Why Some People Struggle to Lose Weight - Dr. Michael Ruscio, DNM, DC

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Why Some People Struggle to Lose Weight

How Metabolism, Body Composition, and More Actually Affect Your Weight with Dr. Barbara Corkey

Weight loss is a perennial struggle for many people, and it’s not because they haven’t tried every approach available (including counting calories, restricting carbs, and increasing the amount of exercise they get).

Today’s podcast guest, obesity expert Dr. Barbara Corkey, explains that many people have difficulty losing weight due to factors that go beyond behavioral change. These include the changing macronutrient content of food, additives in carbs that may be affecting our metabolism, and the resulting rise in metabolic disease.

We discuss how individual differences affect the ability to lose weight, the role of genetics and heredity, and how to sort through all of the noise to find the weight loss approach that works best for you.

In This Episode

Episode Intro … 00:00:45
The Calories In-Calories Out Hypothesis … 00:06:23
The Third Variable: Energy Efficiency … 00:10:10
The Metabolic Set Point … 00:15:17
Macronutrient Compositions … 00:20:18
Our Ancestral Diets & Evolutionary Premises … 00:24:04
The Changing Composition of Food: Pros & Cons … 00:30:09
The ‘CarboLight’ Recipe Book & Videos: Success Stories … 00:34:53
Hormones, Hypothyroid & Insulin … 00:41:17
Thoughts on Bariatric Surgery … 00:49:49
Episode Wrap-Up … 00:55:49

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Hey everyone. Welcome to another episode of Dr. Ruscio Radio. Today, I spoke with Dr. Barbara Corkey, who is Professor Emeritus of Medicine and Biochemistry at Boston University School of Medicine. She is the Director of Obesity Research at The Obesity Research Center. This was a conversation I was hoping would give us a bit more of a nuanced perspective on metabolic health, body composition, and being overweight. There’s this one perspective that I think is overly simplistic, which is it’s all about getting yourself on a low carb diet and making sure you’re not doing too much cardio and then you’ll have a perfect body composition. But as we’ve talked about in the podcast before, that doesn’t seem to account for many cases. We’ve had some obesity researchers who seem to be a little bit more in the box and squarely by the data. Stephan Guyenet and Eric Trexler paint this picture of weight gain solely as “people are eating more and not moving enough” perspective, but that also doesn’t account for clear observations. I think we can all say, “Well, I know someone who lives a terrible lifestyle and they’re thin… and I know someone else who does everything right, and they’re overweight.”

This seems to be where Barbara’s research has been pointed. This is a great chance to speak with someone who is in academic medicine, but also is looking for evidence beyond what the big data meta-analysis trends show us. I should clarify that as helpful as meta-analysis can be, they can’t answer all questions. They can’t answer where we may not be asking the right questions in research. As one example… probiotics – looking at their effects on IBS via meta-analysis can give us a good answer on how effective they are for IBS. But, if we’re looking at weight gain in a population, which is a multifactorial issue, and meta-analyses are showing a connection between weight, exercise, and caloric intake, there may be a layer that has not been integrated into the meta-analyses. Just to sharpen that up in case that’s not super clear, that trend was correct, but it seems that the lines of caloric balance and body composition are now starting to diverge from one another. This means that now that public health initiatives have led to a decrease in consumption of processed food and therefore lower calorie intake and people are better about moving, we’re not seeing a corresponding drop in weight. So, while the meta-analyses may make one suggestion, they may not inform all of the causative factors that may be at play as it pertains to weight.

This isn’t to say we’re gonna just go over to “we’ve gotta do this one special functional medicine test that has zero validation, and that’s gonna give us all the answers.” This is what I was attempting to get after – clarifying some of this gap knowledge with Barbara – and I think she did a very good job answering some of these questions. If you’re looking to get a bit more perspective on weight and ask some of these questions that are trying to reconcile these differing opinions, then I think this conversation with Barbara will be very insightful. We will now go to our conversation and I hope you enjoy it.

➕ Full Podcast Transcript

Episode Intro:

Welcome to Dr. Ruscio Radio, providing practical and science-based solutions to feeling your best. To stay up to date on the latest topics, as well as all of our prior episodes, make sure to subscribe in your podcast player. For weekly updates, visit DrRuscio.com. The following discussion is for educational purposes only and is not intended to diagnose or treat any disease. Please do not apply any of this information without first speaking with your doctor. Now, let’s head to the show.

DrMichaelRuscio:

Hey everyone. Welcome to another episode of Dr. Ruscio Radio. Today, I spoke with Dr. Barbara Corkey, who is Professor Emeritus of Medicine and Biochemistry at Boston University School of Medicine. She is the Director of Obesity Research at The Obesity Research Center. This was a conversation I was hoping would give us a bit more of a nuanced perspective on metabolic health, body composition, and being overweight. There’s this one perspective that I think is overly simplistic, which is it’s all about getting yourself on a low carb diet and making sure you’re not doing too much cardio and then you’ll have a perfect body composition. But as we’ve talked about in the podcast before, that doesn’t seem to account for many cases. We’ve had some obesity researchers who seem to be a little bit more in the box and squarely by the data. Stephan Guyenet and Eric Trexler paint this picture of weight gain solely as “people are eating more and not moving enough” perspective, but that also doesn’t account for clear observations. I think we can all say, “Well, I know someone who lives a terrible lifestyle and they’re thin… and I know someone else who does everything right, and they’re overweight.”

