Viewpoint Endocrinology

Viewpoint Endocrinology Board-certified endocrinology care in Puyallup, WA. Dr. Robert Kimmel specializes in diabetes, thyroid, and hormone health. New patients welcome!

Serving Tacoma, South Hill, Bonney Lake, Spanaway, Graham, Pierce County, and Auburn. Dr. Robert Kimmel, MD
Board-Certified in Endocrinology, Diabetes & Metabolism – American Board of Internal Medicine

Dr. Robert Kimmel is a board-certified endocrinologist with over four decades of experience in both clinical practice and research. He earned his Bachelor of Science in Electrical Engineering from

Northwestern University, participating in the nation's first undergraduate biomedical engineering program. He obtained his medical degree from Saint Louis University School of Medicine, followed by a residency in internal medicine. After a decade in family and preventive medicine, Dr. Kimmel specialized in endocrinology, completing his fellowship at the National Institutes of Health (NIH) in Bethesda, Maryland. His training included clinical rotations at the NIH Clinical Center, Georgetown University, and Washington Hospital Center. At the NIH, he conducted research on gene regulation under Dr. Alan Wolfe. In 1998, Dr. Kimmel returned to the Pacific Northwest for post-doctoral fellowships at Fred Hutchinson Cancer Research Center and the University of Washington's Department of Epidemiology. His research focused on radiation-induced genomic instability in post-Chernobyl thyroid cancer. Since 2009, Dr. Kimmel has been serving the Puyallup and Pierce County communities, providing expert care in diagnosing and treating diabetes, thyroid disorders, hormone imbalances, and other endocrine conditions.

Medicare Update: Coverage for Certain GLP-1 Weight Loss MedicationsStarting July 1, 2026, Medicare began a short-term de...
07/05/2026

Medicare Update: Coverage for Certain GLP-1 Weight Loss Medications

Starting July 1, 2026, Medicare began a short-term demonstration called the Medicare GLP-1 Bridge, which provides eligible Medicare Part D beneficiaries with access to certain GLP-1 drugs.

According to Medicare.gov, Medicare covers certain GLP-1 drugs under this program, including Wegovy and Zepbound, for eligible patients who meet program requirements.

This temporary program is available nationwide for qualifying individuals with Medicare drug coverage, and eligibility is based on specific criteria outlined by Medicare. Complete details at government site below.

Patients with questions about whether they may qualify should review their Medicare drug coverage and discuss treatment options, risks, benefits, and appropriateness of therapy with their physician.

Government sources
• CMS: Medicare GLP-1 Bridge
• Go to Medicare.gov and enter “weight loss drugs” in the search.

"Structured water." "Energized water." "Alkaline water that changes your body's pH." If a product promises ordinary tap ...
06/18/2026

"Structured water." "Energized water." "Alkaline water that changes your body's pH." If a product promises ordinary tap water has been permanently transformed into a superior health drink, the science doesn't back it up — and the marketing is often designed to sell you something you don't need.

Here's the difference that matters: pseudoscientific water claims (magnets, vortexes, hexagonal "structure," ionizers) are not supported by chemistry or clinical evidence. But real water-quality concerns — lead, PFAS, VOCs, microplastics — are legitimate and measurable. The fix for those isn't a $400 device with mystical claims; it's independent testing and a certified filter matched to what's actually in your water.

A few quick rules of thumb:
• If a sales pitch can't name the specific contaminant it removes, be skeptical.
• "Changes your blood pH" is not how human physiology works — your kidneys and lungs tightly regulate pH regardless of what you drink.
• Look for NSF/ANSI-certified filtration (Standards 42, 53, 58, 401) for legitimate treatment.
• Get your water tested through your local utility's report or a certified lab — not through the company selling you a fix.

If you've been told you need expensive "special water" for a thyroid, adrenal, or metabolic condition, please ask us first. We're happy to walk through what the evidence actually shows.

Is Your Drinking Water Really Clean?  Check out our practical guide to home water filtration, especially for people livi...
05/30/2026

Is Your Drinking Water Really Clean?
Check out our practical guide to home water filtration, especially for people living in apartments or homes with older plumbing.

Most people think about taste and chlorine when they buy a water filter. We worry more about lead, other heavy metals, PFAS, VOCs, industrial chemicals, and microplastics.

Here are the key points:
1. Countertop reverse osmosis is one of the most conservative options
A high-quality countertop RO system can be a practical choice for apartments because it requires no plumbing changes and can serve as a central “water station.”

2. Certification matters more than marketing claims
Look for independent NSF/ANSI certifications, especially:
• NSF/ANSI 42: chlorine, taste, and odor
• NSF/ANSI 53: health-related contaminants, including lead and VOCs
• NSF/ANSI 58: reverse osmosis performance
• NSF/ANSI 401: emerging contaminants
• NSF P473: PFAS reduction
If a product claims lead, PFAS, VOC, or contaminant reduction, look for the specific certification and test data.

3. The best systems have broad contaminant data
Some high-certification countertop RO systems have testing for 80+ contaminants, including lead, arsenic, chromium-6, PFAS, solvents, and other industrial chemicals.

4. Storage matters too
After filtration, consider storing drinking water in glass or stainless steel when practical. Plastic containers can degrade over time, especially with heat, sunlight, wear, or long storage.

