Diet Doctor Podcast #24 — Robb Wolf

Welcome to the Diet Doctor podcast
with Dr. Bret Scher. Today, it is my pleasure
to welcome Robb Wolf as my guest. Now, Robb is one of these amazing people
who has expertise in so many different areas and I think you're going to see that
in our talk today. We cover politics, we cover the biology
and chemistry of food science, we cover the emotions
and the psychology of it.

And of course, we cover sort of how to view
these things from a different perspective because one of Robb's messages
that I think is so important is that we shouldn't get bogged down
all the time in the specifics, whether it's genetics
or whether it's number of carbs or whether it's paleo or keto, but sort
of view it from a health perspective and make it an individualized approach, specifically when it comes
to metabolic health and carb flexibility. So, I really hope you take away
some of Robb's perspectives and you're able to incorporate that
into your life, to say okay, how does this fit in
to my bigger picture of health. Now, Robb is a very prolific author
with The Paleo Solution and Wired to Eat.

He's working on two new books which
we'll hear a little bit about at the end, and I can't wait for those to come out. And of course, he's got a number
of videos on YouTube and of course his website So, I really hope you enjoy this interview
as much as I did about this just whirlwind of different topics
and the perspective of Robb Wolf. And if you want to see more,
you can see us at where you can see the full transcript
and of course all our other interviews. So, thanks and enjoy this episode. Robb Wolf, welcome to the Diet Doctor podcast,
it's a pleasure to have you here.

Thank you,
a huge honor to be here. Yeah, well, Robb Wolf takes on
a lot of different meanings when people think of who Robb Wolf is, so
I want to start with who really is Robb Wolf because sometimes when you listen
to you speak, you can sound like you're
an anthropological PhD or you can sound like
you're a biochemistry PhD, or you can sound like you're
a functional medical practitioner with years of experience
or you're the CrossFit expert. You seem to branch across so many
different disciplines and who's Robb Wolf? How did you get to the point
of having so much expertise? Oh, man… One – thank you. Some good luck
and I guess some hard work. So, I stumbled on this kind
of paleo diet concept in 1998 as part of a health crisis that I had and it was kind of the last ditch,
you know, roll of the dice, to try to deal with the ulcerative colitis
that I was dealing with.

But my mother had been diagnosed
with celiac disease and a whole complex of interrelated
autoimmune conditions, lupus, rheumatoid arthritis, Sjogren's, and now, when we kind of look back,
that's super common. We see that all the time where people have
these complexes of autoimmune conditions but at the time,
it was kind of this novel thing. But her rheumatologist had determined
that she was reactive to grains, legumes and dairy. And when she told me this at the time
I was a very sick vegan and again, the ulcerative colitis problem
and whatnot. And I sat there thinking like,
she can't eat grains, legumes and dairy. What on earth do you eat
if you don't eat that, you know? I mean, the dairy wasn't an issue for me
at the time because the vegan shtick, but I was like, grains, legumes and dairy,
man that's like agricultural.

What did we eat before agriculture? And I was like, oh, caveman,
Paleolithic, Paleolithic diet. So, this is 1998 and literally
it was a stream of consciousness and I had heard this term "Paleolithic diet"
and I went into the house, turned on the computer,
waited for it to boot up and do its thing. And then there was
a new search engine out called Google and into Google I put the term
Paleolithic diet and I found a lot of material from this guy Arthur De Vany
and less material from a guy Loren Cordain. And I started interacting
with both these guys, I ended up shaking Loren down
for a research fellowship and spent some time at Fort Collins.

And so, I was right at the beginning
of that scene and then, I've always been interested in
kind of the strength and conditioning world. And in 2001 when
I was poking around online, I found this really weird workout
called CrossFit and they were referencing
the low-carb diets and paleolithic diet at a time when nobody,
I mean, nobody talked about this stuff. -Yeah, this is back in 2001, right.
-2000, 2001. So, I ended up cofounding
the first CrossFit affiliate gyms in the world and worked with CrossFit HQ
for a number of years and so, I've been really lucky to be
at kind of the ground floor level of a lot of these I guess, kind of movements that have really arguably changed the world
that we live in in a lot of kind of ways.

So, very fortunate in that regard. And then, I don't know why but at
a reasonably young age like in my early 20s, I kind of sat down and I thought, what are
these like, big picture governing concepts that help you understand the world. And I, for myself, I kind of boiled it down
to economics, evolution, and what I would call
like thermodynamics, you know. I mean, basically physics
but really thermodynamics because of like the energy input
and energy output. If someone says, hey ethanol
is a great fuel source, you know for carbs, I would say, okay, well do you get more
out of it than you put into it? And they say no and I'm like, okay,
then it's not a good fuel.

And so, if you're able to run things
through some basic economics like supply and demand, and you know efficient market theory
and some stuff like that, it really, in things like moral hazard, like if you're going to set up
a safety net for people, make sure that it doesn't turn
into a noose that keeps them trapped there
for multiple generations. Like there are some basic economic stuff
and then using this evolutionary template, it doesn't answer all the questions, but it helps you ask some really good
questions about, you know, ranging from human health, psychology,
to movement to our circadian biology.

And like, it really gives you
kind of an advantage and so, I'm not a particularly smart guy
but I've got kind of an operating system that I think gives me a disproportionate
advantage when I look out at the world and I try to figure out
what's going on in that. And so, it led me to some things
like functional medicine, like CrossFit, like this paleo low-carb type approach and so, I've been really lucky in that some
of my early mentors helped me form that kind of world view based in
economics, evolution and thermodynamics and then also being in kind
of the right place at the right time and then also kind of worked really hard
with some of these concepts.

Yeah, that's a great way you describe it
about the different modalities because you do pull
from so many different areas and I think that really helps
your perspective because no matter how much people
like to put things in buckets and put people in buckets,
you sort of defy that and say hang on, we're not all in buckets. So, you're initially known as the paleo guy
because of your Paleo Solution book. And then, you sort of became known
as the keto guy because you started talking
a bit more about keto. But really, it sounds like your message
is you don't have to be paleo, you don't have to be keto, you have to apply
the principles for a healthy lifestyle.

-Right, right.
-Yeah. And folks forget that in my paleo book, my recommendation for the first three
months was between 30 and 50 g of carbs and then start tinkering with reintroduction
and whatnot, and so you know, even then, the funny thing is my North star has really
always been the low-carb side of this story. But using the paleo orientation to think
about broader picture of things, like gut health, circadian biology,
immunogenic foods, and so that's where the– maybe the paleo-ancestral health template
has been really valuable for me in trying to figure out some kind
of logic trees for trying to help folks. Right, and that makes a lot of sense. So, when you're talking about people
trying to be healthier and the challenges they overcome, so I think that's what sort of leads
to the Wired to Eat book thing. And that's another part of your message
and it's so important, you know, that the types of foods you eat
are important, right.

Trying to find you macros, trying to stay
away from the unhealthy foods, you know, go towards the healthier
ancestor type foods. But the society we're in is sort
of stacking the deck against us. Absolutely. It's making it much more challenging and that was sort of like
the take-home behind Wired to Eat. So, what led you down that path to say, okay let's take a detour from
the type of foods to what's going on emotionally,
what's going on intellectually that's keeping
us from achieving our health? You know, in the first book,
The Paleo Solution, I had maybe a paragraph related
to the neuroregulation of appetite and I made mention to the notions like
adiponectin and leptin and ghrelin, these things regulate our appetite and if we eat in a certain way
then it can improve our satiety and it can make it easier for us
to be successful. But it was really like in a side. So those are the hormones,
just for definition, that regulate say if your body is hungry,
your body is full, how those are regulated
by different factors.

