The Checkup with Doctor Mike - Debating Dr. Jason Fung On Calories & Insulin

Episode Date: February 9, 2025

Truth-Seeking moments:Fact Check 1 - 6:36 - https://youtu.be/2d7MITbdFHwFact Check 2 - 42:05 - https://youtu.be/BClwtV79UFYFact Check 3 - 45:53 - https://youtu.be/-pjhwHTFZAkFact Check 4 - 54:16 - https://youtu.be/O0-_ml1J0NwFact Check 5 - 1:22:36 - https://youtu.be/NzoUVKSDYqcFollow Dr. Jason Fung here:https://www.doctorjasonfung.com/https://www.youtube.com/channel/UCoyL4iGArWn5Hu0V_sAhK2whttps://x.com/drjasonfung?https://www.facebook.com/jason.fung.313/I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/00:00 Intro1:27 Nephrology / Controlling Blood Sugar / Diabetes19:40 Weight Loss / Intermittent Fasting34:50 Lowering Insulin40:55 Counting Calories52:33 Set Weight Theory58:29 Hormones1:02:45 Counting Calories Part 21:21:20 Is It All About Calories?1:29:18 Which Meal Should You Skip?1:40:22 Losing Weight On Vacation1:46:38 Future Research1:51:30 Artificial SweetenersHelp us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, an exclusive discord community, and many other perks for just $10 a month. Become a Resident today:https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [e-mail] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **

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Because that assumes that the calories can go in and out of the body fat, which is the storage, anytime it wants. But it can't. Right? So you think about your fridge, right? Your fridge is a store of food. So you go to the grocery store, you buy food, you store some of it in the fridge and you eat some of it. But what if there's a lock on that fridge? Today we're joined by Dr. Jason Fung, a leading nephrologist and author of the best-selling book, The Obesity Code. Dr. Fung has taken the social media world by storm, igniting passionate discussion surrounding calories and their value when it comes to weight loss. His belief is that insulin and other hormones are more impactful than calories. when it comes to weight management. Today, I wanted to directly discuss some of these hotly contested statements and find some common ground

in this highly complex and often heated nutrition space. Turns out, it's way more complicated than I thought. So for the very first time, I'm trying a new truth-seeking approach where upon a significant point of disagreement during the conversation, you will hear this sound.

And that is the signal to you that there's a footnote in the description of this video, leading to a separate short video, clearing up the controversy with sources. Get ready for a deep dive on the science of nutrition, weight loss, and reverse in chronic disease. Let's get started. Hit pause on whatever you're listening to and hit play on your next adventure. This fall get double points on every qualified stay. Life's the trip.

Make the most of it at Best Western. Visit bestwestern.com for complete terms and conditions. Dr. Fung, I'm really excited to talk with you. on a topic that very much needs more attention, the topic of obesity. As you've said in previous conversations, I mean, we've had guests talking about it. We're in a crisis state where 60, maybe now 70%, overweight or obese as a nation here, at least in the United States. I'm assuming similar figures in Canada?

A little less, but a little bit less, but also climbing. And truly a worldwide issue, right? More pandemic than epidemic at this point. I've heard your very strong interest in the topic, but you're a nephrologist, which is a kidney specialist and not necessarily the specialty that usually talks about obesity.

How did you find that to be a topic that you were so passionate about? Yeah, it sort of followed from type two diabetes. So what happened from 1977 is that obesity went up. And about 10 years later, 12 years later, what you saw is a huge, epidemic of type 2 diabetes, which is very closely related diseases. And so once you have the type two diabetes, you can develop kidney disease somewhere around 10 or 15 years into the diagnosis

of type 2 diabetes. So as you get, so 1977, you start to see this uptick in obesity by 1990. You see uptick in type 2 diabetes by 2000, 2002 when I'm getting out in practice. Now you're starting to see diabetic nephropathy like all over the place. And it's by far in a way. And it's by far in the biggest cause of kidney disease. So the two big ones really is type 2 diabetes and hypertension. So both of them are related in some way because they're very much metabolic diseases. They're related to weight and so on. And to lifestyle.

And to lifestyle, exactly. And the point was that around 2008, 2009, I realized that as a nephrologist, as a medical profession, we had been thinking about this completely the wrong way. So when people develop their type 2 diabetes, we'd give them medication such as insulin. They'd gain weight, but we didn't actually change the course of the disease. And that's in 2008, 2009, several very large trials, the Accord trial, the advanced trial, and the VADT came out.

All of it showed that if you control the sugars, the blood sugars, by giving lots of insulin, then you actually don't change the course of the organ damage. So you're not slowing down the kidney disease or heart disease or mortality in any significant way. And so I really started... Wait, are you saying by controlling sugar levels, blood sugar levels, you weren't controlling mortality and morbidity rates? Yeah. So we all learned, like I learned, so I went to school in the medical school in the 1990s. So we all thought that the sugar in the blood was what's causing all the problems.

The sugar in the blood causes glycation end products, which would... cause atherosclerosis, which would cause heart disease, kidney disease, and the whole rest of it. So the idea was we should give people lots of insulin, get their blood sugars down. And so that was the trial, a big NIH trial, multi-center, randomized control trial, three different ones, actually. And what they did was they looked at giving people lots of drugs to get their A1Cs down, which is a measure of the blood glucose. And sure enough, you could drop their A1C from about 8 to about 7, 6 and a half, something like that.

But the thing was that that's not what they're interested in. We knew we could get that blood sugar down. What we wanted to know was whether we could slow down the heart disease or the kidney disease or the total death. Turns out it wasn't effective at all. So if your sugars were quite high and you didn't treat it, it was basically the same as if you did treat it, which was a huge, huge shocking sort of thing. So this was the Accord study.

In fact, those who got the insulin and the tightly, glucose control did worse. They died at a higher rate, which was completely opposite from what we thought the result of the trial was going to be. The problem was that people didn't change their practice after that, but I thought it was actually very striking because it wasn't one trial. There's three large, randomized, multi-center randomized control trials that showed the same result. That's so weird because right now my guidance from the major organizations, the American Academy family physicians, ADA, AHA, is controlling the hemoglobin A1C or the fasting glucose to a range. Well, not necessarily solve all the problems because there's usually comorbidities happening

at the same time as you mentioned, high blood pressure, usually some lifestyle issues related to either obesity, poor sleep, all those factors. But controlling the blood sugar does yield better outcomes, even in the sense of you're preventing patients from ending up in DCA. Yeah, the acute things for DCA for sure. But no, if you had an A1C of 8% versus 6.5%, no difference in mortality whatsoever. In fact, maybe, according one of the studies, but not the other two, maybe even a higher mortality.

So in fact, a lot of the guidance prior to 2008 was a target A1C of 6.5, actually. That all changed to about 7 to 8 is considered acceptable now. It didn't make a difference. And there's a good reason why, and it's because their understanding of type 2 diabetes was fairly rudimentary. They didn't focus on the weight loss part of it. You know, this is a thing that struck me as crazy. So at the time, of course, there were not the same number of medications. We treat people with insulin.

And so what happens when you give people insulin, right? So you have a type 2 diabetic. Their A1Cs are high. You give them insulin, what happens? they all gain weight right it's just universal so patients would go out i'd give them insulin because i i followed those guidelines and they gain weight and as they gained weight their diabetes got worse right because that's what happens as their diabetes got worse you had to give them more insulin which made them gain more weight and they all knew this because they it was happening to them

and they kept saying you know what are you doing to me right like why are you giving me this insulin that's making me gain 20, 30, 40 pounds. I didn't really have a good answer. But the point was that the insulin wasn't doing anything good for them. They're actually hyper-insulinemic. We know that those people had too much insulin, yet we're treating them with more insulin, which was making actually the underlying diabetes worse because they're gaining weight, so their diabetes was getting worse, and we knew it was getting worse because we're giving more and more insulin. This is so strange because my practical experience is that if I have a patient with the hemoglobin A1C of 8 or 9, And I treat them, in most cases in type 2 diabetes, I'm not jumping to insulin unless

their hemoglobin A1C is above 10 or they're very poorly controlled. So I'm treating them with other medications. Right now, obviously, GLP1 medications are very popular. But starting even with the basics of a metformin, a sulfonyurea with all the risks that can come with that. And they do better. Their blood sugars do better. But also clinically, they're less likely to be hospitalized.

they're less likely to end up with amputations, eye issues. No, it didn't reduce. So this, remember, first it's 2008. So the GLP-1s and SGLT-2s, which I agree are actually quite good medications. Because they cause weight loss as opposed to weight gain. But the sulfonoreas caused weight gain and the insulin causes weight gain. So the idea in 2000. Metformin also causes weight loss as a side of that.

Yeah, a little bit. It's sort of weight neutral. It's not as good as GLP-1s. Of course, yeah. For sure. But metformin is the only drug at the time, right? that was really any, like it was weight neutral. At the time you had metformin, sulfono urea, and insulin, right?

So by the time you got through metformin, which was virtually everybody by the time they saw me, they were all heading into sulfono urea's and insulin, which is causing weight gain. So we all expected in 2008, and remember, this is, what, 15 years ago, right? So we all expected that we would see less, you know, microvascular disease, less macrovascular disease, less heart attacks and less deaths.

But it didn't show that. that's what it didn't show and that's why all the all the guidelines got loosened is that because they were treating with insulin because again this is before my time when I wasn't in medicine yet I started practicing medicine in 2014 um that they were treating with insulin too early like they were jumping in and treating with insulin at a hemoglobinase of eight and trying to get it to six and a half we all had the targets were six and a half at the time so absolutely we're the starting point is my curiosity because I can see if you're starting insulin too early that you may run into some issues, but, because now the guidelines are starting insulin above 10.

Yeah, but remember the targets were 6.5 at the time, right? So in, in 2008, the targets was 6.5. So you'd start with metformin, and if you were still out of seven, then next step was sulfonelioria, and then the next step was insulin, right? Because you only had those medication. When was the DPP4s and the SLG-2s? When did that... SGLD-2s didn't come out until much later, 2017, 2016, 2016, 2017. Yeah, so my sort of timeline of this is a little bit off because you may not remember this. Right, so I guess let's play a little catch-up. So now we're in the present and what is happening now in the diabetic space in the world?

So, yeah, in the diabetic space, actually those drugs are much different because the thing is that if you think about what was happening in type 2 diabetes with insulin particularly, because a lot of the patients, because there's only three drugs, right, a lot of people, wound up on insulin. So for a while, it was, you know, like five of the top ten drugs, like by revenue was insulin, right? So for a while, it was like a huge, huge seller, right? And that's where a lot of the debate got into the, with the pricing of insulin and so on. But the whole point was that the insulin wasn't making people better. It was making them gain weight, but it wasn't, and it was getting their A1C's down. It was getting their blood sugars down. But the question was, where is all that sugar going? Nobody really thought about that. It's like, okay, well, you're giving insulin, their blood sugars, eight or nine, or nine,

you know, their A1C's or eight or nine or ten, what's happening to all that sugar? Right? And it's like, well, if you just think about it, you know what's happening to the sugar. It's all turning into fat because that's what insulin does. It tells you to store that sugar, goes through the liver, becomes through de novo lipogenesis creates fat. That's what insulin's supposed to do, right? So if you're giving people insulin, you're telling them that they should be gaining more

fat. So you're turning that glucose into fat, and that's why all my patients were gaining weight. But the weight gain was the problem, which was causing that type 2 diabetes, right? So we're treating the symptom of the high blood sugar as the disease. So would you say in that situation that those patients were over-consuming calories, perhaps carbohydrates, and as a result, getting insulin simultaneously, thereby storing it, gaining more weight, you're saying instead of been focusing on insulin, we should have and focusing on their dietary changes. Absolutely.

And that's where we are now, right? So the most recent... Yeah, with my education, for sure, it's... So the most recent ADA guidelines was weight is actually a huge part of management strategy, right? But this is 20... I don't know when they came out, 2023. Sure. Something like that.

