The Melanie Avalon Biohacking Podcast Episode #178 - Best Of 2022 (Part 1)

TRANSCRIPT

Melanie Avalon: To start off our first best of episode ever, we have Dr. Karen Becker. So, Dr. Becker came about because I actually was researching developing a pet food line. I was asking people for recommendations for vets and everybody was saying that I had to read this book called The Forever Dog. I read The Forever Dog. Oh, my goodness, friends it was basically like David Sinclair's Lifespan meets pets. She literally talks about all the things, like all the things we talk about on this show. She talks about it not only for the health of our pets, but for the health of us humans as well. It is mind blowing. I was already suspicious about what we were feeding our pets today. After reading her book, it's honestly just shocking. There is a major problem here with conventional pet food. I can't even express how much I think she is revolutionizing the lives of our pets. Friends, I don't even have a dog, I don't even have a pet and I love the book. I love this interview and I can't wait for you guys to hear it. So here is Dr. Karen Becker. 

Karen Becker: Dom D'Agostino was very instrumental. We flew to Florida and interviewed him, but he was also instrumental in helping Keto Pet set up their protocols. That's basically the protocol that we recommended in the dog cancer series. Out of that, so many people around the world have been able to contact us and let us know that their animals since they learned about a species-appropriate raw food diet or unadulterated diet, there's been this overwhelming change in the vitality and the health and well-being of the other animals in their home. Just by getting the highly processed carbohydrates out of your dog and cat's diet, switching from an entirely dead overprocessed diet to an entirely fresh living food diet, the health transformations that are occurring in animals, it's shockingly jaw-dropping. It's also so fun to watch, because when you and I decide to go from eating Total Cereal, that's the equivalent of dog food.

Total Cereal, gives people 100% of synthetic vitamins and minerals that they need a day and so does your dog food. It's a carb-based synthetic vitamin and mineral-supplemented little pellet. That's what we're trying to sustain vitality and well-being with is this little crunchy pellet with a multivitamin on it. Common sense would say probably your animals need more than that and you are correct. Animals need a whole lot more than that. What's amazing is when you're like, okay, got it. I'm going to add a paste that resonates with meat. I'm not going to throw my kibble out right now. What I am going to do is start incorporating more living fresh foods. I'm going to use fresh food toppers. I'm going to ditch my crappy dog treats that cost a lot of money and I'm going to switch to fresh foods. I've decided I'm going to give carrots and parsnip and celery.

I'm going to give the bottom and the top of the green beans when I trim them off to my dog. I'm going to give the dented blueberries that all of the health and longevity researchers, but Dr. David Sinclair was the most profound is saying, "Never throw out dented blueberries, those always go to the dogs because they have twice the polyphenols because they had to survive death, right?" All of those ways that we can very economically share safe and biologically appropriate human foods from our fridge with our dogs. Every single bite of fresh living food that you put into your dog's mouth or bowl, replacing ultra-processed, bad, cheap, carbohydrate-based, poorly made food that is a step of health in the right direction. So, you don't have to make it. "Oh, my gosh, I've been doing it wrong. I feel horrible. I've got to switch everything." Don't do that to yourself.

As you begin to incorporate one health strategy at a time, you see the results. Your dogs shed 50% less. The chronic ear infections go away. They become more muscular and lean and they lose that mid-tier belly fat. Their eyes are brighter, their breath improves. They quit farting, that mucus on the stool and that intermittent belchy, farty, gassy, constipation, diarrhea, it all goes away. It goes away because now they are having the raw materials, the nutrients in this unadulted fashion, meaning they're not heated. We're providing food up the food chain in its whole absorbable form. Dogs and cats do such a magnificent job of taking those nutrients from the real foods that we're giving them and absorbing them and assimilating them into their bodies in such fine fashion that literally, in three months' time, you can watch your animals transform before your eyes.

That's the inspiring piece that I want to give your listeners that this doesn't have to be a race, you don't have to change your whole lifestyle, you can take little incremental steps that empower you to feel comfortable. You're like, "Okay, I did that, woof." I'm feeling good about that. I'm going to do the next thing. As you improve the health and well-being of the animals in your life, you become empowered to do a little more and a little more because you see their results in front of you. That's probably the best part for me, is that our animals' bodies show us what magnificent changes are doing. You can physically see it and that's just so inspiring, especially as a health and wellness veterinarian, like, brings tears to my eyes--

Melanie Avalon: Up next, friends, we have somebody who is not only an incredible researcher, scientist, and author, but is just a sparkling human being. I love Rick Johnson. He is so kind, so knowledgeable. I was always listening to his episodes with Peter Attia, which were fascinating. It was a true honor when he wanted to come on the show. On top of that, I've grown to know him personally and he is just so amazing. The work he is doing surrounding fructose is honestly revolutionary. He came on for his new book, Nature Wants Us to Be Fat: The Surprising Science Behind Why We Gain Weight and How We Can Prevent--and Reverse--It. It was a pretty mind-blowing conversation, so please enjoy this clip from my conversation with Rick Johnson.

