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Language: en
and your new book makes a pretty bold
assertion that I would like to get
straight into around fat and that being
fat does not necessarily mean that
you're metabolically unhealthy that was
scandalous when I read it so how can
that be true now listen I'm going to
throw myself under the bus here
when I was in medical school I was given
the same lecture about metabolism that
pretty much you can look up on Wikipedia
you know it's a blah blah blah blah blah
chemical reactions and everybody assumes
that has these assumptions about body
fat and Metabolism right so you're born
with the faster a slow metabolism and if
you're born with a slow metabolism
you're going to struggle with your food
because you're going to actually gain a
lot of body fat and struggle with your
weight that's what a lot of people feel
people always feel that like your
metabolism is gonna shoot up when you're
a teenager
eating two or three dinners bouncing off
the wall full of energy must be
metabolism going up and then of course
the the main thing is that people in
their middle age you know like 30 is
sort of like the last Golden Era of
Fitness once you get to 40 45 50 55
menopause you know all that kind of
stuff your shape's gonna change because
your metabolism is going to slow down
you're going to gain body fat because of
a slow metabolism and so I always wanted
to figure out all right
why does all that happen and is it
actually true that we're born with
different metabolisms and Metabolism
naturally slows as we get older and that
being fat is bad for you this is the
part that I consider scandalous well
here's the thing
being fat is a subjective statement what
I would actually say that that that my
my book addresses is that body fat isn't
harmful in normal at a normal level fat
is actually good
the big Discovery is that fat is an
actual organ in your body that forms
when you're in the womb and in fact if
you didn't have body fat you wouldn't
have a metabolism you need body fat it
creates hormones that drive that fuel
your metabolism it sounds kind of weird
like it like it would be the opposite
but in fact if you didn't have body fat
you wouldn't have any energy all right
it's only when you have too much body
fat
that that basically the entire system
goes into chaos all right too much body
fat a little bit of body fat is like air
traffic control running the way it is
landing planes taking them off the
Runway too much body fat is basically
like uh putting a a rock and roll band
into air traffic control tower all right
and playing as loud as they can having
the crowds Rush In And now the air
traffic controllers are distracted don't
know what to do and extra body fat
derails your metabolism so it's not a
slow metabolism causes you to gain body
fat and gain weight it's the other way
around
extra body fat slows your metabolism so
it's not quite right that being fat is
good
having fat is good having too much fat
is bad well let me ask a really pointed
question yeah that I took away from your
book that you're gonna say yes to this
but I maybe not uh in the book The
paraphrase that I wrote down was being
big isn't necessarily bad and so what I
want to know is can you be
clinically obese and be healthy like
could you when you look at somebody when
I'll I'll say it from my perspective
when I look at somebody who's clinically
obese with love in my heart I just think
they're killing themselves and just by
seeing that they're obese I know they're
unhealthy but when I was reading your
book it made it sound like I can't make
that assumption they may be because it
certainly isn't automatic that having
that kind of body fat is good
but it may not be as automatic as I
thought that that kind of body fat is
bad great point to discuss so body size
is different than body fat and obesity
so people are big they can be they can
have big body size I mean think about a
heavyweight boxer or an Olympian who
actually you know is a weight lifter
those are big people let's go to the
example you give in the book which is a
sumo wrestler exactly I was going to
bring that up so I look at a sumo
wrestler and I just assume they die
young 100 no offends or butts they are
going to Die Young the amazing thing is
that they are actually at a peak of
Fitness uh when they're actually
training and they're overloading their
bodies and they've develop that shape
they're very strong they're
metabolically stable uh they don't
actually have problems with glucose
regulations what is metabolically stable
mean it means that they are able to
process their food without having huge
insulin spikes it means that they're
they have normal levels of energy their
inflammation levels are not through the
roof which by the way is a matter of
training sleep discipline food their
diet is very specific as well but the
point is that if a sumo wrestler isn't
tragically ill for the period of their
career we do need to rethink just
because you're big doesn't mean that
you're sick now chronic obesity coupled
with poor diet coupled with the least
inflammation coupled with poor sleep
coupled with stress coupled with lack of
physical activity okay that is sort of
that's the that's the train wreck that
actually begins to happen what do we
know about longevity of sumo wrestlers
do they because like you'll often hear
the statement and I haven't looked
closely enough of the data to know if
this is true but it seems intuitively
true that you don't get heavy set
centenarians like people that make it to
that age they're all going to be thin
uh I don't think that's necessarily true
it's what we would imagine to be true uh
I think people can be portly they could
be middling is there any data on this I
don't know of any data that takes a look
at you know uh I mean look I I I I think
that what you're trying to get at is is
there evidence that obesity actually is
not harmful but helpful perhaps and that
you could have better longevity by being
having X carry on excess body fat and
the answer is no yeah I'm going to say
your book paints a far more nuanced
picture and so the the
nitty-gritty that I want to get into is
around that so the case that I'm trying
