Dr. Gabrielle Lyon [0:00:02]

Welcome to the Dr. Gabrielle Lyon Show, where I believe a healthy world is based on transparent conversations.

In today’s episode of The Dr. Gabrielle Lyon Show, I sit down with my friend, Dr. Ted Naiman. He’s a board-certified family physician and has had a large medical practice for many years. He’s really unique in his perspective. He’s a physician who has implemented, as a primary focus, diet and exercise for health optimization into his practice. He’s the author of the book The P:E Diet, which, if you haven’t read it, you definitely should.

This episode was a fat-loss masterclass. We discuss so much, all related to fat loss, like number one: how do you measure if you are overfat? Is this something you could do yourself? Number two: what should I eat to lose weight? What exactly should I eat? Number three: the best exercises for weight loss. We discussed this and so much more.

Thank you so much for supporting the show. We have a new, Forever Strong community. If you would like to engage with myself, other podcasters that have been on the show, or just members of our community, please click on the link to join us. As always, if you love this episode, share it, send it to a friend, and leave a review. I’m so deeply grateful for your time.

Thank you to VivoHealth for sponsoring this episode of the show. I am bringing to you my favorite Vivobarefoot shoe. It is what I’ve been using for the last year to train in, and I’m going to tell you what. Vivobarefoot is on a mission to create regenerative footwear. Why do I love Vivobarefoot? It allows me to lift in a way where I feel the ground. I never have to worry about whether my shoe is going to be unsteady. I’m able to get into a good squat position. I’m able to do a good deadlift. I’m able to train closer to what I would do if I were, in fact, barefoot. Studies show that foot strength increases by 60% in a matter of months just by walking around in these Vivobarefoot shoes.

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Dr. Ted Naiman is a friend, and truly, you have innovated a lot of the protein discussion from a practical standpoint. I consider you a great friend, an excellent physician, and a sound board. Welcome back to the Dr. Gabrielle Lyon Show.

Dr. Ted Naiman [0:04:43]

Thank you so much. That was very complimentary. It’s great to be here. I feel the same way about you, you know. Great, thank you.

Dr. Gabrielle Lyon [0:04:52]

Ready for some rapid-fire questions? You and I are friends. Just so you all know, I will do Ted justice, and I’m going to put him on the spot about the top three ways to lose body fat. You can only give me three. You’ve got to give me your top three.

Dr. Ted Naiman [unclear 0:05:12]

Okay, let’s see. Obviously, the big buckets in the weight loss jar are diet and exercise. But were you looking for something more specific than that?

Dr. Gabrielle Lyon [0:05:25]

Exactly.

Dr. Ted Naiman [0:05:26]

Got it, okay.

Dr. Gabrielle Lyon [0:05:28]

Protein, fiber—where does training fit in? For those of you guys who don’t know Ted, which everybody should know, he talks a lot about training and he talks a lot about protein and satiation. You name it.

Dr. Ted Naiman [0:05:45]

Protein would have to be there, for sure. Number one would be targeting protein and prioritizing protein. Protein awareness: you want to make sure you’re eating adequate protein. You want to be eating that protein earlier in the day and earlier in the meal. You’re just trying to leverage it for satiety, body composition, and all the other great things that protein does for you. Number one would be protein prioritization. Number two would be lowering the energy density of your carbs and your fats. If you can keep the energy density of your carbs and fats lower, you’re going to automatically lose calories. You’re going to be avoiding some hedonic, hyper-palatable combinations of high-energy-density carbs developed together that you can’t say no to.

The third thing would be exercise. Basically, you are eating the calories of a moderately active version of yourself at all times, and if you’re not at least moderately active, you’re screwed. You’ll be going nowhere. You can only get so far with diet, so you have to have a little bit of the higher energy flux, and that’s going to be some kind of exercise, probably more than most people trying to lose weight are already doing.

Those are the big three. If you really just put a gun to my head and said, “What are the three biggest things?” it would be protein prioritization, lower energy density of nonproteins, macros, and carbon fats, and then just upping the exercise in any way you enjoy so it’s sustainable.

 

Dr. Gabrielle Lyon [0:07:14]

I love that. I love that reiteration of protein, lower energy density, and exercise. Protein recommendations: how do you recommend protein? How do you think about it?

Dr. Ted Naiman [0:07:28]

We’ve pretty much established that you don’t need more than 1.6 grams per kg of ideal body weight, normal body weight, or non-obese body weight for maximum muscle protein synthesis. But I think going a little bit higher might give you satiety benefits that we haven’t really explored as much as we should in literature. I like a gram per pound of your ideal body weight as your reference body weight for your height. That has nothing to do with how much you actually weigh. I have all these patients who are, yeah, I should be about 220, and I’m 250 now. No, you should be 150. It’s just way lower than what they think.

You have to basically look at what your absolute ideal body weight would be for your height, and then a gram per pound of that, I think, is a super awesome target. Most people, even if they’re a little bit below that, are going to be fine. That’s basically my favorite metric: a gram per pound of ideal body weight based on your height, which might have nothing to do with how much you actually weigh.

Dr. Gabrielle Lyon [0:08:42]

A wonderful recommendation: one gram per pound ideal body weight. As you’ve mentioned, the evidence is really 1.6 grams per kg. However, when we’re thinking about other things like satiation and perhaps protein turnover if someone is getting ill or increasing their training volume, there are many different reasons why one could choose protein over fats or carbs. When you think about protein, do you care about the source?

Dr. Ted Naiman [0:09:10]

Less and less, to be honest, every day because we have some really good studies now on various types of soy protein, legume protein, and other non-animal protein isolates, and they do seem to be okay if you up the quantity a little bit so you’re basically getting enough of all of the individual amino acids. I’m not as worried about source; I’m more worried about quantity. Just getting a total quantity high enough is more important to me than where it came from because, at the end of the day, it’s just 20 amino acids broken down. I’m actually looking at the carbs and fats that come along with the protein more than I am where the protein actually came from. There are some animal proteins that just have horrible macros, like hot dogs. It’s like carnivore’s an instant win. Maybe not, since your hot dog has only 15% protein in it, and the ratio of fat grams to protein grams is horrific. You’ll probably not lose any weight doing that.

I’m not oh, it just has to be animal protein versus plant protein because there’s some jacked vegans out there just consuming a bunch of soy isolates who’s way more successful than someone who just hit the carnivore button and is just eating hot dogs. I’m worried about the fat and carbs that come along with protein. I’m worried about the total amount of protein. I’m worried about the ratio of protein-to-protein energy. But at the end of the day, the protein’s actually just 20 amino acids that break down immediately in your stomach anyway, so who cares where they’re actually from? Although there is a little bit of a spectrum difference between plant proteins and animal proteins when it comes to some of the essential amino acids, you have to take that into account. But as long as you increase the quantity by maybe 20% or 30% at the most, you can get there with any source of protein.

Dr. Gabrielle Lyon [0:11:18]

That is true when we’re talking about dietary protein. The evidence does suggest that it is the total amount of protein, and one could overcome this source if the protein is high enough. If you are hitting one gram per pound of ideal body weight, does the source matter when it comes to the amino acids? The answer to that is actually no; Ted is correct on that. I will say that the lower your protein in your diet is, the more important it is that it comes from animal-based sources.

