#251 – How to track your macros for fat loss and muscle gain | Josh Clemente & Dominic D’Agostino

Not all calories are equal. Tracking your macronutrient intake, using AI capabilities, can help you improve your body composition, facilitate weight loss, and boost exercise performance. The three macronutrients are protein, fat, and carbohydrates, with fiber a subset of carbs. Josh Clemente & Dr. Dominic D’Agostino discuss the new macros-tracking feature in the Levels app, the purpose and importance of each macronutrient, how to use macros-tracking in conjunction with biomarker data to improve health and fitness, and how easy the app’s AI functionality is to use.

Helpful links:

Josh Clemente on Instagram: https://www.instagram.com/josh.f.clemente/

Josh Clemente on Twitter/X: https://twitter.com/joshuasforrest

Dominic D’Agostino on Instagram: https://www.instagram.com/dominic.dagostino.kt/

Dominic D’Agostino on Twitter: https://twitter.com/DominicDAgosti2

9:03 — The importance of prioritizing protein intake

Dominic D’Agostino, PhD, recommends about 1 gram per pound of bodyweight per day for active people.

Protein is a macronutrient that you should focus on. Protein is made up of amino acids. Protein provides the bulk structure of your body, not just skeletal muscle but also things like your skin and your hair and antibodies. And ion channels on cell membranes and enzymes are protein. So all these things can compose protein. And if you are deficient in protein, then that could, for example, impact your immune system. So it’s really important to sort of centralize protein.

17:03—Why is tracking macros beneficial?

Tracking macros can help you understand how different nutrition strategies affect your body.

It’s super important to track macros. That’s my personal opinion, and I think some people would disagree with that. But I think the science is going in that direction overwhelmingly because people grossly underestimate the amount of calories that they consume, especially from carbohydrates and especially from fat. So it becomes crucial to understand what your total calories are and also what your macronutrient distribution is and how that will correlate to specific metabolic biomarkers.

21:11 — Each macronutrient has a different role in the body

The three macronutrients are protein, fat, and carbohydrates. Fiber is a subset of carbs.

Macronutrients are each fundamentally different building blocks. And when they enter the sort of chemistry set that is your body, they trigger different pathways and they are processed in different ways and have fundamentally different effects on the body and then really can do different things. Carbohydrates can’t necessarily produce the building blocks of muscle and skin and organs the way protein can. So paying attention to not just the sort of energetic intake and expenditures but also the building blocks that make up that energy are really two different but very important aspects of what we’re feeding ourselves and the sorts of information we’re providing and enabling our body to use in the future.

39:36 — The different functions of macros

Carbohydrates and fats are readily accessible energy, and protein is crucial for building and preserving muscle.

Protein is not a good energetic fuel. So you want to make sure that your protein requirements are met, but not excessive. And you want to then fill in the gap of your macronutrients with good energy sources. And that could be carbohydrates and fat. So in some cases, one or the other, depending upon, well, even if you’re on a high-carb diet, you want to make sure that you’re getting enough fat to get the essential fatty acids you need . . . Your fats and your carbohydrates are there for energy and fuel. And they also help to fuel the rebuilding process and ensure that protein synthesis and protein metabolism is optimal because that’s an energy-dependent process. And you want to derive the energy from not so much protein and the associated amino acids but you want to get your energy from fats and carbohydrates. So I kind of view it from that perspective that protein is for building and maintaining, but not for energy.

48:32— Is excess protein a concern?

Excess protein is generally not a concern except for when some medical conditions are present. Often uric acid buildup is a result of poor metabolic health.

Uric acid is a really important biomarker to track. And I think more recently people are paying attention to this [idea] that excess protein can contribute to higher uric acid. So it’s something that you want to track . . . Other people I know have followed higher-protein diets for a long time, and their uric acid is perfectly normal. It’s more of a feature of excess consumption of a purine-rich diet in the context of poor metabolic health. Whereas people that have good metabolic health can tolerate high levels of protein and even purine-rich foods, like liver and organ meats, and maintain relatively low uric acid levels.

54:55— The problem with excess carbohydrates

Overconsumption of carbohydrates can lead to an outsized insulin response from glucose spikes, which are often followed by a blood sugar crash that can tank energy.

Macronutrient tracking is probably most important from the context of tracking carbohydrates to understand our carbohydrate tolerance. Various coaches and trainers that I know dial in the carbohydrates using CGM. Many of them are using Levels to really dial in the carbohydrates to figure out the optimal level of carbohydrates for performance and body composition but also not to “spillover” (a term they use) that they’re dumping insulin. And excess carbohydrates will make you hold water. And that’s not favorable for body composition or performance.

1:00:37— Tracking macros can help you improve metabolic flexibility

Having metabolic flexibility means your body can easily toggle between fuel sources.

If you promote metabolic flexibility, which is best achieved through carbohydrate restriction, it gets your body used to burning fat for energy. Your glycemia and your insulin levels are more stabilized. Also if your carbohydrates are restricted to a significant degree, you start producing ketones and then those ketones can kind of fill the gap in brain energy. So if your glucose does become low, the ketones are essentially a safety net. You’re essentially asymptomatic for hypoglycemia. If you’re on a ketogenic diet or even doing things like intermittent fasting, that metabolic flexibility can have really tangible effects.

1:02:41 — The issue with overconsumption of carbohydrates

The research is mixed on whether carbohydrates are addictive, but they do impact reward pathways. Reducing carbohydrate intake may help reduce reliance on this macronutrient.

I do think carbohydrates are the easiest to over-consume. People will debate whether carbohydrates or sugars are addicting or not. And I think there’s good evidence to support their effects on dopaminergic reward pathways that are analogous to dopamine-inducing recreational drugs, like cocaine and methamphetamine . . . People who have obesity, for example, just have lower dopamine levels, and they’re kind of self-medicating for that.

1:17:18 — Is fiber a macronutrient?

Fiber falls under the carbohydrate umbrella.

Whether it’s a fourth macronutrient, I guess could be debated, but fiber passes relatively undigested through the small intestine and enters the colon, where it’s fermented to short-chain fatty acids like butyrate, and then butyrate becomes the preferred fuel for the colonocyte. So it nourishes and provides fuel for favorable gut microbiota. In most cases, short-chain fatty acids are the best fuel for the colonocytes. And if they’re deprived of that fuel, that could decrease the health of the gut and perhaps increase intestinal permeability and make us susceptible to different diseases.

1:46:21 — Macros tracking in the Levels app

AI capabilities in the Levels app take the pain points out of tracking macros

I’m really enjoying this new feature set that we have the easy macros entry. So we have artificial intelligence. I basically just dictate verbatim a sentence. I’ll say, “Fajita salad, sliced chicken, sour cream, guacamole over lettuce” and press the button, and it enters it and it breaks it out into the macronutrient ingredients. That’s really straightforward. But then what’s more interesting to me than that is seeing the relationship between that and my goals. So I’ve set a protein goal for myself. We talked today about trying to hit a gram per pound of body weight. That is my current goal. And I’m trying to actually gain weight and put on muscle mass. So I have to eat more than my current body weight. About 170 grams per day is my target. It is amazing when you think that you’re hitting that for months prior and are not putting on the mass that you expect to, then you start actually tracking this closely and realize, “Oh, I was actually 50% short on a lot of days that I just was doing this math and magic in my head and assuming that I got it in there.

1:49:50— Tracking macros can help improve body composition and performance

The Levels app allows you to see your macros and glucose data in real time, which can help you create strategies around changing body composition or boosting exercise performance.

Most people are trying to lose weight and improve body composition. So just to have that history there and something to refer to as you tweak and make adjustments along the way to your training too—if you amp up your training. Preparing for something, whether it be a powerlifting event or a sport event or a marathon or something like that—it’s going to be really important. You’ll be leaps and bounds ahead of everybody else if you nail down your nutrition. And measuring is one way and monitoring these other biomarkers is one way not only to improve your metabolic health but also your performance and body composition.

Dom (00:00:07):

You are living in the dark if you are not tracking your macronutrients and you’re getting unfavorable body composition changes and you’re saying, “Well, I’m eating less calories than I’m burning.” But many people doing that are not precisely tracking their macros in any way, or they’ve cut carbs. This is what I hear a lot, almost on a daily basis. I get emails from people, ” Hey, I tried the ketogenic diet. I cut carbs to less than 20 grams a day and I still kept gaining weight.” But my response is, “Okay, have you been tracking your macronutrients and your calories?” And the response is like, “Well, I didn’t think you had to do that.”

Ben (00:00:52):

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health. And along the way, we have conversations with thought leaders about research-backed information so you can take your health into your own hands. This is a whole new level.

(00:01:08):

A while back, we started building new product features, one of which was macro tracking. It’s specifically tied to food logging. Reason we did it was so that people could get more insight about their specific nutrition. What exactly are macros? Well, it might be a familiar term to some and might be a little foreign to others. Well, macros, for those of you who aren’t familiar, are things like fat, fiber, protein, carbohydrates. They’re the macronutrients that we get from the food we consume. And depending on where you get those sources of food and what the makeup is, as Josh says, and many people often say, “A calorie is not a calorie.” The calories from whole foods and macros from whole foods are much different than some of the things like packaged foods. You might be actually getting the macros, but it doesn’t mean that the composition of those foods are right and they’re not necessarily right for you to help hit your goals.

(00:02:20):

So Josh and Dom sat down and they discussed these ideas across macros and even how the Levels app ties into it, what can people do to track their macros consistently and how can it help to benefit them when they are or aren’t wearing a CGM. It’s a great new feature that we’ve been working on. Dom and Josh give a lot of background and context into the importance of macros. For those of you who aren’t familiar, Dom is one of our advisors. He’s great friend to Levels and he’s got a background in neuroscience, molecular pharmacology, and nutrition and physiology. And Josh Clemente needs no introduction. He is one of the co-founders of Levels. It was a great conversation to hear each of their perspectives pertaining to macros and even things like biomarkers and labs. How does the whole picture of metabolic health tie together? Anyway, no need to wait. Here’s Josh.

Josh (00:03:18):

Dom, welcome to Whole New Level. You’re a regular on the show. Really excited. I think this is actually your and my first opportunity to do an episode together, which is a lot of fun. Yeah, thanks for joining us.

Dom (00:03:28):

Great to see you again, Josh, and great to be here. Thank you.

Josh (00:03:31):

Well, for those who don’t know, Dom D’Agostino is an associate professor at the University of South Florida. He teaches students at the Morsani College of Medicine, Department of Molecular Pharmacology and Physiology, and he’s also a research scientist at the IHMC, Institute for Human Machine Cognition. Lots of deep, deep experience in metabolic health, and he also runs an organization called ketonutrition.org, which I highly recommend checking out. So with that, we have a lot to talk about today.

