2:37
You grew up in Long Island. And then where did you do your training? So I did my undergraduate at Vasser College and I’ll just take a very brief pause there

2:46
to mention two things about Vassor. One is that it’s it’s a place really of spirited open-mindedness.

2:52
And so I really learned to be open-minded and to think about things wildly. And I took a course as a

3:00
sophomore called human emotion and motivation. And in it we studied the work of Stanley Shaker. It was built around his work who was a psychology

3:09
professor at Columbia at the time and uh he had a book called emotion, obesity and crime in which he tied those ideas

3:17
together and I always admired his experimental approach. It was very novel and creative and so that got me hooked

3:24
into obesity research. Um I just was that was the awe, the wonder, the joy,

3:29
the thrill of discovery was obesity um and when was this was this in because obesity early 1980s.

3:37
Okay. So in the 80s so this was right when the obesity epidemic probably started taking shape and had a name at least was perceived to be taking shape.

3:45
Oh interesting. Okay.

3:46
It was taking shape a few hundred years earlier at least.

3:49
Um so anyway I got hooked in that. The other thing about Vassor was is very focused on writing. So um I wrote lots

3:58
and lots of papers and every course I took I had to write a paper and so I found that it was easier if I could

4:05
write a paper on the same topic but from a different angle and so when I took physiologic psychology I’d write from a

4:13
phys about obesity from a physiologic angle and when I took developmental I’d write from a developmental angle and I learned that you not only could address

4:21
obesity from all those different perspectives but in fact you almost had to if you didn’t address it from economic, genetic, psychological,

4:30
developmental, physiological,

4:32
nutritional, and so on, you didn’t have a full grasp. And so that to me was always thrilling. And from there on I

4:39
was in. And so that’s how I I sort of got into obesity. And the science part to sort of skeptical part, I think that’s just in me.

4:49
Um, do you have siblings? I do. And who wins the fights? Obviously you.

4:54
Uh she’s pretty smart and tough. So um we don’t fight too often when they do their d when we do their doozies.

5:03
Okay. Um and you just have a sister. Yep.

5:06
You studied um and then when you finished you you did four years and then you did advanced training.

5:13
So I did my four years at Vasser as an undergraduate. Then I took a year off to work with children in uh um clinical

5:22
settings. And then I went to Hofra to get my PhD. Got my PhD in clinical and school psychology. Went in with the

5:30
expectation that I was going to be a clinician. Even in high school, I knew I was going to be a psychologist. And I never waver from that. But what that meant changed very radically over time.

5:40
And I thought I was mainly going to be a clinician. And I’d talk to people and we’d do talk and cure. and I’d be like some psychologist in an Alfred Hitchcock

5:49
movie and I’d figure out the puzzle and everybody be happy. Um, and I quickly realized that that wasn’t me. And while

5:58
I liked clinical work a little and I was okay at it, I didn’t like it a lot and I wasn’t great at it. What I liked a lot

6:06
was the research. And my professors started calling me aside, the ones who liked me, and said, you know, you think and write like a researcher.

6:17
You’re good at this. You should pursue this. And my reaction was, I’m liking this. And never look back.

6:25
That is I, you know, I didn’t know that. I don’t know if that’s public knowledge.

6:28
I don’t think people realize that you studied psychology and were very interested in behavior. I mean, I’m assuming it was the behavioral aspect.

6:35
Sure. Um and also you spend a lot of time examining evidence. Yes.

6:42
And it’s it’s unusual because there’s um what I think is very unique from your perspective is that there’s the science

6:51
or the truth because I want to know if you think that there’s sc there’s truth in science and then there’s the why people a perceive themselves as experts

7:00
b put out um and again I’m just uh choosing things like large uh statements

7:08
based on epidemiology and we see this proliferation of information and there’s got to be a psychological component. So there’s the science aspect and then the

7:17
psychological component as to what the contribution is and why it’s even happening in that way.

7:23
Sure. Um there’s there’s so many aspects to nutrition and obesity and exercise um

7:31
that are at the intersection of values and empirical facts and epistemology.

7:41
What do we really know? How do we know it? Um, so there are things that are knowable and derable from science and there are things that are not knowable

7:49
or not derable from science and they can all be important and the things that are knowable in

7:56
principle and derable from science are sometimes things I think we think we know like drinking eight glasses of water.

8:05
Right? So there there’s many different varieties of of this sort of pseudo knowledge or false knowledge or presumed

8:12
knowledge and they range from things that are grandfathered down very innocently. You know, most people don’t sort of, you know, have some stake in water that they’re trying to promote.

8:23
It’s just been handed down and it sounded good and nobody stopped to question it. And that’s one. And then there are others where people have these very passionate beliefs and it comes

8:32
from their sort of moral system or their group identity or their tribal identity or their need their their need for

8:40
psychological or social superiority or their economic interests. You know,

8:46
there’s so many interests that drive people, I think, to push an agenda. Um,

8:50
sometimes knowingly, sometimes not knowingly, uh, that either goes beyond what we know or in some cases is just simply false.

8:59
Um, and I think there’s a great deal of that. And I think it tends to work better in or not work better. It tends to people tend to get away with it more,

9:08
ends to propagate more in fields like nutrition because it’s about food. It’s about

9:15
everyday experience. And many people think they’re experts, feel like they’re experts because they have everyday

9:23
experience with food. Most of us eat every day. Most of us have eaten all of our lives. Um, we’ve eaten in many

9:32
circumstances and you kind of feel like that makes you an expert. Um, we all have a body weight. We almost all know our body weights approximately.

9:42
And so it’s it’s not uncommon to be, you know, in any kind of setting and have somebody who has never studied obesity,

9:49
who’s never studied nutrition, who’s never read a paper on any of these topics give you their very strong and

9:56
convicted opinion about some diet or some cause of obesity or what have you. Do you think there’s danger in that?

10:04
Oh, sure. I think it misleads people tremendously. It wastes huge amounts of time, wastes huge amounts of resources.

10:11
Every time you’re you’re telling somebody to do something that’s inert, let’s forget even that it’s harmful,

10:17
maybe harmful, it’s just inert. You’re distracting them from potentially doing the thing that might be helpful. Every

10:25
time you say to a school superintendent, a mayor, a governor, etc., invest in this.

10:36
you’re saying don’t invest in that. Of course, that hurts if if we’re basing those judgments on erroneous information.

10:43
When did you start noticing um that things were misaligned?

10:50
You know, it’s interesting. I started noticing this as an undergraduate. Uh but what I saw as misaligned

10:58
has evolved over time, which as it should because in some cases the the information out there changed. some

11:05
cases I got educated. Um so if you had asked me as an undergraduate and even as

11:11
a graduate student um do I believe that persons with obesity

11:18
eat more calories on average than persons without obesity? I would say surprisingly no they don’t. Um and if you said David this doesn’t make sense.

11:29
You know they’re bigger. They must eat more calories. I would have said, “Well,

11:32
I’m sorry. You you must be a bigot because you know that’s not what the data show.” And I can show you dozens of

11:40
studies of people who over and over report that they eat less when that among obese people, they report eating

11:48
less than non-obese people. I can show you that parents of obese children report that their children eat less. I can show you that observations in

11:56
restaurants done surreptitiously by researchers show people in the restaurant who have obesity are eating less than a and I’d say so you’re just

12:05
wrong. You just don’t know the data. And then doubly labeled water came around and I

12:12
learned what it was and I studied it and I said I guess I was wrong and I changed my mind. So that’s an example.

12:21
Okay. And um just really quickly, doubly labeled water is a way. What did you learn? Um so they use it in research. It

12:28
allows you to trace, how would you explain it? Um various outcomes.

12:33
Sure. Doubly labeled water is is you know water is oxygen and hydrogen. Um and it’s made of um isotopically labeled

12:43
or different hydrogen and oxygen. So it’s doubly labeled.

12:47
Yeah. And without going into the details of it, you give somebody a drink of this water. It equilibrates through the body.

12:55
You then later collect the urine sample.

12:57
You look at the differential rates of excretion of the two isotopes. And from there, you’re able to figure out how much energy was expended because as

13:05
Lavoisier said in French, but the translation is respiration is combustion. So if you know how much

13:14
somebody’s combusting, you know this oxygen, you know the respiration, you know the energy expenditure. So if I know that a

13:22
person expended X calories and I know that a good oldfashioned law of thermodynamics that matter and energy

13:30
can neither be created nor destroyed but only converted.

13:33
Then I can say if your body composition didn’t change, if your body energy stores didn’t change and X went out,

13:43
then X must have to come in.

