And he has a different perspective on that that I think will be really important to hear. I mean he knows his stuff, he's got his training, he is a PhD in exercise physiology and a second PhD in health and physical education. And like I said he has been in practice since the 70s helping people.
And it's important to hear sort of the counterbalance to, 'oh, we don't have to worry so much about exercise', and his point is exercise is absolutely crucial when done correctly and works synergistically with diet to help us metabolically and help our health. So I hope you really appreciate and enjoy this interview with Dr. Ben Bocchichio.
Dr. Ben Bocchichio, thank you for joining me on the Diet Doctor podcast.
Dr. Ben Boccichio:My pleasure, Bret. Always a pleasure to see you.
So I used to go to the fights and I get to go in the gym and watch these guys train and box and stuff and I was always fascinated by it. And as an athlete I was always really interested in how to train to be better at the sport, but I really like the training part as much as the sport in some cases and so I decided I was going to study this in college and I got a degree in phys/ed, health and science and then a Masters in education with a specialization in resistance exercise, then I did a PhD in exercise physiology.
And the second one after I was in practice for a while I had a low back center in Miami, everybody was overweight. I had the largest fitness center in New York City, most people were concerned with their weight. I had a cardiac rehab center... and most of the problems for those people was they were overweight. And I had a pretty good business going and I had time, I decided to take a second PhD to get serious and study obesity.
So when you do a PhD you do a review of literature, so you have a theoretical basis for your hypothesis. So my review of literature was the development of obesity and fat related disorders. So about 8 or 10 years before Gary Taubes wrote Good Calories Bad Calories, I interviewed and studied a bunch of the people like he did for his book. So when that book came out I got ahold of Gary and we've become really good friends and done seminars and presentations together and so I got into that.
But as far as the low-carb thing, to me was all first-hand observation. People wanted to get lean and the leanest people that I knew were bodybuilders. So I kind of asked them. It's kind of like asking a race horse how to run fast, but I asked them what they were doing and I kind of observed what they were doing and they were low-carb. Before a contest these guys were low-carb, big-time low-carb, okay.
And I thought that's a good way to go and I didn't mind it because I loved eating meat and I did it myself and I felt really good and at that time I was still a fairly elite athlete and I felt great in my performances, my energy and everything, in physique... And, you know, I am not a bodybuilder, I always had a decent set of Italian muscles, so I started doing that and I used it for a lot of my first clients and patients and subjects and studies that I did.
And so we did the keto and then I created in 1974 slow resistance training. And the basis of that was high intensity training that was safe and productive. And I really started out training athletes. In fact, going back to 1974 it might be interesting to note that I didn't even first consider that women could do this. There wasn't such a thing. So I had a model come to me, an Olympic volleyball player gal and they work their butts off and I said... light went on... they can do this too. You know, I literally did not even consider that as part of my model.
So it grew rapidly into orthopedic rehab, cardiac rehab, metabolic disorders, all kinds of- you know, sports training and so my clientele just got diverse and big very fast. By the time I was, I think, 27 years old, I had seven of these facilities, centers all over the East coast and that's the deal and I've been doing it ever since.
So I think this time it will stick and I want to- but one of the things, you know, and I think Steve Phinney- I realize Steve is almost as old as I am and I realize we have kind of a similar perspective on some of the new claims made by the keto community. So, you know, pump the brakes a little bit. So we don't get into that, you know, getting ahead of ourselves and making claims that are going to make us less reliable.
But some of these claims- one of my pet peeves is- and I'm not going to mention names unless you want me to, but some of the claims that are being made for example about fasting, I think are still a little over-the-top and are unproven.
Now I wrote my first article about fasting in 1978. I was trained in therapeutic fasting by vegans who had a therapeutic fasting clinic and I saw some wonderful results from this stuff. I mean arthritic conditions- I will tell a story about a girl that came in there at 12 years old and had had her tonsils out at nine or 10. And after she had her tonsils out she started to decline in her performance at school, her attitude, behavior.
And at that time they used ether as a- So they fasted this girl, 12-year-old girl, I watched this and I think on the fourth day of fasting- So fasting to me is not eating... eating once a day is not fasting in my mind, in the therapeutic fasting genre, okay? But anyway, they fasted her for four days and in the fourth day she felt better and the room stunk of ether 3+ years later.
So the fasting thing connected to that to me is a little bit- I spoke to somebody yesterday who was fairly knowledgeable and we had a little bit of an argument. And he said really technically the four hours between my meals is when I'm fasting. I said a fasting person doesn't accept that. I mean so that means every minute that you are not eating, you are fasting... I don't consider that to be the right terminology and the right application of the concept.
So let's go to the cellular- I am a muscle guy, okay, so I know muscle physiology, I know protein synthesis kind of pretty decently, okay? If you're claiming that during fasting you can up-regulate protein synthesis, it's a tough swallow, because certainly no cell is dumb enough to basically grow in the absence of nutrients and no organism really does that. Now can you can you temporarily or something-? Now the HGH claims, okay?
