#1037 - Chris Kresser

[0] move over a little bit i seem all right three two one yes all right welcome back chris what's up man how's things happy to be here things are good happy to have you yeah what's the latest and the greatest with you uh new book came out yesterday that's always a big one what's called unconventional medicine and uh give us the what's the what are those sheets the back sheet what's that called the yeah the back sheet that works the biggest challenge we face today is chronic disease and conventional medicines failed to address it so we need a new system that's the nutshell and you're essentially based is doing nutrition based advice for this three components ancestral diet and lifestyle which we've talked about functional medicine and a collaborative practice model that incorporates health coaches nutritionists and other allied providers to offer more support to patients.

[1] What does that mean when you say functional medicine?

[2] So the easiest way to understand it is it's an approach that is geared towards addressing the underlying cause of a problem instead of just suppressing the symptoms.

[3] So you go into the doctor, you've got high cholesterol, usually given a drug to lower it.

[4] Statins.

[5] Yep.

[6] You've got high blood pressure.

[7] And those are devastating to your health, right?

[8] Statins are.

[9] Well, you know, for some people, you know, they can be.

[10] I wouldn't say they're devastating for everybody and they do save lives in certain situations.

[11] But the idea that they're the first thing we would do in that situation, that's what's off.

[12] Right.

[13] That you wouldn't suggest like altering the diet.

[14] Exactly.

[15] Let's look at why the cholesterol is high in the first place.

[16] Same thing with high blood pressure.

[17] You go into the doctor, high blood pressure.

[18] You get a drug to lower it.

[19] There's rarely any investigation into why the blood pressure is high.

[20] And what are the main factors with high cholesterol?

[21] Because I know that it's a A big part of it is hereditary.

[22] Yeah.

[23] Genetics play a huge role.

[24] Yeah.

[25] So the genetics is one, for sure.

[26] But then you have things like poor thyroid function can actually lead to a high cholesterol or LDL particle number.

[27] You've got infections can do that, like H. pylori, which is the bacteria that causes ulcer.

[28] You've got leaky gut intestinal permeability has been shown to do that.

[29] That's interesting that.

[30] Did you talk about this before?

[31] But a lot of people are not aware of that.

[32] that there's actually gut bacteria that causes ulcers.

[33] Yeah, yeah, there's a, it's a cool story, actually.

[34] So, you know, 20, 30 years ago, the dominant idea was the ulcers were caused by stress and things like eating spicy foods.

[35] And a couple Australian physicians presented at a conference this notion that, no, actually they're caused by this bacterium called helicobacter pylori.

[36] And they were literally laughed off the stage.

[37] Nobody took them seriously.

[38] They were ridiculed.

[39] and they kept going, you know, kept doing this research, kept trying to present this idea, and nobody would take them seriously.

[40] Finally, one of them swallowed a vial of a solution that had the bacterium in it, developed an ulcer as a result, and then treated himself with antibiotics and got rid of the ulcer.

[41] Whoa.

[42] To prove, this is how committed this guy was to this idea and proving this.

[43] And finally, at that point, people started to pay attention, but it still was another 10 years before that theory was widely accepted, and then they eventually won the Nobel Prize in medicine as a result of that discovery.

[44] So to me, that's a great example of how groupthink is such a problem in medicine.

[45] You know, we have a tendency to just, like, get stuck on the status quo, even though a core principle of science is uncertainty.

[46] We come up with the hypothesis.

[47] We have to be willing to challenge our most cherished views all the time.

[48] because if we look at the history of science, it was the history of most people being wrong about most things most of the time.

[49] Yeah.

[50] And it's amazing how many people are still operating under information that has been updated many times over the past couple of decades.

[51] Absolutely.

[52] Talk to the average person about what you should eat.

[53] I mean, they're looking at like the food pyramid from the Dr. Seuss books.

[54] Exactly.

[55] I mean, really.

[56] Yeah, or another one is you probably saw some articles like stents.

[57] Yes.

[58] They don't work.

[59] Yeah, I just read that.

[60] came out, they don't work, but they're still massively being used in part because they get, uh, doctors get paid for that.

[61] Now that's crazy because I thought a stent was like, I thought it propped open the artery.

[62] I mean, what does it do?

[63] Right.

[64] And, but the question is, does that actually have the desired effect?

[65] I mean, was the, I think was based on pain, wasn't it?

[66] And mammograms prevent, we're supposed to prevent breast cancer.

[67] Right.

[68] They don't.

[69] But then we saw, you know, the huge randomized controlled.

[70] trial that showed that they not only do they not prevent breast cancer, they may actually increase death as a result of unnecessary treatments that come from the mammograms.

[71] What?

[72] Yeah.

[73] How would you get an unnecessary treatment?

[74] Like if you did a mammogram, you saw a lump.

[75] Well, it's not always black or white.

[76] So it could be a cyst or something on those lines.

[77] And then somebody gets unnecessary treatment that leads to an adverse event.

[78] So I'm just saying it's, you know, we got to be humble and realize that we don't always have the answers and that in 10 years it's going to look really different than it does now.

[79] Just like 100 years ago, everybody thought they had the answers and we look back on them and we say, how silly, you know, but we forget that people 100 years ahead are going to look back on us with that same, you know, that, you know, they're going to shake their heads.

[80] Yeah, it's very unfortunate, but that is a tendency that people have when they've been living their life based on what they think is like certain rigid information.

[81] Like this is absolute, this is true.

[82] and they've been teaching that.

[83] That's when it gets especially problematic or writing books about that.

[84] And then they just never want to admit that their book is bullshit.

[85] And I think our education system needs to change medical education because, you know, you write a textbook and that takes a long time.

[86] And then, you know, the textbook is used in course.

[87] Like the medical schools are still using the nutrition textbooks that were probably written in the 70s or the 80s or something.

[88] And then we get all these new studies showing that like cholesterol on the diet has no impact, you know, on your blood cholesterol for most people.

[89] Now, say that again, because for a lot of people, they're like, what did he just say?

[90] Yeah.

[91] So even the American, the standard U .S. diet guidelines last year, a lot of people might have missed this.

[92] They completely removed any restriction on dietary cholesterol from the U .S. diet guidelines.

[93] They basically said there's no reason to limit cholesterol on your diet anymore.

[94] Now, for people who don't know why this is so crazy or how this came to be, you need to go to the New York Times article on how the sugar industry bribe scientists and convince scientists to publish faulty or false information pointing towards saturated fats and cholesterol as being the cause of heart disease and heart attacks and all these different ailments so that they could push the blame away from sugar.

[95] And I think they only got paid something like $50 ,000 to do it, which is amazing.

[96] Do you think about how many people that's affected?

[97] Yeah.

[98] And these, I mean, these conflicts of interest are everywhere.

[99] That's a big problem.

[100] That's not just conflict of interest.

[101] I mean, that's just crime.

[102] Right.

[103] They did some horrible things to people.

[104] It totally, you know, it's unfortunately pretty normal.

[105] In medicine, there was a study that just came out a few days ago that showed that the more gifts doctors receive from pharmaceutical companies, the, more expensive, the drugs they prescribe, and the more prescriptions they write in general.

[106] Yeah, I would imagine that's true.

[107] My wife's mom was a nurse, and she would tell me stories about how they would take them out to nice dinners and fancy restaurants and everything on the house.

[108] It's human nature.

[109] I mean, one of my favorite quotes is from Upton Sinclair.

[110] He said it's difficult to get a man to understand something when his salary is dependent on him not understanding it.

[111] That's a great quote.

[112] So one more time.

[113] Dietary cholesterol has no impact.

[114] Yeah.

[115] Well, I'll be more specific.

[116] So in 70 % of people eating, you know, egg yolks and cholesterol and meat and other things doesn't do anything to your serum cholesterol, the cholesterol levels in your blood, in 30 % of people, you'll get a slight raise in your LDL cholesterol, the so -called bad cholesterol, but you'll also get a raise in your HDL cholesterol, which is the so -called good cholesterol, which means there's no net clinical impact of that in terms of your risk of heart disease.

[117] And this is why the U .S. finally, the last industrialized country to actually do this, they finally said, okay, well, we just can't do this anymore.

[118] We can't tell you not to eat dietary cholesterol because there's just not any evidence to support that.

[119] What took so long?

[120] Well, I think you just referred to one of the reasons, you know, conflicts of interest, people that were invested in maintaining the status quo.

[121] I think also there's probably some concern about losing credibility, you know, these government organizations, if they told us not to eat cholesterol for so long, and then they tell us that we can, and it's not a problem.

[122] And they do that with saturated fat.

[123] You know, people stop listening because they just throw up their hands.

[124] They're like, I don't know who to believe or what to listen to.

[125] Saturated fat is another one.

[126] You talk to the average person, they think you should restrict your intake of saturated fat.

[127] Yeah, average person, most doctors still.

[128] And, you know, I think there is some nuance here.

[129] And, you know, maybe we talked about this on the last show.

[130] But where we're headed, in my opinion, with diet and nutrition recommendations is from general blanket recommendations that apply to everybody to more personalized recommendations that depend on your genetics, your goals, your lifestyle, your health status, your age, et cetera.

[131] So let's take somebody who is APOE -44, which has a certain genetic haplotype, and they have, you know, they're really sensitive to the dietary effects of saturated fat if you have that genotype.

[132] How common is that?

[133] Not very common at all.

[134] I can't remember the exact percent.

[135] It's below 10 percent.

[136] I think it's 3, 4 percent or something like that.

[137] And if those people eat a lot of saturated fat, their LDL particle number, which we can define if you want to, those are the particles that carry cholesterol can go up pretty quickly.

[138] And what we know, at least from the research that we have, is that people who have a much higher LDL particle number can be at higher risk for heart disease and Alzheimer's.

[139] There's some murkiness there because that's just on average.

[140] You know, we don't know if that risk applies to people who are eating, you know, paleo type of diet, doing cross -fayette, taking care of themselves in every other way.

[141] We just know that the general population, in the general population, a higher LDLP leads to a higher risk of these conditions.

[142] Now, I know people, I'm sorry to interrupt you, but I know people, some people know this, but some people don't.

[143] What is the difference between LDL and HDL and HDL and why is one good and one bad?

[144] Well, you know, here's a just so this could be a standalone podcast.

[145] Here's an example of how things are changing again.

[146] So historically, the idea has been that LDL, which stands for low -density lipoprotein, and HDL stands for high -density lipoprotein.

[147] The LDL, the idea was it was bad, has a number of effects that contribute to the risk of heart disease, whereas HDL does a kind of like clean up and repair process and actually reduces the risk of heart disease.

[148] But just a couple weeks ago, there was some pretty influential research published suggesting that HDL may not be actually so protective, and it may be more of like a bystander effect, where people that have lower risk of heart disease just also have higher HDL, and it's not that the HDL is protecting them, it's whatever other underlying processes are protecting them happen to lead to higher HDL levels.

[149] Oh.

[150] And the reason that they think this now is that they've done a whole bunch of trials on drugs that raise HDL.

[151] And guess what?

[152] Nothing happens.

[153] They don't, the people who have an increase in their HDL because of the drugs don't have a lower risk of heart disease.

[154] And in some cases, they've even had to stop the trials because it became clear that there was not only no benefit, but maybe even some harm.

[155] So what kind of harm would there be?

[156] Just more, you know, more cardiovascular events.

[157] more deaths.

[158] Oh, wow.

[159] So it's just another example of something that we just assume for so long is true, and then we find out that it's not true.

[160] I had a conversation with a guy who was a brilliant guy, and we were talking about eggs, and I said I like to eat about four to six eggs a day.

[161] He's like, wow, what about all the cholesterol?

[162] Yeah.

[163] And I'm like, wow, you don't know?

[164] Like, you don't know that, and you're a really smart guy.

[165] Like, this is kind of stunning.

[166] Yeah, I mean, it's, and it's going to take, so what I just told you about HDL, think of everything that has to change to reflect that new understanding.

[167] You've got textbooks that need to be rewritten.

[168] You've got primary care guidelines.

[169] You've got, it's just massive.

[170] It's almost impossible to get our head around.

[171] And so the average primary care provider is not going to get this message for decades.

[172] I would say decades, not more than years.

[173] That's crazy.

[174] Yeah.

[175] So they're going to be giving out bad advice to people.

[176] So the average person who works all day and doesn't have the time to do the research that you do or maybe isn't informed about all the various blogs and books and just doesn't have time.

[177] It goes to his primary care doctor and asks some questions, and he gets terrible information.

[178] Because unfortunately, the primary care doctor doesn't have the time either.

[179] You know, they're in a bad spot.

[180] You know, I know a lot of primary care physicians.

[181] Everyone I know went into medicine for the right reason.

[182] They're trying to help people.

[183] They're doing their best, but they're seeing 2 ,500 patients.

[184] That's how many they have on their roster.

[185] their average visit is between 8 and 12 minutes because they get, you know, reimbursed based on the number of visits.

[186] So in order to make a living, they have to see a certain number of patients a day, and the insurance companies often mandate that.

[187] So in a 10 -minute visit, patient shows up with multiple chronic conditions, taking multiple medications, and then presenting with new symptoms that they're concerned about.

[188] There's barely enough time to say hello and, you know, figure out what's going on with their mental.

[189] meds and make an adjustment and make a new prescription, much less to talk to them in any kind of meaningful way about their diet and their lifestyle and their behavior.

[190] Forget it.

[191] It's impossible.

[192] So the primary care doctors, I think, are as much victims of our conventional system and the way it's set up as patients are.

[193] And if they're busting their butt, seeing patients eight hours a day every day, and then they have all the paperwork to do on top of that, last thing they're going to want to do is go home and fire up PubMed and start reading, you know, the latest studies that have come out.

[194] Yeah, for sure.

[195] They're going to be exhausted and non -motivated.

[196] Yeah, and they've got families, you know, they have other things to do.

[197] And there are studies that have shown that the majority of primary care physicians, understandably, given this situation, receive most of their education from pharmaceutical sales reps, you know, who bring in the brochures that, you know, talk about a particular condition.

[198] And, of course, those are, that's not going to be unbiased information.

[199] That's hilarious, that they get their information from that.

[200] Wow.

[201] Yeah, because the reps come to the office.

[202] Yeah, and so they have the brochures to the drugs and the brochures talk about the condition and, you know.

[203] They have cartoons and pictures in there and showing you the bad stuff that's happening to your arteries.

[204] It's a crazy system and it's really, we're in big trouble.

[205] I mean, that's the message in my book.

[206] It's like, you know, this is not just a. about individual health, which is my first book was about, you know, taking back your own health.

[207] This book is about taking back health care because we're screwed.

