The power of protein— Diet Doctor Podcast with Dr. Ted Naiman

[Music] welcome back to the diet doctor podcast i'm your host dr brett sher today it's my pleasure to be joined once again by dr ted naman who's a primary care doctor in seattle and also the author of the very popular pe book which you can find at pe dietbook.com um he's also on twitter and instagram at ted neyman and his website is burnfat not sugar.com but with all that intro what ted really is is he's just he's a great thinker he's he um he's a big proponent of protein and he thinks that if we just can all increase our protein percentage and stay away from the combined fats and sugars that would do wonders for everybody's metabolic health and body composition and he makes a very compelling case for it and this this interview really is sort of a tour de force of protein uh what the role of protein is the struggle some people may have to fit it in what protein sources are best and what the benefits are to our health so if you have any interest in in knowing more about protein how to increase your protein and why you should potentially increase your protein this is the episode for you so enjoy this interview on protein with dr ted neyman pardon the interruption here but i want to tell you something i'm really excited about and the timing is perfect to tell you about it because we're interviewing ted neyman who's a big proponent of protein and the protein energy ratio well at diet doctor we're starting to expand our our repertoire our recipes our meal plans our our message because we also know the importance of protein now obviously we know the importance of carbohydrate reduction and that what that's something that we've really built our site around in our recipes and our meal plans but now we want to increase beyond that to help the people who still need help and maybe provide a different way to improving metabolic health and healthy weight loss because that's what it's all about it's not just about weight loss it's about healthy weight loss and by increasing protein percentage prioritizing protein and still keeping the carbs relatively low we think a great number of people are going to see tremendous success the literature supports it uh you know in clinical and anecdotal reports support it so keep an eye out at dietdoctor.com for more resources and and more products and more recipes prioritizing protein to help you achieve healthy weight loss and helping you achieve greater metabolic health all right now back to the interview ted neyman welcome back to the diet doctor podcast it's great to have you back again thank you it's great to be here good to talk to you yeah so our first interview um was episode number 40 in february of 2020 was when it was released and and now here here we are recording in 2021 it seems like a whole world away so much has changed but the one thing that has been really consistent and popular for that entire year has been this book called the pe diet and it seems like it's got a lot of traction a lot of popularity so i want to just start by asking you what is the pe diet and why did you create it gotcha okay well thank you for mentioning it yes the the pe diet stands for protein to energy and the pe diet was my way of just looking at eating in general from a sort of big picture perspective and for me it comes down to basically energy which is what plants create from solar energy using carbon dioxide in the atmosphere so that's chains of high energy carbon carbon or carbon hydrogen bonds and that's basically carbohydrates or fats and that's everything you eat in your diet that you burn for energy and then there's protein which your body mostly uses structurally and the majority of your body is actually protein or at least the non-water component of your body is protein so i'm kind of looking at diet from like a protein slash structural slash nitrogen point of view versus carbon hydrogen carbon fat um solar energy storage chemical energy perspective it it's it's a weird it's sort of a weird way of looking at your diet that nobody's really ever done quite the same way before and uh it's a little bit unique and so that's that's what the book's all about yeah so getting the the maximum amount of protein for the minimum amount of energy basically or the minimum amount of calories i guess you could say now there are a million diet books and it seems like every angle of diet books have been published so you just said it's kind of unique and hasn't really been done before why do you think that is well i i don't know i know that forever we've had this low carb versus low-fat war i mean that goes back forever and there's just die-hard people who are low-carb or low-fat low-carb low-fat we know from studies that both approaches work both approaches are reasonable some people prefer one over the other um there's certain scenarios where one might work better than the other but i kind of zoomed out above that one layer higher than that to sort of look at it from a protein versus non-protein energy ratio and when you look at it that way a low carb and low fat are almost actually the same kind of thing or fairly similar they're both increasing the protein to energy ratio of your diet well it's interesting because when you say low carb and low fat automatically people i think get like an emotional response about what that means to them and so i'm curious what it means to you because in the literature low carb can be 40 or for some people you know 40 of your calories um low carb can be 40 of your calories from carbs or for some people it's 20 grams of carbs per day those are obviously very different things and i'm sure the same thing for low fat you know 30 of calories is considered low-fat but not to a lot of the big low-fat aficionados so when you say low-carb and low-fat do you have numbers that pop into your mind or is it more of just a feeling like what do you mean by that well i do but i have to admit it's really been poorly quantified the average american's eating 300 grams of carbs at maybe 100 grams each protein in fat and so carbohydrate is 45 50 maybe of their calories and so it's a little hard to define low carb so for some people low carbs anything less than that 45 so you know 30 might be low carb um for uh other people you know low fat is hard to define if you're a plant-based vegan person your diet might not be considered low fat until it's all the way down to ten percent of your calories or something like that uh one of we low-carb uh aficionados might say low-fat would be you know 30 fat or something so these have been poorly defined in both in the medical literature and just in the lay press and in general and you can go by grams grams per pound grams per kilogram you can go by percentage it also depends on whether you're hyper caloric or hypocaloric trying to gain or lose and it gets really murky and really confusing and you go by grams per pound grams per pound of lean mass which takes into account how over fatty you are that's a great point though i mean all those all those examples you're bringing up are a great point how it's just so hard