how do we explain this the truth is the science of weight and metabolism is complex it's about calories for sure but not only calories the science is clear on this not all calories affect our metabolism in the same way welcome to the Doctor's Pharmacy and another addition of Health bites I'm Dr Mark Heyman today we're talking about weight loss a topic millions of people struggle with and even more have questions about how to do it and what is going on and why are we all overweight and how do we fix it now given all the research and the science about weight gain and weight loss there's so much debate still and confusion about what causes weight gain and how best to lose weight you see is weight loss about eating less and exercising more is it about cutting calories or maybe it's cutting back on carbs what about dietary fat should we cut back on that too well weight loss can be super confusing when you hop on social media it seems like everyone has the answer and yet despite the endless information at our fingertips many people are suffering and are trying but failing to shed unwanted pounds and keep them off now the government dietary guidelines and nearly all doctors nutritionists and all professional associations tell us that weight loss is simply about energy you need to burn more calories than you eat you need to eat less and exercise more now this is called the energy balance hypothesis or energy balance model of weight now according to this Theory as long as you eat fewer calories than you expend you'll lose weight right well it doesn't matter if the calories come from 1,000 calories of soda or 1,000 calories of broccoli all calories are the same in this model now the implicit message here is that you're overweight because you eat too much and you don't exercise enough in other words it's your fault because you don't have the willpower and the subtext is that you're a lazy Glutton I don't believe that this is just nonsense the story of weight gain and weight loss and metabolism is far more complicated than that now Americans have been doing their best to follow this advice of eating less and exercising more for the past 50 years and yet obesity rates have gone from 5% when I was born to 42% % how do we explain this the truth is the science of weight and metabolism is complex it's about calories for sure but not only calories the science is clear on this not all calories affect our metabolism in the same way you see food contains calories but also the type and quality of those calories impacts the way the body functions Beyond The energy they contain you see food is information it's instructions or code that impacts your hormones your immune function your brain chemistry your gene expression and your microbiome in ways that have a huge effect on weight and Metabolism if the calorie model doesn't completely explain our obesity epidemic is there something we're missing and the answer my friends is yes the last few Decades of research have shown that a calorie is not a calorie now yes in a lab when they're burned calories are the same but when you eat them and the information has different effects on hormones or your brain chemistry or your immune system or your microbiome they are not the same so a calorie burn is a calorie burn but a calorie eatting is not a calorie eatting to quote my friend Robert lustic now if our current theories don't completely explain our current obesity epidemic then we need a new Theory or maybe theories the emerging model of weight gain and weight loss that's coming out of the science is called the carbohydrate insulin model now this Theory posits that refined carbs and sugar calories drive high levels of insulin and that's the fat storage hormone that makes you store fat it locks the fat in the fat cells and it slows your metabolism not a good combo if you want to lose weight and the special type of fat that's stored which is your belly fat is actually a different type of fat it's hungry fat but is this true and what does the research say well today we're going to discuss the functional medicine approach to weight loss it zooms out and looks at root causes and mechanisms and it includes all the variables that affect weight and Metabolism we'll see whether weight loss is simply about eating fewer calories or maybe about fixing your hormones or whether other factors such as toxins also influence weight so let's cut through the noise and offer a science back holistic road mapap to weight loss and metabolic health so whether you want to lose that extra couple of pounds around the midsection or transform your body composition completely I hope you'll find this episode helpful let's get started so what makes us gain weight now there are two main schools of thought for what makes us gain weight which are truly the subject of a lot of debate the energy balance model and the carbohydrate insulin model we're going to talk about them now later in the discussion we're discuss other factors that can influence weight gain it doesn't just stop with calories or diet or the carbohydrate insulin model or energy balance model there's a there's a lot of more things that can impact your metabolism but first let's take a look at the main diet related theories the two of them that lead to weight gain and the pros and cons of each one okay let's start with the energy balance model now this is the one that we've all been following for decades and decades and it's s not working out for us right eating less exercising more how's that working out for you well let's talk about what it says and the signs behind it and what makes sense about it and what may not the energy balance model suggests that your body weight is maintained when the calories we take in in EA and drinking equals the calories we expend right our basil metabolic rate plus our physical activity plus digestion or we call the thermic effective food regulates your weight and basically weight management and weight maintenance occurs when energy in equals energy out if you want to lose weight well you need to take in less energy than you put out right if you gain weight you want to gain weight you have to take in more energy than you burn right this considers that all calories are metabolically alike and that you can lose or gain weight on any diet it doesn't matter where the calories come from the dietary guidelines from America has been primarily based on this advice the 2025 USDA dietary guidelines State quote losing weight requires adults to reduce the number of calories they get from foods and Beverages and increase the amount expended through physical activity in other words eat less exercise more the endocrine society says quote the impact of diet on Obesity risk is explained largely by its effect on calorie intake rather than By changes of either energy expenditure or the internal metabolic environment in other words a calorie is a calorie is a calorie unfortunately that's not exactly the true story according to science so what are the pros of this energy balance model well it's simple right energy intake has to equal energy expenditure or you lose or gain weight if you're out of balance and it's an easy straightforward Universal model for weight management that basically everybody can understand calories in calories out eat less exercise more people say this is true because it's based on the first law of ther Dynamics which means energy cannot be created or destroyed only transformed now this is true but you have to understand the definition the definition requires a closed system you just look up the first law of thermodynamics it means energy cannot be