Truth-Seeking moments:Fact Check 1 - 6:36 - https://youtu.be/2d7MITbdFHwFact Check 2 - 42:05 - https://youtu.be/BClwtV79UFYFact Check 3 - 45:53 - https://youtu.be/-pjhwHTFZAkFact Check 4 - 54:16 - https://youtu.be/O0-_ml1J0NwFact Check 5 - 1:22:36 - https://youtu.be/NzoUVKSDYqcFollow Dr. Jason Fung here:https://www.doctorjasonfung.com/https://www.youtube.com/channel/UCoyL4iGArWn5Hu0V_sAhK2whttps://x.com/drjasonfung?https://www.facebook.com/jason.fung.313/I'll teach you how to become the media's go-to expert in your field. Enroll in The Professional's Media Academy now: https://www.professionalsmediaacademy.com/00:00 Intro1:27 Nephrology / Controlling Blood Sugar / Diabetes19:40 Weight Loss / Intermittent Fasting34:50 Lowering Insulin40:55 Counting Calories52:33 Set Weight Theory58:29 Hormones1:02:45 Counting Calories Part 21:21:20 Is It All About Calories?1:29:18 Which Meal Should You Skip?1:40:22 Losing Weight On Vacation1:46:38 Future Research1:51:30 Artificial SweetenersHelp us continue the fight against medical misinformation and change the world through charity by becoming a Doctor Mike Resident on Patreon where every month I donate 100% of the proceeds to the charity, organization, or cause of your choice! Residents get access to bonus content, an exclusive discord community, and many other perks for just $10 a month. Become a Resident today:https://www.patreon.com/doctormikeLet’s connect:IG: https://go.doctormikemedia.com/instagram/DMinstagramTwitter: https://go.doctormikemedia.com/twitter/DMTwitterFB: https://go.doctormikemedia.com/facebook/DMFacebookTikTok: https://go.doctormikemedia.com/tiktok/DMTikTokReddit: https://go.doctormikemedia.com/reddit/DMRedditContact Email: [email protected] Producer: Doctor MikeProduction Director and Editor: Dan OwensManaging Editor and Producer: Sam BowersEditor and Designer: Caroline WeigumEditor: Juan Carlos Zuniga* Select photos/videos provided by Getty Images *** The information in this video is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information, contained in this video is for general information purposes only and does not replace a consultation with your own doctor/health professional **
Chapter 1: What is the main topic of this episode?
Today we're joined by Dr. Jason Fung, a leading nephrologist and author of the best-selling book, The Obesity Code. Dr. Fung has taken the social media world by storm, igniting passionate discussion surrounding calories and their value when it comes to weight loss. His belief is that insulin and other hormones are more impactful than calories when it comes to weight management.
Today, I wanted to directly discuss some of these hotly contested statements and find some common ground in this highly complex and often heated nutrition space. Turns out, it's way more complicated than I thought. So for the very first time, I'm trying a new truth-seeking approach where upon a significant point of disagreement during the conversation, you will hear this sound.
And that is to signal to you that there's a footnote in the description of this video leading to a separate short video clearing up the controversy with sources. Get ready for a deep dive on the science of nutrition, weight loss, and reversing chronic disease. Let's get started. Dr. Fung, I'm really excited to talk with you on a topic that very much needs more attention, the topic of obesity.
Chapter 2: How does obesity relate to diabetes?
As you've said in previous conversations, I mean, we've had guests talking about it. We're in a crisis state where 60, maybe now 70% overweight or obese as a nation here, at least in the United States. I'm assuming similar figures in Canada or- A little less, but- A little bit less, but also climbing- But also very high. And truly a worldwide issue, right?
More pandemic than epidemic at this point. I've heard your very strong interest in the topic, but you're a nephrologist, which is a kidney specialist and not necessarily the specialty that usually talks about obesity. How did you find that to be a topic that you were so passionate about?
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.
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.
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.
