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Dr. Peter Kozlowski speaks about How to Unfunc Your Gut with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 

Podcast Highlights

5:00  The gut is so important for our overall health because as Hippocrates told us 3,000 years ago, that all disease begins in the gut.  A lot of things that we do in modern life is damaging to the gut, including EMFs from our phones, stress, our food supply, toxins in the environment, antibiotics, meds, etc.  One of the most important things about the gut is that it is the barrier to keep things out that might harm us, so leaky gut is so problematic.  Once you get inflammation in the body, it can go anywhere and that’s why you get different symptoms when people get SIBO or candida or gluten sensitivity.  We also have 3 to 5 lbs of bacteria living in our microbiome and these bacteria interact with our genes and they help to keep us healthy.  We are mostly bacteria.

8:23  Dr. Kozlowski in his book Unfunc Your Gut discusses the important role that mental, emotional and spiritual health play in our gut health. Your nervous system talks to your gut through the vagus nerve. This is largely through our autonomic nervous system and we tend to be very sympathetic nervous system dominant.  The more we can activate our parasympathetic nervous system through meditation, therapy, heart rate variability, gratitude, acupuncture, breathing, the better your gut is going to function.

19:40  Food sensitivities.  Dr. Kozlowski does not find food sensitivity tests helpful since what typically comes out as a positive is based on what foods they have been eating for the last few months.  Most people who show multiple food sensitivities have open gap junctions, ie. leaky gut. He prefers to place patients on a 21 day elimination diet that eliminates at least gluten, dairy, soy, corn, eggs, and sugar.  On a full elimination diet, he will also cut out beef, pork, shellfish, processed meats, and coffee.   After 21 days, the eliminated foods will be reintroduced one by one. Foods that they still can’t tolerate, they should work on improving their gut health and then test those foods back in 6 months.

28:14  The healthiest diet for longevity is some version of the Mediterranean diet. Dr. Kozlowski recommends that people eat 9-12 servings of vegetables and fruits per day and a serving is 1 cup raw or 1/2 cup cooked.  In our standard American diet we don’t eat many vegetables.  In our typical breakfast of pancakes, bacon, breakfast sandwiches, cereal, etc. we typically don’t eat any vegetables. And then lunch is pizza or hotdogs or sandwiches, no vegetables again. And then perhaps there’s a side of broccoli at dinner.  So we’re eating one to three servings of vegetables instead of 9-12 servings of vegetables and fruits per day that he recommends.  We should definitely avoid sugar, processed foods, and processed vegetable oils in our diet.

31:25  The microbiome.  When you don’t take care of your garden, weeds grow and this happens with our microbiome.  Antibiotics are the easiest way to screw up your microbiome and one round of broad spectrum antibiotics can wipe out half your microbiome.  And then weeds take over your garden, which is dysbiosis.  Dr. Kozlowski prefers to do a stool test and urine testing to see what might be overgrown or out of balance in your microbiome.  It is a bad strategy to give probiotics to patients with SIBO or dysbiosis or candida, since you need to pull out the weeds first before trying to grow back the healthy bacteria. This is typically done through taking herbs like grapefruit seed extract or uva ursi or silver or berberine or oil of oregano or caprylic acid or garlic, or you can use the elemental diet to starve the dysbiotic bacteria.  Dr. Kozlowski likes to order the stool test from Doctor’s Data, which tells you which natural products will likely be effective against whatever is overgrown in your gut. He often uses combination supplements such as FC-Cidal, Dysbiocide, and A.D.P. from Biotics Research or Candibactin AR and BR from Metagenics.  He also likes to use Biocidin, which has the longest research behind it.  If the gut lining is inflamed, Dr. Kozlowski will use L-glutamine 5 gm 3 times per day. He may use high dose fish oil or GLA. He may recommend HCL, digestive enzymes, and/or ox bile.  They may need gall bladder support. His favorite SIBO protocol involves taking the herbs two weeks on, one week off for a total of nine weeks. For re-growing the microbiome, Dr. Kozlowski prefers to use prebiotics like Arabinogalactan or inulin and prebiotic foods like banana, asparagus, and artichokes rather than taking probiotics. 

Dr. Peter Kozlowski is a medical doctor who transitioned to Functional Medicine as an intern in medical school. He has trained with leaders in the Functional Medicine field, including Dr. Mark Hyman and Dr. Deepak Chopra. Dr. Kozlowski’s unique take on gut health is described in his new book, Unfunc Your Gut.

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.

Podcast Transcript

Dr. Weitz:                            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talk to the leading health and nutrition experts and researchers in the field to bring you the latest in cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website, drweitz.com. Thanks for joining me, and let’s jump into the podcast.

Hello, Rational Wellness podcasters. Today, our topic is gut health with Dr. Peter Kozlowski. Dr. Peter Kozlowski, he will give his unique take on gut health as described in his new book, Unfunc Your Gut. Dr. Kozlowski started out as a family practice MD, but transitioned to functional medicine as an intern. He has trained with leaders in the functional medicine field, including Dr. Mark Hyman and Dr. Deepak Chopra. Dr. Kozlowski, thank you so much for joining us today.

Dr. Kozlowski:                    It’s an honor. Thank you for having me.

Dr. Weitz:                           Good. Good. Good. So you’re speaking to us from Montana. How are things in Montana right now?

Dr. Kozlowski:                    I think we’re on like day number 20 over 90 degrees. So, hotter than normal here.

Dr. Weitz:                           Yeah. But climate change doesn’t exist.

Dr. Kozlowski:                    Yeah.

Dr. Weitz:                           So since you started off as a functional medicine MD, how did you find your way to functional medicine?

Dr. Kozlowski:                    Completely randomly. I just tell people that I got lucky. The majority of practitioners that I know in the functional medicine world usually got into it because they got sick themselves and they tried the traditional route and they couldn’t get better, so they found functional medicine and then decided to use that in their practice.  For me, I was an intern in family practice residency. And as an intern or as a resident, you do different rotations every month. So one month we focus on clinics, outpatient, inpatient, cardiology, OB/GYN, and you’re constantly being trained by different physicians. And when you’re on the inpatient service, every week, there’s somebody new that teaches you.  

And we had one doctor that every patient that was hospitalized, he would put them on a multi-vitamin and vitamin D. And we, as residents, thought it was ridiculous and used to make fun of him that he would make us write those kinds of orders because nobody else did it and we just didn’t get it. So I was working with him on… It was a Sunday night at like 2:00 AM and we had some downtime and I just asked him, I was like, “Why are you weird? Why are you different?”  And he’s like, “I’m studying something called functional medicine.” And I was like, “What is that?” And he took me to the IFM website and it just took off from there. I looked at it, I was like, “This looks pretty interesting.” They require you to go do CME during residency. So I was like, “Why not go check this out?” And within the first hour of the first conference, I just couldn’t look at medicine the same. It was all taught from a science, biochemistry, a physiology level. I couldn’t really argue with it, and it just made sense to me.

And then another thing was, at this conference, there was doctors that were from every profession from chiropractic, acupuncture, ophthalmology, cardiology, neurology, and they’re all here. And I was like… I didn’t get it. I was like, “What are you guys doing here?” And they were like, “This is the future of medicine.” And I heard that over and over and over.  So I left that conference and just really with my brain overloaded, but I was like, “I’m going to slowly focus my career on this.” And I continued throughout residency to go to conference, to work on my certification and got invited to do away rotation. So I left residency for like a month at a time to go work with some of the leaders in the field, and I would just follow them around.  And it wasn’t just the doctors. I would follow around the staff, the nutritionist, the health coach, the life coach, because everything was new to me. It was a completely different approach than I had learned in residency. So I was learning from everybody and I just took notes. And when I graduated, I started my own practice and I’ve been out on my own for seven years now.

Dr. Weitz:                            Cool. So why is the gut so important to our overall health?

Dr. Kozlowski:                    Yeah. So Hippocrates said it 3,000 years ago, right? All disease begins in the gut. And what I always tell people is, basically, since he said that, everything we’ve done is pretty damaging to the gut. With our phones, with stress, with what we’ve done to our food supply, our environment, antibiotics, meds, all of that stuff is damaging our gut.  But the reason, the true reason that it’s the key to our health is, in my opinion, because the gut is the gateway into your body. So when we say gut, it’s a long tube that starts with the mouth and ends with the anus, and it has openings on both ends, so it’s literally just a tube. And the inside of that tube is actually considered outside of your body. So if you swallow something and poop it out, it’s never been in your body.  So to me, the gut’s most important job besides digesting and absorbing is to decide what comes in and what stays out. So that’s where a lot of people have heard of this term, leaky gut. That’s pretty much exactly what it means. When your gut’s leaky, the junctions are wide open and anything that’s passing through your gut tube can pass into your body. Now it’s fair game, it’s in your blood, and the blood goes everywhere.  So you could take a hundred patients with SIBO, candida, gluten sensitivity, and they all have different symptoms because the inflammation is in the body and it can go anywhere. That, I think is the biggest reason. And then the secondary one is your microbiome, is that we all have three to five pounds of bacteria growing on the inside of the large intestine, the last part of your gut. And that bacteria constantly talks to us.  We, as humans have about 23,000 genes. They’ve found over 20 million bacterial genes in our gut. So one of my favorite T-shirts that I have says, “Mostly microbe,” that we’re mostly bacteria. And those bacteria, they develop, they start when we’re born and then we can either keep them healthy through our diet and lifestyle or we can damage them through our diet and lifestyle. So those are the two reasons why the gut is the key to your health.

Dr. Weitz:                            Yeah. I certainly know all about the importance of the microbiome and there’s incredible amount of research going on. But one thing I always find interesting is there are people who do not have a colon, they had Crohn’s disease or ulcerative colitis, and they had their colon cut out. And yet they continue to thrive, probably not ideally, but I’m always amazed about that.

Dr. Kozlowski:                    Yeah. I think it just proves the point of how resilient our bodies are, right? I assume if your large intestine gets cut out, your microbiome just starts to grow at the end of your small intestine and your body adjusts.

Dr. Weitz:                            Yeah. I don’t know. It’s a question we need to answer one of these days. So in your book, Unfunc Your Gut, in the beginning, you talk about stress, which is really important and often not talked about. So how does our mental, emotional, and spiritual health play, or what factor does that play in our gut health?

