Dr. Jason Fung
Appearances
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
Yeah, absolutely. So the whole idea with calories in, calories out is that it makes a few false assumptions, first of all. People look at it and they say, you know, calories represents one part of the food to treat. That is the energy that's contained within that food.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
But when you're trying to gain or lose weight, there's actually much more to it than simply the energy that's contained in that food. Yeah. So it's not just the energy, it's what your body does with that energy, right?
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
So if you take 100 calories of cookies, for example, or brownies versus 100 calories of, you know, salad or broccoli or, you know, salmon or whatever, the body can choose what to do with that energy, right? So you can either store it as fat or you can burn it and use it for energy. You can generate body heat, for example.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
So simply taking in that energy doesn't mean that you're gonna store more fat because if your body simply uses it, then you're not gonna store fat. However, on the other side, if you take in 100 calories of cookies and your body immediately shuttles it into body fat, which is simply the storage form of calories, well, you don't have any energy.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
So then your body is gonna have 100 calories less energy because you've put it into storage. And so therefore, you're going to be hungry or you're going to generate less body heat, none of which sort of breaks the laws of thermodynamics. Because people always say, oh, it's thermodynamics. And anybody who says that clearly doesn't understand thermodynamics in any way.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
Because remember that it's the energy balance equation is body fat equals calories in minus calories out. And that's always true. But there's three variables there. There's body fat, which is storage. There's what goes in and what comes out, right? So if you take less in, for example, you're reducing your calories in, you don't necessarily reduce body fat.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
What could also happen is that if calorie, what comes in goes down, what goes out, that's energy expenditure can also go down and your body fat can stay the same. So that is one of the choices the body can make. but it depends on the hormones within your body, right? So if you're eating less, but you're burning less, then your body fat is not going to go anywhere, right?
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
And it doesn't break the laws of thermodynamics. So simply eating less doesn't automatically translate into lower body fat. It depends on what your body does with it. And that's all about the hormones in your body, right? So we know, for example, that insulin is a hormone that promotes storage of those calories. So if you simply take foods that
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
you know, have a very high insulin stimulating effect, your body is going to want to store that because that's what you've told it to do. So therefore, what happens is that you don't have energy to burn because you've stored it away.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
So just like if you have, if you go to the grocery store, for example, and you take that food and you immediately put it all into your freezer, well, you have nothing to eat. So you're either going to have to eat less or whatever. Same thing. If you take those calories, store everything away, you have no energy. So then your body is going to burn less because it has no energy to use.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
So that's one of the most important things. When you eat, the food contains not just the calories, but also contains information as to what to do with those calories. So it's not this simple in and out.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
Yeah, because it really depends on, and it happens to everybody. So everybody notices this, right? So if you look at teenage boys, they are eating a lot. And they're not generally overweight. I mean, if you look at sort of middle-aged and older men, they're more overweight than sort of 20-year-olds. But those 20-year-olds, if you've ever had a teenage boy, Boy, they eat a lot of food.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
And everybody knows that. So therefore, they must be also burning a lot. And that's probably just the stage of life they're at. The hormones and their energy and what they do, their lifestyle, that kind of thing. So it plays a role.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
But the point of the whole thing about calories is that you have to really look beyond the calories, and you really have to look at what the information contained within that food is as to what your body's going to do with it. So if you are taking certain foods that have more fattening, then it's because of the hormonal response to those foods. That is...
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
As soon as you put the cookies in your mouth versus when you put broccoli in your mouth, the hormonal response of our bodies is completely different. We know that. That's just science, right? So we have to pretend that those hormones don't play any role in body fat, but it does. Everything depends on the hormones. That's how our body works.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
So this whole idea of calories is completely unphysiologic. That is... There is no system within our body that simply monitors the calories in, calories out. We actually have no way of measuring how many calories in. The only way our body knows, should I store body fat? Should I burn it and generate body heat? Should I have too much sugar and become diabetic?
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
The only way our body knows what to do with it is the hormones. And that's really what you have to focus on. And it doesn't break any laws of thermodynamics. It doesn't go against, it doesn't mean you can eat everything you want. The only thing it means is that certain foods are more fattening than other foods. And, you know, that's sort of common sense, right?
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
Because your grandmother would have told you, like, nobody gets fat eating broccoli. It just doesn't happen. But the people, all those sort of scientists who are sort of real, it's all about the calories sort of thing, will try and convince you that, you know, well, 100 calories of cookies is just as fattening as 100 calories of broccoli. But it's not true in any way. Cookies are very fattening.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
Everybody knows that. But yet somehow they tried to convince everybody and did. They were quite successful to a certain degree that they did convince everybody. So there are doctors out there saying, oh, you can eat ice cream for dinner and not get fat as long as you count your calories. It's like, well, you know, some calories are more fattening than other calories. If you eat a block of wood.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
It has 100 calories, but it doesn't matter. Your body doesn't absorb it. It just goes right through you. Your body can't process it. So it's not the energy. So it's energy plus what you're supposed to do with that energy. And that's really what's important.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
Yeah, protein can spike your insulin for sure, but it has other effects. It also, because insulin goes up, but then other hormones go up like glucagon, it doesn't tend to have any effect on blood glucose as opposed to carbohydrates where it does have a big effect. But then there's other effects. I mean, it's the sort of totality. If you look at protein, for example, There's other effects.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
If you eat protein, you're going to stimulate peptide YY, which is a satiety hormone, and it's going to make you not want to eat. That's why they have those, you know, contests where you, you know, you eat 120 ounce steak, we'll give it to you for free.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
They're not giving away a lot of free steaks because those satiety hormones are just so strong that you can't force yourself to eat that much meat because of the protein. So there, you know, yes, insulin is going to go up. But if on the other hand, your body is going to naturally stop eating it.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
Like, you know, if you've ever gone to a buffet and just been super, super full and somebody said, here, have another pork chop. You go, you know, I'm going to throw up, right? That's just the way it is. So therefore, it's going to naturally sort of regulate itself. And therefore, protein is not particularly fattening. A lot of people eat high protein diets and do very, very well.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
carbohydrates, of course, is a little bit, especially processed carbohydrates, natural carbohydrates, probably less so, but processed carbohydrates to a big extent is the big problem. And I don't think that's terribly controversial. I mean, it's simply, you know, sugar refined, refined grains and stuff, a lot of stuff that, you know, we probably accept that it's not good.
Habits and Hustle
Episode 418: Dr. Jason Fung: Why Calories Are Not the Key to Weight Loss
You know, the whole point is that it's, it's, it's the foods that you eat, are important in many different ways other than just the calories. So you do have to look at these other things because they're just really, really important.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
People always say body fat equals calories in minus calories out right and that's always true but that's not the way it always works right because that assumes that the calories can go in and out of the body fat which is the storage anytime it wants but it can't right so you think about your fridge right your fridge is a store of food so you go to the grocery store you buy food you store some of it in the fridge and you eat some of it but what if there's a lock on that fridge
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, according to current, like this is since 2023, it's considered in remission, right? That's the term. Yeah, yeah, yeah.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But it can be reversed in that you can go from diabetes into diabetes in remission to pre-diabetes and beyond. Because these are all defined, right? By the A1C.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But the point being that Up until 2023, nobody ever said that this was a reversible disease. It could not be reversed, which was crazy because it's like, yes, I can get that A1C down from eight down to five and a half. Bariatric surgery proved that, right? And not... over a short period of time, like really fast, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Those bariatric surgery trials, if you remember, before they lost a significant amount of weight, their A1Cs came down to normal. It was like two weeks, right? Three weeks. And the sugars were completely normalized, right? So it's long before the rest of that weight loss took place. There was something happening there. And from 2010, 2012, when all these bariatric surgeries came out,
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
That's 12 years before the American Diabetes Association said, yes, it's reversible. Because it's really important to tell people that it's a reversible disease. Because if you tell people it's an irreversible disease, they'll be like, okay, I give up. Yeah, it's demotivating to hear that.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, but to me, it's like you got to tell people the truth. If it's reversible and if it's largely a dietary disease, then that should be the first message you give people. It's a dietary disease and it's reversible. Let me help you do that, which is what they didn't say, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And that's where I say, well, that's really tough because I remember telling patients, look, this is a reversible disease. So just to finish, so what happened was I started to realize that weight loss was really important, which of course everybody agrees on. That's actually in the standards of care in the latest studies.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
sort of 2024 American Diabetes Association guidelines, weight loss is actually quite critical.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But I realized that weight loss is really important and that's where I became super, super, super interested in weight loss, because if you could get people to lose weight, then you could reverse their type two diabetes, which means they never got diabetic kidney disease because they don't have diabetes, right? Or you'd reduce the risk at the very minimum.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So then I started talking to people about a couple of things. One is lowering their carbohydrates, right? And again, it's not a new thing. Like cutting carbohydrates has been around a long time. And if you look at the American Diabetes Association nutrition guidelines, the scientific guidelines, they say there's actually the most data, this low carb diet has the most data of any diet
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
