Show 1463: Why We Eat Too Much and What to Do About It

Obesity is a big problem in the US. The National Institute of Diabetes and Digestive and Kidney Diseases says 2 out of every 5 American adults are obese. What’s more, one in three is overweight, with only about 25 percent of us at a healthy weight. It’s not just adults; children are increasingly suffering weight problems as well. In this episode, we ask why we eat too much and what we can do about it.

At The People’s Pharmacy, we strive to bring you up to date, rigorously researched insights and conversations about health, medicine, wellness and health policies and health systems. While these conversations intend to offer insight and perspective, the content is provided solely for informational and educational purposes. Please consult your healthcare provider before making any changes to your medical care or treatment.

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Why We Eat Too Much:

Excess weight puts people at risk for premature death from cardiovascular disease, kidney problems and diabetes. Unfortunately, the standard advice from physicians to eat less and exercise more hasn’t often been very helpful. That’s because it doesn’t take into account the reason we eat too much: we are hungry. There are at least three different types of hunger that we need to consider, though.

Most people are familiar with homeostatic hunger. If you haven’t eaten for hours, your stomach may grumble and complain. There is also hedonic hunger–eating because something tastes delicious. That’s why you can usually find room for dessert, regardless of how much dinner you’ve eaten. Hedonic hunger is often linked to emotional eating because you feel bored or stressed or depressed. The third type of hunger is conditioned hunger. Think of Pavlov’s dogs, who learned to salivate in expectation of food when they heard a bell. Some people react much the same way when they hear a dinner bell, or when lunchtime arrives, or when they get in the car. If you are accustomed to eating then, you’ll expect food and become disappointed if it isn’t available.

But conditioned hunger can be addressed by deliberately changing your patterns. Set up the environment so the food is not so readily available at the times you have become conditioned to eat. Hedonic hunger yields best to figuring out the emotional basis for why we eat too much: boredom, stress, some other feeling. What other activities can help you cope with those feelings? For some people, it might be going for a walk. Others might find a different approach more helpful.

How Do Weight Loss Drugs Make Us Not Eat Too Much?

The most popular drugs on social media and in ads lately are the GLP-1 receptor agonists. That’s a fancy name for weight loss drugs like semaglutide (Wegovy) and tirzepatide (Zepbound). These medicines blunt the reward center in the brain that responds to food and drives some people to eat too much. They do that by mimicking satiety hormones, essentially telling our bodies “You’ve had enough.” They work pretty well for most people, at least in the short term. However, unless people retrain themselves regarding eating cues (for conditioned hunger) or emotional needs (for hedonic hunger), they are likely to gain the weight back when they stop taking the medication. For homeostatic hunger, making sure to get adequate protein and fiber in every meal can help. That tactic might not be very useful for hedonic hunger, though.

Are you addicted to ultra-processed foods? That can be a challenge. On the other hand, many people who are addicted to nicotine do find ways to overcome that addiction. It is possible to overcome junk food addiction, too. Dr. Fung describes his patient Harry who used fasting, eating carbohydrates last instead of first in the meal, along with some acid such as vinegar, and was successful in losing weight and feeling better. The most important thing Harry did was to use social support from his friends. Social and environmental factors are critical in the development of obesity, so they are also paramount in overcoming it.

Practical Advice to Help Us Not Eat Too Much:

How do you stock up on what you need and avoid what you don’t need at the supermarket? The usual advice is to shop the perimeter, where the fresh food like vegetables, fruit, eggs, meat and dairy products are located. The ultra-processed stuff is usually in the center aisles. You also want to read labels. If that food has ingredients you can’t pronounce, you might want to put it back on the shelf. Later, you can look it up and learn if it is something you want to put in your body.

Using Intermittent Fasting:

Intermittent fasting can be a helpful tool, especially if you approach it as an opportunity rather than with a deprivation mindset. There are many ways to fast. Some people use time-restricted eating, eating only during the first 8 hours of the day, for example. Some skip eating every other day. It is helpful for the body to have an opportunity to burn fat from its stores. This can help regulate insulin as well as contribute to weight loss.

We spoke with Dr. Fung shortly before publication of the Cochrane Collaboration’s review of intermittent fasting. These experts found that in randomized control trials, intermittent fasting is no more effective than counting calories (Cochrane Database of Systematic Reviews, Feb. 16, 2025). We are sorry we didn’t get to ask him about this.

Dr. Fung’s Three Golden Rules for Weight Loss:

The first is simple, if not so easy: don’t eat ultra-processed foods.
The second: give your body an adequate fasting period every day. That might be at least 12 hours, but it could be longer. Each person may need to find their own “sweet spot.”
Finally, find or create a social environment that will allow you to succeed. Hang out with people doing something you enjoy that is not centered on eating.

This Week’s Guests:

Dr. Jason Fung is the New York Times bestselling author of multiple critically acclaimed science and health books including The Obesity Code, The Diabetes Code, The Obesity Code Cookbook, The Diabetes Code Cookbook, The Diabetes Code Journal, and The Hunger Code. Dr. Fung is a Canadian nephrologist and co-founder of The Fasting Method, a program to help people lose weight and reverse type 2 diabetes and obesity.

His most recent book is The Hunger Code: Resetting Your Body’s Fat Thermostat in the Age of Ultra-Processed Food.

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Listen to the Podcast:

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Transcript of Show 1463:

A transcript of this show was created using automated speech-to-text software (AI-powered transcription), then carefully reviewed and edited for clarity. While we’ve done our best to ensure both readability and accuracy, please keep in mind that some mistakes may remain. If you have any questions regarding the content of this show, we encourage you to review the original audio recording. This transcript is copyrighted material, all rights reserved. No part of this transcript may be reproduced, distributed, or transmitted in any form without prior written permission.

