Search for tag: "metabolism"

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Mitch: So maybe you've heard about it on some ads or a TV show, or maybe you got a friend who's getting really into it. It's ketosis or the keto diet. And I just have a lot of questions about whether or not it really is as magic as everyone seems to make it sound. So we're going to find out today.

This is "Who Cares About Men's Health," where we try to give you some information, some inspiration, and maybe a different interpretation about your health.

I'm Mitch, and joining us today is Scot. He is the master of BS, and manager of The Scope Radio. Hello, Scot.

Scot: I am looking forward to hearing about ketosis as well. I hear it's a state that's hard to get into, but you can burn some major fat, so I want to find out if that's true.

Mitch: And also joining us is the MD that gives us a little bit of validity. That is Dr. Troy Madsen. Hey, Troy.

Troy: Hey, Mitch. Just a little bit. Don't overstate it.

Mitch: And to answer some of these questions, we have the wonderful nutritionist. Thunder Jalili is back with us to let us know about this particular process.

Thunder: Hi, Mitch. I'm happy to be part of the crew again.

Mitch: All right. So before we get into kind of ketosis itself, how about you guys? Have you ever tried out a low carb diet before?

Troy: Mitch, I'll just jump in right here and say no. I absolutely love carbs, so I can't . . .

Mitch: Carbs are the best.

Troy: Carbs rock.

Scot: Why would you do that to yourself? No, not really. I mean, the lowest I've ever had, I was on a diet called the Zone Diet, which I've heard is a low to moderate carbohydrate . . .

Troy: Carburetor?

Scot: Yeah. I've known people who've tried low carb diets, and they're not nice to be around. That's not just a cliché. That's actual truth.

Thunder: And I have tried a low carbohydrate diet. Very, very short-term for just a couple of days just to see what it was like, what it's like to follow this. Not for any weight loss reason, just more of an experiment.

Scot: Thunder, how did it go for you? What did you learn?

Troy: Yeah, were you super grumpy? I was going to ask that.

Thunder: No, not really. I mean, I still ate a lot of vegetables. Those were my carbohydrate sources. So I probably didn't have the classically super low carbohydrate diet. I mean, I don't think I was any lower than 30%, to be honest. So it was fine. I did it, and then after a couple days, I just wanted to have beans and some other stuff, so I just stopped. But it was mostly just an exercise to see how hard is it to do this? How limited am I from a practical sense?

Troy: And did you feel limited?

Thunder: Yeah, a little bit, I did feel limited. I don't mind eating salads and vegetables, but I don't like passing up fruit. You guys know how I love my smoothies. So I don't like trying to decide, "Oh, I can't put this fruit in the smoothie," and things like that. So, yeah, I felt limited in that sense.

I don't necessarily miss rice or pasta. But it's just when you start cutting the different fruits and beans and things, that's where it starts to get tough for me.

Mitch: So why don't we start the discussion here with what is ketosis itself? For someone who has never taken a physiology course, who doesn't have a degree in nutrition, Thunder, what exactly is ketosis and what does it do to the body?

Thunder: So ketosis is the metabolic state where your body is using fat for fuel. Basically, your liver has this ability to make ketones, which is kind of like a metabolic energy substrate in the liver, makes it in the liver. It can actually do this from fatty acids. To some degree, it can also do it from amino acids, which are the building blocks of proteins.

So your liver makes these ketone bodies, and it puts it into the bloodstream. And then those ketones can be used as a fuel for all the other cell types in your body.

There are a couple of particular types of cells that really need to use glucose, and if they don't have glucose, the next best bet for them is ketones. So it's important to have that. Your muscles can use ketones for energy, as an example.

So any time you're burning some degree of fat or you're using amino acids for energy, you're producing some of these ketones.

And then the last thing is "ketosis" is thrown around so much. Really, there's a window of ketone bodies, the level you can measure in the blood. And if the amount of ketone bodies circulating in your blood falls within this window, you're said to be in ketosis.

You don't have to be in ketosis to lose weight, but a lot of times, if you're doing something from a dietary standpoint or restricting calories, you are going to be in some degree of ketosis.

And you can actually have too much ketosis where the ketone bodies in your blood are so, so high, it can be dangerous, and it can cause an acidosis and potentially cause some harm, but that's pretty rare to be in that state.

Mitch: That's interesting, because one of the things I came across was what they call the keto flu. Have you ever heard of that?

Thunder: Yeah, so that's if you're just too hardcore about it and your ketones are just really high in the blood, and it just makes you kind of feel bad. It's not really the best thing physiologically. I would say that happens in people who really take the keto to the extreme.

Mitch: Bad breath, soreness, nausea, headaches, irritability. It doesn't sound super great to me, but what are some of the health benefits, I guess, of being in ketosis or using ketones? I guess even if you're not eating a strictly low-carb diet, does the body still go into ketosis? And is there any benefit from that?

Thunder: Yeah, you don't have to be in a low carb diet to have ketosis. If you just have a low-calorie diet, you would be tapping into your fat stores and producing ketone bodies that way, too.

There's not really any great benefit or great detriment of ketosis. It's just one of those natural metabolic states that we fall into from time-to-time. And it's just that in the modern context of people trying to lose weight, people will try to use that as a goal, to be in ketosis for an extended amount of time, with the idea that that means they are burning fat. But there's no specific benefit or detriment. It's just something that happens to us.

The only detriment would be if you go too extreme and you have such high ketone levels in your blood that it leads to keto flu, like you were talking about, or other similar bad effects.

Mitch: Would this be, say, maybe a dangerous thing for someone who's maybe diabetic? Or with how low the nutrients are or how many nutrients you might be missing out on from cutting carbs completely, could it potentially lead to vitamin deficiency problems and who knows what?

Thunder: So, in general, yes to a lot of the things you touched on. I'm also going to give Troy an opening here for the diabetes question if he wants to hop in, but for diabetes especially, diabetics can develop a dangerous condition called ketoacidosis, where basically there's just too much ketones, too much acidity in their blood, and it's very dangerous. They have to be careful with that. Troy, do you want to add anything to that?

Troy: Yeah. I was going to say for diabetics, they definitely would not want to do a ketosis type diet. And I'm sure anyone who's dependent on insulin, they know that. They know their carbs, they're tracking those things, and they're adjusting their insulin doses based on that. So to go to a very low-carb diet could be very dangerous.

Number one, unless they adjust their insulin, they could really drop their blood sugar low, which would be dangerous. But like you said, Thunder, one of the things I treat in the emergency department is diabetic ketoacidosis, where patients come in, their blood sugar levels are really high, but that blood sugar is not getting into the cells, so then their body is producing ketones. And exactly like you said, Thunder, they're acidotic. They're nauseous. They're vomiting. They're confused. It can be a life-threatening condition.

So certainly people with certain medical conditions, you would not want to do any sort of a low-carb diet or really be trying to achieve any kind of ketosis.

Thunder: Yeah. Correct. And the treatment for that is a lot of insulin.

Troy: Exactly. Yeah, that's how you treat it. We start them on insulin. We give them sometimes an insulin drip. Sometimes they go to the intensive care unit. It can be a very serious condition, and something I see on a regular basis.

