0 (1s): Coming up on the, get lean, eat clean podcast. 1 (4s): If you asked any cardiologists and you will, well-meaning cardiologists, you know, do you think blood sugar's important? Do you think triglycerides are important? Do you think, you know, domino obesity is important? They'll all say yes. I mean, they all, they all sort of agree it's it's in there, but the way practices are structured, where you don't have much time with your patient, when there are financial incentives to your bigger medical group, to get X number of people on statins to get LDL below a certain number. Those are our predetermined goals. That's going to get your medical group paid more money. Now that's not a perverse incentive in medical care. I don't know what is 0 (41s): Hello and welcome to the get lean eat clean podcast. I'm Brian grin, and I'm here to give you actionable tips to get your body back to what it once was in five, 10, even 15 years ago, each week. I'll give you an in-depth interview with a health expert from around the world to cut through the fluff and get you long-term sustainable results. This week, I interview the medical director of diet doctor and low carb cardiologist, Dr. Brett shirt. We discussed the advantages of living a low carb lifestyle, along with the truth about statins and LDL cholesterol, lifestyle tips to prevent heart disease, ways to reduce hunger animal versus plant proteins and his one tip to get your body back to what it once was really enjoyed meeting Dr. 0 (1m 27s): Brett shirt and his interview was hard hitting and lots of great tips. I hope you enjoy it as much as I do. Thanks so much for listening. All right. Welcome to the get lean eat clean podcast. My name is Brian grin and I have Dr. Brett. Sure. On welcome to the show. 1 (1m 44s): Thanks. Brian's pleasure to be here today. 0 (1m 46s): Yeah. I love having you on your podcast host. I'm a big fan of it died Dr. Podcast, correct? 1 (1m 54s): Yeah, that's correct. Yeah. I really enjoy doing that. You know, I don't know how you feel about your podcasts, but for me, it's like any opportunity to sit down and chat with all these amazing, interesting people. Like I don't care if anybody listens or not. I'm just having a great time docking all these people. And I'm just thankful that so many people find it interesting enough to tune in and listen. 0 (2m 11s): Yeah, I agree. I agree with you. It's been, it's been great. Just the networking meeting, new people, and like-minded individuals also have a book, right. Author of the, your best health ever. I was checking that out. When did you write that? What year did you write? 1 (2m 27s): Oh boy, that was a number of years ago, maybe 20 18, 20, 70. I got it. I got it. You, you, you surprise me with that one. I got to go back and check. It was a few years ago, but I think it, I think it's still holds up, you know, it's really just about the pillars of a healthy lifestyle that are not talked about enough or maybe overly simplified and therefore really not really talked about in a helpful enough way because when you boil things down to make them so simple, they just so many times don't really resonate or stick with people. So sometimes getting into the details and the nuances really make a difference. If you, you know, if the person can find what really connects with them and really give them their aha moment to help them along their health journey. So that's what it was the motivation for that book. 0 (3m 9s): Yeah. And I'm curious what got you into, I, you know, I, I know you're a cardiologist by trade, right? Maybe give the audience a little bit of a background on, you know, what got you into low carb and podcast hosting and everything. Yeah, 1 (3m 24s): Sure. Yeah. It's been an interesting journey to be sure, you know, I started, I was always interested in prevention, so my, my cardiology fellowship was a combined prevention and general cardiology. So I was just in my time in the hospital and the cath lab and do the echos and the stress test. And then I had an extra focus on prevention. Then I got into the quote unquote real world and I was excited. I was going to really put my mark on, you know, cardiac prevention and really help my patients. And my training program was an Ornish style program. You know, it was a great comprehensive program, getting people to quit smoking, get them exercising, get them, managing their stress, get them in, in good social environments. 1 (4m 5s): And then of course there was the very low, fat vegan based diet. And so when I got out into the real world and tried to implement all these strategies, boy was I just, I was struggling. And I noticed my patients were struggling and I'm embarrassed to admit how long it took me to figure out why, but, you know, I was just so sure that this was the right approach because is what I had been taught. But all the journals said, what's all, you know, all the, the big cardiologists and well-known cardiologists were saying, so it took me a little while to sort of realize this wasn't the right approach. So my first step was to say, you know what? I just need to spend more time with my patients. So in addition to my general cardiology job, I started a wellness center, boundless wellness health with a good friend of mine who is a amazing health coach. 1 (4m 52s): But luckily, luckily for me, he's also very knowledgeable about ketogenic diets. And so on a couple of our challenging patients, he suggested, Hey, how about we try ketogenic diet on this guy? And of course my first response is a well-trained cardiologist, which really crazy, I don't want to kill the guy. Right. But then he, to his credit, he just, you know, kind of looked at me and says, well, have you looked into it? Have you looked at the science? Have you read the studies? And I had to admit, I hadn't, you know, I was just going on what I'd been trained to do. So from there, it opened up a whole Pandora's box. Once I started realizing there's actually quality medical literature about low carbon keto diets. And this was back in, you know, eight years ago or more. And then of course the number of books that were out and it was like, huh, there's this whole new approach that we don't talk about because we're so ingrained. 