(00:03:57):

And I’m also excited to introduce a new feature set that is going to be the foundation for the subject that we’ll be talking about today, which is macronutrients. Gigantic topic, but something that a lot of people have heard about, haven’t necessarily considered, and/or maybe they have been using it for years and potentially have not explored the full scope of what macronutrients are and what the macronutrient tracking tools could look like.

(00:04:20):

Yeah, I’m very excited. Levels has been working in the space of metabolic health now for about five years, and only recently did we roll out macronutrient tracking. And the reason for that is that we were waiting to develop a set of features that we felt fit seamlessly with the Levels experience, which is goal-oriented around minimal overhead, just being able to quickly and almost effortlessly put mile markers throughout your day about what you ate and then how your body responded to that. Macronutrient tracking can often be pretty onerous, requires a lot of counting and weighing and portioning, and we wanted to make sure that we could work around that and build a set of tools that would streamline this quite a bit.

(00:04:59):

So that’s my introduction. We’ve got macro logging now out to both iOS and Android users of Levels, and the features are pretty exciting. I’m using them very consistently and I’m really excited really to back up from that rollout and talk about the big picture. What are macronutrients, why are they relevant, and how are we planning to use this information to improve metabolic health? So with that intro, I’d love to just hear from you, Dom, how would you describe what exactly are macros? And for those that are unfamiliar with the term, what are the major ones?

Dom (00:05:35):

Before I describe them, I’d just like to say that most people do not engage in the tedious calculation with a gram scale to measure them out and track macros. But just being networked with the fitness community, this is the thing that they do on an average day. And also if you really have plans to optimize your metabolic health and also body composition, understanding macros and what you’re eating and just doing it for a couple of weeks or even doing it for a week or two would be incredibly informative. So diet composition, your macronutrient profile describes your diet composition. The difference in diet composition is actually one of the key focus of the medical education in nutrition that our class is focusing from a very high level. It’s probably the most talked about and important thing in nutrition research right now.

(00:06:36):

So you have protein, you have fat, and you have carbohydrates. A component of carbohydrates is fiber. That could be some considered a fourth macronutrient. But from a very basic level, your protein is probably the most central macronutrient that you should focus on. We have essential amino acids that comprise protein. Protein is made up of amino acids. Protein provides the bulk structure of your body, not just skeletal muscle, but also things like your skin and your hair and antibodies and ion channels on cell membranes and enzymes are protein. So all these things can comprise protein. And if you are deficient in protein, then that could, for example impact your immune system. So it’s really important to centralize protein.

(00:07:29):

There are I think nine essential amino acids in protein that you have to… If you’re following a vegan diet, for example, calculating your protein is super important. And also the amino acid composition of that macronutrient is also really important. For example, when we discuss different vegetarian or especially vegan-based diets, you need to formulate in a way that makes sure there’s sufficient amounts of methionine and lysine, especially lysine is deficient in vegan diets, and B12 and iron too.

(00:08:05):

So protein should really be central. It’s hotly debated how much protein we should have, and that becomes a whole another field of research in and of itself, probably one of the more active areas of research. Generally speaking, dietary guidelines, something like 0.6 grams per pound, but I am of the opinion that that’s too low. At the very least, 0.75 grams per pound would be ideal. And then if you’re an active person, upwards of 1 gram per pound. So a 200 pound person… Well, I’d correct that to 1 gram per pound of ideal body weight. So if you’re an obese person that’s overweight, you don’t want to… So you want to do it grams per pound of ideal body weight would be a good way to go about doing it.

(00:08:59):

In protein, there’s a lot of discussion about excess protein associated with aging and inhibiting kidney function and being toxic to the kidneys. We can get into that discussion I think maybe later on. But from a general perspective, you have protein. Just we’re discussing macronutrients. We have fat. There are essential fatty acids. There are four different types of fats in the diet. There’s saturated fat. There’s polyunsaturated fatty acids or PUFAs. There’s monounsaturated fatty acids or MUFAs. And then there’s trans fats, which we should try to minimize. Some trans fats are actually found in nature. But generally speaking, they’re synthetic fats that are produced in a factory. And then there’s the discussion about omega-6s, seed oils, and then omega-3 fatty acids. And there’s ratios. And we could go down the rabbit hole to talk about what are the optimal fats that we should avoid and shouldn’t avoid.

(00:09:58):

But the next macronutrient would be carbohydrates. Carbohydrates are the only macronutrient that’s not essential. That doesn’t mean that leaving carbohydrates out of your diet is optimal. So in many, avoiding carbohydrates altogether is probably not optimal. With carbohydrates, you have monosaccharides and disaccharides. You have starches. You have glycogen. You actually eat glycogen if you’re eating liver or muscles and different types of seafood actually has glycogen so you need to calculate that into your carbohydrate allotment. And then fiber. And then fiber is broken down into insoluble fiber. That would be cellulose. And then you have soluble fiber that’s inulin or various oligosaccharides. And then there’s also resistant starch. So resistant starch is not technically, haven’t looked at it, not technically a fiber but it behaves like a fiber. I’ll say that. So it has some ability to ferment and things. So you have protein, fat, and carbs. And that’s an overview.

(00:11:03):

And then fiber is and of itself. It’s also hotly debated if we need fiber or not. There are people who follow a carnivore diet that seem to do well, completely well on zero fiber. I am of the opinion based upon the massive amount of epidemiological data that having fiber anywhere from 25 to 30 grams of fiber per day is probably optimal for the diet that helps to attenuate glycemic spikes. I would choose fiber… Try to get it from whole food sources. So if whole foods sources of carbohydrates are high in fiber, for example, broccoli is one third fiber, and if you get it from vegetables and fruits and you make sure that those sources of carbohydrates are 20 to 30% fiber, that’s going to significantly attenuate glucose spikes and also probably insulin too. So try to pick your carbohydrates based on their fiber consumption, I think, is important. And then we could take a deep dive into the specifics of proteins and fats and carbohydrates and their effects on metabolism.

Josh (00:12:09):

We should certainly dive into each of those more deeply. And there’s obviously a ton of subject matter here to map, so we will by no means be able to cover the full spectrum of what’s contained in the statement macronutrients. But I think that was a great introduction to the main categories. And I think maybe we could also, just for those who are really approaching this subject for the first time, Dom just touched on a number of the high level reasons that one would pay attention to these primary macronutrients. But Dom, I’m curious for you, you had started off by saying it’s essentially the 101, it’s the foundation for a lot of your nutrition curriculum. And so I’m curious. How would you describe the importance of tracking macros in one’s diet? Is this something that really only applies to people who, for example, are bodybuilders or elite athletes? How does it apply to the everyday person?

Dom (00:13:02):

From the general perspective, from the 30,000-foot view, I think people just doing general nutrition research probably think, their general opinion in this field is that it’s almost like micromanaging. But at the same time, there’s two camps in that. And one way to think about it is if it fits your macros, there’s that cam. And that is an extremely effective way to, if you do it on a weekly basis and adjust your macronutrient composition and total energy intake is, and I guess Weight Watchers and other organizations have profited off of this, that is the most effective way to improve your metabolic health and body composition. And there are more difficult ways to do and easier ways, and the app is just amazing in that. And you can talk about the features of everything from the barcode scanning to customizing and then do the AI features. So that has become the barrier to entry, I would say, for tracking macros.

Josh (00:14:09):

The way that macro tracking is used efficiently, what is happening that people are able to improve body composition through tracking macros specifically? Are they… Yeah, could you just expand on that just a little more?

Dom (00:14:21):

It’s super important to track macros, and that’s my personal opinion and I think some people would disagree with that. But I think the science is going in that direction overwhelmingly because people grossly underestimate the amount of calories that they consume, especially from carbohydrates and especially from fat. So it becomes crucial to understand what your total calories are and also what your macronutrient distribution is and how that will correlate to specific metabolic biomarkers that we can talk about. The high level ones are average glucose, glucose spikes, insulin, but even things like HSCRP, APO-B, uric acid, triglycerides, all these things are important because 95% of people are not optimal. And to understand why they’re not optimal, they need to understand what they’re eating, and the macronutrient distribution of what they’re eating is absolutely essential.

(00:15:24):

Really the most important thing is that people grossly underestimate how much they’re eating. So when they start tracking macros, and this is even true in my case where I track macros for a while and then I essentially don’t track. I track every once in a while just if I change my diet, but I buy 10 foods at the grocery store once a week and I eat the same meals every day. So I know the macronutrient composition of that and I vary it. I add it, egg or two here and there if I want to increase or decrease weight, or add an extra cup of blueberries at the end of the day if I want to increase carbohydrates or fiber or something like that. But you have to understand your baseline and where you’re starting at to make… If you don’t measure it, you can’t improve it.

(00:16:06):

So the first step is measure it. Not that you have to do it all the time because some people are regimented and they have a routine where… Although other people, many people I know are not regimented and they go out to eat, they’re eating from packaged foods where the app can allow you to scan the barcode and it pops it in there. So they’re eating a very high variety. Their meals are very inconsistent. So in that case, it’s probably important to track macros. It’s also really important if you’re an athlete and you want to dial in your carbohydrate tolerance based on your CGM and other biomarkers. And many people like to, for example, if they’re in a sport, to cut weight or to increase weight or increase muscle size in bulk. And to do that optimally, you need to calculate your initial macros and then strategize a way to increase protein and overall calories over time. So you can gradually put on muscle size and strength and do it in a very incremental way that’s not impairing metabolic health.

(00:17:14):

These are all the reasons why people in the fitness community do it, but I think the general population has so much to learn from that community. And now, we have the tools available to do it.

Casey (00:17:32):

This is Dr. Casey Means, co-founder of Levels. If you’ve heard me talk on other podcasts before, you know that I believe that tracking your glucose and optimizing your metabolic health is really the ultimate life hack. We know that cravings, mood instability, and energy levels and weight are all tied to our blood sugar levels. And of course, all the downstream chronic diseases that are related to blood sugar are things that we can really greatly improve our chances of avoiding if we keep our blood sugar in a healthy and stable level throughout our lifetime.

