Dr. Jeffry Gerber – Common Sense Isn’t Common Medical Practice

Jonathan: Hey everyone, Jonathan Bailor back with another bonus Smarter Science of Slim podcast. Today’s show, truly a special one. We have an individual who is certainly bringing sanity in every sense of the word back to family practice medicine. We have a steward medical doctor, we have Jeffry N. Gerber who is an FAAP board certified family physician and owner of a south suburban family medicine practice in Littleton, Colorado where he is known as Denver’s Diet Doctor.

Folks, I tip my hat especially to Dr. Gerber, because if you go to his website which is quite wonderful, it is denversdietdoctor.com. Right on the homepage, he tells us good food is good medicine, and as common sense as that sounds, I think we have all experienced that it is not that common in the medical practice. Dr. Gerber, thank you for bringing sanity back to medicine, and thank you for joining us today.

Jeffry: Thanks for that wonderful introduction, John. I can’t take credit for that saying ‘Good food is good medicine’. I stole it from an individual by the name of Hypocrites.

Jonathan: I think he has an oath that you took at one point, didn’t he?

Jeffry: Yes, that’s true.

Jonathan: Thank you for resurrecting that many thousands year old phrase. Dr. Gerber, tell me, what lead you to this seemingly obvious but seemingly lost conclusion in medicine?

Jeffry: Well, I’ve been a family physician on traditional allopathic trained doctor for almost 20 years now. My training was back in Philadelphia at Temple University, both undergraduate and for medical school. Spent a couple years of doctoring in Philadelphia area and in ’93 moved out to Colorado. My focus was based on mainstream at the time, low-fat, low-calorie based on traditional dietary guidelines, the USDA food pyramids, and so on and so forth.

The first half of my career, the first ten years just seemed to be kind of frustrated because nutrition really didn’t make sense. They just said to watch the quantity of food, eat less, exercise more, and in my clinical experience, it was very hard for people to do something like that and to adhere to a program where it was essentially self-deprivation and didn’t see much success. I have to say a change for myself and my focus really came in the late ‘90s starting with my patients who had come in and done a lot of reading about nutrition.

They were reading, back at the time it was Atkins, one particular patient was reading Suzanne Somers. I think she’s written lots of books on lots of everything. One of the books was about nutrition, and it was actually suggesting that reducing carbohydrates in the diet might be a good thing to do, and that one patient really stuck with me. Back in the time, I told most patients that came in telling me they were going to try Atkins diet, like most docs I would say that’s not healthy, you’re going to drop dead of a heart attack eating all that meat and fat.

I said okay, we will watch you, and to my surprise, their metabolic markers like their cholesterol and blood pressure started to improve. I said that’s kind of interesting, let me read a little bit further about it. Also had some experience with family members who were trying this. There seemed to be a surge at least for me in the ‘90s where all these different people were coming at this from different angles in terms of this new nutritional approach. Then I had some personal experience, and after reading quite a bit, that light bulb went off in my head, and I said a-ha, this makes sense.

What we’ve learned for basically the past 30 years seemed to be quite problematic that the issue here is not about perhaps eating less and exercising more but more about how the macronutrients interact with our metabolism. It turns out that the carbohydrates tend to be fattening and inflammatory, and this is the type of macronutrient that is more associated with chronic diseases like diabetes, obesity, hypertension, heart disease.

From that point forward, it has been an awakening event for myself and for my patients. We realized and learned what primary care is really all about and what primary prevention is and to focus on appropriate nutritional programs. We have just had so much fun, it’s made what I do enjoyable. Instead of treating chronic disease, diabetes and strokes, we teach people how to prevent chronic diseases, John, so it has been very rewarding.

Jonathan: Dr. Gerber, I can only imagine that helping people to avoid disease rather than to help them live with the disease, it’s a bit like trying to put the spilt milk back in the glass. Not nearly as rewarding, and there is probably still going to be a stain on the floor, but why is it, Dr. Gerber that… I am probably not as smart as a lot of the doctors out there, but this seems so common sensical. It seems to say let food be thy medicine.

