Simply Health ME

Help support the podcast by becoming a patron on Patreon! Finally got a chance to sit down with Dr. Sam Madore of Weightloss207.com. This episode is perfect for Maine residents to listen to and hear his approach to wellness.

Please consider donating to our Patreon and support keeping the show free from advertisements:  In this episode we chat with sleep consultant/coach Martha Lewis. Her website, https://www.thecompletesleepsolution.com/ is where she helps people combat some of the issues we all face when trying to rectify our sleep. It was a fun conversation and she echoed quite a bit of what Emmy and I talk about constantly on the show on the importance of prioritizing sleep. Enjoy!

Feasting  What is “feasting”? The refeeding process after a deliberate period of not eating (fasting).  What is “re-feeding syndrome” Refeeding syndrome has been defined as the “potentially fatal shifts in fluids and electrolytes that may occur individuals with prolonged malnutrition (mainly low phosphorus)  Refeeding problems can happen once food is given, particularly carbohydrate-containing foods. During the refeeding period, insulin and other hormones are activated. This causes electrolyte shifts.  (phosphorus, potassium, calcium and magnesium) Avoid by not fasting if you're malnourished. Very long fasts should be have doctors supervision for slow introduction of food.  Why is refeeding so important? Autophagy happens during fasting and in order to replenish those expunged damaged proteins et al, you need nutrients(material) to rebuild new, healthy cells and tissue. **Some could argue that refeeding is even more important than fasting.**   What are the most nutrient dense foods to refeed with? Vegan options? Liver Salmon Eggs Avocado Sauerkraut (highest source of vitamin C) Oysters Spinach Seaweed Steak Mushrooms Sardines almonds     Bioavailability of animal foods vs plants - be aware.  Be careful of RDA. It's the minimum to prevent disease not optimize health. Protein is a great example Side effects of breaking a fast incorrectly for your body Abdominal pain, diarrhea, nausea, Suggestions Avoid highly glycemic foods (they can pull water into GI tract and cause diarrhea - this is called “early dumping syndrome”. Late dumping syndrome relates to huge insulin spike after huge glucose load and low blood sugar after the meal.  SXS: abd pain, nausea, weak, dizzy   More on Nutrient Density check out Chris Mastrjohn phD https://www.biohackerslab.com/ep90-dr-chris-masterjohn/ https://chrismasterjohnphd.com/what-chrismasterjohn-does/2018/06/22/what-i-eat/ https://www.nutritionadvance.com/most-nutrient-dense-foods-in-the-world/?fbclid=IwAR3r-pgTE-jdZPXZvWIupE9jQ-z9ASs04BsysaLZvNdDljCAl569vmPmXWs https://www.dietdoctor.com/fasting-and-re-feeding-syndrome  

Mitochondrial Health E96 What is the mitochondria of the cell and why is it important? The “powerhouse of the cell”. Mitochondria are in each cell. The mitochondria take energy like glucose, fatty acids, amino acids and convert that into ATP (adenosine triphosphate) which then powers your cells  Cells make up tissues, tissues make up organs, you are organs wrapped up in skin. If you have dysfunction of your mitochondria it affects your whole body. Most chronic disease (maybe all?) have a degree of mitochondrial dysfunction which may be why many disease have fatigue as one of their many symptoms.  How your body handles stress in the environment may be largely related to the mitochondria health. Some stressors are good and strength the mitochondria but if too much (chronic) over time that can lead to mitochondrial dysfunction i.e fatigue / disease / aging  etc.  The more mitochondria you have and the healthier that mitochondria are the more able you are to be resilience (preventing you from disease / obesity / aging etc. )  http://www.biology4kids.com/files/cell_mito.html What are some things in our environment that affect our mitochondrial health? Negative environmental factors   Aging!!!    Dec number DNA mutation Change of structure Decrease autophagy Increase in oxidative damageDecrease in antioxidants Not enough mitochondrial stimulation (good stress - hormesis)We are too DAMN LAZY AND COMFORTABLE Positive environmental factorsExercise (best) Cold shock therapy Heat shock therapy (SAUNA)  Intermittent Hypoxic Training (a type of breathing exercise) Nutritional variation More on Hormesis Your cell is stressed.  Transient burst of oxygen reactive species to cell. Cell’s anti-oxidant system is up regulated and gets stronger. (this is kind of like vaccinations - a little infection teaching the immune system how to fight a bigger infection) Autophagy is increased which stimulates your cell to repair damaged and dysfunctional parts. Making the cell stronger.  There are other pathways stimulated as well but don't want to get into the weeds. You get the point Hormesis leads to greater number of mitochondria and stronger mitochondria. Sometimes doubling the number in the cell. More energy - less fatigue! https://www.ncbi.nlm.nih.gov/pubmed/31178772 https://www.sciencedirect.com/science/article/pii/S1567724913002390 https://www.ncbi.nlm.nih.gov/pubmed/28357237 https://www.medicalnewstoday.com/articles/316229.php https://www.ncbi.nlm.nih.gov/pubmed/18480142 https://www.ncbi.nlm.nih.gov/pubmed/17964227

In this episode we chatted with Neurologist Dr. Don Dworek about lifestyle changes as related to headaches (including migraines!!). We were so thankful that he took the time out of his day to speak with us and hope you get as much from the conversation that we did. 

Help support the podcast by becoming a patron on Patreon!  Dr. Emory Liscord MD, and Dr. Samuel Madore DO present Grand Rounds on the topics of sleep and Time Restricted Feeding (TRE) as they relate to weight loss. The talk is titled: "Beyond the Basics: Further Considerations for Weight Loss"Help spread the word by sharing on social media and writing a review on your favorite podcast platform!

Help support the podcast by becoming a patron on Patreon! 5 Things:   Restricting your eating window   At least 14hrs restriction of NO FOOD (even if you’re healthy) If you have t2d / neurodegenerative disorders, obesity, then extend 1,2, or 3 disparate meals during your feeling window. Do NOT snack all day long Eat during the daylight hours of the day not at night4pm? 5pm? What does the most recent research show? Circadian Rhythm   What you eat. Lower your carb intake   No vegetable oilsCardiovascular health issues? Read labels (most processed foods have veggie oils) Just eat real food Why have we backed away from using the terms ‘ketogenic’, ‘diet’, et al… Carbohydrate restrictionNot the SAD (100-150g/day as a normal human diet as opposed to the SAD 300+g/day)Breads, pasta, crackers, et al… Carbohydrates are not necessaryStored as glycogen Can be used as instant energy Can be stored as fat Carbs are NOT a necessary macronutrientGluconeogenesis   Sleep optimization/Stress management   Sleep deprivationDim lights at night Align with circadian rhythm Red LED bulbs, wear blue light blocking glasses (evolutionary relevant because of campfire light spectrum)Recent campfire in Acadia Avoid stress thingsShift work Long commutesGuided meditation during commutes? What opportunities are you taking advantage of Saying no (JOMO) Toxic relationshipsDifficult conversations with clients “You don’t owe anyone an explanation for you health and lifestyle choices.” Stay off social mediaHuman body has not evolved to differentiate stress   Resistance training   Increases metabolism Increases metabolic flexibility Previous paradigm of ``chronic cardio” doesn’t work. Long term weight loss/improvement in metabolic health we need to heal your metabolism first. Emmy’s working with clients, optimizing and healing metabolic health. You want to build muscle Chronic cardio loses fat AND muscle Resistance training loses fat AND BUILDS muscle Squats, deadlifts, chest presses, shoulder presses, et al Costs? Planet fitness ($10/month), get a trainer, youtube visualizations, something is better than nothing. Go SLOW! Ask questions of the bros at the gym   Getting outside into nature.   Emmy is a hippie Being in nature allows some separation from our busy world. We evolved with nature.

Help support the podcast by becoming a patron on Patreon! A great conversation with @doctorketoing (Instagram) Kristin Baier, MD who is a practicing family doc who works with patients using a low-carb approach to weight loss. The conversation ranged all over but there are so many great points she brings up. Really one of my favorite conversations I've had in a long while! Dr. Kristin Baier completed residency at University of Chicago-Illinois in 2014 and is a board-certified family physician practicing in the suburbs of Chicago.  Her passion lays within helping people achieve optimal health through diet and life-style changes in place of or in addition to pharmaceuticals. Follow her on Instagram @doctoringketo or visit her website, www.doctoringketo.com, launching this summer.