Yes, yeah, including sleep and exercise
and all kinds of stuff, your gut microbiome, you know,
influences these things. But then over the course of time there's
been this kind of macronutrient war, is it high carb, is it low carb? Well, we have the Kitavans, they lived
really well and eat tons of carbs. I tried to eat that way and I felt terrible,
and my blood lipids go sideways, and it doesn't matter if it's sweet potatoes
or rice or what have you… so what's happening there? And so, over the course of time I think
putting some of this ideas around metabolic flexibility
and individualized medicine and some folks at the Whitesman Institute
did a really fascinating bit of research that I believe was published in 2016.

They took 800 people,
put continuous glucose monitors on them, did a full gut microbiome screening,
genetic testing, full lipidology, then they started feeding these folks
different meal and what they found was there was
massive difference from person to person. And even for a single individual, white rice
might not be a big deal but a banana would be. And you know, sometimes producing nearly diabetic blood sugar levels
after a banana versus a cookie. So, there was just this massive individual
variation both in the amounts of mass of carbs
that the people respond favorably to and then again using this kind
of ancestral health template, whether non-westernized cultures
eat a lot of carbs or don't, the little bit of data we have on them
providing like oral glucose tolerance tests, they look amazing.

And these people tend to be small, which would skew the oral glucose
tolerance test unfavorably for them because there's just less volume
to dilute the glucose in. But for these non-westernized populations
that have been tested, a high blood sugar number at hours one
and two was 100 or 105, which don't– we're not really concerned until we start
getting north of like a 160. Right, it shows how the society
and the norm can change so much. Yes, so, what it kind of directed me to,
was a couple of different factors. One, almost nobody, even though you
could maybe make an argument because of the amylase chain frequency
and all of this different stuff that maybe humans should be able to eat
a significant amount of carbs, and maybe carbs played a pretty significant
role in ancestral human living. But today, we just don't tolerate it
that well, like in general; some people do but most people don't and then if you apply a standard
that is consistent across the board with non-westernized populations
of what constitutes healthy blood sugars, then you're forced to either eat very small
amounts of carbs or very infrequently or post-exercise or you know.

It starts ordering some stuff out and what
we found is that if we tighten those parameters with an eye towards
the neuroregulation of appetites so that people could, you know,
spontaneously reduce or maintain caloric intake at healthy levels. And that was driven in large part by finding the amounts and types of carbs
that kept them within, you know, pretty tight blood sugar regulation because
I think that that is the ancestral norm. These huge excursions in blood sugar
were not normal and what we look at as benign I think is
anything but and is actually much lower in magnitude and duration
that is not injurious. Once you start running
everything through that, that was kind of the framework
for Wired to Eat and then it, you know– so it helped educate people on maybe
that background information and I think pretty practically helped people
to walk through, you know, getting to a spot that they could find
a healthy place in that.

So, let's talk about that for a second because this metabolic flexibility
is a big topic that comes up, you know. When you're treating diabetes,
when you're treating insulin resistance, you really have to be pretty strict
about avoiding carbohydrates. But people always ask,
"Is this a forever thing?, is there some point where I can start
to introduce carbs in a healthy manner?" And that's where this carb challenge, this
concept of metabolic flexibility comes in. So, what kind of advice
can you give to people on ways to determine if you're at that point
or how to monitor yourself to say okay, if it try some carbs, am I at a point
where I can do this in a healthy manner? Yeah, in general, if folks get
to a reasonable level of leanness, that's probably a decent indicator that
they may be more metabolically flexible. We can do some testing like LPIR score,
lipoprotein, insulin resistance score, which is interesting. It does everything
that like the craft pattern does but without being hooked up to a glucose
clamp for like six-hour at a shot. And so, if your LPIR score looked good,
which good for me would be like 40 or less, then we could get in and start kind
of kicking the tires on how folks do with carbs and they usually
start with about a 50-gram amount.

And if people have been eating historically
pretty low-carb, then I would recommend
just titrating some carbs in so that if there's any physiological
insulin resistance in the background that's been kind of sparing glucose
for you know, must-have resources, then we can kind of shift things around
and kind of test things and see how folks look, feel and perform,
see how their blood glucose responds and there's just kind of a reality that some
people will regain significant headroom with regards to metabolic flexibility
and other people will not. I've been eating approximately ketogenic,
peri-ketogenic for 20 years now and I have tried everything under the sun
and honestly, it's gotten better and ironically, like I started using
some low dose loperamide, the– you know, anti-diarrheal drug
almost a year ago and that fixed like maybe the remaining 5%
or 10% of kind of my IBS stuff that I've had and I can eat a little bit more carbs now,
you know.

I probably hopped it up 10, 15 g per meal
where blood glucose looks good and it's– I know it's crazy like people
are like oh my God, you know, like hemolytic E. coli and all the stuff. So, if I get food poisoning, I actually
discontinue it then but it's– I've done everything you can imagine. If I do a really hard jiu-jitsu session,
if I lift weights pretty hard, if I do something like CrossFit, I can throw
some carbs in the back side of that. It's unclear to what degree that really does
anything favorable for me because I actually like kind of fatty and
more protein foods at this point anyway and there's like stevia-sweetened sugar,
sugar-free chocolate bars at this point and so I'm like okay,
I just don't need that other stuff but– So, what numbers do you shoot for,
because you mentioned the Kitavans and the more ancestral type communities that their blood sugar is 100
even after they eat carbs.

In our society we're talking about 140, 160, so what do you use
as your guide, your benchmark? I think like about 115, like you don't want
to see an excursion above that. One hour, two hours, 30 minutes, like we'd like to see the whole curve
under that 115, yeah, yeah. Which is really low but interestingly,
my wife who is 40 pounds lighter than I am, she and I will eat the same amount of rice. Like we did a lot of testing on this
and posted on social media. We'll eat the same amount of rice
and she will top off maybe 120. I mean, occasionally she will pop up to 120. Mine will be 195 and I have blurry vision,
I feel horrible, my mouth is dry, which is like no difference and you know
what's so interesting about that? She has no like keto flu,
she doesn't hit a wall going low-carb, she was a 17th place CrossFit games

What I noticed is that people who are legitimately what I think
as metabolically flexible, there's no wall that they hit
going into ketosis. Whereas folks like me that have had
some metabolic breakage at some point, if I get into a thing
where I'm doing some experimenting and I'm doing a bit more carb fuel and then I go back into a ketogenic state,
it's kind of a brick wall. Like, I've got to be totally on point
with my electrolytes, I've got a 30-day period where my VO2
max is down, like my work output is down. Whereas Niki, she'll go in, out,
doesn't matter, and she doesn't even notice a cognitive
boost being in ketosis whereas I really do. So, I think historically, humans went
in and out of ketosis all the time and because they're metabolically flexible, it didn't really matter because it wasn't like
hitting a brick wall when they first did it. But I think when you have people
that their metabolisms over their lifetime, potentially has been habituated
to just carbohydrate intake, it's a really gnarly transition but sometimes it's the only therapeutic
intervention we can do that gets blood sugars
at reasonable levels that drops, like the total inflammasome load and you know, makes things generally look
much better and the person feels better.

