Dr. Gabrielle Lyon [0:00:01]

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 interview Dr. Andreas Eenfeldt. He’s a Swedish medical doctor who specializes in family medicine. He is the founder and CEO of Diet Doctor, which has been the world’s most popular low carb website for a decade. Let me repeat that it has been the world’s most popular low carb website for a decade. Interestingly, in the past few years, Dr. Andreas has moved his company into higher protein diets. No surprise, but the surprise comes from the innovation of taking a higher satiety approach and in this episode, we discuss are there more flexible ways to incorporate carbohydrates in your diet, and overall diet flexibility? Can you predict the actual amount of weight loss one will have based on a satiety index? How do we incorporate technology into our learning and execution of dietary choices? Recently, he launched a new website called hava.co where they believe the future of eating from metabolic health and body composition is satiety. This is a very interesting concept. If you liked this episode, please take a moment to like, subscribe, share it with a friend. I’m always trying to provide you the listener or you the viewer with new information that you can take back into your own life. Okay, let’s get started.

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Dr. Andreas Eenfeldt, thank you so much for coming on the show. I am really excited to interview you. You have been a long-time advocate of using nutrition as a tool to get the best out of people.

Dr. Andreas Eenfeldt [0:04:58]

Thank you for having me on the show. It’s going to be fun to talk about that; my favorite subject.

Dr. Gabrielle Lyon [0:05:05]

One thing that really strikes me about you, and first of all, you were a practicing family medicine physician. However, you’re so mission driven. I think it’s one of the things that perhaps you don’t speak so much about, you talk a lot about the science, I’m very curious about the person behind the science, and you are one of, again, the most driven people to get the message out there. Why?

Dr. Andreas Eenfeldt [0:05:32]

Well, thanks. I mean, for me, it’s working as a family doctor, just seeing how many people suffer because of the environment we live in today, that drives this epidemic of metabolic disease and obesity, and this really fuels all our chronic diseases and destroys quality of life. Just experiencing how through medical school and through working as a family doctor, we basically mostly treated with medication. They don’t really remove the cause. Some might get close to it, but pretty much they don’t remove the cause of the of the problem, they just reduce the symptoms, the complications, and we don’t get to the root cause because it’s so much more complicated to change your lifestyle, change what you eat, and change how you live. It’s so controversial, but I think what really drove this home to me is reading a lot about it, getting into myself, trying it myself, and then seeing in patients what tremendous, enormous differences it can make in people’s lives. When you know, because generally, as a doctor, what you’re used to seeing is people just get a little bit older, every year a little bit sicker, and they need more medications, etc., but when they can change their lifestyle, and come back and be transformed, their health markers are vastly improved, they feel much better, they are much lighter, they can get off medications instead of on medication. It’s pretty exciting. When I started experiencing this and started talking to patients about this, it was such a change.

Dr. Gabrielle Lyon [0:07:38]

That’s beautiful. Was there one thing that really changed for you? Did you have a patient? Was there a defining moment that there was perhaps even a fork in the road, where you said, you know what, I don’t feel good about prescribing this. There’s got to be a better way.

Dr. Andreas Eenfeldt [0:07:55]

I think there was many people that influenced me all the way, many patients. But I remember one patient where I printed the the glucose curve, which has been really high. It just dropped like a rock down to normal in a few months, and I was still a relatively junior. I was taken around to show the other doctors in the clinic, they’d been working for decades and they had never seen anything like it before. I think that is one of the many things like that. That’s one of the things that made me feel like, wow, this is really something special, and even experienced doctors don’t really know this. They don’t really experience it. I felt like trying to help one person at a time wasn’t really effective enough, right? It doesn’t really move the needle. I mean millions and millions of people could benefit from this. I started a blog in Swedish, and it turned out to be quite popular, a lot of people reading it and it turned into the biggest health blog in Sweden within less than a year. That’s kind of how it got started.

Dr. Gabrielle Lyon [0:09:24]

I love that and now it is a massive website. For those of you listening, it’s the dietdoctor.com. What is the mission? What is your mission? What is the diet doctor’s mission?

Dr. Andreas Eenfeldt [0:09:36]

It’s about contributing to well with more healthier, happier people living more fulfilling lives. That’s what it’s about. It’s about helping people unlocking their potential to live the life they want. We want to do that by our guiding people to healthy and filling foods that they love. Something that is simple and doable. My diet doctor, we always tried to make low carb simple, make low carb and keto simple, it’s difficult to change your lifestyle, it’s hard to know what to believe and what to trust, so we just want to make it simpler. Now we have also another new website, another new approach that we’re exploring, because I think while low carb is great, there might be room for something even more innovative, and more flexible. Probably close to what you’re doing.

