Insulin Expert Exposes The CARB CRISIS - The Rules of Weight Loss Have COMPLETELY Changed

How much carbs can a person eat? What are they justified in eating? And women, women are just such metabolic curiosities. You're such beautiful creatures, but you're so curious.

That's one nice way to say it.

Yeah, you're so curious. You know, like I've joked before that male metabolism and maybe even male endocrinology, it's like a barbershop quartet. It's so simple. But female endocrinology, it's like a 100-piece symphony. There are so many There's so many characters, there's so many individual sections, and within those sections, there are some that are playing louder than others. It is the most elegantly designed system wrapped in the most lovely cocoon of the female individual, but it sure is complicated.

Very good. You know, the way I always say it is, I say women are like sophisticated violins and men's hormones are like a kazoo. It's just one note.

I like that. Yeah, we're just sitting in the corner with our dunce hat humming along.

Well, Ben Bikman, I have to start by just welcoming you back, what I think may be like the 10th time I've brought you on my podcast, because my audience loves what you have to say. So I'm so happy you're here.

Oh, well, Mindy, there are a few people with whom I feel such a kinship. I really— every time we're visiting, it's almost like I'm visiting with one of my sisters. This is great. I'm glad to be here.

Yeah, thank you. So in preparation for this podcast, I really dove into my YouTube questions to see where people are getting stuck with carbs. And I feel like carbohydrates are the most misunderstood macronutrient that we have. And you believe that we have a carb crisis, not a sugar crisis. Where do we start to understand if we should be eating carbs or not?

Yeah, yeah, good question. In fact, it's funny, just as a intro to the, to the answer here. It is interesting to look at how some macros have been so maligned over the decades, like fats, while some have been so embraced. And I'd make the case that we kind of got it perfectly wrong in that regard. Not that carbohydrates are the— are a problem. Now, as I kind of segue into answering the question, but it is, I think, the macronutrient we have to be the most cautious with.

Mm-hmm.

Because they're so ubiquitous and they come in so much variety. That I don't think it's fair to paint them with the favorable brush that they're often painted with. And just to put that in perspective, by some estimates, like the Nutrient Global Database, about 70% of all calories consumed globally are coming from this one single class of macronutrient.

Wow, wow.

And so it is, I think, worth scrutinizing, despite our obsession with focusing on fat. We eat far fewer of our calories from fat than we do from carbohydrates.

Interesting.

So with the question being, you know, how do we eat them? I think that's how you framed it.

Yeah.

Or how much? I think there are a handful of variables that come into someone knowing how much or how frequently they should be eating carbohydrates and in what forms. I won't necessarily get into that in this answer, but my answer will be a little general in that there are people who can consume Much higher amounts of carbohydrates than others and have very little to no consequence. That would be a negative consequence, that is. Whereas those are— there are others who are much more intolerant of them. Part of what goes into that formula would be— the biggest piece of that formula would be how much muscle do you have and how much are you using it?

Mm-hmm.

Um, where I think it's prudent for people to look at carbohydrates as a fuel. You don't need those carbohydrates for building blocks or for signaling. in the body. That's going to be the realm of the fats and the proteins that you eat. Those are going to give you the building blocks, or, or those are building blocks that you're, you're making, like in the case of, say, cholesterol and all of the sex hormones being built from a single molecule of cholesterol.

Right.

Well, whether you eat the cholesterol or make it, you know, that's, that's something you need, uh, there. But in general, when it comes to carbohydrates, if you're very active, That's a good justification where, look at the carbohydrate as fuel. You don't need it as a building block. You don't need it as a signaling molecule, per se, like you do the others, fats and, say, peptides or proteins.

Right.

But the body can absolutely use it as a fuel. And then beyond athletics, I think more into your realm, especially a menstruating woman, a premenopausal woman, She can have, within her own cycle, times where she, I would make the case, she ought to be a little more judicious and cautious, because she's a little more insulin resistant, and so there might be a greater consequence to those carbs that are being consumed. And then there is the other period, of course, where she's quite insulin sensitive.

Right, yeah.

And has a lot more metabolic wiggle room. But as much as I've just answered this in the context of metabolic, one of the cases I try to make in the book is, are these the burdens? I, in trying to identify some of the problem with carbohydrates, I have historically really just focused on the metabolic side, and that's certainly my strongest background.

Yeah.

A person would do well to remember that I'm a metabolic scientist, but I'm capable of reading the literature. And to me, there are 2 other burdens that come with it, which is the anti-nutrient burden, which is a little more relevant to autoimmune conditions. And then there is the, The chemical burden, which I'm naming that distinct to refer to all the pesticides and herbicides and fungicides that are generally unique to the carbohydrates that we're eating, as opposed to, you know, whereas if you look at a comparable amount of calories from, say, meat, you're going to get those at the level of like a thousandth or a millionth of that same, you know, chemical burden, or let alone the anti-nutrient burden.

Yeah.

Coming in.

So let's go to the woman's conversation here in a moment, because as you were talking, I was reminding myself that when I put Fast Like a Girl out into the world, I had really studied the glucose and insulin demands of the different sex hormones. And I was practicing different principles of fasting in my clinic. And I saw there was a time when women could fast really easy. I was super into the keto diet at that time. I found that that was really easy at times. And then, Other times of her cycle, she she couldn't follow fasting or the keto diet at all. And when I saw that trend, I saw that it was the week before her period that that she was the most insulin resistant. So when I brought that forward in Fast Like a Girl, what has fascinated me is how many people have challenged that concept to the point that I hear some wellness influencers and doctors say this idea that a woman should have a a time to eat carbs and a time not to eat carbs is basically bullshit. Can you, can you explain that to my audience? Because I still stand by what I brought forward in that book.

Oh yeah, in fact, I, I support it, uh, as well. And I, I say this as a professor who teaches endocrinology. Of course, I'm not a clinician, and I always have a tremendous amount of respect for clinicians who are on the front lines. They are where the rubber meets the road. I'm the guy— they're the ones who get paid to see patients. I'm the guy who gets paid to answer questions. And that's the beauty of being a scientist. That's my job. But in my endocrinology class, when I teach the female cycle, I make a point, of course, 'cause I'm the metabolic guy, of highlighting the role specifically of progesterone.

Yeah.

