The Metabolic Reckoning: How Medicine Rediscovered Carbohydrate Restriction

In 2012, telling a heart patient to cut carbohydrates could still get you labeled a heretic. Fat was the villain. Carbohydrates were the gospel. Medicine spoke in percentages and pyramids, not physiology. Calories were our currency, and balance was our creed. But the numbers on my desk told a different story.Triglycerides were falling, waistlines shrinking, … Read more

The Myth of the Routine Procedure

He was on the list for what we called a routine coronary angiography—possible PCI if needed.
Mid-sixties. Retired electrician. Lived alone. The kind of man who apologized when the nurse missed his vein.
“Bad veins, sorry,” he said, as if it were his fault.

The morning had gone smoothly. Five patients down, two to go. The rhythm of competence had settled in—steady, predictable, almost comforting…

Chest Pain Explained (2025 Update): 20 Causes and What to Do

Author’s note (2025 update) This article was originally published in 2017 and revised in 2021. It has now been updated and expanded for 2025 to include new clinical insights, refined explanations, and additional causes of chest pain. Chest pain is one of the most common—and most alarming—symptoms in medicine.In the United States, millions of people … Read more

Medicating Appetite: The GLP-1 Dilemma

At first, they were diabetes drugs.
GLP-1 receptor agonists—liraglutide, semaglutide, and later tirzepatide—were developed to help patients with type 2 diabetes regulate blood sugar. They mimicked a gut hormone, GLP-1, that modulates insulin, glucagon, and gastric emptying. They also acted on the brain.
Appetite went down.
Weight came off.
And people noticed.