Sylvia Tara

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S: Hello and welcome to The Optimized Geek. I’m your host, Stephan Spencer. Today, we have Sylvia Tara with us. She’s the author of The Secret Life of Fat: The Science Behind The Body’s Least Understood Organ And What It Means For You. Sylvia holds a PhD in Biochemistry from the University of California at San Diego and an MBA from The Wharton School of the University of Pennsylvania. She’s a consultant with McKinsey & Company and has worked at the world’s largest biotechnology companies. Sylvia, it’s great to have you on the show.

T: Thank you. It’s great to be here.

S: Let’s start with an easy, softball question. What exactly is the point of fat? It’s not often thought of as an organ. Surprise us with how misunderstood that organ is.

T: Fat is actually not just fat, it’s not just excess calories although that is one of its function. What I learned as I did the research on fat is that fat actually functions like an endocrine organ. It makes hormones that it releases, and our bodies depend on these hormones to function properly. Fat is linked to a healthy immune system, it’s linked to our reproductive system, it’s linked to our bones. Even our brain size is dependent on our fat because of the hormones that it emits. I think people have to think a little differently of it because fat is this important, nature tries to protect it. It’s one of the ways that fat is very hard to lose. One hormone that it does produce is called Leptin. Leptin has direct effects on appetite and metabolism. We lose fat, we lose Leptin and our appetite gets bigger and our metabolism gets lower. It’s one of the ways we’re driven to actually regain weight. Our fat is trying to come back, our body values fat even though we don’t. I learned a lot about just fat and how it functions collectively as an organ. It’s not unlike skin. A piece of skin is just skin tissue but skin in its totality also functions as an organ and fat is the same way.

S: There are different kinds of fat. There’s brown fat for example. What are the different kinds of fat and what do we need to know about that?

T: We have all different kinds of fat in our body. One type of fat is subcutaneous fat and it’s the fat that’s right underneath our skin. That’s the healthier deposit of fat that we have, our thighs, buttocks, arms, legs. There’s also visceral fat and that’s the fat underneath the stomach wall. That’s the more dangerous fat. When that fat gets crowded, it gets inflamed. Meaning it’s infiltrated by a number of immune cells and immune signals. That inflammation actually interferes with insulin signaling. It’s correlated with heart disease and diabetes. That’s all the fear of fat, the dangers of fat that we hear so much about, it’s often times visceral fat. We have other types of fat too. We have brown fat in our body and that is fat that actually burns energy for heat. White fat which hoards energy for use later, for what we need it. Brown fat actually produces heat and so it burns energy. There’s beige fat. Beige fat is the type of fat that can turn brown upon cold exposure or even exercise. There are all other types of fat too. We have fat around every membrane of our cells. In a way, fat holds the structure of cells and holds it together. We have fat in our brain. There’s a substance called Myelin that insulates brain cells, parts of brain cells, and helps us conduct signals. Fat has multiple uses in our body. It’s the visceral fat that we really have to watch when we talk about health.

S: What I’ve heard about visceral fat is, I forgot that exact statistic, but for every two inches of fat in your midsection, you increase your heart disease risk by 20% or some large number. I don’t remember the exact statistics. Do you have any stats on that?

T: Yeah. There’s one statistic that if we just lose 7% of that fat, we can improve insulin sensitivity by 57%. Fat reduction can get you off a lot of diabetes medication, heart pressure medications. I do tell stories of that in The Secret Life of Fat, people who managed working very hard and get their fat level down and they were able to manage their disease better and get off some drugs.

S: My understanding of stem cell therapy is that one of the best places to harvest stem cells is the adipose tissue, the fat in the back. You can get millions of stem cells that way instead of tens of thousands by getting it from your bone marrow.

T: Yeah, it’s turning out to be this wonderful source for medicine which is so surprising because we’ve always reviled fat and wanted to get rid of it and looking like the future of fat, it might actually be therapeutic. If fat does harbor a number of stem cells in it, those are the plural potent cells that can turn to many different types of tissue, and they aid in healing. It’s been used quite a bit. Rick Perry, the governor of Texas, I guess, will now be the head of energy. He actually used it in his back. He had some back pains, back injury. It wasn’t a proof for this so he got in some hot water but he was very happy with the results. It helped him heal, helped him go further. It’s been used in fractures, extracting some of these stem cells from fat and injecting it back into a wound or a fracture. It’s actually been seen to heal skin faster and heal bone fractures fast as well. Who knows, all the liposuction we get, all that fat stored in jars somewhere could actually be quite useful for medicine.

S: Cool, why is it that some of us end up with love handles, and why are they so hard to get rid of?