[208] If you look at the numbers by the year 2040, it's estimated that 100 % of the federal budget will go towards Medicare and Medicaid expenses, leaving nothing for anything else, military education.

[209] By 20, what?

[210] 2040.

[211] What?

[212] Talking about our lifetimes.

[213] That's real?

[214] That's real.

[215] That's if health care spending continues to increase at its current pace.

[216] That's insane.

[217] You're right.

[218] That doesn't even make sense.

[219] This is why the Department of Defense has named healthcare as an existential threat to this country, just like, you know, nuclear war or any other military threat.

[220] They've named chronic disease as an existential threat that could actually, you know, threaten our survival as a nation.

[221] Wow.

[222] Who ever thought of it that way?

[223] Who could have ever imagined that literally all of our budget would go to taking care of people's health by 2040?

[224] Yeah.

[225] That's not long.

[226] It's not long.

[227] That's 22 years from now.

[228] Let me give you a few examples just to make this more clear.

[229] So the cost of treating a patient with type 2 diabetes is estimated to be $14 ,000 a year.

[230] Okay.

[231] So we know now that 100 million Americans, that's like a third of the population, have either pre -diabetes, or type 2 diabetes.

[232] What?

[233] Yeah.

[234] Wait a minute.

[235] CDC just published these numbers.

[236] 100 million Americans.

[237] That's insane.

[238] Pre -diabetes or type 2 diabetes.

[239] One -third?

[240] One -third.

[241] That is, I'm having a hard time with this.

[242] If you had just asked me, like, what percentage of Americans have diabetes?

[243] I probably said, like, 4%, 3%.

[244] Yeah, well, the percent who actually have type 2 diabetes is lower.

[245] But I said pre -diabetes or type 2 diabetes.

[246] Well, they're on their way.

[247] Yeah.

[248] But a third.

[249] So here are a couple other stats.

[250] 88 % of people who have pre -diabetes don't know that they have it.

[251] 88%.

[252] And the average amount of time it takes for someone to progress from pre -diabetes to full -fledged type 2 diabetes is just five years.

[253] Wow.

[254] So let's go back to that number.

[255] $14 ,000 a year to treat a single patient with type 2 diabetes.

[256] imagine someone gets diagnosed at age 40, which is totally possible.

[257] I mean, now even 8 -year -old kids are being diagnosed with type 2 diabetes.

[258] And imagine that person lives another 45 years, which is also feasible because we have these, one of the amazing things about conventional medicine is the technologies that keep us alive, probably a lot longer than we should be.

[259] So let's say that person lives 45 years.

[260] We spend $13 ,000 a year, $14 ,000 a year treat.

[261] that person, that's $630 ,000 to treat one patient with one disease over that patient's, you know, remaining lifetime.

[262] Now, if you start doing some math and you assume, you know, even 50 million people with diabetes times $630 ,000, you get a number with so many zeros after it.

[263] I don't even know what it is.

[264] It's like a Google or a Googleplex or something.

[265] So this is why, we're facing this threat.

[266] And this is why I wrote the book.

[267] It's like people aren't aware that we're at this point where, you know, like one in two Americans now has a chronic disease.

[268] One in four have multiple chronic disease.

[269] One and two Americans has a chronic disease?

[270] One and two.

[271] One and four have multiple chronic diseases.

[272] And I know you're a parent.

[273] So, and I am too, 30 % almost of kids now have a chronic disease.

[274] And that's up from just 13 % in 1994.

[275] So there's been more than a doubling of kids.

[276] with chronic disease in less than 25 years.

[277] How is that part?

[278] What is change in the American diet?

[279] Are you attributing it to the American diet that's caused?

[280] Or is it environmental effects as well?

[281] All of the above.

[282] So I would say it's the diet.

[283] It's an increased sedentary activity, you know, like sitting for very long periods, not moving around, not enough exposure to artificial, or not an exposure to natural light, too much exposure to artificial light, not enough sleep.

[284] you know so all these things come together and now we've got a nation of people with chronic disease and chronic disease is bankrupting our country and it's extremely difficult to treat it lasts for a lifetime and our only hope actually of dealing with this problem and surviving as a country as a nation is to figure out a way to prevent and reverse disease instead of just suppressing symptoms and putting band -aids on it, which is what our current conventional medical system does.

[285] You really scared me with that diabetes number.

[286] That's really freaking me out.

[287] I can't believe that.

[288] What is this?

[289] What do you put it up, Jane?

[290] More than 100 million Americans have diabetes or its precursor, staggering CDC report reveals.

[291] And this is just from July.

[292] Wow.

[293] In 2015, at least 1 .5 million new cases were diagnosed in people over 18.

[294] It means that now a third of the U .S. population has diabetes or pre -diabetes.

[295] Let me throw a couple others at you.

[296] The CDC just updated its obesity statistics.

[297] Now 40 % of U .S. adults are obese.

[298] Oh, my God.

[299] 40%.

[300] 4 %, 4 and 10, not just overweight, obese.

[301] 40 %?

[302] 40 % and almost 20 % of adolescents are now obese.

[303] Now, are they basing this by those body standards?

[304] Body mass index.

[305] Yeah, but I'm obese then.

[306] Yeah, it's not perfect.

[307] That doesn't work.

[308] It's not perfect, but it's not so, so imperfect that it's, you know, we're talking about a 20 % difference.

[309] Look at body mass index, 5 foot 8, 200 pounds.

[310] I think I'm, like, dying.

[311] I think, like, if you look at the body mass index, I think I'm, like, of terrible health.

[312] But all you have to do is go to an airport.

[313] You know, I just flew down here.

[314] Right.

[315] You know, you sit in an airport and you look around.

[316] Yes, you know that statistics are correct.

[317] But there's also a lot of people that lift weights.

[318] Like, there's a lot of people that are bigger.

[319] I would like to know what the, you know, what am I obese?

[320] Yeah.

[321] Yeah, I'm obese.

[322] Come on.

[323] That, come on.

[324] But, I mean, look, but you don't have diabetes.

[325] Well, I have 10 % body fat, too.

[326] Yeah.

[327] It's just not real.

[328] That's not real.

[329] It's not that, well, I don't know.

[330] I think that statistic, I mean, what do you think?

[331] Out of 10 people that you see on the street are four obese?

[332] Well, if I'm obese, now I know that I'm obese, right?

[333] According to that.

[334] You've got to throw that thing out the window.

[335] That's not a good metric.

[336] It's not a perfect metric, but they have done studies where they have accounted for that.

[337] And you do see some variation, but you're not the norm.

[338] You're not, you're an outlier.

[339] I'm aware of that, but I think there's probably got to be quite a few outliers out there.

[340] There are quite a few, but not enough.

[341] More today than ever before, no. Not enough to change that statistic in a really meaningful way.

[342] It's not going to, you know, there aren't 20 % of you.

[343] You know, it's not going to drop that from 40 % to 20%.

[344] So maybe 40 to 35, is that reasonable?

[345] Still a lot.

[346] I think it's, yeah, that's, I would say maybe 40 to 39 or 38.

[347] Jesus.

[348] Yeah.

[349] So, so here's the deal.

[350] You know, we can't, it doesn't matter who, so the whole recent health care debate with, you know, Affordable Care Act and then the current administration suggesting something different.

[351] That whole discussion revolved around how we're going to pay.

[352] for health care, you know, health insurance.

[353] But we have to understand that health insurance is not the same thing as health care.

[354] Right.

[355] It's a method of paying for health care.

[356] And my key point in the book is it doesn't matter what method that we use to pay for health care, whether it's the government, whether it's corporations, or whether it's individuals.

[357] There is no method that's sustainable in the face of the rising rates of chronic disease that we're seeing.

[358] There's There's nothing that we can do.

[359] What's fascinating is that I am pretty aware of this stuff, and I didn't know what you're telling me. Yeah.

[360] And I'm stunned.

[361] I'm stunned at the number of people with chronic disease, and I'm stunned at the number of people that are either pre -diabetic or diabetic.

[362] I really don't know how to digest that.

[363] Yeah.

[364] That's horrific.

[365] And that could be attributed almost entirely to diet and a lack of exercise.

[366] It's a preventable disease.

[367] That's the crazy thing.

[368] Type 2 diabetes is a fully preventable condition.

[369] And type 1.

[370] diabetes varies in what way?

[371] Yeah, it's an autoimmune condition, and it's strongly genetically mediated, so it's, which means that it doesn't, you know, necessarily mean that if you have the genes, you're going to get the disease, but there's, you know, 50 % of the risk, I think, is the statistic that I've seen of type 1 diabetes is genetic, whereas we know now that 85 % of the risk of disease in general comes down to environmental and behavioral factors.

[372] Behavioral meaning your diet.

[373] Yeah.

[374] Or you sleep or your physical activities, stress management, etc. So that means only 15 % of the risk of disease is genetic, you know, purely genetically driven, whereas the other 85%, which is a vast majority, is actually under our control.

[375] I was looking at a statistic that made a correlation between sleep and weight loss and saying that people who slept an average of 8 to 10 hours a day, had a significant significantly less body fat and weighed less and lost more weight than people who did the exact same activity but slept four to six hours.

[376] Yeah, I would say that among people who research weight regulation, sleep is now recognized as being the second most influential lifestyle factor that determines our weight aside from diet.

[377] Whoa.

[378] More so than exercise.

[379] Yeah, ahead of physical activity.

[380] So I got a couple of good ones for you.

[381] A single night of sleep deprivation has been shown to cause mild insulin resistance, even in healthy people with no pre -existing blood sugar disorders.

[382] So just one night of not sleeping well can cause a little bit of insulin resistance the next day.

[383] I mean, it's transient.

[384] It goes away.

[385] But that's significant.

[386] There was a study where they deprive people of sleep for eight nights in a row pretty severely.

[387] It wasn't, you know, obviously not totally.

[388] sleep deprivation because they'd be dead.

[389] Would you really be dead for eight nights in a row?

[390] I think so.

[391] Yeah, I mean, partial but significant sleep deprivation for eight nights in a row.

[392] These people ate an additional 566 calories a day during that period with no changes in resting energy expenditure.

[393] So that's equivalent to gaining a pound a week of body weight or 52 pounds in a year.

[394] So most people won't have that severe of sleep deprivation, but if you just even have mild sleep deprivation, you know, over a significant period, what if that could account for 10 pounds of weight gain a year?

[395] And over, you know, 10 years, you're talking about a lot of weight gain.

[396] Yeah, so is it because you're sleepy, so you just force yourself to eat food?

[397] No, it just, it totally screws with hormone production and all the hormones that regulate appetite and satiety.

[398] and things like that.

[399] Oh, cortisol, leptin, crying.

[400] Yeah.

[401] Appetite's higher.

[402] It's hard to get satiated.

[403] And it also decreases your willpower and judgment around food.

[404] So people are likely to make worse choices when it comes to food.

[405] I know I do.

[406] Dude, if I'm really, really tired, I immediately go to, like, bullshit cheeseburgers or something.

[407] Absolutely.

[408] It's part of what's been documented that happens.

[409] Yeah, you like reward.

[410] yourself with something that's terrible for you.

[411] Yeah, probably there's, that's also related to the changes in brain chemistry that happen.

[412] Wow.

[413] Yeah.

[414] Wow.

[415] And now we know that the third of Americans get fewer than six hours of sleep.

[416] And outside of like maybe three percent of the population that has a gene that allows them to, you know, be okay with that few of hours of sleep, the vast majority.

[417] of people need seven to eight and a half hours of sleep to function properly.

[418] And that's been clearly documented.

[419] Yeah, I had read something about outliers in terms of performance outliers.

[420] There are a lot of people that are like entrepreneurs, guys are killing it out there.

[421] They're getting like four to five hours sleep at night.

[422] And I was stunned by that.

[423] And I was like, how is that possible?

[424] Like how are these people that are, you know, they're doing all these physical activities, working out, running their business.

[425] And then I found out about Adderall.

[426] Right.

[427] So there's that.

[428] I mean, as I said, there are some genetic polymorphisms that we, at least some research suggests that allow people to, you know, deal with less sleep than others.

[429] But, yeah, I think in that community, there's a lot of stimulant use that's driving that.

[430] And at some point, they're going to pay the price.

[431] Yeah, they need to come clean about that.

[432] Like, that's the dirty little secret.

[433] I have friends that are entrepreneurs and Silicon Valley people.

[434] And the way they describe it, it's like people.

[435] chewing gum.

[436] It's just everywhere.

[437] Everyone is doing new vigil, pro -vigil, which are apparently less problematic, and then Adderall across the board.

[438] Yeah, it's crazy.

[439] I mean, we're making choices now, both, you know, individually and collectively that are taking us in the wrong direction.

[440] And, you know, I've shared a few stats that kind of blew you away, and they've blown me away, too.

[441] you know, when I was researching the book, this is how it all came together for me. It was like a wake -up call, you know.

[442] So I have a six -year -old daughter.

[443] I know you have kids.

[444] Today's kids are the first generation that are expected to live shorter lifespans than us, their parents.

[445] That's just crazy.

[446] You know, as long as we...

[447] This is based on the statistic about diabetes and chronic disease.

[448] Yeah, all the dramatic increase in chronic disease.

[449] So as long as we've been measuring it in the modern world, lifespan's just been going like this.

[450] You know, there's been a few blips due to pandemics, like the Spanish flu, but for as long as we've been measuring, it's just going up, up, up, up.

[451] And now this is the first generation of kids.

[452] It's actually expected to start going back in the other direction.

[453] I showed my kids that sugar documentary.

[454] My wife showed it to them.

[455] It lasted about four months, and then they were like, who gives a shit?

[456] Let's get back to the ice cream, dad.

[457] Well, you know, the kids, it's hard.

[458] It's hard.

[459] Yeah, because we're hard.

[460] This is where the evolution.

[461] perspective is so important for people to understand.

[462] We're hardwired to seek out foods that are calorie -dense and highly rewarding.

[463] And by rewarding, I'm talking about that term in the scientific context, which means eating something makes you want to eat more of it.

[464] Right?

[465] So potato chips, ice cream, highly rewarding because you'll keep eating them even beyond the point where your hunger has been satisfied.

[466] A baked potato with no salt or butter.

[467] not very rewarding.

[468] You know, you'll eat, if you're hungry, you'll eat it.

[469] But you won't eat more than you're hungry for.

[470] And even a steak, which is most people like and tastes good, when's the last time you heard about somebody binging on a steak?

[471] Right.

[472] It doesn't really happen because it's not highly rewarding in that way.

[473] But human beings evolved in an environment of food scarcity.

[474] So we have these hardwired genetic biological mechanisms that cause us to seek out foods that have a lot of.

[475] lot of calories and that are very palatable and rewarding because that would signal to us that they have different different nutrients, macronutrients, flavors, et cetera.

