#88 - Paul Grewal, M.D.: Treating metabolic disease and strategies for long-term health

In this episode, Paul Grewal, internal medicine physician and co-author of Genius Foods, discusses what has got him so focused on lifestyle changes for metabolic health which was partly brought on by his own experience of losing almost 100 pounds at two points in his life. Paul and Peter discuss how the results from a NuSI-funded study has impacted their feelings about the supposed “metabolic advantage” of a low-carb diet. Paul then makes the case for what he calls the “active poisoning” of the American food supply, defines his five phenotypes of obesity manifestation, as well as lays out his nutritional and training approach with his patients (as well as himself personally). Overall, this discussion is a treasure trove of topics from endocrinology, insulin resistance, caloric restriction, fasting, exercise, causes of obesity, LDL and heart disease, and much more. We discuss: Paul’s health story—two instances of major weight loss [3:15]; The multiplication of adipocytes after weight loss, and why an obese adult that was overweight in childhood is harder to treat than adult-onset obesity [7:30]; Low-carb diets—Is there a metabolic advantage in energy expenditure? (And Peter’s take on the NUSI study) [12:45]; The relationship between hyperinsulinemia and hyperglycemia—which is causing which? [27:00]; Weight gain—Which macronutrients are driving it, processed foods, and overfeeding studies [31:15]; The active poisoning of our food supply with processed foods [36:15]; The role of fructose in metabolic disease and NAFLD [39:00]; Where traditional medicine falls short in the real world and why “functional medicine” is gaining steam [45:45]; Relationship between heart disease and LDL, residual risk, LDL clearance problem, and a patient case study [54:00]; Relationship between heart disease and fatty acids (SFA, PUFA, seed oils, etc.) [1:04:30]; Paul’s nutritional approach with patients [1:12:30]; High-carb/low-fat diet for muscle gain, and the “reverse diet” to combat the slowdown of metabolism after caloric restriction/weight loss [1:15:00]; Fasting—ideal duration, how to preserve muscle mass, and the ultimate tool of medicine [1:23:30]; The 5 phenotypes of obesity, and the impact of carbs, cortisol, and sleep on adiposity [1:28:30]; Uric acid [1:38:15]; Paul’s 2nd big physical transformation—How he did it and kept the weight off [1:39:15]; Paul and Peter’s personal struggles with food, internal dialogue, and self-image [1:45:00]; Paul’s personal nutritional strategy (and how his exercise influences it) [1:52:00]; A low-fat diet Peter is willing to try [2:00:40]; The keto diet for competitive athletes [2:05:00]; How Peter prescribes exercise to his patients [2:08:30]; Calculating glycogen depletion and RQ, creatinine-kinase system, Tabata workouts, and more [2:10:30]; and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/paulgrewal Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.