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Insulin Resistance Doctor: This Ends Insulin Resistance Over 40 — Transcript

by Thomas DeLauer · 10,392 words · 1,621 segments · language en · Watch on YouTube

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0:00If you think of say like a Ring doorbell
0:02as being um the insulin receptor. I have
0:05a little daughter. You have a little
0:06daughter. When she was two, she figured
0:08out the Ring doorbell at our house and
0:10thought it was amazing. She press Ring
0:11doorbell, makes a sound, someone comes
0:13running, right? So what's she do? Starts
0:15dinging the doorbell, right? Infinitely.
0:18We have chronic exposure to insulin.
0:20Insulin's that my daughter's finger. The
0:22doorbell is the insulin receptor. When
0:24you have chronic exposure, and this is
0:26where I think the the key part of the
0:28puzzle is chronic exposure to what we
0:31talk about glycemic variability, it's
0:33not the glucose spike, it's how high is
0:35the spike, how long is the spike, how
0:38variable is the spike, highs and lows,
0:41right? And then how often is that
0:43happening during a day? Every one of
0:44those spikes, the body has to deliver
0:46insulin. So now you get higher and
0:48higher levels of circulating insulin,
0:50fingers on the doorbell all the time.
0:52That's circuitry. This is the true
0:53mechanism of insulin resist. That
0:55circuitry starts to go bad. And where
0:57does it start to go bad first? It's not
0:59in muscle. It's in the liver. Dr.
1:01Jonathan Chef, let's pretend that I'm 50
1:03years old. I just got my lab work back.
1:07I have high HBA1C. My doc tells me I
1:10have insulin resistance. What would you
1:12tell me to do?
1:14>> Well, for starters, that's one data
1:16point out of hundreds that I do think
1:19are worth looking at. We have to
1:21understand that age- related decline
1:25while it's an inevitable process as
1:28we've thought of it in the past is not
1:30at all inevitable and is very much
1:32controllable. But by the age of 50, if
1:34you're an American, there's likely a lot
1:38more going on than simply understanding
1:40your metabolic health. There's way more
1:44tied to it than that. So having the
1:46complete picture and understanding what
1:48are the key or principal drivers and
1:50then looking strategically at what are
1:53the the lowhanging fruit what are the
1:56things that are going to move the needle
1:57most for you as an individual insulin
2:00resistance we can say diet exercise but
2:03that's way oversimplified for what we
2:06need to really accomplish we have to
2:08look at hormone health we look have to
2:10look at the environment with which your
2:12body is existing is it pro-inflammatory
2:14Are there other conditions going on?
2:17Then we have to really look at what are
2:19you doing day in day out to directly
2:23impact on that. I think the answer to
2:25insulin resistance starts very simply.
2:28If you want two things, move more.
2:31Well, I'll make it three, okay? Move
2:33more, build muscle, and get rid of added
2:36sugar. You start there. That's probably
2:3875% of the way to being metabolically
2:41healthier. That other 25% is where we
2:45really have to look more strategically
2:47across the whole human body and how can
2:49we influence pull levers adjust dials
2:53accordingly. But muscle, if you were
2:56going to make it all about one thing,
2:58muscle is medicine. Muscle's the organ
3:01of longevity. And it's also the most
3:03critical performance metric that we can
3:06seek to live longer, better lives.
3:09>> I noticed you didn't mention calorie
3:11restriction. What would your strategy be
3:13from a diet perspective?
3:14>> Gosh. Well, I mean, that's true. I' I'd
3:17definitely want to restrict them like a
3:18thousand calories a day because that
3:20works really well. No, it really the the
3:24the calorie we've had this discussion
3:26already, but the the the the calorie
3:29conversation is is antiquated and it's
3:32myopic. It's way oversimplified to how
3:35the human body exists. And let's just
3:37get it out in the open. Calories in,
3:39calories out. Energy balance. First law
3:41of thermodynamics. It's science. Yes,
3:43it's science in a vacuum in a lab, but
3:46not in a biological organism because
3:48there's one word that changes
3:50everything. That entire dynamic. Why
3:52calories and calories that doesn't work.
3:54It's adaptation.
3:56A biological organism adapts. It's a
3:59complex interaction between hormones,
4:03peptides, right? Naturally occurring
4:05peptides. um how the minute-to-minute
4:09changes in each individual cell
4:11influence the organism. So calories in
4:15calories out loses the big picture. And
4:18you know my perspective on why we got so
4:20hung up on it was 10 20 years ago. One
4:24we had no concept of body composition
4:26and we really didn't have any analytics
4:28to expose body comp readily available. I
4:31think like Lifetime Fitness now every
4:33Lifetime Fitness has an inbody scale.
4:35You could get on there and you can tell
4:37total body fat mass, skeletal muscle
4:38mass, smis, those kinds of data points.
4:41Before we had that, all we have was a
4:43scale in your bathroom. So, calories in,
4:46calories out works for the scale to a
4:49point, but scale weight is a terrible
4:52metric to follow anyone. Anyway, when
4:54you talk about metabolic health and
4:55performance, right? I mean, losing
4:57weight, it's be beyond me that we have
5:00those conversations or the weight loss
5:02clinics because weight loss is is is a
5:06detrimental end point if you use it as a
5:09single data point, right? If I said to
5:12you today, hey, to get you healthy, I
5:16want you to lose three pounds on the
5:18scale. You'd look at me and you'd be
5:20like, Zach, I mean, I don't think that's
5:22going to cut it. You know, I I I was at
5:24my best 20 lbs lighter. Were you? How
5:27How can you say that?
5:30If we lose 30 pounds of fat mass and put
5:32on 11 pounds of skeletal muscle mass,
5:34your scale weight is not going to change
5:37significantly. I see that every day. And
5:39yet, your metabolic health is going to
5:43skyrocket. Literally flip the script.
5:46So, so calories in, calories out misses
5:48the whole point that we're biologic
5:50organisms. And we know this. We see this
5:51time after time after time. The best
5:53example of energy balance, an epic fail
5:57is the biggest loser.
5:58>> Yeah. I mean, we we have one of the
6:02world's greatest longitudinal studies on
6:05calorie restriction ever made on live
6:08TV. If you look at the metabolic
6:11adaptation, six years post filming,
6:15right? 11 of the 13 that were followed
6:19regained the weight and then some right
6:22and if you look at their body
6:23composition but more importantly you
6:25look at their basil metabolic rates I
6:27mean that's the crux of metabolic
6:29adaptation right 6 years post massive
6:32weight loss with calorie restriction
6:33only what did it show up to a th00and
6:37calorie reduction in basil metabolic
6:39rate 6 years later you've already gained
6:42all the weight back and initially people
6:44looked at that and said oh well it's
6:45they lost muscle along the way. That
6:47doesn't account for that discrepancy. So
6:51that's the net failure of the calorie
6:54restriction. And by the way, restrict
6:56calories, more cardio. That's the
6:59standard gold standard 2026. People
7:01still come in like, "Doc, I'm doing I'm
7:03doing all my cardio." Yeah. Stop.
7:07Do some resistance training, intentional
7:09movement, and look strategically at what
7:12you consume, not in the form of
7:15calories, but in the form of
7:18macronutrient distribution.
7:20I am a principal guy. It's calories,
7:23carbs, early fuel with a purpose. You
7:25know, protein is a non-negotiable.
7:27Protein is a priority in a diet largely
7:30if you if you consider it very simply
7:31put, it's thermic effect. and also the
7:34importance of being in a positive
7:36nitrogen balance to support muscle
7:38health, right? That's where the magic
7:41happens. But it's way more simple and
7:44it's way more sustainable. You know this
7:46to be true. Building muscle early.
