Dr. Tom Rifai

NYC!

Happy 250th Birthday, America. 🇺🇸

This Fourth of July feels a little different for me.

Instead of thinking first about fireworks or cookouts, I find myself thinking about my father.

This photo was taken years ago in my hometown of Birmingham, Michigan—the very community I’ll soon be returning to. Looking at it today reminds me that, in many ways, life has come full circle.

My father came to the United States from Syria in 1966 as a physician. Like so many immigrants, he recognized the extraordinary freedoms and opportunities this country offered and embraced them wholeheartedly. He loved America deeply—not because he was born here, but because he chose it.

He wore an American flag on his lapel nearly every day. He taught me the Pledge of Allegiance as a young boy. He talked to me about the Constitution, individual liberty, personal responsibility, and what an extraordinary privilege it is to call yourself an American. Patriotism wasn’t something he practiced once a year—it was simply part of who he was.

He went on to become an incredibly respected physician, serving his patients with humility, compassion, and gratitude for the country that had welcomed him.

Today, I realize that one of the greatest gifts he ever gave me wasn’t medicine—it was teaching me that loving America and honoring our Syrian heritage were never competing ideas. They were simply both part of who we are. I am proud to be 100% American with Syrian ancestry—a living example of what makes America the greatest melting pot the world has ever known.

As I prepare to return home to Birmingham and begin the next chapter of my own medical career, I find myself thinking often about the example he set. I hope to honor his legacy by serving my patients with the same integrity, gratitude, humility, and compassion—and by passing those same values on to Antonio and Lily.

On this 250th birthday of our nation, I’m simply grateful.

Grateful for my father.

Grateful for the opportunities this country has given our family.

And grateful that I now have the privilege of teaching my own children to love this country with the same quiet pride that he taught me.

Happy Birthday, America.

And Dad…thank you for bringing us here.

I miss you every day. ❤️🇺🇸

The World Tour Comes Home. ❤️

After what has truly felt like a professional world tour, I’m incredibly excited to share…

I’m coming home to Metro Detroit.

Over the past several years, I’ve had the privilege of immersing myself in some of the most unique healthcare environments imaginable—not simply geographically, but philosophically.

From the blue-collar Midwest of Detroit and the Cleveland Clinic Endocrine & Metabolism Institute…

…to the immersive Lifestyle Medicine environment of the Pritikin Longevity Center…

…to health system leadership with Henry Ford Health…

…to corporate health and wellbeing with Fortune 500 Magna International…

…to teaching thousands of physicians through Harvard Medical School’s Lifestyle Medicine program…

…to helping shape health and longevity strategy within NEOM, Saudi Arabia’s historic giga-project…

…to most recently helping establish Lifestyle Medicine within one of America’s most respected insurer-based healthcare organizations at Capital Health Plan in Florida’s Panhandle…

Along the way, I was deeply honored to be appointed Chair of both the Nutrition and Health Coaching Working Groups of the Healthy Longevity Medicine Society, collaborating with colleagues from around the world to help advance the future of healthy longevity.

I was also humbled to be invited as the only physician speaking across all three days of The Longevity Show in London—including the Gala Dinner—one of Europe’s premier conferences on healthy longevity, coming to New York next year.

Those weren’t goals I ever set out to achieve. To me, they were affirmations that continually pushing beyond traditional boundaries—clinically, academically, entrepreneurially, and globally—creates opportunities to contribute in ways we never imagined.

Each stop challenged me differently.

Different populations.

Different healthcare systems.

Different incentives.

Different cultures.

Even different food environments—from the manufacturing Midwest to the famously Southern (and yes… remarkably sodium-rich) Gulf Coast.

Every experience strengthened my conviction that while people may differ enormously, the principles of metabolic health remain remarkably universal.

Looking back, this past year has felt like an intensive professional power tour—an immersion into dramatically different healthcare ecosystems, cultures, incentives, and patient populations.

And in many ways, I feel like I’ve spent the past several years earning my Flex5 black belt—integrating internal medicine, nutrition, exercise science, psychology, behavior change, health coaching, digital health, employer wellness, healthcare systems, and longevity medicine into one unified philosophy of care.

Every patient has been a teacher.

Every organization expanded my perspective.

Every challenge sharpened my thinking.

Today, I see medicine differently than I ever have before.

Most recently, I want to sincerely thank everyone at Capital Health Plan and the Nancy Van Vessem Center for Healthy Aging.

Helping build the foundation for Lifestyle Medicine within an insurer was a once-in-a-career opportunity. I gained invaluable insight into both the tremendous strengths and the unique challenges of practicing medicine from within a health plan.

From the Chairman of the Board…to executive leadership…to physicians…to nurses…medical assistants…administrative staff…

…and especially my patients…

Thank you.

The relationships we built together will remain among the most meaningful of my career.

Now comes the chapter that I truly believe all of these experiences have been preparing me for.

In late September/early October, I’ll be joining a phenomenal physician-owned Internal Medicine practice in the Bloomfield/Birmingham area as Director of Metabolic Health.