T: There’s lots of ways we get fat. It’s assumed that people are sloth, and they’re gluttons if they get fat or they’re not just following a diet. There’s a lot of guilt and judgment put on fat. In truth, what I found with all of my research, and this was reading thousands of papers in the scientific literature and talking to at least 50 scientists around the world about their research on fat, is that there are so many ways we get fat. One is yo-yo dieting, it will make it easier to gain weight for some people than others. As I mentioned, fat produces Leptin and when we lose fat, we lose Leptin. That sends our appetite higher and our metabolism slower when we have less Leptin. There’s actually a caloric penalty for that. Someone who’s say 170 pounds and lost 20 pounds to get to 150 pounds compared to someone who’s 150 pounds naturally, the person who’s lost the weight to get there actually has to eat less now than the person who’s naturally at 150 pounds without dieting. That’s because metabolism is lower after we lose the fat. That person who’s dieted will have to eat about 22% pure calories which translates to 250 to 400 calories less per day than the person who’s not dieted. Fat is designed to come back on us, if you will. It’s one reason why some people just have to eat less to be thin than others. Other factors that contribute are genetics certainly contribute. There’s some genes that are identified that either affect appetite or they affect fat cell creation. There’s thrifty genotypes in populations. People just have collective number of genes that helps them be more efficient with their calories and their weight. There’s also bacteria, viruses that have a role on fat. Gender has a role on fat. Women certainly gain weight faster. I devoted a whole chapter into that in The Secret Life of Fat because that’s something I noticed and I really needed to get to the bottom of this, why men can eat so much more? Hormones and age affect it too. When we’re young, we have plenty of testosterone, growth hormone, these are terrific fat burning hormones. As we age, those hormones add and we tend to get heavier, easier. The same meal we ate in our 20s, we certainly can’t eat later. In fact, there’s some interesting research done by Paul Williams that I cited in The Secret Life of Fat. He measured male runners and how they gain weight over the years. He noticed, no matter what, how much they’re running, they tend to gain fat. If they’re running 10 miles a week when they’re 30, unless they increase their running by 1.4 miles every year weekly, they will gain weight. Which means a runner who is running 10 miles a week, when they’re 30, will have to increase the running to 24 miles a week. 1.4 miles a year increase when they’re 30 in order to be able to fit into the same tuxedo they did when they were 30. He called it a force of nature. Somehow, we just gain fat in the years and you have to take extra measures to make sure you stay at the same weight if that’s your goal.

S: Let’s talk about some of these things in a little more detail that you talked about, just briefly. What is the thrifty genotype? How exactly does genetics play a role in whether you gain weight easily or lose weight easily or whatever?

T: The book is really told through stories just to make that clear. I tried not to be an encyclopedia or textbook. I go through stories of researchers, of patients, of populations, and tell all of this research in a narrative. The one narrative I gave is on the Pima Indians in the United States. The Pima Indians actually crossed over the barrier straight around 30,000 years ago and came into the West Coast of America and some went into Mexico and other places. They usually hunted and gathered food, they did farming. They were pretty active and they stayed thin. The Pimas did experience drought a few times a century. There was famine soon after that. Those Indians that were actually very efficient with their metabolism, they were able to sustain those periods of drought, were the ones that survived this. The philosophy is they evolved a thrifty genotype, a set of genes, a collection of genes that allows them to subsist on less food and be more efficient with their energy than other people. That served them well for a long time. However, in the 1800s, they started encountering western settlers coming through for the Gold Rush. Some phase of Pima Indians diverged so there was a group in Phoenix, and there was a group in Mayakoba, Mexico. The group in Phoenix started gaining a lot of weight as they adopted more of a Western lifestyle. In fact, in 1900s, when it was measured, they had about three times the obesity rate compared to Caucasians in the same area largely eating the same diet. They started going to work for factories, in the military, they left their real life behind. They weren’t farming or hunting anymore. They started eating breads, fats, more of a Western diet. When they were compared to the Mayakoba in Mexico, their obesity rate was actually 10 times higher than the Mayakoba in Mexico. Mayakoba, Mexico actually retained their real lifestyle. They were still hunting and farming, they didn’t have cars, they rode bikes. Even though the Pimas were eating the same diet as the Westerners that were in the same vicinity as them, they gained more weight. It’s thought that this thrifty genotype that evolved over centuries that helped them survived in times of drought were now hurting them in times of plenty. Not everyone has that same collection of genes. Depending on where you’re from, your lineage, you might have the propensity to put on more weight. That’s considered the genotype type hypothesis. But there’s also specific genes that have been discovered as well that are linked to fatness. One is called FTO. People with an FTO variant, they have actually have a higher appetite for energy rich foods. There’s one experiment done where they have kids with the FTO variant and those without. They take these two groups, they let them run to a buffet, they pick up whatever they want. They noticed kids with the variant will get more foods like chocolates and chips that are really high in energy because they have more propensity to like those kind of foods. What they’ve also found about this variant is people that have the FTO variant also have a higher proportion of white fat cells, their beige cells instead of turning brown will have a tendency to turn more into white fat cells instead. There’s more fat cell creation. Another gene, IRS-1, certain variants of that gene also are linked with higher fat cell creation. We’re just in the beginning of genes and fats but there’s certainly a role for it. Depending on what you’ve inherited, it doesn’t mean you have to be obese. I don’t want to send that message at all, but you might have to work harder at keeping your weight down than someone who hasn’t inherited those types of variants or that collection of genes and the genotype.

S: I also understand that epigenetics can play a role. How the gene is express changes depending on your environment and your upbringing. If you had scarcity as you were growing up, didn’t get enough to eat or you have a low quality food, like going out to McDonald’s all the time, then you’d have a hard time keeping the fat off as an adult, was my understanding.

S: That’s really burgeoning field, very new and very exciting. There’s methylation of DNA depending on what our activities are. Some gene expression will get blocked, some will get promoted. It can change though over time. There’s one experiment that you might have seen where they have people exercise with one leg and the other ones not. They noticed that the methylation patterns. The chemical additives to DNA, which affect which DNA will get expressed or not, is actually changed in the leg that’s exercising. Depending on our actions, it’s actually somehow recorded in our bodies to these methylation patterns. It will change. I think they see that too in mothers who have been through starvation when they’re pregnant. Those kids end up being heavier than other kids. It is in a way, our activities are recorded in our body in some way and I think, how we can change that, I think, will be the frontier of some really exciting research down the way.

S: There’s also some really interesting developments scientifically, in terms of CRISPR and having the ability to edit our own genes as an adult. Anything interesting there that relates to fat and the research that you did around the book?

T: No, I haven’t seen things on CRISPR yet. I haven’t seen that applied to obesity. I know it’s being applied for some other very deadly diseases but I have not seen it yet, at least on obesity.

S: You mentioned bacteria and viruses having a role in whether or not you can easily lose fat or keep it off. Let’s talk more about that.

