0:00:03 If a woman has obesity and diabetes,
0:00:07 she has quadruple the risk of having an autistic child.
0:00:12 But I want to go deeper, and most people don’t know this.
0:00:14 Something horrible has happened.
0:00:17 Dr. Chris Palmer, the Harvard psychiatrist,
0:00:19 whose groundbreaking new research could be the missing piece
0:00:21 to cure the mental health epidemic.
0:00:24 Mental disorders are the leading cause
0:00:26 of disease and disability worldwide.
0:00:29 Governments are actually labeling them
0:00:30 as hormonal illnesses.
0:00:33 And to allow people to die by assisted suicide.
0:00:35 And they’re going to allow them to die
0:00:38 because they know what I’m saying is true.
0:00:43 They know there are treatments fail people year after year after year.
0:00:48 And what I’m here to say is you can, in fact, get better.
0:00:51 I struggled with mental illness myself for 20 years.
0:00:54 I tried to kill myself several times.
0:00:56 There was no hope for me whatsoever.
0:01:02 And I was furious with the mental health field
0:01:04 for being so incompetent.
0:01:06 And I wanted to try to help.
0:01:09 And the thing that people have not opened their eyes to
0:01:11 is the science of metabolic health.
0:01:14 And there’s tiny things in ourselves that can heal
0:01:18 and recover people who have had chronic, horrible mental illnesses.
0:01:19 -Really? -Yes.
0:01:23 And if autism is genetic, it shouldn’t quadruple in 20 years.
0:01:25 These are facts, and we can do something about it.
0:01:28 Today, but the easiest way to understand it is that…
0:01:42 Chris, when you speak, before we started recording,
0:01:49 you speak with a deep, authentic sense of mission.
0:01:53 And that underneath there is a personal driver
0:01:58 that is unimitatable and that is getting you out of bed every day.
0:02:00 Because I could see it in your eyes.
0:02:03 I could see it in the way that you said the words that you said to me.
0:02:05 Where does that drive begin for you?
0:02:08 What was the catalyst moment in your life that inspired you
0:02:11 and gave you that fire that seems to be unquenchable
0:02:14 to pursue the path that you’ve pursued?
0:02:20 I struggled with mental illness myself, starting in childhood.
0:02:23 Nobody recognized it. Nobody diagnosed it.
0:02:26 I didn’t know what it was. Nobody knew what it was.
0:02:32 I just knew I was different and somehow ostracized for who I was.
0:02:36 And it just felt like part of who I am.
0:02:40 And then a series of horrible tragic events happened
0:02:47 in my extended family when I was about 12 years old.
0:02:52 And my mother ended up having a nervous breakdown.
0:02:55 She called it a nervous breakdown.
0:02:58 It started with what we would call major depression,
0:03:03 quickly escalated to depression with suicidality.
0:03:06 And then she developed psychotic symptoms.
0:03:09 She became very delusional.
0:03:15 She got mental health treatment, but the treatment didn’t work.
0:03:22 They basically were just kind of in my 12-year-old mind.
0:03:25 The psychiatrists were just drugging her.
0:03:28 And those drugs weren’t making her symptoms better.
0:03:31 They weren’t restoring her health.
0:03:37 She went on to live the rest of her life with a chronic psychotic disorder.
0:03:44 And that disorder completely ruined and devastated her life in so many ways.
0:03:47 She lost everything.
0:03:50 She lost custody of her eight kids.
0:03:53 She lost all of her money, everything.
0:03:58 The courts didn’t give her any support or any money.
0:04:06 I had my own struggles, even worse, with mental illness after all of that.
0:04:09 I ended up leaving home before I finished high school.
0:04:15 I had chronic depression and suicidality and OCD and other things.
0:04:18 And the mental health field was worthless for me
0:04:21 and probably caused a lot of harm for me.
0:04:26 And so at the end of the day, the reason I’m a psychiatrist
0:04:34 is because I recognize how horrible and devastating mental illness can be.
0:04:40 And I came to the field really angry with the mental health field
0:04:43 for being so incompetent.
0:04:45 And I wanted to try to help.
0:04:50 I wanted to try to maybe contribute to better solutions for people.
0:04:54 My futile attempts to save you from the ravages of mental illness
0:04:57 lit a fire in me that burns to this day.
0:05:01 I’m sorry I didn’t figure this out in time to help you.
0:05:06 May you rest in peace.
0:05:11 That’s my mom and that’s the dedication of the book.
0:05:21 Her story and the devastation to her life is the thing that drives me to this day.
0:05:28 And I just know that there are hundreds of millions of people just like her
0:05:32 with different diagnoses, with different symptoms.
0:05:38 But the devastation to their lives is the same.
0:05:41 And those people deserve better.
0:05:46 And I want to help them. I want to get them better treatment.
0:05:49 Those people, those people exist on some kind of,
0:05:52 I guess, multiple different spectrums of disorder.
0:05:54 What are those spectrums of disorders?
0:05:57 And what are those disorders that you’re referring to when you say
0:06:00 those people are the people that I want to help?
0:06:04 People who are diagnosed with a mental illness.
0:06:12 And so, you know, the diagnoses are all over the map.
0:06:20 We have all of these different diagnoses and the DSM-5TR,
0:06:24 the Diagnostic and Statistical Manual of Psychiatry,
0:06:27 which is kind of considered the Bible of psychiatry.
0:06:30 And it has all of these labels in it.
0:06:36 Schizophrenia, bipolar disorder, major depressive disorder,
0:06:42 alcohol use disorder, which most people know as alcoholism,
0:06:51 other addictions, anorexia, nervosa, but also autism,
0:06:59 autism spectrum disorder, or dementia that most people know as Alzheimer’s disease.
0:07:09 Those are all of the labels in our kind of Bible of psychiatry.
0:07:15 And the reality is that when you look at the treatment outcomes
0:07:21 for people who are getting treatment for those diagnostic labels,
0:07:27 there is no doubt that our treatments do work for a lot of people,
0:07:29 millions of people.
0:07:32 And so, millions of people are helped.
0:07:37 Their lives can be saved by the current treatments that we have.
0:07:40 And I’m not here to take that away from anyone.
0:07:44 So, for people who are getting treatment and those treatments are working,
0:07:46 keep getting that treatment.
0:07:51 I don’t want to interfere with anyone’s access to those medications
0:07:57 or psychotherapies or electroconvulsive therapy or whatever treatment they’re getting.
0:07:59 I don’t want to stand in the way.
0:08:06 But there are far too many people just like my mother who did everything they were asked to do,
0:08:09 who took all of the pills, who showed up for their therapy appointments,
0:08:14 who did everything they were asked to do, and they’re not getting better.
0:08:24 Mental disorders as a whole are now the leading cause of disease burden and disability worldwide.
0:08:27 And it’s not because those people aren’t getting treatment.
0:08:29 Many of them are getting treatment.
0:08:35 Yes, there are people who can’t afford treatment or can’t get access to care.
0:08:38 But a lot of people are getting treatment.
0:08:43 I work at one of the best psychiatric hospitals in the world.
0:08:46 I have the privilege of doing that.
0:08:50 And we see patients that aren’t getting better.
0:08:54 We see them all the time, day in and day out.
0:09:08 And the crisis, the tragedy is that some governments are actually now moving to labeling mental illnesses as terminal illnesses.
0:09:18 The Canadian government in March of 2024 is going to allow people to die by assisted suicide
0:09:21 because of a treatment-resistant mental illness.
0:09:22 Really?
0:09:25 They’re going to allow them to die.
0:09:29 And they’re going to allow them to die because they know what I’m saying is true.
0:09:34 They know that our treatments fail people year after year after year.
0:09:38 And those people become desperate and hopeless.
0:09:46 And they give up on treatment for good reason because they’ve participated in treatment for decades.
0:09:48 And it hasn’t helped them.
0:09:55 And the Canadian government has now made the decision that they should be allowed to die with the help of a physician
0:10:03 who can prescribe deadly medications and make it easy for them to die by suicide.
0:10:12 The UK is now labeling some people with eating disorders as terminal eating disorders.
0:10:18 And that maybe, you know, if they’ve exhausted treatment, if they’ve had treatment for several years or more than a decade,
0:10:21 well, treatment’s just not going to work for them.
0:10:27 So let’s call them terminally ill with an eating disorder.
0:10:31 People are frustrated and hopeless.
0:10:36 Again, I’m not talking about the people for whom treatment’s working.
0:10:41 If treatment is working for someone, if they’re taking a pill and it’s working, fantastic.
0:10:43 You’re lucky. Keep doing it.
0:10:48 And I don’t want to interfere with anyone’s access to that treatment.
0:10:55 But we can’t hide from the tragic realities of the world.
0:11:00 For all of those people that are, they might have extreme anxiety, depression, schizophrenia,
0:11:03 these extreme sort of mental health disorders.
0:11:09 What is it that you want to put into their hearts and minds with your work, with the message that you’re spreading?
0:11:11 What is it that those people need to know?
0:11:18 And I say that not as all of the details which you’re going to go into, but the very top line message that, you know,
0:11:21 maybe in a sentence you want those people to have.
0:11:28 If you have been trying treatment and those treatments aren’t working for you, please don’t give up.
0:11:32 There is hope. You can, in fact, get better.
0:11:36 If you understand the science, you can get better.
0:11:44 The mental health conversation, the prevalence of mental health,
0:11:47 lots of these things seem to have changed in the last 28 years.
0:11:53 What is the state of mental health as we sit here today?
0:12:00 And how has that changed in the 28 years that you’ve been at Harvard and working in this field?
0:12:06 I think I have a slightly different perspective. Yours sounded more hopeful than mine.
0:12:10 You kind of said things have changed in 28 years.
0:12:15 And tragically, I actually feel like they haven’t changed a whole lot.
0:12:24 If you look at, if you look globally at the problem, the problem of mental illness is increasing.
0:12:31 It is not stagnant and is not decreasing. It is increasing in prevalence throughout the world.
0:12:37 Prior to the pandemic, about one billion people had a mental or substance use disorder,
0:12:41 representing about 13% of the world’s population.
0:12:45 And that was just in one given year, 2017.
0:12:51 The pandemic added insult to injury and rates are much higher now.
0:12:57 And the rates of mental illness have been increasing across a wide range of diagnostic categories.
0:13:04 Rates of autism in the United States over the last 20 years have quadrupled.
0:13:06 A fourfold increase.
0:13:11 Rates of ADHD are up and through the roof.
0:13:15 Rates of bipolar disorder in adults.
0:13:20 A lot of people think bipolar disorder, that’s genetic. Well, in adults, in the United States,
0:13:23 over the last 20 years, rates have doubled.
0:13:30 In children and adolescents, rates are through the roof, up exponentially, a thousandfold percent.
0:13:37 Rates of plain old bread and butter depression, major depressive disorder.
0:13:45 The Gallup poll does an annual survey in the United States of current and lifetime prevalence of depression.
0:13:53 And just this year in 2023, rates of both, both current prevalence and lifetime prevalence,
0:13:56 reached all time ever recorded highs.
0:14:01 So we have a catastrophe. We have an epidemic.
0:14:06 Mental illness is a growing escalating problem.
0:14:12 And I wish that I could say our treatments were dramatically better.
0:14:16 There is no doubt we do have new treatment options.
0:14:19 We have ketamine and psychedelics.
0:14:25 We’ve got transcranial magnetic stimulation, which wasn’t around when I first started.
0:14:28 We have some new medications.
0:14:38 But the real answer is the medications that we have are no better than the old medications because they’re all based on the same mechanisms.
0:14:46 So companies are simply repeating what we already know kind of sort of works.
0:14:51 And they’re just making new molecules that kind of sort of do the same thing.
0:15:04 And so they still just kind of sort of work. They don’t work for everyone and they even fail to work for most people in the largest study ever done of depression.
0:15:16 When people come in, the very first antidepressant treatment they get over 4000 people treated at the best academic centers that we have in the United States.
0:15:21 The first antidepressant treatment only about 30% get a remission.
0:15:26 That means 70% still have major depressive disorder.
0:15:32 They have enough symptoms to still be labeled clinically depressed.
0:15:40 Even if the pill helped them a little bit, it didn’t help them enough to make their symptoms enough of their symptoms go away.
0:15:49 Now even those 30% who got a remission, many of them are still having low grade symptoms like all of their symptoms didn’t go away.
0:16:05 And after four levels of treatment, the original published reports said that 67% got a remission after four different types of treatment for major depressive disorder.
0:16:17 If we take that at face value, that means one third of patients are still clinically depressed after four levels of treatment.
0:16:28 Other researchers have challenged that 67% figure because the reality is half of the people in that study dropped out because it just wasn’t working out for them.
0:16:37 So we got a problem there, like this protocol clearly isn’t working out well for people when half of the people are dropping out of your study.
0:16:50 And the second problem is that there are some researchers who point out that they changed the criteria for remission during the study.
0:17:00 They prospectively said they were going to define remission in a very certain way using certain metrics.
0:17:12 Those researchers said if they stuck to their protocol, only about 35% got a remission after four treatment levels.
0:17:21 That would mean two thirds of people after getting four levels of treatment are still clinically depressed.
0:17:31 And that is the current state of affairs for depression, something that we all know it’s something that we’ve got so many treatments for.
0:17:41 If we look at more “serious” mental disorders like bipolar disorder and schizophrenia, the results are abysmal.
0:17:52 One large study of 6,000 patients with schizophrenia, only 4% of the patients got a recovery.
0:17:57 Meaning that their symptoms were in full and complete remission.
0:18:03 They had a decent quality of life and that they were able to function in the world.
0:18:06 They were able to have a job or go to school.
0:18:16 Only 4% of people with schizophrenia got that using our best treatments available today.
0:18:24 Those statistics aren’t a lot better than they were 50 years ago, tragically.
0:18:33 Chris, when people say to you, or when people say they’re quite common rebuttal, that the reason we’re seeing this rise in mental health disorders is just because there’s more of a conversation about it.
0:18:36 So more people are stepping forward. We now have a word for it.
0:18:46 So there’s just more labelling and these mental health disorders, like the ones you’ve named and even things like ADHD and autism, it’s just because there’s more conversation going on.
0:18:49 And these things aren’t, in fact, increasing.
0:19:02 That is a common argument and I would argue that it’s like just putting your head in the sand.
0:19:22 The easiest place to get an accurate read on the true prevalence of mental illness and not just the recognition of it, but the true prevalence of it is to talk to school teachers who’ve been teaching for more than 30 years.
0:19:33 If you ask them, were you just not recognizing the children 30 years ago who are screaming and tantruming in your classroom?
0:19:43 Were you just not recognizing the children who were melting down when they got bad grades and injuring themselves in class?
0:19:51 Were you just not recognizing the level of despair and anxiety that you see in children?
0:19:54 Did you just have your head in the sand back then?
0:20:00 And now, since everybody’s talking about it, you see those behaviors, you see those symptoms.
0:20:15 The school teachers and the guidance counselors will laugh at you and say, “No, no, no. Something has happened. Something horrible has happened.”
0:20:22 I wasn’t ignoring mental health 30 years ago. I wasn’t ignoring despair 30 years ago.
0:20:31 I wasn’t ignoring extreme anxiety and panic. I wasn’t ignoring tantrums in my classroom 30 years ago.
0:20:35 They are skyrocketing in prevalence.
0:20:48 If we look at emergency rooms, so emergency rooms in the United States, I can speak best about statistics here in the United States,
0:20:54 but I think in most Western countries, these statistics are similar.
0:21:05 We have a crisis in mental health in emergency rooms, in particular youth mental health, but it’s across the board.
0:21:12 We have all of these children and adolescents showing up to emergency rooms, having attempted suicide,
0:21:22 or they’re becoming psychotic and they’re diagnosed with bipolar disorder at skyrocketing rates.
0:21:30 And we don’t have enough services to treat these people, these kids, these adolescents, our children.
0:21:38 We don’t have places to put them, so they sit in emergency rooms, not getting optimal care,
0:21:48 simply getting medicated, sometimes restrained to a hospital gurney so that they don’t try to run away or hurt themselves.
0:21:53 Talk to anybody in an emergency room. We’re seeing that.
0:21:59 Those people weren’t hiding in their homes 30 years ago.
0:22:07 Something’s happening. They are actively acting on mental health symptoms.
0:22:14 They are acting out of despair. The suicide rate has gone up.
0:22:22 In the United States over the last 20 years, total suicide rate has gone up by about 30%.
0:22:31 But if you look at a different statistic called deaths of despair, it has doubled in 20 years.
0:22:41 Deaths of despair includes not only suicides, but also deaths from alcohol use, drug overdoses, and others.
0:22:48 Those are mental health problems. Those are addictions. They are mental health disorders.
0:22:55 They are in DSM. Rates have doubled in 20 years.
0:23:00 People weren’t dying 30 years ago and we just didn’t recognize it.
0:23:04 And now we’re recognizing death. Now we’re recognizing suicide.
0:23:09 We didn’t really recognize it 30 years ago, but now we recognize it. No, no, no.
0:23:16 We know what death is. Morticians know how to recognize it and diagnose it.
0:23:26 And the rates are skyrocketing, a doubling in 20 years. That is nothing to ignore.
0:23:31 That begs the question. What do you believe is causing it?
0:23:38 Because clearly, when I say people, I mean, just the things you see in culture and media and maybe on Instagram,
0:23:43 that say there’s a chemical imbalance in people’s brains, I’ve always struggled with that.
0:23:49 I understand there might be some times, but I struggle with that as a broad answer to a very complicated nuance set of issues.
0:23:54 Because I just have a bias to believing that humans aren’t born broken.
0:24:04 I believe that my ancestors go back very, I’ve got a lot of ancestors that I understand how natural selection and evolution works.
0:24:08 I don’t think that I was born broken. So I think maybe there’s an environmental factor,
0:24:14 maybe something I’m doing or something we’re doing as a society is increasing these rates of suicidality that you talk about.
0:24:20 What you believe is the answer that we’re missing or not talking about enough.
0:24:26 The root causes which we can get to, and I have lots of ideas and thoughts on it.
0:24:32 If you want to get into the weeds of like what are the exact causes, we can talk about that.
0:24:43 But the thing that people have not opened their eyes to is the science of what we call metabolism or metabolic health.
0:24:52 And what I ultimately am arguing, the easiest way for me to put it is that what I’m arguing is that mental health conditions,
0:25:02 the chronic serious ones in which the brain isn’t functioning properly, brain disorders that are causing mental health symptoms.
0:25:04 Those are the things I’m talking about now.
0:25:06 But we’re all susceptible to, you believe?
0:25:09 I think we’re all susceptible to it.
0:25:15 Those, in fact, are metabolic disorders affecting the brain.
0:25:23 And so the easiest way to understand why do we see skyrocketing rates of mental illness?
0:25:33 It’s not a coincidence that we’re seeing those skyrocketing rates at the same time that we see skyrocketing rates of obesity, overweight,
0:25:40 diabetes, and prediabetes, which are also metabolic conditions.
0:25:49 That all of those things are rising simultaneously and that the brain is an organ.
0:25:58 And so some people can have metabolic problems and some people can be thin and still have a metabolic problem.
0:26:05 So I’m not at all saying that obesity is the only driver because a lot of times people think about it in that way.
0:26:08 So are you saying obesity comes first and then everybody gets a mental illness?
0:26:10 No, I’m not saying it that way.
0:26:19 Sometimes the mental illness starts first because it’s a manifestation of metabolic dysfunction in the brain.
0:26:22 And it basically means the brain isn’t working right.
0:26:33 And so somebody might have unrelenting depression or unexplainable anxiety or psychotic symptoms or bipolar symptoms
0:26:43 or eating disorder symptoms or substance use disorder symptoms that they may have symptoms.
0:26:48 But all of those things are a manifestation of metabolic dysfunction in the brain.
0:26:52 Can you explain metabolic dysfunction to me like I’m a 10-year-old?
0:26:59 The easiest way to explain it is that our bodies and our brains are made up of cells.
0:27:06 And all of our cells need two essential things to function properly.
0:27:12 They need food, oxygen, those are the big ones that most people know.
0:27:17 It gets much more complicated fast because food contains all sorts of nutrients,
0:27:20 so we need certain vitamins and nutrients and hormones are playing a role.
0:27:22 All sorts of things are playing a role.
0:27:25 But at the end of the day, that’s what metabolism is.
0:27:30 Metabolism is taking food and oxygen and keeping us alive.
0:27:38 They are fundamental to our health, but also the function of our cells.
0:27:45 And when something goes wrong in that process, and there are lots of things that can go wrong,
0:27:56 when something goes wrong with taking food and oxygen and turning it into energy, the cell can malfunction.
0:28:02 And when it happens in your brain, it means that your brain can malfunction.
0:28:09 And the way that we know the brain is malfunctioning are all of the symptoms of mental illness.
0:28:20 When somebody has depression for no good reason, when somebody has anxiety for no good reason,
0:28:29 when somebody just has experiences like hallucinations or delusions for no good reason,
0:28:33 then all of those things represent the brain malfunctioning.
0:28:42 If you could take me one step deeper into this idea of food and oxygen being converted into energy in the cell,
0:28:45 something goes wrong there.
0:28:49 What goes wrong? Why does it go wrong?
0:28:52 So the real answer is it’s extraordinarily complicated.
0:28:55 There are many pathways in metabolism.
0:28:57 There are many things that play a role.
0:29:06 But the easiest way to understand it, and the way to unify it, the helpful insight, the immensely helpful insight.
