Dhru Purohit Show - A Deep Dive Into the Role That Insulin Plays in Weight Gain and Chronic Disease with Dr. Ben Bikman, Ph.D.

Episode Date: August 21, 2023

This episode is brought to you by Rupa Health and ButcherBox.  There are many conflicting viewpoints on what drives weight gain. Excess calories? High insulin levels? Unwavering hunger? Dhru has been on a quest for answers to learn exactly how to shift body composition to lose fat and build muscle.  Today on The Dhru Purohit Podcast, Dhru welcomes Dr. Ben Bikman on the show to continue his summer weight loss. In this episode, Dhru and Dr. Bikman dive deep into insulin's critical role in weight gain, obesity, and cardiometabolic disease.  Dr. Ben Bikman is a renowned metabolic research scientist and a popular speaker on human metabolism and nutrition. Dr. Bikman has a Doctor of Philosophy in bioenergetics and completed his postdoctoral fellowship in metabolic disorders with the Duke-National University of Singapore Medical School. He is the author of the book Why We Get Sick, which offers a thought-provoking yet real solution to insulin resistance and reversing prediabetes, improving brain function, shedding fat, and preventing diabetes. In this episode, Dhru and Dr. Bikman dive into (audio version / Apple Subscriber version): -The perfect formula for creating a sick society (1:46 /1:46) -The most underrated blood test for metabolic health (6:12 / 6:12) -Optimal fasting insulin reference ranges (11:51 / 9:47) -The two primary factors that contribute to weight gain (17:10 / 14:45) -Dhru’s weight-loss journey and its relationship to calories and insulin (29:23 / 27:00) -Is it possible to gain weight on low-carb diets? (48:26 / 46:16) -Dr. Bikman’s stance on the role of calories in weight loss (1:01:14 / 57:48) -Dr. Bikman’s thoughts on using satiety as a metric for weight loss (1:17 / 1:14:33) -The protein leverage hypothesis (1:26:22 / 1:24:35) -Protein recommendations for optimal health and weight loss (1:30:49 / 1:28:20) -The role of skeletal muscle in glycemic control and diabetes prevention (1:33:57 / 1:31:31) -The link between resistance training, muscle mass, and insulin resistance (1:38:56 / 1:37:33) -Dr. Bikman’s four pillars for eating a healthy diet (1:49:42 / 1:49:10) Also mentioned in this episode: -Why We Get Sick -Instagram: @benbikmanphd -Dr. Bikman’s meal replacement shake: gethlth.com For more on Dr. Ben Bikman, follow him on Instagram @BenBikmanPhD, and through his websites bikmanlab.byu.edu and insuliniq.com. Access more than 3,000 specialty lab tests with Rupa Health. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com today. Right now, new members of ButcherBox receive New York strip steaks for a year PLUS $20 off your first order. Go to butcherbox.com/DHRU to sign up and use code DHRU. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

You must have elevated insulin to signal the growth of fat cell, and you must have sufficient energy to fuel the growth of the fat cell. Either is insufficient. You need both. This week, we are continuing our weight loss and body composition series by getting into all the nuances around fasting insulin, insulin resistance, metabolic health, and their relationship with weight loss. If you're fascinated about these topics, today's episode is absolutely for you.

Welcome to the Drew Proet podcast. Each week, we explore the inner workings of the brain and the body with one of the brightest minds in wellness, medicine, and mindset. This week's guest is Dr. Benjamin Bickman, who's been on this podcast twice now, and this will be his third appearance. It's always great to have Dr. Bickman in the house. Now, a little bit more about Ben. Dr. Bickman earned his PhD in bioenergetics and was a postdoctoral fellow with the Duke National University of Singapore in metabolic disorders.

Currently, his professional focus as both a scientist and associate professor at Brigham Young University is to better understand the role of elevated insulin, which is not a good thing, in regulating obesity and diabetes, including the relevance. of ketones in mitochondrial function. Stay tuned for a fantastic episode on all things weight loss, body composition, and metabolic health, and fasting insulin with Dr. Ben Bickman. Dr. Ben Bickman, welcome back to the podcast. Pleasure to have you here.

I want to jump right in. If I ask you to create the perfect recipe for society to make them sick, fat, hungry all the time, miserable and ultimately die a painful death how would you do that yeah yeah well the easy answer is just to be doing what everyone's doing but the to say that another way it would be to start life to become insulin resistant as early as possible in life you know becoming insulin resistant as a child which happens more and more around the world truly around the world China India

Southeast Asia, the Middle East, North America. We always think in North America that we're the worst, that we're the fatest, sickest, and we're not. In fact, we're not even in the top 20 when it comes to these problems that we're speaking about. But it's a global problem. So become insulin resistant as early as possible in your youth, which will start driving greater hunger because insulin and leptin will be disrupted centrally at the hypothalamus, promoting greater hunger.

So satiety will go down. It will be focusing on more processed foods, which will be protein deficient. Everyone in this space, a lot of people we've discussed would agree that is a lot of the problem as protein goes down that will facilitate greater hunger

or reduced satiety. And that will mean eating more and more processed foods. So the basic, every meal essentially is coming from bags and boxes with barcodes, which is a wonderful way to get a lot of refined carbohydrates

to spike insulin and a lot of refined oils to fuel unhealthy fat, fat, growth. And in the process, these insulin-resistant children will be sedentary, you know, living a life either because of school or because of, you know, parents not engaging them, ideally, or living in communities where it's not safe or practical to be engaging in a lot of outdoor activity. But they will be vitamin D deficient. They will be losing muscle mass

when they should be growing it during their childhood in adolescent years, you know, making it difficult to control glucose for the reasons that we mentioned earlier. And then underlying all of this process of becoming overweight and sick at a very early age, you know, developing hypertension and diabetes in their teens, increasing the risk of heart disease, cancers, and dementia, increasing the economic and lifespan burden in a society. But underlying all of it is this disease of, you know, family and even morality, where we are losing the moral foundation that help people have this sense of pride in being something unique and something special with, I would say, you know, a bit of divinity in every person that is worthy of capitalizing

and growing. So there's this loss of, you know, sort of spiritual sense. and even a common sense of morality across societies that used to anchor everyone together. So maybe to say that all another way is this loss of connection. That might be a more sort of palatable way to explain it. That once upon a time we had these units within communities that really fostered connections with other individuals,

certainly within the home and outside the home. And I think all of these variables come together. It's increasing isolation, killing people emotionally and perhaps even a little intellectually, and then of course the destruction of the physical body by embracing a diet and a lifestyle with sleep deprivation in kids and the almost incessant consumption of processed foods that make children insulin resistant before they ever reach 10,

and then they're early, in their teens, they get type 2 diabetes, and then they're on multiple medications by the time they're 20, that once upon a time were medications for someone who was 80, you know, so we are, we're getting fatter, sicker, and we're aging faster all while we're getting more miserable by losing the social connections that were once so prevalent within communities. Beautifully said for a situation that is unfortunately taking place, if people care about losing weight and they care about reducing their risk of chronic disease, talk to us about the number

one most underrated blood tests that they should be getting, which is fasting insulin. Yeah, there are a lot of ways we could define metabolic health and even overall health. For me, it is a matter of insulin resistance. The problem with defining a lot of cardiometabolic outcomes is that we have a very glucose-centric paradigm. And this has led conventional clinical care to focus almost exclusively on glucose as the primary metabolic marker. And yet underlying the changes in glucose that could be happening over time is the humble little hormone insulin who's just overlooked, you know, just kind of crying out for

some attention sitting in the corner. But to sort of bring these ideas together, we look at glucose all the time and any blood tests when someone goes into the clinic, they're going to measure glucose and they're going to measure hemoglobin A1C. And it could be normal and normal and normal for years, but the person has high blood pressure. They're gaining weight. They have migraine headaches. And so there's no even suspicion that the glucose could not only be contributing to this, these problems, but that there is any problem, metabolically speaking.

But while the glucose levels have stayed at a normal range during all these years, decades even, the hormone insulin has been the canary in the coal mine. It has been increasing steadily year over year, over year, over a year. And so to answer your question explicitly, if I were to say, is there a marker that has been overlooked? It is fasting insulin completely, full stop, because it is the earliest sign of metabolic disruption, that if we could shift from the glucose-centric paradigm away from the glucose and focus, have an insulin-centric paradigm, by measuring insulin, we can not only detect the problems decades before they manifest, in other words, insulin would be

elevated potentially 10 or 20 years before the glucose ever starts to change. So we detect it at its earliest stages. But by focusing on the insulin, we also embrace more effective strategies. Because with a glucose-centric paradigm, conventional clinical care will say, we need to lower the glucose at all costs, even at the expense of increasing insulin. And that is a way to make people fatter and sicker, which is why people with type 2 diabetes who are given insulin therapy to correct their glucose, because it's only seen as a glucose disease, do in fact get fatter and die faster. They're twice as likely to die from cancer, three times as likely to die from heart disease, twice as likely to develop Alzheimer's disease, because those chronic diseases are not problems of hyperglycemia, per se.

they're problems of hyperinsulinemia. So focus on the insulin. We can detect problems sooner and we can treat them better because it's the high insulin that's contributing, not the high glucose. The high glucose is a symptom. This episode is brought to you by Rupa Health. When it comes to achieving optimal health,

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Butcher Box will send grass-fed beef and wild-cut salmon right to your door just like they do mine. And right now, if you're new to Butcher Box, they're giving away New York strip steaks with every order for an entire year, plus $20 off. Just go to butcherbox.com slash Drew, that's D-H-R-U, to sign up and use the code D-H-R-U, Drew, that's me, and you can get these incredible stakes for free all year long. That's butcher, B-U-T-C-H-E-R-B-O-X.com slash D-H-R-U with the code, Drew, D-H-R-U, to get $20 off plus an entire year of New York strip stakes. Before we pull on some threads that are there, I always love when you come on the podcast

and you give people tangible, practical things that they should be paying attention to. So when it comes to fasting insulin and the fact that it's one of the most underrated test out there and that often doctors don't order it unless if they suspect that something might be wrong with the patient, but you're saying basically that your fasting insulin could be out of whack years ahead of time before you are diagnosed with something and it could look like excess weight. It could look like low energy.

It could feel like being tired all the time. So what are the optimal numbers and what are the ranges when it comes? comes to fasting insulin. And of course, this is not medical advice. Everybody's got to talk to their doctor, but I do think that there is medical literacy. And people should be literate when it comes to fasting insulin and the ranges that they should be targeting. Yeah. And I wish that there were firm consensus with regards to fasting insulin, like we have with so many other markers. There isn't. And the ranges will vary almost from lab to lab. Someone could, if they convince their clinician to get their fasting insulin measured, it's entirely possible.

that the lab will say anything under 15 microunits per mill is normal. And I blanche at that idea. I think that's way too high. So with a little bit of scrutiny in the evidence, digging through the evidence, my conclusion is that if someone has a fasting insulin of six microunits per mil or less, it's a very, very good sign that the body is insulin sensitive. In other words, you only need a modest amount of insulin to get the job done. You know, whatever insulin needs to do.

