Podcast appearances and mentions of David S Ludwig

Milk has long been sold as the key to strong bones, but research challenges that claim: many people don't tolerate dairy, calcium needs are lower than advertised, and higher milk intake doesn't necessarily prevent fractures. Politics and industry marketing helped set “three glasses a day,” even though healthy bones depend more on overall diet and lifestyle—things like vitamin D, movement, and avoiding soda, excess sugar, and stress that drive calcium loss. Dairy may be helpful for some diets, but it can also trigger bloating, acne, congestion, or digestive issues. The good news is that strong bones and good nutrition are still very doable without cow's milk—think leafy greens, sardines, almonds, chia, and sunshine for vitamin D. In this episode, I discuss, along with Dr. David Ludwig and Dr. Elizabeth Boham why bone health depends more on diet, lifestyle, and nutrient balance than on dairy. David S. Ludwig, MD, PhD, is an endocrinologist and researcher at Boston Children's Hospital, Professor of Pediatrics at Harvard Medical School, and Professor of Nutrition at the Harvard T.H. Chan School of Public Health. He co-directs the New Balance Foundation Obesity Prevention Center and founded the Optimal Weight for Life (OWL) program, one of the nation's largest clinics for children with obesity. For over 25 years, Dr. Ludwig has studied how diet composition affects metabolism, body weight, and chronic disease risk, focusing on low glycemic index, low-carbohydrate, and ketogenic diets. Called an “obesity warrior” by Time Magazine, he has championed policy changes to improve the food environment. A Principal Investigator on numerous NIH and philanthropic grants, Dr. Ludwig has published over 200 scientific articles and three books for the public, including the #1 New York Times bestseller Always, Hungry? Dr. Elizabeth Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women's Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine. This episode is brought to you by BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN to save 15%. Full-length episodes can be found here:Why Most Everything We Were Told About Dairy Is Wrong Is It Okay To Eat Cheese And What Types Of Dairy Should You Avoid? Is Lactose Intolerance Causing Your Gut Issues?

This episode is brought to you by Rupa Health and Athletic Greens. Osteoporosis is very common, especially as we age, but it doesn't have to be the life-threatening risk that currently it is. We've been led to believe that getting enough calcium is the key to healthy bones. In truth, your bone health is determined by your diet, gut health and nutrient absorption, physical activity levels, muscle mass, and more. I talk with Dr. Todd LePine, Dr. David Ludwig, and Dhru Purohit about the myths surrounding bone health and why it's important to take steps to strengthen your bones at every age. Dr. Todd LePine graduated from Dartmouth Medical School and is board certified in Internal Medicine, specializing in Integrative Functional Medicine. He is an Institute for Functional Medicine certified practitioner. Prior to joining The UltraWellness Center, he worked as a physician at Canyon Ranch in Lenox, MA, for 10 years. Dr. LePine's focus at The UltraWellness Center is to help his patients achieve optimal health and vitality by restoring the natural balance to both the mind and the body. His areas of interest include optimal aging, bio-detoxification, functional gastrointestinal health, systemic inflammation, autoimmune disorders, and the neurobiology of mood and cognitive disorders. David S. Ludwig, MD, PhD, is an endocrinologist and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is codirector of the New Balance Foundation Obesity Prevention Center and founder of the Optimal Weight for Life program, one of the country's oldest and largest clinics for the care of overweight children. For more than 25 years, Dr. Ludwig has studied the effects of dietary composition on metabolism, body weight, and risk for chronic disease. Described as an “obesity warrior” by Time Magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. Dhru Purohit is a podcast host, serial entrepreneur, and investor in the health and wellness industry. His podcast, The Dhru Purohit Podcast, is a top 50 global health podcast with over 30 million unique downloads. His interviews focus on the inner workings of the brain and the body and feature the brightest minds in wellness, medicine, and mindset. This episode is brought to you by Rupa Health and Athletic Greens. Rupa Health is a place where Functional Medicine practitioners can access more than 2,000 specialty lab tests from over 20 labs like DUTCH, Vibrant America, Genova, and Great Plains. You can check out a free, live demo with a Q&A or create an account at RupaHealth.com. Right now when you purchase AG1 from Athletic Greens, you will receive 10 FREE travel packs with your first purchase by visiting athleticgreens.com/hyman. Full-length episodes of these interviews can be found here:Dr. Todd LePineDr. David LudwigDhru Purohit See acast.com/privacy for privacy and opt-out information.

Doce é muito bom, né? Infelizmente, a vontade de doces é o que impede muitas pessoas de conseguir seguir uma alimentação saudável e emagrecer. Veja o que estes dois estudos revelaram sobre a vontade de doces, e qual o método para você parar de ser "escravo" dos doces - e poder degustá-los com prazer e calma, sem desespero. Você encontra receitas deliciosas e baixas em carboidratos estão disponíveis no nosso Livro Físico 120 Receitas Low-Carb De Sucesso (receba em casa com frete grátis): http://bit.ly/120-receitas-tanquinho Outros de nossos livros, cursos e treinamentos: https://landing.senhortanquinho.com/ ------------ * Dicas E Comentários Sobre Como Diminuir A Vontade de Doces * Existem algumas medidas práticas para acabar com a #vontade de doces. Como falamos, a vontade de #doces, ou de carboidratos, não é uma questão de "força ou fraqueza". Por exemplo, você sabia que algumas desregulações hormonais estão intimamente ligadas à vontade de comer carboidratos a noite? Falamos sobre isso aqui https://www.youtube.com/watch?v=wag8oD-hQhk E o estudo 1 mostrou que o "consumo cronicamente alto de carboidratos pode afetar os sistemas de recompensa do cérebro, de maneiras que pode impedir a manutenção da perda de peso". Ou seja: coma muitos carboidratos, e pode ser mais difícil para você se manter magra. Já o estudo 2 mostrou que as pessoas que faziam um café da manhã mais rico em carboidratos tinha maiores oscilações na glicemia, e tiveram mais fome, e comeram mais calorias. Ou seja: mais um ponto para a dieta #lowcarb. (Entenda as diferenças e semelhanças entre low-carb, paleo, cetogênica, primal, aqui: https://www.youtube.com/watch?v=IMDMteQg8N8 ) E veja como fazer um café da manhã low-carb aqui: https://www.youtube.com/watch?v=w0ie_q52mFY Estudos citados: 1 - Laura M Holsen, W Scott Hoge, Belinda S Lennerz, Hilâl Cerit, Taryn Hye, Priyanka Moondra, Jill M Goldstein, Cara B Ebbeling, David S Ludwig, Diets Varying in Carbohydrate Content Differentially Alter Brain Activity in Homeostatic and Reward Regions in Adults, The Journal of Nutrition, Volume 151, Issue 8, August 2021, Pages 2465–2476 2 - Wyatt, P., Berry, S.E., Finlayson, G. et al. Postprandial glycaemic dips predict appetite and energy intake in healthy individuals. Nat Metab 3, 523–529 (2021). Mas note que o *grau de processamento* dos alimentos é importante. Neste aspecto, prefira sempre a comida de verdade - explicamos o porquê aqui: https://www.youtube.com/watch?v=Wh5z_aC7YnQ --- Support this podcast: https://anchor.fm/senhortanquinho/support

