Satiety: the path to healthy weight loss — Diet Doctor Podcast

Foreign Welcome back to the diet doctor podcast I'm your host Dr Brett Sher today I'm Joined by Dr Ted Naaman or I should say Joined Again by Dr Ted Niemann hopefully You've seen him on the diet doctor Podcast before he was on episode 40 back In February of 2020 talking about the Pillars of long-term health and then Again episode 70 in May of 21 talking About the power of protein well today He's back again to talk about satiety Now satiety is a word that you know you May not have heard of all that much and You know so it's important for us to Talk about what does satiety mean and More importantly than what it means what Does it mean to you how can you use the Concepts of satiety to help you eat Better which then can help with healthy Weight loss improve metabolic Health Whatever whatever your health goals may Be so satiety could be the most Important number one factor to help you On your your journey for a long-term Sustainable eating pattern and we also Talk about how these concepts of higher Satiety eating can apply to any kind of Diets whether it's a plant-based diet a Carnivore diet Mediterranean diet Anywhere between high protein low Protein how the concepts of satiety fit Into those different patterns so Whatever eating pattern you're coming

From this podcast is likely going to Help you this concept of satiety is Likely going to help you now if you Haven't heard of Dr Ted Naaman before He's a family physician in the Seattle Area he's the author of the PE diet book He's very active on Twitter and Instagram at Ted Naaman and he's a big Proponent of healthy eating eating Better eating higher satiety so without Further Ado let's get into this podcast So you can learn if higher satiety Eating is right for you [Music] So Ted let's start with what sounds like A simple question but maybe isn't what What is satiety how do you think of Satiety satiety well satiety is the Absence of Hungary and satiety is the Non-hungry Sensation that you get in Response to eating and uh you can kind Of measure satiety A couple of different ways it could be How long you go after eating before your Next meal or it could be Um at a subsequent time to meal how much You eat so if you ate something for Breakfast like maybe you go all day Without eating that would be a lot of Satiety or maybe you have lunch uh Planned four hours later but you don't Eat very much that would also be satiety So it's really just the absence of Hunger that one gets as a consequence of

Eating um and getting nutrients yeah you Know it's interesting in in diet doctor Which is based in Sweden we've been Talking about the term satiety a lot and I love how they brought up there's this Swedish term Mech which means like just Kind of comfortably full and we don't Really have the same term in English and Is because some people think like it's a Tidy like stuffed like I'm just full and Can't eat anymore or is it more Mech is It more that comfortably full so how do You help people understand that it's not Like I don't know that you don't just Stuff yourself and you're satiated but At what point Can someone say I'm Adequately say appreciated how do they Get in touch with those feelings well I Think that's tough and you're right we Don't have a good word for that here in The US and it's probably too bad I know In Japan they have an excellent concept Uh for a similar phenomenon and we kind Of need something analogous and I I Always encourage people to get very in Touch with hunger and fullness so they Really know what it's like to be Actually hungry and what it's like to be Comfortably full or properly um stated And that's one of the things that I Think maybe intermittent fasting might Be somewhat beneficial for is people Know what it's like to actually be Hungry rather just than just you know

Running out of glucose from their last Carb snack or something so there are Different levels of hunger and different Levels of fullness and satiety and the More in tune with that you are the Better off I think you're going to be in The long run so it's a very important Concept in terms of like I think around Here you know you go to the All-you-can-eat buffet and satiety is Just like eating so much that you can't Move like the meal's not over until you Just hate yourself and you can barely Move and you feel sick so we need a we Need a word like that that's definitely True yeah so the Japanese concept you Refer to is at the the harihachi boo That like eat to your 75 full basically That concept right right I don't know if It's 75 or 80 but it's like something's Around there and it's just like not Quite full and just comfortably okay Yeah that's a good point so if you're Trying to design the worst diet for Satiety is can you think of a worse one Than like the standard American diet or How would you design the worst diet for Satiety no I can't think of a worse diet Than that and in fact uh you know there Have been a lot of companies trying to Design obesogenic radchild that is uh That is most efficient at fattening uh Rats and mice in the lab to create Western diseases like diabetes and

Um you know metabolic syndrome and Obesity and they've really found nothing That's more effective than human junk Food which tends to be this strange Combination of lowish protein around 10 Percent a high carbon high fat at the Same time 40 to 60 percent of each and Then uh very high energy density and Pretty much every omnivore mammal will Overeat that by about 40 percent of Calories in your lab rats and mice will Um just completely overeat that from a Weird combination of Hedonism because It's so tasty with the trifecta of high Carb high fat high energy density and Also the protein and nutrients are low Enough that nothing's stopping you from Radically overeating non-protein Calories and so uh I don't think we have Anything that's better than human junk Food at um I don't think there's a worse Diet and believe me people have tried For a laboratory rodents so no I think We've pretty much hit Peak obesity with Uh tasty junk food and when you think About it the just kind of the free Market uh economics of all this is Designed to just slowly evolve towards The food that is the most addictive the Most over consumed and generates the Most profit for shareholders for um you Know Mars or you know whatever company Isn't designing this uh junk food so I I Think everything is working as it should

