In this episode, I am speaking with Brad Dieter Ph.D., a trained exercise physiologist, molecular biologist, and biostatistician with expertise in metabolism and inflammation. We will talk about the best ways for optimizing your nutrition to achieve fat loss, increase energy, and prevent disease.
Table of Contents
In this podcast, Dr. Dieter will cover:
- Why disease prevention is more important than disease management
- The “Energy Flux” Paradigm (And why you want to have high energy flux levels)
- Why most drugs don’t compare to basic lifestyle
- Whether to eat high carbs or high fat (What does the science REALLY say?)
- Keto Diet: Myths vs. facts
- The best tips on optimizing your nutrition for fat loss
- Why chronic disease is on the rise (And how you can prevent it)
Listen or download on iTunes
Listen outside iTunes
Ari: Hey there, welcome to the Energy Blueprint Podcast. I am your host Ari Whitten, and today I have with me Brad Dieter, Dr. Brad Dieter, who is a trained Exercise Physiologist, Molecular Biologist and Biostatistician. He received his bachelor’s from Washington State University and a Master’s of Science in Biomechanics at the University of Idaho and completed his PhD at the University of Idaho. He completed his post-doctoral fellowship in translational science at Providence Medical Research Center, Providence Sacred Heart Medical Center and Children’s Hospital where he studied how metabolism and inflammation regulate molecular mechanisms that drive disease and was involved in discovering novel therapeutics for diabetic complications. Currently Dr. Dieter is the Chief Scientific Officer at Eat to Perform, Chief Scientific Advisor at Outplay Incorporated and is active in health technology and biotechnology. In addition, he is passionate about scientific outreach and educating the public through his role on scientific advisory boards and regular writing on health, nutrition, and supplementation, which is where I found him. I have been reading his work, his articles online for a couple of years now. I have always been very, very impressed with his stuff. It is just very objective, very scientific, and he has done really, he has put the pieces together and compiled some really great data on a number of kind of leading edge topics. For example, stuff related to the keto diet, exogenous ketone supplementation, you know, compiling all the evidence, around what the research says and how that compares to some of the claims that people are making. And he is just doing a lot of great work that I really appreciate so I had to have him on the show. So welcome Dr. Dieter, such a pleasure to have you.
Dr. Dieter: Yeah, thank you very much. I am excited to be here. I know you and I have kind of connected tangentially over the years so it is great to meet I guess via e-person, not in person.
Ari: That is almost in person. We are one step closer than Facebook Chat.
Dr. Dieter: Yeah, perfect. Awesome. Yeah, well thanks so much for having me here. I am looking forward to chatting with you.
The most common nutrition myths in the health field
Ari: Yeah, likewise. So I want to talk to you about, you know, kind of nutrition myths, fat loss myths. Maybe we will get some tips on energy in here since this is the Energy Blueprint. And I want to start off with a post that you did maybe last week that I was really impressed with and also surprised by given that you kind of are, I would say to a large extent, kind of entrenched in the sort of conventional medical world. And, you know, as a biomedical researcher, as I said, you know, you kind of did these fellowships and training at these medical research centers. So you are very much in that world working with pharmaceutical companies and things like that.
So I was very surprised to hear you, or to see you I should say, writing this post that said a few things. I am going to just summarize a few points here without going into the whole long post. But point one was you said we have yet to see the full burden of chronic disease on our population and the surging tide is still rising. And so you are talking about kind of obesity and diabetes and a lot of chronic disease more broadly. Number two, you said medicine, especially in the US, is not designed to deal with these sorts of issues. Number three, there is a motif that health care is a right for all of us, but there also needs to be a motif that “health is a responsibility for all of us.” And then the fourth one you said, this is the most surprising part to me, you said that it is becoming increasingly obvious that we are unlikely to solve these large issues through pharmacological approaches or through medical interventions. So, yeah, and again, to everybody listening, I am leaving out a lot of the details of what he wrote for each one because I would like to have you discuss, sort of paint this picture of why you wrote this post and what you mean by it.
Dr. Dieter: Yeah. So, you know, maybe I will color that with a little bit of my journey through kind of biomedical science. That will kind of help put a lens on that. And then I will kind of dive into each piece. So I actually started my kind of biomedical research career coming at it from more of a like exercise is medicine idea. That was how I started and then got, you know, pretty heavily entrenched in biomedical research because that is kind of just where I ended up. I always kind of had that lens of, you know, how do we think about medicine from both perspectives of, you know, how does the human body, you know, how is it involved in its own health? And then, you know, from a kind of a western, allopathic medicine view, how do we address a lot of these health issues? So I have kind of always had both tracks of thought kind of going through my career. And, you know, one of the things that, if you have ever written scientific papers or read scientific papers, is they always have the same introduction, right? It is always like, Oh my God, there is this huge health issue and I am going to tell you about how we are going to solve it, etc. Right? And so when you spend enough time, you know, writing those types of papers and seeing the data over a decade, just the numbers continue to grow and you start to realize the problems that we thought we had are smaller than the problems we actually have. Right? And they are continuing to get bigger. You know, we have seen obesity rates as, you know, prevalence percentage, the percentage of the population is growing. You know, we, every year we kind of hit a new peak of prevalence.