I think that's different than HGH from exercise and some of those study show that you can increase HGH to double the basal rate. But by the same token my pitch is... there are plenty of studies that show high intensity training exercise, muscle training, increases HGH by 15 to 20 to 25 times. So I think that if you calculate that these things are somehow equivalent I think it's just silly and I think a little irresponsible.
Now years ago I did a fasting experiment with about 12 athletes and at that time we used a hydrostatic weighing in, you know, under water weighing for body. I wanted to see on a five-day fast what happened, what I could measure. This was maybe late 70s or early 80s at the latest. And I did it myself. And the first two days according to hydrostatic weighing we lost lean tissue, no question. Now understand, Bret, that hydrostatic weighing considers everything of equal or higher density than water to be lean.
Now I don't recommend five day fasted un-therapeutic and un-supervised. But in the lexicon now, you know, once a day eating I don't think has this drastic effect, I think that's perfectly fine. I knew plenty of people, I'm talking hundreds of people that ate once a day and did well and had huge muscle mass and kept it into, you know, extended years.
There are guys that have played NFL football, that have run Olympic races in that condition and there's no evidence- But again now it depends on the response, like any medication, like any behavioral intervention, depends on the response, depends on the pathways that we've induced to what level, for the individual, but in my experience I've not seen a problem with that at all.
You can go high-intensity, you can blow it out if you want. If it's one day fast I haven't seen any problem. Now do I think- to answer your question, doing some exercise during a fast, a three day fast or something you could- I have no reason to believe and I don't think there's any evidence in the literature to believe that at least moderate intensity exercise would be damaging. I don't see why it would.
With keto diet we're trying to instigate metabolic pathway. So we identify these pathways, so we know what some of them are and I can show you literature and pound for pound how high-intensity exercise is at least an additive if not a synergistic component of this. You're going to get much more bang for your buck and I can instigate a lot of those pathways without being on a keto diet. So what's more important?
To me the sensible way to apply this is together. So I don't think- Now behaviorally I understand if you get a 350 pound diabetic and you don't want to give them too much to absorb behaviorally as it's going to be ominous... "I have to watch - I can eat bread and I have to exercise..."
Okay, I could go with that but physiologically metabolically I do not go with that. I mean I think you have to exercise the muscle systems power and efficacy as an endocrine organ has been underestimated and we in medical and the graduate school have not been taught to recognize and appreciate it.
But when you used the word high intensity interval training, I think that's come to be synonymous now with sprinting, with, you know, treadmill repeats or bicycled repeats as hard as you can for 30 seconds or a minute, you know, the boot camp type workouts. But you use that also to mean resistance training.
What we are trying to do is to induce these fight or flight, life or death, type 2B muscle fibers to come into play and tax them to a threshold level. So now we have certain parameters that are human parameters. Nobody can work at a high intensity with those type 2 muscle- type 2 fiber sorry- type 2B fiber was more than probably about 90 seconds.
So if you're going longer than that either you have the lower the intensity- So it's not that it's hard exercise, it's not that it's demanding and grueling, it may be all of those, but that's not what defines high-intensity exercise. So this is a universally applicable concept. If somebody is very sedentary having them get off that share three times may tax their type 2B muscle fibers and therefore they are in a high-intensity metabolic load.
So the concept that we normally... "High-intensity, oh it's hard"... You know, that's my little red badge of courage, has nothing to do with it. It has very little to do with it. It's this... in my mind, this is a prescribed controlled environment to tax those muscles to this threshold level under control, safely and in a sequence of time and recovery that's organized and subject to physiological parameters that we know exist.
My last slide said, you know, fat kids, rich kids, poor kids, anybody can do this. In any case you can do this with anybody. I did it with phase 2 cardiac rehab patients, I did it with orthopedic patients, I've done it with people in wheelchairs, I've done it with the world-class world record holder athletes, kids, older people. All we're trying to do is to tax those fibers. And subjectively it's the same demand but objectively could be totally different planets.
The circulatory system increases, the respiratory system has to supply oxygen, your breathing accelerates, hormonal changes happen, skeletal system adapts, neurological system... okay, so the driver of all these major organ systems is exercise, muscle contraction if you think about it.
We would not have needed a heart that can pump 10 times above normal if we didn't have a muscular demand. We would not have to breathe four times, seven times more oxygen per unit of time if we didn't have to do some exercise... some muscle action didn't demand it.
Even the brain - the brain didn't grow, you know, until it grew much more significantly when we had vigorous exercise and we know that the more you exercise or at least you tax these muscle fibers at a certain level, the more the brain increases the neural transmission capacity. So my point is the muscle system is really important and I don't know if I'm going off track a little bit, but with that in mind we tried to develop the system that's safe and scientific and not time-consuming but it is universally applicable. You don't have to have- I mean, you can do this with bands at home.