[476] And we're in an environment of food scarcity, that works really well because, you know, stocking up on calories would allow us to survive a period of, you know, famine or food shortage or, you know, unable to locate food, et cetera.

[477] So we have all these mechanisms that were originally designed to help us survive starvation in a natural environment.

[478] That's all well and good when we're living in that kind of environment.

[479] But what happens when we live in an environment where there is a 7 -Eleven on every corner and Amazon delivering food to your door and Costco around the block?

[480] Food is everywhere.

[481] And so all of these mechanisms that actually helped us to survive in our ancestral environment set us up for failure in this modern food environment.

[482] And we capitalize on that with things like the banana split.

[483] Yeah, well, the thing is, the big food, they hire scientists who understand these mechanisms and specifically designed foods to hit all of those circuits, you know.

[484] What do you think is like probably, is there a statistically most addictive food?

[485] I don't know, actually, the answer to that question.

[486] I mean, there's a lot of controversy about whether sugar is addictive in the true sense of the way that scientists use the term addictive.

[487] Like meth addictive.

[488] Yeah, exactly.

[489] And they're both sides of that debate.

[490] But I think most of us can have, you know, just in our own personal experience, can kind of assess the effect that sugar has on us or our kids or whatever.

[491] it's highly rewarding in the sense that it makes us want more and more of it.

[492] Yeah, it's not addicted to me in the sense of like I get a detox if I'm not having it, but if it's around me and I want it, the craving is very creepy.

[493] Right.

[494] You know, like, what is this, Jamie?

[495] Most addictive foods.

[496] Oh, yeah.

[497] Pizza's number one?

[498] Yeah.

[499] Wow.

[500] It's based on a healthline .com study.

[501] I'll tell you what, man, there might be something of that.

[502] Because when we were in New York and you brought over those slices of people, pizza?

[503] God damn, those are good.

[504] If they could figure out a way to make that pizza here, we'd have real problems.

[505] Well, it's interesting that you showed that because the top six foods in the American diet, according to the amount of calories that they comprise in our diet are pizza, bread, grain -based desserts, alcohol, sugar -sweetened beverages, and chicken dishes, primarily fried chicken dishes like chicken nuggets from McDonald's, those six foods comprise the majority of the calories that the average American eats.

[506] And then you look at our ancestral diet.

[507] It was mostly, you know, meat and fish, wild fruits and vegetables, not even the domesticated varieties that we eat today, nuts and seeds, and a lot of starchy, fibrous plants, many of which aren't even available to us at this point.

[508] But, you know, sweet potatoes would be our kind of modern analog of that.

[509] And so you have a situation where we evolved in the context of eating those foods, which are they're nutrient dense, they're anti -inflammatory, and they're naturally low in calories, and they're all foods that are very hard for us to overeat.

[510] Again, like it's, you don't hear about people binging on broccoli.

[511] You don't hear about them binging on steak.

[512] No one needs too many macadamian nuts.

[513] Oh, man. Yesterday, last night, I got home and I just had 14 sweet potatoes.

[514] You don't hear about that either.

[515] And even if they have sweet potatoes, a lot of times people, but brown sugar on them.

[516] Right.

[517] Like maple syrup or patans or something like that, which then you might overeat them.

[518] But if those foods in their natural state, we're not going to overeat them.

[519] We're going to eat until we're satiated.

[520] But all the other foods that I just mentioned, those top six foods, pizza, grain -based desserts, like cake, bread, et cetera, there are all foods that trigger all those reward circuits in a big way, and we've all had the experience, I'm sure, of overeating pretty or overconsuming everything on that list.

[521] I used to always, coming home from jujitsu, I would order an extra large pizza, and I would eat it myself.

[522] It was this big.

[523] It was huge.

[524] And I would get either pineapple, double pineapple and double anchovies, which I know some people think is disgusting, but it's very delicious.

[525] Or I would get pepperoni and mushroom, and I would kill it.

[526] kill that thing and then afterwards i would literally feel like somebody opened up my mouth like they were trying to force feed a goose to make fogwa and they just poured cement into my stomach and then i just lay there and just feel terrible and feel that insulin spike and your whole body just reacts this sludge that you're forcing it to process it's just dough you know dough and cheese yeah the cheese is great though yeah i mean it's uh but it's that that it seems to the dough is what gives you that boom that's the heavy the gut bomb yeah the gut bomb yeah why is it so good though because I'll tell you what those alternatives they suck they're not they're not that good they're good food but they just there's not the same there's no free ride right there's no decadent alternative although I did find a very good cookie there's a company called no do you know no foods no I haven't seen that go grab one of those things yeah they have oh we got one right there yeah it's not bad man They're fucking delicious Oh no, K -N -O -W.

[527] You know, no?

[528] Yeah, I mean, sugar's like, for the entire cookie, 28 grams.

[529] 28 grams of sugar.

[530] It's a big -ass cookie.

[531] Yeah, I see that.

[532] But it's all like, and I actually enjoy eating it.

[533] But if you look at the ingredients, it's all, okay, here we go with, almonds, coconuts, egg whites, flaxseed, chia seed, zero trans fat.

[534] and 16 grams, 18 grams of protein, 4 grams of net carbs, 12 grams of fiber.

[535] Yeah, not bad.

[536] And it tastes pretty good.

[537] But it's not as good.

[538] It's not a large pizza with anchovies and pineapple on it.

[539] But it's not as good as like a Mrs. Fields chocolate chip cookie, you know, when you pull it apart and that string of chocolate.

[540] You know that?

[541] Absolutely.

[542] A nice glass of milk.

[543] And those are all good because they, they, they, they, they, you know, you.

[544] They, like I said, they trigger all of those hardwired reward circuits.

[545] They push all the right buttons.

[546] Yeah, they get you.

[547] It is amazing how many foods there are that are like that.

[548] If you stop and think about, like, just going down the street, in any normal street where there's a bunch of stores and restaurants, like how much of that stuff is bad for you?

[549] It's primarily bad for you.

[550] It's primarily bad.

[551] And you think the whole modern food environment is that way, and that's what I mean.

[552] We're set up to fail.

[553] Anyone who sets out to be lean and fit and healthy is swimming upstream.

[554] Yeah, you have to be put in some serious extra effort.

[555] You have to constantly be putting in effort because there's a barrage of advertisements.

[556] You walk into a grocery store.

[557] All of those foods are, you know, they're triggering all of those circuits that make us seek and crave those foods because those are evolutionary mechanisms that cannot be consciously overridden very easily.

[558] And this is why weight loss continues to be a billion dollar.

[559] multi -billion dollar industry because information is not enough it's for most people right it's not enough just to know what foods are healthy and and which foods are unhealthy because you're we're operating from a much deeper system the limbic you know the the the the limbic system or kind of lizard brain that is driving our our preferences for food and what foods we seek and which foods we don't seek and that's below the level of conscious thought that you know where we say okay I know that food's not good and I know this food is good but then that lizard brain is like you know.

[560] Yeah it pushes you it's almost like if you're walking by like if you have some potato chips or something on the shelf and you walk by it it's almost like there's an invisible hand on your shoulder pushing you towards you can kind of go hey man stop pushing stop pushing me or you can go all right yeah you just kind of give in and here's the key thing to understand too that it's not because you're a weak person or you don't have willpower.

[561] It's because you're a human being and that's how your brain is programmed.

[562] Yeah, that is a very important thing to realize that there's a reason why it's difficult for you.

[563] And even for people that think, well, it's not difficult for me, man. Well, maybe if you've conditioned yourself and if you conditioned your body and conditioned, especially your diet, there's something that does happen when your gut biome changes where your cravings change.

[564] Absolutely.

[565] But if you're eating a lot of sugar, it is incredibly difficult to get off that because that is what that gut biome wants.

[566] And there's some sort of a very strange, difficult to pin down feeling that what that craving is.

[567] It's very difficult to sort of intellectualize, right?

[568] Like, if you have to go to the bathroom, it's very clear.

[569] Oh, my God, I got to pee.

[570] It's like there, you feel it, you know what it is.

[571] But the weird hunger craving for sugar is almost like you can't grab it.

[572] You can't, like, hold on to and go, this is what I'm talking about.

[573] This is that thing.

[574] Well, there's an example I like to use.

[575] There's a parasite that the whole life cycle is really interesting.

[576] You're probably aware of it.

[577] It, you know, ends up in mice and it changes the behavior.

[578] Yeah, toxoplasma Gandhi.

[579] Changes the behavior of mice so that they are dumber in terms of their ability to evade getting eaten by a cat.

[580] Yeah.

[581] And then so then they get eaten by the cat, and then the toxoplasma transfers to the cat and goes to the cat's brain where it normally lives.

[582] So that's an example of how a tiny, tiny little microbe you can't even see with your eye can powerfully control behavior.

[583] And as you just said, we've got trillions of these microbes in our gut that control our behavior and things like our food preferences and cravings.

[584] We had Robert Sapolsky on the podcast talking about that.

[585] And he said that some of the mice, it actually rewires their sexual reward system, makes them attracted to the smell of cat urine.

[586] Right.

[587] So they're testy swell.

[588] and they're literally like horny little zombies running straight towards the cats.

[589] It completely rewires their fear of cats.

[590] That goes out the window.

[591] And the reason being is that the only way that toxoplasma can reproduce is inside the cat's gut, which is just insane.

[592] Like what kind of a twisted system, and how did this evolve over all these years?

[593] The gut biome and gut bacteria, it is so fascinating to me. Well, here's an interesting way of looking at.

[594] Do you know Justin Sonnenberg?

[595] No. He's a microbiologist at Stanford.

[596] Really interesting guy.

[597] Brilliant.

[598] He, I'm going to paraphrase this because I won't get the quote exactly right, but he wrote a book about the gut microbiome.

[599] And he said something to the effect of humans are just the elaborate vessels for the propagation of microorganisms.

[600] Ooh.

[601] Yeah.

[602] he's probably right he's basically saying that we're kind of the evolutionary vehicle or tool for for the microbes that live in our gut they've been around a lot longer than us a lot longer they're they outnumber us you know the the number of microbial cells in the body are more than the number of human cells so you know there's lots of different ways to interpret that but I think at the very minimum you you start to see how important that microbial community is to our overall health and also our behavior.

[603] Yeah, and if you really want to get creepy, think about how, like, categorically, they don't vary individually.

[604] Like, they're essentially the exact same thing, you know, in mass numbers, acting in the interest of the mass numbers, and then influencing us, which vary widely, and our different actions propagate them in different ways.

[605] Yeah.

[606] I'm freaking out.

[607] It's, yeah, it's especially weird, too, when you think that all of that stuff, all of those microorganisms that are, in our gut, they're not actually in our body, so they're not really part of us.

[608] They're just hanging out there.

[609] Well, think about a tunnel.

[610] So you go through a tunnel under a river.

[611] Right.

[612] You're not in the river.

[613] Ooh.

[614] You're just in the tunnel under the river.

[615] Right.

[616] And our gut is a hollow tube that goes from our mouth to our anus intersects our body, but everything inside the tube is technically outside of the body.

[617] What?

[618] So they're influencing us from inside.

[619] Inside the tunnel.

[620] From inside the tunnel.

[621] They're not really inside of our bodies.

[622] So they're kind of running the show, but they're not really in us.

[623] So it's like a car inside the tunnel that's controlling the river.

[624] Yeah.

[625] Jesus Christ, I can't do this anymore.

[626] Freaking out.

[627] Freaking it out.

[628] It's a headspin here when I first thought about that.

[629] And the crazy thing is that they can affect mood.

[630] They can affect depression.

[631] They can affect your ambition, the way you behave.

[632] Intulse control.

[633] I just saw a study on the way down here.

[634] I get a feed of all the new research and it showed that overgrowth of bacteria in our small intestine, which is part of our gut, is associated with heart problems.

[635] So it's, you know, and they don't actually know why yet.

[636] But so, you know, something going on and with the cars in the tunnel is really tweaking the river in just about every way you can imagine.

[637] It's not just about gut, as you know.

[638] It affects every system of the body.

[639] So Palski was saying that one of the people that he worked with found during his residency that there was a disproportionate number of motorcycle accidents that were attributed to people who were infected by toxoplasma because it made them more impulsive.

[640] Right.

[641] I could change human behavior as well.

[642] Yeah.

[643] Well, I think we talked about this last time, but the prevalent theory now on what causes depression is that it's a disrupted gut microbiome that causes inflammation.

[644] it leads to the production of what are called cytokines.

[645] They're chemical messengers, inflammatory cytokines.

[646] They travel, they cross the gut barrier, they go into the blood, travel up into the brain and cross the blood -brain barrier, and then they suppress the activity of the frontal cortex, which causes all the telltale signs and symptoms of depression.

[647] Jesus.

[648] So what if depression, which we have always thought about, either as a disruption of brain chemistry or something that's purely situational, is actually, you know, has a physiological cause as a driver.

[649] Now, that's not to say that those situational factors don't matter.

[650] I don't want to be reductionist here and say depression is only caused by gut inflammation.

[651] I think that's ridiculous.

[652] But the problem is the average person goes into the doctor with depression.

[653] They're going to come out of that office with a prescription for an antidepressant.

[654] There's not going to be any investigation into their gut and whether they have inflammation in the gut and intestinal permeability.

[655] There's not going to be a referral to a gastroenterologist to check that out.

[656] And this is, of course, one of the problems with the conventional system, the way it's set up, is we had a doctor for every different part of the body, and there's no quarterback that's really overseeing that whole thing.

[657] Ideally, that would be the primary care provider.

[658] But because their appointments are 10 minutes, they've got 2 ,500 patients on their roster, there's no time for that.

[659] Yeah, you'd have to find a doctor that's very meticulous.

[660] It's willing to go over your blood work for you and check out what your diet is.

[661] Yeah.

[662] It would take hours.

[663] And W &L, as they say, we're not looking.

[664] So imagine a patient that goes into the doctor and they've got depression, let's say, they've got eczema or psoriasis.

[665] They've got digestive issues, and they've got brain fog, cognitive problems, like a whole big roster of symptoms.

[666] and the primary care provider might give them an antidepressant for the depression.

[667] They give them a steroid skin cream for the skin problem.

[668] They leave with a handful of medications.

[669] But what if there was one thing that was causing all those problems or one underlying cause that was leading to all that?

[670] So just in this example, what if that patient had gluten intolerance and they hadn't been properly diagnosed?

[671] We know now from the research that gluten intolerance doesn't just cause the GI distress that a lot of people get, it also can cause, you know, it's associated with dermatitis, which is eczema, it's associated with all kinds of cognitive and neurological problems.

