低碳水 Robert Cywes 医生

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Rob Cywes博士，自称“碳水成瘾医生”（The Carb Addiction Doc）

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Cywes博士将本期视频定位为“最佳肉食”系列讲座的一部分。他指出，长期坚持肉食的最终目标和“圣杯”，是达到一种被称为“瘦体超敏者”（Lean Mass Hyper-Responder, LMHR）的生理状态。他坚信，任何人，无论起点如何，都可以通过时间和正确的实践达到这一状态。本期视频将深入探讨LMHR的益处、潜在的问题，以及如何通过微调来将自己维持在最健康的LMHR状态中。

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Cywes博士详细阐述了他对LMHR状态的定义，这一定义基于一系列严格的生理和生化指标。

“瘦体”（Lean Mass, LM）的定义

• 体重标准：长期坚持高脂肉食后，会经历显著的体重下降。Cywes博士通常使用身体质量指数（BMI）低于25作为标准，理想范围在21到24之间。
• 脂肪分布是关键：他特别强调，仅仅体重达标是不够的。LMHR状态的核心在于脂肪的健康分布。
  • 低皮下脂肪：皮下脂肪的减少是显而易见的。
  • 极低的内脏脂肪：这才是关键中的关键。他指出，内脏脂肪（包裹器官的脂肪）的减少至关重要。他认为，内脏脂肪的堆积本身不是问题，而是其背后的代谢功能障碍（特别是睾酮水平和胰岛素抵抗）才是问题的根源。因此，LMHR状态要求内脏脂肪被最小化。
  • BMI的灵活性：他补充说，即使一个人的BMI可能略高（如26或27），但只要其内脏脂肪水平极低，他仍然认为这个人符合LMHR中“瘦体”的部分。

“超敏者”（Hyper-Responder, HR）的定义：血脂与激素指标

这部分主要关注血液中的生化指标，特别是血脂和关键激素。

• 总胆固醇与LDL胆固醇：
  • 高总胆固醇：他认为LMHR状态下，总胆固醇水平应该偏高，他给出的范围是200至500 mg/dL。
  • 高LDL胆固醇：同样，LDL胆固醇也应该偏高，范围在120至300 mg/dL或更高。但他强调，LDL颗粒的大小和形态（即“大而蓬松”的A型颗粒）比绝对数值更重要。他承认，总胆固醇超过500或LDL超过300的情况需要谨慎对待。
• 激素水平——胰岛素与胰高血糖素：
  • 高胰高血糖素：这是他定义中一个独特的、需要谨慎看待的指标。他认为空腹胰高血糖素水平应高于35 pg/mL。
  • 极低的胰岛素：空腹胰岛素水平应低于6 μIU/mL，理想范围在3到4或更低。
• 甘油三酯与HDL胆固醇——血糖管理的间接指标：
  • 低甘油三酯：他使用的标准是低于75 mg/dL。
  • 高HDL胆固醇：他使用的标准是高于75 mg/dL。
  • 1:1的比率：他喜欢使用75这个数值，因为它形成了一个甘油三酯与HDL的1:1比率。持续下降的甘油三酯和持续上升的HDL，是他判断一个人是否已经成功脂肪适应（fat adapted）的关键指标。

LMHR状态的本质

Cywes博士总结道，LMHR的本质是极度胰岛素敏感和深度脂肪适应的体现。在这种状态下：

• 身体优先且高效地以脂肪作为主要燃料来源。
• 细胞对胰岛素极其敏感，因此只需要极少量的胰岛素就能将少量的、必需的葡萄糖送入特定细胞。
• 每日的能量循环以脂肪的利用和储存为主导，而葡萄糖的通量则非常低，其他营养物质更多地扮演着“营养供给”而非“能量来源”的角色。

他坚信，LMHR是人类最健康的生理状态，而达到这一状态的最佳途径就是通过长期、适应良好的肉食。

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然而，Cywes博士话锋一转，指出了一个关键问题：一旦达到LMHR状态，如果继续推向极端，反而可能变得不健康。他称之为“肉食钟形曲线”的两端。

过度LMHR状态的警告信号

• 极高的胰高血糖素：当空腹胰高血糖素水平远超35，特别是高于50 pg/mL时，这是一个危险信号。这表明胰高血糖素的主导地位过强，身体正处于一种过度的分解代谢状态，即过度分解自身组织（如肌肉）来通过糖异生制造葡萄糖。
• 胆固醇吸收过高。
• 持续而非循环的酮症：虽然进入生酮是目标，但如果酮体水平持续过高，而血糖水平持续过低，这也可能是有问题的。

一个真实的案例：来自患者的邮件

为了证明“过度”LMHR状态的真实存在和其负面影响，Cywes博士朗读了一封来自他患者的邮件。这位患者此前正处于他所描述的“过度”LMHR和胰岛素抑制（insulin suppression）状态。在Cywes博士的指导下，她开始进行调整。

邮件内容如下：

• 感受改善：“顺便说一句，在饮食中加入了牛奶和稍高水平的碳水化合物后，我感觉好多了，更像以前的自己了。”
• 血糖波动与正常化：“一开始确实出现了一些吓人的高血糖数值，但现在似乎开始再次正常化了。”
• 享受碳水：“说实话，我真的很享受一点点美味的碳水化合物——谁能想到呢？（她尝试了樱桃番茄、豌豆和红薯）”
• 体重与食欲的变化：“我没有增加任何体重，也没有触发糖瘾。我的食欲不再像在高脂肉食时期那样贪婪、绝望和无法满足了。”
• 对“胰岛素抑制”的确认：“对于您在‘胰岛素抑制’视频结尾提出的问题——‘胰岛素抑制是个问题吗？’——对我来说，答案是：胰岛素抑制是无法忍受的。它让我处于一种危险的分解代谢状态，正如您在我血检中观察到并通过高胰高血糖素水平所测量的那样。”
• 对其他医生的疑问：“我很好奇为什么其他肉食医生没有在他们自己或他们的病人身上体验到这一点。也许是因为他们缺乏这种意识，因为他们是如此坚定地支持肉食。”
• 呼吁与感谢：“您敏锐的观察非常重要，需要更多地宣传。解决方案很简单，而且对我的帮助巨大。如果您需要这个现象的代言人，我随时愿意提供帮助。”

这封邮件生动地证实了，长期且极端的LMHR状态会导致一种有害的“胰岛素抑制”，其特征是无法控制的饥饿感和身体的分解代谢。

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当通过血液检查（如高胰高血糖素、低胰岛素、甘油三酯、A1C和尿酸上升）确认一个人处于过度的LMHR或胰岛素抑制状态时，Cywes博士提出了两种核心的纠正策略。

策略一：调整脂肪和蛋白质的摄入

• 减少脂肪摄入量：关键在于减少每餐摄入的脂肪总量。这并不意味着要转为低脂饮食，而是进行微调。
  • 选择更瘦的肉类：例如，从牧场饲养、谷物育肥的牛肉转向纯牧场饲养的牛肉，后者的脂肪含量明显更低。
  • 减少额外添加的脂肪：例如，在吃80/20的汉堡肉饼时，不再额外添加培根、奶酪或黄油。
• 注意蛋白质总量：在降低脂肪与蛋白质比率的同时，必须警惕不要过度增加蛋白质的总量，以免给身体带来额外的代谢压力。

策略二：引入胰岛素触发器——碳水化合物

这是纠正胰岛素抑制状态的核心。Cywes博士解释了一个关键的生理机制：

• 胰岛素的触发机制：与普遍认知相反，肝脏自身通过糖异生产生的葡萄糖，或者通过静脉注射的葡萄糖，通常不会引发强烈的胰岛素反应。胰岛素的释放主要是在响应肠道中的碳水化合物时，通过一种叫做肠促胰素（incretin）的激素（主要是GLP-1）来触发的。
• 纠正的目标：目标是打破“高胰高血糖素、低胰岛素”的恶性循环，转为“升高胰岛素、降低胰高血糖素”的健康循环。
• 引入碳水化合物的方法：
  • 最佳荤食选项——牛奶：他认为，对于想保持荤食的人来说，液态奶是最好的选择。牛奶含有葡萄糖和半乳糖（不含会引发尿酸问题的果糖），能有效地触发胰岛素反应。他提到，他的四岁儿子每天喝两次牛奶来触发胰岛素。患者刚开始可能会经历血糖升高，但身体会逐渐重新适应。
  • 非动物性碳水选项：对于可以接受非动物性食物的人，他建议引入少量的淀粉类蔬菜，如红薯、豌豆、胡萝卜或南瓜，并强调应避免谷物、米饭或土豆，因为这些最容易引发成瘾。
  • 聪明的“混合”技巧：为了避免触发“碳水成瘾”，他提出了一个非常实用的技巧——将碳水化合物混合到肉类中。
    • 碎肉是极佳的载体：碎牛肉、碎鱼肉等是混合添加物的理想载体，就像英国传统食物“牧羊人派”一样。
    • 具体做法：可以将少量煮熟的红薯泥、一点蜂蜜或牛奶混入碎肉或炒蛋中。这样既能触发胰岛素反应，又不会因为直接看到或吃到大量的碳水而引发暴食的欲望。
    • 时机很重要：他建议将这些含有少量碳水的混合餐放在进食窗口的早期，而将最后一餐保持为纯高脂食肉餐，这样可以确保在一天的大部分时间里胰岛素水平仍然保持在低位，从而维持健康的胰岛素循环。

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Cywes博士最后为肉食的运动员提供了专门的指导。

• 短时间运动（&lt; 45-60分钟）：对于训练时间在一个小时以内的运动员，完全不需要额外补充碳水化合物。身体会自动通过肝脏释放葡萄糖来应对运动需求。他展示了自己 乏食24 小时后跑半程马拉松的CGM数据：在跑步的5到8英里处，他的血糖自然升高，跑完后又迅速回落。这是正常的、健康的生理反应。
• 长时间运动（&gt; 60-80分钟）：对于训练时间显著超过一小时的运动员（如长距离自行车手、跑者、游泳运动员、橄榄球运动员），他建议在运动中补充碳水化合物。
  • 为什么需要补充：长时间运动会耗尽肝糖原，此时大脑会感知到能量危机，通过“中枢控制理论”（Central Governor Theory）来主动降低运动表现，以保护身体。
  • 补充的最佳时机：在运动开始后30到45分钟开始补充，然后每30到45分钟补充一次，直到运动结束前约30分钟停止。
  • 最佳的补充剂——慢速淀粉：他强烈推荐使用慢速释放淀粉，而不是会引起血糖剧烈波动的快糖（如葡萄糖或果糖）。慢速淀粉能提供一个稳定的能量流，触发适度的胰岛素反应，从而在不完全退酮和脂肪燃烧的情况下，为细胞提供额外的燃料，实现能量来源的最佳混合。
  • 对于力量型运动员：对于力量举运动员，他建议可以在训练期间和休息期引入少量碳水化合物，以确保摄入的蛋白质能优先用于肌肉修复，而不是被用于糖异生。

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Cywes博士最后总结道，这些都是基于科学的、功能性的策略，用于优化肉食，避免其潜在的长期风险。他强调，通过监测自己的身体反应和血液指标，每个人都可以学会如何微调自己的饮食，从而安全、健康地享受LMHR状态带来的益处。他以“我是碳水成瘾医生”作为结束语，再次强调了他帮助人们摆脱碳水依赖、走向真正代谢健康的使命。


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Cywes在碳水瘾领域工作，但也接诊各种患有代谢疾病或希望关注自身代谢健康的人。在这个领域，他有时会调侃一位名叫 保罗 Paul Saladino 的医生，因为保罗的建议通常不适合Cywes的大多数病人。所以Cywes的标题是“当保罗说对的时候”

Cywes有一个特别的病人案例。这位病人名叫詹姆斯 ，大约46、47岁，非常健康，是个资深冲浪爱好者，肉食者，各方面都做得非常好，心态积极，生活均衡。几年前他来找Cywes，主要是想检查一下血液指标，因为他自认为非常健康，一切都做得对，把Cywes的每条建议都做到了极致。

