Author: drshintani

Insulin resistance is one of the most important concepts in modern medicine — and one of the most misunderstood. It sits at the heart of type 2 diabetes, metabolic syndrome, fatty liver disease, cardiovascular disease, and a growing list of chronic conditions that together represent the leading causes of death and disability in the developed world.

Most people now understand, at least in general terms, that insulin resistance means the body’s cells have become less responsive to insulin — the hormone that signals cells to absorb glucose from the bloodstream. When cells resist insulin’s signal, blood sugar remains elevated, the pancreas works harder to produce more insulin, and over time the system breaks down, leading to prediabetes and eventually type 2 diabetes.

What far fewer people understand is what causes insulin resistance in the first place. The conventional answer — that sugar and carbohydrates are the primary culprit — is not supported by the research. The real answer, established in the scientific literature for nearly a century, points to something else entirely.

Fat.

The 1935 Study That Changed Everything

In 1935 — decades before the modern low-carbohydrate movement, decades before the advent of continuous glucose monitors, and long before insulin resistance had become a household term — researchers conducted a remarkably clear experiment.

They took people with normal blood sugar and normal glucose tolerance and placed them on diets with gradually increasing percentages of fat. At each level of fat intake, they evaluated participants with a glucose tolerance test — measuring how effectively their bodies were processing sugar.

The results were unambiguous. As fat intake increased, glucose tolerance worsened. In other words, the more fat people ate, the more insulin resistant they became.

The most striking finding came from comparing the extremes. People following a diet in which 58% of calories came from fat had blood sugar levels nearly double those of people on a diet where only 24% of calories came from fat. Same people, same researchers, same testing conditions — the only variable was the proportion of fat in the diet. And the effect on blood sugar was dramatic.

This finding ran counter to the intuitive assumption that eating sugar raises blood sugar while eating fat does not. The biochemistry is more complex. When dietary fat — particularly saturated fat — accumulates in muscle cells, it interferes with the insulin signaling pathway at a cellular level. The fat metabolites block the molecular machinery that would normally respond to insulin’s signal to take up glucose. The result is insulin resistance — not from eating sugar, but from eating fat.

What More Recent Research Confirms

The 1935 study was not an isolated finding. In the decades since, a substantial body of research has refined and confirmed its core insight. More recent studies have clarified that it is specifically saturated fat — the kind found predominantly in animal products, including meat, dairy, butter, and processed foods — that contributes most significantly to insulin resistance.

Unsaturated fats — found in nuts, seeds, avocados, and olive oil — appear to have a more neutral or even modestly beneficial effect on insulin sensitivity. But saturated fat specifically has been shown in multiple clinical studies to impair the insulin signaling cascade in muscle and liver cells, directly contributing to the development and worsening of insulin resistance.

This helps explain a pattern that has puzzled some researchers — why populations eating traditional plant-based diets rich in carbohydrates, like traditional Asian populations eating rice-based diets, have historically had very low rates of type 2 diabetes, while populations eating high-fat Western diets have dramatically higher rates. The carbohydrates in traditional Asian diets were not driving insulin resistance because the diets were simultaneously very low in saturated fat.

The problem is not carbohydrates per se. The problem is the combination of refined carbohydrates with high saturated fat intake — the hallmark of the modern Western diet — which creates both the insulin resistance and the glucose load simultaneously.

What This Means Practically

The practical implication of this research is straightforward: reducing saturated fat intake is one of the most direct dietary interventions available for improving insulin sensitivity and reducing the risk of type 2 diabetes.

This means reducing or eliminating:

• Fatty processed meats — bacon, sausage, hot dogs, salami
• High-fat dairy — butter, cream, full-fat cheese, whole milk
• Tropical oils high in saturated fat — coconut oil and palm oil in large amounts
• Fried foods — which concentrate saturated and trans fats

And replacing them with:

• Whole, unprocessed plant foods — vegetables, legumes, whole grains, and fruit
• Plant-based proteins — tofu, tempeh, edamame, lentils, and beans
• Healthy unsaturated fats in moderation — nuts, seeds, and avocado

This is precisely the dietary philosophy behind the Peace Diet — a whole-food, plant-centered, low-saturated-fat approach that addresses insulin resistance at its root rather than simply managing the blood sugar symptoms it produces.

A Note on Low-Carbohydrate Diets

It is worth addressing the elephant in the room. Low-carbohydrate, high-fat diets — ketogenic diets, Atkins, carnivore — have become enormously popular as approaches to blood sugar management. They do often produce short-term reductions in blood sugar, for a straightforward reason: if you eat very few carbohydrates, there is less glucose entering the bloodstream regardless of how insulin-resistant your cells are.

But this is symptom management, not root cause resolution. The underlying insulin resistance — driven by saturated fat accumulation in cells — continues and in many cases worsens on high-fat diets, even as blood sugar readings improve in the short term. When someone on a ketogenic diet reintroduces carbohydrates, their blood sugar often spikes more dramatically than before they started, precisely because the underlying insulin resistance has not been addressed.

The research on long-term insulin sensitivity consistently favors low-fat, whole-food, plant-based dietary patterns over high-fat approaches — not because fat is inherently dangerous, but because saturated fat specifically impairs the cellular machinery that insulin depends on.

The Bottom Line

The answer to the question — high fat or low fat for insulin resistance? — has been clear in the scientific literature since 1935. Low fat, and specifically low saturated fat, supports better insulin sensitivity. High fat, and specifically high saturated fat, worsens it.

The good news is that insulin resistance is highly responsive to dietary change. Studies have shown meaningful improvements in insulin sensitivity within days to weeks of reducing saturated fat intake and replacing it with whole, unprocessed foods. The body wants to regulate blood sugar effectively — it just needs the right conditions to do so.

Give it those conditions, and it will.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org | Watch the video: https://www.instagram.com/p/Da4fd5fz8m7/

📖 Also read — Top 5 Breakfast Foods to Avoid for Blood Sugar: https://drshintani.com/2026/07/16/top-5-breakfast-foods-to-avoid-for-blood-sugar-and-weight-loss-2/

Breakfast is often called the most important meal of the day — and there is truth in that. The food you eat in the first hours after waking sets your blood sugar tone for the entire day. A breakfast that causes a sharp spike in blood sugar triggers an insulin surge, followed by a crash, followed by cravings, fatigue, and a cycle of overeating that can persist through the afternoon and evening.

Conversely, a breakfast that keeps blood sugar stable provides sustained energy, mental clarity, and better appetite control throughout the day.

The problem is that many of the breakfast foods most deeply embedded in American culture — the ones served at every diner, hotel buffet, and family table on the weekend — are among the worst possible choices for blood sugar and weight management.

Dr. Terry Shintani has identified five breakfast foods in particular that people trying to manage their blood sugar or lose weight should seriously consider avoiding. Number five may genuinely surprise you.

1. Processed Meats — Bacon, Sausage, and Ham

Processed meats are a breakfast staple across America — and one of the most misleading foods in the category. They are commonly perceived as a high-protein, low-carbohydrate choice that should not significantly impact blood sugar. The reality is quite different.

Despite their protein content, processed meats like bacon and sausage derive approximately 70% of their calories from fat — specifically saturated fat and in many cases trans fat, both of which promote systemic inflammation and insulin resistance over time. They are also extraordinarily high in sodium — a single serving of sausage links can contain more than 700mg of sodium — and in nitrates, chemical preservatives linked in research to increased cardiovascular risk and certain cancers.

From a weight perspective, the caloric density of processed meats is significant. Two strips of bacon contain approximately 90 calories — easily consumed in seconds — with almost no fiber, minimal satiety value, and a composition that actively promotes inflammatory processes in the body.

The bottom line: processed meats are not the blood-sugar-friendly protein they appear to be. Their high fat, sodium, and nitrate content makes them one of the least health-supporting breakfast choices available.

2. Pastries and Muffins

Pastries — croissants, Danish, doughnuts, cinnamon rolls — and commercial muffins represent one of the most concentrated sources of empty calories in the modern diet. They are made primarily from refined white flour and sugar, with significant amounts of added fat, and they provide virtually no fiber, protein, or micronutrients worth mentioning.

