When I launched Fix the Formula, pre-baby, I was so naive.

Priority #1 is getting your kid to eat. Eat anything, really.

A mom recently mentioned that the only thing her baby would eat was melted ice cream in a bottle. She was desperate. It was her last resort. A feeding specialist I spoke to afterwards said this is a common band-aid solution for babies with extreme food challenges. Honestly… you got to do what you got to do 💪.

I share that story because if your kid will only eat formula with pesticides, your kid will only eat formula with pesticides. You can’t starve your kid.

Parents need to feed their kids. And regulators need to make sure our food system isn’t poisoning our babies. That’s their job.

But alas, the US isn’t known for world-class food regulation. So here we are, a bunch of parents crowdfunding testing formula for contaminants. To everyone who chipped in — thank you!

My goal with Fix the Formula was to share a ranked list of formulas from cleanest to most contaminated. That's what parents deserve.

Turns out, that's not how this went. Definitively answering "What's the cleanest formula?" would take millions of dollars and ongoing mandatory testing. Sorry, friends!

To recap, we tested the following products:

• Holle Organic Stage 1

• Enfamil NeuroPro

• Bobbie Organic Infant Formula

• Similac 360 Total Care

• Kendamil Organic Infant Formula

For the following:

• Macronutrients

• Minerals

• Heavy metals

• Glyphosate & AMPA

• BPA / BPS

• Phthalates

• Mycotoxins

• Pesticides

We ran the tests because formula isn’t regulated for most contaminants.

We were surprised — none of the general “rules of formula” held up in our testing

The formula hierarchy that lives on the internet:

1. European formulas are better

2. Organic formulas are better

3. Premium-priced formulas are better

None of this was clearly supported in our data.

The top formulas depend on your priorities

If heavy metals are your primary concern: Every formula tested positive for arsenic. Bobbie Organic had the lowest total heavy metals summed across arsenic, cadmium, lead, and mercury. Holle Organic had the highest, testing positive for arsenic, cadmium, and lead.

If phthalates are your primary concern: All five formulas tested positive for phthalates, the synthetic chemicals used to make plastics flexible. Enfamil NeuroPro and Holle Organic tested lowest. Similac tested the highest.

If pesticides are your primary concern: Enfamil NeuroPro was the only formula with no detected pesticides. Kendamil Organic had the highest pesticide reading. DPA showed up in all three organic formulas tested — a good reminder that organic doesn’t guarantee contaminant-free.

No formula tested above detection for mycotoxins (mold).

This might be when you start freaking out

Arsenic and plastics in all the formulas?! Yeah, it sounds bad. The challenge is that this applies to most of our food supply. It’s not a formula-specific problem. Contaminants are in our soil, water, manufacturing process, and packaging. They’re in our placentas, cord blood, and breastmilk. It’s a mess and an incredibly difficult problem to solve.

Now you might be thinking, “Ok, well how much of these contaminants is in the formula? Maybe it’s a low amount, and I don’t have to worry?” On fixtheformula.org, you’ll see the amounts listed for each contaminant. You’ll also see how things compare to regulatory limits and health benchmarks. But here we run into another challenge: we don’t actually have consensus on what amount of contaminants causes a problem. More on this below.

The nitty-gritty is where things get really interesting

The industry lacks regulatory limits and health benchmark data

When you look at the data table on fixtheformula.org, you’ll see there is a toggle in the upper left between regulatory and health benchmarks. That’s because these are not the same.

Regulatory limits reflect what’s politically and commercially feasible. They’re shaped by what today’s supply chain can achieve, what industry can produce, and what consumer prices support. Not to mention the lobbying power of Abbott, Reckitt, and Nestlé, the three companies that control the U.S. formula market and spend millions keeping the rules as they are.

For the website, we looked at the regulatory thresholds set by the FDA, California’s Prop 65, and the EU. We used the most conservative regulatory limit available. The US has no regulatory limits for most contaminants, so most of the limits listed are from the EU.

Health benchmarks ask a totally different question: what does the science say is actually safe for a developing infant?

Infant-specific health guidelines barely exist. As a proxy, we used the Environmental Working Group’s drinking water benchmark when available. A developing infant’s brain and organs are entirely reliant on formula. That exposure warrants as much caution as adult drinking water limits, if not more. Where EWG numbers weren’t available, we tried to include other benchmarks.

The difference between regulatory limits and health guidelines is sometimes 100x. The EU regulatory limit for lead is 20 ppb. The EWG’s suggested safe limit is 0.2 ppb. That’s a 100x gap. The difference between those two things is a longer conversation and a problem worth addressing.

Testing capacity is limited

On fixtheformula.org you’ll see “< #.” Below “#” doesn’t mean absent. It means: if it’s there in small quantities, we can’t detect it yet.

Health benchmarks are sometimes set at quantities below what’s detectable in a commercial lab. For example, the Environmental Working Group sets the healthy limit for glyphosate in drinking water at < 5 ppb, but the lab can’t detect below ~10 ppb. Here, science has outpaced the commercial tools available to verify it.

This is one snapshot in time, not enough to draw conclusions

We tested one batch per formula, at a single accredited lab. One test isn’t enough evidence to switch formulas over.

Results vary dramatically between batches and between tests. For example, the numbers don’t match across Consumer Reports, Moms Across America, and Healthy Florida First on the same products. Sourcing, manufacturing, and testing methods all introduce variation. That’s why testing needs to be frequent, independent, and mandatory. Notably, OpenLabel Research is working on the independent part and was core to building Fix the Formula.

After all of this, here are my 3 main takeaways

First, we need better health research

The EWG, FDA, EFSA, and WHO can’t agree on what contaminant levels are actually harmful to infants. That disagreement is convenient for everyone except parents. Without scientific consensus, regulators default to the status quo. Most of what we know about these contaminants comes from animal studies or thresholds tied to cancer and lethal toxicity, not what happens when a tiny developing human is exposed to low doses daily. We need independent research that studies infants.

Second, we need updated regulation

The gap between what's allowed and what health research considers safe is sometimes 100x.

