David Taylor, MD (Host): Hello, everyone. Welcome back to the On-Call podcast from Riverwood Healthcare Center in what's currently sunny Aiken, Minnesota. No tornadoes so far this week. Did you have any tornadoes hit you last week, Tim?

Tim Arnold, MD (Guest): No, we just had torrential rain. More rain than we've known what to do with.

Host: We had a tornado like a golf tee shot north of the house and then about another one three miles south of the house that damaged a whole bunch of trees and like I've got a picture that somebody who was storm chasing took. Yeah, it's kind of crazy. Like, it's just we don't usually get tornadoes up here.

Tim Arnold, MD (Guest): Right. Yeah.

Host: Well, for everybody listening our guest again is Dr. Tim Arnold, who is one of our family physicians in McGregor, Minnesota, and he has been a previous guest on the show and has a very interesting topic to discuss today, because we'd like to go over some basics of nutrition and then maybe get into some details about things people may be interested in, like certain diets that they've either tried or heard about and just some general topics and some specific topics regarding nutrition and health and how that affects longevity and healthspan and just your general health. So.

Maybe to start what I was thinking we could do is we could do like we did at the beginning of med school. I guess I went to a different medical school than you did, but one of the very first things we did in biochemistry was to have a nutrition, like I think it was one week or something in biochemistry.

And it was great because it was a lot easier than the Krebs cycle and the electron transport chain and all that stuff afterwards, at least for me. But we talked about things I never knew about, like the caloric value of carbohydrates versus proteins and fats and how that all interacts. And just could you maybe give us a rundown on some of the very basics of nutrition and, what you feel like it's important for patients to know?

Tim Arnold, MD (Guest): The way that I explain this to patients is I try to break it down into just everyday life sort of scenario. So when we think about food, people talk about macronutrients, which are these kind of bigger groups of nutrients. And everybody's heard of a protein. They've heard of a carbohydrate. And they've heard of a fat. And I think of those as our three big macronutrients. And when I think about it in terms of what it means to our body, I try to think about it like our house. So we all live in a house and we have to heat our house. And I think of the fats and the carbohydrates as the energy that we use, the fuel that we burn to heat that house, that's the energy that keeps everything running.

And there's really sort of two ways to think about that. The carbohydrates are those that burn really, really fast. So that's the stuff that like gasoline burns quick, hot, fast, a lot of energy it's a good way to kind of think about that. Fats are more of kind of a big, heavy oak log, burns over a longer period of time, still has a lot of energy in it, in fact, a lot more energy in it. And we can get into the specifics of how much per gram and all that stuff. I'm not sure that that's needed for this podcast, but really more to just know that those two types of fuel are energy and they burn at different rates and at different speeds and different carbohydrates do the same thing and we can get into all that and the technicalities of that a little bit later on, but just high level.

So, and then the proteins are the things that we use to build our house. So you can't have a house without 2x4s and sheetrock and steel and iron and all those kinds of things. So when you're building your body, the protein is the thing that really builds the body. It builds the structure. Now you can use the 2x4s for fuel if you want to, and we can do that in our body. We can use protein and turn it into energy. But generally speaking, we think of protein as a thing that actually builds the body. It builds the house. And then the last group that I think of is the vitamins and minerals. I typically don't think of those as energy producing macronutrients. They're more of the things that help us do what we need to do better. They make the process that we need to do to build the house quicker and faster. It's the tool that needs to be used to cut the board in the right way to build the wall correctly. So that's kind of my analogy when I think about those big kind of groups. Do you have other things to add to that, Dave?

Host: No, and I actually, I've never heard that analogy. I think that's great because I agree with you that like the calories per gram, isn't as important unless you are looking at counting your calories, tabulating those up, and, getting an idea of how to make sure you're having more calories out than in if you want to either, you know, be maintaining or losing weight, things like that.