A realistic setup for many households is:
• Countertop RO as the filling station
• Glass pitcher for cooking water
• Glass or stainless bottles for daily drinking

This strategy goes a long way in reducing avoidable exposures in a practical, cost-effective way.

Note: Educational information only. Always verify product certifications, maintain filters as directed, and check your local water quality report.

𝗢𝗵, 𝗜 𝗹𝗼𝘃𝗲 𝘁𝗵𝗶𝘀 𝗶𝗱𝗲𝗮! Natural fruit infusions with a little spice kick sound absolutely delightful and super refreshing....
02/22/2026

𝗢𝗵, 𝗜 𝗹𝗼𝘃𝗲 𝘁𝗵𝗶𝘀 𝗶𝗱𝗲𝗮! Natural fruit infusions with a little spice kick sound absolutely delightful and super refreshing. Let's find some winners.

Infused water is a fantastic way to enjoy more water! Infused waters are perfect for adding flavor without extra sugar or artificial sweeteners. Plus, they look so inviting, it's hard not to want a sip!
Here are a few recipes and ideas inspired by your requests:

• 𝗟𝗲𝗺𝗼𝗻, 𝗟𝗶𝗺𝗲, 𝗮𝗻𝗱 𝗢𝗿𝗮𝗻𝗴𝗲 𝗜𝗻𝗳𝘂𝘀𝗶𝗼𝗻: This is a classic for a reason! Simply slice up a lemon, a lime, and an orange and add them to a pitcher of water. You can let it infuse in the fridge for a few hours, or even overnight for a stronger flavor. Some recipes also suggest adding a sprig of fresh rosemary with the citrus for an extra aromatic kick.

• 𝗔𝗽𝗽𝗹𝗲 𝗮𝗻𝗱 𝗖𝗶𝗻𝗻𝗮𝗺𝗼𝗻 𝗦𝘁𝗶𝗰𝗸: For a cozy and subtly spiced option, thinly slice an apple (like a Honeycrisp) and add it to water with one or two Ceylon cinnamon sticks. This gives you that warm, spiced cider vibe without any sugar.

• 𝗦𝗽𝗶𝗰𝗲𝗱 𝗔𝗽𝗽𝗹𝗲 𝗮𝗻𝗱 𝗢𝗿𝗮𝗻𝗴𝗲 (𝘄𝗶𝘁𝗵 𝗦𝘁𝗮𝗿 𝗔𝗻𝗶𝘀𝗲): Take the apple and cinnamon idea a step further by adding orange slices and even a star anise pod. This combination creates a truly aromatic and flavorful water.

• 𝗢𝗿𝗮𝗻𝗴𝗲, 𝗙𝗲𝗻𝗻𝗲𝗹 𝗦𝗲𝗲𝗱, 𝗮𝗻𝗱 𝗔𝗻𝗶𝘀𝗲 𝗦𝗲𝗲𝗱: If you're really into unique spices, this one is intriguing! Combine orange slices with a few fennel seeds and anise seeds in your water. It offers a sophisticated, sugar-free twist.

• 𝗖𝗶𝘁𝗿𝘂𝘀 𝗮𝗻𝗱 𝗛𝗲𝗿𝗯 𝗯𝗹𝗲𝗻𝗱𝘀: Many recipes combine citrus with fresh herbs. Think lemon with basil or mint, or grapefruit with rosemary. These are super refreshing and can offer a lot of flavor.

𝗧𝗶𝗽𝘀 𝗳𝗼𝗿 𝗺𝗮𝗸𝗶𝗻𝗴 𝘆𝗼𝘂𝗿 𝗶𝗻𝗳𝘂𝘀𝗲𝗱 𝘄𝗮𝘁𝗲𝗿:
• 𝗨𝘀𝗲 𝗳𝗿𝗲𝘀𝗵, 𝗼𝗿𝗴𝗮𝗻𝗶𝗰 𝗳𝗿𝘂𝗶𝘁𝘀 𝗮𝗻𝗱 𝗵𝗲𝗿𝗯𝘀: This ensures the best flavor and avoids any unwanted pesticides.
• 𝗦𝗹𝗶𝗰𝗲 𝘁𝗵𝗶𝗻𝗹𝘆: Thinner slices expose more surface area, allowing the flavors to infuse more quickly and intensely.
• 𝗠𝘂𝗱𝗱𝗹𝗲 𝗴𝗲𝗻𝘁𝗹𝘆 (𝗼𝗽𝘁𝗶𝗼𝗻𝗮𝗹): For a stronger, quicker release of flavor from soft fruits or herbs, you can gently press them with a spoon before adding water.
• 𝗜𝗻𝗳𝘂𝘀𝗲 𝗶𝗻 𝘁𝗵𝗲 𝗳𝗿𝗶𝗱𝗴𝗲: Let your water infuse for at least 2–4 hours, or overnight for maximum flavor. Remove citrus after 4–6 hours to avoid bitterness.
• 𝗖𝗼𝗻𝘀𝗶𝗱𝗲𝗿 𝘀𝗽𝗮𝗿𝗸𝗹𝗶𝗻𝗴 𝘄𝗮𝘁𝗲𝗿: If you want some fizz, you can use plain sparkling water instead of still water for your infusion.

Enjoy experimenting with these combinations! It's all about finding what you love.

When You See Water, DRINK IT!Most people do not drink enough plain water. Chronically low fluid intake is common and l...
02/20/2026

When You See Water, DRINK IT!