1 (5m 36s): And we're so biased against dietary fats, but that's all been this place. And you know, I've said it before. So many people have said at once you see the benefits of low carb diets, you can't unsee them. And my approach has never been that it's like the one diet for everybody, or it's what everybody needs to focus on, but boy does it need to be an option for people. And the fact that it isn't even an option. And so many medical practices to me is just a crime because there's so many people we could be helping. So that led me down this path of, of low carb diets. And then I really just want them to spread the word. Like one of my biggest passions is educating clinicians because I know as a, you know, very well-trained preventive cardiologist, I was never taught this stuff. 1 (6m 18s): So what about an internist who really isn't focused on nutrition and exercise and lifestyle or other cardiologists or their endocrinologists, they're hardly taught this at all either. So really that's where the podcasts started to come from is I wanted to reach the average person and say, look, here's a cardiologist who believes in this and wants to show you how to implement it into your life appropriately, but also listen, clinicians, here's a cardiologist saying that this is an option and you should be considering it. So that led me down the podcast route. Unfortunately for me, the folks that died doctor, I guess, were a fan of my podcasts, the low-carb cardiologist podcast. So then we got together and, and now I'm the medical director of diet doctor and run the diet doctor podcast. And I've been there for a little over three years now. So it's a, it's been a great journey. 1 (6m 60s): No, 0 (7m 1s): Yeah. That's amazing. And as a cardiologist, obviously you're not, you're you're training, you're not getting taught the things that you learned after school, correct? Like this was something that you went above and beyond most cardiologists now aren't getting taught diet, lifestyle trainings, correct. 1 (7m 20s): Yeah. You know, in your general cardiology practice or just are your general cardiology fellowship, you may get a little bit of nutritional education, but it's all, plant-based, you know, it's all vegan, it's all low fat. That's still their traditional teaching. There's very little teaching about improving metabolic health through your low-carb lifestyles. There's, you know, the focus is still squarely on LDL with much less of an emphasis on, you know, triglyceride to HDL ratio, metabolic health, blood sugar, hyperinsulinemia that stuff is not really discussed in cardiology training now. 0 (7m 56s): Yeah. And it's, it's it? Yeah. It's sort of sad in the sense, because I even saw this with my dad recently, like he just got put on a statin and I was like, well, I was like, let me just see your blood work. I'm curious because what was the reasoning? And they didn't even, and I'm curious your thoughts about this, cause I know you talk about it quite a bit is, you know, they just look at total cholesterol and LDL all that's high. Okay. You should be on a stat and then really they, it is more, there's more detailed nuance to it than just looking at those numbers as you know, as a total. Correct? 1 (8m 31s): Yeah, absolutely. You know, we're, we're very much, cardiology is very much in the focus of LDL. No question about it at the, at the expense of other other markers. Now, if you asked any cardiologists and the well-meaning cardiologists, you know, do you think blood sugar is important? Do you think triglycerides are important? Do you think, you know, domino obesity's important? They'll all say yes. I mean, they all, they all sort of agree it's it's in there, but the way practices are structured where you don't have much time with your patient, when there are financial incentives to your bigger medical group to get X number of people on statins to get LDL below a certain number, those are our predetermined goals. 1 (9m 11s): That's going to get your medical group paid more money. Now, if that's not a perverse incentive and medical care, I don't know what it is. So that really sort of skews the practice towards LDL and Stanton so much more and look Stanton have their role. I still prescribe Statens. I am not in the camp that so many on the internet are that Stanton's are poison and shouldn't be avoided in all people. But, you know, do you use a terrible analogy? They should be used like pinpoint rifle with a laser site, not a shotgun to get, you know, everybody under the, under the sun. So, so I think they have their part and LDL is definitely correlated with cardiovascular disease and involved in the process of cardiovascular disease. 1 (9m 56s): There's no question about that, but to say it as the number one, most important thing that is causative of heart disease, I think goes a bit too far, especially when you're talking about, you know, you look at these, some of these studies that show the association between risk factors and heart disease and LDL, or even better able B are definitely on that list, right? They have an association, but things that are just way higher association are high blood pressure type, two diabetes metabolic syndrome, the lipoprotein insulin resistance score, you know, smoking family history. Those are all way up here, you know, those down here. So it's not that you should ignore LDL, but I really think our focus needs to be turned elsewhere, to look at the whole picture. And LDL is a part of that. 1 (10m 37s): And then put it into context, you know, in LDL, in the setting of metabolic dysfunction, low HDL high triglycerides is a different risk factor than LDL in the setting of very good metabolic health, normal blood pressure, low triglycerides, high HDL. You know, those are two completely different scenarios that should be addressed differently. Not across the board, LDL equals X equal status. That's where I think we really break down, 0 (11m 3s): Right. It's almost like too much of a simplistic viewpoint. If you just look at that one marker and say, okay, you know, let's, let's put that individual on a stat and because they have high LDL, what about like small and large particles not to get too down too much down this rabbit hole, but, but there are tests, right? That can sort of give you an idea, a little, get a little more into the details of it, 1 (11m 27s): Right? So your standard lipid profile that most people get at the doctor's office is not going to tell you anything about the size of the LDL particles you can use triglycerides and HDL is sort of a surrogate. You know, if the triglycerides are low and the HDL is high, chances are, your particles are more of the large particles. But to really know, you need to test it. You need to test the size of your particles. And it's very clear that the small denser particles are, have a higher association with cardiovascular risk. That is clear. Now the question is, is that the particles themselves, or is it because that, that setting is associated with metabolic dysfunction, diabetes, insulin resistance, and it's likely a combination of both the larger, less dense particles are clearly less associated with heart disease. 