一年前的血液检查结果（肉食，高脂饮食，每天一到两餐）：

• 体格状态：体重完美，体脂率极低，肌肉发达但精瘦，BMI 23或24。由于他非常瘦，身体所需的大部分营养和热量都需要从饮食中获取，除了自身组织的自噬回收外，储备不多。
• 铁代谢：铁、铁饱和度完美。铁蛋白（细胞内炎症的有力标志物）很低（96，医生希望男性低于100-150），表明没有炎症。
• 睾酮：游离睾酮非常低，只有23.1（医生期望值60-100）。医生思考：是制造不足还是身体不需要那么高？
• 血脂（参考了Dave Feldman的瘦体超敏者 LMHR 概念）：
  • 总胆固醇：高达598（医生期望值&gt;200，但598“高得离谱”）。
  • HDL（高密度脂蛋白）：84（非常健康，医生期望值&gt;75）。
  • 甘油三酯：105（偏高，医生期望值&lt;75）。这有点奇怪，因为他是早晨空腹检测的。
  • LDL（低密度脂蛋白）：计算值大于350（超出检测范围上限）。
  • VLDL（极低密度脂蛋白）：21（医生期望值约10），表明肝脏在制造脂肪并输送到脂肪细胞。
• 血糖：空腹血糖91（尚可，医生期望更低在80多）。
• 肾功能与蛋白质代谢：
  • BUN（血尿素氮）：27（高，医生期望值18-22），表明过量蛋白质被分解成糖，然后可能转化为脂肪。
  • 肌酐：0.99（高，医生期望值约0.7），但肾功能完美，他不使用肌酸补充剂。
• 电解质、钙：完美。
• 肝功能：
  • 碱性磷酸酶：50多，正常，肝脏无炎症。
  • AST/ALT（谷草/谷丙转氨酶）：分别为35和70（非常高，医生期望值10-15），表明肝细胞受损后释放。
• 糖化血红蛋白 (A1c)：5.3-5.4（虽然不算差，但比医生对这种“完美样本”的预期要高，医生期望值&lt;5.2）。
• 镁：正常。
• 尿酸：低，3.6（正常）。
• GGT（γ-谷氨酰转移酶）：20（肝脏炎症标志物，医生期望值约10）。
• 甲状腺功能：
  • TSH（促甲状腺激素）：0.83（低）。
  • 游离T3：2.7（偏低，医生期望值2.5-3.3）。TSH和游离T3都低。
• 血常规：白细胞3.8，血红蛋白15.3，血小板207，均正常。
• 尿液：完全干净，但没有酮体（这对于一个脂肪适应的肉食者来说出乎意料）。
• 维生素B12、叶酸：良好。幽门螺杆菌：阴性。
• 胰岛素与胰高血糖素：
  • 胰岛素：2.3（极低）。
  • C肽：0.85（极低）。
  • 胰高血糖素：66（极高，医生期望值15-20）。

初步诊断总结：

这位看似健康的患者表现出：低睾酮、低胰岛素、低C肽、低甲状腺激素、高胰高血糖素、甘油三酯偏高、血糖略高、AST/ALT升高。

Cywes医生判断这是“胰岛素抑制”（insulin suppression）。患者的身体过度适应脂肪供能，钟摆摆得太远了。他每天吃大量蛋白质（可能集中在一餐），几乎不用葡萄糖。在胰高血糖素的作用下，他产生酮体，但由于血糖升高（过量蛋白质转化为糖，再转化为脂肪，证据是甘油三酯、GGT、AST/ALT升高），酮体水平可能不足以在尿液中检测到。他没有得到足够的胰岛素反应来清除血糖。这与Ben Bikman的观点相符。

给他的建议：

1. 停止一天一餐（OMAD）：对于他这样储备不多的人，一天一餐的负荷太大，间隔时间太长。建议改为每天两到三餐。
2. 触发胰岛素和GLP-1：GLP-1是肠道中触发胰岛素分泌的激素。碳水化合物可以触发GLP-1。
3. 增加碳水化合物摄入：建议他每天喝一两次全脂牛奶或生牛奶，并可能增加一些浆果和蜂蜜。目标是触发胰岛素，而非作为主要能量来源。

调整饮食后的复查结果：

• 体重：增加了2磅（约0.9公斤），但看起来依然精壮。
• 睾酮：升至46（之前是23.1）。这是胰岛素效应。虽然仍偏低，但对于激素敏感的人来说可能足够。
• 血脂：
  • 总胆固醇：降至241（之前是598）。胰岛素控制胆固醇，之前可能是肠道吸收过多，现在肝脏制造更多但吸收减少。
  • HDL：降至67（之前是84），因为进食频率增加和摄入碳水，但仍健康。
  • 甘油三酯：降至64（之前是105）。
  • LDL：降至256（之前&gt;350）。
  • 虽然总胆固醇和LDL仍按常规标准偏高，但Cywes医生认为无需使用他汀类药物。
• 血糖：降至81（之前是91）。
• 肾功能与蛋白质代谢：
  • BUN：降至22（之前是27）。
  • 肌酐：降至0.76（之前是0.99）。
  • 蛋白质代谢改善，用于能量的蛋白质减少，用于结构的蛋白质增加。
• 电解质、钙、碱性磷酸酶：仍然良好。
• 肝功能：
  • GGT：降至10（之前是20）。
  • AST/ALT：降至15和18（之前是35和70）。肝脏炎症消失。
• 糖化血红蛋白 (A1c)：5.3（与之前相近，良好）。
• 甲状腺功能：TSH 0.68，游离T3 3.3（完美）。
• 胰高血糖素：降至8（之前是66！）。
• 尿液：出现微量酮体。
• 胰岛素与C肽：胰岛素2.6，C肽0.85（空腹水平与之前相似）。
• 关键变化：他现在是胰岛素敏感的。按照Kraft餐后血糖胰岛素反应模式，他从之前的第五型（类似1型糖尿病）转变为第一型（正常）。

结论：

患者现在更像一个“碳水肉食者”（carb carnivore），可能碳水摄入量没有保罗 Paul Saladino那么多，但状态非常好。 这个案例展示了血液检查和专业解读的重要性。这是一个非常复杂和精细的调整过程，很少有人能达到这种状态。 Cywes医生的建议是：并非每个人都应该增加碳水，这取决于个体情况和血液指标，尤其要考虑碳水瘾的问题。不要随意解读为可以自由摄入碳水化。了解自己的血液指标至关重要。


时长: 00:20:24

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00:00 Coming up on today's show…

00:01 If you have had five DUIs, you don't have control of the relationship. One DUI maybe. In my space, if you already have type 2 diabetes, you have no control over your relationship with carbohydrates. They love to tell us that apples are healthy, but donuts aren't. They love to tell us that whole grains are good, but maybe brown bread is better than white bread. What's entering my bloodstream is sugar. And if you just change what you're eating, but you don't change why, you're always going to go back to it. The what is easy. I can give you a sheet of paper with what to eat, but it doesn't fix the why.

00:31 and the why is the rest of your life. So whenever anybody in this country says, oh my God, I'm hungry, it is almost always an expression of emotional need, not nutritional need. Rob, as the carb addiction doc, how do you describe when somebody enters that realm of carb addiction from somebody that's just having carbs as part of a healthy diet, if that's even possible?

00:58 It's an excellent question. And it's not a fence that you climb over. It's a gradual part. And there are a couple of ways to look at it. The thing about addiction is that it defines who somebody is. It's not something you do. It is who you are. So, you know, if I drink some alcohol and I get hammered one night, I may have abused alcohol, but I may not be an alcoholic. But if I'm getting hammered every night, if I get one DUI, it might be a mistake.

01:28 But if I've had five DUIs and I've got liver disease, I am no longer in control of that relationship. So it never is about the drug. It's about my relationship with my dependency on it. And it's a little bit more sophisticated in that by the time you have a chronic excessive relationship with a behavior or a drug that gives you massive instant relief from emotional tension, you don't need anything else.

01:54 So most people have a dominant and somewhat exclusive mechanism of emotion management. It's a drug that dissipates emotional tension but disconnects them from issues. So the first thing is that the dominance and the prevalence of that relationship. The second part is, and the word addiction is thrown around too often, to define addiction, there has to be measurable harm.

02:23 maybe not visible to the person themselves because the last person to know they're an alcoholic is the alcoholic. But if you have had five DUIs, you don't have control of the relationship. One DUI maybe. In my space, if you already have type 2 diabetes, you have no control over your relationship with carbohydrates. If your A1C is maybe 5.5, 5.6, you've been a little bit sloppy, a little bit lazy, but

02:50 It doesn't necessarily define you. If you've gained 10 or 15 pounds, you may be a little bit sloppy with carbohydrates. But by the time you 50 plus pounds heavy, that's who you are. That defines you. So when it comes to addiction, it really is about the relationship and the level of harm and then the way in which we distort the reality of the harm to justify the use of the drug.

03:18 I just had a DUI yesterday, but I'm really stressed out about going to jail. For that valid reason, I should have a bottle of whiskey. And the distorted nature in which we give ourselves permission to do something we inherently know is a problem is a large part of understanding addiction. So there isn't a defined answer, but it's a degree. And then also the other piece also is nobody, nobody quits the first time.

03:49 So, if you are able to have one beer on a Sunday for the rest of your life, you've never been an alcoholic in my opinion, but if you're that person who thinks after a year of sobriety or whatever, maybe I can handle one beer, and you try it, and six months later, you have to dry yourself up again.

04:11 then hopefully you're smart enough to realize or to recognize that my relationship is broken. All too often, we have people that go on a ketogenic diet, cut out carbohydrates, kumbaya, I'm carnivore, I'm here. I've done it for six months, this is forever. Two years later, we have that same conversation.

04:28 And yeah, well, you know, Christmas happened or my wife died or some awful tragedy that triggered them to go back to their drug of choice. And with that depth of experience, you realize, okay, I just can't have these things around me. And the final thing, a little thing about addiction is it's the absence of control. And the problem is you. So I have to distance myself. I have to protect me from myself.

04:59 It isn't about carbohydrates. It's about protecting me from easy access. And if you look at anybody that quits, they're going to crumple up a cigarette, throw them away. You can't have cigarettes in your pocket and smoke. So it's about you and your relationship and you can't outsource that treatment. One of the things that becomes really difficult when it's carbohydrates versus cigarettes or alcohol is the fact that as a human being, we're required to eat on a daily basis and

05:27 to maintain normal function. So it's not like we can quit eating cold turkey like we can with alcohol where we push it right out of the house and then we don't have to look at it. This is still something, although carbs is just a subcategory within food, it's going to be very difficult not to have those still in your life physically in some way. And you have to negotiate that relationship differently than, say, alcohol.

05:55 I'm going to disagree with you. There are two ways in which I'm going to disagree with you on that. Now, I understand the sentiment, so there's a different narrative. What is the only thing an alcoholic should do? Stop drinking. They're dead. If you stop drinking, you're dead. What you meant to say is they should stop drinking alcohol.

06:14 If they stop drinking, they're dead. They dehydrate and they die. Semantics, though. Just as carbohydrates. But so is semantics saying that carbohydrates are part of food. It makes it more difficult. Alcohol is part of hydration. Alcohol is part of what we drink. So again, it's semantics because as a society, you've created that semantics. Let me take you back a few years to pre-prohibition. Nobody thought alcohol was a problem.

06:41 We had prohibition for a reason because nobody thought it was a problem. In the 1950s and 60s, when I was growing up, everybody smoked and even doctors told their patients, smoking is just fine, no harm here. So our view on cigarettes has changed 180 degrees over the last 70 years. 1950s, ah, come and let's have a cigarette together and you and I would be sharing a cigarette. I've never smoked. Now, if I lit up a cigarette in your room, you'd be pissed off and angry at me if you don't smoke.

07:12 Okay, so the narrative has changed and society has shifted against it. So that's the first thing. The second thing is, I don't know what religion you are, but there are plenty Muslims and Jews who don't eat pork. There's a lot of Hindus who don't eat meat. Meat's part of nutrition. Pork is part of nutrition. Meat is part of nutrition. You're going to tell a vegan or vegetarian, their diet is, well, I will tell them it's terrible, but be that as it may,

07:44 You can't tell me that carbohydrates are sacrosanct, but don't eat pork. You can't tell me don't eat meat, but carbohydrates are okay. You see, it's a societal issue. It is a perception. It isn't a reality. Plenty of people live without pork. Plenty of people live without meat.

08:04 part of the challenge with the society piece is the fact that society tells us carbs are what we should base our diet on. Not only include them in the diet realm, they're the base of what we should be consuming. So if somebody is addicted to carbs and they go to their doctor, their doctor is going to say, no, this is good. This is what you should be eating. This is what our, I don't know if it's, I think it's the food plate now, but

08:29 I still think of the pyramid a lot of times. This is the base of the pyramid. This is what you should be eating. This is not an addiction. So there's that whole layer too. I'm going to say that that's also completely wrong. You said society tells us to do that. Society doesn't. Society is predetermined to be healthy and we figure it out, albeit slowly. Who told us that vaping was good? Society or the tobacco companies?

08:54 Tobacco, I assume? Not society. Society, a lot of New Zealanders just banned vaping. India never allowed e-cigarettes in it. America is, oh, come on, have your vaping because it's so much better than smoking. Smoking is really bad.

09:12 Society didn't say that. Society eventually said that. But now the tobacco companies are saying smoking is bad, but vaping is fine. And now here in Florida, 60% of high school kids vape on a regular basis. And one hit of Juul is five times as much nicotine as a hit on a cigarette. That wasn't society. That's industry. Same thing with carbohydrates.

09:32 Coca-Cola said, “Hey, nothing wrong with Coke. In fact, you need the sugar in Coke. You've just got diabetes, and you're just fat because you're lazy. You don't run enough.”

09:43 And Coke spent billions of dollars on their Move More campaign in the 70s and 80s. You cannot go to a sports event without seeing an ad for a sugar-sweetened beverage. That is intentional. That is industry driving the narrative. Society didn't drive that narrative. And when society started to shift against sugar, what did the Coke do? Yeah, Coke's bad, but drink a Diet Coke.