13:45
If your body composition did change, I can subtract the change. And now I know how much energy you took in. And I know

13:52
it without having to ask you. And it turns out that people don’t accurately report their food intake, their energy

13:59
intake on average. And the bias, the discrepancies are not random. So more

14:06
obese people tend to under reportport their energy intake more and their their age, sex, race, gender differences, etc.

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15:23
Are there And I just wanted to ask because again doubly labeled water is used in research not typically like we don’t use it in clinic. Um uh it allows things to be standardized.

15:35
Um so there has been decades of nutrition research, obesity, lots of myths. Is there anything that you think

15:43
that we’ve gotten really really wrong that just stand out like wow uh we missed you know X Y and Z? Oh I mean the

15:52
list is huge. Um I think one of the things we’ve gotten really wrong which

15:59
is more speculative on my part. Some of the other things I could mention are less speculative. This one I think is interesting although speculative. I

16:07
think one of the biggest things we’ve gotten wrong, especially in the last couple of decades,

16:12
is this implicit notion that there is a diet, there is a way of eating that for most people, the vast majority,

16:24
if they ate this way, they would achieve a desirable body weight without having

16:32
to explicitly think about restricting their calories. and feeling deprived.

16:39
And I think in the current society,

16:42
unless you are on a drug that makes you feel differently, which now we do have around this, I think that’s a fictitious fantasy.

16:52
Meaning that what I’m hearing you say is that there’s no perfect diet for a particular um body composition outcome. that

17:01
there’s uh and please correct me if I’m wrong that there’s multiple ways to get to one outcome.

17:07
No. Okay, tell me what I mean is that while there may be whether there’s multiple ways or one way

17:15
that if the outcome is a certain weight that for probably somewhere in the neighborhood of 2/3 of the US population

17:25
that there is no way of eating that will have them achieve that weight without

17:32
any conscious attempt to control energy intake and without any feelings of restriction.

17:39
I see. And so as opposed to what we hear in the social media landscape that if you’re on this grapefruit diet, you’ll never be hungry again. You mean those kind of fat?

17:48
Just eat between this time and this time. Just eat whole fruits and vegetables. Just eat high volume. Just eat low carb.

17:56
Just eat low fat. Uh just eat all natural foods. Only eat things your grandmother would have known. Don’t eat ultrarocessed.

18:04
that in the short term any of these may be helpful. Even in the long term, some of those enjoiners may be helpful. But

18:13
the idea that if I put a plate of food in front of you and I say, “Look, I altered this food in some way and

18:20
Gabrielle ate less than she ate in the other condition and I didn’t have to tell her to eat less. She just chose to eat less.

18:28
Therefore, if I have people eat like this forever,

18:33
they’ll do fine.” Well, there’s a number of assumptions in there. The first one is if I tell Gabrielle to continue to eat like this. If I say uh you need to

18:41
have three times as much broccoli on the plate as meat or something that first of all that will be making that change will

18:48
be any easier than the change of just eating less, right? Soon you may say,

18:53
“I’m sick of putting three times the broccoli on my plate or only oneird the meat or whatever it is.” The second is

19:00
that you won’t feel deprived when you’re doing that. further down the road that you’ll be able to stick with that. Uh

19:07
these are all assumptions and I think there is not evidence for those assumptions and I think that’s important because what it does it’s back to the

19:15
idea of inert information. If we keep saying to people this will help you this will help you and either they don’t help

19:22
at all or they help a very small amount then the person but I’m doing this I’m I’m doing all the good stuff. I’m eating the fruits and vegetables. I’m not eating after 10 p.m. I’m And you say,

19:33
“Yeah, yeah, but you know what? You’re not eating less.” And eating less energy is the big mover.

19:45
And guess what? You might feel uncomfortable.

19:50
Do you think that there is that part of the landscape is um dancing around this idea of just human discomfort?

19:58
Yes. And I think especially for children. So I think when the adult comes in for clinical treatment, that

20:06
adult has volunteered. I want clinical treatment. I want help losing weight.

20:10
They’re an adult. I think people are a little bit more comfortable the the provider and saying, “Yeah, you might

20:17
have some discomfort.” Again, especially if you’re not on a drug that’s taking that discomfort away or reducing it. Um,

20:24
let us help you get over that discomfort. let us help you combat it, not pretend it’s not going to be there.

20:31
Whereas, when you go into the public health setting, the school setting, the the family setting, and you’re dealing with the children, people just seem

20:40
reluctant to say that. They just seem reluctant to say, “Guess what? If you want to live in this world and you don’t want an elevated weight, and if you’re

20:48
like, it’s probably about a third for whom that is true, right? You just eat what you want and they don’t have an elevated weight. But for about twothirds, that’s not true. You may just have to accept
there’s some discomfort.

20:59
And it’s interesting to me that we seem to accept this in other ways, right?

21:03
Imagine your four-year-old is sent home from preschool with a note. Little uh so and so. Leo, I have a four-year-old. Yeah.

21:11
Little Leo bit another kid or punched another kid.

21:14
And you say, “Leo, what happened?” Leo says, “Well, the other kid did this and it made me angry.” Now, what you could say to Leo is, “I’m going to give you a

21:23
number of techniques to never feel angry and then everything will be okay.” Well,

21:30
that’s not very realistic. If Leo lives in a world I live in, sometimes people are going to do annoying things and Leo’s going to feel like punching him.

21:37
Sometimes I feel like punching people,

21:39
but I don’t But not on this podcast. Not yet. I don’t punch people for many reasons.

21:44
One of which is I don’t want to be punched back. Another is not right. And others I don’t want to go to jail. Um,

21:49
and so good reasons, reasonable.

21:51
And so I say to myself, if you want to live in this world and not go to jail and be the person you want to be and yada yada,

22:01
you just can’t punch people when you get angry at them. And you will be unsatisfied, David. Sometimes that’s the way it goes. You accept that. So we

22:09
don’t get to punch everybody when we want to, and we’re not all that worked up about. And guess what? Sometimes you feel unsatisfied. So, here’s a way that despite the fact that you get angry,

22:20
Leo, to control yourself, not we’re not going to make it that you never get angry. Think about sexual impulses. We

22:30
don’t say, “Oh, here’s a little technique. If you just live this way,

22:33
you’ll never want to have sex with somebody you shouldn’t have sex with.”

22:37
We say, “You can’t have sex with everybody you want to have sex with under any circumstances. Um, control yourself.” And we all think that’s

22:46
normal. So why can’t we think that gee you can’t eat everything you want to eat um and always feel satisfied. Sometimes

22:55
you’ll feel a little unsatisfied. Let’s help you deal with that.

23:00
minutesIs and it’s I mean um probably some of that framing comes from this idea of thinking about people and psychology.

23:08
Do you think that um and I’ve heard you talk about childhood studies and really

23:14
it’s a lot of um clusters in groups and that we’ve gotten a lot of things wrong

23:22
about what we believe to be true about say childhood obesity or children’s health. Can you can you speak to that?

23:29
Sure. This is particularly in the area of of what uh specific techniques or programs have

23:37
or have not been shown to work or how much they work. Uh my colleagues and I authored a paper um Andrew Brown, my former mentor,

23:47
uh was the first author and I was the lead the senior author on that talking about ways to avoid exaggeration in the childhood obesity intervention world.

23:59
meaning what?

24:00
And it was a way of trying to guide editors and authors and readers of

24:07
papers in saying these are many things that are done again intentionally or unintentionally that lead to the

24:15
sperception that a treatment was more effective than it really was shown to be. And we talk about things like

24:23
inaccurate incorrect statistical analyses of multiple types and I won’t go through all of them here. One particular I will mention is called uh

24:31
the analysis of cluster randomized trials. So these are trials in which instead of randomly assigning each individual person to a treatment you

24:41
assign clusters of people or groups often they’re classrooms or clinics or towns or schools. So you assign a whole

24:49
school at once and you might have 10 schools let’s say. And it turns out that the statistics needed to analyze those

24:56
are very different than the statistics needed to analyze when you individually randomize. And they those cluster

25:04
randomized trials if analyzed correctly have much lower statistical power than all other things being equal and

25:12
individually randomized study. And so people the investigators often don’t like that because less statistical power means less chance of saying Eureka I

25:21
found something. And so often they analyze them without taking without the correct analysis without taking the

25:29
clustering into account. We, my group and I tend to spot those often but not always and then we try to get them

25:36
corrected if they need to be and we’ve as a result we’ve had several papers corrected several retracted meaning the

25:44
editors have said this paper is not valid we need to take it out. When you think about that and you look at the evidence, not for clinical treatment,

25:56
but for community based treatment,

25:58
schools, communities, these kinds of things, uh, for childhood obesity treatment or prevention with things like mild physical activity or nutrition,

26:08
educational schools, examples like that.

