Optimal Nutrition: True Personalization Means Throwing Away the Rulebook | BBH Podcast Ep 7

Foreign.

Welcome back to the Big Bold Health Podcast. Making Health Personal in a World of Disease. Today, we're going to be talking about nutrition, and over the last few episodes, we'll be talking really about this difference between a disease care system and a healthcare system and how they are very, very different. And a typical entry point for this kind of conversation is what we eat. And ultimately, I feel that the Big Bold Health podcast has something to offer to contextualize where we've gone wrong and where we should be looking for the future. So why is this such a. Why is this such a pervasive conversation and why is it in need of rebooting?

Yeah. You know, I think, James, that one of the biggest challenges that we've had to follow through with health and behavior changes that people might make to really improve their health is, is a disillusionment that comes from them locking onto a single person who says they have the solution to everybody's problems. And that really relates to diet. You know how many diet books I have seen in my life of 40 years as a professional in this field that have claimed that this is the diet for everybody, this is the solution to all problems? I can't even really speculate how many it's been. But. But what I guess we can say without any doubt is that there is no one diet that's optimal for everyone. And because the Big Bold Health Podcast is all around personal affirmation of health, it doesn't really matter what might be the best diet for somebody else. It's really what's the best diet for that person to achieve their own personal health. And so the questions that we might ask to identify what is the diet of our specific need are different than, than the question of can I find the author who has the best selling book that One Diet Fits all?

The concept of a diet book where every one fits all is actually.

A.

Product of the old way of thinking. Right. Of us as a group. And maybe you could just unpack a little bit of where that thinking comes from and why disease based thinking has made its way into health creation.

Yeah. Yeah. Thank you. I think this really relates to the whole nature, the origin of the science of nutrition and how that translates into diet recommendation. So if you'd bear with me just for a sec, let me give a brief capsulated view of my kind of classics illustrated view of the history of nutrition. So about the turn of the last century, that would be the 19th going into the 20th century, the science of nutrition was just starting. And there was a gentleman by the Name of George Atwater, who was very famous that lived during this period of time, who wanted to understand the energy capabilities of food because it was recognized that we ate food for energy, right? First kind of concept of nutrition, going way back. And so he wanted to know, what is the energy potential of food? And so he thought, well, how would I measure that? And I would measure that. Like, I might measure the heat content of any substance that I would, like, burn in a fire, like a log. And so he said, you know, different kinds of wood have different heat potential, like a hardwood would burn different in a fire than a soft wood. So maybe foods burn differently in the body. And I'm using an analogy here. So he used the technique that was used to determine the heat content of materials. This came from physics called a calorimeter. And a calorimeter is a device that measures heat output of burning something. And so you can't burn people up, obviously. And so what he did is he took food that people ate, and he said, what happens if I partition the food into the three major sources of energy, and those are carbohydrate, fat, and protein. And he said, what happens if I then purified fat, protein, and carbohydrate? And I put them in a calorimeter and I burned them and saw how much heat they would produce. So I would take so many ounces of carbohydrate, put it in a calorimeter, and look at the heat produced. When he did that, he was able to show, just like if it was a physics experiment with wood or any other material, combustible material, how much heat was produced. And what do physics use? What term did they use to define heat content? It's called the calorie. And so he said, aha, food has potential calories. It's potential energy. And so he measured then the potential energy of carbohydrate. And he came out and he found out that it has food, 4,000 calories of energy per gram of being burned in the calorimeter. And then he tried protein, and he found, lo and behold, protein has about the same about 4,000 calories per gram. These are little calories. And then fat was a higher heat content. It had around 9,000 calories per gram. And so that then got translated from the physics calorie, which is called the kilocalorie, the thousands of calories, to the nutrition calorie, which is a capital C. So one Nutritionist, calorie is 1000 little calories, right? So we move from physics now into nutrition. So when we talk about 4 calories per gram per carbohydrate. That would be like 4,000 of the little calories from physics. And so everybody got thinking, oh, my word. Okay, now I can really understand food as an energy source because that means if I eat a lot of fat, I'm going to get almost two and a half times more energy per mouthful than if I eat carbohydrate or protein, because Those are only 4 calories per gram. So this is the whole basis of the concept of dieting and obesity. For years and years and years, it was built on the primacy of the calorie. And it was assumed that everyone burned these calories in their body the same and that they were always the same from person to person, just like as if we were all calorimeters. Well, now we look back and we say, that was pretty stupid. And because we're not calorimeters, we are very complex physiological instruments that regulate carefully the production of energy from our food in ways that are controlled by multiple hormones and enzymes and various vitamins and minerals and difference from person to person based on our genes. And so we just can't say a food, no matter what it is, would always produce the same energy potential in a person. Now, why is that an important concept for 21st century nutrition? It's important because we have seen over the last 50 years, multiple public health nutrition programs focused on how to treat obesity by counting calories, by, you've got to cut back calories this, cut back calories that, that fat calories are bad, that carbohydrate calories. There's no difference whether it's complex carbohydrate coming from unrefined grains, or if it's simple carbohydrate coming from white flour and sugar. It's all the same heat potential. And so it leads people to a completely erroneous view as to how to really manage their diet based on their own unique physiology. So there is no primacy of calories as a central guiding principle. Now you might say, well, gee whiz, does that mean we just throw the calorie entirely out? It has no relevancy? No, it still has relevancy. So I don't want to say it's, it's immaterial. But what I want to say is that as we're defining in the big, bold health approach towards personalized nutrition, how each one of those foods gets used by the body is independently unique to that person. So for one person, they may be very adept at burning up Carbohydrate of using it as a source of energy. Another person might be really, because of the whole way that their body manages carbohydrate, which, as you know, is composed of glucose, which is the building block of carbohydrate, they may be much less adept at managing that than if they're managing protein or they're managing fat. And so what we need to start doing is to really understanding the unique predisposition of that person, how their body specifically converts food into energy and function, and that stores it as a source of energy for a rainy day that never comes, that we call body fat. Right. That is very interesting to think of. Or why would the body store energy when the person is behaving as if they're lower of energy? Have you ever seen that before with a person that looks like they're overweight? And you would say, wow, that person has so much stored energy, they must have energy galore. But when you watch how they're actually performing in life, they're low energy, they're tired, they're worn out, they feel like they have to get more food in to keep up their energy. Why is that? Because their body has what I call switched metabolism. It is taking the energy of food because it's inappropriate for their specific type. And it's converting into a storage form that's called fat stored in our body, for which it's a rainy day that never is used up. So I think that we are starting to see a whole different evolution of how to personalize nutrition to lead to proper body composition, to proper energy, to proper cellular regulation so that we're not kind of having this fallacy that one diet fits all.

