Dhru Purohit Show - #261: Fasting Tips and the 2-Steps to Sustained Weight Loss with Dr. Ben Bikman

Episode Date: January 27, 2022

This episode is brought to you by InsideTracker and Rupa Health. Most people are pretty confused when it comes to metabolic health. Fasting, macronutrient ratios, and blood glucose regulation are only a few of the topics that trip people up when it comes to managing a healthy weight and relationship to food. Naturally, I like to look to the latest research to find a clearer picture. And science has come a long way since the “eat less, exercise more” paradigm was first introduced.  If you’ve wondered what aspects of your diet and lifestyle made the biggest impact on your metabolic health and how to make subtle tweaks for maximum impact, this episode of The Dhru Purohit Podcast is for you. Today I talk to my good friend, Dr. Ben Bikman about all this and more.  Dr. Bikman is a renowned metabolic research scientist and a popular speaker on human metabolism and nutrition. He is the author of the book, Why We Get Sick, which offers a thought-provoking yet real solution to insulin resistance and reversing pre-diabetes, improving brain function, shedding fat, and preventing diabetes.   In this episode, we dive into:     -The best approach to take when you start fasting (6:27) -Why eating fruit first thing in the morning is not the best thing for our health (9:00) -Dr. Bikman’s daily eating routine (11:40) -What Dr. Bikman feeds his kids (17:32) -The debate around fat metabolism and obesity (24:26) -The implications for following the advice of “eat less, exercise more” (35:13) -The two-steps to weight loss (36:44) -Weight loss and psychological addictions (40:51) -Dr. Bikman’s go-to snacks (46:23) -The unique metabolic state in pregnancy and physiological insulin resistance (54:52) For more on Dr. Bikman, follow him on Instagram @BenBikmanPhD, and through his websites http://bikmanlab.byu.edu/ and https://www.insuliniq.com/. Get his book, Why We Get Sick at https://benbellabooks.com/shop/why-we-get-sick/. Find Dr. Bikman's HLTH Code Meal Replacement Shake at https://gethlth.com/. This episode is brought to you by InsideTracker and Rupa Health. InsideTracker provides detailed nutrition and lifestyle guidance based on your individual needs. Right now, they’re offering my podcast community 25% off. Just go to insidetracker.com/DHRU to get your discount code and try it out for yourself. Rupa Health is a place for Functional Medicine practitioners to access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, Great Plains, and more. You can check out a free live demo with a Q&A or create an account at RupaHealth.com. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

that weight loss and improving insulin sensitivity would very much go hand in hand. My view on it is, it's a long journey that can start with one of two steps. Hi, everyone, back on the podcast today. We have Dr. Ben Bickman, renowned metabolic health researcher talking about best practices around fasting and how to achieve sustained weight loss. Stay tuned. Have you ever gone to your doctor for your normal annual physical? And after sitting with them for 10 minutes,

they quickly look at your labs and tell you, hey, everything looks normal. Keep it up and I'll see you again next year. Maybe even give you a nice little pat on the back. I can't tell you how many listeners of the podcast have told me that they've had this exact experience and how honestly how frustrating it can be. Now, we all know that normal isn't always optimal. Just because something's not wrong doesn't mean that we feel great. So traditional medicine is great at finding out when something is blatantly wrong, but they don't always do the best job when we need to highlight how we can do better.

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Right now, InsideTracker is offering my podcast community 25% off their system. Just go to inside tracker.com slash Drew. That's D-H-R-U to get your discount code and try it out for yourself. That's inside tracker, I-N-S-I-D-E, tracker, T-R-A-C-K-E-R-com, backslash-D-R-U for your 25% off. I've done a lot of digging into my health over the years, and I'm sure most of you could say the same. I know many of you are even practitioners who help people go through this process using the framework of integrative, precision medicine, or even functional medicine. What I've learned through my experience in pursuing better health and from the guidance of people like my business partner, Dr. Mark Hyman and other experts on the podcast is that a big part of understanding what kind of support each individual body needs is testing.

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for you and your patients. You could check out a live demo with a Q&A or create a free account at rupahealth.com. That's rupa health.com. Welcome to the Drew Perot podcast. Each week we explore the inner workings of the brain and the body with one of the brightest minds and wellness, medicine, and mindset. This week's guest is Dr. Benjamin Bickman. Dr. Benjamin Bickman is a renowned metabolic research scientist and a popular speaker on all things, human metabolism and nutrition. He's one of our most popular podcast guest, and I think that his episode last year was our most downloaded episode from 2020. and we have him back on the podcast to talk about best practices around fasting for longevity,

top tips for sustained weight loss, and most importantly, this was the part of the interview that I loved, how we can actually integrate balancing our blood sugar, keeping our insulin levels low, while also living life and occasionally getting a chance to have fun because food should be fun. We never want to make ourselves so miserable in the pursuit of trying to be healthy. Dr. Benjamin Bickman has many tips on that, especially for those who have kids and are trying to do their best to feed their kids healthy. A little bit more about Dr. Ben Bickman. He's the author of the newly released book, Why We Get Sick, which offers a thought-provoking yet real solution-based approach to insulin resistance and how to reverse pre-diabetes, improved brain function, shed fat, and even prevent diabetes.

I hope you enjoy today's wide-ranging conversation. As always, if you know someone who's struggling with these topics in their life, be sure to share the episode with them. I want to dig into fasting. Do you think that it's important to start making changes in the diet first before they go down the rabbit hole of fasting? Or can we jump into fasting right away? Yeah, that's a good question.

And my view on it is probably that diet needs to be somewhat aligned. Or maybe I'll say it this way. I think a person just would need to have a plan. Nowadays, I worry that people jump on to, say, like an omad or one meal a day kind of bandwagon. And they will say, I'm going to eat one meal a day. So they fast for 22 hours. And then they're not used to it. And they get hungry, hungry, hungry.

And then they just break at their meal and they binge and they eat garbage and they overeat. And so I worry that nowadays a lot of people are looking at fasting, and it's turned into kind of a glorified version of a binge purge cycle. I know that's kind of crass to say, but they are going hungry all day, and then they are breaking their fast with garbage. They're eating junk food, processed carbohydrates, processed seed oils, and they eat themselves sick because they overeat. So my view on fasting is how you break a fast matters much more than how long the fast goes. And so I would rather personally see someone who says, I'm going to do a 16-hour fast, which is very modest. Most people should, most adults should be able to do that very easily. But then have a plan.

And they know, all right, when I break my fast, I'm going to eat these two hard-boiled eggs first with salt and water. And then I'm going to give myself an hour or so to get over that and not see how full I am. later. And then anyway, but focus on foods that won't just spike your insulin up. That's what worries me is that so much of the value of a fast is that your insulin levels have come down. And there's tremendous benefit to that. You're becoming more insulin sensitive. Your mTOR is turned down so you can break things down before you build them back up. It helps with the brain because a little bit of ketosis can fuel the brain in a way that glucose simply cannot. not. So we've lowered insulin. We've worked so hard during this fast to lower insulin,

and then we immediately spike it up and turn everything off. Well, why would we want to do that? Let's help insulin stay low a little longer and then focus, however you break your fast, focus on foods that won't spike insulin quite so much. So, yeah, I don't know that there's a right or wrong way to fast, but I would say the wrong way to fast is when you're focused purely on the timeline and not on the plan for when the fasting ends. What would seem to be whether people know it or not when you're going to sleep, right? You're taking a break from food and then you start breakfast the next day. And a lot of individuals who think that they're doing the right thing and are being healthy,

they'll start off their morning with, let's say, some fruit or fruit juice. Talk to us about why that might not be the best thing for your long-term health. Yeah, yeah. So not all fruits would be included in this kind of scrutiny that I have for them. But unfortunately, most breakfast fruits happen to be those that are the most sugary, like the tropical fruits, pineapples or banana. People love bananas, right? Everyone's always adding bananas to a smoothie. And so those kinds of fruits happen to be the ones that spike insulin the most.

