genuine clinical partnership.

The Antidote

For Patients

(Gentle reminders and affirmations)

• Wanting an effective treatment for a metabolic health condition is not weakness. It is reasonable.

• Using a medication does not mean you failed at lifestyle change. It means you have a condition that may benefit from medical treatment.

• You deserve a full conversation about what this medication can do, what it cannot do, and what the plan is if circumstances change.

• You also deserve to be asked about your relationship with food before anyone prescribes you something that changes appetite and reward pathways.

• Feeling uncertain or conflicted about this is appropriate. This is genuinely complicated, and you are allowed to take your time.

• Weight stigma is real, and its effects on your health and your care are also real. You deserve a clinician who sees that.

For Clinicians

(Language you can borrow, tweak, or make your own)

• “I want to make sure we talk about what this medication can and can’t do — and what it would mean to be on it long-term.”

• “Before we go further, I’d love to ask a few questions about your history with food and eating. Not to judge anything, but because it actually changes how I think about the right approach for you.”

• “The cardiovascular benefits we hear about are real, but they’re strongest in people who already have heart disease or diabetes. Let’s talk about where you actually fit in that picture.”

• “If cost or access becomes an issue down the road, I want us to have a plan. Stopping without a plan is a clinical risk, and I want to think through that with you now.”

• “This medication works best as part of a broader picture — including nutrition support, movement you actually enjoy, and monitoring for how it’s affecting you.”

• “Our goal isn’t a number on the scale. Our goal is your metabolic health and your quality of life, and I want to keep checking in on both.”

Sources and Further Reading

• Cardiovascular Effects and Tolerability of GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis of 99,599 Patients. JACC, 2025. https://www.jacc.org/doi/10.1016/j.jacc.2025.08.027

• Cardiovascular and Kidney Outcomes and Mortality with Long-Acting GLP-1 Receptor Agonists in Type 2 Diabetes. Diabetes Care, 2025. https://diabetesjournals.org/care/article-abstract/48/5/846/158048

• Efficacy of GLP-1-based Therapies on Metabolic Dysfunction-associated Steatotic Liver Disease and Steatohepatitis: A Systematic Review and Meta-analysis. J Clin Endocrinol Metab, 2025. https://pubmed.ncbi.nlm.nih.gov/40489581/

• Efficacy and Safety of GLP-1 Receptor Agonists for Weight Loss Among Adults Without Diabetes. Annals of Internal Medicine, 2025. https://pubmed.ncbi.nlm.nih.gov/39761578/

• Once-Weekly Semaglutide in Adults with Overweight or Obesity. NEJM, 2021. https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

• Tirzepatide for Adults Living with Obesity. Cochrane / PubMed, 2025. https://pubmed.ncbi.nlm.nih.gov/41161687/

• Weight Trajectory Impacts Risk for 10 Distinct Cardiometabolic Diseases. J Clin Endocrinol Metab, 2025. https://pubmed.ncbi.nlm.nih.gov/40498904/

• Nutritional Priorities to Support GLP-1 Therapy for Obesity: A Joint Advisory. American Journal of Clinical Nutrition, 2025. https://ajcn.nutrition.org/article/S0002-9165(25)00240-0/fulltext

• Bone Health After Exercise Alone, GLP-1 Receptor Agonist Treatment, or Combination Treatment. JAMA Network Open. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2820308

• GLP-1RA Use and Thyroid Cancer Risk. JAMA Otolaryngology, 2024. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2829462

• GLP-1 Receptor Agonists and Cancer Risk in Adults with Obesity. JAMA Oncology, 2024. https://jamanetwork.com/journals/jamaoncology/article-abstract/2837870

• Suicide and Self-Harm Events With GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis. JAMA Psychiatry, 2024. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2831637

• Psychiatric and Psychological Adverse Effects Associated with Dulaglutide, Semaglutide, and Liraglutide: A VigiBase Study. Clinical Nutrition, 2025. https://pubmed.ncbi.nlm.nih.gov/40617160/

• GLP-1 Receptor Agonists and Research to Treat Overeating and Substance Use Disorders. PubMed, 2025. https://pubmed.ncbi.nlm.nih.gov/41224657/

• FDA: Concerns About Unapproved GLP-1 Drugs Used for Weight Loss. https://www.fda.gov/drugs/postmarket-drug-safety-information-patients-and-providers/fdas-concerns-unapproved-glp-1-drugs-used-weight-loss

• Medical Students for Size Inclusivity. GLP-1 Agonist Medications: Informed Consent Resource. 2023. https://sizeinclusivemedicine.org/glp1/

• SCOFF and ESP Validated Eating Disorder Screening Tools

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A patient came in having just joined what he described as a longevity and wellness program — one of those exclusive, ultra-discreet operations you find out about through a friend of a wealthy friend. He forwarded me his new regimen. It was a long PDF, full of tables and acronyms and numbers I didn’t recognize: BPC-157, TB-500, sermorelin.

I went line by line and Googled everything. And I kept arriving at the same place: limited data, no FDA approval, no clear prescribing guidelines for humans. I told him honestly that I couldn’t recommend these things, that I didn’t have the clinical experience with them, and that the evidence wasn’t there yet.

That was a couple of years ago. Since then, peptides have moved from the back corner of bodybuilding forums to the front pages of wellness influencers, biohacking podcasts, and med spa menus. Now they’re being casually offered alongside Botox and IV drips, presented as something natural, something your body basically already makes, something with essentially no downside.

So we thought it was time to slow down and ask the bigger question:

What actually are peptides? Why is everyone suddenly talking about them? And what does the evidence actually say?

The Claim

The pitch for peptides goes something like this: these are naturally occurring compounds — short chains of amino acids that your body already produces — and when used therapeutically, they can help with nearly everything people want most. Fat loss. Muscle gain. Better skin. Faster recovery from injury or illness. Gut healing. Immune optimization. And unlike the pharmaceutical drugs your doctor prescribes, peptides are framed as natural, low-risk, and available right now — no referral, no prescription, no insurance, no waiting. If the FDA hasn’t approved them yet, that’s presented not as a safety signal, but as institutional gatekeeping. One podcast claimed that 75,000 people had already used a particular peptide with no adverse effects. Why wait?

Why It’s Going Viral

The appeal of peptides is not irrational. It’s rooted in some genuinely real things that deserve to be named.

Fitness and wellness culture have gone thoroughly mainstream over the last decade. The desire to not just be healthy but to optimize — to reach peak performance, to slow aging, to get ahead of disease before it happens — has moved from elite sports medicine into suburban gyms and Instagram reels. In that context, peptides fit neatly into an existing cultural narrative about biohacking and “medicine 3.0.”

GLP-1 agonists — semaglutide, tirzepatide — were a kind of gateway. Most people now know someone who has had a visible, significant result on a GLP-1. And GLP-1s are peptides. That’s not always made explicit in the conversation, but it’s part of why the category as a whole has gained credibility. If one peptide can do that, why not others?

There’s also a real and understandable undercurrent of distrust. Many people have had experiences of feeling dismissed by the medical system, or of watching regulatory agencies make decisions that seemed financially rather than scientifically motivated. When the framing is that the FDA and “big pharma” are gatekeeping treatments that could genuinely help you, and when you can access those treatments today with one click, the calculus can feel simple.

And then there’s the K-shaped economy reality: people at opposite ends of the financial spectrum are both drawn to peptides, but for different reasons. Wealthy patients join exclusive longevity practices that quietly incorporate them as part of a full optimization protocol. Patients with fewer resources, who can’t afford adequate conventional care or who have run out of options for a chronic condition that medicine hasn’t answered well, are buying research chemicals online and doing their best with dosing information from Reddit. The middle — the patient with a solid PCP and good insurance — is less likely to be asking. And that middle is shrinking.

The way these compounds are framed matters enormously. The podcasts and influencers promoting peptides spend the vast majority of their time describing biological mechanisms: this peptide binds to this receptor, triggers this cellular process, and your body does this remarkable thing. It’s genuinely fascinating science. What gets almost no airtime is the adverse effects, the contraindications, the limits of the human data, or the quality of the studies behind the claims.

What the Science Shows

Let’s start with what’s true: peptides are real, they do things, and the category holds genuine therapeutic promise. Compared to small molecule drugs, peptides tend to have lower immunogenicity and fewer unintended drug interactions, precisely because of their specificity — they tend to act like a lock and key, binding to a particular receptor rather than wandering through the cell doing unpredictable things.

The science of peptide drug development has also advanced significantly over the past few decades. Manufacturing is cheaper. Identification of promising peptide sequences is faster. Hundreds of compounds are in research and development pipelines right now. This is a genuinely exciting area of medicine.

But the evidence for individual compounds varies dramatically — and that distinction matters.

Some peptides have substantial human clinical trial data and FDA approval. Insulin. Semaglutide and tirzepatide. These have been through rigorous phase III trials. We know their benefit profiles. We also know their risk profiles, because going through that process is precisely what generates the information needed to prescribe safely.

Some peptides have clinical data in humans and are approved in other countries or for very specific indications in the US. Thymosin alpha-1, for example, has been studied extensively in the treatment of hepatitis B and C and as a cancer adjuvant — though there’s no FDA-approved product in the US. Tesamorelin is FDA-approved specifically for reduction of visceral fat in HIV patients with lipodystrophy. And because it went through phase III trials, we actually know what it does to people: arthralgia in 13% of patients, injection site reactions in 17%, peripheral edema in 6%, meaningful increases in risk of glucose intolerance and diabetes compared to placebo. None of that means it’s a bad drug — in the right clinical setting it’s a useful one. It means that when a compound goes through proper testing, side effects emerge. They always do.

Retatrutide — a peptide acting on the GLP-1, GIP, and glucagon receptors simultaneously — is currently in phase III trials and not yet approved. Phase II data showed remarkable weight loss outcomes. People can’t wait and are buying it on the gray market. That may be understandable, but it means using a drug with no established dosing guidelines for humans and no data on long-term safety.

And then there’s the third category: compounds with little to no human data. BPC-157 and TB-500 — often marketed together as the “Wolverine stack” — are the most widely discussed examples. BPC-157 has meaningful preclinical and animal data for gastric protection, tissue healing, and angiogenesis. One small human study in 12 patients with knee pain exists. There are rumors of phase II trials in ulcerative colitis and multiple sclerosis that were never fully published. TB-500 has no human data at all. These compounds were removed from the list of substances compounding pharmacies can legally use precisely because the safety data isn’t there. They now exist primarily on the gray market, purchased as “research chemicals” technically labeled not for human use.

And the gray market introduces a separate, significant problem: purity and contamination. A 2018 study examining peptides sold on the gray market in Belgium found that purity ranged from 5% to 75% of labeled concentration — and also found high levels of heavy metal contamination, including arsenic and lead. The manufacturing of peptides is technically demanding and storage-sensitive. There is no mechanism requiring that what you’re purchasing contains what it says it does.

Clinical Nuance

None of this is a reason to dismiss patients who are using or curious about peptides — or to assume they’re being reckless. A lot of the people asking about these are people who have been failed by the healthcare system in some meaningful way: patients with fibromyalgia or chronic fatigue syndrome or other conditions where conventional medicine has offered them very little, patients who feel dismissed or undertreated, patients who are watching the people around them make health gains with GLP-1s and wondering what else might be possible.

For patients like that, the offer of something that might help — and that’s framed as safe and natural — is not irrational to consider. Our goal isn’t to shame the interest. It’s to help fill the informed consent gap, because the companies and influencers selling these things often aren’t.

Framing matters. The same patient who was unbothered by injecting an unregulated compound he’d read about online was, a year later, deeply anxious about starting an SSRI — because his physician had walked him through the risks and uncertainties carefully. The information felt different coming through a relationship built on honesty. That’s the role we can play.

If a patient has exhausted conventional options and wants to explore something investigational, that’s their autonomy to exercise. The most useful thing we can offer is: honest acknowledgment of what we don’t know, clarity that this is a drug with potential effects and risks, awareness of the purity and contamination risks of gray market products, and openness to continue the conversation as evidence evolves. That’s not gatekeeping. That’s medicine.

We’re also genuinely hopeful about the category. The science is real. The pipeline is full. If regulatory pathways can be made more efficient and better funded, many of these compounds may eventually reach the market with the safety data needed to use them responsibly. We want that outcome too.

The Antidote

For Patients

• Wanting to feel better — to optimize, to recover faster, to get ahead of disease — is not something to feel embarrassed about.

• Being curious about peptides doesn’t make you gullible or reckless. These are genuinely interesting compounds with real science behind some of them.

• A compound being “natural” or available without a prescription does not mean it has no risks. Anything that does something in your body can also do unintended things.

• The absence of a side effect list is not reassurance. It usually means the compound hasn’t been studied carefully enough in humans to generate one.

• If you’re considering using a peptide — especially one purchased outside of a clinical setting — you deserve honest information about what is and isn’t known, including the real purity and contamination risks of gray market products.

• It’s okay to want more from your healthcare than you’re currently getting. That desire is valid. It deserves to be met with better care — not just better marketing.

Language Clinicians Can Use

• “I’m really glad you brought this up. There’s a lot of information out there about peptides — some of it exciting, some of it misleading — and I’d rather we talk through it together than have you navigate it alone.”

• “These are drugs. I know they’re not presented that way, but anything that affects the structure or function of your body is a drug — and that means there are potential risks, even when we don’t have a full list of them yet.”

• “The reason this one doesn’t have a side effect list isn’t because it’s safe. It’s because it hasn’t gone through the testing that would generate that list.”

• “I understand why you’re interested in this, especially given how hard it’s been to find answers through the usual routes. I don’t want to dismiss that. Let’s talk about what we know, what we don’t, and what I’d want you to watch out for if you decide to try it.”

• “If you’re buying this online, I want you to know that purity is a real concern. What’s labeled on the package may not reflect what’s actually in it.”

• “I’m genuinely excited about where peptide medicine is headed. I just want to make sure any decision you make is fully informed — not just by the people who are selling you something.”

Sources and Further Reading

• Therapeutic peptides: current applications and future directions. Signal Transduction and Targeted Therapy. 2022.

• Immunogenicity risk assessment of synthetic peptide drugs and their impurities. Journal of Pharmaceutical Sciences. 2023.

• Immunogenicity of therapeutic peptide products: bridging the gaps regarding the role of product-related risk factors. 2024.

• Impurity profiling of the most frequently encountered falsified polypeptide drugs on the Belgian market. Drug Testing and Analysis. 2018.

• Comprehensive Review of the Safety and Efficacy of Thymosin Alpha 1 in Human Clinical Trials. Alternative Therapies in Health and Medicine. 2024. Dinetz E, Lee E.