And the other piece that comes with that is the number of people on the planet is increasing, right? So not only are we seeing a higher percentage of people, but we are just seeing more people in general, right? So maybe it is, you know, 100 million people this year. Next year it is 120 million. Next year it is 140 million. And so these burdens start to grow, and it is not going to get smaller faster, right? So it is going to take at least some time to correct the prevalence and decrease that and then maybe those numbers will start to drop. But we still haven’t hit kind of critical mass. We are still going to be seeing at least numbers of people rising. And if you look at the projections, even the pretty conservative projections, they get really scary really quick in terms of how many people are kind of, you know, affected by a lot of these chronic health issues.
The most common reasons for the rise in chronic disease
Ari: Yeah, so I think the, you know, I am sure we could talk for a long time about all of this. But I think the biggest shocking thing was the last part, that it is becoming increasingly obvious that we are unlikely to solve these large issues through pharmacological approaches or through medical interventions. This is something I completely share your view, by the way, and I think we come from similar backgrounds, like in the fitness, nutrition space, appreciating the power of exercise and nutrition as being like the most powerful forms of medicine. And I have always, you know, kind of felt this way, like, it is just, it has always been somewhat obvious to me that these diseases are not rapidly being cured by pharmaceuticals. There is this constant pursuit, constant talk. There has been talk since the 1940s or ’50s of, “We are right on the verge of curing cancer and we have the pharmaceuticals to do it,” and all this talk of curing all these other diseases. And what we have actually seen during this time as we have poured trillions of dollars into pharmaceuticals, in pharmaceutical research is a huge skyrocketing of the disease burden and the emergence of all sorts of new chronic diseases.
Dr. Dieter: So yeah, there is, and I think this is one of the areas where a lot of nuance is kind of needed because I think a lot of times people have two very polarizing views. And I think I have been in a unique position to see a little bit of both sides. So there is, you know, one is, I think the most important thing is to realize there is prevention, there is treatment and there is management, right? And for a lot of people who do have kind of established disease, a lot of the modern pharmaceuticals are fairly effective at disease management. Right? And that is really what they are used for. I think most people who are especially kind of in the medical community would be pretty open in saying, you know, a lot of these kind of chronic diseases that are treated with pharmacotherapy are really for management, right? We know insulin is not the cure for diabetes, right? But it does allow you to live longer. We know that even the new frontline medications like the GLP-1 receptor agonists, you know, some of the other newer ones like that, they are just basically how can me prevent or slow disease progression, right? That is really what they are meant for. [Crosstalk].
Ari: Sorry to interrupt. I just want to interject one thing about that, which is I completely agree with that distinction. I think the problem is the general public who is not educated on health, who are not educated on health, don’t understand that distinction. And they think they are going to go to their doctor who is trained in disease management and get whatever the latest science is that is shown how to cure or reverse that disease or prevent that disease for that matter. And that is just not what they are going to get in the vast majority of cases.
Dr. Dieter: Yes, exactly. Right? And I think that is a big piece is people don’t really understand how we are managing disease, how we are not really treating it. And I think one of the fundamental things that we have learned from a lot of the research over the last, you know, several decades is most of these chronic diseases are incredibly complex, right? Even if you have type two diabetes, it is not just a singular thing. It is, there is a lot of pieces to it and trying to cure it with a drug or a series of drugs is very unlikely. Right? We have pretty much gotten to that point. And so we are, even if there is some sort of, you know, medical intervention that is “a cure,” it is a long ways away and it is probably going to look something completely different than modern medicine. Right? So that is the first piece.
And I think the other piece to kind of tie in some of the other ones is, you know, the prevention piece is huge. And that is a kind of social responsibility piece right? One, that doesn’t really fall on the medical establishment, two, the medical establishment is not designed to handle that. Right? Physicians are trained a specific way. They are not designed to handle that. The insurance system is designed a certain way. It is not designed to handle that. You know, hospitals, the whole system is just not, it is designed for more acute medical care and, you know, some chronic disease management for things like, you know, cancers or other diseases like that. But it is really not designed for the burden that we are placing on it.
Ari: Yeah. There is, I think this prevention piece is massively important. To add to your point, it is actually insane to me, it is absurd that we don’t focus more on it because, you know, I am sure you are familiar with David Katz, nutrition researcher and head of Yale’s Prevention Research Center. He has written extensively in articles and his books that 80% of the chronic disease burden could basically be eliminated from taking, I think it is like four basic steps. It is like, stop smoking, stop drinking, do exercise like 30 minutes a day and make some simple nutrition changes. So we are not even talking about… I mean this is like scratching the surface of like the first little layer of knowledge of the most basics of the basics as far as, you know, someone like your expertise or my expertise in nutrition and lifestyle strategies. We could go 50 levels deeper than that, but just those few simple steps could probably eliminate 80% of the disease burden, a huge amount of of obesity, diabetes, cancer, autoimmune disease, so many other chronic diseases, eliminate a huge chunk of it. We already know how to do that and we are not doing it. We are pouring 90% of the research money into disease management and pharmaceuticals.
Dr. Dieter: Yeah. And I think it would be, I mean this is just my perspective on that issue is kind of allocation of resources. One is a finite problem that you can come to a solution with a given amount of time that will actually return money on an investment. Right? The other one is really a very large, complex socio-cultural issue that you have to get buy-in from hundreds of millions of people and you kind of have to shift a whole culture in way of being. So one is at least there is, on one hand, there is at least some return of like, “Okay, there is something tangible I can feel good I did with my work.” And there is another one of, “I don’t even know how to go about doing this and it is probably not going to work anyway.” Right? And that is kind of the mindsets when you think about it of… Like, have you ever worked for a company culture where you go in and you are like, “This culture is so broken there is no way I can even think about fixing it.” Right? It is kind of like something almost as simple as that, as to how do you take this and completely shift just the whole focus?
