Eat More: The Dietitian Rewriting the Rules on Weight Loss for Men | Dr Jessica Turton
A blood test flagged your blood sugar, and your doctor's advice was the same as always: eat less, move more, and check back in six months.
If that number never really moved no matter how disciplined you got, or you're quietly turning "pre-diabetes" over in your head without knowing what to do about it, this one's for you.
Dr Jessica Turton is an Accredited Practising Dietitian with a PhD in nutrition from the University of Sydney, where her research focused on low-carb approaches to diabetes. She has presented her work at international conferences and built a Sydney practice around treating insulin resistance using a method built on eating more of the right foods, not less of everything.
She is not selling another diet you white-knuckle for a fortnight. She is honest that it takes real changes to what ends up on your plate. What shifts is that you stop fighting your own biology and start working with it.
If a doctor has ever handed you advice that never worked, this is the conversation that explains why.
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Meet the Guest
Dr Jessica Turton
Dr Jessica Turton is an Accredited Practising Dietitian and the Director of Ellipse Health, a Sydney-based dietetics practice she leads alongside her husband Tom and a team of practitioners. She holds a PhD in nutrition from the University of Sydney, where her doctoral research investigated low-carbohydrate diets for the management of type 1 diabetes, including an Australia-wide clinical trial run with the CSIRO.
Jessica has co-authored peer-reviewed research published in journals including Diabetes, Obesity and Metabolism, and has presented at international conferences such as the American Diabetes Association Scientific Sessions, Low Carb USA and Low Carb Down Under.
Her clinical work spans type 1 and type 2 diabetes, insulin resistance, PCOS, disordered eating and weight management, and she has helped thousands of patients improve their health without restrictive dieting. Jessica also co-authored the eBook Getting Started with Low-Carb and created the online program Eat More to Lose Weight.
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POD: Jessica, welcome to Don't Let the Old Man In. I'm so excited you're here.
JESSICA: Thank you for having me.
POD: I first came across you on this magazine cover, and I thought, "Jessica Turton says you should eat more to lose weight." That sounds like a woman I should meet.
JESSICA: You speak my language.
POD: And I read the article, and I've watched many of your interviews, and I can't wait to dive deep into the way you think about food, and the way you don't think about dieting, and the hundreds if not thousands of people you're helping because of that. So for our audience listening, what would they get from our conversation today?
JESSICA: Well, hopefully they understand that low calorie diets, or the whole eat less move more movement, which we hear about for weight loss from everywhere, hopefully they understand that that is not the only way to lose weight, and there are other ways that you can improve your health. There's other ways that you can lose weight without restrictive dieting.
POD: That sounds like a great start. So as I said, you were on the front cover of a national magazine. It wasn't a little two page article, it's a 12 page spread, which is a big article. It's a cultural movement if you want to go down that route. How does the 32 year old PhD graduate end up where you are now?
JESSICA: I think, so, I mean, it all starts with my own experience dieting, I suppose. I became very passionate about nutrition, health, weight loss, and so I went into university to become a dietitian and do what I had to do to help other people essentially. But as I was doing that, I realised that the way that I thought about dieting and weight loss was very different to the way that was being taught. And it wasn't just different, but it wasn't acceptable, I guess.
POD: And so it's not simple to you. That's me, to them, the way you thought about food was not acceptable to the people teaching about nutrition.
JESSICA: Yeah, exactly.
POD: Yes, really interesting place to find yourself.
JESSICA: So as I was just an excited uni student, asking questions, going through the lectures, all that sort of stuff to become a dietitian, I realised that my questions, what I was interested in, wasn't really being well received by lecturers, other people in my class. And what we were being taught was really the complete opposite.
So at that point I realised through my own journey that low carbohydrate diets, for example, were a fantastic way to lose weight and improve your health. And one of the components of a low carb diet is eating more healthy fats. But as you go through university you learn a lot about how bad fats are for you and how you should restrict those fats, but specifically for weight loss you should restrict total energy, and that's the only way to lose weight.
The more I went through university the more I realised I sort of had to keep my mouth shut to get through. But because maybe I'm stubborn, I don't know, I decided, you know what, I'm gonna do what I have to do to get this degree. But I'm not gonna just leave it there. I knew I had to do more to really prove myself.
I guess because, as I was going through uni, I sort of realised that the way the system was set up is that I wasn't gonna thrive as a practitioner. I wasn't gonna be able to help my patients unless I built trust with people. And so I guess to build trust I decided to do a PhD, so that I could have some more credibility in terms of what I was talking about, but also so that I could learn how to dive into the scientific literature deeper than you would just doing a bachelor or a master's. And it was such an interesting process for me.
My PhD was low carbohydrate diets for type 1 diabetes. We basically drew upon the research in type 2 diabetes and then we applied that to type 1. But that allowed me, it kind of just opened this new world. It allowed me to speak at conferences. I was invited to lots of podcasts, and slowly, slowly, not only found a way to speak about really controversial topics that sounded grounded and evidence-based, but I was also being able to get out there in such a way that I was able to present this information that seems somewhat controversial as a logical step for type 1 diabetes management.
And so even though this article and a lot of what I talk about now isn't necessarily about type 1 diabetes, that's kind of where my research was. And then because of that, and because of, I think, the people I met and the presentations that I was involved in and all of that, there's some presentations on YouTube, I think that's what kind of led me to this article, I suppose.
POD: I want to get to the science, I want to get to the way you think about food, I want to get to the way you work with your patients and the results that you seem to get. There are many things, it's quite extraordinary. And I want to maybe talk about how even some, like Weight Watchers, seem to be changing the way it talks about what it does, closer and closer to what you talk about, which is really interesting.
But if I could, you have a deeper story, in the sense that before you went to uni, according to the article I read and some of the stuff you talk on YouTube, you had a multi-year cycle of difficult relationships with food, which probably really informed the way you think. Can you share some of that with us?
JESSICA: Yes. I think that is a pivotal part of it, because I came into university already having this strong idea on nutrition and health that was different to what was being taught, and I think most people, well, many people, don't have that, I guess.
But yeah, so when I was just starting out in high school, I was extremely tall. I think I was as tall as I am now, but in year six, right? So I towered above everyone, all the boys, because they hadn't quite gotten there yet, right? And I felt really big, really large, and a lot of people made comments about, like, "Wow, you're so big," and, "You're so tall", some nice, some not so nice. And I think that just sort of got to me, but not necessarily in a bad way.
I was carrying a little bit of extra weight and I was like, well, I am interested in nutrition and I'm not really doing anything about my diet to eat healthy at the moment, so maybe I'll just learn a little bit, maybe I'll learn how to eat a little bit healthier, and maybe I'll trim up a little bit, and that'll solve that problem, I guess. But the intention was to be healthy. And I was like a bit of a self-confessed chocoholic, so I definitely wasn't healthy before that point, right? Like, I was just eating whatever I want, like most kids do, I guess.
And so when I searched online, "What is a healthy diet? How can I be healthy? How can I lose a little bit of weight?" Really the only advice that was there was calorie restriction. So if you eat less energy than you expend, you will lose weight. And there were all these different ways of doing that, I suppose, but the core of it was you've just got to eat less energy, eat less calories.
So I started counting my calories, and I was using those books, because we didn't have all that stuff now. So I was using those books to write down everything that I ate and calculate all my calories, and I was like, cool, this is how much I'm eating, I'm just gonna gradually reduce it day by day. And this is what people do when they're trying to lose weight, even to this day.
And I did start losing a little bit of weight, and I initially probably felt quite good, because my diet quality improved as well, I would say, in some ways. I started going to the gym and exercising and all these sorts of things, and people were asking, "Hey, what are you doing? You look great." This is really exciting. People sort of wanted to jump on board and wanted me to help them as well. So it's like, okay, cool, what I'm doing is right.
And somewhere along the line it turned from being this sort of healthy, normal thing that everyone was excited about to being this thing that became quite toxic, and other people started getting concerned. And I did develop what we call disordered eating behaviours. And so even though I went into the initial diet very healthy minded, I had no mental health issues, I had no disordered eating behaviours at that point, the diet itself sort of led to that, I guess, and we can talk more about that later.
At the time I didn't think about it in this way, but essentially, I guess I didn't really have a goal at the time of where I wanted my weight to be, but I just started getting, in some ways, addicted to it, right? Like, restricting calories and losing weight just became my identity, I guess, in many ways, and I just kept pushing harder, doing more, and I didn't know what else to do. Right, like, I had no other tools than to just count and restrict calories. So eat less, but then also to move more.