1 (12m 11s): Now I need to be clear though, it's less associate is not zero association. It's less association. So I wouldn't say, you know, if your particles are large, you can completely ignore them. No, you still need to pay attention to them. But again, within the context of all the other risk factors, the metabolic health triglycerides, HDL, blood sugar, insulin, blood pressure, all those things, put it into context, but I'm going to be a lot more concerned about the smart part, small particles than I am about the larger particles. And interestingly, when you talk about smart small particles, if you start somebody on a statin, it's not going to help your small particles. They may actually go up. The total LDL may go down, but your small particles may go up, which is the perfect example of Stanton does not solve all problems. 1 (12m 56s): You still need to work with lifestyle to improve those small particles cause the most important and effective intervention to change the small particles in the bigger particles in my experience is low-carb lifestyles and regular exercise. That is what you can do to really have your best effort at changing those small particles into larger part. 0 (13m 16s): Yeah. I'm glad you made that. Make that point because I had Dr. Robert Lustig on and he touched on that, that the statins actually might affect the overall number and more so the large point ones, as opposed to the ones that could have caused the damage, which is a small, 1 (13m 32s): Right, which doesn't mean in certain circumstances, you don't want to also lower the large particles. Sure. Some circumstances you do. You know, if we have patients with very high calcium scores and family history of heart disease, and you know, some people have small particles regardless of their metabolic health and that setting, you just need to lower the overall number to try and improve risk and do everything else you can do with lifestyle to try and improve metabolic health and make sure that is on point too. I mean, sometimes that's the right intervention, but it's a very individualized thing. And our medical society or medical practices are not really set up for individualized care. Unfortunately they're, they're definitely set up for guideline based care, treat everybody like the quote unquote average. 1 (14m 17s): We treat everybody like the, the same, pretty much like the middle group. That's how a lot of medical practices are set up. And that's, I guess, good if you talk about population medicine, but not so good if you talk about individual medicine and what I care about is for me as a patient is, you know, me individually and for the patient I'm seeing at the moment, I care about them as an individual, not as a population. 0 (14m 39s): Yeah. So we talk about low carb and keto, and this is definitely, you know, I don't like to put myself in necessarily camp, but I've probably been low carb for a while now. And I just feel better on that. But you know, there's people who actually can probably, and I know, and this is the one thing I love about your podcast is you have these differing opinions, come on and talk. You might have a vegan and then you might have a carnival come on. And, and it, it's, it's fun to listen to those two differing opinions. What would be, what would you say some of the, you know, biggest movers. I know you talked about exercise and low carb, but what are some of the other things that individuals can do to help improve their health as well? 1 (15m 21s): Yeah. And it's interesting, you know, I mentioned low carb, but again, low carb means different things, right? It does not mean everybody needs to be on a ketogenic diet. Certainly if you have type two diabetes or if you have maybe even a mental health condition or a neurologic condition, or, you know, there are certain settings where ketogenic diet is likely more beneficial than other versions of low carb, but to be on a moderate or liberal low carb diet, that's sort of high in protein and higher in fiber. Those can still be perfectly healthy diets. For many people, you know, different people have different levels of insulin resistance that may mean they want to start at a different level. But I think when you talk about the biggest markers, one of the first things you can do is of course stop the ultra processed foods and, and the quote-unquote junk foods, but that's easy to say and a little bit harder to do, right? 1 (16m 8s): You can't just tell somebody to stop it, see you later, right? You need to structure a diet. That's going to make them more likely to be successful with that type of intervention. And that's where low carb diets, or I think higher protein diets can come into effect because this concept of satiation or satiety or feeling comfortably full and not hungry is so important from a practical standpoint, but so often ignored when people give dietary prescriptions. So it's finding the right diet for somebody that's going to keep them falling. I love the data. When you look at low carb diets that shows even for ad-lib eat as much as you want, they tend to eat less just spontaneously. That's a powerful statement, same for high protein diets. 