The Dr. Hyman Show - The Surprising Secrets of Fixing Your Metabolism

Episode Date: March 18, 2024

View the Show Notes For This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal Poor metabolic health is the largest underlying cause of early death worldwide, making it the canary in the coal mine for not just type 2 diabetes, but a multitude of illnesses such as Alzheimer’s, heart disease, cancer, obesity, and even some cases of infertility and depression. Sadly, many people are walking around without even knowing they need to address their metabolic health or have any idea how to do that. In today’s episode, I talk with Dr. William Li, Dr. Casey Means, and Dr. Richard Johnson about why metabolic health is important and ways that we can start improving it immediately at home. This episode is brought to you by Mitopure, Cozy Earth, and AG1. Support essential mitochondrial health and save 10% on Mitopure. Visit Timeline.com/Drhyman to order today. Right now, you can save 40% when you upgrade to Cozy Earth sheets. Just head over to CozyEarth.com and use code DRHYMAN. Get your daily serving of vitamins, minerals, adaptogens, and more with AG1. Head to DrinkAG1.com/Hyman and get a year's worth of D3 and 5 Travel Packs for FREE with your first order.

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But there are actually many other factors at play. Did you know that the more fat you have, the slower your metabolism? Or that toxins and sugar play a significant role in your metabolic function? In today's episode, we feature three conversations from The Doctor's Pharmacy about tips and tricks to improve your metabolic function. In today's episode, we feature three conversations from the doctor's pharmacy about tips and tricks to improve your metabolic health. I talk with Dr. William Lee about how visceral fat or belly fat first appears on your tongue. Yeah, that's right. And why we want to avoid that. What Dr. Casey means about why toxins like obesogens impact your metabolic health. And with Richard Johnson about how sugar slows your resting metabolism. So let's jump in.

Waist circumference is a good surrogate of the amount of harmful body fat you have inside you because the visceral fat is a dangerous fat. The subcutaneous fat is either beautiful or could make you not be so happy with your body shape. All right. But the visceral fat, which you can't see, is actually inside the cavity of your body. So when you, it's like peanuts you would pack into a FedEx container, your shipping light bulbs. You can pack a lot of peanuts in a thin box and tape it shut. The box still looks thin, but it could be bursting with pressure on the inside. And basically visceral fat is something that whether you've got a big body or a small body, whether you're obviously overweight or whether you're skinny as a stick, you can still have too much body fat. By the way, here's an interesting

little factoid. Do you know where is one of the first places you gain visceral fat, extra body fat when you start gaining weight? I would assume your belly, but maybe you're going to be wrong. I'm going to be wrong. Well, 90% of people think it's around the belly and reason understandably, because that's what you would see. I'm gaining weight. You look in the mirror, I've seen around your belly, but actually that's not. So turns out that the first place you gain, start building body fat, especially the original fat is in your tongue. Your tongue can get fat. So if you take a look at the anatomy of the tongue, the tip of the tongue is the Cirque du Soleil acrobat. It's

actually capable of doing all kinds of crazy acrobatics. The middle of your tongue is muscular. It is buff and full of muscle to be able to move food around your mouth. The back third of the tongue is normally marbled like a ribeye steak with fat. And a lot of people don't realize this, but when you start gaining extra fat, one of the first places that it starts to grow where it matters, the visceral fat grows in your tongue. You get more marbling in the back of your tongue. Wow. This happens even in skinny people. And in fact, it was studied in Sweden. Young women, women who are middle-aged or younger, who are thin, actually, when they started to gain weight and they started to gain visceral fat, they found it was in their tongue. They started snoring. Their bed partners would say, wait a minute, you started snoring. Now why? Because when you're sleeping, you're relaxed.

And when you're relaxed, your tongue's relaxed. Your fat tongue is relaxed. It blocks your airways. And guess what? You have sleep apnea. And so even thin people who have a lot of visceral fat, it's not just the diameter of the airway. We used to think it's like the tunnel getting narrower, but even your tongue can gain weight. So these are some of these really interesting facts about body fat that we never really even thought about. Amazing. Which is why we need to actually take actions, as you say, to eat foods. If you really want to fight body fat and raise your metabolism, you don't want eat foods. If you really want to fight body fat and raise your

metabolism, you don't want to fear your food. You want to actually lean into it to look for delicious, healthy foods eaten at a modest volume and also eaten at the right time. So it's not just, it's obviously what you eat is important and how you eat is important, but when you eat can also make a difference. How do people best lose weight and lose their body fat? And what is your sort of prescription and sort of the eat to beat diet? Yeah. How do we take all this science and make it real for people?

Yeah. Well, look, I get asked this question all the time when, you know, when people see me wherever, you know, on the street or, or, you know, in a lecture hall, they basically say, Dr. Lee, what diet do you follow? Right? Because they're assuming we all follow our own, a special diet or our own diet. And I answer very, very, very authentically, very sincerely. I'm not on a diet. I don't go on a diet. However, I do eat in a certain way. And the way that I eat, and I think there's people will relate to this. I call it Mediterranean style of eating. Mediterranean happens to reflect the ways that I like to eat. I enjoy eating and reflects my

own background. I'm Asian. I grew up eating Asian food. I lived in the Mediterranean and I spent time in Italy and in Greece and elsewhere. And I lived Mediterranean. I lived and learned to love Mediterranean cuisine, especially traditional cuisine. And so I always whenever I'm choosing a meal or ordering off a menu or going shopping in a grocery store or the farmer's market, I naturally gravitate towards recipes and ingredients from one of those genres, which, by the way, Mediterranean Asian happened to be traditionally among the healthiest eating patterns on the planet. Yeah, yeah, yeah. Well, the Blue Zones are in Okinawa and basically the Mediterranean places, right? Exactly. Right. So, I mean, you were just there seeing this in action. And so I call it Mediterranean style eating. And I think that I use that to inform what ingredients I pick, what catches my eye, how foods are prepared.

