Dr. Mark Hyman – Eat Fat Get Thin

Do you think eating fat makes you fat? Are you confused about cholesterol? What does a healthy diet really look like? We answer all this and more this week with Dr. Mark Hyman, a practicing family physician, a nine-time No. 1 New York Times bestselling author, and an internationally recognized leader, speaker, educator, and advocate in his field.

He is the director of the Cleveland Clinic Center for Functional Medicine. He is also the founder and medical director of The UltraWellness Center, chairman of the board of the Institute for Functional Medicine, a medical editor of the Huffington Post, and has been a regular medical contributor on many television shows including CBS This Morning, the Today Show, CNN, The View, the Katie Couric show, and The Dr. Oz Show.

In This Episode

Dr. Mark Hyman Bio … 00:01:15
Eat Fat, Get Thin Synopsis … 00:03:49
Key Medicinal Benefit of Fat … 00:07:58
More Facts on Fat Calories … 00:13:59
Fat, Heart Disease, and Cholesterol … 00:19:24
Dr. Mark Hyman’s General Dietary Principles of Healthy Eating … 00:28:38
Dr. Mark Hyman’s Least Healthy Fun Thing … 00:33:09
Episode Wrap-up … 00:34:34

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Dr. Michael Ruscio: Hey, folks. Welcome to Dr. Ruscio Radio. This is Michael Ruscio. And I am here with Dr. Mark Hyman, who has just released another book and was kind enough to take some time out to speak with us today about his book, some of the great lessons embedded in it, and some of what he has learned through the process of writing it.

Mark, thanks for being here!

Dr. Mark Hyman: Well, thanks for having me.

DrMR: My pleasure. Can you tell folks…I’m sure many people listening to this have already heard of you because you’re definitely a very prominent name in the field. But for anyone who hasn’t, can you give people a kind of short synopsis on your background and what you’ve been doing?

Dr. Mark Hyman Bio

DrMH: Sure. I’m a doctor, a family doctor by training. And for the last 20+ years, I’ve been focused on functional medicine after I got sick and ended up working at Canyon Ranch, where I really got a living laboratory to explore biology in a whole new way, looking at the root causes of disease and how to solve my own illness.

And through that, I really got deep into functional medicine, got connected with a lot of the founders and pioneers like Jeff Bland, Sid Baker, Leo Galland, and others, Bob Rountree, David Perlmutter. And I really realized that there was this whole untapped world of healing that I never knew about when I went to medical school but I had an intuition about because I knew the body was a system and everything was connected and that I didn’t really have the whole story.

And I just didn’t know exactly how things worked. But once I had to figure it out for myself, and once I got connected with this way of thinking, which was functional medicine, it really turned my world upside.

And so for the last 20 years, I’ve been doing that, first at Canyon Ranch for ten years almost and then in my own practice at the UltraWellness Center for the last 12 years. And now I’ve started a center for functional medicine at Cleveland Clinic, which is extraordinary. We have now one of the largest centers in the world. We have over seven doctors, two nurse practitioners, up to 30 staff. We have health coaches, nutritionists. We’re building a new facility that’s 18,000 square feet. And it’s just growing every day. We have 1,500 people on the waiting list. I think it’s actually more now.

DrMR: Wow.

DrMH: And so we’re doing research. We’re changing medical school curriculum. We’re doing community work. We’re building training programs. So it’s really very exciting.

DrMR: Yeah. That’s awesome. I didn’t know that the Cleveland Clinic Center was that big. But it’s really just great that you’re making some nice inroads into the conventional system, because I think there’s a real need for the conventional system to get some of this stuff, to be influenced by functional medicine. And it seems like you’re really making some big waves in terms of doing that. So thank you.

DrMH: Well, it wasn’t actually me that wanted to make the inroads because I was like, “Hey, I’m not going to Cleveland. It’s going to be banging my head against the wall.”

But it was really them asking us to come and build a program there because they realize that the future of health care is not doing what we’ve been doing. It’s something quite different. And it’s really about revolutionizing our approach to dealing with chronic disease.

DrMR: Absolutely. Totally agreed. So you’ve written a number of books. And you have a new one out called Eat Fat, Get Thin.

Eat Fat, Get Thin

Can you tell people a little bit about that book? And I’ve heard you comment that this was the hardest book that you’ve ever written.

So I’m curious to hear a little bit about the book and why this one in particular was so challenging for you.