DrMR:

This seems to be where Barbara’s research has been pointed. This is a great chance to speak with someone who is in academic medicine, but also is looking for evidence beyond what the big data meta-analysis trends show us. I should clarify that as helpful as meta-analysis can be, they can’t answer all questions. They can’t answer where we may not be asking the right questions in research. As one example… probiotics – looking at their effects on IBS via meta-analysis can give us a good answer on how effective they are for IBS. But, if we’re looking at weight gain in a population, which is a multifactorial issue, and meta-analyses are showing a connection between weight, exercise, and caloric intake, there may be a layer that has not been integrated into the meta-analyses. Just to sharpen that up in case that’s not super clear, that trend was correct, but it seems that the lines of caloric balance and body composition are now starting to diverge from one another. This means that now that public health initiatives have led to a decrease in consumption of processed food and therefore lower calorie intake and people are better about moving, we’re not seeing a corresponding drop in weight. So, while the meta-analyses may make one suggestion, they may not inform all of the causative factors that may be at play as it pertains to weight.

DrMR:

This isn’t to say we’re gonna just go over to “we’ve gotta do this one special functional medicine test that has zero validation, and that’s gonna give us all the answers.” This is what I was attempting to get after – clarifying some of this gap knowledge with Barbara – and I think she did a very good job answering some of these questions. If you’re looking to get a bit more perspective on weight and ask some of these questions that are trying to reconcile these differing opinions, then I think this conversation with Barbara will be very insightful. We will now go to our conversation and I hope you enjoy it.

DrMR:

Hey everyone. Welcome back to Dr. Ruscio Radio. This is Dr. Ruscio today joined by Dr. Barbara Corkey. We are going to be talking about metabolism, body composition, and weight. Obviously, this is something where expert opinions vary widely, and it is something where I’ve really struggled to see where the consensus is or where the trend in the data lies. And of course, we’ve talked about this to some extent on the podcast before, but Barbara’s area of focus seems to really be where I’m hoping we’ll get that grain of truth that sometimes lies in the middle between seemingly polarized debates. Barbara – I’m very, very excited to pick your brain and have you here on the show today.

DrBarbaraCorkey:

Thank you.

DrMR:

Can you tell us a little bit about your background before we go into some of the Q &A?

DrBC:

Yes. I actually started out in medical school and was much too curious about the various diseases to want to go on in medicine. So, ultimately I obtained a PhD in biochemistry and biophysics at The University of Pennsylvania, and I have been studying metabolic disease, diabetes, and obesity for about 60 years now. It’s been my only focus and my major interest in life.

The Calories In-Calories Out Hypothesis

DrMR:

That’s fantastic because someone who has dedicated their life to this might be needed to really give us a tenured and nuanced perspective. If you don’t mind, there’s a short groundwork preface I’d like to lay. I’m assuming this will get a fair facet of audience up to speed, and then I I’d love for you to shade in some of the gaps. So, I think much of the natural medicine community – Gary Taubes probably being one big advocate – has criticized the “calories in-calories out” hypothesis. Oftentimes, there’s this calorie partitioning – meaning it’s not just how many calories you eat, but it is how the calories stimulate your endocrine system and dictate either storage or burning. In theory anyway, and as it has been posited, a high carb diet leads to more insulin that leads to more storage of calories that leads to more fat gain.

DrMR:

There seems to be some truth to this, as some of the earlier literature that pitted lower carb versus higher carb diets seemed to find that. However, some of Christopher Gardner’s work over at Stanford and his more recent DIETFITS (Diet Intervention Examining The Factors Interacting with Treatment Success) trial looked at a healthier iteration of a higher carb diet, and that favoring of lower carb and better metabolic health seemed to diminish. That made me think that maybe it’s not quite the calorie partitioning hypothesis that’s the right way to think about this. Then, we’ve had some obesity researchers – Stephan Guyenet and Eric Trexler – on the podcast, and they were pretty convinced that the calories hypothesis is a correct hypothesis. In fact, Eric had said that the data is pretty clear that as people age, their metabolisms don’t slow, they just become less active, and that’s what accounts for weight gain. Some of that, I suppose, makes sense to me, but then I’ll look at some people who seem to do nothing healthy and are rail thin and other people who do a lot to be healthy and are significantly overweight. And you could argue maybe they’re closet eaters or what have you, but it still doesn’t seem to account for that observation. So, I know I laid a lot on the table there, but that’s what I bring to this conversation somewhat confused.