And by the way, also Mediterranean and traditional Asian foods, these culinary traditions tend not to be ultra processed. They tend to use fresh, local, seasonal ingredients combined in really unique ways and flavored with herbs and spices and nuts and lingons and healthy oils like olive oil. So that's one approach I take is sort of how do I, you know, for anybody who's sort of confused, like, okay, well, what style of eating should I have? What's Mediterranean? But Mediterranean can be anything. It can be like pasta and pizza, or it can be like, you know, fresh fish and vegetables. So that's really what I try to do is I try to present people with a list of ingredients you can buy in my book, in the grocery store, in the produce section, in the middle aisle, whether you're going to the seafood counter, or you're going to the farmer's market, you can find these ingredients and they taste delicious. And you have to, you know, somebody who said, I haven't had broccoli or I don't like fish.

You haven't had somebody prepare it for you in the right way. That's my theory. I think the reason people don't like vegetables is they were prepared poorly. I remember, you know, I was in the movie Fed Up and I went down and this family would basically never eat vegetables and, and they thought they tasted bad because mostly they came out of a can and were awful or overcoated. I hope you whipped them up. I did. But you know, this woman said she,

she had a friend of hers make her asparagus on the grill and she thought, Oh my God, this is really good. And that's by the way, where I think if you see an ingredient that can activate your brown fat and help your metabolism, and you don't know how to cook it in this day and age, go onto Google or if you're shopping for it, go onto Google, type the ingredient, type Mediterranean or Asian and type recipe and then search video and somebody will come up to show you with passion how to do it. That's a great, simple way to learn how to cook these ingredients. But it's not just ingredients. I mean, so basically fruits and vegetables, nuts and

legumes, all the usual cast of characters. And I try to identify specific ones. The middle aisle, dried fruits and dried mushrooms, dried chili peppers, dried beans, all great candidates as well. Capers, I really love. Seafood, I take people into the seafood section. Why are capers so good? Oh, okay. Do you know that in onions, okay, which are not related to capers, you go to the produce section, you see onions, they've got quercetin. Quercetin is a natural bioactive that activates your brown fat. It actually redirects your white fat that causes beijing to your white fat, harmful fat, starts to look a little bit more brown, starts to do the right thing um and also redirects the stem cells so you make less white fat more brown fat but quercetin in an onion is found 66 times higher okay in a in a caper oh wow so it is i love

capers i love capers too and by the way for those who are listening you've been checking in on my podcast you heard me talk about quercetin for longevity. And it's one of the compounds that's super important that actually can help reverse biological age. So I think it's very, very key. And where do you get quercetin? You get them in dry, rocky Mediterranean islands. And capers are actually flower buds that are picked before they turn into open up as flowers. And they're packed in salt or they're packed in brine or a little vinegar.

And, you know, you got to rinse off all that extra salt. But whatever you are eating that's savory, if you add some capers to it, anything. It'll make it taste so much better. Yeah. And, you know, like if you haven't been exposed to capers, you got to try it. Capers from the island of Santorini or capers from the Sicilian island of Pantalea. Those are some of the most famous culinary capers that are out there. I like to cook. I mean, I know you do as well. But you know, I think that the other thing is really talk to somebody who really enjoys

cooking about these ingredients and you'll get excited about them as well. But the point is that you can go to the seafood section. Something I wanted to tell you that I discovered. When I was writing the book, some of the people advised me and said, you know that Dr. Lee, that a lot of people don't like to eat seafood, so be careful, including fish in your book. And that made me want to really write about a whole chapter on seafood. I call it the daily catch. And the reason is this. If you've ever lived near the shore, if you've ever been to Asia or the Mediterranean, there is so much tasty seafood there. And, you know, here, I think in most, you know, like in America, most places go, ah, salmon, the salmon or the chicken.

I'll take the chicken at the wedding or whatever. It turns out that, yes, oily fish are healthy because you get marine omega-3 fatty acids. But there was a study from Iceland that was quite surprising. They wanted to look at what the effect of omega-3 fatty acids were on body fat. And guess what? Turns on brown fat, helps you lose weight, burns away visceral fat so your waist size can shrink. And of course, they found it that eating salmon three times a week for eight weeks will actually cause you to lose up to 15 pounds.

All right. So that's a lot of weight. Yeah. Wait, wait, wait. So you just said eating salmon a few times a week and help you lose 15 pounds. Yeah. So basically, now this is the study where they actually did a little bit of caloric restriction to get it started, then added salmon to see if eating salmon would actually trigger faster weight loss. So that's a pretty good amount of weight loss. Now, omega-3s are in salmon, right? So oily fish.

In fact, I can tell you there's 1,500, 1,565 milligrams of marine omega-3 fatty acids in a five-ounce serving of salmon, okay? But here's what's crazy, and I think this is what opened my eye. The same researchers studied what they thought was going to be a non-oily fish like cod cod's not considered an oily fish cod only has 284 milligrams not 1500 of omega-3 fatty acids pretty low guess what they found people that ate cod three times a week lost 10 pounds over eight weeks wow three times was it because of what they were not eating or was because because of the fish, you think? Both.

Because basically when they lowered their calorie intake, that kickstarted it. But when you compare cod with salmon, you lost 10 pounds with cod over eight weeks. You lost 15 pounds, 30% more if you had salmon. But guess what? Cod has so much less of the omega-3s. All right. So we're just comparing two kinds of seafood here. So you don't need as much omega-3 as we thought.

You don't have to eat mackerel and anchovies in order to get adequate omega-3s. When it comes to your metabolism to fight fat, something as low as cod with that amount of omega-3s will do it. So in my chapter, I convert in different seafoods that cod amount of omega-3s. You want two and thirty-four milligrams of omega-3s in a serving. Guess what that translates to? To medium-sized Gulf shrimp. You only need to eat four Gulf shrimp to get as much you get in a serving of cod. How many oysters? You need to eat eight oysters.

You want mackerel, which is really oily. You only need one forkful of mackerel to get that amount as a cod. You don't even need that much mackerel. Open a patina, just take one forkful and you're done. That's amazing. Halibut, another white fish. You can even plug your nose. Halibut, which is, you know, a very mild white fish, right? Not oily. You can even plug your nose. tiny lobster, mitten crab, razor clams, like stuff that I love to eat. Yeah.