In a free market economy where you just Uh evolutionarily fine-tuned food to be Maximum Um consumable and here we are yeah it's Like well welcome to America so yeah I Know I don't think there's anything Worse honestly yes when we look at all These graphs that show in like the late 70s early 80s just the takeoff of Obesity and type 2 diabetes and how it Just like continues to go up do you Think the number one cause is lack of Satiety or increased hunger or you know Too many of the non-satiating calories Would you go so far to say that is the Number one cause or we say it's like Yeah it can equally contributing as Other factors Well I think it's a weird combination of On one hand nutrient dilution so you Have you've diluted protein and minerals And nutrients with refined carbs and Refined fats you basically just dump Sugar and oil into the food supply so You get this nutrient dilution and You're forced to overeat calories from Fat and carbs to get enough satiety to Not be hungry but then on the other hand So you're pushing it forward with this Nutrient dilution and then you're Pulling obesity forward with the hedonic Tasty addictive rewarding nature of These hydrogenic carbs and fats and so You're liking and you're wanting is very

Very high for these Foods so it's this Weird combination of push pull uh both Of which however is generated by this Protein dilution and nutrient dilution And absence of fiber and so technically The satiety is very very low either side Of that coin that you look at the amount Of satiety for the number of calories You ate is horrible so whether you're It's tasting addictive that's negative Satiety for a trillion calories and and Then if it's just protein diluted Donuts Or something that's also very little Satiety for a billion calories and That's also horrible satiety per calorie So the the lens of satiety per calorie It really explains both sides of this Obesity Push Pull which is really just Dilution of nutrients for refined carbs And refined fats so I do think that kind Of explains you know both sides at once That's a good explanation except Ted now You just really stepped in it you used The c word you said the word calorie so As soon as some people say hear the word Calorie they just like it's not about Calories it's not calories in calories Out calories don't matter so you know It's I think it's more nuanced and we Actually have a recent guide that we Published a diet doctor about when is a Calorie not a calorie but you said Satiety per calorie so help us Understand the difference between

Satiety and satiety per calorie nothing Would give you more acidity than Actually eating a billion calories of Junk food if you just say like 10 pizzas And a gallon of ice cream you would have A ton of real satiety like you would not Be hungry for a long time but you would Have also eat you know like 150 million Calories so that's if when you take the Satiety you got and divide it by Calories that's Horrible's tidy for Calorie but if somebody made you eat you Know 20 chicken breasts for a Competitive eating some sort of food uh Eating competition uh you would have a Lot of satiety for way less calories and So that would be satiety per calorie You've got calories in the denominator So something that makes you feel really Full like a skinless chicken breast that Doesn't have a lot of calories it would Have very high society of calorie but Like just eating you know a dozen Krispy Kreme Donuts would give you uh a lot of Society but even more calories so fairly Poor satiety per calorie it's It's Tricky and everyone's like well you know I get tons of satiety from oil and Butter and fat and lard and bacon and And nuts and I'm like uh yeah but Um that is a lot of calories and I know Some people don't believe in calories Right I don't either like a calorie is Just a made-up thing but the carbons the

Carbon atoms in every single gram of fat You ever ingest will end up one of two Places inside your fat cells or Somewhere else or if they're full Somewhere where your body's trying to Sort of fat like shoving in your liver Uh or you will exhale them after you've Oxidized them in your mitochondria Period so this is just mass balance Every carbon atom you ingest from fat Has to either be stored in your fat Cells or exhaled after you've oxidized Your mitochondria Um and you have to either exercise more So you're exhaling more carbons or eat Less to begin with and so whether you're A calorie believer or not and I'm I Honestly like to think about it more as Mass balance in carbons personally just From a mechanical engineering background I do agree that calories is sort of a You know make-believe construct but uh It's very very real it's the the energy In these carbon bonds is a real thing And it's going nowhere unless you burn It off and yet there's you know so many Examples that diet doctor and throughout The world of people who started a Ketogenic diet by purposely eating bacon And putting butter in their coffee and You know cooking their meals and cream And adding cheese to everything Which theoretically is poor satiety per Calorie but they lose weight and they

Feel better and they start hitting a lot Of their health goals and reduce their Blood sugar so how do we balance the Concept of satiety per calorie with Knowing that other examples exist with Poor satiety per calorie foods like fat Helping people lose weight at least Initially gotcha well first of all in Almost every scenario people who've done This have increased the protein Percentage of their diet which is Incredibly powerful for society Um another thing that we know is Evidence-based for improving satiety for Calorie is a reduction in the glycemic Index of your food so if you're eating Lower glycemic index carbohydrates Um you know Dr Ludwig has some great Studies on this this is evidence-based You will have higher satiety per calorie You'll eat less with a lower glycemic Index so Um eliminating refined carbs which have A very high energy density Um eating less refined carbs which have Higher fiber which definitely produces a Tidy for calorie eating a higher protein Percentage the lowering the glycemic Index all of these things have been Dramatically proven to improve satiety Into tidy for calorie so every single Thing that you mentioned mentioned there Is going to make people have higher Study for calorie with the possible

Exception of adding a lot of added fat And to be perfectly honest I think Um the addition of saturated uh or not Just saturated fat but adding any kind Of fat might be one of the reasons People Plateau on a low carb diet Because you know I you know I have so Much low carbon experience with patients And everybody like immediately just Drops 20 pounds and then plateaus out a Little bit fatter than they want to be And that's where you might want to look At the next level of society per calorie Which is possibly Increasing protein and fiber and water And uh weight and volume of food for Fewer calories which typically does Involve at least eating less added fats If not even lower fat proteins so that's Just one other lever people can pull and I think that's the one lever that isn't Already pulled on a well-formulated low Carb or ketogenic diet yeah that's a Good point there's a lot about a keto Diet that makes it inherently a higher Satiety diet but then the question is Can you do even better but so the next Perception I think is well to do even Better means I have to eat Skinless chicken breast and plain Steamed broccoli and that sounds Miserable for a lot of people and that's You know old dietary advice that many People have have not succeeded on so is

