#216: Ted Naiman, MD: How Insulin Slows Fat Burning, How Donuts & Pizza Make You Fat

by Deanna Mutzel, DC



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Connect with Ted Naiman, MD

Ted's a board-certified in Family Medicine and has devoted much of his career to the study of diet and exercise and their relationship to health. He's used thousands applied these techniques to thousands of patients and has seen miraculous health transformations and fat loss results.

Outside of work and medicine, Ted enjoy spending quality time with his wife, daughter and playing bass for one of Seattle's most popular dance bands and playing Ultimate (frisbee).

Related Discussion: #163: David Perlmutter, MD – Gut Bacteria, Carbohydrates and the Ketogenic Diet


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Show Notes


02:32 Insulin prevents us from burning fat for fuel. Insulin is a hormone whose job is to store energy. In type 1 diabetes there is an insulin deficiency and lean mass is burned for energy. Insulin resistance can put someone on the same path, with resistant receptors with sarcopenia and loss of lean muscle mass. Different tissues have different levels of insulin resistance.

04:36 You become insulin resistant when your fat cells are full and you do not have anywhere to store fat. The larger your fat cells become, the higher your insulin level grows. Because insulin is high and your fat cells are full, you end up with ectopic fat.

05:12 Why did you overfill your fat cells? They overfill when you eat carbohydrates and fat together, displacing fat oxidation. Glucose always controls oxidation preference in your cells. Every cell in your body with mitochondria in it is constantly burning either glucose or fat. If you are eating carbs, you are burning glucose and fat is sent into storage. If you are genetically able, you will create more fat cells. Otherwise, you hit your personal fat threshold. You must either eat less fat or eat fewer carbs. If you eat fewer carbs, you can oxidize more fat. Otherwise, you have hyperinsulinemia or insulin resistance.

08:11 How can you burn more fat and store less fat?  You can oxidize more fat by restricting exogenous glucose.

09:12 The bigger you get, the faster you are going to die. For most of us, the circumference of your waist tracks with the size of the adipocytes and fasting insulin levels/insulin sensitivity. Measure your waist at the belly button, divide it by your height. You want to be less than point 5. If you are higher than that, you are probably in trouble. You can also graph years of life lost and waist/height ratio and it is exponential.

10:56 Metabolically obese normal weight individuals are an exception to the waist/height ratio. Lipodystrophy is a condition where you have no subcutaneous fat. All of Dr. Naiman’s patients with lipodystrophy are horrifically insulin resistant. When they ingest fat, there is nowhere for insulin to store it and their insulin levels skyrocket. Lipodystrophy rat model study proves our current model of insulin resistance. Rats that were bred to be lipodystrophic had fat sewed under their skin and connected it to blood supplies. Having this place to store fat cause the immediate cure of their insulin resistance and diabetes.

13:53 Your personal fat threshold is genetically built in. It is the maximum amount of fatness that you can achieve. You either get bigger fat cells or grow more fat cells. If you are able to grow more fat cells, you can be 600 pounds and be insulin sensitive. For others, it takes only a few pounds of fat to overfill their fat cells and make them diabetic and insulin resistant. They cannot get fatter. Hyperinsulinemia is when you meet your personal fat threshold and you cannot get fatter.

15:34 Becoming fat can be protective. Thinner people can get Alzheimer’s/dementia more often than fatter people. Getting fat can protect you from hyperinsulinemia, high blood sugar, high insulin, and diabetes, as long as your fat cells can continue to suck up the fat and glucose. When you get visceral (abdominal) fat, you have already filled your subcutaneous fat. Subcutaneous fat fills first. Then visceral fat begins to fill, heralding hyperinsulinemia. When ectopic fat begins to fill, you are packing fat everywhere, including your liver, pancreas and heart.

17:12 Everyone has fatty liver now. Dr. Naiman used to see 25% of his patients with fatty liver. Now he cannot recall a recent patient that didn’t have it.

17:49 If you have an abundance of free fatty acids in your blood and it is being rejected by your cells and tissues, your body goes to war with itself. Every tissue becomes more insulin resistant in order to protect itself from more glucose. This will result in constantly high insulin.

