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welcome back to the keto summit. i'm here with dr. jason fung. jason is anephrologist from toronto in canada. i first became aware of jason through hisetiology of obesity youtube playlist which is just a phenomenal series ofpresentations. i will link to those and jason's new bookthe obesity code: unlocking the secrets of weight loss, thewebpage at ketosummit.com that hosts this video. jason, thank you so much for joining me today.

thank you very much. thanks for having me. it's my pleasure. and i've really enjoyed those videos. i have to say i think you'rea brilliant critical thinker and you've certainly -- you've made me think really hardabout some of the problems that you talk about. but why don't we start aboutyou telling us about gino. so, gino is a case report that you publishedon your website today.

i know that you have permission to talk aboutsome of his details and his test results. yeah. i mean, this is a reader actually who wroteinto me and very briefly what happened is that -- i'll tell you that thishappens all the time that people get on the wrong track about type ii diabetes. and i can talk a little bit more about whathappened but his story was that he -- it's quite typical. he basically went to hisdoctor and gotten on, put on a lot of medications.

so, it's interesting but over50% of the american population is classified as pre-diabetic or diabetic. so, in fact, it's the majority of the population,which is scary. diabetes is the newblack. so, the thing is that when you go to see yourdoctor, what happens is that they give you medications. that's really what we're trained to do. you go tosomebody and you get medication and then you go back and get moremedication and more medication and more medication,

eventually get more oninsulin and then more insulin and then more insulin and more insulin. and that's pretty much what happened to him. he also got some advice from adiet and exercise standpoint to basically eat low calories, reduce your calories,increase your exercise, which is basically the kind of eat less move more advicethat we've been giving for about 30, 40 years. unfortunately, it doesn't work. weknow that it doesn't work because practically everybody has done it and itdoesn't work for everybody.

we also have large studies that show it doesn'twork. so the women's healthstudy, for example, shows that these sort of ideas where you can just cut off 2 your calories a day and walk for an extraten minutes and take the stairs, they simply don't cause weight loss. so, anyway, he did this for years and wasn'tgetting anywhere. and then finally, he read about some of whati was talking about which is that what we think about obesityis not quite correct, that we really have to treat the underlying hormonalcause.

and by applying theseprinciples, he is able to drop pretty much all his weight and his diabetesessentially went away. and you should see the pictures. they're quite stunningactually. yeah, it's really striking, the picture. was that his primary complaint? when hefirst went to a doctor, what was he complaining about? well, most of these people get diagnosed aspre-diabetic so it's mostly they

don't complain. they usually go there for their routine checkupand their blood sugars have been kind of creeping up yearafter year. and the thing is that what ideal with is a lot of type ii diabetes and it really affects a lot of people. and ithink that most doctors actually have the wrong idea about it, and this is an ideathat this is a chronic and progressive disease. i have a lecture that i call the twobig lies of type ii diabetes. and really the first big lie of type ii diabetesis that it's kind of progressive, that

once you get it that you have it for life,there's nothing you can do about it, you got to take your medications and then you'regoing to go on insulin and take your insulin and it's progressive. there's nothing you can do about it. it's likeaging. it's a one way street. you get older you can't go the other way. and that'sthe idea that's promoted, in fact, by a lot of people, a lot of doctors.

so, the american diabetes association talksabout it, diabetes australia, all the major diabetes associations have on theirwebsite something to the effect that this chronic and progressive, don't even tryto get better, is the sort of the message that's out there. and i think it's completely wrong becauseit's actually a reversible disease. and the thing about type ii diabetes is thatit's actually quite easy to prove that it's a reversible disease. if, for instance, somebody comes to me andsays, well, they're diabetic or pre-

diabetic and all of a sudden they lose 50pounds and they take themselves off their medication. you go, "okay, great. that's terrific." you don't go, "oh, you'resuch a liar. it's chronic and progressive. there's no way you can get better." and it's simply a case that if you lose thatweight that diabetes will go away. so,the question is, how do we get there?

and this is the problem with the diabetesassociation is that they kind of promote this idea that it only gets worse. so, 3 they're telling people to kind of give uphope now, just this kind of learned helplessness that they're trying to instillin the population that you shouldn't even try to get better, you shouldn't eventry some of these alternative dietary methods like ketogenic diets or other dietslike that. so, that's really important to understandbecause if you believe them then you'll just simply go along with doing what theysay which is taking medications, taking

insulin, and it's actually the wrong thingto do. the second big lie really is thatlowering the blood sugar is really the goal of therapy. because again, theproblem is that blood sugars are only the symptom of the disease. it's not thediabetes itself. so, you can take insulin, for example, tolower your blood sugars and it will. itwill lower your blood sugar. but you're going to gain a lot of weight.

everybodywho takes insulin knows that. so, this is the thing that always happensso that people start these medications or insulinthat makes you gain weight and then they come back and they say, "well, doc, youalways told me that i needed to lose weight and here you are, you gave meinsulin, i gained a bunch of weight. how is that good?" and the doctor never has a good answer. he says, "well, that's just the way it is. you should eat less and move more."

and the problem is not that you needed toeat less and move more. the problem is you started them on insulinand it's pretty obvious to see the problem is insulinso you need to get the insulin down, not up. and those are the things i talked about specificallyto type ii diabetes. but in the end, the idea is that this is actuallya reversible disease. it affects a lotof people and there's this kind of movement to kind of normalize it and say thatit's okay to have it. it's not okay to have it.

this is a disease that's completely reversible,that's completely curable. but our treatments are making things worse. so, therefore,we have to use the right treatments, not just say it's okay if it gets worse. it's notokay. because diabetes, type ii diabetes is theleading cause of blindness. it's theleading cause of kidney failure. it's the leading cause of amputations.

there'sdiabetic foot ulcers. there's heart attacks. there's strokes. it basically kills everypart of you. so, it's not okay. it's not okay that it's progressive. you need to say,"well, i have type ii diabetes. let me find an appropriate treatment for itand it's not medications and it's not insulin and it'snot the low fat diet."

we've done allthree of them and they're a complete failure. right. so, i know that gino wasn't directly underyour care then. he was areader. but, obviously, you do have a lot of peopleunderneath your care. i thinkthat's one of the things that makes you such an interesting person to listen to, isthat you are in the trenches helping people. you're not just a researcher sat in 4 some ivory tower.