for control of blood sugars. And that makes sense, right? Because if you eat white bread, you know that the blood sugar goes up. If you eat an egg, you know the blood sugar doesn't go up. So eat less of the white bread and eat more of the egg. That's sort of logical, right? And then I started talking to them about intermittent fasting. So this is in 2010, 2011.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And at the time, again, you have to remember that everybody thought it was the dumbest thing they had ever heard. Intermittent fasting, not eating, was known to kill people, right? There was so much bias against that. And I said, well, let me look at the data here. What's so bad about it really? What happens to your body when you fast?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And it's like, well, if you're diabetic, if you're overweight, if your blood glucose is high, nothing bad happens. Remember that your body has the ability to store calories. It stores calories, which is a form of food energy in the form of glucose, right? You can store glycogen, which is chains of glucose, and you can store body fat.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
When you don't eat, your body is going to start burning the glucose or start burning the body fat. And you have too much of both. Therefore, if you fast, that's all that's going to happen. And it's a completely natural process. It happens in everybody. Back in caveman days, people were fasting all the time, whether it's voluntarily or involuntarily. It's the very reason you have body fat.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's not there for looks. It's there for you to use when you don't eat. And as a doctor, I had been prescribing fasting to patients. Pre-op you have to fast, colonoscopy you have to fast, post-op you have to fast, treatment of pancreatitis you have to fast, for fasting blood glucose you have to fast.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So it's like, okay, if I'm telling people they should fast for all these reasons, then why can't they do it from a therapeutic standpoint? It doesn't make any sense, right? So I told them you should fast. And I started them on a fasting regimen and crazy. It was crazy.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I used a 24 hour fast three times a week for my patients. And that was just because, you know, at least you're eating once a day and they could take their medications if they had pills and stuff. It wasn't too much and it wasn't too little for like, I wanted to go gently. Got it. And so I had this one patient, which I wrote up as a case report. I had been treating him for like 10 years.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, it sort of followed from type 2 diabetes. So what happened from 1977 is that obesity went up. And about 10 years later, 12 years later, what you saw is a huge epidemic of type 2 diabetes, which is very closely related diseases. And so once you have the type 2 diabetes, you can develop kidney disease somewhere around 10 or 15 years into the diagnosis of type 2 diabetes.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
He was on 120 units of insulin and he was very dedicated, wrote down everything, wanted to know everything. So I told him, you should try this, right? And keep track. Within a month, He came off all his insulin, all of his blood sugar pills, and his A1C went down to like 5.9. I'm like, holy crap, in a month. And then I had three of these cases in the first six months.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I had three cases just like that. And I thought to myself, holy crap, I've actually been doing all my patients a huge disservice. I've been treating them for the last 8, 9, 10 years as a type 2 diabetic that had it for the rest of their life and would inevitably go on to nephropathy when that type 2 diabetes was completely reversible. You got to recognize that we call it diabetic nephropathy.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's like, if you don't have diabetes, then you're going to have less chance of getting the diabetic nephropathy. It happens, but it's unusual. So it's like, okay, that's crazy. All because I didn't focus on the right thing. And that's where I started really to think about both weight loss and fasting as a therapeutic tool.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, I mean, it's just another tool. You don't have to fast to lose weight. You can lose weight.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
actually a lot of different ways you can use low fat you can use low carb you can use carnivore you can use vegan they actually all work right there's a lot of stuff that works uh but it was something that people um had always done so the the funny part about fasting is that there's so many advantages from a weight loss standpoint so if you do caloric restriction
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
most people have zero idea how many calories they're eating in a day. It's actually very difficult because if you buy broccoli or steak, you have no idea how many calories are in that piece of steak or whatever. If you fry it up with butter or without butter, what sauce do you put on it? All these change how many calories you take.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So it's a complete guess how many calories you're eating and a complete guess how many calories you're burning. And the amount of calories you're burning actually fluctuates because some people try and measure it, you know, oh, I'm burning 2000 a day. Well, that actually can go up or down by like 40%. It can go up and down a lot. So you have no idea how many calories you're eating.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You have no idea how many calories you're burning. How are you supposed to actually use that as a therapeutic strategy? As opposed to simply saying you should not eat for 16 hours of the day or 24 hours of the day. Oh, well, it's very easy to figure that out. If you only eat once in a day, then that's it. You're following the rules, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So as a therapeutic strategy, it's much, much more effective. So there's a huge number.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Practically, yeah. It was something that people had never done. Like at the time I started using it, 2013, 2014, like zero people thought it was a good idea, right? I mean, it seems strange now because it became very popular. But I published the Complete Guide to Fasting and the Obesity Code in 2016. So I started using it around 2012, 2013. And there was nobody who thought it was a good idea.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Even up until about 2020 or so, people were still really against fasting.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So as you get, so 1977, you start to see this uptick in obesity. By 1990, you see uptick in type 2 diabetes. By 2000, 2002, when I'm getting out in practice, now you're starting to see diabetic nephropathy like all over the place. And it's by far and away the biggest cause of kidney disease. So the two big ones really is type 2 diabetes and hypertension.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think it's because it was not something that they had heard of before. So then people just thought, oh, well, if I haven't heard of it, it's got to be a bad idea, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
The general public was much more accepting than academics and doctors. They are the slowest to pick it up.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
They never recommended it. Or when they talked about it, it was in a, like, you shouldn't do it sort of an idea. Never skip your meals. What was their concern? I don't know that they had legitimate concerns. Their concern was that if you didn't eat, then you would binge eat afterwards, which can be a concern.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But on the other hand, if it is a problem, like it can happen, but everything has its problems. If you restrict certain foods, you don't eat sweets, which is a good idea. You might binge, right? If you don't eat chips, you might binge when you get out. Like that's the college 15, right? So there's a risk with all of that.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But the whole point is that if you think about intermittent fasting as a strategy for weight loss, it's simple, right? So everybody understands it, right? It's free. So it's not like I'm telling you to go to Whole Foods and buy like all organic, you know, grass-fed this and that, right? That's going to be so expensive, but that's not accessible. This is free. It's convenient, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You're not putting more time, right? You're not like, oh, I need to do this and this and home make all my meals. It's like you're not eating. So you're taking less time than before. You're taking less money. And you can change it up. You don't have to always do it. You can do it more this week.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And then next week, if it's Thanksgiving or if it's Christmas or whatever, you can decide not to do it and then do more the week after, right? So a huge number of advantages. But the main thing is that if you look back, People have been doing it for thousands and thousands of years. Like I didn't make it up.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I mean, you can find references, lots of references in virtually every single major religion, which means that even back, you know, 2000 plus years ago, people had talked about fasting as something which is very healthy for you. It wasn't – when they talk about fasting, my priest used to talk about it every Easter around Lent.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And he talked about fasting and purification and praying and all this sort of stuff. And I remember thinking at the time, I don't think anybody fasts. We're all told not to fast. You're the only one who ever talks about it. But clearly – It's in that tradition and you can find it in Buddhism. You can find it in Hinduism. You can find it in, you know, Islam. You can find it in every religion.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And it's not ever in a negative connotation. It's not like I'm fast. You're fasting because it's punishment for you. Right. It's a, oh, you need to fast to make yourself better. Yeah. It's always a choice. And that's the important thing because I always get this thing. Oh, it's starvation. No, no. fasting is the voluntary abstinence of food.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You could eat, but you choose not to eat for whatever reason. It could be religious, it could be weight loss, it could be whatever. But the point is that if you fast, if there's something wrong with fasting, like wouldn't we have figured this out like 2000 years ago?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think it's a legitimate point because it's like saying that, you know, it's a tool, right? Fasting is a tool just like everything. Low carb is a tool. Low calorie is a tool. Everything's a tool, which means that it has the ability to hurt you and it has the ability to help you. But you have to know how to use it. It's like a knife, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It can kill somebody or if it's a scalpel wielded by a surgeon, it can cure somebody, right? It's the same knife. You don't ever say, oh, knife, bad. Must not use knife. It's like, okay. Maybe hammer's a better analogy for that one. But you know what I mean, right? So fasting, yes, there are definitely problems. That's why you need to know about it and know how to use it.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So both of them are related in some way because they're very much metabolic diseases, they're related to weight and so on. And to lifestyle. And to lifestyle, exactly. And the point was that around 2008, 2009, I realized that as a nephrologist, As a medical profession, we had been thinking about this completely the wrong way.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And fasting does not mean 40 days and 40 nights, right? It can be any length of time. You think of the very word breakfast, right? Breakfast, it's the meal that breaks your fast. If you don't fast, you cannot ever break your fast.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So therefore, even from the beginnings, the origins of the English language, we acknowledge that there's a period of time that you should be feeding and that's when you're gonna store calories, right? Insulin goes up and we know the physiology has been so well worked out. You eat fast. And assuming you're eating a variety of foods, your insulin is going to go up.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You're going to store calories because you eat, say, a thousand calories.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Exactly. You can't burn it off. So you need to store some of it. Why? Because you don't want to die in your sleep. So you store it. Then when you fast, when you're not eating after dinner, 12, 14 hours, your insulin is going to go down. Now you're going to pull those calories back out. So you fast from, say, dinner, say it's 7 p.m. to 7 a.m. That's a 12-hour fasting period.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Then you break your fast. Or if you don't eat breakfast until 10 o'clock, you sleep in. It's 10 o'clock. You're talking 13 hours. And people did that every single day without calling it a fast. Then all of a sudden in 2019, 2020, it's like, oh my God, you shouldn't be going more than six hours without stuffing your face, even to lose weight.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, so I think there's some truth to that, but the whole calories thing is a whole other debate I have. with people. So one is that it is a way that you're going to eat fewer calories because it's actually harder if you compress the time that you're eating. And there's lots of studies to back this up. It's harder, right? If you take three meals- And harder to absorb. Yeah, exactly.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So a lot of it's going to pass through. But if you compress the time you eat, it's harder because you get full. Of course. Right? So you can't eat three meals at one meal. It's very difficult. Less snacking. Less snacking. So the compressing it does make you eat fewer calories.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But I think there's actually another benefit to it, which is the hormonal benefit, which is what I talk about a lot because it's like, to me...