0:29:11 And this is new cutting-edge information.
0:29:16 Most people don’t know this.
0:29:21 But there are these tiny things in our cells called mitochondria.
0:29:37 And they are actually the primary sites in our cells that food and oxygen are getting converted into energy or building blocks for our cells.
0:29:42 When you do a deep dive into the science of mitochondria,
0:29:52 you can actually begin to understand what’s happening in the brains and bodies of people with mental illness.
0:30:01 And you can begin to understand all of these very complicated things like why would neurotransmitters become imbalanced?
0:30:06 What’s causing a neurotransmitter imbalance if there even is one?
0:30:09 What’s causing a hormone imbalance?
0:30:17 What’s causing higher levels of inflammation in the brains and bodies of people with metabolic and mental disorders?
0:30:22 What about the gut microbiome? How does that play a role?
0:30:32 But what about stress and trauma? Psychological stress? Trauma? How do those things fit in?
0:30:40 Mitochondria are actually the scientific way to begin to connect all of those dots
0:30:53 and to help us understand why the brains of some people “malfunction” or why they are “disregulated” might be a better way to put it.
0:31:02 Or why some people can’t “get over it”, get over a trauma or get over a breakup with someone.
0:31:08 What’s going on? Why aren’t they more resilient? Why can’t they pull it together?
0:31:16 Mitochondrial dysfunction as nerdy and sciency as that is can help us connect the dots.
0:31:21 What do I need to know about the mitochondria? What it is? I know it’s in every cell in my body.
0:31:25 Is there anything else I need to know about it before we explore these three lines
0:31:29 and how all of these other things come back and connect to the mitochondria?
0:31:36 Mitochondria are present in most cells in the body. Not every single human.
0:31:41 The glaring example are red blood cells which actually lose their mitochondria.
0:31:45 They have them when they are first forming but then they lose their mitochondria.
0:31:51 Red blood cells, interestingly, don’t live all that long. We’re constantly creating new ones and turning them over.
0:31:58 Most people know mitochondria as the powerhouse of the cell, which means they take food and oxygen and turn it into ATP.
0:32:02 That’s what most people learn in school. They’re the powerhouse of the cell.
0:32:05 I’m here to tell you they are so, so much more than that.
0:32:10 There are hundreds or thousands of them in most cells.
0:32:14 They are highly dynamic.
0:32:23 At one point, you know, the theory of multicellular life on planet Earth
0:32:30 is that mitochondria were once independent living bacteria
0:32:38 and that another single cell organism engulfed that very first bacterium.
0:32:44 And the two of those organisms lived, they stayed alive.
0:32:49 Usually when you get engulfed by another organism, that means getting eaten and you die.
0:32:57 For whatever reason, these two stayed alive and they became symbiotic with each other.
0:33:06 And actually that event is thought to maybe have only happened once on Earth.
0:33:14 And that single organism evolved into all multicellular life that we know today.
0:33:25 So all living organisms that we can see with our eyes, plants, all animals are evolved from that same organism.
0:33:29 So mitochondria divide and replicate.
0:33:31 They actually move around cells.
0:33:33 They fuse with each other.
0:33:35 They bud off from each other.
0:33:46 They form patterns around the cell nucleus, which plays a role in which genes get expressed or don’t get expressed.
0:33:48 They do all sorts of things.
0:33:53 When people say that we have a predisposition, a genetic predisposition to mental health disorders
0:33:57 and that you’ll have depression if depression runs in your family, etc.
0:33:59 Is there merit in that in your view?
0:34:01 Is there evidence to support that?
0:34:02 Absolutely.
0:34:06 So we know that mental illness runs in families.
0:34:10 Genes explain some of that, but not all of that.
0:34:18 The environment actually can influence things called epigenetic factors,
0:34:26 which are factors that control the expression of genes.
0:34:28 They turn genes on or off.
0:34:33 And those epigenetic factors are actually inheritable.
0:34:36 You can inherit them from your parents.
0:34:40 And so it’s not all strictly genetics.
0:34:43 Some of it is epigenetic.
0:34:49 So first and foremost, there are no genes that are specific to specific disorders.
0:34:56 Most people think, well, if bipolar disorder runs in my family, there must be a bipolar disorder gene.
0:34:59 And in fact, there isn’t a bipolar disorder gene.
0:35:03 There are genes that increase risk for bipolar disorder,
0:35:16 but at the same time, they also increase risk for schizophrenia and epilepsy and autism and depression and other types of mental and neurological disorders.
0:35:23 And if you look at the unifying theme, like, is there a theme for these genes?
0:35:28 Is there a common pathway that can help us better understand mental illness?
0:35:34 The common pathway is that most of the genes are affecting metabolism and mitochondria.
0:35:45 One research study that came out a couple years ago, researchers have been looking for years at a high-risk gene for schizophrenia.
0:35:50 And we know that people who have this very, very rare gene, so almost nobody has it,
0:35:54 but if you do have it, you’re at high risk for developing schizophrenia,
0:35:58 along with lots of other mental illnesses, but schizophrenia is the big one.
0:36:04 And the researchers did this deep dive into trying to understand what exactly is this gene doing?
0:36:09 And at the end of the day, they said it’s affecting mitochondria,
0:36:12 and that is probably how it is causing schizophrenia.
0:36:17 Metabolism, that happens as a result of the work of the mitochondria, is accurate.
0:36:20 So we make sure I’ve come clear on them before we proceed.
0:36:25 90% of metabolism at least is occurring in mitochondria.
0:36:30 So that definition as a scientist, I have to say, isn’t 100% accurate,
0:36:36 because there is a thing called glycolysis that can happen in cells
0:36:40 where you can actually produce ATP without using mitochondria.
0:36:41 What’s that?
0:36:48 So ATP is usually known as the energy currency of living organisms, cells.
0:36:54 And that ATP ends up making cells work.
0:36:59 It is the energy that’s flowing around cells, or the molecule that’s flowing around cells,
0:37:06 to make receptors work, to make all of the machinery of cells work.
0:37:09 And that becomes relevant.
0:37:11 Maybe some of your listeners will know this.
0:37:15 If you exercise really hard, like you’re running a marathon,
0:37:20 or you’re running as far as you can get with a marathon before you absolutely are exhausted
0:37:25 and you just have to stop, your mitochondria will actually become maxed out.
0:37:29 That is what’s preventing you from running, is your mitochondria maxed out.
0:37:33 And it looks like you don’t have enough of them, or they’re not healthy enough,
0:37:35 and so they can’t keep you going.
0:37:39 They can’t keep your muscles going, and so you peter out.
0:37:43 And when you peter out, you turn to this process called glycolysis,
0:37:47 which actually ends up producing lactic acid or lactate.
0:37:51 And so runners will get higher levels of lactate,
0:37:55 and that can create soreness and all sorts of things.
0:38:03 But, yeah, so metabolism is really the process of taking food and energy,
0:38:07 food and oxygen, I’m sorry, and turning it into energy or building blocks.
0:38:12 And that can occur on a small scale outside of mitochondria.
0:38:18 But as soon as the mitochondria in most of your cells are dysfunctional or dead,
0:38:21 you die. There’s no way around it.
0:38:24 So let’s use some of those examples that you gave earlier.
0:38:27 You talked about stress and trauma and these kinds of things.
0:38:32 I’m really keen to know how a traumatic event can have an impact on your metabolism,
0:38:36 your mitochondria, which then manifests as a mental illness.
0:38:40 So if we take trauma, for example, people go through early trauma in their life.
0:38:42 I mean, you had a very traumatic upbringing.
0:38:45 How do you think that maybe even in your case,
0:38:48 if you were able to see inside of your body and what was happening,
0:38:54 that external traumatic event came into your body in some way, caused a physiological reaction,
0:38:59 had an impact on your metabolism, which results in a mental health disorder of sorts.
0:39:04 It gets a little complicated because it goes through a couple of stages.
0:39:09 So I’ll try to walk you through it in the simplest way I can.
0:39:17 When somebody is first traumatized, everybody, if they are normal, will have symptoms.
0:39:21 If you get traumatized, you will experience fear.
0:39:24 You will experience hypervigilance.
0:39:29 You will want to fight or flee or you might freeze or you might surrender.
0:39:34 You might beg for forgiveness or mercy or whatever.
0:39:37 Everybody is going to have those reactions.
0:39:41 In my mind, those reactions are not disorders.
0:39:48 They are not malfunctioning brains or malfunctioning anything.
0:39:51 So everybody will have that.
0:39:58 However, when that happens, it immediately changes your metabolism.
0:40:07 Your metabolism, the easiest way to understand it is the sympathetic nervous system gets turned on fiercely
0:40:13 if the trauma is really bad because you have to defend yourself.
0:40:16 Your life is threatened.
0:40:20 Your safety is threatened.
0:40:25 Traumas can even be less extreme than that.
0:40:30 You can have highly stressful events in which maybe even though your physical life isn’t threatened,
0:40:32 maybe all your money is threatened.
0:40:37 The stock market crashes and you lose everything.
0:40:45 And you now think, “I’m worthless. I’m penniless.
0:40:49 I’m losing my status in society.
0:40:51 I’m going to have to live a very different life.
0:40:55 I’ve just disappointed everybody who depends on me.”
0:41:01 That could be a trauma even though by definition because it doesn’t threaten your life.
0:41:04 It’s not technically considered a trauma.
0:41:08 So for those people that have been through a traumatic event,
0:41:14 what then is going on in their body as it relates to metabolism based on that traumatic event?
0:41:18 Trauma immediately changes metabolism.
0:41:26 So trauma puts us into this…
0:41:30 Most people know it as fight or flight mode.
0:41:33 And again, there are other responses that one can have.
0:41:37 You can surrender, you can freeze, you can do other things.
0:41:48 But when people feel threatened, either physically or their reputation is threatened or their identity is threatened,
0:41:54 immediately their nervous system and hormones are changing.
0:42:01 And the reason they’re changing is because our bodies are hardwired to protect us.
0:42:06 And in order to protect us, it means that we need more energy and we need it now.
0:42:12 We need more energy in order to be able to run or fight or whatever we need to do.
0:42:26 And that means that our heart rate goes up, our blood glucose goes up, cortisol is flowing, adrenaline is flowing through the body.
0:42:33 Inflammation is actually occurring and epigenetic changes are occurring.
0:42:41 Memory formation is occurring in a powerful way during a trauma.
0:42:48 Memory, our brains are hardwiring this event so that we remember it.
0:42:53 We remember this threatened us and you cannot forget this.
0:42:56 This is not a trivial moment.
0:43:02 You must remember this for the rest of your life because it’s threatening your survival.
0:43:05 And you must remember how to respond to this again?
0:43:08 Not necessarily because our responses can be all over the map.
0:43:16 Sometimes our responses can be quite effective and other times people can die.
0:43:19 They don’t respond effectively and they are killed.
0:43:24 I mean, that would be the worst case scenario and then there’s everything in between where you get a suboptimal outcome.
0:43:27 You end up homeless with your psychotic mother.
0:43:29 That’s not a very effective response.
0:43:33 When I asked that question, we see patterns in trauma, like a trauma pattern.
0:43:40 There’s a trigger, there’s a response and then I even think about some of the small t traumas that I had in my life.
0:43:45 That meant that I would run from romantic commitment for the rest of my life, for example.
0:43:46 And it was like a pattern.
0:43:48 I was going through the same loop over and over again.
0:43:51 Trigger, Steve’s responses like this causes this outcome.
0:43:59 So I was wondering if I learned at that very young age that cycle somewhere in my neurons in my brain.
0:44:05 So that’s why I said, do we then learn the response to that trauma at that point as well?
0:44:07 We learn the response.
0:44:10 We remember the response that we did.
0:44:16 And as long as we’ve survived, that is the ingrained memory.
0:44:20 The ingrained memory is when this happens, do this.
0:44:24 Because this is what I did and I survived it.
0:44:27 And so that becomes the default.
0:44:32 And then that becomes a default pattern for many people.
0:44:41 At some point in life, it can be actually be quite useful to look at that response.
0:44:49 Okay, so when I was five years old or 20 years old or whatever, and that thing happened, I responded this way.
0:44:51 And I survived it.
0:44:53 Great.
0:44:57 But how’s this working out for me now?
0:45:01 Is that the optimal response?
0:45:06 It’s not about beating yourself up for I should have done something different back then.
0:45:10 It’s simply about recognizing and honoring.
0:45:13 I did what I thought I was the right thing to do.
0:45:16 I did my best back then.
0:45:17 But I’m smarter now.
0:45:18 I’m older now.
0:45:21 I’m wiser now.
0:45:31 If I could do it again, if I could go back in time as my smarter wiser self, would I do it differently?
0:45:35 And what would the outcome be if I did it differently?
0:45:39 And then that becomes highly relevant to today.
0:45:52 So when I’m in this romantic relationship now, I keep having this urge to break up because this person is disappointing me in this way.
0:46:00 And I feel like she or he is going to threaten me or betray me or whatever.
0:46:05 And is that the right approach?
0:46:12 Is it true that this person is going to betray me like the person in the past did?
0:46:15 Or am I hypersensitive to that?
0:46:22 Again, we’re wired to look for any clue that a trauma might happen again.
0:46:32 So we’re going to overinterpret things sometimes in an erroneous way.
0:46:38 So that early trauma or that trauma I experienced made my body go into that survival mode, fight all kinds of ways.
0:46:43 And my glucose levels went out my, all of these things, all metabolism related stuff happened.
0:46:48 How does that then cause a mental health disorder at some point down the line?
0:46:52 If that trauma is not resolved.
0:46:56 So for some people, they can experience a trauma.
0:47:04 They can be quite effective at mitigating it and move on with their life.
0:47:07 Somebody could get into a fight.
0:47:09 Somebody could get mugged on the street.
0:47:11 They’re just walking down the street.
0:47:15 Somebody pulls a knife on them or a gun on them and wants to rob them.
0:47:30 If somebody manages that trauma highly effectively, let’s say you happen to have a black belt in karate and you disarm your assailant very quickly and rapidly.
0:47:33 You may not think twice about the trauma.
0:47:38 You may actually be emboldened after that traumatic event and think, I’m quite effective and skilled.
0:47:41 Wow, those karate classes really came in handy.
0:47:47 And I’m quite powerful and maybe even feel a little more confident than you normally would.
0:47:50 And that’s the interpretation element, right, of the situation.
0:47:52 So two people could be in the same situation but have.
0:48:02 So that person still had the same physiological reactions, a gun in your face or wherever.
0:48:06 That person’s glucose was going up, their heart rate was going up.
0:48:10 All of those metabolic changes were occurring.
0:48:23 So that’s a success story and that’s probably a resilient person who moves on and never thinks twice about that trauma or rarely thinks about it and thinks about it with pride if they do think about it.
0:48:32 In the case where it doesn’t go well at all, let’s leave the extreme out where the person is murdered.
0:48:41 Let’s leave something less severe than that, but the person is beaten.
0:48:47 They are injured severely.
0:48:54 They are terrified to go out in public for fear that there could be another one just like that.
0:49:01 That person, their fighter flight system is not turning off.
0:49:13 Their fighter flight system is now on at least at a low level, possibly a very high level for a very prolonged period of time.
0:49:19 They are now afraid of the world immediately after that type of horrific assault.
0:49:22 They are now afraid of the world.
0:49:25 They probably aren’t sleeping as well.
0:49:37 And what’s happening physiologically and we know this is that those higher cortisol levels are actually causing something called hyper metabolism.
0:49:46 Their mitochondria are actually working on overtime because the body is still primed for the world is unsafe.
0:49:49 Everything is unsafe.
0:49:55 Maybe that person who assaulted me is going to somehow figure out where I live and come through that door any minute.
0:50:04 So you’re sleeping at night and you hear a sound or you hear a creak and you panic and you wake up and you’re startled and you’re terrified.
0:50:13 Or you sleep at night and you have a nightmare and you wake up and you’re reliving that experience and just you’re horrified and overwhelmed again.
0:50:21 Is this conscious because often you speak to people with severe anxiety and they have panic attacks and they don’t know why they’re having panic attacks.
0:50:25 They can’t name something that they’re scared of or a fear they have.
0:50:27 No, this is not at all conscious.
0:50:37 So at this point in the week or two after a horrific trauma like I’ve described, I would argue this is not a disorder.
0:50:39 This is not the brain malfunctioning.
0:50:41 This isn’t the body malfunctioning.
0:50:47 The brain and body are doing precisely what they are programmed to do, protect you.
0:50:50 Your life is in danger.
0:50:51 Why?
0:50:55 Because somebody just tried to take it and they were close.
0:50:58 They came close to taking your life.
0:51:00 They could have killed you.
0:51:04 And so your body and brain are trying to protect you.
0:51:07 Unfortunately, that comes at a cost.
0:51:24 All of this energy going toward the defense system means that energy that should be going toward maintaining your cells is actually being bypassed sometimes.
0:51:46 So we know this. So for example, there are these things called stress granules where cells that are trying to just do basic home everyday repair work, create some new proteins or new receptors or do some cleanup work.
0:51:54 The code for those, which are called messenger RNAs, actually gets sequestered in these little bubbles called stress granules.
0:51:57 And what that means is that they’re not getting done.
0:52:07 The messages are starting from your DNA because the cell is saying, hey, I need some repair work over here.
0:52:11 Send some new proteins over here to do some repair work.
0:52:19 When your body is in fighter flight mode, those messages actually get interrupted.
0:52:31 And that means bottom line, it means that when you feel threatened, your body is diverting metabolic resources toward your self-defense system.
0:52:32 Hypervigilance.
0:52:34 Be ready to run at any minute.
0:52:37 Be ready to fight off the offender at any minute.
0:52:41 You cannot feel safe. Don’t feel safe.
0:52:53 When that goes on for a prolonged period of time, your cells can fall into a state of disrepair because metabolic resources are not going toward cell maintenance.
0:53:05 If that occurs long enough or in a severe enough way, it means that some of your cells can now fall into a state of disrepair.
0:53:09 And they can begin to malfunction.
0:53:25 When that happens, if it’s happening in brain cells, that’s when I would say the person has crossed the line from a normal survival reaction to trauma.
0:53:37 If their cells in their brain begin to malfunction now because they are on a state of disrepair, that can turn into what we call a mental illness.
0:53:42 And that means that maybe they can’t remember like they used to.
0:53:48 It means that maybe and now they can’t pay attention like they used to.
0:54:01 Now somebody might say, hey, maybe you got some ADHD going on or their anxiety pathways become what’s called hyper excitable.
0:54:08 And now their anxiety pathways are being triggered even when they shouldn’t be triggered.
0:54:13 And out of the blue, they’re having panic attacks or anxiety symptoms.
0:54:16 They can be sitting in the comfort of their own home.
0:54:25 Not thinking any scary thoughts, not having any, not watching anything on television or anything that’s really disturbing.
0:54:29 And out of the blue, they can just be overwhelmed with a panic attack.
0:54:38 And that person, I would say, if they have a panic attack for no reason, that person’s brain is now malfunctioning.
0:54:53 That person is dysregulated and I would say that that person has now crossed over into what I would call a mental disorder where their brain is in fact malfunctioning now.
0:55:02 The great news, the hope, and we can get to more of it, is that those cells can be repaired.
0:55:04 We can fix that.
0:55:07 We can do something about that.
0:55:11 We cannot need to be like that forever.
0:55:18 This notion that they now have a chemical imbalance that they were probably genetically predisposed to.
0:55:23 And now we’ve got to just medicate them for the rest of their life.
0:55:25 I don’t agree with that.
0:55:27 I’m not at all opposed to medication.
0:55:32 If medications can be helpful to that person, 100%, let’s use them.
0:55:35 Let’s help that person heal and recover.
0:55:38 But I want to go deeper.
0:55:51 I want to understand what is happening in that person’s brain and body using this kind of information about metabolism in mitochondria.
0:55:58 And how can we effectively help them heal and repair and recover?
0:56:01 We talk a lot about diet and food on this show.
0:56:07 As it relates to metabolism and mental health, diet.
0:56:11 So diet is huge.
0:56:21 And most people have no clue that diet plays any role in mental illness or mental health.
0:56:33 95% of mental health clinicians think it’s laughable that anybody would suggest that diet can play a role in mental illness.
0:56:35 They think it’s laughable.
0:56:36 What do you think?
0:56:50 I think if you do a deep dive into the science, all of the science that we have accumulated over the last 100 years and longer sometimes.
0:56:56 If you do a deep dive into all of those neuroimaging studies that we’ve been doing, all of the genetic studies we’ve been doing,
0:57:04 all of the neurotransmitter and hormone studies and trauma studies and adverse childhood experiences studies.
0:57:15 If you do a deep dive into the science and you understand what is happening in the brains and bodies of people as a consequence of those things.
0:57:19 Or what could be causing those things?
0:57:29 If you put it all together, you come to this sound bite that mental disorders are metabolic in nature.
0:57:34 And there is no questioning whatsoever.
0:57:44 It is incontrovertible that diet plays a massive, huge role in metabolism.
0:57:56 And therefore, I believe very strongly that diet might be playing a role in the mental health epidemic that we are seeing.
0:58:05 And it also might provide an avenue of hope and healing and recovery.
0:58:12 And I use the word might as the scientist in me, as the clinician in me.
0:58:24 I know without certainty it can heal and recover people who have had chronic, horrible, debilitating mental illnesses.
0:58:35 And I know from my own personal story, when I was in medical school and residency, I’m still suffering from low-grade depression, OCD, other symptoms.
