Transcription
Hi folks, it's Dr. Rob Cyverus. I'm the carb addiction doc, and today it just gives me so much pleasure to reconnect, uh, with Dr. Jason Fung. Um, just one of the absolute mentors and gods of our space. Uh, everybody knows who he is. Um, but Jason, weren't you? Well, let's go back a little bit. The first time we met was with Tim Noakes' conference in Cape Town. Uh, and you were just coming out. I remember hearing about unpacking suitcases and trying to squeeze insulin into a suitcase and that kind of thing in that talk that you gave there. And we've just grown so much from that time. And then we wrote *Diabetes Unpacked* with Zoe Harkham. You wrote a chapter in that. I wrote a chapter in that. That's 2012, 2020. So, it we go back a very, very long way. Um, you're a nephrologist practicing in Toronto, Canada. Um, I'm assuming you still practice nephrology as a clinician, and if you wouldn't mind, just telling us how you got into, from nephrology, which is the specialty of kidney disease, how you got into metabolic health. How did your journey start?
Yeah, it's an interesting course because, like many of us, we didn't sort of see it coming because I trained very conventionally as a kidney specialist. But over the last sort of 20-plus years, we saw, of course, this massive rise in obesity, which led to this massive rise in type 2 diabetes, which is the most common cause of kidney disease. So, as I'm studying kidney disease, really, it's just diabetes, type 2 diabetes, sort of over and over and over. And the other diseases are just, you know, start to pale in comparison because the other one, the other big one, of course, is hypertension. But hypertension control, uh, you know, has gotten, you know, so much better. Like, uh, so, so hypertensive kidney disease is down. Diabetes was going way up. So, it used to be sort of 50/50, 50 between hypertension and diabetes. But, you know, back when I was, uh, started training, they, they used to say stuff like, "Normal blood pressure is 100 plus age." I don't know if you remember that. So, guys are walking around with pressures of 170.
>> Yeah.
>> You know, it would blow the minds of clinicians coming out now. It's like people walking around with 170. Your doctor would say, "Yeah, it's normal. You're 70 years old." It's like, "No, no, everybody goes crazy now." So that's where I really got interested in, in the case of diabetic kidney disease, is sort of how I got started.
So, diabetic kidney disease, after a few years, so I was practicing, it's becoming more and more prevalent. I'm thinking about it, and it strikes me that we, we sort of did things all wrong. If you think about type 2 diabetes, it causes disease. So then you treat it with drugs, and then eventually dialysis. But that's the complete wrong thing to do because, really, if you have type 2 diabetes causing kidney disease, you should get rid of the type 2 diabetes, which, of course, everybody says was impossible at the time, right? It's not reversible. It's a chronic and progressive disease. And that was just complete garbage because everybody knew that if you lost weight, your diabetes got better, right? Every patient knew, every doctor knew. At the same time, we knew, we were saying on the other side of our mouth that it was chronic and progressive. So I'm like, "That makes no sense." If you lose weight, your diabetes will get better. If your diabetes gets better or goes away, then you don't get the diabetic kidney disease. So, I became very, very interested in the question of weight loss. And of course, the predominant sort of, uh, teaching, uh, is that it's all calories in, calories out, right? And this sort of, "A calorie is a calorie," right? That like you could eat donuts for dinner and it's fine because it's, you know, 1,000 calories. And it's the same as if you ate a nice grilled salmon with salad, right? It's the same thing. They're both 1,000 calories, which is so stupid, really. Um, because of course, there are huge differences other than the number of calories. There's huge differences in the way our bodies metabolize those two foods, right? Donuts versus salmon is very, very different. And why would you think they're the same? Because you can measure those differences, right? You can do glycemic index, you can measure insulin levels, and so on. So that's where I became interested in sort of like, not just the number of calories, but like, what's the effect of those calories and what's the effect of changing it? And that's where we met, right? In Cape Town in 2015, we were all discussing low-carbohydrate diets, which of course made complete sense from a physiologic standpoint once you abandon this "a calorie is a calorie" physics model of counting. You know, it's like, you know, "Donut calories are the same as salmon calories." Like, "Well, you know, that makes too much sense." But once you got past that, you could see that, hey, there's a huge important, uh, difference here. And the number of carbohydrates made a difference because, you know, carbohydrates are metabolized in a way that, you know, creates a lot of insulin, right? Carbohydrates are glucose or chains of glucose, which is of course the big problem in type 2 diabetes. So, cutting down carbohydrates was a very, very good way to treat type 2 diabetes. And, you know, years later, of course, David Unwin has published his, uh, series. I mean, it's insane how good that is for type 2 diabetes, right? It's insane. So, he has, he has hundreds of people who have reversed their diabetes. Like, 25% of his, his practice has gone into a, um, drug-free remission. Like insane numbers, um, just from this simple thing. And finally, people are starting to listen, right? 10 years later, right?
>> Let me pivot for a second because I agree 100% with you. You know, we're aligned. But you pivoted completely. And really, the first impression I had of you, and I think that the world had of you, is don't eat intermittent fasting.
>> Yeah.
>> So, you know, we've been talking about calories all the time. Use a, which is kind of the best way of reducing calories. But how did you come upon, uh, intermittent fasting as a major, a rapid improver, and a major driver of getting rid of diabetes?
>> Yeah. Because, because the idea was that once you get past calories, then you start looking at hormones. So you start looking at insulin, right? Insulin is a key driver, and carbohydrates, of course, is cutting carbohydrates is one way to reduce insulin. But, you know, another way is simply not eating, right? And you cut everything. So everything goes down. And of course, at the time, this is 2014, 2015, people were saying, "Oh, you, you must eat and never skip a meal. You're going to have heart disease. You're going to have this. You're going to have that. You're going to have eating disorders. You're going to have, uh, you know, starvation mode." All this stuff, right? And the thing is that as a physician, I was like, "Well, how does this make sense, right?" Because I, I heard all the same stuff, but it's like, "Show me the data." Because it makes actually no sense. Because if you just think about what body fat is, body fat is a store of calories. So if you're storing calories, then if you don't eat, you're going to use those calories. That's completely natural and normal. There should be no detrimental health effects from doing fasting, right? So it's an option for you. You don't have to do it. You can lose weight in many ways, but it's an option for you to simply extend the time that you don't eat, which is fasting. So, you can do 16 hours, you can do 20 hours, you, 24 hours, you can do, you know, three days, four days, five days, whatever you want. And it's okay from a physiologic standpoint. And that's where I dug into the data, the physiology, and I started writing about it because virtually every person I met thought it was a terrible idea to do fasting, right? But I'm like, "Well, look at the data. Here's the data. Here's the physiology. Here's what happens. What's so bad about it?" And really, as a doctor, you know, we tell people to fast all the time, right?
>> As a surgeon, all >> post-op, you have to fast. Pancreatitis, you have to fast. Fasting blood work, you have to fast. Colonoscopy, you have to fast. Like,
>> Well, except, except for one thing. So bad for you.