Dr. Richard Johnson: Ah, so, this is a big question, Melanie, absolutely great question. A long time ago, people were thinking that-- it was known for a long time that if you gave fructose to people that triglycerides go up in the blood 30 minutes later or four hours later, I'm sorry, it's four hours later. The conception was that those triglycerides were coming from the fructose itself, so that when the fructose is broken down components of other breakdown products then get turned into fat. There are some breakdown products of fructose that do go into fat, but it was a very small amount. It couldn't account for this big rise in triglyceride. The really fantastic discovery was done by my partner, Miguel Lanaspa and he was studying how fructose works and what he found was that when you eat fructose, there's this thing called oxidative stress that occurs. There's a burst of chemically reactive oxygen that's produced in the liver cell and that affects the mitochondria. It's driven by the uric acid. Remember, we knew that the uric acid was involved and that oxidative stress stuns the mitochondria. What it does is it sets up for fat production from precursors of fat that do not have to necessarily be from the fructose. It stimulates other glucose and other things present and fatty acids and so forth. It stimulates them to start making fat. The fat doesn't actually come from the fructose, it comes from the other nutrients that are there. So, it turns out that fructose itself is like glucose. It's just a type of sugar, not table sugar, but a type of sugar in the global sense.

It can be broken down to make energy and it can be turned into fat and glycogen. But fructose activates another process that tries to stimulate fat, not even from its own molecule, but from other things present. It stimulates hunger which makes you want to eat other foods. It's not just sugar that you want to eat, it does cause craving of sugar or sweet, but it also makes you eat more food even if you can't really taste it. This leptin resistance kicks in that makes you hungry. Fructose is a different beast. We've fell into the big mechanism by which it works. It's interesting because it's a nutrient. Nutrients provide calories and calories give us energy. When we get energy, it's either an instant form of energy, what we call ATP, which is made largely by mitochondria and other mechanisms. It makes stored energy and stored energy is like fat or glycogen. Whenever you eat, it's used to drive biologic act, how we live, and move, and act, and think. We need calories for that. Some of the calories are converted to instant energy and some is converted to stored energy. What fructose does is it creates an alarm signal because it drops the instant energy by 10% or 20%. What it does is it tells the animal that there's some kind of alarm going on that you don't have quite enough food. So, that's what seems to trigger food intake, fat accumulation, everything is like, "Uh-oh, I'm running low on my stores."

One of my friends called an insurance plan. Fructose stimulates an insurance plan. It isn't really. It's triggered by starvation, but it's not starvation. It's just a drop in the energy in the cell that makes the animal feel like it doesn't have enough fat stored away. When that happens, it stimulates more fat storage and it does that, even though, you already may have fat. It tricks you. You actually may have all this energy available. You have this fat and glycogen that are stored energy, but when it drops the immediate energy, it tricks you into thinking that there's not enough energy around, so you make more fat. It's a way to increase your fat. All animals, all of us have some body fat. We didn't have any body fat we'd be really in trouble. But everybody has some body fat. What this does is when you eat fructose, it wants to increase your body fat no matter where you start. If you're at 10% body fat, it wants to make it 15%. If you're at 15%, it wants to make you 20% and so forth. Fructose is an insurance plan aimed at increasing your fat stores, while glucose is the immediate fuel. It's there to really make immediate energy that you can use right away. So, the two sugars look very similar in composition. One is there to make immediate energy and one is there to make stored energy.

Melanie Avalon: Up next, we definitely have a crowd favorite. When I've been pulling you guys about your favorite episodes, so many people have said, Dr. Gabrielle Lyon. Of course, Dr. Gabrielle Lyon is a woman after my own heart because she is all about the protein intake and she is so knowledgeable on the science of it. This was a thrilling conversation to have and I think does such a service to so many people out there, especially women who may not be getting their adequate protein intake. I've also become friends with Dr. Gabrielle Lyon and can say that she's a pretty awesome human being. Please enjoy this clip from our conversation.

Gabrielle Lyon: Is protein dependent on-- Are you saying that? Is it dependent on body size or not?

Melanie Avalon: Yeah, like total muscle or--

Gabrielle Lyon: Yeah, okay. So, let's break that down. The first thing that we have to think about is what is the total protein need of an individual. And protein is responsible for a multitude of factors from hair, from skin, nails, protein turnover, which is the body's continuously breaking down and building up, which is essentially 250 to 300 g a day of turnover in the body, which is different than dietary protein. But turnover is about 250 to 300 g of protein. As the body ages, the body becomes somewhat less efficient. Muscle becomes less efficient at sensing proteins, just the body isn't as robust, which isn't a great word, but isn't quite as capable as it once was when we are younger and in growth.

We have to understand that when we think about dietary protein needs, there's the difference between what is basic, and what is optimal. In my mind and the science would support that 0.8 g/kg is enough to prevent deficiency. Okay, so basically, if you're getting enough calories and you're getting 0.8 g/kg, you're not going to be protein deficient. The average female according to the UNHIN's data gets about 75 g of protein a day. The average male gets about 100 g of protein a day.

Now, let's think about what a great recommendation would be. And I would argue that while the recommendation is incredibly variable. So, if you go and you look at the RDA, you could also then point out the AMDR, which is the average requirements, which are anywhere from 10% of the diet to 35% of the diet could be from protein. So that's not a great strategy because the percentage is so high. If you are eating 1,000-calorie diet and the range of protein is between 10 and 35% and 1,000 calories, 10% of that is what? Like 100 calories from protein. So again, there's a huge disparity in the recommendations and we have to account for that.