7:50Sustaining it over time is the key. And
7:53you you you're talking about the 50-y
7:54old old male. We're not talking about
7:56the 50-y old female yet.
7:57>> Yeah. Because the 50-y old female is 10
8:01times worse off if there's no early
8:03intervention.
8:05>> You look at the per decade loss of
8:07skeletal muscle in a female relative to
8:09a male, it's devastating.
8:11>> Yeah.
8:11>> And then women, I mean, menopause, we
8:14that's a whole whole topic to itself,
8:16but what happens in menopause? And
8:18people are like, "Oh, it's it's um you
8:20know, my metabolism slowing up." No,
8:22you're you're psychopenic.
8:25Super simple. After today's video, I
8:27popped a link down below for Seed Daily
8:29Symbiotic. So, if you're trying to make
8:31any kind of dietary change or different
8:33lifestyle at all, one of the first
8:35things you want to focus on is your gut
8:36health. A lot of things start there. And
8:39we look at the world of the microbiome,
8:41it's pretty complicated, right? We're
8:43just starting to scratch the surface
8:44some of the science there. The cool
8:46thing is is Seed is paving the way for a
8:48lot of that research. They've got
8:49multiple clinicals. They've really
8:51looked at the data and how this stuff
8:52works. So, so that symbiotic down below,
8:54that is a 20% off discount link for
8:57their prebiotic and probiotic that's
8:59inside one capsule. So, you get proper
9:01absorption throughout the right areas of
9:03the digestive system. So, you're getting
9:04a prebiotic that breaks down first and
9:06then you have the probiotic that
9:07potentially colonizes a little bit later
9:09in the gut. So, again, that link down
9:11below gets you 20% off seeds daily
9:14symbiotic. What about I mean people get
9:16so concerned with especially over the
9:19age of 40 even with fasting versus like
9:22caloric restriction when when you back
9:25the data out and you look at like what's
9:26your net calories over the course of the
9:27week like there's a there might be a an
9:31equal deficit just kind of split up in
9:32different ways. So you know if you have
9:34someone that's 45 50 years old that's
9:36coming to you with metabolic issues what
9:39would you say to them in terms of a
9:40fasting strategy? So fasting to me, one,
9:44let's unpack fasting. One of my [snorts]
9:46biggest pet peeves on social media is
9:49fasting equals eating windows,
9:52intermittent fasting. That's all there
9:54is to fasting. Now, it's it's
9:56>> that idea and the reference point when I
10:00say fasting, what I'm talking about is
10:02strategic sustained water only fasting.
10:05Again, black coffee, fine. We can unpack
10:07that piece. but greater than 24 hours.
10:10Why does that matter? Well, when you
10:13look at the intermittent fasting data,
10:15I'll be the first to agree that it is no
10:18different in long-term outcomes than any
10:21other form of calorie restriction. There
10:23is a modest impact on insulin
10:25sensitivity. It does. Calorie
10:27restriction over time does modestly
10:29improve insulin sensitivity. Does it
10:32radically reverse insulin resistance?
10:34No, not at all. because it's not a
10:36targeted therapy. Sustained fasting,
10:40achieving the same calorie deficit in an
10:43abbreviated or an abrupt period of time
10:45does something that chronic calorie
10:47restriction can never do. It reverses or
10:51flips the insulin glucagon ratio on its
10:54head. It presents it presents such an
10:57acute stress and this is an important
10:59concept that I I try to share with my
11:01clients every day is acute stress good
11:03the body acute stress adaptation is the
11:07most powerful impressive god-given
11:10cellular response that we have chronic
11:13stress adaptation is maladdaptation 100%
11:17of the time you present someone with
11:19chronic calorie deficit they
11:21metabolically adapt you present someone
11:23with acute metab metabolic at metabolic
11:26um calorie restriction they
11:29metabolically optimize
11:31>> but the crux of it is that shift
11:34strategically in insulin balance if you
11:37consider that probably upwards of 90
11:39plus% of Americans today are insulin
11:40resistant based on critical metrics and
11:44based on all comers [snorts]
11:46I go into
11:48most conversations with a 50-year-old
11:51male
11:53assuming there's probably an element of
11:55that on board. That's a pretty safe
11:57assumption, right? Maybe you don't have
11:59insulin resistance, but the general
12:01public does. So, I think we have to
12:02approach it that way. So, I use
12:03strategic fasting as a mechanism to
12:07optimize metabolic health and
12:08performance. And I I really pare it down
12:10to two categories. Moderate to high
12:13insulin resistance,
12:15moderate to high visceral fat load is
12:18sort of that metabolically diseased or
12:21dysfunctional individual. Those
12:23individuals
12:25need a really a complete reset to their
12:28metabolic system. That typically looks
12:30like longer duration fasting than
12:33someone who is modestly insulin
12:36resistant has a baseline skeletal muscle
12:39mass indicy that's appropriate for age
12:41related cohorts. That person we can
12:44really engage a very strong aggressive
12:47stimulus. So until we've really reset
12:49and kicked out of that high-grade
12:51insulin resistance, I don't [snorts]
12:52think you can convert over to more of
12:54what I call an accelerator protocol.
12:56>> Yeah.
12:57>> But the difference in all of these
12:59conversations for me is it's all data
13:03driven. That's what I think is the
13:05greatest gap in understanding
13:08in the general public. How many times do
13:11you hear or do you get a a question
13:13about like, hey, I'm fasting for 48
13:15hours or 72. Why? For what? To what end?
13:19How do you know for you what the optimal
13:23fasting window is?
13:24>> Well, first of all, we have to
13:26understand what data we can collect real
13:29time to define a a again a datadriven
13:32fasting protocol. What are we trying to
13:34accomplish? For me, the principal issue
13:38is radical glycogen depletion. That's
13:42needs to happen upfront, right? In order
13:44to really engage
13:47the body's hormonal response to
13:50strategic fasting, we want to wipe
13:52glycogen.
13:54Principle number one. Principle number
13:56two, we want to drive ketosis. And the
13:59only way to drive ketosis that no, this
14:01isn't ketogenic dieting. This is acute
14:05control, measurable control of ketosis.
14:08Only way to drive that is to eliminate
14:11insulin. The only way to eliminate
14:13insulin is glucose glycogen depletion.
14:16Is that fair?
14:16>> Y
14:17>> again,
14:19that may be slightly oversimplified, but
14:21it's really not rocket science. And
14:23[snorts] the beauty of today, I mean,
14:25look, I can continuously monitor my
14:29glucose levels. Coolest thing out there,
14:32by the way, that's on the horizon. I can
14:34continuously monitor my ketone levels.
14:36>> Yeah.
14:37>> So, I have all the data right in front
14:39of me. And so we can look at inflection
14:41points and what I call the crossover
14:44point between serum glucose and serum
14:47ketones.
14:47>> Yeah.
14:48>> To define strategically where is that
14:51point where the body is actually
14:53shifting into lipolysis.
14:56>> Yeah.
14:56>> Your GKI kind of your glucose.
14:58>> Exactly. How does the regular person uh
15:01like what would you say that feels like?
15:03Right. Because let's say
15:04>> I know right.
15:04>> That's where it can get a little bit
15:06tough is
15:07>> I I love the data. I know we can't get
15:09everyone to wear a continuous ketone or
15:11a continuous glucose monitor, but I
15:13think over over the years, you start to
15:14feel like you know when that feeling is
15:16happening, right? And the best way that
15:17I could describe it is like it's that
15:19feeling when you get up in the morning,
15:22you're fasted, you you work out, and
15:24you're about halfway through your
15:25workout and you just feel like you can
15:28flip between being aerobic and anorobic
15:31very well. So, for like maybe for the
15:33person that's not clicked in from a
15:36fitness perspective, maybe they haven't
15:37been, you know, they're just getting
15:38started,
15:39>> it's almost like it feels like when
15:41you're in that fasted workout and you're
15:43no longer gassed and winded and you feel
15:46like the wheels are turning. You just
15:48feel like you're in that groove.
