GLP-1 Drugs & Bariatric Surgery Explained by a Top Obesity Researcher | Dr. David Allison

We keep saying to people, this will help you, this will help you. And either they don't help at all, or they help a very small amount. Somebody who has never studied obesity, who has never studied nutrition, who's never read a paper on any of these topics, give you their very strong and convicted opinion. If you're on this grapefruit diet, you'll never be hungry again. You mean those kind of fat type? Just eat between this time and this time. Just eat whole fruits and vegetables. Just eat high volume. Just eat low carb. Just eat low fat. Just eat all natural food. Don't eat ultra processed. Do you think there's danger in that? I think it misleads people tremendously. Waste huge amounts of time. Waste huge amounts of resources. You're distracting them from potentially doing the thing that might be. People will say, well, trust the science. Do we need to trust the science? It's a process, absolutely. But if you said to me, do you trust a lot of the science that comes out around dietary supplements? No. Is there anything that you think that we've gotten really, really wrong? Here's the thing. You don't have to learn a lot of nutrition. You don't have to understand what protein is. You don't have to know what a carbohydrate is. All you got to do is this. How did you get involved in what you're doing now? Because you occupy a very unique lane. Your question is an enjoyable one for me because it allows me to sort of think about tying the two paths of my life together. And I think one of them is just who I am. I sometimes get asked, how did you choose to become a scientist? And I say, there's no choice. Choice had nothing to do with it. I never chose to become a scientist. From the earliest I can remember as a little kid, when I could speak, I would ask questions. I was the kid in the backyard who liked to turn over the rock and say, what's under here? How did it get there? What does it do? How does it eat? How does it live? And sometimes people would give me answers, adults. And then I often had the temerity to say, how do you know? And are you sure? Which didn't always please adults and it doesn't always please them today when I say things like that. But it does tend to please people who are true scientists in their spirit. Because that's what scientists do, they ask those questions. And so that's part of me. It's one part joy and wonder and it's one part rigor and hard-mindedness. And you grew up in Long Island. Correct. And then where did you do your training? So I did my undergraduate at Vassar College. And I'll just take a very brief pause there to mention two things about Vassar. One is that it's a place really of spirited open-mindedness. And so I really learned to be open-minded and to think about things wildly. And I took a course as a sophomore called Human Emotion and Motivation. And in it we studied the work of Stanley Schachter. It was built around his work, who was a psychology professor at Columbia at the time. And he had a book called Emotion, Obesity and Crime, in which he tied those ideas together. And I always admired his experimental approach. It was very novel and creative. And so that got me hooked into obesity research. I just, that was the awe, the wonder, the joy, the thrill of discovery. Was obesity, and when was this? Was this in, because obesity? Early 1980s. Okay, so in the 80s, so this was right when the obesity epidemic probably started taking shape and had a name. At least was perceived to be taking shape. Ah, interesting. Okay. It was taking shape a few hundred years earlier. At least. So anyway, I got hooked in that. The other thing about Vassar was, is very focused on writing. So I wrote lots and lots of papers. And every course I took, I had to write a paper. And so I found that it was easier if I could write a paper on the same topic, but from a different angle. And so when I took physiologic psychology, I'd write from a, about obesity, from a physiologic angle. And when I took developmental, I'd write from a developmental angle. And I learned that you not only could address obesity from all those different perspectives, but in fact, you almost had to. If you didn't address it from economic, genetic, psychological, developmental, physiological, nutritional, and so on, you didn't have a full grasp. And so that to me was always thrilling. And from there on, I was in. And so that's how I sort of got into obesity and the science part to sort of a skeptical part. I think that's just in me. Do you have siblings? I do. And who wins the fights? Obviously you. She's pretty smart and tough. So we don't fight too often when they do their do, when we do their doozies. Okay. And you just have a sister? Yep. You studied. And then when you finished, you did four years and then you did advanced training. So I did my four years at Vassar as an undergraduate. Then I took a year off to work with children in clinical settings. And then I went to Hofstra to get my PhD, got my PhD in clinical and school psychology, went in with the expectation that I was going to be a clinician. Even in high school, I knew I was going to be a psychologist and I never wavered from that. But what that meant changed very radically over time. And I thought I was mainly going to be a clinician and I'd talk to people when we do talk and cure and I'd be like some psychologist in an Alfred Hitchcock movie and I'd figure out the puzzle and everybody be happy. And I quickly realized that that wasn't me. And while I liked clinical work a little and I was okay at it, I didn't like it a lot and I wasn't great at it. What I liked a lot was the research. And my professors started calling me aside, the ones who liked me, and said, you know, you think and write like a researcher. You're good at this. You should pursue this. And my reaction was, I'm liking this. And never look back. That is, I didn't know that. I don't know if that's public knowledge. I don't think people realize that you studied psychology and were very interested in behavior. I mean, I'm assuming it was the behavioral aspect. Sure. And also you spend a lot of time examining evidence. Yes. And it's unusual because there's, what I think is very unique from your perspective is that there's the science or the truth. Because I want to know if you think that there's truth in science. And then there's the why people, A, perceive themselves as experts, B, put out, and again, I'm just choosing things like large statements based on epidemiology. And we see this proliferation of information. And there's got to be a psychological component. So there's the science aspect. And then the psychological component is to what the contribution is and why it's even happening in that way. Sure. There's so many aspects to nutrition and obesity and exercise that are that the intersection of values and empirical facts and epistemology. What do we really know? How do we know it? So there are things that are knowable and derivable from science. And there are things that are not knowable or not derivable from science. And they can all be important. And the things that are knowable and principle and derivable from science are sometimes things I think we think we know. Like drinking A glass is a bother. Right. So there's many different varieties of this sort of pseudo knowledge or false knowledge or presumed knowledge. And they range from things that are grandfathered down very innocently. Most people don't sort of have some stake in water that they're trying to promote. It's just been handed down and it sounded good and nobody stopped to question it. And that's one. And then there are others where people have these very passionate beliefs. And it comes from this sort of moral system or their group identity or their tribal identity or their need. Their their need for psychological or social superiority or their economic interests. You know, there's so many interests that drive people, I think, to push an agenda. Sometimes knowingly, sometimes not knowingly that either goes beyond what we know or in some cases is just simply false. And I think there's a great deal of that. And I think it tends to work better in or not work better. It tends to people tend to get away with it more, tends to propagate more in fields like nutrition. Because it's about food, it's about everyday experience. And many people think their experts feel like their experts because they have everyday experience with food. Most of us eat every day. Most of us have eaten all of our lives. We've eaten in many circumstances. And you kind of feel like that makes you an expert. We all have a body weight. We almost all know our body weights approximately. And so it's not uncommon to be, you know, in any kind of setting and have somebody who has never studied obesity, who has never studied nutrition, who's never read a paper on any of these topics, give you the very strong and convicted opinion about some diet or some cause of obesity. Or what on you? Do you think there's danger in that? Oh, sure. I think it misleads people tremendously. It wastes huge amounts of time, wastes huge amounts of resources. Every time you're telling somebody to do something that's inert, let's forget even that it's harmful, maybe harmful. It's just inert. You're distracting them from potentially doing the thing that might be helpful. Every time you say to a school superintendent, a mayor, a governor, etc., invest in this, you're saying don't invest in that. Of course that hurts if we're basing those judgments on erroneous information. When did you start noticing that things were misaligned? You know, it's interesting. I started noticing this as an undergraduate, but I saw as misaligned has evolved over time, which as it should, because in some cases, the information out there changed. Some cases, I got educated. So if you had asked me as an undergraduate and even as a graduate