Dr. Kozlowski:                    So, spoiler alert, that’s the big secret that I reveal in the book is that your mental, emotional, spiritual health is the most important component. And that I learned through my own story, but more in my… I learned it from my patients because one of my faults is that I’m a perfectionist. So I don’t really think about the patients that get better, I only focus on the ones that didn’t.  And trying to figure out why could I put 10 people on a CBO Protocol and half get better and half don’t. And what I started to see over and over, it was usually their mental, emotional, spiritual health, which other terms are anxiety, depression, trauma. To me, I like mental, emotional, spiritual health.  But this, just like everything else in functional medicine, and there’s science behind it; and the main reason, anatomically, why that is because your gut, that tube is surrounded by a nervous system called the enteric nervous system. There’s 200-250 million neurons in that nervous system, more than in your brain or spinal cord or anywhere else.  That nervous system talks to your gut, but then it also sends signals to your brain and your brain sends signals to your gut. So that whole gut-brain connection that people talk about, it’s between the two nervous systems; your central and your enteric. Those systems are connected by the vagus nerve, that’s one of your cranial nerves. And this is where the mental, emotional, spiritual component comes in.

Your vagus nerve runs on your autonomic nervous system, which is your automatic nervous system, which is divided into two responses; sympathetic and parasympathetic. Sympathetic is fight-or-flight. So that is hiking in Montana, you see a bear and you want to escape, all the blood goes to your muscles and brain to try to figure out how to get away. Then when you’re sitting by the campfire, you go into parasympathetic and you rest and digest your food.  People right now, nowadays, are living as if they’re running from a bear 24/7. We wake up, we go straight to our phone, we check our email, our texts, we check the news, we sit down for breakfast, we’re reading our phone or watching the news. And so we’re just constantly activating that sympathetic nervous system, which is sending signals down your vagus nerve to your gut to tell you to not digest, to not absorb. It shuts down your gut bacteria. So that is the connection.  So the more that someone can activate their parasympathetic nervous system through things like meditation, therapy, heart rate variability, gratitude, acupuncture, there is a lot of ways to do it, just breathing, the better your gut is going to function. And then treating something like candida or dysbiosis or SIBO is much easier.

Dr. Weitz:                           Yeah. Actually, this is a device that uses vibrations and it helps get you into a parasympathetic mode as well.

Dr. Kozlowski:                    Oh, excellent.

Dr. Weitz:                           Yeah. Yeah.

Dr. Kozlowski:                    What’s it called?

Dr. Weitz:                            The Apollo.

Dr. Kozlowski:                    Okay. I’ll take a look at that.

Dr. Weitz:                            Yeah. So what do we do about how stress, our mental, emotional spiritual health affects our gut health? You just hinted at it by saying we got to get out of being in sympathetic mode all the time, but what else do we do? If your emotional health is affecting your gut health, what can you do?

Dr. Kozlowski:                    Yeah, the first step is just admitting there’s a problem. My own personal story is I’m in recovery and I used alcohol as a coping mechanism, and so that’s where I learned mental, emotional, spiritual health personally. But what I’ve seen over and over is, as someone who’s spent a long time in denial, usually, you can see it in other people, and so I see it in my patients.  And just having the first… Like I said, the first step is just admitting like, “Okay, maybe my relationship with my parents or with my spouse or my kids or my job could be having a role in my health.” And once you know that, you can’t really un-know it. And even though it’s the most important part of health, it’s the most difficult one for me to help someone with because it’s not what I was trained in. I learned it from my own story, but-

Dr. Weitz:            Interesting. I’ve really been enjoying this discussion, but I’d like to take a minute to tell you about a new product that I’m very excited about. I’d like to tell you about a new wearable called the Apollo. This is a device that can be worn on the wrist or the ankle, and it uses vibrations to stimulate your parasympathetic nervous system. This device has amazing benefits in terms of getting you out of that stressed out sympathetic nervous system and stimulating the parasympathetic nervous system. It has a number of different functions, especially helping you to relax, to focus, to concentrate, get into a deeper meditative state, even to help you sleep, and there’s even a mode to help you wake up. This all occurs through the scientific use of subtle vibrations.

                                For those of you who might be interested in getting the Apollo for yourself to help you reset your nervous system, go to apolloneuro.com and use the affiliate code, Weitz10. That’s my last name, WEITZ10. Now, back to the discussion.

Dr. Kozlowski:                    Every patient that I meet, I encourage them to work with a therapist while they’re working with me.

Dr. Weitz:                           Okay.

Dr. Kozlowski:                    And therapy was a huge part for me to uncover why did I need to use alcohol to deal with my feelings and emotions? And the analogy is like peeling back the layers of an onion. And over time, you just get deeper and deeper and figuring out what’s underlying that. And so that takes… I mean, it’s hard. It’s not easy, so I get why people don’t want to do it. It would be a lot easier to just find the right supplements to take or find the right procedure or treatment, whatever. This is the real work.  And for most people, it starts when we’re children. Trauma is… I have the best definition I’ve heard of trauma, is trauma is anything less than nurturing. And for a lot of us, it could be your parents working two jobs or working and not being around. And then that can start making you feel like you’re not good enough, and then that affects your gut, and then you start having abdominal symptoms. And then by the time you come into my office, you’re in your 30s, 40s, 50s and there’s autoimmune disease. And it started with something as simple as just being uncomfortable in your own skin, which shut down your gut.

So then the good thing about mental, emotional, spiritual health is there are so many different modalities to use, and it’s about exploring and finding which one works for you. For me, exercise is a big one. I feel much better when I exercise. I do a gratitude list every day with my wife. We usually take a walk in the evening and we always do three things that we’re grateful for. Building connections, helping others, these are things that work for me, but then there’s meditation, prayer. So it’s about exploring what is the right combo for you.

Dr. Weitz:                           Yeah, it’s interesting. I think that there’s a tendency for… When dealing with patients with some of these gut disorders that are not really structural, these functional gut disorders like SIBO and IBS, over the years, because it’s been difficult to get quantitative tests that really show what’s wrong. Typically, if you have a patient with IBS, a traditional gastroenterologist is going to do a colonoscope or an endoscope or a CAT scan, you’re not going to see anything.

Dr. Kozlowski:                    Never.

Dr. Weitz:                           So it’s difficult to see the exact structural reasons for why they’re having the problem. So, for many years, patients with IBS were dismissed as basically having an emotional disorder and given antidepressants and things like that. So there’s, I think, a tendency to try really hard to focus on the physical causes for these conditions. And maybe we’ve gone too far and forgotten that there really are emotional and stress-related issues that affect the gut.

Dr. Kozlowski:                    Yeah, I agree. And I think that there’s just a balance because for the… I mean, a lot of patients that have been diagnosed with IBS that come through with me and we do testing, the most common thing that I find is SIBO, an intestinal overgrowth of your small intestine, or dysbiosis or candida or low stomach acid, leaky gut. And treating those things, to me, I think we have good testing now so there’s tests for all of those conditions, and then there’s treatment plans that work.  I guess my point of my book was just, if that’s not working, if you’ve had the right testing, you’ve had a good treatment plan and it’s still not getting better, in my experience, usually, it’s been the mental, emotional, spiritual health that was the big thing that was missed.

Dr. Weitz:                            Right. Let’s talk about food sensitivities.

Dr. Kozlowski:                    Yeah.

Dr. Weitz:                            To begin with, why do so many people seem to have a lot of food sensitivities these days?

Dr. Kozlowski:                    I think it’s mostly because of what we’ve done to our food supply. Most of the food that we eat is not in the form that it started, that it was created as. It started with the hybridization of wheat in the 1960s. Right now, over 90% of soy and corn are genetically modified in the United States. Cows don’t eat grass. They are put in pens and fed hay and other things.  So we’ve changed the proteins of the majority of the foods that we eat, but we never tested how that would affect human beings. And that is, I think, the biggest reason why food sensitivities are increasing at the rate that they are.

Dr. Weitz:                            Now, there’s lots of sophisticated lab tests to measure food sensitivities that look at IgG, IgM, IgA. Companies like Cyrex, [inaudible 00:20:53] have very sophisticated food sensitivity testing. But you say in your book that you don’t feel like these tests are helpful.

Dr. Kozlowski:                    Yeah. And my experience has been that those tests are helpful for diagnosing leaky gut. And when someone does those… The majority of people that do those tests, it’s typically a log of what they’ve been eating for the last few months. Because if your gap junctions in your gut are open, then those proteins from those foods are going to be getting into your blood and you’re more likely to create an immune response against them.  To me, the gold standard that I’ve always used is an elimination diet, which is 21 days of cutting out the biggest offending foods and then reintroducing them one by one. And that’s another thing that is science-based. And when you have a sensitivity, you create IgG antibodies.  Everything in your body has a half-life. So if you smoke cigarettes, if you take prescription meds, if you drink alcohol, everything has a different half-life, or your hormones, toxins. The half-life of IgG antibodies is around 21 days. So let’s say I react to gluten and I had a bagel for breakfast today, and I have 100 antibodies floating around; if I don’t have any gluten for the next 21 days, that antibody count will drop in half to 50.  When I eat it again on day 22, if my immune system has identified it as an invader, it will attack and create inflammation which can present as symptoms like a headache, abdominal pain, a rash, acne, joint pain, it can present anywhere. So, to me, the best way that I’ve found to diagnose sensitivities, the most reliable, is you cut out the foods and then you add them back in one by one, every two days.

Dr. Weitz:                            Now, there’s different versions of the elimination diet. Some people recommend cutting out two foods or six foods or 10 foods. Which foods do you recommend cutting out?

Dr. Kozlowski:                    So typically, the top five or six offenders are gluten, dairy, soy, corn, eggs, and sugar. In a “full elimination diet”, we also cut out beef, pork, shellfish, processed meats, coffee. And I think there might be one more that I’m missing. I have it listed, the full list in the book.  So I really believe in meeting patients where they’re at. There are some people where if all you’re ready to cut out is your energy drink, that’s better than nothing, right? And if you’re just ready to cut out gluten, I’d rather have you do that than try to do a full elimination diet and quit after a day because you’re going nuts.

Dr. Weitz:                            Right.

Dr. Kozlowski:                    One of the things that I think has happened in our field is that there’s so many restrictive diets out there and there’s so much information out there that’s like, “You have to be paleo or you have to be keto or vegan or Mediterranean.”

To me, I and my patients think I’m nuts, I tell them, I’d rather have you eating fast food if it doesn’t stress you out. If you’re so worried about eating the perfect meal, it’s not going to help. You’re going to shut down your digestion, your cortisol is going to elevate, and you’re not going to get the benefits from that meal. And that’s okay. Like right now, you might not be ready for an elimination diet, but a year from now, you might be.

Dr. Weitz:                            [inaudible 00:24:38] is when they layer one diet on top of the other.

Dr. Kozlowski:                    Right.

Dr. Weitz:                           So they’re following their paleo diet, and then they eliminate high-FODMAP foods, and then they eliminate histamine foods.

Dr. Kozlowski:                    Yeah. Right. Then there’s like three things you can eat.

Dr. Weitz:                           Right.

Dr. Kozlowski:                    I’ve seen that a lot with the sensitivity testing too. People come in, they’ve had the testing and they’re eating like six foods. I believe in a candida diet, a low-FODMAP diet, elimination diet, but in short-term. Right? Some of those diets are too stressful to do long-term.