It’s been said for so many years, yet people who say that – I am curious if you have had any experience with this – are sometimes thought of as – let’s just use the same word people used for Dr. Atkins – a quack. It seems the furthest thing from quackery I could imagine, what’s going on here?

Jeffry: It seems that anybody thinking outside the box in any area, you can consider them a quack, but the magic of it is their ability to free their mind and at least to explore other options. In terms of the world in nutrition, mainstream is so hung up in sticking to the norm and what is preached by most. I think doctors, intelligent people in general were usually very good at following rules and it’s spelled out and it’s all based on our background, our education, and traditionally we are trained to focus on eating less and exercising more.

That’s basically been the mantra, and our job, both you and myself and others out there that have really opened themselves up to redefining healthy nutrition, would be a goal to just to reeducate everybody interested in health.

Jonathan: Dr. Gerber, what is it about this one area of medicine – let’s say obesity and diabetes are two related areas – ’cause I was listening to Dr. Peter Attia who is one of the presidents and cofounder of NuSI with Gary Taubes, and he tells a wonderful story. If you haven’t watched his talk, listeners, I highly recommend it. He talks about how when he was doing cancer research, in cancer research, challenging the norm and looking outside of the box and recognizing when things aren’t working and trying new things is praised in medicine.

But it seems like when it comes to diabetes and obesity, trying new approaches, the exact opposite respect is given. Let’s keep the analogy going, when it comes to cancer, the guidance is not avoid everything, it’s avoid carcinogenic substances. Avoid substances known to contribute to the likelihood of cancer. We know sugar contributes to diabetes, but we just say eat less. We don’t just say avoid sugar. Why is there such a disconnect between nutrition and obesity and diabetes and other medical issues such as cancer?

Jeffry: Peter’s great, and NuSi and Gary Taubes. I had a chance to listen to Peter talk about cholesterol recently. But it is a great analogy in terms of cancer, they try anything and everything, and I guess nutrition doesn’t work that way. There is a big disconnect, and perhaps some people view nutrition more in the realm of a religious experience rather than true science. There may be a certain amount of truth in that, because it is so difficult to scientifically explore nutrition in terms of doing feeding trials on people.

In a sense imprisoning or caging individuals for a period of time where they are forced to only eat certain types of foods, and then you create this experiment and how long you can possibly run that. Plus on top of it, that maybe that’s not really a good experiment, because in real life, people aren’t caged, and they are not necessarily strict in their diet. I think the problem with it is it is just so hard to study nutrition and really understand what’s going on.

It’s really the NuSI organization that’s trying to study this scientific and more important in an unbiased way to look at macronutrients. I think they are working on a hypothesis that insulin and these fat storage hormones such as insulin and lepton really play a significant role in terms of these chronic diseases that we are dealing with. To look at macronutrients in particular and maybe they will look at micronutrients; there is a lot of interest in that as well. To hopefully come up with some answers as to what’s going on.

Jonathan: I love what you said, Dr. Gerber, about it’s so difficult to study nutrition because not only is it so difficult to study nutrition in terms of isolating the variables, but it is also so easy to make blanket moral statements about the cause. It’s pretty hard to say, well actually there was with lung cancer and smoking, ‘Ah, don’t smoke, you don’t get lung cancer’.

But with other forms of cancer, it’s very difficult to just say do less of this and more of this and you won’t get cancer. But it’s very easy to make the assumption that if you just eat less food and you just exercise more that you can avoid these things, but it’s also true that if you took less breaths in you would probably have a less likelihood of having lung cancer. Again, we don’t seem to make those connections, we don’t seem to dig any deeper.

Jeffry: That’s correct. A little funny side story on nutrition is that essentially mainstream is telling us to just stop eating. If you go to the endocrinologist and he tells you that he’s worried about your diabetes so you have to cut out your carbohydrates, and then you go to the cardiologist and he says ‘well, I am worried about your cholesterol’ so you know you have to cut back on fat content. Then you go to the nephrologist and he’s worried about your kidneys, and he tells you to cut back on protein. So that basically says well, maybe I’ll be healthier if I just stop eating.

