people always say body fat equals calories in 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 but what if there's a lock on that fridge today we're joined by Dr Jason fun a leading nefrologist and author of the bestselling book the Obesity code Dr Fong 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 and chronic disease let's get started Dr fun I'm really excited to talk with you um on a topic that very much needs more attention uh 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 or a little less but a little bit less but also climbing very high and truly a worldwide issue right more pandemic than epidemic at this point um I've heard your very strong interest in the topic but you're a nephologist which is uh 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 um followed from type two diabetes so what happened you know from 1977 is that obesity went up and about 10 years later 12 years later what you saw as a huge epidemic of type 2 diabetes which is very closely related diseases and so once you have the type 2 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 20002 2002 and 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 the biggest cause of kidney disease so the 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 uh metabolic diseases they're related to weight and so on and to Lifestyle and a lifestyle exactly and the point was that um around 2008 2009 I realized that as a nephologist uh as a medical profession we had been thinking about this complet completely the wrong way so when people develop their type 2 diabetes we give them medications such as insulin they'd gain weight uh 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 vad came out all of which 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 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 multicenter randomized control trial three different ones actually and what they did was they looked at uh giving people lots of drugs to get their a1c's down which is a measure of the blood glucose and sure enough you could drop their A1C from about 8 to about seven six and a half something like that but the thing was that that's what not what they're interested in we knew 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 deaths turns out it didn't 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 uh sort of uh thing so that this was the Accord study in fact those who got the insulin and the tight glucose control did worse they died at a higher rate which was completely opposite from what we 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 it was 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 uh Ada aha is controlling the hemog globin A1C or the fasting glucose to arrange will not necessarily solve all the problems because there's usually comorbidities happening at the same time as you mentioned high blood pressure uh 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 dka yeah the acute things for dka for sure but no if you had an A1C of 8% versus 62% no difference in mortality whatsoever in fact maybe according to one of the studies but the not the other two maybe even a higher mortality so in fact the a lot of the guidance prior to 2008 was a Target A1C of 6.5 actually that all changed to about s to8 is considered acceptable now it it didn't make a difference and there's a good reason why uh and it's because the their understanding of type 2 diabetes was fairly rudimentary they didn't focus on the weight loss part of it uh you know this is a thing that 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 a1c's 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 I followed those guidelines and they'd gain weight and as they gained weight their diabetes got worse right CU 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 were 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 uh practical experience is that if I have a patient with the hemoglobin A1c of eight or nine and I treat them in most cases in type 2 diabetes I'm not jumping to insulin unless their hemoglobin A1 C is above 10 or they're very poorly controlled yeah 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 um a sanura 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 uh eye issues no it didn't reduce so this remember first is 2008 so they're gp1s and S gt2s which I agree are actually quite good medications uh cuz they cause weight loss as opposed to weight gain but the Sano uras cause weight gain and the insulin causes weight gain so the idea in also causes weight loss as a side effect yeah a little bit it's sort of weight neutral it's not as good as GP uh for sure but meformin is the only drug at the time right that was really any like it was weight neutral at the time he had metformin SAS and Insulin right so by the time you got through metformin which was virtually Everybody by the time they saw me uh they were all heading into uras 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 right that's that's what it didn't show and that's why all the all the guidelines got loosened and 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 uh um that they were treating with insulin too early like they were jumping in and treating with insulin at a hemoglobin C of eight and trying to get it to we all had the targets were six and a half at the time so absolutely we're try the starting point is my curiosity cuz I can see if you're starting insulin too early that you may run into some issues but cuz now the guidelines are starting insulin above 10 uh yeah but remember the targets were 6.5 at the time right so in in 2008 the targets were 6.5 so You' start with metformin MH and if you were still out of seven then next step was Sano Ura and then the next step was insulin right cuz you only had those when was the dpp4s and the SLG 2s when did that all come uh SGL g2s didn't come out till much later 2017 2016 2017 the sort of timeline of this is a little bit you remember this this I guess let's play a little catch up so now we're in the present and uh what what is happening now in the diabetic space in your world so so yeah in the diabetic space actually those drugs uh are are much different because the thing is that um if you think about what was happening in type 2 diabetes with insulin particularly uh because a lot of the patients because there's only three drugs right you a lot of people wound up on insulin so for a while it was you know like five of the top 10 drugs like by Revenue was insulins 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 A1 Seas down it was getting their blood sugars down but the question was where is all that Sugar going right nobody really thought about that it's like okay well you're giving insulin their blood sugar is eight or nine you know their a1c's are eight or nine or 10 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 denova lipogenesis creates FAT that's what insulin 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 our my patients we gaining weight but the the weight gain was the problem which was causing that type two 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 p 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 the insulin we should have been focusing on their dietary changes absolutely and that's where we are now right so the most 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 better everybody knew that right and the the crazy part and 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 the criteria for remission didn't come in until 2023 so last year up until 2023 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 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 but the risks that were created by becoming a quote unquote type 2 diabetic of having a higher risk of ascvd of um kidney issues of peripheral neuropathy those risks stayed elevated is that fair you