that would resolve like 75% of nutritional
issues. everything you knew for the last 50 years is clearly wrong. some people were
more successful than others is, some were more satiated than others. we want you to be at the
diet that you could look us in the eye and say, this works for me, I could do this for the rest
of my life. what's the best diet for humans? is there even such a thing or is it different for
everybody? arguably the goal of nutrition science is to figure out what's the healthiest diet. it's
also the topic of all this Lively debate on the internet. there are a few people alive who are
more qualified to answer these questions than our guest today. Dr Christopher Gardner is one of the
most respected nutrition scientists in the world, he's professor of medicine at Stanford, he
received his PhD in nutrition science from Berkeley and for decades he's been running
nutrition trials looking at the effect of different diets on Health, weight loss and
disease risk. we had a fascinating conversation about food, health and individual variability.
enjoy. I mean, all this fighting over my diet is better than your diet and these things, yeah, and
you're sitting there, you're one of the people who actually runs these trials looking at scientific
data on comparing these different diets, do you think there is such a thing as a universal
ideal diet or best diet for humans? or dietary pattern, however you want to call it? or do you
think there's a different diet for everybody? so I think there's a foundational diet. I
think as people are waiting for the genotype diet and the other thing, it's like, I swear
I think some people are holding out thinking, I know it I'm the Green Jelly Bean
person, I'm the Dunkin Donut person, I'm gonna be the one who's predisposed to thrive
on cotton candy. no! that is never gonna happen, cotton candy, green jelly beans and Dunkin
Donuts, they're not healthy, not for anybody, right? and so we have, I think we have this
foundational diet, eat food, not too much, mostly plants, sort of the Michael pollen kind
of thing, kind of as we did in dietfits when we had a healthy low carb and a healthy low fat, we
found very few differences at all, on average, but when you looked individually at the hundreds
of people in that study, some thrived and some failed on both of those diets, so I do think if
we had a foundational diet, which I end up saying sort of as the inner core is, more whole foods and
vegetables, less refined grain and added sugar. I don't know anyone who disagrees with that,
even Keto and low-fat vegan agrees with that, I can't think of any more Polar Opposites
than those two, they all agree on that, and in the U.S we do all four of those things
miserably, so like, couldn't we put our energy together to get those four, I think that
would resolve like 75% of nutritional issues if we did that. and then I feel like there's
a next core, beans, everybody likes beans, except for lectins, ah come on, get over it,
lectins are just not that bad. fruit, it has sugar in it, oh come on, it's in a food matrix, it
comes with fiber. nuts, they have fat, oh come on, it's unsaturated, it's really not that big a deal.
eggs, they have cholesterol, oh, let's go through the metabolism, dietary cholesterol does not
really affect blood cholesterol very much. fish, they have a face. okay, vegetarians, get over it,
most people think fish are pretty healthy. and so, there's an outer core of those things that maybe
the keto and the low-fat vegans won't buy into but I think everybody else does, if this was Zone,
Mediterranean, paleo, I mean other than the ultra extremes there's even that core that most of them
would agree with, and then after that when you get into poultry and Grains, think about that
for a minute, so Kentucky Fried Chicken versus pasture-raised, organic, whatever chicken, braised
and not deep fried, for grains how about steel-cut oats versus white bread, that's just really not
the same thing for grains, so pick those, and my outer core, that's the most controversial I
think, is dairy and red meat, and I still think there's room there, that if we were honest and
got together, yogurt, plain yogurt, not low-fat yogurt that's pineapple/guava/raspberry that
has as much sugar as soda, just plain yogurt versus Gogurt which, does that even have yogurt
in it? I'm not sure if it has yogurt in it. and on the meat side, right? so are we talking
hot dogs and a lot of processed red meat or are we talking regenerative farming, lean cut,
whatever, I think by the time, you know, I've had the privilege of sitting in with American
Diabetes Association, American Heart Association, the Menus of Change that came up with some
principles, I'm always kind of stunned how much a group of scientists looking at the evidence agree
on almost everything when we get together for these, and it's just when we get into the social