created or destroyed in a closed system the body is not a closed system you've got so many variables like hormones and the microbiome your immune system so many other things that regulate your response to energy it also Embraces physical activity this needed to maining a healthy Weight and Wellness which is great I think that's important exercise but you cannot exercise your way out of a bad diet I promise you that anybody who's tried will know what I'm talking about and this also allows for diet flexibility right as long as you quantify energy intake and expenditure they say counting calories and counting steps basically then you can follow any dietary approach low fat low carb you could drink Coca-Cola as your sole food it doesn't matter as long as you Monitor and track your calories intely it just doesn't quite make sense right it doesn't make sense that all calories are the same because any Kindergarten kid would say well gee if you drink a th000 calories of Coca-Cola or have a th000 calories of broccoli probably not the same even within this model they they do acknowledge and this doesn't quite fit the model though that ultr processed hyper palatable energy-dense Foods impact our brain chemistry makes it easier to overeat well so they're saying well maybe calories aren't the same because some calories make you overeat well that doesn't make sense right if it's just calories in calories out but they also say in the same breath that there's little human evidence to suggest that hyper palatability is related to over consumption well that's just not true I mean the NH study from Kevin Hall we've talked about before on the podcast where he basically gave people Ultra processed food or Whole Foods and tell them to eat whatever they want people who ate Ultra processed foods were hungrier and ate 500 calories more a day now research supporting this model this energy balance model is is there some research about it of course depends what studies you look at how they're looked at and just sort of sifted through but a met analysis of 32 controlled feeding studies argues that when calories are controlled metabolism weight loss are essentially the same amount of low fat versus a low carb diet but you have to look at what defines a low carb or lowfat Diet is it 10% fat is it 10% carbs is it 50% fat is it 50% carbs like it matters right and so so maybe some of the the differences are not really that significant in order to shut down insulin we'll talk about that and the studies again a little bit contradicting the model because if all calories are the same they should affect you the same right but they but they do acknowledge that the macronutrients count for the differences into distribution of body weight so for example high carb diets promote more belly fat than high fat diet diets which don't promote more belly fat in a systematic review and Men analysis of randomized controlled trials it was published in the British medical journal they compared low fat versus low carb diets from1 trials and approximately 202,000 adults who were overweight or obese and reported that they both had a similar effects on weight loss and cardiovascular markers at 6 months however the weight loss diminished and the heart benefits disappeared at 12 months for all the diets now another study randomly assigned 131 healthy overweight or obesity adults who had lost about 8% or more of their body weight to either a moderate fat low glycemic diet a lowfat medium glycemic diet or a high glycemic sugar I mean high sugar Control Diet with a similar protein content and they could eat whatever they want and they found really no difference in weight gain after 18 months what are the things that contradict this energy balance model some studies show it works some studies show it doesn't so let's get into what the cons are it doesn't really explain how or why weight gain happens or what's driving the process other than just energy right obesity rates have continued to climb despite Americans eating less now this is really fascinating folks if you take the hypothesis that obesity is all about calories it's hard to reconcile that with the fact that over the last decades and I'll get into that our calorie consumption has gone down but our weight has gone up so that's a really important fact and this is the enhs data which is the national health and nutrition examination survey government data tens of thousands of people over decades and decades and they looked at calorie and added sugar intake and they found that has gone down since the year 2000 but obesity and type 2 diabetes have gone up right how do you explain that it also doesn't consider the nutrient Matrix are the quality or bioavailability of certain foods for example nuts have a high energy density right because they're they're higher in fat but eating nuts has been shown to help maintain a healthy weight and even lose weight in a 2012 study published in the American journal of clinical nutrition they found that the average energy extracted from almonds is 32% less than what's written on the nutrition labels meaning even if it says 100 calories it's 32% less than that that's actually used by the body because it takes so much work to digest it same goes from wal nuts about 21% less and pistachios 5% less and cashews 16% less so how do you explain that well it's the food matrix it's the degree of processing it's the indigestibility of certain parts like insoluble fiber and things that feed the gut microbiome cutting calories without focusing on nutrition quality can actually lead to nutritional deficiencies which can impact mood mental health and Metabolism so for example if you're if you're on a calor restricted diet but you're not in a nutrient-dense diet you're going to end up with problems there's also metabolic push back that happens you know cutting calories makes you hungrier and it decreases your metabolism so you're in a vicious cycle so you eat less but then your metabolism slows down and then you increase your hunger so it makes it hard to push past a weight loss Plateau by just adjusting calorie intake it's really hard to reduce your calorie intake because you're going to be hungry and that's going to overtake your body and willpower just is not enough so you have to use science and this whole energy balance model also doesn't account for the complexities or the differences in individuals uh genetically and metabolically hormones genetics your blood sugar your microbiome impact of nutrition on your brain chemistry under metabolism the role of environmental toxins things like obesogens endocrine disrupting chemicals stress mitochondrial damage free radicals inflammation all that is not taken into account by the energy balance model and just calorie restriction doesn't work a long time nobody can stick with it right research shows that humans are really bad also at measuring their energy intake so we can underestimate our consumption by about 50% and we overestimate our calorie expenditure from exercise by about 70% I always said that when I worked at Kenyon Ranch that people basically underestimate the amount the eat by 50% and overestimate the amount they exercise by about 50% now people can't adhere to a calor restricted diet long term they really can't especially lowfat diets because they're not very satisfying and fat makes you feel full and protein makes you feel full so counting calories is kind of unsustainable anyway even if you get a PhD nutrition and you you are are really focused on understanding calories it's really hard to be accurate unless you weigh and measure every single thing you eat and