More than 75% of my visits with patients end with the same question: “Doc, is it okay if I still have a glass of wine?” It’s usually followed up by, “It helps me sleep.”

The honest answer is simple, but not always easy to hear: there is no safe amount of alcohol.

The World Health Organization puts it like this: no level of alcohol consumption is without risk to health.

The truth, as hard as it may be to digest, is that alcohol is a toxic, psychoactive, and dependence-producing substance. It has been classified as a Group 1 carcinogen by the International Agency for Research on Cancer—the same category as tobacco and asbestos. And importantly, it’s the ethanol itself that drives harm, not whether it’s wine, beer, or a skinny margarita.

Alcohol has been linked to at least seven types of cancer, including breast and colorectal cancer. As the body metabolizes alcohol, it produces compounds like acetaldehyde that can damage DNA and interfere with normal cellular repair.

Some may say that the dose makes the poison, but it’s not only people who consider themselves “heavy drinkers” who are at risk. Data suggest that a significant proportion of alcohol-related cancers occur in people who would be considered “light” or “moderate” drinkers.

And at the same time—there’s nuance. Alcohol is often tied to connection, celebration, and social rituals. And we know that social connection itself is protective for health and loneliness carries real physiological risk.

This is where individual decision-making comes in. Not from a place of guilt or restriction, but from awareness.

What I know to be true is this: alcohol is not a health-promoting behavior. It’s a trade-off. Understanding that allows you to make decisions more intentionally, rather than based on outdated narratives like “a little is good for you” or “it’s full of resveratrol.”

If you’re looking for an alternative, one of my go-to’s: soda water, bitters, and lime. Recipe below!

Share

follow @wiktbt on instagram

We don’t have a knowledge problem in health. We have an implementation problem.

The science is there. We’re just not building (or updating) systems that reflect it.

Take sleep.

We know children need it. According to the U.S. Centers for Disease Control and Prevention, infants require up to 14–17 hours, while teenagers need 8–10 hours per night. And yet, many school start times still run counter to adolescent circadian biology. Children are naturally inclined toward later sleep and wake cycles and yet the school bus arrives at 6:30am.

Take nutrition.

There is a robust body of evidence linking diets high in ultra-processed foods to poorer metabolic and long-term health outcomes. And yet, the U.S. still lacks meaningful regulation around these foods. At a minimum, we don’t even have a standardized front-of-package labeling system (like those used in the EU) to help consumers make informed choices quickly.

Photo courtesty of Foodtimes

Look at our cafeterias.

Children’s brains require adequate protein, essential fats, and micronutrients like iron, zinc, choline, iodine, folate, and B12 for proper development and learning. Patients in hospitals require nutrient-dense food to support recovery and healing. And yet, in two of the highest-stakes environments (schools and hospitals) cafeterias are often filled with highly processed, calorie-dense, nutrient-poor options.

Then there’s screen time.

Extended screen exposure has been associated with higher rates of anxiety, depression, and disrupted sleep in both adults and children. And yet, our workdays, education systems, and leisure time are increasingly built around screens - with little structural protection for mental health.

And we can’t ignore women’s health.

We have decades of research showing that hormonal fluctuations across the menstrual cycle, pregnancy, and perimenopause impact sleep, metabolism, cognition, and performance. And yet, most workplaces and health recommendations remain largely standardized, failing to account for these physiological differences.

Or movement.

We know regular physical activity is one of the most protective factors for long-term health. And yet, many built environments (from car-dependent cities to sedentary work structures) make consistent movement difficult to integrate into daily life.

At some point, the question shifts from “Why aren’t people healthier?” to: “Why aren’t our systems built to support health?”

We say we value health. But we consistently design systems that don’t support it. And when that happens, the burden shifts to the individual - to overcome environments that were never built with their biology in mind.

What I know to be true is this: if we can fund and prioritize large-scale initiatives in other areas of our government, we have the capacity to invest in environments that make healthy choices more accessible, more realistic, and more sustainable.