15:49>> There's almost like an energy uptick,
15:51right? And you can follow it. What's
15:53really cool is with highly insulin
15:56resistant clients that I work with,
15:59there's a what I see is there's sort of
16:02a a gap period where they you really
16:06start to feel like you're hitting that
16:08wall just energetically
16:11and then it all sudden flips. And for
16:13some people, again, that's 24 4872. the
16:17you see my kind of hesitation with
16:18answering how does it feel because that
16:21is one of the hardest things I think
16:23people latch on to that really kind of
16:27distracts from the the end goal because
16:30it is it's hard to put a finger on
16:32that's why I find with clients we
16:34typically you know we'll do high
16:37resolution data collection for the first
16:39two maybe three fasts for most clients
16:43from then on they know exactly how it
16:46feels It's that it's hard though coming
16:48out of the gate. One, if you've never
16:50been in ketosis, you are going to feel
16:53that drop off. Some people find it, I've
16:56even found it, you feel a little bit
16:58shaky, just kind of a little bit.
16:59>> It gets worse before it gets better.
17:00>> Correct. Yeah. It's almost like there's
17:02a little drop off
17:04>> and that's where most people fail.
17:06>> Yeah. They react. They react in that
17:08point and then we we're conditioned to
17:10>> like you get a little bit hungry, you
17:11get a little I mean it's like what
17:12you're boiling it down to is the person
17:14that is metabolically they come to you.
17:15We come back back to that initial
17:17question. Okay, your HBA1C is high.
17:18You're just told you were insulin
17:19resistant like you don't what to do now,
17:21>> right?
17:22>> Like for one, it's like
17:24>> maybe you have to become a little bit
17:26comfortable with discomfort for a little
17:27bit. You have to be okay with being a
17:29little bit hungry for a little bit and
17:30not through the means that most people
17:32would tell us in terms of not hungry
17:34through restricting your calories or,200
17:36calories a day. No,
17:37>> but a little hungry in the sense that
17:39maybe you're going to be skipping
17:40breakfast and and lunch
17:42>> and it might feel a little weird and it
17:43might feel emotionally uncomfortable
17:45because every signal in your body is
17:47going to be telling you to eat because
17:48it's getting a cattywampus signal in the
17:50first place.
17:51>> Yep. Well, I'm going to say something
17:53that people may or may not like to hear,
17:57but as a strategist, as a physician, I'm
18:00going to tie this to big picture, cuz I
18:02hear this all the time on social media.
18:04Evidencebased
18:05medicine. Well, the evidence says this.
18:08Well, the guidelines say this, okay, at
18:11the end of the day, we know this to be
18:13true. Optimized hemoglobin A1C, optimal
18:16fasting insulin, let's call it what it
18:17is. Hemoglobin A1C less than 5.2 two
18:20fasting insulin less than seven
18:23optimized five high performance
18:25optimized less than two. Is there such a
18:27thing as too low of fasting insulin in
18:29my professional experience? No.
18:31>> Your body shouldn't be producing insulin
18:33at at rest. So when you look at those
18:36those parameters and you you consider
18:39all that [snorts] the endgame is those
18:41parameters. We know that correlates
18:43again across large volume population
18:46series to longer better life.
18:48In my mind, as a physician, we need to
18:50do what we need to do to get to that
18:52point.
18:52>> Yeah.
18:53>> Here's where I actually use GLPS as a
18:56strategic tool to support fasting
18:59protocols because I know the most
19:03aggressive and also most likely to
19:06succeed protocol to rapidly reverse
19:09insulin resistance is through strategic
19:12fasting. It's simple, very simple. Where
19:14do people fall out? food noise,
19:18the physical discomfort as glucose
19:22regulation shifts, right? Their bodies
19:24never, A lot of people have lived a
19:26lifetime and never Think about this. A
19:29lot of Americans have lived a lifetime
19:30and never experienced a glucose level on
19:33average less than 100.
19:34>> Yeah. Wild.
19:35>> That's crazy. I don't know about you, I
19:38feel best with a glucose level in the
19:4170s,
19:42>> right? with ketone three three and a
19:44half millm moim moim moim moim moim moim
19:44moim moim moim moimles you feel very
19:47clean lasered in focused
19:51>> but you got to go from this all the way
19:53over there that's a that's a leap so I
19:56use GLPs quite commonly in that context
19:59actually bullish GLPs around a fasting
20:02protocol specifically strategically
20:05quiet food noise balance provide a more
20:09balanced uh um homeostatic level of
20:12insulin and glucose and allow that
20:16person to build the self-confidence and
20:18also have the physiologic experience of
20:20cuz you know once you get over that hump
20:23you're like whoa all of a sudden like
20:25you're struggling in that workout all of
20:27a sudden you've got that it's not even a
20:29second wind it's that clean fuel your
20:31body starts using fat which is an
20:33excellent energy source and you actually
20:36feel more energized but [snorts] that
20:39getting through that process especially
20:41if you're doing blind without data is
20:43not not a pleasant experience. So this
20:46is where as a physician I believe very
20:48strongly in the role of GLPs. Um
20:51specifically tzepide you know dual
20:53aagonist is a potent mechanism in bolus
20:57fashion. Do I think you need to be on a
20:59GLP for life? Absolutely not.
21:01>> No. But a GLP can play a powerful role
21:04in what I would term a metabolic reset.
21:07>> Yeah. Agreed. Yeah. It's allowing you to
21:08get into that into that state. I think
21:10we were talking about with that
21:11metabolic flexibility which is rather
21:13than
21:14>> staying on a GLP1 is or any kind of
21:17receptor agonist is or even a triple
21:18agonist for that matter staying on it is
21:20just a it's just a synthetic form of
21:23caloric restriction. That's essentially
21:25what you're doing. I mean you're staying
21:26on it for a long time. I mean you're
21:27just artificially I mean the GIP is a
21:29little bit different obviously but when
21:30you get into that world if you're doing
21:33it for prolonged periods of time I mean
21:35yes you're restricting calories. as
21:37you're um you know reestablishing a you
21:40know glucose homeostasis for sure but
21:42the bless fashion by using it to train
21:44the body to be able to get into these
21:46extended fasts because I think what what
21:48you're saying which I appreciate so much
21:50about a fasting perspective because it's
21:51exactly how I look at it is fasting
21:54should be the acute stressor not the
21:56norm
21:56>> correct
21:57>> like intermittent fasting is and I've
21:58caught so much crap for this because
22:00it's just like I have a lot of fasting
22:02people that watch my but I'm not pro 168
22:05like I feel like skipping Breakfast
22:06every day is just another means of
22:07caloric restriction.
22:08>> Exactly. That's all it is.
22:09>> Acute stressor being able to
22:11occasionally once a week, once every
22:13couple weeks, go 24 hours, go 36 hours,
22:15go an extended period of time.
22:18>> But what people don't often understand
22:20is that if you don't have the metabolic
22:22flexibility to do that, that is almost
22:24torture for them because some
22:26>> it's not even tor I mean it it it is
22:29going to be not just challenging. I
22:32mean, get the the mental toughness. You
22:34know, I've been criticized for
22:35suggesting using a bullish GLP strategy.
