Discussing the Paleo Diet with an Expert - with Robb Wolf | The Empowering Neurologist EP. 42

Hello everyone, welcome to The Empowering Neurologist. I'm Dr. David Perlmutter. Our interview today is with Robb Wolf. That's certainly a name that's going to be very familiar to a lot of you, especially those of you who are involved in the paleo movement. You'll remember Rob is, in fact, the author of the New York Times bestseller, The Paleo Solution, that he wrote back in 2010. He is a former research biochemist, and his new book is called Wired to Eat, and that's what we're going to be talking about today. He has been and is an editor for the Journal of Nutrition and Metabolism and Journal of Evolutionary Health. Rob serves on the board of directors of Specialty Health Medical Clinic, which is located in Reno, Nevada. Yes. He is also a consultant for Naval Special Warfare Resilience Program, and he is a former California State Powerlifting Champion. Again, Rob is one of the pioneers, and certainly his works have served as the harbinger for the whole paleo movement. This is a very exciting book, and I'm really looking forward to our interview today. Robb Wolf, great to talk to you again.

Huge honor to see you. Hope all is well with you.

As I mentioned in the intro, we're going to talk today about your new book, Wired to Eat, as if we weren't. We're wired to eat. We're going to get into this and explore it really in depth, but let's first recap. Your book, The Paleo Solution, was really, I think, a landmark. It really set the stage for a movement that has captivated the world in terms of trying to emulate the diet of our ancestors. In other words, kind of recapitulate our communication with our genes, basically. But that said, that's— that was written in 2010. What have you been up to since 2010?

Oh man, about 5 years ago we moved to Reno, Nevada, of all places, and it was supposed to be just kind of a holdover, and we were pregnant with our first daughter. My wife's father lived here, so we thought we'd be here a year and then figure out where we were really gonna live. And I was in town maybe 3 weeks and I got a phone call from a guy who identified himself as Greenie. And he said, hey, we have a medical clinic in town. You should come down and check all this out. And Greenie turned out to be a guy, Dr. Jim Greenwald, who is a now retired but formerly pretty famous orthopedic surgeon. And they had created a wellness program And as an outgrowth of the wellness program, they worked with the Reno Police and Reno Fire Department. They found 35 individuals that were at high risk for type 2 diabetes and cardiovascular disease. They got these folks on a paleo-type diet, modified their sleep and exercise as best they could, and based off the changes in the health risk assessment parameters and also the blood work, it's estimated that the pilot study alone saved the city of Reno $22 million prorated over a 10-year period. Wow. with a 33-to-1 return on investment. And so I was pretty impressed with that. You know, like I had suspected that there was some sort of benefit similar to that, you know, lurking using this kind of ancestral health evolutionary medicine template. But this wasn't one of the first best examples where we had a pretty tightly controlled study, some good economic analysis. And so the last 4 or 5 years I've been working to try to scale this whole thing up and, and kind of take it out to the masses, which I, I must say somewhat chagrined. It's been a much more complex and difficult process than what I thought. Like, the savings and the efficacy were so incredible that I assumed that this would just go like wildfire. And we have talked to people at the very highest levels of the insurance scene, and the way that the incentives and the whole system is set up right now, it's not well aligned actually for cost savings and efficiency and whatnot. It's a very— neurotic scene, as I'm sure you are earlobe deep in that, so you could articulate it better than I, but that's what I've been doing the last, you know, 5, 6 years, helping these folks to develop that program. And parallel to that, I've continued to do more research and just kind of look at where the messaging, particularly within my first book, where did that succeed, where did it fail, and is there a different way to reach people? And that's largely this outgrowth of where Wired to Eat came from.