That gap only closes when the industry is required to change — ingredient sourcing, manufacturing processes, and packaging materials. Not by lobbying to keep the bar where it is.

Third, we need better testing and enforcement

Right now, results vary dramatically between batches and labs. Single-batch, self-reported testing tells us almost nothing. We need labs that can detect smaller quantities (Light Labs is working on this!). And we need regulators to require frequent, independent batch testing with public disclosure.

What’s next?

I started this project assuming I’d end up with a clean ranked list. Buy this one… skip that one… done. Instead I got a masterclass in why the system is so messed up, why that list doesn’t exist yet, and what it would take to build one.

If you want the underlying data: it’s all free on fixtheformula.org, for every contaminant we tested. This was all made possible by the friends who crowdfunded this experiment. You know who you are — thank you for pushing this conversation forward!

As a next step, share this post. The more parents asking these questions, the closer we get to answering them. You can like, comment, or retweet this.

Lastly, if this is a project you want to run long-term, email me at team@fixtheformula.org. I’d love to see it live on and help however I can.

Thinking of you,

Julia Lipton

I’m currently investing, researching, and helping friends build things. Reach out if you’re working on anything related to environmental toxins, the exposome, or anything else you think I’d find interesting!

P.S. Thank you to Evan Fisher, Alana Podrx, Justin Mares, Kevin Fisher, Maytal Ayal, Andy Bromberg, and Alexa Bromberg for your encouragement throughout this project. And a big thanks to Natajsa Nielsen for building the website and starting OpenLabel.

This post is for everyone who has a woman in their life with bad periods. If you’re that woman, this post is especially for you.

If you know someone who is suffering, send this to her. It might just help.

A few weeks before my endometriosis surgery, I emailed my surgeon. “I have to cancel. I’m pregnant.”

His response was, more or less, “How is that possible?”

I was 36. I had deep infiltrating endometriosis in my pelvis and rectum, bad enough that I had a surgery date with multiple specialists involved. A few weeks before that surgery, I got pregnant.

People with endometriosis often struggle to get pregnant, and two years earlier, I was told I’d likely never be able to get pregnant naturally.

I wasn’t sure how it was possible, but I had an idea.

For years, I had been trying to manage endometriosis and avoid surgery. A few months prior, I put myself on a course of herbal antibacterials to treat SIBO (small intestinal bacterial overgrowth). It was Step 1 in a new protocol I was trying. I got pregnant soon after.

What is Endometriosis?

Endometriosis is when tissue similar to the uterine lining grows outside the uterus — on the ovaries, bowel, bladder, and pelvic wall. In rare cases, it grows as far as the diaphragm, and in extremely rare cases, the brain.

Every month, that tissue responds to hormonal signals the same way the uterine lining does. It swells, it bleeds, but unlike the uterine lining, it has nowhere to go.

The pain is often described as a knife twisting and stabbing your insides. Or labor contractions. I had an unmedicated homebirth. For me, endo attacks are worse. Yes… my once-a-month endo attacks are worse than giving birth.

Different women have different symptoms. Heavy bleeding, vomiting, diarrhea, shitting blood, passing out, pain during sex, infertility, fevers…. The list goes on.

Since 1/2 this newsletter is men:

It affects roughly 10% of women, takes an average of 7 to 10 years to receive a diagnosis, and there is no cure.

When I found out I was pregnant, I was terrified that we’d have a girl. Endometriosis runs in families — daughters are 5x to 7x more likely to have endo if their mom has it (men, it can be passed through your bloodline too). I didn’t want her to experience pain like this. As the universe would have it, we now have a beautiful, healthy baby girl.

Below is the research I’ve done for myself, my daughter, and everyone else who might be suffering.

Wait… How do 10% of women have this disease, and almost no one is talking about it?

For decades, diagnosis required laparoscopic surgery — general anesthesia, a surgeon, and a willingness to be cut open. Most women wait until the pain is unbearable.

Since it’s hard to diagnose, it’s hard to study, and hard to understand.

The disease also doesn’t show up on standard MRIs or ultrasounds. A woman can walk out of a normal scan with endometriosis on her bowel, bladder, and pelvic wall, and be told everything looks fine.

There’s also a training problem. Lesions are classically taught as black spots, but they can also be clear, pink, red, or white. A surgeon who doesn’t know exactly what they’re looking for won’t find it.

Thankfully, the diagnosis problem is starting to improve. In February 2026, ACOG ended the requirement for surgery to confirm a diagnosis. For the first time, treatment can begin based on symptoms and an exam.

There are also new blood tests, for example, EndomTest and HerResolve. They’re not FDA-cleared yet, and won’t catch every case, but it’s progress. There are a handful of other diagnostic startups working on the problem.

Better diagnostics unlock better studies. Regularly cutting women open to measure and monitor disease progression (or regression) is not a viable option, and a huge reason why research has been so slow.

How do you treat it? Spoiler alert: you don’t.

Women are given two primary options:

1. Birth Control

2. Surgery

Neither treats the root cause of the disease.

Birth control suppresses your cycle. It doesn’t eliminate lesions or address the underlying inflammation. It treats symptoms for some women.

By the time a woman stops birth control, the disease is often more advanced than when she started. This is one of the reasons why women are often shocked by super-painful periods when they come off the pill. The disease didn’t pause. It progressed. The lesions deepened, and adhesions formed. They just couldn’t see it.

Surgery is the closest thing to a real intervention, but recurrence rates range up to 67%.* Surgery removes the lesions without changing the biological environment that allowed them to grow. This is why I want to understand the disease and change my environment. I’m terrified it will just grow back.

*Most patients also don’t know that ablation (burning the surface of lesions) and excision (removing them at the root) are fundamentally different procedures with dramatically different outcomes. If you or someone you love is considering surgery, make sure it’s excision surgery with a trained specialist.

So what’s actually causing it?

These are the 4 root causes that I’m most focused on:

1. Immune dysfunction and inflammation

2. Poor gut health

3. Hormonal imbalances

4. Nervous system disruption

Notably, even if you don’t have endometriosis, it’s helpful to understand how these 4 systems impact your body.