0:58:39 But I also developed what’s called metabolic syndrome.
0:58:47 I developed high blood pressure, high cholesterol, prediabetes, and I wasn’t really overweight.
0:58:55 I was exercising, I was following a low-fat diet, mostly processed foods because they’re cheaper.
0:59:00 But that was the diet that was touted as a healthy diet.
0:59:05 It was low in fat, and as long as it was low in fat, that was supposed to be good for us.
0:59:09 And my metabolic syndrome just kept getting worse and worse.
0:59:20 And so at some point, in order to treat my metabolic syndrome, I changed my diet to essentially a low-carbohydrate diet.
0:59:31 And within three months, my metabolic syndrome was completely gone.
0:59:43 But the thing that just dumbfounded me was that my mental health was better than it had ever been in my entire life.
0:59:47 And I just couldn’t believe what I was experiencing.
0:59:50 I didn’t know that I could be that kind of a person.
0:59:56 I didn’t know that I could be happy and positive and energetic and confident.
1:00:01 I had no idea. I didn’t think that was in me.
1:00:05 And by changing my diet, all of those things happened.
1:00:23 At the level of the mitochondria, do you believe that because you changed your diet to more natural, healthier foods, at the level of the mitochondria, the mitochondria were able to function more naturally themselves
1:00:37 and in a more functional way, which meant that the chemicals they released and the processes they go through were more consistent with positive mental health.
1:00:39 Is that like the simpleton’s way of understanding it?
1:00:43 And before then, you talked about man-made compounds in the foods, etc.
1:00:54 I’m assuming you’re saying that some of the modern foods that we eat, the ultra-processed foods that have all of these random named chemicals inside them that we see on the labels, the mitochondria don’t know how to deal with that.
1:01:04 So it’s causing the same sort of dysregulation and dysfunction that they might see if we’d gone through like an extreme trauma or something else or some other adverse environmental situation.
1:01:09 It’s just this dysfunction of the mitochondria, which is causing the knock-on effects we see.
1:01:12 But there’s many things that can cause dysfunction in the mitochondria.
1:01:14 And we went through a bunch of them earlier.
1:01:16 Is that like a simple way of understanding it?
1:01:17 100%.
1:01:18 Okay, great.
1:01:19 It’s perfect.
1:01:20 Super interesting.
1:01:24 Okay, so on that point then, we have to zoom in on this thing of diet.
1:01:38 If you wanted my mitochondria to be perfect and maybe even give me a case study of patients you’ve worked with that you’ve prescribed a certain diet to, what diet, what food would you tell me to eat?
1:01:40 And what would you tell me not to eat?
1:01:46 So I actually don’t have a one-size-fits-all prescription.
1:01:50 And so I want to say that up front.
1:01:58 So I would want to know who am I working with and how is their mental and metabolic health now?
1:01:59 Me.
1:02:00 So you?
1:02:01 Yeah.
1:02:03 So I would want more details.
1:02:07 Are you having symptoms of any mental health condition?
1:02:08 I would say no.
1:02:14 However, I can have moments where I feel a little bit anxious.
1:02:23 So, you know, I’ve been through a lot of, I’d say like stressful events in my life because I was running a big business, we had entrances of employees, paydays all the time.
1:02:28 So I had this, at one point, I had this constant subtle stress.
1:02:35 And so I would want to know, do you feel like you have anxiety for no good reason?
1:02:40 Sometimes, sometimes it can feel a little bit like that.
1:02:44 It’s very infrequent, I’d say.
1:02:51 But I can also have moments where I just think of something and then I get the same kind of like, it’s almost like the fight-or-flight response has just kicked in.
1:02:54 But you think of something adverse or stressful?
1:02:55 Yeah, yeah, yeah, yeah.
1:03:05 So the one thing I would say about that, and we could get into a lot more details, which we probably don’t want to do now.
1:03:06 Out of mind.
1:03:07 Podcast.
1:03:17 But my strong guess, based on just what you’ve said, is that that level of stress and anxiety is quote unquote normal.
1:03:18 Okay.
1:03:34 Because you are sensing, I have to go do something that’s really scary right now, or I have to go do something that’s going to ruin someone’s life, or that might threaten my success.
1:03:42 It is normal and actually healthy to have anxiety and stress in those situations.
1:03:53 The anxiety and stress can sometimes be quite helpful and adaptive because it can make you pause and reflect on, is this really what I want to do?
1:03:59 As opposed to being overly confident and just proceeding.
1:04:07 Your own personal history almost certainly informs your level of stress response.
1:04:18 And again, so if you go back to your own traumas, you’re going to remember when I’m facing a situation like this, it’s helpful to be on hyper alert.
1:04:21 It’s helpful to be hyper vigilant.
1:04:28 And your body and brain will remember that helped you navigate this safely and effectively.
1:04:40 But if I have that profile, if I have that sort of mental profile now as I sit here, and then for the next decade, I process junk food.
1:04:47 Am I going to send my mitochondria into disarray, which is going to increase the probability that I have a mental health disorder?
1:04:49 Yes, I think yes.
1:05:00 There’s no way we will ever be able to do a human randomized controlled trial to test that precise hypothesis.
1:05:17 But we have large epidemiological studies that strongly suggest that people who eat a lot of ultra processed food have higher risk for developing depression, anxiety and other mental disorders.
1:05:28 And based on the science, the granular science, based on animal models, so we can do that to mice and rats.
1:05:31 And in fact, that’s exactly what we see in mice and rats.
1:05:43 We feed them an obesogenic diet, which is usually high in fat, high in carbohydrates, ultra processed foods.
1:05:52 Some researchers have fed rats and mice cafeteria diets where they feed them a lot of delicious junk food.
1:06:03 And those mice develop higher rates of obesity, but also higher rates of diabetes and prediabetes.
1:06:12 And oh, by the way, also higher rates of depression and anxiety, because those are the two things that we can kind of measure in mice and rats.
1:06:15 We can’t necessarily measure ADHD symptoms.
1:06:23 It’s really hard to actually measure psychotic symptoms, but we can measure depression and anxiety symptoms pretty well in animals.
1:06:27 And so in animal models, we know that that’s unequivocally true.
1:06:34 And we see the same in humans, though, because I was reading your book and in chapter four, you say people with ADHD are more likely to develop obesity.
1:06:41 People who are obese are 50% more likely to develop bipolar and 25% more likely to develop anxiety or depression.
1:06:48 And weight gain around the time of puberty leads to a 400% increase in the chance of depression by the age of 24.
1:07:00 Yes, and insulin resistance at age nine increases your chances of developing a psychotic at risk mental state,
1:07:05 which is like meaning your high risk for developing schizophrenia or bipolar disorder, 500%.
1:07:07 And Alzheimer’s?
1:07:13 All mental disorders are associated with an increased risk of Alzheimer’s disease.
1:07:22 Anywhere from the lowest is 50% increased risk and the highest is 2000% increased risk.
1:07:27 And the thread that unites all of these problems is metabolism.
1:07:29 Metabolism.
1:07:38 And at the end of the day, you have to talk about mitochondria in order to understand metabolism.
1:07:49 Only 7% of U.S. citizens have no signs of metabolic health problems,
1:08:00 meaning 93% or so of U.S. residents will have at least one of the biomarkers of metabolic syndrome,
1:08:13 meaning they have prediabetes or abnormal lipids or high blood pressure or abdominal obesity or abdominal fat, excessive abdominal fat.
1:08:16 So what do we offer those 93%?
1:08:27 So those people diet interventions would absolutely be a part of a healing strategy, a part of it.
1:08:29 Not the only strategy.
1:08:31 I would want to know about their sleep.
1:08:33 I would want to know about substance use.
1:08:36 I would want to know about medications, lots of things.
1:08:42 But for dietary interventions, I would want to meet them where they’re at and just find out where are you at?
1:08:44 What are you eating?
1:08:49 Do you have preferences or demands for what your diet should be?
1:08:51 Could you give me a case study then?
1:08:56 Maybe a more extreme case study from your practice that you’ve seen.
1:09:09 I can give you the simple cases which probably apply to the majority of human beings on the planet.
1:09:16 But if it’s okay, I’d rather give you the extreme case because a lot of people are skeptical.
1:09:22 They probably hear me saying this and they think, “Well, you’re just talking about general health and wellness.”
1:09:25 What about people with real mental illness?
1:09:30 What about people like your mother whose lives were decimated by mental illness?
1:09:33 This doesn’t have anything to do with them.
1:09:39 And what I’m here to say is, “No, actually this has everything to do with them too.”
1:09:43 But yes, it applies to just common everyday people.
1:09:51 But probably it’s a one story that I will just share.
1:09:55 Because it’s probably one of the most powerful stories I know.
1:10:02 It was a woman whose real name was Doris.
1:10:06 And in the book, I called her Mildred because I changed everybody’s names.
1:10:09 But she actually gave me permission to use her real name.
1:10:12 So in honor of her, I want to use her real name.
1:10:19 So she was a woman who actually had a horrible abuse of childhood, lots of trauma.
1:10:28 And by the time she turned 17, she started having daily hallucinations and delusions and was diagnosed with schizophrenia.
1:10:40 Over the ensuing decades, she tried numerous antipsychotic mood stabilizers, antidepressants and other medicines.
1:10:43 But none of them stopped her symptoms.
1:10:46 She remained with all of the symptoms of schizophrenia.
1:10:50 She ended up gaining a massive amount of weight.
1:10:57 She ended up weighing about 330 pounds by the time she was 70.
1:11:02 Her life was devastated by this diagnosis.
1:11:08 She had a court appointed guardian to manage her financial affairs and other affairs.
1:11:14 She had professionals coming into her home to help her with paying bills and grocery shopping and stuff like that.
1:11:19 Because she couldn’t do it for herself, which is not at all unusual for people with schizophrenia.
1:11:29 And between the ages of 68 and 70, she tried to kill herself at least six times and was hospitalized for those suicidal times.
1:11:33 She hated herself and she hated her life.
1:11:40 When she was 70 years old, her doctor told her, “You’re overweight and you need to go lose some weight.”
1:11:53 And she was referred to a weight loss clinic at Duke University where they just so happened to be using the ketogenic diet as a weight loss tool.
1:11:56 And for whatever reason, she decided to give it a try.
1:11:59 And so she tries the ketogenic diet.
1:12:10 And within two weeks, not only does she start losing weight, but she notices dramatic reduction in her hallucinations and delusions.
1:12:17 Within months, all of her symptoms of schizophrenia were in full and complete remission.
1:12:21 She starts tapering off her psychiatric meds.
1:12:31 Within about six months, she was off all of her psychiatric meds and her symptoms of schizophrenia remained in remission.
1:12:46 Doors went on to live for another 15 years, symptom-free, medication-free, out of psychiatric hospitals, no more suicide attempts.
1:12:52 She stopped seeing mental health professionals pretty quickly because they were kind of worthless to their mind.
1:12:55 They hadn’t really helped all that much.
1:13:01 She lost 150 pounds and kept it off until the day she died.
1:13:07 She ended up dying at the age of 85 of COVID pneumonia.
1:13:18 But her story tells us, like we could get, if you want, we don’t have to.
1:13:23 We could get into the science of the ketogenic diet and what it’s doing to metabolism in mitochondria.
1:13:24 I love to know.
1:13:36 But there’s an entire story that helps us understand what happened to her and how exactly that resulted in her really spectacular and almost miraculous recovery.
1:13:43 Unbeknownst to most people, most people know the ketogenic diet is a fad diet.
1:13:45 A lot of people are really worried about it.
1:13:47 They’ve heard that it’s dangerous.
1:13:49 It’ll give you a heart attack.
1:13:50 You’ll die.
1:13:59 Unbeknownst to most people, the ketogenic diet was developed over 100 years ago now by a physician for one and only one purpose.
1:14:02 It was developed to stop seizures.
1:14:13 And in fact, the ketogenic diet has been studied extensively for its effects on the brain over the past 100 years.
1:14:18 And it is an evidence-based treatment for epilepsy.
1:14:27 And the reason that is so important is because we use epilepsy treatments in psychiatry all the time.
1:14:33 Lots of the medications that we prescribe to psychiatric patients are in fact epilepsy treatments.
1:14:45 And so we know that there’s a lot of overlap between epilepsy and mental illness and that treatments that help with epilepsy can also help with mental illness.
1:14:55 And so we actually know more about the biology of the ketogenic diet and its effects on the brain than we do any other dietary intervention.
1:14:57 It changes neurotransmitter systems.
1:15:00 It decreases brain inflammation.
1:15:04 It changes the gut microbiome in beneficial ways.
1:15:08 It actually changes gene expression or epigenetics.
1:15:17 But most important and relevant to my theory is it improves mitochondria and mitochondrial function.
1:15:30 And if you do it long enough over a long enough period of time, you can actually repair mitochondrial dysfunction in cells, at least for some people.
1:15:35 And then you can actually stop the diet.
1:15:42 So in the epilepsy world, when neurologists use this diet to stop seizures, it’s usually not a lifetime treatment.
1:15:47 They usually only need to do the diet for anywhere from two to five years.
1:15:54 Many people, about a third of people who have treatment-resistant seizures, will become seizure-free.
1:16:01 And another third, so two-thirds total, another third will have a dramatic reduction in seizure frequency.
1:16:07 So that leaves a third for whom it’s not really working, but these are people with treatment-resistant epilepsy.
1:16:13 And there’s no treatment that’s going to work for everybody because we need to look at all the other things involved.
1:16:20 If, say, somebody has seizure cessation, they get rid of their seizures on a ketogenic diet,
1:16:27 usually they have to do it for two to five years, somewhere in there, and their clinician will help them decide how long they should do it.
1:16:34 And then they can stop the diet, and most often the seizures don’t come back.
1:16:37 It seems to actually heal the brain.
1:16:44 What is that diet adding or subtracting from the body that’s causing that pretty phenomenal effect? Do people know?
1:16:49 The real answer is we don’t entirely understand, we don’t know.
1:16:53 I mean, the ketogenic diet removes sugar, for example.
1:16:55 It does.
1:17:06 Pretty much it gets entirely. I mean, I’ve been on that diet for about eight weeks or so just to try, and I couldn’t have anything with sugar in it pretty much.
1:17:12 No sugar, no carbohydrates, very few carbohydrates.
1:17:19 So some people will argue, well, the diet is getting rid of gluten, and gluten is maybe the toxic thing.
1:17:33 Other people will argue, oh, the diet is adding some extra protein or meat, and maybe that’s replacing a nutrient deficiency like vitamin B12 deficiency or something like that, or iron deficiency.
1:17:38 And all of those things might be true for some people.
1:17:42 I don’t think those are the primary explanation.
1:17:47 I mean, obviously, if somebody has vitamin B12 deficiency, replacing vitamin B12 is essential.
1:17:52 If somebody has iron deficiency, yes, recognizing that and replacing it.
1:17:59 But most people don’t have those deficiencies, and they can still have mental symptoms or mental health problems.
1:18:08 I believe what the diet is doing is it forces a transition in brain and body metabolism, essentially.
1:18:12 And that transition is actually mediated through mitochondria.
1:18:18 So the ketogenic diet forces your liver to start producing ketone bodies.
1:18:21 So it forces your liver to break down fat.
1:18:28 So you’re losing fat from your fat stores, but that fat is being shuttled to the liver.
1:18:32 And then the liver takes that fat and breaks it down.
1:18:37 And I mean, I shouldn’t say all of the fat is being shuttled to the liver.
1:18:41 Some of the fat is going to muscles and other tissues and just being used directly.
1:18:45 But a fair amount of the fat is actually being shuttled to the liver.
1:18:50 And then that fat is being converted into ketone bodies.
1:18:56 Some of it is being converted into glucose so that you maintain normal glucose levels through this.
1:19:02 Those ketone bodies are then going up to the brain and fueling brain cells.
1:19:05 But those ketone bodies are actually doing so much more.
1:19:08 They’re changing mitochondrial function.
1:19:10 They’re changing epigenetics.
1:19:14 They’re changing neurotransmitters and inflammation and all sorts of things.
1:19:34 But at the end of the day, I’m convinced that it’s really the metabolic changes and the mitochondrial changes that are so important and that are so instrumental in these dramatic improvements and things like stopping seizures or stopping hallucinations and delusions.
1:19:36 What about fasting?
1:19:41 There’s been a lot of talk, especially recently, about fasting and the impact that that can have on our mental health.
1:19:47 Do you think fasting is a positive for our mental health?
1:19:50 So it depends on the person.
1:19:55 And so the ketogenic diet actually mimics the fasting state.
1:19:57 That’s why it was produced.
1:20:07 The ketogenic diet was actually developed by a physician recognizing that fasting can have really powerful brain effects, including stopping seizures.
1:20:14 If you’re out on an island and your friends start seizing uncontrollably, the best thing to do is to fast them.
1:20:23 Even if the seizures stop intermittently, you would think, “Oh, let’s feed you to keep up your sustenance and take care of you.”
1:20:34 The best thing to do for your friend, if they are seizing repetitively over days or months, the best thing to do is to fast your friend.
1:20:41 And to tell them, “Let’s have you go without food for a few days,” and that can stop the seizures.
1:20:47 The challenge with fasting is that you could starve to death if you do it long enough.
1:20:51 That’s not a very good treatment for your friend on the island.
1:20:55 And this physician who developed the ketogenic diet recognized that.
1:21:09 And so that’s why he developed the ketogenic diet was really looking to see, “Can we mimic the fasting state with a diet and get these longer-term benefits?”
1:21:16 So back to your question, can fasting play a role? 100%? Yes, fasting can play a role.
1:21:20 And fasting is doing pretty much the same thing that the ketogenic diet is doing.
1:21:31 It’s changing mitochondrial biology. It’s improving mitochondrial function, changing neurotransmitters, changing the gut microbiome, improving insulin signaling and insulin resistance.
1:21:38 It’s doing all sorts of beneficial things. There are a couple of caveats with fasting, though.
1:21:44 One is that people who are underweight should not fast.
1:21:50 So that includes people with eating disorders who are emaciated or underweight.
1:22:02 But it also includes people who have had severe depression and lost weight as a result of their severe depression, or people with cancer who have lost a significant amount of weight.
1:22:11 Fasting is not good for them. Fasting mimicking diets, like ketogenic diets, may in fact be very powerful for those people.
1:22:16 But it needs to be done in a safe, supervised, medical way.
1:22:25 Sugar. What impact does that have on the mitochondria? If I’ve got a super high-sugar diet, is that impacting my mitochondria in some way, and therefore my metabolism?
1:22:38 It is. So low intake of sugar in people who are otherwise healthy is perfectly fine and acceptable.
1:22:51 So lots of people can consume treats every now and then, or desserts a few times a week, or special holiday.
1:22:59 They can maybe even binge on sugar over the holidays, and they don’t have any problems as a result of it.
1:23:09 And that is fine if that’s the way it’s working out. Again, only 7% of the population is metabolically healthy.
1:23:14 So the majority of people, that’s not the way it’s working out.
1:23:29 So high levels of sugar over time, we know can impair mitochondrial function. So there’s this term called oxidative stress.
1:23:43 And oxidative stress is primarily, it’s directly related to mitochondria, because mitochondria are producing the energy, and then that energy production results in oxidative stress.
1:23:54 And oxidative stress we’ve known for decades is bad for cells, and it is highly correlated with all of the metabolic disorders and all of the mental disorders.
1:24:00 High levels of oxidative stress in different cells, in different people with different diagnoses.
1:24:07 High levels of oxidative stress are a unifying theme, but that is a reflection of mitochondrial dysfunction.
1:24:23 So we know that if you eat a lot of sugar over time, it can dysregulate glucose levels, and then those high glucose levels can cause mitochondrial dysfunction, and you can end up.
1:24:26 Kind of on the downward spiral.
1:24:41 What about caffeine and these stimulants? There’s like pre-workout stimulants, and you know, before you do a workout, you have a big dose of this pre-workout, and it kind of makes you go like, you know, do you have a view on caffeine and these sort of energy stimulants?
1:24:52 I do. So caffeine gets complicated because we have to talk about whether it’s in tea or coffee or not, because tea and coffee are different stories.
1:24:59 And they have other compounds that almost certainly are beneficial to human health.
1:25:06 And whether it’s the caffeine itself or not is still kind of a question, an open question.
1:25:25 Caffeine stimulates metabolism in cells. We know that. So it blocks the adenosine receptor, and the function of the adenosine receptor and adenosine on it is to slow a cell down.
1:25:39 It’s basically a feedback loop that slows cells down. It inhibits their function. So when we block adenosine, we basically stimulate the system and we stimulate our brains.
1:25:48 And if you have low metabolic brain function, that can actually be really good.
1:25:57 If you are feeling tired and sluggish, it can make you feel energized and clear thinking.
1:26:11 The challenge is that you can overdo it. So when you stimulate it too fast, that in and of itself can end up causing oxidative stress or mitochondrial dysfunction.
1:26:21 Maybe the easiest way to think about it is this. If you think about a car, you have an accelerator and a brake.
1:26:31 If you’re going to maximize the car’s function, there’s a right balance for all of that.
1:26:43 You don’t want to floor the accelerator and you don’t want to underdo the accelerator. Likewise, you want to determine like you don’t want to be pushing on the accelerator and the brake at the same time.
1:26:55 So when we think about metabolism and mitochondria, when we think about caffeine or even glucose, caffeine and glucose are stimulating the system.