student, do I believe that persons with obesity eat more calories on average than persons without obesity, I would say surprisingly no, they don't. And if you said, David, this doesn't make sense. You know, they're bigger. They must eat more calories. I would have said, well, I'm sorry, you must be a bigot because, you know, that's not what the data show. And I can show you dozens of studies of people who over and over report that they eat less when among obese people, they're poor eating less than non-obese people. I can show you that parents of obese children report that their children eat less. I can show you that observations in restaurants, done surreptitiously by researchers, show people in the restaurant who have obesity or eating less than I. And I'd say, so you're just wrong. De-store the data. And then doubly labeled water came around and I learned what it was and I studied it and I said, I guess I was wrong. And I changed my mind. So that's an example. Okay. And just really quickly, doubly labeled water is a way, what did you learn? So they use it in research. It allows you to trace, how would you explain it, various outcomes? Sure. Doubly labeled water is, you know, water is oxygen and hydrogen. And it's made of isotopically labeled or different hydrogen and oxygen. So it's doubly labeled. And without going into the details of it, you give somebody a drink of this water, it equilibrates through the body, you then later collect the urine sample. You look at the differential rates of excretion of the two isotopes. And from there, you're able to figure out how much energy was expended. Because as Lavoisier said, he said in French, but the translation is, respiration is combustion. So if you know how much somebody's combusting, you know, this oxygen, you know, the respiration, you know, the energy expenditure. So if I know that a person expended X calories, and I know that a good old fashioned law of thermodynamics, that matter and energy can either be created nor destroyed, but only converted, then I can say, if your body composition didn't change, if your body energy stores didn't change and X went out, then X must have had to come in. If your body composition did change, I can subtract the change. And now I know how much energy you took in. And I know it without having to ask you. And it turns out that people don't accurately report their food intake, their energy intake on average. And the bias, the discrepancies are not random. So moral beast people tend to underreport their energy and take more and their their age, sex, race, gender differences, etc. Thank you to our sponsor, One Skin, for sponsoring this episode. If you've ever felt burnt out from skincare, too many products, too many promises and not much to show for it, you're not alone. What finally made sense to me about One Skin is that they're not focused on surface level fixes. They're focused on changing how your skin functions over time, which is incredibly valuable. Their products are powered by a peptide called OS-01, designed to target senescent cells, the aging cells that drive inflammation, thinning skin and loss of resilience. I've noticed improvements in skin texture, hydration, and I've talked about this before, especially under my eyes, which has always been a problem area for me. Right now, I'm using their eye cream, broad spectrum, base sunscreen, and topical body supplement. This is skincare for people who care about longevity, not just quick cosmetic wins. You can get 15% off One Skin by going to oneskin.co and using the code Dr. Lion. That's 15% off oneskin.co and use the code Dr. Lion. Are there, and I just wanted to ask because, again, doubly labeled water is used in research, not typically, like we don't use it in clinic. It allows things to be standardized. So there has been decades of nutrition research, obesity, lots of myths. Is there anything that you think that we've gotten really, really wrong? Just stand out like, wow, we missed, you know, X, Y, and Z. Oh, I mean, the list is huge. I think one of the things we've gotten really wrong, which is more speculative on my part. Some of the other things I could mention are less speculative. This one I think is interesting, although speculative. I think one of the biggest things we've gotten wrong, especially in the last couple of decades, is this implicit notion that there is a diet, there is a way of eating. That for most people, the vast majority, if they ate this way, they would achieve a desirable body weight without having to explicitly think about restricting their calories and feeling deprived. And I think in the current society, unless you are on a drug that makes you feel differently, which now we do have around this, I think that's a fictitious. Fantasy. Meaning that what I'm hearing you say is that there's no perfect diet for a particular body composition outcome. That there's a, and please correct me if I'm wrong, that there's multiple ways to get to one outcome. No. Okay. Tell me. What I mean is that while there may be, whether there's multiple ways or one way, that if the outcome is a certain weight, that for probably somewhere in the neighborhood of two thirds of the US population, that there is no way of eating, that will have them achieve that weight without any conscious attempt to control energy intake and without any feelings of restricting. I see. And so as opposed to what we hear in the social media landscape, that if you're on this grapefruit diet, you'll never be hungry again. Even those kind of fat. Just eat between this time and this time. Just eat whole fruits and vegetables. Just eat high volume. Just eat low carb. Just eat low fat. Just eat all natural foods. Only eat things your grandmother would have known. Don't eat ultra processed. That in the short term, any of these may be helpful, even in the long term, some of those enjoiners may be helpful. But the idea that if I put a plate of food in front of you and I say, look, I altered this food in some way and Gabrielle, I less than she ate in the other condition. And I didn't have to tell her to eat less. She just chose to eat less. Therefore, if I have people eat like this forever, they'll do fine. Well, there's a number of assumptions in it. The first one is if I tell Gabrielle to continue to eat like this, if I say you need to have three times as much broccoli on the plate as meat or something. That first of all, that will be making that change will be any easier than the change of just eating less. All right. Soon you may say, I'm sick of putting three times the broccoli on my plate or only one third of the meat or whatever it is. The second is that you won't feel deprived when you're doing that further down the road, that you'll be able to stick with that. These are all assumptions. And I think there is not evidence for those assumptions. And I think that's important because what it does, it's back to the idea of inert information. If we keep saying to people, this will help you, this will help you. And either they don't help at all, or they help a very small amount. Then the first of what I'm doing this, I'm doing all the good stuff. I'm eating the fruits and vegetables. I'm not eating after 10 p.m. I'm here and you say, yeah, yeah. But you know what? You're not eating less and eating less. Energy is the big mover. And guess what? You might feel uncomfortable. Do you think that there is, that part of the landscape is dancing around this idea of just human discomfort? Yes. And I think especially for children. So I think when the adult comes in for clinical treatment, that adult has volunteered. I want clinical treatment. I want help losing weight. They're an adult. I think people are a little bit more comfortable, the provider, and saying, yeah, you might have some discomfort. Again, especially if you're not on a drug that's taking that discomfort away or reducing it. Let us help you get over that discomfort. Let us help you combat it, not pretend it's not going to be there. Whereas when you go into the public health setting, the school setting, the family setting, and you're dealing with the children, people just seem reluctant to say that. They just seem reluctant to say, guess what? If you want to live in this world and you don't want an elevated weight, and if you're like, it's probably about a third for whom that is true. Right? Just eat what you want and you don't have an elevated weight. But for about two thirds, that's not true. You may just have to accept there's some discomfort. And it's interesting to me that we seem to accept this in other ways. Right? Imagine you're four year old is sent home from preschool with a note. Little so-and-so. Leo. I have a four year old. Yeah. Little Leo bit another kid or punched another kid. And you say, Leo, what happened? Leo says, well, the other kid did this and it made me angry. Now, what you could say to Leo is, I'm going to give you a number of techniques to never feel angry. And then everything will be okay. Well, that's not very realistic. If Leo lives in a world I live in, sometimes people are going to do annoying things and Leo's going to feel like punching it. Sometimes I feel like punching people. But I don't- But not on this podcast. No, I get it. I don't punch people for many reasons, one of which is I don't want to be punched back. Others not right. And others don't want to go to jail. And so- All good reasons. Right? Reasonable. And so I say to myself, if you want to live in this world and not go to jail and be the person you want to be and yada, yada, you just can't punch people when you get angry at them. And you will be unsatisfied, David, sometimes. That's the way it goes. You accept that. So we don't get to punch everybody when we want to. And we're not all that worked up about. And guess what? Sometimes you feel unsatisfied. So here's a way that despite the fact that you get angry, Leo, to control yourself, we're not going to make it that