We Know Better. We’re Just Not Doing Better, yet.

follow @wiktbt on instagram

How often do you find yourself eating while something else is happening?

Your phone in one hand. The television on in the background. A laptop open beside your plate. A YouTube video playing while you rush through a sandwich. A podcast filling the silence. Or standing at the kitchen counter, taking quick bites between feeding your kids.

Modern life has turned eating into something we do while doing something else.

But digestion begins long before the first bite.

The moment your eyes see food and your nose catches its aroma, your brain sends the signal: meal time.

This triggers what is called cephalic phase of digestion - the body’s anticipatory response to food. Through vagal nerve signaling, the brain begins activating the digestive system before food even reaches the stomach.

Salivary glands increase saliva production.
Digestive enzymes begin to be released.
The stomach starts preparing acid and gastric secretions.
The pancreas and gut begin preparing for the work ahead.

In other words, the digestive system is being switched on.

When eating begins, chewing provides the first stage of mechanical digestion while enzymes in saliva (like amylase) start breaking down carbohydrates. From there, coordinated muscle contractions guide food down the esophagus toward the stomach, where the next stages of digestion continue.

Digestion isn’t a single event that begins in the stomach. It is a coordinated process involving the brain, nerves, enzymes, and organs working together.

And all of it works more efficiently when the nervous system is in a state that allows digestion to occur– what we often refer to as rest and digest– or the parasympathetic state.

Trying to eat while distracted, rushed, or stressed is a bit like using a food processor that’s unplugged. The ingredients may be there, but the system isn’t fully switched on.

We spend so much time optimizing what we eat: organic foods, perfect macros, nutrient diversity. But digestion is the gateway to nutrition. If the body isn’t prepared to receive a meal, absorption and metabolism cannot happen as efficiently.

What I know to be true is this: sometimes the most important part of nutrition isn’t what you eat. It’s how you eat.

learn more about dr. malani

Your body runs on a clock. At the center of that clock is the suprachiasmatic nucleus (your master circadian regulator) which is set primarily by light. Daylight tells your body it’s time to be alert, to move, to metabolize. Darkness tells it to wind down, repair, and fast.

Melatonin rises when the light falls. It signals biological night. It prepares the body for rest. But melatonin doesn’t just influence sleep, it also affects insulin secretion and glucose metabolism. When melatonin is elevated, insulin response is reduced. In other words, your body is less prepared to efficiently process a meal.

Cortisol does the opposite. It rises in the early morning, helping you wake up and mobilize energy. Insulin sensitivity is also higher earlier in the day. Your metabolism is primed for fuel when the sun is up.

Glucose tolerance follows a daily rhythm. Most people handle carbohydrates more efficiently in the morning and early afternoon than late at night. Peripheral clocks in the liver, pancreas, and gut are also cued by meal timing. When you eat in alignment with daylight, those clocks stay synchronized. When you regularly eat late into the biological night, the system begins to fall out of sync.

This misalignment carries consequences: higher post-meal glucose levels, disrupted hormonal rhythms, impaired sleep quality, and over time, increased metabolic strain.

This isn’t about perfection. It isn’t about rigid food rules. It’s about remembering that we are diurnal beings.

Eat when insulin sensitivity is strongest.

Let melatonin do its job at night.

What I know to be true is this: your metabolism is not separate from your circadian rhythm. When you eat with the light, your biology works with you. When you eat against it, your biology works harder.

Sometimes, the simplest upgrade isn’t a supplement. It’s honoring the body’s innate intelligence.

We can debate the type, the intensity, the heart rate zone. We can argue about protocols and programs. But beneath all of it is something simpler:

Movement is non-negotiable.

The research is clear and remarkably consistent: regular movement supports cardiovascular health, metabolic function, mood, cognition, and longevity. The human body is designed to move. Where we’ve gone wrong is turning movement into a product: something to be tracked, optimized, monetized, and aestheticized.

You don’t need a wearable to move. You don’t need a boutique gym membership. You don’t need to wake up at 5 a.m. or finish a perfect 60-minute session before your kids are awake. You need a body, and a willingness to use it.