22:38Well, what about the self-discipline and
22:40all that stuff? Well, listen, that's
22:42great and I'm obviously I believe very
22:43strongly in self-discipline,
22:45but if I can't get someone over the
22:47hump, self-discipline is not even part
22:48of convers. It doesn't matter. It's
22:50irrelevant. You're you're a unicorn in
22:52the sense that you are talking about um
22:54you know, not buying into calories in
22:56calories out BS
22:57>> yet at the same time still condoning the
22:59use of a GLP, right? That makes you that
23:01makes you a unicorn because I think
23:03which I think people should listen to
23:04that because you're talking about it
23:06from this is a strategy
23:08>> metabolically
23:10not just to reduce your caloric intake
23:13>> to talk about those things from two
23:14different perspectives is very unique
23:16and to be able to kind of because that's
23:17exactly how I view GLPs. I'm not opposed
23:19to them.
23:20>> I [clears throat] don't like Ozic. I
23:21don't like the I don't like that stuff.
23:23I don't like the fact that it's
23:24monetized the way it's monetized. I
23:26don't like the the the pharmaceutical
23:27aspect of it. But mechanistically, these
23:29things have been used
23:31>> in diabetes and in these metabolic
23:33conditions for a very long time before
23:35they were ever even talked about for
23:36general weight loss.
23:37>> Right?
23:37>> So using that to allow someone to be
23:39able to achieve metabolic flexibility
23:42through fasting
23:44>> faster so that then they can adopt the
23:46fasting lifestyle without the use of it
23:48faster.
23:49>> I see it as a pretty appropriate tool.
23:51>> And that's and that's all it is. Fasting
23:54is a tool. GPS are a tool. Hormone
23:57health. I mean we could unpack that
23:59whole segment of the conversation.
24:01They're tools [snorts] for performance
24:04output. And if you look at it from that
24:06perspective, then I think it all ties to
24:09a strategy. And then something I obsess
24:12over as [clears throat]
24:14a 48-year-old father of two, multiple
24:18businesses, you know, efficiency is
24:20everything. I believe I I say this
24:23outright to my clients. I get 90 days to
24:26have radical impact on your health and
24:29performance or there's there's the
24:31likelihood that you know you really buy
24:33in and stick with the plan is pretty
24:35low. That's just human nature, right? So
24:39why wouldn't I use every tool, every
24:43advantage possible? And this is my
24:46biggest challenge for especially a lot
24:48of physicians now who have kind of
24:49shifted in this coaching role. I don't
24:51quite get it. If I'm taking care of you
24:54from afar and I can't do anything more
24:57than say give you suggestions, that
24:59becomes hard for me as a physician. I
25:01don't feel like I can add enough value
25:04to justify my existence. What's really
25:06cool is when I get to work with you
25:08one-on-one,
25:09it's we can get so into the weeds, it's
25:12crazy, right? But all of these become
25:16tools in a think of it as like a massive
25:19tool shed that you're ultimately working
25:22towards is in fasting of all the things
25:25we could talk about muscle health and
25:28fasting. If that's all you dialed in,
25:32there's really not a lot outside of
25:33genetic predisposition that's going to
25:35trip you up. Do you agree?
25:37>> Yeah, absolutely.
25:38>> I mean, and that's where I would say
25:41it's a lot less
25:44magical or mystical or you know um scary
25:48than I think a lot of what people have
25:49in their mind and people hear fasting
25:52and again a lot of clients first time I
25:54bring up fasting with a client you know
25:56they they have sort of a visceral
25:58reaction it's either I've tried it
26:00before I've failed oh yeah know I
26:02intermittent fast I skip breakfast every
26:04day and it it it hasn't really worked
26:05well that's not fasting I mean we got to
26:08get away from that alto together but
26:10when you explain fasting and then you
26:12say And someone asked me this the other
26:14day. They were like, you know, what
26:15percent of your clients actually
26:18complete their fasting protocol and even
26:21go on to adopt that as part of a
26:23lifestyle um management piece 100%.
26:28Because I'm hellbent on doing whatever
26:30it takes to allow you to get over that
26:32hump, which you and I both know once
26:34you're over that hump, fasting's
26:37fasting's a workhorse. I mean, I feel
26:41consistently better when I fast.
26:45Not just from a health standpoint, but
26:47even from a logistical standpoint. Yeah.
26:49The other thing I heard someone say
26:50recently was like, you never realize how
26:53much time, especially as Americans, we
26:55spend every day
26:58related to food.
27:00thinking about food, where are we going
27:02to get our next meal, making the
27:04reservation at at at the um restaurant,
27:07getting takeout, going to the grocery,
27:09planning, prepping. The amount of time
27:12Americans invest in food is is shocking.
27:16And the only way to understand that
27:18fully is to spend a day not eating. And
27:21all a sudden, you've got two, three
27:22hours of time you didn't know you had.
27:25Yeah.
27:26>> Right. And so for me it's it's it's even
27:29strategy in terms of daily logistics
27:31that frees it up. But the metabolic
27:33impact if you consider most Americans
27:37are metabolically deranged.
27:40The answer to me is pretty simple. It's
27:42extract value from strategic fasting.
27:45[snorts]
27:45>> I think and you mentioned something at
27:47the very beginning which was the sort of
27:50inflammatory state of the body in the
27:51first place.
27:52>> Right. I think people have a
27:53misconception that insulin resistance is
27:56a glucose problem,
27:58>> right?
27:59>> And that's the glucose is a that's a
28:01that's a further down the cascade,
28:03right? That's that's a response, right?
28:05The response is your inability to manage
28:08glucose because insulin is the insulin
28:10dynamics are messed up. And I think when
28:12you start looking at it, I think people
28:14oftentimes put this cart before the
28:16horse where they're just they're so
28:18overly fixated on carbs becoming the
28:21carb being the problem.
28:22>> Sure.
28:23>> And insulin being the problem,
28:24>> right?
28:26>> That it can get twisted because like
28:28what you're saying could absolutely be
28:30misconstrued through the wrong lens of
28:33like, oh, this guy's saying insulin is
28:34bad. This guy's saying I should never
28:36spike my insulin. I should never. But
28:38you said something very clear which was
28:41you're there's no reason that you should
28:43have a fasting insulin level above
28:44essentially zero
28:47at baseline. Right.
28:48>> Right. Now obviously when you consume
28:51food you should have some level of
28:52insulin. Can we talk about kind of the
28:54balance that you think people should
28:56follow? If they are insulin resistant
29:00>> and they are trying to lower their
29:02fasting insulin levels.
29:04What they should do to not be afraid of
29:07insulin? Let's yet still leverage these
29:09low dips in insulin that are going to
29:11allow them that metabolic flexibility
29:12because the goal should be
29:13>> you should be able to have carbs without
29:15a problem. Like you should carb carbs
29:18are are freaking jet fuel.
29:20>> Carbs are great
29:21>> if you can use them.
29:22>> Right. Right. Well, here I mean oh I see
29:26this going off in in a couple
29:27directions. One thing I want to say not
29:31not at all in disagreement but I think
29:36in today's today's understanding of
29:39insulin resistance people hear insulin
29:42and they think insulin bad.
29:44>> Yeah.
29:44>> I think of insulin like you remember the
29:46Goonies. I think of of insulin as like
29:48your big dumb older brother. Okay. It's
29:51not bright but it's well-intentioned.
29:54Insulin's doing its job. And plain and
29:56simple. I'm going to say something uh
29:59that's going to sound like heresy. I
30:00think Gary Brea has one reasonable point
30:05which is insulin really has three roles
30:08in the human body. It's it's it's
30:10ultimately about glucose homeostasis and
30:14glucose free glucose in the bloodstream
30:16is toxic. That is a true statement.
30:18>> Right. Yes.
30:19>> Now carbs and glucose are not one and
30:22the same. There's a relationship.
