Heroic Interview: Always Hungry? with David Ludwig, MD, PhD

You're listening to Always Hungry an optimal living interview with David Ludwig and Brian Johnson.

Hi, this is Brian. Welcome back to the Optimize interview series. Today I'm thrilled to be chatting with David Ludwig. David holds both a PhD and an MD and he's a professor in both Harvard's medical school and Harvard's School of Public Health in their department of Nutrition. He wrote a great book called Always Hungry, subtitled conquer cravings, retrain your fat cells and lose weight permanently. He's one of the world's leading researchers on the science of optimal nutrition. He's overseen dozens of diet studies, authored over 100 peer reviewed scientific articles, and supported thousands of patients looking to optimize their lives. David, I'm truly thrilled to be chatting. I appreciate you taking the time.

Thank you, Brian. It's great to be with you today.

Well, well, let's start at the top. I'd like to ask our authors what led you to name the book Always Hungry?

Well, I have to give credit to the New York Times. Like many academics, I'd been sending them op eds for years and they, like they do, turned me down time and time again. But in 2014, I had a provocative piece that was accepted and published in the journal Jamaica that basically asked the organizing question of this book, which comes first, overeating or obesity? You know, we classically think that we overeat due to lack of willpower that leads to weight gain and ultimately obesity and we just have to cut back calories. So we asked the opposite question, which is what if the body is being triggered to gain weight and the fat cells start hoarding too many calories, so there's actually too few in the bloodstream and that's what the brain picks up. That's why we get hungry. Hunger is a consequence, not the cause of overeating. You know, if that's true, it has a profound implication for how we treat it. It says that just cutting back calories doesn't work. Anyway, we got this published in JAMA and the New York Times took my first op ed and I had some, you know, very nice academic sounding title for the New York Times op ed and as they always do, they changed to something much better. And the title they chose was Always hungry question mark. Here's why. And then so I, when I, and that helped attract publishers for my book, which came out earlier this year, when we were looking for a title for the book we had, we, we went through probably 100 different wines. Nothing seemed to work. We pilot tested things. Finally we realized we Couldn't do any better than the New York Times did. Because that really is the challenge, that people on a conventional low calorie diet are always hungry. When you cut back calories, you make that situation worse. And the conventional paradigm would have you, what, just neglect that for the rest of your life? You know, just, just ignore your hunger, eat less and it'll be fine. Well, it's not fine. Almost nobody can do it. And even if you could, that doesn't say anything about what's happening to your stress hormone levels, your body composition, you know, the relative amount of lean tissue and fat tissue. Yeah, if you can succeed in eating less over the long term, you'll lose weight, but that doesn't mean you're going to do it in a healthy way.

Which leads us to one of the most important points of the book, which is a calorie does not equal a calorie. Can you talk to us about that?

You know, we know that's the case from many different lines of investigation. In fact, the whole concept of nutritional epidemiology, and that's, you know, that's an area that some people have questions whether some of these, you know, big studies can reach the wrong conclusions. Just because there's an association doesn't mean that there's a causality. But modern epidemiology has come a long way in getting closer and closer to cause. And the entire foundation of epidemiology, nutritional epidemiology, is that all calories aren't alike. That when you eat more processed carbs, controlling for body weight, risk for diabetes, heart disease, cancer goes up. Turns out that the delicious high fat foods we were told to banish from our plate by the first food guide, Pyramid nuts, olive oil, avocado, even real dark chocolate, calorie for calorie, greatly reduced risk for chronic diseases. We know that just. And then from clinical trials you can give people identical calories of fast digesting carbohydrate versus slow digesting carbohydrate versus fat or protein. And those differences produce radically different changes in the body in the hours after eating. Hormones, metabolism, even the expression of genes throughout the body will differ not just based on the number of calories you consume, but, but more importantly based on how much. And that has everything to do with whether we are going to be struggling with hunger and slowing metabolism, gaining weight or feeling satiated, robust energy, and naturally maintaining a healthy weight.

That's great. And one of the studies that I believe you conducted, that you share in the book is the individuals who were brought into the lab, your lab, I believe, and given either corn sugar or corn starch. And we looked at same exact caloric breakdown in terms of carbohydrate, protein, fat, et cetera. And then the milkshake, right. With the same flavoring all the way down to the end, but the quality of the carbohydrate they consumed was different either I think you call it fast acting or slow acting. Can you talk to us about that and what that did metabolically? And then of course, there's a nucleus accumbens. That was fascinating as well.