Dr. Gabrielle Lyon [0:10:35]

Yes, which I’m biased, but I think that from a protein for perspective, it’s critical. It’s interesting, because the low carb diet has a long history. The earliest documented low carb diet was in 1862, for those individuals who are interested in the history of things. For me, and I’m sure for you, the history always paints a beautiful picture, because if we take things as if they’ve always been there, then we have no idea where we’re going or where we even came from, or perhaps errors in the way that we think about things. By looking at history, it will tell us a lot about the interface that we’re going to have with the future. In 1862, there was the Banting diet, and this was a lower carb, protein focused whole foods diet, which was so interesting. The Robert Atkins known as the Atkins diet in 1972, which defined low carb ranges. We’re going to define low carb for the listener, anywhere from 20 to 150 grams of carbohydrates, to lay out our paradigm of thinking for the next hour or so. When we think about a very low carbohydrate diet, and you correct me if you have a different definition, but in the literature, we’re looking at 10% carbohydrates or less, this could also be 20 to 50 grams per day. A low carbohydrate diet is less than 26% carbohydrates, or less than 130 grams of carbohydrates per day, which would be defined as the RDA, moderate is interesting. It moves 26 to 44%. Interestingly, it doesn’t give a number. I’m sure the astute listener will say, Well, how come? I think there’s issues when we look at diet in terms of percent. A heart high carbohydrate diet would be 45% or higher. Can we agree that that’s how you would define it?

Dr. Andreas Eenfeldt [0:12:37]

Yeah, man, it’s close enough. Absolutely. Something like that.

Dr. Gabrielle Lyon [0:12:42]

Something similar? Why, from your perspective, and what’s so interesting, and I really want to talk about how you initially thought about and implemented a low carb diet, what the health benefits were, and as you transitioned, which I know, I believe that you’re now transitioning from a lower carbohydrate diet to something potentially even more flexible. So let’s start with the low carb portion.

Dr. Andreas Eenfeldt [0:13:10]

Yeah, low carb is kind of how I got into this. Like you say, you went through the history, it’s, it’s a long history, lots of experience. Also, in the last 20 years or so quite a few high quality studies have been made to demonstrate gold standard research, randomized controlled trials, and to demonstrate that this can be quite effective for a lot of people. It’s got a good evidence base, it’s got a lot of history, and a lot of experience. I think the strength of the low carb approach is in the fact that it’s been validated by a lot of experience by a lot of studies, that is works for for weight loss for improving metabolic health, etc. I do think, though, that in the last, five or 10 years, certainly in the last five years, there has been a lot of research to suggest that maybe the reasons why low carb diets can work so well are a bit different than we used to think. That is what makes it really interesting, I believe, to explore. Can we actually shape something that is more flexible and still more effective potentially at the same time? To me, that’s really exciting. But with that said, I think low carb is something really solid to fall back on, something we know works.

Dr. Gabrielle Lyon [0:14:41]

When you define low carb and you started your patients on low carb, are the people that you’re talking to, how do you tell them to do it? How do you design a diet? What are some of those grams? How can the listener who’s thinking about it and saying, gosh, I hear this concept of low carb all the time. What is it? Is it a 130 grams low carb, is it 50 grams? What is it?

Dr. Andreas Eenfeldt [0:15:04]

I think the way I see it, there is not one specific limit, the fewer carbs people eat, the more effective it tends to be. Whether that, I would argue now that that depends a little bit on, on what you replace the carbohydrates with. I think your listeners know this, probably relatively well, that you avoid big sources of carbohydrates like bread and pasta, and rice and potatoes. Of course, most ultra-processed foods, and candy and donuts and cake and all that. Then you try to eat as close to real, whole, low carb foods as possible, so meat, fish, eggs, vegetables, and various kinds of fats like butter and oil. Most people would probably avoid this.

Dr. Gabrielle Lyon [0:16:03]

It’s just disappointing that a lot of people in the podcast, because now you’re telling them that potentially they wouldn’t be eating cakes and muffins. I know my family is very disappointed, especially my husband, who’s eating pancakes under the table, but the hypothesis for why a low carb diet works. Can you talk a little bit about what the original thought process was and potentially where it is now?

Dr. Andreas Eenfeldt [0:16:31]

Yes, I mean, there has been sort of an evolution of this, this theory. I think for most people, when they have gotten into it over the last few decades is this version of the carb, insulin, low carbohydrate insulin model that goes something like if you eat carbohydrates, they break down in your body to simpler sugars, this raises your blood sugar levels, and this results in the production of insulin, the hormone, which is the fat storing hormone, and that makes you body store fat. Therefore if you eat carbohydrates, your body stores fat. Then you have to eat more to get the energy you need, because your fat stores are now growing. It’s sort of focusing on the fat cell as sort of controlling this sequence of events through these hormone insulin. It puts a lot of focus on carbohydrates specifically as fattening and sort of gives a free pass to other fields such as fat.

Dr. Gabrielle Lyon [0:17:47]

And where are we now?