But back then it wasn't. Nobody cared about it. Weight was not even in the ADA. So anyway, to finish off how I got interested in it, so the, what happened was I realized that we're coming at this all wrong. if type 2 diabetes is primarily a dietary lifestyle disease and all we're doing is giving medications you're never going to make it better in fact what you need to do is get these people to lose weight when they lose weight then their diabetes gets better everybody knew that right and the the crazy

part i called this one of the ADA's biggest lies of course they've changed it since then was that type 2 diabetes was a chronic and progressive disease. So, you know, the criteria for remission didn't come in until 2023. So last year, up until 20203, if you looked on the website, the ADA said it's a chronic and progressive disease. But it was a complete lie because everybody knew. Nurses knew, I knew, patients knew, if you lost weight, that type 2 diabetes would either get much better

or go away completely. everybody knew it well the disease itself in terms of the sugar regulation could be managed maybe put in remission i guess it's like a issue of vocabulary yeah but the risks that were created by becoming a quote unquote type two diabetic of having a higher risk of ascvd of kidney issues of peripheral neuropathy those risks stayed elevated is that fair to say Then compared to a person who's never had an abnormal A1C? It's still elevate because they still have some insulin resistance. But, you know, if you have somebody, say you have somebody who's A1C of 8, 20 pounds over,

and compared to an A1C of 6 and 20 pounds less, like I think their risk is much different, right? And the point was that at the time, we weren't focused on getting the sugars down through dietary control. And neither were we focused on getting that weight down either. Nobody cared. We were plying them with so much insulin that they couldn't lose weight, right? And I saw it day and day out because I have, because I'm a kidney specialist, I see. You would see the worst cases. Yeah, I see the worst cases.

And almost my whole practice is like, because it's that, it's that for sure. Because it's just, you know, it's much more common than polycystic kidney disease. Yeah, I think where, again, I came in six, seven years into medicine after that, uh, seeing bariatric surgery cases where we saw the biggest cases of remission after a drastic, 40% of body weight being lost where everyone hesitated to use the term cured. Right. But we saw drastic improvements where now it could be managed with just dietary control as opposed to getting medications on board.

And perhaps we still recommended some preventive medications, managing blood pressure more thoroughly by getting an ACE inhibitor on board, managing cholesterol a little bit more aggressively because we considered them higher risk by getting a statin on board. But in general, I think bariatric surgery provided us a really good window into seeing how drastic weight loss can impact diabetes. And at the same time, we had all these studies of bariatric surgery, which basically proved that it was a reversible condition, right? Because it's defined by that A1C greater than 6.5 on no medications, right? That's how you define type 2 diabetes. So when you change their diet, and this was a very drastic measure, of course, right?

But that diabetes came down, like within a month, like within weeks. Those sugars came right down. That's what all the studies showed. So if it's reversible, why would you tell people it's irreversible, right? It's all due to the diet. Well, I think they were talking about the risk. The risk of what? The risk of...

That the risk stays elevated. That you can't really reverse the risk. I think that's the thought process. Okay, but the diabetes itself is reversed. I would say it's controllable, but the risk is always ever present. Well, according to current, like this is 20, since 2023, it's considered in remission, right? That's the term. Yeah, yeah, yeah.

And also, like, why pre-diabetic range is so interesting, it's the range that is considered the time where you can reverse it and completely stop the progression into type 2 diabetes. But it can be reversed in that you can go from diabetes into diabetes in remission to pre-diabetes and beyond. because these are all defined, right, by the A1C. And honestly, these will change as time goes on as we get more data. But the point being that up until 2023, nobody ever said that this was a reversible disease.

It could not be reversed, which was crazy because it's like, yes, I can get that A1C down from eight down to five and a half, bariatric surgery prove that, right? And not over a short period of time, like really fast, right? Those bariatric surgery trials, if you remember that before they lost a significant amount of weight, their A1Cs came down to normal. It was like two weeks, right? Three weeks. And the sugars were completely normalized, right?

So it's long before the rest of that weight loss took place. There was something happening there that, you know, and from 2010, 2012, when all these bariatric surgeries came out, that's 12 years before the American Diabetes Association said, It's reversible because it's really important to tell people that it's a reversible disease. Because if you tell people it's an irreversible disease, they'll be like, okay, I give it. Yeah, it's demotivating to hear that. Yeah, I think it's like in science, we get very caught up in the nuance of vocabulary. Yeah. And we sometimes put too much emphasis on it because in a condition, whether it's reversible, remission, curable.

At the end of the day, what's the practical implication? We don't want to demotivate patients, so keep them as motivated as possible. and say there are factors that are under your control that are valuable, which at the same time you want to be careful because it's easy to get into a victim-blaming situation where it's this diabetes is your fault and that could also be demotivating. So there's a range and barometer. Yeah, but you know, to me it's like you got to tell people the truth. Okay, flights on air Canada.

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patients, look, this is a reversible disease. So just to finish, so what happened was I started to realize that weight loss was really important, which of course everybody agrees on. That's actually in the standards of care for, for, in the latest sort of 2024 American Diabetes Association guidelines. Weight loss is actually quite critical. But I realized that weight loss is really important and that's where I became super, super, super interested in weight loss because if you could get people to lose weight, then you could reverse their type true diabetes, which means they never got diabetic kidney disease because they don't have diabetes, right? Or you'd reduce the risk at the very minimum. So then I started talking to people about a couple of things. One is lowering

their carbohydrates, right? And again, it's not a new thing. Like cutting carbohydrates has been around a long time. And if you look at the American Diabetes Association, nutrition guidelines, the scientific guidelines, they say there's actually the most data. That low carb diet has the most data of any diet for control of blood sugars. And that makes sense, right? Because if you eat white bread, you know that the blood sugar goes up. If you eat an egg, you know the blood sugar doesn't go up. So eat less of the white bread and eat more of the egg. That's sort of logical, right? And then I started talking to them about intermittent fasting. So this is in 2010 2011. And at the time, again, you have to remember that everybody thought it was the dumbest thing

they had ever heard. Intermittent fasting, not eating, was known to kill people, right? There was so much bias against that. And I said, well, let me look at the data here. What's so bad about it, really? What happens to your body when you fast? And it's like, well, if you're diabetic, if you're overweight, if your blood glucose is high, nothing bad happens. Remember that your body has the ability to store calories. It stores calories, which is a form of food energy in the form of glucose, right? You can store glycogen, which is chains of glucose, and you can store body fat. When you don't eat, your body is going to start burning the glucose or start burning the body fat. And you have too much of both. Therefore, if you fast, that's all that's going to happen. And it's a completely

natural process. It happens in everybody. You know, back in cave mandates, people were fasting all the time, whether it's voluntarily or involuntarily. It's the very reason you have body fat. It's not there for looks. It's there for you to use when you don't eat. And as a doctor, I had been prescribing fasting to patients. Pre-op you have to fast. Colonoscopy, you have to fast. Post-op you have to fast. Treatment of pancreatitis you have to fast. For fasting, blood glucose, you have to fast. So it's like, okay, if I'm telling people they should fast for all these reasons, then why can't they do it from a therapeutic standpoint? It doesn't make any sense, right? So I told them, you should fast, and I started them on a fasting regimen, and crazy. It was crazy. What regimen did you choose?

I used a 24-hour fast three times a week for my patients, and that was just because, you know, at least you're eating once a day, and they could take their medications if they had pills and stuff. it wasn't too much and it wasn't too little for like i wanted to go gently got it um and so i had this one patient which i wrote and wrote up as a case report uh i had been treating him for like 10 years he was on 120 units of insulin and he was very dedicated wrote down everything wanted to know everything so i told him you should try this right and keep track within a month he came off all his insulin all of his blood pressure all of his blood sugar pills and as A1C went down to like 5.9.

I'm like, holy crap, in a month. And then I had three of these cases in the first six months. I had three cases just like that. And I thought to myself, holy crap, I've actually been doing all my patients a huge disservice. I've been treating them for the last eight, nine, 10 years as a type 2 diabetic that had it for the rest of their life and they would inevitably go on to nephroposis.

when that type 2 diabetes was completely reversible. You got to recognize that we call it diabetic nephropathy. It's like if you don't have diabetes, then you're going to have less chance of getting the diabetic nephropathy. It happens, but it's unusual. So it's like, okay, that's crazy, all because I didn't focus on the right thing. And that's where I started really to think about both weight loss

and fasting as a therapeutic tool. So the summary of it would be that you started seeing this uptick, as a result of the huge spike in people gaining weight, being overweight, obese, then developing diabetes, then developing kidney disease, and instead of just treating the condition, you started thinking more preventively. How can we get ahead of this?

And the dietary aspect, the weight loss aspect, is probably the most efficacious way of doing it, which we see now and we're talking about more so these days. Why did you choose fasting specifically as your approach to helping people lose weight as opposed to the low carbohydrate diet, caloric restriction, keto, you know, there's all sorts of avenues

by which people try and use it. I mean, it's just another tool. You don't have to fast to lose weight. You can lose weight actually a lot of different ways. You can use low fat, you can use low carb, you can use carnivore, you can use vegan. They actually all work, right? There's a lot of stuff that works.

but it was something that people had always done. So the funny part about fasting is that there's so many advantages from a weight loss standpoint. So if you do caloric restriction, most people have zero idea how many calories they're eating in a day. It's actually very difficult because if you buy broccoli or steak, you have no idea how many calories are in that piece of steak or whatever. If you fry it up with, you know, butter or without butter, you know, what's sauce? you put on it, you know, all these change how many calories you take. So it's a complete guess how many calories you're eating and a complete guess how many calories you're burning.

And the amount of calories you're burning actually fluctuates because some people try and measure it, you know, oh, I'm burning 2,000 a day. Well, that actually can go up or down by like 40%. It can go up and down a lot. So you have no idea how many calories you're eating. You have no idea how many calories you're burning. How are you supposed to actually use that as a therapeutic strategy? as opposed to simply saying you should not eat for 16 hours of the day or 24 hours of the day

oh well it's very easy to figure that out if you only eat once in a day then that's it you're following the rules right so as a as a therapeutic strategy it's much much more effective so there's a huge number practical aspect practically yeah it was something that people had never done like at the time i started using it 2013 2014 like zero people thought it was a good idea, right? I mean, it seems strange now because it came very popular. But I published the Complete Guide to Fasting and the Obesity Code in 2016, so I started using it around 2012, 2013. And there was nobody who thought it was a good idea, even up until about 2020 or so people were still really against fasting. So, but the idea. Why do you think people were against

fasting? I think it's because it was not something that they had heard of before. So then people just thought oh well if i haven't heard of it it's got to be a bad idea right you mean the general public academics doctors the general public was much more accepting than academics and doctors they were they are the slowest to and you believe that academics and doctors never heard a fasting before this they never recommended it or when they talked about it it was in a like you shouldn't do it sort of an idea what was their concern um i don't know that they had legitimate concerns their concern was that if you didn't eat, then you would binge eat afterwards, which can be a concern. But on the other hand, if it is a problem, like it can happen.

Sure. But everything has its problems. If you restrict certain foods, you don't eat sweets, which is a good idea. You might binge, right? If you don't eat chips, you might binge when you get out. Like, that's the college 15, right? So there's a risk with all of that. But the whole point is that if you think about intermittent fasting as a strategy for weight loss,

it's simple right so everybody can everybody understands it right it's uh it's free so it's not like i'm telling you to go to whole foods and buy like all organic you know grass fed this and that right that's going to be so expensive but that's not accessible this is free uh it's convenient right you're not putting more time right you're not like oh i need to do this and this and home make all my meals it's like you're not eating so you're taking less time than before you're taking less money. It's, you know, and it's, you can change it up. Like, you don't have to always do it. You can do it more this week. And then next week, if it's, if it's Thanksgiving or if it's Christmas or whatever, you can decide not to do it and then do more the week after, right? So a huge number of advantages,

but the main thing is that if you look back, people have been doing it for thousands and thousands of years. Like, I didn't make it up. I mean, you can find references, lots of references, in virtually every single major religion, which means that even back, you know, 2,000 plus years ago, people had talked about fasting as something which is very healthy for you, right? It wasn't, you know, when they talk about fasting,

you know, my priest used to talk about it every Easter, right, around Lent. And he talked about fasting and purification and praying and all this sort of stuff. And I remember thinking of the time, I don't think anybody found. We're all told not to fast. You're the only one who ever talks about it.