also the other problem with this model is it kind of blames the individual when they can't lose weight well why didn't you lose weight well you're just not eating the right way you're you're you're eating too much and you're not exercising enough and that sort of blames the the victim which is not really true I think that there's a lot of flaws with the energy balance model calories do matter I'm not saying they don't matter they're not the whole story and and I think the quality of the calories matters and it turns out from from a lot of data from Dr L at Harvard and others that turns out that what you eat is more important than how much you eat because when you choose the right foods that regulate your biology in the right way you don't have to White Knuckle your way to weight loss it actually will automatically start to shift your body in terms of the right metabolic health so what's this next model this carbohydrate insulin model and I think we try to sort of narrow things down into simple little categories but we have to sort understand that biology is complex and not any single Theory will explain everything but I think this one is much closer to what I've seen in my practice and also what I've seen to be more effective clinically with many patients and what I've heard from many of my colleagues as well now this this offers a different perspective to this energy balance model but I should I shouldn't say just going back to energy malice model the energy malice model was so attractive to the food industry that Coca-Cola spent $2 million do paying scientists to fabricate data to show that this actually worked the weight loss was just about calories and calories out it didn't matter where the calories came from all calories in moderation including Coca-Cola that's just nonsense I'm sadly to say it's nonsense and they were actually exposed I wrote a lot about this in my book food fix and and also some other things I've written but it's a very uh attractive model for the food industry because it basically lets them off the hook right if if you're a big food company or a fast food company you can feel good about yourself because it's all about just the quantity of calories read so people don't overeat that's fine they can eat their junk food but it's very very much not the case let's get back to the carbohydrate insulin model it basically suggests that the quality of the calories consume particularly rapidly digested calories like refined starches sugars and empty carbs they play a real critical role in weight regulation and obesity because they influence your hormones particularly insulin now insulin is is a very important hormone what is insulin and what does it do in the body well insulin is a hormone that's released by the pancreas when we eat something that has a high glycemic load meaning it raises your blood sugar that how how rapidly a meal raises your blood sugar is is called glycemic load now when a me is rich in a lot of su Sugar and starch your blood sugar spikes and then insulin is released to help deliver the glucose and fuel to your cells your muscles to your liver your fat tissue and too many calories from each meal then when you have high insulin levels because it's the fat storage hormone they're siphoned off into the fat tissue and then too few remain in your circulation which then makes your body perceive that you're in an energy crisis that you have low energy states and that makes you crave more carbs and more sugar you know exactly what I'm talking about if you eat sugar and carbs you want more sugar and carbs even though you have so much energy I mean mean people who are obese are just having enormous storage amounts of calories but they feel like they're hungry and starving why because of the role of insulin and how it works in the body by storing the fat in the fat cells by locking it in there by clearing the the the blood of a lot of the available fuel so it's stored in the fat cells and your brain doesn't perceive that you've got enough food around so basically obesity is a state of starvation emits plenty it's the feeling that you're starving in in when you have plenty of food and calories now this perceived state of starvation negatively affects all sorts of systems in your body including your thyroid and that slows your metabolism even more to conserve energy also if you have a high carb diet it increases cortisol so we know that eating sugar and starch raises stress hormones cortisol also epinephrine adrenaline and that can lead to fluctuations in blood sugar it can lead to more insulin resistance weight gain hypoglycemia and you can just you know get the terrible vicious cycle of being hungry and in the cycles of low and high blood sugar now we also know from the data that restricting your energy intake meaning eating less while consuming a high sugar starch or high glycemic diet is going to increase your predisposition to store belly fat okay and liver fat and it's going to make you hungrier so even if you're restricting calories or you're eating high carbs you actually are going to be hungry and store more belly fat so high insulin and the low glucagon from eating a high glycemic Diet also inhibits our ability to mobilize and burn fat as long as insulin is high it blocks our our ability to burn fat what we call lipolysis and that makes weight loss difficult so it's like a one-way Turn Style the fat gets in the cells and the sugar and the calories get in the cells but they can't get out it's really difficult to lose weight as long as your insulin level is high and I've seen this over and over my patients the key to getting them weight down by any mechanism is lowering insulin and when you have higher and higher amounts of starch and sugar your cells start to become resistant to the effects of insulin so you need more insulin which leads to more weight gain and more chronic diseases like type 2 diabetes obesity Alzheimer's and cancer that's kind of the theory now what are the pros of this carbohydrate insulin model well it focus on food quality on what you eat not just how much you eat and it focus on getting rid of these empty fast adusting high sugar high starch carbohydrates because they have a really bad effect on metabolism and weight gain it also tells us that all calories are not created equal in terms of their metabolic impact now they're equal in a laboratory when you burn them if you burn 1,000 calories of broccoli and 1,000 calories of Coca-Cola in a lab they release the same amount of energy but when you eat them they have very different effects on the body I mean think about that 1,000 calories or 100 calories of broccoli versus the same amount of Coca-Cola very different impact on your Biology another really important feature of the carbohydrate insulin model is that IT addresses the role of insulin in fat storage and metabolic Health you see when you have high insulin it makes you store fat which means lowering insulin through diet and other mechanisms can actually improve fat loss and improve metabolic health and reduce obviously the risk for insulin resistance type two diabetes chronic diseases without hyper fixating on calorie intake focusing on what you eat versus how much can make a big difference this also has a huge impact uh for type two diabetes less insulin spikes lower insulin levels less insulin resistance and help can prevent and even reverse type two diabetes in fact the work by Sarah halberg and others using a ketogenic diet which is like 75 to 80% fat and you know 5 to 10% carbs has been able to completely reverse type 2 diabetes iness diabetes and insulin resistance is