Dr. Andreas Eenfeldt [0:17:49]

I think that there’s been a number of studies that call into question, if it’s really this simple, I would argue it’s probably not, it’s probably a bit more complex. For example, all of these studies that show that low carb leads to weight loss and improved metabolic health, they are generally also higher in protein, because if you remove carbohydrates, you tend to want to eat more of something, and that something usually is partially fat, but also partially more protein. Let’s say more meat, or fish, or eggs, so very rich in protein. We know that protein is the most satiating, macronutrient, the one that leads to people generally eating less. Probably this is a big part of the fact, but there might be other things too, because if you go on a low carb diet, you also exclude pretty much all ultra-processed, hyper palatable foods, like we talked about cakes and dough, some pizza and chips, they all go away on a strict low carb diet. We also know that these are perhaps the class of foods that drive the most over eating, and the most obesogenic. I would argue now that there is there’s a lot of evidence that ultra-processed foods in general are driving overeating. Even if the amount of carbs is the same between two different diets, one high and ultra-processed foods and one low in ultra-processed foods, they tend to be very different in their effects and, and also vice versa. There has been this interesting study called diet fit, which was actually partially funded by an organization that tried to prove this carb insulin model. This is one of the biggest and best studies that have ever been made on this topic, so they divided a large group of 600 people into two groups, one had a low carb diet, and one had a high carb diet for weight loss, and they both lost a lot of weight, pretty much the same in both groups, one low carb, one high carb. How is that possible? If it’s all about the carbs, I don’t think it is. What they actually did was, it was a healthy high carb diet, so they didn’t have any processed foods, sugar, etc. It’s more whole foods, low fat, high carb, and it’s just goes to show that that can work too. We also know that from from looking at the world, where people in Asia are living on traditionally at least living on very high carb diets, rice and other things, very high carb and still having no metabolic problems, no obesity, we have a lot of people who are interested in fitness, who are often eating quite a high carb diet and still being extremely lean. We have these indigenous populations or hunter gatherer populations, or at least populations that have no sort of Western foods, various populations that have been studied, like the hodza people, the Kitavans, etc. That is a mostly carb diet. Same thing there, they have no obesity, no metabolic problems. I mean, there are various lines of evidence, but I think it all points to the fact that even if low carb diets work, you can also be lean and healthy on a high carb diet, if it is unprocessed, if it is nutrient rich and not full of sugar and processed foods, basically.

Dr. Gabrielle Lyon [0:22:21]

I do have a really great perspective because initially, when you started, you were having patients do low carb diets, and really believe that it was about the fact that the carbohydrates needed to be low. Again, that working model was a carbohydrate insulin model with the primary hypothesis to be lowering insulin. It seems as if over the years, you’ve evolved in your thinking, which is, of course, the sign of someone who is well read and very open minded in a way that potentially there are multiple ways to get to the end result, which is exactly what you said, we all want individuals to be healthy. When you started doing the low carbohydrate diet. I would say that it probably wasn’t mainstream at the moment, right?

Dr. Andreas Eenfeldt [0:23:19]

Very controversial, for sure. So this is back in 2006. It was quite controversial, much more so than now.

Dr. Gabrielle Lyon [0:23:29]

Kudos to you, because people initially when something is different, always will definitely try to take down that individual. Until of course, as time evolves, and then they are proven to be right. That’s kind of how that works. When it was low carb for you, you had mentioned a low carb ketogenic diet. Ketogenic diet is 70% or more fat. It’s actually not a high protein diet, I believe, 20% or less, potentially.

Dr. Andreas Eenfeldt [0:24:02]

I mean, it varies with different people, but certainly it can be. I mean, I think it can be slightly higher, too.

Dr. Gabrielle Lyon [0:24:09]

When did you shift your focus? Perhaps maybe you didn’t shift your focus away from fat to the concept of increasing dietary protein?

Dr. Andreas Eenfeldt [0:24:20]

So it’s been quite a long process, I think. Probably 2018 is when I really started exploring this much more. I mean, I was exploring it before that too, but that’s when I really started getting you know, deep into protein. Just to connect back to what you started by saying staying open minded learning, I think this is what science is right? We are supposed to be open to the idea that we are always going to be wrong to some extent. If you want to learn, if you want to improve, if you want to, approach the future and be a little bit ahead of it, if you will, then the goal is to be become less wrong as quickly as you can. That means learning as quickly as you can. We always make some mistakes. The only difference is, if you refuse to accept that, then you will keep doing it forever, right? Or if you accept that you’re making mistakes, then you have a chance to stop doing it. So I choose the latter, I guess.

Dr. Gabrielle Lyon [0:25:49]

When you now make a recommendation for carbohydrates, how do you think about it?

Dr. Andreas Eenfeldt [0:25:56]

Yeah, great question. I don’t think that carbohydrates is the only thing anymore, it’s just one factor out of many. I think that for people who want to lose weight, improved body composition, improve metabolic health than increasing protein as a percentage, is quite impactful, which means that lowering carbs is one way to do that, but you can actually lower fat as well, at least lower added fats. It’s also quite effective. When the fats that come with foods like fish and meat and eggs, I wouldn’t worry so much about that unless you have some kind of extreme targets, but adding oil and adding butter and oil, adding cream, etc, it’s quite possible to get more effective results by reducing that as well.

But I think actually that there are multiple factors, it’s not just about protein either. If you look, there’s a lot of exciting studies showing that multiple factors can influence food intake, and satiety. This includes the energy density of food, how many calories per gram, or the sort of the hyper palatable nature of foods. If they’re extremely rewarding, like certain combinations of foods are very rewarding for us like fat and sugar together, you think of ice cream, or starch and fat, and salt together, like potato chips, can be made extremely hyper palatable, so it’s very hard to stop eating it. Once you start, you’re probably going to decide to eat all of it. We better not, or to have a small portion. Fiber seems to have not a very powerful effect, but a little bit of an effect to plant food intake and increase satiety. Probably there are other smaller factors too, but these seem to be perhaps the biggest four.