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
the idea that it's all about calories is highly destructive because it leads, I think, in one sense to this sort of blame game, blaming the victim, where it's like it's all calories in, calories out, and therefore it's all your fault if you're overweight, you should eat less or you should exercise more. That whole idea is this whole idea of fat shaming and all that stuff.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think it's a little bit... a little bit destructive because I don't think that it comes down all to calories. I think that it also depends on the hormones, primarily insulin, right? You need to lower insulin in order to lose weight. How do you lower insulin though? There's lots of ways. Less calories will definitely do it. But the point is that there's an overlap between calories and insulin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But certain foods raise insulin more than other foods. So if you eat a cookie, like 100 calories of a cookie, your insulin is going to go way up. If you eat an egg, it's not going to go way up because it's mostly proteins and fats.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So when people develop their type 2 diabetes, we give them medications such as insulin. They gain weight. But we didn't actually change the course of the disease. And that's in 2008, 2009, several very large trials, the ACCORD trial, the ADVANCE trial.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So the idea that you can take two 100-calorie portions, so 100 calories of cookies, 100 calories of egg or broccoli or something like that, and the people who say it's all about calories will say they're equally fattening. Because they're both 100 calories. I'm like, there's no way they're equally fattening, right? Because they're different. This one will spike your insulin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Your glucose will go up. The cookies, your insulin will go up. Your glucose will go up. What does the insulin do? Well, we know what insulin does. It tells your body to please store those calories as either sugar or fat because that's the way it is. So you take 100 calories of cookies. Insulin goes up. You store those 100 calories directly into glucose or body fat.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, there's nothing left for your body to use. So you're still hungry. So you go out and eat, right? If you eat an egg, well, the insulin doesn't really go up. So it's still circulating around. You've still got a hundred calories.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah. Yeah. Yeah, the thermic effect of food is relatively small. But clearly those two foods have very different insulin profiles, right? We can measure it. You can do a glycemic index, right? Easy as pie. One of them is very high. You eat white bread, glycemic index of 95%. You eat an egg, glycemic index, zero. So insulin, which follows fairly closely for that, is going to be the same.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
There is going to be some insulin rise with protein, but protein tends to raise both insulin and glucagon. But either case, a lot less insulin than white bread or cookies or something. So to pretend that change in insulin makes no difference to people, why would we do that, right? I'm not asking if the two are equal calories.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
We're setting the two as equal calories, but the minute you put them in your mouth, your body is going to respond very differently in terms of the insulin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
and the VADT came out, all of it showed that if you control the sugars, the blood sugars, by giving lots of insulin, then you actually don't change the course of the organ damage. So you're not slowing down the kidney disease or heart disease or mortality in any significant way.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Uh, well, there's also no trials that have shown that if you reduce calories without affecting anything else, that you can actually lose weight in the long term. So all of those studies, like Women's Health Initiative, you know, like DPP, they're all like, you know, a kilo of weight loss over like six, seven years.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You see, I have a different opinion. See, again, I think there is a difference in terms of eating behavior. And you alluded to this, right? So if you eat two slices of white bread and jam, so all refined carbohydrates for breakfast. Right. And, you know, there was a study in pediatrics. Dr. David Ludwig did this.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
He had people taking instant oatmeal, actually, which is a high glycemic index, and steel cut oatmeal, which is a medium glycemic index. So he gave these to any, you know, the two groups would switch afterwards. So it's not the people.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
He gave them the same calories, same carbohydrates, in fact, the same food, even oatmeal, just differently processed so that they actually have different glycemic index. The glycemic index or the high glycemic index, the instant oats, was like double that of the steel cut oats. Then he tested them and said, how much do you eat at the lunch afterwards? They ate like 30, 40% more.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So the point is that you don't eat because you're trying to fulfill a certain caloric quota or whatever. So it does come down to the calories you eat. But what determines how many calories you eat? It's how hungry you are. So if you're eating certain foods that are going to leave you hungry, then you're going to eat more. And that's the whole point.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
If you're eating these high insulin foods like refined carbohydrates, a lot of that's going to just get sucked into storage, which is going to leave you wanting more. So when you're talking about eating behavior, you're going to wind up naturally eating more calories. Yes, you can artificially try to, you know, keep all the calories the same. And that's what they do in these metabolic warts.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But that's not real life, right? It's like I used to tell people like for decades, you know, you got to count your calories and all this. It doesn't didn't help with like barely a single person. Like I look at these studies like the Women's Health Initiative where they had like 300 calories less per day for like seven years.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And the difference between the usual diet and the low-fat calorie-restricted diet, 300 calories per day for a year should equate to about 30 pounds less.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
True, but the actual weight difference at the end of seven years was like a quarter of a pound, right? Usual diet between, and these people are followed, right? They're not just like they're, you know, people are measuring what are you eating and trying to calculate how many calories are you eating. They reduced 371 calories per day, every day for seven years.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah. So we all learned, like I learned, so I went to school in the medical school in the 1990s. So we all thought that the sugar in the blood was what's causing all the problems. The sugar in the blood causes glycation end products, which would cause... atherosclerosis, which would cause heart disease, kidney disease, and the whole rest of it.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And by the end of that, they weighed a quarter of a pound. So somebody who followed their usual diet might weigh 200 pounds. A person who followed this calorie-restricted diet weighed 199.75.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Both groups actually dropped. So if you look at, and that's probably just an effect of time. As they got older, both groups actually ate less. But the difference between the two groups and the Women's Health Initiative, and that was published in JAMA in, I think, 2007.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Agreed? 300 calories per day? They didn't, though. Compared to the usual diet group.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
No, because all the studies show you lose weight for about six months and then that weight always comes back up, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
No, metabolically something does happen. When you lose weight, the metabolic rate goes down, right? So the weight loss slows.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
No, actually, so there's been multiple studies on this. So even in 1991, they did a big meta-analysis on this. They did 29 studies. And they looked at it and they took all the studies about 10% to 20% reduction in calories. So, you know, 300 calories a day sort of thing. And then when they looked at the metabolic rate, the reduction was about 10% to 20%.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So if you're eating 10% to 20% less calories, but burning 10% to 20% less calories in response to that, well, you're not going to lose weight, right? You're eating 20% less and burning 20% less.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Oh no, I've seen it. Because people have come to me and they've done the studies and stuff, they wanted to. I have people who are like at 800 calories a day. They're barely burning any energy. And that's why they don't understand. I'm eating 1200 calories. That's like your metabolic rate.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, but if you look at the metabolic rate, so Rudy Leibel did that study where he sort of
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
adjusted people gave them a diet made them gain weight and looked at their metabolic rate it went up and then when he got made them lose weight their metabolic rate went down so it's clearly in response so that metabolic rate if if you don't look at anything other than calories what happens and virtually every study has shown this that as you start to lose weight your metabolic rate starts to come down almost in lockstep right even those bigger biggest loser studies right
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So the idea was we should give people lots of insulin, get their blood sugars down. And so that was the trial, a big NIH trial, multicenter, randomized control trial, three different ones actually. And what they did was they looked at giving people lots of drugs to get their A1Cs down, which is a measure of the blood glucose.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah. That's strange. I actually didn't see that.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think that the human body has to self-regulate the amount of body fat because if you think about it, like the average person will gain about a pound a year, right? That's the average weight gain of an American and European. It's about a pound a year, right? So that's 3,500 calories. Most people are eating around 3,000 calories a day. So your accuracy rate of – this is the whole population –
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
most of whom are not counting their calories and most of whom's caloric variation is huge throughout day to day, right? It's like 99.8% or something like that to consume 365 days of 3000 calories. And then at the end of the year, only be off by 3,500 to have gained that one pound with Christmas and Thanksgiving. All in between means that your body has to be regulating how much body fat you have.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
That's why it's so difficult, right? Because if you try to now artificially turn that to lower your weight, your body's going to resist it by making you more hungry or reducing your metabolic rate. And the question is not then how do you adjust your calories, but how do you adjust that so that the body sort of adjusts your body fat to the correct level?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, the average American gains a pound a year, which is 3,500 calories, roughly. A pound of fat is about 3,500 calories, right? So that means the average American or European has matched their caloric intake to their caloric expenditure to a sort of 99.8 or 9% accuracy rate without counting their calories or knowing how many calories they're burning.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And sure enough, you could drop their A1C from about eight to about seven, six and a half, something like that. But the thing was that that's not what they're interested in. We knew we could get that blood sugar down. What we wanted to know was whether we could slow down the heart disease or the kidney disease or the total deaths. Turns out it wasn't effective at all.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think, you know, to me it's about both the calories, but also about the insulin, not just insulin, but the sort of hormonal effects of the foods that we eat. Because to me, I see food as containing two things, right? It contains the energy, which is the calories, and it contains certain information. So you eat a food,
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