In reading the book, which I did last weekend, I was taken by— this is a bit of a radical shift for you because The Paleo Solution and others who had written earlier, I think, tried to paint a broad stroke that was as encompassing as possible based upon the premise, again, of trying to emulate this relationship of— Mm-hmm. lifestyle choices, in this case primarily food, in terms of how they influence our gene expression and our metabolism. So it was a very encompassing, broad-stroke approach, and these are the tenets of the Paleo diet. Having said that, what it looks like you're doing now is retrenching a bit, and I mean that in a good way. Mm-hmm. There's been, as everybody knows, this move towards personalized medicine, where we try to determine based upon a person's microbiome, genome, early life events, ongoing events, etc., what might be the specific best recommendations for that individual. And in a very detailed way, I think that is the core of the new book. So it's certainly a bit of a shift for Robb Wolf here that, you know, you made these broad stroke recommendations, which I think will help a lot of people, but now Your new book is really along that vein of being a little, you know, quite a bit more personalized. And what I think is really exciting is it's not high-tech personalized in that you provide, you know, kind of an assessment. In fact, a specific assessment for individuals when they read the book. So tell us how you go about allowing a reader to assess himself or herself, and then what Is the outcome that they can expect based upon your recommendations?

Sure, that's a fantastic question. And, and, uh, maybe even just to back up a bit before that, I think we both would love it if like a simple one-size-fits-all approach worked. You know, it's like just do ABC and, and, you know, you'll be off and running. And a basic, you know, kind of whole foods, lowish carb, which can be kind of variable, but, you know, whole foods, lowish carb, paleo ancestral health kind of diet, go to bed early, get some exercise, feed your gut biome. That's a pretty darn good place to start. Like, you're not going to send too many people astray starting with that. But there are a ton of details that need to be addressed if we're going to go from that very big picture and get a little more granular and help people address individual needs. And so part of what I do in that, that process is I help people figure out where they are on what I call a health map. And it's basically, who are you and where are you at currently? You know, uh, Uh, what's your age? Uh, do— are you overweight? Are you underweight? Do you have an autoimmune disease? Do you feel good? Do you feel bad? You know, and so there's some, some, uh, very simple question and answer stuff that I have the person do that starts off very subjective, you know, like how do you feel between meals and, and, uh, what's your general energy levels? And then it progresses to more objective. And so we start looking at things like waist-to-hip measurement, blood pressure, maybe even some blood work. So we have a spectrum of both subjective and objective measurements and observations that helps us paint where the person is in their individual health story. This largely boils down to what their insulin sensitivity is, which is still though an outgrowth not just of total carbohydrate load in the diet, but their sleep and their gut biome and their stress because all those things influence it.

That's really, really well said.

Thank you.

Again, for our viewers, I want to just take that step back. I want to take a step back, and that is to say that what Robb Wolf is talking about here are not really these very high-tech, expensive, can't seem to come by them technologies that are, you know, that you have to find and fly to a place and have done. These are pretty straightforward, simple measurements, some very straightforward, simple blood tests that are pretty routinely available, and then measurements of things like waist-to-hip ratio. You need some very high-tech machinery for that called a tape measure. Right. But I'm really there with you that you can absolutely extrapolate from this data and get a really strong sense as to whom you are dealing with in terms of what that person's— not just morphology is like, but what their physiology is like.

Right, right. Yeah, and it's kind of funny. I don't know if because my past life I was an organic biochemist and I had to weigh and measure every single thing that I did in my life, and now I just like things simple, you know. And clearly there's some Great benefits from some quantified self-movement and things like heart rate variability monitors. You can do continuous blood glucose monitors. There's some really cool stuff, but I also put a lot of stock in people just being in their own skin and feeling what's going on. But also, if we can anchor that with some more objective measures, you know, like getting an electronic blood pressure cuff is like $15 at, you know, the local pharmacy. And as you well know, and you've talked about in your work, one of the first things that goes sideways with people when they're insulin resistant— is oftentimes an elevated blood pressure. And, it's also one of the most dangerous problems that they face because of increased stroke and also other cardiovascular risk parameters. And, if we start getting things right, it's one of the very first things to respond favorably. So, it can be a really good benchmark and it can also act as a really incredible carrot because people 5, 6 days in, they're like, wow, my systolic and diastolic blood pressures are down 10 points each and I'm feeling way better. So, I do try to keep it as simple as possible, but provide both the subjective and objective anchors so that we could either just be in our skin and kind of get a sense of how our sleep, food, movements, and gut biome are influencing our day-to-day experience, but also a little bit of objectivity too. It's always good to get some outside verification that what we think is going on is really happening.