One thing to understand is that a great starting place is 1 g/lb ideal body weight. And people can titrate up or titrate down based on that. And it doesn't matter if you are a male or female. If you are a 150-pound female or a 150-pound male and that is your ideal body weight, then I definitely recommend 1 g/lb ideal body weight.

Now, let's talk about the next most important thing, So, a 24-hour protein intake is really important. The next thing to consider would be how are we going to distribute those calories. And how are we going to distribute those amino acids over the day? And there is one particular amino acid that one could make an argument for a meal distribution and that is leucine. And what's so fascinating is that if you are sub-threshold in leucine and I define that by the blood levels of leucine being low and not high enough to reach a threshold amount, a hyper amino acid level in the blood, which ultimately for people who are interested is 2.5 g of leucine will increase the leucine level in the blood enough to then trigger muscle-protein synthesis.

And this is really essential for helping with health and longevity. Okay, muscle is the organ of longevity. It's the most important factor in my personal opinion. So, after we determine the amount of protein an individual should eat, which I recommend is 1 g/lb ideal body weight. And again, you can titrate up or titrate down, there isn't negative side effects with protein, but we then have to consider that it's actually the amino acids that we're eating for. And these amino acids, in particular, leucine require a threshold amount and that translates to 30 to 50 g of dietary protein per meal feeding, and you could eat two meals a day or you could eat three meals a day if you're fasting? However, you want to do it, but what becomes really important is you must reach that amino acid threshold because if you don't, you do not stimulate muscle-protein synthesis. And over a period of time, if you do not stimulate muscle, you will destroy it over a period of time.

Melanie Avalon: It is always a pleasure to bring on people of all different perspectives onto this show. I really love when I bring on people who are really intense in the vegan world. Dr. Will Bulsiewicz is a legend in that sphere. His book Fiber Fueled is everywhere. I always see it at Target, for example. That's how you know you've made it. And what I love about Dr. B is I really appreciate his research, his nuance, his openness to meeting people where they're at, what I perceive to be a lack of bias in his findings. It was a pleasure to connect with him. And, of course, we had to discuss the controversy of gluten and grains. Should we actually be eating gluten and grains after all? Check out this clip to find out.

Dr. Will Bulsiewicz: Let me unpack gluten a little bit. First of all, gluten is a protein. It's a protein that is found in wheat, barley, and rye. If you have celiac disease and you consume gluten it activates your immune system in an inflammatory way, that is problematic. In people with celiac disease, gluten is off the table. All of these things that I'm talking about like low and slow, reintroduce, it's about variety and abundance, that does not apply to a person who has celiac disease. If you were in my clinic and you have celiac, I would say, “You need to be gluten free and you need to be gluten free for the rest of your life. There's no bringing it back.” But let's move beyond celiac disease and by the way, I mentioned earlier that there's a big three of food sensitivity and I said that constipation was one of the three. The second is celiac disease. So, we're touching on it right now and the third is gallbladder dysfunction, which is another thing that can cause food intolerances. If you fix any of these three, people's food intolerances get way better.

Now, with celiac disease it becomes imperative that you rule this out. I want people to understand that a blood test is not adequate. The vast majority of people that I have diagnosed with celiac disease, they have a normal blood test. I was raised being taught, by raised I mean in a healthcare system, being taught by the healthcare system in my medical education that these blood tests were really reliable for celiac and it is not true. We misunderstood what is celiac disease. The reliable test for celiac is an upper endoscopy. You have to go down into their small intestine and take biopsies and people have to be consuming gluten in order to do that properly.

But let's assume that that a person does not have celiac disease, okay? We're moving beyond that. They have heard that gluten is inflammatory and gluten is implicitly bad for the gut microbiome. The problem is that if you look at research studies, not in a test tube, which is I think a quite unnatural way to measure what I do and how I live. So, rather than looking at a test tube or a rat study, let's look at real humans eating a slice of bread. What happens? What we see is that when people eat high-quality sources of, for example, bread or high-quality carbohydrates that do include gluten, their microbiome becomes more healthy. Their inflammatory markers actually go down. The reason why is because wheat actually contains a lot of prebiotic compounds that are good for our microbes. Flipside, we all know that wheat includes a very broad spectrum where it could be high-quality sourdough bread, but it could also be total junk food. The vast majority of wheat-based calories in your supermarket are junk. I am not advocating for those in any way. Those are not healthy foods, but that's not exclusively because of gluten. They just happen to contain gluten and be unhealthy foods.

They did this study, Melanie, that I think you may have been leading me into a little bit, so, I'm going to talk about it, where they looked at people who have what's called a gluten intolerance. What this means is that when they consume gluten, they feel unwell. Like they have gas, or bloating, or cramping, or abdominal pain, or something like that. First of all, they verified that these people, they do not have celiac disease. Celiac disease is off the table. As I said, if you have celiac, you need to be gluten free. In this group that does not have celiac disease, they sent them home with three weeks’ worth of breakfast bars and they said mark down every single morning after breakfast how you feel, how many symptoms you're having? The three bars were first the placebo, that's our baseline, we're going to compare to that. Number two, a gluten-containing bar, and number three, a bar that contains what are called fructans. Fructans are FODMAPs. When they analyze the results, it was a bit of a surprise.