The caloric impact of these foods is dramatically underestimated. A large commercial muffin — the kind sold at coffee shops and convenience stores — can contain as many as 550 calories. That is equivalent to eating six apples. Could you eat six apples in one sitting? Almost certainly not. But finishing a large muffin while standing at a counter takes most people about five minutes and feels entirely unremarkable.

From a blood sugar perspective, the combination of refined flour and sugar in pastries produces some of the most dramatic post-meal glucose spikes of any food category. The glycemic response is rapid, the insulin surge is significant, and the crash that follows — typically 60-90 minutes after eating — drives hunger, irritability, and carbohydrate cravings that set a difficult tone for the rest of the day.

3. Pancakes with Butter and Syrup

Pancakes occupy a special place in American breakfast culture — weekend mornings, family traditions, the smell of batter on a griddle. And like many beloved comfort foods, they are far more caloric and glycemically challenging than most people realize.

Three pancakes with butter and syrup — a modest serving by diner standards — can contain as many as 880 calories. The pancakes themselves are made from refined white flour. The butter adds significant saturated fat. And commercial pancake syrup — which in most cases contains no actual maple syrup, only high-fructose corn syrup and artificial flavoring — delivers a concentrated dose of rapidly absorbed sugar directly into the bloodstream.

The result is a breakfast that can account for nearly half of an average person’s entire daily caloric needs in a single meal, while delivering a massive glycemic spike that triggers a corresponding insulin surge and subsequent energy crash.

If pancakes are a meaningful part of your food tradition and you are not ready to abandon them entirely, oat-based or whole grain pancakes made with whole grain flour — served with fresh fruit instead of syrup — represent a significantly more blood-sugar-friendly alternative.

4. Biscuits with Gravy

Biscuits with gravy is another deeply embedded breakfast tradition — particularly in the American South — that delivers a combination of nutritional challenges that make it one of the most problematic breakfast choices for anyone managing blood sugar or body weight.

A single serving of biscuits with gravy can contain up to 490 calories. More concerning from a cardiovascular and blood pressure standpoint is the sodium content — up to 992 milligrams of sodium in a single serving, which represents more than 40% of the recommended daily sodium intake before the day has properly begun.

The biscuits themselves are made from white flour with significant amounts of butter or shortening — contributing refined carbohydrates and saturated fat simultaneously. The gravy, typically made from sausage drippings, white flour, and whole milk, adds additional saturated fat, sodium, and calories. The combined effect on blood sugar, blood pressure, and arterial health makes this one of the most challenging breakfasts for people with hypertension, diabetes, or cardiovascular risk factors.

5. Box Cereals — The Surprising Entry

This is the one that surprises most people — and understandably so. Box cereals have been marketed for decades as a healthy, convenient breakfast choice. Many carry health claims on their packaging — “heart healthy,” “whole grain,” “good source of fiber.” The glycemic reality tells a very different story.

The glycemic index is a measure of how rapidly a food raises blood sugar compared to pure glucose. A glycemic index of 55 or below is considered low; 56-69 is medium; 70 and above is high.

Table sugar — the white granulated sugar most people consider the gold standard of blood-sugar-spiking foods — has a glycemic index of 65, placing it in the medium range.

Now consider these numbers: Cheerios, one of the most widely consumed cereals in America and one frequently positioned as a heart-healthy option, has a glycemic index of 74. Corn Flakes — another long-standing breakfast staple — has a glycemic index of 83.

These widely consumed breakfast cereals raise blood sugar more rapidly than table sugar. For people with prediabetes, type 2 diabetes, or anyone trying to manage their blood sugar, this is a critical piece of information that is almost never communicated at the breakfast table.

Even cereals marketed as whole grain or high fiber often have glycemic index values in the high range once they are processed into the fine flours and puffed grains that give them their familiar texture. Processing destroys the fiber structure that would otherwise slow glucose absorption, leaving a product that behaves almost identically to refined sugar in the body.

What to Eat Instead

If these five foods are on your regular breakfast rotation, the good news is that replacing them with better alternatives is not complicated or expensive. Dr. Shintani’s Peace Diet approach points to several genuinely blood-sugar-friendly breakfast options:

Oatmeal — steel-cut or rolled oats have a glycemic index of 55 or below, provide substantial soluble fiber that slows glucose absorption, and have been clinically shown to lower cholesterol. Top with berries and a small handful of walnuts for added nutrition.

Whole fruit — the fiber in whole fruit dramatically slows fructose absorption, making a piece of fruit a far better blood sugar choice than juice, sweetened yogurt, or cereal, despite containing natural sugar.

Tofu scramble — a plant-based alternative to scrambled eggs that provides protein and satisfaction without the saturated fat and cholesterol of conventional egg-and-meat breakfasts.

Brown rice or whole grain porridge — in many Asian cultures, a warm grain porridge with vegetables is the traditional breakfast, and research consistently shows that populations eating this way have dramatically lower rates of type 2 diabetes and obesity than those eating Western-style breakfasts.

Legumes — beans on toast (whole grain toast) is a traditional breakfast in several cultures and represents one of the most complete, blood-sugar-stable morning meals available. The combination of protein, complex carbohydrates, and fiber provides sustained energy without a significant glycemic spike.

The Bottom Line

What you eat for breakfast matters — not just for that morning’s energy, but for your blood sugar patterns, insulin response, and hunger signals throughout the entire day. The five foods above are not occasional indulgences to feel guilty about. They are simply foods worth knowing the truth about — so that when you choose to eat them, you do so with full information.

Knowledge is the first step. The next step is on your plate.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org | Watch the video: https://www.instagram.com/p/Da122qIzVOm/

Few foods in human history carry as much romantic symbolism as chocolate. It is the universal gift of love — exchanged on Valentine’s Day, birthdays, and anniversaries across virtually every culture in the world. But is there any science behind the romance? Or is chocolate’s reputation as an aphrodisiac purely a matter of marketing and mythology?

The answer, as with most things in nutrition science, is more interesting than a simple yes or no.

A Royal History

The association between chocolate and romance goes back centuries. The ancient Aztecs — who first cultivated cacao and developed chocolate as a beverage — considered it a powerful aphrodisiac and a strengthening drink reserved for royalty and warriors. The Aztec emperor Montezuma was famously said to consume large quantities of cacao before visiting his wives.

When Spanish conquistadors brought cacao back to Europe in the 16th century, chocolate’s reputation as a romantic and energizing substance traveled with it. By the 17th and 18th centuries, chocolate houses had become fashionable social establishments across Europe, and chocolate was widely considered a luxury food with stimulating and restorative properties.

Whether these historical associations were based on genuine physiological effects or cultural mythology — or both — is a question that modern science has begun to answer.

What the Science Says

There is no rigorous clinical evidence that chocolate functions as a true aphrodisiac in the traditional sense — a substance that directly and reliably increases sexual desire. The romantic reputation of chocolate is largely cultural and psychological rather than pharmacological.

However — and this is where it gets genuinely interesting — chocolate does contain several compounds that have real, measurable physiological effects that can support the conditions for romance and sexual activity. These are not magical love potion ingredients, but they are legitimate bioactive substances with documented mechanisms of action.

1. Phenylethylamine — The Love Chemical

Chocolate contains phenylethylamine (PEA) — a naturally occurring compound that the brain also produces in response to attraction and infatuation. PEA stimulates the release of dopamine and norepinephrine in the brain, producing feelings of excitement, alertness, and elevated mood.

Interestingly, the brain produces PEA naturally when people experience romantic attraction — which may be part of why chocolate became culturally associated with love in the first place. Consuming it provides a mild external source of the same compound the brain generates during the early stages of romantic connection.

2. Caffeine — Energy and Alertness

Chocolate contains modest amounts of caffeine — particularly dark chocolate with high cacao content. Caffeine is a well-documented stimulant that increases alertness, reduces fatigue, and improves mood. While the caffeine content of chocolate is lower than coffee, it contributes to the overall energizing effect that chocolate is known for.