We live in a world by and large that is reactive as opposed to proactive as it relates to health. And, you know, there's so many individuals who really are under this mythic notion that they can live their lives come what may, and then there's modern medicine with all the great advances we've made that can fix their diabetes, hypertension, their inflammation, inflammatory disorders, whether that's coronary heart disease or Alzheimer's. And, you know, the reality is we can't really very well unwind any of those situations And yet the answers are really at your fingertips. I have to tell you, I was reading your book out by the pool, and about every 15 minutes I would go, yeah! Nice. Because what I like about it, it's, it's for the common man. Again, it's not high-tech. And so often these days we see biohackers who are just, you know, all over the highest level of technology and trying to interpret that to create these personalized approaches that people then need. And people think, again, they need to go to a clinic. That's not what this book is all about. And I really I really commend you for that because this is for, you know, the general audience to really, you know, kind of get their arms around the fact that their health destiny is in their hands. It's a product of their doing. So

yeah, thank you. One of the points that I make in the book, and it was kind of a pretty good insight even in my own health experience, we all know someone that can tolerate High-carb diet, not sleep that well, you know, and they're still lean, they're high-functioning, and maybe it catches up with them at some point, but it catches up with me much earlier. Like, I, I, uh, my, my genetics are probably more the shallow end of the gene pool, but the, the point that I made in the book—

Time to take the diving board away.

Exactly, yeah. But the point that I made in the book was even though, say, like, my early life history wasn't ideal— I had antibiotics, I wasn't breastfed, I was vaginally born, but you know, there's pluses and minuses— but Understanding what I do now about blood glucose response, insulin sensitivity, sleep, etc., etc., even though I didn't pull the genetic lottery, I can eat and sleep and move in a way that makes my physiology look pretty darn close to someone that did pull the genetic lottery. Now, can I have as much fat? No.

You made a great point at the beginning, at the intro— in the introduction of your book. Like so many others, your early life health was, you know, pretty dismal. In fact, you were about ready to cash in your chips from the sound of your description.

Yeah.

And, you know, like, again, like other individuals, you made the lemonade out of the lemons, didn't add the sugar, gratefully, and said, you know, I've had these challenges and this is not going to be my destiny. And that's, you know, that's what obviously motivated you earlier on and seems to motivate you now in the new book.

Absolutely. Yeah. Yeah. And it's a pretty empowering point to reach that, you know, regardless of where your situation is, you know, to coin a phrase from Monty Python, I'm not dead yet. You know, as long as we still have— not dead yet.

I've come for your liver.

Right. You know, if you're still above ground, there's, there's hope. There's something that can probably be done and, and probably a lot more than what most people, uh, suspect. And, and that's a pretty empowering, uh, thing to realize. Now, it doesn't mean it's necessarily going to be easy. It doesn't necessarily mean it's going to be painless. And that's another feature of the book is talking about the fundamental programming that forged the genetics that made us successful in the past and are kind of working against us today. We are genetically programmed to eat anything that's not nailed down and then rest. And this is just some basic economics. It's called optimum foraging strategy. Any critter that burns more energy than what it gets out of its environment, other than humans and our pets, they die because it's just kind of a basic accounting story. So it's not surprising that if our genetics were forged in an environment where we sought out every bit of calories and nutrition that we could while burning as few calories as possible, if that's the way that we are set up, but now we can order food to our front door, it comes in an infinite variety of options. We don't, you know, we can work from a laptop and do no physical work. We have kind of won from a gen— you know, an evolutionary biology perspective in that we've really maxed out optimum foraging strategy. Like, we get all kinds of calories and don't have to do anything, but it's so good that it's actually making us sick now. But it— and we, you know, but everything that made us successful in the past is now kind of playing against us today, and it takes a little bit of effort to pull back into Kind of see what those parameters are and be able to make some different decisions.