Joe

00:00-00:01

I’m Joe Graedon.

Terry

00:01-00:05

And I’m Terry Graedon. Welcome to this podcast of The People’s Pharmacy.

Joe

00:06-00:26

You can find previous podcasts and more information on a range of health topics at peoplespharmacy.com.

Snack foods are everywhere. Gas stations, airports, and of course in the supermarket. How can we resist such tasty treats? This is The People’s Pharmacy with Terry and Joe Graedon.

Terry

00:34-00:45

Obesity and metabolic disorders are major health problems in America and increasingly around the world. Ultra-processed foods are a big contributor to this growing epidemic.

Joe

00:45-00:54

The pharmaceutical industry believes it solved the problem with [the] latest weight loss medications. What are the pros and cons of these drugs?

Terry

00:55-00:57

What else should we be doing to overcome our hunger?

Joe

00:58-01:04

Coming up on The People’s Pharmacy, why we eat too much and what to do about it.

Terry

01:14-02:49

In The People’s Pharmacy Health Headlines:

Highly processed foods often contain preservatives to keep them fresh. A new study from France suggests that a few of the most common preservatives may increase our risk of cancer. Researchers analyzed data from repeated dietary questionnaires completed over 15 years or longer.

In this NutriNet Santé study, the majority of the 105,000-plus French adults were women. No participant had cancer at the beginning of the study. The scientists looked at customary consumption of 17 different preservatives. 11 had no link to cancer. The remaining 6, however, modestly increased the risk for a range of cancers.

Total sorbates, especially potassium sorbate, for example, increased the chance of a cancer diagnosis by 14% and that of a breast cancer diagnosis by 26%. You’ll find potassium sorbate in dried fruits such as prunes or apricots. Cheese, baked goods, and soft drinks may also contain this preservative.

Sodium nitrite increased the likelihood of prostate cancer, while sodium erythorbate increased the chance of any cancer by 12% and breast cancer by 21%.

The investigators point out that the epidemiology linking preservatives to cancer might call for new regulations. They conclude, in the meantime, the findings support recommendations for consumers to favor freshly made, minimally processed foods.

Joe

02:50-03:48

GLP-1 agonists like semaglutide have become immensely popular for weight loss as well as for blood sugar control. Now scientists suspect that tirzepatide, a combined GLP-1 and GIP agonist prescribed by the brand name Mounjaro and Zepbound, might also be useful against addiction.

Researchers in Sweden tested tirzepatide in rats who had become accustomed to drinking alcohol. While they were on the drug, they cut their alcohol consumption by at least half compared to the control group. In addition, when they were once again exposed to alcohol after not having access for a while, they did not go back to their former level of alcohol consumption.

The scientists found that tirzepatide reduces spikes of the reward-related neurotransmitter dopamine in the animal’s brains. It’s not clear whether the potential benefits observed in rats will translate to humans with alcohol use disorder, but it definitely deserves further research.

Terry

03:49-05:03

If you’ve been wondering what you should eat to improve your chance at a long, healthy life, you’re not alone. Curious nutrition scientists analyzed dietary data from more than 103,000 UK Biobank participants. They were all middle-aged and free of disease when the study started.

Over a follow-up period of about 10 and a half years, more than 4,000 of them had died. Five different diets reduced the likelihood that a volunteer would die. The helpful diets included an alternate Mediterranean diet, an alternate healthy eating index, dietary approaches to stop hypertension, a healthful plant-based diet index, and the diabetes risk reduction diet.

Those ranking in the top scores of any of these eating patterns could expect to live a year and a half to three years longer than those ranking at the bottom. The best patterns for men and women were slightly different, though. Men did best on the diabetes risk reduction diet, while women fared better on the alternate Mediterranean diet. Researchers had access to genetic information about all participants. However, taking genetics into account did not alter the results on beneficial diets.

Joe

05:04-05:59

Many people struggle with sleep. While experts often recommend getting more exercise during the day and improving sleep hygiene at night, these suggestions don’t always result in the improved sleep that insomniacs would like.

A randomized clinical trial in China found that a combination of high-intensity circuit training and sleep health intervention is more effective than either approach alone. The scientists recruited 112 women between 18 and 30 years of age and assigned them to one of four groups, training, sleep health intervention, both or neither. The treatments lasted two months and demonstrated superiority of the combination approach. This resulted in better sleep efficiency and less waking during the night.

And that’s the health news from the People’s Pharmacy this week.

Terry

06:14-06:17

Welcome to The People’s Pharmacy. I’m Terry Graedon.

Joe

06:17-06:32

And I’m Joe Graedon. Americans love fast food. We eat on the go. We eat in the car. We eat while watching television, and we just basically eat all the time. Snacks have become part of our routine.

Terry

06:33-06:54

It’s hardly any wonder there’s an obesity crisis. According to the National Institute of Diabetes and Digestive and Kidney Diseases, two out of every five American adults are obese, and one in three is overweight. That means only about a fourth of us are a healthy weight. Increasingly, children are also suffering from weight problems.

Joe

06:54-07:05

How did we end up in this mess? All those extra pounds increase our risk for diabetes, kidney disease, and even cardiovascular problems.

Terry

07:05-07:14

Semaglutide and tirzepatide have made billions for the drug companies. Will they be a long-term solution for the obesity epidemic in America?

Joe

07:14-07:47

To help us better understand how our food choices are affecting our health, we turn to Dr. Jason Fung. He’s a Canadian nephrologist and advocate of intermittent fasting. He’s written or co-authored numerous books, including “The Obesity Code,” “The Diabetes Code,” and his latest, “The Hunger Code: Resetting Your Body’s Fat Thermostat in the Age of Ultra-Processed Food.” He’s co-founder of The Fasting Method, a program to help people lose weight and reverse type 2 diabetes and obesity.