Progesterone is the hormone of gestation. Gestation is a state of insulin resistance. That's one of the physiological states of insulin resistance where the body has become insulin resistant on purpose. And so you noting that the, I think you'd said the insulin resistance And you mentioned that her resistance was highest about a week before her period. Yeah, her ovulation. That would fall right in that— yes, that would fall right in that luteal phase. And I suspect your audience is much more familiar with this topic than the average individual.

Hopefully, yeah.

But just to put a very brief version of it, at the beginning of the cycle, she is in her follicular phase. The follicles are growing in her ovaries, waiting for that big— this is the first half of the cycle, waiting for the big estrogen surge, the LH surge, And one of those follicles will be stimulated to become the dominant, and it will actually ovulate and release its egg. When that happens, we've now entered into that remaining little structure in the ovary. So that little follicle that was developing, it releases its egg. Now that remnant structure is called the corpus luteum, or technically it's called the yellow body.

Uh-huh.

But that is what starts producing this big shift in specifically Progesterone, and estrogens are still coming too, but now we've entered that luteal phase, again, defined by the corpus luteum, that remaining little remnant within the ovary that ovulated. Not only does that allow all the other follicles to go away and get degraded, to prevent her ovaries from becoming too big, of course, and swelling every month, so all the other follicles are told basically, hey, I won. I'm the follicle that won. I ovulated. You can go away now, and then that remnant—

Mm-hmm.

The remnant of that follicle starts releasing again these hormones, the main one being progesterone. Progesterone is a hormone that will not only stimulate some insulin resistance, but I say this with a tremendous amount of sympathy too, because that's when she's the most insulin resistant, but progesterone is also a hunger signal.

Yeah, yeah.

As much as we have looked at GLP-1 as this singular kind of elephant in the room when it comes to appetite, and it's a big one, no doubt, but it is, Far from the only one. There are so many hormones that come into play when you start talking about balancing hunger versus satiety. Progesterone is a hunger hormone. It's acting kind of like ghrelin is, this signal that's coming to the brain wanting her to eat. And that makes sense.

Yeah.

That's a phase where her body's wondering, did we just get pregnant? We don't know yet, but just in case, just in case that egg was fertilized and is going to implant, we're just going to start priming the pump. And there, So back to this physiological insulin resistance, a woman needs to gain a proper amount of fat during her pregnancy. Progesterone's the hormone that wants that to happen.

Absolutely.

So back to this, your comment, I would support you and defend your view based exclusively on peer-reviewed manuscripts published in human females that have shown this principle, that to put a very, very fine point on it, I'm unaware of any line of evidence that's measured this doesn't show. I hate to use a double negative there. In other words, every study that has been done measuring glucose tolerance and insulin resistance during this ovulatory cycle in a woman has— I've probably seen every one of them. I think every one of them supports the idea that that luteal phase is a state of some degree of insulin resistance and thus some degree of a carbohydrate intolerance. Not that she can't eat them, I would say, but it's just a time to be more careful.

Yeah, and I would say every woman that I've talked to says, yeah, that I crave carbs the week before my period. And what— and I— and they think it's something wrong with them, like, like I did something wrong that I can't stick to my diet the week before my period. What I noticed in my clinic was if I allowed those women to eat good carbs, and I want to talk about what good carbs are, then like PMS symptoms went away.

Mm-hmm.

They weren't hungry when they started their period, their moods were better. And I came to the conclusion that the PMS is actually worse once a woman's period starts if she tried to diet and exercise too much the week before her period, because she's going against her own natural biology.

Yeah, well, that's— that makes sense. That's brilliant. In fact, I think you've been one of the good, clear voices in this realm.

Thank you. So what do you think about for postmenopausal women? Because now if progesterone's a hunger hormone, um, and it's starting to go down in perimenopause and menopause, uh, there are a lot of women gaining weight because estrogen has dropped, a lot of women leaning into carbs, um, and gaining even more weight. What do we tell the perimenopausal, postmenopausal woman?

Yeah, yeah, I would, um, at the risk of being kind of pithy here, I'd say welcome to mortality. Um, and, and by that I mean, um, now she may on one hand rejoice that she doesn't have a period anymore, I suppose. Um, but my little joke about welcome to mortality is just kind of based on the idea that a premenopausal woman is sort of a metabolic superhero. Where she can get away with, with more body fat than— and even a little more metabolic wiggle room than her male counterpart can. Now, she may say, well, what are you talking about? My, my, my husband or, you know, the guys in my life, they can eat. They have— they're so big and hulky, they can eat whatever they want. Yeah. Again, muscle mass matters a lot.

Mm-hmm.

But estrogens especially Oh my gosh. Estrogens have the ability to help a woman kind of become bulletproof, where her body fat has very little negative consequence, premenopausal, because the way the estrogens are telling her body how to store fat.

Right.

And so, with, as much as the news gets a little grim, I think peri- and postmenopause, which is, hey, you've lost those estrogens, at least endogenous, and thus, your fat is now going to start to have more consequence. By that, To be really precise, she's going to start losing fat cell number slowly over the next decades, and that's going to be replaced by fewer but larger fat cells, which is why now she's kind of more mortal. That's what her male counterpart has had to kind of struggle with the entire time, where he doesn't have the ability to make new fat cells for the most part, like the female does.

Mm-hmm.

I think that that's the bad news of menopause. But at the same time, we could say there is some good news, which is that you are not subject to the, dare I say, volatility when it comes to hunger and glucose tolerance that—

Right, yeah.

While you were having your cycle, boy, oh my gosh, I mean, buckle up. You've got a lot more planning and caution, or just consideration that would go into how you feel and taking stock of doing what's best depending on where you are in your cycle. Well, post-menopause, you know, welcome to the kind of more plain ride that guys are on, which is you don't have that kind of variability now. And I think that's an opportunity to really say, okay, this is my new normal and these are the habits. I don't have to be as mindful of different times of the month and be a little more cautious with my fasting or my glucose consumption, whatever. She's able to I think if there's some good news, kind of find some habits that work and then lock them in.

Yeah, and that's been my experience with fasting is I can teach almost any postmenopausal woman how to fast and they'll find a rhythm very quickly. It's much easier than perimenopause, very difficult, very turbulent. Premenopausal, if I just teach them to fast according to their cycle, It's much easier. So would you say that there's any kind of advantage for carbohydrates for a postmenopausal woman?