And insulin does a lot of things, because as a reminder to the audience, literally every single cell of the body is responsive to insulin. Or to say that another way, every cell has insulin receptors, these little docking sites for insulin to come and dock onto the cell and then tell the cell to do something. And there are all kinds of some things that insulin will tell the cell to do, depending on the cell. So measure the fasting insulin, hopefully less than six microunits per mil. that to me is a very, very good sign.

If it's up, if it's above, if it's around, say, 7 to 17 or so, that's a warning. And I know that's a bit of a big range, but it's just hard to know in that range whether you are consistently at, say, 15 or whether you are consistently at 5, and you just happen to have a peak in your insulin at that moment when you measured. And then anything above the high teens in insulin, I would say, is only. almost guaranteed to be a problem. But in that kind of middle range to the mid to low teens, it might be a problem,

but again, it might be that you just caught the peak of insulin's natural circadian rhythm. And that's why, as much as I am a great advocate of measuring insulin, I also don't ever mean to imply that it's the only marker, that I think there are other scores, like, for example, the triglyceride to HDL ratio, take triglycerides fasted, divide by HDL fasted, and that number, it varies a little bit across ethnicities, but the kind of average point appears to be around 1.5. So get your fasting insulin

measured, absolutely, but also couple that with your triglysteroide to HDL ratio. And if that number is less than 1.5, it's a very good sign that you're insulin sensitive. Even if your insulin creeped up into the teens, don't lose hope. Look at that number and that'll help fill in some details. And the value of that number is in the event that anyone listening is not able to convince their clinician to measure their insulin, because let's face it, it's not easy to do. It's often a bit of a battle to get it done. You will always get your triglyceride to HDL ratio measured, or not even the ratio, but those two numbers. Every blood test will include triglycerides. Every blood test will include HDL cholesterol. So take that ratio, just compute it on your own. And if it's less than 1.5,

then you can be really confident that your fasting insulin is also going to be good. Yeah. And I want to add a little caveat that fasting insulin is generally considered an inexpensive test, right? So there's the whole medical bureaucracy for good reasons, you can say, where you have to get your doctor to order it. So there's the whole convincing side that's there. And if you generally ask nicely, I find that people are, willing. Some doctors don't like to be told what to do, just like some people don't like to be told what to do. And in that case, remember, you know, you are a client of theirs. You're a patient. So go shop around and find somebody else. And, you know, in some instances, you might be able to use some

direct-to-consumer services. We can list some of those below. There's a bunch of them that are out there. But let's continue. So we mentioned that, and I appreciate that caveat, that by no means is fasting insulin the only thing you're telling people they should be paying attention to. We're just saying why it's one of the most underrated markers to pay attention to, both for short-term health and long-term health. Now, in the short-term health side, there's this whole category. We've been doing the summer weight loss series that I've invited you to be a part of for your deep knowledge and expertise when it comes to the topic of insulin and energy expenditure inside the body. You made a video recently, that was fantastic. And you said, really when it comes to weight gain, we need two things

to come in unison together to basically start that process of significantly starting to gain weight. Can you explain what those two things are and how they work together? Yeah, we can start with the one that appears to have the greater mass appeal, which would be calories or what I would like to refer to as just energy or sufficient energy. So you must have sufficient energy in the body coming into the body in order to provide the fuel for the growth of the fat cell. So that is pretty easy. That's very palatable because we have such a calorie-centric idea or view of obesity and weight gain, weight loss. However, what is too often overlooked is the absolute requirement of elevated insulin.

A fat cell does not inherently know what to do with the energy that it has surrounding it. And let me just refer to my own lab. Here I am at my university right across the hallway in my building is my laboratory. And we are regularly growing fat cells on little petri dishes. And it is so stark to look at the difference in the way the fat cells behave in the absence or later the presence of insulin. So as we are growing the fat cells out across this, little plate, they are surrounded with energy, calories. There's fat and there's glucose,

which are the two building blocks for triglycerides within the fat cell itself, the triglycerides, which are kind of giving the fat cell its big fat blob, or what we call a lipid droplet. And so again, the fat cells are surrounded by calories, an abundance of energy, and yet they're small. There's no changes on those fat cells until we see. start sprinkling in insulin into the culture, into the bath, the medium, we call it, the liquid that the cells are bathing in. Once we start putting in insulin, now the fat cells know what to do, which is store the energy. So that's a part that's so often overlooked. And this doesn't apply to all metabolism in all cells, but it is a pretty central theme that cells need to be told what to

do with the energy they have available. Whether it's energy, available on the outside to come in or other it's energy that the cell already has available within itself. It's the hormones. It's hormones like insulin or glucagon or epinephrine, adrenaline, and others, growth hormone, that signal to the cell what to do with the energy that it has access to. The cell doesn't just know what to do with the energy. The hormones are what's sort of sampling the entire body, understanding what's going on. in the entire body and then dictating individual cells. You know, it's like the hormones are the conductor to the orchestra.

Any individual section, the brass, the woodwinds, the percussion, they don't know what notes to play on their own. They need something to tell them when to come in, the pace, the volume. The hormones are the conductors of the orchestra. And when it comes to fat cell growth, you have on one side the hormone insulin, which is overwhelmingly promoting the growth of the fat cell, and it is so powerful in its own right that it is offset by multiple other hormones that tend to have a catabolic effect to insulin's anabolic effect, like some of the other ones I mentioned, glucagon and epinephrine most obviously,

and growth hormone. So there are a handful of hormones that are trying to get the fat cell to shrink and share its energy all to try to offset the incredible power of insulin, which is telling the fat cell to store energy. But insulin goes even further than that. As much as insulin has a very pronounced central effect on or directed effect on fat cells to stimulate their growth, insulin also has effects at the brain stimulating to a degree, some degree of appetite or satiety in various instances. Not to mention the effect that insulin has on leptin levels from the fat cells, again, a direct effect at the fat cell. But insulin will also elicit a whole body effect to slow metabolic rate. We have known that for decades. Indeed, over 100 years ago,

two famous Harvard scientists, Elliot P. Jocelyn and Francis G. Benedict, Jocelyn, kind of being the father of modern endocrinology, Benedict being the father of modern metabolism, they came together to try to understand the metabolism in what they called severe diabetes, which we would just say kind of uncontrolled type 1 diabetes, that they noted in these individuals who have no insulin, their metabolic rate was 20 to 30 percent higher than it should be. There was something uncontrolled, this fire just raging through their body. And you see this in people with type 1. diabetes. In fact, it's so obvious that some type 1 diabetics are tempted to capitalize on it and engage in a pattern of disordered eating, which is commonly called diabolemia. In other words, the type 1 diabetic

learns that if they can eat whatever they want and enjoy it, eat it, swallow it, and keep it in their stomach and digest it, and they can be as skinny as they want to by simply deliberately underdosing their insulin. That is the most powerful evidence. of the absolute requirement of insulin in telling fat cells to grow or to shrink. Because they learn, again, just if they skip their injections, they will be as skinny as they want. Now, there is metabolic mayhem in the body in that instance. Their glucose levels are 10 times higher than they should be. Their ketones are 10 or 20 times higher than it should be.

And they're dying, but they look as lean as they want to be. And that is because they have learned that insulin, injecting insulin is like injecting fat shots as one type one diabetic referred to it, that they learn that it's the insulin that's making them gain weight, whether they want to or not. So insulin tells the fat cells what to do with the energy that it has available, namely grow, but insulin also helps that growth by enriching the availability of total energy by reducing overall metabolic rate. And we even see this in people with type 2 diabetes. people with type 2 diabetes who go on insulin therapy, taking their already kind of high insulin

and putting it even higher, their metabolic rate slows at the moment the therapy begins. And it's no surprise that diabetics around the world, type 1 or type 2, when they begin their insulin therapy, they gain weight. In a type 1 diabetic, it's often essential because they've been losing so much weight that the insulin hopefully will just get them back to where they should be. but in a type 2 diabetic who's often already overweight, once they start insulin therapy, it's guaranteed they're going to gain more weight, and so up they go. And so within this long-winded answer, Drew, I've touched on a lot of points. If I were to sort of bring it together, I would present what I hope is a unifying hypothesis,

which is that there are two camps, and I don't want to straw man any one of them and speak for either of them, but you would have the kind of pure caloric theorists who would say, no, it's purely a matter, of calories in calories out, hormones be damned. Or you have the other camp, which they would say it's purely a matter of insulin and it's pure hormones. I might have misspoke earlier, but then in that case, calories don't matter, whereas the other group would say hormones don't matter. But in reality, both do. You must, to put it in a distinct sort of thesis statement, you must have elevated insulin to signal the growth of fat cell, and you must have sufficient energy to fuel the growth of the fat cell. Either is insufficient. You need both. I simply harp more on the insulin

because it's the one that's so much more readily overlooked. That we have the caloric-centric view of obesity has so enamored the world that there's almost no room intellectually to consider that there's another facet to this, namely hormones. No, that's a great breakdown. Thank you for that. So a few clarifying questions, right? So you're saying we need both of them. We need access. calories more than what we're burning in a day and we also need elevated insulin right so drew i don't like to use the word excess calories i like to just say sufficient because excess i i worry that the term excess implies a need to kind of be accounting for calories and as much as i agree that calories do matter i'm very readily admitting that i think that if we attempt to quantify them and count them

we're doomed. And I can sort of revisit that idea later. Part of my beef with the caloric view of obesity is this, what I consider absolute fallacy, that we can account for calories where we cannot. The human body to invoke terms of physics, after all, and I can do that because even invoking calories and energy is invoking terms of physics. The human body is an open system. We are not a closed system. We cannot account for every movement of energy, whether we would call it a calorie or not, into and out of the body. For example, if insulin is low, caloric rate goes up. And I mentioned earlier, the studies of Jocelyn and Benedict quantifying metabolic rate in untreated type 1 diabetes, the metabolic rate was 20 or 30 percent too high. That's literally because the energy, the metabolic

machinery is burning hotter. The engine is idling. at a higher rate, but also in the same instance where insulin is low, and now the body is burning so much fat that it can't stop burning fat, because in the absence of insulin, fat burning goes unchecked, that the body is burning more fat than it needs to meet its energetic needs, and thus the excess starts to become ketones. So ketones are simply a product of, if you will, excess fat burning. And now when we start making ketones, every ketone has a caloric value roughly comparable to glucose. Most people don't appreciate that. Ketones have a caloric potential or an energy potential to them, what we could call calories. Again, roughly similar to glucose. And if insulin is low,

that low enough that we're burning a lot of fat, then we start burning more fat and turning it into ketones. Now when we're making ketones, we are dumping the ketones out of our bodies into the atmosphere. Whether we're breathing the ketones out or whether we are urinating them out, every ketone has a caloric value that based on the caloric kind of view of obesity,

we need to account for, as we're counting calories, trying to get into a chloric deficit, or whatever the outcome may be that we want, we cannot quantify the potentially hundreds of calories in a 24-hour period that are just being dumped back into the atmosphere in the form of our breath or our urine. And so that's another reason I grimace a little bit

when people too staunchly advocate for a caloric view. But anyway, to bring it all back to my concern, I don't like to use the word excess calories because it does imply a certain degree of counting, which I disagree with. As much as I think calories matter, I think, and we can get into kind of my advice on specifics and strategies for weight loss later, and I will bring this back up. But calories will sort of take care of itself if the hormones are in order.

