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The Dr. Hyman Show
America’s Obesity Crisis: Is Ozempic a Cure or a Cover-Up? | Calley Means and Tyna Moore
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- [00:00]
Dr. Mark Hyman
Coming up on this episode of the Dr. Hyman Show.
- [00:03]
Dr. Tina Moore
Now, according to this theory, as long as you eat fewer calories than you expend, you'll lose weight, right? Well, it doesn't matter if the calories come from a thousand calories of soda or a thousand calories of broccoli. All calories are the same in this model. Now, the implicit message here is that you're overweight because you eat too much and you don't exercise enough. In other words, it's your fault because you don't have the willpower and the subtext is that you're a lazy glutton. I don't believe that this is just me nonsense.
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Dr. Kelly Brogan
You know, I often remind people that.
- [00:31]
Dr. Mark Hyman
Sleep is not just a luxury, it's a necessity. It impacts your energy, focus, metabolism and overall health.
- [00:36]
Dr. Kelly Brogan
You might not know this, but poor.
- [00:38]
Dr. Mark Hyman
Sleep used to dominate my life, leaving me exhausted and unable to function at my best. That all changed with Sleep Breakthrough from Bioptimizers. These capsules are scientifically formulated to help you fall asleep faster, stay asleep longer, and wake up feeling truly rested. Unlike other products, Sleep Breakthrough doesn't contain melatonin, so there's no grogginess or side effects. They're designed with clinically optimized dosages and are perfect for travel or anyone who prefers capsules over powders. Don't let sleepless nights continue to impact your health. Visit bioptimizers.com hyman to get 10% off your order today with promo code HYMAN10 Bioptimizers even offers a 365 day money back guarantee. So there's nothing to lose except another restless night. Now, before we jump into today's episode.
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Dr. Kelly Brogan
I'd like to note that while I wish I could help any everyone by.
- [01:24]
Dr. Mark Hyman
My personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand.
- [01:32]
Dr. Kelly Brogan
Well, you.
- [01:33]
Dr. Mark Hyman
If you're looking for data about your biology, check out Function Health for real time lab insights.
- [01:39]
Dr. Kelly Brogan
And if you're in need of deepening.
- [01:40]
Dr. Mark Hyman
Your knowledge around your health journey, well, check out my membership community Dr. Hyman Plus. And if you're looking for curated trusted supplements and health products for your health journey, Visit my website doctorhyman.com for my website store and a summary of my favorite and thoroughly tested products.
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Dr. Kelly Brogan
How did obesity triple in the last 60 years from about 13% of the population to 43% of the population? I can guarantee you it's not an Ozempic deficiency. Functional medicine provides a better framework for understanding root causes, particularly around obesity, metabolic dysfunction and type 2 diabetes, and provides a way more sustainable and affordable treatment that works. I've seen this over and over again. We're going to talk about that in a minute. So let's get deeper into what's going on here in America. Why is this drug important and why are we seeing such an increased use of it? Well, we have a problem. There's no denying that. You know, As I said, 93% of Americans have some type of metabolic dysfunction because of poor diet and lifestyle. That means only 6.8% of Americans are metabolically healthy, meaning they're not somewhere on the continuum of type 2 diabetes, meaning they don't have high blood pressure, high cholesterol, high blood sugar or overweight or have had a heart attack or stroke. So only 6.8% of the population meet that criteria. The rest of us are metabolically unhealthy. And somewhere in that continuum, 6 in 10 have a chronic disease, 4 in 10 have two. There's over 400 million people around the world who are diabetic. 90% obviously are type 2 diabetes or more. 40 million Americans, or 1 out of every 10Americans has type 2 diabetes, which is terrifying to me. As I mentioned, over a billion people worldwide are obese and over 2 billion are overweight. 43% of US adults are obese, 75% are overweight. 40% of kids are overweight. It's just really a problem. We saw increase in obesity during COVID because of the stresses and the challenges people faced. And we're seeing now wegovy or Semaglutide, another version of Ozempic, is now approved for 12 to 19 year old obese teens. Now one in four teenage males has either pre diabetes or type 2 diabetes. That's frightening to me. 25%. And the obesity rates are staggering. You know, teenage obesity is at over 22% from between 12 and 19 year olds. And as I mentioned, 40% of kids are overweight. This is not a problem. That's because of genetics. It's a problem because of our toxic food environment. And the cure isn't a drug, especially a drug that has serious side effects and needs to be taken for a long time or lifelong. Now this is a great business model for pharma. You have a very expensive drug that needs to be taken forever. It's a gold mine and it grates customers for life. But teens have a problem. They're targeted by the food industry. They have all Sorts of issues around eating disorders. There's lots of unlawful advertising and targeting of kids videos going viral on TikTok. And it's really concerning to me. I think people don't realize that there's literally $10 billion or more spent just directly targeting junk food and processed food ads to children. And now there's currently trials going on in kids as young as six years old for the govinozempic. I mean, six years old. What are we talking about here? This is nuts. And it's not addressing the root cause. It's not addressing our food system. It's not addressing our toxic nutritional landscape. It's not addressing the fact that ultra processed foods make up 60% of our diet and 67% of kids diet that ultra processed foods account for about 90% of the added sugar in our diet, which is about 150 pounds of sugar per person per year. About 34 teaspoons a day for kids and 22 for adults. That's nuts. It used to be, you know, maybe 22 teaspoons a year when we were hunter gatherers. This is causing all sorts of metabolic dysfunction. And, and, and, and this metabolic dysfunction is, is not just about weight. It's obviously about obesity, but it's also about type 2 diabetes, Alzheimer's, dementia, fatty liver disease, chronic kidney disease and premature death. Now this is a huge problem. Chronic disease is bankrupting our system and our nation. There's four now $4.3 trillion spent on chronic disease and healthcare in this country. In 2000 it was 1.6 trillion, and that's only 23 years ago. So we are in a crisis of accelerating disease, accelerating costs. And it's not solved by a new drug that is serious side effects and is and may actually cause a bankruptcy of our nation if we follow through on this. You know, if you look at the cost here, diabetes alone is 413 billion in 2022. Ozempic is exploding in its revenue. And you know, one study in the New England Journal of Medicine found that if just obese Medicare patients were prescribed Ozempic, the cost annually to the government would be $267 billion a year. Now to put that in perspective, the entire Medicare Part D, which is the drug benefit program, is 145 billion. So it's another hundred plus billion dollars a year over what we're spending for the entire drug benefit for all drugs, for all seniors. It is an insane amount of money. So if we were to do that, we'll bankrupt our country. And if all the overweight People and obese people in America took Ozempic or similar drug, it probably will cost over $5 trillion, which is more than our entire healthcare expenditures. Now let's talk about the risks because I think this is where it gets sticky. Everybody's looking for the miracle cure, the miracle shot, instant weight loss. And it can work. I'm not saying it doesn't work. I'm just saying that it's not a free ride. Now part of the problem is that many drugs don't, don't have long enough studies when they're initially approved. And the longest study is about 68 weeks in these drugs. Now often these side effects don't occur till more chronic use of two years or longer. And there's some of that data coming out now which is called post market surveillance, meaning after the drug comes out, let's look at what's happening. And it's a bit concerning. Now we're seeing a lot of side effects, not just the nausea, vomiting, diarrhea that's in 50% of users, but we're seeing side effects that are life threatening. Things like gastroparesis or paralysis of the stomach, bowel obstruction and pancreatitis, and deaths rising. Now to put things in perspective as I share some of the statistics around the findings of people who've been on this drug longer and what it's doing to them in medicine, when we see a 20 to 30% increase in a response to a drug or a side effect, it's considered highly significant. For example, statins, which are a