And even glucose, it's surprising when people wear a CGM, like they have the levels app. And you see what happens when you eat these sugary fruits. It's pretty significant. So, but especially, I would say, if someone's going to have fruit, at the very least, eat it, don't drink it. Don't make a juice smoothie or a smoothie or juice, a fruit. I am vehemently opposed to fruit juice. I think it is a result of remarkably clever marketing. And with the best of intentions, parents will be giving their kids.

And, of course, I'm sensitive to this because I have little kids. they'll be giving their kids fruit juice thinking they're doing them a favor but fruit juices often will have as much or more sugar than soda pop will now there may there may be some other beneficial molecules in there so i'm not trying to say they're worse than soda but just comparing it head to head with regards to the sugar content it can have as much sugar in it as a soda pop will so i am not i'm not a fan of fruit um well drinking fruit i'm more a fan of eating fruit, but those tropical fruits, I think we do need to be careful with, like bananas and mangoes, et cetera, but other fruits some people could enjoy liberally. In fact, I'm kind of on that, I don't even like to say I'm a low-carb advocate. I'm a control carb advocate. Just be smart about the carbohydrates. And where it comes to fruits and vegetables, if these are the kind of lower sugar fruits, then my view is enjoy them ad libidum. There's no need to count grams. Maybe if you're a type 2 diabetic trying to get off medications, you've got to be a little more careful. But

for the lot of us that are just trying to be metabolically healthier, correct, some mild metabolic disruption, my view is fruits are to be enjoyed liberally, but scrutinize if you need to, that it's not these tropical fruits. So for yourself this morning for breakfast, did you have breakfast? Did you skip breakfast? Yeah. Let's talk about your routine, which again is your routine. We're not trying to extrapolate that for everybody else, but it's always nice for people to hear.

Yeah, yeah, right. Sure. So I will say that, you know, I'm 45. And when I started going bald in my early 20s, I told my wife, right when we got married, kind of mid-20s, I said, sweetheart, I'm going to be bald, but I'm always going to, I'm going to keep it real. You know, that's a kind of filtered version, you know, for the kids in the crowd here. I said, I'm going to look good. You know, I'll do what I can to control my health. And so I will say there's something somewhat effortless about it. When you, my simple strategy is control carbohydrates, prioritize protein, don't feel. fear fat. Really, those three, if someone adheres to those, it makes, at least for me, it's been reasonably effortless to stay lean. Now, it's not that I just come from a family of purely lean people. No, we have the potential to get chubby like most people do. So for me, breakfast is really a matter of how hard did I work out the day before. And yesterday, kind of getting back into the swing of things from Thanksgiving, I had a very hard, good workout yesterday. And And when I woke up this morning, I was really noticeably hungry.

Normally, I won't eat. I'll just drink a cup of tea or something. But this morning, I made a shake. And so I helped design a low-carb meal replacement shakes, full disclosure. So I have a best interest, perhaps, in saying this. But I wanted a shake that was very low-carb, but high in protein and fat, matched one-to-one by mass. And so I made myself up a little shake. I added a little egg to it, one raw egg.

I just love raw eggs and shakes. I know it sounds crazy. things like really frothy and oh it's so creamy it's so in fact drew a little aside i would sometimes make my wife a shake in the morning because she'd ask for one and then one and i would and she loved it every morning she came in one time and saw me putting it in the blender and saw me cracking the egg and she says ben what are you doing with that egg i don't want an egg in my shake and i say sweetheart i always put an egg in your shake no no don't put that in there i don't want that she drinks the shake and she says all right ben i just don't want to see you put the egg in the shit

So anyway, that's what breakfast was this morning. So my view on diet is I am very strict with myself for breakfast and lunch. I have very, very low carbohydrate, very high protein and fat reasonably. And if I don't eat breakfast, then I make sure I eat a larger than normal lunch. I want my lunch to be the most filling, large meal of the day, at least for me and my addictive habits or my habits, maybe to put it more mildly, If I go home at the end of the day very hungry, it makes it very hard for me to control my appetite at dinner and even into the evening that I am snacky all evening. Even though I am full, I am stuffed, I just am like creeping around the house trying to

find something to snack on. But if I go home from work and I've had a big filling lunch, I'm still kind of full when I go home for dinner. Now, dinner is the social meal. That is the meal. I want to spend time with my wife and my kids. and so I'm going to eat dinner. And usually I just eat dinner with the family.

Now my wife is generally, she sees things the way I do. So our dinners are generally pretty well planned, you know, not a lot of refined starches. But I will eat dinner with the family. Whatever the family's having, that's what I'm eating. And if it's a lot of processed carbs that are going to spike my insulin, I know it's going to happen. I'll try to eat a little less of it. But I don't want my kids to be looking at dad in a kind of weird way and have, have that kind of form. I want them to know in our home we eat real food and real protein,

real fat. But I don't want it to be weird, you know, for them. And that's the social time. I want my priority to be visiting with my kids and my wife. So I'm very strict with breakfast. I'm very strict with lunch. And then I'm much looser with dinner. And then again, if I can come home reasonably full, I have a smaller dinner, but I'm social, I'm visiting. And it makes it really easy to not be snacking in the evening. I can just be sipping on some club soda, which is kind of my favorite thing to do, and I'm good. You know, I'm so glad that you brought that up because I think in our first couple interviews, a lot of the questions that I got sent in and on comments was it's easy to,

when somebody's such an advocate for knowledge around a particular subject, right? Insulin resistance, being mindful of how your glucose is spiking, being mindful about how many refined carbohydrates, we tend to project back upon that person that, wow, this person doesn't eat. any, I mean, everybody eats some carbs, right? We think that this person is a, is either perfectly, but also that their definition of doing it right is some weird, perfect thing, but it's not. And I think that that what you're sharing here is, in addition to you sharing earlier, that like, I'm not a low carb, I'm a smart carb, you know, mindful carb advocate and getting

those carbohydrates from vegetables primarily. And then there's times, especially in the context of a family, you're not just eating with you. You are raising kids. You have a partner as well. So you're trying to demonstrate that like we can still be healthy without being so attached to one particular way of viewing the world. So I really appreciate you bringing that up. And also too, you've probably seen monitoring your own glucose and I don't know how often you check your fat, you know, your insulin levels, but you've also probably seen that you still get the results that you want to get. Yeah, yeah, that's right. Absolutely. I've definitely found that for my tendencies, and I don't have a family history of type 2 diabetes. And so that does allow me

a little bit more wiggle room than someone who, say, has struggled with type 2 diabetes in the past. That is absolutely someone who has to be more careful. But yes, I've found that what I'm doing is working well. And I'll also add very, very quickly, you didn't ask this, but I wonder, I get so many questions about this that I wonder if someone would be wondering, what do I feed my kids? Like, if I'm just sipping on a cup of tea or I'm having a shake in the morning, because I just like breakfast to be simple. I don't like putting a lot of effort into it. I do make breakfast for the kids every morning. It's a very exceptional day when they just have cereal. We just don't keep cereal in the house. It's very infrequent. And so that's something that's important to me. When I grew up,

my dad would make breakfast. We lost my mom when we were all quite young. My dad was kind of just all, he did it all. And he would make big, hearty bowls of oatmeal like from scratch every morning, none of this kind of quick oats. And I appreciated seeing my dad do that. And breakfast became a very important time in my family. It was a very important time of day. Because, you know, I'm one of nine kids. You know, all the rest of the day was just chaos.

