Health Series 5: Dr Evan Nadler / Pediatric Obesity Surgeon

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Welcome to another episode of
Come Together,

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Just here. 2nd Doctor Nadler,
Welcome.

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Welcome back to another episode.
I really appreciate you coming.

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Thank you so much.
My pleasure, thanks for having

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me.
We just, it's so funny.

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You were just telling me that
the audio, you had to correct

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it.
I recorded a full hour and a

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half phenomenal conversation
with a gentleman from Australia

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that was actually doing a little
bit of research with LSD and

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micro dosing to cure depression,
suicidal ideation.

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And we recorded a phenomenal
episode.

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And I thought I heard like Echo,
you know, at the beginning and

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it's happened once before and
then it was totally fine.

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So I just think, oh, I'm sure
it's fine.

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And after a full hour and a
half, I listened back and I'm

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like, you cannot, I can't use
this.

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And it was such a shame I have
to record Part 2 with him.

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And Riverside can't.
It doesn't.

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Like clean that up.
No, I tried running it through

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AI have a couple of buddies that
pay for, you know, I guess more

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potential or you know, yeah,
higher capabilities and they ran

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it through and it was because
apparently it was a separate the

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Riverside was recording my input
and then re recording the output

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on his end.
So everything was was her twice.

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But I welcome to the show, so
I'm going to have you here.

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Everybody needs a show on how to
podcast.

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You know what?
I.

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Mean that's right, by the way,
by the way, I'm not I've been

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learning that, as you know,
throughout throughout the last

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year and change is, you know, I
mean, it's a lot of learning

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lessons, but the truth is not to
overthink it.

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That's what I found, you know,
don't overthink it.

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Pick it up when you can and if
it's a bad episode, you know, or

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not as good as you could make
it, it's not as good as you can

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make it.
Move on to the next one.

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You know, so you, you
specialized in obesity,

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pediatric obesity particularly.
Correct.

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I'm a pediatric surgeon by
training, actually, and when I

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well, even before my formal
pediatric surgery training, I

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had this sort of epiphany moment
where I decided someone needed

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to do something about the
obesity epidemic in the United

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States especially.
What year was this or around

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what year?
If you're going to date me and

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you're also going to test my
memory.

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But I think, well, I've told the
story a few times and so to be

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consistent with the story I tell
each time, say in the year 2000.

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OK, Was obesity an epidemic at
that point already?

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So depending on who you ask,
it's been around for 50 years,

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but we as a society didn't
really recognize it.

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And my epiphany moment was
actually at the Dolphin and Swan

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Hotel in in Orlando and Disney.
I think I was at the Swan, but

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the pool was shared between the
two hotels.

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And I was sitting in the pool at
a pediatric surgery meeting,

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actually, where I was going to
present my data on something

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completely unrelated to obesity.
And I'm there with my wife.

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And although I guess at that
time, we got married in 2001, so

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at that time, she was not my
wife yet.

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And we're sitting at the pool
and across the pool, I see.

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And by the way, this is like May
or maybe even Memorial Day

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weekend.
And it's like hot, hot.

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Hot.
Yeah.

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Orlando's miserable.
This time of year or that time

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of year, Yeah.
And or all times a year, but

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the, but that's a different
story.

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The, so I'm at the pool and
across the pool.

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First of all, everybody at the
pool is, is struggling with

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weight issues.
And the, but the, the, the

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epiphany or the kid that caught
my eye.

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And I certainly don't want to
stigmatize this kid, although

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this was in 2000.
So he probably will have no

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recollection of, of even if he
knew I was talking about him, he

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wouldn't have no recollection.
But he's probably about 12,

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clearly struggling with his
weight.

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He had a big old greasy
hamburger, giant hamburger, a 2

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liter bottle of Coke, sugar
Coke, and a 1 LB bag of Lays of

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potato chips.
And I can still see the grease

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dripping down his arm.
Yeah.

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And I was like, this is crazy.
Like, how can we this like, so,

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you know, like what's going on
here?

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And, you know, so that led to my
pediatric surgery training where

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in 2004 I actually did my first
pediatric bariatric surgery

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operation as part of a group of
pediatric surgeons who were

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starting to explore it at the
time.

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And, you know, I just thought
surgery was never going to be

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the cure at a population level,
but certain people benefit from

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it.
But I thought that maybe the

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lessons learned from surgery,
like if we could figure out how

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surgery works, maybe we could
come up with medications, maybe

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we could come up with other
interventions that could mimic

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surgery, which frankly, 20 years
later, we actually haven't

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really.
Or 20?

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Yeah, 20 years later, we haven't
really gotten there yet.

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I was going to ask what was the,
what were the methods at the

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time?
If someone, if you, if you were

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at at 20 in the year 20, I guess
the year 2000, someone's like,

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OK, you need to lose some
weight.

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What do you do?
You know, I mean, what would you

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tell someone at the point at
that point?

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It's the same sort of basic
stuff that's being talked about

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today.
And frankly, it's the same basic

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stuff that the fitness guru
gurus of the 50s and 60s, Jack

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Lalanne, I like to bring him up,
but no one has any idea who Jack

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Lalanne is anymore.
But he was the original.

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He was America's original
fitness guru in the 1950s, and

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it was diet and exercise.
And 75 years later, RFK is

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talking about diet and exercise.
I mean, it's like, it's

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incredible to me that we haven't
moved past that conversation.

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I mean, I get it because I, you
know, so I do videos for like,

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TikTok and other things where
I'm in a grocery store and I'm

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showing people what they should
and shouldn't eat.

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So yeah, everybody should eat
better and everybody should

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exercise if they have the time,
no doubt.

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I'm totally in favor of all that
stuff, but to think that that's

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going to cure the 140 million
Americans who suffer from

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obesity and the 15,000,000
children who have obesity.

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If you think that diet and
exercise is going to fix them,

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then you just don't haven't been
paying attention.

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Because there are, you know,
boatloads of data, hundreds of

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studies in the medical
literature showing that the diet

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and exercise programs, even at
their best, even if it's like

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super intense, even if it's like
The Biggest Loser, which by the

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way, there's a Netflix
documentary that's exposing all

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of the bad things that were
going on behind the scenes.

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I don't see me.
At that point in television, in

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entertainment history, there was
bad things going on behind the

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scenes everywhere you looked.
I mean, you could not catch a

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break from that point in time.
And they're.

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Actually now a bunch of great
documentaries being made because

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of that.
But anyway, the but like the

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people from The Biggest Loser
all regained their weight after

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they left their show.
Most of them, but in the

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scientific.
Community, do we do we know why

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that was?
Was it because they did not

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maintain it or was it because
there was other factors that

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were required or so you know, I
feel yeah, go ahead.

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Oh.
No.

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Well, so we know.
So all this has been studied and

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studied actually really well now
and there are hundreds of

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studies and medical leaders are
showing this.

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So 95% of people who used
lifestyle intervention to lose

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weight will regain their weight
once they stop the intervention.

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So you basically have to behave
like you're on The Biggest

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Loser.
For the rest of your life, the

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rest of your life, it's not
going to work.

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And that's, and so with
medications, the GLP 1

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medications, and I'm sure we'll
get to that at some point

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because it's a hot topic that
everyone wants to talk about.

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80% of people regain their
weight after stopping.

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So better than better than
lifestyle, but neither of them

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come even close to surgery where
the numbers completely flips,

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flips flipped where only 20% of
people after bariatric surgery

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regain the significant amount of
their weight.

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So.
Surgery.

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Always been surgery has always
been the most sustained weight

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loss and it's usually you asked
why and in the early days people

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just blame the patient.
Oh, you know, a firm must be

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cheating.
He's he's you know, he, he, he

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got his surgery or he's on.
He took his medication.

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He stopped his medication and
now he's having a smoothie.

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It's Smoothie King every day and
pounding sugar packets in his in

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his free time.
Well, that you know that that

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didn't happen.
People didn't do that.

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Like nobody sabotages
themselves.

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Maybe not nobody.
Few people sabotage themselves

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to that degree.
Like why would why would you do

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that?
Why would you purposefully do

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that to yourself?
But that was what we thought for

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ages.
We just blame the patient.

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It's the easiest thing to do.
But then we realized it's

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actually just the biology of of
obesity, which we didn't really

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understand.
We still don't understand big

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chunks of it.
But there have actually been

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recent studies that are really
interesting, which talk about

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epigenetics.
And for your listeners who don't

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know what epigenetics is all
about, that's the study of how

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the environment changes your
genes.

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And then what that means is that
your genes don't work the same.

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They may not work as well.
They might make different

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proteins, they may not make any
protein sort of different

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depending on the gene, but.
Wait, yeah, I'm sorry, before we

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get there, which I'm I want, I
want to get there.

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I just have a couple of quick
follow-ups just and a couple of

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things you said at first just to
break it down in case anyone has

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any questions or that anyway
because I just.

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Yeah, yeah, yeah.
I'm trying my hardest to keep it

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simple, but it's complex.
You're doing a great job.

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No, there's so far, so far this
is perfect, but there's just a

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couple of like what I like to do
is introduce a concept and then

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if I have any questions like
that, I myself don't know, you

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know, would like to know more
about to elaborate them real

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quickly and then kind of keep
keep track along the way.

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Can you just explain real
quickly how the surgery works?

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Sure.
And what and what the process is

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for that, please?
Sure.

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Yeah, thanks.
So there, there are two major

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types of bariatric surgery in
the United States make up the

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vast majority of procedures,
although there are other

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procedures as well that are
performed by some.

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But the two major ones are the
gastric bypass, which is the one

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that most people know about and
most people equate with

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bariatric surgery because that
was the one that got really

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popular sort of in the late 90s,
early 2000s.

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It's the one where people had
some really bad complications.

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So it made a lot of news.
What was that?

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What?
How does that surgery work?

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How does the gastric bypass
work?

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Right.
So in that surgery, what we do

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is we well, so first of all,
back in the old days, we used to

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do those surgeries via a cut on
the abdomen.

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Now we use laparoscopic
instruments, which means five

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small holes, biggest one's about
a inch.

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And we can do everything with a
camera and instruments that look

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like, well, they almost look
like chopsticks with little

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something on the end of it to,
to, to do what you need to do.

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And so there's been a lot of
advances in bariatric surgery

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since 1991, when the NIH, the
National Institutes of Health

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first sort of approved bariatric
surgery as a treatment of

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obesity until now, which is
what, 35 years later.

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But with that operation, we make
a, we take a stapling device, we

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make a small pouch out of the
stomach, and then we actually

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divide the intestines and bring
a piece of intestine up to that

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small pouch.
So that food goes in, it goes

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into this little pouch.
So you don't eat very much

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before you feel full.
It goes.

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Out into your intestines, but it
bypasses A, hence the main

226
00:12:33,080 --> 00:12:36,040
bypass.
But it bypasses the stomach and

227
00:12:36,600 --> 00:12:39,000
then a fair amount depending on
how it's done.

228
00:12:39,000 --> 00:12:43,160
It bypasses a significant amount
of your small intestine, so some

229
00:12:43,160 --> 00:12:45,920
of the foods you eat doesn't
even really get absorbed that

230
00:12:45,920 --> 00:12:47,040
well.
Right.

231
00:12:47,040 --> 00:12:49,760
So what happens to that food,
hypothetically?

232
00:12:50,800 --> 00:12:54,160
Oh, it just runs through you for
lack.

233
00:12:54,160 --> 00:12:57,120
Of OK, gotcha yeah, OK we're.
Going to keep it PG.

234
00:12:57,520 --> 00:13:00,680
But it but it limits but it but
so but it would so it

235
00:13:00,680 --> 00:13:03,600
essentially limits the amount
that you can consume.

236
00:13:04,160 --> 00:13:08,440
It limits how much you eat and
then OK also limits to some

237
00:13:08,440 --> 00:13:11,120
degree what you can absorb of
what you eat.

238
00:13:12,040 --> 00:13:15,520
So for kids that wasn't really a
great option in my mind.

239
00:13:17,120 --> 00:13:24,240
And now about actually, I would
say almost 20 years ago for

240
00:13:24,240 --> 00:13:28,360
adults as well, everybody, most
people move to something called

241
00:13:28,360 --> 00:13:33,440
the sleeve gastrectomy, which is
a much simpler surgery, easier

242
00:13:33,440 --> 00:13:36,480
to perform, easier left, lower
complication rate.

243
00:13:38,000 --> 00:13:41,720
And with that operation, we
basically just remove about 80

244
00:13:41,720 --> 00:13:44,840
to 90% of your stomach, take it
out.

245
00:13:45,120 --> 00:13:47,400
Yeah.
So it also obviously limits how

246
00:13:47,400 --> 00:13:51,960
much you can eat, but it doesn't
impact your absorption at all

247
00:13:51,960 --> 00:13:54,840
because your intestines are
still in the normal anatomy.

248
00:13:55,440 --> 00:14:00,480
And it it in kids has been shown
to be pretty much just as good

249
00:14:00,800 --> 00:14:03,320
as bypass.
In the adults.

250
00:14:03,320 --> 00:14:06,800
It's still a little there's
still controversy.

251
00:14:07,400 --> 00:14:10,160
Which is better?
What would be the controversy?

252
00:14:10,160 --> 00:14:14,040
Which is more effective?
Well, they both have similar

253
00:14:14,040 --> 00:14:18,440
weight loss and similar
resolution of the obesity

254
00:14:18,440 --> 00:14:23,280
related diseases.
Upfront bypass is a little bit

255
00:14:23,280 --> 00:14:27,760
more weight loss, but there's
some question about recurrence

256
00:14:28,200 --> 00:14:31,000
or weight regain and whether
sleeve gastrectomy has higher

257
00:14:31,200 --> 00:14:35,160
weight regain, which I think is
going to become irrelevant

258
00:14:35,160 --> 00:14:37,680
because I think what's maybe is
going to happen is that when

259
00:14:37,680 --> 00:14:40,200
people start to regain their
weight, they'll just that's when

260
00:14:40,200 --> 00:14:42,120
they'll get on their GLP one
medication.

261
00:14:43,240 --> 00:14:46,920
And because it is depending on
whose numbers you look at, the

262
00:14:47,320 --> 00:14:51,960
sleeve is about 10 times as safe
as the gastric bypass or 10

263
00:14:51,960 --> 00:14:56,120
times safer.
I guess is the is is English. 10

264
00:14:56,120 --> 00:14:57,760
times safer.
Yeah.

265
00:14:57,880 --> 00:15:03,080
So if you if, if a gastric
bypass complication rate might

266
00:15:03,080 --> 00:15:10,520
be 1%, OK, sleeve gastric?
Ah, I see, is 1/10 of that. .1%

267
00:15:10,520 --> 00:15:12,040
yeah.
I see, I see, I see.

268
00:15:13,120 --> 00:15:15,120
So for kids that became like
that was easy.

269
00:15:15,200 --> 00:15:18,320
But you know, when I started
doing kids in 20 and and 2000

270
00:15:19,320 --> 00:15:22,400
and I guess nine, well, I guess
my first bariatric surgery

271
00:15:22,400 --> 00:15:24,280
operation on the kid was in
2004.

272
00:15:24,280 --> 00:15:31,520
But then when I started my own
program in 2010, I only wanted

273
00:15:31,520 --> 00:15:36,440
to do, I only wanted to do sleep
gastrectomy because I didn't

274
00:15:36,440 --> 00:15:42,800
want, I was worried about the
gastric bypass in terms of

275
00:15:42,800 --> 00:15:46,240
nutrition and because of the, of
the amount of food you don't

276
00:15:46,240 --> 00:15:49,320
absorb for kids.
And then I was also worried

277
00:15:49,320 --> 00:15:53,200
about the complication rate and
I should, I should go back one

278
00:15:53,200 --> 00:15:59,760
step and say so from 2005 to
2009, I was doing laparoscopic

279
00:15:59,760 --> 00:16:03,560
adjustable gastric banding in
kids, which that procedure is

280
00:16:03,560 --> 00:16:06,240
pretty much almost extinct now,
although you can still find it.

281
00:16:06,920 --> 00:16:10,680
What was it?
We put a little device around

282
00:16:10,840 --> 00:16:14,080
the top of the stomach and it
had it's basically like a belt

283
00:16:14,400 --> 00:16:17,560
with a balloon on the inside.
And the balloon was attached to

284
00:16:17,560 --> 00:16:20,720
actually a port that sat outside
of your abdomen underneath your

285
00:16:20,720 --> 00:16:22,680
skin.
And you would come into the

286
00:16:22,680 --> 00:16:26,560
office, let's say once.
What was it?

287
00:16:26,600 --> 00:16:30,760
It was early.
It was becoming frequently and

288
00:16:30,760 --> 00:16:32,960
then it would spade maybe once a
month and then he spaced out and

289
00:16:32,960 --> 00:16:35,720
you would just put a little bit
of fluid into that balloon and

290
00:16:35,720 --> 00:16:38,160
eventually it would tighten up
and it would basically make you

291
00:16:38,160 --> 00:16:42,440
feel full all the time.
But it had lots of complications

292
00:16:43,880 --> 00:16:47,400
and it was a pain for patients
to have to come in and get the

293
00:16:47,400 --> 00:16:50,080
adjustments and it just didn't
really work that well.

294
00:16:50,640 --> 00:16:53,960
It's still FDA approved and I
still think one company makes

295
00:16:53,960 --> 00:16:56,680
them, I think, but it doesn't
make up.

296
00:16:57,040 --> 00:17:00,160
It's not generally practiced
right, right, right.

297
00:17:00,160 --> 00:17:03,640
And real quick, I'm sorry if
when someone's walking into

298
00:17:03,640 --> 00:17:09,400
these cases, say either with
surgery, you know, either of the

299
00:17:09,400 --> 00:17:13,160
surgeries say, right, what's the
process look like in terms of

300
00:17:13,160 --> 00:17:15,160
weight loss?
Does that happen immediately?

301
00:17:15,200 --> 00:17:19,800
Does that what do they walk out
and they're £40 less or how does

302
00:17:19,800 --> 00:17:21,640
that work exactly?
Can you explain that please?