Become a Patron and support keeping the podcast free of advertisements by donating via Patreon Darryl Edwards is an innovator who wants you to play more! This might be my favorite interview that I've listened to or had the opportunity to take part in. Wow! You can find out more about Darryl and his mission at:www.primalplay.comFrom the Primal Play website:"Darryl Edwards, is a Movement Coach, TEDx speaker and thought leader in the area of creativity and innovation in fitness and health. Darryl developed the Primal Play Method™ to inspire others to make physical activity fun while getting healthier, fitter and stronger in the process.  Darryl is the best-selling and award-winning author of several books including the April 2018 Amazon best-seller Animal Moves, 2013 release Paleo Fitness, and 2015 lifestyle encyclopaedia Paleo from A to Z. His work has been published in titles such as Men’s Health, Women’s Health, Elle Magazine, Men's Fitness and The Daily Telegraph, and featured on the BBC documentaries Eat to Live Forever, and Doctor In The House. He has also appeared in the full-length documentaries Love Paleo and The Human Longevity Project."  Please check out and share his TED talk: Darryl Edwards TEDx Talk

Please consider supporting the podcast on Patreon! Any amount is greatly appreciated  Mike England of Procabulary and EnliftedHow we met at PaleoFX/quick intro to concept of Enlifted Session with Mike Bledsoe Changing language around our intentions and goals Enlifted athlete concept plus service to coaches. Pete signing up for class. This is the first of two interviews (1st at onset of Enlifted course, 2nd at completion) Mark England TED talk https://youtu.be/K-6as-5dxSs Path from ‘broken’ Muay Tai fight —-> teacher —> Enlifted? Importance of the nuance of language? Why do people often fail at self reflection? What are some good “first steps” to changing language in regards to oneself? What happens “in the moment of failure”? The importance of breathing What is “chunking-down” /goal setting and why should people be using it (or balancing it) in their long term goals? Pillars of conflict language: Negations Soft talk Projections

We were so fortunate and grateful to be able to sit down for a few minutes with master trainer, Bert Massey, of Austin's Adapt.Fitness. This chat was one of my favorite conversations on health that I've had in a long while. If you are ever in Austin, you need to swing by the location and get a workout session in with Mr. Massey. You won't regret it.

The trouble with travel Early mornings Long days Boredom Tired Poor food options in airports Motion sickness (emmy) Stress I deserve trap Observations this morning People watching. What do we see? Obesity Long lines at the Starbucks and dunkin donuts First thing people seem to be eating are bagels, orange juice, Diet Coke, sugared ice coffee, et al…. What can you do? A little bit of pre planning (hard boiled eggs) Look for healthiest options at airport store (almonds, quest bars, RXBars, pistachios, cheese, salami, fruit, jerky, hard boiled egg) seem to be the only good option). Have to read the ingredients!!! I read the ingredients on some “kale chips”..... (potato starch, kale flour, then a whole bunch of vegetable oils in different amounts) If you know you’re a bad traveler (stress) plan ahead and fast well the day before and start a fast a little earlier. Just remember you’re going to pay through the nose in any airport store.

Why are we revisiting it?  Why do we sleep? Why is it important to understand the role sleep plays? Takes a third of our lives. Every species of animal does it Seems to have evolved with life itself Dr. Walker address sleep as it relates to cardiovascular disease, dementia, weight loss, fertility,  and gain, immune system and cancer. 4 pillars of sleep Regularity-how consistent is your sleep schedule? Social Jet Lag Continuity? Is it fragmented? Quantity: How much sleep do you get? How much of the different stages are you getting? Quality: What is the electrical signature of your sleep. Just because you’re getting 8hrs doesn’t mean you getting 8hr of good quality of sleep.Caffeine, alcohol, sleep medication, et al… things that can make you feel like you’ve gotten good sleep but in fact interfere with the quality of your sleep Ambien is like getting hit over the head with baseball bat CARDIOVASCULAR DISEASE Study: Healthy middle aged adults tracked for 5yr and tracked sleep (associational/longitudinal /prospective study) At start of study there were no signs of calcification of coronary arteries At the end of 5yrs those in the study with less than 5hrs sleep per night or less had 200-300% increase risk of calcification of the coronary artery which is the main corridor of life. DEMENTIA Comparing 7hr sleep or less VS 7hr sleep or more (associational studies again in humans) Amyloid build up. After 1 night of sleep interruption (human studies) there is a significant build up of amyloid and tau circulation. The mechanism that underlies that causal relationship between sleep and alzhiemers has been demonstrated in human studies and has been demonstrated acutely in a 24hr period.   IMMUNE SYSTEM AND CANCER Cytotoxic T cell decreased after one night of under 4 hours of sleep WHO and shift work as carcinogen   WEIGHT LOSS We have touched upon this. Many mechanisms by which less sleep leads to weight gain and makes it hard to lose weight Insulin Resistance Cortisol Melatonin When you control for EVERYTHING else, people gain weight with sleep deprivation. Studies show that when you are losing weight, if also sleep deprived you lose fat AND muscle versus more fat and preserved muscle when rested. How Much Sleep Do you Need 7-9  (chronic disease risk increases below and above this number) Sleep more for children / ill etc. https://peterattiamd.com/matthewwalker1/ https://peterattiamd.com/matthewwalker2/ https://www.foundmyfitness.com/episodes/matthew-walker

What is Decision Fatigue The more choices you make throughout the day, the harder each one becomes for your brain, Eventually your brain looks for shortcuts, act impulsively instead of expending the energy to first think through the consequences. do nothing. “Decision fatigue helps explain why ordinarily sensible people get angry at colleagues and families, splurge on clothes, buy junk food at the supermarket and can’t resist the dealer’s offer to rustproof their new car. No matter how rational and high-minded you try to be, you can’t make decision after decision without paying a biological price” Why modern society has way too much of this? Food choices, clothing choices, netflix choices, instagram, facebook, selfies What does this lead to? Eating too much (studies show variety leads to overeating) This might relate to willpower too How Do we counteract Acknowledge it “Steve Job’s outfit (scrubs for me, capsule wardrobe) Eat same thing for the most part. Just say no to foods you are addicted Mindfulness and meditation Focus on the process https://www.nytimes.com/2011/08/21/magazine/do-you-suffer-from-decision-fatigue.html?pagewanted=all https://www.apa.org/helpcenter/willpower https://www.nytimes.com/2016/11/01/health/americans-obesity-willpower-genetics-study.html https://www.dietdoctor.com/losing-willpower-at-night http://www.bariatricnews.net/?q=news/112687/usa-survey-obesity-due-lack-willpower https://en.wikipedia.org/wiki/Ego_depletion https://digest.bps.org.uk/2015/06/24/new-research-challenges-the-idea-that-willpower-is-a-limited-resource/ https://jamesclear.com/willpower-decision-fatigue https://michaelhyatt.com/the-science-of-decision-fatigue/  

  Why? A Lot of misinformation out there Disclaimer: whatever exercise you will do is the right exercise What I discovered  by necessity - Emmy The benefit of injury! What Happens when you only do aerobic exercise? The human body is smart and adapts Studies with the Hazda The Hadza, or Hadzabe, are an indigenous ethnic group in north-central Tanzania, living around Lake Eyasi in the central Rift Valley and in the neighboring Serengeti Plateau “Conventional wisdom holds that physically active people burn more calories than less active people do. But studies show that traditional hunter-gatherers, who lead physically hard lives, burn the same number of calories as people with access to modern conveniences.” Biggest Loser is another example Why people regain weight Adaptive thermogenesis How is Resistance Training Different? Counteracts the significant decrease in RMR accompanied by weight loss Calculating RMR (most accurate is indirect calorimetry) mifflin st jeor equation (may be off with chronic dieters) Helps with passive calorie expenditure NEAT does not decrease as much Improves physical appearance If you want definition, you have to build underlying muscle AND lose fat Prevents sarcopenia in old age (maintaining function) “The findings suggest that regular exercise training, in particular resistance training, is likely to reduce body weight and improve body composition of overweight inactive people by suppressing orexigenic hormones and stimulating the anorexigenic hormones”   Ghrelin decreased Increased PYY Increased GLP-1 (https://www.ncbi.nlm.nih.gov/pubmed/301489730 This is actually true for vigorous aerobic activity too https://knowledge.library.iup.edu/cgi/viewcontent.cgi?referer=https://www.google.com/&httpsredir=1&article=2104&context=etd https://www.ncbi.nlm.nih.gov/pubmed/26609965 https://www.ncbi.nlm.nih.gov/pubmed/30888221 https://www.ncbi.nlm.nih.gov/pubmed/28903957 https://www.ncbi.nlm.nih.gov/pubmed/26956987 “While the lifestyle of late Pleistocene hunter-gatherers was no doubt highly active as seen in foragers today, our results suggest that their daily energy requirements were likely no different than current Western populations” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3405064/ https://exss.unc.edu/files/2018/09/Exercise-paradox-Pontzer-2017.pdf “If you pair strength training with the traditional cardiovascular endurance exercise in a planned program, you can create an effective symbiotic relationship” https://us.humankinetics.com/blogs/excerpt/training-to-improve-body-composition https://www.physiology.org/doi/full/10.1152/ajpregu.90706.2008 http://www.drmcguff.com/ https://www.amazon.com/Body-Science-Research-Strength-Training/dp/0071597174