you never get angry. Think about sexual impulses. We don't say, oh, here's a little technique. If you just live this way, you'll never want to have sex with somebody you shouldn't have sex with. We say you can't have sex with everybody you want to have sex with under any circumstances. Control yourself. And we all think that's normal. So why can't we think that, gee, you can't eat everything you want to eat and always feel satisfied. Sometimes you'll feel a little unsatisfied. Let's hope you deal with that. Is, and this, I mean, probably some of that framing comes from this idea of thinking about people and psychology. Do you think that, and I've heard you talk about childhood studies and really it's a lot of clusters in groups and that we've gotten a lot of things wrong about what we believe to be true about, say, childhood obesity or children's health. Can you can you speak to that? Sure. This is particularly the area of what specific techniques or programs have or have not been shown to work or how much they were. My colleagues and I offered a paper. Andrew Brown, my former mentor, was the first author and I was the senior author on that. Talking about ways to avoid exaggeration in the childhood obesity intervention world. Meaning what? And it was a way of trying to guide editors and authors and readers of papers and saying, these are many things that are done, again, intentionally or unintentionally, that lead to the perception that a treatment was more effective than it really was shown to be. And we talk about things like inaccurate, incorrect statistical analyses of multiple types and I won't go through all of them here. One particular I will mention is called the analysis of cluster randomized trials. So these are trials in which instead of randomly assigning each individual person to a treatment, you assign clusters of people or groups, often their classrooms or clinics or towns or schools. So you assign the whole school at once and you might have 10 schools, let's say. And it turns out that the statistics needed to analyze those are very different than the statistics needed to analyze when you individually randomize. And they, those cluster randomized trials, if analyzed correctly, have much lower statistical power than all of the things being equal and individually randomized study. And so people, the investigators often don't like that because less statistical power means less chance of saying, Eureka, I found something. And so often they analyze them without taking, without the correct analysis, without taking the clustering into account. We, my group and I tend to spot those often, but not always. And then we try to get them corrected if they need to be. And we've, as a result, we've had several papers corrected, several retracted, meaning the editors have said, this paper is not valid. We need to take it out. When you think about that and you look at the evidence, not for clinical treatment, but for community based treatment, schools, communities, these kinds of things. For child that obesity treatment or prevention with things like mild physical activity or nutrition, educational schools, examples like that. Many of them that are purported to be successful, even when you look at evidence and somebody summarizes it, most of the time they come up when you summarize all the studies as essentially no effect. A few of the meta-analyses say small effect, very small, but small. Now, what if I said, let's take those meta-analyses that combine many studies, say very small effect on average. And I said, X percent of the studies in there are completely invalid. That purported to show an effect, did it? Remove those or erase the data and write the correct data in. Would even very small become zero. And so these are examples of where I think we've, we've misled the public. We have and continue to misspend funds on methods that don't work when we could be investing it either in research defined methods that do or in some methods we have that do. We mislead the public and that's unfair, give false hope. We distract from doing things that might work. So I think these are pretty serious problems. I think the pretty serious breaches and at best competence and at worst integrity among some researchers. And I was looking at some data, the amount. So I did my fellowship at WashU and I finished that 2015. AI, I did it in Sam Cline's lab, do you know Sam Cline? Of course. And I did a combination of geriatrics and nutritional sciences. We were not, AI wasn't there. I'd have to go to the library and, you know, maybe I was looking at PubMed. There was not, there was not the volume of information and papers that are coming out that are now being written by AI. And what do I mean by that? Is I was looking at the, so let's say there is a claim that's made and maybe it's based on epidemiology. Those that eat red meat are more likely to have colon cancer or cancer or higher mortality. And let's just say, and then there are multiple studies, epidemiology or however they make it, that now curate this knowledge. Maybe it's from NHANES or some large data set. And now instead of investigators writing and analyzing the data, it's all done through AI and the amount and the volume of now low quality studies. Seems to dilute good science, but also it's almost as if it's advertising. It's like scientific advertising. Yes. I've often felt that the field, many fields, but especially the field of nutrition epidemiology is often research, and I'm intentionally using the word research and not science, research as idea advertisement. And by that, I mean the researcher has an idea. They think it's a good idea or an idea they want other people to believe or pay attention to. And a way of getting people to believe it or pay attention to it is to put some data out that seemed to support it. And so a study is done not for the purpose of learning something, which might make it science, but it's done for the purpose of. Reinforcing beliefs. And so there might be some real research. They may have really collected data, but it's not data collected with the idea of advancing knowledge. It's just to reinforce an existing belief. Are you seeing that? I was just trying to pull up the, again, I don't have my phone on me, but I was just looking at it was almost. I don't know, in this small time frame, it was like 4000 new studies coming out on this one topic, which again, it's not. Are you seeing that that there are people are using AI to put out junk research? And then if you wanted to create a narrative and you want to be really smart about creating a narrative, you can cherry pick any of these studies and say, oh, but look, this is this proves that. And then it further debuts the scientific integrity. You said something else really interesting. Science versus trust. Do we need to trust people will say, well, trust the science. Do we need to trust the science? No. Not because one shouldn't. Well, no, because science is fundamentally not about trust at a deep level. The very idea of science is that it gets its privileged role in talking about the state of the world by collecting data and the methods by which data are collected and the logic connecting those data and methods to conclusions. That's it. Science is the data, the methods used to collect the data, which give them their probative value and the logic connecting the data and methods to conclusions. Anything else is not science. In order for it to be meaningful assessment of science, one needs to look at the data and look at the methods and think about them and sometimes debate them and ask questions about them and the same thing for the logic. And that's not trust, right? So if you say to me, David, I just did this study. And I found that eating this causes that. It's not that I don't like you or don't trust you or, you know, don't trust you as a person, but I'm going to ask some questions. What dose did you use? How did you administer it? How long did you study these people for? How did you measure the outcome? And you could be perfectly wonderful, smart person of great integrity. And I say, you know, the way you did that, Gabrielle. You destroyed the nutrient because you heated the thing and you didn't know that. And so I don't think your result is valid. That doesn't mean I trust you as a person, but I don't put my trust in the science. I put my trust in the methods. So we need to go through the methods. There's a narrative now at a more social level that we have an anti-science movement in this country, maybe the world, and that trust in science is way down. Neither of those things are true as far as I can tell. And my colleagues and I have written papers about this. Trust in science is down a little bit in this country, but not a lot. Trust in some things, Congress, the media, way, way down. Science relatively steady, military relatively steady. Nurses, that's good. People like nurses, they trust nurses. What it seems to be is not a distrust in science or an anti-science movement. Pick your, whoever you think gives the craziest information about health and so on. And usually they talk about molecules and substances. They might even mention something about data and evidence. So it's not that they're not talking about science. They're not saying demons told me this and that's why I believe this. But you and I might look at and say, but that's erroneous science or weak science or bad science or pseudo science or something or non-science that you think is science. The trust issue is not trust in science as a process. The trust issue is trusted individual communicators of scientific, purported scientific information or trust in particular studies or facts. If you ask me, do I trust science as a process? Absolutely. I mean, that's totally who I am. I think it's the best and only really vertical way of obtaining knowledge about the objective world. But if you said to me, do you trust a lot of the science that comes out around dietary supplements? No. If you said to me, do you trust a lot of the science that comes out of academic researchers looking at intervention effects on obesity in children? No. I trust science, but I don't trust those studies because I don't think they're done very well. You said to me, do you trust the results on pharmaceuticals in the last 20 years? Not going back more than 20, in the last 20 years that are registered randomized controlled trials funded and conducted by pharmaceutical companies and submitted to the FDA? Yes. I think those are some of the rigorous studies in the world. People have that wrong. There is this false perception. And one of the reasons I wanted to have you on was specifically to address this is that we are now in a new landscape. You know, as a career scientist, you've had to evolve to ask these questions. It's a new landscape with AI, social media, the velocity at which information spreads. I would say both good and bad, but it seems like it skews mostly overblown and large claims are made on low quality studies that then impact populations. Would you say that that's accurate? Yes, I would. 