so, tell me, what are people doing? so, if it's not themedication and just moving more and eating less as the solution, what did ginodo? what he did was he implemented a very lowcarbohydrate diet and used some intermittent fasting as well. so, what you have to understand is that thewhole -- it's a little complicated, but the whole ideaof type ii diabetes, what you have to think about is that really the body is justfull of sugar. it's not the blood sugar butit's the sugar in the body.

so, what happens when you take insulin? so, if yourbody, you're eating a kind of sad american diet for 50 years, you've gained a lotof weight, not all at once but a pound or two every year and then all of a suddenyou've got this big beer belly. you get the fatty liver and you get the typeii diabetes. that's very typical by the time you hit 50or 55 or 60. and that's what happens. then you get diagnosed with diabetes or pre-diabetes.

essentially what you have to think about isthat your body is basically filled up with a lot of sugar. and the reason is that with eating a lot ofprocessed foods. there's a lot of foods that really aren'tthat great for us. so, as you fill up withsugar, what happens is that the sugar that you eat, the carbohydrate, eventuallyspills out into the blood because our body is kind of full of sugar already. imagine that our body is a sugar bowl. you eat, the sugar comes in and then itspills out into the blood.

so, what the insulin does and what a lot ofthe medications do, things like sulfonylurea andthen most of the standard medications for type ii diabetes, they don'tget rid of that sugar. so, what they do is they take that sugar that'sspilled out in the blood and they basically just ram it back into your body. so, the body says, "whoa, what am igoing to do with it?" so, it sends it all elsewhere. it sends it into the liver, sends itinto the heart, sends it into the feet, sends it into the eye and turns a lot of thatinto fat.

and the problem is that you haven't done anythingabout this sugar bowl that's too full. your body is still full of sugar. so, the next time you eat exactly the samething happens. sugar comes in, spillsout into the blood, you take your insulin, you ram it back in. so, the bodyessentially just fills up with sugar. now, once it gets to a certain point, it reallycan't take anymore sugar. so, you try and use your insulin to kind ofram it in but

it doesn't go in. it's like that suitcase. when you're putting in your clothes andstuff, it fills up. but at a certain point it's really hard toput those extra two pairs of pants in. 5 it's the same idea. your body is now so full of sugar that eventaking the insulin you can't ram it in.

so, what do you imagine your doctor does? he gives you ahigher dose of insulin. he doubles up your dose of insulin. so now you're reallyramming in the sugar into your body. so, eventually it just fills up again. and atsome point it fills up and even the higher dose doesn't work so your doctorincreases your insulin again. and that's exactly what happens to everybody. so, people start with one medication and thenthey go to two medications and

three medications and insulin and more insulinand more insulin. so, you seethat when you started your type ii diabetes, you started with one medication,low dose and you wound up on like 100 units of insulin a day, for example. so,your diabetes never got better. you're taking more and more medications toget the same blood sugar result. so clearly, your diabetes has done nothingbut get worse.

and so what they try to tell you is that it'sworse because that's the way it works. that's the way that the disease is. but it's not the way it is. what you've done isyou've treated the disease entirely incorrectly because what you've done is youfocused on the sugar in the blood and you're just ramming it into the body andnot getting rid of it. so, you'll never get better. so, what happens over ten, 15, 20years, of course, is that all that sugar is in your body and every part of you juststarts to rot away.

so, you get the kidney disease, you get theheart disease, you get the strokes, you get the cancer, you get the blindness,you get the amputation, you get the diabetic foot infections, you get every kindof damage imaginable. and that'sbecause all that sugar is everywhere. it's the same as if you have a dirty kitchenbut instead of throwing out all your garbage, you just throw it under the sink. then you can pretend like your kitchen isreally clean but it still smells. that's the whole problem. you forced all this sugar from the blood outof the

blood. but you didn't get rid of it. you shoved it into the body. so now yourdoctor can say, "wow, look at your blood sugars are so good. i'm doing such agood job. i'm a good doctor." and meanwhile, you've got your heart attack,you're on dialysis and you've got a nerve pain like crazy because your nerves arecompletely shot to hell.

and you're going blind. and your doctor thinks that he'sdone a great job because your blood sugar is so great. but he's done a terriblejob because you're getting sicker and sicker. and the funny part is that in 2008 the firstof like five, six trials came out that proved that this concept of just focusingon the blood sugar was entirely incorrect. so, what they did was they took two groupsof people and one group got a lot of medications to force down thatblood sugar, the other people got

kind of a medium amount. according to the conventional theory thatit's all 6 about the blood sugar, you should do betterif you take a lot of medications to force it into your body, right? of course, it didn't make any difference. so whether your blood sugar, youroverall average was 8.5 or 7.5, it made no difference. and people were reallypuzzled by this because that was kind of -- the thought was that it's all due to theblood sugar.

so, they really should have known for quitea few years now that this paradigm of simply treating the bloodsugar is incorrect because that's not the disease. the disease is that your body has too muchsugar. you haven't takencare of the problem. so, if you look at it that way, then you canunderstand that the solution is actually very simple. if your body has too much sugar, you can dotwo things. you can stop putting it in or you can burnit off.

and that's what you need to do. what you don't want to do is just keep forcingit in, which is what we're doing with our current therapy, like 99.9% of typeii diabetics are treated by forcing the sugar in, right? so, think about your car. so, if you have a car and you're filling upthe gas tank but there's no more room in the gas tank soyou start pumping the gas into the backseat. well, okay, that's not very good.

you have too much gas. so, what areyou going to do? pretty obvious. you're going to stop putting the gas in thenyou're going to run your car a little while to burn it off. what you're not going todo is go back to the pump six times a day and keep pumping it in. but that's whatwe tell people to do. eat plenty of carbohydrates, cut your fatswith glucose to sugar.

and it's chain ofsugar that gets broken down. and we keep eating all the time. so, people say,"oh, you should eat six times a day. and don't fast." it's funny because peoplewho do it for religious reasons, they get told not to fast. but what happens whenyou fast? your body lowers down the blood sugar. that's what it does.