Thank you for that clarification. You know, I'd love to just talk about my own personal journey and kind of get your thoughts on it, right? And from a standpoint that might resonate with the audience. I get a lot of people that write into me, people that leave comments on YouTube, people in my newsletter who are in a similar boat as me. So last August, almost about a year ago, I came back from a trip in Italy. I know you've been traveling with your family this summer. You were in Europe. So you know how it goes, right? Enjoying all the different foods, getting a chance

to explore, eating some things that I maybe traditionally wouldn't eat as much as I'm in America. And I came back and I said, you know, in particular for me and now we're blending a lot of different topics. But these are all topics that you talk about. So I think you have a unique standpoint. So I had just conducted an interview with somebody that I believe you're familiar with Dr. Gabriel Lyne. And on her coming on the podcast, I really got the sense. And you've shared this a lot when it comes to insulin is that if I'm going to improve my insulin sensitivity even further and also improve my overall metabolic health, which already was testing really great. I think at the time my fasting insulin was right around like four, four point three, somewhere around the there. It's been as low as like three. And I want to reduce my risk of sarcopenia and all these

other things that I really needed to focus on building skeletal muscle. Right. So I found a great gym over here in Los Angeles that it's called UP. And I, and they would measure me regularly just to get a baseline through caliber testing. I also got an in body scan. And I came in and I measured in at, of course, it was after a month into the lead, but still, it was a, a combination of being under-muscled and sort of having a little bit extra, you know, body fat. So I measured in at body composition at around 26, 25, 26 percent body fat, right? And I really set on a journey of, okay, I'm going to get serious about strain training because of all the benefits, including many of the benefits that you've talked about, not just people

wanting to have vanity metrics and not just longevity, but metabolic health today, right? right? And we'll break that down a little bit further. And so through this process of initially increasing muscle mass and sort of temporarily for the program that I was on, cutting, you know, sort of body fat percentage, one of the things that I had experienced is that at different phases, even with my fasting insulin, which I get measured pretty much every quarter, so I have pretty good data on it on a regular basis and I can see the trends that are there. is that even with a pretty good fasting insulin of like four, five, five point three maybe was the highest that I've been, even for me, I was able to put on a little bit of extra belly fat and

you could kind of pinch it. Now, by no means at all, just to be super clear with people, I'm not obese, I'm lean, I've never been obese, I wouldn't even pretend to understand what it means to be overweight and all the different things that go with that. But specifically from the standpoint of packing on a little bit of belly fat, which a lot of people experience, I was able to do that, even with a sort of optimal insulin range. What do you think was going on for me? Was it just simply that my metabolic health was not optimized because I didn't have enough muscle mass? Any thoughts that you have? Oh, yeah, for sure. Yeah, I think it's very important that we don't conflate the ideas of insulin resistance and weight gain, that the fact that a body is gaining weight actually suggests

that the fat cells are insulin sensitive. Now, there are so many thoughts that I want to express here that I'm going to try to make it a very cohesive line of thinking here. You really can't appreciate whole body insulin resistance without appreciating the origins of it, which I believe are very firmly at the fat cell. Every tissue is responsive to insulin, and as it becomes insulin resistant or not

would contribute to whole body insulin resistance. But in your case, we have, a guy whose fasting insulin levels are good. My counter would be what were your insulin levels throughout the day when you aren't fasted? You know, that's where I think we have to appreciate this. You know, where Drew was on vacation and where Ben was on vacation, because I experienced very much the same thing coming back from this wonderful European trip with my family, definitely chubbier than when I left. And I don't have a full head of hair like you do, Drew, to kind of mask it. You know, if you got a bald chubby guy at the beach, you just see a bald chubby guy. I don't have a

beautiful head of hair to, you know, act as this. At least you can say, give me some kind of compliment. It's just a pasty, freckled, bald, chubby dude. So I was very mindful of that and have been just like you. So now, whereas you and I are still generally insulin sensitive and we have a fasted insulin that falls in a normal range and indeed a range that I would consider good, what was happening from sun up to sundown when we weren't fasted? And that's where so many people have the problem where we have such a culture of carbohydrate heavy foods and eating so frequently that the average individual, certainly when Drew and Ben are on vacation, spends almost every waking moment in a state of elevated insulin. And we're still insulin sensitive enough that after a 12-hour

fast, our insulin comes down. But what happens in those other 12 hours during the day, or more than 12 hours, depending on what we eat before we go to bed, when our insulin is elevated, we, again, we have such a culture globally of focusing on carbohydrates as the primary source of calories and often very refined carbohydrates and eating every two or so hours. So we never actually give insulin a chance to come down, right? When insulin's starting to come down, we spike it right back up. That is how we can gain weight and yet still have a nice fasted insulin number. Again, when we are fasted. But the net effect, there was a paper published in humans that had people overeat carbohydrates for seven days. So it was a high carbohydrate diet for seven days. And at the end of the seven days,

the fasted insulin was two and a half times higher. So I would say the bill comes due that, that, you know, maybe that you or I, in your case, you, because you were measuring your fasted insulin so readily, it wasn't enough to actually start promoting a more lean. lingering insulin resistance, but we know it happens this just in the shortest one week, the fasted insulin went from around five microunits per mill up to high teens in these people. Again, in a fasted state. And that just means in that case, even when you are fasted, you have gone into the realm of what scientists at University of Pittsburgh identified years ago called metabolic inflexibility,

which is basically just your insulin resistant in your body now is having a hard time shifting to fat burning, even when you're fasted, even when you should have gone to fat burning, you know, the body's a hybrid burning glucose or fats primarily. And insulin is the switch that determines which fuel the body's using. And so that is, again, when fat gain will start to amplify, where you're not only gaining fat during the day, but you're potentially not turning to fat burning during the night when you should be, which would be helping with some degree of fat loss. You know, you're still potentially storing fat, even when the body wants to be burning it.

But let me just revisit the role of the fat cell very briefly. And this is a particular interest with two guys like me and you. You have Ben Bickman, who is kind of European, Northern European descent, and I have Drew, I think you're South Asian. Indian, yep. Yep. So these are two remarkably comparable ethnicities. When I did my postdoctoral work in Singapore,

one of the reasons Singapore was so interested in partnering with Duke University which is where I was, was to understand these ethnic differences on how you can take ethnicities, particularly in Singapore, with both Chinese, South Asian, Malaysian, and European. And you have these four different guys

who are best drinking buddies and they're all gaining weight, and yet they start to suffer the consequences of that weight gain at very different rates. But a study done in Caucasians compared to South Asians, not only do we know that the average South Asian Indian has a fasted insulin that is more than double what his Caucasian

counterpart is, but also, even at the same body weight, his fat cells are about three to four times larger than his Caucasian counterpart. And there, so there are these, and this could explain why partly India has more people with type 2 diabetes. Um, the absolute numbers more than anyone, but of course, India's population is so massive. Even per capita, it's approaching the number one spot in the world, being truly the diabetes capital of the world. And a part of it is this combination, yes, environment, diet matters, but also genetics.

And so it's very much important for us to understand what we could call the personal fat threshold that based on our genetics and partly our diet, certain bodies have the potential to store fat in their fat cells to varying levels. and just Caucasians in the case of this example appear to have the higher threshold. But basically, as long as you can continue to store fat in fat cells,

the body stays metabolically sound. And that it's once the fat cells start to reach a point of maximum dimension. And by that, I mean every individual fat cell is getting too big. Now the body has reached its threshold. And if insulin is attempting to still tell the body to store energy, now you have a war, a metabolic, mutiny, where the fat cell starts to rebel. So we gain fat through two different processes. You know, you have two buddies, you drew and Ben, we're going on vacation, hanging out together,

and we both come back from our trip 10 pounds fatter. Because of our unique ethnicity and the genetics that come with that, some of my weight gain potentially would have happened through some modest degree of hyperplasia, where when my fat cell started to get a little big, I would simply create some new fat cells. Whereas Drew, with South Asian ethnicity, your fat cells, you have a very limited potential for hyperplasia. In other words, you're not going to multiply your fat cells. The number of fat cells is pretty set.

But what, so then what happens is the fat cells each just get bigger and bigger and bigger. So each fat cell is carrying a bigger metabolic load than it would normally. Whereas again, in another body that can undergo hyperplasia, the fat cell gets a little big, and it recruits a new fat cell, which gets a little big. So more important than the mass of fat we have on our body is the size of each individual fat cell, which, of course, is impossible to measure outside of a lab. We can do that thing here in my lab by taking biopsies of people's fat tissue. But even still, it's not something you're going to really do.

That's why you start to look at these other markers that we mentioned. But to sort of wrap through this idea quickly, when the fat cell gets really, really, big, two problems start to happen. One, it starts to reach a point of maximum dimension, that it can't grow anymore, otherwise the cell membrane starts to lose its integrity and literally start to pop, which would be a very messy inflammatory process. And at the second, the fat cell, as it's swollen up to 10 or 20 times bigger than it used to be, is now suffocating. It's getting pushed too far from capillaries, in other words, blood vessels where it's, it can get oxygen and give it CO2 and get nutrients.