• EGRIFTA SV (Tesamorelin). FDA Drug Label. DailyMed.

• The Emerging Science and Clinical Application of Peptide Therapy (video). YouTube.

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A patient came in recently and told me her personal trainer had instructed her to eat 150 grams of protein a day. She wasn’t sure how to do it. She was exhausted trying.

That number — 150 grams — didn’t come from her doctor. It came from Instagram. From a fitness influencer. From the general cultural hum of this particular moment, which has decided, collectively, that we are all deeply, urgently protein-deficient.

The memes write themselves. One making the rounds lately goes something like: I had to quit my job so I could eat enough protein. It’s funny because it’s true-ish. Meeting some of the targets being thrown around online would essentially require eating protein to become your full-time occupation.

So what’s actually going on here? Is the protein boom legitimate? Are we truly not eating enough? And what should we do with the fact that the U.S. government just updated its dietary guidelines to recommend significantly more protein than before?

Let’s slow down and look at what the evidence actually says — and what it doesn’t.

The Claim

The message circulating on social media, in fitness spaces, and now even in official government guidance goes something like this: Americans are dangerously under-consuming protein. Getting enough protein is essential for metabolic health, weight management, and building muscle. Most of us need to be eating significantly more. And a commonly cited target — particularly in fitness communities and from personal trainers — is one gram of protein per pound of body weight per day.

That last number sounds reasonable until you do the math. One gram per pound translates to 2.2 grams per kilogram — nearly three times the previous official recommendation of 0.8 grams per kilogram per day, and well above even the newly updated guidelines of 1.2 to 1.6 grams per kilogram per day released by the U.S. Department of Health and Human Services and USDA in January 2026.

Why It’s Going Viral

Protein has had an interesting trajectory in the nutrition discourse. We lived through the low-fat era. Then the low-carb era. Protein is the one macronutrient that has, so far, escaped cancellation. It carries a halo — associated with strength, discipline, even a kind of nutritional virtue — that no other macronutrient has managed to hold onto.

Part of what’s driving the current moment is a broader shift: fitness culture has seeped into the mainstream in ways it simply hadn’t before. Conversations that used to live exclusively in bodybuilding forums and gym locker rooms — about optimal protein targets, creatine, muscle mass preservation — are now happening in primary care waiting rooms, at suburban dinner parties, in the group chats of people who have never competed in anything athletic in their lives. This is a genuinely new cultural phenomenon.

COVID accelerated it. The pandemic forced a reckoning with mortality and health that sent a lot of people toward optimization in a new way. What followed was a surge of interest in longevity, metabolic health, and what you might call the architecture of the body — how to build muscle, preserve it as you age, keep your metabolism running. These are legitimate concerns. They just get mixed up, online, with a great deal of noise.

There’s also a more structural driver: the supplement and food industry has correctly identified protein as a wildly marketable concept. Walk into any Starbucks and you’ll find protein foam. The grocery store yogurt aisle has become almost incomprehensible. Protein-enhanced bagels, protein chips, protein waffles that are more powder than actual food. The marketplace is not neutral here. Someone is making money on every gram of protein people are convinced they’re missing.

And now, for the first time, the U.S. government is on board too. When the dietary guidelines shift in a direction that aligns with what influencers have been saying for years, it becomes very easy to feel like the science has settled. It hasn’t — but we’ll get to that.

What the Science Shows

Let’s start with what is genuinely true. Protein is critical. It is one of the fundamental building blocks of the body — made up of amino acids, some of which must come from food because your body cannot synthesize them on its own. Beyond muscle, protein functions as enzymes, hormones, and neurotransmitters. Inadequate protein intake — we’re talking very low, in the range of 0.4 to 0.5 grams per kilogram per day — can cause muscle wasting, immune impairment, poor wound healing, and edema. In children, it can impair growth and brain development. Protein deficiency is a genuine, serious clinical problem.

There’s also a condition called sarcopenia — generalized loss of muscle mass and function — that is increasingly recognized as a major health concern, particularly in older adults (where its prevalence is estimated between 10 and 25 percent) and in people who are losing weight rapidly, including through the use of GLP-1 medications. Sarcopenia is associated with frailty, falls, disability, and poor quality of life. These are real stakes.

But here’s where the nuance comes in: most Americans are not protein-deficient in any clinically significant sense. According to NHANES data collected between 2001 and 2014, average American adults were already consuming 80 to 90 grams of protein per day — which works out to 1.1 to 1.3 grams per kilogram per day. That’s right at the lower boundary of the newly updated guidelines, and well above what is needed to prevent serious deficiency.

The new dietary guidelines did raise the recommended daily protein intake — from 0.8 grams per kilogram per day to 1.2 to 1.6 grams per kilogram per day. This reflects a genuine evolution in the research, particularly around aging populations and the role of resistance training in muscle health. But even the guidelines themselves include a line that often gets lost in translation: “Although dietary protein can increase muscle mass and strength when combined with regular strength or resistance training, there is little evidence that, absent sustained training, higher protein builds muscle or provides other health benefits.”

In other words: for a sedentary adult who doesn’t fall into a higher-need subgroup, eating more protein without also increasing resistance training is unlikely to do much. And the majority of American adults are sedentary.

Clinical Nuance

The reality is that protein needs are highly individualized — and the degree of individualization is significant enough that any single blanket recommendation is going to be imprecise for most people.

Older adults likely need somewhere between 1.0 and 1.6 grams per kilogram per day, with stronger evidence clustering around the higher end of that range. Pregnant women need at least 1.2 grams per kilogram per day in early pregnancy, increasing to about 1.5 grams per kilogram per day later in pregnancy. Breastfeeding women need 1.1 to 1.3 grams per kilogram per day. People going through menopause may benefit from 1.0 to 1.6 grams per kilogram per day. And people with metabolic health conditions who are on GLP-1 medications should be aiming for at least 1.2 grams per kilogram per day — but calculated based on lean body mass, not total body weight, which matters a great deal and which most people aren’t accounting for.

There’s also the question that often goes unasked: where is the protein coming from? The evidence strongly supports that the healthiest overall dietary patterns — in terms of cardiovascular risk, cancer risk, inflammation, and longevity — are whole-foods, plant-forward diets low in ultra-processed foods. When people hear the message “eat more protein,” they overwhelmingly think of meat, eggs, cheese, protein bars, protein shakes, and protein powders. Most of those things are either animal products or ultra-processed foods that we already consume in excess.

Plant-based protein sources — lentils, legumes, tofu, tempeh, edamame, hemp seeds, quinoa, nutritional yeast — tend to arrive with fiber, antioxidants, and phytochemicals. Animal-based protein sources tend to arrive with saturated fat and sodium. These are not equivalent, even if the protein gram counts are.

What we wish the conversation acknowledged more often: it is entirely possible to meet protein needs from plant sources. Complete plant proteins — those containing all essential amino acids — include tofu, tempeh, edamame, hemp seeds, chia seeds, quinoa, buckwheat, nutritional yeast, and spirulina. The idea that adequate protein requires heavy animal consumption is a common misconception, not a nutritional fact.

The Antidote

For Patients

• I am allowed to find this confusing. Nutrition science is genuinely complicated, and the marketplace makes it even harder.

• Feeling overwhelmed by all of this does not mean I am failing at my health.

• I do not have to optimize every gram of what I eat to be taking care of myself.

• What someone else needs — even someone I trust — may not be what my body needs.

• I can eat in a way that feels sustainable and still be nourishing myself well.

• It is okay to not have a perfect answer right now. This is worth a real conversation with someone who knows my full picture.

For Clinicians

• “I’m really glad you brought this up — protein needs are more individualized than the headlines suggest, and it’s worth thinking through what actually applies to you.”

• “Most people are closer to meeting their protein needs than they think. Let’s figure out where you actually stand.”

• “There’s good evidence for higher protein in specific situations — older age, pregnancy, significant weight loss — but the blanket ‘everyone needs more’ message is a real oversimplification.”

• “The source of protein matters a lot. Leaning heavily on animal products to hit a number isn’t necessarily moving us in the right direction overall.”

• “If you’re interested in building or preserving muscle, protein is only part of the equation — resistance training is the other half, and honestly an equally important one.”

• “This is genuinely confusing territory, and the marketplace doesn’t make it easier. It’s okay to not have all the answers — that’s what registered dietitians do best!”

Sources and Further Reading

• The 2025-2030 Dietary Guidelines for Americans — JAMA

• Protein intake trends and conformity with the Dietary Reference Intakes in the United States: NHANES 2001–2014. AJCN, 2018.

• Protein and Amino Acid Requirements in Pregnancy. Advances in Nutrition, 2016.

• Guidance on Energy and Macronutrients across the Life Span. NEJM, 2022.

• Protein requirements of marginally nourished lactating women. AJCN, 1995.

• Protein Requirements and Optimal Intakes in Aging. Advances in Nutrition, 2018.

• Dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women — ESCEO Consensus Statement. Osteoporosis International, 2014.

• Estimating the effect of hypothetical dietary protein interventions on changes in body composition of postmenopausal women over 3 years using data from the Women’s Health Initiative (WHI) Study: an emulated target trial. 2025.

• Malnutrition in Older Adults. NEJM, 2024.

• Prevalence and Factors Associated with Sarcopenia in Community-Dwelling Older Adults: Systematic Review and Meta-Analysis. 2025.

• Nutritional priorities to support GLP-1 therapy for obesity — Joint Advisory, ACLM/ASN/OMA/TOS. 2025.

• AACE Consensus Statement: Algorithm for Evaluation and Treatment of Adults with Obesity — 2025 Update.

• Effect of protein supplementation on resistance training-induced gains in muscle mass and strength — Systematic review and meta-analysis. BJSM, 2018.

• Healthline: Complete Protein Sources for Vegans and Vegetarians

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We started this project with a question we couldn’t quite articulate: why does so much health content on social media feel wrong, even when parts of it are technically true?

In our 10th episode, we have some answers. And some of them surprised us.

This episode is different. Rather than examining one viral health claim, we wanted to step back and look at the patterns — the themes that surfaced again and again across full-body MRIs, perimenopause, thyroid health, clean eating, clean beauty, and all the rest. Because once we started seeing them, we couldn’t unsee them.

We also wanted to be honest about something: we are not outside this. We are in it with you. We are also millennial women who have doomscrolled, who have felt that gut-level pull toward a clean solution, who have wondered whether our doctors were telling us everything. Having medical training helps — but it doesn’t make us immune. It just gives us slightly better tools for talking ourselves down.

So here’s what we’ve learned.

We Are Part of the Problem

This is the theme that came up in literally every single episode, and we think it has to be the starting point for any honest conversation about health misinformation online.

When people turn to social media for answers about their thyroid, their hormones, their anxiety, their fatigue — they are not being gullible. They are responding to a real unmet need. The traditional healthcare system has left enormous gaps: in information, in time, in validation, in the kind of deep, contextual conversations that actually help people make sense of their health. Social media didn’t create those gaps. It just moved in to fill them.

This doesn’t mean the answers people find online are good ones. Often they’re not. But if we as clinicians want to be part of the solution, we have to start by owning our part of the problem. The rushed visit, the jargon-heavy portal message, the referral that takes six weeks — all of it contributes to the conditions in which misleading wellness content thrives.

At the same time, we don’t want to make this a critique of individual doctors. Most physicians working within large healthcare systems have very little control over their schedules, their appointment lengths, or the time they can spend on nuanced conversations. The structure itself is the problem. And that structure is also notably absent from most social media health content, which tends to locate all solutions in individual behavior and personal purchasing decisions rather than in the systems that shape our health in the first place.

Health is biopsychosocial. Socioeconomic factors, structural discrimination, psychosocial stress, access to resources, the built environment — these are some of the most powerful drivers of health outcomes, and they are almost never addressed in either the exam room or the wellness feed.

Why It’s Going Viral

Every episode of this podcast has, at its core, the same underlying question: why does this resonate so much? And almost every time, the answer comes back to a few things.

People are seeking control in genuinely uncertain times. And social media is extraordinarily good at offering the illusion of control: a simple explanation, a buyable solution, a clear villain, a clear fix. Afraid of cancer? Avoid these toxins. Exhausted and inflamed? Here’s the supplement protocol. Feeling off in ways no one can explain? This one diagnosis — perimenopause, thyroid dysfunction, mold exposure — explains all of it. And then, almost immediately: here’s what you can do about it. Click here. Add to cart.

There’s also a deep cultural hunger for a one-stop explanation. We saw this with thyroid content and perimenopause content especially — the way a single diagnosis can feel like a revelation when you’ve been walking around with a constellation of vague, non-specific symptoms and no one has been able to make sense of them. That experience of finally having a framework, even an imperfect one, is genuinely meaningful. We don’t want to dismiss it. We want to help people find frameworks that are also accurate.

What the Science Shows (About Social Media Itself)

There are a few things we’ve come to understand more clearly after spending months in this space.

Fear-based content is algorithmically favored. It gets more clicks, more shares, more time-on-screen. “Go get your mammogram” is not going to outperform “Mammograms are secretly harmful.” This isn’t a conspiracy — it’s just how engagement-optimized systems work. And it means that our feeds are structurally biased toward health content that activates anxiety rather than reducing it.

The line between informative and fear-mongering is thinner than most people realize. A post describing a medication side effect, or a test your doctor might not be ordering, or an ingredient in your skincare routine can feel like education — and sometimes it is. But when context is stripped away, when risk and benefit aren’t discussed, when the information is accurate but the framing is designed to alarm, the net effect is often more anxiety, more distrust, and less confidence in the boring-but-effective basics of evidence-based preventive care.

We’ve also become more attuned to what we’d call the moralization of health and wellness. Words like “clean” — in clean eating, clean beauty, clean living — carry moral weight that has nothing to do with the science. They bypass the need for evidence and appeal instead to values of purity, naturalness, and virtue. As clinicians, we’re paying much more attention to the language we use around health, because that language shapes how patients relate to their own bodies and choices, often in ways we don’t intend.

Clinical Nuance

One of the hardest things about this project has been sitting with how much is genuinely uncertain — and how poorly that uncertainty translates to social media formats.

Risk-benefit calculations are not universal. Something that makes sense for a person with unlimited resources, full access to primary care, and a complete picture of their health history may be actively harmful for someone with limited income, no insurance, and a healthcare system that has repeatedly failed them. When optional, luxury interventions are presented online as necessary for safety, that framing causes real harm — it misallocates scarce resources, it displaces evidence-based care, and it shifts responsibility from systems to individuals in a way that ultimately protects the status quo.

