Calories, Insulin, and Weight Management | Episode 30

In this episode of The Health Pulse Podcast, we explore the groundbreaking work of Dr. Jason Fung, a physician who challenges the outdated "calories in, calories out" model of weight management. Instead, he places the focus where it belongs: on hormones—especially insulin—as the true regulators of fat storage and energy use.

We dive into Dr. Fung’s clinical experiences treating patients with diabetic kidney disease and how conventional approaches, including insulin therapy, often led to weight gain and worsened outcomes. Learn why aggressive blood sugar control doesn’t always prevent complications, how intermittent fasting and low-carb eating promote fat burning, and why ultra-processed foods sabotage your body’s natural satiety cues.

🎧 Tune in to hear how rethinking insulin's role could change everything about how we approach weight loss and type 2 diabetes.

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Episode Transcript

Nicolette (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.

Mark (00:24):
You know that old saying calories in, calories out.
It's super simple, been aroundforever.

Rachel (00:29):
Right the basic energy balance idea.

Mark (00:31):
Yeah, but in this deep dive we're looking at Dr Jason
Fung's work based on his chatwith Dr Mike.
And he has a pretty differenttake.

Rachel (00:40):
He really does.
He argues hormones well,insulin mostly are way more
important for weight than justcounting calories.

Mark (00:47):
Okay, so that's what we're unpacking for you today.
We want to get into Dr Fung'sarguments, really understand why
he thinks this way.

Rachel (00:53):
Exactly, go beyond just the headlines and see if there
are some you know aha moments inthere about weight management.

Mark (01:00):
So let's set the scene Dr Fung.
He's a nephrologist, right Akidney doctor.

Rachel (01:05):
Yeah, that's his specialty.

Mark (01:07):
So how does a kidney doctor end up focusing so much
on obesity and diabetes?

Rachel (01:12):
Well, it really started because he was seeing so many
patients with diabetic kidneydisease.
It was a direct consequence ofwhat was happening metabolically
.

Mark (01:21):
Ah, okay, so there's a timeline here.

Rachel (01:23):
Yeah, think about it.
Obesity rates they startedgoing up.
What late 70s.

Mark (01:27):
Around, then yeah.

Rachel (01:28):
Then maybe 10, 15 years later, type 2 diabetes rates
follow suit.
They start climbing too.

Mark (01:34):
Okay.

Rachel (01:35):
And then, predictably, the complications like diabetic
kidney problems.
They become much more common bythe early 2000s when he started
practicing, it was well, it wasa huge issue.

Mark (01:45):
So he was right there seeing the end result of these
metabolic problems.

Rachel (01:50):
Exactly Seeing how things like diabetes,
hypertension, often tied toweight, were causing real
lasting organ damage.
So his focus shift wasn'trandom.

Mark (02:00):
No, it came directly out of that clinical reality.

Rachel (02:03):
Right, driven by this health crisis he was seeing
every day.

Mark (02:06):
And this leads to something really key.
Doesn't it Around what, 2008,2009,?
He had a bit of a realizationthe major one.

Rachel (02:12):
yeah, he realized the standard way of treating type 2
diabetes back then, mainly justfocusing on controlling blood
sugar with insulin.

Mark (02:20):
Why it?

Rachel (02:20):
wasn't actually stopping the organ damage.

Mark (02:22):
long term Wait so lowering blood sugar wasn't actually
stopping the organ damage longterm Wait.
So lowering blood sugar wasn'thelping with the complications.

Rachel (02:26):
Well, not as much as everyone expected.
There were these big studiesACORD, advance, vadt that came
out around then and the resultswere frankly surprising.
Just pushing blood sugar downhard with insulin didn't
significantly cut rates ofkidney disease or heart attacks
or even death.
Wow.

(02:46):
And actually some data evenhinted it might increase
mortality in some cases, whichreally flew in the face of
conventional wisdom.

Mark (02:51):
OK, so that really challenges things.
If that approach wasn't workingas hoped, what was the standard
treatment back then, before wehad these newer drugs like
GLP-1s and SGLT-2s?

Rachel (03:08):
we had these newer drugs like GLP-1s and SGLT-2s.
The typical path was start withmetformin.
If that wasn't enough, add asulfonylurea drug Okay, and then
pretty often the next step wasinsulin.

Mark (03:14):
Right and insulin lowers blood sugar.

Rachel (03:16):
It definitely does.
But and this is crucial italmost universally caused weight
gain and Dr Fung saw thiscreating a kind of vicious cycle
Gain weight, maybe worsen theunderlying insulin resistance.

