So, I mean, I know where you land on it because I read the book, but the calories versus the hunger, does it even matter at the end of the day? Where do you land?

I've heard that argument too, that it's all about the calories and, you know, oh, that's what it shows.

It's like, I think it's, truthfully, I think it's a really Shows really a very shallow sort of level of understanding, because if you think about, you know, if you say, OK, people are over or getting overweight because they're overeating.

Right.

So it's like, OK, that's fine.

That's a very shallow level of understanding because you have to understand why.

why they're overeating.

So are those hungers on a hierarchy where if you really address like that, you know, actual hunger that it filters into the emotional and the environment and everything else?

Does that help you as a clinician? Does it get in the way, or how would you like people to approach that?

I don't mind if people research their own stuff on Google.

I mean, obviously there's a lot of information out there, and, um, even as doctors, we can't know everything, so for sure it's useful.

The problem is that there's a lot of noise out there.

There's a lot of people making claims about things, and it's not always easy to figure out who's right, who's wrong, and that's where the problem really lies is that there's a lot of people on one side which touts one thing.

You know, another side touts the opposite.

How do you know which is true? Everybody has an opinion, so therefore it's hard to tease out what's the right opinion.

What conversations might be helpful for them to have with their clinician? How do we navigate these differences?

I can imagine the benefit of the weight loss during a fast, but I'm unclear as to what the long-term benefit is later on.

Yeah, it's something that you really have to follow people on, right? It's not like you can do a two-day fast and that'll take care of the last 30 years of like sugar and bread, right? It's something that you have to catch up on and it's a time-dependent process, right? The insulin resistance is a time-dependent process.

So, I mean, I've probably supervised close to a thousand people on various fasting regimens.

We work with them individually on what they like to tolerate and what they don't like to tolerate.

But most of them do have to continue for some time because you've got to realize that by the time you get to see me, it's usually about 20, 25 years of this kind of excessive insulin state.

And it's not going to go away in a month, right? Even if you do a lot of fasting, it's not going to go away.

It takes time, right? It can go away, but it takes time and it takes a lot of work at it.

get excellent and then a longer question harder maybe is how do you evaluate if somebody is losing too much protein you know as they're going through and you say how do you decide oh it's time to stop this particular fast or have more protein or anything like

Can you talk a little bit about those two?

Yeah.

So this is actually really important because it's in the way that it measures.

So let me start with your cholesterol panel, right? So a cholesterol panel usually consists of LDL, which is the so-called bad cholesterol.

That actually is not part of the metabolic syndrome.

That's what everybody completely obsesses over.

They get put on statins, they get put on Ezetrol, they get put on PCSK9s, which are these injections that lower cholesterol.

Which again emphasizes why knowing earlier that you're developing this metabolic syndrome, that your hyperinsulinemia is happening over years, there's the best prevention of cardiac risk.

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Your stars go down.

Well, that's only true, only true, if the amount you're burning stays constant.

And that, as we saw yesterday, is simply not true.

That's the only way it is true.

The other possibility is that as you reduce the amount of coal that's coming in, you reduce the amount of power you're burning, and you keep this stable.

Again, you're not breaking any laws of thermodynamics.

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What does that actually mean? And what are some key sort of tried and true strategies that people could employ to improve their insulin sensitivity?

Yeah, so insulin sensitivity is really how much your body responds.

So if your body is insulin resistant, that is, then it takes a lot of insulin to get the same effect.

And therefore, insulin levels can be very high, which is a bad thing because then you're going to try and store more of them away.

One of the keys to insulin sensitivity, insulin resistance, I mean, those are just sort of flip terms, right, is really to eat – real foods, right? And this is sort of the big push in the last dietary guidelines is to really go back to real foods.

Why? Because the processed foods change your hormonal response in such drastic ways, right? They take out a lot of the nutrients that are in there.

So they're often very nutrient poor, right? You think of white flour, they've basically got all their proteins stripped out, all the fat, stripped out, all the nutrients stripped out, then they have to put it back in.