For nearly 70 years now, Americans have been bombarded with advice on how to lose weight. Countless diet books have become bestsellers. Some diets like Atkins keep coming back in sort of a recycled way. And there really hasn't been agreement, even among nutrition scientists, about which approach is best. Lots of attention has focused in recent years on carbohydrates, but over the years, protein and fat have had plenty of attention. In this podcast, our guest, Dr. David Ludwig of Harvard University, discusses this history and the reason for re-envisioning how best to lose weight – and for people to maintain the weight loss, perhaps the most important issue of all. Ludwig recently published a landmark, exquisitely designed and controlled study that tests whether limiting carbohydrates actually makes sense. This study, published in the "American Journal "of Clinical Nutrition 2021," has been generating lots of attention.   Interview Summary   Access the study: https://doi.org/10.1093/ajcn/nqab287     I'll begin by asking a question fundamental to this work. Why care so much about carbohydrates?   Great question, Kelly. Carbohydrates amount to at least half the calories in a typical diet today, which is interesting from a historical and evolutionary perspective. Because of the three major nutrients we eat, protein, fat, and carbohydrate, carbohydrate is the only one for which humans have virtually no requirement. Think of Northern populations, especially in the Ice Ages but also up to recently, such as the Inuit, that had access to only animal products and could eat plant products like berries maybe one or two or three months a year at most. So for nine months a year, they were eating only fat and protein. And yet, those populations were healthy. The women were fertile; they could breastfeed. And children grew normally. So recognizing that there's no absolute requirement for carbohydrates, the question then becomes: How much carbohydrate and what kind would be optimal for health and allow for the greatest flexibility, diversity and enjoyment in our diets?   So David, if the body doesn't have an innate need for these, presumably there's no biological driver to go out and seek these, why in the heck are people eating so much of this?   Well, carbohydrates are delicious. And the food industry certainly knows that and has taken advantage of that. In fact, when you step back and ask: What are the foods that we tend to binge on? They may have a combination of key flavors and nutrients. Oftentimes, we hear sugar, salt and fat. But I'll argue that there are virtually no binge foods that are just fat. Do people actually binge on butter? I mean, butter is very tasty. You might enjoy an initial bite. But very few people, perhaps with the exception of a major eating disorder, would sit down and eat a quarter pound, a stick of butter. But there are all sorts of high-carbohydrate binge foods. Sugary beverages are 100% sugar. Bread, baked potato chips, popcorn, especially the low-fat versions, these are easy to binge. And from one perspective, the key difference is the hormone insulin. Fat does not raise insulin. And so fat is digested slowly, and doesn't get directly stored in large amounts into body tissue. It has to be metabolized more slowly. Whereas carbohydrates, especially the processed ones, when eaten in large amounts, raise insulin to high levels. That insulin directs those incoming calories into storage. And a few hours later, blood sugar crashes and we get hungry again and are ready to have another blood sugar surge by indulging the next time in those foods.   So what question specifically was your study designed to address?   We conducted a large feeding study that had two parts. The parent study had 164 young and middle-aged adults, who were at least a little bit overweight, ranging from overweight to having obesity. And the first thing we did was bring their weight down by providing them all of their foods, delivered foods to their home, in a calorie-restricted way. You know, you cut back calories, and of course you're going to lose weight for a while. It doesn't address why people get hungry, and why they regain weight. But in the short term, we cut their calories, and they lost 10% to 12% of their weight. Then we stabilized them at their new, lower body weight, and then randomly assigned them to one of three groups: low, moderate or high-carbohydrate diets. And we kept them on these three different diets for another five months. And during this time, we were again delivering all of the meals to the participants. This was over 100,000 prepared meals throughout this time, so it was a really major effort. And during this low, moderate, and high-carbohydrate diet period, we adjusted calories to keep their weight the same. We wanted to keep them at that weight-loss anchor, 10% to 12% below where they started. The first study looked at what happened to their metabolism and their energy expenditure. And we found that when people were on the low-carb diet at the same weight as the other groups, they were burning about 200 calories a day more. So the study raised an interesting possibility, that the kind of calories you eat can affect the number of calories you burn. That from a biological perspective, all calories are not alike to the body.   David, this is fascinating work. I'd like to ask a strategy question. So this was an extremely intensive study of 164 people. And you mentioned the people were provided all their meals, very careful measurement and things like that. So the same amount of money, you could have studied many more people but just done a less intensive study with less supervision and fewer measurements of outcome. So why do the study in such an intensive way?   Right, there's always going to be a trade-off in design considerations. And you've identified a classic trade-off. You can study fewer people more intensively, or more people less intensively. Most weight loss trials have chosen the second route. They take a lot of people, and they try to study them for a long period of time, or at least some of them do: a year or ideally two years or longer. The problem is that without an intensive intervention, so what are we talking about? These studies would oftentimes have participants meet with a nutritionist once a month. They would get written educational materials, and maybe other kinds of behavioral support. But that's about it. And without greater levels of support and intervention, people characteristically can't stick to these diets over the long term. Maybe they make changes for two, three or four months. But by six months or a year, they're largely back to eating what they were originally. And the different diet groups don't look much different. So if the groups didn't eat in much of a different way throughout most of the study, why would we expect to see any differences in outcomes, such as weight or energy expenditure, or cardiovascular disease risk factors? So these studies don't test a dietary hypothesis very well. It leads to the mistaken conclusion that all diets are alike. Really, what the conclusion of these studies has to mean is that we need more intensive intervention in our modern toxic environment, if you will, to promote long-term change. And it's only when we get that long-term change can we actually figure out which diet is better and for whom.   So you've explained how the study was done and why you did it. What did you find?   So the first leg of the study, which was published in "BMJ" late in 2018, so just before the pandemic, showed that the kinds of calories you're eating can affect the number of calories you burn. And, that by cutting back on the total and processed carbohydrates, you can increase your metabolic rate. And that could be a big help in the long-term management of a weight problem. You know, you want your body on your side rather than fighting you when you're trying to maintain weight loss. And a faster metabolism would be a tremendous help if this is a reproducible finding and applies to the general population. We recently published in the September "American Journal of Clinical Nutrition," a second part of the study. And that asks: How do these different diets, low, moderate and high carbohydrate, affect cardiovascular disease risk factors? It's one thing to lose weight. Maybe a low carbohydrate diet helps you lose weight. But if your cardiovascular disease risk factors go up, that might not be such a good trade-off. So that's the aim of the second study. Because low-carbohydrate diets are often very high in saturated fat. So we wanted to find out what were the effects of this low-carbohydrate, high-saturated-fat on a range of risk factors.   So tell us specifically some of the cardiovascular risk factors that changed. And if you would, place the changes that you found in your participants in a context. Like are these big-deal changes? Are they small changes? Or put it in context, if you would?   The big problem with saturated fat is that it clearly raises LDL cholesterol, low-density lipoprotein cholesterol, which is a classic cardiovascular disease risk factor. It's the main one that's targeted by many of the drugs, such as statins. Yeah, I think there's no question that on a conventional high-carbohydrate diet, a lot of saturated fat is harmful. So the combination of bread and butter is not a good one. But the question we wanted to ask was: What happens when you get rid of a lot of that bread? Does the saturated fat still comprise a major risk factor? And so our low-carbohydrate diet was exceptionally high in saturated fat, as is characteristic of how these low-carb diets are usually consumed. It had 21% saturated fat, which compares to the 7% saturated fat on the high-carb, low-fat diet that's oftentimes recommended to people at risk for heart disease.   So what did we find? Well, the first thing we found was that LDL cholesterol was not adversely affected at all. There was no difference in LDL cholesterol between those getting 21% versus 7% saturated fat. Suggesting that when you substitute saturated fat for processed carbohydrates, from the standpoint of this key risk factor, it's pretty much a wash. However, the low-carbohydrate, high-saturated-fat diet benefited a range of other risk factors that go along with what we call the metabolic syndrome, the insulin resistance syndrome. Specifically, we saw strongly significant, from a statistical perspective, improvements in triglycerides, that's the total amount of fat in the bloodstream; HDL cholesterol, that's the good cholesterol that you want to be higher; and other lipids that indicate overall levels of insulin resistance. Suggesting that insulin resistance was improving. And we know that low-carbohydrate diets show promise for diabetes in other studies, in part because they do tend to improve insulin resistance and lower blood sugar. And so our study suggests that if you are pursuing a low-carbohydrate diet, and we can talk about the different degrees of restriction of carbohydrate, and at the same time you're reducing the processed carbohydrates, then the saturated fat might not really be such a problem.   So then if you take all this information in this, as I said, exquisitely designed intensive study and distill it into what dietary recommendations would be, what do you think is a reasonable proportion of fat, carbohydrate and protein in the diet? And what sort of things should people think about as they want to lose weight and keep the weight off?   One key qualification I need to mention is even though this was an intensive study with a relatively large number of people for a feeding study of this magnitude, we still don't know how generalizable these findings are to people at different ages, different body weights, different levels of susceptibility. So no one study can inform a change of clinical practice like this, especially in the world of nutrition where there's so many complicated and interacting factors. I will also venture to say that there's no one diet that's going to be right for everybody. We know that some people can do perfectly well on a high-carbohydrate, low-fat diet. I mean, think of the classic Asian agrarian societies where rates of obesity and diabetes are very low. But those societies tend to be highly physically active and the people insulin-sensitive. America is characterized by high levels of overweight and obesity, sedentary lifestyle. And these create insulin resistance as a highly prevalent problem. For societies such as ours, we think that high-carbohydrate diets that are raising insulin levels on the background of insulin resistance is a recipe for metabolic problems. And so for Americans, especially those struggling with weight, pre-diabetes, and even more so diabetes, a reasonable first step is to cut back on the processed carbohydrates. And I think that's an intervention that increasingly few experts would argue with. We're talking about concentrated sugars and refined grains. Where we start to get into the controversy is whether carbohydrates should be further reduced down to say 20% as in our study, which still leaves room for some unprocessed grains, beans, and a couple of servings of whole fruit a day, or even lower to what's called the ketogenic diet that's less than 10%. And that's where you really have to give up most carbohydrates and focus just on the proteins and fats. I think for people with diabetes, such a strict approach looks appealing in preliminary research studies. But again, this is going to need more research. And I would caution anybody with diabetes or anybody who's thinking about a ketogenic diet to discuss these kinds of dietary changes with their healthcare provider.   I realize your study wasn't meant to address this issue that I'm about to raise, but I'd appreciate hearing your instincts. One key, of course, to any recommended nutrition plan or diet, if you'd like to call it that, is whether people will stick to it. What do your instincts tell you, or data if you have it, on how readily people can adhere to this sort of an approach over the long term compared to other kinds of approaches?   Great question. And I'll approach that by saying: We all understand that if diet is a problem that's contributing to obesity, diabetes, heart disease, other chronic health problems, then we have to change our diet in one way or another regardless of what the mechanisms are. So I'll return the question to you by saying: Which do you think is going to be easier for most people over the long term: cutting back calories, getting hungry and trying to ignore that very intense drive to eat, or getting rid of certain kinds of foods that may be triggering hunger and making it so much harder to stick to a lower calorie intake?   As a doctor, as a pediatrician, and as a researcher, and also myself, I try to do N of 1 experiments on myself with any kind of a nutrition approach I might use with patients or with research participants. I've found that it's so much easier to just give up the processed carbohydrates and enjoy a range of other very satisfying, delicious, higher fat foods. And oftentimes, in my experience personally and I hear as reported by patients that the cravings for these highly processed carbohydrates go down. And lastly, I'll just say, it's not that these processed carbohydrates are inherently so irresistibly delicious. I mean, white bread, these common binge foods, white bread, unbuttered popcorn, baked potato chips, even though these are almost 100% carbohydrate yet they're commonly binged on not because they're so incredibly tasty. But I would argue because they're producing changes in our body that are driving overeating. So it's not that they're so tasty and we're getting so much enjoyment. We're eating these foods because we're driven to metabolically. And once you come off that blood sugar rollercoaster, it becomes much easier to say no.   When you mentioned before that with one approach, you're kind of fighting your body; and another approach, your body is becoming your ally in this process, I thought of going to the beach and, you know, you can go out and try to swim against the waves coming in, or you can ride the waves toward the beach. And one, of course, is a lot easier than the other. And it sounds that's kind of what you're talking about, isn't it?   When you line up biology and behavior, and clearly behavior, psychology, and our food environment are all factors that are going to have to be addressed. We don't want to make it much harder for people. So we do need to think in systems dynamics: the food supply, the environment. But on a strictly individual level, when you line up biology with your behavior, the effort required to accomplish your goals becomes less. You know, this is characteristic of so many areas of medicine and research. This is why we aim to identify the cause of a problem when you treat a cause. So let's use the example of fever. Fever you could say is a problem of heat balance: too much heat in the body, not enough heat out. And so from that perspective, you could treat any fever by getting into an ice bath. Couldn't you, right? The ice would pull the excess heat out of your body. But is that an effective treatment for fever? No, of course not. Because your body's going to fight back violently with severe shivering, blood vessel constriction. And you're going to feel miserable and you're going to get out of that ice bath quickly. In the case of obesity, the timeframe is much longer, but similar kinds of responses occur. The body fights back against calorie restriction because calorie restriction, according to this way of thinking, is an effect. It's not the cause. If the cause is the body's been triggered to store too much fat, then we have to address that problem by lowering insulin levels and producing a more stable blood sugar pattern after eating. If that happens, then the effort that you put into cutting back calories goes a lot further.   Bio:   David S. Ludwig, MD, PhD is an endocrinologist and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is the founding director of the Optimal Wellness for Life (OWL) program, one of the country's oldest and largest clinics for the care of overweight children. For 25 years, Dr. Ludwig has studied the effects of diet on metabolism, body weight and risk for chronic disease – with a special focus on low glycemic index, low carbohydrate and ketogenic diets. He has made major contributions to development of the Carbohydrate-Insulin Model, a physiological perspective on the obesity pandemic. Described as an “obesity warrior” by Time Magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has been Principal Investigator on numerous grants from the National Institutes of Health and philanthropic organizations totaling over $50 million and has published over 200 scientific articles. Dr. Ludwig was a Contributing Writer at JAMA for 10 years and presently serves as an editor for American Journal of Clinical Nutrition. He appears frequently in national media, including New York Times, NPR, ABC, NBC, CBS and CNN. Dr. Ludwig has written 3 books for the public, including the #1 New York Times bestseller Always, Hungry? Conquer Cravings, Retrain your Fat Cells, and Lose Weight Permanently.  