DrBC:

This is exactly the area I’m most interested in, and that has been the focus of my most recent attention. I think all of those things that people aren’t willing to readily believe or are willing to readily believe are not exactly right. And I will begin by saying that if you look at the natural world – for example, the lions in Africa – they have plenty of food and they can catch a gazelle whenever they feel hungry, but they don’t overeat. And neither do most of the animals of the universe. They maintain what for them is a normal weight, without any effort. Only humans even ever have thought of counting calories – nothing else does this. You can give me some exceptions and I can explain them, but in general, most creatures – from plants to animals – eat what they need and not more and maintain what is a healthy, normal body weight.

The Third Variable: Energy Efficiency

DrBC:

So, what happened to us humans? Now, if I think back to my childhood and to the childhood of my children, there were no fat kids. It didn’t happen. Occasionally, you’d see a family where everybody was fat, and we know there are some genetic disorders that can explain that, but the vast majority of people were not. That isn’t to say that as people aged, they didn’t gain a little weight. I think that might be a somewhat different matter altogether. So, on the one hand, to say “calories in and calories out” as a simple equation is simply not viable. It simply isn’t true. However, you can’t gain weight if you don’t put calories in, and you will lose weight if you don’t put calories in. So, that’s absolutely true, but there’s a third variable that people don’t take into account, and that is energy efficiency. Some people are very efficient in the energy they take in and store it all. Some people are very inefficient and eat an awful lot and produce a lot of heat and do not gain weight. And the analogy would be a home that you have heated with a certain number of calories worth of heat. If that’s a very leaky home with thin walls, it’s gonna take a lot more heat to maintain the temperature. In other words, there are three variables. If you don’t open any windows, that is. If you open the windows, then that’s another ball game.

DrBC:

So, there’s the third variable that is not accounted for much of the time, but there’s very good scientific evidence from the laboratory of Dr. Rudy Leibel that if you fast people and over feed them, people react very differently. Some people – the skinny guys you were talking about that eat everything – have to eat a lot of calories to gain any weight and have a very hard time losing it.

DrBC:

Other people who have an easy time gaining weight — As soon as they are deprived of food, they become much more efficient. They become colder, they sleep more, and they do everything. Their bodies are designed to conserve the energy. For them, losing weight is difficult. The skinny guys lose weight very easily. There was a study done in the 1970’s in Vermont which is called ‘The Vermont Prison Study.’ Normal weight people were over fed in order to try and gain 20% overweight. And what they found was that these people had to eat, on average, something like 7,000 calories a day to gain the extra weight. As soon as the study was over, they went back to normal weight. This is just to point out that yes – energy in counts and yes – energy out counts, but energy efficiency in the middle probably counts even more.

DrMR:

This is a very interesting point. I recently came across this study (I believe Dr. Mike T. Nelson was reviewing this), and it partially ties in what you’re describing here, where they manipulated the total calorie intake of a few groups of people. I’m not sure if it was a crossover design, but essentially it summed out to — When being overfed in the 1st group, some people will move more and they won’t gain weight. And other people won’t move more, but they’ll gain weight. And then in the other group that was underfed, some of who were underfed will lose weight, and some of who are underfed will just move less, be fatigued, and not lose weight. So, this is a really interesting hypothesis. Is this going under a certain name, in case anyone wanted to go into PubMed and try to pull up some papers on this?

DrBC:

Well, none of this is unknown. I quoted Dr. Rudy Leibel, but this Vermont Prisoners study… I think the authors were Ed Horton and Ethan Allen Sims… those two studies make this point very, very nicely, although they don’t give it a name. I think though the concept of energy efficiency is something that is not alien to us. We certainly have to deal with that in our cars. Some of them are gas guzzlers – they don’t go farther. They just use more gas to get there. So, I think it is the nature of things that the efficiency with which calories are used varies from person to person. That doesn’t address the high carb/high fat – that’s a different issue altogether.

The Metabolic Set Point

DrMR:

I definitely want to come to the macronutrient piece of this, but while we’re here, is part of this encapsulated by the metabolic set point? This is a theory that I remember Christopher R. Keroack discussing. He was on the podcast a number of years ago, and he studies bariatrics. Does this have remnants of that?

DrBC:

It’s related, but it’s not the same thing. So, somehow all bodies – plants, animals, anything you can think of – has a weight that they’re trying to maintain. And I guess you could call it a set point. Humans always did, too. What’s interesting, and what we need to focus our attention on, is the fact that this has changed since the mid-1900’s. In all the previous years, it wasn’t an issue, and now it is. Not only is it an issue now for most humans – more than three quarters of the people in the United States are not at what might be considered to be an ideal weight – but the percentage of children who are overweight and obese continues to increase. So, when something changes, something must have happened to change. And the concept that suddenly people started to eat more food, because for whatever reason it tasted good, it’s a nonsensical concept. It doesn’t work like that.