(00:18:07):

So I’ve been using CGM now on and off for the past four years since we started Levels, and I have learned so much about my diet and my health. I’ve learned the simple swaps that keep my blood sugar stable like flax crackers instead of wheat-based crackers. I’ve learned which fruits work best for my blood sugar. I do really well with pears and apples and oranges and berries, but grapes seem to spike my blood sugar off the chart. I’m also a notorious night owl and I’ve really learned with using Levels, if I get to bed at a reasonable hour and get good quality sleep, my blood sugar levels are so much better. And that has been so motivating for me on my health journey. It’s also been helpful for me in terms of keeping my weight at a stable level much more effortlessly than it has been in the past.

(00:18:53):

So you can sign up for Levels at levels.link/podcast. Now, let’s get back to this episode.

Josh (00:19:08):

One interesting and made us maybe more succinct way I’ve heard this stated is when people are confused about… A lot of people have heard about calories. And for myself, for example, I grew up with the “a calorie is a calorie tagline” just seared into my brain. And so Skittles and broccoli both contain calories, which is a unit of energy, and really it’s just the amount of calories you’re consuming in the two of them that would matter when determining how many calories you’ve consumed. And if all calories are equal, which they are thermodynamically, this is a question of really energy is energy equal, and the answer to that is at an abstract level, yes. Then it really doesn’t matter what your food sources are, you’re just consuming energy.

(00:19:52):

Macronutrients, on the other hand, pose a different question, which is that it’s not are all calories equal? That is the answer is yes. It’s, are all macronutrients equal? And I think what you’ve just laid out for us in the intro here is that macronutrients are each fundamentally different building blocks. And when they enter the chemistry set that is your body, they trigger different pathways and they’re processed in different ways and have fundamentally different effects on the body and really can do different things. Carbohydrates can’t necessarily produce the building blocks of muscle and skin and organs the way that protein can. So paying attention to not just the energetic intake and expenditures, but also the building blocks that make up that energy are really two different but very important aspects of really what we’re feeding ourselves and the sorts of information we’re providing and enabling our body to use in the future.

(00:20:46):

If someone was tracking macronutrients over a long timeframe, what sort of information would you say that they have that someone who has not tracked their macronutrients over a long timeframe would not have? And how would this be useful in understanding the onset of conditions changes in ones say, metabolic status and biomarkers? How do those two things connect your sort of holistic health and your macronutrient history?

Dom (00:21:11):

Yeah, that’s a good question. The best answer is that you are living in the dark if you are not tracking your macronutrients and you’re getting unfavorable body composition changes and you’re saying, “Well, I’m eating less calories than I’m burning.” But many people doing that are not precisely tracking their macros in any way, or they’ve cut carbs. This is what I hear a lot almost on a daily basis. I get emails from people, “Hey, I tried the ketogenic diet. I cut carbs to less than 20 grams a day, and I still kept gaining weight.” And my response is, “Okay, have you been tracking your macronutrients and your calories?” And the response is like, “Well, I didn’t think you had to do that if you went on a low-carb diet or ketogenic diet.”

(00:21:56):

It’s really important. For those who have tracked macronutrients and have a history of doing that, they will have a very clear understanding about how changing macronutrients, how changing diet composition impacts their overall health, their body composition, their hunger and their weight in general. It’s just like whereas someone who has fluctuated in weight over time may say, may attribute those weight gain and fluctuations to eating a particular food or stress or something else where the reality is, the truth is that they were overeating. Or they’re under eating if they’re losing weight, and they could basically claim that, “I was eating the same thing but my weight has been fluctuating up and down.” And they may attribute it to specific macronutrient compositions.

(00:22:45):

And that could be a factor. I’m not saying that’s a factor, that it’s not a factor because some people really do very well on a low-carb diet or a ketogenic diet, and some people do very well on higher carbohydrate diets. My wife, for example, chooses to eat a higher carb diet and does really well, and our biomarkers are pretty much the same. But I think the person not tracking macros were just in the dark. And I think if they start doing it, it’ll be eye-opening and it’ll help to clarify their body composition issues and then they can plan according to that. And it doesn’t have to be an abrupt thrust into tracking macros to every gram, but I think just you can ease into it. And we see that sometimes it’s better for people to ease into it.

Josh (00:23:35):

So starting to pay attention to it in some capacity is better than ignoring it altogether. You mentioned a few dietary philosophies there, and I was excited to step into some of those next. Are the different diet fads or names or philosophies, are they really fundamentally just macronutrient differences or composition differences? What sets apart a ketogenic diet from, for example, a carnivore diet? And does this come down to a macro composition and is that what causes any positive effects someone might see? And from there, I’ve got a few other questions which we can get into on the interpersonal differences and how somebody responds to a specific diet.

Dom (00:24:16):

Humans are incredibly adaptable to a wide spectrum of macronutrient and diet compositions, so that’s super key. Not all species are able to do that. In addition, we can follow vastly different macronutrient compositions and have metabolic adaptations to that composition that can be favorable or unfavorable. And that’ll be partly dependent upon individual variability, genetics. Even some people are poor oxidizers of fatty acids or have various things that make them susceptible to different metabolic derangements. So even me, I got my genetic results back this week and it’s really interesting to look through that and see that I have specific mutations for cholesterol transporters and things like that, that I’m making actionable adjustments too.

(00:25:10):

The app tracking macros would be absolutely essential to make those adjustments, but generally speaking, high-carb diets are perfectly fine if your carb tolerance is good and your glucose is under control. And that includes your mean glucose levels, and that could be an aggregate of glucose measured by hemoglobin A1C. But more importantly, the glucose excursions after a meal would be a more precise and informative variable to measure in response to following a higher carb diet. And the people who thrive and do really well on high-carb diets tend to have a very nice appropriate metabolic response and insulin management to high carb, whereas a large majority of people do not. And some degree of carbohydrate restriction would produce favorable changes in their metabolic health and body composition, but they do not have to be extreme to the point of a ketogenic diet.

(00:26:12):

And I think that’s where people think it’s low-carb or high-carb. There’s a spectrum that we need to appreciate, and I think from just a very simple, just producing carbs from 60% to which is the standard American diet is like 300 grams of carbs or more for someone my size. And I could probably even tolerate that. I may not thrive on that, but if just dialing it back to 150 grams of carbs for someone my size maybe not in the optimal health, can have enormous favorable changes. But then the question is, what do you fill in? How do you fill the gap from the macros that you’re pulling out in the form of carbs? Do you put that back in as fat? Do you put it in as protein? If we eat in the upper range of protein…

PART 1 OF 4 ENDS [00:27:04]

Dom (00:27:03):

… protein. If we eat in the upper range of protein, which is one gram per pound, it’s a good equalizer and it helps to provide improved body composition, we have better satiety with higher protein diets. Including protein in with your meal also attenuates glucose and insulin fluctuations. I think whether you’re in a high-carb camp or the low-carb camp, I think centralizing protein is probably the most important thing to do, and then it really comes down to your diet preference and what you’re used to eating and the foods that you enjoy eating. You have to balance that with the biomarkers that we can talk about and your glucose control, and then find a happy medium there. We do research on ketogenic diets and low-carb diets and they have very specific and important therapeutic applications, but I do not like to proselytize and try to convert everyone on high carb to low carbs. I don’t think that’s helpful or useful. I think it’s much more nuanced, and we need technology like this and biomarker tracking to understand what works best for us.

Josh (00:28:13):

Yeah, absolutely. I think this is a really good intro and I think that summarized point there is that we almost don’t have to use these buckets, these label buckets, and force everybody into a high or a low of really anything. We have the potential now to start to build that nuance in and each individual can converge on the composition that works best for them. I think what’s important and what previously, and I’d love to get into some of the specifics on this, it’s not just the inputs of tracking macros, we also have the potential now to measure the outputs, so how your body then responds to those macros. You can do this almost closed loop of adjusting the inputs, seeing how the outputs shift and then dialing it in. Then eventually, you’re really converging on something that is uniquely ideal for you, the individual, even if it may not work for somebody who thrives on some other compositions.

Dom (00:29:03):

Yeah, very good point.

Josh (00:29:05):

Great. I’d love to, maybe from here, dig into the individual major macronutrients directly. We’ve touched on some of the high-level benefits and use cases for each macronutrient. Why don’t we just continue the thread with protein you had started. I think we’ve touched on why protein is an important macronutrient. It’s really the amino acids that make up proteins are the fundamental building blocks of the tissues and structures in our bodies. Would you add anything else to why protein is an important macronutrient and one that we need to make sure that we are consuming in adequate quantity?

Dom (00:29:43):

I think it’s really important to emphasize that protein should be essential. We should really make sure that we’re getting on a daily basis adequate protein every day, and that will set the stage for good dietary patterns. My belief too, and I think the literature supports this, is that ensuring that you get adequate protein in with each meal probably prevents overeating just because of the satiety factor. Of course, from fitness standpoint, it ensures that we provide the building blocks for skeletal muscle mass, enzymes, antibodies, hair, nails, things like that, things that people feel important. There is a debate whether how many feedings of protein is optimal per day. I think if you refer to some of the experts on this like Stu Phillips and Dr. Donald Layman, I think the general consensus is one meal a day, which is a trend for some people is probably not ideal that you want to separate and spread out your protein feedings.

(00:30:47):

That could be, you could separate and spread them out in even an eight-hour window if you want to do intermittent fasting, but two to four feedings per day is probably optimal. Whereas if we’re eating, and I did this in the past when I was younger, like six to eight times a day, your body actually becomes refractory to the stimulus, the skeletal muscle protein stimulus for example, leucine can stimulate that, almost becomes refractory to it if with frequent feedings every day where you’re not giving your digestive system a break. People in the fitness world are always trying to amp up and maximize skeletal muscle protein synthesis. If we’re eating all the time and we don’t go through a period where I guess you would call it semi-fasting or in an unfed state, there’s literature to support that if you’re constantly feeding smaller meals throughout the day, you do not get the same skeletal muscle protein synthesis response to feeding.

(00:31:44):

If you give your body a break and then circulating levels of amino acids go down, the metabolic machinery that’s associated with stimulating skeletal muscle protein synthesis is re- sensitized to another feeding, a protein feeding, and various amino acids can be the signal, for example, like leucine. A similar phenomenon happens as we age that this protein synthesis machinery is not activated in such a robust way. When we’re younger and we’re growing, especially in the teenage years, we are super sensitive to things like IGF-I and other hormones to stimulate anabolic activity, especially in skeletal muscle and growth. Then those hormones and those factors, hormones, maybe not, they become reduced as we age, but also our sensitivity to them is thought to diminish too, and that there’s a term that people use, it’s called anabolic resistance as we age.

