But what separates Ted from sort of your average low-carb doctor, average low-carb enthusiast, is he is not so much in the camp of the low-carb high-fat. Ted is really big on protein and the importance of protein and it's amazing how protein as a macronutrient can be so controversial. Now remember we don't eat fats, we don't eat proteins, we eat real foods, but the percentages matter.
And there's this concern, this fear about getting too much protein. So hearing Ted's perspective is very interesting from the standpoint because it's a message that we don't hear a lot of and is still controversial some of it, but I think it's a great perspective. Now he's also known as the exercise guy. If you've seen his before-and-after pictures he's ripped, I mean this guy is built and fit.
Not super bulky, but fit and trimmed, great lean body mass and he does it on 15 minutes a day of exercise which makes a lot of people unhappy and upset with him, but he gives us some of his secrets and some of his tips about how to achieve that and more importantly how to do it safely for people who maybe don't have any experience in exercise.
Now let's be honest not everybody is going to get the results he has, but the importance of exercise, how it contributes to health is still a crucial concept and maybe doesn't get enough emphasis because although exercise may not be the keto weight loss, there are some other components about maintaining lean muscle mass and strength that can be very important for health and recovering from episodes where you may have struggles with your health.
So we talk about that, we talk a little bit about Dr. Ted as the doctor and as the person. He's got a very relaxed approach to things, a very relaxed attitude that hopefully you will appreciate. If you want the full transcripts, go to DietDoctor.com. Otherwise enjoy this interview with Dr. Ted Naiman.
Dr. Ted Naiman, thanks so much for joining me on the Diet Doctor podcast today.
So tell us about your transition about what you learned growing up in that type of environment and how your thought process differs and how that change happened.
And then I went to Loma Linda Medical Center and of course Loma Linda is this famous blue zone where everybody is vegetarian and it's sort of an Adventist vegetarian Mecca and I just- well, my personal experience was that I was never in a really great shape. My body composition was not that great, I was not that healthy, I had a lot of issues, I had a really bad eczema and I had a really bad body composition and I didn't feel particularly healthy at all.
And so what I ended up realizing is that diet doesn't matter. Diet is not a big deal because here I am eating the healthiest diet you possibly could and I'm in really bad shape. So clearly diet is not that important. And honestly even though Loma Linda is, a you know, diet based institution, they're very big into diet and lifestyle even there my training was basically, okay if somebody's having a bad health outcomes it's mostly genetic.
If you're obese, it's genetic. If both your parents are obese, there's 80% chance you're going to be obese. If you have type 2 diabetes it's mostly genetic because your parent was diabetic or your grandparent. And so I got this training that oh yes diet is important, you should never eat meat, but at the same time if you get a bad outcome, you can blame it on your genetics and you should just feel sorry for people who are overweight or diabetic.
They can't help it because their parents were overweight or diabetic. So you do the best you can and you just give them more and more drugs. So this is my mindset... is like okay diet is important. Almost from a religious point of view you should not eat animals and you'll be healthy. And then if something bad happens to you it's really just bad genetics.
So here I am in residency with this clinic with just tons of diabetes pathology and everybody is slowly getting worse, getting fatter and more diabetic and amputations and blindness and kidney failure and the whole thing. And really I'm just there feeling sorry for people, because I think, wow, you know, such bad genetic... You just can't overcome that, right? It's not your fault, you're just born that way.
And then really it was a patient of mine who came in one day and wow, he'd lost 30 pounds and his blood sugar was totally normal. And he told me I feel great and I asked him... I said, "What did you do? You have to tell me what you did so I can tell everybody else to do the same thing." And this guy pulls out a copy of the Atkins book and he said, "I went on this Atkins diet where I just didn't eat carbs and bam... I feel fantastic."
And that blew my mind because never had I seen anyone go on a vegetarian diet and have this miraculous transformation. This was my first experience with diet as a huge lever for health and it was a big deal.