Why health is a responsibility
Ari: Yeah. Interesting. One more aspect of this I want to dig into, which is point number three. You said there is a motif, health care is a right for all of us. But there also needs to be the motif that health is a responsibility for all of us. What do you mean by that?
Dr. Dieter: Yeah. So I think there is kind of a few layers to that. You know, one is, as human beings we all realize that we are going to get sick and die at some point, right? We are not immortal. We are biological creatures. And at some point we are going to put a burden on the rest of society to take care of us, right? That is just kind of what we are born with. But the choices you make in life really determine how much burden are you going to place on society, right? So as kind of an individual, you know, we want to care for people when they are in places where they can’t care for themselves. But you also don’t want to, you know, put a lot of extra burden on other people that is unnecessary, right? So think about somebody who, you know, takes care of themselves, lives 70 years, needs care for the last 15 to 20 years of their lives.
You know, we provide insurance for them even when they are not working. That is a much different story than somebody who starts accumulating health care costs at the age of 22. Right? They are not productive members of society because of their health issues. And so when you think about it is being treated for your health really is probably something that is a right that all people should have, right? As a collective society, we should give that to each other. But to do so, we have to take responsibility that we have to own that. And so if we don’t share in that responsibility, we can’t take care of everybody. Right? It is kind of like, you know if you have a household and everybody is, you know… Let’s say you are the only person making money and you have nine people in your house and everybody is spending money, but only one person is making it. Where is the distribution of rights versus responsibilities? And so just kind of starting to think about, you know, you do have a responsibility to your whole society of, “Okay, I need to contribute to this whole system of health and health care.”
The polarization of different diets
Ari: Yeah, beautifully said. There is a lot of different subjects we could talk about as far as nutrition, as far as exercise and health more broadly. I would like to go into nutrition a bit with you here. I definitely want to cover, there are some specific topics I want to cover around carbs and fats and keto and things like that. We have this very polarized landscape when it comes to diet, everything from hardcore veganism to, I mean it is literally, it is like the most extreme things that you could imagine of as far as the poles from veganism to an all-meat diet, which is something I never thought I would see but now exists and is gaining popularity, the carnivore diet. So I am just curious if you have like, I don’t want to, I want to ask for your input basically of where you think we should go. What would serve my audience the best of which sub-topics we could talk about here.
Dr. Dieter: Yeah. You know, I think I am just going to make sure that I have got this list of questions that we have. And you know, I think some of the things that I think would be the most helpful, you know, are probably the topics of, you know, what role do things like, you know, carbohydrates and fats play in your diet. Right? Of how, you know, they have been very polarized, right? For decades we had, you know, high carbohydrate diets, we had a decade of very low carbohydrate, very high-fat diets. So maybe we will kind of start there and, you know, talk about the pros and the cons and how to actually start thinking about those pieces.
Ari: Perfect. Cool. So, as you said we had this low-fat era. We have now swung in the other direction, low carb, high fat has become popular. We have got keto. We have got the zero carb, all meat carnivore diet. Carbs, and insulin, in particular, have been demonized to the extent, I would say quite successfully demonized, to the extent that the majority of the population now thinks, you know, things like carbs make you fat, fat doesn’t make you fat or insulin is the key regulator of our body fatness. So what is your take on that? Do you, which aspects of that do you think are true or untrue?
Dr. Dieter: Yeah. So one of the best parts about having decades of really polarizing kind of mass media topics is that it seeps into the research world so a lot of really cool research gets done. So the best part is we have a lot of the data to actually answer these questions. And so we can say with a pretty high level of confidence, you know, what are the answers to these big questions. So, you know, to kind of start in probably small picture and kind of build up in maybe forward to backward time-wise is, you know, kind of a lot of the recent research around kind of low carbohydrate diets, you know, how hormones change with those, how those relate to fat loss and then even, you know, kind of optimal human performance have been really fleshed out. And so we have got some really good concrete data. And if you kind of summarizes the literature, you know, what we have learned from that is the percentage of your total energy intake, your total food intake in a day that comes from carbohydrates doesn’t really appear to dictate body composition, doesn’t really appear to dictate weight loss or weight gain, it doesn’t really have a massive effect on hormones. Things like insulin or even things like leptin, which is another kind of fat mass regulating hormone.
Ari: And when you say insulin there, you are talking more baseline levels of insulin. Like let’s say your fasting levels of morning insulin as opposed to levels right after a meal.
Dr. Dieter: Yeah. So your kind of baseline fasting levels of insulin, which is a marker of basically how insulin resistant or insulin sensitive your body is. So it doesn’t really appear to matter for those metrics which is really interesting, right? So it starts to tell us a lot about the body is pretty adept at using fuel sources to kind of compensate for total energy, right? And that a lot of these hormones really just kind of dictate when certain fuels are used. And we have kind of really learned that over the last 10 to 15 years. And there has been a series of really kind of elegant studies that have been really controlled and very scientific environments that have really fleshed that out, right? And we can say with high confidence that, you know, the percentage of your diet that comes from carbohydrates or fat does not make a big difference for body composition. We do know that. Now, some of the disease states, things like, you know, type two diabetes, things like cardiovascular disease, those typically are not greatly affected by carbohydrate or fat, you know, distribution, right?