1:27:02 They are through different mechanisms, but they are both stimulating energy production.
1:27:16 But when you overdo it, it would be like flooring the accelerator and then possibly putting on the brake at the same time because you don’t want to be going that fast because you’re going to crash.
1:27:24 So either you’re going to floor the accelerator, crash and burn, or you’re going to floor the accelerator and slam on the brake at the same time.
1:27:32 You’re not serving your car well by doing that, by flooring the accelerator and pushing on the brake.
1:27:43 And when we use substances like caffeine or alcohol or marijuana, which are all working at the level of metabolism and mitochondria.
1:27:50 When we use those substances, in essence, we’re using accelerators or brakes for cells.
1:27:56 And we can overshoot or undershoot. So it’s not that I’m against the use of those things.
1:28:04 If you use reasonable, small to moderate amounts of those on a regular basis, I’m all for it.
1:28:13 So I drink coffee every morning to disclose my bias.
1:28:19 I drink coffee every morning, about two cups of coffee every morning, but that’s my routine.
1:28:23 I don’t go beyond that. I don’t drink coffee in the afternoon.
1:28:30 When I do drink coffee in the afternoon, I notice it starts to interfere with my sleep and then that throws me off.
1:28:35 I have to ask you as well. I’ve had so many parents message me about autism and ADHD.
1:28:43 So many. I’ve had so many concerned parents message me specifically on Instagram saying, “Please, Steve.”
1:28:50 I’ve had a child diagnosed with autism. They’re trying to understand it. They’re trying to get good information on it.
1:28:54 You’ve used the word autism and ADHD as we’ve been speaking about metabolism.
1:28:56 What is the link in your view?
1:29:00 Everything. The link is everything.
1:29:01 Really?
1:29:07 The mitochondrial theory of autism actually was first proposed in 1985.
1:29:16 Since then, we have had an explosion of research linking mitochondria and mitochondrial dysfunction to autism specifically.
1:29:25 As I’ve mentioned to you, the rates of autism have gone through the roof in the United States have quadrupled in the last 20 years.
1:29:31 People think, “Well, what does that have to do with diet? Those kids haven’t eaten a diet yet.”
1:29:33 Well, their parents have.
1:29:38 Let me share a couple of statistics so people are scratching their heads.
1:29:40 Where’s all this autism coming from?
1:29:43 I thought autism was genetic.
1:29:49 If autism is genetic, it shouldn’t quadruple in 20 years.
1:29:54 Quadrupling in 20 years means something in the environment is causing it.
1:30:01 And to provide just one piece of evidence to support what I’m saying.
1:30:13 If a woman has obesity, she has double the risk of having an autistic child.
1:30:21 If a woman has diabetes, she has double the risk of having an autistic child.
1:30:33 If a woman has both obesity and diabetes, she has quadruple the risk of having an autistic child.
1:30:42 If a man is obese, he has double the risk of having an autistic child.
1:30:47 So people are scratching their heads trying to figure out where is all this autism coming from?
1:30:51 Well, look around in the population.
1:30:53 Are the rates of obesity going up?
1:30:55 Are the rates of diabetes going up?
1:31:00 The answer is unequivocally, yes.
1:31:04 And that is a reflection.
1:31:06 It’s not about fat shaming.
1:31:11 I don’t want anybody to hear that and wag their finger at fat people and say,
1:31:14 “Oh, you’re causing autism because you’re overeating.”
1:31:18 It’s not that simple. That’s not the way it goes.
1:31:23 People with obesity have a metabolic or mitochondrial problem.
1:31:26 That is why they have obesity.
1:31:32 Now, that might be caused by the foods they’re eating, but they don’t know any better usually.
1:31:34 They think it’s just about calories.
1:31:38 And what I’m here to say is no, there’s more to food than just calories.
1:31:43 It might be those chemicals in the food that you’re eating or something else,
1:31:46 or it might be chemicals in our environment.
1:31:54 It might be pesticides or microplastics, the forever chemicals that are becoming more and more ubiquitous.
1:31:59 All of these things disrupt metabolism and mitochondrial function.
1:32:07 And so when I talk about obesity and diabetes, increasing risk for autism,
1:32:11 it’s not about fat shaming. It’s about understanding.
1:32:16 It’s about understanding that the parents have a metabolic problem already.
1:32:22 That means that they have a problem in their cells with their mitochondria,
1:32:26 and they then pass those on to their children.
1:32:34 And in some cases, it may not show itself immediately as obesity or diabetes.
1:32:42 It might show itself as a brain condition because lots of other things can play a role.
1:32:48 And if an obese woman, for instance, also has an infection during pregnancy,
1:32:53 that’s going to increase her risk for having an autistic child even more.
1:32:57 So she couldn’t help whether she got an infection or not.
1:33:04 Tragically, we just had an epidemic called COVID,
1:33:13 and the early signs are telling us that in fact, neurodevelopmental disorders are going to increase as a result of that.
1:33:26 We already had a quadrupling of the rates of autism. We are likely to see even worse statistics going forward.
1:33:37 The hope is that if we understand that science, we can do something about it now, today.
1:33:43 If you understand, if you see signs of autism in your child,
1:33:49 if you see signs of metabolic or mental health conditions in your children,
1:33:55 if we intervene early enough, we can probably do something about it.
1:34:11 Number one, by recognizing the problem, and then two, for some people, it could be as simple as dietary interventions or just hyper-focusing on good, clean living.
1:34:22 So that means prioritizing sleep, little less screen time, little more human contact, purpose and life, family connection.
1:34:27 No alcohol, no alcohol, no marijuana, no CBD.
1:34:33 Try to avoid pills. Try to avoid pills for everything that ails you.
1:34:40 If your child’s sleeping, please try methods other than pills, including melatonin and over-the-counter pills.
1:34:45 Don’t just whip out a pill for your child not being able to sleep.
1:34:51 At least try some other interventions, like let’s get you off the screen two hours before bed.
1:34:57 Let’s develop a routine in our household that we’re all going to wind down.
1:34:59 We’re all going to turn off the electronics.
1:35:04 Maybe I’m going to read you a bedtime story, or we’re going to play a game,
1:35:10 or we’re going to do something really boring that everybody’s going to say, “This is so boring, I’m getting sleepy.”
1:35:15 And I’m going to say, “Great! It’s so boring that you’re getting sleepy.
1:35:18 That means you’re going to go to sleep because it’s bedtime.”
1:35:23 I have to ask, you mentioned that you moved in with your mother to try and save her.
1:35:32 When she was suffering with a multitude of mental health disorders, what is that like as a child?
1:35:40 I was trying to imagine if I moved in with my mother when you used the word “delusion,” all right?
1:35:42 What is that like?
1:35:47 I’ve heard people speak to me about a parent with dementia and that kind of that loss.
1:35:49 But what is the loss like that you experienced?
1:35:52 If I was a fly on the wall in those moments, what would I have seen?
1:35:58 And if I was a fly inside of your heart, what would I have felt?
1:36:08 It was actually really horrendously awful.
1:36:13 When I first moved in with her, we had a little bit of money still.
1:36:15 And so we were living in a rooming house.
1:36:18 We were renting rooms.
1:36:25 At some point, the money ran out and the support that we were getting wasn’t enough.
1:36:30 And that’s when we became homeless.
1:36:44 But almost from day one, living with someone who is severely depressed and suicidal and psychotic,
1:36:48 it’s hard to not feel that yourself.
1:36:59 It’s like you’re living in this just oppressive cloud of despair.
1:37:00 And it’s everywhere.
1:37:02 It’s in the air.
1:37:09 Like when you’re in the home with that person, it’s in the air that you’re breathing.
1:37:17 It’s hard to describe it, but that hopelessness just overwhelms.
1:37:23 I mean, you try to cheer the person up and it’s just futile.
1:37:32 And I remember, I think the first like three or four months I lived with her,
1:37:41 I like cried myself to sleep every night, like just sobbing, crying, crying into my pillow
1:37:45 so that she wouldn’t hear me because I didn’t want to burden her.
1:37:47 But I didn’t know what to do.
1:37:53 I was just, I was, it was just overwhelming.
1:37:59 And after about four months, I actually, I couldn’t cry anymore.
1:38:01 I just lost the ability to cry.
1:38:04 I became numb.
1:38:11 I just, I couldn’t tolerate those emotions that just despair.
1:38:13 I couldn’t manage it.
1:38:19 That actually persisted with me for probably like 20 years.
1:38:24 I wasn’t able to cry for like 20 years.
1:38:31 There was a part of me that just felt like, you know, crying is weakness and crying is futile.
1:38:32 It doesn’t do anything.
1:38:40 It doesn’t solve any problems.
1:38:49 It’s interesting because when I was with her, I hadn’t gotten to the point of suicidality myself.
1:38:57 I was desperately wanting to stay alive to see if I could help her and keep her alive.
1:39:15 Within about a year of that, though, I started developing my own suicidality and that persisted in me for years after I tried to kill myself several times.
1:39:17 I was injuring myself.
1:39:22 I was doing all sorts of things.
1:39:34 I was very, I was actually convinced if you asked me at the time, I would have said I was 100% certain that I wouldn’t be alive to the age of 20.
1:39:45 I knew with certainty that I would be dead and I knew that I just couldn’t tolerate living and that there was no hope for me whatsoever.
1:39:46 Chris, thank you.
1:39:50 Your book is full of solutions and it’s full of hope.
1:40:06 And I think that’s why it’s such an incredibly important book and it’s a book that has the bravery to illuminate another set of answers and another path forward out of the despair and the epidemic of mental health illness that we’re.
1:40:09 Unfortunately, I agree with heading.
1:40:13 We are in and increasingly heading towards that makes sense.
1:40:15 It’s certainly increasing in prevalence.
1:40:24 A revolutionary breakthrough in understanding mental health and improving treatment for anxiety, depression, OCD, PTSD, and much more brain energy.
1:40:33 Really, really a remarkable book and once upon a once in a while books come along that challenge the status quo in the most necessary way and your book is certainly one of them.
1:40:38 We have a closing tradition on this podcast where the last guest leaves a question to the next guest not knowing who they’re leaving it for.
1:40:43 And the question that’s been left for you is you are known for your work.
1:40:51 Chris, but what would you like to be known for as the human that you are?
1:40:55 I think I would like people to know.
1:41:01 Like I’ve shared with you today.
1:41:11 That I was somebody who had given up on myself who actually thought there’s no possible way.
1:41:20 I could never have a future. I could ever live a meaningful or even tolerable life.
1:41:24 And that all has changed.
1:41:34 And if it can change for me, and you happen to be one of those people in a similar state right now, it can change for you too.
1:41:36 Chris, thank you.
1:41:37 Thank you so much.
1:41:45 There’s this wonderful quote that I read earlier from the start of your book where you send that message to your mother.
1:41:51 “My futile attempts to save you from the ravages of mental illness litter fire in me that burns to this day.
1:41:56 I’m sorry I didn’t figure this out in time to help you. May you rest in peace.”
1:42:13 But I have to point out the fact that the work you’re doing, the passion you’re bringing to it, the wisdom and the 28 years of study and care you’ve put into all of the work that exists in your book and your wider work is saving many people’s mothers.
1:42:19 Thousands of peoples of their mothers, their fathers, their daughters, their sons.
1:42:28 And that, I think, is an absolutely incredible thing. So on behalf of all of those people that you’ll absolutely never meet, you’ll meet many of them.
1:42:41 Sure, many of them message you, but all of the ones that aren’t able to or haven’t yet, I just want to extend a big thank you for the work you’ve done in your life, for those mothers, for those fathers, for those daughters and for those sons.
1:42:44 Thank you, Steve.
1:42:56 Do you need a podcast to listen to next? We’ve discovered that people who liked this episode also tend to absolutely love another recent episode we’ve done, so I’ve linked that episode in the description below.
1:42:58 I know you’ll enjoy it.
1:43:05 .
1:43:07 (gentle music)

0:00:03 This calories-in-calories-out model doesn’t work at all.
0:00:06 If you’re trying to lose weight, what you need to do is
0:00:07 Dr. Jason Hung,
0:00:09 the founder of intermittent fasting,
0:00:11 whose influential work could beat the key
0:00:14 to a healthier and even longer life.
0:00:17 Every continent is seeing this increase in obesity,
0:00:20 but we put the blame on the individual.
0:00:22 The problem is there’s something wrong
0:00:24 with the message we’re giving people,
0:00:25 and I can go over a few examples.
0:00:29 First of all, exercise is really good in a number of ways.
0:00:31 But in terms of weight loss,
0:00:33 it’s actually a very, very small effect.
0:00:37 The whole idea that you need to eat as soon as you get up
0:00:38 is just false.
0:00:41 We know from twin studies that 70% of your risk
0:00:43 of becoming obese is due to genetics,
0:00:46 but it doesn’t explain why the population
0:00:47 became much more obese.
0:00:49 And we know that you can’t cure obesity
0:00:51 by saying eat fewer calories.
0:00:54 It’s about fixing the hormones that are behind the calories.
0:00:56 If you want to lose body fat,
0:00:59 you actually need to extend the period of time
0:01:00 that you’re not eating,
0:01:02 so you do some intermittent fasting.
0:01:05 There’s all this data showing that fasting activates
0:01:08 the body if it increases your energy and your concentration.
0:01:12 A treatment available to everybody for free,
0:01:13 and it will be healthier for us.
0:01:15 – So I need some advice then.
0:01:16 What does your fast look like?
0:01:18 What food should I be giving my body?
0:01:19 And in what proportions?
0:01:22 – The first thing you got to do is…
0:01:24 – I’ve got to talk to you about these new injections
0:01:27 people are getting to lose weight.
0:01:28 – I think.
0:01:33 (upbeat music)
0:01:39 – Dr. Jason.
0:01:41 – Hey, Stephen, how are you?
0:01:43 – I’m really, really good.
0:01:45 This book here, “The Obesity Code,
0:01:48 “Unlocking the Secrets of Weight Loss.”
0:01:51 Why did you write this book?
0:01:54 What was the sort of driving motivation
0:01:56 behind committing what must have been
0:01:59 a very long part of your life to this subject matter?
0:02:03 – It was actually a very interesting
0:02:05 sort of journey of discovery for me.
0:02:08 So I did my training in nephrology,
0:02:09 which is kidney disease,
0:02:10 so I’m a kidney disease specialist.
0:02:13 And I thought about weight loss sort of very conventionally,
0:02:16 sort of calories in, calories out,
0:02:18 just watch what you eat sort of thing.
0:02:20 And that’s what’s taught to all doctors
0:02:24 is that it’s extremely unhelpful for people.
0:02:26 It doesn’t work at all.
0:02:27 It doesn’t work for patients
0:02:29 and it doesn’t work for doctors even, right?
0:02:31 So doctors who want to lose weight,
0:02:35 they don’t use calories and calories out
0:02:36 because it doesn’t really work.
0:02:37 And we all know this.
0:02:41 Every person has sort of counted their calories
0:02:44 and almost all of them fail to succeed.
0:02:48 So the whole point was how to get people to lose weight.
0:02:50 And so I started to look into the literature
0:02:52 and I started to read about it and so on.
0:02:54 I got very, very interested in it.
0:02:58 And again, I started to become very unhappy
0:03:01 with the discussion about calories and calories out
0:03:06 because the whole point was that people had this idea
0:03:08 that it was energy balance, right?
0:03:11 And there’s this sort of energy balance equation
0:03:16 which is calories in minus calories out equals body fat,
0:03:16 right?
0:03:19 Because body fat is a way to store calories.
0:03:24 But that’s not a very helpful sort of description
0:03:27 of how to approach the problem, right?
0:03:30 The problem is not that people didn’t realize
0:03:32 that they had to eat fewer calories
0:03:35 or increase their calorie expenditure.
0:03:38 The problem was why were they eating more calories
0:03:40 than they could expend, right?
0:03:45 And it’s because the body is being told to store energy,
0:03:48 right?
0:03:49 That’s the way it is.
0:03:50 That’s why you’re taking in more calories
0:03:52 or you’re storing more calories
0:03:54 is because your body has hormones
0:03:56 that tell you to store calories.
0:03:59 So there’s a hormone called insulin, for example.
0:04:01 And if you give people insulin,
0:04:04 so inject them with insulin,
0:04:06 which is a drug for type two diabetes,
0:04:09 almost everybody gains weight.
0:04:11 So if you give somebody insulin, they gain weight.
0:04:13 If I gave you insulin, you would gain weight.
0:04:15 It has nothing to do with the, you know,
0:04:18 your willpower, for example.
0:04:19 If I gave you insulin, you would gain weight.
0:04:20 Why?
0:04:23 Because I’m giving your body the instructions
0:04:24 to store energy.
0:04:26 – So you’re saying that weight gain
0:04:27 and obesity in particular,
0:04:31 isn’t a function of calories in, calories out.
0:04:34 It is a function of hormones.
0:04:35 – It’s a function of hormones.
0:04:38 And it’s sort of, you have to think about it
0:04:40 in sort of levels, right?
0:04:42 So calories and calories out is true.
0:04:45 So body fat is a storage, it’s a way to store energy,
0:04:49 which is calories, equals calories and calories out.
0:04:50 But that’s not the real question.
0:04:53 The question is why are you storing more calories
0:04:54 than you’re expending?
0:04:56 And it’s because you’re telling your body to do so.
0:05:01 So for example, if you take another equal,
0:05:02 I’ll give you an analogy.
0:05:07 Say alcoholism is alcohol in minus alcohol out, right?
0:05:09 Same idea.
0:05:12 Or if you have a room, it’s the number of people,
0:05:15 how full it is, is how many people enter the room
0:05:16 or exit the room, right?
0:05:19 So same idea, right?
0:05:20 It’s absolutely true.
0:05:22 So alcohol in minus alcohol out.
0:05:23 – Equals how drunk you are.
0:05:24 – Equals how drunk you are.
0:05:25 So alcoholism.
0:05:30 So can you simply cure alcoholism by telling an alcoholic,
0:05:33 oh, just drink less alcohol than you expend?
0:05:37 It’s like, yes, you can say that and it’s absolutely true,
0:05:39 but it’s not useful in any way.
0:05:41 Because you’ve never gotten to the really,
0:05:44 the deeper understanding of why that person
0:05:46 is taking in more alcohol, right?
0:05:47 You have to get to that next level
0:05:50 and say, you know, it’s like going one level deeper.
0:05:51 Why?
0:05:52 Why are they drinking more alcohol?
0:05:56 Well, maybe they’re depressed, maybe they’re addicted.
0:05:57 Deal with the addiction.
0:06:00 That is the way to deal with alcoholism.
0:06:03 You can’t cure it just by saying drink less alcohol.
0:06:06 The same way you can’t cure the obesity
0:06:08 by saying eat fewer calories.
0:06:10 Because you’re not understanding
0:06:14 why the body is storing more energy.
0:06:15 With the amount of information we now have,
0:06:16 the amount of science we have,
0:06:18 when would expect that obesity levels
0:06:20 would be coming down?
0:06:24 – Yeah, unfortunately, if you think about
0:06:26 the way most people think about it,
0:06:27 it’s mostly still in calories.
0:06:29 Even in the academic centers,
0:06:31 they all think about sort of calories,
0:06:34 how to get calories down, how to reduce calories.
0:06:37 And I always say, well, it’s not about the calories, right?
0:06:39 It’s about fixing the hormones
0:06:40 that are behind the calories.
0:06:43 Like, ’cause you can choose to eat fewer calories.
0:06:44 Yes, that’s true.
0:06:47 But you have to ask yourself,
0:06:50 why are people eating so many calories, right?
0:06:52 Well, it’s because they’re hungry.
0:06:54 You can’t choose to be less hungry.
0:06:57 And therefore you have to really talk
0:07:00 about controlling the hunger and controlling the hormones,
0:07:02 which are behind the calories that you eat.
0:07:05 And that’s gonna be much more successful to you.
0:07:07 If you take two different foods,
0:07:10 equal number of calories, and you eat them,
0:07:14 the hormonal response to those calories
0:07:15 are completely different.
0:07:19 So you eat two slices of white bread and jam.
0:07:21 All that energy, so insulin spikes up
0:07:24 because it’s very high in refined carbohydrates.
0:07:26 All that energy goes straight into your body fat,
0:07:30 and you’ve left none of it for energy for your day.
0:07:32 By 10.30, now you’re ravenous,
0:07:35 and you go get yourself a low-fat muffin.
0:07:38 Again, pure carbs, insulin spikes up,
0:07:40 all of that goes straight into your fat stores,
0:07:43 why? Because you told it to.
0:07:46 Remember that when you eat white bread,
0:07:49 or muffins, or refined carbohydrates,
0:07:50 you’re gonna have this insulin spike,
0:07:53 which is going to tell your body to store energy.
0:07:56 If you eat an egg, you don’t get that spike in insulin.
0:07:58 So that energy that you’ve taken,
0:08:01 those calories are there, you can use it.
0:08:02 And so what happens?
0:08:03 Well, that keeps you full during the day.
0:08:05 If you’re telling your body
0:08:08 to immediately store those calories as body fat,
0:08:09 well, guess what?
0:08:10 Over time, you’re going to gain body fat,
0:08:13 ’cause you told your body to do that.
0:08:16 If you eat the egg and insulin’s not spiking up,
0:08:18 well, you haven’t told your body to store that energy,
0:08:21 so it’s gonna be around for you to use all day long.
0:08:22 And you won’t be hungry.
