5HT: 5 Healthyish Things, including getting a nose job and McCaviar

This year’s Super Bowl was heavily health-coded, and unlike the slow first half, I didn’t hate it. Here are my yearbook-style superlatives for this year’s health ads 😌.

🏆 Most likely to make your uncle laugh and finally schedule that doctor's appointment

🏆 Most likely to help destigmatize weight loss medication.

🏆 Most likely to lead to a tough week.

🏆 Most likely to cause an argument between family members.

🏆 Most likely to kill the mood for the 35-plus seconds of warnings about side effects.

🏆 Most likely to stick with you (and my personal favorite!).

Honorable mentions: BoehringerUS (what blood test?), Liquid Death (strange), and Poppi (too thirsty).

I was 38 years old when I learned the buildup of what’s called acetaldehyde (not just dehydration) is largely to blame for rough morning effects after a bonus G&T 😮. 

What is it? Acetaldehyde is a toxic byproduct your body produces when it metabolizes alcohol. It’s part of a highly reactive class of molecules… and let’s just say it doesn’t play nice in the body. It’s responsible for some of your least favorite morning-after effects (think: anxiety, sweating, a racing heart rate, or that general ughhhh feeling 🥴).

Once I learned this, I couldn’t help but dig deeper into how acetaldehyde affects the body. Turns out, it does more than give you the ick (I think I finally used that right?). 

One study found while acetaldehyde pushes the brain toward deep sleep, it limits REM cycles—key for memory, emotional processing, and mental recovery. It also accelerates the breakdown of—wait for it—5-HT 😱. As a result, serotonin is cleared faster than normal, reducing its ability to stabilize things like sleep and mood. Long term, repeated acetaldehyde exposure can damage liver cells, disrupt DNA, and lead to inflammation. Yikes. 

While small amounts of acetaldehyde can be naturally found in foods like yogurt and fruits like bananas and pears, alcohol is by far the biggest source of exposure. Which is why it’s so cool that this week’s sponsor, ZBiotics, figured out a way to help address it at the source.

ZBiotics Pre-Alcohol works by delivering 🚚 an enzyme-producing probiotic that is engineered to break down acetaldehyde in the gut before it can do its damage. While this won’t stop the acetaldehyde your liver produces, targeting acetaldehyde formed in the gut addresses a small but meaningful source of total exposure. That’s why ZBiotics is a tool, not a pass.

Bottom line: Acetaldehyde is doing a lot more than making you feel a little rough—it’s actively interfering with sleep (alongside ethanol), inflammation, and how your brain bounces back after happy hour. ZBiotics gives you a way to reduce that impact responsibly.

That’s why when I want to enjoy a few drinks here and there—without paying the full acetaldehyde tax—I make their Pre-Alcohol the first drink of my night. And you should consider it, too! 

To help, ZBiotics is extending its offer to 5HT readers for 15% off your first order when you use “5HT” at checkout. 

Earlier this week McDonald's dropped limited-edition McNugget® Caviar kits featuring premium Baerii Sturgeon caviar as a Valentine’s Day campaign. While this is certainly not healthyish, I gotta give all the brands (and their creative agencies) some credit for being clever.  😆

Oh—and if Valentine’s Day caught you off guard, I’ve got you covered. Check out last year’s 5HT on healthyish ways to strengthen relationships… and the neural hack below for building an ideal date night.

If you need a TL;DR on the Hims drama, here’s a simple timeline of events. 

I don’t quite know what Hims was thinking. I mean, sure, they’d probably have made a killing from selling an oral GLP-1 for $100/mo less, especially with a controversial Super Bowl ad coming. Buuut there was no way Novo Nordisk—or any drug company—would let this blatant rip off happen without a fight and almost certainly legal action.

Believe it or not, I’m actually somewhat sympathetic to pharma companies. They’ve spent zillions on R&D to get drugs to market and deserve to recoup some of that money for some time. Compounding is basically a workaround—and I think sometimes makes sense (as I’ve written about before) when there are shortages, when the costs are too high, when there’s pent-up demand that’ll go somewhere more dangerous, and/or when actually deeply personalizing something. And yes, I do ultimately want more access to these life-changing treatments. 

But nonetheless, it’s obvious many co’s are taking advantage of this moment—and often charging an unnecessary monthly subscription price to boot! PLUS the craziest part of this is, as friend Ashwin Sharma writes in his newsletter GLP-1 Digest, that Hims’ knockoff probablyyy doesn't even work!

Anyway, Hims clearly miscalculated how this would go over and it feels like a big mistake that’ll probably bring further scrutiny on everything else they (and others) are doing that’s already a little in the gray area ☹️. For now, the GLP-1 saga continues. (Or should I say compounds?) Tune in next week to see what happens next. 🍿

I know, I know. You’re probably thinking: didn’t this guy just have heart surgery? Yes. Yes, I did. And now I’m prepping for a nose job. A functional rhinoplasty, to be exact. And, yes, sharing this makes me slightly uncomfortable. 🫣

Which is why I want to start by saying: I like my nose. I have zero interest in changing how it looks. If anything, I'm actually anxious about it changing at all. My goal here isn’t  aesthetic, it’s airflow. 

Basically, I've had a long-standing nasal obstruction and impaired breathing for years. I have a (double/s-shaped!) deviated septum that's never been corrected and real structural issues that make breathing harder than it should be. 

I’m also a little allergic to everything and a lot allergic to inconvenient things like dust mites and mold. In Austin, which is famous for allergens, I basically wake up sneezing.

And unlike my heart ablation—which escalated quickly—this surgery has been on the calendar for a long time. I didn’t rush into it and frankly have been putting it off for a really long time.

I’ve tried everything in the meantime. I’m talking intranasal steroids, antihistamines, saline rinses, prescription sprays, a pill called ODACTRA that was supposed to cure my dust allergy but just messed up my throat, the works. Nothing has meaningfully fixed the problem.

I also got lotsss of opinions. The consensus: this should materially improve function.

And yet—I’m still nervous.

I’m nervous about the drawn-out recovery (and the swelling, the bruising, the congestion, you know, all the glamorous stuff).

I’m nervous about looking in the mirror and seeing someone different.

I’m nervous I’ll go through all of this, and only feel a minor breathing improvement that won’t justify the risk.

I’m nervous everything goes “technically right,” but my nose somehow feels off. Or somehow it ends up like Michael Jackson (!). 

So that’s where I’m at. Nervous. Slightly embarrassed. And aggressively planning my recovery like it’s an Olympic event. (Go Team 5HT?)

If you've had functional rhinoplasty or have strong opinions on recovery, I'm genuinely curious about what helped, what was overhyped, and what you wish you'd known beforehand. I’ll report back with what I learn—and what I try—in a future edition.

Until then, sniff ya later? 👃

Directions: Copy and paste the below prompt into your AI platform of choice to plan an intentional date night aligned with your relationship goals.

👋 Who are you again? I’m Derek Flanzraich—founder of two venture-backed startups in Greatist (👍) and Ness (👎). I’ve worked with brands like GoodRx, Parsley, Midi, Ro, NOCD, and Peloton. I now run Healthyish Content, a premium health content & SEO agency (among other things).

Every Thursday, I share 5 health things I feel strongly about so you can live healthyish. (Disclaimer: I’m more your friend with health benefits. None of this is medical advice.) 

And oh, you also feel strongly about some health things? Hit reply—I’d love to hear it.