Qualy #102 - Is the food industry still saying that all calories contribute equally to adiposity and insulin resistance？
Episode Stats
Words per Minute
165.25743
Summary
In this bonus episode of The Qualies, Dr. Peter Atiyah talks about how the food industry is wrong about the role of carbohydrates in obesity and insulin resistance, and explains why the problem is not all about calories, but about the gut bacteria that digest them.
Transcript
00:00:00.000
Welcome to a special bonus episode of the Peter Atiyah Qualies, a member exclusive podcast.
00:00:16.100
The Qualies is just a shorthand slang for qualification round, which is something you
00:00:20.120
do prior to the race, just much quicker. The Qualies highlight the best of the questions,
00:00:25.320
topics, and tactics that are discussed in previous episodes of The Drive.
00:00:30.000
So if you enjoy the Qualies, you can access dozens more of them through our membership
00:00:33.520
program. Without further delay, I hope you enjoy today's Qualies.
00:00:40.560
And currently the food industry says, I mean, I haven't really paid much attention to this,
00:00:45.560
to be honest with you, in the last few years, but is the food industry basically still saying that
00:00:49.200
while a can of Coke is not ever deemed even by Coca-Cola to be as nutritious as a carrot,
00:00:55.320
in the end, are they basically saying that all calories contribute equally to adiposity
00:01:02.960
Yes. They are all saying it's about obesity and therefore it's about energy balance,
00:01:07.140
therefore it's about calories, therefore all calories are the same. That's what they say.
00:01:12.140
It is absolutely not true. And we have all the reasons in the world to show why it's not true.
00:01:18.820
We have empiric data. We have mechanistic data. We have plausibility data. We have hard data that
00:01:25.460
show that is just not the case. And if you want, I'll give you examples of it. All right, let's start.
00:01:32.220
Let's talk about fiber. You eat 160 calories in almonds. How many do you absorb?
00:01:38.680
130. Yeah. I mean, 75%. Okay. Well, what happened to the other 30?
00:01:43.760
Presumably, it's going to drag some stuff out in your colon.
00:01:47.920
Well, no. What happens is the soluble and insoluble fiber in the almonds forms a gel on
00:01:52.260
the inside of the intestine. You can actually see it on electromicroscopy, a whitish gel.
00:01:57.060
That's going to act as a secondary barrier preventing absorption of some of those almond
00:02:02.560
calories early on. Well, if they don't get absorbed in the duodenum, where do they go next?
00:02:08.780
Jejunum. Well, what's in the jejunum that's not in the duodenum? The microbiome.
00:02:12.580
Yeah. The duodenum is essentially sterile. It's got a pH of one. Only H. pylori can live
00:02:19.180
there. You have to get the bicarbonate infusion.
00:02:21.740
Wait, you're saying that that lining is formed in the duodenum?
00:02:25.060
Duodenum, yeah. Exactly. To prevent your liver from getting the whole dose because anything
00:02:32.680
that's absorbed in the duodenum goes straight to the liver.
00:02:36.560
A lot. I mean, I can't give you a number of grams.
00:02:38.440
But I'm just directionally, I'm making this number up. But let's say there's, how many grams
00:02:43.700
There's 30 calories in a standard apple, half of which would be fructose of 15.
00:02:49.980
That seems low. An apple, like a big-ass Fuji apple?
00:02:52.540
Well, I mean, not a big mother apple, but like an apple apple.
00:02:56.700
But so based on that, you're saying only half the fructose that you would eat in a piece
00:03:03.080
Yeah, or less. Most of it's going to end up in the jejunum. And once it goes to the jejunum,
00:03:07.920
it's a free-for-all. Do you absorb it or do the bacteria digest it and metabolize it for
00:03:12.140
their own use? Remember, you have 10 trillion cells in your body, but you have 100 trillion
00:03:17.160
bacteria in your intestine. Every one of us is just a big bag of bacteria with legs. Those
00:03:24.360
If the fructose gets absorbed at the level of the junum, in other words, if the gut outcompetes
00:03:28.380
the bacteria, can it still get back to the liver?