That the satiety per calorie diet that Most people should be following plain Skinless chicken breast and plain Steamed broccoli definitely no so so Um you get a lot of very acute Short-term satiety from things like Water and fiber and these improve Satiation which is terminating meal Basically feeling like you're full at That time but for a longer term for a Medium term in late term satiety this Post ingestive satiety you absolutely Have to have fat in your diet you will Not have good medium to long term Society and late to tidy without fat if You go too low in fat you're just going To be hungry again way way too soon and We see this in low-fat vegan fried Italians who are just eating you know 20 Times a day because they uh you eat a Whole watermelon you've got a ton of Satiation and very early term satiety And intramile satiety which is where you Just stop eating because your stomach Can't hold another head of cabbage but Um you know medium satiety lay satiety Hours later you're starving again way Too soon so you absolutely don't want to Go to zero on fat that's a huge mistake And so there's kind of this spectrum Where if I just took everyone's food and Just poured oil on all of it all the Time you would possibly overeat calories You would actually get fatter

Um because you're ingesting calories That are not improving satiety or adding Nutrients you just are ingesting carbons That have to go somewhere usually your Fat cells so um the worst case scenario Will be pouring oil on all your food and You're basically just going to Automatically have more calories for the Same satiety and there's a sweet spot Where like pouring oil and everything Would be bad and then just eating Nothing but skinless chicken breasts and Egg whites whey powder with no fat at All would be really bad because you Might be full during the meal but you're Going to be hungry and way too soon and Somewhere in the middle of that spectrum Is sort of this sweet spot there's Probably a pretty good range where you Know if that's you know 40 of your calories or you know maybe You know 30 or 50 60 somewhere in this Middle Zone where it's not too low or Too high and I think that's what people Need to be aware of Um so it's like yes you have to have fat For medium to long term so type relates To type but no you don't have to pour Oil on every single thing you eat Because that's probably going to add Calories without any additional satiety That's a good summary no no you know You're the author of the PE diet book And one thing that book is really known

For is the graphics the graphics are Amazing and you so you're you're well Known as like a just a graphic Creator To show Concepts difficult Concepts more Simply and in cool ways so I saw one Recently on your Twitter profile which I Highly recommend Everybody follow that Was the three these three different bars And it was fat and water on one it was Carbs and fiber on another and then it Was protein what was the other side of Protein in the middle energy yeah Protein protein and energy exactly Exactly so tell us tell tell us how this Diagram Fits into the concept of satiety the Specific parts and sort of what we need To focus on this diagram was honestly Kind of confusing and busy and nobody Got it and it might have been a total Fail which is fine but I was looking at Basically the satiety per calorie from Three different axes so there's already Sort of three different Spectrum uh the Number one being protein versus Non-protein calories and I displayed it As sort of a vertical axis with protein At the top and non-protein calories That's net carbs and fats at the bottom And this is really just protein percent Of calories and to be honest that is the Single most powerful metric when it Comes to satiety per calorie and ad-lib Uh caloric intake or how much you're

Going to eat protein percent of calories Is the single most important thing that Anyone could pay attention to if they're Trying to eat less automatically still Feel full and lose weight and that's why I read the whole book the PE diet about It because it is the most part powerful Thing and this isn't really debatable This is basically Um you know there's nothing else you Could point to that's more powerful for People automatically English so that was One of the the Spectrum I was looking at Protein versus non-protein energy in Terms of calories so it's basically Protein for 10 calories the other Spectrum I was looking at is uh had Fiber at the top and non-fiber Carbohydrates at the bottom so this is Basically the carb Spectrum everyone's Familiar with the carb Spectrum at diet Doctor because all of our visual guides For like the lowest carb nuts and lowest Carb vegetables and lowest carb fruits Is really just this same thing it's Looking at fiber versus non-fiber Carbohydrates it's like if you look at The whole carb Spectrum you'd have like Pure fiber at one end and you'd have Just pure sugar at the other end so it's Really almost like a fiber to just pure Sugar Ratio and uh obviously going a little Bit higher is better for satiety calorie

As every single low carb or can tell you Because that seems to be Universal on Successful low carbine ketogenic diets Is people are eating less refined carbs Glycemic carbs High GI carbs sugar-ish Carbs and they're eating more Um non-digestible carbide more fiber More you know vegetables and that sort Of thing and so this is another spectrum That is very evidence-based for uh your Calorie we know that higher fiber gives Highest Saturday so it's a lower Glycemic index gives higher satiety so You're kind of doing both at the same Time when you go up that axis and then The third one in this crazy crazy Graphic of mine then nobody really Really liked is um uh I like why well Thank you Um one vote water versus fat so there's This water fat Spectrum which a lot of People might have never heard of but This is actually fairly well documented In the medical literature and in the Scientific literature there's a spectrum From from water to Fat where foods that Are higher and higher and higher in Water have less and less less fat and Then foods that are higher and higher And higher in fat have less and less Water so like oil has no water at all And butter has no water at all and then You know your foods that are 99 water Are not going to have any fat and this

Is a huge driver of caloric energy Density so when you look at like just The caloric energy density of a food Like you know you got a candy bar that's 50 grams in weight and it's 200 calories So it's got you know uh 0.25 I mean I'm Sorry for kcals per gram so it's Basically got a caloric energy density Of four calories per gram and this is Like mostly driven by the water versus Fat Spectrum so like you've got a food With no water in it like potato chips They're just like starch in oil and They're dehydrated so there's no water At all so they're very very low way down Here in this fat Zone they have Incredibly high energy density they are Also by the way super obesogenic in the Food most associated with obesity use Potato chips basically because it's Dehydrated and all the water's gone so You have all these foods that are dried And have no water and just a lot of fat Having super high energy density and They're easy to overeat like nuts for Example nuts are all the way down here They have no water at all they're super High in fat and the energy density is Crazy high so you probably will over Consume them peanut butter nuts of any Kind cheese is kind of down there Unfortunately and you've got all these Dried foods that are hideous like Crackers they have absolutely no water