303
00:17:21,800 --> 00:17:23,480
Yeah.
So I should say first of all,

304
00:17:25,160 --> 00:17:27,640
almost every patient goes
through a three to six month

305
00:17:27,839 --> 00:17:31,480
preoperative preparation period
where you sort of learn how to

306
00:17:31,520 --> 00:17:34,840
eat, you sort of make some of
the behavior changes that are

307
00:17:34,920 --> 00:17:38,720
going to be necessary.
So it's not like you walk into

308
00:17:38,720 --> 00:17:45,880
surgery and then after surgery.
The so one of the really

309
00:17:45,880 --> 00:17:49,320
interesting scientific findings
that has spurred a lot of

310
00:17:49,760 --> 00:17:55,680
scientific discovery, including
some of the GLP one type

311
00:17:55,680 --> 00:18:01,800
hormones is that for gastric
bypass patients, they, if they

312
00:18:01,800 --> 00:18:06,520
had diabetes and they were on
insulin, many of them, if not

313
00:18:06,520 --> 00:18:11,720
most of them would no longer
require their insulin even

314
00:18:11,720 --> 00:18:14,280
before they left the hospital,
even before they lost any.

315
00:18:14,640 --> 00:18:15,920
Because you don't really lose
weight.

316
00:18:16,400 --> 00:18:19,160
You lose weight in the first
three months more or less.

317
00:18:19,880 --> 00:18:23,600
And you can lose 100 lbs in
three months, but, but you don't

318
00:18:23,600 --> 00:18:28,160
lose it on the day of surgery.
And so that was a really

319
00:18:28,160 --> 00:18:30,680
interesting finding that a lot
of people have spent a lot of

320
00:18:30,680 --> 00:18:32,360
years trying to figure out why
that happens.

321
00:18:32,360 --> 00:18:35,640
And I, I don't really think
anyone has quite figured it out

322
00:18:35,640 --> 00:18:41,920
yet, but the.
Yeah.

323
00:18:41,920 --> 00:18:45,200
So you, you get surgery usually
go home one or two days post

324
00:18:45,400 --> 00:18:49,080
procedure.
You really are almost doing

325
00:18:49,080 --> 00:18:50,960
nothing but drinking for the
first two weeks.

326
00:18:50,960 --> 00:18:54,160
And then you get advanced on.
Everybody has their own sort of

327
00:18:54,520 --> 00:18:57,120
special little diet, but most
patients after either surgery

328
00:18:57,120 --> 00:18:59,960
can only eat about a handful of
bites before they get full.

329
00:19:00,520 --> 00:19:04,280
So we need to teach people
before that, you know, if you're

330
00:19:04,280 --> 00:19:07,040
only going to eat this little
bit, this is what you need to

331
00:19:07,040 --> 00:19:09,200
eat.
You need, you need to take a

332
00:19:09,200 --> 00:19:11,760
multivitamin and you need to
stay hydrated.

333
00:19:12,320 --> 00:19:19,960
And most recently there was a, a
publication where I think it was

334
00:19:19,960 --> 00:19:24,560
the, whatever the lifestyle
medicine association doctors are

335
00:19:24,560 --> 00:19:28,680
got together with the obesity
society, I think, and then the

336
00:19:29,120 --> 00:19:34,200
obesity medicine association to
talk about how to tell how to

337
00:19:34,200 --> 00:19:38,080
teach people how to eat after
while taking AGLP one medication

338
00:19:38,080 --> 00:19:42,320
because it, it makes it so you
don't eat very little and, and,

339
00:19:42,600 --> 00:19:44,840
or you don't eat very much.
And as soon as it came out, I

340
00:19:44,840 --> 00:19:50,120
actually emailed like the lead
guy because he's randomly some

341
00:19:50,120 --> 00:19:55,840
guy that I went to college with.
And I said dude did, did no one

342
00:19:56,040 --> 00:19:59,840
bother to talk to the surgeons?
We've been teaching people how

343
00:19:59,840 --> 00:20:04,840
to eat 5 bites of food three
times a day for 30 years.

344
00:20:04,840 --> 00:20:08,960
Like you guys, you guys didn't
think that we could be of use.

345
00:20:08,960 --> 00:20:11,000
And he actually was honest with
me.

346
00:20:11,000 --> 00:20:12,840
He was like, Oh yeah, I didn't
think to.

347
00:20:13,320 --> 00:20:14,840
I didn't.
I have nothing against the

348
00:20:14,840 --> 00:20:16,800
surgeons, but it didn't occur to
me to include them in these

349
00:20:16,800 --> 00:20:19,160
guidelines.
And I'm like, yeah, that's the

350
00:20:19,160 --> 00:20:20,680
problem.
And that's the problem with

351
00:20:20,680 --> 00:20:22,320
like.
Everything is too

352
00:20:22,320 --> 00:20:24,440
componentalized.
Yeah, it's a problem with

353
00:20:24,440 --> 00:20:26,960
medicine in the in in America
anyway, but it's certainly a

354
00:20:26,960 --> 00:20:29,240
problem with obesity.
And it's getting better.

355
00:20:29,240 --> 00:20:31,720
We're we're starting to learn to
play in the same sandbox more

356
00:20:31,720 --> 00:20:33,520
and more.
And that's a great people

357
00:20:33,520 --> 00:20:37,400
understand that Like Medicaid,
kind of like with cancer, where

358
00:20:38,040 --> 00:20:41,400
chemotherapy and surgery work
together to best cure the

359
00:20:41,400 --> 00:20:45,440
cancer, treat the cancer.
It's the same thing with

360
00:20:45,440 --> 00:20:48,320
obesity.
It's like it's not, you know, do

361
00:20:48,320 --> 00:20:49,800
you need meds or do you need
surgery?

362
00:20:50,200 --> 00:20:53,040
There's a good and lifestyle
goes for every, everybody gets

363
00:20:53,040 --> 00:20:55,960
lifestyle.
But then what else?

364
00:20:55,960 --> 00:20:57,360
Is it medicine?
Is it surgery?

365
00:20:57,760 --> 00:21:00,600
And the answer is, you know, you
figure out which one's right for

366
00:21:00,600 --> 00:21:03,560
you to start, but you might need
both and you might need, you

367
00:21:03,560 --> 00:21:05,360
know, medication, surgery, then
medication.

368
00:21:05,360 --> 00:21:10,000
Or no one at the individual
level can predict what your

369
00:21:10,000 --> 00:21:13,600
outcome is going to be like.
I can't, you know, even with the

370
00:21:13,600 --> 00:21:17,120
best genetic testing out there,
I can't say you're going to.

371
00:21:17,120 --> 00:21:19,360
Benefit, there's too many,
there's too many variables,

372
00:21:19,360 --> 00:21:20,960
right?
I mean, there's too many

373
00:21:20,960 --> 00:21:23,200
variables that you can't that
that I couldn't even begin to

374
00:21:23,200 --> 00:21:26,560
tell you as a patient and you
couldn't even begin to think to

375
00:21:26,560 --> 00:21:29,440
figure out as my doctor, right?
Yeah.

376
00:21:29,680 --> 00:21:31,720
Well, that's why I think like,
you know, they're, they're the,

377
00:21:31,880 --> 00:21:35,400
the medication advocates and,
and I have nothing against them

378
00:21:35,400 --> 00:21:38,280
and I will, I'm starting a
practice where I'll be

379
00:21:38,280 --> 00:21:39,800
prescribing these medications as
well.

380
00:21:41,840 --> 00:21:45,560
But there are a lot of folks who
are really excited that someday

381
00:21:46,320 --> 00:21:48,840
there'll be a medication
combination that can be as good

382
00:21:48,840 --> 00:21:52,280
as surgery.
But I think that that probably

383
00:21:52,280 --> 00:21:55,920
is never going to happen because
when you do surgery there are

384
00:21:55,920 --> 00:22:01,040
internal connections between the
gut and the brain that get for a

385
00:22:01,040 --> 00:22:02,320
better.
Word, I was actually about to

386
00:22:02,320 --> 00:22:05,480
start asking you about that,
right, right then.

387
00:22:05,640 --> 00:22:08,160
And that's that that
communication is through the gut

388
00:22:08,200 --> 00:22:11,800
microbiome, right, the
communication.

389
00:22:12,040 --> 00:22:14,480
Between the gut.
Potentially.

390
00:22:15,160 --> 00:22:19,400
I'm not sure either way.
OK, please.

391
00:22:20,200 --> 00:22:24,440
There's something called a gut
brain axis and basically you

392
00:22:24,440 --> 00:22:27,400
know, there's the vagus nerve
which goes from your stomach to

393
00:22:27,400 --> 00:22:29,400
your brain.
And then there are all sorts of

394
00:22:29,400 --> 00:22:35,040
like mediators like GLP, one
that your gut releases that go

395
00:22:35,040 --> 00:22:38,080
through your circulation to your
brain and they mostly.

396
00:22:38,080 --> 00:22:39,360
Tell your brain you're hungry or
not right?

397
00:22:39,400 --> 00:22:42,000
Which is.
The part of your brain, that's

398
00:22:42,000 --> 00:22:45,000
what the hypothalamus does, it's
sort of the hunger center it,

399
00:22:45,040 --> 00:22:47,080
but it turns out it's not only
the hunger center, it's actually

400
00:22:47,080 --> 00:22:49,880
also the fullness center, the
satiety center.

401
00:22:50,480 --> 00:22:57,080
And it's also where your weight
set point gets for better, for

402
00:22:57,560 --> 00:23:00,800
lack of a better word.
It gets determined probably in

403
00:23:00,800 --> 00:23:09,480
utero by your hypothalamus.
And the hypothalamic set point

404
00:23:10,080 --> 00:23:15,400
may have to do with the mom's
gut microbiome, the fetus, it

405
00:23:15,400 --> 00:23:19,080
doesn't have a gut microbiome
when they're born, but it can

406
00:23:19,080 --> 00:23:25,800
certainly it's a possible
mechanism by which the

407
00:23:25,800 --> 00:23:28,680
environment can impact your
weight.

408
00:23:28,920 --> 00:23:31,640
And and the reason I'm a little
bit of a skeptic about the

409
00:23:31,640 --> 00:23:35,080
microbiome, although I'm open
minded about almost everything

410
00:23:35,080 --> 00:23:37,280
so I don't want.
To.

411
00:23:38,680 --> 00:23:42,320
Close off that opportunity that
the microbiome is important, but

412
00:23:42,320 --> 00:23:46,840
I'm a skeptic because I've done,
I published one study in my own

413
00:23:46,840 --> 00:23:51,280
patients where we looked at
their microbiome both before

414
00:23:51,280 --> 00:23:54,320
surgery and then after they'd
lost, you know, 50 lbs.

415
00:23:55,080 --> 00:23:57,960
And it actually wasn't that
different between before surgery

416
00:23:57,960 --> 00:24:00,440
and after surgery.
Then we're back.

417
00:24:00,440 --> 00:24:02,400
Sorry about that.
So sorry.

418
00:24:02,400 --> 00:24:07,800
So my question before we cut out
was what factors determine or do

419
00:24:07,800 --> 00:24:10,560
we know if factors determine the
gut microbiome health?

420
00:24:10,560 --> 00:24:13,760
Because I mean, I'm sure weight
has something to do with it, but

421
00:24:13,760 --> 00:24:17,240
if someone's like, especially
post surgery, if someone's not

422
00:24:17,240 --> 00:24:19,320
getting a lot of nutrition, if
someone's not eating a lot of

423
00:24:19,320 --> 00:24:22,680
food, I could imagine that it
wouldn't necessarily be

424
00:24:22,680 --> 00:24:25,880
strengthened right away until
they got back to a regular diet,

425
00:24:26,000 --> 00:24:29,120
no?
Well, I think, I mean, I think

426
00:24:29,120 --> 00:24:31,920
it's a complicated question
because I don't Well, first of

427
00:24:31,920 --> 00:24:38,240
all, the it's certainly possible
that the reason for instance, in

428
00:24:38,240 --> 00:24:41,240
my study there weren't great
microbiome changes is that we

429
00:24:41,240 --> 00:24:44,000
don't actually have a good way
of measuring the microbiome,

430
00:24:44,160 --> 00:24:46,440
right.
The microbiome mostly people

431
00:24:46,440 --> 00:24:52,000
measure in stool samples, but
what's actually in your small

432
00:24:52,000 --> 00:24:55,800
intestine might be completely
different than what is coming

433
00:24:55,800 --> 00:24:59,360
out in your stool.
So part of the issue is that we

434
00:24:59,360 --> 00:25:02,640
don't have a great way of
measuring it for most people.

435
00:25:04,480 --> 00:25:12,320
But the the issue, so you know,
I think, I think we're sort of

436
00:25:12,320 --> 00:25:15,440
staying away from ultra
processed foods and eating foods

437
00:25:15,440 --> 00:25:18,640
that come right out of the
ground and eating healthier.

438
00:25:18,920 --> 00:25:21,720
I think those things can
contribute to a healthier

439
00:25:21,720 --> 00:25:27,640
microbiome.
Again, I'm not 100% sure whether

440
00:25:27,640 --> 00:25:32,560
a healthy microbiome helps you
lose weight or contributes to

441
00:25:32,560 --> 00:25:37,800
the the development of obesity
or if it's just an innocent

442
00:25:37,800 --> 00:25:41,720
bystander where like if you lose
weight and get healthier, your

443
00:25:41,720 --> 00:25:44,240
micro changes.
Like what direction is the

444
00:25:44,240 --> 00:25:45,440
interruption?
I don't know.

445
00:25:46,760 --> 00:25:49,960
And there are companies who are
trying to market like even,

446
00:25:50,280 --> 00:25:53,200
well, not just companies like
there's now like you can buy a

447
00:25:53,200 --> 00:25:56,240
soda that has probiotics in it
because.

448
00:25:56,720 --> 00:25:58,120
That's all over the place now.
Right.

449
00:25:58,120 --> 00:26:04,480
People are playing on the idea
that the microbiome can be

450
00:26:04,480 --> 00:26:08,960
manipulated for better health,
but unfortunately the reality is

451
00:26:08,960 --> 00:26:13,160
that just like everything that
seems to be a viral trend before

452
00:26:14,120 --> 00:26:17,560
before too long, the science
just isn't there yet.

453
00:26:17,560 --> 00:26:20,920
Like people are like making
companies based on the

454
00:26:20,920 --> 00:26:24,880
microbiome well before the
microbiome has been shown to

455
00:26:24,920 --> 00:26:28,000
actually have an important place
in human health.

456
00:26:28,680 --> 00:26:31,320
Yeah, we're jumping the gun.
And then what happens is people

457
00:26:31,320 --> 00:26:32,560
need to make money from that
company.

458
00:26:32,920 --> 00:26:35,840
So they become they, you know,
they get online influencers or

459
00:26:35,840 --> 00:26:40,440
they become online influencers.
I like to, I'm positioning

460
00:26:40,440 --> 00:26:45,560
myself as AD influencer.
So I'm going online or videos or

461
00:26:45,560 --> 00:26:49,760
podcasts like this one where I
just basically talk about facts.

462
00:26:49,760 --> 00:26:53,960
I don't talk about like if I
have a topic where I don't

463
00:26:53,960 --> 00:26:56,240
actually know the facts, I can
present the facts that are on

464
00:26:56,240 --> 00:27:01,200
both sides if they're if they're
they're not in in congruence

465
00:27:01,200 --> 00:27:03,640
with each other, if they don't
jibe with each other.

466
00:27:04,400 --> 00:27:08,000
But I'm not going to go tell
you, you know, go buy a

467
00:27:08,000 --> 00:27:11,000
supplement because I'm not
selling any supplements and also

468
00:27:11,000 --> 00:27:13,280
because most supplements don't
do anything for your health.

469
00:27:13,960 --> 00:27:18,080
But where we're at as a society
is where, you know, our HHS

470
00:27:18,080 --> 00:27:25,240
secretary and then the woman
he's appointed to be the surgeon

471
00:27:25,240 --> 00:27:27,320
general.
Yeah, Doctor means.

472
00:27:27,640 --> 00:27:28,120
Yeah.
I.

473
00:27:28,560 --> 00:27:34,960
Mean yeah, they're basically
peddling in the misinformation

474
00:27:35,200 --> 00:27:38,800
sort of business like they.
You feel that way?

475
00:27:39,240 --> 00:27:42,240
Oh, for 100% if you like and
I'll tell you why.

476
00:27:42,880 --> 00:27:46,440
Sure.
So certain things that RFK says

477
00:27:46,840 --> 00:27:49,680
or wants to do are for sure
great.

478
00:27:49,960 --> 00:27:51,520
Like they don't need our.
The dyes, yeah.

479
00:27:51,600 --> 00:27:54,640
It needs those, yeah.
And yes, everything should have

480
00:27:54,640 --> 00:27:57,080
has have less sugar totally
support all that.

481
00:27:57,120 --> 00:27:59,000
And I've actually been on TVA
fair number of times talking

482
00:27:59,000 --> 00:28:01,200
about those things.
But then in the next breath he

483
00:28:01,200 --> 00:28:05,640
talks about vaccine conspiracy
theories or he talks about beef

484
00:28:05,640 --> 00:28:07,960
tower.
And and these are things that

485
00:28:08,200 --> 00:28:12,240
are that completely have been
vetted by the scientific

486
00:28:12,240 --> 00:28:15,840
community and there's no
question about them anymore.

487
00:28:15,960 --> 00:28:20,400
But his base doesn't want to
believe that.

488
00:28:20,400 --> 00:28:25,120
So they peddle in these sort of.
Yeah, I understand.

489
00:28:25,440 --> 00:28:29,200
I think right now is actually
we're living in a beyond

490
00:28:29,600 --> 00:28:33,240
fascinating time because there's
been a collapse of.

491
00:28:33,320 --> 00:28:35,760
And I've talked about there's a
bunch on the show, just, you

492
00:28:35,760 --> 00:28:38,200
know, both in a professional
setting, you know, with

493
00:28:38,200 --> 00:28:39,920
professionals and shooting the
shit with my friends.