I love razor clams. I'm telling you. So you got to check out this chapter eight. It's called The Daily Catch. And I have a complete list with all the converted doses of how many you need to eat. You know, Joe Stone Crab kind of thing. Like a stone crab. How many claws would you need to have?

It's all there. So look, eating for your metabolism and to fight body fat doesn't have to be a chore. Don't fear your food. Love your food. Look at all the stuff that comes from the Mediterranean and from Asia. Look at the recipes. You know, you got to be careful, you know, what you eat. But then like the last part of it, by the way, of how I do this, just to share how a practical way, besides what to eat and be careful not to overload your fuel tanks by overeating, you know, there is really quite a profound aspect of metabolism, body fat and fat burning when it comes to intermittent fasting. So everyone thinks that intermittent fasting is it's like modern trend, but it turns out that we're always intermittent fasting. When we're sleeping,

we're not eating, we're fasting. When we get up in the morning, eat breakfast, we're breaking our fast, which is what's called breakfast. Now, remember I told you, right. Remember I told you when you actually eat food, your insulin rises and draw that energy to load into your cells. Our metabolism is hardwired so that when you're eating and your insulin is going up, our metabolism stays focused on loading up on fuel and not burning it. When we're not eating, our insulin goes down, our metabolism switches gears like switching train tracks. And basically it says, all right, let's try to burn some of that fat stored in cells. And maybe you're burning the fat from dinner. Maybe you're burning the fat from yesterday.

Maybe you're burning the fat from the holidays. But that's actually when you're sleeping, you're actually able to burn. That's the way our metabolism is hardwired. So here's what I do. I try to give my body as much time to naturally burn fat as possible. If I'm sleeping eight hours a day from 11 o'clock to 7 o'clock, for example. All right. Here's what I do. When I eat dinner the night before, if I eat dinner at seven o'clock and I put the dishes away at eight, I don't eat anything after dinner. I've stopped. I closed my

eating window at eight o'clock. No midnight snacking, no noshing. I don't raid the fridge, no extra slice of pie before I go to bed. Now, guess what? I put the dishes away at eight o'clock. I go to bed at 11. I've gained three extra hours of fat burning, metabolism, grooming. When I get up in the morning, I don't do what our moms told us to do, which is hurry up and eat breakfast and catch the school bus to go to school. I get up, I take a shower, I get dressed, I take my time, I go for a walk, or I'll check my email or do something else. I'll wait an extra hour before I eat breakfast. Okay. Now I've gained an extra hour.

So the eight hours of sleep plus the three hours of night before 11 hours, plus one extra hour in the morning, I have just spent half my day burning down extra fuel. Super easy. You want to go intense. You want to go 16 hours and squeeze down eight, go for it. But 12 hours works as well. I'm just trying to tell people easy, practical, delicious ways to do it. And then if you want to go hardcore, go for it. Hey everyone, Dr. Mark here. The supplement aisle at the grocery store can feel overwhelming. With so many options, it can be hard to navigate and choose the right product for you. And that is why I love AG1. AG1 takes all the guesswork out of trying to combine the right supplements. It provides prebiotics, probiotics, digestive enzymes, and other whole food nutrients all in one easy

scoop. AG1 covers your nutritional bases while providing comprehensive brain, gut, and immune support. Plus, I love how easy AG1 makes it to get the nutrients my body needs to thrive. It's as easy as adding one scoop to a glass of water. We have an exciting new offer for my listeners. Right now, AG1 is offering my audience a full year supply of their vitamin D3 K2 liquid formula free with your first purchase. They're also going to give you five free travel packs as well. Just go to drinkag1.com forward slash hymen to get your free supply for a year of vitamin D3 and K2 and five free travel packs with your first purchase. Again, that's drinkag1.com forward slash hymen. What are the things that people have gotten confused about when it comes to fat and metabolism? What are the top misconceptions?

You know, I think, you know, it starts all the way back to how we think about our bodies and metabolism and body fat and how they're all kind of intertwined. Because all of us have had this experience where you step out of the shower in the morning naked and out of the corner of your eye, you see the mirror and you see a lump or a bump that you don't want to have there. Then you step on the scale. I never do. What do you mean? And the point is that, you know, we wind up cursing, I think, body fat.

And we start thinking our metabolism isn't actually working on our behalf. And that's actually just completely incorrect. Our body fat and our metabolism are so tied together in ways that give us health, generate our health. And what I write about in my book, Eat to Beat Your Diet, is really the new science of the metabolism, some of which is only 24 months old. It is brand spanking new research that is changing and upending everything we used to think about human metabolism and how that connects to body fat, good and bad. And then the really exceptional part of this is that, guess what? We don't need to fear our food. We can actually love our food in order to be able to up our metabolism. So, you know,

where do you want to begin? Well, I love that. I always say, you know, love the food that loves you back. A lot of times we love the food that doesn't love us back. But the good news is there's lots of food that loves us and that we love. So I think that's great. So the myths are things that have to do with people's view of like why we get gain weight, how our metabolism works. I just like you to sort of unpack that a little bit because I think I want to get you know, I want to get to what we got wrong, and then we'll talk about what we can do right. Yeah, that's a great place to start. So first of all, I'm a scientist as well as a physician. And as a scientist, I'm always interested in the origin story. Where do things come from? And how does it actually develop over time? So this, and now I'm going to kind of give you the mic drop research that occurred just published just 24 months ago. The largest human and most ambitious study of human metabolism ever undertaken in history was published two years ago in the journal Science, which is the top one of the top medical journals. It was led by a guy named Herman Ponser, who is at Duke University, and he worked together with 90 other collaborators. So this is a big research project.

And they recruited subjects from 20 countries, every continent. And in total, they had 6,000 people. And what was really remarkable is they studied metabolism in exactly the same way. So that's one very unique aspect of this, to study 6,000 people, human metabolism in exactly the same way. The way they did it, by the way, is they gave them a drink of water. Water is H2O, H being hydrogen and O being oxygen. And what the researchers did, they tweaked the hydrogen, they tweaked the oxygen very minimally, but that you can detect it so that when people drank this cup of water, their metabolism, you know, worked its magic on hydrogen and oxygen. They could measure it in their breath, in their blood, in their urine.

