Intermittent Fasting for Women: Dr. Molly Maloof's Fasting Journey

Intermittent Fasting for Women: Dr. Molly Maloof's Fasting Journey

Authored by Zhill Olonan • 
August 2, 2018
That's where fasting is beautiful. Fasting wins in so many cases. I've noticed that since I started, I can eat a lot more of a diverse diet and maintain the same weight. I can actually tolerate a lot more foods and still have a day where I can cheat a bit and recover faster. To me, that's a pretty great example of someone who is winning in different environments.Dr. Molly Maloof


How does a doctor approach intermittent fasting for the first time?

Dr. Molly Maloof is the Head of Medical Science at Sano Intelligence, a continuous glucose monitoring startup. She also runs her own private practice serving Silicon Valley. We last spoke with Dr. Maloof about a year ago and since, she has started experimenting with intermittent fasting.

In this discussion, you'll discover:

  • Dr. Maloof's experience with intermittent fasting and the nuances between men and women
  • Fasting's effect on the gut microbiome and larger health implications
  • Empowerment over food after the body adapts to fasting

Listen now on iTunes and Youtube.

You can follow Dr. Maloof on Instagram here.

With technology, with all this information, with all these new tools that we have to advance our physiologies and our lifestyles, how do we become a more evolved human in the future and what does that look like? And to me, it looks like how can I take whatever fuel supply available to me, by the way by fuel, I do not mean packaged, processed crap. I mean fuel. Real food. How do I take whatever food's available to me and metabolize it effectively without having problems?Dr. Molly Maloof

Transcription

Geoff: Hey friends, welcome to this week's episode of The HVMN Podcast. This is your host Geoffrey Woo. I had another great conversation this week with my good friend, Dr. Molly Maloof, who's not only the head of medical science at Sano Intelligence, a continuous glucose monitoring start-up, but also a private doctor for prominent folks in Silicon Valley. 

After our last conversation with Molly, episode 55 about half a year ago, she began to experiment with intermittent fasting. We touch upon a number of aspects of fasting, its effects on the gut microbiome, the feeling of empowerment one gains over food as the body gets adapted to fasting, and Molly's N=1 fasting experiences and experiments as a woman.

This is a great discussion that elucidates the frequently asked question, how do the effects of fasting differ between men and women? Hope you all enjoy this episode as much as we did recording it, let's get started.

Geoff: Great to have you back Dr. Molly.

Molly: Thanks.

Geoff: So, that's weird to call you Dr. Molly, but-

Molly: I know.

Geoff: But no, you earned your medical degree there.

Molly: It's true.

Geoff: So, last time you were on the show was five months ago, and a lot has happened since then. I know that you were just starting at Sano at the time, continuous glucose monitoring company, and obviously a lot has happened-

Molly: Yeah.

Geoff: ... since these last five months for you guys. A lot has happened for us at Human, where our ketone ester is finally now launched to the world. I know you've been experimenting with that, so go talk about that.

Molly: Yeah.

Geoff: I know you also been traveling a lot, so, what's new, what have you been up to?

Molly: Oh my gosh, so I think around five months ago I was just getting interested in fasting, and still was quite skeptical, but also very curious. And as I've been doing just so much research in continuous glucose monitoring, and glucose metabolism, I had this hypothesis that, "Okay, maybe if I fast, it'll lower my fasting glucose". Because over the last year I had changed my nutrition, and I'd lowered my postprandial glucose, so after meal glucose pretty dramatically. And I dropped my hemoglobin A1C a whole point, from like 5.6 to 4.6.

But I still had like a-

Geoff: This was just through diet? 

Molly: Through diet. But I hadn't really implemented fasting yet and I was really curious about it and I wanted to see what would happen to my fasting glucose if I started fasting and I was thinking, "Okay. First principles. It would make sense that if you would fast that you're fasting glucose would just go down. Like why wouldn't it go down?" And over the last two months, I started using the Freestyle Libre and I've been sort of chronicling it on my Instagram and going from intermittent fasting, I mean, first what I did is I did a month on keto, which I didn't really feel awesome on that month, however, I did get really well fat-adapted. 

So that made doing intermittent fasting a lot easier for me and then from intermittent fasting for a couple of weeks, I went into like a full 24-hour fast and then I went into like 36 hours, then 48 hours, then 52 and 63 then 72 and it just got easier. The more I fasted, the easier it got. I became better friends with one of your investors, Phil Libin, who basically like brainwashed me into believing that fasting would change my life. And I actually totally believe him now because in a lot of ways, I think, after doing, I read Jason Fung's book, The Ultimate Guide to Fasting. I'm such a fan girl of him at this point. He's just like such a hero. I'm trying to get him to advise Sano. I actually need you to send an intro to me for him. 

Geoff: Will do. 

Molly: Yeah, so fasting has like, sort of came from a challenge of wanting to see what would happen to my fasting glucose and not surprisingly, it's gone down pretty dramatically but-

Geoff: Where'd it start? Where you at now? 

Molly: It was hovering around like 89 or so and now I've gotten it down to like 80, so like early 80s. So like today, I'd eaten a bunch of food for breakfast and it was still only 83. I was like that's weird. It was pretty low carb but still, like I had enough carbs in the breakfast for it to have gotten higher. I actually think my metabolism's been changing. 

Geoff: Yeah, especially when you're glucose control's really, really good. 

Molly: It's gotten really good and it's also just kind of amazing how by doing continuous glucose monitoring and then also doing ketone monitoring and also doing fingerprint monitoring, I'm starting to be able to predict where my blood sugar is, and I kind of know, like, "Oh, this is what it feels like to be like 50", and also to have ketones. I've been doing tons of experimentation with different types of fasts and different types of fasting aids and then just doing research on what's the science behind what would be the best type of fast for different goals and so I'm working on my own succinct version of The Complete Guide to Fasting and really like what's scientifically backed for different links of fasts and yeah, I'm kind of like a full on fasting cult convert. 

Geoff: That's actually a good point that you bring up. There's like broad rules around a 16, 8, or a 36-hour fast. 

Molly: Yeah. 

Geoff: But you should really take into context what your goals are and what your initial body composition is. 

Molly: Oh, I 100% agree with that. 

Geoff: My fasting protocol's really changed since I'm marathon training. Like I'm doing a lot shorter fasts 'cause I'm exercising a lot more. 

Molly: Yeah, because you don't wanna get too low body fat. 

Geoff: Right. 

Molly: I mean, this is something that a lot of people need to think about, especially women in particular. Because we are not the same as men and I've been combing through the literature, I've been trying to find research or human studies on female hormones and fasting for the female body and women health benefits and I'm coming up with very little information on this because it just doesn't exist. Like if it existed, I would be able to find it and I'm not, I'm finding a little bit of data, I'm finding some animal data-

Geoff: I think there's some data on Ramadan and women. 

Molly: Yeah, yeah, but the thing about Ramadan-

Geoff: But it's not for extended fasts.

Molly: ... is that is that Ramadan fasting A, is mostly isocaloric work, meaning that most people are eating the same amount of calories, they're just eating them at night. They're not drinking water and most of the time it seems to not affect metabolism that much. It seems like, it's kind of like a null metabolic effect, which is interesting because I haven't seen many studies showing any harm from Ramadan fasting, but I also haven't seen a lot of improvements in health. 

Geoff: Right. 'Cause you're kind of having like a 12, 14 hour fasting window. It's like not a super long fast. 

Molly: You're also just eating at night, and there's really a lot of evidence suggesting that circadian rhythms actually do, we're kind of programmed to put on fat in a way, if we eat at night, on purpose, right? Because if you think about evolutionary biology, it would make sense if you spent your day hunting and then you spent your evening maybe either, if you had fire, cooking and eating the food and not eating very much of it. Like any type of food you had at night, like you were probably trying to store that because you knew that you didn't know when your next meal was gonna be. 

So there's some great research coming out on circadian rhythms and I just don't think that like that Ramadan fasting necessarily is good or bad. I think it's a religious practice. But my own personal experiences with hormones and for keto in particular, while I was doing that month on Keto, I was doing a urine hormone menstrual cycle rhythm test, where I was doing multiple urine samples throughout the course of a month to track my hormones. 

Geoff: And then just to be clear, like what was your macros on the keto? 

Molly: I was eating less than 25 grams of carbs a day. Net carbs. And I was testing for ketosis. 

Geoff: Okay. 

Molly: And I was pretty much in ketosis most of the month. 

Geoff: Okay, so like above 1.0 minimal-

Molly: Yeah, yeah. It wasn't nearly as high as fasting ketosis I would get into, but it was still generally hovering above-

Geoff: Through legitimately eating keto. 