T: That’s always very surprising to people, that viruses can have a role in fatness. But in truth, it’s been known about for some time that it happens in animals. [00:15:28] associated virus has been known to cause fatness in chickens and pretty much accepted. Canine Distemper virus causes fatness in mice and that was all discovered in the 80s. There’s been a virus that’s been discovered to correlate with fatness in humans and it’s called Ad-36. I go through the story of Nikhil Dhurandhar, one of the leading scientists in this field and he had a very interesting story in how he came to research this, discover this. He was in India and there was a disease, an epidemic affecting chickens and hurting the poultry industry and it was a virus called SMAM-1. What they found on these chickens is that they actually had higher visceral fat. He thought that that was very odd because usually when you get a virus, you lose weight, you don’t gain weight. He became very interested in this and he was an obesity doctor at the time and he actually went and launched a PhD to research this. He did find that SMAM-1 was correlated to fatness in chickens. It could be transmitted between chickens and it would lead to fatness but what he also found that was surprising is that this virus for humans that carried it, they had a three to four fold higher likelihood of being obese than people who didn’t carry this virus. He got so excited about this research, he decided he wanted to come to America and put all of his weight behind this work and get some discoveries. He packed up his wife and kid, three suitcases, came to the U.S. and his personal tail itself is interesting. Once he got here, he couldn’t get a job for years, he had to work on sunflowers and he miraculously got a job at the University of Wisconsin just before he was about to come back to India. Once he finally got this job, he couldn’t get the virus. The U.S. wouldn’t let him import it from India. Very serendipitously, he found a virus in the U.S. that has all the same qualities as SMAM-1 and that virus was Ad-36. Ultimately, as Nikhil Dhurandhar was studying this, what he found is that Ad-36 actually leads to a higher absorption of glucose from the cells. They internalize more glucose. They create more fat molecules and it also helps bodies create more fat cells. The cells that we have, the fat cells we have are getting bigger and we’re creating more of them. It’s not that rare, what he found is that about 10% or more people actually carry this virus and overall, they have about twice the risk of obesity than someone who doesn’t have the virus. This has been studied long-term by a number of researchers now. There’s one study, I think, for 17 years, an army personnel, where they found, I think it was a three-fold higher risk of obesity and people had it. Just studying a longitudinal study where they study them for a number of years and see what the differences in their weight over time. That is a factor and I think it’s just interesting to know. Again, it doesn’t mean you have to be obese but it is harder to manage your weight if you have it, you have to be careful. I did go to the story of a patient named Randy who, unbeknownst to him, carried the virus for a long time and he had really struggled with his weight. I think he was 250 pounds in his 40s and was finally referred to University of Wisconsin program and that’s where he met Nikhil Dhurandhar. They did a test to learn him and he found that he was positive for Ad-36. He thinks that it happened in his childhood. He remembered being scratched by a rooster on his farm and he thought that’s when he really started gaining weight and having trouble managing his weight. Once he learned all this, he felt really empowered. It really did change his life, just the knowledge. This is where knowledge about fat can be very powerful. He was able to finally get a hold of it. He understood he had to eat a lot less, he took a number of measures to control his weight after that and he finally is in really good shape now. I think he’s around 62, 63 probably, 170 pounds, very fit. But I think the knowledge gave him that incentive, the understanding that it wasn’t his fault, it wasn’t a blame heavy program and he was able to manage his fat after that.

S: That’s great. What about bacteria?

T: Bacteria is another one of these little critters that has a role in our weight. We have a lot of bacteria. In fact, we’re more microbial than we are humans. We have more bacterial cells in our body than we do human cells. A large part of that bacteria population lives in our lower gut. Bacteria, they have enzymes that we don’t carry. As such, they can turn complex sugars, polysaccharides into simple sugars and help us absorb them. Depending on the bacteria that you do have in your gut, you could be getting more or fewer calories out of your food. This is a very evolving space too, there are not very hard conclusions here yet but there are some types of bacteria that are associated more with heaviness and there’s some that are associated with leanness. Depending on what you eat, you can actually tilt this bacteria to be more of one associated with a leaner body type profile versus a heavier profile. More fruits and vegetables will actually tilt it towards a leaner profile bacterial distribution that’s associated with a leaner profile versus if you’re having more carbohydrates and more fats. Not only do you get fewer calories if you’re eating more fruits and vegetables, but you’re also tilting your microbiome towards that associated with a leaner body type. That’s very interesting. There’s very convincing studies in mice where they do this, where they have germ-free mice, those mice that are raised without any bacteria at all versus those who are raised more conventionally. What they find is when they give them the same amount of food, the ones that have no bacteria actually eat more and are thinner by about 50% than the ones that have normal distribution of bacteria. They actually eat less, those mice with normal bacteria, and yet they’re 50% heavier. At some point, they thought it was metabolism that these germ-free mice must just have a higher metabolism but they find it’s actually lower. Heavier mice are actually eating less but they have more fats and they have a higher metabolism. It’s very interesting that I think it’s pretty convincing evidence that bacteria has a role in fatness.

S: I read about a related study while researching for this interview, thin mice got bacteria from obese mice and they became obese.

T: That’s right. The same germ-free mice that were thin, when they put the bacteria in the conventionally raised mice, they gained weight, they gained about 50% fat fairly quickly. He has done other interesting studies in twins, when they take twins for obesity. One twin is heavy, the other one is thin. From the fecal matter, they pull out the bacteria and they put it in the germ-free mice. The mouse who got the bacteria from thin twin will stay thin and that mouse that got bacteria from the heavier twin will gain weight. Very interestingly, it takes on the phenotype of the donor. There’s something there. The good news is that it’s not permanent. You can tilt it, it does take some work. Again, it’s a very evolving field so exactly which bacteria are associated with leanness versus heaviness is still being researched. But I think, again, the removal of some fats and carbs are more towards fruits and vegetables, not only are you passing more weight of fruits and vegetables, not only are you decreasing your calorie count but it’s also tilting your microbiomes. Weight loss begets weight loss and on the flipside, weight gain begets weight gain. If you eat a lot of fats and carbohydrates, your microbiome is developing in a way that is very good at extracting those calories, you’re gaining more weight there too. We can get set on the spiral of either weight loss or weight gain within microbiome.