Scot: I'm sorry. I might have just dozed off or something. I'm a little confused. I thought ketosis . . . People do like the Atkins diet or a very low-carb diet because that puts them in the state of ketosis, which helps them burn additional body fat. Is that not true? I'm kind of getting the feeling that that's not the case.

Thunder: No. One of the ways to encourage burning body fat is to do a lower carbohydrate diet, but a lot of times lower carbohydrate diets can also be lower calorie diets. You've got to get the energy from somewhere, so you mobilize your fat stores.

One of the ways of thinking about this weight loss, fat burning, and all these different diets, there are a lot of different ways to get around the same thing, trying to produce some calorie deficit. So, really, you're not comparing the merits of a keto diet to a high protein diet or whatever other diet you want to find. It's not so much that. It's what kind of diet advice can a person follow to produce the weight loss that they want? That's really the question. Not necessarily does it have to be exactly a keto type diet or whatever else kind of diet?

But yeah, bottom line is any kind of low-calorie diet will produce some kind of ketosis because you've got to tap into your fat stores to provide the balance of energy that you're missing because you're not eating as much food. Does that make sense?

Troy: It does, yeah. And, Thunder, along the lines of weight loss, I've wondered how much weight loss . . . I know with a low-carb diet and pushing yourself toward ketosis, a lot of people do see some fairly quick results in terms of weight loss. But my understanding is that a lot of that is water weight and you get ketones in the blood.

And again, I see the extreme of this with diabetic ketoacidosis where they have these ketones in the blood that pulls fluid from the cells into the blood. That's why you often hear of people who, when they have diabetes or when they're first diagnosed with diabetes, are urinating a lot more frequently, because they're losing a lot of fluid.

And I've wondered with these low-carb diets, where you're pushing yourself toward ketosis, how much of that weight loss is truly long-term fat breakdown versus just pulling a whole lot of water out of your body and losing weight because of that water loss.

Thunder: Yeah, that's a great point. There have been feeding studies, clinical trials have been done comparing different diets over longer time periods, like a period of months, sometimes even up to a year. And a lot of times, you look at the graphs of weight loss, and they kind of look the same. There's an initial big drop in weight in the first few weeks, and then actually, the weight kind of comes up a little bit, and then it stabilizes.

So there's definitely an element of what you said, Troy, in there. You have some water loss initially, but obviously, if you stick with it for the long-term, you're going to be also losing some fat. It's just probably going to take a few weeks for it to stabilize at a certain level. You can't say what you lose in the first three days is going to be the trajectory because that's probably not accurate.

Troy: Interesting. And maybe that's kind of self-reinforcing. You say, "Wow, look at the weight I'm losing." But probably, like you said, you're not going to keep losing that amount of weight over the longer term. You're probably seeing a lot of water weight loss, and then eventually, you're going to kind of level out to where maybe it's more realistic.

Thunder: Yeah. You just kind of settle in on an amount of weight loss, and then you hit a point of diminishing returns where, in these studies, people don't necessarily lose any more weight. They just kind of stabilize at a certain level. And then if you want more weight loss to occur, you have to try something different.

Mitch: So I guess to wrap up that idea, is a keto diet worth it, or are there other ways to lose weight? Is it comparable? For me, at least, it just seems like such a lot . . . I mean, we were kind of joking, but I do love carbs. Carbs are delicious.

Thunder: Especially in the form of cookies.

Troy: Sure.

Mitch: Oh, cookies, whatever, sure. But is it worth that amount of . . . are the benefits, the increased potential for weight loss, etc., enough of a difference that would make cutting all those things out worth it, in your opinion?

Thunder: I think with any kind of change in food behavior, you have to land on something that you can stick with. So, yes, you can lose weight following this keto diet. But the question you have to ask yourself is, "Is this something you can stick with for the next 40 years or whatever?" Forty or 50 years. And if you can't, then it's going to be something you do temporarily, and then you're going to stop and then maybe fall back into old habits.

So I'm not a fan of extreme diets of any kind for exactly that reason, because I'm afraid that this is something that people just can't stick with long-term. It's like a short-term fix.

Troy: Yeah, I agree. And again, it's a theme that seems to come up again and again as we talk about diet and exercise and all that. In my mind, too, it's all about sustainability and not just that short-term fix and getting ready for swimsuit season or whatever it is. It's like, "Hey, can you do this for the next 40 years and enjoy it and have this lifestyle that's rewarding for you?"

And I guess if ketosis is, if a low-carb diet works for you, and you're good with that, you enjoy it, then great. If it's something you're doing just to try and lose the weight and looking at as a short-term fix, it just doesn't seem like a great approach.

Mitch: So why do you guys think that the keto diet is so popular, then? I mean, some of the numbers that I was able to kind of pull up were saying that in the last year, 24.5 million Google searches were trying to figure out whether or not keto was right for them. It continues to have more and more people being a part of it. Why keto? Why cutting out all carbs? Why is that the diet of the time?

Thunder: That's a complex question to answer, but I think maybe some of the themes that are involved there are people are looking for some sort of program that they can easily follow that has noticeable quick results.

People are looking for any kind of crutch or help. A lot of times, if an individual is overweight and wants to lose weight, they don't feel great about it and they may be approaching it from a place of desperation. So if they can latch on to something that they see has worked for other people, and they're like, "Oh, all I have to do is cut out carbs. I can do that," I think that has a pretty powerful element.

And then there's also the element of marketing. I mean, not that there's a specific company marketing keto, but there are a lot of lifestyle-, nutrition-, exercise-based websites that market keto is the way to go. So you have also that marketing that's out there in the ethos that is always promoting keto. So that gets people to try it.

And then the last thing I'll say to that is keto diets have definitely been studied. Low-carb diets have definitely been studied in clinical trials. And the general conclusion is they don't work really any better for weight loss than any other diet. But a lot of times, people will see medical research like that and they will rationalize and say, "Well, that's the averages, but I think it'll work for me." And then they're willing to take the plunge that way anyway because they figure there's no harm in trying.

So that's my personal take of some of the things that are involved in keeping keto popular and really any other kind of fad diet or supplement that comes around.

Scot: Hey, Troy, what about the medical benefits of keto diets? I remember on thescoperadio.com one time we did an interview with a doctor that said there was some evidence that showed that for young children that had epileptic seizures, some of them responded really well to low carbohydrate diets that put them in that state, that ketogenic state.

Are there other health benefits that you're aware of? I mean, you'll see it on the web. People will claim diabetes, cancer, epilepsy, Alzheimer's disease. What do you know about that?

Troy: I'll say, in my opinion, and this is purely my opinion, I think the detrimental effects of a low-carb diet are probably greater than the health benefits. And the reason I say that is because I think a lot of low-carb diets lead to higher meat consumption, and primarily a lot of red meat consumption. So, right there, you have the detrimental effects there.

When we talked about that before, there are those rare exceptions where being in a state of ketosis does help maybe some children with seizure disorders.

Certainly, if you have weight loss, and it's a decent amount of weight loss, and you're able to maintain that that's going to help with potentially reversing diabetes, like a type 2 diabetes, and potentially helping with some of those long-term effects of being overweight. But again, in my mind, the sustainability of a low-carb diet I think is just a challenging thing for probably most of us.

