Bill Lagakos and The Trouble With Diets

Diets. They work for some, but not for others. "You're just not on the right diet," purveyors of the latest trend will tell you. "You're just not on the right diet for your blood type, ethnicity, age, hair color," says another set of true believers.

So what's right and what's wrong?

Today on Fork U, a conversation between Dr. Terry Simpson, weight loss physician, and Dr. Bill Lagakos, nutritional biochemist and physiologist, where they expose the truth behind diets and why they may, and may not, work for you.

And check out Bill's book, The Poor Misunderstood Calorie.

TRANSCRIPT:

Terry Simpson: Bill, there are a lot of weight loss programs out there. The one that I'm hearing the most about most often is the Keto movement, which says that they're going to cure everything from heart disease and cancer.

Bill Lagakos: I think from a 30,000-foot view, Keto works for a lot of people. So does low fat. I like some of the recent work, the studies showing it's more about the level of processing of the food.

So you can have a vegan diet or you can have a Ketogenic diet and as long as it is excluding a lot of processed foods, it tends to not be over eaten. And people that tout the magical benefit effects of any of these diets, 99% of the time it's due to weight loss.

Terry Simpson: We actually had an experiment with Evo, who you met. He uhh did it several years, three or four years in a row for one month, Evo would go on a beer and sausage diet, rigorously kept his calories to 1500. We measured his liver function tests, his lipid panel.

Every year he lost weight, kept it off, and every year his liver function was fine, surprising with the number of beers he had a day, which was limited to six. But it was, he had weight loss and he had sustained weight loss over the year with a, kind of this funky diet we sort of made up.

Bill Lagakos: Well, that's terrific. And that's an awesome diet. I'm jealous.

But, uh, yeah, that, that basically proves the point. I mean, even if it's not a lot of weight he lost, I think a weight loss is a major driver in a lot of the health improvements that people like to attribute to particular dietary trends.

Terry Simpson: There doesn't seem to be a lot of long-term data in these diets. When I look at the sort of metadata, I see that if you eat really high on the low-fat side, you have a little lower lifespan. If you eat really high on the high-fat side, you have a little lower lifespan. If you have your carbs at about 55%, you seem to have a little longer lifespan.

Is there much good data saying one diet versus another, other than the Mediterranean, has great long-term results?

Bill Lagakos: I don't think so. I don't think it comes down to macros at all. I think that there's the confounding in those studies is so deep that I don't think the macronutrient composition of your diet is going to be what kills you in the end.

Terry Simpson: Part of your job is helping people lose weight. What are sort of the big messages you try and get through to people?

Bill Lagakos: One of the biggest things is the importance of adherence, which is why I try to say, you know, what do I know that, that you can adhere to 100%? It's what you've been doing because you've been doing it. So let's try and find the lowest hanging fruit that we can change so it doesn't turn your whole world upside down, which is something that would probably never work.

Terry Simpson: So in other words, you're not going to change a Keto into a vegan or a vegan into a Keto.

Bill Lagakos: Correct. However, I don't like to put those two at odds because there is, there have been a few studies on the vegan Ketogenic diet.

Terry Simpson: So give me an example of some of the things for our audience, some of the things that they can do to incorporate it in their life now to help them lose weight and just feel a little better about themselves.

Bill Lagakos: Well, feeling better about yourself and health outcomes and health profile, exercise can help with that a lot. I like to advocate all kinds of exercise. Cardio is good for the heart. Weights is good for quality of life and muscle mass, which also seems to bode well for quality of life.

In terms of diet, probably nix the ultra-processed foods. Nobody needs single serves bags of potato chips lying around the house.

Terry Simpson: Is that, that big, that great big bag? Is that the single serve?

Bill Lagakos: [Laughing] No, no, but I know people that will go through multiple single serves in one sitting.

Terry Simpson: Like when you see the Oreo cookie's just a hundred calories that you'd probably say it'd be better to have the apple?

Bill Lagakos: Uh, yes. Yeah. And actually, even when it comes to the apple, one of the studies that was comparing processed to unprocessed foods, it was very interesting. I was trying to figure out how are they going to do this? And it was like an apple versus apple sauce. And that's sort of not an obvious comparison, but the people in the apple group tended to eat a little bit less.

Terry Simpson: And when you start looking at, at some of the ultra-processed foods, are there some that you find that it has a lot of bang for the buck when you get people to sort of move away from them?

Bill Lagakos: Yes. Uh, the lowest hanging fruit there is obviously potato chips because, you know, it's all too common that someone will sit down for lunch, have a sandwich, you know, a diet soda, thinking they're doing something great, and then instead of taking a couple potato chips and putting them on the plate, they'll just open the bag and sit down in front of it and generally overeat a lot because of that. The potato chips just don't seem to hit the satiety button.

Terry Simpson: How about candy bars?

Bill Lagakos: Candy bars are, I don't know, for kids maybe, but I don't think adults should be eating candy bars. Or, if they do, very rarely.

Terry Simpson: That's the wrong answer, Bill. [Laughter]

Bill Lagakos: Hey, I'm okay with the sausage and beer diet. Isn't that enough?

Terry Simpson: When they hear us talk about that people will, you know, and Evo wrote a book about it, people say, "Oh, I can have all I want." And it's like, it's not all you want it. You know? I mean, Evo was...

Bill Lagakos: Right, as soon as you told me that he lost weight on it, I was instantly convinced that that could definitely happen. That's very feasible for your health to improve because you're losing weight. You can eat pretty much every diet.

I think there was a, there was a McDonald's diet where the guy over ate everything and it was a TV show and he got very sick, and somebody else did the McDonald's diet and they underrate at every opportunity and they lost weight and got healthier.

Terry Simpson: What you're saying is, increasing fiber in the diet seems to not only help you from a satiety sense, which then keeps your appetite smaller, but provides a lot of health benefits because you're going to lose weight.

Bill Lagakos: Yeah, I'm trying to move away from the word fiber, because if that was the plainest form, then Metamucil would've solved the obesity epidemic decades ago. And it seems to be like whole food based fibers seem to be the way to go. Not like an isolated fiber powder, for example.

Terry Simpson: We see some of this problem in our weight loss surgery patients. So we start out weight loss surgery patients on what I call "formula," which is our version of some protein shake of which there are about a thousand out there that'll sell.

But when patients come in and they haven't lost weight, they'll say, "Well, I'm going to just have more shakes," and it's like that's, you know, we, we, we would rather have them have some beans or, or something rather than the shakes.

Bill Lagakos: I agree with that. That's, that's good, sound advice. The other thing that you mentioned is the shakes is something that I tend to, I don't rail against this movement on the social media, as people are starting to catch onto higher protein diets, which I tend to like that. You know, have a couple, three servings of protein a day seems to do well. Protein does seem to hit the satiety button quite well.

And all of the hysteria about the kidney health leeching calcium from your bones, any of that stuff, I mean, the only thing that might be remotely true is from the KDOQI studies on the people with end-stage renal disease might have improved outcomes changing their protein intake. But even that is not 100%.

Terry Simpson: We're pretty good at processing and breaking down protein and eliminating too much of it. We don't store it. So it tends to be when we can store my macronutrients that we have problems.

Bill Lagakos: That's a good way to look at it.

Terry Simpson: I want to talk to you a little bit about fatty liver disease. Uh, it's something that we in weight loss surgery see a lot of and, and we're usually the first ones to diagnosis. We're never surprised when we see it. We open up people and take a look