[672] So a single food protein could be leading to all of these different symptoms, but in the conventional system, they might go to the primary care doctor, then they get a referral to the dermatologist, they get a referral to gastroenterologist, they maybe get a referral to a neurologist or a psychiatrist, they're seeing all these separate people to deal with all these separate symptoms, symptoms, like, you know, playing whack -a -mole with the symptoms, they take, you know, one drug, the antidepressant, but then maybe the antidepressant causes constipation.

[673] So then you go to the gastroenterologist and they get a drug for the, you know, a laxative for the constipation.

[674] And then before you know, it's just this incredibly complex web of all these drug interactions and all the focus is on suppressing these symptoms with different doctors for different body parts when, in this example, at least, it was something as, you know, simple as a food protein.

[675] It could be easily removed from the diet, maybe not easily, you know, gluten's in a lot of things, but taken out and then all of those problems which seemed like they were separate and disconnected go away.

[676] And that's really the promise of functional medicine because instead of looking at things, starting with the symptoms and then working backwards, we're starting from the inside and working out.

[677] So, you know, an analogy I like to use is if you have a rock in your shoe and it's making your foot hurt, you go into the conventional system, you'll end up with a diagnosis of foot pain.

[678] Or actually, it will be fancier.

[679] You know, there'll be like the Latin name for foot and pain or something.

[680] So it sounds more official.

[681] And then you'll get a painkiller.

[682] And the painkiller will help.

[683] You know, it'll reduce the pain a little bit.

[684] But obviously, it makes a lot more sense to just take your shoe off and dump out the rock and that's really what functional medicine is about now when it comes to gluten intolerance that's one that gets dismissed like because it sounds it sounds frivolous like all of a sudden everyone's gluten tolerant like this is crazy but my belief is that there's varying levels of this and that it's something that people have just dismissed is a weird feeling that you get after you eat gluten yeah and that they're not really in tune with the effect of inflammation and that there's a real difference between the weed of today and the weed of, say, the early 1900s.

[685] It's been manipulated.

[686] I think there are a few reasons there's misunderstanding about this.

[687] Number one is that there up until recently has not been an understanding of the difference between celiac disease and non -celiac gluten sensitivity.

[688] So for a long time, the idea was either you have celiac or you're not sensitive to gluten.

[689] That's it.

[690] that even recently.

[691] Yeah, there's no gray area.

[692] That's preposterous.

[693] Anyone who still believes that has not even done the most cursory search of the scientific literature.

[694] You can go in, anyone who's listening or watching can go to pubmed .gov, p -u -b -m -ed -gov.

[695] In the search field, type non -celiac gluten sensitivity or non -celiac wheat sensitivity, and tell me how many results come up.

[696] Do it.

[697] It's going to be a lot, okay?

[698] And it's going to be linking, and this goes.

[699] to the second point, it's going to be linking not just to gut problems and diarrhea, it's going to link to all kinds of different conditions, from depression to anxiety, to heart issues, to hormone imbalance, to cognitive problems, et cetera.

[700] So that's the second problem is historically how many studies we got here.

[701] Jesus.

[702] And there's lots of others, if you use some different terminology, you can find more.

[703] So, with celiac disease, the initial idea was it just causes diarrhea and, you know, severe diarrhea and cramping.

[704] And so the assumption was that if you don't have severe diarrhea and cramping when you eat gluten, you don't have celiac and you don't have any other kind of gluten intolerance.

[705] But we now know that with celiac, there are forms called atypical or silent celiac.

[706] These are forms that do not present with the typical gut presentation.

[707] And the number of atypical celiac cases is much higher than the number of typical ones.

[708] So a patient goes to the doctor, they're having headaches, they're having motor problems, they're having, you know, all kinds of other issues.

[709] The doctor, if they think that celiac is only about gut issues, they're not even going to think about testing that patient for gluten intolerance.

[710] What kind of motor issues would you get?

[711] Well, there's something called ataxia, which is a form of paralysis that can be caused by gluten sensitivity.

[712] From spaghetti.

[713] Yeah.

[714] You can get paralyzed from spaghetti.

[715] In kids, it's called gluten -associated ataxia.

[716] Jesus Christ.

[717] And this is for people who are non -celiac.

[718] Yeah.

[719] So that's the second problem is, again, W &L, we're not looking.

[720] So the patients go to the doctor.

[721] They have all these weird kind of complaints, the doctor, but they don't have gut issues.

[722] so the doctor then rules out celiac or non -celiac gluten sensitivity because they don't yet know that it can manifest in all these different ways.

[723] So how is this happening?

[724] Is that whatever intolerance that you have for gluten, when you consume that gluten, the gluten goes into the gut and interacts with your gut biome, and then what's the mechanism?

[725] So there's two different mechanisms.

[726] In celiac, there's an autoimmune mechanism where the proteins in gluten, the body creates antibodies towards those proteins, and also there's like a bystander effect where certain tissues in the body that have similar protein structures to gluten get attacked as well, certain enzymes, transglutaminase 2, transglutamines 2, trans glutamination 3, and transglutamase 6.

[727] And here's the thing related to what we were just talking about.

[728] Transglutamination 2 is typically found in the gut.

[729] So that's why a lot of people who have celiac have these gut issues is because their body is actually attacking the gut tissue and breaking it.

[730] down.

[731] It's an autoimmune reaction.

[732] But now we know that that same autoimmune reaction can be directed at transglutamase 3, which is primarily in the skin, which is why something like 30 % of people with celiac also have eczema and other skin problems.

[733] And transglutamase 6 is in the brain.

[734] So if a person who has antibody production against transgutamination 6 eats gluten, their body attacks their brain.

[735] Whoa.

[736] And that's why it breaks down the enzyme, which plays a number of important roles in the brain.

[737] And so this is why celiac and also non -celiac gluten sensitivity is associated with a whole bunch of different cognitive issues and also actual motor problems like ataxia because it's attacking the brain.

[738] Wow.

[739] The immune system is attacking the brain, and that leads to some potentially very serious problems.

[740] When did they start to alter wheat?

[741] like what year do you know i don't know and i do think that is um an issue because i've there's so many people that have gone to europe you know they eat wheat here and they go to europe and they can eat wheat and it's fine yeah i've had experience yeah but i think there are some other things that are actually more meaningful and significant and this leads me to the third reason why i think we've underestimated you know gluten sensitivity and why people don't understand how significant it can be.

[742] We're not living in a vacuum, you know, so let's say you've got a person who is like a hunter gather, they've been living in a pristine environment, you know, they eat all nutrient dense, you know, good food, their gut microbiome is thriving because they've been eating plenty of fermentable fiber and, you know, probiotic type of foods and, and they're just super healthy.

[743] If that person gets exposed to gluten, they might not have any problem.

[744] But then you take a person who is living in the modern industrialized world.

[745] They're sleeping, you know, five hours a night.

[746] They've taken antibiotics, you know, 30 courses of antibiotics by the time they're an adult, which is not an exaggeration.

[747] You know, I can't remember the exact number, but it's extremely high, the average number of courses of antibiotics.

[748] They were born by a C -section.

[749] They eat a crappy diet with a lot of processed and refined foods.

[750] They're sedentary.

[751] They're not exercising.

[752] So this person is in really bad shape, and their immune system seriously dysregulated.

[753] And then when they get exposed to gluten, which might otherwise be a harmless protein, it causes problems.

[754] So I think the reason that more people are intolerant of gluten and intolerant of other foods now is not just because the foods have changed.

[755] It's because we have become compromised.

[756] You know, we should, human beings should be resilient and able to tolerate.

[757] these kinds of food proteins.

[758] But when our immune system breaks down, we talked about the gut as a barrier system where everything that's inside the gut is outside the body.

[759] It's important to understand in that the purpose of the gut is to serve as a selective barrier that determines what gets in and what stays out because everything we eat is either absorbed or eliminated as waste.

[760] And if that barrier becomes, permeable in a non -selective way, meaning it loses the ability to make appropriate decisions about what gets in and out, then food proteins that would otherwise be benign and, you know, be broken down into smaller particles and those small particles get absorbed and don't cause any problems.

[761] The larger food proteins get absorbed before they're broken down.

[762] And then that initiates an immune reaction that wreaks havoc.

[763] Wow.

[764] So if someone has a healthy gut, then the insult of some sort of a gluten protein being introduced into their gut is not going to be as big of a deal as if someone is just drinking Gatorade all day and eating cookies.

[765] Exactly.

[766] That makes sense.

[767] And it's like any other ecosystem.

[768] So if you think of like an ecosystem that's really healthy and you introduce, you know, a predator or, you know, another, something else that could could potentially throw it out of balance, it won't go out of balance, because the whole ecosystem is working together to keep that in check.

[769] But then, you know, you hear about, like, those small islands where they introduce a particular, you know, a predator or a prey species that then just because the ecosystem of that island is fragile, you get a huge proliferation, you know, where it's just, all of a sudden, there's nothing but deer on the island.

[770] And until they start dying because of that imbalance, you know, and then it starts all over again.

[771] So I've seen that before.

[772] I've seen that in Hawaii on Lanai.

[773] Right.

[774] They're overrun with an animal called Axis Deer.

[775] They're all over the place.

[776] And for that same reason.

[777] For that reason.

[778] And so we have the same phenomenon.

[779] Like if we have, if someone's gut microbiome is severely disrupted, especially, and that started as a kid, then they develop gluten intolerance.

[780] They develop intolerance to corn and soy and dairy and allergy.

[781] This is why allergies are on the rise in kids, is my belief.

[782] It's not because there's some weird, you know, all of a sudden someone introduced some kind of poison that is causing kids to be more allergic.

[783] It's because of immune dysregulation.

[784] Right.

[785] And that's happening because of the sleep issue, the food, and all of the other aspects of the modern lifestyle.

[786] So what's the best approach for someone who wants to be healthier if they want to take control their gut biome?

[787] Is it just consuming a lot of very strong probiotic foods?

[788] So the first thing is to just eat real food.

[789] I mean, I really like to boil it down to that three words, you know, eat real food.

[790] And by real, I mean, not stuff that comes in a bag or a box, you know, the less processed and refined, the better.

[791] Stuff that either came out of the ground or lives on the ground.

[792] Right.

[793] And, you know, there are a lot of, we tend to get really, you know, worked up about all the differences between, you know, because you could say eat real food and do vegan.

[794] You can say eat real food and do paleo.

[795] And, you know, that's all great.

[796] But I really actually believe that if people just ate real food of any kind, we'd be in a totally different place than we are now.

[797] And there were individual health issues who'd be worked out in the variations of those diets.

[798] Exactly.

[799] That's where the fine tweaking comes.

[800] But we didn't get to this point because, you know, everyone's eating real food and everyone's doing vegan or everyone's doing paleo.

[801] We got to this point because people are eating trash, essentially.

[802] So one of the most key things with the gut microbiome to understand is that, our healthy gut bacteria thrive on what are called fermentable carbohydrates.

[803] Or Justin Sondiberg, who we talked about before, he calls them microbiota -accessible carbohydrates.

[804] These are fancy terms that just mean fiber.

[805] So what distinguished as fiber is that we don't break it down and turn it into glucose or, you know, other molecules that we can absorb and use for our own energy.

[806] It stays in the gut to, you know, all the way to the colon.

[807] and then the bacteria eat that fiber.

[808] So fiber is food for our beneficial gut bacteria, and that's what makes them thrive.

[809] That's fascinating because most people think of fiber.

[810] They think of it almost as like...

[811] Like a laxative.

[812] Yeah, yeah.

[813] They think it is something that's going to clean out their bowels.

[814] So not all fiber is fermentable by the gut bacteria.

[815] Some fiber just has that mechanical effect.

[816] It's more like pushing things through the bowels, whereas other fiber can actually be used as food by your gut bacteria.

[817] And that fiber is probably more.

[818] That's the more beneficial fiber.

[819] So they're talking like sourcrow, kimchi, things on those ones.

[820] So, yeah, there's soluble fiber that that's present in a lot of fruits and vegetables.

[821] You've got non -starch polysaccharides like Inulin and FOS and things like that that that are in like onions and garlic, juice, some artichokes, leaks.

[822] And then you've got resistant starch, which is actually not, that's in a lot of starchy plants that we used to eat, you know, way back in Paleolithic.

[823] era, and some traditional hunter -gatherers still do, but resistant starch these days can be found in certain types of starches that have been cooked and cooled, like potatoes or lentils.

[824] Some people now are supplementing with resistant starch, or they're eating like green, unright bananas, unripe plantains, you know.

[825] What do those do?

[826] Because they're unripe, the starch is resistant.

[827] As they ripen, the starch, it becomes.

[828] just regular starch.

[829] How do you cook those?

[830] Like if you wanted to cook a green banana?

[831] A green plantain, you can slice them and then dehydrate them and you make them into chips.

[832] You can even buy plantain chips now at some health food stores.

[833] So if you buy plantain chips, that's what you're getting?

[834] You're getting dehydrated?

[835] You're getting some resistant starch there.

[836] Oh, interesting.

[837] Or you can bake a white potato, for example, and then let it cool.

[838] And that cooling process is what forms the resistant starch.

[839] And this is what's really interesting.

[840] You know, most people think of potatoes is something that would spike their blood sugar because they have a lot of carbohydrate.

[841] But when you cook and cool the potato, it won't have that effect because the resistant starch, you can't absorb and break that into glucose.

[842] Whoa.

[843] So when you cool a potato, it's better for you.

[844] Yeah.

[845] So like a cold potato salad would actually not have the same effect on your blood sugar as eating a warm baked potato that you just cooked.

[846] Wow.

[847] In fact, have you heard of the potato hack?

[848] No. This is probably the most effective diet that I've ever come across for weight loss.

[849] And this is what I use in my practice with patients when, like, nothing else has worked.

[850] Or if someone's super motivated and just wants to make progress quickly, a guy named Tim Steele introduced me to this.

[851] And it was, he has sent me some books that he found in the 1880s that referenced this diet.

[852] So this is old school.

[853] And what you do is you basically eat nothing but potatoes.

[854] And you, but you don't, they're plain potatoes.

[855] So you can roast them or boil them, but you don't, you know, in the hard core, the hardest core version, you don't even add salt.

[856] It's just plain baked potato or boiled potato.

[857] Certainly no butter, chives, sour cream, bacon, you know, because that increases the reward value, as we were talking about earlier.

[858] Right.

[859] The more variety there is, the more rewarding a food is.

[860] Okay.

[861] So you just eat potatoes, and there are different variations or different ways of doing it.

[862] You can do it for maybe just three days a week, and then you can do your normal diet.

[863] You know, the other four days a week.

[864] Tim talks about a variation called potatoes by day, which means you just eat potatoes for breakfast and for lunch, and then you eat a normal dinner.