Who needs to listen to this episode Everyone Why are we talking about this? It’s something we all have stress talking about (very few of us feel comfortable bringing it up with our loved ones) Equip us with the language and tools to use as we age We are all aging. We actually can’t get out of this predicament... So you can enjoy end of life So you are not subject to treatment that you would not want Its selfless You take the stress away from your loved ones (I see this daily - Em) Fighting families when things are not clear Guilt over making the wrong decision Families feeling like they are “giving up” on you and assoc guilt How to Start Ask to sit down with an agenda Not during another event Know what paperwork you should fill out Advance Directive “This is called different things in different states (e.g., living will, health care power of attorney) but, regardless of the term, this describes a legal document you use to provide guidance about what types of treatments you may want to receive in case of a future, unknown medical emergency. It also is where you say who can speak for you to make medical treatment decisions when you cannot speak for yourself (called a "surrogate"). All adults should have an advance directive.”  POLST “This is called different things in different states (e.g., MOLST, MOST, POST—but, regardless of the term, a POLST form is a medical order for the specific medical treatments you want during a medical emergency. POLST forms are appropriate for individuals with a serious illness or advanced frailty near the end-of-life”  Know the language Full Code vs DNR/DNI Tell your family where this info is and give them copies It's never too early It will change throughout your life  

An Overview of Fats (The Breakdown) Saturated UnsaturatedMonounsaturated Polyunsaturated (healthy in unadulterated forms)(essential fatty acid)(ratio)Omega 3 Omega 6Essential (we get way too many though) Are oxidized at high temps so you must eat them without heatingRaw or nuts cooked at lower temps THIS IS WHAT VEGGIE OILS ARE Vegetable oils 100yrs ago we didn’t eat these oils. In 2014 the average American now consumes (on average) about 50g/day, that’s about 11 teaspoons) equating to 450 calories/day or approx 20% of the average American diet. That’s 2x as much as 40yrs ago. No other source of caloric intake accounts for the rise in total calorie intake increase between 1970 and 2014. Differentiating oils derived from nuts, fruit et al. (coconut, palm, olive) that have been a part of the human experience for thousands of years as opposed to oils derived from the entire plant. The process to extract oils from plants is an industrial process: Seeds are crushed/flaked High heat Cold High speed spinning (sodium hydroxide) Solvents “De-gumming agents” Deodorizers (steam injection heating process) Bleaching agents All this must happen to create a product that is palatable to humans. https://www.youtube.com/watch?v=omjWmLG0EAs Half of the vegetable oils consumed in the US are from one crop (Soybeans) Highly Refined Hexane is used to extract canola oil (See here) Hexane is derived from crude oil Where Do we FIND vegetable oils EVERY SINGLE PACKAGED FOOD LIKELY HAS IT Vegan, Paleo, Keto or Standard American diet - READ the label Salad dressings Even at Maine General! Baby and toddler food (along with sugar) - very disturbing Packaged brands I have found that DON'T have veggie oils Siete Jackson Honest https://www.dietdoctor.com/low-carb/vegetable-oils https://www.dietdoctor.com/low-carb/vegetable-oils#How-they-are-made https://podcastnotes.org/2018/07/03/attia-patrick/ https://chriskresser.com/the-diet-heart-myth-cholesterol-and-saturated-fat-are-not-the-enemy/ https://www.dietdoctor.com/stunning-saturated-fat-and-the-european-paradox/comment-page-1 https://www.maxlugavere.com/blog/chill-with-the-butter

Blue Zones – Places In the World Where People Live to 100 and Stay Healthy   1/5000 people in the US live to be 100 10% of longevity is due to genetics. 90% is due to our lifestyle   Caveats before we get started In general many of these things are things we talk about BUT These people do have have chronic disease to reverse (might not be enough) These are epidemiological observations These are not useless but this is not rigorous science Does not take into account genetics. Although relatively diverse over several groups The five blue zones are as follows: The Italian island of Sardinia   Move all day (shepards), eat lots of plant, cheese that is grass-fed and high in omega 3 fatty acids, wine with 3x number of polyphenols If grains are eaten always whole grain No process food exists They treat older people with respect Okinawa, Japan Community. When you are born you are put into a group of people who support you your whole life. Average american has 1.5 close friends. No one retires. Ikigai Eat lots of plants Fermented soy products They don’t overeat Eat on smaller eat. They don't serve family style (no seconds), They stop eating when their stomach is 80% full. They eat small Loma Linda, California Costa Rica’s isolated Nicoya Peninsula Ikaria, an isolated Greek island   9 commonalities   None of them exercise, they set their lives so that they are in constant physical activity Live in houses with stairs, walk everywhere, sit on the floor so they are getting up and down constantly. All garden They have language around “purpose” They have strategies about how to eat less. (till 80% full) They drink a little each day (wine) They eat lots of plants, some quality meat / cheese. They eat nuts and legumes. If grains, a little and always whole grains. NO processed food period. No veggie oils! They hang out with people who live the same way Community connection (often faith based) Family  / loved ones first (very close relationships between older and younger generation They all take daily time for mindfulness   I would like to take a moment to point out The eat no processed food with fake sugar / chemicals They don't eat vegetable oil That requires quite the nasty production process They eat a lot of healthy fats (olive oil, fish, grass fed meat/butter etc.) high in omega 3   The Happy Planet Index is similar   Connect Be Active Take Notice Keep Learning Give   There is a difference between pleasure and happiness. Pleasure is anything that increases that dopamine. Companies can sell you things that do this. Any shopping/food/drugs etc. They try to convince you that they are selling you happiness but this is not true. Studies show that happiness is more likely to come about by the above things not by stuff. http://happyplanetindex.org/ https://www.ted.com/talks/dan_buettner_how_to_live_to_be_100  

Please help us keep this podcast free! Become a supporter on Patreon by clicking here!   Pete’s injured foot   Why do injuries happen? Some common types of injury: Chronic vs. acute Sprains Strains Tendonitis breaks/fractures Illness What is the best way to treat a new injury? Talk about The Brave Athlete “Approach your recovery the same way you are approaching your training. Learn about it. Ask questions. Treat recovery like its a job. (maybe more like having kids…. It’s  24/7 kinda thing. Somethings that ‘get in our way’ when trying to recover? Life Kids Work Boredom Misunderstanding of guidance from provider (why do we need to become knowledgeable about ourselves?) Lack of patience

Please help us keep this podcast free! Become a supporter on Patreon by clicking here! There is a pathway in the brain that promotes weight gain Orexigenic Pathway Decreases movement throughout the day (you don’t even notice it!) Increased appetite Stimulated by Ghrelin, cortisol (stress) Sleep deprivation And a pathway to promote weight loss Anorexigen Pathway Increases spontaneous movement NEAT (the biggest thing linked with weight loss) Stimulated by Leptin, Insulin, Serotonin One reason overweight folks with leptin resistance are more hungry Stimulated by a whole host of hormones we will talk about briefly later Stimulated by Stomach stretch Your body sends signals that stimulate one of these pathways.   Hormones that Make that decrease your appetite Insulin From the pancreas in response to food Stops the hunger pathway directly A problem if you are insulin resistant Also causes your body to store nutrients (glycogen in muscle / liver) Stores fat as well Leptin Secreted by the fat cell Stimulates the pathway making you full, Inhibits the pathway making  you hungry. This is at the level of the brain Proportional to body fat (less than leaner you are) Serotonin We talked about this on another podcast CCK (cholecystokinin) From your small bowel In response to fat and protein Decreases stomach emptying (making you feel full longer) Decreases Ghrelin (your hunger hormone) *Weight Loss leads to CCK NOT elevating as much after food BUT if in Ketosis, normal response of CCK after eating is maintained   GLP-1 (Glucagon-like peptide) Small bowel Stimulated by by carbs Lower levels in folks affected by obesity, and people with pre-diabetes / diabetes Dec liver making glucose (gluconeogenesis) Reduces appetite Decrease gastric emptying. E.g Trulicity is an example of drug modeled after this. Others from the small bowel:; PYY, OXM, etc.   Things that make you more hungry Ghrelin is the more powerful What stimulates Ghrelin and makes you more hungry Stress, sleep deprivation, The expectation of food WEIGHT LOSS (any) Fasting Ketones (SIDE NOTE) Ketones inhibit the rise in ghrelin that occurs with weight loss The pathway that makes you hungry is inhibited by many of the hormones that make you full   Other side notes Fructose does not help your brain to register that it is full E.g candy Fruit has fructose but also fiber which causes stomach stretch So, How can you regulate your appetite When you do eat: Protein > Fat > carbohydrates Eat carbohydrates with fiber Bulk helps (stomach stretch) Sleep More Stress Reduction   Mindfulness has its place but intuitive eating may not be a good approach if you have metabolic dysfunction Plan your day / meal times So you are not just eating out of boredom or stress If you just ate, you probably are not hungry Why do you want to eat?  

