Michael Smith, MD (Host): This is Meaningful Medicine, a Novant Health podcast. I'm Dr. Mike, and with me today is Dr. Neil McDevitt, a Bariatric and General Surgeon from Novant Health. We're going to be discussing today a fascinating topic. Why can't you out exercise a crummy diet? Dr. McDevitt, welcome to the show.

Dr. Neil McDevitt: Mike, thank you so much. It's great to be here.

Host: So how come I can't out exercise my weight issue? What's going on there is there's some persistent myth that I can?

Dr. Neil McDevitt: Well, I think, number one, I believe it because I want it to be true so that as most things I can backfill some logic. But the truth of the matter is you can't backfill a bad diet. Our diets unfortunately, particularly over the last 50 years, we take in so much more energy than we could ever burn off, and it's created this huge disparity.

You know, the average American takes in about 30% more calories or more energy than they burn off, and it's really been a major contributor to the obesity epidemic.

Host: And I've noticed too in my own life, some of my friends, when they do exercise more and they're being consistent, they tend to even eat more. It's like they're not really making a lot of gain there. Right. That's part of that, maybe another part of the process or problem.

Dr. Neil McDevitt: Well, part of the problem is we are finally honed to survive famine. We've been doing it for thousands and thousands of years and our genetics haven't changed. But over the last 50 years, so much has changed in our society. The idea of processed foods, right? So we now take in meals that are so processed that all of the fiber and nutrients are taken out of them.

So it's like eating jet fuel. It's a profound amount of energy in a small, compact area. And because of that, they even have to enrich food, right? Enriched flours because they've taken everything good out of it, that they've gotta put it back in. Well, when we take in that much energy, it is impossible to exercise enough to offset it.

So, 4th of July coming up. If I decide to go to a fast food restaurant, need a hamburger, fries, and a Coke, I will actually have to walk two hours climbing stairs to offset the amount of energy I just took in, I can barely make it up three flights of stairs without getting winded here to the office. So the idea of walking two hours to offset the energy, it's incredible and it's just completely makes it impossible to out exercise a bad diet.

Host: Yeah. And, what a great analogy there because that, I think paints a great picture. Most people listening, I mean, I'm going to say most, you never know. There's some out there that are amazing, but most people aren't going to be able to do two hours upstairs. I mean, there's no way.

I understand that you use a character to kind of help your patients understand all of this, food noise, the brain chemistry involved, can you tell us about her?

Dr. Neil McDevitt: Yeah, we've nicknamed her Helena. Helena is that best friend that you had growing up that's been a bad influence, but you should have gotten rid of her a long time ago. So essentially what I believe is there's two types of hunger. There's body hunger, which is driven by seven, eight different hunger hormones.

The most famous one everyone knows now is GLP. And what that is, if you don't have enough caloric energy, your body sends these messengers saying, Hey, I'm starving. Feed me. Right? There's a second different set of hormonal regulators called serotonin and dopamine in our brain. We all know these. These are the feel good chemicals, right?

When people smoke, they actually get a bump of serotonin and dopamine. When you have alcohol and when you eat certain foods, particularly bread, rice, potato, pastas, and sugars are comfort foods, and the reason we tend to gravitate towards these foods, we're actually compelled to eat them because they help fix our brain chemistry.

So when people quit smoking, right, everyone gains weight, eating bread, rice, potato, pasta, sugars, because we're compelled to do these things to fix our brain chemistry. So the problem is we gravitate towards these foods to make us feel better, makes us gain weight. Which makes us feel worse, which has us eating to feel better, which makes us gain weight.

And that's the whole theory of starch addiction. Well, in order to make this a little more palatable, what I said was, let's give it a name, right? If I name it, I can beat it. So we've nicknamed her, Helena, she's great. She's been there, she has helped us. We have a bad day, Helena comes and says, baby, you had a horrible day at work.

