FOOD IS MEDICINE

Today’s posting addresses the increasing recognition of the importance of the food we ingest for our health. And this, of course, also includes our fertility. This issue has come into better focus with the relatively recent discovery of the so-called gut-brain axis, which has taught us how important gut health is for normal brain function. And since our brain basically controls everything in our body, - one can actually make the argument that - at least to a degree - it is really our gut that controls everything!

Because of this, nutrition has become a much more important issue in counseling our infertile patients. Therefore, the CHR, as today’s posting demonstrates, addresses nutritional issues on a regular basis in its publication.

As always, we welcome your questions and comments!

The CHR’s Editorial Staff

Does Drinking Coffee and Tea Reduce Dementia Risk and Prolong Life?

So here is the final truth: Coffee is good for you, especially in the morning. Morning coffee drinkers had a 16% reduction in death from all causes. Greatest benefits were obtained with more than 2-3 cups. The association was especially strong in regard to cardiovascular diseases. Interestingly, however, those who consumed coffee all day long (like yours truly!) did not achieve the same benefits. One wonders why?

Then there is the dementia question, and – lo and behold – Chinese research in JAMA just reported that tea as well as coffee in a study of 11,033 dementia cases followed for up to 43 years demonstrated that greater consumption of caffeinated coffee and tea was associated with significantly lower risk of dementia and modestly better cognitive function, - with the most pronounced association found at moderate consumption.

REFERENCES

1. Wang et al., Euro Heart J. 2025;46(8):749-759

2. Zhang et al., JAMA. 2026; doi: 10.1001/jama2025.27259. ahead of print.

The Effects of Fermented Foods on Our Diet

It is now no secret that fermented foods are healthy. Interestingly, they, indeed, have been a mainstay of many different cuisines all over the world. Few are, however, so reflective of a cuisine as kimchi in the Korean diet. And with Korean restaurants having become quite popular in NYC’s dining scene, kimchi is gaining more attention.

It, therefore, is of interest that Nature’s npi Science of Food recently published an article on kimchi that demonstrated that kimchi modulates human-antigen presenting and CD4⁺ T cells.¹ The results were fascinating: After 12 weeks of consumption, kimchi enhanced intercellular signaling mediated by antigen-presenting cells, increased antigen uptake, and promoted the upregulation of MHC class II–related genes through the JAK/STAT1–CIITA axis. Single-cell trajectory analysis revealed accelerated CD4⁺ T cell differentiation toward effector and regulatory phenotypes, whereas CD8⁺ T cells, B cells, and NK cells remained stable, indicating preserved systemic immune homeostasis. In short, kimchi modulates our immune system, and other fermented food products probably do so as well.

Kimchi, of course, has been known in Korean culture for its health-promoting properties.² Its fermentation is mostly the result of lactic acid bacteria (LAB), including Leuconostoc, Weissella, and Lactobacillus, which produce diverse bioactive metabolites, including organic acids, vitamins, peptides, and exopolysaccharides. They then exert antioxidant, anti-obesity, and immunomodulatory effects, synergistically influencing host physiology, including immune responses.

REFERENCES

1. npj Science of Food. 2025;9:236

2. Park et al., J Medicinal Foods. 2013;17(1): https://doi.org/10.1089/jmf.2013.3083

Eating Out Is Getting More Expensive

This is probably not news for most of our readers. Our impression, moreover, is that nothing in our economy has increased in price as much as eating out.

The restaurant business is a very tough business, - usually operating on very tight profit margins. It was hit hard by the COVID pandemic, then - mostly learned during COVID, - by significant changes in population behavior in cities like NYC. These changes led to new habits, which included frequent home deliveries, then inflation in food prices and staffing costs; and it has not gotten any easier! Moreover, consumers spent less on restaurants in 2025 than in 2024.As the headline in a recent FOX News article noted, Americans have hit menu price fatigue. In December of 2025 alone, restaurant prices rose by 0.8%,¹- annualized representing a 12% annual inflation.

REFERENCE

1. Margolis A. FOX News. February 5, 2026. https://www.foxnews.com/food-drink/eating-out-getting-more-expensive-americans-hit-menu-price-fatigue-nationwide

Healthy Eating

INFECTIOUS CONTAMINANTS -- A recent Medscape article¹ reported on hidden complexities around the world involving healthy eating. Some recent food safety incidents in Europe have renewed scrutiny of dietary risks and their global relevance. This included Escherichia coli-contaminated meat in France, causing severe disease in some cases and even one death, contaminated pizzas linked to two infant deaths, and more than 70 reported cases of salmonellosis tied to cheese consumption in 2024. The U.S., of course, also intermittently reports such outbreaks.

CHEMICAL CONTAMINANTS -- The article notes that modern diets, however, also expose populations to chemical contaminants and nutritional imbalances that contribute to chronic diseases.