>> Let me stop you. I mean, this is how ridiculous the opposite has gotten. In surgery, we try to wait eight hours before feeding a patient. But now, because of the massive changes that somebody who fasts for eight hours undergoes under anesthesia, we're telling them to drink sugar four hours before surgery. It is like giving an alcoholic a shot of whiskey so they don't get the DTs. It is ludicrous how we've done in, you know, RAS, the, uh, um, the optimal therapy is now to give people sugar so they don't go hypoglycemic during surgery, which is the opposite of exactly what you're talking about. And that's how screwed up our society is. So,
>> Yeah.
>> You know, but, but
>> It really is because there's this whole thing.
>> Oh, sorry. I was going to.
>> No, no, go ahead.
>> See, there's this interesting study. I don't know if you remember, uh, I talked about this study where in the '60s they did fasting because hypoglycemia is always people always concerned about that, right? But really, if you're not taking insulin or if you're not that bad, you really should never go hypoglycemic. So, anyway, what they did was they fasted people, I think they fasted them for like two or three days or something, then they gave them a big whack of insulin intravenously.
>> And that was like just to see what would happen.
>> So unethical. And their sugars crashed. They went down to like 30 or something like that, like really, really low. And the funny part was that they didn't feel it at all because they were so adapted to fat metabolism, ketones, fats.
>> But they didn't feel it at all.
>> So this hypoglycemia worry is like, it's a little bit overblown. But anyway, it is, it is sort of screwed up how, how everything has has become like there's this orthodoxy that gets thrown out there with no evidence. And if you challenge it, you're expected to produce all this evidence that, you know, you know, it's like, why? Like, it should be equal on both sides, right? So, you know, we're, we're at the point where fasting is sort of acceptable, but it was never from the doctors, of course. Like, as I started talking about it, it was really the public that started thinking, "Hey, here's another option that we can use, right?" And if it works for you, great. If it doesn't work for you, don't do it, right? I don't really care.
>> I can tell you that over the course of a decade, you have taken exactly what you've said, something that is absolutely contraindicated in healthcare, and, oh, you're ma, you must eat to to lose weight. You've got all those concepts you just talked about. And within literally a decade, there's hardly anybody that has access to the internet that doesn't know and doesn't appreciate, whether they do it or not, the value of intermittent fasting. And that is a direct and pretty much exclusive, uh, connection with you. You started that. And I mean, the brilliance of the simplicity of that brilliance is ridiculous. Now everyone's talking about it, but it is Jason Fung. It is not eating is Jason Fung.
>> Listen up, type 1 diabetics. In my opinion, it is malpractice to promote the consumption of carbohydrates in a type 1 diabetic and then cover it with insulin. The ideal is to stay away from carbohydrates, but even then, you may have problems regulating, especially early on as you convert to a more carbohydrate-based, low-carbohydrate diet, you may still have surges of blood sugar production by the liver and a degree of insulin resistance. Well, one of the best ways to combat that, and it's important to understand the difference, is to use Ketone IQ. This is an exogenous source of ketones that drives you into ketosis. The key thing is this: that it is an alternative fuel source, but it doesn't replace insulin. You want to be using insulin to drive sugar into your bloodstream. If the energy supply is sugar plus ketones, at first from exogenous ketones, you significantly lower your insulin requirement. You treat that early insulin resistance because once you are insulin sensitive as a type 1, you need far less, far, far less insulin. And using Ketone IQ, an exogenous source of ketones on a regular basis, reduces and stabilizes your blood sugar and makes you more insulin sensitive. Now, be cautious with dosing, but it is a radical way to give you energy when you don't want a bump in sugar and you can tolerate lower blood sugars. You definitely don't want to do this when your blood sugars are super high in lieu of insulin. If you're super high, you're in ketoacidosis. Don't add ketones to that. But if you're in a decent sugar range, but you're requiring a lot of insulin, Ketone IQ will get you to lower your average insulin requirement while still keeping a normal, normal range blood sugar. Try it as part of your therapy, as part of your conversion, as part of getting rid of insulin resistance.
To go back and talk a little bit about what, what you were talking about is even if people are eating two or three meals a day, generally their bodies can keep pace with what they're eating and there's a flux between eating and not eating, whether it's three meals a day, even if you don't do a lot of intermittent fasting. What has happened in the modern era is two major things: unprecedented abundant immediate access to food, um, and then the introduction, in my opinion, of a highly endorphin-activating form of food. So while intermittent fasting is a way to resolve this, what drove the problem in the first place is not just a normal pattern of eating, whether it's two or three, where the breakfast is the most me important meal of the day. It's a transformation since the 1970s of the nature of the food we're eating and the abundant availability. And what you've done extremely well is in *The Hunger Code*, broken down what has driven people unconsciously. Nobody chooses to be diabetic or fat. But unconsciously, how our society has driven us to eat more and more often and eat more of a food that has a positive reinforcement cycle that overrides any satiety signaling. And you've done a brilliant job of looking at three different forms of hunger in *The Hunger Code*. Can you break down for me what those three forms of hunger are and why what I call physiological starvation hunger is really just not an issue in this country anymore because nobody eats so infrequently that we would get to the point of nutrient deficiency to drive hunger. If we do, that's almost pathologic. So, so break those three down for us, and then we'll explore those, and I'm going to hammer you hard on this because,
>> that's kind of my territory for quite a long time.
>> Yeah. No, it's, it's totally. I, you know, I, I agree with you 100% because it really is one of the things that was sort of missing, uh, you know, like this whole idea of food addictions, ultra-processed foods, the quality of the foods make such a difference, which is not reflected in the calorie count, right? Because a lot of processed foods have good calorie counts. But, you know, just to back up a little bit, why I focused on hunger, um, is that, you know, again, if you think about this, this question about, uh, what's driving eating behavior, right? It, it turns out that you really have to think more deeply than sort of calories because there's this concept in logic called the three W's. That is, if you want to really get to the root of a problem, you have to ask the question "why" sort of three times. So, if you ask the question, "Why did the Titanic sink?" for example, you say, "Well, because it hit an iceberg." And that's actually a very useless, sort of, very superficial, um, sort of question-answer because if you're then to say, "Well, what advice would you give to future to prevent future marine disaster?" you'd say, "Don't hit icebergs." Right? That's not useful, right? So you have to sort of go past that. You have to really think deeper. So you can say, then, "Why did the Titanic hit the iceberg?" Right? That's your second why. You say, "Because the captain couldn't avoid it in time, couldn't turn around in time." And so you say, "Well, why couldn't the captain turn around in time?" And the answer is because it was going too fast. So the answer actually is the Titanic sank because it was going too fast. Now you can then say, "In the future, in bad weather, you need to slow down." Right? Same as if you're to get in an accident on an icy road, you're going too fast. That's the problem, right? Everybody knows that. It's not because the force of gravity exceeded the force of friction or whatever, you know, stupid, you know, thing. It's like that's the thing. So when you gain weight, it's the same thing. You have to say why. So, "Why did you gain weight?" And people say, "Well, because calories in is greater than calories out." So that's where that sort of calories argument lives in that very superficial first why. It's basically the "don't hit icebergs" advice. It's superficial. It's useless. Sort of like saying, "If you have alcoholism, don't drink alcohol. Don't drink so much alcohol. I just solved your problem." It's like, "No, you didn't. Like, you didn't solve any kind of problem. That's just stupid." So you say, "Well, why are people eating?" And the answer really is because they're hungry. And then you get to that third question, which is, "Why are they hungry?" Right?
