The Connection Between Lectins and Leaky Gut - An Interview With Steven Gundry, MD

The Connection Between Lectins and Leaky Gut - An Interview With Steven Gundry, MD

What follows is a transcript for the podcast The Science of Leaky Gut - Steven Gundry, MD - Mind Body

Dr. Steven Gundry is a medical doctor, clinician, researcher, and a well-known author who has spent the last two decades studying the microbiome and helps patients use diet and nutrition as a key form of treatment. He retired as one of the world’s top cardiothoracic surgeons to teach patients how to eat, guiding them on how to get ahead of the problem, not fixing it after the fact.

Topics within the interview include the following:

  • What Lectins Are: And Their Interaction With Leaky Gut, Fatigue, Energy Levels, Cognitive Function, And Heart Disease,

  • What To Eat, And What Not To Eat, 

  • The Apoe Protein Variants, And Its Effect On Metabolize,

    • Saturated Fats And Mcts,

    • Poultry Vs. Red Meat,

  • Why Fatigue Is A Ubiquitous Problem,

  • How To Live Forever, And The Two Best Predictors Of Healthspan,

What Lectins Are:

And Their Interaction With Leaky Gut, Fatigue, Energy Levels, Cognitive Function, And Heart Disease,

Heather Sandison: Welcome back to Collective Insights. I'm your host today, Dr. Heather Sandison, and I'm so pleased to have Dr. Steven Gundry here today to talk about his new book The Energy Paradox, and all of the other interesting things he's learned on his journey as both a doctor, a researcher, and a renowned author. So Dr. Gundry, you are particularly well-known for making lectins something people have actually heard of. Dr. Gundry, lectins have been called an anti-nutrient. Tell us what are lectins exactly.

Steven Gundry: Well, they're certainly far more than anti-nutrients. They're the one of the principle plant defense mechanisms against being eaten or having their seeds, their babies eaten. And they're sometimes called sticky proteins because they actually seek out sugar molecules to bind to. And coincidentally, I guess, these sugar molecules line the lining of our gut. They line our joint surfaces. They line the space between nerve transmission. They're in the myelin sheath and nerves. And they even line the surface of our blood vessels. And there's very good works, some of which is my work, that shows that lectins are a big cause of, for instance, heart disease.

But thanks to Dr. Fasano's work, who's now at Harvard, he was the first to really prove that gluten, which happens to be a lectin, is a major cause of leaky gut, by binding to the sugar receptors on the lining of our gut and actually promoting the breaking of tight junctions. I've quite frankly never seen a person with autoimmune disease who doesn't have a measurable leaky gut. I've never seen a person with fatigue or low energy that doesn't have a measurable leaky gut. We'll probably get into this, but I think Dr. Dale Bredesen and I have never found a person with neuroinflammation that doesn't have a leaky gut and doesn't, for the most part, have a leaky brain or a leaky mouth. And so we can say, "Oh, these aren't very important," but certainly in my practice, eliminating major lectins and doing a few other things, we have about a 90% remission rate of auto immune disease. That's not bad.

Heather Sandison: That's fantastic. I guess it begs the question then, who doesn't have a leaky brain, leaky gut? These things seem almost ubiquitous. And so, do you even bother testing anymore? It's one of the conversations I have with my patients is maybe we just assume you have it and go ahead and treat you for it.

Steven Gundry: Yeah. I think that's a great question. And in fact, that's what, in general, the vast majority of people who come to my clinics, and I see patients six days a week even on the weekends. The vast majority of people who follow The Plant Paradox program and the iterations, the most recent of which is The Energy Paradox program, resolve their issues, resolve their autoimmune diseases. All of these markers go away. They resolve their fatigue, but there's about 10% that don't. And despite being... They're perfect. They don't cheat, no little piece of sourdough bread comes through their mouth. And those people, when we get their tests for leaky gut, absolutely still have leaky gut. And then, we go further and we look at food sensitivities. We look at, there are certain people that clearly react to all forms of dairy and clearly react to either egg white or egg yolk or both.

