RHR: Why We Gain Weight—Beyond Carbs, Fat & Protein with Robb Wolf


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Diet is always a hot topic in the Paleo and ancestral health community. There are diehard advocates on every side. Today I talk with Robb Wolf about his new book Wired to Eat. We explore how his approach to diet has evolved beyond just choosing the right mix of carbs, fats and protein and why a personalized approach is the key to understanding weight loss. In this episode we discuss:
  • The focus of Wired to Eat
  • The Paleo diet 3.0
  • Is it really about the food?
  • Why the concept of “cheating” is harmful
  • How stress impacts your weight
  • The right tool for the job: why personalization is key
Show notes: [smart_track_player url="http://traffic.libsyn.com/thehealthyskeptic/RHR_-_Why_We_Gain_WeightBeyond_Carbs_Fat__Protein_with_Robb_Wolf.mp3" title="RHR: Why We Gain Weight—Beyond Carbs, Fat & Protein with Robb Wolf" artist="Chris Kresser" ] Chris Kresser: Hey, everybody, Chris Kresser here. Welcome to another episode of Revolution Health Radio. In this episode, I'm excited to welcome back Robb Wolf, a good friend and colleague. For those of you who don’t know who Rob is (I can't imagine there are that many of you listening to this podcast), but he is a former research biochemist, health expert, and author of New York Times bestseller The Paleo Solution and the eagerly anticipated Wired to Eat, which is his most recent book that we’re going to be discussing today. He has been a review editor for the Journal of Nutrition and Metabolism and Journal of Evolutionary Health. He serves on the board of directors at a specialty health medical clinic in Reno, Nevada, and is a consultant for the Naval Special Warfare Resilience Program. Rob is also a former California State Powerlifting Champion and holds the rank of blue belt in Brazilian jiu jitsu. He lives in Reno, Nevada, with his wife, Nicki, and his daughters, Zoe and Segan. I'm really looking forward to this show because I think Robb is one of the smartest people in the room when it comes to these topics, and if you’ve been around the Paleo Primal Movement for any length of time, you’ll know that Rob has done more to advance these concepts into the mainstream than pretty much anybody else. His most recent book is a deep dive into the mechanisms that lead to overeating and that govern food intake in general, and it goes far beyond protein, carbs, and fat and calorie intake. So, without further ado, let’s hear from Robb Wolf. Chris: Robb Wolf, welcome back. Robb: It has been a while. You’ve been busy. You’ve been busy. Chris: I saw you two days ago, but it has been awhile on the podcast. Robb: You’ve had a lot going, not much grass grows under your feet. Chris: I've had a few things going on but you have as well. You released The Paleo Solution in 2010, and I don’t think you’ve just been sitting on your hands since then, have you? Robb: Not completely, no. Chris: Well, you had a couple of kids along the way. Robb: A couple of kids, permaculture farm, a 90-pound Rhodesian ridgeback, which was almost the end of my and Nicki’s relationship—yeah, we’ve had some fun stuff. Chris: I think you’ve also been doing a little bit, squeezing in a little bit of work in between those major life events. Robb: A little bit. I joined a medical clinic here in Reno several years ago. I'm on the board of directors and those folks did a two-year pilot study with the Reno Police, Reno Fire Department, where they found folks at high risk for type 2 diabetes and cardiovascular disease and that they’ve put these folks on a Paleo-type diet, got them to modify their sleep and exercises as best they could, and based off the changes in their blood work and their health risk assessment, it’s estimated that the pilot study alone saved the city of Reno about $22 million, with a 33:1 return on investment. Chris: Whoa. Robb: Yeah, I was pretty impressed with that. I was like, “Ah, this evolutionary medicine stuff, there might be something to it.” So, I've been fiddling with that. You know this back story. I've been looking at some opportunities to scale this and hopefully take it to the masses, and that has proven to be more challenging to I thought. But amidst all that process, I've learned a lot and it kind of lit a fire under me to write a second book, which is Wired to Eat. Which looks pretty deeply at the neuroregulation of appetite and it still is very much steeped in this ancestral health/evolutionary biology template. But (and you did this in your book—you really tried not to have a one-size-fits-all approach) I may have made the disastrous decision of trying to do something that wasn’t a black-and-white, all-or-nothing recommendation. Chris: Nine steps to weight loss in five minutes with no effort at all, the groundbreaking new approach. Robb: Yeah.