494
00:28:40,240 --> 00:28:44,520
But the sense that no one really
kind of knows who to trust

495
00:28:44,520 --> 00:28:47,560
anymore, that there's just been
such a breakdown of trust and,

496
00:28:47,560 --> 00:28:50,120
and processes.
And, you know, and, and, and,

497
00:28:50,120 --> 00:28:52,360
and like what you just said, on
one hand, someone could say

498
00:28:52,360 --> 00:28:54,840
something that makes a lot of
sense, like food dyes are bad,

499
00:28:55,160 --> 00:28:57,400
you know, and, and you know, and
you probably don't want to be

500
00:28:57,400 --> 00:29:00,320
consuming as much ultra, ultra
processed food as we do, you

501
00:29:00,320 --> 00:29:02,560
know, and, and that, and that
resonates with people.

502
00:29:02,560 --> 00:29:05,440
And So what follows is that any,
you know, beef tallow, whatever

503
00:29:05,440 --> 00:29:09,480
follows next is, is held in the
same light or associated with

504
00:29:09,480 --> 00:29:12,800
the same kind of positivity and
vice versa on people that feel,

505
00:29:13,080 --> 00:29:15,640
you know, that if they feel
disenchanted with the whole, you

506
00:29:15,640 --> 00:29:18,240
know, with everything that has
to do with COVID, then all of a

507
00:29:18,240 --> 00:29:20,280
sudden anyone that makes any
kind of recommendations for

508
00:29:20,280 --> 00:29:21,760
health, they say, what do you
know, you did, you messed up

509
00:29:21,760 --> 00:29:23,480
with COVID.
You know what, just because

510
00:29:23,480 --> 00:29:24,960
you're right about one thing
doesn't mean you're wrong about

511
00:29:24,960 --> 00:29:26,160
everything else.
And vice versa.

512
00:29:26,600 --> 00:29:29,920
But even the COVID example and
and getting back to to KC means

513
00:29:29,920 --> 00:29:34,120
like she never finished her
medical training but she ended

514
00:29:34,120 --> 00:29:38,120
up starting like a sort.
Of yeah levels medicine.

515
00:29:38,360 --> 00:29:41,800
You know, arthritis medicine
practice and became a wrote a

516
00:29:41,800 --> 00:29:44,200
book and became a social media
influencer.

517
00:29:44,480 --> 00:29:47,880
And now that's, that's who our
surgeon general nomination is,

518
00:29:48,240 --> 00:29:52,960
not some, you know, academic
guru who actually only talks

519
00:29:52,960 --> 00:29:57,400
about science and facts, but a
woman who, you know, is on the

520
00:29:57,400 --> 00:29:59,320
fringe of accepted medical
practice.

521
00:30:00,640 --> 00:30:04,360
But even with COVID, so like, or
the COVID vaccines.

522
00:30:05,400 --> 00:30:11,880
So yes, some of the mRNA
vaccines had side effects for

523
00:30:11,880 --> 00:30:13,520
sure.
Like lots of people have had

524
00:30:13,520 --> 00:30:16,720
side effects from those vaccines
and some of them were severe and

525
00:30:16,720 --> 00:30:21,920
some of them were not so severe.
But it's been made into, it's

526
00:30:21,920 --> 00:30:26,000
been demonized actually to the
point where now RFK has

527
00:30:27,440 --> 00:30:32,080
basically stopped running for
all mRNA vaccines, which is like

528
00:30:32,560 --> 00:30:38,040
basically paralyzing us for the
next COVID that comes along, the

529
00:30:38,040 --> 00:30:42,160
next virus that comes along.
If we can't use mRNA technology,

530
00:30:42,520 --> 00:30:47,320
we are hosed.
And so even if you didn't like

531
00:30:47,320 --> 00:30:52,160
the COVID mRNA vaccine, the
answer is to study it more.

532
00:30:52,400 --> 00:30:54,120
It's not.
The answer is to stop all

533
00:30:54,120 --> 00:30:59,440
funding for that particular type
of vaccine or even that vaccine

534
00:30:59,440 --> 00:31:01,280
in itself.
Like there are still people who

535
00:31:01,280 --> 00:31:04,640
are getting, especially kids who
get long COVID, and it's

536
00:31:04,640 --> 00:31:08,440
devastating for them.
And they don't have the vaccine.

537
00:31:08,440 --> 00:31:13,840
It's not available this fall
because RFK basically disbanded

538
00:31:13,840 --> 00:31:17,840
the committee that makes the
decisions and then repopulated

539
00:31:17,840 --> 00:31:22,960
it with his sycophants, not
medical like giants, but people

540
00:31:22,960 --> 00:31:26,400
who we knew were going to make
his base happy.

541
00:31:27,360 --> 00:31:29,800
And that's sort of where we are
in politics and in the world.

542
00:31:29,800 --> 00:31:33,640
And and as you said, it's just
like it's really, I mean, I saw

543
00:31:33,680 --> 00:31:38,640
something in, I can't remember
which news agency, whether it

544
00:31:38,640 --> 00:31:43,160
was, I don't know, anyway, some,
some CNN or New York Times or

545
00:31:43,160 --> 00:31:45,200
Washington Post or something,
U.S.

546
00:31:45,200 --> 00:31:46,400
News Award report, can't
remember.

547
00:31:46,400 --> 00:31:51,080
But somebody did a survey of
sort of trust and leadership.

548
00:31:51,640 --> 00:31:54,840
Yeah.
Across the different domains and

549
00:31:55,520 --> 00:31:58,480
it was crap.
In life, it's been, it's been

550
00:31:58,480 --> 00:32:01,560
going down.
It's been going down for 6070

551
00:32:01,560 --> 00:32:05,240
straight years and the last
five, the last five or six years

552
00:32:05,240 --> 00:32:07,480
have the last five or six years
have really plummeted.

553
00:32:08,040 --> 00:32:14,440
I was actually curious to ask
because, and I don't want to

554
00:32:14,440 --> 00:32:16,440
stick on it too long because I
feel like it's a topic that's

555
00:32:16,440 --> 00:32:19,480
kind of been beat over the head
so many times, but I think it's

556
00:32:19,480 --> 00:32:22,120
relevant just just as a
finishing point.

557
00:32:22,120 --> 00:32:25,640
I think it's interesting
because, you know, there at the

558
00:32:25,640 --> 00:32:28,080
beginning of COVID, everyone
kind of was like freaked out.

559
00:32:28,080 --> 00:32:31,360
And then at one point, I
remember at one point there was

560
00:32:31,360 --> 00:32:34,720
a shift and maybe it was after a
month or three months or five.

561
00:32:34,720 --> 00:32:37,960
I don't remember exactly what it
was, but at some point I got the

562
00:32:38,280 --> 00:32:41,160
IT dawned on me like, Oh my God,
this has turned into a political

563
00:32:41,160 --> 00:32:43,200
conversation.
It's not a health conversation.

564
00:32:43,480 --> 00:32:47,560
Like this isn't a question of
like is, you know, how do I, how

565
00:32:47,560 --> 00:32:49,280
do I make sure that I'm healthy
and not sick?

566
00:32:49,280 --> 00:32:52,120
And how do we stop this?
What feels like a rampant virus

567
00:32:52,120 --> 00:32:55,080
been going through now it feels
like it's a question of like,

568
00:32:55,440 --> 00:32:57,880
are you, are you Republican?
Are you Democrat?

569
00:32:57,880 --> 00:32:59,000
Are you moderate?
What do you think?

570
00:32:59,000 --> 00:33:01,200
And I'm like, what the heck does
one thing have to do with the

571
00:33:01,200 --> 00:33:02,720
next?
And why, why is this even?

572
00:33:02,720 --> 00:33:06,920
Why is this even that?
And so I was, you know, and I

573
00:33:06,960 --> 00:33:11,960
think that health, especially
now with the, with the obesity

574
00:33:11,960 --> 00:33:14,960
conversation and the general,
you know, the fact that and you

575
00:33:14,960 --> 00:33:19,040
know, again, I mean, I don't,
there was a great point I heard

576
00:33:19,040 --> 00:33:21,280
recently, I forgot who was
saying it, but I haven't heard

577
00:33:21,280 --> 00:33:24,760
anyone public figure in my at
least in my life.

578
00:33:24,840 --> 00:33:28,480
And I'm only, you know, I'm 30,
but you know, ever, ever

579
00:33:29,360 --> 00:33:34,520
campaign politically on health,
on Children's Health, on adults

580
00:33:34,520 --> 00:33:37,520
health, on the, you know, on
fitness, on, on any of that.

581
00:33:37,520 --> 00:33:39,280
And I thought that was really,
really fascinating.

582
00:33:39,400 --> 00:33:42,440
Yeah, I think RFK tried that
because he didn't really have

583
00:33:42,440 --> 00:33:46,720
much to offer in anything else.
But as you saw, it didn't get

584
00:33:46,720 --> 00:33:50,520
him anywhere close to enough of
a support to be a major party

585
00:33:50,520 --> 00:33:54,600
candidate.
But the Yeah, and like, again,

586
00:33:55,360 --> 00:34:00,720
if Anthony Fauci, he's not a
perfect human being.

587
00:34:00,760 --> 00:34:03,320
I I know people who have worked
with him said he was kind of

588
00:34:03,320 --> 00:34:10,159
like a know it all jerk in many
ways, but he was trying to do

589
00:34:10,159 --> 00:34:11,800
what he thought was right for
the country.

590
00:34:12,080 --> 00:34:16,080
It wasn't because he had one
political agenda or another.

591
00:34:16,520 --> 00:34:20,360
He was just trying to save as
many lives as he thought as he

592
00:34:20,360 --> 00:34:22,199
could.
And he thought he was doing

593
00:34:23,080 --> 00:34:25,960
what, you know, he was trying to
accomplish that aim.

594
00:34:26,320 --> 00:34:30,159
So again, even if you disagree
with him, and I think that again

595
00:34:30,199 --> 00:34:32,560
getting getting back to you, it
goes back to like everything in

596
00:34:32,560 --> 00:34:36,040
our world today, rather than
having a like an intellectual

597
00:34:36,040 --> 00:34:40,199
discourse with him or with other
public health figures, it just

598
00:34:40,199 --> 00:34:42,719
became.
You know, a shouting match,

599
00:34:42,800 --> 00:34:44,920
Everything's a shouting match,
everything's a shouting match.

600
00:34:44,920 --> 00:34:48,560
The same thing happens today.
Like, you know, again, I go back

601
00:34:48,560 --> 00:34:51,360
to the, you know, the example of
the mRNA vaccine.

602
00:34:51,360 --> 00:34:56,800
Like there's nothing wrong with
that technology necessarily

603
00:34:57,160 --> 00:35:01,440
until they prove that there is.
But like, it's such a political

604
00:35:01,440 --> 00:35:04,280
hot button that, you know, it
was like, oh, we're just.

605
00:35:04,280 --> 00:35:07,200
Going to yeah, it's going to be
very even even if there is even

606
00:35:07,200 --> 00:35:09,440
if anything's done, it's going
to be hard for it to be

607
00:35:09,440 --> 00:35:11,520
objective because it's become so
politicized.

608
00:35:11,520 --> 00:35:13,160
So.
And now, yeah, that's.

609
00:35:13,440 --> 00:35:18,760
On the flip side, like anything
that comes from the vaccine

610
00:35:20,400 --> 00:35:24,600
committee that RFK has now
reappointed, everybody, no one's

611
00:35:24,600 --> 00:35:26,840
going to believe that either.
Like no one's everybody's like.

612
00:35:26,840 --> 00:35:30,000
That right and either way, we
either way, we end up worse off,

613
00:35:30,000 --> 00:35:32,200
which is a shame, you know, and
that's kind of yeah.

614
00:35:32,200 --> 00:35:34,720
And I mean that was that was
actually, you know, you know,

615
00:35:34,720 --> 00:35:36,800
full circle back to even my
podcast.

616
00:35:36,800 --> 00:35:40,800
It was, you know, there was that
things have strayed so far from

617
00:35:40,800 --> 00:35:45,440
just being able to have a
regular conversation that it's

618
00:35:45,440 --> 00:35:47,840
obscene, you know, and it's
really, it's really a shame.

619
00:35:47,840 --> 00:35:51,440
And I think that and, and yeah,
I mean, I don't want to, I don't

620
00:35:51,440 --> 00:35:54,840
want to get, I don't, I don't
think much more into it than

621
00:35:54,880 --> 00:35:56,400
this.
Because I think that it's a

622
00:35:56,400 --> 00:35:59,560
different episode it.
Is and and you know what at the

623
00:35:59,560 --> 00:36:02,120
end of the day, I also think
that this particular topic also

624
00:36:02,120 --> 00:36:04,560
has been being on being over
the, you know, everyone's head

625
00:36:04,600 --> 00:36:08,480
until like a dead horse.
And I think that I think that,

626
00:36:08,640 --> 00:36:11,400
you know, it's, you know, what I
think for a lot of people, their

627
00:36:11,400 --> 00:36:13,480
opinions are their opinions at
this point about it.

628
00:36:13,480 --> 00:36:16,200
And there's not much else that
that we're really going to do

629
00:36:16,200 --> 00:36:19,000
because echo chambers and
yelling and podcasts and

630
00:36:19,000 --> 00:36:22,400
everything like that, you know?
And so, you know, I welcome, I

631
00:36:22,400 --> 00:36:24,600
welcome everyone's perspective.
And you know, I think it's

632
00:36:24,600 --> 00:36:26,960
really great.
But that's why I'm sort of

633
00:36:27,400 --> 00:36:30,400
positioning myself as a quote UN
quote D influencer.

634
00:36:30,400 --> 00:36:32,240
Yeah, that's a great.
It's it's really cool.

635
00:36:32,600 --> 00:36:36,200
Because like, I don't really
have an agenda other than

636
00:36:36,280 --> 00:36:38,320
getting people healthier.
Like I don't really care.

637
00:36:38,320 --> 00:36:40,320
I like to.
I often describe myself as

638
00:36:40,680 --> 00:36:43,760
intervention agnostic.
Like I don't care if you want to

639
00:36:43,760 --> 00:36:45,560
use diet and exercise.
I don't care if you want to use

640
00:36:45,560 --> 00:36:46,840
medications.
I don't care if you want to use

641
00:36:46,840 --> 00:36:49,080
surgery.
I just want you to to to get

642
00:36:49,080 --> 00:36:51,240
healthier.
And I can tell you the, the, the

643
00:36:51,640 --> 00:36:53,560
data, I can tell you the facts,
the data.

644
00:36:53,920 --> 00:36:57,440
And then you as the patient
should do what you want with

645
00:36:57,440 --> 00:36:59,200
them.
Because that's the great thing

646
00:36:59,200 --> 00:37:03,160
about being, you know, being a
human is that you get to decide,

647
00:37:03,280 --> 00:37:04,840
well, at least in this country,
you get to.

648
00:37:04,840 --> 00:37:09,520
Decide what you want to do.
And so, like, again, it's like,

649
00:37:09,520 --> 00:37:13,480
why are there people out there
who are saying things like, oh,

650
00:37:13,480 --> 00:37:16,320
if we just change food policy,
that's all we need to do.

651
00:37:16,320 --> 00:37:18,000
Everything's going to get, you
know, everything.

652
00:37:18,000 --> 00:37:20,760
Everybody's going to get
healthier or you know.

653
00:37:20,760 --> 00:37:22,680
There's no magic button.
There's no magic button.

654
00:37:22,680 --> 00:37:24,520
But I think it's just in
general, I think it's like, I

655
00:37:24,520 --> 00:37:29,840
think at least from what I I try
to be charitable, my, my, I

656
00:37:29,840 --> 00:37:32,960
think that these are all
positive steps that if we did

657
00:37:32,960 --> 00:37:36,080
would only have, I feel
essentially net positive.

658
00:37:36,080 --> 00:37:38,080
It's only net positive to get
rid of the dyes from the food.

659
00:37:38,720 --> 00:37:40,440
I mean, unless you can make a
case otherwise.

660
00:37:42,800 --> 00:37:44,680
Yeah.
And actually, you know, so I

661
00:37:44,680 --> 00:37:46,240
think that people in general
were held.

662
00:37:47,040 --> 00:37:47,600
Go ahead, please.
Oh, I.

663
00:37:48,280 --> 00:37:55,880
Was just going to say even if,
even if those things don't cause

664
00:37:55,880 --> 00:37:59,840
problems, like no one needs
them, no one needs their ice

665
00:37:59,840 --> 00:38:02,600
cream to be bright blue or
bright green, right?

666
00:38:02,600 --> 00:38:08,160
Like I said, like it's not a big
deal when you do some of those

667
00:38:08,160 --> 00:38:10,480
things and you're right those
are probably net positives.

668
00:38:10,720 --> 00:38:12,200
They're either neutral or
positive.

669
00:38:12,480 --> 00:38:15,600
There's no downside, but there
are some downsides to some of

670
00:38:15,600 --> 00:38:17,000
the other things.
So that's when you really have

671
00:38:17,000 --> 00:38:19,120
to be a little bit more careful
about what you're saying.

672
00:38:19,720 --> 00:38:27,200
And you know, again, I think
the, the the obesity world is

673
00:38:27,200 --> 00:38:30,560
starting to learn to play
together much better.

674
00:38:31,520 --> 00:38:35,400
And I think that's the key step
in the right direction.

675
00:38:36,360 --> 00:38:41,360
And I think docs in general have
started to realize that the old

676
00:38:41,360 --> 00:38:46,800
fashioned paternalistic, do as I
say type of model is not really

677
00:38:46,800 --> 00:38:49,800
well received.
Yeah, not much anymore, yeah.

678
00:38:49,960 --> 00:38:53,440
So it's like it's called shared
decision making or something

679
00:38:53,440 --> 00:38:57,320
like that.
And so I think we're starting to

680
00:38:57,320 --> 00:38:59,920
move in the right direction in
terms of that kind of stuff.

681
00:39:01,800 --> 00:39:03,520
But you know, yeah, the rest of
the.

682
00:39:03,520 --> 00:39:06,960
I mean, can I ask you about
alcohol and and obesity?