When people consumed the gluten-containing bar compared to the placebo they actually had less symptoms when they were consuming gluten than they did when they consumed the placebo-containing bar. Placebo bar was more of a problem than gluten. When people consumed the fructan-containing bar, they were triggered. The fructans which coexist in wheat-containing products are the reason that people get gas, bloating, discomfort when they eat wheat-containing foods and that's because they are FODMAPs, but they're also prebiotic. They should not be thrown out, we should not be vilifying them, we should be looking at ways to overcome these limitations and restore function to our gut, make it stronger so that we can consume these foods. That's what you and I have been talking about for most of our conversation today.

The point is this. Here's how I see this. If you are celiac, you need to be gluten free. If you're not celiac, you don't need to be gluten free, but I do encourage you to buy organic if it's wheat, because most wheat is being sprayed with glyphosate unless it's organic. That actually can cause harm to your microbiome. Nonorganic wheat being sprayed with glyphosate to me is problematic. I think that people need to make sure they're consuming whole grains. 98% of Americans are not getting the recommended amount of whole grains. When you look at the evidence on whole grains, they reduce our risk of heart disease, our number one killer, reduce our risk of cancer, our number two killer and people live longer when they consume more whole grains. I think we should be eating them. If it's not wheat, then it needs to be something else. So, you don't have to be a wheat-consuming person. That's okay. But if you're going to go gluten free, you need to make sure that you make an effort to replace the wheat, our number one whole grain with something else. Quinoa, sorghum, teff, amaranth, brown rice, these are some examples of gluten-free whole grains that you could use as a substitute. You don't have to consume gluten. You do need to consume whole grains. But the evidence on gluten is just a little bit more nuanced than what we've all been led to believe.

Melanie Avalon: Okay, friends, now it is a true honor to bring you this excerpt from my conversation with Dr. Laurie Mintz. She is doing revolutionary things when it comes to reframing. How we view women and sex, and women's pleasure with sex. She came on to discuss her newest book, Becoming Cliterate: Why Orgasm Equality Matters--And How to Get It. If this is not evident by now, I am all about supporting women's orgasm, taking things into your own hands, and especially for the health benefits. Yes, I do still implement my nightly orgasm challenge. I actually don't think I've missed a night in I actually don't remember the last time I missed a night. That is a good train to be on. We talked about so many things, so definitely listen to the whole interview. One of my particular favorite parts was some of the myths and hype surrounding the elusive G-spot.

Dr. Laurie Mintz: Honestly, I think it was the media hype and Betty Dodson, before she passed away said, “The media hype around the G-spot has set us back to a Freudian era, where we're all looking for some magic spot inside our vagina to make us orgasm.” It's not the scientific stuff around the G-spot. That's excellent. It was the media hype that this is like this great new discovery and you can find this, you can orgasm from intercourse, your vagina has this capability that set us back, back to that Freudian era, where women were “supposed to." It’s the most ridiculous thing I've ever heard. Freud said that, “Once you're mature, you'll transfer your sensations from your clitoris to your vagina,” which is like-- That's like saying, when we grow up.

Melanie Avalon: It makes no sense.

Dr. Laurie Mintz: Right. We’ll stop breathing out of our nose and we'll start breathing out of our ears. We don't change functions of organs and that has really done so much damage and I think we started getting away from that when people, in my era, knew about the clitoris and that it's the source of women's pleasure. And then this G-spot hype, I think set it back. Plus, again no progress on sex ed. We've actually gone backwards in some ways. So, all of those things, I think, have set us back.

Yeah, I think our genitals, there's so much to them that we don't know about still, but I do think that there is probably-- I agree with that theory. I think there is probably an evolutionary factor for the G-spot, which isn't really a spot at all. It includes part of the vagina, part of the internal clitoris, and part of the urethra. But you were saying, we know that if you push on it for some people, it's pleasurable, for some it's not, some it results in orgasm. But we know that pushing on it results in feeling less pain and that is right where the baby's head comes through. And so, it could have that evolutionary function that it's to decrease pain during childbirth. We do also know like you were saying, when you have an orgasm from stimulating that area, your cervix pushes down, whereas if you have an orgasm from stimulating the clitoris, it pulls up, which gives more evidence that, hmm, maybe this was intended for evolution to make childbirth less painful.

The vagina is a canal where babies can come out, penises can go in, dildos and fingers can go in. Yet, we call our entire genitals a vagina. By doing this, we are linguistically erasing the part of ourselves that gives us the most pleasure because we know that only 4% to 18% of us can orgasm from penetration alone. The rest need external clitoral stimulation. When we call our whole genitals a vagina, we're linguistically erasing the part that gives us the most pleasure and we're calling our genitals by the part that gives our male partners the most pleasure, not the part that gives us the most pleasure.

So, everything isn't the clitoris, but the clitoris is the biggest part of our anatomy. It's a vast internal and external organ, the hood and the glands are the only part that can be seen externally, but there're also legs and bulbs, and in fact the G-spot, the real name for it is the clitourethrovaginal complex because it includes part of the clitoris, part of the legs, part of the urethra, and part of the vaginal wall. But there is some thinking that maybe we could get away with, not get away with, but get away from this horrible hierarchy we have of vaginal orgasms are better than clitoral, if we called our whole unit, our whole genitals instead of even vulva and vagina, if we had one name for the whole interconnected unit. Helen O'Connell, who's the person who discovered the internal clitoris and made it public says, “It's the biggest organ down there. Why don't we call the whole thing a clitoris?”