(00:32:46):

I think an important thing to mention is that some people think you should eat less protein as you get older, but you should actually increase and really focus on getting more protein as being a central component of your diet with age. That’s going to preserve and maintain your lean body mass. As our skeletal muscle increases and our strength increases, that correlates very tightly with bone mineral density and the strength of your bones, which could be measured with DEXA over time. Of course, exercise greatly enhances the efficiency of protein utilization. If you ensure that you get enough protein and you do exercise, especially resistance exercise, it’ll make sure that protein is utilized in the best way possible in regards to building and maintaining the skeletal structure and the muscle structure.

Josh (00:33:37):

A ton there, super interesting, especially the point about consuming more protein over time as we age. I think it’s counterintuitive if the body is able to use protein less efficiently over time, it leads to a conclusion potentially that, oh, well, in that case, we shouldn’t overdo it. In fact, we should lower maybe the load of protein that we’re providing, but it’s actually the opposite as you’re saying. What are some other misconceptions that people might have about protein? I’d love to hear for example, whether you would recommend for someone who is trying to lose weight that they reduce all macronutrients, including protein or if someone’s trying to lose weight, is there some benefit to maintaining a higher level of protein relative to the other macros? A recent example of this that I think is really common people are thinking a lot about is GLP-I agonists. A lot of people are taking these pharmaceutical interventions that are causing whole body weight loss and is there some benefit, for example, in that accelerated weight loss to maintaining a protein intake that would be higher than they otherwise would?

Dom (00:34:44):

Yeah, great topic. With protein, I just want to touch on another protein misconception is that it’s toxic. When I was younger, I had excessive protein intake sometimes, and drinking protein shakes between meals and things like that. This could happen as someone just exercising very hard, just smelling like ammonia, especially if you’re taking off your clothes, it almost stings your eyes like you’re smelling like ammonia. One of the most common questions or it’s kind of a myth is that protein can be toxic or excess protein, and that could be the case for someone with impaired kidney function or renal function.

(00:35:22):

You want to track your blood urea nitrogen, track your creatinine, get your glomerular filtration rate or that calculated rate. That’s going to be important if you’re considering a higher protein diet or listening to this and thinking, oh, I got to double my protein intake. Just make sure you get labs that show you don’t have impairment of kidney function. Some people don’t realize they might have polycystic kidney disease or something, they realize it later on in life. Your question was optimizing protein intake and what would be the optimal way to go about that?

Josh (00:36:00):

Well, I think protein is typically considered, I think a lot of people associate it with bodybuilding and people who are trying to gain muscle. I’m curious to hear, is there a misconception there where it’s only for the anabolic mode when you’re trying to gain muscle mass or is there some benefit to maintaining high protein intake even if you’re actually trying to do the opposite and trying to lose body weight?

Dom (00:36:24):

I think the general consensus is that you could probably consume up to two grams of protein per pound. That sounds like a lot, that’d be like me over 400 grams, but that is probably not optimal. I think to get to your question, protein is essential and super important for maintaining skeletal muscle mass, tissues like hair and nails and skin and your immune system and all the enzymes that are part of your metabolism. After you meet the basic requirements, which is probably about 0. 75 grams, or let’s say the upper limit I think is like one gram per kilogram, or one gram per pound, sorry, of ideal body weight. If you’re 220 pounds, 220 grams of protein, it sounds like a lot, but typically, if you’re active and you have more skeletal muscle mass, then you’re going to need more protein.

(00:37:22):

Protein is not a good energetic fuel. You want to make sure that your protein requirements are met but not excessive and you want to then fill in the gap of your macronutrients with good energy sources, and that could be carbohydrates and fat. In some cases, one or the other depending upon, well, even if you’re on a high-carb diet, you want to make sure that you’re getting enough fat to get the essential fatty acids you need. We can talk about the omega-6s and omega-3s, your fats and your carbohydrates are there for energy and fuel. They also help to fuel the rebuilding process and ensure that protein synthesis and protein metabolism is optimal because that’s an energy dependent process and you want to derive the energy from not so much protein in the associated amino acids, but you want to get your energy from fats and carbohydrates. View it from that perspective is that protein is for building and maintaining, but not for energy.

(00:38:28):

A protein sparing modified fast is really like a super calorie restricted higher protein diet. I think you asked the question in the context of a caloric restriction, you actually want to keep protein, you don’t want to decrease protein in the context of a calorie deficit because your body will be more catabolic. You want to decrease fats and carbohydrates, create that energy deficit and then protect your lean body mass with maintaining your protein levels and just reduce calories through reducing fat and carbohydrates. Small adjustments are really nothing extreme. The faster you lose weight, the more likely it will be muscle and the more likely that the calorie deficit will result in a reduced metabolism in the form of reduced T4 to T3 conversion and thyroid and just like your body temperature will go down. Whereas if you do it slow and gradual, you’re more likely to maintain not only your muscle mass, but also your performance, your energy levels and things like that. It’s important to do it gradual but to not drop your protein levels.

Josh (00:39:40):

I think that’s such an important segment right there on the goals that most people have are to be able to adjust body mass without slowing proportionally their metabolic rate and continuing to be able to eat to society and all that without gaining that weight right back. I think that the role of protein in maintaining lean body mass and basal metabolic rate relative to the other macros can’t be overstated there. Let’s maybe talk as a last topic here on protein about some of the maybe markers of protein consumption. You touched on a few of them, but how do we know when we’re consuming too much or too little protein? Specifically, you touched on kidneys, is this something… Basically, can over consumption of protein actually drive issues for someone who doesn’t have pre-existing kidney issues? If so, are they just kidney related? What about gout? Is mTOR IGF-I a concern with over consumption? A lot of folks, especially those who might be eating maybe more of a plant-based diet have read a lot about the potential downsides of protein. I’d love to just address some of those.

Dom (00:40:44):

People are really scared and I get enough emails to make me realize that people are really scared of higher protein as it pertains to maybe reducing longevity, stressing not only your kidneys but your liver too. It’s very clear to me that if I eat a large amount of protein, if I was to double my protein intake today and get blood work in two weeks, my liver enzymes would be elevated from the 20s to the 40s or 50s. I’ve seen this time and time again, I’ve proven it to myself that whether that increase in liver enzyme function is pathological, usually you have to get three or four times elevation of liver enzymes to indicate. I think it’s important to look at do your labs, your liver enzymes, your blood urea nitrogen, your creatinine.

(00:41:36):

Of course, if you smell any kind of smell, ammonia, especially if you’re working out, that is an indicator of higher protein catabolism. That’s seen in people that are in a calorie deficit, maybe people taking lots of stimulants too, and they’re over-exercising, doing cardio, you typically see these things. I think it’s really hard to overdo it on protein, especially as we age. If you’re concerned about it, then it’s really important to just track your biomarkers. Your kidney function and protein will increase insulin too. If you have hyperinsulinemia and you’re eating a very high-protein diet and everything else is kind of dialed in, you might want to reduce your protein a little bit and you’ll get a more favorable reduction in insulin with carbohydrates. You might want to try a diet that’s moderate in protein, higher in fat and low in carbohydrates, but maybe higher in fiber and do that approach too.

(00:42:41):

I can’t really bash protein, there’s not too many things. I think generally speaking, when you talk to people and they think they’re going in the direction of a healthy longevity diet, plant-based diet, and you look at their macronutrient distribution, it’s deficient in protein and I think that, that’s not going to be helpful as we age. I’d also like to just throw in there that exercise, you could follow a relatively low protein diet, but if you’re exercising a lot and you have great metabolic health, then your sensitivity to that protein that you’re eating could be high and that could be enough for you. I’ve seen people on really lower protein diets, but they’re just in really good metabolic shape and they do resistance training and they’re not deficient in muscle size or strength and they’re somehow maintaining it.

(00:43:33):

Of course, genetics play into that too, and what your body composition was in your earlier years. If you’ve built up a lot of surplus in muscle currency, metabolic currency, and you’ve added a lot of muscle when you’re younger, that muscle is far, far easier to maintain than it is building muscle in later age. If we’ve gone through the duration, our lifespan with not a lot of muscle and we want to gain muscle because we’re reaching critically low levels of muscle, it becomes really important to increase your protein. Whereas if you’re into resistance training when you’re younger, it’s going to be much easier to maintain that muscle, maybe even on a lower protein diet.

Josh (00:44:18):

I would love to go deep down that rabbit hole and I’m sure there’s a whole episode available for that one. I think we really covered the spectrum there on protein. There’s maybe one additional biomarker I’d love to hear your input on as it relates to protein, and that’s uric acid. Uric acid is coming up a lot. We certainly get a ton of questions about it, we’ve produced some content on it. How does uric acid play into the protein synthesis and or metabolism feedback loop?

Dom (00:44:44):

Higher protein diets can definitely increase uric acid. My uric acid usually runs about 2.5 or something like that. I was tinkering with it and communicating with Dr. Perlmutter on this and we were sending pictures back and forth. I had a big meal of liver, some red wine and some fruit, and I think an hour, a couple of hours after that, it was up to seven, and I think that was my highest. Foods that are high in purines will increase uric acid. Uric acid will also increase with fructose consumption, especially excess fructose consumption as a driver of high uric acid. Uric acid is a really important metabolic biomarker and correlates with metabolic dysregulation from hyperinsulinemia to inflammation, to gout. Obviously, non-alcoholic fatty liver disease. Uric acid is a really important biomarker to track, and I think more recently people are paying attention to this.

(00:45:48):

Excess protein can contribute to higher uric acid. It’s something that you want to track, although I followed, and other people I know have followed higher protein diets for a long time and their uric acid is perfectly normal. It’s more of a feature of excess consumption, of purine-rich diet in the context of poor metabolic health. Whereas people that have good metabolic health can tolerate high levels of protein and even purine-rich foods like liver and organ meats and maintain relatively low uric acid levels. Alcohol, high fructose consumption, not so much from whole foods, especially from sugar-sweetened beverages, obviously. Also, if you have good metabolic health and uric acid trends on the high side, you might want to just look at the purine content of the protein foods that you’re eating and then reduce that. For example, if you’re eating more red meat and organ meats and things like that and certain shellfish and seafood are higher in purines and you might want to just eat lower purine sources of protein like eggs and things like that.

Josh (00:47:05):

Awesome. Last question on protein is, what are your specific strategies around protein consumption? You mentioned you have a pretty high protein diet. Do you take supplements for protein? You mentioned maybe thinking about purine sources, but how about timing, supplements, overall strategy?