So what role did organ meats, particularly liver, play in these sort of more traditional diets across cultures?

1-800-CONTACTS.

This sort of extreme measure, it goes back up.

The question is why? So this is another, uh, study of the long-term effects of bariatrics, and you can see that at baseline and at follow-up, this is several years later, the resting metabolic rate and the total energy expenditure, how much energy you're burning, has really not gone down, right? As opposed to the eat less, move more, where it's, keeps going down, keeps going down until you fail, right? That, of course, is the saddest part of all, right? The saddest part of the entire thing is that we know about this metabolic slowdown.

This was shown in 1915, so we've known about it for 100 years.

What I think is sad is that we give people this really horrific advice to eat less and move more, and then when they fail, we blame them for it, right? And that's basically you're blaming the victim, because here's this poor fellow or poor lady who's victimized because they're suffering from obesity, from Type 2 diabetes.

You give them really bad advice which you know is gonna fail, 'cause we've all done it.

It fails every single time.

[laughs]

Does normal always mean you're in the right place, that that's a good place to be? Or is it worth looking into more than just what's normal?

In terms of metabolic health, I think we need to define it a little bit better because there's a lot of people, again, talking about metabolic health without really knowing what they're actually talking about.

So when we talk medically about metabolic syndrome, it's a very specific constellation of five things, which is abdominal obesity, high blood sugars, high blood pressure, high triglycerides, and low HDLs.

So that's the five criteria for metabolic syndrome.

I've discussed this on various YouTube videos and stuff.

Metabolic syndrome, these five things all move together.

And what that does is it points you towards a common origin, right? So what is causing the high blood sugars, abdominal obesity, high triglycerides, that kind of thing.

i just encourage people to check out is it something they can pay for out of pocket and are they willing to pay that to get that information

What do you think is the root cause based on your work?

It, it comes down to hormones.

I think it's mostly the hormone insulin, although a lot of other hormones play a role in weight loss and weight gain.

Um, and I, I detail that in, in The Hunger Code.

Um, I talk about some of the other ones.

But insulin is probably the main one because that's the one...

Uh, insulin and cortisol, say.

Um, I have a question around, you know when somebody starts to gain weight, and then they're on a spectrum to get, like, di- uh, a diabetes type 2, where does insulin resistance come into that piece? Does that develop dur, uh, during the time to get to diabetes towards the end?

Yeah.

So it's not me saying that it's a foreign species.

It's your own body has identified [laughs] it as a foreign species, which is fascinating because now you can bring in this whole new sort of evolutionary biology, all the tools we've developed in evolution of bi- uh, evolutionary biology, and apply them to cancer therapeutics, which gives you ...

Like, we have a system to deal with foreign invasive species, our immune system.

So what happens is that you can now boost the immune system and attack these cancers by using our body's own sort of immune system, and that leads to this whole new treatment paradigm, which is let's not focus on killing cells.

That's paradigm one.

Let's not focus on changing genes.

... for, for cells to throw off these shackles and just say, "Screw it, I'm gonna do what I wanna do." And that's-

So can you help us understand hunger? Because one of the things that's blowing me away right now is everybody's walking around with this sort of identity of, "Oh yeah, I have food noise." Like, food noise has become this b- this buzzword, and it's like, w- do we even know what food noise is? We don't even have a good relationship to our own body's cues of when we should fuel and when we shouldn't.

Yeah, and the whole food noise, um, idea is exactly what I'm talking about in The Hunger Code.

So, um, y- you know, before we get to the three types of hunger, what I, you know, focused on i- in terms of hunger is sort of w- we're trying to get to the real sort of deeper understanding of why we're eating, right? Because again, if you think about, um, calories, right, it's- You know, people say, "Oh, you just have to restrict calories," right? But it actually doesn't work.

So if you think about treatment of obesity, there's lots of different ways you can treat obesity.

So a classic way w- is to wire somebody's jaw shut, right? And that was popular in the '40s and '50s, for example.

