17. Why Your Diet Isn’t Working (And What Actually Does) - Extend Podcast with Darshan Shah, MD

Episode Summary

Podcast: XTEND with Darshan Shah, MD
Episode 17: Why Your Diet Isn’t Working (And What Actually Does)
Date: December 19, 2024
Host: Dr. Darshan Shah

Main Theme

This solo episode challenges the simple notion of “calories in, calories out” in weight management and health. Dr. Darshan Shah explores why diets often fail, the nuance of calorie sources, and the three main methods to control weight: calorie restriction, dietary restriction, and time-restricted eating. He emphasizes that successful, sustainable approaches go beyond just numbers and require an understanding of metabolism, nutrient density, and individual physiology.

Key Discussion Points & Insights

1. Are All Calories Equal? (00:37)

Dr. Shah kicks off by debunking the myth that weight management comes down solely to total calories.
- Quote: “Is it all about the calories? The answer is both yes and no. Yes, because the laws of thermodynamics are immutable... But no, because not all calories are created equal.” (01:16)
Calories from different sources affect metabolism, insulin response, and satiety differently—e.g., “200 calories from a sugary soda…[vs] 200 calories from a salmon fillet.”

2. Three Approaches to Caloric Control (02:11)

Referenced: Dr. Peter Attia’s “Outlive” emphasizes always using at least one of these three levers—sometimes two or all three:
1. Calorie Restriction
2. Dietary Restriction
3. Time Restriction (Fasting)

A. Calorie Restriction (02:50)

The simplest method: eat less, often tracked using apps.
Mindful Eating: Cites the Okinawan practice of Hara Hachi Bu (eating until 80% full).
- Quote: “The Japanese call this method of eating until you're 80% full. Hara Hachi Bu…an approach to mindful eating.” (03:25)
The average American consumes 3,600 calories daily—much more than needed, especially given sedentary lifestyles. (04:15)
Quality matters: Prioritizing nutrient-dense foods fuels the body and increases satiety, unlike ultra-processed foods that increase hunger.
How many calories do you need?
- Depends on age, gender, weight, height, activity (Basal Metabolic Rate is the basis).
- Example: A moderately active 180-pound man may need 2,790 calories/day; a 150-pound woman might need 2,170.
Weight Loss Math: 1 pound of fat ≈ 3,500 calories. A 500-calorie daily deficit = about 1 lb lost per week.
Drastic calorie deficits can backfire; sustainable, gradual changes are ideal.

Total Energy Expenditure (05:50)

Three main components:
- BMR (Basal Metabolic Rate): 60–70% of expenditure (breathing, body temp, etc.)
- NEAT (Non-Exercise Activity Thermogenesis): 15% (“everyday activities…get in those 8,000 steps a day.” (07:06))
- TEF (Thermic Effect of Food): 10% (digesting, absorbing food)
- EAT (Exercise Activity Thermogenesis): Smallest portion (intentional exercise)
- Quote: “This is the lowest portion of all caloric expenditure for most people. It's also the reason that spending countless hours on a treadmill often doesn't result in weight loss.” (08:30)

B. Dietary Restriction (09:12)

Involves cutting specific foods/food groups (e.g., Keto, Vegan, Paleo).
These methods “are at their core just another way to reduce calories.”
Most people can’t sustain “named” diets beyond 12 months and often regain weight.
- Quote: “My personal feeling…is that I actually dislike all of them. I prefer to have my patients stick to a diet that prioritizes real food and…pick an eating pattern that provides nutrient density while minimizing blood glucose spikes.” (10:41)
Sustainability and real food should be the focus rather than rigid rules.

C. Time-Restricted Eating (Fasting) (11:10)

Popular approach: eating in a daily 8-hour window (16:8 method).
Research shows time restriction (especially early time-restricted feeding) can improve insulin sensitivity, metabolic health, and lower inflammation.
Not for everyone: Caution for postmenopausal women, pregnant/breastfeeding women, or intense athletes.
- Quote: “Dr. Mindy Pelz, in her book Fast Like a Girl, offers tailored strategies for women navigating fasting.” (12:10)
- Inadequate protein during fasting can lead to muscle loss; “Start with protein.” (13:00)

3. Tracking and Personalization (13:15)

Use tools like:
- Bioimpedance scale (track muscle/fat mass)
- Continuous glucose monitor (“understand how your body reacts to…eating patterns”)
- Wearables for HRV, recovery
Emphasizes personal experimentation: “As with everything in medicine, there's no universal answer. You have to experiment and see what works for you.”

4. When to Seek Medical Help (14:05)

If all efforts fail despite diet, exercise, and sleep, consult a physician.
Medications modifying GLP-1 receptors (e.g. semaglutide) may help if genetic/hormonal factors prevent weight loss.