Yeah, well, sure. So, I mean, this is really what, you know, the area that I cut my teeth in and scientific clinical research. I used to be a laboratory researcher and was feeling very isolated from the actual challenges of obesity and nutrition with humans. I was working in the laboratory studying genes in mice and rats and feeling that there's a huge disconnect from seeing patients with obesity in the clinic and how discovering just another gene was going to influence that clinical reality. So I switched to research, clinical research involving humans. And the first set of studies up until today have been looking at what happens with following meals with identical calories, in some cases identical protein, fat and carbohydrate, but just varying the quality of the nutrients. And so let's take just carbohydrate. You can use what's called high glycemic index or very fast digesting carbohydrate. Those are all the carbs that flooded our diet during the low fat years. We may come back to this. Not all carbs are alike, not all fat is alike, not all low fat diets are alike. But the low fat diet that we were told to eat for 40 years had all these processed grain products at the base, plus more potatoes. And many researchers at the time and public health experts were saying sugar is fine because it helps you eat less fat. So that's the diet we ate, that's what we were interested in looking at. So high glycemic index or fast acting carbohydrate, which might be in one study, instant oatmeal. In another study, we used corn syrup versus old fashioned oatmeal. So slow cooking, slow digesting or uncooked corn starch that digests much more slowly as well. So we found that when you give these two different meals to research participants, as expected, after the fast acting carbohydrate consumed, blood sugar shoots way up. That causes a massive outpouring of the hormone insulin. And you can think of insulin as the miracle grow for your fat Cells, just not the kind of miracle you want to have happening in your body. So that insulin tells all of your organs and tissues, the key ones to suck up calories. It says, we're in a feast, go to town. And so the liver takes up glucose, the muscle takes in glucose, fat tissue takes in glucose and fatty acids. The problem is these fast acting carbohydrates cause so much insulin to be produced that a few hours later, we go from feast to famine, Blood sugar and the other calories in the blood plummet. So by three, four hours after that meal, two, three hours after the meal, there aren't enough calories. The brain, we see that the brain releases stress hormones that tell the body we're in trouble and how hunger goes up. We know that because we can ask people to report their hunger and they report more hunger. When we give them a big plate of food like a cafe meal, they eat more after the fast acting carbohydrate. And then when we looked at the brain at four hours with something called functional mri, we saw after the fast acting carbohydrate, this one area lit up. It was called the nucleus accumbens. That's the center of the dopamine, pleasure and reward system. Considered ground zero for the classic addictions of cocaine, heroin, alcoholism. Raising the provocative idea that these highly processed foods we're eating, and especially the processed carbs, are hijacking basic reward systems in the brain, leading to something that looks like food addiction. So it's one thing to be hungry because your blood sugar's crashing. It's another thing when your nucleus accumbens, that's the addiction center, lights up. That's your willpower, that's your ability to say no. When that lights up, it's game over. You know, when you walk by Au Bon Pain, you know you're going to walk in and get that 500 calorie bear claw.

And then when you put the two together, you're in even more trouble, right?

That's right. The other thing that happens when that two, three hours, four hours after the. So the blood sugar and other calories in the blood crashes, hunger center of the brain lights up. The addiction center of the brain lights up. Plus, the last thing that happens is stress hormones are released. So that's epinephrine and also cortisol. So those are going to try to suck calories out of storage wherever they can find them. And unfortunately, that includes muscle. Now, if that just happens once, it's no big deal. But if you go through the cycle, meal after Meal day after day, it could be eroding lean body tissue. So during the surge of insulin, those calories get excessively stored in fat. But during the crash, too many calories get pulled out of lean tissue. So at the same weight, you could have a much greater metabolic risk because you're relatively more fat. And that's exactly what we saw in an animal study that we did. I don't do many animal studies anymore, but this one, we gave rodents rats for 16 weeks, that's like 20 rat years to a human. Identical diets, again, just fast acting versus slow acting carbohydrate. And we further controlled their weight so that the both groups weighed the same and at the same weight, the group that got the fast acting carbohydrate had 70% more fat. And thus since they weighed the same, you know, much less lean tissue, it's heart disease and diabetes risk factors were sky high. So again, case after case demonstrating that all calories aren't alike. That based on how calories affect our hormones and our metabolism, the same number of calories can be doing very different things to our biochemistry, to our body, to our health.

