Fads Versus Facts: Busting Myths about Nutrition and Exercise

Fads Versus Facts: Busting Myths about Nutrition and Exercise



the very first thing you need to know is it is the one session in all of the ideas festival where you will be encouraged to go to sleep you are given other permission to sleep during this panel and Christy London will be telling you why so with that authorization we'll begin by introducing Christy London a longtime journalist and a great favorite of mine for her extremely sensible reporting that I bookmark I put in Evernote I can index I've got lots of Christie pieces in my Evernote her latest book is called good to go the athlete and all of us can learn from the strange science of sports recovery which is for sale right here in the registration tent on the other side and she also has a regular podcast emerging forms which you can all download then Eric Topol who said just introduced me as being of the Scripps Research Institute and once you see how many followers he has on Twitter you will understand why he needs no further introduction but he's an authority on artificial intelligence and medicine of all kinds but we'll be talking about personalized nutrition and what you can learn from your own Gino on microbiome so I'd like to start with some of the excellent advice and findings I heard Christie give at a lunchtime session that a few of us were fortunate enough to listen to this very day across the way so some of the Kyle Q you if you can't remember what was particularly counterintuitive but could you start with some of the findings from the book all right so the book is about exercise recovery all the things that athletes need to do to be good to go from one thought of exercise or one event to the other and I will just do it a big spoiler which is the number one thing that athletes can do for recovery is sleep sleepest number one it's probably number two three four five nothing else comes close but the other thing that's kind of interesting is that sleep is also really important for recovery from all sorts of tasks not just from sports but from any kind of performance and so I think it's really important I was just telling Corby earlier that the New York Times did this really interesting interview with a bunch of Democratic presidential candidates and one of the questions they asked everyone is how much sleep they got and I was just going oh my god I can't believe this so many of them were saying they got four or five hours of sleep which is just terrible terrible for cognitive performance or anyone who wants to be at their best that's just you know it shows a lack of priorities you really need to prioritize sleep if you're going to be performing in any kind of event let alone a large campaign rally right right and so naps are good too I saw a couple people napping outside here in between sessions that's great I give my own if it weren't for the fact you would wake them up you would have applauded that's right I did take a couple photos and what about general nutritional advice yeah so this is really interesting there are so many products now out there nutritional products marketed for recovery and what I found in looking at the research is that most of this is hype so what's really important for recovery is good nutrition but it's really the the good nutrients that you need it's not one particular food or another there used to be this notion that you needed to eat something immediately following exercise the idea was there was something called the window of recovery so the concept was they thought that after you exercise you deplete the glycogen in your muscles which is what the fuel that muscles use and the idea was that immediately following that bad of exercise you really needed to refuel then or it would not be as replenished as well and that this timing was really important but what ended up happening is as they did more studies and research this issue more it became apparent that it was the nutrition itself and the actual nutrients the protein and the carbohydrates that were important it was not the timing itself didn't you mean to say protein only never-never carbohydrate right well this is a whole point contention right and I think yeah Eric and I were talking right before the session about how so much of what is said in the public and people's feelings about nutrition are really sort of bordering on religion rather than science and I wrote a whole story I did a project for 538 when I was the lead science writer there looking at nutritional studies and the headline was something like you can't trust what you read about nutrition which it was more sweeping than that but the issue was that nutritional studies are extremely difficult to do and the reason is it's very hard to figure out what people are actually eating even if you try your best let me just give you an example if I were to ask you how many times did you eat tomatoes in the last year on a daily basis what serving size tomato to chew it's very difficult to even answer that question right but if your research are trying to look at say the health benefits or health detriments of a particular food whether it's tomatoes or berries or whatever it might be it's extremely difficult to quantify and even if you wanted to take people you know take a large group of people and split them into two what they've found again and again in these sorts of studies where they try to randomize and control it is that what ends up happening is it's very difficult to get people to adhere to these diets that are done in the study and I think anyone who's tried to lose weight knows that it's hard to adhere to a diet right unless it's the thing that you're choosing and so it often ends up happening and this happened with some of the studies on say low-fat and high-fat diets where what ended up happening is the two groups are actually much more similar than they were intended to be because you had adherence problems and so it's just an extremely difficult problem to study and so the issue here is not that nutrition researchers are horrible people and they're not doing a good job and not trying their best but the issue is that it's an