Molly: Yeah. And this was the first time I actually tracked everything and like measured everything and I wasn't at a major calorie deficit so I wasn't necessarily losing weight this month. I lost a little bit of water weight, but I was pretty surprised at how my estrogen and progesterone levels went lower. 

Geoff: Hmm. 

Molly: So I started thinking a lot about what is ketosis telling your body? And really, it seems like ketosis is telling your body that you're in a famine. Because typically, when our ancestors were exposed to fat metabolism, it was when they didn't have access to food or you were Eskimos, right? So you were like eating fat to stay alive. And it seems like, to me, my hypothesis is that when you send those signals to your body as a woman, you're kind of saying, "Hey, resources need not go to fertility. You should probably be trying to stay alive right now." And so survival, I think, will always trump fertility and if your body thinks it's in a survival mood then it would make sense for you to have an effect on your hormones.

Geoff: That's interesting. 

Molly: Now at the same time, I do believe that there are a lot of women who have insulin resistance and have tried ketogenic diets and have actually improved their ovarian health, because they've reduced insulin resistance and hunger hormones and fertility issues and overall improved their body's metabolism. It has made healthy women. So again, it's like where are you beginning in terms of your metabolic health and where do you have to go? So like I am starting out with like a fairly well-toned metabolism and then you put it into ketosis and then you put it into fasting and now I'm actually really curious to know like how my hormones are gonna change because of this. And I'm also just curious to know, what's the best schedule for me, because eventually I do wanna have kids, but I do like feeling leaner in the summer. I don't mind feeling a little bit softer in the winter, because it's hibernation mode, right? 

Geoff: Yeah. 

Molly: But I think we need to start doing large-scale studies on human metabolism and learn more how intermittent fasting works to understand what's the best dose for everyone. 'Cause like we know that too much is bad for people. And I know that, like I have a family history of Alzheimer's disease, of cancer, of what else? Rheumatoid Arthritis, hypercholesterolemia and hypertension. And guess what? 

Geoff: What do you don't have?

Molly: Fasting improves all of those things. 

Geoff: Yeah. 

Molly: Like I have a list of like 40 different things that fasting does for your body and overall health and those are pretty amazing things that can happen from just reducing food intake. 

Geoff: Those are the diseases that are the top ten killers, right? Like heart disease, Alzheimer's, cancer, obesity...

Molly: Like these are, Rheumatoid Arthritis, like I already have celiac, right? So I already have one autoimmune disease, and it's really common for people with autoimmunity to have more than one. And so like if I can actually improve my immune system through fasting, this is gonna be part of my life now. Question is how much for what dose to keep my hormones healthy, to keep my body weight-

Geoff: What's the balance? You don't go in starvation mode or a fasted state and like fast for seven days and like just drop all your hormones, right? 

Molly: Yeah, exactly. Exactly. 

Geoff: What's that balance? You don't want it to be a rollercoaster, right?

Molly: So this is the coolest thing that's happened to me. I, before starting fasting, was not able to eat dairy easily, right? So I go to Israel recently. And you asked earlier about where I've been traveling, I go to Israel and then I go to Lebanon and I'm eating foods out there and I've been fasting on the way there, I fasted during every plane trip I took on this trip. I took a flight over there and then I went to Israel for a few days, for like a week. And then I took a flight to Cypress, fasted. Went to Lebanon, still fasted. And then on the way back, through Iceland and on the way over I was fasting. So I fasted about four or five days on this whole trip out of two weeks. 

And the funniest thing is I'm in Israel and I'm kind of like, not necessarily letting myself go, because I'm actually eating healthy, but there's a lot of dairy in their food there and I don't normally eat dairy, but I ate dairy in Israel and I was just like totally tolerating it with no digestive complaints at all. 

So I started learning about how fasting affects your-

Geoff: Lactose intolerance.

Molly: Well, I just started learning about how it modulates microbiome. 

Geoff: Oh, okay.

Molly: So fasting, a lot of it is preliminary animal studies, but there's evidence to suggest that fasting actually improves the health of your microbiome in a pretty significant way. And first of all, you're not exposing your gut to food for awhile, so it's giving some time to heal if you have any problems. Second of all-

Geoff: You're probably reducing processed carbs, which fosters a certain form of microbiome bacteria that's not necessarily optimal. 

Molly: Sure. I mean, like I think everyone would benefit from just like not eating as much sugar or refined carbs. But at the same time, I read this study recently where they took two sets of animals. One, they gave ad libitum feeding, so whatever they wanted and the other one, they basically fasted every other day. And then they took another group of mice that were on a normal diet. They transplanted the microbiomes of both groups into two sets of these new mice and they found that the same clinical end points, the same reductions and cardiovascular end points, like high cholesterol, like glucose metabolism abnormalities, they found the same effects in the mice with the transplants that were in the every other day fasted mice.

And then the mice that were eating whatever they wanted, which had the worst end points, with high cholesterol, they had gained weight, all these bad things that happened to them, the mice that got those microbiomes had the exact same thing happen to them. 

Geoff: Yeah. 

Molly: So one of the questions that's coming from all this to me, is like, are we gonna be able to develop therapeutics based on the microbiomes of people who are fasting? That we can just give to people through pills and maybe give them the benefits of fasting without having to actually do the fast? 

Geoff: That's interesting. I mean, I think there's probably so many targets, how fasting works. I think it affects microbiome. It obviously affects autophagy. Something with just a core metabolism. But that's an interesting end point of fasting. Changing microbiome. That just reminds me of a conversation that I had recently with a friend, Josiah Zayner, who literally fecal transplanted themself. 

Molly: Oh, who? With whose poop?

Geoff: So he had a friend with like apparently really good GI and he had been struggling with GI issues through his life and he literally like purified the poop of his friend. 

Molly: How did he do that? What did he do to it? 

Geoff: I think he just like capsulized them. I think he literally swallowed this guy's feces. 

Molly: No, this is a thing. Was he taking antibiotics? 

Geoff: Yeah, he took full antibiotics-

Molly: Whoa.

Geoff: ... to destroy his entire gut microbiome and then transplanted and matched, he had successfully matched-

Molly: And then what happened afterwards? 

Geoff: He said he felt like his GI was great. 

Molly: That's amazing. So the craziest thing about this whole world of microbiome transplants is what's really depressing about it is that it's actually incredibly hard and very challenging to get a microbiome transplant from a doctor. 

I spent a year for one of my clients, trying to get her a microbiome transplant. And finally, we got it done but it took us-

Geoff: Yeah, how, what is that-

Molly: You have to contact, first of all, you have to have a team of doctors. You have to have a poop sample from a lab that's allowed. You have to clinically contact a lab that collects poop samples, essentially. And you have to basically develop a relationship with them to get that sample sent to the doctors who will then insert it through colonoscopy. If you have Chron's disease, there's arguments of like which way you would wanna get it inserted and so in this patient's case, they wanted to do it through colonoscopy. Mostly because that's the only way the insurance would pay for it. Like they wouldn't pay for it any other way, so she had to go to the hospital, be sedated and have this inserted into her and to me, it's just like, "Really? Why would you have to take that much time and effort if this is something that somebody can just do at home?" You know? 

Geoff: He's a pretty experienced bio hacker but yeah, I mean sounds like-

Molly: And there are risks, for sure. You need to get your, you need to get like, we actually tested her partner's stool, 'cause we wanted to see like maybe it would be easiest just to get it from him. He had the exact same make-up as she did because they live together. 

Geoff: Right. Makes sense. 

Molly: Which is so fascinating, as well. 

Geoff: Probably similar diets. 

Molly: Exactly. Yeah. 

Geoff: One thing that I thought was interesting was that you were basically doing a pilot study on yourself of how fasting effects female hormones, right? So I'm actually curious, when I was looking into this-

Molly: Oh, I have more information on this, by the way. 

Geoff: Well, I think it's an interesting topic and I think it's important topic because most of the fasting studies are done as you're referencing, and not only just for fasting, just most clinical studies are done on men, period. In like American, Western men period. Just because there's less variables and, I don't know, for whatever reason, there's an easier population to sample from. 

Molly: Yeah. 

Geoff: Or repeat from. And I think, hopefully in the future, we can effect that and have a more diverse population from which to run clinical trials, but that's a different conversation to be had.

Molly: Sure. 

Geoff: But I think one thing that was interesting was that there is some confusion around women and fasting and like how much does urine hormone levels correlate to blood serum levels of hormones? 

Molly: Sure.

Geoff: I imagine there's obviously some correlation. 