1 (16m 49s): They sent, they tend to just eat less spontaneously and that's kind of magic. So I think that's one big key is finding the diet that works for you. That helps your hunger, gives you enough protein and nutrition and energy and helps you eat less. Then the other part is what's going to impact your metabolic health and metabolic health is sort of a grab bag for basically I think hyperinsulinemia insulin resistance and it factors into triglycerides and HDL and blood pressure. All those things are interrelated frequently. That's going to be reducing the carbohydrates to help with that, and then exercise. You don't need to exercise to lose weight by any stretch, but it absolutely helps with losing the right kind of weight. Cause when we're talking about weight loss, what I don't want is somebody losing a lot of weight, both fat mass and lean mass, because then what happens if by chance they kind of fall off the wagon, so to speak or they start gaining muscle back or start gaining weight back. 1 (17m 45s): You only gain weight. You gain back as fat. You're not going to gain muscle back most likely. So now you've done a harm cause you've lost muscle and fat and then just gain back fat. So you're worse off than when you started. So for me, healthy weight loss means maintaining your lean mass. And that's where exercise really comes into play. And I think first and foremost has to be some form of resistance training. I'm still a big fan of cardio. I'm a big fan of high intensity interval training, but I see it as like a three-legged stool with resistance training, being the most important part of that stool because muscle mass is most important for metabolism as like a sink for blood sugar and to keep you functional and to keep you healthy for long-terms long time to come. 1 (18m 29s): Now, you know, that doesn't mean going to the gym and pumping iron and you know, trying to look like Sean Baker or some of these guys are pumped blood iron, but it means it means stretching your muscles in some way, whether it's body weight exercises or with bands or whatever, some sort of regular resistance exercise. And then trying to combine that with also some sort of cardio, because studies are very clear that higher cardio-respiratory fitness and physical activity correlate with better health and longevity. So if you can combine all that, that's key. And then of course there are lots of other things, you know, sleep and chronic stress are things we talk about a lot, but people don't necessarily prioritize a lot. And that's sort of the hump we need to get over is the discussion part to the practical implementation parts that people are trying to get regular consistent restorative sleep and people are taking time for themselves and are busy, you know, restaurant world. 1 (19m 21s): It's very easy to not take time for yourself and not just have a moment of sort of quiet reflection, relaxation, breathing, whatever works for you. I think all of those concepts are so important for long-term health. 0 (19m 34s): Yeah. I mean, you brought up a lot of great points and I'm glad you touched on sleep and stress. I think that's something that can get overlooked. I work with a lot of males and middle-aged males and it's like, that's like sometimes I'll bring that up. And they look at me like, what's, what's that all about, you know, like sleep and stress, you know, if you don't, if you're not getting adequate sleep, I mean, a lot of the other things, the pillars of health probably don't really won't come into play as much. So definitely. I agree with you with that. What just going back to touching on protein, cause I know listening to your podcasts, you just, you just had a couple of guests on one was I think a way to be more of an advocate of animal protein. One of them was a little bit more of an advocate of like maybe like a vegan protein or vegetarian protein. 0 (20m 17s): What did you learn from that? As far as, you know, quality and you know, w what's the most optimal way to get protein? 1 (20m 25s): Yeah. You know, it's interesting. The statement that animal protein is higher quality protein is absolutely true. No question about it. Animal protein is higher quality protein than plant-based protein, but that doesn't mean you can't meet your protein goals with plant-based protein. You certainly can. But if you're looking to do it, I think in the easiest with the fewest calories and the fewest carbs, focusing on animal protein is, is the best way to go. If you prefer to eat plant protein, you don't want to eat animal protein. That's perfectly fine. You can still meet your, your protein goals and you can have the same muscle building muscle maintaining effect as if you were eating animal protein. 1 (21m 7s): So it's not that animal protein is the only way to do it in the clear better way to do it. No plant protein will absolutely get you there. It's just different, right? It comes with more carbs. It comes with more calories. It requires a lot of mixing and matching acquires a little more attention. And, but that's perfectly fine for people who want to do that. Right. So I think one of the biggest take homes I learned is just that we have to be careful about how we say it, right? Animal protein is quote unquote, better, more bioavailable has the complete availability of all the essential amino acids in the right amount. But that doesn't mean it's the only way to do it, 0 (21m 52s): Which plant protein. I, you know, it's interesting. Cause I used to be like a pescatarian and I remember having plant proteins for awhile there. And I remember buying like hemp protein, cause that got, that got sort of like a lot of good reviews regarding a quality protein, but are there certain now, like now I don't, I actually more towards the animal based side and I think that's actually helped my lifting it's helped me put on muscle. Sure. But I'm just curious, like if someone is on the plant side, other certain plant proteins that they should maybe lean towards. 1 (22m 22s): Yeah. Well from a complete protein standpoint and a muscle building standpoint, I think soy is the best now. So it comes with its own concern. Certainly, you know, the majority of soy is GMO. So if that's important to you, you're going to really have to search for non GMO soy. There's a concern about maybe the estrogenic effects of soy. Well, it's got pro and anti estrogen effects. The majority of the studies in humans don't show an issue, even though there's some mechanistic concerns maybe it's got to do with the frequency and the mountain sorts of things. So if it's, if you're having a lot of soy protein every day, that's a different scenario than someone who has a few days, a week as, as a type of protein. But so it's got its own issues, unclear how important those are for most human intervention studies, but it is the most equivalent to animal protein. 