A paper just released in the American Journal of Clinical Nutrition challenges, and I mean really challenges conventional thinking about nutrition, weight gain, and what has caused the very rapid and profound increase in obesity rates over the last 50 years. This is a landmark paper by any standard, and saying that it will raise eyebrows is an understatement. The paper is authored by a number of distinguished nutrition scientists. The lead author is Dr. David Ludwig from Harvard University. Interview   David Ludwig MD, PhD is Professor of Nutrition at the Harvard School of Public Health, and Professor of Pediatrics in the Harvard Medical School. He has published innumerable books and papers on nutrition, contributors to obesity and diabetes, and what might be done with both practice and policy to improve things. He has a real remarkable breadth and scope of his work. David, Time Magazine once named you a warrior in work on obesity. This is exactly how I see you as well. You're really challenging the traditional ways of thinking, and as I said, you've broken new ground. So I'm proud to say that you and I have been friends for a number of years, and I'm also proud to say that we've written a number of things together. So thanks so much for being with us today. It's a real honor to have you.   Thanks, Kelly. Great to be with you. And I'm sitting here in my office looking at a plaque I have on the wall of an op-ed we wrote for the Washington Post almost two decades ago, so it's been a real honor and productive pleasure to know you.   The pleasure has been mine. So let's talk about the paper. So in this paper, you and your co-authors challenged the widely-embraced energy balance model. So can you say what the energy balance model is?   Well, the notion of energy balance is really just a restatement of physics, the first law of physics that says, that speaks to energy conservation, and it's commonly interpreted that in order to gain weight, you have to have a positive energy balance, that is you have to consume more calories than you burn off, and that to lose weight, you have to reverse that. You have to have a negative energy balance. You have to consume fewer calories than you burn off. But we argue first off that this doesn't tell us anything about causality, cause and effect, what's actually driving obesity. We use the example of a fever. Of course, a fever can only happen if the body generates more heat than it dissipates, more heat into the body than heat out of the body. But that's obvious that's, it's, you know, we don't need to be emphasizing that in textbooks. We don't need to be teaching patients that notion. The question is what's cause and what's effect? And the conventional way of thinking is that the positive energy balance is driving weight gain, is causing obesity. So we're surrounded by all these convenient, inexpensive, energy-dense, hyper-palatable, highly tasty foods. We lose control. We overeat them. We don't burn off those excess calories with our modern lifestyle, and so those excess calories get forced into fat cells, and we gain weight. So ultimately this view considers all calories are alike to the body, and that we have to eat fewer calories, and ideally burn more of them off by exercise to address the problem. So that's the conventional way of thinking.   So you have a different, and very science-based explanation for all of this that I'll get to in a minute, but before we do that, why did the field come to adopt this energy balance model?   Well, it does seem to make sense, and certainly over the short term, we know that this way of viewing things applies. If you force feed an animal, or if we just intentionally overeat ourselves, we can gain weight, and conversely, if we put ourselves on a low calorie diet, we can lose weight for a while, but characteristically, we know the body isn't a, you know, an inert energy storage depot. The body fights back in a dynamic way against changes in body weight and in energy balance, and this is something that almost every dieter has experienced, right? If it were just a matter of eating less and moving more, 150 calories less a day, that's a serving of juice, 150 calories out more a day, that's walking moderately for half hour, then virtually every weight problem should be solved within, you know, months to at most, a few years, but that's not the case. Very few people can adhere to, can stay with low calorie diets for very clear reasons. The first thing that happens is we get hungry, and hunger isn't a fleeting feeling. It's a primary biological signal that the body wants more calories. And even if we could, those few of us who are highly-disciplined, and can resist hunger, the body fights back in other ways, most notably by slowing down metabolism, which means that to keep the weight coming off, even as we're getting hungrier. We have to keep eating less and less, because the body's getting more efficient. So the conventional way of thinking about things, all calories are alike, calorie in calorie out, just eat less and move more. Doesn't seem to address the difficulty that people are facing, and recognize that despite a lot of attention to calorie balance, the obesity epidemic is getting worse and worse every year. I mean, the data just from the last year suggests that the weight gain during the pandemic was even faster than it was just prior.   Well, let's talk for a minute about what's at stake here. So vast numbers of people in the United States, both adults and children are overweight. This is increasingly becoming true of essentially every country in the world. The amount of weight that people have been gaining seems to be going up over time, and people find it very difficult, perhaps for the reasons you mentioned, to lose weight and keep it off, so it's a pretty dire situation then, and given the health consequences of excess weight, and the psychosocial implications of things, there's really a lot at stake here, isn't there?   Certainly so. We know that in childhood, obesity can affect virtually every organ system in the body, and set the stage for a lifetime increased risk of diabetes, heart disease, even many cancers. Among adults, the majority, and in fact 70% of adults in the United States have at least overweight, if not obesity, and this is becoming a huge driver of the chronic health burden on the healthcare system, and which so many patients themselves experience, in terms of diabetes, risk for heart disease, fatty liver, orthopedic problems, sleep apnea. So we have a problem that has gotten so much attention, and yet keeps getting worse with every effort that we can bring to bear. My coauthors and I have this new paper in American Journal of Clinical Nutrition, arguing it's time for new thinking. And the carbohydrate insulin model that we are proposing is perfectly consistent with the laws of physics around energy balance, but it suggests that we've been coming at the problem in exactly the opposite way than would be most effective.   So let's talk about that. So if you have a different explanation than the traditional energy balance model, what is it exactly?   So the usual way of thinking, as we considered earlier is that overeating causes weight gain, and that certainly happens in the short term, but that model has a hard time explaining why people are gaining weight year after year, and their bodies are wanting to hold onto those calories. So we argue that a metabolic perspective would better explain this continuing creep upward in the so-called body weight set point. So the carbohydrate insulin model suggests that we've had it backwards, that overeating is not the primary cause of weight gain, that the body's process of gaining weight, and storing too much fat is driving overeating. So overeating and a positive calorie balance certainly has to exist. That's a law of physics, but it's a downstream effect. It's not at the source of the problem. And so this may sound a little surprising. How could the body gaining weight cause us to overeat? Well, let's take the example of an adolescent during the growth spurt. We know a teenager might consume hundreds, or a thousand calories more than he or she might have a few years earlier, and that adolescent is growing really quickly, but which comes first? Is the overeating that that child is doing causing the growth, or is the rapid growth and the deposition of many calories into new body tissue causing that adolescent to get hungry and to eat more? Neither explanation violates any law of physics, but they have radically different implications to how we understand growth, and what we might do about growth disorders. In the case of the adolescent, it's clearly the other way. It's the growth that's driving the overeating, and how do we know that? Well, Kelly, neither you or I, no matter how much we're going to eat or overeat are going to grow any taller. So something in the body is regulating hunger, based on the needs of growth, and we argue that the same thing is happening in the case of obesity, that the aspects of our diet, importantly, including the processed carbohydrates that flooded our diet during the low fat years, that these are triggering fat cells in the body to hoard too many calories, to hold onto too many calories, so there are fewer calories available for the muscle, the liver, and the brain, and our body recognizes that. We get hungry, and we eat more as a consequence.   You mentioned the highly processed foods, especially carbohydrates that bombarded the American scene during the low fat craze. Explain more about that.   These processed carbohydrates, that at one point, just 20 to 30 years ago, people thought, and you can find many examples of this written in the literature. In fact, the first food guide pyramid is a clear illustration of the fact that all fats were considered unhealthy, because they have so many calories per bite, more than twice the calories per gram than carbohydrates. Whereas the bottom of the food guide pyramid, you know, we were supposed to eat six to 11 servings of grains, many of which were highly processed. Sugar was considered benign, and a good way to, and this is what they said, dilute out fat calories. The problem is that these processed carbohydrates, white bread, white rice, potato products, virtually all of the prepared breakfast cereals, and of course, concentrated sugars, and sugary beverages. So when you eat these foods in substantial amount, and it's worse if the meal is also low in fat and protein, because they tend to slow down digestion. So if you just eat a lot of these processed carbohydrates, the body digests it into glucose literally in minutes. So blood sugar shoots upwards 10, 20, 30 minutes later, and that causes a lot of the hormone insulin to be produced. I sometimes refer to insulin as the Miracle-Gro for your fat cells, just not the sort of miracle you want happening in your body. We know that when a person with diabetes gets started on insulin, they'll typically gain weight, and if insulin is given in excess dose, they'll gain a lot of weight. So insulin is the hormone that promotes fat storage, and we argue that basically just endocrinology 101, all these processed carbohydrates, by stimulating more insulin than we would normally make on a less processed, lower carbohydrate diet, are driving too many of the incoming calories from a meal into storage and fat cells, instead of into muscle where they can burn. And so when you store, all it takes us to store one gram of fat too much a day to explain basically the whole of obesity, if one looks from childhood to adulthood.   So David, provide some context for this, if you would. So what fraction of the American diet is comprised of these kinds of foods, and what would that number be if people followed the recommended dietary guidelines you suggested?   Well, back in the 1950s, it's not as if Americans were extremely healthy. We had much higher rates of heart disease, although much of that related to smoking, and we of course, had many fewer medications, and surgical procedures to help prevent or treat heart disease. But at that time, obesity rates were much, much lower, you know, about only one third of the rates they are today. And at that time in the 1950s, Americans ate about 40% of their calories as fat, and about 40% as carbohydrate, and maybe 15 to 20% as protein. Because of concerns around saturated fat and heart disease, which then got generalized to all fats being bad, well, we got the low fat diet of the 1980s, nineties, and the beginning of the century. Fat came down as a proportion of our diet. Carbs went up, but also the processing of those carbs. We got foods like the fat-free SnackWells cookies, a whole range of these fat-reduced products that simply took out fat, dumped in sugar and starch. These are after all processed foods, so they're not going to be putting in fruits and vegetables. And these products were considered healthy. We ate them as we were told to eat them, and at that time, obesity rates really exploded. And we're arguing that this is not just an association, that this change to our diet has played an important role in driving obesity, and that by bringing both the total amount of carbohydrates down, not necessarily a very low carb or ketogenic diet, but bringing them back down, maybe to what might oftentimes be characterized as a Mediterranean diet, focusing on getting rid of the processed carbs, eating more of the delicious and nutritious high fat foods, like nuts and nut butters, olive oil, avocado, even real dark chocolate. All of these high fat high, calorie foods look a whole lot healthier than the processed carbohydrates do in the best cohort studies.   You know, it's a somewhat hopeful message, isn't it? Because you're not just telling people you have to eat less of everything, but there are actually some things that are quite delicious where you can eat more, and maybe that hope will lead more people to try this sort of approach.   That is exactly the issue with the conventional approach. If all calories are alike, and overeating is the primary problem, then we really just have to control our appetites. We have to discipline ourselves. Yes, clearly the conventional thinking recognizes that environment has a lot to do with it, and psychology of behavior, but ultimately, one way or another, you have to cut back on calories, because overeating is driving the problem. But if the driver is at the fat cells, if the foods that we're eating are triggering our fat cells to store too many calories, and that's what's causing the hunger and the overeating, then just eating less doesn't solve the problem, and it actually could make it worse by slowing down your metabolism. So this model argues that a focus on what you eat, not how much is more effective. You focus on controlling the quality of the foods, importantly, the processed carbs, but there are other aspects that can help hormonal and metabolic response. That's what the person focuses on, and we let the body, based on our hunger levels, and satiety levels, determine how much we need to satisfy metabolic requirement.   So you've got what we call in the field a testable hypothesis, that people will do better if they follow the approach that you've mentioned, compared to the traditional approach. And you put that to a test in a study that we're going to be talking about in a second podcast. But before we get to that, what sort of pushback, if you had, as your paper has been published, are corporate interests involved in this picture at all?   Yeah, let me just say that we recognize that these ideas are not fully proven. There are animal studies, we've done one of them that provides what we could call a proof of concept, that when you give rodents, and this has been reproduced by many different groups. This is a very rigorous finding. When you give rodents high glycemic index, versus low-glycemic index starch, so that's fast-digesting, versus slow-digesting starch. You keep everything else the same, the ones that get the fast-digesting starch, that's like, all of those processed carbs we're eating that raise insulin a lot, well, they in fact show this whole sequence of events. Their insulin levels initially go up, they start getting fatter, and their energy expenditure goes down. They start moving less, and if you restrict their calories to that of the control animal, they're still fatter, because more calories wound up getting stored than burnt in muscle. So they wind up getting more fat tissue, and less lean tissue, even at the same total body weight when you prevent their weight from going up. So we argued that there's no way to explain that finding based on the conventional, calorie in, calorie out way of thinking. We need to examine whether this applies in humans, and to whom, you know? It may be that one model explains certain situations, or certain people better than the other, but it is a testable hypothesis. Unfortunately, this debate has become polarized, and we, in our article, specifically invite opponents to work with us on generating common ground. There's plenty of basis for common ground already, and in our article, which is freely available online at American Journal of Clinical Nutrition. We put out a diagrammatic model in which each step leads to another step, and each of these steps is testable. So we can figure out what we got right, what needs improvement, you know, and where common ground is. After all, this is what science is supposed to be about, to come up with new ways of thinking for intractable problems.   You know, you reminded me when you talked about the animal studies of work that occurred many decades ago on something that people in the field were referring to as the cafeteria diet. And I remember the slide that I used for years in my own talks that was given to me by Ted Van Itallie, one of the pioneers in the obesity field, that showed a rat sitting on top of basically a junk food diet, where they take animals, and in the cage, they would put Cheetos and Hershey bars, and marshmallows, and things like that. And the animals would eat a lot of those things, and gain an enormous amount of weight. But people were really attributing the weight gain to the fact that these were highly palatable foods. The animals would eat a lot of it just because it tasted really good, and that would bring a lot of calories, and that was the reason for the weight gain. And what you're saying is just, "Wait a minute, what happens to be that food that goes in there is a really important part of the picture," And that's been proven by controlling the calories in the experiment that you set.   Well, I think that's a really great point that you raised that it's easy to think in the cafeteria diet model, that the animals are getting fat because of the tastiness of the food, but these studies can't distinguish tastiness, and whatever that means, and we could come back to that point, because tastiness is elusive. It's a very squishy term to define, for reasons we can consider, but it's impossible in these studies to distinguish tastiness from the nutrient content of the foods, and they tend to be full of sugar and processed carbs. In fact, the few studies that have aimed to disentangle this provide clear support for the carbohydrate insulin model that tastiness by itself, when you control nutrients, does not result in obesity, but the nutrients, even in a bland or untasty diet does result in weight gain in animals.   Fascinating science. So, David, what do you think are some of the main policy implications of all this?   Well, there has been push back. Some of that relates to just the difficulty of paradigm change, amidst scientific uncertainty. You know, we need ultimately to be all working together on all sides of this. But in addition, there's resistance from the food industry that loves the notion that all calories are alike. All calories are alike, and there are no bad foods, and that you can drink a sugary beverage, have any kind of junk food, as long as you eat less of other things, or burn off those calories with physical activity. Whereas if this way of thinking, involving the carbohydrate insulin model, this opposite cause and effect conception is correct, then those foods have adverse effects on our metabolism above and beyond their calorie content. And that from that perspective, you really, can't just outrun a bad diet, that we really need to be thinking about how our food is influencing our hormones and metabolism, otherwise we're going to set ourselves up for failure, and that's not a message that many, although not all in the food industry like to hear, because it requires corporate responsibility for helping to create the nutritional nightmare that confronts so many of us, and especially children throughout so much of their days.   You reminded me about an interesting parallel with tobacco here, where the tobacco companies, you know, long after it was known that cigarettes were killing people, just said that it's not the tobacco that's killing the people, it's the fact that they're just consuming too much of it, and the food companies have made very much that same argument. And then the tobacco researchers said, "No, tobacco is bad in any amount, and even a little of it can be harmful." And that's not totally true of the processed foods you're talking about. I'm assuming people can have them in small amounts, but the parallel really kind of exists there, doesn't it? That these things are risky, and dangerous really, after you go beyond whatever that small amount is, and then you're going to have trouble, no matter what you're doing elsewhere in your diet?   The metaphor with tobacco is useful to a point, although it can also elicit some strong responses, because obviously, tobacco products aren't needed for survival, food clearly is. But I do think that there are some parallels that if these highly processed carbohydrates are undermining our metabolism, and also triggering, in part because of the metabolic changes. Fat cells communicate with the brain in many ways, including by releasing or withholding nutrients. If these foods are also triggering pathways in the brain that make managing calorie balance increasingly difficult, then we do really begin to need to think about food way beyond calorie issues, and that all calories aren't alike, and that the food industry may indeed have to manage the food supply in a way that makes weight control easier rather than harder.   The paper we were discussing today was published in September, 2021 in the American Journal of Clinical Nutrition and is publically available for free.   Bio: David S. Ludwig, MD, PhD is an endocrinologist and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is the founding director of the Optimal Wellness for Life (OWL) program, one of the country's oldest and largest clinics for the care of overweight children. For 25 years, Dr. Ludwig has studied the effects of diet on metabolism, body weight and risk for chronic disease – with a special focus on low glycemic index, low carbohydrate and ketogenic diets. He has made major contributions to development of the Carbohydrate-Insulin Model, a physiological perspective on the obesity pandemic. Described as an “obesity warrior” by Time Magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has been Principal Investigator on numerous grants from the National Institutes of Health and philanthropic organizations totaling over $50 million and has published over 200 scientific articles. Dr. Ludwig was a Contributing Writer at JAMA for 10 years and presently serves as an editor for American Journal of Clinical Nutrition. He appears frequently in national media, including New York Times, NPR, ABC, NBC, CBS and CNN. Dr. Ludwig has written 3 books for the public, including the #1 New York Times bestseller Always, Hungry? Conquer Cravings, Retrain your Fat Cells, and Lose Weight Permanently.  