saying uh if compared to a person who's never had an abnormal A1C uh 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 eight 20 PBS over and compared to an A1C of6 and 20 PBS 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 the the sugars down through dietary control neither were we focused either weing with insul 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 see the worst cases yeah I see the worst cases and almost my whole practice is like CU it's that because it's just you know it's much more common than polycystic kidney disease 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 uh managing um 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 abolutely and and 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 two 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 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 RIS 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 uh well according to current like this is 20 since 2023 it's considered in remission right that's the ter yeah and also like why pre-diabetic range is so interesting it's the the range that is considered the time where you can reverse it yeah and completely stop the progression into type two diabetes but it it can be it can be pervers in that you can go from diabetes into diabetes and remission to 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 so the point being that up until 2023 there the no 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 and and not over a short period of time like really fast right those those bariatric surgery trials if you remember that before they lost a significant amount of weight their a1c's 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 and and from 2010 2012 when all these bariatric surgeries came out that's 12 years before the American Di IES Association said yes 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 yeah it's demotivating to hear that exct yeah I think it's like a in science we get very caught up in the Nuance of vocabulary yeah and we sometimes put too much emphasis on it cuz 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 asly 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 then a victim blaming situation where it's this diabetes is your fault and that could also be demotivating so there's a a range and barometer of yeah I like but but you know to me it's like you got to tell people the truth if it's reversible and if it's largely a dietary disease then that should be the first message you give people it's a dietary disease and it's reversible let me help you do that which is what they didn't say right and that's where I say well that's that's really tough because I remember telling patients look this is a reversible disease so so just to finish so so what happened was I started to realize that weight loss was really important which of course everybody agrees on that's in that's actually in the standards of care for for for in in the latest uh sort of 2024 American Diabetes Association guidelines weight loss is actually quite critical uh 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 2 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 low lowering their carbohydrates right when and again it's not a new thing like cutting carbohydrates is has been around a long time and if you look at the American Diabetes associ ation nutrition guidelines the scientific guidelines they say there's actually the most data this low carb diet has the most data of any diet for control of 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 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 M and it's like well from 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 a 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 caveman days 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 preop you have to fast colonoscopy you have to fast postop 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 just told them you should fast and I I started them on a fasting regimen and crazy it was crazy what regimen did you choose I used a 24-hour fast uh three times a week for my patients uh 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 in in in 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 his 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 I've actually been doing doing all my patients a huge disservice I've been treating them for the last 8 nine 10 years as a DI as a type 2 diabetic that had it for the rest of their life and would inevitably go on to nephropathy 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 it's 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 uh both weight loss and uh 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 uh kidney disease and instead of just treating the condition you started thinking more preventive how can we get ahead of this and the dietary aspect the weight loss diet uh the weight loss aspect is probably the most efficacious way of doing it which we see now and we're talking about more so uh 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 yeah I mean it's just another tool it's you don't have to find has 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 uh but it was something that people um had always done so the 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 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 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 cuz some people try and measure it you know oh I'm burning 2,000 a day but that actually can go up or down by like 40% it can go up up and down a lot so you have no many 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 the Practical aspect practically yeah it 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 it it seems strange now because it became 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 um so but the why do you think people were against fasting I think it's because it was uh 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 s they are the slowest to and you believe that academics and doctors never heard of fasting before this they never recommended it or when they talked about it it was in a like you shouldn't it sort of an idea never concern um I don't know that they had legitimate concerns their concern was that if you didn't eat then you would binged afterwards which can be a concern but on the other hand if it it is a problem like it can happen sure but every 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 the 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 homemake all my meals like you're not eating so you're taking less time than before you're taking less money it's uh you know and and 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 you're 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 referen 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 um you know my my um my um priest used to talk about it every Easter right around lent uh and he talked about fasting and purification and praying and all this sort of stuff and I remember thinking at the time I don't think anybody fast we're all told not to fast uh you're the only one who ever talks about it um 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 a oh you need to fast make yourself better yeah it's always a choice and that's the important thing cuz 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 if you fast if if there's something wrong with fasting like 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 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 is 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 um you know it's a tool right fasting is a tool just like everything low carb is a tool low car calorie 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 o knife pad must not use knife it's like okay maybe Hammer is a better an allergy for that one hammer 