5. Big Picture: Personal Responsibility and Ongoing Experimentation (14:40)

“Calorie control [is] important for overall health. But it's about so much more than just counting numbers. It's about understanding how those numbers interact with your body and your unique physiology.”
Advocate for your own health: Experiment, track, adapt.
- Quote: “No one is going to care more about your own health than you do, so commit to taking personal responsibility for your caloric intake, your glucose curve, and trying different dietary patterns until you find one that works.” (15:36)

Notable Quotes

On calorie quality:
- “A donut and salmon filet might have similar calorie counts, but their effects on your metabolism, hunger and overall health are worlds apart.” (05:03)
On sustainability:
- “Massive studies have shown that most people cannot follow a named dietary pattern for more than 12 months, and most will gain all the weight back…” (10:07)
On personalization:
- “As with everything in medicine, there’s no universal answer. You have to experiment and see what works for you.” (13:34)
On responsibility:
- “No one is going to care more about your own health than you do, so commit to taking personal responsibility for your caloric intake…” (15:36)

Memorable Moments & Timestamps

01:16 – Debunks “calories in, calories out” and highlights the metabolic difference between food sources.
03:25 – Introduces Hara Hachi Bu, the Okinawan practice of eating until 80% full.
08:30 – Why endless cardio often fails for fat loss due to low impact on total daily expenditure.
10:41 – Advocates ditching rigid “named” diets for sustainable real-food patterns.
12:10 – Mentions special fasting considerations for women, referencing Dr. Mindy Pelz.
13:34 – Emphasizes personal experimentation and tracking as the way forward.
15:36 – Encourages listeners to be their own health advocates.

Takeaways

Calorie control is essential, but food quality, nutrient density, and the method of restriction matter greatly.
Mindful, gradual changes, personalization, and ongoing experimentation trump strict dieting.
Prioritize protein, active lifestyles, and sustainability rather than quick fixes.
Consult professionals when underlying medical factors may be preventing progress.

(Advertising, intro/outro, and disclaimers omitted in accordance with request.)

Transcript

A (0:03)