What I find really exciting now is low carb is good in a way, because it’s so simple, right? All you have to do is say, counter carbs, eat fewer carbs, it’s very simple. If you start saying that you should mind your protein percent and the energy density of your food and hyper palatable combinations, etc, and the fiber per 1000 calories. Now, suddenly, it becomes almost impossible to do, right? Anybody normal would just give up. What I find exciting is that with technology, we can build tools to make it simple, you can take all that complexity, and make it super simple again. The benefit of that is that now you have multiple levers, and you can be much more flexible in your choices. You don’t have to prescribe to one sort of specific dietary approach. You can choose whatever works. You may also potentially get an even stronger effect, if you’re struggling on low carb or any other approach, struggling to reach your goals, you could imagine that having access to all of these factors, having been able to leverage all of them, now you can get a much stronger effect. That’s a fantastic thing. That’s what we’re building tools for now.

Dr. Gabrielle Lyon [0:29:47]

Give me an example give the listener example of what percentage of protein for the diet do you typically recommend?

Dr. Andreas Eenfeldt [0:29:58]

Again, I think that’s just one of the levers. What we’re building now is a model called satiety per calorie, so that you can rank foods, or we haven’t an algorithm that takes in all of these various pieces of data about a food or a meal or a diet. Then it uses it to predict from zero to 100 how much this food drives overeating and obesity versus maximum satiety versus in the middle of the range might be, you might consider normal satiety, or at least you know, something that will tend to lead to normal body composition and normal metabolic health, if you were to eat it everyday. Let’s say they are taking all this complexity with 20 different numbers and boiling it down to one number, and then making it easier to see which foods are higher or lower, if your goal is to lose body fat, for example, or improve blood pressure, or something like that, then you want to get a little bit higher on that satiety scale, on average over the day.

Dr. Gabrielle Lyon [0:31:13]

That’s amazing, is it one out of 101 out of 10? What is the range?

Dr. Andreas Eenfeldt [0:31:19]

The way we have done it is from zero to 100. Low into single digits is where you find the worst enterprises foods like the doughnuts, Pringles chips, Doritos, all that stuff. At the very top, that’s not really where you want to be on average, because it’s just going to be too effective for you. That’s why I said this is a pretty powerful tool, which means that going all the way to the top now you’re only eating protein and fiber and not much else. and you’re going to starve to death in another kind of way. Down at zero, you might eat yourself to death by you know, eating too much. At the top, you might starve to death by eating too little. It’s basically like vegetables, egg white, shrimp and stuff like that. That’s just protein and fiber.

Dr. Gabrielle Lyon [0:32:13]

Low fat, high protein would be at the top.

Dr. Andreas Eenfeldt [0:32:19]

Yeah, low everything except for protein and fiber.

Dr. Gabrielle Lyon [0:32:23]

Okay. Do you, off the top of your head, know a handful of 100 scoring foods?

Dr. Andreas Eenfeldt [0:32:30]

Spinach, for example, is 100 scoring food. People might say, I don’t get satiety from spinach. That’s ridiculous. I’m not going to be fooled by eating spinach. That’s absolutely true. That’s the point, you can’t even eat enough to be satisfied. Try to get obese eating just spinach. That’s going to be very impossible. If you want to be in the center. Think of things like eggs and bacon, fried eggs and bacon as pretty much, right square in the middle 50. You could probably eat all of that and stay normal. You wouldn’t starve to death and you wouldn’t get obese, you would just be normal.

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Dr. Gabrielle Lyon [0:33:17]

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Where does fruit fall in to that?

Dr. Andreas Eenfeldt [0:36:22]

Fruit? Yeah, good question. That’s actually, to me quite interesting. I’m going to keep it as a bit of a cliffhanger because some people think that fruit is the healthiest thing you can eat, and other people feel like it is evil and all full of sugar, and it’s going to give you diabetes and make you obese. When you put fruit into our satiety algorithm, it ends up somewhere in the middle, low average. So like an apple might be 45 or something like that.

Dr. Gabrielle Lyon [0:36:59]

How does someone construct a diet with this satiety calculator.

Dr. Andreas Eenfeldt [0:37:05]

You can calculate the satiety value of any food, any ingredient, any recipe, or an entire day or an entire week. The goal is to stay at a good average over time. Doesn’t matter perhaps so much if you eat something that’s low satiety now, as long as you combine it with things that are higher satiety over the day. But you can use our tools for that, or you can just, to some extent, these things are not super controversial. If you go for higher protein, higher fiber, less processed foods, then you are basically using something very similar to this. I would assume that the food that you eat and that you recommend to patients, is not so far from what this would end up recommending. I think what the benefit this may bring is a few more insights about how to tweak, you can find some insights about how to tweak your diet and make it even more effective or use it to find some new things that you hadn’t thought about before that might fit your preferences.

Dr. Gabrielle Lyon [0:38:28]

How does the relationship between food combination work with satiety?

Dr. Andreas Eenfeldt [0:38:35]

How do you mean?