3. Theobromine — The Gentle Stimulant

Theobromine is a compound found almost exclusively in cacao and is one of the primary bioactive ingredients in chocolate. Like caffeine, it is a mild stimulant — but it works more slowly and gently, producing a longer-lasting sense of energy and wellbeing without the sharp spike and crash associated with caffeine.

Theobromine also has vasodilatory effects — meaning it helps relax and widen blood vessels, improving circulation throughout the body.

4. Quercetin and Nitric Oxide — Blood Flow and Arousal

Perhaps the most clinically significant compounds in chocolate from a sexual health perspective are quercetin and the nitric oxide precursors found in cacao. As discussed in previous articles, nitric oxide is one of the most important molecules for cardiovascular health — it signals blood vessel walls to relax and dilate, improving blood flow throughout the body.

This mechanism is directly relevant to sexual function. Improved blood flow supports arousal in both men and women, and the role of nitric oxide in erectile function is well established — it is the same pathway targeted by pharmaceutical medications for erectile dysfunction. While chocolate’s effects are far more modest than pharmaceutical interventions, the underlying mechanism is the same.

Quercetin, a flavonoid also found in apples, berries, and onions, has anti-inflammatory and vasodilatory effects that complement the nitric oxide pathway.

5. Tryptophan — The Relaxation Molecule

Chocolate contains tryptophan — an amino acid that serves as a precursor to serotonin, the neurotransmitter associated with calm, contentment, and positive mood. As discussed in our recent article on the gut-brain connection, serotonin plays a central role in emotional wellbeing and stress regulation.

The tryptophan in chocolate may contribute to the relaxed, contented feeling that many people associate with eating it — creating what might be described as a romantic mood from a neurochemical standpoint.

Choosing the Right Chocolate

Not all chocolate is created equal from a health perspective. The bioactive compounds described above are concentrated in cacao — and the higher the cacao content of the chocolate, the more of these compounds it contains.

Dark chocolate with 70% cacao or higher provides the greatest concentration of phenylethylamine, theobromine, quercetin, and nitric oxide precursors. Milk chocolate and white chocolate — which contain less cacao and more sugar, milk, and additives — provide far fewer of these benefits.

As with all foods in the Peace Diet approach, quality and moderation matter. A small amount of high-quality dark chocolate provides genuine health benefits. Large quantities of sugar-laden milk chocolate work against cardiovascular health and overall wellbeing.

The Verdict

Is chocolate a magical aphrodisiac? No — the evidence does not support that claim.

Does chocolate contain real, bioactive compounds that can support energy, mood, blood flow, and the physiological conditions for romance? Yes — and the science behind those effects is solid.

Perhaps most importantly, chocolate is one of the few genuinely pleasurable foods that can be part of a healthy diet when chosen wisely. A square or two of quality dark chocolate shared with someone you love — that may be the most honest description of what chocolate actually offers.

Not magic. But not nothing either.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org | Watch the video: https://www.instagram.com/p/DazQT2gTFkt/

In the years since the pandemic reshaped daily life, mental health professionals around the world have documented a troubling trend: rates of stress, anxiety, and depression have risen significantly — and in many cases, they have not returned to pre-pandemic levels even as restrictions have lifted.

The reasons are complex. But one contributing factor is remarkably simple — and remarkably easy to address.

We are spending too much time indoors.

What Happens to Your Brain When You Stay Inside

The human body was not designed for the modern indoor lifestyle. For the vast majority of human history, people spent most of their waking hours outside — moving, working, and living under natural light. The brain, the endocrine system, and the immune system all evolved in an environment of regular sunlight exposure and daily physical movement.

When we deprive ourselves of these basic inputs — as millions of people did during pandemic lockdowns, and as many continue to do in the years since — the effects on mental health are direct and measurable.

The Endorphin Deficit

Exercise triggers the release of endorphins — the brain’s natural feel-good chemicals. Endorphins reduce the perception of pain, create feelings of euphoria and wellbeing, and help regulate mood and stress response. They are, in the most literal sense, the brain’s built-in antidepressant system.

When we stop exercising — as inevitably happens when we spend all day sitting indoors — endorphin production drops. The brain loses access to one of its primary mood-regulating mechanisms. Over time, this contributes to a baseline of low mood, irritability, and increased vulnerability to stress and depression.

The encouraging reality is that the endorphin response to exercise is dose-dependent and relatively rapid. Even a single 20-30 minute walk produces a measurable increase in endorphin levels and a corresponding improvement in mood. You do not need an intense workout to access these benefits — you simply need to move your body, preferably outside.

The Vitamin D Connection

The second major consequence of staying indoors is a reduction in Vitamin D levels — and the mental health implications of this are more significant than most people realize.

Vitamin D is unique among vitamins in that the body can produce it directly from sunlight exposure. When ultraviolet B rays from the sun hit the skin, they trigger a chemical reaction that converts a precursor molecule into Vitamin D3 — the active form that the body uses. Just 15-20 minutes of direct sun exposure on the arms and legs can produce a meaningful amount of Vitamin D in most people.

When sun exposure is reduced — as happens when people spend most of their time indoors — Vitamin D levels decline. And the consequences extend far beyond bone health, which is what Vitamin D is most commonly associated with.

Research has established a clear and consistent link between low Vitamin D levels and depression, anxiety, and seasonal affective disorder. Vitamin D receptors are found throughout the brain — including in regions involved in mood regulation, motivation, and stress response. When Vitamin D is deficient, these brain systems do not function optimally.

Seasonal Affective Disorder — No Longer Just a Winter Problem

Seasonal affective disorder — commonly known as SAD — was historically understood as a winter condition, triggered by the reduced daylight hours of the colder months. People in northern latitudes, who experience dramatically shorter days in winter, were most commonly affected.

But as Dr. Shintani has observed, the pandemic may have transformed seasonal affective disorder into a year-round phenomenon for many people. When individuals spend most of their time indoors regardless of the season — working from home, avoiding outdoor activities, spending leisure time in front of screens — they can develop the same Vitamin D deficiency and light deprivation that previously only occurred in winter.

The result is a form of depression that does not follow the traditional seasonal pattern — it simply persists, driven not by the time of year but by the indoor lifestyle.

The Simple Solution

The solution to this specific form of stress and depression is, as Dr. Shintani emphasizes, remarkably straightforward: get outside.

Going outdoors addresses both contributing factors simultaneously. Natural sunlight stimulates Vitamin D production, regulates circadian rhythms, and directly affects the brain’s serotonin system — another key mood-regulating neurotransmitter. Physical movement outdoors triggers endorphin release while also providing the additional benefits of fresh air, nature exposure, and a change of environment that all have documented positive effects on mental health.

Specific recommendations:

Aim for at least 20-30 minutes of outdoor time daily. Morning sunlight is particularly valuable — it helps regulate the circadian rhythm and sets the hormonal tone for the rest of the day.

Walk whenever possible. A daily walk — even a short one — provides both the endorphin benefits of exercise and the Vitamin D and mood benefits of natural light. Walking after meals, as discussed in previous articles, also provides blood sugar benefits.

Combine outdoor time with social connection. Walk with a friend, family member, or neighbor. Social connection has independent mental health benefits, and combining it with outdoor movement amplifies both.

Consider Vitamin D supplementation if outdoor time is limited. For those whose lifestyle, climate, or health situation genuinely limits sun exposure, a Vitamin D supplement can help maintain adequate levels. Most adults benefit from 2,000-4,000 IU of Vitamin D3 daily — though individual needs vary, and testing your levels with a simple blood test is the most accurate way to determine the right dose.

The Bigger Picture

Stress and depression are complex conditions with many contributing factors — including genetic predisposition, trauma, relationship difficulties, nutritional deficiencies, and underlying health conditions. For people experiencing significant mood symptoms, working with a qualified healthcare provider is important.

But the role of sunlight, movement, and Vitamin D in mental health is real, well-documented, and consistently underappreciated in conventional medicine. These are not alternative medicine claims — they are well-established physiological mechanisms supported by decades of research.

And unlike most pharmaceutical interventions for depression, going outside has no side effects, no cost, and no prescription required.