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 cuz you eat say a thousand calories 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 700 p.m. to 7:00 a.m. that's a 12h hour fasting period then you break your fast or if you don't eat breakfast until 10:00 right you sleep in it's 10:00 you're talking 13 hours and people did that every single day without calling it a fast right then all of a sudden in 2019 2020 it's like oh my God you shouldn't be going more than 6 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 uh 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 if you take three 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 um the the the compressing it does make you eat fewer calories uh but I think there's actually another benefit to it which is the hormonal benefit which is what 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 um you know this whole idea of uh fat shaming and all that stuff I think it's a little bit a little bit destructive because I don't think that it's 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 uh there's lots of ways less calories will definitely do it but the point is that there's a uh so there's an overlap between calories and Insulin but certain foods raise insulin more than other Foods right so if you uh eat a cookie like a 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 the idea that it's you take you can take two 100 calorie portions so 100 calories of cookies 100 calories of uh 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 I'm like there's no way that're they're equally fattening right because they're different this one will spike your insulin your glucose will go up the cookies your 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 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 right if you eat an egg well the insulin doesn't really go up so it's still circulating around you still got 100 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 the ther 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 but but clearly those two foods have very different insulin profiles right we can Mech right you can do a glycemic index right easy as easy as pie one of them is 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 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 pret to to pretend that that that change in insulin makes no difference to people why would we do that right I'm not asking if the two two are equal calories we 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 ws 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 uh 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 the fact that a certain calorie depending on which uh macronutrient it comes from will impact the amount of weight loss hasn't really been borne out by evidence uh 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 the like DPP they're all like you know a kilo of weight loss over like six seven years well the the failures in a lot of these studies is that keeping weight offs with diet and exercise is very hard and yeah the reasons for that I don't think most people would say is because of insulin uh you see I 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 uh you know there was a study in Pediatrics Dr David Ludwick did this he he he had people taking instot meal actually which is a high high glycemic index and steel cut o meals which is a medium glycemic index so he gave these two 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 uh glycemic index of the high glycemic index inodes was like double that of the steel cut OES then he tested them and said how much do you eat at the lunch afterwards they eat 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 uh 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 and 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 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 lowfat 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 ual weight difference at the end of seven years was like a quarter of a pound right usual diet between and and these people are followed right they're not just like they're 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 lbs a person who who followed this calorie restriced diet weighed 190 and it was it 300 calories less than they were originally eating or what both groups actually Dro 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 and the women's health initiative and that was published in jamama and I think 2007 but but either way it's like it sort of it 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 end 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 um 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 6 months and then that weight always comes back up right well behaviorally uh yeah I me not because metabolically something's happening no metabolically something does happen when you lose weight the metabolic rate goes down right so the metabolic rate goes down 5 to 15% and usually is tied to how much weight also people are losing so it's a pretty small factor no actually the so the there's been multiple studies on this so uh even in 1991 they did a big metaanalysis on this they did 29 studies and they looked at it and they do all the studies about 10 to 20% reduction in calories so you know 300 calories a day sort of thing and then they looked when they looked at the metabolic rate the reduction was about 10 to 20% so if you're eating 10 to 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 10 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 th000 calories my body's not going to cut down to a th000 oh no I've seen calories people because people have come to me and they've done the studies and stuff they 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 wise how do you gain weight or not lose weight when you're under consuming that many calories cuz the amount of calories out is not just your basil metabolic rate that's important hugely but it's also your neat your exercise uh 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 liel did that study where he sort of adjusted people gave them a diet made them gain weight and looked at their metabolic rate it went up and then when he got made them lose weight their metabolic rate went down so it's clearly in response so that metabolic rate if 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 lock step right even those bigger biggest loser studies well the Biggest Loser studies even at the most they had someone's basil metabolic rate and 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 strange I actually didn't see that 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 uh 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 is about a pound a year right so that's 3500 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's caloric variation is huge throughout daytoday right uh is like you know 99 8% or something like that to to to to consume 365 days of 3,000 calories and then at the end of the year only be off by 3500 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 Cor 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 3500 calories roughly a pound of fat is about 3500 calories right so that means the average American or european uh has met has matched their caloric intake to their caloric expenditure to a sort of 99.8 or 9% accuracy rate with 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 basil 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 gp1 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 I think you know to me it's 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 eat because to me I see food as 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 it produces you produce a lot of insulin your body is going to respond differently than if you eat like you know lean chicken breast so so you eat cookies for example your