The other aspect to that is dietary protein consists of 20 amino acids. I think, Ted, we’re going to see the importance of low-molecular-weight molecules like creatine and serine, taurine, and some of these components when we look at the food matrix. From my perspective, adding in a mix of animal and plant-based proteins is probably going to be more effective for overall aging, B12, and zinc. curious as to what your thoughts are on that. I will also say, when you’re younger, does the protein source matter as much? Not necessarily.

Dr. Ted Naiman [0:12:32]

All great points; I totally agree with you. If you’re flying your protein plane really close to the ground and you’re trying to live on your 48 grams per day, it’s a huge deal if it’s animal versus plant. But if you’re like some jacked vegan bodybuilder who’s just consuming hundreds of grams of soy isolates every day, it doesn’t really matter what the spread of the aminos is. The less protein you’re eating, the more critical it is that it’s on the right spectrum of aminos.

I totally agree with the micronutrients that come along with that protein. I do think that probably omnivore is optimum. There’s a reason why humans are omnivores, and I do see patients who are strict religious vegans, and they do have deficiencies in B12, zinc, and iron, and I see this all the time. I also have patients who are pure carnivores who have horrifically low folate levels and sometimes magnesium. It does seem to be optimal to be somewhere in between; this middle path might be the way to go on, honestly, a lot of this stuff, so good point.

Dr. Gabrielle Lyon [0:13:44]

Definitely, the combination of both plants and animals is ultimately where we’re going. Ted said something that changed my perspective on thinking a while ago. I had always thought about the negative impact of processed foods, and we’re going to move on to that highly palatable food discussion. But when you take a step back and think about it, protein powders are highly processed, and definitely in the words in which we choose to speak about this, it probably makes a difference. Are all processed foods bad? No, because again, even with the soy proteins, it’s a processed type of food.

Dr. Ted Naiman [0:14:22]

Right. From a first-order heuristic, okay, just eating whole, unprocessed food sounds really good, and that’s overarchingly correct. But then there’s so many whole, unprocessed foods that if you just ate dates, honey, tallow, and lard and that’s it, it would probably not be great. But then, if I’m eating my artificially sweetened Greek yogurt with amazing macros, I might have a huge success with that product. It’s not 100%. There are unprocessed foods that are not going to get you closer to your goals, and there are processed foods that will. I wish it was that easy, but it’s not.

I hate to say it, but if you just look at the trend, humans are eating more and more processed foods, and we will continue to eat more and more processed foods. We’re not going to colonize Mars, eating whole, unprocessed food. You’re not just going to pull a turnip out of the ground and kill an animal with your bare hands when you’re on the asteroid colony or whatever. Going forward, it’s just going to be more and more processed, so we really need to have a way to sort out which of these processed foods are good and bad, and it’s not going to be enough to just say unprocessed food because nobody will be able to afford that, or they won’t be able to find it, or it’s just going to be less and less common, unfortunately, which is probably bad. But that’s just the way it’s going.

Dr. Gabrielle Lyon [0:15:56]

It is absolutely the way it’s going. It is and will be about finding solutions. You mentioned eating protein earlier in the meal and also earlier in the day. Why would one want to do that?

Dr. Ted Naiman [0:16:09]

Protein is incredibly satiating. It’s the most satiating macronutrient, and it takes a while for that information to get to your brain. It’s going to be 20 minutes before your aminos are hitting your bloodstream, and then you’re getting some of this fullness from the lower portion of the small intestine and the incretins and the GLP-1 and all of these other signaling hormones. It takes a while; it’s slow. If you can frontload that protein, you’re just going to eat fewer downstream calories. We have lots of studies on preloads where you give someone something to eat or drink, and then they hit the buffet an hour or two later, and we weigh and measure how much people eat.

Proteins are a really great preload, especially if it’s before a meal. We have studies where, for example, people drink a protein shake half an hour before their meal, and they just eat 110 fewer calories. It’s sort of a front-loading thing for a satiety effect that takes a little bit of time to really maximize. It’s just really helpful to eat your protein first. That’s why dessert should last. If I just gave you a whole box of Krispy Kreme to eat, you’re going to eat the whole thing. Then here’s your 50-gram protein shake, and you’ll force that down. Now you really haven’t gone anywhere, even though you ate your 50 grams of protein with that meal.

On the other hand, if you drink the 50-gram protein shake and then maybe 20, 30 minutes later, I ate a big box of Krispy Kremes, you’re going to eat two, and you’re going to be done. It’s just very valuable to frontload that protein, not only per meal but throughout your day. We have studies on people who eat more protein earlier in the day, and they’re just more successful. They just eat fewer downstream calories later because they got something they really needed.

That’s why protein prioritization should be the focus of every meal, every snack, where’s the protein, how much protein I’m getting, eating your protein first, or something else first that has fiber or water in it. Drinking two glasses of water before you eat has been shown to help people consume fewer calories. eating a salad before you eat, you eat fewer calories. You’re loading protein, fiber, and water, which are the main things that raise satiety per calorie. It’s giving you more weight, volume, and nutrients for just fewer calories, basically.

Dr. Gabrielle Lyon

That is absolutely correct, and you can see that in brain studies. There’s been a lot of work. Dr. Heather Leidy really kicked this off when she imaged young women, whether they were skipping breakfast or having high-protein meals, and then the later-on downstream effects of their food choices. If you are out there listening and you’re thinking, I have my protein dialed in, another layer of strategy would be when you’re sitting down to a meal, have your protein first, perhaps even have two glasses of water, then have your protein and see if that impacts the amount that you’re consuming. Ted really believes in calorie control as much as I do. There are some camps that say calories don’t matter. I am in the camp where I firmly believe the quality of the calories and that the calories do matter. Do you care about how the distribution of dietary protein happens?

Dr. Ted Naiman [0:19:41]

Way less than I used to. Now I’m mostly worried about how much you get in a day. It’s probably good to divide that into two meals instead of one. If someone bookended their eating window with a bolus of protein at both ends, I think that’s great. There also seems to be a bolus effect on protein and muscle protein synthesis. If you get a meal with a large amount, it would be better than just having an IV drip of one gram every 10 minutes. I like this large amount at once bolus effect. I do like to possibly go from one meal a day to at least two and have a longer period of time where you have amino acids available in your bloodstream.

Other than that, not really; it’s just that the total amount for the day is overwhelmingly the most important, and then maybe just dividing it up into more than one meal and then trying to keep it bolus. I think these are helpful. Beyond that, I am not super worried about it.

Dr. Gabrielle Lyon [0:20:52]

Excellent advice, and you’re talking about a protein hierarchy. Number one is how much protein you’re getting and then dividing it into two meals, or two meals and a snack, but two meals is certainly adequate, depending on your capacity to eat. I really like that advice. When you think about fiber versus fat, where does fiber fall when you are designing a diet or telling your patients? Where does fiber fall versus fat?