We’ve also become more aware of how wellness content can function as a pipeline to more alarming places. The journey from “let me find a non-toxic sunscreen” to “can I really trust my doctor’s recommendation about this vaccine” is shorter than most people expect. The algorithm is very good at finding the next, slightly more extreme version of whatever you were just looking at. Radicalization is not a word we expected to use in the context of wellness. We use it now.

The Antidote

For Patients

• It makes sense that I want answers about my health. Wanting more information is not a character flaw.

• The healthcare system has real gaps, and my frustration with it is legitimate.

• Social media can offer connection and information — and it can also amplify fear in ways that don’t serve me.

• When I feel pulled toward a simple solution, I can ask: who benefits from this? What does the full picture look like?

• I am allowed to ask questions, take my time, and hold uncertainty without immediately needing to buy something.

• My health is shaped by far more than my personal choices — and that is not my fault.

For Clinicians

• “I understand why you’re looking for answers in other places. A lot of people feel like the system hasn’t fully met their needs — and honestly, that makes sense.”

• “Let’s talk about what drew you to this. I want to understand what you’re hoping to find out.”

• “I can’t give you certainty about everything — but I can help you figure out what questions are worth asking and what next steps would actually help.”

• “The goal isn’t just more information. It’s information that’s relevant to your situation, your values, and your actual risk.”

• “You’re not gullible for finding this appealing. A lot of this content is designed to feel compelling. Let’s think through it together.”

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A patient sent her doctor a report after getting one of the increasingly popular full body MRIs being advertised all over social media.

They hadn’t discussed it beforehand.

The report was long. Beautifully designed. Color-coded. Written in clear, reassuring language. It looked comprehensive in a way most routine medical reports do not.

And that, honestly, is part of the appeal.

Because most people don’t experience the healthcare system as clean, straightforward, and confidence-inspiring. They experience it as fragmented. They wait weeks for referrals. They juggle multiple appointments. They get portal messages full of jargon. They sit through rushed visits that leave them feeling like they’re only scratching the surface.

So when a company offers one scan that promises to look from head to toe—and catch the thing no one else would have caught—it lands.

Especially in an era where we are constantly being shown stories of the “healthy” person who suddenly turned out not to be healthy at all.

The widow on Instagram whose husband died young of something no one saw coming.
The friend-of-a-friend with surprise pancreatic cancer.
The headline about the marathon runner with a hidden aneurysm.

These stories are emotionally powerful. They stay with us. And they make a certain question feel impossible to ignore:

If there’s a way to look everywhere, why wouldn’t I do it?

So let’s slow down and ask the bigger question:

Should we all be getting full body MRIs?

The Claim

The pitch for direct-to-consumer full body MRI screening goes something like this: in a single scan covering your head, neck, chest, abdomen, pelvis, and legs, you can screen for solid tumors, brain aneurysms, spine degeneration, metabolic disorders, autoimmune conditions, and more — all without a referral, all without insurance hassle, and all with a beautifully written report delivered straight to you. Testimonials on company websites describe catching cancers that dramatically improved survival odds. The recurring themes are early detection and, perhaps most powerfully, peace of mind.

Why It’s Going Viral

The emotional truth underneath this trend is real, and it deserves to be named before we get into the science.

Health anxiety is at an all-time high — and social media is part of why. Algorithms serve us the most emotionally engaging content, which means our feeds are full of stories of people whose lives were upended by a diagnosis that came out of nowhere. The GoFundMe. The “I had no symptoms.” The before and after. These stories are harrowing precisely because they feel random, and our brains are wired to look for a way to make randomness feel controllable.

At the same time, navigating the traditional healthcare system for even basic screenings is genuinely hard. Getting a mammogram, a colonoscopy, a pap smear, a lung CT (if you qualify) often means multiple appointments with multiple providers spread across multiple weeks. It means referrals, insurance approvals, time off work, childcare. The system makes prevention feel like a second job. So when someone offers you a single appointment that promises to check everything, it’s not irrational to be interested.

There’s also a growing cultural narrative — amplified significantly online — that what your doctor offers you is barely scratching the surface. That “medicine 3.0” and biohacking and optimization represent a higher tier of care. That the reason your physician isn’t ordering these things isn’t because they’ve weighed the evidence, but because of gatekeeping, cost containment, or simply being behind the curve. For patients who have felt dismissed or under-served by the medical system — and many have, for entirely valid reasons — this narrative has a lot of traction.

All of this makes sense. The desire for a comprehensive, clear, reassuring picture of your health is deeply human. It doesn’t make someone gullible or naive to want it. And that’s exactly why we think this conversation matters.

What the Science Shows

Let’s start with what’s true: screening works. There are genuinely conditions where catching something before you have symptoms can change the outcome, sometimes dramatically. Pap smears, mammograms, colonoscopies, blood pressure checks — these are recommended precisely because the evidence shows they improve outcomes at a population level. The concept behind full body MRI screening isn’t invented from nothing.

There are also specific, evidence-based clinical situations where whole body MRI is genuinely useful — patients with certain rare genetic syndromes that carry high cancer risk, specific rare cancers where staging benefits from full-body imaging, certain inflammatory or infectious conditions. This isn’t fringe medicine. It’s just that these situations are uncommon, and none of them describe the general population being targeted by direct-to-consumer companies.

For asymptomatic, average-risk adults, a 2019 systematic review published in the looked at twelve studies involving more than 5,000 subjects and found that the pooled prevalence of “critical or indeterminate” incidental findings was 32%. Read that again: nearly a third of healthy people who got these scans had something found. That sounds reassuring — until you look at what happened next. When those findings were verified through follow-up testing, the rate dropped to about 12.6%. About sixteen percent of findings were false positives — meaning they prompted additional testing, additional cost, and potential additional risk, and ultimately turned out to be nothing.

False positives aren’t just inconvenient. They lead to more imaging (sometimes with radiation or contrast dye), biopsies, and procedures — each with their own risk profiles. They consume time, money, and enormous amounts of mental and emotional energy. And once a finding is documented, the medical system essentially requires that it be followed — even when the clinical probability that it represents anything significant is very low.

It’s also worth understanding what these scans miss. According to the companies’ own fine print: they don’t evaluate the mucosal lining of the GI tract (meaning they won’t catch early colon cancer the way a colonoscopy would), they don’t replace dedicated breast imaging, they have limitations in assessing lung micro-nodules, they don’t visualize smaller brain vessels, and they cannot detect common conditions like high blood pressure, diabetes, prediabetes, or thyroid disease. In a single scan lasting 45 to 60 minutes covering the entire body, the resolution is simply not what you’d get from a targeted, high-quality study of a specific organ.

Clinical Nuance

None of this means that if you’ve had one of these scans, you made a terrible mistake. It means the conversation is more complicated than the marketing suggests.

Thoughtful clinicians think about tests the way they think about any intervention: what is this likely to find? What will we do if it finds something? Will knowing that thing change the outcome — or will it primarily generate anxiety, follow-up appointments, and cascade testing without meaningfully improving your health? These aren’t bureaucratic questions. They’re the actual questions that determine whether a test helps you or harms you.

There’s also the question of what these scans replace versus what they add. For someone who can’t access the traditional healthcare system, there’s a real risk that a full body MRI becomes a substitute for evidence-based screenings rather than a supplement to them. A beautiful report doesn’t replace a colonoscopy. It doesn’t replace a mammogram. And the illusion that it might is one of the more quietly concerning aspects of how these products are marketed.

That said: people have different values, different risk tolerances, different relationships to uncertainty. If you have the resources, you’ve already completed all recommended evidence-based screenings, you understand the limitations, and you’re making this decision in consultation with a physician who knows your full history — that’s a different conversation than someone using this as their primary health screening in place of established care.

What we’d ask for, from the companies offering these services, is honest and prominent informed consent — not in the fine print, but front and center. What this scan can and cannot detect. What it means if something is found. What follow-up typically looks like. The rate of incidental findings and false positives. That’s the kind of transparency that would let people make genuinely informed choices.

The Antidote

For Patients

(Gentle reminders and affirmations)

It makes sense that I want to avoid a surprise diagnosis.

Wanting more information about my health is not irrational.

A full body MRI is not the same thing as a full body guarantee.

A normal scan does not rule out every serious condition.

An abnormal scan does not always mean something dangerous was found.

Before I pay for an optional screening test, I deserve to understand what it can detect, what it cannot detect, and what happens if it finds something incidental.

For Clinicians

(Language you can borrow, tweak, or make your own)

“I understand why this feels appealing—especially when healthcare already feels so fragmented.”

“This scan is not a replacement for your usual screening tests.”

“The question isn’t only whether it can find something. It’s whether finding that thing actually improves your outcome.”

“One of the main risks of broad imaging is incidental findings that lead to more testing, more cost, and sometimes procedures for things that may never have harmed you.”

“If this is something you’re still considering, let’s make sure you understand the limitations and are prepared for what follow-up might look like.”

“Our goal is not just more information. It’s information that actually helps you.”

Sources and Further Reading

• Clinical Applications and Controversies of Whole-Body MRI: AJR Expert Panel Narrative Review. AJR Am J Roentgenol. 2023.

• Whole-body MRI for preventive health screening: A systematic review of the literature. J Magn Reson Imaging. 2019.

• Whole-body MRI for preventive health screening: Management strategies and clinical implications. Eur J Radiol. 2021.

• A Practical Guide to MR Imaging Safety: What Radiologists Need to Know. Radiographics. 2015.

• U.S. Preventive Services Task Force

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A patient once came in feeling deeply frustrated with her health.

She had already been diagnosed with one autoimmune condition and was in the process of being evaluated for another. Her symptoms were unpredictable—joint pain, fatigue, inflammation that seemed to flare without warning.

She had read about the Autoimmune Protocol diet, and friends had encouraged her to try it. The promise sounded compelling: eliminate certain foods, reduce inflammation, and potentially control autoimmune disease naturally.

More importantly, it offered something she desperately wanted—a way to avoid medication.

So she decided to try it.

For a while, it seemed promising. She felt hopeful. She thought some of her symptoms might even be improving.

But over time something else started happening.

The diet became harder and harder to maintain. Cravings increased. Social meals became stressful. And slowly, something she had hoped would make her feel healthier began to make her feel anxious around food again.

Eventually she stopped.

Looking back, she realized the diet had taken a bigger mental toll than she recognized at the time.

That experience reflects something we see often in clinic: when someone is living with a difficult, unpredictable illness, the idea that food might hold the key to control can feel incredibly powerful.

So let’s slow down and ask the bigger question:

Is the Autoimmune Protocol diet actually helpful?

The claim

The Autoimmune Protocol diet—often called AIP—is a very specific elimination diet designed to reduce inflammation and improve autoimmune disease symptoms.

The core idea is straightforward:

Certain foods may trigger inflammation or disrupt gut health.
If you remove those foods completely and then gradually reintroduce them, you can identify which ones worsen your symptoms and eliminate them long term.

The elimination phase typically removes:

• grains

• legumes

• nuts and seeds

• dairy

• eggs

• nightshade vegetables

• and processed foods

After several weeks or months, foods are slowly reintroduced one at a time to identify “triggers.”

In some corners of the internet, the claim goes even further:

If you follow the protocol strictly enough, you may be able to control autoimmune disease without medication.

It’s a powerful message.

And it’s not hard to see why it resonates.

Why this idea spreads so easily

Autoimmune diseases are incredibly frustrating to live with.

They often develop gradually, with symptoms that can be vague and hard to diagnose. Even after diagnosis, symptoms can fluctuate unpredictably.

And the treatments can be intimidating.

Some medications are expensive.
Some have significant side effects.
Some require injections or infusions.

For someone who already feels like their body is out of control, the idea that food might be the root cause—and the solution—can feel empowering.

There’s also a broader cultural backdrop.

“Inflammation” has become one of the most powerful buzzwords in online health culture. It’s often framed as the hidden cause of nearly every chronic illness—from autoimmune disease to heart disease to brain fog.

So if inflammation is the problem, it feels logical that a powerful anti-inflammatory diet must be the solution.

And finally, there’s a message we see over and over in wellness spaces:

Natural solutions are safer.
Medications are “toxic.”

That framing creates a false choice that can feel emotionally compelling:

Either manage your illness naturally through diet, or accept harmful medications.

But real life—and real medicine—is usually more nuanced than that.

The nugget of truth

Diet does influence inflammation.

There is strong evidence that certain dietary patterns—especially those rich in whole plant foods—are associated with lower inflammatory markers and improved metabolic and cardiovascular health.

Dietary patterns like the Mediterranean diet emphasize:

• fruits and vegetables

• whole grains

• legumes

• nuts and seeds

• olive oil

• fatty fish

• fermented foods

These foods provide fiber, antioxidants, omega-3 fatty acids, and other compounds that can support immune regulation and reduce inflammation.

So the idea that nutrition matters for inflammation is not wrong.

Lifestyle factors like sleep, stress, physical activity, and nutrition all influence immune function.

But that doesn’t necessarily mean extreme elimination diets are the answer.

The facts (with context and nuance)

The first thing to understand is that an anti-inflammatory dietary pattern is very different from the Autoimmune Protocol diet.

Anti-inflammatory diets focus on adding beneficial foods and improving overall dietary patterns.

The Autoimmune Protocol, by contrast, is a highly restrictive elimination diet.

During the elimination phase, people remove multiple major food groups—including grains, legumes, nuts, seeds, eggs, and dairy—for weeks or months.

These foods are then slowly reintroduced to identify symptom triggers.

This approach sounds logical in theory. But when researchers have tried to study AIP directly, the evidence is extremely limited.

The most frequently cited study followed 15 patients with inflammatory bowel disease who followed an AIP-style diet for 11 weeks.

Some participants reported symptom improvement.

But the study had major limitations:

• very small sample size

• no comparison group

• participants were also using medications

• inflammatory markers did not significantly change

In other words, it raises interesting questions—but it does not provide strong evidence that AIP treats autoimmune disease.

There are also important risks to consider.

Because AIP eliminates so many food groups, it can make it difficult to meet nutritional needs. Foods removed in the elimination phase are major sources of:

• fiber

• calcium

• vitamin D

• B vitamins

• healthy fats

Patients with autoimmune diseases may already have nutritional deficiencies due to inflammation or absorption issues. Restrictive diets can sometimes make those problems worse.

There’s also the psychological side.

Highly restrictive diets can increase anxiety around food, especially for people with a history of disordered eating.

Studies of elimination diets more broadly have found associations with avoidant restrictive food intake disorder (ARFID) symptoms, particularly when diets are self-directed without professional support.