683
00:39:06,960 --> 00:39:10,480
Do do, do, do, do, do, is there
a correlation between people

684
00:39:10,480 --> 00:39:13,240
that, that drink a lot
frequently and people that are

685
00:39:13,240 --> 00:39:16,240
overweight or vice versa?
Or what do you what have you

686
00:39:16,240 --> 00:39:20,120
seen?
So actually, so alcoholism is a,

687
00:39:21,960 --> 00:39:25,600
an example analogy that I used
to talk about obesity quite

688
00:39:25,600 --> 00:39:29,600
often because, you know, 30-40
years ago people thought

689
00:39:29,720 --> 00:39:34,240
alcoholism was a disease of the
weak minded and the weak willed.

690
00:39:34,240 --> 00:39:37,000
And you know, you just couldn't
keep away from the bottle.

691
00:39:37,000 --> 00:39:40,040
The temptations were too great
and you just indulge.

692
00:39:40,440 --> 00:39:43,960
But then people realized that
it's actually a heritable, it's

693
00:39:44,000 --> 00:39:47,040
a genetic disease that you can
inherit from your parents.

694
00:39:47,520 --> 00:39:51,920
And it changed a lot of the
stigma around alcoholism and it

695
00:39:51,920 --> 00:39:54,200
changed how we treat it and how
we view it.

696
00:39:54,720 --> 00:39:57,320
And obesity is the same way.
Like people just think obesity

697
00:39:57,320 --> 00:40:00,600
is because people don't work out
enough or eat well and that

698
00:40:00,600 --> 00:40:03,240
they're lazy or whatever, which
is insane.

699
00:40:04,360 --> 00:40:06,480
And we actually now know that
there are a lot of it is

700
00:40:06,480 --> 00:40:12,680
genetically inherited, but it's
still so stigmatized that folks

701
00:40:12,680 --> 00:40:15,280
don't want to, they don't want
to appreciate that.

702
00:40:15,280 --> 00:40:16,520
They don't want to consider
that.

703
00:40:16,960 --> 00:40:20,120
So take some time I think.
Yeah, so it's actually the

704
00:40:20,120 --> 00:40:23,320
opposite.
People with alcoholism tend not

705
00:40:23,440 --> 00:40:25,320
to, they actually, they're
usually skinny because they

706
00:40:25,320 --> 00:40:30,040
don't eat enough anything else.
So most people with alcoholism

707
00:40:30,040 --> 00:40:31,520
are actually on the thinner
side.

708
00:40:31,880 --> 00:40:35,440
But if you drink a lot of sugar
sweetened beverages, certainly,

709
00:40:35,480 --> 00:40:37,360
certainly alcohol has a lot of
calories too.

710
00:40:37,840 --> 00:40:40,200
And obviously everybody knows,
everybody knows somebody with a

711
00:40:40,200 --> 00:40:44,000
big beer belly.
So it it, it's not black and

712
00:40:44,000 --> 00:40:49,720
white, but yeah.
So calories consumed by drinking

713
00:40:50,080 --> 00:40:56,080
are probably the number one
modifiable behavior for people

714
00:40:56,160 --> 00:41:00,840
if they really want to start to
think about their weight or

715
00:41:00,840 --> 00:41:04,680
address their weight and get
healthier is, you know, like

716
00:41:05,320 --> 00:41:09,360
every, there's sugar in almost
every drink that's out there

717
00:41:09,360 --> 00:41:11,760
unless you specifically look for
things without it.

718
00:41:13,640 --> 00:41:19,320
And obviously, like I had a, I
was in New York.

719
00:41:19,320 --> 00:41:21,120
I used to live in New York City.
I haven't lived there in a

720
00:41:21,120 --> 00:41:24,640
while, but I was in New York,
let's say, I don't know, 15

721
00:41:25,120 --> 00:41:26,720
years ago.
Which part of the city are we

722
00:41:26,720 --> 00:41:29,240
living in?
I lived in Murray Hill, which is

723
00:41:29,320 --> 00:41:32,760
so I worked at NYU, so I.
Lived in Murray Hill, gotcha

724
00:41:32,760 --> 00:41:34,600
even.
Before that I was in the Upper

725
00:41:34,600 --> 00:41:36,480
East Side, so I did my general
surgery training at.

726
00:41:38,320 --> 00:41:40,120
I love the East Side, by the
way.

727
00:41:40,680 --> 00:41:42,800
I love it.
It's a great, it's a great, it's

728
00:41:42,800 --> 00:41:45,520
my favorite part of Manhattan.
It's it's, it's quiet, it's

729
00:41:45,520 --> 00:41:48,160
residential, and it's affordable
or more affordable, relatively

730
00:41:48,160 --> 00:41:50,200
speaking.
Yeah, everybody has their own.

731
00:41:50,440 --> 00:41:51,520
Everybody has their own
favorites.

732
00:41:53,280 --> 00:41:57,760
But I remember I was downtown,
probably in Soho because that's

733
00:41:57,760 --> 00:42:00,680
one of my favourites.
And I went to, I can't remember,

734
00:42:00,680 --> 00:42:02,960
I was meeting, I mean meeting my
wife.

735
00:42:02,960 --> 00:42:07,600
I don't know who I was meeting,
but I was at bar and I, they

736
00:42:07,600 --> 00:42:10,520
were sort of famous for their
mojitos and I had them make me a

737
00:42:10,520 --> 00:42:12,880
mojito and that one of their
things is they make them right

738
00:42:12,880 --> 00:42:17,320
in front of you.
And the dude or dudette woman, I

739
00:42:17,320 --> 00:42:25,000
don't know who was started
making one and he or she opened

740
00:42:25,400 --> 00:42:28,200
four of those little sugar
packets.

741
00:42:28,920 --> 00:42:31,040
Oh man.
To put it in the bottle of the

742
00:42:31,040 --> 00:42:35,000
mojito with the, I guess the
mint to, to muddle it and then

743
00:42:35,000 --> 00:42:37,960
put it in the rum and whatever.
And I've never had a mojito

744
00:42:37,960 --> 00:42:44,320
since I was like, Oh my God, if
I knew that a mojito had each

745
00:42:44,320 --> 00:42:46,960
one of those sugar packets is
usually about 5 grams of sugar

746
00:42:46,960 --> 00:42:49,520
or 4 grams of sugar.
So if I knew a mojito, I had 20

747
00:42:49,520 --> 00:42:52,720
grams of sugar in it, I never
would have had them.

748
00:42:52,920 --> 00:42:58,240
So that's where alcohol can
really, mixers especially can

749
00:42:58,240 --> 00:43:00,360
really increase your calorie
intake.

750
00:43:01,840 --> 00:43:03,920
I had the same thing, by the
way, with beer, right, because I

751
00:43:03,920 --> 00:43:06,640
love craft beer.
And so Ipas apparently part of

752
00:43:06,640 --> 00:43:10,360
the way or sours, the way that
they get these Ipas or sours up

753
00:43:10,360 --> 00:43:15,760
to 8910 percent ABV is by
dumping more sugar in or more

754
00:43:15,760 --> 00:43:18,360
fruit, you know, more, more
fruits, you know, and, and it

755
00:43:18,360 --> 00:43:22,360
might.
I think it's, I don't actually

756
00:43:22,360 --> 00:43:26,720
know the caloric difference
between an IPA and or a sour and

757
00:43:26,720 --> 00:43:29,880
let's say a lager.
Well, I mean, a Bud Light, a

758
00:43:29,880 --> 00:43:32,560
buddy has less than 100
calories, right?

759
00:43:32,640 --> 00:43:36,360
Or Guinness, I think has
famously, you know, they say

760
00:43:36,480 --> 00:43:37,760
whatever that whatever that
means.

761
00:43:37,760 --> 00:43:39,960
I don't know what the equivalent
of whatever it says on the

762
00:43:39,960 --> 00:43:43,280
bottle, you know, 100 calories.
But I, there was a brewery I

763
00:43:43,280 --> 00:43:47,560
went to where they had the
calories next to the beers and

764
00:43:47,560 --> 00:43:50,880
they had a stout which was like
a heavy barrel aged, you know,

765
00:43:51,840 --> 00:43:55,200
you know, sweet beer.
And I think I had like 450

766
00:43:55,200 --> 00:43:58,200
calories for an 8 oz pour or
something crazy like that.

767
00:43:58,600 --> 00:44:01,880
Well, right.
And you know, I'm no brew, no

768
00:44:01,880 --> 00:44:04,880
brew Meister, but I do know
that, you know, the sugar is the

769
00:44:04,880 --> 00:44:06,920
fuel for the yeast to make the
alcohol.

770
00:44:06,920 --> 00:44:10,400
So I think, you know, they have
to add more sugar in it to to

771
00:44:10,400 --> 00:44:13,520
get the higher alcohol contents.
But yeah, like it's a, it's a,

772
00:44:14,760 --> 00:44:20,160
it is AI think that's sort of
helped start the whole like the

773
00:44:20,160 --> 00:44:22,760
White Claw craze or whatever
the, the the seltzer.

774
00:44:22,760 --> 00:44:24,760
Craze.
Because they can make them with

775
00:44:24,760 --> 00:44:28,560
relatively little few calories.
You know, it's basically like.

776
00:44:28,680 --> 00:44:31,120
Alcohol consumption in general
feels like it's going down, I.

777
00:44:31,960 --> 00:44:37,160
Mean, yeah, I just saw that
actually in a I'm always

778
00:44:37,160 --> 00:44:39,280
scouring the news because I'm
always looking for things to

779
00:44:39,720 --> 00:44:44,760
sort of pitch to TV, cable TV
networks because I, I've been,

780
00:44:44,760 --> 00:44:47,120
was doing a bunch of them,
although it's dried up over the

781
00:44:47,120 --> 00:44:50,920
last month or so.
But anyway, the I think mostly

782
00:44:50,920 --> 00:44:52,960
because there's so much other
news other than health that

783
00:44:54,480 --> 00:44:58,720
people talk about.
But I did see another survey

784
00:44:58,720 --> 00:45:03,480
that did and it was actually
interesting because it said that

785
00:45:04,440 --> 00:45:07,640
that so in general, alcohol
consumption is down for sure.

786
00:45:07,960 --> 00:45:12,160
But they, for whatever reason,
they they compared it by

787
00:45:12,480 --> 00:45:16,080
political party, which I have no
idea why that anybody.

788
00:45:16,440 --> 00:45:21,920
But supposedly the there's a
bigger decrease in alcohol

789
00:45:21,920 --> 00:45:25,040
consumption among Republicans
than Democrats.

790
00:45:25,040 --> 00:45:28,800
I have no idea what that means.
I don't.

791
00:45:29,520 --> 00:45:35,120
Even if I were to take a wild, a
wild stab, really I would.

792
00:45:35,160 --> 00:45:42,400
I would just probably say that
younger crowds tend to be

793
00:45:42,400 --> 00:45:44,840
left-leaning.
Younger crowds are a little bit

794
00:45:44,840 --> 00:45:47,680
more leaning towards weed and
cannabis today than they are

795
00:45:47,680 --> 00:45:51,880
towards alcohol in general.
And I think that, but it's I

796
00:45:51,880 --> 00:45:53,800
think that.
It's Republicans who've dropped

797
00:45:53,800 --> 00:45:56,520
less, dropped more than
Democrats.

798
00:45:57,160 --> 00:45:58,520
Oh, yeah.
Well, because I don't think, but

799
00:45:58,520 --> 00:46:00,520
I don't think Democrats were
drinking very much recently

800
00:46:00,520 --> 00:46:02,280
anyway.
So a lot of, you know, these,

801
00:46:02,600 --> 00:46:05,920
you know, Logan Bros Bros or
whatever, you know, I've been

802
00:46:05,920 --> 00:46:07,440
hearing about this last five
years.

803
00:46:07,440 --> 00:46:10,680
I think a lot of those kind of
people have been, you know, have

804
00:46:10,680 --> 00:46:13,520
been dropping that.
But either way, it's

805
00:46:13,520 --> 00:46:15,240
fascinating.
I bet you're going to say, I

806
00:46:15,240 --> 00:46:18,400
thought you're going to say it's
due to the, you know, Trump one

807
00:46:18,400 --> 00:46:20,680
and Trump 2 that the Democrats
are still drinking their

808
00:46:20,680 --> 00:46:24,680
sorrows.
No, that's funny.

809
00:46:24,680 --> 00:46:28,880
I didn't think about that.
So can we get back to

810
00:46:28,960 --> 00:46:31,960
epigenetics a little bit now?
I'm sorry that, you know, that's

811
00:46:31,960 --> 00:46:33,880
right, that's right because I,
because I think it is the

812
00:46:33,880 --> 00:46:36,280
perfect spot back-to-back.
Well, we're back to it, right?

813
00:46:36,280 --> 00:46:37,960
Because now we're talking about
people.

814
00:46:37,960 --> 00:46:41,360
Don't you know, think that it's
not just a stigma anymore, just

815
00:46:41,360 --> 00:46:44,200
like alcoholism.
And so, So what, what, what are

816
00:46:44,200 --> 00:46:46,720
epigenetics and what are the,
what's the context for alcohol,

817
00:46:46,720 --> 00:46:49,960
for, for sorry for, for obesity?
Yeah.

818
00:46:50,360 --> 00:46:56,640
So epigenetics is the field of
how genetic material gets

819
00:46:57,840 --> 00:47:00,840
altered by the environment, by
the extreme environment.

820
00:47:01,680 --> 00:47:04,680
And it's a burgeoning field.
It wasn't even really a field

821
00:47:04,680 --> 00:47:10,640
until maybe like 1520 years ago.
And it's not really well

822
00:47:10,640 --> 00:47:13,200
understood.
But what is understood is that

823
00:47:13,200 --> 00:47:17,880
your DNA can be altered by.
Experience.

824
00:47:18,400 --> 00:47:21,920
Yeah, let's say ultra processed
foods or let's say environmental

825
00:47:21,920 --> 00:47:25,800
toxins, you know, that's that's
how radiation meets the cancer,

826
00:47:25,800 --> 00:47:35,680
for instance, potentially.
And what what is known now is

827
00:47:35,680 --> 00:47:41,600
that the epigenetic, the
epigenetically modified DNA

828
00:47:41,760 --> 00:47:46,120
genes passed down can be passed
on from parent to right.

829
00:47:47,320 --> 00:47:53,000
So it, you know, the people who
are in the food camp, like the

830
00:47:53,000 --> 00:47:56,440
food is medicine people, which I
don't necessarily support

831
00:47:56,440 --> 00:47:58,240
because food is food and
medicine is medicine.

832
00:47:58,320 --> 00:48:03,520
But they argue that the obesity
epidemic can't be about anything

833
00:48:03,520 --> 00:48:05,960
other than food because food is
the only thing that's changed in

834
00:48:05,960 --> 00:48:08,400
the last 50 years.
And as we talked about earlier

835
00:48:08,400 --> 00:48:11,480
50 years about when the obesity
prevalence really started to

836
00:48:11,480 --> 00:48:14,200
rise.
But what they don't consider is

837
00:48:14,200 --> 00:48:16,560
that, yes, it's the food, but
it's the food and how it

838
00:48:16,560 --> 00:48:19,240
interacts with your genes.
And that's how it gets passed on

839
00:48:19,560 --> 00:48:22,000
from parent to child.
That's why you know, me as a

840
00:48:22,000 --> 00:48:25,240
pediatric surgeon and a
pediatric obesity expert, I see

841
00:48:25,240 --> 00:48:28,880
kids who are 8 or 9 who haven't
been on earth long enough to to

842
00:48:28,920 --> 00:48:32,040
eat enough to eat themselves
into obesity.

843
00:48:32,040 --> 00:48:35,920
Even if I believe that anybody
did that, which I don't like,

844
00:48:35,920 --> 00:48:37,680
nobody eats themselves into
obesity.

845
00:48:38,720 --> 00:48:45,960
People eat and then their bodies
react with obesity because, you

846
00:48:45,960 --> 00:48:49,240
know, we all know.
We all either have a sibling or

847
00:48:49,240 --> 00:48:53,240
a family member or a cousin or a
friend who eats the same as we

848
00:48:53,240 --> 00:48:56,240
do but is either, you know, 20
lbs heavy.

849
00:48:56,240 --> 00:48:57,560
Yeah, of course, 20.
Pounds lighter.

850
00:48:57,840 --> 00:49:00,600
Like, sure, or you can be a
freak athlete and you can work

851
00:49:00,600 --> 00:49:04,600
out every day and eat garbage,
sorry and eat garbage and you're

852
00:49:04,600 --> 00:49:07,000
fine and then they're sorry.
Vice versa, you know you're

853
00:49:07,040 --> 00:49:09,240
healthy all day and the people
that you know genetically, they

854
00:49:09,240 --> 00:49:10,960
just walk out of the bag of
candy all day and they're

855
00:49:10,960 --> 00:49:12,920
totally fine and they're good to
go.

856
00:49:13,440 --> 00:49:15,320
Right.
So, so it's clearly more

857
00:49:15,320 --> 00:49:20,520
complicated than diet, but the
study that came out recently,

858
00:49:21,080 --> 00:49:28,760
which I think really is going to
help shed light on, on the whole

859
00:49:28,760 --> 00:49:31,760
weight regain thing that we were
talking about with both

860
00:49:33,800 --> 00:49:41,440
medicines and surgery and
lifestyle, is that there's now

861
00:49:41,720 --> 00:49:45,360
evidence that fat cells have
what's, what people are calling

862
00:49:45,360 --> 00:49:49,000
memory.
So like the the genes and the

863
00:49:49,000 --> 00:49:54,080
proteins that are being made in
fat cells, even if you lose

864
00:49:54,080 --> 00:49:57,480
weight, they still, they may not
change.

865
00:49:57,480 --> 00:50:01,960
So when you stop your
intervention, they may still

866
00:50:03,080 --> 00:50:06,480
basically drive you back to the
unhealthy.

867
00:50:06,480 --> 00:50:10,040
Fascinating that you.
Had originally and it actually

868
00:50:10,040 --> 00:50:12,280
makes a lot of sense if you
think about it because.