Most people do not drink enough plain water. Chronically low fluid intake is common and linked to kidney stones, constipation, cardiometabolic disease, and possibly to accelerated biological aging, even in the absence of overt, symptomatic dehydration. Let’s look at the evidence. [1][2][3][4]

How much water is “enough”?

- Major expert panels (IOM/National Academy of Medicine, EFSA) suggest an adequate intake of roughly 2–2.7 L/day for adult women and 2.5–3.7 L/day for adult men (all fluids, including water in food).[2][5]

- The IOM AI values widely cited in US guidelines are about 3.7 L/day for men and 2.7 L/day for women.[5][1]

- These are population-level targets; individual needs rise with heat, exercise, fever, high solute load, pregnancy, and lactation.[2][5]

How common is inadequate intake?

- In US adults (NHANES 2009–2012), average total water intake was 3.46 L/day for men and 2.75 L/day for women, but large subgroups—especially non-Hispanic Black and Hispanic adults—fell substantially below IOM adequate intake levels.[1]

- Among US children and adolescents (NHANES 2009–2012), “inadequate hydration” (urine osmolality >800 mOsm/kg) had a prevalence of 54.5%, indicating that more than half were not optimally hydrated on a given day.[6][7]

- Plain water consumption is unevenly distributed: about 81% of US adults report drinking any plain water on a given day, with lower use among lower-income and less-educated groups and marked racial/ethnic disparities.[8]

Who is most susceptible?

- Young children rely on caregivers for access and may not articulate thirst reliably; NHANES data show particularly high rates of hyperconcentrated urine in boys.[7][6]

- Older adults have impaired thirst, are more likely to limit fluid because of continence concerns or mobility issues, and are consistently identified as a high‑risk group in geriatric nutrition and hydration guidelines.[4][9]

- Patients with cognitive impairment, those who are bedbound or institutionalized, and people with limited access to safe, palatable water (e.g., disadvantaged communities with tap-water mistrust) show lower plain-water intake and higher risk of underhydration.[4][8]

- Physically active individuals, outdoor workers, and those in hot environments have higher water turnover and are vulnerable to both acute dehydration and chronic under-replacement if they “chase” thirst rather than drink proactively.[10][5]

Consequences of chronic low intake and mild dehydration

Even without dramatic hypernatremia or hemodynamic collapse, chronically low fluid intake and mild underhydration are associated with several problems:

- Kidney stones and kidney function: Inadequate water intake is a recognized risk factor for nephrolithiasis and has been linked with accelerated decline in kidney function in epidemiologic cohorts.[1][2][4]

- Constipation and gastrointestinal issues: Low fluid intake in older adults predicts higher rates of acute constipation; higher intake is part of standard nonpharmacologic management.[4]

- Urinary tract infections: Suboptimal hydration is associated with increased risk of UTIs, particularly when low water is replaced by sugar‑sweetened beverages.[11][1]

- Cognitive and mood effects: Even mild dehydration impairs attention, executive function, and mood in experimental studies, and poorer cognitive performance is cited as an outcome of inadequate intake in population data.[2][1][4]

- Cardiometabolic and global chronic disease risk: Large NIH analyses using serum sodium as an inverse biomarker of hydration found that adults with higher-normal sodium (above roughly 142–144 mmol/L) had higher “biological age,” increased incidence of chronic diseases (heart failure, stroke, chronic lung disease, diabetes, dementia), and higher risk of premature mortality.[3][11]

- Skin and mucosal health: Narrative reviews note improved skin turgor and barrier function with better hydration, and chronic low intake is linked to poorer skin and mucosal health, though data are less robust than for renal and cardiometabolic endpoints.[2][4]

Why “When you see water, drink it!” makes sense

- Thirst is a relatively late signal that hydration is inadequate and becomes less reliable with age, illness, medications, and cognitive decline; waiting for strong thirst often means you are already underhydrated.[9][4][2]

- Because a large share of both children and adults spend much of the day in a state of suboptimal hydration, simple environmental cues—keeping water visible and accessible and drinking small amounts repeatedly—are a practical way to reduce chronic underhydration risk.[6][7][1]