Dr. Gabrielle Lyon [0:38:36]

For example, if it’s an individual food, a person may not just be eating spinach, but maybe they’re eating spinach with a pancake? Hopefully, people aren’t eating spinach pancakes, that’s gross, but things of that nature.

Dr. Andreas Eenfeldt [0:38:54]

Basically, for a recipe, you can look at the macronutrients, the weight of the whole recipe, of the whole meal, and plug it into the calculator to get the satiety score of that. So you wouldn’t have to necessarily calculate every ingredient by itself. You can also just take the full macros and weight of it.

Dr. Gabrielle Lyon [0:39:24]

That’s interesting. Do you believe that the calorie balance matters, but it’s just difficult for individuals to know their calorie intake to track where the calories come from? So, what I’m hearing you say without saying it is that individuals really struggle to maintain an optimal body composition because tracking is difficult. What you’re saying is, in essence that if they just focus on satiety, an individual would not have to track.

Dr. Andreas Eenfeldt [0:39:58]

Yes. I would say though, that It’s more than difficult to track calories and lose weight by tracking calories. I would say is, it’s pretty much impossible for almost everybody to do if all you do is eat, track, and eat less. You’re eating, let’s say, your standard American diet, then you’re probably doomed to fail. I think everybody who succeeds by tracking and restricting calories, they also tried to make better food choices at the same time, because they quickly figured out that if they eat French fries, and they drink, sugary soda, etc, they’re going to pass their calorie limit without reaching satiety, right? They’re going to be hungry and miserable at their calorie limit. But if they switch to higher protein, higher fiber foods, etc., lower carb foods, than then they can do it. What I’m proposing is, why not start with that instead? Then you don’t have to track calories.

If you eat higher satiety foods, foods that you know are going to make you feel satiety, then you may not need to track your calories, you’re going to end up in the right place anyway. I think that’s ultimately the way that humans are supposed to work, and that’s the way any animal in nature is supposed to work. If you look at animals in nature, none of them know anything about calories, right? Except for humans in the last 100 years or so. As long as animals eat their natural foods that they’re adapted to, they never get to base. So how is that possible? They can have any amount of food; they can be standing in an ocean of food. They don’t get to base, they just eat until they’re satisfied, and then they stop. I think that’s exactly how humans work too, just like any other animal. As long as we eat foods that were adapted to, we are going to want to stop when we have had enough and the problem is caused.

The problem we’re in now, I would argue is caused by the food industry, by big food, and not by some conspiracy or malice or anything like that. It’s just they have been doing what they have to do for 100 years, they have been chasing profit. That’s what they’re incentivized to do. That’s what they have to do to please their shareholders who are the ones who are deciding. They don’t have a choice, they have to chase profit, and how do you find profit in the food industry? You sell cheaper ingredients at a higher price or more of it, right? Cheaper ingredients mean less nutrient, and less nutritious ingredients, less protein. Protein mix is expensive, meat and fish and eggs are expensive, but added oil added sugar are very cheap. If you can package it in a way that makes people want to eat more, and buy more than you also increase your profit, right? The goal becomes how can we sell the cheapest possible ingredients that people want to eat as much as possible off and buy as much as possible off. That’s the formula to increase profit.

Unfortunately, that’s also the formula for creating an epidemic of obesity, and diabetes in the world. That’s what’s happened. I think there is no big secret here. It’s just our science has improved, and we have learned how to create foods that are very cheap to produce, and that’s what people want to eat as enormous amounts of, it’s just very rewarding to eat. People basically can’t stop eating it. Profits for the food industry is up, and then people get obese and diabetic and heart disease and cancer and dementia, and then they need lots of medications every day and then it’s good for the pharmaceutical industry to so everybody profits, but people pay the price with poor health.

Dr. Gabrielle Lyon [0:44:42]

Absolutely, and that cost is tremendous. The burden on society. It’s everything, and it destroys people’s lives. Unfulfilled dreams and a world of regret at the end because they’ve been so anchored in food or chasing body composition or chasing poor health. It is devastating. I certainly had that experience when I was doing my fellowship in geriatrics. It is so above and beyond the profit, the impact to the world, just tremendous.

Dr. Andreas Eenfeldt [0:45:19]

You can think of it if you’re an entrepreneur and an optimist. I guess we both are sort of thinking, wow, what an opportunity to do something meaningful here. It’s really fantastic, in a way, because this, to me, seems like the biggest health problem in the world. If we together could find a way to just reduce it by half, then, like you said, I think there would be an enormous release of human potential happiness, productivity, in our fulfilled dreams, that will be amazing.

Dr. Gabrielle Lyon [0:46:05]

We’re doing fine. We’re on track. Do you think that the low carb, keto, all these different diets have failed and that’s why you decided to create the satiety index?

Dr. Andreas Eenfeldt [0:46:22]

No, I don’t think it’s failed. I think that all diets tend to work for people who can imagine doing it for the long term. Clearly, a low carb diet is quite effective for lots of people. As long as people want to do it, it works. But people can go on other kinds of diets and get a good effect as well. I think actually, the strict low carb, keto diet may have some benefits that other diets don’t have they tend to lose a few pounds of fluid, for example, in the first few days, that is pretty good for people’s motivation, which this is not something you get from any other diets. I wonder if that’s actually one of the reasons why it is as popular as it is, because you get a more rapid effect.