to build to see if I can get myself on
board with this idea because reading
that and I happen to be researching two
people right now that are both making a
very similar claim in their books and I
was so literally in the last 48 hours I
feel like I've had my world upended and
it's like oh the Earth is is round it's
not flat what and so so I I feel on
unshaky ground so here's how I read your
book okay there is a sweet spot you can
be too fat and you can not have enough
fat but there are two times in the book
where you say that actually being skinny
is the more dangerous thing and so you
said you're far more likely to die of
all cause mortality if you're
underweight than if you're overweight so
that was startling statistic number one
and then the other one was that if
you're if you have lean diabetes which
I've never even heard that phrase before
but I get it what I used to call skinny
fat so if you have lean diabetes you
have the blood markers like if I was
looking at your blood panel because
metabolically you're just a mess I would
assume that you were obese but in
reality you're not that that's more
dangerous 2.5 times you're more likely
to die I don't know I can't remember if
it's all cause mortality or heart
disease or whatever but you were two and
a half times more likely to something
terrible uh if you were lean diabetes
and if you were obese and had diabetes
so I was like whoa this really does feel
like the table's been upended yeah well
so let's kind of do a reset to say what
does body fat actually do okay and and
and I you know so as I was writing this
book because I'm very curious about
where things come from where does fat
come from fat isn't you know we
associate fat as adults as you know
something we see in the mirror and when
you step out of the shower and we might
not like what we're seeing or step on a
scale and you look at a number somewhat
You're Expecting and you kind of curse
it right or if you go up to the grocery
store and you walk by the butcher
section the meat section you see nice
steak with a big rind of fat on it you
go ugh like it's it's we're we're as a
society
I think that we have some repulsion to
the idea of seeing anything that's
associated with fat but it turns out
that it's not always true when we look
at babies
when babies make us smile they're pudgy
they're fat big pot bellies big fat
cheeks or arms and legs are like
balloons Twisted together like in the
you know in a carnival it's cuter than a
baby it's not not cute like if I rolled
out of the shower looking like Twisted
balloons I would not be impressed that's
true but on the other hand if you had a
baby that had chiseled cheekbones long
thin arms long thin thighs like a like a
runway model that would also not be cool
you would think that that baby is sick
and indeed it would be and so the real
question that I started asking is what
is the developmental role and what is
the adult role of body fat when does it
start and what does it do over the
course of our lifetime because you talk
about longevity so what is actually this
thing called fat actually do where does
it start and where does it go so here's
actually the interesting thing body fat
starts in the womb uh at about eight
weeks after your mom's egg met your
dad's sperm and the first tissue that
gets laid down are blood vessels because
every organ needs a circulation then the
next tissue are nerves because you need
instruction options to be able to
operate your organs and the nerves can
convey those instructions another tissue
that forms right after that is fat
fat the cells that comprise fat are
called adipocytes okay adipose tissue
adipocytes and the way that they form
looks like bubble wrap you know the
bubble wrap you use for packing right
the small bubble wrap and what they do
it's like they bubble wrap around blood
vessels and you go like okay so they're
not forming like in the waist or the
butt right away why do they form around
blood vessels well it turns out this has
to do with a later fate of what the fat
cells actually do for you fat cells one
of the functions that they do uh they're
padding okay so good thing we have fat
to Pat us so we didn't have any body fat
we slipped on a rug fell on the ground
our organs might rupture all right so
padding is good number two fat and this
has to do with the blood vessels fat
cells are fuel tanks for our energy all
right so our metabolism relies on fuel
tanks just like your car relies on some
kind of either a battery or a fuel tank
and when your fuel runs low
you gotta actually go to The Filling
Station or the charging station to tank
up
fill up on your your fuel for your car
similarly when our fuel tanks run low in
our body under healthy conditions okay
uh are we we have to go pull over to The
Filling Station what happens to be a
dinner table a refrigerator pantry
restaurant to be able to fill up on our
energy which comes from our food and our
metabolism uses all the energy its needs
to kind of run its operating system so
blinking heart beating walking around
but anything extra gets stored in those
adipocytes into our fat now why are they
near blood vessels because when you
swallow food you digest it from your
stomach it gets absorbed or your small
intestines gets absorbed into your
bloodstream and guess where the energy
needs to get stored right in the fuel
tank right out of the blood vessel so
from a time where babies before we're
born that's where the fuel tanks are all
right and that's what one of the things
that it does padding fuel tank the third
the third thing that fat does for normal
healthy function for metabolism for
health health is it actually is an
endocrine organ
so our fat releases hormones normal
healthy hormones for our metabolism at
least 15 hormones have been identified
from fat that fat makes almost you
exclusively and three of them are
critical for having normal energy normal
a metabolism our fat controls normal
metabolism in healthy people so what are
they what are the three hormones that I
want to talk about number one uh
something called leptin now you might
have heard of leptin as sort of like the
satiety hormone it makes you feel full
but I like to explain leptin as a volume