Movement doesn’t have to be maximal to be meaningful. It can be woven into the day.

Have stairs in your house? Walk them a few times.
Waiting for your coffee to brew? Do 10 squats.
At the playground with the kids? Run, skip, climb.

We can call them “movement snacks,” but really, it’s just returning to what the body has always needed: frequent, varied use.

Truthfully, we overcomplicate it. It’s not about protein timing, creatine intake, pre-workout, or calculating your basal metabolic rate. Those details may have a place, but they are not the foundation.

And we can’t ignore the deeper layer. For too long, exercise has been entangled with beauty standards. We’ve been taught to equate thinness with health, aesthetics with worth. But healthy is not a measurement. Healthy is mobile. Healthy is strong enough to carry groceries and flexible enough to get up off the floor. Healthy is resilient - physically and emotionally. Healthy is alive.

What I know to be true is this: movement is not punishment, and it is not performance. It is participation in your own life. And that is worth protecting, every single day.

learn more about dr. malani

We often celebrate discipline as the gold standard of change. Wake up earlier. Train harder. Diet stricter. Force the habit until it sticks. But discipline, especially when it comes from external pressure or self-criticism, is often difficult to sustain. It can carry us for short bursts, but it rarely carries us for a lifetime.

Showing up for yourself consistently is far more powerful.

You cannot discipline yourself into self-worth. But you can build self-trust by showing up for yourself, over and over again, in small and steady ways. Each time you keep a promise to yourself, even a simple one, you reinforce the belief that you are someone worth caring for. That’s the foundation of a strong sense of self.

We tend to frame the routines we see online as acts of discipline. The early alarms. The perfect morning routine. The strict meal plans. But the routines that actually last are not powered by force. They are built through repetition, flexibility, and the understanding that you can begin again the next day. Consistency allows room for being human. Discipline often leaves little room for error.

Over time, it is consistency that reshapes identity. It is what turns a walk into a habit, a habit into a lifestyle, and a lifestyle into something that feels natural rather than forced.

And underneath it all is something deeper. Showing up consistently is easier when it comes from a place of self-respect rather than self-criticism. When you believe you are worth caring for, the motivation shifts. You are no longer punishing yourself into change. You are supporting yourself through it.

What I know to be true is this: transformation isn’t about intensity. It’s about building enough self-respect to keep coming back to yourself.

This week isn’t about nutrition or physiology, at least not directly. It’s about a simpler truth: it is okay to not be okay.

I’ve lived enough life to know this much: we like to believe we are in control. We optimize, plan, prepare, and manage. And while we can influence our responses, our breath, and the people we surround ourselves with, much of life remains outside our control. Accepting that is not weakness. It is honesty.

In times like these, I think often of my cancer patients. Many arrive for treatment on days when they feel relatively well, fully aware that the hours ahead may leave them feeling worse. They know the side effects that may follow: the fatigue, the nausea, the malaise. They show up anyway. They show up knowing the toll that treatment may take on their bodies, their energy, their hope. That willingness to keep going, even when the weight of illness and the state of the world already feels unbearable, is a quiet and extraordinary kind of courage. A kind of courage that I draw strength from.

What I know to be true is this: strength does not always look like positivity or resilience. Sometimes it looks like showing up, breathing through the hard moments, and allowing yourself to be human. In a world that feels uncertain and heavy, that may be more than enough.

A simple analogy helps here. Before a long road trip, there’s one non-negotiable: you fill the gas tank. You don’t wait until you’re halfway there, and you don’t assume the engine will “figure it out.” The human body works the same way. Busy day ahead? High cognitive load? Physical training or stress? Fuel has to be available.

Food is more than calories- it’s energy and building blocks. Nutrient-dense meals provide glucose, amino acids, vitamins, and minerals that are distributed to the brain, muscles, and vital organs to keep systems online throughout the day. When fuel is insufficient, the body doesn’t stop working, it compensates. That compensation often shows up as increased strain on metabolic, hormonal, and stress-response systems.