extremely difficult issue to study and if it wasn't we would have solved it all by now right right in fact there's a there's a time study about two groups that we're going to bring up later but but that'll be after Eric has some stuff to say you also had different news oh I wanted to ask actually the the group how many of you have filled out a food survey or questionnaire for your nutritionist is part of a checkup a very few of you but I think that you might all agree that it's really hard to think of what you actually ate with any kind of accuracy you immediately forget and you do what everyone does on food surveys which is why you say what you think was probably more helpful but you don't actually want to admit and we're going to be hearing about a piece of software that Eric was telling us about that might be able to call it catch you out on your lies but before we move to Eric there's one more piece of what I thought was very counterintuitive advice when someone asked but what about stretching speaking of that window of recovery and what we really need to keep in mind because so many of us think of stretching as a kind of religion right well it is something that it's very ritualized it feels good we've all been taught that you need to stretch to prevent injuries but it's interesting when you look at the research and there's been quite a bit of research on stretching it turns out that stretching doesn't reduce the risk of injury from sports and exercise and in fact stretching before an athletic event may actually reduce your performance a little bit this is based on some researchers and runners and so you know so many people are stretching in hopes that they will be either less sore or they will reduce their chance of injury and it turns out that that doesn't hold up what it does do though stretching will help your flexibility so if you are stretching in order to be able to touch your toes better by all means continue to do so but if you're doing it in hopes of you know preventing injury or preventing soreness you can save your time yours you know I think everybody here is open-mouthed as I was because this is such a religion but you had at least a justification for when you were you've been kind of an extremely trained athlete all your life yeah when you were captain of a team in high school yeah in high school I was the captain of the track team and we would have before practice every day we would have a very ritualized stretching routine and it was like there was something like ten stretches and we would do them in order and we would sort of finished up with these buddy stretches and I think that that stretching served a very important purpose which was it was all of us sort of bonding as a team it was a ritual for us to come together and get prepared for the run or the day's events and so I think that sometimes some of the things that we do may be very beneficial in some way but the explanation that were given or the sort of science or scientific explanation that we're told doesn't hold up but that doesn't mean that it's not serving some purpose that is beneficial for example and we're about to come to Eric the data that you eat less if you are conversing at a meal you digest better absorption is better because the social interaction slows you down and allows the feelings of satiety that you're full to reach your brain much more intuitively and better than if you are checking your microphone at a sweet green in the afternoon next to your cell phone Eric so you recently wrote a very provocative piece in March in the New York Times about thinking of tailoring your own diet and your reaction to sugar to glucose which is so important when editing one thinks of controlling their weight their energy balance all of it by analyzing your microbiome so can you lead us through what that analysis entailed and some of the things you kind of did not think you were going to find out right well I used first want to get back to Christie's about the poor nutritional science that was the history but I think it really got turned around and what this was a work from Israel the Weizmann Institute and instead of the food diaries that you talked about they actually had prepared meals and they've now studied thousands of people and they gave the exact same food the exact same amount the exact same time and they studied everything about these people including a glucose sensor including all their labs their their sleep their activity their stress and their gut microbiome and at the end of all that what they came up with is they can recommend foods that would avoid glucose spikes on an individualized basis now that cracked the whole case because up until now everybody's 'soon there's this one diet that somehow magical for all people which couldn't be further from the truth and it's finally what we can acknowledge that we have this unique response to food and it isn't just a gut microbiome but that's a big part of the story now just a couple of weeks ago the group from London Kings College they have a project statement where they have the largest twin study in the world and they've brought in a thousand twins from all over the UK and they not only replicated that work but they also put in a line in their blood blood stream to detect triglyceride response to food you know I'm going to just be a little pat and say I read 6,000 but it didn't say pairs of twins or people but it was a lot of twins yeah a thousand and one twins and so anyway they they had the triglycerides and the insulin levels and they to the exact same food showed this mark divergence so I was very intrigued by these experiments and I signed up with the Israelis and I did this for two weeks and this was before there's now an app called bite snap where you can take a picture of your food and it tells you what it is I had to write down everything I ate and drank through two weeks had a glucose sensor I had a gut microbiome sample and then it got an output for me about what food would be the best food to avoid glucose spikes now before I go too far in this it doesn't mean that glucose spikes are going to lead to diabetes or heart disease we don't know that so this is not