Standard treatment for obesity, based on a law of physics, assumes that all calories are alike, and that to lose weight one must simply “eat less and move more.” However, this prescription rarely works over the long term. According to the Carbohydrate-Insulin Model of obesity, the metabolic condition of fat cells plays a key role in determining body weight. High intakes of processed carbohydrate raise insulin levels and program fat cells to store too many calories, leaving too few for the rest of the body. Consequently, hunger increases, and metabolic rate slows in the body's attempt to conserve energy. From this perspective, calorie-restricted, low-fat diets amount to symptomatic treatment, destined to fail for most people. Instead, a dietary strategy aiming to lower insulin secretion promises to increase the effectiveness of long-term weight management and chronic disease prevention. David S. Ludwig, M.D., Ph.D., is an endocrinologist and researcher at Boston Children's Hospital, professor of pediatrics at Harvard Medical School and professor of nutrition at Harvard School of Public Health. For more than 25 years, Dr. Ludwig has studied the effects of dietary composition on metabolism, body weight and risk for chronic disease—with a special focus on low glycemic index, low carbohydrate and ketogenic diets. Described as an “obesity warrior” by Time magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has authored more than 200 scientific articles and presently serves as an editor at the American Journal of Clinical Nutrition and The BMJ. Dr. Ludwig is author of the number-one New York Times bestseller Always Hungry? Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently. MLF ORGANIZER Patty James SPEAKERS David S. Ludwig M.D., Ph.D., Endocrinologist and Researcher, Boston Children's Hospital; Professor of Pediatrics, Harvard Medical School; Professor of Nutrition at Harvard School of Public Health Patty James M.S., N.C. Nutritionist; Chef; Author—Moderator In response to the COVID-19 pandemic, we are currently hosting all of our live programming via YouTube live stream. This program was recorded via video conference on October 12th, 2021 by the Commonwealth Club of California. Learn more about your ad choices. Visit megaphone.fm/adchoices