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It works at the cellular level, supporting mitochondrial renewal, which over time may help improve muscle function and recovery. If muscle is the organ of longevity, supporting the engine inside that muscle matters. Go to timeline.com slash Dr. Lyon to get 35% off a mitopyr subscription. Um, and so you really stepped in to say, okay, well, like for example, what's the evidence if we're told to drink a glass of water? Yet I've heard that you've heard it and we continue to repeat it. I tell my kids to do that, but there is, is there evidence for that? There is not to my knowledge evidence for that particular one. I think what often happens and again, sometimes it's very innocent is, um, there are layers, you might say, of digging as a scientist, uh, or as an individual who respects science, even if one is not in the moment, a scientist. I think any of us can be scientists at times and not be scientists at other times in regards to whether you're employed as a scientist. Um, I look at myself as an example. If you said to me, do you think that this particular medicine you take, David, is safe and effective? Um, let's just say effective. We'll put safe aside for a moment. I would say yes. So what's your basis for that? You know, so scientific as well. Sort. You know, if you said to me, have you actually pulled up all the raw data on that drug and examined it yourself? No. So why do you trust? Why do you think that that's a perk? Well, because the FDA said so. Well, why do you so mean you trust the FDA? Yes. Why do I trust the FDA and why do I not trust maybe somebody else? I trust the FDA because I know how they evaluate drugs and they evaluate drugs in a very rigorous scientific way. Um, who knows what the future holds, but at least up until recently I was, I trust the FDA because I understand their processes. And so there is some trust that they execute their process as I believe they execute their process. But assuming that, then that's there. But another level is have I looked into myself? Yet one up from I trust the updates and other processes. Well, I've heard this from lots of mainstream experts for everyday life. That's probably a good signal. Said, do I really know it? No. And is it because there's a lot of regurgitation of information that is not accurate? That's the grandfathering in and that's where we have to go back and take periodically. I caught myself in one of these very recently where, you know, listening to many podcasters who talk about growing muscle and reading some things. But reading at the mountain tops, though, is not going back to every original paper, but reading sort of summaries, listening to summaries. I would say things like, well, the most important thing is how much resistance training you do in the volume. And then the second, you know, might be how much calories and a third might be how much protein and and then somewhere down below that is, you know, very important, but probably a little smaller sleep. And I stopped myself a few days ago and I said, what do you really know about sleep? How much sleep is needed? How big is the effect? I do a little search. There's almost no randomized controlled trials. Randomly assigning people to different amounts or types of sleep while we undergoing resistance training and looking at the causal effects on skeletal muscle strength, quality or hypertrophy. That doesn't mean sleep is not important. It just means, oh, I guess I don't know. And it's a really good point. Are there things, again, obviously read all the time and I would encourage everyone to sign up for obesity and energetics, which I've been getting for years. It's a newsletter. It's so well curated, really extraordinary. So we'll put a link to that and send that out. Completely free. Yes. It's a new thing. You're good to go. It's amazing. Basically, it'll have headlines, null findings, scientific, you know, randomized controlled trials. It'll have all kinds. It's just so well done. You know, as you think about the landscape, are there things where you were have been pleasantly surprised? So as we think about like, say, obesity, where you hear this medication works and this is the outcome, are there trends or statements that you're like, okay, I think one, two and three are really, really good and they're onto something. Whereas opposed to drink more water, sleep more and I don't know, meditate in the sunlight, these are out. Yeah. The most obvious ones are the advances we've had in medical treatments in the last 20 years. And so it's the rise of bariatric surgery and the refinement of it and the recognition of its effects. I was not expecting that the bariatric surgery because now with the GOP ones. Well, and then subsequently, the strong pharmaceuticals, which I think many people, including me, feel will likely or eliminate bariatric surgery, but will likely radically mitigate its use. Because what we've got is a treatment that's or treatments that at least that present, even if they're not quite as powerful as bariatric surgery, they're getting close. And you can turn them off, right? You can't say tomorrow. You know, I don't, after all, I don't think I like this bariatric surgery so much. Switch it off. It doesn't work that way. Right. But you could say, I don't like taking this drug. I'm going to stop tomorrow. So I think that we've got some tremendous growth there. I remember when Lepton was first discovered, 1994, I think, and very shortly thereafter, one of the group and it was the Cambridge group came out with a paper showing treatment of, I forget if it was just one, one member of the family or a subset of a family who had very, very rare homozygous inactivating mutations for leptin production. And they gave them exogenous leptin and great things happened clinically. And I was so envious of them, of the research group, not because they got the paper in nature. I mean, everyone wants their paper in nature. That was true. But yeah. And they're probably the first people in history to be able to honestly look a patient with obesity in the eye and say, I know why you're obese. And this was the leptin resistance hypothesis. This was the inability to make leptin. So leptin is a hormone produced from adipocytes that helps regulate hunger, right? It helps individuals stay lean, regulates long-term energy balance. Right. Exactly what it does sort of at, you might say, within the normal physiologic range among most of us who do make some leptin is, I think, still a little bit, you know, the jury's still loud a little bit on that. Totally agree with you. We used to just decide early on in my practice, we used to measure leptin out of Ponectin and look at the ratios. And we're like, you know, after a period of time, what's the evidence of actually looking at this? And does this just relate to obesity? And what is the point? What is the information that we are now getting with this? And how are we furthering patients' health? And quite frankly, there isn't unless there's some genetic mutation. I can't say that there's a reason to be doing that. Exactly. So there are many things that within the sort of, you might call the normal observed physiologic range, may not play such a big role or play the role we expect them to. But when you get them out of the physiologic range, then they can be huge. So GLP-1 is an example. Within the normal physiologic range of what we endogenously produce, I think there's debate about this, but question is how important is that? How much difference does it make? But when you give a GLP-1 agonist that has a long half-life, now you're going into super physiologic ranges. In the case of a leptin deficient human, you're getting into sub-physiologic where you're having zero leptin, not low leptin. And when you get zero leptin, then big things happen. So zero leptin, you get hyperphagy, you get enormous hunger and excessive food intake and a very fatty body composition and other. But super rare doesn't really happen. Probably a few dozen people on the planet. But anyway, some of those people were identified by the Cambridge Group. And as I said, they were the first providers ever to be able to look a patient in the eye and say, I not only know why you have obesity, I know what to do about it. I know how to fix it and say it honestly. Lots of people could say it. Lots of people still say it. They were the first people who would say it honestly. And that was tremendously, I was very envious of that ability. And since then, until relatively recently, we haven't been able to make similar kinds of statements to many people. Now with the new anti-obesity drugs, I don't think we can necessarily say, now I know why you have obesity. That part I still think is a little bit unclear in many cases. But