And there's a whole new class of lectins that have been recently discovered called the aquaporins, and the aquaporins are present in among other things, spinach and bell peppers. And I've yet to find any evidence that pressure cooking will destroy these aquaporins. And since you're interested in brain health and I'm interested in brain health, aquaporins are highly associated with leaky brain and highly associated with MS, attack on the myelin sheath. And so when we discover that certainly of these patients who aren't getting better, they're better but they're not all the way. We do these more sophisticated tests. We go, "Aha! Here were the culprits that we were unaware of."

But you're right. 90% of the time, we don't have to test for leaky gut because I agree, all disease processes, like Hippocrates said 2,500 years ago, begin in the gut. I mean, what a genius. He didn't have all these tests to make him so smart.

Heather Sandison: And you mentioned the mouth. One of the things that of course you, Dr. Bredesen, myself, that we really prioritize is dental health and the health of the mouth, because as you said, disease starts in the gut or health starts in the gut and the gut starts in the mouth.

Steven Gundry: That starts in mouth. He makes a very good point. The closest access to your brain is from your mouth and sinuses. You know what I mean? It's a direct shot and so it doesn't take a genius to figure out. But he's a genius. But that of course, leaky is going to start this. And years ago, my colleagues and I at Loma Linda, Leonard Bailey and I found that you could find mouth flora in the plaques of patients that we were operating on for coronary artery disease. And I actually like the infectious theory of heart disease more than I liked the cholesterol theory of heart disease for that reason.

What To Eat, And What Not To Eat

Heather Sandison: Well, let's talk about what to eat because part of what we come up against when we talk about The Plant Paradox is that we think of plants as really healthy, right? And so if, as a doctor, I'm going to say to a patient, I think you should take some plants out of your diet. I want to have a really good reason why. And certainly, I think the lectins are in that category of a good reason. But tell us what's left. What do you suggest people eat?

Steven Gundry: Well, I'm a plant predator. I eat mostly plants, but you got to know who your friends are and who really doesn't have your back. My research as an undergraduate at Yale was actually in human evolutionary biology of tracing the evolution of food choices from great apes to modern humans. And one of the interesting things that I think most of us agree on is that we were, like great apes, a plant eater. And certainly our diet did change into eating I think lots of shellfish and fish, and then eventually maybe some animals. But tubers, once cooking arrived, once fire arrived somewhere around 300,000 years ago, we really see the transition of all these proto-humans into homo-sapiens. And I think for instance, cooking tubers probably was one of the real things that finally made us human, the advent of fire, because we can actually break down plant cell walls.

Steven Gundry: Most people somehow don't realize that we have no digestive ability to break down the cell wall of a plant. We have to, like all other animals, have to have bacteria to do that job to ferment them. Even a termite can't eat wood. He can eat it, but he can't digest it. So the advent of fire broke down these plants, and fire is actually, I will admit, a pretty good way of detoxifying lectins. Now, the really mischievous lectins like in beans, for example, or in grains like wheat, are very resistant to just cooking and that's been proven over and over again. In fact recently, I had Joel Fuhrman on my podcast, The Dr. Gundry Podcast, and he admitted that he pressure cooks his beans and I'm going like, "Wow! Newsflash! Why do you pressure cook beans? Might there be something in there that you want to avoid?"

So, a long way of saying is we really want to try and avoid gluten containing foods and that's wheat, rye, barley. And by the way, oats have a gluten like protein that really cross-reacts. So if it says gluten free oats, just run the other way. In our clinic, 70% of people who react to the components of wheat react to the components of corn. In fact, there is a protein in corn that if you react to it, and most people do, your immune system thinks the corn is wheat. And so corn, quinoa is another mischief maker. Unfortunately, even buckwheat has a lectin in it. Sorghum and millet do not have lectins. They're whole as grains. So in all my books, I really highly recommend if you're going to eat a grain, sorghum and millet are right up there.

