Ep. 561 Why Eating Less Isn’t Working – The Real Root Causes of Obesity & Metabolic Disease with Dr. Jason Fung | Menopause & Metabolic Health

Welcome to Everyday Wellness Podcast. I'm your host, nurse practitioner, Cynthia Thurlow. This podcast is designed to educate, empower, and inspire you to achieve your health and wellness goals. My goal and intent is to provide you with the best content and conversations from leaders in the health and wellness industry each week and impact over a million lives. today i have the honor of reconnecting with friend and colleague dr jason fong he is a renowned expert in intermittent fasting metabolic health and is a trained nephrologist he is the author of multiple books including a new york times best-selling book as well as the obesity code, the diabetes code, and the recent hunger code. Today, we spoke about the obsessive focus on calories that is neither useful nor effective, key root causes and whys for the shallow thinking around calories being the only precipitant for obesity, differences between types of hunger and condition responses, how hormones impact hormones and lessons of GLP ones, why fiber and protein are critically important, carbohydrate clarity, the impact of meal timing, the role of sleep and circadian biology, the fat thermostat and sympathetic tone, as well as ultra processed foods, the impact of nutrition and stress and mindful eating. Another truly invaluable conversation with Dr. Fung, one you will listen to, likely more than once. Dr. Fung, always a pleasure to have you on the podcast. Welcome back to Everyday Wellness. Oh, thanks so much. Great to be here, Cynthia. Absolutely. Your new book, The Hunger Code, is obviously one that I'm going to recommend that listeners purchase and have at their ready in their home libraries. But I think from many perspectives, when I reflect over the last 20, 25 years of working in clinical medicine, one of the things that I learned that is incredibly unhelpful when talking to patients about moderating food intake or understanding the way that our body processes the food that we eat is focusing on calories. And you have a quote in the book that says, the obsessive focus on calories is neither useful nor effective. So let's unpack what you have learned about this kind of myopic view and how it is impacting not only the way that our patients perceive weight loss is just all about calories and calories out, but how I know it's a source of frustration, not just for you, but many of us. Yeah, I think that the whole problem and like you, you know, I sort of grew up with this whole calories, calories, calories, right? That's what they taught in medical school. That's what everybody said is true. So you assume it's true. But really, the further you go into it, the less and less helpful it really is. And I think that the idea is, you know, technically correct, but just not useful. And, you know, the way I try to explain it is that you can think of, for example, alcoholism as alcohol in minus alcohol out, right? That's always true. But it doesn't mean that you can simply tell somebody, tell an alcoholic, hey, just drink drink less alcohol. That's all you need to do. It's easy, right? Because that's not useful, right? Of course, they need to drink less alcohol. They know that you know that that's not the real question, right? Or if you have a cocaine addict, it's all cocaine in minus cocaine out, guys, right? Just take less cocaine. That's not useful, right? It's the same thing with calories, because it's a very sort of shallow understanding of what it is. Like, what you're trying to do, you know, is to if you think that the problem is overeating, and to an extent, it always is right, if you define overeating as, you know, gaining weight, then the question is not that you're overeating. The question is why you're overeating, right? And that's what this whole calories thing can't really help you with, right? So you have to really get into the question of why are you eating, right? And that's much more important. So it comes to a concept in logic called the three whys, So if you want to understand the root cause of any problem, you really have to ask the question, why, three times. So, for example, if you were to ask the question, why did the Titanic sink? You might say, well, because it hit an iceberg. Again, technically correct. But what advice would you give a future captain to avoid such disasters? You'd say, don't hit icebergs. And it's like, OK, well, that's just like the most useless advice I've ever heard. Of course I know that I shouldn't hit icebergs. Right. That's not what I'm asking. So then you have to get to the second why. Right. You have to get to that sort of why did the Titanic hit that iceberg? Right. And now you're getting into the deeper question. You say, well, because the captain couldn't really turn around in time, couldn't avoid it. And you get to the third why. Why couldn't the captain avoid it? You say, because it was going too fast. Right. And hey, now you've actually got actionable advice because now you're getting to the root of the problem. So the advice is make sure you slow the ship down when you have poor visibility, right? So it's like, okay, that's great advice. In order to avoid sinking, you need to slow down, right? It's not that you don't, like the advice should be slow down, not don't hit icebergs, right? And that's where that sort of calories in, calories out understanding lives at that sort of first order sort of don't hit icebergs advice, right? So you say, why am I gaining weight? And you say, well, because calories in is greater than calories out. Okay, that's the don't hit icebergs advice, right? So you have to ask, why is calories in greater than calories out, right? That's a much, much, much more important question. And the answer is because you're hungry, right? There's no other reason why we eat, right? It's not like we eat so that we can gain weight that we don't want, right? It doesn't make any sense. We're not going to spend money to eat extra food so that we can gain weight that we'll never be able to lose and be ridiculed for, right? That makes no sense. So it's because of the hunger, right? And then you get to the third why, which is a sort of even more interesting question. Why are you hungry? And this gets to the point that there's actually much more than the physical hunger that we actually think of as hunger. That's not the only reason we eat. So that physical hunger is called, in scientific terms, homeostatic hunger. And that's run by a lot of the hormones that we talk about. And really, I talked about in the obesity code and the hunger code sort of takes it forward because there's actually much more than this physical homeostatic hunger because there's a whole aspect of emotional hunger that is not really discussed at all. We eat because eating is pleasurable, right? Why deny that? There are lots of people who eat things because they just want to, not because they're physically hungry. Every time you eat dessert, it's not because you're hungry. You just ate a meal. You want to eat because it looks good, it tastes good, and makes you feel good. I mean, that's the whole point of comfort foods, right? You eat because it provides you emotional comfort, not physical comfort, right? Not at all. So these foods can release dopamine and, you know, rewarding pathways in the brain. And sometimes that tips over into food addictions and ultra processed foods is probably one of the biggest culprits here because of the way that it sort of spikes dopamine. And there's this really increased, you know, this very spike in dopamine that you get with ultra processed foods that you don't get with natural foods. And then the third reason why people eat is really a sort of social environmental reason, which is it's actually extremely powerful, but it's this conditioned hunger. So that's sort of social and environmental. So you have three different types, main types