I think what we can say is, we do know how to help you. Do, would you say comfortably that we now have a treatment in essence for the majority, 80 plus percent of obesity and also even type 2 diabetes? Certainly for obesity and type 2 diabetes, I'd say that's, you know, I'm not going to give an exact number, but that's in the spirit of things that's in the realm of how I would answer. I think we always want more information. We will never have complete information. Somewhere between where are we today and some hypothetical perfect complete information that we will never get to. We need a little more. We'll get a little more over time. But I think we're going to start to get to the time where we're going to flip the question, or at least we should flip the question around. And I realize we're about to say we'll be controversial, but I think it makes sense. There are many things for which we take for granted that just about everybody should do them. Even though these things are not exactly natural, and we didn't always do them, but there comes a point where people say, yeah, of course, everybody should do that, unless there's some very rare exception. So should you wash your hands before you eat or after you use the restroom? Yes. Should you use soap? But it's not natural and we didn't all evolve having bars of soap with us. That's OK. You should still wash your hands and we think this is good for almost everybody and you might say, but is there some rare individual has some skin disorder that maybe they shouldn't use? Maybe. But that's the exception. The rule is you should wash your hands with soap. The rule is you should brush your teeth. And maybe there's some people who shouldn't brush their teeth. There's some strange gum disease. We won't get into vaccines because there's a lot of different opinion on that. The point I was making is that you take some things like toothbrushing and hand washing and so on. And the norm is, of course, almost everybody should do that. And the real question is not who are the rare people who should. It's who are the rare people who maybe should. Great point. OK. Now let's take taking a statin, an SGLT2 inhibitor, a GLP1 agonist, an antihypertensive drug. That's known to be very mild and been studied for a very long time. And I think we are at the point where we should be starting to think about flipping the question from who should get it to who should it. I don't think that's controversial at all. I think that's right on the money. And I think that, and I'm curious to your perspective how that informs our dietary guidelines. Because we talk about, say, for example, reducing saturated fat to 10% less of calories. Well, OK. So for some people, that might be really relevant, but it's not for who that's relevant. It's who that's not relevant for. And let me say this a different way. If 70, if I don't know, 20% of the population actually has a problem with LDL cholesterol that is impacted by saturated fat, then that means that 80% of people might not necessarily have an issue with saturated fat. And that could be one aspect or even triglycerides. What if, you know, I think it's roughly, the number is low, I'd have to look, but 20% or less actually have elevated triglycerides. And that, to me, is a carbohydrate problem. And then the next question would be, well, what percentage of people actually have to restrict carbohydrates versus those that don't, but we make these recommendations for perhaps the few, not the many. I'm curious to see your perspective. Hopefully that made some sense. Some semblance of sense. I think there's multiple things embedded in what you're asking. I think one is, do we make recommendations for the few or the many? And the answer is sometimes we, erroneously, I think make them for the few rather than the many and we should flip that. I think another thing is what do we really know about these particular things you're talking about, carbohydrate, saturated fats, and that's a whole different can of worms. And then I think there's this notion, this question of individual effects. And that is something my group and I are very interested in. We write a lot about. I think there's an implicit assumption that we're all very different. And, you know, the right diet for you is not the same as the right diet for me. And while I think that's intuitively very appealing idea, and there's almost certainly some truth in it, it's based on a lot of assumption. So the idea that we, we all respond differently to things is usually not demonstrated. It's usually assumed. Even the well-meaning research-based clinician, scientist, who says, don't tell me this is not evidence-based. Look at my randomized controlled trial here. Look at the fact that some people had huge reductions in body weight on this drug and some small or none or gained weight. Look at the change in LDL cholesterol when I put people on this diet versus that diet. Look at how variable it was. And they say, you see great heterogeneity response. And they say, no, I don't see that. What I see is great heterogeneity of outcome. If outcome equal response, I wouldn't need control groups and studies. And so outcome. So let's pause there. That's really important. Can you say that again? And because it's a very important distinction. So let's say you and I both go on a weight loss drug. We're in a clinical trial. You lose 10 kilos. I lose zero kilos. The investigator comes along and says, could responder, non-responder. I say, no, good outcome. Not so good outcome. However, maybe what happened is the drug caused you to lose five kilos. You happened to also get the flu during that time and felt ill as heck. And that caused you to lose another five kilos. Your total weight loss was 10 kilos, but only five was due to the drug. I lost zero kilos. It turns out though that right before I went on the study, I moved in next to a donut shop. Bad move friend. And I'm just loving it and I'm eating donuts every day. Long Island does by the way. I would just say they have some good food. There's some good donuts over there. And had I not been on the drug, I would have gained five kilos. So the donuts caused me to go off the ground. So basically we can't, I mean, your point as well. Take a ahead. I'll let you finish, but your point as well taken. Basically there's so much that we don't, we know less than we know. Sure. The point is that the drug pulled me down five, the donuts pulled me up five. Yeah, you know, you integrated zero. But in fact, you and I had exactly the same response. The drug caused each of us to gain five less kilos or lose five more kilos than we otherwise would have done. But it's hidden behind other factors in our lives, the flu, the donuts. The standard I've randomized control trial doesn't estimate that. It estimates the average effect. So it's not that it's wrong when I say across all people taking the drug, they lost five kilos more on average than people not taking the drug. The drug caused a five kilo weight loss on average. That's true. In that hypothetical I've given you, it caused exactly five kilo weight loss for both of us. But it's not obvious. And so that's something we need to keep in mind. Now there will be other times when there are situations, even if the drug causes exactly a five kilo weight loss. Let us just suppose for the moment that you were exactly five kilos above the threshold for obesity. And I was not. I was ten kilos above the threshold for obesity. Now we express the outcome as did it make you obese or not obese? It made you go from obese to not obese. It made me go from obese to still obese. Same weight loss, different outcome by measuring things differently. So now when you think of other thresholds, the threshold to have a heart attack, right? It could be that something lowers my LDL cholesterol exactly the same amount as it lowers your LDL cholesterol. But my LDL cholesterol had me up at the threshold of about to get a heart attack. Your LDL cholesterol, let's say, was not at that threshold. So it rescued me from the heart attack. It didn't rescue you. So what, you know, as you're, so you've mentioned your group a few times and your group is very well known for looking at evidence, statistical evidence. And I don't want to say policing, but saying, hey, does this really show what this says that it shows? And if it doesn't, you guys have to fix that. And you've been doing this, again, for many years, which one makes you popular in some groups and not so popular in other groups. You know, you've spent your entire career doing something that's a bit uncomfortable. I mean, unless that's always been comfortable. I mean, you know, it's sort of comfortable times. It makes you different because it's something that's confrontational, but it's like, hey, it's accountability, which is something that we're lacking, I think, in this scientific space. So if someone is listening to this and their mind is blown, so there's scientists, there are doctors, they're going, oh, well, now I don't really know what I think I know. You probably have that group. And then you also have people listening going, well, darn it. I have no idea what to think and actually how to assess information because I don't have statistical rigor. I am dependent on outsourcing those types of things while also having to make very real decisions for my family. What do people do? I think there's different levels of knowledge. I used the example of myself. One of my heuristics, not my only one, but one of my heuristics is if the FDA has said this pharmaceutical for people like me is reasonably safe and it's effective, that's usually good enough for me to judge, to make the judgment that for someone like me, it's effective and reasonably safe. Safety is a social judgment. Effectiveness is not. Effectiveness is empirical. Safety is a social judgment. So when I got out of the car today and walked into your area here, there's some risk I could have been hit by a bus. Very low. Very low. And so I made the judgment that it's safe. Maybe bad decorating, but... To get out of the car and walk across the street. But it wasn't zero. It was my social judgment that that risk was so low as did not it be worth thinking about. But somebody else might feel differently. That's a social judgment. Risk is a scientific concept. Risk is probability. Long range frequency. Safety is a social judgment. So... Interesting. Safe to go on a plane, to hang glide, to ride a bicycle, to ride a bicycle without a helmet. To get a vaccine. These are social judgments. I'm thrilled to announce one of the new sponsors of the show, and that is the Carol Bike. Now, if you've listened to the show, you know that I believe muscle is the organ of longevity. And of course, you need resistance training, but you also need high intensity interval training. And I would say nothing improves cardiovascular fitness like a targeted program and tool. And that is why I'm so excited about the Carol Bike. 