Dr. Weitz:                           Yeah. Short-term to get rid of symptoms, to help get your condition on the road to healing.

Dr. Kozlowski:                    Exactly.

Dr. Weitz:                           But long-term, you’re going to end up with nutritional deficiencies.

Dr. Kozlowski:                    Right. Yeah, absolutely.

Dr. Weitz:                           So you have patients cut out all these foods for 21 days. And then how often do they put food back and how long do they wait for? How many times a day do they need to eat it?

Dr. Kozlowski:                    Yeah. We’re starting an elimination diet challenge on August 1st on social media, on my Instagram and Facebook. So I’m going to be posting… In my book, we have over 50 recipes to help people, but we’re going to be posting recipes, answering questions, and just hopefully making it easier for people to do.  The way that I approach it is you reintroduce the food, one food at a time, three times that day. So day 22, you introduce, let’s say, gluten three times. You don’t add anything else new. You wait, day 23. If nothing’s happened in those two days, then you start the next food. So we’re doing every two days. A classic reaction to dairy is like, everything’s fine on day 22. But day 23, you wake up and your face is broken out in acne or something.  So, we do one food every two days, three servings on that day. If you have a reaction, you wait until the reaction’s gone to start the next food. For some people, it could be a couple of days. I’ve seen it be a week. And you use a tracking journal, which we have a copy of, and you just write down what happened. And the symptoms, if you went into an elimination diet because of migraines, when you have dairy and you react to it, you might get joint pain. You might not get the exact symptom that you’re looking for, but it still means it’s inflaming your body.

Dr. Weitz:                           If somebody has a pretty strong reaction to gluten, will you have them try it again in the future or will you just say, “Just avoid gluten?”

Dr. Kozlowski:                    Yeah. I tell people to try it again. What I tell them is to Unfunc their gut, get their gut right, and then try again in about six months. I mean, it can change. I’ve seen it change. What you’re sensitive to, you might not be sensitive to in the future. So my advice always is to try, especially if you’re missing the food… You meet a lot of people that are like, “I don’t care about gluten. I don’t ever want to eat it again.” And they’re fine. But then, I think more people are like, “Well, when can I eat this again?” So I always encourage trying.

Dr. Weitz:                            Sure. So what’s the healthiest diet for most people to follow for longevity?

Dr. Kozlowski:                    I keep it very, very simple. I give two main goals. The most evidence, what I’ve seen is behind the Mediterranean diet. But to keep things simple, what I encourage people to do is to eat 9-12 servings of vegetables and fruit a day. And if you’re eating that… A serving is a cup raw or a half-cup cooked. And if you’re eating that many vegetables and fruit in a day, there’s not room for the other stuff. You’re full from everything else.  And so, in our standard American diet, our typical breakfast of pancakes, bacon, breakfast sandwiches, all this stuff, cereal, we don’t eat any vegetables. And then lunch is pizza or hotdogs or sandwiches, no vegetables again. And then there’s a side of broccoli at dinner. So we’re eating one to three probably, the average American. Whereas I encourage people to shoot for 9-12.

So I think that’s an easy… I mean, it’s not easy for people to do, but it’s easy to remember like, “Okay, if I’m going to try to eat well, what should I do?” And it’s just like, “Increase that intake of natural vegetables and fruit.” And then I think that everybody should do an elimination diet because you might not even have symptoms right now, but you might be sensitive to some things. Besides the Mediterranean diet, that’s what I would recommend for people.  But I’ve met people that they swear by vegan, they swear by paleo, they swear by keto. That’s fine. I don’t tell people, “No. If that’s working for you, you have to stop it because I believe in something else.”

Dr. Weitz:                            Right. So in terms of prevention of cancer and cardiovascular disease, what do you think are some of the things to focus on? What foods or food groups or macronutrients, what should we reduce or avoid for most people?

Dr. Kozlowski:                    Sugar.

Dr. Weitz:                            Sugar.

Dr. Kozlowski:                    Yeah. You just cut out sugar, it’ll take you a long, long way.

Dr. Weitz:                            [inaudible 00:30:42].

Dr. Kozlowski:                    And then processed foods and saturated foods.

Dr. Weitz:                            Okay.

Dr. Kozlowski:                    Yeah.

Dr. Weitz:                            What do you mean? Saturated fat? Is that what you mean?

Dr. Kozlowski:                    Yeah. Yes. Yeah.

Dr. Weitz:                            Okay. Lots of controversy over what causes heart disease. Does saturated fat really cause heart disease? Does it raise your LDL Why? How does saturated fat do that?

Dr. Kozlowski:                    Sorry. So I misspoke. Yeah, I agree with you. So it’s like the trans fats, the fats that are in fast food and in French fries and the processed vegetable oils and canola oils and all that stuff.

Dr. Weitz:                            Right. Okay. Can you talk about the microbiome and what’s the best way to test for it, and what do we do to optimize our microbiome?

Dr. Kozlowski:                    Yeah. Your microbiome, the analogy that I really like is it’s like your own garden, like your garden at home. And so, in that analogy, the probiotics are the plants of your garden. Fibers and good sugars are the fertilizer of your garden. But what happens when you don’t take care of your garden is weeds grow, right? And that’s what happens in our guts. And that’s where you can get dysbiosis, candida, SIBO, those things.  So I think the best way to screw up your microbiome is antibiotics because antibiotics are tablets that were designed to kill bacteria. And where do you put them typically? In a tube that has five pounds of bacteria in it. So just taking antibiotics once can wipe out up to half of your microbiome. And then if half your garden is wiped out, what happens? Weeds start to take over, right?  And we’re being exposed to all these different weeds every day, all the time. And if your garden’s empty, those weeds see this fertile soil and will take over. So antibiotics are a big thing. A microbiome in general, because of that analogy, even though I’m known for gut health, I don’t typically start probiotics. I prefer to do it through food.

Probiotics, there’s a lot of discussion of do they actually stay in your gut? Where do they get broken down? How long do the effects last? But also, if there’s weeds overgrowing in your garden, you wouldn’t go to the nursery and buy more plants, right? You would pull the weeds out. And so pulling the weeds out is, in my experience, done through stool and urine-testing to identify what’s growing in there, and then treating that to make sure it goes away, and then focusing on pre and probiotic foods.  The other thing that’s happened to me is the most common condition that I treat is SIBO, and that’s when your microbiome, which should be living in your large intestine, is now living in your small intestine. And your small intestine is where you should be absorbing your nutrients and digesting some food, should not be covered in bacteria. So it’s bacteria overgrowing.  And if you have SIBO and you start a probiotic, you can actually get worse because you’re feeding the problem. And in our general society, if you tell someone you’ve got abdominal pain, they’re going to tell you to eat more fiber and take a probiotic, which for a lot of people works but if it doesn’t and you’re feeling worse, that could be a sign that you have SIBO.  So, stool testing, a stool analysis tells us what’s growing in your garden, how inflamed your gut is, how well your gut bacteria eat, do you have parasites?

Dr. Weitz:                            I’d like to interrupt this fascinating discussion we’re having for another few minutes to tell you about another really exciting product that has changed my life and the life of my family, especially as it pertains to getting good quality sleep. It’s something called the chiliPAD, C-H-I-L-I-P-A-D. It can be found at the website chilisleep.com, which is C-H-I-L-I-S-L-E-E-P dot com.

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If you go to chilisleep.com and you use the affiliate code, Weitz20, that’s my last name, W-E-I-T-Z, 20. You’ll get 20% off a chiliPAD. So, check it out and let’s get back to this discussion.

Dr. Weitz:                            So, Peter, what do you use to treat dysbiosis or bacterial overgrowth?

Dr. Kozlowski:                    Yeah, it varies in everybody. The three options typically are antibiotics, which I usually try to push people away from just due to all the side effects; a natural herbal approach, which I’ll talk a little bit more about; and then a third, and I call it the nuclear option, is an elemental diet, a liquid diet for two or three weeks. That’s usually… I’ve only used in either people that can’t get an ulcerative colitis under control or people that have failed treatment with SIBO multiple times, I’ll try that.  I’ve had a few patients over the years that have just started with an elemental diet, but that’s pretty rare because it’s so difficult. But when it comes to the herbal approach, so if you do a stool analysis and they find dysbiotic bacteria, they’ll do sensitivity testing. So they’ll tell you that whatever species is growing inside you reacts, responds to grapefruit seed extract or uva ursi or silver or berberine or oil of oregano. So if you have that information, you can really target your treatment because you’ll see resistant patterns on there.

Dr. Weitz:                           Yeah. Some of the stool-test companies do and others don’t. What stool tests do you usually order?

Dr. Kozlowski:                    Majority of the time I use Doctor’s Data.

Dr. Weitz:                           Okay.

Dr. Kozlowski:                    Because I’ve just found they always test more herbs than anybody else. So I like to see the resistance and sensitivity patterns. And my experience is that they seem to be better at catching candida and yeast overgrowth than other labs that I’ve used. So I like Doctor’s Data a lot.

Dr. Weitz:                           I think a lot of us are using other stool tests that don’t necessarily test those. So if you don’t have those, how do you decide what herbs to use?

Dr. Kozlowski:                    It’s a shotgun approach. So you can pick the herbs that are the most effective, and that’s some of that list, oil of oregano, uva ursi, silver, grapefruit seed extract, caprylic acid, garlic. These are all things that you can use. And when I’m treating, let’s say, SIBO, which with SIBO, through breath testing, you can get a yes or no answer. “Yes, you have it.” “No, you don’t.” But you have no clue what’s overgrowing.  So you don’t know if that’s probiotics overgrowing, you don’t know if that’s yeast overgrowing, you don’t know if it’s dysbiosis growing. So that’s a situation where we’re definitely using a shotgun approach. We’re just doing a broad spectrum.

Dr. Weitz:                           Well, a little bit, because if it’s methane, you know it’s archaea. If it’s hydrogen-

Dr. Kozlowski:                    That’s true.

Dr. Weitz:                           It’s likely different organisms. And now we have the hydrogen sulfide, which some say it’s the type of organisms that are involved in that.

Dr. Kozlowski:                    So when I’m treating those, I typically use a supplement from Biotics Research, FC-Cidal, Dysbiocide, and A.D.P. That combination of the three, that I’ve used for the last few years, mostly. Metagenics makes a combo product called CandiBactin.

Dr. Weitz:                            [inaudible 00:39:41].

Dr. Kozlowski:                    Yep, exactly. And then Biocidin, I think has the longest research behind it, or at least I’ve used that one the longest. And right now, just with all the things going on in the world, so many things are backordered, so it’s just trying to figure out what’s available and trying that.

Dr. Weitz:                            Yeah.

Dr. Kozlowski:                    Stuff.

Dr. Weitz:                            Yep. Yep. Yep. So, besides herbal antimicrobials, what else will you use?