of hunger. There's probably more, but there's the physical homeostatic. There's the emotional, which is called hedonic hunger. and then there's the social which is conditioned hunger which is that if you are eating all the time you can start to pair you know stimuli so if you're always eating in front of the tv that means the minute you sit in front of the tv you're now going to create that new hunger because you're you've linked it in your brain right and this is from a whole area of behavioral psychology called uh and this is you know the classic experiment was Pavlov's dog which is where you could pair the sort of salivation and dogs to a bell. A bell should not signal a dog to expect to eat. But because they had heard a bell every time they ate, they began to pair that. Now you can see that if you pair TV to food, and you pair sitting in the car to food, and you pair movies to food, and you pair sitting at your desk to food, and you pair eating, like reading to food, pretty soon you're creating hunger all through the day, which means you're going to eat, right? So then when you get into that third level of why are you hungry, now you can really start to unpack, is it homeostatic hunger, hedonic hunger, or is it conditioned hunger? And that's where you're going to be able to say, okay, well, your problem is food addiction, for example, and ultra processed foods, eat less ultra processed foods, not eat less calories, right? Because that's the don't hit icebergs advice. The advice is avoid ultra processed foods. Or it might be if you're addicted to certain foods, avoid those foods, you know, carbohydrates. And you think about what people they say they're addicted to, right? Oh, I'm addicted to pizza. I'm addicted to this chocolate. I'm addicted to sweets. I'm addicted to bread, right? They generally are very ultra processed. So then you have to say, well, if you're addicted to bread and you know that makes you lose control, then avoid bread. It's not avoid eggplant. It's avoid bread, right? Because I hear that people say, well, you can't eat no food, right? That's not what I'm saying. Identify the food, right, that you're addicted to and then deal with it, not eat less calories, right? Because again, that advice is stupid. It means that if you're addicted to bread, then you should eat bread. You could eat bread in moderation. Do you ever say that to an alcoholic? Do you ever say, you know what, You could handle a drink now. No, like that'd be the worst advice ever, right? You'd be the worst sponsor for AA, right? Oh, yeah, yeah, yeah. You had a tough day. Have a drink, right? No, you're addicted to alcohol. You must abstain, right? You know, getting to that sort of deeper understanding of eating behavior is so essential. I think this whole calories obsession is so simplistic and so horribly, you know, useless. while it's technically correct, it's just so unhelpful to people. And we gaslight people because we say that this is the answer for everything, right? We try and dumb down the problem into all calories, not identifying that, hey, your problem is a social environmental problem. Your problem is that you eat all the time in all these different places, food addictions, ultra processed foods, sleep, right? If you're not getting enough sleep, right? So it's like to the man with a hammer, every problem is a nail. So you don't have enough sleep, eat less calories, right? What? You have food addiction, eat less calories. What? Your problem is ultra processed foods, eat less calories, right? What? Why don't you deal with the problem as it sits, right? You have too much stress, you're an emotional eater, eat fewer calories. How is that solving the emotional eating problem, right? In fact, it completely ignores that problem. And then tries to sort of shoehorn this sort of advice and say, well, if you didn't lose weight, it's your fault, right? And that's where all that fat shaming comes in. It's so unhelpful. Like it's very, very bad. This sort of calories obsession, this calories in, calories in. And it's everywhere. You know this. Like it's everywhere you look. I feel like it's starting to change, but like all the sort of nutritionists, all the dieticians, all the professional American Heart Association, all these places, they still have this whole sort of, it's all about calories. So therefore it's about willpower. It's like, no, it's not. What does comfort that carries you from morning to night feel like? 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You can pre-order The Menopause Gut wherever books are sold. And when you do, be sure to check out the special pre-order bonuses I've put together for you. Again, you can go to www.cynthiatherlo.com. You'll click on the banner. It'll take you to multiple options for where you can order the menopause gut in presale. Well, and I think, you know, this is, these are the kinds of conversations that I think are so beneficial because it really is a very nuanced conversation. And I think anyone that's in the trenches or has worked directly with patients understands most if not all of our patients it not a lack of willpower They understand that if I just sit there and mindlessly count calories and I trying to eat in a caloric deficit all the time And, you know, because you and I have been in medicine for so long, we've been through many iterations. You know, there was the fat phobia and then, you know, there was the volumetrics. I mean, there've been so many different conversations around this, but intrinsically what it comes down to is, are you eating for a true intrinsic hunger or are you eating for, as you astutely stated, you know, these condition responses? You know, when you sit down in front of the TV in your own home that you are going to crave something sweet. You know, when you go to the movies, you're going to sit down and you're going to want that big tub of popcorn or you're in a bar. You know, hopefully that's many, many years behind this, but, you know, you're younger, you're in a bar and that's when you smoke. And that's when you drink alcohol and that's when you eat those hyper palatable foods that you find in most bars. And so I think it really speaks to a larger conversation, one of which I'm so grateful that you're talking about. Let's talk a little bit about the hormonal regulation of appetite. And I think that, you know, for many listeners, they're probably familiar with leptin and ghrelin and a lot of these hormonal regulation pieces. but I think with the advent of the GLP-1 drugs, I mean, they've been around for a while, but they're much more popular now. I think people are a bit more interested in how hormones regulate our appetite and satiety cues. And I'm curious in your clinical experience over the last probably five years, have you seen improvements in your patient's ability to feel more satiated and have less truant, you know, kind of this hedonistic pleasure around food? Or do you feel like that is, it's just the status quo, and that's fairly consistent? I think we're starting, I mean, you see it, you know, people talking more than calories, right? Because you really, you can have two foods, and they will have completely different effects on hunger and satiety, right? And, you know, again, trying to go beyond calories to the hunger is important. And that's really the lesson of drugs like Osempic and these GLP ones, right? Because if you, there are ways that you can control calories, right? You can wire somebody's jaw shut, which was actually very popular in the 60s as a method of weight loss because you couldn't eat, right? And the problem is that when you think about it, you have hunger and you have calories. If you lower calories, most of the time, if you don't do it right, your hunger goes up. And now you're constantly fighting with yourself. But the issue, and you do that with lap bands, for example, Roux-en-Y surgeries and so on. You're constantly fighting with yourself. And that's the reason, no, basically