Robb Wolf explains why you shouldn’t use the word “cheat” when you diet

The focus of Wired to Eat

Chris: You're a total geek like I am, and whenever we get together, we like to nerd out and talk about all the research behind this stuff. You’ve done a really deep dive into kind of like the next level, looking at the mechanisms behind food intake and weight regulation, body fat mass, and not just using the same Paleo evolutionary kind of template, but going deeper to look at what is this big mismatch between our genes and our biology and our current food environment really all about. And how is that driving the epidemic of obesity and metabolic disease? For people who have already read The Paleo Solution, which I think is just about everyone listening to this podcast probably, what’s different about Wired to Eat, your most recent book? Robb: That’s a super-good question, good lead in. The big differences that—somewhat indirectly, I talked about this whole discordance idea within The Paleo Solution. We talk about the observations of preindustrial societies and how despite a really aggressive medical presence, like these folks are remarkably healthy, generally free of Western degenerative diseases. I think it’s really interesting, powerful stuff, but it’s maybe a bit far afield for many people, and still we see stuff devolve almost immediately into these macronutrient wars and folks really getting out in the weeds. And so in reading and thinking about this stuff, I started getting this into—and I'm really backing up a little bit, there was a paper a couple of years ago that was looking at brain evolution, and one of its catchy taglines was “the omnivore's real dilemma,” and it made this really strong case about the fundamental kind of forces that forged not just our genetics in the way that we seek out food, but any organism that moves to obtain nutrients, that there’s this basic need to get more than what you spend on the acquisition of trying to get nutrition, basic calories and also vital nutrients and whatnot. This idea really struck me because I'm like, okay, if we’re wired on a really fundamental level to need to eat more and move less to make that equation work—because we can make a super simple accounting. If you spend more money than you make, you're going to end up bankrupt at some point. From an energetics perspective, if you live out in a natural environment and you consistently burn more calories than what you consume, we’re going to have a serious problem. Wild animals, if they find some food, make a kill, and they don’t consult their Fitbit and say, “Oh man, so I just ate 600 calories, so I need to walk or jog or jumping jack for x number of minutes to burn this off.” Typically, it gets some food and then it goes and lays down and rests. This is the only way that that free-living scenario works. Whereas with humans, because of technology and because of culture, we’ve created these massive surpluses in energy, basically in the form of food, but also convenience measures, and so in a way, you could argue that we’ve pushed that optimum forwarding strategy idea to this mega and ultimate winning scenario. It’s like, “Okay, we can burn one calorie a day trying to obtain food.” We literally click Amazon and then AmazonFresh delivers food to your door and then you pop it in the microwave and you're good. We’re so good now at gaming that system that we have been developing chronic degenerative diseases for quite some time—type 2 diabetes, neurodegenerative diseases. And so this perspective on the neuroregulation of appetite, for me, it’s really almost like cutting the Gordian Knot. Is it about carbs? Is it about fat? Well, maybe. Let’s consider the context, but really let’s look at what governs the neuroregulation of appetite, what allows us to, in a free-living scenario—not being locked in a metabolic ward, but in a free-living scenario—to spontaneously eat in a way that doesn’t make us metabolically broke and then sticks us in an early grave. So that’s really the big difference between Wired to Eat and The Paleo Solution. Both of them are super-steeped in this evolutionary biology framework, but in Wired to Eat I'm really looking first at that neuroregulation of appetite story because when you start then unpacking that piece, then carbohydrates take on a certain context. It’s like, oh, cellular carbohydrates from beans and even properly prepared grains and ... Chris: Don’t say beans, or grains! You’re cut. Robb: I know I'm cut. I'm no longer getting the Cordain inheritance package. Chris: Paleo foul. Robb: But you know these things react to our physiology, and perhaps more importantly, they alter the neuroregulation of appetite and they alter our gut microbiome in very different ways than refined flours or added sugars. Everything from sleep to stress, the stress of altered circadian rhythms, inadequate socialization, all of this stuff feeds back into the neuroregulation of appetite. I think that by looking at that, then we can kind of bypass the macronutrient wars because we're able to get to a spot where we could make a pretty defensible argument that, okay, we just need to find a way, whether it's high carb or low carb, that you individually eat within the parameters that keep you healthy, and there may be certain trigger foods that are inappropriate for you. So we're going to consider all that stuff, but it bypasses the macronutrient wars. It integrates things, like, to what degree does insulin play a role in health and disease? To what degree is the calories-out model accurate or inaccurate? If you start with that first-principle story and then kind of work your way forward, a lot of this stuff, for me, gets quite a bit of clarity. It's still a reasonably complex story, but Stephan Guyenet, we just got to hang out with him last this last weekend. He wrote an amazing book, The Hungry Brain. Chris: I just had him on and we just talked all about those mechanisms, so this is a perfect follow-up to that. Robb: Yeah. Stephan gets so much drama and hate mail, and the guy has just been consummately professional. He's always just presented his case, let the research speak for itself. If you've got a better mousetrap, then let's compare those mousetraps and what not. I really credit him with putting this whole topic into a potentially popular context and his treatment of that material is just really nothing short of stunning. To the degree that I have attempted a treatment of some similar material, I hope I can carry his gym bag on that because it has just been a remarkable thing. In the following, I don't want this to be overly self-serving, but I can make a pretty good argument that I think going forward if we're not talking about two things, if we're not talking about inability to personalize nutrition for folks and if we're not starting this conversation around what goes into the neuroregulation of appetite, then I think that the material at hand is not really topical. It's not really relevant to our current understanding of stuff, and again, that's a very self-serving argument given my book is oriented towards the neuroregulation of appetite. But, again, I think we have a pretty defensible spot on that.