Fascinating stuff. So much to talk about there as well. I want to talk specifically about low fat, but first that idea that eating refined carbs made these, you know, rats. And obviously extrapolate to. Well, don't need to extrapolate. There's also research on the humans fat. And again, for me, this has been one of the most challenging things to wrap my brain around is wait, I thought fat made us fat and now it's the processed carbohydrates making fat. Can you just walk us through that a little bit more?

Well, you know, fat. The problem that people identified with fat in the 1970s, 80s and 90s was based on this, primarily on this very simplistic notion that fat has twice the calories per gram per bite of carbohydrate and protein. Calories are bad, and so let's get rid of fat and people will naturally eat less and they'll, and they'll naturally have an easier time maintaining a healthy body weight. You know, many researchers at the time, and this is the beauty of the scientific literature, it's all in print, wrote that it was virtually impossible to gain weight, to become obese on a high carbohydrate diet. But that's a terribly simplistic notion because it takes out of the equation the other key point, which is how much satiety do those calories produce? You know, energy density, if you just think about energy Density, the number of calories per gram or per bite. You're considering the body like an inert storage tank. But we're not. We're a dynamic biological system that responds differently to different kinds of calories. So when we eat fat, yeah, it has a lot of calories, but those calories can be intensely satiating, filling. You know, do a little mind experiment. Consider eating 500 calories from bread. So that would be like maybe half a loaf, six slices or something. Or from butter, which would be about half a stick butter. Now, first of all, which would be easier to do? You know, a lot of people can eat six slices of bread. You know, that's not a problem. You know, that oftentimes happens when they bring the bread basket before a meal. Think about eating a half a stick of butter. First of all, that first bite might be, that's kind of interesting. But you know, you've gotten through a quarter of a stick of it. It's getting pretty intense. Half a stick, like you're just feeling pretty disgusted. Now, what's going to happen to those calories? That butter doesn't raise your insulin, fat doesn't raise insulin. So that fat is going to be hanging around your system for a long time. But the bread shot your insulin sky high. So as soon as those calories came in, they were being stored. And so pretty soon you start crashing. And that's why people don't binge on butter. I mean, there may be rare true psychiatric issues where people do that. Virtually every binge food has carbohydrate and many binge foods have zero fat, like popcorn. Fat free popcorn is a great binge food. Bread, fat free Twinkies and fat free snack meals, these all are commonly binged to potentially who binges on olive oil or butter? You know, it's just not. The thing is it doesn't activate your nucleus accumbens, it doesn't produce the reward. And all of that is ignored based on a simplistic calorie count model. So what we're understanding, the bottom line is eating fat doesn't make you fat. In fact, the fats that were banished, many of them in the first food grade pyramid, are among the healthiest things we can possibly eat for our waist and for our heart.

Well, let's go there. So then what are those healthiest fats?

Well, you know, another big concern has been saturated fat. And that actually predated the campaign against all fats. Ancel Keys and others were very concerned that saturated fat raised LDL cholesterol, which it does. And that high LDL cholesterol would cause heart disease. To some degree. The pendulum has swung far in the other direction with now people saying saturated fat is a health food just because these processed carbohydrates are bad. It's almost like saturated fat is now inherently good. And I think the truth is in the middle that many foods with lots of saturated fat are perfectly healthy. Full fat yogurt has the number one source of its calories is saturated fat. Dark chocolate has probably, if you don't put much sugar in it, that's dark chocolate. The vast majority of calories are from saturated fat. And both of them look very, very good in clinical trials. In epi, there are no high added sugar foods that look healthy. But in practice that doesn't mean we want to be just loading up on butter. And I think we need a good distribution of fats ranging from some saturated fat in whole foods, monos which come from monounsaturated fats, which come from olive oil. But if you're eating that olive oil, especially extra virgin, you're getting that all that green color is phytonutrients and antioxidants, anti inflammatory substances. So you're getting this beautiful concoction of healthful foods. Avocado is also mostly monounsaturated. Most nuts are mostly monounsaturated. And then actually the only essential fats are polyunsaturated fats. Both the Omega 6 and Omega 3. They're absolutely required for survival. You need some of both. And I think we want to get a good balance. Some people are concerned today about too much Omega 6. Those are the ones that come from seed oils and from plant oils like safflower, sunflower, soybean oil and the like. But I think that if we get enough Omega 3s and we stick to whole foods, including plant based foods, we get a nice distribution and that's going to really be optimal for health.

