Ozempic, Weight Loss, and What Really Works

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a fifteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Dr. Hyman Show with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman
Coming up on this episode of The Doctor Hyman show. Now according to this theory, as long as you eat fewer calories than you expend, you'll lose weight. Right? Well, it doesn't matter if the calories come from a thousand calories of soda or a thousand calories of broccoli. All calories are the same in this model.

Now the implicit message here is that you're overweight because you eat too much and you don't exercise enough. In other words, it's your fault because you don't have the willpower, and the subtext is that you're a lazy glutton. I don't believe that. This is just nonsense. Now, before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale.

And that's why I've been busy building several passion projects to help you better understand well, you. If you're looking for data about your biology, check out function health for real time lab insights. And if you're in need of deepening your knowledge around your health journey, well, check out my membership community, doctor Hyman Plus. And if you're looking for curated, trusted supplements and health products for your health journey, visit my website, doctorhyman.com for my website store and a summary of my favorite and thoroughly tested products. How did obesity triple in the last sixty years from about thirteen percent of the population to forty three percent of the population?

I can guarantee you it's not, and it was an epic deficiency. Functional medicine provides a better framework for understanding root causes, particularly around obesity, metabolic dysfunction, and type two diabetes, and provides a way more sustainable and affordable treatment that works. I've seen this over and over again. We're gonna talk about that in a minute. So let's get deeper into what's going on here in America.

Why is this drug important and why are we seeing such increased use of it? Well, we have a problem. There's no denying that. You know, as I said, ninety three percent of Americans have some type of metabolic dysfunction because of poor diet and lifestyle. That means only six point eight percent of Americans are metabolically healthy, meaning they're not somewhere on the continuum of, type two diabetes, meaning they don't have high blood pressure, high cholesterol, high blood sugar, or overweight, or had a heart attack or stroke.

So only six point eight percent of the population meet that criteria. The rest of us are metabolic and healthy and somewhere in that continuum. Six in ten have a chronic disease. Four in ten have two. There's over four hundred million people around the world who are diabetic.

Ninety percent obviously are type two diabetes or more. Forty million Americans or one out of every ten Americans has type two diabetes, which is, terrifying to me. As I mentioned, over a billion people worldwide are obese and over two billion are overweight. Forty three percent of US adults are obese. Seventy five percent are overweight.

Forty percent of kids are overweight. It's it's it's just really a problem. We saw increase in obesity during COVID because of, the stresses and the challenges people face. And, you know, we're seeing now Wegovy or semaglutide, another version of Ozempic, is now approved for 12 19 year old obese teens. Now one in four teenage males has either prediabetes or type two diabetes.

That's frightening to me. Me, twenty five percent. And the obesity rates are staggering. You know, teenage obesity is at over twenty two percent, from between 12 and 19 year olds. And as I mentioned, forty percent of kids are overweight.

This is not a problem that's because of genetics. It's a problem because of our toxic food environment. And the cure isn't a drug, especially a drug that has serious side effects and needs to be taken for a long time or lifelong. Now, this is a great business model for pharma. You have a very expensive drug that needs to be taken forever.

It's a gold mine and it greats customers for life. But teens have a problem. They're targeted by the food industry. They have all sorts of issues around eating disorders. There's lots of, unlawful advertising and targeting of kids, videos going viral on TikTok.

And and and it's really concerning to me. I think people don't realize that there's literally $10,000,000,000 or more spent just directly targeting junk food and processed food ads to children. And now there's currently trials going on in kids as young as six years old for the Govee Nose Epic. I mean, six years old. I what are we talking about here?

This is nuts. And it's not addressing the root cause. It's not addressing our food system. It's not addressing our toxic nutritional landscape. It's not addressing the fact that ultra processed foods make up 66 make up 60% of our diet and 67% of kids' diet.

That ultra processed foods account for about 90% of the added sugar in our diet, which is about a 50 pounds of sugar per person per year, about 34 a day for kids and 22 for adults. That's nuts. It used to be, you know, maybe 22 a year when we were hunter gatherers. This is causing all sorts of metabolic dysfunction, and and and and this metabolic dysfunction is is not just about weight. It's obviously about obesity, but it's also about type two diabetes, Alzheimer's, dementia, fatty liver disease, chronic kidney disease, and and and premature death.

Now this is a huge problem. Chronic disease is bankrupting our system and our nation. There's four now, $4,300,000,000,000 spent on chronic disease and health care in this country. In February, it was 1,600,000,000,000.0, and that's only twenty three years ago. So we are in a crisis of of accelerating disease, accelerating costs, and it's is not solved by a new drug that is has serious side effects and is and may actually cause, a bankruptcy of our nation if we follow through on this.

You know, if you if you look at the, cost here, diabetes alone is $413,000,000,000 in 2022. Ozempic is exploding in in its revenue. And, you know, one study in the New England Journal of Medicine found that if just obese Medicare patients were prescribed Ozempic, the cost annually to the government would be $267,000,000,000 a year. Now to put that in perspective, the entire Medicare Part d, which is the drug benefit program, is a hundred and 45,000,000,000. So it's another hundred plus billion dollars a year over what we're spending for the entire drug benefit for all drugs for all seniors.

It's just it is an insane amount of money. So if if we were to do that, we'll bankrupt our country. If if and if all the overweight people and obese people in America took Ozempic or similar drug, it probably will cost over $5,000,000,000,000, which is more than our entire health care expenditures. Now let's talk about the risks because I think the this is where it gets sticky. Everybody is looking for the miracle cure, the miracle shot, instant weight loss, and it it can work.

I'm not saying it doesn't work. I'm just saying that it's not a free ride. Now part of the problem is that many drugs don't don't have long enough studies when they're initially approved, and the longest study is about sixty eight weeks in in in these drugs. Now often these side effects don't occur till more chronic use of two years or longer, and there's some of that data coming out now, which is called post market, surveillance, meaning after the drug comes out, let's look at what's happening. And and it's a it's a bit concerning.

Now we're seeing a lot of side effects, not just the nausea, vomiting, diarrhea that's in 50 of users, but we're seeing, side effects that are are life threatening. Things like gastroparesis or paralysis of the stomach, bowel obstruction, and pancreatitis and deaths rising. Now now to put things in perspective as I as I share some of the statistics around the findings of people who've been on the struggle longer and what it's doing to them, In medicine, when we see a twenty to thirty percent increase in a response to a drug or a side effect, it's considered highly significant. For example, statins, which are a blockbuster drug to reduce heart attacks, they only reduce the risk of heart attacks by twenty to thirty percent, and that's a blockbuster drug. Now now now listen carefully as I explain this next study.

In the study of over 4,000 patients published in JAMA, Five out of every thousand patients had stomach paralysis, which was an increased risk of not twenty percent or thirty percent, three hundred and sixty seven percent. The risk of pancreatitis, which is an incredibly dangerous illness, which causes your pancreas to be inflamed and leads to type one diabetes, maldigestion, and and really very serious problems, went up by nine hundred percent. And bowel obstruction, which is very serious and often requires surgery, went up by four hundred and twenty two percent, not twenty or thirty percent. So this is not insignificant. It's not an artifact.