to say the words low carb and low fat because when you say and the reason why i'm pushing on this is because to hear low fat works i can i can just see people saying ah i tried it it didn't work trust me it doesn't work but if you're in caloric excess if you're hungry if you have cravings and your fat is you know 30 and your carbs are uh 50 like that low fat doesn't work so um when i guess what i'm what i'm trying to get is like for the low fat to work it still is sort of a higher protein very low fat like that for that it's got to be like down to like 10 low fat um and a higher protein so that your carbs still aren't through the roof like is that the am i right there do you think that's on target yeah you're definitely right and you really bring up a good point so anytime you go either low carb or low fat you want to replace at least some of that macronutrient with protein so in studies iso caloric replacement of any non-protein macro carbs or fats with protein always improves anything you could look at um you know satiety per calorie outcomes when you're eating ad lib any kind of lab findings just about anything you can measure improves when you replace isocalorically carbs or fat with protein and so i think low carb works if some of those carbs are replaced with protein low fat works if some of the fat is replaced with protein if you just substituted your carbs for fatter your fat for carbs i don't know if that would be equally successful at all so from my point of view that's one more reason to look at it from a protein versus non-protein energy standpoint yeah it's a great point and especially when you look at sort of the average diet having maybe 15 percent of calories from protein and when you're talking about in your pe diet if we're talking about percentages it's more around the 30 to 35 percent of protein so that's a pretty big jump for the average person wouldn't you say that's a huge jump for the average person but if you look at anyone who's had long-term meaningful successful weight loss typically what they've done is they've found a way to go from the 12 and a half percent protein of the standard american diet to around 19 or 20 percent if you look at uh databases of people who've lost weight and kept it off long term they're all getting their protein at least close to 20 percent mark and that seems to be across the board no matter what you do with carbs or fats and then i think that if you look at you know hunter macronutrient estimates on average you know we're talking 30 plus percent protein and you look at fitness competitors and bodybuilders who are you know 40 plus percent protein and all of a sudden this protein percentage starts being extremely important you know and that's why i think that in in most of the medical literature you always have to fix protein before you can investigate anything else because it's such a huge huge factor yeah and that's such a great point because of there are so many studies showing that a low-carb diet leads to better weight loss and better glycemic control compared to a low-fat diet but the other variable that changes in the vast majority of those studies is the protein is also higher so it's like that combination of higher protein and lower carbs you know i've been i've been guilty of this as much as anybody and i say see low carb is better low carb works but you could also say see higher protein works and it's it's sort of one in the same in some instances but it doesn't have to be and i think that's sort of part of what your book and your message gets at is that right that's correct yeah and we do have multiple studies that strongly suggest that the biggest factor in the success of low-carb diets is the increase in the protein percentage and so i do think that's a huge factor yeah and that that brings up this concept of what is a well-formulated low-carb diet or well-formulated keto diet because i mean let's be honest a lot of people have seen tremendous success and the literature can support it of of giving up your carbs and adding lots of fat you know all of a sudden eating lots of bacon cooking everything in butter adding olive oil to everything choosing the fattiest cuts of meat so the fat is is much higher and the protein has gone up a little bit and people see success with that but are you saying that there's maybe even a better way or a different way or would you say if you're having success leave it alone and you don't need to change it even if your protein is down around you know 18 20 percent well yeah i think there is a better way and we have a couple things that support this you know first of all we have a lot of medical literature on the classical ketogenic diet for seizure control and unfortunately these diets were extremely low protein and very very high in fat and we we know that anytime somebody looks in the literature for something criticizing ketogenic diets they're usually pulling from this very low protein very high fat standard classical ketogenic diet studies where we really did see sarcopenia and osteopenia and sub-optimal outcomes when we were using lots of refined fat and oil and very low protein percentages that some of these people unfortunately required for high levels of ketones and seizure control but it's definitely not optimal for health or body composition and there's a number of studies in the medical literature where they literally kept calories the same isocaloric carbohydrates the same isocarbohydrate and simply substituted protein for fatter fatter protein we have uh 15 protein higher fat versus 30 protein lower fat and higher protein always basically destroys lower protein on any metric you can measure fasting insulin body composition subjective hunger scores emotional eating like anything you can graph or measure or quantify is better when you iso calorically replace fat with protein i'm sure there would be an upper limit to that i think if you went from 99 protein to 100 protein it would you know things would start really rapidly going the other way but all the way up to 30 proteins certainly any any fat that you replace with protein you're just going to get a better outcome and and that brings up a good point i mean can you get to the point where you are eating too much protein there's your body has a urea wasting mechanism you know a way to get rid of urea which is sort of a byproduct of protein where it may reach its upper limit so is there a concern of eating too much protein yeah i definitely i i know that there's a level that's too much or too high to be sustainable and we have almost no anecdotes from free living humans eating for any length of time higher than about 50 percent of calories or maybe at the most extreme i've ever heard of 60 percent of calories which uh it's really only just very extreme bodybuilders and it's probably not sustainable for 99 of people so i think that you're going to run really really hard into some upper limit there that's probably going to be fifty percent of calories and uh probably even a pr before you approach that it's going to be start going in the opposite direction for most people i'm sure