Whether you are eating 10% carbohydrates or 90% carbohydrates, there is not a huge difference in terms of the total risk of disease. The biggest factor is body weight and body weight loss. So if you lose bodyweight, you have a big reduction of risk of those types of diseases and it doesn’t matter what your diet is, right? So if you are 110 pounds overweight and you lose 110 pounds on a low-fat diet or a low carbohydrate diet, it doesn’t matter what your approach is. That weight loss is going to contribute to almost all of the risk reduction. So that is the other important piece, right? Which starts to tell us what we need to prioritize and what we need to focus. Now for…
Ari: I want to interject just one thing because you are saying, some of the stuff you just said is like, you are saying it so matter of factly like it is just, it has already been proven, we already know it. And I know for a lot of people listening who have been, you know, kind of entrenched in some of the let’s say the low carb dogma around carbs are the devil, carbs are what is making us fat and driving disease and all that, I mean, you probably just completely rocked their world. And they are saying right now, “This guy is crazy. He doesn’t know what he is talking about.” And you are saying it so matter of factly, like it has already been so well established that you don’t even have to prove it, which has, I would say is completely true in the world you are in, in like the research world, the academic world, the people who have read all this literature that you are referring to. However, for the average regular person, you just rocked their world. So just go into that a little bit more and maybe talk about some of the layers of research that have led the scientific community to those conclusions.
Dr. Dieter: Yeah. So, you know, that is a very good point, and thank you for kind of stopping me and kind of doing a little bit deeper dive. So the way that I always conceptualize a kind of scientific research is there are several layers to it, right? And one of the easiest ways for me to kind of put that across to people is the very top layer is what I call kind of idea-generating, right? Where you just see things that are correlated or associated and it is kind of an idea sparker right? So in the context of this, you know, a really good, you know, place to start the investigation would be, you know, a book like, “Good Calories, Bad Calories” by Gary Taubes, right? Where he draws a lot of kind of observational data of people who in populations who consumed higher carbohydrate diets and they tend to be more overweight than other ones, right?
So you kind of make an observation and you go, “Okay, these are correlated so maybe this is the cause, right?” So that is the first level. So when we look at that data, we can say, “Okay, there is definitely populations of people who have, you know, higher carbohydrate content diets who are more overweight than other people.” On the other side of the coin, there are also populations of people who have high carbohydrate diets who are some of the leanest people on the planet, right? We know that, right? So you have got populations like the Okinawans, you have got populations like the Kitavans, you have populations, you know, even modern-day, many vegan populations of people tend to consume very high carbohydrate diets and can have very low levels of body fat. So even from that level, we have some data that supports the idea and some data that disputes the idea.
So then the next question is you can go in kind of two directions. You can go into like very basic science and you kind of look at the most zoomed-in level, are carbohydrates actually causing your body to store fat at a greater rate than dietary fats? So we have done those studies. There have been several studies that have been, that were done in the ’90s, and then there have been more studies that have been done in the last four years with just much more sophisticated techniques. And so those studies have actually taken people, randomized them to different, you know, carbohydrate or fat diets, and actually measured how much body fat is being added or lost at a very, very zoomed-in level. And so those studies show, you know, that it doesn’t really matter what you are consuming for body weight, right? So that is kind of the most zoomed-in level.
And then we have what I like to call kind of more, you know, realistic scenarios of like, okay, maybe it is not the carbohydrates themselves that are inherently fattening. But maybe when you add them into your diet and like a normal life, they just change your whole body and how you interact with food to cause you to gain more weight. And so those, there has been a series of studies that have looked at that, whether they have been, you know, randomized controlled trials, whether they have been free-living eating studies. And all of them typically show very similar results to the very basic science investigations. So we have really examined this idea at several levels, right? As hardcore science as you can get, as high level as you can get, in kind of in the real world scenario, what does this look like? So what that tells you is diets can work, a whole lot of different diets can work. And the macronutrient composition, whether they are low carbohydrate or low fat typically isn’t the determining factor of whether they are successful.
Ari: Excellent. Very well explained. So this is, I mean, shocking to a large extent. Basically what you are saying here is for the last 30 years or so, 40 years maybe or maybe even longer than 40 years now, this whole giant focus of the entire American population on fat and carbs is mostly missing the point. Is that accurate to say?
Dr. Dieter: I would say very much so, with the caveat of we didn’t know what we didn’t know.
Ari: Sure. We had to learn that it was the wrong…
Dr. Dieter: Yeah. At the time we were like, “Well, this makes sense. This might be the biggest, most important factor so let’s study it.” And then we were like, “Oh crap, that didn’t work.” Right? Kind of like the pharmaceutical industry, right? Of, “We think we have a cure based on the drug.” And then we use it and we compare it to exercise and we go, “Well, exercise is better than the drug that we spent $10 billion, you know, discovering.” So you don’t know until you actually do the work.
Ari: Yeah. Like in Alzheimer’s there was, you know, the theory for a long time that the beta-amyloid plaques are the cause of the symptoms and the progression of the disease. And then they spent all this money developing a drug that interrupts the synthesis of these amyloid plaques. And they are like, “Yes, this is going to cure Alzheimer’s.” And then they actually discovered that it accelerates the progression of the disease and that the amyloid plaques are probably serving some kind of protective role and they are not the thing that is driving the disease process.
Dr. Dieter: Yeah, exactly.
Ari: So one other layer to this story is, so if it is not carbs and fats that are the thing that is driving fat gain, what is?
Dr. Dieter: Yeah. So typically what we see is it is a combination of a few things. One is total energy consumption, right? We are just consuming more food now than we have been historically. That tends to be driven by the availability of food, right? It is so much easier now to get high-energy-density foods than it was even 30 years ago. You know, just the way food is made, we have got Uber Eats, you know, you can have everything delivered. Our lives are much different. We eat out at restaurants way more than we used to.