now, thatcar with too much gas, you got to run it. and you force your body to burn it off. you force your car to burn down the gas. you can do the same thing. so, if you look at it that way, the solutionis quite simple. one, eat a very lowcarbohydrate diet, so ketogenic diets are great. and there's tons of people whohave done ketogenic diets and reverse their if that is not enough, thenyou can do more.

you can run that car. if you take zero calories, if you fast fora day, you will force your body to burn 2000calories of glucose. that's what it'sgoing to do. and it's not that you have too little energy. everybody says, "oh, i'mgoing to be tired. i do a lot of physical exertion." good. you should.

because you 7 got too much energy, not too little energy. so, you got to burn it off. and that'sthe whole thing. yeah, you might be hungry. i'm not saying that it's the easiest thingin the world but you're not going to be sick. you're not going to be tired because yourbody will provide you the energy it needs.

and that's what you need to get better. ihave other people say, "oh, yeah--" it is funny actually because i've puthundreds, probably over a thousand people on fast. and when we started,people might say, "yeah, it might work but nobody will do it, right?" and i said,"i'm a doctor. my job is not to tell people what's easy todo. my job is to tellpeople what they need to do to get better."

whether they do it or not is not myproblem. of course, i provide support so that theycan do it obviously. but the key is not to give a solution that'sjust ineffective but easy. who wantsthat? it's like if you need to get surgery, youdon't say, "yeah, you know, you need surgery but it hurts a lot so, you knowwhat, you should just die." that'sjust ridiculous. if the solution is to change your diet andto fast then we'll provide enough support that people will be able todo it.

not, "here, take your insulinbut i know that you will get worse in the future. for sure, you'll get worse." andthe funny part is that the diabetes associations, they don't even pretend that youwill get better. they actually tell it to your face that, "hey,you'll take this insulin stuff and you'll get worse. count on it." but that's just the way the disease is.

but it's not. it's getting worse becausethey're treating it completely incorrectly. it's crazy because in any other field, ifyou have a success rate of 0% most people would just say, "okay, that's thewrong treatment. that's the wrong solution." they don't just say, "wow, that'sjust the way it is, so get with it." it's crazy to think that this is the way wetreat type ii diabetes which is honestly the 21stcentury kind of plague because it affects so many people and it affects so muchof what we do.

but haven't they got at least half the equationright? so, the analogy that yousaid with the car, what can you do to dispose of more gas? well, you can drivethe car harder and faster. so, maybe the recommendation to move moreis correct and you can dispose of some glucosemaybe doing some weight lifting or maybe even endurance exercise. that is at least helpful. it's helpful for sure.

but in terms of whether or not it's goingto make a difference -- like there are definitely peoplewho can but if you look at how many calories you burn, for example, doing exercise,it's very little. we've all gone onthat treadmill and watch that calorie counter and it goes up really slowly, right. we're not talking about 30-year olds. i'm talking about 80 year olds, 75-yearolds. so, you have to be aware that i'm talkingabout a 75-year old lady who 8 weighs 250 pounds who has bad knees and badhips and a bad back who really

can't even walk let alone run. so, i'm not saying that that 30-year old shouldn'tjust go ahead and do a lot of exercise. i think that is actually very useful. but if you're 75 and your knees hurtand you really just can't do it, then you live in -- i live in canada and it's likefreezing cold outside. it's difficult to exercise that much. so, if you think about it,the scales are totally off. again, yes, if you can do several hours ata time, that's

fine. but mostly people i'm talking about are goingto do maybe a little bit of walking, half an hour three, four times aweek. that's good for them. you thinkthat that's not much but that's good for them. and if you think about how many calories they'll burn, that might be 100, 150 something like that. they're walking slowly, right. let's face it.

they're like yourgrandmother. they're just not going to be out there running10ks and half marathons. so, the thing is, if you're going to burn150 calories four times a week and you really should burn in a day of fasting,say 2000 calories, because of that sugar, the scale is totally off. so, they will do much better with the fastingthan the other. the other problem with exercise is that itnever causes as much weight loss as

we think it does because there's a lot ofcompensation effect. so, again, it'sdifferent depending on your population. but for the general population, whenthey have done studies of exercise and they calculate how much weight peopleshould lose, and this is a well known phenomenon in research, the amount ofweight people actually do lose is often at least one-third. it's two-third less thanthey think it should be. and it's because if you do a lot of exercisethen you're going to compensate in your spare time that you're not exercisingby being less active.

and they see thisin studies of children in phys ed, for example. every study of phys ed in schoolshas failed. the reason is that when you put these odometerson kids, for example, and you measure how many steps theytake and you would do phys ed in school, what happens is that that childwhen they go home they're less active. if they didn't do phys ed in school when theyget home they're more active. so, the overall amount of activity in theday is actually the same whether you do phys ed in school or whether you don't. that's why this sort of things are not aseffective as you think they should be.

so, definitely there is an effect. so, yes, ifyou can do a lot of exercise, you will probably do pretty well. but again, there arelots of stories of people who are endurance athletes who developed type iidiabetes. tim noakes, for example. he ate a very high carbohydrate diet. he 9 developed type ii diabetes.

peter attia, right? he wrote all about this. he wasthis endurance swimmer and he was like 25 pounds overweight, swimmingthree, four hours a day. so, there are lots of stories out there ofpeople who have done lots of exercise but have not stillbeen able to get rid of the type ii there's sir redgrave who is the uk-- the british rower, yeah. -- rower who wound up a type ii diabetic ithink shortly after he retired.

so,again, yes, they are related but not exactly the same thing. i know i've certainly seen it in myself boththe insulin resistance in spite of exercise and then what you're talking aboutbeing really hungry as the result of doing a fairly moderate amount of exerciseand then being more sedentary too, certainly. if i do a huge bike ride then i'm definitelygoing to move my body a lot less as a result of that. and surely those things start to cancel eachother out.

so,what's going on here? when i walked down the street here in california,some people the rest of the world might considerit as quite healthy place, i would say that most of the people that i see are atleast slightly overweight. so, what'sgoing on? is this just about food choices or are peopleeating too much food? i think a lot of it has to do with the foodchoices that we make now. so, if youlook at overall trends, for example, you can see that much more people eat outthan eat it.