Standard treatment for obesity, based on a law of physics, assumes that all calories are alike, and that to lose weight one must simply “eat less and move more.” However, this prescription rarely works over the long term. According to the Carbohydrate-Insulin Model of obesity, the metabolic condition of fat cells plays a key role in determining body weight. High intakes of processed carbohydrate raise insulin levels and program fat cells to store too many calories, leaving too few for the rest of the body. Consequently, hunger increases, and metabolic rate slows in the body's attempt to conserve energy. From this perspective, calorie-restricted, low-fat diets amount to symptomatic treatment, destined to fail for most people. Instead, a dietary strategy aiming to lower insulin secretion promises to increase the effectiveness of long-term weight management and chronic disease prevention. David S. Ludwig, M.D., Ph.D., is an endocrinologist and researcher at Boston Children's Hospital, professor of pediatrics at Harvard Medical School and professor of nutrition at Harvard School of Public Health. For more than 25 years, Dr. Ludwig has studied the effects of dietary composition on metabolism, body weight and risk for chronic disease—with a special focus on low glycemic index, low carbohydrate and ketogenic diets. Described as an “obesity warrior” by Time magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has authored more than 200 scientific articles and presently serves as an editor at the American Journal of Clinical Nutrition and The BMJ. Dr. Ludwig is author of the number-one New York Times bestseller Always Hungry? Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently. MLF ORGANIZER Patty James SPEAKERS David S. Ludwig M.D., Ph.D., Endocrinologist and Researcher, Boston Children's Hospital; Professor of Pediatrics, Harvard Medical School; Professor of Nutrition at Harvard School of Public Health Patty James M.S., N.C. Nutritionist; Chef; Author—Moderator In response to the COVID-19 pandemic, we are currently hosting all of our live programming via YouTube live stream. This program was recorded via video conference on October 12th, 2021 by the Commonwealth Club of California. Learn more about your ad choices. Visit megaphone.fm/adchoices

