Transcription
One thing you mentioned earlier, which I've been thinking a lot about, is salt. And I think a lot about salt because I went to the doctor many years ago, and I think I was using this like Maggie seasoning that I put on my food. And the doctor said to me that my salt levels were too high.
And I, and then I've heard since then from other people that we're actually probably not getting enough salt in our diet.
Yeah. So I, I'm interested to hear that your physician would have said your salt is too high. That is very rare that that gets measured.
Sodium, I think you. Yep. They could have measured sodium, and that could have been higher. They absolutely could have. It's just not common. So salt has earned a terrible reputation because of a series of studies that implicated salt consumption as a cause of high blood pressure. And, and really briefly, as a, as a momentary physiology professor, that is a real effect. If you and I were to go eat salt, our body for the next several hours afterwards would retain its water in order to balance out the salt so that we didn't get too salty. So, we would retain water in order to keep our salt at a normal level. And so, that could be reflected by an elevated blood pressure.
Um, however, multiple huge studies have found that if you go to a population of humans that have high blood pressure and you tell them you need to cut your salt in order to correct your blood pressure, they may at most move their blood pressure by one or two points. It has an absolutely negligible, irrelevant effect.
Um, and it's because salt is not a key contributor to blood pressure. It's actually insulin resistance. Insulin resistance will force the body to hold on to salt. Insulin resistance will force the blood vessels to be very constricted. All of which play together to make for a very high blood pressure. So as much as we have been telling the world that we should be cutting back salt, no, we should have been telling them to cut back on what spikes your insulin, refined starches and sugars.
But with regards to salt, it's interesting for me to note where did that whole view come from? Within the United States, decades ago, there was a study that was published and they called it the DASH diet. Dietary Approaches to Stop Hypertension, D- Ah, the DASH diet. And in the DASH diet, one of the critical changes was to tell people to eat less salt. And when they found that when people adopt a DASH diet, it's amazing. Their blood pressure goes down. However, unfortunately, they also tell people to do lots of other things with the DASH diet. Like when they tell someone to go on the DASH diet, they also tell them to eat less sugar and less refined starches and sugars. Well, it's possible, indeed, I would say it's absolutely the case that what's actually lowering their blood pressure isn't that they cut their salt back, it's that they were cutting their refined starches and sugars back. And it's that that had the main effect. And the cutting the salt was just some innocent bystander.
But to put a fine point on it, in human studies, if you have humans cut back their salt considerably, they become insulin resistant. So take a healthy group of humans, say you need to eat less salt, and they do so. If you measure them a week later while they're adhering to this, they will be significantly more insulin resistant than before they ever cut back their salt. It's one of the ironies of the whole scenario where a physician may be telling a patient with high blood pressure, you need to cut back your salt, and they end up eating less salt, and yet their blood, their blood pressure gets worse. It's because the main contributor to high blood pressure is insulin resistance. And by telling them to cut back on their salt, you made them more insulin resistant. And that whole mechanism is because one of insulin's many, many effects is to want the body to hold on to salt and water. And so if you start cutting your salt, all of a sudden insulin says, "Well, there's little salt coming in. I need to do what I can to retain whatever salt we do have." And so it starts retaining salt and water more in order to try to offset the lack of salt coming in. And while insulin's going higher and higher, the body is becoming more and more insulin resistant. So salt restriction can cause insulin resistance in humans.
You talk about four pillars to eating in your book, "Why We Get Sick." You outline these four essential pillars to develop a strategy for maintaining low insulin levels and combating insulin resistance.
What are the four pillars?
Yes. So, when it comes to controlling insulin resistance, the key is to manage macronutrients. And the best way to manage macronutrients is going to be a strategy that helps lower insulin. Lowering insulin is the key to both slow insulin resistance and fast insulin resistance. So the more the strategy lowers insulin, the more effective it's going to be. And there are four pillars. So the first one, control carbohydrates. Second, prioritize protein. Third, don't fear fat. And then fourth, after the first three have been taken care of, four, frequently fast.
So with the first one, very briefly, by control carbohydrates, I mean that it is time to focus more on whole fruits and vegetables. Eat them, don't drink them. And then don't get your carbohydrates from bags and boxes with barcodes. That the more you're opening up a package and getting your chips or your crackers or your cereal or your bread, the more you're going to be spiking your glucose and your insulin. Keep that on the shelves at the grocery store. Focus on whole fruits and vegetables. That's going to be the key for number one, control carbs.
Now, while you're eating fewer carbohydrates, you need to eat something. And so, prioritize protein. I would say particularly animal source protein, which is the best source of all of the amino acids that humans need. And then with those proteins will come fat. Don't fear that fat. That's number three. Fat is very satiating when combined with protein. When fat and protein come together, we digest it better. Sometimes people will find that if they just have a scoop of whey protein, it can be very upsetting on their stomach. It's because we're not supposed to eat protein alone. In nature, that never happens. In nature, protein always comes with fat. That's how we should eat it. We digest it better. And human studies have shown that when a human eats pure protein, there's some degree of muscle growth, albeit microscopically minuscule. But when we eat protein with fat, we have significantly greater muscle growth than we do with the protein alone. So that is the three pillars that encompass the macronutrients or the big parts of our diet.