Mark (03:28):
So you need more insulin.

Rachel (03:29):
Exactly, which then could lead to more weight gain,
and patients felt it too.
They tell them you know mynumbers look better, but I'm
gaining weight.
This doesn't feel right.

Mark (03:37):
That sounds incredibly frustrating for the doctors and
the patients.

Rachel (03:40):
Absolutely.
And all this was happeningwhile the official line, like
from the American DiabetesAssociation, was that type 2
diabetes was just chronic andprogressive.

Mark (03:51):
They really thought that even though people could see
weight loss helped.

Rachel (03:54):
Pretty much.
Yeah, that was the officialstance until, believe it or not,
2023.

Mark (03:59):
2023.

Rachel (04:00):
That recently.

Mark (04:00):
Yep, that's when the ADA formally recognized remission
criteria, even though we'd seenfor ages with things like
bariatric surgery.

Rachel (04:08):
Right Drastic weight loss, often reversed it.

Mark (04:11):
Exactly Bariatric surgery showed clearly lose enough
weight and the diabetes cansignificantly improve, even go
away in many cases.
So that chronic and progressivelabel just didn't quite fit the
reality for everyone.

Rachel (04:24):
So Fung sees this disconnect.
The standard treatment isn'tpreventing complications, it's
causing weight gain.
The official view seemsoutdated.
What does he start thinking?

Mark (04:34):
He starts thinking you have to address the underlying
issue the weight.
You need to focus on diet andlifestyle to get the weight down
.

Rachel (04:40):
And that led him to his main recommendations yes, Around
2010, 2011,.
He really started pushing twomain things lowering
carbohydrate intake andintermittent fasting.

Mark (04:51):
Okay, let's take low-carb first.
It's kind of interesting, isn'tit, that even the ADA
guidelines now say low-carbdiets have the most evidence for
blood sugar control.

Rachel (05:00):
It is interesting and it makes intuitive sense, doesn't
it?

Mark (05:03):
How so.

Rachel (05:04):
Well, just think about basic foods you eat.
Say, a piece of white bread,lows of carbs, breaks down fast
into sugar.
Big blood sugar spike right Now.
Compare that to eating an eggMinimal carbs, minimal impact on
blood sugar.
So, logically, if you want tocontrol blood sugar, reducing
the stuff that spikes, it seemslike a good place to start.

Mark (05:23):
Makes sense Now.
Intermittent fasting.
That was probably morecontroversial back then.

Rachel (05:28):
Oh, definitely there was a lot of skepticism, some
pretty negative reactionsactually.

Mark (05:32):
Why?
What was the pushback?

Rachel (05:34):
Well, the whole idea of not eating for chunks of time
went against all the adviceabout, you know, eating small
meals frequently to keep yourmetabolism up.

Mark (05:43):
The grazing idea.

Rachel (05:44):
Exactly, but Fung's logic was pretty simple
physiology Our bodies aredesigned to store energy,
glucose and fat, and they'redesigned to use that stored
energy when we're not eating.

Mark (05:54):
It's a natural process.

Rachel (05:55):
It's totally natural.
Plus, he pointed out, doctorsprescribe fasting all the time
before surgery for tests.

Mark (06:02):
Good point.
So the idea it's inherentlydangerous doesn't really track.

Rachel (06:06):
Not really, not when done appropriately.

Mark (06:09):
So what kind of fasting did he suggest people start with
?

Rachel (06:12):
Often he'd start with something like 24-hour fasts,
maybe three times a week.

Mark (06:16):
Okay, why that schedule.

Rachel (06:18):
The idea was to get a significant period with low
insulin and calorie restrictionbut still have regular eating
days, manage medications ifneeded.
He actually shared this amazingearly case A patient on tons of
insulin other meds started thisfasting protocol.
Within a month apparently, hewas off all his diabetes meds.
Blood sugar massively improved.

Mark (06:38):
Wow, okay, that's pretty dramatic.

Rachel (06:40):
It really highlights the potential impact.

Mark (06:42):
So, apart from the weight loss and blood sugar, what other
advantages did he see withfasting?
Why recommend it over, just say, cutting calories?

Rachel (06:52):
Well, practicality is a big one.
It's simple right, you eat oryou don't eat.
No complex counting.

Mark (06:57):
It's free.

Rachel (06:58):
It's convenient.
You actually save time notpreparing or eating food.
Sometimes.
It's flexible and, like he says, it's ancient Cultures and
religions have practiced fastingfor millennia.
It's not some weird new fad.