Dom (00:47:22):

Supplements can be really handy, especially if you just don’t have the appetite to get the whole food sources of protein in. I think supplements are essential for someone following a vegan diet, maybe a vegetarian diet if you’re not getting in a lot of eggs. Otherwise, I enjoy eating and I enjoy protein food, the meat and fish and chicken and eggs. Years ago, I did lots of protein supplements and can’t say they hurt me. Nowadays, I really like to just get my protein from whole food sources. I think it’s going to be ideal also from the perspective of the micronutrients and other things that you’ll find in whole food sources, like beef and liver and eggs with the yolk, of course. I think that’s important. However, we do research on different disease processes where it becomes really hard for people, whether it’s age-related dementia or cancer or cancer cachexia where people just don’t have the appetite to eat.

(00:48:27):

I think in that context, protein supplements are super important and potentially even life-saving because reduction in skeletal muscle mass correlates with function, and that’s a big driver for mortality in many of the disease processes that we study. I think it depends on your ability to get the protein that you need in whole food sources. If you can’t, there are many. With protein, whey is ideal if you can tolerate dairy-based protein. Mark Bell has the steak shake, which is a beef-based protein supplement. There’s an egg-based protein supplement, and now there’s fairly good, although they wouldn’t be my go-to plant-based protein supplements are out there too. If you’re following a vegan diet, would be important that you really want to pay attention in those cases to the essential amino acid profile. There’s nine essential amino acids and make sure that there’s sufficient amounts of lysine and methionine in those plant sources of protein.

Josh (00:49:37):

Super deep dive on protein so far, tons to extract from that conversation. Let’s move into carbs. Carbohydrates, one of the big three we could call them macronutrients. Just if you could tee off with why are carbs an important macronutrient and maybe some initial role that carbohydrates play in the body.

Dom (00:50:00):

Carbohydrates are not essential, but I think they’re optimal in the human diet to include, especially from the context of the fiber and all the various phytonutrients that you get from eating vegetables and fruits for example, and the energy that they supply in the form of sugar, which is not all bad. We have to view these things from the context of excess carbohydrates are bad and can quickly become bad to metabolic health. We have carbohydrates in the form of sugars, as mentioned, monosaccharides, disaccharides, even glycogen from some sources like liver, starch. Then we have fiber, soluble and insoluble. Then we have resistant starch, which is becoming a popular supplement now. Different people are, for example, doing potatoes and showing the difference between resistant starch after it sits in the refrigerator. That’s an interesting area because you could alter starch in a way to make it much more satiating in reducing the glycemic response. That’s becoming a trend recently.

(00:51:13):

Macronutrient tracking is probably most important from the context of tracking carbohydrates to understand our carbohydrate tolerance. This is super important in various coaches and trainers that I know that dial in the carbohydrates, they’re using CGM. Many of them are using levels to really dial in the carbohydrates to figure out the optimal level of carbohydrates for performance and body composition, but also not to spill over, is a term that they use where they’re dumping insulin. Also, excess carbohydrates will make you hold water, and that’s not favorable for body composition or performance. In excess carbohydrates I think is the problem that many people talk about. Sugar sweetened beverages, processed foods obviously will impact your amine glucose levels, most visible on CGM, but also hemoglobin A1C. Probably the most important biomarker, cardio metabolic biomarker is triglycerides.

(00:52:16):

I was a pretty healthy person eating a high carb diet and my triglycerides were not optimal, somewhere around approaching like 80 to 100. I was good body composition, great overall health, good biomarkers. Then years ago, when I switched to low-carb keto, it went down into the 40s, my triglycerides. Insulin, hyperinsulinemia is most quickly reversed with reducing with carbohydrate restriction, some degree of it, doesn’t have to be zero carbs. An experiment that I did about a year ago now was a transition to eating low-carb, like 50 grams to 200 grams a day, maybe 250 for two weeks. Then I did a full blood panel again, and my insulin level did not change. My hemoglobin A1C, maybe trended up a little bit.

(00:53:05):

What changed, what was a real change that I observed was an increase in high sensitivity C-reactive protein. It went from 0.1 to 1.2, which is still kind of low, but I track that biomarker so many times, dozens, if not hundreds of times with over the last two decades. There was no reason for that to go up other than just increasing my carbohydrates. I clamped everything that I didn’t have any increase or decrease in body weight. If anything, I lost a pound or two. I was in a calorie deficit. This correlates to a past history where a higher-carb diet was triggering things like eczema in me and maybe triggering a mild autoimmune. That could’ve been to the type of carbohydrates, probably was, but not carbohydrates in general. I’ll say with my carb experiment, I was eating sweet potatoes, I was eating very healthy.

PART 2 OF 4 ENDS [00:54:04]

Dom (00:54:03):

… and I was eating sweet potatoes, I was eating very healthy forms of carbohydrates, but I did see that trend up, so that was just two weeks. I don’t know what would happen if I would extend that to a longer period of time.

Josh (00:54:14):

Yeah, it’s fascinating. I’ve had a somewhat similar experience myself, and I think what a lot of the conversation around protein converged is, is that protein, it’s fundamentally essential, it’s part of building blocks of everyone’s body and the important tissues in it. It’s not so for carbs, as you said, not essential though, likely ideal to have some form of carbohydrates involved in the diet. For people who are experiencing some sort of consequence of over or under consumption of carbohydrates, they might see things, as you mentioned, like insulin changing, might see inflammation going up as evidenced by a CRP measurement. Maybe I’ll hand it back over to you, but those are some of the biomarker indications.

(00:55:05):

What would some of the qualitative indications be? In your case, you said eczema or some other inflammatory condition. Yeah, what would most people want to be looking for to understand maybe that this could be what they’re experiencing is potentially carbohydrate related?

Dom (00:55:19):

Yeah, fluctuations in energy level is probably the biggest thing that I notice when switching to a low-carb diet. I would rephrase it to glucose homeostasis management and insulin management. So, essentially what that allowed me to do is, to keep very steady and consistent energy level throughout the day. And for my occupation, that was really important, because I’d have long work hours in the lab, or writing papers, or teaching, or whatever, that that actually became a really a big advantage, switching over. And prior to that, I was eating good. I would have a can of tuna fish and rice, or a potato and chicken or something like that. But I do remember, if I wore CGM back then it would’ve been like night and day. And if you’re eating even a healthy mixed meal with carbohydrates, you have the characteristic rise in glucose and that could be 30, 40, 60 milligrams per deciliter.

(00:56:23):

And then, what often happens in people is that, you have the postprandial dip that could occur 1, 2, 3 hours after, where you’re not clinically hypoglycemic, but mildly hypoglycemic to the point where you just want to sleep or you just don’t feel as energetic. Whereas if you promote metabolic flexibility, which is best achieved through carbohydrate restriction, it gets your body used to burning fat for energy, your glycemia and your insulin levels are more stabilized. Also, if your carbohydrates are restricted to a significant degree, you start producing ketones, and then those ketones can fill the gap in brain energy. So, if your glucose does become low, the ketones are essentially a safety net.

(00:57:15):

So, you’re essentially asymptomatic for hypoglycemia if you’re on a ketogenic diet or even doing things like intermittent fasting. And that metabolic flexibility can have really tangible, subjective effects that are really important in a lot of people. That’s why people will gravitate, even if they’re not metabolically managing a disorder that can be helpful for a ketogenic diet, they do it as a lifestyle being in a mild state of ketosis just for the energy flow.

Josh (00:57:51):

Yeah, that’s a great one, the qualitative experience there. And then the relationship between that energetic flow. For me, the highs and lows, the major indicator for me that something was off in my diet was exactly this. It was energy crashes. And what’s interesting is that correlation between glucose elevations, insulin release to pull that glucose out of the bloodstream, the energy crashes, but for other people that can also manifest through the continued insulin elevations in weight gain as well. That could be another indication that maybe somebody is driving the glucose… Maybe it’s spilling over, is I think the phrase you had used. So, what’s the relationship maybe between over consumption of carbohydrates and weight?

Dom (00:58:39):

Of all the macronutrients, I do think carbohydrates are the easiest to over consume. People will debate whether carbohydrates or sugars are addicting or not, and I think there’s good evidence to support their effects on dopaminergic reward pathways that are analogous to dopamine inducing recreational drugs, like cocaine and methamphetamine. So, actually, I teach in part of this and just show people who have obesity for example, just have lower dopamine levels and they’re kind of self-medicating for that. And this is accepted, at least in the context of obesity, but I don’t think the general consensus, at least in the nutrition field where I come from, the conventional view is that sugar is not addictive, although I think the research is going in that direction. With obesity, especially in the younger population where they have access to sugar sweetened beverages and processed food, and they’re creating really unfavorable dietary patterns at such a young age, then those patterns are going to be super hard to break over time, unless they just go down the rabbit hole of embracing their own metabolic health, which most people don’t. Listen, I grew up on box cereal and pop tarts and things like that, and probably because I gravitated more towards fitness and stuff in high school, did I steer away from that, but the large majority of people don’t. And I think that carbohydrates are the macronutrient that we have to pay most attention to, because they’re the easiest to over consume. And I think they can be addicting, definitely, for some people.

(01:00:19):

And I think that carb management through macronutrient tracking is probably the most important thing. And carbohydrates mixed with fat and salt and things, create hyper palatability where… So, I don’t want to demonize carbohydrates completely because fat, especially the fat that’s in processed food, which tends to be omega-6 seed oil type fats, and not so much fats from whole food sources like steak and eggs, but fat that’s found with carbohydrates in processed food and amped up in palatability with salt and other things can be problematic too.

Josh (01:01:04):

Well, the interesting thing about carbohydrates, given it’s, as you said, likely the most important to pay close attention to, is that we have a real-time indicator in the CGM that allows us to be able to see. We can’t see all of the monosaccharides, we can’t, for example, track fructose directly, but we can see glucose excursions and typically the sources that we’re getting include at least sucrose or some glucose in them, so we’re able to see an indication of how much carbohydrate load we’re taking on in a single meal, which is a really powerful tool. And then coupled with that macronutrient tracking, we start to see the input, the macro we consumed, and then the output, how our bodies were able to respond to it, which is for me, Ben, an entirely new paradigm for how I’ve approached my diet composition. I’m curious about your strategies around carb consumption. So, I would love to just hear how you approach it, what your sources are? Do you supplement anything related to carb consumption, resistant starch or anything like that? Probiotics? And then, just timing of your carbs if you are consuming them?

Dom (01:02:08):

Yeah, the last decade or more, I feel best really on… I’ve had almost no carbohydrates all day. And I tend to then do, I guess if you want to call it back feed carbohydrates in later in the day, which also correlates with my activity level. During the day, I’m just not active, for one thing, that’s why I don’t consume them. When I wake up, sometimes I do cut the very tips of the broccoli floret off in my omelet and I give the stalk or whatever to my dogs, they just love that and they seem to benefit from the fiber. And sometimes I will cut up an onion if I put in some cheese in my omelet or something like that. But otherwise, almost zero carbohydrates throughout the morning and throughout the afternoon. And then in the evening, we typically have some kind of vegetable, a salad, chicken, beef, fish, liver, something like that, and protein will be the central component.