a carbohydrate intolerance problem and this is what's happening in America we have a huge population that's carbohydrate intolerant because we weren't adapted to eating such large amounts of sugar and starch what does it the carbohydrate insulin model explain well it doesn't quite explain the fact that overeating alone causes weight gain even if you are eating healthy food if you eat too much you will gain weight it's true that that's true but it's much harder to do on a low carb diet because protein and fat and fiber actually make you feel full so it's harder to overeat like who can binge on a bag of avocados nobody right nobody's going to eat a dozen avocad but you can eat a dozen cookies in a snap right I've done it before trust me so you know you have to understand that the quality of the food you're eating affects your ability to want to eat it and how full you feel now on a high glycemic diet which is high sugar there's a lot of hormones that are messed up for example leptin and you get lepin resistance which causes the body to to actually gain weight the more lepin resistance you have the more you don't feel full the more you eat and you get in this vicious cycle this this kind of model doesn't completely explain everything related to weight because there's obviously toxins the role of the microbiome and many other things we'll talk about and so it oversimplifies weight gain it's simply related to carbs and insulin and it doesn't really consider total calorie intake overall diet quality saturated fat physical activity genetics environmental toxins obesogens so we have to sort of use a broader broader range of theories to explain what we're seeing but but everybody likes to focus on their Theory but it's it's just more complicated than that now the research is mixed some studies show that lowfat and low carb diets have no difference in terms of weight loss others show the opposite that actually low carb diets outperform lowfat diets when when when given to people to eat now the other thing the model doesn't quite explain is that obesity is typically associated with normal or high glucose and triglycerides and this carbohydrate insulin model says that when you have a high glycemic diet it leads to low metabolic fuel concentrations about two to 5 hours after eating which increases craving so you know you kind can't explain everything with this model the counterargument from the carbohydrate insulin folks is that fat cells hit their limit and eventually do not expand anymore and at that stage um the weight gain plateaus and circulating fuel concentrations rise meaning after a while you know you're going to see the insulin working and and and getting your blood sugar and your your free fatty acids in your blood down but eventually you're you're going to just fill up the tank and you're going to spill over and there'll be higher amounts of fuel in the blood in other words High more higher levels of glucose and free fatty acids what does the research tell us well there was a 2023 multicenter randomized control trial that looked at about 300 overweight obese individuals and they randomize them to a low carb diet calorie restricted diet or a low carb and a calorie restricted diet or just a normal control out for 12 weeks so they basically could either low carb low carb low calorie or a 12we normal diet now the results showed that the low carb and low cal calorie diets was more effective than the low carb or calorie restricted diet alone but they also found that the low carb plus the calor restricted diet or just the low carb diet alone reduce body weight weight circumference and body fat more than the calorie restricted diet so just calorie restriction alone wasn't enough when you added low carb to it or you just did low carb alone you did better than on calorie restriction now it's easier to weight on a low carb calorie restricted diet when you keep your insulin than a calorie restricted diet because your insulin can still be high if you're doing calorie restriction and eating a lot of carbs in 2008 and this was a very impressive study was a 2-year randomized control trial published in the top tier Journal New England Journal of Medicine they assigned about 322 moderately obese people to a lowfat calorie restricted diet a Mediterranean plus calor restricted diet or a low carb and not calor restricted diet you either are calorie restricted on Mediterranean low fat or just low carb with no calorie restriction you could use as much as you want now here's really the interesting data the low carb group that wasn't calorie restricted lost the most weight okay and had a 20% reduction in total cholesterol to HDL ratio versus 12% in a low fat group that's pretty amazing so basically not restricting calories and just using low carb actually had the most weight reduction and the best Improvement in cholesterol another review systematic review and met analysis of randomized control trials again the highest level of evidence this is from Dr will and lweek from Harvard and they looked at 53 trials with over 68,000 participants and they compared lowfat versus low carb diets and they found that low carb diets outperformed low fat diets for weight loss every time so that's a lot to take in I know a lot of studies a lot of information but basically if you look at the data it seems that Calor restriction can work it's hard to maintain but the best approach is a low carb diet which is not going to be spiking insulin and actually works better than a low-fat diet so which theory is correct well the truth is they're both right and they're both wrong we are eating less calories than we did and we're gaining weight in society total sugar consumption has gone down a little bit but high fructose corn syrup has gone up so calories from sugar are still higher than it was before protein and fat intake have not really changed since the 1970s but guess what refined carb and sugar intake has increased although it's sort of hitting a plateau we were told to eat 6 to 11 servings of bread Rice Serum pasta day and we added sugar to almost everything and that was in the 1992 food pyramid and we listened and it's led to the greatest obesity and diabetes epidemic in human history the other thing that's really happened uh in the last 20 30 plus years is the intake of ultra processed food has just skyrocketed and it's now 60 to 70% of American's diet in the adult population the consumption of ultra processed foods went from about 53% in 2000 to about 57% in 2018 and it's now by some estimates well over 60% and even looking at what's sold in stores it's about 73% of foods and this is even worse in kids a study analyzing total energy intake from ultr processed food in adolescence show that they increase from 61 to 67% that's 67% of foods that our kids eat is essentially highly processed junk food there's been a big increase in ready to eat meals and and various kind of foods we eat that are pre-processed and rating eat from about 2.2% to 11.2% we are having less soda that's good but still we're eating more processed food so you know one thing goes up one thing go go down but at the end of the day we're eating more processed food and and Al more more refined sugars and starches also we having a lot of other things that are affecting us additives preservatives emulsifiers gums which in the gut cause a lot of problems they cause disbiosis leaky gut they cause inflammation and they make us gain weight because of the role of leaky gut and we're going to explain that a little bit when the microbiome is affected and the quality of the food we eat affects the microbiome it leads