ready for people to go sign up this is really still in the research phase so many reasons it's not interesting so there's a great podcast out there that you should all go listen to it's called merging forms more emerging form is my podcast and you should certainly listen to that but gastropod is a podcast about the science of food and they actually a special episode on this recently they also wrote a companion piece of the New York Times about this very study that Eric is talking about and what's really interesting is so the two hosts of the podcast took part in the study as well and they got some of their personal results back but what was really interesting is that they both experienced a sense of anxiety based on some other the results and I think that this is a really important thing to think about in a consequence that needs to be taken into know absolutely but I think what what we're getting at is that were so the twins just to be getting back to that they had markedly identical twins markedly divergent response to glucose replicating the Israeli study and triglycerides and insulin and then when I did this I had these glucose spikes I'm not a diabetic up to 180 190 s of wall and I learned that there were these foods that I like my favorite food we're doing and the foods that they recommended that I eat like cheesecake and Brad recommended yeah and what I avoid the glucose spikes and I wouldn't go near that stuff I'm a cardiologist you know that and then what was causing the spike wait I want to know how are they deciding that cheesecake like what is the evidence that cheesecake is going to be better than say ice cream or well they have they have basically every food in their resource now from machine learning that's another part of the story if we didn't have AI a machine learning we would never act this case there's so much data this was billions of data points so they then can take the foods from the thousands of people that have been studied and impute the other foods and then of course I replicated their work I mean I went ahead with the glucose sensor and I tried the food I didn't tnd bratwurst but but I think worse is something that they said was really important not only for you but me it's all individualized and Eric tell us what were some of the things that you really didn't expect to be causing these spikes according to this yeah well you know I I just were so surprised I thought you know things like oatmeal me might be very different for anyone else here you know that was a glucose spiked problem for me so I learned a lot from this now is it going to change my whole nutritional plan no but I think what it indicates is we're chipping away at this this is not like the nutritional science that I totally agree with it's pretty shoddy and questionable this is a new form of multimodal data that's authentic and is we're learning a lot about it and it and the gut microbiome when we're learning everyday I mean today we learned that the gut microbiome from elite athletes has a bacterium that is associated with any remarkable endurance and when that same bacterium was put into mice they ran on the treadmill forever you know reduction weren't you're saying a reduction of life so the lactate metabolism was markedly altered as it was shown and then they went back to a whole bunch more elite athletes and they had this specific bacterium this vanilla a típica atypia and so now you can just envision they're gonna start selling crap souls of vanilla a tibia anyway don't but the gut microbiome has got a large part of our individualized response to food and we do want to be able to turn to food instead of medications in the future if that will make us healthier the missing link here is that we don't know that these spikes of triglycerides or glucose or whatever is linked to heart disease or cancer or neurologic diseases that's the missing piece and since you're about to tee me up for a little promotion for my food to society program could you talk about the Geisinger pharmacy to do with diabetes control so but I just was reviewing as a high tech side the low tech side which is another food as medicine story was initiated by guising or a very progressive Health System in Danville Pennsylvania and what they did was they recognized that there are a lot of people in their community that had their so-called food insecurity that weren't getting the right foods and they didn't know where their next meal was coming from from one day to the next exactly and so they they had food delivered to them this this food pharmacy program and the diabetics in this program had a remarkable improvement of their glucose regulation and they had a big reduction in their need to have emergency room visits and hospitalizations so it was a great program and you wonder why we don't do this more well thank you because in fact the food is medicine initiative of the food society program it's looking to extend exactly this kind of advice to underserved areas to programs and aren't aware of it and make that reach much more because the data you say about emergency department admissions coming down it's already been shown in a few pioneer studies to significantly reduce healthcare cost so it's very important that these be extended but bring us into the future with AI and machine learning so first tell us some of the factors that made that glucose read out in that list of a hundred and fifty thousand foods and you could go into to predict your glucose reaction wasn't entirely useful because there were factors they hadn't bothered to ask yeah so they never asked me did you have other medical conditions that would could be diet related and I happen to have had multiple bouts of kidney stones which was calcium oxalate I'm not supposed to have high oxalate foods so the diet recommendations were totally absent that vital piece so that just shows you how kind of complex this story is it needs to be truly bespoke and it has to take in all of one's concurrent conditions and if you did this again would you go to bite snap which we are now promoting because this is the Big Brother Big Sister app in which you take photographs of your plate rather than