The MAHA Wishlist: Let's Find Out What Actually Works
The news that Coke is going to offer soda with real cane sugar instead of high fructose corn syrup raises the question of whether the MAHA agenda is truly focused on reducing chronic disease or more interested in public health by press release.
And so if the “Make America Healthy Again” movement is serious, here’s my wish: do the work.
We live in a time where way too many Americans are fat, sick, and don’t know who to trust for information.
In our current health information landscape, the loudest voice wins. Influencers throw around mechanistic theories, cherry-picked studies, and jacked-up bro science with total confidence. Supplements, wearables, and wellness routines are sold with more conviction than any prescription drug, only without the pesky requirement of proving they’re effective or safe.
But what if the MAHA crowd actually did the work? What if they took their anti-establishment energy and did what they claim the NIH, FDA, and much of mainstream medicine is just too slow or cautious (or financially conflicted) to do and rigorously tested the stuff they believe in?
Here’s my wishlist for how to Make America Healthy Again. Not with vibes, but with data.
🧪 Supplements and Peptides, Tested Like Drugs
Let’s stop pretending that “natural” means “safe” or “effective.” If we hold prescription drugs to a high bar, we should demand the same for anything sold with a health claim.
Large, rigorous RCTs we need:
Nattokinase & Citrus Bergamot: For LDL/apoB lowering, prevention/regression of atherosclerosis, and thrombosis risk. These are purported to be cardiovascular drugs. Let’s treat them like it. Randomize thousands, follow them for years, and track hard outcomes (MACE, cardiovascular death, all-cause mortality), subclinical progression of disease with carotid ultrasounds and coronary CTAs, and off-target effects.
Berberine: Touted as “nature’s Ozempic”? Great. Let’s compare it to Ozempic and study it for longer than it’s been studied and in a larger group of patients (SURMOUNT-1 randomized over 2500 patients). Not for blood sugar surrogates, but for weight loss, diabetes remission, and cardiometabolic outcomes.
Beetroot Extract/Juice: Purported blood pressure treatment? Then run the 5,000-patient placebo-controlled, blinded RCT for a few years to prove it reduces heart attacks and strokes (or reduces prescription medications) in hypertensive U.S. adults.
Salt Substitutes: Yes, it worked in a Chinese population. But Americans eat (and salt) differently. Let’s see if it helps here.
NAD/NMN/Resveratrol: Follow the TAME model that shows proof of concept of studying longevity. Study thousands, follow for years, look at multisystem aging endpoints, cancer, CVD, cognition. Prove it’s not just “longevity vibes.” And while we’re at it, let's fully fund TAME and try to recruit people to answer this question for metformin. Hell, you could even throw Athletic Greens and other green supplements into the mix if we’re looking.
Peptides (BPC-157, GHK-Cu): For post-op recovery, wound healing, chronic pain. People are injecting these in their bathrooms. Study them like drugs. Look at people going for surgery, in chronic pain, or with conservatively managed orthopedic issues. Let’s see safety data, endpoints, and long term follow-up.
And let’s cut the “Big Pharma won’t fund it so doctors won’t study it” excuse. If NIH or private research dollars backed these trials, there are countless investigators who’d jump at the chance to study them.
Prestige drives research more than pharma money ever has.
If you don’t believe that, ask any smart med student, resident, or attending how much titles and publications are worth in the world of academic medicine (hint: way more than shilling for big pharma).
🌿 Food Fights, Settled With Data
Some of the most passionate fights in wellness aren’t over medication, but over food. Let’s stop arguing and start studying:
Seed Oils vs Beef Tallow: Don’t celebrate PR wins like fries in beef fat. Instead, run an RCT. Fry chips in soybean oil vs. tallow. Compare lipids, insulin resistance, arterial inflammation (via PET), carotid plaque, DEXA for visceral fat. Prove that seed oils are truly toxic and don’t just show me a scary graphic about how they’re industrially produced.
Sugar vs High Fructose Corn Syrup vs Artificial Sweeteners: While we’re talking about meaningless PR wins, don’t forget Coke swapping HFCS for cane sugar. But maybe there’s something to a 5% difference in fructose. Let’s run a 3 pronged RCT and then have people crossover to be their own control. Look at their blood pressure, lipids, inflammatory markers, glucose, and weight. Prove that this isn’t just PR nonsense.