Mm

... sort of especially when you're eating too much glucose.

So carbohydrates, you're eating too much glucose, your body can store a certain amount of glucose.

In so many words, what's, what's is this book offer? What motivated you to write The Hunger Code?

Well, it was sort of a takeoff from The Obesity Code.

So The Obesity Code was really sort of talking about how weight gain.

So weight gain, uh, which causes type 2 diabetes, which leads to metabolic syndrome and a lot of bad problems like heart disease and strokes and kidney disease and all kinds of bad issues, right? So it's sort of the root cause, and I think how, w- my, my, the, the impetus to write that was that we had been taught as physicians to so, you know, that it's all calories, calories, calories, calories, but it's not actually.

The, the body doesn't run on calories.

It runs on hormones, and that's what tells our body what to do.

And so The Obesity Code was really talking about how, um, you know, the, the, uh, insulin particularly, but the hormones, uh, really drive weight gain, and the calories are the result of the whole, uh, gaining weight rather than the cause of it.

Yeah

Dr. Fung, another phenomenal book, and so what was your inspiration here with writing this?

I think that it was because there's a lot of recent, uh, data looking at things like ultra-processed foods and food addictions and, um, sort of there's a couple of interesting studies on the socioeconomic, you know, implications of obesity and so on.

Why does it, uh, correlate to poverty and so on? So I think some of that new research really inspired me to take a deeper look into it, and the more I looked, the more interesting it was because this whole idea that I was brought up with, uh, that it's all about calories, count your calories, it's so spectacularly unsuccessful that, you know, it boggles my mind that anybody still sort of, uh, just, just relies on that.

And so that was sort of, uh, one of the things that really, uh, you know, got me interested because something like ultra-processed foods, for example, um, it's not about the calories, it's about the processing, right? That's what's important.

And more and more data shows that, yeah, there's something interesting there that we really need to dive into, and that's what this book is about.

So the idea is that, um, you know, if you think about calories and, you know, that's, that's the amount of energy, right? Calories is a unit of energy.

It's how many, you know, when you burn it in a bomb calorimeter or how much it comes out.

Let's talk about that, that idea.

So, I mean, I know where you land on it because I read the book, but the calories versus the hunger, is it both? Does it even matter at the end of the day? Where do you land?

I've heard that argument, too, that it's all about the calories and, you know, oh, that's that's what it shows.

It's like I think it's truthfully, I think it's a really shows really a very shallow sort of level of understanding, because if you think about, you know, if you say, OK, people are over or getting overweight because they're overeating.

Right.

So it's like, OK, that's fine.

That's a very shallow level of understanding because you have to understand why they're overeating.

It's not that they're overeating.

So are those hungers on a hierarchy where if you really address like that, that, you know, actual hunger that it filters into the emotional and the environment and everything else?

Meanwhile, the artificially low fossil fuel prices ensure that renewable energy can't compete.

compete.Now we see renewable energy prices like 4.5 to 5 new Taiwan dollars per kilowatt hour compared to the conventional price averaging 3 new Taiwan dollars.

The renewable is much more expensive than the conventional electricity.

If there's no such push or encouragement, normally people will not want to use renewables.

When Taipower raises prices, they discriminate by industry.

They categorize industries in Taiwan, saying we have this high margin industry, could be semiconductors, could be AI data centers.

These are the ones that make more money.

They will be directly impacted by this price increase.

Meanwhile, the artificially low fossil fuel prices ensure that renewable energy can't compete.

compete.Now we see renewable energy prices like 4.5 to 5 new Taiwan dollars per kilowatt hour compared to the conventional price averaging 3 new Taiwan dollars.

The renewable is much more expensive than the conventional electricity.

If there's no such push or encouragement, normally people will not want to use renewables.

When Taipower raises prices, they discriminate by industry.

They categorize industries in Taiwan, saying we have this high margin industry, could be semiconductors, could be AI data centers.

These are the ones that make more money.

They will be directly impacted by this price increase.