Terry

07:48-07:52

Welcome back to the People’s Pharmacy, Dr. Jason Fung.

Dr. Jason Fung

07:53-07:54

Thanks for having me. It’s great to be here.

Joe

07:55-08:35

Dr. Fung, you are dealing with one of the most important topics people have to address, and shortly we will deal with the elephant in the room, the GLP-1 agonist receptors. But first, you know, you have described weight gain and the understanding about, you know, how it happens and how to lose that weight gain and keep it off.

And I guess I’d like to ask you, what new understandings do we need about weight gain so that we can make the critical changes in our life that will produce sustained weight loss?

Dr. Jason Fung

08:36-12:11

Yeah, so, you know, I trained pretty conventionally as a physician. You know, through medical school all this time, people are just like, well, you know, you’re just gaining weight because you’re eating too much. So therefore, the solution is just eat less.

And the problem with that is that it’s very, very superficial. It really doesn’t try to understand the underlying causes of that eating behavior. Which is that if you don’t, you know, we’re not trying to, you know, see, you know, that calories in is greater than calories out. We need to understand why.

So it’s just like alcoholism. Alcoholism is alcohol in minus alcohol out. So does just telling somebody just drink less alcohol, like, is that useful advice? And it’s not because you’re not understanding the reasons why people are drinking alcohol. So if the reason that somebody is alcoholic is because of depression or addiction or PTSD, then deal with the depression or the addiction or the PTSD.

So it’s the same thing with understanding why people are overeating. So the simple fact is that if you are trying to understand why people are sort of overeating, you have to understand why people are eating in the first place. And it’s very simple. You eat because you’re hungry and you stop eating because you’re full. So that’s sort of a fundamental truth.

So if you’re saying you’re overeating, then the problem really is over-hunger because that’s the reason you’re overeating in the first place. So that’s the thing that you have to understand. And the GLP-1s, for example, do not restrict calories. They reduce hunger.

And that’s a critical difference because if you simply tell somebody to eat less, their hunger is just going to go up and your body is going to keep fighting itself. Your body is trying to make you eat more because you’re going to be more hungry and you’re trying to eat less because you’re trying to lose weight. And something always breaks at that point.

So you have to understand what is hunger and how is it driving eating behavior. And it’s actually a fascinating, complex topic. And it’s not simply because you ate, you’re less hungry. There are different foods, for example, that create hunger and satiety. So you can eat, say, a three-egg vegetable omelet, and that’s going to make you really full. If you eat the same number of calories but instead drink a Frappuccino, you’re hungry five minutes later. That’s a huge difference, even though they’re the same number of calories.

So it’s not the number of calories that determines hunger and satiety, it’s the hormones that are triggered. So things like GLP-1, which is affected by the drug like Ozempic, but also, you know, all these other hormones play a role. Insulin, cortisol, GLP-1, GIP, glucagon, the sex hormones play a role. So all of these different aspects of human physiology play a role because food doesn’t just contain calories, it contains information, right?

And what it means is that the food energy is measured in calories. But when you eat a food, the minute you put it in your mouth, you produce different hormones. So the vegetable omelet or with some kind of meat, for example, is going to stimulate a lot of GLP-1. The Frappuccino is not. And that makes a difference. The Frappuccino will stimulate a lot of insulin, and the egg omelet will not. And that makes a difference.

Joe

12:11-12:15

Let me challenge you on one thing, if I may.

Dr. Jason Fung

12:16-12:16

Sure.

Joe

12:16-12:51

There are lots of times when I will snack when I’m not hungry. I mean, zero hunger. But I’m anxious. I reach a kind of a point where I’m not making progress. And I go upstairs and look in the pantry and the nuts look so appealing. Not because I’m hungry, but because I hit a roadblock in something I was writing. What about all of the other reasons that we eat besides hunger?

Dr. Jason Fung

12:52-13:25

Absolutely. That’s very, very important because that is a type of hunger. It’s a different type of hunger, right? So when you’re describing hunger, there’s actually three types of hunger at least. There’s probably even more.

The physical hunger that we all think about is scientifically termed homeostatic hunger. That depends on the hormones. But that’s not the only reason you eat, just like you said. There’s a hedonic hunger. And hedonic hunger, hedonic is a word that means relating to pleasure, is that you eat because it makes you feel better.

Terry

13:26-13:27

So that’s the dessert hunger, right?

Dr. Jason Fung

13:28-17:38

Exactly. Because nobody eats dessert because they’re hungry physically. They’re eating it because it looks good. It tastes good. It makes you feel better. Same thing with comfort foods. You’re eating it to soothe that emotional hunger. You’re trying to feel better. You’re trying to give yourself pleasure because eating gives us pleasure. And that’s the reality. So why deny it?

Why pretend like this hedonic hunger does not exist? If you’re under a lot of stress, you need something to make you feel better. So you go look and, oh, hey, there’s some cookies or there’s some nuts or some whatever. That’s emotional eating, right? That’s a completely different type of hunger, but it is a type of hunger.

And where that’s important is really ultra-processed foods. It speaks to ultra-processed foods because ultra-processed foods are really engineered to make you want them, right? They talk about bliss points, but there’s all this artificial flavors, artificial colors. There’s all this processing that makes it easy to eat, that minimizes satiety. So there’s many, many different reasons why the ultra-processed foods are engineered to create this hedonic hunger so that you go out and eat them. Not because of the physical, you know, oh, my stomach is growling, I need something, but because of that emotional hunger.