DrMH: Well, it was hard because I think fat is confusing. And I wrote a number of books. I’ve written a dozen books. And they’ve all been pretty straightforward—about sugar, about biology and functional medicine. But the issue of fat is so controversial. And there are such polarized opinions. There are people who think if you touch an avocado or an almond you’re going to die of a heart attack. And there are other people who are like, “No, no. You should be drinking butter every morning.” And it’s a huge spectrum in between.

I’m trying to figure out what the stories are. There are scientists on both sides who are extremely esteemed experts, talking about how we should be having more omega-6 polyunsaturated fats. And others are saying we should be more having saturated fat. Or that saturated isn’t an issue. So there’s a real diversity of science.

And that’s really unfortunately what I had to struggle with, which is what is the truth? What is the place where we can come together and really understand the true nature of how fats work in our body, what fats we should eat, what fat we shouldn’t eat, how they affect us? And so I had to do all that research.

And I had to literally review all the data, not just read about people’s reports on it, but actually read the studies, see where the issues were. I had to address, what about butter? What about meat? What about saturated fat? What about refined oils? What should we be eating? How much should we be eating? Do we really need to eat low fat to reverse heart disease? Or is there another way to do this? And what’s really driving so much of our obesity epidemic? How do we gain and lose weight?

I think those are the questions that I really wanted to take a fresh look at. And that’s what I did. And I reviewed over 1,000 papers. Five hundred of them are in the book. They wouldn’t let me put any more in there.

DrMR: I share your affinity for references. I think many of the people listening like the fact that we really have a very evidence-based set of recommendations that we make. And it’s not so much so about dogma, so to speak, but it’s more so about looking at things progressively and using the science to guide our decision-making.

DrMH: Exactly.

DrMR: And definitely with fat, it can be a very hairy issue. There are a number of things that go through my head. But one of the things that pops up right away is sometimes fat is lumped in as a catchall including processed foods. And so is it really the fat? Or is the fact that fat got lumped in with a lot of other unhealthy processed foods? And I think that may be one of the reasons why we see some challenge—

DrMH: Sure. I’m not talking about fried chicken or donuts, right?

DrMR: Right, exactly.

DrMH: Not talking about French fries and ice cream as a source of fat. I’m talking about fat that’s from whole foods, fat that’s actually not connected to carbs, which is the problem. When you combine them, it’s called sweet fat, whether it’s a donut or French fries or ice cream or bagel and butter. Those are all things which can create great harm. And I think you have to be very cautious about that.

So I’m excited about helping people understand what the real nature of fat is and how we can actually use it to help our health, both in preventing disease, helping us feel better, and actually even losing weight, which seems paradoxical but actually is how it works.

DrMR: Right. And I think definitely, depending on where you received much of your education on nutrition, many, I’m sure, other people share the same frustration that I share where you have family and friends who are constantly eating low fat because they’re trying to lose weight.

But at the same time, they are getting a huge bolus of carbs. Not to say all carbs are bad. We’ve talked about this on the show before. But, gosh, when we look at some of the literature, we do see that a lower carb diet that tends to be a little bit higher in fat—because when you limit carbs, that’s one of the other nutrients that you need to increase to make up the difference—has really been show to be superior for weight loss in a lot of the studies.

Key Medicinal Benefit of Fat

So I guess maybe with that is a transition, Mark, are there some kind of key medicinal—I guess, if you will—benefits to increasing fat? Are there some conditions that people can really heal by changing their diet in this kind of Eat Fat, Get Thin way?

DrMH: Oh, yeah. Yeah, sure. And for all of us, I think we do need fat just as part of our basic foundational diet. And the right fats from whole foods which we can into. But I think that the thing that is striking to me is how it can be effective in actually reversing diseases.

So I just got off the phone with one of my patients who came in with a hemoglobin A1c of 11, which is really poorly controlled diabetes, and struggling to keep his sugars under control. Body was doing all the right things.

And I essentially put him on fat for breakfast. I actually got him off all starches. And he was extreme. He was at the end of the spectrum of diabetes where he had to go on insulin. He wasn’t going to get it under control. And within a couple of months, his hemoglobin A1c went from 11 to 7, which is still a little high but much, much better. And his blood sugars are really mostly normal now. And he’s eating probably 70% fat.

So someone who’s diabetic, these people do much better. And there was a lot of research I reviewed on this where scientists looked at all the evidence around dietary fat and low carb diets for, not just preventing or controlling diabetes, but actually reversing it. And I’ve seen this many, many times in my practice. And when you aggressively use it, it can help.