1 (23m 12s): Now, beyond that, you just have to sort of mix and match your proteins. And you know, again, it's perfectly doable like this, the old beans and rice, right? So, you know, whatever amino acids, one is deficient in, you get from the other. So you get your full compliment of nine amino acids. But if you're just getting your protein from pea protein, or you're just getting your protein from beans or whatever, then you're going to be deficient in some of the amino acids. So it is this sort of mixture of proteins that you have to do, but again, perfectly reasonable, as long as you have the knowledge base to do it, you have the time and the interest in the effort to put into it and reasonable to do. 0 (23m 47s): Okay. Yeah. I thought that was an interesting interview with, with sort of both sides of the, of the table there. What about, what about fasting when it comes to this? Is this something that you implement into your life or that I know obviously with diet doctor, they, you know, it's actually a great resource I use, I've used it just to check out and you know, the some great outer articles and blogs and things like that. But what role do you think fasting has for individuals? 1 (24m 13s): Yeah. So fascinating first on that you have to talk about separate fasting time, restricted eating and then longer, fast. So time restricted eating is, I mean, really, it depends how you talk about it. Some people say 12 hour fast as time restricted eating to me that just shows how backwards we are, you know, 12 hour overnight fast should just be normal. That should not have a name associated with it. I think if you're eating that you're having a shorter than a 12 hour window that should have a name of like, like, I don't know, hyper eating or frequent eating or something. That should be the one with the name, not the normal 12 hour overnight fast. Cause that's what we're sort of meant to do. You know, beyond that, when you go 16, 8, 18, 6, OMAD they all come with potential benefits and potential downfalls. 1 (24m 53s): And I think that's, what's so interesting about some of the literature we've seen come out recently around time, restricted eating this question of, is it just a better way to reduce calories? And on the one hand, the answer might be well, who cares? What if it is? Cause if it is a better way for some people, then you're being successful and it's helping you because like I said, a big part is addressing the hunger, right? Being able to get adequate nutrition, reduce your hunger and health in a healthy way, reduce your calories. So time-restricted eating helps you do that. That's a huge victory. And if it helps you better than just trying to, you know, across the board, reduce your calories, that's a huge victory than it is that it works. And it's perfect. Right? Some people have the opposite reaction, which is kind of interesting. 1 (25m 35s): So if you go back a couple of years to a study by Dr. Ethan Weiss and his colleagues about time restricted eating the time restricted eating group actually ate more calories during the day. And I see this in my practice, it happens with some people that they feel this urge to kind of binge or to kind of make up for lost calories or feel like they need to eat more. And they actually end up eating more and having more cravings. So that's where this personalization comes in. If you're in that camp time restricted eating isn't right for you yet may not always be that way, but yet if you're not in that camp now, and then time restricted eating can be really helpful. And theoretically, you know, lower insulin, this concept of autophagy, it's still kind of unclear how long you need to be fascinating to tap into a tautology. 1 (26m 17s): But it certainly makes sense that if you could try to have periods without food intake, it certainly makes sense. That is helpful. Again, as long as there are no downsides to it, but like anything you can take a good thing too far. So one thing I am concerned about is people who eat like OMAD every day, one meal a day every day. And that's because, you know, basically protein, your protein demands for the day are still the same. Whether you eat three meals or whether you eat one meal. So if you're you a guy trying to put on weight, trying to get 160 grams of protein per day, that's pretty hard to do in one meal that was really hard to do in one meal. Now, some people can do it. I couldn't, I can tell you that I couldn't get 160 pounds of protein in one meal. So in that case, I get a little concerned about pushing the time, restricted eating too much, too long, too frequent. 1 (27m 3s): Again, I hate to keep saying it, but individually individualization comes into play. I just like people to know that it's, you know, they know the potential downsides and the potential concerns. Now, when you get into longer fasts, you know, so many people have had great success with longer, fast for helping their blood sugar and their insulin levels, getting off diabetes medications, and a little bit more concerned with those. Because if you're on medications, you definitely need to do it in conjunction with a physician who can help you change your medications around and show you what to be cautious about again. Then there's this whole world of longevity do longer, fast help with longevity like five day fast every quarter. 1 (27m 45s): And the answer is maybe right. It's so hard to show human longevity data. You have to extrapolate from animals and use surrogates in humans. So it's certainly possible. So in my practice with my patients, maybe half of them, I have doing longer fasts every quarter and half of them, I say, Nope, not right for you. Don't do it. That's where working with a clinician who has some experience is really helpful. So I see the benefits of time restricted eating, and I see the benefits of longer fasting, but we have to be aware it's not, not the right intervention for everybody. It's a tool just like anything. And sorry, one more point is the baseline diet, I think makes a difference. So in the most recent study that came out, I just did a video for it on our diet doctor, YouTube channel, they were following a 50% carbohydrate, you know, 25% fat diet and using time restricted eating. 