Ari: I have to just say that I have a new baby right now and Uber Eats is coming in very handy. So don’t bash Uber Eats right now.
Dr. Dieter: Oh, for sure. Like, and I am, you know, I use that kind of stuff too, just because our lives are so different, right? So just, we consume more energy just based on a whole lot of factors, right? It is not, “Oh, we have a higher percentage of our diet is fat or carbohydrates.” Our diet is a higher percentage, or it is a higher amount of both. So energy intake has been a big piece. Another piece is physical activity levels, right? If you look at historical data, the drop in physical activity levels is pretty dramatic. And it is, you know, from jobs changing from more physically active jobs to more sedentary jobs. You know, people driveway more than they used to. They ride bikes way less than they used to. Their kind of recreational time activity is a lot less than it used to be.
So those are the two very unsexy answers, but they are the most accurate answers. And there have been a couple of papers that have been published that have basically said if we look at, you know, obesity rates or, you know, body mass index changes over a 40 year period and we track the increase in energy intake and the decrease in energy expenditure, those almost completely explain the change in body composition. Right? Now that is a very simple idea, but it is also horrendously complex. I am like, “Okay, well how do we fix that?” Right? It is very difficult.
Ari: Now, just to kind of loop back to the carbs and fats for just a moment for people listening to what you just said who are going, “Oh, this guy believes in calories in, calories out. He is not up on the latest research that insulin is the key factor that is driving our body fatness.” What would you say, and having said that you already explained all the layers of research debunking this hypothesis, what would you say in response to somebody thinking that right now?
Dr. Dieter: Yeah, so what I would say is, you know, people who say that they have some nuggets of truth, right? They are not crazy and they are not completely wrong. You know, one of the things we do know is that the calories in, calories out piece explains body weight change. Right? But that doesn’t explain the calories out piece, right, of like what makes up your caloric expenditure, how do hormones affect that, and then how does nutrient selection effect that, right? And so we do know that you know, there are some effects of, you know, what your macronutrient ratio is. It has small effects on, you know, the calories in, calories out equation. And the important thing is to not take those small truths and let them kind of override some of the bigger principles, right? And that is what I usually, whenever people, you know, tell me that we kind of go into the details, right?
So if somebody says, “Okay, you know, how do, you know carbohydrates have a bigger effect on insulin than you know, dietary fat.” And then you go, “Okay, well how much does that actually affect your fat mass change over the next six months?” And you kind of go into, “Okay, well it is, you know, 0.1%. Okay, does that really matter? You know, how was your nutrient selection affecting your satiety and your hunger, right? Are carbohydrates or fat more satiating?” And kind of talking about the research about that and then structuring the conversation about that piece. Because we do know that, you know, the idea of a calorie is kind of not the right discussion to have, right? Is it more pedantic than it needs to be and it doesn’t really help people understand their food better, right? Anybody who says, “You know, 500 calories from Twinkies and 500 calories from salad are the same thing.” It is like, “Okay, as a unit of energy it is the same thing. But in the context of your actual diet, they are two completely different things.”
Ari: Yeah. So what about, let’s throw keto into the mix now. You know, there has obviously been a lot of claims around keto especially in the last, maybe we are going on five or 10 years now. But it is actually, especially in the last couple of years, keto has really surged in popularity. And there are all these claims from it is way more effective for fat loss, to it makes you a super athlete, to it makes you, it gives you tons of energy, to it is the ancestral way of eating that our human ancestors ate traditionally and it is the correct, the most optimal diet for human physiology. What do you think of some of these claims?
Dr. Dieter: Yeah, so there is kind of the hardcore scientific answer and then there is the pragmatic answer and maybe I will start with the pragmatic answer. So I think for a lot of people it has been a useful tool to kind of initiate weight loss for a lot of people. I think it is a huge shock in dietary patterns, right? You completely change the way you eat. It limits a lot of your food selection. It typically promotes higher protein intake and it a lot of times will change people’s view on food, right? So I think from a pragmatic standpoint is it can be a very useful tool for people. And a lot of times whenever people lose weight or have a big change in there, you know, kind of their dietary patterns, they do see big benefits in health, mental clarity, energy, the way they feel, etc.
Now, when you kind of take that and then go below the surface, what do we know about this way of eating, right, what do we know about the physiological state of ketosis, and then how does it map to all those other pieces? And that is a much different question. So if we kind of dive into those questions, you know, we do know that, you know, ketones in general, whether they are elevated from, you know, low carbohydrate intake, just if you don’t eat at all, whether it is, you know, low everything, you are going to have high levels of ketones in your body. It is not just if you eat a bunch of fat or if you take exogenous ketones. That state doesn’t really have any effect on body fat loss, right? So if you are in a state of ketosis, for instance, if you are not in a state of ketosis, it doesn’t really make a difference for bodyweight loss or even, you know, body fat mass loss. Right?
Ari: So what is the distinction there? Because one of the claims made is you know, things to the effect of, “It turns you into a fat-burning machine and makes your body super efficient at burning fat.” So how could it be doing that but still not matter as far as body fat loss?