to more weight green so what can we all agree on well cheap convenient energy dense Ultra processed food it's high in starch high in sugar and full of low quality fats are bad for metabolism and our health and our risk for chronic disease so no argument there I don't think any Camp will say that we should really be eating more processed food Ultra processed food I mean the energy balance model does support that at some level particularly the food companies are happy about it because it means there's no good and bad foods but I hate to break it the news to you folks there are good and bad foods right Coca-Cola it's just a bad food uh Pepsi is a bad food Doritos is a bad food I mean I can go on and on those are just not actually food by the definition of food so what else makes us gain weight besides calories or carbohydrates or sugars right hormones hormones play a big role in our metabolism including insulin and high insulin is the biggest driver because it's a fat storage hormone and we meet a diet that's high in sugar starch or even high in calories it will Spike insulin also our thyroid is often playing a big role in our metabolism and low thyroid hormones do affect your metabolism high levels of stress which are driving more cortisol cortisol will make you gain weight high leptin which happens because of our leptin resistance and inflammation we also have low gp1 which is known as OIC and that there's many reasons for that but our diet definitely causes our body not to produce as much G1 because of all the ultra processed food other hormones are important like glucagon and Gip which stimulates insulin secretion it promotes fat storage and it slows gastric emptying so all that not so good right you get you get more insulin more fat storage the other factors uh that may play role our genetics particularly epigenetics so there's a lot of environmental influences on our weight and our risk of getting weight in fact the social factors are huge Chris stx's work is really really impressive this is from Harvard where we looked at Framingham data and he found that if your friends overweight you're far more likely to be overweight than if your parents or your siblings are overweight and about 171% more likely than about 40% more likely if your family members overweight so it's it's it's the social connections we have play a big role there are other factors perinatal factors like what happen happens in utero for example if fetus is exposed to a diet high in starch and sugar or environmental toxins in utero we call obesogens it makes them more susceptible to weight gain by this epigenetic imprint and I've discussed this in uh in my health bite called preparing to conceive I'm going to put the link in the show notes you can learn more about it but definitely plays a role epigenetics play a role in setting up programming of the fetus to become overweight or diabetic or have other issues later in life there are other factors our gut Flora plays a huge role for example when they do studies on rats when they take the microbiome of a thin healthy Mouse and put in a overweight fat mouse the fat mouse loses weight even though they're eating the same amount of calories so it's clearly way more than just calories so disbiosis leaky gut what we call metabolic endotoxemia also play a role when you have also bad bugs in your gut they Rel to release toxins one of them is called lipopolysaccharides and these get absorbed in the body the immune system creates a response and that immune system response drives insulin resistance so anything that drives inflammation will cause in resistance and of course insulin resistance itself causes inflammation so when you look at bacterial strains you can actually see bacterial strains that actually are associated with more obesity for example high fices and low bacteroides are associated with obesity when you can measure that on a stol test we do that all the time in my practice low levels of good bacteria right like lactobacillus Bido bacteria which are the good guys they they also affect our metabolism so when you eat an energy dense High processed fat high carb sugar diet from Ultra processed food it increases the these bacterial endotoxins these LPS's they just increase inflammation throughout the body they increase gut lining inflammation they loosen the connections between our intestinal cells called tight Junction Junctions which causes leaky gut those toxins leech into the circulation they cause inflammation and and and they basically cause your body to gain weight so they they they lead to insulin resistance in the muscle and liver and fat tissue and basically just create this vicious cycle of weight gain obviously there are other factors too as I mentioned Ultra processed foods and sugar sweeten beverages which are super easy to overc consume are a big factor the overall impact of excess calories is for sure a factor from refined carbs from starches from sugar and when you eat those Foods they make you overeat them so you end up eating more calories if you eat that food but if you eat real whole food your body will naturally regulate and you won't be hungry and you won't want all that junk so what are the ways in which the ultra processed food and all this crap affects us well there's many Pathways one of them is called amk I've written about this in my book young forever but when your energy levels are low in a fasted state ampk goes up and it increases glucose and fatty acid uptake and the breakdown of fuel across various tissues like the liver brain and muscles now when energy levels are high in a Fed state ampk is inhibited and that increases liver triglycerides it increases insulin resistance and increases metabolic dysfunction so basically when you're in a fasted state or you do overnight fasting it actually makes you have a better metabolism and that's what the drug metformin does is it activates mpk which is a good thing but when your energy levels are high which is most of the time for most of us amk isn't activated and you end up with all this metabolic dysfunction and weight gain the other big thing in our diet that's a problem is fructose and free fructose from high fructose corn syrup is a big problem it's an ultra processed food it's pretty much in everything and this inhibits ampk so when you inhibit ampk it's not good because you end up gaining weight and having all these metabolic issues now in mice studies they fed fructose Rich diets to these mice and they found lots of problems with their liver metabolism of fats and their bio acid metabolism and that led to fatty liver so basically fructose which is the main thing in Sugar sweeten Beverages and and a lot of foods and high fructose corn syrup basically causes fatty liver it also leads to leaky gut because fructose requires a lot of energy to be absorbed and it it takes away energy from the gut which is needed to keep the cells suck together and you get the breakage of these tight junctions and end up with leaky gut and then you end up in this terrible cycle the other thing is sugar is kind of addictive right this is a really good study it was in the American journal of clinical nutrition and it basically showed that foods high in sugar and glycemic index or loaded trigger addiction-like responses in humans now David lwig and his team from Harvard conducted a study that demonstrated that high sugar foods activate the brain in the area called the nucleus accumbent which is a brain region associated with opioid addiction and addiction in general now they did this really very elegant study the study utilized a rigorous randomized blinded