DrBC:

If you’ve ever had a skinny kid – and I had two of them – there’s nothing you can do to make them eat when they say they’re full. It’s like they put tape over their mouth – it’s all over. So, this satiety signal… it’s broken and that’s what we need to figure out. Is it a set point? I don’t know. I think that the weight that we can maintain may be a variable. In fact, all people maintain their own weight. If we go before this obesity metabolic disease epidemic, not everybody was skinny and not everybody was fat. There was a range. And most people from year to year to year maintained the same weight. So yeah, there were a variety of set points. It’s a very complex regulatory system that has to do with all of the organs in your body perceiving that they have sufficient energy. It certainly involves the brain, the gut, the liver, the pancreas. But, I think we animals – the creatures of the world – are all programmed to maintain a particular weight.

DrMR:

Now, I’ve all also heard that public health campaign initiatives to increase exercise, reduce the consumption of sugar-laden and processed foods, to some degree have been successful. And there is now an observable mass reduction in caloric intake, but that trend line doesn’t seem to overlap with weight.

DrBC:

Interesting… Isn’t it?

DrMR:

I’m first asking if that’s true. You hear things and you’re not sure if people are cherry picking or if this seems to be representative of the body of data or quality data. Is that a true statement or generally true/observant of the trend?

DrBC:

What I think is true from the data I’ve seen is that we’re not eating more as we’re becoming more obese. There was a period of time when food consumption increased and it kind of correlated with the increased incidence of obesity and that’s not true anymore. We’re kind of leveling off. And that makes a lot of sense to me. I think most studies that have increased physical activity have had no impact whatsoever on obesity. I’m not surprised because the body knows you’ve been exercising and will request more food to compensate. In my youth, when I was an athlete, I ate a lot and I was never overweight. In my old age. I eat very little and I’m overweight. So, you know, the two things can be connected or cannot be connected.

Macronutrient Compositions

DrMR:

Right. Coming over to macros… Is your perspective that the macronutrient composition is a significant driver of metabolism and weight?

DrBC:

Yes, but not for the reasons that you think. So, for example, the most processed food that has thousands of new ingredients that have entered our food supply since the 1950’s and 1960’s are carbohydrates. If you walk the middle aisles of any supermarket, they’re full of carbohydrates. If you look at the snack foods and the highly advertised things, they’re full of carbohydrates. So, the consequences that carbohydrates as a group, if you only look at that macronutrient and not all the other stuff that’s been added to it, is what’s really different in this period of time that the metabolic problem has arisen. Cutting carbs has the benefit of cutting junk – all manner of things that have not yet been defined. The situation with fat is different. There are plenty of tasty fats that have not had this modification made. Therefore, a high fat diet is likely to have less of the thousands of new things in our food supply than a high carb diet. If I had to make a guess, I would say low carb diets are effective because they’re eliminating a lot of things that we weren’t taking into account. Not necessarily because the carbs are lower, but because the preservatives and the additives and the flavor enhancers are lower.

DrMR:

This kind of ties in with Christopher Gardener’s DIETFITS trial. This was a follow up to his initial study – The A To Z Weight Loss trial, where they looked at essentially an Atkins-type diet on one end of the spectrum through a Pritikin high carb diet (just for our audience to bring them up to speed). He found favorability for the low carb intervention, but he wanted to do a follow-up trial. It was for a number of reasons. He was mainly trying to assess this this hypothesis called heterogeneity and insulin sensitivity. He thought maybe some people are a bit more genetically prone to insulin resistance, and maybe they will do better on a lower carb diet, and there’ll be another subset that does better on any diet.

DrMR:

What he ended up doing in that follow-up trial was also putting together a healthier iteration of the higher carb diets. This makes part of your point, Barbara. When he had a healthier, higher carb diet – essentially less processed foods – the difference between the outcomes in the groups went down to pretty much zero. You make a very interesting point. I think it’s important for us as a healthcare community to be aware of that. In the functional medicine community, we often criticize the fact that things like meat and fat have been maligned because some processed foods were high in fat; fried foods that are a Western delight were vilified and then all fat and all meat got lumped in with that unjustifiably so. I think it’s important that we don’t do the same thing with carbohydrates, and that you make an excellent point.

Our Ancestral Diets & Evolutionary Premises

DrBC:

The reality is that our government dinged fat. That’s been a very interesting study because the consumption of fat has diminished as a consequence of that particular set of edicts and the recommendations that we should eat much less fat, but the obesity epidemic continued unabated. So, it had absolutely zero impact, but I would remind you of another thing. And that is, if you look at our ancestors, they came from a variety of places – some of them warm and equator and Mediterranean-like; others of them very cold, like the Northern countries and the far Southern countries. People who live in the region where everything grows have historically had a very high carb diet because those things – the fruits and vegetables and grain – grow very well. However, the ones that live in the north have had a very high fat diet because they live on fish and dairy that are easily preserved in a climate where nothing grows in the wintertime. Neither of those groups have had any problem maintaining their body weight, suggesting to me that perhaps the people whose ancestors and whose genes come from the north might do well on a high fat, low carb diet. And those who come from the warm regions of the earth might do better on a high carb, low fat diet. We may not all be the same. We may not have exactly the same enzymatic equipment to handle all of the different nutrients.