your body reacts to it by producing hormones, which then translate what you're telling your body. So if you produce, you eat a food and it produces, you produce a lot of insulin, your body is going to respond differently than if you eat like lean chicken breast So you eat cookies, for example, your insulin is gonna spike way up. You eat chicken breast, same calories.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Your insulin is not gonna spike up, but your GLP-1 will spike up because the protein actually tends to raise GLP-1. Or you eat a really high fiber lentils or something like that, right? All that fiber gets into your colon, which produces short chain fatty acids, which stimulates GLP-1. So you eat all that fiber, you got stretch receptors, you got GLP-1s, you're gonna be full.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So those two are very different to me So all I'm saying is that you have to account for the hormonal effects of the food, which means that some foods are more fattening than other foods, right? Which to me doesn't seem like a huge leap, but that's really all I'm saying. Like you have to consider more than just the calories.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
because the foods affect the hormones, the insulins, the GLP-1s, the stretch receptors in our stomach, the peptide YY, all of those things.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, that's not much of a difference.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I hope so, because to me, I think both things are very important, right? So 100 calories of lean protein is different than 100 calories of refined carbohydrates. Like to me, that's just obvious. But I don't know, a lot of people come, like they come at me and they go, the calories, the calories, it's all calories. It's like, it's all the insulin fairy. Like, it's like, no.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So if your sugars were quite high and you didn't treat it, it was basically the same as if you did treat it, which was a huge, huge shocking sort of thing. So this was the ACCORD study. In fact, those who got the insulin and the tight glucose control did worse. They died at a higher rate, which was completely opposite from what we thought the result of the trial was going to be.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, because it has a physiologic role. That's all I'm saying, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yes, we'll agree on that. To varying degrees. But they've done those studies, right? And the thing is that you will gain weight, yes. But then when you stop the study, what happens is that your weight just goes right back down, right? And they did these studies. What do you mean it goes right back down? So Ethan Sims did these studies in the 1960s and another researcher, I can't remember.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You're saying it's not lasting weight gain if I get it through protein? Yeah, so do you remember this? So Ethan Sims in the 1960s. I mean, we're going way back. Yeah, so this is very interesting because he was trying to get mice to gain weight and he couldn't do it. The mice would eat a certain amount then stop and they wouldn't go and become obese. So he thought, okay, well, this is very strange.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So then he got college students. So he went to Vermont College and he got college students and said, I'm gonna do a study. You're gonna come, you're gonna eat and you're gonna gain weight. That's all I want you to do. They're like, no problem. I'll just eat. They couldn't do it. They couldn't eat too much and gain weight. They couldn't gain weight.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So he said, okay, well, maybe because they're exercising more or something. So then he went to the prison. This is before they had like ethical reasons. You can never do this now. So he got these prisoners and he basically forced them to eat and restricted their exercise. And it turns out that he did eventually get them to gain about some weight, 10 to 25%.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But they had to eat like 8,000 to 10,000 calories to do that. Their bodies were fighting it every step of the way. So he got them to gain the weight. Like it's a lot harder than people thought. He was actually stunned. And then at the end of the study, he said, okay, fine, you're done. Just eat whatever you want. Their weight actually fell right back down within like two months.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
They went back down to their normal weight with no, they weren't trying to lose weight. They just stopped eating. So there's natural mechanisms to do that, right? So it will gain in the short term, but what happens in the long term in those studies-
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think it's that your body has a natural set weight, which is sort of determined, and you can artificially push it up, but your body will eventually lower it down. So we know that, for example- Eventually based on what timeline or- So in those studies, it was like two months.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, it's a good question, right? Because I think that what happens is that in those situations where they artificially made them gain weight- So those people, their fat cells expanded, right? They gained weight. They're eating 8,000 to 10,000 calories. Their fat cells then produce leptin. Leptin causes anorexia. They stopped eating. So then they lost all that weight.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So there's hormones that will push your body weight upwards like insulin. You give somebody insulin, they gain weight. And there's hormones that will push it back down. So leptin did in that case. Obesity mostly is a leptin resistant state, but GLP-1 also pushes it down. So I think the point is that the changes in the diet, in the American diet from like 1977, where it started to spike up to...
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
you know today there's been such a change in the diet that has gradually been pushing it up and a lot of it I think has to do with the processing of foods which tends to make foods like it sort of hijacks the brain, right? So if you eat natural foods, it's very hard to overeat those foods. Why? Because we have natural satiety hormones, because it all comes down to hormones.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So you eat, for example, beef or steak or chicken. You eat that. Well, can you keep eating it until you explode? No, there are restaurants that will give you a free steak if you do that, right? No, but they're not giving away a lot of free steak. Why? Because the peptide YY goes up, the cholecystokinin goes up, and these satiety, the GLP-1 goes up.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
The problem was that people didn't change their practice after that, but I thought it was actually very striking because it wasn't one trial. It was three large, randomized, multi-center, randomized control trials that showed the same result.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
These satiety hormones are so powerful that they basically stop you from eating. So just like if you eat a pork chop at a big buffet, then you're so stuffed. And somebody says, here, have this pork chop. You're like, oh, I'm gonna throw up. It's the same pork chop, but the difference is that your hormones are on full satiety.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
The difference with ultra processed foods is that you're taking away all those satiety signals. You change them into ultra refined carbohydrates. So there's no protein, there's no fat. So there's no peptide YY, there's no cholecystokinin. If you eat a bulky meal like lentils or something or beans, Well, your stomach fills up, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And your stomach stretch receptors sends through the vagus nerves, tells you stop eating. Just like if you have a bezoar or something, right? You have to stop eating. So big volume, high fiber foods are gonna do that. Other foods like the GLP-1s, they're going to slow down your gastric emptying rate. We know that. So you eat lots of protein, gastric emptying rate's going to slow down.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Fiber, it gets fermented in the gut, becomes short-chain fatty acids. GLP-1 goes up, slows down the movement of the gut, right? So if you're slowing down the gastric emptying rate, stomach stays full longer. You know, you're activating those stretch receptors. So natural foods is very hard to overeat because you have protective mechanisms against that exact thing.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because you have to, you know, people always say, okay, body, you know, body fat, we're designed to store fat. And now that calories are easy, we must gain fat. No, that's absolutely not true because no wild animal becomes obese. Why? Because if you're fat, you can't, catch food and you can't run away from predators. You're gonna die if you've got too much body fat. So body fat is regulated.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Eating behavior is regulated.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, I think that's true. I mean, obviously, it's better not to be in this situation we're at now. But that's what I mean. It's like it all comes down to the hormonal effects, which is why it's important. Because if you eat foods that are hormonally, you know, not the insulin spikes, lots of, you know, satiety hormones, then you're not going to overeat. So it's not about the calories per se.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
it's what's driving the calories to go above like you know people say body fat equals calories in minus calories out that's always true that's not what i'm debating i'm saying that it's the difference in hormones that's driving the calories in above the calories out which is a behavior it's which is a behavior so you're saying calories in calories out plus behavior
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, the behavior is what drives the calories in, calories out, right? So if you eat ultra processed foods, you're not getting any satiety signaling, you're getting a huge insulin spike. So therefore you are going to wind up eating more calories. So you can't just say eat fewer calories is the solution any more than you can tell somebody you're a heroin addict, take less heroin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Like that's not helpful, right? Let me deal with the addiction because that's your problem, the heroin addiction. Let me give you counseling, let me do this. You can't just say, you know. Well, do people just say that? I don't know. A lot of people say that to me. Because whenever I talk about, I keep, because I always think about the hormones.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I always think about how they're important and how you can change the hormones, right? And fasting is really a way to change the hormones. You're dropping insulin in the sort of fastest, most direct way. If you eat nothing, because you can't go less than zero, fasting goes to, you know, drops your insulin. But there's tons of people who come back to me. It's all about calories.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's only about calories. It's only about, I'm like, okay, well,
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Oh, I never tell patients all this. What I tell them, because the insulin to me is, I like to think about this stuff, right? I like to think about what's happening, what the hormones are, but patients don't need to know any of that. What I tell them is you should- There are a lot of people who are actually very interested in it. I will say that.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But, you know, when I'm just telling people what to do, I don't say count your calories any more than I say count your insulin, right? Both are horribly, you know, not practical, right? What I do say is that- Why do you think counting calories, I guess you mentioned that it's not super accurate and hard. It's inaccurate.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Clearly it's like all the, so you can get only a calorie count on processed foods. Any food, like you buy a head of lettuce, it doesn't come with a calorie count, right? So you have to guess. Yes, you can weigh it, but that's not sort of most people don't weigh all their food. How you cook it is going to be important.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So now you're going to have to not only count how much broccoli you have, but you have to count how much butter you're putting in.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, the acute things for DKA for sure. But no, if you had an A1C of 8% versus 6.5%, no difference in mortality whatsoever. In fact, maybe, according to one of the studies, but not the other two, maybe even a higher mortality. So in fact, a lot of the guidance prior to 2008 was a target A1C of 6.5 actually. That all changed to about 7 to 8 is considered acceptable now.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Do you disagree with that? I think it could work. I think it could work. But I actually tell them to eat natural foods, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Try not to eat anything out of a box or anything and only eat at certain times that you designate. Right. So stop with all the, you know, snacking. You can have this. And I think this is one of the things that really makes it difficult is this idea that you can eat whenever you feel like. Right. Never skip a meal. You have, you know, mid-morning snacks. You have after school snacks.