switch when you actually have a lot of
leptin you are not that hungry but if
you can talk you can it's not a toggle
but you can actually turn it down when a
leptin goes lower you got to fill up in
your fuel tank because you're hungry so
it's part of our gas our fuel gauge to
let us know if we're hungry we need to
fill up or not okay so very important
because we didn't know we didn't fill
our tanks we'd starve all right it's a
signal second there's a hormone called
adiponectin
okay and many of your listeners may not
know what a typical necton is I'll tell
you uh uh if I uh Tom uh took you into a
medical clinic Drew your blood for a
regular physical exam and told the lab
from our vial of blood to measure every
hormone in your body and tell me what
the levels were including adiponecton
that a dipanectin in your body would be
one thousand times higher than any other
hormone in your body it's a thousand now
why is it that important because a
dipinectin is which is made by fat is
what allows insulin to bring fuel into
your body is it a is it a molecule
that's calling for fat is it saying or
for the insulin to come and store it
partners with insulin to make insulin's
effect of bringing in your blood glucose
more efficient it actually insulin will
do its job adiponectin will do it a lot
better in fact so what happens is that
if you screw up your fat and you don't
make a dippinectin so let's say ultra
skinny somebody with less than five
percent body fat like bodybuilder type
all right they're not having a lot of
adiponectin they actually have problems
with energy because they don't have
enough fats
to have their insulin working okay I'm
not following though why why does it why
do we need such a high quantity and do
you know the mechanism of action what is
it actually doing so I have a visual I
can put around what insulin does in
terms of coming to the cell looking for
insulin receptors and actually shuttling
typically glucose into the cell to
actually store it as adipose tissue but
I don't know what a different neck and
binds to it's a different receptor on
the same cell that insulin does and it
actually helps insulins function it
actually triggers the the pathway that
it allows insulin to bring in that
energy more efficiently swifter it's
kind of like uh
uh wd-50 is kind of like the grease to
allow insulin to actually bring that
fuel in you don't have it around you'll
insulin still work but not quite as
efficiently your diseases were uh
dependectin is uh it breaks down and we
start having problems and if so what
does that look like well you know I
think that uh there are inherited
diseases where a dipinecta may be
affected and you know people might not
survive they can't their metabolism it's
like inherited disorders of metabolism
would it have the same result as insulin
resistance where you just can't produce
enough to get it it kind of like is like
insulin resistance like insulin is not
not performing uh what it uh what it
wants to actually do and do you know
does the body respond to that by
producing more insulin thinking like oh
this is I just need to keep shoving more
in to get this out of the Bloodstone to
see if they can so insulin levels will
rise and so basically if you have too
low amounts of body fat you don't have
enough adiponectin all right um what
happens is that your insulin's not
functioning properly your body will make
more insulin to see if it's maybe the
problem is insulin let's make some more
insulin so that's if you have too low
body fat similarly if you've got too
much body fat all right by the way
before we go there a dipinectin brings
the the energy helps insulin bring the
energy in a third hormone made by fat
it's called resistant if a dipinectin is
the gas pedal resistant is the break so
you're you're you're you're eating fuel
you're you're eating food you want fuel
insulin is going to store it into your
cells so you're in the fast lane now a
dipinectin goes boom pedal to the metal
let's get in the fast lane to make our
metabolism as efficient as possible
let's bring that energy in baby all
right resistant is the break up got a
truck ahead slow down not so fast all
right and so this gas pedal break
accelerator and Brake works all the time
to help fine-tune our metabolism at
different points of the day very very
important too little fat like Ultra lean
bodybuilding you know or starvation you
know uh type of situation you don't have
enough addicted nectar you're going to
be very very weak and your insul is
going to try to rise to compensate but
still is not working efficiently that's
how important it is now the other side
of the spectrum all right if you have
too much body fat
this is where fat functions like a
cancer
so fat like any organ requires a blood
supply but if you actually overeat and
you have too much fuel stored it's like
going to the gas station and instead of
having to click in the nozzle when your
tank is full there's no click it just
keeps on pouring out gasoline what's
going to happen in your car gas tank
fills up the gas the fuel runs out of
the tank down the side of the car around
your tires around pools around your feet
and now in a gas station you're standing
in a toxic flammable dangerous mess now
in your body we don't also we don't have
an automatic clicker so to stop all we
do is we can keep on eating seconds
third something delicious or maybe even
worse something not good for you like
Ultra processed foods or sodas and you
just keep on slugging it down your
metabolism is your is going to store it
into body fat and now your body fat can
expand 300 times its size now you cannot
see body fat uh with a naked eye you
need a microscope to see the cell of
body fat but once it blows up 300 times
you can actually start to see these fat
cells all right so you keep on eating it
blows up more keep on eating it blows up
more more fat stored more energy stored
oh run out of fat cells for your fuel
tanks are all stuffed up
your body will tap into stem cells to
make more fat cells and now those will
get filled up as well so you can see how
overloading on fuel when does it start
so when you get something like a
non-alcoholic fatty liver disease uh I