Please help us keep this podcast free! Become a supporter on Patreon by clicking here! Body Image episode Define “Body Image”: “The subjective picture or mental image of one’s own body”. The key here is that it is subjective. There is not objective way to view our own bodies. We can use objective measurements (height, weight, waist, et al…) but those objective ‘factual measurements’ will always be viewed through the skewed lens of our own psyches. Can be positive or negative. Women AND Men have issues with body image. Women- Often relates to being smaller / thinner May relate to the time in which you grew up E.g twiggy, kate moss models of my youth Lets remember there is nothing wrong with also being very thin unless eating disorder Many women (and men) want a body “TYPE” that would be unattainable Remember genetics is a big factor Men: Often relates to being larger / bigger / taller Men have just as many issues with body image as women do but are often not allowed to share those thoughts for fear of being outcast or ridiculed by peers. The adonis complex is a perfect example where men are told they need to have massive ‘shoulder boulders’, huge biceps, a chiseled chest and back. For many men it is difficult to put on weight or lean mass. It is also unrealistic to compare the amount of time you can devote to training vs. the professional body builder whose JOB is to be a gym rat and create his/her physique.   2014 study in JAMA found that adolescent boys are increasingly affecting with body dysmor https://jamanetwork.com/journals/jamapediatrics/fullarticle/1766495 So Can you have positive body image AND always being pursuing improving health / performance and physical appearance??? Recognize, you will likely never “arrive” at the perfect look or the best performance, and that is okay. It is human nature to push to be better. Imposter syndrome How Do we combat negative body image? Gratitude journaling related to the way you look List the things that you like about your body Focusing on improved strength / performance Focus on exercise and food you enjoy Don’t “punish yourself” (this is what I like about high fat / low carb) Surround yourself with others who are positive in general Think about how others see you (the way your children see you) BE OTHER CENTERED Postcards / phone call / email / text to say you appreciate someone else Help someone on their health journey Focusing on Health (getting off meds / BP down) Recognize you will have negative thoughts and that is okay Once you have reached one health goal (say related to body composition) have an unrelated goal (volunteering, doing more for others, a goal related to work, get better sleep)

Things Pete Learned today..... Autophagy necessary to prevent cancer. https://www.nature.com/articles/s41586-019-0885-0?fbclid=IwAR38qMSbtdSORlt2xUDYrm6oRHmsvctKzxz2tXQ-fC33Qt20_F3fyrZ6PJ8 https://www.sciencedaily.com/releases/2019/01/190123131706.htm?fbclid=IwAR1rw8sGJWNNNxkj6nY5Ag_78UxmVwp0QFYcQBYkKA6LzDaT9tKxP3Wcl8U Question: If metabolically healthy, do you need to eat a ketogenic diet? NO Unless epilepsy, cancer, dementia, etc. May be able to get preventative effects just from daily fasting Ketogenic diet is a therapeutic tool It is also not a religion And it is not a magic bullet Paleo/Whole30/Keto - whatever works just eat real food Doesn’t really matter your macros Question: Why does it matter as long as you are doing the right thing for you? Maybe it doesn’t It’s hard to watch suffer (especially friends and family) Diet choices also affect all of us with regards cost of healthcare Disability (financial implications, emotional implications)

What is Emotional Eating Eating when you are not hungry, often with underlying emotion as a cause Not always a bad thing I would say most do this on a daily basis Most people eat at times the Common Emotions: stress, BOREDOM, sadness, happiness etc. Boredom Worth talking about We live in a society where we need to be occupied at all times (social media) And we even need to be occupied WHILE engaging in social media We are not present with our kids, our friends, ourselves We are constantly doing something else (I would say social media and food) In fact, we usually do something WHILE eating When was the last time you sat down at the table by yourself with no one else, no phone, no computer and ate a meal slowly. (I don't remember the last time I did this What Do we Eat Not broccoli Why We Do It To distract (stress / sadness) More of a dopamine hit when stressed (“book “Deep Nutrition”) To augment pleasure of a situation (Christmas / Thanksgiving) When do we emotionally eat (if we do) Emmy? ALL THE DAMN TIME. My two most common emotions are boredom and stress. Stress when kids are whining / crying. Stress after shift (even driving home in car). Boredom during watching a movie or evening, if Pete is out and after kids go to be. Overnight shifts.

-----> Click here to support the podcast and keep it free! Support us via Patreon!   Emmy -The adenovirus, one of the most widely studied viruses and causes very benign sxs is linked with obesity the virus DNA enters the adipocyte (fat cell) and increases the uptake of fat making it larger. It also causes increase (adipogenesis) in number of fat cells by a genetic mechanism. more proof that it is not calories in and calories out Pete - “Weight on knee.... 1lb of weight loss is equal to 4lbs of weight loss in the knee which is walking and it becomes amplified. The mechanics of the knee....Your center of gravity and how that applies torque into the knee is part of the reason that body weight is amplified. So it’s not just pound for pound. When patients gain a pound, it’s 4lbs for walking, 6lbs more for going up and down stairs, 8lbs more with running. It’s a significant multiplier. There are similar multipliers for the hips and back.” -Dr. Eric Chehab quoted in The Peter Attia Drive podcast Emmy - Spatchcock Chicken Pete - For every 2.2lbs (1kg) of weight you gain there is a 9% increased risk of getting diabetes. Diabetes is the leading cause of: kidney failure, blindness, non traumatic lower limb amputation, and the 7th leading cause of death in the United States in 2015.  Emmy - CCK (cholecystokinin) is secreted by small bowel in response to FAT and PROTEIN and stomach distention. Within 15-30 minutes it makes you feel full by decreasing your stomach emptying, and stimulating the neurological pathway in the hypothalamus to make you stop eating. GLP-1 (glucagon like peptide) is secreted by bowel in response to CARBOHYDRATES. It too makes you feel full by several mechanisms. It's degrades much quicker. GLP-1 levels are decreased in Obesity, pre-diabetes, and diabetes. This means with obesity and diabetes you are more hungry Pete - Peripheral metabolic effect of exercise ---->Muscle produces myokines ---> causes increased mitochondria (browning) of fat ---> increased adiponectin ---> causes increased insulin sensitivity Emmy - Shift Workers rotating shift workers have higher post meal glucose, insulin, and triglycerides blunted post meal ghrelin secretion (no feeling full) reduced Leptin (tells your brain your full) elevated glucose and insulin all the time elevated cortisol leading to fat gain & increase blood pressure if sleeping < 5.6 sleep/day sig reduced metabolic rate

-----> Click here to support the podcast and keep it free! Support us via Patreon!   What is Serotonin? Neurotransmitter (allows nerves to talk to each other). biological function is complex and multifaceted, modulating cognition, reward, learning, memory, and numerous physiological processes Produced in the GI tract primarily but also the brain (Hello gut health influences brain health!!!!!) Serotonin is produced, does a job and then then is cleared by reuptake. Various agents can block re-uptake and increase serotonin: SSRIs (a kind of antidepressant e.g. sertraline (zoloft), cocaine Regulates mood, sleep (improves sleep), appetite, highly involved in behaviors requiring high cognitive function, learning and memory From a weight loss perspective Serotonin stimulates the same pathway as Leptin Increases the thermogenesis of brown fat Increases lipolysis Increases subconscious activity Increases overall energy expenditure Decreases food intake (by blocking the Ghrelin led pathway) The weight loss drug Belviq or lorcaserin stimulates serotonin receptors in the hypothalamus Why do we want to naturally increase serotonin? Positive mood is linked to longevity and decrease risk of all cause mortality Ways to increase Serotonin Sunlight (or bright light (3000 lux)?) exposure (at the right time of day) Bright light during the night hours might disrupt serotonin levels            “Light cafes” pioneered in Scandinavia have come to the United Kingdom GET OUTSIDE for a walk (lunch break/morning etc.) Exercise Anti-depressive and anti-anxiety effects of exercise have been documented over and over.       The most consistent effect is seen when regular exercisers undertake aerobic exercise at a level with which they are familiar We think this is due to increase serotonin Diet   Tryptophan is an amino acid which is a pre-curser for serotonin. Unfortunately it’s hard to get that tryptophan you eat in your diet to your brain due to the meal you are eating it with. Due to interactions too complicated to go into here, it does not reach the brain easily.  When eating foods with other amino acids, they compete for access to your brain. Its very hard to get things past your blood-brain barrier (the semi-permeable barrier between your blood and cerebrospinal fluid). Not everything you put in your blood (or gut for that matter) reaches the brain.    *** this is the problem with MANY supplements that you waste your money on. Supplements promising better mood / sleep etc. may not actually make it to your brain. Scientists have been trying to figure out how to manipulate the meal make up so that more tryptophan makes it to the brain A few studies showing eating foods high in dietary tryptophan can improve memory and mood You can google what foods have lots of tryptophan (eggs/salmon/almonds/ etc.).   Make sure you eat these things with a little carb as studies show this improves the ability for your body to use the tryptophan   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4728667/