if you go back 50 years, right, there's alot more people who eat in fastfood restaurants. there's a lot more processing of our foodsand so on. andit's not necessarily that eating out is bad for you but they tend not to use thebest things. so, they'll put in a lot of sugar becausesugar, for example, makes food tastes really good and it's really, reallycheap. so, you can make a food taste amazing withvery little cost by simply putting more sugar in.

so, you see this with sauces, for example,barbecue sauce, all kinds of sauces. they're just loaded with sugar, ketchup andall these other sauces. and stuff you wouldn't probably never do yourselfpeople would do in processed foods. they inject chicken breast with all this sugarsolution and stuff and it makes it taste really good. so, the processing of the food is one of themajor changes.

so, we've made several changes in our dietaryhabits since the 1970s so it's interesting because there's two main changessince the 1970s in the way that americans eat. so, the 1970s seven dietary guidelines foramericans, of course, switched everybody to a kind of high carbohydratediet, which would have been 10 fine if everybody was eating kind of yamsand beans but nobody ate that and it was all white bread and pasta. so, the bottom of the food pyramid, whichi grew up with, was rice, potatoes and bread.

so, we're all told to eat lots of bread, lotsof bread because it's low in fat. turns out, of course, it wasn't that greatan idea to go to a very high carbohydrate diet. not that i have -- i think that insulin isthe main driver of gain weight so you can eat a high carbohydratediet as long as it's relatively unrefined, unprocessed kind of whole foods. you can still do very well. there are studies of people who eat lots ofyams and sweet potatoes and so on

and do fine. but there's lot more fiber, there's lot lessprocessing. but in canadaand the united states, carbohydrates generally means bread and pasta anddonuts and waffles and that kind of thing. that's what we ate because wethought low fat was so healthy for us and we ate lots of fat. now, that wasn't agreat idea so that a caused a lot of problems. but the second major changewhich nobody really talks about very much is the increase in food, in mealfrequencies.

if you look at the nhanes study, the nhaneswas a giant american survey of health trends. and if you look at 1977, the average americanate three times a day -- breakfast, lunch, dinner, that's it. if you go to 2005, that's gone up toalmost six times a day. so, people are eating all the time. so, you're not goingbreakfast-lunch-dinner, you're going breakfast-snack-lunch,-snack-dinner-snack. so, you're constantly stimulating insulin. so there's two important things whenyou're talking about development of insulin

resistance which is how high yourinsulin goes and how often you stimulate it. because it's always the case. it's a combination of the level and the persistenceof that level. just like if you are to make money. if you say, "i make $100." great. if you made $100 in a year it wouldn't bevery good but if you made $100 in an hour it would be very good. so, that frequency is very important.

it's equally asimportant as how high the level is. but yet we kind of ignore it and think itdoesn't matter. of course, it matters. so, those two changes actually are the twochanges you need, high levels of insulin, persistent levels of insulin to developinsulin resistance because that's what happened over time. so, you actually have to address both issues. so, youhave to change your diet back to a kind of a whole foods diet, one that doesn'tstimulate insulin a lot and then you have

to go to kind of three meals a day atleast with a period of fasting in between. because the thing is that the reason thatwe're all getting sick is that we've lost that balance. remember that fasting is really just the flipsideof eating. when 11 you don't eat, you're fasting. that's the technical definition of it. or we wouldkind of fast from say 7 o'clock p.m. we'd have dinner at 7:00 p.m. and say eatbreakfast at 7:00 a.m. there's 12 hours of

fasting. so, you've got 12 hours ofeating, 12 hours of fasting. nice balance. now, we eat the minute we get up to the minutewe go to bed. so now you havelike maybe six hours of fasting or seven hours of fasting and the only time we'renot eating is when we are sleeping. and we put food in our mouths all the othertimes. so now you've got like 16, 18 hours of feedingand six hours of fasting. so,it doesn't work.

our balance is completely off. so, in order to get us back intobalance, you have to, one, change the food back to kind of whole unprocessedfoods and then, two, make sure that you have a period of fasting every day. i mean, the very word itself, breakfast, isactually interesting because it's the meal that breaks your fast. what does that mean? it means you should befasting every day because if you are not fasting you cannot break your fast.

so,therefore, what people recognized long, long time ago was that fasting is part ofeveryday life. it's part of that balance between totallythrown off and nobody ever talks about it. they just talk about should we eat fat orcarbs, low fat, low cab, this and that. well, what about the meal frequency? what about reintroducing periods whereyou let your body digest what you eat? because when you eat you're puttingfood energy in your mouth and your body is

going to store it. so, if you putenergy in for 12 hours in a day and you let that energy come out for 12 hours in aday you're more likely to be in balance than if you're putting energy in for 18hours a day and then you can come out for six. you do that for several decadeand you wonder why you're gaining weight. well, i'll tell you why. your balance is completely off. i mean, it's crazy to thinkthat people will say something like eat six

times a day to lose weight. it's like,okay, well, eating doesn't make you lose weight. eating more is not likely goingto make you lose weight. it's like you should rub your hands in thedirt six times a day to clean your hands. well, rubbing your hands in the dirt makesthem dirty. that's the very definition. you don't do it more to get clean. eating more times a day is just not goingto make you lose weight.

there's noreason. you hear it enough people go, "yeah, that'sa good idea." that's not agood idea. why don't we go back to a time when we didn'thave the obesity epidemic and look at how many times they ate? it was two to three. and nobodycared if you skipped breakfast. they'd say, whatever, right? you skip breakfast,fine.

you skip breakfast. i don't care. there's nothing in the word breakfast that12 says you have to eat it as soon as you getup. you can break your fast at dinnertime. it doesn't matter. but you must have that period of fasting everyday. christopher okay. i'm quite drawn towards this idea becauseit seems to me that you're not

just replacing one nutritional bogeyman foranother. so, i've seen that in thissphere or community where before it was sugar that was the villain and now wejust swapped one macronutrient for another. so, do you think that's the mostimportant thing or is there something specifically evil about carbohydrate? i don't think there's anything specificallyevil about carbohydrates. so, in fact, ifyou look at populations, there are lots of populations that have eaten highcarbohydrate diets and done very well. so, what you have to do is try to explainthat fact.