But breakfast was kind of the one quiet time where dad could be in charge. And it was kind of a, we would read scriptures, you know, have a family prayer and have a breakfast together. And so for me, in the culture of my family, I'm in charge of breakfast. And I make almost every morning, it's a restaurant. rotation of waffles and crepes. Now that's surprising, I'm sure, to some people, but I just make sure my priority is every single crepe the kids are eating has one egg in it. Like the way I've kind of quantified it all. And so even though it has a little bit of whole milk, which I'm good with, with the kids drinking, but it also has maybe, I don't know how much flour it would have,

but I use flour. It's almost impossible to make good crepes without just wheat flour just because you need that gluten. And none of my kids have a gluten sensitivity. So I, I will make crepes so that every single crepe has one full egg in it, or I'll make waffles where every single waffle has two or three eggs in it. They're very hearty. And my view is I'm looking at the kid. And sometimes it'll be bacon and eggs. Sometimes I'll make little kind of egg muffins or bacon and cheese.

And those, of course, are obviously good. But even I would want anyone to know, even for me, as much as I know, I don't mind if my kids are having a big, hearty, eggy crepe or a big hearty eggy waffle, lots of butter, a little bit of maple syrup on it. I want my kids to just be accustomed to eating real food, not just from bags and boxes with barcodes, and that they're getting good fats and good proteins. And I think eggs are just kind of the perfectly packaged little product. And so I just, breakfast for me is my priority for the kids is how many eggs can I shove

in their adorable little mouse? That's great. I mean, people are always wondering about kids. And, you know, kids have, human beings have this biological shortcut, tend to. as we've, you know, we tend to go for concentrated calories, right? And when kids have a taste of something, they're going to want it. But as long as you can make those things from home is really what I'm hearing you say, then we're not getting all the additives that have been added to it, all the extra sugar, right? It's the maple syrup that you're adding to it. It's not the pack sugar

that happens at the factory before it even comes to you. And that's one way of just doing the that we can and making sure that also, too, kids are growing. So they can handle a lot of calories and they can handle a lot of foods that maybe as we get older, those foods would have a lot more of an impact on us. The same way that I think that a lot of the fasting conversation has evolved for saying, okay, here's the general fasting advice, but also too, if you're a woman who is in your prime fertile years, you know, you may not benefit from doing these long fasting. And maybe one meal a day could end up stressing you out biologically, even if you're not trying to have a baby right now. So maybe eating, you know, just sticking to time restricted eating of 12 to 16

hours is going to be better than trying to do one meal a day, which could cause a lot of other challenges and stress on your body. Any thoughts on that? Yeah. Yeah. No, I would just say well said. Yeah. Back to the kids just specifically, my thought is when a mammal is growing, it makes sense for the mammal to have all three macronutrients, carbs, protein, fat. And that is why I think mammalian milk is, in fact, high in all three macros, because this is mama mammal trying to grow baby mammal well and in a healthy way and rapidly. And so humans, of course, we grow more slowly than most animals do, most mammals do. But even still with my kids, if they're eating more carbs than I am, I don't mind, especially if it's coming with lots of fats and lots of protein from real natural sources,

because it's going to be much more satiating and they're not going to be snacking. You know, it's kids that are snacking on crackers and chips where it's just pure carb, basically, or very protein devoid at the very least. That's the problem. You know, my kids, if they eat one big, hearty, buttery waffle with a little bit of syrup, they're done after one waffle because it's so filling. Yeah, and especially on that note, just the same advice that you gave to adults, as long as our kids are not drinking their calories as a primary source throughout the day,

then that's another big aspect. You know, we were chatting a little bit beforehand, but we just did a couple episodes on how fructose really activates that uric acid component. And one of the biggest components of that is is going to be, you know, fruit juice and drinking it, as you mentioned earlier, is completely different than eating a whole fruit, which is going to do well for most, you know, people. Yeah, that's right. Yeah, in fact, I like, not that I'm an expert on this topic, but the reason I love you just said pointing out fruit, and when the body metabolizes fructose, uric acid is an unavoidable byproduct.

And it's frustrating for me how many people. And I don't mean to be a great advocate of meat eating. I really don't. Even someone the other day said, well, you're just such an advocate of the ketogenic diet so that you can't see anything else. I really resented that, although I wasn't offended, but I thought to myself, I don't. want to be an advocate, but I will be a defender. And so I'm a defender of meat. But as much as people vilify meat for the purines, for example, and they'll say, well, meat's going to cause gout because of the uric acid, the amount of uric acid you're getting from eating meat is so insignificant compared to what you get from, say, metabolizing fructose, especially with how much fructose people are eating these days. So I, yeah, so I think it's important to note people that are struggling with uric acid and gout in particular in a lot. lot of people are, well, all the more reason to control the fruit juice and don't be so afraid of the meat, perhaps.

Yeah. And that's right in line with a lot of the material from Dr. Richard Johnson, who he had on who talked about that. You know, he's not meatphobic, just like you're not fruitphobic, right? We don't want to be phobic of anything. We're trying to help people design their lives and their food in a way that leads to the best results. And obviously, we don't need to have fear, be a part of it.

of that. It's just more about awareness. So speaking of awareness, taking a little bit of a turn, recently you guys submitted your manuscript for publication in conjunction with David Ludwig. Talk to our audience about what that paper was trying to bring awareness to the folks who are coming across it. Yeah, yeah. So there is a tremendous debate in the realm of fat metabolism and obesity. And the debate is essentially waging on two-frofroft. which is that, or the war is on two fronts, that some people are advocates purely of a purely caloric paradigm, that human fat gain or fat loss is simply a matter of balancing the calories in versus calories out. There's this other side which is saying, maybe I'm kind of straw manning both,

but the other side in its purest sentiment would say it's all about the hormone insulin, calories are irrelevant. Now, the truth is, in my view, kind of in the middle that and I think most people on both sides would probably agree despite us being on one side I do tend to be more on the hormone side simply because it's it's ignored it's overlooked so people will just I can say this with absolute um authority because we literally are growing fat cells in my lab right now you know we have we study fat cell metabolism from the very origins of the fat cell you can have a fat cell bath cell bath cell bathed in calories. It can be swimming in a sea of fats and glucose, which are the substrates

that a fat cell will use to grow its own fat. It will either pull the fat right in and turn it into a triglyceride, or it can pull in the glucose and turn that to a fat and then link it to a triglyceride. That can happen. As much as some people say can't, that is not true. A fat cell can turn glucose into fat. The liver can as well, of course, and that liver does it very readily. Now, nevertheless, less, you can have a fat cell swimming in a sea of all these calories, and it will do nothing with them. It will do nothing. It will not know what to do with the energy. It needs to be told what to do. And insulin is the primary signal, and it will tell the cell what to do with energy, namely, take it in and store it as triglyceride or stored fat. That cannot happen. Now, otherwise,

and this is why in a type 1 diabetic, and this was the origins of my interest in this topic are entirely from the early 1900s where these legends in physiology, Elliot Jocelyn and Francis Benedict, they found that in people with type 1 diabetes, and this was before the use of insulin, before the discovery of insulin a few years later, the metabolic rate in people with type 1 diabetes was much higher than it's supposed to be.