But, you know, clearly it's in that tradition. And you can find it in Buddhism. You can find it in Hinduism. You can find it in, you know, Islam. You can find it in every religion. And it's not ever in a negative connotation. It's not like I'm fast, you're fasting because it's punishment for you. Right?

It's like, oh, you need to fast. To make yourself better. Yeah, it's always a choice. And that's the important thing, because I always get this thing. Oh, it's starvation. No. Fasting is the voluntary abstinence of food. You could eat, but you choose not to eat.

For whatever reason. It could be religious. It could be weight loss. It could be whatever. But the point is that if you fast, if there's something wrong with fasting, wouldn't we have figured this out like 2,000 years ago? I mean, I hate to harp on extremes. I'm just going to point out the devil's at it.

advocate of it, is that there's a group of people who believe that it can fuel an eating disorder where they say, starting to think in this way of withholding food can create perhaps an unhealthy relationship. I don't think that's the general case for most people. And I also think it's unfair to take away a strategy from a great sum of people because there are people who can be harmed by it. Because just the topic of talking about weight loss can be unhealthy for one individual who perhaps has disordered eating versus there's still value in talking about weight loss for those who are morbidly obese or obese, what have you. I think it's a legitimate point because it's like saying that, you know, it's a tool, right?

Fasting is a tool just like everything. Low carb is a tool, low carb is a tool, low calories is a tool. Everything's a tool. Which means that it has the ability to hurt you and it has the ability to help you. You have to know how to use it. It's like a knife, right? it can kill somebody or if it's a scalpel wielded by a surgeon it can cure somebody right it's the same knife doesn't you don't ever say ooh knife bad well must not use knife

it's like okay maybe hammers a better analogy for that one yeah but you know what i mean right so fasting yes there are definitely problems that's why you need to know about it and know how to use it and fasting does not mean 40 days and 40 nights right it can be any length of time You think of the very word, breakfast. Breakfast. It's the meal that breaks your fast. If you don't fast, you cannot ever break your fast. So therefore, even from the beginnings, the origins of the English language, we acknowledge

that there's a period of time that you should be feeding, and that's when you're going to store calories, right? Insulin goes up, and we know the physiology has been so well worked out. You eat, and assuming you're eating a variety of foods, your insulin's going to go up, you're going to store calories because you eat, say, 1,000 calories at dinner. Of course, you're not going to burn it off right away. Exactly. You can't burn it off.

So you need to store some of it. Why? Because you don't want to die in your sleep. So you store it. Then when you fast, when you're not eating after dinner, right? 12, 14 hours, your insulin's going to go down. Now you're going to pull those calories back out. So you fast from, say, dinner, say it's 7 p.m. to 7 a.m.

That's a 12-hour fasting period. Then you break your fast. Or if you don't eat breakfast until 10 o'clock. right? You sleep in. It's 10 o'clock. You're talking 13 hours. And people did that every single day without calling it a fast. Then all of a sudden in 2019, 2020, it's like, oh my God, you shouldn't be going more than six hours without stuffing your face, even to lose weight. It's so interesting. I never came across, because I also talked about intermittent fasting at some point when we started the YouTube channel. I never got feedback that intermittent fasting was terrible. The only feedback that I got,

which I think is very accurate, I'm curious if you agree, that the reason why, intermittent fasting works is that it's another way of lowering calories consumed because you're eating in a smaller time window yeah so i think i think there's some truth to that but the whole the whole calories thing is is a whole other debate i have with people so one is that it is a way that you're going to eat fewer calories because it's actually harder if you compress the time that you're eating and there's lots of studies to back this up it's it's harder right you're If you take three meals. And harder to absorb.

Yeah, exactly. So a lot of it's going to pass through. But if you compress the time you eat, it's harder because you get full. Of course. Right? So you can't eat three meals at one meal. It's very difficult. Less snacking.

Less snacking. So the compressing it does make you eat fewer calories. But I think there's actually another benefit to it, which is the hormonal benefit, which is what I talk about a lot because it's like, to me, the idea that it's all about calories is highly destructive because it leads, I think, in one sense, to this sort of blame game, blaming the victim where it's like it's all calories and calories out and therefore it's all your fault if you're, if you're, you know, overweight, you should eat less or you should exercise more. That whole idea is, you know, this whole idea of fat shaming and all that

stuff. I think it's a little bit, a little bit destructive because I don't think that it comes down all to calories. I think that it also depends on the hormones, primarily insulin, right? You need to lower insulin in order to lose weight. How do you lower insulin, though? There's lots of ways. Taking in less calories? Less calories will definitely do it. But the point is that there's a, so there's an overlap between calories and insulin, but certain foods raise insulin more than other foods, right? So if you eat a cookie, like 100 calories of a cookie, your insulin, is going to go way up. If you eat an egg, it's not going to go way up because it's mostly proteins and fats. So the idea that you can take two 100 calorie portions, so 100 calories

of cookies, 100 calories of egg or broccoli or something like that, and the people who say it's all about calories will say they're equally fattening because they're both 100 calories. And like, there's no way they're equally fattening, right? Because they're different. This one will spike your insulin. Your glucose will go up. The cookies, your insulin. You're insulin will go up, your glucose will go up, what does the insulin do? Well, we know what insulin does. It tells your body to please store those calories as either sugar or fat, because that's the way it is.

So you take 100 calories of cookies, insulin goes up, you store those 100 calories directly into glucose or body fat. Well, there's nothing left for your body to use, so you're still hungry, so you go out and eat. If you eat an egg, well, the insulin doesn't really go up, so it's a lot. It's still circulating around. You've still got a hundred calories. But the insulin does go up.

With eggs? Yeah. Not really a lot. So protein. Well, yeah, it'll spike less. A lot less. And there's also the thermic cost of breaking down the proteins, which will decrease the amount of calories absorbed.

Therefore, lower the insulin spike. Yeah. Yeah. The thermic effect of food is relatively small. Yeah. But clearly, those two foods have very different insulin profiles, right? We can measure. You can do a glycemic index, right?

Yeah. Easy as pie. them's very high. You eat white bread, glycemic index of 95. You eat an egg, glycemic index, zero. So insulin, which follows fairly closely for that, is going to be the same. There is going to be some insulin rise with protein, but protein tends to raise both insulin and glucagon. But either case, a lot less insulin than white bread or cookies or something. So to pretend that that change in insulin makes no difference to people, why would we do that, right? I'm not asking if the two are equal calories we're setting the two as equal calories but the two the minute

you put them in your mouth your body is going to respond very differently in terms of the insulin but i think the people who talk about calories in and calories out i mean i'm one of those people i don't think we equate each calorie being identical i think we just kind of zoom out and look at it more practically and holistically and say if you look at the studies that have changed the amount of carbohydrates one group consumed in literally in human trials and metabolic wards and said if you feed less carbohydrates to one group of people more proteins and fats to another group or swapped it the other way around you see the same weight loss depending on the amount of caloric intake they have the one difference that i could see that happens is from an insulin standpoint is

perhaps behavioral change because there could be a craving effect that happens that can create a person wanting to eat more often or snack more often or consume less healthy choices. But to say that the fact that a certain calorie, depending on which macronutrient it comes from, will impact the amount of weight loss hasn't really been borne out by evidence. Well, there's also no trials that have shown that if you reduce calories without affecting anything else, that you can actually lose weight in the long term. So all of those studies, like women's health initiative, you know, like DPP. They're all like, you know, a kilo of weight loss over like six, seven years.

Well, the failures in a lot of these studies is that keeping weight offs with diet and exercise is very hard. And the reasons for that, I don't think most people would say is because of insulin. You see, you know, I have a different opinion. See, again, I think if you, there is a difference in terms of eating behavior, and you alluded to this, right? So if you eat two slices of white bread and jam, so all refined carbohydrates for breakfast. And, you know, there was a study in pediatrics. Dr. David Ludwig did this.

He had people taking instant oatmeal, actually, which is a high, high glycemic index, and steel cut oatmeal meals, which is a medium glycemic index. So he gave these to any, you know, the. the two groups would switch afterwards. So it's not the people. He gave them the same calories, same carbohydrates, in fact the same food, even oatmeal, just differently processed so that they actually have different glycemic index.

The glycemic index or the high glycemic index, the insinodes, was like double that of the steel cut oats. Then he tested them and said, how much do you eat at the lunch afterwards? They ate like 30, 40% more. Right. So the point is that you don't eat because of, a certain, you're trying to fulfill a certain caloric quota or whatever.

So it does come down to the calories you eat. But what determines how many calories you eat? It's how hungry you are, right? So if you're eating certain foods that are going to leave you hungry, then you're going to eat more. And that's the whole point. If you're eating these high insulin foods like refined carbohydrates, a lot of that's going to just get sucked into storage,

which is going to leave you wanting more. So when you're talking about eating behavior, you're going to wind up naturally eating more calories. yes you can artificially try to you know keep all the calories the same that's what they do in these metabolic warts but that's not real life right it's like i used to tell people like for decades you know oh you got to count your calories and all this it doesn't didn't help with like barely a single person like and i look at these studies like the women's health initiative where they had like 300 calories less per day for like seven years and the difference between the usual diet and the calorie low fat calorie restricted diet, you know, 300 calories per day for a year should equate to about 30 pounds less. Well, that's not true because as they lose weight, they will have a lower caloric requirement. True, but the actual weight difference at the end of seven years was like a quarter of a pound, right?

Usual diet between, and these people are followed, right? They're not just like, you know, people are measuring, what are you eating and trying to calculate how many calories are you. they reduced 371 calories per day every day for seven years and by the end of that they weighed a quarter of a pound so somebody who followed their usual diet might weigh 200 pounds a person who who followed this calorie of sugar diet weighed 190 and it was it 300 calories less than they were originally eating or what both groups actually dropped so if you look at and that's probably just an effective time as they got older both groups actually ate less so but the difference between the two groups actually eat less so but the difference between the two groups actually groups in the Women's Health Initiative, and that was published in JAMA and I think 2007. But either way, it's like, it's sort of, I guess to simplify the question is if you take someone who should be consuming, let's say 2,000 calories, if they cut out 300 calories, no matter what insulinogenic food or on the opposite and a low glycemic index food that they eat, they will

lose weight. Agreed? 300 calories per day? They didn't, though. Compared to the usual diet group. I'm not saying in that study. I'm saying if you calculate for a group of individuals what they're supposed to consume

to keep their base metabolic weight or their base weight, let's say it's 2,000 calories and you cut it down to 1,700, that group of people will lose weight or you disagree with that. No, because all the studies show you lose weight for about six months and then that weight always comes back up, right?

Well, behaviorally. Yeah, I mean, it all depends on the study. something's happening. No, metabolically, something does happen. When you lose weight, the metabolic rate goes down, right? So the weight loss slows. Sure, the metabolic rate goes down five to 15 percent and usually is tied to how much weight also people are losing. So it's a pretty small factor. No, actually the, so there's been multiple studies on this. So even in 1991, they did a big meta-analysis on this. They did 29 studies and they looked at it and they took all the studies about 10 to 20% reduction in calories. So, you know, 300 calories a day sort of thing. And then

when they looked at the metabolic rate, the reduction was about 10 to 20%. So if you're eating 10 to 20 20% less calories, but burning 10 to 20% less calories in response to that, well, you're not going to lose weight, right? You're eating 20% less and burning 20% less. Right. That's what makes it hard, but it doesn't mean that's a window you can't overcome. Because there's at some point where you, like if I cut down to a thousand calories, my body's not going to cut down to a thousand calories. People, because people have come to me and they've done the studies and stuff they wanted to. I have people who are like at 800 calories a day. They're barely burning any energy. And that's why they don't understand. I'm eating 1,200 calories. It's like your

metabolic rate. But energy wise, how do you gain weight or not lose weight when you're under consuming that many calories? Because the amount of calories out is not just your basal metabolic rate. That's important hugely, but it's also your neat, your exercise, the thermogenic effect of food. There's so many variables there that are not being accounted for besides the metabolic rate. Yeah, but if you look at the metabolic rate, so Rudy Libel did that study where he sort of adjusted people, gave him a diet, made them gain weight and looked at their metabolic rate, it went up. And then when he made them lose weight, their metabolic rate went down. So it's clearly in response.