That's great. And I kind of jumped the gun there, getting into the healthy fats and kind of your overall approach. Let's step back again and, and then I want to talk about the three phases of your always hungry approach. But talk to us about the low fat diets and you talk about some research done recently that shows some pretty compelling evidence about the efficacy or lack thereof of the low fat approach. Can you talk to us about that?

Okay, well, so for many years it was if you want to lose weight, you have to eat less fat. That's the only way to be less fat is eat less Fat, I think we can throw that baby out the window. You know, the meta analyses are quite clear that low fat diets, as they have been done in the United States, we'll come back to that point, are about the worst way to lose weight. That every comparison diet, be it very low carbohydrate, low carbohydrate, Mediterranean or all higher fat diets put together, when you compare them fairly so that both groups in a clinical trial get the same level of attention, treatment intensity, the low fat diet is inferior. Okay, so then the argument became, well, all right, maybe you can lose more weight on a low carb diet, but you're going to be a good looking corpse. Your cardiovascular disease, you remember this, Brian, right? Your cardiovascular disease risk factors are going to be sky high and you're going to be in trouble. So that's where we would refer. We can refer to two, three very big studies. These are the three biggest studies ever done of this question. So first there was the Women's Health Initiative, which was a low fat diet. 50,000 women put onto a low fat diet or a controlled diet biased to favor the low fat diet. They had 16 sessions with individual group sessions, lots of support. The control group just got written educational materials. Despite that imbalance in design, despite the fact that the low fat diet decreased diet significantly by report down below about 30%, down to about 30%. There was no benefit for any chronic disease, no lower heart disease, cancer, diabetes, nothing. It was a blowout. The second of three studies was. So that was the Women's Health Initiative clinical trial. The second was the look ahead. This was another American study that looked at, that recruited people with type 2 diabetes for whom heart disease is the leading killer. And again they were put onto a low fat diet or a controlled diet, again biased to favor the low fat diet because they got much more attention. That study was closed early for futility, meaning that an initial analysis by the independent statisticians showed not any hint of a benefit of the low fat diet, nor promise that no matter how long they would have conducted the study, there would ever be a benefit. So it was considered unethical to keep the study going. The third study was not American. It was done in Spain. It was of a higher fat Mediterranean diet. And they had three groups. One group got nuts, an ounce a day of nuts. That's one high fat group. A second group got a liter of olive oil a week, a liter of olive oil a week per person. So that should be a nightmare from the low fat scenario. Makes you fat clogs up your arteries. The control group was a low fat diet, and they made efforts to control treatment intensity at least better than those other two. So this higher fats study also had to end early, but for the opposite reason. The higher fat groups showed such unexpectedly fast reductions in cardiovascular disease. The study was proven long before the expected end date, and it would have been unethical to keep the control group eating the low fat diet. So these three studies, I think, put very substantial nails, as you were saying, in the coffin of the low fat diet, at least as it was consumed in the United States now, and also as it was done in Spain during that study. Now, does that mean that all low fat diets are inherently bad? Of course not. There are many different kinds of low fat diets. There are some populations around the world that seem to be able to eat a low fat diet, Some in these blue zones quite healthy. Which doesn't mean that the healthy part of their diet is the low fat component. If you took a low fat diet and added nuts and olive oil, maybe people would do even better. But that's a separate question because in the United States today, these blue zones are people who are highly physically active. They have very high overall diet quality. We have low rates of obesity and insulin resistance. America is most, most people in America are substantially overweight with high levels of insulin resistance. If somebody has insulin resistance, what does that mean? It means they're carbohydrate intolerant. Essentially, it means that insulin can't manage the influx of carbohydrates effectively. And so much, much more insulin has to be produced to manage carbohydrate. So what might work for Chinese peasants working 12 hours a day in the fields doesn't work, won't necessarily work with Americans in the 21st century with prevalence rates of overweight and obesity at about 70%. And the last thing I'll say is that as those Chinese peasants who were eating grain based low fat diets move to the cities in China carrying their grain based diet with them, but leaving their physical activity levels behind, their rates of obesity and diabetes are skyrocketing even.

Without emulating the western diet.