So it was about 15 to 20% higher than you would expect based on the size of the person. And that's justifiable basing metabolic rate on size because that is what dictates metabolic rate. There's tremendous myth in the realm of metabolism in the lay culture, in the lay audience. And we think that I gained weight because my metabolism slowed down. That's not the way it works. If you're gaining weight, your metabolic rate is going up. Like, for example, when a woman gets pregnant and she's gaining so much weight, her metabolic rate is shockingly high, and yet she's still getting fat. That's because her insulin is high and because

her progesterone is high and the hormones are telling her body what to do with energy. Metabolic rate is almost irrelevant at that point. And nevertheless, if someone loses weight, their metabolic rate will go down. So our metabolic rate is typically coupled to our body weight. So in these type 1 diabetics, they look at the individual in the early 1900s and they found your metabolic rate is much higher than it's supposed to be. And then this was followed up decades later by groups that found that when you treated a type 1 diabetic with insulin, Their metabolic rate went from much higher than it was supposed to be to perfectly matched with what you'd predict based on the body size.

So putting insulin in the system slowed their metabolic rate back down to normal from this 20% excess. And that's not insignificant, back down to a normal level. So my lab had for a few years been focusing on these two aspects of what might have been happening in a type 1 diabetic without insulin. So we found that when fat cells, and we used, in my work, we used mostly cells and rodents and a little bit of human evidence. And then I'll come back to what we've just done with David Ludwig's group with more human because he's so good with doing human research and we're better with more mechanistic stuff. So we found that when fat cells were exposed to insulin, even in animals, not just cells, it slowed the metabolic rate. And all humans have what's called brown adipose tissue. And I'm sure the audience has heard this before.

I think you and I have talked about it before. But all humans have little pockets of this fat tissue that has a very high metabolic rate. It's unlike the rest of the fat, the white fat throughout our body. It's brown because it has so much mitochondria in it. And the mitochondria is kind of the bonfire within the cell. And so when the brown fat was exposed to insulin, it slowed the metabolic rate significantly. And it made the brown fat act more like white fat cells, the very low metabolic rate. In contrast, when fat cells were exposed to ketones, not the visceral fat, not the fat around our organs internally, but the subcutaneous fat, the fat that we can pinch and jiggle under our skin, that started to have a much higher metabolic rate when it was exposed to ketones.

And our study at the time only looked at people that were in and out of ketosis. But we were able to get them into the lab and we pulled a fat biopsy from their belly fat and measured the metabolic rate. And the people that were in ketosis had a higher metabolic rate at their fat cells. So suggesting that they were acting a little bit more like brown fat cells. And that is where the project with David Ludwig came up. I was thrilled when he reached out, having seen some of the work we'd done, and he heard me give a talk at a meeting about this. they had access to fat tissues that had been taken before and after an intervention. So we could do a follow-up in the same person and then determine to what degree did the dietary intervention affect the metabolic rate within the fat cells themselves.

And to I guess to put it more brief now, there were three dietary strategies in the diet, isocalloric over these, I think, 20 weeks, isochaloric. And this is unpublished, everyone. So everyone needs to know. But the preliminary data suggests that the diet that was highest in carbohydrates had no effect on altering metabolic rate in the fat cells. And the two diets that were the lower carbohydrate diets had a significant increase in the metabolic rate of those fat cells. So that's what we've submitted. And hopefully it'll get published really soon because it's just more compelling evidence that the number of calories.

Yes, it matters. but so too to hormones like insulin because hormones tell the body and especially the fat cells what to do with the energy that it has. You know, I love that, I love, first of all, that's amazing. I can't wait for that paper to come out. And I love that you talk about how it both matters, but when we ignore one specific key side, and obviously calories have gotten so much of the attention, that it's almost like you become, people become a calorie advocate.

And there's a couple different types of calorie advocates that are there. There's the folks that are out there that are coming from government or processed food sort of companies are like, hey, look, it's all about calories in, calories out, people aren't moving enough. It's not our food. It's not our junk food and processed food. It's really just willpower and control. And the other folks that are there often tend to be people that, you know, and I'm saying

this lovingly because I used to be, you know, vegan myself and, you know, you know, heavily I would identify as plant-based, even though the crazy thing is I eat very plant-based now, still with targeted amounts of meat protein that have been added. So I never reduced the number of plants that I ate. I just added in the meat and I feel a little bit better. Again, that's just me. And so I was saying that there's a group of folks that are worried on that side that if it is insulin connected to the refined carbohydrates that people are getting in their in their diet, then it tends to be harder to stick to a diet and be satiated when it's primarily based around a lot of carbohydrates like breads and pastas and rice, which those foods, we don't want

to demonize them. But if that's all we're eating, even if we're low calorie, we can still end up with poor metabolic health, is what I'm hearing you say. Yeah. Yes, that's right. Yeah. So in addition, just the potential for more nutritional deficiencies, the more we avoid animal products. David Ludwig's group, to cite another one of his papers that is already published just last year, they found that when they gave human subjects isochloric diets that varied only in the fat to carbohydrate content. The protein was clamped. The calories were clamped. One group was high carb low fat. The other was low carb high fat. Same protein. And this was largely a matter of the insulin spike that happened as a result of it. But they found that they found that they

there was a much lower, I think what they termed it was energy availability or available energy in the blood after the high carbohydrate version of it. And that's because insulin will promote the storage of nutrients. So you eat this insulin spiking meal, and insulin is stimulating the uptake of all the nutrients out of the blood into the tissues. And in contrast, if it's lower carbohydrate, insulin stays low. Well, then there's more energy available and it's floating around. And this could be why when someone has an insulin spike, Viking meal, another human study that has confirmed this, they're much hungrier, much sooner.

It could be that when insulin spikes, it's lowering your glucose, it's lowering your ketones, it's lowering your free fatty acids in the blood. And now the brain, which has no storage capacity, the brain is thinking, because it needs energy in real time, it's thinking, hey, energy in the blood's gone down. And I don't care if the liver has all of its glycogen stored and fat. I don't care if the fat cell has its fuel. I don't care if the muscle cell has its glycogen and storage. I don't have any food storage, any energy stored, rather. We need to eat more. And so it stimulates appetite much sooner. And so there's a much earlier return to hunger when someone has had an insulin spiking meal. And it could, I suspect, very, very strongly.