Dr. Shintani’s message is simple: your mental health needs sunlight and movement just as much as your body does. Step outside. Take a walk. Let the sun reach your skin.

Your brain was designed for this. Give it what it needs.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org | Watch the video: https://www.instagram.com/p/DawrTPgz7qt/

📖 Also read — Feeling Down or Stressed? Your Gut Flora Produces 90% of Your Serotonin: https://drshintani.com/2026/07/12/feeling-down-or-stressed-your-gut-flora-produces-90-of-your-serotonin/

When most people think about controlling blood pressure, they think about reducing salt, losing weight, or taking medication. These are all valid approaches — but there is a deeper, more fundamental mechanism that is rarely discussed in routine medical appointments, and it may be one of the most direct levers available for natural blood pressure control.

Blood vessel relaxation.

The walls of your blood vessels are lined with smooth muscle cells that can either contract — narrowing the vessel and increasing pressure — or relax — widening the vessel and reducing pressure. The state of these muscle cells at any given moment is one of the primary determinants of your blood pressure reading. And the remarkable thing is that food, movement, and lifestyle choices have a direct and measurable influence on whether your blood vessels are in a state of constriction or relaxation.

Dr. Terry Shintani has identified five natural approaches to promoting blood vessel relaxation — each backed by solid clinical evidence and each consistent with the broader Peace Diet philosophy of addressing root causes rather than masking symptoms.

1. Eat More Foods That Produce Nitric Oxide — Greens and Beets

Nitric oxide is one of the most important molecules in cardiovascular health. It is a natural signaling molecule produced in the cells lining blood vessel walls — called endothelial cells — that directly signals the smooth muscle cells in those walls to relax and dilate. When nitric oxide production is adequate, blood vessels remain flexible and open. When it is insufficient, vessels constrict and blood pressure rises.

The good news is that certain foods dramatically support the body’s nitric oxide production. Leafy green vegetables — spinach, arugula, kale, Swiss chard, and particularly beetroot — are exceptionally rich in dietary nitrates. When consumed, these nitrates are converted by beneficial bacteria in the mouth and gut into nitric oxide, directly triggering the relaxation of blood vessel walls.

Research has consistently shown that diets high in nitrate-rich vegetables produce meaningful reductions in blood pressure. Beetroot juice in particular has been shown in multiple clinical trials to reduce systolic blood pressure by an average of 4-10 points within hours of consumption — a result comparable to some low-dose pharmaceutical interventions.

Practical additions to the diet: raw spinach in salads, steamed beet greens, roasted beets, arugula as a base for grain bowls, and dark leafy greens added to soups and stir-fries.

2. Eat More Magnesium-Rich Foods

Magnesium is one of the most versatile and important minerals in the human body — and one of the most commonly deficient in people eating a modern Western diet. Its role in blood pressure control is particularly significant because it works through two complementary mechanisms.

First, magnesium acts as a natural calcium channel blocker. Calcium channel blockers are a major class of pharmaceutical blood pressure medications — they work by preventing calcium from entering the smooth muscle cells of blood vessel walls, which would otherwise cause those cells to contract. Magnesium does the same thing naturally, competing with calcium at these cellular entry points and promoting muscle relaxation in blood vessel walls.

Second, magnesium is essential for the production of nitric oxide — working synergistically with the dietary nitrates from greens and beets described above. Without adequate magnesium, even a diet rich in nitrate-containing vegetables cannot produce optimal levels of nitric oxide.

Foods rich in magnesium include dark leafy greens (particularly spinach), legumes, nuts and seeds (especially pumpkin seeds, almonds, and cashews), whole grains, avocado, and dark chocolate. The Peace Diet’s emphasis on whole, plant-centered foods naturally provides far more magnesium than the standard American diet — which is one of the reasons plant-based eaters consistently show lower rates of hypertension in population studies.

3. Eat Less Red Meat, Egg Yolks, and Dairy

This recommendation addresses a less well-known but increasingly important mechanism of blood vessel constriction — one that Dr. Shintani has been aware of for years and that mainstream cardiovascular research is now confirming.

When red meat, egg yolks, and certain dairy products are digested, gut bacteria metabolize a compound called choline and carnitine — found abundantly in these foods — into a molecule called trimethylamine (TMA). This TMA is then converted by the liver into trimethylamine N-oxide, or TMAO.

Elevated TMAO levels in the blood have been strongly associated with blood vessel dysfunction — specifically, reduced ability of blood vessel walls to relax and dilate in response to nitric oxide signals. In other words, TMAO impairs the very mechanism that greens, beets, and magnesium are trying to support. High TMAO levels have also been linked to accelerated atherosclerosis and increased cardiovascular risk in multiple large population studies.

Reducing consumption of red meat, egg yolks, and full-fat dairy — the primary dietary sources of TMAO precursors — therefore directly supports blood vessel flexibility and relaxation. This is one more reason why the Peace Diet’s plant-centered approach produces such consistent improvements in blood pressure and cardiovascular health.

4. Exercise Regularly

Physical activity is one of the most powerful natural vasodilators available. When you exercise, your muscles demand more oxygen and nutrients, signaling the body to increase blood flow. In response, the endothelial cells lining blood vessel walls produce more nitric oxide — causing vessels to dilate and blood pressure to drop during and after exercise.

But the benefits of regular exercise extend beyond the workout itself. Consistent physical activity over time improves what is called endothelial function — the ability of blood vessel walls to produce nitric oxide and respond to relaxation signals. People who exercise regularly have more flexible, more responsive blood vessels than sedentary individuals — and this translates to lower resting blood pressure and better cardiovascular resilience overall.

The type of exercise matters less than the consistency. Walking, swimming, cycling, dancing, gardening — any form of sustained movement supports blood vessel health. Dr. Shintani himself has long maintained a daily basketball practice — a habit he credits with keeping his cardiovascular system sharp well into his 70s.

Even a 10-minute walk after meals — as discussed in an earlier article — produces measurable improvements in blood vessel function and blood pressure in the hours that follow.

5. Use Herbal Supplements

Certain herbal supplements have demonstrated specific abilities to support blood vessel relaxation and blood pressure control — complementing the dietary and lifestyle approaches above.

Dr. Shintani’s previous posts have covered ten supplements for blood pressure control in detail — including CoQ10, beet extract, magnesium supplements, hawthorn, and hibiscus tea. Hawthorn in particular is worth highlighting in the context of blood vessel relaxation — its flavonoids directly improve the function of endothelial cells and have been shown to enhance nitric oxide production, working synergistically with the dietary approaches described above.

Hibiscus tea — which acts as a natural ACE inhibitor — also directly supports blood vessel relaxation by blocking the hormonal pathway that would otherwise cause vessels to constrict. Three cups of hibiscus tea daily has been shown in clinical research to produce meaningful reductions in blood pressure in pre-hypertensive and mildly hypertensive adults.

As always, discuss any supplements with your physician before starting — particularly if you are already on blood pressure medication, as some supplements can interact with pharmaceutical treatments and may require dosage adjustments.

Putting It All Together

These five approaches — eating nitric oxide-producing foods, maximizing magnesium intake, reducing TMAO-producing animal foods, exercising consistently, and using targeted herbal supplements — all work through the same fundamental mechanism: keeping blood vessel walls relaxed, flexible, and responsive.

They are not independent interventions to be applied one at a time. They work synergistically — each reinforcing the others. A diet rich in greens and beets provides nitrates; adequate magnesium converts those nitrates into nitric oxide efficiently; reduced TMAO means blood vessels can actually respond to those nitric oxide signals; exercise amplifies nitric oxide production further; and targeted supplements fill any remaining gaps.

Together, they address the root cause of elevated blood pressure — not by forcing the cardiovascular system into submission with medication, but by restoring the conditions under which it naturally functions well.