And in fact, when you see these kinds of studies, these, these data, you you have to pay attention. You know, this is the kind of almost the risk we see with with smoking and cancer. These are really concerning, concerning numbers for me, and they're not trivial, and they can cause permanent damage and require surgery. The other thing that people don't realize is when you lose weight, 40% of the weight loss with Ozempic or these drugs is muscle, and muscle is where your metabolism is. When you lose muscle, you lose your metabolism.

It slows down, and you end up needing less food to maintain your weight, even when you gain the weight back. The other problem is that 65% of the weight that you lose is regained when people stop the medications. So I think it's really it's really quite concerning. How we get off the drug? What happens?

What happens with these drugs with kids? We don't know. How does it affect development? How does it affect puberty, menstruation? It's it's a lot of open questions.

Now I wanna kinda get into this whole issue of obesity being a disease or, being genetic. I I think there's a lot of conversation out there that's a little bit disturbing to me. And and I just think, you know, just, you know, if if if when I was born, five percent of the population was obese, and now it's forty three percent, did we somehow magically have a genetic mutation in the global population or in America to account for this? No. This is an environmental problem.

Same thing with the Pima Indians. You know, a hundred years ago, they were thin, fit, healthy. They had no obesity, no diabetes. They ate their traditional diet. They lived in Arizona.

Now they're the second most obese population in the world, and eighty percent get diabetes by the time they're 30, and their life expectancy is 46. And kids as young as two years old get type two diabetes because they're genetically predisposed. They're not predestined. And when they're in the wrong food environment, which they are, which is the white poisons, white flour, white sugar, and white fat, otherwise known as Crisco or shortening, which was their government commodity surplus foods they were given. They have a word for it.

They call it commod bod. You know, we need the commodity food, you get big and and diabetic. Now this is not a genetic problem, and what's disturbing is that, doctor Fatima Sanford, who's an obesity medicine doctor at Harvard and Massachusetts General, who was also in the dietary guidelines committee in 2025, very disturbing to me, she said, you know, obesity is genetics. You set it on sixteen minutes. Now it's true that if your parents are overweight, you're more likely upper weight, but this is epigenetics, not not necessarily genetics.

This just means it's changeable. Now where are all the obese people sixty or a hundred years ago? This is a whole nonsense. It's our toxic and food environment. It's impacting our gene expression and our predispositions.

Now the idea that it's genetic is very disempowering. It removes our autonomy, our agency. It essentially says, this is a disease that must be treated with medication. There's nothing you can do about it. It's just genetic.

So it's it's hard. Now the cost of this are staggering, as I mentioned, for the for the drug. It's over a thousand dollars a month, $1,700 a month, you know, you depend on where you get it, but it's a lot of money. And you're supposed to take it for life, and really, it's hard to come off of. It and it's gonna be completely bankrupting our our nation if we continue to to do this.

And there's, again, as I mentioned, nationwide shortages for people who have diabetes because everybody who wants to lose five or 10 pounds or 20 pounds is taking this drug and getting it from their doctor. Because any doctor can prescribe a drug for any reason once it's been approved by the FDA. It's called off label use. And this whole pill for every ill quick fix is is really not the solution here. We not we have not been addressing the root causes.

The other thing I wanna address here is this whole body positive movement and healthy at any size. You know, I think what's happening is that, you know, there's there's a confusion about this. The we we do not wanna blame the person who's got this problem for the problem. If you're overweight, it's not your fault. You're living in a toxic environment.

If you take somebody and you put them in an environment where all you can get is ultra processed food and and sugar and starch, and you're told by the government to eat six to 11 servings of bread rice here on pasta a day, it's no wonder that we have become obese. It's not your fault. And by the way, I'm getting to this in a minute, but there's a lot of data on the addiction properties of these foods. So what's happening is that it, you know, is is this whole movement that doctors aren't talking to their patients about obesity. They can't they can't say the word.

It's considered fat shaming if a doc or diagnose someone who's medically obese or overweight. People don't wanna be weighed in the doctor's office. They don't wanna talk about diet and lifestyle. I feel like it's shaming or somehow belittling. I think this is a problem.

And, I think there's a lot of celebrity kind of endorsements and news media magazines normalizing obesity as healthy, but it's just not. It's just just no data that it's healthy. I think the only I think data was, you know, if you look at people who are older, sometimes the data on on when you're older shows that you die if you're thin, but that's because you have cancer or some kidney disease or something else that's wasting your body waste, not because, being thin is is a is a is a is a is a risk factor for diseases. It's the diseases. And, unfortunately, a lot of people are getting canceled for talking about this.

I saw a report about an an email that went out to all the students at Columbia University talking about this in medical school saying, no. You can't talk about this. It's fat shaming, and it it sort of made it not okay to talk about. Imagine them saying, well, we can't talk about diabetes because, you know, that is a disease that, you know, they don't they don't have any control over, and, it's it's fine, and it's diabetes healthy in any way. It's just it's just it's kinda nuts.

Now I've I've been practicing this medicine for decades, and I've been doing deep dives on their people's biology with all these problems, and I see real issues when people have metabolic issues. Now, this this whole being overweight thing being normalized is not scientifically true. It's it's it's, I understand the goal, right, which is not to victimize or blame the person who's overweight, but the truth is it's our toxic food environment, and it's the addictive ultra processed foods that are driving the obesity epidemic, not our genes. Now there was a review of 281 studies in 36 countries, and it found that fourteen percent of adults and twelve percent of kids meet the scientific definition for food addiction. And to put that in perspective, the prevalence of alcohol addiction in the population is fourteen percent.

Now twelve percent of kids are food addicts based on strict criteria and scientifically validated metrics. This is not, an accident, by the way. By the way, the reason for this is that the food companies have designed these foods to be hyperpalatable and hyper addictive and stimulate dopamine. And even do such things as put children in an MRI machine so they can see on a functional MRI which part of their brain lights up once triggered by different images of different junk foods. So it's not it's not trivial.

It's not an accident, and it's not your fault. So if you struggle with weight issues, it's it's really a complex issue that your metabolism, your hormones, your neurochemistry has all been hijacked by the food industry, and so is our kitchen center, restaurants, and our grocery stores, and we're just unable to often find their way through. Now, there's certain, concerns about Ozempic too because people are using counterfeit Ozempic. They can get online. They can buy it from different places, and people can get very sick from it.

So I think I would watch out for that. Now, you know, there's there's a large part of the way traditional medicine is that misses the mark, no pun intended, because it doesn't address root causes. And functional medicine is about root causes. It treats symptoms, not mechanisms. It treats symptoms, not causes.