So that metabolic rate, if you don't look at anything other than calories, what happens, and virtually every study has shown this, that as you start to lose weight, your metabolic rate starts to come down almost in lockstep, right? Even those biggest loser studies. Well, the biggest loser studies, even at the most, they had someone's basal metabolic rate in extreme form where they were on extreme starvation-esque diets, extreme exercise. I think the highest that they had someone come down was 499 calories.

And that's the most extreme case in the biggest loser study. In the metabolic? Yeah. So like to see... Well, because if you factor in how many other things cause caloric burn throughout the day,

the numbers are quite small. Even when we say like if you overeat, the body can regulate by burning more calories, like if you have a bigger meal, that's a pretty small margin. Because while the human body does try and self-regulate. It does a way better job at self-regulating by storing than it does by burning. Do you agree with that? I think that the human body has to self-regulate the amount of

body fat, because if you think about it, like the average person will gain about a pound a year, right? That's the average weight gain of an American and European. It's about a pound a year, right? So that's 3,500 calories. Most people are eating around 3,000 calories a day. So your accuracy rate of this is the whole population, most of who are not counting their calories and most of whom caloric variation is huge throughout day to day, right, is like 99.8% or something like that to consume 365 days of 3,000 calories and then at the end of the year only be off by 3,500 to have gained that one pound, you know, with Christmas and, you know, Thanksgiving, all in between means that your body has to be regulating how much body fat you have.

That's why it's so difficult, right? Because if you try to now artificially turn that to lower your weight, your body's going to resist it by making you more hungry or reducing your metabolic rate. And the question is not then how do you adjust your calories, but how do you adjust that so that the body sort of adjusts your body fat to the correct state? You're saying that we overeat so many calories, but only put on a certain amount of weight? Well, the average American gains a pound a year,

which is 3,500 calories, roughly. A pound of fat is about 3,500 calories, right? So that means the average American or European has matched their caloric intake to their caloric expenditure to a sort of 99.8 or 9% accuracy rate without counting their calories or knowing how many calories they're burning.

I mean, a big part of that is because, again, as they gain weight, their basal metabolic rate goes up because they have more weight that they need to maintain. And as you store fat, you're also storing more lean muscle tissue so that you are burning more calories by being heavier, which is a concern of why, if everyone gets on GLP1 medications, are we going to find a hugely sarcopenic population? because they were overweight and having decent amount of muscle because they were overweight, but then once they lose the body fat, that they actually get exposed for not having enough muscle. So I think that is probably the higher likelihood of why people don't gain as much weight as they do per year, despite the caloric intake. I think, you know, to me it's about both the calories, but also about the insulin,

not just insulin, but the sort of hormonal effects of the foods that we, because to me, I see food is containing two things, right? It contains the energy, which is the calories, and it contains certain information. So you eat a food, your body reacts to it by producing hormones, which then translate what you're telling your body. So if you produce, you eat a food, and you produce a lot of insulin, your body is going to respond differently than if you eat like, you know, lean chicken breast, so you eat cookies, for example.

Your insulin is going to spike way up. You eat chicken breast, same calories. Your insulin is not going to spike up, but your GLP1 will spike up because the protein actually tends to raise GLP1. Or you eat a really high fiber, you know, lentils or something like that, right? All that fiber gets into your colon, which produces, you know, short chain fatty acids, which stimulates GLP1. So you eat all that fiber, you got stretch receptors, you got GLP1s, you're going to be full. So those two are very different to me. So all I'm saying is that you have to account for the,

hormonal effects of the food, which means that some foods are more fattening than other foods, right? Which to me doesn't seem like a huge leap, but, you know, that's, that's, that's really all I'm saying. Like, you have to consider more than just the calories because the foods affect the hormones, the insolins, the gLP ones, the stretch receptors in her stomach, the peptide Y, Y, all of those things. For sure. Yeah, I think the idea that certain macronutrients of food play a role in behavior and how the body behaves, I don't think is disagreed upon by people in the nutrition space. I think it's widely, in fact, celebrated to incorporate lean cuts of protein, that the villainization of fat was kind of a really big mistake that we made because

there's actually very healthy fats that can contribute to a healthy metabolic profile that can contribute to weight loss, that can contribute to satiety, and that refined carbohydrates is probably the main reason why our American standard diet is so terrible. We frequently, especially on podcasts, get into the situation of nitpicking a specific chemical, saying, oh, high fructose corn syrup, that's the thing. If we only replace it with cane sugar, we'll fix all our problems. No, we're not. Yeah, that's not much of a difference. Yeah, exactly. In those situations, I think we're getting more into the headlines as opposed to the practical implications. So I don't think most people would disagree on that.

Well, I hope so, because to me, I think both things are very important, right? So 100 calories of lean protein is different than 100 calories of refined carbohydrates. Like, to me, that's just obvious. But I don't know, a lot of people come, like, they come at me and they go, the calories, a calories, it's all calories. It's like, it's all the insulin fairy. It's like, no, because it has a physiologic role. That's all I'm saying, right?

I think everyone, I think it's just a situation. of talking about, again, the nomenclature, the words of it all. Because if you really look at it, if you, and again, I think you'll agree with this. For me, it's very obvious if I consume 4,000 calories, I'll gain weight. If I eat 4,000 calories of Oreos or 4,000 calories of beef, I'm gaining weight. And I think like that's the starting point we have to agree on before we move on. Yes, we'll agree on that. It's varying degrees.

But they've done those studies, right? And the thing is that you will gain weight, yes. But then when you stop the study, what happens is that your weight just goes right back down, right? And they did these studies. What do you mean going to go through? So Ethan Sims did these studies in the 1960s and another researcher. You're saying it's not lasting weight gain if I get it through protein? Yeah.

So Ethan Sims, so Ethan Sims in the 1960s. I mean, we're going way back. So this is very interesting because he was trying to get mice to gain weight. And he couldn't do it. The mice would eat a certain amount and stop. And they wouldn't go and become obese. So he thought, okay, well, this is very strange. So they got college students.

So he went to Vermont College. And he got college students and said, I'm going to do a study. You're going to come. You're going to eat and you're going to gain weight. Right? That's all I want you to do. They're like, no problem. Right?

I'll just eat. Right. They couldn't do it. They couldn't eat too much and gain weight. they couldn't gain weight. So he said, okay, well, maybe because they're exercising more or something. So then he went to the prison. This is before they had like ethical re-reports.

You could never do this now. So he got these prisoners and he basically forced them to eat and restricted their exercise. And it turns out that he did eventually get them to gain about some weight, 10, 25 percent, 10 to 25 percent. But they had to eat like 8 to 10,000 calories to do that. Their bodies were fighting it every step of the way. So he got them to gain the weight. Like it's a lot harder than people thought. He was actually stunned.

And then at the end of the study, he said, okay, fine, you're done. Just eat whatever you want. Their weight actually fell right back down within like two months. They went back down to their normal weight with no, they weren't trying to lose weight. They just stopped eating. So there's natural mechanisms to do that, right? So it will gain in the short term. But what happens in the long term in those studies?

What's your takeaway from that research? I think it's that your body has a natural set weight, which is sort of determined, and you can artificially push it up, but your body will eventually lower it down. So we know that, for example... Eventually based on what timeline or... So in those studies, it was like two months. So we know a lot of... I mean, if that's the case, why are we just exponentially going up with our obesity?

Yeah, it's a good question, right? Because I think that what happened is that in those situations where they artificially made them gain weight. So those people, their fat cells expanded, right? They gain weight. They're eating with 8 to 10,000 calories. Their fat cells then produce leptin. Leptin causes anorexia. They stopped eating. So then they lost all that weight. So there's hormones that will push your body weight upwards, like insulin. You give somebody insulin, they gain weight. And there's hormones that will push it back down. So leptin did in that case. Obesity mostly is a leptin resistance state, but GLP-1 also pushes it down. So I think the point is that the changes in the

diet, in the American diet from like 1977, where it started to spike up to, you know, today, there's been such a change in the diet that has gradually been pushing it up. And a lot of it, I think, has to do with the processing of foods, which tends to make foods like a lot, like it sort of hijacks the brain, right? So if you eat natural foods, it's very hard to overeat those foods. Why? Because we have natural satiety hormones, because it all comes down to hormones. So you eat, for example, beef or steak or chicken.

You eat that. Well, can you keep eating it until you explode? No, there are restaurants that will give you a free steak if you do that, right? No, they're not giving away a lot of free steak. Why? Because the peptide YY goes up, the colostocytin goes up, and the satiety, the GLP-1 goes up, these satiety hormones are so powerful that they basically stop you from eating so just like if you eat a pork chop at a big buffet then you're so stuffed and somebody says here have this pork

chop you're like oh i'm going to throw up right it's the same pork chop but the difference is that your hormones are you know on full satiety the difference with with ultra processed foods is that you're taking away all those satiety signals you change them into ultra refined carbohydrates so there's no protein, there's no fat. So there's no peptide y-y-y-y, there's no cholocystokinin. If you eat a bulky meal, like lentils or something or beans, well, your stomach fills up, right? And your stomach stretch receptors, and through the vagus nerves tells you stop eating, just like if you have a Bezoar or something, right?

You have to stop eating. So big volume, high fiber foods are going to do that. Other foods like the JLP ones, they're going to slow down your gastric emptying rate. we know that so you eat lots of protein gastric emptying rate is going to slow down fiber it gets fermented in the gut goes becomes short chain fatty acids glp1 goes up slows down the movement of the gut right so if you're slowing down the gastric emptying rate stomach stays full longer you know you're activating those stretch receptors so natural foods is very hard to overeat because you have protective mechanisms against that exact thing because you have to, you know,

people always say, okay, body, you know, body fat, we're designed to store fat and now that calories are easy, we must gain fat. No, that's absolutely not true because no wild animal becomes obese. Why? Because if you're fat, you can't catch food and you can't run away from predators. You're going to die if you've got too much body fat. So body fat is regulated. Eating behavior is Well, I mean, it's hard to relate us to other species because if you're hunting for your food and you're obese and you can't run to catch your meal, you're no longer going to be fat. I'm here for Bet Rivers Online Casino and Sportsbook with poker icon Phil Helmuth. Thanks to Bet Rivers, I'm also a slots icon. Great.

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Is every fabulous item I see from winners? Like that woman over there with the designer jeans. Are those from winners? Ooh, are those beautiful gold earrings? Did she pay full price? Or that leather tote? Or that cashmere sweater? Or those knee-high boots?

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But the point I want to point out with this whole situation, because I think I agree with you in totality when it comes to the hyper-processing of food with how non-satiating it is, and really those are hormonal issues, the non-satiating, the fact that it causes you to overeat the cravings of it all. These are all hormonal issues.

But the issue that I feel like we're not talking about when we're discussing that is how those hormones, either, as you mentioned, with leptin resistance, become resistant, dysfunctional, which then throws our mechanism by which you described in that prison experiment completely off. Because the reason, in my expert opinion, why the prisoners were able to lose the weight is because they didn't yet develop a sort of resistance to those hunger hormones, because there's a short-term weight loss, a weight gain and weight loss.

But when you have a population like we are that is already obese by the majority, you're overweight and obese by the majority, you're getting into a situation where, A, you're having resistance of those hormones. So I think it's almost less valuable to focus on the hormones. And second, when you're at a point of obesity,

even once you lose weight, the fact that the presence of those fat cells we're there at one point, creates an easier environment to refill those fat cells and therefore regain the weight. Yeah, I think that's true. I mean, obviously it's better not to be in this situation we're at now. But that's what I mean.