- For most healthy adults, regularly choosing water over sugar‑sweetened beverages improves hydration while lowering intake of added sugars and calories, and may indirectly reduce cardiometabolic risk.[12][11][2]
~~~

Sources & Links
[1] [PDF] Daily Water Intake Among US Men and Women, 2009–2012 - CDChttps://www.cdc.gov/nchs/data/databriefs/db242.pdf

[2] Narrative Review of Hydration and Selected Health Outcomes in the ... https://pmc.ncbi.nlm.nih.gov/articles/PMC6356561/

[3] Dehydration Accelerates Aging, Leads to Chronic Diseases https://www.cardiometabolichealth.org/article/dehydration-accelerates-aging-and-chronic-disease/

[4] Water, Hydration and Health - PMC - NIH https://pmc.ncbi.nlm.nih.gov/articles/PMC2908954/

[5] Dietary Water and Sodium Requirements For Active Adults https://www.gssiweb.org/sports-science-exchange/article/sse-92-dietary-water-and-sodium-requirements-for-active-adults

[6] Prevalence of Inadequate Hydration Among US Children and ... - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC4504329/

[7] Prevalence of Inadequate Hydration Among US Children and ... https://ajph.aphapublications.org/doi/10.2105/AJPH.2015.302572

[8] Disparities in plain, tap and bottled water consumption among US ... https://www.cambridge.org/core/journals/public-health-nutrition/article/disparities-in-plain-tap-and-bottled-water-consumption-among-us-adults-national-health-and-nutrition-examination-survey-nhanes-20072014/C61DB872569668D3A97B740B93E2A7EF

[9] Hydration matters - BDA - British Dietetic Association https://www.bda.uk.com/resource/hydration-matters.html

[10] National Athletic Trainers' Association Position Statement - PMC https://pmc.ncbi.nlm.nih.gov/articles/PMC5634236/

[11] Poor hydration linked to early aging and chronic disease in study https://www.nbcnews.com/health/health-news/poor-hydration-linked-early-aging-chronic-disease-study-rcna63741

[12] How Much Water Do You Need? - The Nutrition Source https://nutritionsource.hsph.harvard.edu/water/

[13] [PDF] Hydration Guidelines - SPORTS NUTRITION TOPICS - NATAhttps://www.nata.org/sites/default/files/2025-08/hydration-guidelines_handout.pdf

[14] Water: How much should you drink every day? - Mayo Clinic https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/water/art-20044256

[15] We all need water for a healthy life – but how much? https://www.heart.org/en/news/2018/07/11/we-all-need-water-for-a-healthy-life-but-how-much

Taking  Care of Fish Oils  by Robert Kimmel, MD “My omega-3 fish oils smell funny and taste fishy. What should I do?”Wel...
02/13/2026

Taking Care of Fish Oils
by Robert Kimmel, MD

“My omega-3 fish oils smell funny and taste fishy. What should I do?”

Well, I’m glad you had the courage to pop one in your mouth and taste it! Heat light and air degrade oils in general, some more than others depending on their structure. Here are some useful guidelines for omega-3 oils and other high-quality oils.

Some omega-3’s truly need the fridge and others don’t because of how they’re formulated, packaged, and exposed to air/light; what really matters is oxidation risk, not a categorical “must refrigerate” rule.

Key Differences

- Liquid vs capsules
- Liquid fish or algal oils (bottles) have a large surface area exposed to air with each opening, so they oxidize faster and are commonly labeled “refrigerate after opening” to slow rancidity.
- Softgels/capsules are sealed and largely protect the oil from oxygen and light, so most are stable at room temperature if kept cool and dry.

- Antioxidants and formulation
- Products with added antioxidants (e.g., vitamin E, mixed tocopherols, rosemary extract) and higher-quality purification tend to be more stable at room temperature.
- Some “highly refined” or ethyl-ester/triglyceride-formula products are specifically stability-tested for room-temperature storage and labeled accordingly.

- Packaging and environment
- Dark glass or opaque blister packs reduce light exposure and help capsules stay stable in a cupboard.
- In hot or humid environments (e.g., consistently above ~80–86 °F / 27–30 °C), refrigeration becomes more important even for capsules to limit oxidation and softening of gels.

Is Refrigeration Important?

- When the label says “refrigerate after opening”
- You should follow that; those products (usually liquids) are relying on cold storage to meet their shelf-life claims and taste/smell acceptable.
- For a patient, the practical risk of ignoring that is taking partially rancid oil (fishy smell, burping, throat irritation), with uncertain benefit and potentially pro‑inflammatory lipid peroxidation products.

- When the label says room temperature is fine
- If stored in a cool, dark, dry place, most capsules remain stable through their labeled expiration and do not *require* refrigeration.
- Refrigeration is optional “extra insurance”; it won’t hurt the product and may slightly slow oxidation, but it’s not mandatory if conditions are reasonable.

- Signs you should not take it
- Strong fishy or paint/varnish-like smell, sour or “off” taste, cloudy or thickened liquid that wasn’t originally, softgels sticking together, leaking, or discolored.
- In those cases, regardless of storage, better to discard than have patients ingest rancid lipids.

Practical Takeaways

- Follow the storage directions on the label (refrigerate liquids once opened; capsules in a cool, dark cupboard unless the label specifies fridge).
- Avoid bathroom/kitchen heat and sunlight; don’t leave bottles in the car or near stoves.
- Use opened liquids within the manufacturer’s suggested window (commonly 1–3 months) and do a quick “smell test” periodically.