Well, it's— the notion of being a hunter-gatherer doesn't mean you hunt down a 7-Eleven and gather up the Doritos, which are— the point is, there are so many opportunities for incredibly calorie-dense foods, but again, making the point that we're well beyond just the understanding of the calorie in versus calorie out. Right. Balance sheet here, that the type of food we eat has a huge— the type of calories we consume have huge influences in terms of gene expression, in terms of regulation of insulin, etc. I think you leverage that wonderfully in setting people up. You've come a long way from Paleo and the new book, but where does Paleo figure into what you're talking about now?

Yeah, I mean, so, you know, when you ask me what I've been doing the last 5, 6 years, that, that story about the risk assessment here in Reno, that was really powerful for me. It was, you know, there's nothing else that I've seen that has worked to that degree, has those types of numbers, uh, and we've been able to replicate it in other areas. So that's very powerful. So I still start folks— so in the beginning of the book, we, we lay the foundation of kind of how we're wired to eat and it— it addresses a lot of the why. You know, why do we do this? Why would we do that? And then the second part of the book is really the how. And the beginning of the how is a 30-day reset which is effectively a Paleo-type diet and we do a prescreen using some of those objective and subjective measures to figure out where you are on the insulin sensitivity, insulin resistance story. We do a little bit of recommended diagnostics to figure out if you have some gut issues or autoimmune con— conditions because I have I have 4 different meal plans in the book, a basic 30-day reset, which is basically kind of a Paleo approach, an autoimmune Paleo, a ketogenic approach, and then also a transitional ketogenic approach, which is a low glycemic load, high MCT oil, kind of— what's the gal's name? Not Nestlé. She really popularized this whole process using coconut oil on her husband. She's a physician also.

I'll look it up in just a minute.

Yeah, yeah, yeah. I can't believe I blanked on that. I'll Google it while I'm looking at you. Perfect. But it's— so I have these 4 different approaches that all kind of get woven into that basic 30-day beginning template. And so we motor along with that, and ideally folks will get— Mary Newport, there we go. Thank you, thank you, thank you.

My upload speed was a little slow. Actually, for our viewers, you can look back to the interview we did with Mary Newport where, you know, exactly what Robb Wolf is talking about, talks about the science of upping the availability of so-called ketone bodies to be used not only as fuel but also as signaling molecules, at least as it relates to beta-hydroxybutyrate. Where were we, Rob?

We use that 30-day period to reestablish gut health, rewire the neuroregulation of appetite, try to normalize a lot of those parameters using basically a Paleo-type approach. I recommend what's called a 7-day carb test, and that can be, again, either mainly subjective or subjective and objective. I really encourage people to get just an inexpensive blood glucose meter. And then we, we tend to eat kind of the same foods most of the time, so I recommend that people pick 7 to 10 carb sources that they, they want to experiment with. I recommend that they check it in the morning. And they try to set it up as close to a scientific experiment as they can. Sleep the same way. If you have coffee, then have coffee all of those days. If you, you know, try not to randomize all that. And the, the carb test then gives us a pretty good insight into what your blood glucose response is to various foods. And one of the really surprising findings of the last couple of years is that for any given individual, something like white rice may cause a barely perceptible blood glucose increase or it may put the person into near diabetic levels. And this is a highly individual story and there appears to be both the genetic component, the epigenetic component largely driven by gut health, sleep, exercise status, but this is definitely the area that we can really get things well refined for an individual's metabolism because again, a really insulin-sensitive individual can throw almost any carbohydrate source down and they get a very— modest blood glucose response and consequently insulin response. Someone like me, unfortunately, both parents developed type 2 diabetes in their early 30s. My 23andMe genetics analysis suggests I'm about 300% more likely than average to develop type 2 diabetes. So I really need to keep my carbohydrate content and types pretty tightly under control. And what I discovered was that things like white rice and white potatoes would put my blood sugar near diabetic levels, whereas fruits, vegetables, even some lentils, interestingly, lentils I do pretty well with, whereas black beans and kidney beans I do pretty poorly with. So it was really fascinating what things I did do well with and what things I didn't do well with. And I've got to be honest, the whole carb test is a little bit of a bait and switch. Over the course of time, I've learned That you can tell people what to do and you'll get a certain degree of buy-in, but if you can make them feel like they've got a lot of latitude, but then they do experimentation that, you know, allows them to arrive at the answer, then this is largely— it's a much more effective way to get people to do things. And so even though in the book I do believe that there is a much broader spectrum of how people respond to various carbohydrate sources than what we've generally Uh-huh. Talked about in kind of the Paleo low-carb scene, but I also have seen how powerful that approach is. And so I've got to be honest, like the book sets folks up to have a sense that, oh man, maybe I can eat white rice. Maybe I can kick my heels up and, and do all this stuff. But when they actually run the tests, it usually, you know, if they're being honest about it, it, it provides them a feedback mechanism that says, no, this is putting your blood glucose at near diabetic levels. And so we either avoid that food or we dramatically reduce the amount of the serving that they have. I'll be honest that there is somewhat of a bait and switch in the book, but instead of telling people emphatically, don't eat these foods, I give them a sense that who knows, maybe it will work for you, and then when they experiment on themselves, they'll probably find that it's actually not as great of a fit as what they might hope.