I think that is less useful like you're suggesting then having a good analogy for people just to understand burn rates and what your body is using these different macronutrients for. The other thing that's really nice about that analogy is it's so easy to slip in and say gluconeogenesis instead of saying you can burn your 2x4s as fuel, but it makes a lot more sense to understand you can burn your 2x4s for fuel than it does to say the word gluconeogenesis, which, you know, so many words we have that nobody else knows.

Tim Arnold, MD (Guest): I think for patients, the carbohydrates, what exactly does that mean? What does really a fat mean? What does a protein mean? Sometimes I think that's, we kind of have to just go back to just kind of the basics of that. And, and if you really just think of those carbohydrates as just fast burning fuel, any sort of fast burning fuel, whether it's gasoline or it's, you know, some other quick burning fuel, like a piece of paper or something, it burns fast. That's, think of that as a carbohydrate. A lipid is a very slow burning, something that takes a long time, has a lot of energy in it. That big oak log has a ton of energy in it, but it just takes a long time to burn it.

Host: Yeah. If you've given a patient this analogy to start, to give them some foundation from which to build their understanding of nutrition from, where, what do you like to go to next? You know, how do you segue into the next part of your discussion when you have 15 minutes to try to get this all in with a patient?

Tim Arnold, MD (Guest): So I try to actually go back to just the origin of confusion. There's so much confusion about nutrition and what you should be eating. And everyone's got a different diet and a different name. And we should be keto and paleo and vegan and Mediterranean. I mean, there's just put any word in front of the word diet, and there's just a million of them.

And so there's so much confusion. And then you pick up a newspaper or you look on the computer and there's a new article today saying eating this food is great for you and then next week it's that same article says eating this food is really bad for you. So one of the things I try to do is to try to explain to patients why it's so confusing, why there's so much confusion and why do you hear one week you should drink coffee and the next week you shouldn't.

And so I kind of go back to trying to explain a little bit about the science of nutrition because it's really important to understand why this stuff is so darn confusing. And so if I have the time, I try to go back to really tell patients about how do we actually do science? Because I think it's really helpful to sort of get an idea.

 When we are trying to essentially prove something as fact or say we have a really high degree of confidence that this thing changes this process in your body. We have to do that in a certain way. And the best way to do that is to study it in a very defined way. And I'm going a little off track here, but I think it's going to be helpful. So just bear with me for a second. So there's something called a placebo controlled randomized double blinded trial. So what exactly does that mean? There's a whole bunch of words there. So placebo controlled. So, if we were to take a particular intervention, let's say it's a nutrition, or let's say it's a medication.

Let's just say it's penicillin and we're going to treat pneumonia. We need to prove that that penicillin really actually treats pneumonia. The way that we do that is we give one group of patients penicillin and we give one group of patients a placebo. So just a fake drug, whatever it might be. We know that there's a placebo effect. It's actually pretty robust. Patients get better when we give them a medicine and we tell them, hey, this is really going to be helpful because of the power of our brain and the power of positive thinking and our body's ability to heal ourselves. So we know that there's a placebo effect. So we have to account for that. So placebo control means one group gets the drug or the nutrition and one patient gets nothing or a fake drug or a fake nutrition.

Host: Or even a fake surgery.

Tim Arnold, MD (Guest): Or even a fake surgery, you're right, even a blinded fake surgery. So the next thing that I said was blinded, and what that means is the patient doesn't know whether they're getting the real treatment or the real nutrition or the real drug or whether they're getting the placebo.

Patient doesn't know, and the scientist studying it, the doctor that's studying it doesn't know who's getting what. So there's no undue influence. The patient can't say, hey, I'm for sure I'm getting this drug. You know, this is going to make a difference. So there's, the scientists or the doctor can't say to the patient, hey, yeah, you're getting the drug here. I know this is going to work out for you. This is going to be a great outcome.

So no one knows, no one knows who's getting what. So that's placebo controlled and double blinded. And the third is randomized. So what that means is that if we have these two groups of patients, we have those that are getting the real drug, the penicillin and those that are getting the placebo, that those groups of patients look roughly the same.