I’ve seen patients with Alzheimer’s who are extremely cognitively impaired. And you actually change their diet and get all the sugar. And they’re calling Alzheimer’s now type III diabetes because of the effect on the brain of sugar. And when you actually give them high-fat diets, even ketogenic diets, there might be benefits to the very high-fat diets of these patients where they clear up. And I had a number of patients who’ve done that.

It’s used in epilepsy. It can be used in cancer. I was talking to an oncologist the other day. I was on the Dr. Oz Show about carbs and how carbs can cause cancer—purely sugar and high-glycemic carbs. And I said to the oncologist, “What about high-fat diets for cancer?” And he’s like, “Yes, it’s actually showing that these can actually help in the treatment of certain cancers like brain cancer.”

So there’s a lot we’re learning about fat and the treatment of disease. I’ve seen in autism. I’ve seen other conditions that I think are challenging around the brain, metabolism, weight. I’ve seen people who are really stuck with their weight and inflammation. And on a very, very low-glycemic diet, you see a huge improvement.

DrMR: Absolutely. And this is something that we’ve talked about on the show before, which is using really the highest level science to guide decision-making. And I can’t speak to all these issues. But I know that for weight loss and for treatment of type II diabetes and pre-diabetes, systematic reviews with meta-analyses—so really the highest level of scientific evidence that we have—have concluded that a lower carbohydrate diet seems to be better than the standard nutritional recommendations.

And for people listening, in case that sounds a little bit confusing—again, usually when we go lower carb, we take away the carbs and we add in a lot of these healthy fats like Dr. Mark is speaking to. So this is certainly something that we’re really starting to see be reflected in the high-level science.

And it’s great that we have people like yourself, Mark, writing the books to kind of translate that science and make it a little bit more easy to digest, I guess you could say, for a lay audience. And I’m really hoping that’s going to start to change that person you’re next to at the coffee shop who is getting the low-fat latte. Or maybe a latte is not a good example. Get rid of this fear of fat that seems to really permeate the culture.

DrMH: Totally. It’s really quite an interesting thing. I go places. Can I have the egg white omelet? Can I have the skim milk in my coffee? And I thought to myself, “Wow, this is still such a prevalent concept.” And I think people have a hard time because when you think about it, everything we know about nutrition and weight loss is really focused on the calorie theory. “All calories are the same.”

And if that’s true, fat has more than twice as many calories as carbs and proteins, so if you cut out the fat, you’re going to cut your calories. And you’re going to lose weight. And it seems like a logical concept. And also, when you look at fat, it actually looks like the fat that’s in your body, and it’s the same word—fat and fat, right?

DrMR: Right.

DrMH: And so it seems like, gee, if you eat fat, you get fat. But when we start to look at biology, it’s not really a math problem. And the thing that people don’t understand is that—they go, “Oh, Dr. Hyman, what are you talking about? It’s not calories? Because it’s all about thermodynamics? What are you saying, physics isn’t true?”

Well, no. I’m not saying physics isn’t true. If you look at the definition of the first law of thermodynamics, it says, all calories—or all energy—is conserved in a system. A system. That means a closed system. Guess what? Your biology is not a closed system. If you take 1,000 calories of broccoli and 1,000 calories of soda and you burn them in a laboratory, they release exactly the same amount of energy. If you eat them, they’re not the same.

DrMR: Yes.

DrMH: First of all, 1,000 calories of broccoli is like 25 cups of broccoli. And then 1,000 calories of soda is like a little more than a Big Gulp, which people consume quickly.

DrMR: Right.

DrMH: And one has adverse effects on your liver, causing high levels of fatty liver and some resistance, high triglycerides, low HDL, inflammation. It lowers testosterone. It causes hunger. It causes fat deposition. There’s the issue of fat storage. Whereas if you eat the broccoli, the opposite happens. You feel full. You can’t even eat it all. Your inflammation goes down. Your lipids get better. It’s got 35 to 40 grams of fiber. It’s got no sugar in it. It’s a totally different food. Now, I don’t know why that’s such concept for people to understand, especially nutritionists and doctors, because it’s just common sense when you think about it.

More Facts on Fat Calories

But with fat, it’s a little trickier. But now, fat, what it does is it—one of my colleagues, David Ludwig from Harvard, is a professor. He said something to me. He was like, “Mark.” He said, “Think about a type I diabetic. What happens when they get diagnosed?” Well, they’re hungry all the time. And they eat everything in sight. And they lose weight like crazy.