Well, we all know that we make recommendations, that readers generally try to follow recommendations, but they're— everybody cheats.

Right.

And you have actually a nice discussion about that, and tell us about that.

Oh man, so you probably experienced this pretty early on, but you know, when I first started working with folks specifically related to nutrition, there was a certain person that would say almost out of the, you know, hi, my name is Rob, what's your name? And then the very next question was, When do I get to cheat or what do I get to cheat with? Like, I know you're the paleo guy, so what do I get to cheat with? And initially it, it seemed like a pretty reasonable question. You know, uh, in the back of my head I'm thinking, well, they're wondering if they ever get to eat a chocolate chip cookie again in their life. And, you know, depending on their gluten sensitivity and stuff like that, there may be some parameters, but clearly like we're gonna kick our heels up and have a little fun at, at, at some point. Uh, but what I discovered is the people who led with the cheating question, were the biggest pain in the backside that I'd ever met in my life. Like, there was just all kinds of drama that, that came out of that. And it's interesting, and this gets a little far afield, but you like evolutionary biology, so I'll go out into geek land a little bit. But all primates have a really strong sense of justice and right and wrong. Like, people know when they're being treated well and not well. And monkeys, you know, chimpanzees, all the same stuff. If somebody's being kind of victimized from one person to another, if they're Yeah. Being cheated, there's a social accounting for that and there's some really heavy repercussions for it. So we take the process of eating and we apply this word cheating to it, like I'm cheating on my diet or I'm cheating on this or that. But when you look at the root meaning of the word to cheat, it means to take an unfair advantage of someone or some situation. And I would ask people, whether you're eating Paleo or vegan or macrobiotic or whatever it is, if you choose to to eat off of your meal plan, who are you gaining an unfair advantage against? I mean, no one. The point that I make in the book when people start asking about the cheating is that we eat and there are consequences and that's it. But the process of emotionalizing cheating around food creates the same sense of drama and guilt and failure as if we did actually do something bad to someone. So there's a whole kind of weird It's an evolutionary biology kind of artifact if you can get your head wrapped around something that would have some negative social repercussions if you cheated someone and then you apply that to a situation in which there's no cheating that can occur. You can cheat on your taxes. You can cheat in a marriage. You can't cheat with food. You just have consequences with food.

But is it really cheating if Robb Wolf gave me the go-ahead to once a week eat X, Y, or Z? Then that whole paradigm crumbles.