10:05 So it's industry driven. It's economics and politics. It isn't society. Society is self-preservationistic. We just slow to get it. And awful things have to happen in a society before we fix that. We knew in the 1950s and 60s, smoking was really bad. Professor at Harvard said smoking causes lung cancer. Tobacco companies came out and said, oh, no, no, no, that's false. It's not true.

10:31 Just like a lot of industries are now saying, oh, no, no, sugar and starch is good. Depends on how you have it. These are all healthy foods. That's industry-driven. It's economics. And society eventually overcomes the harm of those economics.

10:47 So again, I disagree with that statement that you made, but again, we're having a conversation, but you've got to look at it from a slightly different perspective because we've been into, and I'm not a conspiracy theorist. No, I'm just bringing these ideas out so we can, you know, riff on them together and explore them. And the difference though, I'll tell you something else that's going to happen. Watch this. I'm going to play Nostradamus here. Okay.

11:10 What is one of the commonest drugs currently sold in the US? Nicotine, alcohol. One of the biggest moneymakers over the last 50 years for drug companies, about 30 years for drug companies, statins. Right. Statins to lower cholesterol, okay? And it's malpractice for me to have a diabetic or I'm practicing outside of the standard guidelines if I don't prescribe a statin. I will tell you that statins will be obsolete

11:39 as a treatment for cardiovascular risk within 10 to 15 years from now. Why?

11:45 Because we know the studies that have been suppressed and pushed away tell us categorically that statins don't work. They don't reduce cardiovascular disease. They may lower LDL, but they don't reduce cardiovascular disease. But the narrative is still, take a statin because it lowers LDL and they allow you to connect the dots because that's how they're making money. But what is now rapidly ascending the money curve on drugs? Ozempic? GLP-1s, Ozempic, Wegovi, Manjaro. I've got a…

12:14 A sheet of paper here, that sheet of paper are all the new experimental drugs, GLP-1s, that are being produced, that are in production and testing, massive reminigeneration, exactly what we saw 50 years ago or 30 years ago with the statin industry, where they were just producing statin after statin after statin. So who drives that? Not healthcare, not medicine.

12:41 We now know that GLP-1s, in fact, where Gove has just got an indication for cardiovascular use of GLP-1s, because it does effectively reduce cardiovascular disease. GLP-1s treat insulin and blood sugar. They don't treat lipids. And industry. So if you go to your doctor and you're a fat person or a diabetic and you've heard about Ozempic and the doctor says, oh, you're diabetic. I'm going to put you on metformin and a statin. You go, oh, no, no, no. I've heard about all the bad things about a statin. Don't give me it.

13:08 But almost always, when you go in to see that doctor, you're going to demand, at least my pay, you're going to demand a GLP. I want Wegovy. Please put me on Munjara. So the pharma industry is going to sacrifice their current money winner.

13:26 statins for the bigger moneymaker, GLP-1s. And that's what they've already begun to do. So that's industry-driven. It's not society-driven, it's economics. And as Nostradamus, as my little French hat on me, I'm going to predict that statins will be obsolete in the management of heart disease in 10 to 15 years because the pharma industry is going to change that to GLP-1s. And we're already seeing it. Coming back to carbs, the point I was trying to make though is the fact that

13:56 The MyPlate is a government initiative that is dictating so much of what people are doing in society. And there's trust in that.

14:07 So that's why I was pushing on that. And when I said society, it's coming from the government all the way from the top that we should be having carbohydrates as the base. The board of directors of Nestle, the board of directors of Kraft Foods, who are sponsoring the MyPlate stuff, the Seventh Day Adventist movement who are sponsoring Blue Zones. No, I get that. But it's still in the end, the government's word saying, this is what you should be eating. Of course, it's coming down. So what they have to do is they've got to find someone that we…

14:36 still to a certain degree trust. But if you look at each one of those people on the US Dietary Guidelines Board, which makes those, the majority of them have a list of sponsorships from these food industry companies. So

14:52 over time and what's happening. And I agree with you right now, that is still true because we trust the government. Most people still trust the government, but that trust is being eroded at a massive rate. And anybody that works in the ketogenic space is very skeptical of that because we take that food pyramid upside down and we see healthy health happening. And let's face it, if that was the healthiest way of eating, one of two things is happening because our society is getting fatter and sicker by the day.

15:20 So either nobody's following those guidelines, so therefore you're wrong. Nobody's following those guidelines, even though it's a trusted source of the government, or the guidelines are just plain wrong. Now, let me take you back to 1977 when the McGovern Commission, which is the place where the food pyramid first started. One of the food pyramid came out of the, they created the US Dietary Guidelines, which get reviewed every five years. What was the McGovern Commission? And they did this and they've done an amazing job of fixing this.

15:50 What was the call to action for the McGovern Commission in 1977? Not that long ago. I couldn't tell you. Right. So the McGovern Commission was convened to deal with rural starvation, rural hunger. The majority of Americans, especially on the, which is bizarre, on the farms were suffering from a lack of access to food.

16:14 So the McGovern Commission created, okay, what's the best food to have people? And you can understand when people are starving, what's the quickest, easiest way to provide energy to them? It is stable, storable, mass-producible carbohydrates. So we ramped up our carbohydrate production. You know, if you look at South Sudan, what are they dropping on South Sudan where everybody's starving? Or what are they dropping right now in Gaza?

16:45 They're not dropping steak and lamb chops. They're dropping grain. They're dropping sorghum. They're dropping what fixes starvation, which is carbohydrates. And carbohydrates do fix starvation. So the McGovern Commission shifted our society and our production very heavily toward carbohydrates. Forget about the seed oils and the lipophobia. In order to solve American hunger. And guess what? They did a pretty good job.

17:14 And it's bizarre to still see these ads on TV talking about feed the children, hunger, hunger, hunger, when everybody's fat. There's an incongruity there. You see some of these Hollywood actors still talking about hunger and raising money for hunger. But that is a narrative that comes from the late 1970s, early 80s. So again, they solved that problem, but they swifted the pendulum too far across. We're going to shift it back.

17:38 And there's no shortage. We can certainly cope in this country with healthy food production, where I call healthy food. But the industry has taken over the mass production of carbohydrates, and it's going to be very difficult to unwind the money trail. Well, to come back to how we initially opened this, talking about when somebody goes past that threshold and they're in the realm of carb addiction, it sounds like it's still pretty gray where that is, other than if you're type 2 diabetic, if you're overweight, right?

18:09 - Or obese. - It should be great to know that. - But somebody who is in the middle and isn't there yet, say they're insulin resistant and they're just starting to put on some weight and they're having, it's very subjective, but a modest amount of carbs. And we're gonna get into how you recommend eating and I know this isn't it, but just speaking to the average person out there, how do they put themselves on that continuum and find out where they are to know where they need to go

18:39 if they haven't gotten to the far end where they are type 2 diabetic? I think that's a very good question. So I think there are two concepts at play here, and they are synergistic rather than clashing, but it's a very good concept you talk about. The majority of people that recognize they've got a problem, removing carbohydrates has therapeutic benefit. In other words, they're reversing disease. So there's a therapeutic component and then a health prevention component.

19:08 But there are a number of people, be they athletes who are looking for performance, be they younger people whose parents got into this, or they just ahead of the curve, who are getting into this for improvement in health reasons. And we've got to cater to both. And the management is different. In order to improve your health when bad things have happened, you have to be much more austere

19:34 on your relationship than in somebody who wants to prevent having problems down the road. So you're right, but there are two different camps. And in the work that I do, I've got to understand, and I spend a lot of time, a lot of time,

19:50 getting to know each of my patients as individuals. The problem with healthcare, and healthcare has also had a shift toward being more observational and associative rather than causal and understanding processes, but healthcare has created an algorithm called best practices. And it doesn't matter who you are, okay? And part of it is to service the healthcare industry and all the sick people we've had to create

20:13 Folks who are trained at a much lower level. What am I talking about? It took me 19 years. I know I'm a slow learner to become the physician specialist that I am. You can become a nurse practitioner or a PA with two years of didactic training after a basic degree. So you have to create more of a recipe approach for those folks. And I understand it and the focus on epidemiology, but there's a box.

20:41 And it's called an algorithm. And every patient is now an algorithm.

20:45 Where I practice, I spend probably the first 15 to 20 minutes of every encounter I have, which is longer than most people ever spend with their patients, just getting to know who you are, asking questions about your family history, your genetics, your practices. So by the time those 20 minutes are done, I know exactly who you are. Are you in this for therapeutic reasons? Are you an addict? Are you just someone who wants to improve your health? Are we treating heart disease? Are we treating obesity, diabetes?

21:13 Everyone is an individual and deserves individual therapy. So,

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24:06 We take about 20,000 breaths per day. Don't you want to take as much stress off your system as possible by filtering your indoor air? Air Doctor is your simple solution. So for somebody tuning in today, how do they begin? Because obviously this is more of a general conversation. Let's talk about the diet you recommend in a general sense, and then we can talk about how to get there. Right. So the first thing you want to look at is physiologically, what does your body need?

24:34 Your body needs three, maybe four categories of things. It needs fat. That's the first. The body needs fat. And certainly in the context of America, that's the thing that is most frowned upon. But there are two fatty acids that are essential to the human body without which we die, three and six omega fatty acids. The other fats are ancillary. And if fat is a fuel source, is the ideal fuel source for the human body? Most people, when they think about so-called good diets, they focus on protein.

25:07 There are very, very few diets that are truly lacking in adequate protein. The biggest problem that I see in my practice is an excess of protein, not a deficiency. Now, if you're a vegan diet, you may be struggling with it, but less than 1% of Americans are truly vegan.

25:23 Okay, 5% are vegetarian, which includes eggs and dairy or eggs or dairy. Vegan is no eggs or dairy. And that's about 1%, 5% are true vegetarian, which is a significant fraction, but a small fraction. Those are the ones that probably have a little bit too little, the vegans, too little protein. But protein should never be an issue. And yet, even in the ketogenic space, everyone's talking protein, protein, protein, protein. In an era of food abundance,

25:48 which is where we currently live. Protein is never an issue. And I know that's going to, oh my God, my protein. Protein is never an issue. Okay. So fat, but certain amino acids, nine of them are essential amino acids. I think it was nine or 11 are essential amino acids. We have to get those two things in. So the problem with veganism is it's somewhat deficient on those essentials. Minerals, vitamins, trace elements can come from a pill, but there's no pill that makes up for what you get with your food.

26:17 So no matter how many supplements you take, you're not going to get them in in the right amount in the right ratio, or you're going to go too much because everything's on a bell curve. So minerals, vitamins, trace elements, those are the three essential elements to food. And almost every diet is going to give those to you. Even a crappy standard American diet, even a vegan diet for the most part, except maybe a little bit to a protein, a carnivore diet, all of those will give you those three standards.

26:49 The carbohydrates are only there, are only essential if you lack adequate energy. So if you are living in an area of starvation, South Sudan, Gaza, a few other places where there is inadequate of the first three, then carbohydrates become an essential component to the diet. They are of value in that they give us great pleasure. They're enjoyable. They're fun to eat. They make us feel good.

27:18 but they are not essential in your diet. But if you incorporate them, some of it doesn't have any problems. If you incorporate them as part of that diet, they're absolutely fine. The first three are essential. The fourth one rounds it out and is pleasurable.

27:30 So if you're going to drink, drink water for hydration, drink a few other things for hydration. And if every now and then you want to have a beer or a glass of wine, I have no problem with it. That's how I see carbohydrates. So they are part of that formula. But if you never ate them again, you'd be fine. If you never ate one of these three again, the fat, the protein, the mineral, the vitamins, trace elements, you will die at some point or you'll get sick and die of malnutrition.

27:53 So that's the way I look at that essential diet. The problem is, in our society, the average American, and oh, no, I don't do well. If you look not at how the carbohydrates go in your mouth, but what enters your bloodstream, amino acids, glucose, galactose, fructose, and fatty acids, fatty acids go up the lymphatics. The majority of Americans are between 65% and 80% carbohydrate-dominant.

28:22 And that leaves a degree of deficiency of the other three. And the body has to hormonally handle the carbohydrates. That's what we haven't talked about either, is the effect of each of these substrates on the body. Because how the body handles them, that is as important as the amount you're getting in. So if I was to formulate a diet, it would be all four of those. All four of those, but only three are essential. Well, let's get into how these are impacting the body.

28:49 You cannot look at each hormone individually because they all interact with each other. The entire human function is based on what we call homeostasis. And homeostasis is push and pull. It's feedback. So for every action, there's an equal and opposite reaction that modifies and controls it. And when that tight feedback control is disrupted, that's when harm happens.

29:14 Okay. So for example, it's simply, you take the three and the six omega fatty acids, which I said are the two essential fatty acids. The six omega fatty acids are kind of the fire alarm. Hey, there's a problem here. They're the pro-inflammatory fats. And then the three omega fatty acids kind of put the fire out. They say, okay, you've lit the fire here. My immune system is taking care of things. Now we've got to dumb those down. So you need both. Every little seed oils are so bad. Six omega fatty acids are so bad.