Melanie Avalon: Okay, friends, Bill Schindler, talk about a mind-blowing book, a mind-blowing interview. This is one of those interviews where you're just like, Wow. What I love about Bill Schindler is he doesn't talk so much about what to eat and not eat, but rather how to eat. How have our cooking methods and our processing methods actually been the key part of our evolution in becoming human and related to why we experience so many health issues today? His book touches on so many fascinating topics dairy, grains, meat, insect protein and what I love about Bill is how passionate he is about everything that he's doing. I got so much incredible feedback from this episode I knew it had to be included. Please enjoy this excerpt from my conversation with Bill Schindler for his book Eat Like a Human: Nourishing Foods and Ancient Ways of Cooking to Revolutionise Your Health.

Bill Schindler: But we were doing a program with people we had something called-- we are grinding grains and we're using something called a corn stone and a corn stone are these two round rocks that sit on top of one another and you spin the top rock and you feed the grains in the middle and it grinds it. So, just keep that in mind for a minute. That happened the day before. I reached up inside of this duck, and I pulled everything out, and it's literally laying on my forearm, and I realized that the duck has a lot of things in its digestive tract that humans don't have, and they're designed specifically to process grains. When a duck or other granivorous bird, a bird designed to eat grains, consumes grains. Remember, the first thing is, they're not chopping them up, they're taking a raw grain right off of the stalk, right off the ground, and they're swallowing it. A huge, a whole raw grain covered in lectins, phytic acid, anti-nutrients, all the things that we know grains have and they swallow it.

The first place that it goes in their digestive tract is a crop or a crop like part of their body depending on the bird that they are. What this is, it is just an enlarged pouch in their esophagus where the grains sit. Now, the grains will sit there for sometimes up to 14 to 16 hours in a warm, moist, dark environment. During that time, a lot of things are happening. It's not just sitting there. They're absorbing water, they're swelling up, and they're soaking, they're fermenting, and sometimes depending on the grain how fresh it is, the length of time and by all this, sometimes they're even sprouting and anybody who's listening that knows all the great ways to deal with grains before we eat them, soaking, fermenting, and sprouting are incredibly important. These soaked fermented sometimes sprouted grains, after they leave the crop, then go down into an organ called the gizzard. Anybody who's butchered a chicken or taken apart a turkey for Thanksgiving dinner, they know what the gizzard looks like. The gizzard are two incredibly strong muscular discs that sit against one another. The birds they eat rocks, they're called gastroliths, little tiny rocks, gravel that they consume on purpose that sits between these muscular discs and these soften detoxified grains go in between these discs, and they literally get stoneground.

What I saw in that was that gizzard was exactly what that corn stone was, I using the day before in County Mayo from Belderrig. These grains are detoxified, they're softened, they go down into a gizzard, they’re stoneground, and then and only then do the grains go into the rest of their digestive tract, which operates in a very similar way to ours at that point. I'm looking at and thinking, “Oh, my gosh, other than baking, actually, heating the grains, these birds are making sourdough bread inside of their bodies.” I'm like, “Wow, that's amazing.” It really kicked off a lot of my thoughts about detoxifying grains, and thinking about sourdough bread, and all that sort of thing. I also had this thought. I'm looking at their digestive tract, I wonder if we took a grain and bypassed those two, the crop and the gizzard, and stuck that grain into their digestive tract a little bit lower, what it would do? Because that's essentially what we're doing when we're eating grains that are-- what would it do? I'll never know. That's a question I'll never get answered.

Well, about three or four years ago, it did get answered. I came upon a disease of malnourishment issue that ducks and geese get that live in city parks that get fed by really nice old people that are sitting on the bench and feeding them bread, they get a disease called angel wing disease. It's because they're malnourished and not getting the nourishment that they need and just think about how crazy this is. Here are these birds, granivorous birds that are designed to eat grains, that are getting fed grains in the form of bread from nice old people sitting on a park bench, and they're getting sick, and they're getting deformed because of the malnourishment in this. What's happening is that the grains that are in that bread, just regular sliced pan loaf, Wonder Bread kind of baked bread that they can't go through that process. Even though, it goes into the crop and the gizzard, it doesn't get done what needs to be done, because it's already been processed, it's already been cooked and they're getting sick. That's exactly what is happening to humans when it's simplified. When we're eating bread that hasn't been processed the right way, but the good news is, we can replicate what happens inside of those birds, outside of our bodies. When we make real traditional, wild, slow-fermented sourdough bread, it is a completely different food than even the most high-quality yeasted all grain whatever kind of bread.

Melanie Avalon: Okay, friends, time for a legend of a guest. Especially if you listen to my other show, the Intermittent Fasting podcast, you are probably familiar with the fabulous Dom D'Agostino. He is the go-to researcher on all things, ketones and the keto diet. Having him on the show was the highest of honors. I got to ask him all of my nitty gritty questions regarding ketones and ketosis. It was honestly a dream to enjoy this excerpt from our conversation.