1 (28m 34s): Well, I think the results might be very different if they were following a, you know, 15 or 10 or 5% carbohydrate diet and a 30% protein diet, right? Like I think those findings would be very different. And I would love to see that head to head comparison of time, restricted eating in those two groups, which hasn't been done. But that'd be really interesting because there's certainly mechanistic reasons to think that maybe it would be different. 0 (28m 58s): Yeah. Yeah, no, I mean, you bring up a lot of good points regarding fasting. I was actually just interviewed last night and I talked about old Matt a little bit and you know, I typically have two meals a day when one of the main reasons why I do that is because getting in the amount of protein that I want to get in, in one meal, it just seems like it's a lot, like, although I will say I don't really track my macros much. I'm going to start doing it just a little bit more just maybe for like a week because I eat the same stuff. So it's like if I track it for a few days, I know where I'm at. And I, I've never been like a big calorie counter either, but I was just, I'm just gonna do it for a few days and see where I'm at, but regarding getting enough protein. 0 (29m 42s): And what would you say, I know you just had your interviews regarding protein quality. What would you say? Like the, you know, you hear different amounts thrown out there. It probably depends on, you know, if the individuals looking to grow more, if they're more of just like, you know, maybe like a catabolic state, what would you say? How much protein would you say would be ideal? 1 (30m 3s): Yeah. So for the average person trying to, you know, lose weight in a healthy way, maintain lean muscle, lose body fat, improve their metabolic health. I think the 1.5 grams per kilo is a, is a really good starting point. You know, it can go up to two, maybe down to 1.2 for some people, but really shooting for that 1.5 grams per kilo and the per kilo of kind of referenced body weight or ideal body weight, whatever you want to say. We have some, some guides on the diet doctor website to guide people about this, but based on your bait, kind of based on your height estimate what your weight is, not your current weight. So if you're like 40, 50 pounds overweight, you don't want to use your current weight necessarily to, to gauge your, your protein goals. 1 (30m 47s): But, so I liked that 1.5 grams per kilo, which, you know, for the average woman is like 80 to 90 grams. And the average man is like 120, 130 grams somewhere around there. But of course, with individual variation based on how active you are, how tall you are, your age, your gender, you know, another number of other factors kind of come into play for that. 0 (31m 7s): And what about just switching gears a little bit? What about keto diets? As far as like in mental health, I noticed you, you interviewed Dr. Chris Palmer. What did, what did you learn about that? I know that's been used for a while now. 1 (31m 23s): Yeah. And that is a really growing field, but I'm really excited about, you know, cause I think I have to be honest when it comes to healthy weight loss, metabolic health, keto diets are definitely helpful, but you can also achieve very similar results with moderate, low carb diets that are well-constructed when it comes to the brain. That's where I think higher ketones and actual ketogenic diet is going to be far superior than moderate, low carb diets or liberal low-carb diets or otherwise sort of just like quote unquote healthy diets because this is where the ketones seem to have like their, I don't know, their magical power. You can call it right to have this added benefit about the way the brain uses ketones. 1 (32m 3s): And so I'm really excited about that. Dr. Shabani Steffi and Dr. Chris Palmer, they're really sort of on the forefront of the research and furthering this, this whole field of metabolic psychiatry, which I find so fascinating. And actually there's a, there's a podcast called the bipolar cast, which is really interesting. It's just sort of, it's a new podcast. It's on YouTube and it's people talking about using lifestyle to improve their bipolar disease. And the stories are incredible. I mean, you know, just the drugs piling piling up to try and control their disease and still having problems and not being able to get it under control, going to a ketogenic diet and boom, the drugs start coming off, maybe not completely, but certainly lowering. 1 (32m 50s): And that's so important because psychiatric drugs affect your brain, right? They can affect them in beneficial ways and with significant side effects. So anything that you can use to treat psychiatric conditions and doesn't have those negative side effects is really reassuring and welcome for most patients. So, you know, bipolar, potentially schizophrenia, even severe depression. And then of course, things like Alzheimer's disease, Parkinson's disease, traumatic brain injury is anything neurologic. It really does seem that the ketogenic diets can be beneficial. And the, you know, maybe the research was kind of teetering along for a little bit, but it seems like we're at this inflection point right now where the research is really starting to take off and it's really starting to get adopted. 1 (33m 34s): And I love that there's now a metabolic psychiatry clinic that, you know, five years ago, if you would have used those words, people would have been like, what's that that's not a thing. Yeah. Now it's a thing. And it's an important thing and it's a growing thing. So yeah. I'm pretty excited about that. 0 (33m 51s): Yeah. That that's, that's some great research that's being done. And I had, I interviewed doctor Diego Stino and we touched on that as well. Cause he's, he's he's does a ton of research around ketones and how they affect the brain. What was, what was the one thing you learned? Like if someone's listening to this, you know, you hear keto diet and there's many forms, I guess, would you say of keto diets in a sense, I mean, we're talking high fat, moderate protein, low carb, right. Is there anything else that individual should know or that you got from just doing those interviews? 