But once a person has done that, then they are well positioned to adopt a strategy, a structured strategy of fasting. And that can be, there are as many ways to fast as there are people who want to do it. There's no right way or wrong way. My goal by invoking that fourth principle, and I do think it should come last, once you've learned how to eat better food, your your body has adapted to burning its own fat for fuel. But it can take the, it can take, uh, intermittent fasting where it's one meal of the day you're fasting through. Um, it can do where people do alternate day fasting. There are countless different ways to do it.
Even if I'm in ketosis?
Then you don't need to do it as much because you're already lowering your insulin. So, if a person's already in ketosis, in fact, if a person were in ketosis and frequently fasting, um, depending on how lean they are, it's going to become extremely difficult to retain muscle.
Yeah.
So, those are the four pillars. It will be an extraordinarily effective way to address insulin resistance. But the problem, as I started at when I that I mentioned, is that while these concepts are simple, that does not mean they're easy. Because humans show addiction, addictive tendencies to only one macronutrient, not fats, not proteins. All of the evidence of the neurobiology of addiction in humans points to carbohydrates. And, and so as much as I lay out this simple plan, it can be difficult. And this is why the self-discipline required is difficult enough that it's why people find that they have to resort to, you know, relying on drugs for these kinds of things.
Physical activity?
Exercise is useful for keeping my insulin levels in check.
Yeah. Yeah. I'm really glad you brought up exercise. I'm an enormous advocate of exercise. The best exercise to improve insulin sensitivity is the one you'll do. And so if someone listening to this is an 80-year-old grandma, and, um, if she, if her form of exercise is walking around the street down around the block with her girlfriends, but then if someone else has the ability to go cross-country skiing or CrossFit, do it. So the best exercise is the one you'll do.
Now, having said that, the better exercise is the one that you'll do that keeps muscle. Um, muscle building work is going to be, minute for minute, a more effective way of improving insulin sensitivity than than any kind of aerobic activity. And that's because muscle is the great consumer of glucose.
Um, and back to the, in fact, not only does muscle eat the most glucose from the blood, but it's also how it eats the glucose when it's exercising. So earlier we talked about how insulin, it kind of comes and knocks on the door of the muscle cell, and then the muscle cell will open the door and allow the glucose to come in, thereby lowering blood glucose, unless the muscle is exercising. When a muscle is exercising, and I'm kind of mimicking the contraction and relaxation of a muscle, when the muscle is exercising, it has its own way of opening those doors. So there's an insulin-independent method where the muscle cell essentially tells insulin, "Insulin, I know normally I have to wait for you to come and open these doors, but I'm so hungry during this exercise that I'm not going to wait." And so the doors just open. So the contracting muscle has its own way to rush to pull the glucose in, which means of course that a person's going to have an easier time controlling their blood glucose, which in turn would mean a better time controlling insulin.
But the more muscle a person has, the easier it is. And this could be one of the reasons why if you look at longevity and look at the markers of muscle strength versus the markers of cardiovascular aerobic fitness, the aerobic fitness markers are terrible predictors of longevity. It's muscle and strength that predicts longevity for multiple reasons, including just a very active living and moving, but also because if you have more muscle, you're going to control your glucose better, which means you're going to control your insulin better. Then you're back to these variables that people use to predict or what are the most accurate indicators of longevity. It's who has the best glucose control. More muscle helps that happen.
There's a big debate around whether we should be calorie restricting and low-fat diet. Whether we should be calorie restricting and a moderate fat diet, or calorie restricting and a low-carb diet.
What's what's your take on that?
Yeah, I am unabashedly in favor of carbohydrate restriction. Um, I, I would say for two reasons. Um, that one reason I think that carbohydrates should be the macronutrient that is most scrutinized is because it's the one we eat the most of. 70% of all calories consumed globally come from carbohydrates. That is the one that has the biggest insulin effect. And that's a problem for all the reasons we've discussed.
But two, carbohydrates are not essential. Um, this is controversial. People don't like to acknowledge it, but there is literally no biological need that humans have for carbohydrate. Um, the, in the United States, a report decades ago from the Department of Agriculture looking at the needs of human nutrition, there's a quote there, and I'm not going to get it exactly right, but I'll get it pretty close. It stated in this document that the lower limit of carbohydrate consumption in humans is zero. In other words, there is no such thing as an essential carbohydrate. Now, I'm not saying, "Well, then let's not eat any of them." No, but I am saying, why is that the one we focus the most on? As 70% of all calories globally are coming from that one. You're telling me that we, most of what we eat comes from what we don't need. Why not put the focus on the things we do need? There are such things as essential fatty acids. Let's eat fat. There are such things as essential amino acids. So, let's eat protein and make sure we get what we need. And then on any remainder of the plate, we can get some other things that we want to nibble on, like plants.
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