So how could you eat 10,000 calories a day and lose weight? Simple. If your pancreas is pooped out, you have no insulin. With no insulin, you can’t store the calories. So if you eat a diet that keeps your insulin low, you will not store calories. You’ll burn them. And you’ll also not be hungry all the time.

DrMR: Great.

DrMH: And when you eat starch, sugar, carbs… It can even be a potato. I was talking to this guy who was a type II diabetic, but he’s super poorly controlled. And he’s super sensitive to what he’s eating. And he uses a continuous blood sugar monitor so he can see even with anything he eats.

He says, “If I eat steak and wine, my blood sugar goes down.” I’m like, “Why? Really?” He’s like, “Yeah, if I have a little bit of wine, it actually seems to benefit my diabetes.” I’m like, “Yeah, that makes sense because it’s a vasodilator. It reduces inflammation. There are other factors that might affect you.” Whereas he said, “If I have anything with a breaded calamari or something, my sugar goes through the roof.” And I thought, “Wow, that’s fascinating.”

So it really depends on what’s happening with your insulin level. And when your insulin levels are low, if you eat fat without the starch and sugar, you keep your insulin levels low so you’re not hungry. You stimulate fat burning. You release fat from your fat cells. And with sugar and carbs, you actually increase insulin. And that drives fat into fat cells. That prevents lipolysis, or fat burning. And it also makes you hungry. So it actually shifts your body into a starvation state. It’s like you have hungry fat cells all of a sudden.

So this is where the concept of calories all being the same is just not right. From a functional medicine perspective, as I’m sure you’ve discussed on your show, food is not just calories. It’s information. It’s instructions. And it controls your biology through all sorts of mechanism far beyond calories.

DrMR: Exactly. And it’s, I think, hard sometimes for people to understand that there may be a food that has a little bit more calories or a little bit more fat. But the way those calories are used in your body or they way those calories are partitioned could be more or less healthy depending on the constitution of the food.

Yeah, I know Gary Taubes has talked a lot about this, which is exactly what you’re saying, which is the type of food will determine how those calories are used.

DrMH: Yeah.

DrMR: And we want the stuff that’s going to be burned for energy and not just be sucked right into our fat cells. And so if something has slightly more calories but those calories are going to be the type of calories that aren’t going to stick to your fat cells but rather be burned for energy, then I think hopefully this is the understanding that will get people out of this fear of fat and allow them to look at things more for the food quality rather than just how many calories are in here and how much energy would be elicited if we just burnt it in a stove, so to speak.

DrMH: Exactly. And I think that’s what people don’t really recognize is that, like David Ludwig said to me. He said, “Mark, if you were to drink a liter of olive oil a day, it might have a bazillion calories, but you’re not going to gain any weight because it doesn’t have insulin around to push it into the fat cells.” And that’s a big, powerful idea.

DrMR: Absolutely. And there’s another interesting piece I’ve seen published in a few papers. And maybe you can speak to this, Mark, also. When people tend to eat a lower-carb, higher-fat diet, they tend to just automatically eat less overall calories.

DrMH: Yeah. Yeah.

DrMR: Because the food’s more satiating.

DrMH: It’s true actually. I found that when I was doing my research that when you look at controlled studies, you think, “Oh, if you eat fat snacks, you can eat as much as you want versus carb snacks, eat as much as you want. You’re getting more calories if you eat the fat because it’s more calorie dense.” What they actually found out was that people stopped eating the fatty snacks because they were full.

DrMR: Right.

DrMH: Whereas the carb snacks, you just binge on them. People never binge on 15 avocados. But they would eat a sheet cake. You know what I’m saying?

DrMR: Right. Right. And actually we had one of my good friends, Melissa Hartwig, on awhile ago. And she wrote a book called The Whole30.

DrMH: Yeah.

DrMR: And I love the way she puts this. She calls it “food with no brakes.” Food that you just can’t stop eating.

DrMH: Exactly.

DrMR: Or these high-carb foods.

DrMH: Exactly. Exactly.

DrMR: Yeah.

DrMH: Exactly. Exactly. And I think that’s right. How do you actually eat food with brakes? That’s a great way to talk about it. And she’s actually deriving also from functional medicine too. A lot of her work is really driven from elimination diets, and that’s great.

DrMR: Yeah. Yeah, I think we’re all saying really similar things. And there’s this saying that I love, which is, “The closer you get to truth, the more commonalities you find.” And I think it can be refreshing that when we see different people saying very similar things, it tells us that we’re probably heading in the right direction.

DrMH: Totally. Totally.