But then there’s actually a third type of hunger called conditioned hunger. And again, conditioning is a phenomenon which is well described. So the classic example is Pavlov’s dogs, for example. So you can take dogs and if you give them food, they’ll salivate, they’ll become hungry. Now you can take a neutral stimulus like a bell, which normally does not make dogs salivate. But if you pair the bell with the food consistently, when you bring a bell, the dogs will soon start to get hungry and salivate. So you’ve turned this sort of neutral stimulus into a conditioned response of hunger.

But you think about what we’re doing in the United States, right? People eat all the time. The minute you get up, you have to eat. If you get a coffee, you have to eat. If you go for lunchtime, you have to eat. If it’s a meeting, you have to eat. If it’s dinner time, food everywhere. You go to the mall, there’s billboards, there’s food, there’s smells. Everywhere you look, there’s food. And what it does is you’ve paired all these things with food. So now you sit in front of the movie theater, you sit in front of the TV, now you become hungry. You stimulated this conditioned hunger.

And it’s important to understand these types of hunger because they all have different toolkits that we need to fix them, right? So if your problem is you’re eating too many refined carbohydrates and not enough proteins, for example, then you can fix that. That’s homeostatic hunger. But if your problem is that you’re looking for, you’re eating out of boredom, for example, then you need to fix that. It’s not just about saying eat less.

You need to say, hey, what should I do so that I will not use food for comfort and I’ll find something else? Maybe it’s going for a walk. Maybe it’s getting a hobby. Maybe it’s playing basketball. Maybe it’s talking to your parents or talking to your friends or something else, right? But what you’ve done is you’ve identified the hedonic hunger and you’ve been able to neutralize it because you understand it to say, hey, instead of, you know, going to food to feel better, I’m going to go for a walk. I’m going to go get a manicure, a pedicure. I’m going to go for a massage. I’m going to talk to my friend to feel better. And I’m going to schedule this on a regular basis, right?

But it’s a different toolkit. Or if your problem is conditioned hunger, that every time you walk past the coffee store, you have to get a muffin, then you say, oh, this is conditioned hunger. But now you understand it. So say, oh, what I’m going to do, I’m going to start using my app and I’m going to order coffee and only coffee. Now when I go pick it up, that’s all I get, right? Because I’m not lining up.

Terry

17:38-17:42

Or perhaps you take a different route so you don’t walk past the coffee store.

Dr. Jason Fung

17:43-17:53

Exactly. Or you say, okay, well, I’m not going to go to the mall because they have the Cinnabon there that’s wafting all that, you know, wonderful cinnamon bun smell that’s snagged so many people.

Terry

17:55-18:05

You’re listening to Dr. Jason Fung, nephrologist and author of “The Hunger Code: Resetting Your Body’s Fat Thermostat in the Age of Ultra-Processed Food.”

Joe

18:05-18:11

After the break, we’ll discuss the GLP-1 agonists like Ozempic and Wegovy.

Terry

18:11-18:13

How long might people take them and what happens when they stop?

Joe

18:14-18:16

How can you fix all three types of hunger?

Terry

18:17-18:24

Hedonic hunger, eating because something tastes yummy, is the hardest to address. Getting enough protein and fiber alone may not do the job.

Joe

18:24-18:30

If obesity is multifactorial, which factors are most important?

Terry

18:39-18:42

You’re listening to The People’s Pharmacy with Joe and Terry Graedon

Joe

18:51-18:54

Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

18:54-19:08

And I’m Terry Graedon.

Terry

19:25-19:30

Today, we’re talking about why we eat too much and what we can do about it.

Joe

19:30-19:56

The pharmaceutical industry thinks it’s figured out the solution. If everyone just took a drug like Wegovy or Zepbound, the problem would be solved. Except the drugs are expensive and have some serious side effects. Some researchers estimate that 50 to 75 percent of those who start on such medications quit within a year or two. What happens then?

Terry

19:57-20:26

To find out, we’re talking with Dr. Jason Fung. He’s a Canadian nephrologist and advocate of intermittent fasting. He’s written or co-authored numerous books, including “The Obesity Code,” “The Diabetes Code,” and his latest, “The Hunger Code: Resetting Your Body’s Fat Thermostat in the Age of Ultra-Processed Food.” He’s co-founder of The Fasting Method, a program to help people lose weight and reverse type 2 diabetes and obesity.

Joe

20:28-21:39

Dr. Fung, you’ve described elegantly the different kinds of hunger and perhaps how we can modify our response to boredom or actual, oh, I am so hungry, I can barely stand it. And we want to segue to the elephant. It’s not just an elephant. It’s a gigantic elephant. It is the GLP-1 receptor agonists, the Ozempics, the Mounjaro.

There’s no question that they have changed the world because literally millions of people all around the world are taking these medications, now coming out in oral form instead of injectable form.

So I guess the first question is, why do they work? And clearly they do. How long should people be taking them, and what happens when people stop? So give us your, you know, quick overview of the GLP-1s because a lot of people say, you know, I don’t have to worry about all that stuff that Dr. Fung is talking about. I’m just going to take a pill or get an injection and my hunger’s gone.

Dr. Jason Fung

21:39-25:59

Yeah, and that’s the important thing. So GLP-1, so the GLP-1 system is part of a hormone system called the incretins, which includes GIP, which Mounjaro affects both GIP and GLP. There’s a third one, glucagon, which is actually in development now. There’s a new drug that’s going to target all three of them.

But what you have to understand is that’s part of the homeostatic system, right? The homeostasis is a natural biological phenomenon where you set a certain point, right? A sort of set point. And, you know, if you go over it, your body tries to bring it back. If you go under, it tries to bring it up, just like body temperature.