Is Dairy Good For Us? | This episode is brought to you by ButcherBoxWe have no biological requirement for dairy, and yet, we've been told over and over again that this food is a great source of calcium and that milk makes healthy bones and we should drink it daily. However, the research shows that none of this is true. In fact, close to 70 percent of the world's population is genetically unable to properly digest milk and other dairy products—a problem known as lactose intolerance. But even if you aren't lactose intolerant, consuming dairy can lead to weight gain, bloating, acne, gas, allergies, eczema, brittle bones, and sometimes even cancer.In this mini-episode, Dr. Hyman discusses why he often works with patients to eliminate dairy in conversations with his colleagues Lisa Dreher and Dr. Elizabeth Boham. He also speaks with Dr. David Ludwig about his recent research on milk and dairy products.Lisa Dreher is a registered dietitian who got her undergraduate nutrition degree at the Rochester Institute of Technology and completed a dietetic internship through Cornell University. Lisa first worked in the acute care hospital setting and became a Clinical Nutrition Specialist working in Pediatric Gastroenterology at the University of Rochester Medical Center. At the same time, she pursued her Masters degree in Nutrition and Integrative Health from the Maryland University of Integrative Health and started practicing integrative and functional nutrition in private practice before joining UWC in 2015. She has since received additional training through the Institute for Functional Medicine. Over the past 10 years, Lisa has delivered several public health lectures on the role of food as medicine and her work has been showcased in Reader's Digest, on National Public Radio, and she was featured in the Broken Brain 2 series. She also developed the Digestive Health and Gut Microbiome training module for the Dietitians in Integrative and Functional Medicine practice group through the Academy of Nutrition and Dietetics. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the Functional Medicine approach to keeping your breasts and whole body well.David S. Ludwig, MD, PhD is an endocrinologist and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is co-director of the New Balance Foundation Obesity Prevention Center and founder of the Optimal Weight for Life program, one of the country's oldest and largest clinics for the care of overweight children. For more than 25 years, Dr. Ludwig has studied the effects of dietary composition on metabolism, body weight, and risk for chronic disease. Described as an “obesity warrior” by Time Magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has been a Principal Investigator on numerous grants from the National Institutes of Health and philanthropic organizations and has published over 200 scientific articles. Dr. Ludwig was a Contributing Writer at JAMA for 10 years and presently serves as an editor for The American Journal of Clinical Nutrition and The BMJ. He has written 3 books for the general public, including the #1 New York Times bestseller Always, Hungry? Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently.This episode is brought to you by ButcherBox. Right now ButcherBox has a special offer for new members. If you sign up today you'll get 2 ribeye steaks free in your first box plus $10 off by going to butcherbox.com/farmacy.Find Dr. Hyman's full-length conversation with Lisa Dreher, “A Simple Diet Experiment That May Solve Most Of Your Health Issues” here: https://DrMarkHyman.lnk.to/FeJHNRJ3 Find Dr. Hyman's full-length conversation with Dr. Elizabeth Boham, “Acne, Weight Gain, Facial Hair, Hair Loss, Infertility: Is PCOS The Cause?” here: https://DrMarkHyman.lnk.to/68G64S1YFind Dr. Hyman's full-length conversation with Dr. David Ludwig, “Why Most Everything We Were Told About Dairy Is Wrong” here: https://DrMarkHyman.lnk.to/DrDavidLudwig See acast.com/privacy for privacy and opt-out information.

Why Most Everything We Were Told About Dairy Is Wrong | This episode is brought to you by Thrive Market and TushyThere are so many myths when it comes to nutrition and health. One of the most prominent, that is still being supported by our government policies today, is that we need three servings of dairy a day to get enough calcium and achieve optimal wellness. We now have plenty of research to show us this just isn’t the case. Not to mention, upwards of 65% of the world’s population are lactose intolerant after infancy! Cow’s milk is not nature’s perfect food for human adults, despite what the lobbying efforts of the dairy industry say. On this episode of The Doctor’s Farmacy, I was excited to sit down with Dr. David Ludwig, whose research I’ve followed for the past 20 years and has helped shape the way I practice medicine. David S. Ludwig, MD, PhD is an endocrinologist and researcher at Boston Children’s Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is co-director of the New Balance Foundation Obesity Prevention Center and founder of the Optimal Weight for Life program, one of the country’s oldest and largest clinics for the care of overweight children. For more than 25 years, Dr. Ludwig has studied the effects of dietary composition on metabolism, body weight, and risk for chronic disease. Described as an “obesity warrior” by Time Magazine, Dr. Ludwig has fought for fundamental policy changes to improve the food environment. He has been a Principal Investigator on numerous grants from the National Institutes of Health and philanthropic organizations and has published over 200 scientific articles. Dr. Ludwig was a Contributing Writer at JAMA for 10 years and presently serves as an editor for The American Journal of Clinical Nutrition and The BMJ. He has written 3 books for the general public, including the #1 New York Times bestseller Always, Hungry? Conquer Cravings, Retrain Your Fat Cells, and Lose Weight Permanently.This episode is brought to you by Thrive Market and Tushy.Right now, Thrive is offering all Doctor's Farmacy listeners an amazing deal. Select a free gift from Thrive Market when you sign up for a 1 year membership. And, any time you spend more than $49 you’ll get free carbon-neutral shipping. Just head over to thrivemarket.com/Hyman. The Tushy bidet is a sleek attachment that clips onto your existing toilet and connects to the water supply behind your toilet to spray you with clean, fresh water. And it’s really affordable, starting at only $79. Right now Tushy is offering Doctor’s Farmacy listeners 10% off, too, so it’s a better time than ever to make the switch to a bidet. Just go to hellotushy.com/HYMAN. Here are more of the details from our interview: Examining the potential impact of people following the US dietary guidelines for drinking milk, and how these guidelines originated (10:59)Debunking the “Got Milk?” campaign (14:40)The importance of considering the impact of milk in the context of its interaction with overall diet quality (17:19)Do you really need to drink milk to get enough calcium, and for healthy bones? (19:54)How industrial agriculture results in higher amounts of naturally occurring hormones in milk (30:13)The misguided school lunch requirements for milk (34:35)Whole milk vs skim milk (36:40)Butter and saturated fat from dairy (40:02)How is the quality of the dairy we consume today different than it was 100 years ago? (49:43)Summary of Dr. Ludwig’s findings on dairy consumption (58:38) See acast.com/privacy for privacy and opt-out information.