Dr. Kozlowski:                    So, for dysbiosis, if somebody’s gut lining looks very inflamed, then I might do things to calm the gut lining, and my favorite is glutamine.

Dr. Weitz:                           Okay.

Dr. Kozlowski:                    High dose. Five grams, three times a day. Sometimes just anti-inflammatories like high-dose fish oil or gamma-linolenic acid (GLA), omega-6. So sometimes I’ll do some stuff like that. If somebody we suspect or they have low stomach acid, I will put them on hydrochloric acid. Sometimes we’ll use pancreatic or digestive enzymes, ox bile, gallbladder support. So those are the main things I think that I use.

Dr. Weitz:                           Okay. And do you go through phases of treatment or?

Dr. Kozlowski:                    Usually, my SIBO most common treatment plan is nine weeks where it’s two weeks on, one week off, and you cycle that three times.

Dr. Weitz:                           Okay. With the same herbs each time?

Dr. Kozlowski:                    Mm-hmm (affirmative). Yeah. There’s been times where I’ve tried to use different ones because one of the concerns is if you use the same stuff over and over, there’s obviously resistance. So you can definitely try to cycle it.  But no, typically, I’ll use… At least through the first time through, right? In the first two or three months that we’re trying, then I’ll stick to the same regimen and then either repeat testing or talk to the person and see if they’re not really getting better, then we need to adjust something.

Dr. Weitz:                           Right.

Dr. Kozlowski:                    I always try to take the path of least resistance. So usually, whatever’s going to be the easiest, let’s try that first, assuming the symptoms are not severe. Instead of just throwing everything all at once. It can be overwhelming, I think.

Dr. Weitz:                            Right. So let’s say you have a SIBO patient, you do the nine weeks of herbs. Is treatment done then?

Dr. Kozlowski:                    If they’re better. It depends. If their symptoms have gone away, which happens many times, it’s great, and they move on. And then the next phase is reintroducing the higher FODMAPs because I do like people to stay on a low-FODMAP diet during SIBO treatment.  The interesting thing I’ve found with people that have recovered from SIBO is frequently you’ll hear that there’s one food that they just can’t tolerate. And it’s always different. Every person tells me something different. So it’s just adding them back in the higher FODMAPs and making sure that your body doesn’t react to those still.

Dr. Weitz:                            I know Dr. Pimentel will put the patients on a promotility, prokinetic after he uses antibiotics, to decrease the likelihood that it’ll come back because there’s a whole motility focus. Some natural practitioners will use natural prokinetics.

Dr. Kozlowski:                    Absolutely. Yeah, I definitely agree with that, with the motility activators. I’ve found to be, to me, more important is to make sure the patient’s digesting, that their stomach acid is sufficient because to me, that’s the key, that’s what kills off the bacteria. So if you’re not making enough stomach acid, then that’s a pretty high recurrence rate for SIBO.

Dr. Weitz:                            So how do you know if you’re not making enough stomach acid?

Dr. Kozlowski:                    There’s two ways to test that I’ve found to be reliable. And the first one to me, when I first heard about it, I laughed. I thought it sounded kind of ridiculous. It’s called the baking soda test where you mix a quarter teaspoon of baking soda and a few ounces of water, drink it on an empty stomach. Baking soda is basic, your stomach should be acidic. When the bass and the acid meet, it creates an explosion which presents as gas and you start burping, which you should burp in the first three to five minutes.  So when I first heard of that, I was like, “This sounds like a high school chemistry experiment. This sounds ridiculous.” But I’ve actually found it to be pretty reliable. If people don’t burp, then it usually means they don’t have enough acid.

And then the second step is actually supplementing hydrochloric acid. I outline the whole protocol in the book, but you start with one capsule, but you only take it before eating protein. So I tell people in the beginning, just with meat, fish, eggs, your bigger proteins. Definitely not with a smoothie. But you start with one and you take it and then you eat.

A normal reaction would be to get some heartburn, to get some discomfort because you dropped in acid, your stomach’s making acid, there’s too much and it refluxes. An abnormal response to that is to not feel anything or to feel better, that’s a marker that you have low acid. And then the question is how bad is it? So every two days, we increase the dose from one to two, two to three, until you get some heartburn or discomfort. And let’s say that happens after you took three, then your dose is two. And that’s what I would have you on.

And the most common question that I get is, “Well, how long am I going to be on this?” And to me, it usually depends. What I tell people is it depends on the underlying cause. With majority of people that I’ve seen, the biggest cause of low stomach acid besides aging is our stress and the sympathetic nervous system. So if that’s activated, you’re shutting down your acid production. So when your parasympathetic gets activated, then you’ll start making more. And then let’s say you’ve been on two capsules; all of a sudden, you take it one day and it kind of burns, you know it’s time to cut back or come off of it.

Dr. Weitz:                            And you don’t like to use probiotics. You use what? Fermented foods?

Dr. Kozlowski:                    For stimulating the microbiome?

Dr. Weitz:                            Yeah.

Dr. Kozlowski:                    Yeah. I prefer focusing on pre and probiotics and foods. So fermented foods, sauerkraut, things like that, dairy or dairy alternatives, and then prebiotics. I believe more in prebiotics, so things like banana, asparagus, artichokes, things like that, that are going to feed your microbiome.  And to me, if you’re going to supplement one, I usually actually go with prebiotics just to stimulate your bacteria to grow. I can’t say that I don’t ever use them. In general, supplements I think should be supplements. And so what I tell people frequently is if you’re traveling or if your diet sucks that day, you didn’t have anything fermented, then take a probiotic. But if your diet is strong, then you don’t need it, in my opinion.

Dr. Weitz:                            What’s your favorite prebiotic product?

Dr. Kozlowski:                    Arabinogalactan or inulin? Inulin is typically in a powder. Arabinogalactan comes in capsules and powder, so sometimes that’s easier. If you take your pre and probiotic together, they call it a symbiotic. So those are the two big ones that I would use.

Dr. Weitz:                            Okay. I think that’s pretty much a wrap, Dr. Kozlowski. Have final thoughts you want to leave our viewers and listeners?

Dr. Kozlowski:                    No, thank you very much for having me. And if I can give one piece of advice, it is to stay in the present moment. There is an ancient philosopher that said anxiety is worrying about the future, depression is worrying about the past, so what’s the best treatment is the present moment. And I think so much of our lives are taking us out of the present moment, so the best thing you can do is to get back into it and your gut will heal and then all the protocols or supplements or whatever you need to treat whatever’s going on will be much more effective.

Dr. Weitz:                           That’s great. How can listeners and viewers find out more about you, your book, et cetera?

Dr. Kozlowski:                    Yeah. So my book, Unfunc Your Gut, with a C, Unfunc with a C, you can get it anywhere on Amazon, Barnes & Noble, your local bookstores, so it’s pretty available. To contact me or to learn more about me, doc-koz.com, D-O-C dash K-O-Z dot-com. And I’m on Instagram and Facebook. On Instagram, it’s @doc_koz. And on Facebook, it’s just Peter Kozlowski M.D., which I’ve gotten more active lately and just sharing stuff there.

Dr. Weitz:                           Great. Thanks, doc.

Dr. Kozlowski:                    Yeah. Thank you.

Dr. Weitz:                            Thank you listeners for making it all the way through this episode of the Rational Wellness Podcast. Please take… I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111. That’s 310-395-3111. And take one of the few openings we have now for an individual consultation for nutrition with Dr. Ben Weitz. Thank you and see you next week.

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Dr. Joseph Antoun speaks about Longevity and the Fasting Mimicking Diet with Dr. Ben Weitz.

[If you enjoy this podcast, please give us a rating and review on Apple Podcasts, so more people will find The Rational Wellness Podcast. Also check out the video version on my WeitzChiro YouTube page.] 

Podcast Highlights

5:35  There are five things you can do to prevent chronic diseases and keep your body younger:  1. Nutrition and diet, 2. Exercise, 3. Stress, 4. Sleep, 5. Happiness and receiving and giving love. 

7:13  There are pro-aging pathways in a cell, including the PKA, the RAS, and the TOR pathways.  If you trigger those pathways, it sends a pro-growth signal which is a pro-aging signal. These three pathways are triggered by protein intake and carbs and are inhibited by exercise and caloric restriction.  Patients with acromegaly have very high growth hormone levels and they tend to die much younger.  You also see bodybuilders and wrestlers who inject growth hormone and steroids tend to die in their 50s, 60s, and their 70s. 

9:37  Is promoting growth good or bad for aging and longevity?  When we get older, we tend to get weaker, our bones tend to get thinner, we tend to lose brain cells, and we get frail. Our thymus gland tends to shrink and our immune system gets weaker.  We tend to get pathological fractures. Breaking a hip dramatically increases your mortality.  This is why the anti-aging movement was mostly about giving hormone replacement therapy, growth hormone, and other interventions designed to keep people from getting weak and frail as they age.  Whereas now the focus in the longevity movement is on reducing calories, fasting, and reducing growth, including reducing IGF1 levels by consuming less animal protein.  On the other hand, Dr. Longo believes that at age 75 you should make sure that you get a good level of protein because increasing IGF1 at that age is important for longevity to maintain strength and mobility.  When you are in your 50s you are at the pre-chronic disease onset age with significant risk of cardiovascular disease and cancer and fasting or the Fasting mimicking diet can have great value in reducing these risks, whereas it does not make much sense to fast someone who’s 16 and is growing fast or someone who is 82, who really needs more nutrition.  

17:09  The Longevity Diet was developed by Dr. Valter Longo. It’s based on the science and they also studied centenarians to see what they have in common. It is a pescatarian diet that is mainly plant based but includes fish a few times per week and some red meat from time to time.  People who live the longest do not eat red meat every day, but they are also not vegetarian. Keto is also not the best diet. While Dr. Antoun and Dr. Longo believe in precision medicine and that each person’s diet should be unique, those who live the longest are somewhere between pescatarian, flexitarian, and Mediterranean.

24:57  Dr. Antoun says that having more muscle in your 40s and 50s does not promote longevity and bodybuilders tend not to live as long. Most of the people who live to 100 and beyond did not have large muscles or six pack abs at age 55.  While eating low carb should be recommended for diabetics, for most people, eating a plant based diet with complex carbs and moderate protein, such as .7 or .8 gms of protein per pound of bodyweight is best for longevity.  But today many in the fitness world are eating too much protein and drinking protein shakes and this is not necessary and Dr. Antoun argues that cancer rates are increasing and he claims that cancer is driven mainly by protein intake.

32:38  Fasting.  Fasting should not be equated with caloric restriction because they are very different.  If you restrict your calories, your body will adjust and make some changes but not drastically.  If you fast, esp. for more than a few days, your body is in a crisis mode and your cells will start eating debris and organelles, which is called autophagy. After a few days, you also stimulate stem cells to replace older cells, which is a regenerative phase, which goes beyond autophagy.