If you could imagine the group that is getting the treatment are all 80 year olds, and the group that's getting the placebo are all 20 year olds. Generally speaking, when you're 20, you get, you recover from whatever illness or injury on your own in a lot better fashion than you would if you were 80 years of age.

So, there's a significant difference in those two groups and just their age and their ability to respond, and that may, might look like the drug is either working or not working. When it should or shouldn't. So.

Host: Yeah, if people hear about things like confounding factors, confounders, or various types of bias, you just described how that could be there with, and the idea of randomizing is to minimize the chance of that bias or that these confounding factors skew your results.

Tim Arnold, MD (Guest): Right, exactly. So, if we were to study something like nutrition. Generally speaking, we're studying a disease process that takes more than a week or two. You can't change your diet and all of a sudden see that you don't get heart disease two weeks down the road, or maybe you lose a bunch of weight, or maybe your blood pressure goes down.

You can't do that in two weeks or a month, or even sometimes three months or six months. And sometimes with some of these disease processes, it takes ten years. So now apply what I just said about really knowing whether or not something's working or not to that sort of scenario. So I can't blind you from the food that you're eating, right?

Because you know what you're eating, right? I can't really do a placebo. Right? Because again, you're eating and you know what you're eating. And then I also you can get it randomized. So two groups of patients that look the same, that, that is possible to do. But it's very, also very hard to do nutritional studies over years to decades. It's really hard for a group of patients. We need a thousand patients and we've split them 500 in each. One of them gets the high protein. One of them gets the high carbohydrate. If we're talking about nutrition and say to this group of patients, you have to only eat the high protein and no carbohydrates for the next five years. No one's gonna stick with that.

You got birthday parties to go to, you got celebrations to go to. So the way that a lot of the nutritional studies are done is they do these kind of retrospective looks. They look at a bunch of people and they say, hey, this group of patients over here is really healthy.

Let's look and see what their behaviors are that allow them to be really healthy. And one of the things that we'll do is ask, well, what types of foods do you eat? And so we'll kind of do this, these studies where we look back to see, well, you know, do you eat a lot of protein or do you not? So tell me Dave, what you ate 10 days ago on a Tuesday morning. Can you tell me right now what you ate?

Host: Yeah, a three egg omelet with spinach and a combination of Colby Jack cheese and six ounces of orange juice and a smoothie. Which I'm completely made up. I have no idea what I ate. It was more likely a donut, unfortunately. Like, I wish it was what I just described to you, but it was more likely a donut.

Tim Arnold, MD (Guest): So therein lies part of the problem is when we do these kind of retrospective looks at nutrition to try to figure out why one group of patients is healthier than the other; it's really hard to tease out what exactly did they really truly eat? Cause our memories are not very good. We know this from studies where we actually have had people walk around and watch people eat all day long, just passively, just standing in the background, watching what they're eating all day long, and then a week later, they asked that patient to recall what they ate that day and it's nowhere near was actually went through their lips. So, getting really good, high quality data to understand nutritional science is very, very difficult is the point. And that's the reason why this stuff is so confusing. That's the reason why you will see one study that says drinking coffee is good for you and one study that says drinking coffee is bad for you.

Because we have this really, really soft, very challenging data that is so hard to interpret and so subject to confounding variables, that it just makes it almost impossible to really get good data and good science out of it. So when you read these articles on the news and they say, okay, this thing is good today and yesterday it was bad.

I want all the listeners out there to stop and think, how did they get the data? How did they arrive at this conclusion? How clear was the data? Probably wasn't very good. Most of the newspaper articles don't tell you any of that. And it's a journalist who is interpreting it and may not have any real understanding of how these studies are designed and how they're put together and how good or bad the data is. So just be really careful with what you read.

Host: I'm gonna reiterate that and take it a step further, in part because I spent more time, you know, in medical school, and people may or may not know this, but in medical school, we have journal clubs. In residency, we have journal clubs. If, the idea is to instill lifelong review of literature with the skills to be able to look at a study that's published in a journal and critically appraise it, which is a skill.