- Clinically, the reason some are refrigerated is to slow oxidation of a vulnerable formulation, not because the biological omega-3 itself is different; the distinction is formulation stability and packaging, not EPA/DHA per se.

Sources
[1] Essential Checklist: Storing Omega-3 Supplements Right https://wellbeingnutrition.com/blogs/gut-detox-cleanse/essential-checklist-storing-omega-3-supplements-right

[2] 5 Supplements You Should Keep in the Fridge, According to Dietitians https://www.eatingwell.com/supplements-to-refrigerate-11762217

[3] Omega-3 supplements, how to store them? - Omegor.com https://www.omegor.com/en/blogs/ask-the-pharmacist/omega-3-supplements-how-to-store-them

[4] Storing Omega-3 Liquids and Pills or Capsules https://shop.natureswaycanada.ca/blogs/news/storing-omega-3-liquids-and-pills-or-capsules

[5] How should I store Omega-3? - Help https://help.livemomentous.com/hc/en-us/articles/24153290235795-How-should-I-store-Omega-3

[6] Simple but effective. Omega-3 fatty acids are highly susceptible to ... https://www.instagram.com/reel/DFuISL1MLsR/

[7] Should Fish Oil Be Refrigerated? - Calgee https://calgee.com/a/blog/should-fish-oil-be-refrigerated

[8] Purchasing and Taking Care of Omega-3 Supplements https://alwaysomega3s.com/what/explore-good-sources/supplements/purchasing-and-taking-care-omega-3-supplements

[9] Effect of packaging and encapsulation on the oxidative and sensory ... https://pmc.ncbi.nlm.nih.gov/articles/PMC10003024/

[10] How to Tell if Fish Oil Capsules are Rancid - OmegaQuant https://omegaquant.com/how-to-tell-if-fish-oil-capsules-are-rancid/

[11] Should fish oil be refrigerated? A comprehensive guide to storage https://whc.com.hk/en/blogs/whc/%E9%AD%9A%E6%B2%B9%E8%A6%81%E5%86%B7%E8%97%8F%E5%97%8E-%E4%BF%9D%E5%AD%98%E6%96%B9%E6%B3%95%E5%A4%A7%E8%A7%A3%E6%A7%8B

[12] How to Store Omega-3 Supplements - Ballstad Global https://ballstad.global/en/blogs/ballstad-articles-and-blogs/how-to-store-omega-3-supplements

[13] What to Know About Refrigerating Supplements - Nature's Way https://naturesway.com/blogs/articles/what-to-know-about-refrigerating-supplements

If you are seeing an ad that encourages MEDICARE A and B recipients to call a 1-800 number to find out if they are eligi...
02/07/2026

If you are seeing an ad that encourages MEDICARE A and B recipients to call a 1-800 number to find out if they are eligible to receive some kind of cash benefit or reward, … beware! They claim that MEDICARE is trying to hide this benefit and may shut it down. If this sounds like a scam or misleading advertising, or that this might be a cloaked ad for a Medicare advantage plan, then you’re right to be suspicious. This has multiple red flags for a misleading marketing pitch and quite possibly a scam, and it is very likely tied to selling Medicare Advantage or other private plans rather than some “secret” cash benefit from Original Medicare.[1][2][3]

# # Why this looks illegitimate

- Original Medicare (A and B does not offer “cash rewards” or hidden cash benefits you unlock by calling third‑party 800 numbers; when it adds or changes benefits, it does so publicly and in writing, not via secret hotlines.[4][5]
- A classic scam/abuse pattern is claiming there is a special refund, card, or allowance that Medicare is “hiding” or “ending soon” to pressure people into calling and giving personal information.[3][1]
- Another known tactic is to dangle grocery cards, flex cards, or other “cash‑like” perks to get you switched from Original Medicare into a particular Medicare Advantage plan, sometimes without people fully understanding the trade‑offs.[2][6]

# # Likely what’s behind it

- Many deceptive ads online and on TV use generic phrases like “new Medicare benefit,” “cash back,” or “up to $X in rewards” when they actually refer to extra benefits offered by certain Medicare Advantage (Part C) plans or other private plans, not by Medicare itself.[2][3]
- Some of these operations are run by aggressive brokers whose goal is to enroll you into a specific Medicare Advantage plan that pays them a commission, using the “cash benefit” pitch as the hook.[6][3][2]
- In worse cases, callers harvest Medicare numbers and other personal data to bill fraudulent services or to change someone’s plan without clear consent.[3][4]

So yes, it is very plausible that this is either:
- A cloaked Medicare Advantage sales lead generator, or
- A more overt scam aimed at getting your Medicare number and personal data.[2][3]

# # How to handle it and what to tell patients

- Advise patients: do not call these numbers, and never give their Medicare number, Social Security number, or bank information to unsolicited advertisers.[7][1][4]
- If they’re curious whether any new benefit is real, they should:
- Call Medicare directly at 1‑800‑MEDICARE (1‑800‑633‑4227).[5][4]
- Or talk with a SHIP counselor or their state’s Senior Medicare Patrol, which specifically educates about and investigates Medicare scams.[1][2]
- If someone has already engaged with the number and disclosed information, they should monitor their Medicare Summary Notices and consider reporting concerns as suspected fraud.[5][7][3]

# # Bottom line

There is no legitimate “secret” cash benefit for people with just Parts A and B that Medicare is trying to hide, and ads that suggest otherwise are, at best, highly misleading sales pitches and, at worst, scams designed to harvest data or push plan switches.[3][5][2]

NOTE: Public domain photo at the Centers for Medicare & Medicaid Services (CMS) located at 7500 Security Boulevard in Woodlawn, Maryland
~~~
Sources & Links
[1] 5 Warning Signs of a Medicare Scam—and How to Protect Yourself https://www.ncoa.org/article/5-warning-signs-of-a-medicare-scam-and-how-to-protect-yourself/