And again, I think probably a lot of the protein intake in the form of meat . . . At least a lot of people I know who are on low-carb diets, they tell me they are eating a lot of meat. It's often a lot of red meat. And I think the health effects of that there, you're talking about increased risk of colon cancer, other types of cancers, certainly increased risk of heart disease, vascular disease, leading to risk of stroke, all those sorts of things. So I think it's kind of a mixed bag, quite honestly.

Thunder: Yeah. And if I could just add on to what Troy was saying, too, I think there are certain medical conditions, like you mentioned epilepsy, where this type of very high-fat, ketogenic-type diet may be required. Sometimes people have inborn errors of metabolism and they have to do kind of crazy special diets. Sometimes these patients are backed into a corner, so to speak, because they just may have to do that to move on.

But for most of us who are not in that camp of medical conditions that require it, then I would agree with Troy that the risks are probably outweighing the short-term weight loss benefits.

Troy: Yeah. And I will say anytime anyone asks me, "What kind of diet should I do?" and we say this again and again, I say the Mediterranean diet. The reason I say it is because there are so many good studies out there looking at long-term health effect impacts on heart disease risk, cancer risk, stroke risk, weight loss, and it does the trick.

And certainly, I don't consider it a fad diet. It's a very, I think, manageable, sustainable long-term diet. And it's certainly not a low-carb diet either.

So, in terms of just scientific evidence, that's the one diet that just seems again and again to come up over many years, lots of really good studies published in very strong reputable journals that really show beneficial health effects.

Thunder: Yeah, 100% agree with Troy. And also it's more of a moderate carb diet, and it's delicious because you get to eat a lot of delicious foods.

Troy: Yeah, exactly.

Mitch: Well, thank you so much for joining us, Thunder, and kind of enlightening us a little bit about keto and what it can and cannot do. I guess keto isn't really magic. So thank you so much, Thunder, and thank you for caring about men's health.

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This content was originally created for audio. Some elements such as tone, sound effects, and music can be hard to translate to text. As such, the following is a summary of the episode and has been edited for clarity. For the full experience, we encourage you to subscribe and listen— it's more fun that way.

Scot: We had a whole episode about Scot's fatness, and this is an update to the fatness because I decided to take a different route to losing the weight than I had in the past.

So we had Thunder Jalili on, and in order to lose the 15 pounds, I normally would put myself in a calorie deficit. I would figure out what my base metabolic rate is. And this gets a little complicated, but your base metabolic rate is basically the amount of calories your body would burn just to survive. And you eat less than that, and you do some exercising, and that puts you in a deficit, which then would encourage your body theoretically to burn fat.

Thunder told me not to do that, which was totally different. So this is a little update on what's going on.

You're listening to "Who Cares About Men's Health," providing inspiration, information, and a different interpretation on men and men's health. We've got a good crew here today. It's the core crew, as I like to call it. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I'm part of the core, and I'm proud of it.

Scot: All right. My name is Scot Singpiel, and we've got producer Mitch over here. He brings the microphones and so much more.

Mitch: So much more. Hoo-gah.

Scot: Mitch just got promoted.

Mitch: I know.

Scot: Mitch got a promotion.

Mitch: Love it. Yeah. Core, I'm in the core.

Troy: You're in the core.

Scot: Thunder encouraged me to just stop eating the stuff that got me there, which was Reese's peanut butter cups and probably drinking too much beer, to go back to time-restricted eating, which is this concept that you stop eating for a prolonged period of time. It could be 10, 12 hours, whatever. So you might stop eating at 6:00 at night, not eat until 6:00 the next morning. And get some activity. And remember that I had a fun time and it took me a while to get to where I was, and it might take me a little while to get back.

So I've got a little update. I'm down five pounds. Yeah, I've gotten rid of 5 of the 15.

Troy: That's pretty good.

Scot: Yeah. I mean, I don't know. We'll see if this continues. The win for me was I went on a weeklong vacation and I just didn't eat sweets.

Troy: Wow.

Scot: But you can't necessarily control what you eat as well when you're on vacation. And when I came back, I was at the same spot. So that makes me happy.

Troy: Oh, so that was the win. Okay. I was going to say, "You lost weight on vacation?" But you're just saying you were able to maintain.

Scot: I was able to maintain. I didn't think about it too much and I didn't probably have as much activity as I would.

Mitch: Did you road trip?

Scot: Yeah.

Mitch: Do you not get fun snacks every time you fill up the gas?

Scot: Normally, yes. This trip, no.

Mitch: Okay. Not this time? No?

Scot: No.

Mitch: All right.

Troy: It doesn't sound like a fun road trip.

Scot: No. The snacks . . .

Mitch: That's what I was about to say. That's a part of it.

Scot: Yeah. Well, we did have snacks. I mean, it was Triscuits and cheese, and it was trail mix, but not with chocolate in it. So it was a lot of nuts and some dried fruit. So kind of healthier stuff, I guess.

Mitch: Sure.

Scot: Yeah, Mitch does not look enthusiastic.

Mitch: No. I'm about to go on a road trip myself and highlight, day one, going and filling the tires, topping off at the gas station, and getting a big old sack . . .

Scot: That's right.

Mitch: . . . of every bit of junk food.

Scot: I mean, I guess . . .

Mitch: Maybe I won't do it this time.

Scot: No. I think every once in a while, you might be able to do that, right? I mean, if you're in a position. It just kind of worked out for me that way.

Mitch: Okay. That's good.

Scot: So anyway, down five pounds. I've been doing some reading and I'm a little scared, because I'm afraid that five pounds is just kind of those five easy pounds, right? Like, just maybe some water weight, some salt weight. I don't know.

So I started doing some reading because I was interested in this base metabolic rate and the different exercise levels. So you've got your base metabolic, which is your body. If you just sat around, did nothing, this is how many calories your body needs to function.

And then you've got some of these other levels, right? You've got sedentary. Sedentary, that's how you pronounce it. What is sedentary, do you think? And that bumps you up a couple. You get to eat a couple hundred more calories if you're sedentary. What do you think that is?

Troy: I mean, you're a couch potato. Those are couch potato calories. Those are like just lifting your arm to use the remote and turn on the TV and reach for your soda. Those are your sedentary.

Scot: This is, I think, where some people might run into problems. That's not the case.

Troy: Sedentary?

Scot: Sedentary, according to a couple places I looked, includes activities of daily living. So doing the kinds of things like going out and raking, vacuuming, and even they included walking the dog.

Troy: No. I think of sedentary as . . . Someone who's sedentary in my opinion, in medical terms, in my practice, if I describe someone as sedentary, they're not walking a dog. They're able to take care of themselves, so they're getting up, walking to the kitchen, and walking to the restroom, but they're not doing a whole lot beyond that. I don't see them as out raking leaves and walking dogs. I don't know.

Scot: Yeah. I think that's where this problem is. I think the problem could be as an individual that you're trying to figure out what your activity level is so you can go, "This is how much I should be eating." Well, I'm not sedentary because I go out and I do stuff. I clean the house. I rake leaves. I mow the lawn. In the definitions I've seen, all those things are included in sedentary. The difference is that you do not do 30 minutes of intentional exercise a day.