And not everyone can do that. And if you don't keep those skills up, it's challenging. And what you don't realize, and I doubt the general public realizes, is just because it's in the New England Journal of Medicine and is quote unquote, peer reviewed, does not mean it's actually a good study. It's amazing the amount of studies that come out that are actually poor studies.

And because they are in a quote unquote peer reviewed journal that has good credibility and has produced landmark studies that are very important to medicine, they get reported on by journalists as something we should be looking at. And if you just read the headline, like you said, you're going to be misled, and it's going to be very confusing.

I think the other thing I would say, and let me know if you agree with this, I think retrospective observational type studies are good at finding correlations, but it's very important to understand the difference between correlation and causation because of confounding variables.

Tim Arnold, MD (Guest): So I actually have a great example of that for the listener um, this is one that I can actually if I can off the top of my head, I can even give you a newspaper article that will go with this. I'll try to do this off the top of my head if I can. So, here's the statement I would make. As the consumption of ice cream goes up, more kids drown. So here's the newspaper article. Oh, I'm going to try to again do this off the top of my head if I can here. So, link between ice cream consumption and death by drowning noted in recent study. And it goes on to say Dr. So and so from the, published a study in the Journal of Advanced Biochemistry and Nutrition stating that there's a link between the consumption of ice cream and childhood death by drowning, end quotation marks.

Dr. So and so goes on to state that this correlation is quite strong and we see quite an uh, an impact between the amount of ice cream consumption and the death by drowning. And I could go on and make up more in this journal article, but you kind of get what I mean. So, and I'll tell the listener right now that there is a very strong correlation between the consumption of ice cream and the rate of drowning in children ages 7 to 14. There's a very, actually a very strong correlation that I'm not making that up. That's real. There's actually a very real strong correlation there, but that does not mean that there's causation. So when I say there's actually a very known real strong correlation, the reason is because more ice cream is consumed in the summer. And more kids swim in the summer. Swimming causes drowning, not ice cream. Okay. And because there's more kids swimming in the summertime, there's more drowning. But it has nothing to do with the amount of ice cream consumed. It just so happens to be that you don't consume ice cream on a January, 7 o'clock in the PM, sitting outside at Dairy Queen on a January night.

No one does that because it's 20 below zero, so the amount of ice cream consumption goes down in the winter. They have nothing to do with each other, but they're highly correlated with each other.

Host: Yeah, that's a great example. And I think that's, examples like that are great to keep in mind for understanding why you have to look at these studies that come out in the press with a real careful eye.

Tim Arnold, MD (Guest): Yep, and it can sound really convincing. The Advanced Journal of Biochemistry and Nutrition, Dr. So and so says this. I mean, can really get fooled and physicians get fooled. We look at these things and we get fooled and we don't ask the right questions.

Host: I would submit, especially now having gone through the COVID time and realizing how much confusion I had despite how many daily hours devoted to trying to research COVID and look at articles coming out and all that, it's the minority of physicians that actually are really adept at separating the wheat from the chaff, so to speak, and understanding what is high quality data and what is not high quality data.

Tim Arnold, MD (Guest): Going back to nutrition topic, so just be really careful when you read those articles to all the listeners out there. Be really skeptical what you're listening and what you're reading about. Um, take a step back, ask yourself, does this really make sense?

Host: So once you get through kind of the discussion about why there's so much confusion, do you have a next step that you take?

Tim Arnold, MD (Guest): Yeah, I try to make it really simple. Everybody asks me, what's the best diet? And my answer is there isn't a specific best diet. First of all, every patient is a little bit different, but I try to make it really, really simple. So if the food that you're eating has less than five ingredients in it, it's probably pretty healthy for you.