describing and estimating what's on it and it and analyzes according to you with uncanny accuracy what the calorie and protein and fat content are yeah so it's a free app there are others but this one is rated the best for accuracy it's a lot better than what I had to do and all the other people will they had to log right right in everything that they ate in dried this is more automated I don't think anybody wants to do this long-term but for a week or two to learn about certain foods that could have an adverse and unwittingly verse effect it might be useful and what's the potential that I'm going to ask you to judge your evaluation of what you think the potential is so so vault us into the future what needs to be done to get to the point where we could all ascend in some saliva or something that would enable this kind of individual readout that you think might be taking into account enough factors enough data with a database sufficiently robust as a reference to result in something we would actually follow day by day well I think it's coming right now there is absolutely no offering that has any science behind it that's credible which is not to say that there's no offering right after everybody yeah there's all this personalized nutrition nutrition new tree genomics vine omics I mean all this stuff is complete balderdash yeah balderdash that's the word of the day it is but it's also I think the concern here like look the low-hanging fruit here is not the personalized spike that this particular food it's the stuff of like basic nutritional I mean go study you were talking about with guys no we're talking about helping people have access to healthy foods it wasn't that they were having one particular food it was that these were people that had food insecurity to begin with that they were being given access to healthy foods they were being given help I'm in managing their diabetes and things like this and so I think we're so quick to look for that magic solution or the idea that you know for me I'm so different and so if I just eat this one food instead of the other everything will be perfect and there probably are cases of that but it's far less important than the big picture and the overall I appreciate the point here is that if you have glucose spikes you know about a billion people on the planet or at risk for developing type 2 diabetes and if you're having spikes of 180 in 200 and you don't know it and you can avoid that that might be a good thing so we shouldn't just turn our backs on this it's it could be useful information we want to prevent people from developing diabetes and you know it's just this is the sort of information with a low-cost glucose sensor a short-term thing for a week or two it could be some day you know really inexpensive and useful but I just have to be the skeptic here and it's like so you do this for one week we know that there are a lot of other things that can influence these things your sleep status stress other nutritional things and so is this reproducible you know say you eat this food that this week is giving you this big spike will that also be true under different circumstances ever because it's tomato season with tomato season nine months of the year I'm not going to eat a tomato I don't know that these apps are designed for seasonal followers and farmers market adherents like you right and so the other danger here so this 538 piece that I did I enlisted some colleagues and we actually did this fun project so one of the the concerns here is when you get a very large dataset it's easy to find spurious results and this is a whole other issue we don't have time for but there's a thing called peaking so basically using statistical analyses with very large samples you can find associations that are probably always worth looking into but really need to be confirmed and so in our project we sort of played around with this using actual data we took these food frequency questionnaire as we enlisted some readers to help us and we were able to associate math aptitude with potato chip consumption so if you want to be good at math you eat lots of chips or one of my favorites was that people who cut the fat out their steaks were more likely to be atheists than people who ate their that God see that that God had given them on that stage that seems intuitive know why you would be surprised could you take us through just since pee hacking is a really important concept when reading any nutrition study but really any meta survey in general could you just tell us what pee hacking sure so pee hockey and the very best that you can do I wrote a story for 5:38 called science isn't broken and with this I worked with one of my date of his colleagues and we actually built a tool the best individual yeah the best way to understand P aking is to try it and if you go to science isn't broken at 5:38 you'll find this and you can actually play around with it so what we did is we basically gave readers a chance to see what this what this is like and so we used real data and we presented a research problem so the research question was this you are a social scientist and your hypothesis is that the political party that's in charge can influence the economy and that has a direct effect on the economy okay great so how are you gonna test this immediately you run into this problem how are we going to measure this but we used real data we presented real data and so readers could choose the datasets and choose so it's things like are you going to look at Congress are you looking at who's president are you looking at governor's and in state houses things like this and so but basically by fiddling around with these decisions you could create data you could create a p-value and a p-value is a statistical it's it's a statistic that's used very often and erroneously is sort of a threshold test of whether it's the threshold test so people say it's passed to the P threshold or they will say statistically significant it's often the terminology and these are useful tests that have a place in science I believe but they are too often misused as sort of a barometer of like is it true or isn't it and what we we showed with