>> Well, let's define hunger. I mean, that's what your book does. And I, I just wanted to throw that out there because your definitions of hunger have even educated me with a third one. But go ahead and and continue that narrative.
>> Yeah. So then the, you say, then the third why is, "Why are you hungry?" And there's actually several reasons. So there's the first reason, which is that physical hunger, right? Which is called homeostatic hunger. I think you call it, um,
>> Starvation. Starvation. Yeah. Where you're missing your body's missing nutrients. Even if you had the top of your brain cut off, uh, your body needs certain nutrients.
>> Yeah.
>> We rarely see that. And, uh, you know, in this day and age, and this is actually interesting because, you know, when you start fasting, you realize that that physiologic sort of homeostatic hunger, very few people actually eat for that reason, right? It's, it's like, so I've done these five-day fasts, and I've actually felt the hunger, and it's like, "Well, I actually don't get this very much at all, right?" In a regular day when I'm not doing long fasts, I mean, I do shorter ones, but I rarely get this. It rarely drives my eating behavior. So what is driving it? Right? And then you have to say, there's, when you start to look into the literature, there's actually two other main types of hunger. There's probably more, but the second important, important type is so-called hedonic hunger. And hedonic is a word meaning referring to pleasure. And this is the fact that eating is pleasurable, right? It gives you pleasure, gives you comfort, it makes you feel better, you like it, right? That's why you eat dessert, right? Because once you're full, you can still eat, uh, you know, apple pie and ice cream because it gives you pleasure. Not because you have that physical, you know, homeostatic hunger, but because you want to eat it because it looks good. That's like comfort food, right? You eat it because you're depressed. That's emotional eating. Turns out it drives a lot of eating behavior, especially, and this is where ultra-processed foods becomes a super big problem, as you alluded to. And then that tips into food addiction, right? So ultra-processed foods are a problem because they are deliberately engineered to sort of maximize these dopamine-driven reward systems in the brain. You get these, you know, there's there's a couple of things. One is that they're absorbed very, very quickly. So that by the processing, they're easy to chew. It basically melts in your mouth and then it goes down and so processed that the, you know, by the time it gets into the small intestine, the absorption is like practically.
>> Yeah. The processing bypasses enzymatic digestion.
>> So that there's, you, you don't have to rely on the gut to digest the food. It just gets absorbed almost instantaneously. Uh, but that, that is an issue right there. Um, the processing is the mechanical processing of that food. But there's something else when it comes to processed foods. There's something else that I focused on very heavily because what goes in your mouth and how we determine food as being healthy versus unhealthy is far more complex than the label that is attached to it. Um, the food that we put in our mouth is actually outside of our bodies. The lumen of the intestine is outside. It is only when that food is broken down and enters the system, um, as basic building blocks, do we actually have an interaction with it. So when it comes to hedonistic eating, there is not just a food aspect to it. There's a visual cue, there's a smell cue, there are so many cues before we even put that in our mouth that drives the hedonism, if that makes sense. And one of the things that I talk about quite a bit is that, and you and I are kind of not dissimilar. I think I'm a little bit older than you, but I tell patients this is that not a single plant that we currently eat that we buy at any grocery store, be it at Loblaw's or Publix, um, existed in its current form when I was born. So even the fruit that we eat, the foods that the plants that are supposed to be so natural and healthy are as highly processed as a box of Cheetos or whatever it may be. Grapes are supposed to have seeds. Strawberries aren't supposed to be the size of an apple. Tomatoes are supposed to be these gnarly, ugly things with flavor. They're clones. And that hybridization has happened in laboratories. And it hasn't enriched the nutrient content. It's enriched the caloric or the sugar content. And the, a large part of the manufacturing has been toward hedonistic triggers, visual triggers, that kind of thing. So, it's not just the, the ultra-processed in a box, multiple ingredients. It has happened generally with all of our food.
>> That's a, a great point because, you know, when they put out the, remember in the '70s, they're like talking about fruits and vegetables. They talked about it like that because fruits were nasty, right? I, I grew up in the '70s. Like apples were sour like crazy. You had strawberries, and they were sweet like for a week of the year, right? It's like it was crazy. Like they're great, but for a week, and then after that, they're nasty. They're sour like crazy. Pineapples were sour like crazy. Now, of course, you have every fruit under the sun, like available anytime, but they're so sweet, right? You got ultra-sweet, uh, strawberries, you have, you know, you have white peaches, which were never around, you have the golden pineapples, which were never around. So, all of that stuff. And then the watermelons always had seeds, right? Now, they don't have seeds, right? So, the whole thing. And also the wheat. The wheat has completely changed as well. So when you talk about wheat, you know, this goes back to the Green Revolution, right? They changed the type of wheat that we eat. So instead of regular wheat, they have dwarf and semi-dwarf wheat. Why not? Because they studied it and said it was better. It was because when you have the dwarf wheat, it doesn't fall over as much, right? So the entire thing was changed. The food, sort of, what we ate changed without us even realizing it. So, you know, I, I think your point is correct. I, I remember going to Italy and eating some of the foods, and everything tasted different. Like the fruits tasted different, right? The tomatoes tasted different. And it wasn't just because they're more local, which they were, of course, but but they were actually natural, more natural varieties. Like obviously they're not as natural as, you know, 100 years ago, but
>> you know, hybridized by Mendelian genetics.
>> Yeah. They were Mendelian, you know, where Mendel crossed peas and created new peas. So they were generationally,
>> the new stuff is all done in a laboratory with genetic engineering.
>> Yeah.
>> Uh, you know, in 1999, a Belgian botanist took the bitterness gene out of Brussels sprouts. Brussels sprouts were disgusting when we were growing up. Now they're sweet, and everybody's eating them. So, I, I think when we use the word "processed," it isn't just what occurs in boxes and and packages. Those are some of the worst ones. But we often get fooled into thinking and telling our kids and telling our friends that, "Oh, this apple or these grapes that are the size of an apple are healthy because they're natural." And that is as much a false concept as having, you know, Lucky Charms cereal being healthier than eggs. So, it, it just, the entire context is an issue. But, but go ahead and attach that to why our emotions are satisfied or why our emotional needs are triggered and satisfied by this type of food that carries more of a hedonistic appeal rather than a nutrient appeal.