So and it doesn't focus on prevention or lifestyle. There's no early intervention for prediabetes or weight gain. There's no lifestyle or exercise prescriptions that really are integrated into our health care system. There's no pain in system for it. I say, you know, if your people and doctors got paid to do this, we it would work.

Right? I I remember being, working on health policy in 02/2008, and, I was met with the secretary of health human services, and we proposed a lifestyle change program where we would basically guarantee that people would become healthier and reduce health care costs. And if they didn't, we wouldn't pay back the money that Medicare paid us and, or paid the doctor. And she said, well, this is great, but who's gonna know how to do it? Well, I said, if you pay for it, it's like if you pay for angioplasty, people will figure how to do it.

There was nobody who said, oh, well, how do we reimburse angioplasty? No doctors know how to do it because it's a brand new procedure. Well, guess what? As soon as they pay for it, people figure out how to do programs at work. And we we often don't we don't do things until it's too late.

We wait and see. I had a patient with a blood sugar of a 10, and I said, you need to see your doctor about this. And she said, well, yeah. But I I they said, well, come back later when I get, higher in my blood sugar, and then we can treat it with diabetes drug drugs rather than dealing with the the fact that he was already on his way. So rather than dealing with the root causes, which is our food system, you know, we're trying to get a quick fix with these GLP one agonists like Ozempic, which do help suppress appetite, which do reduce calorie intake.

But, you know, it really is important to deal with the the causes, not just the the the problem that is is is, quickly fixed by a drug because there's downsides to it. And the real issue is our excess intake of refined starches and carbohydrates and sugar, ultra processed foods, and a a lack of ability or access to follow a really whole food nutrient dense diet that's full of satisfying foods, lots of fiber, fruits and vegetables, protein, good fats. And, you know, the fact that we, you know, don't live an active lifestyle, the fact that we don't use our bodies, the fact that we're under muscle, then our metabolism is slower, all these things drive obesity. I think, it it you know, one study by Kevin Hall at the NIH showed that people who are freely allowed to eat as much food as they want, whether it's ultra processed food or whole food, they ate 500 calories more of the ultra processed food because there was no rate limiting thing in the brain or the body. It was like the body didn't recognize it as something that was food, and so it just kept getting more and more hungry in order to satisfy some nutrient needs.

But it was like like looking for the love in all the wrong places. So, it's important that that we, also focus on nutrition quality, and and and our diet quality. You know, people are eating all this ultra processed food, but they, you know, they may be eating same stuff by just less of it because they're they're not yet. But, you know, the if you focus on a lower calorie intake, which is what's with Ozempic without focusing quality, you're gonna become nutritionally deficient. You're gonna get worse metabolic dysfunction.

You're gonna have copper, selenium, mineral deficiencies, zinc deficiencies. You're not gonna get protein, potentially, and have muscle loss, which definitely happens. And, you know, when you look at when you look at these studies, they don't look at body composition. They look at weight. And weight is is not exactly the most effective way to look at your metabolic health.

It's really looking at how much muscle you have, how much fat you have, where it is. Is it in your belly, is it in your arms or legs, and and the percentage. And so body composition is something that's critically important to do, and yet most of the studies don't look at it because they don't wanna see it. The drug companies don't want you to tell you. So they just measure weight loss.

They don't measure the percent fast, fat loss versus the percent muscle loss. They don't look at the ratio of body fat, percent of body fat. You know, they they don't see how all this works. So, if you lose lean muscle, it's serious. If you lose lean muscle, that's where your metabolism is.

That's what your energy factories is. That's where your glucose sync is. So, basically, what happens is if you if you especially in the elderly, if you lose more muscle, you're you're gonna become more frail and weak. But even if you don't, when you lose the weight, if you lose 40% as muscle, which you do with, these drugs, then let's say you gain the weight back after you stop, you may be the same weight as when you started, but your metabolism will be slower because usually you gain all the weight back as fat. So you don't gain back the muscle.

So you basically end up worse off and needing to eat less and having a slower metabolism after the fact. So it's it's it's really quite concerning.

Dr. Tyna Moore
So I started researching, and my background is in regenerative medicine, so regenerative musculoskeletal medicine. I help people rebuild their joints naturally with natural substances, stem cells, PRP. I've been doing that for a long, long time. And so the first thing I did was research GLP one and its regenerative properties. I always look up things according to what my brain knows.

My brain understands pain. I understand regeneration and neuroinflammation. All of those things always interest me greatly. And I found so many studies showing impacts on some of the older versions of GLP ones and the current versions impacting neuroinflammation very positively. I found data supporting its potential use in Alzheimer's and Parkinson's.

I found data showing regenerative properties in joints, in cartilage, in ligaments. And, I mean, the list goes on and on. I found data showing used early, it could because it actually heals the pancreas, it can reverse type one diabetes if used early and started early. I see. Simaclutide, specifically.

And I thought, this is not at all what I'm hearing. Like, this is not at lining up at all with what I'm hearing. So, of course, I got super interested. I did a podcast. The feedback was incredible.

I had people from all over the world messaging me, telling me, I do all the things you say. I do all the things you preach. I mean, I was severely, severely censored during COVID for telling people to go outside in the sun, lift weights, and eat meat. I mean

Dr. Mark Hyman
God. How radical you are.

Dr. Tyna Moore
I was deplatformed for the work I was pushing back then. So

Dr. Mark Hyman
Clearly, that's misinformation. Right? Eating eating healthy and exercising and being in the sunlight. God forbid.

Dr. Tyna Moore
The hashtag sunlight was banned in 2020 off of Instagram. So I have been on this journey of sort of bucking the norm for a long time, and I thought, okay. I'm not what I'm finding is not lining up with what I'm hearing from everybody. And then, of course, all the health influencers had to come out against it, and everybody was really quite hot on my tails about it. I was getting a lot of hate for even mentioning that there might be other impacts that they have on the body.

It's regenerative. It's healing, and it's anti inflammatory throughout the body. There's GLP one receptors throughout the entire body, including the brain. It's not just made in the gut. It's a steroid or I'm sorry.

It's not a steroid. It's a, peptide signaling hormone.

Dr. Mark Hyman
Yeah. And just for for people background, peptides are things that our bodies make, and they're the communication networks. And there's tens of thousands of these molecules, and insulin is one of them. Yep. And people are using peptides like thymosinopha one or b p one five seven for sports injuries.

These are things that that are available. Some of them need a prescription, like Ozempic. There are other ones like Vyleesi, which is a prescription for sexual arousal in women and men. So there's a lot of things out there that are used as as, in traditional medicine. Over 70 of these peptides have been approved, and they're they're things that the body uses naturally.

Yeah. So there are not things that are pharmacological agents. They're actually things that the body has and uses as part of its normal physiology. So GLP one is is that. And so when we say GLP one agonist, which is what these class of drugs are, it means they work to stimulate the GLP one receptors to have the effects of GLP one.