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You have bedtime snacks. And you can eat anytime you want. I'm like, no, no, no. What you want to do is eat natural foods to the best of your abilities, eat until you're full and only eat at those times. Any other time, don't eat. So if you're hungry in the middle of the night, you don't eat because that's not what we used to do in the 70s. It's it's it's a simple rule.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Once you establish the eating structure, then people can follow it. Right. Rather than saying I need to get to 2000 calories. This is what I don't know. But this is how a lot of people see it. I have 2000 calories for today. Right. I'm going to take a little here and then I'm going to look here and I can eat whenever I want and I can eat whatever I want. as long as I get to the 2000 calories.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's like, well, that's not all that, like it's not an intuitive way to eat, as opposed to saying you eat breakfast, you eat lunch, you eat dinner, you don't eat snacks, You don't eat after dinner and you're only eating at a table real food, right? Because people eat foods. They don't eat calories, right? That calories is sort of that extra step.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So while I don't doubt that counting calories could work, it's this sort of artificial structure. And sometimes it's not good because if you eat, you know, and I've seen this. I read this in a book actually by some doctor. You can eat ice cream for dinner instead of steak because they're the same calories. It's the same thing. I'm thinking, is nothing the same thing?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Like, how can you think they're the same thing? Eating ice cream and steak is different.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Calorically they were the same and they were making the point that they're exactly. But like health implication wise, they're not exactly the same. Exactly. That's what I think. It drives me crazy because it's like, yes, they're the same calories. I agree with you on that. but the health implications are vastly different. You have to think about what happens next.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
If you eat ice cream, clearly you're not gonna be as full as if you ate a thousand calories of steak. A thousand calories of ice cream does not fill you up. Therefore you're going to go out and eat more because you're hungry, right? That's just what's gonna happen. So is it come down to calories? It does in the end, but it comes down to the behavior.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You said that eating those thousand calories of ice cream was the same as eating the thousand calories of steak, but it wasn't. Now you're fighting hunger all night because you ate ice cream for dinner, right? And to me, it's like, that's not helping people. You have to help people by saying you need to eat
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Good food, like two foods can be the same calories, but have different effects on the overall eating behavior, therefore on the overall fattening experience. Now, if you artificially in a lab, say you eat a thousand calories of ice cream, you eat a thousand calories of steak, and then I'm gonna track your weight. Yes, they'll be the same. But that's not how real life works, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And I'm only interested in real life because my patients live real life.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It didn't make a difference. And there's a good reason why. And it's because their understanding of type 2 diabetes was fairly rudimentary. They didn't focus on the weight loss part of it. You know, this is the thing that struck me as crazy. So at the time, of course, there were not the same number of medications. We treat people with insulin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, let me give you a different situation because, you know, people always say energy or body fat equals calories in minus calories out, right? And that's always true, but that's not the way it always works, right? Because that assumes that the calories can go in and out of the body fat, which is the storage, right? anytime it wants, but it can't, right? So you think about your fridge, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Your fridge is a store of food. So you go to the grocery store, you buy food, you store some of it in the fridge and you eat some of it, right? So if you have extra food that you bought, you put it in the fridge. If you didn't buy so much, you take it out of the fridge, right? But what if there's a lock on that fridge so that sometimes you can put the food in? Is the fridge like fat stores?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, the fat stores. So sometimes the fat stores, you can only put the calories into storage. And sometimes you can only take them out of storage, right? Yeah. That changes everything. So let's take the situation, 2,000 calories in, 2,000 calories out. So you're even, right? Body fat doesn't go up or down. Now you want to lose weight. So you cut it down to 1,500 calories, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So 1,500 calories going in, 2,000 coming out. What happens to body fat? Well, what if you eat very high insulin foods, you're eating refined carbohydrates all day long, insulin's up.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, exactly. You're able to. Exactly. So insulin's up. Well, what happens? Well, you cannot take energy out of those fat stores because insulin... It's a storage hormone.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
No, but if you're eating every two or three hours, which is what a lot of people used to say, right? Eat eight times a day, eat snacks.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think it's probably from more like five, six years ago, people used to say that a lot. Like a lot of dieticians used to say, eat, you know, every two hours, eat something, keep those metabolic fires stoked. I don't know if you've ever heard that, but I heard that a lot. But say you keep insulin high, right? So this is just a thought experiment.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, a steak can, although it also spikes glucagon, so therefore glucose doesn't go up.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, yeah. But I mean, as I said, it's just a thought experiment, right? So suppose that you keep it high, like by whatever, right? Say you're just taking crackers.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I don't think so because certain foods spike it really high, right? The refined carbohydrates, right? So every two hours, you're eating like a slice of toast or crackers or something like that. That's a lot.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So you're saying that if you eat 1500 calories, your insulin has to go low.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
If you're eating the same foods at 1500, it's going to be lower than 2000.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, I mean, if you look at, like there's a huge difference. So in that David Ludwig studies, he compared an omelet to the instant oats, same calories. The spike is like, you know, four times higher with the instant oats. So the high glycemic index, like you can get way higher spikes. It's not like a little bit higher, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And so what happens when you give people insulin, right? So you have a type two diabetic, their A1Cs are high, you give them insulin, what happens? They all gain weight, right? It's just universal. So patients would go out, I'd give them insulin, because I followed those guidelines, and they gain weight. And as they gained weight, their diabetes got worse, right? Because that's what happens.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So even if you cut your calories, but change your diet so that you're eating all high glycemic index refined carbs, you can keep your insulin pretty high, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, if your insulin stays high, and you can get this also by injecting people with insulin or if they have a lot of insulin resistance, right? And this is where it comes down to if you have a lot of the insulin resistance and the hyperinsulinemia that goes along with it, then it's actually really hard to lose weight, right? So say you have the insulin resistance then. Insulin levels are high.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, what does insulin do? Well, insulin inhibits lipolysis. It also inhibits glycogenolysis. So that's well-known. That's sort of first-year medical student physiology. It means that when insulin is high, you're telling your body you want to store calories. You don't want to pull them out. And you can't do both at the same time. So if you're taking 1,500 calories coming in,
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
2,000 that you want to burn, but insulin is high for whatever reason, you can't get any of those calories out of your fat stores. So their only way to balance the equation is for your calories out to drop to 1,500.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I don't know about the biggest loser study. Some of the ones that I saw were actually down almost 1,000 calories. I've never seen 1,000.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
In one of it, that was in the New York Times. They had this graph of that guy they profiled. Anyway, his dropped, I think, from 3,800 to 2,900 or something like that. It was quite a bit.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Total energy expenditure. Not the basal metabolic, the total energy expenditure. Okay.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Uh, well, in this thought experiment, if you can't get any of your calories out of your body fat, that's the only response that you have, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, but you're not going to because if your insulin is high, say you have high insulin resistance and insulin levels just very high, you can't get the glycogen to break down.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, and this is why I recommend fasting a lot because it's trying to drop it as much as you can to overcome that insulin resistance. Drop what? Well, during fasting, you're going to drop the insulin levels as low as you can, right? Because you're not taking anything, right? Because there are other things protein can stimulate.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
As their diabetes got worse, you had to give them more insulin, which made them gain more weight. And they all knew this because it was happening to them. And they kept saying, you know, what are you doing to me? Like, why are you giving me this insulin that's making me gain 20, 30, 40 pounds? I didn't really have a good answer.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, but then over the 24 hours, that's the comparison, right? What's your insulin over that 24 hours?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, I think it's the total insulin effect. I mean, to me, it's like... And if you give somebody insulin, they gain weight. And it doesn't matter so much how much willpower they have or anything. It just always happens. So therefore, to me, it's a causal factor.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
No, they've actually done the study. So they did this study. And actually, that's not true because they did this study. This was about 10 years ago. where they actually gave people insulin. So type two diabetics, they gave them, they went from, it's a six month study. They went from zero units of insulin to a hundred units of insulin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And the idea was that you should give people lots of insulin to get their blood sugars down. So they reduced their calories. So they went from zero to a hundred units of insulin over six months. And when they measured the calories that they were taking in, the calories went down about 250 calories. This was from Henry.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
They weren't controlled because it was a six-month study.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, because of, yeah, they told them not to eat so much, you know, for all this stuff. So they gave them general guidance. They gave them general guidance, right, to maintain your weight. But your insulin went from zero to 100 units a day. Mm-hmm. And your calories went down from about, I think is around 2000 to like 1800 or something like that, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So the question is, which one is more important, right? If the insulin is more important, they'll gain weight. If the calories are more important, they're gonna lose weight, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
