Nicolette: 0:01

Welcome to the Health Pulse, your go-to source for quick, actionable insights on health, wellness and diagnostics. Whether you're looking to optimize your well-being or stay informed about the latest in medical testing, we've got you covered. Join us as we break down key health topics in just minutes. Let's dive in.

Mark: 0:24

You know that old saying calories in, calories out. It's super simple, been around forever.

Rachel: 0:29

Right the basic energy balance idea.

Mark: 0:31

Yeah, but in this deep dive we're looking at Dr Jason Fung's work based on his chat with Dr Mike. And he has a pretty different take.

Rachel: 0:40

He really does. He argues hormones well, insulin mostly are way more important for weight than just counting calories.

Mark: 0:47

Okay, so that's what we're unpacking for you today. We want to get into Dr Fung's arguments, really understand why he thinks this way.

Rachel: 0:53

Exactly, go beyond just the headlines and see if there are some you know aha moments in there about weight management.

Mark: 1:00

So let's set the scene Dr Fung. He's a nephrologist, right A kidney doctor.

Rachel: 1:05

Yeah, that's his specialty.

Mark: 1:07

So how does a kidney doctor end up focusing so much on obesity and diabetes?

Rachel: 1:12

Well, it really started because he was seeing so many patients with diabetic kidney disease. It was a direct consequence of what was happening metabolically.

Mark: 1:21

Ah, okay, so there's a timeline here.

Rachel: 1:23

Yeah, think about it. Obesity rates they started going up. What late 70s.

Mark: 1:27

Around, then yeah.

Rachel: 1:28

Then maybe 10, 15 years later, type 2 diabetes rates follow suit. They start climbing too.

Mark: 1:34

Okay.

Rachel: 1:35

And then, predictably, the complications like diabetic kidney problems. They become much more common by the early 2000s when he started practicing, it was well, it was a huge issue.

Mark: 1:45

So he was right there seeing the end result of these metabolic problems.

Rachel: 1:50

Exactly Seeing how things like diabetes, hypertension, often tied to weight, were causing real lasting organ damage. So his focus shift wasn't random.

Mark: 2:00

No, it came directly out of that clinical reality.

Rachel: 2:03

Right, driven by this health crisis he was seeing every day.

Mark: 2:06

And this leads to something really key. Doesn't it Around what, 2008, 2009,? He had a bit of a realization the major one.

Rachel: 2:12

yeah, he realized the standard way of treating type 2 diabetes back then, mainly just focusing on controlling blood sugar with insulin.

Mark: 2:20

Why it?

Rachel: 2:20

wasn't actually stopping the organ damage.

Mark: 2:22

long term Wait so lowering blood sugar wasn't actually stopping the organ damage long term Wait. So lowering blood sugar wasn't helping with the complications.

Rachel: 2:26

Well, not as much as everyone expected. There were these big studies ACORD, advance, vadt that came out around then and the results were frankly surprising. Just pushing blood sugar down hard with insulin didn't significantly cut rates of kidney disease or heart attacks or even death. Wow. And actually some data even hinted it might increase mortality in some cases, which really flew in the face of conventional wisdom.

Mark: 2:51

OK, so that really challenges things. If that approach wasn't working as hoped, what was the standard treatment back then, before we had these newer drugs like GLP-1s and SGLT-2s?

Rachel: 3:08

we had these newer drugs like GLP-1s and SGLT-2s. The typical path was start with metformin. If that wasn't enough, add a sulfonylurea drug Okay, and then pretty often the next step was insulin.

Mark: 3:14

Right and insulin lowers blood sugar.

Rachel: 3:16

It definitely does. But and this is crucial it almost universally caused weight gain and Dr Fung saw this creating a kind of vicious cycle Gain weight, maybe worsen the underlying insulin resistance.

Mark: 3:28

So you need more insulin.

Rachel: 3:29

Exactly, which then could lead to more weight gain, and patients felt it too. They tell them you know my numbers look better, but I'm gaining weight. This doesn't feel right.

Mark: 3:37

That sounds incredibly frustrating for the doctors and the patients.

Rachel: 3:40

Absolutely. And all this was happening while the official line, like from the American Diabetes Association, was that type 2 diabetes was just chronic and progressive.