Uh, no. Um, that's what I'm thinking too. I don't think there's an advantage there. In fact, I dare say the time has come to be a little more roll up your sleeves. And I say that for a few reasons. One, you will be a little less glucose tolerant and insulin resistant. And those are 2 different things, but they're They're complementary, but they're not the same. So I want to be clear, you'll be a little less glucose tolerant and a little more insulin resistant. Now, insulin resistance does play into glucose tolerance, but they are distinct. But at the same time, she needs to be exceptionally mindful of her brain.

Yeah.

And the reliance of her brain on energy. There are, when you look at the whole, pantheon of chronic diseases, men die pretty much more from everything at younger ages. But the one realm where ladies dominate is brain pathologies. And it's an interesting shift as her brain has benefited so much from the flush of estrogens, which are extremely neuroprotective. They're neurogenic. They're metabolically favorable. They help a woman burn more fat than a man does, which is true. She might not think it's true. Estrogens do facilitate fat burning. They also facilitate more fat storage. She's storing, but she's just cycling through her fat more. She's storing more and burning more and storing more and burning more. There was a paper which was shockingly interesting. It was mostly based on rodent work, and then they found some human correlation. So it's a pretty good complement in the humans. And they found that the female brain post-menopause starts to become a little more insulin resistant. That's not surprising with the loss of estrogens in particular and just a growing insulin resistance. But that the female brain was so It was getting so energy deprived because of its forced reliance on glucose, which again has a gatekeeper where insulin needs to be working well to get that glucose into the brain, at least all sections of the brain. And, and so the, the brain was starting to become energy deficient that it started catabolizing its own white matter.

Yeah.

Its own, its own physical fatty substance. The brain is a very fat organ, actually has a lot of fat in it. in its substance, and it starts burning through its own mass in order to turn that white matter into ketones to try to make up for the energetic gap that is caused by the, the growing insulin resistance. So all that to say, she— I think, I think her opportunity to kind of shrug off some bad habits pre-menopause, now, um, you can't. You've got to be a little more strict.

Yeah, I saw that study after I put Age Like a Girl out into the world, which was really about how the brain changes for the better as we go through menopause. And what I— when I heard that study, I was like, wait, the brain innately makes ketones so that as it is adapting to the hormonal change, the brain is telling us what the proper fuel source is by making its own fuel source in the breakdown of neurons as she starts to age. To me, there's no bigger signal that a postmenopausal woman needs ketones than that study.

Amen. I couldn't agree more. Yeah. So all of this is still kind of circling around that initial question you'd asked, which is how much carbs can a person eat? What are they justified in eating? And women, women are just such metabolic curiosities. You're such beautiful creatures, but you're—

One nice way to say it. Yeah.

You're so curious. You know, like I've joked before, That male metabolism, and maybe even male endocrinology, it's like a barbershop quartet. It's so simple. But female endocrinology, it's like a 100-piece symphony.

Yeah.

There are so many characters. There's so many individual sections. And within those sections, there are some that are playing louder than others. It is the most elegantly designed system wrapped in the most lovely cocoon of the female individual. It sure is complicated.

Very good. You know, the way I always say it is, I say women are like sophisticated violins and men's hormones are like a kazoo. It's just one note.

I like that. Yeah, we're just sitting in the corner with our dunce hat humming along.

Talk to me about good carbs and bad carbs, because I think that is the new cultural discussion. Every— all of a sudden people are like, wait, there's a difference?

Oh, yeah, yeah. In fact, Mindy, let me answer that by kind of invoking the 3 burdens that I bring up in the book.

Right.

So the lowest-hanging fruit for both you and I, because of our expertise, is the metabolic burden. And so I'll start with that view. And it's fairly simple, where when you consider the quality of carbohydrates through the lens of the metabolic burden, It can largely be based on how much is this— what's the glycemic load of the carbohydrate that I'm about to eat? In other words, how much is this going to result in a significant glucose excursion in my— or it can result in a big hyperglycemia. But, and then unfortunately, the higher you go, the lower you're probably going to go as well.

Right, yeah.

And that, speaking of the brain again, Part of what I inserted into the book, and I wanted to make sure The Carb Crisis was not redundant to Why We Get Sick. Why We Get Sick was all about the insulin response to what we eat, and then the consequences of that insulin response.

Mm-hmm.

And so with this, when I, in part 2, where I talk about the mechanisms and the menace of these dietary carbohydrates, I wanted to make sure I was focusing more on, in this case, with regards to the metabolic burden, the glycemic problem, the problems of hyperglycemia and the oxidative stress that comes from that, the problems of just glycemic variability. So we just talked about the brain being so sensitive to energetic changes. I couldn't— I was amazed at the quality of evidence and the consistency of the evidence finding that when the brain is forced to live through these hyper, hypo, hyper, hypoglycemic variability moments, that alone represents a pathological trigger that starts to compromise cognition, like, in real time.

Wow.

So the metabolic burden, when it comes to understanding what are good carbs and bad carbs, with the metabolic burden in mind, I think you could just say, how much is this going to spike my glucose or not? And the simplest, The simplest way of, of getting to the meat of the matter with that topic is, is it a carbohydrate that comes from a bag or a box with a barcode, or am I drinking the carbohydrate versus biting it and chewing it? Not only— and so on that more favorable end, when you are biting and chewing your fruits and vegetables, which are the carbs that I think are the most appropriate or justified in eating, those are good carbs.

Right.

You're not only going to eat a lot less because of the simple time of biting it and And chewing it, but you're also getting it with fiber.

I was just going to ask you that. Yep.

Yeah, yeah. Fiber is, uh, I know people within, within, within our community, Mindy, there are of course, there's the subset of like the really strict carnivore keto people, which I totally respect.

Yep.

Um, but they, there may be some who just universally, um, poo-poo fiber. I don't think that's entirely fair. I think it's fair if you don't eat any carbs, but if you are eating carbs, then I think fiber's supposed to come with those carbs. Part of that reason is probably, at least in my mind, part of the reason, part of the justification is that it's going to help reduce the metabolic burden.

Yes.

You're going to significantly slow the digestion of those carbohydrates, and the subsequent glycemic and insulinemic bump is going to be significantly blunted. So that's the metabolic view of defining good carbs and bad carbs.

So would it be fair— I'm just going to stop you right there for a moment because I want people to grab this. I think then the goal of your carbohydrate quality is how much fiber does it have?