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That's C-A-R-O-L-B-I-K-E.com and use the code lion for $100 off your bike. So as someone is making decisions for their family, I mean, again, so this podcast, the ideas we have transparent conversations and we have world class experts on to discuss social issues, medical issues, just all of what is at the landscape because of the volume of noise. How someone listening to this, let's say, I don't know, well, hey guys, hope you're listening to the podcast. But if you're not, say, for example, my dad who lives in Ecuador and he heard from, I don't know, Dr. Brad who is on the internet saying that if you drink castor oil, you know, this has been shown to, I don't know, clear you immediately of worms or whatever it is. How, and all kidding aside, the decisions when you're younger seem less impactful, right? There's a lot of like my four year old, okay, eat the Twinkie off the floor or, you know, eat the carrot that's also been sitting in the yard for five days. There's like flexibility, right? They're doing immune system push-ups or whatever. But as you become more mature, so the postmenopausal woman who is confused about should she take calcium or not, should she make the decision to go on estrogen or not, these become a real challenges. And then the impact is much more meaningful. How do they begin to make decisions in a noisy landscape? I think the important thing if one wants to be sort of rational and, well, the first question is, do you need to be rational and scientific about it? I wouldn't hate to argue with you. And can you imagine RJ, one of the producers here, I mean, really, would you ever win? You would never win. You'd be like, oh, I never thought about that. I'm not going to be right about that. So, you know, the Nobel laureate who's now deceased, Danny Conerman, talked about this in his book, Thinking Fast and Slow. And he said, you know, talks about regret. And how do you avoid regret by, you know, making some decision and then later saying, why did I make that bad decision? And he said, here's two different ways you can approach it. And I kind of like these because I've had some regrets. And in fact, I have less regret now because I use this method. Really? Yeah. And so first is to make a decision. So I'm going to go with this either one of two ways. I'm either going to say I'm willing to be wrong. And that's okay. And I'm going to randomly pick a path. And I'm not going to worry about it too much. And then if it turns out later that things go bad, I'm saying, it was random, you know, what the heck? Give me an example. Give me an example. I might say, look, I don't know if I should take this new job or that new job. How about a flip a coin? I just can't decide. By the way, I do want to talk about your new job. Okay. I'll come back to that. And then say, look, I didn't have a real good way of deciding. So I flipped the coin and it's not on me. It's the coin. The other way is to say... So removing responsibility, essentially. The other way is to say, I don't want to do it that way. This one's important to me to get right. I'm going to study the heck out of this thing. I'm going to turn over every stone to get every piece of critical information. I'm going to get experts to advise me. I'm going to carefully integrate this. I'm going to ask multiple experts. I'm going to think this through as carefully as I possibly can. I'm going to sleep on it. I'm not going to make a decision immediately. And then I'm going to make the best decision I could possibly make at that time. Now, it may turn out that a year later, it was a really bad decision or not a bad decision, a decision that turned out to be really to have a really bad consequence. And I'm going to say, I made the best decision anyone could reasonably make knowing what I knew when I made it. Knowing what I know today, I would make a different decision. But at the time I made it, it was the best, most rational, intelligent decision that could be made. So it's not bad on me. So I still wish it hadn't happened the bad thing, but I don't feel any guilt, any remorse, which is a lot of what we've read us about. So those are different ways of making decisions, of saying where do you want to go with this? And then I think more generally, if you say, look, I do care about this. I don't want it to be a complete chance. Sometimes it might, you know, you might say, I don't know which tie to wear today and which would make me look, you know, more, more whatever I want to look in this setting, flip a coin. Then you might say, well, here's an arm, I'm going to go get surgery or not for this thing. I think that one I want to think through a little bit. Should I get a hip replacement? Should I, whatever it is you want, you know, should I get plastic surgery for cosmetics? I think you want to think that through a little bit. And that's where I think, you know, we sort of want to work your way down to a heuristics. And you mentioned about AI is one great example. I use AI a lot for myself, but I use it in a very particular way, which is I use it as an information gatherer and integrator, but I don't trust it completely. So I use it, not in exactly the same way, but not unlike I would use conversations with anybody else I might have. If I talk to the Uber driver on the way over, and I say, what do you think of the best barbecue restaurants in Houston? And he or she tells me the ones they think I don't immediately think those are the best and those are the ones I will like the best. But I think it's a good lead, good lead. And then I might later say to you if I'm looking for, hey, you lived here, you're all along it. What do you think of the best barbecue restaurant? And if you say the same thing the Uber driver said, well, strengthened. If you say some different ones, okay, I've got some different ones. Then I might ask, hey, I, you know, Yelp or something. And so I think you start to integrate sources and then you'll say, how important is this? What if I get it wrong and I don't pick the best. So like, let's say you're choosing between vitamin D or amino acids and you go, okay, well, this isn't that big of a decision. So I don't care which vitamin D I choose. Then that takes very little effort, cognitive load, no big deal. What's the likely cost of being wrong? So the likely harm of taking a vitamin D supplement as long as you don't go crazy with something like that, pretty low. But over a lifetime, so for example, like the whole protein conversation. I don't know, I've been talking about protein for 20 years. If you're in your 20s and you get it wrong, and when I say get it wrong, maybe you're eating closer to a minimum or you choose to eat some kind of way. You know, when I was in my 20s, I was vegan. And that's just an example. That might, the consequences for the first five years or even seven might seem small, not immediate, but let's say 30 years later. Now, because I wasn't able to assess those outcomes and you talk a lot about psychology, humans are, I don't know, they're creatures of habit. It's kind of like if you're wrong, you stay wrong over a long period of time. How, you know, with the landscape, people might not even know how dangerous it is to be wrong. So, you know, like, do you, obviously you're in a whole different league, you have obesity, energetics, you guys curate science, but even then, is, are there people that you go to that you trust that you would say, hey, for protein research, I looked at Don Lehmann for high intensity interval research, I looked at Martin Gabala, I trust, do you know what I mean? Like, there are ways in which you identify trust and that you could potentially help teach RJ, you know, one of the producers to think about how he can curate more trust for, let's say, even something simple like parenting. Absolutely. So, there's no single source. I do go to a lot of podcasts, yours. Dabin's, Peter Ateez, Lane Norton's. Lane is still waiting to be on anyway. Melissa Dabin's, and even though these names may sound lightweight or something, they're actually pretty good. I think that barbell medicine, Daxu Lift, so there are a number of ones I go to, but even them, I take with a grain of salt. um, SIGN Nutrition's another good one, The Proof with Simon Hill. We're definitely editing that out. I don't agree with everything they say. I don't agree with everything you say. And I'm sure you don't agree with everything I say. That's okay. I- So I don't- I don't want to be wrong. I'm wrong all the time. I'm mom, two kids. I'm wrong all the time. And it's okay. So, um, but anyway. So- As long as you have people that, you know, are smarter than you are around you that say, hey man, guess what? Don's always like, no, Gabriel, that's not right. Like, that's- you sound like an idiot. That's wrong. And then you go, okay, you know. I heard a funny statement somebody said recently. He said, if you're