Dr. Tyna Moore
Correct. However, semaglutide and tirzepatide are actually very closely well, tirzepatide's a little bit different, but That's one

Dr. Mark Hyman
jar off for people listening.

Dr. Tyna Moore
Yeah. Semaglutide is almost bioidentical to GLP one. It's simply got as little tinkering on one of the amino acids to keep the half life longer. So GLP one that is produced naturally in the body, it's produced by the l cells of our gut. It's also produced in the brain, in the medulla.

If it's produced in the brain, I immediately thought, well, it must have use in the brain, and it sure does. It actually has impact on neuroinflammation beyond appetite signaling, beyond any of that. We've got it sort of in this box of being it slows gastric motility. It, you know, decreases appetite by slowing gastric motility, very sort of basic kindergarten version. And then in the brain, it inhibits appetite.

Dr. Mark Hyman
Right.

Dr. Tyna Moore
And that's how people have got it. Well, I start looking into it, and I'm like, this is a signaling peptide hormone. Why would we macrodose a hormone? You'd feel awful if you were cranking high levels of thyroid or testosterone or estrogen.

Dr. Mark Hyman
Right.

Dr. Tyna Moore
And those are sex steroid hormones, but still hormones.

Dr. Mark Hyman
High doses of insulin, which is one of the first peptides ever synthesized and is, you know, obviously been around for a long time.

Dr. Tyna Moore
You die if you took high doses. Too high of a dose. So I got to thinking, why don't we just dose physio? I do bioidentical hormone replacement by dosing physiologic doses, which are much, much lower even than some of the standard dosing. So I've always been a fan of starting people very slow and low on any hormone, and I ramp them up, and I titrate them up until they get tissue saturation and until their symptoms resolve.

And then that's the dose. And then I test to make sure I'm not causing them any harm, and that's how I manage patients on hormones. We've got leptin and ghrelin. Those are peptide signaling hormones. Turns out leptin and ghrelin, so leptin for the audience listening, is secreted by your fat.

It goes to your brain. It tells your brain you're full. It tells your brain it's it's basically the, thermostat of the brain. It lets the body know energy status. Right?

Ghrelin is secreted by the stomach, and it goes to the brain and tells you you're hungry. I always think gr, ghrelin. Right? That's how I remember the two. Ghrelin and leptin don't work if GLP one isn't present.

The receptors actually don't even come to the cellular surface. So I was like, well, this is very interesting. Then I started

Dr. Mark Hyman
Ghrelin doesn't work because ghrelin seems to be make you hungry. So some people are hungry even when they're overweight and maybe GLP one deficient.

Dr. Tyna Moore
The receptor signaling of and this was just in rats, but the receptor signaling of the whole orchestra of how these work together, it's much more nuanced, I think, than we understand. The orchestra doesn't work if GLP one isn't there. So then I thought, I wonder if we have GLP one deficiency. I wonder if that's a thing. Right?

Yeah. It is. Mechanistically, it's a thing in those with fatty liver, those who are obese, and those with type two diabetes. And then I thought, is this a chicken or egg? Right.

Is it due to the chronic insulin resistance and the damage to the vagal nerve and, you know, on and on and the leaky gut and the damage to the gut mucosa and the damage to the microbiome? Is that is what is inducing the GLP one deficiency?

Dr. Mark Hyman
Environmental toxins. Who knows? Right?

Dr. Tyna Moore
Then I started talking to my friends who were like the nerdy genetic people. They love their genetic mutations, and they started telling me that there's SNPs that code for GLP one and that they're seeing deficiency in those or they're seeing mutations in those SNPs in a lot of people. And in fact, one of my friends runs a diabetes clinic, has done so for decades, functional medicine, diabetes. And he said that ninety five percent of the patients he's seeing have this genetic SNP mutation.

Dr. Mark Hyman
So And does that mean, like, seventy five percent of the people who are overweight in America have a have this mutation? Or is it you know?

Dr. Tyna Moore
I don't know. So what's happening is

Dr. Mark Hyman
likely that's true. It seems like maybe

Calley Means
I should all yeah. They they all it

Dr. Mark Hyman
seems like probably a, like, a a larger portion of maybe the severely obese might have that. Right? What were we

Calley Means
gonna say, Cali? Well, we talk a lot of the, genetic arguments brought up a lot. And, obviously, it's the genetics change in the last fifty years is obesity has absolutely taken over our country.

Dr. Mark Hyman
But gene expression changes. Right? So I think that's that's the thing that happens. We have gene expression changes. I mean, I think it's it's genes are complicated.

There was Darwin, which is, you know, genes change by natural selection over millennia. And then was Lamarck who said traits can be passed from generation to generation and Lamarck was kind of dismissed and Darwin won the day, but the truth is they're both right because Darwin is about gene changes and Mark is really talking about epigenetic changes, which can happen from generation to generation. And I think I think one of the things we're seeing now is generations of kids who are born to obese Yes. Parents. And the consequences of that, the epigenetic changes in the womb that happened from the environment the baby is bathed in from processed food and sugar and starch and lack of exercise and stress and all the things environmental toxins.

All of that is programming these children. We know this data from many many epigenetic studies is programmed these children to be obese, have heart disease, have diabetes, end up with cancer and many other problems. And there's kind of screwed before they're even born. Yep. So these these kids come into the world and then they're more likely to be over be obese or more likely to have these programmed epigenetic changes that maybe are are affecting the expression of the genes.

So genes don't change, but the expression changes. And that's, I think, that's an important point. And I agree, Kelly.

Calley Means
Which but they could change if that child is provided a whole

Dr. Mark Hyman
food diet. Genetic changes can be reversed.

Calley Means
Exposed to sunlight. So we have an Orwellian situation where we have such a crisis in America that children are in utero developing metabolic dysfunction because we're being our food is so toxic and our we've had a sedentary lifestyle and aren't looking at the sunlight and being, you know, sleeping. It just regulates sleeping, chronic stress with our phones. So we have such a bad metabolic health environment that we have an epidemic of kids being born, you know, born with metabolic dysfunction. So it is societally vital.

There's nothing more important than this.

Dr. Mark Hyman
I agree.

Calley Means
So we have an opportunity. It's not a both and. Are we going to, as a matter of public policy and as a matter of focus in that country, change that dynamic of changing our USDA guidelines to say that that two year old shouldn't be eating sugar? When you go the route of Ozempic, when you go the route that this is so bad that we need to jab those children at six, that's a different route. That's a different prioritization.

It's not both

Dr. Mark Hyman
I'm, for keeping kids six years old, Ozempic. I think that's another conversation. I I I think that's a little extreme, and I I

Calley Means
But but if we agree with the idea, if we actually agree with the science and that this drug is good and should be used as a standard of care, why not?

Dr. Mark Hyman
I don't think any drug is good or bad. You're thinking from public policy, social. I'm a doctor. Tina's a doctor. We're both thinking about the patient we see in our office who's stuck as you know what, and how do we help them.