Troy: So that's the next step up? So to not be sedentary, you have to do 30 minutes of intentional exercise a day?

Scot: Yep, and that's called low active. And low active is daily . . .

Troy: No. Low active is 30 minutes?

Scot: Yeah. Low active is exercise equal to walking 30 minutes at four miles an hour, which burns anywhere from 135 to 165 calories for the average-weight person.

Troy: Four miles an hour is a pretty brisk walk.

Scot: That is an incredibly brisk walk. I have long legs and I can walk fast. I'm probably doing 3.7, 3.8 max. So that seemed a little weird.

Troy: That's fast. I don't know who made the scale up.

Mitch: Let me tell you. It is the FDA and the NCBI. [Crosstalk 00:06:08] this group is the front for public health. It was published back in 2018 when they decided that this is what sedentary meant.

Scot: So this is all going someplace that hopefully will be helpful to listeners and also is going to inform my thinking, and I wanted to throw this out to you guys.

So then the difference between low active to active is it's kind of the same. Your daily activities of living, except for you're doing an hour and 45 minutes of intentional exercise. So that's walking at four miles an hour.

Troy: A day?

Scot: Yeah, a day.

Mitch: A day.

Scot: And then very active is daily exercise walking four hours and 15 minutes at four miles an hour, or you could jog for two hours a day. And that burns anywhere from 1,100 to 1,400 calories.

Troy: This is an interesting scale.

Scot: It is. I mean, think about the individuals we've had on the show in the past who have struggled with losing weight, right? We're saying, "Well, if you get out and get those 30 minutes of activity, that should be pretty good." But I'm starting to kind of wonder if those 30 minutes is good for your cardiovascular health, it's good for your health in general, but if you're trying to lose some weight, you're going to have to go beyond that.

Troy: See, the problem with this scale, though, is there are just so many studies that show if you can just do 30 minutes of activity three times a week, there are very clear health benefits from it, where this scale is implying that those people are just low active, and even they're less than low active.

Scot: I'm going to say there's a differentiation. There's a fine differentiation here.

Troy: Thirty minutes?

Scot: Thirty minutes a day has health benefits for cardiovascular and those other things, but if you're trying to lose body mass, fat, you need to do more.

Troy: But do you think that's sustainable? We're talking 30 minutes of brisk walking at four miles an hour every day. For the average person, it's . . . I feel like you have to have a routine that's sustainable for you. And on the activity side, it sounds like they're recommending high activity, where I'm sure you could balance that with just some decreased caloric intake or adjustment in whatever your dietary intake is, and you're going to accomplish the same thing,

I don't know. I guess I'm trying to figure out where they're going with this, just because that activity level they're putting for active and very active is really active. And maybe I'm kind of taking it a little bit personally here, because I feel like I'm pretty active. I'm pretty active, but I'm not meeting their definition of very active.

I mean, maybe over the course of a week, if you added it all up, I would meet that definition. But over the course of a week, I get about 11 hours, 10 to 11 hours of . . . I don't want to call it jogging because I don't want to be called a jogger.

Scot: I mean, you're running.

Troy: It's running, but still it's . . . Yeah, that's really active what they're getting at there. Two hours a day of what they're describing as jogging.

Mitch: Well, again, this is just how you do your calculations. So when you look up base metabolic rates and things like that and try to get your diet clued in . . .

Scot: Yeah, and you're trying to figure out how many calories you need to sustain. But it could also be used for, "How many calories can I eat, and then what do I have to do to put myself in a bit of a calorie deficit so I can lose that weight?"

Troy: So maybe that's the flip side, just saying, "If you really want to eat this many calories, you're going to have to exercise a ton." Maybe that's what they're trying to say.

Scot: Yeah, I think so.

There was a "Time" magazine article, and I need to send this to you because they quote a lot of research. This is the next part of my thinking, because this was the next thing that I read.

So they cited many studies that exercising at a moderate level for 30 minutes, which is good for health, results according to these studies in little weight loss. So it's good for maintaining, but for losing it's not.

And then they cited some other studies. A combination of diet and exercise generated no greater weight loss than diet alone after six months. At 12 months, the diet and exercise combo showed an advantage, but it was slight, about four pounds on average.

So, in this, the conclusion that they came to based on the research . . . And there was another study. It said exercise results in weight loss when 400 to 500 calories are burned per session at least five times a week.

Troy: So I see what you're getting at here, Scot. What you're saying is if you want to lose weight, don't focus on exercise. Focus on diet. There are clear health benefits from exercise, but it's not going to accomplish the weight loss you need.

Scot: Yeah. Exercise is not going to accomplish the weight loss you need, diet and exercise. But then beyond that, you have to put in a certain amount of exercise, which they're saying is something that can burn 400 to 500 calories per session, 5 times a week, which they equated to 90 minutes of brisk walking or 30 minutes of running 8-minute miles.

Troy: Yeah.

Mitch: Geez.

Scot: I mean, 400 to 500 calories, that's a lot, right? Ninety minutes of brisk walking? Or if you get on a cardio machine and you're not pushing yourself super hard, 90 minutes, that's a lot.

Troy: It is a lot. And how many calories are in just a large soda?

Scot: Right?

Mitch: Too many.

Scot: Too many.

Troy: Yeah, you get a large soda for your road trip and right there you're at 400 calories.

Mitch: This is something that I'm really excited . . . We have a guest coming on in a couple weeks who is part of the weight management program here at The U. And she was talking a lot about in our little pre-interview . . . She was like, "Yeah, losing weight is a lot more than just diet and exercise," and I'm excited to kind of talk to her about all this.

Scot: Yeah. So, for some people, diet and exercise might work, but there are some people that it does not work. And she's going to hopefully tell us some of the things that could happen or some of the things that could be going on that could be preventing somebody from losing.

But I just feel like there's a huge disconnect in the information that I've received. And again, you know what? There are a lot of studies out there. Who knows? But if in order to get some weight loss I have to be doing 400 to 500 calories burned per session, that's a lot more than what I'm currently doing. So maybe that's where my frustration is that in the past I haven't lost weight, or where other people have frustration. So I feel like that needs to get figured out.

Troy: Yeah. I mean, again, it just seems like . . . Like you said, Mitch, maybe we'll have someone on here who talks about all the other factors besides diet and exercise. But my takeaway from this is that you can't just sweat off the calories. You've got to focus on the caloric intake if you really want to lose weight.

Scot: Yeah. You've got to focus on both.

Troy: Yeah. I mean, you've got to do both, but it's going to come down a lot to caloric intake. You can't just say, "I'm going to burn it off by going out and walking the dog," or something. It's a lot of exercise to burn off 400 to 500 calories.

Scot: Yeah. Like you said, what's an average soda have? And if you are doing 30 minutes, according to the scale, which is low active, that burns 135 to 165 calories. So a soda is probably what, 220? I'm guessing.

Mitch: It's 180 per 12 ounces.

Troy: A 12-ounce can.

Mitch: If you get a Big Gulp . . .

Scot: Yeah. So you can either walk for 30 minutes at four miles an hour to burn that or just not drink that, right? So that really kind of shows the importance of watching some of that stuff.