the smartest person in the room, you're in the wrong room. Yeah, that's right. Yeah. So- The Black Podcast, that's interesting. So you're a career scientist and podcasts probably haven't been around for, I mean, again, the landscape for podcasts probably, I don't know. I mean, I suppose Joe Rogan's been the longest, but the scientific podcast, I mean, Andrew is a friend, he's- it's probably, I don't know, five, a little or five, maybe five to seven years, not- I mean, not even that long. But for you, it's interesting that you would go to listen because you understand, have access to the data. What is it that you hope to get from hearing? So I like them because, you know, I can listen to them while I'm- while I'm eating dinner, if- If we're barbecuing us. I can listen to them while I'm out for a walk. So it's that, it's entertaining. But also it- it's a way of my getting exposed to things I wouldn't know to ask about. So- Interesting. You know, I can always go look up and say, oh, I'm wondering how much protein to eat, and then start to look up, how much protein to eat, and so forth. Or I say, you know, oh, I'm wondering if, you know, this peptide is safe. Well, I never know the peptide existed. But now I listen to- oh, that's out there. Maybe I should look up whether that's safe. So it exposes me to things that I just didn't even know to ask about. They're entertaining. But again, they're- they're my first draft. They're not my final decision. Unless again, unless it's very light. If I hear you say, I like to make my ginger salad dressing this way. I might say, not a big risk. Maybe I'll try it. But if you said, this is my decision on surgery, and I'm going to advise someone on surgery or make a decision myself on surgery, no matter how much I respect and like you, I'm not stopping there. Now I'm going to say, let me check the references she cited. If she cited some, let me go to another podcast. Let me go to AI. But when I do AI for this, again, first of all, I don't trust it. It's my first take. And I ask it very specific questions. I don't say, should I eat my protein? What I say is, Relying only on randomized controlled trials in the English language, scientific peer reviewed literature, summarize for me the results of efficacy of protein intake on these outcomes. Then summarize the results of safety information for protein intake on these outcomes or something like that. Then, even that's not my final take, then I may look up the papers that I cited to make sure they're real papers. They actually exist. Did they actually say what the AI says they say? Are there other papers it missed? Then I will go to, if it's about me, I may go to my personal physician and say this because what, as a scientist, I often have very deep knowledge on something, but I don't have the broad knowledge that a physician is. I'm not a physician. And I've had many occasions where I'm thinking deep thoughts about some health thing and the physician who has, again, a much different training says like, David, you're out there looking for zebras. It's a horse and it's right here in front of you. I didn't know that horse existed. So I had one where at the end of the pandemic, as I think many of us were sort of emerging after the first year, I've been locked down the house for a year and weird things are happening. And I had some tingling in my legs and I'm thinking, I've got that diabetic paropathy and I'm checking my urinary glucose and I don't have diabetes and I'm checking for Lyme disease, not Lyme disease. I go to the physician and I say, you know, I did this, I tell them that's my weightlifting. I used to be able to do pull ups. So you have a little neuropathy or something. And I would have a weight belt and I could do pull ups with 90 pounds on a weight belt and I only weigh like 125 pounds at the time. And he says, and I said, you know, when I stop, it went away. And he said, yeah, he said, that's your lateral femoral nerve. He said, cops get that the gun health is heavy or construction workers from the tool belt. He said, that's a look. Yeah, never in my life would I have thought of that. So go to a general physician, talk to my friends or physicians, read the literature, ask a guy to point me in the right direction, listen to a podcast. And again, if it's depending on how much I really feel like I must know this, as opposed to operate on some heuristic trust, then maybe pull up every paper myself and read them myself. Now that's as a scientist, right, as a, you know, as a general person who just wants to make intelligent decisions about their own life, you may not need to go to reading every paper and you may not have the ability to know what to ask more when reading every paper. But you can certainly go to your own physician, you can ask another physician, you can listen to a podcast. And if they start to converge, then you could. Yeah, it's the equivalent of looking at continuity of data over time, you know, when you see a scientific discovery, and then it's in multiple different labs, and here's the totality of evidence. I think that that makes, it makes a lot of sense. And you start to learn who you can trust. Yeah. So, you know, if, if I'm listening to Lane Norton, and he's making some commentary on what studies show about a particular thing on protein intake, I, I know Lane well enough, and I've listened to him long enough to know, he's almost certainly, I won't say certain. Don't you dare say is right. Lane, I was kidding. Lane, you know, I trained with Lane. She's a very dear friend. Well, more like a brother, but yes. He's almost certainly a mother better looking. Got it. Got it. Right. Whereas, if you were on some other topic, I might say, I'll let you know that this is a really good perspective. Maybe not. Let me learn from somebody else. So, I'll have people, you know, that I can trust to varying degrees, and even though it gets not absolute, doesn't mean Lane's got everything right on protein. It doesn't mean that this person's got everything right on carbohydrate or whatever. What are you, so there's been, there's a couple very hot topics that seem to be trending right now. Seed oils, ultra processed foods. Do you have opinions on either? Sure. Let's start with the ultra processed foods. I think the value of the category and the meaningfulness of the category depends upon what one is doing with it. So, if you are a scientist and you are studying social phenomena, and one of them is perceptions around ultra processed food, fair game, fine. I don't have any concern or criticism, so. If you are either a person recommending things to others for their health and diet, or you're trying for yourself to choose things, if you're looking for a general heuristic, and by heuristic, I mean a way of doing things that might have some benefit, but not a statement about the state of nature, about how things actually work. Meaning, can you give me a more specific example? Sure. If I said to you, or I said to your kids, maybe, might be a little more. They're very young. I didn't want them to go into that wooded area, because there's a cliff and a stream and you can fall in and you can drown and there's wells and. It's a whole situation. Right. Yeah. And I say, there's evil fairies that live in that forest. Don't go in there. Now, we can have an ethical conversation about. You might now have their attention. Should I be lying? But let's put that aside for the moment. You might say, that's a very effective way to get them not to go into that forest. And then I'd say, well, if that's your goal and you don't have an ethical concern about line, then you talk about fairies. Okay. Now, if you said to me, no, no, no, I'm actually an epidemiologist and I'm trying to understand the degree of danger that comes from going into that forest or things like that and the causes and effects and what causes the bad outcomes. And so I'm a fairyologist. I'd say, no, you're crazy. You're not a fairyologist. There's no fairies. Hology is the study of stuff. You can't study stuff that doesn't exist. And Richard Dawkins talks about that. There's no fairyology. So I think that's ultra process foods. If I wanted to say to, I remember my dad who was a PhD in math education, very, very smart man, but he always struggled with his weight. Is that how, is that was one of the things that drove you? I got me interested. And he said, I remember him, he would say these things. He'd call me up and ask me how many calories is in this and that. And he'd say, look, I'm eating nuts. Isn't that great? You know, because it's all natural. Isn't that healthy for my weight? No, I'm having nuts in a martini. I'm like, well, well, the nuts are good food, but no, they like calories and the martini has some calories too. And that's not really all that helpful for you. But he could convince himself of any nonsense and nutrition if it let him have this martini and his nuts and a few other things. And I think, you know, we can look at these things as just ways of operating. And if it works for you, that's fine. So if I said to my dad, dad, here's, here's the thing, you don't have to learn a lot of nutrition. You don't have to understand what protein is. You don't have to know what a carbohydrate is. All you got to do is this, don't eat ultra process foods. And I'll give you an easy way of identifying what an ultra process food is. And let's suppose he could do that, which probably not he probably wouldn't, but let's suppose he did, he probably would weigh less than otherwise. And if that's a good outcome, fine. And if you say, but ultra processing, now David, you've shown that ultra processing, at least in your father, causes great awakening. No, I have shown no such thing. What I've shown is that telling my dad to not eat ultra processed food led to this outcome. If I said to you, I want you to only eat foods that are in the peripheral aisles of the grocery store, not that you get in the central