Molly: So I moved to urine hormone testing for convenience mostly. And also because I really like this company called Precision Hormones. Most functional doctors that I really trust are using Precision Hormones or ZRT Labs to do really convenient home urine testing. 

Geoff: Yeah. 

Molly: And hormone testing and so they correlate pretty well and the key is is like do you trust the company? Are they giving you information that's actionable and is there good customer service in case you have questions? And so I still do blood testing, because it's the standard, but then on top of that for the, it's really hard to do blood testing for the menstrual rhythm, and so because of that, it's just easier to pee on a piece of paper and fry it and to send it in, but I think they correlate very well. 

Now the interesting thing was so for the last month, basically the last two months, I started to ramp up, ever since that keto experiment, I started ramping up fasting and this creepiest month, my cycle was like shorter than it's ever been, right? And so that was interesting and I don't know if that was, if that came from the fact that I was traveling a lot, which is stressful, but usually when I'm stressed out my cycle's longer. So I was kind of like what is this about? And the second time, I was wearing a glucose monitor and the previous month, my glucose monitoring was like pretty darn normal the entire time, but this last fast that I did, I know I did two three day fasts two weeks in a row. 

That might've been too much for my system to handle and it was during my luteal phase so right before my period and this last week when I was wearing my continuous glucose monitor, I re-fed on a retreat, right? Maybe not the optimal place to get re-feeding, because like I basically had only access to food the people were making us and I broke some of my big rules. So I'm going from like ketosis to ad libitum eating, right? And-

Geoff: With what? Like nachos and pasta and like easy to make stuff? 

Molly: I didn't eat pasta but we definitely made like pumpkin pancakes with brown rice flour. 

Geoff: Okay.

Molly: Which I never eat flour of any kind unless it's like nut flours and that's even still rare. 

Geoff: Right.

Molly: And then like I hadn't touched my glucose monitor until the next day. Actually what did I first eat? I think I had some tortilla chips and some granola and some salad and some, so whatever was laying around. I was just like-

Geoff: Your sugar was-

Molly: So my sugar went, so first of all, you're not supposed to go from ketosis to carbs like that. Your body doesn't want to do that, 'cause you're physiologically insulin resistant, right? 

Geoff: Yeah. 

Molly: So I hadn't been paying attention to my glucose monitor and I also was slightly stressed from the drive. I'd worked four hours on the drive and then I, it was an OnConference and so I started giving a lecture on fasting right after this. Right after eating. And so the next day, after breakfast, when I had those pancakes that I had made, which were by the way, amazing, but like I never do that. I never eat pancakes with rice flour. I looked at my monitor and I'm like, "Oh, my god. This is bad". 

Geoff: What? 150? 

Molly: Okay, so it was 187 after these pancakes. I went outside, did 30 minutes of yoga, dropped it to 107 in 30 minutes. From just yoga. 

Geoff: Just context, so above 125 fast is considered type 2 diabetic. 

Molly: It's fasting, but I wasn't fasting. It was postprandial. 

Geoff: Postprandial-

Molly: Postprandial 140, generally, is considered to be, like but that's after a glucose tolerance test, which I basically had done. But I was hovering around like pre-diabetes range, like 187's really high. But the cool thing was is that I caught it. It was only 30 minutes of an exposure and I basically dropped it 80 points from yoga. 

Geoff: Yeah. 

Molly: And I measured it from my finger prick, as well, to make sure that it was accurate, because then when you see a glucose monitor, you have to understand that glucose monitors are imperfect. And so often times I'll see a spike after like a carb, after fasting and then I'll be like, "Uh-oh." Then I'll check it with my finger stick and double check to make sure it's not abnormal and I've seen changes as much as like 30 points differences. So I was like, "Okay, is this as high as I think it is?" And because I saw it and because I acted on it, I was like, "Great." I now know that pumpkin, rice flour is not optimal plus honey, like not good for my metabolism. Especially not good after fasting. 

Geoff: Right. 

Molly: But I think the thing I learned from this experience is that we need to be vigilant about our blood sugars and these experiments that we're doing. Especially if you're a woman and you're challenging your body's physiology, especially around times like where there are hormonal differences going on. That's why I'm a big fan of continuous glucose monitoring. Because without knowing that, I could, like I was listening to Sumaya Kazi, your friend, who's a big faster and I was looking at her Instagram and I'm looking at her diet and what she eats on feasting days. 

Geoff: Yeah. 

Molly: And she's eating a lot of refined carbohydrates. And she's maintaining a healthy weight, but I'm dying to see what her blood sugar looks like. I'm just dying. 'Cause like I wanna know is it healthy or is it not? And feeding a fasting, I think, is like what we're designed to be doing in terms of evolutionary biology, but the question is is feasting on what? Certainly not feasting on refined carbs and sugar. Maybe on special occasions but on a day-to-day basis, it could be detrimental to our metabolism to be challenging our metabolism with these types of behaviors. 

Geoff: Yeah, I think you bring up a interesting point that I think is not super well understand, which is that insulin resistance actually increases after a fast. 

Molly: Mm-hmm (affirmative).

Geoff: Which is like counter intuitive, but in some sense it kind of makes sense that your body's not used to the insulin.

Molly: Well, insulin decreases but you can get insulin resistant because your brain is saying if there is sugar in my body, it's coming to me first. 

Geoff: Right. 

Molly: And so it's really just your brain is doing this on purpose. 

Geoff: Right. It's on fatty acids which is opposing insulin. 

Molly: Right. It would make sense, and by the way, when your body breaks down fat, triglycerides, when your body's breaking down glycogen, initially it's producing carbohydrates from that, and then eventually during ketosis and your brain is still craving sugar, so if there's any sugar in your body, any place, it's going to your brain. And your peripheral tissues are basically like trying to protect your brain and so it's not a bad thing. And I think that there are people, there's like certainly the high carb, low fat people who believe that fats are bad and fats cause insulin resistance or we're gonna die.

I'm a big believer that we should just understand what our body is trying to do in order to keep us alive. And also with respect to that, be careful with how we experiment. 

Geoff: Yeah. I also underline, 'cause I think you bring a really good point. So the brain needs sugar and when you are in a ketogenic state, it's basically showing as much of the remaining glucose to your brain. 

Molly: Yeah. 

Geoff: As opposed to your skin and to your muscle. And your muscles are running off of fat. 

Molly: Right. 

Geoff: Which is why people see weight management or weight loss goals off of ketogenic diets or ketosis. I think that's interesting. It's an important way to look at it. When you get that short term insulin resistance so your muscles aren't using sugar and your body has to have a few hours to readapt. That initial shock can have like high glucose for an extended period of time. 

Molly: Sure. I think another topic that needs to be talked about is like, I've gotten a lot of people messaging me on Instagram who are body builders who've experimented with ketosis. And some of the men, in particular, have said I started doing keto for many months while doing a really heavy lifting regimen and I totally screwed up my hormones. So it's not just women. Like this is happening to men, as well. And so-

Geoff: It makes sense. Like testosterone is-

Molly: Testosterone, thyroid hormones, adrenal hormones, like basically I think different hormonal systems can be thrown off from just too much damage. Like if you put your body in a, I mean if you think about a really lean, really muscular looking body builder, their body fat is so low that their body's like-

Geoff: That's the weakest body of their life. 

Molly: It's not healthy and you might look really cool and you may look really shredded, but we need to actually ask ourselves what is really optimal for longevity? And I don't know enough studies on body building to know like do they live longer, do they live shorter? What is the benefit to this long term? Besides aesthetics? 

Geoff: That's a good point. So I do know when people are body building they're cutting so much water weight and fat just for the competition. That whole time as they say, that's literally the weakest they've been in their entire training cycle. 

Molly: Yeah. 

Geoff: I think it's a really interesting conversation around the role of lean muscle tissue for glucose-

Molly: Sure. 

Geoff: ... this other area that I think hasn't been discussed as much where I think a lot of people associate lean muscle tissue as correlated for longevity and I think people think about that in the sense of, "Oh, you get more muscle, you're gonna have less point of injury", but I think a less well understood point of that is that besides your liver, your muscles are where you can store glucose. 

Molly: Yeah. Okay, so this is really important. Let's talk about this. 

Geoff: If you have more muscle, you can store more glucose. 

Molly: So one of the things that most people don't understand about pre-diabetes that I think is like I wanna hammer into the world, because the science is there, is that there's two types of pre-diabetes. Actually, technically, three. There's impaired fasting glucose, there's impaired glucose tolerance, and then there's people who have both, right? 

Geoff: Okay.

Molly: If you have impaired fasting glucose, you have hepatic insulin resistance. If you have impaired glucose tolerance, you have impaired skeletal muscle insulin sensitivity. So if you have both, then you're kind of screwed. So-

Geoff: Yeah, it's relative. So to explain it for-

Molly: Yeah, so-

Geoff: You wanna explain that a little more?