S: One of the first things to do is to learn the health of your microbiome and the components. In fact, one of my upcoming guests is going to be Dr. Jessica Richman, the CEO and co-founder of UBiome. You can order a test kit and get your microbiome tested with this technology. It’s pretty interesting. I’ve had it done. Any particular approach to analyzing your microbiome that you like? Have you tried UBiome or any other?

T: There’s a number of different places out there. I think there’s one in Colorado too, American Gut, I think it’s called. I know this is becoming more popular and there’s more companies doing this. I think it’s fine, one that you think is quality then you can have it done. The thing is that, you can know. It gives you the knowledge I guess. But in the end, the solution is more or less the same whether you have it tested or not. I think people growing more towards leafy, fibrous vegetables, it’s going to help you tilt it in either case.

S: Got it. Also, knowing your genes and getting your DNA tested can be really valuable too, right?

T: It can. I think 23andMe will test for FTO. They don’t test for all of them and again, that’s really a changing field as well. I don’t know of a way to test for a thrifty genotype, a collection of genes, but the ones that are identified in research at least should be in some of these genetic tests. What it tells you though is that you have a propensity to gain weight when you have propensity to higher calorie foods. The work is the same. I hate to say that but in the end it really gets down to what we know we can control which is diet and exercise but it is harder for some and hopefully what this research does is it removes some guilt. I think people have a lot of guilt when they fail on a diet, when they feel like they’re just too hungry and they can’t go on, they end up eating. They feel like failures. There might be a reason you feel that way, why you’re hungrier or why you’re not losing at the same rate. Part of what I hope The Secret Life of Fat does is help people with self-acceptance in a way. It helps you understand if you have to ratch it up or ratch down your diet and you can decide if you want to that extra work. I think the way that we’ve been going which is selling diet plans, the diet industry is full of this easy diet where you’ll never be hungry, it’s as simple as 1, 2, 3 and if you fail this diet, surely you’re not just doing it right. That sells a lot of diet books. It sells a lot of meal plans. It’s not necessarily helping people maintain weight loss. The effect of the caloric penalty whereas if you gained weight and lost it, you have to eat less, you do have to get on a diet for the long run. Not just for 6 months to lose 10 pounds and then go back to normal. Weight maintenance will be as hard as losing weight to begin with. That’s what people have to understand. The diet has to work for you biologically, your body is responding to it but also psychologically, there are foods there that you want to eat for the long run. It has to work for your lifestyle. If there’s a lot of meal prep, and you don’t have time for that, you will fail in the end. Pick a diet as if you’re going to stay on it for at least six years. I know that you might have to work harder. It might be a little bit uncomfortable for you, all those stories of “I lost 20 pounds and I was never hungry,” just take that with the grain of salt. Not everyone’s the same. There’s not one diet that fits all.

S: An interesting way to think about this too is that if you go to a place to get your genes tested, your DNA tested, I’ve done 23andMe. It’s really interesting, I did it before the FDA stopped them from sharing all the medical reports and switched primarily just to the heredity and relatives and that. There’s a really interesting service called Simplified Genetics. I just recently had my DNA tested with them and instead of giving you a bunch of data on all these different genes that they found, they’d give you an exercise plan and diet plan and it’s tailored to your DNA. It’s pretty interesting.

T: It is. Do you know what genes they picked up? Did they give you that analysis?

S: No but I’m going to have the CEO of the company on the podcast. Stay tuned for an episode where we’ll get into those details. So far, it looks really interesting. He’s already agreed to be on the show. What about blood type? I’ve heard about “Eat for your blood type.” Is there any validity in that?

T: I didn’t uncover anything significant there when I was doing my research. I don’t know. I guess, as a biochemist, it’s a little hard for us to understand how that makes such a difference. Genetics obviously, you can see how that would make a difference, microbiome, you would see how that would make a difference. I don’t know enough about the blood type theory about it. I didn’t uncover it in my own research. That wasn’t a big factor I was finding on weight gain.

S: When you were talking about the twin study, it reminded me of some reading I did about fecal transplants and how sometimes the way to solve medical issues is through transplanting the feces from a healthy individual to a person who has this situation. How would this play in with regards to fat and fat related disorders?