Bret:Were you interested like jump in right away or were you still like, 'yeah, but that can't really be healthy... I'm sure there's something to that that's more concerning'? Did you like resist it right away because of your training or were you open right away? Ted: Oh no, I was like this is the coolest thing I've ever seen... I was so excited. And I will never forget what happened to me.
I went to my instructors in residency and I was like, look at this guy, he lost all this weight, his blood sugar is down, his blood pressure is down, his A1c is down, he lost a bunch of weight, he looks like $1 million. And they looked at me and they said, "What happened to his total cholesterol?" And I hadn't really paid any attention to it and so I looked it and I was like, well it did I guess go up 20 points.
So I was crestfallen and my instructors were like, "Good job, Naiman... "He probably had a heart attack in the parking lot. And you are basically going to kill people." And they told me under no circumstances could I recommend this diet and this was just a bad idea. So that was the spark, you now, and then in residency we are required to do a research paper and I started researching basically macronutrients and health.
And that was about 20 years ago and you know back then it was a lot harder to do research but I found all this evidence that people are eating way more carbohydrates than they probably should. And I've been doing this low-carb thing now for 20 years.
For me... the popular keto diet for me has kind of evolved into something where you're just going out of your way to eat a ton of fat and drive you ketone levels up as high as possible and I think that at a certain point that becomes more bad than good. And so I don't really focus on ketone levels or make sure you eat enough fat to be in extreme ketosis all the time. So I just like the carbohydrate restrictions side of keto.
So everyone's generating a tiny amount of ketones at all times. And then as you restrict more and more carbohydrate or expend more energy your ketone levels go up and it's because it's on a spectrum. I don't really say right now you're in ketosis and then, you know, an hour later, oh now you're not in ketosis. It's just I don't like thinking about it in this binary fashion.
Have you found that to be the case at all?
And actually I feel like this is unrelated to just making ketones. So like I could take anyone off the street and just tell them to not eat carbs for 16, 18, 20, 24 hours and they are going to be fully generating ketones.
But they're going to feel awful and they're going to be starving and their exercise performance is going to nosedive and now you're talking about the process of fat adaptation which to me is totally different than just making ketones which honestly anyone on any high carb diet could just not eat carbs for 16 to 24 hours, and they're in ketosis. So to me it's not about... it's not so much about the ketones. It's more about fat adaptation and doing better, running your whole metabolism off of fat.
And it's in such an interesting discussion and going back to the RDA, you know, the recommended daily allowance of protein, you see ranges out there from 10% of your calories to 0.8 g per kilogram, to 0.3 g per pound, which is really a small amount of protein, but somehow that's the recommended daily allowance. So help us understand what this RDA of protein means and how it can be so small compared to what we were used to.
You basically can't do it. So it's very, very possible to not eat enough protein and have protein deficiencies which is horrible and very severe and you will actually die. So the RDA is just there to tell you what to not go below. In no way does that suggest how much you should be eating.
And three is ketogenesis, you know, with gluconeogenesis and kicking you out of ketosis. So let's take each one of those individually starting with the last one - gluconeogenesis. It's a big word, basically creating new glucose in your body from something else, and frequently from protein. Is it real? Does it happen?
And my advice is just keep insulin pulsatile, you know, by just not eating all the time and I think you'll probably be fine. I'm not convinced that eating more fat and less protein is going to be longevity benefit to anyone... You know what I mean? And I know this is controversial and I am a big fan of Dr. Rosedale and a lot of people other think, you know, if you can just squeak by with the very lowest amount of protein you're going to live longer.
But I don't think we have any data in humans to support that at all. And honestly, you know, look at elderly people in America. American adults age 70 to 79 eat 66 g of protein a day and 247 g of carbohydrate. So I really don't think protein restriction is that beneficial because those people are restricting a hell lot of protein and their outcomes are not necessarily that great on average.