Mark: 3:51

They really thought that even though people could see weight loss helped.

Rachel: 3:54

Pretty much. Yeah, that was the official stance until, believe it or not, 2023.

Mark: 3:59

2023.

Rachel: 4:00

That recently.

Mark: 4:00

Yep, that's when the ADA formally recognized remission criteria, even though we'd seen for ages with things like bariatric surgery.

Rachel: 4:08

Right Drastic weight loss, often reversed it.

Mark: 4:11

Exactly Bariatric surgery showed clearly lose enough weight and the diabetes can significantly improve, even go away in many cases. So that chronic and progressive label just didn't quite fit the reality for everyone.

Rachel: 4:24

So Fung sees this disconnect. The standard treatment isn't preventing complications, it's causing weight gain. The official view seems outdated. What does he start thinking?

Mark: 4:34

He starts thinking you have to address the underlying issue the weight. You need to focus on diet and lifestyle to get the weight down.

Rachel: 4:40

And that led him to his main recommendations yes, Around 2010, 2011,. He really started pushing two main things lowering carbohydrate intake and intermittent fasting.

Mark: 4:51

Okay, let's take low-carb first. It's kind of interesting, isn't it, that even the ADA guidelines now say low-carb diets have the most evidence for blood sugar control.

Rachel: 5:00

It is interesting and it makes intuitive sense, doesn't it?

Mark: 5:03

How so.

Rachel: 5:04

Well, just think about basic foods you eat. Say, a piece of white bread, lows of carbs, breaks down fast into sugar. Big blood sugar spike right Now. Compare that to eating an egg Minimal carbs, minimal impact on blood sugar. So, logically, if you want to control blood sugar, reducing the stuff that spikes, it seems like a good place to start.

Mark: 5:23

Makes sense Now. Intermittent fasting. That was probably more controversial back then.

Rachel: 5:28

Oh, definitely there was a lot of skepticism, some pretty negative reactions actually.

Mark: 5:32

Why? What was the pushback?

Rachel: 5:34

Well, the whole idea of not eating for chunks of time went against all the advice about, you know, eating small meals frequently to keep your metabolism up.

Mark: 5:43

The grazing idea.

Rachel: 5:44

Exactly, but Fung's logic was pretty simple physiology Our bodies are designed to store energy, glucose and fat, and they're designed to use that stored energy when we're not eating.

Mark: 5:54

It's a natural process.

Rachel: 5:55

It's totally natural. Plus, he pointed out, doctors prescribe fasting all the time before surgery for tests.

Mark: 6:02

Good point. So the idea it's inherently dangerous doesn't really track.

Rachel: 6:06

Not really, not when done appropriately.

Mark: 6:09

So what kind of fasting did he suggest people start with?

Rachel: 6:12

Often he'd start with something like 24-hour fasts, maybe three times a week.

Mark: 6:16

Okay, why that schedule.

Rachel: 6:18

The idea was to get a significant period with low insulin and calorie restriction but still have regular eating days, manage medications if needed. He actually shared this amazing early case A patient on tons of insulin other meds started this fasting protocol. Within a month apparently, he was off all his diabetes meds. Blood sugar massively improved.

Mark: 6:38

Wow, okay, that's pretty dramatic.

Rachel: 6:40

It really highlights the potential impact.

Mark: 6:42

So, apart from the weight loss and blood sugar, what other advantages did he see with fasting? Why recommend it over, just say, cutting calories?

Rachel: 6:52

Well, practicality is a big one. It's simple right, you eat or you don't eat. No complex counting.

Mark: 6:57

It's free.

Rachel: 6:58

It's convenient. You actually save time not preparing or eating food. Sometimes. It's flexible and, like he says, it's ancient Cultures and religions have practiced fasting for millennia. It's not some weird new fad.

Mark: 7:10

He does address the eating disorder concern though, right?

Rachel: 7:17

Oh yeah, absolutely. He's clear. It's a tool and, like any tool, it needs to be used correctly. It's not for everyone. Especially those with a history of eating disorders needs responsible application.

Mark: 7:24

And he makes that point about breakfast.