So rice, interestingly enough, 4 billion people use rice as their staple, and yet 4 billion people take the hull off of brown rice and eat it white. Now, 4 billion people can not be that stupid, because everybody knows how good brown rice is for you. But in fact, the hull contains lectins and these smart 4 billion people have been taking the hull off of rice for a very long time.

Heather Sandison: So, who should avoid this diet? Is there anybody that this diet doesn't work for?

Steven Gundry: Again, I haven't found any... 90% of the time, people do very well on this diet. With whatever they come in, about 70% of my practice now is autoimmune diseases that people have quite frankly been all over the country, all over the world, to clinics and haven't had any success. And so that's who kind of ends up in my clinics now. But is there a reason not to eat the diet? Well, I haven't found one.

Heather Sandison: And then there's a lot of foods on here that maybe we put them on the maybe list, or there's just a certain way to prepare them. Like you mentioned beans.

Steven Gundry: Correct.

Heather Sandison: So, can you go through a little bit of what would make something tolerable?

Steven Gundry: Yeah. Recently, I was speaking with some researchers from the University of Sydney, Australia, who have written a wonderful book that I fully enjoyed called Eat Like the Animals. And I do recommend that book, folks. One of the interesting things that we talked about is, traditional cultures have almost always found out a way to detoxify the plant defense systems. And traditional cultures soak. For instance, in Italy, they soaked beans for 48 hours before they cook them and they change the water every four hours and put in fresh water. And it turns out that that's soaking actually activates fermentation of the beans themselves. And again, the lectins are in the outer part. And then they cook them. And interestingly, the Incas, who lived on quinoa, soaked their quinoa, then they fermented it. They let it rot and then they cooked it.

And so, you look at the Italians, did not eat tomatoes for 200 years after Christopher Columbus, their native son, brought them back because they knew how deadly they were. So Italians, once they started peeling and de-seeding tomatoes, began eating them and of course using them in sauce. And it's fascinating, I spend a lot of time pre COVID in going through these little villages and meeting chefs and mothers, every one of them peels and de-seeds their tomatoes. And I go, "Well, where'd you learn that from?" "Oh, my mother taught me." "Well, where did she learn it?" Well, everybody knows you have to peel and de-seed a tomato. And I think it's the same way with rice. Traditionally, they have removed these things.

And just as an aside, for 10,000 years since grains have become a major food source, particularly in the West, we have been trying to take the hull off of wheat. And in fact, there were debates who had the whitest wheat, and only the rich had white bread and the brown bread were given to the peasants. So traditional cultures have figured this out. And the other thing that's important about traditional cultures as I write about is they have a diverse microbiome that can actually defend you and eat most plant lectins. And as you and I know ours is a barren desert.

Heather Sandison: Would you consider this plant paradox diet an ancestral diet?

Steven Gundry: Oh yeah. I mean, none of us ate any of these modern foods up until about 10,000 years ago. These foods did not exist primarily because these defense systems were so good that you'd be hard pressed to adopt these diets. One of the things that I think is fascinating that I wrote about in the plant paradox is there's a lectin in wheat germ called wheat germ agglutinin. Wheat germ agglutinin is actually a really good way of binding on insulin receptors in fat cells, and it actually allows you to store more fat. I've conjectured and written that I think one of the reasons we adapted these grains into our diet was there wasn't a whole lot of food. And if you ate a food that prompted storing fat more than some other food, that would be a really good food despite the fact it might be making you sicker and smaller as I've talked about before. That's one of the reasons that for instance, wheat belly or things like that, when we take these foods out of people's diet, they almost universally lose weight.

Heather Sandison: Yeah. And I'm sure you're familiar with Jared Diamond, who wrote Guns, Germs, and Steel, and his whole hypothesis is that these protein containing grains are actually part of what made society, I mean from an evolutionary societal perspective, like that is what made Western cultures predominant. And so it's not all bad and perhaps previously-

Steven Gundry: Correct.