Dom D'Agostino: Well, biochemically what happens is, the simplest way to explain it is that when you enter a state of ketosis, whether it’d be fasting ketosis or the ketogenic diet, the beta oxidation of fats are so high in the liver, you accumulate acetyl-CoA and the accumulation of acetyl-CoA gets directed into the path of ketogenesis, where two acetyl-CoA molecules will condense enzymatically to what's called acetoacetate and that's a ketone body and then through another enzyme the acetoacetate can convert to beta-hydroxybutyrate, which is another ketone. And then they both enter circulation in the blood, it's about a three to one, or four to one ratio beta-hydroxybutyrate to acetoacetate. But the reason that happens that your body makes ketones is, well, to preserve energy flow to the brain. That's probably the evolutionary reason why. But biochemically, what happens is that the level of beta-oxidation of fatty acids in the liver is so high, you’ve got to do something with the acetyl-CoA and the Krebs cycle gets a bit backed up and the acetyl-CoA then gets condensed and forms, goes down the ketogenesis path.

And that's almost entirely dependent upon the suppression of the hormone insulin. So, if you were to get even just a little bit of sugar, or anything that increases insulin, insulin is a storage hormone, and you go quickly from a fat catabolic state primarily to an anabolic state. And so, if you're fasting, for example, and you're in a high state of ketosis, and you inject the hormone insulin, it can cause a dangerous scenario where your ketones will start to come down after a period of time, you’ll probably be protected from the hypoglycemia. And that has been shown in some early work. But that production of ketones is primarily a result of the lowering of the hormone insulin and that stimulates your fat burning so much. Ketones are a really good indicator that you are burning fat. In that case, Atkins was right, you get your ketones elevated and you know your body is in a fat burning state, you can't make ketones without burning excess fat. That's a statement that no metabolic physiologist would argue with.

Melanie Avalon: To clarify, so the acetyl-CoA building up in the liver is coming from fat stores of our body or our diet?

Dom D’Agostino: Yes. When we fast or we go into a state of ketosis, whether it’d be diet or fasting, then you're getting fatty acids to the liver through your adipose. For example, if your sympathetic nervous system is activated, it can activate hormone sensitive lipase and then the adipose tissue are like cells that contain the fat and then you're liberating the fatty acids-- the triglycerides and fatty acids from your system and these fats go in circulation and the fats are an amazing source of fuel for skeletal muscle, the heart preferentially burns fat for energy, the liver relies on fat for energy and many organ systems do. But the long chain fatty acids that are typically dietary and the fats that are stored in adipose do not readily cross the blood-brain barrier. So, what happens is that these long chain fats are broken down through a process called beta-oxidation and to their constituent molecule, which ultimately is acetyl-CoA and then the acetyl-CoA is a breakdown product of fat, which is occurring at a very high rate in the liver. The liver is chock full of mitochondria and there's just like massive fat oxidation in the liver. Interestingly, the liver cannot use ketones as an energy source. The ketones that are produced in the liver get spilled into circulation and then they become fuel most importantly for the central nervous system.

Melanie Avalon: Up next, friends, we have a guest I was particularly excited to interview because he is somebody that I have been following for years. Years, years, years. Ever since I really started getting interested in health, Chris Masterjohn was one of the go-to guys. I would read his blogs, read the forums of people talking about his work. So, it was an incredible honor when Robb Wolf introduced me to him. Chris Masterjohn is honestly one of the smartest people I have ever met. I was also a little bit overwhelmed about interviewing him because there're so many things I could talk to him about. Definitely check out the episode because we covered so many topics. It's like a grab bag of fun things. Here is just one of them, which is the reasoning and logic of the RDAs for vitamins. It might not be what you think.

Chris Masterjohn: Okay, let me go back to your first question before I answer that because your first question was about amounts. The RDAs, so, there's the National Academy of Medicine which used to be until recently was the Institute of Medicine, their food and nutrition board sets the dietary reference intakes or DRIs. Within the DRIs, there are minimal amounts, and upper limits, and various other values that feed into them. The most popular of those are the one that people pay the most attention to is the RDA, which is the recommended dietary allowance. And then when there's not enough evidence to make an RDA, there is an AI or an adequate intake. And then there also are tolerable upper intake levels, which usually people, if they refer to them at all, just call them the upper limit, those are set for some nutrients and not others just based on whether there's any known toxicity. And then very recently, just with the salt and potassium guidelines, they came out with a new one, which is, I don't know if I remember it right. I think it's something like the chronic disease reduction requirement. I'm messing it up. But it's one that's aimed at not preventing a deficiency disease, but rather reducing the risk of a chronic disease.

Then when people look at the values on a food package, usually, those are the daily values that are set by the FDA. They are not set by the National Academy of Medicine and they are not part of the group of DRIs that I was just talking about. But they usually are derived in some way from the DRI set by the National Academy of Medicine. But actually, there are some very significant discrepancies. For the longest time, they were recently revised, but for most of our lives, the daily values are actually using old DRIs from significantly longer ago. And so, you would see, for example, that the daily value for biotin was 10 times higher according to the FDA than the adequate intake set by the Institute of Medicine. There are definite discrepancies with what you'll find on a food label for these. But dietitians will usually utilize the DRIs, food tracking apps will often, they may be using the daily values or the DRIs you would have to look. And then if you google what's the RDA for something or what's the upper limit for something, you're generally going to find the DRIs.