It does, but I'm hoping to get people even beyond that. Like, I would really— I really want just, uh, uh, again, because there's some interesting psychology that I think is kind of an outgrowth of our evolutionary biology, that if we even put the term cheat attached to it, then we've got some problems. And so I, I, you know, make some recommendations. Let's assume that we do 3 meals a day. 7 days a week, that's 21 meals. Let's try to be on point 19 of those meals in general. And so that means there's kind of 2 free meals. But how free are those free meals if they're so free that it ends up looking more like, uh, you know, some sort of a hookers and cocaine binge in, in college or something? That's too much, you know.

And I don't know what college you went to. That's really quite the college.

Chico State, uh, it was Playboy's top party school in the nation in 1987. Oh, wow. It has no, no credibility beyond that. But it, uh, you know, if, um, if we can get folks to kind of diffuse that emotionality around the topic, then I, I think that we just— again, we're, we're starting from a spot where there's still work to do and there's still challenge. But one of the things that really motivated me to write this book is that I saw a lot of people struggling on kind of the psycho-emotional side And it was because of these senses of guilt, fear, failure, gee whiz, if I was only a better person, then this stuff would be easy, it wouldn't happen to me. And my goal was really to try to diffuse all that energy and then start from a baseline where, again, there's still work to be done. It's still oftentimes a challenge, but if we are at least beyond that— that process of moralizing our food, you know, like the— the whole term cheating. Then I think that we stand a pretty good chance to get better results.

I think that the problem is that we have created a scenario in which there are ideal images about what we should look like, not just from a cosmetic perspective, but even from a metabolic perspective. What are those goals that we're trying to achieve? That's the goal. That's the endgame, and yet a day off takes you out of training and you're not going to achieve that goal, which I promised myself I would do. What I often tell people is that your cells don't know that it's Christmas, New Year's, or your birthday. The notion of, well, it's my birthday. I'm going to eat as much cake as I can and end up sick the next day, your Your body is doing the same thing it will do 24/7, 365. I think when people realize that, you really want to keep your foot on the accelerator and not let up if you really— because you can get into some serious trouble very quickly. Right. Having said that, there are ways to cater to your desires which don't sink the boat, as in some dark chocolate, a glass of wine. Generally, foods I find are very satiating that have higher good fat content really get people through this, you know, the time or the times when they think they might otherwise crash and burn. But I would say that, you know, tomorrow is another day, and people do crash and burn, and it doesn't mean the program is finished. Everybody messes up, so you, you know, you wake up the next morning, it's a new day, and you get back on the train.

So I make that point, you know, you're— if you go do something that's off rails You are either— you can take it as a complete failure and abandon ship and everything's done, or you can say, oh, my next meal, I'm right back on track.

I think that people who watch interviews like this and who read the various books think that we all have the answers and we're 100% committed. We're doing our best. We're doing our best to set examples, but there's no one out there that I know of, myself included, who isn't 100% perfect on all the recommendations that we make. Face it, that's being as transparent as can be.

Right.

Now, I'd like to move on to— you know, you do cover fasting. It's something near and dear to me that I've always— I felt is, you know, really integral part of any of these programs, from the notion of jump-starting, but also from the perspective of relating back to your genome and augmenting expression of some really life-supportive gene pathways. So you touch upon fasting as well. Bring us up to date on that.

Yeah, so I take fasting and ketosis and kind of pull it out. It's the last chapter of the book. I believe the title is Hammer's Drills and Ketosis: The One Tool Your Doctor Is Unlikely to Ever Use. Clearly you're the exception in that, and that was why when you really came on the scene, it was such an incredible point of validation that somebody with your, your academic and clinical stature has embraced this kind of ancestral health approach. But my dad was a contractor, and it was funny when the contractors would get together because they would bicker about, oh, you should do things this way, or you should do things that way. But I kind of noticed that, you know, when it was time to use a screwdriver, used a screwdriver. When it was time to use a bandsaw, used a bandsaw. And when I've looked at this nutrition world in this medical world, it's either High carb or it's not, you know, or, or it's low carb. And either, you know, the two— it's oil and water, the two can't mix, there's no interface. And that was just kind of crazy to me. It's kind of like, these are tools. Each tool has its right place, and there's consequent, you know, and there's pluses and minuses to the various tools. But I've always looked at this, um, you know, this, uh, fasting and ketosis— these are, are fantastic tools. And the, the folks that follow your work They'll be well-versed in the fact that the state of ketosis, whether brought about by fasting or nutritional ketosis, huge benefit for things like epilepsy. We're discovering huge benefit for just a wide variety of neurological conditions in particular. Like if ketosis wins out of anything, cancer, autoimmune disease, neurodegenerative disease, I think neurodegeneration is really going to be the place that it really, really shines.