19:26 You can reverse insulin resistance by eating either an extremely low fat diet or an extremely low carb diet. Studies prove this.  Low carb makes more sense from an evolutionary perspective. People who oxidize more glucose are metabolically less healthy. You want your respiratory quotient (how much fat you are burning at rest) to be as low as possible. Burning fat makes you less hungry, less tied to food, able to exercise in a fasted state, and can go longer without eating. It is the way the human body was designed to function. If you are only eating carbs and no fat, no fat is stored.

22:06 If you are fat to begin with, you should do the low carb/high fat approach. You have lots of extra fat to burn and you want to be good at it. Without dietary glucose, you go from burning glucose to burning fat all the time. The switch from burning dietary fat to burning stored body fat is seamless.

22:46 If you already have very low body fat, if you eat a high carb/low fat diet, you will remain thin. You will be burning glucose, but you aren’t eating fat, so you are not storing fat.

23:27 For someone who is very overweight and very insulin resistant, a protein heavy/low carb diet is Dr. Naiman’s recommendation. This does not mean high amounts of protein, but high dietary percentage of protein. Eat enough protein for satiety. It is the fastest way to reverse insulin resistance.

25:03 You will lose just as much lean/muscle mass as fat mass with fasting or undereating calories. You want to lose fat. If you are eating a high percentage of protein and restricting fat and carbs, you lose fat. You want to eat more protein and less energy by percentage.

26:53 If you don’t hit your protein target, you will overeat energy as carbs or fats to get enough protein. Every species has the ability to navigate between utilizing protein and energy and find the optimum balance. We have this too. We have a strong protein satiety drive. As a population, our protein intake has dropped from 14% to 12.5%. We flooded the food supply with the empty calories of carbs/fats. For every 1% of protein that goes down in your food supply, you have to eat 14% more of that food to get where your body wants to be. If you protein restrict, your cravings for savory snacks goes up.

32:19 What about vegetarians and vegans with protein? There are high and low protein plants foods. Grains, sugars and starches are very low protein/high energy. Green vegetables, mushrooms and soy have a high protein to energy ratio. Vegetarians should prioritize the few animal products eaten, like eggs and dairy. It is more challenging for vegans to get adequate protein and may find supplementation, like B12 and protein powders, to be beneficial. The less processed and refined your diet is, the higher the protein to energy ratio you will have. Across populations, tiny shifts in protein consumption drive huge swings in obesity.

36:13 You should get to ketosis with carb restriction. If you eat a 35% protein diet, equal grams of fat and protein, you will be in ketosis all the time.  Your average animal protein is 2 grams of protein to 1 gram of fat. You can eat a ton of protein and be ketogenic.

39:20 Muscle is the organ of longevity. You can look at someone and how strong they are and tell how long they are going to live. We want the highest lean mass with the lowest fat mass. Lowest fat mass gives us the lowest insulin levels, most insulin sensitivity and places to store fat so insulin is low. Eating higher protein will get you there.

39:26 Keep your insulin pulsatile. Insulin goes up every time you eat. When fasting your insulin is very low and you are running off stored body fat. It is like you are running on battery power. Eating should refill your battery, but not overfill. Fast and feast cycles also benefit mTOR. This is probably how it worked for our ancestors.

42:21 Ambient temperature is a huge factor in diabetes. If you are cold all the time, you will have more mitochondria in your fat cells. This is similar to lifting weights creating more mitochondria in your muscle cells. The more mitochondria you can get, the better. You have to have a transient energy crisis in your cells and a bit of discomfort to create more mitochondria. Keep your house a bit cold. Push yourself out of your comfort zone.  Push yourself. Challenge your body. Be uncomfortable. This with diet and exercise brings you robust health.

47:56 Always start with diet. Take one meal at a time and replace your carbs with protein and fat. When you begin producing your own glucose, as your ancestors did, then take on exercise.

50:20 Dr. Naiman has no morning routine, though he does drink cold brewed coffee. He fasts in the morning, not eating until about 1 p.m.

51:37 Dr. Naiman’s singular favorite exercise is the muscle up. It is the best upper body exercise. It is an intense push and an intense pull. Intensity is most important.

54:29 Dr. Naiman takes no supplements and rarely recommends them. You are better off getting your nutrition from your food, rather than from supplements.

56:35 Dr. Naiman’s elevator pitch is to reverse protein dilution. Eating carbs with fats is obesigenic rat chow. Put protein first. Ruminant agriculture on natural grasslands would turn around obesity and diabetes, and it helps the environment.

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