So the fat cell starts to get too big and it starts to suffocate. This elicits two responses. When the fat cell starts to get so big, it starts to tell insulin. Insulin, you are trying to make me big and yet I can't grow anymore. And so while you are trying to block me from breaking down my fat, I'm not listening and I'm going to start leaking fats. to say that in a more precise term, insulin normally inhibits lipolysis, which is the term for breaking down fat. That's the primary mechanism whereby insulin promotes the growth of a fat cell,

not necessarily force-feeding it, but preventing it from breaking it down. So the fat cell says insulin, fats are still coming in or glucose is still coming in, but now I'm going to start breaking down fat, even though you're trying to tell me not to. So one, the fat cell, the hypertrophic or swollen fat cell becomes insulin resistant to prevent further growth, leaking free fatty acids into the blood in the midst of elevated insulin, and those two things should not be high at the same time. High insulin and high free fatty acids

now means you're going to start storing fat in other places throughout the body, most especially the liver, getting fatty liver and excess fat in the pancreas, creating insulin resistance in those tissues. But the second problem, as I mentioned, is that the fat cell becomes hypoxic. It starts to suffice,

if you will, as it's gotten pushed too far from the capillary. The fat cell has a potential solution for that too, and that is by secreting a bunch of pro-inflammatory cytokines into the bloodstream. So the hypertrophic fat cell becomes very pro-inflammatory because some of those cytokines that it's secreting have the ability to promote the growth of new capillaries. And so it starts to correct its hypoxia by stimulating the growth of new fat cells, which is a better outcome than suffocating and becoming necrotic. Once again, a very messy, inflamed death, if that were to happen. So the hypertrophic fat cell, in order to ensure its own survival, becomes insulin resistant to prevent further growth, inadvertently thereby flooding the body with

free fatty acids to be stored elsewhere. And two, becomes very pro-inflammatory in order to correct its own hypoxia, but in the process, flooding the body with pro-inflammatory. And two, becomes very pro-inflammatory. cytokines, things like C-reactive protein, for example, which is increasingly measured on blood tests. But the combination of these two things, high-free fatty acids and high inflammation, is a wicked combination because now you start promoting the accumulation of these other types of fats in the body called seramides within the cells. And when these two signals come to a cell promote seramide development or accumulation, now those cells become insulin resistant as well, whether it's the brain, whether it's the muscle, whether it's the liver, or the blood vessels,

you know, promoting hypertension. This is why I have a fat first focus, that fat cells are the first domino to fall. That when the fat cells become insulin resistant, that's that earliest stages where the insulin's going up. But it's all still enough to keep glucose in check. You know, the muscles are still responding to the insulin, pulling in glucose. The liver is still responding to the insulin, pulling in and storing glucose, helping blood glucose levels stay low. But once the fat cells have become insulin resistant and now pro-inflammatory, they start spreading that insulin resistance to, like, for example, muscle and liver, now you have the glucose levels start to climb. So where you have other people who may promote or advocate an idea that the muscle

becomes insulin resistant first or the liver, I don't agree with that because of that were the case, then glucose levels would start to climb immediately. They don't. glucose levels stay low because insulin resistance starts in the very low metabolic rate fat cells and then it spreads to the higher metabolic rate, higher glucose consuming tissues, you know, like the muscle, for example. But anyway, Drew, to sort of put a fine little bow on this to wrap it up nicely in response to your question, which was a long time ago and it was this comment about your fasted insulin, how could you gain weight? To say that maybe in one final sense, the longer a body stays insulin sensitive, the more weight it can continue to gain.

And this is why you see these instances of these TV shows where it's people who weigh 600 pounds. And yet, if you were to measure their blood and measure their metabolic markers, they would look probably pretty okay. Now, they're clearly not okay. There are consequences to having that degree of supermassive obesity.

But if we were to look at, say, their triglyceride HDL ratio or their fasted insulin, it would probably be normal because it's not the amount. they're at their heaviest. Like, like, we're talking about, like, let's say, like, the biggest loser or something, just to make sure, because I wasn't following, you're saying if we looked at their labs

when they are at their heaviest or when they lost the weight? No, even when they're heavy. Now, although it would depend on how close they'd come to their threshold. And maybe, let me say this another way, I guess. People who have the genetic propensity to continue to go through fat cell hyperplasia have an almost limitless amount of fat gain. I mean, maybe there would be a point. at which the body simply would stop.

But the fact that they can continue to gain more and more fat means that the fat tissue is responding to the insulin, and that means they keep multiplying their fat cells. What starts to happen in people who don't have hyperplasia, who have a set number of fat cells, which is actually how most people are across all ethnicities, despite kind of what I alluded to, Caucasian or not. Most people have a very finite number of fat cells.

And this is why most people can't, gain a limitless amount of weight. You know, Drew, you and I, if we were both to challenge ourselves to gain 500 pounds, it would probably be impossible. You know, maybe we could gain about 100 pounds. And then even if we kept eating and abusing our bodies that way, we simply would stop. We had reached our threshold of the total amount of fat our bodies could store, but now we start to really have the metabolic consequences of it because the fat cells have reached their maximum point. Now all the metabolic mayhem ensues. We become hypertension. We become very diabetic, but it's when the fat cells become insulin resistant that the body can't gain any more fat.

That's why most people reach a limit. They've reached their threshold and as the high insulin and the sufficient calories continue to try to tell the body to store more energy, now it can't be stored in the fat cells and now you have what sometimes referred to as ectopic fat deposition, where you are now storing fat in tissues that are poorly designed for the fat storage or for the long-term fat storage. like fatty liver disease, fatty pancreas, even too much fat in muscles, which facilitates insulin resistance in the muscle tissue. Anyway, that was a long, long answer, but hopefully there's some clarity in there. No, there's a lot of great science that you shared there. So just a couple questions off of that. Have you seen, and I don't know anybody personally, because I don't know anybody personally that's in my friend group that I interact with on a regular basis, that's been on like a carnivore type diet? But have you seen some of these accounts?

or at conferences. I know you speak at a lot of different conferences of people who are even on a carnivore diet talking about it's not the vast majority, but even some of them talking about, hey, I've been doing carnivore for a little while and I'm, and I hit a point where I particularly noticed where I started gaining excess weight or some of these low carb conferences, sometimes people come. Obviously, it's always tough because you don't know exactly, you know, are people, how much are they adhering to it? Do they have the data to back it up? But these, again, are anecdotal accounts where people would share similar things that,

hey, I've been on what I consider to be. These seem to be a little bit more stricter individuals. I'm on a couple Facebook groups online where I kind of see some of these things. I wish I could brought some of those screenshots here and maybe I'll follow up afterwards. But have you seen any of those accounts where people who are on carnivore strictly or on very strict low carb and they themselves notice that that they could be in a situation where they could be gaining weight. Have you come across? Yeah, yeah, for sure. Yeah, and it definitely kind of challenges the dogmatic view that I don't want to necessarily convey. I hope that people can appreciate

that I'm saying weight gain or weight loss is both a function of hormones and calories. But yeah, yeah, I've definitely seen that. I would say those are the anomaly where it does appear that most people who say go carnivore, which is the kind of purest end of the spectrum version, it's very uncommon for someone to notice any kind of weight gain, unless they started a carnivore diet and they were underweight due to, you know, some starvation or they were just coming off, you know, a poorly formulated vegan diet. It's not uncommon in that case to gain weight simply because the body is filling back out. But yeah, I mean, let's, it is not hard for me to imagine what might be happening there. And I don't want to make it sound too simple for my own sake. But in those instances,

I would say this is a person who probably either had type 2 diabetes when they started and thus very high insulin levels or were very insulin resistant and had high insulin. And then the high insulin simply is still generally promoting fat storage. And in this case, promoting it from the fat calories that they're eating. They're not going to have any fat being produced from glucose, really in this case, because they're not eating any. But if you have high insulin and you eat fat, you will, you will store fat or you will slow fat burning. You know, maybe you'll plateau before you want to and not get to the weight loss goal that you're hoping for. And I would either say, just to clarify, going back to your markers that you said earlier, high for you. And again,

you said that it's debated in different labs would be, let's say, like seven to like, you know, 15 and definitely of course 15 and above. Is that what you're saying is higher? Yeah, I am. Yeah, so we could maybe cut it off. I would almost want to refer to work by George Cahill, who is really the godfather of fasting science. He noted that around 10 microunits per mill appeared to be the threshold

where a body would shift over below that, it would go from fat breakdown lipolysis. Above that, it would shift to inhibiting lipolysis. So relatively promoting perhaps a greater growth. Now, that wasn't a hard fast number, but he proposed it on one of his figures, and he was such a legend in that regard that I can't help but feel comfortable invoking him there. So let's maybe in this case, in this conversation, we go around 10 microunits per mill. But if someone's fasting insulin were higher than that, getting into the teens, I would say that's a person who might want to incorporate fasting a little more regularly. So as much as I acknowledge that calories matter, I don't think it is prudent to focus on calories as the metric.

I think calorie counting is doomed to fail because we simply cannot account for every calorie coming in. And you cannot account for every calorie going out. And so I don't want to get ahead of myself, Drew, but my view on maybe I'll answer the question this way, and that might answer that question more explicitly. my view on weight loss is that you have two steps you can take to lose weight. One is a step to deliberately lower insulin, and the other is a step to deliberately lower energy coming in, or to lower calories.

Too often, we take the first step with the low-calorie step, and people just start cutting fat because that's the most calorie-dense food, and they keep their carbohydrates as the main part of their diet. If a person is starting this weight loss, journey and they're already insulin resistant or diabetic and they have high insulin. If the first step is low calorie, David Ludwig and others, other labs have shown this too, that if you just lower calories, but insulin is staying high, the total amount of energy available or the calorie rich molecules in the blood drops. So total energy availability goes down and that stimulates greater hunger.

So if you try to lose weight where you're cutting calories, but you're not addressing the high insulin, insulin wants to tell the body to store energy. So it's always pushing energy from the blood into cells. Well, the brain is uniquely suffering in that case because the brain doesn't have a lot of energy storage capacity. Unlike the liver, which can store a few thousand calories as energy or glucose, unlike the fat cells, which can store hundreds of thousands of calories, or even muscle, which can store some thousands of calories in total. They have a little bit of reserve

so that if the energy in the blood goes down, they can rely on their own energy for a time because they have it in them. The brain doesn't really have that capacity. It has a very, very modest amount of glycogen, but it needs to constant... So combined with the fact that the brain has essentially no energy storage in itself

and the fact that the brain has a very, very high metabolic rate, It makes the brain very, very sensitive to analyzing. It's kind of the energy thermostat, the cholera stat in the body, where if energy starts to go down, the brain panics, it senses that and will say, hey, I'm going to start running out of energy. I have two pathways ahead of me. I either shut down because the energy isn't sufficient to maintain my current level of activity, in other words, lose consciousness, or I'm going to make us eat more,

which is to say it increases hunger. And so if someone starts their weight loss journey without addressing the insulin, keeping insulin high, but cutting calories, then my worry is that that is doomed to failure because hunger will win. I mean, to say this another way, if, you know, Drew, you and I were hosting this, this beautiful buffet, and we've invited the world's best chefs to come prepare the most delicious foods. It is an all you can eat. We want to invite our friends and family to come enjoy this with us.

We would tell them, friends and family, we're hosting this buffet. It is going to be the most delicious food you've ever had. Come hungry because you're going to want to try everything. What would be the two things our friends and family would do to come as hungry as possible? They would eat a little less in the days before the event and they would probably exercise a little harder. Those are the two very pieces of advice that modern weight loss science is built on. Eat less exercise. more. And yes, it will put you into a caloric deficit. It will shrink your fat cells, but it will be a temporary win because the more you're cutting energy in the midst of keeping insulin elevated without addressing insulin, you will go hungry. And sure enough, in this case, it worked. They come to the buffet as hungry as possible. But the problem is if our weight loss strategy is built on those same ideas, hunger always wins. So before the first step of cutting

calories has ever taken, let the first step be cutting insulin. So this is the idea of, you know, my kind of three pillars of control carbohydrates, focus on the least starchy, sugary carbohydrates in your diet. So eat more fruits and vegetables, whole fruits and vegetables, prioritize protein and don't fear fat, because fat is not going to have any effect on your insulin. And if you can lower your, if you can follow those rules, insulin will come down and metabolic rate will go up because when insulin comes down, metabolic rate goes up, and fat burning will go up.