[865] But in my clinic and from Tim's experience working with a lot of people, most people will lose an average of a half a pound a day.

[866] And I think there are two, there are a few things happening here and why it works.

[867] Number one, it's totally playing towards these mechanisms that we talked about before.

[868] The reward value of food, which is called the hedonic system that drives our food craving and preferences.

[869] And just let's do a thought experiment.

[870] If you have two plates of food and on one plate you have a steamed, potato with no salt or butter or fat of any kind and on this plate on the right you got bag of potato chips or just a plate of potato chips which one are you going to eat less of i mean goes without saying right you're only going to eat the potato when you're when you're hungry and you're not going to eat probably a bite more than you're hungry for whereas the potato chips all bets are off yeah for most people and so what happens is when you do the potato diet you get a spontaneous calorie reduction and by spontaneous i mean not voluntary you're not you're setting out to say okay i'm only going to eat a thousand calories today you're saying i'm going to eat as many potatoes as i want to satiate my hunger but just by definition because of how our brain works you're only going to eat you're going to eat less than you would typically so that's one thing you get a reduction in calorie intake the second thing is that when when you cook the potato most people the way they do this diet is they'll just cook like, you know, all the potatoes that they need for the week on Sunday to make it easy.

[871] So they don't have to cook the potato every time they sit down to eat.

[872] So they cook the potatoes and then they let them cool.

[873] And so then each time you can still heat them back up.

[874] But they now have a lot of resistant starch.

[875] Even if you heat them back up.

[876] Even if you heat them back up.

[877] And here's what's really cool about it.

[878] If you heat them up and cool them again, each cooling cycle forms more resistant starch.

[879] so that by the end of the week, if you're heating all of the potatoes back up and then cooling them again each time, you're going to have a potato that's mostly resistant starch, which means it will have zero impact on your blood sugar, and it will be like a feast for your beneficial gut microbiome.

[880] Wow.

[881] And that's another reason this diet probably works.

[882] You know all about the studies correlating disrupted gut microbiome with obesity and diabetes.

[883] And so you're basically, the way I tell patients is you're basically, going on an all -fiber diet.

[884] And you got to eat the skin too.

[885] You can eat the skin.

[886] You should eat the skin, shouldn't you?

[887] Yeah.

[888] Yeah.

[889] Skin has vitamins in it, right?

[890] So people will lose up to a half a pound, you know, between a quarter and a half a pound a day that they're on the potato diet.

[891] That's amazing.

[892] So if you, let's say, you know, you decide, I want to lose one and a half pounds a week.

[893] You do it for three days a week and you do that for six months.

[894] Then by the end of that six -month period, you've lost a pretty significant.

[895] significant amount of weight.

[896] If you can keep that up.

[897] If you can keep it up.

[898] The blandness of it.

[899] That's another fascinating aspect about diet is like how much of our life we are willing to forego health, happiness, all these different things, just for some simple mouth pleasure for a few moments.

[900] I mean, if you think about a pizza that you would eat, that, I mean, how long you to eat it for, 20 minutes?

[901] 20 minutes out of a 24 -hour day and you're going to feel like shit for at least an hour or two afterwards, you know?

[902] And if you try to do anything like physical, it's going to be more than two hours before you really want to go to the gym or you want to go for a run.

[903] And look, I'm not saying I think everyone should do this.

[904] I think food should be pleasurable.

[905] And I think, you know, the way I eat, for example, I love the foods that I eat.

[906] You know, it's – but – and this is why I say I don't suggest that anyone should start here.

[907] But I think it's interesting because it gets at some of what we've already been talking about how – why the modern food environment contributes to a – obesity and how using that knowledge and understanding of what triggers, you know, us to eat, we can turn that around and use it in our favor.

[908] So another strategy that's similar is to just eat, but not quite as extreme, is just eat the same thing for breakfast, lunch, and dinner for like two or three days in a week.

[909] So you get bored with it that way?

[910] Exactly.

[911] That seems like all mental tricks.

[912] Like someone would tell you, like someone like Jock would say, just suck it up and stop No, it's using our understanding of our biology and our, you know, behavioral mechanisms to, to combat the way that the modern food environment is working against us.

[913] What do you think about, like, pre -planned meal programs?

[914] Like, there's a lot of companies that sell prepackaged meals, pre -portioned.

[915] Yeah.

[916] That's not a bad way to do it, right?

[917] Yeah, I think those can play a role, too, because it's kind of a set -and -forget kind of thing, and you know what the portion size should be.

[918] There's another strategy that's very simple that's been shown to contribute to weight loss.

[919] And, again, it plays to these same mechanisms, which is to get smaller plates.

[920] So, you know, a lot, you go targeting, you buy plates are like this big.

[921] Right, right.

[922] If it don't even fit in some of the dishwashers.

[923] Yeah.

[924] And we don't even think about it.

[925] It's just something you wouldn't even think about, but we have a tendency to fill that plate up.

[926] Yep.

[927] And just getting a smaller plate and eating off the smaller plates has been shown to have a meaningful impact on weight loss.

[928] Yeah, like you ever go to a buffet?

[929] Like when you go to a buffet, you always take more food and you're going to eat.

[930] You feel like some obligation to get your money's worth, you know, and just gorge yourself.

[931] And they eat like a monster.

[932] And it's like bizarre combinations of food that you would never put together in any other context.

[933] I know, but it's all there.

[934] It's like variety is a real problem for some people.

[935] Yeah.

[936] So the buffet is like the antichrist for the way our brain works with food because it's variety.

[937] It's all like highly rewarding, you know, palatable foods.

[938] It's like the absolute worst possible thing.

[939] But if you think about it, our entire food environment is like a buffet.

[940] You can go into any store at any time and get any kind of food to trigger any of those cravings.

[941] Yeah.

[942] Do you supplement with any sort of probiotics outside of regular food?

[943] I will occasionally take probiotics.

[944] I mostly try to get it just through fermented foods, you know, because I think that's probably...

[945] Like, what do you choose?

[946] Sourcrow is a great one.

[947] Kimchi.

[948] I do fine with full -fat fermented dairy, like caffeine.

[949] fear or yogurt.

[950] Sometimes we make our own yogurt and ferment it longer, so it has more microbes.

[951] Beek kovas is a lesser known.

[952] It's a beverage comes from Russia in that area.

[953] It's fermented beets.

[954] It made it into a juice.

[955] Disgusting.

[956] No, if you like some of these other ferments, I think you'd like it.

[957] No, I'm just joking around.

[958] I like kimchi, and most people think it's vile.

[959] Yeah.

[960] Everyone in my house thinks it's vile.

[961] No, the beekovas is good and its beets are super nutrient -dense.

[962] And the fermentation brings out even more nutrients.

[963] So it's like a superfood beverage.

[964] The fermentation brings more nutrients.

[965] Interesting.

[966] In what way?

[967] What nutrients?

[968] It makes them more bioavailable.

[969] Really?

[970] Yeah.

[971] What nutrients does fermenting?

[972] Well, fermenting creates vitamin K, for example.

[973] So fermented foods are one of the best source of vitamin K2.

[974] And that's why Natto, which is a fermented soybean product from Japan, is the highest, you know, pound for pound or ounce for ounce is the highest source of vitamin K2 there is that we know of.

[975] But cheese is another high source of K2, and that's because it's fermented.

[976] So most fermented foods have vitamin K. Is it in beer or wine or any of the other alcohol?

[977] I don't think so.

[978] Too bad.

[979] Yeah, too bad.

[980] So kimchi, sourcrow, netto, this beet stuff.

[981] Beat kvass, yogurt.

[982] Yogurt.

[983] Kaffir, which is like a liquid form of yogurt.

[984] There are certain kinds of cheese.

[985] Cheese doesn't tend to be as beneficial in terms of the amount of microbes that are in it.

[986] What about blue cheese?

[987] Cambocha.

[988] I love that stuff about that.

[989] And there's lots of different kinds of kombucha.

[990] There's also water kaffir, which is like dairy kaffir, but it's more like kombucha, but it's used, they use the kaffir cultures to make it.

[991] Every traditional culture almost has a fermented food to it because our ancestors understood, even without knowing the science, that they were beneficial.

[992] How bizarre.

[993] But, yeah, they must have just trial and error, right?

[994] Now, outside of that, like, what's a normal day in Chris's life, like, as far as, like, your diet?

[995] Like, what do you, do you consume basically the same foods all the time, or do you mix it up?

[996] I mix it up quite a bit.

[997] Lately, I've been experimenting a lot with keto and ketogenic diet, fasting.

[998] I'm really interested in fasting right now.

[999] so like I haven't eaten yet today I just had coffee and some cream which I do again I do fine with full fat dairy I always do that lately I'm not always but I'm doing that a good solid four to five days a week where I'm doing intermittent fasting about 14 hours yeah I feel great when I do it I love it like the mental clarity the focus and to be honest it's actually I mean I love food preparation I like to cook but it's nice to be able to have a break from that, you know, not to worry about what I'm going to eat and cleaning up and all that stuff.

[1000] And so, you know, these days, my average day is kind of like no breakfast, fasting.

[1001] Then I might have what Marxist and calls a fat bomb salad for lunch.

[1002] If, you know, if I have lunch, I might have a later lunch.

[1003] So that would be like a salad with a little bit of protein, chicken, fish, et cetera.

[1004] and then like avocado and olives and, you know, really good, healthy fats.

[1005] And then if I'm not doing a ketogenic phase, I'll have a normal dinner, which would look like a portion of protein, a lot of non -starchy vegetable, and like a sweet potato or a plantain or some tarot root or one of these paleo -friendly type of starches.

[1006] And if you were going keto, how would you switch it up?

[1007] And then I would typically have the protein, the non -starchy vegetables, and either like some zucchini noodles or turnip noodles.

[1008] You can get like a spiralizer and make the noodles really easily.

[1009] And I would put some additional fat on those vegetable noodles or I might just have another non -starchy vegetable along with that or a salad on top of that.

[1010] So you're essentially just manipulating the fat levels.

[1011] Other than that, you're eating primarily the same type of foods.

[1012] You're just you're manipulating the fat versus carbohydrate levels.

[1013] Yeah.

[1014] And how do you feel, do you find it difficult to maintain the ketogenic diet?

[1015] And how do you feel when you're on it versus when you're not?

[1016] Yeah.

[1017] So for me, because I'm lean, obviously, and I have a fast metabolism, I can do keto for a couple weeks and feel pretty good.

[1018] I've done it for as long as three months.

[1019] So I've done, you know, the full experiment.

[1020] And what happens is after about two or three weeks, my exercise.

[1021] exercise tolerance and recovery starts to go down.

[1022] So I start to have less capacity to do like more glycolytic activities, explosive movements, you know, weightlifting, even or sprinting, high intensity types of training.

[1023] And, and I start, my sleep starts actually deteriorate a little bit.

[1024] That's one of the biggest notice.

[1025] So why would it be beneficial then?

[1026] What's beneficial about it?

[1027] well I think so two things number one not everybody has that response a lot of people just feel better and they're able to do it for a sustained period of time and they don't have that problem number two I the way I'm trying to do it is kind of replicating what I think was typical in the ancestral environment so in most hunter -gather cultures that we've studied would have naturally had periods of food scarcity so they're not always starving but because they don't have a 7 -11 on the corner or Costco or whatever they would have periods where they weren't successful on a hunt so you know they would go without eating or they would eat less that's just built into our our template I think and so I do a thing where I'm you know I'll do intermittent fasting for a period and I might do a week or two of ketosis and then I might just eat my normal diet for you know six weeks or two months after that and then I might do another week of ketosis and I don't think schedule it.

[1028] I don't plan it.

[1029] I just let my body tell me, you know, oh, kind of feels like I want to do that now.

[1030] And are you doing blood tests?

[1031] Are you doing breath tests?

[1032] How are you monitoring your ketone?

[1033] Oh, I totally.

[1034] So I have the blood ketone monitor.

[1035] And from all the research that I've seen at this point, breath ketone testing is not accurate at higher levels of ketosis.

[1036] It's accurate at lower levels.

[1037] But when you get into the therapeutic range around 2 .0, you know, 1 .5 to 2 .0, which is kind of the sweet spot for me, then blood ketones are more accurate.

[1038] And the problem with the blood ketone strips is they're super expensive, especially if you buy them just like at the drugstore or something like that.

[1039] But if you, you can look around and try to find them in bulk and they're cheaper that way.

[1040] And frankly, at this point, and I think this is true for most people, once you get used to it, you know, and you've done it enough, you don't need to keep using them over and over.

[1041] You just kind of know when you're going to be in ketosis and when you're not.

[1042] And I've tracked my values, and I've treated hundreds of patients where we've done these kinds of experiments.

[1043] And this goes back to the discussion about LDL.

[1044] So for me, on a ketogenic diet, you know, if I measure my typical diet, my LDL particle number is about 1 ,200.

[1045] So I'll just briefly describe what that is because I think some people might not be familiar with that.

[1046] So if you imagine that your bloodstream is like a highway, the cars on the highway are the LDL particles, and the passengers in the cars are the cholesterol that are carried by the LDL particles.

[1047] So for years, we've measured the passengers, the cholesterol inside of the particle.

[1048] And now most of the research suggests that it's actually the number of particles or cars on the road that is the biggest driver of heart disease risk, not the...

[1049] amount of cholesterol inside of them.

[1050] So you can measure this.

[1051] You know, LabCorp and Quest, they all have a test panel called an NMR where you can measure the number of particles that you have.

[1052] And so my normal diet is around 11 or 1 ,200, which is technically high normal or, you know, in a kind of intermediate range.

[1053] I'm not worried about that level.

[1054] But when I go keto, my LDL goes above 2 ,000, which is in like the 99th percent.

[1055] and a high, high risk range.

[1056] Wow.

[1057] So this is where I was talking before about getting to a point where we can be maybe a little more personalized in terms of the recommendations that we make, because not everyone who goes keto experiences that.

[1058] You know, some people do and some people don't.

[1059] What do you think that is?

[1060] Oh, it's just that in that, you know, for me, you know, on a keto type of diet, it affects my lipids in that way.

[1061] And, you know, this is a much larger conversation.

[1062] around, does that actually increase my risk of heart disease?

[1063] Again, I said before, we know that higher LDL on average in the general population does.

[1064] But if, like, let's say I have a doppelganger, you know, genetically identical to me and everywhere, an identical twin, and that one is not eating healthy, not exercising, not sleeping, you know, not doing anything to take care of himself.

[1065] and he has an LDLP that's high and I have an LDLP that's high and they're exactly the same.

[1066] Do we think that we're going to be at the same risk of heart disease just because that one number on the paper is exactly the same?