It's like it all comes down to the hormonal effects, which is why it's important, because if you eat foods that are hormonally, you know, not the insulin spikes, lots of, you know, satiety hormones, then you're not going to overeat. So it's not about the calories per se. It's what's driving the calories to go above.

Like, you know, people say body fat equals calories in minus calories out. That's always true. That's not what I'm debating. I'm saying that it's the difference in hormones that's driving the calories in above the calories out. Which is a behavior. Which is a behavior. So you're saying calories in, calories out plus behavior? Well, the behavior is what drives the calories and calories out, right?

Right. So if you eat ultra-processed foods, you're not. getting any satiety signaling you're getting a huge insulin spike so therefore you are going to wind up eating more calories so you can't just say eat fewer calories is the solution any more than you can tell somebody you're a heroin addict take less heroin like that's not helpful right let me deal with the addiction because that's your problem the heroin addiction let me give you counseling let me do this you can't just say well do people just say that uh i don't know a lot of people say that to me Because whenever I talk about, I keep, because I always think about the hormones, I always think

about how they're important and how you can change the hormones, right? And fasting is really a way to change the hormones. You're dropping insulin in the sort of fastest, most direct way. If you eat nothing, because you can't go less than zero, fasting goes to, you know, drop your insulin. But there's tons of people who come back to me. It's all about calories, it's only about calories. I'm like, okay, well, you can do whatever you want. If you're trying to create a modifiable factor for someone, in the same way that you talk about time-restricted eating or intermittent fasting as being a practical solution for people, because it's simple, for some people, calories is much more simple to think about and actionable than it is

to think about your insulin. It's way easier to say, I'm going to get into a caloric deficit and decrease the amount of calories I'm consuming, weigh myself, average it over seven days, see how my body weight is behaving. And if it's not enough, lower it some more, perhaps increase my energy, expenditure, than it is to think about all these hormonal processes, which are much harder to control in some ways. Oh, I never tell patients all this. What I tell them, because the insulin to me is, I like to think about this stuff, right? I like to think about what's happening, what the hormones are, but patients don't need to know any of that.

What I tell them is you should... I mean, who do you think is listening to the podcast? There are a lot of people who are actually very interested in. I will say that. But, you know, when I'm just telling people what to do, I don't say count your calories anymore than I say count your insulin, right? Both are horribly, you know, not practical, right? What I do say is that...

Why do you think counting calories... I guess you mentioned that it's not super accurate and hard? It's inaccurate. it clearly it's like all the so you can get only a calorie count on processed foods any food like you buy a head of lettuce no it doesn't come with a calorie count right so you you have to guess yes you can weigh it but that's not sort of most people don't weigh all their food how you cook it is going to be important so now you're going to have to not only count how much broccoli you have you have to count how much butter you're putting in but isn't that a valuable educational like

I never really recommend calorie counting per se for most people because long term at least. Because I think long term it can be overwhelming in something that most people probably won't stick to. But I think for a period of two weeks, four weeks to get a sense of usually when I order a fistful of chicken or a fistful of steak, when I get it from the butcher shop, this is how much calories it has on average. And that's a valuable education point, at least that I've seen with my patients who are empowered to make that change and not every patient will be yeah i mean i think it could work i think it could work but i i actually tell them to eat natural foods right so whole foods try not to eat anything out of a box or anything and only eat at certain times that you designate

right so stop with all the uh you know snacking you can have this and i think this is one of the things that really uh makes it difficult is this idea that you can eat whenever you can eat whenever you feel like, right? Never skip a meal. You have, you know, mid-morning snacks, you have after-school snacks, you have bedtime snacks, and you can eat any time you want. I'm like, no, no, no. What you want to do is eat natural foods, to the best of your abilities, eat until you're full, and only eat at those times. Any other time, don't eat. So if you're hungry in the middle of the night, you don't eat, because that's not what we used to do in the 70s. It's a simple rule. Once you establish the eating structure, then people can follow it, right?

Rather than saying, I need to get to 2,000 calories. This is what, I don't know, but this is how a lot of people see it. I have 2,000 calories for today, right? I'm going to take a little here, and then I'm going to live here. And I can eat whenever I want, and I can eat whatever I want, as long as I get to the 2,000 calories. It's like, well, that's not all that. Like, it's not an intuitive way to eat, as opposed to saying you eat.

You eat lunch, you eat dinner, you don't eat snacks, you don't eat after dinner, and you're only eating at a table real food, right? Because people eat foods. They don't eat calories, right? That calories is sort of that extra step. So while I don't doubt that counting calories could work, it's this sort of artificial structure. And sometimes it's not good because if you eat, you know, and I've seen this, I read this in a book actually by some doctor. You could eat ice cream for dinner instead of steak because they're the same calories. It's the same thing.

I'm thinking, it's nothing the same thing. Like, how can you think they're the same thing? Eating ice cream and steak is different. I don't know what, maybe they were making a point of like the fact that calorically it's the same thing. Chlorically, they were the same and they were making the point that they're exactly. But like, health implication-wise, they're not exactly same. Exactly. That's what I think.

It drives me crazy because it's like, yes, they're the same calories. I agree with you on that. but the health implications are vastly different. You have to think about what happens next. If you eat ice cream, clearly you're not going to be as full as if you ate a thousand calories of steak. A thousand calories of ice cream does not fill you up. Therefore, you're going to go out and eat more because you're hungry, right? That's just what's going to happen.

So is it come down to calories? It does in the end, but it comes down to the behavior. You said that eating those thousand calories of ice cream was the same as eating the thousand calories of steak. But it wasn't. Now you're fighting hunger all night because he ate ice cream for dinner, right? And to me, it's like that's not helping people. You have to help people by saying you need to eat good food. Like two foods can be the same calories but have different effects on the overall eating behavior,

therefore on the overall fattening experience. Now, if you artificially in a lab, say you eat 1,000 calories of ice cream, you eat 1,000 calories of steak, and then I'm going to track your weight. Yes, they'll be the same. But that's not how real life works, right? And I'm only interested in real life because my patients live real life. I think what ends up happening by people who may disagree with you is I don't think they're disagreeing with you on that message. I think the people who are disagreeing also agree that ultra-processed foods are the problem, the fact that they're non-satiating.

We are drastically under-consuming fiber as a country. We're not eating enough whole foods. I think they'll all agree with the sentiment behind that. I just think that they are more purist in their description of storage, of calories, of insulin behavior. And when they're more pure in that regard, when you say insulin is fattening and it is what is driving the driving factor in weight gain, it's not exactly true if we're holding it to the verbatim definition.

because if I take someone who's consuming a thousand calories only and I give them extra insulin, that person's not going to be gaining weight. Well, let me give you a different situation because, you know, people always say energy or body fat equals calories and minus calories out, right? And that's always true. But that's not the way it always works, right? Because that assumes that the calories can go in and out of the body fat, which is the storage, anytime it wants.

but it can't, right? So you think about your fridge, right? Your fridge is a store of food. So you go to the grocery store, you buy food, you store some of it in the fridge and you eat some of it, right? So if you have extra food

that you bought, you put it in the fridge. Right. If you didn't eat, if you didn't buy so much, you'd take it out of the fridge, right? But what if there's a lock on that fridge so that sometimes you can put the food in? Is the fridge like fat stores?

Yeah, the fat stores. So sometimes the fat stores, you can only put the calories ends in the storage. And sometimes you can only take them out of storage, right? That changes everything. So let's take the situation, you know, 2,000 calories in, 2,000 calories out, so you're even, right?

Body fat doesn't go up or down. Now you want to lose weight, so you cut it down to 1,500 calories, right? So 1,500 calories going in, 2,000 coming out. What happens to body fat? Well, what if you eat very high insulin foods? You're eating refined carbohydrates all day long, insulin's up. And you're fighting those cravings. Yeah, exactly.

You're able to. Exactly. So insulin's up. Well, what happens? Well, you cannot take energy out of those fat stores because insulin, it's a storage hormone. But insulin spikes and then drops down two to three hours later. So you will be able to access it. No, but if you're eating every two or three hours, which is what a lot of people used to say, right?

Eat eight times a day. I mean, I don't think I've ever said that or my institution ever thought that. I think it's probably from more like five, six years ago. People used to say that a lot. A lot of dietitians used to say, eat, you know, every two hours, eat something. Keep those metabolic fires stoked. I don't know if you've ever heard that, but I heard that a lot. But say you keep insulin high, right?

So this is just a thought experiment. So $1,500. And high is also kind of a weird statement because eating any food that has some sort of caloric intake will create a spike in insulin. High, I mean, a beef steak will spike your insulin pretty high. Yeah, a steak can, although it also spikes glucagon, so therefore glucose doesn't go up. But I'm saying the insulin spike is pretty high.

It can be, yeah. So, like, I guess it depends how much you're eating every those two hours. Yeah, yeah. But, I mean, as I said, it's just a thought experiment, right? So suppose that you keep it high, like, by whatever, right? say you're just taking crackers. But I just don't know how you're keeping it high at a 1,500 calorie diet every 2, 3 hours.

That seems like impossible. I don't think so because certain foods spike it really high, right? The refined carbohydrates, right? So every 2 hours, you're eating like a slice of toast or a crackers or something like that. That's a lot. That's going to be more than 1,500 calories. Like the math doesn't add up in that dog experiment.

So you're saying that if you eat 1,500 calories, your insulin has to go low. Yeah, lower than if you were eating the 2000, which... Oh, yeah, yeah, yeah. If you're eating the same foods at 1,500, it's going to be lower than 2,000... Which means you're either eating less of the food or less often. Yeah. So then you'll have less insulin spike, whether you're measuring the amplitude of the spike

or the frequency of the spikes. Yeah, I mean, if you look at, like, there's a huge difference. So in that David Ludwig studies, he compared an omelet to... the instant oats, same calories. The spike is like, you know, four times higher with the instant oats. The high glycemic index, like you can get way higher spikes. It's not like a little bit higher, right? So even if you cut your calories but change your diet so that you're eating all high glycemic

index refined carbs, you can keep your insulin pretty high, right? And you're saying you won't lose weight. Well, if your insulin stays high and you can get this also by injecting people with insulin or if they have a lot of insulin resistance, right? And this is where it comes down to if you have a lot of the insulin resistance and the hyperinsulinemia that goes along with it, then it's actually really hard to lose weight. Sure, of course. So say you have the insulin resistance then. Insulin levels are high. Well, what does insulin do? Well, insulin inhibits lipolisis. It also inhibits glycogenalysis. So that's well known. That's sort of first-year medical

student physiology. It means that when insulin is high, you're telling your body you want to store you know calories right you don't want to pull them out and you don't you can't do both at the same time so if you're taking 1500 calories coming in 2000 going that you want to burn but insulin is high for whatever reason you can't get any of those calories out of your fat stores so their only way to balance the equation is for your calories out to drop to 1500 we just talked about that study with the biggest loser where in the most extreme starvation diet with the most extreme energy expenditure, they were cutting it by 500. And in this situation, we're dropping it that aggressively, the basal metabolic rate?

I'm not sure that, like, I don't know about the biggest loser study. Like some of the ones that I saw were actually down almost 1,000 calories. But if you look at the- I've never seen 1,000. That's so aggressive. So the old... The basal metabolic rate, you've seen the studies drop by a thousand? In one of it.

That was in the New York Times, they had this graph of that guy. They profiled. Anyway, his dropped, I think, from 3,800 to 2,900 or something like that. It was quite a bit. His basal metabolic rate was 3,800? Or his total expenditure? Total energy expenditure. Well, is that...