But that aside, I think there are many diets that can work. I think the low carb and keto approach, the solid option, with a lot of good evidence behind, I certainly support it. If people want to go on a low carb diet, our website, Diet Doctor and our app, we tried to make it simple. It’s free to start out. We’re going to keep keep doing that. I do believe that there is the potential now to create something more innovative, more flexible, that could fit more people for longer, and potentially also help people on various diets, including low carb to break through plateaus and get more effective version of, for example, low carb. That’s what we’re building, we launched a website called hava.co. We’re building an app for that. I think this might be something special.

Dr. Gabrielle Lyon [0:48:43]

It’s a really interesting, because on one hand, I suppose you could just say, satiety is going to increase if you’re just eating whole foods. As you had mentioned, the whole foods that we choose, may or may not be as satiating as a different food, whether it’s a stick of butter, or a large pineapple. The overarching statement to say we’ll just eat more whole foods without thinking that those foods have varying degrees of satiation to then limit hunger and to limit over eating, basically, is what you’ve done is you’ve put it into some kind of context.

Dr. Andreas Eenfeldt [0:49:26]

I think this idea of Whole Foods and ultra-processed foods has a lot of merit, and it’s very helpful. I think that it also gets rightfully criticized for being an imperfect division, very binary, and quite imperfect. There are examples of whole foods that may not be great for various purposes. There are examples of other processes that could be great. I also think that it’s highly unlikely that we’ll ever get to a world where nobody’s eating any ultra-processed foods, because it’s convenient, it’s cheap, it’s tasty, and it’s very available. It’s the majority of what people eat today. To just remove it completely, that’s a huge change. Because of the benefits of it, I don’t see that happening. I actually think that a benefit of the satiety approach is that we can also get away from this binary and imperfect division into whole foods and ultra processors. Instead, look a little bit more at the big variety of other foods like you can imagine.

Some ultra-processed foods are dreadful, some are just slightly bad, and some are actually quite okay. Maybe we can help people find less bad ultra-processed foods. Within these whole foods area, depending on what goals people have, good find, find more effective whole foods for them. For example, and this may be controversial, butter is relatively unprocessed, but it’s also pretty low in protein. Very low in fiber is no fiber, they’re energy dense. It can easily be combined with higher carb ingredients to make something very palatable. It’s something else perhaps like nuts, macadamia nuts, for example. Not so processed, right? Pretty unprocessed. If you want to lose weight, it may not be the most effective thing is pretty low protein again, very energy dense etc. If you add salt to it is relatively rewarding to drive eating.

Again, all unprocessed foods are not enough. On the other end of things, ultra-processed foods you can imagine something like a whey protein powder. Yeah, with additives in it. Highly Ultra processed food about for people who want to lose body fat and improve their body composition build muscle, it can probably be quite quite good for that purpose. Yes, but highly nutritious, and very, very low in in pure energy calories.

Dr. Gabrielle Lyon [0:52:55]

I totally agree with you. I was actually thinking about the whey protein example, as it relates to where potentially an ultra-processed food may be really beneficial to us. I wonder if at some point, the industry that is making ultra-processed foods will improve the satiation. I suppose that goes against what kind of the impetus is to generate profit, but it would be pretty amazing. If there are individuals that are making or in food industry, I think that there’s probably ways to do it. You had mentioned macadamia nuts are whole foods that, again, if an individual can control calories, then they can eat those foods, right?

Dr. Andreas Eenfeldt [0:53:47]

I’m not saying you stop eating it completely. I’m just encouraging people to be aware of the kind of effect it can have, depending on your goals. It may be smart to keep that in mind.

Dr. Gabrielle Lyon [0:53:59]

Yeah, essentially, it takes the halo off the food just because something is unprocessed doesn’t necessarily mean it’s healthy. I hate to use the word healthy or unhealthy, but that it is very easy to over consume those foods. What do you think is after this satiation component? What do you think is next? Are you guys solely focused on really changing the narrative because most people are not talking about satiety?

Dr. Andreas Eenfeldt [0:54:29]

Now, if we’re solely focused on this, I think it’s going to be massive. I think that this is something that could be of huge benefit to 1 billion people, maybe more. That’s big enough. This is all we do, our tava. Although, it is of course more complex with the implementation of it, because eating is a very personal thing. People have very different preferences, likes and dislikes, situations, budgets and million other things. There’s certainly a lot of complexity and building tools to make this super simple for people. I wouldn’t say it’s where we’re just doing satiety, we’re just building satiety tools. We’re also trying to find ways to make implementing that in people’s lives. Simple. That’s a huge thing.

Dr. Gabrielle Lyon [0:55:51]

Diet and nutrition, even exercise, will always be difficult for humans, because we’re so domesticated. Where does alcohol fall in the spectrum of satiety? How big is your database?

Dr. Andreas Eenfeldt [0:56:07]

We bought a big database. We have millions of food items, but we’re also curating this ourselves in various ways to make it really good at the most common things. On alcohol, unfortunately, I have to say it’s quite low, an awful lot of nutrition in alcohol. It does have a bit of a hedonic thing going for it, meaning that people tend to like drinking alcohol. So it is unfortunately not super helpful for weight loss.