assume we've filled up all of our cells
that's right we're not able to make new
cells fast enough exactly and so now is
is
glycerides what happens is that the fuel
leaks out of the fat cells in what form
it's actually like squeezing out uh well
it it's it's stored in a particular
triglyceride form in the cell but when
it leaks out it starts to really become
uh different types of short medium and
long chain fatty acids that are just
seeping out okay of our of our of our
fat cells stay in the blood how do we
get to something like non-alcoholic
fatty liver yeah so chronic overeating
is basically like chronically
overfilling your gas tank the fuel is
going to start leaking out of the cells
out of the fat cells and it actually
goes right into your bloodstream yeah
and because your liver detoxifies your
blood it goes straight to the liver and
unfortunately fat in that leaking form
is toxic to liver cells so as the liver
is trying to clean up your blood to
detoxify it the fat toxins the leaked
fat toxins kill your liver injure your
liver which then leads to scarring which
then leads to non-alcoholic fatty liver
disease interesting so it's not actually
an accumulation of fat
on the cells of the liver which is what
I was imagining I was imagining like
visceral fat on the liver but it's not
it's scarring the liver it's actually
destroying it I mean first offense
actually does accumulate but then it's
toxic all right is it accumulating
around the liver in the same way that it
would accumulate around other organs or
is it because it's trying to process it
out it infiltrates the liver so if so
you know if you if you look at a a CAT
scan of somebody who has uh visceral fat
or a lot of subcutaneous fat you'll see
a rind of the fat in different parts of
the body in the liver it's much more
nefarious when fat accumulates in the
liver it kind of penetrates the spaces
between the cells and just gets stuck
there just get stuck there and while
it's stuck there it poisons and it's
toxic to the liver cells so it's fat
plus liver the liver cells are dying the
fats are still there and then when the
cells are dying uh you know your body's
trying to clean it up autophagy and all
that other kind of stuff except that
there's it can't regenerate fast enough
Liberation regenerates can't regenerate
fast enough and the toxicity causes
inflammation of the liver and then the
inflammation kills the liver more and
then scarring sets in and now you've
basically replaced normal liver cells
with hard scar
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so if we catch that early can we reverse
it in diet
we can but the problem is that
non-alcoholic fatty liver disease is
kind of just slowly sneaking up on you
disease most of the time like by the
time you know you have a problem or the
doctor can detect you have a problem
it's really the end result it's the car
crash you know that was happening in
slow motion for years right but so and
and by the way this is actually one of
the big epidemics it's a pandemic really
of the non-alcoholic fatty liver disease
it's the number one reason for having
liver transplants now wow used to be
alcohol
no more or hepatitis no more it's now
overload of fuel leaking toxic fat that
scars your liver shuts it down and now
you need a liver transplant okay so uh
why does alcohol create fatty liver
disease I get why overeating and you
just literally run out of storage space
which means it's in your blood which
means the liver is trying to clean it up
but with alcohol why isn't it just
scarring from alcohol when does it
become fat got it so look check this out
alcohols directly toxic to your body and
the liver is very sensitive because the
liver is desperately trying to detoxify
the body metabolism alcohol into you
know something less toxic all right so
on one hand too much alcohol it's not
you know it's not a glass of wine it's
not a beer it's chronic alcoholism that
actually weighs on the liver by
poisoning the liver direct toxicity but
guess what alcohol is the sugar
so alcohol itself is overloading your
cells you gotta It's gotta it's gonna be
stored into the fat which is still then
running into the same problem so is it
literally uh it starts as your cells are
trying your liver's breaking it down
sending it to be stored you're
overfilling your cells it's coming in
too fast to make new cells it's leaking
back out of the cell and now the liver
is trying to clean up the fat and that's
then now we have the exact same problem
that is one of the common Pathways
however don't forget alcohol that We Sip
we drink we chug all right the you know
the keg party that alcohol is right in
our blood and goes straight to the liver
all right where it's poison delivered so
basically I'm trying to figure out why
it's called fatty alcohol disease like
why why I if if it is what we just went
through and at first it overwhelms your
metabolism your fat stores are kicking
it back out because it's just too much
too fast right and then we're back into
the liver then I understand the process
if it isn't that I don't so let me ask
the question a slightly different way
okay you're a medical doctor if I set
before you a liver that had
alcohol-driven fatty liver disease and I
set one in front of you that had
non-alcoholic fatty liver disease could
you tell the difference or they would
look different on the microscope because
the alcohol itself poisons the liver so
it's basically uh uh you you see
alcoholic livers are actually shrunken
they're not as fatty so you call it a
fatty alcohol disease it's alcoholic
livers are shrunken because actually
they're poisoned and they start to
decrease it's true some fat can
accumulate because alcohol itself gets
metabolized and stored into fat so over
time and by the way this is not a it's
like I said it's not a TR it's not a
light switch it's not like if you don't
drink you're going to be fine if you
drink you're going to be cook your goose
is cooked this is a matter of degree
if you abuse your if you abuse food even
healthy foods every abused drink over
time these are the kinds of things that
can actually happen so moderation
self-control discipline taking it easy