So the 20th century really looked to create kind of rules to live by for everyone.

Yes.

And there was a small subsection of humans that those rules work quite well for, and they operated well. But outside of the sort of middle of the bell curve were all these outliers that actually end up probably being the majority of the population for which it's not working. So I know that, you know, one of the things that you're. You advocate for, you're interested in is this idea of personalized public health.

Right.

To think differently about it. So we're designing public health now for the 21st century. What do nutrition guidelines look like in a big, bold health world?

Oh, boy. That's a really important frontier level question that is going into exactly where the puck is going, not where it's been, but where we should be skating to meet it. So it turns out that public health, which certainly has made contributions, no doubt to community health. Things like sanitation, hygiene and nutrition certainly have come out of public health principles which have been advantageous for eradicating many infectious diseases in developing countries, including the United States, led to sanitation and various things that are really important hygiene principles. But then if we get down to personalized health, as we're talking about in big bowl health, then the equation kind of shifts over to say, okay, then how do we take what we've learned about generalized health principles and precisely deliver it to the individual? And that's the emergence of this new field that you alluded to called precision public health. It almost sounds like an oxymoron. How do you make precise public health? And the way that this is occurring is quite fascinating. I think it's reflective of exactly the whole trend of going from life for the average to life for the individual. That's a major cultural shift in everything. In consumer products, in healthcare, in technology, in, in music and arts. We're moving from that of the average to that of the individual. So how does precision public health emerge out of public health? So thanks to extraordinary work that's been been done by the Institute for Health Metrics and Evaluation in Seattle, It's a Gates foundation funded organization for this global project to actually evaluate down to the community level, down to actually the individual small township level, what are the actual health indicators at that particular region. Because we're almost segmented by our zip codes, aren't we, into our various health and lifestyle factors. And so what they started to do is to take these public health principles and to actually translate them down into precision understanding of individual communities, down to actually individual block area health related factors. And when they did that, they developed what was called quality of life years, lost qualities, Q, A, L, Y, which says in this community, those people that are doing these things are losing this many quality life years because it's not that they're necessarily dying young, but their life is. Their quality of life is being adversely affected. Now when you introduce quality into the equation, you've moved away from the old model because the old model was the absence of disease is the presence of health. Now we're saying no, it's not just the absence of disease, it's the presence of function that relates to your health. So quality life years, how do you measure quality of life? Well, you measure quality of life, don't you? And the way you assess it, as I do, as does anybody. So when you start saying quality of life here is lost and tie that to public health. It's much more precise to say what's going on in that individual, maybe home or that individual community that is actually relating to the stealing from them of quality life years lost. And I think that this is a trend that is giving rise to the convergence or the intersection between public health now and what we're calling personalized health care. This is not like two completely separate fields. They're sharing similar bodies of data so that ultimately what we will deliver as we are talking about in the big bold health is health is a personal matter that is individualized. And the community health is, is dependent upon not only what the community is exposed to, but how each individual personalizes their approach and delivery of that to their lives. And I think diet is an extraordinarily good example because there are certain general principles that we know are probably applicable to everybody. Like if you eat junk, no matter what your genes are, you're gonna be probably less than ideally affected. But then the question is, okay, within the scope of individuals trying to eat a reasonably good diet, how does it affect their specific effects or specific outcomes? So we. You can use gluten as an example. Not everybody needs to be on a completely gluten removed diet, eliminating all sorts of gluten. But there are certain individuals for which this protein that's found in grains is a foreigner in their body. And their immune system responds by producing not only problems of their digestive system, but systemic problems. It can even be related to their brain function. In fact, now there's a well known association between early stage dementia and gluten sensitivity that goes back, you know, probably 20 years in understanding. Does that mean everybody should remove gluten entirely from their diet? No, that doesn't necessarily say that. But what it does say is that there are individuals who are uniquely sensitive based upon the way their immune system, built upon their genomic book of life, determines their response to that material. Then we start saying, well, if it's gluten, what other things, what other additives, what other proteins, what other substances would send signals to an individual's immune system to produce an adverse effect that would be called lack of health or dysfunction. And that's the way that this field is really evolving is to go down the lexicon of foods. And that's why things like food elimination diets allow us to kind of explore individually how this affects us.