media world and some other things and some media headlines that it seems like, whoa, whiplash,
oh my God, everything you knew for the last 50 years is clearly wrong! and then you look
at the dietary guidelines for Americans, which apparently caused obesity, and you
see, updated every five years since 1980, the changes have been so painfully
incrementally slow, it's not like, there was no whiplash there, people, it was
always very incremental. go back and look, it'll say, watch your calories, avoid added sugar,
avoid saturated fat, get some exercise. it really wasn't very different in 1980, and it's not like
anybody did a 180. so I'm having fun trying to help explain that there is this foundational diet
that almost all health professionals agree on, whether it's a cancer, a heart disease,
a diabetes, an Alzheimer focus, and yet, sort of this world of Precision Nutrition is
pretty cool, people do have different microbiomes, I think people do have different levels
of satiety, I know people who are more satiated on higher fat foods and people who
are more satiated on higher fiber foods, and higher fat and higher fiber don't go hand
in hand, those are kind of different foods, so my My Hope Is that we'll come to more of
an agreement about more of a foundational diet that okay, basically probably everybody should
eat these, with room to personalize your diet based on some of those other factors is my goal,
so should we play around with The Fringe and get all hyper excited about, I do better on this
little thing? okay, but now you're having a donut for breakfast. yeah, I know, because what
I really need to do is avoid soy or avoid red meat or avoid this thing. but you're having
a donut. yeah yeah, so that's what I like to eat but I'm into this personal thing around the
edges and I... no no, if we get the core right, then you'll have more room to hedge your Bets
with some of those things around the outside [Music] actually one of my favorite slides that I show all the time now from a study that was
with NHANES data and really nice graphic over time from I think 1999 to let's say 2016, looking
at types of proteins, carbs and fats, and if you start with the fats, the percentage of energy
in the U.S diet from saturated, poly and mono is about 10 percent each, with hardly any change over
20 years, if you go to the protein side and you look at animal versus plant, it's almost always
ten percent animal, six percent plant, almost with no change for 20 years. if you go to the carbs, it
gets broken down into low quality and high quality carbs, and the high quality carbs is 10% pretty
much the whole time. now, I've left one thing out for the end, so just think about it, what's
left? 40. 40% of the energy from crappy carbs. it's like, do we have room for a lower carb
diet? yes. almost half our calories. and so fun thing for me is, could you replace all
of that 40 percent with high quality carbs? that would be high. if you were eating a crap
ton of vegetables and a crap ton of beans, it would be hard to get that many calories,
40% of your diet from more vegetables and beans. and if you're trying to do it
all from mono and polyunsaturated fats, you'd have to be drinking cups of olive oil to hit
that. so I don't really know any way you could do it without replacing some of it with high quality
carbs and some of it with unsaturated fats. an interesting little tidbit is, if you
go across different studies that I've run, because I keep noticing this no matter what
kind of diets I put people on, protein hardly ever changes. it's dramatic. people talk about
a 30 or 35% protein diet, none of my studies, and I haven't focused on a high protein diet
but I've had arms doing low carb, and low carb was wiping out a lot of grains and fruits and
beans, and not veggies, keep going on the veggies, and so that meant more eggs and more yogurt and
more fish and more meat and chicken and yet at the end of the day the protein content had barely
nudged as a percent of calories in a diet. really stunningly in real diet, and if you go
from country to country across the world, very consistent, 15 to 20 percent protein, so
it's really, if you wiped all those calories from carbs out, the crappy ones, it has to
be some balance of more carbs and more fats, and it's too hard to do just one or the other so
you will end up with a lower carb diet and I like to type this but the laptop always corrects me,
I type little l-o-w, big ER, like this is a lowER than I was eating before, but I don't know if it's
20% or 30% or 40% calories but it's not 50 or 60 because a crap ton of those are added sugars and
refined grains and those aren't doing anybody any good. or some people call it "lower low quality
carbs". I eat a "low low quality carb diet", some people like to use that. the LLC. the LLQC.