869
00:50:13,720 --> 00:50:15,520
Would that be coming to form of
a craving?

870
00:50:15,520 --> 00:50:19,960
Is that like is is this?
Or is this just that it reacts

871
00:50:19,960 --> 00:50:23,240
to food in a similar way?
Well, so again with the gut

872
00:50:23,240 --> 00:50:27,120
brain axis, we don't really know
how fat cells interact with the

873
00:50:27,120 --> 00:50:29,360
brain directly or even
indirectly.

874
00:50:29,720 --> 00:50:34,240
But let's say they have let's
say fat cells have a memory and

875
00:50:34,680 --> 00:50:40,280
fat cell when you have obesity
is has changed your brain to,

876
00:50:41,360 --> 00:50:44,880
you know, prefer salty foods or
or or processed foods or.

877
00:50:45,800 --> 00:50:47,160
Or.
Sugar, sugar, foods, whatever

878
00:50:47,640 --> 00:50:54,360
and then you have surgery and if
you have surgery, let's say and

879
00:50:54,360 --> 00:50:56,480
you respond well.
So we didn't haven't talked

880
00:50:56,480 --> 00:50:58,960
about statistics, which bores
everybody, but I'd like to.

881
00:50:58,960 --> 00:51:00,960
Talk about No, I'd love to.
I'd love to talk about it.

882
00:51:00,960 --> 00:51:02,200
Yeah, please.
Well, mostly because

883
00:51:02,200 --> 00:51:05,200
everything's a bell curve.
So like when you hear average

884
00:51:05,200 --> 00:51:08,400
patient, what does that actually
mean and what does that mean for

885
00:51:08,400 --> 00:51:11,040
you as an individual?
It almost means nothing for you

886
00:51:11,040 --> 00:51:13,400
as an individual.
You might be average or you

887
00:51:13,400 --> 00:51:16,240
might be a super responder or
non responder.

888
00:51:16,640 --> 00:51:21,440
And the data are that like with
any bell curve, 2/3 of the

889
00:51:21,440 --> 00:51:26,000
people are within one standard
deviation above the average or

890
00:51:26,000 --> 00:51:30,120
below the average 2/3, but then
1/3 live on.

891
00:51:30,240 --> 00:51:31,720
The either end live.
Further out.

892
00:51:32,000 --> 00:51:35,840
So if you're in the one for 1/3
that is a super responder, good

893
00:51:35,840 --> 00:51:38,000
for you.
Like you're going to respond to

894
00:51:38,000 --> 00:51:40,320
surgery like gangbusters.
You might probably not going to

895
00:51:40,320 --> 00:51:42,360
need anything else ever, like
medication or anything else.

896
00:51:42,760 --> 00:51:47,880
But you also might be in the
lowest 5% where surgery doesn't

897
00:51:47,880 --> 00:51:51,960
really do much for you.
And some of that might be due to

898
00:51:51,960 --> 00:51:57,160
your epigenetics and whether
your fat cells are still,

899
00:51:57,160 --> 00:51:59,960
whether the epigenetic
modifications are so entrenched

900
00:51:59,960 --> 00:52:03,560
that you can't fix them or are
they still modifiable.

901
00:52:03,960 --> 00:52:07,720
And that may explain why, you
know, 20% of people gain weight

902
00:52:08,160 --> 00:52:13,040
from surgery, but 80%, I mean,
to regain their weight, you

903
00:52:13,080 --> 00:52:16,320
know, two years after surgery.
And 80% of people don't.

904
00:52:16,720 --> 00:52:22,040
It also there are data from
pediatric bariatric surgery that

905
00:52:22,040 --> 00:52:25,800
show that the effects of surgery
are actually longer lasting than

906
00:52:25,800 --> 00:52:28,920
they are in adults.
And it could be the same thing,

907
00:52:28,920 --> 00:52:32,240
like maybe we're getting the
kids before these epigenetic

908
00:52:32,240 --> 00:52:36,280
changes are so entrenched in
there fascinating fat.

909
00:52:36,280 --> 00:52:39,320
It could be other cells around
the body, like it's such a new

910
00:52:39,320 --> 00:52:42,240
field that we really don't even
we don't even have enough

911
00:52:42,240 --> 00:52:44,880
information to to hang our hat
there.

912
00:52:45,080 --> 00:52:50,440
Although I, I've always believed
in the what what's called the

913
00:52:50,440 --> 00:52:53,960
intergenerational transmission
of obesity, meaning from parents

914
00:52:53,960 --> 00:52:59,360
to kids, because I've seen so
many young kids with obesity.

915
00:53:00,520 --> 00:53:05,640
And again, there's just no way,
even if I believe that poor

916
00:53:05,640 --> 00:53:09,160
behavior, not poor behavior,
lack of exercise and not eating

917
00:53:09,160 --> 00:53:11,680
right could lead to obesity,
which again, I don't believe

918
00:53:11,680 --> 00:53:14,480
that.
But even if I did, you can't

919
00:53:14,480 --> 00:53:18,800
tell me that, you know, 8 year
olds can do that in eight years

920
00:53:18,800 --> 00:53:20,400
on earth.
Like it's just.

921
00:53:20,920 --> 00:53:23,720
Well, I mean, we know, I know,
for example, and I don't know

922
00:53:23,720 --> 00:53:26,480
whether what like what this has,
I'm sure this has to do with

923
00:53:26,480 --> 00:53:29,040
genetics for sure.
But my, you know, my wife just a

924
00:53:29,040 --> 00:53:32,320
couple months ago was just, you
know, she gave birth thing, you

925
00:53:32,320 --> 00:53:34,920
know, and thank God everything
was smooth and OK, thank you

926
00:53:34,920 --> 00:53:36,960
very much.
She's really exciting little

927
00:53:36,960 --> 00:53:41,080
girl.
And, and, you know, and we're

928
00:53:41,080 --> 00:53:43,560
talking to the nurse and she was
telling and the baby was born I

929
00:53:43,560 --> 00:53:48,080
think at 7/1 or 7/3.
And the nurse said that she was

930
00:53:48,080 --> 00:53:50,440
just coming.
And she's like this past, you

931
00:53:50,440 --> 00:53:54,720
know, the last couple of days
I've seen, you know, 1012 LB

932
00:53:54,720 --> 00:53:57,680
babies being born on a regular
basis.

933
00:53:57,720 --> 00:54:01,600
And, you know, I mean, I grew up
and I'm one of six and none of

934
00:54:01,600 --> 00:54:03,640
us were anywhere ever really
anywhere near that.

935
00:54:03,680 --> 00:54:06,160
You know, it was considered, it
was considered crazy at that

936
00:54:06,160 --> 00:54:07,360
point.
But apparently it's becoming

937
00:54:07,360 --> 00:54:08,880
pretty common.
I'm sure that has to do with

938
00:54:08,880 --> 00:54:10,600
what we're talking about, right?
Right.

939
00:54:10,600 --> 00:54:16,120
So we know that moms who gain
excess weight during their

940
00:54:16,120 --> 00:54:19,880
pregnancy or get gestational
diabetes or actually have

941
00:54:19,880 --> 00:54:24,280
diabetes from their weight going
into pregnancy, their babies all

942
00:54:24,280 --> 00:54:26,880
have a much higher incidence of
obesity.

943
00:54:28,240 --> 00:54:31,080
And actually interestingly,
another interesting study that

944
00:54:31,880 --> 00:54:35,440
is relatively recent, it turns
out that those same babies have

945
00:54:35,440 --> 00:54:38,880
a higher incidence of autism
spectrum disorder.

946
00:54:39,840 --> 00:54:45,120
So like in when all this again,
the vaccines causing autism

947
00:54:45,560 --> 00:54:48,800
furor came up, there were a lot
of publications that showed that

948
00:54:49,080 --> 00:54:52,640
actually, you know, there are a
lot of other factors outside of

949
00:54:53,440 --> 00:54:57,240
even before people are born that
can impact your autism risk.

950
00:54:59,000 --> 00:55:02,320
So, yeah, no.
So for sure the obesity epidemic

951
00:55:02,320 --> 00:55:10,560
has has impacted fetuses, for
lack of a better word, and they

952
00:55:10,560 --> 00:55:15,360
are being born bigger and they
are born with often with again,

953
00:55:15,360 --> 00:55:18,120
higher hypothalamic weight set
points.

954
00:55:19,520 --> 00:55:22,600
And there was even a study at
CNN that I saw that showed that

955
00:55:22,600 --> 00:55:26,480
sugar exposure, what was it in
the first 100 days?

956
00:55:27,520 --> 00:55:30,480
No, 100 days.
Wait, what was it first?

957
00:55:30,480 --> 00:55:32,880
Thousand days first.
Hundreds are lost.

958
00:55:34,120 --> 00:55:37,200
Thousand days is 3 years, right?
Yes.

959
00:55:37,520 --> 00:55:43,960
So the first thousand days from
conception from from nine months

960
00:55:44,040 --> 00:55:47,240
pre.
Right to two years old.

961
00:55:47,920 --> 00:55:54,720
Post birth sugar exposure in
that period of time was and

962
00:55:54,720 --> 00:55:57,440
sugar obviously on the fetus is
coming from mom.

963
00:55:58,200 --> 00:56:03,000
Sugar exposure in that period of
time was critical to your risk

964
00:56:03,240 --> 00:56:06,400
of developing type 2 diabetes as
a child.

965
00:56:07,080 --> 00:56:12,560
And again, it's like no one
thinks about people that young,

966
00:56:12,640 --> 00:56:14,560
right?
They just think, you know, kids

967
00:56:14,560 --> 00:56:18,840
will be kids if they're chubby,
they'll grow out of it or it

968
00:56:18,840 --> 00:56:21,040
doesn't really matter how much
what they eat because they're

969
00:56:21,040 --> 00:56:22,920
going to be exercising, running
around all day so they can eat

970
00:56:22,920 --> 00:56:25,160
whatever they want.
And for lots of people that's

971
00:56:25,160 --> 00:56:27,120
true.
And that may be true even for

972
00:56:27,120 --> 00:56:30,800
the majority of people.
But I think where the like the

973
00:56:30,800 --> 00:56:33,200
genetic scores that are being
developed and some of the other

974
00:56:35,120 --> 00:56:38,200
predictive models that are
coming out, this is where this

975
00:56:38,200 --> 00:56:40,320
is where they can be useful.
Because like, well, first of

976
00:56:40,320 --> 00:56:45,840
all, I encourage any woman, any
person actually, man or woman

977
00:56:46,120 --> 00:56:49,520
who's thinking of conceiving to
think about their own health

978
00:56:49,880 --> 00:56:52,800
before they conceive.
Because if you optimize your own

979
00:56:52,800 --> 00:56:54,640
health before you conceive,
you're going to optimize the

980
00:56:54,640 --> 00:56:58,960
health of your child that you're
going to conceive, probably also

981
00:56:58,960 --> 00:57:00,520
optimize your chance of
conceiving.

982
00:57:03,080 --> 00:57:09,360
And you know, so, but not only,
you know, not only do you do

983
00:57:09,360 --> 00:57:13,520
moms have to pay attention to
their not only mom could not

984
00:57:13,680 --> 00:57:16,360
only would it help if moms pay
attention to their or potential

985
00:57:16,360 --> 00:57:18,680
moms pay attention to their
weight before they conceive, but

986
00:57:18,880 --> 00:57:23,720
during pregnancy and then in the
first 2-3 years of life and on.

987
00:57:23,720 --> 00:57:29,680
Because obviously it's not only
sort of the direct impact of

988
00:57:29,680 --> 00:57:33,480
what you're feeding or of what
the kids eating or whatever, but

989
00:57:33,480 --> 00:57:35,600
also just think about the
behavior that you're modeling,

990
00:57:35,760 --> 00:57:38,600
right?
So if you're a a young parent,

991
00:57:38,600 --> 00:57:42,600
mom or dad and you're eating
chips in front of your 4 year

992
00:57:42,600 --> 00:57:47,040
old, your 4 year old's going to
automatically be like, Oh yeah,

993
00:57:47,040 --> 00:57:49,120
chips are like that's normal.
Yeah, chips.

994
00:57:49,920 --> 00:57:50,800
Yeah.
So like.

995
00:57:51,480 --> 00:57:54,480
We grew up thinking of wanting a
tree, and you have a strawberry.

996
00:57:54,480 --> 00:57:56,680
We thought like, you know, we
thought, we thought that, you

997
00:57:56,680 --> 00:57:58,880
know, blueberries, like my mom
would be like, OK, if you're

998
00:57:58,880 --> 00:58:01,040
good, we'll give you a
strawberry, you know, but you

999
00:58:01,360 --> 00:58:03,360
grew up.
In a stricter household than I

1000
00:58:03,360 --> 00:58:05,960
did.
I grew up and I'm also 25 years

1001
00:58:05,960 --> 00:58:07,840
older than you, so things were,
you know.

1002
00:58:08,080 --> 00:58:10,360
Yeah, I think it was.
Heavily easier, but.

1003
00:58:11,240 --> 00:58:14,080
It was, it was, it was I think
my mom was heavily influenced by

1004
00:58:14,080 --> 00:58:17,760
her Eastern European parents,
you know, which there's a whole

1005
00:58:17,760 --> 00:58:20,280
generation in them of
themselves, you know, But yeah,

1006
00:58:20,760 --> 00:58:23,280
tough cookies.
And they're very, very, you

1007
00:58:23,280 --> 00:58:25,680
know, very sensitive, I guess,
towards this kind of stuff.

1008
00:58:25,680 --> 00:58:29,520
So I just, you know, I like my,
my youngest brother is 13, you

1009
00:58:29,520 --> 00:58:30,760
know, he'll make himself a
snack.

1010
00:58:31,240 --> 00:58:33,640
Like he doesn't go to the, he
doesn't go to the supermarket

1011
00:58:33,640 --> 00:58:36,280
to, or it's the gas station.
He grabs an apple, you know, or

1012
00:58:36,280 --> 00:58:37,680
a couple of, a couple of
oranges.

1013
00:58:38,080 --> 00:58:40,520
And that's how he just, that's
all he knows.

1014
00:58:40,520 --> 00:58:43,320
That's all he's used to.
Yeah, but even in communities

1015
00:58:45,000 --> 00:58:53,280
where that sort of dietary
behaviour is common and like I

1016
00:58:53,280 --> 00:58:57,880
used to work at in, in New York
City, at NYU and there were, you

1017
00:58:57,880 --> 00:59:03,640
know, Hasidic communities, you
know, in the in, in Brooklyn and

1018
00:59:03,640 --> 00:59:09,840
elsewhere.
And they have the same Eastern

1019
00:59:09,840 --> 00:59:14,000
European roots as you do.
But there were families with

1020
00:59:14,000 --> 00:59:17,800
severe obesity problems in it.
I believe it most, it's mostly

1021
00:59:17,800 --> 00:59:20,600
genetic.
It just got passed down from

1022
00:59:20,600 --> 00:59:25,840
generation to generation and you
know, I, I've taken care.

1023
00:59:25,840 --> 00:59:28,280
Of, well, they, they, a lot of
these guys don't eat like Saints

1024
00:59:28,320 --> 00:59:29,840
either.
I'll, I'll tell you that.

1025
00:59:29,960 --> 00:59:32,240
Well, and not anymore, right?
They may have, it may have

1026
00:59:32,240 --> 00:59:34,320
started that way, but but maybe
not anymore.

1027
00:59:34,400 --> 00:59:38,280
But but but but it definitely, I
mean it runs in families.

1028
00:59:38,280 --> 00:59:43,680
And then I'd see families where,
let's say you said you had

1029
00:59:44,120 --> 00:59:47,760
you're one of six, I'd see
families where everybody in the

1030
00:59:47,760 --> 00:59:52,160
family eats as you described,
but one of the six kids has a

1031
00:59:52,160 --> 00:59:54,040
weight problem.
And the parents would come in

1032
00:59:54,040 --> 00:59:58,240
and they'd be like super upset
because I don't understand why

1033
00:59:58,240 --> 01:00:01,480
is my one child having weight
issues when nobody else in the

1034
01:00:01,480 --> 01:00:03,480
family has?
And they eat the same stuff and

1035
01:00:03,480 --> 01:00:06,840
they exercise the same amount,
you know, And then I'll start

1036
01:00:06,840 --> 01:00:09,880
asking like, well, does, does,
does mom or dad do either of you

1037
01:00:09,880 --> 01:00:12,160
guys have any obesity that runs
in your families?

1038
01:00:12,600 --> 01:00:16,440
Oh, yeah.
You know, somebody's brother or

1039
01:00:16,440 --> 01:00:18,240
somebody's uncle or cousin or
whatever.

1040
01:00:18,240 --> 01:00:20,080
Somebody.
And then you can usually chase

1041
01:00:20,080 --> 01:00:23,880
it back to where.
It might have had some genetic

1042
01:00:23,880 --> 01:00:26,960
origins, but again, that's sort
of it's like the natural

1043
01:00:26,960 --> 01:00:29,400
experiment that I've lived
throughout, taking care of all

1044
01:00:29,400 --> 01:00:29,960
these.
Patients.

1045
01:00:30,440 --> 01:00:35,600
Where I mean, I know, I know for
a fact that diet and exercise do

1046
01:00:35,600 --> 01:00:43,160
not impact obesity in everyone
because again, because I've seen

1047
01:00:43,200 --> 01:00:49,520
families where it.
Yeah, it's, it's it if, if it

1048
01:00:49,760 --> 01:00:53,800
the we're, we're so used to
trying to come up with 111 word

1049
01:00:53,800 --> 01:00:56,520
answers for all these things.
You know, I mean, think about

1050
01:00:56,520 --> 01:00:59,200
how long we it took.
So how many years it did it

1051
01:00:59,200 --> 01:01:01,280
take.
And I'm not comparing, you know,

1052
01:01:01,640 --> 01:01:04,400
at all by any means, of course,
but you know, the homeless issue

1053
01:01:04,400 --> 01:01:08,120
that we've had in the last, you
know, 30-40 years or maybe less,

1054
01:01:08,120 --> 01:01:10,600
but you know, how many, how long
people spent saying it's a money

1055
01:01:10,600 --> 01:01:13,040
problem, You know, where as, and
now we're having the

1056
01:01:13,040 --> 01:01:15,120
conversation, a lot of it's a
mental health problem as well.