Welcome to xtend with me, Dr. Darshan Shah. A podcast dedicated to cutting edge science research tools and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21 and trained and board certified at the Mayo Clinic, I've accumulated three decades of practice as a board certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results. When it comes to your health span, we are living in a new era where we are creating a new healthcare system no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world renowned experts offering you a step by step guide to proactively avoid disease and most importantly, extend your health span. Hello everyone and welcome back to the XTEND podcast where we explore the 20% of insights that drive 80% of our health, wellness, longevity and mindset. Today we're diving into a topic that stirs up a lot of discussion and sometimes confusion when it comes to our calorie control. We often hear that controlling calories is key to weight management. But is it really as simple as calories in and calories out? And does this principle apply universally or are there nuances that make all the difference? So let's break it down. First, let's address the elephant in the room. Is it all about the calories? The answer is both yes and no. Yes, because the laws of thermodynamics are immutable. To lose weight, you need to consume fewer calories than you burn. That's science. But no, because not all calories are created equal. The effect those calories have on your metabolism, insulin levels and overall health depends on their source and nutrient density. For example, 200 calories from a sugary soda is impact your body very differently than 200 calories from a salmon fillet. One spikes your insulin and adds empty calories, while the other provides protein and omega 3s that fuel your body, stabilize your metabolism and cause you to feel satiated. It's not just about the numbers, it's about the impact. Let's now explore the three methods that people often use to control their weight. Now, Peter Attia actually does a really good job talking about in his book Outlive. These are calorie restriction, dietary restriction, and time restriction. Each approach has its pros and cons, and it's crucial to figure out what works best for you. As Dr. Tia says, you should always be pulling one of these levers. Often pull two of these levers and sometimes pull all three. Let's talk first about overall calorie restriction. This is the simplest to understand, basically because it's just. Basically just you eat less. Many people use apps like MyFitnessPal or Cronometer to track their daily intake and these tools can be incredibly effective. The Japanese call this method of eating until you're 80% full. Hara Hachi bu. This practice originates from Okinawan culture, which is a common saying and is an approach to mindful eating. It encourages stopping eating before feeling completely full, which helps prevent overeating and supports better digestion and long term health. The reality is that most Americans consume way too many calories. Did you know that the average adult in the US eats about 3,600 calories a day? That's well above the recommended levels for most people. Especially considering that most people are sedentary almost all day long. Cutting down even slightly can have a significant impact on your health. But calorie restriction isn't just about eating less, it's about eating smart. Prioritizing nutrient dense foods so you're not just reducing calories, but also fueling your body with what it needs to thrive is what automatically will result in less intake and more satiety. This is basically the opposite of what ultra processed foods do. They make you more hungry because they have very poor nutrient density. So how many calories do you really need every day? And how does caloric deficit lead to weight loss? Understanding this, how many calories you need each day really depends on your age, gender, weight, height and activity level. Your basal metabolic rate or bmr. The calories your body burns at rest forms the foundation of this, which is then adjusted based on your activity level. There's a formula for this that helps you figure this out. For example, a moderately active 180 pound man might need about 2,790 calories a day, while 150 pound woman might need about 2,170 calories a day, creating a caloric deficit. Eating fewer calories than your body needs leads to weight loss by forcing your body to use stored fat for energy. Since one pound of fat equals about 3,500 calories, a daily deficit of 500 calories can result in about losing one pound a week. However, as we talk about all the time, not all calories are created equal. A donut and salmon filet might have similar calorie counts, but their effects on your metabolism, hunger and overall health are worlds apart. Also remember that drastic deficits can backfire, so aim for a balanced, gradual change that supports your long term health goals. It's also beneficial to understand how the human body uses calories on a daily basis. This concept is called Total Energy Expenditure. Total Energy expenditure, or tee is the total number of calories your body burns in a day and is divided into three main components bmr, NEAT and tef. First is Basal metabolic rate, which accounts for the largest portion, 60 to 70% and represents the energy used for basic functions like breathing and maintaining body temperature. You don't have much control over your BMR other than by staying active and having good overall metabolic rate. Foreign. I've been dissecting the science of NAD for over three years now and I want to tell you what I use for optimizing my own mitochondrial health if you want to support healthy aging at a cellular level. True. Niagen's NR is scientifically proven to increase NAD levels, a critical coenzyme for energy production and overall cellular health. It's my favorite supplement for boosting NAD and improving how your body handles stress, optimizing your recovery and supporting longevity. Whether you're looking to stay sharp, feel more energized or simply age better, Truniagen NR is my go to solution. Next, let's talk about non exercise activity thermogenesis or NEAT, which is about 15% of your energy expenditure. This includes calories burned through through everyday activities like walking around, fidgeting or doing chores. This is why it's incredibly important to get in those 8,000 steps a day. Finally, there's a thermic effect of food or tef. Tef. This is the energy required to digest, absorb and process food and believe it or not, this is actually 10% of your daily energy expenditure. Finally, you can add on exercise activity thermogenesis or eat. Eat. This refers to the calories burned through intentional exercise such as running or lifting weights. This is the lowest portion of all caloric expenditure for most people. It's also the reason that spending countless hours on a treadmill often doesn't result in weight loss for so many people. So what's the main message here? Make sure you are staying active. Take in less calories overall on a daily basis and keep moving throughout the day. Maintain your muscle mass as a priority to have long term fat mass control. Next, let's talk about the other method of caloric control called dietary restriction. This method involves cutting out specific types of food or food groups. Think Keto, Vegan, Paleo. These are all different forms of just dietary restriction at their core. They're just another way to Reduce calories, for example, by eliminating carbohydrates on a keto diet, you're naturally reducing your caloric intake. Dietary restrictions can work for many people because they provide a structured framework, but they aren't a one size fits all solution. The key here is sustainability. Find a dietary pattern that fits your lifestyle and aligns with your health goals. In reality, massive studies have shown that most people cannot follow a named dietary pattern for more than 12 months, and most will gain all the weight back that they've initially lost. My personal feeling about named diets, as many of you might know from my previous episodes, is that I actually dislike all of them. I prefer to have my patients stick to a diet that prioritizes real food and simply pick an eating pattern that provides nutrient density while minimizing blood glucose spikes. Lastly, let's talk about the last method called time restriction eating. Time restricted eating, often referred to as fasting, is another popular approach to control calories. The most common method of These are the 16:8 dietary pattern. This involves eating during an 8 hour window and fasting for the other 16 hours. Research shows that time restriction, especially early time restricted feeding, where you delay breakfast and stop eating earlier in the day, can improve insulin sensitivity, metabolic health and even inflammation. But fasting is not for everyone. For example, many women, especially postmenopausal or menopausal women, may experience hormonal and stress imbalances if they fast too long. Dr. Mindy Pelz, in her book Fast Like a Girl, offers tailored strategies for women's navigating fasting. Also, fasting is not ideal for pregnant or breastfeeding women and those engaged in intense training like for a marathon or triathlon. And let's not forget, inadequate protein intake during fasting can in some people lead to muscle loss, which is the opposite of what we want. So when you're fasting, please make sure you're maintaining adequate protein intake. Start with protein. As with everything in medicine, there's no universal answer. You have to experiment and see what works for you. Some tools that I have all my patients use to guide their journey are a bioimpotence scale to track their muscle mass and fat mass, a continuous glucose monitor to understand how your body reacts to different foods and different eating patterns, and also wearables to monitor factors like hrv, heart rate variability and overall recovery. As you test these methods, if you tried all the methods above, calorie restriction, dietary restriction and time restricted eating and nothing seems to work despite doing everything right like exercising and getting good sleep, it might be time to consult a doctor for some modifying GLP1 receptors with medications like semiglutide might be an option. These medications can help regulate appetite and metabolism for those who struggle with weight loss due to genetic or hormonal factors. So is calorie control important for overall health? Absolutely. But it's about so much more than just counting numbers. It's about understanding how those numbers interact with your body and your unique physiology. As always, you must always be your own best advocate. Experiment, track your progress and find out what's working for you. No one is going to care more about your own health than you do, so commit to taking personal responsibility for your caloric intake, your glucose curve, and trying different dietary patterns until you find one that works. If you enjoyed this episode, please share it with someone who might find it helpful. If you and don't forget to leave us a review. Your support helps us bring more health transforming conversations to light. See you next time on the Xtend Podcast. Thank you so much for listening to the podcast today. Please remember to subscribe if you like this episode and give us a good review and share a link with your friends. It really helps to support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.