it's on a u-shaped curve and i guess that brings up another great point though in that it's hard to overeat protein it's that's part of the benefit of protein it's hard to hard to eat so much of it so is that the do you think that's one of the main benefits or is it the main benefit or what else are the benefits of of prioritizing protein that why it helps with weight loss and metabolic health and body composition right well protein has a couple of really great benefits first of all we know it's the best macro for building muscle and building lean mass and nobody just wants to lose weight everyone wants to just lose fat you actually want to keep as much lean mass as possible your your whole goal is really recomposition you're trying to get the highest muscle at the lowest fat and that's going to give you the very best health and degree of function and longevity and strength and basically metabolic flexibility which muscle is awesome for so you're actually trying to hang on to as much muscle skeletal muscle and lean mass as you can and get lower body fat so you don't just want weight loss you want fat loss protein is the best macro for building muscle protein is also the best macro for losing fat and so it really has you covered on both directions of recomposition it's also the highest satiety per calorie and it's kind you know for all these reasons it should clearly be the focus of everyone's diet in my opinion i'm extremely biased of course well so let's talk about the flip side then i mean there are people who say too much protein is associated well let me rephrase that that restricting protein is associated with increased longevity certainly in fruit flies and mice and maybe in apes and some you know i guess one fairly weak observational study in humans but then looking at surrogate markers like il1 and you know mtor activation and autophagy that you know all these buzzwords that lowering protein has beneficial effects on all these potential markers for longevity so then does this message sort of contradict that well the problem is we don't have any actual data in humans to support protein restriction and longevity there's literally zero data there whatsoever so we do have some data in lesser organisms but we don't have any in in higher mammals especially if they're being fed a species appropriate diet so we have a couple studies in primates um suggesting that if we feed them less they live longer but the problem of these studies is we were feeding them crap and if you actually feed them a higher protein diet they're going to live longer and caloric restriction doesn't seem to be helpful anymore so i don't know i really think that uh most people if they increase the protein percentage of their diet the absolute amount of protein they're eating only goes up a little bit but the amount of non-protein energy they're eating goes way down and as a result they're leaner and they're thinner and they have they're more insulin sensitive they have lower fasting insulin they have lower post brandel insulin that every marker you can measure is better and so mechanistically a higher protein percent you know might only yield eating a small amount of absolute protein more than you did before but a lot less non-protein energy yeah that's a great point the non-protein energy is is the important cofactor we talk about the protein but it's because the protein is taking the place of the non-protein energy now although we talk about protein as if it's one thing which it clearly isn't right there are many different types of foods that have protein in them and different protein percentages so some people when they hear a high protein diet they think of bodybuilders just chugging protein shakes and eating tuna right out of the can or you know egg white powder on everything you know like so when when you talk about higher protein is that what you're talking about well i'm really just looking at the ratio of protein to calories or non-protein energy calories in a food and some really surprising things show up like uh if you if you look at the protein percentage by actual calories in green vegetables for example it's pretty high you know green leafy vegetables are way up there with you know greek yogurt or something the amount of protein they have is very small but the protein percentage of the calories is quite high things like brussels sprouts and asparagus and broccoli are actually all fairly high protein to energy ratio foods um i wouldn't suggest anyone get all their protein from those foods because you're going to have to eat a billion pounds of those but um but the point is the protein to energy ratio and this is how your calorie and the nutrient density versus caloric density is really really high so there are some things on the list that aren't just what you would picture a bodybuilder chugging like whey shakes and egg whites yeah and i gotta say i gotta promote your book here a little bit because the the pictures and the diagrams and the graphics and the books the book are phenomenal and then that's that's one of the things where you show the dial changing for the different foods and although you might have egg whites and whey protein way up here at the highest ratio that doesn't mean that's where you have to be and they're you know you can see in where the chicken is and where the steak is and where the seafood is along that spectrum and the diagrams are awesome that must have taken you a long time to do all those diagrams oh thanks a lot yeah yeah unfortunately yeah well it turned out well it was worth the time and that's the other concept that you know anytime we talk about a diet or you know food choices or weight loss you have to talk about hunger and you have to talk about how full you feel from your meals and the concept is higher protein is more satiating but is is it the same across the spectrum of protein again you know is protein from a ribeye protein from a chicken breast from uh shrimp and from whey protein are those gonna is the protein content gonna be the thing that dictates the satiety or the fullness that someone feels well first of all i think satiety is probably the most important factor of all and i think a lot of times we really really get down in the weeds with mechanisms and carbs and insulin and things like this but the reality is it all comes down to satiety per calorie because if i can give you a little cube of food that's only one calorie but a whole day's worth of satiety you're gonna lose all the weight you want you're just gonna be the thinnest person on the planet like so it really comes down to satiety per calorie and protein is is definitely the most asian macro by far but there are other factors when it comes to satiety weight and volume of food is a big deal so anything that has larger weight in volume for fewer calories is going to have higher satiety per calorie that's some of the magic of fiber and water and minerals and green things like leafy green vegetables which have a ridiculously high satiety per calorie and so this energy density is a big big deal and so you know i feel like every other day kevin