>> Yeah. And the, the thing is that the, um, you know, they're deliberately, it's, it's quite deliberately like these foods are literally engineered for pleasure, right? So all of these, whether it's, you know, sugar pops or Lucky Charms or whatever it is, all of these foods because food companies are trying to sell foods, right? So they do it by giving you this big, you know, spike in pleasure when you eat it. And, and there's lots of ways they do that, right? There's artificial flavors, there's artificial colors, right? If it's bright and advertised and stuff, you, by the, you see it, you want it, right? Um, but there's texturizers to change the, you know, mouthfeel. There's emulsifiers, you know, they, they break it down so that, you know, it's so easy to eat. There's something called vanishing caloric density. You know, when it gets down, you can measure gastric transit times. They come out of the stomach very fast because, you know, in the stomach, your, your stomach is supposed to hold the food there, grind it up, mix it with acid, and then it shoots little boluses into the intestines where it gets absorbed, right? So, you know, there's a whole process that goes from the food. It has to be first digested, then it has to go into the intestines for absorption, which then influences the hormones, which then influences your weight, right? People go directly from calories to weight, but they're, they're skipping all these important physiologic processes that have been worked out over like, you know, decades of research.
>> But you're talking about, but you're talking about hunger. So there is a, a visual appeal that we see that drives that intensity to eat.
>> But then there must be a chemical, a chemical impact on the brain.
>> Oh, yeah. Yeah. And that's, that's the speed of the absorption because if you, by the time you process it, so it's so easy to digest, so easy to absorb, what you get is this really quick spike, right? So you get this quick spike in glucose, you get this quick spike in dopamine. Of course, you know, they, they've measured all these functional MRIs where they see all the sugar and when you, you spike up your glucose, you know, you light up all these reward areas in the brain. And so you're basically giving people pleasure, which is exactly what you see on a sort of, uh, person-to-person level, right? So when people talk about comfort foods and stuff, right? They're talking about, you know, highly processed carbohydrates for the most part, right? Nobody's saying, you know, "I'm addicted to salmon or beef or anything, right?" Like that, right? They're addicted to, you know, the mac and cheese and the chips and the Cheetos and all these sort of ultra-processed foods because, because they're so highly processed, they give you this massive spike, and that makes a difference, right? So, the speed of absorption makes a massive difference because if you think about things like nicotine, like smoking, why do you smoke cigarettes? Well, because the, the, the nicotine goes from your alveoli in the lungs directly into your pulmonary blood vessels, right? When you eat nicotine, yeah. And the speed of absorption is instant, right? When you eat nicotine, like nicotine gum, it's a way slower absorption. So the addictive potential is so much lower. You don't get that high. Same thing with heroin. Why do people inject it? It's not fun. They could eat it, but the eating is way less pleasurable, right? Cocaine, why do you sniff it? Well, it goes directly into the blood vessels in your nose, right? It's, it's the same anywhere. And it's the same thing. You're mainlining this glucose, but it's because you're processed it so much, right? It goes down so quickly. The gastric transit time is very fast that it gets into the intestines. When it gets into the intestines, it's so ultra-processed that it gets absorbed very quickly, right? So, that's the whole thing is designed to light up those reward centers. And then on the flip side, they minimize all the satiety because even if you have a quick spike, if you get full after a couple of bites, that's it. You're not buying any more food, right? So the food companies take away everything that creates satiety, right? So they take away the things like the, you know, there are baroreceptors in your stomach, right? When when you fill up the stomach, like a bezel, like hair, right? You stretch those baroreceptors in the stomach, which signals your brain that you're full, you need to stop eating. Ultra-processed foods are very, very small, like, you know, they, they just have no volume practically.
>> Exactly.
>> And then you think about how they don't have any protein. They're very low protein because that's higher in satiety. They don't have any fats and stuff.
>> Ultra-processed. Ultra-processed. And then by that time, you, you can keep going. You can keep eating. You can keep eating. You can keep eating because you can still get the hit of pleasure. Right? When you, when you stimulate something like GLP-1, for example, with Ompic, right? When you, and remember that GLP-1 is not, you know, those Ompic and stuff, they're not physiologic doses of GLP-1, right? They're super physiologic, they're pharmacologic dosing, right? So that can wipe out, like, that can completely, you know, turn off your hunger. That's because it's a massive dose. Well, that's, that's why you don't want those ultra-processed foods as much because you're, you're fighting it on the other side with these massive doses. But the point is that when you have ultra-processed food, you have maximum pleasure, minimum satiety, and that winds up causing a lot of eating behavior, which often tips into food addiction, which again,
>> Let me stop you for a second there because
>> I, I fully understand and appreciate the mechanism by which any drug gets you high. Be it heroin, be it nicotine, be it alcohol, be it carbohydrates, as you've described. And the nature and the rapid absorption that not everybody is vulnerable to addictive behavior. So who, there must be a psychological or a psychopathological, uh, uh, issue where people have a vulnerability to addictive behavior because we human beings are generally pretty smart. We recognize most people know smoking is a bad idea. Cigar, every now and then might be okay, but I'm not going to smoke because I know the consequences. Why is it or what is it about certain human beings that gives them a vulnerability to addictive behavior where there is no endpoint? I understand the, the psy, the, the, the physiology, but what's the psychology behind it? And as part of that, if you could also answer the question, then what is your definition of addiction?
I think an addiction to me is something that has the potential that you, for somebody to do it despite them knowing that it's bad for them. And that doesn't mean that everybody who takes it will get addicted. So not everybody who smokes gets addicted, but smoking is, can be addictive, right? Not everybody who takes cocaine becomes addictive, right? But that doesn't mean that cocaine is not addictive, right? Because it affects a certain number of people. Alcohol is the same, right? So lots and lots of people drink and are not, you know, are not alcoholic. They're not addicted to it. So, you know, that's an addiction. And to me, food is, ultra-processed foods, you know, starts to fall into that category because I think there are clearly some people who are addicted. Most people are not. And some people say, "Oh, that's ridiculous. You can't get addicted to food, right?" It's like, "No, no, you're missing the point." And they say, "Oh, food is natural. You can't not eat food, right?" And to me, those are stupid arguments because if you think about it, you know, "Oh, it's natural." Well, so is like nicotine. It came from tobacco leaves, right? Where did narcotics come from? Poppies, right? Marijuana. It came from, you know, the marijuana plant, right? That's THC. So, everything came from a natural source. It's the processing. By the time you process the, the, the poppies and turn it into morphine or, you know, dilotted or whatever, now you have a potentially addictive substance. But it's the processing. You take the addictive part and concentrate it, that's what's going to cause the problems. It's the same with food. So it's not foods that are addictive. It's the processed foods that are going to be addictive. And I think that if you look, you know, it's a crazy, uh, thing to say, "Oh, well, you can't not eat food." Well, it's like, you don't have to not eat food. You have to identify which food you're addicted to. If you're addicted to chips, then it doesn't mean you can't eat eggs, right? Just like if you're addicted to alcohol, doesn't mean you can't drink tea, right? That's a dumb argument, right? So if you're addicted to certain things and you know for sure, like people recognize that, "Hey, once I start eating this, I cannot stop, even though I know it's bad for me," right? And you see this on TV. I see this on TV a lot, actually. You know, those shows that are like, you know, these thousand-pound people, right? It's like they cannot stop eating. It's not ever like a big bowl of salad, right? It's, it's always some kind of ultra-processed food because that's what's driving that high. Like just like an alcoholic over, they're getting that high. They know the alcohol is wiping out their liver and they're going to get, they're going to die of alcoholism, but they don't care. They can't stop. That's addiction, right?