Dr. Dieter: Yeah. So you have got to realize that your body fat mass and the amount of fat you are burning at a given moment are two very different things. Now that is kind of a hard idea to wrap your mind around, right? But the amount of fat you are oxidizing at a given moment and the percentage of it doesn’t translate to your changes in body mass, right, your changes in fat mass. That is, it is kind of a weird concept, but that is what we see right? Is your amount of fat oxidation is really just which substrate your body is using and its stores of carbohydrates can get turned into fat and stores of fat can get turned into carbohydrates and they will over time balance out based on energy balance, right? It is the weird way the body works, but it is kind of just the way that it works in how we go about doing it. Now, the thing where people say, you know, you have got to, you know, “If you eat fat, you burn fat,” you are also just burning the fat that you have eaten, right? So if you were to eat a lot of carbohydrates, you are going to burn carbohydrates and you are going to burn stored body fat. If you eat dietary fat, you are going to burn the dietary fat and then burn some body fat. So you are kind of getting the same amount of stored body fat utilization regardless of what you are burning on top of it. So that is kind of probably the best answer for that question.
Ari: So in other words, let’s say like you eat a 2000 calorie-a-day diet with lots of potatoes and lentils versus a diet with lots of fatty foods, let’s say egg yolks and avocados and red meat and things like that. And on both, on one diet you have mostly carbs, but it is still 2000 calories. The other diet is mostly fat and it is 2000 calories. You have got to burn through whatever excess energy, whether it is coming from carbs or fats before you are actually tapping into burning off your body fat. Is that correct?
Dr. Dieter: Yes, exactly. And that is exactly what we see in all scientific research. And if anything, it actually appears that lower fat intake may actually be a little more efficient at burning body fat. It is not a big effect, but that tends to be what we see. And it is just the way your body will store carbohydrates and how much energy it takes versus storing dietary fats as body fat. It is just kind of a, it is like an energy tax, right? You pay more energy tax consuming carbohydrates than you do dietary fats.
The science on the ketogenic diet
Ari: Got you. What about some of these other proposed benefits of the keto diet? Are any of them legitimate or where are they legitimate and not so legitimate?
Dr. Dieter: So, you know, there are some definite benefits for specific situations. We do know there are some medical conditions that ketogenic diets can be beneficial for, specifically some of the neurological things and it has been kind of really fleshed out. So things like intractable epilepsy, it appears to have, you know, a therapeutic benefit. Now outside of that, there are not a lot of very clearly defined and demarcated benefits of either a ketogenic diet, the state of ketosis, or exogenous ketones that have been really fleshed out. None of them that we have really studied have shown a big effect. The one that there may be a benefit of that is still kind of disputed but shows up pretty strongly in the literature as a small effect is a hunger, right? There does appear to be some small effect on hunger in the fact that it actually reduces hunger a little bit.
So that is kind of the big piece that we have actually seen. And typically the other benefit that kind of goes along with that is people tend to consume a little fewer calories when they are on a ketogenic diet than when they are on anything else. That is one of the other things that we see. Now, whether that is due to, you know, the hunger-suppressing effect of elevated levels of ketones in the blood, or whether it is just because they typically tend to eat higher protein intakes and a lot more like satiating vegetables than different dietary patterns, it is really up for debate and discussion right now. So there has been a group of us who have kind of looked at all that literature and we are still trying to figure out, you know, how much of it is due to one versus the other actual effect.
Ari: Interesting. So you mentioned exogenous ketones there for a moment. These are ketone supplements, basically, that people can take to, even if they are not necessarily eating a strict low carb diet, they can take some of these ketone supplements and then get some of the effects of proposed benefits of having these ketones in your bloodstream. Do you think, is there any legitimate benefit of those? They are obviously very expensive, so to make sense of that they should be giving some very significant benefit if they are very costly. So do they?
Dr. Dieter: So they are expensive. They generally don’t taste very good if you get like a really potent dose,
Ari: So now they really have got to do something amazing.
Dr. Dieter: Yeah. So we do know that if you take exogenous ketones, your blood levels of ketones will basically increase and you will be in a state of ketosis so to speak. Now within the next six to 12 hours of you taking those, most of those will show up in your urine. So you are basically peeing out most of them. There was a paper by, I think it was Lewis Burke who did it, who actually looked at urine kinetics of ketones kind of showing how much you are peeing out right after you take them over the next couple of hours. So we do know that those things occur.
Ari: Now is it possible they could have some effect during the time they are in our body and then we pee them out? Or do they need to be sort of taken up by the cell and utilized within the cell to have effects?
Dr. Dieter: Yeah. So they will have to be taken up and utilized and they are, right when you take them. Your body doesn’t have a storage capacity for ketones. So that is why they get metabolized “preferentially to other substrates.” Right? And now what we do know is your body will kind of delay metabolizing carbohydrates and fats to metabolize ketones, right? It is kind of like when you drink alcohol, it kind of puts the brakes on some of the other pieces and burns alcohol, you know, oxidizes it or breaks it down instead of using the other ones. So what it does is it kind of suppresses some of your other metabolic processes to do that. Now there is some idea that that might be beneficial for kind of sustained physical activity on really long duration stuff. If so, if you are working out at a pretty minimal exercise capacity, like 40 to 50% of your max effort, which is pretty low, taking exogenous ketones might delay your body from using its internal stores.
So you can kind of sustain that a little bit longer. Right? Now, could you just consume extra actual food and have the same effect? It is still up for debate. But what we do know is that it doesn’t really benefit high-intensity exercise. If anything it tends to make it worse. And for things like diabetes, weight loss, or anything like that, there is no established benefits for, you know, weight loss or kind of disease management. And if anything, there is some rationale to suggest that, you know, if you are taking something that prevents your body from metabolizing its stored nutrients, you are probably doing more harm than good.