hall comes out with a study where uh low low-fat plant-based study basically leads to people eating fewer calories than a high-fat animal-based study and the reason for that is caloric density the um high-fat animal-based people are getting like butter and oil um which is like a billion calories for you know tiny little bit of food um whereas the plant-based people just get like a bushel of hay or something which is you know like it's 50 pounds of food for one calorie and you can't discount that that's a very real thing and i think that's why all your bodybuilders are just eating these giant salads the size of their head every day just like a machine because they know they get a crazy amount of satiety per calorie and i think that protein is a huge factor but the other factors are fiber and water and weight and volume and things like that yeah i think that's that's a great point about the the fiber the weight the volume that plays a role as well but again sort of the the counterpoint to that is studies show that a ketogenic diet is sort of uniquely formulated to decrease appetite as well whether it's the ketones themselves or whether it's the fat and there's you know just thousands of people with personal experience that comment on a diet doctor and are part of our facebook group that say you know increasing the fat decreases their appetite and improves their satiety um so i mean there's got to be something there as well or do you think it's still somehow related to the protein and not the fat well um three things number one they're probably increasing their protein percent um almost universally i would guess um but the other things are uh fat is definitely satiating it's just not high satiety per calorie so if i eat an entire stick of butter i have a ridiculous amount of satiety like i won't be hungry for the rest of my life but it's also 3 000 calories so i'm literally getting fatter at the same time so i think sometimes we feel that fat is um very satiating and it can be for sure but we didn't count how many calories we just ate so satiety per calorie might actually be terrible um i know that in the past you know my number one snack used to be macadamia nuts i used to buy pounds of macadamia nuts and i would eat these and you know i had tons of satiety and i the problem was i just literally walked around about 10 pounds fatter back when i ate these nuts just as a snack because they're so high in cal i mean fat calories so the they do have satiety sure but satiety per calorie is terrible and um so you're really not winning anything there i don't think so it sounds like your personal transition is sort of what a lot of people maybe are also going through that it was sort of the lower fat higher carb diet then you went to the lower carb diet and then transitioned maybe even to a keto diet and started feeling really good and improving everything but then but then it reached this point where maybe you were slipping backwards a little bit probably because of all the increased fat so then went to the higher protein part and all of a sudden saw improved gains is that sort of like your timeline that is exactly correct and somewhere in there most recently i've also noted that i can iso calorically dial fat down and carbs up a little and as long as protein is always super dominant it doesn't seem to matter i can get away with that a lot which for me just really underscores the importance of protein yeah so so this is really interesting so you can get away with that but you know we've seen your pictures you are a rip dude and you've clearly got some muscle mass and metabolic flexibility so are there going to be some people who maybe don't have the metabolic flexibility that you think might struggle with that or do you think once protein is is high enough that it almost doesn't matter and most people will be able to dial up the carbs in that setting i think that there's always going to be people who have a strong preference for a fuel mixture that's more carb less fat or more fat less carb but i think that the most important lever to pull is getting protein percent significantly higher and then playing around with this carb fat fuel mixture just to see which one gives you the very highest satiety per calorie and i think that will be different for different people now the other concept of not all protein being the same is plant versus animal protein so some of those same observational studies seem to suggest plant protein is better than animal protein for health and longevity although you know we've talked a lot about observational studies nutritional epidemiology healthy user bias that make that very difficult to interpret but how do you see the main differences for plant versus the animal protein because like you said broccoli and spinach have a huge percentage of protein per calorie but is it different than eating a steak for your protein right yeah i think that unfortunately plant protein is inferior to animal protein for two main reasons first of all it's frequently not a complete protein so plant protein is great for building plants animal protein is great for building animals if you want to build an animal out of plants you have to mix and match a little bit it's like a it's like a lego kit you know and if you have the one lego kit here and another lego kit here you can't build the second one from the parts of the first one if you combine different plant proteins you can make a complete protein with all the essential amino acids but it's definitely not as good as animal protein in terms of completeness for animals the other problem is digestibility scores and unfortunately all of that fiber and plants which is great for satiety per calorie is actually kind of bad for extracting protein and minerals so the proteins are less bioavailable and pretty much anyone who seriously researches protein will tell you that animal proteins are always superior and even in the animal protein world there are some proteins that are just considered the gold standard like whey protein and egg whites are extremely digestible bioavailable and complete and so those are usually sort of your gold standard proteins that everything else gets compared to yeah so so better digestibility or absorbability i guess you could say for the proteins and a complete amino acid profile but by combining different plant proteins you could get something similar but you need a higher number of grams of plant protein to equate you know a lower which you would get from a lower number from animal protein right right the efficiency is lower so you basically have to eat more you'd have to eat you know 20 more or it well it depends on what you're combining it's highly variable but there is some uh basically you would have to eat a certain percentage more implant protein to get the same anabolic effect that you would from animal protein yeah so so doable but you rarely hear of plant-based diets being 30 protein 35 protein seems like that might be the challenging point but getting into 20 25 protein certainly doable with the right mix now and there was actually a recent study that looked