1 (34m 23s): Yeah. So I guess a couple of things, I mean, when you look at the, a lot of the literature goes back to the seizure literature, cause that's where kid agenda guys were sort of first use. And traditionally it's been this four to one keto diet, meaning your, your ratio of fat to protein plus carbs is four to one. So a very high fat, lower protein keto diet, but now Dr. Eric Kossoff and others have done studies with a modified Atkins diet, which is a lower fat higher protein. So still not low fat by any means. Right? So instead of like, you know, 85% fat, maybe it's 70% fat. Now the protein is going up like 20, 25% or something like that, but that was still beneficial for seizure control. 1 (35m 2s): So maybe there is this a broader spectrum of ketogenic diets, as long as you're still in ketosis, your ketone levels are still reasonable. You know, you can play with the diet and have a little more flexibility to still have beneficial impact on neurologic conditions. And, you know, look, I'm not a researcher, I'm not on the forefront of this. I'm just following along as others are doing the research. And I find it really interesting. And you know, you mentioned Dr. Dom D'Agostino, so him and his colleagues, they're, they're putting on the metabolic health summit with actually as we're recording this right now, sort of the end of April, it's going to be next week. So I don't know when this is coming out, but those going to be next weekend, it's really a dedicated conference for ketogenic therapies. 1 (35m 45s): A big focus of which is on mental health and neurological function. And then there's a pre-conference, which is focusing specifically on metabolic psychiatry put on by the bazookie group and the Milligan foundation. And these are, you know, they're basically philanthropic foundations led by very well-meaning and very involved individuals trying to help further this field. So it's a really exciting time. 0 (36m 14s): Wow. Yeah. And yeah, so that's a whole week of just like, that's a big conference. Where is that in? Is that in 1 (36m 22s): Santa Barbara? 0 (36m 23s): Santa Barbara. Okay. Very cool. What is your, 1 (36m 26s): And so people can still join if they want or going virtually as well. And it just put that plug in, there's a, there's a virtual way to access it to. 0 (36m 33s): Yeah. And what would you say, what are your thoughts regarding, I know this is maybe not even a right answer to this, but you know, you have this, this calorie camp first, like the carb insulin model, I'm sure. You know, we could probably talk to her blue in the face and go back and forth on this, but, you know, cause you'll have Dr. Jason know I've had Dr. Jason Fung and he, you know, he's obviously all about lowering insulin and Dr. Ben Beekman and people like that. And then you have other people who are like, well, you know, calories do play a role more than we think. And what are your thoughts regarding that? 1 (37m 10s): Yeah. I mean, look, I think it's clear calories play a role, but that's very different than saying all calories are the same. And all you have to do is lower your calories and you're fine. Like those are, those are, are not the same thing to say, calories play a role at the same time, carbs and insulin play a role. But that's not to say that carbohydrate insulin model explains obesity. And it is the one unifying hypothesis that we need to address. That's not true either right there. Plenty of examples, contrary to the carbons, the model. So I think, again, the problem is when we try and boil it down to one thing and say, this is the one thing instead, you know, acknowledge that we are complicated people, human beings, we are not just emotionally, psychologically, we're physically and physiologically very complicated with a lot of processes going on. 1 (37m 56s): So how much you eat matters and the quality in what you eat matters and when you eat matters. Right? So I guess the other part about the time restricted eating thing, I didn't mention whether you eat your calories more in the morning or in the evening, like that makes a difference, right? So there's, there are a number of different factors and so absolutely insulin plays a role. Absolutely. But just lowering your carbs, isn't the only way. And the 100% successful way to lose weight and improve your health. So I think we have to recognize that. And so I think the key is finding ways to successfully long-term lower your calories in ways that also help you maintain your lean mass, not be hungry and lower your insulin. 1 (38m 39s): And that's the key. And you know, the more pieces you put in the puzzle, the more complicated you get. But I think that, you know, the dietary structure sort of remains the same, right? Or even no matter how many pieces you put on it, the dietary structure remains the same, make sure you're getting adequate protein, make sure you're avoiding the hedonic foods that trigger more cravings and trigger you to eat more, you know, make sure your, the, your carbs that you're focusing on are the higher fiber, lower energy density carbs, and then use your fat to help you enjoy your meal because we have to enjoy our meals. Otherwise we're not going to eat it, but don't think of fat as like a free food that you can just pile on as much as you want. That can work really well for ketogenic diets in the beginning. 1 (39m 21s): But I think over time, it sort of catches up with people and that's where we see keto diets. You know, people start to stall or even gain more weight or, or why not. So I think that's the key prioritize your protein limit, limit the foods that, that trigger your craving, focus your carbs on the higher quality, higher fiber carbs, and use that donut don't avoid fat. Don't think fat is bad, you know, eat your fat naturally fatty foods and then add fat to enjoy your meals. Just don't go overboard and think of it as a free food. I, I think that's the structure that if more people adhere to that general, those general principles, we'd be in a much better position than we are now in terms of, you know, obesity type two diabetes metabolic disease. 