They're not, 100 units is a lot for sure.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But the question is, if it's all about the calories, they're eating 200 calories less per day. They gained 20 pounds.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, I mean, they don't report that in the study because of course they only counted the calories.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, I think that- Besides the behavior component. Yeah, the behavior component, I think, is actually very important. That's where the metabolic studies don't really give us insight into that, for sure.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But the point was that the insulin wasn't doing anything good for them. They're actually hyperinsulinemic. We know that those people had too much insulin, yet we're treating them with more insulin. which was making actually the underlying diabetes worse because they're gaining weight, so their diabetes was getting worse and we knew it was getting worse because we're giving more and more insulin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, in this study, for example, on average- But that's not a randomized controlled study, so it's like- Oh, no, no, it's not a randomized controlled trial, but- And you can't do it over six months because over six months you will lose weight.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Like every weight loss study has shown over six months you're going to lose a lot of weight, then you're going to regain it one year, by two years, by five years, it's going to be virtually the same. And that's why it's hard because if you do a randomized control trial, and there were a few on low carb diets, remember the shy study, and there's a few other ones that showed some minor differences.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
To me, there's clearly something more than just the calorie story. Like in the end, I don't think we disagree as much as it comes out to because we're sort of arguing around the periphery. Like everybody sort of agrees that, yeah, don't eat cookies. eat chicken, right? Because as I said, the ultra processed foods are the issue, the satiety of it all, the behavior of it.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Exactly, the satiety and all that, those sort of things. In the end, it probably doesn't make as much difference as we say. It's more about the mechanism of how it works, because I think the hormones The hormonal impact of the foods that we eat does play a role, whether it's insulin or GLP-1s or peptide YY or cholecystokinin or gastric stretch receptors. Or one we haven't named yet. Exactly.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because fiber, for example, fiber has no nutrients. So why is it important?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Exactly, it plays a role. Baroreceptors. Baroreceptors and- Slowness of gastric emptying, absorption. Same thing with, you can do the same thing with, I can't remember what they did, glucomannan or something like that. It forms like this gel inside the stomach and then it slows down the gastric emptying, which made a difference, right? And various, there's lots of studies. But in the end,
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
it's not necessarily just the calories, right? That's all I'm saying. It's not just the calories. There's other factors, whether it's stretch, volume, right? These volumetric diets. I think they can work.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
On a practical level, I don't think so. Although I have heard a lot of people tell me that it's all about calories. Calories is everything. And maybe they don't say that much anymore.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, but I think, I agree with that. Although I'm not 100% sold that it makes no difference because if you give somebody 100 units of insulin and reduce their calories by 200, they'll still gain weight.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Like you're giving way more insulin and taking up so many calories. Yeah, but if it's all about calories, if it's only about calories, they should lose weight, but it's not, right? Because clearly that huge dose, and I agree with you, that's a huge dose, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
That huge dose of insulin has told their bodies to slow down their metabolic rate enough so that that 1800 calories, they're gonna gain weight, right? That's the only way it can work.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Oh yeah, and the magnitude is different, but there's plenty of people. I mean, I guess I hear a lot of critics who are like, no, insulin doesn't make any difference at all. I'm like, yes, it does, because it has an effect on the body, just like GLP-1s have an effect, just like all those other hormones. Fiber has an effect.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think all of those things are important and shouldn't be – like I think – as I said, I think it's just – we're just sort of around the peripheries of it. In the end, it's still about eating the right things. But – Eating less. Because that's what time-restricted eating ultimately accomplishes. But it's also about eating less of the right foods, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, exactly. And it's like you're going to eat less junk food. You don't want to eat less broccoli.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Highly processed. Yeah, exactly. And I guess it's sort of, because I hear a lot of this, it's all about the calories. It doesn't matter what the food is as long as the calories are the same, right? I hear that a lot.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah. And even then it's only in the short term because I think that what happens if you eat you know, less calories, but all ultra processed stuff. I think it makes a difference. I don't, I think you're going to gain weight actually.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I don't like that. This is actually a really important topic. You have food addictions, food cravings, emotional eating. And I think that sometimes that gets lost in the, oh, it's only about calories. And this goes beyond the hormones too, right? It's not just about the insulin. It's about why are we eating, right? Because that's the point.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
If you say we're eating too much because it's more than calories out, right? That's why we're gaining weight. Then why is it that you're eating? It could be that you're hungry, but it could be something completely different. You could be craving it. You could be addicted to it. And if you are, you know, and I think this happened a lot during COVID.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
If you're a little bit dysthymic or depressed and that Snickers bar makes you feel better, Because the sugar sets off dopamine. Sure. You're going to eat that Snickers. You were never hungry. Yeah. It was the- For sure.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And the stress plays a role and the sleep plays a role. And that's where I'm always like, no, it's not all about calories. It's what's behind the calories, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Their blood sugars do better.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah. Yeah. And people will always do that, I suppose, because it's, you know. I won't. I promise I won't.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
This is about bringing the conversation to show how much we agree as opposed to that there's disagreement. And it's, you know, I always think of the calories as sort of the proximate cause. That is, it's not that calories in is greater than calories. I'm not, I'm not. denying that calories in is greater than calories out. I'm interested in why the calories in is greater than the calories out.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Is it because the foods that you eat are not setting off the right signals? Then to me, you got to eat the foods with the right signals, whether it's GLP-1 or insulin or whatever. Is the reason your calories in is greater than calories out because you're addicted? Then you need to deal with the addiction. Is it because you're stressed? Then you need to, is it because you're not sleeping?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Is it because you're working night shift? Is it because you have cravings? Is it because you're depressed, right? Then deal with the depression. Don't just say, eat fewer calories, which is sometimes, I guess, maybe I see these clickbaity things. It's all about calories, right? And it's like, no, no, no. It was about, It was about addiction.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It was about cravings that caused the calories in to be greater than the calories out, which led to the weight gain. So to get back to the actually treating the person, deal with the food addiction. Yeah, the food drive of it all. Exactly. Because we eat for different reasons. And some of it is habits. because if you're- Or cultural or socioeconomic or all these factors.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
No, it didn't reduce. So this, remember, first it's 2008. So there's GLP-1s and SGLT-2s, which I agree are actually quite good medications because they cause weight loss as opposed to weight gain. But the sulfonylureas cause weight gain and the insulin causes weight gain. So the idea in 2000- Metformin also causes weight loss as a side effect. Yeah, a little bit. It's sort of weight neutral.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Exactly, because if you are in the habit of eating six, seven, eight times a day, you're gonna want to. If you think it's normal to have cookies in the middle of the day and the board meeting, then you're going to. But you didn't need to, you never needed to. But yes, it's going to make your calories in greater than your calories out. But what was the problem?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
The problem was the environment that made it normal for you to do that. But definitely not the insulin. Well, it plays a role. Sure, of course.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, I never say that. People say that actually.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think that there's some data that says that if you look at the insulin effect of the food, it's actually different depending on what time of the day you take it. So if you eat the same food at 8 a.m. versus 8 p.m., same food, same portions, everything, you actually get much more insulin effect of it due to the circadian rhythm.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So you know in the circadian rhythm, you get this before around 5 a.m., you get the spike of cortisol, growth hormone, and so on, which is actually going to antagonize the effect of the insulin. So maybe when you do that, you get less of an insulin effect.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
effect in the morning maybe that's it but you get more of an effect also some insulin sensitivity because of fasting overnight yeah it could be certainly but there's that there's you can look at natural circadian rhythms in terms of uh hunger so if you look at take a bunch of people just say how hungry are you and just aggregate the data people are hungriest at 8 p.m and least hungry at 8 a.m so if you're going to skip a meal you first breakfast versus dinner if you skip
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's not as good as GLP-1. Of course, yeah. For sure. But metformin is the only drug at the time, right, that was really any, like it was weight neutral. At the time, you had metformin, sulfonylureas, and insulin, right? So by the time you got through metformin, which was what virtually everybody by the time they saw me,
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
breakfast, that's a time when you're at least hungry. So it's easiest, but you weren't going to eat that much anyway, because you're not as hungry, right? As opposed to skipping dinner, which is generally a larger meal. Then for the amount that you skip, you're getting, you know, more insulin effect that dinner. So you're better off skipping that one if you're going to lose insulin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And if you're eating early, you still have a chance to sort of burn it all off.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah. Yeah. Cause people ask me, should I skip breakfast or dinner? So, so really I think it's like so individual. Yeah.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, exactly. And, and, and what I say is that skipping dinner, probably physiologically, um, is better for you because you're gonna skip, like dinner tends to be bigger, right? Than breakfast. So if you skip dinner, you're gonna skip more, right? But practically, it's not easy to skip dinner all the time because that's the most social of all your meals. Right. Right. That's when you go out.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