Mark (07:10):
He does address the eating disorder concern though, right?

Rachel (07:17):
Oh yeah, absolutely.
He's clear.
It's a tool and, like any tool,it needs to be used correctly.
It's not for everyone.
Especially those with a historyof eating disorders needs
responsible application.

Mark (07:24):
And he makes that point about breakfast.

Rachel (07:26):
Yeah, I love that breakfast.
The word itself implies you'vebeen fasting.
It suggests that cycle ofeating and not eating is just
normal.

Mark (07:35):
OK, let's dive into the core of it then Calories versus
hormones.
He accepts calories in,calories out is technically true
.

Rachel (07:42):
Fundamentally yes.
Energy balance is physics.

Mark (07:45):
So where does his argument diverge?
What's the nuance?

Rachel (07:48):
The nuance is how hormones, especially insulin,
mess with both sides of thatequation.
He argues high insulin makes itreally hard to get the calories
out part working properly,specifically getting calories
out of your fat stores.

Mark (08:01):
How does that work?

Rachel (08:02):
Think of insulin like a guard at your fat cell door.
When insulin levels are high,the guard basically locks the
door, stopping fat from leavingto be burned for energy.

Mark (08:13):
So, even if you're eating less, if insulin is high, you
can't easily access your storedfat.

Rachel (08:18):
Pretty much, your body is getting signals to store
energy, not release it.
It's like having a full pantry,but the door is locked.

Mark (08:24):
And how does insulin make you store fat in the first place
?

Rachel (08:26):
Well, its main job is moving sugar out of the blood
after you eat.
But if there's excess sugar,insulin tells the liver hey,
turn this extra sugar into fat.
That process is called de novolipogenesis making new fat.

Mark (08:39):
So that directly explains the weight gain he saw in
patients starting insulintreatment.

Rachel (08:47):
Exactly.

Mark (08:48):
More insulin signal equals more fat storage signal.
Ok, but what about the ideathat, like, 100 calories is 100
calories?
If I eat 100 calories ofcookies or 100 calories of eggs,
shouldn't the long term weighteffect be the same?
Eggs?

Rachel (08:59):
shouldn't the long-term weight effect be the same?
That's where Fung really pushesback.
He says no because those foodstrigger vastly different
hormonal responses.

Mark (09:06):
OK.

Rachel (09:06):
The cookies.
Big insulin spike tells yourbody to store fat might also
lead to a blood sugar crashlater.

Mark (09:12):
Making you hungry again sooner.

Rachel (09:14):
Right, so you end up eating more overall.
The eggs minimal insulinresponse, much more satiating.
You probably eat less later.
Same calories initially, verydifferent hormonal message,
different impact on hunger andsubsequent intake.

Mark (09:28):
He mentioned studies on this right, Like the oatmeal one
.

Rachel (09:30):
Yeah, dr Ledwig's study.
Instant oatmeal versus steelcut Same calories, same carbs
mostly, but the instant stuffhigher glycemic index, bigger
insulin spike led to peopleeating significantly more at
their next meal compared to thesteel cut group.

Mark (09:45):
So the type of calorie sends a signal that affects
future calorie intake.
It's not just the number itself.

Rachel (09:49):
Precisely.
It influences your hormones,your hunger, your behavior.

Mark (09:53):
So what does this mean for the standard advice?
Just eat less, restrictcalories long term.

Rachel (10:00):
Pham was pretty critical of that as a primary strategy.
He points to studies like theWomen's Health Initiative where
long term calorie restrictionjust didn't work well for
sustained weight loss.

Mark (10:09):
Why not?
People just can't screen you it.

Rachel (10:11):
That's part of it.
But there's physiology too.
When you consistently eat less,your body adapts.
It slows down, your metabolismburns fewer calories at rest.

Mark (10:20):
Oh, the metabolic slowdown .

Rachel (10:21):
Yeah, meta-analyses confirm it.
Cut calories, your metabolicrate tends to drop too.
It makes it harder and harderto keep losing weight and really
easy to regain it if you thopup.

Mark (10:32):
It's like the body's fighting back, trying to
conserve energy.

Rachel (10:34):
Exactly A survival mechanism, basically.

Mark (10:36):
But if our bodies are so good at regulating weight and
preventing starvation, why do wehave an obesity epidemic now?
Does those mechanisms justdisappear?

Rachel (10:45):
That's the million dollar question, isn't it?
The mechanisms are likely stillthere.
Think about those oldoverfeeding studies like Ethan
Sims's work.
People had to force feedthemselves thousands of extra
calories just to gain weight,and their bodies fought back,
trying to burn it off.