AJ and Chris dive in to an all new mini-series called the PNW State of Mind Series. Taking a bird's eye view of something often neglected, but highly critical to our well-being: Our health! The duo talk Chris * Wrapping up the hiking season, and changing my mindset in approaching food* Requiem for a personal newsletterPrimer: Published Aug 8: NYT OP.Ed.*The Toll of America’s Obesity *Beyond the human suffering, diet-related diseases impose massive economic costs.By David S. Ludwig and Kenneth S. RogoffDr. Ludwig is a pediatrician. and Dr. Rogoff is an economist. https://www.nytimes.com/2018/08/09/opinion/cost-diabetes-obesity-budget.htmlDiet discourse, views and opinions * Whole30 * Ketogenic* Paleo* Slow carb diet* Intermittent Fasting.* Slow Food- Carlo Petrini (Italy) * “Slow Food was started by Carlo Petrini and a group of activists in the 1980s with the initial aim to defend regional traditions, good food, gastronomic pleasure and a slow pace of life. In over two decades of history, the movement has evolved to embrace a comprehensive approach to food that recognizes the strong connections between plate, planet, people, politics and culture. * Our approach is based on a concept of food that is defined by three interconnected principles: *good, clean and fair.* * *GOOD:* quality, flavorsome and healthy food * *CLEAN:* production that does not harm the environment * *FAIR:* accessible prices for consumers and fair conditions and pay for producers.What AJ is trying:* Eating healthy- not as a diet. * Eating “Culturally and Traditionally” * Son with allergy issues, means some things can't be in the house or used in cooking; adapting what goes on the family plate. * RECALIBRATE that sweet tooth.* Have tried/using Zero fasting app: * https://itunes.apple.com/us/app/zero-fasting-tracker/id1168348542?mt=8* See books + Argus app + Netflix as reference. * Yes weight-loss as a result for the last month, but went into this for the mindset of better wholistic diet health; not as a diet. * Observations from traveling abroad, and borrowing from Japan; BENTOBooks & Media:* Mindless Eating: https://www.amazon.com/Mindless-Eating-More-Than-Think/dp/0345526880 * “This book will literally change the way you think about your next meal. Food psychologist Brian Wansink revolutionizes our awareness of how much, what, and why we’re eating—often without realizing it. His findings will astound you.”* Omnivores Delima - https://www.amazon.com/Omnivores-Dilemma-Natural-History-Meals/dp/0143038583/ref=sr_1_1?s=books&ie=UTF8&qid=1534452217&sr=1-1&keywords=omnivores+delimma * *Michael Pollan- “ *What should we have for dinner? Ten years ago, Michael Pollan confronted us with this seemingly simple question and, with The Omnivore’s Dilemma, his brilliant and eye-opening exploration of our food choices, demonstrated that how we answer it today may determine not only our health but our survival as a species. In the years since, Pollan’s revolutionary examination has changed the way Americans think about food.”* ** In Defense of Food - https://www.amazon.com/Defense-Food-Eaters-Manifesto/dp/0143114964/ref=sr_1_1?s=books&ie=UTF8&qid=1534452286&sr=1-1&keywords=In+Defense+of+Food * Because in the so-called Western diet, food has been replaced by nutrients, and common sense by confusion--most of what we’re consuming today is longer the product of nature but of food science. The result is what Michael Pollan calls the American Paradox: The more we worry about nutrition, the less healthy we see to become. With In Defense of Food, Pollan proposes a new (and very old) answer to the question of what we should eat that comes down to seven simple but liberating words: *"Eat food. Not too much. Mostly plants." **Netflix: BBC Food Delicious Science* https://www.netflix.com/title/80204401 2017: 3 episodes* “ TV presenter Michael Mosley and botanist James Wong explore the physics, chemistry and biology inside every bite of food we eat.”Apps:* Want an analog option? Try a food journal* Argus: Calorie Counter & Steps by Azumio Inc. http://www.azumio.com/s/argus/index.html (iOS and Android) Meal PrepBlue Apron (https://www.blueapron.com/) - monthly subscription-based delivered-to-your-door whole meal kitDandelion Organic (https://www.dandelionorganic.com/) - Healthy produce brought to your door for a budget-friendly price, right here in Whatcom CountyShopping the outside perimeter of a grocery store#DisciplineConnect*AJ*: patreon.com/ajbarse (http://patreon.com/ajbarse) or follow on Instagram (http://instagram.com/ajbarse) @ajbarse AND an all new www.ajbarse.com (http://www.ajbarse.com/)*Chris*: mnmltek.micro.blog (https://mnmltek.micro.blog/) or chrispowell.co (http://www.chrispowell.co/)*Twitter Hashtags*: #bhampodcastListenIf you're in the Bellingham area, be sure to listen to our show on KMRE 102.3 FM (http://www.kmre.org/bellingham-podcast-media-tech/) Thursdays @ 9:00 am and Saturdays @ 1:30 pm.TalkGot a question about technology or anything else about life in Bellingham? Call 201-731-8324 (tel:2017318324) (TECH) and leave us a voicemail, and ask us nicely! We may include it in one of our future shows.SubscribeiTunes, Google Play Store, Soundcloud, Spreaker, TuneIn, or wherever else you podcast. And check out our website at bellinghampodcast.com (http://bellinghampodcast.com/)