Okay, so, the RDA, when there's an RDA set for a nutrient is set on the assumption that the amounts-- This is where I'm getting to the answer to your question about variation. The RDA assumes that there's variation in the amount that different people need of a nutrient. The RDA is not meant to be used by an individual to say you need to consume this amount. Rather, the RDA is basically set for a population. First, what they do is they calculate an estimated average requirement or EAR for a population. And then they try to make the RDA cover 97.5% of the needs of that population. Usually, this involves assumptions rather than data. That's because usually they have no idea what the variation and the need for a nutrient in the population is. The standard thing that they do is they say, “We have no idea what the variation in the need for this nutrient is. So, we will assume that it is normally distributed, which means that it takes the shape of an ideal bell curve. And we will assume that, so if you have data that that takes the shape of an ideal bell curve, two standard deviations covers--” If you take the mean and you go up two standard deviations, you'll arrive at the 97.5% coverage point. You have 2.5% of the area that bell curve is left out. They assume that there's a bell curve of some variation. They say, “We have no idea what that variation is, but we'll assume that a standard deviation is 10%. And so, we will cover the need for 97.5% of the population by taking the estimated average requirement and multiplying it by 1.2.” In other words, adding the two standard deviations of 10%. So, adding 20% to it to cover the needs of 97.5% of the people.

Now, one of the problems with this approach is that anytime they ever do have any data on the variation in the need for this nutrient, it's way higher than 10%. There's never been a nutrient where they've measured the variation and the needs for the nutrient in the population and arrived at something as small as 10%. But for very long time when the DRIs were being set, the person who was the chair of the committee over, actually, probably the majority of the DRIs that are set was at that time very concerned that if you set the RDAs too high, everyone would go out and be supplementing, then we'd wind up with a mass vitamin toxicity problem. Under this concern, they systematically erred on the side of setting the DRIs to be in the absence of knowing exactly where they should be on the lower end of where they thought they might turn out.

Melanie Avalon: Up next, we have one of those interviews where I heard this guest on Joe Rogan and was immediately like, "Can I please book this person?" Dr. Anna Lembke is doing fascinating research on the nature of addiction, the neurotransmitters in our brain that are involved, what addiction actually is. One thing I love about her book is it's a really nice blend of science and also really interesting personal stories about her experiences with many of her patients, including some pretty shocking ones. And even Dr. Lembke talks about her own addiction with romance novels. In particular, I was really excited to talk to her about my own perceptions of my addictions. Like, for example, do I have work addiction? Is that actually a bad thing? We talked about so many things and I definitely recommend her New York Times bestseller, Dopamine Nation: Finding Balance in the Age of Indulgence.

Anna Lembke: Yeah, so, habit versus addiction. Habit describes a behavior that we do that is outside of conscious awareness, that we can start doing that thing without even really realizing that we're doing it, whether it's biting your nails, picking our nose, sucking our thumb, whatever it is. In many ways, habits are really useful because it's a very energy efficient way of engaging in motor activities without the cognitive load of having to think about doing it. Tying my shoes is a habit. I no longer have to think about making the bunny ears and having the bunny go and up down the hole or whatever. Habit in and of itself is not a bad thing, although, we can have bad habits.

Addiction encompasses habit and yet is more than that. There's certainly a level of automaticity in most of our addictions where we start doing the thing before we even realize that we're doing it. But addiction is beyond habit and it's negative, almost always negative. I think of addiction as conceptually as, again, a maladaptive form of coping that encompasses habit. I think CBD is a tough example, because the science to date suggests that it actually doesn't have much impact on the brain, even though, it is FDA approved for this rare form of epilepsy and even though a lot of people swear by it. The controlled studies suggest it's really no different from placebo or a sugar pill.

On the other hand, placebos are powerful. Even when people know they're taking a placebo, if they were told that it helped other people, they will have benefit from it, even when they know it's a placebo. So, I guess, what you're asking in a way is something like, if you believe that what you're doing releases dopamine, is that the same thing as releasing dopamine? I don't know the answer to that question.

Melanie Avalon: That was what I was wondering. Going back to the solution here, I feel there's two big camps that are here. One of them you talk about at length in the book, so something complete abstinence. Like AA for Alcoholics Anonymous, for example, compared to a camp of more moderation. How do you feel about those two different approaches? Is it that some people just really do require complete abstinence forever? Can some people moderate? What does the recovery pathway look like, especially in regards to abstinence?

Anna Lembke: Whether your goal is abstinence or your goal is moderation, the place to start is a period of abstinence long enough to allow those neuroadaptation gremlins to hop off the pain side of the balance, so that baseline homeostasis can be restored. When patients come in to me and they say, Ultimately, I'd like to use this substance or behavior like "normal people," I say, "Okay, I can help you with that. I can try to help you with that. But first, you have to abstain for 30 days because otherwise, you're not going to reset reward pathways." It is much harder to go from using a lot to using in moderation than it is to go from using a lot to using none going into moderation. It always begins with this period of abstinence. Again, I argue that the neuroscience supports that path. Then in terms of after that month of abstinence and resetting reward pathways, who should continue to abstain and who can use in moderation? I don't even have the ability to predict that. You might think based on past experience that I could predict that, but I've really given up trying to make those types of predictions and I just really try to help patients do the experiments to figure out for themselves.