0:08:23 And you’re not gonna be hungry,
0:08:26 because your body’s like, why do I need to eat again?
0:08:31 Because you basically have taken the energy that you need,
0:08:33 I’ve got it available, right?
0:08:36 It’s sort of like if you go to the grocery store, right?
0:08:39 You can store food in the refrigerator.
0:08:40 Suppose you go to the grocery store,
0:08:44 put all your food away, lock it away in the refrigerator.
0:08:46 Now you have nothing to eat, right?
0:08:48 You’re gonna say, oh, I need to go out
0:08:50 and get some more food, right?
0:08:51 Same thing with your body, right?
0:08:53 So if you take food,
0:08:56 but you’ve also spiked up your insulin,
0:08:57 you’re gonna lock away all those,
0:09:01 that energy immediately into your fat stores,
0:09:03 it’s not gonna be available for you to use.
0:09:05 Well, you’re gonna say, I’m gonna go out and get more.
0:09:07 So you haven’t controlled the hunger
0:09:09 that’s going to lead to the caloric intake,
0:09:12 which is gonna lead to the weight gain.
0:09:14 People look at this through an evolutionary lens
0:09:16 and say, we just didn’t have this much food,
0:09:21 so it’s the abundance and ease of access to food.
0:09:22 It’s the fridges that we now have.
0:09:24 It’s the, we never had fridges in our home.
0:09:26 So people point at it and go, well,
0:09:29 that’s why people are gaining weight
0:09:32 and we’re suffering with obesity at epidemic levels,
0:09:35 which is because there’s more supply.
0:09:36 And the brain is taking advantage of it
0:09:38 because once upon a time,
0:09:41 if we didn’t eat that jam and toast,
0:09:42 then we would have, you know,
0:09:44 maybe not have been able to find food
0:09:46 for another two weeks or something.
0:09:48 – Yeah, I don’t think that’s the whole story
0:09:50 because if you think about it
0:09:54 and people, again, make that assumption
0:09:59 that we don’t have any control over our body fatness, right?
0:10:00 So they say, well, it’s available,
0:10:02 so you’re gonna take it, right?
0:10:04 In fact, that’s not true
0:10:09 because we actually have a number of different hormones
0:10:12 that tell us to stop eating, okay?
0:10:14 So if you eat,
0:10:17 you cannot simply keep eating and eating and eating, right?
0:10:18 If you go to an all you can eat buffet,
0:10:22 at some point you have to stop because you’re full, right?
0:10:26 So there are systems, very powerful systems
0:10:28 within our body that tell us to stop eating.
0:10:33 So you eat food, there are stomach stretch receptors,
0:10:35 for example, so as your stomach stretches out,
0:10:38 it sends a signal to your brain and says stop eating.
0:10:41 If you eat a lot of protein,
0:10:44 it activates a hormone called peptide YY,
0:10:45 which tells you to stop eating.
0:10:48 If you eat a lot of dietary fat,
0:10:50 you activate a hormone called cholecystokinin,
0:10:52 which again, tells you to stop eating.
0:10:54 And these are very powerful.
0:10:56 If you look in the wild, there are no obese antelope,
0:10:59 there are no obese lions, why?
0:11:03 Because how much body fat you carry
0:11:05 is actually very important.
0:11:08 If you are obese as an antelope, you’re gonna get eaten.
0:11:10 If you are an obese lion, you’re not gonna catch any food.
0:11:12 So therefore it’s gonna correct itself.
0:11:14 – So if I overeat now,
0:11:16 my body will basically overcompensate
0:11:19 by burning off the extra calories.
0:11:22 – Absolutely, so if you eat a huge meal, right?
0:11:24 You eat, you know, you go to a big wedding
0:11:26 or something like that, you eat a huge meal.
0:11:29 The next day, you’re probably not that hungry.
0:11:31 If you eat a giant steak,
0:11:33 so you’re activating all these satiety hormones,
0:11:37 peptide YY, cholecystokinin, you’re eating all this food,
0:11:41 well, you may not be hungry for the next day.
0:11:45 – So that means that my body has some kind of baseline weight.
0:11:49 – Yeah, it will know whether you should eat more or less.
0:11:54 So there’s a, this concept called the sort of body set weight,
0:11:56 which is a sort of thermometer.
0:12:00 That is your body sets a weight that you should be at.
0:12:04 And if you go above that weight, or if you eat too much,
0:12:07 it will activate hormonal systems to bring it back down.
0:12:08 If you don’t eat enough,
0:12:12 it will also activate hormonal systems to bring it up.
0:12:15 So it’s like a thermostat that you have in your room,
0:12:17 for example, you set the room temperature.
0:12:22 If it’s too hot, the room activates the air conditioning.
0:12:24 If it’s too cold, it activates the heat.
0:12:26 Your body actually acts the same way.
0:12:30 If you gain too much body fat, your fat cells, for example,
0:12:33 will produce leptin, which is another hormone.
0:12:36 The leptin tells your body to stop eating.
0:12:37 – That’s really interesting.
0:12:39 So in the case of a beast people,
0:12:41 their set point must just be really high.
0:12:43 – Yes, and that’s the crux of the matter.
0:12:46 Why is that set point being overridden?
0:12:49 Just like if you have a room that’s too hot,
0:12:51 and you look and you say the thermometer is set
0:12:54 for room temperature, why is it so hot in here?
0:12:56 Then you can say, okay, well, what’s the problem?
0:12:58 And the problem is not, you know,
0:12:59 heat in versus heat out, right?
0:13:02 That’s a very simplistic way.
0:13:05 Same thing, if your body has too much body fat,
0:13:08 you got to then think about why are you overcoming
0:13:13 the normal compensatory mechanisms that are happening,
0:13:15 that are stopping you from eating?
0:13:18 A lot of it relates to processing of foods, of course.
0:13:20 So if you take out, so remember,
0:13:23 I talked about stretch receptors in the stomach, right?
0:13:28 So you eat natural foods, there’s a natural break.
0:13:30 It stretches the stomach, you stop eating.
0:13:32 Well, what’s one way?
0:13:35 Pull out all the fiber, process the foods,
0:13:37 turn it into say a very fine dust.
0:13:40 That means it’s absorbed extremely quickly
0:13:41 into the blood stream.
0:13:45 So that means that pure, you’ve got pure carbohydrate,
0:13:49 basically main lining it into your IV, like an IV.
0:13:52 Your glucose spikes way up, your insulin spikes way up.
0:13:54 Completely unnatural, right?
0:13:57 If you eat pure carbohydrate instead of eating it
0:14:00 with proteins and fats, it’s gonna go,
0:14:03 it’s gonna shoot way high, that’s unnatural.
0:14:07 And that’s gonna overcome the natural tendencies
0:14:08 for you to stop eating.
0:14:13 So you’ve basically overcome that protective mechanism
0:14:17 because you’ve ultra processed the carbohydrates.
0:14:20 If you don’t eat any protein, if you don’t eat any fat,
0:14:22 you’re not activating peptide YY,
0:14:24 which is the satiety hormone.
0:14:26 You’re not activated cholecystokinin.
0:14:28 All of a sudden, you’re eating, you know,
0:14:33 500 calories of white bread, but you have zero satiety.
0:14:37 Or if you drink a Coca-Cola or a soda, for example.
0:14:38 I’ve always, you know, thought about this.
0:14:42 It’s like, how can you take 1,000 calories, for example,
0:14:43 in one of those giant sodas
0:14:46 you get at the ball game or something,
0:14:48 and don’t feel full at all.
0:14:51 Whereas if you took a steak that’s 1,000 calories,
0:14:53 you’d be like, I’m pretty full.
0:14:54 I don’t really feel like eating.
0:14:55 You drink the soda.
0:14:57 You’re like, I really feel like eating
0:14:59 some chips or popcorn or something.
0:15:00 Why?
0:15:03 Because it has zero satiety.
0:15:06 – Interesting, so if I’ve got a baseball stadium,
0:15:10 what I wanna do is I wanna make sure people get a soda
0:15:13 because then they’ll also buy the chips.
0:15:15 But if they just eat the chips, you know,
0:15:16 maybe they won’t buy anything else.
0:15:21 But the soda’s gonna increase my revenue
0:15:23 because it’ll basically just pass right through them.
0:15:24 – They’ll pass right through them.
0:15:27 They’re gonna store all that energy, those calories,
0:15:28 but they’re gonna want more
0:15:30 because you haven’t made them full, right?
0:15:33 So the whole point is that you have to think more
0:15:35 than about the calories.
0:15:37 There’s more there than just the calorie story.
0:15:39 There’s this whole hormonal balance.
0:15:41 – You’re saying that overeating isn’t just a choice.
0:15:43 It’s a hormone-driven behavior.
0:15:44 – It’s a hormone-driven behavior.
0:15:45 I mean, the whole thing about obesity
0:15:47 is quite interesting to me
0:15:50 because if you think about obesity,
0:15:52 if you think about in the United States,
0:15:54 which is where I get a lot of my data from,
0:15:59 you know, you have maybe 70% of people overweight or obese
0:16:00 and it’s going up every year.
0:16:03 It’s been going up every year since 1977.
0:16:05 And if you think about that,
0:16:09 it tells you that the problem is not willpower.
0:16:11 The problem is not the people.
0:16:13 The problem is the environment that they find themselves in.
0:16:16 The food environment that they find themselves in.
0:16:18 ‘Cause you can take an analogy.
0:16:20 Say you have 100 children, one of them fails.
0:16:23 Well, that might be the child they didn’t study.
0:16:25 What if 70 of them fail?
0:16:28 Would you say it’s each and every one of them’s fault?
0:16:32 Or would you say it’s more likely that it’s the teacher’s fault?
0:16:34 I think it’s more likely that it’s the teacher’s fault.
0:16:39 So if we have 100 Americans and 70 of them are obese,
0:16:43 the problem is likely not an individual willpower problem.
0:16:47 The problem is likely that there’s something wrong
0:16:48 with the message we’re giving people,
0:16:50 the information we’re giving people
0:16:52 and the food environment that we’re finding ourselves in,
0:16:55 which is dominated by the sort of calories
0:16:56 and calories out thinking.
0:16:58 And what’s really unfair, of course,
0:17:03 is that we put the blame on the obesity or overweight
0:17:06 on the individual.
0:17:08 And we say, well, they let themselves go
0:17:09 and they didn’t watch themselves.
0:17:11 They weren’t careful, it’s their fault.
0:17:13 And that’s the stigma that comes
0:17:15 with this whole calories and calories out thinking
0:17:17 because we say it’s their fault
0:17:18 because they could choose what they eat.
0:17:21 It’s like, yes, they could choose what they eat,
0:17:23 but they didn’t choose the food environment
0:17:26 that is telling them to eat all this ultra-processed food
0:17:28 that is making all this ultra-processed food available
0:17:29 to them that is telling them
0:17:32 that all this ultra-processed food is good for you.
0:17:34 – So leptin is this hormone
0:17:39 that essentially brings down my hunger, makes me less hungry.
0:17:40 Is it therefore possible
0:17:44 that people are becoming leptin resistant?
0:17:45 – There is leptin resistance.
0:17:47 The question again is why?
0:17:49 And the way to think about it is
0:17:50 it’s sort of this sort of balance, right?
0:17:53 So insulin, if you give people insulin,
0:17:55 like if you think about causes of obesity,
0:17:57 what causes people to gain weight?
0:17:59 Well, if I give you insulin, you’ll gain weight.
0:18:01 If I give me insulin, I’ll gain weight.
0:18:02 So insulin causes weight gain,
0:18:03 whereas leptin will cause the opposite.
0:18:05 So it’s sort of the seesaw.
0:18:10 Body fat is nothing more or less than a store of energy, right?
0:18:13 And you only store energy when your body tells you.
0:18:15 Our entire body runs on hormones, right?
0:18:18 Nothing happens without the hormonal system being activated.
0:18:20 So insulin is pushing us to gain weight.
0:18:23 Leptin is pushing us to lose weight.
0:18:24 And what’s happening is that one
0:18:26 is sort of overcoming the other.
0:18:28 Insulin is overcoming the leptin.
0:18:30 – If obesity isn’t about a lack of world power
0:18:33 and it isn’t just a case of people being lazy
0:18:34 or all those things that sometimes
0:18:37 some people stereotypically assert,
0:18:40 I’ve also heard the counter-argument
0:18:42 that obesity is a function of our genetic makeup
0:18:47 and we inherit obesity from our parents, you know.
0:18:49 Is there any truth in merit in that?
0:18:52 – It’s yes and no.
0:18:57 So yes, there is a very strong sort of genetic predisposition
0:18:59 to obesity.
0:19:02 So if you take, you know, somebody with a family history
0:19:05 and look at the genetics, about 70% of your risk
0:19:08 of becoming obese is due to genetics.
0:19:10 And we know that from twin studies, for example.
0:19:11 – What do we know from twin studies?
0:19:15 – If you take twins and raise them sort of
0:19:18 in different environments, you know,
0:19:20 they actually turn out very similarly.
0:19:23 So we know that there’s a genetic component to obesity.
0:19:27 So when they sort of do the calculations,
0:19:31 they say about 70% of obesity is sort of genetically related.
0:19:33 – So if you take a twin that comes
0:19:36 from originally a family that were obese
0:19:39 and you put them with a family that are not obese,
0:19:44 the child will still likely become obese,
0:19:46 even with the family that are not obese.
0:19:51 – So this was done and obviously they had twins
0:19:53 that were sort of separated at birth,
0:19:55 compare them after they’ve grown up
0:19:58 and say what’s the sort of correlation
0:19:59 between the weight of the two?
0:20:01 And it’s about 70%.
0:20:04 So you have somebody who’s very overweight
0:20:06 and you know, twin A goes into one family,
0:20:08 twin B goes into a second family.
0:20:12 You know, twin B is gonna be more prone to gaining weight
0:20:14 even if they’re with a thin family, right?
0:20:17 So the environment has some role,
0:20:20 but the genetics have a very large role too.
0:20:23 – 70% of obesity. – About 70% is genetic.
0:20:27 So there is, however, the part that’s important
0:20:32 is that that doesn’t explain why we have obesity
0:20:35 in the last 40 to 50 years
0:20:38 because the genetics of the world population
0:20:40 has not changed.
0:20:42 So if we’re seeing more obesity now,
0:20:45 and remember this is not a USA problem,
0:20:47 it’s a worldwide problem.
0:20:49 We see it in Asia, we see it in Europe,
0:20:51 we see it in America, we see it in South America,
0:20:54 we see it everywhere, we see it in Africa.
0:20:58 So every continent is seeing this increase in obesity.
0:21:01 Therefore, it’s not due, this recent change
0:21:05 within the last 50 years is not due to a change in genetics.
0:21:06 So while, yes, it’s true
0:21:09 that there is a strong genetic component,
0:21:14 that explains my risk of, say, obesity compared to yours,
0:21:17 but doesn’t explain how the population
0:21:19 of the United States, for example,
0:21:22 all of a sudden became much more obese in general.
0:21:25 So you’re saying this is really about a predisposition,
0:21:27 which basically means your genetics
0:21:31 make you more or less likely, for some reason,
0:21:32 which is a genetic reason,
0:21:37 to become obese when you make certain lifestyle choices.
0:21:42 But that is a predisposition, which means that,
0:21:43 and I guess your work asserts
0:21:45 that the predisposition relates
0:21:49 to your hormones response to the foods that we eat.
0:21:54 – So really it’s really a genetic response to foods,
0:21:55 which is based on your hormone response.
0:21:57 – We all have a certain genetic
0:22:00 sort of predisposition to obesity, right?
0:22:01 So all of us have a certain risk.
0:22:03 Some people, obviously they eat whatever they want,
0:22:04 and they don’t gain weight.
0:22:05 We all know people like that, right?
0:22:08 And some people sort of look at a muffin and they gain weight.
0:22:11 So you have that genetic predisposition.
0:22:15 So that explains the difference between two people,
0:22:16 but it doesn’t explain the difference
0:22:18 within an entire population.
0:22:21 Like if you take the entire population of the earth,
0:22:23 or even of America or whatever,
0:22:26 the genetics haven’t changed sufficiently
0:22:28 of that entire population
0:22:31 to say why there’s more obesity now than before.
0:22:34 – So we’re inheriting our parents hormone response.
0:22:38 – Yeah, but the hormone response that we have
0:22:42 is going to be dependent a lot on genetics,
0:22:44 but the food choices we’re making
0:22:46 are different than our parents.
0:22:47 So they’re eating different things.
0:22:51 If you think back about what your grandmother ate and stuff,
0:22:52 it’s different than the food environment
0:22:54 that we find ourselves in right now.
0:22:58 And that food environment is creating this sort of,
0:23:03 is sort of increasing the risk over time.
0:23:07 That’s the sort of what we need to try and figure out
0:23:09 and why we need to have a deeper discussion
0:23:11 as opposed to calories.
0:23:13 Because we’ve been having this sort of calories discussion
0:23:15 for 30, 40 years.
0:23:17 It just hasn’t been very helpful.
0:23:19 – You call it a deception.
0:23:20 You say in part two of your book,
0:23:23 you say the calorie deception.
0:23:25 And you say there are five wrong assumptions
0:23:26 about obesity and weight loss.
0:23:30 The calorie in, calorie out are independent of each other.
0:23:32 So we won’t trigger one another.
0:23:35 This interesting point about the basal metabolic rate
0:23:36 being stable.
0:23:38 Is that in essence because people,
0:23:41 people will often say I have a low metabolism.
0:23:42 It’s kind of like a word in culture.
0:23:47 If someone is obese, often the diagnosis is
0:23:48 they have a low metabolism.
0:23:49 Is there any merit in that?
0:23:50 Is that true?
0:23:51 – Oh, absolutely.
0:23:52 The question.
0:23:54 So when you think about, so body fat,
0:23:56 you think about the energy balance equation.
0:23:59 Body fat equals calories in minus calories out.
0:24:00 This often leads people to say,
0:24:02 well, just eat 500 fewer calories
0:24:05 and you’ll lose a pound of fat per week.
0:24:08 It’s unquestionably false
0:24:11 because every single study that we’ve done
0:24:14 over the last 50 years,
0:24:17 shows that if you eat 500 fewer calories,
0:24:21 then over time, depending on what foods you’re eating,
0:24:24 eventually your body will just burn 500 fewer calories.
0:24:25 So that’s your basal metabolic rate,
0:24:28 the number of calories that your body is expending
0:24:29 in one day.
0:24:33 So we see this in almost every single study.
0:24:36 We’ve known about it for like 80 years at least.
0:24:40 You eat fewer calories, your body burns fewer calories.
0:24:42 Well, that’s going to limit how much weight
0:24:44 you’re gonna lose, right?
0:24:46 So this idea that just eat fewer calories
0:24:49 will automatically lead to weight loss
0:24:52 is completely false because we know
0:24:55 that eating fewer calories leads also
0:24:57 to burning fewer calories.
0:25:01 So you eat 500 less, your body burns 500 less
0:25:03 and you’re not losing any body weight.
0:25:06 – So I go on a diet, let’s say,
0:25:08 ’cause I’m trying to lose weight.
0:25:12 My metabolism lowers to meet the calorific restriction
0:25:14 that I’ve imposed on myself.
0:25:16 What then happens when I come off the diet?
0:25:19 Does my metabolism stay?
0:25:20 – Generally, yes.
0:25:21 – Low?
0:25:21 – Yeah.
0:25:23 So that’s that yo-yo dieting effect.
0:25:26 So say you start with 2000 calories in,
0:25:28 2000 calories out, you’re not gaining weight,
0:25:29 you’re not losing weight, right?
0:25:31 Now you decide, okay, I’m gonna go on a diet.
0:25:33 So you go down to 1500 calories,
0:25:36 thinking that you’re gonna burn 2000
0:25:39 and the body fat’s gonna provide 500, right?
0:25:42 That’s how you balance that equation.
0:25:44 However, if you eat the wrong foods
0:25:46 and you’re eating all the time,
0:25:47 so you’re eating 10 times a day,
0:25:49 eight times a day like people say you should,
0:25:51 you’re eating low fats or you’re eating tons of carbs,
0:25:53 you’re spiking your insulin,
0:25:57 insulin prevents you from burning body fat, okay?
0:25:59 So again, we’ve known about this for 80 years.
0:26:02 So now you eat 1500 calories
0:26:04 but you’re keeping your insulin levels really high.
0:26:07 So fewer calories but lots of high-carb foods,
0:26:10 eating all the time, insulin stays high.
0:26:14 You’re taking in 1500, your body is now burning 2000
0:26:16 but you can’t burn any body fat.
0:26:19 So the calories that are stored in your body fat
0:26:22 cannot be sort of taken out.
0:26:24 It’s like it’s in the bank and the bank is closed.
0:26:25 You can’t take it out.
0:26:27 So what’s gonna happen?
0:26:30 Well, you don’t have a balanced equation.
0:26:31 So that cannot happen.
0:26:34 So what happens is that in order to balance that equation
0:26:36 because your insulin levels are high,
0:26:39 you’re eating 1500 calories coming in,
0:26:41 your body can only burn 1500 calories.
0:26:45 Your metabolic rate has just now gone down by 500 calories
0:26:48 and guess what, you’re not losing any body fat.
0:26:51 So that’s an example of how the whole,
0:26:54 the calories idea is completely wrong
0:26:57 because if you continue to do that,
0:27:00 what’s gonna happen over time is that you get tired
0:27:02 because you’re burning fewer calories.