nobody uses these bariatric surgeries anymore, right? Because they didn't really work. People were hungry. Even though you physically restricted their calories, they wound up getting around it. You can drink, you know, smoothies and eat ice cream and get, you can get around it. So anyway, they regained all that weight. So the thing is though, if you take a different approach, which is, you know, the approach of GLP-1s, what you do is reduce hunger. and therefore you also eat less. But now you know is you're not fighting with yourself, right? So it's much, much, much more successful. So you have to understand what is it that causes hunger? What is it that causes satiety? And everybody thinks it's, well, when you fill the stomach or in a certain number of calories, creates a certain number of satiety. That's completely untrue. It's like it has no bearing in science whatsoever. And you can easily do a thought experiment. You can say, well, imagine that you were to eat, you know, steak and eggs in the morning. you know, maybe 800 calories, you'd probably be pretty full or, you know, three egg vegetable omelet. You'd be pretty full at least until lunch or maybe even until dinner, right? And maybe it's five, 600 calories, 700 calories, right? Now imagine that you drank a Frappuccino, right? You'd be hungry like five minutes later, right? Obviously, everybody knows that, but it's the same number of calories. So why pretend they're the same? But we do all the time. It's like calories a calorie, calories a calorie. No, there are clear and distinct differences in satiety. And there's clear and measurable differences in the hormones that are stimulated or not stimulated. So the vegetable omelet, for example, is going to stimulate peptide YY, cholecystokinin, and GLP-1. The proteins stimulate a lot of GLP-1s, for example. So that makes you full. Great. That's exactly what you notice. The Frappuccino, on the other hand, does none of those things. So you don't feel full. On the other hand, it stimulates a lot of insulin. Those calories immediately get stored away as body fat, leaving no energy for your body. And five minutes later, you're hungry, looking for something to eat, right? So why pretend those two 800-700 calorie situations are identical, right? It makes no sense whatsoever. It's idiotic. Like, let's just put it out there. It's so stupid. But people insist that it's true. And that's the only reason. So I think that this whole, you know, you see that a lot of people are sort of, let's get the fat back, let's put the protein back. Protein is particularly hot at this time. And I think that sort of discussion is much more useful and real food, right? That's a big focus of a lot of, you know, the last couple of years. And I think there's a good reason why that's true. But when you eat real foods, you stimulate these satiety hormones. So even if you don't know the names of them, you at least know that, hey, there's a difference here when you eat the real food compared to the ultra processed fake food because of the way it affects us in terms of hunger and satiety. And therefore, we're sort of moving past this whole, hey, it's just about the calories thing. Like, I don't even know why we would pretend those two things are the same, right? Because they're not in any way. And that's where I see it sort of, okay, let's, you know, that's sort of hopeful, right? We're starting to get these conversations around how things differ beyond the sort of calorie count or even carb count or whatever. There are other things that are important because the whole thing is that foods contain calories, right? But it doesn't go from calories to fat, right? There's a whole process of digestion and then absorption, which affects your hormones, which then affects your weight gain, right? But each step, the digestion, there's lots of different ways you can affect digestion. even if it's the same food, the absorption, the hormones, and so on. So it's actually a very complex sort of thing. And again, it's been worked out over decades and decades of research. And somehow, for some reason, in obesity medicine, we like to throw out all that knowledge about the different hormones that are important, like GLP-1, GIP, sympathetic tone, insulin, cortisol, all that kind of thing. We like to throw all that out and just go with the don't hit icebergs, right? It really is mind boggling, you know, why you would ever think that, right? And so of the hormones, you know, I think that the GLP-1 obviously is very topical because of Ozempic and so on. And there are certain things, there are certain foods that will stimulate GLP-1s more than other foods. And that's important knowledge, right? So protein is certainly one of those foods. And I think, you know, again, just looking at a lot of the foods, I see protein plus foods everywhere now, right? It's in the coffees and stuff, right? It's everywhere. So that's probably a positive thing. And then the other thing is fiber also stimulates GLP-1 through different mechanisms. So fiber is actually quite interesting because it actually does several things. It actually increases the bulk of the food, which activates the baroreceptors in the stomach, which signal your brain, signal satiety to your brain. It slows down how quickly the food gets passed out of the stomach, which again slows down the glycemic index of the foods. And then when the fiber gets to the colon, it gets fermented into short chain fatty acids, which stimulate GLP-1. So again, several different mechanisms. It's not like you can, you know, eat a big pizza, have a little bit of fiber, and then that'll be fine, right? That's not the saying. But, you know, when you're trying to think about the whole physiology, it's important. So GLP-1, sympathetic tone, there's so many that we really have to know. And here's the thing that I always think is funny, is that the more you know about something, the better you do, because you can understand the nuance of the situation. but in obesity medicine we always try to deliberately get rid of the nuance and go back to like calories in calories out and then say that it's thermodynamics it's like none of this breaks any laws of thermodynamics it's like i don't know what they're thinking anybody who says that clearly doesn't even understand thermodynamics because just because you have insulin is an important regulator of your body fat or cortisol or GLP-1 doesn't mean you break any laws of thermodynamics. It's crazy. It's like, for example, if you take the body fat equals calories in minus calories out, which is always true, you could simply rewrite that and say calories in equals body fat plus calories out, right? So that means for every calorie you eat, you could either store it or you could burn it. The question is, which one do you do? Because if you store it, you get fat. If you burn it, you have lots of energy, right? And it all comes down to the hormones, obviously. So it's not the calories that you eat. It's what your body does with those calories, right? And that's why focusing on the foods is important because every food contains, yes, calories, but also contains information about what you're supposed to do with those calories, right because when you eat certain hormones go up others go down you know there's a whole range of 10 different hormones at least that go up or down depending on the food so every food is going to have a different pattern of hormonal release after you eat them that's just we know that we can measure it and that's important because it tells your body to store it or to burn it right that's so important so i think you know these sort of you know this sort of knowledge is really important And, you know, honestly, I've read a lot of books about weight loss and stuff. And, you know, 90 percent of them just talk about calories. And it's like, oh, as if we didn't already talk about it enough. Right. It's like, let's move past that so we can get into the other really important