Anyway, here's what I'm thinking. And again, it comes back to sustainability on a couple of levels. One, time. I don't have 90 minutes a day. Two, I'm not in that great of shape anymore.

Troy: Oh, no.

Scot: And I don't know if I could sustain five sessions of 400 to 500 calorie burning and not be completely drained. So I don't know. Part of me wants to try to start to burn some more calories so I can get . . .

Here's the deal on the road trip. This time, instead of the punishment pants, I just sat and played with my fat to remind myself how miserable it is.

Troy: So you were just . . . Is this as you're driving? You're just holding your fat rolls and kind of bouncing them and jiggling them?

Scot: Yeah, exactly.

Troy: What are you doing?

Scot: You drive with one hand and you kind of bounce it and you kind of grab it.

Mitch: For the listeners, he's cupping underneath his lower abdomen and kind of making a flipping, squishing motion. I'm so glad I'm back in studio.

Troy: Yeah, that's wonderful.

Scot: I want not to have to do that anymore.

Troy: So was this what you did just to keep yourself from going in every gas station and getting a large soda and a big thing of candy or something?

Scot: Top of mind, man. Top of mind.

So I don't know what to do with this information other than to say it was kind of eye-opening to me the amount of activity that it kind of takes to burn fat. There are two things. There's the amount of activity that takes to be healthy and reduce the risk of disease. But if you're trying to get rid of body fat, that number has got to go up quite a bit. And then once you get rid of it, maybe your daily exercise goes down again because maintaining is easy. I don't know. But anyway . . .

Troy: I totally get it now. At first, I just thought, "Wow, where is this going?" But I get the point of it, that you have to exercise a lot to burn calories. I mean, that's the simple reality. You've got your basal metabolic rate and that burns quite a few calories, just the thing that keeps you alive. But then beyond that, it's not like you can tell yourself, "Hey, I just went and did a brisk walk with the dog for 30 minutes, and I'm going to reward myself now for that exercise by having a soda or taking in some extra calories." Yeah, you did not burn that many calories.

Scot: Yeah. Even if you don't take in those extra calories, you're probably not going to be losing much fat from just walking the dog.

Troy: Yeah. It takes a lot to burn. Yeah, it really does.

Scot: So that's my update. Those are the things I'm kind of struggling with and I'm trying to figure out. So I'll keep you up to date. Mitch, you have an update too.

Troy: Well, I was going to say, though, Scot, you made progress. I thought that was the best point. I mean, Thunder made a lot of great points, but the one that I think really made sense is it takes you a long time to put that weight on. Think how long it took. It's not going to come off in a month. It's a process. So you're a month out from that discussion with Thunder and you've already lost a third of the weight. That's great.

Scot: Yeah. We'll see if that keeps going down.

Mitch brought up that he felt like he had a different situation, that he has struggled his whole life to try to lose those extra pounds. What's your update?

Mitch: So I was weighing around 230 a little over a month ago, and I am just under 210 pounds as of this morning. So in a month I've lost over 20 pounds.

Troy: Wow. That's crazy. You've lost almost 10% of your body weight in a month.

Scot: Yeah. You want to ask him what he's done, Troy? Do you have any guesses what the difference is? For you, Mitch, this is crazy.

Troy: Let me guess. Did you just stop eating or what?

Mitch: No. I'm eating red meat and sunlight.

Troy: Eating red meat and sunlight. You just go outside and open your mouth.

Scot: Yeah. Any other guesses as to why? Like Mitch said, this is just kind of unheard of that it would be this easy.

Troy: Wow, I'm trying to think what you could have done. I'm guessing you went back to time-restricted eating. I'm sure that was part of it.

Mitch: I was doing that before. I'm still doing it.

Troy: Oh, you were doing it before. That's right. You were doing it before, and you had already really focused on cutting down on sodas and sweets and all that kind of stuff.

Scot: Yeah. He was doing all the right things, remember, and then he was just getting frustrated because it wasn't happening.

Troy: Yeah. I know you were talking more about the carbs. Have you focused more on carbs?

Mitch: I'm eating the same I've always eaten.

Troy: Did you get a different scale? I'm kidding. "This scale makes me look great."

Scot: The best way to lose weight is get that little dial underneath the scale and calibrate it differently.

Troy: Just change the dial. Wow. I really want to figure out how you've done this. Are you exercising more? I know you were trying to . . . You were already doing some exercising.

Scot: I mean, I'm doing it maybe once more a week, once more than I used to, but no, not really.

Troy: Okay. This is huge. You've lost almost 10% of your body weight in a month, and you were struggling before and you were doing everything right. So I don't know the answer. What have you done?

Mitch: So I got my hormones figured out.

Troy: That's right.

Mitch: So I've been working with Dr. John Smith, and he identified that I had really low testosterone. And now that the hormones are . . . I've been three, four weeks on this medication that we'll probably talk about in a future episode that just helps up my testosterone a little bit, and suddenly, I have tons more energy, and I'm losing weight like crazy, and I haven't changed anything.

I've been working out the same I've always been and struggled. I'm eating the same 1,800 to 2,000 calories every day that I've been doing forever and watching the macros and blah, blah, blah, sleeping all the time, etc. But all it took was getting my hormones in check and suddenly I'm starting to get to a healthy weight.

Troy: Wow. That's impressive. Are you putting on muscle mass too?

Mitch: We'll find out when I get in the BOD POD. I don't know if I trust my scale, but maybe. Hopefully. I don't know.

Scot: He just pulled out the guns.

Mitch: Scot, how are my guns?

Troy: He's flexing.

Scot: Does your scale give you a body fat percentage?

Mitch: It does.

Scot: And has that been dropping too?

Mitch: Yes.

Scot: My scale did not match up at all with the BOD POD, so it'll be interesting to see how accurate yours is.

Mitch: That's what I'm curious about too, yeah.

Troy: But it seems like on the scale it was all about relative change. Like, the number itself isn't as meaningful. How much has your body fat percent changed on your scale?

Scot: He's looking that up.

Mitch: It says 4%.

Troy: So you're a 4% body fat change. Like we've talked about before, the actual number maybe isn't super accurate on those home scales, but the relative change is . . . Again, that's significant.

Scot: It is significant. So it was all hormones. How does that make you feel?

Mitch: Well, it's a little strange because I do not want to be the guy that is like, "Testosterone solves everything. It's the magic bullet. You'll lose weight. You'll get your libido back," all the stuff you see on those irritating ads on the internet.

But if you legitimately have a hormonal imbalance, you should go talk to your doctor and you should probably get it fixed, right? It's not the magic bullet for people who are just a little low or something like that. But for me, I was well below the acceptable range when I did my follow-up test with John Smith, and it's night and day for me.

Troy: What was your level?

Mitch: I was in the lower 200s when I got it tested.

Scot: Because the low range is like 180, right?

Mitch: Three hundred.

Troy: He said if you're less than 300, you're low and you were . . . what did you say again? Low 200s?

Mitch: Yeah, 226 I think was the average between the two tests.

Troy: Yeah. So it wasn't like you were going in there and just being like, "Oh, I'm 330 and I need to get on testosterone." You were definitely below the level that he said he really kind of uses as a cutoff. And you'll get your levels rechecked here, it sounds like, in the next couple of weeks.