I think that's a good way to break it down. Yes, that would maybe be the tidiest, simplest way of defining it, good versus bad, or distinguishing between the two. You look at it and you say, Is there fiber with this carb that I'm about to eat? And if you're looking at that glass of apple juice, there's no fiber there. But if you're looking at the apple, oh my gosh, you know, tear into that thing.

Right. So one of the ways I've said it is, is it a nature's carb or is it man-made carb?

Well said.

Because the man-made carbs, all that processing, they take all that fiber out. But if you, if you look and just go, did nature give this to me? And if the answer is no, then you're probably in a carb without fiber.

Yeah, well said. I agree with that completely. Yeah. And that's, that's the more articulate way of my view. No, no, no, that's like my kind of, my kind of mnemonic comment of it is, if it comes in a bag or a box with a barcode, beware. And largely, it's because the fiber has been stripped out of it.

Right. So something interesting that I've been researching is the concept of protein. And I think we're now overusing protein. And I started to dive into this and I was like, oh, here's the simple answer to that. And you said this with carbs. The simple answer is, are you using protein?

Mm-hmm.

And I think that's the same question we need to ask with the carb. You said it earlier, like, are you actually using that or are we just Putting carbs into our mouth because they taste good, or how are you going to use it now? Are you going to go walk? Are you going to go lift weights? So what could we teach people about the usage of carbs? It's quick energy, right?

Oh, yeah, for sure. Yeah. So that's, that's the other part of carbs where the more you are moving your muscle to demand the glucose, the more wiggle room you have. Right. So as much as you and I, we just got done defining good carbs and bad carbs. I define that through the lens of kind of the older, the aged adult, the person who's getting older and just wanting to be their best metabolic overall self.

Yeah.

However, I'm blessed to be a university professor. I have multiple college athletes in the class that I'm going to go teach in just a few hours. They're literally NCAA athletes. Okay, come on. You guys can do whatever you want.

Right.

They're training. They're training 5, 6 hours a day. Very high intensity, very high power training. Oh, those guys, you have athletes who can eat 200 to 300 grams of carbs per day, but their output or their demand for energy is so significant that they can be in a robust state of ketosis every single morning.

Right, right.

Because they're using so much of that fuel. So that's the other view where if you're using the glucose, if you're using the fuel, then you don't— I think that line between good and bad starts to blur a bit.

Right.

Where you have a little more, you have enough metabolic wiggle room that you can handle that, what would otherwise be kind of self-abuse in someone else, to you, it is just, you're fueling the high, high demand of your muscle.

So if I'm mostly sedentary, then I'm going to need a lower carb amount.

Absolutely.

This was really, really popular in my community. How many carbs should I have? How many? And I really love that we're moving to, well, how many are you using?

Yeah, well said. Yeah, so then, yeah, in fact, that's part of how I, um, towards the end of the book, I, I present this view of how can you know where you are, like what is your carb tolerance. And a part of it is based on this kind of a loose algorithm of, well, how active are you, um, what does your CGM show you. You know, there's a handful of inputs that go into this, but suffice to say, it will not be the same with everyone. And I really wanted to make an effort to not come down to a singular Yeah. That just doesn't work.

That's why I love you, Ben. I'm the same way. I'm like, we have to look at this in a holistic view in order to be able to figure out your N of 1.

Yeah.

And we live in a world where people, 90% of health information is coming from social media. If somebody only has 90 seconds to teach you a concept, they're gonna give you an absolute. But these conversations like this can really help people make better decisions for themselves. And I wanna make sure my audience knows you have your new book. coming out, we'll leave the link below. So that— because I'm excited about what you're bringing forward. Where does the nervous system fit into this? Because one of the things that I'm seeing with fasters is if somebody's nervous system is frozen, it's really hard to teach them to fast because they're just in a different nervous system state.

Yeah, well, Mindy, I need you to tell me, what do you mean when you say the nervous system is frozen?

So this is more leaning towards the polyvagal theory, where if you've been in fight or flight for too long, you start to withdraw and numb out.

Okay. Yeah. Okay. That makes sense. Yeah. Um, in fact, I like what you're talking about there because the older I'm getting, the more I am mindful of this. And, and maybe because I teach it. In fact, in next week in my seminar, in my lecture this semester, we talk about the autonomic nervous system. And within the human body, just so the audience familiar with this. You have different types of— you have different nervous systems, actually. One of the dominant ones that we always think about is what's called the autonomic nervous system, and the autonomic nervous system is split into generally 2 halves. There's that sympathetic one that you just mentioned, the fight or flight, or there's the parasympathetic, the rest and digest and reproduce. You know, we could put that there too. Um, I do. That's— I like how you framed it. Which is that I do think we live primarily in a sympathetic world. Now, I don't mean that we have compassion for people. That's not what I mean. I mean, through the lens of the sympathetic nervous system, where we are— if only we were all more sympathetic, right?

Right.

We have more patience and tolerance. Yeah. But with the sympathetic nervous system, we have such constant stimulus, whether it is emotional through social media and the algorithm playing into that, because it knows it will grip us a little longer, or whether it is our poor sleep. Poor sleep is a stimulant for the sympathetic nervous system, or whether it is too much caffeine.

Right.

Caffeine is, of course, obviously a stimulant for that. But most people don't appreciate the metabolic drive to another part of the book, which is hyperglycemia activates the sympathetic nervous system. It's almost as if your body is attempting to ramp up its metabolic engine to clear out the glucose that you're forcing it to use, or you're forcing it to be flooded with. This is one of the reasons I've started to harp so much on windows for carbohydrates and being exceptionally mindful of that evening window was my own experience. I am a terrible sleeper. I'm just always thinking about stuff. I'm anxious about one thing or another, or I'm not anxious and I'm just thinking about things. I just am a terrible sleeper. At one time of my life, just a few years ago, I was really looking at numbers and trying to understand my habits. I happened to be wearing a sleep tracking device and a CGM, and I noticed this almost perfect overlap where my worst nights and my worst sympathetic kind of tone during the night linked perfectly with when I went to bed hyperglycemic. So most people don't appreciate that hyperglycemia—

Interesting.

activates the sympathetic nervous system, which means your body's going to be a little warmer because things are moving a little faster. Your heart is beating harder, your blood pressure is higher, it's beating faster. That's a terrible thing to have happening when you're trying to go to bed.

Yeah.