1057
01:01:15,120 --> 01:01:17,720
A lot of this is a sickness.
A lot of this is, you know,

1058
01:01:17,720 --> 01:01:21,040
other factors that, and I'm, and
I'm, I'm not saying this to

1059
01:01:21,040 --> 01:01:23,840
compare, God forbid, I'm not
trying to do that.

1060
01:01:23,840 --> 01:01:26,680
I'm just trying to say that
anyone that says it's, it's one

1061
01:01:26,680 --> 01:01:29,600
thing, it's just diet.
It's just if you, if you were,

1062
01:01:29,600 --> 01:01:31,800
if you just got off the couch, a
random marathon, then you

1063
01:01:31,800 --> 01:01:34,240
wouldn't be obese anymore.
You know, like, I'm sure that's

1064
01:01:34,240 --> 01:01:37,600
not the case either.
Well, so, you know, it's human

1065
01:01:37,600 --> 01:01:39,960
nature.
Humans don't like ambiguity and

1066
01:01:39,960 --> 01:01:41,960
they don't like not knowing the
answers.

1067
01:01:42,200 --> 01:01:47,920
It's much more satisfying to be
able to say yes or no, black or

1068
01:01:47,920 --> 01:01:49,840
white, you know, like people
don't like grey.

1069
01:01:50,280 --> 01:01:54,920
And so like, people don't like,
even in medicine, people don't

1070
01:01:54,920 --> 01:01:58,480
like the, you know, doc, what
should I, what should I have

1071
01:01:58,480 --> 01:02:00,200
surgery or should I take a
medication?

1072
01:02:01,000 --> 01:02:01,360
Right.
You know.

1073
01:02:02,720 --> 01:02:05,480
It's that that there's there are
no answers to those types of

1074
01:02:05,480 --> 01:02:08,160
questions.
And the reality is, again, I go

1075
01:02:08,160 --> 01:02:12,160
back to statistics and it's
because of bell curves and how

1076
01:02:12,160 --> 01:02:14,360
statistics work.
And it's just, it's never going

1077
01:02:14,360 --> 01:02:17,600
to be most questions are never
binary.

1078
01:02:18,320 --> 01:02:22,600
These questions are, you know,
what's the solution to

1079
01:02:22,600 --> 01:02:25,960
immigration?
It's not just throwing people

1080
01:02:25,960 --> 01:02:28,640
out of the country.
It's something far more complex.

1081
01:02:29,120 --> 01:02:33,400
That's the, you know, any, any
major issue you brought up

1082
01:02:33,400 --> 01:02:37,640
homelessness, poverty, you know,
whatever.

1083
01:02:38,840 --> 01:02:41,840
Whatever divorce rates that's a
it's a big deal in the in the

1084
01:02:41,840 --> 01:02:44,000
country for the last 20.
Years or like, I mean, just

1085
01:02:44,000 --> 01:02:46,720
freaking look at what's going on
internationally.

1086
01:02:46,720 --> 01:02:48,920
What's the what's the solution
in the Ukraine?

1087
01:02:48,920 --> 01:02:52,520
What's the solution?
In Gaza, it's yeah, yeah, like.

1088
01:02:52,840 --> 01:02:57,000
There, there's no.
I mean, I don't want to be too.

1089
01:02:57,760 --> 01:02:59,960
I don't know what the right word
is, pessimistic or nihilistic,

1090
01:02:59,960 --> 01:03:02,480
but there are no solutions to
those.

1091
01:03:04,040 --> 01:03:06,680
There are.
There are like, there are

1092
01:03:06,680 --> 01:03:08,760
compromises that everybody
hates.

1093
01:03:09,080 --> 01:03:12,640
Yeah, there's no solution like.
Yeah, I don't, I don't, Yeah,

1094
01:03:12,640 --> 01:03:15,680
especially because all because,
you know, because issues that

1095
01:03:15,680 --> 01:03:19,760
are complicated to get to
require complicated and nuanced

1096
01:03:19,760 --> 01:03:21,520
answers too.
You know, I think that's also

1097
01:03:21,520 --> 01:03:23,480
the thing, right.
Not to like again, if we can't

1098
01:03:23,480 --> 01:03:26,880
even tell you what the factor,
what factors epigenetics have or

1099
01:03:26,880 --> 01:03:29,040
not, then how in the world
you're going to tell me whether

1100
01:03:29,040 --> 01:03:30,720
or not it's going to be
something that's going to be

1101
01:03:30,720 --> 01:03:34,040
part of the part of the answer.
Like I, I, I, I, I hear you.

1102
01:03:34,040 --> 01:03:34,960
I right.
It's a great.

1103
01:03:34,960 --> 01:03:37,400
Point, but I do think you know,
again going back to that the

1104
01:03:37,400 --> 01:03:39,960
positives with RFK and the
positives with the food is

1105
01:03:39,960 --> 01:03:43,800
medicine movement.
Like there are, there are

1106
01:03:43,800 --> 01:03:50,200
modifiable food factors and dyes
and ultra processing and things

1107
01:03:50,200 --> 01:03:55,360
that we can definitely improve
upon to make food in the United

1108
01:03:55,360 --> 01:03:59,280
States healthier, but it's not
going to.

1109
01:03:59,880 --> 01:04:01,840
Cure.
It's not going to cure obesity.

1110
01:04:02,280 --> 01:04:05,800
It's not going to cure obesity.
It might help prevent obesity in

1111
01:04:05,800 --> 01:04:08,600
future generations.
But the only like, real

1112
01:04:08,600 --> 01:04:10,840
solution, if you're talking
about solutions, and I'm not

1113
01:04:10,840 --> 01:04:13,040
even sure this would be a
solution, but it's the best I

1114
01:04:13,040 --> 01:04:15,160
can come up with, is you
basically have to do everything

1115
01:04:15,160 --> 01:04:16,680
all at once.
You have to treat everybody who

1116
01:04:16,680 --> 01:04:19,880
has obesity now before they have
the next generation of kids,

1117
01:04:20,200 --> 01:04:23,360
while improving the food and
improving exercise opportunities

1118
01:04:23,680 --> 01:04:26,200
and getting rid of the stigma
and dealing with mental health

1119
01:04:26,520 --> 01:04:30,600
and adverse childhood
experiences and all the other

1120
01:04:30,600 --> 01:04:33,480
things that have been shown to.
It's a societal problem.

1121
01:04:35,080 --> 01:04:37,880
So if you could do all that at
once, yeah, if you could do all

1122
01:04:37,880 --> 01:04:40,520
that at once, that's like the
same as saying, well, you know,

1123
01:04:40,800 --> 01:04:44,680
if you can, you know, you know,
again, all these complicated

1124
01:04:44,680 --> 01:04:48,480
problems have, as I said,
complicated solutions.

1125
01:04:48,480 --> 01:04:51,800
And maybe even like I like I was
sort of alluding to with the

1126
01:04:52,680 --> 01:04:55,800
international affairs type of
stuff.

1127
01:04:56,400 --> 01:04:58,520
Maybe it's not, maybe solutions
aren't even really what we

1128
01:04:58,520 --> 01:05:00,120
should be looking for.
Maybe we should just be looking

1129
01:05:00,360 --> 01:05:04,600
like to make things better to a
degree, like or, or just, you

1130
01:05:04,600 --> 01:05:09,320
know, making things like if we
can make, let's say we can even

1131
01:05:09,320 --> 01:05:11,600
get obesity rates.
The basically rate in America

1132
01:05:11,600 --> 01:05:13,480
right now is about 40%, which is
crazy.

1133
01:05:13,760 --> 01:05:17,200
And it keeps going up.
It's, it hasn't like plateaued,

1134
01:05:18,200 --> 01:05:20,120
but maybe we could just get it
to plateau.

1135
01:05:20,640 --> 01:05:22,000
Like maybe that's what we should
be like.

1136
01:05:22,200 --> 01:05:24,200
That's the first step.
Let's just try to get things to

1137
01:05:24,600 --> 01:05:27,200
stop getting worse.
And now we can start to think

1138
01:05:27,200 --> 01:05:30,720
about how do we make things
better And how do we, you know,

1139
01:05:30,840 --> 01:05:32,840
how do we stop things from
getting worse by letting people

1140
01:05:32,840 --> 01:05:34,920
get treatment and encouraging
people to get treatment.

1141
01:05:35,000 --> 01:05:38,960
And you know, like the
healthcare costs related to

1142
01:05:39,000 --> 01:05:42,440
obesity and the cancers, Oh my
gosh, obesity.

1143
01:05:42,440 --> 01:05:46,000
It's like, it's just like all
this, there's all this data and

1144
01:05:46,040 --> 01:05:50,360
information that frankly is mind
blowing that it hasn't spurred

1145
01:05:50,360 --> 01:05:55,800
some sort of massive, as you
said, like not even maybe not a

1146
01:05:55,800 --> 01:05:57,400
political movement, but like a
movement.

1147
01:05:57,440 --> 01:05:58,200
Awakening.
Yeah.

1148
01:05:58,200 --> 01:06:00,480
Awareness.
Yeah, if we wanted to, if we

1149
01:06:00,480 --> 01:06:04,120
wanted to deal with the with our
30, whatever it is, 3 trillion

1150
01:06:04,120 --> 01:06:06,640
or $30 trillion debt or whatever
our national.

1151
01:06:06,880 --> 01:06:10,400
Yeah, yeah, yeah. 30 trillion.
Treating obesity actually might

1152
01:06:10,400 --> 01:06:13,440
be the best way to do it because
if we could figure out, and of

1153
01:06:13,440 --> 01:06:16,800
course treating obesity right
now is expensive, but the long

1154
01:06:16,800 --> 01:06:19,560
term savings, if we could figure
out, you know, like how to

1155
01:06:19,600 --> 01:06:23,440
maintain the health benefits,
long term savings would be

1156
01:06:24,480 --> 01:06:26,840
immeasurable.
And again, that's never that's

1157
01:06:26,840 --> 01:06:29,240
never going to happen.
Like that's pipe dream that.

1158
01:06:30,480 --> 01:06:32,760
I you know, so you think, do you
think that it's one of those

1159
01:06:32,760 --> 01:06:35,520
like shoot for the moon and if
not, you land along along the

1160
01:06:35,520 --> 01:06:38,360
stars kind of, you know, cutesy
things where like you try to,

1161
01:06:38,360 --> 01:06:40,600
you say, let's try to cure it.
And then the people, if people

1162
01:06:40,600 --> 01:06:42,680
are a little better and don't
even if they don't make it to

1163
01:06:42,680 --> 01:06:44,400
the finish line, at least
they're better than they were

1164
01:06:44,400 --> 01:06:46,480
before.
So like you're kind of hoping

1165
01:06:46,480 --> 01:06:48,800
for that.
I mean, like, I guess like

1166
01:06:48,920 --> 01:06:50,840
that's just my immediate thought
when I think of that.

1167
01:06:51,920 --> 01:06:55,680
Well, on the individual level,
people can definitely get better

1168
01:06:55,840 --> 01:06:58,280
and get healthier and live
happier and healthier and longer

1169
01:06:58,280 --> 01:07:03,760
lives 100% on a societal level
and a population level.

1170
01:07:04,640 --> 01:07:07,320
I mean, I think that's actually
why sort of food is medicine has

1171
01:07:07,320 --> 01:07:10,240
so much traction is because
it's, it's somewhat achievable.

1172
01:07:11,360 --> 01:07:13,600
It's just not likely to have a
huge impact.

1173
01:07:13,920 --> 01:07:16,600
So how do you like what, what's
the right strategy?

1174
01:07:16,840 --> 01:07:20,760
Shoot for the moon and hope that
you get somewhere along the way.

1175
01:07:21,240 --> 01:07:26,280
Or, you know, bite off something
that's relatively easier to

1176
01:07:26,280 --> 01:07:29,120
achieve and hope that it
accomplishes something.

1177
01:07:30,480 --> 01:07:31,400
But.
Even I don't know like.

1178
01:07:31,600 --> 01:07:33,680
I think.
I mean, when it comes to it, I

1179
01:07:33,680 --> 01:07:36,680
think, I think, I think when it
comes to, I think when it comes

1180
01:07:36,680 --> 01:07:38,960
to health, it's hard.
I, I don't because I think that

1181
01:07:38,960 --> 01:07:40,960
it's also something that's not
even rational for something for

1182
01:07:40,960 --> 01:07:44,200
most people, you know, this kind
of thing is, has nothing to do

1183
01:07:44,200 --> 01:07:47,520
with rationality or whether, you
know, it's good or not, You

1184
01:07:47,520 --> 01:07:50,840
know, I mean, when I, I beg my
dad, I, my dad and I are very

1185
01:07:50,840 --> 01:07:52,920
close.
We work together and, you know,

1186
01:07:52,920 --> 01:07:56,560
very close and I beg him to
exercise because he's in his

1187
01:07:56,560 --> 01:07:58,720
late 50s and he doesn't work out
a ton.

1188
01:07:58,720 --> 01:08:01,360
And I'm like, it could only make
your life better.

1189
01:08:01,360 --> 01:08:04,280
It could only be good for you.
You know, I'm, you know, please.

1190
01:08:04,280 --> 01:08:07,040
And he's like, I know, I know, I
know, I know, I, I, I know it's

1191
01:08:07,040 --> 01:08:07,880
good for me.
I know I have to.

1192
01:08:07,880 --> 01:08:09,640
You just can't.
But like, it's not about

1193
01:08:09,640 --> 01:08:11,560
rationality.
It's not about whether you know

1194
01:08:11,560 --> 01:08:13,000
something, you know there's
something.

1195
01:08:13,000 --> 01:08:15,920
Else and there's been yeah,
right, there's been lots of

1196
01:08:16,120 --> 01:08:20,680
advocates who feel like
education campaigns are what we

1197
01:08:20,680 --> 01:08:23,200
need to to health America's
health.

1198
01:08:23,800 --> 01:08:26,880
But I would argue no one drinks
a Coke thinking it's good for

1199
01:08:26,880 --> 01:08:28,319
them.
No one eats a bag of chips

1200
01:08:28,680 --> 01:08:30,760
thinking it's good for them.
Everybody knows what's.

1201
01:08:30,760 --> 01:08:32,240
Good for you.
Yeah, but you deny it's that bad

1202
01:08:32,240 --> 01:08:34,160
for you.
A lot of people deny.

1203
01:08:34,200 --> 01:08:36,200
Oh, it's not so bad, you know,
I'm drinking a Diet Coke.

1204
01:08:36,200 --> 01:08:38,439
It's better than a Coke, you
know, Like by the way, which I

1205
01:08:38,439 --> 01:08:43,080
do want to ask though.
Sorry, I think it's like like

1206
01:08:43,080 --> 01:08:46,840
your dad like most people know
that they should eat better and

1207
01:08:46,840 --> 01:08:49,880
exercise more.
It's not rocket science.

1208
01:08:49,880 --> 01:08:51,880
And, and people have heard that
message for years.

1209
01:08:52,359 --> 01:08:55,040
It's how do we make that easier
for folks?

1210
01:08:55,520 --> 01:08:59,920
And you know, and then again,
part of it is that like your dad

1211
01:09:01,439 --> 01:09:04,880
will go through a period where
if he ever starts to exercise,

1212
01:09:04,880 --> 01:09:07,760
where it sucks because starting
to exercise sucks.

1213
01:09:07,760 --> 01:09:11,840
And he's going to be, but if he
can fight through that period,

1214
01:09:12,319 --> 01:09:14,160
he'll then get to a period where
he feels great.

1215
01:09:14,680 --> 01:09:16,680
And they're like, Oh my God, I
wish I'd done this 10 years ago

1216
01:09:16,680 --> 01:09:18,640
or whatever.
But it's getting to that first

1217
01:09:18,640 --> 01:09:22,479
initial suckatude or or yeah,
pick a word that's.

1218
01:09:22,520 --> 01:09:24,040
You.
Yeah, I like soccer tea.

1219
01:09:24,040 --> 01:09:27,520
Soccer tea is good.
Is good.

1220
01:09:27,520 --> 01:09:29,319
Can we, can we talk a little bit
about?

1221
01:09:29,319 --> 01:09:32,319
Can we talk a little bit about?
That sodas are terrible.

1222
01:09:32,960 --> 01:09:34,960
That's.
Probably work that sodas are

1223
01:09:34,960 --> 01:09:36,160
probably terrible.
Are terrible.

1224
01:09:36,160 --> 01:09:38,600
They're probably almost worse
for you than sugar soda.

1225
01:09:39,120 --> 01:09:41,720
OK, right.
So forget about soda.

1226
01:09:42,240 --> 01:09:46,680
So we could use soda, diet soda
in the as like a, as like a base

1227
01:09:46,680 --> 01:09:49,760
metaphor, but the fake sugar
versus real sugar or the, you

1228
01:09:49,760 --> 01:09:53,920
know, stevia, Splenda, you know,
artificial sugar world.

1229
01:09:54,480 --> 01:09:55,760
Yeah.
How does that impact?

1230
01:09:56,280 --> 01:09:59,160
Yeah, it's interesting.
I wish I knew more about stevia

1231
01:09:59,160 --> 01:10:02,520
because I think of the
artificial sweeteners that one

1232
01:10:02,520 --> 01:10:07,840
might have more because at least
it's from a plant, so it's not

1233
01:10:08,040 --> 01:10:11,280
as manufactured as some of the
other ones.

1234
01:10:11,720 --> 01:10:14,880
But usually those sorts of.
Well, first of all, there's now

1235
01:10:14,880 --> 01:10:18,080
data that there was always data
that saccharine caused cancer.

1236
01:10:18,080 --> 01:10:21,920
But back in the 70s, long before
you were born, there was a soda

1237
01:10:21,920 --> 01:10:24,480
called Tab that basically got
run off the market because it

1238
01:10:24,480 --> 01:10:26,920
had saccharine in it and it.
Caused.