Even in conditions like celiac disease, where strict dietary elimination is medically necessary, research shows that up to 14–57% of patients may meet criteria for ARFID depending on the screening tool used.

This doesn’t mean elimination diets always cause eating disorders.

But it does remind us that food restriction isn’t risk-free.

And the more restrictive the diet, the more closely it should be supervised.

The part that often gets missed

One of the biggest challenges in nutrition science is that the overall dietary pattern matters more than individual foods.

When we zoom in too narrowly on specific ingredients—gluten, dairy, nightshades—we can lose sight of the bigger picture.

Someone who eliminates gluten might feel better not because gluten itself was the problem, but because they reduced highly processed foods.

Someone who follows AIP might initially feel better because they started cooking more meals at home or eating fewer ultra-processed foods.

Those improvements are real.

But they don’t necessarily mean that eliminating entire food groups was the key.

So…is the AIP diet helpful?

For some individuals, identifying specific food sensitivities can be useful.

But the evidence that the Autoimmune Protocol diet treats autoimmune disease is very limited.

What we do know is:

• Anti-inflammatory dietary patterns are beneficial for overall health

• Extremely restrictive diets carry potential nutritional and psychological risks

• Sustainable lifestyle changes tend to be more effective than drastic ones

And importantly, diet changes should not replace medical treatment.

Often the most effective approach is combining lifestyle strategies with evidence-based therapies—not choosing between them.

The Antidote

For Patients

(Gentle reminders and affirmations)

It makes sense that I want to control my illness in the most natural way possible.

Nutrition does influence inflammation, but extreme elimination diets are rarely the answer.

A sustainable dietary pattern is usually more helpful than a highly restrictive one.

If a diet increases anxiety around food or feels impossible to maintain, that matters.

Medications and lifestyle changes can work together—this is not an either-or choice.

My health does not depend on perfect dietary control.

For Clinicians

(Language you can borrow, tweak, or make your own)

“I completely understand why the idea of controlling inflammation through diet is appealing.”

“There is evidence that overall dietary patterns influence inflammation, but the evidence for very restrictive elimination diets is limited.”

“If you want to explore dietary changes, we can do that safely and ideally with a dietitian involved.”

“My goal is to support your health from multiple angles—lifestyle, nutrition, and medical treatment if needed.”

“We don’t have to choose between medication and lifestyle changes. Often the best outcomes come from combining both.”

Resources

• Mediterranean Diet Overview
  https://www.nutrition.va.gov/docs/UpdatedPatientEd/Mediterraneandiet.pdf

• DASH Eating Plan
  https://www.nhlbi.nih.gov/education/dash-eating-plan

References and Experts to Follow

• Intake and Source of Dietary Fiber, Inflammation, and Cardiovascular Disease in Older US Adults.

  https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2790576

• Overview of Anti-Inflammatory Diets and Their Promising Effects on Non-Communicable

  https://pubmed.ncbi.nlm.nih.gov/39411832/

• Interaction Between Food Antigens and the Immune System: Association With Autoimmune Disorders

  https://pubmed.ncbi.nlm.nih.gov/31917265/

• Current Evidence on the Efficacy of Gluten-Free Diets in Multiple Sclerosis, Psoriasis, Type 1 Diabetes and Autommune Thyroid Diseases https://pubmed.ncbi.nlm.nih.gov/32752175/

• Efficacy of the Autoimmune Protocol Diet for Inflammatory Bowel Disease. https://pubmed.ncbi.nlm.nih.gov/28858071/

• Avoidant/Restrictive Food Intake Disorder in Celiac Disease https://pubmed.ncbi.nlm.nih.gov/41156450/

• Bidirectional Relationship Between Eating Disorders and Autoimmune Diseases https://pubmed.ncbi.nlm.nih.gov/30178543/

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A few years ago, most women in their late 30s and 40s weren’t walking into the doctor’s office asking about perimenopause.

Now, it’s everywhere.

Not just in clinic. In group texts. On podcasts. In Instagram reels. In TikToks with symptom lists so long and familiar they can make almost anyone pause and think: Wait… is this me?

Hot flashes, poor sleep, low libido, fatigue, brain fog, weight gain, mood swings, skin changes, hair changes, headaches, joint pain, urinary symptoms, dizziness, vertigo.

At this point, it can start to feel like there’s almost nothing perimenopause can’t explain.

And to be clear: perimenopause is real. It can absolutely affect quality of life. It has been underrecognized, undertaught, and undertreated for a very long time.

But something else is happening too.

Many women are arriving already convinced that perimenopause is the answer — and already bracing for a fight. They expect doctors to dismiss them, refuse labs, or withhold treatment. They’ve been told they have to push, advocate, insist.

And sometimes that advocacy is warranted.

But sometimes it also means we walk into the room already anchored on a diagnosis before we’ve had the chance to ask the bigger question:

Is this perimenopause?
Or is perimenopause becoming the container we’re using to hold a much bigger story about why so many women feel so unwell right now?

So let’s slow down and ask the question underneath the question:

Are we all in perimenopause?

The claim

The social media version of this message tends to sound something like:

Every woman over 35 is potentially in perimenopause. Perimenopause can wreck your body, ruin your sleep, tank your mood, cause weight gain, brain fog, low libido, and make you feel like a stranger to yourself. Doctors don’t know enough about it, may try to dismiss you, and won’t diagnose or treat it appropriately unless you push for labs and hormones.

There’s a reason that message lands.

It’s validating. It gives a name to suffering. It offers an explanation for symptoms that often feel diffuse, frustrating, and hard to pin down.

And for women who have spent years being told they’re “just stressed,” “just anxious,” or “just getting older,” that kind of explanation can feel like oxygen.

Why this is so viral

There are deep roots here.

First, women’s health has historically been neglected. It has been underfunded in research, undertaught in medical training, and shaped for generations by systems in which women were underrepresented as researchers, professors, and physicians.

Second, there is substantial evidence that women’s symptoms — especially when they are vague, painful, or medically unexplained — are taken less seriously. Women are more likely than men to have the same presentation interpreted as psychosomatic or functional. Even when clinicians are trying to be thoughtful, those biases are part of the water we’re all swimming in.

So of course perimenopause content feels validating. It says:
No, you’re not making this up.
No, you’re not weak.
No, you’re not crazy.
There is a physiologic reason you feel different.

That part matters.

But there’s another layer too: millennial women are not doing especially well.

And that is not just anecdotal.

There is research suggesting that younger generations of women report worse self-rated health, more physical symptoms, more anxiety, and faster weight gain than previous generations did at the same age. Stress appears to explain a meaningful portion of that difference. Proposed drivers include social isolation, poor access to mental health care, social media exposure, rising inequality, inflation, racism, gun violence, climate anxiety, and the erosion of older forms of community and support.

In other words: many women really do feel bad. They really are carrying a lot. They really are more anxious, more stressed, more exhausted, and more physically uncomfortable than the generations before them.

That’s important context.

Because if you are 39, underslept, overstimulated, carrying a full-time job, aging parents, young kids, financial pressure, nonstop digital exposure, and a body that already feels stretched thin… perimenopause can start to sound like the neatest available explanation.

And social media loves a neat explanation.

The nugget of truth

Perimenopause is very real.

It can cause a wide range of symptoms. It can absolutely disrupt sleep, mood, libido, energy, temperature regulation, vaginal and urinary health, and overall quality of life. It has likely been underrecognized and undertreated for years.

It is also true that many doctors — especially those trained during the long shadow of early hormone therapy fear — did not get robust education in how to recognize and manage perimenopause well. Many patients have felt dismissed. Many have had to advocate for themselves. Some still do.

So the push for better awareness is not wrong.

The push for more informed, more compassionate, more evidence-based care is not wrong.

And yes, for some women, part of the answer really is finding a clinician who understands the menopause transition and is willing to have a nuanced conversation about treatment.

That is the nugget of truth.

The trouble starts when that truth becomes so broad that it swallows everything else.

What the research and clinical reality actually tell us

Let’s start with definitions, because this gets blurry fast.

Menopause is officially defined as 12 consecutive months without a period. The average age is 51, and about 90% of women reach menopause between ages 45 and 56.

Perimenopause is the transition leading up to that point — the span that begins with menstrual cycle changes and menopause-related symptoms and extends through the last menstrual period to one year after menopause. On average, it lasts about 3 to 6 years.

That timing matters.

Because while early menopause can happen, and premature menopause does happen, the idea that most women in their early to mid-30s are in perimenopause is not supported by the usual age ranges.

Could a woman in her early 30s be experiencing it? Sometimes, yes — especially if there is a strong family history or other risk factors.

But for most 30- to 35-year-olds with vague symptoms and no cycle changes, perimenopause is probably not the most likely explanation.

And that brings us to another important point:

Perimenopause is a clinical diagnosis.
It is not something that has to be “proven” by lab work.

Menopause society guidelines do not recommend routine hormone labs to diagnose perimenopause, because hormone levels fluctuate dramatically during this phase and often do not give a clear or reliable answer.

This is one of the places where patients and clinicians often start to feel at odds. A patient may feel that not ordering labs means the doctor doesn’t believe her. But in many cases, the doctor is actually following current guidance.

That said, the lack of a definitive test makes the history even more important — and it means we have to think carefully about which symptoms are most specific to the menopause transition.

The symptoms that tend to be most helpful clinically are:

• Menstrual changes

• Vaginal or vulvar changes, including dryness and genitourinary symptoms

• Vasomotor symptoms, like hot flashes, night sweats, and temperature dysregulation

These are the ones that most clearly point us toward hormonal transition.

By contrast, symptoms like fatigue, brain fog, mood changes, headaches, joint pain, and weight changes are real — but they are also common, nonspecific, and shared by many other conditions and life stressors.

A large Australian study published in The Lancet surveyed more than 5,000 women ages 40 to 69 and categorized them into premenopausal, early perimenopausal, late perimenopausal, and postmenopausal groups. What they found was important: symptoms like fatigue, brain fog, and mood changes were extremely common across all groups and did not reliably distinguish women in the menopause transition. Vaginal symptoms and vasomotor symptoms did.

Those nonspecific symptoms often worsened when vasomotor symptoms were present — which suggests that hormonal changes may exacerbate existing burdens — but they were not unique markers of perimenopause on their own.

That distinction matters.

Because if someone comes in with fatigue, anxiety, headaches, joint pain, poor sleep, and weight gain — but no cycle changes, no vasomotor symptoms, and no vaginal symptoms — there is a real risk in anchoring too quickly on perimenopause.

Not because the symptoms aren’t real.
Not because women shouldn’t be believed.
But because other explanations still deserve careful attention.

Thyroid disease. Sleep apnea. Depression. Anxiety. Medication side effects. Iron deficiency. Autoimmune conditions. Chronic stress. Trauma. Life circumstances. A body under strain.

Sometimes the harm isn’t just missing another diagnosis. Sometimes it’s also treating the wrong problem with something that may not help.

Hormone therapy is safer and more nuanced than many of us were taught. But it is still not risk-free, and it is not magic. It reliably helps certain symptoms — especially vasomotor symptoms and vaginal symptoms. It may help other things. It may not.

That is a very different message than:
“Everything you’re feeling is perimenopause, and once you get the right hormones, you’ll feel like yourself again.”

The part that often gets missed

What social media often presents as a hormonal crisis may also be, in part, a human one.

If you are already anxious, already exhausted, already under-supported, already absorbing impossible expectations around work, caregiving, appearance, marriage, parenting, finances, and aging — then perimenopause may not be the whole story. It may be the thing that pushes an already strained system over the edge.

That doesn’t make it less real.

It makes it more complex.

And that complexity matters, because the true drivers of symptom burden are often much less clickable than a hormone fix.

Things associated with more severe menopausal symptoms include anxiety, depression, stress, smoking, sedentary lifestyle, trauma history, partner violence, and broader socioeconomic factors. Those are not the kinds of things that fit neatly into a 30-second reel or an affiliate link.

But they are part of the truth.

And when we ignore them, we risk turning a real physiologic transition into a catch-all diagnosis for modern female depletion.

So… are we all in perimenopause?

No.

But a lot of women are looking for an explanation for why they feel bad. And perimenopause is one of the first explanations that finally feels physiologic, valid, and socially endorsed.

That matters.

At the same time, not every symptom in a woman over 35 is perimenopause. Not every tired, anxious, foggy, puffy, irritable season is a hormone disorder. And not every woman needs labs or hormone therapy to feel better.

Some do.

Some need treatment for clear perimenopausal symptoms.
Some need a more thorough workup.
Some need sleep.
Some need support.
Some need iron.
Some need less screen time.
Most need more than a single reel can offer.

The Antidote

For Patients

(Gentle reminders and affirmations)

• It makes sense that I want an explanation for why I feel different.

• Perimenopause is real — but it is not the only possible explanation.

• Not every symptom in my late 30s or 40s is automatically hormonal.

• If my doctor doesn’t order labs, that does not automatically mean they are dismissing me.

• I deserve a clinician who takes my symptoms seriously and thinks broadly.

• A useful question is not just “Could this be perimenopause?” but also “What else deserves attention here?”

For Clinicians

(Language you can borrow, tweak, or make your own.)

• “I absolutely believe perimenopause can cause significant symptoms, and I take this seriously.”

• “Some symptoms are more specific to the menopause transition than others, so I want to think carefully with you about the full pattern.”

• “Not ordering hormone labs does not mean I don’t believe you — those labs often don’t reliably diagnose perimenopause because hormone levels fluctuate so much.”

• “If this is perimenopause, I want to treat it thoughtfully. And if it’s something else, I don’t want to miss that by anchoring too quickly.”

• “We can hold two things at once: your symptoms are real, and the answer may be more complicated than one diagnosis.”

• “Social media can be incredibly validating, but it can also make common symptoms feel more specific than they are. Let’s sort through this together.”

Sources and Further Reading

• Menopause Society Glossary and Patient Education https://menopause.org/patient-education/menopause-glossary

• Physicians’ Gender Bias in the Diagnostic Assessment of Medically Unexplained Symptoms and Its Effect on Patient-Physician Relations https://pubmed.ncbi.nlm.nih.gov/31124165/

• Physical Health of Young, Australian Women: A Comparison of Two National Cohorts Surveyed 17 Years Apart.

  https://pubmed.ncbi.nlm.nih.gov/26528902/

• Does the Millennial Generation of Women Experience More Mental Illness Than Their Mothers?

  https://pubmed.ncbi.nlm.nih.gov/34273942/

• Trajectories and Determinants of Weight Gain in Two Cohorts of Young Adult Women Born 16 Years Apart.

  https://pubmed.ncbi.nlm.nih.gov/33941842/

• Tics and TikTok: Functional Tics Spread Through Social Media. https://pmc.ncbi.nlm.nih.gov/articles/PMC8564820/

• Experts to Follow:

  • https://www.instagram.com/drjengunter

  • https://www.instagram.com/drrachelrubin

  • https://www.instagram.com/anushreekumarmd/

Prefer to listen to a human conversation?