That's when you have your kids. That's when you have your family dinner. So skipping dinner socially, you pay a huge price if you do that all the time. And if you're not going to if you make it hard to fast, you're not going to do it. Whereas skipping breakfast is actually dead easy. Yeah. Because most people don't care.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And I did that for years, not because I wanted to lose weight or anything, just because I was in medical school. I was tired. I wanted to sleep. So I just had coffee. Boom. That's it. And then I went through to whenever. And honestly, the funny part about fasting is that people are so against it. But then in 2015, 2014, right? Not now, not now.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But, you know, it's funny because the doctors where I say, oh, yeah, I used to do that all the time is to skip, you know, go days without eating. Right. Because I was just too busy. And then I wanted to sleep. Right. And it's like, it's funny. But, yeah, I mean, if, you know, depending on where.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But it is very individual because if you're going to do skip dinner and it's going to really take a toll on your social life. then no, you might be better off skipping.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Oh, absolutely. It's what habits. And that's another thing we never talk about. People don't talk about this enough, but the habits are so important because the habits you put down are what drives your behavior day after day without thinking about it. So you look at the habits like brushing your teeth. You don't have to think about it. You just do it because it's a habit.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So if your habit is only eating two meals a day, then it's not hard for you. So for example, I don't eat breakfast most of the time. And as I said, I started in medical school. But it got into a habit. So I almost never eat breakfast. I mean, I do sometimes.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
They were all heading into sulfonylureas and insulin, which is causing weight gain. So we all expected in 2008, and remember, this is, what, 15 years ago, right? So we all expected that we would see less, you know, microvascular disease, less macrovascular disease, less heart attacks and less deaths. But it didn't show that, right? That's what it didn't show.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But now if I eat breakfast because I'm going out for breakfast or whatever, I wind up not eating lunch because I can't, because I'm too full, right? So is it difficult for me to only have those two meals a day? No, not at all. So I'm not using willpower. And willpower is like a finite resource. So- I'm at a huge advantage compared to somebody who's now habituated to eating six times a day, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because you go to school, it's breakfast, mid-morning snack, lunch, mid-afternoon snack, dinner, bedtime snack, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And I'm not saying that you can't. It's just that from a habit standpoint- I'm actually just way ahead because there's- You've been doing it for a long time. Yeah. Less decisions you make. Less decisions to make. It's easier. And I'm not using my store of willpower to skip those. Yeah.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So just fasting alone doesn't solve the problem. Oh, for sure, for sure. And I remember that one of the first few studies in 2018 that came out, these studies were terrible because what they did was they had somebody fast, this alternate daily fasting, they'd have somebody fast for one day and then eat 125% the next day because they wanted to match the calories, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
why the hell would you tell somebody to eat extra the next day? That's not the point of intermittent fasting. The point of intermittent fasting, so say you eat three meals a day, right? Breakfast, lunch, dinner, then you skip breakfast or dinner, whatever. What you want to do is, so you say you take 500 calories breakfast, 500 calories lunch, 1000 calories dinner.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
What you're trying to do is you skip breakfast, And your body is going to take the 500 calories that you would have eaten at breakfast out of your fat stores. Then you eat 500 calories at lunch and 1,000 at dinner. That's what you want to happen. If you eat, you know, skip it and take 1,000 calories at lunch and 1,000 calories at dinner, well, you might get a bit of benefit.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But it's going to be kind of small, right? And so those first few studies- And there are some people that- fall into that pattern. Some people actually do well with that. I don't doubt it.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Although I do see a lot more studies now where they're doing this early TRE. So there's a couple of studies that came out recently that looked at early TRE, which was stopping at 2 p.m., right? So it's like that's early, right? Because they shifted everything up early. They didn't compare it to the late TRE, but they just used it as a baseline, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because I think the researchers thought that was going to be the most effective, so it showed the biggest difference. Which I agree sort of, but again, you have to weigh, you know, you can't take it out of the context of life. Exactly. Because it's just like anything else. If you impose such a difficult regimen on people, they'll stop doing it. And that's why most fail.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And that's why all the guidelines got loosened.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think so because I think that you have to understand that we eat not just for sustenance. We eat for pleasure. Sure. And if you just say, oh, it's all calories, it's all this, it's all that, you take that entire pleasure, addiction, cravings out of the –
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
you're not gonna be successful because you're actually only dealing with like 30% of the actual problem, which is that people eat for all different reasons, right? And you have to eat also.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But you can say, for example, no sugar. But I never do because it's like, one, it's really hard. And two, it's almost too much to be- Yeah, it's unreasonable. 100% sugar-free, right? You can do that for alcohol and heroin and stuff. And you can do it for sugar too, but- It doesn't solve the problem. Yeah, like if you're taking so much pleasure out of food, are they going to sort of rebound later?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, it's not enough. And I think for sure you have to take a little bit more of a holistic view. So it's not just about calories and it's not just about hormones and it's not just about social behaviors. It's not just about habits, but it's all of those things. It's about the pleasure you derive from it.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's about the social norms because, again, if you look at Americans versus Europeans or something, there's a massive difference in obesity rates between Americans and Italians, for example. But Italians, you know, they're eating their pasta, right? They famously love their food and stuff, but their whole relationship with food is quite different. You don't see them eating in their cars.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You don't see them snacking all the time. Like there's a huge amount of differences, right? Sure. They get together as a family to eat and they're eating relatively whole foods, right? So not a lot of ultra processed foods. I mean, I had a friend who went to Italy just recently. So I thought I'd gained five pounds. I actually lost a couple of pounds.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, the walking is a huge thing. Like you see it in New York City too.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah. So drive for food potentially can drop. Because I talked about in the obesity code, I talked about cortisol too, because you look at cortisol and cortisol has nothing to do with calories, right? It's a hormone. And if you give somebody prednisone, they gain weight. So if you way overstimulate cortisol, like prednisone, that's artificial, but you gain weight.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
The targets were six and a half at the time.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So, but you can extrapolate, like if you are under a lot of stress. So I know a lot of people who think they gain weight. If you don't get enough sleep, do you gain weight? Probably. Right. I would think so, right? And maybe it has nothing to do with your diet, but it has to do with- Well, ultimately it does. Ultimately it does.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because does that stress then lead you to eat this food, which is going to lead your calories in to be greater than your calories out? Yes, it has to in the end. Exactly. Exactly.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
We need treatment. Because I think that this is sort of what's the root cause. And then the calories is sort of that sort of intermediate step, which leads you to the weight gain. So focusing on that intermediate step's not useful. You got to get to the root cause of things, right? It can be.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, I don't know that that's 100% true. Like- What's 100% true? That you can just eat whatever, like as much- Yeah, exactly.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
No, it's not because it's if you eat healthy foods, but then you have to stop. Right. When you're supposed to stop, right? So those healthy foods are supposed to tell you at some point, you should stop eating now. If you eat past that point where those hormones have said, you should stop eating now. Well, yeah, you're gonna gain weight. Or if you eat those healthy foods, but then eat,
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, but remember the targets were 6.5 at the time, right? So in 2008, the targets were 6.5. So you'd start with metformin. And if you were still at a seven, then next step was sulfonylurea. And then the next step was insulin, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Another snack, you know, in between when you should have gone right through to lunch or right through to dinner, but you stick in, you know, all these healthy snacks, right? Granola bars and stuff, right? Well, no, you're not supposed to do that because you're not hungry. So you're not supposed to eat, right? The hormones are supposed to tell us what to do, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And they're pretty good most of the time. Unless they develop that resistance and disordered eating. Yeah, yeah. So I think it is far more nuanced. It is far more nuanced than, yeah, I can eat whatever I want, as much as I want, as long as it's healthy and unprocessed. There is a stopping point that you're supposed to listen to.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, exactly. Because those natural foods are supposed to signal you. The issue is that you don't have to.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
The signals are all messed up. That's, I think, the real issue. The signals, and to me, the signals are all hormonal because that's, to me, the body runs on hormones. So those hormonal signals are all messed up. Why? I think there's a lot of reasons. Of course, yeah.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, yeah. And I think that's where intermittent fasting to me was a very useful thing to be talking about because yes, it's calories as well as hormones. Like you're moving them in the right direction. They always move in the right direction. Yeah, they always move in the right direction. Whereas you can move, you know, just like that insulin and calories thing.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
When your calories go down, your insulin is supposed to go down. Like, you know, there's a correlation between the two. When you have your calories going down, but your insulin going up, That's not good, right? You want both moving in the right direction, right? And that's where some of the, sometimes it's just useful to think about what other hormone influences you can affect, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, exactly. The GLP-1 is obviously very topical, GIP. But there are natural ways you can actually augment them.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Certain foods do stimulate that. So how can you use that knowledge, because you know that the GLP-1s are actually effective.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So if you know that say protein is going to stimulate a lot of GLP-1, which it does, and so does fiber, you can say, well, I want to eat more whole fiber foods. Sure. Which to me is like, yes, you should.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
When did that all come out? SGLD-2s didn't come out till much later, 2017, 2016, 2017. Yeah, so my-
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Well, I think that – so it sort of fell along the lines of – so weight loss being much more than just calories. There's a whole hormonal component. Then intermittent fasting was the second. Third was type 2 diabetes being a reversible disease, which is just now sort of being mainstreamed, accepted that it is a reversible disease and all that sort of stuff.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I think the next thing, and then I wrote another book actually called The Cancer Code, which was actually I thought really the most fascinating stuff that I had written. It's about the evolutionary paradigm of cancer. It's like how cancer develops. Had nothing, not a lot to do with insulin, although there is actually a correlation between the two.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So that was to me the most interesting, although the least sort of practical book that I did. And then now I think what I want to talk about more is about that whole more than insulin and like, how are you going to affect the insulin? Because it's not the carbohydrates necessarily, right? So everybody thinks that it's just reducing your carbohydrates is how you reduce your insulin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