Fat, Heart Disease, and Cholesterol

DrMR: So Mark, something I’m curious about—what may be some things that are new or different in this book compared to some of your other books? And I know we’re always learning. We’re always evolving. We’re always growing. So I’m sure that there have been some updates or some new things or some things that maybe looking back ten years ago, you said, “Boy, we thought this back then. But now, this has really changed a bit.”

DrMH: Yes. So if I look at my book UltraMetabolism, I really was saying fat is good, which I wrote over ten years ago. But I said saturated fat is bad. So avoid saturated fat. And I would say don’t eat meat or not that much meat. And I was like, “Well, I’ve got to kind of see what the data is.”

So I went back and looked. And I can tell you there is so much data now on saturated fats that really we hadn’t had before. So review after review after review—and I talk about all these in my book—have really looked at the evidence. And there’s no connection between total unsaturated fat and heart disease.

For example, one study looked at 72 meta-analyses, 72 studies in 19 countries, 600,000 people, and could find no link in randomized controlled trials, observational trials, fatty acid levels, looking at their blood levels of saturated fats, and other things. No link between heart disease and saturated fat.

When we actually look at the effect on lipids, we go, “Well, saturated fat raises cholesterol.” Well, it actually does raise cholesterol. The question is, what does that mean?

DrMR: Right.

DrMH: And if you begin to look at the issue of cholesterol, I was sort of shocked because I was like, “Wait a minute. Is LDL really the problem?” Because if you were to listen to every commercial on television, if you were to look at all the statin adds and listen to your doctor, it just really makes it clear that you want your LDL to be as low as positive.

Well, when I actually looked at the data, it was fascinating. There was a study where they looked at—it was, I think, 231,000 hospital admissions at 541 hospitals over six years. It was about 130,000 people they had blood levels for of LDL.

And 75% of people who had heart attacks, admitted to the hospital with a heart attack, had normal LDL. Fifty percent had optimal levels, which is under 100. And 17% had super optimal levels, under 70. But what was really interesting was that the HDL, on average, was low, and the triglycerides were high. And over 54% had levels of HDL under 40. And only 10% had levels over 60, which is optimal. So that’s really fascinating to me.

And then you look at the data on the discordance between LDL and LDL particles. LDL particles—it gets a little technical here, but I think it’s worth going into. So not all LDL is the same. We know about good cholesterol and bad cholesterol—HDL and LDL. But now we know, oh, wait a minute. There are different kinds of LDL. There is good and bad LDL. There is good and bad HDL.

So when you look at the studies on saturated fat and we look at the other studies, when you have a low LDL, if you have a high LDL particle number, then you have very low risk. Even if you have a very high LDL, if you have very low particle numbers—if they’re large, fluffy particles and not small, dense particles—then your risk is super low. But if you have a very low LDL but very high particle number and a very small size, you have the highest risk.

DrMR: Right.

DrMH: So it’s a little confusing. But the bottom line is you can’t really tell from your regular cholesterol test. You need to do a special test that’s called NMR or Cardio IQ. It’s available from LabCorp or Quest—NMR or Cardio IQ. You should not have any other cholesterol test because they’re pretty meaningless when it comes to understanding the nature of your cholesterol.

And when you look at saturated fat—I’m getting around to this kind of issue here. But when you look at saturated fat, saturated fat actually increases the size of your LDL. So it makes it less dangerous. And two, it reduces your triglycerides which is great. And three, it’s one of the few things besides vigorous exercise that raises your HDL, or good cholesterol.

So at the end of the day, even though your total might be high and your LDL might be higher, the overall pattern might be better and less likely to cause heart attack. So that’s fascinating. And I think I covered a lot of that in my book in the article. So I think that’s the biggest change that I’ve had. It’s really a rethinking of saturated fat.

Now, do I think we should all be eating sticks of butter a day? No. Do I think you can include sat coconut oil and butter as part of your diet without worrying about it as long as you’re eating a low glycemic diet? Absolutely. And I’m working on another essay. It’s like a 5,000-word essay where I’m just really digging into all this because I think people are so confused about this. So that was a big shocker for me.

DrMR: Yeah. I mean I love the points that you’re making. And I think some of the writing has been on the wall for a little while now. I know that Christopher Gardner who’s a PhD researcher at Stanford—we had him on a little while ago, talking about his A-to-Z weight loss trial.

DrMH: Yeah.

DrMR: And he found that, yes, LDL actually, in his study, did go up a little bit on the low-carb, high-fat diet. But HDL also went up. Blood sugar came down. It was the best diet for weight loss. It was the best diet for triglycerides. So when he compared some of the really typical diets, ranging from low-carb all the way through high-carb, he found, as you’re saying, Mark, the total cardiovascular picture—not just one marker, but the total picture—

DrMH: Yeah.