crossover design test which is the best kind of study to test the biological basis of sugar addiction and then by doing the study this way they avoided bias and criticisms which were going to come for sure from the food industry so what did they do well they took 12 overweight or obese men and they were given milkshakes with the same amount and this is important the same exact amount of calories and fat and carbs and protein and fiber now they were designed to taste exactly the same but they differed only in how they affected blood sugar levels because one had a low glycemic starch and the other had a high glycemic star Char but they looked and tasted the same and they had the same protein calories carbs and fiber and fat so it's not just about calories folks this is one of the studies that really compels you to see that now when they measured the brain Imaging and brain activity they measured blood sugar they measured hunger after consuming each milkshake type the results showed that the high glycemic milkshakes the ones with the quickly absorb carbs they cause significant spikes in blood sugar and Insulin they cause more hunger more cravings and most importantly in my mind it lit up the area in the brain called the nucleus cumbent which is the Addiction Center in the brain so literally even though people didn't know what they were eating even though it tasted the same even though it had the same amount of calories even though it had the same amount of carbs where those carbs came from mattered and it affected their brain and their hormones and their metabolism now this study suggests that the body response to calories varies a lot based on the composition of the diet I meaning carbs fat protein quality of the carbs the quality of the food and that foods that cause rapid blood sugar spikes are biologically addictive and that's pretty much all the food we're eating today in America the other thing is really important is our low fiber diet and our diet that's low and essential nutrients for two reasons one fiber is critically important helping slow the absorption of glucose and prevent these insulin spikes and glucose spikes it makes you feel full and it overall helps you lose weight uh we used to eat about 150 grams of fiber per person per day now we eat about eight the other thing is that essential nutrients are important because when you're low in vitamins and minerals your body is craving more food and so you start eating anything with junk food and fast food and Ultra processed food we're looking for love in all the wrong places right there are no nutrients in that food so we keep on eating it's like kids who are iron deficient will eat dirt try to get iron we just keep eating more chunk food hoping their nutrients in there but they're not in there not consciously it's not what our brain thinks it's what our body is actually reacting to also if you eat a high sugar starch diet it overwhelms your cells and it causes reactive oxygen species or free radicals which basically are byproduct of metabolism but when you're eating a lot of calories and food you get a lot more of them and that causes all sorts of issues that damages our mitochondria which are our energy production Factor it damages our energy sensing Pathways so high levels of free radicals can inhibit for example the ampk we talked about which senses energy in the body and then it makes your cells just not burn calories as much now over time this imbalance in the cellular signaling and the mitochondrial damage that can can occur from these fre radicals affects your metabolism and it can potentially lead to weight gain where do these reactive oxygen species come from a lot of places just from overeating from eating too much sugar and starch but also from toxins and I wrote a an article years ago called systems biology toxins obesity and functional medicine and I wrote a lot about how the mechanisms are of these these environmental toxins and how they affect our weight now here's here's the big picture there are 80,000 new chemicals that have been introduced since the turn of the 20th century I think it's maybe up to 100,000 now and most have never been tested for safety so where do these toxins come from well they're obviously the ones introduced but they also in internal toxins right the gut is a great source of toxins if we have bad bugs in there you talked about the bad bugs producing lipopolysaccharides or LPS's that's one source of toxins but a lot of the toxins we're talking about here are environmental toxins things we should not be having in our bodies but are because of industrialization and pollution and petrochemical use and there are many kinds of toxins out there like heavy metals lead Mercury cadmium arsenic nickel aluminum and I had one woman who was a fitness trainer obsessed with her weight and health and could not lose 40 PBS no matter what she did it turned out she had high levels of mercury we got the Mercury out of her system and she dropped the 40 PBS there also something called volatile organic compounds voc's that are everywhere off gassing from pains solvents things in cleaning materials from Malahide toine Benzene all these things are all around us medications sometimes have toxins in them alcohol pesticides pcbs herbicides air pollution food additives all this stuff affects us and of course so infections you know we know that weight can be caused by even infections like adenoviruses which create inflammation anything that creates inflammation will create weight gain mold I had a patient who was in a moldy apartment and she was so sick from it it caused her to gain 50 lbs so anything that caus inflammation will will cause weight gain and of course obviously our modern refined diet is a toxin in of itself right with all the sugar starch high fructose corn syrup trans fats crap aspartame all the weird food reading and then all the the Plastics we get in our environment BPA phalates past the forever chemicals hormones antibiotics in our food supply it's a lot so a lot of stuff we're exposed to and our bodies have to handle it why are they a problem how do they affect our metabolism when we are exposed to a lot of environmental toxins they interfere with our metabolism they they overload our ability to detoxify them from our liver they disrupt our Central weight control mechanism so our brain function gets disrupted and our ability to control our weight it promotes insulin resistance so toxins cause insulin resistance like BPA we know for example causes diabetes it Alters our circadian rhythms Alters our stress response because toxins are a stress just by having a toxin your system body perceives it as a stress and that leads to higher cortisol also those toxins are highly impacting the thyroid and will slow your thyroid down and that leads to low thyroid function which leads to slow metabolism and more weight gain and people you know see this when you see people dropping a lot of weight they'll plateau and often they'll Plateau because their fat tissue releases all these stor toxins and it poisons their mitochondria but also poisons their their thyroid so you get all these problems so what are these things called well all these toxins are referred to as obesogens because they make you obese and there's a lot of them out there we just went through them all one of the ones that concerns me a lot are the the xenoestrogens these are foreign molecules that mimic estrogen in the body and high estrogen levels promote fat gain and fat storage and really are bad news so how do toxins prevent people from losing weight well they're stored in our fat tissue and