You're basically risking some very real osteoporosis and sarcopenia for some theoretical longevity benefits that just haven't been demonstrated. So I think it's a horrible idea. You know, Valter Longo, all of his data is from mice and we have zero human data to support protein restriction. So until I see some sort of data in humans I'm probably not going to restrict protein.
So do you see any concerns in someone who is fairly insulin resistance at baseline, fighting with metabolic syndrome, who hasn't really gotten a handle on it yet, eating too much protein then because of the insulinogenic response from it?
And these people typically lose a ton of weight really rapidly and their insulin sensitivity dramatically improves even though they are just eating a bunch of protein. So I actually think that's optimal. I think if you're insulin resistant you are clearly internally over fat and you don't have a lot of room to store any kind of energy glucose or fat and in that setting you might want to just eat protein a la the medical protein sparing modified fast.
I've seen patients do that and have pretty good results. So I don't think- I'm not saying is optimal to just eat protein but I'm saying that I don't think it's actively bad. I would have no concerns about that.
And I wonder if that would be different, because you said when you are insulin resistant you have nowhere else to put fat but clearly people are getting fatter and insulin resistant. So I wonder if there's a differentiation we need to draw there about defining insulin resistance better rather than just using one blanket term of insulin resistance.
So if you are going- and again I almost hate talking about about macros, because we don't eat protein, we don't eat fat... we eat food and it's a combination of both. But if you're going to put your finger on one macro or one specific area that hits satiety the best... would you pick protein?
So I love like 30% protein diets. I mean this is kind of, you know, Hunter gatherer diet territory and I like to look at every diet through an evolutionary lens. So if I had to pick a percent for everyone to be eating, it would probably be 30% protein. If you're not eating any carbohydrates that's roughly equal grams of protein and fat.
That would be one-to-one grams of protein and fat. Foods that are one-to-one grams of protein and fat would be eggs, would be ribeye steaks. So basically your steak and eggs region is kind of a 30% protein diet and I love that. I love that so much more than some keto diets that are 10% protein and 90% fat. I have just a big problem with those diets.
So you go low in one of those two and you're pretty much okay. And that's how it works. And then we know that the combination of the two is what's really driving the obesity epidemic. It's carbs and fats together, this is a huge dopamine rewarding to your brain so all your obesogenic foods are high in carb and fat together, it's your doughnuts, it's your cookies, it's your muffins, it's your... basically your baked potato with butter and your bagel with cream cheese and your candy bars... it's this combination that's bad.
So if you can get either one really low, you're home free. Of course I prefer a low-carb approach, but that's how these higher carb diets are working.
Okay, so let's get back to protein here for a second, the quality of protein, because you see all sorts of arguments about plant protein versus animal protein. So assuming we can agree on the amount of protein we require, how about the quality and the source of protein of where it's coming from? Do you see a big differentiation there?
But the reality is that plant foods are different than animal foods and they have a different composition of amino acids and they are less complete for animal health, you know what I mean? So like leucine, lysine, methionine, tryptophan, some of these crucial amino acids that your body really needs and is really looking for from your diet are much lower in plant foods than in animal foods.
So it's just a medical fact that you have to eat more of a plant protein to get the same amount of- a full amino acid profile that you get from animal foods. And this is a really- if you're a bodybuilder for example and you are getting protein from P protein or rice price or hemp protein, or one of these plant-based sources everybody knows you have to eat about 30% or 40% more to get all the amino acids you need to build muscle that you get from whey protein or egg white protein or some sort of animal-based protein.
So there's definitely a higher quality to animal proteins. And that's, if you're looking at just the pure protein, then there's also absorbability, so a lot of the plant proteins are locked up in this fiber matrix and some of it is not getting absorbed. And so you've got bioavailability in the G.I. tract and then you've got incomplete profile of amino acid. So the animal foods are crushing the plant foods.