if you look at the kitava, because everybody,it's been well-studied. so,the kitava were this kind of tribe in new guinea, i think. they ate about 70%carbohydrates. and they didn't have any obesity at all. and people would say,"wow, look. you can eat lots of carbs and have no obesityand no diabetes." that's true. if you measure their insulin levels, whichthey did, their insulin levels were at the

five percentile of the swedish population,which is because dr. lindeberg who did the study was swedish. so, he compared them to swedes. so, these peoplewere eating a lot of carbohydrates, had an insulin level which was lower than95% of the swedish average kind of european population. so, yes, you can eatcarbohydrates and have very low insulin levels. and that's the whole point. if we make the argument that insulin is themain driver of obesity, which is what

i do in the obesity code, then it doesn'tlogically follow that the only thing that raises insulin is carbohydrates. there's actually a lot more that goes intoit because insulin resistance, for example, affectsinsulin levels, fiber affects insul in levels, vinegar affects insulin levels, fructoseaffects insulin levels, fatty liver affects insulin levels, cortisol does, animalproteins do. there's so many different things. so, we have to kind of move past this ideathat it's all just carbohydrates because it's not.

lots of people -- so, the okinawanswere a notoriously healthy in the old days. now, they're kind of becomingwesternized. but in the old days they eat tons of sweetpotato, very high carbohydrate diet, and yet they are one ofthe longest lived people on earth. andit's not that carbohydrates are intrinsically bad. i think what's intrinsically bad isthe processing that we do to carbohydrates. so, the bread and the refined grains and stuff,you take out the fiber, you take out the fat.

so all these things make insulin go higher. so, when you eat -- ifyou're to look at say a glycemic index, because the glycemic index forcarbohydrate food is very closely approximates the insulin index. you can look at 13 two carbohydrates foods, beans, for example,and white bread. the glycemicindex is very different. you can take 100 grams of beans and you canlook at that glycemic index and you can see that it doesn't raise the bloodglucose very much and, therefore,

insulin also doesn't go up very much. but if you eat a couple of slices of whitebread, insulin and glucose goes way up and you know that insulin goes way up tofollow. so, you can't say that it's simply the carbohydrates. and this is to yourpoint of switching bogeyman, right? at first, the big bogeyman was fat and thatwasn't a great idea. and then we switched it to carbs and thenwe switched it to sugar. i mean, they all have a grain of truth.

but the question is what's the language thebody talks? because the body doesn't give two shits aboutcalories. there's nobomb calorimeter in our body. it doesn't measure calories so it doesn'tcare about it. and it really doesn't care about carbohydrates. but it cares aboutinsulin. because if the insulin is high it respondsone way, if insulin is low it responds a different way.

and we can measure these differences. so that's whatwe need to know. because we need to speak the language thebody is speaking. you can't go and demonize calories becauseyou can take two foods, say a plate of cookies and a salad, with the same amountof calories. the minute you put itin your mouth the cookies will spike your insulin and the salad with olive oil willnot. so, they're vastly different for the sameamount of calories. therefore,calorie is not the language that the body

speaks. so, why arewe obsessed about calories is truly beyond me because my body doesn't care ifyou ate 100 calories or not. but when that insulin goes way up that's instructionfrom my body to react a certain way, which is to store fat. whereas you eat -- say, i drink a cup of oliveoil and it's got like 500 calories. butinsulin doesn't go up at all. so, that's instructions to act a differentway. and youcan debate about what way it is but in the

end you got to find out what it is thatthe body really cares about so that you can make those adjustments. this kind of brings me around to one of thethings you've talked about which i think is most interesting and that'sproximate versus ultimate causes. and i instantly recognized this from the conversationsi have with my two-year old daughter. like any kid, she continually asks why. and the reason she askswhy is because i haven't satisfactorily answered her question.

so, she will see afat guy and say why is that guy fat? i could say, "well, he consumed morecalories that he expended." and technically that's the correct answerbut you 14 know what she's going to say. why? why did he consume more calories than heexpended? why do you think that's happening? and maybe can you just explain thedifference between a proximate and ultimate cause?

yes. so the proximate cause is what happens immediatelyupstream. so, if yousay the proximate cause of fat gain is too many calories in versus how manycalories out, it's not a very good way to approach how you treat people. becausethere's something that caused it. and if you don't treat that, then you're notgetting to the kind of root cause. so, if you take the example, for example,of a plane crash.

a plane crashes because gravity was strongerthan lift. that's true inall cases. just like the first law of thermodynamics. it is always true. so, therefore, you might say, well, if that'strue, then all you have to do to prevent all plane crashes in the future isto have more lift than gravity. boom. bigger wings, less weight, you're done. it's obvious, right?

it's the law of gravity. it's just not the general suggestion. it's the law. well, obviously think that's reallystupid, right? because what caused the lift to fail was,say, inclement weather, poor training or mechanical failure. and that's the ultimate cause. that's whatactually caused the problem. so, therefore, if you have poor pilot training,lift

fails and then, therefore, lift goes down,gravity is the same, boom, you crash. so, if you treat the proximate cause and justbuild the plane with ginormous wings, you will still crash because the pilothas no training will still crash that plane. and then you're going to wonder why. you go, "wow, it's the law ofgravity. how can it be wrong?" it's because you didn't understand. it wasn't thelaw that was wrong.

it was that you had the wrong idea. you're treating theproximate cause. so, if you treat the ultimate cause, you'llsay, "wow, the ultimate cause is poor pilot or human errorand we need more training. orinclement weather and we need better forecasting or we need better scheduledmaintenance." and, therefore, when you treat the ultimatecause, therefore, you are able to actually reduce problems. and the same thing happens with alcoholism.

and isay alcoholism is the same. there's too much alcohol in versus alcoholout. so,again, if you look at the first law of thermodynamics for alcoholism, you saythat's always true because you can't manufacture alcoholism from thin air. so,therefore, it's always true. therefore, if you simply stop drinking alcohol,boom, you're done. you've cured alcoholism.