this tool that we made is that you could play around at the data to support any hypothesis you could support using actual data and real science that Democrats are better for the economy or that they're worse for the economy or Republicans are better for the economy or they're worse for the economy but I think the takeaway here is that you know it's that whole lies damn lies and statistics and the takeaway is not that science is unreliable it's read lies damned lies and statistics it is a short and great book about and also how to lie with statistics yeah these are great books can I go back to Eric thank you for that skepticism you mentioned the Mike nothing if not skeptical we are the microbiome that's so important in understanding individualized reaction but for a long time it was the genome yeah and being able to go and find what was in your genome can you lead us through this progression from genome to microbiome right so you know back in 2000 when at the White House lawn when they announced the the secret of life code was broken and you know this was Clinton inventor and Francis Collins all together it obviously was misguided because you know here we are 19 years later and we haven't exactly demystified all of life we made some progress but the difference was the expectations from our genome which obviously is very important were exceptionally high and we didn't understand how important the gut microbiome in particular is and now every week we're seeing things not only the fact that almost every drug we take has a specific interaction with our gut microbiome so you may be taking a drug and it doesn't work because of a bacterium that you have or a not you may have the bacterium but you have a different sequence in it and you can only find it through a nasty cold we call metagenomics but you know just a couple of weeks ago a striking study showed that there was a bacterium in the gut microbiome that was discovered that makes an enzyme that changes a blood type from A or B or AV to blood type all so now that can be used to convert everybody's blood to a universal donor which is changing the entire landscape of blood transfusion so we expect to see a revival of thorough dose any day no but I think the key takeaway here is that it's very different the genome we had unrealistic expectations and the the microbiome is just the opposite where we're finding all these things that are you know I mentioned the athlete thing today who would have ever guessed and who knows what we're going to find next week so it's wild and did either of you have go ahead Christine I just go say it's really exciting but I think it's really important to understand and I agree with most of what Eric just said this is really exciting stuff I think but we are at a part in the process I think it's important and I don't think that the public always has a good understanding of how science works and how it progresses and so science is actually a process of uncertainty reduction and I think too often the public has sort of been given this view that science is a magic wand that turns everything it touches into truth but it turns out that science is very often wrong on the way to being right and I think it's important that we understand this because if you don't understand that it's a process of uncertainty reduction and that each study can maybe if you're very lucky provide answer an answer to one very very specific question and yet it will always throw up ten other questions then each time you see this a new study that overturns something else it's easy to think oh well what a science no everyday now we have a different finding or things get overturned I mean this is the classic like it's coffee good for you or bad for you today I wrote a book on coffee and had to go through 300 studies of caffeine mature it was actually 312 because I'll never forget it or do it again I hope and they were so conflicting but in general I I found a consensus and I I happen to teach at the Tufts Friedman school of nutrition science and policy and this bee devil's anyone trying to understand nutrition the idea is you've just beautifully said that science is progressive at zigs and zags and it arrives at an answer but the problem with the media yes where I say is I do think that we are partially responsible this is something I've thought a lot about and I've done a lot of work and a lot of speaking about just how the media portrays science in public and I think it's important that we are very clear about the caveats of every study I mean the microbiome stuff is so exciting and we know that it's very important but I think it's important as the media but also is the public to understand that these are early days and so right now we know that the microbiome is very important we know we have tantalizing evidence that it can make a difference and that there are probably things that we can learn that will help us be healthier but we're not there yet and we need to be really careful and one thing that we've seen again and again and this is something I document in my book is times when we had one small little study that had some really enticing and interesting finding everyone jumps on the bandwagon all of a sudden everyone's doing this thing or taking this drug or this food or whatever it is adopting this practice and then you know more studies come out and we do some more research and it turns out we had things completely wrong the first study was bad but because we were for example Eric you're a complete fan of the keto diet or you know gosh no no but you know there the people are religious about this there's probably some you know the keto diet aficionados here and if you don't have to raise your hands if you if you question it oh my gosh you know it's it's like religion or politics so the problem is some people keto diet is for good and I go back to another point coffee and everything that we take in their studies to show it's either good or bad you know in in the deep diet chapter in deep medicine I show the remarkable graphic about all these studies hundreds of studies were it makes you know it'll kill you or it'll make you healthier now the point is that there may