insulin's going to spike way up you eat chicken breast same calories your insulin's 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 uh you know short chain fatty acids which stimulat gp1 so you eat all that fiber you got stretch receptors you got gp1s 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 insulins the gp1s the stretch receptors in our 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 disagre greed upon by people in the nutrition space I think it's widely in fact celebrated to incorporate lean cuts of protein uh 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 that's not much of a difference yeah exactly we're we're that's 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 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 refine 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 a calorie is a calorie it's all calories it's like it's all the insulin Fairy like it's like no has a physiologic role that's all I'm saying right I think everyone I think it's just a 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 over I yes we'll we'll agree on that 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 what happens is that your weight just goes right back down right and then they did these studies what do you mean goes right back down uh so Ethan Sims did these studies in the 1960s and uh another another uh researcher I can't you're saying it's not lasting weight gain if I get it through protein yeah so eth do do you remember this so Ethan Sims in the 1960s I mean we're going way back yeah so this is very interesting because he he was trying to get mice to gain weight and he couldn't do it mice would eat a certain amount then 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 student 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 uh and gain weight they couldn't gain weight uh 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 you could never do this now so he got these prisoners and he basically forced them to eat and restricted their exercise and turns out that he did eventually get them to gain about some weight 10 25 10 to 25% but they were 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 he was actually stunned and 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 didn't 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 takea away 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 we know a lot of about I mean if that's the case why are we just exponentially going up with our obesity that's a good question right because I think that what happened is that in in those situations where they artificially made them gain weight so those people they're fat cells expanded right they gained weight they're eating with 8 to 10,000 calories their fat cells then produce leptin leptin is 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 and there's hormones that will push it back down so leptin did in that case uh obesity mostly is a leptin resistance state but gp1 also pushes it down so I think the point is that the the changes in the diet in the American diet from like 1977 where it started to Spike up to you know uh 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 um 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 nobody they're not giving a away a lot of free steak why because the uh peptide y y goes up the chosy toyin goes up and these satiety the gp1 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 you change them into Ultra refined carbohydrates so there's no protein there's no fat so there's no peptide YY there's no kisinin if you eat a bulky meal like lentils or something or beans well your stomach fills up right and your stomach stretch receptor sends through the vagus nerves tells you stop eating just like if you have a beoir or something right you have to stop eating so big volume high fiber foods are going to do that other foods like the gelp ones they're going to slow down your gastric uh 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 Gast 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 re you know people always say Okay body PE you know body fat we're 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're got too much body fat so body fat is regulated eating behavior is reg 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 your meal you're no longer going to be fat so that's a self self fixing problem there but I think you might get caught yeah but but anyway the point I want to point out with this whole situation cuz I think I agree with you in totality when it comes to the hyper processing of food with how nons satiating it is and really those are hormonal issues the nonsti 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 the prisoners were able to lose the weight is because they didn't yet develop a sort of resistance yeah to to those hunger hormones because it was 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 uh the majority yeah 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 were 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 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 it's which is a behavior so you're saying calories in calories out plus Behavior well the behavior is what drives the calories in calories out right so if you eat Ultra processed foods you're not getting any Sati 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 few 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 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 when they all because whenever I talk about I 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 drops your insulin but there's tons of people who come back to me it's all about calories it's only about calories it's only about I'm like okay well you I just feel like if you're trying to create a a modifiable factor for someone yeah in the same way that you talk about Tim restricted eating or intermittent fasting as being a practical solution for people because it's simple yeah 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 yeah 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 exponential than it is to think about all these hormonal processes which are much harder to control in some ways oh I I I never tell patients all this what I tell them because the insulin to me is I like 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 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 oh I guess you mentioned that it's not super accurate and hard uh it's it's inaccurate clearly it's uh 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 but you have to count how much butter you're putting in but isn't that a valuable educational like I I I never really recommend calorie counting per se for most people because longterm at least cuz I I think longterm it can be overwhelming and 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 fist full of chicken or a fist full 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 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 really uh makes it difficult is this idea that you can eat whenever you feel like right never skip a meal you have you know midm morning snacks you have after school snacks you have bedtime snacks and you can eat anytime you want I'm like no no no what you want to do is eat Natural Foods that's 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 it's 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 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 a little 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 utive way to eat as opposed to saying you eat breakfast 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 well I I don't doubt that counting calories could work it's this sort of artificial structure and and sometimes it's not good because if you eat you know and I've seen this I 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 I don't