Mitch: Yeah. And we'll have him back on, and we'll kind of talk about what's going on. Yeah, there was something about, "No, this isn't 'optimizing T levels.'" I had a hormonal deficiency, and it was impacting metabolism, energy levels, etc. And it took some meds to get back to where I needed to be.

Scot: Wow. I think that's awesome.

Troy: It is.

Mitch: I think it's awesome too.

Scot: I keep looking for the thing that's wrong with me, Troy. I keep hoping . . .

Troy: What's yours, Scot?

Scot: I keep looking. Is it testosterone? No. I keep looking for that test that's going to just shine a light on why I have struggled in the past to put on muscle or to lose . . . Even when I was at my lower weight, I still had a good percentage of body fat because I just don't have a lot of lean mass. So I'm still looking for my thing.

Troy: The magic bullet.

Scot: Yeah. It's a magic bullet, right? What's the difference between a magic bullet and what Mitch experienced?

Troy: There's not. That is a magic bullet. That's a dramatic change. You want to talk about a magic bullet? Yeah. I mean, 4% body fat reduction, almost 10% weight loss in a month, that's impressive. And I've known very few people who could ever say they had that sort of experience while really not making any other changes. It sounds like you said you're exercising maybe one more day a week, but . . .

Mitch: Yeah. It's not huge changes. It's tracking a little closer on my calories. I'm working out a little bit more. It's not anything huge. It really is this medical thing that needed to get fixed before anything else could work.

Scot: And I think it's worth, if you are curious about testosterone, going back to our episode on testosterone. I think the thing to really keep in mind for everybody is it is not a magic bullet.

I can't remember what Dr. Smith said that range was. Like much beyond 600? You're not getting much return on that. So if you're around 500 or 600, you're probably fine, right? That's probably not what the problem is. Does that sound familiar to you, Troy?

Troy: I can't remember the exact numbers. I wish I did. Yeah, again, we should probably look at that just to give the exact numbers, but I do remember him saying the 300 number and if you're under that, you definitely need to be on some sort of hormonal therapy.

That episode, I was kind of skeptical throughout it, like, "Really? Do we really need testosterone? Does it really make that big of a difference?" But, Mitch, your experience, and clearly you met the criteria he talked about, and it's made a difference, no doubt.

Mitch: So I was having a conversation with one family member who had been experiencing some hormonal issues themselves. And it was really interesting because from the female perspective, hormones are a huge part of everything from energy levels to how your skin looks, to how much energy you have, how well you sleep, etc. And I think a lot of times as guys we just assume it's a yes or no, like an "Am I low on oil?" kind of approach to your car. Am I low on testosterone? Better put some more in me if it's going to work.

But talking with the doctor and stuff like that, testosterone has everything to do with estradiol levels, with all these other pieces and parts floating in your soup of juices all through your body. And it has a holistic impact on everything.

Troy: Yeah. That's cool.

Scot: Troy, do you have an update for us? Now, you don't have a weight problem. Actually, you'll be gaining about 8 to 10 pounds here in a few months in the form of a new life, a new Madsen.

Troy: I know. I've got a baby carrier that I'm going to be carrying on my . . . I looked at it. So, for the first several months, I carry the baby on my front side and then I can transfer the baby to my backside. I guess my back, not my backside. It's going to be another 8 to 10 pounds I'll be carrying around.

Scot: Are you going to go running with the newborn?

Troy: Oh, you know it. This is so funny. So Laura shared the news with me as I got home from work from a late shift. That next morning, I was reading all about running strollers, reviews, what's the best thing, all that stuff.

Scot: Good for you.

Troy: I know. This is embarrassing. I spent more money on a running stroller than I would ever care to admit. But I asked around. I talked to people. Yeah, I will be taking her running, and this is what some good runners I know recommended and said, "If you really are serious about going on long runs with a child, get this." So yeah, I'll be taking her running.

Scot: That's good. We learned that exercise is super important even for the dads when the child first comes along to counteract any potential . . . I mean, it's a massive lifestyle change, and you're trying to mitigate that as much as possible. Anything else going on? Any other new updates?

Troy: No, things are good. And it's a good point you made too, Scot, because I think it can be a massive lifestyle change. But I was talking to my brother about it. He was just visiting here a week or two ago, and he has three kids and he said that's what people always said to him too. It's a massive lifestyle change, but he said, "Hey, we're just going to do the same things we've always done. We're going to bring our kids." And his kids now are early teens down to about 9 years old. And the kids are crazy active. They love running.

My little 9-year-old niece, we just did a run. She ran a half marathon with me, just went out and busted out a half marathon trail run with me. They're just super active. And so I'm hoping that's how this can be. I'm hoping running can be something that we share as a family and that we're all out doing things together.

So I don't want it to be a massive lifestyle change, because I kind of have had that thought as I'm continuing to run. Not necessarily, "Why am I doing this?" but kind of the back of my mind thinking, "Wow, I'm not going to be able to do this as much in about two months." But then I tell myself, "Well, it doesn't have to change. We can keep doing this, we can stay active, we can keep running and doing all these things." So that's what I'm hoping for, and that's our plan.

Scot: Have to come up with some creative solutions and just have to be dedicated to it, I guess.

Troy: Yeah, I think so. Yeah, you come up with some creative solutions. You have to spend some money on some gear. Like I said, it's a whole lot more money than I ever expected to spend on a stroller, but it should be a stroller that lasts us for many, many years and hopefully running marathons together and doing lots of long runs with her. That's the hope, so we'll see how it all works out. I'll report back in about three months, Scot, and tell you where things are.

Scot: All right. Well, I guess that's that. This is going to be kind of an ongoing thing. We're really excited about some of the upcoming episodes talking about body weight control, losing some body weight, some fat if you have to.

Mitch: And having some people on to talk about testosterone again, and a little bit more about how all that connects and . . .

Scot: Yeah. And I'm just going to keep on keeping on and we'll see if I can catch up to Mitch. He's a Troy Madsen distance ahead of me in the marathon.

Mitch: Oh, no.

Troy: Mitch is smoking you, Scot.

Scot: He really is.

Troy: He's far beyond where I would be right now if this were a marathon. That's impressive.

Scot: I'm going to keep investigating just the amount of activity that you need and keep reading on that. I'll send you some of that information, Troy. You can see what your take is.

Troy: But give yourself credit though, Scot. You didn't lose 10% of your body weight, but you're down 33% of your weight gain. That's great.

Scot: No, I'm cool with it.

Troy: Yeah, you're making progress.

Scot: I just want to get to a point where I'm not playing with it anymore.

Mitch: You've got to quit doing that. I will leave the studio if you keep doing that.

Troy: Well, you can't play with it on a road trip, because you're sitting down. You're kind of hunched down. It's naturally just going to kind of bunch up there. So it's like, "Oh, feel all this fat here." I'm sure it's not as bad as you're saying it is.

Scot: All right. Well, gentlemen, as always, great conversation. Thanks for listening. And if you have any questions, you can reach out to us. It's super easy to do. You can just email us at hello@thescoperadio.com if you have any questions or stories you want to share. Thanks for listening, and thanks for caring about men's health.