(01:03:11):

And then typically, if I’m going to work out, I’ll do it before dinner and then have an amount of carbohydrates that’s maybe about 30 grams of carbs. But my rule is, in the carbohydrates that I pick, at least one quarter to a third of that carbohydrate content is fiber. So, that seems to really cause no glucose response on my CGM at all, especially when you eat it with a mixed meal. And then, after dinner, we always do, 99% of the time, unless the weather’s really bad, a fairly lengthy walk, like an hour more, then I do activity outside, catch up on things just outside. And that’s when I always get my lowest glucose levels. So, after my carbohydrate feeding, I work out, and then dinner, which is probably the biggest meal of the day, typically always over 1,000 calories.

(01:04:06):

And then, in the evening, I do have the munchies at night. I tend to eat probably more than most people would recommend in the evening, but I have some kind of chocolate keto mousse thing, chocolate ice cream. Sometimes I’ll do the Rebel ice cream here and there, but I also have fruit. So, wild blueberries every night, maybe an apple and some pistachios is typical. And my total carbohydrate consumption is usually anywhere from 30, on higher weekends maybe up to 100. But like I said, I tend to pick carbohydrates that are about 25 to 30% fiber.

(01:04:50):

However, sometimes I’ll eat watermelon and sometimes, we have mango trees and I’ll eat a mango. Yeah, if I eat a mango on an empty stomach, man, that shoots it up more than a candy bar. But when you combine carbohydrates… Well, if the carbohydrates have fiber, then that’s a huge equalizing effect there, but consuming that in the presence of protein or source of fat really creates almost a non-significant increase in CGM if the carbohydrates are a moderate amount. 200 grams of carbs are going to shoot you up, obviously, but 20, 30 grams of carbs are not even going to put a dent in the CGM often.

Josh (01:05:29):

So, portion control, a lot of timing decisions there, especially around exercise and incorporating a complete macronutrient complete meal, that really meshes well with what I have started to converge on. I do consume more carbs than you. Are you in a continual ketogenic protocol? Is that your approach still?

Dom (01:05:51):

Yeah, I’m borderline, threshold ketogenesis, I keep my body hungry for carbohydrates, but I don’t starve it. And I think that, in my case, if I dialed carbohydrates back to like 20 grams a day, I think I do produce some level of insulin resistance, where my insulin actually starts to creep up a little bit, but adding 60 to 70 grams of carbs a day with one third of that being fiber, keeps my insulin sensitivity high. So, if I do eat carbohydrates, occasionally I’ll have popcorn or I’ll get a watermelon or something like that, then I have really good glycemic control. And interestingly, during my two-week carb experiment with 200, 250 grams of carbs, my insulin level pretty much stayed the same. It might’ve creeped up a tiny bit, but my hemoglobin A1C, it all stayed the same pretty much. I didn’t go from a super strict ketogenic diet to that, I went from just a low-carb but not ketogenic.

(01:06:50):

Whereas, when I do follow a very strict ketogenic diet and I introduce carbs back in, I do notice, for sure, a bigger postprandial rise in glucose. And not that that was a warning sign for me, but at the same time I like eating certain vegetables and fruits and things like that, so over time I added them back in and I found out I could essentially keep the same CGM profile and same biomarkers, and some of them actually improved. So, more recently, I’ve been really doing experiments on LDL and APO-B, and I think excess fat consumption, especially saturated fat, can… And this is debatable, excess fat, saturated fat may inhibit the LDL receptor and may increase APO-B production. So, there’s still some debate about that, and it’s an area that I’m super interested in. But what I noticed is that, when I increased my carbohydrates from 25 grams a day to 60 or 70 per day, my LDL and APO-B went down. And more recently, I did some genetic testing and I have a mutation in the NPC1L1 transporter that transports cholesterol in the gut. And I had a hyper-response to a drug called Ezetimibe, which inhibits that. So, when I took a low dose of Ezetimibe, it essentially cut my LDL and APO-B in half. And this is not something I expected, so I went down the rabbit hole and just trying to find out why this happened. I did not want to take a statin or something, but I was just curious as to why it was elevated. So, as of now, I’m doing an experiment on almost micro dosing Ezetimibe, which is also sold under Zetia, to mildly reduce the hyper-absorption of cholesterol, because I also looked into how much fat and cholesterol did our early ancestors eat. And I eat about five to 10 times the amount. I’m literally getting five to 10 grams of cholesterol a day.

(01:09:04):

And some, depending on who you ask or what reference you look at, but the most cited references are saying, early man only ate 500 milligrams to a 1,000 grams of cholesterol a day at the height, and I calculated my cholesterol. And I’m, in order of magnitude above that, several times more. So, maybe my diet’s kind of un-physiological in that way, but I prefer this and I seem to thrive on it, except for the elevated APO-B, which is part of the biomarker tracking that level. So, yeah, I’m doing an experiment now, but also titrating carbohydrates back in, and fiber is another non-pharmacological way to lower LDL and APO-B.

Josh (01:09:50):

Fascinating. So, that correlation there is one that I wanted to touch on in the next segment. So, we’ve connected the dots between carbohydrate intake, how it plays a role in the body, especially energy levels, weight, some of the biomarkers, insulin, A1C, CGM, that you can track, triglycerides, which you had seen as a case study in yourself, changing dramatically from a change in just carbohydrate consumption. So, there’s a lot of feedback we can get from carbohydrates. Leading into what I think we will take as our last macro, which is fat, I’d love to bridge that with fiber. So, fiber, technically a carbohydrate, or a form of carbohydrates, is it a macronutrient? And let’s just maybe dive into the sources of fiber and how you, for example, use fiber in your diet today?

Dom (01:10:40):

Well, people will debate this, and I think it is true that fiber is not essential. Some references will actually say, and some websites will say that it is essential, but I think it’s highly beneficial for the composition and, to some extent, the diversity of our microbiome, which can help build a number of bacterial species, including Akkermansia, for example, that creates the mucous lining, the mucous barrier on the brush border membrane. And so, that could be sort of important. So, the fiber can be soluble and you have inulin, would be an example, and insoluble would be cellulose, and there’s many examples of both.

(01:11:28):

And I’ve done a deep dive and talked about fiber with a number of different people. And although I say fiber is non-essential, I think getting a minimum of 20 to 30 grams a day can be highly beneficial. And this is based on a mountain of epidemiological data, which is not perfect, but I think very informative and insightful in showing the benefits of fiber. There’s also potential, and I have this too, problems with excess fiber, can cause perhaps even small intestinal bacterial overgrowth, can cause irritation, can cause flatulence, can just be… Some people do not tolerate it, almost have an allergic reaction to certain carbohydrates or high fiber carbohydrates, or even just some forms of supplemental fiber.

(01:12:20):

I’m of the opinion that we should try to get fiber as much as possible from whole food sources, although maybe people that are on a purely meat-based diet, if they want to experiment with fiber, things like psyllium husk or there’s a couple of different flax seed, like ground flax seed could be beneficial. They might want to experiment if they’re having some gut issues with that. Whether it’s a fourth macronutrient, I guess, could be debated, but fiber passes relatively undigested through small intestine and enters the colon where it’s fermented to short-chain fatty acids, like butyrate, and then butyrate becomes the preferred fuel for the colonocyte.

(01:13:08):

So, it not only nourishes and provides fuel for expanding favorable gut microbiota, in most cases, but the short-chain fatty acids are the best fuel for the colonocytes. And if they’re deprived of that fuel, that could decrease the health of the gut, perhaps increase intestinal permeability, and make us susceptible to different diseases. I think it does not have to be a lot of fiber. I guess there’s some evidence too, some of the earliest nutrition books that I studied in college when I studied nutrition, was basically saying that early man ate sometimes 100 to 200 grams of fiber a day, depending upon the geographical location.

(01:14:02):

So, I was under the impression that fiber was essential and absolutely important. So, that was my educational backgrounds, but when I gravitated more towards low-carb diets and seeing people thrive off diets that were completely devoid of fiber, like carnivore diets, that I questioned that. But I still think it’s difficult to question the massive amount of epidemiological data we have on the benefits of fiber.

Josh (01:14:28):

It’s super interesting to me, in particular, because I also gravitated, in the past few years, towards what I currently eat as likely a high-protein, moderate-fat, low-carb diet. And that’s where I’m starting to feel the most sustainability. And the one element that I had really cut back on was fiber, and it did have some consequences for me in digestive health. I was just not feeling great every day with the super high protein without the fiber. And so, recently as an experiment, I’ve started eating whole psyllium husk a lot, like 15 grams in the morning. It’s not the powdered, like Metamucil, this is large almost bran flakes. And I mix that into a yogurt bowl in the morning with actually some protein in there, so it’s a huge protein bowl, it’s also a large amount of fiber. At least a lot of folks would not be eating that much in a single sitting. And then I also add a few chia seeds in there and some blueberries.

(01:15:26):

And so, the overall fiber content is really high. And so, first of all, delicious, super satiating, and I tolerate it really, really well. The fascinating thing is that after making that change, which I did to try to see if I would feel more satiated and improve digestion, I saw a 24% reduction in APO-B in my next blood panel checkup with the Levels lab. And that was super surprising to me, I did some searching around and I found several references to this, specifically psyllium husk as a supplement for cholesterol lowering, but in combination therapies, for example, with statins, where people were showing 15% benefit over just a statin monotherapy if they add psyllium husk. And then, just as a standalone, this is actually an effect that seems to be somewhat consistent.

(01:16:16):

So, you had mentioned this before we started talking about fiber as the correlation with lipids is really interesting to me, and I’d love to hear, as we’re ending this one, do you have a fiber related strategy in your diet that is related to lipids specifically? Or is it generally digestive? Or how are you treating fibers in your diet?

Dom (01:16:38):

Well, I am of the opinion, because I think you’re the fourth person that told me verbally, and then I have a lot of emails too from people who have introduced psyllium husk and showed me before and after LDL. Two people showed me APO-B, which went down anywhere from, one person, 50%, which was almost hard to believe, but usually 20%, 25% reduction by adding psyllium husk. Actually, Dr. Mary Newport, we just interviewed her for the Metabolic Link Podcast, and she maybe saw our keto nutrition newsletter on LDL and then followed up with an email that there’s a particular supplement that I looked into, Garden of Life fiber supplement or whatever. But I think you can get it on Amazon and then it has psyllium as the main ingredient, maybe four or five other. And then that significantly cut her LDL and APO-B.