Immune dysfunction fuels lesion growth

The immune system uses messenger chemicals called cytokines to tell your body what to do. Think of them like an alarm system. In a healthy body, if endometrial tissue ends up somewhere it shouldn’t, the immune system spots it, sounds the alarm bell, and clears it.

In endometriosis, those alarms don’t shut off. Instead of triggering a quick cleanup, they trigger blood vessel growth — the same process behind healing a cut. That blood supply runs straight to the lesion, drip-feeds it, and drives more growth.

To make matters worse, the alarms don’t stay contained. They flood the bloodstream and cause chronic inflammation. The whole body responds to alerts meant for one small patch of tissue. That’s likely why women with endo have higher rates of autoimmune diseases, IBS, chronic fatigue, migraines, brain fog, and other conditions.

Fighting the inflammation

Nothing below makes lesions disappear. Surgery remains the only thing that physically removes tissue. But several of these have shown real impact on inflammation and pain. NAC has shown measurable reductions in lesion size in human studies. Omega-3s and Vitamin C have shown similar reductions in small animal studies.

• Sleep is one of the few inflammatory levers you actually control. Poor sleep raises the same inflammatory chemicals already flooding your system, and chronic inflammation disrupts the sleep your body needs to regulate. It’s a loop.

• NAC (N-acetyl cysteine, 600mg 3x daily) reduces cellular damage from chronic inflammation. Small trials show a measurable reduction in endometrioma size (an ovarian cyst from endometrial tissue). This may actually impact lesion size, not just symptoms.

• Omega-3s (EPA-dominant, 1500–2000mg daily) directly modulate the inflammatory chemicals that cause cramping and lesion activity. The dosing matters here. Most commercial fish oil falls well short.

• Vitamin C (1000mg) + Vitamin E (800 IU) has RCT evidence for reducing pelvic pain and severe menstrual cramps.

• Vitamin D deficiency is common in endo and linked to worse inflammatory markers. Test and correct.

• Low-dose naltrexone (LDN): modulates immune function through an opioid receptor rebound mechanism. The evidence is mostly extrapolated from other conditions like PCOS and chronic pelvic pain — endo-specific trials are still in progress.

• Melatonin (10mg nightly) reduced pain scores and analgesic use in trials. It also improves sleep, which has its own anti-inflammatory effect.

• GLP-1/GIP agonists (semaglutide, tirzepatide) are on this list for their anti-inflammatory effects, independent of weight loss. There are no endo-specific trials yet, but the rationale is strong, and clinicians (and patients) are reporting anecdotal symptom improvement.

• There are a handful of clinical trials anywhere between phase 1 and phase 3, other studies, and endo startups.

The gut can’t detox properly and is recirculating estrogen

In addition to the supplements above (everything sleep - vitamin D), after I stop breastfeeding, this is where I’m focusing my energy.

“Endo belly” is one of the most common symptoms of endometriosis. Post-pregnancy, I can confirm: my stomach looks the same after most dinners as it did at four months pregnant.

If you have frequent bloating, constipation, “period poops,” or GI symptoms that worsen around your cycle, your gut isn’t a separate problem. It’s one of the most significant drivers of it.

Here’s how the gut fits in:

Your gut hosts a community of bacteria called the estrobolome. Their job is to escort used estrogen out of your body. Estrogen feeds lesion growth. When your gut is inflamed or constipated, that estrogen doesn’t leave. It gets reabsorbed, recirculates, and fuels endo. Your body continues to make new estrogen while reabsorbing the estrogen it tried to eliminate.

This broken estrogen-detox loop shows up in fibroids, PCOS, and bad PMS, too.

I first learned about the gut-endo connection from Dr. Iris Kerin Orbuch, one of the country’s leading excision specialists and author of Beating Endo.

Before she operates, she requires every patient to get a SIBO test. She won’t operate until it’s fixed. An unhealthy gut makes endo far more likely to come back after surgery. A 2025 peer-reviewed paper found that 91.9% of women with endo have SIBO. In addition to disrupting estrogen clearance, broader gut dysbiosis drives systemic inflammation.

What you eat drives all of this. Fiber feeds the estrobolome bacteria that properly clear estrogen. Ultra-processed food and excess sugar feed the bacteria that cause problems.

There’s no specific endo diet. A 2026 review of the full literature found no dietary strategy currently supported as treatment, and warned that restrictive elimination diets carry a real risk of nutritional deficiency without proven benefit.

That said, in a 2025 survey of nearly 2,400 women with endo, 53% who cut alcohol reported less pain, 45% for gluten-free or dairy-free, and 43% for caffeine. There isn’t peer-reviewed research to support cutting things, but if cutting something makes you feel better, it might be worth doing.

Personally, I’ve cut alcohol, gluten, dairy, most sugar, and caffeine (other than matcha). Any time I accidentally eat any of these things, I feel the inflammation. I hope that one day my gut will be stronger and I can tolerate more foods.

Breaking the loop

• Resistant starches and soluble fiber: feed the bacteria that clear estrogen. If you have SIBO, make sure these are SIBO safe since many resistant starches and fibers can aggravate SIBO. A well-studied option is Sunfiber. Other common fibers include flaxseed and chia seed, although both have mixed reported SIBO results.

• Magnesium at night (400–500mg): may support gut motility and help ease the constipation-reabsorption loop. A large NHANES study of nearly 9,500 adults found that higher dietary magnesium intake was linked to significantly lower rates of chronic constipation.

• Lactobacillus gasseri: a specific probiotic strain with endo-specific research behind it. Strain matters more than category here — some common probiotic strains, including certain other Lactobacillus species, can worsen SIBO rather than help. Do a stool test before starting probiotics.

And at a minimum, ask your doctor for three things:

1. a SIBO breath test

2. a comprehensive stool test

3. a liver panel (the other half of the gut equation is the liver and bile, more on this in a future detox post)

Each catches a different place where the process breaks down. If you want to see how your body is metabolizing estrogen, ask about the DUTCH test. It’s a more specialized urine panel that maps your hormones over time and flags where you’re struggling.