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Interviewer: New insights into how cancer cells gain the deadly power to grow uncontrollably up next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: I'm talking with Dr. Jared Rutter Professor at The University of Utah. Dr. Rutter you've published a report, "Molecular Cell," describing what could be a key change that takes place in cancer cells that gives them an advantage over the normal cells in the body. I think what's fascinating about your discovery is that it relates to a hypothesis that was posed early last century. First of all, can you explain what this hypothesis is, The Warburg Effect?

Dr. Rutter: Dr. Warburg discovered that cancer cells do a different kind of metabolism than normal cells. That fundamental observation has been born out repeatedly in the years since and now has become a very active area of research both in discovery based research and academia, as well as more applied research going on in companies trying to treat cancer. The question will be whether that can now be exploited and in treatment.

Interviewer: You can tell me if I have this right, in a normal cell sugars or carbohydrates eventually go down a pathway where the cells powerhouse, mitochondria, makes energy, but in cancer cells it's different. What happens in cancer cells?

Dr. Rutter: So cancer cells go through about half of that pathway. They take the carbohydrates about halfway through that pathway but they don't take the carbohydrate into the mitochondria, the powerhouse of the cell, they do other things with it, and specifically they use that carbohydrate to create the building blocks that will enable them to make a new cell. So obviously cancer is a disease of overgrowth of cells dividing and duplicating themselves more rapidly than they should and that's what creates a tumor, or what creates the cancer.

Interviewer: I think your work really argues that there's a protein called MPC1 that is a key component of this shift in metabolism. What is MPC1?

Dr. Rutter: The MPC1 and MPC2 together make up a protein complex that enables carbohydrates in the form of a specific molecule called pyruvate to enter the mitochondria, again the powerhouse of the cell, and enable the mitochondria to then take that pyruvate and use it to create energy.

Interviewer: And what happens to this protein in cancer cells?

Dr. Rutter: We've shown that in a large number of cancers, most prevalently in ovarian cancer, that the part of the genome that encodes this protein is just lost. It's lost from the genome and therefore the gene is not expressed, the protein isn't made, and this MPC protein complex is just never formed. So what we did next was pretty simple in that is the hypothesis is that it being lost is actually important then what if we put it back in and force the cancer cells to make this protein, and what happens is they lose their ability to behave like cancer cells. Their metabolism reverts from the way that most cancer cells do in metabolism to be a much more normal type of metabolism and they lose the ability to form tumors in different situations, and so...

Interviewer: Wow, that's amazing.

Dr. Rutter: Yeah.

Interviewer: So you saw that effect both in a dish but also in the context of an animal too, correct?

Dr. Rutter: That's right. So yeah exactly, we saw it in a dish and then the gold standard for this type of experiment is to put tumor cells, cancer cells, into a mouse and ask whether they can form tumors, and what we found is that the cells that had this protein, this MPC protein, put back in were quite dramatically impaired in their ability to form tumors in mice and how fast those tumors grew.

Interviewer: What kind of difference are we talking about? I mean is it there's a tumor compared to no tumor, or is it a difference in size, or is it the number of tumors that form, or...?

Dr. Rutter: Yeah that's a good question. I would say the way that the experiment was done it really wasn't done in such a way that we could see a tumor versus no tumor. So what was done is to inject about 100,000 cells into the flank of a mouse and then so that you already have a fairly large number of cells there and then look at the ability of those cells to grow, form a tumor and how big that tumor becomes, but always they grew slower when this MPC protein was put back in.

Interviewer: When you're talking about the progression of cancer where do you think metabolism fits in the scheme of things? Do you think it might be one of the early changes that must take place in order for a cell to become invasive for example or...?

Dr. Rutter: Yeah we do, we actually know that. In some cases that there are certainly many cancers where one of the early steps is to manipulate the metabolic profile of those cells.

Interviewer: And what are you most excited about going forward?

Dr. Rutter: Well I think there are a few different things that I would say we're most excited about. I would say first is just trying to understand what is the cause of the failure of the cancer phenomenon when we force cancer cells to make that protein. We just really don't understand it and whatever the answer is it will be interesting, and then the second, like we've talked about, is to try and understand how to exploit this observation to make a difference in the context of the treatment or diagnosis of cancer, and we have some ideas that I think are quite good as to how to try and translate that into direct clinical application.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Announcer: Examining the latest research, and telling you about the latest breakthroughs, The Science and Research Show is on The Scope.

Host: One day will there be a pill that cures obesity? Jared Rutter, a professor of biochemistry at the University of Utah is researching ways to combat obesity and diabetes at their source by fixing problems with the body's metabolism. Dr. Rutter, what do you think about the argument that the reason that obesity and diabetes are such huge problems today is that our bodies' metabolism is really designed for our caveman ancestors' who lived in a very different world.

Dr. Jared Rutter: I remember when I first heard that concept and it just made so much sense to me. The pressures that our ancestors were under were completely different than the pressures we're under. When I say pressures, I mean from a survival sort of context and as a result, there was a much greater selector pressure to avoid starvation, because especially in a historical context, we may not eat for a couple of days and if we're not good at storing the energy we ate today, we may starve in 36 hours when we haven't eaten. And so our bodies are very good at taking the energy we consume and putting it into a storage form that can then be accessed over the course of the next days, week, months. And so now when we essentially have access to unlimited food, or many of us, most of us do, and don't have an imperative to do extensive exercise, that now puts our bodies in a situation as you said that they are not optimized for.

Host: It seems today the answer is fad diets. Every year there's a new one, the paleo diet, the Mediterranean diet, what's your opinion of fad diets?

Dr. Jared Rutter: There are obviously good aspects to all dietary regimes. At the end of the day, if that diet is a balanced diet that enables us to consume a smaller number of calories, that brings it more into balance with the number of calories we expend via exercise and our body's basal metabolism, then that's probably a good thing. I do think, however, that highly unbalanced diets that are focused around one key element or principle and don't enable us to have a balanced diet to provide our body with the nutrients we need, are probably unbalance, unhealthy and should probably be avoided.

Host: Why is it important to study metabolism? What do we still need to know?

Dr. Jared Rutter: We understand in most cases the steps, you know when we eat a carbohydrate, we understand most of the steps by which that carbohydrate is converted into energy that our body can use. What we don't know as well is how does the body do what it needs to do with the nutrients that we bring in through our diet. And how does that change when we've eaten a lot, how does it change when we haven't eaten, how does it change when we've just, you know, run 15 miles, how does it change when we're sitting on the couch watching TV? We need to understand what that difference is and what the body is perceiving to make that change and then how does it enact that change. And if we can understand that at a deep level, that may be where we can use therapeutics, be they behavioral therapeutics or pharmacologic, or other means to manipulate that process and maybe put us into a healthier state given our environment.

Host: So what exactly are you researching?

Dr. Jared Rutter: One major area of research interest for us is how does the cell decide, how does the body decide really what to do with the carbohydrates that we take in and one of the possible options for the fate for carbohydrates in our body is to convert them into fats. And that's done quite efficiently in, among other places, our liver. And we study the process by which that happens, and again how that is regulated, how the body decides when to do that, how much to do that. I think it's quite clear now, from studies around the world, that this process is fundamentally important in obesity and I think there's emerging evidence that it's fundamentally important also in diabetes. And I think there's emerging evidence that's not quite as clear yet, but that this process is also important in other diseases like cancer.