you know fasting you're going to go
there all those things can actually
contribute to reversing the good thing
about the liver is that it's one of the
organs in our body that clearly
regenerates at a very very fast pace
there's not that many organs that can
actually do it quickly but deliver
if I took your liver and removed any
operating two-thirds of your liver the
one-third that's remaining will grow the
rest of it back over the course of a
year
so injure livers if you give it a break
cut down on your food intake your
caloric intake
stop drinking
the damage will start to reverse even if
you have scarring
well at the point of scarring
no that's there forever that's that's
why you would then be could you go cut
out like let's say that uh two-thirds of
your liver is scarred could you go in
and cut out a third or a half and get
that to then regenerate I assume it
would regenerate Health you know
unfortunately the damage can be very
very uniform so you sort of just need to
replace it that's why liver transplants
common interesting okay I'll believe you
obviously know so much more about it it
seems like you should be able to cut a
piece off and have it grow back but well
it will try to grow back except that
once you've actually replaced healthy
liver cells called hepatocytes with scar
tissue there's not enough cells working
cells left to regenerate God right so
and by the way when you regenerate when
the liver regenerates it needs to grow
within a happy medium of its own uh
architecture it needs to be in the
garden of the liver but when the garden
of the liver is filled with scar tissue
it can't doesn't have enough stuff to
hang on to it can't reform a healthy
liver you've got scar that's kind of on
the interstices it's kind of penetrated
the liver mostly scar tissue and and you
can't grow back right what has started
you won't do the Regeneration process it
not only won't it'll actually start any
cells that do want to regenerate it'll
block their path because it's in the way
so you can't replace the scar wow okay
that sucks
um I want to go back to the sumo
wrestler so that we can get to the the
full picture here of what I'm really
trying to understand okay so we know you
need some fat one of the earliest things
that you get as a fetus is fat super
important we find babies cute because
they're pudgy because pudgy is good for
them as we get older I know that we have
a deeper road to go down which will
probably go down after we finish the
Sumo thing of these phases of metabolism
but it's uh you need some fat for many
reasons but I certainly before reading
your book and I think even still I think
you're going to say this is true that
there is a point at which you become too
fat and now the fat becomes problematic
and I'm wondering is that point you're a
hundred percent fine it is not
negatively impacting your health in any
way as long as the fat isn't being
squeezed back out
or is there like a BMI that you sort of
Ballpark and say look if as long as
you're under 15 body fat for a guy and
23 body fat for a woman though I'm
making those numbers up but like you're
fine
um is it that or is it no as long as it
doesn't squish back out you're good it
has to do with the fact that every
individual has their own optimal amount
of fat in their body that they carry
around and how do you know when it
becomes a problem what are the signals
the you know the metabolism is a great
actually clue uh obviously you can
measure so first of all fat comes in
different forms white fat Brown fat the
white fat can be under the skin
subcutaneous Under the Skin why don't
you break down real fast what what is
white fat okay white fat is the most
common fat it's most of the fat in our
body and it looks white Under the
microscope and it can be located in two
and it functions it's a fuel tank it
actually
um uh that gives a padding and it can be
located in two main areas one is under
the skin which you can see that's the
wiggly jiggly lumpy bumpy stuff that you
see in the mirror it's the muffin top
it's the thigh and butt it's the stuff
under the arm under the chin that's
subcutaneous you can see it then a more
dangerous version of white of white fat
is called visceral fat visceral means
gut so this is the fat that's packed
inside the tube of your body all right
so you could be thin it'd be looking
thin have a thin tube but have a lot of
fat in there or you could be a big
person with a and and have a lot of
extra fat as well or maybe not so much
fat you're just you just got a big frame
all right the amount of visceral fat
turns out to make a big uh have an
impact it's a more deadly kind of fat
visceral fat think about it like um
peanuts that you put into a container
you're shipping like you go to a FedEx
and you're going to ship some light some
fluorescent light bulbs so you're going
to ask for a thin box and now you got to
pad that light bulb so you can ask for
some peanuts you can buy a big pack of
peanuts you're going to throw them in
and you've got just enough but yeah I
don't waste the peanuts I'm going to
stuff them all in there okay and now
you've actually put way too many peanuts
for that box but you can force them in
there so much that the peanuts are
actually choking the light bulbs Force
the Box shut tape it shut at arm's
length that's still a skinny box but
inside the peanuts are killing the light
bulbs that's what can happen that's what
skinny fat is when you have too much
visceral gut fat it's like a baseball
glove of fat wrapped around your organs
and it's filled with inflammation when
it's too big now the reason that big
huge amounts of fat become dangerous is
because they outstrip their blood supply
when you have normal amounts of fat
they're fed like every other organ in
your body but with blood vessels you
need oxygen you need nutrients into your
blood vessels this is what I study it's
a process called angiogenesis how blood
vessels grow and when fat expands
because you're loading up the fuel okay
before it leaks you're loading up the
field it's going to grow now now you're
loading it we need some more more fat
cells to grow if when it when it starts
to grow Beyond its blood supply you can
fill it up much faster than the blood