Which makes so much sense based upon just It's nothing more than the energy demands of the brain.

Exactly, yeah, just providing that alternate fuel source and, and normalizing oxidative stress and whatnot. Yeah, it's just really an incredible boon. But all that stuff said, as amazing as ketosis is and fasting is, there are situations that you might want to go a little easy on that, or maybe it's not an appropriate fit for you. I've seen a lot of CrossFit Games type people Mixed martial artists, jiu-jitsu players, and it's not to say they have to eat a high-carb diet. Like, I, I do a lot of Brazilian jiu-jitsu and I eat about 100 to 125 grams of carbs a day, which in ketosis land seems like a lot of carbs, but most people my size doing the level of work that I'm doing are eating 600 or 700 grams of carbs a day. So I'm pretty darn low-carb when, when you get right down to it. So But I find that there is a point where these highly glycolytically demanding sports like CrossFit or mixed martial arts, soccer, they can usually fat adapt up to a point, but they usually need a little bit of additional carbs just to make that whole process work. But it's really not that crazy of a change relative to what they were doing previously.

Let me add, if I could, my observations on athletes. In terms of being in ketosis or mild ketosis and cutting their carbs and relying on fat as a fuel source, I find that when we add back in adequate amounts of dietary fiber, that it really tends to smooth things out. You know, I find that when people are really pushing ketosis and are cutting their carbs, they unfortunately cut out some of the carbs that they desperately need, not so much as an energy source, but more as a prebiotic for the microbiome. Mm-hmm. So my word of caution is that if you're having issues with being on a modified ketogenic program and you're athletically training, to be certain that you're getting plenty and plenty of good prebiotic fiber, which is a carbohydrate complex, though. Right. And I often find that is the missing link and allows people to move forward with keto adaptation. Yeah. Mobilizing body fat as a fuel source and still allows them not to crash and burn or get this keto brain that we were hearing about. So, but your point is well taken. So you're right, a lot of advocates of ketogenic diets and in terms of athletics are going to nod their heads at you saying 120 to 150 grams of carbohydrate seems like an awful lot. But again, you know, at the level of activity that you're talking about, And provided you are— you know, they're adequate sources of good fat. Mm-hmm. It really depends on what your parameters then are going to look at. You'll want to follow your fasting insulin level, for example. You're already following your blood sugar, and, you know, some measurement of ketosis from time to time, whether you're testing your urine or blood, I think would not be unreasonable. But I think at the end of the day, and probably even the beginning of the day, the subjective assessment that you make— how do I feel this morning now that I'm waking up Or, how do I feel after a 10K run, is really very valid. How do I feel now versus how did I feel before when I was taking in a lot more carbs? Right. You make a point in the book about that, too, about the importance of leveraging subjective assessment, and I think that's really very, very important because while people can look good on paper and look good in terms of their lab studies, the bottom line is everybody wants to feel great, energetic, not have brain fog, have great libido, sleep well. I mean, that's what people are reading your book about, and have longevity.

Right, right. Yep, absolutely. And so, yeah, thank you. I really do— I'm a huge fan of ketosis and fasting. I mean, hard to find a person more passionate about it. But I also think that there are some, you know, when we look at the total population, there may be some Venn diagrams where it's not as perfect a fit as what we would hope.