So they asked the question, what was human metabolism across 6,000 people? And what was really remarkable is this question was asked because they studied people that were two days old, newborns, and they studied people that were 92 years old at the tail end of life. So six thousand people over the entire human lifespan. And I know that, you know, we've just been talking about lifespan, right? That's really what you've written about in Young Forever. And in this whole lifespan, the question is, how does your metabolism change? That's one of the things we've always had an assumption about. And I think that, you know, you and I, when we went to medical school, we were taught the rudimentaries about metabolism and the biochemistry, but we never had any of the nuances of how it changes over our life.

So like most people, we assume that some people are born with a slow metabolism. Some people are born with a fast metabolism and some people are skinny and don't have to worry about eating what they eat. And other people are struggling with their weight and they have to fight with their food. Same kind of assumptions. I think that many people carry around. That's a myth because it turns out that, let me tell you what they did in a study. When they, when they looked at the metabolism, they looked at what they found in the beginning is that the metabolism was all over the map for 6,000 people, just what you'd expect. But we now live in the era of artificial intelligence and supercomputing. So they developed an algorithm that would go to every subject and correct the result of the metabolism

on the basis of excess body weight, excess body fat, so they could remove the effect of excess body fat every individual 6,000 times. All right, now you gotta remember, 6,000 people over 20 countries, that's men and women, young and old, different racial backgrounds, different body sizes, different eating patterns. And what they did when they removed the effect

on metabolism of excess body fat, it was like pulling the cloak off the statue of David. They found that all humans go through only four phases of metabolism in their entire life. We are hardwired. This is like revealing the operating system of your- Wow. Tell us, tell us. I'm so excited. The four phases, everyone is born with the same metabolism. In the first phase, it's zero to one. Human metabolism skyrockets so that at one year old, when you reach 12 months, your metabolism is 50% higher than what it would be later when you're an adult. All right. So it's like a rocket ship blasting off. Phase two,

that's from one year old to 20 years old. Your metabolism goes down, down, down, down, down, down. Now, why is that important? Because most of us who have had kids assume that when your teenagers are eating two meals and bouncing off the walls and growing like a bean sprout, their metabolism must be going up, right? Wrong. It's going down. It's going down and it descends to adult levels. That's phase two. Phase three is starting from 20 to 60. And you know what the result was? This is the most surprising part. 20, 30, 40, 50, 60. Metabolism is hardwired to be a straight line. It does not change as the hardwiring in our body. And what that means is that 60 can be new to 20. If you allow your

metabolism to do a sting. All right. That's phase three. Now I'm going to, I'm going to come back to that in a second. And then phase four, the four phases from 60 to 90, you do decline a little bit, but only by 17%. So by the time you're 90, all right, your metabolism's basically only less than 20% decrease from what it was at 60 or at 20. All right. That's amazing. So it is amazing. Now, and basically what this discovery has done is led us to completely rip up the old metabolism textbooks. And the new ones are being rewritten right now based on this new science. Now, the key part though, because people say, well, wait a minute, I'm 40 years old. I'm 50 years old. I'm gaining weight. Like I know this happens. What happens is that when you add the data back, when you add the effective extra body fat back, you crush the metabolism. So it's

not that a slow metabolism causes you to gain body fat. Okay. Uh, and gain weight. It's the other way around our body fat, our metabolism runs this way. But if you undertake behaviors, whether you're inactive, you're not getting enough sleep, you're overly stressed, you eat incorrectly, your microbiomes derange, what happens is you gain body fat and it's body fat that crushes your metabolism completely the other way around than what we thought. So being overweight slows your metabolism down. That's right. So the good news, by the way, with this discovery is that it means that suddenly we have a new ability, a newfound ability to be able to control our metabolism. Because if we can actually right size our body fat, because this is the other point. Fat isn't our enemy. Fat's,

in fact, a critical part of our health, except when we have too much of it. So what you want to do is sort of like shave it back down, tune it down, turn the volume down. And as you do that, your metabolism rises because that's the hard wiring in our body. What does the research say about what other factors might be involved in improving our metabolism, our weight, our overall health, our longevity that aren't just the main ones we talk about, which are food, sleep, stress management, and exercise. And there are really three additional factors that seem to really have strong research backing that impact metabolic health in a big way that you're probably not going to hear about from your doctor. And these three are one, how much exposure we're

getting to sunlight and at what times of the day we're getting it. The second one is the amount and types of metabolism disrupting environmental chemicals we're exposed to. And these now have a special name of this category of metabolism-disrupting chemicals called obesogens because they actually promote obesity. And the third, and this one does relate to food, but it's a little bit more specific, is the levels of specific micronutrients in the body that we know are critical for metabolic processes to run properly in our cells. So we often sort of stop the conversation at food around macronutrients, how much protein, fat, carbohydrates are in our food, but really shifting the conversation towards specific micronutrients, these vitamins, minerals, cofactors, antioxidants in our food

is another level of the dietary conversation that I think often gets missed. So those are really three that I think are strong that can accelerate or enhance that journey of weight loss, of metabolism optimization, of improving insulin resistance for many people who are feeling stuck. Yeah. And I would, can I add a few more? Please. yes. Because I thought about this a lot. In fact, you know, in case you have my first book,

on metabolism, ultra metabolism, in 2005, I wrote, one of the chapters was love your liver. Yes. And it was really about the role of toxins and the load of toxins causing obesity in ways that really had not really imagined before. And the data since I wrote that book in 2005 has just been overwhelming about its effect on all sorts of things from insulin resistance. So BPA, for example, which you get on credit card

receipts, it's in plastic bottles, cans, that causes insulin resistance. And that's just one example. So there's a whole slew of those things. But there's more. For example, the microbiome, turns out, plays a huge role in our metabolism, independent of what we eat. And they've done studies on mice and animal, little rats, or whatever they do the studies on. And they found that just swapping out, for example, a poop from a thin mouse to an overweight mouse causes that mouse to lose weight, independent of their dietary intake. So the microbiome is huge. Also hormones.