Your blood vessels were designed to be flexible and relaxed. Give them what they need, and they will be.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org | Watch the video: https://www.youtube.com/watch?v=c9wMwAXkckI

📖 Also read:
— 9 Ways to Help Control Blood Pressure: https://drshintani.com/2026/06/30/9-ways-to-help-control-blood-pressure-by-reducing-hardening-of-the-arteries/
— 5 Natural Supplements for Blood Pressure: https://drshintani.com/2026/07/06/got-high-blood-pressure-5-natural-supplements-that-may-help/

When people feel persistently low, anxious, or unable to cope with stress, the first place most doctors look is the brain. Antidepressants, anti-anxiety medications, and mood stabilizers all target neurotransmitter activity in the brain — and for many people, they provide meaningful relief.

But there is a dimension of mood regulation that conventional medicine has been slow to integrate into mainstream practice, despite a rapidly growing body of research pointing directly to it.

Your gut.

Specifically — the 100 trillion microorganisms living in your digestive tract, collectively known as the gut microbiome or gut flora. And the remarkable fact at the center of this emerging science is this: more than 90 percent of the body’s serotonin is produced not in the brain, but in the gut — in direct conjunction with the gut flora that lives there.

What Is Serotonin — and Why Does It Matter?

Serotonin is one of the most important neurotransmitters in the human body. Often called the “happy hormone,” it plays a central role in regulating mood, emotional stability, and the experience of calm and enjoyment. It helps modulate anxiety, supports healthy sleep cycles, and contributes to a general sense of wellbeing.

Low serotonin levels have been associated with depression, anxiety, irritability, poor sleep, and difficulty managing stress. Most pharmaceutical antidepressants — including SSRIs (selective serotonin reuptake inhibitors), the most widely prescribed class of antidepressants in the world — work by preventing the breakdown of serotonin in the brain, effectively making more of it available.

But here is what most people — and many doctors — don’t fully appreciate: the brain’s serotonin supply depends heavily on what is happening in the gut. The gut produces serotonin, and the gut flora plays a direct role in that production. When the gut microbiome is healthy, diverse, and well-nourished, serotonin production tends to be adequate. When the gut is dysbiotic — unbalanced, inflamed, or depleted of beneficial bacteria — serotonin production can be compromised, contributing to the very mood symptoms that are typically attributed to the brain alone.

The Gut-Brain Connection

The gut and brain are in constant, bidirectional communication through what scientists call the gut-brain axis — a complex network of neural, hormonal, and immune signals that flows in both directions between the digestive system and the central nervous system. The vagus nerve — one of the longest nerves in the body — serves as a primary highway for this communication, carrying signals from the gut directly to the brain.

This means that what happens in the gut does not stay in the gut. Inflammation in the gut triggers inflammatory signals that travel to the brain, affecting mood, cognition, and stress response. A disrupted gut microbiome sends different signals than a healthy one — and the brain responds accordingly.

Researchers studying the gut-brain axis have found that people with depression and anxiety tend to have less diverse gut microbiomes, lower levels of certain beneficial bacterial strains, and higher levels of inflammatory markers in the gut than people without mood disorders. While the direction of causality is still being investigated — does gut dysbiosis cause depression, or does depression cause gut dysbiosis? — the relationship is increasingly clear and almost certainly runs in both directions.

How to Support Healthy Gut Flora for Natural Serotonin Production

The good news is that the gut microbiome is highly responsive to dietary change. Unlike the brain — which is protected by the blood-brain barrier and can be difficult to influence directly — the gut flora can begin to shift meaningfully within days of changing what you eat.

Dr. Shintani identifies two key categories of foods for supporting a healthy gut microbiome:

Probiotic Foods — Direct Sources of Beneficial Bacteria

Probiotics are live beneficial bacteria found in fermented foods. When consumed regularly, they contribute directly to the diversity and health of the gut microbiome.

Miso — the fermented soybean paste central to Japanese cuisine — is one of the richest and most accessible probiotic foods available. It contains multiple strains of beneficial Lactobacillus bacteria and has been consumed for centuries in cultures with some of the world’s lowest rates of depression and anxiety.

Sauerkraut — fermented cabbage — is one of the most studied probiotic foods in Western research. Its beneficial bacteria survive the digestive process and have been shown to colonize the gut and support microbiome diversity. Choose unpasteurized sauerkraut — the pasteurization process kills the beneficial bacteria.

Kimchi — the Korean fermented vegetable dish — contains a rich diversity of beneficial bacteria along with powerful anti-inflammatory compounds from its chili, ginger, and garlic ingredients. Research has linked regular kimchi consumption to improved gut microbiome diversity and reduced inflammatory markers.

Other excellent probiotic sources include tempeh, kombucha (low sugar), and plant-based yogurts with live active cultures.

Prebiotic Foods — Fuel for Beneficial Bacteria

Prebiotics are the fiber-rich foods that feed and sustain the beneficial bacteria already living in the gut. Without adequate prebiotic fiber, beneficial bacteria cannot thrive — regardless of how many probiotic foods are consumed.

Whole grains — brown rice, oats, barley, and whole wheat — provide the fermentable fiber that beneficial gut bacteria use for energy. The short-chain fatty acids produced when gut bacteria ferment this fiber also have direct anti-inflammatory effects throughout the body, including in the brain.

Whole beans and legumes — chickpeas, lentils, black beans, mung beans — are among the most prebiotic-rich foods available. Their resistant starch and diverse fiber types feed a wide range of beneficial bacterial strains, supporting microbiome diversity.

Cooked vegetables — particularly cruciferous vegetables, root vegetables, and leafy greens — provide multiple types of prebiotic fiber along with the antioxidants and anti-inflammatory compounds that support gut lining health.

Whole fruit — particularly berries, apples, and pears — provide pectin and other soluble fibers that specifically support beneficial bacterial growth and serotonin-producing bacterial strains.

The Bigger Picture

The connection between gut health and mental health is one of the most exciting and rapidly evolving areas of nutritional science. It reframes how we think about mood disorders — not as purely brain-based chemical imbalances, but as whole-body conditions that involve the gut, the immune system, and the food we eat every single day.

This does not mean that diet alone can treat clinical depression or anxiety — and anyone experiencing significant mood symptoms should work with a qualified healthcare provider. But it does mean that what you eat is not irrelevant to how you feel emotionally. The gut flora that lives inside you responds to every meal you eat — and it responds by producing the very neurotransmitters that shape your mood, your calm, and your ability to handle the stresses of daily life.

Feed your gut well. Your brain is listening.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org | Watch the video: https://www.instagram.com/p/DaryUGSTD8K/

Stomach pain. A burning sensation that gnaws at you between meals. Discomfort that worsens when you eat certain foods and briefly improves when you eat others. These are the hallmark symptoms of gastritis and peptic ulcers — conditions that affect millions of people worldwide and are among the most common reasons people visit their doctor.

For decades, the standard medical explanation for peptic ulcers was stress and spicy food. We now know better. Between 80 and 90 percent of peptic ulcers are connected to a specific acid-resistant bacterium called Helicobacter pylori — commonly known as H. pylori — a spiral-shaped organism that burrows into the protective mucus lining of the stomach and duodenum, allowing stomach acid to damage the tissue underneath.

When H. pylori is identified, the standard treatment is a course of antibiotics combined with antacid medications. This approach is effective — but it is not the whole story. Antibiotics disrupt the entire gut microbiome, not just the H. pylori bacteria. And antacids, while providing short-term relief, do not address the underlying conditions that allowed H. pylori to take hold in the first place.

Dr. Terry Shintani’s approach, as always, goes deeper — addressing the dietary and lifestyle factors that either promote or prevent gastric damage, reduce the risk of H. pylori establishing itself, and support the stomach lining’s natural ability to heal.

Here are five things you can do to prevent gastritis and peptic ulcers — and to hasten healing and prevent recurrence if you have already been diagnosed.

1. Eat Plenty of Well-Cooked Oatmeal, Brown Rice, Barley, or Poi

The stomach lining — called the gastric mucosa — is protected by a layer of mucus that acts as a buffer between the acidic environment of the stomach and the delicate tissue underneath. When this mucus layer is damaged or depleted, the stomach becomes vulnerable to irritation, inflammation, and ulceration.