I know you mentioned that there's more than 12 hormones, but it's mainly insulin.

It's not.

It's a mix.

Insulin is the main one that's affected by food.

So insulin, cortisol, GLP-1, GIP, glucagon, testosterone, estrogen, progesterone, thyroid hormone, all of those things are going to impact your hunger, right? So if you think about sleep deprivation, for example, right? Sleep deprivation, which may increase your cortisol levels because you're stressed, because you're out of sync with your hormones, with so on.

That's going to increase cortisol, which then drives your hunger, which drives homeostatic hunger, which makes you eat more, which makes you gain weight, which is why people then go back and say, hey, sleep deprivation causes weight gain, which it does, right? It's been fairly well documented, right? But it's nothing to do with your diet and it has nothing to do with your insulin.

Same thing with perimenopausal weight gain, for example.

Can you change the fat thermostat then using hormonal manipulation?

Yeah.

As in this is the first time government's ever said what to eat, and this is also the time that [chuckles] there was this massive change in the rate of rise of obesity 'cause, you know, it, it was sort of slowly creeping up.

So I think that was the problem.

And, and when I look back on it from a, you know, from a-- it, it makes sense from a physiologic standpoint too because of course eating a lot of carbohydrates, like refined carbohydrates, so white bread and so on, is, uh, traditionally what has-- people have, uh, associated with gaining weight, right? You can look back, I mean, Gary Taubes, of course, you mentioned, had looked back at the history and he shows that, you know, there's lots of mentions prior to the '60s, '50s and '60s of, you know, how do you lose weight? And everybody was sort of in agreement, eat less sugar and eat less starchy carbohydrates, right? And that was sort of common knowledge at the time.

And then of course that alls got flipped on its head because all of a sudden now refined carbohydrates were bad for y- uh, w- w- sorry, refined carbohydrates were good for you, so they couldn't be bad for you and yet they're causing obesity.

So they had to sort of- ... twist themselves around and say, "Well, it wasn't the starches that were causing the fat," which was what people in the '40s, '30s were talking about.

Now it was dietary fat was causing it, right? Because it had so many calories, so they made up this great reason why oil has higher calorie density and all this sort of stuff.

Mm-hmm.

So I wonder, as you think about this, what are your thoughts about how can people reframe this for themselves so it's not just outcome driven and success or failure based?

Yeah.

I think it's really important because ultimately you have to live with yourself, right? And what it means is that certain people will be driven by those metrics.

Like, you know how you have people have the Oura Rings and the CGMs and this and that, and, and for them they rely on that to say it's successful.

Like, "Oh, I had a good sleep," and you know, "I've been having good sleep." And it's based on sort of whatever this thing tells you.

And there, there's some power in that of course, because for example, if you're measuring your blood glucose and it is very high, then obviously there is some health benefit to bringing it down.

But for a lot of people, they're not at that level, right? It's sort of like the sleep monitors and all these other biometric things.

How do I do that on Monday when my boss gives us a new assignment and we only have until Thursday? How do I do that when my in-laws are coming to town and then we're leaving on a cruise? You know, how do we navigate these things, be aware of how we're responding to hunger, what hunger is about, what to do with our hunger when life is so lifey that we just don't even feel like we have the time to really focus on it?

So is your thesis that calories eventually will matter if your hormones or, are healthy, in that if you're counting calories but your hormones are jacked, like it doesn't matter how many calories you're eating because your hormones are just gonna not be able to efficiently be processing those? Like how do you, like how do you kind of separate those two things?

Well, they're completely different, right? There's-- one is like how, how it works, right? So if you, if you give-- suppose I give you a lot of insulin.

You're gonna get fat.

I don't really even care how much exercise you do, how much willpower you have.

So how do you get fat? Well, you either have to eat more calories, right, calories in, or your body has to burn fewer calories, right? Metabolic rate.

So your hunger is gonna go up, your metabolic-- and, and, and that's gonna help you gain weight, right? So the calories is the way that you gain the weight, right? But so if people think you can just adjust your calories, but you can't...