You guys are like the perfect couple, the highlight, the difference,
the individual variation. It's really cool. If we were both identical in that regard– It would be pretty boring. Yeah, but it was
a really compelling story and even people like Joe Rogan,
we're really following that and we're really kind of jaw-dropped that
there was that big difference between us. Yeah, so if people are interested,
they go onto your YouTube page because you documented every single day
of that seven-day challenge and more, so that was really interesting.

So, you've brought up exercise a few times, so I think that's an important too,
about carb use before and after exercise. Because I remember you saying
you've broken many a good man by trying to make them go low-carb, or man and woman, I presume,
with jiu-jitsu training and you work a lot
with mixed martial artists. So, you've broken many a person
by having them go low-carb. Tell us what you mean about that? So, I think some of these highly glycolytic
sports like CrossFit, boxing, jiu-jitsu, don't really lend themselves well to a like
purely ketogenic diet, by people sticking in that
like 30 to 50 grams a day level. But this also reflects
kind of my Dunning-Kruger, my time done
in Dunning-Kruger land, you know, like Mount Stupid where you think
you've got it all figured out and then you start to figure out
how little you know. And what I've learned over time
is someone who is fat-adapted, may eat 150 to 200 grams of carbs a day and they're still at a therapeutic
ketogenic level but they're also providing enough carbs. And this is a guess,
so I'm really guessing here.

Because when we look at muscle biopsies
of people that are keto-adapted, the muscles replete glycogen pretty well,
but the liver doesn't. And that's like, you know, kind of
the reason why we end up in ketosis. And I suspect that there's a central
governor element piece in our brain that senses our energy needs
and energy availability. And what I've noticed is just adding 10, 20 g
of quick acting carbs like doing the glucose tablets
for diabetics. If I do that, if I have athletes do that,
immediately before a session, what's interesting is their total blood
glucose spike from the session is lower and I think that's because they get less
of an adrenocortical response to kind of dump glucose out
of an already glycogen-depleted liver.

And so, I think part of where I broke folks, a big piece was I wasn't attending
to their electrolytes appropriately, they needed far more electrolytes. That was a piece I didn't do but then also
I was overly strict about what ketosis was. And the reality is if someone is
vegan and eating a 90% carbohydrate diet but they're doing an Iron Man triathlon,
they're producing ketones, you know. Then they swear up and down
that they're not, but they absolutely are because the body is trying by hook
or by crook to get energy substrate any way it can and one of the ways
that it will do that is by producing ketones. So, a piece that I didn't appreciate
was electrolytes and another piece was that ketosis
can mean a lot of different things depending on the context, and high work output can, you know,
change the carb tolerance significantly.

And then also appreciating that
some peri-work out carbohydrate, particularly glucose, may actually alleviate
a lot of that glucocorticoid pain that we get. We see it really prominently
in type 1 diabetics. You know, where they'll do a hard work out
and their blood glucose may go into the 200s and so then you have to figure out
a strategy of do we do some
slow-acting insulin before and you know,
this whole mitigating strategy there. But over the course of time,
I've just recognized that we can cycle carbs a little bit
so on a harder training day, we'll do particularly
more pre and post work out, we'll do peri-work out nutrition
like the targeted ketogenic diet.

And so, we just do a little bit of fiddling
and I found you know, where normally, say 170-pound MMA athlete, they may
be eating 6 or 800 grams of carbs a day and they're inflamed
and they're having gut problems. 6 or 800 grams? That's the standard,
I mean that's what these folks do. We might get them 2 or 300 grams
of carbs and their inflammation is low and you know, when they wake up
in the morning, they've got a decent level
of ketosis occurring. We might throw some MCT oil in the mix
to kind of goose all that stuff. But being a little bit
more flexible on that and really just keeping oriented towards
performance and inflammation and recovery. And, but, you know, they're at a fraction, the carbohydrate intake
that they historically have been. And reap some benefits consequently. So you're dealing with very high
performance athletes doing very high performance type activity so the so-called average Joe out there
who's going to hit the treadmill, hit the elliptical,
do some resistance training, do you think the same concept applies or is
there sort of a minimal level of intensity that you need to worry about
adding this extra glucose? I think it varies a little bit
from person to person, like I think some people probably don't
need to add peri-workout carbs at all.

I do jiu-jitsu four or five days a week
and I find, in general, if I just do 10, 20 g– so what I do, I show up at class
and I see who's there. If there's a bunch of 22-year-old cops
that are, you know, 200 pounds, and I'm like okay, just going to be
one of those days, then it's like 20 g of carbs because I know
that it's going to be a fight for my life if it's people my size
and they're all white belts and I don't even add anything to it
because it's going to be a good day for me.

I think you kind of map what the experience
is and you can play with that. And I mean it's really a nominal amount,
you know, that folks get a benefit from. The guys from KetoGains I've learned
so much from them. They will do a little bit
of peri-work out carbs, you know, 10, 20. 20 grams is very high, like they're more like
5 grams or a little bit of a dose right before the workout and it seems to–
and again, it's not a muscle glycogen thing. People get pretty spun out about that. I think it's a central governor issue
where the brain just senses, oh there's a little glucose there,
we're good, we can get after it a little bit. What about if you're using food instead? Would you recommend
like a handful of berries or you know, would you even go
like a cereal or rice? Like what are the food equivalents
for that glucose tab for those who want to have a little–? I think a little fruit.

Probably more like tropical fruit, like
the higher glycemic index, faster acting fruit because you want it
to be pretty quick acting. But again, folks can play with that,
you know. Yeah, and again, because ketosis
is so damn effective, like it's the most underutilized medical
intervention in the world right now, like it is just such a powerful tool.

That's a great comment. But it's so powerful that people have forgotten there's this
whole world of low-carb that's like 50 to 150 g of carbs a day,
which is incredibly healthy and incredibly beneficial and people will go
in and out of ketosis all the time and I could encurage folks to just play
with things and kind of see how they do. Because, again, like ketosis has been
so valuable, like I was looking on PubMed. You can look at the number of citations
that have been published over time… And it starts in the 1900s
like one or two, and around 2000 you start getting–
last year there were 380 like, it's gone exponential because it
addresses so many different issues, it's so effective. And unlike paleo,
like I kind of look at keto versus paleo. Paleo is kind of like the Old Testament and
then keto is kind of like the New Testament and I don't worry about all that stuff,
you know, just do this. Just get your blood glucose to these levels,
and things are going to be good.

And in general, that's pretty accurate but you know, it's just a much simpler
intervention. If somebody says what about gluten
intolerance… okay, we'll check that… and you can tick the box on all the food
intolerance stuff very easily but it's not this whole like crazy song
and dance routine, so, it's so effective but I think that people
have gotten a little overly wed or a little paranoid about the notion that
like 100 g of carbs from whole food sources, fruits and vegetables is probably
not a bad idea for a lot of people, particularly more active people,
so I would play with peri-workout carbs.