Listen to the episode

A patient recently told Sonia something that sounded small at first.

“I don’t even know what to eat for breakfast anymore.”

She wasn’t trying to lose weight. She wasn’t starting a new diet. She just wanted breakfast to stop feeling stressful.

She liked yogurt. But now there were too many questions.
Full fat or nonfat? Too much sugar? Artificial sweeteners? High protein? Hormone-friendly? Clean? Inflammatory?

Every option felt like a potential mistake.

When Sonia gently asked where all this information was coming from, the answer wasn’t a textbook or a doctor.

It was her feed.

She’d been watching #WhatIEatInADay videos. Not intentionally, at first. They just started appearing. Influencers sharing beautifully plated meals. “Realistic.” “Balanced.” “For hormone health.” “For gut healing.” “For fat loss.” “For PCOS.” “For busy moms.”

She wasn’t trying to copy anyone exactly. But slowly, without realizing it, she had absorbed a new standard.

And suddenly yogurt felt complicated.

That’s the quiet power of #WhatIEatInADay.

So let’s slow down and ask the bigger question:

Is it actually helpful to know what someone else eats in a day?

The claim

Unlike some viral health trends, the claim here is rarely shouted.

It’s implied.

The format is simple: someone walks you through their meals and snacks across a day. Often there’s more layered in — a workout, a supplement routine, a productivity montage, a body shot, a skin routine.

And the framing usually sounds like this:

“What I eat in a day as a woman balancing hormones.”
“What I eat in a day postpartum trying to lose baby weight.”
“What I eat in a day managing PCOS naturally.”
“What I eat in a day as a fat person not trying to lose weight.”

The underlying message often becomes:

If you want what I have — my body, my energy, my results — this is how you should eat.

And subtly:

What you eat in a day says something about who you are.

Not just your health. Your identity.

Why this is so viral

Before we critique it, we want to validate something important:

There’s a reason this content resonates.

Humans are wired to be interested in other humans. We are social creatures. Eating has always been communal — families, villages, cultures gathering around food.

But increasingly, we’re eating alone.

Data from the World Happiness Report (2025) show that in the United States, about one in four adults reported eating all of their meals alone the previous day — a significant increase over the last two decades, especially among young people.

When shared meals decrease, watching someone else eat may feel like connection.

There’s also aspiration.

If we see someone whose body or lifestyle we admire, it’s natural to assume their habits are the key. Copy the inputs, get the outputs.

And then there’s the algorithm.

Social media doesn’t just show you what you search for. It learns what holds your gaze — even for a few seconds — and gives you more. Food, bodies, routines, transformation narratives. Slightly more intense each time.

What begins as curiosity can quietly become comparison.

Most people watching these videos aren’t trying to be extreme. They’re trying to feel certain.

The nugget of truth

There is something useful here.

Seeing how someone structures meals can reduce decision fatigue. It can make feeding yourself feel doable in a busy season. It can spark ideas.

For someone newly postpartum, newly diagnosed with a chronic condition, or overwhelmed by conflicting advice, an example can feel grounding and make an overwhelming new normal feel doable.

And yes — some creators share thoughtfully and transparently.

But there are two important caveats:

First, what someone eats in one day may not reflect what they eat most days. Filming changes behavior. Social media rewards aesthetics and certainty- so there is certainly editing involved to grab the algorithm’s attention.

Second, even if it is accurate, it is not transferable biology.

Two people can eat the same foods and have completely different outcomes because genetics, stress, sleep, medications, hormones, culture, and access all matter.

What the research tells us

Here’s where this conversation gets more complex.

A 2025 analysis of nutrition-related TikTok content found that a large portion lacked advertising transparency, conflict-of-interest disclosure, or balanced evidence framing. Engagement (likes, shares) did not reliably correlate with accuracy. Although "#WhatIEatInADay videos may not overtly claim to be educational nutrition content, they often imply it, and there are often conflicts behind the scenes.

That doesn’t mean everything online is wrong. It means platforms are not structured to reward nuance.

More strikingly, a 2025 experimental study in Appetite exposed college students to six minutes of short-form #WhatIEatInADay content. Compared to a non-food control condition, those exposed to lifestyle and eating videos showed increases in weight and shape preoccupation and shifts in urges related to eating disorder behaviors.

Six minutes.

That doesn’t mean everyone who watches these videos will develop disordered eating. But it does challenge the idea that this content is neutral background noise.

Another 2023 study found that the type of content consumed — particularly weight-loss–focused content — was more strongly associated with body image disturbance and disordered eating behaviors than total screen time. Notably, body positivity content did not clearly buffer these effects in that sample.

Content matters.

This is particularly important for adolescents, whose autonomy is developing while algorithms are refining.

There is also research exploring “mukbang” (videos focused on watching someone eat, often emphasizing sensory elements). Some viewers report increased loneliness and guilt. Others report feeling less alone or more able to eat.

Whether there is any causation of these responses from this content is not clear. People vulnerable to food preoccupation may seek out this content, and the content may also amplify vulnerability- both could be true. However it is worth learning more to understand the potential impact this kind of content might have.

The part that often gets missed

We’ve become accustomed to thinking of content as something we choose.

But increasingly, content chooses us.

You don’t have to search for weight-loss videos to see them. You only have to pause long enough for the algorithm to notice.

And because food is tied to identity, morality, control, and health fears, it’s particularly sticky.

We also want to gently name something about the phrase “what I eat in a day.”

It sounds neutral. Observational.

But it often functions as aspirational.

It implies that there is a correct way to eat in a day. That normal is stable. That discipline is visible. That health is aesthetic.

Real eating is messy. Variable. Cultural. Emotional. Practical. Boring some days. Joyful others.

A curated reel rarely captures that.

So… is it helpful?

Here’s the honest answer:

It depends on how it makes you feel.

If it gives you ideas and you move on without spiraling, it may be neutral or mildly useful.

If it leaves you tense, comparing, second-guessing, cutting out food groups, or feeling like your day “didn’t measure up,” that’s important information.

The biggest drivers of long-term health do not come from following a “perfect” day template every single day.

They are found in overall patterns: sleep, movement, nutrition, vaccination, social connection, mental health support, education, not smoking, moderated alcohol use.

And those rarely go viral.

The Antidote

For Patients

• It makes sense that I want clarity around food.

• One person’s day of eating is not a medical prescription.

• Filmed food is curated food.

• If content increases my anxiety, I can step back.

• Health is built with patterns, not perfection.

• I don’t need to earn nourishment.

• A helpful check-in question:
  After watching this, do I feel grounded — or more hyperaware and tense?

  That answer matters.

For Clinicians

• “Are you concerned about how social media is affecting your relationship with food?”

• “What kinds of food or body-related content are you seeing most often?”

• “It makes sense that you’re looking for clarity — nutrition messaging is very noisy right now.”

• “Content isn’t neutral. Even brief exposure can shape thoughts more than we realize.”

• “Let’s tailor this to your life. What works sustainably for you?”

• Consider direct screening with a validated eating disorder screening tool.

Sources and Further Reading

• World Happiness Report 2025, Chapter 3: “Sharing meals with others: How sharing meals supports happiness and social connections” https://www.worldhappiness.report/ed/2025/sharing-meals-with-others-how-sharing-meals-supports-happiness-and-social-connections/

• #WhatIEatinaDay: The Quality, Accuracy, and Engagement of Nutrition Content on TikTok

  https://pubmed.ncbi.nlm.nih.gov/40077651/

• Does watching short-form #WhatIEatInADay videos impact eating disorder cognitions and urges to engage in eating disorder behaviors? An experimental investigation of TikTok

  https://pubmed.ncbi.nlm.nih.gov/40188953/

• The impact of social media use on body image and disordered eating behaviors: Content matters more than duration of exposure

  https://pubmed.ncbi.nlm.nih.gov/37060807/

• Mukbang and Disordered Eating: A Netnographic Analysis of Online Eating Broadcasts

  https://pubmed.ncbi.nlm.nih.gov/32277331/

• The relationship between problematic Instagram use and eating disorders psychopathology: an explanatory structural equation model

  https://pubmed.ncbi.nlm.nih.gov/37022359/

• Association between engagement with appearance and eating related TikTok content and eating disorder symptoms via recommended content and appearance comparisons

  https://pubmed.ncbi.nlm.nih.gov/38108594/

• Wait Until 8th:

  https://www.waituntil8th.org/

• The 5 Cs of Media Use: Guides for parents from the American Academy of Pediatrics Center of Excellence on Social Media and Youth Mental Health

  https://www.aap.org/en/patient-care/media-and-children/center-of-excellence-on-social-media-and-youth-mental-health/5cs-of-media-use/

Listen to the episode

A patient messaged Sonia in a panic: she’d broken out in a rash “all over her face.” It was red, itchy, bumpy, and sudden. Her skin had been clear before. She was worried it was hormonal. Or something she ate. Or “something going on internally.”

When she came in, the pattern was classic: the redness and irritation sat exactly where you’d expect a new face product to land—cheeks, around the mouth, along the jawline. It looked like allergic contact dermatitis.

Sonia asked the question that often unlocks the mystery:

“Have you used anything new?”

The patient paused, then said yes—but it couldn’t be that. Because the new product was “clean.” Natural. Safer.

She’d recently thrown out her old skincare to make the switch to cleaner products. The new moisturizer was made from ingredients that felt almost comforting in their simplicity: beef tallow, olive oil, lavender oil, tea tree oil, beeswax.

And it had completely wrecked her skin.

That visit ended up being a perfect snapshot of the clean beauty conversation: a movement that often starts with a legitimate concern—I want products that are safer for my body—but can quickly drift into a confusing, moralized, anxiety-provoking maze of ingredient lists, fear-based marketing, and false certainty.

So let’s slow down and ask the bigger question:

Should we all be switching to clean beauty?

The claim

The clean beauty message usually goes something like this:

Conventional beauty and personal care products contain “toxins.” Clean products don’t. Therefore clean products are safer—less irritating, less hormonally disruptive, less carcinogenic, and better for you in the long run.

Sometimes the claim expands into a whole constellation of promises: “clean” also means more ethical, more sustainable, cruelty-free, better for the environment, better for your hormones, better for your skin.

And it can feel like the stakes are high.

Not just “what moisturizer should I use,” but “am I harming myself by using what everyone else uses?”

Why this is so viral

Here’s the part we want to validate immediately: there is a reason people are worried.

There are historical examples of personal care products turning out to be harmful, sometimes after being marketed as safe for decades. Many of us remember the headlines about talc powders and ovarian cancer risk, or the stories about skin-lightening products containing mercury.

At the same time, there’s been a lot of public conversation about rising rates of certain cancers in younger people. The medical community is still working through the “why”—and the likely answer is that it’s multifactorial. But when science doesn’t yet have satisfying explanations, our brains search for something we can control.

That’s where clean beauty fits perfectly.

It offers a simple, consumer-friendly solution:
If you switch your products, you reduce your risk.

It feels empowering. It feels protective. It feels like taking action in a world that often feels out of control.

And the marketing is skilled. It often frames clean beauty as advocacy—especially for women and children—because those groups have historically been underprotected and undertested in consumer product safety.

So yes: the emotional logic behind clean beauty is understandable. Most people aren’t trying to be “extreme.” They’re trying to feel safe.

The nugget of truth

There are ingredients found in personal care products that have been linked—through a mix of laboratory studies, animal studies, and human epidemiology—to potential health effects.

Some of the concern centers on endocrine-disrupting chemicals: substances that may mimic, block, or interfere with hormonal signaling.

And here’s where the conversation gets tricky, because the science isn’t simple—and it isn’t settled in the way many social media posts suggest.

In traditional toxicology, we’re taught a principle that’s worth keeping: the dose makes the poison. Whether something is harmful depends on the concentration, the route of exposure, the frequency of use, the timing (pregnancy, infancy, puberty), and the person’s biology.

But endocrine disruptors have challenged some of the clean lines toxicologists like to draw. Some experts argue that hormonal systems can be sensitive to small exposures at key developmental windows—and that we may not fully understand the long-term effects yet.

That disagreement is real.

It’s not “doctors denying science” versus “clean beauty telling the truth.” It’s a genuine scientific debate about how to interpret imperfect data in a world where exposures are widespread and hard to isolate.

The piece most people aren’t told: “clean” doesn’t mean what you think it means

One of the biggest problems with clean beauty isn’t that people want safer products. It’s that the word “clean” itself is not regulated.

It isn’t a scientific label. It’s a marketing label.

A brand can call a product “clean” without proving anything about safety, hormonal effects, cancer risk, or irritation risk. Sometimes “clean” simply means “free from the handful of ingredients that consumers currently fear most.”

Which leads to the first big paradox:

A product can remove one ingredient you’re worried about—and replace it with something else that is less studied, more allergenic, or simply differently risky.

Parabens are a good example.

Parabens are preservatives. Their job is to prevent bacteria and mold from growing in products that sit in warm bathrooms and get repeatedly touched by hands. They’re used because they work—and because they’re relatively non-allergenic compared to many alternatives.

If a company removes parabens to satisfy consumer demand, it still has to preserve the product. That replacement might be a preservative that triggers more contact dermatitis. Or a botanical ingredient that is “natural” but highly sensitizing. Or a newer preservative with less long-term data.

And we don’t always notice those tradeoffs until something goes wrong—like a patient who switches to “natural” and ends up inflamed, itchy, and miserable.

“But I’d rather be safe than sorry”

This is the sentence we hear all the time, and we get it. It makes emotional sense.

But “safe” is not a single switch you flip. It’s a set of tradeoffs.

If you remove preservatives, you increase the risk of microbial contamination. That might not feel dramatic until you realize that contaminated eye makeup has caused serious infections in real people.

If you replace “chemicals” with essential oils, you may reduce one category of concern and increase another: essential oils are a common cause of allergic contact dermatitis, and certain oils (including lavender) have been implicated as endocrine disruptors in children.

So the question isn’t “is natural safer?” The question is:

Safer in what way, for whom, at what dose, and compared to what alternative?

The apps don’t solve this

A lot of people try to navigate clean beauty with ingredient-scanning apps that score products as green/yellow/red.

We understand why: when you feel overwhelmed, you want a simple tool that tells you the answer.