So I started going to the gym even more than I already was, two, three, four hours a day. And I remember getting to the point where I thought if I ate more than 1,000 calories, that was bad. So I was trying to restrict to less than 1,000 calories while going to the gym for multiple hours, and while growing as well. And so yeah, it did become extremely toxic. And I lost a lot of weight. So I started around 75 kilograms, and by the time I got to my lowest point it was around sort of 47 kilograms. So it's a lot of weight to lose for someone who was growing, who was just starting to go through puberty, I guess.
But yeah, it wasn't my intention, I didn't start out that way. At the beginning I wasn't saying, all right, have this terrible relationship with food and get really skinny, that wasn't the plan. And I think when you speak to most people that have experienced that sort of disordered eating, they say the same thing. It starts off you're just trying to eat a little healthier, or maybe you do need to lose weight and so you are just trying to lose weight, and oftentimes you're following the advice that's on accredited websites or government websites. Like, that's what I did. And so you think you're doing the right thing.
And what I know now is that the calorie restriction itself induces the disordered eating behaviours. I didn't know that at the time. When someone's got disordered eating, everyone around them just says stop, why are you doing this? As if it's a choice. But it's not a choice. It's a consequence of calorie restriction. And I think that's part of the reason I am so passionate today about showing people there are other ways you can lose weight. It doesn't have to be calorie restriction, and it doesn't have to be, that's not the only approach. Eat more, look, eat less move more, it's not the only approach.
POD: It's in effect, you use macronutrient manipulation, in terms of really focusing on your macronutrients as opposed to restriction.
JESSICA: Yes.
POD: In terms of, to come out of that phase...
JESSICA: Well, it took me a while to get there. This is probably the most interesting part when I reflect on it, and especially with the sort of clients I work with today, because when I did get to that point where I was at a really low weight, I started really feeling it in my body. Like, I was depressed. I felt cold all of the time. I was shaky, and I just knew that I wasn't well, and I was like, I just can't keep doing this. And I started even getting worried, because it's all I knew.
So I remember getting to a point where I was like, alright, I just have to, quote unquote, eat normally again, and everything will be solved. I'll just go back to where I was when I started this whole thing. But it's not that easy either. You can't just eat normally, or at least I couldn't, because I didn't even know what that meant. But the other thing that happened was, when I tried to let myself eat more food again, I sort of lost control and I found myself essentially binge eating, and I gained weight rapidly. So I went from 47 kilograms up to around 90 kilograms in a very short amount of time. And again, I'm going through high school, right? Like, this is very confronting.
I remember as I was gaining weight, everyone's like, you look healthy, you know, you're back to normal, everything's great. But inside I was probably at my darkest point internally. Because it's one thing to restrict your calories and lose weight, but that's kind of like what you wanted to do, right? Like, you wanted to lose weight. That was part of the goal. You're sort of in control at that point. When you're going through a binge eating disorder and you're rapidly gaining weight, you are out of control, and you're becoming everything that you feared.
When I speak about binge eating, I'm talking about a true clinical binge eating disorder. I think a lot of people might say, oh yeah, had a binge, like they overate a little bit. But the way that I define it is when you have a clinical binge eating disorder, it's like you have zero control over what's going in your body, and it's really quite scary when you think about it like that. And it does lead to this pretty significant weight gain, which is what happened to me.
So it was sort of at the point where I then kind of reached my second lightbulb moment, I guess. Because I was lucky to get to that point when I had been restricting, to saying, no, I can't keep doing this. I know a lot of people don't get to that point. And so again, on the other end, I was like 90 kilos or whatever, and I think I was about to go into uni to become a dietitian. This whole time I'm like, yeah, I'm going to figure this out, right? Selfishly, probably for myself initially. But yeah, so I'm like, gosh, I'm going to go to uni to learn how to be a dietitian, I've got this binge eating disorder and I'm overweight. There was a lot of me feeling embarrassed, I guess.
So that sort of started the quest of trying to reflect on my whole experience and just figure out, firstly, how to stop binge eating, because that was wild. But secondly, how do I lose weight in a sustainable way? Because I knew I couldn't go back to what I started with, which was that whole calories in, calories out. So I had to figure out a different way to do it while I was still dealing with this binge eating disorder.
Luckily, as part of my undergrad, so I did a bachelor's in exercise and sports science and then my master's was nutrition and dietetics, so when I was going through first year at university, we learned about different fuels for different forms of exercise. It had nothing to do with weight loss. But the lecturer said, oh, and when insulin levels are low you can burn fat, and when they're high you're essentially storing fat, or you're not burning fat. And I was like, wow, that's so interesting.
I should say his name, because he did then go on to be my lecturer, sorry, not my lecturer, my PhD supervisor, Professor Kieran Rooney at the University of Sydney. Yeah, it was a pivotal moment for me, because in the lecture he wasn't even talking about weight, he was talking about exercise. But then I was able to use that to help open the door to all this research on low carbohydrate diets, because that is how you can lower insulin levels, get your body to burn fat.
And so that's what I started doing for myself. I was like the guinea pig, I guess. And so I just started lowering my carbohydrates, but eating lots and lots of fat, lots of protein, lots of fat. And I'm talking a lot more than a typical person would eat, because I was binge eating, right? So that didn't just go away overnight. Through that I managed to reach my healthy weight with what seemed like minimal effort, to be really honest. I completely stopped binge eating, and I also improved my relationship with food significantly, all without having to restrict calories. And so that is where my love for low carbohydrate diets came into play, but also my interest in methods for weight loss and health gain that don't involve calorie restriction.
POD: And I think that point is really important. First of all, thank you for sharing your story. Really, really helpful, not just from a context point of view, but to hear someone explain what it's like to go on both of those two extreme journeys like you did, so appreciate that. But the other point you just made, there's lots of low calorie diets that actually are restricting. Well, that's not what you're saying. You're saying low calorie diets, but are not restricting what you eat. The volume is not being restricted. It's the kind of foods, like you're encouraging a particular kind of food to eat as much as you want. I eat fats.
JESSICA: Yeah, so I guess the main method for weight loss as it stands, and I think it's still this way at the moment, is just low calorie, which is just eat less of everything. But with a low carbohydrate diet, you are technically restricting calories from carbohydrates, but you're eating the other components, the fats and the proteins, to satiety. Not everybody does it that way though, I should clarify. There's a lot of low carb diets out there that are also low calorie as well. But when you look at the research, especially for type 2 diabetes, because that's where most of the research for low carb diets is, most of those studies do not restrict calories. And so that's sort of the method that I found particularly interesting, and I've applied that to different clinical populations.
POD: Well, given our audience is typically between 40 and 65, where are we in your population in terms of who you work with? Let's start at the beginning. Let's get some core ideas on the table. And can you talk to us, what is basal metabolic rate, and what is the relation between insulin and glucose in terms of food, in terms of how the regulation works? You've already mentioned when it's higher, when it's low, the effect that has.
JESSICA: So the basal metabolic rate is essentially how much energy your body needs to fuel vital organ systems. A lot of people like to say it's the amount of energy you burn at rest, but I don't think that really explains it, because it's the minimum amount of energy your organs need to function. So that's a better way of thinking about it.
So one example I like to give is if you were in an induced coma, hopefully you never have to experience that, but if you were, your brain's not working, right? It's not switched on essentially. You're not thinking about things. Like you and me, we're at rest right now, but our brain is switched on, we're thinking about things, it's using a lot of energy. So we have to make that distinction, that let's say our brain is not switched on, we're lying in a dark room, we're not processing any information, we're not moving our body at all aside from just breathing, I guess. The amount of energy we need for that circumstance, that's our basal metabolic rate.
Okay, so for women it's around 1,500 calories a day, for men it's around 1,800 calories a day. But it all depends on how many cells are in your body. So if you're a larger person you have a higher resting metabolic rate; you're a small person, it's lower. So that's the resting metabolic rate. I'm sure we'll get into this, but a lot of diets restrict below that, which is extremely dangerous in my opinion.
And then when we think about glucose and insulin and how that ties into weight management, that's slightly different. So rather than talking about how much energy your body needs, which is sort of what we're talking about with the basal metabolic rate, when we talk about insulin and glucose we are sort of referring to what type of fuel your body is running on. And a lot of people don't know this, I didn't know this, when you talk about restricting calories for weight loss you just think about energy in, energy out. You don't actually realise your body can use different sources of energy.