If you are using intermittent fasting long term, it is worth reassessing whether you are consistently meeting energy and micronutrient needs, and whether your body is thriving, not just tolerating it.

This is one of the hardest truths I’ve learned from working with cancer patients. In nearly every first visit, I watch patients searching for an explanation. They replay their lives, scanning for mistakes. Experimenting with cigarettes in college. A stressful job. A season of poor sleep. Then the question comes, quietly and often with shame: Was this my fault?

As clinicians, we want answers too. We are trained to look for causes, risk factors, patterns. But the truth is, there is no single behavior, food, or decision that explains why one person develops cancer and another does not. Human biology is far more complex than that.

We have slowly absorbed the idea that health is something that can be optimized through enough discipline, purchasing power, or wellness practices. That if we just buy the right food, the right supplements, and follow the right routines, we can opt out of illness. But health is not a commodity. If it were, illness would only affect those with fewer resources. We know that is not true. I have cared for countless patients with exceptional access, knowledge, and health habits who still developed cancer. Cancer does not discriminate.

Human health is shaped by genetics, environment, immune function, metabolism, and exposures across a lifetime. It is also influenced by less visible forces like chronic stress and trauma, factors that can’t always be solved by products or protocols. These are not moral failures. They are biological realities that shape physiology gradually and often invisibly.

What I know to be true is this: a cancer diagnosis is not a verdict on how well you lived your life. And health is not a reward for doing everything “right.” It’s the result of biology, chance, and a body doing its best over time. Sometimes compassion begins with remembering that illness is part of the imperfect reality of being human.

The same principle applies inside the body.

Each organ has a defined role.
The heart moves blood and oxygen.
The lungs exchange oxygen and carbon dioxide.
The liver processes nutrients, detoxifies compounds, and produces essential proteins.
The kidneys filter waste and regulate fluid balance.
The stomach breaks down food.
The pancreas releases digestive enzymes and hormones like insulin to manage blood sugar.

These systems are designed to work in coordinated cycles of activity and recovery. They are not meant to be on duty around the clock.

Take the pancreas, for example. In a healthy body, it works in clear, deliberate pulses, releasing insulin when food arrives and going off duty until the next meal. But when we eat late into the night, graze continuously, or spike blood sugar again and again with sweets and snacks, we keep asking it to clock back in. The pancreas (and liver) are forced to work overtime when they should be moving into rest and repair. Over time, this nonstop demand dulls insulin signaling and builds metabolic strain.

Your body is not built for constant demand.
It is built for balance.

follow @wiktbt on instagram

When a symptom shows up, our instinct is almost always to add something to make it go away. Sneezing leads to allergy medication. A headache leads to Advil. Poor focus leads to another supplement or stimulant. Before adding yet another input, it is worth pausing to ask a different question: is there anything I could subtract?

This comes up most clearly with sleep. Many of us sprint through the day and then reach for something to “turn the body off” at night. But sleep is not something the body needs to be forced into. It is something that emerges when obstacles are removed.

Instead of adding a sleep aid, could we subtract screens in the hour before bed? Could we subtract the late afternoon coffee? Could we subtract the evening alcohol that quietly disrupts our circadian rhythm?

The medicine of subtraction asks us to identify what is interfering with the body’s innate regulation before trying to override it. Often, the most effective intervention is not another pill or protocol, but fewer inputs and more space for physiology to do what it already knows how to do.

learn more about dr. malani

follow @wiktbt on instagram

Health trends change constantly.
Human biology does not.

What truly supports the body is often quiet. It’s not loud, trending, or extreme.

Today I’m launching a series called “What I Know to Be True.”

These are principles I return to again and again in patient care, research, and health education - ideas that are surprisingly simple, deeply evidence-based, and hard to dispute.

One grounded truth each week - based on science, clinical experience, and what consistently supports healing. No hype. No fads.

I hope these posts feel empowering and clarifying in a very noisy world.

Week 1 begins next week.