The hormonal environment is feeding lesion growth

This is the section where I’ve gotten the most conflicting advice. I’ve spoken to a dozen-plus doctors: western, functional, surgical, and naturopathic. Everyone has a slightly different answer. Partly because everybody is different, and partly because the research is limited.

Here’s what I’ve pieced together from doctor interviews, books, research, and my own experience.

In a healthy cycle, estrogen and progesterone balance each other out. In endometriosis, estrogen often stays elevated, feeding the lesions. Progesterone counters that dominance. It calms inflammation, and for most women, reduces pain and bleeding. Progesterone supplementation is an accessible starting point since every gynecologist can prescribe some form of it.

Three hormonal prescription options

They all have real side effects. I’ve learned the hard way. Discuss them with a doctor you trust first.

• Bioidentical and synthetic progestins are similar but not the same. Bioidentical progesterone tends to be better tolerated, with fewer breast tissue and lipid side effects. Synthetic progestins are cheaper, more widely available, backed by more clinical data, and proven to be more effective. I’m slightly skeptical that they’re actually more effective, but because bioidentical progesterone isn’t patentable, there’s no incentive to fund large trials.

• Dienogest (Visanne) gets its own callout. It’s a synthetic progestin that almost no American has heard of. It’s the standard of care in Europe, Australia, and Japan. Unlike most hormonal treatments that just change your hormonal environment, dienogest acts directly on the lesion, stopping it from spreading and cutting off its blood supply. It’s the only progestin option here with clinical evidence of actually shrinking lesions, not just slowing them.

• GnRH antagonists (elagolix, relugolix) block estrogen production from the start. These are especially useful for the 1/4 to 1/3 of women with progesterone resistance. These can shrink endometriomas somewhat, similar to menopause. They also carry the most severe mental health risks of anything on this list, including documented suicidal ideation.

Do your own research here. Find a doctor who actually knows this disease.

The nervous system is stuck in fight-or-flight

I’ve only kicked my endo attacks into remission twice since 2020. The most recent was after some big personal life shifts. I noticed that the safer, happier, and calmer I felt in my body, the less bad my flares were. Same lesions, same disease, totally different pain levels. That led me down the nervous system rabbit hole.

If you’re in pain month after month, your nervous system gets better and better at sending pain signals. Neurons that fire together wire together. This is called central sensitization, and it makes you more sensitive over time.

Your pelvic floor compounds the pain. Pain makes your muscles clench. Clenched muscles start to hurt on their own. Now you have another pain source feeding the same loop.

Your autonomic nervous system sits underneath both. You may have heard this described as your sympathetic and parasympathetic systems. The sympathetic triggers fight-or-flight. The parasympathetic shifts you into rest-and-digest (largely the vagus nerve).

A healthy body spends most of its time in rest-and-digest and only switches into fight-or-flight when there’s a real threat. After years of pain, the body starts to default to fight-or-flight. A body stuck in fight-or-flight never lets the sensitized pain system downshift. It just keeps sounding the alarm. Women with endo tend to run lower vagal tone as a result. The vagus nerve weakens from underuse.

This is partially why surgery doesn’t always fix the pain: the sensitized nerves, clenched muscles, and low vagal tone keep sending the same signals even after surgery.

What the research backs specifically for endo

• Pelvic floor PT is the strongest option here. Trials combining trigger point work, nerve release injections, and PT reduced pain, even in women who’d already had excision surgery. It treats the loop, not just the lesions.

• Sleep is incredibly important (sleep is always good!). Poor sleep raises inflammation and worsens central sensitization, and pain wrecks sleep right back. Fix the loop.

• TENS (an over-the-counter nerve stimulation device) has real-world trial support for reducing pelvic pain. Cheap and low-risk enough to try before anything bigger.

Other things that help nervous system regulation

I’ve benefited from all of these.

• Breathwork: women with endo have measurably lower vagal tone, confirmed via HRV data. Deep breaths with longer exhales are one of the only ways to directly recruit the vagus nerve.

• Stretching is mechanically doing PT’s job. Most pelvic PTs recommend stretching homework to release chronically clenched muscles.

• Shaking, singing, and humming are rooted in vagus nerve physiology, vibration, and vocalization near the vocal cords and diaphragm. Low-risk, and it feels good.

What to do with this

Send this to anyone you think it might help. If that person is you, bring this post to your next appointment.

A few starting points:

• Track your cycle, pain, and symptoms for a full cycle (or more) before your next appointment. Ask your doctor about finding an expert in your network.

• If surgery comes up, ask how many excision cases your surgeon does a year. Make sure it’s excision, and not ablation. Ask about recurrence rates and the plan post-surgery. If the only plan is “birth control,” I’d be very skeptical.

• Get a SIBO breath test, gut test, and a full lab workup to understand liver function, inflammatory markers, metabolic function, iron levels, and more.

• Ask about supplements, progesterone, pelvic PT, and other things on this list to manage symptoms.

I started writing this because I spent close to a decade managing a disease nobody ever explained properly to me. I wanted a plan for myself. I’ve spent too many months of my life throwing up, passing out, and shitting blood — fake smiling through board meetings, hikes, and family brunches. If my daughter ends up with it too, I want her experience to be better.

I’m optimistic. Our understanding of the disease, the diagnostics, and the drug pipeline are improving rapidly. And if you or someone you love is in the 10% of women who have endometriosis, I hope this helps you, too.

Thinking of you,
Julia Lipton

currently investing, researching, and helping friends build things

Big thank you to Evan Fisher, Alana Podrx, and Justin Mares for giving feedback and edits. And to Azure Grant and PeopleScience for helping people run studies on the disease.

*You’re receiving this because you are a subscriber to Awesome People List. That newsletter has been MIA for a while.

Moving forward, I’ll mostly post here on It’s Personal. I’ll share things I can’t shut up about: health, wellness, and business.