be some truth to that it may not be such a wrong signal because we are so individualized in our response and so for some people a keto diet may be really good for them some people may be a Palio diet some even there may be the grapefruit diet who knows but that's what I'm the excitement I have and I agree about the science and the need for replication and the need for uncertainty and always assume it's wrong until it's replicated you know umpteen times but we're making some headway here and no one had expected that gut microbiome was gonna be such a big driver in on a nutritional response no one had expected that identical twins would have such a remarkable difference in their food intake response so we're learning things and these things have been replicated they're not one-off report yeah I think the distinction here is to think about so this is really exciting science and Eric's scientists and working in this field and it's the difference between being excited about the science of studying it more and saying this is a really cool study and now replicated it but now we need to do even more studies to see how generalizable it is and we did it and we're seeing this really exciting finding of mice but does it translate to humans okay we're seeing it under this context and another and I think danger here is when we all sort of get on the bandwagon there's all this there's very good evidence to show that medical reversals are really hard so like basically one once something comes into widespread practice it's very difficult to change that practice so I think we need to be really careful about adopting things until we've really done enough confirmation that it's something worthwhile because we can really go down the wrong track and some of you might have been in this very room at the beginning of Aspen ideas health which preceded the first part of the Aspen ideas festival in which there's a presentation of the new welcome monitor science trust report in which the trust of science and particularly vaccines was enormous ly variable by country much more than then any scientists would wish and so we see that variants playing out across the world one of the studies and I'm about to throw it open to questions so please think of questions and we've gotten mic runners that just was reported on was done by the National Institutes of Health terrifically expensive study for only four weeks why is it terrifically expensive because it had 39 subjects who were otherwise completely healthy and in their 30s no dietary risk no nothing they were sort of tabula rasa's and they were given for two weeks a diet with a certain amount of protein saturated fat fat sugar calories and fiber every day and they were told here's your set of snacks and you can eat just as much as you want between meals and we're gonna give you the main meals they looked very similar in photographs if you shoot them prettily but one was made from highly processed and ultra-processed foods what does ultra-processed mean it's a technical term meaning one food that's made from several kinds of processed foods so it becomes ultra process whereas the other was largely from whole foods cooked in the workshop at nih and everything about these people was measured just we Eric was saying early their stool their blood their exercise levels everything about what they were Exuma ignite their their transpiration rate and after two weeks and then they were switched to the other one to be controlled so four weeks two weeks on each diet and they found that after two weeks the ones on the processed food diet ate a five to six hundred more calories a day in gains two pounds the ones on the whole food diet lost two pounds in the same amount every explanation of this so far is a theory is it because the fiber on the ultra processed food was given in liquid it was stirred into your juice your diet lemonade which is exactly what they did or was it because it's your individualized microbiome so this is the kind of thing looks provocative but there's no actual conclusion that we can draw it absolutely no I think it is a fascinating study one thing I was struck by was how come it took so long to do this time right it's like money I mean this goes back to my notion that so many nutrition studies are a very low quality it's very difficult the only way you can truly know what people are eating is to feed it to them yourself it's a lockable provide all the meals you're weighing it I mean even like I mean this this snapchat whatever the byte chat it's now really interesting but you know how can the picture know whether there's two tablespoons or one tablespoon of butter and that thing or like I mean I think that there's just there's a there are inherent limits and being able to measure what people are actually and by the same token how do we know when we do the machines work better than humans in this case you do I believe right thanks Eric could we have questions do we have any questions in the audience we've got a gentleman in the back we can hear you nor repeat it if you can I've heard about the Hippocrates Institute that's all I heard which sounds intriguing by the way not good and there you go that was a careful note to open the mic can you can you identify if it is what test is there for an individual each each of us sitting here is it a blood test a saliva test that will actually say in your case you shouldn't eat this but in your case over here you should you know I actually think we don't have that it's in a research mode right now I understand Christy is the deputy it'll ever be a worthwhile but I actually do think it will be but right now we don't have a way to do that there are people marketing through your companies but they haven't done it right that is you have to have all this data and in fact it's not even just sleep it's not just how many hours it's the actual level of light and REM and different types of sleep it's not we don't oversimplify any of these components but yes all these things interact they have to be collected for the individual and it's part of our uniqueness so anybody who claims that this diet is right for you all people is just off-base because we have