The Paleo diet 3.0

Chris: Yeah. I wouldn't say... it may serve you in the sense that you wrote this book but it's actually true. I’ll just step back and summarize a little bit for people who might be a little lost at this point because we’ve covered a lot of ground. If we think of we can think of Paleo 1.0 and even weight loss 1.0, which was way more focused on quantity, the quantity of the kind of food you're eating, maybe a voluntary calorie restriction, which doesn't, I think we know, turn out to work very well for most people over the long term. And then, that focus may be switched over to quantity of macronutrient, so initially it was low fat but then more recently it's become low carb, maybe that was 1.5 or even 2.0. What we're talking about now I would say is the 3.0 level, whether we're talking about weight loss or even just a Paleo type of approach to diet, which is that yes, the quantity of calories matters, and yes, the quantity of macronutrients may matter and make a difference, but those are not the best entry points. A better entry point is understanding these concepts of how the brain is wired to control food intake and manipulating those wisely. That will in turn affect your intake of calories and your intake of macronutrient, but it will do it in a much more effective way—in a way that can be tailored and personalized for each person’s particular circumstances and need. It's kind of agnostic to the dogma that surrounds any of these approaches—whether we're talking about Paleo, low carb, ketogenic or any of this stuff—because it's kind of like a meta-perspective that incorporates and ties together all of these notions that have been floating around out there for many years. Robb: Yeah. Very well said, much better said than I did. You should probably write a book on this topic. Chris: You brought up Stephan, and we both agree that Stephan is the smartest guy in the room when it comes to this stuff and we've both learned a tremendous amount from him. I've read both Stephan's book and your book. What I would say to people who are thinking about these two books, or looking for a way to think about them, is Stephan’s book is definitely oriented towards the public and even though he's a scientist himself, it is a popular book. So it's not something that you're going to get lost in necessarily if you're not familiar with the science, but it's not a “how-to” book either. It goes pretty deep into the mechanisms and it's an exploration of how we got to where we are, and it does provide some very practical tips along the way. Whereas, Robb, I think your book does a fantastic job of summarizing all of the mechanisms but goes a little bit deeper into the “how,” like how you can actually utilize these various concepts to create an approach that works for you. That makes sense to me because you've always been concerned with practical application, whether it was running a gym or working with the Naval Special Warfare and the specialty health program that you just mentioned. Do you think that's an accurate summary? Robb: Yes, yes. Both gracious and accurate, yes, thank you.

Is it really about the food?

Chris: Cool. One of your perspectives that I appreciate in the book was a kind of different take on the healthy relationship with food. It's kind of a meme that we hear thrown around a lot in the mainstream media and medical establishment. We should have a “healthy relationship with food,” but what the heck does that even mean, really, and what's your take on that? Robb: Oh man, it's one of those things—my mom’s side of the family is from the Deep South, Appleton, Arkansas. My wife is still kind of perplexed at some of the cowboy witticisms that I'll drop every once in awhile, and she's like, “Where do you get this stuff?” It was totally my grandmother's influence, and you just love these almost Mark Twain-esque pithy sentences in this whole “you need a healthy relationship with food,” like there's something that just intuits with that. Oh man, my inner child is happy when I think about this. It just seemed so good, and then over the course of time and working with people, I just … and again, this started off very empirically, and then I started digging in where I saw some problems, but empirically, I'm working with a person and it comes out there are maybe some challenges, so I'm like, “What's going on here?” We’d start having conversations. Well, in one way or another, the individual articulated the following: I'm trying to develop a healthy relationship with food. I have problems eating or I overeat … whatever the deal is, I'm trying to find a healthy relationship with food. Again, on your first blush, you're kind of like, “Okay, that's totally reasonable.” Who could argue with that? We need to be in a good place with our food, but then over the course of time, in working with these folks, it felt like the mating dance of an exotic tropical bird. You’re like, “Man, if I just wiggle my butt, bob my head, and flap my ears in just the right way, it will allow this person to finally have a healthy relationship with food.” And it just never happened. It was calculating the final decimal point of pi. It just kept going and going and going. Then I started asking some questions. Is it really about the food? And so, I would dig and dig and dig, and what I found is that when people are … Mostly people that I've worked with and I wouldn’t say all of them, but these black-and-white universalities I'm getting more and more hesitant to throw out there, but I mean, a very consistent trend. Put it that way, trying to sound somewhat scientific ... A very consistent trend is that when I've interfaced with folks, that they're in a situation where they are endeavoring towards having a healthy relationship with food, almost always somewhere in the past, this individual has suffered some sort of pain. There's been some sort of a traumatic event that could be family, school, or peer group. It could be a variety of things. And for whatever reason, food has become kind of a palliative tool in dealing with that pain, and then that can lead into essentially overeating. Either making more food choices or consistently just overeating to kind of get the satisfaction and the dopamine release associated with eating. And what I've noticed is that a real strong focus on that relationship with food guarantees that the fundamental underlying issues will not be dealt with. We've turned this into a situation of chasing symptoms and not root cause, and it's going to be an unresolvable scenario versus if we can sit down and say, “Okay, I understand that food has kind of become the focus, but I'm going to throw out this suggestion. I'm not saying it's true, but the suggestion is that this really isn't about food. There's something else deeper here going on that food has become kind of a Band-Aid, has become a symptom. Can we talk about and explore this? Maybe work with a therapist and really get some professional eyeballs and ears on this thing.” And when I help people, guide them towards that path, we've had really, really good success. Now, this oftentimes comes on the heels of these people hitting me, crying on me, or hitting me and then crying on me because it puts them into a potentially really defensive state. And again, to your point when you kind of broached this subject, this is the message that comes out of the media and medicine, dietetics, self-help, and self-care, but I'm just starting to think that this is something that literally ensnares and entraps us and distracts us from actually dealing with the root issues that are ultimately going to liberate us out of this scenario.