Dr. Ted Naiman [0:21:21]

First of all, the more carbs you’re eating, the bigger deal fiber is. If someone’s eating less and less carbohydrate, I’m not as worried about fiber. Fiber seems to be more and more important as the percentage of calories in your diet from carbohydrates goes up. The more carbs you’re eating, the more fiber you should be eating. I’m almost more worried about the ratio between fiber and non-fiber carbohydrate than I am about fiber overall. But I do think it’s a mistake to eat zero fiber. I think it is providing some satiety for hardly any calories. You’re just leaving money on the table if you’re not eating some fiber and getting some satiety from that. I’m not trying to nag people; oh, make sure you eat your 30 grams of fiber per day, but let’s look at the ratio of fiber to non-fiber carbs in the foods that you’re choosing, because I think that’s a big deal. For me, you should be leveraging fiber to some extent because it’s helpful, and then you really just want to keep the ratio of fiber to non-fiber carbs as high as you can.

Dr. Gabrielle Lyon [0:22:36]

Give me an example of that. What does that look like?

Dr. Ted Naiman [0:22:38]

Let’s say I buy some Wonder Bread, and a slice has 50 grams of carbs and one gram of fiber, or zero grams of fiber. But then I got my Ezekiel bread, my sprouted bread that’s super whole grain or whatever; it might have 25 grams of carbs and five grams of fiber. It’s like a five-to-one non-fiber-to-fiber carbohydrate ratio versus Wonder Bread, which is 50-to-zero or something like that. That’s the sort of thing that I’m talking about. If you’re looking at a label, you just look at the rough ratio between total carbohydrate and fiber carbohydrate, and you just want the fiber-to-non-fiber ratio to be higher; higher is better. That’s mostly what I’m talking about.

Dr. Gabrielle Lyon [0:23:30]

I really like that. Is there a number that you shoot for? For example, if you see that it’s less than X, you’re out.

Dr. Ted Naiman [0:23:39]

I’d like to see it at 15% or so, so a six to one fiber-to-non-fiber ratio would be pretty good. If something had 30 grams of carbs and five grams of fiber, that’s pretty good. A five-to-one is even better; a four-to-one’s really good. You’ll see some low-carb tortillas that are just crushing it, and they’re just half-fiber or more. They’re made out of flax seeds and just hay or something. You’ll see a really wide spectrum from the Krispy Kreme donut, which has 100 grams of carbs and zero fiber, all the way down to just some super low-carb tortilla thing that’s basically all fiber. So that’s really what you’re looking at.

Dr. Gabrielle Lyon [0:24:24]

Do you have a favorite source of carbs for yourself personally?

Dr. Ted Naiman [0:24:29]

I absolutely do. I like soluble fiber. It’s really the best for satiety, and fruit is a pretty good source of this, and there are some fruits that I eat a lot of. Berries are my absolute favorite. Apples are second, so I eat a lot of apples because they have soluble fiber. Of course, all of this stuff has almost no protein. This is like a side dish to something with protein in it. but it’s an excellent accompaniment to some high-protein foods.

I love fruit. I like basically any kind of low-sugar fruit; all of your peppers and your cucumbers, your tomatoes and your olives, your avocados, and all of your low-sugar fruit. I love all of your fruit as well, like citrus, which is amazing with lots of really high satiety per calorie, lots of fiber, lots of water, and very low energy density.

But if you look at the ones I’m eating the most, it’s probably fruit, mostly berries and apples, and then your low-sugar fruit that people think are vegetables like cucumbers, tomatoes, and peppers, and then tubers as well. I eat a lot of carrots. I eat a lot of potatoes. I’m typically throwing those in the airfryer and not adding any fat to them. But those are some of my favorite carb sources. It’s basically fruit, tubers, the low-sugar fruit people think are vegetables, and a few whole grains in there too. I eat some air-popped popcorn, maybe some brown rice—that kind of thing.

Dr. Gabrielle Lyon [0:26:06]

Do you worry about the fructose in the fruits?

Dr. Ted Naiman [0:26:11]

No, not at all.

Dr. Gabrielle Lyon [0:26:15]

You know I have to ask these questions. I’m anticipating questions from our community about fructose because we have a world-leading expert on fructose metabolism.

Dr. Ted Naiman [0:26:28]

Basically, fructose is bad for overfeeding. Fructose is bad for overfeeding when you get a lot of it all at once. If you’re just pouring regular soda with high fructose corn syrup on top of a hypercaloric diet and someone is already overfat, that’s going to be mercilessly giving you fatty liver, and it’s bad. But saturated fat is just as bad as fructose. Fructose and saturated fat are two sides of a coin where they’re both empty calories; they’re both bad for overfeeding. They’re both bad in hypercaloric situations. They’re both mercilessly driving fatty livers.

But they’re both super harmless if you’re on a low-calorie diet, if you’re hypocaloric, if you’re thin, and if your metabolism is healthy. They are empty calories, true, but they’re harmless. The dose makes the poison in all of this stuff. If you’re thin, healthy, and metabolically intact, and you’re not eating a hypercaloric diet, I’m not too worried about fructose or saturated fat.

However, because they are empty calories and because they are not really that helpful other than being a pure energy source, you do want to keep them in a smaller percentage of your diet, which is probably why the guidelines say less than 10% of your calories should come from saturated fat and less than 10% should come from sugar. That also illustrates the fact that there are two sides to the same coin, and they’re both kind of bad, and you don’t want to eat tons of them.

Dr. Gabrielle Lyon [0:28:05]

That’s an interesting point. You do believe that the guidelines did an appropriate job for saturated fat and sugars from that perspective?

Dr. Ted Naiman [0:28:14]

Absolutely, because these are both just empty calories that are frequently unnecessarily added to the food supply, diluting out other things like saturated fat. Let’s look at a wild animal that has amazing macros: your venison, your extra-lean ground beef. This is just crazy, awesome food. But I’m going to overfeed a cow and make it the fattest cow you’ve ever seen, and then I’m actually going to make ground beef and throw more fat into that and make the cheap 70/30 ground beef in the grocery store, which is actually only 18% protein, has a super high energy density, super low protein percent, kind of horrible from a satiety calorie point of view or any point of view. What’s in there that’s making it bad? just a crap ton of saturated fat that you generated by overfeeding an animal and then maybe even adding more when you made the ground beef.

Saturated fat is bad. This is the reason why red meat looks bad in all your epidemiological studies: they’ve overfed the animals, they’ve added more fat later to make it cheaper, and you basically end up with a horribly protein-dilute monstrosity that just has a bunch of saturated fat from the overfeeding agricultural practices, and then the economic drivers of just diluting out all your cheap meat, so your hot dogs and your burger patties and your super cheap 70/30 $1 a pound ground beef in the grocery store. This is all terrible, and it’s terrible because of all the saturated fat that’s been added for profit by agriculture and industry.