Jonathan: What is that? The old logical reductio ad absurdum, where you show if the argument leads to an absurd conclusion as this one certainly did, certainly there has to be something wrong with that logic.

Jeffry: Exactly. Again these are things that are always floating around in my head. The first law of thermodynamics that you eat less and exercise more – let me rephrase that. We don’t cheat physics. The rules of physics apply no matter where you are, but there’s much more to it than the principles of thermodynamics. It really has to do with these fat storage signals, and that’s where our focus has been.

I think cholesterol is another interesting area to discuss. I think this year, I have always been fascinated with cholesterol, and there’s this big debate between is it cholesterol that causes heart disease or the alternative hypothesis that is perhaps inflammation and oxidative stress that seems to be causing heart disease, atherosclerosis and plaque. It just brings us back to this whole idea of thinking outside the box.

Jonathan: I love getting back, Dr. Gerber, to your point about this flawed paradigm of if you just avoid food, then clearly all these problems will also be avoided. We also see that in some of the vegan or vegetarian — let’s be very clear, you can be a healthy vegetarian. I am not here to say any critique of vegetarians. But sometimes, you talked about carbohydrates are attacked for this reason and fat is attacked for that reason. We hear this mythology about protein in some cases promoting cancer.

There’s this “oh, it promotes the stimulation of IGF1, which stimulates the growth of cancer.” Well, IGF1 stimulates the growth of everything. It’s an anabolic substance. It also promotes the growth of your muscles and bones so you don’t turn into a pile of osteoporotic and sarcopenia-ridden person. It just seems there is this moral conflation taking place. It really becomes a moral discussion and a religious discussion as you talked about. How can we help bring more science and more common sense back to the field of nutrition?

Jeffry: Good points, Jonathan. I have actually some lacto-ovo vegetarian low-carb people. It’s almost an oxymoron.

Jonathan: Certainly a tongue twister.

Jeffry: We have a great group of people throughout Colorado but a group in Boulder that actually are low-carb vegetarians, and they put an interesting angle. Looking back on it, I think back in the 1970s, some of the nutrition councils with McGovern Report. There were actually vegetarians on that board, and it actually seemed at the time that vegetarianism really seemed to feed into this low-fat, low-calorie mantra, so it seemed to go together. I think that it’s kind of changing a little bit in terms of what we understand.

You brought up vegetarianism which makes me think about other types of diets, and I tend to look at what’s in common with all these particular things, and that might be a great starting point. Some people might like to say well my diet’s better than your diet. I said well let’s find some common ground. What do you think about that, John?

Jonathan: Dr. Gerber, you know I am a huge fan of celebrating the similarities rather than demonizing the differences. I think that is really the common sense thing and why I get a little confused, because we talked about MDs are smart people. You cannot get through medical school without being a baseline intelligent person. The idea that consuming substances found directly in nature that contain the most essential things for human nutrition which are amino acids, essential fats, vitamins and minerals – there is no such thing as an essential carbohydrate – that contain the most of those things and the least of things we don’t need seems that saying having more happiness is better than having less happiness. It’s like it has to be true so why don’t we just accept that and move on.

Jeffry: Exactly, that is the common ground. Let’s say we eat real food, unprocessed food, the food that comes into our palate that we eat should be as nutrient-dense as we can possibly get. I totally agree that in terms of macronutrients, dietary fat, dietary protein, number one are mostly essential building blocks. Number two they do provide sources of energy.

Clearly carbohydrate is the optional fuel. That’s exactly how I have been speaking about it for years, and yet the dietary guidelines that we have been following since the late 1970s have made carbohydrates the predominate macronutrient that we consume. Again in terms of common ground, most people agree that we should be reducing carbohydrates in the diet, we should eat a healthier form of carbohydrate.

I think that has to be yet defined and agreed upon. I think for people like myself and you that the more insulin resistant you are, the better off you are trying to avoid carbohydrate as much as possible. It’s interesting why there are so many insulin resistant people in the United States these days, and everyone seems to have an opinion.