Well, that's true because as they're moving to the cities, they're bringing their grain based diet, but they're also adding in some junk food, you know, McDonald's and so forth. So it's a very confounded comparison. But, you know, so I think it comes back to the, to the basic quality of scientific research. There are different levels of evidence when you look at blue zones and do these cross national comparisons, these are called ecological studies. You're comparing groups of people who are profoundly different in many ways. Yes, you can form hypotheses and you can learn things, but that's considered the lowest quality of evidence. There is higher quality, much higher quality than that is epidemiological studies that are prospective within a population, like the Nurses Health study or the Health Professionals follow up study where you follow people who either increase or decrease their fat intake. And those studies are very consistent that increasing fat intake in no way predicts increasing body fat. And that quite to the contrary, increasing fat intake, according to a study that just came out in JAMA Internal Medicine, reduced premature deaths. To say that the other way, people who followed advice to eat a high carbohydrate, low fat diet had increased, not decreased, premature death. And that is the hardest of all endpoints. Again, that doesn't speak to what a low fat diet could be, but it suggests that focusing on decreasing fat has been harmful.

Again, like you said, so many confounds there in terms of the broader research of the carbohydrate vis a vis the refined and the western kind of introduction of sugar and flourish. But let's leave that at that for now.

But then that's the last line of evidence, which is the clinical trials. And we've discussed those three trials, including the predimed which was done in Spain. Now maybe you could say that. Let's compare the best possible. Or let's ask it another way. Let's say what if America during the 70s, 80s and 90s reduced fat, but they replaced them with vegetables, whole fruits, legumes, minimally processed grains. What would have happened? Very likely the harms would have been much reduced and maybe there would have been benefits. We don't know. That's not what happened. And again, remember, this is a different population than a lean population in Japan or elsewhere. But it's also possible that the American public wouldn't have done it. You know, we've got to ask what is pragmatic if you want to improve diet quality? We've been trying to tell the American public to eat more fruits and vegetables and process the grains less for years. That's a tough sell. Alternatively, tell them to add back luscious, tasty, rich, high fat foods, olive oil, dark chocolate, avocado, full fat dairy. That will be a much easier sell. And if that can be done, and if rates of heart disease and even cancer, let alone diabetes, plummet, we have a public health solution that has been ignored, dismissed, which could do the Job.

Well, can it be done?

Well, I think it requires a change in mindset. We still, as a, as a result of 40 years of being told to fear fat, the American public fears fat. According to a Gallup poll, most Americans are still trying to reduce fat intake in the school. Children can get sugary non fat milk called chocolate milk. They take out the fat and dump in sugar. They can't get plain whole milk. According to national policy. There's no evidence basis for this. In fact, the evidence base is suggests that's harmful. So we're still stuck in a calorie in, calorie out, fat is bad, carb is good mindset. And the first thing we have to do is change the mindset and then we can ask, well, would some people do better with relatively lower fat, higher carbohydrate diet that was focused on really good quality carbohydrates? Sure, undoubtedly there are people who can eat that way and do eat that way very successfully. But if you're obese, if you've got obesity and insulin resistance, carbohydrate intolerance, you know, just switch, you know, even whole grains, minimally processed grains, too much of them could be a substantial problem for you.

I want to pull a thread that you mentioned in terms of the low fat chocolate milk the kids get. You talk about the effects of our diet on our ability to focus on and eating what was recommended for 40 years by the food pyramid. I think you had whole wheat bagel and fat free cream cheese and a glass of orange juice as your example. Creates a lack of focus and if persistent could look a lot like add. Can you talk to us about that?

Sure. Well, in one of our feeding studies that I referred to earlier, we gave instant oatmeal a low fat meal with little milk and sugar. But very consistent with the first food guide pyramid to have a high so called complex carbohydrate. That term doesn't mean anything because if that carbohydrate doesn't have to have a lot of sugar, if it's processed, it's going to digest quickly. So anyway, we gave this to adolescents and we compared it to steel cut oats or a vegetable omelet with fruit that had a little more protein and fat, less carbohydrate. And again, after the instant oatmeal, blood sugar surged, a lot of insulin was poured out. A few hours later, blood sugar was crashing. With that crash, stress hormones as we discussed earlier, are released, including epinephrine or adrenaline. So if you were that 10 year old boy who ate the bagel, fat free cream cheese and glass of orange juice as your mother gave you because she thought that was healthy, because that's what was told to us. And now your blood sugar and your other calories in your blood are crashing. At 10:30 in the morning as you're sitting in social studies class, your adrenaline levels are skyrocketing. Are you going to be, is that 10 year old boy going to be sitting politely, focused, paying attention, listening, learning, or is he going to be distracted and maybe shooting spitballs at the girl next? Tim. And what diagnosis is the teacher going to think that boy has? Add? And what is the. Interestingly, what is the treatment that we use for add? Amphetamine, Ritalin, These are all analogs of adrenaline, epinephrine, they have very similar properties. These are stimulants. And so interesting, isn't it, that the body is like responding to this hypoglycemia with a surge of adrenaline and yet we find that we can treat those symptoms by in effect just giving stimulants. So maybe the problem, not for everybody. And of course ADD has got many causes. All these screens and not enough physical activity and hyper focus that we expect of kids. But why is it so surprising that a highly processed diet would affect the brain, not just the body?