Molly: Your muscles are a sync for glucose to go after meals, right? And then when your muscles fill up with glucose and there's no more space left for glycogen, you start taking that extra glucose and you start taking the triglycerides and you basically make fat, right? 

Geoff: De novo lipogenesis

Molly: Exactly. 

Geoff: My favorite phrase. 

Molly: Exactly. So whenever you've actually glucose laying around and your body says, "Okay, cool, I'm gonna store it." And then often times if you do this consistently, you get fatty liver. So if you fast, what you're doing is you're first and foremost, eliminating the glycogen in your liver. When you exercise, you're eliminating the glycogen in both your liver and your muscles so you're producing a glucose sync and you're also improving insulin sensitivity with exercise. And I think-

Geoff: Your muscles uptake glucose after work outs. 

Molly: One of the best things you can do if you're fasting, is also continuing to exercise. One of the worst things you can do if you're fasting is stay sedentary. One of the problems with fasting is that it does send a signal to your body that you don't wanna move as much, 'cause you don't have as much fuel, but I have found that, doing all these experiments with fasting like it makes sense that I drop into ketosis faster when I'm exercising, but I've also noticed that sometimes I get even better performance when I've fasted, which is kind of interesting. I do Ashtanga yoga. And it's not easy. But I feel more focused and I feel like I've got more catecholamines in my body, but because like I do and that gives me a little bit of extra fuel to really push into my exercise. 

Geoff: It's aerobic. Not doing anaerobic like power-

Molly: Yeah, you're lifting your body with body weight, but you're also doing a lot of breathing, so it is both. And you're doing a lot of-

Geoff: You're probably not going like much above like 120, 140 heart rate. Right?

Molly: Not too much. It really depends on, there are handstands that I'm doing sometimes where I'm lifting my whole body above my head and then arm stands, those can be kind of-

Geoff: I agree. Those are anaerobic. 

Molly: But it's nowhere near as-

Geoff: Squatting like 300 pounds. 

Molly: Yeah, exactly. Exactly. But I do think that most people when trying to hack pre-diabetes and diabetes, a lot of doctors are like just focus on food and food is important but you also, exercise does really improve insulin sensitivity. And also just muscle mass, turns out, I was reading a study how, it was either, I think it was on human, I think I've read studies on both Humans and animals but extended day fasting can improve growth hormone secretion in both humans and animals, which also can improve your body composition. And one of the weirdest things I've noticed from fasting is that even though I regain a lot of the weight that I lose when I start re-feeding, I feel leaner overall and so I do feel like it's changing my body composition, which is kind of cool. 

Geoff: You should get DEXA scanned. So I actually did like a, okay.

Molly: I did get DEXA scanned before I started doing all this so I'm gonna do another one in one more month, after three months of all this. 

Geoff: Yeah, and that's basically what I did so I did a three-month period of weekly 36-hour fasts and then I did a 7-day fast and have between there, as well. 

Molly: One weekly? 36-hour? 

Geoff: Yeah, so weekly, 36-hour and then in the middle was a 7-day straight water fast. 

Molly: Oh, wow. 

Geoff: Aggressive. 

Molly: Yeah. 

Geoff: Kind of a Phil Levin style fast and I had lost 2% of body fat percentage and gained like one or two pounds of lean muscle tissue. 

Molly: Wow. 

Geoff: Which is a nice combination, right? 

Molly: Yeah. 

Geoff: Like you get leaner and you gain more muscle. 

Molly: It's just funny though, 'cause everyone's like you're gonna lose so much muscle. You're gonna lose all your muscle fasting and I'm like, "No, you're not, actually. In fact, you might gain muscle. And lose fat." 

Geoff: If you work out. If you work out-

Molly: You have to work out though. 

Geoff: That's the most anabolic thing there is. You don't eat and build muscle. You have to work out and of course, eat to gain muscle. 

Molly: Yeah, exactly. Totally. I mean, that's the thing I try to tell people. It's like, if you wanna build muscle like a body builder, you actually do need a decent amount of insulin, because you need a growth stimulus. But if you're trying to lose body fat and gain muscle and just get leaner, than fasting exercise is great. I mean, you're a great example of this. I mean, just seeing you over the course of two years, you've gotten way leaner and it's awesome to see. Like your entire team, you guys are super lean people. 

Geoff: Yeah. No, it's been a fun journey just to sort of take what we experiment with, see that it actually works. I mean, I think we're just actually curious in some way, right? Like if fasting didn't work for us, then we wouldn't do it. Like if I just, I don't think we're dogmatic here. 

Molly: No, no. 

Geoff: If we find out tomorrow that fasting's gonna kill us, we'd be like, "Let's not do that". 

Molly: Okay, so another thing we should talk about is like the different types of fasting that I've personally done with different assistant aids, so I did my first three day fast with just tea and black coffee, with no creamer, just mostly I was drinking a lot of Oolong tea and because I was just kind of going nuts, a little bit, 'cause I was like, "Oh my god. No food. This is a lot of days."

Geoff: This is fun. It's all about tea and fasting. 

Molly: Tea nailed it. Like my ketone levels were sky rocketed after like one day. 

Geoff: Yeah. 

Molly: And mostly, I think, because I was drinking so much tea. So by day two I was at like ketones of 4.4. 

Geoff: Whoa, okay.

Molly: So you typically would see that after a few days, but it was way sped up from just drinking tons of tea. I discovered this milk Oolong tea, which is amazingly good tasting. So I'm really into teas these days. The only concern I have about teas is my doctor told me that caffeine is not great for female hormones and may cause hormonal imbalance-

Geoff: Interesting.

Molly: ... so I'm like I can't give it up, though. 

Geoff: Really? 

Molly: I love caffeine. 

Geoff: I didn't know about that. 

Molly: This is something I've been reading more and more about. 

Geoff: How strong is that? 

Molly: I think it's a fairly strong association. However, I'm gonna do more deep research before I come to a conclusion, because I've always been a caffeine drinker and-

Geoff: How many women do I see just walking out of Starbucks all day long? 

Molly: Yeah, exactly. 

So the question is, is what's the dose? And then the other thing I do is a fat fast, because I was like, "Oh, this Complete Guide to Fasting says I can have fat for a fast", and it wasn't very much, it was like maybe 150 to 200 calories a day.

Geoff: Okay. 

Molly: And I have to say-

Geoff: I wonder if that's tea oil or butter-

Molly: It was coconut oil-

Geoff: Okay. 

Molly: ... ghee, maybe one or two nuts. Definitely nothing crazy. 

Geoff: Right. 

Molly: But I have to say that that was a far harder fast to do. I think that when you give your body any type of calories, it's just like, "What? You're just giving me 200? That's it?" So my body was just like, "Nope." So I hated that fast. That was like the worst fast. I was not happy. 

Geoff: That's 'cause, with my experience, too. If you're gonna eat, then you're body just expects to actually have a real meal. 

Molly: Yeah. 

Geoff: Like are you really gonna die over 200 calories? It's like, if you're gonna fast, just fast. 

Molly: Okay, and then I did one of my previous 24-hour fasts when I was traveling to Israel with the ketone esters and I'm sitting on Turkish Airways in business class, 'cause I decided beforehand I was gonna upgrade, 'cause I was like, "I deserve this". And did not realize how good their food was going to look. They had a chef on the flight and there was like food going back and forth. 

Geoff: Actual business is great. 

Molly: Oh, my God, it was ridiculous. And here's the thing. The guy sitting next to me is like head of GE of Saudi Arabia, right? He's sitting there, he's like eating everything and watching me prick my fingers, test my ketones, drink human ketone esters, prick my finger again. He's like, "What are you doing?" 

Geoff: Are you sick? 

Molly: Who are you? 

Geoff: Do you have a disease? 

Molly: What kind of a person are you? And I'm just like, "Oh, I'm doing all this metabolism research." And we started getting into, like talking about why Saudi Arabia is just suffering so much from diabetes. And he was like, "You're like in the future", he's like, "You're literally from the future", he's like, "This is where things are gonna have to go, because we're really getting sick. Our country's getting super sick". 

And I was like, "Yeah, the problem is that the solution is fasting and most people don't wanna fast".

He's like, "No, we're fasting for Ramadan, we're used to fasting". He's like, "You just gotta tie in the cultural aspect of it and make it more of like, you gotta figure out how to get people to think about it from that perspective, as well." Which I think is really smart. 