blockbuster drug to reduce heart attacks, they only reduce the risk of heart attacks by 20 to 30%. And that's a blockbuster drug. Now, now, now listen carefully as I explain this next study. In a study of over 4,000 patients published in JAMA, five out of every thousand patients had stomach paralysis, which was an increased risk of not 20% or 30% but 367%. The risk of pancreatitis, which is an incredibly dangerous illness which causes your pancreas to be inflamed and leads to type 1 diabetes, maldigestion and really very serious problems, up by 900%. And bowel obstruction, which is very serious and often requires surgery, went up by 422%, not 20 or 30%. So this is not insignificant, it's not an artifact. And in fact, when you see these kinds of studies, these, these data, you have to pay attention. You know, this is the kind of, almost the risk we see with, with smoking and cancer. These are really concerning, concerning numbers for me and they're not trivial, and they can cause permanent damage and require sur. The other thing that people don't realize is when you lose weight, 40% of the weight loss with Ozempic or these drugs is muscle. And muscle is where your metabolism is. When you lose muscle, you lose your metabolism. It slows down, and you end up needing less food to maintain your weight, even when you gain the weight back. The other problem is that 65% of the weight that you lose is regained when people stop the medications. So I think it's really quite concerning how we get off the drug. What happens, what happens with these drugs with kids? We don't know. How does it affect development, how does it affect puberty? Menstruation is a lot of open questions. Now, I want to kind of get into this whole issue of obesity being a disease or being genetic. I, I think there's a lot of conversation out there that's a little bit disturbing to me. And, and I just think, you know, just, you know, if, if, if when I was born, 5% of the population was obese, and now it's 43%. Did we somehow magically have a genetic mutation in the global population or in America to account for this? No, this is an environmental problem. Same thing with the Pima Indians. You know, 100 years ago, they were thin, fit, healthy, they had no obesity, no diabetes. They ate their traditional diet. They lived in Arizona. Now they're the second most obese population in the world, and 80% get diabetes by the time they're 30, and their life expectancy is 46. And kids as young as 2 years old get type 2 diabetes because they're genetically predisposed. They're not predestined. And when they're in the wrong food environment, which they are, which is the white poisons, white flour, white sugar, and white fat, otherwise known as crisco, or shortening, which was their government commodity surplus foods. They were given even a word for it. They call it commod bod, you know, when you eat the commodity food to get big and diabetic. Now, this is not a genetic problem. And what's disturbing is that Dr. Fatima Sanford, who's an obesity medicine doctor at Harvard and Massachusetts General, who was also on the Dietary guidelines committee in 2025. Very disturbing to me. She said, you know, obesity is genetics. He said it on 60 Minutes. Now, it's true that if your parents are overweight, you're more likely up overweight, but this is epigenetics, not, not necessarily genetics. This means it's changeable now. Where were all the obese people 60 or 100 years ago is this whole nonsense? It's our toxic food environment. It's impacting our gene expression and our predispositions. Now the idea that it's genetic is very disempowering. It removes our autonomy. Our agency, it essentially says this is a disease that must be treated with medication. There's nothing you can do about it. It's just genetic. So it's hard. Now the cost of this are staggering. As I mentioned for the drug, it's over $1000 a month, $1700 a month. You know, you depend on where you get it, but it's a lot of money and you're supposed to take it for life. And really it's hard to come off of and it's going to be completely bankrupting our nation if we continue to do this. And there's again, as I mentioned, nationwide shortages for people who have diabetes. Because everybody who wants to lose 5 or 10 pounds or 20 pounds is taking this drug and getting it from their doctor. Because any doctor can prescribe a drug for any reason once it's been approved by the fda, it's called off label use. And this whole pill for every ill quick fix is really not the solution here. We have not been addressing the root causes. The other thing I want to address here is this whole body, positive movement and healthy at any size. You know, I think what's happening is that, you know, there's a confusion about this, that we do not want to blame the person who's got this problem for the problem. If you're overweight, it's not your fault. You're living in a toxic environment. If you take somebody and you put them in an environment where all you can get is ultra processed food and sugar and starch and you're told by the government to eat 6 to 11 servings of bread rice here on pasta a day. It's no wonder that we have become obese. It's not your fault. And by the way, we'll get into this in a minute, but there's a lot of data on the addiction properties of these foods. So what's happening is that, you know, is this whole movement that doctors aren't talking to their patients about obesity. They can't, they can't say the word. It's considered fat shaming. If a doctor diagnosed someone who's medically obese or overweight. People don't want to be weighed in the doctor's office. They don't Want to talk about diet and lifestyle. They feel like it's shaming or somehow belittling. I think this is a problem. And I think there's a lot of celebrity kind of endorsements and news media, magazines normalizing obesity as healthy, but it's just not, it's just no data that it's healthy. I think the only, I think data was, you know, if you look at people who are older, obviously sometimes the data on when you're older shows that you die if you're thin, but that's because you have cancer or some kidney disease or something else that's wasting your body. Waste not because being thin as a risk factor for disease, it's the diseases. And unfortunately, a lot of people are getting canceled for talking about this. I saw a report about an email that went out to all the students at Columbia University talking about this in medical school saying, you can't talk about this, it's fat shaming. And it sort of made it not okay to talk about. Imagine saying, well, we can't talk about diabetes because, you know, that is a disease that, you know, they don't, they don't have any control over and it's fine. And diabetes healthy in any way. It's just, it's just, it's kind of nuts. Now I've been practicing this medicine for decades and I've been doing deep dives on their people's biology with all these problems. And I see real issues when people have metabolic issues. Now, this whole being overweight thing, being normalized, is not scientifically true. I understand the goal, which is not to victimize or blame the person who's overweight. But the truth is it's our toxic food environment and it's the addictive ultra processed foods that are driving the obesity epidemic, not our genes. Now, there was A review of 281 studies in 36 countries and it found that 14% of adults and 12% of kids meet the scientific definition for food addiction. Then put that in perspective. The prevalence of alcohol addiction in the population is 14%. Now, 12% of kids are food addicts based on strict criteria and scientifically validated metrics. This is not an accident, by the way. By the way, the reason for this is that the food companies have designed these foods to be hyper palatable and hyper addictive and stimulate dopamine. They even do such things as put children in an MRI machine so they can see on a functional MRI which part of the brain lights up ones triggered by different images of different junk foods. So it's not trivial. It's not an accident, and it's not your fault. So if you struggle with weight issues, it's really a complex issue that your metabolism, your hormones, your neurochemistry has all been hijacked by the food industry, and so is our kitchens and our restaurants and our grocery stores, and we're just unable to often find our way through. Now, there's certain concerns about Ozempic too, because people are using counterfeit Ozempic. They can get it online, they can buy it from different places, and people can get very sick from it. So I think I would watch out for that now. You know, there's a large part of the way traditional medicine is that misses the mark, no pun intended, because it doesn't address root causes. And functional medicine is about root cause, root causes. It treats symptoms, not mechanisms. It treats symptoms, not causes. So it doesn't focus on prevention or lifestyle. There's no early intervention for pre diabetes or weight gain. There's no lifestyle or exercise prescriptions that really are integrated into our healthcare system. There's no payment system for it. I say, you know, if people and doctors got paid to do this, it