26:11
Many of them that are purported to be successful even when you look at evidence and somebody summarizes it most of the time they come up when you

26:19
summarize all the studies as essentially no effect a few of the meta analyses say

26:26
small effect very small but small now what if I said let’s take those meta analyses that combine many studies seem

26:34
very small effect on average and I said x% of the studies in there are completely invalid that show purported

26:41
to show an effect did it remove those or erase the data and write the correct

26:48
data in would even very small become zero. And so these are examples of where I think we’ve we’ve misled the public.

26:59
We have and continue to misspend funds on methods that don’t work when we could be investing it either in research to

27:07
find methods that do or in in some methods we have that do. Um we mislead the public and that’s unfair. Give false

27:15
hope. Um uh we distract from doing things that might work. So I think these are pretty serious problems. I think the

27:22
pretty serious breaches and at best um competence and at worst integrity among some researchers

27:30
and um I was looking at some data the amount so I did my fellowship at Wu and

27:37
I finished that 2015 AI I did it I did in Sam Klein’s lab do you know Sam Klein of course

27:45
um and I did a a combination of geriatrics and nutritional sciences we were not AI wasn’t there. I’d have to go

27:53
to library and you know maybe I was looking at PubMed. I there was not there was not the volume of information

28:02
and papers that are coming out that are now being written by AI. Um and what do I mean by that is I was looking at the

28:10
so let’s say there is a a claim that’s made and maybe it’s based on epidemiology. those that eat red meat are more likely to have colon cancer or

28:18
cancer or higher mortality and let’s just say and then there are multiple

28:26
studi studies epidemiology or however they make it that now uh curate this knowledge maybe it’s from NHANES or some

28:33
large data set and now instead of investigators writing and analyzing the data it’s all done through AI and the

28:40
amount and the volume of now lowquality studies seems to dilute good science but also it’s almost as if it’s um advertising.

28:52
It’s like scientific advertising.

28:54
Yes. I’ve often felt that the field many fields but especially the field of nutrition epidemiology

29:03
is often um research and I’m intentionally using the word research and not science. research as idea advertisement.

29:13
And by that I mean the researcher has an idea. They think it’s a a good idea or an idea they want other people to believe or pay attention to.

29:23
And a way of getting people to believe it or pay attention to it is to put some data out that seem to support it. And so

29:30
a study is done not for the purpose of learning something which might make it science

29:37
but it’s done for the purpose of reinforcing beliefs.

29:43
Um and so there might be some real research. They may have really collected data but it’s not data collected with

29:50
the idea of advancing knowledge. Um it’s just to reinforce an existing belief.

29:56
Are you seeing that? I was just trying to pull up the um again I don’t have my phone on me but I was I was just looking at it was almost

30:04
I don’t know in this small uh time frame it was like 4,000 new studies coming out on this one topic which again it’s not

30:13
are you seeing that that there people are using AI to put out junk research and then if you wanted to create a narrative and you want to be really

30:20
smart about creating a narrative you can cherrypick any of these um studies and say oh but But look, this is this proves that and then it further dilutes the the scientific integrity.

30:32
You said something else really interesting. Um science versus trust. Do we need to trust people will say well trust trust the science. Do we need to trust the science?

30:42
No. Um not because one shouldn’t. Well,

30:48
no. Because science is fundamentally not about trust at a deep level. The very

30:55
idea of science is that it gets its privileged role in talking about the

31:02
tate of the world by collecting data and the methods by which data are collected

31:10
and the logic connecting those data and methods to conclusions. That’s it.

31:15
Right? Science is the data, the methods used to collect the data which give them their probative value and the logic connecting the data and methods to

31:23
conclusions. Anything else is not science. In order for it to be meaningful uh assessment of science, one

31:31
needs to look at the data and look at the methods and think about them and sometimes debate them and ask questions about them and the same thing for the logic. And that’s not trust, right? So,

31:41
if you say to me, David, I just did this study, um, and I found that eating this causes that, it’s not that I don’t like you or don’t trust you or, you know,

31:50
don’t trust you as a person, but I’m going to ask some questions. What dose did you use? How did you administer it? How long did you study these people for?

31:58
How did you measure the outcome? And you could be perfectly wonderful, smart

32:04
person of great integrity. Um, and I say, you know, the way you did that,

32:11
Gail, um, you destroyed the, uh,

32:14
nutrient because you heated the thing and you didn’t know that. Um, and so I don’t think your result is valid. Um,

32:21
that doesn’t mean I trust you as a person, but I don’t put my trust in the science. I put my trust in the methods.

32:28
So, we need to go through the methods.

32:31
There’s a narrative now at a more social level that we have an anti-science movement in this country, maybe the world, and that trust in science is way down. Neither of those things are true,

32:42
as far as I can tell, and my colleagues and I have written papers about this.

32:47
Trust in science is down a little bit in this country, but not a lot. Trust in some things, Congress, the media, way,

32:54
way down. Science relatively steady. military relatively

33:01
teady. Um, nurses, that’s good. People like nurses, they trust nurses. Um, what

33:08
it seems to be is not a distrust in science or an anti-science movement.

33:13
Pick your whoever you think gives the craziest information about health and so on. And usually they talk about

33:20
molecules and substances. They might even mention something about data and evidence. So, it’s not that they’re not talking about science. They’re not

33:29
saying demons told me this and that’s why I believe this.

33:35
But you and I might look at and say but that’s erroneous science or weak science or bad science or pseudocience or

33:43
something or non-science that you think is science.

33:47
The trust issue is not trust in science as a process. The trust issue is trust in individual

33:55
communicators of scientific purported scientific information or trust in particular

34:03
tudies or facts. If you ask me, do I trust science as a process? Absolutely.

34:08
I mean, that’s totally who I am. I think it’s the best and only really vertical way of obtaining knowledge about the objective world. Um but if you said to

34:17
me, do you trust a lot of the science that comes out around um dietary supplements?

34:27
No.

34:28
Um if you said to me, do you trust a lot of the science that comes out of academic researchers looking at uh

34:37
intervention effects on obesity in children? No, I trust science, but I don’t trust those studies because I

34:45
don’t think they’ve done very well. You said to me, do you trust the results on pharmaceuticals

34:52
in the last 20 years, not going back more than 20? In the last 20 years, that

34:59
are registered randomized control trials funded and conducted by pharmaceutical companies and submitted to the FDA. Yes,

35:09
I think those are some of the most rigorous studies in the world.

35:12
People have that wrong. They there is this false perception. And you know, one of the reasons I wanted to have you on was specifically to address this is that we are now in a new landscape.

35:23
Um,

35:24
you know, as a career scientist, you’ve had to evolve to ask these questions.

35:28
It’s a new landscape with AI, social media, the velocity at which information spreads.

35:35
I would say both good and bad, but it seems like it skews mostly um overblown and um large claims are made on

35:43
lowquality studies that then impact populations. Would you say that that’s accurate? Yes, I would.

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37:16
and so you’ve really stepped in to say,

37:19
okay, well, like for example, what’s the evidence if we’re told to drink eight glasses of water? Yet, I’ve heard that,

37:26
you’ve heard it, and we continue to repeat it. I tell my kids to do that,

37:29
but there is, is there evidence for that?

37:32
There is not, to my knowledge, evidence for that particular one. I think what often happens and again sometimes it’s very innocent is um there are layers you

37:42
might say of digging as a scientist uh or as an individual who respects science

37:51
even if one is not in the moment a scientist right so I think any of us can be scientists at times and not be scientists at other times regardless of

37:59
whether you’re employed as a scientist um I I look at myself as an example if you said to me, “Do you think that this

38:07
particular medicine you take, David, is safe and effective?” Um, let’s just say effective. We’ll put safe aside for the

38:15
moment. I would say yes. So, what’s your basis for that? You know, is it scientific? I said, “Well, sort of.” You

38:22
know, if you said to me, “Have you actually pulled up all the raw data on that drug and examined it yourself?” No.

38:31
So why do you trust why do you think that that’s important? Well, because the FDA said so. Well, why do so mean you

38:39
trust the FDA? Yes. Why do I trust the FDA? And why do I not trust maybe

38:45
somebody else? I trust the FDA because I know how they evaluate drugs and they

38:53
evaluate drugs in a very rigorous scientific way.