And so now you have all of these other energy-rich sources in the blood. Now you have free fatty acids, which can be burned because insulin is low, and you have ketones which will fuel the brain because the moment ketones start coming into the blood, the brain will immediately start using them. And so we always say that glucose is the brain's preferred fuel. I reject that idea completely.

Because if you match glucose and ketones in the blood at the same level, the brain is relying more on the ketones than it is the glucose. So if it has a preference for either of those, it's the ketones. But suffice to say, if insulin is down, the blood is flush with energy, the brain has an abundance of energy, and it doesn't sense the panic if calorie coming in isn't what we expected it to be, because now the body is relying on its own energy for fuel, because in the midst of low insulin, we can mobilize all of that energy. It's not locked up.

And so with the first step being, lower your insulin. And if you're hungry, eat. If you're not hungry, don't eat. And you'll find that you're not as hungry because you're using your own energy for fuel. And that will typically, just that one step alone, will get the person to a significant weight loss, whether they get to where they want to get or not.

Maybe they reach a plateau a little sooner. That will vary based on the person. But if they do get to a plateau and they find that they want to lose more, now we look at that other step and we say okay now it's time to start controlling the energy that's coming in but rather than counting calories which is a kind of miserable way to live now it's just time for structured fasting the fasting combined with this lower insulin step already will allow you to start naturally controlling the energy coming in because you're structuring your meal plans in such a way to just limit the total amount that's coming in but again it's not

taken, that step isn't taken with the explicit goal of reducing calories by some certain amount. It's still this idea of let the calories work themselves out. Now it's just time to start fasting. So that was my fourth rule. I already mentioned the three based on macronutrients. Control carbs, prioritize protein, don't fear fat, and frequently fast. That fourth step is taken once the three other steps or three pillars have already been in place, allowing the body to lower its insulin and with lower insulin, start using its own energy for fuel, which you cannot do if insulin's elevated. And now it's not as much a panic or hunger if you skip some meals sometimes.

The brain is adequately nourished because it's relying on the fat burning and the ketones that come from that that you're able to use in the midst of low insulin. You hinted towards it too and said it explicitly earlier that, you know, you see yourself as somebody who's in the middle, right? You're looking at both of these aspects that are there. And some of the guests that we've had on previously, I'd love to get your thoughts and comments on this. In particular, for people who are not severely obese, people who just feel like they have 10, 20 extra pounds that have been hanging on or every year they're noticing they're adding and they're two pounds heavier than last year, four pounds heavier than last year. They're

slowly, slowly sort of adding these pounds over a period of time. So let's say there's somewhere between 10 and 20 pounds over weight, which obviously there's a whole bunch of caveats in there. And let's say that the goal is they want to improve their body composition in particular, right? Some of the advice that was given before on here is that the reason that people, I don't love the word should, but should temporarily audit their calories. Nobody's arguing for long-term calorie tracking, which is very difficult and kind of is very invasive in people's lives and it's quite challenging to do is that a lot of people that are even eating healthy in the wellness space it's so many processed healthy foods that are out today

they're not ultra processed but they're processed and they're processed and they taste so good we all have now gravitated towards not having as much straight up whole foods that we cook at home and we're having a lot more of these snack foods that are out there right the keto snacks the bar that's there, that that. And it's just so easy and pervasive to overeat. So a lot of times people don't even know the baseline of some of their favorite things or snacks they're eating in terms of a total caloric delivery that they are. So what are your thoughts on that?

That at least for some people who, you know, we're not that, nobody's coming from an total energy balance perspective, but that a lot of people actually don't have any idea. And even though calories are not perfect, similar to protein, so many people talking about we're kind of under eating on protein, which is impacting skeletal muscle mass. Of course, there's the strength training piece, too, that people are not as active as much. You've chatted about this. They're living more of a sedentary lifestyle.

And even if that's not perfect, still tracking your protein helps you at least get to a level, as long as it's coming from whole food sources and it's not combined with a bunch of other, you know, carbohydrates and fats at the same time where you're not just independently looking at protein, that it gives you some proxy that you're heading in the right direction. So what are your thoughts about that of just even temporarily auditing your calories so you have some sense of what you're consuming? Yeah. And you can completely disagree, right?

This is why we have you all. Right, right. This is why we want you all. Well, as much as I always do like to find a common ground, I really do. My baseline personality is to try to find something to agree with on people. I just have a hard time ever wanting a strategy to be calorie focused. So in this case, you're bringing up a lot of very good points. My view would be rather than tell the person, hey, you know, just really be mindful of the calories that are coming in.

Because I just think that is a tedious way of eating that leads to problems in the end or just a hatred of eating. Can I end one more thing before you continue there? And this is also generally speaking, like nobody that has been on this part of the series, they're like you, there are many people that are in the middle. So they're not saying like only calories, right? So it's like whole foods, staying away from ultra-processed foods, and generally not being afraid of any micro-nutrient, don't be afraid of carbs, don't be afraid of fats, right? And just have a general sense.

And if you especially focus on protein and making sure you hit those protein goals from a satiety perspective, it's just going to be a hard to eat those other things. The challenge becomes when you, this is their, the argument that's been there and part of a little bit of my lived experience, but I want you to comment, I want your perspective on it. I don't want you to agree with me if you don't agree with me. Yeah. Yeah. Is, is that I, when I audited my calories for a temporary period of time, I saw actually, man, I'm getting so full on the fat that I'm eating, not that I'm afraid of fat at all whatsoever. And my metabolic labs and markers, my A1C, my fasting, insulin, all these things still really look good. And this is not the European trip. This is much

after that process. And a high percentage of my calories, I'm sort of filling myself up on fat. I'm getting kind of full and I'm not eating enough protein in particular. And so I am sort of missing out on maybe some of my ultimate outcomes that I'm looking at. So that's a little bit of the context that I was adding to it. Yeah. In fact, let me maybe start with the protein aspect, then I'll kind of revisit the calories. I am an enormous advocate of protein and have been from the very, very early on. In fact, when I first got sort of introduced into the low carb community, you know, outside of the scientific space as a publishing scientist, in the low carb community, I was very struck by people who were demonizing protein. In fact, I was so impressed

in a negative way by these views that I gave a talk, one of my very first talks that people can still find on YouTube, was me defending protein, referring to the insulin to glucagon ratio, and the differences of insulin response to protein in the context of a high-carb diet and the difference in response to protein in the context of a low-carb diet. And it is very, very different. The degree to which protein elicits or amino acids elicit an insulin, response depends heavily on the underlying glycemia or the glucose that is coming with those

amino acids in some instances. So I'm an enormous defender of protein and even advocate, which is why prioritized protein is one of my central dogmas when it comes to nutrition. The beauty of protein is that it is, I would say, calorically inert. I think that one of the problems with the thermodynamic view of obesity in this obsession with calories is that we assign calories to a class of macronutrient that is not a fuel. Protein is not a fuel. I don't think on any label you look at, protein should be counted as having a caloric load because it is all but the most, it is a rare instance when you're relying on

amino acids for energy. That is not common. It's not healthy. And again, thankfully, it's not common. So I think protein should be off the label. I mean, list it, sure, but don't give it a caloric value. That's not accurate. because we don't use the protein for energy.

We use it for a building block. Energy is glucose and fats. That's what we burn. Amino acids, even the rare instances when we are burning for energy, it is an incredibly modest amount, unless we get to true starvation. And that is the difference between fasting and starvation. The difference is, do you have fat to burn?

Once you run out of fat, and now you're in a caloric deficit, it, now you're burning muscle, relying on amino acids for energy, that is starvation. So, not common. Now, having said all that with protein, I'm an enormous advocate, eat protein. One way to, but I also think we should eat protein the way, if you'll pardon me for saying, invoking deity, the way God intended. In nature, protein always comes with fat. There is no exception to this. No exception. But in our hubris, or our fear of fat, we have pulled the two apart. And now we have sources of just primarily protein.

People will invoke chicken, but look 100 years ago, people didn't really eat chicken. We kept the chickens around for their eggs, which are this perfect balance of one-to-one protein to fat. You look in the US, what's happened to chicken consumption over since 1909, it was essentially zero. And now it is the single most common source of meat we eat. And I'm not trying to vilify chicken meat, I'm not.

But I do think it's, worth sort of wondering how we used to eat once upon a time when we weren't so afraid of fat. But even still, chicken meat has fat. There is no such thing as protein in nature without fat. And that's why my third rule is don't fear fat. In other words, don't fear the fat that comes with the protein that you're attempting to prioritize. When we eat fat with protein, we digest the fat, sorry, we digest the protein better. Most people just think of protein as having its own digestive pathway, and fat as having its own digestive pathway, yet bile acids that are secreted when we eat fat only actually accelerate the proteolytic enzymes that are involved in protein

digestion. We literally digest the protein better when the protein comes with fat. This could be why people who just eat way, get a stomach ache. And yet when they drink whole milk, for example, they don't. Or they even take that way with some source of fat, like what I did, pardon the plug here, with my health code shake, making sure that the protein source had a fat source with it, you will digest it better. That's how it should come. Now, one last comment on this is that I am an enormous advocate of whole food and to, you know, knowing me by now, people know my affection for alliteration and you know a little helpful mnemonics but if the food is coming in a bag or a box with a barcode be careful

with it that's not to say it's going to be bad but it is to say it's something that might be coming in a more concentrated form than you want and so Drew as you were sort of self-experimenting and becoming a little more caloricly minded I think you know a counter or an alternative process or strategy would have been rather than looking at the calories if If it is even coming in something where you can count the calories, you know, maybe control it a little more. Focus on the foods that aren't coming in bags and boxes with barcodes.

And then the calories will work itself out. You don't need to count them. So it's almost like, you know, that can be the simpler strategy rather than the tedium of counting calories. If much of what you're eating, well, not to mention just protein and fat together, that's always a nice balance and certainly the natural way of eating. if you're controlling the foods that come in bags and boxes with bar codes, that's typically going to be a pretty good strategy.

Well, even in that case, you know, I've written about it. So I do want to just talk about it for a second. It was as simple as, again, I don't fear fat, but I was adding like, I would go a little bit ham, you know, just slang for hard. Like, I would go pretty hard on like, you know, on my big fat salad that I still have on a regular basis. Yeah. Just even me kind of cutting down and getting to adding more lean muscle, which over the

past year, and this is coming from, I think I've mentioned it to before, I grew up vegetarian in sort of a standard sort of Indian and then also standard American diet, eating Taco Bell and this and that. Later on, became vegan for a little while, discovered the world of functional medicine, starting getting my labs done, was having a lot of brain fog, a fish. I felt like my brain turned on for the first time after a few years, even though vegan were great until it didn't, right? Like I was feeling so great because I wasn't eating a lot of the process.