And a lot of things go on around hormones, thyroid hormones, sex hormones, obviously insulin, which is hugely involved in diet. But that can be involved in many other things that are independent of diet. And also food sensitivities, I think, are one that people don't often realize that anything that causes inflammation independent of calories can cause a problem. So if you're eating something you think is healthy, but actually your body's creating immune response, that's going to create inflammation and that's going to cause insulin resistance. And then there's also other phenomena that might happen like mitochondrial

disorders that are more uncommon or other factors. So I've looked at so many different things over the years that are driving resistance to weight loss. And usually if you're a good detective and you kind of drill down, you can really get to the bottom for most people. And the obesogen thing is really true. I had a patient who was this trainer. She was like a fitness trainer, super healthy, ate great, and she just could not lose weight.

And we did a deep dive and we found that she had really high levels of mercury. We got rid of the mercury and she dropped 40 pounds like that. It was pretty amazing. So it's super powerful. Absolutely. And I think you really get at a key point here, which is that there are so many factors that are involved in what's happening with our metabolism, our cell biology, and you really need to dig deep and ask those questions and have time with the patient or the patient needs to have this baseline understanding to even go down that road of identifying what is going on and what are the potential barriers to actually having the health that we want? And this is where, of course, functional medicine absolutely shines because we tend to have a little bit more time with the patients and actually are going down all of these different pathways that actually lead to the reality of our cellular physiology in the body.

And so I think from that perspective, at this point, I think we probably named 10 things that are related to insulin sensitivity and metabolism. And, you know, really, it comes down to being a detective, like you said, and figuring out in your life, in your body, which are the factors that are at play? What are the barriers to improving them? And how do we do it? And so it's, I think knowing these things can really help just a sense of hopefulness because there's probably several avenues that any person has not dug into before they're kind of at the end of the road in terms of getting their health on track. For sure. So Casey, let's dig into the toxins. And first, I want to talk about how much we learned in medical school about this, right? Zero. Zero. Okay. We learned about acute poisoning, but we never learned about the low... I mean, honestly, the two things or the three things that we really need to know about our health, like our microbiome, toxins, and food, we know nothing about in medical school. So it's insane. But these are the areas that have the most leverage in getting people healthy. So in terms of the framework around obesogens, what are the ones we should be most worried about when it comes to metabolism? And then we'll get

into how we diagnose problems with that and actually how the mechanism of these toxins influences our metabolism. Yes. So like you said, obesogens are toxins. And obesogens, as you can tell from the name, it has to do with fat and obesity. And so the real landmark thing that's kind of happened recently is we've realized that obesogens are specific metabolism disrupting chemicals in the environment that it directly increase fat mass. So this is not a correlation. This is causation. And there was this great paper that came out earlier this year. It was 49 pages. It was a tome. And Dr. Rob Lustig was one of the authors. And it was called Obesity 2 and it was all about obesogens. And it concluded that these chemicals we now know directly increase fat mass through about a dozen different

mechanisms. And it is thought that potentially 15% of obesity is directly attributable to these chemical exposures. So where are they from? They are basically all around us. They are in the air we breathe. They are in the food we eat. They are on the food we eat. They are in our cosmetics and our personal care products, our home care products. They're in our furniture, our electronics, papers. They are all over the place. And actually, a few come from natural origins like lead and cadmium. And you mentioned mercury. But most are industrially manufactured chemicals that are largely unregulated. And so some of the specific examples of where you can find these.

So mercury is natural, but it doesn't mean it's healthy, right? Lead and mercury are natural. Exactly. They're healthy. And there is that handful of natural obesogens like the mercury and the cadmium and the lead that can increase fat mass, but you want to be conscious of how much of this you're consuming. But the vast majority of these are coming out of factories, coming out of companies that have huge lobbying power and that are putting these in everything. And so this is things like can linings, thermal papers, toner, printer toner, vinyl floorings. They are in basically all plastics, even if the plastic is BPA free. They're found in our personal care products,

especially shampoos, conditioners, lotions, deodorants, sunscreens, makeups, food preservatives, food colorings. They're actually in drugs. Antidepressants have been known to have obesogenic properties. They're in car exhaust, so it gets in our air. Paint that goes on our walls, our clothing. They're in flame retardants on children's toys, on mattresses, on couches. A lot of different home care products like disinfectants. And then, of course, one that is on everything, which is agricultural pesticides. So all of these things that I just mentioned have been shown to have mechanistic properties that increase fat, basically the printing of fat in our bodies. So this is kind of fascinating. And the mechanisms are,

it's not just one thing. They really all work together synergistically to cause metabolic problems. And some of the big ones touch on one you were talking about earlier today, which is microbiome. So these chemicals can directly impact our microbiome, the diversity and function of the microbiome. These chemicals can alter the hormonal control of eating behavior. So actually affecting our satiety hormones and our hunger hormones. They affect thyroid function, which is directly linked to metabolism. They impact sirtuin genes, which are, of course, as Dr. Sinclair has popularized, these are very important for our longevity.

They change the folding of our genome. So actually our epigenetics and the way genes are expressed, they can directly cause gene mutations. They cause inflammation. And then they can really affect our hormone receptors. So this is a big one. They can either be activators of hormone receptors or blockers of hormone receptors. And of course, hormones are so, so critical. That's nuanced balance of our health and our day-to-day functioning. And these

chemicals can literally go in and block or activate those receptors. One frightening thing I'll just mention is that they not only affect all these things in our bodies, but they also do it to our sex cells. So our germ cells, like our sperm and eggs, which means that the impact of these chemicals that are all over our environment can affect our offspring through germ cell, which is essentially our sperm or eggs, epigenetics, and DNA. So we really need to all be familiar with the term obesogen, understand where they come from and understand how to advocate both for ourselves and on a systems level to minimize the exposure that we're getting to these in our environment. And many of them last for generations. So yeah. Like you were saying, yeah. I mean, just thinking about how, for example, leptin is,

you know, you get leptin resistance with increased environmental toxins you get, which makes you feel like you're hungry all the time and you get effects on your mitochondria, which helps affect your metabolism and how fast your metabolism works. So there's so many different mechanisms that are underlying this. And I think we're now beginning to understand this. And we also see how they trigger inflammation. So any toxins, they're also immunotoxins.