>> Well, I think one of the things that you've just mentioned now is actually for me the biggest reveal in this book. Uh, 'cause I work in the space. I mean, this is a large part of the foundation of the way I manage my patients. But the thing, and you've just articulated without saying it, is that what changed with tobacco is before it was heavily advertised. It was available everywhere. You could smoke anywhere. So there was a huge societal or social drive to normalize and actually encourage smoking. And as you said, when that was progressively restricted, we did less of it, and it was more easy to understand that this was a noxious thing to do. You, in your book, you mentioned the third form of hunger, you cover the third form of hunger, which is the big highlight for me, and that is what you've called social hunger, which are the cultural, the societal cues. You can see an ad for Lucky Charms cereal all the time on TV or for whatever the local latest carbohydrate is. Nobody advertises broccoli and steak on TV because it doesn't make money. But all the processed carbohydrates are heavily advertised to our young kids all the way through. And there are no, or very, very few social constraints on that. In fact, there is social encouragement on portion size, on multiple meals, on snacking. And a snack, to my mind, is always an emotional event, never a nutritional event. So we're encouraging all of these social cues that you have so well discussed in your book. Can you take that, the concept of social hunger, that you've outlined, a little further? I think that that's actually one of the most important types of hunger that we never talk about is this sort of social and environmental that, you know, the, the, the talk about obesity has been so long like personal responsibility. You see this all the time, right? But it's like, but it's not, right? Like there are whole countries in the world who don't face the same issue. Why do you think that Americans are simply less willpower or are stupid or whatever? I, I don't think so because, you know, Americans in general, I think are very hardworking and very intelligent, right? No different. But countries like Japan have extremely low obesity rates. Why? Well, it's the social environment, then. And this is something that in the literature is described as conditioned hunger, right? So this is what is acceptable, right? Because, and this is the whole, uh, idea of social influence, right? Social, like who you see, who you talk to, your friends, your family have a huge role in determining sort of what is normal to you, right? And that drives how, what you do. Like, if, if everyone around you is going for a hike, you're hiking, right? If everybody around you is eating French fries instead of salad, you're eating French fries, right? That's just the way humans are, right? We're social people. That's why, you know, in certain cultures, they eat this and that, and it's perfectly normal, whereas we like, "Oh, you're eating, you know, lamb brain? That's gross, right?" It, it's just what you're used to, right? That's all it is. And this is actually really important because if the social environment around us says, "Eat all the time. It's okay to eat. It's okay to eat in the car. It's okay to eat in front of the TV. Everything, you can, you can eat anything you want. Sugar doesn't matter. It doesn't matter how natural it is. Ultra-processed is okay." If everything around you says, "Eat, eat, eat, eat, eat." Guess what? That's what happens, right? So you look at a Japanese person in Japan, their risk of obesity is really low. You take that same Japanese person and plop them in the United States, guess what? Their risk of obesity skyrockets within a couple of generations. They're as fat as an American. Why? What changed? Well, it was just the social environment. So it's not an individual issue. And I always bring up the point that, hey, think about it this way. If you had a classroom of a hundred kids and and one person, one kid failed, you'd say, "Well, it's probably their fault. They didn't study, right?" What if 70 kids failed? Would you say it's the kids' fault? Or would you have to say, "Well, let's look at the teaching. Let's look at the teachers. Let's look at the learning environment because it's obviously an environmental problem."
>> So, in the United States, you have 70% of Americans overweight or or obese. That's not an individual problem. You can't treat it like an individual problem. What's wrong with the diet of Americans that they are getting so fat? And you take immigrants from everywhere in the world, and this, what's crazy is that they come to America and they get fat. It doesn't even matter where they come from. It's the food environment is so obesogenic. Why? It's the ultra-processing. Because if you look at the ultra-processed foods, it's like 70% of the diet of Americans is ultra-processed foods compared to
>> Also the social normalization and the, I mean, it's obscene the portion size, all the cues of our society of the complex that's trying to sell you food is so high. Just to segue again, your, uh, first book, *The Obesity Code*, if I may, and you can tell me I'm wrong, but if I may summarize it, and Tim Noakes way back when I was in his physiology class, even then in the late '70s, early '80s, talked about something called the glucose stat. And when it comes to insulin resistance, it really is a disruption of glucose regulation in our bloodstream. That's the diabetes that got you there. And he called that the glucose stat and blamed as much glycogen as he did insulin. But that's that book. Now you've introduced a new concept. Um, you've called it the fat thermostat. Um, I tend to call it the lipostat, but, uh, lipo being lipids, but it's the same concept, which is, and, and in fact, our friend Ben Bikman, who is one of the big researchers using, uh, lipid cells, has done a lot of science in this regard. He's worked with some insulin, but introduced to us the biologic fat thermostat concept and how you've explored this in this book and, and what you've proposed as some of the theory and some of the concepts that you are introducing to us as this new shift away from this being glucose and insulin to regulation in the fat cells and the, and fat regulation.