Dr. Gabrielle Lyon [0:56:47]

What do you think you were very surprised about when you started collecting this data?

Dr. Andreas Eenfeldt [0:56:52]

There are so many things that are slightly surprising here and there. The thing that blows my mind the most is coming from the low carb area, and having spent 20 years exploring this, I’ve heard so so many times that for people who struggle on low carb, they should be careful with eating nuts and dairy. Nobody’s really come up with such a good explanation for why, because a butter cream etc. Very low carb, why is that a problem? Nuts tend to be quite low carb, cashew nuts, moderately low, perhaps. Generally speaking, they’re quite low carb. High fat should be fine if it’s all about the carbohydrates. The thing that fascinates me is when you look at it from this title lands, these are the lowest tide foods out of all common low carb foods. All the foods that people tend to eat on low carb, nuts, butter, and cream, are the absolutely lowest on the satiety scale. That blew my mind a bit. It’s totally obvious why these foods are a problem, something that nobody has been able to explain to me for all these years.

Dr. Gabrielle Lyon [0:58:24]

That’s so interesting. These algorithms, how did you formulate them? You have a team of scientists that chose different validated lenses or questionnaires. How was that developed?

Dr. Andreas Eenfeldt [0:58:37]

We’ve done this together with a bunch of different experts in the nutrition world and try to sort of train this algorithm to fit as much as possible with existing data that we have, with a special emphasis. I want us to really lean very heavily on randomized intervention trials and not so heavily on observational data, the immunology which I think is prone to a lot of problems and biases. We try to choose the factors that seem to be the most powerful in multiple studies. The factor is that when we consult with various experts, that they agree are the probably the biggest and most influential factors that gets at it. There is no way today to know exactly is that how do we weigh exactly the protein percentage versus the energy density, versus the fiber component, versus their dynamic factors. Nobody’s really done these studies to conclusively prove, if it’s 38% of this or 22% of that. It’s impossible today to know exactly. We get criticized for that and I think that’s fair.

What I would I would say is that we try to weigh them in the way that seems to predict the existing data as well as possible. We are very open with the fact that this is a work in progress, and that future evidence, future studies might tweak this a bit, so if some study comes out, that conclusively shows that it’s actually a little bit more energy dancing, and a little bit less protein, we can tweak this algorithm. In fact, we do that quite regularly, when we find new data that we can work into it. Ideally, we would want to do a whole series of intervention studies ourselves, but the problem is that that would cost us probably $100 million or more to do in a really good way. In the future, I’m hoping we’re going to be able to drive this forward, faster. But today, what we do is we lean on all the studies that are being made in the world and just piggyback on that, or the adlib intake human randomized control trials, on various proportions of offers. We tried to match the results of our algorithm to the existing data from the status.

Dr. Gabrielle Lyon [1:01:49]

How long did that take to develop?

Dr. Andreas Eenfeldt [1:01:52]

We’ve gone back and forth with hundreds of iterations on this. Close to two years now. But again, it’s still a work in progress.

Dr. Gabrielle Lyon [1:02:02]

For the listener, ad libitum fed is eating as you please.

Dr. Andreas Eenfeldt [1:02:08]

It’s eating to satiety, eating as much or as little as you want.

Dr. Gabrielle Lyon [1:02:16]

Some of the randomized control trials, were you looking at gut hormones? I’m sure there was multiple markers that went in there to define the impact on satiety.

Dr. Andreas Eenfeldt [1:02:27]

No, we don’t actually look at that, because what we are interested in is food intake. Even better if we have weight or body fat measurements of changes in weight and body fat. It’s those things primarily food, adlib food intake a number of calories. Even better if we have changes in weight, changes in body fat. Some of the studies we’ve been looking quite closely on these are the impatient studies from Kevin Hall, entrepreneurs, especially on processed or low carb versus a low fat plant based diet. Those are really interesting. The diet fit study said that there are many but those three are some of the most interesting ones for me, because coming from a low carb perspective, they all give a result that you cannot explain with a carb insulin model. It’s just very different results than what would be predicted. With our model, it the results fit perfectly with the with a predicted outcome. That’s pretty cool to see.

Dr. Gabrielle Lyon [1:03:53]

Could you just explain a little bit more because it is fascinating.

Dr. Andreas Eenfeldt [1:03:59]

For example, Kevin Hall, quite famous study now, even though it’s only been a few years since it came out, where they took a group of people and had them for two weeks either an entreprises diet or an unprocessed diet for two weeks, and then they tried to match. For example, the carbohydrate intake so they were they were eating equal amounts of carbohydrates. And fat in in both both arms. He also tried to match the protein intake, but it was slightly off but close enough, but one was entreprises. One was unprocessed. And what they found was that when people were told to eat as much or as little as they wanted, they still ate 500 more calories per day on the ultra-processed diet and they quickly gained weight on that diet and gained in in fat mass as well. While they they quickly lost Based on their unprocessed diet, and of course, if you come from a local perspective, you would say, same carbs, they should have the same effect. But they didn’t, right. But if you look at it from our algorithm, you can see that the ultra-processed diet has much higher energy density and the food much higher, much more hyper palatable. And it would be predicted that they would eat quite a lot more, which is exactly what happened. So that’s pretty cool.