41:14  Fasting.  We should all go 12-14 hours per day without eating, which should be called time restricted eating, but most of us are constantly eating and snacking and this is not good for longevity.  Dr. Antoun recommends the Fasting Mimicking Diet which mimics fasting while eating a lower calorie, lower protein and lower carbohydrate diet contained in a kit called Prolon.  This program, developed by Dr. Valter Longo at USC stimulates your cells to rejuvenate over a five day period.

Dr. Joseph Antoun is the CEO and Chairman of the Board of L-Nutra, which is the company founded by Dr. Valter Longo that  developed the Prolon kit that is utilized in the Fasting mimicking Diet.  Dr. Antoun is an MD who studied Public Policy at Harvard, Public Health at Johns Hopkins University, and has a masters in Medical and Biological Sciences from Saint Joseph University. The Longevity Diet from Valter Longo is available from Barnes and Noble. 

Dr. Ben Weitz is available for nutrition consultations specializing in Functional Gastrointestinal Disorders like IBS/SIBO and Reflux and also specializing in Cardiometabolic Risk Factors like elevated lipids, high blood sugar, and high blood pressure and also weight loss and also athletic performance, as well as sports chiropractic work by calling his Santa Monica office 310-395-3111. Dr. Weitz is also available for video or phone consultations.

Podcast Transcript

Dr. Weitz:            Hey, this is Dr. Ben Weitz, host of the Rational Wellness Podcast. I talked to the leading health and nutrition experts and researchers in the field to bring you the latest and cutting-edge health information. Subscribe to the Rational Wellness Podcast for weekly updates. And to learn more, check out my website drwhite.com. Thanks for joining me and let’s jump into the podcast.

Hello, Rational Wellness Podcasters. My topic for today is longevity with Dr. Joseph Antoun. Among the topics, we’re speaking about the benefits of caloric restriction, fasting, and the Fasting Mimicking Diet. There has been a lot of ongoing research on potential benefits of caloric restriction and fasting to promote longevity and to reduce the chronic disease burden, but what if there is a way to get the benefits of caloric restriction without having to starve yourself and without the stress associated with the difficulty of not eating for days on end? Dr. Valter Longo worked in the lab of Dr. Roy Walford who pioneered the concept of caloric restriction to promote longevity and even took part living in the Biosphere 2 for two years during which he lost considerable weight and when he came out, looked particularly unhealthy. And Dr. Walford basically lived the life of caloric restriction. Unfortunately, despite much promising research in animals, Dr. Walford died at age 79 from ALS. And then, he speculate that his early demise may be linked to a combination of stress and prolonged caloric restriction.

Dr. Longo continued researching longevity at USC, and he wanted to find a way to get the benefits of fasting and caloric restriction without the downside and make it less painful and inconvenient. Dr. Longo developed the Fasting Mimicking Diet, which involves consuming the ProLon kit for five days, which is being sold and marketed through a private company L-Nutra, which Dr. Joseph Antoun is the CEO and Chairman of the Board. This program involves eating the contents of the ProLon kit for five days, and this is essentially a vegetarian low-protein, low-calorie program.  

Dr. Antoun studied Public Policy at Harvard, Public Health at Johns Hopkins. He has a Masters in Medical and Biological Sciences from St. Joseph University as well as an MD degree. Dr. Antoun, thank you so much for joining us today.

Dr. Antoun:        Thanks for having me, Ben. I look forward for a healthy discussion.

Dr. Weitz:            Absolutely. We need to know the keys and we need to know them now. So, Dr. Antoun, before we get into diet and some of the things that we can do to promote longevity, what do you think are some of the most important mechanisms or processes underlying the aging process that we need to address if we want to live longer and live better? That is, if we want to not just extend chronological life but have better biological age.

Dr. Antoun:        Yeah. Thanks for this question and I think it’s pretty important to understand the difference between chronological and biological aging, and the easy example for the audience is the car. I always give the example of our cars. You may have a 2017, whatever, Mercedes, but if it has been driven only for 100,000 miles versus a 2019 that has been driven for 300,000 miles. And actually, the one that’s younger, the 2019, is more exposed to having issues because it was driven for 300,000 miles. And this is what we need to do for our body is how do we keep our body healthy from the inside and our biological age younger than our chronological age.  Experts talk about five things you can do to help your body stay healthy longer and, obviously, this is five natural things. And science and medicine and research are looking at potential pharmaceutical or nutraceutical intervention to bias biological aging, but I think five things that we can do, I’ll give you five tips that we could do naturally to-

Dr. Weitz:            Oh, how about before we get to that, what are the mechanisms? The biological factors? People talk about a whole series of different things that we should be focused on. How do we prevent or delay the onset of chronic diseases?  How do we prevent sarcopenia and osteoporosis?  How do we prevent neuronal degeneration, the importance of insulin sensitivity, inflammation, oxidation, glycation, DNA damage?  What are some of the most important things that we should focus on before we get to the interventions?

Dr. Antoun:        Yeah. There are five things, five common factors that I think would help. All the things you mentioned are symptoms of aging, right?

Dr. Weitz:           I’m trying to get to, I want to know what the underlying mechanisms are.

Dr. Antoun:        Yeah. All the health conditions you mentioned are symptoms of aging and in order to keep the body younger, this is how you get the onset of all these age-related health conditions. This is how you postpone their onset, and there are five things you can do. Number one is we’re going to talk a lot about nutrition and diet today. What kind and how and timing of eating and all of that. Exercise definitely is very well known to be a slower or slower of the pace of aging. And then number three is stress.  Decreasing stress and having that serene and happy inside. NIH is sponsoring studies on yoga today.  We also know that people who are observing religiously tend to live a little bit healthier and longer.  Actually, there are some documentations that are on that, so stress and serenity is an important factor. Sleep is emerging as a very important factor that now, not even on just as a prevention but also in the short term people with sleep apnea is others were seeing eminent direct cardiovascular and other consequences and actually event linked to the brain.  And then, number five, very important actually, could be actually the second most important, is happiness and receiving and giving love.  And what we call under social capital.  So, people who are close to their families, they feel loved and they spend time with others, and these moments of human to human interaction seemed to be also very beneficial for longevity.  So, nutrition, exercise, stress, sleep, and social capital.

Dr. Weitz:          So let me ask the question another way.

Dr. Antoun:        Okay.

Dr. Weitz:          What are the most important physiological processes that makes you age faster than me, say? I’m not saying you’re aging faster than me, but… yeah.

Dr. Antoun:        Yeah. You mean within the body biologically?

Dr. Weitz:          Yeah.

Dr. Antoun:        Oh, okay. If you’re talking about the perception of a cell, there are pathways in a cell that we call the pro-aging pathways.

Dr. Weitz:           Okay.

Dr. Antoun:        If you accelerate those, if you trigger those, so the PKA, the RAS, the TOR pathways, if you actually trigger those pathways, it sends a growth signal to the cell. And when the cell, we are born in a day and the faster we go, we go towards our end, we don’t go somewhere else. And the more you trigger a pro-aging signal to cells, the pro growth signals are actually related to pro-aging signals of the cell. And so, these three pathway cells are triggered by nutrition proteins and carbs that are also inhibited by exercise and caloric restriction. Our pathways that tell the cell, “Hey, you feel free to grow,” and when the cell grows it’s biologically aging is the same routes, common routes of growth and aging.  One good example there is the overstimulation of growth is either people are born with acromegaly. They have a very high growth hormone in their body and the pituitary gland is producing the stimulus. And they actually tend to be giants but actually they die younger, so that’s an overstimulation. A more personal intervention is our bodybuilders that inject themselves with growth hormone or you’d say high level of proteins, it over triggers the TOR pathway, which tells the cells to age faster.  And this is how we Ronny Coleman, for example, and was at his high level in the 40 suddenly  and unfortunately, we lost him. In many of the big wrestlers or bodybuilders, you see them passing away at ages of 60s and 50s and 70s. Their inside from their biological clock is probably 10 to 15 years older.

Dr. Weitz:            Well, I think this is one of the main controversies in aging is when I first studied to focus on longevity and anti-aging maybe 20 years ago, the big focus was on promoting growth that when people get older, they get frail, they get weak, their bones get thinner, their muscles get thinner. There’s people who can’t get out of bed because they’re simply too weak. They have sarcopenia. People get these pathological fractures. When you break a hip, your mortality increases dramatically. You’re much more likely to die. And the importance of maintaining a level of growth and regeneration, as you get older, your brain cells tend to break down and not get replaced this quickly. Your thymus gland tends to shrink and your immune system is weaker.  There was a big focus in the beginnings of the longevity, anti-aging movement on giving hormone replacement therapy, giving growth hormone, doing various interventions that keep people from getting weak and frail as they get older.  And now, the focus is on… So it was all about giving people more, yet so… Now, it’s all about taking things away, about reducing, about trying to reduce aging, about reducing IGF-1, about making sure… taking away, reducing calories, fasting, and I wonder if that has-

Dr. Antoun:        It’s not-

Dr. Weitz:            … become sort of a balance there because we need to maintain strength and structural integrity, and we look at a 25-year-old as the marker of great health, and they’ve got all these growth factors going on.

Dr. Antoun:        Yeah. This is actually a really critical question, and science is lacking in the answer. So, everything you said, actually, is right on both sides. It’s about also timing. And we see this ourselves that one of the papers that was found there published, Dr. Longo. Again, Time Magazine nominated him among the top 50 most influential people in health for his work, but he discovered that, and there are other papers coming out, about IGF as stimulating the muscle and stimulating growth hormone is actually the value of the reader’s defer in life, right?  So like you said, if you’re 75 and your muscle at that age, especially if you’re frail, is an organ of longevity. You want to maintain the muscle and you might need to feed more meat actually, and there’s more absorption at that age.  Mobility is so important for so many factors.  And in that time, feeding a good level of protein and increasing IGF is actually important for longevity.

Now, if you’re 50 or 55, you’re at that pre-chronic disease onset age. You have a good risk of cancer coming up from your genetics. If you have other risk of cardiovascular, and this is where at that age your muscle is probably not the most important longevity factor but actually your risk of cancer, your risk of cardiovascular. And this is where, at that age, you might want to have a different level of IGF in your body and different level of nutrition and proteins.