I’ll share the full details soon, but I’m deeply grateful for the opportunity to bring everything I’ve learned back home—to the community, colleagues, lifelong friends, family, former patients, coaching clients, and media partners who have meant so much to me throughout my career.

For former coaching clients interested in a Flex5 Tune-Up, my door is always open.

And for those looking for something truly transformative, I’ll soon be introducing an intensive one-month Flex5 immersion designed to permanently change the trajectory of your metabolic health, healthspan, and quality of life—not at a destination resort, but in the place where lasting change actually happens:

your own home, your own routines, and your real life.

As I approach my 58th birthday, one thing has become increasingly clear to me.

Reality doesn’t become something to fear with age.

It becomes something to embrace.

I’ve never been more energized.

Never been more grateful.

Never been more prepared.

And never been more convinced that the very best work of my career still lies ahead.

The world tour wasn’t about leaving home. It was about discovering what I was meant to bring back.

Detroit…it’s good to be coming home.

Detroit will be my home base, but I’ll continue collaborating with friends and colleagues around the world—and traveling wherever the opportunity to learn, teach, or contribute leads.

Good post from Ph.D. Williams Wallace. I’m a big believer in understanding renal health/disease. I added this comment to his post - note that I teach about understanding kidney function in the second lesson of 36 lessons in my Flex5 Lifestyle Masterclass available on my YouTube channel.

 Excellent overview. One point I’d add from the clinical side is that we rarely think about creatinine in isolation anymore. Today’s conversation is really about two complementary questions:
1) How well are the kidneys filtering? …best assessed with eGFR (often creatinine based and, when greater precision is needed, confirmed with a combined creatinine/cystatin C equation
and
2) Is there evidence of kidney injury? This is where a simple urine albumin to creatinine ratio is valuable. The ratio can become abnormal well before GFR declines in many patients, and beyond being an early marker of kidney disease, it’s also a powerful indicator of overall vascular and cardiovascular risk. Anyone having, or even any single issue within the, metabolic syndrome is a worthy candidate for this test.

In metabolic medicine, looking at both filtration (eGFR) and albuminuria provides important additional insights.

Keep up the good work Dr. Wallace!



The kidneys are built with so much spare capacity that they can be failing for years while every standard test says you are fine. Each kidney holds roughly a million tiny filtering units called nephrons, and you are born with far more than daily life requires. That redundancy is a gift for most of your life and a trap when something goes wrong, because it means the organ can lose a large share of its working units without any change in the number most doctors check first.

That number is creatinine, a waste product your muscles produce at a steady rate and your kidneys clear from the blood. The logic seems sound: if the filters are failing, waste should back up, and creatinine should climb. The problem is what the surviving nephrons do in the meantime. When some filtering units are lost, the remaining ones do not simply carry on at their old pace. They ramp up, each one filtering harder to cover the shortfall, a compensation called hyperfiltration. For a long time this works almost too well. The remaining nephrons clear creatinine fast enough that the blood level stays normal, and the standard panel reads reassuringly unremarkable even as a substantial fraction of the kidney has already gone offline. By the time creatinine finally rises above the normal range, a great deal of irreversible damage has usually already happened.

What makes this avoidable is that other tests see the damage long before creatinine does, and they turn abnormal in a consistent order. The earliest is albumin in the urine. The filtering barrier is supposed to hold protein back in the blood, and when it starts to be injured, small amounts of the protein albumin begin leaking through into the urine. This leak shows up while filtration rate is still entirely normal, which is why a urine albumin test can flag kidney trouble at the very beginning, before any decline in filtering capacity has occurred at all. It is both the earliest warning and one of the strongest predictors of where the kidney is headed.

The next marker to move is cystatin C, and it covers the exact blind spot that creatinine has. Cystatin C is a small protein produced by nearly every cell in the body at a steady rate and cleared by the kidneys, much like creatinine, but with a crucial difference: its level does not depend on muscle mass. Creatinine is generated by muscle, so a person with more muscle runs a higher baseline and a person with less runs a lower one, which blurs the signal and lets early declines hide inside the normal range. Cystatin C sidesteps that, so it detects mild reductions in filtering capacity that creatinine misses entirely. This is why kidney guidelines now use cystatin C as a confirmatory test when a creatinine-based estimate sits in a borderline zone, to catch the decline that creatinine alone would wave through.

Creatinine moves last among the filtering markers, and symptoms last of all. Fatigue, swelling, and the other felt signs of kidney disease typically do not appear until reserve is largely spent, which is precisely why the disease has a reputation for being silent. The practical lesson is not that creatinine is useless, because it is a reasonable test once disease is established. The lesson is that a normal creatinine is not proof of healthy kidneys, and that if you have reason for concern, especially with diabetes or high blood pressure, the two leading drivers of kidney disease, the tests that actually catch it early are a urine albumin measurement and, where filtering capacity is in question, cystatin C. Those are the signals that move while there is still something to protect.

Stevens & Coresh, NEJM 2006
Levey et al., 2020
Jerums et al., 2008
KDIGO CKD Guideline