0:27:05 You don’t have enough energy to generate body heat.
0:27:08 So you’re cold, you’re tired, you’re hungry.
0:27:11 So you say, okay, I’m gonna go to 1800 calories.
0:27:13 So now you’re eating 1800 calories
0:27:15 but you’re only burning 1500 calories.
0:27:17 Guess what, you gain weight.
0:27:19 And you say, but how can I gain weight?
0:27:20 I’m eating less than I did.
0:27:23 Yes, you are eating less than the 2000 calories
0:27:24 you used to eat.
0:27:26 You’re eating 1800 but you’re eating the wrong foods.
0:27:29 It’s very high insulin foods.
0:27:31 So therefore you’re going to gain weight.
0:27:36 In fact, everybody says that and all the nutritionists,
0:27:38 all the doctors, they just don’t believe them.
0:27:39 They say, you’re lying, you’re cheating,
0:27:41 you’re eating more than you think.
0:27:43 – So this explains something that happened
0:27:45 with one of my friends, which I’ve always puzzled me.
0:27:48 He swears by the calories in calorie out thing.
0:27:49 I’ve spoken about him a few times.
0:27:51 He posts about it online as well.
0:27:54 And he actually managed to get a pretty much
0:27:57 like six pack abs, pretty much.
0:28:00 And at the time it appears that he was eating
0:28:02 a lot of Domino’s pizzas, a lot of pizzas.
0:28:04 And I was thinking, how’s this guy eating all these pizzas?
0:28:07 But he’s using his calories in calorie out thing.
0:28:10 And then when the pizza stopped,
0:28:12 there was this yo-yo effect.
0:28:15 Where he managed to get to basically
0:28:17 what I described as a six pack, they’re abouts.
0:28:21 And then stopped eating, stopped the diet per se.
0:28:23 And then there was this big yo-yo effect,
0:28:25 which I imagine is what you’ve said there.
0:28:27 What he’s done is he’s lowered his metabolism.
0:28:30 Then when he goes up just a little bit.
0:28:31 – It all comes back.
0:28:33 – It all comes back and then some.
0:28:34 – And then some, yeah, absolutely.
0:28:37 – So this form of dieting is actually
0:28:39 over the long term probably gonna make you gain weight.
0:28:41 – Oh, it’s very detrimental.
0:28:43 And that’s what yo-yo dieting,
0:28:44 we all know it’s very detrimental.
0:28:47 But think about it differently, right?
0:28:50 So let’s take a different example with the same calories.
0:28:51 Which is why I keep saying,
0:28:53 you have to think about more than the calories.
0:28:55 You have to think about what the hormones are
0:28:57 because that’s the instructions to your body.
0:28:59 Food contains calories, energy.
0:29:01 But it contains instructions as to what to do.
0:29:03 So let’s take an example.
0:29:05 You’re eating 2000 calories in, 2000 calories out.
0:29:08 Now you go on a diet, you take in 1500.
0:29:11 But what you do is you do some intermittent fasting.
0:29:14 When you fast, insulin is going to fall.
0:29:15 That’s the whole point.
0:29:17 Insulin is a hormone that goes up when you eat.
0:29:19 It goes down when you don’t eat, right?
0:29:21 So when you eat, insulin goes up.
0:29:23 Your body wants to store energy.
0:29:25 When you don’t eat, insulin goes down.
0:29:27 Your body says, I have no energy,
0:29:30 I have no food coming in, please take it out of storage.
0:29:32 So now you take 1500 calories,
0:29:33 but you do intermittent fasting.
0:29:35 So you’re allowing your insulin levels to fall.
0:29:38 Now 1500 calories are coming in.
0:29:40 Insulin levels are low.
0:29:43 Your body wants to burn 2000 calories.
0:29:44 It says, well, insulin levels are low.
0:29:47 Let me take 500 calories from my body fat.
0:29:48 Guess what?
0:29:49 You have 500 coming from your body fat.
0:29:51 You have 1500 coming from your foods.
0:29:52 You burn 2000.
0:29:56 It’s a balanced equation.
0:29:58 So instead of the opposite situation,
0:30:00 so and you see that the calories are the same.
0:30:04 You went from 2000 in to 1500 in,
0:30:05 but what the difference was,
0:30:06 so you allowed insulin to fall,
0:30:09 which allowed you to burn body fat, right?
0:30:12 It’s the hormonal signal that says,
0:30:15 please take energy out, open up the doors
0:30:17 so that body fat can come out.
0:30:18 And this is the piece that’s missing
0:30:21 because people are all like, well, I’m this, I’m that.
0:30:23 And it’s like, well, why can’t you burn the fat
0:30:24 that’s on your body?
0:30:28 ‘Cause there’s 200, 300,000 calories of body fat.
0:30:30 Why can’t you access it?
0:30:33 It’s because you haven’t activated the right hormones
0:30:35 so that you can access it.
0:30:38 So now if you do intermittent fasting,
0:30:41 you eat 1500 calories, you take 500 calories out,
0:30:43 your body’s burning 2000.
0:30:45 Now all of a sudden, if you go off your diet
0:30:48 and you go back to 2000 calories, guess what?
0:30:50 You don’t gain weight, you don’t lose weight.
0:30:51 Same as before.
0:30:55 Whereas before you go even to 1800 calories, you lost weight.
0:30:57 But the difference was, not the calories,
0:31:00 it was always 2000 to 500.
0:31:02 The difference was you paid attention
0:31:05 to the hormones that you’re telling your body.
0:31:08 And the insulin is sort of the primary hormone.
0:31:09 There’s actually a lot more.
0:31:13 There’s cortisol is a very important hormone.
0:31:15 There’s other hormones.
0:31:16 – You mentioned burning calories there.
0:31:19 One of the thoughts around the calories
0:31:22 and calories out model is that you can just exercise.
0:31:25 And if you burn 1000 calories exercising,
0:31:27 then that gives you a little bit of a reserve there
0:31:29 to eat more, for example.
0:31:33 – Yeah, and it’s probably a very, very small effect
0:31:34 for a couple of reasons.
0:31:38 So we know that if you exercise,
0:31:43 and I say this, exercise is really good for you
0:31:48 in a number of ways, flexibility, strength, core,
0:31:49 all kinds of things.
0:31:50 Very, very important.
0:31:52 But in terms of weight loss,
0:31:55 it’s actually a very, very small effect.
0:31:57 Why? Because one, the amount of calories you burn
0:32:00 during exercise are simply not that high.
0:32:03 So if you look at, if you do walking,
0:32:06 I mean, if you did eight hours of high-intensity exercise,
0:32:08 yeah, you’re gonna burn a lot of calories.
0:32:09 But most people I deal with,
0:32:11 which are sort of middle-aged and higher,
0:32:14 you’re talking about sort of a quick walk
0:32:18 or 45, half an hour, three times a week sort of thing.
0:32:20 And if you ever go on the treadmill
0:32:23 and you ever watch that calorie counter on the treadmill,
0:32:26 you know, it goes up very, very slowly, right?
0:32:31 You’ll do half an hour and it’ll be up to like 120 calories
0:32:33 or something like that, right?
0:32:36 So that exercise really didn’t burn off very many calories.
0:32:37 It’s the amount that you’d get
0:32:38 in a couple of cookies, for example, right?
0:32:41 So it’s just, numerically, it’s just very small.
0:32:45 So if you’re taking in, if your body is normally
0:32:48 using 2,000 calories with your brain,
0:32:51 generating body heat, your heart, your lungs, your liver,
0:32:53 they’re using 2,000 calories
0:32:56 and now you go up to 2,100 calories.
0:32:59 Well, percentage-wise, it’s not a huge deal, right?
0:33:02 The other problem with exercise is that
0:33:06 it tends to actually cause you to eat more.
0:33:10 So again, we’ve had decades of study for this.
0:33:13 If you exercise, during the exercise,
0:33:16 you have reduced appetite.
0:33:20 So you have exercise, it’s called exercise-induced anorexia.
0:33:22 So in the middle of a basketball game,
0:33:24 you don’t suddenly go, “Oh, wow, I’m really hungry,” right?
0:33:29 ‘Cause your blood is flowing in your muscles and so on.
0:33:30 You’re not thinking about the hunger.
0:33:33 So hunger actually goes down during exercise,
0:33:35 but after exercise, we see this rebound.
0:33:38 So we see that people are actually more hungry after exercise.
0:33:40 And if you’re hungrier after exercise,
0:33:43 it’s gonna cause you to tend to gain more weight.
0:33:45 In fact, there’s this very interesting study
0:33:47 that was done a few years ago in Harvard
0:33:50 where they measured the sort of calorie difference
0:33:55 that you get for children in certain activities.
0:33:59 So they said, “Okay, what if the child is watching TV?
0:34:03 What’s the average caloric difference?”
0:34:05 And it was like plus 100 calories per hour.
0:34:07 So for every hour of TV,
0:34:10 they’re sort of positive 100 calories over time, right?
0:34:12 And that makes sense, you’re just sitting there.
0:34:15 When you look at mild exercise, it’s about the same.
0:34:17 It’s about positive 100 calories.
0:34:19 So the only way that happens
0:34:23 is that if that exercise is causing you to eat more, right?
0:34:25 And you say, “Well, why are you eating more?”
0:34:27 It’s like, “Well, because you’re hungry.”
0:34:30 Like the exercise is inducing you to eat more.
0:34:33 And that’s gonna make it difficult to lose weight.
0:34:34 – You say in the book in chapter four
0:34:38 that 95% of weight loss is diet.
0:34:41 – Yeah, and that’s the reason why exercise
0:34:45 is very hard to exercise enough to lose weight.
0:34:48 And that’s not to say that you shouldn’t exercise.
0:34:50 You really should exercise.
0:34:52 Everybody should exercise.
0:34:54 But if you’re trying to lose weight,
0:34:59 you still gotta focus on the main topic,
0:35:01 which is the foods that you eat,
0:35:02 which is not just the calories.
0:35:05 It’s about the types of food that you eat,
0:35:07 which is going to affect the hormonal balance
0:35:08 and also how often you eat.
0:35:09 If you’re eating all the time
0:35:13 versus if you’re only eating very infrequently,
0:35:16 then you’re gonna have a different hormonal balance
0:35:18 that is going to affect your weight as well.
0:35:22 – An American survey of more than 60,000 adults and children
0:35:26 revealed that in 1977, most people ate three times a day.
0:35:30 By 2003, most people were eating five to six times a day.
0:35:34 – Yeah. (laughs)
0:35:38 Yeah, this is the whole idea of sort of eating all the time.
0:35:40 And this I find fascinating
0:35:45 because it was this sort of inadvertent change in our diet
0:35:47 that we never talked about, right?
0:35:51 So in 1977, we told people eat lots of carbs, okay?
0:35:53 So we know that, that’s in print.
0:35:56 For sure, the American government said
0:35:59 eat 55 to 60% carbs, eat less fat.
0:36:02 What happened is that, in 1977,
0:36:04 people ate breakfast, lunch, and dinner.
0:36:05 No snacks.
0:36:08 If you wanted an after-school snack,
0:36:10 your mom said no, you’re gonna ruin your dinner.
0:36:12 If you wanted a bedtime snack, your mom would say no,
0:36:14 you should eat more at dinner, right?
0:36:14 No problem.
0:36:19 But what happened is that as we started to eat
0:36:21 sort of a lot of carbs,
0:36:24 what happened is exactly as what we discussed before,
0:36:28 you eat two slices of bread in the morning with jam.
0:36:30 You have no satiety, insulin spikes way up,
0:36:33 glucose spikes way up, but then it crashes.
0:36:34 – So you get hungry again.
0:36:36 Then you get hungry at 10.30.
0:36:38 So you go around looking for a low-fat muffin.
0:36:43 And it was because your sugars are going down,
0:36:46 your insulin’s going down.
0:36:48 So now you’re eating mid-morning snack,
0:36:50 then you eat a big plate of pasta,
0:36:52 then you get ravenous at like three o’clock.
0:36:54 So you go find yourself some crackers
0:36:55 or something like that, right?
0:36:58 And then so now you’re having a mid-morning snack,
0:36:59 you’re having mid-after-school snack,
0:37:00 then you’re having a bedtime snack.
0:37:04 And that’s the average American by 2003,
0:37:06 eating six, five, six times a day.
0:37:08 But they’re saying, hey, I’m eating so low-fat,
0:37:10 this must be the right way to eat.
0:37:12 This must be good for me.
0:37:14 So now the snacking becomes institutionalized.
0:37:19 Whereas pre-1977, snacks are an indulgence, right?
0:37:20 It’s not something good for you.
0:37:21 It’s something bad for you,
0:37:24 but hey, once in a while you indulge.
0:37:27 Then it becomes institutionalized
0:37:30 as something that every single one of us should be doing.
0:37:32 And we should never be without food
0:37:34 for more than an hour and a half.
0:37:37 Let’s think about this very simply, okay?
0:37:40 So if you eat, your insulin’s gonna go up,
0:37:42 your body’s going to store calories,
0:37:43 because you’re told it to.
0:37:45 If you don’t eat, or if you fast,
0:37:48 your body is, your insulin’s gonna go down,
0:37:50 you’re going to bring those calories back out of storage,
0:37:51 right?
0:37:52 So you’re gonna burn calories.
0:37:54 You eat, you store calories, you don’t eat,
0:37:56 you burn calories, very simple.
0:37:59 So why would you wanna eat all the time?
0:38:01 That makes no sense at all.
0:38:04 If you want to lose body fat,
0:38:06 you actually need to extend the period of time
0:38:08 that you’re not eating.
0:38:10 In other words, extend your fasting period
0:38:12 and get rid of all the snacks.
0:38:15 In order for you to have enough time
0:38:17 that your insulin is low, when insulin is low,
0:38:19 it’s gonna allow fat burning,
0:38:22 which is gonna allow you to pull those calories back out.
0:38:25 – You’re cited as being really the founder
0:38:27 of modern intermittent fasting.
0:38:28 And I’ve heard people talk about
0:38:30 intermittent fasting on this show
0:38:33 over and over and over and over again now,
0:38:38 but the internet says that it really came from you.
0:38:39 I know that intermittent fasting
0:38:40 has been happening for thousands of years,
0:38:43 but the idea of it as a tool for weight loss,
0:38:44 they say it came from you.
0:38:47 – Because in 2013, 2014,
0:38:49 really nobody was talking about it
0:38:51 from a medical standpoint.
0:38:52 Like what’s happening in the body?
0:38:53 Why is it good?
0:38:54 Why is it bad?
0:38:56 And really I was, for years,
0:38:58 sort of this one voice in the wilderness
0:39:02 that was saying, like, hey, this is a tool for us.
0:39:04 If you want to lose weight because it’s important,
0:39:07 then you can just set aside a period of time
0:39:08 that you don’t eat.
0:39:11 At the time, people thought it was extremely bad for you.
0:39:13 And I looked through all the literature
0:39:15 and I said, well, why is it bad for you?
0:39:17 And they had all these reasons.
0:39:19 There’s all these myths about intermittent fasting
0:39:21 and how it’s gonna cause you to gain weight
0:39:24 and be tired and hungry and all these sorts of things.
0:39:26 And I said, well, no, there’s actually a lot of data here
0:39:29 over the last, you know, 2,000 years
0:39:31 that we’ve used intermittent fasting.
0:39:32 And they’re simply not true.
0:39:34 And I can go over a few of those,
0:39:37 but that’s why there was nobody talking about it at the time.
0:39:40 And that’s where I started to sort of bring it into
0:39:43 the sort of public consciousness that this is a tool.
0:39:44 That’s all it is.
0:39:45 – Were you attacked for that at the time?
0:39:46 – Oh, absolutely.
0:39:50 Like I got, I got attacked from all sides.
0:39:52 I got, you know, doctors were coming after me,
0:39:53 dieticians were coming after me.
0:39:56 Everybody thought I was gonna do so much harm.
0:39:59 And the funny part was that, you know,
0:40:02 as I think back, as I spoke to a lot of colleagues,
0:40:04 a lot of colleagues would say to me, you know what,
0:40:06 I used to do that when I was in training.
0:40:07 We did that all the time.
0:40:10 We’d go 24 hours without eating because we’re in the OR,
0:40:13 or we’re in the ER, or we’re busy.
0:40:15 So we did that constantly and nothing bad happened.
0:40:18 And I remember thinking, you know what, as a doctor,
0:40:21 I actually tell people to fast all the time.
0:40:23 If you have to go for surgery, you need to fast.
0:40:26 If you’re after surgery, you need to fast.
0:40:29 If you do fasting blood work, you need to fast.
0:40:32 So why is it that I’m actually telling people to fast
0:40:33 all the time?
0:40:35 And yet for weight loss, you shouldn’t fast.
0:40:37 That doesn’t make any sense.
0:40:39 And physiologically from a body standpoint,
0:40:41 it doesn’t make any sense.
0:40:45 One of the things people talked about was, you know,
0:40:47 it’s gonna make you eat more later.
0:40:48 It’s gonna make you more hungry.
0:40:50 Your basal metabolic rate is gonna go down.
0:40:52 This was one of the big myths of intermittent fasting.
0:40:55 That’s gonna cause the so-called starvation mode, right?
0:40:57 And this is the idea that your basal metabolic rate
0:41:00 will fall so low that when you do start to eat,
0:41:02 you’re gonna gain weight again.
0:41:04 So I said, well, let’s think about this.
0:41:07 You can do a study where you take somebody,
0:41:11 say you, for example, and you could fast them for four days
0:41:13 and measure how many calories they’re burning,
0:41:16 their basal metabolic rate on day zero before the fast
0:41:18 and measure them four days into the fast
0:41:21 and see how many calories you’re burning.
0:41:24 So on day zero, they say you’re burning,
0:41:25 say 2,000 calories a day.
0:41:27 On day four of zero food,
0:41:29 you don’t eat any food for four days.
0:41:31 They measure how much calories you’re burning.
0:41:34 Your body is burning 2,200 calories.
0:41:37 Your basal metabolic rate didn’t go down.
0:41:39 It went up.
0:41:42 Your body’s activating itself during fasting,
0:41:45 which is fascinating because if you’re trying to lose weight,
0:41:49 dropping that basal metabolic rate is death.
0:41:51 Like if you drop that metabolic rate,
0:41:53 it’s so hard to lose weight.
0:41:55 That’s what the calorie restricted diets did.
0:41:57 That’s what the low fat diets did,
0:41:59 the eating all the time did.
0:42:00 But when you actually fast,
0:42:02 your metabolic rate went up.
0:42:04 And we see this in study after study.
0:42:07 And the reason is actually basic physiology.
0:42:09 It’s actually medical physiology,
0:42:11 like first year medical school stuff.
0:42:13 When you don’t eat,
0:42:16 what happens in your body from a hormone standpoint
0:42:18 is that your insulin’s gonna fall.
0:42:20 You’re gonna allow your body
0:42:23 to start using the calories that are in the body.
0:42:26 At the same time, other hormones go up.
0:42:28 So the sympathetic tone goes up,
0:42:30 which is your fight or flight response.
0:42:33 Your cortisol levels go up because again,
0:42:35 it’s an activation and your growth hormone goes up.
0:42:38 Because those hormones are gonna start telling your body
0:42:40 to start pulling calories out.
0:42:43 So you’re actually activating yourself.
0:42:44 Think about it in the wild.
0:42:46 If you see a hungry wolf,
0:42:50 is that wolf just sort of, you know, all like lethargic?
0:42:52 No, he’s activated.
0:42:55 He’s actually more dangerous than any other wolf
0:42:58 as opposed to say a lion who just ate.
0:43:00 Because when you just eat, you just wanna lie there.
0:43:02 You know, you wanna digest your food.
0:43:03 You have no energy.
0:43:06 So people say, well, your metabolic rate’s gonna go down
0:43:07 if you fast.
0:43:10 No, the truth is actually the opposite, it goes up.
0:43:12 – You’ve got me thinking about food as an instruction.
0:43:15 I’m giving my body because if I eat this food,
0:43:17 it’s gonna have this impact on my hormones,
0:43:18 which is gonna have this impact on my body.
0:43:21 So if we view food as an instruction to the body,
0:43:23 we talked a little bit about the timings
0:43:25 of eating a little bit about fasting.
0:43:28 I wanna get into that a little bit more, but breakfast.
0:43:32 I read that you didn’t think most people need breakfast.
0:43:35 – Yeah, the whole idea that you need to eat
0:43:39 as soon as you get up is just false.
0:43:42 So there’s this whole thing about breakfast.
0:43:44 Now you will always break your fast.
0:43:46 Think of the actual word, right?
0:43:47 Break fast.
0:43:49 It’s the meal that breaks your fast,
0:43:52 which tells you that in the English language,
0:43:55 we accept that your body should have a fasting period
0:43:57 every day.
0:43:58 Why?
0:44:00 There’s a period of time that you’re supposed to feed,
0:44:03 you eat, insulin goes up, you store calories.
0:44:06 Then there’s supposed to be a period of time that you fast.
0:44:09 That’s after dinner, until the next day’s meal,
0:44:11 which is breakfast, right?
0:44:14 So say you stop eating at six p.m., you eat at eight a.m.
0:44:19 That’s a 14 hour period where your body is not eating,
0:44:23 it’s fasting, and therefore it’s gonna use calories, right?
0:44:25 But the word breakfast tells us
0:44:27 that that’s actually a normal pattern,
0:44:28 this normal cyclical pattern.
0:44:30 You feed, then you fast, right?