FIBERS BUT NO ULTRA-PROCESSED FOOD -- The goal is always a balanced diet with a higher intake of fiber-rich foods, including fruits, vegetables, and legumes, all consistently linked to lower cardiometabolic risk across populations. Food processing has also emerged as an independent risk factor, - with especially ultra-processed foods (by the NOVA classification, products that have undergone extensive industrial processes and are formulated with ingredients such as hydrogenated oils, protein isolates, glucose/fructose syrup, and additives like colorings, sweeteners, and emulsifiers), which have been tied to metabolic dysfunction, chronic inflammation, and gut-microbiota disruption.

According to the Medscape article, data from a large French study involving more than 180,000 participants, established links between ultra-processed foods and an increased incidence of chronic diseases: cancer, cardiovascular disease, diabetes, and obesity.

CHEMICAL CONTAMINANTS -- Pesticides can leave residues in agricultural products. Choosing organically grown foods helps reduce this risk. Persistent organic pollutants including dioxins, polychlorinated biphenyls, perfluoroalkyl, and polyfluoroalkyl substances are of global concern because of their environmental persistence. They then accumulate in the food chain, especially in animal fat, and prolonged exposure has been linked to neurotoxic, immunotoxic, and endocrine effects, with possible implications for reproductive health and cancer. International dietary advisories typically recommend moderating the intake of fatty fish, dairy products, eggs, and red meat to limit cumulative exposure.

FOOD ADDITIVES and THE NEW SCIENCE OF MICROBIOTA -- Food additives are used to enhance texture, flavor, color, and shelf life, but not everything is innocent: For example, certain emulsifiers and sweeteners have been shown to alter gut-microbiota composition. Though individual susceptibility varies, emulsifiers found in many industrial baked goods and packaged breads may promote inflammatory bowel disease or metabolic disturbances, reflecting differences in baseline microbiota shaped by genetics, environment, and diet.

According to the Medscape paper, a recent French study also showed that sensitivity to this emulsifier can be predicted through microbiota analysis. In general, as repeatedly noted before in these pages, the gut-brain axis – because of the gut microbiome – has become a study subject revealing significant surprises.

REFERENCE

1. Salmon. Medscape. January 9, 2026. https://www.medscape.com/viewarticle/hidden-complexity-healthy-eating-whats-changed-2026a10000qx

Obesity-associated Inflammation

Obesity is continuing to increase in many populations, and it is associated with many comorbidities, which often coincide with a low-grade chronic inflammatory state that can be quantitated using circulating inflammatory proteins. In a here-discussed study, therefore, morning urine samples were taken from normal-weight controls (n = 30) and from people with obesity (n = 58).

Normalized protein expression data were obtained using the Olink Explore 384 inflammation panel. Of the 384 inflammation proteins, 48 proteins had a P < .05 with false discovery rate correction between the persons with obesity and the persons without obesity. Network analysis revealed 5 different clusters of proteins with several clusters associated (P < .05) with circulating concentrations of high-density lipoprotein, waist circumference, and fat distribution in individuals with obesity.

The paper, therefore, demonstrated that urine may represent a novel, noninvasive approach to measure the state of inflammation in individuals with obesity using Olink-targeted proteomics.

REFERENCE

1. Clanki et al., J Endocrine Soc. 20206;10:bvaf212

The Gut Microbiome in Obesity

That the gut microbiome (the bacterial flora in the bowels) affects human health in many different ways is now already widely accepted. A recent review, however, addressed a related subject that has not been addressed before in an organized and systematic approach,- namely, how the gut microbiome may influence dietary, surgical, and the new pharmacological interventions for obesity,- and did so very well.¹

This is, of course, a multifaceted and very complex subject (almost 12 pages of text), - much too substantial to even just summarize here; but the relevance of this relationship for potential efficacy, treatment costs, and patient-specific variability seems obvious, and we, therefore, wanted to point this very interesting Review article out to our readers with an interest in the study of obesity.

REFERENCE

1. Masi et al., Cell Rep Med. 2026;7:102573

Gut Microbiome Testing - Same Stool Sample, but Different Results

Reading this headline, every fertility service provider may immediately think about PGT-A and may be wondering what PGT-A may have to do with nutrition. But give us a minute to explain: What we are writing about here has - for once - nothing to do with PGT-A, but has a lot to do with another test, which in our opinion is oversold (in its accuracy) by the laboratory testing industry, - and that is microbiome testing. And just as the CHR’s investigators convinced themselves in 2014 and 2015 of the incompetence of PGT-A laboratories when – unknown to two testing labs – they sent them biopsy samples from same embryos,¹ - only to often get back hugely different results – here, U.S. investigators did the same for gut microbiome testing and found similarly disturbing divergences between diagnostic laboratories, which they reported in Nature’s Communications Biology journal.²

As they noted, these tests (like PGT-A) are so-called laboratory-developed tests (LDTs) – a troublesome subject we previously discussed in these pages - which “straddle the line between more strictly regulated medical devices and minimally regulated general health and wellness products“ because the FDA chooses not to review them,- a distinction that may not be readily apparent to consumers.