I wasn't a processed vegan. I was eating a lot of, I was for a little bit, but I wasn't long-term processed vegan. I was eating a lot of whole foods. And then it stopped working. And then I switched and I started eating fish and then incorporating other animal foods in my diet. And of course, the whole metabolic health aspect that's been coming in the last few years, which has even sort of narrowed it in with the emphasis on protein. So as I went from 26% body fat down to 15% body fat through a combination of strength training,

which was about adding in the lean muscle mass being even more increasing my sensitivity, right, to insulin, I would see things that would just be a little bit helpful for me, right? Even though I don't fear fat, I was going from a massive, generous pour of olive oil. And yes, that olive oil came from, you know, it's just olive oil, but it has a barcode on it to now, okay, great, I just put in, you know, two teaspoons. Whereas before, I probably was like, you know, legitimately, I love olive oil so much. I probably was doing like eight to ten teaspoons. And then, again, not that I fear fat at all. I'm just talking about my own personal experience as somebody who was eating a lower carb diet.

And just that alone, and I wasn't overweight, I was focusing on optimization and dialing into that 15% body. composition just to even see if I could do it while adding lean muscle. And by actually cutting a little bit of the fat, it worked for me. I was able to kind of drop down. And I got from, let's say, I was plateaued a little bit at like 17 percent. And then I was able to drop down and get to like, you know, 16 percent by making a few changes. Now, because I still was eating regular fats inside of my diet and because I was eating a lot of protein and I was eating a lot of fiber, I didn't feel hungry on like a regular basis. but there were some little tweaks that I made to adjust things to dial it in. So what I'm also here, partly I think what I'm hearing from you is that not that you

would have any problem with that and people can, you don't have a problem with anything. People can do anything that they want to do, but that if that's advice that we're giving to everyone, which I'm not, I'm just talking about my own personal journey. And really the biggest issue is not people like me who are already skinny, who are trying to dial in their body composition and added muscle. the biggest issue is in America, it's severely obese people who are getting really bad advice, which is to just focus on calories and exercise a ton. And that's not working.

And that's where we really need to find something that doesn't require them to spend their whole day thinking about how they can start to not only drop weight, but improve their body composition, which is why calories is not the angle for you. We need to focus on these other core principles. Is it four rules or five rules? These five rules, you focus on those and your premises, the rest will sort itself out for those individuals. Is that kind of the lay of the land that you're thinking about? Yeah, no, I think that's a pretty good summary. My thought also is that when it comes to the third principle of don't fear fat, my advocacy

of fats is primarily that, you know, get your fats from animal and fruit sources. fruit sources being coconuts, avocados, olives, and being very careful with seed oils, or more and more these sort of new developed cooking oils like zero acre farms. And I believe you just had Jeff in an episode with Jeff Knob's is going to come out soon. Yeah, it'll probably be out before this episode here. So people will learn all about that. Right. There's some wonderful alternatives that are reaching kind of mainstream. But when it comes to the cooking oils, which are separate from a source of protein. I do think there's a reason to, you know, be a little careful if you're going eight tablespoons of olive oil or, you know, zero acre farms oil, maybe go to four, you know, depending on

what the situation is. I do think there's a reason to be a little more careful on the pure sources of fat. As much as I am very friendly towards fat, I acknowledge energy does matter. And so it's no surprise to me that you found that that was something you could leverage and experience and benefits. It is still, I mean, I do think part of our problem is we have a very fat phobic culture. And that has led us to not only develop seed oils on mass, mass, kind of industrial industrially produced, which are problematic, but also to focus on the lower calorie density fuel, which is carbohydrates, which I just believe we eat too much of. And of course, I would say we eat too much refined starches and coupled with too much of the unhealthy oils.

In fact, those come together. If the food, generally, if the food comes in a bag or a box with a barcode and it's starch-based or, you know, carbohydrate-heavy, it's also going to have soybean oil or canola oil or some kind of seed oil in it as well. So it's a particularly wicked combination. So anyway, focusing on real foods and being, you know, being. a little prudent with the sources of pure fat, I think that's a very good strategy. I'd love to get your perspective on this. We recently had on Dr. E on the podcast.

He's a gentleman that's primarily known for his work on satiety. He started the website, Diet Doctor, and I believe he's based in Sweden. Sweden, yeah, he's based in Sweden. And a lot of his focus these days from his angle, and he is started off his journey. I think he read the book by Gary Tobs, which I believe is good calories, bad calories. Yeah. That was really influential in his journey. And then he became a really hardcore low carb advocate. And still, he follows a low carb diet. He talks about it. And his real question became over a period of time as his ideas changed, which a lot of people, you know, their ideas, I wouldn't say change, but they become more nuanced based on who they're talking to and how to make,

a difference in public health. And as a medical doctor, he was thinking, if we, you know, to paraphrase for him, my best attempt after interviewing him was if we don't think about how to help people make better decisions within this context of packaged and processed foods, we're never going to make our way out of this obesity epidemic because those individuals that are relying on those foods, it's a little bit wishful thinking that they're going to have the circumstances, the time. the education, the everything to say, okay, I'm primarily going to go focus on whole foods. And if somebody is able to figure that out, amazing. Please, we need a thousand people working on

that. His approach is I'm going to start talking about foods that even if their process have the highest satiety score, which are protein as being one of the big ones as part of that. The next thing is fiber. He has sort of an algorithm that him and his team have created. And I believe the next thing was a hadonic score and there might be one of the thing that's missing maybe you know which one it is if not i can pull it up what are your thoughts on that aspect it's really sort of twofold that our society and our modern world and increasing the rest of the globe is so addicted to processed foods that if we don't figure out how to help them eat within that spectrum it's such a small amount of people that are actually able to legitimately have the time to cook and get their foods from whole foods, which is, of course, nobody argues that that's how we've been eating for a long time.

And that's definitely how our ancestors were eating. It's just a very challenging thing to expect people to do that. So love your opinion on that. And then love your thoughts on the general approach of satiety as an indication of how to decide what to eat. Yes, I'm very familiar with Andreas's work and have enormous respect for him and what he's contributed historically. And I even appreciate his attempts to sort of fine-tune what he perceives is perhaps an imperfect approach to weight loss. I really do. So I want to make sure that I really express that respect up front.

I know him personally and have enormous respect for him and what they've created. Having said that, I don't agree with the central premise of their satiety per calorie model. I very much appreciate the focus on protein. That is one I share with them. But I somewhat, I'm a little disheartened to see that this is another way of just promoting focusing on calories, as if calories are the unit of satiety, as if calories are what conveys, what satiates hunger, Now, I don't want to speak for Andreas either, but I'll just note my main concern. Studies that really compare fiber find that as fiber, you know, which has no calorie load, is incorporated into a diet,

while it does fill the stomach, it does not promote long-term satiety, that people still get hungry. You know, you can't trick the body. Volume in the gastric system does not convey to satiety. at least certainly over time. So that's one concern is that the unequal evidence in that regard with regards to how well fiber actually does promote satiety. But also the part that worries me the most is the idea of perfectly equating all calories from fuel.

What I like is that they consider protein as not a fuel source. I agree with that completely as I elaborated earlier. But they equate any calories that come from carbohydrate is the same as any calories that come from fat. And that is a premise I cannot endorse, I cannot agree with, because we have very well-controlled clinical studies that have people eat isochloric meals. So the exact same number of calories,

controlled for the same amount of protein, it only varies in fats to carbohydrates. And we know from multiple different labs, different studies, that if the diet, if the meal is, one that is higher carbohydrate and lower fat, even if it's the exact same amount of calories as the low carb higher fat, the higher carb lower fat has what these scientists refer to as an

earlier return to hunger. In other words, they get hungrier faster. And it's probably, as David Ludwig's group found, because the total energy available in the blood drops. Because if insulin goes up, which it does more in a higher carb lower fat meal, even if calories are the same, If insulin goes up, it will stimulate the movement of calories from the blood into cells, and the brain will sense that relative reduction in available energy, and the brain will stimulate hunger. So regardless of the mechanism, and David Ludwig proposes a mechanism, namely reduced overall energy availability in the blood,

which makes the brain get worried. And again, independent of that mechanism, we see that if the isochloric meal spikes insulin, because it has a higher carbohydrate to fat ratio, the people will get hungrier sooner. And so while I appreciate the model, and I really do, I don't mean that to sound pithy, I appreciate the satiety per calorie.

I appreciate their attempts. Even if I somewhat grimace a bit at seeing the way they're putting it together, like the hedonic factor, for example, which is sort of their little bit of witchcraft. There's really no metric of hedonism when it comes to food. What is hedonic to Ben is not the same thing as what's hedonic to Drew, for example. You know, what works for me to really please my palate won't be the same as what works

for Drew. So I take some issue with that factor, but even still, I appreciate the attempt, but I sort of, I can't help but be to groan a little bit inwardly when I see carbohydrate calories and fat calories get equated when it comes to satiety simply because you've now eliminated the insulin effect of those calories, and the insulin effect matters, not only with overall metabolism, but even with satiety. In these studies, we see that if insulin goes up, satiety goes down, and the person will be hungrier sooner. So not all calories will have an equal satiating effect. That's my primary concern with this new paradigm that Andreas has embraced. Yeah, I don't, I'm a little, I'm a little disheartened, to be frank, because I just can't help but see it as actually a step back.

That while we say that it's an evolution, in my mind, I see that it's just a return to the old kind of calorie-centric view of obesity. And I would be, you know, happy for Andreas to disagree with what I'm saying, but the evidence that I'm citing, I'm very, very certain exists. And I don't know how that's been reconciled in that paradigm, in that calculator, if you will. Well, I always appreciate, you know, it's so healthy for people to disagree. That's actually how society actually progresses and moves forward. And we have to make sure that anybody that's involved in allowing these discussions or ideas to disseminate, we should encourage more of this, have people share their thoughts. And we should never be so fragile that our thoughts and ideas. And that's one thing that I do respect about Andreas after having met him is I see him leaning into people saying, hey, great, like, this isn't perfect. tell me your thoughts. Oh yeah, he's been very humble about it. He's been very humble about it. It's a really, it's a testament to his character.

He's been, he knows he's doing something new. And as the fiery darts have come in, he's handling it, I think pretty maturely, frankly. And I don't envy him. Even if I disagree with the approach, I can appreciate the way he's doing it. Yeah. And that's why I respect both of you because you're engaging in healthy discussion, right? That's actually how we move forward. We are in such a bad mess.

in society that it's going to take a lot of different angles and a lot of debating to actually get us out of this. But one thing, because you mentioned, you know, you're always looking for common ground, consistently that I want to share with the audience over here. And this has really shown up in the last couple of years as people have been paying attention to this podcast is time and time again, people coming back to the idea of just how important protein is in the diet. Now, some of the recommendations that are out there and we've had Dr.