Ari: Interesting. Okay. So I want to leave this topic of carbs and fats and keto. I feel like we have covered that sufficiently. Any tips that you have related to energy levels and maybe nutrition factors or other lifestyle factors that could relate to energy. And having said, you know, energy is what my whole brand is built around, but the science here is complex because energy, as you can imagine, is a tough thing to measure. It is even hard to measure mitochondrial energy production at the cellular level. We don’t really have good tests for that either. So energy is this kind of subjective state that we all experience and we all know is very real. And yet from hardcore research, you know, biomedical perspective, it is sort of this nebulous concept that is like, researchers don’t really want to research energy and energy levels because it is too subjective and too hard to measure. But having said that, we all know it is real. Do you have any tips that relate to helping people increase their energy levels?
Dr. Dieter: Yeah, what I would say is, you know, in no exact order of priority is one, is make sure you are sleeping. I think a lot of people’s energy problems are just they are not sleeping enough. I throw myself under that bus pretty regularly, so that is something I have to work on quite a bit. The other one is I think people very much underappreciate the effect dieting has on your energy levels, right? People who are constantly dieting are kind of existing on a pretty low energy intake, you know, just like food-wise, you are probably going to really struggle with energy levels, you know. There is a lot of science that you could go into but basically, the human body when it is functioning at a high level, you know, you are moving around a lot, you have pretty high energy and you are doing things, should be, you know, burning 2,500, 3,000, 4,000, 5,000 calories a day.
And so you should be consuming an adequate amount of food to kind of fuel actual physical work and kind of mental work. I think a lot of people spend a lot of time on kind of chronic dieting cycles, like in and out, and they just spend a lot of their time low energy because they just don’t have a lot coming in and they don’t move very much because they have no energy. So they just kind of stay in this, “I am going to burn 1,800 calories a day and eat 1,600 calories a day.” And there are actual studies that have looked at, you know, what is that energy flux and how do people do when they are, you know, eating 3,500 calories a day and expending 3,500 calories a day versus eating 1,800 and burning 1,800. And the results are just so substantially different it would kind of blow your mind.
Ari: I am so glad you brought this up because this has actually been a like a pet interest of mine, the research around the concept of energy flux, and I have been shocked. I have been reading the research on this and really like I consider, I have considered it a big concept for geez, at least five or six years. And I have just been shocked to see so few people in the evidence-based nutrition and fitness communities and, you know, kind of the fat loss area, people in that whole community talking about the concept of energy flux and referring to these studies. It seems to be almost like a little bit of a hidden secret that not a lot of people have figured out. But I am absolutely convinced it is not only a big deal when it comes to fat loss but also to energy levels.
Dr. Dieter: Yeah. And it is kind of one of those ideas when you think about it, it makes sense, right? Like your, Toyota Tercel is not a high-energy, high-performance car. Right? So it doesn’t eat a lot of gas. But your Ferrari does, right? So just kind of, you know, how much energy something requires to put out requires you put into it. So you can’t have high levels of energy if you don’t have high levels of energy coming in. You know, I think the other, some of the other pieces to it are, you know, kind of managing your own self. Right? And that sounds really nebulous, but like I kind of have learned when I am high energy and when I am low energy and what, you know, what that takes. Right? I know that I may, I have a lot of energy in the mornings but at night it is just, I crash. Right? I know that if I have too much caffeine it is not a good thing. If I don’t have enough caffeine it is also not a good thing. You know, stress levels, how do I handle stress? Some people are, you know, wired for high stress and they can just go, you know. Other people are too much stressed kind of just shuts them down. So it is kind of being a little bit self-aware of how you are wired to kind of interact with the world, too.
Ari: Now we talked a lot about diet, like debunking a lot of myths. I am curious, and probably a lot of listeners are curious, what kind of diet do you eat?
Dr. Dieter: That is a good question. It fluctuates quite a bit, you know, I would say throughout the year it fluctuates quite a bit. Over years and cycles, it fluctuates quite a bit. I try to eat to like what I am doing. So when I was in graduate school and I was working a ton, and I was not, you know, I was probably working out every day but it was like 35 to 40 minutes of just kind of dinking around in the gym basically is what it was. You know, it was probably, it looked a lot more like a kind of lower carbohydrate, higher protein diet. Right? Because I didn’t want to eat six meals a day. I didn’t want to eat a ton of calories because I wasn’t expending a lot because I was sitting at the computer in the lab.
So it was a pretty, you know, vegetable-rich, meat-rich, nut-rich kind of diet. Then when I got done with graduate school and I was doing a lot more, you know, kind of endurance type of training, I was riding my bike a lot, I was running a lot, I started to eat, you know, my calorie intake went up 1,500, 2,000 calories a day. I started eating a lot more starch, you know, was doing some extra supplementation. Then when I switched to doing more like Olympic weight lifting, my calorie intake stayed the same but I shifted my carbohydrates and fats around. So it is just kind of, it has always been changing, but the constants have always been, you know, kind of understanding my energy needs and my energy balance and do I need to lose bodyweight? Do I need to gain bodyweight? You know, fuel for the type of activity I do. We know if you are a lot more physically active, having a higher percentage of your diet from carbohydrates is probably going to fuel your performance better.
The primary factor for deciding on the best meal for you
Ari: Yeah, I was just about to ask that, actually. Like we spent all this time kind of talking about carbs and fats and saying basically it is not a factor for the most part at the end of the day in terms of weight loss results or even in terms of disease risk based on most of the existing research that we have as of 2019. So is there any real reason, and as you were just alluding to there, is there any real reason to modify carbs and fats one way or the other?