-----> Click here to support the podcast and keep it free! Support us via Patreon!Acute: stimulates SNS, raise your defenses Chronic: Increase in cortisol stimulates neuropeptide (NPY) - hunger pathway (discuss) Increases insulin  and leptin resistance Shifts white fat into visceral abdominal region Decreases brown fat activation Brown fat is the fat on babies and decreases throughout life Metabolically active (converts chemical energy to heat) Lots of mitochondria (why its fat) Fasting makes white fat behave more like brown fat The more fat the more cortisol (having fat is a stressor to itself) ANOTHER vicious cycle. Half of patients with obesity have hypercortisolism and have are normal. If high cortisol higher risk for heart disease DECREASE STRESS BY Reasonable exercise SLEEP Screen time Just say no - JOMO (Joy of missing out) meditation

-----> Click here to support the podcast and keep it free! Support us via Patreon!Mini series on hormones. Thanks to our new Patreon supporter “Drew from Liverpool, England!”. Asked about dopamine and other hormones. We will get there!   Inverse correlation between measures of obesity and testosterone levels. The larger the waist the lower your testosterone Prevalence in men with type 2 diabetes is 40% Low testosterone Insulin resistance, increase fat mass, high cholesterol, high blood pressure, increase risk, diabetes, of heart attack Independent risk factor for ALL cause mortality   Symptoms of low testosterone Fatigue, depression, low libido, hair loss, low muscle mass etc. Obesity causes low testosterone because testosterone is converted to estradiol (an estrogen) by aromatase enzymes in fat cells. More estrogen causes feminization of men. 'Moobs'. Decreased fertility Then reduced testosterone increases adipocyte (fat cells) (vicious cycle) and decreases lean mass (worsening body composition) Testosterone also works on something called the hypothalamic-pituitary-testicular axis. This hormone “highway” connects  your brain to your reproductive organs. Obesity acts on this highway to reduce testosterone What to Do Weight loss from diet, exercise, bariatric surgery sig increase testosterone levels Increase in testosterone is proportional to weight loss   Testosterone replacement (or increasing your own) Increase lean body mass Strength Decrease fat mass and body fat Decreases waist circumference Increase lipolysis Decrease inflammatory markers Decreases triglycerides and increase HDL, decreases ApoB BUT some possible safety risk with exogenous replacement

-----> Click here to support the podcast and keep it free! Support us via Patreon!   Why are we talking about this? Tracey Crouch was just appointed the U.K.s minister of Loneliness. Loneliness is a huge growing public health issue in most developed countries ⅓ of older Americans report feeling lonely and isolated This has long term health consequences including function decline and increase risk for heart disease, stroke, dementia, insomnia (and we know what that does!). Individuals without meaningful social relationships are twice as likely to die from all cause mortality. IS THERE ANYTHING ELSE SO RISKY?! “It’s proven to be worse for health than smoking 15 cigarettes a day, but it can be overcome and needn’t be a factor in older people’s lives,” Mark Robinson, the chief officer of Age UK, Britain’s largest charity working with older people Higher risk populations: new parents, children, disabled people, refugees Dr. Holt-Lunstad at Brigham Young, who has analyzed 70 studies encompassing 3.4 million people, said that the prevalence of loneliness peaks in adolescents and young adults, then again in the oldest old. people can be socially isolated and not feel lonely; they simply prefer a more hermitic existence. Likewise, people can feel lonely even when surrounded by lots of people, especially if the relationships are not emotionally rewarding. But can affect ANYONE at any time. I have felt many times in my life and still do at times. Why do we have this problem No mix between young and old generations (retirement is just bad for most people!) Social Media and the FOMO Working too much to just pay your bills or afford luxury items Abraham Maslow (psychologist) considered the most basic of needs — warmth, food, shelter, security and a sense of connection. (he later added the concept of transcendence) Physiological Needs Safety Needs Social Belonging (or lack of) Esteem Self-ActualizationThe Challenge It's hard to admit you feel Lonely (it's embarrassing) Often in the ER we see physical complaints even though there might be a more pressing issue like loneliness underlying this What do we do??? If YOU are lonely Don’t blame yourself Acknowledge the feeling. Careful not to distract with unhealthy behaviors. Online groups can be good and bad Meet-Up groups Church if that is for you Clubs Reaching out to family Reaching out to a medical professional If You are NOT LONELY Recognize many are and reach out Especially older folks We can learn a lot by making friends with older folks https://www.wbur.org/cognoscenti/2018/12/28/misery-anton-chekhov-jay-baruch https://www.nytimes.com/2018/01/17/world/europe/uk-britain-loneliness.html https://www.nytimes.com/2017/12/11/well/mind/how-loneliness-affects-our-health.html https://www.simplypsychology.org/maslow.html https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3303190/

Click here ---->Help us keep this podcast free and ad-free! Support us with whatever you can on Patreon.After a hiatus for a few weeks we are back with the presentation of Grand Rounds that Dr. Madore and Dr. Liscord did on Dec 20, 2018. The audio isn't the greatest but the information contained in it, IS! 

Help us keep the podcast free of advertisements! Support us on Patreon by clicking here  We will update the show notes with links to some of the studies mentioned in the show a little later tonight/tomorrow (scheduling, adulting, kids, et al...)

Help us keep the podcast free of advertisements! Support us on Patreon by clicking here Carol Dweck: Stanford professor, researcher coined the phrase and has been the lead researcher on the topic for the past 20+ years. “The thinking that intelligence and personality can be developed and are not immutably ingrained traits” Define Fixed Mindset: Knowledge and intelligence are fixed. Talent is innate and fixed. “I’m just not smart in math”. Often focused on avoiding challenges to preserve status of intelligence. Feeling constant need to prove their intelligence. Sees failure as a confirmation of lack of intelligence. “Believing that your qualities are carved in stone — the fixed mindset — creates an urgency to prove yourself over and over. If you have only a certain amount of intelligence, a certain personality, and a certain moral character — well, then you’d better prove that you have a healthy dose of them. It simply wouldn’t do to look or feel deficient in these most basic characteristics.”-Carol Dweck Define Growth Mindset: People who believe that their talents can be developed (through hard work, reflection, learning new strategies, and input/feedback from others) are considered to have a ‘growth mindset’. The goal is learning, not the answer. Effort makes me stronger. I reflect on my effort to find moments of new understanding to build a better foundation to learn more/better in the future. People who embrace a growth mindset worry less about ‘looking smart’ and focus on doing something because there is something to learn and it is for that sake, or love, of learning that effort is applied. Some Common Misconceptions: People think it’s the same thing as being open-minded or flexible. #nope People Think it’s the just praising/rewarding effort and ‘grit’. #nope This is NOT a “Little Engine That Could” mindset. If effort was all that it took, then anyone could just work really hard and then achieve. It is more complicated than that. Growth Mindset will automatically deliver results and you will become more intelligent, et al…#goodthingswilljusthappen. NOPE. Embracing the process means reflecting on the process. When that happens, studies (by Dweck et al) have shown that new neural connections are made. Students must be explicitly taught what is happening in their brain. Just being told that a growth mindset will lead to positive changes is not enough. How to nurture a growth mindset in your children? Dweck’s research indicates that it can be a simple as reframing the perspective and explicitly teaching the child ‘what is happening’ in their brains. https://hbr.org/2016/01/what-having-a-growth-mindset-actually-means https://www.mindsetworks.com/science/ https://www.brainpickings.org/2014/01/29/carol-dweck-mindset/

Help us keep the podcast free of advertisements! Support us on Patreon by clicking here   Today we revisit the topic of FAT and go down the rabbit hole of differentiating between the different kinds of fats and their health benefits and also their health concerns!