It's a result of what David Ludwig found. It's this phenomenon of a lower overall energy availability in the wake of an insulin spike. what do you think are the practical implications for somebody who's listening here and really the advice that they're getting from their doctor you know a lot of people go into their doctor they're yearly physical and the doctor says hey listen you know things are not headed in the right direction but you don't have diabetes yet right you're not uh you're you're you're overweight but you're not obese yet so there's a lot of like we're kind of waiting and monitoring you know you're on this uh train ride and you're about to wreck into another train. It's like you haven't wrecked yet,

but you're on your way to wrecking, but there's nothing that we can tell you right now, besides lower your calories and lose weight. What do you think would be the implications of people really embracing this paper and your findings down to the one-on-one patient appointments that people are having with their doctor? What would that doctor start telling those patients now in the wake of this new information? Yeah. Yeah. Oh, may that day come sooner than later, Drew, frankly. Can't come soon enough. So yeah, it would change the conversation from one that I think would just lead to nothing but discouragement to one with a little more hope because it's not like the average person hasn't heard that idea before, eat less, exercise

more. And so any even well-intentioned clinician that leaves the patient with that advice is doing the patient such a disservice because the person has heard this. We've been saying that kind of thing for 50 years and we're fatter and sicker than we've ever been. So it's, It's clearly not working. And my view of it is that hunger always wins. That weight loss and improving insulin sensitivity would very much go hand in hand. My view on it is it's a long journey that can start with one of two steps. Too often people take the first step and it's this low calorie step, which is eat less,

exercise more. And I'm not saying there's no value to portion control and learning how to respond to your appetite a little better and sense satiety a little better. I think that's wonderful. But if the entire dietary paradigm is, I need to lower my calories and need to exercise more, well, that's what you see on those game shows, like the biggest loser, those reality TV shows. And what people don't appreciate is that you never see the reunion tours. You never see them get back together like you do other kind of reality shows.

They get back together 10 years later or even a year later because they've gained it all back. It's a catastrophic way to try to lose weight. Yeah, the New York Times did a whole expose. and followed up with a lot of those individuals who won from the biggest loser. And in almost every instance, except for, I think, two of the people they highlighted, they had all not only gained back the weight, but most of them were actually heavier than before. Yep, that's right. Yep.

It ends up being catastrophic, to put it mildly. So if the weight loss, improved metabolic health journey is starting with this kind of low calorie, eat less exercise, more paradigm, I believe it's doomed to fail because hunger always wins. So you need to have a paradigm that isn't starting with hunger. And in my view, it should be the first step being control insulin. Don't worry about hunger. If you're hungry, eat. If you're not hungry, don't eat and kind of renew your sensitivity to your own satiety signals.

But with that paradigm, I think it's a little encouraging, again, because it's not based on hunger. And it's not based on this view of depriving yourself of delicious, satisfying food, where it is just kind of like those three things I mentioned. Control your carbohydrates, prioritize protein. and don't fear fat. And there's a little nuance within each of those. But the proof is in the pudding. In collaboration with a local clinic three years ago, we took 11 women with, and these are middle age to older middle age women

who had just been diagnosed with type 2 diabetes. And I knew the clinician well enough that we kind of conducted this approved kind of pilot study. But basically the conversation went with these women. You have type 2 diabetes. you can leave the office with a prescription for a drug, or you can engage in this dietary protocol. All of these 11 women that are the case report followed the dietary protocol, but it was just that simple, Drew, it was literally as simple as I just outlined. Control your carbohydrates, and again, a little more nuanced, prioritize protein, don't fear fat. And within 90 days, there was no clinical evidence of type 2 diabetes whatsoever.

The A1C had dropped three points. The glucose was in a normal range. they'd lost about 20 pounds. And the retention was fantastic because it was not based on hunger. Now, however, I do believe calories matter. And so my view is now that's the second step. So the first step is control insulin. Let's see where you get by just controlling insulin.

You're going to lose weight. You're going to become more insulin sensitive. All the benefits that come from that, which are myriad. Now, if a person has plateaued and they still sense that there is room for improvement, now we can start to focus on the energy aspect of it. But then I think it should just be a matter of structured fasting. That is where I think we really lean into fasting, where it's not viewed as a low calorie effort.

It's not starvation. It's just structured fasts. But that's the second step. A person has learned, they've learned what it feels like to have an empty stomach. They've learned to appreciate that that does not mean they're hungry, that they don't need energy, that they have plenty of fat stored as energy in their body. And they can kind of go through that phase. But that's where I think it's a fast.

So the first step is low insulin by controlling those macronutrients. The second step is controlling energy by engaging in structured fasting. You know, the beautiful thing about that is that there's a lot of reasons besides, well, a lot of people think it's hunger, but it's psychological addictions that we have. And they have nothing to do with hunger, but food is our protective layer. And it can mean a whole bunch of different things. Maybe when you were a kid and certain things or attention in the home or family or you feel more safe when you feel sort of like something's in your stomach.

And so all another reason that when we fast from anything, when we take a break from social media, when we take a break from, you know, too much input, watching too much TV, whatever it is, stimulation, fasting from the news, which is a great idea for a lot of people. Yes, yes. We actually can bring up the true feelings that we have around something and see that there are some people that overeat because that eating gives them a protective layer. But if you can sit with that and actually see what comes up for you and see, you know, are you lacking a sense of connection or are you lacking a sense of faith in your life? Are you lacking community and tribe? Do you want to, you know, address this deeper root that's there that makes you feel like you're not whole that you're covering?

that you're covering up with food. But in my experience, I tend to see that it's harder to find that and get to the source of that addiction. I'm using that broadly here. It's harder to do that when we have a diet that's constantly putting us on that roller coaster of glucose throughout the day and firing off dopamine in a way inside of our body that we're getting that hit of our blood sugar going up and then our blood sugar crashes afterwards.

So it's a lot easier to address those things when you're approaching it from a more stable point of view. Any thoughts on that? Oh, yes. Yes. You're touching on the kind of deeper aspect here, where I'm always very quick to tell people the concepts, and I just, as I just described them in a couple minutes, are quite simple, but that doesn't mean they're easy.

Because when it comes to changing diet, you were talking about deep-seated habits, and yes, there we say addictions, where people have all kinds of addictions to all kinds of different things, including I heard a talk of. of an expert talking about eating disorders, there is eating addictions where the person's addicted to feeling full. It's not that they're addicted to any one particular food. They're addicted to feeling full.

And I thought that is such a unique form of eating addiction where the person is just, they can't stand having an empty stomach. It's physically, emotionally, psychologically, it's very uncomfortable for them. And I think so, so as much as I say that these ideas are simple, and they are. Control carbs, prioritized protein, don't fear fat. They're simple, but that doesn't mean it's easy to incorporate because you're talking

about people changing their habits, and that is not something people do very, very readily. You know, I think when we embrace these principles and we see it as sort of an adventure and we're learning about what works for us, because within everything that you've shared, as you've talked about, there's nuances and there's personalization, right? Some people, I come from a tradition and faith background. I don't identify it by it now, but it's a spiritual tradition out of India that really strongly identifies with being vegetarian. That's kind of like one of their core aspects. It's the Jain tradition. There's a lot of beautiful things about that religion and that background. And I really

respect anybody who's using, is any faith-based group that's out there and is trying to make the world better. And largely, those people are more giving. They're more caring in the world. You know, there's a lot of beautiful benefits that come from, you know, a lot of faith-based. groups that are out there. Now, I'm not going to try to go and convince somebody out there to change their diet, which is actually harder than probably changing your religion, is changing your diet and doing these things, especially if you were vegan or vegetarian, and now somebody's trying to tell you that they felt better eating meat and you should too. You know, they're not, they're not going to do it. And that's not obviously in my interest to try to shift anybody's ideas.