too much evidence against that that's all research there is no commercial entity today that I'm aware of that is bringing us to the public and don't you believe it if you see someone who tells you that there is gentleman right there nope sorry nope he's got the mic and then we'll come to you sorry I like Whole Foods has a terrific new product where you can buy butter lettuce washed ready to put into the South Pole and it's encased in a pretty heavy plastic Topman what do you have to say to that now tell us what the product encased in the heavy plastic we're all hissing at just that the idea of what is the product itself well I'll just say that lettuce is an incredibly easy crop to grow and I would love to see more of a movement towards home I mean I understand I did a huge piece on vertical farming and whenever you're getting something that's been grown indoors by specific light it's generally lettuce it doesn't say on the label but I would wager that that probably was grown indoors and and it's perfectly good for you it's it's hydroponic or its aeroponic but that's what you often find in Whole Foods and stores but the fact is it seems to be healthful and you eat it it appeals to you and you actually eat it and that's the huge barrier in all of these dietary recommendations getting people to adhere to it it doesn't matter you like it and you're eating it so I think any nutritionist would say keep eating it right – gentlemen let's have two questions since they're right next to each other you were the next and then behind you what are the three biggest current good we've got one question then we're going to immediately fall with the gentleman behind all of them yeah I don't know Christy wait before the answer Oh got it I guess two to two parts of the question one is can you explain as a layman why glucose spikes and insulin resistance are so important longevity and – I loved your op-ed about the AI diet thank you there are I think a few things that are near commercialization that you've alluded to how many years until you let's start with three dumb fads all of them I mean by a definition of fad is sort of dumb right but keep going with 1zu particularly just like we've had Eric on keto we're gonna ask you for more Christy can you think of three dumb the Paleo diet I wrote something for The Washington Post about this so you know the fact the idea even that it's based on what our paleo ancestor is is ridiculous yeah like all that nice sweet and local diet that really got us in trouble was the low-fat yeah just promoted obesity and it was a disaster it was the diet for you know decades there's lots of chapter and verse on that the history of demonizing fat as opposed to sugar and how that's already changed now diets uh products that are coming along that are a few years ahead ya know this is a really good point so there have been companies like the one that I mentioned in the New York Times essay called day two they just are taking shortcuts so I can't recommend it that is they only do the gut microbiome and then they give you a output of recommended food that's not that doesn't cut it to me and I wouldn't pay a dime for that because it isn't getting you through all this multimodal data together but the other point you asked which I think is fundamental what about these glucose spikes that after you eat and you gets to 180 or you know 200 that you didn't know about and remind us of that leading to insulin resistance yeah and an insulin resistance which it turns out people that might have very high insulin levels and they aren't responding to insulin these are things that we do know are precursors to diabetics to diabetes the problem what we don't know is pinpointing it on that person say if you have a glucose spikes multiple spikes and you know high are you going to develop diabetes factor we also know that if you have high glucoses on a frequent basis it gives permeability of your gut mucosa so you're much more likely to have inflammation in your body and whether that can lead to many different diseases but what we need to do is invest in a long term trial where we look at these spikes and do a randomized trial and see what happens about heart disease and cancer and neurodegenerative diseases and autoimmune diseases and then we'll get the final thing but right now glucose spikes and triglyceride spikes are not enough what I tried to do is convey that we're chipping away at this we're not there and nobody should I don't believe sign up for any kind of commercial test and as soon as you say what we need is a long-term study you know everybody pictures enormous dollar signs who's going to sponsor this who's going to do the kind of basic science that it was amazing the NIH did in this control process versus ultra-processed a non processed food the lady in the back and then the gentleman right here and could we have mic runners cue them both up oh good everybody's favorite subject nutritional supplements and are they worth the money are they yeah I have a piece coming on the annals of internal medicine next week and I mean no supplements no there's no data for those I have an entire chapter in my book I'll just give it away the title of the chapter is a selling snake oil so that tells you an important thing to know about nutritional supplements is not just that no one actually needs them but also that there's very little oversight and regulation ya know you're exempted ya from the kind of regulation we expect they're subject to and the nutritional supplement industry has done a very good job of getting them classified as something that just escapes so there's completely untrustworthy and so are their claims because we have two questions there's there's the gentleman right here and then two rows behind what are your thoughts on fasting and micro fasting maybe 12 to 16 hours oh I'm so glad you asked about intermittent fasting so that there's a lot that's a fan right now but what's really interesting about this is the circadian clock and so you know we all have our own biorhythm circadian clock and it may be Sachin Panda whose colleague of mine at the Salk Institute in La Jolla where I work has written a book the