Help support us on Patreon by clicking here! Episode 67: The benefits of Resistance Training Why is resistance training recommended? If you have T2D - can reduce plasma glycosylated hemoglobin levels Increase muscle glycogen stores (this is important for anyone, not just people with T2D). More available “quick” energy. Think zombies chasing you and you need to run NOW. In a study by ADA (American Diabetes Association) there was a reduction in medication needed by 72% of participants in a blind study. http://care.diabetesjournals.org/content/25/12/2335.short For women who are aging there is evidence of increasing type ii muscle fibers in as little as 8 weeks of beginning a resistance training regime. https://www.physiology.org/doi/abs/10.1152/jappl.1991.70.5.1912 Muscle quality improves with strength training in older people. https://link.springer.com/article/10.2165/00007256-200434050-00005 Contributes to the maintenance of functional abilities, and prevents osteoporosis, sarcopenia, lower-back pain, and other disabilities These are the physical issues that affect most people as they age. 2-3 sessions per week https://www.sciencedirect.com/science/article/pii/S0091743501909090 Who should be doing resistance training? EVERYONE. Especially if you are an adult who has not exercised in a long time or if you are getting older. What are the basic movements that people should focus on? According to Mark Sisson (Primal Blueprint) Squats Planks Pushups Pullups Move frequently and at a slow pace! Time under Tension is the most important rule to remember. . . AND FORM! How long should/how many times per week should you exercise with resistance training? Depends on your schedule and goals If you are just starting out, try twice a week for the first four weeks and then reassess Optimally you should be resistance training at least 3-4 days per week for 30 minutes But what about my cardio?!?!?! Cardio is important but the studies seem to be showing that it is resistance training and movement that are more effective with weightloss and longevity. What about core? Since the core is such an importance muscle group and is involved with almost every single action taken in daily life, you can (and should) exercise your core EVERY DAY. No you will not burn out. How long until I see results? I want them washboard abs. Everyone is different Depends on the load/routine/commitment Abs are made in the kitchen. Your diet is going to be the thing that creates tone and definition more than how much weight you lift.

Support us on Patreon! Click here! Time Restricted Feeding - Looking back at the past year What is TRF or If?  Why is it one of the most important lifestyle interventions for health? Insulin Autophagy Different kinds of TRE/Intermittent Fasting 16:8 (leangains) Martin Berkhan 20:4 (warrior) OMAD 5:2 (calorie restriction for 2 days) Fasting Mimicking Diet - Valter Longo Dementia protection / baseline health: 14-16 hours a day Probably important to stop eating 3 hours before bed Circadian rhythm - Sachin Panda Why it’s different then calorie restriction Does not decrease metabolic rate When insulin is low, your body “sees” its own fat When you eat all day but calorie restrict / your body is blind to its own fat It only sees what you eat which is calorie restricted What “breaks a fast”? Dry fast (not recommended) Depends on your goals If going for autophagy - stick with water If going for weight loss Nothing that is going to stimulate a metabolic response What do we do? Emmy: I try to change it up more Pete: I also try to change it up but I've become so accustomed to not eating breakfast that it is rare that I do these days... How have our thoughts changed? Helpful Hints when starting out When starting out take salt and magnesium Have a buddy or person to reach out to for support Read and learn about it! Drink lots of water Insulin causes reabsorption of salt and water from kidneys When insulin is low, you lose water weight so you need to drink...Especially if exercising.

Holidays can be trouble Starts around Halloween (leftover candy) Runs through the New Year Weekly holiday parties Daily treats at work Family events Left overs 24 access to unhealthy food Alcohol Hard to “stay on plan”. Seems like everyone is trying to convince you to have that donut or piece of cake. “You’ve been soooo good” People often are talking to you from a place of love and their offer of food isn’t meant to be an indictment of your new way of eating. They are simply trying to ‘be nice’How do we broach the conversation with them? Talking about what you are going through and asking for support is key. #ideservetrap What can you do? Talk about it. Don’t be shy. Say your goals out loud. Remind the people who are your support system why you need their help. They are there to listen and not to judge. Make a plan. A plan is not, “I’m not going to have anything” dealing in absolutes is setting yourself up for failure and guilt. Frame your goals with intention and honesty. Remember how far you’ve come. Motivation comes from experiencing success. Keeping your successes front and center in your mind associates those successes with a dopamine hit. What is dopamine? Write things down. Your plan, your goals, journal your food choices. If you have a lot of weight to lose it can be helpful to develop some discipline by journaling. Make a plan at the beginning of the day of everything you will eat. If deciding on eating a goodie, make a plan of exactly what that will be Don't eat any sugar if need be (it's going to be different for everyone) Fast. Get professional help. Getting into a program before Jan can be helpful with recognizing your triggers around food and avoid a massive backstep in your progress. Learn to cook alternatives that are healthy

Q1: If I am competing in an anaerobic fitness event (like Strongman), how should I fuel prior to and the day of the event? I typically train fasted, but wonder if my strength suffers a bit due to heavy weightlifting being so anaerobic… Still early Benefits: body composition, ketones may preserve muscle mass Downside: takes longer to break up fat for fuel, but via gluconeogenesis I would not think this is an issue https://www.ncbi.nlm.nih.gov/pubmed/29910305 Q2:  I just want to know how the hell to deal with indulgences without feeling guilty. Wish we had this one figured out, too.... Mantra. Have One Mantra to return to (Pete’s is “Try to be a little bit better today than yesterday”) Walk through birthday party example: “There was cake and I didn’t have willpower to say no. Then I felt guilty about the cake” Don’t say “I’m never going to do that again”.  Lapse, relapse, collapse. Allow yourself to “grieve” in the moment but set a timer for a few minutes. Once the time goes off, you have to close the book on that moment. It happened, it’s in the past. Recognizing where the guilt is coming from. Is it comparison? Keto-comparison/ fasting-comparison / FB comparison / Remember that Social media is nothing more than image management. Book: Radical Acceptance https://www.tarabrach.com/ Q3: Should people with Hashimoto Thyroid disease refrain from the ketogenic lifestyle? If not, how many grams of carbs or what % Of carbs would you suggest starting them with? Emmy will tackle this one... Q4:Is it possible for someone with a gastric sleeve to be successful on LCHF diet? Pay attention to nutrient density however Nutrient deficiencies and dehydration are a major problem with surgery B vitamins especially. Eat your eggs :) Eat things rich in nutrients such as quality meats

Three doctors/researchers you should know about in the field of DementiaDr. Dale Bredesen wrote “The End of Alzheimers” Professor of Neurology Easton Laboratories for Neurodegenerative Disease Research David Geffen School of Medicine at UCLA Richard Isaacson, M.D: Director of the Alzheimer’s Prevention Clinic at Weill Cornell Medicine and New York-Presbyterian Amy Berger who wrote the “Alzheimer's Andidote” ------------------------------------------------------------ Alzheimer's is the most common neurodegenerative disorder. Responsible for 60-80 percent of all dementia (cognitive decline) There may be a predisposition (genetic component) if you carry ApoE-4. This gene increases risk 5-15% A common one amyloid plaques (for the docs) or tau proteins. They are a mediator likely NOT the cause We need to stop thinking of amyloid as a target There are also subtypes  (a mix but what is predominant) Inflammatory : assoc with overactive immune system Constantly be fighting somethin Chronic infection, leaky gut etc.. Atrophic : lacks proper signaling to promote synapse preservation Missing necessary signaling molecules or support. E.g not enough hormones (estradiol/testosterone thyroid), vitamin D, BDNF etc. The brain “downsizes” because you cannot support the neural network you have Many people have both inflammatory and atrophic. These first two are more common with APOE4 "Type 1.5": glycolic damage (insulin resistance of the brain) Toxic (possibly earlier onset) Less common BUT many times if type 1 or 2, likely a bit of contributing toxic type Fungal (molds), viral, bacterial, chemical Often APOE4 negative individuals / younger / women Trouble with executive function like calculating a tip / bills etc. Often have low Triglycerides/low zinc/high copper. Not sure what this means PPIs decrease absorption of zinc, copper pipes too Even if you have the gene, if you identify this early enough, we can institute changes in our lifestyle to delay or avoid onset. What does Dr. Breseden suggest: Look at toxin burden (molds/skincare/food/food containers etc) Wash after (mercury/BPA) etc comes out in sweat mycometrics.com Remove from environment PLUS sauna EPA relative mold index (want less then 2) 12-16  hours of daily fasting starting 3 hours before bed If APOE 4 (closer to 16) Reduce inflammation Low carb/sleep/stress Removing food intolerance Heal leaky gut (inflammation is how gut is so connected to brain) Mild Ketosis (his program is called Ketoflex) You many be able to stop supplementing Unless you lose too much weight If lose weight 1-2 days of adding carbs Fish works, supplements don't Avoid fish high in mercury like tuna Stick to salmon, mackerel, sardines 70% of calories from fat, low carb Plus fasting If your starting from high carb - start with MCTS → omega 3/polyuns Once you can make ketones on your own (fat adapted) ITS NOT ABOUT ONE THING and its about changing the signaling and providing the appropriate tools (omega 3), decreasing toxins or getting rid of toxins

Emmy chats about her recent (yesterday) experience running a marathon after being compliant with a true ketogenic training plan. 