1239
01:10:26,920 --> 01:10:29,280
Cancer.
Turns out that you had to be a

1240
01:10:29,360 --> 01:10:32,560
lab rat and you probably had to
drink like 2 liters worth of tab

1241
01:10:32,560 --> 01:10:37,160
every day to get saccharine that
you would need to to get cancer.

1242
01:10:37,400 --> 01:10:40,000
But that didn't matter once the
word got out that saccharine

1243
01:10:40,000 --> 01:10:41,840
caused cancer.
Like you still see some

1244
01:10:41,840 --> 01:10:44,840
saccharine packets like sweet
and low is still saccharine and

1245
01:10:45,120 --> 01:10:48,160
they're still in some like delis
and and restaurants.

1246
01:10:48,160 --> 01:10:51,640
But that saccharine basically
was run off the face of the

1247
01:10:51,640 --> 01:10:57,160
earth by by, you know, by
whomever by lobbyists or or some

1248
01:10:57,160 --> 01:11:00,880
other folks that probably isn't
probably was never as bad as as

1249
01:11:00,920 --> 01:11:03,240
it was made out to be.
But all of those different

1250
01:11:03,240 --> 01:11:09,120
artificial sweeteners have some
negative health consequences.

1251
01:11:09,520 --> 01:11:12,880
Some are linked to cancers, some
are linked to diabetes.

1252
01:11:13,720 --> 01:11:17,000
Some data suggest that they
actually just stimulate the same

1253
01:11:17,000 --> 01:11:20,000
part of your brain that makes
you crave sugar and it just

1254
01:11:20,000 --> 01:11:25,640
makes you crave sugar more.
So in general I am not a fan of.

1255
01:11:25,760 --> 01:11:28,360
Those That's interesting because
your brain thinks you're getting

1256
01:11:28,360 --> 01:11:30,520
sugar, but you're not actually
getting enough.

1257
01:11:30,920 --> 01:11:33,240
Right, Yeah, exactly.
Like it makes you want more

1258
01:11:33,240 --> 01:11:37,040
sugar.
It's like having a sweet tooth

1259
01:11:37,040 --> 01:11:42,000
that like gets worse, I guess.
But I think like, you know, so

1260
01:11:42,000 --> 01:11:46,920
the reason that fruits when
they're eaten whole are not

1261
01:11:47,880 --> 01:11:52,720
nearly as bad for you as when
they're turned into a juice and

1262
01:11:52,800 --> 01:11:54,760
and obviously good for you
because of some of the nutrients

1263
01:11:54,760 --> 01:11:57,040
they provide.
Is that the fibre that's in a

1264
01:11:57,040 --> 01:12:01,480
real plant in a, in a strawberry
or blueberry like you mentioned,

1265
01:12:02,120 --> 01:12:04,760
that makes it so that some of
the sugar that's in the fruit

1266
01:12:04,840 --> 01:12:06,120
actually doesn't even get
absorbed.

1267
01:12:06,560 --> 01:12:09,360
But when you concentrate that
fruit into a juice, you

1268
01:12:09,360 --> 01:12:12,160
basically remove all the fiber,
but you keep all the sugar.

1269
01:12:12,400 --> 01:12:15,280
And now you just have like,
like, you know, growing up

1270
01:12:15,280 --> 01:12:17,760
again, everybody was thought was
told that orange juice was like

1271
01:12:17,760 --> 01:12:20,840
the best thing for you.
Orange juice isn't actually very

1272
01:12:20,840 --> 01:12:25,520
good for you at all.
And it's like, you know, it's

1273
01:12:25,560 --> 01:12:29,720
just like it's part of the issue
with this field in general and

1274
01:12:29,800 --> 01:12:33,000
potentially why people have so
much mistrust in docs is that

1275
01:12:33,840 --> 01:12:37,920
it's not intentional, but things
change and our understanding of

1276
01:12:38,040 --> 01:12:40,560
of these things change.
So sometimes we make

1277
01:12:40,560 --> 01:12:44,160
recommendations and then ten
years later we're like, you know

1278
01:12:44,160 --> 01:12:48,320
what, all that low and that
stuff we had you eat in the in

1279
01:12:48,320 --> 01:12:51,320
the 90s or the 2000s or
whatever, whenever low fat was a

1280
01:12:51,320 --> 01:12:53,360
thing.
Turns out those are all bad for

1281
01:12:53,360 --> 01:12:56,040
you.
So sorry our mistake are bad

1282
01:12:56,680 --> 01:12:58,520
gave you all this dietary
recommendations that were

1283
01:12:58,520 --> 01:13:02,440
totally off base, but that's.
Scary, but that's scary for

1284
01:13:02,440 --> 01:13:04,560
people, no?
Right, of course.

1285
01:13:04,880 --> 01:13:11,760
Well, that's why it's, it's
easiest for like, and, and

1286
01:13:12,000 --> 01:13:15,400
they're actually data even it's
easiest for people to just sort

1287
01:13:15,400 --> 01:13:20,040
of stick to the basics like the
Mediterranean diet, like eat

1288
01:13:20,040 --> 01:13:24,120
fish, eat olive oil, eat nuts,
eat things that come out of the

1289
01:13:24,120 --> 01:13:27,120
ground.
If you forget about everything

1290
01:13:27,120 --> 01:13:32,640
else, that's probably still and
the data suggested is still the

1291
01:13:32,640 --> 01:13:35,040
best diet for you.
So rather than try to get too

1292
01:13:35,040 --> 01:13:40,120
fancy and do everything else,
it's just really, you know, it

1293
01:13:40,120 --> 01:13:42,120
probably comes back.
It goes back to what your

1294
01:13:42,480 --> 01:13:45,240
parents parents taught them and
my parents parents taught them.

1295
01:13:45,240 --> 01:13:47,400
It's just everything in
moderation.

1296
01:13:48,120 --> 01:13:53,440
Like that's probably like still
the best advice now as food has

1297
01:13:53,440 --> 01:13:56,040
gotten lower quality there.
And there are certainly some

1298
01:13:56,040 --> 01:13:58,160
things that even in moderation
are not good for you.

1299
01:13:59,600 --> 01:14:02,960
But again, we don't have to get
too, I don't think we have to

1300
01:14:02,960 --> 01:14:05,480
get too analytical about it.
We really just need to, you

1301
01:14:05,520 --> 01:14:10,560
know, lean proteins, fish, lean
meats, legumes, nuts,

1302
01:14:11,440 --> 01:14:14,240
vegetables, fruits, things that
come out of the ground.

1303
01:14:14,240 --> 01:14:18,760
It's like, and, and if you do
that most of the time, you know,

1304
01:14:18,760 --> 01:14:22,400
if you want an ice cream sundae
on, you know, once every couple

1305
01:14:22,400 --> 01:14:24,960
weeks, it's OK.
Yeah.

1306
01:14:25,440 --> 01:14:29,920
Like because you're generally
healthy and again, I don't think

1307
01:14:29,920 --> 01:14:32,800
you need to necessarily depends
on who you are.

1308
01:14:32,800 --> 01:14:34,960
Everybody, it's different and
everybody reacts differently.

1309
01:14:34,960 --> 01:14:41,240
And and you know, most people
probably don't need to go crazy

1310
01:14:41,600 --> 01:14:44,200
with that sort of diet as long
as they stick to the tenets of

1311
01:14:44,200 --> 01:14:46,080
it.
But if you have a high genetic

1312
01:14:46,080 --> 01:14:49,720
predisposition towards obesity,
maybe that's just how you have

1313
01:14:49,720 --> 01:14:52,400
to eat your whole life.
Like maybe that's just what you

1314
01:14:52,400 --> 01:14:58,040
need from preconception,
postconception year old, 4 year

1315
01:14:58,040 --> 01:14:59,280
old, 5 year old.
You just need.

1316
01:14:59,520 --> 01:15:01,760
And even if that happens, you
probably there's still going to

1317
01:15:01,760 --> 01:15:05,720
be people who still get obesity
even with doing everything quote

1318
01:15:05,720 --> 01:15:08,880
UN quote, right, You know?
That's crazy.

1319
01:15:08,880 --> 01:15:10,600
Do you, do you, have you, have
you seen that a bunch?

1320
01:15:10,600 --> 01:15:13,520
Have you seen someone that's
diet is good and they kind of

1321
01:15:13,520 --> 01:15:15,680
move around and I'm not saying
work out every day, but like

1322
01:15:15,680 --> 01:15:17,240
really move around.
Yeah.

1323
01:15:17,240 --> 01:15:19,760
And, and what is it?
They can't lose weight or they

1324
01:15:19,760 --> 01:15:21,080
keep gaining weight.
What is it?

1325
01:15:22,120 --> 01:15:28,000
Well, it depends more of it.
Well, I would say that some of

1326
01:15:28,000 --> 01:15:30,840
them can't lose weight, some of
them gain weight.

1327
01:15:31,120 --> 01:15:35,240
But like you know, again, and
that's it's sort of why I used

1328
01:15:35,240 --> 01:15:37,680
to tell.
I have lots of great stories of

1329
01:15:37,680 --> 01:15:40,920
people calling me a monster for
offering surgery for weight loss

1330
01:15:40,920 --> 01:15:42,880
in children, which we can come
back.

1331
01:15:42,880 --> 01:15:47,480
We can talk about that some
other episode when you want an

1332
01:15:47,480 --> 01:15:50,640
episode on like, Worst Stories
of my career.

1333
01:15:51,200 --> 01:15:57,680
Please, I would love that.
But I used to tell that like the

1334
01:15:57,720 --> 01:16:00,040
haters, I'd say, listen, just
spend the day in my clinic and

1335
01:16:00,040 --> 01:16:02,240
actually talk to these children
who come in to see me.

1336
01:16:02,760 --> 01:16:06,720
They're like 15 year olds who
are on the soccer team and who

1337
01:16:06,720 --> 01:16:10,240
don't eat terrible.
And they're on their high school

1338
01:16:10,240 --> 01:16:14,040
soccer team, but they're like
the goalie or the centre back

1339
01:16:14,040 --> 01:16:17,320
because they're too big to play
some other position where they

1340
01:16:17,320 --> 01:16:18,920
can run up and down the field as
easily.

1341
01:16:19,520 --> 01:16:23,400
And you know, they're not,
they're not eating at McDonald's

1342
01:16:24,080 --> 01:16:27,080
five times a week and they're
not sitting on their butt

1343
01:16:27,520 --> 01:16:30,080
playing video games all day
every day, which is what

1344
01:16:30,160 --> 01:16:32,440
everybody thinks of kids who
have obesity.

1345
01:16:33,800 --> 01:16:37,360
And yes, there are some people
who aren't exercising and there

1346
01:16:37,360 --> 01:16:38,640
are some people who aren't
eating right.

1347
01:16:39,040 --> 01:16:41,600
But I've also seen the people
who are totally doing everything

1348
01:16:41,600 --> 01:16:46,160
they're supposed to do and they
still they still either can't

1349
01:16:46,160 --> 01:16:49,200
lose weight or just kept gaining
weight so.

1350
01:16:49,280 --> 01:16:53,920
So how does so how does so how
does so and so and may and maybe

1351
01:16:54,120 --> 01:16:57,880
hopefully let's see if you could
try to if it's a little bit too

1352
01:16:57,880 --> 01:17:00,480
long of an answer detail of a
question and you could just tell

1353
01:17:00,480 --> 01:17:04,520
me.
But if that's the case, then how

1354
01:17:04,520 --> 01:17:10,040
do how do drugs like like
Ozempic or whatever work and

1355
01:17:10,040 --> 01:17:13,320
successfully having a physical
impact?

1356
01:17:13,600 --> 01:17:17,640
Because if it is genetic or you
know, if you know the other, if

1357
01:17:17,720 --> 01:17:21,040
other things don't seem to be
working that do work for other

1358
01:17:21,040 --> 01:17:24,040
people, then what works about
the drugs that that the other

1359
01:17:24,200 --> 01:17:26,320
other stuff can't, can't, can't
touch really.

1360
01:17:27,560 --> 01:17:32,520
Right.
So the simplistic, so I've had

1361
01:17:32,520 --> 01:17:38,320
patients who I've offered a
sleep gastrectomy to where I

1362
01:17:38,320 --> 01:17:40,400
tell them I'm going to take out
89% of your stomach.

1363
01:17:41,320 --> 01:17:45,240
They will say to me, but doc, I
already eat like almost nothing.

1364
01:17:45,320 --> 01:17:50,880
So I don't understand how this
surgery is going to help me and

1365
01:17:51,000 --> 01:17:52,760
it's obviously a legitimate
question.

1366
01:17:53,480 --> 01:17:57,480
But with surgery, there are all
these other hormones that

1367
01:17:57,800 --> 01:18:02,320
regulate your metabolism that
are impacted.

1368
01:18:02,400 --> 01:18:04,800
And actually again, we talked
about the gut brain access a

1369
01:18:04,800 --> 01:18:07,520
little bit.
There is probably direct gut

1370
01:18:07,520 --> 01:18:12,320
brain access changes in the
hypothalamus that change your

1371
01:18:12,320 --> 01:18:15,000
weight set point because the
body does what's called

1372
01:18:15,000 --> 01:18:18,000
something called metabolic
adaptation, where if you lose

1373
01:18:18,000 --> 01:18:22,240
weight, your body will react by
slowing down your metabolism

1374
01:18:22,240 --> 01:18:24,080
because it doesn't want you to
lose too much weight.

1375
01:18:24,320 --> 01:18:25,960
It thinks you're like starving
or dying.

1376
01:18:26,320 --> 01:18:29,000
So it'll slow down the
metabolism to keep you from

1377
01:18:29,000 --> 01:18:30,880
losing more weight.
The same thing actually happens

1378
01:18:30,880 --> 01:18:35,520
in the other direction in a in a
in a short term, like a short

1379
01:18:35,520 --> 01:18:38,120
term experiment like the guy who
did super size me.

1380
01:18:39,760 --> 01:18:42,040
If you like, try to gain weight
intentionally.

1381
01:18:42,200 --> 01:18:44,680
Your body will speed up its
metabolism because it wants you

1382
01:18:44,680 --> 01:18:46,520
to stay within a fairly narrow
range.

1383
01:18:46,760 --> 01:18:49,600
Oh, interesting.
And it may be that the ultra

1384
01:18:49,600 --> 01:18:55,240
processed foods are impacting
obesity rates by changing your

1385
01:18:55,240 --> 01:19:00,480
hypothalamic set point where
people set points are being

1386
01:19:00,480 --> 01:19:03,760
artificially elevated.
Yeah, that's a whole nother so.

1387
01:19:03,800 --> 01:19:06,680
Common my brother-in-law who's
in high school is very focused

1388
01:19:06,680 --> 01:19:10,120
on on on working out and he his
friends call it dirty dirty

1389
01:19:10,120 --> 01:19:11,320
weight.
A dirty what's it called?

1390
01:19:11,320 --> 01:19:14,560
Dirty weight gaining where like
in order to bulk up dirty

1391
01:19:14,560 --> 01:19:17,400
bulking in order to gain in
order to get bigger.

1392
01:19:17,400 --> 01:19:20,880
If there's scrawny kids, they
eat a lot of garbage food and

1393
01:19:20,880 --> 01:19:24,040
they get big on purpose, and
then they work out and they work

1394
01:19:24,040 --> 01:19:26,200
out like crazy and then they
kind of sculpt that into

1395
01:19:26,200 --> 01:19:27,960
whatever they want.
But I can't imagine that's a

1396
01:19:27,960 --> 01:19:31,800
very good for you either, right?
No, and it's actually not going

1397
01:19:31,800 --> 01:19:34,600
to work long term either.
There were actually studies back

1398
01:19:34,600 --> 01:19:37,520
in the early 2000s where, and
this is talking about things

1399
01:19:37,520 --> 01:19:39,840
that could never be done again
today.

1400
01:19:40,000 --> 01:19:43,600
But there is a study that where
they had inmates at some prison

1401
01:19:44,080 --> 01:19:45,960
intentionally gained like 20
lbs.

1402
01:19:45,960 --> 01:19:49,320
Like they just fed them 24/7
until they gain weight.

1403
01:19:49,800 --> 01:19:52,600
And then when they stopped
feeding them like that and just

1404
01:19:52,800 --> 01:19:55,920
like let them go back to their
natural eating habits, they all

1405
01:19:55,920 --> 01:19:57,240
came back down to their starting
weight.

1406
01:19:58,040 --> 01:19:59,360
Because that's what your body
wants to do.

1407
01:19:59,360 --> 01:20:02,200
Your body wants you to be at
whatever weight it thinks you

1408
01:20:02,200 --> 01:20:04,400
should be at, for better or
worse.

1409
01:20:05,800 --> 01:20:10,000
But so the drugs again, like so
if you don't, let's say you

1410
01:20:10,040 --> 01:20:12,720
exercise and you don't eat a lot
yet you're still struggling with

1411
01:20:12,720 --> 01:20:15,840
weight.
I think the medications sort of

1412
01:20:15,840 --> 01:20:20,920
can do some of the same stuff.
That the surgery does in terms

1413
01:20:20,920 --> 01:20:25,840
of changing your metabolism
certainly changes your food

1414
01:20:25,840 --> 01:20:28,680
preferences certainly get sort
of like food noise.

1415
01:20:28,680 --> 01:20:35,120
So even if you so if you are
eating some, if you have some

1416
01:20:35,120 --> 01:20:37,800
unhealthy foods mixed in with
your healthy eating, because no

1417
01:20:37,800 --> 01:20:40,800
one's perfect, it certainly
limits that.

1418
01:20:42,240 --> 01:20:45,800
But yeah, I mean, that's, it's
sort of it's, it's, it's why

1419
01:20:45,840 --> 01:20:48,520
obesity is such a complex and
interesting disease, because if

1420
01:20:48,520 --> 01:20:53,680
it was just purely eat less and
exercise more and you'll lose

1421
01:20:53,680 --> 01:20:56,040
weight, then that should work
for everybody.