the low low quality carb diet. yes, I would be a fan of that, and then the challenge is always
Translating that, what does that mean? right. on this note of the nomenclature, people get so
upset, I started also saying on the videos lowER carb or lowER fat because we started featuring
some studies and even when the study uses in the title "low-carb diet", "low-fat diet", it´s
usually not the extreme version, it's usually 20 or 30% of calories, and immediately you get
a torrent of hate mail, "it wasn't low carb", "it wasn't low-fat", "useless study". because
if it isn't exactly the range that... and for some people the low is 20 and for some it´s 10 and
for some it´s five so you never please everybody, so yeah, it'd be great to, In your experience
actually running these trials, if you could speak a bit on this issue of adherence, like, how
hard is it when you try to get people on a eight percent of calories coming from carbohydrate or
from fat, and especially if it's longer term, how hard is it to get humans to stick to these
diets? so hard. okay, so you could do a Kevin Hall study where he says domicile, I say incarcerate,
I think he incarcerates them with prison bars and guards at the windows, and the food gets slipped
under the door, you can do that. my favorite study is an example, and I want to make sure I put
this in the right context, the pounds lost study is my favorite example of this, largest weight
loss study ever, 800 people, longest time ever, two years. elegant design on paper, so there's
two levels of protein, two levels of fat and four levels of carb to make it work. so the protein is
either 15 or 25% protein. 15 is on the low side and 25... those aren't extreme but they are very
different, 15 and 25. the fat is 20 or 40 percent. is 20 low enough to be low fat? yeah, it's lower
fat than most people get. and 40, yeah that's sort of even maybe more than Mediterranean.
and to make that work the carbs had to be 65, 55, 45 or 35. so on paper it was elegant.
at the end of the study two years later... and there's four groups, right? because there's...
all those different things are into four groups. the protein intake across the four groups on
average was either 20 or 21 percent. not 15 or 25. they couldn't do it. they couldn't get 15 or
25. and the fat range was supposed to be 20 to 40 and it was, it was only eight percent
different, it was like 35 to 27 or something like that. and the carbs was supposed to
be 65 to 35, was much lower than that, so you know, the lowest thing was probably
45 ish, which most people wouldn't call low carb. right. I think even if you got
dietitians, paid professional dietitians, and said okay, I want you to eat 37 and a half
percent of this and 42 and a half percent of that, or even rounded up, you get 30 20 50 and you get
20 40 20. or 40. they couldn't do it. you can't eat food... like, is that every meal? okay, no,
every meal is a little harsh, how about every day? whoa, at the end of the day you'd be sitting
there with a calculator thinking, crap, I had so much of that at lunch, I'm gonna have
none of that at dinner... how about every week? that could be a little more feasible but you'd
still be messing with your calculator, so this idea of hitting percentages is just not attainable
unless you domicile or incarcerate people, which is why, can I give a plug for our DIETFITS
study and our approach? sure. we call the approach "limbo titrate quality", and it's so funny that
they actually gave me the money and published the paper because we were having a healthy low carb
and a healthy low fat, we never defined what that was, we never said it was a percentage, and this
was because of my experience doing these studies, I know people can't hit it, and partly because the
reason we ran dietfits was, we were trying to see, we assumed there would be a massive spread of
success and failure across both diets and we just wanted to give both of them the best chance
possible, it's a term I like to call equipoise, make them both very challenging, give them both
lots of support, have dietitians who are teaching them be proud that they're teaching the best low
carb and the best low fat that they can, but as we recruited people I said I think you might be
predisposed because of a genetic predisposition or a metabolic predisposition of insulin resistance,
to do better than the person across from you who's being assigned to the same diet, and I'm guessing
at some point in a study you're going to come into situations where you show up for one of our
supportive classes and somebody says "God this is so easy, I'm kicking butt", and you're working
your ass off and it's not happening for you, and don't shame yourself. I think there might be
a reason that this person is more successful with lowering their carb or fat than you, please just
do the best you can. so the whole principle was, in the first eight weeks of the one year study,
go limbo, go as low as you can. lower. can you go lower? come on, I'm pushing you. lower.