(01:17:35):

So, I don’t want to introduce large amounts of fiber now, because I’m doing this Ezetimibe experiment, but my off-ramp, I guess if you will, to… I do not want to use pharmacotherapy to manage my lipids, I’d rather not. That’s why I’m kind of micro dosing it now. But what I’m going to do is get off a bit and see what happens, and then reintroduce fiber, probably be psyllium husk and maybe two or three other sources of fiber, and probably do that maybe with meals, especially meals that maybe have contain, since I know I’m a hyper absorber, higher amounts of cholesterol, and transition to that over time.

(01:18:15):

And I think that’s an important message for people who maybe have elevated LDL and APO-B and want to do something about it without necessarily having to resort to Ezetimibe or statin, which most doctors I know, even my primary care doctor was very adamant that I needed to get on something. So, I was very resistant to that, and I was like, “Well, I want to try Ezetimibe as a standalone therapy, as a monotherapy. It’s usually combined with a statin, and that had a tremendous decrease in knocking my APO-B. But I think people could take, which is a more feasible dietary approach, this fiber approach would be a great way to experiment and try to keep all other variables consistent and do that and would love to… Could be a little mini experiment with the levels group.

Josh (01:19:05):

Yeah, I’m certainly excited. I’ve been tracking macros prior to making that fiber change. And so, really excited to follow the trend over time in APO-B specifically, triglycerides, other sort of lipid carb, fiber oriented biomarkers over time, and just seeing how that ratio change lasts and whether this is something sustainable or if that was just a temporary acute response of some kind. So yeah, super interesting to see, tangibly, in that blood work for me, the impact of really changing one major element, adding in fiber, which I certainly don’t rely on as an energetic component, and otherwise wouldn’t have done if not for just this experiment with digestion. So, with that, why don’t we move into a really interesting and, I think, wide-ranging topic, which is fat as a macronutrient. And I’d love to hear your intro on, is fat an essential macronutrient? What makes it such an important component of our diet?

Dom (01:20:08):

Fat is absolutely essential, and we should not try to go on a zero fat diet, as I think people maybe in the ’80s did or ’90s or whatever. When I was in school, there was a lot of talk about super low fat. It’s probably a good idea to reduce omega-six fats, but I think it’s absolutely okay. There’s a lot of discussion about seed oils and omega-6, and I think it’s absolutely okay to get your omega-6 from whole food sources and to try to get ample amounts of omega-3 fats. Not everybody likes fish, but I think if you are not eating fish, you might want to think about supplementing docosahexaenoic acid, a DHA or EPA, and get a good source for that. Nordic Naturals is a good one I’ve used in the past, but I may recommend it to my wife, because she doesn’t eat as much fish. But because I eat so much fish, I’ve taken a number of different tests. Lipidomics-

PART 3 OF 4 ENDS [01:21:04]

Dom (01:21:03):

… eat so much fish. I’ve taken a number of different tests, lipidomics tests, OmegaQuant tests and things Rhonda Patrick had recommended and I followed up with. And I eat so many sardines and mackerel and stuff. So there’s no need to supplement I think fats, if you are eating fish. The fat with protein and carbs will reduce your insulin and glucose spikes. And also omega-3s can lower your triglycerides, omega-3 fats can improve your HDL, maybe lower your LDL, there’s a little bit debate about that. You know you’re eating too much fat, especially on a low-carb diet if your triglycerides start to become elevated. And I’ve seen this before and encourage people to get a genetic test, and sometimes people have snips for fatty acid oxidation disorders or certain fatty acid oxidation enzymes. So this is an area that I’ve become kind of interested in.

(01:22:02):

Just people that are intolerant to these high-fat diets for one reason or another. They don’t have that metabolic flexibility, which sometimes you do see. But generally speaking, you have saturated fat, which as mentioned in really high amounts, and many people will probably debate this, could decrease the sensitivity of the LDL receptor and that could cause LDL to go up. It can also… There’s some evidence that it could increase the production of apoB. So you have saturated fats that you probably want to make, like 20% or less of the total fat consumption. Your biggest contributor to your fat should probably be monounsaturated fats or MUFAs. So oleic acid, I think is the main component in like an egg yolk. And then you have monounsaturated fats or PUFAs, and then you have trans fats, which are most widely seen in processed foods, although companies are phasing them out.

(01:23:03):

Not all of them though, you have the spectrum of fat there. But I think it’s important to have at least probably 20% of our macronutrient profile as fat. Just because of the satiating effects it has, the glucose moderating effects, and also to ensure that you’re getting the essential fatty acids you need. And that could be with omega-6, that’s linoleic… Omega-6 would be linoleic and omega-3 would be alpha-linoleic acid. But you want to get them… The omega-3 is ideally cut from animal sources. So fish would be… Although you could get the alpha-linoleic from plant-based sources if you are a vegetarian. Like algae and spirulina I think have some and you just need the enzyme to convert it over.

Josh (01:23:57):

So all these sub sources of fats, do you consider those individual macronutrients or are those micronutrients or how do you characterize or categorize the different sources of fat within the overall category of fat as a macro?

Dom (01:24:12):

Yeah, that’s a good topic because people in the world of ketogenic diets really paid no attention to the fatty acid composition of the fat content in the meal. So there was a lot of dairy-based, just drink heavy cream and kind of fill the gap. But generally speaking, if you’re getting some animal protein, you’re getting a lot of the essential fats that you need. Omega-3 fats are probably the most researched. There’s an enormous amount of literature on DHA and EPA on PubMed. And large randomized controlled trials, systematic reviews, meta-analysis showing the benefits of omega-3s. Many of the bigger studies basically did research on omega-3s from food sources. But in the last 10 years or so, there’s been evidence that supplemental omega-3s can be… But I’m of the opinion to get it from whole food sources whenever possible. Omega-3s have drug-like properties on decreasing inflammatory pathways, brain injury repair, brain function.

(01:25:27):

I chaired the American Epilepsy Society on the special interest group that’s called the SIG, Special Interest Group in dietary therapies in Washington DC one year. And we had a speaker just talk about Omega-3s on epilepsy and simply doing nothing but increasing Omega-3 content can have an anti-seizure effect, a neuroprotective effect. So there are people that are looking at these fatty acids because they have drug-like properties on many signaling pathways, inflammatory pathways, changing the neuropharmacology of the brain even in ways. And we know that the ketogenic diet too can change neurotransmitter systems. Then you have an interesting class of fats that I’ve always been interested in, it’s medium-chain triglycerides. So these are primarily the 8 and 10 carbon, and when you consume those, they go directly to the liver via hepatic portal circulation, and they’re not packaged in the chylomicrons like the long-chain fats and delivered to adipose.

(01:26:33):

So they go directly to the liver via hepatic portal circulation, and they stimulate beta-oxidation of fatty acids. They stimulate fat oxidation in the liver and generate an ample amount of acetyl-CoA, and that condenses to acetoacetate and to beta-hydroxybutyrate. So medium-chain triglycerides can be consumed and they can stimulate ketogenesis independent of carbohydrate restriction. Some studies showing about 20% of the MCT that you consume get converted to ketone bodies, which then spill into circulation and then can provide energy to the brain. There is a drug, years ago called AC-1202, and that drug was essentially caprylic triglyceride, which is an eight carbon fatty acid. And Dave Asprey has it as brain octane, and then you can get it cheaper at the store as a mix of C8, C10. So what’s interesting about fatty acids or medium chain fats is that they can also cross the blood brain barrier. So long chain fats can’t, they need to be converted to ketones to provide energy to the brain, but these medium chain fatty acids can cross into the blood brain barrier and actually be used by neurons as a source of energy.

Josh (01:27:53):

An example of an MCT would be like coconut oil.

Dom (01:27:56):

Coconut oil has maybe 10 or 20% of the composition. A big part of coconut oil is the 14 carbon lauric acid. But if you buy MCT oil off the shelf, I mean you can get it in Walmart, CVS, you can get it on Amazon. Purified MCT oil is about 60% C8 and about 40% C10. So that would be caprylic triglyceride, also known as octanoic acid. And then capric triglyceride, yeah, capric would be decanoic, can break down to decanoic triglyceride. So these are very unique fats in that they’re digested completely different. And like I said, they can enter circulation as MCTs, medium chain fatty acids, and then they can convert to the ketone bodies and then they can also cross the blood brain barrier. So they’re very different than long chain fats, and they become an intense area of investigation by people who study Alzheimer’s disease. But also there’s the MCT ketogenic diet where you could use a more liberal form of a low-carb diet, a ketogenic diet, and then make it ketogenic by formulating the fat composition of the diet with more MCTs.

Josh (01:29:18):

Amazing because there’s so much depth, again inside just this one category we call fats. And I think that goes to this point of, by starting to pay attention to macronutrients, we are also able to pay attention, even just using regular nutrition labeling, we’re able to see some of the categorization of the fat profile in a food. So I’m curious to hear, although the nutrition labeling today doesn’t necessarily go into the medium or long chain triglycerides that are present in the dietary source. You’ve laid out here some of the reasons someone would go and seek out whole food sources of these differing fats. Tons of really fascinating elements here. Low inflammation, super energy dense. So fat has nine calories per gram where the other two primary macros have four, so more than twice as energy dense per unit mass, which is really interesting. And our bodies preferentially store energy as fat as opposed to as glycogen likely for this reason.

(01:30:25):

Despite all of these upsides, all these benefits, what are some of the potential downsides of over consumption and/or potentially specific consumption of the various fats? So for example, I think one of the major topics is what’s the correlation between fat consumption and heart disease? Do some fats straight up just contribute only to atherosclerosis? Are there some fats that do not at all contribute to atherosclerosis? Curious there.