Fructose is the same. I’m going to take a sugar cane, a sugar beet, or whatever. I’m going to press it with rollers. I’m going to squeeze out all the sugar, I’m going to dry it, I’m going to crystallize it, and I’m going to sprinkle it on every single thing I eat. Then boom, I’m just putting fructose in everything. This makes it more palatable; you can eat way more of it. It’s just pure empty calories; literally, fructose and saturated fat are the flip sides of the same coin, one on the carb side, one on the fat side, one on the plant side, and one on the animal side. They’re the same thing: flip both sides of the same coin. If you really want to give somebody a fatty liver like your mouse in the lab, you just overfeed them with both sugar and saturated fat. Your high-sugar, buttery diets are just making fatty livers go crazy in the lab.

Dr. Gabrielle Lyon [0:30:55]

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There are a few really good points that you made. Number one is the idea that red meat is bad for you. It seems to not do well in a lot of the epidemiological studies, which are essentially large populations with low quality evidence because of the saturated fat content or the overfeeding aspect of it, which is a really good point. It’s not the red meat per se. Red meat, either venison or bison, there’s lots of lean steaks; it is likely the overfeeding effect.

I have a question on satiation. I’ve known you for years, Ted, and originally, there was a lot of talk about protein and fiber, and now you’ve really evolved the conversation through practice to this satiety model. Do you think that when individuals are overfed via saturated fat, we’ll start with saturated fat, that it deranges their satiety or their capacity to have satiation, meaning that as they are overfeeding or going through periods, whether they are emotionally overeating or overeating because they’re making bad choices, do you think it’s a feed-forward mechanism?

Dr. Ted Naiman [0:35:02]

I think, to some extent, it is. As people get more and more insulin resistant, their protein percentage requirement actually goes up because they’re burning more protein when they’re insulin resistant. That’s why obesity didn’t just go up and plateau out. It just keeps climbing because, as you get more and more fat and more and more insulin resistant, you actually need a higher and higher protein percentage, but you’re not eating that, so you just continue gaining weight forever.

Also, the hedonic factors are huge. If you’re constantly exposed to very hedonic, hyperpalatable, and super tasty food, that resets your dopamine system to the point where that’s all you need to eat now, and everything you eat has to be 10 out of 10. It has to be like all you’ll eat is the Haagen-Dazs, the Krispy Kreme, and the Ben and Jerry’s. You’re not going to eat just a protein shake because you have this feed-forward hedonic effect where everything just has to be more and more tasty, almost like a drug addict using higher and higher doses. The hedonics, feed forward, the insulin resistance, and overfatness and protein requirements are fed forward. Absolutely. You’re totally right; all of this stuff feeds forward, which is why obesity keeps climbing and doesn’t just go up with the amount of sugar we put on everything and then plateau out.

Dr. Gabrielle Lyon [0:36:30]

Speak more about that. Talk more about what we’re actually consuming and where the numbers of obesity are driving to. That’s a really good point.

Dr. Ted Naiman [0:36:41]

Basically, 75% of the world is overweight. 92% of Americans are overweight.

Dr. Gabrielle Lyon [0:36:52]

I’m going to stop you right there because, I bet you, when we talk about 70% of them being overfat, we would also say that 70% would be undermuscled in terms of the quality of muscle.

Dr. Ted Naiman [0:37:03]

I have some patients who, because they weigh so much, would have an okay amount of muscle if they weighed way less. But I absolutely agree. I have an avalanche of patients with normal-weight obesity or sarcopenic obesity. Now this is the worst thing ever. If someone who’s so sedentary and just sits on the couch has no muscle at all, even though they look hugely fat, they actually don’t weigh that much. You’re absolutely right; there is simultaneously an undermuscled crisis because we’ve basically disconnected movement from survival. Nobody ever has to move at all. You can literally just sit on your couch your entire life. You’ve got Uber Eats on your phone; your whole job’s on Zoom; you never have to even stand up. You can just live your whole life without moving. Everybody’s simultaneously overweight and undermuscled. I totally agree; this is absolutely true.

Dr. Gabrielle Lyon [0:38:12]

To the point that we’re measuring body fat, are you using an InBody or are you using DEXA? What are you using?

Dr. Ted Naiman [0:38:21]

I don’t do a lot of body composition measurements with my patients, to be honest, because I can just look at them and tell them they’re overweight. It’s not that helpful. I’m mostly just doing low-budget stuff like waist-to-height measurements. That’s where I’m at. I do have skin calipers in the office, and we do DEXA in the office, but I’m not regularly doing those to track anything because you can just measure your waist circumference at the belly button and know exactly what your problem is.

Dr. Gabrielle Lyon [0:38:51]

What number do you like to hit, and how would someone do it? If someone is like, wow, this is so great. I don’t have to go to the doctor. I don’t need to get an InBody scan. I don’t need to get a DEXA. What do I have to do, Ted?

Dr. Ted Naiman [0:39:02]

The waist-to-height ratio is incredibly powerful, incredibly important, super good, and free. You measure your waist circumference at the belly button with your abdomen completely relaxed. Then you cry because it’s so high, and it’s so much higher than your pants size. I have so many patients who’re shoving themselves into 32 jeans or whatever. But you measure their abdomen at the belly button, and it’s 40. You measure your waist at the belly button, abdomen fully relaxed, divide that by your height, and you want that to be less than half your height. Your weight should be less than half your height.

It’s going to work on almost everyone, even people who look kind of skinny. I have a lot of skinny, fat patients who look pretty thin, and nobody would ever think they have any issues. But if you actually measure their waist at the belly button, with their abdomen fully relaxed, it’s not always as low as you wish it was. That’s a really great metric for just about anyone.

Dr. Gabrielle Lyon [0:40:17]

It’s free, like you said. Waist height measurement is very helpful; less than half your height.

Dr. Ted Naiman [0:40:28]

Right. Your waist should be less than half your height. If I’m 75 inches tall, my waist circumference should be 37.5 or lower. That’s probably a bad example of challenging math. But if you’re 60 inches tall, your weight should be less than 30 inches.

Dr. Gabrielle Lyon [0:40:47]

Really easy to do. I’ll mention that part of me agrees with you. Do we need to continuously measure body fat? Perhaps by looking at themselves or doing a measurement like this, because we don’t have great ways of getting a wonderful, comprehensive picture. What do I mean by that? We’re not directly measuring skeletal muscle. You could have an individual who is overweight, and if you measure their skeletal muscle, it looks as if they have enough. But the reality is, that is not healthy muscle; it is typically marbled, and it is not necessarily as metabolically effective as it should be because the tissue changes skeletal muscle. As an organ system, that tissue changes. You get fat infiltration and a decrease in flux, meaning you’re not moving glycogen and you’re not utilizing these fatty acid byproducts the way that you should. Again, we’ve really been hyper-focused on body fat. The reality is that, just like fructose and saturated fat, body fat and muscle are, essentially, opposite sides of the same coin.