stuff. Well, and I think, you know, your voice in this conversation is so vital because we know that it takes anywhere from 10 to 20 years of what's being done in research to trickle into kind of clinical medicine. And I feel like there's still a degree of rigid dogmatism around this calories in calories out model. And yet we're learning more and more and more of the influence of hormonal regulation in terms of appetite and satiety. and I love that you touched on fiber because I think there's also this misconception that anyone that talks about metabolic health or talks about intermittent fasting, that they're anti-carbs. And you definitely make it very clear in the book that there are the right types of carbohydrates and fiber being one of them and how critically important it is. And certainly for listeners, understanding that as women navigate that perimenopause to menopause transition, we get a drop in short chain fatty acid production. And this is why fiber intake is really, really so, so important. Jason, do you feel like kind of that low carb intermittent fasting space, sometimes carbohydrates overall, like not just processed carbs, but all carbs get bastardized in your clinical experience? Do you feel like there are some patients that should be significantly limiting carbohydrates or you feel like it's the processed carbs that we really need to be most focused on? I think it's the processed carbs, really, because again, it comes down to what to look at, right? And I've always said the main thing to look at is the hormones, because the hormones really determine what our body does. So you can take two carbohydrates and when you compare them through a very standard index, like the glycemic index or glycemic load, what you see is that there's huge differences in how high your blood glucose goes after the same amount of carbohydrate based on the food that it is. So if you look at beans, for example, compared to Cheerios or something like that, right? So one is very processed, Cheerios, and you get this very big glycemic spike or white bread, for example, get this big glycemic index, very high glycemic index, which means your glucose is spiking way up. You compare it to another carbohydrate, which is the same amount of carbohydrates, but the glycemic index is much lower. So it's like the glycemic index is how high your glucose goes, which also stimulates insulin. So therefore, how high your insulin goes also depends on the glycemic index, which depends not just on the carbohydrate, but on the form of the carbohydrate, right? How quickly it absorbs, right? So Cheerios versus beans, for example. And I think one of the studies that I was really impressed with was David Ludwig from, he used to be at Harvard. I think he's at University of Copenhagen now. Anyway, he had done a study years ago where he took steel cut oats versus instant oats. And I think it was such an interesting comparison because these are the two of the same foods, the exact same food, right? Not just the same calories, but the same carbohydrates and the same food. But the way they were processed was different. Instant was ground up into a very fine dust so that when you just pour hot water on them, you get the instant oatmeal. The steel cut oats is, you know, it's a much bigger particle, right? The particle size is bigger. So then when you cook it, you actually have to cook it for like 30, 40 minutes in order to make it able to eat. But the carbohydrates, the calories, proteins, everything is the same. And clearly those two things had a different glycemic index. That was known already. But when you measure how much people eat afterwards and their feelings of satiety, it was also markedly different. That is people ate much, they felt less full after the instant oats and they also ate much more at lunchtime, right? So here it is, the exact same food, But the processing of that food made such a huge difference, a measurable difference, right? And I think that goes, and that's where some of the carbohydrates can be tolerated. Like if you're, you know, on, you know, your sugars are off the charts and you're very diabetic, you probably need to cut out all carbohydrates. But for most people, you can tolerate a certain amount of carbohydrates and do well, but they're all different. That's where this whole, you know, a calorie is a calorie, but a carbohydrate is also not a carbohydrate. Because again, there's all these differences. And the ways that you take them can influence the hormonal response. So not just how fine the particle is. So if you compare instant oats versus steel cut oats, it's the size of how big you cut the pieces. But also the foods that you eat them with, the order that you eat them with. So there's all these other things that are going to influence them. And if you can influence them to a point that your body can handle it, hey, you can eat it. Because you think back in the 60s, right, where a time where there's not just not a lot of obesity. There's still tons of people eating potatoes, you know, steak and potatoes and white rice in China and all this other stuff. So there's definitely different things. I mean, in China, for example, in the 80s, people are eating like 300 grams a day of white rice. So why was there no obesity then? Well, probably comes down to the hedonic hunger, right? So if you think that, hey, all you're eating every day, three meals a day is white rice and vegetables. You're not that enthused for the next meal of white rice and vegetables, right? And when you are full, you're probably going to stop eating that white rice and vegetables because it's just not that pleasurable, right? The minute you satisfy that physical hunger, boom, I don't want any more white rice and boiled vegetables because I'm going to get it the next day and the next week and the next month after that too. So therefore the differences can be explained by other things other than the carbohydrates and so on And that what I mean right The more nuanced you can understand these things the better it is Now of course China because it modernized it has much more variety and stuff Now they're actually having a huge problem with overweight. And maybe it's because, you know, they can't handle that carbohydrate because they don't have that sort of limiting factor, which used to keep all that refined carbohydrate intake in check, which is that, you know, there's just no, you know, the hedonic hunger was basically zero, right? I think that's what happens with the Kempner rice diet too, right? People talk about this rice diet in the 20s that people use and say, it's like white rice and sugar and you can eat as much as you want. Okay, white rice with sugar doesn't sound very appetizing. You could eat it twice or three times. And after that, I'd be like, no, no, thank you. Right. And that's the reality. Right. So, you know, again, I think that these things are really important aspects. You know, I'm glad people are talking about them more and I'm happy that people are, you know, we're sort of moving forward. But, you know, again, let's bring some of these sort of nuanced understandings back to the understanding of a complex medical decision. Right. And that's where I think it is. I was actually pointing out that the Obesity Medicine Association on its website has already started to do this. So on its website, it says that obesity is a complex disease. It's much more than calories in, calories out, and it needs much more than just eat less, move more. Right. So it's moving. Things are moving. Optimistic. Yeah. I mean, I think that's definitely the message we want to share is that I think there's growing awareness. I think there are more and more clinicians and prescribers that are thinking more broadly as opposed to kind of that rigid dogmatism that so many of us trained within. Talk to us about the impact of meal timing. Obviously, I know this is a topic you and I hold near and dear to our hearts. But in terms of meal timing around