If you aren’t interested in this content, please unsubscribe. I promise, I won’t be offended 🙏

First things first, you’re receiving this because you are a subscriber to Awesome People List. That newsletter has been MIA for a while.

Moving forward, I’ll mostly post here on It’s Personal. I’ll share things I can’t shut up about: health, wellness, and business.

If you aren’t interested in this content, please unsubscribe. I promise, I won’t be offended.

This post is for everyone who has a family member or friend with Alzheimer’s. It’s one of the worst diseases, and if you’re watching someone you love decline, I hope something here is useful. Share anything that resonates with your doctor and care team. If you don’t have time to read the details, here is the Claude summary.

Unfortunately, you are not alone. About 1 in 9 people ages 65+ has Alzheimer’s, and nearly two-thirds of those are women. By age 85, it’s 1 in 3 — truly tragic.

For decades, Alzheimer’s research was dominated by one idea: abnormal protein buildup, specifically amyloid plaques, causes the disease. Clear them out, cure the disease.

Except it hasn’t worked. Almost all clinical approaches targeting amyloid beta have failed over the last three decades, costing the field 25 years and tens of billions of dollars.

Quick note: I’m not a doctor. My dad has Alzheimer’s, and this is what I’ve learned tracking the space for years and supporting my family.

Alzheimer’s is likely a category of related diseases, each with different causes and treatments. Researchers have started identifying subtypes based on the underlying drivers they see in the brain:

• Metabolic. The brain becomes resistant to insulin.

• Inflammatory. Chronic inflammation damages brain tissue.

• Vascular. Blood flow to the brain is impaired.

• Amyloid- or tau-predominant. Some patients’ decline tracks more closely with sticky plaques between neurons (amyloid); others with twisted protein tangles inside neurons (tau).

Brain scans, lab markers, and metabolic profiles each tell a different part of the story. Most patients have more than one thing going on.

Below is a growing list of suspected root causes, along with interventions and studies. The field is moving fast, and it’s still early — 192 clinical trials are happening now.

There’s plenty I haven’t covered here — metformin, ketamine, and interventions that are a bit more nuanced. If you’ve tried other things or have research to add, please send it my way.

And if you’re building something in this space, I’d love to chat about collaborating or investing!

Root Cause #1: The Brain’s Energy Crisis

The brain runs almost entirely on glucose. In Alzheimer’s, the brain loses the ability to use that fuel. You can see it on PET scans years, sometimes decades, before symptoms appear. The neurons are essentially starving in a room full of food.

The mechanism looks a lot like diabetes. In type 2 diabetes, cells stop responding to insulin (the hormone that lets cells absorb glucose), so sugar gets stranded outside the cells that need it. In Alzheimer’s, the same insulin resistance appears to develop in the brain — which is why some researchers call it type 3 diabetes.

That energy crisis may be driving the disease long before anyone gets a diagnosis. Several of the interventions below target it directly.

Ketogenic Diet

The mechanism: If the brain can’t use glucose, give it a different fuel. A ketogenic diet shifts the body into ketosis, producing ketones from fat — a fuel Alzheimer’s brains can still use. It also reduces inflammation and improves insulin sensitivity.

The evidence:

• 2024 meta-analysis (10 Randomized Clinical Trials, 691 Alzheimer’s patients): Ketogenic diets improved cognitive scores on standard measures.

• A clinical trial recently wrapped up studying keto specifically as an Alzheimer’s treatment.

The popular and controversial ReCODE protocol is rooted in a plant-rich, mildly ketogenic diet alongside other lifestyle interventions covered later (sleep, exercise, brain training).

The reality: The earlier you catch it, the easier the lifestyle changes. Late-stage, getting a patient to follow a specific diet can be brutal. How hard do you fight an adult — throwing a tantrum, slowly dying — because they can’t have ice cream? You need the full care team committed to cutting sugar, and even then, go in with realistic expectations.

Creatine

The mechanism: Brain cells use creatine to rapidly regenerate ATP, their primary energy currency. Alzheimer’s brains are energy-starved, and research shows creatine levels are depleted in affected tissue.

The evidence:

• 2025 pilot trial (Alzheimer’s & Dementia: TRCI): 20g per day for 8 weeks produced measurable improvements in both cognition and brain creatine levels.

The reality: Small study, excellent safety profile, credible mechanism. Worth a conversation with a doctor.

GLP-1 Receptor Agonists

The mechanism: GLP-1s started as metabolic drugs, but they impact nearly every root cause on this list. They improve brain glucose metabolism, reduce neuroinflammation, and help clear toxic proteins.

The evidence:

• EVOKE & EVOKE+ Phase 3 trials (3,800+ early-stage Alzheimer’s patients, Dec 2025): Oral semaglutide did not significantly slow disease progression, but it did improve tau biomarkers and brain inflammation markers.

• U.S. observational study (1M+ type 2 diabetes patients): Semaglutide was associated with a 40–70% drop in first-time Alzheimer’s diagnoses vs. other medications.

The reality: GLP-1s get hyped as miracle drugs for everything, and Alzheimer’s is no exception. It’s still very TBD. The field is now asking whether GLP-1s work better as prevention than as treatment.

Root Cause #2: Chronic Neuroinflammation

Inflammation isn’t just a symptom of Alzheimer’s. Increasingly, researchers believe it’s a primary driver. The brain’s immune cells become overactivated, creating a chronic inflammatory environment that accelerates neurodegeneration. The question is: what’s triggering that inflammation in the first place?

We’re more inflamed than ever — new viruses, mold, pesticides, plastics, ultra-processed food, chronic stress, poor sleep. Chronic inflammation isn’t just bad for the brain. It’s linked to most of the chronic diseases in the developed world.

Lower inflammation is better, full stop. Below are interventions being tested specifically for Alzheimer’s.

The Shingles Vaccine (Shingrix)

The mechanism: The varicella-zoster virus, which causes chickenpox in childhood, never fully leaves your body. It goes dormant in nerve tissue and can reactivate decades later as shingles. When it does, it triggers significant brain inflammation. The Shingrix vaccine prevents that reactivation.