But I found that that international travel with ketones really, really different experience than just regular fasting. First of all, the first time I did it, I was actually in your office the first time I tried your ketones when I was doing a 16-hour fast. I had a pretty decent ketone level, I think it was like .8 or something and I was just like, "What is this stuff? What am I gonna be drinking? What is this like?" Drank your ketones and I remember thinking, "I feel like I'm a video game character and I'm getting a new life". I felt my legs sort of tingling and I just felt like I had all this energy that was just going from my feet to my head. And this keeps on happening every time I do a fast with ketones, it's like I get this tingly feeling in my feet like, "You're getting another life now", and it really does provide a sense of, part of it is, I think, psychology, because I know that I have fuel, but part of it is physiology. 

My body is getting a boost of ketones that frankly makes it easier to just go into that state and I think for a lot of people who aren't fat-adapted yet, this might be one of the few solutions that could actually help people learn to fast more efficiently. My personal belief is that you need to really think about fat adaptation before jumping into fasting, but I'm really curious to know wit this tool, can we get people to that state of fasting faster and maybe can they use fasting to get fat-adapted? Maybe they won't have to use ketogenic dieting. I don't know. 

Geoff: Yeah. No, I think that's a good point. And I think that's something we're exploring. Obviously, a lot of our customers are athletes and performance use case. But I would say that maybe 20 to 30% of our customers are using it for a fasting tool for metabolic health and even aid in fat loss.

Molly: Yeah. 

Geoff: And I think what you're describing is that when people aren't fat-adapted, you have low sugar and you have low ketones at the same time. 

Molly: And then if you like-

Geoff: You feel like shit. 

Molly: Shit. 

Geoff: Right? So your body's just like, "We need to eat something", or freaking out. If you get that ketone level right? Put like ten days of fasting in like 30 minutes. 

Molly: So this was me when I first started fasting. I would get hangry. I would be irritable. I would feel low energy. And then through, basically when I was in your office a few months ago, you were like, "You just gotta stick with it and just keep fasting and just try it, 'cause it's gonna get easier". And I was like, "I really hope you're right." And then it did. And next thing I knew, every week I was like, "I can do more. I can do more than this". And then two weeks of three days in a row, I was like, "Okay, I think I can do a little less". 

But the fact that it's now something that I can be like, "Oh, if I need to fast, I'm gonna fast", and it's no longer a thing that I worry about. It's no longer even a question of can I do it. That to me, like the coolest thing that I have found is the heart rate variability and chronic stress improvements. Have you heard about this work? 

Okay, so-

Geoff: I mean, I actually do see if I'm eating earlier, so basically I have a longer window before sleeping, my heart rate variability is higher and my resting heart rate is lower. Feels like a more optimal heart-

Molly: Okay, so I've been finding all this research on how fasting improves heart rate variability and I put this to the test because I started fasting and I spent this year at the beginning of the year studying all my new year's resolutions and I sent tons of them. And I usually get more than half of them every year. It's really fun to challenge yourself in every aspect of your life, but in terms of my own emotional health, I wanted to be more even keeled under stress. I wanted to figure out how do I maintain balance despite upping your workload. 'Cause I knew I was gonna be doing a lot more things than I was last year this year. I had a feeling this year was gonna be a year of a lot of action. 

And it has been. And the craziest thing I've noticed through fasting is how I do feel like I can handle more stress and just remain calm. I was traveling from Israel to Lebanon, which you're not supposed to do, because they are not friends. And I was like, "Well, I'm gonna do this anyway, 'cause I'm Jewish, but I'm also Lebanese and I'm like, "No one's gonna stop me". So I go to Tel Aviv and then I go to Cypress and then I go to Lebanon. And I get to Lebanon's border and I think I'm already, "Oh, yeah, home stretch. I'm gonna get in." And the guy turns my passport over and he sees not the stamp, they sticker you. And Israel people almost don't realize this, but these stickers have meaning behind them. They rank your level of Zionism and its their stickers. Their own security stickers for when you come back to Israel. 

Geoff: Whoa. 

Molly: Yeah. So I didn't know what number I was, but I was kind of like, I'd ripped off my previous sticker that I'd just gotten but the one that was from before, it was like from two years ago and it was only half of a sticker so I was like, I guess I could just leave it. Big mistake. Guy says, "Come with me". And I'm-

Geoff: So it was like super high in the Zionism ranking? 

Molly: Well, no, no. Lebanon just knew that I was in Tel Aviv. And you're not allowed to go from Israel to Lebanon. 

Geoff: Okay. 

Molly: Big no, no. And I was like, "Oh, they'll never know. I don't get stamped in Israel". So I went to this back room and there's people that are arguing with these border patrol guards. They're like, "You can't kick us out of the country", and I'm sitting there just smiling and I turn my app on my phone, my breathe app on my Apple watch. I start breathing deeply and I'm just chatting up the people. I'm like, "Yeah. I was in Israel like two years ago". 'Cause I needed a good story 'cause I wasn't gonna be like, "Yeah. I was there two hours ago or two days ago". 

I go look, my last name's Maloof. I'm Lebanese. My dad's Lebanese. My grandfather's Lebanese. I really wanna see the country. That's why I'm here. And I was on layover before. And that's where I got that sticker. And I was just really calm the whole time. And then he takes me into another room. And the other room was like, there's a guy in a jail cell, there's a guy at a desk, he's smoking a cigarette and there's no windows and it's fluorescently lit and I'm just sitting there like, "Oh, shit". And he's like, "Okay. We need to take your statement for the military court". And I'm like, "Shit. Am I going to jail?" 

Geoff: Wow. 

Molly: And I tell them my story, which I'm not a big believer in lying but if you're in the situation like I'm in-

Geoff: I think it's excusable. 

Molly: It's excusable. 

Geoff: It's excusable. 

Molly: And so I go, "Look. I was", this is actually a true story, I was in Athens a few years ago. I did have a layover in Tel Aviv. I showed them my stamps. I was like, "This is when I was there". And so he takes my statement and the guy barely speaks English. And he's using copy paper and they don't even have computers. It's like literally he's handwriting it out. He faxes it to the military court, right? These fax machines. And I realized about halfway through this experience that the guy was on my side. Because I looked Lebanese, my last name sounds Lebanese, my story worked out. But I'm like sitting there for hours and typically I think most people would've been kind of uncomfortable. I just took the whole experience as like you know what? This is gonna be fine. Regardless of what happens, I'm gonna be fine. If I have to go home, great. I'll go to another country. Like whatever. 

Geoff: You weren't concerned about just getting thrown in one of the cells and-

Molly: Well, they let the guy out of the jail cell out, which made me feel better. He was from Paraguay, apparently and I didn't understand why they were holding him, but about three and a half hours into this experience we get a call and they're like, "You can go now." And I'm like, "What do you mean I can go?" They're like, "Yeah, you're free to go". I'm like, "Yes." And I just had the best high of my life. I got into Beirut. I had the best time. But I learned a lot about how to remain calm and I honestly think that this would never have been me a year ago. I would never have been this calm under pressure. And the biggest change of my life over the last two months was literally fasting. 

And so I really do believe that this has contributed to a greater improvement in my heart rate variability than anything else. It's pretty astonishing. 

Geoff: Yeah. I think part of it, from my perspective is that it also practices discipline. Right? You have a mastery over your own body's desires in some sense, right? Eating's very pleasurable. That's what I just noticed through the fasting sprints. A lot of times when you eat, it's like for fun, not for actual really nutrition.

Molly: For hedonism or for because something smells good or because, people don't totally understand hunger. And really true hunger is something that comes in waves throughout the day with growling curves. So you get a few growling curves throughout the day. And most hunger is actually just people who are constantly riding the glycemic response curve and are constantly spiking and dropping their blood sugar and so they're getting low blood sugars, they're getting insulin spikes. Insulin makes you hungry. So if you're constantly pulsing insulin throughout the day with sugar, you're getting hungrier because you're eating food that is making you hungrier, right? And on top of that, we get thousands of messages of food all day long to eat and that activates the dopaminergic systems in our brain, the hedonism pathways, the pleasure pathways. The wanting and the liking of food. And that can make you think you're hungry even though you just want the food. Or you just like the way food tastes. 

Geoff: Right. 

Molly: And this is why when you're eating a multi-course meal, you're able to easily eat more food, because of different foods tasting good continues to activate that pathway and so it's not that you're actually necessarily have room for all this food, it's that it's a novel experience. 

Geoff: Novelty factor, yeah. 

Molly: And then there's also the emotional hunger that most people are suffering from in our country because a lot of people are suffering from loneliness, depression, anxiety. People are using food as a medication because carbohydrates activate serotonin and that makes you feel better. For a lot of people, I think, they're consuming carbs because their cortisone might be too high and that makes you crave carbs or they're just chronically depressed and they wanna medicate and really one of the things that I've been trying to understand more is what's true hunger? When am I really hungry? 