And we'll kind of break this down a little bit more, but the first starting steps are eat whole foods, unprocessed foods, get rid of the ultra processed foods. So if it's got more than five ingredients in it, start to question whether or not this is a food you should be eating. And if those ingredients that are in there are not things that you find on your seasoning shelf, your cupboard, where you pull out your seasonings, if you don't have it there, that's going to be a processed food. Then probably shouldn't be eating it. Fairly simple.

Host: Yeah, that's a good starting rule of thumb.

Tim Arnold, MD (Guest): Yeah. So then, patients start to ask me about protein and carbohydrates and they ask me about fats and alcohol and all those other things. And the first kind of statement I would ask them again, about that particular food is the first thing you need to know is you need to know what's in it, what's in that food. I'm going to go right back to my first statement. What's actually in that food? That's the first statement. And the second thing is we do need to start to think about protein and carbohydrates. We are not carbohydrate deficient on the most part here in America, for sure. We are for sure protein deficient in my mind.

And I think anyone that looks at the data would also agree with that. We are not protein deficient. Now, does that mean that you can't eat any carbs? No. It just means that if you're thinking about these three big macronutrients, fats, carbohydrates, proteins, and then of course, all of our vitamins and minerals, that's kind of that fourth group in my mind, we are not deficient in carbohydrates.

Host: I mean you could argue carbohydrates technically are not needed, whereas fats and proteins are. That's a little oversimplified, but of those three macronutrients, you can get by without carbohydrates, but ultimately you cannot get by without protein or fat.

Tim Arnold, MD (Guest): Correct. So then if patients want to talk a little bit more about it, they want to know how much protein to eat. And if we have the time, I start to talk about what proteins are made of. Proteins are made up uh, remember I used the example of the 2 x 4. That's the structure that builds our house. Well, that's a protein, but that 2 x 4, if you break it down, it's got little wood fibers in it. And I think of that as what's called amino acids. The proteins are broken down into these smaller chunks called amino acids, and there are nine that are essential, which means that we can't make them inside of our body, and then of the other 11 our body can make. So, I start to talk a little bit about what proteins are made of. There's little blocks uh, that make up the larger 2x4. And then we start to talk about how much protein should we really be getting. So this is where I'll get a little bit technical. So the current national recommendation, I think it's 0.8 grams per kilogram per day. That data came out of these studies where they looked at what amount of protein do you need to stay alive, basically. And it's actually a fairly hard thing to study. It's not easy to figure out how much protein you need coming in the system to stay alive. But the bottom line is that that's, that 0.8 is really basically just to maintain what you have.

Host: Right.

Tim Arnold, MD (Guest): It is not to build muscle. It's not to maintain high quality muscle. That's just to kind of hold your own, so to speak. So if we translate that into what we need per day. It depends on the age. And so let's just assume that a vast majority of our listeners are, you know, 30 and older, let's just say. As we age, we have a certain resistance to building more protein into our muscles. And so, as I had said, protein is what builds the house. The house is our body. Primarily, we're talking about skeletal muscle, but protein is used to make white blood cells. It's used to make red blood cells. It's used to make our skin and our eyes and our hair and all these other things, our connective tissues. But if we want to think about it in the lens of a specific part of the body, let's talk about muscle to start with. In order to maintain and or build high quality muscle, we need a lot more protein than what the current national recommendations are, and a lot of the data is really pointing towards almost approaching one gram per pound of lean body weight, which is a lot.

Host: Yeah, that's a little over double what we would have been at 0.8 per kilogram.

Tim Arnold, MD (Guest): Correct. Yep. So, if I can ask my patients to get to a half a gram to even three quarters of a gram per pound. So I weigh 200 pounds. That means that I've, you know, really should be at 150 grams of protein a day. High quality protein. That's actually a fair amount of work to get that high.

Host: Right. If you have a three egg omelette, since I brought that fake example up earlier, how many grams of protein is that roughly?

Tim Arnold, MD (Guest): 21.

Host: Yeah. What is a, what's a ribeye?

Tim Arnold, MD (Guest): Well, there's six ounce, eight ounce, and all that kind of stuff that makes Yeah. It's probably gonna be in that 30 to 40, probably. Depends, but,

Host: Whats a hamburger?