I do talk about my story and what I felt my history with depression, my low omega-3 to omega-6 ratio was off, low amount of omega-3 fats that are in there. And that sometimes speaks to individuals that are there. But within that, you can still be vegetarian and still take advantage of all these principles that you're talking about and feel better. We have a mutual friend, Dr. Casey Means, who is largely plant-based. She does eat a little bit of fish. She's been on this podcast before.

And I love what she posts because even though she's eating a lot of foods that kind of give me a lot of irritation like beans and other things like that. She's combining them and showing them and making them in ways that goes beyond the food wars and shows that regardless of what your beliefs are, regardless of how you decide you want to eat, you can still take advantage of these principles and reap the rewards of following them. Yeah, I agree 100%. I think that it's so important for us to never talk about these topics in a way that is going that's going to alienate individuals.

And Casey's a perfect example. What a delightful person. Yeah, I never want these ideas to come across as polarizing. These should be ideas that are foundational upon which a myriad of homes can be built. You know, as long as we have the common foundation, there's the strong, firm foundation. Well, then what goes on top of it can be different. Yeah, just like you were talking about with your kids or at night sometimes that you eat. So, okay, little fun question I'm going to toss in before we go into a couple other topics while I still have you here.

what is at night when you are a little bit more, you know, more unstructured with your carbohydrate intake? Yeah. Are there a couple go-to things that you like to enjoy? And because you also monitor your blood sugar and your glucose, just as I do, you know, using the Levels app and everything, are there things that you can do or that you do do to lower the sort of impact and have you feel still better and not like you are coming off a hangover the next day. Yeah, yeah. Yeah. So I, um, so what I can't do, what I've learned is that

I can't have cereal around. I, I'm like, I'm honest to goodness, I'm addicted. If, if there is cereal in the house, I don't know where this comes from. It must be from college days, you know, because I was a typical undergraduate and eat cereal like every meal of the day. And you can get away with it. You know, you're bulletproof. Nothing really upsets your stomach or upset your sleep habits back then. But that is something I cannot do. Like I will look at that and I will tell myself, I got a little bit of cereal because it's leftover because we, you know, the kids got cereal today. And I'll say, I'm just going to have one little bowl. It can't happen. And that's why I, that's why I am so opposed to this idea of moderation in all things. I think that is an insidious, dangerous idea

because try telling that to an addict. I mean, I think it's just so ignorant to the reality of human behavior that if you would say, well, I don't want any wine. I can't have any, I can't have wine. Well, just have one little glass. Well, no, I have a hard time stopping. We'll just stop at one. I'll help.

No, the person can't stop at one. That's like me with cereal. It's embarrassing to admit it. So what I can't do is indulgence cereal in the evening. If there is a true indulgence, you know, normally, normally I try not, I try not to eat anything and it's just like I'm sipping on club soda, maybe with a little apple cider vinegar. And sometimes I'll also sip on pickle juice.

I know that sounds bizarre, but we get these pickles that have like full dill and garlic cloves in them. And it's just really satisfying. And it just kind of takes the edge off my appetite. But if I'm indulging, we will occasionally have, in fact, very often in the home, we have true sourdough bread like from an actual sourdough starter. I'll cut two slices of that. I'll toast it and put on garlic butter and then a little slab of cheese on the top. And just the kind of crunchy from the toast, a little bit of tart from the sourdough,

you know, because everything that's fermented is a little tart because of what the bacteria are doing. And I'm a huge advocate of fermented foods. I think that's one thing our modern technology and conveniences have deprived us of because we don't have to ferment things for storage anymore. So anyway, that's an indulgence. where, and frankly, it does, in fact, have minimal impact on my blood glucose, which is why I sometimes will indulge. But even then, Drew, I'll have two pieces and I'll start thinking, maybe just two more, maybe four more. So I do, in the evenings, I just am much weaker.

And then I tend to kind of have to embrace the ideology of St. Augustine, you know, kind of a rich kind of of, of the Catholic faith, which I'm not a part of, but this, idea, and he said, and I think it's genius, I would say inspired, abstinence is easier than perfect moderation. I think that is such an insightful comment, right? Because I may tell myself, I'm just going to have one little bowl of cereal, but it would be easier for me to just not eat a single bite than it will be for me to stop at one bowl. And that to me, in fact, you were kind of alluding to this, and I believe so much of my view of life, even beyond dying, is controlling addictions. I don't want to be become a slave to a habit. I don't like being a slave to

addictions. And that's why in my own behavior, I try to moderate what what I do. I don't like feeling addicted to things. And so I think with St. Augustine, abstinence is easier than perfect moderation, at least when it comes to me and snacking in the evening. Very, very often, it's better if I just don't even start. I appreciate the honesty because, you know, when people are hearing the on a podcast like this, it humanizes the journey that we're all on. You know, I've never had that with food. I've never had a sense of addiction with food except for when I was first went vegan. And again, this is my own story. I'm not trying to put that, you know, approach or lifestyle down. I then later on, I got into this whole sort of trend that that happened of like the raw food world.

Are you familiar with that? Oh, yeah. You're eating like raw food diets. The beautiful part about that is I never ate as much fruits and vegetables as ever before. My skin looked amazing. Like there was a lot of great things. But I was under eating and I was already a scrawny kid, you know, growing up vegetarian. And even though I was pretty active and lift weights and stuff, I just never could put on any muscle.

And when I went in that sort of world, I was just under eating and just, you know, out of ideology, thinking that this was the right approach or thing that I needed to do. and then I'd have these binge moments where I'd go and want to eat all the food that I could get. And that was my body's way of being like, we need more calories, you know, inside of there. So outside of that, I've never really had that with food with addiction. But I can relate to you because I've had that with video games. There was a period of time where I really had to actually take a step back and say, I think I have an addiction to video games and it was in college, just like your serial addiction probably started in college too.

Mine started in university. And then at that time, I just decided, you know what, video games are great. It's an opportunity to connect, but I just don't want to play them because I know my tendencies and I know that I can want to beat this game and I get so into it. And I have so many other productive things in my life that I want to do. I want to spend time with my, you know, wife. I want to build companies. I want to interview incredible experts like yourself.

So it's just easier for me not to go down that pathway in the first place because I know my brain leans towards that addiction in that topic. Yeah. Oh my gosh. Yes, yes. Yes. A thousand yes is here. even me with video games, you know, kind of having a lot of my childhood in the 80s,

you know, video games, that was really coming in. And now the home rule in my house is only because of dad and my fear of wasting my life away in a video game that you can only play on the little Nintendo Switch if you're playing with other people. That's the rule. Yep, that's right. No solo playing. And so you're playing with others or they're there with you. my little boy is playing a kind of solo player game going through a dungeon or whatever,

then I'm there with them and we're talking about it where it has to be something social. Or if my girls are building a little home on a Nintendo game, then someone's, and I'm talking with them about it. Like, oh, you pick the bamboo flooring, but that looks really nice. I want it to be social. For many reasons, I'm to foster familial bonds, certainly, but also just to try to let video games be a bonding moment and not lead into the addictive tendencies because almost always if it's addictive, you're doing it on your own. You don't want other people doing it with you. That's an interesting insight. Wow. Yeah. When you're binge eating or you're going on something and you feel the shame so you actually also isolate yourself. Yes. And food actually

should really be a source of connection of bringing people together and really I love that. That's actually a really great hack. I never thought about it that way, but it makes complete sense. Is that if you have an addiction. It tends to be something that you want to do alone. And so really, you can still participate in some level, but it's got to be in community. And if it doesn't feel right to participate in community, then maybe that's a behavior that we might want to think about modifying in some sort of way. Yeah, yeah, that's right. So Drew, basically what I'm telling you is once you have kids, it's time to get a little Nintendo. Time to embrace your video games again. I'm sure, I'm sure, I'm sure. Ben, as we wind down here and we have a little bit of time,

Any other topics that you feel very present to right now that you feel like we didn't get a chance to hit or you want to just unpack a little bit more while we have about five, ten minutes? Yeah, oh yeah, yeah, you bet. So in fact, this was something I alluded to when I mentioned pregnancy earlier. So pregnancy is this unique metabolic state in the body where her metabolic rate is really high and yet she's gaining a lot of weight by design. And so pregnancy is one of only two states where a body can experience something called physiological insulin resistance. Now insulin resistance, to briefly refresh the audience here, because I would have talked about this before, is a confluence of two problems in one. And you always have them together. I am unaware of any exception.