DrMR: Looked much more favorable when you ate this type of diet.

DrMH: Yeah. Exactly. Yeah, so when you look at the Ornish Diet in that study, the LDL came down the most of all of them because it was low fat. But the triglycerides went up the most. The HDL went down the most. The blood sugar went up the most. The insulin went up the most. The weight didn’t change as much as the other ones. And it just was clearly not as beneficial from an overall cardiovascular point of view.

DrMR: Yep. It reminds me of—

DrMH: Actually, I review that study in my new article that’s coming out.

DrMR: Oh, good. Good, okay.

DrMH: Yeah.

DrMR: This reminds me of a very unfortunate incident with one of my friends. Her husband died after they were only married for a year, just absolutely tragic. And a good friend of mine reached out to me and said, “Boy, I need to get my cholesterol under control. I heard about our friend so-and-so whose husband passed. And I’ve had high cholesterol for awhile.” And he says, “My total cholesterol is this. My LDL cholesterol is that. What should I do?” There’s not a ton you can do with just looking at the total cholesterol and the LDL. But it just shows you how ingrained this is in the population.

So really to help my friend—and I share that story because I’m sure there are many people listening who are either thinking something similar, or if they’re a practitioner, they’re trying to help someone who’s asking a similar question.

You’ve got to go a little bit deeper with the cholesterol analysis because we’re learning more about it’s not just the LDL. It’s some of these more subtle markers or more advanced markers. And a lot of this leads back to a diet that probably comes back to a diet that’s a little bit more ancestral or a little bit more in alignment with our biology.

DrMH: Yeah.

DrMR: Which may have a little bit more fat. And that fat may cause a little bit of a jump in the LDL. But again, it’s the total picture and what that really looks like that’s going to be important.

DrMH: Yeah, that’s right. I think what you can use is surrogate markers of your particle size. And actually if you look at the data, it’s not just particle. If you look at your total to HDL ratio, much better predictor than LDL. If you look at your triglyceride to HDL ratio, much bigger predictor.

So you want a low ratio of both. And the higher it is, the worse you are. If your triglycerides are high and HDL is low, that’s bad. If your HDL is low and your total cholesterol is high, that’s bad. And so you can kind of use those as surrogate markers because if those ratios are off, guess what? Your particles are going to be bad even if your LDL looks normal.

DrMR: Precisely. And it’s probably a daily occurrence at the clinic where we’ll run an initial panel through LabCorp or Quest, just some basic initial blood work. And patients may see their total cholesterol is maybe 238. And they’re concerned about that. And they ask me, “Am I at risk? Is there something that we need to do?”

And it’s almost daily I have to remind them, “Well, your HDL looks good. All of your ratios look good. Your insulin looks good. Triglycerides look good. So really there’s not really much risk here. This is not something that I’m concerned about.” But yeah, it’s something that it’s important for people to be aware of because it’s easy to see that one number high or bolded or in red and scare you. But it’s a little bit more complex than that, I guess.

DrMH: Totally.

Dr. Mark Hyman’s General Dietary Principles of Healthy Eating

DrMR: Now, Mark, if someone is listening to this, how would you kind of advise them? And of course your book, I’m sure, is a great resource for exactly what to do. But if someone’s just trying to wrap their head around some of these initial concepts, “Okay, I need to eat some more healthy fats, probably eat some less carbs,” do you have some general principles? Some people recommend less than 150 grams of carbs a day. Or ketogenic folks may say you should only do 50 grams a day. Do you have kind of a basic starting point for people?

DrMH: I think everybody’s different. So here’s the other take home. One person, for example, might be severely insulin resistant, type II diabetic, can look at a bagel and just gain weight thinking about eating it, right?

DrMR: Sure.

DrMH: And other people are super fit and don’t have insulin resistance, are not pre-diabetic, and have more metabolic freedom. So I think it’s hard to say, “This is what you should do. Or that’s what you should do.” I think there are general principles that I’ve come up with that I think are fair and work for everybody. And then, within that, people kind of can play around. But if you actually think about anybody, very few people are going to count calories or measure exactly what they’re eating or count carbs. And it’s super hard to do, right?

DrMR: Agreed.