Why the concept of “cheating” is harmful

Chris: Yeah. I couldn't agree more. I mean, there's often a myopic focus on food and the particulars around food, without looking at the things that influence food intake that are non-food related. And this kind of reminds me of this whole notion—that became really popular in the Paleo world, but also, any other world that is kind of based on the idea of a strict diet rather than just eating what you should eat that's good for you—of cheating. I just absolutely hate this kind of concept of being on this really super-strict diet and then you cheat. Robb: Right. Chris: To me that's just a setup for failure. Can you talk a little bit more about that? Robb: Oh, man. Again, this is one of those things that when I talk about this people get really angry at me. It kind of flies in the face of what's generally being recommended but— Chris: [Crosstalk] … safe space, Robb. Robb: Perfect. I am happy with that. Chris: Not that you're not going to get some email after this. But here and now, I'm not going to get them out of you. Robb: Perfect. Okay. That's all I need for right now. This was again something that I would kind of experience in working with people. I'd sit down and start working with somebody. We're building a relationship, and maybe about 30 seconds into a conversation, the person is like, “So, what do I get to cheat on? Like, what are my cheats?” And initially, I was kind of like, “Okay this is a reasonable question.” I'm kind of suggesting this Paleo-type shtick, and so this person is wondering, will I ever in my life get to eat a chocolate chip cookie again. So, this is a pretty reasonable question. But over the course of time again, I slowly, empirically … this is an observational story ... but I've noticed, these people that really lead with this cheating idea, they were a handful. There was a lot going on with these people. This gets a little out in the weeds, but I know your listeners are pretty deep down, and so I’ll go out in the weeds more so than what I've done in chatting with other folks about this. I'm a student of evolutionary biology. I'm also kind of a student of the roots of words and like really what the meanings of words are. Oftentimes we use them in a very slapdash fashion, and so from this evolutionary biology perspective, we as a primate, all primates have some really intrinsically deeply woven senses of right and wrong and justice. If there is an individual in a group that's being treated poorly, that is immediately understood within the group, and this is true even with New World monkeys. It's really fascinating. This is a deeply conserved thing, and individuals that cheat or inappropriately treat other individuals in a group, they can be ostracized and there can be really profound feelings of shame and guilt, and this is part of what keeps these primate communities woven together. There are ideas of reciprocity, and literally, “I'll scratch your back today, you scratch my back tomorrow. In the process, we're going to delouse each other.” And so, there's this interwoven stuff, so that is a thing that exists and it's real and it's part of the reason why we exist as humans, that human society is what it is. This is part of the fabric, this justice element that we have in right and wrong. But, when we look at the word “cheat,” the Webster's definition of the word cheat is “to take unfair advantage of someone, particularly at their expense.” So, you knew all about that and you're like, okay, take unfair advantage—ha! Whatever way you want to eat, whether it's Paleo, vegan, macrobiotic, or what have you, if you go off the rails from that plan, are you taking an unfair advantage of someone? Is someone suffering because of your choice? No, not at all. It's absolutely ridiculous. But if we attach this terminology of cheating to a process that really isn’t emotional, really isn't victimizing somebody, we still feel the emotional content, the emotional blow of feeling like we cheated on our peer group, that we did something really profoundly bad, and so, we're taking one element of our kind of primate evolutionary history. We're grafting on this inappropriate terminology of cheating and it guarantees that if we do anything other than absolute perfect adherence to a specific plan, that we're now a cheater and we're a failure and we've let down the peer group, we’ve let down ourselves, and so instead of saying, “Well, the next meal, I'll be back on track,” it's like, “Oh, screw it. It's all hookers and cocaine now y’all. I'm going to Krispy Kreme and shutting the place down.” So, this cheating concept, as what I've seen is, it’s really dangerous. It's dangerous from the perspective that it ties a really powerful emotional trigger to a process that is really a non-issue. If you are generally eating pretty well and let's say we eat three meals a day, seven days a week, that's 21 meals, let's say, 18 or 19 of those meals are generally pretty on point two or three of those meals a week kick your heels up, do whatever you want to do, and so long as that “kick your heels up time” doesn't lead into three or four days of the, you know, wacky eating, over-the-top eating, so long as you're not someone like me who has serious gluten issues and, like, you decide to do a gluten binge and you're sick for a week afterwards, we have some caveats with that. But generally, if we're on point and then we “deviate off the norm,” it just doesn't matter. You made this point at the UCSF medical gig just a couple of days ago. Our goal should be to be as resilient as possible. Ideally, we're like a cockroach. We’re almost impossible to kill, and that's a really good place to be, and it's not to say that then you want to adopt horrible eating habits, but it would be really nice to just be as resilient as possible, and the more you play within some certain lines, that help support that resiliency. But then, when we decide to go a little bit outside the norm, it's not cheating. It’s just living. But again, we make, we make some decisions. We understand that there are consequences. If I decide to have a couple of extra NorCal margaritas, I try to have a little earlier in the evening instead of later because I know it disorders my sleep, but sometimes I'm hanging out with friends and that's just this what's going to go down, and I may not feel quite as hundred percent the next day. But that's okay within the bigger context. And so, it's a long, convoluted treatment of my ideas on cheating, and again, it's a pretty hot-button topic for a lot of folks. It really gets them fired up, but I think if people can think through that whole story and then kind of decouple the emotionality from the reality that, “Hey, you don't need to be perfect all the time.” But at the same time, if you go off the rails, you're just one meal away from being back on. Let's not even get into this cheating discussion or any of that.