T: I’ve heard of this to. [00:29:32] is probably what you’re talking about where there was a fecal transplant that helped people with this terrible infection and they actually got better. The thing with the microbiome is that it’s not static, it does change. Even if this were to become available for obesity, trying to help people to lose weight, if they continue to eat potato chips and candy and then high fat high trigger foods, your microbiome will tilt back to one that accommodates those types of food. It’s an ecosystem in there and depending on what you’re eating, you’re going to foster a certain type of growth of bacteria. Will this ever work on obesity, I guess that’s far out there, we’ll see but even if it does, just like gastric bypass, you still have to do the work. You can use these tools and these interventions but if you go back to the lifestyle that you had, they’re not going to matter in the long run. I know people, especially someone like me does all this research, what’s the magic bullet, what can I do that’ll get this weight off. Right now, what we have is we have gastric bypasses. I know people have been successful with that though they still have to watch their diet and exercise. Hormonal replacement therapy is a tool if you’ve gotten to that age where your hormones are actually declining and putting more in will help you but it has its own risk benefit profile. There are certainly drugs out there, diet pills, again, have risk benefit profile. What we really have to work with is the diet and exercise part. I know that’s disappointing because some people want something more, they feel something will come out on a research like this. There are things on the horizon. There’s the talk about Leptin injections which will help people maintain weight loss. Again, if you’re weight reduced and your low Leptin level, that can help people alleviate some of the appetite and metabolism issues with losing Leptin. Brown fat being injected into white fat is being looked at in a lot of different ways as ways to lose fat. For the here and now, what’s most reliable is that it is diet and exercise and I think you have to be smarter about it especially if you have stubborn fat like I do where you gain it very easily and it doesn’t come off very well at all. What can you do? What smart things can you do to really play with all the things that we’ve learned to burn the fat off? One of the things I use is intermittent fasting. It’s kind of working with your hormones if you will. Certainly, insulin is something that we hear about a lot and those hidden sugars and those hidden carbs, they help insulin stay high and it helps with weight gain. Growth hormones is something I talk about which isn’t so talked about in as many books. It peaks at night and growth hormone is a great fat-burning hormone. When you fast, you extend that overnight fast, it’s thought that you promote the release of growth hormones, you extend the release of growth hormone that overnight surge that you get. I just found that to work really well. It’s not always easy to do. In the beginning, it was actually quite hard but it got easier with time to extend that overnight fast. I think that’s an example just to kind of smart things you can do to work with the knowledge that’s on Secret Life of Fat. Try to apply these things and see if you can get those last 10 pounds off. Deal with your stubborn fat. None of this is a magic bullet and it does fall back to what we have here now to work with which is our food, the time we eat, the type of exercise we do until some of those better research areas like with Leptin replacement or brown fat actually come into being.

S: Right. Diet and exercise are really the secret sauce here. Don’t run out and get liposuction. In fact, I’ve heard that the same amount fat in the bloodstream after liposuction occurs or like this seen risk levels of heart disease, even though you might have gotten sucked away a lot of your excess fat, you’re not actually any healthier.

T: I actually wrote about that in The Secret Life of Fat, I did a section on liposuction. Subcutaneous fat, like I said, it’s a healthy deposit of fat so when you remove some of that, you removed some of these healthy deposits where fat would probably go in your bloodstream. What they find is people who did liposuction, they also have a lower metabolism after they get liposuction and unless they increase their exercise, that fat doesn’t stay off. In fact, what happens is some of the fat that was removed, when these experiments repeat from their abdomen or their legs and buttocks, that fat actually came back but in the visceral area. It came back in a more dangerous place than it was before. Liposuction or even freezing your fat, that’s not really a great solution. It does have the same effects as just losing fat in general, which means it’s going to lower your Leptin, it’s going to decrease your metabolism, and you do have to do more work afterwards to keep the fat off. If you just did the more work to begin with, you might not need that liposuction, you might not have to take that risk. Also, you can come back in a less healthy area like your visceral fat and according to what you’re saying, also circulating more in your blood, in your higher triglycerides levels too.

S: Yeah. Basically, you need to earn the fat loss.

T: You should respect your fat. That’s another thing I hope The Secret of Life does, understand how much it’s doing in your body. It’s not just sitting there some unsightly body part that we have to get rid of. It’s actually a great service. I write about people who don’t have fat. There’s one patient I wrote about named Christina she had lipodystrophy. Her fat started disappearing, it was a genetic defect. She became unhealthy very quickly. It happened in her teens. She started losing her fat and she had an enormous appetite. She was eating volumes of food yet losing fat all the way. At first we thought she might have diabetes and we started treating her for that but it didn’t help, she continued to have a huge appetite and her weight continued to decrease. Finally, she went to NIH and was diagnosed with lipodystrophy, the disease where your fat atrophies. Her health problems were linked to having no fat, without any place to go. The triglycerides, cholesterol, sugars from her blood, they just circulated endlessly. They were depositing in her liver. Her liver was about eight times the size of a normal liver. She had these blisters on her skin because that’s where fat was depositing. There wasn’t fat to go to. She was really quite unhealthy. For a while, they did plasmapheresis on her so they would actually cleanse her blood like they do for dialysis patients. Her doctors said her blood was cream colored. It wasn’t like normal red blood. That’s how much fat was in her blood. It was 100 times the triglyceride level that was normal. Finally, when Jeffrey Friedman discovered Leptin from Rockefeller University, it became available for her. Once they injected Leptin into Christina, her appetite subsided considerably. She wasn’t eating as much. When she ate a lot less, she didn’t have all the extra triglycerides and cholesterol nutrients in her blood. She was able to manage her diabetes better. It just shows you the importance of fat. With no fat in her body, she wasn’t naturally producing Leptin, which is why she ate all the time. Her appetite was to the roof. Also with no fat, those extra nutrients have no place to go. Unless you manage your intake minute to minute which no one can really do, you have to thank your fat for being there to absorb that extra as you need to. Not only is that reserve of calories and energy an incredibly function of fat but the hormones it’s emitting like Leptin, like adiponectin, even estrogen that it’s making, it’s critical for our body. Respect your fat, learn to love it, keep it in the right places, keep it away from your visceral section. If you want to manage it, if you want to reduce it, be as smart as you fat is and learn how to interact with it in a way so it will actually make an impact. Fat is really important to us and I hope people come away with that understanding.

S: It actually can be protective as we age.