Left and it's just 50 50 fat and carbs Refined carbs and this is like a Horrible combination of uh not only a High energy density high carbon high fat But there's just no water no fiber no Protein is like crackers would be at the Bottom of all three axes right it's like All fat in the water all carbs and fats No protein uh and then basically all Refined glycemic carbs in no fiber and So that's the very worst so down at the Bottom you'd have potato chips and nuts And crackers and all these foods that Are just sadly horrifically obesogenic Um and then at the top you would have Stuff that's really high in protein and Fiber and water and things that nobody Could overeat even if they tried that's Like salad and lettuce and and you know Vegetables and asparagus and the Skinless chicken breasts and uh Um you know low-fat cottage cheese and Just things that like you just cannot Overeat this like fish and salad you're Just gonna stop eating that like you Know I I defy anyone to overeat fish and Salad with a low calorie dressing like You're just you could like if we just Put anyone on a desert island with Unlimited amounts of salad low calorie Dressing and fish you're just gonna Cruise right down your ideal body weight And stay there forever because you Literally cannot overeat these foods and

That is why Um so I just I felt like this was a very Powerful way of kind of summing up Almost all of the evidence-based factors For satiety per calorie and one nice Little graphic and yeah and again I Don't know I don't know if it's uh Effective or not but yeah I like it yeah I love the effort I guess yeah based on The Twitter comments the graphic wasn't A home run it was a little confusing for People but I think the effort is awesome And I love I do of how how it combines The different components of satiety and Does sort of sum it up but so there's The counter argument though that look if You're coming from a standard American Diet and applying these changes no Question you're going to improve satiety And you're going to improve your health And weight loss but then there are also Sort of the extreme sides of things and One of which especially when you talk About fiber is a no carb diet a Carnivore diet an all-meat diet where People who start those diets tend to Feel full tend to lose weight they'll Eat once or twice a day and for it tends To be a very satiating approach for them With zero fiber and zero carbs and so You know sometimes the extremes uh kind Of break the break the theory a little Bit and to be honest the studies at Energy density and the studies of fiber

Didn't look at this because you know 10 Years ago this was crazy nobody would Even do it and a lot of people still Think it's crazy and wouldn't do it Within the medical community so so how Do you sort of uh I don't know how do You bring that into the picture to say Yeah this exists and this is a satiating Diet for many people who try it yeah Absolutely and this is a great example Um I I and I I like you know carnivore Diets I have nothing you know Particularly bad to say I have a lot of Patients who've tried this and had some Success with it and what what that's Doing is automatically pulling almost Every single lever there is I mean first Of all Mead uh it's fairly low energy Density there's a lot of water in meat Most meat is just a medium to low energy Density some meat like fish and shrimp And anything out of the ocean is Actually super super low energy density So most of your meat is like medium to Low energy density uh it's all you know Zero carbohydrates the glycemic indexes You know absolute zero so you've got Food with a large weight in volume a Very low energy density uh very low Amount of glycemia or like not at all It's got you know a low carb low alcohol Hall low energy density tons of protein Like absurdly high protein like you just Go ahead and kill an animal and eat the

Whole thing if it's the fattest cow You've ever seen that's 30 Protein That's as low as it ever gets and Everything else is higher than that so Like uh you know you've just got like The fattest cow ever 30 Protein that's Like crazy high uh and then everything Else is leaner and even higher so like Uh you know poultry is higher and uh Wild game like venison and rabbits and Bison is way way higher in fish and Seafood is just absurdly high and like You just got incredibly high protein Percentages and we know that's the Biggest driver of all so you're pretty Much just done right off the bat with Protein then you've got micronutrients So all of these micronutrients have some Type of satiety uh value add for society Per calorie like potassium and calcium And you just got so many microbes in in Here so you're pretty much hitting the Win button instantly on every lever There is except for fiber and so then You have to ask well what if I had like A really well-designed carnivore diet Over here and I randomized people into a Really well designed carnivore diet with A freaking salad you know with a side Salad of every meal and I stuck them in A metabolic board uh I I don't know if You read the latest Kevin Hall study With the uh low low fat plant-based diet Versus the uh you know high fat low carb

Animal based but the plant the low fat Plant people ate like 750 calories less Per day and so I I think it's possible That the total exclusion of fiber is Helping people who have irritable bowel Syndrome or are sensitive to fodmaps or Have any kind if you have any kind of Inflammatory bowel irritable bowel uh GI And happiness with certain fibers maybe It would be good to not eat as much Fiber but most people I would say you Probably actually do slightly better Um eating that side salad on your well Formulated carnivore diet and until Somebody proves me wrong with a Well-designed randomized uh you know Uh trial in an impatient Ward and I'm Challenging Kevin Hall to do exactly That Um I would say you know maybe it's Carnivore is great but maybe it could be Even a tiny bit better well my plea to Kevin Hall would be to and I talked to Him about this on on the podcast a while Ago was to be to make these studies more Than two weeks because that study you Referenced was two weeks and the Calories in the low carb group was going Down dramatically between week one and Week two and would it have kept going Down we don't know because the trial Stopped at two weeks and you know for Any kind of diet especially a keto diet It's got to be longer than two weeks