[2] Medicare Flex Card Scams: Find Out the Truth - AARP https://www.aarp.org/money/scams-fraud/medicare-flex-card/

[3] Medicare fraud and scams: How to spot them and protect yourself https://www.medicareresources.org/blog/medicare-fraud-and-scams-how-to-spot-them-and-protect-yourself/

[4] Protect yourself against Medicare scams | Consumer Advice https://consumer.ftc.gov/consumer-alerts/2019/03/protect-yourself-against-medicare-scams

[5] Reporting Medicare fraud & abuse https://www.medicare.gov/basics/reporting-medicare-fraud-and-abuse

[6] AVOID These "Easy-to-Fall-for" Medicare Scams in 2025! - YouTube https://www.youtube.com/watch?v=nnsRSdFwOyU

[7] [PDF] How To Identify Medicare Scam Calls - Cleveland Stroke Clubhttps://clevelandstrokeclub.org/wp-content/uploads/2023/05/how-to-identify-medicare-scam-calls-avoid-these-7-scams.pdf

[8] Commercial scam alert : r/PlutoTV - Reddit https://www.reddit.com/r/PlutoTV/comments/1obyzg0/commercial_scam_alert/

[9] Beware of Medicare and Medicaid Scams Offering Free Groceries https://www.facebook.com/groups/216202001763374/posts/9086569211393231/

[10] Senior Medicare patrol is warning people about an uptick in calls in ... https://www.facebook.com/KaraKenneyNews/videos/scam-alert/1601025621268630/

[11] Fraud Warning: Watch Out For Fake Medical Records Requests https://www.sunshinehealth.com/newsroom/fraud-warning.html

[12] Medicare Scam Alert We've received reports of phone calls from ... https://www.facebook.com/gpdky/posts/-medicare-scam-alert-weve-received-reports-of-phone-calls-from-scammers-claiming/1328608945979373/

[13] Is that call about your Medicare card legitimate or just another scam? https://www.youtube.com/watch?v=ajCTrXZrxpM

[14] SCAM ALERT: has a warning out about an uptick ... https://www.instagram.com/reel/DSDuvEBEpbN/

[15] Medicare scam calls: what you need to know - WellMed Medical Group https://www.wellmedhealthcare.com/patients/healthyliving/medicare/medicare-scam-calls-what-you-need-to-know/

Kani in My Sushi - Robert Kimmel, MD In most U.S. sushi restaurants, the “kani” in your roll is imitation crab made from...
01/26/2026

Kani in My Sushi
- Robert Kimmel, MD

In most U.S. sushi restaurants, the “kani” in your roll is imitation crab made from “surimi”, not chunks of real crab meat. Surimi is a refined paste of lean white fish—predominantly Alaska po***ck—that is seasoned, colored, and formed into crab‑like sticks used in California rolls, kani salads, and “spicy kani” fillings.[1][2][3][4]

# # # What “kani” actually is

On menus, *kani* is used generically to mean “crab,” but commercially it usually denotes surimi‑based imitation crab rather than whole crab muscle. To make these products, manufacturers start with minced fish muscle, repeatedly wash it to remove fat, blood, and many sarcoplasmic proteins, then mix the resulting myofibrillar protein concentrate with cryoprotectants, starch, salt, flavorings, and colorants before cooking the mixture into sheets or sticks that can be shredded or sliced for sushi applications. In higher‑end settings you may encounter real crab labeled as kani, but industrially produced crabsticks and the kani in most California rolls are Alaska‑po***ck‑based surimi.[2][3][4][5][6][1]

# # # Surimi as a food: composition and nutrition

Surimi is essentially concentrated fish myofibrillar protein with added ingredients for gel strength, flavor, and shelf stability. Typical surimi pastes are very high in moisture (often >80%), provide complete, highly digestible protein, and are naturally low in fat; the final nutrition profile of imitation crab then depends strongly on the level of added starch, sugars, lipids, and salt in the formulation.

Experimental and review work highlights that surimi proteins have high biological value and may yield bioactive peptides with potential effects on dementia, colon cancer, and lipid and glucose absorption, though most supporting data come from laboratory and animal models rather than clinical trials.[3][5][6][7][2]

Compared with true crab meat, surimi‑based kani generally supplies less protein, more carbohydrate, and a narrower micronutrient and omega‑3 profile per gram. True crab meat is naturally rich in high‑quality protein with minimal carbohydrate; typical portions provide substantially higher protein density with almost no starch or added sugars, whereas imitation crab often dilutes fish protein with added starches and sometimes sugars, lowering the protein‑to‑calorie ratio and increasing glycemic load.

In terms of fat quality, real crab contributes meaningful marine omega‑3 fatty acids, which are largely preserved in minimally processed crab but are present only in modest amounts in surimi products once the mince has been repeatedly washed and reformulated, making kani a comparatively weaker omega‑3 source.

Micronutrient differences are also material: real crab is notably richer in vitamin B12, zinc, selenium, and other trace elements that support neurologic, hematologic, thyroid, and immune function, while the washing and processing steps that create surimi remove a portion of water‑soluble vitamins and minerals, so the final imitation crab product generally has lower concentrations of these micronutrients per calorie than true crab meat.

When imitation crab formulations include added salt to build gel structure and flavor, sodium levels can equal or exceed those in plain crab meat; thus, from the standpoint of overall diet quality, true crab tends to provide more concentrated protein, omega‑3s, and key micronutrients with fewer refined carbohydrates and additives than surimi‑based kani.[8][9][10][11][12][13][14][15][16]

# # # Which fish become surimi, and how big are they?

Modern surimi production is dominated by Alaska po***ck (Gadus chalcogrammus), a cod‑family species from the North Pacific that supplies a substantial fraction of the world’s surimi and imitation crab raw material. NOAA Fisheries describes Alaska po***ck as one of the largest U.S. fisheries by volume, harvested in the Bering Sea, Aleutian Islands, and Gulf of Alaska and managed under science‑based catch limits.