DrMR:

Sure. Fully agree. I know Weston A. Price talked about that and there’s also the metabolic typing diet, which I think is a little overly fastidious just to get you to what you could get with a little bit of experimentation. We certainly on the podcast have discussed how some people in the clinic do very well on a low carb diet. Other people come in from a low carb community and we just up their carbs and they feel so much better. I agree with some of the evolutionary premises upon which that is based, and then my clinical experience has also shown that same thing. Some people can do well on any diet. Some people do well lower carb. Some people do well higher carb.

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DrBC:

Well, I think we’re all an experiment. I’m not treating patients, but if I were, I would – first of all – believe what they tell me. If they lowered their food consumption, I would be inclined to believe it. If they were on a low carb diet and it had no impact, I think I would probably recommend a low fat diet. We’re not all the same and we’re all part of the experiment. The answers aren’t in. There is no absolute right answer. I’m giving you my opinions based on a variety of different kind of experiences. I have rejected many concepts – the ones that I adamantly tell you can’t be true based on evidence. The correct way to go? I don’t know. We don’t know yet. And the evil ingredients that are causing the problems may not be the same in every person, but we don’t even know what they are. I said thousands of ingredients – I wasn’t fooling.

DrMR:

Certainly with processed food, the list is so difficult to keep up with that. I think we have to give people kind of an operating system that supersedes an ingredient list. Multiple people have said something along the lines of – “If you can’t pronounce it, don’t eat it. And the longer the ingredient list is, the worse it probably is for you.” And I think those are good heuristics to operate by.

The Changing Composition of Food: Pros & Cons

DrBC:

But even there you have a problem. I’ve written a cookbook, which is available free to anyone who wants it. It’s called carbo light, but it’s not really low carb – it can be low carb, it can be low fat – but it’s focused on less processed foods. Even the least processed foods are processed. And if you look at the mineral content of fruits and vegetables in the last 50 years, it has changed. So, the peaches and the tomatoes we eat are not the same. Does this matter? I don’t know, and nobody is looking at it.

DrMR:

By that, I’m assuming you mean they’ve been crossbred to be bigger… sweeter. I have heard this mentioned that when you look wild type apples, or whatever, they’re smaller… and oftentimes less sweet. That certainly makes sense. We think we’re just eating an apple and that’s healthy, but perhaps that’s gotten so out of control now that the apple contains 40% more carbohydrate, 10% less fiber, and more sugar.

DrBC:

I don’t know about the fiber and the carbohydrate, but the minerals are all different. And the reason is that they’ve been selectively bred to last a long time on the shelf, to look pretty, and to travel well. They’re different. Is this good or bad? We don’t know. For someone who has no food and because food doesn’t travel well, this is wonderful. They’re gonna live instead of dying. So, I can’t be totally negative. And I certainly am not down on the food industry because I noticed that when our government said fat is bad for you, all the food companies made low fat foods (that I think are causing even more problems than they were when they weren’t low fat), but they were listening to the science or what they thought was the science. Starvation is no longer the major problem that it used to be. And that’s partly because we make so many things now that travel well and last a long time. Is it good or is it bad? Well, it’s both.

DrMR:

Right. I think with many things you’ll find a pro and a con. I think it’s important that you bring up some of those points of not being too quick to vilify the food industry, to some extent, and/or genetic engineering, because if things do last longer and that helps to some extent with a higher output of crops, then that could be helpful. And I know it’s been partially criticized by some in the sustainable agriculture community. I think that’s also an interesting argument – the viability of it. I don’t know enough to adjudicate, but certainly it seems more attractive to get back to this closed ecological system on a farm where you’re not dependent upon monocrops that have been genetically engineered to resist pests and therefore, have a higher yield. To your point, you’re solving one problem of starvation in one group, but you’re creating maybe two or three others.

DrBC:

Exactly. Genetically modified food is either good or bad. It is not one thing. I’m not at all in favor of dinging all genetically modified foods. There were huge starvation problems in parts of the world where crops didn’t grow and altering those crops so that they could grow in sandy soil or slightly salty water has saved the lives of millions of babies. Is this bad? I don’t think so.

DrMR:

Right. I think it’s important not to be overly idealistic, so point well taken.

DrBC:

But there are things in our food that need to be removed. And the real problem is we don’t know what they are.

DrMR:

It’s a good segue to the next question I wanted to ask. What are you seeing in terms of things that people should be aware of? If someone feels like they’re doing a lot to have a healthy body composition and a healthy weight, and they’re stuck, are there some action items/things you would recommend they investigate?