15 well, you haven't. you have done nothing. because you're just looking at theproximate cause. what was the ultimate cause of alcoholism? well, it's anaddictive drug. there are people who have a lot of socialproblems or they have problems and that's why they have turned toalcohol. that's the ultimateproblem.

so, if you treat alcoholism with alcoholicsanonymous, which is support groups and peer support and stressrelief and all this stuff, now you're getting and acknowledging that it's addictiveand going for substance abuse counseling and that kind of thing. now, you're actually going to make adifference because you treated the actual ultimate cause. if you just treat the proximate cause andsay no more alcoholism, you haven't done anything. then that's the thing.

if you look at proximate cause you thinkyou're being very logical but you're really just being very stupid. you don'tunderstand what's going on. and the same thing happens with calories. theproximate cause is calories in, calories out. it's always true. but what causes thecalories in to go up and what causes calories out to go down? well, that's theultimate cause and that's what you really

need to know. this will be unspokenaccusation. there's a problem with all these calorie theorists, is that the unspoken accusation is that it's your choice. eat more calories or reduce your caloriesout. so they say, okay, calories is themain ultimate cause because that's the proximate cause but the ultimate causeis you. you let yourself go. you didn't want it bad enough.

you didn't follow thediet. i don't think that's true at all. i think that you're looking at the proximatecause. and for instance -- and that was just recentlyshown, that big kevin hall study on the biggest loser. what you find, of course, and you're familiarwith that, right? it's all over the news for a while. yeah, i'm familiar.

when they followed the biggest loser contestants,their calories out went super, super low. because you never treated the ultimate causeof the obesity. youdidn't break the insulin resistance. you didn't give them a treatment that actuallyworked which is -- so their diet was eat less, move more, right? they ate a lotless. they moved a lot more. their metabolism just went to nothing.

they'reburning like 800 calories a day less. and that's the thing. if you say calories in minus calories out,you assume that calories out stays stable. it does not. it absolutely does not. so, therefore,nobody is breaking any laws of thermodynamics here. what's happening is thatyou reduce your calories in and you cause

your calories out to reduce. so, youstart out, say, at 2000 calories in, 2000 calories out -- and this is what happens toeverybody. you reduce your calories in to like 1200 andyou think that this 16 calories out will stay at 2000 and then you'rejust going to lose weight like crazy. that never happens. what happens very quickly and forever, likefor six years of the biggest loser, is that your body just does this. now, you're eating 1200 you're burning 1200.

you're not losing weight. the problem is you're burning 1200 and youstill feel like crap. you're cold. you're tired. you're hungry. so then you say, "okay, well,i'm not going to eat 1200 anymore. i'm going to eat 1500 because i feel likecrap." your body is still burning 1200 because itwants to regain its weight,

boom, all your weight comes right back. and now, you feel like crap, you feel worsethan you did originally because before you're burning 2000 calories you werestill overweight but you're at least not feeling so lousy. now you're feeling lousy and you've regainedall your weight. it's such a bad strategy. i mean, for so many years, all based on thisfaulty understanding what thermodynamics actually mean.

and these peoplewould just say, "oh, just cut a few calories." and there's so many people whojust say that, cut a few calories, cut a few calories. that is guaranteed to fail. guaranteed to fail. we know why it happens. we know why it fails. we have 30 years of experience. who hasn't reduced their calories in?

99% of people have done it. i've done it. and it doesn't work. we all know it doesn't work. so, to continue to advise people just to reducetheir calories and focus on calories, remember your body just doesn'tcare about calories. so to focus onsomething your body doesn't even care about is ridiculous. but the strategy itselfis so bad that i find it almost laughable

if it wasn't so serious that people wouldfocus on something that is so irrelevant. there's an overlap between insulin and calories,of course. i say that calories arenot relevant because it's not what the body cares about. but almost all caloriesraise insulin to some extent., unless you drink pure fat which very few people do. i mean, bulletproof coffee is one examplemaybe of a pure fat drink. but if youdrink pure fat you may not raise your insulin but almost no food that we eat innormal society is pure fat.

so, almost all foods will raise insulin. but they don't doso in the same degree. so, if you eat salad with salmon you can eatthe same calories but it will stimulate insulin a lot less. the bread slices will raise it a lot moreso, therefore, it's much more fattening. that's what i'm saying. there's an overlap herebetween calories and insulin. but we focused on the wrong thing.

we should 17 have been focusing on the insulin responseof the body. we focus instead on thecalories because it's easy. it's easy to measure. you can read that package offood and say it's this many calories. when you just try and reduce those caloriesand the problem is when all those calories are highly processed, they're alldesigned to stimulate insulin maximally. so, you take food which is like thosehundred calorie packs. your insulin probably goes way up.

it's 100 calories butit's all like processed like wheat and sugar. it's just enough to make you really, reallyhungry. you think you're okay but you're not. you're much better eating 500 caloriesof say protein and fat, like nuts. that's the funny part, right? so, we have allthese studies and the predimed study and all these studies aboutolive oil and nuts, for example. it's been fairly well established. and all thesepeople talk about mediterranean diet.

well, that's a much higher fat diet and,therefore, it has more calories. so, nuts are very high in calories. they have a lotof protein and a lot of fat. avocados, very high in protein. it's very high in oil so, therefore, a lotof calories. but what we're starting to recognize is thatthose are very healthy foods because the insulin response is not that high. so, you can take a lot of calories but itdoesn't stimulate the insulin so much so it doesn't give your body the instructionto hold on to that fat.

so, eating a lot of these healthy fats, forexample, will give a lot of calories but not a lot of insulinso, therefore, your body doesn't want to store it because it has no instruction tostore, which is the insulin. it has a lot ofcalories. but what does it do? it burns it off. and, therefore, you can keep yourmetabolism running at a high level using a much higher fat diet. and that's the mistake we've made.

we've gone through a very low fat diet and,therefore, that's the problem that's why we get into this biggest loser sort ofproblems where they just -- their metabolism just shuts down. but i think it'skind of ironic, is that people talk about this kind of metabolic shut down and it'skind of like discussed all over the place and what nobody real ly had an articleabout is how do you fix that? because that's really what we want to know. howdo you fix that? and that's what we can do.