Tim Arnold, MD (Guest): Ah, it's gonna be 20, 20 to 30.

Host: Yeah, that people an understanding, if you're trying to get to 150 in a day. It's a lot more than you think.

Tim Arnold, MD (Guest): Right. Now we do get protein from not just meat sources. We get protein from the plants that we eat and the dairy and that kind of thing. It comes from lots of sources. There are lots of good apps that you can get on your phone that will help you track that. You can easily plug in the food that you eat and they have all these great AI engines.

I've got one that I'm using right now that will calculate or you will get roughly close to the amount of protein that you're getting in with you know, if you have a three egg omelette with cheese, it'll estimate that it'll be, you know, 25 or 27 or something like that. So you can get pretty close pretty easily. Big chicken breast is 30, salmon is pretty protein dense. So you can get quite a bit out of a piece of salmon or fish. You can push over 30, get in that 40 range.

Host: Just a specific side question while we're talking about this. If you have a vegetarian or vegan patient, what are some high protein sources like kale, nuts, what are some things that you would tell a patient who doesn't want to look at meat or dairy as a way to get some protein in?

Tim Arnold, MD (Guest): Yeah it gets a little more challenging in particular, the type of amino acid that helps us maintain a muscle mass, something called leucine. So those that are really into this, they can start to dig into what leucine does in our body and how it turns on the building of muscle and other, and a building of other cells.

 Yeah, so everything from quinoa to pea proteins, nuts are great, of course. Tree nuts are a good option. I think it really depends on how vegan someone is, whether or not they're willing to do eggs or not, or dairy. Obviously, they're not vegan at that point, but so I think it really depends on the person. And I think a lot of those patients really kind of know that they need to focus on the protein, and they've done the research on their own, generally speaking. I don't have to do much.

Host: Yeah, there's a kind of like there's healthy user bias with people who exercise and try to eat healthy. There's a educational bias with people who've made the decision to be vegetarian or vegan, and they've learned a lot about the nutritional aspects of what they're eating. And

Tim Arnold, MD (Guest): Correct. Yep.

Host: I just wanted to kind of just throw out a couple ideas for listeners who may either have a may be vegetarian or vegan themselves, or may have a relative, or that kind of thing.

Tim Arnold, MD (Guest): In order for me to get the amount of protein that I need in a day, I need to do some sort of protein powder and I am intolerant of whey and casein, so I have to do a pea protein. So I get a really high quality pea protein and that's what I do on a daily basis to try to add what I need. It doesn't have as much of that leucine that we're kind of talking about before, but if I get enough of it, I'm still meeting that threshold that I'm looking for.

Host: Yeah. As your ability to incorporate protein into your muscle and build muscle decreases with age, do you try to compensate for that by increasing the either absolute quantity or proportion of protein in your diet?

Tim Arnold, MD (Guest): Yeah, so first of all, it looks like you need to be over 30 grams, generally speaking of a high quality protein to stimulate any sort of muscle protein synthesis. If we're talking about muscle, again, trying to get that muscle to build a little bit, maintain that strong muscle. Generally when you kind of get over 50, 55, somewhere in there, the body really can't generally incorporate more than that in one feeding and so then that, that protein then gets burned.

Like we said, you can burn the 2x4s, you can burn the sheetrock. So the body does end up burning that. So it's kind of in that 30 to 50 gram per meal and anything over that you're probably not going to use it to build the structure of the house. You get much over that gram per pound and you're probably not really going to incorporate any more of that protein into the body. It can't tolerate it, so you end up burning it.

 The reason I'm focusing on muscle so much, if the listeners think back to our very first podcast, we talked about, you know, what are, what's the most important thing for longevity. And I had mentioned exercise and how important that is. You can take in a fair amount of protein per day, but if you're not getting some exercise, some stimulus to that muscle and to the body, you're probably, as we age, we're probably still going to lose muscle mass over time. So getting back to kind of step number one, to being healthy, it's going to be regular routine exercise.