The fight or flight doesn't work when you should be in rest and digest mode, or at least certainly just rest mode. So I think the, the, the fact that we are in this constant state of a sympathetic tone or a sympathetic drive is at least in part Driven by our incessant, constant carbohydrate consumption, which keeps us hyperglycemic almost all the time. And this is something fasting is antithetical to. Fasting, actually, now that I said that, there's a study I'm remembering right now that makes me want to correct myself. There is actually a temporary sympathetic bump in a fast. If I remember the timeline correctly, it was around 24 to 36 hours. Yep, something like that. It's nothing huge.

No.

But there's a little bit of a sympathetic bump. But prior to that and after that, no, you are, you are parasympathetic. This is, I think, why some people notice they're so much calmer when they're fasting. They're a little slower to anger. They can handle their spouse's quirks or their kids' drama. Things at work just doesn't faze them quite as much. And I think a part of it is because fasting doesn't want the body to be burning through stuff. It wants it to be kind of toned down. And so I think that's a good counter to, uh, to that, that sympathetic drive that we're living in, to try to shift our body over to parasympathetic.

Yeah, it's interesting. I, when I first started studying women's hormones, I saw that they were dramatically affected by insulin. And this was one reason I got into fasting, because I was like, wait a second, if I can do the ketogenic diet, I can do a lot of fasting with and bring their hemoglobin A1C down, get their fasting glucose and insulin down, then their hormones were balanced. But here is where I got stuck, is that above insulin is cortisol.

Mm-hmm.

So if cortisol goes up, you become more insulin resistant. So the reason I ask about the nervous system is after watching so many people fast, I've been trying to figure out why can I give fasting to one person and they rock it, and I give fast— that same fasting experience to another one And they get completely shut down. And I've come to the conclusion it's your nervous system state. So if I'm in fight—

I like that.

Right? If I'm in fight or flight, my— I'm naturally more insulin resistant because my body is moving glucose to the larger muscles so we can get away from the threat that's coming at us. So it gets difficult to lose weight when you're in fight or flight. And if you've been in fight or flight for too long, your nervous system will start to move into this freeze And now we want to numb ourselves. And all of a sudden, the carbohydrate consumption goes way up, but now we're calling it food noise. So I love what you just said, because I think that cortisol flexibility and metabolic flexibility go hand in hand.

That's a good— I like that comparison. I do. In fact, cortisol is a wonderful Cortisol is a powerful agent in the body. It's also essential in more and more— like, there are people who genuinely lose the ability to make cortisol where they have an autoimmune destruction of that part of the adrenal glands, and you'll die. You'll die if you don't get that corrected or supplemented or addressed. But more and more, I think one view that might be— this view might be helpful for the audience.

Yeah.

You and I both would call these stress hormones, and that's not wrong. They're part of a stress response.

Right.

But at the same time, I wouldn't want people to just uniformly look at them, cortisol or adrenaline, as villains, because— They're not, yeah. I more and more actually like to call them metabolic adaptation hormones. They're just a signal that your body is shifting into a different state. And I say, I kind of thought through this because there was so much concern about a cortisol bump with adherence to a ketogenic diet. Mind you, I think that concern is overplayed.

Mm-hmm.

It's not as significant or as relevant or as consistent as people think. But within a fast or within the adoption of a ketogenic diet, there is a bump in cortisol. And I found one study that showed it in women only. Men didn't, the male subjects did not have this. And so I would hear people say, well, I don't want to adhere to a ketogenic diet 'Cause my cortisol will go up. And I would think, one, it's a pretty modest bump, and it was shown to be very temporary. But the same thing over that same period of time, a slightly different timescale, you see epinephrine going up, and you see glucagon going up.

Yes.

Glucagon getting a lot more love, and it's going to get even more love when this newest GLP-1, retatrutide, comes out, because it's kind of playing on glucagon's ability to signal fat burning. All that to say, I looked at these hormones and thought, well, you could say that this is a metabolic stress, at least temporarily, as the body shifts, but it's more reflective of just this shift in metabolic or in fuel use. Back to your comment about metabolic flexibility and cortisol flexibility, I like that. I'd never heard it before, and kudos to you. If I ever say it again, I will try to remember to give you credit for it.

It's all good.

But it does, I think, help us understand Both are dynamic. With metabolic flexibility, we want the ability to shift between fuels. With cortisol flexibility, we want— we have to have cortisol on occasion. You will die without it.

That's right.

Even epinephrine and glucagon, they're not enough to help make up for what cortisol wants to do to help maintain blood glucose at a certain level. And so, it's important not to— as much as over my career I've painted insulin as a villain, Well, sure, but if you don't have it, you die.

Right, you need it.

Similarly, you need it. Similarly with cortisol, it's often painted as a villain, and in some contexts, like insulin, it is, but once again, if you don't have it, you're dead.

Right. You know, the way I like to look at it is we need a new relationship with these hormones, just like we need a new relationship to carbohydrates. It's like we're so looking for the absolute, and, you know, to your point, you need insulin. The one thing I think that's interesting about cortisol is, Its primary function is to make you move. So if I— if that was primarily what it was meant to do, you saw a stressor, cortisol came in, you got— you ran from the thing that was going to kill you.

Yeah, it helps you move. Yeah, it wants to give you the fuel. Yeah, to fuel what you're about— what you have to go do.

Right.

Yeah.

So that may— it makes you naturally more insulin resistant, so you have glucose in the big muscles so you can go. But if you are— you are stuck in a stress state at your desk, Now, where's that cortisol gonna go? And you're not moving. You're going against your biology.

Yeah, there's no goal for it.

That's right.

Yeah, yeah, I mean, our modern environment has definitely kind of hijacked. Back to the point that you'd brought up originally, the sympathetic nervous system, gosh, we need it. And it's fight or flight for a reason, because it would have been the physical danger that would've elicited this. But nowadays, we don't have that kind of physical danger. That's so uncommon. It's going to be a mental stressor, That there's no then outlet for it. It's the social anxiety of a young teenage girl feeling left out or, or an older adult worrying about their child or their, their retirement. There's no clear villain there. There's nothing to run away from that can act as a depot for all that circulating energy. So it lingers and starts contributing to chronic disease.

Yeah. What do you think about food pairing when we're looking at insulin and glucose? Like, so let's say I want to eat carbs. And I get that I'm going to eat nature's carbs. Does it matter what I pair it with? Should I pair it with a fat? Should I pair it with a protein? Because that's been a new conversation that's emerging.