To assess the current state of the industry, the authors evaluated the performance of seven DTC gut microbiome-testing services using a standardized NIST–developed human fecal material. And results then revealed major discrepancies, both within and across the different service providers. Significantly, they found that variability between providers was on the same scale as biological variability between different donors.

They then attributed the observed differences to methodological variability and lack of sufficient quality control. Additionally, they highlighted that analytical performance is a prerequisite for making sound clinical recommendations, demonstrating the need for standards to ensure analytical validity and consumer confidence.

REFERENCES

1. Gleicher et al., Reprod Biol Endocrinol. 2017;15(1):23

2. Servetas et al., Commun Biol. 2026; 9:269

All the New Information About GLP-1s, - the Wonder Drugs Beyond Just Weight Loss

BELIEVE IT OR NOT, GLP-1s ARE CHANGING HOSPITAL ADMISSION PATTERNS – A very interesting recent Medscape article by Julie Peck reported that this family of “wonder drugs” has become so ubiquitous, hospitals are seeing shifts in the kind of patients admitted.¹ The article reported that a September 2025 study determined that initiating treatment with a GLP-1 receptor agonist (RA) was associated with an almost immediate decline in overall risk of having to visit an emergency room or being admitted to the hospital, and by October 2025, another study reported that patients with obesity and/or congestive heart failure who were treated with only 2.4 mg of the GLP-1 RA semaglutide (a first-generation drug in this family of medications) demonstrated significantly lower medical costs and inpatient resource utilization in comparison to similar patients who were not on GLP-1s.

In a retrospective population-based observational cohort study in adults including 24,576 new users of a GLP-1 receptor agonist (RA) and 23,600 controls, GLP-1RA initiation was associated with a lower risk of all-cause emergency department encounters or hospitalizations (hazard ratio [HR] 0.90; 95% CI 0.87-0.94; P < 0.0001).² These data obtained in a study population of patients with renal diseases confirmed similar data previously reported for patients with cardiovascular diseases.

AND THE BIGGEST CHALLENGE IN REGARD TO GLP-1s IS INSURANCE COVERAGE – And here, like with fertility medications (especially gonadotropins), the Trump administration deserves credit by having achieved huge price reductions for these drugs (monthly injectables used to run at between $1,300 to $1,400 for a 4-week pack, - and this cost has now been reduced to $350 per month).

As another article in Medscape recently pointed out, this remarkable price-drop may help future plaintiffs who may try to compel medical insurance companies to offer coverage for these drugs. As the article also noted, the argument is further strengthened by the improving cost-effectiveness of these medications.³

In 2025 – according to a New England Journal of Medicine article – only 15 Medicaid programs covered obesity treatments with GLP-1s.⁴ An immediately following article addressed the possibility that generic GLP-1s are now expected to enter the market⁵ (HIS & HERS not too long ago got into trouble with the FDA for doing that).

THE DRUGS’ CARDIOVASCULAR EFFECTS, - ARE THEY DEPENDENT ON ADIPOSITY? – That semaglutide treatment reduces major adverse cardiovascular events in overweight and obese individuals has been known for quite some time. Now, a large group of U.K. and U.S. investigators in the same study population tried to determine what the relationship was between baseline adiposity measure, treatment-induced adiposity changes, and subsequent major cardiovascular events risk.⁹

And, once again, results were somewhat surprising because what they found was that the cardioprotective effects of semaglutide (and, therefore, likely all GLP-1s) were independent of baseline adiposity and weight loss and had only a relatively minor association with waist circumference. And these findings now, of course, mandate a better understanding of what mechanisms beyond adiposity reduction may be at play.

AND HOW ABOUT CNS-EFFECTS ? – Once again, that GLP-1s have direct CNS effects is by now well-known; but who would have thought that brain stimulation matches semaglutide for weight loss? This is, however, exactly what Italian investigator, Anna Ferrulli, MD, and collaborators recently reported in Obesity.¹⁰

She already in 2019 reported in Diabetes, Obesity and Metabolism that 5 weeks of high-frequency deep transcranial magnetic stimulation (dTMS) is safe, effective, and well-tolerated for inducing weight loss in obesity. The treatment reduces body weight for up to 1 year by modulating the dopaminergic pathway, reducing impulsivity, and improving gut microbiota. She now demonstrated that treatment with transcranial magnetic stimulation produced a comparable reduction in body weight to that observed with the GLP-1 semaglutide (at the dose of 0.5 mg/week). dTMS, therefore, represents another promising intervention for the treatment of obesity and type 2 diabetes.¹¹

GLP-1s AND PREGNANCY – In attempts to improve pregnancy rates, in many fertility clinics, GLP-1 treatments now increasingly by several months precede fertility treatment beginnings. Weight loss of as little as 2% of bodyweight can already improve outcomes and a weight loss of 5% virtually guarantees improvements in pregnancy rates, as Australian investigators already decades ago demonstrated.¹² But a word of caution may be in place here.