Not the basal metabolic, total energy expenditure. Which is not just the basal metabolic rate. basal metabolic rate. So that's energy that he fidgets, energy moving around. So are you saying in that situation where they're cutting from 2,000 calories and they're eating only 1,500, their entire out will drop to 1,500 through behavior change as well? Well, in this thought experiment, if you can't get any of your calories out of your body fat, that's the only response that you have, right? If you're eating 1500 and well once you clear your storage of sugars in your body from your liver from your muscle you will start breaking down fat yeah yeah but you you're not going to because if your insulin is

high say you have high insulin resistance and insulin levels just very high you can't get that you can't get the glycogen it makes it there's a dysregulation of it for sure but you still can otherwise people would die in those scenarios if you can't get any Energy. Yeah, yeah, yeah. As long as you're, and this is why I recommend fasting a lot, because it's trying to drop it as much as you can to overcome that insulin resistance, right? Well, during fasting, you're going to drop the insulin levels as low as you can, right? Because you're not taking anything, right? Because there are the things protein can stimulate. But then your insulin spike will be higher because you're going to be consuming higher caloric load when you do eat. Yeah, but then over the 24 hours, that's the comparison, right? What's your insulin over that 24 hours? So is your theory or, I guess, hypothesis that if you have less insulin spikes in general, that is a healthier state than if you had more insulin spikes, irrespective of calories? Yeah, I think it's the total insulin effect.

I mean, to me, it's like, you know, if you give somebody insulin, they gain weight. And it doesn't matter so much how much, you know, willpower they have or anything. It just always happens. So therefore, to me, it's a causal factor. Well, it doesn't always happen. If they're not eating enough calories, it's not enough energy to store. No, they've actually done the study. So they did this study and it actually, that's not true because they did this study.

This was about 10 years ago where they actually gave people insulin. So type 2 diabetics, they gave them, they went from, it's a six-month study. They went from zero units of insulin to 100 units of insulin. And the idea was that you should give people lots of insulin to get their, blood sugars down. So they reduced their calories. So they went from zero to 100 units of insulin over six months. And when they measured the calories that they were taking in, the calories went down,

about 250 calories. This was from Henry. Controlled? This was... Meaning the calories were controlled? They weren't controlled because there's a six-month study. So people were just self-reporting how much they're consuming? Yeah, because of, yeah, they told them not to eat so much, you know, for all this and stuff.

So they gave them general guidance. general guidance, right, to maintain your weight. But your insulin went from zero to 100 units a day. And your calories went down from about, I think, is around 2000 to like 1,800 or something like that, right? So the question is which one is more important, right? If the insulin is more important, they'll gain weight. If the calories are more important, they're going to lose weight, right?

Well, that's not, they're not equivalent in that scenario. They're not. A hundred units is a lot, for sure. It's like cutting someone's calories by 1,000 and saying, look how much better it is But the question is, if it's all about the calories, they're eating 200 calories less per day. Well, I don't know what they were consuming before then to get started in that study. Yeah, I mean, they don't report that in the study because, of course, they only counted the calories.

I'm just curious, like, in the metabolic wards of these scenarios, where they're eating foods that are potentially hyper-insulemic, that they produce more insulin with the foods that they're eating, in a metabolic ward, they gain or lose the same amount of weight, strictly depending on calories. Yeah, yeah. How do you take that randomized control data from meta-analysis and say that insulin is more important where we have people that have high insulin with their high-carbohydra diet versus a low-carbohydra diet?

And if the calories are maintained, the weight doesn't change. How do you make sense of that in your mind? Well, you know, I think that, well, I mean, the behavior component. Yeah, the behavior component, I think, is actually very important. That's where the metabolic studies don't really give us insight into that, for sure. But that's not what you're saying when you're saying that insulin is more important than calories. Well, in this study, for example, they all, on average, but that's not a randomized controlled study. Oh, no, no, it's just, it's not a randomized controlled trial.

But, uh, and over, and you can't do it over six months because over six months, you will lose weight. Like every, every weight loss study has shown over six months you're going to lose a lot of weight. Then you're going to regain that one year by two years, by five years. going to be virtually the same. And that's why it's hard, because if you do a randomized control trial, and there were a few on low-carb diets, remember the shy study, and there's a few other ones that showed some mild, minor differences. To me, there's clearly something more than just the calorie story.

Like, in the end, I don't think we disagree as much as it comes out to, because we're sort of arguing around the periphery. Like, everybody sort of agrees that, yeah, don't eat cookies. eat chicken, right? As I said, the ultra-processed foods are the issue. The satiety of it all the behavior of it. Exactly. This satiety and all that, those sort of things. In the end,

it probably doesn't make as much difference as we say. It's more about the mechanism of how it works because I think the hormones, the hormonal impact of the foods that we eat does play a role. Whether it's insulin or GLP-1s or peptide Y or colostocycine or gastric stretch receptors Or one we haven't named yet. Exactly.

Because fiber, for example, fiber has no nutrients. So why is it important? Mechanical. Exactly. It plays a role. Barrow receptors. Barrow receptors and, you know, we know. Slowness of gastric emptying, absorption.

Same thing with, you can do the same thing with, I can't remember what they did, glucomanin or something like that. It forms like this, this gel inside the stomach. And then it slows down the gastric emptying, which makes. made a difference, right? And various, there's lots of studies. But in the end, it's not necessarily just the calories, right? That's all I'm saying.

It's not just the calories. There's other factors, whether it's stretch, volume, right? These volumetric diets. Yeah, and I think no one argues that. I don't, I think that the people who have disagreed with you won't argue any of those points. Because I'm trying to just take their standpoint on this and also mine as a family of a doctor.

And I don't think that there's much disagreement here on a practical level. On a practical level, I don't think so. Although I have heard a lot of people tell me that it's all about calories. Calories is everything, right? And maybe you don't see that much anymore. You could see as a purist, you could see why they're saying it. Because if you see that in a metabolic ward, whether you're consuming carbs, proteins, fats, ultimately, if you control the calories, you control the weight.

And that's been proven over so many randomized controlled studies. But then you have to go into the real world. You know, like I have the studies that show me how well condoms work in terms of contraception. And then I have real world numbers, which, they're lower, still effective, but lower because people don't use them right or they say they use them and they lied, what have you. So there's the real world implications. So I think like calories in calories out in the research, clinical world, metabolic world, that's key. That's what works. And then you have the real world and it gets a little bit more muddled than nuanced.

Yeah, but I think, I agree with that, although I'm not 100% sold that it makes no difference. because if you give somebody 100 units of insulin and reduce their calories by 200, they'll still gain weight. Well, because the numbers are not the same. Right, there's way more insulin and take off so few calories. Yeah, but if it's all about calories, if it's only about calories, they should lose weight,

but it's not, right? Because clearly that huge dose, and I agree with you, that's a huge dose, right? That huge dose of insulin has told their bodies to slow down their metabolic rate, enough so that that 1,800 calories they're going to gain weight, right? That's the only way it can work. And also, like, the idea why I think it's so valuable to talk about the calories in calories out is that, A, there's an educational component to it. You can learn a little bit more about the foods

that you're eating and how difficult it is from an energy expenditure standpoint to burn off those foods because some people are like, oh, I'll eat a Snickers bar and I'll go for a walk. It's like, do you know how long you have to walk to burn off a Snickers bar? And it's a good education point. But like the example that you're creating of 100 units of insulin or lowering by 200 calories, one is very doable, lowering by 200 calories. Giving 100 units of insulin is not just impractical. It's not really going to happen in the majority of cases. So that's why like, I don't know what to do with that information. Nor is it comparable. Oh, yeah. And the magnitude is different, but there's plenty of people. I mean, I guess I hear a lot of critics who are like, no,

insulin doesn't make any difference at all. I'm like, yes, it does, because it has an effect on the body, just like GLP-1s have an effect. Just like all those other hormones, fiber has an effect. I think all of those things are important and shouldn't be, like, I think, you know, as I said, I think it's just, we're just sort of around the peripheries of it. In the end, it's still about eating, eating the right things. But where I also- Eating less. Eating less, yeah, yeah. That's what time-restricted eating ultimately It's also about eating less of the right foods, right? Of course, of course.

And that's where... You can eat toilet paper and lose weight. That's not what's recommended for us. Yeah, exactly. And it's like you're going to eat less junk food. You don't want to eat less broccoli. It's the same way that people say eating vegans healthier and then they eat impossible burgers, which are junk food in the vegan sense.

Yeah, exactly. And I guess it's sort of, because I hear a lot of this, it's all about the calories. It doesn't matter what the food is, as long as the calories are the same. Right. I hear that a lot. If you're going to be strict with it and treat yourself like you're in a metabolic ward, that's true. Yeah. And even then, it's only in the short term because I think that what happens if you eat, you know, less calories, but all ultra-processed stuff, I think it makes a difference.

I don't, I think you're going to gain weight, actually. Yeah, I think on a practical level, because you're going to not be full, you're going to reach for cravings. All those things are absolute. And then there's the whole world that is unexplored. of the microbiome and what impacts the ultra-processed foods have on that and how that impacts your cravings because we've seen initial ideas of how those cravings can be impacted by the signaling of that microbiome and how those change. We don't understand it yet and people are peddling a little bit too much of supplements in this space from my taste. I don't like that.

This is actually a really important topic. You know, you have food addictions, food cravings, emotional eating and I think that sometimes that gets lost in the oh it's only about calories and this goes beyond the hormones too right it's it's not just about the insulin it's about why are we eating right because that's the point if you say we're eating too much because it's more than calories out right that's why we're gaining weight then why is it that you're eating it could be good you're hungry but it could be something completely different course you could be craving it you could be addicted to it. And if you are, you know, and I think this happened a lot during COVID, if you're a little bit dystimic or depressed and that Snickers bar makes you feel better

because the sugar sets off dopamine. Sure. You're going to eat that Snickers. You were never hungry. Yeah. It was the for sure. Mental health plays a role in this. And the stress plays a role and the sleep plays a role. And that's where I'm always like, no, it's not all about calories. It's what's drive. What's behind the calories, right? I think you're probably getting into these semantics arguments with people who are really focused in on the mechanisms at play, more so on the practical implications. Because I think you largely agree. So I'm glad that actually we're having this conversation of bringing it to light.

Because like what ends up happening is if you go on a podcast with a non-medical individual, like Diary of a CEO. Yeah. And they clickbait the title and the intro. it doesn't do you any favors in the medical community because it then looks like you're saying something inaccurate. Yeah, yeah. And people will always do that, I suppose, because it's, you know, I won't.

I promise I won't. It's not what this is about. This is about bringing the conversation to show how much we agree as opposed to that there's disagreed. And it's, you know, I always think of the calories as sort of the proximate cause. That is, it's not that calories in is greater than calories. I'm not denying that calories in is greater than calories out.

I'm interested in why the calories in is greater than the calories out. Is it because the foods that you eat are not setting off the right signals? Then to me, you've got to eat the foods with the right signals, whether it's JLP 1 or insulin or whatever. Is the reason your calories in is greater than calories out because you're addicted? Then you need to deal with the addiction. Is it because you're stressed? Then you need to, is it because you're not sleeping? Is it because you're working night shift?

Is it because you have cravings? Is it because you're depressed? Then deal with the depression. Don't just say eat fewer calories, which is sometimes, I guess maybe I see these clickbait things. It's all about calories, right? And it's like, no, no, no. It was about depression.

It was about addiction. Of course. Cravings that caused the calories in to be greater than the calories out, which led to the weight gain. So to get back to the actually treating the person, deal with the food addiction. Yeah, the food drive of it all. Exactly, because we eat for different reasons.

And some of it is habit, because if you're... Or cultural or socioeconomic or all these factors. Exactly, because if you are in the habit of eating six, seven, eight times a day, you're going to want to. If you think it's normal to have cookies in the middle of the day and the board meeting, then you're going to. But you didn't need to. You never need it to.

But yes, it's going to make your calories in greater than your calories out. But what was the problem? The problem was the, you know, the environment that made it normal for you to do that. But definitely not the insulin. Well, it plays a role. Sure. Of course. No one's arguing that.