we know the science behind it. we can fix it. well, don't stimulate insulin butgive a lot of calories and your metabolism will get better. the other one isfasting. fasting is quite interesting too because itforces the insulin way down. and then so how do you -- have you ever measuredsomebody's body composition as they go through an extendedfast? because one of the concernsthat i had from looking at the work of george

cahill and the minnesotastarvation experiment was that you saw a lot of lean tissue loss as well as the 18 and so you might lose some -- so when youlook at an obese person they want to be inefficient with their calories. they want to up-regulate theirmetabolism. and muscle is one of the most metabolic activelyactive tissues. so,the last thing you want to do is get rid of some muscle during an extended fast. have you actually measured somebody's bodycomposition and seen it change

over a fast? no. i don't have access to that but i'll say this. first, the minnesota starvationstudy was interesting because it was not a starvation study. they took 1500calories a day. so, it was actually a calorie reduced diet. and what happened, ofcourse, their metabolism is just same as the biggest loser.

they just totally gotshut. the metabolism like dropped 30%. so, it's exactly the same thing as thebiggest loser. the exact same data. the fasting is completely different. so, the problem with the print scans is thatthere's two issues. one is that everybody assumes that loss ofprotein means loss of muscle. but it doesn't.

there's a lot of other tissues, a lot of connectivetissue that i think can be gotten rid of. so, there's a whole process calledautophagy which is where you stimulate the breakdown of these kind of oldsubcellular parts. and you can actually show that they actuallyfeed into gluconeogenesis. so, yes, you are burning protein. but i'm not sure that that's a bad thing becausei think that there's a lot of excess protein. so, if you lose a lot of weight, for example,you have this connective

tissue because that's what was holding thefat cells, that's your skin and so on. and so i'm not sure. yes, you do burn some protein. but i don't think it's muscle. second is that if you look at the -- thereis some data from kevin hall. he did anextended fast and measured oxidation. so, carbohydrate oxidation, proteinoxidation and fat oxidation. now, what i'm going to show and has been shownkind of over and over again, even with cahill's data, is that the protein,you have a baseline kind of protein

oxidation. it doesn't go up. it goes down very slowly though. you continue tohave some protein turnover. but what you're not doing is you're not revvingup your body to burn protein. you have the kind of normal turnover and that'sit. because if you think about it, if you haverepeated -- so, a couple of questions. why would the body store energy as fat ifit planned to burn muscle?

it doesn'tmake any sense. that's like saying, "oh, i'm going to storea lot of firewood in case i need it for the winter." but when i need it, i actually chopped ofmy sofa and throw it into the fire. and then i have all these firewood. why would the body do that? now, 19 it doesn't make any sense.

so, yeah, some protein gets burned but i thinkthat's actually good thing, not a bad thing. and, two, if you look at the actual amountof oxidation, so initially carbohydrate goes way up but then after two, three daysit's kind of completely gone. all the glycogen is gone. and then fat oxidation goesway up. but protein does not, never go up. it has a small blip and then it goes downand continues to go down as you go.

and what you can show is also that the amountof protein is reclaimed through the urine. so, you have a lot of, in terms of theammonia stuff, cahill's data, look at all that. so, the thing is that if you thinkabout it, if you think that you store fats and burn muscles as soon as you fast,think about what would happen in the caveman days, with the lions and tigers,who will routinely go three, four, five days without fasting. so, if you keep doing that where you eat andthen don't eat for five days, as may have happened in the caveman days, you'regoing to store fat and burn muscles,

store fat and burn muscle. eventually, you're going to just turn into100% fat. that doesn't happen. those cavemen, those kalahari bush people,those indigenous american indians, they had no fat. because when they didn'teat for three, four, five days, because it was winter and there's no food, theyburned fat. that's exactly what kevin hall's data shows. when the chips are down, you burn fat becauseyou stored it.

not for the firstcouple of days. and the first couple of days are actuallyjust burning glycogen, carbohydrates. but this whole worry that you're going tolose all your muscle mass is kind of ridiculous truthfully. people have fasted for 2000 years minimum. so, they talked about it, jesus christ talkedabout it. so, you know that at leastthere's 2016 years of fasting. every time around easter they talk about the40

days of lent and this and that. so, people have fasted for that many years,2000 years. so, do you think that when people are fastingregularly people are just falling down on the streets? no, not really. they did their fast and then they went onwith their day because they burn fat, they burn sugar and that's it. they didn't allof a sudden become weak as kittens.

it doesn't make any sense. if there wasgoing to be a problem with the fasting the way that we do it then nobody does40 days and 40 nights anymore. we would have known about it a long, long,long time ago. i mean, there are problems with fasting. there are re-feeding syndromes. thereare different things that you do have to watch out for.

but severe musclebreakdown is not something that i worry about. i mean, i put like over athousand people on fast in varying durations. zero people have come to me and 20 said, "well, my muscles are so weak i can'tget around." in fact, a lot of them say,"wow, i have so much energy that i just don't know what to do with it anymore." and the reason is that we've kind of unlockedthose fat storage. we forced yourbody to burn some of the fat stores and they have like 100 pounds of fat there.

they're suddenly releasing it all and they'relike, "wow, i have energy to spare." and the thing is that if you look at leanmass of the biggest loser people who remember of doing like six hours a day ofexercise, their lean mass was still going down. so, it's not like it's zero lean mass whenyou lose weight anyway. so, everybody gets all worried about thatbut it's like i don't worry about that at all. and people talk about, "oh, what about nutritionaldeficiencies and this and that?"

like, okay. let's think about this for a second. if i have somebody in frontof me who is 300 pounds type ii diabetes and is going to have diabetic footinfections, amputations and blindness and kidney failure, what you need to do istreat that diabetes. the fastest way i know how is to put themon a fast. that willget the sugars down. that will get the weight down, yes. is there a problem?

there actually could be problems. but those are potentialproblems that i can deal with. what i want to deal with is the problem rightin front of me. i don't worry that he has nutritional deficiency. like scurvy? vitaminc deficiency? are you kidding me? like i'm not going to treat the problem rightin

front of my face because i'm worried aboutscurvy. i'm not worried about scurvy. i'm not worried-- you're worrying about reshuffling the deckchairs on the titanic. exactly. so, i mean, yeah. i mean, sure. maybe there are some muscle loss. potentially.