T: Yeah. That’s really interesting too. I wrote about the obesity paradox. Some of these diseases, fat is completely linked with diabetes and heart disease. What they find is that people with a little extra fat actually do better after a traumatic event from those diseases. After a heart attack, if they’re sick, if they’re hospitalized because of diabetes, for whatever reason, patients with a little bit more fat higher than normal have a lower mortality rate from those diseases. I think a paper just came out in Jama I think it was maybe last fall, last November. I want to say about, even alzheimer’s diseases, dementia, people who are overweight actually had lower incidence of dementia which is confounding because there’s other studies that show something different. It could be like as we age, fat is actually a little bit protective. It protects us from death a little bit. Again, don’t just all out hate your fat. There are reasons we get it. Nature has ways of protecting it because it needs it. Do keep your fat healthy, do keep it away from your visceral section, do exercise and keep it at a manageable level.

S: This intermittent fasting that you talked about, what are the specifics around that? Like is it an eight-hour window when you eat, is it ten-hour window? How does your typical day look as far as when you eat and when you don’t eat?

T: The guidelines I’ve seen is it’s about a 16-hour fast for women and a 14-hour fast for men. For me, personally, what I do is I stop eating after around 3:00PM or 4:00PM and I won’t eat again until 9:00AM or 10:00AM the next day. I do that overnight fast. Really, it gets down to a late breakfast, your main meal of lunch and early dinner and then I just stop for that overnight period. People can do this in different ways. I like not eating dinner. I find it to be more effective but I do know people will also eat later at night but then they won’t eat again until lunch the next day, they’ll just push it back. There’s a number of ways of doing it, intermittent fasting. I think you can make it work for you. I’ve also known people who were miserable on it. They didn’t like it all. If it doesn’t work, certainly there’s other ways to lose weight as well. I think ketogenic diets, people have some success with that. I had success with that for a while. But again, here’s where the diet–it’s not just how you respond biologically. Intermittent fasting works for a lot of people. If it doesn’t work for you, don’t do it. Remember, you have to be on this diet for years, not just a few weeks or few months. If it makes you miserable, if you have to have dinner with your clients or your family and you don’t want to do it, it won’t work for you. You’ll come off this diet and it will fail. Pick a diet that works for you biologically, that works for you for your lifestyle that you have and that works for you psychologically, something you can stay on that has the foods on it that you really feel like you need to eat. It has to be a very holistic diet.

S: Speaking of ketogenic diets, I’ve had Dave Asprey on the show and we spoke about the bulletproof diet. What are your thought about bulletproof?

T: I’ve been on ketogenic diets and they work. I had success with it. I think where it failed for me or where I came off of it is that it was restrictive for me. I actually really like sugars and I just will admit that. I have no apologies or guilt about that, it’s just a part of who I am. If I can’t have that once in awhile, I find that I don’t stay on the diet. I did Atkins, I did various other diets as well. What I opted for instead was a diet that gave me more flexibility on what I can eat. That is for me intermittent fasting. I could pretty much eat what I want during the day, I can come off my diet, I could have chocolate if I want. I can have carb if I want. As long as I don’t eat in that overnight fasting period, I’ll still lose weight. There’s other research that’s very interesting that’s good to know. Here is coming out of Weizmann Institute in Israel, I think Eran Segal did this research where he measure the blood sugar response to various foods on a number of people. What he found out was that not everyone reacts the same way. There are people who can have chocolate, they can have alcohol, and they don’t get a blood sugar response. Their bodies manage it just fine. Other people can just get a morsel of something sweet and their blood sugar spikes. We don’t all react to food the same way. I hear this from personal trainers I talk to as well, they have clients that can eat whatever and it’s fine, other ones who can’t even, I heard the term, “Who can’t even lick a prune without gaining some weight.” For me, at least, what I did because I was a scientist at heart, I kept a spreadsheet of what I was eating and what effect it had on the scale the next day. I found out that I could actually get away with some foods. For example, chocolate actually doesn’t make me gain weight. I can continue to eat, to lose weight rather if I eat this amount of chocolate, it doesn’t seem to affect me. However, something like a cookie, that will. I can gain a pound on a cookie. I think if you just analyze it for yourself, individualize your diet, what is working for you. What can you stay on for the long run? Again, not only are you losing weight but can you live on that diet for a while. I’m hoping that we’re really leaning towards more individualized diets like you mentioned, having your DNA analyzed, that might help you on a diet. Weizmann Institute will be very interesting too to help people individualized diet for them.

S: What do you think about having a cheat day? I know there are people who are really strict during the week and then they have one cheat day. They eat all sorts of garbage. I can’t imagine that’s healthy but for them, the diet works. What are your thoughts on that?

T: I actually think that you need to have some cheat days once in awhile. I think it’s very hard to stay on something all the time. Some people might have that metal but most people don’t. When we’re on our diet regimen, it requires some self control and willpower to stay on it. No matter what change you’re making in your life. If you want to stop swearing for a while, if you want to meet your deadlines better, it requires a behavioral sustained change. That requires willpower. What they find with willpower, and I have a chapter on this in my book too, it’s that it gets worn out, it’s just like a muscle, it actually gets tired. Health care workers, they’re supposed to wash their hands all during the day. They find towards the end of the day, they just stop doing it, they’re just tired. But if they give them longer breaks, in between shifts, they’ll continue to do it. That break actually helps them sustain with the program a little bit longer. Another study where they have people hold a hand exercise so they have to do physical task and then they separate them. One watches a sad movie, one watches a happy movie. The people who have watched the happy movie, after the movie, they’re ready to come back and hold that hand exercise, they’re gungho, ready to go. People who watched a sad movie, they have much less energy to try back at that test. We do have to replete our bodies and our mind, our psychology on this. I speak to one physician who runs an obesity clinic, Michael Dansinger at Tufts University. This is what makes his program a success, he says people go off all the time. What he asks for is 80% compliance. 70%, he doesn’t get weight loss but around 80% to 90%, he can still get weight loss. One of his big value adds is that he coaches people when they’ve come off they’re diet. A lot of people go down the slippery slope. They come off of it, eat ice cream and they go, “What the heck, I ate ice cream yesterday, I might as well have it again today too.” It’s called the economist thinking, where you get an A or an F. People who have the economist thinking, they don’t have that in between state. You either failed or you’ve succeeded on something. When they failed, they want to keep failing. They think that there’s no point in going on anymore. Surprisingly, women seem to have this more than men do. One of his big value adds is when people do go off, he works really closer with them to get them right back on, so they’re not down that slippery slope of dieting. Even though I think people need a break, I certainly take breaks too, the real key is to get back on the very next day, except that you’re going to go off your diet every once in awhile, it’s okay once in awhile, just get back on so you’re having 80% to 90% compliance in whatever diet it is you’re picking.