Dr. Ted Naiman [0:42:00]

You’re totally right. All these measurements are just really rough estimates; nothing’s accurate. DEXA is kind of inaccurate; skinfold is inaccurate; and your impedance is inaccurate. The best view we’ve got is some four-compartment model and an MRI, and it’s going to cost you thousands of dollars. Even then, even if you knew exactly what your composition was, it’s a Sisyphean daily struggle the rest of your life to constantly get more muscle and less fat, and you have to worry about that. It’s like a war of grams every day and every time you eat, and you’re trying to get more muscle and less fat, and you’re going to be doing that forever. Health is never owned, only rented, and the rent is due daily. Even if you had a snapshot that looked pretty good, it’s going to go downhill after Christmas, Thanksgiving, or the cruise you’re going on.

It doesn’t even matter. Let’s pretend I did a DEXA on someone, and it stinks. You’re too fat; you don’t have enough muscle. Now, what are you going to do about it? Then, oh, by the way, you have to do that every week for the rest of your life. It’s entertaining to track these things, but it’s not value-added for me, to be honest.

Dr. Gabrielle Lyon [0:43:16]

How long have you been in practice?

Dr. Ted Naiman [0:43:21]

Let’s see, there was dinosaurs, and then–

Dr. Gabrielle Lyon [0:43:24]

Listen, Ted, I know these answers. But the reality is, it’s so fun that Ted and I get to chat, and you guys are all involved in this conversation. I’m asking because the more advanced a clinician is, there are certain components of the body or certain ways of practice that we see is very cyclical. In the beginning of your practice, as a physician, we do have lots of providers listening; you are testing and tracking everything, literally everything. By the way, that is extremely overwhelming for the patient. I’m in my second decade of practice. As you advance in practice, you do less. You are hyper-focused on more, and you are hyper-focused on the things that truly move the needle. I bet you if I put a gun to Ted’s head, which I’m not going to, when I said is diet or exercise more effective in moving body composition and creating change in homeostasis, he would say exercise.

Dr. Ted Naiman [0:44:29]

Probably so, but it’s still right in the–

Dr. Gabrielle Lyon [0:44:34]

Not that I’m holding you, but again, that is very difficult to impart, which is why you can’t really do one without the other. You really have to nail in nutrition. You can train like a maniac, but you do have to have your nutrition in balance. He’s done a wonderful job at that.

We’ve talked about protein. We’ve talked about how to prioritize it. We’ve talked about carbohydrates and fats. When you’re looking at the overall picture, what are some numbers that you would give? How do you think about it? For example, in your model of eating two meals a day, how much are you consuming? Are you worried about the dose of carbohydrates that then stimulates insulin, say, for example, over 50 grams? Or are you worried about the impact of a dose of saturated fat at that first meal?

Dr. Ted Naiman [0:45:27]

Basically targeting protein first, gram per pound of ideal body weight based on your height, and then divided into two or three meals or two meals and a snack in an eight-hour eating window, that would be ideal for me. If you’re dieting, you want to keep fat to about half a gram per pound of ideal body weight based on your height.

Dr. Gabrielle Lyon [0:45:56]

I have to stop you. This was on my question list. How do you determine ideal body weight? I’m going to tell you how I determine ideal body weight, but there’s lots of talk about it because everyone is going to be thinking, okay, I’ve got to calculate this. How do you determine your ideal body weight?

Dr. Ted Naiman [0:46:09]

If I’m just looking at someone and I don’t care about gender or anything, I basically do some fancy calculation of solving for a BMI of 22, what your height would be in meters if your height in meters solved for what kilograms would get you to a BMI of 22. But that involves square roots and a lot of math, and you have to be a mathematician to even understand that. But you know how a BMI is: kilograms per square meter. If you just take a BMI of 22, for everybody on the planet, men, women, large, small, whatever, just as a rough average, and then you enter your height in meters squared, and you solve that for kilograms, you will get the ideal body weight for pretty much anybody indiscriminately, whether they’re male, female, or whatever.

But on a practical level, like in the book, I had a little quick and easy calculation where for women, you get 100 pounds for the first five feet of height, and then you get five pounds for each additional inch over five feet. If you’re even five feet tall, you should weigh 100 pounds. If you’re five four, that would be 120 pounds, so 100 pounds for the first five feet, and then five pounds for each inch over five feet, which is four inches, which is four times 20, that’d be 100.

Men are allowed to weigh 110 for the first five feet and then five pounds for each inch over that. If a male was five and four, he could weigh 110 plus; four times five is 20, so 130. That appears to be a very simple task that anyone could complete. When I’m designing calculators for ideal body weight based on height, I’m basically solving for kilograms using height in meters and a BMI of 22.

Dr. Gabrielle Lyon [0:48:18]

Interesting. You want to hear my way of doing it? Listen, it’s very difficult. How do we know? You may totally disagree with this because, again, it’s really difficult to say what your ideal body weight is. I think the last time someone was ever fit, so for example, in college, I weighed 110 pounds, pretty lean and fit; that’s my ideal body weight. I look at my husband; in college, he was pretty skinny, but his ideal body weight’s 200 pounds. The last time he was super fit, he was 200 pounds. I think picking a weight that you feel great at could be just as effective. I know it’s not scientific, and you’re also pushing yourself a little bit. We often have patients pick a college weight.

Dr. Ted Naiman [0:49:19]

That works for all people like me because we weren’t always fat, but that’s not working for the next generation because they had childhood obesity and were never at a good weight. That’s going to work less and less going forward, unfortunately, but yeah, I do actually like that for older people.

Dr. Gabrielle Lyon [0:49:46]

That’s a really good point. With this whole childhood obesity thing, we have to then begin to think about where we set our standards in terms of nutrition. In my mind, we have to go back to what the calories are, and this is going to be a huge challenge because the people listening to this podcast are doing the same thing. But what about everybody else who is outside of the arena? What are the recommendations that we’re going to tell them? Are we going to tell them that the RDA is 48 grams of protein, depending on how much you weigh? It’s going to be a challenge. We’re going to be in for some real struggle.

Dr. Ted Naiman [0:50:28]

It’s a disaster. Just look at a school lunch, look at a hospital lunch, and look at a nursing home lunch. It just makes you want to cry. It’s disgusting. It’s disturbing, and protein is what’s really getting thrown under the bus on all of those.

Dr. Gabrielle Lyon [0:50:43]

I know, it’s so odd. It’s odd because I think that there’s a political agenda there. I think that there’s a money agenda there. When I say politics, I mean we have to account for the whole world. It’s not just us. There’s a lot of challenges with animal-based products, and even taking out the animal-based products, even the plant-based products. How are we going to prioritize? That’s not really the message that we’re getting. It truly is reducing dietary protein, which is the worst piece of advice I could ever give somebody.

Dr. Ted Naiman [0:51:20]

I agree. I hear you. The whole plant-based thing—they might be right that fiber is good. They might be right that a lower energy density is good. They might be right that you’re going to have fewer hedonic factors in your diet. But they’re really missing the protein angle for the most part—the big picture. A lot of the plant agenda is like, oh, you’re already eating too much protein; don’t even worry about that. I just really don’t agree with that. That’s problematic. If you have a bigger view, you can see there are some advantages to this plant-based thing, which might be fiber and energy density and lower hedonic, but they’re missing out on the protein side. Why don’t you actually look at both sides, combine them all, and take some sort of middle road where you can actually see the pluses and minuses on both sides of the political aisle?