>> Yeah. So the, the fat thermostat. So there, there's an idea that we all grew up with that body fat is basically, if you eat calories, your body burns a certain number of calories, and it's totally unrelated. And if you have an excess, you'll just dump it into your fat stores. Therefore, if you wind up eating more than you are, you know, think you should be eating, it just gets dumped in. And so, you know, that's, that's the sort of concept that has driven the whole calories in, calories out argument. But it's completely untrue, right? It's, it's actually obviously untrue because if you look at the number of calories that a person, a regular person eats in a day, you know, over a year, how closely you have to regulate it to get to plus or minus one pound. So the average weight gain in a person is about a pound per year, right? Roughly. You have to match your caloric consumption and caloric expenditure to within like 99% accuracy without actually knowing how many calories you eat or how many calories you burn. Like, how is that even possible, right? Obviously, it's regulated just like your body temperature. And this is a process called homeostasis. So homeostasis means that you set a sort of, you know, a sort of certain, uh, level, and if it gets too high, it goes down. If it gets too low, it goes up. And it's like a thermostat, right? So, if you have a set, your room thermostat, and it gets really hot outside, it turns on the air conditioning. If it's really cold outside, it turns on the heat. Either way, you maintain that stable temperature. Or you're like your body temperature. Like, if it's too hot, you sweat. If it's too cold, you shiver. No problem. You get to that stable level. And body fat's the same. You actually set a certain level. And it must be regulated. Again, why? Because otherwise, we'd all die, right? If you have too much fat, if you're, if you look at wild animals, like, is there any morbidly obese animals in the wild? No. Because you die. If you're a predator and you're morbidly obese, you'll never catch anything. If you're a deer and you're morbidly obese, you're going to die. Something's going to eat you really, really fast, right? So, it's actually critical that you maintain the right amount of body fat. There's lots of times in history where there's been lots of food, right? Like, you know, the biblical story of Joseph says seven years of plenty. They didn't describe seven years of morbid obesity, right? Why? Because you set that level and you maintain it. So when you set that level and your weight goes too high, what happens? Your body turns off your hunger, right? And you can do all kinds, there's all kinds of, you know, overfeeding studies where they do this, right? If the body fat thermostat, they force people to eat so that their weight goes up 10%. What happens? As soon as the experiment stops, they don't eat basically for a month until their weight goes right back down. But the other part, which we always worry about, is that your body fat thermostat is here. You try to lose weight. The problem is your weight goes back up. You increase hunger or you decrease your metabolic rate. Why? Well, it's all controlled by hormones. Certain hormones are going to push your thermostat up, and certain hormones are going to push it down, right? So, if you think about insulin, what happens when you give insulin? People gain weight. It actually doesn't really matter who you are. Doesn't matter how much willpower you have or how much exercise you do. If I give you enough insulin, you're going to gain weight. If I take away insulin, like untreated type 1 diabetes, guess what? You lose weight. Again, I don't really care how much willpower you have, right? If you wipe out the pancreas, and they've done it.
With rats and stuff, right? With experimental type 1 diabetes.
We've done that, Jason. I've done my share of pancreatto. Yeah, exactly. And then you lose weight. And cortisol is the same. If you give somebody prednisone, I just don't care who you are, right? I don't care how much willpower you have.
Give you enough prednisone for long enough, you gain weight. If you have Addison's disease, which is too little cortisol, guess what? You lose weight. Why? Because it's adjusting that thermostat. GLP-1s is another example. If you just pump up the the the GLP1s, what happens? You lose weight. That's what Ozempic tells you. GIP with Mounjaro, you know, glucagon, retataglutide. What happens? So, so when you pump those up, you push the thermostats out and you lose weight.
But people often forget that there's been other weight loss drugs. If you pump up the sympathetic tone, you will lose weight, right? So, think about, I don't know if you remember Fen-Phen. Fen-Phen was that old weight loss drug. You know what the weight loss on Fen-Phen was? It was 17% of body weight. It was fantastic.
Some people died though. If you... Yeah. Not enough. That skewed the data. That's stupid. Yeah. But the problem, they went to zero. No, but it actually was a very effective weight loss drug. And how did it work? Well, it increased your sympathetic tone. Appetite went down. And before that, a generation before that, there were amphetamines. So speed was actually a routinely prescribed weight loss medication. And when you read people prescribed getting speed or amphetamines for weight loss, what did they say? You take it, your hunger goes away.
You think about nicotine, which is also a sympathetic stimulant. Nicotine makes people lose weight. How? It basically pushes your thermostat down, right? A little bit, not as much as Fen-Phen or amphetamines, but increased sympathetic tone is going to push it down. Um, you know, so, so sympathetic tone is huge. I mean, you think about things like testosterone. What happens when you, you know, before puberty, girls and boys have roughly the same body fat. After, girls have 50% more body fat. Why? It's not willpower.
It's because women have estrogen, and they develop breasts, and they get fat along their hips to prepare for childbirth. And boys have all this testosterone. They're not, you know, they're not lower in fat because they watch what they eat. Have you seen what, you know, a teenage boy eats? And those hormones also affect the distribution. So the testosterone, you're going to be more central adiposity, organ-based. Estrogen, more fluffy fat. Progesterone, uh, more lower body. So we see those, uh, different phenotypes based on those driven by the hormones. And then if you change the hormones, that phenotype may change. Both menopause and certain certain...
Hormonal changes. Yeah. If you take away, if you castrate somebody for prostate cancer, you see a change like their body fat goes up and their muscles go down. Like it's, it's very clear, right?
But that is that is somewhat separate. Uh, you're describing the physiology. How does the hedonistic override? You know, this book is "The Hunger Code." How does your drive to eat in a non-physiologic way, in a psychologic way or a societal way, override that, uh, lipostat or the fat thermostat?
Yeah. And that's where that's where you, you have to say there's there's totally separate things, right? Because if you're eating for emotional reasons, emotional eaters and stuff, you're going to figure out a way to satisfy that emotional hunger, the hedonic hunger, while not tripping over the homeostatic hunger, right? And that's where ultra-processed foods is so bad for you, right? Because in the past, like if you started to eat a lot of like, you know, if you're depressed or something, instead of being able to eat a bunch of cookies, right? Cookies have very little satiety value, right? Because they're actually designed that way. But like, you can't just keep eating, like, some steak because you'll fill up and then, and then they're going to bump up against each other. But that's where ultra-processed foods winds up being so bad. It actually cuts across multiple different types of hunger because not only is it so hedonic, but it has no homeostatic value. That is, it doesn't, uh, create satiety. And then it's super convenient, super cheap, available, and advertised everywhere, right?
So the whole idea of conditioned hunger is that you can pair two things together, and then you can create this additional hunger. It's very easy to do with ultra-processed food. So conditioning is this other, uh, there's a whole area of behavioral psychology. So the social hunger is that you get, uh, basically, if you think about Pavlov's dogs, that experiment was a classic in in conditioning because basically dogs will salivate when you give them food, they'll get hungry, right? But if you ring a bell and then give them food very soon, they'll learn that the bell signals food, and when you ring a bell but don't give them food, they will still get hungry because they've learned to pair that. Now, you think about this, and now we've paired in our modern society, you know, as soon as you get up, must eat. Get your coffee, must eat. Must have a snack. Must have lunch. Must have a snack after school. Must have a snack before bed. You get in the car, you eat. When you go to the movies, you eat. When you go to the mall, you eat. When you go to a sporting event, you eat. When you watch a movie, you eat. Every single thing, every day, you go around, every single minute, there's stuff telling you, eat, eat. There's all this conditioned hunger, and you're signaling all the time. And people sometimes call it the food noise, right? It's just this noise that's telling you, eat, eat, eat. That's not the homeostatic hunger. It's not even the hedonic hunger. It's the fact that because you've paired these two things together for so long, you start to expect it that when you sit in front of the TV, you're going to have a few potato chips or something like that, right?
So, how do you deal with that, right? And that's where you have to first identify it. Say, okay, this is actually a problem. So how am I going to change that, uh, so that you don't get it, right? And you can unpair things, right? And that's called counter-conditioning or extinction. So again, there's a whole area of of psychology that you can bring now, bring to bear on these important problems because...