The evidence:

• 2026 study (Nature Communications): People who received Shingrix had a 20–51% lower risk of dementia.

• Dec 2025 study (Cell): Vaccination also reduced mild cognitive impairment diagnoses and lowered deaths among people already living with dementia.

The reality: The benefit isn’t only preventive — it appears to help across the disease course. Most people 50+ are eligible. Ask about it at the next appointment.

A broader hunch: I think we’ll learn that latent viruses — the ones that hide in the body for life and flare up periodically — have unexpected long-term consequences. Shingrix has strong data right now, and the pattern is emerging elsewhere. A 2022 Harvard study of 10 million people found Epstein-Barr infection increases the risk of multiple sclerosis by 32-fold. HSV-1, the cold sore virus, has been repeatedly linked to Alzheimer’s pathology. My guess: these quiet infections will turn out to drive more seemingly unrelated diseases than we realize.

Gut Health and the Microbiome

The mechanism: Ask about your loved one’s poop. Seriously. The gut-brain axis is one of the more active areas in Alzheimer’s research. People with Alzheimer’s consistently show less diverse gut microbiomes than cognitively healthy people. When the gut’s bacterial balance is off, harmful waste leaks into the bloodstream, crosses into the brain, and drives inflammation.

The evidence:

• 2025 study (Alzheimer’s & Dementia): Directly linked gut microbiome composition and function to Alzheimer’s pathology in humans.

• Shanghai 10th People’s Hospital FMT trial: Small fecal microbiota transplantation trial in 30 Alzheimer’s patients recently wrapped — results pending. Worth watching when they drop.

The reality: Eat a fiber-rich, diverse diet, and address any gut issues. The Mediterranean diet has the most evidence behind it. No downside, real upside. A gut health test can give you a baseline. If digestion seems off, mention it to their doctor — there’s likely upside for their well-being, in addition to their brain.

Omega-3 Fatty Acids (DHA / EPA)

The mechanism: Omega-3s are one of the few supplements with real clinical evidence — especially if your loved one carries the APOE4 gene variant. APOE4 is the strongest genetic risk factor for Alzheimer’s, and carriers appear to deliver less DHA (a key omega-3) to their brains in the first place. Supplementing helps close that gap.

The evidence:

• 2017 Chinese trial: 2g DHA daily for 12 months reduced hippocampal shrinkage and preserved memory in older adults with mild cognitive impairment.

• 2023 network meta-analysis (52 trials, 21,000+ participants): Long-term high-dose EPA-dominant omega-3s with antioxidants outperformed FDA-approved Alzheimer’s drugs on cognitive improvement.

The reality: Dose and formulation matter. Most supplements are too weak — under 1g per day appears to have minimal brain effect, especially in APOE4 carriers. The trials that worked used 1500–2000 mg per day, EPA-dominant. Worth knowing if APOE4 is at play, and worth a conversation with your doctor.

Root Cause #3: Vascular and Structural Decline

The brain depends on healthy blood flow and intact sensory input. Both deteriorate with age in ways that directly accelerate cognitive decline, and both are more addressable than most people realize.

Exercise

The mechanism: This one is massive. Exercise hits multiple root causes: it improves cerebral blood flow, reduces neuroinflammation, and stimulates new neuron growth in the hippocampus — the brain region Alzheimer’s attacks first.

The evidence:

• EXERT trial (sedentary older adults with MCI, 12 months): Cognitive function stayed stable in both low-intensity and moderate-high intensity groups — gentle movement was nearly as effective as harder workouts.

• Johns Hopkins analysis: As little as 35 minutes of moderate-to-vigorous activity per week — vs. none — was associated with a 41% lower dementia risk, even in frail older adults.

The reality: If your loved one has limited mobility, the bar is lower than you’d think. A walk, a chair yoga class, a swim. Start now.

Hearing Aids

The mechanism: Untreated hearing loss forces the brain to divert cognitive resources to processing sound, accelerating brain shrinkage and decline.

The evidence: Large trials show hearing aids can cut dementia risk by up to 48% in people already at elevated risk.

The reality: If there’s any question about your loved one’s hearing, a test and fitting is an easy win.

Social Connection

Friends. Work. Community. Potentially a matter of life and death. My dad was a professor back in the day, incredibly smart. He started declining after he retired, and I’ll always wonder how much was age and how much was the loss of daily routine.

The mechanism: Social engagement appears to build cognitive reserve — the brain’s ability to keep functioning despite accumulating damage.

The evidence:

• Meta-analysis of 600,000+ people: Loneliness was associated with a 31% higher risk of dementia and a 39% higher risk of Alzheimer’s.

• Large brain imaging study: Socially isolated individuals had measurably lower gray matter volume in the hippocampus and frontal regions.

The reality: this is one of the hardest things to maintain as the disease progresses, but it’s worth fighting for. Regular visitors, familiar routines, phone calls, even familiar voices on television. All of it counts.

Final one in this section — and it’s important to get the details right if your loved one is on blood pressure medication.

Certain Blood Pressure Medications

Roughly 70% of adults over 65 take blood pressure medication. Not all of them are equal when it comes to the brain.

The mechanism: One class — angiotensin receptor blockers (ARBs) — appears to protect the brain in ways other blood pressure drugs don’t. Common ARBs include losartan, valsartan, candesartan, and telmisartan. The mechanism is partly vascular (better blood flow, better blood-brain barrier integrity) and partly anti-inflammatory.

The evidence:

• University of Washington analysis (1M+ Medicare enrollees): ARBs were more protective against Alzheimer’s than other blood pressure drugs, including ACE inhibitors (the most commonly prescribed class).

• Randomized trial in MCI patients: One year on candesartan (an ARB) produced better executive function than one year on lisinopril (a common ACE inhibitor).

The reality: This isn’t a recommendation to start a new prescription. It’s a conversation worth having with their doctor. Look at the pill bottles. Is your loved one on an ARB? If not, would switching make sense? And if hypertension comes up as a new diagnosis, ARBs may be the smarter starting point.