dinner versus breakfast, what does the research suggest in terms of insulin sensitivity and why it's important to not be eating so close to bedtime? Yeah, I think that if you take the same meal and eat it early versus late, you actually get much more insulin effect. And it's probably because when you're eating it early, there are other hormones like cortisol and stuff which actually counteract it. So there's a whole bunch of hormones called the counter-regulatory hormones, which sort of move opposite to insulin. And in the morning, they tend to be a bit higher and then go down through the day. And so if they're sort of counteracting that insulin, if you eat it early, then you don't have as much insulin. And if you think about what's happening, say you take a thousand calories. So you eat your big, big meal earlier in the day, right? So you take that thousand calories, but insulin doesn't go up because it's relatively early. You've got these other hormones that are counteracting it. Well, if you think about the energy balance equation, which again, you rewrite as calories in equals body fat plus calories out. So every calorie you eat, you either store it or burn it. If you have little insulin, you're not going to store a lot. So then what happens, of course, is that the thousand calories floats around your body and your body can use it. And therefore, you're not going to be hungry. Why would you be hungry? You've got plenty of energy sitting around. You're not going to be hypoglycemic and so on. So on the other hand, if you eat it late, like just before bedtime, for example, where there's none of this sort of stuff to oppose the insulin effect, Insulin is going to go way up. Insulin, because it's way up, stores all thousand calories into your body fat. It's like, oh, okay, well, that's not good. So the meal timing can actually play a huge role and eating a big meal late can be very detrimental to health. I mean, there's other reasons you don't want to as well. So hunger tends to go up later. So if you look at circadian rhythm analysis of hunger through the day, right? If you take a bunch of people, ask them to measure their hunger levels throughout the day, you'll find that people are hungriest at 8 p.m. and least hungry at 8 a.m. So if you're hungriest at 8 p.m. and then you eat your big meal late, you're going to be eating. You're going to be hungrier. You're going to wind up eating more. For the amount that you eat, you're going to get more insulin effect. And then the third problem is that you actually can't make up for it because if you eat a giant breakfast, you can skip lunch, right? It's okay because you're just working it off through the day. If you eat a giant meal at 11 p.m. just before you go to bed, there's nowhere to make it up, right? You go to sleep, your body's like, what am I going to do with all this, right? I'm going to have to store it and store it just body fat. So there's a few reasons why eating a big meal late is problematic and it does happen to a lot of people. I mean, but certain cultures do have late meals like Spanish and stuff, but they're actually very light meals. So their big meal is actually in the midday. So when they go out at like 11 p.m. and so on, it's actually a very light meal that they have. Yeah, it's so interesting. I know when we travel abroad, it's always the Americans that are looking to have meals for dinner around five or six o'clock. And whether it's the Greeks, the Spanish, the Portuguese, they're always so humor to see that Americans eat really early. And to your point, they're not having large meals at eight, nine, 10 o'clock at night. They tend to be lighter meals and they do have their bigger meals during the day. One of the things that I find really fascinating is the interrelationship between hunger, hormones, and sleep. And I pulled up a meta-analysis from 2019 that said the risk of obesity increases by 9% for each one-hour decrease in sleep duration compared to seven hours. When you're talking to your patients, how do you impress upon them how important sleep is? I think many people kind of have this, you know, like my 20-year-old doesn't think sleep is all that important because he's 20. And as we get older, we start to realize that sleep is our superpower. Why do you think not enough of us are understanding that complex in a relationship between not just hunger, but hormonal regulation and sleep quality? Yeah, I think that's one of the sort of victims of this whole calories and calories out discussion is right. Because if you sleep more, you don't get more or less calories, right? It's like, but that's not the point. how does it affect your hormones because it's all about the hormones that affect weight right and you know because of that it sort of gets shunted aside at the same time as we have all this data on people with disturbed sleep and people who work night shifts and shift work how they are at super high risk of weight gain and metabolic disease we have all this data And we say, well, sleep, no calories. Oh, well, right. It's like, it doesn't make any sense. And that's where sort of not understanding, because if you have disrupted sleep, like, you know, stress levels are going to go up and that's going to affect hunger and stuff, right? So there's all these other effects of it, but because it's not a calorie effect, it gets sort of ignored. Just like, you know, something like diet sodas and artificial sweeteners, which I was happy in the latest dietary guidelines that they said, don't take artificial sweeteners, right? Because again, it's not about the calories. There's zero calories, but it's about the hunger. Like if you're stimulating sweetness, are you going to generate more hunger? Because if you are, then that's not going to be conducive to weight gain because you're increasing your hunger. And it's really all about these hormones and how sleep, you know, getting adequate sleep really helps, you know, set these, these proper hormones. And it's, it's sort of like this whole calories in calories out discussion really ignores the whole, you know, the whole sort of body fat regulation, which is that, you know, the amount of fat that we carry is regulated not by calories in calories out, but really like a thermostat, right? When it goes too high, we try and bring it down. When it goes too low, we try and bring it up. And this is set by those hormones, right? Insulin, cortisol. It's not by one hormone, right? It's by insulin, cortisol, GLP-1. And we know this because we give people insulin, they gain weight, right? And why do they gain weight? Yes, maybe they became more hungry so that they had to eat. But the point is that the cause of it was the increased insulin, right? Same thing with cortisol. You give people synthetic cortisol in the form of prednisone, which is a drug that we use for different reasons. But then they gain weight, right why did they gain weight it's like because you put them on cortisol how did they gain weight well because they ate more than they burned right that's the how that's not the why right you have to get to the why not the how and and the whole the whole thing is that you know if you understand this body fat thermostat it can you can push it up right you can push up the amount of body fat that your body wants to carry you can push it down it goes up and down and it all depends on the hormones. And sleep is part of that stress is part of that, right? It pushes that body fat thermostat sort of up or down. If it's set too high, of course, you're going to defend that. And that's why people who are obese and have lost weight have have real trouble keeping it off, because you have to focus not on the calories, but on the hormones, right? You can temporarily suppress it, temporarily suppress it with calorie restriction, but then you haven't reset your sort of baseline, right? And that's, that's the thing about, you know, these sort of discussions, there's a lot of people who don't, you know, we