AJ and Chris dive in to an all new mini-series called the PNW State of Mind Series. Taking a bird's eye view of something often neglected, but highly critical to our well-being: Our health! The duo talk Chris * Wrapping up the hiking season, and changing my mindset in approaching food* Requiem for a personal newsletterPrimer: Published Aug 8: NYT OP.Ed.*The Toll of America’s Obesity *Beyond the human suffering, diet-related diseases impose massive economic costs.By David S. Ludwig and Kenneth S. RogoffDr. Ludwig is a pediatrician. and Dr. Rogoff is an economist. https://www.nytimes.com/2018/08/09/opinion/cost-diabetes-obesity-budget.htmlDiet discourse, views and opinions * Whole30 * Ketogenic* Paleo* Slow carb diet* Intermittent Fasting.* Slow Food- Carlo Petrini (Italy) * “Slow Food was started by Carlo Petrini and a group of activists in the 1980s with the initial aim to defend regional traditions, good food, gastronomic pleasure and a slow pace of life. In over two decades of history, the movement has evolved to embrace a comprehensive approach to food that recognizes the strong connections between plate, planet, people, politics and culture. * Our approach is based on a concept of food that is defined by three interconnected principles: *good, clean and fair.* * *GOOD:* quality, flavorsome and healthy food * *CLEAN:* production that does not harm the environment * *FAIR:* accessible prices for consumers and fair conditions and pay for producers.What AJ is trying:* Eating healthy- not as a diet. * Eating “Culturally and Traditionally” * Son with allergy issues, means some things can't be in the house or used in cooking; adapting what goes on the family plate. * RECALIBRATE that sweet tooth.* Have tried/using Zero fasting app: * https://itunes.apple.com/us/app/zero-fasting-tracker/id1168348542?mt=8* See books + Argus app + Netflix as reference. * Yes weight-loss as a result for the last month, but went into this for the mindset of better wholistic diet health; not as a diet. * Observations from traveling abroad, and borrowing from Japan; BENTOBooks & Media:* Mindless Eating: https://www.amazon.com/Mindless-Eating-More-Than-Think/dp/0345526880 * “This book will literally change the way you think about your next meal. Food psychologist Brian Wansink revolutionizes our awareness of how much, what, and why we’re eating—often without realizing it. His findings will astound you.”* Omnivores Delima - https://www.amazon.com/Omnivores-Dilemma-Natural-History-Meals/dp/0143038583/ref=sr_1_1?s=books&ie=UTF8&qid=1534452217&sr=1-1&keywords=omnivores+delimma * *Michael Pollan- “ *What should we have for dinner? Ten years ago, Michael Pollan confronted us with this seemingly simple question and, with The Omnivore’s Dilemma, his brilliant and eye-opening exploration of our food choices, demonstrated that how we answer it today may determine not only our health but our survival as a species. In the years since, Pollan’s revolutionary examination has changed the way Americans think about food.”* ** In Defense of Food - https://www.amazon.com/Defense-Food-Eaters-Manifesto/dp/0143114964/ref=sr_1_1?s=books&ie=UTF8&qid=1534452286&sr=1-1&keywords=In+Defense+of+Food * Because in the so-called Western diet, food has been replaced by nutrients, and common sense by confusion--most of what we’re consuming today is longer the product of nature but of food science. The result is what Michael Pollan calls the American Paradox: The more we worry about nutrition, the less healthy we see to become. With In Defense of Food, Pollan proposes a new (and very old) answer to the question of what we should eat that comes down to seven simple but liberating words: *"Eat food. Not too much. Mostly plants." **Netflix: BBC Food Delicious Science* https://www.netflix.com/title/80204401 2017: 3 episodes* “ TV presenter Michael Mosley and botanist James Wong explore the physics, chemistry and biology inside every bite of food we eat.”Apps:* Want an analog option? Try a food journal* Argus: Calorie Counter & Steps by Azumio Inc. http://www.azumio.com/s/argus/index.html (iOS and Android) Meal PrepBlue Apron (https://www.blueapron.com/) - monthly subscription-based delivered-to-your-door whole meal kitDandelion Organic (https://www.dandelionorganic.com/) - Healthy produce brought to your door for a budget-friendly price, right here in Whatcom CountyShopping the outside perimeter of a grocery store#DisciplineConnect*AJ*: patreon.com/ajbarse (http://patreon.com/ajbarse) or follow on Instagram (http://instagram.com/ajbarse) @ajbarse AND an all new www.ajbarse.com (http://www.ajbarse.com/)*Chris*: mnmltek.micro.blog (https://mnmltek.micro.blog/) or chrispowell.co (http://www.chrispowell.co/)*Twitter Hashtags*: #bhampodcastListenIf you're in the Bellingham area, be sure to listen to our show on KMRE 102.3 FM (http://www.kmre.org/bellingham-podcast-media-tech/) Thursdays @ 9:00 am and Saturdays @ 1:30 pm.TalkGot a question about technology or anything else about life in Bellingham? Call 201-731-8324 (tel:2017318324) (TECH) and leave us a voicemail, and ask us nicely! We may include it in one of our future shows.SubscribeiTunes, Google Play Store, Soundcloud, Spreaker, TuneIn, or wherever else you podcast. And check out our website at bellinghampodcast.com (http://bellinghampodcast.com/)

David S. Ludwig, MD, PhD, is a practicing endocrinologist and researcher at Boston Children’s Hospital, Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. He is Founding Director of the Optimal Weight for Life (OWL) program at Boston Children’s Hospital, one of the oldest and largest family based weight management programs. He also directs the New Balance Foundation Obesity Prevention Center. Described as an “obesity warrior” by Time Magazine, he has been featured in the New York Times, Boston Globe and USA Today and on NPR, ABC, NBC, CBS, CNN and other networks. His new book ALWAYS HUNGRY? published on January 5 is a New York Times bestseller drdavidludwig.com/ www.facebook.com/davidludwigmd/

Listener Comments: Happy 2016 Dave!I love, love, love your podcast. I’ve been listening since June 2012. I’m so incredibly proud of you eating for health. Dumping sugar. Dumping empty calories from fast “Fraken” foods. Working more activity into your daily routine. Taking care of yourself. I lost my weight (50 lbs) early on and I keep listening to podcasts like yours to stay motivated in my Sugar and Starch dodging lifestyle. You are always upbeat. I love your voice, your corny jokes, and fun sense of humor. I’m writing to challenge you to keep pod casting, at least monthly, for a year AFTER you hit your goal weight. Staying on target after you are rocking your (insert size here) jeans turns out to be tougher than I anticipated and I’m really looking forward to your insights.You are always so full of tips, tricks and heartfelt sharing of your trials. You turned me on to FitBit (pedometer on steroids) and I look forward to your tech reviews. Keep it up for 2016! So happy/ proud/ encouraged for you finally eating like a person who gives a damn about themselves and their world.Thank You for sharing with all of us.Best ,Laura in Oregon What Dave is Listening to: Always Hungry David S. Ludwig has a new book where he looks at how we treat obesity currently and if there is science to back up the way we treat this condition. His groundbreaking studies show that overeating doesn't make you fat; the process of getting fat makes you overeat. That's because fat cells play a key role in determining how much weight you gain or lose. Low-fat diets work against you, by triggering fat cells to hoard more calories for themselves, leaving too few for the rest of the body. This "hungry fat" sets off a dangerous chain reaction that leaves you feeling ravenous as your metabolism slows down. Cutting calories only makes the situation worse-creating a battle between mind and metabolism that we're destined to lose. You gain more weight, even as you struggle to eat less food. ALWAYS HUNGRY? turns dieting on its head with a three-phase program that ignores calories and targets fat cells directly New Fitness TV Shows: My Diet's Better Than Yours I actually like the new show. It focuses on a bunch of what appears to be fad diets, but in the end they all seem to focus on quality foods, and exercise. The diets that didn't, didn't seem to have as much impact. I don't think the Paleo or on the other side Vegan are the way to go. Everything in moderation, and focus on protein, fruits and vegetables. I like My Diet's Better Than Yours (Thursdays nights on ABC) because it focuses more on food than something like the Biggest Loser (which is also back). You also need to get your head in the game, and there is one diet that is called the No Diet Diet. That program focuses on getting your brain right.  What Dave is Listening to: Always Hungry David S. Ludwig has a new book where he looks at how we treat obesity currently and if there is science to back up the way we treat this condition. His groundbreaking studies show that overeating doesn't make you fat; the process of getting fat makes you overeat. That's because fat cells play a key role in determining how much weight you gain or lose. Low-fat diets work against you, by triggering fat cells to hoard more calories for themselves, leaving too few for the rest of the body. This "hungry fat" sets off a dangerous chain reaction that leaves you feeling ravenous as your metabolism slows down. Cutting calories only makes the situation worse-creating a battle between mind and metabolism that we're destined to lose. You gain more weight, even as you struggle to eat less food. ALWAYS HUNGRY? turns dieting on its head with a three-phase program that ignores calories and targets fat cells directly Available at Amazon.com

David S. Ludwig, MD, PhD is a practicing pediatrician and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is Founding Director of the Optimal Weight for Life (OWL) program at Children's Hospital, one of the country's oldest and largest multidisciplinary clinics for the care of overweight children. He also directs the New Balance Foundation Obesity Prevention Center. His research focuses on the effects of diet on hormones, metabolism, and body weight. Dr. Ludwig is Principal Investigator on numerous grants from the National Institutes of Health, has published over 150 scientific articles, and presently serves as Contributing Writer for JAMA. Enjoy the show!

David S. Ludwig, MD, PhD is a practicing pediatrician and researcher at Boston Children's Hospital. He holds the rank of Professor of Pediatrics at Harvard Medical School and Professor of Nutrition at Harvard School of Public Health. Dr. Ludwig is Founding Director of the Optimal Weight for Life (OWL) program at Children's Hospital, one of the country's oldest and largest multidisciplinary clinics for the care of overweight children. He also directs the New Balance Foundation Obesity Prevention Center. His research focuses on the effects of diet on hormones, metabolism, and body weight. Dr. Ludwig is Principal Investigator on numerous grants from the National Institutes of Health, has published over 150 scientific articles, and presently serves as Contributing Writer for JAMA. Enjoy the show!