29:43 But it's the relationship between the two that's important. And the ideal ratio is a one-to-one to a one-to-three ratio, six-to-three. In the modern American diet, we're talking about a 15-to-30 ratio of fire alarms versus fire extinguishers.

30:00 And the problem then is you're getting just this massive overload. So the interesting thing about the sixes and the threes, and I know this is off topic, but it's about how the body works. If you're eating a lot of sixes or you're eating too few threes, that ratio's up. Now you're getting your immune system into chronic continuous overdrive.

30:23 Okay. You're the little boy running down the hallway and shouting fire, fire, fire. And, you know, there's 40 cops outside and there's the firemen outside and the ambulance and there's no fire or this, or the fire was already put out when somebody spat on it.

30:38 And that is, so the sixes are a problem because they over light up your immune system. And a large part of the body's dysfunction is from inflammation. We haven't even talked about the hormones yet. And nobody talks about what I've just talked about. But that's the problem. So the fire extinguisher isn't there. You don't dumb down that. Hey boys, it's okay. We just need one cop car here to put out this little fire or one fire truck. Does that make sense? While we're in this, you did mention seed oils. I want to go further into that.

31:05 - Yes. - You made it sound like when it comes to the omega-6s, the source doesn't matter. Would you say there is a difference though between say getting your omega-6s through a steak versus pouring vegetable oil on a salad and eating that? - Again, it's all, we talked about this earlier on, it's about ratios and about how much and how often. Because I think you said something which most people don't understand is that the dominant fat in meat

31:35 except for one type of carnivore product is polyunsaturated fat, yes. Not saturated fat. It was saturated fat so bad. But if I eat a steak, the dominant fat is a polyunsaturated fat. There's only one place in the animal kingdom or what we eat on a carnivore diet, some people do, some people don't, where saturated fat is dominant and that's milk.

31:53 Okay. All the others, the polyunsaturated fats, they're polyunsaturated. So I hear what you're saying. So we always go, oh, I don't eat six omegas. Well, then don't eat steak. But is there a difference between steak though and seed oils? That's what I'm getting at. There's not a difference, right? There isn't that much. There's a little bit of a difference. The issue is the amount. So if you want to put a little bit of sesame oil on a salad, I have no problem with that. If you want to eat a can of sardines that's in cotton seed oil,

32:20 and you pour off the oil and you eat a little bit, I don't want you sitting there rolling it in a towel to get every molecule. It doesn't matter. If you that, I use the word orthorexic. If you that orthorexic, I just did a video on this on my channel, where you are so particular, then don't breathe. Because if you go outside and you breathe, you're breathing more crap into your lungs from the cars going by than there probably is in that. Or if you eat the salmon, I'm going to eat my sardines in olive oil.

32:50 I know the mercury story has gone away and I know sardines are low in mercury, but you're still getting a bunch of crap from the sea in you. So again, we can't be perfectionistic and that orthorexia is a problem in our space. But if you're putting a little, and I know this is blasphemy in our world, two things about seed oils, and I don't use them, I don't use them. But I'm also, you asked the question, if you are having a salad, if you are a, like my Hindu patients who are vegetarian,

33:19 I just try to convert my Hindu patients away from being white vegetarians to being green vegetarians. It's not race. White vegetarians eat a lot of pasta, papadum, naan, potatoes. They're very white starch related. Whereas a healthy vegetarian is going to be eating predominantly green or leafy vegetables or maybe some peas and carrots and corn and that kind of thing, but they're not going to be eating the refined white stuff.

33:48 They will also add some milk and some eggs to that diet. But if they use some sesame oil, if they use, now don't go and use canola oil, that you put in your car's engine. But if you want to use some grapeseed oil or cotton seed, or maybe cotton seed oil is also part of the grapeseed, I'm not going to have a problem with that. But if you're going to use tons of it in your cake, if you're going to use tons of it when you batter your fish and you eat this big conglomerate of batter that's been fried in Crisco, that's problematic.

34:16 If you have a glass of wine every now and then, probably healthy for you. And he's not going to be that much hungry. But if you're drinking two bottles of wine a day, come on, guy. You see where I'm coming from with that? And I think while it is important to raise a red flag against seed oils,

34:32 They aren't as awful. You're not going to drop dead if you don't socially distance from a bottle of Crisco. All right. Like you said, a lot of people in our world are saying the opposite of that. And one of the challenges with them, which makes them a little bit different than some other toxic foods, say sugar, is the fact that they do stay in the system apparently for years, affecting the body in a negative way versus say having sugar, having the negative effect on the system, but being more transient.

35:01 I just want to say something. I am absolutely against seed oils. No question about it. But the reality is sometimes we're too obsessive about that change. So the two reasons not to consume them is, number one, if they cause you harm. But you can't just say, oh, I ate these seed oils and I broke out in a rash. Prove that that's true. And then also, when we look at the six and the three argument, we need both. Now, we're getting them from our meat. So if you want to be pure carnivore, that's fine.

35:31 and we are carnivore. And that's a choice. It's because it's easy and simple and I like to eat that way, not because it's healthy or better. I'll come back to that. However, I think we over-demonize and therefore isolate ourselves as a ketogenic community when we go ballistic about seed oils. And also when we go ballistic about seed oils,

35:54 We take away, I'll give you another little story. We take away the focus on carbohydrates because here's the interesting thing. Where do we use a massive amount of seed oils if we do not eat carbohydrates at all? I would say it would be very rare. I can't think off the top of my head. I really can't think of it.

36:15 Well, right. So the point is the only time you may use them if you eat vegetables and meat is maybe in a salad dressing or something like that. But you're certainly not going ballistic with that. No. I mean, if you're a carnivore, you wouldn't be getting them, at least for the most part. But even there, you get them from your stomach. Right. No, I mean the additional ones, like putting canola oil on a salad or something like that. Yeah. So the point I'm making is that if you eliminate carbohydrates, you don't have to talk about seed oils.

36:42 If you eliminate carbohydrates, you don't have to talk about gluten. So, so yeah, the seed oils are an issue, but if you focus so heavily on the seed oils, then maybe I can have a little bit of carbohydrate. Maybe I can eat some what, I don't know what carbohydrates don't contain, uh, uh, seed oils, but I was going to say chocolate, but they do. But the point is the focus is on the carbohydrates because they really are measurably the enemy. So if you drink a, uh, um,

37:10 Nobody's going to do this experiment, but if you drink a cup of canola oil every day, but you eat no carbohydrates, I'm not certain that there's going to be a massive amount of harm. However, if you eat 80% of your diet is carbohydrate without any seed oils, you're still going to be in trouble.

37:30 And again, this comes to where a lot of people in our world would definitely disagree with that. Of course. But you know what? That's an intellectual knee joke. That's a knee joke. It isn't. If you step back and you look at it, you couldn't answer the question and neither can I. We're in a non-carbohydrate eating diet to get massive amounts of seed oils. Yeah, no. And that's my point. So if I focus on the carbohydrates, I never use the word gluten. Why do I never use the word gluten? Because I use the word never carbohydrates.

38:01 And if you don't eat carbohydrates, you're not getting gluten in. But we have to realize too that a lot of people aren't going to go as far as you've gone with your diet. Of course. Because we live in modern society and whether it be cost or accessibility or just wanting to fit in and there being certain pros and cons with fitting in with family, with friends,

38:20 We have to meet people that want to make healthy change in the middle as well. And then for people that want to take it all the way to carnivore, we want to provide them with the information too and support them. Well, don't use that word healthy because vegans will tell you that they're very healthy. I don't like that word. Okay. So an apple a day keeps the doctor employed.

38:44 So if you go gluten-free, if you look at the gluten-free industry, it's massive. And everything they produce is pure carbohydrate. That's not healthy, to use that word. So the point is that if you remove gluten, oh, gluten's so bad for you. But you can eat all these breads, all this beer, all this massive amounts of carbohydrate and still cause yourself all the damage related to obesity and diabetes. I'm gluten-free.

39:14 You go into any restaurant, they will advertise gladly big letters on their menus, oh, we're gluten-free. But they'll never, ever tell you that they're carbohydrate-free or seed oil-free. Again, it's semantics and it is perception. It isn't reality. And we've got to be realists in our space.

39:39 You never have to worry about carbohydrates if you don't worry about, you never have to worry about C2s if you don't worry about carbohydrates. And if somebody wants to eat them, then you've got to take what comes with them. Well, let's continue moving through the different parts of the food. We got into fats and then we went on a tangent, which was good. But let's come back to the different impacts of these foods on the body. And then when we get to carbs, I want to really go deep because-

40:05 Obviously, a thesis of this conversation is that they're damaging the body. And that's like you just said, if we avoid those, that's getting to the root of the problem, according to your message and your thesis. So we'll spend time going into the destruction they cause when we get to those. Yeah. So let's say, you know, really, the majority of the destruction is not just caused by the substrate. The substrate is the trigger.

40:27 Okay. What they do is they disrupt homeostasis, that hormonal feedback. And I use the six, the three, six homeostatic control as one of those, and we're going to go from that tangent. But there are a myriad and many of them undiscovered or under-discovered. So we know about them, but we don't quite know what they do. But as we eat, certain hormones get triggered

40:54 And so I look at, to simplify things, I look at the human body in three phases. The first phase is the storage phase. And whatever we eat goes through our gut, we eat through our intestine, and it triggers certain hormones in our gut because hormones and enzymes. And human beings, in my opinion, are ideally enzymatic digesters, not symbiotic digesters with bacteria.

41:22 which cows and other vegetarian animals are. We've got a pancreas. We've got a very long small intestine. We are designed to be, I'm going to put my light on here. It goes off by itself. We are designed to be, let me go, play not. We are designed to be enzymatic digesters. So what happens is in the gut, we just started to discover this. We've got GLP-1, we've got somatomedin, we've got peptide YY, we've got hormones in our gut.

41:51 that then regulate other hormones in other organs. So for example, one of the things that we've discovered, we, myself and Ben Bittman and a few others are talking about this, whereas it's still not taught anywhere, is that sugar does not primarily trigger the release of insulin. That was what I was taught in medical school. But if you inject sugar intravenously, you don't get a big insulin bump. If you take that same sugar and you give it to the gut, it triggers GLP-1 and GLP-1 is the trigger for insulin.

42:20 Now we've got this whole industry of a Zempik and Regovia and Manjaro leveraging that. But that's the first level of hormones. And if there's hormonal disruption at that level, you're starting to get gut irritability. You're starting to get irritable bowel syndrome, where the carbohydrates, whether they're in vegetables or other products, are causing problems in the gut. So that's the first level of defense. And some people, the primary source of those foods are causing irritation in the gut. I've got a gut of steel. It doesn't bother me very much.

42:50 Then it gets absorbed and almost all of the nutrients, except fat and fat soluble vitamins, go through the blood vessels and they end up in the portal vein. They all traffic through the liver. In the liver and slightly beyond the liver, they trigger other hormones. So your hormones that are getting triggered is insulin from the pancreas, triggered by GLP-1. We don't quite know why we release testosterone, thyroid hormone, human growth hormone.

43:17 All of those, those four and a few other ones that I'm putting in a minor or we don't quite know category, but those are the four dominant storage hormones.

43:26 And what they do, the gut enzymatically breaks all our food down into simple building blocks. Amino acids, lipids that get absorbed slightly differently go straight to the fat cells, bypass the liver, longer chain fats, shorter chain fats go to the liver. And the carbohydrates, no matter how the carbohydrate goes in your mouth, doesn't matter if it's a donut, a glass of milk, or a box of chocolates, what's entering your bloodstream is glucose, galactose, fructose, enzymatic digestion. In the liver,

43:54 Under the influence of those storage hormones, you rebuild them. Insulin and testosterone regulate protein synthesis in the liver, and they may also help to construct globulin and albumin and some of the proteins that are then either transport molecules or a way to get amino acids

44:14 from the liver to your cells that can then reuse those amino acids, like the brain. So those are all regulated by the storage hormones, okay? And then as our stores go down, as the GLP-1s in the gut start to go down, your storage hormones go down, and you've stored all the food. You've either stored it or used it. And then you should see, ideally, what insulin does. As insulin goes up, it shuts down glucogarbs.

44:42 And then as insulin goes up, glucagon starts to shut insulin down. So as you get out of storage mode, you should then get into early utilization mode, where you take away the GLP-1 trigger for insulin, blood sugar started to come down. Now you've got the cells in the body saying, hey, I need energy. And glucagon is the dominant hormone. Glucagon, not insulin, is the dominant hormone that supplies energy to the body.

45:13 Insulin's dominant role is not actually energy control because insulin doesn't really control protein absorption or production of sugar. That's a glucagon product. So insulin controls cholesterol synthesis. Insulin controls protein synthesis. Insulin controls steroid hormone synthesis. Those are all happening during storage mode. As that goes down, those things go down, and then your glucagon levels go up.