you saw that even when you're exercising sixhours a day. so, i don'tdoubt that there is some. is there going to be loss of connective tissue? yes,absolutely. i hope there is. because what are you going to do with allthat excess connective tissue once all the fat goes? so, i hope that there is? is there aautophagy which is again a protein clearing

out process? i hope that there is. so, there is all these things that i do wantto happen that i need to face right now because that's the problem, not some potentialproblem in the future, therefore, i'm not going to treat this guy with the besttreatment i know how. it'sridiculous, some of the people, they're like, "oh, yeah, we have muscle loss." okay. so then who's going to have diabetes, blindness,dialysis and nerve pain

and then we'll cut off his feet? that's better? you've got tobe kidding me. it's ridiculous. 21 there's a problem here. treat it. it's like chemotherapy. are there going to beproblems with chemotherapy?

hell, yes. your hair falls off, you're nauseated, allthis stuff. it doesn't mean you don't treat that cancer. you got to treat it. so, ifsomebody staring me in the face and saying, "i need to take care of thisproblem," then take care of the problem. and then you can deal with the restlater. if somebody just has the five count salute,yeah, that's not the appropriate person to put on this severe fasting regimen.

that's not what i'm talking about. we never do that. we never have a protocol for everybody. so, if you came to me and you said you wantedto fast for 30 days, i'd say you're crazy. you don't have enough fat that you need toand it could be you could start losing muscle. but the guy -- i had a 75-year old guy i sawthis morning. he haddiabetes for 35 years.

he was like 380 pounds. he went on 30 days of fasting. is itappropriate for him? in fact, he felt so good he's done it a couplemore times since then because his diabetes justwon't go away and his weight won't go down. it goes down when you fast but you have tokeep at it. so, you have tochoose the appropriate tool. the context is important.

so, there's some people that, oh, sometimesyou see these comments that are like, "oh, you know--" they havelike three pounds to lose and they're actually body builders and then they wantto fast. i'm like, okay. you're totallytaking what i say out of context. this is not for you. don't take it like it's for you. you have three pounds to lose and no diabetesand your main goal is to build muscle.

don't fast. that's not the right thing. you want to do something else. butif you're 300 pounds, do no exercise and have type ii diabetes, yes, then it maybe the appropriate thing for you. and that's why we individualized all of itfor people. so, do people need to be supervised? if they're watching this video and they seethe context and they see this might be relevant,

do they need to be medicallysupervised or is there something that people can do by themselves? if you're on medications, then you shouldbe medically supervised. if you're noton medication and you're simply pre-diabetic, short fasts are okay. anything upto like 24 hours is not bad. but there are people that shouldn't fast -- pregnantwomen, children, breastfeeding women, if you're severely underweightor amenorrheic, yeah, there are people that shouldn't do it, justlike everything else.

you got to have 22 the experience to know how to do it. so, if you're on medications then, yeah,you probably should be supervised. you should ask your doctor, "i want to doit." you know what's going to happen when peopleask their doctor about this? they're not going to know anything about thisand they don't want to know who you are. so, how can people make it happen? so, do they need to come and seeyou or how does it work?

well, we provide dietary counseling but wecan't provide medical counseling. so,we can't tell people you should take this medication and this medication. it's notlegal. you can't give advice like that online. we can give kind of general advice interms of diet and so on. but in the end, their own doctor or themselveshave to take responsibility for that medication change. so, if you're taking insulin, forexample, and you don't eat, that dose of insulin

has to go down. otherwise, youmight go very low and die. those are the things that we provide in ourclinic because i can supervise people and take care of all those problems beforethey happen. and we have a lot ofexperience with that. we can do that for people. but if you're on medication, soyou have to be aware that there could be problems. if you change your diet andit's not just for fasting, if you change to a very low carbohydrate diet, you mayneed to change that medication too.

that low carb diets are much more well -known and accepted and this is a much more intensive sort of regimen. and there's nothing wrong with being moreintensive. it means that you'll getbetter effects but there's greater risk as well. yes, you do have to have, makesure you're kind of well covered in terms of that. i don't say that everybodycould do it. but a lot of people can.

you go back to some of these religious likea lot of muslims, for example, where you havea month of fasting, ramadan. they're not supervised. but the whole community does this. so, everybodyknows what's going on. so, if you're having problems somebody willfix you right away. and people say they can't do it. what about those millions of people who doit

all the time, all those greek orthodox peoplewho do it constantly, all the muslims who do it constantly, all the buddhistswho do it constantly, all the hindus who do it constantly? there are literally hundreds of millions ofpeople right now that are fasting. is it just us westerners that have this problem? yeah, exactly. it's crazy that we kind of humanize that somuch when it's really just a tool for us to use.

it's the most powerful tool because you reallycan't go lower than zero. you can't do any better than eating zero. so, it's a very powerful 23 tool and has lots of problems too, which weacknowledge and we take care of. but to throw it out is like ridiculous. it's like taking the best tool of your toolboxand just saying i'm not going to use this. it's done. well, no. you're done becauseyou have a tool and you're not using it.

ketogenic diets, fasting, they're actuallyin the same kind of thing. both of them try to lower insulin. but fasting is justmore effective. but there's more problems when you try touse it kind of willy- nilly. well, jason, this has been wonderful and veryinformative. i'm grateful for yourtime. and the book, if anybody is interested inreading it, it's the obesity code: unlocking the secrets of weight loss and thatis out now.

and then also, i willagain link to the etiology of obesity youtube playlist which is a weekend wellspent, isn't it? how many hours of video is that? it's a lot. yeah, thanks. yeah, i know. thank you so much for your time. and is there anything else thatyou want people to know about? i think that's it.

i mean, the book covers essentially what causesweight loss, what doesn't cause weight loss. i think it's good for everybody to understandthat because then you can adjust your diet to the way that you want. and it mayprovide that kind of missing piece especially talking about insulin resistance andmeal frequency that a very, very few people actually discuss. i think it's just ahuge part of weight gain, is this kind of frequent eating all the time, not givingyour body a chance to kind of digest the food

and use the foods. nobody talks about it anymore because we'veall kind of been brainwashed into, "oh, you must eat breakfast. you have to eat constantly throughout theday." ifwe're meant to graze, we're like cows, right? but we're not. we're humans so weshouldn't be grazing. you should eat your meals and that's it. when you eat, youeat.

when you don't eat, you don't eat. don't just eat all the time. it's the worstthing you can do. excellent. that's great advice. and, of course, intensivedietarymanagement.comis the website as well. i will link to that. oh, great. thanks.

cheers then, jason. thank you.