Certain whole grain foods provide a natural, soothing coating that supports and complements the stomach’s own protective mucus layer. Well-cooked oatmeal is particularly valuable — its soluble fiber, beta-glucan, forms a viscous gel that coats and soothes the stomach lining, reducing irritation and creating a protective environment for healing. Brown rice and barley provide similar protective benefits through their fiber content and gentle, non-acidic nature.

For those in Hawaii, poi — the traditional Hawaiian staple made from taro — deserves special mention. Poi has an extremely low acid load, a smooth, easily digestible texture, and a fiber content that supports gut health. It has been used historically in Hawaii as a gentle, healing food for people with digestive conditions — and its benefits are now being recognized in nutritional research.

Well-cooked grains are particularly important — cooking breaks down the fibrous structure of these foods, making them easier to digest and reducing any potential for irritation in an already inflamed stomach.

2. Eat Plenty of Cooked Vegetables

Raw vegetables, while nutritious, can be difficult for an inflamed stomach to process — their rough texture and high fiber content can irritate already sensitive gastric tissue. Cooked vegetables, by contrast, provide the same nutritional benefits in a form that is much gentler on the digestive system.

Certain cooked vegetables have specific benefits for gastric health. Broccoli and other cruciferous vegetables contain sulforaphane — the same compound studied at Johns Hopkins for its cancer-fighting properties — which has also been shown in research to inhibit H. pylori directly. Cabbage juice, famously, has a long history of use as a traditional remedy for ulcers, and modern research has confirmed that cabbage contains compounds that stimulate the production of the stomach’s protective mucus layer.

Sweet potato, pumpkin, and other orange and yellow vegetables are rich in beta-carotene, which supports the health and regeneration of the cells lining the digestive tract. Steamed or boiled, these vegetables provide powerful protective compounds without the digestive challenge of raw fiber.

3. Chew Well

This may seem like simple advice — but it is one of the most clinically significant things a person with gastritis or peptic ulcer disease can do, and it is almost universally ignored.

Digestion begins in the mouth. Chewing thoroughly breaks food down into smaller particles, mixes it with saliva (which contains digestive enzymes and antibacterial compounds), and significantly reduces the workload on the stomach. When food arrives in the stomach inadequately chewed, the stomach must work harder — producing more acid and contracting more forcefully — to break it down. This increased acid production and mechanical stress aggravates an already inflamed stomach lining.

Beyond the mechanical benefits, thorough chewing makes the fiber in vegetables and whole grains physically available to the beneficial bacteria in the gut — the friendly flora that compete with H. pylori for space in the digestive tract. A well-chewed meal feeds the right bacteria, supports a healthy microbiome, and reduces the environmental conditions that allow H. pylori to thrive.

A practical guideline: aim to chew each mouthful 20-30 times before swallowing, and put your utensils down between bites to slow the pace of eating.

4. Limit Dairy and Animal Protein

This recommendation surprises many people — particularly those who have been told that milk soothes an ulcer. While dairy does provide temporary relief by coating the stomach and neutralizing acid briefly, it then triggers a rebound effect: the protein and calcium in milk stimulate increased acid production, making the underlying condition worse.

Animal proteins in general — meat, poultry, fish, eggs, and dairy — are among the strongest stimulants of stomach acid production. The body requires high levels of acid to break down animal protein, and for someone with an already inflamed stomach lining, this sustained acid production prolongs irritation and delays healing.

This does not mean complete elimination of all animal protein is necessary for everyone — but significantly reducing intake, particularly during active gastritis or ulcer flares, can make a meaningful difference in symptom severity and healing time. Plant proteins — legumes, tofu, tempeh, and well-cooked grains — are far gentler on the stomach and support healing rather than hindering it.

Highly spiced foods, coffee, alcohol, and carbonated beverages should also be minimized, as all of these stimulate acid production and can directly irritate the gastric mucosa.

5. Take Probiotics — Especially If You Are on Antibiotics

The gut microbiome — the community of trillions of bacteria living in the digestive tract — plays a critical role in protecting against H. pylori and supporting gastric health. A diverse, healthy microbiome creates a competitive environment that makes it more difficult for H. pylori to establish itself and proliferate.

When antibiotics are prescribed for H. pylori, they are effective at eliminating the bacteria — but they also significantly disrupt the broader gut microbiome, wiping out many of the beneficial bacteria that protect the stomach and digestive tract. This disruption can lead to digestive side effects, increased susceptibility to other infections, and potentially a higher risk of H. pylori recurrence if the microbiome does not recover adequately.

Probiotic supplementation — particularly strains of Lactobacillus and Bifidobacterium — has been shown in multiple clinical studies to reduce the side effects of antibiotic treatment for H. pylori, improve eradication rates when taken alongside antibiotics, and support the restoration of a healthy gut microbiome after treatment.

Fermented foods — miso, tempeh, kimchi, and yogurt (plant-based, for those minimizing dairy) — also provide beneficial bacteria that support gut health. Incorporating these foods regularly, alongside a probiotic supplement during and after antibiotic treatment, gives the gut the best chance of full microbiome recovery.

The Bigger Picture

Gastritis and peptic ulcers are not random misfortunes. They develop in an environment — a gut microbiome under stress, a stomach lining weakened by poor diet and inadequate fiber, an immune system compromised by chronic inflammation — that makes H. pylori’s job easier.

The five steps above address that environment directly. They support the stomach’s natural protective mechanisms, feed the beneficial bacteria that compete with H. pylori, reduce the acid burden on an inflamed stomach, and promote the conditions for healing rather than further damage.

As with all of Dr. Shintani’s recommendations, these steps work best as part of a broader dietary pattern — the whole-food, plant-centered, low-fat, high-fiber approach of the Peace Diet — that supports not just gastric health but the health of the entire body.

Your stomach was designed to heal. Give it the right conditions, and it will.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org | Watch the video: https://www.instagram.com/reel/DapzxlezXa5/

You wake up tired even after eight hours of sleep. Your thinking feels sluggish by midafternoon. You carry extra weight around your midsection that refuses to budge no matter what you eat or how much you exercise. You have been told your labs are “borderline” but not quite bad enough to treat.

Sound familiar?

Most people in this situation are told they are simply getting older, stressed, or not trying hard enough. But there is another possibility — one that is rarely discussed in routine medical appointments — and it has everything to do with an organ most people never think about until something goes seriously wrong.

Your liver.

The Most Overlooked Organ in Your Body

The liver is the body’s most hardworking and most underappreciated organ. While the heart gets all the attention and the brain gets all the glory, the liver quietly performs over 500 distinct functions every single day — filtering toxins from the bloodstream, regulating blood sugar, producing bile for fat digestion, synthesizing proteins, storing vitamins and minerals, and processing virtually everything you eat, drink, breathe, and absorb through your skin.

When the liver is functioning optimally, you rarely notice it. But when it begins to struggle — as it does in the estimated one in three American adults with non-alcoholic fatty liver disease (NAFLD) — the effects ripple throughout the entire body in ways that are easy to miss and easier to misattribute.

The troubling reality is that most people with fatty liver disease have no idea they have it. It is called a silent disease for a reason. Standard blood tests may show mildly elevated liver enzymes that doctors note but don’t act on. And the symptoms — when they do appear — are so common and so easily explained away that they rarely trigger suspicion about the liver.

Until now.

5 Signs Your Liver May Be Struggling

1. Persistent, Unexplained Fatigue

This is the most common and most overlooked symptom of a struggling liver. Not the normal tiredness that follows a busy day — but a deep, pervasive exhaustion that is present even after adequate sleep, that worsens throughout the day, and that does not improve with rest.

The connection makes biological sense. The liver is responsible for converting nutrients into usable energy for the body’s cells. When it is congested with excess fat and under oxidative stress, this energy conversion process becomes inefficient. Cells throughout the body — including brain cells and muscle cells — receive less fuel. The result is a fatigue that feels different from ordinary tiredness — heavier, more persistent, and harder to shake.

If you have been told your fatigue has no clear cause, and if standard thyroid and iron tests have come back normal, the liver is worth investigating.