Three root causes down, one to go. We’re almost done! The last one is the one most people overlook entirely — the brain’s nightly cleanup crew.

Root Cause #4: The Brain Can’t Clear Its Own Waste

The brain generates waste during the day and needs to be cleaned up overnight. It has a dedicated waste-clearance system, the glymphatic system, which flushes out toxic protein buildup, including the amyloid that accumulates in Alzheimer’s disease. When this system is compromised, waste builds up, plaques form, and the brain falls progressively further behind on its own maintenance.

Sleep

The mechanism: Deep sleep is when the glymphatic system does most of its work. A single bad night slows the clearing process. Chronic poor sleep means the trash piles up night after night. That’s why poor sleep is both a symptom of Alzheimer’s and something that actively makes it worse.

The evidence: The NIH/NIA has published substantial research connecting sleep quality to dementia risk and progression. Not glamorous, but possibly the most important thing on this list.

The reality: The intervention isn’t a drug — it’s sleep quality.

• Treat sleep apnea — CPAP can be a genuine game-changer

• Establish consistent sleep-wake schedules

• Address nighttime waking

All high-impact, low-risk.

Hyperbaric Oxygen Therapy (HBOT)

The mechanism: HBOT involves breathing pure oxygen in a pressurized chamber. Flooding the brain with significantly more oxygen than normal gives the glymphatic system more fuel to clear toxic protein buildup. The intervention touches multiple root causes: it reduces brain inflammation, stimulates new blood vessel growth, and triggers the release of the body’s own repair cells.

The evidence:

• 2024 meta-analysis (11 RCTs, 847 patients): HBOT improved cognitive scores in Alzheimer's patients with a favorable safety profile.

• Trial underway for early Alzheimer’s with vascular issues.

• Bryan Johnson (n=1): p-tau217, a key Alzheimer’s biomarker, dropped 36% in a protocol combining HBOT and sauna. Not a trial — one data point.

The reality: The mechanism is credible — the clinical evidence is still developing. HBOT carries real risks: ear and sinus trauma is the most common, and it can be dangerous for people with heart conditions, certain lung issues, or recent ear surgery. Ask your doctor first.

One more thing worth knowing: the soft-shell chambers at most wellness studios operate at far lower pressures than the medical-grade chambers used in research. If you’re going to try this, find a facility running clinical protocols, not a spa.

Focused Ultrasound (FUS / LIFUP)

The mechanism: Sound waves aimed at specific brain regions temporarily open the blood-brain barrier, letting the brain’s own immune cells reach and clear amyloid plaques more effectively. Some forms also directly stimulate memory-related regions and may promote new neuron growth.

The evidence: UCLA is currently running a trial in patients with mild cognitive impairment and mild Alzheimer’s. The Focused Ultrasound Foundation tracks the broader pipeline.

The reality: Still early, but the trial activity is meaningful.

What to Do Right Now

Always do your own research and keep an eye out for new findings. The science is moving faster on this than it has in decades. Researchers are chasing multiple angles simultaneously.

Caregivers who bring specific questions get different conversations than those who wait to be told what to do. Ask about the subtypes. Very few doctors are specialists — you need to be your own advocate. There’s no guaranteed treatment today, so the decisions are yours to make alongside your care team.

If they’re in early Alzheimer’s, start lifestyle interventions now:

• Ketogenic and/or Mediterranean diet

• Sleep (treat apnea, consistent schedule)

• Exercise (any amount counts)

• Social engagement

The window for these matters.

Easy wins with little to no downside:

• Check shingles vaccine status

• Get a hearing test

• Do a stool/gut health test

• Start a symptom journal (cognition, mood, energy, sleep)

Bring to your next doctor’s appointment:

• This post

• Questions about Alzheimer’s subtypes

• The pill bottles

• If on BP meds: are they on an ARB? Would switching make sense?

• Shingrix eligibility

• If APOE4 is known: omega-3 dose and formulation

And remember to take care of you too. The caretaker’s job is no joke.

Thinking of you,

Julia Lipton (currently investing, researching, and helping friends build things)

Big thank you to Andy Coravos, Alex MacCaw, Alana Podrx, and Evan Fisher for giving feedback and encouraging me to share this post.

First things first, you’re receiving this because you are a subscriber to Awesome People List. As you’ve probably noticed, that newsletter has been MIA for a while.

Moving forward, I’ll post here on It’s Personal.

I’ll share things I can’t shut up about: mostly health, wellness, and business-related. And occasionally, like today, launch side quests!

*If you aren’t interested in this content, please unsubscribe. I promise, I won’t be offended.

I’m kicking off It’s Personal with a bang.

First, a piece of personal news. I’m expecting my first child this fall.

My friends and I spend a lot of time optimizing our health, so I assumed we'd do the same for our babies. But when I dug into baby formula, I was shocked: nearly half contain contaminants, and there's almost no independent public data.

As a result, I’ve teamed up with OpenLabel, Light Labs, and my friend, Justin Mares, to launch my first side quest: fixtheformula.org.

You are what you eat, and so is the next generation. Help us test formula for heavy metals, toxins, vitamins, and contaminants here.

Woah! Cliff hangers… I know. Here’s the full story:

Feeding the Question: What’s Really in Baby Formula?

Half of the baby formulas tested by Consumer Reports contained potentially harmful levels of at least one contaminant. Think lead, arsenic, and “forever chemicals” (PFAS). That’s not a fringe conspiracy theory. That’s mainstream, published testing data.

When I first read that, my stomach dropped. We’re expecting our first child this fall.

After I got pregnant, friends added me to a dozen group chats, Facebook groups, and Instagram threads, all buzzing with the same formula questions: “What’s the healthiest?” “What’s the least toxic?” “What’s the most nutritious?”

Unfortunately, there’s almost no data in these conversations. I want to change that.

Formula Matters

Formula isn’t some niche backup option. It’s a core part of how we feed babies in this country. According to the CDC, almost 20% of newborns in the U.S. start life entirely on formula, and by six months, roughly 75% of babies regularly have it as part of their diet. The vast majority of people (even die-hard breastfeeders) end up needing formula at some point.