Yeah, same with the diet fit study that was mentioned earlier in the podcast where, you know, one low carb or one high carb arm, but yet the effects were the same, right? With a low carb, carb insulin model, you would predict that the low carb group would do do much, much better in this group of overweight people, but it didn’t. With with our algorithm, they score about the same in satiety per calorie. So it would predict that difference should be minor, which is exactly what what happened, they both score high. And the final study, again, by Kevin Hall was this study on a low carb, animal based ketogenic diet versus a low fat plant based diet, where at least i 10 years ago, would have predicted that the keto diet would lead to people eating much less, but it didn’t, you know, there, there is much more, and they, they had less loss of, of body fat than this low fat plant based diet. And what you can see looking with subtitle lands on it is that the ketogenic diet was was was far higher in energy density, much, much lower in fiber. And that may be what explains that, because you can see with our algorithm that that it actually scores quite a bit lower. So it’s samples that are pretty cool to see that it’s a better predictor.

Dr. Gabrielle Lyon [1:07:12]

Yeah. You know, this has the potential to really change the way things are done in the way that the things are thought about. So in retrospect, based on using the satiety index, it’s you or it was able to predict exactly what we’re seeing in some of these very well designed studies.

Dr. Andreas Eenfeldt [1:07:33]

That would be cool. Now that you get new big studies. I know Kevin, Allah has a new big study coming up, that I’m very good to see the results from. We’ll be also interesting to see, of course, if we can predict in the future, what’s going to happen, not just predict the studies that we had access to when we designed it right. But I think it will. And to the extent that it doesn’t well, then then we can of course improve it. For for next time.

Dr. Gabrielle Lyon [1:08:03]

Yeah, it’ll be amazing to see as these studies come out, through the lens of the way in which you’re looking at them, how it all correlates, is if you could predict it, you know, what you should do is you should get the studies and then not read the results.

Dr. Andreas Eenfeldt [1:08:18]

sure, we can do that. We can call it in advance. Of course, they have already announced what it is they’re going to study, right? We can pre-announce what we predict. Before anybody knows the results, and that we’ll see if we were right.

Dr. Gabrielle Lyon [1:08:39]

I would consider it. I do have a last question. What role do you think that the gut microbiome plays in the satiety factor?

Dr. Andreas Eenfeldt [1:08:49]

Yeah, so I have some somewhat controversial view on this, although I think that’s where, where the experts are sort of call asking if you if you will, I mean, I think the gut microbiome is not a major factor here. I think the gut microbiome is a result of, of what we eat just like weight loss or weight gain is a result of what we eat is not the cause. Because this is something that for a while, people thought that the gut microbiome is in charge. But actually, if you do fecal transplantation from someone who’s thin to someone who’s obese, it has no effect whatsoever. And this has been tested in humans now, I think at least six times. And all of the results show the same thing, no effect whatsoever. It seems pretty clear to me that what we eat will affect our gut microbiome quite powerfully. And it will affect our health but not through. The microbiome, it’s just that and I would say, at least, at least from the perspective of weight and metabolic health, that is what it seems like to me. I don’t think it’s a big thing at all.

Dr. Gabrielle Lyon [1:10:14]

I think that that is a very interesting perspective. It’s important. We will see, I think, as the years go on where all of these pieces fit.

Dr. Andreas Eenfeldt [1:10:23]

But still, if you eat whole foods with a lot of fiber and nutrition, etc., you’re going to get good health, and you’re going to get what is considered to be a good microbiome. So then everybody’s happy, right? But I wouldn’t waste money. Well, I would consider it wasting money to take probiotics and prebiotics and all kinds of things and analyzing your gut microbiome. I think it’s a waste.

Dr. Gabrielle Lyon [1:10:51]

Do you think that the better target would be to focus on foods, satiety factors, and body combo?

Dr. Andreas Eenfeldt [1:10:59]

Meal and better foods inside? Yeah.

Dr. Gabrielle Lyon [1:11:02]

Well, Andreas, thank you so much for chatting with me. I think that this is a very interesting concept, very interesting episode and different. it’s a different lens through which we can begin to think about nutrition.

Dr. Andreas Eenfeldt [1:11:16]

Well, thanks. Thanks, Gabrielle. It’s been a pleasure to be on the show.

Dr. Gabrielle Lyon [1:11:19]

We’ll link all of this stuff on where to find you where to find this. I actually had the privilege to see you speak and you’re just a wonderful speaker and the information that you’re putting out there and the visuals on this topic was it was really quite powerful.

Dr. Andreas Eenfeldt [1:11:39]

Thanks a lot. Appreciate it.

Dr. Gabrielle Lyon [1:11:41]

Thank you so much.

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The Dr. Gabrielle Lyon podcast and YouTube are for general information purposes only and do not constitute the practice of medicine, nursing, or other professional health care services, including the giving of medical advice. No patient-doctor relationship is formed. The use of information on this podcast, YouTube, or materials linked from the podcast or YouTube is at the user’s own risk. The content of this podcast is not intended to substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their health care professional for any such conditions. This is purely for entertainment and educational purposes only.