I basically hate politics; I’m super apolitical. I can just immediately see all the good and bad on both sides. I’m just squarely in this middle zone, where I’m just absolutely aghast at the extremes on either side. I do the same thing with carbs versus fat. I do the same thing with plants versus animals. I do think there’s this sort of agnostic-neutral middle ground where you can actually see the good and bad on both sides and weigh them out. It’s probably optimal, somewhere in between.

Dr. Gabrielle Lyon [0:52:51]

Absolutely. Just to round out, and I don’t know if I got the answer to the question because I’m sure people want the tactical aspect of it, do you care about the dosing per meal of carbohydrates and fat?

Dr. Ted Naiman [0:53:05]

Fat, less so. Fat’s fairly passive; it takes a very long time to be absorbed, and then it gets packaged into chylomicrons, filters through your lymphatics, gets dumped out in the thoracic duct, goes to your liver, gets repackaged, and ends up in your fat cells. The timing of that, I really don’t worry about too much. You probably want enough with each meal to add to the longer-term satiety, but it can just be distributed evenly or else however you want. Carbohydrate is a little more strategic. I think carbs could have an ergogenic benefit.

Dr. Gabrielle Lyon [0:53:46]

What do you mean by that?

Dr. Ted Naiman [0:53:49]

Some people, if they eat carbohydrates right before they work out, might have a better workout. They might be able to perform better either at cardio or resistance training, so there seems to be a bit of an ergogenic effect to carbohydrate, kind of like caffeine. It’s almost like a pre-workout effect. I think using carbs strategically and the things that carbs do that I think are good are possibly ergogenic before a workout, possibly speeding up recovery after a workout, or if you’re doing multiple bouts of working out in a day. If you’re playing soccer for four hours, you might want to drink your Gatorade somewhere in there. It’s basically timing carbs around workouts before, during, or after, and then possibly in the evening. There might be a rest and digest parasympathetic mode benefit to carbohydrate, which is why so many people backload their carbs to eat them later in the evening because you seem to trigger more of a parasympathetic rest and digest state. I like using either backloading carbs later in the day for just like some people sleep better or just using them around workouts before, during, or after. Carbs are more of a strategic thing around exercise for me.

Dr. Gabrielle Lyon [0:55:15]

Do you dose it? For example, I tell my patients that if they’re going to have a meal, they should not exceed, outside of training, 40 or so grams of carbohydrates because I don’t want a secondary insulin response. Again, if you’re eating all these vegetables or some of these fibers and carbs, you could potentially go higher. But I give them the baseline recommendation that 50 grams or 40 to 50 grams or less if you’re not training; the rest of the carbohydrates are earned during exercise or post-exercise. The amount that I give them is, I’ll say, for every hour of moderately intense training where your heart is over 120 beats per minute or so, I might offer them anywhere from 40 to 60 grams of carbohydrates or something like that. Do you have a number that you shoot for?

Dr. Ted Naiman [0:56:08]

Yeah, roughly. Per day, I’m thinking about a gram per pound of ideal body weight and carbohydrates, similar to a gram per pound of protein, with the caveat that you want the fiber-to-non-fiber ratio as high as you can get. Then I’m a little bit less worried about per meal if the fiber-to-non-fiber ratio is high enough. That’ll take care of itself, I think. But I do agree with what you’re saying. You could add in an extra gram per minute for all the high-intensity exercises you’re doing. If you do an hour of high-intensity glycolytic exercise, definitely another six grams of carbs, sure. I like that you’re going to eat roughly a gram per pound. You’re going to divvy it up with your meals, use it around exercise, or use it in the evening. then you’re going to basically keep the fiber-to-non-fiber ratio as high as you can get. That’s how I would make my carbohydrate recommendation.

Dr. Gabrielle Lyon [0:57:10]

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What about saturated fats or fats around training? Do you have any concern or worry about it?

Dr. Ted Naiman [0:58:41]

It’s so passive, and it’s so delayed, and nobody’s getting an ergogenic benefit from fat. Nobody’s getting anything right away. The carbohydrate is so immediate. It’s definitely more time-sensitive and more of a timing issue. It’s way more tactical. Fat is not tactical at all. You just mix it in with your meals so you get a little more satiety, and you want to make sure you don’t go less than 20% of your calories from fat, pretty much ever. Probably somewhere between 20% and 40% of your calories is good; 30% or 35% would be awesome. You have to have some fat in there for a bunch of reasons, and it doesn’t really matter when. In my opinion, timing is the least important aspect of fat.

Dr. Gabrielle Lyon [0:59:31]

Yeah, I absolutely agree with you, and the evidence would suggest a diet lower than 20% fat can affect hormonal status. I see this often with men, particularly those whose fat intake is below 20%; again, these are just individual cases anecdotally, but their testosterone decreases. You will definitely find information in the literature about lower-fat diets and their potential impact on hormonal regulation.

What about exercise? What kind of exercise? Where do you throw exercise if someone is looking to be less fat and more muscle, just improve body composition? What’s your go-to?

Dr. Ted Naiman [1:00:12]

There are three forms of exercise that everybody should be doing. The first one is resistance training. You have to put maximum tension in all of your muscles, and you have to give your body the signal that it needs more muscle or you’re going to die. That’s the only way your body will make more muscle. You can’t create muscle by just eating more protein; that’s like pushing rope. You have to demand more muscle from your body by telling your body you’re going to die if you don’t have more muscle, and that’s doing things to failure.

I like compound exercises: push, pull, legs, and hinge. You want to do at least twice a week full body to failure, three times a week, probably slightly better. But you’re basically trying to do big compound movements, all the way to failure. That’s resistance training everyone should be absolutely doing. You’re never going to get more muscle without it, which is super critical.

The second thing that everyone should be doing is cardiovascular exercise. You want the positive adaptations from cardio. You want a higher VO2 max because that’s more associated with longevity than pretty much any other number you can measure on a human. You want to challenge your cardiovascular system regularly. I like people to get maybe not to their maximum heart rate, but close to 90% or 95% at least once or twice a week. Of course, talk to your doctor first because there’s somebody out there every time you do maximum effort cardio. You have a 0.00001% chance of just dropping dead because you have some widowmaker, left anterior descending thing that you don’t know about. But the vast majority of the time, you’re just going to be better and stronger after getting this sort of thing. But as long as you’re healthy, you want to be approaching your maximum heart rate once or twice a week, at least to try to get positive adaptations that are going to improve your VO2 max and your cardiac output.

Dr. Gabrielle Lyon [1:02:21]

How intense are we talking?

Dr. Ted Naiman [1:02:25]

I’m talking rate of perceived exertion of 10. You really want to max out. You’re trying to push out of your comfort zone, and as you crank the intensity up, you get better and better adaptations. It’s just like resistance training. The closer you get to failure, those reps that are close to failure are where you’re getting all of the bang for your buck. When it comes to cardio adaptations, you’re getting a lot of those at the higher output levels. You’re just not going to get the same thing from walking, for example. You’re trying to get a bunch of adaptations from exercise, but you’re trying to increase speed, you’re trying to increase power, you’re trying to increase skill, and you’re trying to increase endurance. You’re not going to get all those things without doing some high-end cardio.