Let's go get a pizza. And when we give it a name, it takes a lot of the guilt out of weight because weight is such a sensitive topic and we have so much guilt associated with weight gain that by being able to kind of separate it from us, we can look at it subjectively instead of internalizing it, and it's really been a great tool.

When people come back to me and they go, God, I'm embarrassed. I go, Hey, it wasn't you, it was Helena. Now let's figure out how to get rid of her again.

Host: That's great. I like that. I have a lot of, Helena's in my life, by the way. Okay, so when you do all this, right, so you're having this conversation, and you're speaking about the brain chemistry and hopefully, the patients are starting to understand that. How does that really help overall? When they have this understanding, do you see them more committed, better results down the line? What are some of the outcomes you have?

Dr. Neil McDevitt: Well, I think first and foremost, it takes the guilt out of it. My patients are seeing me because they're so busy caring for everyone else's needs, they neglect their own. And when I can help them see that a lot of these forces that are driving their weight are brain chemistry, it's not a character flaw.

They're being driven by brain chemistry. Then it enables me to say, all right, now let's look at how we can alter that brain chemistry. Let's find a dietary plan that makes sense. Let's understand the why behind why we make these food choices and put barriers in place to keep them from falling into those same identical ruts. At the same time, it gives me a real good way of including movement as a way of helping offset that brain chemistry. So we encourage movement at the same time that we're encouraging these lifestyle changes and movement, exercise, let's face it, it is a crucial component to maintaining and getting weight loss. You have calories in, you have calories out or energy in, energy out.

If the energy in exceeds the energy out, we're going to gain weight because our body is designed to store it for that next time we're starving. So by including movement in there, we can really increase that energy output and more importantly, we do that, we build muscle. And I love muscle when it comes to metabolic, muscle is sexy.

What muscle does it is constantly burning energy, so it increases our, basically our idle speed. It increases the amount of energy we burn, even at rest. It increases our metabolic rate, which then makes it easier for us to lose weight down the road.

Host: I'm glad you went over that because we want to make it clear to the audience. We're not saying don't exercise and just focus on diet. You're saying there has to be this nice balance between what you're bringing in and what you're burning out in order to achieve a more lasting weight loss success. Right.

So I'm glad you went over that. I want to focus on diet though, right now. There are so many different diets out there, right? How do you help patients decide which diet is going to be best for them based on the types of calories that that diet is going to be providing? Is that, or do you even really go over that with them as long as they're just maybe eating less, you're happy?

Dr. Neil McDevitt: Well, where I go with is not necessarily the volume of eating. What I'm looking at first and foremost is what. What I want to do is get rid of the brain hunger, feed the body, and what I want to do is feed the body with as complex of a nature of food that I can, so our body is absorbing it in a slower steadier pace.

So for me, it's a function of while you're trying to lose weight, really get rid of the bread, rice, potato, pastas, and the sugars. Get rid of those foods that really kind of get into the head hunger component. Now, it's not a no carb diet. I want carbs. Our body needs them, but I want to get them from fruits and vegetables.

I want to have far more complex forms of nutrition that aren't going to give me that dopamine burst, but are still going to provide the nutrients we need.

Host: So that's an important point there. It's not that it's no carb, it's better carbs, carbs fruits and vegetables. I think that's a fantastic point. So, but how does your body, okay, let's go back to that carb, what's really then the big difference for the Iistening audience between calories from that simple carb, the pastries, the sugary stuff, the white pastas versus carbs from, say vegetables. That, what's, how does the body handle those carbs differently?

Dr. Neil McDevitt: So what I think of it is the processed carbs, right? Our processed foods, the breads, et cetera. It's like drinking jet fuel. It's just pure energy. And our brain gets that bump of serotonin and dopamine, and that's why it's so attractive to eat those dense calorie foods. And the problem is when we look at it compared to something that is not processed. Right? We look at the same volume of food. We look at a plate worth of food. This is going to provide profoundly more energy versus this. This is going to have a lower energy content. It's going to have me feeling fuller, longer. It's going to provide me better nutrition. It's going to give me fiber that's going to be important to help my gut, and it's going to make me feel satisfied because I get to eat more of it with less energy coming in.