Preferably four weeks or even longer Which is really hard to do in a Metabolic Ward so I think we're we're Gonna have to hold our breath on that Although Kevin did say he was going to Do longer studies and at least four week Studies I think Um but I like the idea of Um Dr David Ludwig's trials better that You're like at some you know his trials Were like at this lake house out you Know out in the woods and that's where You get to stay as opposed to being Stuck in a metal block Ward you know Like just doesn't sound quite as Enjoyable so harder to do that longer Time that's true well I feel like you Can have well-controlled or really long But never both it's like a total Trade-off and so we're never we're never Gonna get what we want okay so we talked About one end of the spectrum then with Uh zero carb or carnivore diets so the Other end of the spectrum would be like The traditional Okinawan diet which is Reported to be like nine percent protein And all sort of sweet potato Um and and like kind of like local Vegetables and things that they forage For so I guess we don't really know Their satiety levels but we know that They didn't have type 2 diabetes or Heart disease and they lived until their You know 90s and

Um so how do you explain that from a Satiety perspective then right right and So you know this just completely Destroys anything I had to say about Protein being most powerful and we got The samane eating 12 protein diet it's Like slightly less than the protein in The U.S and I think that really Highlights the importance of not being Like mono focused on any one factor Because you know all of your plant-based Vegans who are successful are eating This fairly low protein percent but They're driving all the satiety for Calorie with low energy density and Micronutrients and fiber and water and All they're basically doing everything Else on the list and they're totally Getting by they're they're in incredible Health and all of these groups uh with Low protein diets you know are Accomplishing that because the energy Density solo so like in Okinawa they get All these calories from potato these Sweet potatoes which uh are incredibly Fibrous like the the fiber per thousand Calories in their diet it's like a Hundred compared to 15 in the U.S energy Density is super super low so like your That potato is like 0.8 Cake House per Gram that's that's nothing I mean yeah You have to eat your body weight in Those every day to get enough cow Dollars just to be alive so you can't

Overeat it so that's a perfect example Of how all these other levers added Together can be just as powerful as uh Like something like protein so you know The potato has an absurd amount of Potassium in it uh that is probably the Most important micronutrient when it Comes to satiety for calorie so they're Getting this crazy high micronutrients Crazy high potassium uh super um high Fiber glycemic index is actually not as Bad as you would think energy densities Rock Bottom low and then it doesn't Matter what the protein percent is as Long as you get adequate protein all Those other factors are going to raise Type calorie enough that you're going to Be fine and I not even mention the fact That they you know they have a step Count of twenty thousand steps per day Versus four thousand steps per day in The U.S so if you are having to eat more Carbs to get to the protein where you're Not hungry you're just walking it off or Basically you're eating that after You've already walked and you're Starving so I would say that that's Probably a factor somehow too you if you Have to eat a protein daily diet but You're doing a lot of walking exercise Caloric expenditure with physical Activity then you're probably insulated From some of that yeah good point I like I like the analogy of pulling the levers

That if you're going to pull the protein Lever pretty hard you don't have to pull The other levers as hard but if you're Not going to pull that protein lever you Can still get there by really cranking Down on the other level levers to to More of an extreme so I think that Visual can really can really help and You talked about exercise so how does Exercise play into satiety because we Hear you know exercise isn't the best Way to lose weight although it may help You maintain weight A lot of times exercise can actually Make you hungrier depending on how you Do exercise so how do you see exercise Fitting into satiety basically we do Know from studies that exercise is not a Great way to drive weight loss like you Don't want to say okay it's time to lose A bunch of weight I'm going to do it With exercise and the problem is as you Exercise more and more your body just Puts a rigid ceiling on calorie burn by Just making you sit on the couch the Whole rest of the day so you do an hour Of CrossFit and then you literally don't Move for the rest of the for the other 23 hours a day because you're just wiped Out and so your body throttles back on Everything else and so it really caps How much actual weight loss from just Burning calories you're going to get From exercise so it's never good to just

Say oh I'm gonna just keep eating the Same diet and drive all my weight loss By just doing more and more and more Exercise that is not going to work and We do know that Um for a fact however we have all these Uh ideas that are actually kind of wrong Like everyone thinks well exercise is Just going to make me hungry or I'm Going to eat more I might even gain Weight all of this is pretty much Mythical like we have a ton of studies Now that show that people do not Um compensate all the calories back from Exercise almost universally people do Lose weight when they add in exercise so Uh there's a couple factors there first Of all if you're doing any high Intensity exercise higher than about 60 Percent of your maximum output so if You're jogging or sprinting or whatever You get this extreme exercise induced Anorexia where for an hour or two Afterwards you're just super not hungry If you don't believe me just go you know Just do 20 minutes of sprinting and you Are extremely not hungry even if you're Hungry before you're not hungry for an Hour or two now that doesn't really Change your overall daily balance and Studies show that acute exercise people Give this acute exercise induced Anorexia for a few hours if they were Doing anything over about 60 percent of

Maximum output but then later in the day Okay what happens is nothing people are Not eating more they're not eating less They're not like compensating uh they're Not eating back all those calories They're they're basically just burning The calories to exercise and doing Nothing on the compensation side in the Short term that's if you're looking at Same day several days we have studies Looking at uh you know the rest of one Day two or three days in a row and you Just don't get this short-term Compensation that everyone thinks they Get your appetite is not going to be Higher you're not going to eat more food You're not going to overcompensate even The worst case scenarios which is Someone who's very very overweight and Very insulin resistant you might Compensate 50 of those calories back That you expended with cardio Um so you're it's mythical that it's Going to make you gain weight because You're going to be more hungry that's Not true what it has been proven to do Extremely dramatically is to improve uh Satiety signaling so you get much more Sensitive just Society signals so people Get way more in tune with hunger and Fullness they're a little bit hungrier When they should be hungry they're full Or after meal when they should be full And the long-term effect of chronic