Yeah, Mindy, my view on that is one of caution, where I think that the use of a CGM, which I wholeheartedly embrace, may lead some people into a false understanding of, of the upside or the utility of pairing. So by all of that, I mean, a person could have a piece of bread and they would eat that plain piece of bread and look at a really big spike in their glucose and it come back down really quickly, up and down. And then they say, well, look what happens when I pair that piece of bread with a big slab of peanut butter.

Right.

Now, what was a really big bump is a kind of more modest, delayed bump. Yeah, but it came with a lot more fat. Now, now, I— you and I are both very friendly when it comes to dietary fat, but combining an insulin spike and carbohydrates with a big bolus of fat, that's a really good way to get fat.

Mm-hmm.

Um, even if the protein and the fat from the peanut butter has shifted the way we digested that bread, we still do digest it. We've just taken one big spike and turned it into more of a mound. Now, Mm-hmm. I would say, well, there's a value in avoiding the hyperglycemic bump, absolutely. And especially if for no other reason than it prevents the big drop in the hypoglycemic rebound, which makes you want to go have more pieces of bread. So I think there's value there, but looking at it solely through the lens of glycemic control, I think, is a little too narrow because you are still getting an insulin bump from that bread, and now, High insulin plus high calorie with fat. Boy, that is a wonderfully fattening combination. So, but having said that, by putting the peanut butter on that bread, you probably won't eat as much. Yeah, because that is going to be— Yes, it's going to be so much more satiating that if you're just eating the bread with honey on it or something, oh my gosh, I could easily eat 10 pieces of toast. Like that.

But if I'm taking a nap, then I'd have to take a nap.

Yeah, that's right. But if I had— if I have a piece of toast or something with peanut butter, I have 2 and I'm done.

Yeah.

And I feel very satisfied. I have a lot of satiation from that. So I don't want any— I don't want my answer initially with CGM alone to present a negative view. I still think pairing is probably the better way to do it, but I think it might be prudent to be mindful of what you're pairing. For example, if I were having a plain piece of bread with cheese, that I don't think is as healthy as an apple with cheese, because the bread essentially has no fiber in it to help control the consumption, the digestion of that glucose, whereas the apple still has some digestible— it has some fructose and glucose which are going to get in. But the fact that it had— Or maybe let's go back to peanut butter. Because I know people will eat an apple with peanut butter. You get an apple slice, dip it in peanut butter. I think that would be better than a comparable amount of carbs in the form of 2 pieces of bread or a piece of bread with peanut butter, where that is— there's no fiber coming with that glucose and you're just ripping right back into the body. So I think pairing has value, but I think the pairing is better when it is paired with the carbs that we'd already defined as good.

Yeah. With fiber. I was thinking the same thing as you were talking. I'm like, well, what about— I was thinking exactly about apples. I'm like, what about apples and nut butter? So then is there ever a case for bread?

I hate to say this because I love a freshly baked loaf of bread. It's one of the most intoxicating scents, I think, for me at least. But there's very little case to be made for normal bread as we eat it. I think that the more you have true— this, this comes to the kind of burdens in the book that the metabolic burden and actually the, the other burden, the anti-nutrient burden, these chemicals that come with our carbs that want to punish us for eating them by, by compromising our digestion. When you have fermented a carbohydrate, You have not only reduced the amount of digestible glucose in that carbohydrate because the bacteria are eating that glucose, they leave the protein, they leave the fat. In fact, they give back good fats in the form of short-chain fatty acids. That's why whatever's fermented tastes a bit tart, because short-chain fats have a tart taste activation. But at the same time, the process of fermentation has often stripped down a considerable amount of the anti-nutrients. Things like the phytates and the tannins, the trypsin inhibitors, these, these anti-nutrients that want to punish us for eating the plant, they get heavily, heavily cut down over the process of fermentation. So to me, back to— so bread, so sourdough, a true fermented sourdough.

Yeah, I was wondering about that.

Yeah, that's what I'm kind of getting around to in a long-winded way. But it has to be people who just go to the grocery store and think they're going to buy from sourdough bread, probably what you're buying is just one that's had a little bit of vinegar added into it to give it a tart taste. And so it's a fake sourdough. Now, I'm a fan of vinegar, of course, but that's not the same. And so you want to make sure that it's a true sourdough started from a true starter. You know, this, this little colony of a fermented kind of dough. And that's not so common. You can find them, but it's likely not going to be in the typical area of your bread section at the grocery store.

Yeah.

It's probably going to be in the kind of bakery section and you want to turn it over. And make sure that it has some mention of a starter, or at least it doesn't show that it has added vinegar into it just to fake the flavor or the taste of a sourdough. That's really powerful.

Yeah. What do you think of this, uh, how enamored everybody is right now with the GLP-1 drugs? Where does this fit in? Because what I'm hearing, and I hope everybody else is hearing this, is that we've abused carbs. There's not much especially the highly refined carbohydrates, there's not much benefit there. And now we have a world that's obese, we have a world that is high in food noise. And so we found a drug to solve for that. And, you know, it sounds so trite when I say it that way, but then on the flip side, people's food noise going away is life-changing.

Oh yeah, yeah, yeah. Mindy, I suspect our thoughts on GLP-1 I think they're probably going to be pretty aligned. I initially came out very opposed to the use of GLP-1 medications for obesity. I've been familiar with them since my PhD days.

Yeah, I know.

In the early 2000s. Yeah. When they were just used, they were this obscure little diabetes class of drugs. And there they worked pretty well. And the mild nausea was just considered a kind of throwaway side effect. But they found, well, if we kind of turn up the nausea a little bit, that's a crass way of putting it, but I don't think it's totally wrong. Boy, people just started eating less. Um, and, and much of the benefit of GLP-1 appears to be the delayed gastric emptying, but you cannot deny the central nervous signaling. So my own views, I just want everyone to know, have, have evolved a little bit. My initial opposition was based on primarily on the lean mass loss studies. However, over time, I have— there are studies now more and more to show that actually muscle mass doesn't change. Muscle strength doesn't change. What could be happening is, well, there's a slight change in muscle mass, but it's probably the loss of the, the lower levels of muscle fat and muscle glycogen, which are accounting for the, the lean mass loss. It's not actual muscle protein, because again, muscle strength appears in every study I've seen to be totally unchanged. In some studies, it's even gone up. And part of what What is when people use a DEXA scan to measure body fat and lean mass versus fat mass and fat-free mass, even the liver, everything in the liver gets considered fat-free mass. Even if the liver gets 10 pounds smaller because it has a lot less fat in it, it's marked as a fat-free mass loss or a mean or a lean mass loss.