45:41 And so there's a feedback between the two. When that feedback is broken, you may have high blood sugar, but glucagon is releasing sugar from the liver. That's type 2 diabetes. So glucagon then is releasing at first, and the energy is a variety of different things. For example, it's releasing fat. When your insulin levels go down, your glucagon levels go up, you're releasing fat from the fat cell, LDL. But also glucagon is converting excess protein to sugar.

46:07 and then in the liver driving that sugar to become triglycerides or to be stored as glycogen, which is actually happening under insulin. And it's releasing glycogen from the liver to supply sugar to the bloodstream. So after you've eaten, your sugar levels go down, glucagon says, your cells say to glucagon, hey, I need energy. Glucagon supplies glycogen glucose from the liver. When your liver starts to run short,

46:32 on as the glycogen store diminishes. So that is the first utilization phase is a sugar dominant utilization phase. And then as you use up your liver, you can accelerate that with exercise. Adrenaline also causes that to be overridden. So the dawn effect is an adrenaline override where you're releasing sugar from the liver, even though you haven't eaten for eight hours. That's eight to 12 hours, hopefully.

47:01 The second phase, once the liver is depleted of, or there's a threshold reduction in blood glucose, now you're at least in liver glucose glycogen, your blood sugar starts to go down just slightly. This isn't a healthy person. And the cells are saying, hey, I need energy. And then under the influence of glucagon, you switch from burning sugar to burning fat. And glucagon then governs ketogenesis.

47:27 So under high insulin, low glucagon, the same pathway, the HMG-CoA reductase pathway, is producing cholesterol. And under T3 and the storage hormones, under T3 and insulin, you're producing cholesterol. As those levels go down, as glucagon goes up, it switches that pathway, and you're now producing ketones. Exactly the same pathway that produces cholesterol is producing ketones under a different hormonal influence.

47:56 So now you're getting ketosis, you're using LDL is now transporting fat, that bad hormone, that bad molecule LDL is big, fluffy LDL, transporting triglycerides, phospholipids, fat-soluble vitamins from the fat cells, cholesterol, back to the liver and to the cells. And the cells are now shifting away from mitochondria, flexible mitochondria, shifting away from using glucose to which using fat. And that switch happens under the influence of glucagon.

48:26 And you stay in fat utilization mode. So what's happening during fat utilization mode? Hormonal production, autophagy, you're breaking cells down, bringing them back to the liver. And under the influence of glucagon, you're turning the protein into fat and into sugar. That's gluconeogenesis. So that is happening all the time in the body. So the cellular breakdown is happening under the influence of glucagon. That's your autophagy stuff. That's why fasting is a good thing, prolonged fasting, if you're not too lean.

48:55 Because you don't want to be bringing your own muscle down as a source of energy. And then you eat again and you shift to insulin. And depending on what you're eating, we should be going a very long time or a very short time.

49:08 with eating. So for example, the study that just dropped that says, I was talking to Eric Berg about this the other day, the study that just dropped that says that intermittent fasting is bad. Well, who produced that? It's produced in China by a group of cardiologists who studied the NAN study. So a lot of flaws with the study. But if your mentality is everybody should be vegetarian or vegan, well, vegetarian animals have to eat all the time. They're in

49:32 And their intestine and their biology is naturally conducive to 16 hours of continuous eating. That's what cows do. That's what grazing animals do. Okay. Human beings are not designed to do that. We're more on the carnivore adapted side where we eat a massive amount for a short period of time. And then in the gut, we are absorbing it in that storage mode for a while. And then we have to use that. So it is true that if you're a vegetarian, you probably have to be eating a lot. And fasting isn't a good idea.

50:02 if you're a healthy vegetarian. But if you're more on the carnivorous side, if you're more omnicarnivore, the capital carnivore, small omnivore, you only need to eat. Well, let me ask you this question. How often does the average pure carnivore animal eat? Whether it's an alligator, whether it's a vulture, they're opportunistic, or whether it's a lion or a cat, how often does the average carnivore eat?

50:28 That's tricky. Depending on access to food, obviously, I would say one time a day. I would tell you there's no carnivores that eat twice a day. I can't think of a single carnivore that eats once a day. On average, it's maybe once or twice a week, two or three times a week, or maybe even in the alligator side, once a week, once every two weeks. You think about a python, you think about pure carnivores. Yes, it's opportunistic, but they don't eat all the time and they spend a lot of time resting.

50:57 Now, we're not pure carnivores. We're not pure carnivores. We're not designed to be pure carnivore. Yes, again, a lot of controversial stuff. If we were pure carnivore, we wouldn't need GLP-1 to trigger insulin. And I'm still trying to figure that one out.

51:15 Okay. Because we don't, carnivores, pure carnivores don't get insulin suppressed as far as I'm aware, but that is still something I'm trying to research. I just did a video on that. I don't know the answer to those questions. But certainly where we are, we're carnivore dominant by our physiology and our biology. So we don't, even probably one to two meals a day is too frequent. Think that one through. So even though, oh, I'm carnivore, I'm OMAD, I eat once a day, it's probably still too often.

51:44 because we're disrupting that biology. So again, there's lots we still have to learn, but we live in an era of abundance. If you look at people who live in my part of the world, in parts of Africa where they're undernourished, they may go several days at a time without eating. Yes, they lean, but they are metabolically more healthy in a starvation lifestyle. All right, well, you've gone deep into the physiology.

52:08 You've given us that piece on fasting and the benefits of not continuously eating. Let's get really practical now. We have the foundation here. What is somebody supposed to do? How do they transition into this way of eating? So the very first thing you've got to look at, and this is what most people don't do. Most people start, as you talked about slightly earlier, on a diet because they recognize there's a problem.

52:34 Okay. They recognize the problem. They want to correct the problem. So we go on elimination routes. But the first thing that I try to tell my patients is, and again, this is what I do in my practice. Let's draw a line with carbohydrates. Let's remove carbohydrates from the equation. Okay. What is the only thing an alcoholic should do? Not drink alcohol. Right. Not drink alcohol. Nobody tells an alcoholic what they should drink. Okay. But everybody loves to tell fat people and diabetic people what they should eat.

53:05 That's nuts, at least if you look at it in a similar addiction way. Okay? So the first thing is, okay, if we eliminate carbohydrates, the next question is, what do you like to eat? What do you like to eat? Because the issue here is, is this change that you're making going to be sustainable? If you take the number 100 and you subtract your current age, whatever that is, 40, 50 years, is this change going to be sustainable for the next 50 years?

53:37 And if it isn't, it really doesn't have a lot of value. Oh, I'm carnivore. I've been carnivore for six months. Majority of people are not there two years later. Some are, but the majority are not. If that was true, if they were able to be that person for the rest of their lives, we would still be using the word Atkins. Atkins, everybody lost. I lost 90 pounds on Atkins, but now I'm 120 pounds heavier. It wasn't because Atkins didn't work. It worked great, but we weren't sustaining it.

54:08 because we were on a diet, we're changing what we're eating, not why we're eating. So the first question is, what do you like to eat? Because if you like something, you're going to keep doing. And I don't care. And again, a lot of this is blasphemy. And I know, but if you step back and you remove your perception and you have perspective, it changes. Perspective is somebody else's. Perception is your own. Did a video on that. If you look at what you like to eat,

54:36 I don't care if you're more on the vegetarian side or more on the carnivore side. What matters is, is what you're eating causing you major harm? So if you've got Crohn's disease, stay away from the plants. But if you're like me, who's got a solid gut, it's your choice. I've chosen to be carnivore, but I can eat plants that don't affect me. Now, I'm not getting nutrition from them, but that's why I use the word vegetarian, not vegan. Because if you're eating some eggs and some cheese, you're going to be okay. Oh, no, you're not going to get it. You're going to be fine.

55:09 You're going to be just fine. So depending on what type of vegetarian, I mean, if it's a green vegetarian diet, if you know what I'm talking about there. So the point is, what do you like to eat? And you don't stay right there. I started out on a ketogenic diet where I eliminated carbohydrates. I was eating both vegetables and animals. And I slowly migrated just because I enjoy it to being mostly carnivore. But you don't start just eating steak and eggs. It's just too tight. It's too tightly controlled. And you're going to crash and burn.

55:38 And the majority, you can use that as the eye and the needle to get back on track after a crash and boom, but you don't stay there. So the first question is, what do you like to eat? And then if we break that down, now I've got a dietician, we look at, okay, a few things, and this is where individual treatment comes down. Long-term, based on who you are, how often, how many calorie-consuming events should you be having in a day? And anywhere from three times a day to one or two meals a day to maybe one meal a day, and each day can vary, but what does your week look like?

56:07 So Tuesday, Wednesday, Thursday, Friday, I personally eat one meal a day. Saturday, Sunday, I'll eat up to two meals a day with my family. And then Mondays that I don't eat. But that's for me. I'm obesogenic. I've got some of my LMHRs who I want to eat two, three times a day. Some of my gym rats, some of my ultra distance athletes, different stories. So it depends on who the individual is. Meal frequency. The second one is, okay, what range of food are you going to eat so that we are nutrition complete from our food?

56:37 When I see a patient, they come in and they've got three pages of supplements. How the hell can you be fat if you're so busy eating those supplements? You know, there's no room for food. So you only want to supplement what's truly missing. And ultimately, the objective is to never need a supplement. Now, it may take you time to replenish, but Eric Berg is full of supplements. Tim Milk's is a big supplement. I respect these guys.

57:02 I have a different philosophy. My goal is to eventually get off supplements because here's a philosophical difference. Okay. If you look at a child when they're born or a child, when they are first become an embryo, there is a genetic code of that embryo that predetermines on a genetic basis, how long that child is going to live. You cannot live longer than that.

57:28 unless you do gene editing, which is coming. But you can't live longer. And yet the majority of the internet is geared toward, how do I live longer? Oh, if you do this, you're going to live longer. If you do this, you're going to live longer. That's bullshit. That's a medical word. It's Latin. I can explain it to people if they don't know what that word means. Nobody's going to live longer than their genetically predetermined age. What we do is we subtract or we don't subtract from how long we're going to live. So for example, everybody knows texting and driving is a bad idea.

57:59 So if you text while you're driving, you may suddenly live a shorter life. But if you don't text while you're driving, you're not going to live longer. You're just going to live to here. If you eat a ton of carbohydrates, you're highly likely, or you smoke, or you indulge in certain things that subtract. That's what we've got to treat, not this. We sell product to make money with a pretext of helping people to live longer. Supplements don't make you live longer. If you're deficient,

58:33 They lessen how much you're going to shorten your life. But if you're healthy, if you're eating a decent amount of food and you don't have supplemental deficiencies, the majority of people don't eat them. But oh my God, I've got to take this on and live longer. No, you get rid of inflammation. You eat the appropriate things your body needs and you do that through your diet. You don't need a whole bunch of crap to live longer. But we love selling people and diving deep into, oh, you're deficient in this, you're deficient in that.

59:00 Anyway, that's a sidetrack. So we then formulate a diet where you're getting either on the vegetarian leaning side or on the animal product side. We lean into, okay, let's formulate a diet that gets everything into you over a block of time so that you are nutritionally replete. And then the overriding thing we've got to look at is the addiction or not. And addiction is carbohydrate addiction is not just to carbohydrates.

59:27 A snack is always, always, always an emotional event. It is never a nutrition event. So if you're snacking, even if it's something that, oh, it's pepperoni or cheese, it's healthy. It's still calories for your head. It still disrupts that physiologic storage utilization cycle. And then the third thing is binge eating.

59:55 Okay. Binge eating is where we disrupt the hormonal feedback that instinctively or naturally regulates how much we should be eating at any one time. And every baby that's breastfed automatically has that. They're hungry. Mom puts them on the breast. They start to feed the saturated fat in the breast milk, triggers hormones in the gut that go back to the brain that say, dude, you've had enough.

01:00:21 And there are times when a breastfed baby eats a little bit. There are times when a breastfed baby eats a lot, but it's always the right amount. If you take that same breast milk and you put it in a bottle, and now some dietician or some pediatrician has told the mom, that's how much your baby needs. It needs eight ounces of formula or eight ounces of milk. If that's a good mom, she's going to plug that baby and come hell or high water. That baby's going to get that amount.

01:00:44 So already the mother or the baby's brain is regulating how much it's going to feed its gut rather than the gut telling the brain how much it needed. And that's called binge eating disorder. And everybody almost in this country overeats because our portion sizes are enormous. If you've ever been to Europe, I always get pissed off when I go to Europe the first time because they put a little amount of food. That's normal. I just get pissed off because I'm so used to this amount.

01:01:10 So those are the three concepts of addictive eating. Carbohydrates, the drug, snacking and binge eating. And each person has a slightly different variance of those. So we've got to take those three in account when we design the eating pattern. Who are you? And there are some people that need to eat more. There's some people who are very efficient with the utilization that can afford to eat less. So each one of those is me treating you as an individual. As a general underlying concept,

01:01:40 premise with all of this, somebody cutting down on carbs, cutting down on snacking, who has been using that for the emotional, using that as a tool to help them emotionally. When we pull that away, how do we facilitate them not just jumping to something else, whether it be pornography, alcohol, because they're addicted to carbs, we're tearing that away from them, that crutch, that emotional crutch.