And I've had patients who have lost 200 pounds, 150 pounds, 110 pounds, 116 pounds, one hundred and thirty eight pounds just using food as medicine. But it's tough for them. They can do it. But the question is, is there something else that could be done in a way that actually is is, like Tina was saying, is physiologic that doesn't use this kind of heavy handed pharmacologic approach to actually help people with fixing some of the metabolic and biochemical things that are going on. And I I think this is an open question.

I think we need more data on this, but I I think what you're saying, Tina, is really interesting that that there are effects of this this natural peptide that are different than just regulating weight.

Dr. Tyna Moore
Absolutely. And it

Dr. Mark Hyman
may be working through other mechanisms. You know, I had a patient once say to me recently, can I just take phentermine? And and that's a basic appetite suppressant. Crack. It's basically yeah.

It's basically speed or crack. And basically, yeah. It's like crackheads are so skinny because they don't need their appetite suppress. But it's basically speed. And I said, no.

No. No. This is really not good because it's gonna cause you to be anxious, palpitations, and have all these, you know, issues of sleep. And I think it's not a good idea. But, you know, then we talked about Ozempic maybe being a solution because it it it can be done in a way that is different that works physiologically and works on some of these other pathways that I think people aren't aware of.

Like the neuroinflammation is a big one, and I think what we're seeing is sometimes decreased suicide rates, we're seeing decreased depression, we're seeing a lot of other things with these drugs, and I think how is that happening? And and what what's what's probably happening in my view is people are eating less of the crap because they don't want it, and and so their brain and their body inflammation is going down, and maybe some of the effects of the g l p one drugs are anti inflammatory, by by mechanism.

Dr. Tyna Moore
They are.

Dr. Mark Hyman
And they are, and so so, if that's true, then you know the neuroinflammation crisis, and I again I've talked a lot a bit about this in the podcast and written a whole book about it called the Ultra Mind Solution, is our brains are on fire, and our brains on fire lead to depression, anxiety, suicide, aggression, you know, societal division, Alzheimer's, Parkinson's. I mean the list goes on and on. Anything that affects the brain is about inflammation. So these drugs may modulate that. It's very fascinating.

So they're being studied for Alzheimer's and many other things. Now I I think the idea that we should just, like, fall in love with this drug and it's great for everybody and we should put in the water. I don't think Tina or anybody, I think, who is is smart about this thinks that. But but for the select patient, in a way given in a way that can can actually regulate some of these pathways, I'm I'm not so sure it it should be thrown out. It's like any any tool.

It's it's like any tool we have in medicine. It's for the right person at the right time, the right dose.

Calley Means
The right person just generically. I'm just curious.

Dr. Mark Hyman
Well, that's that's a great question.

Dr. Tyna Moore
So let me finish what I was trying to tell you guys. I started using this in patients, and I have only one who is using it for weight loss. Everybody else is on it for a different reason. So and I'm using it at a fifth of the starting dose, compounded droplets. And when I started doing this, my colleagues all started who listened to my podcast, all started also microdosing GLP ones in their clinics.

And we've all reported back to each other, and we're seeing phenomenal results in all different kinds of conditions that leads me to believe that we may actually be able to do away with a lot of the lifestyle pharmaceuticals that people are using. So people are on other drugs for life, such as high blood pressure meds or statin drugs. These these peptides have been shown to heal heart tissue and to reverse heart failure. So I've got one patient on it for high blood pressure. Tiny little dose, high blood pressure, blood pressure's down.

I personally take it because I have psoriatic arthritis, and I have crippling pain from tip to toe. Doesn't matter how clean of a life I live. It doesn't matter how clean my fish tank is. I menopause hit me. The brain fog was real, and the pain came with it.

And I knew it was due to neuroinflammation. So tiny little doses mitigates my autoimmune conditions like nothing I've ever used without any side effects. None of the people I'm using it on. None of the people none of the patients that my, colleagues are using it on are having any side effects. You keep the dose low.

The nausea, the vomiting, the terrible side effects, the muscle loss, that is all a dosing and management issue. And brand names start in a prefilled pen. I don't use them. They're too high of a dose. We are monodosing at high doses, monotherapy, a hormone, and that's why we're seeing these horrific side effects, which I completely agree with.

I've listened to your argument on different podcasts, and I'm like, I totally agree with them. I totally agree with what's happening there. But we wouldn't throw out thyroid if all the doctors were overdosing their patients on thyroid. It's a management and dosing issue on the doctor's part. And then how compliant are patients?

Right?

Dr. Mark Hyman
Why is pharma starting the dose so high? I mean, the injection first dose is point five milligrams, and it goes to one and two. You're talking about using point one or point o eight as well,

Dr. Tyna Moore
which is a

Dr. Mark Hyman
fifth a fifth of that.

Dr. Tyna Moore
Tiny. Because they're dealing with severely metabolically busted people already. And the people I'm dealing with are doing all the things that are generally metabolically healthy.

Dr. Mark Hyman
Medium Americans, man. What would you what would you do if you had someone come in who was, like, three hundred and fifty pounds who would just start a month? Or the average American.

Dr. Tyna Moore
So you give them a leg up. I have a license to prescribe, so I prescribe things to give people a leg up. I do use Prozac as needed at very low doses. And the way that I have been taught by my mentor is when a patient comes in and here's their pharmacological profile and here's their lifestyle, you lower this as much as humanly possible or get them off is the goal. The reason I became a naturopathic physician in the state of Oregon, so I prescribe, is to get people off drugs, and then you bring up their lifestyle.

Dr. Mark Hyman
To put them on and to take them off.

Dr. Tyna Moore
Right? You bring up their life style. Right? And so you hopefully get this as low as possible, but I'm not opposed to keeping people on tiny little doses. This is not the first drug I microdosed.

I microdosed Prozac in patients. I microdosed statins. I microdosed all kinds of drugs to give them you get a different mechanism of action when you use things at tiny little dosages than when you macrodose them. Macrodosing a drug gives you a different pharmacologic impact on the body.

Dr. Mark Hyman
And do they work at that low dose for people? Yeah. What if they're for your patients who are not really doing it for weight issues, I understand.

Dr. Tyna Moore
Everybody lost weight.

Dr. Mark Hyman
What about for people who are, like, three hundred pounds? Did you start with the same dose?

Dr. Tyna Moore
So I have one patient who is morbidly obese. He's well over three hundred something pounds and can't move. In so much pain, he can't move. He sleeps in a La Z Boy, spends all day in a La Z Boy, doesn't get up, doesn't move. Cognition's off, has had too many strokes.

I don't even have him at the starting dose yet. And it's been months, and he is very happily, very slowly shedding the weight.

Dr. Mark Hyman
Yeah. The starting dose the pharmacologic starting dose.

Dr. Tyna Moore
Yes. So I've got him at a fraction of that, and he his cognition has improved. The cognitive impacts have been huge. I've seen it eradicate depression. I've seen it reverse PCOS.