Geoff: Right.

Molly: And also when you're really hungry, and you're fasting and you learn to handle that wave, and you realize that it's not a tidal wave, it's just a breaker, you're like, "Oh, my god. I'm a super hero. I can handle anything. I can be under a state of true hunger and be okay." And to me, that's an ultimately adapted human is like I can be anywhere in the world without food for a week if I needed to and I would be fine. And that's actually where we wanna get people to go. But most people couldn't be without food for a few hours without falling apart. 

Geoff: Or so they think. 

Molly: Well, that's the thing. So they think. I mean, that was me even a year ago. Is like, well, maybe not a year ago, but like two years ago, for sure. I definitely would get hangry. I definitely would feel low blood sugar and be like, "Oh my god. I'm in survival mode". And you have to flip that brain switch and realize you're gonna be fine and also you got enough food to eat because you have fat in your body. And you're eating that fat when you're fasting. 

Geoff: One thing that I thought was interesting was the benefits of having some insulin for body building or just for exercise and I think that it's easy in a discussion like this to go super polar against carbs like carbs are evil and all of that and it's like, you know, I think it's pretty well accepted, you probably don't need to eat refined sugar, you can probably remove that. But there's a role for carbs, especially for weight lifting, exercise. 

Molly: I totally agree. 

Geoff: We should talk about that. I mean, i think it's like, we should find this, I think there's like a nuance here where I feel like you don't get any attention if you're not just like crazy polar. It's happening in the political system. It's happening with like nutrition, as well, these days. I feel. 

Molly: Great company called Meta Flow, that I may or may not start doing some work with them. Haven't yet, but I've just been using their device as a beta tester. And what they do is they measure your respiratory quotient. I might've mentioned this in the previous podcast but I've started to use them more and what it does is it measure the-

Geoff: How does it work? Do you have to-

Molly: No, you blow into this device. And you blow in oxygen, right? 

Geoff: Will you explain RQ before-

Molly: Yeah, so RQ is kind of tricky to explain, but basically the percentage of carbohydrates in fat that you are burning can be determined by the difference in carbon dioxide blow off that you create. Like the difference in the oxygen you blow into the device and the carbon you actually blow out. But fundamentally, you have two sources of fuel that you can burn. You can burn fats or carbs. And the percentage that you're burning of fats or carbs is your respiratory quotient. 

Geoff: So a ratio closer to one is carb burning, ratio closer to 0.7 is fat burning. 

Molly: Exactly. So this device can tell by the carbon dioxide blow off how much you are actually burning. 

Geoff: Yup. 

Molly: So what's nice about this is that it's really a tool for assessing your metabolic flexibility, which is really like how easily do you convert back and forth between carb burning and fat burning. And what they've noticed in their program is like what they'll do is they'll cycle carbohydrate consumption with like higher carb and lower carb and they're having people lose pretty significant weight loss. Like 15 to 20 pounds weight loss from just using this device and just modulating carbohydrates. And I think that, obviously, I'm waiting to see the totals numbers of what their success stories are and I'm also just like, I have a lot of research to do in this space before I totally convert over to like this is the future, but I think having a glucose monitor is a pretty cellular tool for analyzing your field stores. It's like, what's in your blood stream? 

But then post-cellular is a respiratory question. It's like what have you already metabolized? And I think both of these together is a pretty magical combination because now we're starting to get real-time fuel store analysis. And that's pretty astonishing. 

Geoff: Yeah. RQ's been interesting. I've been meaning to get that done.

Molly: Yeah, I mean really, the sensors have gotten cheaper. They've gone from hundreds of dollars to like tens of dollars and so because of that, they can make it something more scalable. 

Geoff: Yeah, so I think one of the early, early pilots of ketone ester showed that your RQ's more efficient while using ketone ester versus other sub straights. One of the starting principles that led down to the development of the ketone ester. 

Molly: Oh, my god. Wow. 

Geoff: 'Cause if you actually think about why is the ratio closer to one when you're burning carbs, is it carbohydrates are more oxidized? There's more oxygens in a carbon molecule versus fatty acid chain and ketones look more like a fatty acid chain than a carbon molecule. So it's an interesting sub straight to be more efficient for metabolism. 

Molly: Right. And the thing about human health and adaptation. We have this concept of like being able to adapt and self manage, being metabolically flexible, I think, is a marker of a healthy human. And there's a great paper, I'll send it to you, and it's called Flipping the Metabolic Switch. And why this is important for health span and life span. And really the belief is that the more often you can go between carb burning and then also depleting your glycogen reserves, that in itself is really good for your metabolism long term. 

And it may be that being sustained in a ketonic fat burning state isn't good long term. It may be that that is damaging to hormonal balance if you do it too much. It may be that we're supposed to go back and forth or it's possible that like seasonally we're supposed to eat differently. I mean, there's so much we need to learn about what makes for the healthiest lifestyle possible, but I think it makes intuitive sense and also there's a lot of papers on this now that say that we should be tapping into our own fat source more often. We should not be burning carbs consistently. And that's what most people are doing and it's not surprising that most people have too much blood sugar in their blood stream. 

Geoff: I mean, I would respond by saying that I think sustained keto is likely to be safe, just given all the longitudinals of somebody who's on keto but I would say that I think it is open as you were saying that it's not necessarily optimal. I think there's a point about cyclical keto-

Molly: That's what I'm thinking more about. 

Geoff: I think that's something that I've been incorporating. 'Cause I noticed from like an exercise perspective, if you are eating keto you're just not gonna have that burst of energy and like all of the elite athletes that we work with, they might train ketonically to be more metabolically flexible but during their Olympic trials or their gains, they're getting a full fuel selection. 

Molly: Well, let's think about that, right? So I always use a candle or kindling analogy. But if you have a bunch of kindling and you light it on fire, it burns real fast. It's like you want that kindling in your body, you want that glycogen so you can burn it. So you can run. So you can produce power, energy. Like our bodies are not that, like they're so complicated, but they're not, right? 

Now to me, ketones is kind of like a little bit of rocket fuel, right? That's cool that you can pour a little bit of extra fuel onto a body and say I'm gonna have this extra fuel stores, but most of us, you know, like just using our own fat stores for an Olympic trial, that's really like burning a candle. It's not gonna burn fast. You wanna have that fast burning fuel for power. And what I'm trying to figure out right now as I dig deep into fitness and continuous glucose monitoring, is how do we use the glucose monitoring tool to optimize human performance in athletics? 

And right now, I'm getting so much of my evidence from type ones, because they're the ones who've been monitoring this longest but I don't have enough research from people who are healthy. And so we're gonna have to start doing some studies eventually on that. 

Geoff: That reminded me the point I wanted to bring up, which is the metabolic flexibility point so there's been good success where diabetics are going on keto and then reversing their blood sugar and reducing their insulin. Need less medication. But I think there is a good, interesting open question around have they really reversed diabetes or cured diabetes or they just manage the symptoms? 

Molly: This is a good, really good question. 

Geoff: No one has tried to like re-feed them carbs. 

Molly: Right. 

Geoff: It sounds like you have really good glycemic control. 

Molly: Control. Except for after a-

Geoff: After fast. 

Molly: I fast when I didn't. There is evidence that shows that after, for some women who have already normal glycemic control, if you do fast then there can be abnormal glucose tolerance after. But here's the thing. Does that mean I currently have abnormal glucose tolerance or was that a temporary state? 

Geoff: Right.

Molly: Now, let's get back to diabetes. I think a lot of people focus so much on these clinical end points and measurements and less about the big picture of what's really going wrong with this person's health. And diabetes is not just a disease of too much blood sugar. It's a disease of a person who is not adapting to the environment that they're living in. And by not adapting to the environment, I mean, they're not getting enough sunlight. They're not getting enough nature exposure. They're not getting enough fresh air. They're getting way too much pollution. They're getting the with wrong packaged, processed foods in their bodies. They're often times like not getting enough family and community time and there's a lot of reasons why all of these things contribute to abnormal blood sugar. 

To me, abnormal blood sugar is just an end point that's showing a person is breaking down. And it's like, yes, you can treat the symptoms, you can treat the problem, like you can treat the insulin resistance. You can treat the high blood sugar, but it's not fixing the societal issues that are contributing to people's health. Getting disordered. And I think the same thing can be said about hypertension and hypercholesterolemia. Like these are just markers of an unhealthy person. And these are markers that show that you can be predisposed to pathology but it's like, let's look at the big picture of society and say where are people thriving without any of these problems and what's different about their lifestyles? 