If you live in the Sahara Desert, you’re too hot, you sweat. If you live in the North Pole and you’re cold, you shiver, right? So either way, you get back to that homeostatic set point. So homeostasis is the same.

So GLP-1 is part of this homeostatic system. That is, when you eat, the foods you eat are going to stimulate certain hormones like GLP-1, which tell you you’ve eaten enough. So when you eat beef, for example, and protein is probably one of the biggest stimulants of GLP-1, but also fiber, for example. So when you eat a big bulky meal of whole grains, for example, or if you’re eating a lot of beef and stuff, you’re going to stimulate the GLP-1, which tells you that you are now full, you need to stop eating.

And it’s a very powerful system, right? You think about, you know, all you can eat buffet. If you’ve eaten a lot and somebody says, here, have some more pork, you’re like, I’m going to throw up, right? That’s because it’s such a powerful system. That’s part of the homeostatic system. And that’s why when you stimulate that system, you can create satiety and overwhelm the hunger from a homeostatic standpoint.

The problem is with that drug is that it sometimes goes over the line and you get side effects, right? So nausea, vomiting, and that’s one of the problems. But it works, right? People stop eating because they’re full, right?

So it’s not about restricting calories. It’s about restricting hunger. And this can lead into those other types of hunger. Because if you have emotional hunger, that is hedonic hunger, or if you have conditioned hunger, so you go to the car and normally you would want to eat.

But what you’ve done is you’ve overwhelmed it with satiety coming from this GLP-1 system. Then you’re not going to want to eat because you actually have, you’ve sated this hunger. But it’s not a normal satiety, right? So when you look at the GLP-1 levels, the drugs don’t give you normal levels. They give you super physiologic pharmacologic doses of this GLP-1 system. That’s why it can overwhelm those other systems. So it can certainly work.

The major problems is there’s a couple of them. One is that there’s side effects, right? But if you can tolerate the side effects, then the other major problem is that when you stop taking it, you will gain all that weight back. Why? Because you never learned to fix the problem. You simply overwhelmed it with GLP-1 to fix all your problems. So if your problem is emotional eating or your problem is conditioned hunger, you can take a drug and overwhelm it by affecting the homeostatic system. But you never fix the underlying emotional hunger or the hedonic hunger or the conditioned hunger, right? And that’s the problem because then when you take away that drug, all your weight comes rushing right back.

And so, you know, the most effective is really to pair the two, right? It’s not to say that you should never use GLP-1. They have a role because certain people have to lose weight. So they do have a lot of benefits, right? So when you lose weight, you do better from a diabetes standpoint, you do better from a heart standpoint, fat and liver. So there are a number of medical benefits.

But understand that you’re not actually fixing the problem that led to the weight gain in the first place, right? You fixed it by using a separate thing, right? So that’s why when you stop and you haven’t fixed those other problems, then it’s going to come back. So if you can use that as a sort of bridge and say, okay, well, I’m going to use this to help me now, but I’m going to try and understand what is it? Why am I eating so much? Why am I always hungry? Is it conditioned hunger? Is it hedonic hunger? Is it homeostatic hunger? And try and fix it. Then you’re going to be more successful when you do try to come off of it.

Terry

25:59-26:22

Let’s talk a little bit about fixing that hunger then. Especially, I think, the hedonic hunger, I think, is something that people find very difficult to address. And I’m not sure that, you know, making sure that you eat your protein and your fiber is going to address the hedonic hunger problem, is it?

Dr. Jason Fung

26:23-28:16

Yeah, the hedonic hunger is actually a very interesting problem because it actually, the two main topics within that are actually going to be ultra-processed foods and food addictions. Both of which have had sort of the research behind those two topics has sort of exploded in the last five years. And that’s really what the hunger code I cover in the new book is a lot of this new understanding of sort of hedonic hunger and the reason why ultra-processed foods are so dangerous.

So to give you some history, in the 1977 dietary guidelines, the dietary villain was fat, right? So the unwanted consequence or unintended consequence was that people felt that highly processed foods that are lower in fat are good for you. And that’s where you got margarine and all these other sort of really super artificial foods. Because people thought the processing was actually something good because you took out the fat.

The problem with ultra-processed foods is that you can create them in any way you want. And as a food company, if you’re making a food, you want to engineer it for maximum pleasure, right?

So, you know, you want to create huge dopamine spikes, huge glucose spikes, because when you can take a food and the way you engineer it is by not just the salt and the sugar and the fat, or you talk about bliss points and stuff, but you engineer it by creating very quick absorption. So if you eat a food and it’s really, really easy to eat, it practically melts in your mouth, it goes into your stomach and then basically goes absorbed very quickly. Then you’re going to get massive spikes in your blood of all these things, which is going to give you a big hit in terms of dopamine and pleasure and so on.

Terry

28:16-28:18

And of course, it tastes like “more.”

Dr. Jason Fung

28:19-29:24

Yeah. And then you want more and you want less satiety. So you want maximum pleasure and also maximum absorption. And the way you do that is you engineer it with texturizers and emulsifiers for the mouthfeel and you put artificial flavors and artificial colors to get people to want it.

And then you take away everything that gets in the way and creates satiety. So first is creating the pleasure. So for the hedonic side of things, because the quicker you absorb the food, the faster it goes from sort of your mouth into your bloodstream, the more effective it is. And that’s why you smoke nicotine, for example, because when you smoke cigarettes, the nicotine goes from your lungs into your blood vessels through the lungs.

You don’t eat it because eating the nicotine is much slower. And that’s why you use nicotine gum to sort of wean yourself off. Because by the time you eat it and it gets through the stomach and into the intestines and into the bloodstream, it’s so much slower. You don’t get the quick hit.