I've seen people walk straight into fertility after decades of infertility, issues from p or just decades of PCOS. So and this is all at micro doses. I'm talking droplets.

Dr. Mark Hyman
So this compound which our body makes maybe is deficient because of why? Why why is it because of epigenetic programming? Is it because of our microbiome changing? Is it because of toxins in the environment?

Dr. Tyna Moore
I think all of it. You know, the mess of toxic soup we live in. Yeah. I mean, we live in a toxic soup period. Epigenetically, like you said, mothers the the data around maternal diabetes and metabolic inflammation in the offspring is you do you know Pottinger's cats?

Did you guys ever hear about Pottinger's cats? Yeah. So Pottinger in the thirties took cats, and he fed he was a veterinarian. He fed them cooked meat and pasteurized milk.

Dr. Mark Hyman
Yeah.

Dr. Tyna Moore
That's all he did was change it. And within one to three generations, they were completely infertile. Their intestines were inflamed and boggy. Their livers were enlarged and fatty, infiltrate. And it took him multiple generations with optimal cat diet, which is raw milk and raw meat, multiple generations to reverse them back to a fertile, healthy animal.

Dr. Mark Hyman
Yeah.

Dr. Tyna Moore
So my I'm 50. I watched all of this happen. I've seen it. I remember when there was, like, one kid in school who truly had a glandular problem who was overweight.

Dr. Mark Hyman
Yeah.

Dr. Tyna Moore
I've watched this

Dr. Mark Hyman
Erica, my class.

Dr. Tyna Moore
Yes. I've watched this whole thing unfold. I've watched food change. I've been battling against it too for long, long time. But, we're in a pickle.

Yeah. And I think we're I think I am actually a few generations into potting or at least one into the Pottinger's cats. My parents, the boomers, had the convenience foods. Crisco oil came into play, and here we are. And my daughter

Dr. Mark Hyman
margarine. That was what I lived on when I was a kid.

Dr. Tyna Moore
Yeah. Me too. And wonder bread and baloney. But my daughter's my daughter's 24 next week, and her generation is a mess.

Dr. Mark Hyman
Well, weight loss can be super confusing. When you hop on social media, it seems like everyone has the answer. And yet despite the endless information at our fingertips, many people are suffering and are trying, but failing to shed unwanted pounds and keep them off. Now the government dietary guidelines and nearly all doctors, nutritionists, and all professional associations tell us that weight loss is simply about energy. You need to burn more calories than you eat.

You need to eat less and exercise more. Now this is called the energy balance hypothesis or energy balance model of weight. Now according to this theory, as long as you eat fewer calories than you expend, you'll lose weight. Right? Well, it doesn't matter if the calories come from a thousand calories of soda or a thousand calories of broccoli.

All calories are the same in this model. Now the implicit message here is that you're overweight because you eat too much and you don't exercise enough. In other words, it's your fault because you don't have the willpower, and the subtext is that you're a lazy glutton. I don't believe that. This is just nonsense.

The story of weight gain and weight loss and metabolism is far more complicated than that. Now Americans have been doing their best to follow this advice of eating less and exercising more for the past fifty years, and yet obesity rates have gone from five percent when I was born to forty two percent. How do we explain this? The truth is the science of weight and metabolism is complex. It's about calories for sure, but not only calories.

The science is clear on this. Not all calories affect our metabolism in the same way. You see, food contains calories, but also the type and quality of those calories impacts the way the body functions beyond the energy they contain. You see, food is information. It's instructions or or code that impacts your hormones, your immune function, your brain chemistry, your gene expression, and your microbiome in ways that have a huge effect on weight and metabolism.

If the calorie model doesn't completely explain our obesity epidemic, is there something we're missing? And the answer, my friends, is yes. The last few decades of research have shown that a calorie is not a calorie. Now, yes, in a lab when they're burned, calories are the same. But when you eat them and the information has different effects on hormones or your brain chemistry or your immune system or your microbiome, they are not the same.

So a calorie burn is a calorie burn, but a calorie eaten is not a calorie eaten, to quote my friend Robert Lustig. Now if our current theories don't completely explain our current obesity epidemic, then we need a new theory or maybe theories. The emerging model of weight gain and weight loss that's coming out of the science is called the carbohydrate insulin model. Now this theory posits that refined carbs and sugar calories drive high levels of insulin, And that's the fat storage hormone that makes you store fat. It locks the fat in the fat cells, and it slows your metabolism.

Not a good combo if you wanna lose weight. And the special type of fat that's stored, which is your belly fat, is actually a different type of fat. It's hungry fat. But is this true? And what does the research say?

Well, today, we're gonna discuss the functional medicine approach to weight loss. It zooms out and looks at root causes and mechanisms and includes all the variables that affect weight and metabolism. We'll see whether weight loss is simply about eating fewer calories or maybe about fixing your hormones or whether other factors such as toxins also influence weight. So let's cut through the noise and offer a science backed holistic road map to weight loss and metabolic health. So whether you wanna lose that extra couple of pounds around the midsection or transform your body composition completely, I hope you'll find this episode helpful.

Let's get started. So what makes us gain weight? Now there are two main schools of thought for what makes us gain weight, which are truly the subject of a lot of debate. The energy balance model and the carbohydrate insulin model. We're gonna talk about them.

Now, later in discussion, we'll discuss other factors that can influence weight gain. It doesn't just stop with calories or diet or the carbohydrate insulin model or energy balance model. There's a there's a lot of more things that can impact your metabolism. But first, let's take a look at the main diet related theories, the two of them, that lead to weight gain and the pros and cons of each one. Okay.

Let's start with energy balance model. Now this is the one that we've all been following for decades and decades, and it's sort of not working out for us. Right? Eat less, exercising more. How's that working out for you?

Well, let's talk about what it says and the science behind it and what makes sense about it and what may not. The energy balance model suggests that your body weight is maintained when the calories we take in, in eating and drinking, equals the calories we expend. Right? Our basal metabolic rate, plus our physical activity, plus digestion, or we call the thermic effective food, regulates your weight. And basically, weight management and weight maintenance occurs when energy in equals equals energy out.

If you wanna lose weight, well, you need to take in less energy than you put out. Right? If you gain weight, you wanna gain weight, you have to take in more energy than you burn. Right? This considers that all calories are metabolically alike and that you can lose or gain weight on any diet.

It doesn't matter where the calories come from. The dietary guidelines from America has been primarily based on this advice. The 2025 USDA dietary guidelines state, quote, losing weight requires adults to reduce the number of calories they get from foods and beverages and increase the amount expended through physical activity. In other words, eat less, exercise more. The Endocrine Society says, quote, the impact of diet on obesity risk is explained largely by its effect on calorie intake rather than by changes of either energy expenditure or the internal metabolic environment.

In other words, a calorie is a calorie is a calorie. Unfortunately, that's not exactly a true story according to the science. So what are the pros of this energy mat balance model? Well, it's simple. Right?