My opinion really lies in what are the predominant macronutrient that stimulates the fat storage hormones such as insulin and lepton, and the answer is carbohydrates, and we are eating too many of them.

Jonathan: Dr. Gerber, you are spot on that even a well-formulated vegetarian diet, people who talk about they have seen wondrous health benefits, of course you will get wondrous health benefits if you go from a standard American diet which contains 40-60% processed garbage to if you to go any form of eating that eliminates that 40-60% of processed garbage.

You can just be eating whatever, you are going to see marked health improvements. The question I sometimes find fascinating is like vegetables obviously everyone seems to agree – except there are some extremists out there – pretty much everyone seems to agree that non-starchy vegetables are good for you, and everyone agrees that you need some level of protein.

I have never heard yet – I have spoken to Dr. Joel Fuhrman, he acknowledged nuts, seeds, natural whole food fats, those are good for you. The question then comes into where do you get your calories from? Because you do need some energy, you need energy. You’re probably going to get most of your energy from either carbohydrate or fat because using protein as an energy source is probably not metabolically optimal. Should you get the majority of your calories from fat or from carbohydrate? What do you think and why?

Jeffry: That’s the big area of disagreement. You can go from a vegan to a vegetarian to a Mediterranean diet to Paleo diet to a low-carb diet, and everyone seems to have a different opinion. One thing that is you want to individualize people’s diet based on looking at metabolism, and that’s what we do in our office each and every day. People are often confused. There’s information overload.

We try to provide guidance, we measure metabolic markers, we look for degrees of insulin resistance, and it answers questions about how much protein, fat and carbohydrates should we be consuming. In my population, my expertise is really treating chronic disease first and treating the cause of chronic disease, which I believe to be chronic low levels of inflammation, by fixing things in our lifestyle such as diet, lack of exercise, alcohol, smoking, and those kinds of things.

Diet is really the last uncharted area. We do see quite a few patients that have weight issues, and they tend to be insulin resistant. The answer for those patients tends to be reducing carbohydrates, so reducing that source of energy and increasing natural fats in the diet. Yes, when we talk about natural fats, we are talking about saturated fat which may be a preferred source of fuel in terms of energy that we consume.

Again it goes against traditional wisdom, but when you look at fat storage hormones, you realize that natural saturated fats in the diet don’t trigger these fat storage hormones. So it’s actually a good thing to be eating these natural fats. Now Joel Fuhrman who is a vegetarian, perhaps vegan, since you talked to him, I think he kind of vacillates back and forth.

With respect to animals, if people for ethical reasons don’t want to eat animals, that’s fine, and I understand that and respect that. When you look at individuals, not only vegetarians but other people that tend to eat a lot of carbohydrates and they come in and they have all these chronic illnesses, you have to take a look at it and say hey, I think that the carbohydrate consumption may indeed be a problem.

Sometimes they say, ‘well, we eat healthy whole grains’, so are they real foods? From my perspective, grains are definitely problematic, John.

Jonathan: I think that the scientific community would have a hard time arguing with that, and I think that Dr. Davis, the author of Wheat Belly, puts the logic very well where this conflation of not as bad for you and good for you are like breaking one leg is not as bad as breaking two legs. That doesn’t mean we recommend people go break their right leg. Similarly whole grains are better for you, they are less bad for you than refined grains. However, that does not mean they are good for you, correct?

Jeffry: Exactly. I love hearing Dr. Davis talk about that. Gary Taubes often talked about the same applies to cigarettes like smoke light cigarettes, they aren’t as bad for you.

Jonathan: Dr. Gerber, you mentioned something about trying to determine what would be the best balance of certain macronutrients for your patients based on some tests and metabolic profiles you look at. One factor I could imagine we talk about when individuals perform intense resistance training that dials up the amount of protein you would need to eat because obviously you need to repair your muscle cells. What do you see as being other critical factors?

Obviously insulin resistance, the more insulin resistant you are, the less affinity you have towards carbohydrate, but what other markers could people look for to help them find that right ratio?