And frankly, like a lot of it has to do with how people live. What their lifestyles are like. 

Geoff: I think eventually, everyone's fixing a version. We all need to build a giant culture company. I think it's basically like we're all trying to do in our various channels, right? 

Molly: Yeah. 

Geoff: You've mentioned cholesterol and blood pressure. Have you been following the LDL, HDL, triglycerides story? 

Molly: Okay so-

Geoff: I've been curious about if you've become like an amateur lichenologist but I'm curious to hear your thoughts on that whole story about how high LDL might necessarily be a demonized biomarker. 

Molly: Well, okay, so-

Geoff: I'm curious to get your thoughts on it. 

Molly: I think, I don't know if I mentioned this to you. I don't think this was on the last podcast, but as I was digging into diabetes nutritional treatments, I came across a high carb low fat group and a low carb high fat group. Well, let's not name these groups, but you know who they are. One of them's in San Diego, one of them's in San Francisco. And I was looking at their numbers and their outcomes and I was like, "Oh, my god. Both groups are seeing the same drop in hemoglobin A1C and both groups are seeing the same drop in weight in the course of a year" and I'm like, "What's going on here?" Okay, like how is this possible? 

But then I said to myself, let's see what the literature says about both of types of diets and what changes in terms of blood markers that are problematic. That they weren't reporting. 

Well, typically what you see in a high carb, low fat group is they elevate their triglycerides. Typically what you see in some people in that high fat, low carb group is you do see some people get high LDL and I'm one of those people. 

Geoff: Me, too, actually. My LDL raises. 

Molly: My LDL goes up. But the question is is like both of those are considered to be bad, according to the cardiology association. But should we be worried about them. My personal belief is that this is just first principles at work. I have AP4 gene and I have a few genes that predispose me to being at risk for high cholesterol if I eat lots and lots of saturated fat. 

Geoff: Did they tell you that?

Molly: Yeah, exactly. And basically anyone with an APOE4 needs to be careful about too many refined carbs and too much saturated fat. 

Geoff: And don't take brain hits.

Molly: Thank God I have not had any concussions. But I haven't experimented yet with the high carb, low fat diet. I'm terrified of doing it, but I also kind of think it'd be fun to just eat vegetables and fruit for a month and see what happens to my body. Like I've never done it before, but like what would happen? What would I feel like? Who knows? 

And what I really wanna know about these two groups of people is who are the failures? And what happened to those people? Like what's going on with the people who failed the keto diet? What's going on with the people who failed the carb diet? And also maybe we need to meet somewhere in the middle and so what I'm proposing right now that we're doing with Sano, we're doing some internal studies where we're taking people on regular diets, giving them the continuous glucose monitors for a week just to see what happens by monitoring their food and then we're gonna give them a plant-based diet with some protein. Mostly plant-based but with some protein diet from a very popular delivery company in the San Francisco area, and we're gonna see what happens when you take a person on a normal type of diet with standard American foods to whole foods. 

'Cause my theory is that part of what's wrong with people's diets is that they're eating all this fake crappy food that's not contributing to a healthy metabolism and maybe what's happening with these people with different macro nutrient ratios is they're getting out real foods. And maybe that's why everyone's getting the same drop in hemoglobin A1C and weight. 

Geoff: I actually agree with that, actually. I think that a large contributing factor when people change to one of these quote unquote fad diets is that they're just probably eating healthier. 

Molly: Yeah, they're eating and-

Geoff: That's right. They have whole foods now. 

And I think there is some interesting, that's something that I think is gonna be interesting to debate and discuss in the literature. I think there's clearly people that see success with high carb, low fat. There's clearly people that see success with the complete opposite. And I think it's cheap to be like, "No, you're lying or you're bs-ing". To either side. It's like maybe there's a genetic component to that, that we don't fully understand or maybe both mods can work. 

Molly: The thing that I'm trying to constantly evolve my own perspectives around and what I'm trying to sort of separate myself from the pack is like how do we move away from blaming so overly focused on clinical end points and so overly focused on signaling pathways and start looking at the macro picture of humanity and saying what would the most adapted and evolved human look like? 'Cause we're going through a massive human evolution right now. 

With technology, with all this information, with all these new tools that we have to advance our physiologies and our lifestyles, how do we become a more evolved human in the future and what does that look like? And to me, it looks like how can I take whatever fuel supply available to me, by the way by fuel, I do not mean packaged, processed crap. I mean fuel. Real food. How do I take whatever food's available to me and metabolize it effectively without having problems to my well-being? And to me, that's what I wanna be. I wanna be able to go anywhere in the world, eat for the most part, any healthy whole food and not get sick. And actually metabolize it well. And that to me like a super power. And that's what I think we should be striving for, potentially. The only issue with that argument is that the microbiomes of the food supplies all over the world do sometimes cause people to react differently. So it would be really cool if I could just go to India and eat whatever I wanted, but I do have a feeling that I might get sick still, occasionally. 

Geoff: All of the GI distress. 

Molly: You know? I think probably is why Americans do get sick when they travel a lot is because we have very weak microbiomes because we've assaulted them with antibiotics for many, many years. And we know now that a lot of these fake sugars and these preservatives are maladapted to the microbiome. 

Geoff: I would say there are probiotic foods like kimchi or sauerkraut. I think they're getting more popular. Hopefully-

Molly: I make my own yogurt. I make my own kombucha. I make my own vinegar now. I make my own-

Geoff: I mean, one thing I thought was interesting was why isn't there like full fat milk yogurt? Everything-

Molly: You can get them now. 

Geoff: I see that-

Molly: But they're all filled with sugar though. Like there's so much sugar. 

Geoff: That's the problem with yogurt. It's like 20 grams of sugar, right? 

Molly: Yeah. I just find at Buy Rite market is sheep's milk yogurt, full fat. That's like amazing. Totally delicious. Over the top good. Creamy and just incredible. Super easy to digest. Kind of expensive, but really good. 

Geoff: No, going back to your point about just being metabolically flexible. To be able to consume any sort of fuel. I would actually very much agree with that. And it reminds me of something that Jordan Peterson who you guys might've heard about. He's interesting 'cause he's carnivore and keto. 

Molly: Oh, really? 

Geoff: He's carnivore. His daughter, who we're talking with, she's pretty public around having autoimmune issues and basically resolved it with going carnivore. Like keto and then going carnivore. 

Molly: Wow. So here's the thing. I think that my question around all this is what happens to your microbiome when you just eat meat? Like how do you grow a healthy microbiome without fiber? 

Geoff: I think that the counter argument there would be well, if you eat awful, like the-

Molly: Yeah, oh, yeah. 

Geoff: ... the liver can be-

Molly: There should be a lot of nutrients in that. So you can balance it. If you just eat a hamburger or like sausages, you're not getting that diversity within just protein. 

Geoff: You can certainly get enough vitamins and minerals, but the question is is like a healthy microbiome typically likes fiber to make small chain fatty acids. And that feeds that mucosal layer. So I would wanna do a stool study on these people and find out what does their microbiome look like? And yes, maybe they've quelled the inflammation and reduced maybe some small bacterial intestinal overgrowth or whatever, but the real question is is like is that long-term healthy? 

And I would also wanna measure Jordan's ferritin levels because there is a pretty significant correlation between high ferritin levels in men and heart disease. And so because I've done so much research on nutrition and I'm at the point where I really feel like nobody really truly understands what's correct for humanity, I admit that the-

Geoff: That's the bespoke, I think.

Molly: The more that I learn, the more that I don't trust like anyone. Where at the same time, the more that I'm striving to think about the big picture. And the reality is that if you look at Eskimos, they're eating a crap ton of animal foods, right? So I mean maybe just eating healthy animals, he's evolved. He's evolving to consume this.

And also like there's a really great story about this guy who survived, he was the sound engineer for the Grateful Dead. He ended up getting esophageal cancer and living off of meat for like 15 years. He was literally starving his cancer. So you can survive on this. But the question is is do you want to? Like I personally love food so much, but I'm also if I had cancer what would I try? 

Would I go Gerson? Would I go carnivore? I'm a big believer that we're gonna have an entire array of diets for cancer in the future for different types of cancer. There's so much to be thought about when it comes to different diets for therapeutics. 

Geoff: Bob joined because I think he has a saying around that. The goal for a meaning of life is not to just win in a specific game but to have a strategy that wins in the set of all possible games. And I think that's-

Molly: Oh, that's great. 

Geoff: Especially when I think about like how do you wanna carry out your life? Right? 'Cause if I win in this one little game that we play and that would really make you feel bad, then we're never gonna play again. 