Terry

29:24-29:53

All right, Dr. Fung, here’s the question. You just mentioned nicotine. And I think that all of us recognize that smoking is bad for you. And a lot of people have figured out how to cut their addiction to tobacco. So they have quit smoking. What do you do about an addiction to ultra-processed foods? How do you quit that?

Dr. Jason Fung

29:53-31:42

Well, you have to understand that addiction has to be treated like an addiction. So food addiction is no different.

And the thing about addictions is that people say, well, you can’t stop eating food. But no, you have to understand that it’s not all foods. It’s the ultra-processed foods, right?

If you’re addicted to alcohol, you don’t have to stop drinking tea, for example. If you think about how people are addicted, it’s because it’s absorbed quickly and it’s engineered and it’s ultra-processed.

So therefore, you don’t have to stop all foods entirely. Like nobody says, oh, I’m addicted to beef. I’m addicted to salmon. I’m addicted to eggs, but they do say, I’m addicted to bread. I’m addicted to pizza. I’m addicted to chocolate. I’m addicted to candy. Those are all ultra-processed foods.

And the key with addiction is abstinence. You have to not take it, right? You can’t say everything in moderation. Like, do you ever say to an alcoholic, just have a drink, everything in moderation? No, because that first drink is going to lead you to want more. It creates that hedonic hunger. Same thing with ultra-processed foods.

If you have an ultra-processed food addiction, you need to not take ultra-processed foods, but you have to identify that. One, the ultra-processed food is the culprit, and two, you have to identify it as a real addiction. And that’s where the research in the last few years, because there’s a scale that you can use now for research called the Yale Food Addiction Score, where clearly a lot of people who have weight problems are actually addicted to food.

But people who are well-meaning will say, hey, you can have this cookie, everything in moderation. It’s only 50 calories, right? That’s like saying to an alcoholic, just have a drink, everything in moderation. You haven’t had one in a while, right? It doesn’t work because you haven’t identified the problem as a food addiction. And that’s a problem with the hedonic side of the hunger.

Terry

31:42-32:10

Dr. Fung, you offer us a wonderful little story in your book, The Hunger Code, a story about Harry. And I hope that you remember Harry and can tell us what he did to lose weight because you lay out several different approaches that he used, not just one thing, but several. Can you tell us the story of Harry?

Dr. Jason Fung

32:10-35:44

So, yeah, Harry was somebody we worked with at The Fasting Method. And, you know, for him, he recognized that part of his problem was sort of how he ate the foods. And so one of the things that he was able to use very successfully is fasting, because fasting helps him sort of break a lot of the conditioned hunger and broke a lot of the hedonic hunger.

He was able to lose some weight. But then even when he started eating again, he did, he ate differently by combining carbohydrates with other foods rather than eating them alone, for example. So when you eat carbohydrates by themselves, which I call naked carbohydrates, you’re getting a very quick hit of carbohydrates. And this is causing a lot of this hedonic hunger.

But if you eat it with other things, it’s going to slow down the absorption. So it’s just sort of like if you think about alcohol, drinking alcohol on an empty stomach, not always a great idea, because the alcohol really starts to hit you.

Same thing with the carbohydrates. If you’re eating with proteins and fats and you’re mixing it, you’re going to absorb it slower and get less of that hit. And using organic acids such as vinegar, vinegar is acetic acid, you can actually reduce again the sort of glucose effect and how quickly it’s absorbed because the organic acids inhibit amylase, which breaks down the carbohydrate. So because the carbohydrate is breaking down much slower, therefore you’re getting less of this hedonic hunger.

The fasting is working on the conditioned hunger. And using a combination of those things, he was able to lose a tremendous amount of weight and he actually felt so much better. And these are sort of simple hacks. And again, you have to understand the problem so that you can bring different sort of a different toolkit to the problem, because you can’t use the same toolkit.

And I think that’s, you know, fasting, you know eating carbohydrates with other foods eating with vinegar those are all little strategies that we cover because the problem with this whole calorie based approach which is just eat less calories is that it’s sort of like the to the man with a hammer every problem is a nail, right?

So if your problem is hedonic hunger, it’s eat less calories. If your problem is you know emotional eating, it’s eat less calories. If your problem is you didn’t get enough sleep the solution is eat less calories. It’s like, what? If you’re getting not enough sleep, isn’t the solution, get more sleep, not eat fewer calories, right?

So you have to understand the problem. And that’s why I say the problem of obesity is actually a very complex medical one. It’s not a math problem. It’s not a calories in calories out counting problem that some people believe it is. It’s not a thermodynamic problem, because some people say it’s about thermodynamics. But no, it’s a human physiology problem. It’s about eating behavior, right?

And if you think that it’s all about the diets, well, you’ve probably already lost because it’s about all these other things, right? Your environment, you know, we saw this during COVID, right? People were gaining weight like crazy. Why? Because they were sitting at home next to the refrigerator, right? They’re eating way more and they’re drinking way more like alcohol than they normally did. Why? Because their environment had changed, had nothing to do with willpower or anything else.

So understanding the problem of environment, understanding the problem of emotional eating and that sort of thing is going to just make us more successful. The more you know, the better you do.

Terry

35:46-35:55

If obesity is multifactorial, as you’ve suggested, which factors are most important? And you have about a minute.

Dr. Jason Fung

35:55-37:14

I would say the most important two factors, I’d say, that we actually never talked about is the sort of social environmental factors. So the people around you have an enormous influence on what you do. Like if everybody around you is hiking, you’re hiking. If everybody around you is eating and watching TV, you’re eating and watching TV. So that’s actually a very important thing.

So the environment, the micro environment that we surround ourselves in, our family, our friends, but also the society around us which dictates the social norms actually plays a huge role in weight gain. And you see that because the obesity rates in different countries around the world are fantastically different, right?