How stress impacts your weight

Chris: The idea behind your book is a better understanding of the mechanisms that drive eating behavior. And so that's what we're essentially talking about here is that if you understand human psychology, neurobiology, and these mechanisms, you understand that creating a super-strict program and then having this idea of cheats is not in alignment with what we understand about human psychology. It's much more successful to, just as you said, create the ideas that you're changing your diet to something that is going to promote health and well-being in many different ways, and you're not on a diet. You're just changing the way that you eat, and in that context, there really isn't any room for cheat. Cheating doesn't really make sense because who are you cheating and what exactly what are you cheating on? Robb: Right. Chris: It's also important, we can maybe use this as a segue to talk about some of the non-food behaviors that influence food intake and overall health that you talk about in Wired to Eat. There was a question at the symposium that we're both up on stage for the panel with a guy who is really excited and enthusiastic about Paleo, and his question was “Where can I go on vacation that will have a hundred percent-compliant Paleo food?” Are there Paleo retreats and vacation programs? And then he asked me, “Where can I go out to eat that's just like a strict Paleo other than Mission: Heirloom here in Berkeley?” Robb: Right. Chris: And again, those are fair questions. You understand how someone could be thinking that way, especially if they've gotten a lot of benefit from eating that way. But my response is maybe not what he was expecting and I think probably in alignment with what you're talking about now. Robb: Yeah. And your response was great. You're like, “Go on vacation and have fun.” It sounds like madness. Chris: Because it's not all about food is it? Even if it was, you could, you could almost make the argument that having a break and having some time to rest and relax and taking some pressure off would actually, over the long term, make it easier for you to stick with your program. Robb: Right, right. It's just interesting because I've noticed for ages that if I get close to the equator, if I get sun on my skin, if I'm in ocean water in particular, my carb tolerance is amazing, my digestion is phenomenal, my libido is great and everything, and I'm kind of like, “Okay, why do I not live in the water?” But you still have to raise kids and make a living and all that stuff. It's fascinating, but I think there's kind of two pieces to this that I see. One is that you go to an event like that, and it's, like, just get into it, particularly if you're traveling internationally or something like it. Immerse yourself in the culture and try to get as much out of that as you can. And then, the other piece is that when we're out of this really stressful, sometimes monotonous nine-to-five, standard day-to-day living, and we get in that vacation mode, you're oftentimes quite a bit more resilient because your total allostatic load, your total stress load is a lot less, so you kind of get away with a little more fun and kick your heels up a little bit. I think that it's an interesting insight in that. “Okay, if I sleep better and my stress levels are better, that means my digestion is better. Wow! Lo and behold, I eat more carbs but I'm even leaner than what I was home.” We had so many clients that would come back after a vacation in Mexico and they're like, “This Paleo diet’s bonk. I ate tacos, drank margaritas, and I'm leaner than what I was.” And I'm like, “Yeah, but you were sleeping 12 hours a day.” And then they get back in their usual routine, and the tacos plus margaritas plus the stressful routine now ends up being a real problem. But it's a really good learning opportunity that it's like, “Oh, I need to make everyday look a lot more like vacation and then I'll be a lot better off.” And it's like, “Yeah, that's a great insight.” Chris: Yeah, I can't tell you how much. As you know, I treat patients with some pretty significant complex chronic diseases, and that's even true for them or perhaps especially true for them. And one of the key questions that I ask people during the intake process for new patients is, do they feel the same way when they're on vacation? And that actually gives me a kind of a hack for getting a rough sense of how much stress and just their daily routine and behavior and lifestyle is contributing to their condition. Robb: Right. Chris: And I can say that 9.75 times out of 10 they feel better on vacation and their resilience goes up. That's what we're really talking about here, is resilience. Humans should be resilient by nature. A really healthy human being can tolerate a lot of insults basically. That's a sign of health. Health is not being super-fragile to the point where if you deviate even one half-of-one percent from your routine that you fall apart. That's not health. Robb: Yeah. That's sometimes worn as a badge of honor, and it's actually just a target that you've painted on yourself. Evolution is working to remove you.