Jeffry: It’s a good question. I think insulin resistance is a great way to start. It’s really new science because the idea of staging insulin resistance is out there, but there is no consensus as to a staging system at this point. What we have done is come up with our own staging system based on doing a two hour oral glucose tolerance test. We do hemoglobin A1C C peptide which is part of the pro-insulin molecule.

We look at CRP, we look at lipid profile, and it really gives us a sense of insulin resistance. We’d love to find some other markers that would tell us how do we optimize a person’s diet based on level of activity. but granted if you are a body builder, you need more protein. I’ve met some wonderful bodybuilders that know more about nutrition than I ever did.

I know that you do a lot of bodybuilding yourself. You are in excellent shape, I guess I am jealous. Good for you, John. We have a lot of athletes that come in and it’s interesting, well are you an athlete that became overweight, are you an athlete that wants to enhance his performance, and it all makes a difference. Are you an endurance athlete? That plays into it. Jeff Volek and Stephen Phinney who wrote The Art and Science of Low Carb Performance, they talk about the benefits of the ketogenic athlete.

I find that fascinating. I wonder often how that would affect power lifters, which I know Jeff Volek is a power lifter, but how it affects explosive energy. In my experience what I found is that if we put people that are trying to lose weight and they are doing explosive types of exercises, my experience has been that it changes the explosivity of it. It’s different again with each athlete. You have to find the balance and what works. I can tell you what doesn’t work. I have some body builders that have been at it for years, and they are in their forties, and one guy comes in and says ‘Dr. Gerber, if I don’t eat two hundred grams of protein a day, I’m just not going to be able to power lift, and I’m just going to collapse’.

Unfortunately, I mean he’s still muscular, but he’s overweight, and he’s got hypertension, he’s got pre diabetes, and we can see the end effect of what he thinks is a healthy diet to help him improve exercise performance, but on the other side we are seeing some chronic illness developing. It’s a good question, John, and I don’t think I have quite the answer, so we just work it out on an individual basis.

Jonathan: Dr. Gerber, two things I want to dig into, one is I love how you brought up athletes and bodybuilders because I want to talk about how a field where results are all that matter becomes interesting. One quick point I want to clarify, was your concern with your patient you just regarded that you believed at his body composition consuming two hundred grams of protein per day was causing his illness? Or was it something else? Or what range of protein do you generally recommend? What say you?

Jeffry: It was a combination of things. He also tended to eat a lot of carbohydrate. I mean it wasn’t just protein, but tt was more of a standard American diet that he was consuming that was extra high in protein. The problem is protein through gluconeogenesis, that macronutrient can be converted to carbohydrate and have some ill effects. We agree that moderate protein is probably a better answer to the question and perhaps a little more protein.

Again it’s on an individual basis. We usually end up having patients consume somewhere between eighty and a hundred grams of protein a day, maybe a little bit more, maybe a little bit less. I guess if you’re a bodybuilder you might push that up a bit, but I think two hundred grams sounds like a lot by anybody’s standard, John.

Jonathan: Fascinating, Dr. Gerber. I want to get back to, you brought up athletes and bodybuilders, because I think it’s a fascinating population to look at because in a field in which, like when your job is to be lean, when your job depends, when your paycheck depends on having a certain level of body fat percentage, other things other than what works go out the window.

All you are interested in is what works, and it’s fascinating if you look back, ever since the inception of bodybuilding or any physique athletes, it was always just eat the most nutrient-dense food you can and ironically a lot of it. Like if you want to be lean, since the 1910s, 20s, it’s always been the same message. Eat a lot of the food that contains the most of which is required and the least of what isn’t required.

You have to eat a lot of it. You see bodybuilders consuming six, seven, eight hundred calories a day and being extremely lean because of the quality of the food they are consuming. In some ways we see this new movement now about food quality, but in some ways it’s an incredibly old movement. It just has only been in this niche bodybuilding world. What do you think?

Jeffry: I was really impressed, I attended my first Paleo f(x) in Austin a bit ago, and I couldn’t believe how healthy a group of people were attending this conference. A lot of them were obviously bodybuilders in great shape, and they’re eating real food, nutrient-dense foods, and again I learned so much from bodybuilders dating way back. They basically ate real foods, and they cut out carbs and bread, and they knew that the carbohydrates were fattening.