DrMH: So I think what are the principles of healthy eating? And I can kind of go through that. I talk about it in the book. But I called the Pegan diet, which is kind of a joke. It’s a joke. I actually was sitting on a panel with a friend of mine who was paleo. Another one was vegan. I’m like, “Okay, guys. I must be a Pegan because I’m neither one of those.”

So the principles are really what do we have in common? Whatever we have in common to healthy eating? One, it should be whole food, fresh food, ideally organic, ideally local as much as possible. It should be very, very low-glycemic food. Whatever it is, it should be low in sugar, flour, refined carbs for sure. It should be very high in vegetables and fruits and the lower glycemic fruits, the better. Low or no pesticides, antibiotics, hormones, and ideally no GMO, these are the things just basic concepts, very few to no chemicals.

DrMR: Sure.

DrMH: We eat about two or three pounds of chemicals every year—additives, preservatives, dyes, MSG, artificial sweeteners. All that stuff is in our food. High- or good-quality fats. What fats? Extra virgin olive oil, lots of nuts and seeds, avocados, omega-3 fats from fish and from wild seafood or even algae, and certain things like flax seed. It should be low in refined, processed vegetable oils.

So extra virgin olive is fine, but all the refined oils, not so much. Good quality protein—it can be plant or vegetable protein or animal protein. But it should be, ideally, sourced from sustainable and humanely raised animals that are grass-fed, antibiotic- and hormone-free if you’re eating meat. Fish, same thing. It should be fish that’s low in toxins like sardines, herring, anchovies, mackerel, wild salmon. And avoid the big mercury-containing fish.

I think the things I would say we should be concerned about are dairy for a lot of reasons. And grass-fed butter or ghee is probably fine because it’s mostly fat. But some people have allergies, inflammation. And there are concerns about that. Grains—I think gluten is a big problem, not even if you’re gluten sensitive, but for people who aren’t, it may be a source of inflammation for a lot of reasons.

I don’t have time to go into them all. But I write about it in the book. Beans, again, can be a great food for some people if they want tofu or tempeh, which are low-glycemic beans, sourced products, only if they’re non-GMO. And then if you are having very-high-sugar issues, you may not be able to eat beans. Meat—I think we talked about eggs are fine. And then just really simple, delicious foods. And that’s really it.

And so most of your plate is non-starchy veggies, lots of nuts and seeds, low-glycemic fruit, fish. I like grass-fed bison, lamb, pasteurized eggs, some gluten-free grains like black rice quinoa, some small beans. If tolerated, very low to no dairy, lots of good fats. Treat—sugar, maple sugar, honey if you want something sweet, but as a recreational drug, small amounts of alcohol, all that. So I think that’s really it. It’s pretty simple concepts. And if people follow them, they usually do pretty well.

DrMR: I love it. We’ve talked a lot on the show about principles and trying to get people out of the mentality of just trying different protocols or different methods but trying to just step back and understand what the principle behind something is and live your life by principles rather than kind of running from protocol to protocol or fad to fad. So I really agree with you on that.

Dr. Mark Hyman’s Least Healthy Fun Thing

One question I’d like to ask you as we move to a close here…And this isn’t a question we’ve asked. I’ve kind of forgotten about it. But I’ll give the quick background to it. One of the things that I’ve seen, more so in my interactions with patients in the clinic, is sometimes people get so focused on their health that they forget about having fun.

And they almost forget about these health pursuits are to help make you healthy and vital to go back to the life that you’re trying to live—to be the best husband or wife or son or father or whatever it is—and to be a fun person and to just enjoy yourself. So I like to ask my guests, what’s maybe the least health conscious thing that you’ve done lately but the most fun?

DrMH: Let’s see. Probably staying up dancing till three in the morning.

DrMR: I love it. I love it. That’s one of my most favorite things to do myself. Awesome!

DrMH: Pretty much. Pretty much.

DrMR: And I thank you for sharing that. I think it’s really good for people to hear this because, again, what I’ve sometimes seen in the clinic is people are afraid to do anything outside of the box. And I think that’s not good for your soul. Sometimes, you want to drink too much wine and listen to music and dance with someone that you love. And that’s awesome. Great.

Episode Wrap-Up

So this has been a really good conversation, Mark. I really appreciate your time. If people wanted to learn more about you or hear more from you, of course you have the book, Eat Fat, Get Thin. Is there anything else or anywhere else people can go to kind of track you down or follow you?

DrMH: Sure, yeah. One, I have a great site for the book Eat Fat, Get Thin. And I have a 45-minute Q&A there. We have an online challenge with the book and get part of a community that’s doing this together. They could also sign up for my weekly House Call where I talk about all sorts of different topics, videos on drhyman.com. And of course, check out my book and everything else that kind of gives you more meat on the bones, so to speak.