vessels can grow then what happens in
the center of that mass of fat it starts
to die it doesn't have enough oxygen and
it doesn't have enough oxygen it starts
to die you get inflammation once
inflammation gets into that massive
white fat in your gut the visceral fat
think about that skinny FedEx pack with
too many peanuts or it could be a big
package as well all right it's also got
too much packing in it then what happens
that inflammation completely Causes
Chaos among the hormones that are there
now that fat that was making leptin
making it dippinct and making resistant
it gets confused because there's so it's
like a wildfire going on in there it's
chaotic leptin goes well I don't know
should I be high or low should you be
hungry or not hungry I can't tell
anymore I forgot a dip a neck and goes
well should I be making more should be
or should be less uh I don't know what
do I do with insulin I don't know and so
a different neck does start going up and
down just like remember I told you if
you don't have enough fat a dip
connecting goes down if you have too
much fat it's inflamed your your fat
doesn't know how much you're dependent
to make anymore it's confused it's got
brain fog same thing as resistant I
don't know break on or break off and
that's really the beginning of metabolic
syndrome how do you tell metabolic
syndrome you have insulin resistance
your glucose levels go high you you can
have a big waste your waistline gets
bigger you got visceral fat and by the
way with all that fat uh you got a lot
of blood that's got to kind of find its
way around that fat your blood pressure
goes up it's not so easy to pump that
blood through your body anymore and
that's what metabolic syndrome is high
blood pressure right high blood
cholesterol high blood glucose and a big
waistline that that's how you tell when
you're saying how do you know when
you've actually exceeded that safe Zone
these are the clinical signs that we see
in the medical office
okay so when you look at somebody and
you see that they have a high body fat
percentage
I'm thinking of the Sumo still
you look at that and go as long as the
it was accumulated at a rate that the
blood supply could keep up with that
accumulation there's not necessarily a
problem here
it's a little bit more complicated than
that because uh excess amounts of fat no
matter what are going to put pressure on
your circulation on your heart remember
I told you it's still hard to pump that
blood even just through a lot of fat
mass that back pressure in your heart is
going to actually wear down your heart
um now you know I know you want to kind
of focus on the Sumo I look at Sumo as
kind of a an extraordinary
exaggerated and somewhat grotesque
version of actually growing too much
body fat to see what they what the uh
extent is of growing body fat but still
staying healthy now now Sumo wrestles
are healthy because they're working out
all the time and only they're eating it
to create their big Mass all right
they're eating a relatively healthy meal
they're not eating french fries the
whole time it's a very regimented diet
they're exercising they're getting diet
they're kept in Stables more or less of
training where they're actually getting
sleep and they're they have a they have
a very rigid schedule and their stress
levels outside of competition are really
you know they're they're trying to stay
calm most of the time so these are all
factors these lifestyle factors also
affect our body fat are we physically
active are we getting enough sleep uh uh
what kind of diet what's the quality of
the food the fuel that we're actually
eating how much stress do we actually
have and now we're realizing enter a new
Dragon which is actually our gut health
our gut microbiome our gut microbiome
our healthy bacteria 39 trillion of them
in a healthy body contribute to
streamlining your metabolism they work
along with insulin they work along with
adiponectin to help your metabolism
streamline pulling in that energy
so I could have asked the question
another way which would maybe be even
more informative as to why I'm focused
on the Suma wrestler and the other way
to ask the question would be if I wanted
to get obese in a healthy way could I do
it the reason I'm so interested in this
question is there is a debate raging in
culture which is can you be healthy at
any size
and up until 48 hours ago when I read
your book I would have said no you
cannot absolutely unequivocally if if I
look at you and you have a a
dramatically high body fat percentage I
can tell you immediately you are
shortening your life period end of story
and I would have been able to pass a lie
detector test but it doesn't mean that
I'm right it just means I believe it and
so reading your book I'm like maybe
there is a way to get obese in a quote
unquote healthy fashion but I need to
keep exploring it I you're definitely
making me believe that this is a far
more intricate picture than I was
originally giving it credit for not
surprised at all as the island of my
knowledge grows so grows the shore of my
ignorance so I'm not at all surprised to
find that I didn't know nearly enough uh
but I am still hung up on a lot of what
I think I know about the metabolic
signaling that fat does
that getting fat is a mind that you have
chronically elevated caloric intake that
you're probably overeating sugar which
is going to be another thing that we're
going to need to get into uh
and that almost certainly
people that get to that level of body
fat percentage they have not done it in
a controlled fashion and so I wanna know
if we just have to rule out and say yeah
I really can't tell if you're healthy or
not from looking at you we're going to
have to run a lipid panel or whatever
metrics it is that we're going to look
at but you know what you're talking
about actually is so important to say
which is
I I you know as you were characterizing
this looking at somebody you can judge
whether or not they are they're they're
unhealthy based on their body size
because they're fat okay let's break
that down you would not be able to look
at somebody and know how what kind of
body fat they have you could guess and
you might be right but how much visceral