just think that calories are completely unregulated that, you know, there's this whole argument that our bodies are designed to store fat, and therefore, food is easy to get, and we're going to store fat. It's like, that actually makes no sense at all, right? If you look at wild animals, if you have too much fat, you are going to die, right? You're either going to get killed by something or you're not going to be able to catch food to eat. If you have too little body fat, you're also going to die because the minute you have winter, you don't have the body fat stores to survive, right? Even bears who gain weight during things, that's regulated, right? They don't gain weight anytime they feel like. They only gain weight at the fall, right? And that's driven by their hormones, right? So the amount of body fat you carry is regulated very tightly by all of these hormones, the insulin. And so what pushes it up? What pushes it down, right? Insulin pushes it up. Cortisol pushes up. GLP-1 pushes it down. Sympathetic tone pushes it down. So all of these things adjusted up or down. And depending on that, that's how much body fat you will carry, right? It's not like you eat a few extra calories and you dump it into the storage bin, right? That's the way that we're taught. And it's completely incorrect. It doesn't work like that. You have a system that adjusts up and down the thermostat. And there's been so many studies that have, you know, confirmed this sort of body fat thermostat sort of set weight sort of idea. I mean, in the 90s, Dr. Rudy Leibel did a very great study where he gave people a liquid diet and he'd increase the amounts to get them to gain or lose weight. What happened when you push people to gain weight, so you force basically overfed them, their metabolic rate went up by like 500 calories a day. Their bodies were trying to burn off that excess calories, right? Then when they returned to their original weight, they went back to their original energy expenditure. And then when they lost weight, their metabolic rate went down. Again, as you're eating less, your body's trying to burn less because it's, again, it's trying to defend that body fat threshold, right? And that's the idea. So if you understand that, hey, there's a body fat threshold, how do you adjust it? Well, it's all about the hormones, right? Say you go into a room, which is really, really hot. You don't say, huh, it's all about heat in minus heat out, right? So where's the heat in coming from, right? Or would you say, why did somebody put the thermostat so high, right? Let's turn it down. Well, that's an easy fix. So here I say, if you're overweight, it's because your body fat thermostat has been set too high. How are you going to push it down? What are the levers that you need to use? What is pushing it up? What is pushing it down? Can we do that? And there's so many different hormones. You know, sympathetic tone is another one that we never talk about, but it's true. If you increase sympathetic tone, you will lose weight. There's so many examples of that, like nicotine, for example. We know that smokers weigh less than non-smokers. Why? Because nicotine is a sympathetic stimulant. If you give somebody the old drug Speed or, you know, crack, which are amphetamines, right? They lose weight. They look like sticks, right? They were used as hunger suppressants. In fact, those drugs which stimulate the sympathetic nerves, which decreases hunger, they're actually part of a drug class called anorexians. That is, they induce anorexia or that is, they induce loss of appetite, right? So if you read some of the old literature, when all these weight loss drugs were around, like basically amphetamines for weight loss, that was like from the 60s and stuff. When you took those, you lost your appetite and therefore would lose weight. That's basically pushing your body fat thermostat down. Your body would say, hey, I have enough body fat. and then it kills your appetite. So you're not hungry, so you don't eat. So yes, calories in is less than calories out, but it's not that calories in is less than calories out. It's why calories in is less than calories out. And it's because you stimulated the sympathetic tone on the other end with the amphetamines, right? Fenfen, which is an old weight loss drug, fenfluramine is a sympathetic stimulant, right? So anything that stimulates it in that way. And it's not that I'm telling people to go back on these drugs, right? They're obviously horrible drugs. like nicotine and stuff. But it just tells you about the mechanisms, right? It's not calories in, calories out. It's the why of the calories in, calories out. That's such an important conversation. And for anyone that's listening that isn't yet understanding that complex interrelationship between our internal body fat thermostat and the role of these ultra processed foods, let's make sure it's really, really clear that we help people understand that this dysregulation in hormones and communication signaling within the body are exacerbated by these ultra processed foods? Yeah, the ultra processed food discussion is one fascinating, but I think very, very important. And it gets to, so again, if you think about calories, then the ultra processed food discussion will not make sense to you, right? But the point is that when you take these foods and you can process them in many, many different ways, and by doing that, you can change what happens to the body, right? Because you take the foods, it have a certain number of calories, it has a certain number of carbs and whatever, but by the time you process them, you can make them stimulate other hormones like satiety hormones or not satiety hormones. The problem with ultra-processed foods is that they're engineered to sell. So ultra-processed foods are made by food companies. They're not grown. And therefore, food companies want to make more money. To make more money, you have to sell more of that ultra-processed foods. So how do you sell more ultra-processed foods? Well, you have to do two things. One is that you have to make them very, very appealing, which means that you need to maximize hedonic pleasure and sort of, you know, to reduce hedonic hunger. So you can add, you know, flavorings and you can add all kinds of texturizers and emulsifiers for mouthfeel. You can do these things called vanishing caloric density, which is if you make something very, very light, it feels like you haven't eaten anything and therefore it doesn't trigger any satiety. You can take out anything heavy so that when it gets into the stomach, it doesn't feel like you've eaten anything. You're not triggering those baroreceptors. So you think about a Cheeto, for example, you eat it, it sort of melts in your mouth or a cheese puff. It melts in your mouth you feel like you haven eaten anything even though there tons and tons of calories in there right So they engineered for maximum sort of pleasure And there been whole books written on this right? And that's true. But the other thing that they do is that they tend to minimize hunger and satiety, right? They want to minimize satiety. Because if you eat a food, which is delicious, but you get full, you can't eat that much, right? So steak is great. But once you eat some steak or fish or whatever, you get full, you just can't go on, right? To a food company, that's not what you want to do. You want to have maximum pleasure. And then you want people to be able to keep eating that over and over and over again. And that's where you want to take out things that are going to create satiety. So you want to take out the protein, you want to take out the fat, you want to take out the heaviness of it, take out the fiber, take out some water. So the problem with ultra processed foods is that they're engineered through the chemicals, the texturizers, emulsifiers, and all that, to do those two things, which is going to maximize, you know, it is not going to satisfy homeostatic hunger. It's not going