aisles of the grocery store. And it turned out that you wound up there by eating lots of fish and meat and eggs and etc. And not lots of cinnamon rolls. Um, maybe you would weigh less. Okay. Does that mean if I move the cinnamon rolls to the periphery of the grocery store, they become better for you? Of course not. So just because telling you to eat a certain way leads to an outcome. And just because I can label things as being there doesn't mean there's anything to do with the causal effect. So there's a man named Schwartz and he has a book called, um, a fly in the ointment. It's a great funny book. And in it, he says, repeat after me. The effect of substances in the body depends on their molecular structure, not their ancestry. So if you tell me that this food that happens to be ultra processed causes some different effect than that other food that happens not to be ultra processed, I can accept that that could be true. If you tell me that it's because in that food that happens to be ultra processed, this substance is in high levels and it's not that substance is not high levels in the non-ultra process food. I can accept that. It's about the substances. But if you tell me the substances are identical, got the same atoms in this food and in this food, these atoms were collected and packaged through something we call ultra processing. These atoms were collected and packaged through something we don't call ultra processing. But you are now going to make a claim that the effect is going to be different. I'd say, okay, now we're in phareology land. Now you're in homeopathy. Yeah. Just thinking if you wrap the Bible three times on the tube containing the water, the water has a different effect. I don't think so. Thanks to one of the sponsors of the show, AMP, because I can walk two doors down and get a great workout. And if you've ever walked into a workout and thought, am I lifting too heavy? Am I not lifting enough? Where is the weights? I can't find anything. And is this even working? You are not alone. Seriously. The uncertainty is one of the biggest reasons why people do not see results and they stop. 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If your goal is to build muscle, get stronger, no more guesswork and be consistent, go to amp.ai. Check it out. That's amp.ai. Training should be effective and it doesn't have to be complicated. Tell me about your new position that you have just recently taken. So I'm very excited. I'm having a great time at this. I've done a few different things in my life. What do they say? U-demonic pleasure and hedonical pleasure. The hedonics is what feels good right now. Even the chocolate cake. The U-demonic, at least for me, is going to the gym. It feels great the moment I leave the gym and I'm so proud of how hard I worked and so on while I was there. Maybe not. My prior two jobs, one was at UAB, University of Alabama, Perium, being an NIH Nutritional Obesity Research Center Director. I loved it. I had a great time. After that, I went and I wanted to learn new things and I went to what became the School of Public Health. It had just been transformed into a School of Public Health before I got there. My job was to make it a reality along with their colleagues at School of Public Health. It was very science-based and we did it. We transformed the school. It's hard work. And this was, is this Indiana? Indiana University, Bloomington. And I'm very proud of what the school and I accomplished and that it was time to pass the baton. And that job was much more of a U-demonic pleasure job. I look back and say, I think that's what it's like to be a dean. You look back and say, did we do well? And thankfully, I feel like the answer is yes. And so I'm very proud of what we accomplished. I'm glad I did it. I will do it again if circumstances came again. But if you said in any moment, you just randomly call me up and you said, yeah, I'm fun today. No, today I'm dealing with a racism complaint or a sexism complaint or a plumbing problem or a budget problem or... All the problems that exist. Whatever. Now, so I did that, I'm glad. And now I'm back to the science. But I'm back to the science in a way where I kind of have the best world of two worlds because I'm the director of a federal center. And I have the budget and the building and the personnel of a, what's equivalent of a small school, so like the dean. So I have sort of the authority and resources of not unlike a dean. But I'm all focused on research and helping people with research and research on not any topic, but on the topic of nutrition, obesity, exercise, particularly as it relates to children pregnant women, life course development. And so I'm having a great time. My colleagues, who I have the privilege of leading are my intellectual peers. I'm interacting with people who are rock solid researchers, who are smart and energized and really committed to their science. We have good people at our center and they know so much more than I know about their domain. I'm just frilly. I'm having a great time. And what are you guys working on? I know that you've got multiple projects here. It's the USDA, I don't want to push this. USDA ARS, Children's Nutrition Research Center at Baylor College of Medicine and Texas Children's Hospital. I mean, that was a lot of words and you mailed that. What are the projects you're most excited? I know that you guys are working on a whole host of projects, but are there a handful that you're just like, wow, this is really transformative? Yeah, I think there are those that are my own research that I'm very involved in and there are those that the center's involved in that as the leader, I try to support, but that's not my research. Some of the really exciting things with Dr. Marta Fioreto, she made a great presentation yesterday and she's looking in model organisms and she's studying whether exercise can mitigate the lifelong effects of in utero under nutrition on long-term obesity. So there are some effects in if, you know, an organism doesn't grow so well in utero that will lead it to be predisposed to obesity in later life and does exercise mitigate that? So that's pretty exciting stuff. We've got others who have shown that certain factors may lead to longer or lesser lifespan, especially when given early, including, I'm probably going to pronounce it incorrectly, but urolithin? Urolithin A. That may have effects that are opposite to what's sometimes reported under some circumstances. Dr. Yizhou ZHU is our expert on that. It's so cool. So we've got some interesting things going there. Then we've got some community-based things. Dr. Jaina Davi is working on the so-called food as medicine and can she help people lead longer and healthier lives by adopting this perspective and adopting techniques? We have a wonderful setup with her and others. We have laboratories that nobody else has. We can bring in children and families to stay overnight in metabolic chambers. That's unbelievable. We have great body composition equipment. We have great staff who know how to help a young child experience calmness and security, even staying overnight in a facility like this because they're pros. So this is really nice. We're trying to upgrade our test kitchen and our feeding so we can actually do controlled feeding studies. So we don't just say, hey, why don't you eat this and let's see what happens, but we can say, come in, eat this in front of us. We'll feed you and then we'll see what happens. So we know it's tight and we're trying to raise some funds. So anybody out here who's got some funds is listening. We're trying to raise some funds to renovate those laboratories and have some of the most modernized, best test kitchens and feeding facilities for nutrition studies and children, pregnant women and families. It's really exciting. It's a pretty extraordinary place that you're at and you guys are making a great team because the combination of scientific rigor with really intellectual integrity, scientific integrity is what I think is desperately needed. I have one last question for you, Dr. David Allison. If you had a wish, as we talk about these methods and these science and making good decisions, what would that be for people? I think it would be to take a step back from the specific and move to the general. In other words, take the priority off the question of should I eat keto or low carb or get rid of food dyes or whatever and say, and you asked me this question earlier, how do I as an individual and how should we as a society make the best decisions in general? How do I evaluate things in general? Let's start by committing to that, committing to doing it rationally, intelligently, honestly through science, and then say, what would it take to do that better? Let's explicitly not think about for the moment keto or carbs or fats or ultra processed or protein and let's think about X and Y. Because when we think about X and Y, we can leave our emotions at the door a little bit and come up with these general rules and say, this is how I would think about it if it was X and Y. And then later when you say, now let's think about keto and I get emotional and I say, or protein and you can say, David, hold on, remember six months ago, we went through this with X and Y and you said, this was a good way to make decisions. Let's apply that framework now. And I think if we can start committing to doing that as a society, as individuals, and I think we already have that commitment in principle in the scientific community, but in practice, we're not doing as well as we should. That's an important thing that Jay Badacharia, the current head of the NIH, is really pushing for. We need to do better in being open-minded, in evaluating of its fairly, in not stretching and exaggerating, and in correcting mistakes when we find them. Very well said. Thank you so much for sharing your time and expertise. Thank you. Thank you. It's been fun.