I would also play with you know, how do
you feel reintroducing a little bit of fruits before your workout like that, like do you
still look, feel and perform as well or better, does your A1c look good, your inflammatory markers,
how do those look, how is your digestion. And if all those things are on point, I tend to lead towards more latitude
in the diet versus less. For those who are more metabolically
healthy and have reached a plateau stage and not in their active treating something
like diabetes or insulin resistance? -Yeah, absolutely, yeah.
-Okay. I think that was a good discussion
there on exercise because so many people wonder
how to handle glucose around exercise. Now, I want to transition
a little bit more to Wired to Eat and sort of the societal pressures
of it's not your fault necessarily. There's so much
from a physician's standpoint, I can say that unfortunately it's been over
a decade of subtly saying it's your fault and you just don't have enough willpower. Not that I ever said that
that sort of implied message that you can't stick to this diet,
but you've pointed out the psychology behind orchestrating
packaged foods and processed foods to make it more addictive.

And you've talked about the differences
in texture and the differences in salt, where you're stuffed, you can't eat anymore, oh, but here comes a change to our palette
and all of a sudden, we can. I mean, was this eye-opening
and kind of revelation, a revelation to learn all this or did you sort
of suspect it from the beginning? No, it was a big eye-opener
because in my earlier career I was a total– to people. And it was kind
of like just do this, you know. Here's the information, just do it. And well, my kids don't want
to eat this way. Make little Jimmy eat, you know,
I was so not appreciative of the complexities of like navigating
a social environment and all that type of stuff and really did a disservice
for a lot of people.

Like, I helped a lot of people
but it was a cross section of people that were ready to go whereas
there was another big group of people that I had some empathy
and a little bit of caring and I understand this is challenging, I understand that your co-workers
are trying to undermine you. Here's how we're going to address that. And so, yeah, I mean,
it was a revelation for me and it's an embarrassing,
painful thing at this point, to realize you know, kind of the way
that I conducted myself early on but again, it was
this evolutionary biology framework that bludgeoned me into understanding
that this is a really difficult thing. If you go into a 7/11, you have more flavor
and palette options available to you than any Pharaoh of Egypt, Tsar of Russia. I mean, other than right up till maybe like
the 1980s or something, like the world leaders, people who could
have pressed buttons and annihilated life on Earth, you could walk out your door,
go into a convenience store and have more amazing flavor options.

And people will get kind of hoity-toity
and be like, oh, that's all junk and give me a break,
a Twinkie isn't amazing, a Slim Jim isn't awesome,
like corn nuts, you know? Like, these are phenomenal, right? They hit all the dopamine receptors. All the dopamine receptors and it's like well I've just had salty crunch,
well I'm going to have sweet and sour.

I mean, you can cycle
through all of that stuff. And if you really appreciate a couple
of things out of evolutionary biology, the optimum foraging strategy,
and palette fatigue. Optimum foraging strategy is this notion that you try to obtain as much nutrition
as possible doing as little as possible. And then the juxtaposition
with that is palette fatigue. We get bored with any given food
that we eat because we want
to diversify nutrient intake and also we want to decrease
potential toxicant load. So, even if you find a lot of a particular
type of food like blueberries or something, there are toxicants in that food.

And so, your body just says,
hey, I'm done, at some point but if you can mix and match flavors
and palette combinations, you can just almost infinitely keep eating. And there's a guy Andrew Zimmer,
he did a show Man versus Food and it was ages ago I watched this show
and it just stuck in my head. He did the kitchen sink
ice-cream sundae challenge where they literally bring like an 8-pound
ice cream sundae out in a kitchen sink and he starts eating it
and he's motoring along and he's got to get it eaten in, you know,
some amount of time and I don't know what the reward is,
it's like diabetes of the year or something. -Like a t-shirt maybe.
-Yeah, yeah. You got diabetes and a t-shirt;
you know, good for you. But he eats maybe a third of the way
through and he start bogging down, and I mean the guy turns visibly green and you can see him almost retching
as he tries to take another bite.

That's awful. And then he turns to the gal
that runs this shop and he's like, "Hey, can I get some extra
salty, extra crunchy French fries?" She's like, "Sure." So, he takes a little break,
the French fries come out and he eats a French fry,
takes a bite of ice cream, eats a French fry. And I mean, he was
a massive pile of French fries. I sat there and I'm like, that's 2000 calories
of French fries but the thing to take away, so in standard dietetics land, he– adding more food should have made it
harder for him and it didn't.

It made it, it was the only way possible
for him to finish that sundae… it was by eating more food. But you've got this cold,
sugary sweet experience, which, once his palette fatigue set in,
it would create a vomiting response. But the salty, crunchy, umami element
of these French fries overrode that and then he could just play them
back and forth and back and forth and was able to finish the whole thing. And if you really can step back and look at
that and understand that, then it's like oh, this is why
the hyperpalatable food environment is a bastard to deal with. And having an expectation that people have like a zillion
different food options in their pantry or you know, they go to work
or family functions, like that is a legitimately difficult
real scenario to deal with.

And what I've found,
the feedback that I've had is that folks who have had eating disorders
or challenges with weight for years they had never heard "couched"
in those terms. They took good engineering, good
evolutionary biology to be this way until now. And now it's a liability and so some people have given me
really pushback on the whole notion in that it's not your fault
like, no, you need to take accountability. Once you are aware, then that's where
the accountability comes in.

And then that's where you ask yourself,
do I want to do what's necessary, which means doing any – not your best –
anything it takes to do it. If you're ready to do that, then let's jump in
and do it and if not, okay, cool. No foul, no harm, let's figure out
other mitigating things – can we improve your sleep?
Can we get you exercising? Can we just maybe, time restricted feeding
is a really interesting way. We're not going to limit the types
but by golly, you only eat between 9 and 4
that's it, get after it. If those strategies work,
there are some other strategies out there and them maybe we get
the person a little bit healthier and then they're like I'm ready to do
some food quality shifts, you know.

So, you know where in the beginning
I had a one tool and it was a blunt tool now I feel like I've got a bit of a Swiss
army knife so we can do some more stuff. But it's that offloading
the emotional responsibility and baggage around our evolutionary heritage. Once you can get to there, then it's kind of like okay,
there's still hard work to be done, there's still challenging social interactions
and whatnot. But it's ultimately just like
I'm not broken, I'm not weird, everybody is like this. That's such a great example. And I mean, I love that ice cream
and French fry example.

It's so powerful. It shows how people say,
we're not a bomb calorimeter, we're not a toaster, we are an emotional,
living, breathing being, and you have to factor that
into the equation otherwise you're not
going to get anywhere. And these things didn't happen by chance,
I mean companies are doing this on purpose. I mentioned that in my talk, you know. There's a Doritos roulette product. It says caution, some chips
are extremely hot and what they've done is within one bag,
you know, if we were to graph this out, there are a very few extremely hot chips,
some medium chips and then some mild chips. And it's in a power law distribution and so, it's this kind of randomized
distribution that maximizes addictiveness.

And I actually wrote a letter to those folks like hey, by chance do the chips follow
a power law distribution and I got a response and the first response
was, "Hey, by the way, the scientists
in the food lab are huge fans of your work." That must have made you feel real good. It was a mixed bag right. But the takeaway for folks
to kind of understand is the processed food manufacturers are
arguably more sophisticated in evolutionary biology,
evolutionary psychology than we are. Scary. They get it. And it's not a controversial topic and
there's not pissing matches over hey, is 50 g versus 30 g really a ketogenic diet, which is where we,
like our community just spins on that. These guys are like, hey, we understand
evolutionary biology and we understand how to create things
to be addictive and we understand optimum
foraging strategy and palette fatigue and here's how we're going
to bypass all that stuff.