2. Brain Fog and Poor Concentration

The liver filters the blood continuously — removing ammonia, metabolic waste products, and environmental toxins before they can reach the brain. When the liver’s filtering capacity is compromised, these compounds accumulate in the bloodstream and cross into the brain, where they interfere with neurotransmitter function and cognitive processing.

The result is what many people describe as brain fog — a sense of mental cloudiness, difficulty concentrating, poor short-term memory, and a feeling of thinking through cotton wool. This phenomenon is well recognized in severe liver disease, where it is called hepatic encephalopathy. But emerging research suggests that even mild liver dysfunction — the kind associated with early NAFLD — can produce subtle but measurable cognitive effects.

In Dr. Shintani’s clinical experience, patients who address their liver health through dietary change frequently report improvements in mental clarity that they did not even realize they had lost — because the decline had been so gradual.

3. Stubborn Belly Fat

The relationship between the liver and belly fat runs deeper than most people realize — and it flows in both directions. Visceral fat — the fat stored deep in the abdominal cavity around the organs — releases inflammatory compounds and fatty acids directly into the portal vein, which feeds directly into the liver. This creates a constant stream of inflammatory signals and excess fat arriving at the liver, accelerating the accumulation of liver fat.

At the same time, a fatty, inflamed liver produces more glucose and triglycerides than a healthy liver, contributing to higher blood sugar and more fat storage — including around the abdomen. The result is a vicious cycle: belly fat stresses the liver, and a stressed liver promotes more belly fat.

This is why people with significant belly fat — particularly the hard, distended kind that sits high on the abdomen — often struggle to lose it despite dietary changes. Without addressing liver health specifically, the underlying metabolic dysfunction continues to drive fat storage regardless of caloric intake.

4. Elevated Triglycerides and Blood Sugar

The liver plays a central role in both fat and glucose metabolism. A healthy liver carefully regulates how much glucose it releases into the bloodstream and how many triglycerides it produces. A fatty liver loses this regulatory precision — it releases too much glucose (contributing to insulin resistance and eventually type 2 diabetes) and overproduces triglycerides (contributing to cardiovascular risk).

If your blood tests show borderline or elevated triglycerides, fasting blood sugar above 100, or an HbA1c creeping upward — these are not just metabolic problems. They may be liver problems expressing themselves through metabolic channels.

Dr. Shintani has observed this pattern repeatedly in his clinical practice: patients whose blood sugar and triglycerides normalize significantly once they adopt a liver-supportive dietary approach — often more dramatically than would be expected from diet alone — because they are addressing the liver dysfunction that was driving the metabolic dysregulation in the first place.

5. Digestive Discomfort and Bloating

The liver produces bile — a digestive fluid stored in the gallbladder and released into the small intestine to help digest fats. When the liver is under stress, bile production and quality can be affected, leading to incomplete fat digestion, bloating, nausea — particularly after fatty meals — and a general sense of digestive heaviness.

Many people with undiagnosed fatty liver describe feeling uncomfortably full after meals that should not be that filling, or experiencing persistent bloating that they attribute to food intolerance, irritable bowel syndrome, or simply getting older. While these conditions are real, the liver is a frequently missed contributing factor.

What to Do If You Recognize These Symptoms

First — get your liver enzymes checked. A simple blood test measuring ALT and AST levels can indicate whether the liver is under stress. If they are elevated — even mildly — it is worth investigating further with an ultrasound or more comprehensive metabolic panel.

Second — address the diet. The most effective intervention for fatty liver disease is dietary change. As Dr. Shintani outlined in his recent articles on the 7 steps to reverse fatty liver and the 7 best supplements for liver health, the approach is consistent: whole grains over processed flour, whole fruit over sugary beverages, high-fiber vegetables, reduced dietary fat, regular movement, and sustainable weight loss.

Third — consider targeted supplements. Milk thistle, berberine, Vitamin E, omega-3s, NAC, curcumin, and dandelion root all have meaningful evidence for supporting liver health and accelerating recovery from fatty liver disease.

Fourth — give it time. The liver is remarkably regenerative. Studies have shown measurable improvements in liver fat content within as little as two to four weeks of consistent dietary change. The symptoms that have accumulated over years will not disappear overnight — but they will improve, often more quickly than people expect, once the liver begins to heal.

The Bigger Picture

Fatigue, brain fog, and belly fat are not inevitable parts of aging. They are signals — the body’s way of communicating that something is not working as it should. And in many cases, that something is the liver, silently struggling under the burden of a modern diet that it was never designed to process.

The liver does not ask for much. It asks for real food, adequate hydration, and a break from the constant flood of processed fats, refined sugars, and empty calories that characterize the modern diet. Give it that, and it will do the rest.

Your energy, your clarity, and your waistline may all depend on it.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org

📖 Also read:
— 7 Steps to Get Rid of Fatty Liver Disease: https://drshintani.com/2026/07/07/7-steps-to-get-rid-of-fatty-liver-disease-naturally/
— 7 Best Supplements for Fatty Liver: https://drshintani.com/2026/07/07/the-7-best-supplements-for-fatty-liver-disease-dr-shintanis-next-step-guide/

Chronic pain is one of the most debilitating conditions affecting millions of people worldwide. Arthritis alone — in its various forms — affects more than 54 million Americans, making it one of the leading causes of disability in the country. For many, the standard medical response is a prescription for non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen, or stronger medications that carry significant long-term risks including stomach bleeding, kidney damage, and cardiovascular complications.

Dr. Terry Shintani’s approach, as always, begins with food. A whole-food, plant-based, anti-inflammatory diet — rich in the foods outlined in his earlier article on the seven best foods for arthritis — addresses the root cause of chronic inflammation rather than simply masking its symptoms. But for those who need additional support alongside a healthy dietary foundation, certain natural supplements have a compelling body of clinical evidence behind them.

Here are Dr. Shintani’s top five supplements for arthritis and chronic pain control.

1. Willow Bark

Willow bark is one of the oldest pain remedies in human history — its use dates back thousands of years across ancient Egypt, Greece, and China. The reason it has endured is simple: it works. Willow bark contains a compound called salicin, which the body converts to salicylic acid — the same active compound that forms the basis of aspirin.

Unlike synthetic aspirin, however, willow bark releases salicin more slowly and gently, providing more sustained pain relief with a lower risk of the stomach irritation that aspirin commonly causes. Clinical studies have shown willow bark extract to be effective for reducing pain associated with osteoarthritis, lower back pain, and headaches. It is one of the clearest examples of a traditional remedy that modern science has fully validated.

It is worth noting that people who are allergic to aspirin should also avoid willow bark, and it should not be combined with blood-thinning medications without medical supervision.

2. Curcumin (Turmeric)

Curcumin — the active anti-inflammatory compound in turmeric — is arguably the most studied natural anti-inflammatory substance in the world. It works by inhibiting multiple inflammatory pathways simultaneously, including NF-κB — a master regulator of the inflammatory response that is overactive in people with arthritis and other chronic inflammatory conditions.

Multiple randomized controlled trials have compared curcumin supplementation to NSAIDs like ibuprofen for arthritis pain relief — and the results have been remarkable. Several studies have found curcumin to be comparably effective to ibuprofen for knee osteoarthritis pain, without the gastrointestinal side effects.

The critical factor with curcumin is absorption. On its own, curcumin is poorly absorbed by the digestive tract. But combining it with piperine — the active compound in black pepper — increases curcumin’s bioavailability by an extraordinary 10 to 20 fold. When choosing a curcumin supplement, always look for one that includes piperine or black pepper extract. Alternatively, cooking turmeric with black pepper in food achieves the same effect.

3. Boswellia (Frankincense)

Boswellia serrata — the resin of the frankincense tree — has been used in Ayurvedic medicine for centuries for joint pain and inflammatory conditions. Its active compounds, called boswellic acids, work through a different mechanism than most anti-inflammatory agents: they specifically inhibit an enzyme called 5-LOX (5-lipoxygenase), which plays a key role in the production of leukotrienes — inflammatory molecules that contribute significantly to joint swelling and pain.