Mindfulness What does mindfulness mean to Pete & Emmy Intentional Present Inclusive One tool to improve daily mindfulness - Journaling What is it? The process of recording daily thoughts, feelings, activities, actions. Why do people do it? The process is shown to activate both left and right brain thinking (analytical and creative) at the same time. Being able to record one’s thoughts and actions has been shown to increase one’s sense of self, provide insight into difficult, stressful situations, and decrease stress and anxiety. Why don’t people journal? Perceived lack of time. Thinking “it just doesn’t work for me” I have nothing to write about I’m going to turn into a hippie Trauma It is a skill. Very few people (if any) are born with the ability to be self-reflective. (see metacognition). https://psychcentral.com/lib/the-health-benefits-of-journaling/

Gut Micro-Biome   Taken from Lecture by Gerard Mullin, MD Johns Hopkins University School of Medicine for OMA 2018 conference in DC Disruptions in Gut Microbiome are linked to range of chronic conditions Certain strains of bacteria predispose you to diseases and you have less of the good stuff Child and Adult Obesity, Anxiety, Arthritis, Asthma, Autism, Autoimmune disorders, Cardiovascular*, Chronic fatigue, Chronic kidney disease, Depression, Diabetes (type 1 and type 2), Eczema and Most all OTHER IMMUNE ISSUES (i.e increase infections) *Fatty Liver, Fibromyalgia, Hypercholesterolemia, ITP, Metabolic Syndrome, Mood disorders, Multiple Sclerosis, Myoclonus dystonia, *Obesity, Oxalic kidney Stones, Parkinson’s Disease, Senile Dementia, etc Gastrointestinal Gallstones, Colorectal Cancer, SIBO, Enteropathies, Hepatic Encephalopathy, *IBS, IBD, FMF, Gastric cancer and lymphoma, *Recurrent Clostridium difficile infection Non-GI Obesity especially. E.g mouse studies SO MANY MECHANISMS One is increase gut permeability You want a good mucosal layer in your GI tract to protect your body from pathogenic bacteria. We actually know some of the strains of bacteria predispose to these diseases Depending on the bacteria you have. One kind of bacteria (firmicutes) are more efficiently at breaking down food / fermenting foods and extracting calories. (tend towards weight gain) Low carb AND low fat diets decrease firmicutes High carb and high fat diet (SAD) increases firmicutes and decreases good bacteria. Whole body chronic inflammation Disruptions caused by Antibiotics (giving antibiotics to cattle make them fat) Also influences people eating the meat Too sanitary an environment C-sections No breast milk SAD Circadian rhythm disruptions (travel, shift work)   What to do about it Probiotic pills Too many options and benefits probably depend on your genetics. Only take if you are also taking antibiotics or if you are treating something specifically    (like h.pylori) Watch Diet Change the makeup of gut microbiome Unprocessed food Cutting down on sugar If eat carbohydrates make sure it also has fiber Fruits / veggies Add probiotics in your diet (fermented food) Swap some of your saturated fat out for polyunsaturated Studies done in SAD diet Saturated fat tends to increase firmicutes Polyunsaturated increases bacteroides. If eating meat, opt for meat with no antibiotics. Also Eat during day. Dysbiosis caused by NIGHT eating. Stress disrupts microbiome Sleep disruptions do it Being too sedentary does it Pre-biotic Support good bacteria They actually kill pathogenic bacteria Compete for nutrition with bad bacteria. BUT if you have IBS, SIBO these are not a good thing (i.e low fodmap diet) Only do it short term (8-12 weeks) One reason Roux-en Y Gastric Bypass Surgery works because of changes in the microbiome. You can still do low carb or keto healthily but not if you’re living on bacon.

Specialties coming together   “Obesity is a neurobehavioral disorder not a character flaw”, it is disease or hormonal and metabolic dysfunction It is also at the center of most chronic diseases, thus why so many specialist were in attendance. Everyone recognizing we (the medical community) told people to do the wrong thing for decades. We have ourselves to blame (and the food industry) Many of these specialists were leaders in their field. Johns Hopkins, Stanford, Columbia just to name a few. Obesity is at the center of most chronic diseases but we treat only the diseases and not the underlying metabolic pathway. We need to treat obesity FIRST and foremost. We need to not stigmatized the word “obesity”. It's just like high blood pressure, cancer, diabetes or any other chronic relapsing disease. Some crazy facts Obesity with surpass smoking as the leading cause of preventable cancer ¼ of men applying to be in the army are rejected because of their weight... This is a national security issue 85 % of americans will be overweight or obese by 2020 The fat cell (adipocyte) is the largest  “gland” . it secretes hormones and changes your brain chemistry, metabolism, etc. There is such thing as “fatty heart” like “fatty liver” which causes heart failure (fluids builds up in lungs) but people will have normal ECHO. The key to prevent all these issues is in childhood. The food industry is making bank by selling processed food. We assume that our children are healthy because they look health but many already would have signs of metabolic disease if you were to test. Not only that, even if they dont, they probably will by early childhood.

Emmy is learning some really cool stuff while studying for her Obesity Medicine Boards.... 

Pete and Emmy chat about the reality that so many people trying to lose weight face... food addiction. 

You can do any “healthy” diet poorly Nutrition is not religion A “poor healthy” diet will work for a while Because it is probably better then SAD At some point, you will hit a plateau in your goals (weight loss/health) All diets CAN be healthy or unhealthy Nutrition is not Religion A reminder that genetics may determine which diet works for us Ways that any diet can be unhealthy Vegetable Oils In all processed food Soybean, canola (organic doesn't make it healthy) Paleo, vegan, keto baked goods, cookies, crackers etc. “Fake” vegan cheese Added Sugar See above Honey in moderation may be okay but tons of added sweetener Artificial sweeteners in “low carb”sweets Foods that you have an intolerance for Grains, dairy “One man's food is another man’s poison” - Titus Lucretius Carus aka: Lucretius Processed Food See above (veggie oils, processed carbs, sugar) Meat can be processed too Weird Ingredients E.g the ice cream we got last night If you don’t know what it is, you probably shouldn't eat it Nutrient Deficiencies B vitamins NEED to be supplemented Vitamin C possibly in Carnivore Just because it says “organic”, “paleo”, “low carb”, “vegan”, does not mean its healthy If it has a label on it, its not real food. No human population ever ate only plants or only meat, we are omnivores  

GERD What are the symptoms? Pressure in chest Nausea Worse with eating or fasting What is Gastroesophageal reflux disease? (GE.R.D.) Stomach acid is needed for digestion Stomach acid should ideally stay in the stomach When the lower esophageal sphincter relaxes, acid creeps up into the esophagus The problem is NOT too much acid The problem is acid in the wrong place Anything that relaxes the lower esophageal sphincter makes GERD worse Caffeine Chocolate Peppermint Alcohol Smoking Age When you go to the doctor they will put you on H2 blocker or PPI Which blocks acid production BUT the problem is NOT too much acid Its acid in the wrong place   When you block acid with H2 and PPI You can’t digest your food well and then you get worsening digestive issues Acid is needed to keep the correct acid / base balance Decrease your acid and you can get bad bacterial overgrowth. Increase in bad bacteria can cause worsening sxs Other dangers of these medications PPIs (Proton Pump Inhibitors) FDA warnings             long-term use of PPIs: risk of fractures, low magnesium leading to muscle cramping, , Clostridium difficile–associated diarrhea, vitamin B12 , kidney issues (acute interstitial nephritis (AIN), and Lupus,  and stroke No big deal right? How do we treat/fix this? Don't just put a bandaid on the problem with antacids Reduce bacterial overgrowth Digestive enzymes Lower carbohydrates FODMAP diet FODMAPs are certain types of carbohydrates that are poorly absorbed by some people Avoid artificial sweeteners Lower fiber. Avoid things that relax the lower esophageal sphincter Safe natural remedies  things that help (I have found) Apple Cider Vinegar / Pickle Juice Works like digestive enzymes Licorice (this works soo well) Tea, DGL supplements https://www.niddk.nih.gov/health-information/digestive-diseases/acid-reflux-ger-gerd-adults

Our very first guest on the podcast over a year ago, Paul Serafino (https://paulserafino.com/) joins Pete to discuss the importance of prioritization vs. accountability and other useful hacks for a busy, overwhelming work life. Paul is an innovator in the world of coaching for busy CEOs and executives. He helps those who need to be on top of their game so their companies can thrive. Balancing one's energy in the right places can make all the difference in the world. 