38:58
Um, who knows what the future holds, but at least up until recently, I was I trust the FDA because I understand their

39:05
processes and so there is some trust that they execute their pro their process as I believe they execute their

39:12
process. But assuming that then that’s there but another level is have I looked at it myself yet one up from I trust the

39:21
FDA I know their processes. Well, I’ve heard this from lots of mainstream experts for everyday life. That’s

39:29
probably a good signal. Said, “Do I really know it?” No.

39:33
And is it because there’s a lot of regurgitation of information that is not accurate?

39:38
That’s the grandfathering in. And that’s where we have to go back and dig periodically. I I I caught myself in one of these very recently where um you know

39:47
listening to many podcasters um who talk about um growing muscle and reading some things uh but reading at

39:56
the mountain tops in other words not going back to every original paper but reading sort of summaries listening to summaries I would say things like well the most important thing is how much

40:04
resistance training you do in the volume um and then the second you know might be how much calories and a third might be how much protein And then somewhere down below that is,

40:14
you know, very important, but probably a little small was sleep. And I stopped myself a few days ago and I said, “What

40:22
do you really know about sleep? How much sleep is needed? How big is the effect?” So I do a little search.

40:30
There’s almost no randomized controlled trials randomly assigning people to different

40:38
amounts or types of sleep while re undergoing resistance training and

40:45
looking at the causal effects on skeletal muscle strength quality or hypertrophy.

40:53
That doesn’t mean sleep’s not important. just means, oh, I guess I don’t know.

41:01
And it’s a it’s a really good point. Are there things, again, obviously read all the time, and I would encourage everyone to sign up for Obesity and Energetics,

41:08
swhich I’ve been getting for years. It’s a newsletter um uh so well curated,

41:14
really extraordinary. So, we’ll put a link to that and send that out.

41:16
Completely free. Just type in, you’re good to go.

41:20
It’s amazing. Uh basically it’ll have headlines, null findings, scientific, you know, randomized control trials,

41:27
it’ll have all kind, it’s just so well done. Um you know, as you think about the landscape, are there things where you were have been pleasantly surprised?

41:36
So as we think about like say obesity where you hear this medication works and this is the outcome. Are there trends or

41:45
statements that you’re like okay I think one two and three are really really good and they’re on to something whereas opposed to drink more water sleep more

41:53
and I don’t know meditate in the sunlight these are out. Yeah,

41:59
the most obvious ones are uh the advances we’ve had in medical treatments in the last 20 years. And so it’s the

42:08
the rise of beriatric surgery and the refinement of it and the recognition of its effects.

42:14
I was not expecting that the buriatric surgery because now with the GOPs well and then subsequently the strong pharmaceuticals

42:24
which I think many people including me feel will likely won’t eliminate beriatric surgery but will likely

42:33
radically mitigate its use because what we’ve got is a treatment that’s or treatments that at least at

42:41
present even if they’re not quite as powerful buriatric surgery. They’re getting close and you can turn them off, right? You can’t say tomorrow, you know, I don’t,

42:52
after all, I don’t think I like this buriatric surgery so much. Switch it off. Doesn’t work that way, right? But you could say, I don’t like taking this

43:00
drug. I’m going to stop tomorrow. Um, so I think that we’ve got some tremendous growth there.

43:08
I remember when leptin was first discovered, 1994 I think and very

43:15
shortly thereafter one of the group and it was the Cambridge group um

43:23
came out with a paper showing treatment of I forget if it was just one one member of the family or a subset of a

43:31
family who had very very rare homozygous inactivating mutations for leptin production

43:39
and they gave him exogenous leptin and great things happened clinically and I was so envious of them of the

43:48
research group not because they got their paper in nature and I mean everyone wants their paper in nature that was great but because they were

43:56
probably the first people in history to be able to honestly look a patient with obesity in the eye and say I know why

44:06
you’re obese and this was the leptin resistance um hypothesis is that this was the the inability to make leptin.

44:14
So leptin is a hormone produced from adiposites that helps regulate uh hunger, right? Helps individuals stay

44:22
lean um regulates long-term energy balance,

44:25
right? how exactly what it does sort of at you might say within the normal physiologic range among most of us who

44:33
do make some leptin is I think still a little bit you know the jury is still loud a little bit on that totally totally agree with you we used

44:41
to just a side note early on in my practice we used to measure leptin adopeneectin and look at the ratios and we’re like you know after a period of

44:50
time what’s the evidence of actually looking at this and does this just relate to obesity and and what is the point what is the information that we

44:57
are now getting with this and and how are we furthering patients That’s right.

45:01
health and and quite frankly there isn’t unless there’s some genetic mutation. I I can’t say that there’s a reason to be doing that.

45:08
Exactly. So there are many things that within the sort of you might call the normal observed physiologic range may

45:15
not play such a big role or play a uh the role we expect them to but when you get them out of the physiologic range

45:22
then they can be huge. So GLP1 is an example within the normal physiologic range of what we endogenously produce. I

45:31
think there’s debate about this but question is how important is that? How much difference does it make? But when you give a GLP-1 agonist that has a long

45:40
halflife now you’re getting to super physiologic ranges. In the case of a leptin deficient human, you’re getting into

45:48
subphysiologic, right? You’re having zero leptin, not low leptin.

45:53
And when you get zero leptin, then big things happen. So zero leptin,

46:00
you get hyperphasia. You get enormous hunger and excessive food intake and a very fatty body composition and other

46:08
but super rare, doesn’t really happen. probably a few dozen people on the planet.

46:15
Um, and but anyway, some of those people were identified by the Cambridge group and uh, as I said, they were the first

46:24
providers ever to be able to look a patient in the eye and say, “I not only know why you have obesity,

46:31
I know what to do about it, I know how to fix it.” And say it honestly. Lots of people could say it. Lots of people

46:39
still say it. They were the first people who could say it honestly and that was tremendously I was very envious

46:47
of that ability until then since then until relatively recently we haven’t been able to make similar kinds of

46:55
statements to many people now with the new anti-obesity drugs I don’t think we can necessarily say and now I know why

47:03
ou have obesity that part I still think is a little bit unclear in many cases But I think what we can say is we do know how to help you.

47:14
Do would you say comfortably that we now have a treatment in essence for the majority 80 plus% of obesity and also even type two diabetes.

47:26
Certainly for obesity and type 2 diabetes I’d say that’s you know I’m not going to give an exact number but that’s in the spirit of of things that’s in the

47:35
realm of of how I would answer. I think we always want more information. We will never have complete information.

47:43
Somewhere between where are we today and some hypothetical perfect complete information that we will never get to.

47:50
Well, we need a little more and we’ll get a little more over time. But I think we’re going to start to get to the time where we’re going to flip the question or at least we should flip the question

47:58
around. And I realize what I’m about to say will be controversial, but I think it makes sense.

48:03
There are many things for which we take for granted that just about everybody

48:10
should do them right even though these things are not exactly natural and we didn’t always do them but there comes a

48:17
point where people say yeah yeah of course everybody should do that unless there’s some very rare exception. So should you wash your hands before you eat or after you use the restroom? Yes.

48:30
Should you use soap? But it’s not natural and we didn’t all evolve having bars of soap with us. That’s okay. You

48:38
should still wash your hands. And we think this is good for almost everybody.

48:42
And you might say, but is there some rare individual has some skin disorder that maybe they shouldn’t use? Maybe.

48:49
But that’s the exception. The rule is should wash hands with soap. The rule is you should brush your teeth. And maybe there’s some people who shouldn’t brush

48:57
their teeth. Has some strange gum disease.

49:00
We won’t get into vaccines because there’s a lot of difference opinion on that. The point I was making is that you take some things like toothbrushing and

49:08
handwashing uh and so on and the norms of course almost everybody should do that and the

49:15
the the real question is not who are the rare people who should it’s who are the rare people who maybe shouldn’t. Great point.

49:21
Okay. Now, let’s take taking a statin, an SGLT2 inhibitor, a GLP-1 agonist,

49:31
a a an anti-hypertensive drug that’s known to be very mild and been studied for a very long time.

49:39
And I think we are at the point where we should be starting to think about flipping the question from who should get it to who should it.

49:51
I don’t think that’s controversial at all. I think that’s right on the money.

49:54
And I think that um and I’m curious to your perspective how that informs our dietary guidelines because we, you know,

50:02
we talk about say for example reducing saturated fat to 10% or less of

50:08
calories. Well, okay. So, for some people that might be really relevant, but it’s

50:16
not for who that’s relevant. It’s it’s who that’s not relevant for. So, and let me say this a different way. If 70 if I

50:25
don’t know 20% of the population actually has a problem with LDL cholesterol that is impacted by saturated fat, then that means that 80%

50:34
of people might not necessarily have an issue with saturated fat and that could be one aspect or even triglycerides.