01:02:12 Is there any part of what you do that facilitates helping them transition without just jumping to another crutch that's even potentially more unhealthy? Yeah, that's foundational to our practice. So what you're talking about is drug transfer and the mechanism instant gratification. So a lot of people who successfully quit smoking may gain some weight.

01:02:32 They didn't quit smoking. They just went from nicotine to carbohydrates, but the pattern is very similar. What did you just do? What did you just do? Two seconds. Just had a sip of electrolyte. And unless I pointed it out to you, you're oblivious to it because it's what you do. That's a snack. That's a cigarette. So we never ever, because a snack, a cigarette may be awful to you. A handful of M&amp;Ms every five minutes, a cigarette every 10 minutes.

01:02:59 may be harmful, but the starting point is enormous value in terms of managing emotional tension. So we have to preserve the value of a snack, but remove the harm. We never ever stop doing something. We replace. So what you did, and I've coined this phrase for it, it's called a bridge drink. A bridge drink is something that you drink. You've seen me sipping on this. You just had your electrolyte drink. A bridge drink is something that gives you a mind-cleansing moment

01:03:27 that doesn't cause caloric harm in the eating space. So when I was fat, this was a Coke. Now this is black coffee. Yours is the electrolyte mix. I've got my electrolyte mix here as well. Here's my, haven't mixed it yet, but it's right there. Okay. And I don't drink coffee. I sip on it throughout the day as if it was a cigarette.

01:03:48 So I start with a big mug. By the end of the day, a little sip here, a little sip there, but it's caused me no harm. Now, I'm happy to get into the coffee argument, but your electrolyte mix. Well, Anthony Chafee will tell you, don't do the salt. We can argue about those little nuances, but ultimately, replacement is the key thing. Right, but it's not necessarily-

01:04:07 for the emotional aspect, the replacement, right? Of course it is. You're not drinking for hydration. Well, I'm talking a lot, so I need to make sure my, you know? Okay, this is the right one to go. Tell me about that. Yeah. Human beings are the only species that pee dilute urine. Think about that. If you take your dog out, your dog's urine is going to be dark. It's going to be this color. It's not going to be like your urine, this color. You are not drinking right there for hydration. You are drinking for your head.

01:04:40 I don't know. Okay. When you eat a handful of M&amp;Ms, I'm telling you. M&amp;Ms I can agree about, but I'm having a conversation. I want to make sure my throat is not parched. But I hear what you're saying. I get the point you're trying to make. So if I had a pack of cigarettes in front of me, I'd be smoking. I wouldn't be drinking. I wouldn't be sipping, even though I'm talking. So the purpose of that little sip, yes, I would agree with you that there's a tiny fraction with this hydration.

01:05:09 But the dominant reason you're drinking that. Right. Or if it was alcohol, because then there's different, or caffeine, because then there can be other psychological impacts on our physiology that causes us to an upper or a downer. So in this case, electrolytes, I'm not really getting a whole lot other than some hydration. Have you ever seen an animal drink? Yeah, I have a dog. I see her drink every day. Right. Does your dog go over to its bowl and go,

01:05:39 No. No, it doesn't. It's true. Your dog goes over to its bottom and it drinks and drinks and drinks and drinks because it's thirsty. No, that's true. You didn't drink that sip because you're thirsty. Maybe a dry mouth. But if you watch any animal drink, they drink a massive amount episodically. Again, I understand that what I'm saying may be very controversial in our space, but I would tell you that we have to step back and look at the general perspective. I'm not

01:06:07 arguing for what I'm talking about. I live in the space. I believe in it. I work in it. I love it. I'm a huge advocate for it. But we also have to question ourselves all the time. The worst mistakes are made when people don't question what they're doing. I've got something called imposter syndrome, where I don't believe that what I'm doing is correct.

01:06:30 I have to prove to myself over and over again that despite the belief that it's incorrect, it's the right thing to do. And every time I take a patient off a statin, every time I take a patient off carbohydrates and they get better, that's proving to me that something I'm doing that innately feels wrong is appropriate.

01:06:50 Does that make sense to you? - I hear you. - Okay. Every time I see a vegetarian who's got better blood work than me because they're eating, I've got good blood work. That's why I'm no supplements and except for fish oil and no medications. But, and everyone looks at me, oh, you're fat, but my body's really good at making weight, but my blood work is perfect, at least for me. Now, my LDL is super high, so I may die of a heart attack or a stroke in 10 seconds. But the point is that's perception versus perspective. And even in our own space,

01:07:22 We have to question everything. And I've kind of tried to be a little bit controversial within our space. And I'm happy to argue with anybody about any of these things. And know that I'm only pushing back to facilitate us looking at these different ideas from different angles. It's not that I'm disagreeing with everything you're saying. So let me come back to something else. So we talked about the difference between sipping on a Coke and sipping on my coffee or your water.

01:07:49 But the other thing that we have to replace, when you remove carbohydrates, if I look at an obese person with type 2 diabetes, if I look in the emotion management toolkit, it's basically carbohydrates, snacks, binge eating, and cobwebs. So if you remove the carbohydrates and you shift them back to a more nutritional way of eating, which is anything they want to eat that doesn't contain carbohydrates for those people, they're devoid of effective emotion management systems. And good days are easy. But on a bad day, where the hell are they going to go?

01:08:19 They're either going to go back to carbohydrates or their brain is going to find some other dysfunctional way to manage emotional need. They're going to light up a cigarette, have an opioid, do something else harmful, kick the cat, yell at the wife, do something harmful. If, however, you direct them at the same time that they're shifting their nutrition back or their diet back to a healthier lifestyle,

01:08:41 a more humanistic, as my friend Ken Berry says, proper human diet. Simultaneously, you have to replace the role that carbohydrates had from an emotion management perspective. What does AA do?

01:08:52 provides community, an outlet to share ideas. I haven't been to a meeting, so I can't say specifically. Everybody knows that AA does not stop you from drinking. You alone have to quit alcohol. AA is there to rebuild you, to give you direction, to help you to rebuild yourself from an emotion management perspective, free of alcohol. In our program, exactly the same. So we talk about chess,

01:09:17 C, creative arts. H, human connection. E, exercise or physical activity. First S, spirituality meditation. Second S, healthy sleep, healthy sexuality. If you consciously force yourself to develop a diversity of those things as part of the foundation of your everyday, then when life throws a curveball at you, I am more likely to take my dog for a walk on a bad day than I am to go to the fridge in the pantry now.

01:09:46 The old me, that was my pathway. But I'm not going to take my dog for a walk on a bad day if I don't take him for a walk once or twice every good day. So you create the new behaviors as a replacement for the old. So when you get rid of carbohydrates, you have to define yourself differently. I call it packing my suitcase. So if you go on a vacation, every person has a dominant thing that they do for emotional relief.

01:10:11 When you pack your suitcase, the fat person is going to slide some snacks in there. You watch them on an airplane. They're going on a four-hour drive, flight, and they've got all these things just in case they die of anorexia on the flight. But they pack their snacks. The smoker is going to put a carton of cigarettes in. The guitar player is going to take their guitar with them. The runner is going to take their running shoes in. The alcoholic is going to slide that bottle of Jack in there. The religious person is going to slide their Bible in there. Everybody's going to do something.

01:10:41 that defines who they are. And so I just use that as an analogy. And a large part of my practice is helping people to change that thing they slide into their suitcase. So you replace the snacks with your running shoes and your yoga pants or your guitar or your Bible or whatever that may be. And if you do that, the issue is not staying away from carbohydrates. Anybody, as Ken Berry says, can do it for 90 days. The issue is the rest of your life.

01:11:13 And if you just change what you're eating, but you don't change why, you're always going to go back to it. Our focus is on why. The what is easy. I can give you a sheet of paper with what to eat, but it doesn't fix the why. And the why is the rest of your life. Throughout our conversation, we've been using the word carbs. I'm curious, do you look at sugars versus carbohydrates differently, such as like fruits, bread? No.

01:11:44 It gets kind of gray with some of these, but whole foods that are high in carbs versus sugar. How do you look at the two? Well, at AA, they don't look at beer differently from whiskey because what enters your bloodstream is alcohol. Same for me. And that's one of the biggest societal challenges is society will tell us all day long. They love to tell us that apples are healthy, but donuts aren't. They love to tell us the whole grains are good, but maybe brown bread is better than white bread.

01:12:18 What's entering my bloodstream is sugar. And then there's the whole glycemic load and glycemic index. How quickly do the sugar… It doesn't matter. If I don't drink alcohol, I can't get drunk. I know that if I drink beer, I'm going to get drunk slower than if I drink whiskey. But if I don't drink either, I'm not going to get drunk. Same thing with carbohydrates. So if you're a skinny, healthy person, go ahead and have an apple every now and then. But at the same time, if you feel like a donut, go ahead and have it. But if you try, if you've placed yourself…

01:12:54 In recovery, I can tell you categorically what carbohydrates are doing to you. I check your blood work. I can tell you categorically what your behavior pattern is, what your genetics are, at least as categorically as the knowledge I currently have. But I can never tell you that you should kill your best friend because I can't do that for you. I don't have a pill. I don't have a surgery. Even though I do biiatric surgery, I don't have anything that can change your relationship. You have to choose to do that. I can give you information, but you have to choose to do that. And you don't choose to do it once.

01:13:25 You have to choose to do that every single day, several times. You see, I can go out and eat ice cream anytime I want to. I can go out right now and eat some ice cream. I have chosen not to. That's my choice. And that's empowering. If I have to, if I need to, if I mustn't eat it, if I've got to change, I've got to go. It's not going to sit. Deprivation is unsustainable.

01:13:49 You know, a vegan, when you offer a vegan a steak, they don't say, oh, no, no, no. You know what? I'm vegan. I don't eat meat. I'm so sorry. You bastard. How the hell can you kill Bambi? They're arrogant about the fact that they don't eat that. I'm arrogant. It's disgusting to see somebody drink a Coke. But when I was fat, I drank a case of Coke a day. I look at that little red can. How the hell can you do that to yourself? Same as an ex-smoker, you know, thinks that about a smoker, some of them. So,

01:14:18 The narrative changes over time, but it's about you defending you from yourself. And it's about your relationship. It isn't about whether something's healthy or unhealthy. So it's not about carbohydrates or sugar or starch. It's about a drug category. Does it matter if you're gambling on a slot machine? Are you gambling playing poker? Are you playing the dogs, which we don't do in Florida anymore? Gambling's gambling. It doesn't matter if it's Percocet or heroin or fentanyl. It's opioids. So if we bring that to carbs…

01:14:52 technically, if we know they're causing trouble in the body, we should look at them like cigarettes then. Because what we're saying with the conversation here is it's okay to have ice cream sometimes. It's okay for somebody who, say, isn't fully addicted to carbs to dabble in that world. But if we're saying they're destructive to the body like heroin, and this ties back to what I said before, in the modern world, it's

01:15:18 It's in front of our faces every day. It's a little bit different than heroin where it's socially acceptable. It's all around. Well, you got a kids, even within the health realm, we're saying we can dip our toe into it. But, but if we're saying they're unhealthy, then,

01:15:32 Why are we allowed? You know what I'm getting at here? Again, I'm pushing back. We're allowing leeway into something that isn't healthy. But two comments there. First of all, I use opioids every day. Not me personally, but I'm a surgeon. I can't do certain surgeries without using opioids, but that's what they're indicating. Every time a baby drinks breast milk, it's drinking sugar.

01:15:57 So it's the relationship that's the issue. I don't do it anymore, but I used to smoke a cigar once a month. No harm. But if I'm smoking a pack of cigarettes a day, that's a problem. I grew up in a wine-producing part of Cape Town. I basically transitioned from Bresnel to red wine. Glass of red wine every now and then, even for a young child, was fun. It was a social thing. I'm not an alcoholic. So you're right. That's the challenge. At the same time, I can tell you that there is no value

01:16:25 I'll just take something simple with this. Nobody can tell me that there's benefit to nicotine. Would you agree with that? I mean, I wouldn't touch it, but people do say it's a good stimulant for focus and concentration and

01:16:42 I'm no expert on nicotine. I wouldn't touch it, but some people do find benefit from it. Yeah, but that's the distortion of reality. There's absolutely no benefit to nicotine as a smoker. However, if you're a politician getting paid by tobacco companies, if you're a farmer growing tobacco, if you're the economics in North Carolina not shifting, but there's…

01:17:05 The reason why they still sell cigarettes is not because there's any benefit to cigarettes. The benefit is the economics and the political power. I could say the same thing about gasoline and renewable energy. Again, I don't want to get into that debate, but there are so many things that we still do because of the bigger picture. I cannot think as a healthcare provider of a single reason why we still sell cigarettes.

01:17:31 And I sure as hell cannot think of a single reason why we have not banned vaping. New Zealand has done it. India's done it. And I think they're going to be much better off for it. But if you extend this to the economics, to the politics, to the power, that's why we still sell e-cigarettes and vaping here.