So, we’ve studied actually at L-Nutra and the USC, University of Southern California, as the main university that our research comes from.  They’re looking in, as they have the longevity institute in the world, and they’re looking at different phases of life, examining each organ at different phases of life.  When you fast, somebody who is 16 and is growing fast.  When you fast somebody who’s 82 and needs actually nutrition, but there’s a great value of fasting somebody with certain health condition, which we’re looking into but also for longevity purposes at mid-age when you are pre-health condition and you want to create that gains you extra years of biological age before you see the onset of those.  I don’t want to disclose things that we haven’t published yet, but even the value of IGF and insulin in the blood versus longevity is not linear.  It’s not flat.  It’s actually a U-shape curve, and there’s going to be different value for different… But the wave of, like you said, from a commercial perspective, there was a big wave of growth hormone injection for aging.  And we got to be careful because on the short-term you look a little better, that’s the growth stimulus you give but not necessarily on a long-term, and hormone replacement therapy again has a lot of great benefits especially around the menopause age, where… And again, everything is depending on age and balance, right?  Is that person has more cardiovascular risk or is the bone fracture risk higher in nutrition precision medicine and precision lifestyle is the future because, again, different age, different body, different risk, and the body has always been a balance.  Thinking about one diet is right, one diet is wrong or thinking about we should inject this or that is definitely a wrong statement from the beginning.

Dr. Weitz:            Okay. We are definitely in accordance with the precision personalized medicine approach.

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Dr. Weitz:            So, let’s get into diet, what do we know about what’s the healthiest diet to promote longevity?

Dr. Antoun:        So, I don’t know if you’ve seen The Longevity Diet book, which Valter Longo promoted. It’s two-and-a-half year old now, but it still has the older foundations in the big discoveries, and we try to look at this topic from different angle. The angle of human evolution and what have we because our body at the end of the day has been sculptured by its interaction with nature. And we’re going to talk more about what that interaction led to. We’ll look at that topic also from a lab perspective and science perspective. If anything about L-Nutra, where our company is, where we start with science and trials before we start talking. And that’s important I think to give the right respect for nutrition, and we think nutrition is important as medicine, so we got to put the right science behind it. So we’ll go back to labs and we do trials and to prove what we’re thinking about.

Then, we look at people living long today. We studied the centenarians, people living 100 and beyond. What do they have in common? And how do they eat? And then, we come up and we look at system biology and we study the body and then from a multi-angle and we come up with the recommendations. But what makes sense and what this could talk about is that humans lived around rivers for the longest period. The river had the water that we can drink, and there was grass and trees and green and fruits and vegetables and things to eat, which you cannot find on the shores of an ocean, and definitely when you live in a desert or on the top of mountains.  So, around rivers, the diet was mainly plant-based and fish is one of the few animals that cannot run or fly or see easily, so it was easy to fish. And so, pescatarian diet where it’s mainly plant-based and has fish a few times a week and we can go more into details. The sequence of amino acid in fish and the combination of the omegas that you eat with fish are also very healthy, but this is explaining downstream. I’m just talking the evolution and how [crosstalk 00:19:13]-

Dr. Weitz:            So, I just want to push back on the evolutionary concept. I think if we really look at evolution, we’ll see that depending upon where human beings developed, diet was drastically different. Dr. Longo mentioned this, but if you were a Greenland Eskimo, you ate a lot of seal meat and whale blubber because that’s what you had to give you calories. If you were an IKung Bushman, you ate a lot of mongo mongo nuts. Within some other part of the planet, you might have eaten a lot of cows and drinking their blood-

Dr. Antoun:        The reason we had to develop ways to domesticate animals and develop cows, but what everyone… what every human you mentioned from Alaska all the way to let’s say South Africa, we had to live next to fresh water. There was no way to survive without fresh water. Let’s agree… let’s start at there, right?

Dr. Weitz:           Okay.

Dr. Antoun:        So, you might have in Alaska, you had more reserve. You had to reserve some of the things you find and you had to live with more carnivore than herbivore for these extraneous circumstances.

Dr. Weitz:           They didn’t have a lot of vegetables and fruits.

Dr. Antoun:        Exactly, exactly.

Dr. Weitz:           They certainly didn’t have grains or beans.

Dr. Antoun:        I agree but this is why first, we’re going to the mainstream evolution but also we’re taking evolution as just one out of the five pillars. We go back and test. We look at centenarians. I can guarantee you that the centenarians living 100 and beyond, most of them are not sitting and eating red meat every day. And I can guarantee you that they’re just don’t sit and eat vegetables and they’re fully vegetarian every day. They are somewhere between the pescatarian and the flexitarian eating meats because also humanity had discovered how to hunt and that happened long time ago, so we evolved also with that. So anywhere between seafood being the main source of animal protein and plus or minus definitely flexitarian/Mediterranean adding some red meat from time to time seems to be, again, you’re asking me a generalist question, and we started the discussion by saying there’s no generalist question.

Precision medicine and precision nutrition, I think, is going to be. But if you ask me today, I can tell you probably if you eat meat every day, you’re not going to live the longest. If you can just eat vegetable every day, you’re not going to live the longest. If you’re going to do keto every day, you’re not going to live the longest. Now, you’re going to live the longest circulating in between a pescatarian, flexitarian, Mediterranean. I would put my money on that person rather than others.

Dr. Weitz:            Yeah. So, let’s just put it out there that the longevity diet is generally a lower animal protein diet, right?  Increased protein intake is associated with increased IGF1 levels, which is bad for longevity, right?

Dr. Antoun:        But again, at certain age, so I would say yes if you’re, say, 30 to 55. If you’re 65, 70, Valter has published many times that at that level, like you said, muscle becomes an important organ for growth versus others. And this is where you have malabsorption, et cetera, so after age 65, the recommendation is you can go back and increase your animal source of protein intake.

Dr. Weitz:            Yeah. I guess my response to that would be if you want to have a strong body when you’re 70, your best bet is not to lose muscle in your 50s so you don’t suddenly have to build muscle in your 70s.  So, that would be why I would be hesitant to want to follow a lower protein diet.  And the other problem with a lower protein diet is we only have three macronutrients, fats, carbs, and proteins.  And if we reduce protein, then we’re left with carbs and fats.  And the problem with the longevity diet, as I see it, is that it ends up being a high-carb diet and it’s hard for me to see how you… In a lot of people, they’re going to have trouble, in my opinion, from my experience, in maintaining insulin sensitivity and stable, lower glucose levels.  I looked through the longevity diet two-week meal plan and almost every morning, there was either toast or a bagel or bread or cereal in the morning, there was often pasta or rice or a pizza at night for dinner, sometimes there was a snack that included some healthy version of a chocolate bar, and so from what I’ve seen is if I ate that way, and I ate that way at one time, I couldn’t maintain stable glucose/insulin levels. And by upping the protein and reducing those complex carbs, for me and a lot of my patients, we find that a better way to maintain higher levels of insulin sensitivity, which leads to lower insulin and glucose levels.

Dr. Antoun:        A great question. We get this question asked a lot, right?

Dr. Weitz:          I’m sure, I’m sure.

Dr. Antoun:        Because we live in a craze of I should eat low carb, right? I mean, the craze went so far that I should eat almost no carb and be on keto every day.

Dr. Weitz:           Those on the carnivore diet eat only meat.

Dr. Antoun:        Yeah. Meat or fat, right? It’s either meat or fat, and this is carnivore or full-blown keto. First of all, what you’re saying is a reaction to what the market is saying, address everything you said, but the science doesn’t prove anything of what you’re saying. There’s no science saying that actually the buff guys that, like you’re saying, at your age have a lot of muscle and even see as you mentioned Roy Walford who passed away, unfortunately, at a younger age and he was big buff at 70. So, most of people who live 100 and beyond, since we’re talking longevity, did not have six packs at age 55 or big muscle and plus, I can show you many trials showing that. But this is great question because we live in multiple lies in nutrition.  The FDA has done a great job regulating drug but has still some progress to do on food because food was for dieting. It was for lose weight, et cetera. They have not enforced heavy science so that people really know the truth rather than live in different waves of whatever the trend is. Let’s right books and publish them, make a little bit of vlogs and make buzz and generate some personal revenues. This is, unfortunately, what’s happening in nutrition, and hardcore science lack… And the most important input in our life which is nutrition.  So, you’re right, it makes much more sense, say, let me eat protein and let me drop my carb. The biggest disease around the world today is diabetes. We’re all concerned with that, right? And you mentioned the word patients and yet the patient with diabetes should eat low carb for sure.

Dr. Weitz:            And obesity. What do people overeat?  People do not eat more chicken. They rarely overeat chicken.

Dr. Antoun:        Exactly. The overeating is the problem. Let me go back to your question and address every part of it. The first part of it you’re talking about the protein levels and about Mediterranean and about the longevity diet being a low protein. The longevity diet is a lower protein. What we’re eating today, we’re over eating protein.  Go to the WHO recommendation.  Go to every longevity.  You should be at 0.7, 0.8.  We’re not saying go 0.4 or 0.5, but the marketing in the nutrition world has been so intensive.  They took advantage of the carb craze, is that you should eat protein. And now, every bodybuilder, everyone going to the gym, or many people going to the gym were drinking the powders every day, were eating meat every day and trying to keep the proteins high.  And the marginal increase in muscle by being over protein, you stated, is very, very low.  So, what’s actually pushing aging so big with being in a high-protein setting versus… And when you push aging, you push risk of cancer, and the question that I would ask everyone is, “Hey, diabetes is increasing.” And because of the high concentration of glucose, we’ll talk about that, but cancer is increasing. Cancer is driven mainly also by protein. So, nobody tells you the other truth, which is cancer has increased tremendously but will tell you, “Oh, we have better diagnosis.” I mean, people were dying before of cancer as well and yet, we don’t have the sophisticated imaging but in the last 20 years we have those, we’re not in the ’80s now to say that. We have imaging. So cancer have increased tremendously but as being over proteinated, we have to watch for that.

The second thing is you’re saying a big part of the longevity diet is carb. It’s complex carb though. And this is why when we talk about the pasta and sugars, diet doesn’t assume that you’re going and eating dessert with it. It just tells you this is what your body needs to operate in a healthy way, which is actually the truth. Look at the evolution. We ate fruits, vegetables, grains, et cetera for years and years. These were the only things available for humanity.

Dr. Weitz:           There were not a lot of grains available.

Dr. Antoun:        Not a lot of grains initially, yes. But the fruits and vegetables that was the main source of… So, complex carbs is what we talked about, not refined carbs. And the body, by the way, truth for everyone to think about, the body works on carb. There’s no… every cell…ATP production.  have actually realized [inaudible 00:29:42] now you tell me my patient is pre-diabetic. Unfortunately, we live in a sick world where most people are overweight. You’re starting with a condition and now on the short term, obviously, you take the low carb and you help them go back to normal. But once they’re normal, the longevity diet assumes you’re a healthy person trying to live longer, does not assume you’re a patient, does not assume you’re an athlete who wants to grow muscle. But in these conditions, it’s important to realize that our body lives on carb and you got to eat a good amount of complex carb.

Dr. Weitz:           And by the way, I saw at least one study in Diabetes Care in 2010 that linked lower IGF-1 levels and increased risk of diabetes. [Association Between Serum IGF-1 and Diabetes Among U.S. Adults]  

Dr. Antoun:        Well, was that randomized or observational? Because it could be low. They’re eating high carb for a while. It doesn’t make sense to be eating less and dropping IGF and developing diabetes, so I would like to see it if you want to send it to me, but it could be observational, not randomized control.