Bodybuilder Diet vs WFPB: Chicken, rice, broccoli with macro tracking vs whole-food plant-based diet in cardiac rehab or post-MI patients. Measure lipids, blood pressure, muscle mass, inflammatory markers, CV events.
Keto & Fasting: For type 2 diabetes, obesity, cancer, epilepsy, and metabolic syndrome. I’m especially interested in studying this stuff rigorously in cancer. Smart cancer researchers want to ask these questions. Let’s give them the money to do it smartly.
🏋️♂️ Exercise, Finally Funded
Exercise trials are underfunded and underpowered. Let’s change that:
Zone 2 vs HIIT: Let’s look at large populations of people, including those who are on the sicker side. Study people with diabetes or prediabetes and look at how these things impact medications, insulin doses, quality of life, progression of disease. You can really medicalize this if you want: look at fasting insulin, glucose fluctuation on CGM, lipids, inflammatory markers. Don’t just study VO2 max in trained people; let’s answer some questions about how this stuff actually impacts risk of getting sick.
Incentives for Exercise: Implementation science is hard. People don’t exercise even after I tell them to. So how can we get more people to exercise and stay consistent? Let’s study incentives. Does a free gym membership make people exercise consistently? Does money? No policy will turn everyone into a gym rat, but let’s look at strategies to improve adherence.
Do Weight Vests or Rucking Impact Fracture Prevention in Osteoporosis? Current science is pretty poor at predicting who is going to have a fragility fracture. Falls and fractures are bad, so let’s think rigorously about how different popular regimens are really doing at preventing this. Let’s look at different regimens of activity on fracture rates. The small studies using bone density as endpoints haven’t shown real benefit of weight vests, but I still see those things everywhere. Let’s see if they impact fracture prevention and not just surrogates like markers of bone turnover or T-scores. Let’s test these things on outcomes that people care about.
Post-Cancer Exercise Dosing: We have proof of concept in colon cancer, so now let’s look at whether there’s a dose-response rate. Let’s study whether strength training matters. Let’s look at intensity of exercise. Let’s look at time spent exercising. Test structured exercise regimens in survivors of other cancers too.
Weightlifting vs Aerobic vs Combined vs Advice Only: In diabetes, HFpEF, and frailty. Let’s test interventions in sick patients, let’s test supervised vs zoom trainers, let’s find the minimum effective dose to see a benefit in chronically ill patients. Answer the questions that my patients are asking all the time.
🛠️ Wearables and Biohacking
We’re subsidizing some of this stuff via HSAs and FSAs. And conflict of interest concerns should apply here the same way they apply to drug companies.
It should mean that you owe us evidence this stuff improves outcomes if our tax dollars are going to subsidize it:
Continuous Glucose Monitors: This stuff may be the future, or it may be creating a generation of orthorexic influencers replacing berries with butter. Let’s study this stuff in people with prediabetes. Does real-time feedback change behavior or progression? Does it make people less likely to end up on medications?
Wearables (Oura, Whoop): It’s hard to study this question well because you can’t blind people to whether they have their data, but we can study whether access to this data improves subjective quality of life and reports of feeling rested. You could give two groups accelerometers that track their activity and give one of those groups a Whoop plus instructions to stay active and the other just gets instructions. Does the Whoop data inspire people to be healthier? Or to go to bed earlier?
Sauna: Randomize people to warm baths vs sauna. Study biomarkers, subjective sleep quality, visceral fat, blood pressure. Study the sweat and look for microplastics - does sauna actually help us detox?
Grounding: We have tiny RCTs from a decade ago. Let’s look at a few thousand people and measure their inflammatory markers, blood pressure, and glucose. Let’s look at their subjective quality of sleep. If this totally free intervention actually makes people’s lives better, then shouldn’t we learn this?
✊ If You Prove It Works, I’ll Prescribe It
I’m not here to dunk. I’m here to find out.
If a CGM prevents diabetes? I’ll prescribe it. If peptides heal wounds or improve pain? Let’s go. If seed oils are poison? I’ll start giving my patients tallow.
But let’s stop pretending that a TikTok claim or PR stunt is the same thing as real health improvement.
I want to Make America Healthy Again too. But not just with vibes.
Do the work. Fund the trials. Show me the data.