Dom (01:30:50):

Yeah. Well, I mean at the high level, excess fat consumption in the form of MCTs or even omega-3s will have a laxative effect and you have a limited capacity to absorb them at the level of the gut. So they can cause a lot of gut issues and even irritation with MCT. So they need to be added. You can build the tolerance over time to consume and absorb more of these. I think the monounsaturated fats have been given the green light as something that we should consume more of, and a higher percentage of our fat composition should be monounsaturated fats versus saturated fats. Although the saturated fat consumption has been called into question by people like Nina Teicholz. And there’s a whole number of legitimate people, not just scientific investigative journalists, a number of people who study lipidomics and dietary fat that kind of feel that saturated fat definitely got demonized. There is some evidence to demonstrate that in the context of excess saturated fat as mentioned, that was the driver for LDL. But there’s equally convincing evidence to show that it’s just kind of like total fat really could be the driver for LDL. I’m of the opinion that… I think it’s very context dependent. I do think that some people… And this is why you need to measure biomarkers, some people are susceptible to saturated fat induced elevations of LDL and apoB, and the only way to determine that is to actually do the measurements. And then you have people like Nick Norwitz that… I mean his LDL, and he’s not ashamed to admit it, is like four or five hundred or something like that. And apoB, I think in the two hundreds, and he went on a diet that was completely devoid of saturated fat, just monounsaturated and PUFAs, and could dramatically increase his LDL independent of with a little or no saturated fat or very low consumption.

(01:33:08):

But he fits in a unique category called the lean mass hyper responder, where his triglycerides are very low like in the forties. HDL is double his triglycerides and his LDL is astronomically high. And we have not seen this. It’s not even in the literature until the last five years or so. So this is an area of intense investigation, but in that context, saturated fat does not seem to be the driver for LDL. It just seems to be if you are adapted to a high fat diet, then there’s evidence supporting the lipid energy model that the lipoproteins are trafficking the fat and cholesterol more or less for peripheral tissues to traffic energy. So that’s an area of ongoing and intense investigation. So more to be discovered there. But I do think for the large majority of people that saturated fat could be a contributor to elevated apoB and LDL, and then that’s a lever that you can pull and adjusting the ratios of your fat intake to improve your lipid profile.

Josh (01:34:16):

Excellent. Yeah. So we talked about… One of the major biomarkers would be triglycerides and other apolipoprotein B which is not a very common at… Triglycerides show up on almost every blood panel you’ll get, apoB not so much. Do you prefer to monitor apoB or total cholesterol over LDL specifically when you’re adjusting your fat intake?

Dom (01:34:36):

They correlate pretty tightly with me for the most part. If LDL goes up, apoB tends to follow it. So I think it’s important to track both to have a firm understanding of how your dietary pattern and your macronutrient composition is influencing it, because I do believe in some people that are susceptible that could be problematic. So I think it’s important to track macros just for the understanding of really how do we decrease our atherogenic risk? And an astronomically high apoB, LDL, if you jump on a low-carb diet, may not be problematic in the short term, but what happens if you have that profile for decades? My belief is that if you have really good metabolic health in general, it may be negligible, which a lot of cardiologists would vitriolically attack me if I’ve put that out there. So I don’t put that out there, but I kind of think that there’s been an over fascination with LDL and apoB because we have drugs that can lower, it’s amenable to a lot of pharmacological manipulation, so it tends to get a lot of attention.

(01:35:57):

But I do think that if all other biomarkers are in great shape, I think that it’s far, far less of a concern. However, if you’re the average person just wanting to improve metabolic health and a large majority of your biomarkers are not like your triglycerides, your HDL is low, your insulin might be elevated. And those biomarkers that are not optimal, especially in the context of elevated LDL is problematic. And I think only under unique scenarios would an elevated LDL and apoB… Only in unique scenarios, would it be less of a concern or perhaps even not a concern at all if you kind of believe some of the recent data that’s coming out on lean mass hyper responders showing… Comparing that data… Dave Feldman and Nick Norwitz and the Citizen Science Foundation is actually spearheading work comparing this to the Miami Heart Study data, cohort of data. And it’s very interesting, and I could let Dave and Nick kind of talk about that.

(01:37:06):

So that’s probably, of all the things most hotly debated and even from a research perspective, one of the most intense areas of debate and investigation with low-carb diets and ketogenic diets, is the atherogenic risk that the elevation of LDL and apoB present. And there’s the large majority of people think it’s something that is of concern that needs to be addressed pharmacologically. But as you observe in that we discussed, I think simply adding fiber, I mean, there’s a lot of self experimentation that people can do with different source of fiber and then adjusting carbohydrate consumption to optimize that.

Josh (01:37:50):

What I would want to double click on there for everyone listening is just that despite the evidence or correlations between lipid intake and atherogenic outcomes or atherosclerosis and heart disease… So there’s likely a link there, the epidemiology shows that, but there are also very strong relationships between just general metabolic health and those same outcomes independent of lipid profile. So it is… apoB, for example, oftentimes described as necessary but insufficient to cause a heart attack, for example. There are other reasons that we could be and really in an exposed condition, and it’s important for us to pay attention to general metabolic health and be considering all the big picture together. And macronutrient tracking is a really powerful way to get a head start on that. To be able to take our existing profile, any biomarkers that are sitting way outside of range, and then compare that against the macronutrient intake, the real macronutrient intake that we’re providing to our bodies to try to discern what is driving this.

(01:38:55):

So let’s dive into maybe, as a wrap up here, some of the ways that macronutrient tracking tools can really make this realistic for everyday people. Do you track your macros every day today?

Dom (01:39:11):

I don’t track every day because my diet is so routine and boring. I eat essentially the same meals. Sometimes I’m trying to lose weight or gain weight, and the way I do that is decrease or increase the number of eggs in the morning. So I do know exactly what the macronutrient composition is because I track and then I know the composition of all the different meals that I eat, which in the Levels app, you just pop them in there and you can just pull them up on the day. So I would have six meals in there, but I do think it’s absolutely essential for people just starting out. So I do it from time to time too as I adjust my diet, but it’s not something that I do all the time.

Josh (01:39:53):

When you’re going to be making a change, experimenting with a new protocol of some kind, you’ll track again to enter that data and see what the outcomes look like.

Dom (01:40:01):

Absolutely. Yeah. And then I’ll track it and then event mark that, and then I’ll have my blood work and biomarkers that I can refer to timestamp that and to see how that caused a favorable or unfavorable change in the biomarkers.

Josh (01:40:18):

Aspirationally would love to be at that level of lifestyle, dial in. I eat a few meals very consistently, like that breakfast bowl I have every single day, like clockwork, but things tend to get… They vary day to day in terms of lunch, snacks and dinner. So it’s been really powerful for me to have… I think for two reasons, firstly, I’ve become really interested in through experiments like the psyllium husk one, just the power that individual macronutrients have over very significant biomarkers like my apoB, which I am trying to modulate. So the connection for me has been an accountability mechanism actually, more than anything else is that I’m really enjoying through this new feature set that we have the easy macro entry. So we have artificial intelligence, we can sort of dictate… I basically just dictate, verbatim, a sentence. Like I’ll say, “Fajita salad, sliced chicken, sour cream, guacamole over lettuce,” and press the button and it enters it and it breaks it out into the macronutrient complete ingredients.

(01:41:27):

So that’s really straightforward. But then what’s more interesting to me than that, because that’s the chore, is seeing the relationship between that and my goals. So I’ve set a protein goal for myself. We talked today about trying to hit a pound or a gram per pound of body weight. That is my current goal, and I’m trying to actually gain weight and put on muscle mass, so I have to eat more than my current body weight, which is about 170 grams per day is my target. And it is amazing when you think that you’re hitting that for months prior and are not putting on the mass that you expect. To then start actually tracking this closely and realize, “Oh, I was actually 50% short on a lot of days,” that I just was doing this math and magic in my head and assuming that, “Oh yeah, I got it in here and there.” And when you really start entering these…

(01:42:13):

So that accountability layer with the macros feature and then with our habit loops, which basically allow us to set a protein target, a fiber target, and for me, a workout target every single day. And I can kind of close the rings almost like your step counting in your Apple Watch. That has been so motivating for me to just stick with this consistently. And I think the most important thing is just being able to keep the burden really low so I don’t have to take minutes out of my day. It’s seconds. I think what I wanted to talk about from there is really the evolution from here to the next phase, which is we talked a lot about how macronutrients impact biomarkers and what I think is maybe lacking in the world of macronutrient tracking today is an opinion.

(01:42:56):

People will download these apps, they’ll start to enter the foods they’re eating on a daily basis. And it’s like, well, once you’ve done that a few times, there’s nothing really… Where’s the value return? It’s really just, “Does the scale change? Do I gain or lose weight the way I’m trying to?” What I envision for the next wave is really understanding at a much more biological level, how are these macronutrients impacting you, and is your body giving you an opinion on whether you’re doing the right thing or should you be adjusting macros?

(01:43:28):

And that comes down to biomarker tracking, CGM data, being able to close the loop with insights and sort of scoring or features. To provide feedback not just on carbohydrates, but then also through our biomarker, our metabolic labs, panels on your macronutrient impact on triglycerides, on apoB, on uric acid, on fasting insulin. So I’d love to hear from you, what would it look like for you in the future? What is the ultimate metabolic health tracking system? What should it do to give people insight into whether or not they’re properly consuming food on a daily basis? And do you see a future where people actually keep track of their biomarkers and their macronutrients in a consistent way day to day?

Dom (01:44:10):

Yeah, absolutely. So I would love to know specifically what my… I would love to have easy access to my macros when I was in high school or in college and things, and I did track it sometimes here and there, just like on paper. But having the ease, this accessibility to have this through the AI generated system, the barcode scanning, things like that. And to have that essentially in the app timestamp with other biomarkers that people can measure with the other features of the app is going to be invaluable. Especially if they’re trying… And everybody’s trying, I was going to say, especially for people trying to make changes, but everybody’s trying to improve and make adjustments. Most people are trying to lose weight, improve body composition. So just to have that history there and something to refer to as you tweak and make adjustments along the way, to your training too.

(01:45:07):

If you amp up your training preparing for something, whether it be a powerlifting event or a sport event or a marathon or something like that, it’s going to be really important to… You’ll be leaps and bounds ahead of everybody else if you nail down your nutrition. And measuring is one way, and monitoring these other biomarkers is one way not only to improve your metabolic health, but also your performance and body composition is going to be sort of important. And for many people who reach out to me to manage, whether it be age-related dementia or type two diabetes. And I know Levels is not a tool for clinical management, but for people who have pre-diabetes or just a history of certain disease processes, this is where you start. You know what I mean? You can invest a little bit now, or you can invest a lot later on for the clinical management of that and all the comorbidities that are associated with it.

(01:46:06):

So the time to improve metabolic health is now before it becomes a problem later on down the line. So in having all those features in one app is super important. And maybe you ask what’s on the horizon? Multi-metabolite monitoring is something that’d be cool. It’s like lactate and ketones, obviously, maybe uric acid, things like that. And having all that in there would be super important for the elite athlete and advanced athlete who really wants to take it to the next level, no pun intended there. But I think everybody has something to really benefit from, from this technology. And I think it’s just all in a one-stop shop within the app.