01:17:50 No, cigarettes and vaping is definitely in a category of its own. Certain people in our world, I've heard, are using nicotine to enhance cognition. That's why I was dipping into that gray area. But personally, it's not something I do or know a lot about, but I hear people are doing it. Again, I mean, if you're going to go to that extent, I understand where you're coming from, but I used smoking because I just can't see any value. I understand where you're coming from with that. Okay. But

01:18:18 As a society, we do want to be able, there's kind of a subtle thing here. In the 1950s and 60s, you could walk into any store and there was a cigarette vending machine. Now you've got a smoking little box at the airport. People are offended by somebody smoking in front of them. 20, 30 years ago, people were offended when they divided restaurants into smoking and non-smoking section. So we talked about this coming full circle. It's a societal transformation that makes a difference.

01:18:51 Well, the funny thing as you say that is people would be potentially offended if you were to push the bread aside and say, I'm just eating the steak in this world. Now they are. Right. Right. But, you know, pre, what's it, 110, 120 years ago, you and I would be sharing a glass of gin. Then prohibition happened. And now as a physician, if I walk into an office with a consulting room with a patient and I got a bottle of whiskey in my hands, they're going to get pissed off. Whereas 110 years ago, we've been sharing it and chatting about their health.

01:19:21 50 years ago, and when I was in medical school, when I was a resident in South Africa, we would go on a ward round and we'd see 10, 15 patients. And then I remember this distinctly, my professor of physiology and a couple of folks in my group that smoked would stand outside in the hallway and have a cigarette. And then we'd go and see the next bunch of people who are there because they had lung cancer and stuff from smoking. So it was perfectly, and then they banned that, but it was perfectly legitimate to smoke.

01:19:49 Now, if I walk into a consultation room and I've got a cigarette hanging out of my mouth, the patients are going to get offended. But if I walk into that same consultation room, always the reps that come in here, well, they don't come in here, they're not allowed to do that, but they come into any office and they put down a pack of donuts, every doctor is going to go over and grab the donuts. Just like 50 years ago, they went over and grabbed the cigarette. So that is a societal transformation. And we will, not in my lifetime, but in the next.

01:20:14 hopefully in my son's lifetime, he's three years old now, we will make the same transition. And the point I was trying to make is that you would potentially be looked at as the odd ball out if you didn't grab a donut in today's world. Correct. And that's exactly the point. But somebody has to take that leadership role. Somebody had to say, no more smoking in this office. And everybody would piss off and get angry, just like they did when they divided restaurants.

01:20:43 But now if you walk into a restaurant and it's divided, there's a pub down the road over here that still allows some smoking. And there's no way on God's earth I'd ever go in there. But that's my choice. And a lot of that's driven by societal norms, but it's also driven by what makes us feel good. And there are a lot of things that are driven by different cultures and different societies. So the carbohydrate is the same. So I will never, ever go out to anybody

01:21:14 and tell them you shouldn't do this. 100% of my patients are patients who've sought me out and say, look, I've chosen this pathway. Please help me. I put out my YouTube videos. I put out my information to inform people, but they have to make the choice because I'm not going to stop them from eating carbohydrates. They have to do that. I'm going to help them with a methodology. And if I use medications and other tools along the way to assist them, I'm totally fine with that.

01:21:43 I don't know of a single doctor that won't prescribe Chantix for someone who's struggling to quit smoking. But in our space, there's plenty of doctors that won't prescribe a GLP-1 to help someone to quit carbohydrates, even though not doing it may kill them. Because not everybody is a man of steel or a woman of steel. Some of us struggle. And if it helps me to struggle positively, why not?

01:22:09 Earlier, we talked about filling that void if we're going to cut out carbs and we got into things like community and such and having positive outlets to fill that void. Talk about the actual addiction aspect of sugar. I assume it's carbohydrates too, and you can elaborate on that, but I know sugar specifically, it acts on the brain and there's an actual addictive component to that that we have to overcome as well.

01:22:37 Well, it's not just the brain, but it's every cell. So if every cell is wired towards, well, let me give you this example, just as an analogy. Do you drive a gasoline or a electric or a diesel car? Gasoline.

01:22:50 Gasoline. Okay. So if you go to the gas station right now and you say, oh my God, the price of gas is terrible. And you put diesel in your car. What happens? The car is going to probably stop. Not good. The car doesn't work. Okay. And when people say, okay, I'm going to go start this keto diet. Seems so good. I want to start keto tomorrow. It's exactly the same thing. Instead of putting sugar in your system, you're putting fat in your system. The machine doesn't work because every cell wants sugar and it's not fat adapted. Your insulin levels are high. So there is a physiologic addiction, just like with nicotine.

01:23:19 There's a physiologic addiction where your levels are fluctuating. Every time your sugar level goes down, you get hungry. Hunger isn't a nutrient deficiency. It's a psychological deficiency as well as a physiologic decrease in sugar. And the body says, dude, eat. Okay? So at first, when you start to remove sugar and starch, if you do it suddenly, now you're having these sugar lows and you're miserable. But if you do it gradually by category,

01:23:49 You slowly, instead of having this, you slowly see the amplitude go down. And that's kind of what the way Chantix works. You slowly reduce your smoking, but you've got to reduce your smoking. So there is definitely, just like with any other drug, a true withdrawal when you stop eating carbohydrates that is at a cellular and physiologic level. Not just the brain. You feel it in the brain. But every cell is deprived of adequate drug, whether it's alcohol, nicotine, heroin, opioid, whatever it is.

01:24:21 The brain also seeks out whatever that drug is for its endorphin value. And that is not just physiologic. It is psychologic, where you don't feel the tension. Nobody says, well, you may say, oh, I'm really stressed right now. But most people just say, oh, I need a shot of whiskey right now. When an alcoholic says, oh, my God, I'm thirsty. I need a drink. It's not because they're dehydrated.

01:24:51 It's because they are subconsciously recognizing emotional tension. They're anxious, they're bored, they're stressed, they're having fun, and their automatic knee-jerk relief, irrespective of what the emotion is, is a single drug called alcohol. So whenever anybody in this country says, oh my God, I'm hungry, it is almost always an expression of emotional need, not nutritional need.

01:25:23 I can take the majority of people in this country and lock them in a cage for 30 days and give them water, and they will not suffer any form of malnutrition greater than they went into the cage with. The first true form of malnutrition is vitamin C deficiency that occurs in about eight to 12 weeks. But most Americans can't go four hours without eating. But if they were to transition to the diet you're recommending, they would have an easier time with that. A lot of that is to do with the fact that they're carb burners and they're

01:25:53 their body needs that hit of carbs continually. - I haven't eaten since yesterday afternoon, late yesterday afternoon. I'm not hungry. - That's the point I'm trying to make. It's different depending on the person's baseline diet. - Absolutely, but that evolved over time. So number one, I'm burning fat, and I've got plenty of it to burn. So physiologically, I'm not seeing the sugar up and down. My sugar levels are very flat. I'm not wearing my desk on right now, but I know what my sugars normally are. So yes, I'm burning fat. That would be like you taking your car and saying, okay,

01:26:21 I want to burn diesel, not gasoline, but I'm going to take my car back home. I'm going to rebuild the engine. It's going to take me three months to rebuild the engine. And then I can put diesel in. And then your car is going to run very well. Same thing what we've done. And that's what I help my patients to do is to rebuild their bodies so that their cells, those that choose to do so, preferentially choose fat, not sugar.

01:26:44 and that their blood sugars are not fluctuating. Plus, there's the restoration of normal hormonal homeostatic feedback. So all that has to be restored slowly. But if this is something you're going to do for the rest of your life, you've got plenty of time. It takes about two years at the quickest to correct type 2 diabetes. Oh, look, I came off my medication in two weeks. You're still diabetic. You're just not on medication.

01:27:10 So it takes about two years for the average person to restore metabolic health for whatever. So it's not a sudden process. And it takes a lifetime, a lifetime to deal with the psychology of addiction. There is no, oh, I'm fine. I can have some Coke again. Just that time, the person that says that, and I've yet to meet somebody. Now, maybe there are a few alcoholics that were true alcoholics that are back drinking again.

01:27:43 But I'm always very leery and skeptical of that. And I'm not willing to test that. I've chosen not to when it comes to carbohydrates. So all of those things fit the narrative. And the majority of people say, oh, yeah, I can. I've gone back to have a little bit. And they say, oh, I just cheated on my birthday. That's not a cheat. That's a relapse. Ask any alcoholic. Well, you're highlighting what I was getting at. Somebody tuning in saying, oh, animals in the wild, they're only eating every day or two. And and.

01:28:13 “Rob here hasn't eaten since yesterday.” That comes with time and fixing your metabolism. Before you get to that point, if you decide after this interview and you're a carb burner, somebody having a lot of carbohydrates, that you're gonna try and go till tomorrow without eating, you haven't prepped your body properly to do that properly in a healthy way. - Absolutely. And that's why we don't start with carnivore. From a standard American diet to carnivore, you slowly transition.

01:28:43 And it's an adaptive process where it's an evolution, not a revolution, because those that do almost always crash in them. You want to be the tortoise, not the rabbit. We've given people a lot of tools on transitioning and somewhat of an idea of what the end goal might look like. I think before we part ways, we should clarify that end goal a little bit better. And we know cutting down on carbs is part of it. Supplementing isn't a big part of it.

01:29:09 Fasting, that's a healthy thing and part of this picture. But let's really get granular for people. Give them that end target that they can shoot for. And then we can talk about some of the ways of transitioning. Okay. So first of all, I'm going to change your narrative a little. There is no end point. There is no goal. Okay. Do you know who the Dalai Lama is or the Dalai Lama? Yeah.

01:29:35 Okay. He's probably the best person at meditation in the world.

01:29:41 Would you agree with that? I don't know a lot about it, but I would say so. Yeah, up there. Okay. Is he an expert at meditation? I would say yes. I don't know a lot about the Dalai Lama. No, no, no. But you don't have to know a lot, but you know the concept. And here's the point I'm trying to put to you. He will tell you absolutely. He may be the best person in the world at meditation, but he's not an expert. He's a student of meditation. Every day he does it because there's more to discover.

01:30:10 And all because he's the best doesn't mean there isn't more to do because there is no end point. Okay. That's semantics though. We got to get people to a baseline where they feel like they have control over their weight, their health. But you see, it's not perfect, but we got to get to. No, not at all. I disagree completely. Okay. I'll have to hear you. I might disagree then. Because this is an evolution. What are the two objectives? The two objectives are two H's.

01:30:35 When you said, oh, I want to get rid of this, there's only two objectives to this pathway. It's health and happiness. Health and happiness are the goals of this program, if you want to use the word goals. But there is no end point to being healthy and to being happy. They are things we earn, we work at every single day. And there'll be days when there's less happiness, a little bit less healthy, days when it's better. But those are things we strive to achieve continuously. And we're continuously evolving our own selves

01:31:06 to chase those two things. It doesn't matter how fit you are. It doesn't matter how few medications you need. It doesn't matter how skinny you are. Those are the two metrics. And it's walking on the treadmill. If ever you stop, if you say, I've reached my goal,

01:31:21 Okay, I'll agree, but again, I think there's some semantics here because somebody who is type 2 diabetic, their metabolic health is a mess, and they're on 12 different medications, they're going to look at where you are as being a different stratosphere. And I'm not saying that we're not going to continue to evolve and learn and change things because I'm constantly doing that too, and I always will.

01:31:47 But we can get people to a level of stability where they feel good in their skin. They feel healthy. They feel like they have energy compared to a metabolic mess, type two diabetic, where they might be worried that they're going to have a heart attack or stroke in the next 24 hours because they know they're unhealthy. No fat person sees themselves as such until they see themselves as such. And I've been a fat person. I've been over 300 pounds. I was oblivious to that fact.

01:32:17 I was happy. I was fine. Only when I became unhappy did I do something about it. That heroin addict that you see on Kensington Street in Philadelphia, they're oblivious to how awful they look, but it's you looking in at them, comparing them to yourselves and saying, oh my God, they must be terrible. No child with Down syndrome, and everybody feels sorry for that child with Down syndrome. They're the happiest kids out there. They have no idea. So don't take something that you see as being unhealthy

01:32:49 and tell somebody that it's a problem. The problem is by their own perception. And once they choose to correct it, if they're capable of doing so, they can then choose to work on it. But there is no definition of perfect health. - No, but we can all agree on somebody that's smoking, on 12 medications, type two diabetic. We can all objectively agree that they're not healthy.

01:33:09 But they may be completely happy that way. Nobody, you're not perfectly healthy. I'm not perfectly healthy. No, I agree with that. Nobody, right. But there are people that are, it's a continuum for sure. Yeah, no, and that's the semantics. But here's the, you see, here's the issue that you're dealing with. You are seeing type two diabetes or obesity as a problem, and it's not. That's not the problem. Those are the consequences of the problem. A DUI is not a problem. It's the consequence of the problem. The root cause problem is a comprehensive deficiency.

01:33:39 of effective, diverse emotion management strategies and a default to a very dysfunctional form that caused harm. So if you get rid of the diabetes, if you get rid of the, you can medicate people. I can operate on somebody and get rid of the excess weight, but it doesn't change their level of happiness. It certainly doesn't even change their level of health. They may be skinny, skinny, skinny. You have a gastric bypass, which I don't like as an operation, but your BMI can be 23, perfectly skinny.