And believe me, I've looked into this. So I know. And that is one, that insulin isn't working the same way that it used to at some cells of the body. So some cells are compromised in responding to insulin, whereas other cells are responding perfectly fine. But then the second variable always comes with this, which is that blood insulin levels are elevated, high insulin or hyperinsulinemia. Those two problems come together. Anytime someone's invoking the term insulin resistance, you have to think that would be compromised insulin signaling and elevated insulin. That's what happens with pregnancy.

When a woman gets pregnant from the moment she becomes pregnant through all weeks of gestation, she's becoming progressively more insulin resistant throughout the pregnancy. The baby is born and it immediately starts to correct. In fact, very, very quickly, even quicker if she breastfeed. And the body's doing it on purpose. The body's doing on purpose. Yep, her insulin's going up. It's helping her store more fat.

It's helping her mammary tissue develop. It's helping baby get fat and grow as well. So that high insulin and the altered insulin signaling is facilitating the growth. The same thing happens in puberty. That's why with physiological insulin resistance, it's the two peas, pregnancy and puberty. Once again in puberty, you have a little boy and a little girl. They start to develop rapidly, physically develop, unlike any other stage in their life so far. They rapidly grow and develop in numerous ways.

Insulin is high. Insulin is altered and it's signaling and they have physiological insulin resistance. it is supposed to happen. Now, in pathological insulin resistance, which is what I study more explicitly as a scientist, that's when it's not serving a good purpose, and it's leading to disease. It's a disease state.

That's when it's making the body infertile. It's increasing blood pressure. It's compromising brain energy use leading to Alzheimer's or even migraines and myriad other problems. So pathological insulin resistance is serving no good purpose, and it's only hurting the body. Unfortunately, some people have become enamored

with the former, the physiological insulin resistance, and they're invoking it too readily. And I say this simply because I, to a degree, have my finger on the pulse of what is stated in pop culture with regards to insulin resistance. And this people lately have started claiming that a low carbohydrate diet or a ketogenic diet, the more far version of that, creates a state of physiological insulin resistance. And that is absolutely false. the body is exquisitely sensitive to insulin that if you were to give this person an injection of insulin it would lower their glucose remarkably quickly it would inhibit ketogenesis remarkably well

that body is incredibly sensitive to insulin but there is some truth in in pointing the finger at an altered metabolic state in with adherence long-term adherence to a low carb or a ketogenic diet and that is more a matter of how much insulin is on hand so So, you know, very briefly, we know that when you eat a refined starch, a glucose load, there's two phases to insulin. There's this first phase and a second phase. And they both work in concert to help bring the glucose that has spiked back down to normal. Because if glucose levels stay too high for too long, it's lethal.

It can start to change the blood volume by forcing the kidneys to dump all the water. And blood volume goes too low. Blood pressure goes low. And then the brain can't get enough blood. and that, of course, is lethal. So insulin comes and helps that glucose has spiked. Insulin wants to push it down. There's those two phases.

The first phase is entirely a function of the insulin that the pancreas has already made, and it's been holding on to. So it's all this pre-packaged insulin. It's all set up in the boxes, ready to ship out the moment the signal comes. And the signal comes, and the beta cells of the pancreas start pushing out all of the pre-formed packaged insulin. from all the boxes, if you will, that it's already built up. And at the same time, it turns on all of the metabolic machinery, all the factory, to start making new insulin.

And so this first phase is all the preformed insulin. The second phase is all the newly formed insulin, which the factory is now making fresh from scratch. If we know in humans that if you just even fast, take an average American adult and have them fast for 12 hours, and then have them go do an oral glucose tolerance test, they may fail the oral glucose tolerance test because they fasted for too long,

that even as short as a 12-hour fast, the beta cells, which are holding on to all of this preformed insulin, starts to break down the preformed insulin. It's almost like the beta cell is saying, you know what, what are we doing with all these boxes of insulin? Let's just start breaking it down. They start dumping the insulin, and they start breaking down all the boxes, if you will.

But to be more precise, the beta cells simply degrade the insulin, and turn it back into its component amino acids. It's just because the beta cell is too efficient. It's thinking we don't need all of this insulin, little knowing that in a couple hours from now it's going to be challenged with a massive glucose load. And thus, the person takes in glucose, what would have been a glucose curve that went up and down in two hours, nice and neat, ends up being a glucose curve that goes up a little higher and stays higher a little longer, altering the trajectory, making it a worse glucose response.

Well, this is what happens, not only if someone has fasted a little too long, so that's a warning to people. Anyone is going to go in and get an oral glucose tolerance test. You actually want to make sure you eat carbs the night before. We're doing experiments to this effect, even now in my lab. If you fasted for too long, you'll basically get a false positive or you'll fail that glucose tolerance test, not because you're sick metabolically, just because you fasted too long, and the beta cells didn't have enough preformed insulin. And so you prime the pump.

And that's what happens basically, to make a long story short, when someone's been adhering to a ketogenic diet, they may eat a load of refined starches or sugars and see that it takes longer for them to clear those sugars. That will happen, but it's not because the bodies become insulin resistant. It's just that they didn't have as much insulin made. If they do the same thing six hours later, they'll pass it with flying colors and it won't be a problem because the beta cells have basically said, oh, wait, we're back to insulin mode. all right, let's fill the shelves and get all this preformed insulin back on, you know, on hand to get ready for when we need it next. So that's the problem.

And in a way, it might be a warning for people that are adhering to a ketogenic diet, be careful of your cheat meals because it is going to take you a lot longer to clear that glucose. And I think there is a metabolic detriment to doing it that way and alter the way we look at how we're going to spike our glucose. And with what are we going to spike it? how refined are these starches or sugar is going to be? And, you know, what are we going to do to our glucose? Maybe prime the pump a little bit. You know, it's funny for me to say this. But if you're planning on indulging and you're going to go get some ice cream,

maybe eat an apple or something a few hours earlier than that, just something with a modest amount of starches, but that is going to require an insulin load, prime those beta cells a little bit. And now when you actually indulge with that higher concentration of starches, you're able to clear it much more readily than you would, because there is value in bringing glucose down. That is one of the reasons why I'm such an advocate of continuous glucose monitors.

It's that we can know how often we're above normal. And having glucose come up and down nice and neatly, that's good. That's fine metabolically. We don't want it when it's spiking up and it's staying up for a long time and going back up or wiggling all around. That's more of a warning sign. So again. Yeah, and just to jump in, I mean, that's great.