Exercise is Improvement in body Composition body fat goes down because You have better satiety signaling also As you're so just exercising resistance Or cardio you get better satiety Signaling you're more sensitive to Satiety hormones you're more sensitive To the signals of hunger and fullness a Couple other things happen you also Actually have less craving and desire For hedonic Foods so people who start to Exercise don't have the same reward from Donuts and candy bars and cupcakes that They had before they actually get more Liking and wanting for healthy foods low Energy density Foods higher protein Foods they get less craving for things Like a high energy density carpet fast Together so you get an improvement in Your likes and wants you get less reward From addict hedonic abuse genic Foods You get more in touch with hunger and Fullness and then the one other thing Well a couple other things about Exercise if you're building lean mass And improving your basal metabolic rate Uh you're just burning more calories all The time and at this higher energy flux You're better able to match energy Intake and energy expenditure so there's This concept about body weight Regulation and managing intake with Expenditure and if you look at um total Energy expenditure people who are in the

Sedentary Zone where they're only Earning like 1.3 times their basal Metabolic rate so you have a basal Metabolic rate if you're just asleep on The couch all day and then you have a an Additive a multiplier of that from your Activity so if you're a super sedentary And just sit around all day maybe your Total daily energy expenditure is a 1.3 Or 1.4 times your basal metabolic rate So if you're just sitting all day but Here's your BMR if you're sedentary You're one point three times your BMR But if you can do an extra half an hour Of exercise a day and get up to about a 1.7 times your basal metabolic rate uh Or even higher you just see people Matching intake to expenditure way more Perfectly so you're just basically Automatically not overeating and uh There's this unregulated Zone where the More and more sedentary you are uh you Keep eating as many calories as you'd Eat if you were exercising and then in Order to burn those calories because You're not exercising you just literally Have to get fatter and have a larger Body your basal metal So the main determinant basal metabolic Radius body size so basically End of the day everybody's burning the Same amount of calories whether active Or not you can either burn them by being Fatter or by moving more period the end

And so that's kind of how it works yeah So it's really interesting so to Summarize that though if if you could do Resistance training and then be fairly Sedentary or don't do resistance Training but move your body kind of all Day long which would you think you would Choose for you know healthy weight loss And satiety You're not going to choose one or the Other you got to do it right down the Middle yeah I mean like if you put a gun In my head and said you can only do Resistance or cardio I would probably Pick resistance but just barely like I Honestly think they're both super Important and uh you know cardio is like Improves uh VO2 max and and cardio Respiratory Fitness is one of the number One metrics you can measure in any human As to how long they're going to live all Cause mortality Um basically the the better your cardio Respiratory Fitness the longer you're Going to live pretty much a bigger Factor than anything else you can Measure so I love doing like brief high Intensity cardio to improve uh VO2 max And maximum output and Carter's poetry Fitness but then I love doing resistance Training so you have better body Composition higher lean mass lean mass Is how you dispose of all your glucose And get rid of all your calories and you

Can burn a lot of fat in uh and um carbs In this skeletal muscle and so you Really want both it's really right down The middle like honestly the whole Metabolic health is equal parts getting More muscle and less fat at the same Time and it's equally about it's tidy Per calorie for lower fat and then Resist this is training for more muscle And then cardio so that your energy flux Is nice and high and you're just burning Through a lot of calories every day and So you you can't you really want to do Them all you want to be high protein low Carb low fat high fiber low energy Density moderate cardio moderate Resistance uh daily step count general Movement like you you kind of want to be Pulling every single lever we've Mentioned to a moderate degree and add Them all together and I think that's The Sweet Spot yeah but that might sound Pretty hard for a lot of people to do It's like wow that's a lot of things to Think about that's a lot of things I Have to change in my life so how do you Help your patients prioritize because I Think we know from experience if you try And change too many things at once you Change nothing and you get frustrated And you give up and say it doesn't work So so what's your your strategy for Helping people make the most important Changes at first so that they can stick

With it long term and succeed Right right and you never want to just Do a whole bunch of crazy things at once You're just gonna burn out Is starting out with exactly what you're Eating now And substituting Out versions that are Slightly higher in protein or Fiber and Slightly lower in carbs and fats And what that looks like is you know you You instead of uh eating you know a Burrito you eat a burrito with a low Carb tortilla and some uh like uh Chicken breast instead of Carnitas and Uh you know maybe uh you know pinto Beans and lettuce instead of like you Know something I can't I can't think of A good example there but basically You're taking each little ingredient and Trying to substitute something that's a Little higher in protein a little higher In fiber a little lower in carbs of fats I think most low carbers are doing this Already because they're like oh instead Of bread I mean low carb bread that's Awesome it's a huge win it's gonna have More protein it's gonna have more fiber It's gonna have lower energy density You're doing all those at once uh or if You're like okay right now I'm just Eating the fattiest bacon I can find Every morning for breakfast maybe I'll Eat like Canadian bacon instead it's Gonna have you know double the protein

Percent a lot lower energy density Higher Society per calorie you're going To feel just as slowing for like 100 Calories less and it's little Substitutions like this throughout the Day you just take everything you're Eating look at the macros and say oh how Could I eat slightly higher protein or Less glycemic carbs or a little more Fiber and less glycemic carbs and you Know and it's just getting like leaner This and low carb that and whole grain Something else and you know just throw It in like a salad or something and then On the exercise side also you want to Just start out really really basic like I'm just gonna wear my Fitbit or my Apple watch and just track my step count And try to get maybe two 8 000 steps a Day which is an awesome goal you know That's four miles that's like a hour of Exercise here you pretty much could just Track your steps and then go to the gym Twice a week and just do like 15 minutes Of uh push-pull legs you know it's like A chest press a row and a leg press and You you just start out really really Small do little tiny bits and just try To make it a habit and keep it Sustainable and then it's mostly about Sustainability and Tiny changes that you Can do a really long time Yes it's an interesting difference in Philosophy the tiny changes to see small