But these apps often oversimplify the science by treating ingredients as inherently “good” or “bad” without accounting for concentration, typical use, formulation, route of exposure, and the quality of evidence.

They also aren’t neutral. Many monetize through affiliate relationships or product recommendations—meaning the “safer” product is sometimes also the product they benefit from you buying.

That doesn’t mean every recommendation is wrong. It means you should be cautious about outsourcing your health anxiety to a scoring algorithm.

So…should you switch?

Here’s the most honest answer we can offer:

If you like a product that’s labeled “clean,” you can afford it, and it doesn’t increase your anxiety or trigger obsessive researching and scanning—there is nothing wrong with choosing it.

But “clean” is not a guarantee of safer. And the individual health impact of switching a few personal care products is likely small—especially compared to well-established risk reducers like not smoking, limiting alcohol, getting HPV and Hep B vaccination, eating fiber-rich foods, and using sunscreen consistently.

This is not the same category of risk as tobacco. It’s not the same category of risk as heavy alcohol use. It’s not the same category of risk as uncontrolled hypertension.

And that matters, because clean beauty marketing often implies you’re making a life-or-death decision at the checkout line.

You’re not.

The part that gets missed: this is a public health problem, not a personal failing

U.S. cosmetic regulation is limited compared to other industries. The FDA does not pre-approve cosmetics the way it approves medications, and companies largely bear responsibility for ensuring safety. That reality contributes to distrust, and it isn’t unreasonable for consumers to want stronger oversight.

But when we respond to systemic problems with purely individual solutions—“just buy the clean version”—we often end up with the worst of both worlds:

• people spending more money for uncertain benefit

• people feeling guilty if they can’t afford the “right” products

• people feeling constant low-grade fear about what they’re using

• and the broader system staying largely unchanged

If we want meaningful change, it requires stronger research funding, stronger regulation, and less reliance on marketing as our safety net.

A note about “clean living” and why the word matters

Clean beauty often travels with clean eating, clean home, clean living.

And we want to name something gently: “clean” is not a neutral word.

It implies purity. It implies morality. It implies that people who don’t do it are careless—or “dirty.” And on social media, those ideas can slide quickly into shame, fear, and sometimes more extreme content.

This doesn’t mean everyone interested in clean beauty is participating in purity culture.

It does mean we should stay aware of how easily anxiety + algorithms can escalate.

If your search starts with “safe sunscreen” and ends with “don’t trust doctors,” that’s not because you’re irrational. It’s because the platform is optimized to serve you more intense versions of what you engaged with.

The Antidote

For Patients

• It makes sense that I want safer products.

• “Clean” is a marketing term, not a medical guarantee.

• Natural doesn’t automatically mean safer.

• If there is risk here, it’s likely small.

• I don’t have to fix a public health issue with my shopping cart.

• The biggest drivers of my health aren’t in my moisturizer.

For Clinicians

• “I completely understand why you’re worried — there are real gaps in regulation.”

• “If there are harms from these ingredients, they’re likely subtle and population-level.”

• “‘Clean’ isn’t a regulated term, so it doesn’t necessarily mean safer.”

• “When one ingredient is removed, it’s usually replaced with something else — and that swap isn’t always lower risk.”

• “Let’s also focus on the prevention strategies we know clearly reduce cancer risk.”

Sources and Further Reading

• Amended Safety Assessment of Parabens as Used in Cosmetics https://www.cir-safety.org/sites/default/files/Parabens_0.pdf

• History- Clean Living Movement https://en.wikipedia.org/wiki/Clean_living_movement

• The Hoax of Clean Beauty and Associated Allergens https://link.springer.com/article/10.1007/s13671-023-00399-4

• Natural Is Not Always Better: The Prevalence of Allergenic Ingredients in “Clean” Beauty Products https://www.liebertpub.com/doi/abs/10.1097/DER.0000000000000863

• Natural Does Not Mean Safe—The Dirt on Clean Beauty Products https://jamanetwork.com/journals/jamadermatology/fullarticle/2751513

• Instagram accounts to follow:

  • @labmuffinbeautyscience

  • @moskinlab

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A Patient’s Story

A patient came to Dr. Singh after being diagnosed with subclinical hypothyroidism.

Her previous doctor checked a TSH and free T4 and recommended monitoring.

She didn’t want to “wait and see.”

So she sought out an alternative practitioner.

They ran a “full thyroid panel” — T3, reverse T3, TPO antibodies, TG antibodies, more.

She was told she had Hashimoto’s.
That she was “inflamed.”
That she needed to cut gluten, dairy, cruciferous vegetables.
And take iodine, selenium, and multiple supplements.

At first, she felt empowered.

Finally, someone was taking her seriously.

But was more testing actually the answer?

Let’s break it down.

What Is the Claim?

If you’re concerned about thyroid dysfunction, you need a “full thyroid panel” — not just a TSH.

A typical “full panel” may include:

• TSH

• Free T4

• Total or Free T3

• Reverse T3

• TPO antibodies

• Thyroglobulin antibodies

• TSI

The implication:

If your doctor only checks 1–3 labs, they are missing something.

Why Is This Viral?

The thyroid is an incredibly important organ, and dysfunction affects a wide variety of body systems.

Symptoms of hypothyroidism include:

• Fatigue

• Brain fog

• Weight changes

• Hair thinning

• Mood changes

• Constipation

They are subtle.
They are common.
They overlap with many conditions.

It is incredibly frustrating to feel unwell…and be told your labs are normal, implying that nothing is really wrong.

When someone else says:

“You just haven’t had the right tests yet.”

That is deeply compelling.

And we don’t always explain the physiology well in traditional medicine. That leaves gaps. Those gaps get filled.

The Nugget of Truth

More testing does give more information.

And:

• Many of these labs can be helpful in specific clinical scenarios.

• The thyroid is complex.

• Labs don’t always tell the full story.

• The healthcare system often feels rushed and dismissive.

It’s understandable to want more data.

But more data is not the same thing as more useful data.

The Physiology (Briefly Explained)

TSH is made in the brain (pituitary gland).
It tells the thyroid to make hormone.

Thyroid makes mostly T4.
T4 converts to T3 (the active hormone) at the tissue level.

In primary hypothyroidism:

• TSH = high

• Free T4 = low

TSH is extremely sensitive for detecting hypothyroidism (≈98% sensitivity).

That’s why major societies recommend:

TSH first. Free T4 if abnormal.

That’s not dismissal.
That’s evidence-based testing.

What About T3?

It sounds logical:

“If T3 is the active hormone, shouldn’t we check it?”

But:

• The T3 assay is less reliable than T4.

• T3 levels often stay normal until disease is advanced.

• Conversion issues usually occur in severe illness or starvation — not mild outpatient symptoms.

Checking T3 in initial evaluation rarely changes management.

What About Reverse T3?

Reverse T3 is often promoted online.

But:

• It reflects non-thyroidal illness (euthyroid sick syndrome).

• It changes in ICU-level illness, trauma, starvation, sepsis.

• It does not improve diagnostic accuracy for hypothyroidism.

Major guidelines do not recommend it for routine assessment.

What About Antibodies?

Anti-TPO antibodies can indicate autoimmune thyroid disease such as Hashimoto’s Thyroiditis.

When are they helpful?

• Subclinical hypothyroidism (TSH high, Free T4 normal) to predict risk of progression

• Presence of a goiter

But:

Up to 20% of the general population has TPO antibodies.
Only 2–4% progress to overt hypothyroidism annually.

Serial antibody testing does not change management.

Lowering antibody levels has not been shown to prevent progression, and there is not clear evidence that anything can be done to lower antibody levels.

The Bigger Issue

This conversation isn’t just about labs.

It’s about communication.

Patients want:

• Explanation

• Validation

• Follow-up

• Partnership

Normal labs should never mean:

“Nothing is wrong.”

They mean:

“It’s not your thyroid. Let’s keep going.”

What Happened to Our Patient?

After a year of extreme dietary restriction and supplements…

Her TSH became overtly abnormal.

She started levothyroxine.

Her labs normalized.

Her symptoms improved.

The supplements hadn’t prevented progression.

And the restriction had taken a toll.

The Antidote

For Patients

• Normal labs do not invalidate your symptoms- you deserve follow-up

• More testing isn’t always more clarity.

• Physiology explanations are compelling — but clinical data matters.

• If you’re unsure, see an endocrinologist.

For Clinicians

• Explain the physiology.

• Validate symptoms.

• Don’t stop at “labs are normal.”

• Schedule follow-ups to close the loop.

Sources and Further Reading

• Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III) https://pubmed.ncbi.nlm.nih.gov/11836274/

• Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association
  https://www.endocrinepractice.org/article/S1530-891X(20)43030-7/fulltext

• Instagram Accounts to Follow:

  • @everything_endocrine

  • @drartithangudu

  • @yourendodoctors

Prefer to listen to a human conversation?

Listen to the episode

When Rebecca was a medical student on a surgery rotation, her days started at 4 a.m. and often ended after 7 p.m. There were no predictable breaks—just a constant scramble to eat when and if you could.

Her co-student on the rotation was deeply committed to “clean eating.” During their ten-minute lunch breaks, they’d complain about the hospital cafeteria being full of “processed crap.” They refused to eat anything available except steamed green beans—the only food they deemed “clean” enough. They commented on the granola bars Rebecca carried in her white coat pockets so she could eat something—anything—between cases.

That day, after nearly fifteen hours on their feet, they had eaten only green beans.

What’s the Claim?

Across social media, influencers and even some health professionals promote “clean eating” as a path to better health, weight loss, and disease prevention.

There’s no single definition, but it usually means:

• Eating mostly “whole” foods

• Avoiding additives, preservatives, or “toxins”

• Demonizing “processed” foods

Today, we’re less interested in debating individual ingredients and more interested in the concept itself: clean vs. unclean eating—and why that framing can be harmful and counterproductive.

Why Is It So Viral?

Despite the lack of a clear definition, “clean eating” has a very positive reputation.

A 2020 study of U.S. adolescents and emerging adults found that:

• 71% viewed clean eating as healthy

• 41% said they would probably try it

• Definitions varied widely, but dietary avoidance and restriction were common

• Willingness to try clean eating was significantly higher among women

People want to live long, healthy lives. Many have watched loved ones suffer from chronic disease. In a world where so much feels out of our control, food can feel like one of the few things we can control.

Nutrition is also deeply confusing. Advice changes constantly, formal education is limited, and reliable guidance can be hard to access.

Layer on top of that:

• A culture that stigmatizes higher-weight bodies

• “Good vs. bad” food messaging we absorb from childhood

• A wellness industry that profits from fear, purity, and weight loss

And suddenly, “clean eating” doesn’t just feel intuitive—it feels virtuous.

In The Gospel of Wellness, journalist Rina Raphael describes how values once tied to religion—purity, discipline, moral worth—have migrated into wellness culture. Social psychologist Jonathan Haidt makes a similar point in his TED Talk on moral psychology, noting how food has become deeply moralized, especially among women.

An essay titled Purity Culture, Diet Culture, and Where They Intersect puts it this way:

“Purity… expresses itself in our culture through female bodies. It asks those with female bodies to restrain, refrain, limit… to make ourselves smaller—physically and in terms of life experience.”

That framing helps explain why “clean eating” is so often marketed to women—and why it can feel both aspirational and suffocating.

What’s the Nugget of Truth?

Nutrition matters. Different foods have different nutrient density. Diet plays a major role in health.

A diet made up mostly of highly processed foods is more likely to be low in fiber and key micronutrients. Incorporating a wider variety of foods can meaningfully improve health outcomes.

That part is real.

The problem is what gets layered on top of it.

The Facts (With Context and Nuance)

Food processing is not inherently bad. Processing:

• Improves shelf stability and safety

• Reduces food waste

• Makes food more affordable and accessible

• Allows large populations to be fed consistently

Processing can be as simple as freezing vegetables—or as complex as engineering snack foods to maximize crunch, salt, sweetness, and reward.

Food companies are incentivized to design products that bypass normal satiety cues, encouraging us to eat more. That matters—but it’s not the same as saying processed food is inherently “bad” or unsafe.

Many people face real barriers to eating a balanced diet:

• Cost and food deserts

• Limited time and demanding work environments

• Lack of nutrition education

• Aggressive and misleading food marketing

It is absolutely possible to eat a nutritionally adequate, balanced diet that includes processed foods—even foods with additives and added sugar.

What Does the Data Say?

According to the CDC, about 60% of the average American diet comes from processed foods. That makes strict “clean eating” not just aspirational—but often unrealistic.

Multiple studies show a consistent pattern:

• People who follow clean eating advice may meet certain dietary guidelines more often

• They also show significantly higher levels of dietary restraint (defined as “ obsessive effort to restrict and control calorie intake and food choices”)

• Dietary restraint is strongly linked to disordered eating behaviors

Studies have also found associations between clean eating beliefs and:

• Orthorexia nervosa symptoms

• Eating disorder symptoms

• Thin-ideal internalization

• Body image distress

In other words: the same framework that looks healthy can quietly increase risk—especially for women and vulnerable populations.

What Can We Learn From This?

“Clean eating” has no standard definition and is not a medical recommendation.

While the underlying desire—to nourish your body—is valid, the clean/unclean framing:

• Moralizes food unnecessarily

• Ignores context and access

• Is unrealistic for many people

• Can increase fear, guilt, and rigidity around eating

For some, it’s not neutral advice—it’s actively harmful.

The Antidote

For Patients:

(Gentle reminders and affirmations)

• I don’t have to earn health through purity.

• Food isn’t a measure of my character.

• One meal doesn’t define my health.

• My body needs enough food, not perfect food.

• Convenience foods are not a personal failure.

• If a rule makes my world smaller, it’s not serving me.

• I’m allowed to unfollow content that makes me feel worse.

For Clinicians:

(Language you can borrow, tweak, or make your own.)

• “When you say ‘clean eating,’ what does that mean to you?”

• “What foods do you actually have access to—time-wise and money-wise?”

• “Are any of these rules making it harder for you to eat enough?”

• “Have you ever noticed anxious or restrictive patterns around food?”

• “Let’s aim for nourishment and sustainability, not purity.”

• “Would it feel helpful to involve a dietitian or therapist here?”