Heather Sandison: Right. It allowed us to do lots of other things, and yet there's a price that it comes with. And right now, we're paying that price in terms of diseases and shorter lifespans and spending the second half of our lives in pain with our brains failing us, with our guts failing us. And so, how do we get that back? How do we get the benefits of these foods without having to pay the price? Is sort of the question.

Steven Gundry: Well, again, I think simple substitutions is one thing. So again, if you like your grains, if you like your carbohydrates, and I'm not anti-carbohydrate, switch over to carbohydrates that don't carry these problems. Believe it or not, I eat pressure cooked beans probably two or three times a week, despite what Michael Greger may think. There are a lot of really good things about beans as long as you diffuse them. And they're, you know, as long as... Do these things. Tubers, I mean tubers are great sources of carbohydrates. There are multiple societies like the Kitavans that I write about, the Okinawans, who primarily their food source is sweet potatoes. And so, cook them and enjoy them.

The Apoe Protein Variants, And Its Effect On Metabolize

Heather Sandison: So, I want to understand a little bit more about your journey towards finding the ApoE variants. You have studied thousands, you've followed thousands of patients who are ApoE4 positive, and you have noticed that they have big differences in how they metabolize versus others. And then, that puts them at risk for Alzheimer's and dementia in particular. Tell me a bit about what else you've found, and is there anything in that research you've done that maybe we can extrapolate to help the rest of us who aren't ApoE4 positive?

Steven Gundry: Well, yeah, I got interested in the ApoE4 gene because "we know" that it is a major risk factor for coronary artery disease. And in fact, a large number of my patients with early coronary artery disease, when we looked at their ApoE status, they sure enough are ApoE4. 30% of the population carries either a single only of a 34, or 2% carry the 44. And so I wanted to know, okay, what is it about this gene that was so mischievous in terms of producing coronary artery disease? And Dr. Dale Bredesen and I, a few years ago were introduced. And it was funny. I met him and I said, "Oh my gosh, big fan of yours." "Oh my gosh, big fan of yours. Learned so much from you." I said, "No, no, you're the genius."

So, he came at it a different way. I came at it from a cholesterol transport system. And one of the things I think we'd both agree with is the apolipoprotein is one of the mechanisms that we carry cholesterol, and also phospholipids and omega-3 fats, in and out of our brain and in and out of individual cells. I like to describe this ApoE, apolipoprotein E, as basically a subway train. The subway train is carrying passengers, and the subway stops at a station. And let's call cholesterol the passengers. The cholesterol gets off and it goes into the cell. Cholesterol is necessary. And the subway moves on. Well, at the "end of the day", the cell doesn't use all the cholesterol. And so the cholesterol is back loaded onto the subway. We'll just talk about in the afternoon.

Unfortunately, the ApoE4, the subway can carry cholesterol very well, but the doors are closed for cholesterol to get back on the subway at the end of the day. So you have this delivery system that delivers cholesterol incredibly well, but it won't take up the excess. And that's where I got interested in it. And I noticed for the most part that saturated fats in my ApoE4 patients were particularly mischievous in terms of prompting more small dense LDLs than a comparable person. So that's kind of where I approach this. Now, Dr. Bredesen approach this from an inflammatory standpoint, that one of the other problems with the ApoE4 is that it appears that neuroinflammation is far more likely if you carry the ApoE4 gene. And so, we've come at it from different ways but we've arrived at a middle ground where we agree on almost everything about it.

Saturated Fats And Mcts

Heather Sandison: The diet. So, here is where diet is really important. Saturated fats and how we metabolize saturated fats, or help those with ApoE4 metabolize these fats, particularly the coconut. So things that we would think of as being very nutritious, very healthy, maybe aren't so much in that system. So, what are the things that people really need to be careful around?

Steven Gundry: Yeah. Definitely, I've banned pretty much coconut oil from my ApoE4 folks. I was very suspicious about medium chain triglycerides because it is a part of coconut oil, but I've subsequently come around and actually think that my ApoE4 folks actually ought to consume MCT oil. And if we have time, we'll talk about why. I think that's probably a good idea.