Incremental goals or make big changes to See the big your you know to see the big Improvements which can be very Motivating as long as you can do it so Uh do you kind of warn people or or tell Them ahead of time if you make these Small changes you might see very small Differences but it's the long term that We're going for like how do you keep Them from getting frustrated like yeah I Did what you said and I lost two pounds Like come on what's that you know how do You prevent that well it's really really Hard and nothing's harder than Resistance exercise so fat loss is Actually faster people can just you know Change their diet for a week and they'll Lose some fat I mean it boom it's Happening but like adding muscle Um are getting stronger or fitter or Better cardio respiratory Fitness is so Slow like you could go to the gym today And tomorrow and the next day and next Week in the week after that and you'll You won't notice really much of anything You won't be that much stronger you Won't have that much more muscle you Won't really look any better and it's so Slow you have to do it you know for six Months or a year and it's just like Building a sand castle with a teaspoon And it is very it is very depressing Which is why you have to make sure that Um people enjoy it that they're having

Fun that they know that they're making a Long-term investment in their future Health and uh you do have to set people Up for the fact that that's going to be A very very slow process and if you just You know could do that for 10 years and Then look at yourself then immediately Everybody would be just like at the gym Right now like if you can see how you'll Look after a decade of intentionally Lifting with a high you know a level of Effort twice a week for you know 10 Years oh everybody be at the gym right Now instead of listening this podcast But like it's so it's so this one is a Podcast while they're at the gym Hopefully right oh yeah there you go Perfect but but in today's society is so Like immediate right it's so like you Turn on your phone you get immediate Gratification it's you want immediate You know Amazon shipping you know one Day shipping not a plug for Amazon but It's like we're we're like trained for Um immediate results so do you get a lot Of resistance or find a lot of people Not succeed because they want better Results right now Yeah absolutely I mean like honestly if You're tick tock's more than about five Seconds everybody's on the next one so You just already lost them so I have to Admit that is very challenging because You have to play the long game and you

Have to enjoy the process and you have To be really patient and you have to see The big picture and it's uh it's that's Not easy I don't think that um you know Intuitively uh people aren't doing that Because they're looking for a faster Reward so that is tough and that's why You have to do some form of exercise That you really like and you're actually Going to enjoy it because it's going to Take a long time for it to have Measurable benefits and you have to eat Foods that you really like to be able to To stick with this long term so I guess Two questions one is you know how do you Factor in uh eating in a way that you Really enjoy that fits with satiety per Calorie but also is there I guess the Core layer that question is is there Risk of going too far high protein low Carb low fat and you know is that Sustainable right like 10 fat and 10 Carbs and the breast protein like who Can eat like that right so there's an Extreme to this satiety approach that That is just not going to be enjoyable So how do you help people find that Sweet spot well the answer to both of Those is the same thing and that's this Tiny gradual progression with little Tiny changes that you can sustain so Like uh if you're like oh wow okay Protein fiber water good Carby fats are Bad I'm just gonna eat whey powder and

Then drink a gallon of water done uh It's you're just gonna completely fail You you really just can't go that Extreme uh the the marsh stream you get The less sustainable it is the faster You're just people and then people fall Off the wagon hard and they just binge And then they're like oh dieting's Stupid I'm never I'll just eat whatever I want and so there's so many things That can go wrong when you try to go too Extreme uh you know first of all if you Lose weight too fast in general half of What you lose is lean mass so then you People rebound they lose you know 50 50 Fat and lean mass and then they're based On the Block rate goes down and their Body still must eat the same amount of Calories so everyone just loses weight Gains it right back so the slower you Can lose weight the better because the The higher and higher and higher percent Of the weight loss will be actual fat Um so the way you kind of prevent either Going way too extreme and crashing and Burning or Um you know and also making it Sustainable is to make these tiny Changes so like I don't care what Anybody's eating right now you could Find a version of that that's slightly Higher satiety per calorie let's say you Just it totally exists on off Krispy Kreme Donuts they make a donut that's a

Cake donut that's not glazed and it's Literally got half the calories so if You switch to cake Donuts from glazed Donuts you're actually gonna lose weight And like you know it's just like little Tweaks like that you know meet people Where they're at but you take your Existing diet and just make these little Directional tweaks to them and uh just You know keep it sustainable keep it Enjoyable make sure you like it enjoy The process and then just iterate on it You know consistency is everything so if You make these tiny changes you can do Everything like could you just be a for The rest of your life could you be a Carnivore and then also a low-fat Carnivore and just eat like shrimp and Boiled chicken breasts uh hell no you're Not even gonna do that one meal let Alone a day let alone forever but could You for the rest of your life you know Eat a bacon that's slightly leaner than Like that super Jeep super fat bacon You've always eaten yeah I think you Could actually do that like people could Actually do that and they would actually Have better body composition eventually After iterating on that and then you Just apply that to a few other areas and I I think that's the secret all right All right that's a good way to describe It Um so transitioning for a second now