So the way our body absorbs it is when we have a processed carbohydrate, it is immediately broken down into sugar. It causes this huge burst of sugar into our body. Our body has to respond quickly by dumping insulin to pull that sugar into our body tissue, so it doesn't even have a chance to be utilized before it's being absorbed and converted into fat, or converted into a storage form. When we eat something complex, it's burned off, it's broken down slower. Our body doesn't respond as aggressively to it, and it's utilized in a much more even pace. And that's important when we look at storing that energy versus using that energy, if that makes sense. Yeah.

Michael Smith, MD (Host): No, your body, like when it comes to calories, your body, it sounds like it's not going to waste a calorie. It's either going to burn it or it's going to store it. It's going to burn it right away or it's going to store it. So what you're saying is if you're bringing jet fuel in all the time, that's going to just go and you're not exercising that much, that's just, it's going to go right to fat eventually down the line. But if you're doing more of the complex stuff, not as much jet fuel, more nutrition, less storage of that fat, utilizing that calorie better. Is that a good summary?

Dr. Neil McDevitt: That's great. And we know that this burst of insulin can really lead to kind of negative effects long term. The insulin is a growth factor, so what happens is when it, it is elevated like that, it causes this, your sugars to decline very quickly, which oftentimes makes you want to eat again, to bounce them up.

But more importantly, it can lead to narrowing of the arteries and it has peripheral effects on our whole body. So the whole goal is not this kind of binge purge, binge purge. We want nice and even, and nice and slow elevation and slow decline in our nutrition.

Host: So when somebody is starting to make some of these strides, right, they are exercising, they're understanding diet better starting to do follow some of this instruction from Novant and you and your team. But do you ever notice like some patterns in people like right off the bat, even though they're trying that, that it, you see them, that they're still going to struggle here?

What are some of those patterns that you recognize pretty quickly?

Dr. Neil McDevitt: Well, there's two, two patterns I noticed. One is with diet and one is with movement of course. The movement one is everybody's a sprinter. Everyone is a professional dieter and exerciser, and they come out of the shoot, all right, today I'm going to wake up, I'm going to put shoes on, I'm going to run a marathon. And it's so miserable that day two, they go, I'm not doing this anymore.

So I, I think one of the things we try to do is say, all right, let's just start moving. Remember, the turtle won the race, and sprinters don't finish marathons. So what we want to do is have realistic goals that just start with movement. That we're going to hit certain thresholds and then we're going to start working on exercise and, weightlifting, et cetera.

But it's just gotta start with movement first. And those goals have gotta be realistic and commensurate with what your physical capabilities are. If you've got bad knees, you're not going to get out there and run.

Host: When you're thinking about some of those patterns starting off real strong and dropping off, I'm sure you have strategies and techniques to let them know, like from the very get go, here's the best way for you to probably start exercising and we're going to work up to this over time, versus just diving right into that gym membership that goes to waste in six months.

Dr. Neil McDevitt: So what I love is I love pedometers. They don't lie. And, much to my chagrin, they don't lie. But it really gives you a good sense of what have I done in a day? So if I go grocery shopping and I walk every aisle and I've done three miles of walking between grocery and parking and work and getting the groceries into the house, what's the difference between walking three miles through the course of my day versus three miles at the gym?

Three miles is three miles is three miles. So I love a pedometer just to remind us, as a constant reminder that you've just got to move first. And I can tell you I've got a gym bag in my car. It's been sitting there. I have the same clothes in it because once life gets busy, the last thing I'm doing is going to the gym. But, I can still move.

Host: For patients that you have that have gone more to a plant forward eating program regimen, however you want to say it. Have you seen those patients with significant health improvements?

Dr. Neil McDevitt: Of course, they're getting rid of most of the processed things, but the challenge I run into with patients who are really pursuing more of a plant-based is, we always talk about weight loss, and people always think of it as a matter of energy and energy out right? Calories in, calories out, and oftentimes when people endeavor into a new diet, they miss a critical component.