Well then obviously you extend that to the 30 year old version of that 10 year old and the 40 and the 50 and there's the same issues of inability to focus and that stress response is going to be persistent and brain fog. Yeah. And then obviously solving, we're talking about.

Brain fog these days and that's, that could be lots of things, masked depression. But also the brain is susceptible to inflammation. And with insulin resistance and with a poor quality diet, chronic inflammation develops in the body. And that chronic inflammation can spread to the brain. There's pretty clear evidence that that not only clearly happens in animals, but experimental animals, but it happens in humans too. Once the brain gets inflamed, you're in real trouble.

Yeah. And then you have the gut, the second brain. Right. With whatever it is, 90% of the serotonin produced in the gut, so that inflammation is occurring before it even is perhaps measurable in the primary brain as we know it, it's already doing its work in the second. Right, right. Can you talk to us about, we talked a lot about kind of just different theoretical perspectives in the research. Can you talk to us about the practical side of it? Your approach has three phases. Can you give us a high level overview of that? And in the book, you go into detail on each with very specific recommendations.

Right. Well, we want to take people. This is targeted for America, where most people are at least a little overweight. Even those people who aren't are likely insulin resistant with some chronic inflammation due to the poor quality. A lot of highly processed carbohydrates in the diet. So phase one, for just two weeks, asks you to eliminate all grains, potatoes and added sugar. It's just two weeks and you replace those with these luscious high fat foods. Nuts and nut butters, full fat dairy, olive oil, rich sauces and spreads. And you can have real dark chocolate, minimum of 70%. So that's just a little touch of sugar that you would get. So because you're using these high fat foods to displace the processed carbohydrates, you don't miss them. In fact, we encourage people to eat as much, to feel satisfied, snack when hungry, and never count calories again. This whole calorie counting notion is, I think, a delusion. Nobody can do it. It's quite clear that not even a trained nutrition expert can get their calorie balance to within 350 a day. If you were off by 350 calories a day in the same direction too much, you'd go from normal weight to massive obesity in just a few years. And, you know, it begs the question, how did humans ever manage to maintain a healthy body weight before the very concept of the calorie was invented 100 or so years ago? So we don't need the conscious brain. You don't need the conscious brain to control calories. We have a hypothalamus. We have brain control systems that have evolved over hundreds of millions of years. If we give them half a chance, that controls our body weight perfectly well by adjusting our hunger and our metabolic rate. So phase one is designed to just jump start this metabolic change, lower insulin, calm chronic inflammation, and get you started. Then phase two, we add back minimally processed whole kernel grains, so things like steel cut oats rather than instant oats, buckwheat, quinoa, brown rice and the like. We bring the total fat down just a little. So from 50% fat in phase one, it comes down to 40% fat in phase two. Then you stay in phase two as your weight comes down to its new lower set point. So that is quick for some people, slow for others. But we say we don't want you to try to consciously control it. You give the body what it needs and it figures out the rate of weight loss that works for you, based on your age and health, genes, physical activity level and the like. Then after your weight stabilizes at this new lower set point, you go into phase three, where you begin to mindfully explore having just a little bit of processed carbs. You know, some people, after cleaning the metabolic slate, can handle a little pastry once in a while, some ice cream at a party, and if you can, a little pasta. Why not? You know, we want maximum benefit for minimum of deprivation. We don't want to come up with this arbitrary principles and expect everybody to live by it. If you can tolerate it, great. And you add it back into your tipping point and we give you symptom checkers and other tools to show you where that tipping point is. And once you find it, you just back off. For most people, the benefits of being in control of their hunger, feeling good, enjoying a healthy weight, are much greater than those fleeting pleasures of the processed carbs. So once people have experienced this, we find that it's very easy for people to self adjust in phase three. And then that's their plan for life, which might change over time. You know, little less processed carbs, little more fat. At times of metabolic stress, or when you go on vacation, maybe you loosen up a little bit.

That's great. Again, so many different threads we can pull there. So let me just say that we.