And then we're kind of on step three or four here, and that's nutrition. And you have to have good nutrition combined with exercise to really combine that into the body and the structure that you're trying to build. And by the way, the other radical statement I'm going to make here for patients and people that are listening is that our muscles are the largest endocrine organ in our body.

So Dave and I, when we went to med school, we were taught about the endocrine system, and that's the system that puts hormones out into our body and tells other parts of our body what to do. Think of things like testosterone and estrogen and that kind of thing, and I think most listeners will know that those are hormones that tell our body to build and to grow.

Host: Right. Thyroid gland, pituitary gland, adrenal glands, the pancreas. Anyway, go ahead.

Tim Arnold, MD (Guest): Yeah. So this kind of this radical statement that the, our muscles are really the largest endocrine system in our body. And it really is kind of true. Our muscles put out hormones. They put out these things called myokines, these communication to the rest of the body that I'm doing work, I'm building, I'm getting stronger.

And that has a downstream cascade effect across the entire system. And when we don't have protein and good nutrition to build that muscle, to build that house; all of it starts to kind of fall apart a little bit. And the nutrition that we take in tells our muscles what to do. It tells our intestines, our heart, our lungs, all those kinds of things, what to do.

And it becomes, nutrition becomes one of the largest communication devices that our bodies see, that tells us about the rest of the world. And again, we're talking about hormones and communication. Nutrition in my mind is also in, in some ways you can almost think of it like a hormone. It tells our body what's going on.

It tells us the environment that we're in. It tells us whether we're in a nutrient rich environment where, or whether or not we're in a nutrient depleted environment. And so the food that we take in tells us all kinds of signals, gives us these massive amounts of information to our body about what's going on around us.

One of the questions that I think all nutritional scientists and folks that are spending a lot of time looking at this are sort of kind of wondering about is how did we get from a population that the obesity rates were really, really very, very low, you know, many hundreds of years ago to the point where we're at today, where we have a population that has really significant metabolic disease or metabolic disorder.

And what I mean by that is it's not just being overweight. It's our body's ability to handle the nutrition that's coming in and what happens to us when we eat the foods that we eat. And this goes back to which diet should we eat? Should it be keto or paleo or Mediterranean or whatever it might be?

And that's the reason why I don't give an answer is because really the diet that we need to be on is a diet that doesn't have ultra processed foods in it. Our body is not meant for these highly palatable, highly enriched foods that we're getting on a regular basis. And it looks like all the science is kind of pointing to that's really the ultimate problem that we have with the nutrition in our country and in the world at this moment. I resist a certain type of diet, Mediterranean, whatever it might be. Mediterranean diet is a great diet but I resist using a word. What I really encourage patients to think about is to get away from the ultra processed foods. The other statement I make to my patients all the time is if your grandmother five or six or seven generations ago looked at the food that's on your plate and she had no idea what you're eating, you probably shouldn't be eating it.

She has no idea what Mountain Dew is. She has no idea about, you know, Snicker bars. She would look at that and say, I have no idea what it is that you're eating. Our bodies were meant to eat whole foods from the origin of where they came from, plants, meats, whatever it might be. If you can try to think of it that way, it really helps you to figure out what choices you should make.

And again, if there's more than five ingredients on the package, or it's an ingredient that's not sitting in your seasoning shelf; probably a processed food.

Host: Yeah, that's a great pro. It reminds me of listening to a big wave surfer who surfed well into his middle age at a very high level. I'm blanking on his name right now, but it doesn't matter. When asked what he eats as part of his health regimen and how he was able to perform at such a high level beyond the physical activity of surfing and the training he did beside that, he goes, well, I eat plants and animals. That's all I eat. Plants and animals. Okay, thank you for being on.

Tim Arnold, MD (Guest): Great, thanks.

Host: Thank you, everyone, for listening. Please let us know if you have any questions and we'll see you at the next podcast.