That was the first thing that they eliminated. Again they’ve done a lot of things right. They can be accused of doing a lot of things wrong for the sake of competition, and you can be sure that they know what they are doing wrong, but again it’s a matter of taking the things, the observations – and unfortunately they are just observations at this time, because studying nutrition is so hard – but taking information from everywhere and coming up with better solutions for all of us.

Jonathan: The irony, Dr. Gerber, is that we talked about in the bodybuilding community, if you want to lean down, you eliminate those starches and sugars. On the flip side, go to your local supplement store and look for a weight gainer on the shelf. Guess what its number one ingredient will be? Maltodextrin. You could very easily melt sticks of butter and drink them, but people tend to not do that when they are trying to gain weight. When we try to fatten cattle, what do we do? We feed them corn, we feed them starch.

Jeffry: It’s definitely more than obvious, John, what’s going on. Hopefully we are all going to be going in the right direction. I was at a conference in Boulder, I think, a half a year ago, and it was wonderful because the series was comparing and contrasting diets. We had Mediterranean diet represented, we had the Paleo diet, we had vegetarian diet, and we had the Ayurvedic diet which is to me mindful eating and I just love that.

Just taking bits and pieces of it and putting it together and hopefully going in one direction with it.

Jonathan: I love it, I love it. Well, Dr. Gerber, certainly you are on the front lines of moving the medical field into that right direction, and I salute you ’cause I know it’s not easy when your career and your license and your credentials are on the line. It’s very “easy” for people like me to sit behind my computer and talk about nutrition and exercise, but when your livelihood and when literally decades of professional work are on the line, and you have the courage to stand by the science and stand by the results rather than just following into the shadows into the mythology. I salute you.

I encourage all of our listeners to salute you as well by supporting you on social media, checking out your website which again is denversdietdoctor.com. Folks, again please do show some love for Dr. Jeff Gerber. Again, always, we need to salute and support our MDs out there who are respecting the wisdom that is our body and wisdom that is natural food. Thank you again, Dr. Gerber, I very much appreciate it.

Jeffry: Sure, John. There actually is enough evidence for me to come out here and make some comments and statements. The American Diabetes Association does recognize low-carb diets. I have done my homework, and I think there is some relatively well done clinical trials in the last ten years, albeit short term, that really show the benefits of low-carb, high-fat diets versus traditional low-fat/calorie diets. I do have a little bit out there to back me up, but thank you for the comments.

Jonathan: My pleasure, and certainly when we talk about what we don’t seem to have a lot of things backing up is whatever we’re currently doing, because what do we stand to lose by trying something else other than the type 2 diabetes and other than the extra forty pounds of body fat we are carrying around, right?

Jeffry: Definitely. We have thirty years of experience to see that that’s not working. The point is we have to forge forward and try different things. I mean we don’t have these long term outcome studies that are providing us with these hard end points looking at diet and mortality and heart attack and stroke and these kinds of things.

Does that mean that we are going to wait and stick with the standard dogma and we may be long dead before they ever figure it out, or do we forge forward and try different things and look outside the box, and that’s exactly what we are doing, John.

Jonathan: The irony again, Dr. Gerber, is that data doesn’t exist for any form of eating, and we’ve tried to come up with it for the standard American diet. We’ve spent over – I document this in my book – we spent over a billion dollars trying to prove the high carbohydrate diet right, and they’ve all failed. If anyone were to say ‘well you don’t have enough evidence to do something different’, well you don’t have enough evidence to do anything by that logic.

Jeffry: Well said, John, it’s so true.

Jonathan: Dr. Gerber, thank you so much for joining us. It’s been an absolute pleasure.

Jeffry: Invite me back, John. I love the work that you’re doing.

Jonathan: Well thank you so much, and listeners, thank you so much for joining us again. Please do check out Dr. Jeff Gerber’s work. He’s over at denversdietdoctor.com. Thank you again for joining us. Remember this week and every week after, eat smarter, exercise smarter and live better. Talk with you soon.