Alaska po***ck are schooling groundfish that can reach lengths near 90 cm, though many commercially caught fish are smaller, mid‑sized individuals appropriate for industrial filleting and surimi production.[4][17][18][19][1]

Beyond Alaska po***ck, industry and technical reports note that other lean, white‑fleshed species—such as Pacific whiting and various tropical species (for example, lizardfish and tilapia in some plants)—are processed into surimi in other regions. These species are likewise medium‑sized marine fish whose muscle yields the low‑fat, neutral‑tasting mince needed to form elastic surimi gels.[5][6][7][20][21]

# # # Where your kani likely comes from (U.S. context)

Agency and industry sources indicate that, for the U.S. market, wild Alaska po***ck caught in U.S. waters of the Bering Sea, Aleutian Islands, and Gulf of Alaska is the principal source of surimi used in imitation crab. NOAA Fisheries and the North Pacific Fishery Management Council manage these po***ck stocks under ecosystem‑based, quota‑driven frameworks that have made the Alaska po***ck fishery a frequently cited model of sustainable large‑scale fisheries management.

The Genuine Alaska Po***ck Producers (an industry group) report that a significant share of po***ck production is directed to surimi, with imitation crab being the most common downstream format, and life‑cycle assessments suggest that po***ck‑based surimi has a comparatively low carbon footprint per unit of protein versus many terrestrial meats.[17][18][22][1][4]

Surimi and imitation crab consumed in the United States therefore often originate from U.S.‑managed Alaska po***ck fisheries and are then processed domestically or in Asia into crabsticks and other forms labeled as kani for sushi and salads.

Additional surimi products on the U.S. shelf may be imported from processors using tropical species, but if you are eating a typical supermarket crabstick or kani in a California roll, the underlying fish is very likely Alaska po***ck from these North Pacific fisheries.[18][22][1][4][17]

# # # Toxicology and contaminant considerations: true crab vs surimi

From a toxicology standpoint, both true crab meat and surimi‑based kani are generally considered low‑to‑moderate risk seafoods when consumed within existing fish‑consumption guidance, but their risk profiles differ in emphasis.

U.S. EPA–FDA joint technical guidance places crab among the “best choice” low‑mercury species, with mean total mercury concentrations around 0.06 µg/g—well below thresholds that would restrict intake to fewer than two servings per week for the general population and for pregnant individuals.

Regional monitoring studies show that when crabs inhabit highly contaminated waters, polychlorinated biphenyls (PCBs), cadmium, and other contaminants can accumulate, particularly in hepatopancreas, but muscle meat (the part most often eaten in sushi) usually carries much lower PCB burdens than organ tissues.[23][24][25]

For surimi, the underlying fish (for U.S. kani, typically Alaska po***ck) has been characterized as a relatively low‑mercury species in federal databases and seafood‑risk assessments, consistent with its inclusion in low‑mercury “best choice” categories.

However, Alaska po***ck and other marine fish are exposed to microplastics and associated additives; a recent study in Alaska po***ck from the Bering Sea found that a high proportion of fish examined had ingested microplastics, raising questions about transfer of plastic‑associated chemicals up the food chain, although direct risk to human consumers at current exposure levels remains incompletely defined.

Surimi products also introduce a different set of potential exposures: surveys have detected titanium dioxide particles (including nano‑sized fractions used as whitening agents) in some white‑colored seafood and surimi products, with estimated dietary intakes in the low microgram/kilogram‑body‑weight range and experimental toxicology data suggesting a need for caution about chronic gastrointestinal exposure.[24][26][27][1]

In addition, surimi products have occasionally been involved in microbial or toxin‑related recalls when processing and refrigeration controls fail, such as Clostridium botulinum contamination episodes flagged by national food‑safety agencies, underscoring the importance of cold‑chain integrity for these ready‑to‑eat products.

Overall, current curated data suggest that:[28]

- True crab meat, when sourced from non‑polluted waters, offers low mercury exposure and relatively low contaminant levels in muscle tissue, but site‑specific PCB or heavy‑metal contamination can be an issue in certain estuaries and rivers.[25][23][24]

- Surimi‑based kani made from Alaska po***ck tends to be low in mercury and classic lipophilic contaminants, yet may carry processing‑related additives (such as whitening agents and food‑grade antimicrobials) and, upstream, some microplastic exposure. Regulatory evaluations of common additives have generally set acceptable daily intakes that typical consumers do not exceed, but long‑term data specific to heavy consumers of surimi products are limited.[26][27][29][1]