So they increase this process of making more inflammatory cytokines through this mechanism called NF-kappa-B. And you get high levels of these cytokines like TNF-alpha, interleukin-6. It's so central to everything. So this sort of inflammation from any cause will cause weight gain and obesity. And then here's the problem, it's even worse when people start to lose weight. Guess where all the toxins are stored? They're stored in our fat tissue. So when you start to liberate fat tissue, you start to liberate more toxins. And actually, there's a phenomenon of resistance to weight loss as you're, as you're losing weight, you're going to actually stop losing weight

because the toxins interfere with the very process of weight loss. They affect your thyroid function and many other things. So it's a little bit of a mess. So you have to really help people detoxify properly and learn how to get their systems working. And that's, that's kind of a, what's so great about functional medicine. And I, you know, I wrote an article, uh, gas, it was kind of, I don't know when it was, God, it was probably forever ago. Uh, it was, it was, it was called systems, biology, um, systems, biology, toxins, obesity, and functional medicine. And it was, uh, I think, gosh, in the probably early two thousands. And it was really just looking back then at the data that we had on this. And now, like you said, there's so much more data. And we're so exposed to toxins,

and they're really pretty much everywhere. So it's a little discouraging for people, because like, what do you do? How do you start to think about this? You have these toxins. So people listening are going, okay, well, gosh, we live in a sea of toxins. This is pretty depressing. If I eat like, you know, straw, I'm still going to, you know, gain weight. So what do I do? Like, how do we avoid them? How do we get them out? What do we do to help address this sort of phenomenon of obesogens in our environment? This is the key question. And I think, you know, I think it's a battle that's going to be fought on many different axes. And I say battle because it really is an uphill battle against industry that

uses these chemicals and wants them in a lot of different things. And of course, top priority is not necessarily our health. So I think there's really four main axes that we're going to need to approach this on. And one is on the systems level. One is on the individual choice level. So we can, of course, advocate through our vote and our dollar about what happens at the systems level. But then, of course, day to day, we also just have to choose what we're putting in, on, and around our body. Then the other two axes really is focusing on personal avoidance, but also improving biologic resilience. So how do we actually build a body that processes these chemicals effectively, detoxifies them, gets them out, and is healthy enough at baseline that

we can manage this additional stress, which unfortunately is almost inevitable. So I think just briefly touching on that systems level, which you have written about in such detail, and Food Fix gets into this a lot. And so I'll just very, very briefly touch on this one. I think it's a crazy statistic, but our rate of global chemical production is increasing at a rate of almost 4% a year and will probably double by 2030. And since just the year 2000, deaths from just ambient air pollution linked to fossil fuels and chemical pollution has risen by almost 70%. And very little regulation has come from this. We have a law that's meant to protect us, which is called the Toxic Substances Control Act, which came out in the 1970s, but has really been poorly implemented. And we see things happening all the time where strong science comes out.

Recently, the EPA put forward a proposal to get rid of a chemical called trichloroethylene, which is used in dry cleaning and removing grease from different things like clothing or car parts or bikes or things like that. And the proposal to ban this was strongly supported by science and was just completely basically rejected and withdrawn because of strong complaints and lobbying from the chemical industry. So the systems level, we can think about using our dollar and advocating for legislation that helps. But really, it comes down to acutely what we're doing on a day-to-day basis. So there's definitely some easy practical tips that we can do to kind of help ourselves.

I think the first one is eat real clean, sustainable, sustainably grown food. This is the basic building block of the body for improving biologic resilience. And if you're eating whole foods that are grown in a clean, sustainable way, you're getting a lot of the way there. It means that you're getting the micronutrients that are going to help your body

process these chemicals. It means that you're getting the different plant chemicals that are going to upregulate our antioxidant defenses and our anti-inflammatory pathways. It means that we're going to be avoiding pesticide exposure, which is an obesogen. It means that we're not buying things that come in plastic. So just by eating fresh, whole, clean, sustainably grown food, you're hitting a lot of the different boxes with the obesogen problem. Within whole foods, there are some that are extra special. So of course, cruciferous vegetables, which are going to have the sulforaphane that activates our antioxidant defense system. So this is the cauliflower, broccoli, kale, bok choy, cabbage, sauerkraut, these things that are directly going to change gene expression to protect us from some of these obesogenic chemicals. Then, of course,

it's like what's your food stored in. So we want to avoid plastic storage as much as we can and really try and opt for glass and other materials. And now it's so easy to find this stuff. You can go on Amazon, you get glass Tupperware, glass water bottles, aluminum or ceramic, things like this. And again, it's not just about BPA. I think that's a little bit of a, we often now look for BPA free plastics, but plastics contain as many as 15 endocrine disrupting chemicals. So BPA is just one and it's great that it doesn't have that, but there's other things like BPF and BPS and these other chemicals that we know are endocrine disruptors. So be the weirdo who brings the bamboo fork and knife in your purse to the takeout restaurant. Be the person who always has the glass water bottle

and who brings your own storage containers because these things actually do add up and make a difference um the next category that is really important be the weirdo be the weirdo i mean i you know and and the and you know give these things as gifts i i have a running google doc of gift ideas and a lot of them are becoming basically these types of things like give people the portable reusable wood cutlery you know and things like this that they might not think about, but that can really help their health. I am someone who loves personal care products. I love cosmetics and you know, all this stuff. And so this one has been really important to me figuring out how to basically reduce the toxin, toxins and toxic load of all these products I'm using. And so I think this

is really low-hanging fruit. So basically, look at your bathroom, look at your shampoos, conditioners, lotions, makeup, deodorant, toothpaste, and probably throw out most of what's in there. And look for the brands that have very few ingredients that are ingredients that you recognize and know and that are ingredients that you recognize and know, and that are approved ideally by the Environmental Working Group website, which has basically a registry of all personal care products. And you can just walk through the store and search things on your phone and find out what is least likely to be toxic. So I've really moved away from a lot of the complex products to things like for moisturizer, like you can use