circadian code which is quite good and he says he's done a lot of good science as others have been in this area and the question is should you there's a question about fasting but it's also about should you have whatever you're going to eat should you have it in a short time of the day within 10 hours let's say because it's this eating and it's been shown in certain studies eating throughout the day in the evening is makes you prone to obesity and gaining weight so we have a lot to learn but there's a lot of really interesting data coming out a lot to learn gentleman in the back and then the two people right here on this row unless he's thought better of it he was the same question about intermittent fasting and so okay great we've got two people right here on the ends in the front row let's start with the lady hi so I'm the mom of small children I have a two year old and a 5 year old little girls and I view them kind of as a blank slate and there's so much information about nutrition obviously for all of us and I feel like at my age it's more about fixing you know bad habits but with them it's a blank slate and is so overwhelming as a mother to figure out how to navigate you know giving them great nutrition obviously good proteins good fats good vegetables where I struggle and I've actually kind of come to conflict with is at school when they're giving them all these sugary treats so there's donuts and they're giving a mess and so obviously that's terrible for children and you'd be proud I took it to the administration but there's also then the social ramifications of having your child be ostracized or not participating and then you get into the whole eating disorder area so as a parent trying to navigate this do you have any suggested resources or some basic information or suggestions because I'm frankly just overwhelmed start with you Christy that Erica this is interesting I was on a panel a few years ago here at Aspen ideas where we talked about there are some really interesting programs going on in schools where they're trying to bring better nutrition to schools but I guess I would come around to I think that there's a common theme here where we know that nutrition is really important I mean it just has to be right it's what we're putting into our bodies it's the fuels that we're running on but it's also something that we can control and so we all you know all sorts of weird and bad things happen to our bodies and I think that we sometimes sort of ascribe an oversized sense of control to the things that we're eating and by that I mean like the idea that like this one snack on a particular day is going to have this like enormous destructive domino effect right and so but but I think the point here is that it be our stress and our sort of need to control this can become a source of stress and a source of like its own problem and I think that's a real danger particularly with kids like you don't want to be demonizing foods or making them obsessed about foods in that sort of way and so I'm not a parent so I can't really speak to like how I would deal with that but I know like particularly with athletes which is what I'm familiar with them what my books about you know if you're getting into situations where what you feel like as acceptable food or good food is so narrow that it's not accessible to you a lot of the time that all of a sudden you you're sort of making yourself unhealthier because you're introducing this major source of stress stress sleep Eric I don't know everything and I think that's good three last question gentlemen all right save the best for last thanks for your time I'm a fitness entrepreneur from Boston developing a platform to empower fitness influencers and my question is because I work with you know various clients throughout the throughout the year and the main goal that I generally attract these clients that are trying to lose weight slash fat and they're scared T carbs what do you say about that both of you car sugars getting back to insulin resistance Eric yeah and I think this is an individualized response and I think that the data to support that Tennant is overwhelming now but we just we're talking about big data per individual and by many different layers of data and that's what's one of the most exciting things about AI practically is to be able to actualize this food as medicine principle but we're in the early stages of that so I I don't think there's an answer for more for more than you know the individual person Chris chose deliberately setting up what I said you don't you mean protein only not carbs because in fact you think it's an overall picture yes an overall picture and I challenged someone to run a marathon without any carbs like you just you can't do it and in fact I was saying in my earlier session about this I just was at the American College of Sports Medicine meeting a few weeks ago and there was a great presentation there by a nutritionist Louise Burke who's one of the top in the field and she actually did a study on race Walker's with keto diet this was something where they were like at the Olympic training they were in a situation where they were actually feeding them the diet so they could be sure they were adhering and the first takeaway was that the athletes hated it it was really hard to do but also their performance plummeted they had a really hard time because it was such low carbohydrate and when you are doing endurance exercise that's what your body is running on as carbohydrates the thing that was really interesting is when the athletes went off the diet then all of a sudden their performance got a hell of a lot better they were so setting PRS and things like that and one of the proposed explanations for this was that the being on this diet which they hated so much sort of increased their capacity for suffering so it's kind of an intriguing idea I don't know you know again it needs to be replicated it's hard to know exactly what to make out of that great so that's we're way out of time but way great panel so the lessons are trust in science be patient read Christie and Eric and sleep thank you

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