The right tool for the job: why personalization is key

Chris: Exactly. Thank you. I think these are super-important topics, and I'm glad we're covering them and that you cover them in the book because there's so much more to this than, like you said, protein, fat, and carbohydrates. Not to contradict myself, but there is still a role, of course, for more specific and advanced interventions in certain cases, when people are dealing with more advanced conditions like neurological disease, memory decline, traumatic brain injury, or something like that. I've personally become really fascinated with fasting and ketosis as interventions in these kinds of conditions, especially because the conventional alternatives are either non-existent or sometimes worse than the diseases themselves. Robb: Right, right. Chris: You covered that a little bit in your book. What have you found in your research and in your self-experimentation, also working with all of these high-level servicemen and women, and other populations that you've been working with? Robb: Yeah. It's interesting. My first real foray into “ancestral eating” was a ketogenic diet. I was super sick. This idea of a low-carb diet removing common gut irritants, and kind of repairing the metabolism got on my radar back in 1998, and it was incredibly profound for me. My whole life before this—and I got sicker and sicker as I went along, and I was the ripe old age of, like, 26 or 27 at this time and I was an absolute mess. But looking back, I had developed some type of an insulin resistance rebound hypoglycemic deal where when I was eating one meal, my current meal, I was thinking about the next meal and when it would go down and what the composition would be because I was terrified of hitting one of these hypoglycemic events because I would get shaky, tunnel vision and just like crazy. And then, when I ate this ketogenic diet, it was like just a switch had been flipped and I had rock-solid energy all day. I could eat. I didn't need to eat. I would go a day without eating or I could eat six meals a day and 6,000 calories. Everything was great at either end of that spectrum. It was incredibly liberating, and it really piqued my interest in this idea of low-carb diets and ketosis and then, by extension, fasting. Unfortunately, what it did also, because this works so well for me, it created a pretty profound confirmation bias where I assumed that this was the one true way for everybody to eat. This was going to be the solution to everyone's ills. If you've got a nail that you need to drive in a wall, a hammer is a really good option, a wrench is a somewhat less good option, and a bandsaw is a worthless option. When you start thinking about appropriate tools for the appropriate situation, there are so many incredible opportunities to use things like ketosis and fasting. I think the neurodegenerative story … I've been pretty geeked out on the autoimmune piece, but I'm finding some things like a fasting mimicking diet instead of continuous ketosis may be very, very beneficial for autoimmune diseases. But these neurodegenerative issues which are intractable, we don't really have much of anything we can do for the vast majority of them. There may be some really legit opportunities there. People have to eat, so there's a certain base level of cost baked in the cake. And so, if we just have them eat differently, eat in a different timing scheme or eat less frequently, or what have you, and we may be able to prevent, reverse, mitigate huge amounts of things like Parkinson's, Alzheimer's, senile dementia, and slowly the mainstream medical scene is kind of warming up to this idea. Ten years ago this was really, you were a heretic and a quack suggesting that there was some therapeutic potential here. I think today, we're finding many many more people open to this, or there is more research that will happen on this topic in the next five years than has occurred in the last 50 years. There are some really powerful opportunities to start implementing this stuff. But at the same time, it's kind of funny because even though … you could argue that within this internet era story, I've maybe been out there beating the drum in favor of low-carb diets and ketosis and fasting longer than just about anybody, but because I'm now in a spot where I'll say, “Man, they’re just the bee's knees for the right situation, but it’s not always the right situation.” Like, a CrossFit games athlete, I've tried to run them low-carb and keto-fueled and I've broken them! There are some people out there that are claiming to be able to do it, and they're doing some targeted ketogenic approaches where you're generally ketonic and will do 50 grams of carbs right before a workout. And so, there's maybe some hacks there, but still, it's not a classic ketogenic diet, and so there is this need for an appropriate tool for the appropriate situation. But man, I get people angry at me. There are groups of people who will say, “You're an idiot for recommending ketosis at all. It's going to kill people.” And then at the same time, you have other folks that are saying, “You're an idiot because everybody should be in ketosis every day all the time.” And I'm kind of like, “How am I wrong in both of these completely different camps?” Whereas actually the reality of things is there's kind of a middle ground that these are legitimately really effective, unfortunately underutilized tools. And like any other tool, you don't use them for everybody every day all the time. Chris: Yeah, I couldn't agree more and have a similar experience. Anyone who has been listening to this show for a while will know that I am a strong believer in an individualized approach and using the right tool for the job. Ketosis and fasting can be incredibly helpful, but they're not for everybody and they're not even for everybody with these conditions. You can't say that it's going to have a hundred percent success rate for someone with Parkinson's, for example. I have two patients with post-concussion syndrome following TBI, and one patient benefited tremendously from fasting and ketosis, and the other patient got significantly worse. So, who knows? There is still a lot we don't understand about this stuff. I think especially if you're someone who is working with patients or clients, you’ve got to let go of any