then when we lose weight they're released into our bloodstream that overloads our liver and our ability to detoxify these compounds it downregulates our metabolism so it slows our metabolism by reducing our thyroid hormone function it increases actually the excretion of thyroid hormones by the liver and competes with thyroid hormones by blocking the thyroid receptors and buying for thyroid transport proteins so all in all it messes up your thyroid in plain English it also increases free radicals which inhibits something called redo signaling which then damages our mitochondria so that's our little energy Factor so when you have damaged mitochondria you don't burn fat very well toxins also inhibit the effects of leptin the the fullness hormone right they block the effect of leptin in the brain they also lead to higher stress on the body because anything that's a toxin will create a stress response and high cortisol will lead to weight gain and it can lead to insulin resistance it's not just diet that can cause insulin resistance it's also stress and toxins as we talking about and also High cortisol affects a lot of the appetite regulating hormones like grin and leptin and neuropeptide Y and that makes you hungry have have more Cravings in fact in a study of 59 healthy premenopausal women who are aged 30 to 45 they found that stress induced reactivity and negative mood were associated with greater calorie intake so toxins can for sure cause stress but stress itself can cause stress right psychological stress and what does it do to the body well a study of 59 healthy premenopausal women age 30 to 45 found that stress induced reactivity and negative mood were associated with greater calorie intake so if you were stressed you ate more right stress eating makes you crave sugar and even fat when we're stressed it's normal cortisol goes up when you're under stress and you want fuel when you're under stress you can run from a tiger right it also makes you store belly fat unfortunately it affects how the body metabolizes glucose and stores fat and we know people who are on predisone which is basically a medication form of cortisol it causes diabetes I just talked to somebody other day who took it for some reason and it's blood sugar went to like a thousand the body thinks you're stressed and it tries to save your life by storing calories and you go under preservation mode now this hormonal imbalance that you happens with cortisol leads to weight gain and then it also interferes with the body's ability to lose weight effectively so there's a lot of things you should know about weight metabolism it's carbohydrate insulin model the energy balance model obesogens stress there's a lot of things the microbiome all play a role infections even inflammation from any Source will all play a role in affecting weight metabolism so it's not just simple as what you're eating it's more complex than that I think I've written a Blog about it years ago called the eight reasons why you can't lose weight that have nothing to do with what you're eating right so there's a lot of factors you just have to pay attention to them all there's a lot of ways to find out what's going on into the hood and it's important to know your data and it's really important to know your hormones leptin glucose insulin hemoglobin A1c lipid fractionation which is the best kind of panel for cholesterol your full thyroid panel stress hormones inflammation markers all really important looking at heavy metals toxins lead Mercury testing your your metabolic Health your liver Health your sex hormones all these things are really really important to help you understand what's going on you might even need infection testing mole testing testing for food sensitivities like gluten a lot of things are really important to look at and we can test for these things we can test for stool microbiome we can test for mold we can test for toxins we can look at your genetic detox Pathways so when I'm working up someone who's got issues I want to look at a lot of these things how do people do this because the average doctor isn't helping them well I co-founded a company called function Health which is a health platform that allows you assess all these biomarkers and lots more and learn about your numbers and how to optimize them with deep insights and science just 499 a year for twice a year testing and if you're interested in want to learn more and get your own test done so you can see what's going on with your health and Metabolism go to function health.com vmark so what is a functional medicine approach to losing weight so what is a functional medicine approach to losing weight while supporting your detox Pathways well first you want to cut out Ultra processed foods sugar sweetened beverages just get rid of that stuff there's just no reason to ever consume those things you want to basically balance your blood sugar and lower insulin and that's a key strategy for losing weight if you can do that you will lose weight now there may be other factors sometimes as I mentioned that are unusual like toxins or infections but for most people struggling with weight lowering insulin is a great strategy how do you do that well you reduce your intake of refined grains processed foods added sugars lots of starchy Foods foods like rice and potatoes foods that have a high glycemic load with low nutritional quality you want to emphasize low glycemic carbohydrates non-starchy veggies those are carbs beans can be okay non-tropical whole fruits also good gluten-free grains can be fine but lower amounts particularly if you're insulin sensitive and ideally gluten-free because gluten can be very inflammatory it can cause leaky gut I've talked a lot about this on various podcasts but gluten in our America is not your friend also you want to have the right amount of protein which is about a pound per gram of ideal body weight and why because protein makes you full it also takes a lot of energy to burn protein so you're actually burning more calories in metabolizing protein so again this goes against the whole energy balance hypothesis if if it actually takes more calories to burn protein than it does to burn carbs your net net is not the same in terms of your calorie intake and use so you kind of have to understand that it's really more complex than just calories in calories out so basically that's actually a good thing because you're need more protein your body spends more energy digesting it than any other macronutrient also you want to eat the right amount of protein every meal it's really about a palm siiz piece of protein about 30 40 grams lots of fats fats are good for you and fats actually also help you lose weight by making you feel full I wish I could go through all the studies but there's a lot of studies that show for example that eating a higher fat diet will cause less visceral fat and more muscle mass building and many things that you you won't see when you eat a high carb high starch Diet also you know in the good fats what am I talking about nut seeds avocados olive oil you know the drill also toxins you want to try to reduce your exposure as much as possible by eating organic food if you're eating animal products make sure you have you know regenera raised ones or grass-fed ones also you want to avoid pesticides herbicides hormones antibiotics in your food you want to drink filtered water get a reverse osmosis or carbon filter to reduce the contaminants get an air filter like a hep ala filter to increase quality of your air decrease indoor air pollution like from dust and molds and voc's get house plants house plants