30:24>> So this is where it gets nuanced. But
30:26what does insulin do? Yeah, it activates
30:28glute 4 receptors in myioytes,
30:31hpatocytes, adapocytes to uptake
30:33glucose. Okay, get it out of the
30:35bloodstream. It activates ultimately can
30:37activate denovoatic lipogenesis, use
30:40glucose, convert it to different
30:42substrates, get it out of the
30:43bloodstream. Right. Yep.
30:44>> And ultimately, yes, it is very true to
30:47say insulin and its relationship with
30:50atyposytes, fat cells, is very linear.
30:54It is the most potent inhibitor of
30:57lipolysis. It's a true statement. Now
31:00people get all the, you know,
31:01pseudocientists get into the weeds of
31:04well that's happening at the cellular
31:05level. That's not whole body lipolysis.
31:07Well, where does whole body lipolysis
31:09start at the cellular?
31:10>> At the cellular level, you know, you
31:11know what I mean? Like these are what
31:12these guys like, guys, you don't have to
31:15make it this complicated. Insulin has a
31:17much higher affinity
31:19>> for atyposytes than it does elsewhere.
31:22Right. So, so if we agree on that then
31:24we have to understand the relationship
31:27between glucose and insulin it's very
31:29simple glucose once it achieves a
31:32certain threshold in the bloodstream
31:34it's by the way this is chemistry it's
31:37pancreatic beta eyelet cells don't have
31:39brains they don't you know how we
31:41present things like what wants to do
31:43this no this is basic chemistry when
31:45there is a glucose threshold in met
31:47insulin is secreted by pancreatic beta
31:50cells now it's fascinating by the way
31:51insulin and man insulin in the body and
31:54the glucose relationships between you
31:57know non-inssulin dependent glute glute
31:59uptake right so glute channels in I'm
32:02sure you know this but there are
32:04non-inssulin dependent glucose channels
32:06in beta cells glucose is actually
32:10cytotoxic to beta eyelet cells kills
32:12them just like it does neurons just like
32:15it does you know ocular cells kidney
32:18cells so on and so forth but free
32:21glucose in the bloodstream
32:22cytotoxic we have to that that is a true
32:25statement and then that you understand
32:27the relationship between glucose and
32:28insulin. So now we have to get more
32:31strategic because yes while insulin
32:34we'll say generically um has a a storage
32:38and an anti- lipolysis mechanism. We
32:42also know it's the most potent
32:43stimulator of muscle growth. So here
32:47here we come right back to that word
32:48strategy. How do we use our knowledge of
32:53human biology to strategize towards
32:55optimal health? Because having high
32:57levels of insulin following a workout
33:00where you have adequate building blocks
33:02amino acids available is the most potent
33:05indeector of mTor activation and MPS
33:09muscle protein synthesis. Agreed.
33:10>> Agreed. Y
33:11>> we have to use it strategically. So
33:13insulin's not bad nor is glucose bad.
33:17all these things. It's not a good bad
33:19situation. It's all about strategy. So
33:22when you're insulin resistant, if we can
33:26do that tangent briefly, the simplest
33:29way I can present insulin resistance to
33:31people is this.
33:33There are
33:35there are insulin receptors on muscle
33:37cells, liver cells, fat cells. That's
33:40the predominant resource for insulin
33:42receptors. Obviously, there's insulin
33:43receptors all over the body. But if you
33:46think of say like a Ring doorbell as
33:49being um the insulin receptor,
33:52I have a little daughter. You have a
33:54little daughter. When she was two, she
33:55figured out the Ring doorbell at our
33:57house and thought it was amazing. She
33:59press Ring doorbell, makes a sound,
34:00someone comes running, right? So, what's
34:02she do? Starts dinging the doorbell,
34:04right? Infinitely. As you know, I'm a
34:07surgeon. So, my my my phone's going off
34:1030, 40 times a minute. And at first I'm
34:12like, man, is the Amazon guy just losing
34:14his mind or something? Then of course
34:16they show me the little video and there
34:17she is smiling and going nuts. So what
34:20happens when we have chronic exposure
34:23and this is the that the the tie to
34:25carbohydrates, specifically glucose. We
34:28have chronic exposure to insulin, right?
34:31Insulin's that my daughter's finger. The
34:34doorbell is the insulin receptor, right?
34:36And then you have postproducts, right?
34:39So you have chemical reactions taking
34:41place with intracellular communicators.
34:44Think of that as the wiring to the
34:46doorbell itself, right? And then the
34:48glute 4 channel, think of it as you, me
34:51rushing to the door, throwing it open to
34:53allow glucose in. That is the insulin
34:55dependent physiology of glute 4
34:58channels. Glucose uptake into muscle
35:00cells for example.
35:02When you have chronic exposure, and this
35:04is where I think the the key part of the
35:06puzzle is chronic exposure to what we
35:09talk about glycemic variability, it's
35:12not the glucose spike, it's how high is
35:14the spike, how long is the spike, how
35:17variable is the spike, highs and lows,
35:20right? And then how often is that
35:22happening happening during a day? Every
35:24one of those spikes, the body has to
35:25deliver insulin. So now you get higher
35:27and higher levels of circulating
35:29insulin. fingers on the doorbell all the
35:31time. That's circuitry. This is the true
35:33mechanism of insulin resistance. That
35:34circuitry starts to go bad. And where
35:36does it start to go bad first? It's not
35:38in muscle. It's in the liver.
35:40>> Mhm.
35:41>> Right. Yep.
35:42>> Which is also the metabolic supercomput.
35:43We can get in to those weeds cuz I think
35:45it's fascinating. But when you keep
35:47dinging that doorbell, those channels
35:50ultimately stop opening, right? And in
35:53so it takes more rings of the doorbell
35:55to get the same net effect.
35:57>> Yeah. Agreed.
35:58>> So what's the body do? it's producing
35:59more insulin. So that's we have to
36:01understand that relationship to
36:02understand how to reverse that
36:05relationship because indeed [snorts]
36:07carbohydrates by themselves do indeed
36:11ultimately convert to glucose. That's
36:13the only currency that's distributed
36:15into the body. But how rapidly that
36:19occurs
36:21and based on how rapidly occurs, how
36:23high does that glucose spike go and
36:25thereby how high is the insulin surge in
36:28response. That is the differentiator.
36:32So control your glucose spikes and this
36:34is what I think is freaking fascinating.
36:36You actually, true story, you turned me
36:39on to this concept I think um a while
36:43back. But the idea that those channels
36:48in muscle cells specifically
36:50>> Mhm.
36:51>> are not actually uniformly insulin
36:54dependent, right?
36:54>> Correct. Yeah.
36:56>> They actually function incredibly well
36:58in an insulin independent manner
37:02>> strategy.
37:03How do we regulate blood glucose
37:08without insulin? Very possible.
37:10>> Yeah.
37:11>> And it's not purely a dietary
37:12conversation. Now, yes, if you keep
37:14pumping sugar into your bo body, you
37:18will continue to have those spikes. You
37:19will continue to have the insulin
37:20response. It's a it's a net effect,
37:22right? But my the thing that I've come
37:24to realize, and this is through again
37:27hundreds of clients, high level glucose
37:30monitoring, right?
37:32The human body is actually incredibly
37:35well positioned to manage glucose and
37:37the the structure that does it best is
37:40arguably I would say muscle skeletal
37:42muscle. Why? And we talked about this
37:44AMK EMPK activation
37:48upregulates glute 4 expression.
37:50>> Mhm.
37:52>> And transllocation.
37:54So you can actually completely control
37:57your blood sugar simply by moving. It's
38:00that simple. And so what's cool is when
38:04you follow glucose curves, right? If you
38:08understand that some quantity of
38:10carbohydrates that you're going to
38:12consume, say it's 30 gram of moderate
38:15glycemic index carbohydrates, right?