50:43
What if you know I think it’s roughly the number is low. I’d have to look, but it 20% or less actually have elevated triglycerides. That to me is a

50:51
carbohydrate problem. And then the the next question would be, well, what percentage of people actually have to

50:58
restrict carbohydrates versus those that don’t? But we make these recommendations for perhaps the few, not the many. I I’m curious as to your perspective.

51:09
Hopefully that made some sense, some semblance of sense.

51:12
I think there’s there’s multiple things embedded in what you’re asking. I think one is do we make recommendations for the few or the many? The the and the

51:21
answer is sometimes we erroneously I think make them for the few rather than the many and we should flip that. I think another thing is what do we really

51:29
know about these particular things you’re talking about carbohydrate saturated fats and that’s a whole different can of worms. Um, and then I

51:38
think there’s this notion, this question of individual effects, and that is something my group and I are very interested in and we write a lot about.

51:49
I think there’s an implicit assumption that we’re all very different. And, you know, the right diet for you is not the

51:56
same as the right diet for me. And while I think that’s intuitively very appealing idea uh and there’s almost certainly some truth in it,

52:08
it’s based on a lot of assumption. So the idea that we we all respond differently to things is usually not

52:15
demonstrated. It’s usually assumed. Even the well-meaning research-based clinician scientist who says, “Don’t

52:24
tell me this is not evidence-based. Look at my randomized control trial here.

52:28
Look at the fact that some people had huge reductions in body weight on this drug and some small or none or gained

52:36
weight. Look at the change in LDL cholesterol when I put people on this diet versus that diet. Look at how

52:44
variable it was. And they say, “You see great heterogeneity of response.” And I say, “No, I don’t see that. What I see is great heterogeneity of outcome. If

52:53
outcome equal response, I wouldn’t need control groups in studies.

52:58
And so outcome, so let’s pause there. That’s really important. Um, can you say that again? And because it’s a very important distinction.

53:06
So let’s say you and I both go on a weight loss drug. We’re in a clinical trial.

53:13
You lose 10 kilos. I lose zero kilos. The investigator comes along and says,

53:21
“Good responder, nonresponder.”

53:25
I say, “No, good outcome, not so good outcome.”

53:32
However, maybe what happened is the drug caused you to lose 5 kilos.

53:43
You happened to also get the flu during that time. and felt ill as heck. And that caused you to lose another 5 kilos.

53:53
Your total weight loss was 10 kilos, but only five was due to the drug. I lost zero kilos.

54:02
It turns out though that right before I went on the study,

54:08
I moved in next to a um doughnut shop. Bad move, friend. Bad move.

54:15
And I’m just loving it. And I’m eating donuts every day.

54:18
Long Island does, by the way, I would just say they’ve got some good food. There’s some good donuts over there.

54:22
And had I not been on the drug, I would have gained five kilos. So the donuts caused over complicate things. So

54:31
basically, we we can’t I mean, your point is well take Go ahead. I’ll let you finish, but your point is well taken. We basically there’s so much that we don’t we know less than we know.

54:42
Sure. The point is that the drug pulled me down five. The donuts pulled me up five. Yeah, you know, you integrated

54:49
zero. But in fact, you and I had exactly the same response. The drug caused each of us

54:57
to gain five less kilos or lose five more kilos than we otherwise would have done. But it’s hidden behind other

55:04
factors in our lives, the flu, the donuts.

55:07
The standardized randomized control trial doesn’t estimate that. It estimates the average effect. So, it’s not that it’s wrong when I say across

55:15
all people taking the drug, they lost 5 kilos more on average than people not taking the drug. The drug caused a 5 kilo weight loss on average. That’s true.

55:26
In that hypothetical I’ve given you, it caused exactly 5 kilo weight loss for both of us, but it’s not obvious. And so, that’s something we need to keep in

55:34
mind. Now there will be other times when there are situations even if the drug causes exactly a 5 kilo weight loss. Let

55:42
us just suppose for the moment that you were exactly 5 kilos above the

55:50
threshold for obesity and I was not I was

55:57
10 kilos above the threshold for obesity.

56:00
Now we express the outcome as did it make you obese or not obese. It made you go from obese to not obese. It made me go from obese to still obese.

56:11
Same weight loss, different outcome by measuring things differently. So now when you think of other thresholds, the threshold to have a heart attack, um,

56:20
right? It could be that something lowers my LDL cholesterol exactly the same amount as it lowers your LDL cholesterol, but my LDL cholesterol had

56:29
me up at the threshold of about to get a heart attack. Your LDL cholesterol, let’s say, was not at that threshold.

56:36
So, it it rescued me from the heart attack. It didn’t rescue you.

56:43
So what you know is your So you’ve mentioned your group a few times in your group is um uh very well known for

56:52
looking at evidence, statistical evidence and and I I don’t want to say policing but saying hey does this really show what this says that it shows and if

56:59
it doesn’t you guys have to to fix that and you’ve been doing this again for many years which um one makes you

57:07
popular in some groups and not and not so popular in other groups you know I I you’ve spent your entire career doing something that’s a bit uncomfortable. I

57:16
mean, unless that’s always been comfortable. I mean, you know, it’s still uncomfortable at times.

57:21
It’s um makes you different because it’s it’s not that it’s confrontational, but it’s like, hey, uh it’s accountability,

57:29
which is something that we’re we’re we’re lacking, I I think, in the scientific space. So, if someone is listening to this and their mind is

57:37
blown, so they’re scientists, they’re doctors, they’re going, “Oh, well, now I don’t really know what I think I know.”

57:42
Uh, you probably have that group. And then you also have people listening going, “Well, darn it. I have no idea

57:49
what to think and actually how to assess information. Um, because I don’t have

57:56
statistical rigor. I am dependent on um outsourcing those types of things while also having to make very real decisions for my family.

58:07
How what do people do? I think there’s different levels of knowledge and as I said I use the example of myself um one

58:15
of my heristics not my only one but one of my heristics is if the FDA has said

58:22
this pharmaceutical for people like me is reasonably safe and it’s effective.

58:31
That’s usually good enough for me to judge to make the judgment that for someone like me it’s effective and reasonably safe. I safety is a social judgment. Effectiveness is not.

58:42
Effectiveness is That’s an interesting statement. Safety is a social judgment.

58:47
So when I got out of the car today and walked into your area here, um there’s some risk I could have been hit by a bus.

58:56
Very low.

58:57
Very low. And so I made the judgment that it’s safe. maybe bad decorating,

59:01
but to get out of the car and walk across the street,

59:06
but it wasn’t zero. It was my social judgment that that risk was so low as to not it’d be worth thinking about, right?

59:14
But somebody else might feel differently. That’s a social judgment.

59:18
Risk is a scientific concept. Risk is probability, long range frequency.

59:25
Safety is a social judgment. So interesting.

59:30
Is it safe to go on a plane, to hang glide, to ride a bicycle, to ride a bicycle without a helmet, to get a vaccine? These are social judgments.

59:40
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And use the code lion for $100 off your bike. So as someone is making decisions for their family, I mean again so this

1:01:25
podcast the idea is we have transparent conversations and we have world-class experts on to discuss um social issues,

1:01:32
medical issues, just all of what is at the landscape because of the volume of noise. How someone listening to this let’s say I don’t know well hey guys

1:01:41
hope you’re listening to the podcast but if you’re not um say for example my dad who lives in Ecuador and he heard from I

1:01:49
don’t know Dr. or Brad who is on the internet saying that if you drink castor oil, you know, this has

1:01:58
been shown to, I don’t know, clear you immediately of worms or whatever it is.

1:02:03
How and all kidding aside, the decisions when you’re younger seem less impactful,

1:02:08
right? There’s a lot of like my four-year-old, okay, eat the Twinkie off the floor or, you know, eat the carrot that’s also been sitting in the yard for

1:02:16
5 days. They’re there’s like flexibility, right? they’re doing immune system push-ups or whatever. But as you

1:02:23
become more mature, so the post-menopausal woman who is confused about should she take calcium or not,

1:02:30
should she make the decision to um go on estrogen or not, these become real challenges and then the impact is much

1:02:38
more meaningful. How do they begin to make decisions in a noisy landscape? I think the important thing if if one

1:02:46
wants to be sort of rational and well the first question is do you need to be rational and scientific about it?