Also, the focus is on food, but we also bring in three life supports. So physical activity, stress relief and quality sleep. Enjoyable physical activities, not to burn off calories, but to improve insulin resistance, tone up metabolism, stress relief and quality sleep. These three things synergize with diet to produce maximum internal metabolic health.

That's great.

The body. Once you get the metabolic health inside, body weight takes care of itself.

You've got my almost 4 year old son asking for a pastegiata after dinner.

The passeggiata is the Italian wok after dinner, which they don't put on spandex and heart rate monitors. They're going out, enjoying the last rays of the sun, socializing. And that physical activity is helping their glucose tolerance. After the meal, they're reducing their stress, they're preparing themselves for sleep. We don't have to be constantly on the treadmill. Some people, that's great and some people need a really vigorous workout. But for other people we can bring enjoyment back into physical activities. We want to get rid of the deprivation model of food. You don't have to deprive yourself of calories and you don't have to deprive yourself of ease in these modern aerobics.

Focused Physical activity programs and even perhaps more importantly, enjoyment. Right?

Exactly. The focused on the enjoyment as opposed to deprivation. When you line up biology with behavior, then you get benefits. As you enjoy yourself, your body gives you positive feedback and you can actually increase your enjoyment. Weight loss does not have to involve suffering and deprivation.

That's great on both sides of the equation. Calories in, although we now know the equation is an accurate calories and does not equal calories out in terms of energy balance, etc. We can enjoy both parts of the process with high satiety, satiating foods and enjoyable physical exercise and movement.

On that point, I'll just add that my wife, who's a gourmet natural food chef and she actually comes from a vegan background, did although we offer vegetarian options, but there's also options for meat eaters. She did all the recipes and meal plans so that you can be sure that what you'll be eating will not only satisfy the nutrient targets, will also satisfy your taste buds.

That is fantastic. On that note, briefly tell us about animal meat, protein, et cetera. Your thoughts on it.

There's a lot of debate right now. People feel very strongly. The Paleo folks think that we should all be eating a lot of meat. We involved in that. The vegan folks think that meat is poison. I think here again the truth is likely in the middle and there's undoubtedly different individual sensitivities and susceptibilities. Some people can do pretty well with relatively less protein. It's hard to get a lot of protein on a vegan diet unless you're using a lot of protein powders and the like and then you're eating protein powders or. I'm not saying there isn't a role for them, but that's a pretty processed thing. Some people just do better with more protein and it's hard to get that high level of protein if you're vegan. I think the big thing is for younger children a strictly vegan diet can be risky. But I think adults can do perfectly well on a vegan diet with adequate attention to nutrient quality. At the same time, I think there's no evidence that we have to banish meat in order to be healthy. Now that beg that doesn't address ethical or environmental questions. There aren't enough wild animals for all of us to be eating grass fed meat all the time. You know, that was one thing when there were 20 million human hunter gatherers. It's another as we approach 10 billion people on the planet. So, you know, we have to Also realize that grains are here with us to stay. And so we want to be thinking of the quality of the grains, restructuring farm policy that will create a healthful plant, more healthful plant based options and not just plant based sugars and refined starches. And you know, I think ultimately we have to make that decision for ourselves and our own ethical views as to how much or little animal products we want to meet, we want to eat. So the book offers options both ways.

Yep. And as you said, a really comprehensive look at recipes. I didn't pick up that your wife had designed those. And that's awesome to hear. Again, we've covered a lot and yet we've barely scratched the surface. I'm just curious, if we looked at your kind of day to day, what would we see in terms of your nutritional intake?

Pretty similar to the book recipes came from how we ourselves live. I experiment on myself all the time and based on those experiments I understand I can begin to learn, get ideas for new studies and also understand the challenges of putting things into place. So I've tried, you know, been very plant based, really plant based, vegetarian. At one point I was on a ketogenic diet which has got virtually no carbohydrate at the other extreme and actually felt great on that diet. But it's hard to. It's very hard to sustain. And I don't think that. I think that for somebody with type 2 diabetes, that's a very promising option, at least initially. But I don't think that that's a public health solution. I think for most people we're going to need more moderate prescriptions.