I mean, there's so many, like, little nuggets inside of there, and my brain is kind of still catching up and, like, teasing them apart and applying it to myself. But one thing that I can think of is that as I've been monitoring my blood sugar, let's say, like, there's a place, you know, one of the big things that I did is when I started going down this pathway through your material and Dr. Hyman's material and a lot of other folks, I pretty much got off of all the gluten-free. foods that were out there because they were spiking me way more like the gluten-free breads, the gluten-free ponsas, which I would not really eat on a regular basis, but still were in my diet a little bit. And I started going out of my way because I do have a little bit of intolerance and sensitivity with gluten, sort of going out of my way. And there's a few places here in Los Angeles that importing wheat from what would be called native wheat. And you can find places online that do that as well too. And when we would make food or we would pick up a pizza for

example, if my wife was feeling like, hey, it's Friday, let's do a little bit of pizza. We haven't done some in a long time. I might have, you know, I tend to be working during the day. I have a big breakfast. I do well with a big breakfast in the morning, skipping lunch, personally, kind of working through that period of time and then eating again dinner. I've just found for my day, my schedule, my thinking that does really well for me. And so I would have a big breakfast in the morning. My glucose would be very balanced. That would be there. Then we would go from basically not having anything to then we would order pizza from this place here that imports their dough from Italy. It's a place called Pisana in Brentwood. And we would go and I'd be naturally ready for

like a meal. And I would go and I would eat that, you know, pizza. Again, this is like once a month, once every other month. And initially, because it was wheat and it was native wheat. And also it's there with like, you know, the cheese, the olive oil, other stuff. It's a slower rise compared to the glucose, you know, gluten-free pizza. You go kind of like, you rock it to the sky right away, right? Because it's so quickly absorbed. So it would be an initial sort of slow. And then all night, when I'd wake up the next morning, I'd look at my glucose monitor. I'd be the up, I'd be the down, I'd be the, you know, I'd be all in different directions. So is that kind of what you were saying that, you know, I had fat for a period of time and then I all of a sudden had this like

kind of heavier carbohydrate intake and, you know, fill of my glucose. Is that an example? Yeah, yeah. So I think it very much would be a part of delaying all that glucose absorption from the blood. But also when we eat glucose in a mixed macronutrient, which is like pizza is a perfect example, right? We're getting protein and fats from the from the meats or the dairy, certainly from the cheese. What you're doing is creating this competition of burning. And so while it will absolutely, when you mix your glucose with proteins and fats, it will blunt the peak. It'll bring down the peak, but it will prolong the elevation. And that's largely a matter of the fact that when you're eating all these mixed macros, you're competing.

You know, you've got your fats that want to be burned. You get your amino acids that want to be metabolized to something else. And the glucose is just sort of trying to fight for space in kind of boarding the metabolic bus. And so you're trying to clear out all the fat you just ate as well in addition to the glucose. But you do have that moderating effect of altering insulin and altering the glucose peak because you've mixed your macros, which I think is generally a good thing, to be frank. But it does mean that you've kept it a little higher, a little longer, which I don't know that it's bad. But when you're waking up in the morning, as you have like a burst of activity, you get up, you stretch. I mean, talk about a stress on the muscle.

you stretch and immediately start pulling in glucose from that, and that can result in a little drop. But you also, depending on how well you slept, have elevated cortisol, which is going to want to push the glucose back up. So, yeah, the morning ends up being a messy time because there are so many hormonal signals that start coming in, that start coming online in that later part of the night and early, early morning, all in an effort to start mobilizing energy well.

But, yeah, when you've challenged the body metabolically the night before with pizza, that would certainly happen. So Drew, it's so funny. Just yesterday, I went out to lunch with a couple of my brothers there in town. And that's not something I get to do very often, very, very close with my family. And so we went to that my brother wanted to go to this sourdough pizza joint. And all the crust is made from sourdough. It's like a true fermented sourdough.

And oh my gosh, I ate, I was so stuffed when we got out of there. You know, I just enjoyed every single bite. But it was at lunch. And so I didn't mind feeling full. and sure enough, I went home and controlled my appetite. But boy, pizza is one of those foods that I can eat myself sick on any day, any day. Yeah, so just to close a loop on that. And I'll have to get that recommendation.

I'm in Salt Lake every so often to go out to skiing and Powder Mountain. Would love to meet up in person one day. But the example I gave was not exactly related to what you were talking about. Not that there aren't themes. That was more of the competition of the digestion of fat and glucose, but going back to what you were talking about, so that the audience is left with it, it's that if we do think that we're going to have a concentrated source of glucose coming up,

like ice cream or you're going to have a birthday, you know, cake or something like that that might be out there, it might be, you might do better off having a little bit of fruit or something, maybe a couple hours before to prime the pump before you end up slamming your body with a bunch of, you know, sugar. That's right. Exactly right.

Great. Ben, every time you come on, my mind is at a whole new level of thinking about things. And what I appreciate about you that we really got a chance to get into this go-around is, number one, you know, just you sharing your humility. And it's like there's this classic phrase that also applies, I think, to kids in a different way. It's this teacher, Ram Dass. And he says that, you know, you think you're so enlightened, go spend a weekend with your family. right? It's like you think you have it all figured out. Like go hang out with your parents and see what

really ends up happening. And that same way, yeah, get humbled. Everybody thinks that they have their diet and everything and I'm going to do this and that. And then you have kids and you're like, okay, good luck, right? Good luck on all those rules. And also too, this is about living life. And this is also about understanding that there's different context of how people might need to eat differently, like when a woman is in her prime fertility years. And as we alluded to before, and how fasting might be different from them, we've done a few podcast episodes on that. When kids are growing and they're in one of those periods where there's just a lot of demand for calories. And as long as those calories are coming from whole food sources, then we're in a good

position. We don't have to worry as much. We're not trying to put kids necessarily on like a ketogenic diet or anything like that. So I appreciate you bringing the humility component in addition to all the education that you shared today because it just makes it more real. And I think that people beat themselves up less, which makes it much more likely that they're going to stick with these core principles that you talk about for the long term. So I just want to say, I appreciate you, brother. And as always, it's a pleasure to have you on the podcast. Oh, the pleasure is mine.

This is always time well spent. I really enjoy it. I think we covered some really helpful topics. And I hope the audience feels as gratified as I do. As always, just a little reminder about your world. You talked about the shake that you're involved in. Would love for you to give it a shout out. And anything else, you can mention the book.

Anything else that you want to mention for our audience, they're always looking to go deeper anytime they hear you. Yeah, well, yeah, thanks for the opportunity. Yeah, so I'm not just in the ivory halls of academia, the ivory tower. I do like to dabble in entrepreneurial pursuit. So if people haven't, get my book, why we get sick, if insulin resistance is something that you're just getting familiar with, or you are a little but want to get more detail.

It is the epidemic most people have never heard of, so why we get sick. And then the shake has been a really fun venture. It's been fun to kind of dabble in that area and provide simple solutions for people that are looking to kind of incorporate those dietary rules that I spoke about. And anyone can learn more about the shake at get health. And health is spelled HLTH gethealth.com. Beautiful. We'll have a link to both of those in the show notes.

Ben, thank you so much. I appreciate your brother for all your. advocacy and knowledge in the space and just helping people feel better. So thank you again. Well, well, ditto. Ditto. Thanks so much, Drew.