would work, right? I remember being working on health policy in 2008, and I was met with the Secretary of Health and Human Services and we proposed a lifestyle change program where we would basically guarantee that people would become healthier and reduce health care costs. And if they didn't, we would pay back the money that Medicare paid us and or paid the doctor. And she said, well, this is great, but who's gonna learn how to do it? Well, I said, if you pay for it, it's like if you pay for angioplasties, people will figure out how to do it. There was nobody who said, oh, well, how do we reimburse angioplasties? No doctors know how to do it because it's a brand new procedure. Well, guess what? As soon as they pay for it, people figure out how to do programs at work. And we often don't. We don't do things until it's too late. We wait and see. I had a patient who had a blood sugar of 110 and I said, you need to see your doctor about this. And she said, well, yeah, but they said, well, come back later when I get higher in my blood sugar and then we can treat it with diabetes drugs rather than dealing with the fact that he was already on his way. So rather than dealing with the root causes, which is our food system, we're trying to get a quick fix with these GLP1 agonists like Gozempic, which do help suppress appetite, which do reduce calorie intake. But you know, it really is important to deal with the causes, not just the problem that is quickly fixed by a drug because there's downsides to it. And the real issue is our excess intake of refined starches and carbohydrates and sugar, ultra processed foods and a lack of ability or access to follow a really whole food, nutrient dense diet that's full of satisfying foods, lots of fiber, fruits and vegetables, protein, good fats. And you know, the fact that we, you know, don't live an active lifestyle, the fact that we don't use our bodies, the fact we're under muscle, then our metabolism is slower, all these things drive obesity. I think. You know, one study by Kevin hall at the NIH showed that people who are freely allowed to eat as much food as they want, whether it's ultra processed food or whole food, they ate 500 calories more of the ultra processed food because there was no rate limiting thing in the brain or the body. It was like the body didn't recognize it as something that was food. And so it just kept getting more and more hungry in order to satisfy some nutrient needs. But it was like, like looking for the love in all the wrong places. So it's important that, that we also focus on nutrition quality and, and, and our diet quality. You know, people are eating all this ultra processed food but they, you know, they may be eating same stuff but just less of it because they're nauseous. But you know, the, if you focus on a lower calorie intake, which is what happened was Ozempic, without focusing quality, you're gonna become nutrition initially nutritionally deficient, you're gonna get worse metabolic dysfunction, you're gonna have copper, selenium, mineral deficiencies, zinc deficiencies, you're not gonna get protein, potentially have muscle loss, which definitely happens. And you know, when you look at, when you look at these studies, they don't look at body composition, they look at weight. Now weight is, is not exactly the most effective way to look at your metabolic health. It's really looking at how much muscle you have, how much fat you, is it in your belly, in your arms, your legs and the percentage. And so body composition is something that's critically important to do. And yet most of the studies don't look at it because they don't want to see it. The drug companies don't want you to tell you so they just measure weight loss. They don't measure the percent fast fat loss versus the percent muscle loss. They don't look at the ratio of body fat, percent of body fat. You know, they don't see how all this works. So if you lose lean muscle, it's serious. If you lose lean muscle, that's where your metabolism is, that's what your energy factories is, that's where your glucose sink is. So basically what happens is if you, if you, especially in the elderly, if you lose more muscle, you're, you're going to be more frail and weak. But even if you don't, when you lose the weight to lose 40% as muscle, which you do with these drugs, then let's say you gain the weight back after you stop. You may be the same weight as when you started, but your metabolism will be slower because usually you gain all the way back as fat. So you don't gain back the muscle. So you basically end up worse off and needing to eat less and having a slower metabolism after the fact. So it's really quite concerning. As a doctor, I know how vital.
- [21:46]
Dr. Mark Hyman
Sleep is for your health. Sleep is the foundation of everything.
- [21:49]
Dr. Kelly Brogan
If you're lying awake at night or.
- [21:50]
Dr. Mark Hyman
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- [22:17]
Dr. Kelly Brogan
Day money back guarantee.
- [22:20]
Dr. David Perlmutter
So I started researching and my background is in regenerative medicine. So Regenerative musculoskeletal medicine. I help people rebuild their joints naturally with natural substances, stem cells, prp. Been doing that for a long, long time. And so the first thing I did was research GLP1 and its regenerative properties. I always look up things according to what my brain knows. My brain understands pain, I understand regeneration and neuroinflammation. All of those things always interest me greatly. And I found so many studies showing impacts on some of the older versions of GLP1s and the current versions impacting neuroinflammation very positively. I found data supporting its potential use in Alzheimer's and Parkinson's. I found data showing regenerative properties in joints, in cartilage in ligaments. And I mean, the list goes on and on. I found data showing used early it could because it actually heals the pancreas. It can reverse type 1 diabetes if used early and started early. Semaclutide specifically. And I thought, this is not at all what I'm hearing. Like, this is not lining up at all with what I'm hearing. So of course I got super interested. I did a podcast. The feedback was incredible. I had people from all over the world messaging me, telling me I do all the things you say, I do all the things you preach. I mean, I was severely, severely censored during COVID for telling people to go outside in the sun, lift weights and eat meat.
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Dr. Kelly Brogan
I mean, God, how radical you are.
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Dr. David Perlmutter
I was deplatformed for the work I was pushing back then.
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Dr. Kelly Brogan
So clearly that's misinformation, right? Eating healthy and exercising and being in the sunlight.
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Dr. Tina Moore
God forbid.
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Dr. David Perlmutter
The hashtag sunlight was banned in 2020 off of Instagram. So I have been on this journey of sort of bucking the norm for a long time. And I thought, okay, I'm not. What I'm finding is not lining up with what I'm hearing from everybody. And then of course, all the health influencers had to come out against it. And everybody was really quite hot on my tails about it. I was getting a lot of hate for even mentioning that there might be other impacts that they have on the body. It's regenerative, it's healing, and it's anti inflammatory throughout the body. There's GLP1 receptors throughout the entire body, including the brain. It's not just made in the gut. It's a steroid or. I'm sorry, it's not a steroid, it's a peptide signaling hormone.
- [24:36]
Dr. Tina Moore
Yeah, for people. Background peptides are things that our bodies.
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Dr. Kelly Brogan
Make and they're the communication networks. And there's tens of thousands of these molecules and insulin is one of them.
- [24:45]
Dr. Tina Moore
And people are using peptides like Thymosin.
- [24:46]
Dr. Kelly Brogan
Alpha 1 or BP157 for sports injuries.
- [24:49]
Dr. Tina Moore
These are things that are available, some.
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Dr. Kelly Brogan
Of the prescription, like Ozempic. There are other ones like Mylesi, which is a prescription for sexual arousal in women and men.
- [24:58]
Dr. Tina Moore
So there's a lot of things out.
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Dr. Kelly Brogan
There that are used in traditional medicine.
- [25:03]
Dr. Tina Moore
Over 70 of these peptides have been approved.
- [25:05]
Dr. Kelly Brogan
And they're things that the body uses naturally.
- [25:07]
Dr. Tina Moore
So they're not things that are pharmacological agents. They're actually things that the body has.
- [25:12]
Dr. Kelly Brogan
And uses as part of its normal physiology. So GLP1 is that. And so when we say GLP1 agonists.
- [25:17]
Dr. Tina Moore
Which is what these class of drugs are, it means they work to stimulate.
- [25:21]
Dr. Kelly Brogan
The GLP1 receptors that have the effects of GLP1.