So, while we are in fighting on
these little details and these nuances, these folks are creating foods that– and you know, it's so frustrating that some
of the evidence-based nutrition world they're like,
"These things aren't addictive." And it's like what planet do you exist on
and who could you help, you know. Like, only fitness competitors arguably have
neuroses around their food because you know, they can't not be
in like contest shape all year.

So, great! You succeed with people that would
succeed if they lived on the moon. Awesome, that proves a lot. Like can you help someone who's 500 pounds
get back to a metabolically weight? Like, show me that, you know? And you can't really do that successfully
over the long haul without some understanding of this kind
of evolutionary ancestral health orientation. Great perspective. And you brought up the issue
of addictiveness, can you prove it's really addictive and Robert Lustig has done some great work about pointing out
the addictiveness to food. But I always like to say, definition or not,
just try and take that bag of Doritos or that ice cream
away from that 10-year-old and tell me if it's addictive or not,
you're in for a fight. Yeah, yeah and you know,
while that's going on, we're 50 years out from a bankrupted
economy in the US due to diabesity related issues.

And that's just the diabetes side of this. Parkinson's and Alzheimer's, which are
the next wave of metabolically driven issues. Diabetes is set to bankrupt us, but you can
arguably manage to some degree a diabetic with different medications
and whatnot. We can kick the can
down the road on that fire. Neurodegenerative diseases
require 24/7 nursing care. Like, if you want to see
an absolute health care disaster like you just project
20 to 25 years down the road when the neurodegenerative issues
that will emerge due to these sane
metabolic underpinnings, and that's where these evidence-based
nutrition people like I just want to throttle them because it's like hey there, we need to get
out in front of this because you know, the big industries, the government,
kind of collusion and all of that, all of it is setting us up for a disaster
and we need a concerted front. Whether you're high carb or low carb, I think we could agree that processed foods
are really legitimately a challenge.

And then, from there we can sort people. Okay, you're more carb-sensitive, cool. Sweet potatoes and occasionally
some junk food. But even the occasional junk food, I mean we all know probably someone
who's an alcoholic and they get to a spot where they're like
I can have a drink, but I have one. But the other people, they're like, I can't use like herbal tinctures that have
alcohol, it's got to be glycerine. And we need to respect that,
that's just kind of a reality.

And unlike an alcoholic,
someone who has food addiction, they still have to eat ultimately. So, how do you navigate that thing and man, the ways that family
and co-workers in this society will try to undermine you,
like there's an active process, trying to pull you back into disordered
eating or unhealthy eating, yeah. There's a great cartoon where there's like
a CEO of a company or something saying we're going to talk
about health in the workplace and institute a wellness program–
oh and by the way, there's cake in the break room
to celebrate the birthdays this week. Right. And I'm like wait a second,
cognitive dissidence right there, yeah. -Yeah.
-It is all around us. Now, I want to go back
to something you mentioned. You talked about time-restricted eating. So, if you can't make
any dramatic changes in what you eat, make changes in when you eat. Yet at the same time I've heard you say
some things against intermittent fasting, that maybe that's not the right way to go.

I think it's important to sort of define
the differences between time-restricted eating
and intermittent fasting and what you see as the good
and the bad in each one because that is a very popular topic,
it can help a lot of people. But when done correctly,
and I think that's the key. We have to realize how does this fit
into our healthy lifestyle? So, give us a little,
a couple minutes on that. Yeah, so, I wrote my first article
on intermittent fasting in 2005. It went in a kind of sister publication
to the CrossFit Journal called the Performance Menu. It was looking at some studies in mice and
the mice ate one day and didn't eat one day and it looked like this beautiful middle
ground of being kind of anabolic and healthy. But also, they got the same longevity
expansion, health expansion, that crammed caloric restriction;
adequate nutrition did. I was super jazzed on this,
released this into the CrossFit world and then I started seeing people just
explode because you get people that if you, even if
the ancestral baseline for activity was high, it's not CrossFit,
it's not CrossFit 5 or 6 days a week.

So, we have to take each one of these
stressors in this kind of allostatic load as an individual thing
and then start adding them together. And if you're doing CrossFit
on a consistent basis, man, you're doing everything
that your body is going to adapt to. You don't need one more hermetic stressor,
which is what that intermittent fasting is. What I've found is that the people who tend
to gravitate towards intermittent fasting are already aype A, drinking a pot of coffee
a day, doing 6 CrossFit workouts a week. They do hot yoga for a recovery day;
they eat 5 grams of carbs a month. I mean, the people who do it are like this
type A, over the top, they're just crazy. It's not the type B personality
like a computer programmer that's mellow and not super active. So, it's a very context-driven story. So, if you had somebody that is in need
of improving their metabolic health and losing weight, I think something like intermittent fasting,
time-restricted feeding, which– I've actually kind of lean
on some of Bill Lagakos' work, you know, putting more calories early in the day and kind of running
with that earlier circadian biology.

So, kind of front loading the calories. So, if we had somebody that just refuses
to modify the type of food that they'll eat, then I think if we just put some lane lines
up there then say okay, eat whatever you want but only eat between
this hour and this hour, what it does is it introduces
some degree of caloric restriction. Like, there may be some other metabolic
benefits from eating earlier but at the end of the day it's calorie
restriction and that ends up being a net win and so that ends up
being one of the wise things that we can use to move things
down the road.

On the fasting topic, like people are so
geeked out on the autophagy and mTOR and all this stuff and that's all great
but working out stimulates autophagy, drinking coffee stimulates autophagy,
sitting in a sauna stimulates autophagy. Now, lifting weights mainly stimulates
autophagy and mTOR in the affected tissues, which is, that's good, that's all good there. But if we just want global autophagy
stimulation like, in the brain, we can do sauna and we can drink coffee,
like it can be decaf coffee, you know.

And so, for like an aging population
and aging is anything above 30, where we have a tendency
to start losing muscle mass. Unless we're triaging the person, priority is
get them to lose as much weight as possible and improve insulin sensitivity all that, then we might lean a little heavier on
intermittent fasting, time-restricted feeding. But once someone gets reasonably healthy,
and this is a personal bias but– I would lean more towards
two or three meals a day, lift weights more days than not
and rely on autophagy to come about from our exercise,
drinking some coffee, doing some sauna. And then by all means, once per month,
once every two months, do a workout and then fast for you know,
three or four days. Do a full body light strength
training session because that bonds almost all
of the lean muscle mass you lost. But as you get older, you know,
losing two, five pounds of muscle, it is a really hard proposition
to get it back.

And so, I see people doing things
out of fear of mTOR and cancer and trying to goose autophagy that is
almost guaranteeing sarcopenia and you know, dying due
to hip fracture, and fall and frailty isn't fun
and cancer isn't fun. But I think if we're not overeating
and if we're sleeping enough and we're drinking some coffee
and we're generally living well, it's not a guarantee
you don't get cancer, but it's not a guarantee you don't getting
cancer doing the fasting either, it's a guess.