S: That makes sense. One thing that I have done, that’s worked quite well for me is to just stop eating desserts, with the exception of holidays like my birthday, Christmas, New Year, that sort of thing. I’ve been doing that for a year and a half. It works quite well, I don’t really miss it. In fact, I feel really empowered that I’m able to stay on this and I’m definitely feeling healthier. What are your thoughts on cutting the sugar from your diet? I’ve heard they call it the white devil, well that one with the flour. Is it as bad as I hear that it is?

T: It’s certainly vilified like nothing else right now, for a good reason. It’s scientifically sound, I think. When you have sugars, it elicits an insulin response which makes you deposit more into your fat. It clears out your blood and then you’re hungry again, you want to eat more. That being said, sugar is all around us. I think this is where your diet has to work for you psychologically as well. I think it’s great that you cut out sugar. It is a great thing to do except for once in awhile. Like I said before, some people respond more to sugars than others. Some people get the spike, some people don’t, the spike of insulin in their blood sugar level. Again, it has to work for you biologically. I think small amount of sugar is not hurting anyone. I went to a meeting at the Obesity Society. It’s all doctors who study obesity. They had a healthy lunch but of course after that, there’s a cookie tray that comes out and they’re having sugar as well. I think sugar is pretty hard to stay away from. I applaud those with the rule of steel who can stay off of it entirely. I can have small amounts of sugar and be okay, but again, I’m very careful about it. I’m not having piles of cookies or piles of cake, or candy. I’m very careful with the limited amount I take. I find I can still lose weight doing that. The other interesting thing about insulin is that insulin has some satiating effects. When we eat something that causes that insulin, on our brain, it actually satiates and I’ve noticed that. I know when I started eating a lot of salad to try to manage my microbiome and weight loss, I found that I kept looking for food after that. No matter how much protein I put on the salad, no matter how much fat I put on it, it didn’t stop. I kept rummaging for food. I finally stumbled upon this that if I ate four gummy bears, four or five gummy bears after my salad, I had zero interest in food for hours afterward. I can only attribute it to that satiating effect that insulin has. If you need to have that sugar, if it’s important to you, if you find that’s a weakness and you try diets like ketogenically, you come off of sugar but you find yourself failing on that diet, I think small amounts of sugar, if that’s what you need to stay on, handle those calories so that it affects in other ways. Eat a little bit less or exercise more but again, make sure that diet works for you psychologically as well.

S: As you say, willpower is a finite resource and as the day wanes on, if you’re not replenishing it, you’re going to end up going for that cookie jar or whatever.

T: Monitor what makes you gain too. Like I said, I can have straight sugar and I don’t seem to gain as much weight. If I eat a piece of chocolate, a small piece of chocolate, it’s fine. But if I have a piece of chocolate cookie, it’s not fine. There’s something in the flour that’s affecting me personally. That doesn’t have the same effect to say, “My husband who can eat cookies and ice cream and not gain any weight at all.” Just monitor your own body and what’s working and not working for your weight loss.

S; What are your thoughts on being gluten-free? Let’s say you don’t have celiac disease but you feel better when you avoid gluten. I know people who are like that.

T: I think there’s a lot of great diets out there. They all can work. There’s a pasta diet out there. I know someone who lost lots of weight on the pasta diet. You just have to pick the one. Like I said, you like it, you can stay on this for six years because remember, weight loss, it’s a permanent effort. It’s not something that you can go back to eating six months afterwards because that’s how weight regain keeps happening. Pick one that fits to you in all those different ways that you’re losing weight on, that you like being on, that you feel satisfied on. But if you feel that even after your best efforts for three to six months, there’s a craving or something you don’t want to live without that I think you have to modulate. But I think it gluten-free is a fine diet, it ends up being a low-carb diet in the end. There’s thoughts around the gluten we get and the value of it after all the process food that we’ve been eating so long. If you like it, and it’s working, stay on it. I think ketogenic diets work. Another diet I’ve been on that has worked where you just eat five to seven smaller meals a day, except I had to exercise more on that diet. I didn’t have to fast overnight but it required, at least for my body, more exercise to lose weight on it. Lifestyle-wise, that didn’t work for me as much. I’m extremely busy with the job and kids, and I couldn’t exercise two hours a day. The one that I end up settling on was more of right, I just stopped eating early and I can eat what I want during the day as long as I do that intermittent fast. It gets me a little bit more latitude of what I do eat. I do exercise but I don’t have to exercise as much as I did on the small meal diet. I can go off once in awhile and it’s not the end of the world. Again, just pick one that you can really live with for the long term. The other thing to remember is that we don’t have to have six pack abs or look like the model on the cover of Sports Illustrated. You don’t have to look the way you did when you were 20. You can be healthy with a little bit of an extra pound. Again, that gets down to knowing what your fat is doing and just making sure it’s deposited in the right areas and making sure the rest of you is healthy as well, that you are exercising, you’re reducing your visceral fat. You’re building more lean muscle. You have high adiponectin levels and you’re getting enough sleep. Healthiness is more than just getting rid of all your fat. We actually need fat and I’m hoping to give people more balance and why is it important and why we need it.