attachment to a particular idea and just be willing to respond to the experiment and respond to what's happening in front of you because if you don’t do that, you're going to, you're going to hurt people. Robb: There are lots of cool nuances there. The person who didn't respond to the ketosis and fasting specifically, maybe ketosis is enough of a stress that it disordered their sleep and now we know that disordered sleep will make these TBIs and post-concussion syndrome issues worse. So maybe that person could benefit from a low-glycemic load, but still carb-inclusive diet, but then we're getting to use pretty aggressively MTC oils, maybe even some ketone salts or something like that and play with that. We've got a rheostat these days. We've got a selector dial where we can still think about this mechanism. Okay, in TBI, we usually see some insulin resistance in the brain. We see some substrate depletion. We've got some membrane depolarization issues, if you really want to auger down really deep, but the ultimate answer is, let's reduce inflammation and provide an alternative fuel substrate, and there is a variety of ways that we can do that. We could fast. We could do nutritional ketosis. We could do what I call a transitional ketosis approach, which is moderate low-glycemic, low-carb intake and then supplement with MCT oils. So, we have a lot of different tools in our toolbox now, and over the course of time, we might be able to get to a spot where we're like, “Okay, your genetics are these, your gut microbiome is this, and so you just suffered a TBI and you're going to be the transitional ketosis that works 98.6 percent of the time.” Until we get to there though, we just need to do a little bit of clinical experimentation. Chris: Yeah, absolutely. And I like your point about nuances. Unfortunately, the wide blogosphere and mainstream media seems to be allergic to nuance and incapable of incorporating it into their thought process. It has to be kind of black and white and oversimplified to get any attention at all. Robb: It's tough because I think there's a little wisdom in that to a degree because you have somebody who is completely unsophisticated in this topic and rightfully so. They're an engineer or a teacher or something, they're not spending all day, you know, talking about this stuff on the internet, and then they have a health problem or they have some sort of a desire to just lose weight or something like that. And then, what do you do? What do you tell this person that’s simple enough to get them moving in the right direction and not overwhelm them with all the details? I think that even though there is … and this is the challenge, how do you keep a general message out there? And we can funnel some people in the front end of this that’s like, largely whole, unprocessed food, go to bed earlier, exercise a little bit. And then, as we move them through this process, then we're like, “Oh, okay, you're doing pretty good, but we have some hang-ups here.” And here's where we need to get more granular and get more detailed. The challenge, though, is that those big-picture, black-and-white stories get written into stone tablets and turned into religious doctrine, and then you can't have any discussion around the nuance like that. That's the bugger. That's the challenge as I see it. Chris: Yeah, no doubt. I mean nuance admittedly is not conducive to getting a big public health message out there. Robb: Right. Chris: And people get overwhelmed with that complexity. But I think for our audience at least, and people who are really paying attention to this stuff, it's important to communicate that. I can't tell you how many—I mean, I can tell you, I have, and you know—how many people I see who come in with these ideas and they're hurting themselves because they're trying so hard to stick with these black-and-white concepts when they just don't match up with their reality. I spend so much time trying to educate people on how to be their own advocate and to observe what's actually happening, do their own experiments, and pay attention to their own responses to things and to use that as their guide. But that's admittedly, to your point, it’s a lot more difficult than just following instructions because you really have to pay attention. And also, I think it's stressful for people to have that level of agency where the decision falls to them rather than to some external authority. Robb: I’ve never thought about it like that. Huh. That's a really good, super-good point. Chris: I know you're kind of a behavior-change geek too, but there's this concept of decision fatigue, right? We only have, we only have a certain amount of mental energy to make decisions throughout the day, and once that's used up, we kind of buckle and we can't. And so, I think for people having to add more decisions that they need to make around their food and diet choices and all of that stuff on top of what they're already existing, decision fatigue is asking a lot. That's why I think programs like Whole30 and Paleo 30-Day Resets are so successful because people don’t have to make those decisions. Robb: Right. Chris: And that's fine for a starting place and for perhaps a first book. Robb: Right. Chris: But then inevitably, you come up against the challenges associated with sticking to that kind of program. There's a place for all of it, you know. Robb: Absolutely. And you know, we saw a little bit of this weekend when Stephan Guyenet did his presentation on his thoughts around the insulin hypothesis. There were some people that needed a hug at the end. They were like, “What the fudge just happened?” And they're like, “So, people can eat whatever they want?” And we're like, “No, no, no, no.” There is this neuroregulation of appetite. There are these other issues, but Stephan was doing a really phenomenal job of keeping it one hundred percent on that topic of “Is insulin the driver of obesity,” and he does a very compelling takedown on that. But man, some folks were … it was like yanked out from under. Chris: Right. And when you've already been through that whole process, it's easy to see it in somebody else, but confusing the mechanism with the effects. If someone says, “Wait a second, how can you be saying that carbs aren't the cause of weight gain because I went on a low-carb diet and I lost