A recent cohort study of primarily obese women published in JAMA produced some surprising findings: Use of GLP-1s – subsequently pre-pregnancy or in early pregnancy discontinued – was associated with more gestational weight gain and higher risk of preterm delivery, gestational diabetes, and hypertensive disorders of pregnancy.¹³

We have a very hard time believing these findings because they are not only counterintuitive, - but to a significant degree contradict physiological logic.

As the authors, themselves, noted, their study also contradicted in many aspects two other large recent retrospective studies, and they also appropriately acknowledged the significant limitations of their study. The CHR, therefore, – at least for the moment – reserves judgment on whether pretreatment of obese patients – if their ages allow for the time – and termination of GLP-1s before or early during pregnancy attempts represents a good, neutral, or bad strategy for obese women trying to conceive. Time will tell shortly,- we are convinced!

And how about using GLP-1s for postpartum weight loss? That, too, appears to be a rising utilization wave, according to a recent Research Letter by Danish colleagues in JAMA;¹⁴ but the paper really does not offer any data of interest beyond the observed increased utilization.

The CHR’s concerns about GLP-1 use in association with pregnancy are not about maternal outcomes, – but about potential effects on the fetus and – postpartum – effects on the maternal milk for the newborn. But wouldn’t it be amazing if we could use these drugs safely through pregnancy and into the postpartum period?

AND – FINALLY – SOME POTENTIALLY REALLY GREAT NEWS ABOUT GLP-1s – One of the alleged principal problems of GLP-1 use to lose weight has been that stopping the medications within the first year results in the reversal of practically all weight loss. What these studies, therefore, suggested was that, like other diabetes drugs, GLP-1s – for persistent weight loss – also have to be taken for life if one wants to maintain the weight loss.

Now, a small retrospective study of 30 adults in Obesity, however, suggested otherwise:¹⁵ Patients who plateaued their weight on either semaglutide or tirzepatide, once they reduced the frequency of administration of the GLP-1 from weekly to usually every other week – as it turned out – were neither affected in their weight nor in metabolic criteria that had improved under weekly treatment.

These data – though only based on a small study size – are fascinating because they suggest that maintenance of weight loss and metabolic gains may be possible, – even if the medication is only administered every other week, – and who knows – maybe only once a month.

And, yes, there is also interesting news regarding the also allegedly unavoidable muscle loss that happens along with weight loss. And that, too, may not be as bad as reported because – as it tuns out – if muscle loss is measured appropriately and correctly, there practically is no serious muscle loss because the body, of course, needs less muscle after significant weight loss.

More on all of that to come, – and we are quite certain that the news will remain good and astonishing. GLP-1s have the opportunity to reshape the world and significantly reduce the burden of overall health service needs.

REFERENCES

1. Peck J. Medscape. January 13, 2026. https://www.medscape.com/viewarticle/how-weight-loss-medications-are-changing-hospital-admissions-2026a1000156

2. Yau et al., Diabetes Care. 2025;48(9):1524-1528

3. Freehoff Y. Medscape. December 24, 2025. https://www.medscape.com/viewarticle/two-new-developments-may-help-future-plaintiffs-compel-glp-1-2025a1000z61.

4. Dusetzina et al., N Engl J Med. 2026;3934(2)105-107

5. Gondi et al., N Engl J Med. 2026;394(2):107-110

6. West et al., BMJ. 2026;392:e085304

7. Sun Q. BMJ. 2026.392:r2586

8. Lapid N. Reuters Health Information. Updated January 22, 2026. https://www.reuters.com/business/healthcare-pharmaceuticals/many-patients-may-keep-off-lost-pounds-after-stopping-glp-1-us-data-suggests-2026-01-22/

9. Deanfield et al., Lancet. 2025; 406:2257-2268

10. Ferrulli et al., Obesity (Silver Spring): 2026; 34(2):317-322

11. Ferrulli et al., Diabetes, Obesity Metabolism. 2019; https://doi.org/10.1111/dom.13741Digital Object Identifier (DOI)

12. Clark et al., Hum Reprod. 1995; 1095;10(10):2705-2710

13. Maya et al., JAMA. 2025;334(24)2186-2196

14. Bliddal, et al., JAMA. 2025;334(24):2227-2229

15. Wong et al., Obesity. 2026; https://doi.org/10.1002/oby.70137