actually help filter indoor air they're great for that in terms of your personal care products and your household cleaning products make sure they're clean use the ew G guide called Skin Deep there's also a guide in household cleaning products but a lot of these things have Plastics States get rid of all those plug-in fragrances for Breeze all that crap is just not good also plastic use not just bad for the planet it's bad for you microplastics are in everything nanoplastics don't drink from plastic water bottles don't heat food in plastic don't do take out Foods in plastic containers use glass instead and don't use plastic cutting boards Etc so all that stuff you can do yourself also cut down your exposure heavy metals right they're in certain fish water sources LED paint some medical products like the Marisol and certain vaccines like the flu vaccine also improve your elimination of toxins making sure you're going to the bathroom every day one or two times a day B movement I drink lots of water six to eight glasses at least a day to flesh out toxins try to sweat every day through exercise or or a sauna or steam or even a hot bath that really helps detox fiber also really important one because it helps slow the absorption of glucose and and sugar into your system and decrease insulin spikes and helps with weight loss that way but also because it helps detoxification so you can have more beans you can have some whole grains vegetables fruit nut seeds that helps boost your fiber also feed your Healthy gut bacteria that you need to feed those guys right have probiotic rich foods things like yogurt kimchi kefir Nat Tempe which help the got Flora also eat foods that boost detoxification a lot of phytochemicals are in there the broccoli family we talked about a lot cabbage broccoli Collard kale brussels sprouts all that really important for boosting detox garlic every day is helpful cuz also garlic has sulfur that boosts your detox system green tea also another great detox fire you can start your day with that maybe try vegetable juices you can use cilantro celery Ginger parsley beets not too many carrots or beets though that makes it sugary but cucumbers sometimes herbs can be helpful for mobilizing toxins things like dandelion root Ginger cardamon cinnamon a lot of herbs can be very helpful curcumin make sure you have sulfur containing proteins eggs whey protein garlic onions all these are great to help you improve your elimination of toxins cuz they all boost Aion which is really important other things can be helpful about flavonoids and colorful things like berries dandelion greens are actually one of the most uh liver detoxifying plants out there they help bof flow and are great cilantro is also great you can juice cilantro that helps remove heavy metals Rosemary is great it has carnosol which boosts your lot of your detox enzymes and curcuminoids which is found in turmeric and Curry well they're full of antioxidants and they're anti-inflammatory and they're detoxifying eat dark green leafy vegetables which have chlorophyll also really good for detox Ying so there's a lot of things you can do with diet and herbs and spices and foods to help your body boost its own detox Pathways next you want to obviously exercise right exercise is really important yoga lymphatic massages all that helps flesh out toxins from your tissues and boost circulation so you can detoxify so you don't obviously want to only exercise for detoxification you want to do it for your metabolism so hit training cardio strength training all important for weight management but you can't get there alone with exercise and then there's a lot of supplements you can use to help with blood sugar regulation and insulin sensitivity and and detoxification you know I start with a multivitamin and mineral formula also use PGX it's a polyglycol Plex it comes from KAC root which is a Japanese root tuber but it doesn't U have any calories and it absorbs 50 times as weight in water you can take it as a supplement either capsules or powder 2 and half to 5 gam 15 minutes before every meal with about 8 O of water and that basically acts like a sponge and slows things down magnesium really important vitamin D chromium is usually in a multiv Vin milk thisle is great for detoxing omega-3 fatty acids reduce inflammation and ayine also helps boost glutathione and lipoic acid it's also really important detoxifier it's also important antioxidant and mitochondrial support nutrient and so is carnitine so there's a lot of things you can take we're going to reference all these in the show notes and and give you a lot more detail but I think basically you can help your body by getting rid of all the such and Sugar by upregulating your detox Pathways by optimizing your microbiome by taking a few nutrients to help your metabolic pathways and detox system you know you can get your weight under control I've seen this over and over and without OIC without drugs without extreme calorie restriction diets I've helped people lose literally hundreds of thousands of pounds I hope we can all agree that that weight loss is not just a simple problem that it's not a one-sized fits-all journey it's not just about counting calories it's not just about carbs it's about everything so whether you're leaning toward counting calories which good luck with that or managing your carb intake the consensus for everybody is really clear nobody disagrees with this Ultra processed foods are bad for your health them it's literally going to cut out 60 to 70% of the foods you eat in your diet if the average American but you need to do it and if you don't do it you're going to screw up your metabolism you're going to screw up your microbiome you're going to screw up your hormones and you're going to screw up your health and nobody wants that and these are highly addictive they're designed to make us overeat which contributes to a lot of the weight game we're seeing and is all these Downstream issues and I've talked at nauseum about Ultra processed foods on the podcast but I encourage you to learn more about it and really understand the harm they do now when we focus on Whole Food on nutrient intense food when we optimize our detx Pathways when we get rid of environmental toxins as best we can then we can address the root cause of waking or the causes because there's often many and when we do that we're going to create a sustainable path to weight loss and Optimal Health and again I've seen people over and over lose weight maintain the weight loss simply by working with their bodies rather than against it so remember if you're overweight it's not your fault it's because of the incredible burden of things that are flooding our system today the excess of refined starches and sugars the excess of calories the excess of environmental toxins the things destroy a microbiome the chronic stress we under and it's a lot to deal with but we can deal with it and we just need to break it down for each individual and personalize the care and by doing that I think we can get people back to health I've seen this over and over I've done this with large groups and I think if you understand your body and how it works which is the whole purpose of why I do all this and give all this free information is I want people to feel better I know people are just literally a few days away from feeling better and if they had the instruction manual for their body they can overcome a lot of the challenges they have and lead a healthy vibrant life which is what I want for all of you if you love that last video you're going to love the next one check it out here