0 (40m 1s): Yeah, no, you, you lay it out really simplistically and well, I mean, everyone's, I know, like you mentioned, everyone has to sort of do their soul own like self experimentation on themselves. Right. And find, you know, that sort of, that what works for them. Whether no matter what camp they fall into. One of the things that I, you know, we talked about fasting, one of the things I will say I like about fasting is sort of the black and white simplicity of it. And, and, you know, it gives you structure too, right? Like if you know that you're eating within the certain time period, cause I think a lot of bad habits can happen in the evening. And so I just think one great tip I like to use for my clients is, you know, pick a time when you're just going to close the kitchen and, and because that'll just help you get into a facet state, it'll, you'll avoid late night eating and you know, then you got your overnight fast and if you want to break it and have breakfast, that's fine. 0 (40m 53s): But I don't know. I just think there's something to having that structure on a daily basis. What did you learn? I know, you know, you had Dr. Panda on who's big and who talks a lot about obviously early time restricted eating and, and has studies around that. W what did you learn from Dr. Panda? 1 (41m 12s): Yeah. I mean, he is, he's such a wealth of knowledge and the research he's been doing for, you know, decades really, he's been on this topic for such a long time. And really sorta, I think on the podcast, I called him the godfather 0 (41m 26s): To get them on. I'll have to get them on. 1 (41m 28s): Yeah. Yeah. He's going to be a metabolic health summit too. So I'm looking forward to connecting with him again, but just the role of circadian is so important that not only does our brain have circadian rhythms, but our individual cells have circadian rhythms and, and the way that plays into this concept of what is healthy, what does a healthy lifestyle that we really can't ignore their circadian rhythm and, and how it's something that most people don't really pay that much attention to. Like when he did the, when he collected the data of people using the app and just putting it in when they were eating. And when, you know, it was sort of like all over the map, they're really, you know, people just don't really by themselves paying much attention to that. So I just, yeah, that's, I think the one takeaway is, is we do really have to pay attention to the circadian rhythm. 1 (42m 11s): And, and I love the point that you made, like one there's, there's eating within a time window to, to be more consistent with our circadian rhythm, but two, like how many people at nine o'clock at night are snacking on broccoli, cauliflower, steak and salmon, or I know it's not what you eat at nine o'clock at night. So there's also the concept of where the quality really degrades that you need to, you know, you can really benefit doubly by cutting it off both to be more in line with circadian rhythm and to, because you've automatically increase the overall quality of your diet by getting rid of that 9:00 PM to 11:00 PM snacking, 0 (42m 48s): Right? Yeah. No, that's a good point. I mean, most people aren't, aren't static, they're snacking on hyper palatable foods that will just lead to more hunger. Right. And yeah. So nothing happens pet. Yeah. So I, I think just picking a time to just like, I like you cut it off and you know, you're done and do do with most of your clients, are you having them in here inherited, like, let's just say two meals a day, or, you know, no snacking and things like that. 1 (43m 17s): Yeah. It's really variable. Like I think the no snacking part is pretty important, you know, to get out of this concept of eating five or six times a day, that's pretty important. But you know, a lot of my patients just do better eating three meals a day, and some of them do much better eating two meals a day. And the important part is finding out who's who and not making them say, you know, people think like, oh man, I'm not time restricted eating. I'm really not helping myself. I'm not doing it right. It's like, no, that's not the case at all. You can still have tremendous progress and improvements without time restricted eating. You got to find out if it's right for you. 0 (43m 51s): Yeah. Awesome. Well, this was great, Dr. Shaw. And I always ask this question, even though I feel like you answered it like 10 times, but I'll ask it either way. What, what one tip, maybe you'll think of something else. What one tip would you give an individual that's looking to get their body back? Let's say they're, middle-aged 60 50, and they're looking to get their body back to what it once was maybe in their thirties. What one tip would you give that individual? 1 (44m 20s): Yeah. I mean, it is hard to give one tip, but, you know, I would just have to sum up by saying, you know, eat better and exercise better. And what does that mean? Well, it means prioritize protein, avoid the hedonic foods, you know, focus on the high fiber carbs. Don't be afraid of fat, use it to enjoy your food and, and start doing some sort of resistance training. That combination, if we could get most of the population doing that, we would be in a much better position. And then at the same time, recognize that sleep and stress and social connections and life enjoyment plays a role too. So don't be, so hyper-focused on these things that it's like, you know, bringing you down in a stressful situation, you got to find a way to fit into your lifestyle, where you can still enjoy your life and enjoy everything else and enjoy your family and your loved ones, because that's equally as important. 1 (45m 6s): So that's not one thing that the big long, 0 (45m 8s): So that was like 10 things, but that's okay. That's okay. Well, this was great. I, I appreciate everything you do with as being a cardiologist and sort of spreading this message. I think it's so important. And, and just with your podcast at di doctor, I love listened to that as well, so yeah, I appreciate you coming on and thanks for sharing so much knowledge. 1 (45m 30s): Yeah, my pleasure, Brian, thanks for having me on today. 0 (45m 34s): Thanks for listening to the get lean clean podcast. I understand there are millions of other podcasts out there and you've chosen to listen to mine. And I appreciate that. Check out the show notes@briangrin.com for everything that was mentioned in this episode, feel free to subscribe to the podcast and share it with a friend or family member. That's looking to get their body back to what it once was. Thanks again, and have a great day.