So in America, you have a very high rate of obesity. In Italy, you don’t, but Italians love food. They absolutely love food. But you take those Italians, stick them in America, and they all become obese. Why? It’s not the people. The people are the same. It’s the environment that they’re in, this ultra-processed environment where all our foods are sort of artificial and so on.

In Italy, it’s not like that. They have a much lower level of ultra-processed foods. So the food environment, the microenvironment, ultra-processed foods, those are the most important things that we need to talk about.

Terry

37:15-37:24

You’re listening to Dr. Jason Fung. His latest book is “The Hunger Code: Resetting Your Body’s Fat Thermostat in the Age of Ultra-Processed Food.”

Joe

37:24-37:54

After the break, Dr. Fung will share his three golden rules of weight control. Welcome back to The People’s Pharmacy. I’m Joe Graedon.

Terry

37:54-38:07

And I’m Terry Graedon.

Terry

38:21-38:26

By now, you’ve heard the term ultra-processed food more than you’d like. What does it mean?

Joe

38:27-38:30

How should you be shopping to avoid these tempting treats?

Terry

38:30-38:52

We’re talking today with nephrologist Dr. Jason Fung. He is co-founder of The Fasting Method, a program to help people lose weight and reverse type 2 diabetes and obesity. His books include “The Obesity Code,” “The Diabetes Code,” and his latest, “The Hunger Code: Resetting Your Body’s Fat Thermostat in the Age of Ultra-Processed Food.”

Joe

38:54-39:25

Dr. Fung, I need some practical advice about shopping. So when we go to the farmer’s market, it’s easy because there are lots of vegetable vendors. They’re every place. There are people who raise chickens. There are people who are creating certain kinds of specialized foods, and there’s no ultra-processed food in sight.

Terry

39:25-39:27

So the specialized foods are like cheese.

Joe

39:28-40:57

Cheese, for example. But you will not find a packaged food, you know, with 14 ingredients and chemicals that you can’t pronounce.

When you go to the supermarket, on the other hand, there is an extraordinary number of stuff that is impossible to know what’s in it because they have names that you’ve never heard of and couldn’t pronounce even if you were a chemist. And they’re all designed to scream at you, “Buy me.” The packaging is very creative and very enticing and you know the flavors. I mean, I’m a sucker for pretzels. I mean, walking past the pretzel aisle is very challenging. And every once in a while I give in and I grab a package of pretzels.

But whether it’s the yogurt with the fancy flavors or whether it’s the cookies or whether it’s even the nut aisle, I mean, there’s just so much food calling out to you and you know how tasty it is because you’ve eaten it before and you love the flavors. How do you avoid buying the stuff that you are describing as the ultra-processed food? It just is so tasty.

Dr. Jason Fung

40:59-45:00

Yeah, that’s a great question. And really, it begins with the mindset, right? And the mindset is the way you sort of filter all your information. So to give you an example, you know, sugar, for example. It used to be very popular.

People love sugar and it was felt to be not bad for you, right? So in the 80s and stuff, there were cereals called like Sugar Pops and stuff. You know, they were proud of the fact that there was sugar in it.

But as people sort of learned that, hey, added sugars are not really good for you, the tide started to turn, but there’s the mindset, right? People went from looking at sugar as a good thing to looking at sugar as really a real indulgence and something you really shouldn’t eat a lot.

So of course, but when you do that, when you change your mindset, that’s how you change your behavior, right? Because your mindset, you know, is how you feel about things and then how you feel about things changes. So if you think sugar is something that you want, but can’t have, then you’ll get a deprivation mindset and you won’t be able to change.

If you start looking at sugar as a toxin, for example, which is okay in small doses, very bad in large doses, then you’re not going to want those things. And that’s going to be all the difference. And it’s going to be the same with ultra-processed foods.

So in the past, people were like, Oh, wow, hey, this is great. This is this food and it tastes really good. But people are starting to change because now they’re like, Whoa, look at all this chemical, I don’t even want this anymore. And you see that because people are saying, Oh, you know, only natural ingredients are all natural. Like you see it on the packaging now, but it’s the mindset because if you take that mindset that this is a, this is really, really bad for me and maybe it tastes good, but it’s really horrible stuff. You’re not going to want that anymore.

So, you know, you go to certain places like the, the, you know, California and, you know, the, the farmers markets and stuff. Right. And then it makes it easy because those are the, what you have to do is change your mindset. And to some extent, when you decide to change your mindset, what you have to do is just repeat yourself. Oh, that’s too ultra-processed. I can’t eat that anymore. And it’s not always so obvious, right?

So I give an example in the Hunger Code of sour cream. So sour cream should just be cream, right? That’s all it really should be with some bacterial cultures. Same with yogurt, right? It should be just bacterial cultures and milk. But if you look at a lot of sour creams on the market, they have xanthan gum and carrageenan and this and that. I don’t even know what it is. And I thought I was getting sour cream. I’m getting six different chemicals in my body.

So I look at that. And because my mindset has changed over the last five or 10 years, now I’m sort of revulsed a little bit because it’s like I want sour cream. I’m not buying carrageenan, right? I don’t want carrageenan. Don’t put it in my sour cream or the yogurt, right? I look at certain yogurts, I was like, okay, but there’s all this sugar, there’s all this other stuff in it, there’s all this xanthan gum in it. Like, that’s terrible stuff. So I don’t even want it, right?

So yes, it might be delicious, but changing your mindset actually is the first step to changing your behavior. So understanding the sort of toxic nature of those ultra-processed foods, and then repeating to yourself that, hey, this is bad for me, I don’t even want this, right? And at first it feels a little artificial, but over time, as you start to repeat it over and over to yourself, it’s like, oh, gross. So ultra-processed, so ultra-processed. Eventually you move away from actually even wanting that.