And there's really four macronutrients. We've got carbs, fats, protein, alcohol, and out of those four macronutrients your body prefers to use carbohydrates or fats for energy. So they're kind of like our two main energy sources. When you eat carbohydrates that turns into glucose in your blood, so that's where that term comes from. Your body can also make glucose.
Now, the interesting thing about the human body, or at least I think it's interesting, is that you cannot burn two fuels at once. So the body has a choice where it goes to. Well, it has a priority system, so it doesn't really have a choice. We have a choice. But our body is going to prioritise the most toxic fuel first.
POD: What do you mean by toxic?
JESSICA: Well, take alcohol for example. So most people can understand alcohol as a toxin. Let's say you drank alcohol and your body wasn't processing and metabolising that, it would build up in the blood and you would die. So that is a toxic fuel. Carbohydrates or glucose is also a toxic fuel, because if glucose builds up in your system, the glucose can start sticking to proteins in your body, damaging those proteins. And I mean, this doesn't usually happen, but you could die, right? Like if it got really, really high, like if someone was just injecting you with glucose. But your body has systems in place to stop that from happening, as it does with the alcohol too. But that's what I mean by a toxic fuel.
And so let's say you went out to a party and all those fuels were coming in, right? You had the alcohol, the carbs, the protein, the fat. It was all coming in, pizza, wine, that sort of stuff. Your body is going to prioritise burning the alcohol first. That is the most toxic.
POD: Did I know that?
JESSICA: Mm-hmm. And you want your body to do that, right? It's protecting you, and so everything else sort of gets put to the sidelines. The way that your body manages that, or one of the ways your body manages that, because glucose, as we just said, it's also a toxic fuel, so you don't want that building up as well. One of the things your body does is it shuts down its own production of glucose while you're drinking alcohol. So it's trying to reduce that second most toxic fuel while it's dealing with the alcohol.
But essentially what happens is you burn the alcohol first, and then whatever glucose is in your blood, you burn that second. And then you usually get to the fats. You don't normally burn protein as a source of energy, it's more like a building block. So even though it is there as a source of energy, your body doesn't like using it. Maybe if you're starving you will use protein, but aside from that you won't. So it's alcohol, carbohydrates, then fats.
Now let's take alcohol out of the equation, because a lot of people kind of acknowledge that alcohol isn't necessarily a healthy energy source to run on. So now let's just look at glucose and fats. Most people have a mixed diet, meaning they're taking in similar amounts of fat and carbohydrate. I would actually say that it leans more towards a high-carbohydrate diet, where people are getting most of their energy from carbs, but they're still having fats as well.
POD: We say carbs, you mean breads and pastas and rice and, yeah, kebabs and all that kind of stuff.
JESSICA: Yeah, so an easy way to think about it is anything that comes from a plant is a carbohydrate. So yes, your fruit and vegetables, but also grains and grain-based products, and sugar and products with sugar in it essentially. So we're talking about processed carbs, but also real food carbs. Your body kind of treats them similarly in some ways.
So when you eat carbohydrates as your primary source of energy, your blood sugar goes up. And when your blood sugar goes up, your body has to bring that sugar back down, because remember we said that's toxic. So that's where your body releases insulin, and that's a hormone that helps that glucose go into your cells. So out of the blood into your cells, maybe into your brain, maybe into your liver, maybe into your fat cells, maybe your muscle cells. Inside those cells that glucose might get used for energy or stored as fat.
So that's a good thing. You want your body to do that, right? Because we don't want glucose building up in the blood. It's dangerous. That's what happens when you have type 2 diabetes.
Remember though, if you also have fat in your system, your body has to have a way of putting that fat to the sidelines, because it cannot burn two fuels at once. So when insulin goes up to deal with the glucose, it also stops your body from burning fat. So it inhibits fat oxidation, right? So when we say in very simple terms, when insulin is high, fat burning is switched off. That's the whole process we're talking about, and that's why it happens. And that's not a bad thing, that's just how the human body works.
POD: But the term insulin resistant now means the body is not utilising the high levels of insulin to potentially look at the fat.
JESSICA: Yes. So when you have insulin resistance, which is extremely common, it can happen because of a genetic component, so it's not always to do with lifestyle. But it can also happen because of your lifestyle and the foods you've eaten, or the exercise or the lack of. Stress can be another thing that causes insulin resistance. But essentially it's exactly what it sounds like: your body gets resistant to that hormone insulin.
So you eat something with carbohydrates, your blood sugar rises, your body releases the insulin, but nothing happens. You're not listening to that hormone, or your cells are insulin resistant. So then your body has to release more insulin, and it does that, it has a good ability to just pump out more insulin, get those sugars down.
Now if you don't do anything about that insulin resistance and it just gets worse and worse with age, then your body isn't going to be able to just keep pumping out more insulin. Eventually you're going to get to a point where you lose control of your blood sugars, and now they go up and they stay up. They stay up for too long, or they never come back down to baseline. And this is type 2 diabetes.
POD: Therefore the body's taking energy from the glucose, not from stored fats.
JESSICA: Well, that's where it gets a little bit complicated. When you have type 2 diabetes, as much as it's a very common condition, it's a real disaster. It's a metabolic disaster. So we've spoken about these fuel systems and how your body should work, right? Type 2 diabetes is when your body doesn't do what it should be. The metabolism is broken.
And so what happens with type 2 diabetes is they're releasing all this insulin to try and deal with the high sugar and turn that into energy, but they can't, because in order to actually get the glucose into the cells to use it for energy, you need working insulin. You need to be sensitive to that insulin. So now they've got a buildup of glucose in their blood, and that's energy that's not getting into the cells. But insulin is always high, so their body's constantly pumping out insulin. They will never burn fat, never going to get around to burning fat.
And so we're in a situation where the body's not very good at using glucose for energy, because you need to be insulin sensitive to do that, and your body can't burn fat because insulin is always high. This is a huge disaster. So what happens in type 2 diabetes is their body starts making extra energy in the form of glucose.
POD: And attaches to the cells, touch the proteins, go around the body, and then, yeah, eventually degrading the body.
JESSICA: Yeah. So the body doesn't process, oh, I'm insulin resistant and I have too much glucose. It's just like, I need energy, I'm starving. Because that's what we're truly saying here. If you can't get glucose or fats into your brain, into your organs, into your muscles, you are starving. People don't really think about it like that. When they have type 2 diabetes, they're usually carrying extra weight, they don't think that they're starving. They usually think the opposite. And so their cells are starving.
And so their body releases all these stress hormones. It makes extra glucose to try and give them more energy, but it's not going to work, because your body still can't use that glucose even if you're making it. So really the best solution for someone with type 2 diabetes is what we were talking about before, a low-carb diet. But it has to be a diet that provides lots of energy and nutrients so they can get the right energy into their cells.
POD: It's a low-carb diet in order to retrain the body to become open to insulin, to then really regulate itself.
JESSICA: Yeah, so you're improving insulin sensitivity, but you're also getting energy into the cells. I think they're the two key parts of an effective diet for type 2 diabetes.
POD: Right. That's a great foundation for a whole lot of questions I have for you.
JESSICA: Excellent.
POD: You've used the word starvation, and in the article that I read and some stuff I've read that you've written, you've cited a Minnesota starvation experiment, which sounds extraordinary that someone would actually do such a thing, but the results were quite extraordinary too. Tell us about the experiment. What does it mean from a post-restriction metabolic state?
JESSICA: Yeah, it's interesting, because I think a lot of good nutrition science happened in the early 1900s when there wasn't rigorous ethics. People report an experiment whether you want to or not. Thank you to those people. So we couldn't repeat this today, right? But we do, that's what's interesting. We couldn't actually call it semi-starvation, but we call it low calorie. So we're doing the same thing.
But let's talk about it. So it was a study published in the 1940s, and basically what they did, they wanted to intentionally starve men so that they could develop an effective refeeding strategy for starved troops after the war. So they wanted to recreate these starved men, refeed them, and see how to do that in a safe, effective way for men in war, right?
The men that they recruited for this study, they were healthy minded men. So they had to undergo rigorous psychological testing to make sure they had no mental health issues, no disordered eating behaviours or anything like that. And they were university students as well, so they were quite intelligent, I guess. But what they were studying at university had nothing to do with diet, right? So they didn't have any background knowledge in diet or a background interest.
POD: Healthy young men.
JESSICA: Yeah. And so what they did was they starved them. So they called this diet a semi-starvation diet, but what it was was a 50% reduction in calories. So the men were typically eating around 3,000 calories a day on average before the study, and in the semi-starvation phase it came down to 1,500 calories a day. So that is what they called semi-starvation. Now today we just call that light and easy, or some kind of just standard weight loss diet. That's just eat less, move more. Everybody is doing that, right? But in the 1940s that was starvation. And so that's already interesting, I guess.