organic coconut oil or jojoba oil. You can use castile soap like Dr. Bronner's for dish soap, for hand soap, for body soap. You can use vinegar and water for disinfecting sprays for your countertops. It's actually, once you get on this train, it's quite easy and there's so many great brands these days. It's not that hard. Yeah, it's super easy. And there's so many great brands these days. It's not that hard. Yeah, it's super important. And then, of course, you need to give your body the things to detoxify, right? Right. And actually, supplements can be helpful in that regard. Whole food, of course, is the foundation. But supplements like vitamin C, curcumin, probiotics, resveratrol, vitamin E, these have all been shown to have basically resilience boosting effects on our ability to process toxic chemicals. And I think the last one I would mention, I mean, we could go

on and on forever about how to avoid these, but I think another important one is air filtration, because air pollution is such an under-recognized contributor of chronic disease. And so getting a really high quality air filtration system actually has been studied and has been shown to have a clinical effect on mitigating the effects of toxic air pollution. So really personal care products, whole foods, making sure you're including cruciferous vegetables and anti-inflammatory foods, avoiding plastics, and getting your air under control, and maybe supplementing with some high-yield supplements. Those are definitely some of the things that we can do that are pretty simple

to avoid the impact, the mega impact of these chemicals. Normally, animals will try to stay at a certain weight. They don't want to gain a lot of weight. And they'll maintain their weight. If they eat more one day, they'll eat less the next. If they exercise more one day, they'll exercise less. So they try to keep their weight normal. But there are some animals that really do want to gain weight. And those animals will gain weight by, you know, like in preparation for hibernation, for example, like when winter is coming and, you know, and they know there's not going to be much food around. So these animals will suddenly, you know, they'll be regulating their weight fine for most of the summer. And then sometime in the fall, suddenly they start to eat a lot more.

And they will eat, you know, thousands and thousands and thousands of more calories. A bear will start gaining 10 pounds a day. And I mean, it's just it goes crazy. And the animal will stay hungry and thirsty and go foraging for food. And that's actually part of this behavioral response. And then they'll start storing fat. And they do it by both synthesizing more fat, but also by breaking down the burning of fat. And so the fat starts to accumulate.

And they will become insulin resistant as part of this. And it's actually a survival mechanism because, you know, it keeps the glucose elevated in the blood, which the brain likes because the brain doesn't really need a lot of insulin for it to work. Whereas the muscles really do need insulin. So by making the tissues resistant to insulin, the glucose, instead of going to the muscles is staying in the blood and it's good for the brain. So it helps shut the glucose from where it would be used muscle to the brain. So insulin resistance is part of this survival response. Blood pressure goes up, you know, because they want you to have strong circulation in this kind of setting. And so all of this happens, and we know it in humans as the metabolic syndrome,

but it's actually something that long-distance migrating birds do before they migrate. It's animals do it before they nest. And it seems to be, like, triggered. So, you know, our big insight, first one, was that there was this trigger that created this and so uh and then is that what you call the fat switch yes a biologic switch you know i also call it the survival switch when it's for these animals because it's it's the same thing initially it's there to help you survive but when you're chronically activating it it becomes a fast switch and um yeah you know it's funny i remember going to admiralty island my daughter years ago on a

kayak trip in alaska it was where they had the greatest density of grizzly bears in the world and they were they were fishing for salmon we were watching them was this one little postage area postage stamp area you could stand on with the guy with a shotgun and when the grizzly bears are all over and they were just chowing down on the salmon and and you know uh and then they go up into the mountains and the end of the summer and they just chowed on the berries and they gained 500 pounds uh you know and and unlike unlike the game of thrones for us winter never comes winter never comes so we just keep storing and then winter never comes and we just keep in this process and i think you know right i think the other thing that i sort of happens is that if we eat the wrong food we're hungrier and i want to talk to you about this

because you know i remember the study was i think um kevin hall did where he looked at people ate ultra processed food versus whole foods and people and they could eat as much as they want to buy there was two groups or i think it was a crossover study. And they actually found that the people who got to eat the ultra-processed food ate 500 calories more a day. Now, in a week, that's gaining a pound a week. In a year, that's 52 pounds of extra weight simply by eating processed food, which is 60% of our diet.

This is the problem, right? It is a big problem because processed food is often filled with sugar and it's also filled with salt. And I know we're going to talk about that later because it turns out that this fructose pathway can be activated by many different foods. So it's not just the sugar we eat. So, but anyway, so yes. So what our discovery was, was that this switch is activated by fructose. And when we gave fructose to animals, they got the very exact switch. They start foraging, they get hungry, they're thirsty, all the things that we talk about in the biologic switch. And so fructose turned out

to be it. You know, one of the big questions we asked, you know, was, is the weight gain because they're eating more? Is it this energy balance? Or is there another thing besides? And what we found, the way you do that is you actually feed animals the exact same number of calories. So one group gets sugar, and another group gets other foods that don't have sugar, and everybody eats the same. And if one guy doesn't eat very much, then all the guys can't eat very much. And so we actually did this, we did this study multiple times. But one time we did it, there was a little guy that did not eat much food. And so everybody was eating less than normal. All these laboratory rats were eating about two thirds what they normally eat. But one of them was eating a high sugar diet and one was not. And the high sugar diet rats, they became diabetic. They all became diabetic. Every one of them. They all developed fatty liver. They had fat in their tissues. Their blood pressure was high. So the sugar was activating this switch, even though they weren't gaining weight because they were on a caloric restriction.

And when we looked at weight. So metabolically, they were fat, even though they weren't overweight. Yes, right. So, weight is driven, you know, it is related to energy belt. So, you know, when we measured their metabolism, their resting energy metabolism was lower. So, even though they were eating the same amount of food, they were spending less energy. So, they tended to be a little higher. They were like 10%, you know, maybe 5% higher in weight. You just said something really important.