Yeah.

This was a study done in animals and then confirmed validated, at least at a superficial level, in humans, finding that, again, a lot of what gets pegged as lean mass loss could just be the reduction in liver mass, that the liver's smaller because it has a lot less fat and glycogen in it, which makes some sense. So my view on GLP-1s is that they should not be used as weight loss drugs. That shouldn't be the marketing or the, the message when the physician gives this to the patient. Don't say, This is your weight loss drug, because to me, that puts the patient in a frame of mind to think, oh, well, then I'm just going to keep eating what I was eating. And as long as I don't— if I'll just stop when I feel sick, eventually 2 things are going to happen. The drug starts to have diminishing returns. That's been well shown at 2 years as the dose keeps scaling up. At 2 years, cravings for sweet things comes back to total normal levels.

Wow.

Even though they've been scaling up the drug, So you have diminishing returns. And then the— at that, along that same time, the almost invariable just shrugging of the shoulder and saying, all right, well, I'm going to get off the drug. And then they gain all their weight back because they never learned habits. So to me, right, to me, the best use of a GLP-1 drug is this is a drug that's going to help you learn to control your cravings for carbohydrates.

Yeah.

Because, Mindy, everyone, if they're being honest with themselves, That's what people crave, right? No one's sitting around craving a plate of bacon and eggs. If only— no one. Even you, Mindy, as much as you and I know, we don't crave bacon and eggs. No, we want something sweet and gooey. Yeah, bacon maybe. Because we want something sweet and gooey or salty and crunchy. Bacon can meet that one. But for the most part, it's going to be a carbohydrate that people are craving. In all of the studies of addiction when it comes to food in humans, It's always carbs. That is the one single consistent thread. Some people would say, well, carbs with fat or carbs alone, but it's always carbs as the one left standing when you look at addiction. So I think that's the best— where you and I would be kind of preaching this message of control your carbs, be smart about your carbs, good carbs, bad carbs. But then the person comes back a week or a month later and says, I have been trying, I just can't.

Mm-hmm.

I can't do it. I'm addicted. That, to me, is the moment where a GLP-1 can be effective, because GLP-1s can help with addiction. In fact, this has been shown with cocaine addiction, with alcohol addiction, heroin, gambling.

Gambling.

Yeah.

Calm down. Yeah.

There are people who— there's clearly this kind of off-target use to help control addictions. So to me, I would love for the physician to say, here's a drug that's going to help you temporarily Learn how to control your carbs. And we're going to be working with you to identify habits. And then we— I would say use it at the lowest possible dose.

Right.

Which is just effective enough for, for you to be hearing that temptation. But there's still enough self-will. There's still enough agency involved that you still have to be a little tough and say, no, I hear the temptation and I recognize it, but I'm going to say no. Then we start strengthening that mental muscle to say no. And that gives the person an off-ramp because they should— I don't think a person should look at these drugs as indefinite. I think there should be— the moment a person goes on, working with their clinician, there should be a way for them to see an opportunity to get off.

Yeah.

And I think that opportunity is essentially defined by your ability. Have you developed new habits? Have you overcome some addictions? And now you know what it looks and feels like Right. So that when you hear those addictions or those temptations, that siren call of that bowl of cereal every evening, in my case, can you look at that and say, no, I hear you, I see you, but I'm going to— I'm not going to do it. And then you're developing the discipline which enables you to get off it. Just like an athlete who's banged up a knee and they're on a crutch. The crutch just helps them until they're strong enough to get off it.

That's a good analogy.

I think the GLP-1 helps them until they're strong enough to get off it.

Do you think there are foods we can eat to make our own GLP-1? Like, I'll show you one that I researched recently that I had to go back and triple-check, and it was oatmeal. And what they were saying about oatmeal, what the study said, is it slows gastric emptying.

Mm-hmm.

And I will tell you, when I was in practice, everybody and their brother eats oatmeal for breakfast. I had— I did not realize how addicted people were to oatmeal. And, uh, I couldn't understand why people couldn't— like, it was almost as powerful as their morning coffee. And I'm wondering if they're— you know, oatmeal's sticky and it's got that gelatinous character to it and it slows gastric emptying.

Yeah, yeah. Well, I think that's a— that would be a known— that would be an obvious variable that would be relevant and would be a knock in favor of oatmeal, that it would slow gastric emptying. Anything that generally slows gastric emptying within reason, I think we could look at as a good thing. But there are, for reasons we don't fully know, some people can have a robust GLP-1 response to a particular food while the other person won't.

Right.

There was a paper to put a very fine point on this. What indeed part of what has informed my own view of GLP-1s that I just finished articulating, part of that was influenced by this paper was published in 1996. And they found that they looked at women and identified— split them into 2 groups: women who were lean and women who had obesity. And they gave them a high-fat meal and found that they both had a modest but fairly— there's a little bit of overlap response with GLP-1. Then they gave these 2 groups a high-carbohydrate meal. The lean women had an enormous GLP-1 release. The obese women Didn't leave baseline at one time over 3 hours. At no point did it reach a statistically significant elevation. So think about this and the compassion that that would elicit in me. One person could eat, let's say, a bowl of oatmeal, which is a lot of carbohydrate. That'd be a high-carb meal and get a big GLP-1 response.

Right.

Someone may eat those, may eat those carbs and get no significant GLP-1 response and be deprived of the satiety and the gastric emptying that would've come with it. So I think it's prudent for us to acknowledge that GLP-1 matters. Boy, does it ever. But not all foods are going to necessarily have an equal response. And so as much as I wish we could kind of come to a clear algorithm to identify the best foods or the worst foods, I just don't think that's going to be accurate. Back to a message that you and I both— I know you've been a particularly good voice in this regard. Everyone is individual.

Yeah.

And so it's going to be a matter of some experimentation.

Yeah, and that's where people get stuck. They're like, oh, now I got to think for myself, and it gets really, really difficult. If you could change— just wave a magic wand and change people's, uh, relationship to carbohydrates, what, what would that look like?