Well, I wanted to ask you about that because you used the word delivered a few times. And if we think of the old way of delivering public health, it was professionals sort of Bestowing it upon the individuals. Where it sounds like what you're talking about when you're talking about delivery of precision public health, is that there's. The onus is a lot more on the individual to work it out for themselves. What are some of the sort of the ways that you've seen that that's happening in a way that's like affordable and accessible to everyone?

You know, I think the powerful part of this movement, which is almost like power to the people, it reminds me of my 60s experience, is that we're starting to recognize that so much of our health is really owned by us. If we only understood how to regain ownership and how to. Because in the end, even if we have a health professional that's very skilled in the art to assist us in making intelligent decisions, it's us that will go home and. And eat, and us that will go home and have activities or sleep or rest or whatever it is that we do will ultimately become our own responsibility. So it's not as simple as just taking a pill and trying to stay adhering to your medicines. It's really trying to be engaged in a life design in which you're the master of your own destiny. So how does that work? Well, in terms of diet, I think for many individuals, the approach that engages a food elimination reintroduction approach is a very educational experience. I started doing this really in the 70s when I met some of the early developers of food elimination diets. This was from the Institute of Environmental Medicine. And individuals that were involved with really the early stage of doing in clinical evaluation of their patients, the food elimination reintroduction diet. And what you find when you do that yourself is that it takes about five days to kind of get your system removed from any kind of immune response that you might have had to the food you're eating. So you're kind of in a clear state, so to speak. Then you start introducing one food at a time. And you just look over the next few hours after you've consumed that food as to what your physiological response is. Does your heart start racing? Do you get hives? Do you get fuzzy head with a cloudy mentation? Do you. Do you feel low energy? Do your joints start to hurt? There are all sorts of. Do you get digestive upset? So you start to recognize that there may be certain foods that you were, including your diet that actually for you are producing not so good response. It wouldn't necessarily be a food allergy. It's a food intolerance or adverse food response. So then you design a Diet, you say, okay, I'm going to kind of rotate those diet, those foods out of my diet, or I'm going to only eat them periodically. They're not going to be the major, major part of the foods I eat. And by the way, it's been found with nutrition studies that believe it or not, 80% of the calories people eat, 80% of their food energy, comes from less than 15 foods. Think of that. So less than 15 foods, and most people are actually over 50% comes from less than seven foods. So we eat pretty monotonous diets. We might think, oh no, I eat a whole variety of foods. But most of them are really insignificant relative to the total volume of foods that we eat. It really comes down to a certain set of very small set of foods that really define most of our intake. So maybe one of those foods, one of those major foods, what I call a driver food, becomes a, recognizes a problem for us. When we do the elimination, reintroduction of provocation, we say, wow, I wouldn't have never known that because that problem was masked by the other things I was eating. And I would have these kind of low grade symptoms that was not necessarily identified with that specific food. So that's one kind of way of getting to it. Another way is to engage in intermittent fasting, which has now become a very interesting and popular concept. It produces intermittent, what's called ketone increases, which beta hydroxybutyrate, or bhb is one of the ketones that's produced during these intermittent fastings. It has favorable effects on all sorts of things. Lowered inflammation, improved improve brain function, improve insulin signaling. And you can, by intermittent fasting also identify certain things that were in your diet that may be producing symptoms you didn't even recognize because you just are in only one body with one set of experiences and you assume that whatever you're eating is doing fine for you. But after going intermittent fasting and reintroduction, you say, oh, you know, some of these foods I was eating really are not fully delivering to me what I want. So when we talk about the word delivery, it's really the individual delivering this information to themselves and taking charge of it.