Yeah. But I see a potential danger there
on like the sarcopenia muscle wasting. And those things again can be mitigated
with strength training and, you know, refeed cycles
and Walter Longo talked about that, that the refeed is
as important as the fasting is and from my perspective, I've seen people
go a little bit crazy on this and an overreliance on fasting as part
of the weight loss strategy in my opinion it's challenging, because
people don't learn good eating habits. Okay, so you're fat,
you've gone from 500 to 200, great. You didn't eat anything during that time. What are you going to do now and what
habits did you create during that process? Are we just going to get into a system
whereby you gain 50 pounds and then you fast it off
and then you gain 25 and fast it off? We also know that
that's not particularly healthy because each one of these big deltas
in bodyweight it gets progressively more difficult
to lose the weight, so we're causing some metabolic damage
in that process.

So, you know, when we make
a recommendation, I think there does need to be
an eye towards like okay… what could be sustainable out of this? And let's look at some, you know,
secondary and tertiary things that we can get out of this like muscle mass,
like athleticism, like community, because we found a sport
or an activity that we enjoy and that keeps us in these economic
tractors moving towards something that's going to help solidify
this healthy lifestyle versus like, I'm just a miserable person
and I'm fasting and I can't handle being around people.
So, yeah. Yeah, there was a lot there
in that answer. That's a good perspective. One, separating those
who are striving for longevity versus those who are trying to sort of repair
their health and weight loss. The issue of community is interesting because now there are fasting communities
popping up as well.

But also, the issue of what lessons
did you learn and making sure that if you're fasting, it's
already part of a healthy nutrition program, basically right, and that
you're not trying to do that to make up for otherwise unhealthy eating. And you brought up the terms
of autophagy and mTOR, so autophagy is sort of the body's cellular
recycling system, cleaning up the damaged cells,
preferentially producing the healthy cells, stimulated by exercise, by coffee, and I think that's interesting because that's
something that's not talked about a lot because it's really talked about
from a fasting perspective. To decrease the nutrient centers. And there's always
this question of threshold, like what minimum threshold is required
to target or to trigger adequate autophagy. I would venture to say that we don't know
the answer to that question. There's some level of fasting when it's 18:6,
eating for six hour a day, not eating for 18 hours a day,
probably is starting to get some of it. Resistance training, so not necessarily
endurance or cardio training, resistance training with weights
is starting to get some of the autophagy and I think that's going to be
a fascinating field of research knowing where you get the biggest bank
for your buck and how much do you need to do
down the road.

And I may modify my position
in the next five years and be much more bullish
on the fasting but right now, just thinking about looking at folks
that do age well, they lift some weights, they don't overeat but like this kind of yoga
fasting community I've seen, just kind of looking at that, I'm like, I don't really like that vector
a whole lot, you know. And so, all of that stuff
that they throw out there, I try to inform it as well as I can
with the research, but there's a huge amount
of speculation and personal bias. Like, these are the things I like,
coffee, lifting weights, I like jiu-jitsu, so there's the personal bias piece
that comes in with that. So, I do think that again, this is where
an economics perspective comes in. Anything that we do
has a risk-reward trade off scenario to it.

So, when we're like autophagy,
you know, okay, great but why
and under what circumstances? What are we potentially giving up
on the other side, you know? Just as a little bit of balancing that stuff
and then that can help orient our goals. Yeah, once again, a great perspective on how to see things
and how it fits into a healthy lifestyle rather, you know, it's a tool
for a healthy lifestyle, not an end in itself. Right. And speaking of that,
speaking of the perspective of a tool, I wanted to talk briefly about genetics and genetic testing because that's another
thing that's come up quite a bit recently. And people reacting to their genes,
specifically in the low-carb community, reacting to their genes that say
how their body processes saturated fats. Whether it's the FTO gene or the PPAR alpha
or the PPAR gamma or APoE, these are all genes that are in some way linked
in how your body reacts to saturated fats and people can say, I've got this mutation,
therefore I should not go low-carb, high-fat because this mutation says
I won't react well.

I've heard you have sort of a broader
perspective on that, so tell me a little bit. Yeah, and it's kind of cool. I have that like favorable FTO gene that
I don't in theory do well with saturated fats and it will mainly manifest and seems to be
particularly responsive to dairy. So, I've done this isocaloric stance
where I'll weigh and measure the food, and do significant amounts
of my fat from butter, cheese, cream. And then, my LDL cholesterol
and my lipoproteins, I mainly follow the lipoproteins. Like, at a baseline, my LDLP might be
1000, 1100, somewhere and will kind of float around that range. Two, three weeks, I can drive it up
to 26, 2800 eating more saturated fat, especially from dairy products. And then I'll eat more almonds
and olive oil and it plummets back down
to that, you know, 1000, 1100.

What's perplexing for me, and I think
it's a completely reasonable statement, that an individual that has an LDL particle
count of 2600 who's in ketosis, so super modulated inflammasome, all the inflammatory markers
are just knocked way down. That is a completely different person from
type 2 diabetic with a 2600– and I have no qualms about that. And it's possible,
like Peter Attia has made the point, that LDL particles
and LDL cholesterol are necessary but
not sufficient for the atherogenic process. So, that's a piece but I see folks that are
maybe a little bit brazen and cocksure like as long as your your insulin levels
are low, great, you're never going
to have a heart attack.

And I don't know
if I'm totally comfortable with that. You know, like I would do a CIMT,
a coronary calcium scan, I might even do like the 3D imaging, and
then, if we come out the back side of that, like thee are people who just see
super high lipoprotein count from any flavor of a ketogenic diet, even more of a monounsaturated iteration. There's a great paper that I just read
on the biochemistry of the ketosis, and ketone bodies can feed back
through HMG-CoA and be a substrate for both lipoproteins
and cholesterol. And some people,
they get that feedback loop and it likely drives up
cholesterol and lipoproteins. This may be why some people
who are anorexic, we see exceptionally high lipoproteins
and cholesterol in these people even though they're starving to death. It doesn't happen to everybody,
but this is one of these outliers and so there is this genotype
that has this elevated ketone levels that absolutely drive up lipoproteins.

It's still a question as to okay,
given that everything else is good, inflammation is good, insulin is good, there's also some papers that suggest
that the main driver of coronary events, of strokes,
is actually blood glucose deltas, like your blood glucose
goes high and then drops and then that inflammatory cascade
that occurs is the precipitating agent. So, if that's the case, and we're not
undergoing these atherogenic processes because of blood glucose deltas,
is that still dangerous? So, the genetic testing is cool but it's like
each layer of the onion we peel, I feel like it just makes it that more complex
and that many more, you know, kind of toggles that we're trying to vary versus kind of just looking
at the clinical outcomes; do you look, feel and perform better? Do markers, disease and health
look generally favorable? There are a cross section of people, that they really just feel great
under ketosis but have what you know,
in that lipoprotein specific realm, doesn't– it looks concerning, like maybe their
triglycerides and blood glucose are good.