But isn't that the focus of the Titanic story? That this, we can understand the physiology of why the Titanic sank when it hit the iceberg, but then you're talking about why did the Titanic hit the iceberg? That's the part. Because the other, the other question I get a lot, and and you can maybe shed some light on this, is if you look at India, right? 200 million, conservative estimate of 200 million people diagnosed with type 2 diabetes. They, the rice and the naan and the papadum that they eat has not changed substantially. And if you go to rural India, you see people this big without diabetes. Same thing with China. Same thing with South America. Although things have changed, and yet the rice that we eat, the potatoes we eat, the wheat that we eat, has that has the food changed that much? Or is it a shift in neurobiology that has driven this? The question I always get is, why in China can they eat rice twice a day, and then you come to this country, and we, you know, you get that question all the time. You know the question I'm talking about.
Yeah. Yeah. That is a psychologic transformation, not necessarily a nutrient transformation. How does that factor into this book?
Yeah. I mean, if you think about Asia, so China, because I don't, I'm not actually that familiar with India, but China in the 1980s, they did a big study, and they're eating 300 grams a day of carbohydrates. And I'm not talking brown rice, right? So my my parents were from that era, right? It's all white rice, all very like highly processed white rice. But what's the difference, right? So you're eating three gram, 30, 300 grams a day of carbohydrates, and people are thin. There's no obesity, right? It's, it's actually like 1%. It's...
And no diabetes as well. I, I... Yeah, exactly. And and and the the answer, I think, I mean, obviously it's just conjecture, but I think the answer is in the hedonic, you know, hedonic hunger because every day you're eating white rice and vegetables, right? Every meal practically is white rice and vegetables. So, how much are you going to eat? Just enough to not be hungry because it's not that much fun to eat another portion of white rice and vegetables because every, like, you know, it was very poor. China was very poor at the time. Very little meat, like not a lot of sugar. So, I mean, that was one of the other things. There's very little sugar. But every single meal is basically white rice and vegetables, right? It's like the Kempner rice diet. I don't know if you've ever, uh, heard of the Kempner rice diet. So I get this question too. It's like, you can do this with any food. If you make it the only thing you eat, you will lose weight. Why? Because very soon you will not be able to stand eating that food, right? You've taken the sort of hedonic hunger and turned it on its side. So if every single meal is white rice and sugar, like the Kempner, you know, rice diet, they said, "Oh, people lost weight." Absolutely. Because, you know, I'm not eating any more white rice or white sugar until I can't stand it anymore, right? Until I have so little nutrients in my body because there's like zero pleasure in it, right?
Now, you go from China, which ate 300 grams a day of carbohydrates and no obesity, and now they've of course been much more, you know, economically they've grown a lot. Obesity has exploded over there because they're still eating a lot of rice, but now there's all this variety, right? It tastes good. So all this hedonic hunger comes in on top of all that rice, and now all the sugar too, because a lot of processed stuff, and diabetes there actually exceeded the United States. It was insane. It's like I couldn't believe it. It's like, holy crap. You went from in one single generation from 1980 to 2020s, right? You went from virtually no type 2 diabetes to the most in the whole world, right? Even more than the United States per capita, which is just insane, right? But that is, how did you do that? Well, you had a background of a lot of rice.
Right. Well, that's exactly the shift that you, so well describe in this book, from the first type of hunger, which is the physical or the nutritional hunger, where you need certain nutrients to be able to fill your energy and your nutrient needs, which is that early 300 grams, whether it's the calorie source is rice or or whatever it may be, protein, carbohydrate, or fat. Now toward the emotional, hedonic eating. And so while the, while the content is not dissimilar, the motivation, the incentive, and the availability is vastly different. And as you said, uh, you're chasing the high, which is a positive reinforcing system, whereas hormonal control, nutrient hormonal control is a negative reinforcement system. Homeostatic versus addictive.
And the social, and the social. Correct. Yeah. And the social, um, um, the social, uh, what am I, habits have changed, right? So in in China in the 1980s, right, you're eating twice a day, maybe three times a day, right? At a table, you know, whatever. Now it's like modern, like, you know, you go to China, it's like being in any sort of first, you know, modern nation, a lot of people on their phones, eating, distracted eating, you know, eating while they're doing something else. And, you know, a lot of advertising. It's like, so the whole thing about the social hunger has completely changed as well, right? So it's not that homeostatic hunger anymore. It's not just the carbohydrates, right? Because the carbohydrates were always there. It's the sort of hedonic hunger and the conditioned hunger that have changed so much, right? And that's where we really need to start the the conversation, which I, you know, you've been saying for a long time, right? To look at these other aspects of eating behavior because they're very, very important.
Right. So without giving, uh, this book is called, it was "The Obesity Code," now it's "The Hunger Code," which is a natural extension. But without giving the entire, uh, "Hunger Code" away, you have, it's not just about the theory that we've talked about. There are some structural behavioral system changes that you recommend in the book. So there is a call to action. You mentioned the three golden rules. You've got so many actionable tips. Could you share a few of those just as a foretaste, as an appetizer, to people that want to pig out on the book, if I can put it that way?
Yeah. So, the golden rules are sort of the most important things. And that to me is one, ultra-processed foods for all those reasons we're talking about. Number two is maintaining sort of an adequate fasting period because again, it cuts across multiple sort of things. Making sure that you have a period of abstention, that you're not always eating all the time, that you're breaking some of these, you know, conditioned, uh, hunger. You know, if you're not going to eat, then then you can't develop the conditioned hunger, right? And then, uh, the third one is really to design your social space to be, to to succeed, right? Because the people you surround yourself with, the place that you live, actually plays a huge role in your behavior, right? It's, it's just a massive, uh, headwind if you're living in a place where, you know, food portions are big, everybody's eating ultra-processed foods all the time in very unhealthy ways, right? If you're, if you plop yourself down into that sort of environment, you, you can only resist it for so long because we're human beings, right? That affects us, right? And they've shown studies of that, right? You take military families, you put them in a county with high obesity rates, the risk of obesity goes up, right? If you have a friend who becomes obese, your own risk goes up by like 117% or something like that. Like there's a crazy increased risk. So those are the most important things, right? And that's, you know, not always easy, but at least if you recognize it, you can start to do it. And ultra-processed foods is probably the number one. That's my number one.