POD: It's easy, because I would have thought that when we think about the abundance of food we have today relative to a hundred years ago, it's not quite a hundred years ago but close to it, I would have thought, one, that the abundance of food was not there. But you're saying typically they're eating 3,000 calories anyway. This is before processed food became mainstream.
JESSICA: Yeah. I think they did have processed foods in the sense that they were preserving their food to try make it last longer. So they did have access to things like pasta and all of that, but it wasn't processed food like we know it today. It wasn't that addictive kind of, you know, we've got food everywhere.
So I think it was either three or six months on the semi-starvation diet. They lost a significant amount of their body weight, which was the goal, right? They wanted to, I think it was 25% of their body weight. It was quite significant. And they were still doing all their daily activities.
Now what was really interesting, and this was not the goal of the study, but what they found out during this semi-starvation phase, the men didn't just lose weight. They became depressed, they became anxious, and they developed disordered eating behaviours. And so that included hoarding food and trying to get control over their food. This was a well controlled experiment, so they weren't just out living their lives. They were in a controlled environment, the food was being given to them. And so in a controlled environment, these were men were trying to get as much control as they could over food.
They also became obsessed around food, nutrition, dieting. All the university programs collapsed, because they didn't want to learn about whatever they were learning about before. Now they just wanted to talk and learn about food, nutrition, which is interesting.
POD: It's very interesting.
JESSICA: Yeah, and this was not an intention. This is just something they observed, and all they did was restrict their calories. They didn't do anything else, everything else continued as normal.
So that was extremely interesting. I actually learned about that study at university when I was doing my master's degree. When we were learning about disordered eating as a dietitian in university, they spoke to us about this study. But it was so interesting what their takeaways were when they were teaching us. They were saying things like, so this proves that the brain doesn't work properly when you have an eating disorder. Therefore you can't really trust what someone with an eating disorder is saying, and that was their big takeaway from this study. And I remember thinking, that's a very odd thing to say. Like, we've just read this whole study and that's your big takeaway? So as dietitians, we just need to not trust what this person's saying because their brain's not working properly.
POD: That does seem a very abstract conclusion. Am I right in saying that one of the other findings was the basal metabolic rate stayed suppressed?
JESSICA: Yes.
POD: Long after their return to the previous weight.
JESSICA: Yes, we didn't learn about any of that. That was something I went back in and looked at later.
POD: Wow.
JESSICA: So at university, we didn't really learn about the actual sequence of events and what led to what. It was just like, oh, when you're dealing with people with disordered eating, you can't trust what they say.
POD: Wow.
JESSICA: That's the classroom environment I was in, I guess, to paint the picture. But when I actually looked at the study and really read through it myself later and studied it more, I realised that, and this is what we were saying before, it was the calorie restriction that caused the disordered eating behaviours in these men. It also caused mental health issues and other problems as well, like low libido.
Then, as you're saying, they went through a refeeding phase, and the initial refeeding phase was a controlled increase in calories. Then the phase after that was eat as much as you want, to see how much they would eat. Now, in the controlled refeeding phase, where the calories were still controlled but they sort of gradually increased back to normal, I think is what happened, but when they did that the men went back to their baseline body weight. So a lot of people would have thought, well, okay, at that point everything's back to normal.
POD: Yeah, exactly.
JESSICA: But then when they went through the unrestricted feeding phase, a lot of the men developed binge eating. So they were excessively overeating, and a lot of people would think, like, yeah, of course, because someone was just giving them a whole bunch of food. But it wasn't like they were having fun. They weren't sitting around together drinking, having parties, things like that. A lot of the men had to get their stomachs pumped. They were dealing with gut distress and they were still clinically depressed and anxious and dealing with all of those disordered eating behaviours, plus binge eating.
There were some interviews, I think one or two of the men, when they were much later in their life, like they were in their 70s or their 80s. There was actually some reports of these men saying that the disordered eating behaviours never left them, and so they became lifelong disordered eating behaviours.
But one of the things, and what you were talking about, is what they were measuring was their resting metabolic rate and how this was changing at different parts of the study. And so initially these men had never dieted. They were eating 3,000 calories a day. They were normal healthy weight, I guess. And so you would assume that their resting metabolic rate was kind of optimised. They showed that when they went through the semi-starvation phase they lost all that weight, their resting metabolic rate went down, and a lot of people kind of understand that, right? Like, when you lose weight you've got less cells, so you're going to burn less energy. But then what was really interesting is when they gradually increased their calories and they returned to normal baseline body weight, their resting metabolic rate remained suppressed. So during that period their weight went back to normal, or baseline, but their resting metabolic rate didn't recover.
POD: So that's interesting. So what does that mean from a practical point of view for those men?
JESSICA: Well, I think a practical point of view for people in today's society might be a better question, because that is kind of the crux of everything I talk about with the eat more to lose weight approach, which is low calorie diets suppress your metabolism in a seemingly permanent way. So beyond the period of dieting, your metabolic rate can remain suppressed, which is why it's so hard to lose weight. You go on a diet, your body starts adapting to that diet, you burn less energy, and then you start eating normally again and you gain weight rapidly. Right, and you're like heavier than you were before you started the diet, and you're like, what the heck, how did this happen?
But when they did the unrestricted feeding phase, for the men who actually experienced the binge eating, and this is really interesting, they were eating like 10,000 to 15,000 calories a day, these men, and in the previous they were eating three. So they started off eating 3,000 habitually, down to 1,500. They gradually brought them back up to sort of like 2,000 to 3,000, and then they just let them eat whatever they want. The ones who actually had the binge eating, they recovered their metabolic rate. So eating 10,000 to 15,000 calories a day actually helped them recover their metabolic rate. And so as much as binge eating is a horrible thing to go through, it seemed like the response of the body to try and recover its metabolic rate.
POD: I don't want to be starved. I'm going to get more and more food to recover.
JESSICA: Yeah. So maybe our body inherently knows that we don't just need a normal amount of calories. When I say normal, when those men started eating quote unquote normally again, that didn't repair their metabolic rate. The body must inherently know that we need beyond our usual calorie intake, or beyond our typical energy requirements, to recover our metabolic rate. And so I think that's really interesting when we're talking about people who have been on restrictive diets in the past, whether that's intentional or not. We need an approach that's specifically designed to repair your metabolic rate.
POD: Got it, got it. I'm smiling because you may or may not remember the first time I reached out to you after I saw the article. I said, I think you're a great person for our audience and I really want to share what you have to say with a wider audience. I also said to you, I might be the typical person in the audience, and therefore this is all about me, or anybody else. But what you've just said has really, really hit home for me.
I have played with intermittent fasting, ketogenesis, Weight Watchers, Jenny Craig, lemon juice fasting, Miami fasting, pineapple fasting, carnivore fasting, home delivery food, 5:2. Like a whole plethora. And what you just said suddenly hit me, to go, I've been going starving and then trying to bounce back, and the metabolic response is not the response that I assumed is happening. Is that a fair summary of what might have been happening for me?
JESSICA: Well, I think there's a couple of things going on there, because those diets that you're describing, even though they've all got like different rules and ways of doing it, at the end of the day they're all a form of calorie restriction. And a lot of those diets that you're talking about, they're quite extreme forms of calorie restriction. And you feel when you're on those diets that the less I eat the better I'm doing, right? And so when you're on those diets, and you can tell me from experience, but it's not as if you're happily following them, right?
POD: No, they're not that exciting. The word happy is not the word I've been using.
JESSICA: No. And so you're, I guess, forcing yourself to eat less because you think it's good for you. You're probably battling low energy, brain fog, maybe your cognitive function isn't where you want it to be. Maybe you're also getting a little bit depressed, maybe a little bit anxious, right? So you're not necessarily feeling good while you're on these diets.
And so as much as, on a biological level, your body is adapting to these diets in a way that's not preferable. I mean, it is in some ways, because your body's just trying to keep you alive and help you survive the famine, right? So your body's doing what it thinks it needs to do, but you're feeling terrible at the same time. And so generally you get to a point where you're like, I just can't keep doing this. So even if the diet itself while you're on it is successful in the sense that you lose a little bit of weight, you can't keep going, right? These diets are not set up for you to follow forever, because you feel so terrible. You have to stop.