Donald Lehman on the podcast. We've had other researchers in the space. We've had Dr. Gabriel Lyon, who has a new book out on protein. Some of the recommendations for individuals there. And one of the hypothesis is that if we're not eating enough protein, we're going to be constantly hungry and we're going to be looking to overeat all in search of trying to get enough protein. I forget exactly what that hypothesis is called.

I know exactly what it's called. Do you know what it's called? Can you talk about that? do it's the it's the protein leverage hypothesis yeah so so talk about the protein have leverage hypothesis your thoughts on it and how it sort of relates to your view of the world and then your recommendations for people who are listening generally we've heard on the podcast previously you know one gram of protein for you know every pound of lean uh healthy uh you know your ideal sort of um lean body weight that you're you know sort of targeting uh yeah so give me your thoughts on both

of those things. Yeah. Yeah. So the protein leverage hypothesis is this really compelling idea, which you elaborated well, and I'll just reiterate, which is that you're going to eat and eat and eat until you get to a certain amount of calorie, a certain amount of protein consumed. That once you reach the amount of protein, your body is wanting. That's an unscientific way of explaining it. Once you reach that point, then your brain will say, okay, you're done, you're full. And there is a lot of road. evidence to support that idea and a very modest amount of human evidence to suggest that it may be the case. I am concerned that that idea is being invoked a little too readily, that there aren't enough,

that there's not enough human evidence to really support the approach. Even the, and I'm not an expert on this topic, but if I recall correctly, even the originators of the protein leverage hypothesis, these two scientists and both of their surnames are a little complicated, so I can't remember them. They noted some of the drawbacks with this. And the original intention in their research, I think, was to actually look at longevity. I think. I might be mistaking some lines here.

But they were quick to point out that there are flaws as that model is extrapolated to humans, where if the satiety, as protein consumption goes up, you start to get problems with. fertility, for example. I believe they noted that the animals stopped reproducing in one of the colonies that were on this diet. So I think that it's a more nuanced discussion than most people would like it to be, but I also think as much as I'm an advocate of protein, prioritizing protein at the expense of any other energy source, you know, and certainly implying,

which the satiety per calorie calculation does, implying that any calorie from carbohydrate and fat is equal, I think leads to a pattern of eating that is not in the human's best interest, where, you know, we are not rodents, of course, we eat differently. We also may have a higher demand for fat. Certainly the ancestral records support this, where Mickey Bendori in Israel finds that, you know, the early humans deliberately sought the fatty sources of meat.

That the idea of our ancestors focusing primarily on the lean meat that was relatively very high protein and relatively very low fat is wrong, if not laughable. But I'm not an evolutionary biologist. I'm not even a protein hunger satiety scientist, so I want to make sure everyone knows that. But I have my concerns with that model that I think that the overall human evidence does not necessarily support it. And so I'm thus quite cautious in advocating. So how does that show up regarding your recommendations? Because you still do prioritize protein. So what are your recommendations when you're thinking about that?

And again, you have your area of expertise. You've been very clear about that, your PhD and what you've studied and what you haven't. But as you start to mesh these ideas together and from your perspective, how do you recommend that people navigate the protein side? Yeah, my recommendation is to really get protein. Of all the macronutrients you have, focus on that one. But again, don't forget the next step, which is don't fear fat. the body, the human body does not digest pure protein very well. I've already mentioned that.

We digest it better when it comes with fat. And in nature, no protein comes alone. It always comes with fat. There's no exception to this. At least not that I'm aware, and I've tried to find it. And we should eat it that way. We should not fear the fat that comes with the protein. And when it comes to protein, I don't think we should fear even being liberal with the fat.

If someone is getting most of their protein from chicken, I actually think it would be helpful to make sure that you've added some fat to that chicken. Whereas I wouldn't say that necessarily with beef or other sources of protein in nature. But when it comes to chicken, which is something it appears in the historical record we did not really eat much of, chicken meat. We ate the eggs from the chickens. I do think it might be prudent to actually add fat. And I don't say that very often in very many instances. It's generally just enjoy the fat that comes with the protein.

So just to be clear, how do you feel about the recommendation of a gram of protein for what people are shooting for for their lean or sort of ideal, ideal weight? So if somebody is 100, you know, their ideal weight is a 135 pound woman or it's a 175 pound man that they should be looking at, which is a lot for a lot of people who don't come from the world of fitness or don't think about that. They sometimes have a hard time imagining it, but that really their target should be in that direction, a gram per ideal pound of body weight. I think even Peter Attia and a few other individuals have talked about this as being a recommendation. Any thoughts about that? Yeah, oh, very much. Yeah, I think it's perfect. Now, again, I'm not a protein expert, but I am expert at other people's research.

And Dr. Stu Phillips in Eastern Canada at McMaster University, he's really, he's the authority that I go to. when it comes to ideal protein for maintaining lean mass or even promoting it. And that is right in his range. And so I think that's a great range. And it's one that I can agree with. There's a study that you shared on your reels on Instagram. We have a link to your Instagram below. Please, everybody follow Ben Bickman.

He does these breakdowns. Ben, you do these incredible breakdowns of studies where you're always keeping the audience up to date on the latest that's out there. And you'll talk about some of your evidence from it. And you'll even show a little screenshot of the studies so people can look at not that I have any ability to really break down or understand what a study is talking about. But there was one that you shared that's on this topic, and it was on the topic of, I believe the title was,

lower skeletal muscle mass is associated with diabetes and insulin resistance, a cross-sectional study. Does this study come to mind? Do you remember talking about it? Can you talk about some of the implications of this study as is related to people who haven't yet fully connected the dots when it comes to muscle and metabolic health. Yeah. Yeah.

Muscle mass is, so this is where, you know, especially Gabrielle, is such an advocate of muscle. And I agree with her in this regard completely. Muscle is a metabolic powerhouse, not only because it represents the majority of our mass, of our tissue mass, mostly the average person, even if they're chubby, is mostly made up of muscle. But when you combine that with the sheer amount of glucose, that the muscle wants to consume at any moment, it starts to paint a pretty full picture, where in the average individual who eats a starchy, sugary load, as you see the glucose curve come up and then it starts to come back down, most of the reason why it's coming down is because

of the muscle taking it in. So to once again invoke a sort of term of physics, the muscle is an enormous sink. And I don't mean like a sink running water. I mean, it will pull in. You know, there are things referred to as heat sinks. This is a, a, a molecule or a metal that will have the ability to absorb a lot of heat. The muscle is a glucose sink. It has the ability to absorb an enormous amount of glucose. Again, a result of not only how much mass we have in our body that's muscle, but also just the metabolic rate of the muscle itself.

So 80% of the post-pranthial glucose removal from the blood is generally going into muscle. So if we can increase the amount of muscle we have and move the muscle we have, we can keep blood glucose level steady much more consistently. And of course as glucose is steady, so too can insulin be. There's no upward pressure on the insulin. But as we start to, it becomes a vicious cycle when you look at muscle wasting or muscle mass loss and insulin resistance. So let's maybe start with the paradigm of someone who's just becoming sedentary.

I have a colleague at the University of Utah, and I was published on one of his papers, where they documented that just about seven to 10 days of bed rest, results in this significant increase in insulin resistance. You can quantify this. So let's imagine the average person who starts to become kind of sedentary as they age. You know, they're on vacation, they're not active, they come home and they just don't quite get back into the swing of things, and that becomes this kind of steady decline in their average activity. If you're not challenging your muscle, of course, you start to lose muscle mass.

And as you lose muscle mass, you start to experience higher, levels of glucose. It takes you longer to clear the glucose from your blood. The longer it takes to clear the glucose, the more your insulin has to be elevated. And the more insulin is elevated, the more the body starts to become resistant to insulin. That's something we've spoken about in our previous podcasts, me and you. So this starts to create more insulin resistance in the body. As the muscle starts to become more insulin resistant, insulin is less capable of defending muscle protein. Insulin wants the muscle to keep its protein, but as the muscle becomes insulin resistant, now we have this proteolysis or this breakdown of muscle protein, which is why so

commonly in people with type 2 diabetes, we see that their plasma amino acid levels are higher. It's because that's a consequence of the muscle becoming insulin resistant, and insulin can't protect the muscle protein. Now it's breaking down the muscle protein and releasing the amino acids into the bloodstream. And as the muscles become more insulin resistant and shrink more, it further amplifies the glucose intolerance and the insulin resistance, which in turn further amplifies the acceleration of the muscle wasting, which keeps us going on this vicious cycle.

So one way to break that cycle, yes, start controlling the carbohydrates coming in to lower insulin, but if you can start challenging your muscle in any way, make the muscle, hungry again, increase the size of the glucose sink, you will just have a much easier time not only returning to baseline level sooner, but also staying, keeping your glucose at an ideal level for longer periods during the day, which allows insulin to be at a lower level, and allows the muscle to become more insulin sensitive, which allows insulin to defend muscle protein better, and now you can start to break that cycle and start to turn it around and reinforce it. So bigger muscle resulting in better insulin sensitivity,

enabling better muscle protein synthesis, enabling greater insulin sensitivity, and again, turning the cycle back on its face. One thing as we've been talking more about protein on this podcast, Dr. Donald Lehman was the one who really wanted our audience to understand that he feels in this perfect recipe of, yes, increased protein, and also challenging the muscle, as you mentioned, right? Just even nine days on best. bed rest, nine days of being sedentary, significantly increased insulin resistance, he sees it

as it's 75% challenging the muscle through strength training, right? Or some sort of similar, well, not something similar, strength training. And people can get to that through body weight activities. They could do that in the gym. They could do that with resistance training, with weights and bands, and then 25% is the protein. But if we just have the protein without having a non-sedentary lifestyle that focuses on strength training, we're not going to get that perfect recipe. Yep. The gentleman that you follow that's in the protein space, when you say that that's generally

your understanding as well? Oh, for sure. Yeah. In fact, Drew, it's not hard for the audience to see the parallel here. Earlier, what I referred to with regards to the growth of fat cells where you have to have both an insulin stimulus and sufficient energy to fuel that growth, it's very much the same with muscles and size where you have to have the exercise is the stimulus, but you need the actual building blocks in the form of the dietary protein to fuel that growth. So again, the parallel being in

the fat cell you need insulin to stimulate growth and the calories to fuel it. In the muscle, you need the exercise to stimulate the growth and you need the protein to fuel that growth to actually provide the structure, the building block, that will become the bigger, better muscle. Yeah, I agree with that sentiment completely, that as much as people want to focus on protein, if you're doing so in order to increase your muscle mass, it won't work. You can eat all the dietary protein in the world. And in the absence of a challenging stimulus, namely strength training, the muscle won't grow. I want to come back to one thing you mentioned about fat.