know what maybe they were making a point of like the fact that calorically it's the same thing calorically they were the same and they were making the point that they're like Health implication wise they're not exactly the same exactly that's what I think I drives me crazy because it's like yes they're the same calories I agree with you on that but the health implication 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 1,000 calories of steak 1,000 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 do 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 you 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 that's not how real life works right and I'm I'm only interested in real life because my patients live real life I think what ends up happening um by people who may disagree with you is I don't think they're disagreeing with you on that message I think they the people who are disagreeing also agree that ultr processed foods are the problem the fact that they're nons satiating we are drastically underc 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 factor is 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 th000 calories only and I give them extra insulin that person's not going to be gaining weight uh well let me give you a different situation because you know people always say energy or body fat equals calories in 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 uh 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 have 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 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 the calories in 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 ,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 so500 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 to exactly so insulin's up well what happens well you cannot take energy out of those fat stores because insulin it 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 uh 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 eat snacks I don't think I've ever said that or my in never T that but I think you're it's probably from more like five six years ago people used to say that a lot like a lot of the 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 but I heard that a lot but say you keep insulin high right so this is just a thought experiment so 2 1500 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 yeah High I mean a beef steak will spike your insulin pretty high uh yeah a steak can although it it also spikes glucagon so therefore glucose doesn't go up but I'm saying the insulin spike is pretty high can be yeah so like I guess it depends how much you're eating every those two hours um yeah yeah but I mean as I said it's just a thought experiment right so suppose that you 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 A500 calorie diet every 2 three hours that seems like impossible I don't think so because certain foods spike it really high right they refined carbohydrates right so every 2 hours you're eating like a slice of toast or crackers or something like that that's a lot that's going to be more than 1500 like the math doesn't add up in that thought experiment so you're saying that if you eat 1500 calories your insulin has to go low yeah lower than if you were eating the 2,000 which oh yeah yeah yeah yeah if you're eating the same Foods at two at 1500 it's going to be lower than 2000 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 um like there's a huge difference so in that David Ludwig studies he compared uh an omelet to uh the instant oats same calories the spike is like you know four times higher with the instant OES so 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 fine carbs you can keep your insulin pretty high right and you're saying you won't lose weight well if you your insulin stays high and you can get this by 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 hyper insulinemia that goes along with it then it's actually really hard to lose weight sure right of course so say you have the insulin resistance then insulin levels are high well what does insulin do well insulin inhibits lipolysis it also inhibits glycogenolysis 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 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 1,500 calories coming in 2,000 going that you want to burn but insulant is high for whatever reason you can't get any of those calories out of your fat stores so they're 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 expedent they were cutting it by 15 by 500 and in this situation we're dropping it that aggressively the basil metabolic rate um I'm not sure that like the I don't know about the Biggest Loser study like some of the ones that I saw were actually down almost a thousand uh calories but if you look at I've never seen a thousand that's so aggressive so so the old the basil metabolic rate you've seen studies drop by a thousand in in one event that was that was um in the New York Times They had this graph of uh that guy they profiled anyway his dropped I think from 3,800 to 2900 or something like that it was quite a bit this is his basil metabolic rate was 3,800 or his total exponential total expenditure well is not the basil metabolic the total energy expenditure which is not just the basil 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 1500 through Behavior change as well uh 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 uh 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 Cal you can't get the glycogen to break down there's a disregulation of it for sure but you still can otherwise people would die in those scenarios if you can't get any energy 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 drop uh 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 other 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 uh yeah but then over the over the 24 hours that's the comparison right what's your insulin over that 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 um irrespective of calories yeah I I think it's the total insulin effect I mean to me it's like you know if 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 me it's a causal well it doesn't always happen if they're not eating enough calories it's not enough energy to store uh no they've actually done the study so they did this study in uh it actually that's not true because they did this study this was about 10 years ago where they actually um gave people insulin so type two diabetics they gave them they went from it's 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 0 to 100 units of insulin over 6 months and when they measured the calories that they're taking in the calories went down about 250 calories this was from Henry controlled this was uh meaning the calories were controlled they weren't controlled because it was a six-month study so people were just self-reporting how much they're consum because because of yeah they told them not to eat so much you know for all so they gave them General guidance right to maintain your but your insulin went from Z to 100 units a day M and your calories went down from about I think is around 2000 to like 18800 or something like that right so the question is which one is more important right if 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 100 units is a lot for sure but they're it's like cutting someone's calories by a thousand and saying look how much better it is than insul well but the question question is if you're if it's all about the calories they're eating 800 200 calories less per day they gain I I don't know what they were consuming before then to get started in that study yeah I mean they don't they don't report that in the study because of course they only counted the C I'm just curious like in the metabolic Wards of these scenarios where they're