Dr. Weitz:          Yeah.

Dr. Antoun:        So but there are probably, if you do meta-analysis there, many, many trials to show you that high IGF-1 linked with both diabetes and cancer. And high insulin, obviously, is linked to both as well. And it makes sense. Dr. Ben, we got to go with what make sense for us as doctors. You eat, you fill this body. This body has to get the growth.

Dr. Weitz:           Right.

Dr. Antoun:        The growth push. You grow a cell. A cell does a mistake in the application becomes cancerous. You grow forward, you increase insulin resistance, you increase aging. So, there might be satellite studies, observation, or some biases here and there, but I think to certain extent, we got the science today as trending in the same direction. But it’s important for people to… Because we live in a craze of carbs, we live in a craze of Atkins then and the protein, now we’re living the craze of keto, and these are craze because they don’t make sense from a longevity standpoint now. If you have a neurological condition you are diabetic kid, you should go on a low fat, low carb on a short-term, God bless, but good fats, low plant-based protein, not animal sources, and low carb would match as your obesity or diabetes control plus longevity. This is what we are, this is what we preach, this is what we study.

Dr. Weitz:           Okay. Let’s talk about the importance of exercise for promoting longevity.

Dr. Antoun:        Yeah. I mean, this is and we’ll talk about fasting as well. There’s a lot of concept that I would love to clear from science coming in here.

Dr. Weitz:           Let’s go to fasting. Go ahead. Let’s talk about fasting.

Dr. Antoun:        Probably that would be a little bit more because it’s more relevant to clear for people’s concept because every day you hear a new idea in that field, and I want to make sure people listen to what the science says and hear. 

Dr. Weitz:           Yeah. I interviewed a doctor who puts patients on a 30-day fasting in a medically supervised setting and claims to get incredible benefits from it.

Dr. Antoun:        You would, if you have autoimmune disease you would, but what the other damages would be that’s different topic. And this is-

Dr. Weitz:           [crosstalk 00:33:16].

Dr. Antoun:        When I told you the way we look at things, one of the ways we look at things is just to embrace it. Again, it’s like also some of the diets where you get super low on carb but you’re doing other damages, and it’s all about balance and the best intervention is timely and gives you the most benefit with the least side effects. 

Dr. Weitz:           So what are the benefits of fasting?

Dr. Antoun:        Yeah. And you equated almost calorie restriction with fasting, and they’re very different actually.

Dr. Weitz:           Okay.

Dr. Antoun:        I mean, obviously, fasting induces calorie restriction but the way fasting works is a little bit different than calorie restriction, and I’ll give you these examples.

Dr. Weitz:            Okay.

Dr. Antoun:        So, say, you’re the CEO of a company and you need a million dollar a month to operate and if I come and then tell you, “Look, I’m not going to give you a million. I’m going to give you 900K.” So, your bank account stops dropping. You’re losing 100K, so you’re fat, I’m equating… I’m going to compare your low-calorie diet with fasting and your body like your company. So your fat starts decreasing because you have 900 out of a million, and this is how most diets work historically. But you can cope with it, you have almost everything you need. You lose some adjustments on the way you manage your corporation and you probably decrease some of your investments or expenditures and you cope with it.

In fasting, it’s different. Fasting is, in a company, I say, “You need a million, I give you nothing.” And as you can imagine, your bank account will drop super fast, but you’re not going to sit and wait for it and cope with it. You’re in a big stress, and the word stress is very critical with fasting. That stress is going to make you as CEO go and restructure the company. You change structure, you let some people go, you change some of the titles, you merge some departments. And in function as well, you got to stop some of the not-so-essential investments and costs, but you’re going to take structure and function actually.  And this is what we see with fasting. The stress is so high on the body that there’s a pressure on… The body tells the cell, “Hey, I have enough.” A little bit of reserve in the fat and some of it is in glycogen in the muscle, and we do have fat cells. We do have some reserve but it’s a crisis.” After a couple of days, this tells the body cannot nourish them any longer and then ask the cells to start eating the debris and organelles inside and try to fix some of the structure and function, and this is what’s called autophagy, and it won the Nobel Prize in Medicine in 2016.

We do believe that after… So again, going in the first two days you can live off your fat, then you ask the cell to eat whatever is inside. What after? In Valter’s research, at least in mice, it’s showing that there’s some level of preservation, meaning now you tell the stem cells that are younger to replace older cells. That’s going from rejuvenation to reservation, which we showed in fasting in mice, meaning you are the CEO, you change the structure, change the function and then now you have to let some people go and maybe you let the expensive salary, the ones in the body, the cells that are a little bit older. They consume calories. They’re not producing at their best, their job and you push a little bit the younger cells who are more cost-effective in the way they spend their calories to promote those.  So this is why fasting, if you want, is now a big wave. It didn’t come as a… It worked only through low-calorie restriction. We have low-calorie diet. We don’t need to go and starve to achieve that goal. So, what people are trying to do with fasting, they’re trying to obtain certain level of autophagia at the cellular level, which hopefully biologically, it’s like taking your car to the mechanic and trying to a little bit fix your things and work with on them-

Dr. Weitz:           Specifically, autophagy is when the body is consuming old bits of protein and damaged cells and it’s a regenerative process, right?

Dr. Antoun:        The definition of autophagy is self-eat. Auto and phagia, self-eat.  So the cell starts eating the inside because it doesn’t have enough calories from the outside.  That’s the rejuvenation side.  Now, there’s a post-autophagia stress, if the stress goes longer now the body starts trying to get rid of certain old cells because this is carrying dead weight that cannot feed or finance and pushes the younger cells to rejuvenate. That’s not part of autophagia. That’s a regenerative phase, which is the advanced phase of fasting we’ll see in-

Dr. Weitz:           So what phase? The…

Dr. Antoun:        The regenerative one. So, you have fast weight loss first two days, rejuvenation with autophagy, regeneration with younger cells being promoted to replace older cells, which again we have seen in some, after research in mice. And that, if you want very fast weight loss. And there’s something very important with the weight loss with fasting is muscle is protected, so as the stress, again remember fasting is calorie and stress component. With stress, you have a high stress hormone so you have a good muscle tone, and there’s some rejuvenation at the muscle. So in fasting, unless though you go for longer period, everything will be depleted. But on the short period, the muscle is more maintained with fasting versus other diets. So, you lose fat, it’s selective fat loss, which is important especially for many people mid-aged women who are after menopause. So, you get all the metabolic benefits the way it relates metabolic benefit, and you start working on the cells.  And this is where you started to see now this therapeutic fasting emerging as when you put the body under stress, now the body is in fixing mode, is in coping, is not as stressed, and want to look after what’s going on and fix it. You start seeing these articles emerging on fasting for health conditions, and this is why fasting has been different from any other diets.

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Dr. Weitz:           So do you recommend fasting?

Dr. Antoun:        Again, there’s right fast and there’s dangerous fast. So, I’ll tell you what I recommend with fasting. I think for healthy individuals, doing 12 to 14 hours a day of fasting is important. We call it today fancy as fasting. It is how people should eat. We’re overeating today. That’s the problem, and we call fasting if you stay 12 to 14 hours. But the Nobel Prize in Medicine, people don’t talk about in 2017, was about the biological clock of the organs. And we have program with the sun as well and 12 hours of sleep is what our ancestors used to have or 10 to 12, whatever. The sun was down. There was no electricity. Our organs also track the daylight, cycle of the circadian rhythm. But also, it’s like, I go back to the bank account example, and if you keep putting money in, it will grow. So, if you keep eating all the time versus allowing some time to spend that money.  So we believe the 12, max 14 hours, is the healthy way of time restricted eating and is how we, human, should eat. We call it, in a fancy way, fasting today, but it’s something I would recommend, again, for healthy people [crosstalk 00:42:36]-

Dr. Weitz:           So, what you’re saying is this, I think the term that these people typically use is intermittent fasting. That’s really time-restricted eating and that’s what we should call it.

Dr. Antoun:        Yeah. I mean, a fasting goes from several hours to two days, by the book definition, intermittent fasting. And after two days, you call it periodic fasting. So time-restricted eating is the time within one day how many hours you restrict your food intake. And so, periodic eating and time-restricted eating is a portion of intermittent fasting. Intermittent fasting goes a little bit one day up to two days before you start calling it a period-of-time or periodic fasting.

Dr. Weitz:           Okay. So, you recommend eating within a 12- or a 10-hour window?

Dr. Antoun:        Yeah. And then, in most people today doing intermittent fasting and going up to 16 or 18 hours and, again, there are some going beyond that. And this is where we go back to, is it good for who and what? Because you go back… Now, you’re reducing a longer stress, right? So it comes that you lose more weight, unless you binge eat after, you lose more weight the longer you stay. At the same time, you’re stressing your organs that need to eat, right? So your heart pumps every second or whatever. I don’t know the exact milliseconds or seconds. Your brain has to function in the morning because the muscle is active and you need to feed these organs.  And the body doesn’t have a magic switch where, oh no, you turn it to ketones. It’s a process. Every organ has to go through the stress and then you switch to ketones and then the body has to… And by the way, that happens probably 15 to 16 hours after fasting. Nobody has that exact number. We have tested that and we start seeing ketones after 15 hours in the blood. So, it’s not a magic after 10 hours, the brain needs ketones, calls for it and it’s there, so there’s a stress that goes there. We don’t know how healthy it is for a normal individual to go 16 or 18 hours from a longevity perspective. And then, if that person wants to lose weight on a short term or is pre-diabetic or starting diabetes, I think that tips the balance so if you go a little bit longer and you get a little bit the short-term benefit. But from a longevity perspective, we don’t know.

The periodic fasting now is a different story going longer. We don’t recommend to go long on water fasting when you have the option to do it with food, and this is why we are in the business of the Fasting Mimicking Diet. People ask us why we try to mimic fasting with food. And by discovery, by the way, most people don’t know the fasting mimicking diet is funded by the National Institute of Health after seeing the benefits of fasting and it all comes from the studies at USC, University of Southern California. We’re studying fasting for cancer, for diabetes in the longer periods. It’s the same [inaudible 00:45:39], right? The longer you go, you have more stress on the cells, the cells try to rejuvenate, which is positive. You have more stress on fat, so you lose fat, so that’s positive. At the same time, you’re stressing your brain, your heart, your essential organs, and these are everything that needs to operate and it needs eats food.  So, the NIH has funded that trials to make fasting a compliant and safe procedure, and they funded the creation of the Fasting Mimicking Diet at USC, and the goal was to make periodic fasting now a little bit healthy and safe and compliant. So, what we advise, what I personally would advise is most people to do your 12 hours of fasting, you can go all the way to 14. If you have short-term reasons, obesity, pre-diabetes, you can go a little bit longer. We always advise you do it with certain food just to keep that balance, again, we’re talking about. And if you want to do a five-day fast, which is what we have, we do it with food, and it’s called the Fasting Mimicking Diet.