The ‘CarboLight’ Recipe Book & Videos: Success Stories

DrBC:

My cookbook. It’s designed to be as quick and easy and tasty as I could make it. It’s completely free. I have no gain, no profit whatsoever from it, nor do I wish to. I’ve had three experiments – three humans. One had a fatty liver – this is a very common problem currently. The fatty liver was a consequence of chemotherapy so it wasn’t bad behavior particularly, but her liver enzymes were highly elevated. She ate this low carb version of my program for one month and her liver enzymes were normal. Prior to that, she had trained for a half marathon because she was told by her physician that exercise was the way to go. She lost a couple pounds. She wasn’t that far overweight anyway, but the enzymes changed very little. However, on a low processed food, relatively low carbohydrate diet, she did fine. She recovered.

DrBC:

Another was actually my husband who was diagnosed with prediabetes, had elevated fasting insulin levels, and abnormal lipids. This is how I developed the cookbook – by cooking at home. He is no longer prediabetic. His lipids are normal and he’s lost about 30 or 40 pounds, but it wasn’t a weight loss diet. It was really a change in eating pattern. I think it’s worth a try. It’s not the solution, but I think for most people who have busy lives and work hard, they need some training in how to do this; how to have good, tasty, healthy meals that don’t take an enormous amount of time or an enormous amount of money.

DrMR:

I just want to second that because I was having dinner with a friend of mine the other night. She’s trying to get into the habit of eating healthier. I’m trying to be encouraging, but I’m sitting there and saying, “My goodness, this meal is probably gonna take you two and a half hours total time.” You’re really preaching the choir here. I’m always trying to eat healthy, but do it as quickly as possible. So, I can make a nice steak dinner and have everything cooked, cleaned, and done in 40 minutes (including eating time). I appreciate how important that is because if not, it just makes it daunting. The one thing I think most people struggle with is having the free time to implement change. So, making it as quick and as easy as possible is a huge gain for people.

DrBC:

I totally agree. I think there are videos on my website that have two meals – Shrimp Scampi and Filet of Sole – that are cooked and on the table in 15 minutes and are absolutely delicious. Anyone can do that. If you went out to McDonald’s, bought your food, and brought it back, it would take more time than that.

DrMR:

I just wanna echo how much you short circuit your desire to eat out when you cook quickly. There have been times when I’ve been feeling a little bit lazy, admittedly, like I think we all struggle with on occasion. I’ve said, “Ah, maybe I’ll get a burger, or whatever, delivered” and I’ll look and it’ll say it will be there in 55 minutes, and I’m thinking I could literally cook and have something on the table in 15 minutes… or I’m gonna wait 50 minutes for this food to get here. That only really works if you do have these strategies that allow you to cook quickly. I love this approach – obviously a big fan.

DrBC:

So try it: carbolightplan.org. You can play around. There are videos that will show you how to do it, but it’s usually so simple that anyone can do it.

DrMR:

With you being a professor of medicine and biochemistry at BU – Are you planning at some point on taking some of this stuff into the lab, so to speak and doing a trial? That would be a fantastic data point for clinicians like me to reference.

DrBC:

I am actually working with clinicians at Boston Medical Center. We’ve actually done a couple of courses now where we’re trying to train patients – for example, with diabetes or with fatty liver – in a training program. I’m not doing it. I’m a scientist. I don’t speak English. I speak science and I’m not accustomed to communicating with normal people (which is a limitation), but I’m working with people who are good at that. I hope we’ll get there. We’re trying. That’s why I’m interviewing with you because I think you talk to normal people.

DrMR:

I do. I think there is something to be said for the clinician who can translate, and that’s why I love having a broad swath of different scientists and clinicians on the podcast so we can get these different perspectives. To your point, some people excel at lab research and then other clinicians have to work on translating that into clinical application. I think if we’re all working together, that’s going to get us to the best outcome so we all work as a team playing to our strengths.

DrBC:

Precisely. And my children will be the first to tell you that I’m not a very good communicator.

DrMR:

Well, you seem to be doing a fine job today.

DrBC:

Working on it.

Hormones, Hypothyroid & Insulin

DrMR:

Is there anything else you think is important for people to know? One question that I should probably ask is hormones. There is a lot of discussion in some realms of the natural and functional health communities that even though your thyroid lab work is normal, that’s really the cause of your weight gain. We’ve done a fairly exhaustive review on this. I shouldn’t say fairly – I’d say moderately exhaustive – and there is a signal there from what we were able to take out of the data. If someone is frankly hypothyroid, they may lose an average (and I think this is the generous end of the estimates) four to eight pounds when they get on the thyroid hormone, which is something. That certainly doesn’t take you from obese to non-obese, and it doesn’t account for many people who are saying you’re hypothyroid when you actually don’t fit any of the diagnostic criteria. I just try to be extra scrupulous in making that delineation to try to counter some of the narrative that permeates online.

DrBC:

If you’re hypothyroid, you need to take thyroid and the thyroid is extremely important in this whole orchestration of the body weight maintenance – your hunger signals, your satiety signals, your fat storage, all of that. Thyroid is a very important hormone. If it’s out of balance, it needs to be fixed, but it is rarely the cause of the problems we’re talking about. I think the guilty party may be affecting thyroid function. For example, some of these food preservatives, additives, plasticizers, packaging materials, et cetera, that haven’t been tested appropriately. They may affect that, but what you really need to do is fix what’s wrong and not worry about what’s working okay. So, if something in your plastics that you carry your food home in is suppressing your thyroid, the solution is not to take thyroid hormone, it’s to stop carrying your stuff home in plastic.