Check out work by Dr. Lustig who is a pediatric endocrinologist Book is called “Fat Chance” Another example of “A calorie is not a calorie”!! Calories affect your body differently Glucose vs Fructose Both carbohydrates Every cell burns glucose. You either get glucose from diet or you make it yourself from Gluconeogenesis (liver makes glucose). You can eat NO glucose but still have glucose in your body We can only metabolize a smaller amount of fructose and we store it primarily. Excess basically leads to aging of cells Fructose In soda, candy, cakes and goodies but also in most breads Basically all processed food Does not decrease your hunger hormone (ghrelin) like glucose Means you can eat and eat and eat You literally can't eat as much food with no fructose in Causes NAFLD (non alcoholic fatty liver disease) We are seeing this in kids younger and younger More common than alcohol disease Fructose lights up the “reward center” of brain (dopamine) Same effect as cocaine, nicotine, etc.   Liver Disease ALT and AST is what we measure. ALT of 40 is considered normal The average (normal level) has increased over the past decade These are basically markers for sugar intake Basically everyone has fatty liver.   Genetic differences E.g latinX population has genetic population where they store more sugar and don’t process it well. Even more important to cut sugar down Pete’s ALT was 32. Is now normal but would have been abnormal, AST 24   Inflammation Causes whole body inflammation. Lustig is a pediatrician so he works with hundreds of families   Epigenetic changes in kids with this consumption (probably - found in animal studies) We know maternal hyperglycemia changes genetics of baby later on Causes metabolic issues later in life   How many times does it take to get a baby to eat a savory food? Need to introduce a new, savory food (Think roasted veggies) 13 times to get child to accept What about sugar? Once   Because it is like cocaine there is a huge issue with down regulate dopamine receptor Hard to experience joy from other things Because of the down-regulator receptors in brain Takes more and more sugar But also more and more of other things Could this be linked to depression??!!!!! The problem is that this addiction is socially accepted.   One benefit of fructose (only in athletes) If your liver if depleted of glycogen, you can replete faster with fructose but fructose (like in energy gels DO NOT replete muscle glycogen)   Fruit Is technically fructose BUT it comes with fiber. THE PROBLEM IS PROCESSED FOOD Its sugar without fiber If it has a label its not real food

I have seen a number of questions at various times regarding refueling during events. I wonder if anyone has used BHBs in this setting? Fat bombs? Electrolytes? I am training for a half marathon-8 mile has been my max run so far without so much as wAter.  How do parents who are eating Keto/LCHF deal with their kids' eating patterns and choices, especially kids of school age and up, who are with non-keto-eating peers a lot of the time? Older kids and/or adult children (and their families) and conversations on health. Good chance to practice stoicism. Modeling your attention to nutrition/aging, especially around grandkids. Ask the kids what you can do to model their nutrition vision with grandchildren when you are visiting and/or weekends/weeks vacation.

What's your IF routine? And how do you shake it up? Do you change it up by carb cycling? Longer fasts? Shorter fasts? What does Emmy Do?What does Pete Do?Define what fasting isDifferent types of fasts and why someone would want to do one vs. another. E.g OMAD constantly may not be good for weight loss but great for maintenance     Weight loss vs cancer vs biohacking vs performanceDefine Carb Cycling Often anecdotal, possibly affects leptin, “the whoosh”, we don't know why Maybe keeping your body guessing is the keyIndividual goals and other variables for choosing different types of fast.  I am a bit stuck, my body is bored with the food I am eating, I find I pick during my eating window and I have not been able to get past 17 hours. My question....How do I reset myself? Pete recently embarked on a reset (6 days). Talks about why it is important to say these things out loud/write them down. It makes it real. (reference Christina Ubell most recent episode where she mentions “Write it Down - Move on” worksheet. The importance of support. Online communities - be vocal. Honest conversations with loved ones at home and practice talking about it often at home. Normalize the conversation about long term health. Stalls and what to do about them. See our episode #17 - Plateaus https://www.podbean.com/media/share/pb-hszyw-888aa6 Stop doing it completely for a month. Go high carb for a week. veggies/fruit Ideas for embarking on a reset. My wife and I are transitioning to LCHF. At the same time, we’re getting into some endurance-ish type events, like GORUCK challenges. The friends getting us into these races are giving us all kinds of carb based products like sport beans and tailwind. To try. Very tasty but probably not the best for someone trying to stay LCHF, right? What other options do we have if we’re doing a long ruck for snacks/energy? If we don’t eat something will we ‘bonk’? Will we eventually become ‘fat adapted’? If we eat the yummy beans, will we get an extra extra boost since we normally don’t eat carbs/sugars like these products?Define “Fat-Adapted”- See: Phinney and Volek Define “Bonk” Talk about metabolic flexibility and what it means to “train low-Race High” Talk about Mark Sisson, Brad Kearns and their books/podcasts

In this episode we chat about the past 50 episodes and our biggest takeaways from this journey of health. We each present our top 3-5 pearls of wisdom and how they have affected/changed our perspective on health.

What is the Circadian Rhythm? Our planet revolves around its axis causing light and dark cycles of 24 hours. Organisms on our planet evolved to predict these cycles by developing an endogenous circadian (circa: about and dies: day) clock, which is synchronized to external time cues. All aspects of physiology, including sleep-wake cycles, cardiovascular activity, endocrine system, body temperature, renal activity, gastrointestinal tract motility, and metabolism, are influenced by the circadian clock Recent studies have shown that the circadian clock controls energy homeostasis by regulating the activity of enzymes, hormones, etc Where is your Circadian Clock Located? EVERYWHERE!! The central circadian clock is located in brain’s  hypothalamus. Most peripheral tissues also have circadian rhythm through expression of “clock genes” The circadian clock regulates various metabolic pathways, such as cholesterol metabolism, protein regulation (building and breaking down muscle), drug and toxin metabolism, glucose metabolism, and effects on basal metabolic rate. Circadian clocks have been shown to be present in white and brown adipose tissues and are important for metabolism in adipose tissue Hormones such as.... Insulin Loss of circadian rhythmicity of glucose metabolism may contribute to the development of metabolic disorders, such as type 2 diabetes Leptin Tightly associated with central circadian clock adiponectin is secreted by adipose (fat) tissue:  a protein hormone which is involved in regulating glucose levels as well as fatty acid breakdown. The expression of many adipokines is blunted in obese patients . In obese subjects, adiponectin levels were significantly lower than lean controls, although the obese group had significantly higher average peak of secretion [ ALSO controls Ghrelin, Cortisol etc. SOOOOO.... Disruption of the clock genes is linked to dyslipidemia, insulin resistance, obesity, diabetes, cardiovascular disease, cancer , reduced life span  then you control for EVERYTHING ELSE including what you eat and how much! WHAT DO WE DO? STOP EATING snacks. Intermittent energy restriction periods of as little as 16 h can improve health indicators and counteract disease processes. The mechanisms involve a metabolic shift to fat metabolism and ketone production, and stimulation of adaptive cellular stress responses that prevent and repair molecular damage TRF may even have some protective effect even if you are eating crap (better to do both) “Feeding time has the ability to reset bodily rhythms.” Time-restricted feeding, which imposes daily cycles of feeding and fasting without caloric reduction, sustains robust diurnal rhythms and can alleviate metabolic diseases.” Sleep … No really .. go to bed Don’t eat late at night. http://www.chicagotribune.com/lifestyles/health/ct-meal-timing-weight-loss-20180327-story.html https://www.ncbi.nlm.nih.gov/pubmed/28585194 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3914271/ https://academic.oup.com/edrv/article/31/1/1/2354749 http://science.sciencemag.org/content/354/6315/1008 http://www.pnas.org/content/111/47/16647.short https://www.sciencedirect.com/science/article/pii/S1550413114004987