You said evolutionarily, there's a strong argument, even though that's not that your area of expertise, you're just synthesizing a lot of things you've read, come across conversations, which I appreciate. There's a strong argument that we weren't eating a lot of protein with the absence of not having like the fat there. Anytime we had protein, we had fat. And in particular, you were mentioning that we even prioritized fat. Now, is part of that do you think? And again, I'm asking you to sort of just extrapolate based on your sort of speculate. Part of that also was combined with the lifestyle and a life of depending on who you, you know, read and kind of talk to, we generally know that food was not as plentiful. And we generally know that it took more effort

and energy to get and come across food, especially if we're talking about pre-agriculture and how life looked on earth prior to that time. So it was part of that that, hey, we're going to eat, first of all, we're going to eat the whole animal because food is so hard to come by. We're not going to let anything go to waste even still hunter-gatherer societies live that way today modern-day hunter-gatherer societies and also secondly we're not worried about how much fat protein egg whatever we're consuming because also just even the struggle to get food in the first place is a massive win famine is at a super high risk and that generally we knew that a next meal may be even up to a couple of days for especially the men if they were especially making sure that food was available to the to you know the women and

the kids inside of the village or the camp or whatever it be what are your thoughts on on that is that some could be one of the reasons why we also heavily prioritized fat is because we had these long bouts of fasting in between where we needed that long term fuel to just keep us going and does that same thought when we extrapolate it and speculate based on our current environment you know does that still sort of add up with how plenty full food is and in particular sources of fats in our society that come along with it's usually fats and carbohydrates together right people eating a donut pizza other stuff that that they're sort of surrounded with and make up the sort of modern-day american ultra-process diet yeah yeah well drew i hate to disappoint especially after you presented

the questions so elegantly i i don't know and that's my answer that i'm i'm so simply not enough of the evolutionary biologist to counter that. I think it's a pretty prudent paradigm, which is, again, to say yours another way, is the reason our ancestors focused on the fattier sources of energy just because their needs were so different than ours, that's totally rational and could be absolutely true. I like your point about fats and carbohydrates together. I believe there's only one source of fat and carbohydrate together in nature, and that is milk. And thus, it becomes a perfect mix, a perfect cocktail to help baby mammal grow as quickly as possible, where you are giving carbohydrate to stimulate growth with insulin,

and you're giving fats to help fuel a lot of that growth. I think, you know, other than dairy, there's no other instance. Every other source of fat just comes with protein. as we've alluded to. So, yeah, I don't know, Drew. I don't know the, I can't answer that. It's entirely possible that guys like, you know, Mickey, Bendori, he may have his own response to that. These guys, the actual evolutionary biologists, or Stephen Kuhnain, who presented this shore-based view of evolution,

where humans really have to focus on fatty sources to promote brain growth. Or the biologists whose names I don't know at Harvard, who presented what's called the expensive tissue hypothesis who posited that the reasons humans departed from other primates in the evolutionary branch or tree is because our ancestors began eating fattier sources of protein, namely other animals. As we became carnivorous, it allowed our intestines to shrink because the nutrient density was so high and allowed our brains to grow because we didn't need to try to eat every two hours. you need to forage. We had time to think. Anyway, all of those lines of evidence do suggest there is a prominence for fat, but I can't say, I can't answer the question, you know,

is that why we focused on fat? Those other lines of evidence, like the shore-based theory or the expensive tissue hypothesis, would suggest that there's something more real to fat consumption than just we need calories at the moment, certainly the shore-based view. Stephen Cunane's work, who is, he's a brain guy, and a brilliant one at that. His view is that the human brain only evolved to be what it was because of the fat that we were eating. You know, his view may suggest a more fat favorable view even nowadays. Of course, he would defend the production of ketones as a brain fuel because the brain doesn't use fat for fuel. But anyway, yeah, Drew, that's a long non-answer for me. You know, that is a very respectful answer because

there are things that we just don't know about and we can all have different theories, but I respect and you should look for somebody who says, I don't know, right? That's like, that's a sign of respect because they just don't want to get out of their wheelhouse that they're trained in. So I really appreciate that answer and I respect that answer. In fact, Drew, let me just take that one step further. I actually think a lot of what's wrong with the world today and a general or growing distrust in science is that you have people who are going outside there.

area of expertise. Not that we can't be Renaissance men or people and be kind of excellent at a lot of things, but I do feel, as I look at the growing trend of people distrusting science and experts, which I think is entirely justified. I think a lot of it is born from people not being humble enough, not that I'm trying to compliment myself on my humility, but people not wanting to admit when they don't know something and instead presenting a facade of expertise that they actually don't have or that they should be discussing with a little more respect of the topic because maybe the very topic itself doesn't lend itself to perfect understanding. Well said. And I'd add to that one sort of caveat, which is that expertise can show up in a lot

of different ways. There are many individuals that were some of the earliest researchers that were sort of amateur researchers in a way who didn't have a background in virology or this, that were speaking up the most during the pandemic about some of the misguided approaches that were there. And yet their triangulation. And they did have background and expertise, but immediately people would place upon it. It's like, well, let me see your PhD in virology. Well, maybe that's not exactly the expertise that's needed to break down a particular category. So yes, expertise.

And let's be more open to where that expertise is and people showing their homework to show a strong argument in favor of what they're trying to present. And I think you generally agree with that as well, too. Yep. Oh, absolutely. Amen. Ben, as we wind down over here, and we're about to recap again, some of your rules and then how people can keep in touch with you. First of all, I just want to say, you know, I can't believe we've not met in person because I really look up to you, the way you break things down. I have so much respect for you. And I also look up to you as a family man, somebody who prioritize this family, who also prioritizes his career, you're an entrepreneur. So there's just a lot of affinity that I have to you and how you've built your world. So I just want to note that gratitude.

There's always that saying of, I appreciate it. You know, people don't get the roses when they get a chance to. That's what the kids are saying. Roses is giving compliments. So I just want to give you a compliment on that side and some gratitude. I appreciate it. And if you wouldn't mind, just to take us out here, can you recap your approach when it comes to a different pathway down the food and the dietary side, and then maybe even put it in a bonus aspect of something to combat the spiritual despair that a lot of people are feeling these days. Yeah, yeah. So just to revisit my four pillars, control carbohydrates. So in order to kind of correct the physical malaise, control carbohydrates. So focus on fruits and

vegetables, eat them, don't drink them, and be careful of any carbs that are coming from bags and boxes with barcodes. Prioritize protein, particularly animal source protein because you know you're going to digest it and absorb it all very, very well. And then don't fear the fat that comes with those proteins. And depending on the protein, be even a little liberal with adding some fat. And then frequently fast, once you've been able to incorporate those three rules and you're feeling good, you're learning to burn your own fat for fuel. Now incorporate some structured fasts and learn that discipline that comes from telling your body, know, I'm in charge, the part me that is not the meaty part. I'm in charge and I'm telling you what to do, body. I'm controlling

the ship. And then maybe to add to this, you know, engage in some physical activity and people always ask me, what is the best exercise? And my answer very sincerely is the one you will do. So if it is to a young healthy guy who wants to go CrossFit, hey, you do CrossFit. If it is to the old 70-year-old, seven-year-old grandma, it's just, hey, take some walks around the block, with your girl with around the block with your girlfriends you know whatever you're going to do do that'll be the best exercise and then lastly you know going from the physical to kind of the mental spiritual emotional it is make connections with people and that usually will be putting your phone down and for me and my family um it is this daily reminder to be physically affectionate with my children

easy for me to be physically affectionate with my wife i adore her i have total fidelity fidelity in my marriage, as much as she may sometimes roll her eyes. She is the singular focus of all of my manly passion, and I make sure she knows it. And I make sure my kids know it, too. I want my kids to see me loving on my wife. I think it's very important, but I also want to hug and kiss them. That even, and it's harder. It's harder as my, you know, my oldest daughter is 16 now, and she won't hold my hand anymore. Not that she's rude about it, but my 13-year-old daughter will still hold my hand. My 10-year-old son will still hold my hand, and I love every minute of it when we're walking. And so I make sure that I will give them some kind of physical affection, that I will

hug them or I will kiss them on the head or just some point of affection that they will get from me every day that I'm home, unless, you know, if I'm traveling, that's an exception. But I want these people in my life to know that I care about them. And then for me, it is also being part of my community and I'm a very religious person, very active religiously in my community. And if someone is religious, well, then that's built in. If you're not religious, I still think you need to find people with whom you share some kind of moral code. That sounds too formal. Just people with whom you share values and get together, get together, no matter what it is, can physically connect with those people in some space to,

reinforce these values, to explore the values, and to promote these values to the next generation, because that, I think, is part of what is making kids so depressed and anxious. Parents are not promoting the values that they might have benefited from when they were young. You know, and you see this a lot, as parents might have grown up in a value-based home, and they start to reject those values, but the parents still benefits because they had a foundation. And I worry about the children who aren't even being given that foundation. So all the four kind of based macronutrient rules with fasting being the fourth, be physically active, and then establish connections in a physical space with people with whom you share common values. And hopefully those common values are based on good foundational, traditional morals.

Ben, you are a legend. Thank you for coming back on. How can people keep in touch with you? You are both research scientists and author. We'll have the link for your book note, for your book below, your social media. You're also an entrepreneur. So yeah, any other places you want to send people to? Right.

Yeah, thanks. Thanks again, Drew. I always appreciate these conversations. Always very thoughtful. And I hope everyone's been able to learn some new ideas. So, yeah, I am active on social media. Generally, any of the major social media platforms, people can find me at Ben Bickman, Ph.D. And Bickman is B-I-K-M-A-N.

And it's just as you noted. I just use that to share ideas. Years ago, when I was sort of bristling at the constraints of academia, I didn't want my career to be defined by just publishing papers and peer-reviewed journals that no one would ever read. I really wanted to have that direct connection to people and sharing what I consider to be valuable ideas. And that's what that is. It's not pictures of me with my family or what I'm eating. It's just me teaching some little simple principles. And then I am entrepreneurial, helped develop a meal replacement shake, which I'm very proud of.

If people can find out more about that at gethealth, hl-thach.com, just an easy way to incorporate a low carbohydrate meal into your daily routine. And then other than that, you mentioned the book, all of these ideas, almost every idea we spoke about today, although I didn't anticipate all these questions and incorporate them into my book, but I wrote a book Why We Get Sick, which is all about insulin resistance. And if people haven't already, go get a copy. I bet you'll learn some things that you'll find. invaluable. Thank you again, sir. Super appreciate it. Hope to connect in person one day. I can't wait.

Hi everyone, Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something. that I've been working on that I'm super excited about. It's my weekly newsletter and it's called try this. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy to digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover

everything from nutrition to mindset to metabolic health, sleep, community, longevity, and so much more. If you want to get on this email list, which is by the way free and get my weekly step-by-step protocols for whole body health and optimization, click the link in the show notes that's called Try This or just go to Drew Perot.com. That's D-H-R-U-P-U-R-O-H-I-T dot com and click on the tab that says try this.