But then there's a lot of sort of little tips, um, you know, ways to, uh, lower the insulin levels, and that's the homeostatic hunger. So whether it's sort of changing your meal timing, like eating meals earlier is generally better than eating meals later. You know, if you eat the carbohydrates, try to eat them last rather than than first. Try not to eat naked carbohydrates, like carbohydrates on their own, like refined carbohydrates, because if you're taking like white bread and jam, which is just pure refined carbohydrates and sugar, when it goes down, it's just going to be like mainlined into your into your system, right? If you take it with like some eggs and some other stuff, by the time your stomach turns it all around, right? Now when it goes into the small intestine, you got a bit of egg, you got a bit of protein, you got a bit of fat, and you got a bit of bread, right? And that all gets absorbed, but not as quickly, right? And it's that speed of absorption that's really important. Um, and then, you know, I talk about the social aspects. I talk a lot about the mindsets because mindsets is actually sort of this really, really important thing. The way you look at something really determines your behavior. Just like smoking, right? When we thought it's the coolest thing ever, right? Remember when we were a kid, right? Joe Camel and all this stuff. We got so brainwashed. Marlboro Man. So we're so brainwashed by advertising. It was not that smoking was any cooler or less cool. It was the mindset that changed, right? You saw it from cool, I'm a cool guy to, oh, this is disgusting, right? The actual habit changed not at all. Smoking itself is not changed at all. It's only the perception. And that's the power of changing it, right?
So, when you start to change your mindset, and and there's a lot of things like ultra-processed foods, sugar, like you see the mindset around sugar has changed a lot. Like if you go back, I mean, look even in like, you know, in how you have these, um, in the hospital sometimes you have rounds with, you know, with lunch and stuff, right? I remember like 20 years ago, it was all soda. You had like one bottle of water, and it was still there at the end, right? Everybody got a soda. Now you go there, there's half of the half of the drinks are water, and they're all gone, and the sodas are barely touched again. It's the same soda that I drank 25 years ago. Nobody's touching them. It's the mindset that's changed. People see, oh, sugar, that's not good for me. I'm, I don't want it, right? So, it's not, you know, to change your behavior, you have to first change your mindset. And you have to start this with ultra-processed foods as well. And fasting, fasting is just a period of time that you need to make sure you have every day to burn off the calories that you ate, right? If you don't have a fasting period, how are you going to burn it off, right? That's that's the bottom line. But it's a change in mindset. That's really the first step. So if you're trying to change behaviors like, you know, uh, eating in front of the TV, again, there are ways. And so I talk also about habit change, right? How do you change a bad habit? How do you break a bad habit? And how do you, uh, create a good habit, right? And there's different ways. Again, lots of literature along that lines about how to do that. And nobody talks about it in in the weight loss circles, right? I'm like, why not? Like, this is like the most important things we need to talk about.
So, all of these, all of these things I go over, and that's why I sort of wrote the book, you know, it's been a while. My last book was almost five or about six years ago, actually. It was released six years ago. And, um, but there's just so much more important things that I thought, oh, this really needs to be discussed that, you know, I, I need to put it out, really try to try and bring some attention to it so that people can really start to say, "Hey, I get it. It's not my diet that's the problem, right?"
It's my emotions. It's my sleep. It's my habits. Let me ask you a question. Uh, uh, because the the fascination for me is the social hunger side, which is society-driven. It's driven by environment, local as well as national. We are trying, forget about the politics. We're trying to change some of that direction at least at a governmental level. We flipped the food pyramid upside down. We're in the process of making those changes. I have a lot of patients in Canada. I do a lot of remote work. A lot of Canadian patients. Can you share with us, or the absence, or just be silent if Health Canada is looking at this as a societal problem, perhaps like it did with smoking years ago? What pressure is there on the Canadian government, the Canadian infrastructure? Because health costs are national, and the best way to reduce the health costs is to improve metabolic health. Is anything happening in Canada from a political or a health policy transformation?
Or, uh, unfortunately, I don't think so. I think, I mean, this is why I've always, the new dietary guidelines, I was so sort of, you know, ecstatic with with the way it went, especially against the ultra-processed foods and eat real food being the main message, right? I mean, that's a huge win. And to me, that's the first step in really changing the mindset, right? It's like that smoking thing, you got to start with the, you know, this is, this is bad, so we need to regulate it and make sure it goes in the way we want it to. And, uh, you know, the United States has done a fantastic job between, you know, guys like yourself and Nina Taubes, who's been very active, uh, politically, and the MAHA movement, and Ben and Dickman, and all these guys like that. We've, we've sort of, you know, we all know, huge props to these guys because they've been able to sort of do something which honestly, I never thought I'd see in my lifetime, right? I've talked to guys, I've talked to guys at healthcare, like you get nowhere. Like, man, you talk to anybody in the university, you get nowhere. Like, they don't even want to listen to what we're saying, the stuff we're saying, right? It's like, even the fasting, like I remember I talked to guys in the University of Toronto and stuff, they're like, very interesting, but didn't change their practice one iota, right? Then I, then I talked to people, and there's like thousands of people who have reversed their diabetes. I'm like, well, why didn't the doctors at the University of Toronto even care one little bit about how to implement intermittent fasting? They could barely even be bothered, honestly. Right. It was...
Well, I would tell you, uh, um, Jason, that it's even worse than that, in my opinion. Uh, there's a guy by the name of, just for example, David Jenkins, uh, who Dr. Professor David Jenkins, doc, he was on my PhD committee, dedicated vegan, and the father of the glycemic index as a mechanism of managing, uh, diabetes. 1981, he wrote the sentinel paper on that. And, you know, my time under my PhD, I was indoctrinated by all of that vegan, vegan theory. So there is an agenda that is opposed to the things that we stand for in the management of diabetes and in the societal changes. They'd much rather have a vegan society, uh, rather than, and a which supports some of what I call the white veganism, which is the processed white foods, as opposed to a green vegan, which is more on the plant-based side. So, my concern with Canada and in speaking to people in the system is that it, it's lagging behind because of influential people that are agenda-driven. Here, we've been able to turn that upside down a little bit. But I, I am concerned because of the much tighter marriage between the economics of health and the economics of food industry in Canada. So I am concerned about that. And I, just one other comment. If people enjoy this book, they certainly should go backwards and read "The Obesity Code" as well, because the two, they're not separate. They are consequential. They basically are two, it's like "War and Peace," two versions of the same of the same book. So I'm very, very impressed, and and this is just such a good tome.
Are there any, is there anybody else, co-authors, or other people that you want to mention that have been part of this, or, you know, it's always a pro, writing is always a a team sport to a certain extent. Anybody else that that we should know about or or give a shout out to or follow?
Um, well, I mean, the writing was all mine, but obviously a lot of the stuff that we discuss in these sort of, uh, circles, I mean, Nina Taubes, Gary Taubes, Ben Bikman, you know, um, the, the Low Carb MD podcast guys, some Vanazati, there's a, there's a number of people. I mean, we all discuss these sort of issues a lot, uh, so it's, it's the Society for Metabolic Health, right? There's a lot of people in that group as well, and we didn't discuss that, you know, we have these these, uh, Google groups that we have, and we, uh, fart around these topics a lot, right? But it's, it's, I think we're really on to some really important topics that really deserve, uh, some, some sort of mention and discussion because I think it actually needs to, so that people can help themselves.
Yeah. And every one of those names are, because social media is out there, are people we should follow in conjunction with us. These are certainly friends and colleagues of ours. So, thank you so much for this. Uh, I really appreciate it. And go out there and get that book.
Thank you so much.
Thanks, Jason.