Now everyone blames themselves and they're like, I don't have willpower, what's wrong with me? Like, I can't stick to it. What's wrong with me, essentially? No one actually asks what's wrong with the diet. But the diet is by default not set up to be a long-term healthy diet, so you have to stop it at some point, whether that's your body driving you or not. And so when you stop it, now you're in a position where you don't know how to eat, because that diet taught you nothing about healthy eating, right? It just taught you about restricting. So you don't know how to eat healthily, but you also have a suppressed metabolic rate. So now your body, your physiology, is actually screaming out for energy. So when you try to start, like, I'll just have one slice of pizza, it's like it ends up being two whole pizzas. Not because you don't have willpower.
POD: I've been there as well. That's how I know.
JESSICA: Yeah, but it's not because you don't have willpower. It's nothing to do with willpower. Your body is designed to survive. And so when your metabolic rate is suppressed and you've been restricting energy for so long, your body will do what it has to do to get that energy. And so again, we blame ourselves, like, what's wrong with us? Why can't we just eat one piece of pizza like a normal person? Why do I have to eat two whole pizzas? But that's your body screaming out for energy. And your body will do that whether you're overweight or not. So your body weight does not necessarily determine your resting metabolic rate or how suppressed it is.
POD: That's really interesting. Yeah. So people who look healthy or look skinny, that doesn't mean that their metabolic rate is better or worse or different to somebody who doesn't?
JESSICA: Not necessarily, no. I mean, a good way to think about it is actually the other example, which is where you... Yeah, so I guess a lot of the way that I'm thinking about it is with people who are carrying extra weight. Their cells can inherently be starving and crying out for energy. And so even though they might have lost some weight on a diet, they might still be overweight, and so that's sort of the point I was trying to make there. Even if you're overweight and you're carrying extra weight, your cells can still be starving.
But you are right, we can also take someone who's never had a weight issue in their life, who from the outside looks very slim and very healthy. They can have type 2 diabetes, they can have a suppressed metabolic rate. And so your weight doesn't determine that.
POD: Okay, is there a difference from men and women in terms of how this works?
JESSICA: That is a good question. Just from what I've seen clinically, I would say with men they have, in some ways, reduced ability to store energy away as fat, which is detrimental in some ways, right? So what we were talking about before with those energy systems, or the fuel in the body, what you may have picked up on is having fuel in your blood, when it builds up, can be dangerous. But if your body can store that fuel away in, like, the fat cells for example, it's safe. It's not actually damaging anything.
Now, women are set up differently to men in the sense that we are biologically designed to store fat better, right? To have more energy reserves for fertility, pregnancy, looking after a child, feeding a child, nourishing a child, right? But men are more set up to use their energy and burn their energy rather than storing it.
POD: That's interesting.
JESSICA: Yes. Now that's obviously a generalised statement, it doesn't work that way for every man and every woman. But what that means for a woman is that usually she has less fuel floating around her system. So her body could be really, really good at making insulin and storing that insulin, sorry, the glucose away as fat, or the fuel away as fat. So she's really good at storing fat and maybe she puts on weight really, really quickly, essentially.
Now men tend to have a bit of a limit as to how much fat they can store in a safe, healthy way. This is why men have that typical body shape which is a bit different to women, where they tend to store a lot of their fat around their midsection, because the visceral fat around the organs, that's not a safe place to store your fat. Like, a safe place or an effective place to store away energy as fat is like the arms, the legs, subcutaneous tissue, the thighs. Now fat stored in those areas is not associated with any negative health outcome. When your body essentially runs out of those places to store fat, then it starts storing away energy in and around your organs, because the cavity there. So yeah, that visceral adipose tissue, now that is not a good thing.
I hope I'm clear when I say this. Women are really good at storing fat in their hips, thighs, legs, arms. There's not necessarily anything wrong with that metabolically. Men don't have that same capacity to store as much in those areas, and so that's why their body starts storing it in the visceral adipose cavity, or the visceral adipose tissue. And men tend to be more prone to larger bellies, right?
POD: Okay, that makes sense. That's why it's dangerous, because it's around the organs.
JESSICA: Yeah, yeah. And women don't like hearing that, right? And men don't like hearing that. I don't think any of those options are necessarily good, right? You don't want to be a woman who's really good at storing fat, but you also don't want to be a man that isn't good at storing fat and then is prone to storing fat around your midsection, but it also increases your risk for diabetes as well.
POD: Okay. Yeah, let's cut to the chase here. Ask you for a friend, who's sitting in front of you. Middle-aged man. I've already told you I've done all these different things. Imagine that we have done some blood tests, and let's assume that I'm insulin resistance, because I'm guessing I am, or anyone in my position, if a mid 50s year old man is. And yet I've come to you, gone, I've done this, this, this, this and this. How would you start, and how do you think about the process from that point forward?
JESSICA: Yeah, I would say that the first thing is just understanding what insulin resistance is. So going through a lot of what we've spoken about in this conversation already, but understanding that you can change your level of insulin sensitivity. So generally what does happen is we do start off being quite insulin sensitive. As we get older, especially as we go above the age of 30, we do tend to become more insulin resistant with age. And that's usually associated with reduced muscle as we get older, that usually causes more insulin resistance. So it's extremely common to be in that position, I guess.
So I think it's important to know that even though we have insulin resistance, there's something we can do about it. And it actually responds really well to dietary change. And that's the thing, a lot of health issues that we deal with today, we sort of feel like there's no hope, like we're stuck, there's nothing we can do, right? But with insulin resistance, type 2 diabetes, and in many cases obesity, there's actually a lot we can do. And so I think firstly having that hope that you can make changes, that's step number one. Because a lot of people don't have that, and sometimes we need to do a bit of education to help bring about that hope.
But then the second thing is looking at where, what you're currently doing, is going wrong. Because I think that's important to reflect on. Because a lot of what I say to my clients is very controversial, right? Like eat more fat, eat more red meat, eat more eggs, eat more cheese, eat more butter, it just sounds wacky, right? And I acknowledge that. So what we have to do is actually look at what they have already done.
So with your diets, let's say the juice fast or whatever, I would then ask you to reflect on that. Like, how did you feel when you were following that approach? And then I would ask you things like, even if it was successful for weight management, which it might have been, what other things did you notice? Like what was your relationship with food like after that approach? Or did you notice any changes to your energy levels, or your ability to focus at work?
POD: I can tell you I hated kale for years. I can tell you straight away.
JESSICA: Totally. So let's reflect on what you've already done, and let's understand if it actually worked for you or not. And most of the time, because we're talking about extreme calorie restriction, we're just bringing to light the fact that that was not healthy. And when someone really takes the moment to think about it, they're like, oh yeah, I didn't feel good at all, and that wasn't the right approach, even if I did lose weight. And so then you're kind of planting the seed in their mind that maybe eating less and moving more isn't the right way forward here.
Then we sort of talk about, I mean, what are those macronutrients, just like we spoke about today, the different types of nutrients that we have in food, and then how they impact blood sugars, how they impact insulin. Because insulin resistance is an interesting condition. It kind of says what needs to happen in the name. Like, you are resistant to insulin. We need to make your body more sensitive to insulin. How do we make your body more sensitive to a hormone? We need to have less of it, right? Like if you're in a really loud, noisy room and I tap the table, you don't hear the table. But if you're in a quiet room, you hear the table, right? You hear me tapping the table. So we know that with hormones, the less of it floating around, the more sensitive your cells become to that hormone signal, right.
POD: And so, going back to make sure I get it, when the body's insulin resistant and bring in some glucose through some meal or some kind, and the body's sugars go up, but it's pumping out insulin, but it's not being taken up by the body. It pumps up more insulin, it pumps up more insulin. There's lots of insulin going around the body, which is the noise you're talking about.
JESSICA: Yes. And then that's just like this progressive cycle. Your insulin resistance just gets worse and worse and worse and worse until you lose control of your blood sugars and you have type 2 diabetes. So what we're talking about is coming in and reversing that process, stopping that process and then reversing it.
And so, yes, then people start to understand, okay, so I need less insulin. Well, how do I get my body to make less insulin? And so the issue answers itself when you fully understand it. Okay, well, what causes insulin to go up? So when your blood sugars increase, your body makes insulin. Okay, well, what causes my blood sugars to increase? And then we talk about the different components in diet.