00:03:30.320
Oh, yeah. But the area under the curve will be wider, which means the insulin response will be
00:03:36.740
lower, which is what you want because it took longer. But a lot of it won't get absorbed. It'll
00:03:42.540
be digested. It doesn't come out in the stool. It gets digested by the gut bacteria who use it for
00:03:48.260
their own purposes. Now, here's the thing that I only learned about a month and a half ago, which
00:03:54.100
is absolutely essential. If you don't consume fiber, that means that your gut bacteria are not
00:04:01.820
getting the food they need because you're absorbing it all early. Well, they still have to survive.
00:04:08.200
So what do they do? They protealize and lipolyze the mucin layer.
00:04:14.940
They auto-digest the mucin layer that sits on the surface of your intestinal epithelial cells,
00:04:20.300
protecting them. And you can actually see on electromicroscopy an increased apposition of
00:04:27.280
the bacteria with the intestinal epithelial cell, which likely causes damage, possibly a leaky gut,
00:04:36.300
and possibly GI disease like colitis and even maybe Crohn's. So the idea is to feed your bacteria
00:04:45.640
or your bacteria will digest you. And what sources of fiber do you think? I mean,
00:04:51.700
people talk about using psyllium husk and all these other things to sort of augment fiber.
00:04:55.320
Do you think that's necessary or do you think you can get enough of it just from...
00:04:58.940
Well, so psyllium is soluble fiber. It's not insoluble fiber. You need both. Fiber has soluble,
00:05:07.620
insoluble like pectins, like what holds jelly together. Insoluble fiber like cellulose,
00:05:12.920
you know, stringy stuff in celery. You need both to make that gel. So the insoluble fiber forms the
00:05:19.040
lattice work like the net. Let's say you put a layer of petroleum jelly on a strainer. You would
00:05:24.960
have an impenetrable water barrier, right? Yeah. So the insoluble is like the strainer
00:05:29.200
and the soluble becomes the thing that fills in the lattice. That's right. Exactly. So when you have
00:05:34.640
both, it works. And there's data that shows that if you have either one or the other, doesn't work.
00:05:40.460
You need both. Well, you get both in real food. And this is why the food industry keeps adding
00:05:47.140
soluble fiber like psyllium husk to food like fiber one bars. It doesn't make a damn bit of
00:05:52.460
difference. They have insoluble fiber in things like certain breakfast cereals. But if you don't
00:05:59.320
have the soluble fiber, also doesn't work. You need both. Real food has both. The point is...
00:06:05.360
So the fiber fortified stuff is... The easy way to do it is to add soluble fiber.
00:06:08.840
That doesn't work. Okay. And that's what the food industry keeps doing and keeps telling us that
00:06:12.760
it's good because it's got extra fiber. Wrong. Doesn't have functional fiber. Doesn't have the
00:06:18.300
fiber that does what you want it to do. That's the reason a calorie is not a calorie all by itself.
00:06:23.280
Hope you enjoyed today's special bonus episode of The Qualy. New episodes of The Qualys are released
00:06:28.960
Tuesday through Friday each week and are published exclusively on our private member-only podcast feed.
00:06:35.180
If you're interested in hearing more, as well as receiving all of the other member-exclusive
00:06:38.740
benefits, you can visit peteratiamd.com forward slash subscribe. This podcast is for general
00:06:45.800
informational purposes only and does not constitute the practice of medicine, nursing, or other
00:06:50.300
professional healthcare services, including the giving of medical advice. No doctor-patient
00:06:56.020
relationship is formed. The use of this information and the materials linked to this podcast is at the
00:07:01.840
user's own risk. The content on this podcast is not intended to be a substitute for professional
00:07:07.300
medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical
00:07:14.260
advice from any medical condition they have, and they should seek the assistance of their healthcare
00:07:19.280
professionals for any such conditions. Finally, I take conflicts of interest very seriously. For all of
00:07:26.800
my disclosures and the companies I invest in or advise, please visit peteratiamd.com forward slash about
00:07:34.580
where I keep an up-to-date and active list of such companies.