I'm 100% on board with you on that. Summer's here, and you can now get almost anything you need for your sunny days delivered with Uber Eats. What do we mean by almost? Well, you can't get a well-groom lawn delivered, but you can get a chicken parmesan delivered. A cabana, that's a no, but a banana, that's a yes. A nice tan, sorry, nope, but a box fan, happily yes. A day of sunshine, no. A box of fine wines?

Yes, Uber Eats can definitely get you that. Get almost, almost anything delivered with Uber Eats. Order now. Alcohol and select markets, product availability may vary by Regency app for details. The world that I think that you've kind of found yourself in and why perhaps there's people arguing against you is you're in the world of this extremist diet tribe world, A. B, nutrition research has been so flawed. C, the podcast where you've appeared, they've kind of taken statements of yours out of context. Perhaps some of your metaphors

were well-intentioned and worked very well for patients on a practical level, but then mechanical mechanol- mechanistically did not hold up for those individuals, so they were upset by them. And it doesn't help when like a diary CEO editor takes and says you founded intermittent fasting or you were the inventor yeah i never say that yeah i i'll say that actually yeah but i always say but that's what i'm saying you see how now because when i do these podcasts and why i started this is not just to get to the truth of the research how we're talking about it but also get down to people's point of views yeah so that they're accurately represented as opposed to doing some kind of gotcha sequence where it's like oh look you see he misspoke and now we got him and we got to

10 million you clip out. That's not the goal. Yeah. And I feel like that's done tremendous harm. There was one point that you made. I forgot where it was about timing of intermittent fasting that you believe it's better if you were to skip a meal, skipping dinner is favorable to skipping breakfast. I was curious why you thought that was the case. I think that it's, it's, um, there's some data that says that if you look at the insulin effect of the food, it's actually different depending on what time of the day you take it. So if you eat the same food at 8 a.m. versus 8 p.m., same food, same portions, everything,

you actually get much more insulin effect of it due to the circadian rhythm. So you know in the circadian rhythm, you get this, you know, before around 5 a.m., you get the spike of cortisol, growth hormone, and so on, which is actually going to antagonize the effect of the insulin. So maybe when you do that, you get less of an insulin effect in the morning. Maybe that's it, but you get more of an effect. Also some insulin sensitivity because of fasting overnight. Yeah, it could be, certainly. But there's that. There's, you can look at natural circadian rhythms in terms of hunger. So if you look at, take a bunch of people, just say, how hungry are you and just aggregate the data? People are hungriest at 8 p.m. and least hungry at 8 a.m. So if you're going to

skip a meal, breakfast versus dinner, if you skip breakfast, that's a time when you're least hungry, so it's easiest, but you weren't going to eat that much anyway because you're not as hungry, right, as opposed to skipping dinner, which is generally a larger meal. Then for the amount that you skip, you're getting, you know, more insulin effect that dinner, so you're better off skipping that one if you're going to lose insulin. And if you're eating early, you still have a chance to sort of burn it all off. So you were looking at it from like the practical standpoint of when you're hungry. Yeah. Yeah. Because people ask me should I skip breakfast or dinner. So so really I think it's like so individual. Yeah. There's already so many variables that you can't control. Yeah. Exactly. And and and what I say is

that skipping dinner probably physiologically is better for you because you're going to get like dinner tends to be bigger right than than breakfast. So if you skip dinner, you're going to skip more. Right. But practically it's not easy to skip dinner all the time because that's the most social of all your meals right right that's when you go out that's when you have your kids that's when you have your family dinner so skipping dinner socially you pay a huge price if you do that all the time and if you're not going to if you make it hard to fast you're not going to do it whereas skipping breakfast is actually dead easy yeah because most people don't care yeah and and i did that for years not because i wanted to lose weight or anything just because I was in medical school I was tired I wanted to sleep so I just had coffee

boom that's it and then I went through to whenever like I'd go and honestly the funny part about fasting is that you know is so you know people are so against it but then in 2015 2014 right I don't know not now not now although there was some research showing some potential heart effects of fasting negatively but I think again a lot of this is overblown and over yeah yeah Why can't I say mechanistic? Mechanistic. Jesus. But, you know, it's funny because the doctor's raw.

I say, oh, yeah, I used to do that all the time. It's to skip, you know, go days without eating, right? Because I was just too busy. And then I wanted to sleep, right? And it's like, it's funny. But, yeah, I mean, if, you know, depending on where, but it is very individual. Because if you're going to do skip dinner and it's going to really take a toll on your social life, then no, you might be better off skipping.

Because it's really what you can stick with the most. that's going to give you the biggest thing. It's what habits, you know, and that's another thing we never talk about. Like, people don't talk about this enough, but the habits are so important because the habits you put down are what drives your behavior day after day without thinking about it, right? So you look at the habits like brushing your teeth. You don't have to think about it. You just do it because it's a habit, right? So if your habit is only eating two meals a day, then it's not hard for you. So, for example, I don't eat. breakfast most of the time. And as I said, I started in medical school. But it got into a habit,

so I almost never eat breakfast. I mean, I do sometimes. But now if I eat breakfast, because I'm going out for breakfast or whatever, I wind up not eating lunch because I can't because I'm too full, right? So is it difficult for me to only have those two meals a? No, not at all. So I'm not using willpower. And, you know, willpower is like a finite resource. So I'm at a huge advantage compared to somebody who's now habituated to eating six times a day, right? Because you go to school, it's, you know, breakfast, mid-morning snack, lunch, mid-afternoon, snack, dinner. I mean, you could eat six times a day and be totally healthy. Oh, certainly.

Certainly, you can. And I'm not saying that you can't. It's just that, you know, from a habit standpoint, I'm actually just way ahead because, you know, there's just less to, yeah. Less decisions you make. Less decisions to make. It's easier. and I'm not using my store of willpower to skip those meals. Yeah, I think this is where the calories and calories in folks would come in and say,

you know, intermittent fasting doesn't solve everything because while on the whole, if you look at people decreasing their eating window, they will eat less calories. You could still overconsume calories in an eight-hour window and not lose weight. So just fasting alone doesn't solve the problem. For sure, for sure. And I remember that one of the first few studies in 2018 that came out, these studies were terrible because what they did was they had somebody fast, his alternate daily fasting, they'd have somebody fast for one day and then eat 125% the next day because they wanted

to match the calories, right? I'm like, why the hell would you tell somebody to eat extra the next day? That's not the point of intermittent fasting. The point of intermittent fasting, so say you eat three meals a day, right, breakfast, lunch, dinner, then you skip breakfast or dinner, whatever. What you want to do is, so you say you take 500 calories breakfast, 500 calories lunch, 1,000 calories dinner. What you're trying to do is you skip breakfast and your body is going to take the 500 calories that you would have eaten at breakfast out of your fat stores. Then you eat 500 calories at lunch and 1,000 at dinner. That's what you want to happen. If you eat, you know, skip it and take 1,000 calories at lunch and 1,000 calories at dinner,

well, you might get a bit of benefit. But it's going to be kind of small, right? And those first few studies. And there are some people that fall into that pattern. Some people actually do well with that. Like, I don't doubt it. No, meaning some people fall into the pattern of binging. Oh, yeah, yeah.

And eating way too much in their small window and then actually gaining weight. So like, again, just like there is no miracle formula, it needs to be really individualized and thought about. The reason I just brought up the timing issue is I came across some pretty good randomized controlled studies from a meta-analysis that looked at time-restricted eating, removing the breakfast component or the dinner component. And from a cardiometabolic marker standpoint, they didn't see much of a difference in which one they changed. So I think it needs to be individualized for the person, socially, culturally, based on what they eat.

Absolutely. I think it really. Although I do see a lot more studies now where they're doing this early TRE. So there's a couple of studies that came out recently that looked at early TRE, which was stopping at 2 p.m., right? So it's like that's early, right? Because they shifted everything up early. They didn't compare it to the late TRE,

but they just used it as their baseline, right? Because I think they thought, the researchers thought that was going to be the most effective, so it showed the biggest difference, which I agree, sort of, but again, you have to weigh, you know, you can't take it out of the context of life, life. Yeah, of course.

Exactly, because it's just like anything else. If you impose such a difficult regimen on people, they'll stop doing it. And that's why most fail. I think so, because I think that you have to understand that we eat not just for sustenance, we eat for pleasure. Sure. And if you just say, oh, it's all calories, it's all this, it's all that, you take that entire,

you know, pleasure, addiction, cravings out of the, you're not going to be successful because you're actually only dealing with like 30% of the actual problem, which is that, you know, which is that people eat for all different reasons, right? And you have to eat also. You have to eat, yeah. So that's the big difference between someone with an alcohol addiction. When I have someone come into my practice who is abusing alcohol, my goal is to get them off alcohol.

Yeah. But if someone's over-consuming food, I'm not getting them off food. Yeah, but you can say, for example, no sugar. But I never do because it's like, one, it's really hard. And two, it's almost too much to be. Yeah, it's unreasonable. 100% sugar-free, right? You can do that for alcohol and heroin and stuff.

And you can do it for sugar too, but is it- It doesn't solve the problem. Yeah, like if you're taking so much pleasure out of food, are they going to sort of rebound later? Well, because there's foods that have sugar that can be very healthy for you, that you'd be missing out on their micronutrients on. So that's why I think harping on one variable like that is not enough.

Yeah, it's not enough. And I think, I think for sure you have to take a little bit more of a sort of, yeah, holistic view. So it's not, it's not just about calories and it's not just about hormones and it's not just about social behavior. It's not just about habits. But it's all of those things, right? It's about the pleasure you derive from it. It's about the social norms because, again, if you look at Americans versus like Europeans or something. there's like a massive difference in obesity rates between Americans and Italians, for example.

But Italians, you know, they're eating their pasta, right? They famously love their food and stuff, but their whole relationship with food is quite different. You don't see them eating in their cars. You don't see them snacking all the time. Like there's a huge amount of differences, right? They get together as a family to eat and they're eating relatively. whole foods, right? So not a lot of ultra-processed foods. I mean, I had a friend who went to

Italy just recently, so I thought I'd gain five pounds. I actually lost a couple pounds. It's like, also people like to increase energy expenditure on vacation, walking around. Yeah, the walking is a huge thing. Like you see it in New York City too. And the stress levels drastically drop. So drive for food potentially can drop. Because I talked about in the obesity code, I talked about cortisol too, because you look at cortisol. And cortisol has nothing to do with calories, right? It's a hormone. And if you, give somebody prednisone, they gain weight. So if you weigh over-stimulate cortisol like prednisone, that's artificial, but you gain weight. But you can extrapolate, like if you are

under a lot of stress. So I know a lot of people who think they gain weight. If you don't get enough sleep, do you gain weight? Probably. I would think so, right? And maybe it has nothing to do with your diet, but it has to do with, you know. Well, ultimately it does. Ultimately, it does. It starts with a behavior thing, it ends up being a dietary. Because does that stress then lead you to eat this food, which is going to lead your calories in to be greater than your calories out? Yes, it has to in the end. Exactly. But which I think we're all on the same page now.

And I'm glad we're all kind of in this nutrition community now fighting the good fight of prevention as opposed to just treatment. We need treatment. Because I think that this is sort of what's the root cause and then the calories is sort of that sort of intermediate step, leads you to the weight gain. Sure. So focusing on that intermediate step's not useful, you've got to get to the root cause of things. It can be. I don't want to limit that because it can be for some.

Oh, for some. And it's a good educational component from an understanding. Yeah, yeah. But it's like, okay, if you're- Because I have had patients that come in and say, oh, doctor, my calories don't matter. As long as I'm eating healthy foods, I can eat a ton of them and be good. And I don't want that message to land for them. Yeah, I don't know that that's 100% true.