Energy intake has to equal energy expenditure or you lose or gain weight if you're out of balance. And it's an easy, straightforward universal model for weight management that basically everybody can understand. Calories in calories out, eat less, exercise more. People say this is true because it's based on the first law of thermodynamics, which means energy cannot be created or destroyed, only transformed. Now this is true, but you have to understand the definition.

The definition requires a closed system. Let me just look up the first law of thermodynamics. It means energy cannot be created or destroyed in a closed system. The body is not a closed system. You've got so many variables like hormones and the microbiome, your immune system, so many other things that regulate your response to energy.

It also embraces physical activity that's needed to maintain healthy weight and wellness, which is great. I think that's important exercise, but you cannot exercise your way out of a bad diet. I promise you that. Anybody who's tried will know what I'm talking about. And this also allows for diet flexibility.

Right? As long as you quantify energy intake and expenditure, basically counting calories and counting steps, basically, then you can follow any dietary approach. Low fat, low carb, you could drink Coca Cola as your sole food. It doesn't matter as long as you monitor and track your calories. Intuitively, it just doesn't quite make sense.

Right? It doesn't make sense that all calories are the same because any kindergarten kid would say, well, gee, if you drink a thousand calories of Coca Cola or have a thousand calories of broccoli, probably not the same. Even within this model, they they do acknowledge, and this doesn't quite fit the model, though, that ultra processed, hyper palatable, energy dense foods impact our brain chemistry makes it easier to overeat. Well, so they're saying, well, maybe calories aren't the same because some calories make you overeat. Well, that doesn't make sense, right, if it's just calories in, calories out.

But they also say in the same breath that there's little human evidence to suggest that hyperpalatability is related to overconsumption. Well, that's just not true. I mean, the NIH study from Kevin Hall, we've talked about before on the podcast, where he basically gave people ultra processed food or whole foods and told them to eat whatever they want. People who ate ultra processed foods were hungrier and ate 500 calories more a day. Now research supporting this model, this energy balance model is is there.

There's some research about it. Of course, it depends on which studies you look at, how they're looked at, and just sort of sifted through. But a meta analysis of 32 controlled feeding studies argues that when calories are controlled, metabolism weight loss are essentially the same on a low fat versus a low carb diet. But you have to look at what defines a low carb or a low fat diet. Is it 10% fat?

Is it 10% carbs? Is it 50% fat? Is it 50% carbs? Like, it matters. Right?

And so so maybe some of the the differences are not really that significant in order to shut down insulin. We'll talk about that. In the studies, again, a little bit contradicting the model because if all calories are the same, they should affect you the same. Right? But they but they do acknowledge that the macronutrients count for the differences in the distribution of body weight.

So for example, high carb diets promote more belly fat than high fat diets, which don't promote more belly fat. In a systematic review and meta analysis of randomized controlled trials, it was published in the British Medical Journal, where they compared low fat versus low carb diets from a 21 trials and approximately 202,000 adults who were overweight or obese and reported that they both had a similar effects on weight loss and cardiovascular markers at six months. Months. However, the weight loss diminished and the heart benefits disappeared at twelve months for all the diets. Now another study randomly assigned a 31 healthy overweight or obese adults who had lost about 8% or more of their body weight to either a moderate fat, low glycemic diet, a low fat, medium glycemic diet, or a high glycemic sugar, I mean, a high sugar control diet with a similar protein content, and they could eat whatever they want.

And they found really no difference in weight gain after eighteen months. What are the things that contradict this energy balance model? Some studies show it works, some studies show it doesn't, so let's get into what the cons are. It doesn't really explain how or why weight gain happens or what's driving the process other than just energy, right? Obesity rates have continued to climb despite Americans eating less.

Now this is really fascinating, folks. If you take the hypothesis that obesity is all about calories, it's hard to reconcile that with the fact that over the last decades, and I'll get into that, our calorie consumption has gone down, but our weight has gone up. So that's a really important fact. And this is, the NHANES data, which is the National Health and Nutrition Examination Survey, government data, tens of thousands of people over decades and decades. And they looked at calorie and added sugar intake, and they found that it's gone down since the year February.

But obesity and type two diabetes have gone up. Right? How do you explain that? It also doesn't consider the nutrient matrix or the quality or bioavailability of certain foods. For example, nuts have a high energy density, right, because they're they're higher in fat.

But eating nuts has been shown to help maintain a healthy weight and even lose weight. In the 2012 study published in the American Journal of Clinical Nutrition, they found that the average energy extracted from almonds is 32% less than what's written on the nutrition labels. Meaning, even if it says a hundred calories, it's 32% less than that that's actually used by the body because it takes so much work to digest it. Same goes for walnuts, about 21% less, and pistachios, 5% less, and cashews, 16% less. So how do you explain that?

Well, it's the food matrix. It's the degree of processing. It's the indigestibility of certain parts like insoluble fiber and things that feed the gut microbiome. Cutting calories without focusing on nutrition quality can actually lead to nutritional deficiencies, which can impact mood, mental health, and metabolism. So for example, if you're if you're on a calorie restricted diet, but you're not in a non nutrient dense diet, you're gonna end up with problems.

There's also metabolic pushback that happens. You know, cutting calories makes you hungrier and it decreases your metabolism. So you're in a vicious cycle. So you eat less, but then your metabolism slows down and then you increase your hunger. So it makes it hard to push past a weight loss plateau by just adjusting calorie intake.

It's really hard to reduce your calorie intake because you're gonna be hungry and that's gonna overtake your body and willpower just is not enough. So you have to use science. And this whole energy balance model also doesn't account for the complexities or the differences in individuals, genetically and metabolically. Hormones, genetics, your blood sugar, your microbiome, impact of nutrition or your brain chemistry, on your metabolism, the role of environmental toxins, things like obesogens, endocrine disrupting chemicals, stress, mitochondrial damage, free radicals, inflammation, all that is not taken into account by the energy balance model. And just calorie restriction doesn't work a long time.

Nobody can stick with that. Right? Research shows that humans are really bad also at measuring their energy intake. So we can underestimate our consumption by about 50%, and we overestimate our calorie expenditure from exercise by about 70%. I always said that when I worked at Canyon Ranch.

So people basically underestimate the amount they eat by 50% and overestimate the amount they exercise by about 50%. Now people can't adhere to a calorie restricted diet long term. They really can't, especially low fat diets because they're not very satisfying and fat makes you feel full and protein makes you feel full. So counting calories is kinda unsustainable. Anyway, even if you get a PhD in nutrition and you you are really focused on understanding calories, it's really hard to be accurate unless you weigh and measure every single thing you eat.

And also, the only problem with this model is it kinda blames the individual when they can't lose weight. Well, why didn't you lose weight? Well, you're just not eating the right way. You're eating too much and you're not exercising enough. And that sort of blames the victim, which is not really true.