So, that's kind of the main one that I've
looked at is certain FTO polymorphisms maybe would do better
doing more monounsaturated fats and you know, nuts and stuff like that
but we don't really know. Right, now, you're speaking my language about
the evaluation of lipids and cholesterol and cardiovascular health. I think it's true,
the question is unanswered, so it doesn't mean close your eyes
and forget about it. But there's enough of a question to say that you don't have to necessarily
react and change your life. We have to find out what's right for you and monitor you
and follow all of your other parameters, like you mentioned the carotid intima media
thickness test, the calcium score, all your other laboratory markers
to make sure you're progressing. The other interesting thing about genetics
that I've heard you talk about is why did these mutations survive? Do these mutations have some
survival benefit or at least did in the past? And there's a reason for them,
it could be immune modulation, it could be the way
they affect lipopolysaccharides, some of the toxins
that come into our body.

And if you think about it
from that perspective, then all of a sudden you don't have
to react so aggressively about trying to work around
these mutations but rather figure out
how they work for you. Right, and I thought that was
an interesting perspective you had. Yeah, so not all of the conditions are, some of them are legitimately like point
deletion, you know a random event. But, so like, celiac disease, when you look
at the folks who are prone to celiac disease, they are less likely to have septic events, they are more likely to fight off
a whole host of gut pathogens because they've got a whole comparatively
elevated kind of gut immune response, particularly in eosinophils, which are usually
associated with parasitic infections.

But the trade-off is that if gluten gets in and disrupts the you know,
zonulin signalling in your gut, then that hyperactive gut environment
is prime to autoimmune conditions. So, it looks like celiac probably developed as we made the transition from hunter-
gathering to just living in small town groups and just living in close proximity to animals
where you get like a poor sign to human, duct to human like this cross
reactivity with different pathogens and this was an attempt at you know,
an attempt– but it was an adaptation
for the people with that condition.

It improved their survival rates,
and it's interesting. There's a variety of celiac that developed
in the Americas that was basically unknown, but it was an adaptation
that improves gut immune response. But it was only discovered
more recently because you know, of these Latin American
tribes that have then been exposed to gluten, like it was a non-issue until they got
an environmental exposure like that. Interesting. And they had a different
but similar adaptation which similarly manifests in kind of,
celiac disease, Huntington's disease, which is a DNA base pair repeat. The folks with that condition tend to have
much higher fertility early in life, they have fewer interactions. They are super bulletproof and what's really
interesting about those groups, this appears to be an old adaptation and also, we don't see what we characterize
as Huntington's disease until relevantly recent in history. So, a degenerative neurological condition
that's devastating? Yeah, we don't really see that
as a feature of kind of clinical medicine even in like the Victorian era. It just wasn't something that we saw. Something has changed in our diet
and our environment that now is taking this benefit in youth and turning it into a liability
a bit later in life.

And I think that number of these conditions,
like the APo-4Es, they're clearly of benefit
in a variety of ways, but then we have environmental triggers
that are now making them liabilities. The really, kind of gnarly and scary thing
with the APo-4Es is that these people tend to be more athletic,
maybe a little more aggressive, football players, MMA, boxing, you are disproportionately likely to be
successful if you have that genotype.

Fascinating. Because you're more athletic,
you're more aggressive and you also happen to be more prone
to problems due to traumatic brain injury. Which, even the traumatic
brain injury though, like it's always probably been a thing
but we have low vitamin D levels, we have a pro-fat inflammatory diet,
we sleep 2 hours less on average per day so there's all these other things
that then get packed into that. And so, the numbers vary but it's about
20% of what we maybe experience is hard-coated genetic expression and the other 80% is largely epigenetics
driven, you know. It's how you sleep, what you eat,
whether you exercise, if you have loving relationships
and all that stuff.

So, other than a few situations, I think that
these things are shockingly malleable and really prone to, you know,
us being able to modify them. Yeah, I love that point because so many
people think once you get our genetic test, then your die is cast and that's like your
fate in life to live out these genetics. -It's not the case yeah.
-Yeah. I know we've covered a lot of topics
and we're running low on time, but I wanted to get to the work you've done
with the Reno Police Department. Oh, yeah. And the native American communities
where you've gone into these sections and like revitalized sort of their health
and saved money. And I think it's so important from a policy
standpoint to see the impact you can have. You know, you reduced the diabetes risk
in the Reno Police Department, you saved them millions of dollars
in health care costs, or at least projected health care costs.

And I'm curious, one,
a little recap of the success you had, two, sort of the challenges you had and how this can apply to you know,
the population in general of making these types of interventions
to save the government money, save health care money,
what it means for insurance companies and so we can propagate this further
so it's not small subses of populations? So, gosh. When I first moved to Reno
eight or almost nine years ago, I was introduced to some folks that were
super interested in Gary Taubes's work, they had his book and my book
in their clinic. Which at that point in time,
if you went into a medical clinic and they had any type of like paleo
or low-carb – it didn't happen like they burned these types of books,
you know.

They told me that they had just wrapped up
a two-year pilot study with the Reno Police
and Reno Fire Department. They found 40 people at risk for type 2
diabetes and cardiovascular disease. This was based off advanced testing
like the LPLIR score and LDLP and whatnot and also an extensive
health risk assessment. They found these very high risk folks,
intervened with a low-carb, paleo type diet, tried to modify their sleep and exercise
as best as they could and this was challenging to do
in a police, military, fire and fireman. But they had great success and based off
the changes in the bloodwork and the health risk assessment numbers, it's estimated the city of Reno saved
22 million dollars with a 33 to 1 return on investment pro rata
over a 10-year period, which, we're coming on the end of that, it actually was much better
that what the initial projection was.

And so, this was just a pilot study and the city of Reno kind of at large applied
this program to their police and fire and when I came on the scene, I thought
man, 33 to 1 return on investment. I had been making this case for–
why don't we see More's Law in medicine? So, like these electronic gizmos
that we were using, they get cheaper
and better every single year. Your smartphone gets cheaper
and better every single year. Everywhere that you will allow
markets to innovate, stuff tends to get cheaper and better. It becomes effectively a commodity,
like there's a tendency. In theory, your iPhone should be effectively
free at some point, you know, because of how efficient things are,
there's reasons why that doesn't happen. The only way we see Moore's Law
occur in medicine is the places that we see that do not have
third party reimbursement.

So, plastic surgery, Lasik is a great example
because of very quantifiable outcomes and Lasik just had an inverse exponential
like it's gotten cheaper and better over time. But medicine at large has not. Like, you know,
we pay more and more money and things are more and more expensive
and it costs us more and more. And I thought that we would be able to take
this thing and take it out to the masses and be a billion-dollar company
and get massive adoption and I wouldn't say it's gone nowhere
but we've had very limited adoption.

The folks that have adopted
are self-insured captives, they're businesses that have put money
in their own insurance pool to insure their employees
or their workers or what have you. And these people are facing
the real costs of health care, which are exponentially increasing, so they're very ears forward in trying to find
something that is going to be effective.

Many folks, particularly within
governmental organizations, they're in this third party shell game where, if you're the doctor on the patient
and somebody else is paying for it, nobody really cares what,
I don't care what it costs and the insurance company
doesn't want to pay you and so you're like, well that guy
doesn't want to pay me, so I've got to increase my cost
to offset that because one third of these things they don't
even look at and they just deny it outright. So, you know, tomatoes would be
$600 a pound if we paid for them
in a third-party payer scenario. So, we've had some success there, I'm on the advisory board for the Chickasaw
Nation's Unconquered Life program which is interesting. What I had envisioned for the Reno Project
was a network of gyms associated with doctors that would provide
a hub of community support, talk about sleep, food, get exercise,
you know, work with local CSAs and farmers markets
and you know, do all this type of stuff.