fat they have you know somebody who's
obviously obese and we've we've all seen
people like that they're you know
there's that's a that's a far that's a
that's a far end of the that's a that's
a tail end of the curve those people are
clearly not going to be healthy and
those people have very shortened
lifestyle I would put a sumo wrestler on
that scale but those people who are
morbidly obese they're not exercising
they're not eating a healthy diet that's
probably how they partly how they got
there to begin with but what that tells
you may have fat isn't the problem it
becomes the lifestyle that's the problem
lifestyle contributes to the growth of
fat excessive fat excessive fat right
and so what really matters for most
people
is actually the kind of fat you have and
the extent of that that kind of fat
visceral fat it's a lot worse more white
fat more visceral fat those are setting
you up and you know the the opposite
side of the sumo wrestler is the
Apparently thin person who also is obese
on the inside you would never judge them
to be obese you might even think they're
healthy but they're probably not
exercising they're probably eating a
very poor diet and although you're not a
human dexa scan that could actually see
the Superman to be able to appear inside
the body and resolve maybe the
Terminator to resolve what kind of fat
that they actually have all right they
they are I wouldn't say equally
unhealthy but it's very difficult to
judge by the size of a person except at
the extremes well according to your book
it would be the the flip if I look at
them and I realize that they are lean
diabetic they're in worse shape than an
obese diabetic so like again getting
back to we've we have found the edges of
what I understand yeah so that was a
very surprising find for me okay so
knowing that that reframes obesity for
me so as soon as I read that in your
book I was like okay so here's the
prediction that makes and I've certainly
heard other people say this that
adding fat to your body is actually a
metabolically protective mechanism and
that if you're able to put on fat more
easily you are probably in better shape
because you have a way to get the excess
glucose out of your bloodstream store it
as fat and if you're able I don't like
so I get fat very easily my wife does
not so for me putting on fat is very
simple which tells me that either I my
fat cells maybe they do 320 percent
bigger or something or I'm just very
good at generating the other ones or or
your metabolism is very efficient So
based on how much you're eating and the
quality of the food you're eating it
gets stored into your fat quite
efficiently I wish it was a little less
efficient uh yeah I hear you so okay so
there for some reason my body and people
like me they're able to get the uh the
excess sugar energy however you want to
look at it out of the bloodstream into
the fat cell
and that is very protective and so now
as they get bigger and bigger
and adding on more and more fat there is
from what I hear you saying there are
ways to do that well and I don't yet
know if you feel like it's there is no
longevity implication to the sumo
wrestler as long as he's working out in
fact maybe that's right let me just ask
that point blank uh would you estimate
that sumo wrestlers as a population will
live just as long as
anybody else that eats a similar
composition of diet I'll be clearly
fewer calories look sumo wrestlers are
trained when they're young and they work
out and they have a very regimented diet
I mean and a lifestyle they're under
control but like any athlete I mean look
at that that's the part that I keep
having lost that but but here's so
here's another but here's another one
think about other big athletes you look
at an NFL player all right oh they die
they're big but you know the reason that
they they they wind up eating a lot of
food so they have a huge caloric intake
when they're working out now I think
it's getting better because they're
actually trying to study that but then
what happens when they're when they come
off the field when they retire they're
still eating that kind of food maybe
worst quality food now they're not
working out
all right now they actually have a
completely different lifestyle where
they continue to eat a ton of food maybe
not high quality food instead of
overloading but they're not actually
physically active so and that they're at
a different point in their metabolic
cycle as well so the the the point of
the matter is is that if some you know
it's a it's an experiment that hasn't
been done yet they have a sumo wrestler
who who gets trained when they're you
know in their late teens actually
continues to have their same lifestyle
over the over the entire spectrum of
their adult life it'd be like an NFL
player who basically plays ball until
they're six years old it doesn't happen
we can't do that experiment you know
like if you we don't know how to do that
study if a football player we're
actually to do exactly what they do over
the course of their life would they live
longer than somebody who stopped playing
at the age of 30 and then went on to eat
junk food and become sedentary for the
rest of their life we can't compare that
so for a short period of time sumo
wrestlers go to a far extreme of body
fat accumulation
some would say even a grotesque extreme
in which you would think that they'd be
metabolically unhealthy you would think
that they would develop diabetes they
would develop heart disease they develop
cancer like because we associate this
with older people who are obese and the
fact is that it's not true they're
actually remarkably fit for their size
but let's not forget they're young
they're trained they're diets regimented
they're exercising their their whole
life is actually contained and
controlled
because they stop their Sumo training at
a certain age we won't know whether or
not this early exposure is going to lead
to premature death right I mean I would
imagine that sumo wrestlers after they
finish training and I and I don't know
this I mean this is that I don't know
I'm as a scientist I can tell you an
honest tells you when they don't know
something sure and I'm just telling you