1422
01:20:56,320 --> 01:20:58,840
And it actually works for almost
nobody.

1423
01:20:59,320 --> 01:21:05,480
So it's just a, you know, it's
just it, it, it's why frankly,

1424
01:21:05,480 --> 01:21:09,160
it's why it's super interesting
to me because it's a completely

1425
01:21:09,160 --> 01:21:12,400
unsolved mystery.
And I think it makes it more

1426
01:21:12,400 --> 01:21:16,400
interesting to me that because
I'm from New Jersey and I, I

1427
01:21:16,440 --> 01:21:19,800
like to pick fights with people.
I think it makes it more

1428
01:21:19,800 --> 01:21:21,480
interesting for me because I
think everybody else does it

1429
01:21:21,480 --> 01:21:22,480
wrong.
Like I think the rest of the

1430
01:21:22,480 --> 01:21:25,200
world, not the rest of the
world, but most people,

1431
01:21:25,600 --> 01:21:28,400
especially the people who are in
power these days, they have it

1432
01:21:28,400 --> 01:21:31,160
wrong.
So it's like super interesting

1433
01:21:31,160 --> 01:21:34,480
and then super important because
they're sort of gaslighting the

1434
01:21:34,480 --> 01:21:38,080
country by telling people this.
And, and it's just not, it's not

1435
01:21:38,080 --> 01:21:41,680
accurate.
And that's just not just RFK and

1436
01:21:41,680 --> 01:21:45,640
HHS and case Cali means or
whoever Casey means, whichever

1437
01:21:45,640 --> 01:21:50,880
means it is.
But it's also like all the

1438
01:21:50,880 --> 01:21:54,920
online influencers and and like,
again, even some medical

1439
01:21:54,920 --> 01:21:59,280
professionals who who will tell
their patients, if you just, you

1440
01:21:59,280 --> 01:22:01,680
know, lifestyle medicine docs or
the food is medicine people,

1441
01:22:02,440 --> 01:22:07,600
they're also gaslighting
patients to a degree because

1442
01:22:08,400 --> 01:22:10,520
again, there's because.
We don't know what it is.

1443
01:22:10,600 --> 01:22:12,880
Well, there's hard science that
shows that it doesn't work.

1444
01:22:13,080 --> 01:22:15,080
There's hard science that shows
that dynamics.

1445
01:22:15,080 --> 01:22:17,920
Well, they didn't work for
everyone, we said, right?

1446
01:22:18,360 --> 01:22:23,400
Right.
Well, so in the most intense

1447
01:22:23,680 --> 01:22:28,200
behavioral lifestyle treatment
programs, you lose about 5 to 7%

1448
01:22:28,200 --> 01:22:30,360
of your body weight.
So I shouldn't say it doesn't

1449
01:22:30,360 --> 01:22:33,640
work, but because it works, you
lose 5 to 7%.

1450
01:22:34,040 --> 01:22:40,400
But that's not enough for most
people with obesity and even the

1451
01:22:40,600 --> 01:22:43,400
weight loss medications that you
know, the reason there was so

1452
01:22:43,400 --> 01:22:46,720
much excitement about them is
that you lose closer to 15 to

1453
01:22:46,720 --> 01:22:52,320
20%, really 10 to 15%.
Let's say surgery is a minimum

1454
01:22:52,320 --> 01:22:55,840
of 20 percent, 20% or more.
So that's why if you have

1455
01:22:55,840 --> 01:22:59,920
obesity, So if you weigh 300
pounds, 5% of your body weight

1456
01:22:59,920 --> 01:23:03,960
is 6 lbs.
So at the end of your intensive

1457
01:23:03,960 --> 01:23:06,840
lifestyle treatment, you'll
weigh 294.

1458
01:23:07,440 --> 01:23:10,400
And that's not really right.
Is that right?

1459
01:23:10,400 --> 01:23:13,520
No, that's not right.
That's the maths wrong. 300 when

1460
01:23:13,520 --> 01:23:17,880
I say 5 percent, 15 lbs.
So you weigh 285 but.

1461
01:23:18,080 --> 01:23:21,160
If you have £300 right, Well,
OK.

1462
01:23:21,200 --> 01:23:23,640
And I guess this would be, I
should have actually opened with

1463
01:23:23,640 --> 01:23:25,520
this question.
Well, I guess I guess I'll close

1464
01:23:25,520 --> 01:23:27,400
with it.
What's, what's the, what's the

1465
01:23:27,400 --> 01:23:29,440
definition of obese versus
overweight?

1466
01:23:29,440 --> 01:23:31,800
So.
Well, so the.

1467
01:23:32,120 --> 01:23:33,080
I really should have opened with
that.

1468
01:23:33,120 --> 01:23:35,000
Yeah, exactly.
You can put in the front, you

1469
01:23:35,000 --> 01:23:38,160
can always put in the front of
the podcast, But the and I, I

1470
01:23:38,160 --> 01:23:41,520
have to correct you because you
shouldn't use obese as an

1471
01:23:41,520 --> 01:23:45,960
adjective because it's a we're
moving away from it's called

1472
01:23:45,960 --> 01:23:48,840
patient first language.
So rather than say someone is

1473
01:23:48,840 --> 01:23:51,560
obese, you should.
So it suffers from obesity.

1474
01:23:52,160 --> 01:23:54,720
Yeah, someone who has obesity,
right, Because you don't want to

1475
01:23:54,720 --> 01:23:57,000
call someone you want to call
someone a diabetic anymore.

1476
01:23:57,200 --> 01:23:58,680
You want to call them a person
with diabetes.

1477
01:23:58,920 --> 01:24:01,480
Because it's more you want to
define people by their disease.

1478
01:24:01,720 --> 01:24:03,160
I see.
Yeah, yeah, yeah, definitely.

1479
01:24:03,480 --> 01:24:04,800
OK.
Yes, absolutely.

1480
01:24:05,120 --> 01:24:07,760
So anyway, that's just the
preferred language for for all

1481
01:24:07,760 --> 01:24:09,520
diseases.
The nomenclature, right?

1482
01:24:10,800 --> 01:24:14,200
Interestingly, the autism
community is the one, sort of.

1483
01:24:14,600 --> 01:24:16,760
Yeah, that's right.
They don't want that.

1484
01:24:16,760 --> 01:24:18,920
They want to be called autistic.
They don't want to be called

1485
01:24:18,920 --> 01:24:21,080
someone with autism, which is
weird, but whatever.

1486
01:24:21,800 --> 01:24:24,560
Again, patient advocacy patients
should be able to do whatever

1487
01:24:24,560 --> 01:24:28,320
they want.
So there is a medical definition

1488
01:24:29,760 --> 01:24:33,800
of overweight and obesity.
And actually the definition of

1489
01:24:33,800 --> 01:24:38,840
obesity is still being debated
in recent debate over the

1490
01:24:38,840 --> 01:24:40,920
diagnosis of obesity and how one
should define it.

1491
01:24:41,040 --> 01:24:47,640
But right now we use BMI, which
is a ratio of your weight to

1492
01:24:47,640 --> 01:24:50,480
height and they're cut offs, so
20.

1493
01:24:50,680 --> 01:24:56,320
So what is it?
18 to 25 is normal weight.

1494
01:24:56,360 --> 01:25:00,400
BMI of 25 to 30 is overweight,
30 and above is obesity, and

1495
01:25:00,400 --> 01:25:03,120
then there are different classes
of obesity when you get to 35

1496
01:25:03,120 --> 01:25:05,240
and 40 and 45 and 50.
I see.

1497
01:25:06,720 --> 01:25:12,480
But the reality is that BMI is a
surrogate.

1498
01:25:12,480 --> 01:25:14,720
It doesn't really necessarily
tell you.

1499
01:25:15,360 --> 01:25:17,160
Like you could be a very
muscular person, you could be a

1500
01:25:17,160 --> 01:25:21,120
bodybuilder and have almost 0%
body fat, but by BMI you'd

1501
01:25:21,120 --> 01:25:23,680
probably be classified in the
obesity range because.

1502
01:25:24,000 --> 01:25:25,840
Oh, fascinating.
Because you've got so much

1503
01:25:25,840 --> 01:25:28,720
muscle mass.
So it's, it's, it's just a proxy

1504
01:25:28,720 --> 01:25:32,000
and it's a screening tool.
But I mean, that's why there's

1505
01:25:32,000 --> 01:25:36,400
so much argument about whether
or not, you know, what really

1506
01:25:36,400 --> 01:25:40,480
truly defines obesity.
And I like to, I like to joke

1507
01:25:40,520 --> 01:25:44,200
that similar to autism spectrum
disorder, that we should change

1508
01:25:44,200 --> 01:25:46,880
the name of obesity to something
like weight gain spectrum

1509
01:25:46,880 --> 01:25:50,600
disorder because like, it's just
not one disease.

1510
01:25:50,600 --> 01:25:53,280
Most likely it's probably a lot
of different quote UN quote

1511
01:25:53,280 --> 01:25:55,640
diseases that just look the same
at the end of the day.

1512
01:25:56,120 --> 01:25:59,200
Oh, fascinating, right?
We call it a phenotype, which is

1513
01:25:59,200 --> 01:26:02,040
how something looks, but it
comes from different genotypes.

1514
01:26:03,160 --> 01:26:05,240
Genotypes are how things like
come.

1515
01:26:05,320 --> 01:26:06,640
To be.
Yeah, yeah.

1516
01:26:07,080 --> 01:26:09,080
So.
That's so interesting.

1517
01:26:09,200 --> 01:26:11,240
Wow, that's so fascinating.
We should come up with.

1518
01:26:11,440 --> 01:26:13,120
I think that's the point.
That's the point of language,

1519
01:26:13,120 --> 01:26:15,360
and that's the point of
vocabulary is like that.

1520
01:26:15,360 --> 01:26:18,600
Specific words encompass
specific contexts and.

1521
01:26:18,920 --> 01:26:25,160
And so the F word fat now has
negative connotations because

1522
01:26:25,320 --> 01:26:27,560
you call someone fat.
Oh, you're fat, and that's

1523
01:26:27,840 --> 01:26:30,960
negative.
But fat just started as a way to

1524
01:26:30,960 --> 01:26:34,240
describe adipose tissue, like
adipose tissue is fat.

1525
01:26:34,240 --> 01:26:35,840
There's brown fat and there's
white fat.

1526
01:26:36,280 --> 01:26:38,720
It didn't always start as a.
Negative.

1527
01:26:38,720 --> 01:26:40,960
Well, of course some people deal
with it, right?

1528
01:26:41,560 --> 01:26:43,000
So it's sort of Obcs the.
Same.

1529
01:26:43,000 --> 01:26:45,160
That's why I think that changing
the term doesn't necessarily

1530
01:26:45,160 --> 01:26:47,320
help because if people are going
to just use a different term to

1531
01:26:47,320 --> 01:26:50,160
be just as derogative, then I
think they have to just stop

1532
01:26:50,160 --> 01:26:52,320
being derogative.
That might be definitely help if

1533
01:26:52,360 --> 01:26:54,080
it's.
Weight gain spectrum disorder.

1534
01:26:54,080 --> 01:26:57,240
So WGSD, they'll just change
those initials.

1535
01:26:57,240 --> 01:27:00,280
They'll say like, they'll just
make it into like.

1536
01:27:00,880 --> 01:27:03,960
Yeah, they'll just sprout a new
word that we'll see you floating

1537
01:27:03,960 --> 01:27:08,320
around on the Internet.
Like WGSD will be it'll it'll be

1538
01:27:08,320 --> 01:27:12,840
stand for white guy with serious
I don't know.

1539
01:27:12,960 --> 01:27:15,840
D.
Diameter there it is.

1540
01:27:15,840 --> 01:27:17,600
So that's what they're going to,
you know, they'll just change it

1541
01:27:17,760 --> 01:27:21,680
into something bad, into
something mean or whatever you.

1542
01:27:21,720 --> 01:27:23,200
Know.
That's just what we do,

1543
01:27:23,760 --> 01:27:27,160
unfortunately.
Well, not not not in this

1544
01:27:27,160 --> 01:27:31,120
podcast, I guess.
You know, like I do think

1545
01:27:31,200 --> 01:27:36,120
they're, you know, I don't know
what the, there's the obviously

1546
01:27:36,120 --> 01:27:43,600
the Joe Rogans in the world who
sort of made their podcast world

1547
01:27:44,520 --> 01:27:47,480
from being controversial and
argumentative and, and frankly

1548
01:27:47,720 --> 01:27:53,880
sometimes being mean or, or not
necessarily positive.

1549
01:27:53,880 --> 01:28:00,000
I actually think it's it's, it's
kind of like I'm trying to just

1550
01:28:00,000 --> 01:28:02,480
do the opposite.
I figure like, you know, and

1551
01:28:02,480 --> 01:28:04,600
maybe I'll get nowhere because
maybe no one will want to listen

1552
01:28:04,600 --> 01:28:07,600
to me unless I start to be, you
know, calling.

1553
01:28:07,600 --> 01:28:09,080
People.
I don't think that I don't,

1554
01:28:09,080 --> 01:28:12,960
yeah.
It's just, I have to hope that

1555
01:28:12,960 --> 01:28:18,640
like it's just enough people in
medicine and other fields just

1556
01:28:18,640 --> 01:28:22,360
get out there and just start
speaking truths and stop with

1557
01:28:22,360 --> 01:28:25,560
all the opinion and all the
hoopla and all the whatever,

1558
01:28:26,120 --> 01:28:29,400
that maybe maybe that'll help
get the world back to sort of

1559
01:28:29,400 --> 01:28:32,840
some sense of normalcy.
Like, you know, I don't even

1560
01:28:32,840 --> 01:28:34,920
need it to be a perfect world.
I just need it to be like a

1561
01:28:35,640 --> 01:28:39,640
relatively normal and stable
world where you can predict, can

1562
01:28:39,640 --> 01:28:42,320
predict what the next day is
going to mean or like what the

1563
01:28:42,320 --> 01:28:43,960
next political movement's going
to mean.

1564
01:28:43,960 --> 01:28:47,360
You don't have to like worry
about all kinds of, you know,

1565
01:28:47,360 --> 01:28:51,880
like, I don't think anybody who
grew up post Roe V Wade actually

1566
01:28:51,880 --> 01:28:54,040
thought there would be a day
where it would get reversed.

1567
01:28:54,040 --> 01:28:57,080
Like, I don't think anybody ever
even contemplated that that

1568
01:28:57,080 --> 01:28:59,560
could happen.
But but that's where we are

1569
01:28:59,720 --> 01:29:06,160
like, it's just, you know, it's
just the world is just whatever.

1570
01:29:06,200 --> 01:29:09,200
The world, it's, it's a
pendulum.

1571
01:29:09,200 --> 01:29:11,160
Everything's a pendulum.
It just gets them swinging in

1572
01:29:11,160 --> 01:29:13,680
different directions, you know,
and, and the only thing you can,

1573
01:29:13,800 --> 01:29:18,520
the only thing that I, I'm kind
of hoping for is that it doesn't

1574
01:29:18,520 --> 01:29:22,240
swing so wildly and that the
motions are a little bit more, a

1575
01:29:22,240 --> 01:29:25,160
little bit less volatile.
You know that if it is going to

1576
01:29:25,160 --> 01:29:26,440
be a pendulum, then it
shouldn't.

1577
01:29:26,440 --> 01:29:30,520
It should be a clock going from,
you know, 7 to 5 instead of

1578
01:29:30,520 --> 01:29:33,240
1:50.
Exactly or like a metronome

1579
01:29:33,240 --> 01:29:35,640
where it's, you know, like it
goes back and forth, but it goes

1580
01:29:35,640 --> 01:29:39,920
back and forth in a more
predictable pattern and again

1581
01:29:39,920 --> 01:29:43,920
with not such wide variation
with each movement back and

1582
01:29:43,920 --> 01:29:46,840
forth, but.
Yeah, well, anyway, Doctor, I

1583
01:29:46,840 --> 01:29:48,880
really appreciate the time.
This is really awesome.

1584
01:29:49,120 --> 01:29:51,360
Maybe we'll do I I would, I
would Love Actually to do a Part

1585
01:29:51,360 --> 01:29:53,360
2 of your horror stories.
I think that'll be a lot of fun.

1586
01:29:53,840 --> 01:29:55,800
But until then, this was really
great.

1587
01:29:55,800 --> 01:29:58,080
I'm so happy we found it.
I'm happy we made this work last

1588
01:29:58,080 --> 01:29:59,760
minute.
But thank you so much for the

1589
01:29:59,760 --> 01:30:01,880
time.
This is it's really enlightening

1590
01:30:01,880 --> 01:30:04,600
and a lot of fun and I think
really, really interesting and

1591
01:30:04,600 --> 01:30:05,880
really informative.
So it's.

1592
01:30:06,240 --> 01:30:08,240
Always fun to chat with, you
know?

1593
01:30:08,280 --> 01:30:11,520
Again, it's like anyone who's
open minded and wants to have a

1594
01:30:12,360 --> 01:30:14,680
discussion about almost any
topic.

1595
01:30:15,080 --> 01:30:17,520
It's it can be super fun and
interesting and informative.

1596
01:30:18,520 --> 01:30:21,120
Like we, you know, we don't have
to agree with everything, we

1597
01:30:21,120 --> 01:30:22,760
just need to.
Have a good time people, and.

1598
01:30:23,160 --> 01:30:26,240
Talk about it and have fun and
not get so worked up if people

1599
01:30:26,640 --> 01:30:29,200
don't agree or whatever.
But yeah, happy to come back and

1600
01:30:29,920 --> 01:30:32,240
yeah, let me know.
Yes, absolutely.

1601
01:30:32,880 --> 01:30:35,440
And I'll make it happen.
Doctor, thank you so much.

1602
01:30:35,440 --> 01:30:36,600
It's such a pleasure.
Have a great day.

1603
01:30:36,600 --> 01:30:37,440
My pleasure.
Take care.

1604
01:30:37,440 --> 01:30:38,000
Thank you.
Bye, bye.

1605
01:30:38,040 --> 01:30:38,240
Bye.
Bye.