• Use a validated eating disorder screening tool

Sources & Further Reading

• “It’s Healthy Because It’s Natural.” Perceptions of “Clean” Eating Among U.S. Adolescents and Emerging Adults
  https://pubmed.ncbi.nlm.nih.gov/32517342/

• The Dirt on Clean Eating: Dietary Intake, Restrained Eating, and Opinions About Clean Eating Among Women
  https://pmc.ncbi.nlm.nih.gov/articles/PMC6164197/

• Is #cleaneating a Healthy or Harmful Dietary Strategy?
  https://pmc.ncbi.nlm.nih.gov/articles/PMC6545628/

• “Eat Clean, Train Mean, Get Lean”: Body Image and Health Behaviors on Instagram
  https://pubmed.ncbi.nlm.nih.gov/35644096/

• CDC: Processed Foods and Dietary Intake
  https://www.cdc.gov/pcd/issues/2018/17_0265.htm

• Jonathan Haidt – The Moral Roots of Liberals and Conservatives (TED Talk)
  https://www.ted.com/talks/jonathan_haidt_the_moral_roots_of_liberals_and_conservatives

• Purity Culture, Diet Culture, and Where They Intersect
  https://www.pastemagazine.com/food/diet/purity-diet-culture-roe-v-wade

• Four Simple Questions Can Help Screen for Eating Disorders

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1494802/

• A Nuanced Look at Ultra-Processed Foods – Your Local Epidemiologist (Guest: Megan Maisano, MS, RDN)

  Your Local Epidemiologist

  What are ultra-processed foods, really?

  It’s time for the annual YLE check-in—and I need your help. Please take 7 minutes to fill out this short, anonymous survey so we can shape the future of Your Local Epidemiologist together…

  Read more

  a year ago · 553 likes · 55 comments · Megan Maisano, MS, RDN

• Instagram/Substack accounts to follow

  • @kids.eat.in.color

  • @drjessicaknurick

  • @dr.adrian.chavez

Prefer to listen to a human conversation?

Listen to the episode

The Claim

A widely shared narrative on social media goes something like this:

“An entire generation of women was put on birth control as teenagers for acne or irregular periods—and now that same generation is dealing with PCOS, infertility, depression, and hormonal imbalance.”

The implication is powerful—and alarming:

• Birth control was used as a lazy band-aid

• Doctors didn’t care to explain why symptoms were happening

• Birth control pills caused long-term harm

• Women are now paying the price

If this story resonates with you, you’re not alone.

Why This Went Viral

There are several very real reasons this narrative spread so widely:

Women often feel dismissed in healthcare settings.
Especially around gynecologic concerns. Many women have been told “just take birth control” without a full explanation of the diagnosis, long-term implications, or alternatives.

Informed consent often feels incomplete.
Even when the recommendation is evidence-based, lack of time means risks, benefits, and alternatives may not be fully discussed.

Women’s health is historically understudied and underfunded.
That uncertainty creates fertile ground for mistrust—and for influencers to fill the gap with oversimplified explanations.

There’s a cultural and political undertone.
We are watching a resurgence of messaging that frames birth control as unnatural, dangerous, or morally suspect—often without acknowledging what a revolutionary advancement it was for women’s autonomy.

This isn’t happening in a vacuum.

The Nugget of Truth

There is truth embedded in this concern.

• Women have been historically dismissed by the medical system

• Time constraints often limit meaningful discussion

• Birth control pills do have side effects—some of them serious

• Patients deserve better explanations and true shared decision-making

Where the narrative goes off the rails is in blaming birth control itself for every downstream issue—rather than recognizing that many of these symptoms existed before the pill and were the reason it was prescribed in the first place.

The Facts (With Context)

For clarity, this episode focuses on combined oral contraceptives (COCs)—the estrogen + progestin pills most people mean when they say “birth control.”

Birth Control Pills Are Not Just for Contraception

COCs are evidence-based treatments for:

• Painful periods (including endometriosis and fibroids)

• Acne and hirsutism in PCOS

• Hypogonadism or premature ovarian failure

• Reducing ovarian and endometrial cancer risk

• Perimenopausal symptoms while still preventing pregnancy

They are often used because they work—not because doctors are avoiding “root causes.” For many of these conditions, we have not yet identified a single root cause (in part because of the limitations of available research as discussed above).

Common Side Effects (Usually Mild)

• Nausea, bloating, breast tenderness (often short-lived)

• Unscheduled bleeding (especially early or with missed pills)

Weight Gain

Large meta-analyses do not show significant weight gain on average.
That said, individual experiences vary—and weight changes are common in adolescence, early adulthood, and life transitions regardless of birth control use.

Both things can be true.

Mood Changes

Data is mixed.

• Some people experience worsening mood

• Some experience improvement

• Pre-existing mood disorders may increase likelihood of discontinuation

A large UK cohort study (2023) found a small increased risk of depression, particularly early in use and during adolescence—but this is not universal, and birth control is also an evidence-based treatment for PMDD.

Fertility, Libido & Other Internet Fears

• No evidence of long-term fertility damage

• Short delays in cycle normalization after stopping are expected

• Libido effects vary—no consistent pattern

• Claims about partner selection and genetic compatibility are based on very small studies and are not clinically meaningful

If fertility issues arise after stopping birth control, the underlying condition that led to its prescription (PCOS, endometriosis, fibroids) is often the true cause—not the pill.

Serious Risks (The Ones That Actually Matter)

Blood Clots (VTE)

• Relative risk increases 3–5x on COCs

• Absolute risk remains low

• Pregnancy and postpartum carry much higher clot risk than birth control

Stroke & Heart Attack

• Risk is low in young, healthy nonsmokers

• Higher risk with migraine with aura, smoking, hypertension, or vascular disease

• Newer low-dose pills are significantly safer than older formulations

Cancer

• No increase in overall cancer risk

• Long-term protection against ovarian, endometrial, and colorectal cancers

• Temporary increase in breast and cervical cancer risk during current use—which resolves within years after stopping

What Birth Control Does Not Cause

There is no credible evidence for a “post-birth control syndrome.”

Some micronutrient levels may be slightly lower during use (often subclinical), which is why:

• People who could become pregnant should take a prenatal vitamin

• Nutrition matters—especially in a culture obsessed with restriction

What many people describe as “post-birth control symptoms” are often:

• The return of underlying hormonal conditions

• Normal cycle variability

• Stress, life transitions, or nutritional issues

A Word on Fertility Awareness & Alternatives

There are evidence-based fertility awareness methods. Most of us have heard of the “Rhythm Method,” but there are many more sophisticated and accurate methods of predicting the fertile window using observable signs such as cervical mucus, basal body temperature, and even hormone monitoring devices.

• Perfect use: 95–99.5%

• Typical use: 83–98%

They require education, commitment, and partner participation—and should be offered respectfully, not dismissed.

So should vasectomy—because contraception is not solely a woman’s responsibility.

3 Take-Home Points

1. Birth control pills have real risks—but pregnancy is riskier.

2. They don’t cause long-term harm or infertility.

3. You didn’t break your body by taking them.

The Antidote

For Patients

(Gentle reminders and affirmations)

• I didn’t ruin my hormones.

• I’m allowed to choose what works for my body.

• Needing ongoing treatment doesn’t mean something was “masked.”

• I deserve full information—not fear.

• If I feel dismissed, I can seek a different clinician.

For Clinicians

(Language you can borrow, tweak, or make your own.)

• “Let’s talk through your concerns before we decide anything.”

• “This treats symptoms and we can still investigate the cause.”

• “Here are the risks, benefits, and alternatives—let’s decide together.”

• “It’s okay if this isn’t the right choice for you.”

• “Your distrust makes sense. Let’s rebuild it.”

Final Thought

Birth control is neither a miracle nor a menace.

It’s a tool—one that should be offered with transparency, context, and respect for patient autonomy.

Fear-based messaging doesn’t protect women.
Informed choice does.

Where to Learn More

• Bedsider (patient-friendly contraception info):

  https://www.bedsider.org/

• Cancer Research UK — Does the contraceptive pill increase cancer risk?
  https://www.cancerresearchuk.org/about-cancer/causes-of-cancer/hormones-and-cancer/does-the-contraceptive-pill-increase-cancer-risk

Evidence-Based Accounts to Follow

• @babiesafter25

• @pagingdrfran

• @drjenniferlincoln

• @theperioddoctor

Sources (Full)

Key studies and clinical evidence

• Combination contraceptives: effects on weight
  https://pubmed.ncbi.nlm.nih.gov/24477630/

• Oral contraceptive discontinuation: do side effects matter?
  https://pubmed.ncbi.nlm.nih.gov/17403440/

• Population-based cohort study of oral contraceptive use and risk of depression
  https://pubmed.ncbi.nlm.nih.gov/37303201/

• The influence of combined oral contraceptives on female sexual desire: a systematic review
  https://pubmed.ncbi.nlm.nih.gov/23320933/

• No evidence that women using oral contraceptives have weaker preferences for masculine characteristics in men’s faces
  https://pubmed.ncbi.nlm.nih.gov/30629658/

• MHC-correlated odour preferences in humans and the use of oral contraceptives
  https://pmc.ncbi.nlm.nih.gov/articles/PMC2605820/

• Combined oral contraceptives: the risk of myocardial infarction and ischemic stroke
  https://pubmed.ncbi.nlm.nih.gov/26310586/

Venous thromboembolism (VTE) risk: COCs vs pregnancy/postpartum

• ACOG Committee Opinion No. 540 — Risk of venous thromboembolism among users of drospirenone-containing oral contraceptive pills:
  https://pubmed.ncbi.nlm.nih.gov/23090561/

• Trends in the incidence of venous thromboembolism during pregnancy or postpartum: a 30-year population-based study
  https://pubmed.ncbi.nlm.nih.gov/16287790/

• Different combined oral contraceptives and the risk of venous thrombosis: systematic review and network meta-analysis
  https://www.bmj.com/content/347/bmj.f5298

• Combined oral contraceptives: venous thrombosis
  https://pubmed.ncbi.nlm.nih.gov/24590565/

• The risk of venous thromboembolism in oral contraceptive users: the role of genetic factors-a prospective cohort study of 240,000 women in the UK Biobank
  https://pubmed.ncbi.nlm.nih.gov/37734636/

• Higher risk of venous thrombosis associated with drospirenone-containing oral contraceptives: a population-based cohort study
  https://pubmed.ncbi.nlm.nih.gov/22065352/

Long-term cancer risks and benefits of combined oral contraceptives

• Lifetime cancer risk and combined oral contraceptives: the Royal College of General Practitioners’ Oral Contraception Study
  https://pubmed.ncbi.nlm.nih.gov/28188769/

• Risk of cancer and the oral contraceptive pill
  https://pmc.ncbi.nlm.nih.gov/articles/PMC1995524/

• Time-Dependent Effects of Oral Contraceptive Use on Breast, Ovarian, and Endometrial Cancers
  https://aacrjournals.org/cancerres/article/81/4/1153/649492/Time-Dependent-Effects-of-Oral-Contraceptive-Use

Micronutrients, nutrition, and oral contraceptive use

1. Counteracting side effects of combined oral contraceptives through the administration of specific micronutrients
   https://pubmed.ncbi.nlm.nih.gov/35856377/

2. Oral Contraceptives and Changes in Nutritional Requirements
   https://pubmed.ncbi.nlm.nih.gov/23852908/

3. Biological variability and impact of oral contraceptives on vitamins B(6), B(12) and folate status in women of reproductive age
   https://pubmed.ncbi.nlm.nih.gov/24067390/

4. Oral Contraceptive Use, Micronutrient Deficiency, and Obesity among Premenopausal Females in Korea: The Necessity of Dietary Supplements and Food Intake Improvement
   https://pmc.ncbi.nlm.nih.gov/articles/PMC4922824/

5. Effect of oral contraceptive agents on vitamin nutrition status

   https://pubmed.ncbi.nlm.nih.gov/1130320/

6. Effect of oral contraceptive agents on nutrients: II. Vitamins

   https://pubmed.ncbi.nlm.nih.gov/1168019/

7. Metabolite Profile Analysis Reveals Association of Vitamin B-6 with Metabolites Related to One-Carbon Metabolism and Tryptophan Catabolism but Not with Biomarkers of Inflammation in Oral Contraceptive Users and Reveals the Effects of Oral Contraceptives on These Processes
   https://pmc.ncbi.nlm.nih.gov/articles/PMC4264024/

8. Association Between Use of Oral Contraceptives and Folate Status: A Systematic Review and Meta-Analysis
   https://pubmed.ncbi.nlm.nih.gov/26168104/

9. Effect of oral contraceptives on nutrients. III. Vitamins B6, B12, and folic acid
   https://pubmed.ncbi.nlm.nih.gov/952302/

10. Oral contraceptive use: impact on folate, vitamin B₆, and vitamin B₁₂ status
    https://pubmed.ncbi.nlm.nih.gov/21967158/

11. Effect of hormonal contraceptives on vitamin B12 level and the association of the latter with bone mineral density
    https://pubmed.ncbi.nlm.nih.gov/22464408/

12. Vitamins and Oral Contraceptive Use
    https://pubmed.ncbi.nlm.nih.gov/47028/

Fertility awareness-based methods (FABMs)

• Fertility Awareness-Based Methods for Women’s Health and Family Planning
  https://pmc.ncbi.nlm.nih.gov/articles/PMC9171018/

Prefer to listen to a human conversation?

Listen to this episode

A few months ago, one of Sonia’s patients sent her a TikTok in a panic.

The video—posted by a surgeon—warned that a commonly prescribed antibiotic could cause fatal aortic rupture in “bendy” or “flexible” people. The implication was clear: a routine doctor’s visit could kill you if you weren’t careful.

Nothing in the video was technically false.
But almost everything about it lacked context.

This patient didn’t have the rare vascular condition being referenced. The antibiotic wasn’t even first-line therapy. And yet, the fear was real—and overwhelming.

That’s the double-edged sword of health content on social media.

What’s the Claim?

Health and wellness content on social media is often framed as:

• Educational

• Empowering

• Patient-centered

• A way to “take control” of your health

People turn to it for tools, trends, products, and advice—often before they ever talk to a clinician.

When asked where they learn about health and wellness:

• 52% say social media

• 37% search engines

• 34% doctors or healthcare providers

• 32% family or colleagues

• 30% health information websites

Social media isn’t just a source—it’s the dominant one.

Why Is It So Viral?

First: it’s free and accessible.

Healthcare often isn’t.

There’s no easy way to ask a doctor a quick question unless you already have an appointment. Visits are short, expensive, and hard to schedule. About one-third of Americans don’t have a primary care provider at all, so they don’t have a trusted person to ask in the first place.

There’s also been a real erosion of trust in the medical system—accelerated by the COVID pandemic, politicized messaging, conflicting recommendations, and very real experiences of feeling dismissed, misdiagnosed, or financially blindsided.

On top of that, information is more persuasive when it comes from someone who feels relatable.