You're going to actually lose weight and get thinner, but a lot of what you're losing is lean mass. And so you're literally going to have lighter organs, your brain's going to be lighter, your bone and muscles will be way lighter, so there is this like extreme low-protein approach that you typically see in the vegan world like the McDougall starch solution and this is you know extremely high carb, but it's very low-fat, it's very low-protein, and it "works" for just weight loss, but I don't know if you really want the osteopenia and the sarcopenia that is definitely going to come with along that.
So as you go up the food chain, as you go up the trophic levels from plants to herbivores, to carnivores, you see higher and higher bioaccumulation and concentration of micronutrients like minerals and nitrogen and protein. And the reality is the higher you go up the food chain, the higher the nutrient density of the food you're eating, it's just a scientific fact. That's why animal foods are always higher in protein and micronutrient density than plant foods... period.
On the flipside every bit of protein you eat is just broken down into amino acids before you even absorb it into your body. So I'm never telling anyone, "oh my gosh, you have to go out and eat X pounds of collagen a day just to get enough glycine", because basically if you're eating, you know, ground beef or an egg, or if you're eating any kind of roughly whole animal food source, you're going to get plenty in my opinion.
So I never tell anyone to take supplements, I think it's not really- If you have the extra money for collagen supplements, I would say just go out and buy some high-quality animal sources, like you know, just try to eat the whole cow, you know what I mean?
Ground beef, not only it's the very cheapest protein you can get, but there's tons of connective tissue and stuff thrown in there. So I like eggs, I like ground beef, I like ingesting seafood in its entirety, like clams and oysters and mussels and that sort of thing.
You briefly touched on P protein supplements versus whey, versus egg white supplements and protein shakes and we hear a lot about people, you know, taking extra protein, those shakes. I know you are a protein proponent, but do you see a difference in again the quality, in the need of real food protein versus protein shakes and supplements?
So I'm not a huge fan. You get way more satiety with real food than drinking food. So you basically never want to drink your calories. You also- the speed at which the protein is delivered to your system is probably better if you're eating a steak instead of drinking whey protein.
So I typically don't tell anyone to ever by protein solvents. I usually don't recommend them. And for me it's more like an emergency level thing, like if you just don't have time to eat, you might want to grab something like that. But it's not my first choice.
Not everybody is going to be able to be you with 15 minutes of exercise. But tell us your general concept when you approach patients of how to implement exercise, the importance of exercise and specifically what types of exercise translate to maximal health.
Like the more muscle you have, the higher your glucose tolerance or carbohydrate tolerance, the longer you're going to live literally. And the same thing with cardio you're basically putting a stress on your body, a hormetic stressor that's going to make it better later. Also a cardio you're depleting muscle glycogen and after you deplete muscle glycogen your fat oxidation goes through the roof and your insulin sensitivity goes through the roof.
Your glucose disposal goes way up and so you get all these massive health benefits. Depleting glycogen from your whole body is a massive like metabolic reset. I like people to do two forms of exercise, cardio and resistance, and I like high-intensity exercise because it's more time efficient. You can always trade intensity for duration when it comes to exercise.
In other words you could do a minute of all that 20 second sprint intervals and you're basically going to get the same benefits you get from just walking for an hour or two. So the idea is you always can trade intensity for time.
So I like people to do the highest intensity they can generate on some sort of cardio that could be just jump squats, jumping up and down, that could be doing jumping jacks, it could be jumping rope, that could be just sprinting, that could be running up flights of stairs. You're trying to maximize your energy output to deplete glycogen and ramp up your fat oxidation and it's really, really good for metabolism.
On the muscle resistant side the goal is to generate the highest tension you can possibly get in your muscles for as long as possible and it only takes maybe 30 to 60 seconds to max out on a set of pull-ups or push-ups or any kind of pushing or pulling or leg type exercise. So I have this really, really, really tiny protocol where you're basically doing a pushing resistance exercise, like a push-up, a pulling resistance exercise, like a rower or pull-up, a leg resistance exercise like a squat and you're doing them all to failure basically which might only take 30 to 90 seconds.