Rachel: 7:26

Yeah, I love that breakfast. The word itself implies you've been fasting. It suggests that cycle of eating and not eating is just normal.

Mark: 7:35

OK, let's dive into the core of it then Calories versus hormones. He accepts calories in, calories out is technically true.

Rachel: 7:42

Fundamentally yes. Energy balance is physics.

Mark: 7:45

So where does his argument diverge? What's the nuance?

Rachel: 7:48

The nuance is how hormones, especially insulin, mess with both sides of that equation. He argues high insulin makes it really hard to get the calories out part working properly, specifically getting calories out of your fat stores.

Mark: 8:01

How does that work?

Rachel: 8:02

Think of insulin like a guard at your fat cell door. When insulin levels are high, the guard basically locks the door, stopping fat from leaving to be burned for energy.

Mark: 8:13

So, even if you're eating less, if insulin is high, you can't easily access your stored fat.

Rachel: 8:18

Pretty much, your body is getting signals to store energy, not release it. It's like having a full pantry, but the door is locked.

Mark: 8:24

And how does insulin make you store fat in the first place?

Rachel: 8:26

Well, its main job is moving sugar out of the blood after you eat. But if there's excess sugar, insulin tells the liver hey, turn this extra sugar into fat. That process is called de novo lipogenesis making new fat.

Mark: 8:39

So that directly explains the weight gain he saw in patients starting insulin treatment.

Rachel: 8:47

Exactly.

Mark: 8:48

More insulin signal equals more fat storage signal. Ok, but what about the idea that, like, 100 calories is 100 calories? If I eat 100 calories of cookies or 100 calories of eggs, shouldn't the long term weight effect be the same? Eggs?

Rachel: 8:59

shouldn't the long-term weight effect be the same? That's where Fung really pushes back. He says no because those foods trigger vastly different hormonal responses.

Mark: 9:06

OK.

Rachel: 9:06

The cookies. Big insulin spike tells your body to store fat might also lead to a blood sugar crash later.

Mark: 9:12

Making you hungry again sooner.

Rachel: 9:14

Right, so you end up eating more overall. The eggs minimal insulin response, much more satiating. You probably eat less later. Same calories initially, very different hormonal message, different impact on hunger and subsequent intake.

Mark: 9:28

He mentioned studies on this right, Like the oatmeal one.

Rachel: 9:30

Yeah, dr Ledwig's study. Instant oatmeal versus steel cut Same calories, same carbs mostly, but the instant stuff higher glycemic index, bigger insulin spike led to people eating significantly more at their next meal compared to the steel cut group.

Mark: 9:45

So the type of calorie sends a signal that affects future calorie intake. It's not just the number itself.

Rachel: 9:49

Precisely. It influences your hormones, your hunger, your behavior.

Mark: 9:53

So what does this mean for the standard advice? Just eat less, restrict calories long term.

Rachel: 10:00

Pham was pretty critical of that as a primary strategy. He points to studies like the Women's Health Initiative where long term calorie restriction just didn't work well for sustained weight loss.

Mark: 10:09

Why not? People just can't screen you it.

Rachel: 10:11

That's part of it. But there's physiology too. When you consistently eat less, your body adapts. It slows down, your metabolism burns fewer calories at rest.

Mark: 10:20

Oh, the metabolic slowdown.

Rachel: 10:21

Yeah, meta-analyses confirm it. Cut calories, your metabolic rate tends to drop too. It makes it harder and harder to keep losing weight and really easy to regain it if you thop up.

Mark: 10:32

It's like the body's fighting back, trying to conserve energy.

Rachel: 10:34

Exactly A survival mechanism, basically.

Mark: 10:36

But if our bodies are so good at regulating weight and preventing starvation, why do we have an obesity epidemic now? Does those mechanisms just disappear?

Rachel: 10:45

That's the million dollar question, isn't it? The mechanisms are likely still there. Think about those old overfeeding studies like Ethan Sims's work. People had to force feed themselves thousands of extra calories just to gain weight, and their bodies fought back, trying to burn it off.

Mark: 11:01

So what changed?