An influencer sharing a personal story about a health scare often lands very differently than a checklist-driven reminder in a clinic visit. Stories stick. Algorithms amplify them.

And once you engage with one piece of health content, the algorithm keeps feeding you more—whether it’s accurate or not.

The Nugget of Truth

Social media can be helpful.

It’s fast. It’s free. It’s accessible. It can be validating and empowering—especially when qualified healthcare professionals, scientists, and patients use it responsibly to educate, advocate, and share lived experience.

We’ve both learned things from social media. We’ve learned from specialists, from patient stories, from other clinicians. We’ve found recipes, parenting tips, and professional community there.

The problem isn’t that social media contains no good information.

It’s that the system isn’t built to reliably deliver it.

The Facts (With Context and Nuance)

Social media is not designed for nuance.

It’s designed for soundbites, emotional impact, and engagement. When patients send videos to us, it often takes paragraphs—not seconds—to explain the missing context, probability, and limitations of what they’ve seen.

Algorithms prioritize attention over accuracy. There is very little regulation or oversight.

When researchers evaluated TikTok health content, they found:

• 82% lacked transparent advertising disclosure

• 77% failed to disclose conflicts of interest

• 55% did not provide evidence-based information

• 75% lacked balanced or accurate framing

• 90% failed to mention risks or downsides

• Only 36% were considered completely accurate

Accuracy was not correlated with follower count, likes, or verification status.

In surveys of users:

• 77% reported negative feelings after consuming health content (overwhelmed, confused, conflicted)

• Only about one-third reported a positive outcome

• 13% said they encountered advice that turned out to be dangerous

• Just 37% asked a doctor about social media advice before trying it

In nutrition-specific content, one large review of TikTok videos found that only 2.1% aligned with established dietary guidelines.

And for people with baseline health anxiety or generalized anxiety, searching for symptoms and reassurance online often backfires—increasing anxiety rather than relieving it. This pattern is sometimes referred to as cyberchondria: repetitive, compulsive health searching that worsens distress.

What Can We Learn From This?

As doctors:

Patients are absorbing enormous amounts of health information online—and acting on it.

That’s not because they’re reckless. It’s because the healthcare system is hard to access, trust has been damaged, and we’re often not positioned as a first or even second resource for quick clarification.

This is a system-level problem, not an individual doctor failure.

As humans on social media:

Most health and wellness content online is inaccurate, incomplete, or misleading in some way.

Some people will find helpful information—but most will feel more confused, and some will be harmed. And if you struggle with anxiety, consuming this content may reliably make things worse, not better.

3 Take-Home Points

1. Social media is not a neutral health educator. Engagement—not accuracy—drives what you see.

2. Relatable stories feel convincing, but they’re not the same as evidence.

3. If health content consistently increases anxiety, it’s not serving you—even if it’s “true.”

The Antidote

For Patients:

(Gentle reminders and affirmations)

• I don’t need to act on this information right now.

• Feeling scared doesn’t mean I’m in danger.

• Rare outcomes are often framed as common ones.

• More information isn’t always better information.

• I’m allowed to unfollow accounts that spike my anxiety.

• I don’t have to figure this out alone.

For Clinicians:

(Language you can borrow, tweak, or make your own.)

• “I’m really glad you brought this to me—this would scare a lot of people.”

• “Social media tends to highlight worst-case scenarios. Let’s slow this down.”

• “What part of this felt most alarming to you?”

• “My job isn’t to tell you to ignore the internet—it’s to help you interpret it.”

• “Let’s check in on how this content is making you feel, not just what it’s saying.”

Sources & Further Reading

• 61% of Social Media Users Have Used These Platforms for Health Research — And Many Aren’t Checking Creator Credentials
  https://www.valuepenguin.com/online-health-research-survey

• #WhatIEatInADay: The Quality, Accuracy, and Engagement of Nutrition Content on TikTok
  https://www.mdpi.com/2072-6643/17/5/781

• Healthline State of Consumer Health (2024 Report)
  https://media.post.rvohealth.io/wp-content/uploads/2024/10/State-of-Consumer-Health-Full-Report.pdf

• Concerning New Statistics Highlight Inaccurate Nutrition Trends on TikTok
  https://www.prnewswire.com/news-releases/concerning-new-statistics-highlight-inaccurate-nutrition-trends-on-tiktok-302114407.html

• Cyberchondria: Parsing Health Anxiety From Online Behavior
  https://pmc.ncbi.nlm.nih.gov/articles/PMC5952212/

• Instagram Accounts to Follow for Evidence-Based Content
  @unbiasedscience
  @niniandthebrain

  Subscribe for free to receive new posts and support our work.

If you’ve ever gone down a health rabbit hole on social media and come out feeling more anxious, confused, or ashamed than when you started — this podcast is for you.

We’re The Antisocial Doctors: two primary care physicians, millennial moms, and curious humans who spend enough time online to see both the good and the harm that comes from social media health content.

Social media can be a powerful tool for education, connection, and advocacy. It can also make people deeply unwell — especially when it comes to health. We’ve seen that firsthand, both as doctors and as patients ourselves.

This podcast is meant to be the antidote to the algorithm.

Not by debunking everything with snark.
Not by blaming people for being “misinformed.”
And not by pretending medicine has all the answers.

But by slowing things down.

Who we are

Rebecca Berens, MD

I’m a board-certified family medicine physician and direct primary care doctor in Houston, TX. My approach to medicine was shaped long before I became a doctor.

I struggled with an eating disorder in college, and during recovery I was introduced to Health at Every Size, intuitive eating, and weight-neutral care. Later, during medical training, I saw how deeply weight bias and stigma are embedded in traditional healthcare — and how much harm they cause.

From medical school onward, I’ve practiced from a weight-neutral, HAES-aligned perspective. I’ve found that patients feel more heard, have more autonomy, and are far more likely to stick with care plans that are actually sustainable. Our relationships are stronger, and care is better because of it.

Sonia Singh, MD

I’m a board-certified internal medicine physician and direct primary care doctor, also practicing in Houston, TX.

I grew up with a physician father and a mother who lived with health anxiety, chronic pain, and unexplained symptoms — and who didn’t believe in Western medicine. Just growing up with these two as parents gave me unique insight into how different people approach wellness and how frustrating it can be when doctors don’t have all the answers.

Without intending to, I’ve spent my career attracting patients just like her. The ones looking for answers and sitting anxiously in the grey.

I’ve always been deeply interested in nutrition — not just on an individual level, but from a population and systems perspective. I completed a master’s degree in nutrition before medical school, and much of my work now centers on caring for people seeking lifestyle solutions or struggling with health anxiety or complex conditions.

Why we’re “anti-social”

This podcast came out of conversations we kept having — in mom groups, in clinic rooms, and in our own feeds.

We’d see the same trends over and over:

• “My doctor never mentioned this.”

• “This is what they’re not telling you.”

• “Doctors just gaslight you.”

Sometimes the content is flat-out wrong.
Sometimes it’s partly true.
And often, it’s appealing because something in healthcare is broken.

We’ve watched well-meaning professionals try to “debunk” misinformation in ways that feel dismissive, shaming, or overly simplistic. And we’ve watched patients shut down — not because they don’t care about science, but because they don’t feel heard.

Social media isn’t built for nuance. Medicine requires it.

So we created a space where nuance is the point.

What this show is (and isn’t)

This is not your average debunking podcast.

Each episode follows the same structure:

• What is the claim?

• Why is it viral?

• What’s the nugget of truth?

• What are the actual facts — with context and nuance?

• What can we learn from this as doctors and as humans?

• How would we talk to patients about this in the real world?

• Where can people go for reliable information?

We don’t do shame.
We don’t do blame.
And we don’t do snark.

We do curiosity, evidence, humility, and compassion.

Why we’re doing this

We’re in a unique position.

We both practice direct primary care, which means we have time — time to listen, time to explain, time to sit with uncertainty. We know most clinicians don’t have that luxury, and most patients don’t have access to it.

Our hope is that this podcast becomes:

• A validating, evidence-based resource for patients who want deeper answers

• A practical tool for clinicians trying to respond thoughtfully to what their patients are seeing online

• A small step toward repairing the doctor-patient relationship

Where to read along

Each podcast episode will also have a companion Substack post.

We know not everyone has time to listen to a full episode — and some people prefer to read, revisit, or share written resources. These posts are designed to stand on their own and to pair with the audio.

Every post follows the same structure:

• What is the claim?

• Why is it viral?

• What’s the nugget of truth?

• What are the facts (with context and nuance)?

• What can we learn from this as patients and clinicians?

• Three take-home points

• “The Antidote to the Algorithm”- scripts for patients and clinicians to heal from social media health content

• Sources and further reading

Think of these posts as a way to slow down the conversation, add references, and give you something you can return to — or bring to your next appointment.

A note about how we create this content

We want to be transparent about how this project is made.

We both run medical practices, see patients, and are working parents. To make this content sustainable — and to get accurate, thoughtful information out quickly — we ethically use AI to search the medical literature and as a writing and organization tool.

Here’s what that means:

• The ideas, clinical reasoning, and opinions are ours

• We provide detailed notes, transcripts, and source material

• AI helps us organize, summarize, and structure content clearly and efficiently

• All sources and written posts are reviewed by us before publishing
  

We see this as no different from using modern tools in medicine itself: a way to reduce friction, increase access, and spend more time on the parts that matter — nuance, accuracy, and care. For the most human experience- listen to the podcast. The first 3 episodes drop today, and new episodes will air every 2 weeks.

If you’ve ever felt dismissed, overwhelmed, or unsure who to trust — we’re glad you’re here.

Welcome to The Antisocial Doctors.

Listen to the first episode

Hi friends,

You already know we’ve been working on a podcast.

What you might not know is how much intention has gone into it. We’ve spent months thinking about what we wanted this show to be—and just as importantly, what we wanted to avoid. The shortcuts. The oversimplification. The kind of “health advice” that sounds confident but leaves people more anxious than before.

The trailer for The Anti-Social Doctors Podcast is live today.

It’s a short listen, but it gives you a feel for what’s coming: conversations about viral health claims, food and body anxiety, social media fear spirals, and how medicine sometimes pushes people online in the first place. We talk the way we talk in clinic—curious, nuanced, and grounded in real life, not algorithms.

Listen to the trailer

If you like what you hear, here’s how you can help us before launch:
• Follow the show on your podcast app
• Download the trailer (it actually helps more than you think)
• Share it with a friend, colleague, or patient who’s tired of health hot takes

Full episodes are coming soon, and we can’t wait to have you with us from the very beginning.

Thanks for being here—and for helping us build something different.

With care,
Rebecca and Sonia

Share The Antisocial Doctors Substack

Before we ever hit record, this project started in exam rooms, group chats, and late-night scrolls.

It started with our patients—thoughtful, rational people—coming in overwhelmed by the health advice they were seeing online. It started with us, as doctors and moms, feeling that same tug: *What if I’m missing something? Why does this sound so convincing? Is also this health information empowering or just confusing?*

So this Substack—and the Anti-Social Doctors Podcast— was born.

Who We Are

We’re Sonia Singh, MD, a board-certified internal medicine physician with a Master’s in Nutrition and a special interest in health anxiety, and Rebecca Berens, MD, a board-certified family medicine physician with a special interest in disordered eating.

We’re also millennial women, anxious moms, and deeply curious humans trying to live and practice medicine inside a very online world. (Oh, and we also doomscroll.)

Both of us practice direct primary care in Houston, Texas. That matters, because having time with patients—and really listening to their stories—has shaped everything about this project.

Rebecca’s path into medicine was deeply influenced by her own experience with an eating disorder during college. Recovery introduced her to a Health at Every Size framework that transformed not only how she saw her own body, but how she now shows up for patients—especially those harmed by weight-centric, fear-driven health messaging.

Sonia grew up with a physician father and a mother who lived with chronic pain, unexplained symptoms, and significant health anxiety—while simultaneously distrusting conventional medicine. Long before social media, she saw what happens when people feel unheard, dismissed, or left to connect the dots on their own. Unsurprisingly, those are now the patients who seem to find her.

Looking back, we both recognize this truth: many of us become doctors trying to answer questions that took hold of us long before medical school.

Why “Anti-Social”?

We don’t hate social media. We’re on it. We make content. We’ve seen how powerful it can be for education, connection, and community.

But we’ve also seen how it can quietly make people feel worse—more anxious, more confused, more ashamed, more convinced that they’re failing their health.

Social platforms are not built for nuance, context, or uncertainty. They reward certainty, fear, and simplicity. And when it comes to health, that combination can be especially potent.

We started noticing the same patterns over and over:

• Viral health claims framed as “what your doctor isn’t telling you”

• People feeling dismissed when they bring these questions to appointments

• Clinicians responding with frustration, sarcasm, or oversimplified rebuttals

• Everyone leaving the conversation feeling worse

This podcast—and this Substack—are our attempt to step outside that dynamic.

Hence: Anti-Social Doctors. Not anti-people. Not anti-connection. Just an antidote to the algorithm.

What We’re Doing Differently

This is not a debunking project.

We’re not here to shame, mock, or eye-roll at people for asking questions. We’re far more interested in why certain ideas spread than simply declaring them wrong.

Every episode (and many posts here) will follow the same structure:

1. A patient story or human moment

2. What is the claim?

3. Why is it viral?

4. What’s the nugget of truth?

5. What are the actual facts—explained with context and humility?

6. How would we talk about this with our patients?

7. Where can you learn more?

Because here’s what we know:

• Most viral health trends start with something real

• Fear spreads faster than reassurance

• People turn to social media when the healthcare system doesn’t meet their needs

If we don’t acknowledge those realities, we miss the point entirely.

Who This Is For

This space is for:

• Patients who want a deeper, calmer look at health trends they’re seeing online

• Parents trying to make sense of conflicting advice

• Clinicians who want better language for these conversations but don’t have the time to chase every viral claim

Our goal is for this to feel:

• Validating

• Evidence-based

• Human

• Judgment-free

We believe rebuilding trust in medicine doesn’t happen through certainty or superiority. It happens through curiosity, accountability, and shared humanity.

A Note on Safety & Scope

Everything we share here is for education and reflection—not medical advice. We are doctors, but not your doctors. Medicine is complex, personal, and constantly evolving. What applies to one person may not apply to another.

We’ll always do our best to stay current, transparent, and grounded—but we’ll also openly acknowledge uncertainty and disagreement when it exists.

We’re Really Glad You’re Here

If you’ve ever felt overwhelmed by health content online—or unsure who to trust—you’re not alone. This project exists because we’ve felt that way too.

Thanks for being here at the beginning. We’re excited to keep building this space with you.

— Sonia & Rebecca

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