to satisfy your hedonic hunger because, you know, it keeps stimulating. It can sometimes lead into food addictions because it stimulates it so heavily. And then they try and make it a habit so that when you sit in front of the TV, you grab some snacks, you go here, you grab some snacks, you get in the car, you grab a drink and you do this, right? So they're hitting all those different areas of homeostatic, hedonic and conditioned hunger to make you want to eat it, right? And the problem is when your diet is full of ultra processed foods, as the American diet is, it's like 70% ultra processed foods, and it's been sold to us as good food. It's not. There are other places in the world, like Italy, where they are famously in love with food. Okay. Italians love food. Everybody knows that. And their obesity rate is very low, but they're eating pastas, they're eating pizzas and stuff. So it's like, what gives? Well, the amount of ultra processed foods they eat is like 20, 25%. It's a lot of real food. And it's because they have very strong food traditions that are maintained. Whereas in America, the food traditions are much weaker and tend to be shaped by a lot of advertising and so on. But you have to understand, if you think about advertising, you're always advertising ultra processed foods. Nobody advertises broccoli because it's not owned by a company, right? It's not like Fruit Loops where that company owns Fruit Loops. When they market Fruit Loops, it's just Fruit Loops, right? It's not like, oh, I'm going to market salmon. You know, that gets them nothing, right? So this whole idea of ultra processed food, this whole discussion fits in perfectly with everything we've been discussing is that you have to go way past the calories. You have to understand what's these foods are doing, why they're doing it, why these things are so important, how they affect the different types of hunger, particularly hedonic and homeostatic hunger, but to a certain extent conditioned hunger. and then you'll understand why that they're so detrimental to you and then that's where you can say okay we need to get these out of our diet to the maximum extent possible it's not going to be 100 possible but you know if we can shut it down a little bit then we're going to allow our bodies to naturally get that satiety again and stop eating right because the fundamental truth is that we eat because we're hungry and we stop because we're full. Why do we ignore stuff like this? It's so obvious that it's true. So if you have a food that creates no satiety, you won't stop eating. Well, that's a problem. But what food is that? Ultra processed foods. It has to be because all the other foods, there are natural satiety signals. Like, you know, if you look at food addictions. It's always ultra processed foods. Why? Because we have natural ways to deal with foods. Like I love eggplant. I'm not addicted to eggplant. I love beef. I'm not addicted to beef. I can stop eating when I'm full, right? You can't always do that with Cheetos and chips and chocolates and sweets and stuff, right? It's very difficult. and um you know that's where i think understanding also creates a bit more um empathy you know because there's this whole thing about people would just say well if you don't if you're overweight and can't lose weight well it's because your willpower like you just didn't want it bad enough right no if the problem is the environment and the food the ultra processed foods and we have to help people through that right let them understand this is because of the ultra processed foods, let them understand that they've created these food addictions and you have to break those food addictions, right? It's a really important discussion that we almost never have if you're stuck on that calories and don't hit icebergs sort of level. Yeah, that's interesting. I think the more I understand about the role of food scientists and Bliss Point and how they make these foods as addictive as possible is no wonder that there are so many people that are consuming an excessive amount of these ultra processed foods. And I think a great deal about like the chip piece. It's interesting. I have one kiddo in college and one that's a high school senior. We were out to dinner last night at a nice historic hotel in my city. And my older son was talking about what he eats. So he lives in an apartment with three other friends, all of whom have mothers that taught their sons to cook. So these four boys all cook most of the time. And my son said, I live on ground meat, ground beef, and rice because he plays lacrosse. And so he was explaining like what his food prep is like for the week. And he said it isn't really worth it to me to eat like fast food because I don't feel good. I don't have the ability to get through a game or to get through practice and fuel myself to be able to take tough engineering classes. And he was talking about how interesting it has been for him to be, well, he was on a college campus for one year, now he's in an apartment. But he said that whole first year, he said he found it fascinating to see what classmates were consuming. And for the first time in maybe many of their lives, they're able to eat whatever they want, whenever they want. And how for some of them, it didn't turn out to support a healthy kind of body habitus or get to a point where they go home for the summer and they're like, oh man, I got to get it all together. So I think for a lot of people that are listening, they may realize that ultra processed foods aren't healthy, but understand that complex in a relation, it tricks your brain into thinking you are not full so that you consume more. Let's circle back to bitter foods. I think, you know, rounding out the conversation, talking about some nutritional aspects that can be helpful for supporting satiety and hunger mechanisms in a healthy way. You do a really nice job in the book giving people very actionable ways to support their hunger and their body and their hormones in ways. It's not that you have to go out and buy a gadget. These are things that we can do that are natural, sensible, actionable. Yeah. So bitter foods is actually quite interesting because the standard thinking is that the bitter sensation is a warning to us. So that if we eat something poisonous, that it's bitter, so we'll spit it out. But that actually isn't exactly true, because there's a lot of bitter foods that are quite delicious, right? Chocolate is actually slightly bitter. And, you know, there's other things like kale and stuff that are a bit and then there's a lot of traditional foods like there's bitter melon, which is sort of I always think it's interesting because I bitter melons actually quite traditional in Chinese cuisine. I never liked it. But my parents love bitter melon. They're like, oh, we should get the bitter melon. I'm like, eat, right? The bitter compound can actually be enjoyable, which is, I always thought, I think kind of interesting. But the point is that when you activate those receptors, it actually turns on a lot of hunger. It turns off a lot of hunger as well, right? Because you eat it and then, you know, it creates a lot of satiety. So if you know that, hey, things like turmeric and stuff can be a useful addition. It's obviously a very small part of the whole diet, but, you know, arugula is a little bit bitter, right? There's a few other things that are like, okay, well, if you can, you know, eat a little bit more, then you're going to create a little bit more of the satiety. And it's not, and that's what's going to tell you to sort of stop eating. And that's where it is. That's how we know to stop eating. So bitterness is actually really interesting. I mean, it's probably not a huge part of everything. But on the other hand, it's just a sort of fascinating sort of, I wonder why this developed in the way it is. Bitter gourd is another one that's used in a lot of Indian cuisine. So yeah, it's exactly right. Like you have