Dr. Dieter: Yeah. And it really comes down to, you know, one, personal preference, right? What do you enjoy eating and is satisfying to you? I mean, the other is what is your physical activity level, right? As we know, carbohydrates tend to rebuild muscle glycogen better than other sources. We know they are more easily usable for glucose sources during exercise and that sustained energy output. So sustained physical activity really does require some level of, you know, carbohydrate consumption for optimal performance. So those are kind of the two ways that you shift people’s macronutrients around, right? What is their preference and then what is their kind of energy output need in terms of actual power and sustained work?
Ari: Yeah. Does it matter as far as like high intensity versus endurance activities?
Dr. Dieter: You know, it tends to be more the volume of the work, right? So if you are doing 30 minutes of super high-intensity work, you probably need a little bit more carbohydrates than somebody who is not doing any. But if you are doing four hours a day of sustained moderate level work, you are going to need more carbohydrates than the other person. Right? And so there is kind of this total amount of workload that is done is a really good metric to determine that.
Ari: Excellent. So, Dr. Dieter, this has been a pleasure. Thank you so much for coming to the show. Last question I have for you, is there any sort of one or two big takeaways that you want to leave people with like, you know, maybe some of the most important principles of health or good nutrition from your perspective?
Dr. Dieter: Yeah. I think probably the big one would be to let people know they have a lot of options that they can use. You know, that a lot of different diets have benefits and can work. And kind of finding the one that fits your lifestyle the best at the current moment is probably the best way to do it. Right? Like, my diet has changed over my lifetime. Your diet can change over your lifetime and realize that you have got a lot of flexibility there. That is probably the first piece. The second piece would be to kind of anchor it in your kind of health and fitness life and this idea of how can I sustain this over a long period of time? Right? I think a lot of people pick up habits that are pretty quick hitters and try to get things done pretty quickly.
But if you can start to view it as a… You know, I always use financial stuff to kind of get things across to my clients. I think about like, okay, think about your retirement account, right? You can either try to save $2 million this month or you can start accumulating assets, you know, pretty steadily, and then by the end, you will get there and you won’t have this crazy, you have got to go rob a bank to get $2 million. Right? And so I try to tell people that with their kind of health and fitness. Right? You know, dietary wise, start working on kind of what are the fundamental principles and skills, right? Learning how to balance energy, learning what types of foods have which nutrients. How do you prepare your own food? How do you fuel yourself over different periods of your life? Exercise, right? Kind of the same thing as how do you develop habits that actually kind of sustain it over the long term because we are not all going to be 20, 30 year old super fit people our whole lives. But how can you, during those periods of your life where you are, you know, super fit, super active, how do you use that to kind of translate into your 40s and 50s?
Ari: Beautiful. Perfect. And then, as you just alluded to, you work with clients, so do you want to tell people where they can reach out to you if they want to work with you and what exactly, what kind of work do you do and who is your ideal client?
Dr. Dieter: Yeah. So all of the coachings that I am involved in is with a company called Macros Inc. So we do one-on-one coaching with people, primarily nutrition coaching. And we also do some training programming as well. Our ideal client is really people who are, you know, kind of interested in developing the fundamentals of a lifetime of success, right? So we coach our clients about what are the key principles of weight management, you know, what are the key principles of dietary nutrition, you know, advice for your current goal and then also kind of in the future. So we are really focused on, you know, finding clients and kind of grooming clients for that kind of mindset of this is how we just instill habits in people.
Ari: Beautiful. I want to say to everybody listening, you know, I interview a lot of people on the Podcast. There are people I interview on the Podcast that they have lots of things they believe in and endorse that I don’t agree with and don’t think are accurate reflections of the science. In this case, I just want to let everybody know that Dr. Dieter, this is someone I have massive respect for and I think is doing great work that is an extremely accurate reflection of the science as of 2019 and, I would give my highest endorsement and recommendation to as far as if you guys want to reach out and work with him. I receive no commission or, you know, kickbacks or anything if any of you guys sign up with him. I just wanted to let you know because I do know that there are people listening that this has been commented on.
You know, I have some people on the show who are saying a perspective that they know I don’t particularly agree with and I am fine with that. Like I am, I don’t necessarily think I am right on every issue. I sometimes host people on the Podcasts that I don’t agree with and basically, my attitude is to convince me, show me where I am wrong. Maybe I am the one who is wrong, you know? And so I think those conversations are important to have. But ultimately at the end of the day, I do think my reading of the literature and my understanding is thorough, obviously, and Dr. Dieter is certainly someone that I would give my highest recommendation to and would have no qualms about sending my mother to, for example. So, I just wanted to say that, so everybody listening knows that I personally endorse you. Dr. Dieter, thank you so much for coming to the show. It was really a pleasure and I really appreciate you sharing your wisdom with my audience.
Dr. Dieter: Yeah, absolutely. Thank you for the more than kind words that you just gave in that. Really appreciated the conversation and look forward to hopefully connecting in person some time.
Ari: Yeah. That would be great. Thanks so much.
The most common nutrition myths in the health field (2:16)
The most common reasons for the rise in chronic disease (6:48)
Why health is a responsibility (14:24)
The polarization of different diets (16:43)
The science on the ketogenic diet (39:52)
Energy flux (48:24)
The primary factor for deciding on the best meal for you (52:34)