lower. 10%? less than 10 percent? fat or carb? and we told them right away, that's not
where we want you to be at the end of the study, we want you to be at the diet that you could
look Us in the eye and say, this works for me, I could do this for the rest of my life, I
don't want it to be, oh study's over, thank God, I can eat again. because that's not going to
be very generalizable for the public, right? so after you did this limbo thing and
you hit whatever the lowest you could, you didn't get kicked out if you didn't meet
it, there was no exclusion for not meeting it, we said, kind of psychologically anchoring you and
trying to say, you are in a study, you are going to make the biggest change possible to lower one
or the other and now you're in the titrate phase, now add a little back, how are you doing? you feel
okay? oh, you're still craving things? Okay, add a little more back. okay, want to add a little more
back? oh, the weight's coming back on? is that bugging you? are you happy with that weight loss?
okay, go back down a little. and so we asked them to titrate and find the place that was lowest for
them that they could maintain without giving them a number, without saying "unless you hit 20 or 25
you failed and you didn't succeed in the study", so this is for your own personal success, the
grant reviewers let us do that and the reviewers who looked at our paper let us do that, the third
quality there was "Limbo titrate quality", we said, just whatever you do, don't do it by going
to the store and buying the thing that emblazoned on it says "low carb" or "low fat Cookies, Cakes,
chips, whatever", we want this to be whole foods, and so once you go to the farmer's market, if you
can, we noticed some cost and access barriers so we don't want you to break the bank doing this
but "limbo titrate quality" and you end up where you end up, and actually the way we kind of
framed it was, we said "America's waiting to know what a realistic low-fat and what a realistic
low carb diet" and when we have 300 people in each group, how much does that differ, because
we don't all expect you to hit the same thing, we think you are individuals and we think there
is room for this personalized Precision Nutrition and we want it to work for you whichever group
you're in, do the best you can, so it kind of cracks me up that I didn't get slammed by
Grant reviewers who are often very rigid, what do you mean you're not going to match protein
in these diets? you're gonna have one group go low fat and low carb, what if it's the protein? I need
you to match the protein at 18.2 percent. I've had that comment in the past and we let protein run
wild and at the end of the day it was almost the same in both groups. but we didn't try to match it
because that would have been very artificial and challenging and I know we would have failed, in
these human intervention studies, the real foods, you can't do it, you can't hit a percent. yeah I
think this is a lot of times what's missing from these discussions, is precisely this aspect of the
applicability to the real world, because people want these experiments to be just this perfect
numbers, everything matches, which you can do in a Kevin Hall setting but then what's the the
relevance of that for the real world? I mean if people can't stick to the diet what's the point
of knowing what is the perfect diet for weight loss if nobody can do it, or if people can do it
for a couple of months and then fall off the wagon after a year or two? there's no point. because
you're not going to house the entire population in a metabolic Ward so at the end of the day you
need things that actually work in the real world. but of course we have some exceptions, some people
who are very gungho who can stick to these extreme diets. and so I'm always wondering what is it,
from DIETFITS it didn't seem to be explained, if I remember correctly, from those
genetic factors that you guys looked at. so do we know if it's just discipline, that
these guys just push themselves harder, or is it like a metabolic difference, do
they like these Foods better? do we have an idea of what allows some people to stick
to these, to some diets better than others? so one of the theories I'm left with is satiety,
so a fun thing that I was looking at was an overview of diets and weight loss, it was put out
by the American Heart Association and the American College of Cardiology and the Obesity Society, and
they summarized all the diet trials and they said, here's all the different kinds of diets,
and really what we find is they all work to some extent for some people, there's a
little more evidence for some than others, and there's a little paragraph in there that I
just loved and I cling to even though I think most people didn't even see it, and it said "we
did see a range of prescribed caloric restriction and achieved caloric restriction", and my eyes
lit up because in dietfits we didn't give them a caloric value to hit, it was just low carb or low
fat, traditional weight loss studies have always perpetuated the myth that Kevin Hall has busted
that a pound of weight loss is 3,500 calories, which divides up nicely over seven days of the