to figure out what it is. The ultra processed food piece is always so difficult. It always gets rid of the bitterness, right? So because you want to get rid of that bitterness so that you can just keep eating and eating, eating and never stop. But you can also play the other side and say, hey, I know this. So what I'm going to do is, you know, if I'm really, really want something for dessert, maybe I'll get some just dark chocolate, right? Yes, there's a little bit, maybe there's a little bit of sugar in it depends on how dark it is. But the bitterness is your risk and really, you know, satisfy me to and motivate me to stop because that's what the bitterness is going to do. So interesting, because a lot of that bitterness is really polyphenols. And so when you think about even if you have really high quality extra virgin olive oil, or I always think about my mom, who is Italian, we had a lot of arugula salads, where she would shave fennel and a little bit of citrus. And so understanding, yeah, so that was a lot. We had salad with every single meal growing up, which I now appreciate, but at the time I did not. The things that our families do as we're growing up, but those polyphenols are really important signaling molecules in the body. So the bitter piece signaling, you know, things like CCK and GLP-1 can be really helpful. Broccolini, I find too. I find that always very bitter, but it's delicious, right? It's like, oh, I love that. I love the broccolini. And then, but it's like, you eat it and it's like, okay, it's bitter, but it's supposed to be, right? There's a lot of foods like that. Absolutely. Let's run out the conversation today, just talking about you have a whole section on kind of mindfulness and meditation. And so things that people can do to help, you know, get their autonomic nervous system kind of in this rest and repose state to be able to appropriately kind of digest and break down food. What are some of your favorite strategies that you discuss with your patients to help them kind of support this parasympathetic process? Yeah, I think there's the The whole third part of the book, which is about conditioned hunger, really talks about sort of the social environmental aspects of it and sort of calming down the, you know, the system is probably, you know, very important because the high stress levels can probably lead to a lot of stress eating and so on. So you really want to try and get that down. There's a whole lot of things, you know, mindfulness you mentioned is such an important thing because, you know, everybody's got distractions. But if you do this sort of distracted eating, which is the opposite of mindful eating, you're not going to notice what's happening, right? Because you're busy watching YouTube or you're busy doing work. And then you're just the food's just going in the food's just going in. And that's where you really have to step back and say, well, if you know, that's a problem, distracted eating, then you have to switch mindful eating, then you have to say, okay, well, what am I going to do? And there's ways to train yourself, right? Like anything else, you can train yourself to be mindful of your foods, right? So, you know, every time you sit down at a food, and there are ways that people talk about this, for example, like, you know, saying grace, for example, is very traditional sort of, you know, it's a way to be mindful. It's like, here's the food, I'm thankful for the food. But in order to be thankful, you have to sort of notice what the food is, right? So if you, you know, just sort of just shovel it in, then you'll never notice that. And then you'll never be able to, you know, eat, notice sort of how much you're eating, what you're eating, whether you should be eating it, right? And then at the end, you know, to be grateful for that, you know, grateful that you're able to enjoy it and so on. So mindfulness is actually a huge part. Mindset is also a huge part. You know, again, mindset is this thing that I think, again, nobody ever talks about it, but not enough, right? In terms of weight loss, because they all talk about calories. And that's just what I mean, right? If you talk 99% about calories, you forget all these other topics, because mindset is really important, because your mindset really determines how you respond to anything. So it can always be in a positive or negative way. Even something like fasting, where you're deliberately not eating, it can be seen as a positive or a negative, right? So in the past, it was seen as a very, very positive thing, right? Something that's good for you, a cleanse, a detoxification, a purification, right? Something very positive, something you do to better yourself. Or it can be very negative, which was sort of everywhere, you know, up until about five or six years ago, fasting was like, oh my God, you're going to kill yourself and give yourself anorexia, right? And it's like, no, fasting is just something natural. So it's just, and the difference wasn't in the fast, it was in the mindset, right? So people saw it as this and then therefore all these connotations. But again, there's ways to train yourself to change your mindset. Same thing with ultra processed foods. Like I've changed my mindset completely in ultra processed foods from 20 years ago, for example. It'd be like processed foods. Hey, as long as it's low in calories, low in fat, it was good for you, right? Margarine, good for you, right? Now I see margarine. I like, whoa, get that thing away from me, right? Because the margarine hasn't changed. It's my mindset. A lot of these things that come in a box, you know, those pre-prepared things like hamburger helper, you know, the thing that the flavor pack, right? Yeah. I used to love those things like 20 years ago, right? I mean, it's a different time. But again, now I like, whoa, get me away from this. Look at this. This is so processed. It's like, it's all chemical. That's all that's in there, right? So now I don't feel like I want it. And the difference with the mindset is that if your mindset is that this is good stuff, this margarine is good stuff, or this hamburger helper is good stuff, what's going to happen is that if you don't do it, you're going to feel a deprivation. I want this ultra processed foods, but I can't have it. Whereas if you change your mindset and say, whoa, this stuff is super, super processed, it's terrible. I don't even want it. I don't exert willpower to not eat this stuff because I look at it and go, wow, you know, that flavor pack is just, you know, you just know that there's nothing good in there, right? So, you know, it's about changing mindsets because it's not about the foods necessarily. If you think it's just about the foods and the diet, you've probably already lost. It's really about changing eating behavior. And there's a whole area of behavioral psychology that deals with behaviors. And again, we ignore it so that we can focus on calories, right? But it's not about that. It's about all this other stuff that is actually very, very important. I couldn't agree more. Dr. Fung, please let listeners know how to connect with you outside of the podcast, how to get access to your new book, The Hunger Code, which I highly recommend, or connect with you on social media. Yeah, so you can check me out on my website, drjasonfung.com. And that's Dr. D-O-C-T-O-R. Or you can find me on YouTube or Instagram and so on. And those, you know, I'm on Dr. Dr. Jason Fung, at Dr. Jason Fung. And yeah, check it out. And then my new book is being released in March, The Hunger Code. And it goes through a lot of these topics. It takes sort of where I left off at the obesity code and then sort of moves forward into these really important topics. Because I think in the last few years, there's been just so much more about it. So yeah, really excited about it. Thank you again. Okay. Thanks so much. If you love this podcast episode, please leave a rating and review, subscribe and tell a friend.