DrMR:

Fully agree. You mentioned toxins earlier. Dr. Pizzorno – he is a naturopathic physician who used to be the editor of the natural medicine journal – had posited that certain toxins are causing insulin resistance and he recommended GGT as a marker to pick out toxic burden. We had run that in the clinic for a while, and I really did not find that to be insightful, but it does make sense that certain endocrine disruptors or other chemicals in our food supply and plastics could be attenuating insulin sensitivity or similar.

DrBC:

I have published this data. I have several reviews written. I strongly believe that hyperinsulinemia – or increased insulin secretion – is the cause of insulin resistance and not the consequence.

DrMR:

Sure. Yeah. I think that makes sense.

DrBC:

So, you don’t need to worry about insulin resistance because it happens because you’re secreting too much insulin. And if you didn’t have insulin resistance, you’d be hypoglycemic and you’d die. So, it’s better to be insulin resistant than the other alternative. I’ve tested a number in my lab of food additives and published that they increase insulin secretion. There’s no doubt that this is the case.

DrMR:

So, if someone were trying to assess that, would you say a fasting insulin would be perhaps an early indicator that they’re exposed to too many of these insulinogenic foods?

DrBC:

To me, it’s either lipids or insulin that are the earliest indication that your metabolic system is struggling. You can fix those. You probably can prevent the unpleasant consequences.

DrMR:

Now, are there certain parameters – let’s say for a fasting insulin – that you’re looking at a cutoff over X as to when you should be concerned?

DrBC:

There are standards of medicine, and I don’t remember them and I don’t wanna say them because I could possibly be wrong with my defective memory, but I don’t think there’s any disagreement there.

DrMR:

So the standard ranges.

DrBC:

Yeah. Standard ranges. If you’re double the standard average insulin level, this is not good.

DrMR:

Gotcha. I’m going to clarify and let me know if you disagree. If you are one or two points over the cutoff, perhaps start paying attention, optimize some of the low hanging fruit – processed foods… foods that you’re storing in plastics – but maybe don’t freak out and go to this panic where you’re a ticking time bomb. Would that be fair? I just ask because some of the patients we work with get really worked up.

DrBC:

No. Alright. So, the insulin assay – I’d like to see it repeated several times before I panic in any event because t’s not the most standard assay out there. I would say, in general, if you have any other symptoms like gaining weight, fatty liver, any cardiovascular symptoms, then stop eating processed food and start eating the most unprocessed things you can find. And ask – between one visit to the physician and the next – is this having an impact?

DrMR:

Right? Sure. That makes sense. It’s practical and the practical solutions tend to be the most effective, at least in my observation. And with lipids, are you looking at a certain fraction in particular? Total?

DrBC:

No, I’m actually mostly focused on triglycerides because they’re a reflection of the total fat pool. Not because they are particularly worse than anything else, but because they’re usually routinely measured and something that can easily be changed. There are medications, et cetera, that can lower your triglycerides.

Dr Ruscio Resources:

Hi everyone. This is Dr. Ruscio. In case you need help, I wanted to quickly make you aware of what resources are available to you. If you go to drruscio.com/resources, you’ll see a few links you can click through for more. Firstly, there is the clinic, which I’m immensely proud of the fact that we deliver cost-effective, simple, but highly efficacious functional medicine. There’s also my book – Healthy Gut, Healthy You – which has been proven to allow those who have been unable to improve their health (even after seeing numerous doctors) to be able to help them finally feel better. There’s also our store where there’s a number of products like our Elemental Heal line, our probiotic line, and other gut supportive and health supportive supplements. We now also offer health coaching. So, if you’ve read the book or listened to a podcast like this one or are reading about a product and you need some help with how/when to use or how to integrate with diet, we now offer health coaching to help you along your way. Finally, if you’re a clinician, there is our clinician’s newsletter – The Future of Functional Medicine Review. I’m very proud to say we’ve now had doctors who’ve read that newsletter find challenging cases in their practices, apply what we teach in the newsletter, and be able to help patients who were otherwise considered challenging cases. Everything for these resources can be accessed through drruscio.com/resources. Alrighty- back to the show.

Thoughts on Bariatric Surgery

DrMR:

Shifting gears for a second… What about this cohort that is significantly overweight and also perhaps don’t have very poor dietary and lifestyle practices, but are still 50… 70… 100… pounds overweight. Something that I’ve been entertaining is maybe there is (for lack of a better term) a metabolic lesion. These people may be actually good candidates for something like a gastric sleeve or something like that. And I’ve reviewed some of the literature and some of those outcomes – they do seem fairly favorable even with a long term weight retention that seems like it would be something someone would be happy with. Is that something you’ve looked into? And do you have thoughts on that?