[1067] That's the assumption that's made in the conventional research literature.

[1068] Right.

[1069] But I think almost anybody just common sense would say, no, that's not true.

[1070] There are many other factors that determine the risk of heart disease.

[1071] So getting back to this thing, so for me with keto, one of the reasons I mean the main reason I don't do it ongoing is I don't feel well when I keep doing it like I said number two I don't like doing it long term and I think that's important and number three I don't necessarily want to have an LDLP of 2000 but you do think there are some benefits to occasionally doing it I think that it was very natural for human beings to be in ketosis at least part of the time and whether you enter into that by just fasting or whether you do it with a ketogenic diet, I don't know that that really matters.

[1072] I mean, fasting has some additional benefits above and beyond just ketosis, like autophagy, which is a cellular cleanup and repair process that happens in a fasted state.

[1073] If you think about it, if fasting or being in a fasted state was a normal part of human evolution, it makes sense that certain processes would only happen in that fasted state.

[1074] It does make sense, but I would feel like when talking to you, based on your experience, I would avoid being in ketosis all together because it sounds like it sucks for you.

[1075] No, it doesn't.

[1076] Those first two weeks are really great.

[1077] You feel great.

[1078] Yeah, and then it starts to shift over.

[1079] Dom de Augustino said that there's like a, there's an adaptation period.

[1080] Yeah.

[1081] Usually three weeks is the full period for most people.

[1082] But like I said, I've done a full, you know, longer experiments.

[1083] So I know it wasn't just a question of me not being fat adapted.

[1084] I think he was talking about several months.

[1085] months in terms of like athletic performance when your performance starts to yeah I think that varies a lot from person to person also varies how quickly someone can get into and out of ketosis I go into it very quickly for me like how many days just the second if I do one day of fasting or one day of keto on the second day I'll generally be at one one point two which most people say is in a therapeutic range and and then by the third or fourth day I'll usually be at two without a lot of effort and do you regulate your protein intake when you're doing a ketogenic diet as well to avoid protein converting to glucose?

[1086] Again, that's highly individual from what I've seen.

[1087] For me, protein doesn't seem to be that significant of a lever.

[1088] I've tried, you know, I did an experiment where I was just fasting in the morning, so I had no protein, and then I would have three ounces of protein only with the salad at lunch, and then I would have a kind of normal -sized portion of proteins.

[1089] So that's actually pretty low protein for someone of my size.

[1090] Yeah.

[1091] And then I've done it where I've just done.

[1092] keto where I've had protein for breakfast, lunch, and dinner, it doesn't seem to make a big difference for me. But I have patients for whom that's actually as big of a lever as carbohydrate.

[1093] Yeah, I had Tom Bill You on the podcast, and he was one of the founders of Quest Nutrition.

[1094] Yeah.

[1095] And he said one of those Quest bars would knock him out of ketosis.

[1096] Just because the amount of protein, I'm like, that's crazy.

[1097] Yeah.

[1098] And I think they're only like, what is it, like 18 grams or something somewhere in the range.

[1099] That's why it's so important for us to get over this idea that there's, one approach that will work for everyone.

[1100] It's just stupid.

[1101] I know you know Rob Wolf.

[1102] Have you ever seen Rob Wolf's experiments that he does on his Instagram, him and his wife?

[1103] They both eat the same things.

[1104] Totally different results as far as their blood sugar.

[1105] His wife metabolizes things far quicker than he does.

[1106] It's really interesting.

[1107] That's really interesting because you're seeing two people that live together that are, you know, they're eating the exact same foods.

[1108] Yeah.

[1109] And, you know, that he's so fascinated by it himself.

[1110] It makes it interesting too.

[1111] Yeah, I mean, it's so necessary for us to take that step because you see so much, like, you know, wasted energy, in my opinion, of people arguing back and forth.

[1112] And it's often based on, like, you know, Joe Blow goes on a low -carb diet, has a life -changing experience, and becomes like an almost religious zealot for the low -carb lifestyle.

[1113] Right.

[1114] And assumes that because it had that effect on him, that it's going to have that effect on everybody else.

[1115] and just starts, you know, proselytizing for low -carb.

[1116] Yes.

[1117] Not recognizing that for someone else, for example, many of my female patients go on low -carb.

[1118] And if they're, like, you know, working and taking care of kids and doing CrossFit several times a week, you know, that could be a disaster for them.

[1119] It really might not work.

[1120] And so, you know, we just got to take the next step.

[1121] Yeah, you have to take into account biodiversity.

[1122] But there's a lot of people that dismiss ketogenic diets because that's not what they've been promoting.

[1123] Yeah, that's an issue as well.

[1124] Like, you've got to be real careful about someone who's not citing actual science when they're talking and dismissing the ketogenic diet.

[1125] Like, I read someone saying that it was a fad, and it's hard to get into ketosis that it rarely happens.

[1126] Like, well, that's just not true.

[1127] Yeah, that's actually factually wrong.

[1128] Yeah, it's not hard at all, and it happens all the time.

[1129] And I've been in it.

[1130] I've done it many times.

[1131] I'm not in it right now.

[1132] But I do the same thing.

[1133] But for me, it's a set of boredom.

[1134] I get bored and I want a peanut butter and jelly sandwich or something, then boom, I'm out.

[1135] Well, again, I think that's probably closer to the ancestral pattern of not being in it continually.

[1136] But, you know, there are some people who need to be in it continually.

[1137] Like ketosis can be a life -changing intervention for a kid with epilepsy, for example.

[1138] And those kids benefit from being in deep ketosis.

[1139] So they might actually even need exogenous ketosis.

[1140] on top of the ketogenic diet, but they can go from having, you know, 40 seizures in a day or being on like just brutal anti -seizure meds, which are horrible for kids.

[1141] I mean, the side effects are so bad to being completely off medication with a ketogenic diet.

[1142] And so for them, that peanut butter, they're not going to have that sandwich because it's going to cause a seizure.

[1143] What was unique in my experience was the cognitive benefits.

[1144] I was like, this is really fascinating because I felt so much more clear -headed.

[1145] and from the fog of refined carbohydrates.

[1146] But I think that that is, I don't know if it's the same but very close if I just follow a low -carb diet, not necessarily ketogenic, but eliminate refined carbohydrates, but don't eliminate salads or fruit or things along those lines.

[1147] Like if I want a pair, eat a pair, you know what I mean?

[1148] But the very strict application of it, one of the first immediate, at things that I recognize is that my hunger is a very different thing.

[1149] When I'm hungry, it's not that big a deal.

[1150] Whereas when I was eating a large amount of refined carbohydrates, the hunger was ferocious.

[1151] Yeah, yeah.

[1152] It's almost like overwhelmed, like drums playing in the background.

[1153] And that's the ketones, you know, because the brain can utilize ketones and may even prefer ketones to glucose.

[1154] And so when you're producing those ketones, it really does take the edge off of hunger.

[1155] Yes.

[1156] Yeah.

[1157] And it also fuels the brain.

[1158] brain in an odd way.

[1159] I mean, I find that before I do difficult tasks, mental tasks, I like to drink exogenous ketones.

[1160] I like to take them.

[1161] I think you actually like it, though.

[1162] Yeah, I do.

[1163] You do like the taste.

[1164] Yeah, I don't mind.

[1165] Yeah.

[1166] I've got that, what is that stuff called?

[1167] Which one do you use?

[1168] Oh, yeah, keygenics.

[1169] They're probably the bad.

[1170] I like them the best, too.

[1171] It doesn't taste bad at all.

[1172] I drink it before I work out.

[1173] You know, I like those.

[1174] Yeah.

[1175] I don't think they're bad.

[1176] Yeah.

[1177] You know, and I throw some alpha brain in there, I just shake it up, but it actually taste pretty good.

[1178] Yeah.

[1179] Yeah, I think there's definitely a role for the ketogenic diet and for ketosis in general.

[1180] And, you know, fasting, as I mentioned before, has some really interesting benefits above and beyond ketosis that I've been exploring a lot might work with patients.

[1181] Have you heard of the fasting mimicking diet?

[1182] No, what's that?

[1183] Dr. Volta Longo.

[1184] So Dr. Longo is at USC Center for Longevity, a superstar scientist, and he basically came up with this approach to get, you know, the idea was to get the benefits of fasting without doing a full water fast.

[1185] And so it's a reduced calorie diet that's done for three to five days with specific macronutrient ratios.

[1186] And he's done some really interesting research.

[1187] Most of it is in animals, so you have to, you know, take that with a little bit of a grain of salt, but there has been some in humans as well.

[1188] And it's shown things like in animals with MS, just doing this fasting -mimicking diet has led to regeneration of the myelin sheath, which is what breaks down in MS, which is just you just don't see that.

[1189] I didn't even know animals got MS.

[1190] There's no, well, they have animal models of MS where they create an MS -like condition in the animal in order to study it.

[1191] And they've shown changes in the brain where actually things are regrowing.

[1192] And the reason for this, it's thought, is that this, the fasting can promote stem cell regeneration.

[1193] So you can actually, through fasting, rebuild certain parts of your body, according to this research.

[1194] So, and then there was the autophagy, which I mentioned before, which is like almost, you can think of it as like a cellular recycling or cleanup or repair process that happens in that fasted state.

[1195] And so if you look in the research literature, it's really fascinating because they're, more older, you know, older studies, they haven't been as much research until recently on fasting, but fasting has been shown to be a cure for all kinds of different conditions.

[1196] Like, you know, severe rheumatoid arthritis, patient can fast and then be completely symptom -free.

[1197] And, of course, they can't keep that up.

[1198] You can't just fast forever.

[1199] You obviously will die.

[1200] But that alone tells us something interesting about fasting and about food and how food is impacting those conditions.

[1201] Yeah, that is absolutely fascinating.

[1202] anything.

[1203] The consumption of carbohydrates, Dom de Augustino, put something up about it recently, about sugar and carbs, that they're closer and closer to connecting sugar and carbs to cancer.

[1204] This is a pretty controversial area, and I'll say right off the top that I don't consider myself to be an expert.

[1205] So, you know, I'll probably just pass on this.

[1206] But I think there's certainly enough research pointing in that direction to continue to look at that.

[1207] And they're, you know, even he probably talked about this, but drugs like metformin, which limit the availability of glucose, are being studied even by the NIH, you know, very traditional mainstream scientific organizations as therapeutics for cancer, as is ketogenic diet.

[1208] Dom studying non and others are as well.

[1209] But I think it's a little too early to say that all cancer is caused by, you know, high blood glucose levels.

[1210] Yeah, I don't think anybody's saying all, but I think they're saying there's a strong correlation between the two.

[1211] Now, when you look at the overall American diet and the number of chronic diseases and all the different various things that we have, and you correlate all these factors.

[1212] When you think about sedentary lifestyle, you think about the lack of sleep, and then, of course, you think about diet and exercise.

[1213] When do you think people are going to recognize or how do we get it?

[1214] people to recognize that what they're eating and what the average person is eating is not what the body is designed for.

[1215] And this may very well be what has triggered this whole cascade of effects.

[1216] That's the trillion dollar question, literally trillion dollar question because we spend $3 .2 trillion dollars on health care a year.

[1217] So, you know, I think there's an easy way and a hard way to get there.

[1218] So the easy way is that we continue to raise awareness through books and podcasts and things like this.

[1219] And we make proactive changes to the health care system that support the most important intervention.

[1220] So let's use an example again.

[1221] Imagine, so you go into the doctor right now.

[1222] Let's say you're one of those 100 million people that has, you know, type 2 diabetes or pre -diabetes.

[1223] And they test your blood sugar.

[1224] They say your fasting glucose is 96.

[1225] and your hemoglobin A1C is 5 .5, good news, that's normal.

[1226] Well, yeah, okay, it's in the normal range, but it's in the high end of the normal range.

[1227] In the current system, they'll just tell you it's normal.

[1228] They might maybe, maybe not make any kind of dietary recommendations and then send you on your way.

[1229] And the idea is we're not going to pay attention to this until it's not normal.

[1230] You know, we're not going to pay attention to this until you actually do have pre -diabetes or diabetes.

[1231] And so the weight until you have that, And then, of course, the longer that you wait to treat it, the harder it is to reverse.

[1232] And then once they do find that you have it, they just give you a drug rather than, you know, give you any kind of real support to make diet changes.

[1233] So even if the doctor does know what to do or what to tell you about diet, which they often don't because they just don't have a lot of training in that area.

[1234] And it's also how few people really have the contents of their body analyzed, how many people actually get.

[1235] blood work done.

[1236] Right.

[1237] Well, as I said, 88 % don't even know they have pre -diabetes.

[1238] But let's assume that they do, and let's assume they get to the doctor, and let's assume the doctor even knows what to tell them.

[1239] Right.

[1240] If they tell them that, are they, is, does that going to be enough to make that person successful in changing their diet?

[1241] Absolutely not.

[1242] Especially not if their gut biome is programmed to crave that sugar and they have low willpower, especially they get very little sleep and they work all the time, all those factors.

[1243] All those factors.

[1244] And we know, like, most importantly, information alone is not enough to change behavior.

[1245] Right.

[1246] I said that before.

[1247] That's well established scientifically, just telling someone, hey, you should eat a healthier diet.

[1248] You know, 1 % of people are going to be able to take that information and act on it successfully, especially over the long term.

[1249] Yeah.

[1250] But let's imagine a different scenario.

[1251] Let's imagine you go into the doctor.

[1252] Same thing.

[1253] They test your blood sugar.

[1254] It's, you know, high normal fats and glucose, high normal A1C.

[1255] And they sit down and they say, look, Joe, and this is obviously happening in an appointment this longer than eight minutes, right?

[1256] They sit down, they say, well, you're not pre -diabetic yet, but your blood sugar is starting to creep up.

[1257] And I'm worried that if we don't do something now, you're going to get, you're going to become pre -diabatic and eventually diabetic.

[1258] So, you know, I could give you a drug, but that's just putting a Band -Aid on the problem.

[1259] So what I'm going to do instead is I'm going to hook you up with our health coach and nutritionist.

[1260] And he or she is going to create a recipe for you, a meal plan.

[1261] They're going to come to your house.

[1262] They're going to clean out your pantry, get rid of all the bad foods.

[1263] They're going to go shopping with you and show you actually exactly what you need to buy.

[1264] They're going to help you set up these meal plans and give you recipes so that you know exactly what you should be doing or they're going to set you up with this meal planning service that we work with.

[1265] And I'm also going to set you out.

[1266] You're going to get a gym membership and you're going to get set up with a personal trainer at that gym.

[1267] And so that you can start becoming more physically active.