- [25:24]
Dr. David Perlmutter
Correct. However, semaclutide and tirzepatide are actually very closely. Well, tirzepatide's a little bit different.
- [25:30]
Dr. Tina Moore
That's mounjaro for people listening.
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Dr. David Perlmutter
Yeah. Semaclutide is almost bioidentical to GLP1. It's simply got as little tinkering on one of the amino acids to keep the half life longer. So GLP1 is produced naturally in the body. It's produced by the L cells of our gut. It's also produced in the brain, in the medulla. If it's produced in the brain, I immediately thought, well, it must have use in the brain, and it sure does. It actually has impact on neuroinflammation beyond appetite signaling, beyond any of that. We've got it sort of in this box of being. It slows gastric motility, it decreases appetite by slowing gastric motility. Very sort of basic kindergarten version. And then in the brain, it inhibits appetite. And that's how people have got it. Well, I start looking into it and I'm like, this is a signaling peptide hormone. Why would we macro dose a hormone? You'd feel awful if you were cranking high levels of thyroid or testosterone or estrogen. And those are sex steroid hormones, but still hormones.
- [26:30]
Dr. Tina Moore
High doses of insulin, which was one.
- [26:31]
Dr. Kelly Brogan
Of the first peptides ever to synthesize and see been around for a long time.
- [26:35]
Dr. David Perlmutter
Right. You'd die if you took high doses too high of a dose. So I got to thinking, well, why don't we just dose? Physiologically, I do bioidentical hormone replacement by dosing physiologic doses, which are much, much lower even than some of the standard dosing. So I've always been a fan of starting people very slow and low on any hormone. And I ramp them up and I titrate them up until they get tissue saturation and until their symptoms resolve. And then that's the dose. And then I test to make sure I'm not causing them any harm. And that's how I manage patients. On hormones, we've got leptin and ghrelin. Those are peptide signaling hormones, turns out leptin and ghrelin. So leptin, for the audience listening, is secreted by your fat. It goes to your brain, it tells your brain you're full, it tells your Brain. It's basically the thermostat of the brain. It lets the body know energy status. Right? Ghrelin is secreted by the stomach and it goes to the brain and tells you you're hungry. I always think, grrr. Ghrelin, right? That's how I remember the two. Ghrelin and leptin don't work if GLP1 isn't present. The receptors actually don't even come to the cellular surface. So I was like, well, this is very interesting. Then I started.
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Dr. Tina Moore
So ghrelin doesn't work because ghrelin seems to make you hungry. So some people are hungry even when they're overweight.
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Dr. David Perlmutter
And maybe GLP1 deficient, the receptor signaling of. And this was just in rats, but the receptor signaling of the whole orchestra of how these work together, it's much more nuanced, I think, than we understand. The orchestra doesn't work if GLP1 isn't there. So then I thought, I wonder if we have GLP1 deficiency. I wonder if that's a thing, right? It is, mechanistically, it's a thing in those with fatty liver, those who are obese, and those with type 2 diabetes. And then I thought, is this a chicken or egg? Is it due to the chronic insulin resistance and the damage to the vagal nerve and, you know, on and on, and the leaky gut and the damage to the gut mucosa and the damage to the microbiome? Is that what is inducing the GLP1 deficiency?
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Dr. Kelly Brogan
The Environmental toxins? Who knows, Right?
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Dr. David Perlmutter
Then I started talking to my friends who were like the nerdy genetic people, they love their genetic mutations. And they started telling me that there's SNPs that code for GLP1 and that they're seeing deficiency in those or they're seeing mutations in those SNPs in a lot of people. And in fact, one of my friends runs a diabetes clinic, has done so for decades. Functional medicine, diabetes. And he said that 95% of the patients he's seeing have this genetic SNP mutation. So.
- [28:54]
Dr. Kelly Brogan
And does that mean like 75% of the people who are overweight in America have this mutation? Or is it.
- [29:00]
Dr. David Perlmutter
I don't know. So what's happening is it seems unlikely that's true.
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Dr. Kelly Brogan
It seems like maybe they all.
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Dr. Tina Moore
Yeah, it seems like probably.
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Dr. Kelly Brogan
Probably like a larger portion of maybe they're severely obese might have that. Right.
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Dr. Tina Moore
What were you going to say, Kelly?
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Dr. Fatima Sanford
Well, we talk a lot. The genetic arguments brought up a lot. And obviously it's the genetics change. In the last 50 years, as obesity has absolutely taken over our country.
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Dr. Tina Moore
But gene expression changes, right?
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Dr. Kelly Brogan
So I think that's the thing that happens, genetic changes.
- [29:28]
Dr. Tina Moore
I mean, I think genes are complicated.
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Dr. Kelly Brogan
There was Darwin, which is genes change by natural selection over millennia.
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Dr. Tina Moore
And then was Lamarck who said traits.
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Dr. Kelly Brogan
Can be passed from generation to generation. And Lamarck was kind of dismissed and Darwin won the day.
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Dr. Tina Moore
But the truth is they're both right.
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Dr. Kelly Brogan
Because Darwin is about gene changes and Lamarck is really talking about epigenetic changes which can happen from generation to generation.
- [29:50]
Dr. Tina Moore
And I think one of the things we're seeing now is generations of kids.
- [29:54]
Dr. Kelly Brogan
Who are born to obese parents and.
- [29:58]
Dr. Tina Moore
The consequences of that. The epigenetic changes in the womb that.
- [30:01]
Dr. Kelly Brogan
Happen from the environment that the baby is bathed in, from processed food and.
- [30:06]
Dr. Tina Moore
Sugar and starch and lack of exercise and stress and all the things, environmental toxins, all that is programming these children.
- [30:12]
Dr. Kelly Brogan
We know this data from many, many.
- [30:14]
Dr. Tina Moore
Epigenetic studies is programming these children to be obese, have heart disease, have diabetes.
- [30:18]
Dr. Kelly Brogan
End up with cancer and many other.
- [30:20]
Dr. Tina Moore
Problems, and they're kind of screwed before they're even born. So these kids come into the world.
- [30:26]
Dr. Kelly Brogan
And then they're more likely to be obese or more likely to have these.
- [30:31]
Dr. Tina Moore
Programmed epigenetic changes that maybe are affecting.
- [30:34]
Dr. Kelly Brogan
The expression of the genes.
- [30:36]
Dr. Tina Moore
So genes don't change, but the expression changes. And that's.
- [30:39]
Dr. Kelly Brogan
I think that's an important point.
- [30:40]
Dr. Tina Moore
And I agree, Kelly.
- [30:42]
Dr. Fatima Sanford
But they could change if that child is provided a whole food.
- [30:45]
Dr. Tina Moore
That's right.
- [30:46]
Dr. Fatima Sanford
Genetic changes can be exposed to sunlight. So we have an Orwellian situation where we have such a crisis in America that children are in utero developing metabolic dysfunction because we're being. Our food is so toxic and our. We've had a sedentary lifestyle and aren't looking at the sunlight and being, you know, sleeping, dysregulated, sleeping, chronic stress with our phones. So we have such a bad metabolic health environment that we have an epidemic of kids being born, you know, born with metabolic dysfunction. So it is societally vital. There's nothing more important than this. So we have an opportunity. It's not a both. And are we going to, as a matter of public policy and as a matter of focus in that country, change that dynamic of changing our USDA guidelines to say that that 2 year old shouldn't be eating sugar? When you go the route of Ozempic, when you go the route that this is so bad that we need to jab Those children at 6, that's a different Route. That's a different prioritization.