A point also very well taken. It's not one size fits all. Right. I mean, for example, we know that the Inuit, the Greenland Inuit, whose diet at least traditionally was virtually all fat and protein based on seafaring mammals, and yet seem to have genetic adaptations or selection probably that selected these individuals Mm-hmm. To— with bigger livers for better levels of glycolysis, higher levels of ability to actually make sugar, make glucose from protein. And that said, would eat glycogen-containing animal parts that would resupplant their glycogen stores. So I think it's really healthy for all of us to take a step back from these pronouncements and realize that we are in the process of evolving our message as the science evolves and as we learn more about that science and about ourselves as well. I think what people like yourself and I are the subject of is criticism because we change our recommendations with time, and I would submit that that's exactly what our job is. It is to be malleable and accepting of new information and not really be bogged down with ideas that have fallen by the wayside. You know, there was a time a couple of decades ago when I had written about the importance of a low-fat diet in reference to immune modification for MS, and people say, oh, Perlmutter used to recommend low-fat, now he's recommending high-fat. So, you know, in defense of all of us, that's what we need to do. We need to stay open-minded and appreciative of others' ideas, ideas of others, because our tenets are going to change with time.

Yeah, I was just listening to a Dan Carlin podcast, and he was talking about the development of the atomic bomb, and he mentioned Robert Oppenheimer. The back and forth was something like, well, you used to say this, now why do you say that? And he said, well, sir, when I'm prevented presented with facts, I change my opinion based off the evolution of the facts. What do you do? You know, and with the implication being, well, once you form an opinion, then you, you ossify and dig your heels in and that's it. And a good number of people do that, and they will go through some remarkable psychic gyrations to try to make the rest of the world fit around that. That's it.

So these are the aha moments of life when, when you are challenged, you know. Right. The notion that we grow new brain cells was revolutionary in the world of science, revolutionary to me. That was hard and true that we couldn't grow new brain cells and that our genetic code was locked in a glass case and forever determined one-way direction, which the outflow of proteins based upon genetic code. The notion that we can epigenetically modify our gene expression moment to moment based upon lifestyle choices was heresy. It would have been considered heresy, you know, 25 years ago. And yet, look where we are now. And now, you know, all the books are written about our ability to change our genetic expression. Sure, it's great to see your 23andMe and understand what your genetic predispositions may be, but to understand that those are not genetic determinants but modifications of which allowing us to express health are well within our grasp. That's very paradigm-shifting for all of us. Right. Absolutely. Well, let me again show everybody your book. I think it's really, really terrific. I'm glad that we had some time together today, and I know this is going to be very, very successful. It's sort of a new age now of recognizing the broad strokes, but now understanding that there are subtle and perhaps significant differences in all of us from not just a genetic perspective but from other perspectives including epigenetic perspectives and early life experience. You mentioned you were vaginally delivered but not breastfed. That has huge implications. Mm-hmm. I talked about that in Brain Maker. So I think this is— it's sort of like you did earlier on in 2010. You're really, I think, helping to set a new set point here for where we're going in terms of understanding the broad strokes But now more personalized, and you did a really, really good job, and it's very— Thank you. User-friendly and actionable, so I praise you for that. It's super cool.

Thank you very much. That is incredible praise coming from you. You're one of my heroes, so thank you very much for that. Yeah,

well, I might see you in Austin, Texas. I'm still looking at my schedule, but if not, it was great touching base with you today, and I hope we get a chance to talk soon.

Me too. Thanks, Doc. Take care.

Okay, Rob. Talk to you later. Bye-bye. Well, that was an interesting interview. And again, Rob, you know, really helped pave the way for this whole notion of reducing our carbohydrates and increasing our fat, the so-called Paleo movement, trying to emulate the diets of our ancestors. And as we learned today, that idea that he talked about back when he wrote The Paleo Solution in 2010 has now been somewhat personalized based upon what he provides in his new book, Wired to Eat, the ability to evaluate what a single person's individual needs might be. So really fine-tuning the dietary recommendations and other recommendations as they relate to other important lifestyle considerations like sleep and even community. A really intriguing individual and I thought a very fascinating interview as well. So thanks for joining us. We'll be back soon. I'm Dr. David Perlmutter.