[1268] We're going to give you this online class that talks about sleep hygiene and how to get better night sleep it's a six -week program you do it for half hour a day no problem and here's the good news joe this is all going to be covered by your insurance you're not going to have to pay for any of this that you know that is totally possible and not only that is there any doubt that if even if we spent ten thousand dollars let's say which is more than that would cost even including the health coach and the fees for the gym and the fees for the personal trainer.

[1269] If we spent that amount of money right up front, we could get that person's blood sugar back to normal level, prevent them from ever getting type 2 diabetes in the first place, give them way more confidence in their own ability to take care of themselves and prevent disease, make them feel better in probably every other way, and save the health care system $640 ,000 over the next 45 years.

[1270] We could have that.

[1271] There's nothing stopping that from happening.

[1272] The real question is, how do you get someone to act?

[1273] That's the question.

[1274] Is it through inspiration?

[1275] That's what I said with the health coach.

[1276] So it's not actually, I mean, this is well defined.

[1277] There's so much research on behavior change and evidence -based principles that support behavior change.

[1278] So there are techniques like motivational interviewing, coaching to strengths.

[1279] Coaching to strengths.

[1280] Yeah.

[1281] So that means helping people identify.

[1282] identify and work with their strengths rather than trying to fix what's broken.

[1283] Motivational interviewing is a...

[1284] What would be an example of that?

[1285] Like, you have a person who works a regular normal job and they've got a big gut and they want to lose weight?

[1286] You have a...

[1287] It's shifting the focus around from what's wrong, which is really disempowering.

[1288] Like, I can't do that.

[1289] I'm this way.

[1290] I have no willpower or whatever to helping them become aware of certain personality traits or characteristics that they can then use to make the change that they want to make.

[1291] Motivational interviewing is like this.

[1292] Imagine a woman who's 55, you know, finds out that she has type 2 diabetes and the doctor's like, you should eat a better diet.

[1293] And she's, she would like to, but she's overworked and tired and it feels overwhelming.

[1294] And she's just not really finding the motivation to do that.

[1295] In this, you know, but she has grandkids.

[1296] She loves her grandkids.

[1297] them grow up.

[1298] She wants to be able to play with them without becoming blind and, you know, immobile from type 2 diabetes.

[1299] And so the health coach who's trained in motivational interviewing can help her help that patient to be able to tie that those deeper values and goals and, you know, motivations with the health goal.

[1300] So that it's not just eating a healthy diet for the sake of eating a healthy diet.

[1301] It's eating a healthy diet because I really want to see my grandkids grow up and be able to play with them.

[1302] Okay.

[1303] So, and then there are these principles of behavior change that are, that are totally well established.

[1304] Um, so one is shrink the change is a colloquial way of putting it.

[1305] Like, let's say you're going to start a meditation practice.

[1306] The way to not do it is to say, okay, so start doing, do an hour meditation a day.

[1307] Good luck with that, you know, that's going to fail in 99 .9 % of the cases.

[1308] The way to do it might be okay step one not even that step one download the headspace app on your phone that's it that's your first step you know step two but get a meditation cushion that's it step three you know open the headspace app and do your first two minute meditation i mean the headspace app is actually built in this way where they start you very small and you build up gradually over time because they know about those principles of behavior change uh we know that behavior change works better in community.

[1309] This is a headspinner too.

[1310] Obesity, some people have argued, is a contagious disease because people who have friends that are obese are more likely to be obese themselves.

[1311] You know what?

[1312] That makes a lot of sense.

[1313] And here's an example of something, one of the reasons why that makes a lot of sense.

[1314] We just did this thing called Sober October, me and...

[1315] It's not that.

[1316] Yeah.

[1317] And R. Schaefeer, Tom Scherer, Bert Kreischer and I, we took 15 hot yoga classes no booze no weed for a month yeah but because we were doing it all together and we kept checking in on each other it was very motivating yeah and um and no one strayed and we all were doing it to we we knew that we had we had all the we had a responsibility we had responsibility to the group and that we knew that we were motivating each other yeah as well as pushing each other and talking shit to each other and making fun of each other which is what we do professionally yeah But at the end of it, we were like, wow, that was great.

[1318] Like, there's something to that.

[1319] Like, a lot of us were like, I'm never doing yoga again.

[1320] Fuck yoga.

[1321] And I'm getting drunk for a week.

[1322] But the real takeaway from it was there was some measurable motivation and inspiration from having three friends doing it with me. Absolutely.

[1323] And that's, again, been proven in the science.

[1324] And even just having one person, like a health coach, who can play that role and be accountable, They can help you, you know, get in touch with the real motivation for doing it.

[1325] They can actually design a program for you that's likely to succeed instead of fail.

[1326] Or perhaps online groups.

[1327] There's got to be online groups you can get involved with.

[1328] We have the knowledge and the technology to do this, and it doesn't take a long time.

[1329] You can train a health coach in six months or a year.

[1330] They don't need to have nine years of pre -medical training and biological sciences and all this.

[1331] They just need to be trained in behavior change.

[1332] You know, they need to be people who can form a good relationship with somebody else and build that trust and rapport.

[1333] They need to have some knowledge, of course, of diet and lifestyle and stuff.

[1334] But like I said, imagine that you go into your doctor and they actually hook you up with someone like that who has all that training.

[1335] If you think of like the health care population as like a pyramid, yeah, at the top of the pyramid, you've got, you know, people who are really sick and who are in the hospital or in some kind of acute care setting, they absolutely need.

[1336] you know, intensive support from the conventional medical system.

[1337] Then you go down, you've got another 25 % of people who have some kind of pretty debilitating chronic disease where they need to be seeing a doctor regularly.

[1338] But then in the bottom 70%, you've got a lot of people who are just overweight, they're a little bit tired, they're not sleeping very well, they've got some gut issues, they've got some skin problems.

[1339] My argument is that those people could be really well served by well -trained health coaches and nutritionists who can work intensively with them on diet, lifestyle, and behavior change.

[1340] And we know that those changes are the single most important step we can take to prevent and reverse disease, but we also know that just telling people about it doesn't work.

[1341] Right.

[1342] You have to create that support system.

[1343] Well, our whole food system is so crazy because it's so fraught with peril.

[1344] Everywhere you go, it's a goddamn minefield.

[1345] Exactly.

[1346] I mean, if you're trying to eat a healthy diet, you have to go way out of your way to find what you can consume.

[1347] Oh, there it is over there.

[1348] Whereas if you just want to eat a shitty diet, it's everywhere in front of you.

[1349] The vast majority of the food that's available to us is not healthy.

[1350] Yeah.

[1351] Which is crazy.

[1352] If you took somebody from our culture and dropped them into, like, there's this group called the Simane in Bolivia, they're a hunter -gather group that still follows their traditional lifestyle.

[1353] If you took someone from here, dropped them in there and just made them live that way, they'd get healthy because they wouldn't have any choice.

[1354] You know, they would eat what was there and they'd be living outdoors and they wouldn't have iPads that they're staying up and looking at until 2 in the morning.

[1355] And, you know, they would be healthy.

[1356] But likewise, they'd get killed by a Jaguar.

[1357] Or they'd get, yeah, exactly possible.

[1358] But if you took one of those people and you dropped them into here, like Woodland Hills or New York City or San Francisco or anywhere else, is there any question that what's going to happen there?

[1359] the same exact thing that happens to all of us in this modern culture.

[1360] Well, we've seen that with the Inuit.

[1361] When the Inuit, one of the more fascinating things about studying the Inuit was how small the number of people that got cancer was, which is an incredibly small number.

[1362] And they essentially had no vegetables.

[1363] They were eating fats from seals and whale and whatever they could consume, an extremely limited diet.

[1364] Harsh environment, yeah.

[1365] Very harsh environment.

[1366] But they had adapted to it.

[1367] And then when Western America came into their lives in terms of, like, cigarettes, shitty food, alcohol, refined carbohydrates, cancer rates went through the roof, just through the roof, which is fascinating.

[1368] Because their genes hadn't changed.

[1369] Right.

[1370] Absolutely the same genes.

[1371] They're not going to change in one generation, you know, or even two or three.

[1372] Yeah, it's horrible.

[1373] Have you seen Weston Price, you're familiar with his work?

[1374] I know the name.

[1375] Who was he?

[1376] He was a dentist back in like the 1920s and 30s, and he wrote a book called Nutrition and Physical Degeneration.

[1377] And what he, as a dentist, his main interest was why there's so many cavities?

[1378] It doesn't seem natural.

[1379] It doesn't seem normal that we're designed to just develop rotten teeth.

[1380] Right, right, right.

[1381] You thought, this is stupid.

[1382] So I'm going to go around and study all of these traditional cultures all over the world.

[1383] And first, I want to find out, do they have cavities in dental decay?

[1384] and like a narrowing of the dental arch and changes in facial structure that we have in the industrialized world.

[1385] And the second question is, if not, what is the common element with all of these cultures that's different than our culture?

[1386] And in his book, he shows pictures.

[1387] So first of all, the answer to the question was no. It's not normal for humans to develop cavities and rotten teeth.

[1388] I mean, how could it be?

[1389] How could we survive in a natural world if our teeth are all falling out?

[1390] So he went and he took pictures of these people all around the world, like in Africa, the Maasai, hunter -gather, people, people living in the remote part of Switzerland, isolated up in the hills that had maintained their traditional diet and lifestyle, and all of them had these beautiful teeth, big, wide, round faces, you know, wide dental arches, you know, all of these signs of health.

[1391] But he also in the book had pictures of people from those same areas that had switched to move to the city, you know, switch to modern lifestyle.

[1392] Within one generation, you see people with these wide faces, big, healthy teeth smiling on one side of the page.

[1393] And on the other side of the page, you see people with these narrow faces like mine, you know, rotten teeth, you know, totally crooked teeth and the kind of dental problems that we all have where most of us get braces and all this stuff.

[1394] And that happened in just one generation of switching from a traditional diet to a modern diet.

[1395] What made their face then?

[1396] So vitamin K2 and a number of vitamins are responsible for facial development.

[1397] So if you look in the book of Weston Price's pictures, you'll see most people in those traditional worlds have these broad, healthy dental arches.

[1398] And then in our culture, because of nutrient deficiencies, we're not eating the healthy nutrient -dense foods, our faces get more narrow, our chins recede.

[1399] we have our mouths become more crowded, which is why many people can't fit the number of normal adult teeth in their mouth because their dental arch is so narrow.

[1400] Really?

[1401] So that's all from a nutritional deficiency.

[1402] Absolutely.

[1403] Wow.

[1404] I had to get adult teeth pulled when I was a teenager because my mouth didn't have enough room for all of my adult teeth.

[1405] Whoa.

[1406] Does the rest of your family have similar facial structure?

[1407] Yeah, largely.

[1408] Yeah, I mean, you can check this.

[1409] out, it's really interesting things to do in the airport.

[1410] I like to, you know, you just look at people's faces.

[1411] Often you'll see, like, the chin is really receded and not, you know, not like a strong, you'll see a narrow face like mine.

[1412] And if you, you might see a person from Africa or someone who's more connected to their traditional diet and lifestyle, they'll typically have a rounder face, a more full face, a broader dental arch.

[1413] They'll have straight, you know, teeth with wider, you know, wider teeth.

[1414] And anyone can do this, anyone can see and look, and you can almost predict, like, how long has that person been away from their, you know, traditional diet and lifestyle.

[1415] Wow.

[1416] I never knew that.

[1417] You know, that's a fascinating point.

[1418] It's a big variable in martial arts.

[1419] Yeah.

[1420] And the ability to take a punch.

[1421] Well, your face is pretty round.

[1422] Yeah.

[1423] You have a broader.

[1424] But it's not just what you're eating.

[1425] It's ancestors.

[1426] My mom is very wide.

[1427] Uh -huh.

[1428] I have a thick mom.

[1429] She's like a pit bull.

[1430] Yeah.

[1431] Well, it's probably part of why you're probably a good performer is you've got that structure that supports it.

[1432] Yeah, I'm sure it has something to do with it genetically.

[1433] But the ability to take a punch is, I think, directly related to the size of your face.

[1434] Yeah, it makes sense.

[1435] Guys with smaller jaws and smaller faces, they have a much harder time getting hit.

[1436] I wouldn't last long.

[1437] Yeah.

[1438] Well, like, Samoans are the best at it.

[1439] Yeah.

[1440] Like, they have just such rigid bone structures.

[1441] And Weston Price has a lot of pictures from people in the South Pacific in that region.

[1442] You know, examples of these beautiful.

[1443] You should check it.

[1444] You love the book.

[1445] It's really amazing to see the juxtaposition of those traditional faces with the modern ones.

[1446] It's like, I mean, pictures worth a thousand words, right?

[1447] You just look at those pictures and you're just like, oh, my God.

[1448] Totally makes sense.

[1449] Yeah.

[1450] Yeah, it is a, it's very weird when you think about what we're doing to the human body.

[1451] Yeah.

[1452] And when you're talking about the diabetes levels, you're talking about are pre -diabetes and chronic disease and all the different issues and 40 % obesity rate and all these different factors it's an epidemic that's sweeping through the entire nation and it's largely ignored other than health fads weight loss videos it's like peripherally examined i like to call it a slow motion plague whoa because like the bubonic plague, you know, which was a fast motion plague, it threatens us in the same way.

[1453] Like, it's literally threatening the health of future generations.

[1454] It's shortening our lifespan.

[1455] It's destroying our quality of life.

[1456] That's a big one.

[1457] Even if you stay alive, the quality of life is being devastated.

[1458] There was a recent article that came out saying just that.

[1459] Like, is, you know, it was a, it was a paper that looked at, um, what's happening in our older years and saying, yeah, we have a long lifespan, but our quality of life has significantly declined in those later years.

[1460] because we're burdened by all of these chronic diseases.

[1461] You know, the average, something like one in five or two in five elderly people over 65 are taking more than five medications.

[1462] It's a huge problem.

[1463] And this is a thing.

[1464] You hit on this point, so I want to reiterate it because it's super important.

[1465] We have accepted chronic disease as normal because it's so common, but there's a really important difference between common and normal.

[1466] What's common is not, you know, it's not necessarily normal.

[1467] It's now common for people to have chronic disease, but that's not normal.

[1468] How do we know?

[1469] Again, the Samane, it's a subsistence farming, hunter -gatherer population in Bolivia.

[1470] And recently there's been some articles in New York Times about them.

[1471] There's some anthropologists, medical anthropologists, and doctors and researchers have gone down there to study them.

[1472] They wanted to see, it's like, this is one of the last places on Earth where people are still living pretty traditional diet and lifestyle.

[1473] so we better study this quickly, you know, to see what's normal, what's truly normal for humans, not common, but normal.