eating foods that are potentially hyper insul liic that they produce more insulin with the foods that they're eating yeah in a metabolic Ward they gain or lose the same amount of weight strictly depending on calories how do you take that randomized Control Data from metanalysis and say that insulin is more important where we have people that have high insulin with their High carbohydrate diet versus a low carbohydrate diet and if the calories are maintained the weight doesn't change how do how do you make sense of that in your mind well you know I think that well me 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 they they all on average that's not a randomized controll study so no no it's just it's not a randomized control 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 it at one year by two years by 5 years it's going to be virtually the same and and that's that's why it's hard because if you do a random 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 um it it there to me there's clearly something more than just the calorie story like in the end I don't think it 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 uh yeah don't eat cookies eat chicken right as I said the ultra processed foods are the issue Behavior exactly the the TIY 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 gp1s or peptide YY or kocy ainin or gastric stretch receptors or we haven't named yet exactly like because fiber for example fiber has no nutrients so why is it important well because mechanic exactly it it plays a role receptors Barrow receptors and slowness of gastric emptying absorption all same thing with you can do the same thing with um I can't remember what they did it glucomin or something like that it forms like this this this gel inside the stomach and then it slows down this the the gastric uh emptying which made a difference right and various there's lots of studies but in the end it's not necessar just the calories right that's 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 think no one argues that I 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 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 it's all about calories it's calories is everything right and maybe 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 the studies that show me how well condoms work in terms of contraception and then I have real world numbers which are 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 and nuanced yeah but I I think I I agree with that although I'm not 100% sold that it makes no difference because if you give somebody a 100 units of insulin and reduce their calories by 200 they'll still gain weight well because the numbers are not the same you're giv way more insulin and taking 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 their metabolic rate enough so that that 1,800 calories they're going to gain weight right that's the only way work also like the idea why 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 exponential 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 this is just so that's why like I don't know what to do with that information nor is it comparable so this oh yeah and and the the the the magnitude is different but there's lot plenty of people I I I I mean I guess I 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 gp1s 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 e that's what that's what time restricted eating also about eating less of the right food right of course you can eat toilet paper and lose weight that's not what's recommended yeah exactly and it's you're going to eat less junk food you don't want to eat less broccoli right it's the same way that people say eating vegans healthier and then they eat impossible Burgers which are junk food in the highly processed yeah exactly and and I guess it's it's it's sort of cuz 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 and and if you're going to be strict with it yeah 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 diff I I 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 absolutely and then there's the whole world that is unexplored of the microbiome and what impacts the ultr 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 pedaling a little bit too much of supplements in this space for my taste yeah and I think that this is the this is actually a really important topic uh 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 that you're hungry but it could be something completely different you could be craving it you could be addicted to it and if you are you know and and I think this happened a lot during Co if you're a little bit dymic or depressed and that Snickers bar makes you feel better because it's the sugar sets off dopamine sure going to eat that Snickers you were never hungry yeah it was the for sure mental health plays a role in this and uh 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 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 cuz I think you largely agree so I'm glad that actually we're having this conversation bringing it to light cuz like what ends up happening is if you go on a podcast with a non-medical individual uh like Diary of a CEO yeah and they clickbait the title and the 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 and people will always do that I suppose because it's you know I will I promise I won't this is not what this is this is about bringing the conversation to show how much we agree as opposed to that there's abely and it's you know I always think of the calories as sort of the proximate cause that is it's it's not that calories in is greater than Cal I'm not 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 got to eat the foods with the right signals whether it's gp1 or insulin or whatever is the reason your calor 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 uh working night shift is it because you're uh have um Cravings is it because you're depressed right then deal with the depression don't just say eat fewer calories which is sometimes I guess maybe I see these clickbaity things it's it's all about calories right it's like no no no it was about depression it was about addiction it was about Cravings that cause 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 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 socionomic or all these 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 in the board meeting then you're going to but you didn't need to you never needed to but it 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 um the the environment that made it normal for you to do that right but definitely not the insulin well it it plays a role there's a there's a of there's a yeah no one no one's arguing that I'm I'm 100% on board with you on that the the world that I think that you've kind of found yourself in and why perhaps there people arguing against you is you're in the world of this extremist diet tribe World a b nutrition research has been so flawed see 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 me mechan mechan mechan mechanic 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 found it intermittent fasting or you were the inventor yeah I never say that people say that actually 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 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 a 10 million view clip out that's not the goal and I feel like that's done tremendous harm there was one uh point that you made I forgot where it was about timing of uh intermittent fasting that you believe it's better if you were to skip a meal skipping dinner is favorable to skipping breakfast uh I was curious why you 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 uh at 8:00 a.m versus 8:00 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 um you know uh before around 