week into a 500 calorie deficit per day per week, so if you wanted to lose 10 pounds 10 weeks in
a row, you need to have a 500 calorie deficit, which means first you have to figure out
what you need to maintain your weight and then you have to subtract 500 and then you
have to eat exactly that much, which is really hard on a day-to-day basis, and what Kevin has
shown is every week that you're losing weight that number actually gets higher, it's not a 500
calorie deficit, that's for the first few pounds, then it's a bigger deficit, and the bigger
the deficit the more the cravings come, and so in our study we never had a prescribed
calorie restriction but what they did was they reported eating about 500 calories a day less
because since they couldn't eat all those high fat foods or they couldn't eat all those high carb
foods, they didn't actually make up for them by eating the same number of the other kind of foods,
they just didn't eat those, and they ended up eating fewer foods, and I think what happened was,
some people were more successful than others is, some were more satiated than others. I've asked
this question in my class a couple times Gil, so maybe you can ask your listeners and we'll
see if they respond, picture sort of a cheesy egg breakfast versus some steel cut oats with some
berries and skim milk on it, something like that, and I find some of my students say, oh my God
that that oats, I would feel bloated and full and it would be a really long time before I
would eat again, and somebody else will say, I'd be hungry in a minute if I ate that, I'd
be hungry within an hour and I´d have to eat again. and how about those cheesy eggs? and some
say, oh cheesy eggs, oh that sounds pretty rich, I could only eat so much, and another kid said,
give me a second helping, I could eat like multiple helpings of cheesy eggs, I could just be
pounding those down, and one time when I took the poll almost half and half in the class, as to
which one they thought would be more satiating [Music] this is an anecdotal so Inever published
anything like this, in the middle of these studies, someone gets in a car accident,
they get divorced, they lose their job, and it's like, "just smile, be in the study,
have a great time, eat", and they're like, dude, I'm ready to drop out, my life sucks, I
have just this insane amount of stress. okay I looked and you're not eating what you're supposed
to. are you kidding? my life... you're lucky I'm showing up right now... actually turns out the
other way, a couple times we had people say, my life is so hard right now, thank you for letting
me be in this study, this is like something that's holding me together, it's like I need to do this
for science, it's a little bit of control I have over my life, but you can tell that some of these
life events that are really disruptive for people, they´ll blow this whole idea of willpower or
personal whatever. life happens. and so that's a clear Factor that's in here, I think satiety
is a clear Factor, we actually just published a paper that looked at respiratory quotient,
are you familiar with that? yeah. right, so if you're only burning carbs your RQ is about
one and if you're only burning fats your RQ is about 0.7, and most people on a given day in
the morning, when they wake up, have an RQ of something like 0.82 which means they're burning
fat and carbs. go back to dietfits and look, the people who had the highest RQ to begin
with, who got randomized to low carb, did a little better than the others, they were
eating low carb high fat and lowered their RQ and they did a little better than the people who
had a relatively low RQ and got randomized to low carb high fat, because they, I'm just speculating,
they didn't have much room to lower that RQ, so this sort of Baseline respiratory quotient is
another little tweaky personal thing. what is the balance of carbs and fats that you burn on any
given day? there isn't that much variability but there is some, that's what we published in this
paper just two weeks ago, there were actually a couple things that we found, sort of digging
deeper, all secondary hypotheses, all more sort of hypothesis generating than hypothesis testing,
but the next study might find people and check out their RQ. given all this variability that we're
seeing in the studies that we do, something explains it, so I'm very curious to know what
explains it. is it satiety? is it the microbiome? is it RQ? are these things that will... and
what percent of the noise will that explain? [Music] so there's a bunch of people who
overexpress insulin when they're eating carbs and the insulin puts their glucose away so fast it
goes hypoglycemic, a small percentage of people, but there's these people who are hungrier after
they eat carbs because they overly express insulin, that's a piece, and they're learning
that because they have all these folks wearing continuous glucose monitors, and so as people
contribute to those databases, in a big way we're learning things, and I think the things that we're
learning are fun and I think it will get better but it won't change the foundational diet,
it'll just compliment for some people. it will tailor it to individual needs and
individual preferences, maybe [Music]