I want to highlight it and I want to let you continue because what you said was so important. I just want to underscore it. When you eat sugar, your metabolism slows down. Is that what you just said? That's correct. That is mind blowing, right? If you eat sugar, your metabolism slows down. That should get everybody to that's correct that is mind-blowing right if you eat sugar your metabolism slows down that should get everybody to pay a lot of attention yes it

absolutely does so you're you're but it's your resting energy metabolism actually so you could they when you're foraging you don't you you they you know nature didn't want you to not be able to forage for food because you're you know they, they're worried that, you know, you're preparing for a bad time ahead. So they want the sugar, you know, the fructose still allows you to forage. It's when you're resting instead of kind of moving around like I tend to, you know, jiggle in my seat and so forth, but I'm just sitting because I have a lot of energy. Right. But but, you know, when you're eating a lot of sugar, you're resting energy metabolism falls. So your net energy metabolism drops. And so even though these rats were eating exactly the same amount, the one group actually started was losing weight. Right. But the other group actually gained a little weight because of that.

The sugar group gained a little weight, but it wasn't significant. The bottom line is that the major thing driving weight gain is the number of calories you eat. That's what drives weight gain and so the energy balance people always focus on the weight but but if you look at what the what the specific calories are doing this metabolic switch includes blood pressure fatty liver fat you know and those things in insulin resistance they are not driven by excess calories so in other words it's been in other words your blood pressure your cholesterol your blood sugar fatty liver inflammation diabetes pre-diabetes all are driven by the quality of the

food you're eating by the quality of the calories because in the sense that you know we're eating really crappy quality calories that's what's driving this problem and it you know reminds me of a study that david literally did years ago where he took rats and he had them, you know, either high fat, low starch sugar diet or a regular kind of high carb diet, which is what we all recommended. In fact, what we were recommending for the diabetics was eating a lot of carbohydrates, which is crazy. Anyway, he found that basically he had to keep reducing, he had to keep increasing the caloric intake of the low starch sugar rats, rats, the high-fat rats, because they were losing too much weight. And then at the end of the experiment, it was kind of awful, but he opened them up.

And the ones who – and they were eating exactly the same calories. The ones that were eating the high-sugar diet had all this fatty liver and fat around their organs and fat, like all this visceral fat, belly fat. And the other ones didn't, even though they were eating exactly the same calories because they were eating high-fat, low-star sugar. Yeah. You are 100% right. And Dave Ludwig, you know, that was a beautiful study. And he basically said, he knows it's not overeating that makes you fat. It's being fat that makes you overeat.

That's flipping everything on its upside down. Yeah, that's pretty cool. I hadn't heard that that's yeah that's really cool yeah one of the questions we asked i mean which was a question that actually ludwig so a lot of people say that the the primary problem with carbs is that they stimulate insulin and then the the insulin uh drives the glucose into the tissues, and then that causes the fat accumulation. And that's, it turns out from our research, that's partly true, but it's not completely the story. So what we did is we had animals that could metabolize fructose, you know, normal animals.

But we also had animals that we genetically modified so that they could not metabolize fructose, you know, normal animals. But we also had animals that we genetically modified so that they could not metabolize fructose, but they could still, you know, metabolize glucose, they could still produce insulin, all that kind of stuff. And what we did was we gave them, we gave them fructose, and we could block the effects of fructose in the animals eating fructose. But then we gave them sugar. We gave them soft drinks, high fructose corn syrup. And so when we give high fructose corn syrup, that contains both glucose and fructose. So we could see which was the more important player. And what we found was that if we blocked fructose metabolism, they still drank a lot of high fructose corn syrup because, but, but they did, they did not get fat.

They did not get, um, uh, they did not get fatty liver. They did not even gain weight very much. And that they gained a little, but very little. And so that told us that it wasn't really the insulin that's causing the obesity, but really it was the fact that the fructose present in the high fructose corn syrup was really what was driving obesity. Well, this is really a remarkable statement because, you know, we, and this was like a common belief among nutritionists and doctors was that, you know, fructose was good for diabetics because it doesn't raise blood sugar. Right. Right. Exactly. And then the other thing about fructose is that, you know, in sugar, in regular sugar, it's bound tightly with glucose. In high fructose corn syrup,

it's free fructose. And the high fructose corn syrup may be 55% to 75% fructose. We've never seen this before. Now, the other thing that's so fascinating about fructose, and I want to unpack what and take us on the fructose conversation, how it works to actually generate fatty liver, insulin resistance, obesity, diabetes in a minute. But what really struck me years ago is, you know, Dr. Bruce Ames is a researcher, very famous guy. I hope he's alive.

I don't even know. Yeah, I think he is. I think he's still, he's like really old. He writes about aging now. But he basically said that they were doing studies looking at fructose requiring a lot of energy to be absorbed. And the high fructose corn syrup leads to ATP depletion in the gut, meaning that the energy source that we need to actually keep our gut intact, preventing leaky gut, was impaired because when you have a lot of fructose in your diet,

the energy gets depleted and the little tight junctions that keep our cells together in our gut, the little lining together preventing leaky gut, starts to break down. So then you get all these proteins from food and bacteria, crap, actually in your bloodstream causing inflammation, which causes even more insulin resistance and more weight gain. So we can talk about that and talk about why is high fructose corn syrup so bad? Because if you listen to the food industry and everybody else, like, oh, it's just the same. It's all the same. High fructose corn syrup, sugar, there's no difference. And I wrote an article years ago called Five Reasons Why Highuctose corn syrup will kill you yeah i remember reading

that no it actually is uh i have to compliment you uh you know on your your knowledge and what you've been doing and how you've been helping people oh thank you i really really mean that so we actually did studies where we compared high fructose corn syrup to sucrose or table sugar. And in general, even when you level the playing field by giving high, you know, so high fructose corn syrup is free fructose and free glucose mixed together. And sucrose, they're bound together. So one will be absorbed more differently, more rapidly. And the high fructose corn syrup.

And when we give them so that the high fructose corn syrup is 50% fructose and 50% glucose, and you give exactly the same amount of food, the animals that get high fructose corn syrup will get worse fatty liver. So there's something beyond, you know, it's more than just the fact that there's more fructose, but it's also the problem that it's free fructose. Thanks for listening today. If you love this podcast, please share it with your friends and family. We'd love to hear your comments and your questions.

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