38:19You you and I both know this. I'm sure
38:22you don't actually ever see a glucose
38:25spike if you move immediately following
38:28consumption. And it doesn't even have to
38:30be you can literally do isometrics is
38:33what's cool.
38:34>> Exactly.
38:34>> So you could be sitting at your desk and
38:36you could be flexing your quad and doing
38:38quad extensions.
38:40>> Yep.
38:40>> And signaling that same glucose.
38:42>> You can be sitting on a plane.
38:43>> Yeah.
38:44>> Right. And people look at me and they're
38:46like, "What is this guy doing?"
38:48>> Yep.
38:48>> I'm moving.
38:50>> You're absolutely right. Asometrics. Um
38:53walking is great. Okay. Why? Why? If I
38:56like I said, intentional movement. If
38:58you said, "What's the one intervention I
39:00can do today, Doc, to improve metabolic
39:03flexibility?"
39:05Move intentionally after every single
39:07meal.
39:08>> That impact is so profound. Now, again,
39:12I geek out over the data. I love It's
39:14not because I love the numbers, but when
39:16when a client sees those trends, sees
39:19that uptick in glucose and does 20 air
39:23squats.
39:24>> Yep.
39:25>> And all of a sudden, their glucose
39:26levels off for sure. Yeah, that's it's
39:30not rocket sciss I really think it I
39:32attribute it to something you said I
39:34think on on a post. Yeah, I've been big
39:36I've been big on that for a while cuz I
39:38think like it's and you know much to the
39:40frustration of some of my low carb
39:42audience honestly because it's just like
39:43this is a place for you to have your
39:45cake and eat it too like you can
39:46actually
39:47>> and the way that I look if we come back
39:48to your doorbell analogy
39:49>> okay let's just say go to the doorbell
39:51insulin's ding ding ding ding ding ding
39:53ding if one person is in that house and
39:55that let's say that one person is you
39:57have one glute 4 okay let's just
39:59hypothetically say you have one glute
40:01four in that house
40:02>> that glute four hears the doorbell and
40:04it's going to
40:05You you said the word transllocation
40:06which for layman's terms has come to the
40:08surface, right?
40:10>> Expression means creating more. So you
40:13have this transllocation of the small
40:14glue 4 receptor.
40:15>> Okay, eventually that insulin receptor
40:17is going to get saturated. It's going to
40:19get like white noise. It's just like,
40:20okay, stop ringing the doorbell. I'm not
40:22coming to the door anymore. Okay,
40:24expression means you just created more
40:27people in that house that maybe haven't
40:29heard that doorbell before.
40:31>> So it's like they're not used to the
40:32doorbell yet. So they might actually so
40:34when you do this kind you actually start
40:36the more glute for you can express the
40:38more potential you have to get glucose
40:41into the cell without insulin being
40:43present right so
40:44>> that's why people think about okay like
40:45movement's going to transllocate glute 4
40:47it's going to allow glucose to get in
40:49yes that's great but what we really want
40:50is more glute for expression
40:53>> and when you say like do something like
40:55squats I just filmed a video last week
40:56that the more muscle that you move even
41:00in short order
41:01>> if you had a pair dumbbells and if you
41:03wanted to be a total weirdo like if
41:04you're at home
41:05>> and you wanted to pump out 10 thrusters
41:08like where you have dumbbells and you're
41:09doing squat to press
41:11>> it's I can't remember the number it's
41:12ridiculously more glute for expression
41:15because it's globally signaled
41:17>> the more muscle you move it's not about
41:20going to failure it's about more muscle
41:22you move so grab some dumbbells move the
41:24full body squat all the way to a press
41:27>> and then you're getting total global
41:29glute 4 expression so then you're then
41:30the area under the curve for glucose
41:32is lower for like 2 hours, not just
41:35immediately.
41:36>> So, it's like the way that I look at it
41:37is the more you train your body to use
41:39glucose independent of insulin,
41:41>> it's almost like you're putting more
41:42people in that house that haven't heard
41:44the doorbell before.
41:45>> So, it's like you have a higher chance
41:47even outside of exercise, you have a
41:50higher chance of insulin coming back
41:51online in a proper fashion. Right. Does
41:53that make sense?
41:53>> Yeah. No, I love that. I love that
41:56analogy. Um, if you don't mind, I I'm
41:59going to start using it. Right? More
42:00people can hear the medical.
42:01>> But it's it's spot on. And here's here's
42:04kind of where I take that even further.
42:07And I've come to realize we've always
42:09talked about muscle as at least I've
42:13talked about the metabolic engine. You
42:15know, muscle increases BMR. Muscle does
42:19all this kind of stuff. So that's a fuel
42:21utilization conversation. But we need to
42:24based on this conversation and this is
42:25where my mindset's changed. We need to
42:28see muscle as way more impactful than
42:30just fuel use.
42:32>> Agreed. Agreed.
42:32>> It's actually a fuel management system.
42:34Think of think of skeletal muscle as a
42:37glucose management system. Very complex
42:40glucose management. What I mean by that
42:41is this.
42:43It's a true statement to say. Now, what
42:46I have, what I'm excited about on the
42:48near horizon, again, I geek out on the
42:51data, continuous insulin monitoring,
42:54right? We have continuous glucose
42:55monitoring, but the relationship between
42:57glucose and insulin is fascinating,
42:59right? Um, but here's the thing. If if
43:03muscle
43:05is porous, spongelike, you've increased
43:08the expression of glute 4 and those
43:10glute 4 channels are being pushed to the
43:12surface, right? It's simply put
43:15parocity. It's just bunch of open doors.
43:17It's like if you live in a safe
43:18neighborhood in America somewhere and
43:20everybody just leaves their front door
43:22open, an Amazon guy just comes by and
43:24just throws things from the the street.
43:27>> The beauty is
43:29>> once glucose is out of the bloodstream,
43:33it is not going to stimulate insulin
43:35secretion. That's a that's a chemical
43:37reaction. So managing glucose, the
43:40beauty is muscle then is making the
43:42decision. Do I need it for active fuel
43:46or am I going to store it? I mean
43:48skeletal muscle 80% of glycogen is
43:51stored in skeletal muscle, right?
43:54The one thing that I learned in way back
43:56when in medical school is the human body
43:58is way smarter than the smartest
44:01physician scientist in the world. Let
44:03the human body
44:06um veer off and talk about like toxic
44:08exposure. That's a big one.
44:09Microplastics, all stuff. The the human
44:12body has this thing called the liver and
44:14the kidneys and they're the most
44:15powerful cleansing agents known to
44:18mankind. Let the human body function.
44:21So, let skeletal muscle run the show.
44:26Once, and you know this to be true, it's
44:28a one-way door. When we valve into
44:31skeletal muscle, once glucose is in
44:33skeletal muscle, it doesn't move freely
44:36in and out of the muscle, once it's
44:38intracellular inside the cell, it's it's
44:42fixed. And now the muscle can choose, do
44:45I need to push it down the pathway of
44:47fuel to energy, ATP, or do I store as
44:50glycogen there? We know it's a demand
44:52phenomenon, right? And it's an ATP ADP
44:55ratio. All that's all kind of the high
44:57level science, but very simply put, the
44:59beauty of looking at muscle from a
45:01non-inssulin perspective is it can
45:04actually almost override the insulin
45:08response if we use it strategically. So
45:10level up, we talk about moving after
45:13food consumption, move before.
45:15>> Yes.
45:16>> As well.
45:16>> Yep. Yep.
45:17>> And
45:19again, this is me as a physician, a
45:21scientist. I geek out over the stuff. I
45:23love to see the data curves and all, but
45:25it's really fascinating.