0:44:34 If you eat all the time, your body’s just gonna store energy
0:44:37 and never have a period to burn energy.
0:44:39 So, okay, well, what’s gonna happen?
0:44:41 You’re gonna gain weight.
0:44:45 I’ve read as well that breakfast eaters averaged 539
0:44:47 extra calories per day compared to those
0:44:49 that skipped breakfast.
0:44:51 And that’s a finding that’s consistent with other trials
0:44:54 that was on page 132 of the obesity code.
0:44:57 – Yeah, so the more often you eat in general,
0:44:59 the more calories you take in.
0:45:03 So if you eat three times a day, or six times a day,
0:45:06 then if you eat three times a day compared to two times
0:45:09 a day, for example, you’ll in general eat less
0:45:13 because it’s harder to eat that, you know, big meal.
0:45:15 So say you eat once a day versus three times a day.
0:45:18 If you eat once a day, it’s not always easy
0:45:22 to eat three meals worth of calories all in one sitting
0:45:24 because you get full.
0:45:25 – Do you fast?
0:45:27 – Oh, I do that regularly, yeah.
0:45:28 – And what does your fast look like?
0:45:30 ‘Cause I’ve heard of all these different types of fasting,
0:45:33 36 hours, 72 hours, 14 hours.
0:45:35 – There’s no rules for fasting.
0:45:38 You could do, you know, it could be 16 hours.
0:45:40 So 14 hours, remember, is sort of a baseline,
0:45:42 12 to 14 hours, right?
0:45:45 That just means you’re not eating after dinner.
0:45:46 That’s it.
0:45:48 And so if you want to lose weight,
0:45:51 that’s probably not strong enough to make you lose weight
0:45:54 because 12 to 14 hours is sort of just this baseline
0:45:56 that people had in the 70s.
0:45:58 So you can go to 16 hours, for example,
0:46:03 and you shrink that by either eating breakfast a little later
0:46:05 or eating dinner a little earlier.
0:46:06 But you can do more than that.
0:46:08 You can do, say, a 24-hour fast.
0:46:11 You could eat two meals a day, say, eat between 12 and six.
0:46:12 That’s a six-hour eating window.
0:46:15 Or you could eat once a day, which is like a 24-hour fast.
0:46:18 Or you could even go multiple days without eating
0:46:20 because, again, your body is smart.
0:46:23 Like, your body knows what to do.
0:46:26 If you have all those calories sitting on your body,
0:46:29 right, 100,000 calories sitting in body fat
0:46:30 and you don’t eat for three days,
0:46:32 well, you need 6,000 calories.
0:46:35 Well, you have 100,000, 200,000.
0:46:36 So what’s the problem?
0:46:37 Take it out of your body fat.
0:46:40 Let your body eat your body fat.
0:46:42 That’s what fasting is doing for you.
0:46:44 And it’s totally natural
0:46:47 because that’s what it’s there for.
0:46:50 That body fat is not there for looks.
0:46:53 It’s there for you as a source, as a store of calories.
0:46:55 So fasting just lets you use that.
0:46:57 There’s nothing wrong with it.
0:46:59 People talk about hunger, for example,
0:47:01 but, again, hunger is very interesting
0:47:03 because people think it’s the amount of time
0:47:05 that you haven’t eaten.
0:47:06 But it’s not true.
0:47:07 It’s actually hormonally mediated.
0:47:09 So if you think about hunger,
0:47:12 I actually found this really fascinating.
0:47:14 So if you look at studies
0:47:17 of when people are the most hungry and the least hungry,
0:47:21 on average, people are the most hungry at 8 p.m.
0:47:24 and the least hungry at 8 a.m.
0:47:25 So in the morning time,
0:47:28 you are actually the least hungry that you will be all day.
0:47:30 That’s just an average.
0:47:33 And at 8 p.m. in the evening time, you are the most hungry.
0:47:35 So 8 a.m. is the period of time
0:47:38 that you’ve gone the longest without food.
0:47:41 So why are you the least hungry?
0:47:43 It’s because it’s hormonally mediated.
0:47:46 When you wake up at 5 a.m.,
0:47:49 your body actually has this surge of hormones,
0:47:53 growth hormone, cortisol, and sympathetic tone,
0:47:56 which is already getting you prepared for the day.
0:47:59 It’s starting to release some of the stored glucose
0:48:02 from your body fat from your sugar stores at 5 a.m.
0:48:06 So your body has already prepared you for the day ahead
0:48:08 without you even doing anything.
0:48:12 That’s why people in general are not hungry at 8 a.m.
0:48:15 – I’ve got to talk to you about these new injections
0:48:17 people are getting to lose weight.
0:48:18 And the role that they must be playing
0:48:20 in our hormone balances.
0:48:21 What are those bloody things called?
0:48:22 – GLP ones.
0:48:23 – GLP ones.
0:48:24 There’s another name for it, isn’t there?
0:48:25 – Yeah.
0:48:26 Well, there’s the drug name,
0:48:31 which is Osempic is the American name.
0:48:34 And these are all in a class called GLP ones.
0:48:37 And essentially, again, very interesting
0:48:42 because they essentially really reduce the appetite,
0:48:44 which goes to show you that,
0:48:46 and people lose weight, like a lot of weight,
0:48:47 and they keep it off.
0:48:48 So 17% – I think very smart people
0:48:50 that are using them.
0:48:51 – Yeah, yeah.
0:48:52 – Like a billionaire friend of mine
0:48:57 that’s very big in a certain industry uses Osempic.
0:48:58 I know Elon Musk came out and said he uses.
0:49:00 – He said he used it, yeah.
0:49:01 He uses Osempic as well.
0:49:06 – I don’t have any problem with the Osempic
0:49:08 because again, if you think about it,
0:49:10 what it’s telling you that the lesson
0:49:13 it’s teaching you about weight loss
0:49:15 is that it’s not about controlling the calories
0:49:18 because the Osempic doesn’t burn in calories.
0:49:20 It’s about controlling your hunger.
0:49:23 It’s about that one level deeper.
0:49:24 Why are you taking so many calories?
0:49:27 So if you simply reduce the hunger,
0:49:29 you’re going to naturally eat fewer calories,
0:49:31 which is going to cause weight loss.
0:49:33 And that’s what the Osempic does.
0:49:36 It really reduces your appetite to very low levels.
0:49:37 How?
0:49:41 It’s this hormone called GLP1,
0:49:43 which is a natural sort of hormone.
0:49:45 It’s released mostly in the intestines
0:49:48 and the distal intestine and the small intestine.
0:49:52 And in response to certain foods, it goes up, right?
0:49:56 So when you eat, the body has a homeostatic mechanism.
0:49:58 So again, remember, you know,
0:50:00 people think that we’re just eating machines.
0:50:02 We eat until, you know, we explode sort of thing.
0:50:03 But that’s not true.
0:50:08 When you eat, you actually activate the GLP1
0:50:09 along with other hormones.
0:50:11 There’s multiple hormonal systems.
0:50:13 The GLP1 is the one we’re interested in.
0:50:16 You activate GLP1, which then sets into motion
0:50:19 the instructions for you to stop eating, right?
0:50:23 So the act of eating sort of sets in motion
0:50:25 that whole feedback loop to stop, right?
0:50:26 So this is homeostasis,
0:50:29 you’re just trying to keep things at a proper level.
0:50:31 – Does that mean if you eat slower,
0:50:33 you’ll eat less?
0:50:37 – There’s probably not, yeah, probably it’s true.
0:50:41 You know, although it’s probably mostly true
0:50:43 that if you eat really, really fast,
0:50:45 that you don’t have enough time
0:50:47 for this sort of homeostatic mechanisms to kick in.
0:50:50 So you don’t have enough time to stop eating.
0:50:54 But the GLP1s then go to the brain.
0:50:55 So they do certain things.
0:50:56 They help with digestion.
0:50:58 So they increase insulin response
0:51:00 and then they go to the brain.
0:51:03 It crosses the blood-brain barrier.
0:51:08 So the GLP1s gets released by the act of eating,
0:51:09 goes into the brain,
0:51:13 crosses and is active in the sort of mid-brain area
0:51:15 that tells your body to stop eating.
0:51:17 What these GLP1s do, of course,
0:51:21 is that it gives you the hormone
0:51:23 that tells you to stop eating
0:51:24 even though you haven’t eaten.
0:51:27 It’s sort of, that’s the way the drug works.
0:51:29 So then what people tell you is that, you know,
0:51:30 they’re just not hungry.
0:51:32 And if they’re not hungry, then they don’t eat.
0:51:34 And when they don’t eat, of course,
0:51:36 insulin falls and you start to burn calories
0:51:38 and lose weight.
0:51:41 But it wasn’t about controlling the calories.
0:51:43 It was about controlling the hunger.
0:51:46 That was the important part of it.
0:51:47 It’s the hormones, right?
0:51:51 Every successful drug to gain or lose weight, right,
0:51:53 is a hormone.
0:51:56 It’s a hormone base because that’s instructions to the body.
0:51:59 Food is energy and food is instructions.
0:52:02 You change the instructions and you change the hormone.
0:52:03 – This whole history of fiber thing
0:52:05 has been so interesting to me
0:52:07 because in the last six months,
0:52:09 so many of the nutritionists I’ve spoken to
0:52:10 have really impressed upon me
0:52:13 that we are fiber deficient.
0:52:15 And I’m wondering how that happened.
0:52:19 – Well, I think it was part of the processing thing.
0:52:21 So taking out fiber is a great way
0:52:26 to make foods more appealing, if you will.
0:52:32 So what happens is that if you take flour, for example,
0:52:34 and you have a lot of fiber in it,
0:52:36 then the digestion is slowed.
0:52:38 So what you get is a slower rise.
0:52:42 So you take flour and you put a lot of fiber in it.
0:52:45 Well, instead of having this huge spike in insulin,
0:52:49 which you’re gonna get as much slower spike in insulin.
0:52:51 When you have the huge spike in insulin,
0:52:54 it basically overloads your system
0:52:57 and it makes you feel, you know, gives you this big hit.
0:53:00 Sort of like if you have like cocaine, for example,
0:53:03 you know, it’s turned into a very fine powder,
0:53:06 then you snored it so you get this massive sort of spike.
0:53:09 Same thing with, you know, carbohydrates.
0:53:11 If you don’t have any fiber,
0:53:14 you pull all the fiber out by processing,
0:53:17 you get this massive sort of unnatural spike in your body.
0:53:19 It says, “Oh, that’s great, it tastes great.
0:53:20 “I really love it.”
0:53:23 And you get people who are sort of addicted to it
0:53:28 because that big spike is then going to release dopamine.
0:53:30 And dopamine is a pleasure hormone.
0:53:32 So you eat, you know, cookies
0:53:35 or whatever highly processed foods,
0:53:37 you get this sort of pleasurable response.
0:53:39 And that makes you crave it.
0:53:41 If you have a lot of fiber,
0:53:45 it acts almost sort of like an antidote to that carbohydrate
0:53:48 because you’re slowing down that release.
0:53:50 – What foods are high in fiber?
0:53:51 – Well, mostly unprocessed foods.
0:53:52 So the things like beans,
0:53:55 and if you’re having, if you’re eating whole grains,
0:53:57 for example, compared to others,
0:54:01 then it’s gonna have a reduction in the speed of absorption.
0:54:03 So it’s, again, not about the calories necessary
0:54:06 or even necessarily about the carbohydrates
0:54:09 because you’re still eating the same amount of carbohydrate,
0:54:13 but you’re slowing down the speed at which is absorbed,
0:54:15 which is going to change the instructions
0:54:16 that you give your body.
0:54:19 If you have a massive spike in glucose,
0:54:22 you get this massive dopamine surge, right?
0:54:26 And your body’s like, “You love it.”
0:54:27 Then the next time you’re like,
0:54:30 “Okay, give me that refined carbohydrate.”
0:54:31 – What about protein?
0:54:33 ‘Cause we tend to think a protein is something that,
0:54:35 you know, is super great for weight loss.
0:54:40 – Yeah, protein is probably sort of inter, it’s not bad.
0:54:43 I mean, the main thing is cutting down the carbohydrates.
0:54:45 But, you know, in the BCD code,
0:54:48 I really talk about cutting the processing down
0:54:53 because proteins usually don’t come as pure protein, right?
0:54:56 In nature, you never find like,
0:54:57 you know how you have like,
0:55:00 whey powder protein or whatever you get.
0:55:03 The only way you can do that is by processing
0:55:07 the heck out of food to get some kind of pure protein.
0:55:08 It doesn’t exist in nature.
0:55:10 Like, it almost doesn’t exist in nature.
0:55:12 Maybe there’s a few examples.
0:55:14 But when you eat meat,
0:55:15 you think, “Okay, there’s a lot of protein.”
0:55:19 But that’s actually a lot of fat in there too, right?
0:55:21 If you eat anything else that has protein,
0:55:23 it’s rarely all protein.
0:55:26 You know, very lean meats like chicken breast and stuff
0:55:28 are gonna be higher in protein,
0:55:30 but there’s still a lot of other stuff in there.
0:55:32 And it’s very rare that somebody will eat
0:55:35 just all pure 100% protein.
0:55:37 It tends to be hard to eat.
0:55:40 Like the fat brings a lot of flavor and so on.
0:55:43 So it’s a bit of an unnatural way to eat.
0:55:46 Sure, if you’re to eat a lot of protein,
0:55:47 it does spike insulin,
0:55:49 so it does have some effect to gain weight,
0:55:53 but it’s actually a very inefficient macronutrient.
0:55:55 That is, there’s three-note macronutrients.
0:55:59 There’s carbohydrates, there’s fat, and there’s protein.
0:56:02 Your body stores energy or calories in two ways.
0:56:05 There’s glucose, which is carbohydrate,
0:56:08 and it stores it as body fat, which is fat, right?
0:56:11 It doesn’t, protein is not a way for the body
0:56:12 to store energy.
0:56:13 So when you’re eating a lot of protein,
0:56:16 it’s very difficult for it to turn it
0:56:19 into a storage mechanism, like, you know,
0:56:22 so you eat glucose and you eat fat,
0:56:24 you can store glucose and you can store fat,
0:56:27 but you eat protein, but you don’t really store it
0:56:28 as a source of energy.
0:56:31 So if all foods then increase our insulin levels,
0:56:35 I guess the best solution is to fast.
0:56:36 Fasting is certainly one way,
0:56:39 but just changing the foods to other ones,
0:56:43 because if you look at the insulin release
0:56:45 in processed foods versus unprocessed foods,
0:56:47 there’s a huge difference.
0:56:51 So if you eat sort of highly refined foods
0:56:53 like white bread, for example,
0:56:56 then you’re gonna have a very different response
0:57:01 in insulin compared to sort of a whole food.
0:57:04 So unprocessed foods in general,
0:57:06 your body knows how to handle,
0:57:08 like we’ve been eating them for thousands of years,
0:57:13 but certainly any time you eat, your insulin is gonna go up,
0:57:16 you’re giving your body instructions to store energy.
0:57:18 So the solution is to eat less often.
0:57:20 – What if you do it juice fast?
0:57:22 – Juice fast, of course, is not a real fast
0:57:24 because you’re taking a lot of sugars.
0:57:26 – What do you think of juice fasting?
0:57:30 – And generally, I think it’s less effective
0:57:32 than regular fasting and it really depends
0:57:33 on how much juice you take.
0:57:35 If you take a lot of juice, you could easily get,
0:57:38 you know, thousands of calories plus a lot of sugar.
0:57:40 If you do it, you know, cucumber juice and stuff
0:57:42 that’s very low in sugar and kale juice,
0:57:44 then it could be very, very healthy for you
0:57:46 ’cause there’s vitamins and stuff there.
0:57:48 So it all depends on how it’s done.
0:57:51 However, the fasting is a way for you
0:57:53 to sort of clean out the body.
0:57:54 So you can clean out the glucose.
0:57:57 If you have excess body fat, you’re gonna use it, right?
0:57:58 So again, way to clean it out.
0:58:01 And then there’s this whole process called autophagy,
0:58:03 which is just fascinating.
0:58:05 And autophagy is this,
0:58:08 so it’s been very topical ’cause in 2016,
0:58:10 one of the key researchers was given
0:58:11 the Nobel Prize in medicine.
0:58:13 So it’s a very important process
0:58:16 that’s been relatively recently discovered.
0:58:17 What they discovered is that
0:58:19 when you don’t eat protein particularly,
0:58:22 but when you fast, your body activates
0:58:24 this thing called autophagy
0:58:27 and it breaks down some of the subcellular organs,
0:58:29 which sounds really bad.
0:58:30 – Subcellular organs.
0:58:33 – Yeah, so, you know, these are sort of like
0:58:34 the organs within the cell.
0:58:36 So it’s not like the liver,
0:58:39 but there’s something called organelles within a cell
0:58:41 and some of that is broken down.
0:58:44 So basically these proteins and so on within the cell,
0:58:45 your body gets rid of that.
0:58:48 And you think, oh, well, that sounds really bad,
0:58:49 but it’s not.
0:58:51 It turns out that it’s very, very good for you
0:58:54 because it’s an opportunity for your body
0:58:57 to get rid of all this old protein, old junky protein.
0:59:00 And at the same time, remember that you’re fasting,
0:59:03 your growth hormone levels are shooting up through the roof.
0:59:05 So like a, you know, two, three day fasts,
0:59:09 your growth hormone levels might go up five times.
0:59:12 So you’re getting rid of all the old stuff.
0:59:13 Then when you eat again,
0:59:17 you actually got growth hormone to produce new proteins.
0:59:19 So in essence, you’re getting rid of the old,
0:59:20 you’re bringing in the new.
0:59:23 It’s basically the process of rejuvenation.
0:59:26 Could this be a very important way
0:59:29 to get rid of some of the chronic illnesses of aging?
0:59:32 And there’s lots of data, you know,
0:59:36 talking about, you know, Alzheimer’s disease,
0:59:38 there’s talk of people talking about cancers,
0:59:41 there’s people talking about just general aging,
0:59:44 you know, Dr. Chris Palmer talking about mental disorders.
0:59:48 We’re all talking about insulin and overeating and diet
0:59:50 as a really important component
0:59:53 of not just diabetes and weight,
0:59:57 but all of these diseases, mental illnesses,
1:00:00 you know, chronic illnesses like Alzheimer’s disease,
1:00:03 neurologic illnesses, and there’s all this data
1:00:06 that suggests that autophagy and fasting
1:00:08 is a way to activate autophagy
1:00:11 could be actually extremely beneficial for you,
1:00:13 which is fine when we used to do it.
1:00:16 And, you know, what’s so interesting
1:00:21 is that people seem to have already known about it.
1:00:26 Like, you see it in almost every major religion.
1:00:29 There’s periods of fasting, right?
1:00:31 And it’s like, why did they do that?
1:00:33 Because it was good for them.
1:00:35 Through trial and error or whatever,
1:00:40 they realized that, hey, periodically abstaining from food
1:00:42 makes us stronger.
1:00:46 If you eat all the time constantly,
1:00:49 day in, day out, week in, week out, month in, month out,
1:00:51 that’s not that good for you.
1:00:53 There are periods that you should feast,
1:00:55 and there are periods you should fast.
1:01:00 So religions set days or weeks or months even
1:01:01 where you should fast.
1:01:04 So it’s like, whoa, why did they do that?
1:01:06 And are they just way ahead of us
1:01:08 in terms of understanding the human body?
1:01:13 Like, we get so enamored of our own intelligence
1:01:16 and science and so on that we think they’re, you know,
1:01:17 that they didn’t know what they’re talking about.
1:01:19 Maybe they knew more about what they’re talking about
1:01:21 and science is just catching up and saying,
1:01:23 oh, this process of autophagy
1:01:26 that you activate with fasting,
1:01:29 this could be really important for longevity,
1:01:30 for other things.
1:01:32 I’m not saying you should do it like every month or whatever.
1:01:34 If you look at the way that people do it,
1:01:36 they don’t do it like, you know,
1:01:38 they don’t do like five days a month or something.
1:01:41 They do it once a year or once every few months.
1:01:42 – How long does autophagy take to kick in?
1:01:44 Is it 72 hours, did you say?
1:01:48 – Nobody knows, but probably it’s,
1:01:50 and it depends on probably how much protein you eat.
1:01:54 Protein is the key sort of when you eat protein,
1:01:56 autophagy just stops.
1:01:58 So low protein, you can activate it
1:02:01 and it’s probably somewhere around 20 to 30 hours.
1:02:03 So you’ll see a lot of religions, for example,
1:02:05 they’ll have like a 24 hour fast, right?
1:02:06 One day that you’re not supposed to eat
1:02:08 or something like that.
1:02:10 And maybe that’s the way to cleanse your body,
1:02:12 not just of the glucose and the fat,
1:02:16 but also the excess proteins that are old, they’re junky.
1:02:19 I mean, you think about renovating your bathroom
1:02:21 or something like that, right?
1:02:22 The first thing you got to do,
1:02:26 you got to throw out the 1970s tub
1:02:27 and the avocado green toilet.
1:02:29 That’s the first thing you got to do.
1:02:31 You got to get rid of it.
1:02:34 You got to break down before you can rebuild better.
1:02:37 Well, autophagy might be that way to break down
1:02:39 some of the stuff that you actually
1:02:41 can’t break down any other way.
1:02:43 If your body’s full of all this junky protein,
1:02:46 you can’t get rid of it.