1:02:53
I would hate to argue with you and can you imagine R.J. So RJ the one of the producers here I mean really I wouldn’t would you ever you would never win you’d

1:03:00
be like oh I never thought about that going to be right about that. you know, the Nobel Laurad who’s now deceased,

1:03:06
Danny Conorman, talked about this in his book, Thinking Fast and Slow.

1:03:11
And he said, you know, it talks about regret and how do you avoid regret by,

1:03:15
you know, making some decision and then later saying, boy, why did I make that bad decision? And he said, here’s two different ways you can approach it. Um,

1:03:23
and I kind of like these uh because I’ve had some regrets and and in fact, I have less regret now because I use his method. Really?

1:03:30
Yeah. And um so first is to make a decision. Say I’m going to go with this either one one of two ways. I’m either

1:03:37
going to say I’m willing to be wrong and that’s okay and I’m going to randomly pick a path and I’m not going

1:03:46
to worry about it too much. And then if it turns out later that things go bad, I say it was random. You know what the heck? Give me an example. Give me an example.

1:03:54
I might say, “Look, I I don’t know if I should take this new job or that new job. I’m going to flip a coin. I just can’t decide.” And then,

1:04:03
by the way, I do want to talk about your new job. Okay, we’ll come back to that. Okay.

1:04:07
Um, and so then say, “Look, I didn’t have a, you know, real good way of deciding, so I flipped a coin and it’s

1:04:14
not on me. It was the coin.” The other way is is to say, just removing responsibility. Yeah. Essentially,

1:04:20
the other way is to say, “I don’t want to do it that way. This one’s important to me to get right. I’m going to study the heck out of this thing. I’m going to

1:04:28
turn over every stone to get every piece of critical information. I’m going to get experts to advise me. I’m going to

1:04:37
carefully integrate this. I’m going to ask multiple experts.

1:04:41
I’m going to think this through as carefully as I possibly can. I’m going to sleep on it. I’m not going to make a decision immediately.

1:04:47
And then I’m going to make the best decision I could possibly make at that time. Now, it may turn out that a year

1:04:55
later is a really bad decision or the not a bad decision, a decision that turned out to be really to have a really

1:05:02
bad consequence. And I’m going to say I made the best decision anyone could reasonably make knowing what I knew when

1:05:11
I made it. Knowing what I know today, I would make a different decision. But at the time I made it, it was the best,

1:05:18
most rational, intelligent decision that could be made.

1:05:22
So it’s not bad on me. So I still wish it hadn’t happened the bad thing but I don’t feel any guilt any remorse and

1:05:30
which is a lot of what we’ve read is about. So that those are different ways of sort of making decision you know of sort of saying where do you want to go with this and then I think you know more

1:05:39
generally if you say well look I I do care about this I don’t want it to be complete chance sometimes it might you know you might say I don’t know which

1:05:46
tie to wear today and which would make me look you know more more whatever I want to look in this setting flip a coin

1:05:53
then you might say well here’s no I’m going to go get surgery or not for this thing I think that one I want to think through a little bit um should I get get

1:06:01
a hip replacement? Should I whatever it is you want, you know, should I get plastic surgery for cosmetics? You want to think that through a little bit and

1:06:09
that’s where I think, you know, we sort of want to work your way down to uristics and your you mentioned about AI is is one great example. Uh I use AI a

1:06:17
lot for myself, but I use it in a very particular way, which is I use it as an information gatherer and integrator, but I don’t trust it explicit completely.

1:06:31
So, I use it not in exactly the same way, but not unlike I would use conversations with anybody else I might

1:06:38
have. If I talk to the Uber driver on the way over and I say, “What do you think of the best barbecue restaurants

1:06:45
in Houston and he or she tells me the ones they think?” I don’t immediately think those are the best and those are

1:06:52
the ones I will like the best, but I think that’s a good lead. Good lead. And then I might later say to you if I’m

1:07:00
looking for, hey, you’ve lived here longer. What do you think are the best barbecues? And if you say the same thing the Uber driver said, well, strengthen.

1:07:08
If you say some different ones, okay,

1:07:09
I’ve got some different ones. Then I might ask AI or, you know, Yelp or something. And so I think you start to integrate sources and then you’ll say,

1:07:18
how important is this? What if I get it wrong and I don’t pick the best? So like let’s say you’re choosing between vitamin D or amino acids and you go okay

1:07:27
well this isn’t that big of a a decision so I don’t care which vitamin D I choose then that takes very little effort cognitive load no big deal.

1:07:38
What’s what’s the likely cost of being wrong? So, um, that the likely harm of

1:07:48
taking a vitamin D supplement, as long as you don’t go crazy, which is about pretty low. Um, but over a lifetime, so for example,

1:07:56
like the whole protein conversation, I don’t know, I’ve been talking about protein for 20 years.

1:08:03
If you’re in your 20s and you get it wrong, and when I say get it wrong,

1:08:07
maybe you’re eating closer to a minimum or you choose to eat some kind of way.

1:08:13
You know, when I was in my 20s, I was uh vegan. And that’s just an example that might the consequences for the first 5

1:08:21
years or even seven might seem small not immediate but let’s say 30 years later

1:08:29
now um because I wasn’t able to assess those outcomes and you talk a lot about psychology humans are I don’t know

1:08:38
they’re creatures of habit if it’s kind of like if you’re wrong you stay wrong over long periods of time how

1:08:45
you know with the landscape if they people might not even know how danger it is dangerous it is to be wrong and so um

1:08:55
you know like do you obviously you’re in a whole different league you have obesity energetics you guys curate science but even then is are there

1:09:04
people that you go to that you trust that you would say hey for protein research I look to Don Layman for

1:09:13
highintensity interval research I look at Martin Gabbala I trust. Do you know what I mean? Like are there there ways in which you identify trust and that you

1:09:20
could potentially help teach R.J. um you know one of the producers to think about how he can curate more trust for let’s

1:09:29
say even something simple like parenting.

1:09:33
Absolutely. So there there’s no single source. I do go to a lot of podcasts. Uh yours. Um Huberman’s, Peter’s, Lane

1:09:43
Norton’s, uh Lane is still waiting to be on. Anyway,

1:09:47
Melissa Dobbins, uh and even though these names may sound um

1:09:55
lightweight or something, um they’re actually pretty good. I think the barbell medicine, Docu Lift. So, there are a number of of ones I go to, but even then, I take with a grain of salt.

1:10:06
Um, Sig Nutrition is another good one.

1:10:08
The Proof with Simon Hill, I don’t We’re definitely editing that out. I don’t agree with everything they say.

1:10:14
I don’t agree with everything you say and I’m sure you don’t agree with everything I say. That’s okay. I So, I don’t I don’t I’m being wrong.

1:10:20
I’m wrong all the time. I’m mom, two kids. I’m I’m wrong all the time. And it’s okay. So, um, but anyway,

1:10:29
long as long as you have people that,

1:10:31
you know, are smarter than you around you that say, “Hey, man, guess what, Don’s always like, no, Gabrielle, that’s not right.” Like,

1:10:38
that’s you sound like an idiot. That’s wrong. And then you go, “Okay.” You know,

1:10:42
I heard a funny uh statement somebody said recently. They said, “If you’re the smartest person in the room, you’re in the wrong room.” That’s right.

1:10:50
So, but why podcast? That’s interesting. So you’re a career scientist and podcasts probably haven’t been around for I mean

1:10:57
again the landscape for for podcast probably I don’t know I mean I suppose Joe Rogan’s been the longest but the scientific podcast I mean Andrew is a

1:11:06
friend he’s it’s probably I don’t know five a little over five maybe five to seven years not maybe not even that long

1:11:14
but for you it’s interesting um that you would go to listen because you understand have access to the data Uh,

1:11:22
what is it that you hope to um get from hearing?

1:11:26
So, I like them because, you know, I can listen to them while I’m while I’m eating dinner if if I’m back.

1:11:33
Uh, I can listen to them while I’m um out for a walk. So, it’s that it’s

1:11:39
entertaining. Um, but also it it’s a way of my getting exposed to things I wouldn’t know to ask about.

1:11:47
So,

1:11:48
interesting. You know, I can always go look up and say, “Oh, I’m wondering how much protein to eat and then start to look up how much protein to eat and say

1:11:55
or say, you know, oh, I’m wondering if you know this peptide is safe.” Well, I didn’t even know the peptide existed.