A-and yes, you can choose how many calories you eat, but you can't choose how hungry you are, and you can't choose your metabolic rateSo say for example that, uh, you, you-- I give you insulin, and insulin tells your body to gain ten pounds, right? So you're eating two thousand calories, you're burning two thousand calories, you're in steady state.

How can people naturally lower cortisol?

So I love this new book, The Hunger Code, and I'd love to just jump in and ask you what the biggest lie has been that we've been told about hunger.

Well, I think that the biggest lie really is just because you haven't eaten in a while, or hunger is because your body needs nutrients or something like that, and it's not actually true.

Like, there's lots of different types of hunger, and the reason focusing in on the hunger is important is because that's sort of the reason why we eat, right? So you eat because you're hungry, and you stop eating when you're full.

So obviously, if you're really, you know, trying to change eating behavior, you have to understand what is causing the hunger in the first place.

And people think, well, you know, either it's, uh, people think, oh, it's just because you haven't eaten in a while, or it's because you, your body demands nutrients.

And I hear this from nutritionists all the time, and it's quite strange because it's like, if you think about it, if you have somebody who's overweight, say they have 50 pounds of fat, well, clearly those...

That's a store of calories, right? So they have thousands and thousands and thousands of calories that they have in excess, not in deficit.

Mm-hmm

So now that we have more awareness, maybe even getting better at identifying what's going on, now what do we do about it?

The main thing I think is trying to identify the types of hunger, 'cause each of those is going to require a different tool.

So if we're talking about the physical hunger, just being ravenous sort of thing, then that's homeostatic hunger, and that's where you have to think about what your satiety signaling is, what your hunger signaling is, and that's really the question.

Like, if you want a quick sort of do I really know what it is, you could ask yourself the question, would I eat a plain grilled chicken breast? It's just pure protein and, you know, not a lot of fat, not a lot of carbs, so a lot of satiety, right? So if that sounds really good to you, then yeah, that's all homeostatic.

If it's something you'd say, "Well, I'm really hungry, but I wouldn't eat that," then it's probably something else, one of the other types of hunger.

And you can substitute it with any non-particularly appetizing but filling food.

So you could say, would I eat plain beef liver or something like that, or plain rice even, right? So it's a carbohydrate, but plain white rice is not super, super appetizing to most people, right? You have to put flavors on it to really make it that hedonic hunger.

So I just wonder how you think about this response to hedonic hunger and things that we could use to help.

Uh, it, it, I don't feel different, it just, it just feels hungry.

Yeah.

So there's different reasons we eat.

So most of us think about the physical hunger, which is, in scientific terms, is called homeostatic hunger, and this is driven by hormones.

So if you think about it, people think about that they're hungry, um, you know, they think it's because they haven't eaten in a while.

But that actually isn't the, the case because if you think about body fat is a store of calories.

So if you have body fat, say you have fifty pounds to lose, you have three hundred and seventy-five thousand calories sitting on your body.

else.Doesn't it seem to you, I mean it seems to me as if people to some extent are just giving up, that bigger is the new normal and that that's okay, and I w- I really worry about that.

... very long time.

Yeah, yeah.

And I think that's the whole, that's the whole thing that you have to understand, that it's a complex medical problem, right? Just like cancer, just like heart disease, just like everything.

Why do we think it's just math, right? It's calories in, calories out.

It's all math.

It's all accounting.

No. It's a complex medical problem.

I have the environmental where I'm, you know, have the social." Is there something else you, you can do?

Right, because you're bored.

It is.

Yeah.

It could be you're bored, it could be that you're depressed, it could be you're looking for something to do, but it's actually a huge reason why we're having this problem with obesity, which is that there's a lot of hedonic hunger.

And I'll just touch on the third one before I go back to hedonic hunger, which is conditioned hunger.

So conditioning is a term used in behavioral psychology where you can pair two things together, right? So the classic experiment is Pavlov's dogs.

If you show dogs food, they'll salivate.

My favorite.