It's really interesting, because when you actually look at typical standard dietary advice for type 2 diabetes, there is a lot of talk around carbohydrates, but they talk about which carbs are better than the other carbs. So you've probably heard of the glycemic index. And so we talk about low-GI carbs as being better than high-GI carbs. Low-GI carbs digest more slowly, so they increase your blood sugars in a more sort of gradual way. High-GI carbs digest quickly, so you get this big spike and this big drop. But no one actually talks about the other nutrients, right? Like there's all this emphasis on, yeah, you've got to eat low-GI, but your blood sugars are still going up. You're still making a heap of insulin for low-GI foods, because at the end of the day they're carbs, whether they're low-GI or high-GI. They are increasing your blood sugars.
So when we start to actually look at the other nutrients, proteins and fats, they don't require hardly any insulin to metabolise, but they keep you full. They keep you full. And if we're talking about typical 50 year old male, and we start talking about, well, what is a protein? What is a fat? We're talking red meat, talking eggs, we're talking cheese. Right, like all the food that a lot of people want to eat anyway, right? So now it starts sounding interesting. And you're like, oh, but this is totally different to everything I've done before. But that's the point.
POD: You know what strikes me about what you're saying is I think back to my grandparents and what they ate. And that's all I ever remember them eating is not necessarily steak per se, but certainly lamb, chicken, goat, cheeses because they had their own farms, lots and lots and lots of vegetables, and cooking with butter or lard. That's what I remember. And I always remember the food being very tasty.
JESSICA: Yeah, because they didn't cut the fat off.
POD: They didn't cut the fat off, yeah. In fact, the most enjoyable part was the fat sometimes. And we seem to have moved dramatically away from that. That's like a terrible way of living. What are you suggesting is actually there's a lot of wisdom in the way they ate and the way we could and should eat?
JESSICA: Well, it's interesting you say that, because there is a medical textbook, I think I remember the exact year that was published, it was around 1940s, 1950s. And they were talking about diabetes. Now at this point in time, there were no medications to manage diabetes. They didn't know the difference between type 1 and type 2. It was actually quite a rare condition in that time period. But it's funny, because back then they knew exactly what to do. I know it sounds really gross, but the doctors tasted the urine of people with type 2 diabetes. It tasted sweet. They realised that they had too much glucose in their blood and it was an issue of the metabolism not working properly. And so they just told these people to stop eating sugar, stop eating carbs, and that reversed the diabetes. This was back in like 1940s, 1950s. They knew exactly what to do.
It's kind of like we know inherently what to do, but then somewhere along the line the way that we thought about these health conditions and the way that we treated them changed. So in many ways this isn't new. A low carbohydrate diet is nothing new. We're actually going back to what we used to do.
POD: I mean, you could bring in a conspiracy theory here, couldn't you, and say the food companies by nature, it's in their interest to sell lots of food, processed food, right? So therefore that could be one conspiracy theory we could talk about.
JESSICA: You said that, not me.
POD: And so you're saying that for my friend who's in front of you, a starting point would be, look at cooking proteins, as in meat, chicken, having eggs, fish, that kind of protein, vegetables and fats. Fats meaning what? Avocados or olive oil? What do you mean by fats?
JESSICA: So again, another hotly debated topic, like what is a healthy fat, because a lot of the advice around this is a little bit conflicting and confusing and everybody has different definitions of what a healthy fat is.
But let's just come back to what we've been talking about this whole time, which is for people with insulin resistance, whether they have type 2 diabetes or not, or people with a suppressed metabolic rate, or maybe they've got both. These people need energy, right? We keep coming back to this point. Their body is screaming out for energy. So when it comes to what is a healthy fat, now a low carb diet is, or should be, by default a high fat diet.
POD: Right. When you restrict energy from carbs, you have to increase energy, going back to your first thing about different sources of energy.
JESSICA: Yes, exactly.
POD: And so otherwise you just drink a lot of alcohol.
JESSICA: Yes, and some people do that.
When we're talking about using fat as our primary source of energy, that helps us actually answer the question, what is a healthy fat? Because there are some fats that you actually cannot use for energy, and that is really dependent on their chemical structure.
So you've probably heard of polyunsaturated, monounsaturated, saturated fats, these different classes of fat, and they're called those different names or terms because of their chemical structure, but the way that your body uses them is different. So monounsaturated fats, a good example is olive oil. Everybody likes to talk about olive oil as a healthy monounsaturated fat. Your body can use monounsaturated fats for energy. Saturated fats, a good example would be butter or cheese. Again, your body can use saturated fats for energy.
Polyunsaturated fats, I'm not necessarily saying they're good or bad, but your body cannot use them for energy. So polyunsaturated fats are more so designed to be taken in in very small amounts, and we use them as structural fats, so they can go in to be part of your brain. There's cushions around all of your cells and they're made up of polyunsaturated fats. So we need them, but we need small amounts of them. So you wouldn't want to use polyunsaturated fats as an energy source. You actually can't. If you tried to, it wouldn't work. You would get very sick.
Now this is important, because when you then ask what is a healthy fat, a lot of people answer that question with, oh well, saturated fats are bad, right? Like a lot of people think they're bad. And healthy fats are kind of like your plant-based fat, so like your vegetable oils or your margarine, anything that's not saturated. But they are polyunsaturated fats. So vegetable oils, canola oil, soybean oil, those kind of oils that have been extracted from plants or seeds, they are, by their chemical structure, polyunsaturated fats. So again, I'm not necessarily saying they're bad, but they cannot be used for energy. So we can't have them be the majority of our energy intake.
Now when you look at saturated fats, although they've been demonised, they're a fantastic source of energy. They don't touch your blood sugars. But we have to define what is a healthy saturated fat. Because when you look at all the research on saturated fats, especially the research that says saturated fats are bad, they increase risk of disease like cancer, diabetes, that type of thing, heart disease, you actually find that these are big epidemiological studies where they're lumping all these different saturated fats into one kind of food category and just calling them saturated fats. So there's no nuance of any kind to that.
So they'll put your kind of like meat, butter, cheese in that category with pizzas, with pastries, with hot dogs, with party pies, with deep fried chicken. It's all in the same category and they're saying saturated fats increase your risk of disease. They're not actually looking at real food or minimally processed forms of saturated fat, like saturated fat that might be in a steak or saturated fat that might be in an egg or in butter. When we actually look at those studies, which are all the studies I researched in my PhD, there is no increased risk of heart disease. There is no increased risk of diabetes. In fact, eating lots of those saturated fats from real whole foods is what reverses type 2 diabetes and insulin resistance.
POD: So there's a secret sauce here, which has been around for a long, long time.
JESSICA: Yeah, exactly. So we're talking about minimally processed, real food forms of fat, essentially.
POD: So if I want to go home and cook a steak tonight using butter, lard, olive oil, lash it on and enjoy it.
JESSICA: If you have insulin resistance, you have to remember that you're particularly bad at using two fuels at once. Right, so the human body is not good at using two fuels at once, but let's take a 20-year-old male who's physically active, he's insulin sensitive. He could have a lot of fat and a lot of carb together. His body would burn the carbohydrate first. His body would use a very small amount of insulin to deal with the blood sugar response because he's insulin sensitive. And then as soon as he's finished burning those carbs, he'll switch over and burn fat because his insulin is low.
When you have insulin resistance, yes, you can add all those healthy fats and it's really great, right? But you have to do it in the context of a low carb diet, because you won't switch back and forth between fuels like you did when you were 20, because you're trying to get the sugar at a stable level to do that.
POD: That makes a whole lot of sense.
Food freedom. You've talked about you want to give your clients food freedom. And when I think about what I said earlier on about having tried lots and lots of different things, none of that was about freedom. In fact, it was the exact opposite, with a promise at the end of it that, at least in my case, the promise never happened. When we talk about any kind of disordered eating, that's again a real lack of freedom. What is your hope for food freedom? What are you hoping your clients will get?
JESSICA: Yeah. Well, I think it goes beyond just not having an eating disorder, right? It's about breaking free from that toxic dieting cycle, which I think more people are in than not, whether you call it disordered eating or not. It's that whole mindset of I'm on a diet, or I should be on a diet, I feel bad about what I'm eating, or this was a good day, this was a bad day. Those food related thoughts that can just plague you, right, and almost kind of control your life.
And that's the thing, when I think about my experience with disordered eating, the worst part of it was that I had no interest in or enjoyment in anything other than food and nutrition. Like it literally takes over your life. You're obsessed with that.
But I think so many people are today, and they wouldn't even call it disordered eating because it's normalised. So many people are sitting there at home thinking about, I should go on a diet, I need to go on a diet, got to start that diet on Monday. Or they're researching diets, right? And whether it's healthy or not healthy, it's still consuming, and then they have less attention going to their kids and their friends and their hobbies and their other passions in life, because they're consumed by it. They're on edge as well.