1:02:47 – Is there an evolutionary explanation
1:02:49 for the role of autophagy, do you think?
1:02:50 – I think there is actually,
1:02:55 I think there’s a huge number of reasons why people do it.
1:02:59 One of it, this whole idea that fasting
1:03:02 actually activates the body, for example,
1:03:04 is very interesting because I think it’s like,
1:03:06 if you’re a caveman, for example, or a cave woman,
1:03:09 and it’s winter and there’s nothing to eat,
1:03:11 if your body starts to shut down,
1:03:13 then evolutionarily you’re gonna die, right?
1:03:16 Because you have less energy, you can’t go out and hunt.
1:03:18 So our body’s just not that stupid.
1:03:19 So what it does is says, okay,
1:03:21 well, I’m gonna give you more energy.
1:03:22 So I’m gonna activate the body,
1:03:25 but then I’m going to change
1:03:27 where you’re getting your energy from.
1:03:29 You’re not gonna get the energy from the food,
1:03:30 you’re gonna get it from your body fat stores,
1:03:32 which is your stored food, right?
1:03:33 You stored food for a reason.
1:03:37 So that’s why I think some of the fasting
1:03:40 has a lot of evolutionary benefits
1:03:45 because it increases your energy, it lowers the glucose.
1:03:47 So if you look at the blood glucose,
1:03:48 the blood glucose goes down.
1:03:50 So in times of stress and so on,
1:03:53 your body actually naturally fast.
1:03:55 If you get sick, you get a flu or something,
1:03:57 you stop eating, first thing you do, right?
1:03:59 You just wanna drink some water and stuff.
1:04:00 Why?
1:04:03 Because your body wants to lock down the glucose
1:04:06 because the bacteria love glucose.
1:04:07 Your body can run on fat,
1:04:09 but the bacteria want the glucose.
1:04:11 So you fast to lock down the glucose.
1:04:13 So there’s a lot of evolutionary reasons
1:04:16 why the fasting might be good for bacterial infections,
1:04:19 taking care of things, increasing your energy,
1:04:21 increasing your concentration at a time
1:04:24 that when you’re not eating,
1:04:27 you’re actually getting more mental capacity
1:04:30 and more energy because you need it in order to go hunt.
1:04:31 Interesting.
1:04:33 What is the most interesting thing
1:04:36 or the most, use the word interesting,
1:04:37 a little fascinating.
1:04:40 What is the most fascinating thing
1:04:42 that we haven’t talked about?
1:04:46 I think to me, the most fascinating thing
1:04:48 is other than for intermittent fasting,
1:04:52 because a lot of the stuff we thought about, it was wrong.
1:04:53 In fact, the opposite.
1:04:56 But the most interesting thing, I think,
1:04:58 is in the field of type two diabetes
1:05:02 because it’s such an important disease.
1:05:04 If you look at the number of people
1:05:08 being affected with type two diabetes, it’s skyrocketing.
1:05:11 So we had, since the 1970s, an increase in obesity.
1:05:13 Then we had an increase in type two diabetes.
1:05:16 And I think the most fascinating thing,
1:05:18 the most promising thing I’ve heard in a long time
1:05:22 is that you can actually start to reverse this disease
1:05:25 by changing the diet.
1:05:27 And I think what’s interesting
1:05:29 is that you have to understand that type two diabetes
1:05:32 is largely a dietary disease.
1:05:35 And so we treated it with drugs for a long time.
1:05:38 And if you give drugs to a dietary disease,
1:05:39 well, you’re never gonna fix it
1:05:42 because you haven’t identified the core problem and fixed it.
1:05:46 You need to change the diet to fix that dietary problem.
1:05:47 Then the disease goes away.
1:05:52 And now we have data on intermittent fasting, for example,
1:05:54 and also low carbohydrate diets.
1:05:58 Dr. David Unwin published his data in the UK
1:06:00 on reversing type three diabetes
1:06:02 with reducing carbohydrates,
1:06:07 which is showing that you can reduce about 50% of the people
1:06:11 and put them into a completely drug-free remission state,
1:06:15 like basically cure 50% of those type two diabetics
1:06:18 who are at risk of cancer, at risk of heart disease,
1:06:20 at risk of strokes, at risk of blindness,
1:06:23 at risk of kidney disease, nerve damage, infections.
1:06:28 All these people you can fix just by changing their diet,
1:06:30 either cutting down their carbohydrates
1:06:32 or using intermittent fasting.
1:06:37 And it’s free and anybody can do it.
1:06:40 I’m not talking about a drug that costs thousands of dollars.
1:06:42 I’m not talking about a surgery
1:06:46 which is only available to the 1%.
1:06:48 I’m talking about a treatment,
1:06:51 which is intermittent fasting,
1:06:56 which is available to everybody in the entire world for free
1:07:01 and yet has the power to completely reverse their disease
1:07:03 and make them so much healthier.
1:07:05 So the question is, why don’t we do it?
1:07:10 – I couldn’t answer that question for you.
1:07:15 I try to do my part to tell people, but you know.
1:07:17 – Did you know I was gonna ask you that question?
1:07:18 – I know.
1:07:20 – I was gonna ask you, why don’t we do it?
1:07:25 Never what is systems, incentives, money?
1:07:26 – I think it is.
1:07:27 – I think it’s– – From Big Pharma.
1:07:33 – You know, the real reason is I think that people are slow
1:07:35 to catch new ideas.
1:07:38 Like when people hear about new ideas
1:07:41 and I’m talking about academic doctors and so on,
1:07:44 there’s an intrinsic resistance to change.
1:07:46 So I started talking about intermittent fasting,
1:07:49 say 2016 when the obesity code was published.
1:07:52 I talked about reversing type two diabetes
1:07:53 around the same time.
1:07:59 And they’re just very slow to say,
1:08:00 hey, this makes a lot of sense
1:08:03 because for them, they’ve invested so much
1:08:05 in this calories in, calories out model.
1:08:07 They’ve built their entire careers
1:08:11 on saying that it’s your fault that you’re fat, right?
1:08:13 It’s the foods that you ate.
1:08:14 It’s the calories that you ate
1:08:17 instead of trying to get to a deeper understanding.
1:08:19 So people are very reluctant to change, in fact.
1:08:22 I mean, it’s been 10 years and you see the public,
1:08:25 the interest in intermittent fasting has skyrocketed.
1:08:28 And yet most doctors still won’t prescribe it.
1:08:29 They won’t talk about it.
1:08:30 They know nothing about it.
1:08:33 There’s how much teaching do doctors get
1:08:35 about intermittent fasting and why it might be helpful?
1:08:37 Probably zero.
1:08:39 Like why?
1:08:42 We have this amazing tool
1:08:45 and people, doctors call it a fad, right?
1:08:46 It’s a fad diet.
1:08:48 Well, it’s been around for 2000 plus years.
1:08:51 That’s a long, long, long fad, right?
1:08:53 It’s proven effective.
1:08:56 If you don’t eat, you’re gonna lose weight.
1:08:57 What’s simpler than that?
1:09:00 If you don’t eat, you’re gonna use up your blood glucose,
1:09:02 your diabetes will get better.
1:09:03 What’s wrong with that?
1:09:04 It’s not hard to understand.
1:09:06 The diabetes code, I’ve got the diabetes journal
1:09:09 here in front of me and put simply,
1:09:12 it talks about step one being to put less sugar in
1:09:14 and step two being burn the sugar off.
1:09:15 Yeah.
1:09:18 And step one, which relates to putting more sugar in
1:09:23 is all about low carbohydrate diets, right?
1:09:24 Cutting down the carbohydrates.
1:09:26 Yeah, that’s one effective way
1:09:28 of cutting down the type two diabetes.
1:09:30 In fact, the American Diabetes Association
1:09:33 and their sort of nutritional journals,
1:09:36 they talk about having the most scientific evidence
1:09:37 of any diet.
1:09:39 There’s no diet with more evidence
1:09:41 for reversing type two diabetes
1:09:42 than cutting down the carbohydrates.
1:09:44 And then step two about burning the sugar off
1:09:46 and that’s where fasting comes into the picture.
1:09:47 Yeah.
1:09:49 I mean, if you think about it,
1:09:52 it’s not that hard to understand.
1:09:53 Everybody can understand it.
1:09:56 You don’t eat, you’re gonna lose weight, right?
1:10:01 I mean, it’s such a simple, powerful tool
1:10:05 but it threatens the whole apple cart.
1:10:08 All these doctors, all these professors
1:10:10 which have built their entire reputations,
1:10:13 all these systems that are in place for people.
1:10:15 Personal trainers.
1:10:18 Yeah, personal trainers work on a different level
1:10:21 because they talk about more exercise.
1:10:22 And calories and calories out.
1:10:25 I think when we talk about calories on this show sometimes,
1:10:27 I think the people that get quite offended,
1:10:30 tend to be personal trainers
1:10:34 because I think they would say they’ve got case studies
1:10:38 of telling one of their clients to monitor their calories
1:10:41 and they saw a reduction in weight.
1:10:43 So for them, that means it works.
1:10:45 There’s calories in calories out model.
1:10:51 Again, it is that, but it’s a simplistic understanding.
1:10:53 That’s my whole point.
1:10:56 It’s sort of like, if I were to say to you,
1:10:58 why did the Titanic crash, right?
1:11:01 And most people would say, well, I hid an iceberg.
1:11:02 Well, that’s very simplistic.
1:11:04 That’s not the right answer.
1:11:08 The right answer is, it was going too fast, right?
1:11:11 If you think the right answer to why did the Titanic crash
1:11:13 is because it hid an iceberg,
1:11:17 you’d say the solution is to hit less icebergs
1:11:20 which is the same as eat less calories or drink less alcohol.
1:11:23 That’s a very superficial understanding.
1:11:25 You have to get to the deeper level which is say,
1:11:28 why did the Titanic hit that iceberg?
1:11:30 It was going too fast and there was all these icebergs
1:11:32 and it was going too fast for where it was.
1:11:36 So then you say, it needs to slow down.
1:11:38 Now you’ve identified that deeper understanding,
1:11:39 same as with calories.
1:11:42 You can say eat less calories and for some people work.
1:11:43 But for some people it’s like,
1:11:45 why are you eating so many calories?
1:11:46 Is it because you’re hungry?
1:11:48 Why are you hungry?
1:11:50 Is it because all those calories that you’re eating
1:11:52 are going immediately into storage?
1:11:54 You’re eating white bread and jam and sugar
1:11:56 and all of it’s going directly into storage
1:11:57 which is leaving you hungry,
1:11:59 which is making you eat too many calories.
1:12:02 So in the end, yes, you are eating more calories
1:12:05 but that’s the sort of first order thinking
1:12:08 and not the second order thinking that we need to be doing.
1:12:10 And that’s what the Osempic and so on
1:12:13 starts to address is the hunger issue.
1:12:14 – And this is really what all your work addresses
1:12:17 and it’s really the first time I’ve heard someone talk to me
1:12:22 about obesity and weight gain through the lens of hormones.
1:12:24 Never really, I’ve never heard that before
1:12:27 and reading through your work was really illuminating
1:12:28 because it allowed me to change my frame.
1:12:32 And as you say, when we’re just focusing on the surface,
1:12:33 it’s very easy to fail
1:12:35 because we need to understand the first principles
1:12:37 of what’s going on underneath the surface
1:12:41 for that long-term success to a standard chance of occurring.
1:12:43 And I think everyone listening to this
1:12:46 who’s struggled with weight or obesity or whatever else
1:12:52 can relate to this idea that something’s not working
1:12:55 in, you know, if there was any diet that worked,
1:12:57 there wouldn’t be a thousand of them.
1:13:00 – Yeah, and I think the other thing is to understand
1:13:05 that it’s not the personal failing that we make it out to be
1:13:09 which is, I think, extremely unfair
1:13:12 because obviously there’s something within the system,
1:13:13 within the food environment,
1:13:16 within the system of how we’re framing it,
1:13:19 which is making a lot of people overweight,
1:13:21 but it’s not because they don’t have willpower
1:13:22 or because they’re weak
1:13:27 or these other number of reasons that we stigmatize obesity
1:13:30 because we look at it from that calories in,
1:13:32 calories out framework, right?
1:13:35 We say you’re eating too many calories, you must be weak.
1:13:38 As opposed to you’re eating too many calories,
1:13:41 what, why is it that you’re eating too many calories?
1:13:43 Why are you hungry all the time?
1:13:47 – In a word, then, if you had to describe what you think
1:13:50 about this idea of calories in, calories out,
1:13:51 what is that word?
1:13:54 – I would say that it’s shallow.
1:13:59 It’s correct if you don’t think about it too hard.
1:14:02 Anybody who focuses in on thermodynamics and calories
1:14:06 hasn’t really thought about the problem enough.
1:14:07 That’s what I think.
1:14:10 So in the end, it is correct, just like alcohol in,
1:14:13 alcohol out, hitting the iceberg.
1:14:14 Yes, it did hit an iceberg.
1:14:16 That’s why I said it, but it was going too fast, right?
1:14:19 Or alcohol in, yes, if you drink less alcohol,
1:14:21 you’ll cure your alcoholism,
1:14:26 but you won’t cure the PTSD that caused you to drink.
1:14:28 – Correct, but not helpful.
1:14:30 – Exactly, that’s exactly right.
1:14:35 It is correct, but it’s sort of not getting to that root
1:14:40 deeper cause that we need to in order to help people.
1:14:44 And that’s causing us to blame them.
1:14:47 So what we’re doing, which I think is very unfair,
1:14:49 is blaming the victim.
1:14:54 Like, do you think this person who’s trying to lose 50 pounds
1:14:57 needs you to tell them that need to lose 50 pounds?
1:14:59 Absolutely not.
1:15:02 That’s only gonna be the 10,000th time they’ve heard it.
1:15:04 – It’s interesting, ’cause one of our guests talked
1:15:08 about the role of compassion and kindness in weight loss.
1:15:11 And now through the lens of understanding cortisol,
1:15:15 now I can understand how kindness and gratitude
1:15:19 and being happy, you know, for lack of a better word,
1:15:20 can help us lose weight.
1:15:22 And when we’re not happy, when we’re resentful,
1:15:27 when we’re low in gratitude, when we’re bitter,
1:15:28 we’re more likely to gain weight.
1:15:30 – And other things help too,
1:15:34 because if you think about things like a sense of community,
1:15:35 it’s very important.
1:15:37 – Lowers cortisol levels.
1:15:40 – Lowers cortisol is a way for you to relieve stress, right?
1:15:42 Talking to other people.
1:15:45 We did, of course, limit that during COVID.
1:15:47 And of course we saw a lot of problems,
1:15:51 but one of them was loneliness and all these sort of things.
1:15:56 But again, I always think about, you know, people,
1:15:58 you know, the way they are.
1:16:00 So if you look at a lot of religions, for example,
1:16:04 it’s like, oh, they were so far ahead of us.
1:16:05 What did they do?
1:16:09 They brought people together every week.
1:16:12 Oh, you’re building a sense of community.
1:16:13 Fasting.
1:16:15 Oh, they all got together and fasted.
1:16:16 They all shared.
1:16:17 They’re lowering their cortisol.
1:16:19 They’re lowering their insulin levels.
1:16:20 They’re staying healthy.
1:16:24 And we in our big McMansions, right,
1:16:26 we eat the ice cream for dinner
1:16:30 and we live alone in this giant house.
1:16:33 And we wonder why we’re not as happy as, you know,
1:16:35 our grandparents or our parents before them
1:16:39 because they understood the power of some of these things
1:16:41 that we’re trying to get back to.
1:16:45 Like the weirdest thing is that I’m not trying to tell people
1:16:48 something that’s weird and unusual
1:16:50 and you never thought about this before.
1:16:52 I’m trying to tell them about something
1:16:57 that everybody in human history has been exposed to,
1:16:59 which is intermittent fasting.
1:17:03 That’s been a part of our human history,
1:17:04 whether it’s through religion
1:17:06 or whether it’s through inadvertent, whatever,
1:17:09 or whether it’s through his cleansing and purifications
1:17:10 and all this sort of stuff.
1:17:13 People have exposed it, even in the English language,
1:17:15 breakfast, break your fast.
1:17:17 You need to feed, then you need to fast,
1:17:19 then you need to break your fast.
1:17:22 So I’m not telling people anything different.
1:17:24 – Jason, thank you so much.
1:17:26 We feel like we could talk for hours
1:17:30 ’cause I’m so, there’s so many sort of,
1:17:31 I was thinking about it like spiderwebs,
1:17:33 but there’s so many little branches we could go off on
1:17:34 as it relates to hormones
1:17:36 and the impact of hormones on the human body.
1:17:39 You have this other book as well called the PCOS plan,
1:17:43 preventing and reversing polycystic ovary syndrome,
1:17:46 which is a, you know, a whole nother conversation
1:17:46 for another time.
1:17:48 But these books are so wonderful
1:17:51 because they provide a new lens on an old conversation.
1:17:53 And our conversation, that’s lacked the depth
1:17:57 that’s required to make any significant progress
1:17:57 on these subjects.
1:18:00 As we’ve seen, obesity levels and other issues with weight
1:18:01 have gone in the wrong direction
1:18:03 for the last couple of decades.
1:18:05 And I think it’s a more systemic understanding
1:18:07 of these issues that will give us any chance
1:18:07 of reversing it.
1:18:10 And that’s exactly what your work does.
1:18:11 Everyone knows where to find you.
1:18:12 Dr. Jason Fung will link all of your work
1:18:14 in the description below.
1:18:16 We have a closing tradition on this podcast
1:18:19 where the last guest leaves a question for the next guest
1:18:22 without knowing who they’re leaving it for.
1:18:24 And the question that’s been left for you
1:18:30 is what is your greatest gift to the world?
1:18:36 – I think if, you know, I suppose it sounds very arrogant,
1:18:45 but I really hope that my work helps people
1:18:51 sort of reverse the type two diabetes
1:18:56 ’cause that is really sort of one of the most close things
1:18:58 that I deal with because I deal with it professionally
1:18:59 sort of every day.
1:19:05 And helps break the stigma of, not just the stigma,
1:19:07 but the understanding like, you know,
1:19:11 stimulates more thinking about weight loss,
1:19:15 how to lose weight more than calories and calories out.
1:19:18 I mean, it’s so sort of pie in the sky
1:19:22 because, you know, there’s a whole, you know,
1:19:25 worldwide sort of institutionalized,
1:19:29 fossilized almost, you know, thinking around calories.
1:19:31 It’s all about calories, that sort of thing.
1:19:35 So for me to upset, it seems ridiculous.
1:19:40 But I hope that I can at least start that conversation
1:19:43 to say, hey, let’s think about these things.
1:19:44 Let’s think about the hormones.
1:19:46 Let’s think about reversing type two diabetes.
1:19:48 Let’s think about all getting together
1:19:52 and helping each other to become so much healthier,
1:19:56 not through drugs and not through more surgery
1:20:00 and not with, you know, weird and new things
1:20:01 that you’ve never heard of,
1:20:06 but with the tried and the true sort of oldest thinking
1:20:08 that has been there, right?
1:20:11 It’s, to me, it’s, I sometimes think about this,
1:20:15 like crazy, like, why do I think I can even do that, right?
1:20:17 It’s just ridiculous.
1:20:18 It’s so much hubris.
1:20:22 But, you know, I can only try, right?
1:20:24 Because I see in my own practice
1:20:27 how much good it’s done for some people.
1:20:30 So it drives me to say, I need to bring it to more people.
1:20:32 I need to explain it to them.
1:20:34 If they want to be helped, they will be helped.
1:20:35 But if they don’t want to say this, oh, hey,
1:20:38 I’m not trying to force myself to do anything.
1:20:41 But, you know, that’s what I hope my greatest gift will be,
1:20:47 but at the same time, I sort of think that’s just, you know,
1:20:50 you’re crazy if you can think you can do that, but.
1:20:54 – Well, it’s the crazy ones that change the world, Dr. Jason.
1:20:55 It’s the crazy ones that change the world.
1:20:57 And even with, you know, your conversation
1:21:00 around intermittent fasting has changed many, many lives
1:21:01 that you’ll never get to meet.
1:21:05 I imagine many, many millions, many, many millions
1:21:07 because it’s even brought the conversation to this show
1:21:09 before you entered the room.
1:21:12 Many, many months and months and months and almost a year ago,
1:21:13 people started talking on the show
1:21:15 about intermittent fasting.
1:21:18 And that’s in many respects due to the work
1:21:20 that you’ve done to further that conversation.
1:21:22 And now your work continues to highlight the fact
1:21:26 that type two diabetes is a reversible disease in many cases.
1:21:30 And I think, again, that’s going to save, you know,
1:21:32 tens of millions, if not hundreds of millions of lives
1:21:33 over the coming decades and years.
1:21:36 So thank you for what you do, Dr. Jason.
1:21:38 It’s a huge honor to get to sit with you today.
1:21:41 And I feel wiser and more enlightened.
1:21:42 And like someone has turned the lights on
1:21:45 in a certain part of my knowledge
1:21:46 because of this conversation.
1:21:47 So I thank you for that tremendously.
1:21:48 – Thank you so much.
1:21:49 It’s been great.
1:21:53 – Do you need a podcast to listen to next?
1:21:56 We’ve discovered that people who liked this episode
1:21:58 also tend to absolutely love
1:22:00 another recent episode we’ve done.
1:22:03 So I’ve linked to that episode in the description below.
1:22:04 I know you’ll enjoy it.
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