45:28Do 20 air squats before you sit down for
45:31dinner.
45:32>> Take a 30 minute walk afterwards. I love
45:34the thruster idea. Whatever it is,
45:37>> movement and it's non-intensive,
45:39by the way, because the other key to
45:41this conversation is I don't want to
45:43force an anorobic environment. We're not
45:46talking about going and doing sprints.
45:48No,
45:48>> just move.
45:50>> And this is the fundamental issue with
45:51Americans. We're under muscled
45:54and undermoving the society.
45:57Those are two problems that are pretty
45:59dog on easy to fix, right? Yeah, for
46:01sure. I mean, it's in and and so we we
46:05think of ourselves at the mercy of this
46:07insulin resistance. Well, the real issue
46:09is build more muscle and then put that
46:12to strategic use. Become intentional.
46:16And yeah, okay. So, it looks a little
46:18bit goofy. You'll see me at a restaurant
46:20like doing some air squats or I'll run
46:23to the bathroom. But if you follow those
46:26glucose curves, it's fascinating. You
46:28literally said you can have your cake
46:30and eat it too.
46:32>> Yeah, it's literal.
46:33>> It's actually literal. Go to Cheesecake
46:35Factory,
46:36>> right? Right. It's so funny cuz it's,
46:38you know, it's something that I've worn
46:41CGMs for years and the biggest net
46:46effect [clears throat] that I've ever
46:47had from glucose is when on my glucose
46:49is when we walk. We my wife and I have
46:53always done this like and we do with our
46:54kids like destination dinners or
46:56destination treats like go walk to get
46:58ice cream and then walk back.
46:59>> Yeah.
47:00>> Such a difference from like going to
47:02driving to ice cream and then even just
47:04doing squats afterwards. That has an
47:05effect. that preload of your exercise
47:08that actually triggers that expression
47:09that triggers like that massive load of
47:11glute 4. So that combination and I think
47:13that's just something that Europe does
47:14that we don't. Right.
47:15>> I was going to say that
47:16>> they it's not like I understand and I
47:19recognize that in the United States we
47:21are not exactly the best like pedestrian
47:23friendly environment to just go walk to
47:24dinner. I totally respect that. But I
47:26also think that we can find ways to make
47:28it an activity and make it fun. If we're
47:31somewhere, you know, I live in suburbia
47:33where it's not exactly like I can't just
47:34go with like my fi my six and
47:36eight-year-old and just go. We're gonna
47:37have to walk two miles to really go each
47:39way to go. That's not always practical.
47:40But what we will do is say why don't we
47:42go drive to XYZ and then from there
47:45we'll go walk to get dinner and make it
47:47make it an adventure. Make it an
47:49excursion lit literally and
47:51metabolically a glucose excursion.
47:52Right? So
47:54>> when you actually have that this is
47:56again what Europe has and why they don't
47:57have the same problems we have. I don't
47:59think it's anything crazy. I think it's
48:02the fact that they have the movement
48:03piece nailed. Yep.
48:04>> And they have an infrastructure and a
48:06public transportation system that
48:08influences that. Right. Even if you take
48:09a train somewhere or whatever, you're
48:10you're going to get off and then you're
48:12going to walk, you know, a half a mile
48:13to go eat and then you're going to walk
48:14a half mile back to the train. It just
48:16it it lends itself nicely to set
48:18yourself up for for that movement.
48:20>> And it's it's not I mean, yes, you can
48:22get into so many different weeds of it,
48:23but
48:24>> it really truly is that simple.
48:26>> Yeah. And the more muscle that you have,
48:29the more impactful said walk is going to
48:31be.
48:32>> Exactly. More capacity, right? I mean,
48:34you have the issue of the global storage
48:38or management capacity. That's more
48:40muscle skeletal muscle mass indices.
48:43>> Intentional movement extracting value
48:47from that muscle mass. So, if you're
48:51strategically aligned, I mean, people
48:53talk about managing the obesity epidemic
48:55and so on and so forth.
48:58This is where someone like Gabrielle
48:59Lion, I I'm I think she says it best. I
49:02mean, we're an under muscle society.
49:05It's not so much an issue of being over
49:07fat. It's simply that we live in a
49:09sedentary society that doesn't move
49:13intentionally, nor do we put enough
49:15emphasis on muscle health. So, going all
49:18the way back to the 50-year-old guy with
49:21metabolic dysfunction, fast move muscle,
49:26that's where it's at. Now, the caveat I
49:29would make to that is within that
49:31context, I'm going to apply every amount
49:35of science tool
49:38and and avenue to optimize those
49:41categories. I mean, when a 50-year-old
49:43male comes and sees me and their
49:47skeletal muscle mass indices are in the
49:50sixes, their total testosterone's 200,
49:54their fasting insulin's 18, right? You
49:58got a lot going on, but at the [snorts]
50:00core, the strategy is still the same.
50:02>> Yeah, it's these three pillars and then
50:03you work supplementation, you work
50:05everything from there, right? It's like
50:06without the pillars,
50:08>> none of that works. in every single
50:10supplement, you know, TMG, bourberine,
50:12all these things. These amplify each of
50:14those pillars, correct?
50:15>> Because they're all bourberine can
50:17amplify faster fasting. Bourberine can
50:20amplify that walk. Bourberine can
50:23amplify glute 4 when you have more
50:25muscle. So, right, they're all
50:26amplifiers. And I think people get they
50:28get hung up on these individual pieces.
50:31Like, and I'm partially to blame for
50:32that. Like, I love doing videos on the
50:34TMG and carnosine, what these things do,
50:37>> right? But it's only because I'm excited
50:38about the mechanism and I know what it
50:40can how it can amplify these same
50:42pillars. Right.
50:44>> So without those that framework that
50:45foundation,
50:46>> right?
50:48>> Those might make a little dent, but
50:50they're going to make a significant dent
50:52if they have these pillars there.
50:53>> Right. Right. And that gets to the
50:55efficiency piece. Why not further
50:58optimize these pathways
51:01to support these key areas of change?
51:05Right? you dihydro bourberine or or
51:07bourberine um it's a powerful tool to
51:11upregulate
51:13activity you still but still the most
51:16potent mechanism we have is fasting
51:19>> but if you can find synergies and
51:21[snorts] go back to what I said if I've
51:23got 90 days to move the needle I'm going
51:26to pull every lever I possibly can again
51:29why does hormone health matter if you've
51:33got a you've got a total testoster es
51:35testosterone 250 free testosterone I see
51:37in men less than five
51:39>> um that switch is effectively off.
51:41>> So the idea
51:43>> this guy may be highly motivated he may
51:46be willing to go after it in the gym but
51:50just in the same token that could you
51:52possibly summit Mount Everest butt
51:54naked? I mean yeah in theory likelihood
51:59close to zero. You got a total
52:01testosterone of five, which by the way,
52:03the principal driver of hypogonatal
52:06low tea in men today is insulin
52:08resistance. That that link is abundantly
52:10clear. So people get into these
52:12>> women too honestly. I mean now they just
52:14saw they just changed PC PCOS, right?
52:16They finally acknowledged just changed
52:19something that's always been a metabolic
52:21disease.
52:22>> Crap I caught for years talking about
52:23the link between PCOS and insulin
52:25resistance which was so clear and now
52:26they finally change it to PMOS like
52:28which is purely a metabolic condition
52:30like anyway. So the point is it's not
52:32just men it's like it's the same with
52:33women too. a thousand% a thousand% and
52:37like I said earlier the challenge with
52:39women is they're already 50 steps behind
52:43my perspective and we could do a whole
52:46whole conversation around women's
52:48health. I mean we have it is truly one
52:51of the greatest tragedies or disservices
52:54we've seen in the modern era of of
52:56medical therapy. I I did a had a
52:59conversation recently about this. Read a
53:01statistic that and and this is not a
53:04criticism of physician training. This is
53:07not where I'm going with the
53:08conversation, but only 31% of OBGYn
53:12residencies in the United States today
53:14report having a structured curriculum
53:18around menopausal hormone care.