Heather Sandison: Well, I want to know.

Steven Gundry: Well, MCT oils, and this is actually a good starting off point where Dr. Bredesen and I completely agree. Saturated fats, a long chain of fats are carried, absorbed through our gut on chylomicrons, which are big transport molecules. Chylomicron, LPSs (lipopolysaccharides), which in my book I call little pieces of shit because that's what they are. Chylomicrons can absorb LPSs. LPSs hop on chylomicron to get through the wall of the gut, even without leaky gut. LPSs are really one of the best ways to start your immune system going crazy, and LPSs are a great way to make neuroinflammation. On the other hand, the medium chain triglycerides are not absorbed with chylomicrons. They're absorbed directly through the wall of the gut. And unlike chylomicrons, which go through the lymphatics, MCT oil goes directly via the portal vein to the liver. And once MCT hits the liver, it's virtually instantaneously made into ketone bodies.

Steven Gundry: Ketone bodies are one of the more protective of substances for the brain, and it's not why everybody thinks... It's in my next book, so I won't go there. But MCTs, particularly an ApoE4s, may be one of the tricks to protect against neuroinflammation. Now, the other thing that's interesting, I have a number of ApoE4s. That cheese, which is mostly saturated fat, is a real mischief maker in terms of making oxidized LDL, in terms of really elevating small dense LDLs. And I've challenged a number of my APOE34s the cheese challenge, it is where okay, eat some cheese. We're going to measure your small dense LDLs. We're going to measure your oxidized LDLs. And then, let's take away cheese for two weeks and do the same thing. And lots of them, you know it's wow, where all my oxidized LDL go? Well, it was the cheese.

Steven Gundry: On the other hand, there's some very, very interesting information that, cheeses, particularly from sheep and goats, about 20% to 30% of the fats in those cheeses, in those cheeses alone, are medium chain triglycerides. And of course, most medium chain triglycerides are named after goats, caprylic acid, capric acid. So, I've altered my recommendations on an individual basis, to let some of my ApoE4s have sheep and goat cheeses.

Heather Sandison: And eggs?

Steven Gundry: So, we've not seen a strong association between egg consumption and small dense LDL particles. And there was a very large finished study that I talked about in The Plant Paradox book, that found no association in worsening dementia in ApoE4 carriers and egg consumption. So eggs get a pretty good pass with the proviso is that some of my real mischief makers who didn't make any sense following my program, sensitivity with eggs was right up there on the list.

Poultry Vs. Red Meat

Heather Sandison: Yeah. It's a common food allergen. And then what about, I think you break down poultry versus red meat. So describe why those animal proteins are different, and who should have which ones?

Steven Gundry: Yeah. Great question. I grew up in Omaha, Nebraska, The Beef State. And so in my research on xenotransplantation where we would take a heart from a completely different species and put it into another one, we, all of our research for years has been looking at the pig as the perfect candidate for a human heart transplant. Pigs are, look, almost identical to human hearts. Pigs are omnivores just like us. Unfortunately, every time we did these transplants, and I have the longest record of a pig to baboons transplant yet, we found vascular rejection at about a month. I mean vicious vascular rejection. So, we look for why is this? And it turns out that pigs, sheep, and cows have a sugar molecule on the inside of their blood vessels called Neu5Gc. And I tell people, who knew? On the other hand, fish, chicken, and humans have a different sugar molecule, Neu5Ac.

Steven Gundry: And there's pretty cool evidence that these molecules are incredibly similar. They differ only by one little bond. We can develop an antibody to Neu5Gc when we eat beef, lamb, and pork, and we'll have an auto antibody to our own blood vessels. And the other thing that's interesting is that cancer cells protect themselves by, among other things, cloaking in Neu5Gc. And yet humans cannot manufacture Neu5Gc. So, we're pretty convinced that Neu5Gc was obtained from beef, lamb, and pork. And that may be one of the reasons why particularly red meat consumption is more associated with cancer than fish, for instance.