01:34:08 But it hasn't changed your health. It hasn't changed your happiness. It hasn't changed how you manage emotional need. So that's where I disagree with you. The root cause problem is comprehensive dysfunctional emotion management if you buy the addiction story. And as you evolve that, as you evolve that, it's a process of change, but there is no end point.

01:34:30 to being perfectly happy, to being perfectly good at how I handle my emotional day. I'll yell at my wife sometimes and apologize for it because I'm not perfect. I think if we were to put this all down on paper and look at each other's lists of what we're talking about here, we would agree. It's semantics in the way we're wording it, but I don't think anything you've said that I can wholeheartedly disagree with

01:34:53 But I'm just trying to emphasize the fact that there are clearly people objectively. And when we do, I know you're a big fan of doing blood work and lab work that we can see are unhealthy and whether they see it or not is one thing, but we can tell that they are a ticking time bomb if they don't make some changes. Well, I think that's true. But you know, the one thing that the one thing I can absolutely guarantee, there's only one thing with this entire narrative that I can 100% guarantee. What's that?

01:35:23 That we're all going to die? You're going to die. You're going to die. How you get there is your choice. How you get there is your choice. Sometimes it happens to us, but the majority of people in the modern era choose, not necessarily consciously, how they're going to die. And we also choose how we're going to live. And my job in a person's life is to help them to be better at those choices, at executing on those choices.

01:35:51 rather than telling them, don't die this way, die this way. So when you do blood work on somebody, it objectifies what they believe the problem is. So I've got people, ha, ha, ha, look at me. I can eat a bag of donuts and I don't gain a pound of weight. I come within six feet of a donut, I gain five pounds. That person doesn't know that what's happening inside of them when they're eating those donuts is a problem. But when I do the blood work,

01:36:19 It reveals the issue. And that is data. That is objective data. So you cannot be heavy and healthy. You cannot overeat carbohydrates and be healthy. It's not possible. Even if you live to 100 and you smoke, you're not healthy. I was talking to a type 1 diabetic a little bit ago. And the guy's in his 50s. And he's been diabetic his whole life, 35 plus years. And I said, you know what? It's very unusual to not have cardiovascular disease. And I say he scores zero.

01:36:49 Okay, great. He's CAC equals zero. He's got no cardiovascular disease, but he's had a frozen shoulder. He can't comb his hair. Okay, that's diabetes. It didn't affect his heart, but it's affected other parts of his body. He's got gastroparesis. He's got ligament injuries. So we've got to define, but he didn't think he was unhealthy. He thought he was perfectly healthy. He goes to the gym every day. I'm healthy. Okay, think about those. Well, let me ask you this.

01:37:16 Would you say that a person who can run a marathon, a sub-215 marathon, a Kenyan athlete who's sub-215 on their marathons is an elite athlete? Are they healthy? I would say no.

01:37:34 Three of them just died in the last three or four months of heart attack. Yeah, I know. I've run marathons back in the day, and I don't think that's a healthy activity. But everybody looking at those guys, you look at that tall, gorgeous, and I've got several of them as patients, tall, gorgeous looking, just phenomenal athletes. You look at them and you say, okay, that guy is healthy. My eyeballs tell me he's healthy. You look at me when I was 300 pounds standing next to him. That guy's disgusting. He's unhealthy. I look that way.

01:38:06 But you look at my blood work, you look at their blood work, you look at my CAC score that's zero, you look at their CAC score that's a few thousand, but you don't see that in your perception of health. I hear what you're saying, but I feel like I would give people more credit to understanding where they're at along that health continuum. Of course. I feel like people that are 300 pounds know that they're making a lot of bad choices. Not all of them, I'm sure, but I would say that if you're going to McDonald's and you're eating the box of donuts, whatever it is,

01:38:37 There are certain things that are pretty blatant that we know we're making bad choices.

01:38:43 So what is the only thing, what are the only two harmful things, dominant harmful things that obesity causes? Because if you're a bear that is hibernating, the fattest bear is the most likely one to survive winter. Now, we don't hibernate as humans, but fat is not. And if you look at women with lipedema, more often women, the big butts and the big thighs, they were the most likely to survive lean times.

01:39:08 That's why lipoedema patients are the healthiest fat people out there. So you can't judge the book necessarily by that cover because the ability to store fat helped us genetically and historically through the lean times. We're just in a very, very narrow era of abundance. But 1977, in my lifetime, we were solving hunger as a problem in America. Within literally 40, 50 years, we've gone the other way.

01:39:36 You look at pictures of Woodstock, 1969. There were very few fat people. Everybody looked healthy and skinny. Everybody had a six pack. None of those guys were athletes.

01:39:45 Now everybody's in the gym trying to attain a six pack and none of them can because it doesn't happen in the gym. It happens in the kitchen. So our perception of health is not necessarily what we see. Not always, but we have a pretty good idea. We don't. That's the problem. I might disagree with you on this and we might just have to move on. But I think that

01:40:09 One of the markers of poor metabolic health is waist circumference. So it's not, somebody might be metabolically healthy and have extra weight, but generally that person, if they have a belly and you look down, you're probably not very metabolically healthy. There's gonna be exceptions, but that's a pretty safe rule. Except for one thing, Jesse, is that the ability to make fat protect you from the damage of sugar. So if you're a young obese person, you're far healthier than a young diabetic person.

01:40:40 And that's what people don't understand. That's why I said that Kenyan athlete who looks, I mean, their waist circumference is zero. I mean, they're tiny, tiny waists, but they have type two diabetes. They don't know it because nobody's going to test for it. The person that comes in, it's the athlete. I had one this morning, had a CSE score of 3,404.

01:41:00 healthy fit. Their doctor never did a CAC because they didn't fit the profile. I did the CAC score because I was worried about them. They're diabetesogenic. They're not fat. They're healthy. They're in the gym all the time. And that person, if I didn't do that test, would have ended up in the ER with a heart attack or a stroke, whereas the fat person probably would have been the doctor watching them. So the ability to become fat, to turn sugar into fat, protects you from a lot of the illnesses of sugar. My highest insulin was 87%.

01:41:31 87 years. My insulin now is three to four, but I was 300 pounds. My ability to produce insulin protected me from the metabolic harm of sugar. That's why my CAC score is zero. So I understand where you're coming from. I clearly do. But your eyeballs are a very false predictor of health. And what we as a society hold up as the healthiest person, that king and athlete, is not necessarily true.

01:41:59 I guess I just see it differently. I don't look at the Kenyan as a healthy person. And the thing too is I'm glad you brought up the insulin piece because that's where I wanted to go next. The fact that a lot of people are in this period, this continuum of likely heading to type 2 diabetes, but because insulin over time is going to slowly rise and keep that blood sugar down and most doctors aren't testing insulin, right?

01:42:26 It's going to take maybe a decade or beyond while somebody is slowly becoming metabolically unhealthy before they get all the way to type two diabetes and the doctor finds out and then they're already caused all kinds of damage. So I'm glad you went there. That's where I was going next. The fact that insulin isn't often tested and it's a marker that if doctors did look at, we could catch this a lot earlier.

01:42:53 So why isn't insulin tested? What is the most over-tested blood? Let me just come back to this, but let me just give you one other analogy. The healthiest Inuits, Eskimos, are some of the fattest ones. If they're living on the land, because in that cold environment, the ability to survive winter with a layer of blubber, you look at a walrus, you look at a seal in the winter, a whale, they're fat.

01:43:21 there's a survival advantage to that. If you look at a woman with lipoedema that comes from the equator historically, that lower body, that lower amount of fat with a leaner upper body, that obesity, and we're just writing a paper on lipoedema right now,

01:43:35 gave them a survival advantage. So it's not, and they, for a period of time, become insulin resistant to be able to accumulate that fat. That's what hibernating animals do. That's what I was going to say, the bear before he hibernates, yeah. Exactly, the squirrel, they tolerate, but that is for a period of time. When it's perpetual, that's when harm happens. So there's a reversibility. There's a survival advantage for a little while, and then there's reversibility as they're going into a three-month fasting cycle

01:44:02 Jason, a three month period of Jason Fungism. So, uh, um, what are the other things to understand about why people don't look at insulin is because we're still following in our society, a false narrative of health. What is the current thought process of the healthiest person? What, what single number for most physicians, most healthcare providers is the most dominant false marker of health.

01:44:30 Probably blood glucose, waist measurement, or weight on the scale. Nope, nope, nope, not at all. Those would be my guesses. No, low total cholesterol, low LDL.

01:44:42 Okay, that makes sense too. Every doctor, you go for a physical, they'll do blah, blah, blah, blah, but they'll always check your lipids. They'll rarely check your ONC. As you said, they almost never check your insulin. They won't check your heart for CAC score, which is the definitive thing that the lower, but their narrative is, and if you walk in there, no matter who you are,

01:45:01 No matter who you are, no matter how fat or how lean you are, your LDL is high, if your triglycerides are high, at least your triglycerides, if your LDL or your total cholesterol is high, they are obligated, obligated as a best practice to prescribe a statin. That's not a measure of health in my opinion, but that is the dominant current false measure of health. And then the weight and all the other stuff comes in. I've got a patient, a classic patient of mine in Jacksonville, actually a pretty healthy guy.

01:45:33 When I first met him, he was 108 pounds. Sorry, not 108, 1,008 pounds. Might have been 1,007. He's six foot three. He now weighs around 250. And every time he goes into his doctor, his doctor recommends weight loss. He's lost 600, 700 pounds of weight. Every time he goes in, his doctor says, or the little young nurse practitioner, you should lose some weight. That's maybe a little bit nasty, but we laugh about that. And then he pulls out his fat picture.

01:46:10 but they still insist on it. Every time a patient goes in with a high LDL, even though they've got a zero CSE score, the doctor is going to recommend a statin. Are you on birth control? Me? No. Yeah. Why not? Because I'm not a female for one. And two, I've heard terrible things about what it can do to the body. But there's also a zero likelihood you're going to get pregnant. Am I right?

01:46:36 Of course. So it's ludicrous to even think that you should be on birth control. Is that not exactly the same thing that they're doing when they try to put you on a statin with a zero CSE score, just in case you get heart disease? Well, there's liability to worry about, right? But you said, but that's my point. And that, yeah, I'm agreeing with you.

01:46:55 is that it, but you asked me what the narrative of health is. You asked any doctor out there outside of this conversation, they're going to say it's LDL, cholesterol, lipid profile, and also exercise. I've got extremely healthy people that do no exercise. Wow. My head didn't go there because we're on the same page and I don't think about those things that way. Yeah. So again, I, you know, large part of this discussion is about perception and perspective. Yeah, I know. It's been good. Yeah.

01:47:22 And our society changes that perception. And the thing that's going to drive us away from lipids toward looking toward insulin resistance is pharma, not doctors. Because Lord knows we've screwed this one up since the 1950s. Driven by tobacco and Coca-Cola. We knew this stuff 100 years ago. We knew this stuff 50 years ago. We knew this stuff in the 1990s under Atkins. We refused to buy into it because there was pressure not to believe it.

01:47:52 Well, hopefully people like us spreading the word. It's building momentum. People need to fend for themselves at this point. If I'm going to tell anybody anything, it is be inquisitive. Because when we stop being inquisitive, then we sit back and we accept who we currently are. And that's fine. If that's what you choose to do, that's fine. But at what point do you accept that there's nothing more I can do? And being inquisitive helps.

01:48:29 You don't have to doubt that you should be inquisitive. And the beauty about the internet is that it allows everybody to be equally inquisitive. So the only two things that matter now are intellect and inquisitiveness, effort that you put into that inquisitiveness. You don't have to be a doctor, and doctors aren't always smart.

01:48:54 If your intellect allows you to be able to do that, which should be, in my opinion, a dominant discriminator. Not anything else. Not social status, anything else. But that's, again, a discussion for another day. But intellect and effort. Learn. Be inquisitive.

01:49:11 I like that. We'll end it there, Rob. Thank you very much. For people that want to connect with you, potentially as a patient, I know you have a phone number. I'll have you share that, that they can connect with you on WhatsApp. As part of the inquisitive nature, you're going to hear a certain opinion that may differ from the convention. And it's our YouTube channel, Carb Addiction Doc.

01:49:30 We're on Instagram as well. And then if you want to set up a visit anywhere in the world, you can text to WhatsApp or call and leave a message, 561-517-0642. And we'll share what we know. There's a lot we don't. Well, thank you for coming on, sharing what you know here today. We're going to link everything up in the show notes. Thank you, Rob. Thank you very much.

01:49:54 Now that you're finished with the episode, head on over to ultimatehealthpodcast.com for detailed show notes, including links to everything we discussed. Thanks for listening and have a great day. High interest debt is one of the toughest opponents you'll face. Unless you power up with a SoFi personal loan. A SoFi personal loan could repackage your bad debt into one low fixed rate monthly payment. It's even got super speed. Since you could get the funds as soon as the same day you sign.

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