Molly: That's where fasting is beautiful, by the way. Because fasting wins in so many cases. Like I've noticed that since I started fasting, I can eat a lot more of a diverse diet and maintain the same weight. I can actually tolerate a lot more foods and still, and also I can have a day where like I do cheat a little bit and I can recover a lot faster. That's to me, a pretty great example of someone who's winning in different environments. 

Geoff: Right. And has some metabolic flexibility. And I think that maybe the solution's not just to have like a 30, 30, 30 macro but like just swing from like, keto into like high carb and then, you know-

Molly: Like if your metabolism wants to be surprised. In fact, I think it had historically been surprised quite a lot with whatever was available. And so we may still have that genetic make up. And that could explain why a lot of people tend to do well when they shift their macro nutrients around. They see changes in their body composition. 

Geoff: Yeah, I think that's definitely something to be explored. I know that a lot of the cyclical work, cyclical keto, people at the Buck Institute, there’s a study by the longevity institute that is showing that cyclical keto is just as good as normal keto and this is done on-

Molly: Can you define that, by the way? 

Geoff: I think they're putting mice on two weeks of keto and then two weeks of standard Western diet and they were living longer than standard Western diet. 

Molly: I think UC has very similar studies with like every other day fasting in animals or even extended fasting in animals, like you just see them live longer. And you know what I love about fasting is how my skin looks so great when I fast. You ever heard of auto fluorescence? 

Geoff: We were talking about this. 

Molly: Yeah. 

Geoff: Yeah, yeah. 

Molly: You can actually measure the light output of a person's skin and that correlates to the level of advanced glycation end products. So the more advanced glycation end products that your skin accumulates, the older your skin looks, more wrinkles you get because the more damage to the proteins in your skin, the collagen and elastin. 

And so what I've noticed is that with fasting, I just start seeing my skin start glowing after a few days. It's pretty cool. I know I'm like becoming this crazy convert, but I have to admit you guys are pretty much responsible for this transformation. 

Geoff: I know. If I think there's some method to that madness in the sense that like some people look healthier and maybe it's an auto fluorescence. 

Molly: Yeah, I mean, you're also taking out the garbage in your cells. You're like regulating all these antiaging pathways. Oh, my god. The coolest thing I learned was listening to this podcast by Krista Tippett called On Being. She was interviewing a physicist, theoretical physicist who was talking about how time is all relative and time doesn't actually exist, right? But it's the difference between variables and specifically, heat. 

And so one of the things that he was saying is that basically, like heat exchanged over time kind of helps define time. The fact that like-

Geoff: That's basically the entropy story? Okay. 

Molly: Exactly. And so what I'm thinking is happening when you're fasting is you're actually just decreasing entropy because you're reducing heat exchange in your body.

Geoff: That's one way to think about it. 

Molly: Think about it. 

Geoff: Yeah, yeah. No. So I think it's an extreme way to think about it. 

Molly: It actually is very simply physics. And to me, I'm really attracted to beautiful, elegant theories of science and I know I'm producing less heat when I'm fasting, 'cause I'm cold. I know when I'm cold and I know when I'm warm and I love the feeling of understanding what's going on inside my body and I do think that fasting is a way to literally reverse the clock in your cells by just the change in heat exchange. 

Geoff: That's funny. I didn't think about it from the entropy story. I think that's a funny way to think about it. 

Molly: Yeah. 

Geoff: That's cool. 

Molly: Maybe I'm wrong, but it makes sense to me scientifically, so I'm gonna go with it. 

Geoff: I mean, I think the heat thing, I think is from a slowing of the metabolism more than-

Molly: Yeah, but that, I mean, that in itself is also-

Geoff: Which I think, again, so the-

Molly: ... produces entropy, you know? 

Geoff: Yeah. Yeah. So yeah, what are the big things? So like busy 2018 so far. 

Molly: Yeah, so last time we talked, you were like I think at the end, I remember listening to the podcast and you were like, "Wait. That's it? Is that all you're gonna do?" And after the podcast I was like, "I guess I should do more things this year". So I've been working at Sano a couple days a week. I've been actually using a lot of the learnings that I've gotten from fasting and continuous glucose monitoring to sort of redesign my practice around a metabolic flexibility program, which I'm continuing to work on and we'll hopefully roll out some time this summer with a Beta test group, where what we'll be doing is we'll be teaching people from like a first hand experience with monitoring their blood sugar or their ketones, they're respiratory quotient and basically teaching them how to become metabolically flexible through different dietary changes as well as through fasting. 

So ketone esters will certainly hopefully be a part of that, because I think that getting people past that inflection point is really challenging and then I have been working on developing a podcast myself, so I hope to launch that in July and then I've been doing a little bit of-

Geoff: What's it gonna be called? 

Molly: I don't know yet, I don't have a good one. 

Geoff: All right.

Molly: I need a name. If you can help me think of a good name, like that's one of the things that's keeping me from fully pushing it out yet. But it's gonna have to be good. I don't know what it's gonna be right now. So if anyone has any good ideas, please come to my Instagram, Dr. Molly.co and give me your ideas, 'cause I need some. 

And then I've done some-

Geoff: How about the Dr. Molly show? 

Molly: I mean, I was thinking that, Dr. Molly show or like Dr. Molly on and then dot dot dot or something, 'cause it's gonna be on different topics. But I have been doing some wellness travel excursions. I went to Esalen Institute and taught a bunch of executives all about how to plan your life like a start-up and how to really create systems for setting goals for your year and really actualizing those goals and really just analyzing how can you make professional improvement in your life over time. 

I'll be doing that again in August. And then I'm trying to think of all the other things. So I'm still advising a few companies and a few months ago, I was like really getting a little burned out from work and so I started traveling a little bit, so I did a bunch of travel and now I'm kind of getting back into the whole like, "Okay. I need to hustle again". 

So really I'm just trying to role out the podcast. Really, I'm just working on this product with Sano, as well and like trying to get some preliminary studies really designed well, where we're doing accuracy studies right now just to really prove that we're equivalent to the existing tools on the market and then we wanna start studying different interventions, different nutritional interventions to see how do we continue to teach people how to lower postprandial glucose and lower fasting glucose. 

And I've also developed some products in the meantime. I've developed a skin product that really has changed my skin dramatically. So I'm working on the labeling over my next vacation with my family in July and then I'll be testing this out on my community before I actually launch a website around selling it. 

Geoff: Very cool. 

Molly: And then I wanna, and then-

Geoff: What's the secret magic sauce or what are the, what's your secret? 

Molly: It has about 15 different oils. It has base oils. It has sort of they call bonus oils, which are like active oils but they're not essential oils and then it's got essential oils and then it also has like a super hyper potent stabilized vitamin C and then it also has a couple absolutes, so it's got a really amazing smell. Like it just smells like magical on your skin. And then it has some preservatives that are plant-based preservatives. And so it's pretty, it does have one product that comes from an animal. It has an Emu oil in it, which I'm gonna replace, I think with macadamia oil, just for the vegans, because I know that vegans are not gonna want animal-based stuff. 

And then I'm actually working on putting a sunscreen into this. 'Cause I want this to be like an all-purpose skin product that essentially just does everything you need it to do for your skin, 'cause I'm trying to become as minimalistic as I can. As I start digging into fertility and understanding health, I'm starting to realize that all these beauty products that I'm putting in and on my body are just not healthy. 

And so I'm trying to develop a product that is all purpose, singular tool that just, you only will need to put this on your skin and you're gonna be good. 

Geoff: Yeah. 

Molly: So that's what I'm working on. Yeah.

Geoff: I mean, if I said anything about not needing more stuff, now you have a lot on your plate for the rest of the year.

Molly: Yeah, I have a lot on my plate. It's pretty fun. Yeah. 

Geoff: Yeah, I mean, thanks so much for coming by. I mean, this was actually gonna be the last podcast taped in this studio. 

Molly: Oh, my god. 

Geoff: So we're closing out this version of the Human Podcast. 

Molly: Wow, this era. And even honestly, I keep on listening to your podcast and just from the very beginning to now, I'm so impressed with just how you guys have evolved. Like I love your work. I'm a fan girl of Human, you know, you guys are great. I actually doubted you. 

Geoff: I'm a fan girl of Molly. 

Molly: I doubted you guys so much when I first met you, and now I'm like, "All right. I'm joining the club."

Geoff: Thanks so much. 

Molly: Sure. 

Geoff: We'll have to have you on in our new studio in the coming months and I think, sounds like you're gonna have a lot to report back on. 

Molly: I sure am, yeah. 

Geoff: Thanks so much. 

Molly: Bye. 

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