I think that there's a lot of flaws with the energy balance model. Calories do matter. I'm not saying they don't matter. They're not the whole story. And and I think the quality of the calories matters.

And it turns out from from a lot of data from doctor Littlebig at Harvard and others that turns out that what you eat is more important than how much you eat. Because when you choose the right foods that regulate your biology in the right way, you don't have to white knuckle your way to weight loss. It actually will automatically start to shift your body in terms of, the right metabolic health. So what's this next model, this carbohydrate insulin model? And I think we we try to sort of narrow things down into simple little categories, but we have to sort of understand that biology is complex and not any single theory will explain everything.

But I think this one is much closer to what I've seen in my practice and also what I've seen to be more effective clinically with patients and what I've heard from many of my colleagues as well. Now this this offers a different perspective to this energy balance model, but I should I shouldn't say, just going back to energy balance model. The energy balance model was so attractive to the food industry that Coca Cola spent $20,000,000 paying scientists to fabricate data to show that this actually worked. That weight loss was just about calories in calories out. It didn't matter where the calories came from.

All calories in moderation, including Coca Cola. That's just nonsense. Sadly to say, it's nonsense. And they were actually exposed. I wrote a lot about this in my book, Food Fix, and and also some other things I've written.

But it's a very, attractive model for the food industry because it basically lets them off the hook. Right? If if you're a big food company or a fast food company, you can feel good about yourself because it's all about just the quantity of calories we eat. So people don't overeat, that's fine. They can eat their junk food.

But it's very, very much not the case. Let's get back to the carbohydrate insulin model. It basically suggests that the quality of the calories consumed, particularly rapidly digested calories, like refined starches, sugars, and empty carbs. They play a real critical role in weight regulation and obesity because they influence your hormones, particularly insulin. Now insulin is a very important hormone.

What is insulin, and what does it do in the body? Well, insulin is a hormone that's released by the pancreas when we eat something that has a high glycemic load, meaning it raises your blood sugar. That how how rapidly a meal raises your blood sugar is is called the glycemic load. Now, when a meal is rich in a lot of sugar and starch, your blood sugar spikes, and then insulin is released to help deliver the glucose and the fuel to your cells, your muscles, your liver, your fat tissue, and too many calories from each meal then, when you have high insulin levels, because it's the fat storage hormone, they're siphoned off into the fat tissue. And then too few remain in your circulation, which then makes your body perceive that you're in an energy crisis, that you have low energy states, and that makes you crave more carbs and more sugar.

You know exactly what I'm talking about. If you eat sugar and carbs, you want more sugar and carbs even though you have so much energy. I mean, I mean, people who are obese are just having enormous storage amounts of calories, but they feel like they're hungry and starving. Why? Because of the role of insulin and how it works in the body by storing the fat in the fat cells, by locking it in there, by clearing the the the blood of a lot of the available fuel.

So it's stored in the fat cells, and your brain doesn't perceive that you've got enough food around. So basically, obesity is a state of starvation amidst plenty. It's the feeling that you're starving in in when you have plenty of food and calories. Now this perceived state of starvation negatively affects all sorts of systems in your body, including your thyroid, and that slows your metabolism even more to conserve energy. Also, if you have a high carb diet, it increases cortisol.

So we know that eating sugar and starch raises stress hormones, cortisol, and also epinephrine, adrenaline, and that can lead to fluctuations in blood sugar, it can lead to more insulin resistance, weight gain, hypoglycemia, and you can just, you know, get in the terrible vicious cycle of being hungry and in the cycles of low and high blood sugar. Now we also know from the data that restricting your energy intake, meaning eating less, while consuming a high sugar, starch, or high glycemic diet is going to increase your predisposition to store belly fat, okay, and liver fat, and it's gonna make you hungrier. So even if you're restricting calories or if you're eating high carbs, you actually are gonna be hungrier and store more belly fat. So high insulin and the low glucagon from eating a high glycemic diet also inhibits our ability to mobilize and burn fat. As long as insulin is high, it blocks our our ability to burn fat, what we call lipolysis, and that makes weight loss difficult.

So it's like a one way turnstile. The fat gets in the cells and the sugar and the calories get in the cells, but they can't get out. It's really difficult to lose weight as long as your insulin level is high. And I've seen this over and over with my patients. The key to getting the weight down by any mechanism is lowering insulin.

Then when you have higher and higher amounts of starch or sugar, your cells start to become resistant to the effects of insulin. So you need more insulin, which leads to more weight gain and more chronic diseases like type two diabetes, obesity, Alzheimer's, and cancer. That's kind of the theory. Now what are the pros of this carbohydrate insulin model? Well, it focuses on food quality, on what you eat, not just how much you eat.

And it focuses on getting rid of these empty, fast digesting, high sugar, high starch carbohydrates because they have a really bad effect on metabolism and weight gain. It also tells us that all calories are not created equal in terms of their metabolic impact. Now they're equal in a laboratory when you burn them. If you burn a thousand calories of broccoli and a thousand calories of Coca Cola in a lab, they release the same amount of energy. But when you eat them, they have very different effects on the body.

I mean, think about that. A thousand calories or a hundred calories of broccoli versus the same amount of Coca Cola, very different impact on your biology. Another really important feature of the carbohydrate insulin model is that it addresses the role of insulin in fat storage and metabolic health. You see, when you have high insulin, that makes you store fat, which means lowering insulin through diet and other mechanisms can actually improve fat loss and improve metabolic health and reduce, obviously, the risk for insulin resistance, type two diabetes, chronic diseases without hyperfixating on calorie intake. Focusing on what you eat versus how much can make a big difference.

This also has a huge impact, for type two diabetes, less insulin spikes, lower insulin levels, less insulin resistance, and help can prevent and even reverse type two diabetes. In fact, the work by Sarah Hallberg and others using a ketogenic diet, which is like 75, 80 percent fat and, you know, five to 10% carbs, has been able to completely reverse type two diabetes. And since diabetes and insulin resistance is a carbohydrate intolerance problem, and this is what's happening in America. We have a huge population that's carbohydrate intolerant because we weren't adapted to eating such large amounts of sugar and starch. If you love this podcast, please share it with someone else you think would also enjoy it.

You can find me on all social media channels at doctor Mark Hyman. Please reach out. I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the doctor Hyman Show wherever you get your podcasts, And don't forget to check out my YouTube channel at doctor Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in.

We'll see you next time on the Doctor. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am chief medical officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests.

This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, please seek out a qualified medical practitioner. And if you're looking for a functional medicine practitioner, visit my clinic, the Ultra Wellness Center at Ultra Wellness Center, DOTComm, and request to become a patient. It's important to have someone in your corner who is a trained, licensed health care practitioner and can help you make changes, especially when it comes to your health.

This podcast is free as part of my mission to bring practical ways of improving health to the public. So I'd like to express gratitude to sponsors that made today's podcast possible. Thanks so much again for listening.