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.
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Chapter 3: What is the role of insulin in weight management?
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.
And so I really started... Wait, are you saying by controlling sugar levels, blood sugar levels, you weren't controlling mortality and morbidity rates?
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.
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.
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.
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 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.
That's so weird because right now, my guidance from the major organizations, the American Academy of Family Physicians,
ADA, AHA is controlling the hemoglobin A1C or the fasting glucose to arrange, well, not necessarily solve all the problems, because there's usually comorbidities happening at the same time, as you mentioned, high blood pressure, usually some lifestyle issues related to either obesity, poor sleep, all those factors.
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Chapter 4: Are calories the only factor in weight loss?
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.
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.
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.
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.
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.
This is so strange because my practical experience is that if I have a patient with the hemoglobin A1C of 8 or 9 and I treat them, in most cases in type 2 diabetes, I'm not jumping to insulin unless their hemoglobin A1C is above 10 or they're very poorly controlled. So I'm treating them with other medications.
Right now, obviously, GLP-1 medications are very popular, but starting even with the basics of a metformin, sulfonylurea, with all the risks that can come with that, and they do better.
Their blood sugars do better.
But also clinically, they're less likely to be hospitalized. They're less likely to end up with amputations, eye issues.
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Chapter 5: How does intermittent fasting work?
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,
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.
And that's why all the guidelines got loosened.
Is that because they were treating with insulin? Because again, this is before my time when I wasn't in medicine yet. I started practicing medicine in 2014. That they were treating with insulin too early? Like they were jumping in and treating with insulin at a hemoglobin C of eight and trying to get it to six and a half?
The targets were six and a half at the time.
The starting point is my curiosity. Cause I can see if you're starting insulin too early that you may run into some issues, but cause now the guidelines are starting insulin above 10.
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?
Because you only had those- When was the DPP-4s and the SLG-2s?
When did that all come out? SGLD-2s didn't come out till much later, 2017, 2016, 2017. Yeah, so my-
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Chapter 6: What are the implications of counting calories?
Then compared to a person who's never had an abnormal A1C.
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.
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.
Because it's just, you know, it's much more common than polycystic kidney disease. Yeah, I think-
where again, I came in six, seven years into medicine after that, seeing bariatric surgery cases where we saw the biggest cases of remission after a drastic 40% of body weight being lost, where everyone hesitated to use the term cured. But we saw drastic improvements where now it could be managed with just dietary control as opposed to getting medications on board.
And perhaps we still recommended some preventive medications, managing... blood pressure more thoroughly by getting an ACE inhibitor on board, managing cholesterol a little bit more aggressively because we considered them higher risk by getting a statin on board. But in general, I think bariatric surgery provided us a really good window into seeing how drastic weight loss can impact diabetes.
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.
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?
That the risk stays elevated. That you can't really reverse the risk. I think that's the thought process. Okay, but the diabetes itself is reversed. I would say it's controllable, but the risk is always ever present.
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Chapter 7: How can dietary changes impact type 2 diabetes?
sort of 2024 American Diabetes Association guidelines, weight loss is actually quite critical.
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.
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
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.
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?
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.
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.
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.
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.
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Chapter 8: What are the benefits of a low-carb diet?
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.
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.
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.
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.
So the summary of it would be that you started seeing this uptick as a result of the huge spike in people gaining weight, being overweight, obese, then developing diabetes, then developing kidney disease. And instead of just treating the condition, you started thinking more preventively. How can we get ahead of this? Yeah.
And the dietary aspect, the weight loss diet, the weight loss aspect is probably the most efficacious way of doing it, which we see now and we're talking about more so these days. Why did you choose fasting specifically as your approach to helping people lose weight as opposed to the low carbohydrate diet, caloric restriction, keto? There's all sorts of avenues by which people try and lose weight.
Yeah, I mean, it's just another tool. You don't have to fast to lose weight. You can lose weight.
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
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.
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