- [31:47]
Dr. Kelly Brogan
It's not both ends. For giving kids 6 years old those epic. That's another conversation. I think that's a little extreme.
- [31:54]
Dr. Fatima Sanford
But if we agree with the idea, if we actually agree with the science and that this drug is good and should be used as a standard of care, why not?
- [32:01]
Dr. Tina Moore
I don't think any drug is good or bad. You're thinking from public policy, social. I'm a doctor, Tina's a doctor. We're both thinking about the patient we.
- [32:07]
Dr. Kelly Brogan
See in our office who's stuck as.
- [32:09]
Dr. Tina Moore
You know, what and how do we help them. And I've had patients who have lost £200, £150, £110, £116, £100, £138, just using food as medicine.
- [32:22]
Dr. Kelly Brogan
But it's tough for them.
- [32:23]
Dr. Tina Moore
They can do it.
- [32:25]
Dr. Kelly Brogan
But the question is, is there something.
- [32:27]
Dr. Tina Moore
Else that could be done in a.
- [32:29]
Dr. Kelly Brogan
Way that actually is like Tina was.
- [32:31]
Dr. Tina Moore
Saying, is physiologic, that doesn't use this kind of heavy handed pharmacologic approach to actually help people with fixing some of.
- [32:40]
Dr. Kelly Brogan
The metabolic and biochemical things that are going on.
- [32:42]
Dr. Tina Moore
And I think this is an open question, I think we need more data on this.
- [32:45]
Dr. Kelly Brogan
But I think what you're saying 19.
- [32:46]
Dr. Tina Moore
Is really interesting that there are effects.
- [32:49]
Dr. Kelly Brogan
Of this, this natural peptide that are different than just regulating weight.
- [32:54]
Dr. David Perlmutter
Absolutely.
- [32:54]
Dr. Tina Moore
Maybe working through other mechanisms.
- [32:57]
Dr. Kelly Brogan
You know, I had a patient once say to me recently, can I just take phentermine? And that's a basically an appetite suppressant.
- [33:03]
Dr. David Perlmutter
Crack.
- [33:04]
Dr. Tina Moore
It's basically, yeah, it's basically speed or crack. Yeah, basically, yeah.
- [33:08]
Dr. Kelly Brogan
It's like crackheads are so skinny because they're underneath appetite suppressed.
- [33:11]
Dr. Tina Moore
But it's basically speed. And I said no, no, no, this is really not good because it's going to cause you to be anxious palpitations and have all these, you know, issues of sleep. And I think it's not a good idea. But you know, then we talked about Ozempic maybe being a solution because it.
- [33:27]
Dr. Kelly Brogan
It can be done in a way.
- [33:28]
Dr. Tina Moore
That is, is different, that works physiologically.
- [33:30]
Dr. Kelly Brogan
And works on some of these other pathways that I think people aren't aware of. Like the neuroinflammation is a big one.
- [33:35]
Dr. Tina Moore
And I think what we're seeing is sometimes decreased suicide rates, we're seeing decreased depression, we're seeing a lot of other things with these drugs. And I think how is that happening?
- [33:42]
Dr. Kelly Brogan
And what's probably happening in my view.
- [33:46]
Dr. Tina Moore
Is people are eating less of the crap because they don't want it.
- [33:49]
Dr. Kelly Brogan
And so their brain and their body inflammation is going down. And maybe some of the effects of the GLP1 drugs are anti inflammatory by mechanism.
- [33:56]
Dr. Tina Moore
They are and they are. And so if that's true, then the neuroinflammation crisis.
- [34:03]
Dr. Kelly Brogan
And again, I've talked a lot about this on the podcast and written a whole book about about it called the.
- [34:06]
Dr. Tina Moore
Aldermine solution is our brains are on.
- [34:09]
Dr. Kelly Brogan
Fire and our brains on fire lead.
- [34:11]
Dr. Tina Moore
To depression, anxiety, suicide, aggression, societal division, Alzheimer's, Parkinson's, I mean, the list goes on and on. Anything that affects the brain is about inflammation. So these drugs may modulate that. It's fascinating. So they're being studied for Alzheimer's and many other things.
- [34:26]
Dr. Kelly Brogan
Now I think the idea that we.
- [34:28]
Dr. Tina Moore
Should just fall in love with this.
- [34:29]
Dr. Kelly Brogan
Drug and it's great for everybody and.
- [34:31]
Dr. Tina Moore
We should put in the water. I don't think Tina or anybody I.
- [34:34]
Dr. Kelly Brogan
Think who is smart about this thinks that.
- [34:37]
Dr. Tina Moore
But for the select patient in a.
- [34:39]
Dr. Kelly Brogan
Way given in a way that can.
- [34:41]
Dr. Tina Moore
Actually regulate some of these pathways, I'm.
- [34:43]
Dr. Kelly Brogan
Not so sure it should be thrown out. It's like any tool. It's like any tool we have in medicine.
- [34:49]
Dr. Tina Moore
It's for the right person at the right time.
- [34:51]
Dr. Fatima Sanford
Who's the right person? Just generically? I'm just curious.
- [34:53]
Dr. Tina Moore
Well, that's a great question.
- [34:55]
Dr. David Perlmutter
Let me finish what I was trying to tell you guys. I started using this in patients and I have only one who is using it for weight loss. Everybody else is on it for a different reason. So. And I'm using it at a fifth of the starting dose, compounded droplets. And when I started doing this, my colleagues all started who listened to my podcast all started also microdosing GLP1s in their clinics. And we've all reported back to each other and we're seeing phenomenal results in all different kinds of conditions that leads me to believe that we may actually be able to do away with a lot of the lifestyle pharmaceuticals that people are using. So people are on other drugs for life, such as high blood pressure meds or statin drugs. These peptides have been shown to heal heart tissue and to reverse heart failure. So I've got one patient on it for high blood pressure, tiny little dose, high blood pressure, blood pressure's down. I personally take it because I have psoriatic arthritis and I have crippling pain from tip to toe. Doesn't matter how clean of a life I live. It doesn't matter how clean my fish tank is. Menopause hit me the brain fog was real and the pain came with it. And I knew it was due to neuroinflammation. So tiny little doses mitigates my autoimmune conditions like nothing I've ever used without any side effects. None of the people I'm using it on, none of the people, none of the patients that my colleagues are using it on are having any side effects. You keep the dose low. The nausea, the vomiting, the terrible side effects, the muscle loss, that is all a dosing and management issue. And brand names start in a pre filled pen. I don't use them. They're too high of a dose. We are mono dosing at high doses. Monotherapy, a hormone. And that's why we're seeing these horrific side effects, which I completely agree with. I've listened to your argument on different podcasts and I'm like, I totally agree with them, I totally agree with what's happening there. But we wouldn't throw out thyroid if all the doctors were overdosing their patients on thyroid. It's a management and dosing issue on the doctor's part. And then how compliant are patients? Right?
- [36:58]
Dr. Kelly Brogan
Why is pharma starting the dose so high? I mean, the injection first dose is 0.5 milligrams and it goes to 1 and 2. You're talking about using 0.1 or 0.08.
- [37:07]
Dr. David Perlmutter
Which is a fifth of that tiny. Because they're dealing with severely metabolically busted people already. And the people I'm dealing with are doing all the things and are generally metabolically healthy.
- [37:18]
Dr. Kelly Brogan
The median American is metabolic. What would you do if you had someone come in, it was like 350 pounds, who would you start them off.