1:12:02
But now I Oh, that’s out there. Maybe I should look up whether that’s safe. Um,

1:12:08
so it exposes me to things that I just didn’t even know to ask about. They’re entertaining. Uh, but again, they’re my

1:12:15
first draft. They’re not my final decision unless again unless it’s very light. If I hear you say, “I like to make my ginger salad dressing this way.”

1:12:24
I might say, “Not a big risk. Maybe I’ll try it.” Uh but if you said, “This is my decision on surgery and I’m going to advise someone on surgery or make a

1:12:32
decision myself on surgery.” As no matter how much I respect and like you, I’m not stopping there.

1:12:38
Right now, I’m going to say, “Let me check the references she cited. if she signed it some let me go to another

1:12:46
podcast let me go to AI but when I do AI for this again first of all I don’t trust it

1:12:53
it’s my first take and I ask it very specific questions I don’t say should I eat more protein what I say is

1:13:01
yes no relying only on randomized controlled trials in the English language scientific

1:13:08
peer-reviewed literature summarize for me the results of efficacy of protein intake on these outcomes. Then summarize

1:13:17
the results of safety information for protein intake on these outcomes or something like that. And then even

1:13:25
that’s not my final take. Then I may look up the papers that are cited to make sure they’re real papers. They actually exist. Do they actually say

1:13:33
what the AI says they say? Are there other papers it missed? Then I will go to if it’s about me I may go to my

1:13:41
personal physician and say this because what as a scientist I often have very deep knowledge on something but I don’t

1:13:50
have the broad knowledge that a physician has. I’m not a physician and I have had many occasions where

1:13:57
I’m thinking deep thoughts about some health thing and the physician who has again a bunch of different training

1:14:06
says like David you’re out there looking for zebras totally hits a horse and it’s right here in front of you and I go I didn’t know that

1:14:13
horse existed right so I I had one where at the end of the pandemic as I think many of us were sort of emerging after

1:14:20
the first here. I’ve been locked out of the house for a year and weird things are happening and I had some tingling in

1:14:27
my legs and I’m thinking I got like diabetic neuropathy and I’m checking my you know urinary glucose and no I don’t

1:14:35
diabetes and you know I’m checking for Lyme disease. No, I have Lyme disease. I go to the physician and I say you know I did this I tell them about my

1:14:44
weightlifting. I used to be able to do pull-ups. So, you have a little neuropathy or something.

1:14:47
And I would have a weight belt and I could do pull-ups with 90 lbs on a weight belt and I only weigh like 125 pounds at the time.

1:14:57
And he says and I said, you know, when I stop it, it went away. And he said,

1:15:02
“Yeah.” He said, “That’s your lateral femoral uh nerve.” He said, “Cops get that. The gun helpers have or construction workers from the tool

1:15:10
belt.” He said that’s like never in my life would I have thought of that. So go to a general physician, talk

1:15:18
to my friends who are physicians, read the literature, ask to point me in the right direction, listen to a podcast.

1:15:25
Um, and again, if it’s depending on how much I really feel like I must know this as opposed to operate on some heristic

1:15:33
trust, then maybe pull up every paper myself and read them myself. Now that’s as a scientist, right? As a, you know,

1:15:43
as a general um person who just wants to make intelligent decisions about their own life, you may not need to go to reading every paper and you may not have

1:15:51
the ability to to know what to ask more when reading every paper, but you can certainly go to your own physician. You can ask another physician. You can

1:15:59
listen to a podcast and if they start to converge then you could Yeah. It’s the equivalent of looking at continuity of data over time. You know,

1:16:10
when you see a scientific discovery and then it’s in multiple different labs and here’s the totality of evidence. I I think that that makes it makes a lot of

1:16:18
sense and you start to learn who you can trust.

1:16:21
Yeah. So, you know, if if I’m listening to Lane Norton and he’s making some commentary on what studies show about a

1:16:29
particular thing on protein intake, I I know Lane well enough and I’ve listened to him long enough to know he’s almost certainly I won’t say certainly.

1:16:37
Don’t you dare say he’s right. Lane was kidding. Lane, you know, I trained with Lane. She’s a very dear friend. Well, more like a brother, but yes,

1:16:46
he’s almost certainly are better looking. Got it right.

1:16:50
Um Yes. Yes.

1:16:51
Whereas um if he were on some other topic, I might say I’m not sure that’s his a really good perspective.

1:16:59
Maybe not. Uh let me learn from somebody else. So I I’ll have people, you know,

1:17:03
that I can trust to varying degrees. And then again, it’s not absolute. It doesn’t mean Lane’s got everything right on protein. It doesn’t mean that this person has got everything right on carbohydrate or whatever.

1:17:13
What are you So there’s been there’s a a couple very hot topics that seem to be trending right now. seed oils,

1:17:20
ultrarocessed foods. Do you have opinions on either?

1:17:23
Sure. Let’s start with the ultrarocessed foods. Um, I think

1:17:30
the value of the category and the meaningfulness of the category depends upon what one is doing with it. So if

1:17:39
you are a scientist and you are studying social phenomena and one of them is perceptions around

1:17:45
ultrarocessed food fair game fine I don’t have any concern criticism so on

1:17:53
if you are either a person recommending things to others for their health and diet or you’re trying for yourself to

1:18:01
choose things if you’re looking for a general heruristic and by heristic I mean a way of doing things that might

1:18:09
have some benefit but not a statement about

1:18:16
the state of nature about how things actually work meaning can you give me a more specific example

1:18:23
sure if I said to you or I said to your kids maybe they’re very young I didn’t want them to

1:18:31
go into that wooded area because there’s a cliff and a stream and you can fall in and you can drown and there’s wells and it’s a whole situation.

1:18:40
Yeah.

1:18:41
And I say, “There’s evil fairies that live in that forest. Don’t go in there.”

1:18:47
Now, we can have an ethical conversation about You might now have their attention.

1:18:51
Should I be lying? Um, but let’s put that aside for the moment. You might say, “That’s a very effective way to get them not to go into that forest.”

1:19:01
um you go and say, “Well, if that’s your goal and you don’t have an ethical concern about lying, then you talk about fairies.” Okay. Now, if you said to me,

1:19:11
“No, no, no. I’m actually an epidemiologist and I’m trying to understand the degree of danger that comes from

1:19:20
going into that forest or things like that. um and the causes and effects.

1:19:27
what causes, you know, the bad outcomes. And so I’m a fiologist.

1:19:32
I’d say, uh, no, you’re crazy. You’re not a fiologist. Has no fairies. Is the study of stuff. You can’t study stuff that doesn’t exist. And,

1:19:42
uh, Richard Dawkins talks about that. You know, there’s no fiology. Um, so I think that’s ultrarocessed foods.

1:19:51
And if I wanted to say to you know I remember my dad who was a PhD in math education very very smart man but he always struggled with his weight.

1:20:02
H is that how is that was one of the things that drove you got me interested? No. Um and he said I remember him he would say these things.

1:20:12
He’d call me up and ask me how many calories is in this and that and he’d say look I’m eating nuts. Isn’t that great? You know cuz it’s it’s all natural. Isn’t that healthy for my

1:20:21
weight? Well, I’m having nuts and a martini. I’m like, well, well, the nuts are good food, but no, they’re a lot of calories, and the martini has some

1:20:29
calories, too, and that’s not really all that helpful for you. But he could convince himself of of any nonsense in nutrition if it let him have his martini and his nuts and a few other things. Um,

1:20:56
have to know what a carbohydrate is. All you got to do is this. Don’t eat ultrarocessed foods.” And I’ll give you

1:21:03
an easy way of identifying what an ultrarocessed food is. And let’s suppose he could do that, which probably not. He

1:21:10
probably wouldn’t, but um let’s suppose he did. He probably would weigh less than otherwise. And if that that’s a

1:21:18
good outcome, fine. And if you say, “But aha, ultrarocessing.” Now, David, you’ve shown that ultrarocessing, at least in your father, causes greater waking. No,

1:21:30
I have shown no such thing. What I’ve shown is that telling my dad to not eat ultra food led to this outcome. If I

1:21:37
said to you, I want you to um only eat foods that are in the peripheral aisles

1:21:46
of the grocery store, not that you get in the central aisles of the grocery store. And it turned out that you wound

1:21:53
up there by eating lots of fish and meat and eggs and etc. and not lots of cinnamon rolls, um maybe you would weigh

1:22:01
less. Okay. Does that mean if I move the cinnamon rolls to the periphery of grocery store,

1:22:08
they become better for you? Of course not.

1:22:11
So just because telling you to eat a certain way leads to an outcome and just because I can label things as being

1:22:20
there doesn’t mean it has anything to do with the causal effect.