weight? Therefore, that makes it impossible that carbs are not the cause, or at least were not in my case.” That doesn't actually follow. There's another argument that makes both of those things that seem like they couldn't be true at the same time true, and of course, that's the argument you're making in your book and Stephan made in his book. But at first glance, it might not even seem possible that those two things could be true. I mean, this stuff requires some thinking at this level, but I think we're at that point now and in this overall discussion that we're having on these topics that it's time to be talking. It's time we’re having this discussion and not just going on with the same old oversimplifications that have gotten people in trouble. Robb: Exactly, and particularly with things like what you're doing with the Kresser Institute and there are so many more coaches and healthcare providers that are now becoming that next layer of interface with people, and so even if the unwashed masses are not really operating at this level of sophistication, definitely health coaches, healthcare providers need to be thinking about that interface of, “Okay, what's our simple heuristic? What’s our simple story to kind of get people in the door, get moving in a good direction?” And then, how do we keep them comfortable with the idea that this may be granular, there may be individual variances? Your wife may react differently than your uncle, and you’re different than both of them. But we have a great opportunity now to start having that nuanced conversation. Chris: Well, Robb, it's always a pleasure to have you on the show. Robb: Thanks, man. Thank you. It was great hanging out with you in real life and great spending a little bit of time with you on the podcast. Chris: Absolutely. So, now this one's in the bag and coming out, when would folks be able to buy this book? Robb: Wired to Eat will be released officially March 21st. That's when it will be in brick-and-mortar stores. Amazon and all the other online book vendors will mail it to folks. It's available for preorder, clearly, before that, and for folks that preorder the book, we have a pretty cool swag bag for folks. [Note: The book has now been released, but readers of ChrisKresser.com can still get the bonus materials mentioned below by emailing the receipt of their purchase of Wired to Eat to wired2eat@gmail.com by March 27th.] If they go to www.robbwolf.com/wiredtoeat, we have a workbook that helps you navigate the 30-Day Reset and the 7-day Carb Test that really helps you to implement the triage process that I have in the book to help you understand where you are on the insulin-resistant, insulin-sensitivity spectrum and kind of plug you in an appropriate place with regards to carbohydrate intake. We have what used to be the first chapter of the book, called “Lies, Damned Lies, and Statistics, and it is my favorite chapter, but the publishers of the book were already really big, and they're like, “So, you're doing this huge historical treatment of how the food system came to be and where our healthcare system is.” And I'm like, “Yes.” And they said, “It's too much. It's got to go.” And I was like, “Damn it.” But we repurposed it into a downloadable guide, and I'm really proud of that chapter, honestly. There’s some pretty funny stuff in it, and I think it really sets a historical perspective for how did we get here, and then we can start making some thoughts about how to uncouple from that. I also did an interview with Dr. William Cromwell, who's the head of cardiovascular disease research at LabCorp and LipoScience. We got in and talked about what do we see in the basic blood panel, what are the laudable and challenging deficiencies of that, and then what might we want to look at so that we get a more nuanced and a more informed picture of what's going on. He talked about some soon-to-be released stuff like some super-early predictive measures that you can get out of this NMR profile, like this marker called GlycA, which is an inflammatory marker, but my understanding of this is that potentially, we could start seeing predictions of you developing type 2 diabetes 98 percent likelihood within 15 years based off these GlycA readings. It gives you a really early view before we really see any of the classic metabolic symptoms even popping up—before blood pressure increases, before blood glucose goes sideways, before insulin levels start going up. Chris: I know all of that stuff will be super-useful, in particular the interview with Dr. Cromwell. There are some real all-stars in the lipidology world. He is definitely in the top five people you want to be talking about this stuff with. Just quickly before you finish up, what's next? Robb: I'm working with Diana Rogers on a sustainability book, and so we're kind of asking this question, “What is sustainability? What might a sustainable food and medical system really look like?” We're mainly looking at the food with the medicine and food production side clearly has an interface. I'm really excited about that. I love the protein, carbs, fat up to a point, but I've been doing that for a long time and my, I guess, kind of my legacy play at this point is hoping to get folks fired up about where are we going in this overall story of food production and sustainability and the environment. I think it's a natural process. People may start off sick and then they get healthier and they feel good, and then they're like, “Oh, now that I feel good I want abs.” And so they get abs. And then, at the end of that they're like, “Okay, what do I do next?” And I'm like, “Well, we take all this newfangled energy and we funnel this into creating a much better world for our kids and grandkids.” And so, I think it's kind of a natural progression as this ancestral health scene grows and kind of matures, I think we'll see much more interest in it. I feel like the timing on this sustainability-oriented book will be really good, but that'll probably be out in 2018. Chris: Cool. I really look forward to it too. It’s a super-important part of this whole discussion. All right. Again, always a pleasure. Wired to Eat—check it out on Amazon. I look forward to having you back after the sustainability book, if not sooner. Robb: Awesome. Thanks, Chris. Take care.

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