- [37:23]
Dr. Fatima Sanford
Or the average American?
- [37:24]
Dr. David Perlmutter
So you give them a leg up. I have a license to prescribe, so I prescribe things to give people a leg up. I do use Prozac as needed at very low doses. And the way that I have been taught by my mentor is when a patient comes in and here's their pharmacological profile and here's their lifestyle, you lower this as much as humanly possible or get them off is the goal. The reason I became a naturopathic physician in the state of Oregon, so I prescribe is to get people off drugs and then you bring up their life.
- [37:51]
Dr. Tina Moore
You have to have a license to.
- [37:52]
Dr. Kelly Brogan
Put them on and to take them off. Right.
- [37:53]
Dr. David Perlmutter
You bring up their lifestyle. Right. And so you hopefully get this as low as possible. But I'm not opposed to keeping people on tiny little doses. This is not the first Drug, I microdosed. I microdose Prozac in patients. I've microdosed statins. I microdosed all kinds of drugs to give them. You get a different mechanism of action when you use things at tiny little dosages than when you macro dose them. Macrodosing a drug gives you a different pharmacologic impact on the body.
- [38:16]
Dr. Kelly Brogan
And do they work at that low dose for people?
- [38:18]
Dr. David Perlmutter
Yeah.
- [38:18]
Dr. Tina Moore
What if they're for your patients who.
- [38:20]
Dr. Kelly Brogan
Are not really doing it for weight issues? I understand everybody lost weight, but what about for people who are like £300? Did you start with the same dose?
- [38:26]
Dr. David Perlmutter
So I have one patient who is morbidly obese. He's well over 300 something pounds and. And can't move in so much pain, he can't move. Sleeps in a lazy boy, spends all day in a lazy boy. Doesn't get up, doesn't move. Cognition's off, has had too many strokes. I don't even have him at the starting dose yet, and it's been months. And he is very happily, very slowly shedding the weight.
- [38:48]
Dr. Kelly Brogan
Yeah, the starting dose. The pharmacologic starting dose, yes.
- [38:50]
Dr. David Perlmutter
So I've got him at a fraction of that, and his cognition has improved. The cognitive impacts have been huge. I've seen it eradicate depression. I've seen it reverse pcos. I've seen people walk straight into fertility after decades of infertility issues from PCOS or just decades of pcos. So, and this is all at microdoses. I'm talking droplets.
- [39:09]
Dr. Kelly Brogan
So this compound which our body makes maybe is deficient because of why?
- [39:14]
Dr. Tina Moore
Why?
- [39:14]
Dr. Kelly Brogan
Is it because of epigenetic programming? Is it because of our microbiome changing because of toxins in the environment?
- [39:21]
Dr. David Perlmutter
I think all of it, you know, the mess of toxic soup we live in. I mean, we live in a toxic soup period epigenetically, like you said, mothers. The data around maternal diabetes and metabolic inflammation and the offspring. Do you know Pottinger's cats? Did you guys ever hear about Pottinger's cats? So pottinger in the 30s, took cats and he fed that. He was a veterinarian. He fed them cooked meat and pasteurized milk. That's all he did was change it. And within one to three generations, they were completely infected, fertile. Their intestines were inflamed and boggy. Their livers were enlarged and fatty infiltrate. And it took him multiple generations with optimal cat diet, which is raw milk and raw meat, multiple generations to reverse them back to a fertile, healthy animal. So my. I'm 50. I watched all of this happen. I've seen it. I remember when there was like one kid in school who truly had a glandular problem who was overweight. Yeah, I've watched this.
- [40:17]
Dr. Kelly Brogan
Erica, my class.
- [40:19]
Dr. David Perlmutter
Yes. I watched this whole thing unfold. I've watched food change. I've been battling against it, too, for long, long time. But we're in a pickle. And I think we're. I think I am actually a few generations into potting, at least one into the pottinger's cats. My parents, the boomers, had the convenience foods. Crisco oil came into play, and here we are. And my daughter's margarine.
- [40:43]
Dr. Tina Moore
That was what I lived on when.
- [40:43]
Dr. David Perlmutter
I was a. Yeah, me too. And Wonder Bread and baloney. But my daughter's. My daughter's 24 next week, and her generation is a mess.
- [40:52]
Dr. Tina Moore
Well, weight loss can be super confusing. When you hop on social media, it seems like everyone has the answer. And yet, despite the endless information at our fingertips, many people are suffering and are trying but failing to shed unwanted pounds and keep them off. Now, the government dietary guidelines and nearly all doctors, nutritionists, and all professional associations tell us that weight loss is simply about energy. You need to burn more calories than you eat. You need to eat less and exercise more. Now, this is called the energy balance hypothesis, or energy balance model of weight. Now, according to this theory, as long as you eat fewer calories than you expend, you'll lose weight, right? Well, it doesn't matter if the calories come from a thousand calories of soda or 1000 calories of broccoli. All calories are the same in the model. Now, the implicit message here is that you're overweight because you eat too much and you don't exercise enough. In other words, it's your fault because you don't have the willpower. And the subtext is that you're a lazy glutton. I don't believe that. This is just nonsense. The story of weight gain and weight loss and metabolism is far more complicated than that. Now, Americans have been doing their best to follow this advice of eating less and exercising more for the past 50 years. And yet obesity rates have gone from. From 5% when I was born to 42%. How do we explain this? The truth is, the science of weight and metabolism is complex. It's about calories, for sure, but not only calories. The science is clear on this. Not all calories affect our metabolism in the same way. You see, food contains calories, but also the type and quality of those calories impacts the way the body functions beyond the energy they contain. You see, food is information. It's instructions or code that impacts your hormones, your immune function, your brain chemistry, your gene expression, and your microbiome in ways that have a huge effect on weight and metabolism. If the calorie model doesn't completely explain our obesity epidemic, is there something we're missing? And the answer, my friends, is yes. The last few decades of research have shown that a calorie is not a calorie. Now, yes, in a lab, when they're burned, calories are the same. But when you eat them and the information has different effects on hormones or your brain chemistry, or your immune system or your microbiome, they are not the same. So a calorie burn is a calorie burn, but a calorie eaten is not a calorie eaten. To quote my friend Robert Lustig. Now, if our current theories don't completely explain our current obesity epidemic, then we need a new theory or maybe theories. The emerging model of weight gain and weight loss that's coming out of the science is called the carbohydrate insulin model. Now, this theory posits that refined carbs and sugar calories drive high levels of insulin. And that's the fat storage hormone that makes you store fat. It locks the fat in the fat cells and it slows your metabolism. Not a good combo if you want to lose weight. And the special type of fat that's stored, which is your belly fat, is actually a different type of fat. It's hungry fat. But is this true and what does the research say? Well, today we're going to discuss the functional medicine approach to weight loss. It zooms out and looks at root causes and mechanisms, and it includes all the variables