For most consumers following general seafood‑intake guidance, both foods appear compatible with low toxicological risk. But if the goal is to minimize exposure to additives and processing‑related agents while retaining seafood’s nutritional advantages, minimally processed true crab from well‑monitored waters has a somewhat cleaner toxicology profile than surimi‑based kani.
~~~
Sources & Links

[1] Alaska Po***ck | NOAA Fisheries https://www.fisheries.noaa.gov/species/alaska-po***ck

[2] Surimi and Low-Salt Surimi Gelation: Key Components to Enhance ... https://pmc.ncbi.nlm.nih.gov/articles/PMC11855292/

[3] Effects of formulation and processing techniques on ... - Food and Life https://www.foodnlife.org/archive/view_article?pid=fl-2021-2-35

[4] Quantification of Alaska po***ck surimi in prepared crabstick by ... https://agris.fao.org/search/en/providers/122535/records/65df5bb70f3e94b9e5d7b663

[5] Comprehensive review: by-products from surimi production ... - NIH https://pmc.ncbi.nlm.nih.gov/articles/PMC10581993/

[6] [PDF] The chemical composition, sensory properties, and myofibrillar ... https://dergipark.org.tr/en/download/article-file/3309273

[7] Surimi - an overview | ScienceDirect Topics https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/surimi

[8] What Is Imitation Crab and Should You Eat It? - Healthline https://www.healthline.com/nutrition/imitation-crab

[9] Is Imitation Crab Healthy? Surimi Meat Nutritional Value https://www.businessinsider.com/is-imitation-crab-healthy-surimi-sticks

[10] 6 Nutritional and Health Benefits of Eating Crab - DC Steakhouse https://www.dc-steakhouse.com/blog/health-benefits-of-eating-crab

[11] What Is Imitation Crab Meat and Is It Safe to Eat? - Dr. Axe https://draxe.com/nutrition/imitation-crab-meat/

[12] Health Benefits of Eating Crab Legs - 7Spice Cajun Seafood https://7spicecajun.com/blogs/health-benefits-of-eating-crab-legs/

[13] What Is Imitation Crab? - WebMD https://www.webmd.com/diet/what-is-imitation-crab

[14] Top 5 reasons why eating crab is good for you https://www.coopers-seafood.com/top-5-reasons-why-eating-crab-is-good-for-you/

[15] Comparing Surimi to Real Seafood - On Nutrition | UExpress https://www.uexpress.com/health/on-nutrition/2017/12/12

[16] Foods you think are healthy BUT AREN'T! #22: IMITATION CRAB https://drpatrickowen.com/foods-you-think-are-healthy-but-arent-22-imitation-crab/

[17] Alaska's Po***ck Fishery: A Model of Sustainability https://www.fisheries.noaa.gov/video/alaskas-po***ck-fishery-model-sustainability

[18] Bleak outlook for Pacific cod and Alaska po***ck https://www.fao.org/in-action/globefish/news-events/news/news-detail/Bleak-outlook-for-Pacific-cod-and-Alaska-po***ck-/en

[19] Gadus chalcogrammus, Alaska po***ck : fisheries, gamefish - FishBase https://www.fishbase.se/summary/Gadus-chalcogrammus.html

[20] [PDF] The production of surimi and surimi seafood from tropical fishhttps://certificationandratings.org/wp-content/uploads/2023/04/Surimi-Landscape-Report-Final-2.pdf

[21] Chemical Composition of Lizardfish Surimi By-Product: Focus on ... http://www.foodandnutritionjournal.org/volume9number1/chemical-composition-of-lizardfish-surimi-by-product-focus-on-macro-and-micro-minerals-contents/

[22] Surimi Seafood - Genuine Alaska Po***ck Producers https://www.alaskapo***ck.org/surimi-seafood

[23] [PDF] Chemical residues in blue crab from New York's marine districthttps://extapps.dec.ny.gov/docs/wildlife_pdf/bluecrabchemicals16.pdf

[24] EPA-FDA Fish Advice: Technical Information https://19january2021snapshot.epa.gov/fish-tech/epa-fda-fish-advice-technical-information_.html

[25] The geography of mercury and PCBs in North Carolina's local seafood https://pubmed.ncbi.nlm.nih.gov/22658912/

[26] Elder fish means more microplastics? Alaska po***ck ... https://www.science.org/doi/10.1126/sciadv.adf5897

[27] TiO 2 particles in seafood and surimi products: Attention should be ... https://pubmed.ncbi.nlm.nih.gov/28910729/

[28] Health Hazard Alert: Various Surimi-Based Products | The Fish Site https://thefishsite.com/articles/health-hazard-alert-various-surimibased-products

[29] Safety of ethyl lauroyl arginate (E 243) as a food additive in the ... - NIH https://pmc.ncbi.nlm.nih.gov/articles/PMC7009305/

[30] The geography of mercury and PCBs in North Carolina's local seafood https://www.sciencedirect.com/science/article/abs/pii/S0025326X12001932

[31] How to Lower Your Risk From the Chemicals in Seafood https://www.consumerreports.org/health/food-safety/how-to-lower-your-risk-from-the-chemicals-in-seafood-a1134575826/

[32] Mercury, PCB, Microplastics and PFAS... is it safe to eat Fish? https://3littleplums.com/blog/decreasing-exposure-to-mercury-pcb-and-microplastics-in-fish

[33] Why mercury and PCBs? - Southern Fried Science https://www.southernfriedscience.com/why-mercury-and-pcbs/

[34] U.S. Department of Health and Human Resources https://www.obgynofhampton.com/mercury/

[35] Safety assessment of the process Utsumi, based on the EREMA ... https://www.efsa.europa.eu/en/efsajournal/pub/7278

[36] Do you know how safe your Maryland-caught seafood is to eat? https://www.chesapeakebay.net/news/blog/do-you-know-how-safe-your-maryland-caught-seafood-is-to-eat

[37] Polycyclic aromatic hydrocarbons (PAHs) in Alaska po***ck https://www.sciencedirect.com/science/article/abs/pii/S0025326X25005995

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