Sadly, babies are especially vulnerable to contaminants because of their small size, developing organs, and constant feeding needs. And the list of toxins showing up in formula is alarming:

• Arsenic: Linked to learning disabilities, behavioral issues, and lower IQ when exposure happens during brain development (FDA).

• Lead: Also linked to ADHD, behavior problems, and lowered IQ (Consumer Reports).

• PFAS: Synthetic “forever chemicals” used in food packaging, nonstick cookware, and waterproof fabrics. They build up in the body and are linked to developmental delays, immune suppression, obesity, and cancer (EPA).

• Glyphosate: The most widely used herbicide in U.S. agriculture, sprayed on soy and corn. Associated with adverse neurodevelopment in babies, with effects showing as early as 24 months (NIH).

The list goes on…

How the Rules Miss Today’s Threats

It turns out formula is heavily regulated… just not for what you’d expect.

In the late 1970s, formulas were inconsistent, and quality control was messy. Then came the Syntex scandal (1978–79). A chloride deficiency in Syntex’s formulas left babies sick, with some suffering lasting brain damage. It was a parent’s worst nightmare. Congress responded with the Infant Formula Act of 1980, which finally set nutrient minimums and required manufacturing safeguards.

The problem? The law was written to prevent nutrient deficiencies, not protect babies from modern threats like heavy metals, pesticide residues, or chemical byproducts. And some of those nutrient rules have unintended consequences.

Take fats: The Code of Federal Regulations requires at least 300 mg of linoleic acid per 100 calories, which is easiest to hit using high-linoleic seed oils like soy, canola, and sunflower. According to the FDA, when these oils are refined at high heat, they can oxidize and produce 3-MCPD and glycidyl esters (linked to cancer), and contain pesticide residue.

My friend Justin Mares wrote a great piece detailing how the FDA practically mandates that seed oils and pesticide-laden crops be included in baby formula.

Why European Formulas Feel Safer

The EU strictly limits those contaminants in finished formula. The U.S.? No such caps. This is why European brands keep coming up in those group chats. EU rules:

• Set strict contaminant and processing byproduct limits for finished products, not just raw ingredients.

• Require batch-by-batch testing before products hit shelves.

• Allow more flexibility in fat blends, so manufacturers can meet omega-6 needs without going seed-oil heavy.

• Harmonize standards across 27 countries, so formulas move freely and competition stays high.

So, should Americans just buy European products? Unfortunately, even when a European product meets or exceeds U.S. safety standards, it’s usually prevented from entering the country by strict FDA labeling and nutrient-format rules. High tariffs and import quotas also drive up prices once low-tariff limits are exceeded.

How the Market Is Set Up to Fail

Formula production in the U.S. is dominated by just three companies: Abbott, Reckitt, and Nestlé. Their dominance is reinforced by the WIC program (Special Supplemental Nutrition Program for Women, Infants, and Children), which buys over half the formula sold in the U.S.

Each state awards a single exclusive WIC contract to one manufacturer. Win that contract, and you control that state’s shelves. Lose it, and it’s tricky. Notably, Abbott controls over half of the states and is a pharma company at heart.

These aren’t just big companies. They’re political heavyweights. Abbott, Reckitt, and Nestlé all have well-funded lobbying operations and trade groups. They work to maintain the status quo by resisting stricter contaminant rules, fighting labeling changes, and keeping high tariffs on foreign competition.

In 2022 alone, infant formula manufacturers and their trade associations spent millions lobbying Congress and federal agencies. You can bet they're at the table when a new safety or labeling proposal comes up.

The formula market’s oligopoly also creates tremendous supply chain risk. In February 2022, Abbott’s Sturgis, Michigan plant — responsible for 20–40% of the U.S. supply — shut down after detecting Cronobacter sakazakii, a deadly bacterium that can cause infant death.

If you were a parent then, you probably remember the panic. It was all over the national news. With imports tightly restricted, shelves emptied, babies went hungry, and families scrambled. By mid-May, 43% of formula products were out of stock, forcing the government to launch Operation Fly Formula to rush emergency shipments from Europe.

Where This Leaves Us

We have outdated rules that ignore modern contaminants, nutrient requirements that lock in risky ingredients, trade policies that block safer imports, a concentrated market that collapses when one plant goes offline, and an industry with enough political influence to ensure reform moves at a snail’s pace. We can do better.

If we want the safest, highest-quality formula for our babies, we need:

• Updated contaminant standards for formula

• Flexibility in nutrient rules so healthier fats are possible

• Trade policies that allow real competition

• A diversified, resilient supply chain

• A political environment that prioritizes child health (I’m optimistic that Operation Stork Speed helps, but only time will tell)

Until then, choosing a formula will continue to feel like a game of “which option is least bad?” and that’s not good enough for the next generation.

What We’re Doing Now

Step 1 is to understand the scope of the problem in the US.

We’re launching a crowdfunded campaign to test baby formulas sold in the U.S. Help us test for heavy metals, toxins, vitamins, and contaminants: https://www.fixtheformula.org. Every dollar goes directly to testing.

Public data is scarce and inconsistent. Consumer Reports, Oasis, and formula company claims don’t line up — leaving parents with no clear picture.

This will be the most complete public dataset on baby formula ever.

I’ve teamed up with OpenLabel Research and Light Labs to independently test formulas for:

• Macronutrients

• Minerals

• Heavy metals

• Glyphosate & AMPA

• BPA / BPS / BPF

• Phthalates

• Mycotoxins

• Pesticides

Each formula costs $3k to test. The more we raise, the more we can test.

Once results are in, we’ll publish them for free for everyone. The goal:

• Give parents real data to make informed choices based on their values.

• Spark public and political debate about formula safety.

• Show that anyone can launch experiments on what they care about. This is a friendly reminder that you can just do things!

Let’s do this! Learn more and join us here.

Cheers to happy and healthy,

Julia Lipton

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