at supplementing um whey protein or supplementing a soy protein for healthy young people and measured their muscle mass with with training it was 1.6 grams per kilo for both of them and they had sort of equivalent muscle growth so it suggests at least for a soy supplement versus a whey supplement at that level that there's equal anabolic effect but i guess then the question is if you do real foods and you do a longer period of time and logistically so there i guess the point is there are lots of other things to consider but certainly doable and plant protein can get the job done just be maybe a little more difficult right right and soy is definitely your best plant protein option uh soybeans are about 40 protein by calories they're pretty solid they're technically a complete protein although the spread of the aminos is such that it's not quite as anabolic as animal protein for building animals but it's pretty good and you can get it done like you said it it's possible not optimal okay so we've talked about the importance of protein uh sort of the targets of protein why it works so well for metabolic health for weight loss for body composition but obviously not everybody i'd assume not everybody who's tried your pe diet and read your book and tried to make this transformation not everybody has succeeded uh so give us some feedback on on what you know of why people don't succeed what are the main hurdles and where people stumble i think one of the things that everyone does is try to go way too extreme with it you know the whole point of the pe diet is like okay let's say you're here you're eating your bacon and eggs right and you're put cooking everything in butter okay maybe a step up from that would be you know turkey bacon and eggs and a little bit less butter um or maybe uh turkey bacon and eggs and a couple egg whites and less butter you know you're just trying to do something in a in a sustainable um incremental way you're just trying to get a little bit better than you were before you don't want to go just straight to whey powder and egg whites like i have some people just going on these extreme uh everyone wants to go extreme with everything like okay low carbs good let's go to zero carb let's be carnivore be raw carnivore pretty much i just eat you know cubes of raw pork fat that's my whole diet um so everyone tries to go really extreme with it and definitely people do the same thing with the pe diet it's like more protein's good i want to be the best i'm literally gonna eat 100 protein and you're just it's a complete fail obviously so the the whole idea is just take where you're at and try to incrementally go up it's just like lifting weights you know you wouldn't just suddenly put you know 600 pounds on the bar and try to bench press you know you're you're going to take where you're at and you're going to micro load that with you know a five pound plate on either side and just like lift a little bit more and you're going to do that for a couple months and then maybe you're going to go up just a little bit more than that and the idea is make it sustainable enjoy the process you have to eat like this for the rest of your life i'm like hey you're at 12 and a half percent protein maybe get to 15 you know maybe your ultimate goal is 20 and you can just live there forever and you'll just walk around thinner um instead of 100 yeah so that's definitely one of the big fails i would think one of the big fails would also be that people just can't get their protein high enough or feel like they can't get their protein high enough because you go you know say you eat lunch out and you always order uh a salmon salad or a steak salad or something you know it comes with with that much steak or you know like four ounces or maybe six ounces and and so if that's what you're used to eating to all of a sudden try and double that or even you know triple that or you to get adequate protein i i'd imagine that would be a challenge for a lot of people do you do you have like tips and tricks that you tell people of other ways to improve their protein absolutely like the literally the only way to survive anywhere you eat out is to double the meat or the protein in whatever the heck you're getting you go to chipotle and you get your salad bowl you have to get double meat like that's that's the starting point um you you you know you always have to get you know two burger patties or three or four you always have to ask for double meat on your caesar salad with smoked salmon or something you want like double protein half the starch that's just like the automatic thing every restaurant you go to and you get kind of used to it it's like okay i'll just double that meat and i know it's going to cost more protein's always the most expensive macro it's expensive to eat protein in fact half the reason the whole planet's over fat is purely economic because protein is by far way more expensive than carbon fats so it costs more but you have to do that i mean that's the only way to eat out is to double the protein and hold the starch pretty much yeah it makes it that much more important probably to try and prepare most your meals at home because of the cost and just buy whatever's on sale and and look i mean i'm a proponent of you know organic vegetables and grass-fed beef and pasture egg pasture-raised eggs if you can afford it and if that's important to you but i think by no means should that be a hurdle um and i think in a situation like this it probably could be a hurdle if somebody thinks that that's what they need to do to eat healthy do you come across that as well yeah absolutely you know i uh it's so expensive to buy protein if you graph out the cost of everything in the grocery store versus macronutrient it just scales linearly with the amount of protein in it and carbs and fats actually don't increase the price of a food at all i mean it's act to get more carb and fat is almost free it's almost cost neutral um it's like when you go to mcdonald's and like super sizing your fries and your soda is like 10 cents but you put another patty on that burger and it's you know two dollars so it's definitely all about the protein is very expensive you know the the the cheap the very most cost effective proteins are always eggs and ground beef those are always the cheapest ones and i do have patients who literally have to buy a lot of those and thankfully you can always get these on sale for almost nothing i mean you can buy a dozen eggs for 99 cents you can get ground beef that cheap per pound at some places and that's always you know reasonably good nutrition for dirt cheap and these foods are 30 protein so they're pretty solid yeah now now what about the concept of enjoying your meals now you see i think there was a comment in your book about like if eating was a chore if eating wasn't enjoyable we wouldn't have the problem that we're in but i i think we have to be honest that you know food intake and eating is is so like just intertwined with our our reward system and our enjoyment that we want to enjoy our meals um and do you think there's some people who just