Heather Sandison: So, I have to go back to your fascinating work on transplanting organs between species. There are not many people I get to talk to who have done that. So, you called it xenotransplantation. Is that right?

Steven Gundry: Yep.

Heather Sandison: What do you see the role of that being in just the future of medicine?

Steven Gundry: Well, I think the exciting thing is, you know, since I left that practice, pigs are now being genetically engineered to no longer express of those antigens on the lining of their blood vessels. One of the fathers of transplantation used to always joke that xenotransplantation will be the future of heart transplantation and always will be, because we'll always hit a stumbling part. But I think now with genetic engineering, with CRISPR technology, I really do think that we'll figure out, and we haven't figured out, what molecules we have to change to stop this hyper acute vascular rejection.

Why Fatigue Is A Ubiquitous Problem  

Heather Sandison: Fascinating, fascinating. And so your next book is called The Energy Paradox. I'm curious, I know this is kind of the next progression of how we apply the plant paradox to different things that we're really suffering with societally. And I think more than half of my patients, probably the vast majority of them, particularly when I start to see them, suffer with fatigue. So this is just a very, very, very common complaint and it affects everything. It's how we engage with our families, how well we show up at work. And so we're talking here with you about how these molecular pieces, the proteins in foods that might be affecting our guts, our brains, our cardiovascular health. And now, can you tell us more specifically how it affects our energy levels? Is this mediated through the mitochondria? Is there another way? How do we get there?

Steven Gundry: Two ways. One, you already alluded to. One of the things that was fascinating to me is a study that was actually done a few years ago by Duke researchers, anthropologists, who wanted to look at the Hadzas, one of the last remaining hunter-gatherer groups in Tanzania, who... The Hadzas, the men walk, go 8 to 10 miles a day. The women walk 3 to 5 miles a day. They're thin. They're fit. They're healthy. And they wanted to look at the energy expenditure of these people and compare them to desk workers, office workers. And of course their hypothesis was well, the reason these Hadzas are so thin and fit is because they're using all this energy up in walking, et cetera, et cetera. And lo and behold, what they found was the Hadzas walk on 8 miles a day use the same amount of energy as a desk worker.

Steven Gundry: And they actually made a conclusion, which I totally disagree with, it doesn't pass the Smith test, is that we all have a fixed amount of energy expenditure no matter what we do, and that's what we expend. And I've gone, "What? Come on." Half the patients I see have fatigue is one of their diagnoses. So if you look at inflammation, if you look at leaky gut, 80% of our immune system, our white blood cells line our gut wall and they're there because that's where the invasion comes across. Let's think of them as soldiers. So soldiers need a lot of supplies, a lot of food, and we have to ration when we're at war so that the soldiers have most of the supplies. And so what I submit and have shown in multiple studies is that the fire of inflammation, which underlies all chronic disease processes, is taking most of our fuel away from our muscles and particularly from our brain.

Steven Gundry: And that's why the desk workers had the same energy expenditure as these people who were walking 8 to 10 miles a day. They were expanding energy that's for sure, but it was for inflammation. The second thing that I think is fascinating to me is that our mitochondria, those little energy producing organelles that are responsible for making most of our ATP, can handle sugars, glucose. They can handle amino acids and they can handle free fatty acids and make ATP. They use slightly different enzyme systems, slightly different electron transport systems to handle each of those things. And traditionally in whole food diets, like I talk about in The Energy Paradox, those substance was, would arrive kind of on a timely schedule. The carbohydrates would arrive first. The proteins, which would take longer to break down would arrive second. And fats, which had to go through a huge circuitous route to arrive, would in general arrive last.