At least once a week, I recommend that people do more endurance cardio for at least half an hour at a fairly high heart rate. I like people to try to approach maximum heart rates at least once a week, if not more, because of the adaptations you’re going to get. You’re trying to get a cardio adaptation. Everyone should be doing high-end cardio and endurance cardio, and then just cardio, more volume, Zone 2, Zone 3, whatever you want.

You’ve got resistance and cardio. Again, you have to have both of them. Just like diet and exercise are equally important, you have to do both. You have to do resistance and cardio. You’re never going to be in optimal health without both of those. Yes, you want to be strong, and you’re just doing your muscle, but you also want to be fast as hell, and you want to have tons of endurance and be so resistant and cardio both.

The third form of exercise that everyone should be doing is just general movement, a high step count, a high level of non-exercise activity thermogenesis, or just walking around a lot. Your hunter-gatherers are getting 20,000 steps a day, and we’re getting 3,000 steps today. You just want to be at least moderately active because there are so many people out there who are just constantly thinking about their diet. They’re just really white-knuckling the diet; everything has to be unprocessed and paleo, and they’re looking at their macros, but they’re never doing enough exercise, and they’re never going to get exactly where they want to be. Half those people would be better off just doing a way higher volume of exercise and then eating whatever the hell they want.

As your caloric burn goes up from exercise, your body just very smoothly regulates intake to expenditure perfectly, and you’ll never get that at low energy expenditure. If you’re just sitting on the couch and really trying to dial in your diet harder and harder and harder, you’re just not going to get to where you want to be. So a lot of these people need to think way less about their diet and just crank the volume of exercise way higher. You really want to be pulling the diet and exercise levers equally hard and not get too freaked out about one or the other.

Dr. Gabrielle Lyon [1:05:41]

That makes me think of the biggest misconceptions that have just been discussed. What do you think are the biggest misconceptions related to fat loss that we’re seeing now?

Dr. Ted Naiman [1:05:57]

That’s tough. The three biggest from mainstream media type thing?

Dr. Gabrielle Lyon [1:06:07]

Yeah, anywhere. Maybe they’re the old things, like just restricting calories and walking more. Do you think that there are certain misconceptions?

Dr. Ted Naiman [unclear 1:06:24]

I think one big one is basically a monofocal approach where you’re just looking at one thing. Like it’s just all about fructose, just don’t eat fructose, look at all the fructose, or it’s just about animal foods, okay, if we were all vegan, if we all went plant-based, or just looking at something like fat, you just need to eat the lowest fat you possibly can. Anytime you’re doing a monofocal approach where it’s just carbs, it’s just fructose, it’s just fat, it’s just saturated fat, it’s just calories, it’s just exercise, you’re really going to get 10% better and then just completely fail. You really have to integrate all of these things at once.

Everybody’s right about something, and it’s really all of them together. It’s a higher protein percent, more fiber, lower energy density, less hedonics, less processing, and doing cardio and your step count, resistance training, and muscle quality. All these things are equally important, and if you’re not looking at all of them together, you’re just not going to get the whole picture. It’s just monofocal reliance. Every time you read a clickbait article, it’s about one thing. Everyone’s eating way too much saturated fat, or you’re already getting plenty of protein. We’re obsessed with protein. or there’s a fiber problem in America. You just focus on one thing, and it’s just really not going to explain everything, and it’s really not going to get you there. I’m definitely worried when somebody tries to just blame everything on one thing.

Dr. Gabrielle Lyon [1:08:09]

Very smart answer putting you on the spot. I could not do better. That is an excellent answer. What do you tell or have you had people that you find are weight loss resistant or whose body composition doesn’t move? Have you had that experience with your patients?

Dr. Ted Naiman [unclear 1:08:29]

Yes, and it’s especially true for people who’ve just always been obese. I have patients whose parents are both morbidly obese; they were morbidly obese as children, in adolescence, and as adults. They’ve had so much fat cell hyperplasia. Basically, your fat cells can either undergo hypertrophy, where they get bigger in diameter, or they can undergo hyperplasia, where you multiply them and get way more and more and more fat cells. These people have maybe 10 times as many fat cells as someone who is never overweight. They hit this major wall on body fat percentage because, let’s say, they were 50% body fat at one point, and they have 10 times more adipocytes than everyone else. They can die it down and shrink down all their fat cells a lot, but they get just so hungry at this shrunken adipocyte level. Their leptin resistance, or whatever you want to call it, their leptin to adiponectin ratios are all screwed up because they have so much fat tissue hyperplasia that they can only get so low, and they’re just starving out of their minds. It’s like if I tried to get down to 5% body fat, I would have the same level of hunger that they have when they’re 30% body fat because of how much fat cell hyperplasia they’ve undergone earlier in life. That is just a really tough situation.

Honestly, I do prescribe drugs for people who’ve had this just-lifelong programmed obesity. I am prescribing GLP-1 receptor agonists: your tirzepatide, your Zepbound, your Wegovy, your Mounjaro, your Ozempic, and your semaglutide. I’m using all these drugs, and they are effective, and they are basically just massively overdriving satiety signaling in a way that you could never accomplish with food. That does seem to be helpful, especially for people who have just always been overweight because it’s so hard for them to get to a normal weight. It’s the same amount of difficulty it would be for me to be stage-lean, bodybuilder-style. Those are about the same degree of difficulty. Definitely people who’ve been fat forever; it’s super tough for them to get all the way down to their goal.

Dr. Gabrielle Lyon [1:11:00]

On the flip side of that, we talk about fat and muscle, the opposite sides of the same coin. Do you then prescribe something for skeletal muscle health? What are your thoughts on that?

Dr. Ted Naiman [unclear 1:11:13]

If someone has low androgens, like if you’re hypogonadal, I might be prescribing testosterone or something like that. But typically, no, it’s really just protein and lifting for most people.

Dr. Gabrielle Lyon [1:11:32]

I think in an ideal world where eventually we’ll get to a place in medicine, we have pretty set standards for how we’re treating obesity. I do feel like we have an obesity problem. I always say we don’t. We do, but I don’t believe that that’s at the root. But we have standards and treatment protocols put into place to deal with someone who is obese or has fat cell hyperplasia, yet we ignore the musculoskeletal health issue and even the medications available. Sarcopenia wasn’t an ICD-10 diagnosis until 2016. Obesity was finally a diagnosis in 2013.

The perspective that we have has to change so that we can then be more effective at treatment. Because those with fat cell hyperplasia, or those with exceedingly low muscle mass, have a skeletal muscle system, it can be somewhat blunted. The muscle protein synthesis effect can be blunted, and it really does people a disservice if we cannot prescribe things that augment skeletal muscle health. We’re so restricted that it has to be based on hypogonadism or low levels of hormones, because it’s just a matter of time before skeletal muscle health is going to catch up to them. Again, these are just my thoughts, and I’m hoping, collectively as physicians, we can really begin to move these guidelines and bring in muscle-centric medicine and create guidelines that would be really helpful for people.