Yeah, it, it would be to try to help change the food culture or our relationship in a way that we would— we're simply getting fewer carbs from bags and boxes with barcodes That they would be generally whole fruits and vegetables. And then, and yeah, I mean, consumed with the fiber that ought to come with those carbs. And then to go a little beyond just the metabolic, it would be to focus even more on ways to reduce, say, the anti-nutrient burden. Like, is it prudent to peel, to remove the peel? Because that's where a lot of fruits and vegetables concentrate their anti-nutrients, especially vegetables. Is it prudent to ferment it?

Right.

The more you could look at— when I lived in Russia in the late '90s and I couldn't believe how much everything was pickled. Of course, cucumbers were pickled, but they would pickle tomatoes, they would pickle watermelon. And I thought, pickled watermelon? Oh my gosh, it was so delicious. I couldn't believe it. The salty and the little bit of the sweet with it. But suffice to say, anything that is fermented is going to have both reduced the metabolic burden and that anti-nutrient burden. And then, you know, the peeling, especially when it comes to vegetables, if you— when by removing the peel or doing like a baking soda wash to try to get rid of some of the chemical residue, because in order to— this is a kind of a big tangent here, but I'll keep it brief. It is not natural to produce fruits and vegetables as big and juicy and hearty and monocropped.

Yeah. Yeah.

As we have. Now, I'm not saying that makes them bad, but when you go into a field and you force that plot of land to only grow tomatoes, which is a perfectly good fruit, that's very healthy and good, very low glycemic load, but it is not natural for this many thousands of acres to only grow tomatoes.

Right.

Now, again, I'm not saying it's bad, but we have to impose our will on that plot of land to force it to grow that plant.

Yeah.

Yeah. So we have a lot of chemicals that we use to help that happen. And I'm not saying that's uniformly bad, but I don't want those chemicals that are killing the bugs. Well, they're not going to do me any good.

Right.

And so there are things where a person can, of course, with tomato, you're not peeling off the peel, but where you can, you're removing the external, the portion of it that would have gotten the burden of those chemicals. And when you can't, Then something like as modest as like a baking soda, like just scrubbing it with baking soda. Baking soda has been shown to heavily remove and neutralize a lot of those pesticide and herbicide, that chemical burden, you know, of the burdens that I've been alluding to. So to me, if I could wave a wand, I guess I mentioned a lot of little waves here.

Big wand. Your wand's big.

Yeah, yeah, yeah. Thank you. Thank you, Mindy. Yeah, I think that there's a lot that went into it, but hopefully it kind of can come to, you know, Yeah.

And what do you think about for women? If a woman— if you were talking to a woman and she asked you, what's the number one thing I can do to get my health back on track? What would it be?

Oh, gosh. That's such a great question. Allow me to have more of a philosophical answer to that.

Yeah, of course.

A substantial, actionable one. I would say one, just because I think it's so important, Be kind to yourself.

Yeah.

I think women are a lot— I see this in my dear wife who is so capable. What an amazing homemaker she is. And I just love her to death. And she is so much harder on herself than I am on myself. I'm critical of myself in ways that I think are productive. She's critical of herself in ways that I don't think are quite as productive. And so when it comes to women, There's just so much more external pressure to look a particular way. And oh my gosh, I just— so, so the philosophical part of my answer is just love your curves.

Yeah, be kind.

Love being a woman and know that pretty much every single man in your life prefers you that way.

Yeah, right.

Any man who matters, for whatever that's worth. Of course, you don't find validation in the men necessarily, but be a little more generous with your view of yourself. And then the second thing is, I would say, at the risk of oversimplifying it, just control your carbs.

Yeah.

That is going to be the primary villain that is making you not feel your best. And, and at the risk of now saying it for the probably the 4th time, if it comes in a bag or a box with a barcode, beware. Focus on whole fruits and vegetables. If, if they're fermented, wonderful. If they've been washed with a little bit of baking soda, wonderful. But those are going to be deeper layers to it. If you're just focusing on eating whole fruits and vegetables, you are accomplishing the vast majority of what you'd need to do in order to really live and optimize your metabolic health, to optimize longevity and just feeling your best.

Yeah, it's so well said. I agree. It's not complicated. And I think we've overcomplicated weight loss for sure. And health.

It's simple, Mindy. It's simple. But that doesn't mean it's easy.

Right.

It doesn't mean it's easy. So back to the compassion, back to the individual approach to this. Back to the role of GLP-1, you know, and how it's used or how it's abused. And I say that as a college professor where there are these young, lean, perfectly healthy 20-year-old girls who are on GLP-1s. And I think your parents have failed you, you dear girl. You should not be on this. I literally just had a girl ask me after class the other day, I heard you talk about this. I'm on a GLP-1. And I'm looking at her thinking, sweetheart, why?

Why?

Yeah, yeah. You need a sandwich. Get off that GLP-1.

Yeah, yeah, agreed, agreed. Oh well, I love this. I know you got to go. I could talk to you forever. Talk about your book. Why'd you write it? Where do we find it? I think, yeah, it's gonna make a big impact.

Yeah, I, I hope it was. It was a really fun book for me to write where I wanted to look more at the global diet and wonder, is there something that went beyond just insulin here? And, and at the time, I'd started collaborating with a colleague here who studies glycation This irreversible binding of when glucose gets too high, how it will bind to a protein and then permanently change it. And that was the seed for me to start looking into the kind of outline of the book that became The Carb Crisis. Yeah, so it's more just about the substance of those foods themselves rather than the hormone response to them, but the consequences of those things.

It's beautiful.

But yeah, it's called The Carb Crisis. It's available for preorder. Now, anywhere books are sold. I think it's officially released in December. Yeah. So depending on when this comes out, it'll still be a little ahead of it. Yeah, it will be. But please everyone go preorder. I've never had a bestseller. I'd love to have an actual bestseller.

Oh, Ben, we gotta get that for you.

No, come on.

Okay. Help a brother out. Okay. I'm gonna rally the troops. Yeah, you deserve that. What date is it coming out in December?

I'm sorry, I think it's mid-December. I assume it might be mid-December. But anywhere books are sold now, it's for preorder.

Yeah. Yeah. Yeah, so we'll leave links down in the notes here and we'll get the word out because the topic is massively important. So I always have just appreciated you. I learned so much and—

Oh, the feeling's mutual, Mindy. Really, you and I are two peas in a pod. We're fighting the same fight.

I love it. Yeah, yeah, great. Thank you, Ben.

Thanks.