Dr. Weitz:           So tell us what does the Fasting Mimicking Diet consist of.

Dr. Antoun:        So, in order to mimic fasting, the body, you mentioned, the body we ingest the macronutrients, fat, carbs, and proteins. And this tells the aging signals respond mainly to proteins and carb. So if you want to really mimic fasting, you have to be a little bit low on carbs and on proteins, and this is what we have mimicked and induced in our fasting mimicking diets. It’s a high fat but good fat. There’s the healthy medium chain fatty acid, so it’s the healthy fat. Everything is from plant-based sources. And then, it’s a low carb, complex carb, and it’s low in protein as well. And there are a lot of probably secrets there, which kind of proteins, which kind of amino acids.  But in order to really mimic fasting and the stress of fasting, you got to be in [inaudible 00:47:45] of carbon IGF, and there’s a lot more. I’m simplifying this, but a lot more of which fast and when, which sequence of amino acids and when, and which sequences of carbs and when that would provide on a daily basis.

Dr. Weitz:           Okay. What if somebody wanted to do the Fasting Mimicking Diet without ProLon? Is that something that they could do?

Dr. Antoun:        I always say you can eat lettuce in the morning and you’ll be fasting. You can eat cucumbers and two pecans, you’ll be fasting. The Fasting Mimicking Diet’s objective is not to just mimic fasting because you can mimic fasting by barely eating or not eating. The goal is to make it safe. There’s three goals. So number one is to really keep the body in a fasting mode, number two is to nourish the body because, again, we want you to experience a healthy fast, and number three is how can we enhance the fast. Like you said, you can go and eat a cucumber in the morning a little bit and you’ll be fasting or you’ll be fasting by starvation. With the fasting mimicking diet, you’ll be fasting by nourishment. And so that makes-

Dr. Weitz:           Is there an ideal amount of calories that somebody should eat and does it depend on the person, their metabolism, their metabolic rate, their size?

Dr. Antoun:        Yeah. The calorie is one input and it’s not the most important. I don’t want to reveal a lot of confidential information, but we’ve tested the Fasting Mimicking Diet on many ages, many different sizes of the body, and because we have found the right amounts, combination, and sequence of carb and amino acids with the right level of fat under a margin of calories, we’ve been able to mimic fasting at different ranges and at different ingredient, so it works for most. Obviously, if you’re a 400 pounder versus a 100 pounder, we might in the future tailor that a little bit more. But today, with what we’ve tested all the way from age 20 to 70, different combinations and different calorie counting, it works. Calorie is on a signal but most important is the sequence of what we feed you with, at which time, and with which combination.

Dr. Weitz:            So, essentially, to follow the program is you get the ProLon box and it tells you exactly what to eat. All the food is contained in the box, soups, and things like that, right?

Dr. Antoun:        Yeah. So when you get the box delivered, you open the box and you have your food for everyday of the five days. And you open the daily box and it has… We try to be as consumer friendly as mimicking your daily normal foods, so you have a bar for the morning and you have soups and crackers for lunches and dinner. There’s a drink and there are some pills for supplementations. You’ll get everything you need to eat within one day starting from 1101 calories on the first day all the way to 800 calories. On the remaining days, that will nourish your body, will make your fasting safe. I think we’ve crossed now 700,000 or 800,000 unit consumption of ProLon, and we haven’t had any major safety or event.

Dr. Antoun:        And again, going back to, can you mimic fasting at home? You can, but you’re taking the risk, the safety risk, and this is why science has shown you that you get the benefits that we’ve tested and [inaudible 00:51:40] at the same time.

Dr. Weitz:           You get the same level of autophagy as you do with the water-only fast?

Dr. Antoun:        So, we have never measured autophagy head-to-head on water in the FMD. Autophagy, again, is important and is the buzz word of the day, but-

Dr. Weitz:           Sorry, how are you supposed to pronounce it, it’s autophagy?

Dr. Antoun:        Nobody knows. It’s autophagy, autophagy, or yeah, autophagy, autophagy. I’ve heard all of that. But yeah, we haven’t gone head-to-head versus water fasting. When you do randomized clinical trials as well, you got to file for safety and going several days on water fast, I don’t know if that’s [inaudible 00:52:30]. This is why the Fasting Mimicking Diet was created. It was… people couldn’t comply. On water fast, it was risky as well for some patients. And the National Institute of Health tapped into how to create this. So I don’t know if we would ever do this. We would have to talk with the IRB Board, under safety on a water only arm and maybe do in the hospital, and that’s the main reason why we haven’t done it.

Dr. Weitz:            Have you used the Fasting Mimicking Diet in cancer patients?

Dr. Antoun:        In trials. We have multiple trials testing the Fasting Mimicking Diet in cancer patients, and several of them are ongoing. We have finished a couple last year. So today, we don’t sell the Fasting Mimicking Diet in the market for cancer yet. We’re still trying to translate the science of it with policy and regulatory to see whether and how we could do so.  We’re very compliant as a company.  It’s very important for us to follow all the regulations FDA, FDC, and others. And food as medicine is a concept we always talked about, but if you go under regulatory basis, food has no pathway to go as medicine. Even the word medical food or the class as medical food is actually restricted to nutrition being an issue for that person, not the disease itself.  So, we are actually in the process of… We’re talking to regulatory about what we have discovered, and we have a lot of interesting findings, again, I don’t want talk openly today so that we don’t look like [inaudible 00:54:11] people to take some action today. But if we talk again a few months, you’ll have a better answer. We are planning to go to regulatories and talk with them how can the system embrace what we have discovered, which could potentially be food as medicine.

Dr. Weitz:            Yeah. Going forwards, I hope that you, guys, can incorporate studies where the Fasting Mimicking Diet or the longevity diet are compared with other versions of what are considered a healthy diet because one of the issues with a lot of diet studies is you take any sort of healthier version of a diet and compare it to the standard American diet and you’re going to see significant better value.

Dr. Antoun:        Yeah. We did actually. The article is being submitted. So we did with Dr. Mark Houston. We did a trial on ProLon versus Mediterranean diet. So, we were exactly what you said. We said, “Hey, how does finding a ProLon compared to everyday healthy diet?” and we went with the Mediterranean because that’s one of the healthiest from an American Heart Association’s standpoint. And so, I don’t know if we had results before we go up, but we are neck to neck with eating healthy food every day.

Dr. Weitz:           And then what should the person eat when he come off the Fasting Mimicking Diet?  Should they just go back to what they’re eating before or should they go on to the longevity diet?

Dr. Antoun:        Yeah, so again, it depends on their goal. If they’re healthy weight and their first objective is longevity, they can go back to pescatarian diet or the flexitarian diet and continue that process. They could do a second ProLon within a quarter or two to three times a year. If they’re healthy, they don’t need to repeat it. Then, when another person might want to lose weight aggressively and that could be one of their concerns, then you can go on a weight-related dietary pattern after ProLon.  Do a second ProLon second month and third month. We’ve tested ProLon in three months and four months, the first Mediterranean diet was four months. And a lot of great benefits there.  So it depends on the goal of that person. If it’s longevity, we recommend pescatarian, flexitarian.

Dr. Weitz:           Awesome. Okay. So I think we’d pretty much have a wrap. Any closing thoughts and then how do people find out about the ProLon program?

Dr. Antoun:        My closing thought is really for people to read the science and think logic rather than think of anything they see in the media today as they give it and work with it. We respect food literally as medicine. We live by it as a company, as people, and we personally… I’m an MD with health policy, and I ended up in nutrition because that’s the biggest trigger I think for longevity and public health. So, we ought to identify and clarify the source of information before we start making conclusions because I think there’s a lot of ideas that are being spread out there that are not scientifically founded. We would love also for regulatory to intervene and come in and really put some discipline in nutrition because I think-

Dr. Weitz:          I hope they don’t, really, because if we think that… We’re getting the most amazing experiments in nutrition. Where else would you get what’s happening…

Dr. Antoun:        Oh, you can [crosstalk 00:57:53]-

Dr. Weitz:            … happening with all these people following carnivore diet [crosstalk 00:57:56]-

Dr. Antoun:        We should keep the entrepreneurship. We should keep the entrepreneurship.

Dr. Weitz:            … all the intervention of the [inaudible 00:58:01] by everybody saying you can only say yes or you get kicked off.

Dr. Antoun:        What you can say is definitely what you can experiment. The FDA and FDC they’re never recommended experimentation, but they would recommend with what you can say. And we’re seeing things that are killing people out there. I mean, you just mentioned people fasting for 30 days. You can talk about people eating protein at 3 grams per kilo per day, and-

Dr. Weitz:            Well, the guy, the doctor who is doing that, he has people medically supervised every day, so [crosstalk 00:58:36]-

Dr. Antoun:        It’s clear that we’re not doing better on neither obesity nor diabetes nor cancer, we’re doing worse as humanity. And there are billions of dollars invested in nutrition. There’s a book published every minute probably and as people are taking advantage of the system at the expense of life of others. So I agree with you, it does not mean that we need to reprimand innovation as much as we still need to put some boundaries and some scientific evidence behind what’s happening because there’s masculine, I mean, companies living off exploiting your taste, your bud taste, other just selling you books and diets, but at least it teaches us in medicine that hypertension is a silent killer. I think there’re many other silent killers out there that nobody talks about.

Dr. Weitz:           How do people listening whether they be doctors, practitioners or patients, find about ProLon? And how-

Dr. Antoun:        There are two ways-

Dr. Weitz:           do they find the Fasting Mimicking Diet?

Dr. Antoun:        Two ways to access ProLon, if you’re healthy, you can go and buy it online. You have to sign off that you’re healthy and can take it, and there are parameters of finding if you’re healthy while you’re checking out on prolonfast.com. And if you have a health condition, we actually have 13,000 clinics in the US, registered with us to recommend ProLon, so you can go to any of the ProLon practitioner. Otherwise, go to your practitioners and talk them on ProLon. We’re happy to then detail them about the product. So you can get it through your provider if you have health condition or online directly through us.

Dr. Weitz:            Excellent. Thank you, Dr. Antoun.

Dr. Antoun:        Thank you very much. Have a good one.

Dr. Weitz:            Thank you, listeners, for making it all the way through this episode of the Rational Wellness Podcast. Please take a few minutes and go to Apple podcast and give us a five-star ratings and review. That would really help us so more people can find us in their listing of health podcasts. I’d also like to let everybody know that I now have a few openings for new clients for nutritional consultations. If you’re interested, please call my office in Santa Monica at 310-395-3111, that’s 310-395-3111, and take one of the few openings we have now for individual consultation for nutrition with Dr. Ben Weitz. Thank you and see you next week.