That's one way, but there's actually a whole lot of ways. You know, there's lots of different like instant oat versus steel cut oats. massive difference in glycemic index between the two, even though they're the same food, same calories, same carbohydrates, same food. So what is the effect of the food matrix?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because it's really important because it's not the carbohydrates or the calories necessarily. It's the insulin effect that your body actually sees in the end, right? So the food matrix is how foods are sort of composed. So when you grind that, uh,
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
If you use stone grinding, for example, it's very different than if you use a modern flour grinder where you get this very, very fine dust because the absorption of the modern flour is instant because everything is ground up. There's no intact cell wall. It's like the brown rice, white rice conversation. It's the same thing. You've got the bran.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, exactly. So those are important. The food order is important. If you eat carbs first versus carbs last. If you eat vinegar, for example, This is actually really interesting. So vinegar and acids, if you eat them with carbohydrates, so you want to have some dumplings and you dip them in vinegar, the insulin effect is far different. And why?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because it turns out that that vinegar, which is acetic acid, partially inactivates the salivary amylases. So your body actually doesn't break down as fast. And it was always thought that when it got into the stomach, the stomach acid would neutralize the salivary amylases, but it doesn't.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So, yeah, in the diabetic space, actually those drugs are much different because the thing is that if you think about what was happening in type two diabetes with insulin, particularly, Because a lot of the patients, because there's only three drugs, a lot of people wound up on insulin. So for a while, it was like five of the top 10 drugs by revenue was insulin.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So in fact, by taking it with vinegar or fermented foods, so things like, you know, sauerkraut and stuff, you can actually really reduce the glycemic and insulin effect of the carbohydrates. So sushi rice, which is rice with some vinegar and sugar, But the vinegar actually reduces the glycemic index by a substantial amount.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, it's the same thing. And also taking... carbohydrates alone versus carbohydrates with proteins and fats makes a difference. So that's the food matrix. And then, you know, the effect on those foods and also the GLP-1s, how foods affect that. And then the sort of super... I think it's super fascinating upcoming area of how ultra processed foods really hijacks the whole process.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because it's not one thing. It's everything. It's a whole lot of, like, it's like, oh man.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, there's all this stuff that's there to protect you. And they've ducked around like all of this stuff, right? And it's like, wow, that's fascinating. So this ultra processed foods that take away all the satiety, increase the dopamine signaling.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And I think a lot of it is also like, it's probably all known, but there's a lot of people fighting against it. It's sort of like artificial sweeteners, right? A lot of people do fine with artificial sweeteners, but there are a lot of people who don't do fine because I think the sweetness triggers off a lot of cravings and stuff.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Like I have a bunch of people who are like, I drink 20 Diet Pepsis a day, right? I'm like, okay, that's not normal, right? And then the minute they cut it out, they're like, wow, I lost like 10 pounds. I'm like, yeah, because it wasn't that the Diet Pepsi had calories. That's not the point.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It was the hormones, whatever is triggering that sweetness was triggering off your cravings so that you ate more calories in greater than calories out, which is what led to your weight gain, right? So that's the whole point of trying to get behind what's behind the calories, right? And a lot of these chemicals, like in the US, they talk about this, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's been very topical about how a lot of ultra processed food in the US is way worse than the stuff you see in Europe, right? It's like- Well, it's mixed.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
I agree with you. I mean, chemicals obviously are not all bad, but are they all necessary? Because I think that's the point of comparing the European... I saw some posts where they're like... fruit loops or whatever it was. And, you know, there's a huge difference. There's all this chemical in the US one. I think it made it brighter or something like that.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
You know, they had all these food dyes and the European one, they're all banned so that they looked a lot paler, but they had the ingredient list was much less. And I'm like, do we really need all this stuff in the US one? Like, is that necessary? Because we don't know. And you might say it's safe, but it's like, okay, but you don't know if it's safe because- there might be long-term effect.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
We don't study these chemicals for 20 years and then determine.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So for a while, it was like a huge, huge seller. And that's where a lot of the debate got into with the pricing of insulin and so on. But the whole point was that the insulin wasn't making people better. It was making them gain weight, and it was getting their A1Cs down. It was getting their blood sugars down. But the question was, where is all that sugar going? Nobody really thought about that.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Yeah, so if people are eating a lot of this, like in the poor states, then yeah, maybe it is playing a huge role.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And it's clearly like, I think the shoe should be on the other foot, right? We sometimes say, well- Let's wait for the problem to occur. Exactly. It's like, you should have to prove that it's completely safe before we accept it, rather than accepting it and then having to prove that there's a problem, right? It doesn't make sense that way.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And I think that this is actually really important because when you get to the point where 70% of the American public is overweight or obese, you know it's not an individual issue. Because it's not like, oh, this guy just didn't follow our advice. It's like, no, there's something going on. Systemically. Systemically, it must be.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because I'll tell you that when I- you know, learned about obesity in medical school. It was all about personal responsibility. I think the world was different then. Calories in, calories out. Well, I think that a lot of people still practice that way, or there's a lot of people who still sort of think- Medical inertia still is there. Yeah, exactly. It's that inertia.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And it's really unfair, I think, because people don't know, so they take whatever they used to learn, which is 1980s, 1990s, sort of like- It's all your responsibility. It's eat less and move more. No, it's got to be something more than that because look at this, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's like you can't make an entire population obese without it being about something about the food or the culture or something in it. You can't do that, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So therefore it's not, let's just get these people to watch what they eat. It's not that. It's like the food environment must change. It's not that. People make choices for a reason. Just like, I think with the people who are poor, they make choices because it's either eat the really cheap ultra processed food or not eat, right? That's an easy choice for them. You can't blame them for that.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And if they gain weight, you can't blame them for that. That's not fair. What you have to do is say, what is it about this and can we do better? You know, pushing more fresh foods, whole foods, you know, into the mix. Like not just take that away from them because, you know, maybe that's all they can afford, right?
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's like, okay, well, you're giving insulin. Their blood sugar is 8 or 9. Their A1Cs are 8 or 9 or 10. What's happening to all that sugar? And it's like, well, if you just think about it, you know what's happening to the sugar. It's all turning into fat because that's what insulin does. It tells you to store that sugar, goes through the liver, becomes through de novo lipogenesis, creates fat.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
That's what insulin is supposed to do. So if you're giving people insulin, you're telling them that they should be gaining more fat. So you're turning that glucose into fat, and that's why all my patients were gaining weight. But the weight gain was the problem, which was causing that type 2 diabetes, right? So we're treating the symptom of the high blood sugar as the disease.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Absolutely, and that's where we are now, right? So the most recent- Yeah, with my education, for sure. So the most recent ADA guidelines was weight is actually a huge part of management strategy, right? But this is 20, I don't know when they came out, 2023? Sure. Something like that. But back then it wasn't, nobody cared about it. Weight was not even in the ADA.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So anyway, to finish off how I got interested in it. So what happened was I realized that we're coming at this all wrong. If type two diabetes is primarily a dietary lifestyle disease, and all we're doing is giving medications, you're never gonna make it better. In fact, what you need to do is get these people to lose weight. When they lose weight, then their diabetes gets better.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Everybody knew that, right? And the crazy part, and I called this one of the ADA's biggest lies, of course they've changed it since then, was that type 2 diabetes was a chronic and progressive disease. So, you know, the criteria for remission didn't come in until 2023, so last year. Up until 2023, if you looked on the website, the ADA said it's a chronic and progressive disease.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
But it was a complete lie because everybody knew. Nurses knew, I knew, patients knew. If you lost weight, that type 2 diabetes would either get much better or go away completely. Everybody knew it.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
It's still elevated because they still have some insulin resistance. But if you have somebody, say you have somebody who's A1C of eight, 20 pounds over and compared to an A1C of six and 20 pounds less, I think their risk is much different. And the point was that at the time, we weren't focused on getting the sugars down through dietary control.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And neither were we focused on getting that weight down either. Nobody cared. We were plying them with so much insulin that they couldn't lose weight, right? And I saw it day in, day out. Because I'm a kidney specialist, I see mostly- You would see the worst cases. Yeah, I see the worst cases. And almost my whole practice is like- Is that. Is that, for sure.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
Because it's just, you know, it's much more common than polycystic kidney disease. Yeah, I think-
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
And at the same time, we had all these studies of bariatric surgery, which basically proved that it was a reversible condition, because it's defined by that A1C greater than 6.5 on no medications. That's how you define type 2 diabetes.
The Checkup with Doctor Mike
Debating Dr. Jason Fung On Calories & Insulin
So when you change their diet, and this was a very drastic measure, of course, but that diabetes came down within a month, within weeks, those sugars came right down. That's what all the studies showed. So if it's reversible, why would you tell people it's irreversible? It's all due to the diet. The risk of what? The risk of?