And the goal is you send a signal to your muscles that they are inadequate the way they are and they have to be stronger or you're going to die. So you did a super high-intensity failure type work out which might take just a few minutes and you actually get this adaptation where you have more muscle the next day.
And I just think everyone should be doing this; it's so important to put tension in your muscles this way and increase the headroom of how much work you're capable of- you're just going to live longer. I mean look at people in the ICU who are in bed for two weeks and then they can't even walk. You now, we have to send people to physical therapy to walk up a flight of stairs after just lying in bed for two weeks.
And as important as diet is, you really start realizing how important generating tension your muscles is if you've ever had your leg in a cast or you've been in bed for two weeks or something... I mean your body just falls apart so rapidly. In a way it's just as important as diet in my opinion.
Once you've done that long enough you can do push-ups on a... off of a bench and then pretty soon you're doing knee push-ups and then you're doing regular push-ups and then you're doing diamond push-ups and then you are doing one arm push-ups and then you're just the strongest person anybody knows. And this is just slow gradual progression from just oh my gosh, I can't even do one wall push-up to as high as you want to go.
So I like high frequency maybe daily, maybe every other day, so I'm typically recommending people do these sorts of exercise if not daily maybe every other day, but the volume is so low that you're just not going to be over-trained, you know what I mean? It might take you two minutes to hit absolute failure multiple times on a pulling exercise and you are definitely going to be able to recover from that in a day or two.
But for anybody out there who's done a high-intensity exercise protocol, where you do Tabata sprints, you know, sprint as hard as you can for 30 seconds, rest for 30 seconds, one thing you'll notice after that is you are just absolutely not hungry because your blood sugar goes up a fair amount, you get this release of glycogen, glucose from the liver, and a lot of people notice that they are actually less hungry after they do this.
And I encourage people to try this... if you're hungry try doing a 30 second jump squat Tabatas: jump up and down as many times as you can in 30 seconds, rest for 30 seconds, do it again for 30 seconds, rest again for 30 seconds.
Do a couple of cycles of that and see how hungry you are afterwards. A lot of people are just really not hungry. So I'm not convinced that high-intensity exercise is going to automatically make people hungrier and make them eat more. I think it's the exact opposite.
This diet exercise thing is kind of a hobby but I'm lucky enough to be able to incorporate it into my job as well. So I'm really grateful; the hobby and the personal health journey and the job all sort of align in the same direction. And then just on a personal level I'm addicted to Ultimate Frisbee, like I just basically live to play Ultimate, it's one of my favorite things ever. I am a bassist so I've played in a lot of bands and done a lot of local music scenes in Seattle kind of stuff. And that's kind of me on a personal level.
So are you starting to see any of that creep up with your relationship or you are wanting your daughter to keep up with these healthy habits?
But then when she goes out, we don't restrict her at all. We just tell her to eat whatever she wants. And it really ends up kind of working out, because, you know, she'll go to a birthday party and eat birthday cake and then she's like, "That was kind of sweet." And she kind of gets to the point where she looks around and she looks at what people are eating and she's like, "Are they really going to eat that?"
So honestly it's just like lead by example. She sees how her parents eat, she sees the food that we have at home, she's free to do whatever she wants and it seems to work out... at least so far.
And then he went back for a second cookie, and then he went back for a third cookie and then later that night he was complaining of how his stomach was bothering him. I was secretly very happy but he said, "Why didn't you stop me from going back for more cookies?" And that was a great opportunity to have this discussion... it's not our job to tell you what to do. It's our job to educate you and show you the way and help you make your own decisions. And sometimes you have to let people fall to learn.
And maybe it was the same thing with the birthday cake, right? She realized, 'that was pretty sweet, maybe I didn't need it', but it's that recognition that, "Wow, look at the way people are eating". Because in our society we don't want to be normal.
Like the normal in society is broken and backwards and so you almost have to be abnormal and stand out which can be hard for kids. So I like your approach, it's a relaxed approach, it seems to be working and hopefully continues to work.