5:00 a.m. you got this 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 uh 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 8:00 pm. and least hungry at 8:00 a.m. so if you're going to skip a meal you vers breakfast versus dinner if you skip um 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 at 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 I see so you were looking at it from like the Practical standpoint of when you're hungry yeah yeah cuz people ask me should I skip breakfast or dinner so so really I think it's like so individual 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 skip like the dinner tends to be bigger right than than breakfast so if you skip dinner you're going to skip more right um but practically it's not easy to skip dinner all the time because that's the most social of all your meals right 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 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 coffe 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 and honestly the funny part about fasting is that you know it's so you know people are so against it but then uh in 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 mechan why can't I say mechanic mechanistic mechanistic Jesus but the the you know it's funny because the doctors were I say oh yeah I used to do that time used to skip you know i' 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 Absolut 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 I don't eat breakfast most of the time and I said as I said I I started in medical school um but I it got into a habit so I almost never eat breakfast I mean I do sometimes but now if I eat breakfast because I 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 day 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 midm morning snack lunch mid-afternoon snack dinner could times a day and be totally healthy and oh certainly certainly you can I'm not and I'm not saying that you can't it's just that you know uh from a habit standpoint I'm actually just way ahead because you know there's there you've been do it for long yeah less decisions you make less decisions to make it's easier and I not using my store of willpower to skip those yeah I think this is where the calories in 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 over consume calories in an 8 Hour window and not lose weight yeah just fasting alone doesn't solve 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' 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 a th000 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 yes so but it's going to be kind of small right and those so those first few and there are some people that fall into that pattern some people actually do well with that like I don't doubt no meaning uh some people fall into the pattern of binging oh 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 metanalysis that looked at uh Tim restricted eating removing the breakfast component or the dinner component and from a cardio metabolic marker standpoint they didn't see much of a difference in which one they Chang so I think it needs to be individualized for the person socially culturally culturally based on what they eat so I think it really although I do see a lot more studies now where they're doing this early TR so there's a couple of studies that came out recently that looked that early TR which was stopping at 2: p.m. right so it's like that's early right because they shifted everything up early uh they didn't compare it to the late TR 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 it show the biggest uh difference which I agree sort of but again you have to weigh you know you can't take you can't take it out of the context of life course exactly because it's it's just like anything else if you if you impose such a difficult regimen on people they'll they'll stop doing it and it's like 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 uh you know pleasure addiction Cravings out of the you're not going to be successful because cuz you're actually only dealing with like 30% of the actual problem uh which is that you know which is that people eat for all different reasons right and you have to eat also you have to 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 overc consuming food I'm not getting them all food but you can say for example no sugar but I never do because it's it's like one it's really hard and two it's almost too much to be unreasonable 100% sugarfree right you 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 if you're taking so much pleasure out of food are they going to sort of rebound later 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 you have to take a little bit more of a s of yeah holistic view so it's not it's not just about calories and it's not just about uh hormones and it's not just about social behaviors 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 um between Americans and Italians for example but Italians you know they're eating their pasta right they're 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 ultr processed foods I mean I I had a friend who went to Italy just recently said I thought I'd gain five pounds I actually lost a couple pounds it's like also people like to increase energy exponential 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 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 prazone they gain weight so if you way overstimulate cortisol like prazone that's artificial but you gain weight so but you can extrapolate like if you are under a lot of stress so I I know a lot of people think they gain weight if you don't get enough sleep do you gain weight probably I would I would think so right and and maybe it has nothing to do with your diet but it has to do with well ultimately it does ultimately it does but start with a behavior thing it ends up being 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 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 PR sort of what's the root cause and then the calories is sort of that sort of intermediate step which leads you to the weight gain sure so focusing on that intermediate step's not useful you got to get to the root it cause of things it can be I don't want to limit that because it can be for some and oh for some for some and it's a good educational component from an understanding yeah variable yeah but it's 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% true that you can just eat whatever like as much yeah exactly but that's how that Mees cuz like that 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 mean yeah no it's not because it's if you eat healthy foods but then you have to stop right yes 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 till lunch or right through till dinner but you 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 and they're pretty good most of the time um unless they develop that resistance and disordered eating and all yeah yeah so I think it's it's it is it is so many of us are in yeah it is it is far more nuanced than yeah I can eat whatever I want as much as I want as long as it's healthy and I'm Pro say there is a stopping point that you're supposed to listen to which is the calories in calories out sort of motto yeah exactly because you're your those natural foods are supposed to Signal you signal you the issue is 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 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 hor hormone so those hormonal signals are all messed up why I think there's a lot of reasons um but I think that that's that's where it's 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 we could actually get the hormonal influences in a better place yeah yeah I and I think that's where intermittent fasting to me was a very uh useful thing to be