And if you saw Doug Reynolds and I doing on Low-Carb USA, me taking him through it and Doug is a pretty strong guy, he got his butt kicked just using bands. And it took us I think 12 minutes to go through his whole body. So it can work, it does work, it's applicable.
Now that's exactly what I do. I came from the gym 50 years ago and came up with this. He came from a petri dish and we've arrived at the same place, which is interesting. And can I'm to get a hold of him and we're going to have some contact, maybe do some studies, but this is pretty interesting, this is really what works primarily and almost exclusively, this kind of formulation.
And so again one of the things I brought up in my talk was that if you are in the top one third for muscle strength in your age group for your gender you are 25% more likely to live to be 100 and at least 40% less likely to die of cancer. As an isolated variable; if you are diabetic, if you're overweight, if you're a smoker, it doesn't matter, it doesn't reflect on that statistic.
So muscle strength as we know... so you asked me about sarcopenia, okay? So sarcopenia is almost always a matter of lack of physical activity or endure exercise, which I consider two separate and distinct issues.
So that's activity and I think you should be active, but exercise is every three or four days taken down a big old animal to eat, working your butt off for a few days, taken easy and then you got to go out again. But if you had to do that every day, you would've been dead. You couldn't have sustained it. So there's a recovery genetically determined from high-intensity exercise.
In an aerobic cycle the normal fatty acid to triglyceride cycle happens continuously. We borrow from that cycle for aerobic exercise. That's why it's steady-state. Steady-state by definition means it doesn't make a big imposition on your metabolism. Right? Because you can sustain it. If we do type 2B high-intensity exercise, it is anything but steady-state.
It drives an adrenaline response. That adrenaline response produces a release of free fatty acids, because I'm running out of glycogen or I'm being threatened of running out of glycogen, the life-and-death fuel and so your body says, 'we need some backup here because I think I'm running out of this'.
Whether you run out of it or not, I think if you threaten that, if you deplete at a very high rate, your body gets into this survival kind of a mode, it releases adrenaline, which in an amplification cascade produces this free fatty acid release. And adrenaline I think can cleave I don't how many thousands of molecules of glycogen. Just one molecule of adrenaline, so it's a powerful potent- So now what we've done in this fat cycle we borrowed from our stored fat, we've actually used, we've now taken this out from triglyceride into free fatty acid.
So when we're done with exercise as opposed to when you're done with aerobic exercise, you've borrowed, you've created this deficit so what does your body do? Gary Taubes has mentioned this, what your body does is it slows down and gets hungry. So the net effect is zero.
So you need your aminos, that's the eating, that's the synergy and we can do the exercise. One of the growth factors is insulin, but as low-carb people we don't want insulin, so forget insulin. Use the amino acid input with the mechanical induction and deformation and stress and you can increase protein synthesis on a ketogenic diet. We don't need the growth factor of insulin.
Some of our colleagues do these stunts, these very difficult body weight exercises, I wouldn't prescribe that to anybody I trained, even my world-class athletes. I think would start to get into Cirque du Soleil stuff, you know. Look what I can do, I can do these pistol squats. Come on, I mean I can't prescribe that to people.
Almost everybody can do all the exercises and the ones that they can't we can substitute and exercise to work that muscle group in one of its functions, so we're not at a big loss, you know. So you work the whole body... again there are local and global benefits of exercise. Locally, insulin sensitivity, you got insulin sensors in all your muscles, why not tax them? You've got mitochondria in all your muscles.
Why not instigate their increase and behavior. We have mTOR production in all of our tissues actually. So all these growth factors can come into play and I think they come into play more globally by working sectionally each muscle group. So I like to work the whole body in one day, then allow the body to recover as a total unit instead of an arm and a leg...
That comes from the bodybuilders and there are a lot of want-to-be kind of guys in our field out that started, you know, they've done some exercise and you can see their abs and you can see their biceps, you know. And you know, good for you, but you're not a bodybuilder, so get off that, okay?
And then again if we don't vacillate in my opinion blood sugar levels, which are going to have these spikes and drive hunger, which again if you're more insulin sensitive but through this muscle work, it serves as almost a panacea for a lot of the exaggerated symptoms of hunger.
And even understanding if we control leptin not only do we control the signals of hunger, we control the psychological hunger. I mean that there are two separate and distinct mechanism that leptin instigates.
So it doesn't really affect, that's what you're insulin resistant, because the dynamic range is minute. Somebody who is down in seven or eight give, you give them something that requires 22 level of insulin. They are going to get a good bang out of their buck from that 22 because the dynamic range is important enough for you to get a significant response. So that's another issue, this dynamic range concept. And in leptin is pretty much the same way.