1:22:24
So there’s a man named Schwarz and he has a book called um a fly in the ointment. It’s a great funny book and in

1:22:32
it he says repeat after me the effect of substances in the body

1:22:39
depends on their molecular structure not their ancestry.

1:22:45
So if you tell me that this food that happens to be ultrarocessed causes some different effect than that other food that happens not to be ultrarocessed, I

1:22:54
can accept that that could be true. If you tell me that it’s because in that food that happens to be ultrarocessed,

1:23:02
this substance is in high levels and it’s not that substance is not in high levels in the non-ultrpocessed food. I

1:23:10
can accept that it’s about the substances. But if you tell me the substances are identical,

1:23:16
that got the same atoms in this food and in this food, these atoms were collected and packaged through something we call

1:23:25
ultrarocessing. these atoms were collected and packaged through something we don’t call ultrarocessing.

1:23:31
But you are now going to make a claim that the effect is going to be different. I’d say, okay, now we’re in fiology land.

1:23:39
Now you’re you’re in homeopathy. Yeah.

1:23:42
You’re thinking if you wrap the Bible three times on the tube containing the water, the water has a different effect.

1:23:52
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1:25:41
Tell me about your new position. um that you have just recently taken.

1:25:48
So, I’m very excited. I’m having a great time at this. Uh I’ve done a few different things in my my life. And you know, there’s there’s uh what do they

1:25:56
say? Udemonic pleasure and and hedonic pleasure. The hedonic is what feels good right now. It’s eating the chocolate

1:26:03
cake. The udemonic, at least for me, is is going to the gym. It feels great the moment I leave the gym and I’m so proud

1:26:10
of how hard I worked and so on. while I was there. Maybe not. Um,

1:26:18
my prior two jobs, one was uh at UAB,

1:26:22
University of Alabama Birmingham being an NIH nutritional obesity research center director. I loved it. I had a great time. After that, I went and I

1:26:31
wanted to learn new things and I went to uh what became a school of public health. It had just been transformed

1:26:38
into a school of public health before I got there. Then my job was to sort of make it a reality along with the colleagues. A school of public health.

1:26:46
It was very science-based. And we did it. We transformed the school. It’s hard work. And this was is this Indiana?

1:26:52
Indiana University Bloomington.

1:26:56
And I’m very proud of what the school and I accomplished. And um then it was time to pass the baton. And that job was much more of a udeimmonic pleasure job.

1:27:08
I look back and say, and I think that’s what it’s like to be a dean. You look back and say, did we do well? And thankfully, I feel like the answer is

1:27:17
syes. And so I’m very proud of what we accomplished. I’m glad I did it. I would do it again if circumstances came again.

1:27:24
But if you said in any moment, you just randomly called me up and you said, “You having fun today?” Uh,

1:27:31
no. Today I’m dealing with a racism complaint or a sexism complaint or a plumbing problem or a budget problem or all the problems that exist,

1:27:41
whatever. Um,

1:27:44
now, so I did that. I’m glad. And now I’m back to the science. But I’m back to the science in a way where I kind of

1:27:51
have the best world of two worlds because I’m the director of a federal center and I have the budget and the

1:27:58
building and the the personnel of a what’s equivalent of a small school. So like the dean. So I have sort of the

1:28:06
authority and resources of not unlike a dean but I’m all focused on research and

1:28:14
helping people with research and research on not any topic but on the topic of nutrition,

1:28:22
obesity, exercise particularly as relates to children, pregnant women,

1:28:27
life course development and so I’m having a great time. My colleagues who I have the privilege of leading are my intellectual peers.

1:28:37
Uh I’m interacting with people who are rock solid researchers who are smart and energized and really committed to their

1:28:46
science. We have good people at our center and they know so much more than I know about their domain. I’m just thrilling. I’m having a great time.

1:28:59
And uh what are you guys working on? I know that you’ve got multiple um projects. So, you’re at the it’s the USDA

1:29:06
um USD I don’t want to USDA ARS Children’s Nutrition Research Center at Baylor College of Medicine and Texas Children’s Hospital.

1:29:17
I mean, that was a lot of words and and you know that um what are the projects you’re most excited? I know that you guys are working on a whole host of

1:29:25
projects, but are there a handful that you’re just like, “Wow, this is this is really transformative.”

1:29:30
Yeah, I think there there are those that are my own research that I’m very involved in and then there’s that the cent’s involved in that, you know, as

1:29:37
the leader I try to support, but they’re not it’s not my research. Um, some of the really exciting things with Dr.

1:29:44
Marta Fiorto, she made a great presentation yesterday and she was actually she’s looking in model

1:29:51
organisms and she’s studying whether exercise can mitigate the lifelong

1:29:59
effects of um in utero under nutrition

1:30:09
on long-term obesity.

1:30:14
So there are some effects in if you know uh an organism doesn’t grow so well in

1:30:21
uterero that will lead it to be predisposed to obesity in later life and does exercise

1:30:29
mitigate that? So that’s pretty exciting stuff. We’ve got others who have shown

1:30:35
that um certain factors may lead to longer or lesser lifespan, especially

1:30:43
when given early, including um uh I’m probably going to pronounce it incorrectly, but uh uralithan

1:30:51
urolithin a um that may have effects that are opposite to what’s sometimes reported

1:30:57
under some circumstances. Dr. Yu Zhu is our expert on that is working. So cool.

1:31:05
So we’ve got some interesting things going there. Then we’ve got some community- based things. Uh Dr. Jana

1:31:11
Davi is working on the so-called food is medicine and can she help people lead

1:31:18
longer and healthier lives by adopting this perspective and adopting

1:31:24
techniques. We have a a wonderful um setup with her and others. We have

1:31:31
laboratories that nobody else has. Um we can bring in children and families to stay overnight in metabolic chambers.

1:31:42
That’s unbelievable.

1:31:43
We have great body composition equipment. Uh we have great staff who know how to help a young child experience calmness

1:31:52
and security. even staying overnight in a facility like this because they’re pros. So, this is really nice. Um, we’re

1:31:59
trying to upgrade our test kitchen and our feeding so we can actually do control feeding studies. So, we don’t just say, “Hey, why don’t you eat this and let’s see what happens, but we can say, “Come
in, eat this in front of us.
1:32:10
We’ll feed you and then we’ll see what happens.” So, we know it’s tight. And we’re trying to raise some funds. So,

1:32:16
anybody out here who’s got some funds is listening. We’re trying to raise some funds to renovate those laboratories and and have some of the most modernized,

1:32:23
best test kitchens and feeding facilities for nutrition studies and children, pregnant women, and families.

1:32:31
It’s really exciting. Um it’s a pretty extraordinary place that you’re at and um you guys are making a great team

1:32:39
because the the combination of scientific rigor with really intellectual integrity, scientific

1:32:46
integrity is is what I think is desperately needed. Um I have one last question for you Dr. David Allison.

1:32:54
If you had a wish, you know, as we talk about these methods and these science and making good decision and making good decisions, what would that be for people?

1:33:04
I think it would be to take a step back from the specific and move to the general. In other words,

1:33:15
take the priority off the question of should I eat keto or low carb or get rid

1:33:22
of food dyes or whatever and say and you asked me this question earlier. How do I

1:33:30
as an individual and how should we as a society make the best decisions in general?

1:33:38
How do I evaluate things in general? And let’s start by committing to that, committing to doing it rationally,

1:33:47
intelligently, honestly through science.

1:33:50
And then say, what would it take to do that better? And let’s explicitly not think about for the moment keto or carbs

1:33:58
or fats or ultrarocessed or protein. And let’s think about X and Y. Because when

1:34:05
we think about X and Y, we can leave our emotions at the door a little bit. and come up these general rules and say this is how I would think about it if it was

1:34:12
X and Y and then later when you say now let’s think about keto and I get emotional and I say blah

1:34:20
blah blah blah or protein and you can say David hold on remember 6 months ago we went through this with X and Y and you said this was a good way to make

1:34:29
decisions let’s apply that framework now and I think if we can start committing to doing that as a society as

1:34:36
individuals and I think we already have that commitment in principle in the scientific community, but in practice,

1:34:45
we’re not doing as well as we should.

1:34:47
That’s an important thing that Jay Badacharia, the current head of the NIH,

1:34:52
is really pushing for. We need to do better in being open-minded, in evaluating evidence fairly, in not stretching and exaggerating,

1:35:02
uh, and in correcting mistakes when we find them.

1:35:06
Very well said. Thank you so much for sharing your time and expertise. Thank you. Thank you. It’s been fun.