S: Do you believe in calorie counting as part of the process? Do you do it yourself?

T: I do it myself. I think there’s some diets for you that you don’t need as much. I think Atkins, you don’t really need it as much because you’re really controlling your insulin level. For what I’m on, I found it to be useful guide. Fats which are categorized with very high calories, I can eat fats and not gain that much weight because I’m not having tons of carbohydrates. I count them but I guess I give more leeway to some types of food than others just because I know my body is responding. Again, that gets down to my details spreadsheet and I study each food that I eat and the effect that it’s had. It almost like a historical analysis of what’s working for me. I encourage people to try it. I think we’re all fairly intelligent, we can all make this correlations and I think people will start to realize when they’re gaining weight or not depending on what they are eating.

S: Okay. There’s a diet where you measure your macros and you just eat whatever you want in the right percentages. Protein, fat, and carbs. You could eat junkie chips or whatever, you could eat a much healthier carb but you eat to that percentage of carbs. Have you tried that diet?

T: I did try it for a while. It took a lot more measuring than I cared to do. Again, that’s for the lifestyle fact did come in. I know people on that diet, it works well and they’re thin. I guess what’s a better measure of what diets work, if you’re kind of thin, you only have 10 pound to lose, I think you have more latitude on which diets you pick. There’s a lot that can work for you. I think if you really gain significant amount of weight, you’ve gotten to obesity levels or something close, it might be a little bit harder to get all of that weight off. I think there’s a proportionate amount of effort that that it takes. I do think that the calorie count matters more, the exercise matters more, some of them were trendy fattish things, they come and go. It’s a really big effort to lose that weight especially when we the see the effects of Leptin and how hungry those people get after losing 10% of their weight. There’s once I write about, which came out in Australia, where they measured hormones after people lost 10% of their weight. Not only does Leptin go down and make you hungrier but stomach hormones are all changed in a way that it seems permanent. Ghrelin levels are higher of making us hungry. That’s a hunger hormone. Other hormones associated with satiation like GLP-1 and PYY, they’re also changed in ways that make us hungrier after we lose weight. It’s a sustained response. It’s not something that goes away quickly. If you’re losing just 10 pounds, you might not have that effect quite as much as someone who has 50 or 100 pounds to lose. Depending on where you are, where you’re starting from, the effort you have to make, I do think there might be a difference in the types of diet that work on obese versus people who just have 10 pounds to lose. My guess is that people who have less weight to lose have more latitude on which diets are actually working.

S: Got it. Still there’s some fundamentals that everybody should be following like eating more leafy greens and more fiber and also paying attention to the quality of fats that you’re intaking like avocado is a good fat, canola oil, that’s see through and that’s been bleached and drained like most of the canola oil in the grocery store, really not good for you. Let’s talk about the difference between BMI, body mass index and body fat percentage because some of our listeners probably don’t know the difference.

T: BMI is a pretty good measure. It’s just taking weight and height, taking those two factors and making a ratio out of it. Someone who’s a bodybuilder might have a very high BMI. They might have higher BMI than someone who’s obese and that’s because they have much higher weight but it doesn’t mean that they have higher fat percentage, they might actually have very low fat percentage. I think it’s being looked at more. In fact, I was looking at people who are considered over fat and this is actually quite dangerous so that people who have a normal BMI but they actually have a very high fat percentage. That’s because they have a higher propensity part of fat, they’re overall lower lean mass, lower bone mass, lower muscle mass but they look normal but a higher percentage of them is fat, they have a higher fat level. Really, the Caliper test, the Underweight Water Weighing test, the waist-to-height ratio is actually a better measure of our fatness than the BMI.

S: Got it. One more controversial question, what’s your thoughts on Statin drugs?

T: If you really have high cholesterol and they are working for you, I guess it’s good but then again, I think I would go the route of the sumo wrestler, just look at that story again. Are there other ways that naturally we can bring some of this down? I do know people that have taken Statin pills and they still had a heart trouble in the end. They didn’t work for the long run for them. Some of them are reading my book now. I get these messages from them. If we can look at diet, if we can look at how we’re really having an overload of cholesterol in our blood as something around the life of the sumo wrestler which is just more exercise, more adiponectin in our blood that can help clear it, I think we have to start to look at alternate paths for some of this.

S: Very good. Well, thank you so much Sylvia for sharing all your research and life experience and wisdom around this topic of fat and how we can use it and not abuse it. Did you have any final thoughts that you wanted folks, listeners to go away with other than of course, to read your book, The Secret Life of Fat?

T: If you’re having struggles with stubborn fat, don’t despair. I had the same struggle and really for decades, I fought with this. It just got worse with time, as I went into my middle ages. The five years of research I did on this, I think I found the answers I needed. You can get through it, it will be hard but you can still do it. Use my book if you can, it’s just an incentive. To understand your fat, I think you’ll respect your fat more, you’ll understand it was actually trying to help you in some of these years. It can go bad if we have too much in the wrong places but there are ways to bust it out too. It might be harder to do than you think but people are much stronger than you would think as well. I think it’s all possible, just keep up the good fight and just know that you are not alone. I think part of the comfort of writing this book was meeting people who were like me. They also had stubborn fat and had to eat less than they thought they would and had to go down that path. You’re not alone in your quest if you’re having that problem.

S: Awesome. Well, thank you again Sylvia. Thank you listeners. Do visit the website for this podcast because we’ll have not only show notes with links, we’ll also have the transcript of this episode and a checklist of actions that you can take. Do remember also that this is not medical advice. Do consult your doctor and all standard disclaimers apply. This is Stephan Spencer, signing off. We’ll catch you on the next episode of The Optimized Geek.