I don't know if any Studies have been
done on retired sumo wrestlers and their
metabolic consequences of their earlier
training it'd be something interesting
to study but in no case is getting fat
young protective of longevity protective
of other diseases as well okay so it
isn't doing them any favors we just
don't know if it's doing any harm when
it's done in that very controlled so
many aspects of the lifestyle are on
point uh but they're still getting fat
it's interesting so here here's the base
assumption that's driving my obsession
with sumos in this interview I have
lurking in the back of my mind even
though very smart people tried to tell
me to let go of this but it doesn't make
sense to me yet again could just be
ignorance I have a feeling that there's
just only so much food calories that you
can process in a lifetime and that you
people tell me not to think of it like
this but I just think it is the right
way to think about it that the body
eventually has done all the things that
it's going to do that whether it's
um gumming up because you've eaten a
certain amount of sugar and all of that
and so just so many things stick around
as they talk about forever chemicals
they accumulate whatever but the only
thing that's shown efficacy for
extending life in basically every animal
that has been tried on is caloric
restriction so I infer from that then
that well over feeding even if you're a
Michael Phelps and you're staying
shredded because you're just working all
those calories off
that that you still you ran those miles
man like a car that gets 250 000 miles
on it uh it's gonna have some wear and
tear to show for it and so the metabolic
system has done those 250 000 miles so
even if you're lean even if you're a
sumo wrestler and you're in good shape
I've just it just seems impossible that
there isn't some sort of price to be
paid for that I agree with you I I 100
agree with you I mean you can actually I
think that it's an interesting
kind of calculation to make right you
eat three meals a day average person
lives what 82 years old now
you can calculate the number of meals
you're eating you can calculate based on
your body size uh how many calories you
might or might not be eating every day
if you were ideal you can calculate how
many blood vessels are in your body
sixty thousand at 60 000 miles worth of
blood vessels you can calculate the
number of times your heart's going to
beat uh over the course of a lifetime
you know and you can actually probably
come up with a metric that approximates
fairly accurately what the total caloric
what what the what the Goldilocks zone
the zone of tolerability of the calories
that you could intake over the course of
your life would be and so you know to to
to
um to to work with you on this thought
process this thought exercise you know I
wonder if you were to eat more calories
if you assume that there's a caloric
bank account that you're limited to over
the course of your lifetime if you eat
more in the beginning and less at the
end uh do you does everything balance
out don't really know you know and I
think it's because there's so many
interconnectedness or if you eat less in
the beginning you know kids born during
wartime that are starving right and then
later on they they have appeared to
Prosperity War's over now we got a job
and now we're actually exiting our
company that we started and now you just
start to pig out and so now later on in
life you wind up over feeding
net net from the from your bank account
as long as you stayed within those
calories are you going to be okay now if
you exceed those allowable calories it's
I'm just I'm playing this mind game with
you it's really interesting to think
about it that'd be like a great model
like a research model to actually like
after this thing I'm going to start to
work on that probably because it's so
interesting yeah over the course of your
lifetime
yeah this is uh this is a really
interesting question that I found the
book so fascinating because you're
really pushing against some of the
Notions that I felt most confident in so
one thing as we're going through and
we're talking about you know Michael
Phelps or a sumo wrestler I want to know
do you think it what's more important
diet or exercise both are both are
equally important there's no you know
like we always want to simplify it like
okay do you want to be dropped in a
volcano or eaten by a shark neither okay
and I think that when it comes to
exerciser's diet they go hand in hand
they're different but they do go hand in
hand you could have a perfect diet and
and do no exercise and you're going to
be compromised you could exercise your
own time and go and eat a crappy diet
junk food staple diet and your exercise
is you know you might look good for a
period of time but inside you're going
to be terrible and so I think it's
really and by the way it's only exercise
and food you're talking about what about
good quality sleep what about Stress
Management you know these are the four
legs of the stool for our metabolic
Health all right let's hold everything
equal and uh let's talk now about
quality of calorie yeah so if I were
let's say that I was going to grossly
overeat and I have a normal more or less
sedentary life and I'm going to eat five
one person my identical twin my
identical twin is going to eat 5 000
calories a day of ice cream
and I'm gonna eat 5 000 calories a day
of a plant
primarily plant-based diet with a little
bit of fish and chicken and stuff but
I'm still eating 5 000 calories it's not
easy anybody that's tried it I know uh
but I managed to get my calories in so
we both have the same overage
will the blood will whatever metrics you
look at whether it's visceral adipose
tissue where it's stored my cholesterol
levels and what parts of that may or may
not matter uh the walls of my arteries
like is there going to be any difference
given that we're eating the exact same
number of calories this is for people
who say it's just a question of calories
it doesn't matter what they're making I
mean you know the whole idea of of
quality calories is absolutely critical
you know you can have a a candy bar that
has
304 a thousan