Steven Gundry: Now, what's happened with our modern process foods and ultra processed foods is that food chemists have figured out how to break whole foods down into simple sugars, simple amino acids, simple fats, and put them all together in a savory package. And so when we eat these processed foods, they arrive at our mitochondria for processing is exactly like rush hour traffic. And the mitochondria literally can't handle that influx of carbon atoms to be processed. And so, a work by Satchin Panda in the Salk Institute in San Diego has shown that the average American now is eating up to 16 hours a day and with about 8 hours off for sleeping, if you're lucky. And he's shown that that rush hour traffic is one of the reasons that our mitochondria don't make energy because everything just kind of grinds to a halt. And in the book, I talk about how our mitochondria literally put up defenses against all of this influx. And that offense that we use initially is insulin resistance in gut.

Heather Sandison: Are you a fan of intermittent fasting then?

Steven Gundry: Believe it or not, as far as I know, and I'm happy to be corrected, I was the first to write about intermittent fasting in 2006 in my first book. And a really quick, funny story. My first book, Dr. Gundry's Diet Evolution, was done by Random House and we had an entire chapter on intermittent fasting, time-restricted eating. And my editor, Heather Jackson at the time said, "This is too crazy. No, we're not going to do it. This is nuts." And I said, "No, it's not nuts. I've been doing this now for five years. Here's the science. It's not nuts." She said, "No, this book is crazy enough already. I'll give you two pages to make your case." And I said, "You're making a mistake." She said, "I'm telling you, it's nuts."

Steven Gundry: So I got two pages, go ahead and look it up. I saw her at MindBodyGreen, in the symposium pre COVID, year before last. And she came up to me and she said, "Can you ever forgive me? You were right. You were so far ahead of your time. I should have known." I said, "It's okay." But yeah, so long before the 5:2 diet, long before Jason Fung, I was writing about this. So, there you go.

How To Live Forever:

The Two Best Predictors Of Healthspan.

Heather Sandison: Yep. So I want to know, since you're ahead of your time, how to live forever. The Longevity Paradox is another one of your books. What's the premise there? What do we need to do to live long, healthy lives?

Steven Gundry: I think we're finding more and more and more about this every year is that the health of your gut microbiome, the diversity of species in your gut microbiome and the integrity of the wall of your gut are the best two predictors of health span that we can come up with. Now in The Energy Paradox, I go on to show that a really elegant work by Dr. Rafael de Cabo from the NIH has shown certainly to my satisfaction that the shorter we make an eating window, the longer we're going to live and live well. And the good news about that is at least in his research, it really doesn't matter the types of foods we eat, whether it's a high sugar diet, whether it's a high protein diet, whether it's a high fat diet, it's actually the compression of the eating window that makes the difference.

And I go into this a lot in The Energy Paradox and my current editor, Julie Will, fought me on this because it's really nerdy, but the really cool thing is probably calorie restriction, which is still the number one way to extend lifespan, works not by restricting calories but works because calorie restricted animals, because they don't get much to eat, eat their calories rapidly. And it's the time they're not eating that actually made the difference. And that was what Dr. De Cabo proved.

Heather Sandison: Interesting. One of the things I come in into basically as an issue for us at my clinic and then also at Meramec is these sweet little old ladies who have dementia start losing too much weight on these diets. And then we have to balance that with their risk of osteoporosis and bone health issues. How do you balance the weight loss with the brain benefits, the longevity benefits? How do we square that circle?

Steven Gundry: Yeah. That's a great question. And there are some fascinating studies in humans that time-restricted eating does cause weight loss. A beautiful study that I talk about in The Energy Paradox with Italian athletes eating the exact same ISO caloric meals. One group ate their meals in a 12-hour window. The other group ate their meals in an 8-hour window. They both maintained muscle mass, which is important, I think we should realize. But the 8-hour window grew spiked the exact same number of calories, it was controlled, lost weight, but the benefit was that their insulin-like growth factor, which I think is still probably one of the best markers for good aging, plummeted compared to the athletes who had a 12-hour eating window. So, I think I'm less worried about weight loss per se, as long as we don't get sarcopenia and loss of muscle. And I think those two are not incompatible. So maybe the old truism that you can never be too rich or too skinny might have some application.