There's a lot of cool stuff happening in A diet doctor with with new tools and Programs to to really work on this uh Satiety approach and you have been Instrumental in a number of these so so Tell us about the satiety calculator Tell us about this a tidy approach that We have at diet doctor and how people Can practically use that to to help Themselves learn how they're eating now And how to improve it Oh sure yeah absolutely well it's been Yeah great working with you guys a diet Doctor I love it I'm super excited uh I've been working on this satiety Calculator uh concept and and a lot of It is really about the the three axes That I was talking about in that graphic So yeah the first and most important one Is protein percent of calories you have This uh on this calculator you have Either a graph that has protein percent On the y-axis or a bar that shows Protein percent and higher is better but Then again this is on kind of a inverted Semi-circle U-shaped curve where uh you Don't want your protein percent to be Too low you don't want it to be too high And there's a middle Zone that's good It's kind of divided into thirds there's Too low which is America there's too High which is like any stage prep Bodybuilder who's just gonna you know be Starving out of their mind and then

Rebound and gain a bunch weight back Later and then there's this kind of a Good you know maybe 20 to 30 40 percent The calories from protein where you Really want to be and so that's one of The major Calculator Metrics is this 30 calories the other One is the energy density of food so That's basically just looking at Um how how many grams of food you get to Eat for how many calories so humans do Two things when they're eating number One they eat until they get enough Protein and then they stop eating so You're just gonna keep eating until you Get enough protein in the day the other One is you eat add a meal until you get A certain weight and volume of food and We have studies showing that people eat Basically the same weight and volume of Food almost irrespective of the calories In there so we have studies were Actually designed the lowest energy Density meal and the highest energy Density meal and people ate them both Randomized and had equal satiety scores Afterwards but the high energy people Eat twice as many calories literally Twice as many calories and so this is a Very powerful phenomenon it's more of a Short-term Society it's more of a Um you know earlier satiety and the Protein is more of a later satiety but

You add the two together and it's very Powerful so the first metric is 40 Calories the second one is energy Density of food which is Um basically how many calories are in How many grams or another way to think Of it is how much weight and volume do You get to eat for a certain amount of Calories so like you know M M's you get A tiny handful of like 10 m M's The Raspberries you get like three pounds of Raspberries a huge weight of volume so The third one is fiber and that's a you Know grams of fiber per thousand Calories and Um you know guidelines say you should Eat 30 grams fiber per thousand calories In the US we're down here at like 15 Grams of fiber per thousand calories the Um you know the odds are eating you know 100 150 grams of fiber per thousand Calories so we you know we could improve And it does improve Society calorie this Is a evidence-based phenomenon so the Third thing we're looking at is fiber Percent of calories which is is more Mostly about like you know eating more Fiber eating less glycemic carbs which Is this other axis in my crazy crazy Graphic Um so you know basically you've got 30 Calories energy food fiber Um and then the last one is the hedonic Factor this is food reward this is

Liking and wanting and addictive food Reward so um we know that this Trifecta Of high carb high fat high energy Density uh is really going to drive Overeating these are foods that are low In protein low in fiber low in water we Talked about them already your potato Chips your nuts your Um things that are you know basically Carved in fat together all your Donuts Your pizza and your junk food and these Are very easy to overeat because they're So palatable you want to eat more and More and more of them Um and it's a lot of calories so that is Almost a negative satiety per calorie so The satiety per calorie I'm just Calculating it's kind kind of you're Getting an additive from protein and Fiber and water or low energy density And then you're kind of getting a Subtraction from hedonic foods and then The net result is this satiety score Where you don't want to be 100 that Would be egg whites and whey powder and Uh 10 gallons of water and that's not Going to work but you don't want to be Too low because that's potato chips and The standard American diet and like 92 Percent of Americans are over fat so There's this middle Zone you know this Sort of like maybe 40 to 60 you know Somewhere we we've kind of designed 50 To be like a good Central Middle Zone

Where you kind of want to be I mean you The only thing you really want to do was To tidy your calorie is be a little bit Higher than you were before so like Let's say you're you calculate your diet You know I figured the standard American Diet right now is about a 25 on this Scale yeah and like you know maybe you Want to be a 30 or a 35 or like you know I think getting up to about 50 would be Good Um but that's kind of how it works and The idea the whole idea is just to be Higher than last time higher than you Were before and uh in a sustainable Enjoyable fashion by making little Substitutions and still eating what you Like still enjoying your diet Um not doing anything crazy but just Making these small tweaks most of which Are very low carb friendly and low carb Compatible in fact low carb is really Just kind of the original satiety per Calorie and you're just making these Little tweaks and trying to be higher Than you were last time and that way you Can automatically eat less without being Hungry and enjoy the process yeah I like That really practical approach Sustainable enjoyable approach and when You do it that way it fits with any type Of dietary pattern you want to eat meat You don't want to eat meat you like Chinese food you like Italian food you

Like you know whatever Ethnic food cultural food whatever type Of dietary makeup Mediterranean Dash Whatever you can apply the same Concepts To it to make it a better version of That diet so I really like your Practical approach and I thank you for Taking the time to to share all your Wisdom and your approach and of course Your your uh your humor I love the way You describe things and Define things in Your graphics it's all great so thanks So much for joining us today oh no thank You for having me great to talk to you Well that concludes this episode with Dr Ted Naaman I hope you enjoyed that and Learned a lot about satiety but it Doesn't just conclude this episode it Actually concludes the season after four Years and 110 episodes the diet doctor Podcast is taking a break and we're Wrapping up this season but don't worry Our team is working on new formats to Bring you cutting edge scientific Information in in ways that you can Understand it and translate it to your Life and how it can help you we're Working on Creative new ways of Delivering content that I'm sure there's Going to be so much coming down the road In the future so although we're wrapping Up the podcast for now stay tuned for More information from diet doctor [Music]


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