DrBC:

I’m very much in favor of bariatric surgery. It has far and away the best outcome results of any therapy for obesity or metabolic disease of anything else that’s out there. Far and away. Maybe someday it won’t be the best solution, but today it is far and away the best solution. The problems that used to occur that actually led to some complications that were pretty unpleasant have been overcome. At good medical centers, bariatric surgery is done well, and it’s a wonderful solution, but if the problem is the processed food that you’re eating and you don’t figure out how to get away from that, there is a problem of weight regain. Nevertheless, the greatest benefit comes from that procedure. So, yeah. I totally support it.

DrMR:

Yeah. That’s why I try to be careful on how I pose that question. If someone is not moving, if they’re not sleeping well, if they’re eating processed foods… if they haven’t gotten those big rocks in place, then that would seem a premature intervention to jump to. However, when someone does, and they’re still 50… 70… 100 plus pounds overweight, I just haven’t seen great outcomes from “Well, it’s because you’re doing cardio, not resistance training… or it’s because you’re eating low carb…” And I just have not seen these miracle stories. I think it’s really important for the natural health community to hold themselves accountable for not making those promises to people and being okay with what I understand might be somewhat scary – the consideration of a surgical intervention. We did do a review of the research on this looking at adverse events and long term outcomes, and even though there is almost always weight regain, you are looking at only a fraction of regain. Let’s say a hundred pounds – even if they had a 30% regain, they are still 70% (70 pounds) down, which in my mind is a huge win. I’m just using some arbitrary numbers there. If you say, “Well, people will regain weight.” This is true, but they’re not going to regain all. They’re not usually going to even regain half. And so that seems like a big win.

DrBC:

The reality is if they follow the advice and exercise more, they will not lose an ounce. They’ll eat more.

DrMR:

Oh I see. Without the surgery.

DrBC:

They will not lose weight. They will eat more.

DrMR:

Yep. Great point.

DrBC:

They would be very frustrated. It doesn’t work.

DrMR:

Sure. Exactly. In a population that’s probably already doing that, they’ve experienced no benefit. And now they’re asking what is next. Just to call out the field again – some of the natural health providers will say, “Well, if we could just get an organic acid test, we could maybe determine if your neurotransmitters are off… then we could give you some precursors for your dopamine… and that would be why you stop eating addictively…” And I think that’s just a huge mess with no data to support it, and we have to be very careful about making those claims.

DrBC:

Precisely. And obese people are the most abused patients in the world.

DrMR:

Yes.

DrBC:

It is totally unfair. They have a disease that no one understands and because they don’t understand it, they blame the patient. Totally unfair, totally unrealistic, and totally wrong.

DrMR:

I think it’s important that healthcare providers don’t misappropriate or leverage motivation because oftentimes those who are overweight are very motivated, but it’s okay to tell someone that you don’t think your toolkit is going to be helpful for them, even though they’re motivated.

DrBC:

Your natural body does a perfectly good job of maintaining your body temperature. It does a perfectly good job – if you’re not diabetic – of maintaining your blood glucose. It would do a perfectly good job of maintaining your body weight if you could identify the toxin that has screwed it up. It is not a volitional/behavioral issue at all.

DrMR:

Agreed. But maybe a counter point question there — Have you seen those who have – let’s say disordered eating due to a psychological issue – and they do cognitive behavioral behavioral therapy (or what have you)? Is there any merit to that claim? That is something I have not looked into at all.

DrBC:

I can’t talk about every manner of disorder, but I would say on average, it has nothing to do with behavior or psychology or self-control or motivation. That’s the problem – blaming things that are totally unrelated has prevented us from finding the true answer.

Episode Wrap-Up

DrMR:

Alright. I appreciate the perspective because some of this I’ve looked into, but this is obviously not an area that is my square focus, so it’s great to be able to pick your brain on these things. Is there anything else that you think is important for us to cover that we haven’t covered yet?

DrBC:

I don’t think so, except I’m very much in favor of supporting the poor people who are struggling with this disease and being told that it’s under their control.

DrMR:

Sure. I appreciate that.

DrBC:

I feel very bad for them.

DrMR:

Yeah. I echo that feeling. Alright. Well, will you tell people again where they can go for the diet guide and if there’s anywhere else you want to point them? Any other website (or what have you) where they could connect with you or follow your work?

DrBC:

I would say, first of all, if you really want to make yourself better, you have to be your own guinea pig and try different things because we’re not all the same. My cooking plan is at carbolightplan.org. It’s available for anybody, and it is best probably used in consultation with a dietician because if you want low carb, you go one way… if you want low fat, you go a different way. It can be modified to your dietary needs. Try one thing. If it doesn’t work, try something else. Don’t give up.

DrMR:

Awesome. Well, Barbara, this has been a really insightful conversation. I appreciate the work that you’re doing. I’m excited to have this as a resource to refer people to, and I’m sure there are some in our audience who will be curious to give this a go also. Thank you again for your work and for the conversation.

DrBC:

Take care. Thank you. Bye-bye.

Outro:

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