think well if i'm trying to get to this level of protein it just takes the fun out of it and the enjoyment out of it and that's part of what the fat is there for to help me enjoy the meal yeah and it's a really really fine balance i mean you absolutely have to enjoy what you're eating or you're going to fail long term period you're not just this isn't a 12 week cleanse it's not like a six week boot camp you have to eat for the rest of your life and you have to eat at a way that you have good body composition so you can be healthy and that means you have to enjoy what you're eating you have to enjoy it now you have to enjoy it then you have to enjoy it after then so this has to be sustainable and that's one of the reasons why you can't go to 100 protein you have to find a way to substitute what you're eating now that's not getting you the goals you want with something that's a little bit higher in protein but sustainable and you have to enjoy it and it's it's definitely it's definitely not easy and then the other factor is that the high energy density carbon fat food that is so hedonic and so addictive um i mean it's really hard to avoid all the cookies and the donuts and the pizzas and candy bars and the potato chips and the french fries and the high energy density carbs and fats together and you you really have to i don't like to say that there's good foods and bad foods i just array them all on this spectrum of higher satiety per calorie and lower satiety per calorie and french fries are low satiety per calorie they're okay they're not going to kill you you know it's not like right right i mean one won't but but it's definitely lower satiety per calorie so there will become a point where it's taking you further from your goals instead of closer to your goals could you find a way to fit a couple french fries in there and then more fish and salad and then come up with something that's sustainable and works you probably could um but it's just you have to be constantly mindful of this food is higher society per calorie uh taking me closer to my goals this food is lower society per calorie and taking me further away from my goals and i have to find a balance that i can maintain for life yeah that's a great point about maintaining for life because that's exactly what we're talking about here but um so now let's transition for a second though i mean we talked about how there are millions of diet books and there are also you know thousands of if not millions of obesity researchers and obesity papers so with your concept of nutrition and and your framework what do obesity research get wrong um where are they sort of missing the boat and what do they think what do you think they need to change well first of all protein percentage is just staring all of us in the face from the medical literature like you you won't find any study where humans eat ad-lib calories and a lower protein percent diet outperforms a higher one that just doesn't exist so virtually everything in the medical literature supports this but then i don't really see obesity researchers highlighting this enough in my opinion i mean i think this is probably the biggest factor of all it just doesn't get much airplay i mean you go to you know obesity week and it's all about all the drugs and all the surgeries and all the bulimia procedures and all these things that um you know nobody talks about protein percentage of the diet and how it's fallen over the past 50 years of the obesity epidemic and how we could possibly drag it higher or like this just isn't on anybody's radar i also feel like the the addictive nature of high energy nancy crypto fast together just doesn't get enough air time it doesn't get enough play and like nobody's really talking about this the way they should it's like these foods are super addictive and probably driving a full half of the entire global obesity epidemic but we don't really highlight that as much and that's you know i i think these are things that are really there in the medical literature staring us all in the face but nobody's shining a light on them or i am but i feel like some other people aren't yeah yeah that's a good point and you know the the drugs and the procedures are like the big shiny objects and and seems like protein is just sort of not that exciting right has a lot to do with it now another concept that you bring up in your book is the said said the specific adaptation to imposed demand right and so i want you to explain that because i think that's an important concept too to help people sort of figure out okay we know protein is important we want to increase our protein but then there's the the road map of how do we get to here to there what is our framework on how we progress so what do you mean in your book when you say the said principle right specific adaptation to impose demand it means if you want your body to get better at doing something you have to make it do that thing so in other words if you want to be able to function better in a low carb environment and you want to be more fat adapted all you have to do is eat less carbs and your body will basically has to adapt or die if you just stop eating carbohydrate i mean your your body has a choice it's like either okay i have to figure out how to make everything run with what i've got or you know what choice do i have and the the specific adaptation to impose demand i was specifically using that for exercise because when you do different forms of exercise you're really utilizing this this um principle like uh resistance exercise right you do a pushing exercise as hard as you can all the way to failure and you're communicating to your body that if it doesn't get stronger at a pushing type movement you're going to die somehow you just put this incredible amount of stress in your body and then you this is a huge stimulus to build more muscle in in your push pushing chain of musculature and you're basically imposing this demand on your body that it can't currently meet and then you'll literally have to change so that you can meet it this is how you get uh better at cardio respiratory fitness you do some sort of cardio exercise that really pushes you you know really pushes your vo2 max it's something you can't do right now but you're trying to force your body to do it and then you're going to get a positive adaptation to that over the next few days so there are all these things that you can force your body to do that it will literally get better you can force your body to live off of stored body fat you can force your body to live in a low carb environment you can force your body to do more cardio or to be stronger at pushing and pulling and all of these things literally make you better and the book is all about pushing out of your comfort zone and demanding these adaptations out of your body so that you're just literally a better person so what are your main tools for forcing your body to burn more of your stored body fat it's really just carbohydrate restriction if you're trying to upregulate your fat oxidation all you have to do is eat less carbs another thing you can do to