Host: So is there a particular pathway or a particular protein that you're focusing on?

Dr. Jared Rutter: Yeah, we focus on a protein that has the name PAS kinase and so its role is a regulatory role; it controls the activity of other proteins and enzymes that participate in this process of lipogenesis, this process of converting carbohydrates to fat among other things that it does so we are now are trying to understand how this regulator, PAS kinase, controls the activity of this lipogenesis process and how that relates to the disease processes of obesity and diabetes in people.

Host: So the idea is that if you understand how PAS kinase work, then you can manipulate that protein, or that pathway and possible influence how well lipids are made or how lipids are stored as fat?

Dr. Jared Rutter: Exactly. Yeah, that's exactly right. Unless we understand what's going wrong with the disease, we don't know what target we're shooting at, right? We don't know what to hit. What we have found is that we think this process is misregulated at the cellular level in context of obesity and diabetes and so, yeah, we think that we now understand enough that we know at least a few targets that we'd want to try and change the disease process in obesity and diabetes.

Host: But is that what we really want? Do we want a magic pill or a magic therapy. I mean, wouldn't it be best to just have people exercise more or eat a better diet?

Dr. Jared Rutter: There's no doubt that that would be the best thing to do. There are benefits to exercise that, in my opinion, will never be compensated by a pill. There are benefits to a healthy diet that will never be compensated by a pill. The sad reality, however, is that in spite of us understanding this, and we've really understood this for decades now, the importance of diet and exercise, globally, at least in our country, and in most others, that isn't working so well. And to deal with that, myself and many other scientists around the world are trying to come up with stop-gap measures that can keep us from having the devastating consequences of obesity and diabetes on a pandemic epidemic scale while we figure out how to encourage ourselves and especially our children to live a healthier lifestyle.

Host: So you must think this has real promise.

Dr. Jared Rutter: That seems like the best therapeutic strategy to me rather than you know, to use another analogy, putting a Band-Aid on the wound if we can really go to the heart of the wound and fix it that seems like such a better strategy than just trying to repair the damage that the disease causes. And so that's really the strategy I believe in and the strategy that my laboratory tries to take toward the understanding of the disease.

Host: What got you into studying metabolism?

Dr. Jared Rutter: Most of the reason is I've come to be convinced that alterations in metabolism lie at the heart of really almost every human disease and just like in any other area of human behavior there are fads and trends in science. And metabolism has been on the wrong side of the fad and trends for many, many years and it's just over the past five, ten years or so, is sort of seeing a reemergence and I decided that if I really want to make a contribution to understanding human physiology and human disease, that metabolism and really the underpinnings of metabolism and how it's regulated would probably be the best thing I could do. To some extent a scientist is like an explorer and we've really just been following our nose ever since that initial decision.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Announcer: Medical news and research from University of Utah, physicians and specialist you can use for a happier and healthier life, your listening to the scope.

Interviewer: Your fat tends to get a bad rap but there is good fat, it's called brown fat and not only does it help you stay thin it has amazing healing powers that you might not know about. Dr. A Patel, director of clinical regenerative medicine at the University of Utah, Tell me about brown fat and how fantastic it is.

Dr. Patel: It's a great question, everyone thinks fat is fat, and really there's two types of fat, there's white fat and there's brown fat. White fat is the big cells that make you gain weight give you heart disease, diabetes, metabolic syndrome, all these bad things. But if you think of little kids, they can eat thousands of calories and until they start getting older they don't lose that, everyone thinks their metabolism is slowing down but what it is, is they're losing their brown fat. When you're really young you have what's called brown fat and brown fat is very unique, it's very metabolically active so that's a fancy term that means it has a lot of horsepower in it,. It's having a little car with basically a big v8 engine, where white fat is a really big car with basically a 2 cylinder engine.

Interviewer: Yeah, it takes up a lot of space but moves real slowly.

Dr. Patel: And that's how most people feel when they get to fat, so what we've done is we've been able to identified a brown fat stem cell in actual patients. And everyone believes it's in kids but we found actually that you could find this even in patients who are 80 years old. The problem is as you get older you get fewer and fewer cells, these cells start dying off. So our goal was how do we one; identify these cells because then we can say can we look at this brown fat stem cell as a potential target for new drugs or new therapies where we can take grown ups who actually have diabetes, metabolic syndrome, all these bad things that can make you die from heart disease and look at a drug that could actually make you increase your own brown fat stem cells or can we grow these brown fat stem cells outside your own body and put them back into you and use them as a target for the diabetes, the weight gain.

Interviewer: So just to be clear, up until just recently it was believed that brown fat existed really in adult humans

Dr. Patel: Yeah, and that surprising, it's one of things that just because no one was able to identify it no one believed that you could actually find it or did it exist. This is incredible because this is something where obesity is an epidemic in the U.S. and there are millions of drugs, medications, fad diets and everything there but there's so little science to support it. This is where science is finally starting to catch up in saying what are we missing? Or what was there when we were younger; or what do bears have that lets them hibernate, and that's brown fat, that's what they have too? So, how do we harness the power of brown fat and not just say well we need more of it but how do we actually develop this in a safe reproducible manner that potentially may actually become not only a cell therapy but also a drug therapy to increase your body's own ability to produce more brown fat as you get older.

Interviewer: What's the biggest challenge that you're facing? You said this is in very early stages.

Dr. Patel: The biggest challenge with brown fat stem cell is that there's so few of them so how do you safely grow them in a large enough, make billions of these so we can study them better and actually make them potentially available for therapy because the goal would be you'd need trillions of cells to start looking at how could you use this as a therapeutic model or basically how would you treat patients with this. So growing them we've been able to identify them now how do you scale up to do the experiments to say does this really work in patients

Interviewer: So children have a lot of brown fat, as you grow older it decreases so your body is getting rid of it for some reason apparently.
Dr. Patel: Well one of the reasons the brown fat originally is what's called a thermal regulator, basically regulates heat, so when you have a shiver response when your young and you don't have a lot of fat, it generates heat. That's even in small animals and things like that. That's what brown fat is used for is to generate heat, regulate body temperature, and as you get older because you get more white fat you basically form your own insulation and you don't need , so it's a natural way of the body to say well if i don't need this cell I'm going to start getting rid of it. the problem is when your own body starts decreasing the amount of brown fat it's thinking I don't need it to produce heat, but we lose the ability to regulate a lot of other things such as fat, sugars, and all that so it's sort of a bad side effect of getting the white fat on board. So the more insulation you have the less metabolically functional or the less efficient you are. You become energy inefficient by having too much insulation.

Interviewer: So if I was to stay very lean and thin and keep the white fat off, would I be more likely to have more brown fat then?

Dr. Patel: You would be, the thinner you are the potential to more brown fat as you get older is much higher.

Interviewer: What's your final thought on this?

Dr. Patel: So brown fat has huge potential both for therapy, for diabetes but also just studying how the body works so we can find better ways to safely develop therapies to treat obesity, type II diabetes, and heart disease which is the number one killer of patients in the U.S.

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