Mark (11:01):
So what changed?

Rachel (11:02):
The environment, specifically the food
environment.
Ultra-processed foods how dothey fit in?
They seem to bypass our naturalsatiety systems.
They're often low in fiber,high in sugar and fat,
engineered to be incrediblypalatable, they don't trigger
the same fullness hormones likePYY, CCK, GLP-1, or the stomach
stretch signals that whole foodsdo.

Mark (11:23):
So they override our stop eating signals.

Rachel (11:26):
Essentially, yes.
As Fun points out, you don'tsee herds of obese gazelles.
While animals eating theirnatural diet don't generally
become obese, their regulatorysystems work.
Ours seem overwhelmed by modernfood.

Mark (11:38):
So it comes back to food, not just being energy.

Rachel (11:40):
But also information, hormonal signals different foods
send different signal.

Mark (11:44):
Got it.
So, based on all this, what'sFung's practical advice?
What should people actually do?

Rachel (11:49):
It generally boils down to prioritize real, whole,
unprocessed foods.

Mark (11:55):
Okay.

Rachel (11:55):
Eat when you're hungry.
Stop when you're full.
Have distinct meals.
Try to avoid constant snackingall day long.

Mark (12:02):
So less focus on hitting a specific calorie number with
whatever food, more focus onfood quality and eating patterns
.

Rachel (12:08):
Exactly, it's a different framework.

Mark (12:10):
But just to be super clear , he's not saying calories don't
count at all.

Rachel (12:14):
No, no, definitely not.
He's very clear Calories alwayscount.
The physics is the physics.
He's very clear Calories alwayscount.
The physics is the physics Okay.
His argument is that the reasonpeople often overconsume
calories is because of hormonalimbalances driven by the types
of food they're eating.
The food itself is driving theovereating.

Mark (12:30):
He uses an addiction analogy sometimes.

Rachel (12:32):
Yeah, like with heroin, you don't just tell an addict
take less heroin.
You have to address theunderlying addiction, the
cravings, the drivers Right.
Similarly, just telling someoneeat less doesn't fix the
potential underlying issues likefood addiction, intense
cravings, maybe emotional eating, stress, poor sleep.

Mark (12:49):
Yeah.

Rachel (12:50):
All things that can mess with hormones and drive intake.

Mark (12:52):
And habits must play a huge role in making this
sustainable.

Rachel (12:56):
Absolutely crucial Building healthy eating patterns
into your routine so you're notconstantly fighting cravings
with willpower which, let's faceit, usually fails long term.

Mark (13:06):
One last point on fasting timing.
He sometimes mentions skippingdinner might be better than
skipping breakfast.
Why is that?

Rachel (13:14):
There's some evidence.
Yeah, looking at circadianrhythms, Our bodies seem to
handle food insulin insulin wisea bit better.
Earlier in the day, Insulinsensitivity might be higher in
the morning.

Mark (13:25):
So eating the same meal at night might cause a bigger
insulin spike.

Rachel (13:29):
Potentially, yeah, and for many people hunger is higher
in the evening anyway.
So skipping dinner couldtheoretically have a bigger
impact on overall insulin andcalories for some.
But skipping dinner is sociallyreally difficult for most
people.

Mark (13:43):
Family meals, social events- yeah, much harder than
skipping breakfast usually.

Rachel (13:48):
Right.
So while physiologically itmight be optimal, for some,
practically consistency is key.
Finding an approach you canactually stick with long term is
probably more important thanchasing the absolute perfect
physiological timing.

Mark (14:01):
OK, that makes a lot of sense.
So, wrapping this up, for you,the listener, the big takeaway
from Dr Fung's perspective seemsto be, yes, energy balance
matters.
Of course it does.

Rachel (14:11):
But it's not the whole story.
The type of food you eat andwhen you eat it profoundly
impacts your hormones especiallyinsulin.
Especially insulin, and thathormonal response is a massive
player in regulating hunger, fatstorage and, ultimately, your
weight and metabolic health.
It's way more nuanced than justcounting calories.

Mark (14:31):
So maybe a final thought for everyone listening, given
how much our food acts ashormonal information.

Rachel (14:36):
Yeah, how much attention are you paying to the messages
your diet is sending your body,beyond just the calorie number,
thinking about food quality,about timing?
It might open up some newperspectives on your own health
journey.

Nicolette (14:53):
Thanks for tuning into the Health Pulse.
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Stay informed, stay healthy andwe'll catch you in the next
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