So, you know, millennials have been accused of killing certain industries. I could see that if they were to really adapt into this, they could kill the diet book.

Well, I don't think necessarily they'll kill the diet book because I think that will live on, but it may kill the one size fits all diet book. It may actually help us to understand better in these future diet Books, how to differentiate, how to personalize. I mean, the whole theme of the Big Bold Health podcast, I think, is a very important theme. And that is moving us from the mentation of the average to the view that of the individual. We are individual. And it's, you know, Roger Williams, who in 1949 wrote this landmark article in the Lancet called Biochemical Individuality, which at the time seemed very ahead of his time, and people didn't accept it. And, you know, what's this nutrition guy from the University of Texas talking about in a medical journal? He shouldn't be talking about things like that. He's not a doctor. But now, over the course of now 70 years, what Dr. Williams was talking about doesn't look so silly, that we are all much more unique in our biochemical response to our diet and lifestyle than we ever fully understood. In the beginning, we thought that we could put recommendations in the back of cereal boxes called the RDIs, used to be called the RDAs, and used to be called the MDRs. Minimum Daily Requirements became the Recommended Dietary Allowances, become the reference dietary intakes of today, that we would then guide our lives by these principles. But they're principles for the average. They're not principles for the individual. And what Williams found is that the range of difference from person to person is far greater than we would have ever expected. When we actually start doing the right studies, we might look similar. We all have, you know, most of us have 10 fingers and two ears and two eyes. But in terms of our biochemistry, how we actually metabolize and utilize our foods, very different from individual. Individual.

And what is some of the mechanistic side of this that is guiding it?

Well, I think the most significant part of the mechanistic driver for this is the marrying of the age of the genome with the age of the nutrition. And this is what the term is called nutrigenomics. That's the new buzzword. It's marrying our individual genetic response to our diet, to our way that we eat, and seeing how nutrition influences our outcome, called our phenotype or our health. And so nutrigenomics starts with, you could do a gene test to start to understand this, or you could just become a good student of how diet and nutrition and foods influences your own health, recognizing that you are a unique face set on the diamond of life. I want to say that again. You know, when we think of it, this is a pretty interesting moment in our history in which for the first time, we have gotten a very clear view that there has never been an us ever formed before. And there will never be another like us, identical to us. There may be people similar to us, but maybe even identical twins don't share as, you know, identical response of their genes to their environment, as was seen more recently by the NASA astronauts. One who stayed on ground and the other identical twin was up at Skylab. And what have they found? That the one in Skylab being in outer space at his epigenetic meaning above his genome, signaling change in space. So he was no longer identical to his brother in the way his genes were responding when he came back to Earth. Now, it did happen that they returned back similar over time, but the point I'm trying to make is that we are unique. And the most precious thing we own is our book of life. And it shouldn't be defaced, it shouldn't be taken for granted, it shouldn't be despoiled, it shouldn't be burned, singed, or water spotted. We should protect our book of life by recognizing its uniqueness, the precious gift it is, and then doing all we can to have it read so that the stories of bliss are experienced to us and not the stories of tragedy.

Absolutely. You know, it is on all of us to participate in this way and to learn about ourselves, because no one really has the opportunity to learn about yourself better than you. There's no health professional out there who's going to solve this for you. And we look forward to more conversations in the big Bold health podcast about bringing this down to the individual. It's been great to be share this time about nutrition. I hope you've learned something. Thanks so much for watching. I'm your host, James Maskell, and we'll see you next.