It's fantastic. And I like the approach with fat's a heck of a lot easier to sell than eat more fruits and vegetables has proven to be. And trying to reduce the refined carbohydrates without creating that satiety and enjoyment in conquering the cravings. I mean, the nucleus accumbens research just blew me away of just not only are you jacking the metabolic switches the wrong way, but then you're creating addictive patterns. And so the subtitle is step one, Conquer Cravings. And I really appreciate the compelling approach that you offer in the book. Highly recommend it. And I love your experimentation too. For me, that's what it's all about. The experiment of one of, okay, well, this is what the research says. This is what the clinical data says. This is what my intuition says. Now let me go out and experiment. And that was a big thing for me. As I've shared in prior interviews, we Named our son Emerson. I was a low fat vegan before he was born and we had some challenges, my wife did, with her skin that merited looking at our approach. And Emerson of course said all life is an experiment, the more the better. And for us that became a mantra of just the willingness to step away from some of the dogma we had. I was very vegan Jellico personally and just open up to the possibility that there might be a more comprehensive approach, if you will. And again, I think your point is it's all, it's an experiment of one. We need to find our paths and.

Be willing to just to emphasize that a vegan choice is a perfectly reasonable one. There are many vegans who are very healthful and feel like they're leading a moral, ethical life. And the way industrial animals are raised in this country, you know, it's horrible as to whether that, you know, we can figure out a way of ethically eating animals, you know, a little more conscious about how they're grown and you know, that's an individual's choice. Yeah, but one can eat a vegan diet with I think in a more healthful way by increasing the fats, so making sure to get the, the nuts, plenty of nuts, olive oil, avocado, dark chocolate, flax. So you push those things that will reduce your reliance on the processed on the carbs, including just even if they're whole kernel grains, 10 servings a day is going to be too much. So if you can reduce that and you increase the fats in a vegan diet, I think it's going to be a win win.

I appreciate making that distinction. And we didn't talk about it and we don't have time to talk about it, but just the unequivocal clarity on factory farmed animals are for the ethical, the environmental and the nutritional reasons. Just an atrocity. So a whole nother conversation. I appreciate you taking the time, I appreciate your wisdom and I'd like to wrap up these chats with one final question, which is if you could just offer one tip and I usually have it be general, it could be anything, it could be nutrition, it could be in general for someone passionate about optimizing their lives. So you can go general or you can keep it focused on the nutrition, but what would the one tip be that you would share with someone passionate about optimizing their lives and actualizing their potential?

Well, I'm going to have to keep it focused on the topic at hand. And so from that perspective, our motto comes first to mind, which is tried to get a Michael Pollan esque short little pithy summary. What was his eat food.

Not too much. Mostly plants.

Yeah mine is forget calories, focus on quality and let your body do the rest.

I love it. Always hungry David Ludwig, MD, PhD David, where's the best place to connect with you? Obviously they can pick up the book wherever they buy books, Amazon, et cetera. What's the best place to connect with you?

Great. Our new and improved website is drdavidludwig.com that's Dr. David ludwig.com and that'll have links to all my social media. My social media name is David Ludwigmd on Facebook and Twitter. We also have a Facebook community called the Official Always Hungry Book Community. Again linked from my website drdavid ludwigmd. That community is free and non commercial. We've got already over 5,000 people following the meal plan so questions support new recipes. Find us in any place. But first come to our website Dr.david ludwig.com that's fantastic.

And I don't really spend any time on Twitter other than occasionally interacting. And I went to your site so I don't ever actually look at any other tweets but your Twitter feed as we traded some messages. Just awesome. There's some really compelling inspiring stuff there, so check that out. DrDavidWudwig.com David thank you so much.

Thanks and keep up the great work.

Brian thank you.

Isn't it a bit odd we went from math to science to history but somehow missed the class on how to live? For some wacky reason, optimal living 101 never made the schedule. Of course it's too late to go back and change that and you're too busy to read full time to catch up yet. If you're like us, you're all about optimizing your life and actualizing your potential.

So.

So imagine this. Imagine having someone read the best books on optimal living and pulling out the big ideas that can truly change your life. You know those sections you asterisk and underline and mark all up? Then imagine that guy me connecting those ideas to other great books and helping you apply them to your life today. Well, that's what I do as something we call Philosopher's Notes where I break down each great book into a simple 6 page PDF, 20 minute MP3 and 10 minute Philosopher's Notes TV episode. Then imagine me taking the absolute best big ideas from those great books and sharing them with you in fun, inspiring, super practical optimal living 101 classes on stuff like purpose 101 confidence 101. Business 101, meditation 101. That sort of thing. You've got a personal trainer? I'm kind of like your personal philosopher. Ancient wisdom plus modern science plus common sense plus virtue plus mastery plus fun. That's what our optimized membership program is all about. We'd love to have you join us.

Check us out at BrianJohnson.

Me join?