DrMR: Awesome.

DrMH: Or more fat on the bones.

DrMR: Right? Awesome. Well, Mark, thank you again for taking the time and also just for all the great work that you’re doing because I think you’re really making some big waves in the functional medicine community. And it’s great to have someone like you doing the great work that you’re doing. So thank you.

DrMH: Thank you so much for having me.

DrMR: Absolutely. My pleasure.

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8 thoughts on “Dr. Mark Hyman – Eat Fat Get Thin

    1. Hi Paul,
      I am not a cancer expert so I don’t have strong thoughts here. That being said ketogenic diets have been shown helpful for some neurological cancers. I would be inclined to think that different diets work better/worse for different types of cancer and that its not a one-sized-fits-all approach.
      Hope this helps!

  1. Dr. Ruscio,

    I would love to hear your opinion on the insulin hypothesis of obesity, because after listening to this episode I’m not sure if you were just being your usual extremely polite self and giving Dr. Hyman the chance to chat about fat and promote his new book, or if you agreed with what he was saying?

    For example, he quoted David Ludwig as having said to him: “Mark, if you were to drink a liter of olive oil a day, it might have a bazillion calories, but you’re not going to gain any weight because it doesn’t have insulin around to push it into the fat cells.” This to me seems ridiculous, and the only way you wouldn’t gain any weight in this instance is because you would be sat on the toilet evacuating your bowels at the same velocity as a fire hydrant!

    I absolutely agree that on a practical level LCHF diets can be effective for weight loss – but it’s not because carbs make you gain weight and fat doesn’t as Dr. Hyman is claiming.

    Danny Lennon over at Sigma Nutrition has just written a superb blog post on this, and it points to research showing that the “eat fat, get thin” message espoused by Dr. Hyman (and other insulin hypothesis supporters), is disingenuous and misleading. http://sigmanutrition.com/just-how-effective-is-low-carb-dieting/

    Many thanks,

    1. Hey Ross,
      I think it’s a pretty simple answer; both are correct. Some do better on a lower carb/higher fat diet and others do better on a lower fat/higher carb diet. For weight loss LCDs do seem to have an edge, according to the published literature. But again, and as Dr. Gardner and I discusses several months ago, some do better low carb while others do better higher carb.
      Hope this helps!

  2. Dr. Ruscio, not that I don’t think all of this is valuable information, because I certainly agree with much of what Dr. Hyman says, but I would like your opinion of this video of Dr. Nicholas Gonzalez and what he says about ketosis and the high fat diet with relation to cancer. You have to scroll down to see the ten minute interview.



    Paul Goldstein DC

    1. Hi Paul,
      I am not a cancer expert so I don’t have strong thoughts here. That being said ketogenic diets have been shown helpful for some neurological cancers. I would be inclined to think that different diets work better/worse for different types of cancer and that its not a one-sized-fits-all approach.
      Hope this helps!

  3. Dr. Ruscio,

    I would love to hear your opinion on the insulin hypothesis of obesity, because after listening to this episode I’m not sure if you were just being your usual extremely polite self and giving Dr. Hyman the chance to chat about fat and promote his new book, or if you agreed with what he was saying?

    For example, he quoted David Ludwig as having said to him: “Mark, if you were to drink a liter of olive oil a day, it might have a bazillion calories, but you’re not going to gain any weight because it doesn’t have insulin around to push it into the fat cells.” This to me seems ridiculous, and the only way you wouldn’t gain any weight in this instance is because you would be sat on the toilet evacuating your bowels at the same velocity as a fire hydrant!

    I absolutely agree that on a practical level LCHF diets can be effective for weight loss – but it’s not because carbs make you gain weight and fat doesn’t as Dr. Hyman is claiming.

    Danny Lennon over at Sigma Nutrition has just written a superb blog post on this, and it points to research showing that the “eat fat, get thin” message espoused by Dr. Hyman (and other insulin hypothesis supporters), is disingenuous and misleading. http://sigmanutrition.com/just-how-effective-is-low-carb-dieting/

    Many thanks,

    1. Hey Ross,
      I think it’s a pretty simple answer; both are correct. Some do better on a lower carb/higher fat diet and others do better on a lower fat/higher carb diet. For weight loss LCDs do seem to have an edge, according to the published literature. But again, and as Dr. Gardner and I discusses several months ago, some do better low carb while others do better higher carb.
      Hope this helps!

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