force your body to up regularly fat oxidation is more activity exercise run around cardio move more you basically have to burn more fat especially if you're not eating carbohydrate and if you want your body to burn more stored body fat not only do you eat less carbs which forces your body to burn fat but you eat less fat as well which forces your body to get the fat it's burning from your own body so now you're low carb and low fat oh what the heck are you gonna eat so you're not starving enough protein yeah so there's you know a belief out there that low carb low fat equals starvation and hunger um but i think again it comes to defining what low fat is necessarily and and you know what do you how do you react when someone says i can't be low carb low fat i'm going to starve my to death you know that's what people have tried and well that's totally true and so you want to be a little bit low carbon a little bit low fat just enough to be sustainable while you slowly lose weight and try to dial down your fat mass and maintain all your lean mass um in a sustainable fashion but you don't want to go so crazy with it that you're trying to eat 100 protein and then you're basically eventually going to die of starvation once you're really thin and you're going to be miserable the whole time so yeah it's it's it's all about pulling the lever not you don't want to pull it so hard it just snaps off and it's gone you just want to pull the lever hard enough that something adapts something moves yeah yeah and if you look at a diet that's maybe 10 carbohydrates 30 protein that's still leaves 60 fat which is maybe lower than you know 75 if you were doing before but certainly by no means a low-fat diet there's still plenty of energy there and the more you dial that up or down the more or less you're going to rely on your own stored body fat so i think that's a good example now you talked about restricting carbohydrates reducing carbohydrates in your book you talk about decreasing carbohydrate frequency and i thought that was really interesting the way you mentioned that because you weren't talking about absolute grams of carbohydrate at least in this section you were talking about changing the frequency decreasing the frequency of carbohydrates so tell us more about that philosophy because that's maybe a little bit different than the way people have heard it before if you go without even carbohydrate for more than you know 12 16 24 hours depending on how carb loaded you were before you're basically going to be in ketosis and you're flipping this metabolic switch where you're generating ketones and you're being filled by ketones and you're basically running most of your metabolism off of fat and i think achieving this state is a form of specific adaptation to impose demand you're putting this demand in your body you're getting really good at fat oxidation and fat mobilization and then if you eat carbohydrate periodically i think that might actually be just fine i think you can get away with that you know you you have room for 100 grams of carbs in your liver and 300 grams of carbs in your muscle and if you have someone who hasn't eaten carbs for 24 hours and did an exhaustive glycogen workout for an hour they can eat a ton of carbohydrate and it literally just falls down a concentration gradient from your blood into your muscles in your liver um and you really actually don't get this giant spike of insulin you don't see anything really negative happening so someone who's glycogen depleted from a period of low carb environment and exercise can get away with some carbohydrates so i like to do like a cyclical ketogenic diet where i might just go all day without eating carbs and then eat you know 100 grams of carbs or more um depending on my activity level and how much muscle glycogen i depleted so in the book we're suggesting like a cyclical type thing you know most people would baby basically be very low carb the majority of the day and then eat an increasing amount of carb in the evening you know maybe 100 grams or something like that after eating protein and fiber almost like a dessert type thing and that gets you on the cyclical ketogenic diet which works pretty well for a lot of people yeah i think that's really interesting the cyclical component to it um and that could also kind of help with metabolic flexibility almost like training your body for metabolic flexibility now an interesting point you make about eating it late in the day um eating carbohydrates late in the day and that it helps with sleep and i know there are a number of people who who say with a with severe cardiac or severe you know strong carbohydrate restriction that they they have some people have trouble sleeping and adding carbs back help them sleep but there's also the sort of circadian rhythm of insulin sensitivity which as far the way i interpret it is better in the morning and a little bit worse in the evening so if you stack your carbs in the evening it might be good for sleep but might be a little bit worse for the glucose um the glucose response to that because of the insulin sensitivity do you make much of that uh well honestly all of this morning insulin sensitivity and your most insulin sensitive in the morning that sensitivity is at the level of the fat cell so your fat cells are the most insulin sensitive in the morning your fat cells are anxious to just suck any calories out of your bloodstream and that's actually not that great later in the day when you've moved more and exercised and done your lifting than your cardio and depleted muscle glycogen your muscle insulin sensitivity is higher and your fat cell insulin sensitivity is lower and i literally specifically eat carbohydrate later in the day because morning insulin sensitivity so high at the fat cell that's the part they're not telling you in this research um so you rely more on the glycogen depletion and let that suck up the carbs right um okay and then it's more anabolic because i've already done my resistance exercise and yeah i'm actually hoping that i'm more insulin resistant at the fat cell at that time of day which i which i am interesting so it's actually advantageous like you don't want to eat carbs first thing in the morning when you're the most insulin sensitive it could because that's at your fat cell and when you say you're eating carbs in the evening are you talking about like a big chocolate shake or something or what kind of carbs you're talking about well again so carbohydrate there's this scale of energy density of carbohydrates so there's what i call low carb carbs and then there's high carb carbs the highest carb carb of all is sugar 100 grams of sugar is 100 grams of carbs it's basically the highest carb carb of all and then you've got something that's really a high carb problem like you know flour is 80 carb 80 of the gram you know 100 grams of flour is 80 80 grams of carbs i'm sorry something like corn flakes you know 100 grams of corn flakes is 80 grams of carbohydrate these are very high carb carbs not really great for satiety per calorie but then way down on the scale you have what