that affect weight metabolism. We'll see whether weight loss is simply about eating fewer calories, or maybe about fixing your hormones, or whether other factors such as toxins, also influence weight. So let's cut through the noise and offer a science backed holistic roadmap to weight loss and metabolic health. So whether you want to lose that extra couple of pounds around the midsection or transform your body composition completely, I hope you'll find this episode helpful. Let's get started. So, what makes us gain weight? Now, there are two main schools of thought for what makes us gain weight, which are truly the subject of a lot of debate. The energy balance model and the carbohydrate insulin model. We're going to talk about them now. Later in the discussion, we'll Discuss other factors that can influence weight gain. It doesn't just stop with calories or diet or the carbohydrate insulin model or energy balance model. There's a. There's a lot of more things that can impact your metabolism. But first let's take a look at the main diet related theories, the two of them that lead to weight gain and the pros and cons of each one. Okay, let's start with energy balance model. Now, this is the one that we've all been following for decades and decades and it's sort of not working out for us, right? Eating less, exercising more. How's that working out for you? Well, let's talk about what it says and the science behind it and what makes sense about it and what may not. The energy balance model suggests that your body weight is maintained when the calories we take in in eating and drinking equals the calories we expend. Right? Our basal metabolic rate plus our physical activity plus digestion, or we call the thermic effect of food regulates your weight. And basically weight management and weight maintenance occurs when energy in equals energy out. If you want to lose weight, well, you need to take in less energy than you put out, right? If you gain weight, you want to gain weight, you have to take in more energy than you burn, right? This considers that all calories are metabolically alike and that you can lose or gain weight on any diet. It doesn't matter where the calories come from. The Dietary Guidelines from America has been primarily based on this advice. The 2025 USDA Dietary Guidelines state, quote, losing weight requires adults to reduce the number of calories they get from foods and beverages and increase the amount expended through physical activity. In other words, eat less, exercise more. The Endocrine Society says, quote, the impact of diet on obesity risk is explained largely by its effect on calorie intake rather than by changes of either energy expenditure or the internal metabolic environment. In other words, a calorie is a calorie is a calorie. Unfortunately, that's not exactly a true story according to science. So what are the pros of this energy balance model? Well, it's simple, right? Energy intake has to equal energy expenditure or you lose or gain weight if you're out of balance. And it's an easy, straightforward, universal model for weight management that basically everybody can understand. Calories in, calories out, eat less, exercise more. People say this is true because it's based on the first law of thermodynamics, which means energy cannot be created or destroyed. Only transformed. Now, this is true, but you have to understand the definition. The definition requires a closed system. Let me just look up the first law of thermodynamics. It means energy cannot be created or destroyed in a closed system. The body is not a closed system. You've got so many variables like hormones and the microbiome, your immune system, so many other things that regulate your response to energy. It also embraces physical activity that's needed to maintain a healthy weight and wellness, which is great. I think that's important, exercise. But you cannot exercise your way out.
- [47:07]
Dr. Kelly Brogan
Of a bad diet.
- [47:07]
Dr. Tina Moore
I promise you that. Anybody who's tried will know what I'm talking about. And this also allows for diet flexibility, right? As long as you quantify energy intake and expenditure, basically counting calories and counting steps, basically, then you can follow any dietary approach. Low fat, low carb, you could drink Coca Cola as your sole food. It doesn't matter as long as you monitor and track your calories intuitively. It just doesn't quite make sense, Right? It doesn't make sense that all calories are the same because any kindergarten kids would say, well, gee, if you drink a thousand calories of Coca Cola or have a thousand calories of broccoli, probably not the same. Even within this model, they do acknowledge, and this doesn't quite fit the model though, that ultra processed, hyper palatable energy density foods impact our brain chemistry, makes it easier to overeat. Well, so they're saying, well, maybe calories aren't the same because some calories make you overeat. Well, that doesn't make sense, right? If it's just calories in, calories out. But they also say in the same breath that there's little human evidence to suggest that hyper palatability is related to over consumption. Well, that's just not true. I mean, the NIH study from Kevin hall, who talked about before on the podcast, where he basically gave people ultra processed food or whole foods and told them to eat whatever they want. People who ate, ate ultra processed foods were Hungrier and ate 500 calories more a day. Now, research supporting this model, this energy balance model, is there. There's some research about it, of course, it depends which studies you look at how they're looked at and just sort of sifted through. But a Meta analysis of 32 controlled feeding studies argues that when calories are controlled metabolism, weight loss are essentially the same on a low fat versus a low carb diet. But you have to look at what defines a low carb or a low fat Diet, is it 10 fat? Is it 10%? Carbs? Carbs, is it 50 fat? Is it 50 carbs? Like it matters. Right. And so, so maybe some of the, the differences are not really that significant in order to shut down insulin. We'll talk about that in the studies. Again, a little bit contradicting the model because if all calories are the same, they should affect you the same. Right? But they, but they do acknowledge that the macronutrients account for the differences in the distribution of body weight. So, for example, high carb diets promote more belly fat than high fat diets, which don't promote more belly fat. In a systematic review and meta analysis of randomized controlled trials, it was published in the British Medical Journal. They compared low fat versus low carb diets from 121 trials and approximately 202,000 adults who were overweight or obese and reported that they both had a similar effects on weight loss and cardiovascular markers. At six months, however, the weight loss diminished and the heart benefits disappeared at.
- [49:27]
Dr. Kelly Brogan
12 months for all the diets.
- [49:28]
Dr. Tina Moore
Now, another study randomly assigned 131 healthy overweight or obese adults who had lost about 8% or more of their body weight to either a moderate fat low glycemic diet, a low fat medium glycemic diet, or a high glycemic sugar, I mean, high sugar control diet with a similar protein content and they could eat whatever they want. And they found really no difference in weight gain after 18 months. What are the things that contradict this energy balance model? Some studies show it works, some studies show it doesn't. So let's get into what the cons are. It doesn't really explain how or why weight gain happens or what's driving the process other than just energy. Right. Obesity rates have continued to climb despite Americans eating less.
- [50:06]
Dr. Kelly Brogan
Now, this is really fascinating, folks.