And so it's about breaking free from that toxic dieting cycle in the sense that you're not thinking about food all day, you're not worried about dieting, you have found a framework that works for your body. And so with that framework you're able to break free from dieting.
Like I used to be the sort of person that I would get every magazine on the shelf and I would just go to the diet section. I'd be so interested in the next diet. Like what can I try? I tried everything you said plus more ridiculous diets, just because I couldn't think about anything else. I lost all my hobbies. I lost a lot of friendships because I was just so obsessed with dieting.
But now people talk to me about diet outside of my work and I'm just kind of like, nothing fazes me. It does not faze me at all. And I think that it puts me in a position to be able to talk about diet so freely. I think a lot of people who have quote-unquote recovered from disordered eating couldn't talk about dieting all the time so confidently and help other people do it. I think you have to truly experience food freedom to be able to do that.
And I've said this many times, but there is not one part of me that is concerned that I'm ever going to have an eating disorder again. Right, so I think food freedom is not just not dieting. It's having the tools and the framework to not fall into the trap of dieting and restriction.
POD: So you just said you want to be provocative, and what you do is often provocative. A counter-argument to your argument is the debate about thermodynamics, calories in calories out, energy in energy out. And there's a lot of well-known institutions, Cambridge being one of them, does a lot of research around this and then purports to, this is the answer. Now that's a very well-known argument. It kind of is as well known as the eat less move more type argument, in terms of being a well-known mantra, but it sits kind of in a contradictory pose to what you're suggesting. Can you talk to that?
JESSICA: The calories in calories out is kind of like the logic behind eat less move more. They're kind of in the same bucket really. And the idea is that if you eat less calories than you expend each day, you will lose weight. I guess we've already talked about, in many ways, why that can't be true, but I'll explain a little bit more.
One of the things that happens, as we've discussed, is that when you do restrict your calories, now maybe I should rewind a little bit, because I think the thing is, when we talk about eat less move more, we're talking about this very relative term. Like what often happens is we've got an overweight individual who knows they need to lose weight. They go to the doctor. They've got these health problems, or they express concerns to their doctor, and their doctor says, well, you're overweight, so you just need to eat less and move more. But no one's actually asking that individual how much you're eating at the moment. No one's calculating their energy requirements for the day. And so they keep hearing this message, eat less, eat less, eat less, eat less, right?
And so my biggest problem with this whole movement is no one's actually teaching individuals how much energy they need. And so because people think it's the only way to lose weight, like I did, they end up restricting their calories to dangerous levels. And at these dangerous levels your body does adapt to the calorie restriction, and it makes sense from an evolutionary standpoint, right? Because humans are designed to withstand famine. If calories in equals calories out we'd be dead in a few days. Do you know what I mean? Like we wouldn't be able to last that long, because we would just keep, the calories would just keep being expended, like we'd just burn all those calories that we're not eating, and we would wither away and lose weight very, very quickly.
But the mechanism that I've been speaking about, where your body adapts and the resting metabolic rate becomes suppressed, it's designed to keep you alive during periods of energy shortage, right? So it's not necessarily a bad thing. Your body's trying to survive. And so I think, because of the adaptations that your body makes to conserve energy, calories in calories out doesn't apply in states of severe calorie restriction.
Right, like maybe if we've got a really healthy individual who doesn't have a suppressed metabolism, and maybe they need 3,000 calories a day, and they restrict that by 200 calories. Now they're eating 2,800 calories and then they get the other 200 from their body fat. That might be a successful calories in calories out story, right? But people aren't doing that. People aren't going, oh, hey, I need 3,000 calories a day, I'm just gonna reduce that by 200 and everything's going to be fine and dandy. That's not how people are doing it. They're downloading meal plans for like 1,200 calories a day. They're going on juice fasts. They're eating one meal a day. They're fasting for three days a week. People are doing drastic things to eat less and move more because they have no idea how much they should eat.
And so I know that there are a lot of people who say, well, your metabolic rate doesn't adapt, right? And also that calories in equals calories out, that you just have to be in a calorie deficit. That might work for people who haven't had severe calorie restriction in their past, right? So they have an optimised metabolic rate. And it might also work if they're being very closely supported by maybe a dietitian who's giving them a very structured meal plan to specifically eat just a little bit less than they were before, right? So it may work in some contexts.
It's not going to work, as we said, if you've got a suppressed metabolic rate, but also if you've got insulin resistance, it can't work. Yeah, because with insulin resistance, and that's what a lot of people are doing, like they find out they have insulin resistance through their doctor or whatever, or they can just tell from their own research, and then they think, okay, well, I'm just going to start eating a little bit less, right? So maybe they are actually doing maybe 200 calories less, right? So a healthy amount of calorie restriction, but nothing's going to happen unless they reduce their carbohydrates. So we spoke about this before, right? So we need to be able to reduce our carbohydrates to get the blood sugars down, to get the insulin down.
And so I think it's just more nuanced than calories in calories out. I mean, I wouldn't even necessarily say I disagree with it, but I just think it's more nuanced, and I think it's a little bit of a cop out. It's an oversimplification for what clearly is a complex topic.
POD: It doesn't help anyone, does it? Like when you start talking about calories in calories out, you make people who are struggling with their weight feel worse about themselves, because then it becomes a them problem.
JESSICA: They're just not dieting hard enough. They're not trying hard enough. They're not restricting their calories hard enough.
POD: Run more.
JESSICA: Run more, yeah. Just go walk, you get a standing desk, never sit down. Like it's not fair. And so that's why I just think we've got to stop giving that attention, and we've got to start talking about methods that actually work.
POD: So another controversial topic, GLP-1 drugs, Ozempic, Mounjaro. And they're obviously hugely mainstream. They obviously do work for some people, not a lot of people, certainly in the short term. I'm aware that a small number of people they never work for. But what's your overall view on the use that they're getting in mainstream?
JESSICA: I mean, I think it's a tool. I think the way that I have seen them to be effective is when you've got someone who's very much committed to their diet and lifestyle alongside the use of the medication. But then the question is, well, why use the medication if you're going to make those changes, the diet and lifestyle? And I think that is going to be a different answer for everyone, right?
So I have a lot of patients who are changing their diet alongside using medications and that works for them. And then I have a lot of patients who really don't want to use the medications, fine, there are ways you can lose weight without it. And then so they'll use diet and lifestyle without medication and that works for them.
And I think the thing about these medications, which is a problem, is they are being pushed on people, and so there is this pressure that if you are overweight you should take them, because they're just everywhere now, and they really are being pushed on patients as almost like a first-line treatment.
What I see in a lot of people's experiences that they have is that there is this general idea, and I probably would say it stems from research, but I would say it stems from clinical experiences of health care practitioners. There's this underlying idea that diet doesn't work. And I think it comes from the fact that we have a lot of research out there that says 98% of diets fail for weight loss beyond 12 months. But when you look at what diets they're looking at, they are looking at calorie restricted diets.
POD: So do you think, when you think of what you recommend to people, do you think of that as a diet?
JESSICA: Well, it is, it's a therapeutic diet. Yeah, so definitely, but what I then teach patients are these core foundations that they take with them for the rest of their life. But the idea of, if you have insulin resistance or type 2 diabetes your metabolism is essentially not working properly, we need a therapeutic diet to fix that, right?
POD: I think that nuance is really important, that the word therapeutic diet is there to fix something that's not right.
JESSICA: Yeah, whereas the 98% of diets that don't work after 12 months that they refer to, they are majority restrictive.
POD: Yes. Yes, I think the broad mainstream, at least the way my brain works, is a diet equals restriction, but that's not what you're saying. You're saying what you do is a diet equals therapeutic intervention.
JESSICA: Yeah, that's the way I would like to think about it. Absolutely. And I mean, I'm a dietitian, right? So my job is to teach people how to change their diet and improve their health. Most people are coming to me with moderate to severe health issues that they need to fix. I don't usually see healthy people that are just trying to stay healthy. So I think they're two different things there. People who have medical conditions, or at very high risk of medical conditions, they need a therapeutic diet.
Some people can get off that therapeutic diet and transition towards a more flexible diet over the long term. But the thing is, the principles that I'm teaching in this therapeutic diet usually remain the same. But there just grows a level of flexibility as people get healthier and healthier, if that makes sense.