53:20>> Yeah.
53:21>> A third.
53:22>> Yeah.
53:23>> Right.
53:24And we're talking about an entire
53:27society that has been severely impacted
53:32by that. A lot of a lot of um
53:35misrepresentations, a lot of
53:36misunderstanding, so on and so forth.
53:38But like I said, imagine the 50-year-old
53:41women woman who's, you know, maybe going
53:43into menopause or maybe, you know, maybe
53:47had early menopause, right? And now
53:50those individuals, you want to talk
53:51about accelerating insulin resistance.
53:54>> Talk about a uh like a, you know,
53:57flipping calories on its head, right?
53:58When you start looking like flipping
54:00that whole model even uh you should talk
54:02to Dr. Bill Campbell. Have you know who
54:03he is? Yeah. I mean, it's funny because
54:05he is for decades has just been like,
54:08you know, a calorie guy and it's like I
54:10had him sitting right where you are and
54:11it's so interesting when we talk about,
54:13you know,
54:15women and like he's talking about his
54:17wife and he's just like the calories
54:18just didn't work. [clears throat] It
54:20just didn't work anymore. And here I
54:21have a guy that's just like and I Bill's
54:23so awesome, but he's just like he's like
54:25I spent my whole career saying it's like
54:27it's all calories in, calories out. He's
54:28like and now and I still he's like I
54:30still believe that. He's like, "But now
54:32I have serious questions because this is
54:34not working."
54:35>> Yep.
54:35>> And it illuminates just this whole other
54:38equation.
54:39>> Yeah. Well, it's it's the once again,
54:42>> are we in a vacuum in a lab or are we in
54:44a biological organism? Yeah. And that's
54:46where the whole energy balance first law
54:50of thermodynamics. Yes, that's true in a
54:53textbook, but it misses the entire
54:56reality of a biologic organism that
55:00adapts that is sensitive to constant
55:03changes in hormonal [clears throat]
55:05millu again environmental lifestyle
55:07factors that contribute. But women
55:10especially, I mean, at least men, we
55:12have this, you know, slow, relatively
55:15slow decline of hormone production.
55:18women. I mean, it's you look at it just
55:21goes and falls off a cliff. What do you
55:23think the impact of that is? And I agree
55:26with you that I mean, I've been using
55:29GLPS and PCOS for years.
55:33It's an incredible tool.
55:35>> GLPs and fasting.
55:38>> It's wild how you can radically improve
55:42hormone production in a woman who's been
55:46diagnosed with PCOS. And I can't tell
55:48you how many women come in on metformin
55:50in 2026 and it's like, wow, we we are
55:53missing the boat. Totally missing the
55:56boat. And even if it wasn't about GLPs,
55:58again, I would strongly say that
56:01>> fasting and muscle optimization
56:04are principal treatment modalities for
56:08PCOS, PMOS.
56:10>> Because it's it's not just a
56:12relationship to insulin resistance. It
56:14is that is the driver.
56:17>> It's a metabolic disease that's been
56:20horribly misunderstood, mistreated, so
56:23on and so forth.
56:24>> Just put them on birth control.
56:25>> Yeah. Right.
56:26>> Throw on an anti-depressant if if you
56:28know if you're feeling frisky, right?
56:30>> Um no, I I think this is I love what you
56:32said too. Um
56:34>> and I'm going to adopt it. We live in
56:36the BBS too in Denver and so we don't
56:39have
56:40>> immediate access. We ride bikes a lot in
56:42the summer. Um but uh and I've been
56:46known to load the kids up in my little
56:48trailer. Yeah.
56:49>> Cheesecake factory, which I'm a big fan
56:51of. True story.
56:52>> It was a scratch kitchen. So you can ask
56:53them to make anything. That's what's
56:54kind of cool. But I want give me a plain
56:56burger with some goat cheese on it and
56:58some broccoli. Okay.
57:00>> So that's about eight maybe 8 10 miles
57:03from my house.
57:05>> So I feel good about riding the kids all
57:07the way there. We get our slice of
57:09cheesecake ride back. You'll never know
57:12the difference, right? But I love the
57:15idea of strategically going to proximity
57:19but then then walking because you're
57:22absolutely right
57:25the the European culture embraces
57:28movement. I saw I saw something
57:30recently. I think it was real where like
57:34you could get a free bus ticket a if you
57:38did like x number of air squats.
57:41[laughter]
57:42So I it may have been AI generated but
57:45it was it wouldn't surprise me
57:46everything somewhere in Europe where
57:48like the people are sitting there in
57:50this little um there's a little camera
57:52lens and they do x number of air squats.
57:54It counts them.
57:54>> Dude, well you think I mean it's a
57:56ticket. A lot of Europe is, you know,
57:58somewhat socialized healthcare and you
58:00think it's like, okay, if we get people
58:02healthier,
58:03>> it's amazing
58:03>> then this, you know, and obviously it's
58:05it depends on where you are, but it's
58:06just like I don't we this different
58:09topic for a different day. I mean, I
58:10socialized healthcare has it has its
58:12issues, but at the same time it's like
58:14at least there is a common theme to like
58:16okay less burden on the system if people
58:18are healthy, right?
58:19>> That's what I do like about that. So
58:20it's like okay, if so that doesn't
58:22surprise me one bit and there is less
58:24burden on that system comparatively,
58:25right? So, um, and especially when you
58:28equate for actual longevity data and
58:31like who's like living longer really,
58:32like who's got the bigger burden, right?
58:34>> So, you know, and we could go all day
58:37with this, but uh, Dr. Chef, where can
58:39everyone find you, man?
58:40>> So, love to connect with people through
58:43social media. Um, YouTube is actually
58:46something we're growing. I started long
58:48form video about two months ago now. Um,
58:52so YouTube channel Johnef or excuse me
58:55at Dr.jchef and then on Instagram, Tik
58:59Tok, Johnfeff, just my name. Um, I think
59:03connecting with people, understanding
59:05where people are at, that has been
59:08probably the greatest net benefit to me
59:12of getting involved in social media.
59:14>> Yeah.
59:14>> Is it's removed in good ways and bad,
59:17but it's removed the barrier of doctor,
59:21patient. Yeah.
59:22>> And it's made it
59:24>> I mean the cool thing is never before
59:26could you just ping a doctor and say hey
59:28what's your thoughts on this right
59:31hierarchy and I'll say one other caveat
59:33about social media that I personally
59:36love is accountability
59:39>> because it's one thing to kind of put on
59:42a show in a structured strategic fashion
59:46but it's really challenged at least the
59:48way I've taken it challenged me to be on
59:51all the time.
59:52>> Yeah.
59:52>> Right. Cuz it's wild. People,
59:56whether it's AI or whether it's really
59:58intelligent people, they'll call you out
59:59on your BS.
1:00:00>> Yeah.
1:00:01>> And that's the coolest thing about
1:00:02social media is you can't get away with,
1:00:04you know, in the old days, you know, the
1:00:06doctor says and that's just it's like
1:00:08gospel.
1:00:09>> Yeah.
1:00:09>> Now you have to actually be Yeah.
1:00:11>> be legit.
1:00:12>> That's where you have to get real
1:00:13patient data, too, right? Yep. Yeah. So,
1:00:16love to connect with people, man. We'll
1:00:17link out to all that stuff down below,
1:00:19brother. Thanks, man.

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