- [50:08]
Dr. Tina Moore
If you take the hypothesis that obesity is all about calories, it's hard to reconcile that with the fact that over the last decades, and I'll get into that, our calorie consumption has gone down, but our weight has gone up. So that's a really important fact. And this is the NHANES data, which is the Natural Health and Nutrition Examination Survey, government data, tens of thousands of people over decades and decades, and they looked at calorie and added sugar intake and they found that it's gone down since the year 2000. But obesity and type 2 diabetes have gone up. Right. How do you explain that? It also doesn't consider the nutrient matrix or the quality or bioavailability of certain foods. For example, nuts have a high energy density, right, because they're, they're higher in fat. But eating nuts has been shown to help maintain a healthy weight and even lose weight. In a 2012 study published in the American Journal of Clinical Nutrition, they found that the average energy extracted from almonds is 32% less than what's written on the nutrition labels. Meaning even if it says 100 calories, it's 32% less than that that's actually used by the body because it takes so much work to digest it. Same goes for walnuts, about 21% less, and pistachios, 5% less. And cashew, 16% less. So how do you explain that? Well, it's the food matrix. Matrix. It's the degree of processing, it's the indigestibility of certain parts like insoluble fiber and things that feed the gut. Microbiome. Cutting calories without focusing on nutrition quality can actually lead to nutritional deficiencies which can impact mood, mental health and metabolism. So for example, if you're, if you're on a calorie restricted diet, but you're not in a nutrient dense diet, you're going to end up with problems. There's also metabolic pushback that happens. You know, cutting calories makes you hungrier and it decreases your metabolism. So you're in a vicious cycle cycle. So you eat less, but then your metabolism slows down and then you increase your hunger. So it makes it hard to push past a weight loss plateau by just adjusting calorie intake. It's really hard to reduce your calorie intake because you're going to be hungry and that's going to overtake your body. And willpower just is not enough. So you have to use science. And this whole energy balance model also doesn't account for the complexities or the differences in individuals, genetically and metabolically. Hormones, genetics, your blood sugar, your microbiome, impact of nutrition or our brain chemistry on our metabolism. The role of environmental toxins, things like obesogens, endocrine, Detroit and chemicals, stress, mitochondrial damage, free radicals, inflammation, all that is not taken into account by the energy balance model. And just calorie restriction doesn't work a long time. Nobody can stick with it, Right? Research shows that humans are really bad also at measuring their energy intake. So we can underestimate our consumption by about 50% and we overestimate our calorie expenditure from exercise by about 70%. I always said that when I worked at Canyon Ranch. So people basically underestimate the amount they eat by 50% and overestimate the amount they exercise by about 50%. Now people can't adhere to a calorie restricted diet long term. They really can't, especially low fat diets because they're not very satisfying and fat makes you feel full and protein makes you feel full. So counting calories is kind of unsustainable anyway. Even if you get a PhD nutrition and you, you are really focused on understanding calories, it's really hard to be accurate unless you weigh and measure every single thing you eat. And also the only problem with this model is it kind of blames the individual when they can't lose weight. Well, why didn't you lose weight? Well, you're just not eating the right way. You're, you're, you're eating too much and you're not exercising enough. And that sort of blames the, the victim, which is not really true. I think that there's a lot of flaws with the energy balance model. Calories do matter. I'm not saying they don't matter. They're not the whole story. And, and I think the quality of the calories matters. And it turns out from, from a lot of data from Dr. Ludwig at Harvard and others that turns out that what you eat is more important than how much you eat. Because when you eat, choose the right foods that regulate your biology in the right way, you don't have to white knuckle your way to weight loss. It actually will automatically start to shift your body in terms of the right metabolic health. So what's this next model, this carbohydrate insulin model? And I think we try to sort of narrow things down into simple little categories. But we have to sort of understand that biology is complex and not any single theory will explain everything. But I think this one is much closer to what I've seen in my practice and also what I've seen to be more effective clinically with many patients and what I've heard from many of my colleagues as well. Now this, this offers a different perspective to this energy balance model. But I should, I shouldn't say just going back to energy balance model. The energy balance model was so attractive to the food industry that Coca Cola spent $20 million paying scientists to fabricate data to show that this actually worked, that weight loss was just about calories in, calories out. It didn't matter where the calories came from. All calories in moderation, including Coca Cola. That's just nonsense. Sadly to say it's nonsense. And they were actually extreme Exposed. I wrote a lot about this in my book Food Fix and also some other things I've written. But it's a very attractive model for the food industry because it basically lets them off the hook, right? If you're a big food company or a fast food company, you can feel good about yourself because it's all about just the quantity of calories. So people don't overeat, that's fine, they can eat their junk food, but it's very, very much not the case. Let's get back to the carbohydrate insulin model. It basically suggests that the quality of the calories consumed, particularly ra rapidly digested calories like refined starches, sugars, and empty carbs. They play a real critical role in weight regulation and obesity because they influence your hormones, particularly insulin. Now, insulin is a very important hormone. What is insulin and what does it do in the body? Well, insulin is a hormone that's released by the pancreas. When we eat something that has a high glycemic load, meaning it raises your blood sugar. That how, how rapidly a meal raises your blood sugar is, is called the glycemic load. Now, when a meal is rich in a lot of sugar and starch, your blood sugar spikes, and then insulin is released to help deliver the glucose and the fuel to your cells, your muscles, your liver, your fat tissue, and too many calories from each meal. Then when you have high insulin levels because it's the fat storage hormone, they're siphoned off into the fat tissue, and then too few remain in your circulation, which then makes your body perceive that you're in an energy crisis, that you have low energy states and that makes you crave more carbs and more sugar. You know exactly what I'm talking about. If you eat sugar and carbs, you want more sugar and carbs, even though you have so much energy. I mean, I mean, people who are obese are just having enormous storage amounts of calories, but they feel like they're hungry and starving.
- [56:02]
Dr. Kelly Brogan
Why?
- [56:03]
Dr. Tina Moore
Because of the role of insulin and how it works in the body by storing the fat in the fat storage cells, by locking it in there, by clearing the, the, the blood of a lot of the available fuel so it's stored in the fat cells and their brain doesn't perceive that you've got enough food around. So basically, obesity is a state of starvation amidst plenty. It's the feeling that you're starving in, in when you have plenty of food and calories. Now, this perceived state of starvation negatively affects all sorts of systems in your body, including your thyroid, and that slows your metabolism even more to conserve energy. Also, if you have a high carb diet, it increases cortisol. So we know that eating sugar and star trees, stress hormones, cortisol, also epinephrine, adrenaline, and that can lead to fluctuations in blood sugar. It can lead to more insulin resistance, weight gain, hypoglycemia, and you can just, you know, get the terrible vicious cycle of being hungry. And in these cycles of low and high blood sugar. Now, we also know from the data that restricting your energy intake, meaning eating less while consuming a high sugar starch or high glycemic diet, is going to increase your predisposition to store belly fat, okay? And liver fat, and it's going to make you hungrier. So even if you're restricting calories, if you're eating high carbs, you actually are going to be hungry and store more belly fat. So high insulin and low glucagon from eating a high glycemic diet also inhibits our ability to immobilize and burn fat. As long as insulin is high, it blocks our ability to burn fat, what we call lipolysis. And that makes weight loss difficult. So it's like a one way turnstile. The fat gets in the cells and the sugar and the calories get in the cells, but they can't get out. It's really difficult to lose weight as long as your insulin level is high. And I see this over and over with my patients, the key to getting the weight down by any mechanism is lowering insulin. And when you have higher and higher amounts of starch and sugar, your cells start to become resistant to the effects of insulin. So you need more insulin, which leads to more weight gain and more chronic diseases like type 2 diabetes, obesity, Alzheimer's and cancer. That's kind of the theory. Now, what are the pros of this carbohydrate insulin model? Well, it focuses on food quality, on what you eat, not just how much you eat. And it focuses on getting rid of these empty, fast adjusting, high sugar, high starch, carbohydrates, because they have a really bad effect on metabolism and weight gain. It also tells us that all calories are not created equal in terms of their metabolic impact. Now, they're equal in a laboratory. When you burn them. If you burn a thousand calories of broccoli and 1000 calories of coca cola in a lab, they release the same amount of energy. But when you eat them, they have very different effects on the body. I mean, think about that a thousand calories or 100 calories of broccoli versus the same amount of Coca Cola very different impact on your biology Another really important feature of the carbohydrate insulin model is that it addresses the role of insulin in fat storage and metabolic health. You see, when you have high insulin it makes you store fat, which means lowering insulin through diet and other mechanisms can actually improve fat loss and improve metabolic health and reduce obviously the risk for insulin resistance. Type 2 diabetes Chronic diseases without hyper fixating on calorie intake, focusing on what you eat versus how much can make a big difference. This also has a huge impact for type 2 diabetes. Less insulin spikes, lower insulin levels, less insulin resistance and help can prevent and even reverse type 2 diabetes. In fact, the work by Sarah Hallberg and others using a ketogenic diet diet which is like 75 to 80% fat and you know, 5 to 10% carbs has been able to completely reverse type 2 diabetes. And since diabetes and insulin resistance is a carbohydrate intolerance problem and this is what's happening in America. We have a huge population that's carbohydrate intolerant because we weren't adapted to eating such large amounts of sugar and starch.
- [59:33]
Dr. Mark Hyman
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