That's what these folks had put together. So, we all love confirmation bias, so it's either confirmation bias
and we're both idiots or it's convergent evolution
where they saw exactly the same problem; they're a self-insured captive, they're facing
exponentially increasing health care costs and when they sat down and thought
about what do we need to do address this, the governor Anoatubby and his sons
have collectively– each one of them has lost
over 100 pounds on a ketogenic diet, so they're super bought in
on like low-carb, keto, ancestral health, they like the CrossFit model
because of the community element.

And they had put a bunch
of the pieces together, but they reached out to us for some help, so we've been doing
some consulting for them. They work with Virta Health also. So, it's really cool but the big challenges
have been– if you go to a large corporation, you deal with an HR department
that's like this wall of you know, just stone and glass and they don't want
to hear any of this stuff. Like they assume that we're trying to reduce
benefits and so it's been interesting. The success we've had is from people
reaching out to us, they're proactive
and they're looking for solutions. I will say this and it's probably going to get
me in all kinds of trouble, but when the affordable care act came out,
when they started trying to consolidate stuff, it made what we were trying
to do ten times harder.

It made it much more onerous and I know a lot of fans
have kind of socialized over medicine. I would love for all
of these medical entities; I would love for there to be ten American
medical associations that all compete against each other. I would like there to be
so much more competition and like really like,
okay, you guys treat cancer? Oh, yeah, we do too,
let's compete and see who wins, you know. And you take 1,000 people
and you do best practices because the current model
is kind of a monopoly so there's not a real motivation
for innovation on any level in particular on this kind of grass route
fundamental health scene.

And if you are a fan
of ancestral health in general and yet you are also a fan of centralizing
medical practices on like a federal government level,
you are cutting your own throat. Like, you should be advocating
for health savings accounts and for more of your medical provisions
to be provided at a local level and not at like a federal government level because that's where
real innovation happens, where we've got
lots of different reaction vessels going– And I know I'm kind of getting off
on a little of a political rant but Bill Clinton when he enacted a welfare
reform, he kicked it back to the states.

He provided some parameters and he was
like, you guys have five to eight years to figure out what you're going to do… go. And some of them were disasters,
some of them were great, the things that went well got pulled up
to a more federal level and disseminated at a broader level. So we had 50 different reaction vessels
in that case versus when we enacted
the affordable care act. It was one. And there's things
like the Singapore health care model where they use HSAs both
for people who are wealthy or not wealthy, a health savings account is where you put
money in it, it's your money. So, poor people in Singapore when they
receive that financial disbursement, that is their money. But when they go to their doctor,
every procedure is listed what the price is, what the outcome is, what the ratings are,
so then they can price-shop.

And if that person gets a better job,
that HSA goes with them. So, they're not creating a scenario where they're "disincentivised" from
improving their personal financial scenario. If you die, that HSA is inheritable
to your family. And I'm not saying that is it
or the thing that we should do– but by God, we should have a couple of states
kick off the tires on stuff like that. And we should do some other things
where we can decentralize this process and then it would also provide
an opportunity if we had 50 different states or even if we went
to a large municipality level, it's the possibility that you or me or someone we know in the keto
ancestral health scene greater than we might have the ear of somebody
that's in a critical position that we could get some movement in a city
like Reno, or Chicago or something like that.

And these effects are so powerful
and so economically impactful, if we get one or two wins,
then it's going to really shift the tide, we're going to–
we're going to see some stuff change. So, again, I know
it's like super controversial, these are things that people
get in fistfights over… you know. When people are thinking about
medicine and health care and stuff like that– again give it a little bit of a thought, do we
want it bigger or do we want it smaller, a more local
or more under a localized control? At least if somebody screws you over
on the local level, you know who to go take a baseball bat
to their knees to… but if it's like Capitol Hill is coming,
they're like here you go, so yeah.

I didn't expect that type
of a political response but that– Metaphorical, of course but I mean there's just more accountability
and transparency in something that folks often don't appreciate
as even in the, you know, places like Sweden and Denmark
and Switzerland, more of the governance happens
on the more of a municipal level than like the centralized level so like,
we've got it all backwards in that regard.

Well, the past five minutes
of that answer just shows your breath of knowledge
and expertise that you can pull in to give a different perspective
for people to see things. So, we talked about the science, we talked about the psychological
and emotional side of it, we talked about the politics of it
and the implementation of it. So, to sort of round out the fact
of how balanced you are, you have your two books,
The Paleo Solution and the Wired to Eat, and now it sounds like you've got
two more in the works.

So, bring us home here, give us
a little foreshadowing of the books to come and how people can learn more about you
and hear more about what you have to say. Sure, yeah.
So, I'm working on a keto-related book. We launched the keto masterclass
a little over a year ago and it's gone great. Like, we've had tens of thousands
of people in the program. It's a very curated process
and it's not a one-size-fits-all approach, it's actually a lot of kind of logic trees
and triage. Who are you? What are your goals?
What do you want to do? Okay, based off that, here's where we go. If you run aground, here are the questions
to ask to figure out how to go forward and so it's been really successful and we've taken what we've learned from
the masterclass and putting it all into a book. And I'm working on a sustainability book
with Diana Rogers. Sustainability topic is a big deal
because I think we're in a scenario, we're kind of fighting an asymmetric
warfare scene but we're on the losing side.

So, kind of the vegan, well, the vegans,
they'll just say meat causes cancer, meat causes heart disease,
meat destroys the environment. It's super compelling and it's an elevator
pitch and it sounds compelling and it's part of an epistemology that is
better thought out than most religions, lie it's just super contiguous
and mean-worthy and sticky. And for you to sit down and unpack "meat
causes heart disease", it's a PhD dissertation. Like, it's such an asymmetric warfare. They throw that out there,
it's scary and it's confusing, it– Then it gets the headlines.

It gets the headlines and then for you
to unpack that– weeks out of your life, you got to write, you have to make– We're trying to put together this book where we look at the the health,
the environmental and the ethical considerations of meat. And it's not just a low-carb book
but it's making the case that meat and animal products are an
indispensable feature of our food system and you know, on the ethical consideration
veganism is not a bloodless endeavor. Grown crops are not a benign entity
and Georgia Ede's talk was fascinating– when you look at– and some other people
are trying to look like this– planet of the vegans is Monsanto and
Conagra on steroids, that's all there is left.

And soil destruction. And soil destruction,
you know and all that. And it's a crazy notion but it may be that
grasslands do really well with ruminants that coevolved with them
over millennia, you know. And so, I'm getting in and kind
of looking at the carbon capture, this whole big term
of non-equilibrium thermodynamics, it's the inputs and outputs
of a whole system, and trying to give
a pretty good accounting to that but also an accessible way
to honor the science but also make it accessible
for kind of a lay public consumption. You and Diana are a dream team
to work on that book and all I can say is do it well and hurry up
because we need it, we need it. I'm going to be intoxicated for probably
a month after I get that book done, so I can't wait to get
that wrapped up too, yeah.

Robb Wolf,
thank you so much for joining me. Huge honor, thanks..

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