What I can tell you is that, if you're going to try moderation, then it's very important to be very specific about what the goal of moderation is. We have data for alcohol, but we don't really have data for anything else. It just comes down to, "Well, what sounds like moderation to you?" Moderation usually means not daily use. It usually means not binge use. People are pretty good at thinking about, "Okay, well, I think I want to smoke this many days in a week or a month under these conditions with this type of substance, or play this many video games under these conditions with this type of video game, or whatever it is." I talk a lot in the book about various self-binding strategies, because I think it's an important point when we're talking about abstinence versus moderation that there are frankly certain drugs that it's impossible to abstain from. If you're addicted to food, you can't just stop eating. If you're addicted to digital devices, for most people, their work requires them to be on devices to be able to do their jobs. So, then the discussion of moderation becomes a universal one, where we then all need to think about, "Okay, how can I manage my consumption of this thing that I essentially must consume in the modern world or for my survival?"

Melanie Avalon: All right, friends, what better way to close this show than with a guest that has been one of my most popular to date, talking about one of the most popular topics that I talk about, which is Intermittent Fasting? Megan Ramos is a legend in the fasting world. She works with Dr. Jason Fung and co-authored the New York Times bestseller Life in the Fasting Lane: How to Make Intermittent Fasting a Lifestyle—and Reap the Benefits of Weight Loss and Better Health. Megan is such a beautiful, sweet, kind soul and so knowledgeable on fasting and especially its practical implementation for people doing it. She works in the clinic. She works with these people. She is a wealth of knowledge, and I definitely, really appreciate her support of fasting and females specifically. To end this Best of Episode part One, please enjoy this excerpt from my conversation with Megan Ramos.

Megan Ramos: Type of movie and that's called your abdominal cavity. There's the space between your abdominal cavity and your skin that covers your belly and subcutaneous fat primarily lives outside of that shield, between the skin and the shield. It's separated from your organs by the shield, by the abdominal cavity. It's not able to infiltrate them and cause issues with them. It just kind of sits there. This is the fat that we don't necessarily like when we're at the beach and we're trying to wear a bikini or trying to fit into a tiny dress or a nice suit. We don't like this fat because it's what society has typically labeled as unsexy. We associate this type of fat to be the fat that comes with disease. And, well, yes, you could accumulate it, accumulate it and put enough strain on the body, it can lead to disease and to problems. What's actually more dangerous is the visceral fat, not the subcutaneous fat.

The visceral fat, that's the fat that is underneath that abdominal cavity, meaning that it can infiltrate inside your organs and wrap around your glands and your organs. It's like putting headphones on your organs because it prevents them from being able to hear signals that are being sent from other organs and other glands to do certain functions in the body, or it will just so infiltrate them with fat that they're unable to function properly. Something that we all very commonly hear about these days is non-alcoholic fatty liver disease. When you have an ultrasound done or CT scan done that diagnosis this, you'll see phrases like mild, moderate, and severe fatty liver infiltration. That's just how much of the liver gland has been infiltrated by fat. We'll see things like this happen with pancreatic function. We'll actually see tons of fatty pancreases now on CT scans and ultrasounds.

And I was just really wild because I've been looking at these results since I was 15, never. When I was like 26, 27, I started to see these coming up on ultrasound and CT scan results. I saw a fatty spleen once, and I was like what the heck is a fatty spleen? And I'm calling radiology. This is like a typo here. I'm like, this is a big typo. And it's not, so you get this infiltration and then that really disrupts organ and gland functioning and communication that leads to a lot of diseases and causes a ton of inflammation in the body as a result. So, this is really scary. These people are usually walking around thinking that they could afford to eat an extra cheeseburger because they don't have a lot of the subcutaneous fat. They're what we call thin on the outside, fat on the inside. We hear from these people all of the time.

We're type 2 diabetic, we're not type 1, but we don't understand. Jason and I have this one patient came in. She was very petite. She was like 4 feet 10 and she was like 89 pounds but she was all fat. By body composition standards, she was morbidly obese. The idea was not to make her 50 pounds, and when I was 97 pounds it was not to make me 50 pounds, but it's to make sure that you've got a healthy body composition by shifting the ratios around less fat and more lean mass, more bone and muscle mass. That's why at 120 pounds, am a size 2 and I'm less obese than I was at 97 pounds, and I wore a bigger size at 97 pounds because I had more fat mass. Body composition and body fat are kind of a finicky thing. Sometimes genetics plays a role in in where you gain this fat.

Sometimes you'll see families where everybody's very slender, but they will have type 2 diabetes and metabolic syndrome. You'll see families that are all very perhaps overweight because they have a lot of subcutaneous fat, but they don't have heart disease, they don't have type 2 diabetes. You're really kind of unfortunate if you get a mixture of both the visceral and the subcutaneous fat, because people with that visible fat, they really feel awful about themselves because society has just set us up to feel that we must fit a perfect box all of the time. There's these different types of fat and they can manifest in different ways, but it's actually those tophi that they're at the highest risk for serious cardiovascular complications, serious diabetic complications. They're the ones that really need to focus on adjusting their body composition the most.

Melanie Avalon: Okay, friends, I really hope you enjoyed this best of recap episode. Again, if you would like to visit the full episode for each guest, check out the show notes. They will have links to each individual episode, so you can check that out. Let me know what you thought of this. If you'd like me to continue doing it every year, join me on my Facebook group that's a great place to connect with me. Also, let me know what your favorite guests were from the year, and stay tuned for part two.

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