Like, what's 100%? percent true that you can just eat whatever like as much yeah exactly but that's how that mess because like the thing that i think what makes the channel the youtube channel successful is that i feel like i have a good grasp on how people understand the messages that we're sending out yeah and that message where like calories in calories out don't matter it's the insulin component lands for a lot of people in as long as i eat healthy foods i can eat it unlimited yeah and i don't want them to get that message because i don't think that's what you yeah no it's not because it's if you eat healthy foods but then you have to stop right when you're supposed to stop right so those healthy foods are

supposed to tell you at some point right you should stop eating now if you eat past that point where those hormones have said you should stop eating now well yeah you're going to gain weight or if you eat those healthy foods but then eat another snack you know in between when you should have gone right through to lunch or right through till dinner but you stick in you know all these healthy snacks right granola bars and stuff right well no you're not supposed to do that because you're not hungry so you're not supposed to eat right the hormones are supposed to tell us what to do right and they're pretty good most of the time unless they develop that resistance and disorder eating yeah yeah so i think it's it's it is so many of us are in now yeah it is it is far more nuanced

then yeah, I can eat whatever I want as much as I want as long as it's healthy and unprocessed. There is a stopping point that you're supposed to listen to. Which is the calories and calories out sort of motto. Yeah, exactly.

Because those natural foods are supposed to signal you. The issue is that you don't have to. So it's 70% of a population that's overweight or obese, those signals are not as strong as they once were. The signals are all messed up. That's, I think, the real issue.

The signals, and to me, the signals are all hormonal because that's, to me, you know, the body runs on hormones. So those hormonal signals are all messed up. Why, I think there's a lot of reasons. Of course, yeah. But I think that that's where it's much more. And I think to improve the hormonal picture, if we think about calories in, calories out, we can, which could be done through intermittent fasting. Yeah. We could actually get the hormonal influences in a better place.

Yeah, yeah. And I think that's where intermittent fasting to me was a very useful. thing to be talking about because yes it's calories as well as hormones you're moving them in the right direction they always move in the right direction whereas you can move you know just like that insulin and calories thing when your calories go down your insulin's supposed to go down like you know there's a correlation between the two sure when you have your calories going down by your insulin going up that's not good right you want both moving in the right direction right and that's where some of the, you know, sometimes it's just useful to think about what other hormone

influences you can affect, right? How can you affect? Well, that's the future drug targeting yeah, exactly. Yeah, yeah, exactly. The gLP one's obviously very topical, GIP, but there are natural ways you can actually augment them. Certain foods are very GLP one. Exactly. Certain foods do stimulate that. So how can you use that knowledge because you know that the GLP ones are are actually effective, like to help you make a behavioral change or a food drive change like Dr. Mike Isretel talks about. Exactly. So if you know that, say, protein is going to stimulate a lot of gLP one, which it does. And so does fiber. You can say, well, I want to eat more whole fiber foods. Sure. Which to me is like, yes, you should. Well, now that we're in the same

diet camp, yeah, yeah, nutritional camp and everyone else, where is going to be your future area of interest in research. Now that sort of intermittent fasting is a totally viable model that people talk about that weight loss is an important factor of the diabetes model. Where do you go next? What's your next

line of thought for inquisition? Well, I think that so it sort of fell along the lines of, so weight loss being much more than just calories. There's a whole hormonal component than intermittent fasting was the second, third was two diabetes being a reversible disease.

which is just now sort of being mainstreamed, you know, accepted that it is a reversible disease and all that sort of stuff. I think the next thing, and then I wrote another book actually called The Cancer Code, which was actually I thought really the most fascinating stuff that I had written. It's about the evolutionary paradigm of cancer.

It's like how cancer develops. It had nothing, not a lot to do with insulin, although there is actually a correlation between the two. So that was to me the most interesting, although the least sort of practical book that I did. And then now I think what I want to talk about more is about that whole more than insulin and like, how are you going to affect the insulin? Because it's not the carbohydrates necessarily, right? So everybody thinks that it's just reducing your carbohydrates is how you reduce your insulin.

That's one way. But there's actually a whole lot of ways. you know there's lots of different like instant oat versus steel cut oats massive difference in glycemic index between the two even though they're the same food same calories same carbohydrates same food so what is the effect of the food matrix because it's really important because it's not the carbohydrates or the calories necessarily it's the insulin effect that your body actually sees in the end right so the food matrix is how foods are are sort of composed.

So when you grind that wheat, if you use stone grinding, for example, it's very different than if you use a modern flour grinder where you get this very, very fine dust because the absorption of the modern flour is instant because everything is ground up. There's no intact salt wall. It's like the brown rice, white rice. It's the same thing. Fruit juice first eating the whole fruit. So yeah, there's absolutely.

Yeah, exactly. So those are important. So food order is important if you eat carbs first versus carbs. carbs last. If you eat vinegar, for example, this is actually really interesting. So vinegar and acids, if you eat them with carbohydrates, so you want to, you know, have some dumplings and you dip them in vinegar, the insulin effect is far different. And why? Because it turns out that that vinegar, which is acetic acid, partially inactivates the salivary amylases, so your body actually doesn't break down as fast. And it was always thought that when it got into the stomach,

the stomach acid would neutralize the salivary amylases, but it doesn't. So in fact, by taking it with vinegar or fermented foods, so things like, you know, sourcrowts and stuff, you can actually really reduce the glycemic and insulin effect of the carbohydrate. So sushi rice, which is rice with some vinegar and sugar, but the vinegar actually reduces the glycemic index by a substantial amount. Well, it's how consuming certain red meats, if you can, consume and with green leafy vegetables, it neutralizes some of the negative effects of the red meats as well.

Yeah, it's the same thing. And also taking carbohydrates alone versus carbohydrates with proteins and fats makes a difference. So that's the food matrix and then, you know, the effect on those foods and also the GLP ones, the how foods affect that. And then the sort of super, I think it's super fascinating upcoming area of how ultra-processed foods really hijacks the whole process. Yeah, for sure.

Because it's not one thing. It's a whole lot of, like, it's like, oh, man. It's the Facebookification, Netflixification of food. Yeah, yeah. To try and get you to click watch next. Yeah, there's all this stuff that's there to protect you. And they've ducked around like all of this stuff, right? And it's like, wow, that's fascinating.

So this ultra-processed foods that, you know, take away all the satiety, increase the dopamine signaling. get one of the food scientists that's hired by one of these industry experts and get them to do like a tell-all vice documentary style where we blur out their face and they tell the secrets of what they're studying, what behaviors they're trying to skip over, where they've had successes, where they've had failures. And I think a lot of it is also, like it's probably all known, but there's a lot of people fighting against it. It's sort of like artificial sweeteners, right? A lot of people do fine with art. artificial sweeteners, but there are a lot of people who don't do fine because I think the sweetness triggers off a lot of cravings and stuff. Like I have a bunch of people who are like, I drink 20 diet Pepsi's a day, right? I'm like, okay, that's not normal, right? And then the minute they cut it

out, they're like, wow, I lost like 10 pounds. I'm like, yeah, because it wasn't that the diet Pepsi had calories. That's not the point. It was the hormones, the whatever is triggering that sweetness was triggering it off your cravings so that you ate more calories in greater than calories out, which is what led to your weight gain, right? So that's the whole point of trying to get behind what's behind the calories, right? And, you know, a lot of these chemicals, like in the U.S., they talk about this, right? It's been very topical about how a lot of Ultras processed food in the U.S. is way worse than the stuff you see in Europe, right?

It's like all these chemicals, right? And also there's, I'm scared of fear months. wrungering around chemicals because like what's a chemo, water is a chemical. But like some of the chemicals that we have in certain foods, like certain food dies here that people say are not present in Europe, for example, just go by a different name out there. So there is a lot of confusion and misinformation in the space. But there's definitely room for improvement. Especially when it comes to pre-packaged foods, ending subsidies for certain foods, or at least changing the incentives to be more health focused. So there's a lot of room for improvement.

I agree with you. I mean, chemicals obviously are not all bad, but are they all necessary? Because I think that's the point of comparing the European, you know, I saw some posts where they're like, you know, food loops or whatever it was. And, you know, there's a huge difference. There's all this chemical in the U.S. one. I think it made it brighter or something like that. You know, they had all these food dyes.

And the European one, they're all banned so that they looked a lot paler, but they had the ingredient list was much less. I was like, do we really need all this stuff in the U.S. one? Like, is that necessary? Because we don't know, and you might say it's safe, but it's like, okay, but you don't know if it's safe because, you know, there might be long-term effect. We don't study these chemicals for 20 years and then determine it. Well, it's also dose-dependent, you know. Yeah, so if people are eating a lot of this, like in the poor states, then yeah, maybe it,

you know, maybe it is playing a huge role. We just don't know. I don't think it's playing a huge role because I think that would have been very quickly found out but is it playing a role and is it a risk that's unnecessary probably that's it's unnecessary yeah and it's clearly like i think the shoe should be on the other foot right we sometimes say well let's wait for the problem to occur exactly it's like why like you should have to prove that it's completely safe before we accept it rather than accepting it and then having to prove that there's a problem right it doesn't make sense that yeah there's a lot of nutritional complications like

even with the pesticides of it all. Like, I've actually taken the time to really dig into the research and figure out why there's, for example, a difference between our EPA here has said that the main pesticide that we use here is not likely to cause cancer in humans versus the WHO's organization to IARC said that there's a probable link to cancer. cancer in humans and how they both came to the appropriate conclusions based on what they were studying was just slightly different in slightly different populations. And we're using a slightly different measuring stick, you can come to those radically

different conclusions. And yet both organizations are actually honest in their evaluation. The question is, what did you want to measure? Yeah, yeah. So very interesting how you can look at that. And I think that this is actually really important because when you get to the point where 70% of the American public is overweight or obese, you know it's not an individual issue, right?

Because it's not like, oh, this guy just, you know, didn't, you know, follow our advice. It's like, no, there's something going on. Systemically. It must be. I don't think, I think that's, like, widely accepted now. Yeah. Especially in education, like the way that I'm teaching my residents,

the way that medical schools. So because it wasn't for a long time because I'll tell you that when I, you know, learned about obesity. in medical school. It was all about personal responsibility. I think the world was different than calories out. Well, I think that a lot of people still practice that way,

or there's a lot of people who's medical inertia still. Yeah, exactly. It's that inertia. And it's really unfair, I think, because people don't know, so they take whatever they used to learn, which is 1980s, 1990s, sort of like, it's all your responsibility, it's eat less and move more. No, it's got to be something.

more than that because look at this right it's like you can't make an entire population obese without it being about something about the food or the culture or something in it you can't do that right so therefore it's not let's just get these people to watch what they eat it's it's not that it's like the food environment must change yeah it's it's not that people make choices for a reason just like you know i think with the people who are who are you know poor they make choices because, you know, it's either eat the really cheap ultra-processed food or not eat, right? That's an easy choice for them. You can't blame them for that.

And if they gain weight, you can't blame them for that. That's not fair. What you have to do is say, what is it about this and can we do better, you know, pushing more fresh foods, whole foods, you know, into the mix, like not just take that away from them because, you know, maybe that's all they can afford. Well, I'm glad we covered it. Thank you so much, Dr. Fung. I appreciate your time.

Wow, what a convo with Dr. Fung. I think it surprised me how much we actually agree on topics. It even surprises me on the points where we disagree because it seems like we're saying the same thing, maybe just having different definitions of words and even people taking some of his statements out of context, clipping them and making him to be a little bit more dramatic than they should be. I hope you enjoyed our new truth-seeking mode

where we have those fact checks labeled in the description of the video, I think that's a pretty cool standard for us to start to follow when it comes to putting out accurate info. It's hard to live fact check, but to do it after the video, it kind of takes away some of the pressure, makes it a bit easier, allows us to be more accurate. Huge thanks to Dr. Fung for being open, for having this discussion in general.

Most people, if they faced any sort of debate, would kind of shy away from that. So huge thanks to Dr. Fung. Huge thanks to you for listening. If you enjoyed this podcast, please give it a five-star review. It helps other people find and discover the podcast. And if you have some comments, leave some of those. That also helps.

And another episode that I think you'll very much enjoy is the one with Marian Nessel, where we talk about food politics and how the invisible hand of marketing and government food agencies change how you eat. Really cool. As always, stay happy and healthy. Thank you.