This unique mechanism makes boswellia particularly valuable because it complements rather than duplicates the action of other anti-inflammatory supplements. Clinical trials have shown boswellia extract to significantly reduce pain, improve joint function, and decrease swelling in people with osteoarthritis and rheumatoid arthritis. Some studies have shown meaningful improvement in as little as four weeks of supplementation.

Boswellia is generally well tolerated with minimal side effects — a significant advantage over many pharmaceutical alternatives for long-term pain management.

4. Omega-3 Fatty Acids

Omega-3 fatty acids — particularly EPA and DHA from fish oil, or ALA from flaxseed oil — are among the most well-researched natural anti-inflammatory compounds available. They work by shifting the body’s production of signaling molecules called eicosanoids away from pro-inflammatory varieties toward anti-inflammatory ones — essentially recalibrating the body’s baseline inflammatory state.

For arthritis specifically, multiple clinical trials have shown that omega-3 supplementation reduces joint tenderness, morning stiffness, and the need for NSAIDs in people with rheumatoid arthritis. The effects are not immediate — omega-3s typically require consistent supplementation over several weeks to months to produce their full anti-inflammatory benefit — but they are meaningful and well-documented.

For those following a plant-based diet, flaxseed oil provides ALA omega-3s, and algae-based supplements provide EPA and DHA directly — the same forms found in fish oil — without fish-derived products. Since fish obtain their omega-3s from algae in the first place, algae-based supplements are a direct and sustainable source.

5. Ginger

Ginger has been used as a medicinal plant for over 5,000 years across Asian, Arabic, and African cultures — primarily for digestive and inflammatory conditions. Its active compounds, called gingerols and shogaols, have powerful anti-inflammatory and antioxidant properties that work through mechanisms very similar to curcumin — making ginger a close relative in terms of its biological activity.

Research has shown that ginger supplementation reduces pain and stiffness in people with osteoarthritis of the knee, with some studies finding effects comparable to ibuprofen. Ginger also appears to reduce the markers of systemic inflammation — including C-reactive protein and prostaglandins — that contribute to chronic pain throughout the body.

One of ginger’s additional advantages is its well-established safety profile and its dual role as both a supplement and a culinary ingredient. Fresh ginger, dried ginger powder, and ginger supplements all provide anti-inflammatory benefits — making it one of the easiest natural pain remedies to incorporate into daily life.

Using These Supplements Wisely

These five supplements — willow bark, curcumin, boswellia, omega-3s, and ginger — each address inflammation through different mechanisms, which means they can be complementary when used together. However, several important considerations apply:

First, always discuss supplements with your physician before starting — particularly if you are taking blood thinners, NSAIDs, or other medications, as some of these supplements have interactions worth monitoring.

Second, supplements work best as part of a comprehensive anti-inflammatory lifestyle. The dietary foundation matters enormously — and a diet high in processed foods, saturated fat, and refined sugar will continue to drive inflammation regardless of what supplements are taken.

Third, for dosages and a more comprehensive list of supplements for arthritis and pain — including seven additional options — Dr. Shintani’s free eBook Health Secrets is available at PeaceDiet.org.

Pain does not have to be managed with drugs alone. Nature has provided a remarkable pharmacy of anti-inflammatory compounds — and the research increasingly confirms their power.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org | Watch the video: https://www.instagram.com/p/DajydN1TLax/

📖 Also read — 7 Best Foods to Fight Arthritis and Pain Naturally: https://drshintani.com/2026/07/02/7-best-foods-to-fight-arthritis-and-pain-naturally/

When people are trying to lose weight, one of the most common questions Dr. Terry Shintani hears is: what can I actually eat? The assumption embedded in that question is that healthy eating means deprivation — smaller portions, blander food, and a constant battle against hunger.

The Peace Diet approach turns that assumption on its head. And one of the best examples of a food that is simultaneously delicious, satisfying, and powerfully supportive of weight loss and blood sugar control is one that most people already have in their kitchens.

Mushrooms.

Why Mushrooms Are a True Superfood

At first glance, mushrooms might not seem remarkable. But their nutritional profile is extraordinary for a food this versatile and flavorful. A 3.5-ounce serving contains just 22 calories, less than half a gram of fat, 3.2 grams of carbohydrates, and 3 grams of protein — along with meaningful amounts of fiber.

For anyone following the calorie density principles at the heart of the Peace Diet, mushrooms are close to ideal. They are extraordinarily low in calories relative to their weight and volume — meaning they physically fill the stomach, trigger satiety signals, and satisfy hunger without contributing meaningfully to caloric intake. You can eat a large, satisfying portion of mushrooms and consume fewer calories than a single bite of many processed foods.

But the most remarkable thing about mushrooms is not just what they lack — it is what they contain.

Anti-Diabetic Properties

Research has identified several bioactive compounds in mushrooms that appear to directly support blood sugar regulation. Beta-glucans — the same soluble fiber found in oats that helps lower cholesterol — are present in significant quantities in many mushroom varieties. These compounds slow the absorption of glucose from the digestive tract, preventing the sharp post-meal blood sugar spikes that stress the pancreas and contribute to insulin resistance over time.

Beyond beta-glucans, certain mushroom compounds have been shown to improve insulin sensitivity directly — helping cells respond more effectively to insulin and take up glucose more efficiently. Studies on specific mushroom varieties, including shiitake, maitake, and reishi, have found meaningful reductions in fasting blood sugar and improvements in glucose tolerance in research subjects.

For people with prediabetes or type 2 diabetes, incorporating mushrooms regularly into the diet is one of the most practical and enjoyable dietary strategies available — particularly because they can be added to virtually any meal without dramatically changing its character.

The Umami Advantage

One of the most underappreciated aspects of mushrooms as a health food is their rich, savory umami flavor. Umami — often described as the fifth taste alongside sweet, sour, salty, and bitter — is a deep, satisfying savoriness that signals protein and complexity to the brain. Foods high in umami are inherently more satisfying, which means they naturally reduce the urge to overeat.

This is particularly valuable for people transitioning away from meat-heavy diets. Mushrooms provide that same savory depth and textural satisfaction that makes meat so appealing — without the saturated fat, cholesterol, and excess calories that come with animal products. When mushrooms are cooked — sautéed, roasted, grilled, or added to soups and stews — their umami compounds concentrate and intensify, making them genuinely delicious as a primary ingredient rather than just a side note.

Versatility in the Kitchen

Part of what makes mushrooms such a practical superfood is how easily they integrate into existing recipes. They can be added to stir-fries, grain bowls, soups, pasta dishes, omelets, tacos, and salads. They can be used as a meat substitute in burgers, bolognese, and stuffed dishes. They can be eaten raw in salads or cooked in almost any method imaginable.

Almost every cuisine in the world — Japanese, Chinese, Italian, French, Hawaiian, Filipino, Mexican — has a tradition of cooking with mushrooms. This makes them one of the most culturally accessible healthy foods available, regardless of background or cooking tradition.

Varieties worth exploring include shiitake (particularly rich in immune-supporting lentinan), maitake (studied for blood sugar effects), oyster mushrooms (high in protein relative to other mushrooms), cremini and portobello (widely available and versatile), and reishi (used in traditional medicine for centuries).

A Simple Addition With Significant Impact

Dr. Shintani’s message is straightforward: you do not have to eat less to be healthy. You have to eat differently. Replacing calorie-dense, nutritionally empty foods with calorie-light, nutrient-rich foods like mushrooms allows you to eat satisfying, enjoyable meals while naturally moving toward a healthier weight and better blood sugar control.

Think about adding mushrooms to your next meal. They are inexpensive, widely available, easy to cook, and genuinely delicious. And as the research increasingly confirms — they are doing far more for your health than their humble appearance might suggest.

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Dr. Terry Shintani is a Harvard-trained physician (MD, JD, MPH), a Living Treasure of Hawai’i, and the creator of the Waianae Diet and the Peace Diet. He continues to see patients at his Honolulu practice and shares daily health insights on YouTube.

🌿 Learn more at PeaceDiet.org | Watch the video: https://www.instagram.com/p/DahOCP_Tuu9/