talking about because yes it's calories as well as hormones like you're moving them in the right Direction they always move in the right yeah 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 is supposed to go down like you know there's a correlation between the two sure when you have your calories going down but your insulin going up that's not good right you want both moving in the right direction right and that's where um some of the you know some some sometimes it's it's just useful to think um about what other hormone influences you can affect right how can you affect well that's the future drug targeting yeah exactly yeah exactly the gp1 is obviously very topical Gip um but there are natural ways you can actually augment them certain foods are very glp1 exactly certain foods are do stimulate that so how can you use that knowledge because you know that the GP ones are actually effective like to help you make a behavioral change or food drive change like Mike Isel talks exactly so if you know that say protein is going to stimulate a lot of gp1 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 nutritional camp and uh everyone else where is going to be your future area of interest and 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 uh line of thought for Inquisition well I think that so it sort of fell along the lines of uh so weight loss being much more than just calories there's a whole hormonal component then intermittent fasting was a second third was type two diabetes being reversible disease which is just now sort of being mainstreamed uh you know accepted that it is a reversible disease and all that sort of stuff um I think the next thing uh and then I wrote another book called the cancer code which was actually I thought really the most fascinating stuff I had written it's about the evolutionary Paradigm of cancer it's like how cancer develops had nothing not a lot to do with insulin although there is actually a correlation uh between the two so that that was to me the most interesting uh although the least sort of practical uh book that I did and then now I think um what I want to talk about more is about that whole um 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 uh you know there's lots of uh different like instant OE versus uh 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 sort of composed so when you grind that um that wheat if you use Stone grinding for example it's very different than if you use a modern flower grinder where you get this very very fine dust because the absorption of the modern flow is is instant because everything is ground up brown rice white rice fruit juice ver eating the whole fruit so yeah there there's absolutely those are important so food order is important if you eat carbs first versus carbs last if you eat uh 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 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 amasis 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 amasis but it doesn't so in fact by taking it with vinegar or fermented foods so things like you know sourkraut and stuff you can actually really reduce the uh 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 um consuming certain red meats if you consume them 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 uh you know the effect on those foods and also the gp1s the how Foods affect that and then um 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 it's not one thing it's a whole lot of like it's like oh man it's the Facebook ification Netflix ification of food 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 it's like wow that's fascinating so this ultr processed foods that you know uh take away all the satiety increase the dopamine uh get one of the food scientists that's hired by one of these uh 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 um 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 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 Pepsis 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 lbs I'm like yeah because it wasn't that the diet peps had calories that's not the point it was the hormones the whatever is triggering that sweetness was triggering 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 what's behind the calories right and and you know a lot of these chemicals like in the US they talk about this right it's been very topical about how uh a lot of ultra processed food in the US is way worse than the stuff you see in Europe right it's like um well it's mixed and also there's I'm scared of fearmongering around chemicals because like what's a chem water's 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 yeah especially when it comes to prepackaged 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 there I I I agree with you I mean chemicals obviously are not all bad but are they all necessary because that's the I think that's the point of comparing the European you know I I saw some posts where they're like you know Froot Loops or whatever it was and you know there's a huge difference there's all this chemical in the US one and I think it made it brighter or something like that you know they had all these food dyes in it and the European one they're all bandn so that they look lot paler but they had the ingredient list was much less I'm like do we really need all this stuff in the US one like is that necessary cuz 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 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 think it's playing a huge role cuz 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 I it's unnecessary yeah and it's clearly like I think the shoe should be on the other foot right we 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 way yeah there's a lot of nutritional complications like even uh with the pesticides of it all like I 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 uh the main pesticide that we use here is um not likely to cause cancer in humans right versus the wh's uh organization the IC said that there's a probable link to cancer and humans yeah and how they both came to the appropriate conclusions based on what they were studying was just slightly different in slightly different populations and when you'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 so very interesting how you look 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 in the systemically it must be yeah right I don't think I think that's like widely accepted now especially in education like the way that I'm teaching my residents the way that medical schools hope so because it it wasn't for a long time because I I'll tell you that when I you know learned about obesity in medical school it was all about personal responsibility think the world calories out well I think that a lot of people still practice that way or there's a lot of people who medical inertia still yeah exactly it's that inertia and and it's it's really unfair I think because 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 last 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 uh 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 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 the 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 uh Fresh Foods Whole Foods you know um into the mix like not not just take that away from them cuz you know maybe that's all they can afford right well I'm glad we covered it thank you so much Dr fun I appreciate your time yeah clearly the nutrition space is very complicated but there's a harsh reality to losing a huge sum of weight click here for a video on that topic very specifically huge thanks to Dr fun for coming on the the podcast for having such a deep intellectual and open-minded conversation it seems like we agree a lot more than we disagree as always stay happy and healthy