Heather Sandison: I'm also curious, the ketogenic diet, I tend to associate that with benefits if it's with this intermittent fasting. However, if we're doing intermittent fasting and there is sugar in the diet, you're burning sugar for fuel. Then I imagine that what's going on is that patients and myself we're on this roller coaster of spiked blood sugar and then dropped blood sugar. And our liver is still going through gluconeogenesis to maintain that blood sugar level. And so, what you had just said was that actually that intermittent fasting does pair well with a diet that does contain sugar when you're not in ketosis. So, do you get all of the benefits or do you want to be doing more of the intermittent fasting with ketosis, or what you're saying is basically it doesn't matter?

Steven Gundry: Yeah. It looks like it doesn't matter. And in fact, I think, personally in the next book is on the subject, a 24/7 ketogenic diet is I think a long-term bad choice. And even in particularly the ApoE4 individuals, there's not a lot actually a strong evidence that ketones have the same effect in the ApoE4's than they do and non-ApoE4s. And these are human studies. So, I think there's more to it than just the presence of ketones. I think from Dr. De Cabo's work, it wasn't the ketones, the continuous ketosis. It was the cycling between ketones appearing and ketones not appearing. And there's some fascinating work that I'll talk about in the next book, but it's premature.

Heather Sandison: So, your next book comes out on Tuesday or mid-March, and it's so exciting. This is the-

Steven Gundry: Energy Paradox.

Heather Sandison: ... Energy Paradox. Thank you.

Steven Gundry: What to do when your get up and go has got up and gone.

Heather Sandison: So, where can people find it? Is this available on all of the major book retailers?

Steven Gundry: Yeah. It's available for pre-order right now. You know, Amazon, Barnes & Noble, but please, please, please try to buy it from your local bookseller. They've been hammered by COVID, and anything we can do to keep them alive and well, it would be greatly appreciated.

Heather Sandison: And you said you were still seeing patients six days a week. We actually share a couple of patients. How can someone get on your schedule?

Steven Gundry: Well, they can come to and find me there. They can come to, that's where they can get on the schedule. We have an 800 number. What I do now, I have a phenomenal physician's assistant who initially sees my patient, but don't worry, you'd get into the queue and then I see you.

Heather Sandison: I can attest to this. I have patients who have been through the process and benefited greatly from your wisdom there.

Steven Gundry: Most patients would rather see her around. [Mitzi 00:48:18] is fantastic. So, shout out to Mitzi. But we don't turn away patients. I used to have to. And I see patients on the weekends because quite frankly, I've learned most of what I've learned in the last 21 years from my patients. And them, allowing me to do blood work on them every three months and say, "Hey, take away this food, add this food. Here, go to Costco and buy this supplement. Let's see what happens. Stop this supplement." And you know what? My patients have taught me most of what I know.

Heather Sandison: It is such a privilege. I agree that from my clinical experience as well, I've learned more from my patients than I did in four years of medical school. And it is so phenomenal to watch the changes and to really watch people perk up, get their health back and be able to get back to doing the things they love. And I know a lot of people don't just get that from seeing you clinically, but get the benefits of that from reading your books and listening to your podcast. So thank you for working so hard, doing the work that you do to make sure that more of us stay healthier longer.

Steven Gundry: Well, I appreciate that. I'm still a kid in a candy store, and not a day goes by that I hopefully... Actually, I always learn something every day and that's why I keep working. I'm in my 70s now and I have no intention of retiring. And one last word, if you want to get tired, retire. I just see so many of my patients when they retire, begin this kind of downward, just slow death spiral. Don't retire, please.

Heather Sandison: At least find something you're excited about. Something [crosstalk 00:49:59].

Steven Gundry: Exactly. Or do something new. Exactly.

Heather Sandison: Yeah. Well, Dr. Gundry, I can't thank you enough for your time. Thank you also to our listeners for joining us today. It's been an absolute pleasure. I've learned so much.

Steven Gundry: Well, thanks for having me on Collective Insights. Appreciate it.

Heather Sandison: You're so welcome.

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