i call low carb carbs potatoes are way way down at 10 grams of carbs per 100 gram of potato you get a boiled potato um and it's about 10 grams of carbs per 100 grams of potato that's why potatoes have such a crazy high satiety per calorie apples are you know maybe 10 grams of carb per 100 gram of apple this is a fairly low carb carb berries are extraordinarily low carb carbs strawberries are ridiculous you could eat four pounds of strawberries that's 12 cups of strawberries and it's only 100 grams of strawberries so that's you know ridiculous you can't even eat that many strawberries raspberries are even slightly better there's so much fiber that you know you get about five grams of carb per 100 grams of raspberries it's ridiculously low so i really like berries i like tubers i like lower sugar fruit for me that's citrus that's melon that's apples these are all very low carb per weight and volume of food so it's like a satiety hack for me to eat these carbs in the evening and then focus on low carb carbs just berries melon citrus apples i might skip some of the higher sugar higher um energy density fruit like bananas i might not eat you know a bunch of bread and sugar and stuff like that you know i'm trying to stay on the on the low energy and nc carbs well so in today's day and age with cgm's being very popular people are learning so much more about their blood sugar so what is your reaction to people who try some of those carbs and notice their blood sugar just go higher than it's ever gone before you know they're spiking up to 160 180 with an apple with berries with a potato um do you say you know that's okay keep going it'll be all right or is it like okay you're not quite ready for that yet give it more time like what how do you respond i have a love hate with cgms right i love cgms because i i try to slap one on anyone who's pre-diabetic or diabetic and i'm like okay you want your average sugar to be lower you know you want your fasting sugar to be lower you want you want all these readings to be lower but like the the ups and downs are not necessarily always harmful you know for example high intensity exercise you do high intensity exercise and even a non-diabetic is going to have diabetic range glucose and if we just looked at that we'd freak out and say oh no one should ever actually you shouldn't exercise at all you should especially not do high-intensity exercise so you know i'm like okay if you haven't eaten carbohydrate you know all day long and now you eat a small amount of carbohydrate it sure it spikes your blood sugar a little but the satiety per calorie you're getting from that it might be higher at that point from something that was just pure fat you know what i mean and what you're not seeing with fat ingestion is that it is it's so slowly absorbed into your system that it is raising your fasting blood sugar 12 hours later if you drink a gallon of heavy cream right now you'll wake up tomorrow morning and your fasting blood sugar will be 10 points higher than it was the day before and people aren't seeing that they're they're seeing these um immediate blips and they're using those to choose more fat and less carb but they're not seeing this slow increase in their basal insulin glucose that goes up when you eat more fat and so basically if we if we really were paying attention to you know postprandial triglycerides if you had a triglyceride continuous triglyceride monitor and you ate your berries and your triglycerides didn't go up at all but your blood sugar shot up a little and then you ate your heavy cream and your triglycerides went up like 4x and then your blood sugar you know barely went up at all i think we would actually start seeing these patterns we saw the big picture like oh wow i eat fat and i'm a little bit more insulin resistant and my basal fasting insulin and glucose goes up you know the next day but if i eat carbs it goes my sugar shoots up comes right back down and that's kind of a trade-off like they're both sub-optimal so you wouldn't want to eat like a hundred percent carbs or a hundred percent fat or ton way too much of either one but there's there's kind of i you know i just feel like when people just purely eat to their glucometer they're not necessarily getting their very best satiety per calorie the very best fuel mixture yeah i mean that's interesting because you talk about the short-term changes um of glucose but the the longer-term change whatever causes you to lose weight become more insulin sensitive is what's going to help you in the long run so you gotta you gotta sort of balance your short-term changes because you know i'm concerned about glycemic variability i think there's good literature for people with type 2 diabetes that glycemic variability correlates with bad outcomes whether that's true for people without type 2 diabetes i don't know that we have that data but it certainly makes sense to me but as long as the long-term trajectory is still weight loss and insulin sensitivity over time and if you're sacrificing the short-term benefits for long-term detriment that's not what anybody wants so yeah i think that's a good point about striking the balance there but that's a nuance that's hard to talk about right because we don't have those measurements and we don't have that data and that's that's where people just start to you know kind of go crazy and throw their arms up in the air and say well if we don't have this information what am i supposed to do with it so that's challenging so your role as a as a physician to communicate all that to your patients is is not easy and that's where a lot of these diagrams in the book come in so handy i think look i mean this has been a great tour i think of of the concept of the pe diet and some of the specifics of it um and a lot of the details of of when it might work when it might not work who it's for any other last thoughts about you know how you how you see eating and how people need to see eating and what they can do to improve their health when it comes to food i i really think honestly that protein percent of calories is probably the single biggest lever that anyone has and if you haven't achieved the body composition you want my number one advice to everyone is try eating a higher percent of your calories from protein that that might not be a huge increase in absolute protein quantity it'll be a slight increase in protein and it'll mostly be a simultaneous reduction in carbon fat but hopefully you'll get better satiety for calorie and better body composition and so that's that's my number one message for everybody great message all right well thanks so much for joining us on the diet doctor podcast today ted thank you for having me [Music] [Music] [Music] you

Channel: Diet Doctor

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Keywords: keto, low carb, diet doctor, protein, P:E diet, Protein energy, ted naiman protein, ted naiman, ted naiman diet, dr naiman, increase protein, protein diet, metabolic health, carbohydrate reduction, carb reduction

Id: w_TbYpd9n0w

Length: 59min 7sec (3547 seconds)

Published: Tue May 04 2021