Rachel: 11:02

The environment, specifically the food environment. Ultra-processed foods how do they fit in? They seem to bypass our natural satiety systems. They're often low in fiber, high in sugar and fat, engineered to be incredibly palatable, they don't trigger the same fullness hormones like PYY, CCK, GLP-1, or the stomach stretch signals that whole foods do.

Mark: 11:23

So they override our stop eating signals.

Rachel: 11:26

Essentially, yes. As Fun points out, you don't see herds of obese gazelles. While animals eating their natural diet don't generally become obese, their regulatory systems work. Ours seem overwhelmed by modern food.

Mark: 11:38

So it comes back to food, not just being energy.

Rachel: 11:40

But also information, hormonal signals different foods send different signal.

Mark: 11:44

Got it. So, based on all this, what's Fung's practical advice? What should people actually do?

Rachel: 11:49

It generally boils down to prioritize real, whole, unprocessed foods.

Mark: 11:55

Okay.

Rachel: 11:55

Eat when you're hungry. Stop when you're full. Have distinct meals. Try to avoid constant snacking all day long.

Mark: 12:02

So less focus on hitting a specific calorie number with whatever food, more focus on food quality and eating patterns.

Rachel: 12:08

Exactly, it's a different framework.

Mark: 12:10

But just to be super clear, he's not saying calories don't count at all.

Rachel: 12:14

No, no, definitely not. He's very clear Calories always count. The physics is the physics. He's very clear Calories always count. The physics is the physics Okay. His argument is that the reason people often overconsume calories is because of hormonal imbalances driven by the types of food they're eating. The food itself is driving the overeating.

Mark: 12:30

He uses an addiction analogy sometimes.

Rachel: 12:32

Yeah, like with heroin, you don't just tell an addict take less heroin. You have to address the underlying addiction, the cravings, the drivers Right. Similarly, just telling someone eat less doesn't fix the potential underlying issues like food addiction, intense cravings, maybe emotional eating, stress, poor sleep.

Mark: 12:49

Yeah.

Rachel: 12:50

All things that can mess with hormones and drive intake.

Mark: 12:52

And habits must play a huge role in making this sustainable.

Rachel: 12:56

Absolutely crucial Building healthy eating patterns into your routine so you're not constantly fighting cravings with willpower which, let's face it, usually fails long term.

Mark: 13:06

One last point on fasting timing. He sometimes mentions skipping dinner might be better than skipping breakfast. Why is that?

Rachel: 13:14

There's some evidence. Yeah, looking at circadian rhythms, Our bodies seem to handle food insulin insulin wise a bit better. Earlier in the day, Insulin sensitivity might be higher in the morning.

Mark: 13:25

So eating the same meal at night might cause a bigger insulin spike.

Rachel: 13:29

Potentially, yeah, and for many people hunger is higher in the evening anyway. So skipping dinner could theoretically have a bigger impact on overall insulin and calories for some. But skipping dinner is socially really difficult for most people.

Mark: 13:43

Family meals, social events- yeah, much harder than skipping breakfast usually.

Rachel: 13:48

Right. So while physiologically it might be optimal, for some, practically consistency is key. Finding an approach you can actually stick with long term is probably more important than chasing the absolute perfect physiological timing.

Mark: 14:01

OK, that makes a lot of sense. So, wrapping this up, for you, the listener, the big takeaway from Dr Fung's perspective seems to be, yes, energy balance matters. Of course it does.

Rachel: 14:11

But it's not the whole story. The type of food you eat and when you eat it profoundly impacts your hormones especially insulin. Especially insulin, and that hormonal response is a massive player in regulating hunger, fat storage and, ultimately, your weight and metabolic health. It's way more nuanced than just counting calories.

Mark: 14:31

So maybe a final thought for everyone listening, given how much our food acts as hormonal information.

Rachel: 14:36

Yeah, how much attention are you paying to the messages your diet is sending your body, beyond just the calorie number, thinking about food quality, about timing? It might open up some new perspectives on your own health journey.

Nicolette: 14:53

Thanks for tuning into the Health Pulse. If you found this episode helpful, don't forget to subscribe and share it with someone who might benefit. For more health insights and diagnostics, visit us online at wwwquicklabmobilecom. Stay informed, stay healthy and we'll catch you in the next episode.