We need to make sure we're getting enough protein to mainain that lean body mass, and we need at least 60, and a lot of folks are even recommending 90 grams of protein during the tiered period of time that you're looking at restricting your calories in order to maintain body mass. Because if we don't get enough protein in, our body starts to chew up that body mass, which then lowers our metabolism, which then lowers our ability to lose weight.

And we can see people's metabolism drop by 30%, and that can last for years following a period of time of severe protein calorie malnutrition.

Host: Wow, that's amazing. You mentioned muscle, towards the beginning of our interview and how important muscle mass is. With that said, what are some of your favorite exercises to help especially older people maintain or even increase muscle mass.

Dr. Neil McDevitt: My favorite is swimming. I am a dolphin swimming, and I'm unfortunately a dolphin on land as well, so.

Host: Stick the water stick.

Dr. Neil McDevitt: Running is miserable. But when I'm in the water, nothing hurts. So I do love water aerobics, I love swimming, I love even walking in a pool. All those things really take the pressure off of the joints, which is a big concern as you get older, as there's a lot of wear and tear on knees and hips, and a good way to offset that whilst continuing to get that energy burn, is, it's through swimming and through aquatics.

Host: That's great. Any last word for the audience?

Dr. Neil McDevitt: I've got two, if you don't mind. Uh, the first is, well, the first is one of the pitfalls with diets and is what we're accustomed to and what we are told. A lot of my patients will say, I'm following a healthy diet, and I go, what are you doing? Well, I started smoothies and there's a huge marketing problem I've found with smoothies.

There's one out there called the Keto GLP1 Berry Smoothie that's at one of the smoothie places around here, and it's supposedly specifically designed for people who are on GLP medications. So I look at this, I go, wow, this sounds incredible. There's a lot of science into this I suppose. It's 720 calories in a 32 ounce smoothie, and you would have to walk three hours to offset the amount of energy taken in, in that smoothie.

So a lot of times people think they're doing the right thing, but you have to really dive into the data to see if there's accuracy in what you're being told.

Host: Love that. That a lot of calories in one little drink, I'll tell you that right now. But, one last question then. What's your overall feeling about smoothies, if they're done correctly with good fruit, stuff like that? Can smoothies be a part of a healthy diet?

Dr. Neil McDevitt: I prefer something called a protein shake, which is effectively to me, a smoothie is an adult milkshake. Usually what you do is you, you throw in a ton of fruit, you throw in something green to justify it, and you drink it and it's typically 70 grams of sugar. And you go, well, I drank all of my, my fruit requirements for the day.

I want to eat the fruit. I want to eat the food. I want to feel full. I want those hunger hormones to feel satisfied so that I'm not hungry an hour from now. And I think the biggest.

Host: As long as it's green though.

Dr. Neil McDevitt: Yeah,

Michael Smith, MD (Host): happy.

Dr. Neil McDevitt: green. The last messagei would add is pretty simple. If you doing all those things and you're still struggling, we have a whole arm of medicine now looking at metabolic research called a bariatrician. It's a metabolic weight loss specialist, and they will do things like look at your basal metabolic rate, what your idle is, if you will. They'll look at your diet. They'll look at so many of these different components, and then we have an arms of medications that we didn't have access to 20 years ago, so you don't have to do it yourself.

There are professionals out there that can help. And then if even those things fail, that's where I come in and we have surgical alternatives to help those who really struggle despite going through all these other endeavors.

Host: Man, that's fantastic information. Thank you so much for coming on the show today.

Dr. Neil McDevitt: Thank you. And, and I look forward, I hope I get an invite back again sometime.

Host: You will, no doubt. For more information, you can visit novanthealth.org. If you enjoyed this podcast, please go ahead and share it on your social channels and explore the entire podcast library for topics of interest to you. This is Meaningful Medicine. I'm Dr. Mike. Thanks for listening.