But coming back to the GLP-1s, I do feel that because a lot of health care practitioners, the way that they see diet and weight loss, it's very like it doesn't work, because they tell their patients to start eating less, moving more. Their patients come back in like two months and say, I've put on weight, right? Like I tried, it didn't work, I've put on weight. And then the doctors say, oh well, diet doesn't work. Like I've worked in medical practices with like over 20 doctors, and they just don't refer to me because they're like, well, diets don't work, and I'm like, yeah, but this isn't any diet.
And so a lot of what I'm doing is convincing people that the standard approach, that doesn't work for a lot of people, I agree with you, isn't the only approach. And so it's unfortunate that in many ways patients feel like it's that standard approach of calorie restriction, or it's weight loss drugs, or it's surgery. They don't realise there's actually a fourth option, and maybe others as well, that doesn't involve that.
POD: Jessica, I could talk to you for hours, and indeed I might need to book in and talk to you for a few more hours based on our conversation today. This has been fantastic. I'm sure you don't have hours to give to me right now, but given our audience is between 40 and 60 and we'll fall into that pre-diabetes, maybe insulin resistance, maybe on the cusp of diabetes too potentially. Certainly a lot of our audience would be in my boat, which is, I've tried a lot of different things, it doesn't seem to work. What question have I not asked you that I should be asking you for us to learn from that?
JESSICA: I think a nice way to finish this off might be, we've spoken a lot about low-carbohydrate diets as being a therapeutic diet, right? And as you said before, sometimes when you say the word diet, it just immediately sounds restrictive. We've spoken about how you don't have to restrict calories, but I think a good question might be, what does a day of eating actually look like with this sort of approach? Because I think that's where people get excited.
POD: Right. Can I get my pen and make some notes as you tell me? Right, breakfast.
JESSICA: Because when we talk about what the foods look like on a plate, people are like, oh, I could do that. When we talk about all this theory, it just sounds like another thing that you have to do, it goes on your to-do list, you may or may not think about it, right? But when we actually talk about what you can eat, there's actually two outcomes here. A lot of people who think just dieting is hard in general are like, oh, that actually looks achievable. And then people who are, for whatever reason, anti-low carb diets, because there's a lot of anti-low carb diet people out there that think they are restrictive and that doesn't work, they actually go, oh, that looks achievable. So I think it's really interesting to talk about it in a practical sense.
So let's talk about a day on a plate, shall we? We're talking about someone, let's say someone who has severe insulin resistance, they're overweight, they're trying to reverse their insulin resistance so they don't get type 2 diabetes, and they're also trying to lose weight. So we're going to pull those carbohydrates down pretty low. So we're not going to have things like bread, we're not going to have things like cereal, nothing like muesli, no pastries, that type of thing, no rice.
So for breakfast, a fantastic option would be an egg-based breakfast, and an omelette is something that a lot of people are happy to eat without bread, right? But we're not talking like a two-egg omelette, we're talking maybe a four-egg omelette. Maybe you add some cheese, maybe you put some smoked salmon in there or some shredded chicken left over from the night before. The idea is you're making this filling, nutrient dense, satiating, right, but we're just not adding the carbohydrates. Now, you might cook that omelette in some butter, or you might serve it with some avocado to get those healthy fats. Some people like to add some veggies, they might want to add some chopped up zucchini or spinach or mushroom or something like that, right? But you don't have to, that's an add-on.
So you've got your proteins, your healthy fats and your low density carbohydrates. So your blood sugars are super stable and your insulin is nice and low, and you've got all this energy to take you on your day. You feel full, you don't feel restricted, right? And even if you ate all of that and you're like, I'm still hungry, well then go make another one, because it's still going to work. It's not going to increase your blood sugars, even if you have to. So you're going to feel really nice and full, you're not going to be thinking about food. You're probably not going to need a morning tea or anything like that, right? Because you're so satiated from this breakfast, so you can go straight through to lunch.
Now, you might normally have something like a burger for lunch, right? A lot of people have burgers. You can still do something like that, but you just take the bun off. So you can still have your beef patty with your cheese, maybe some tomato, maybe some lettuce, maybe a side of avocado, right? But you just take the bun away, and that's the yummy part anyway, right, like all the inside. That's where the flavour comes from. The bread is just holding it, so, on the plate as opposed to holding it. Put it on the plate, get a knife and fork, or wrap it in a lettuce bun or whatever you want to do.
POD: Okay. Iceberg lettuce or something.
JESSICA: Yeah, yeah, like a little lettuce taco thing. I mean, it falls out of there, let's be realistic, but you can start that way, so it looks good. And then some people go, well, I'm just not going to be full if I don't have the bread, right? Like that's the bulk, that's where the volume is. So then have two beef patties, have two slices of cheese, chuck an egg on there if you want to, right? Do what you need to do to make it satiating, because this isn't a calorie restricted diet, we're just keeping the carbs low.
And so a burger is a really good one, because you can get that when you're out and about as well. You can make it at home, but if there's a cafe or a restaurant nearby, you just find the burger on the menu, ask them to make it without the bun, without the chips, double patty. Again, you're feeling full, you're not feeling restricted, you're satiated, you can go right through to dinner. So you're not needing all these snacks across the day.
And so dinner time could be something like a steak or roast chicken, meatballs, whatever sort of protein food you like. But let's talk about a steak, that's a good one for your audience, I guess. So a nice big steak, right, so as big as you like, and then you might serve that with some broccoli, some zucchini, some roast pumpkin. But make those vegetables tasty, right? Like roast them in some olive oil and butter, or make a little cream sauce with some cream and some herbs to pour over your steak and pour over your veggies. If you want to turn those veggies into like a cheesy bake, you can, right? Like throw them in a baking dish with some cheese, some sour cream, roast that, and then serve that with your steak. Like it doesn't have to be... but does that sound restrictive to you?
POD: Restrictive? Not at all. Not at all. I'm looking at this and my first reaction is that's a lot of food.
JESSICA: Yeah. What's your second reaction?
POD: I can now start to understand the insulin piece that you've been talking about. And assuming that I understand you correctly, your blood sugars should be able to be normal the whole way through the day because of this.
JESSICA: Yeah, you won't get big spikes.
POD: Yeah. So if that's true, then over time your insulin can then be taken up by the body. I can become sensitive to insulin over time.
JESSICA: Exactly. And then you start using fat for energy, and when we talk about using fat for energy, we're talking about a mixture of stored fat and fat from the diet. And because you're using fat for energy, the welcome side effect for some people is they lose weight. That may not be the intention of this, of course, but that would be a welcome side effect for some people.
POD: Yeah, okay. There's nothing restrictive about this.
JESSICA: I think it's probably... and again, when you look back at the research, most diets fail. People can't sustain them beyond 12 months. They're not talking about ad libitum low-carb diets, which is what this is. So ad libitum means there's no energy restriction, they can eat to satiety essentially. And so ad libitum low-carb diets, they've been studied for up to five years at this point, and people are happily still on the diet five years later. They've reversed their type 2 diabetes, they've lost weight, they're off a lot of their medications, and it's a lifestyle.
POD: The thing that I loved about what you just said was, if you're still hungry after your lunch, go have another one. More beef patties.
JESSICA: Yeah. Yeah. And I think there's a block for a lot of people, right? Like a lot of people don't fully trust that you can do that and lose weight, because they've been restricting their calories for so long and the general message is not to do what we're talking about.
POD: The opposite.
JESSICA: Yeah, the opposite. And so this is where I encourage people to, well, people that I'm working with, get your blood tests done so we can actually see on a physiological level how your body is responding. But not just blood tests before and after, wear a glucose monitor. There are fantastic glucose monitors that you can throw on your arm and you can see in real time what's happening to your blood sugars. And so people sometimes need that feedback to actually go, wow, when I eat this stuff my blood sugars are really stable. You don't have to take my word for it, you can see it. And then glucose monitors are also really good for seeing what happens when you don't eat like this. You'll get a spike of some kind.
POD: So that can be motivating in itself as well as educational.
JESSICA: Yeah, exactly.
POD: Well, I said to you up front I was excited you joined us today. I'm now even more excited as you're leaving, because I have my plan for tomorrow. I've got a meal plan, so there you go. Jessica, this is fantastic conversation. I'm sure a lot of our listeners are going to walk away with a lot of ideas, and at least a starting point for what might work for them going forward, particularly if they're like me, a lot of stuff didn't work in the last couple years. As we wrap this up, what are your final words of wisdom for our audience today?
JESSICA: Don't overcomplicate it. I think if you take one thing away from this episode, eating more real whole foods, it's going to give you more nutrients, more energy, and it's going to be a step in the right direction.
POD: Jessica Turton, thank you so much.