[1474] Yeah.

[1475] So they eat, you know, paleo type of diet, you know, fruits and vegetables, some meat and fish, nuts and seeds, some plantains, other kinds of starches.

[1476] They walk an average of 17 ,000 steps a day, which is about eight miles, so quite a bit.

[1477] They live in sync with the natural rhythms of light and dark.

[1478] You know, they don't have a lot of artificial light exposure like we do.

[1479] They sleep 7 to 8 hours.

[1480] In fact, the researchers are trying to ask them about insomnia.

[1481] They don't even have a word for it in their language.

[1482] Wow.

[1483] They work.

[1484] Yeah, they're just, you know, they're living their normal, that's as close as we're going to get to a normal human population, right?

[1485] Yeah.

[1486] So they studied, they did blood markers on them for heart disease, but not only that, they did CT scans of their heart, you know, to see if they had calcification of the arteries.

[1487] They found that the rate of heart disease in this population was 80 % low.

[1488] than it was in, than it is in the U .S. 80 % lower, okay?

[1489] Nine and ten Simane adults that they studied had absolutely no plaque buildup in their arteries, which means they have virtually no risk of a heart attack as far as we understand it.

[1490] And, you know, before anyone who's listening to this says, oh, yeah, that's just because Hunter Gathers all die when they're 35 years old, you know, that familiar argument.

[1491] Well, this study included people between the ages of, of 40 and 94 years old.

[1492] What's more, the researchers estimated that the average Simane 80 -year -old had the same vascular age as an American in his mid -50s.

[1493] Whoa.

[1494] There's almost no cognitive disorders or Alzheimer's disease in the Simane.

[1495] So that's a really clear example of, like, what happens when you give human beings the right inputs, and they're not exposed to all this crap that we're exposed to?

[1496] They live long and healthy lives that are virtually free of chronic disease, and that's despite the fact that they have much higher rates of infection than we do.

[1497] They live on a river.

[1498] They've got parasites galore.

[1499] Like, all of them have parasites.

[1500] And yet they still are healthier than us in almost every way you can measure it.

[1501] They have lower body mass index, lower blood pressure, lower weight.

[1502] They don't get heart disease.

[1503] They don't get Alzheimer's and dementia, which is now like climbing up the list of, of causes of death and, you know, tripling.

[1504] I'm glad you brought up Alzheimer's because I read something recently.

[1505] I didn't read the whole article.

[1506] I just read the title of it.

[1507] It was connecting Alzheimer's to gut bacteria.

[1508] Yeah, absolutely.

[1509] There's a strong, this is actually something referred to as the gut brain axis, which is this very well -known connection between the gut and the brain, and it goes both ways.

[1510] So, you know, the gut can influence the brain strongly, and the brain can influence the gut strongly.

[1511] So, I mean, my point is just that what you said, when are we going to realize that just these changes, you know, making these changes is what we need to do to prevent and reverse chronic disease?

[1512] And we have these examples of people like the Simane that show us very clearly that it's the way we're living, not our genes that are causing this chronic disease epidemic.

[1513] So the easy way would be to, you know, write books about it, you know, have shows like this, keep educating things.

[1514] people in doing that and that's what I'm hoping for and that's why I wrote my book but the hard way is that our system fails that it becomes so overburdened by the rising rates of chronic disease and the unsustainable expenses of that that it basically falls apart and it becomes you know we respond in a kind of to it as the crisis that it really is because it becomes apparent at that point that our way that we've been doing it has not been working and that we desperately need to find a new way.

[1515] And that's another possibility.

[1516] And which one you think is going to take place kind of depends on whether you're a glass is half empty or a glass is half full type of person.

[1517] Yeah.

[1518] Well, from your own personal point of view, if you're listening to this, don't rely on all those things to happen.

[1519] Just try to go out and do something about this for yourself.

[1520] And I think that's how it's really going to, my personal view is it's going to be a little of both, actually.

[1521] So I think what's going to happen is you're going to start seeing some big changes on the more local grassroots level.

[1522] So we've already seen stuff like this.

[1523] Examples would be there's a group called Iora Health in Denver.

[1524] It's a primary care group, and they're reversing type 2 diabetes with health coaches.

[1525] You know, they still see the doctor, but they work primarily with a health coach who does all those things that I just said.

[1526] I wasn't making that up.

[1527] They actually go to their house.

[1528] They do pantry cleanouts.

[1529] They go shopping with them.

[1530] They teach them how to eat well.

[1531] But more than that, they just provide the, they're like the accountability buddy.

[1532] You know, they're a person.

[1533] They call them every week.

[1534] They visit their house.

[1535] How are you doing?

[1536] You know, how can I help?

[1537] And that person's totally empowered and they make these changes.

[1538] And they're reversing it without drugs or with a minimum of medication.

[1539] There's Mark Hyman, who's a doctor, pioneer in functional medicine.

[1540] He recently, they tapped him.

[1541] to start a Center for Functional Medicine at the Cleveland Clinic, one of the most prestigious international medical institutions, always on the forefront of the newest changes in medicine.

[1542] And when they first started, they were in this tiny little space, but within a few months, they had like 3 ,000 patients on their wait list, and they moved to 17 ,000 square foot space in Glickman Tower, which takes the whole second floor of this building in Cleveland Clinic.

[1543] Wow.

[1544] And they've got patients from nine countries on the wait list coming from all over the the world to do the, to do functional medicine because they have, you know, people know that the system as it's set up isn't really effective for chronic disease.

[1545] It's fantastic.

[1546] I mean, if I get hit by a bus, I want to go to the hospital, right?

[1547] I mean, antibiotics revolutionize how we treat infections.

[1548] You have anesthesia made surgery, like, you know, imagine surgery without anesthesia.

[1549] It was like a bottle of booze, you know.

[1550] Right, right.

[1551] Antispsis, like, you know, cleaning the surgical theaters has dramatically reduced infections.

[1552] You've got radiologic images that's improved diagnosis of disease.

[1553] So conventional medicine is amazing, and it's here to stay, and we need it.

[1554] But it's just the wrong tool for the job.

[1555] It's a wrong tool for chronic disease.

[1556] Nutrition and for management.

[1557] Yeah, it's using a hammer, going around everywhere with a hammer, you know, expecting not to work.

[1558] Hammer works really well when you're pounding a nail in.

[1559] It doesn't work as well with a screw or, you know, with something else.

[1560] So, I mean, Cleveland Clinic, it's just an amazing proof of concept for functional medicine.

[1561] Then Rob, Wolf, who you know, we both know, he did some incredible work with the city of Reno where, and the first responders, where they projected that just by doing this dietary intervention.

[1562] So what happened was that the firefighters and police cops were having heart attacks and strokes.

[1563] And because of the way the pension plans, you know, are set up, if they have to, if the city of Reno has to medically retire these people, they're going to spend like millions of dollars over the course of their lifetime taking care of them.

[1564] So Rob went in there with this other group specialty health, and they got them on a good, you know, paleo type of diet, lower carb diet, got them doing some more physical activity.

[1565] Well, the estimate was that they saved the city of Reno something like $25 or $30 million just with this simple intervention.

[1566] We're doing a pilot now with the Berkeley Fire Department, with our clinic, with a similar kind of goal.

[1567] So I think you're going to see all these kind of examples of things happening on local community level because you can make changes more quickly that way.

[1568] And then over time, some of those things are going to scale up.

[1569] And, you know, we're going to start seeing them maybe on the state level or the, you know, local government level.

[1570] And then eventually at some point that's going to get attention of people on the federal level who are looking around and going, oh my God, it's 20, 25 or 2030, health care expenditures are 35 or 40 percent of GDP.

[1571] This is completely unsustainable.

[1572] Like, we're not even going to exist as a country in 25 years unless we do something about this.

[1573] So I kind of think it's going to go like that.

[1574] Well, I hope it goes towards the model of the Cleveland Clinic where businesses sort of rise up and take advantage of this opportunity to get people healthy and to profit.

[1575] I mean, it seems like that's the best way to make things happen.

[1576] make it a business or someone can profit off of it, you know?

[1577] And as long as it's affordable for the vast majority of people, if it's not unreasonable.

[1578] Well, that's the thing.

[1579] And, you know, Rob has talked about this a lot for years.

[1580] If you look at economies of scale and you look at things like microprocessors and DNA testing, you know, the first human genome sequence was like a billion, you know, costs like $500 million.

[1581] Now you can just go out and pay $200 bucks to have your genome sequenced.

[1582] You know, microprocessors, when they were first introduced, the computers were as big as the room and, you know, millions of dollars.

[1583] And now anyone can go buy a computer for a few hundred bucks.

[1584] Well, your phone is many times stronger than what they used from NASA in the 1960s.

[1585] But we don't see that kind of innovation in health care.

[1586] Right.

[1587] Like, we see expenses going up instead of going down.

[1588] Every year it gets more expensive.

[1589] I feel like there's a lot of hijacking going on with big money.

[1590] And big money in particular in the pharmaceutical industry.

[1591] They don't want anything that interferes with this.

[1592] this gravy train of money going right into their pockets when people have diseases.

[1593] And that's the key point.

[1594] I mean, Rob, we did a what we called a rally to end chronic disease the other night.

[1595] And Rob came and spoke and so did Mark Hyman from Cleveland Clinic and a few others.

[1596] And in Rob's talk, he mentioned that healthcare should essentially be free.

[1597] If we allowed the same forces that made microprocessors go from being extremely expensive to extremely cheap.

[1598] DNA testing go from being extremely expensive to extremely cheap.

[1599] If we allowed those same forces to work on health care, health care would be extremely affordable.

[1600] The problem is, as you pointed out, we have a lot of misaligned incentives.

[1601] So insurance companies, for example, they only benefit when the overall health care expenditures rise.

[1602] So the more procedures are ordered, tests are ordered, you know, treatments are prescribed, the more they, the insurance company benefit.

[1603] That seems counterintuitive to people because you would think that you're paying for insurance and the insurance company is hoping that nothing goes wrong because then they'll have to pay out far more than you're paying in.

[1604] Yeah.

[1605] There's a great book called catastrophic care that I recommend for anyone by David Goldhill, for anyone who's interested in this.

[1606] It really pulls the curtain back on the whole system and how it's set up.

[1607] Then you've got, of course, pharmaceutical companies who how is it set of the why why do insurance companies benefit from from things going wrong they as the as the whole edifice or the whole system of of health care grows they benefit because they're their recipient they're involved in all of those transactions oh okay and then you have big pharma that um is basically you know they're incentives is to sell more drugs and their for -profit corporations and their duty is to make a profit for shareholders and that's how they do it.

[1608] And so selling more drugs is not always in the same, you know, aligned with the interest of patients or even of doctors.

[1609] Well, the real issue to me that stands out as an example of that is these stupid fucking commercials that they have for pharmaceutical drugs where people are having the best time ever.

[1610] Well, you're looking at them and like, how is this is so deceptive.

[1611] You're showing me like best case scenario, grandpa running, pushing the bike, and the little kids laughing, and everyone's having the time of their life, like, oh, I want the time of my life.

[1612] How do I get in on that?

[1613] Until the last 15 or 30 seconds, which is like, this drug may cause, you know, explosive diarrhea, anal bleeding, eyeballs fall out, your feet don't work.

[1614] It's crazy.

[1615] They seriously go on for like 15 seconds.

[1616] What was that one that we saw the other day, Jane?

[1617] It was like a humera.

[1618] Yeah, what is that stuff?

[1619] It was for, remember she said it's like 120 grand for hepatitis, yeah, I think.

[1620] Yeah, and death is a side effect of that drug.

[1621] Death, suicidal thoughts, contact your physician.

[1622] He'll tell you to fuck yourself.

[1623] Wake him up.

[1624] Wake him up in the middle of the night.

[1625] Here, give me some volume on this so we could hear this.

[1626] I thought I was doing okay.

[1627] I thought I was doing okay, too.

[1628] But I'm not.

[1629] Look at her.

[1630] Managing was all I was doing.

[1631] She's managing.

[1632] When I told my doctor, I learned Humera is for people who still have symptoms of moderate to severe Crohn's disease.

[1633] Oh, my friend are trying other medications.

[1634] In clinical studies, the majority of people on Humera saw significant symptoms.

[1635] relief and many achieved remission.

[1636] Ah, remission.

[1637] Then tell you what significant means.

[1638] Serious sometimes fatal infections and cancers, including lymphoma, have happened, does have blood, liver, and nervous system problems, serious allergic reactions, and new or worsening heart failure.

[1639] Before treatment, get tested for TB.

[1640] Tell your doctor if you've been to areas where certain fungal infections are common.

[1641] And if you've had TB, hepatitis B are prone to infections or have flu -like symptoms or sores.

[1642] Don't start Humera if you have an infection.

[1643] Just managing your symptoms?

[1644] Hold up.

[1645] Stop.

[1646] Okay, kill it right there.

[1647] Why is that lady so fucking sweet and cheery while she's talking about eminent death?

[1648] And the music just does not fit.

[1649] And look, the woman is on a TV set, too.

[1650] Like, she's a successful producer on a television set.

[1651] What a bizarre choice for, like, what she does for a living.

[1652] Like, watch her, kill the volume, but watch her wander around the office there.

[1653] Like, who the fuck works on a TV show?

[1654] like this is we're supposed to relate to this lady how many people work on the set look at her she's got her folder she goes and she grabs a piece of cake yes she's like yeah because even though she has chrome's nothing to do with Crohn's disease what you eat she's gonna fucking die in an explosive imploding rectal or just you know get an infection that would be totally you know not a threat for you or anyone else but because they had taken a drug that globally suppresses their immune system can kill you yeah that that whole thing thing like if you're you know if you have an infection don't take it like what wait a minute aren't those pretty common the fuck are you saying like what kind of infection just try not to get an infect don't get an infection while you're taking humera it's like do you ever try to get an infection I mean how you how do you not try to get an infection yeah this but this is what kills me is the bizarre choice of her being some sort of a director or producer of a television show like that we're supposed to relate well she is so successful well maybe if you yeah maybe if you take humera you could also become a producer of a television show.

[1655] There was another one, Abilify, that killed me. And it was an antidepressant that you give to people that are suicidal while taking antidepressants.

[1656] Like, what?

[1657] Yeah.

[1658] Hang on.

[1659] Yeah, let's talk about Abilify.

[1660] It's one of, I think it's the six or seventh most prescribed drug in the U .S. It's an antipsychotic.

[1661] Okay.

[1662] So if those two things don't, are not resonating, there's a reason for that.

[1663] We don't have that many psychotics in this country where Abilify, could be the, you know, only used as an antipsychotic.

[1664] Give me some volume.

[1665] Let's hear this.