Dr. Ted Naiman [unclear 1:13:13]

I agree. Even in postmenopausal women with severe osteoporosis and sarcopenia, anabolic agents are probably way better than bisphosphonates and protein, and lifting and anabolics are probably where it’s at. You can probably just walk into the room and glance at someone and look at their appendicular lean mass and be like, oh my God, you need way more protein. You need to be lifting. You might even need an anabolic if you’re a postmenopausal female with undetectable estrogen and testosterone.

So you’re all over that. But the average person is not even on their radar. Nobody in the clinic is talking about muscle amount, quality, or any of this stuff. You’re right; that should be. It’s like, how much can you bench press? What are your vital signs? How much can you deadlift? What’s your dead hang time? What ratio of your body weight can you overhead press? These should all be on your chart, along with your blood pressure. You’re preaching to the choir. I really appreciate your muscle-centric approach, and it’s a massive, huge, big deal. If everyone was dialing that in, it would be enormous.

Dr. Gabrielle Lyon [1:14:37]

Well, maybe as I begin to put together the board for muscle-centric medicine, I can count you in.

Dr. Ted Naiman [1:14:42]

Absolutely. Yes, please. Definitely.

Dr. Gabrielle Lyon [1:14:45]

I would love it. What are some of the biomarkers that you’re looking at in your clinic—things that you think are really important?

Dr. Ted Naiman [1:14:55]

It’s like you said earlier. Now that I’ve been out of residency and in practice, I got a residency in 2000, believe it or not, and I used to do so much more lab testing. I did all this functional medicine training, and I was checking all these crazy labs, and with age, you get this wisdom, and you realize that some of this stuff actually doesn’t really matter, so I do less and less testing. I hate to say it, but if you go to a naturopath who’s fresh out of school and has no real good feel for how everything works, they’re going to be thousands of dollars in shotgun labs. You’ve got your reverse T3 and all these crazy things that are just so not helpful. The longer I do this, the less I look at lab testing. It’s a very short list of things that I’m looking at. But I do like hemoglobin A1C; that’s a critical test that I’m doing for everybody. I do like fasting lipids, and I’m looking at triglycerides, which is especially useful to see how that–

Dr. Gabrielle Lyon [1:16:07]

Do you want to share the numbers? So, you guys, fasting triglycerides is certainly one of the things that we think about for insulin resistance and just metabolic dysfunction. What numbers are you looking at?

Dr. Ted Naiman [1:16:19]

You want a fasting blood draw with no calories for nine to 12 hours, and you want your triglycerides to be under 100. Anyone with triple-digit triglycerides has an issue. If you hit 120 or 130, you’re severely insulin-resistant. Of course, the textbook says under 150 is normal, but it just gets worse and worse anything above basically 100. Lower is better. You definitely want to have double digits instead of triple digits under 100. That’s a really useful test, in my opinion.

A1C, I’m looking at that a lot. Fasting lipids, I’m looking at that I’m looking at. Of course, for anyone who’s struggling, I’m checking thyroid. I’m taking testosterone, I am checking some of these other hormones, and everyone who comes in and gets a complete blood count, comprehensive metabolic panel, A1C levels, thyroid, etc. But I’m not doing a lot of other fancy advanced testing beyond that because it’s just not that helpful.

At the end of the day, everyone needs more cardio, a better diet, a higher protein-energy ratio, higher satiety per calorie, more lifting, more cardio, more muscle, and less fat. These are all Sisyphean things that you have to work on every day forever, and you’re playing the long game. It’s a marathon, not a sprint. Whatever your labs are today, I just pretend to check them. They suck, and now you need to work harder in the kitchen and in the gym. The actual numbers are not that helpful.

Dr. Gabrielle Lyon [1:18:03]

I just love that you’re saying this because, again, you’ve been in practice for quite some time, and it ends up being full circle. We can do these fancy things, and yes, some people need them. We have to build the foundation. We have to get the foundation right. Once you build the foundation, you get to have a lot more flexibility in the fun stuff, whether it’s red light or sauna therapy, all things, cold plunging, things I love, I do all of these things. But building the foundation for long-lasting health and the trajectory of one’s health and wellness is so critical.

We had one of your business partners or medical partners on talking about an app about satiety. Before we close out, I’d love for you to mention it where everyone can find you, find the app, etc.

Dr. Ted Naiman [1:18:56]

Oh, great. Thank you so much. I’ve been working with Dr. Andreas Eenfeldt, another awesome primary care family medicine doctor like us. We’re the greatest. Let’s face it. Dr. Eenfeldt of Diet Doctor fame and I developed this or, with his Diet Doctor team, developed this Hava app, H-A-V-A. You can check out the website at hava.co. There’s an app on the Google Play Store and on the App Store for iPhones. It’s basically an app that just calculates satiety per calorie of foods, and it’s looking at things like protein percent, energy density, fiber fraction, and hedonic factors. Basically, you put in your extra lean ground beef and you’ve got an 80 out of 100, spectacular, and then a cookie is literally a zero because the hedonic factors are just going to make you eat a ton of them for no protein, water, fiber, or these tiny calories.

It’s just a very interesting way of looking at your diet from a qualitative point of view instead of a quantitative point of view. You basically take pictures of everything you eat; it all gets tracked; you’re looking at the satiety score; you’re looking at protein. There are two things that the app is trying to encourage you to do. Number one: eat enough protein. Number two, keep the satiety score in a good range. That’s basically lower energy density for carbs and fat. If you’re eating lots of protein and then fruits and vegetables, you’re going to do great. If you’re just eating cookies, you’re going to do horrible.

I think it’s especially helpful for somebody who just doesn’t know all this stuff. You and I walk into the grocery store and just glance at the food and the nutrition label, and boom, it’s like the matrix. We can see exactly what all the macros are, exactly what they’re going to do long-term, and exactly what the satiety per calorie is. It’s almost intuitive at this point. But that’s a skill that you have to learn, and most people just have no idea. This app just takes all this complex nutritional information, makes it super simple, and dials it down to one number. I think it’s pretty cool. People can check it out and see what they think.

It’s been great working with Dr. Eenfeldt. He’s awesome, and his whole team is awesome.

Dr. Gabrielle Lyon [1:21:15]

And very tall.

Dr. Ted Naiman [1:21:16]

Super tall. Holy cow, that guy is tall. He’s 6’, 7′, or something? I’m 5’10”, but I feel so short every time I meet Dr. Eenfeldt. He’s just really tall.

Dr. Gabrielle Lyon [1:21:29]

Dr. Ted Naiman, thank you so much for coming on the show. I really appreciate all the work that you’re doing. If you guys don’t follow Ted, you definitely should. I will link to all of his stuff. His Twitter is wonderful. His website, his Instagram, you name it, I’m going to put it here. Again, thank you so much for your time, and I am counting you in on the muscle-centric medicine board. Thank you so much.

Dr. Ted Naiman [unclear 1:21:53]

Awesome. Thank you.

Dr. Gabrielle Lyon [1:21:56]

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