And that’s where it doesn’t even have a hold on you anymore. And sure, once in a while you’re still going to have it. But what you want to do is cut down from, say, 70% ultra-processed foods, which is where the Americans, the general American diet is, to like, you know, maybe 25, 30% like the Italians.

Terry

45:01-45:28

Dr. Fung, you mentioned a deprivation mindset. And I think that’s where a lot of people approach fasting. Oh, I can’t eat today. I’m going to feel terrible. And you are a proponent of fasting. That’s what we mostly talked about years ago when we spoke to you before.

Can you tell us why fasting is helpful and how we can use it most effectively?

Dr. Jason Fung

45:30-47:22

Yeah, so fasting is really just letting your body use up its stores of calories. Remember, body fat is simply a store of calories. So if you don’t eat, your body will release calories from its fat stores, which is great if you want to lose weight, obviously. So that’s the whole point. It’s natural. This is what it’s for. You can do it.

Is it fun? No, not particularly. So the mindset is very important because if you take fasting and say, oh, this is hard work, it’s deprivation, I’m not going to do it. You’re going to fail, right? And that’s the diet mindset as well, right? I want to eat this, but I can’t, right?

You have to change that. So instead of viewing fasting as a chore that you don’t want to do, you want to see it as an opportunity. You want to say, hey, this is an opportunity for me to use my stores of body fat, because as I lose this weight, I’m going to be healthier, I’m going to feel better, and I’m going to look better, right? So you have to just keep repeating that to yourself.

Again, first, it feels very unnatural. Then after a while, it’s like, oh, okay. Because I remember, you know, sometimes when I do fast, I do sort of sometimes a bit longer because I find it very helpful because it helps some of the aches and pains and stuff. And so I view it very positively. And the thing about fasting is that it used to be something very positive, right? It used to be called a cleanse, a detoxification, a purification. It was always positively associated with improved outcomes, right?

It’s only been in the last 10 years that people said, oh, fasting is bad for you. But because I find it, you know, I feel good sometimes on it. Like I feel some of these aches and pains better. Sometimes I get a little annoyed when people are like, oh, let’s go out for dinner. I’m like, ah, damn, I’m in the middle of a fast. I don’t want to go. Right. I don’t want to be rude.

Joe

47:23-48:07

Let’s just stop there for a second. Because when you say fasting, that means a lot of different things to a lot of different people. So for some people, it means, well, I’m not going to eat for the next three days. And for other people, it’s, well, I’m only going to eat until two o’clock in the afternoon. So I’ll have breakfast and I’ll have lunch, but then I won’t eat again until the next morning. I won’t eat dinner and I won’t eat snacks before going to bed.

Other people say, no, no, I’m not going to have any breakfast. I’ll just wait until noon and that’ll be my first meal. And then I’ll have a little snack at five o’clock and then I won’t eat anything again until the next day at noon. So what do you mean when you say fasting?

Dr. Jason Fung

48:07-49:44

Fasting can be any of that. So fasting is just any period of time that you decide you choose to not eat. So it could be, you know, it could be any of those.

It could be, it could be, you know, 12 hours. It could be 16 hours. It could be 24 hours. It could be two days, three days, four days, and so on. So it doesn’t really matter. But whatever you feel, you know, is your appropriate period of fasting that you want to do, then that’s your fasting period, right?

So if you eat dinner at, you know, five o’clock, six o’clock, and you decide to have an early dinner and then push breakfast late, for example, so you have an eight-hour eating window and a 16-hour fasting window, that’s a very popular term called the 16-8 fast. And it helps for a lot of people, right?

But what you want to do is make sure that you’re viewing your fasting period as your cleansing period, something you’re doing to make you feel good. And when you put down food rules like that, it helps you stick to it because it’s a lot easier to stick to that rule because you say, well, I’m not going to eat between, say, you know, six o’clock at night to, you know, 10 o’clock in the morning. That’s my fasting period. Then you’re no longer tempted because you’ve set that for your rule because you’re feeling like that’s what you need to stay healthy.

Then it’s easier to stick to it rather than something very nebulous like calories, which is like eat whenever you want, whatever you want, as long as you stay within these calorie limits, right? But you don’t know how many calories you’re eating. It’s very hard to count your calories, whereas it’s easy to count your hours that you’re not eating.

Terry

49:44-50:09

Dr. Fung, I do want to ask about potential hazards of fasting because we always like to ask about side effects and downsides of whatever intervention we’re discussing. And it strikes me that there might be some people who could get themselves in trouble, people who are prone to eating disorders. Can you address that at all, please?

Dr. Jason Fung

50:10-52:04

Yeah, so in fact, eating disorders is always a concern. The data on the studies on fasting show that it doesn’t increase the risk of eating disorders. Because remember, fasting doesn’t mean that you’re not eating for 40 days and 40 nights, right? It could be simply you don’t eat after dinner until breakfast time, right? That’s the very term breakfast, break fast. That’s the meal that breaks your fast, which implies that you should be fasting for a period of time every single day. Because when you’re eating, you’re eating more calories than you can use at that moment. So therefore, you need to fast in order to eat the calories that you’ve stored up. And that’s completely natural and normal.

Same with body fat. It’s a natural thing to use your body fat. And the only way you can use your body fat is to not eat. Because when you eat, you’re going to be storing calories. It’s only when you don’t eat that you’re going to be burning them.

Eating disorders like anorexia nervosa are very important. But they’re actually psychological disorders of body perception. That is, people feel that they’re too fat and therefore they don’t eat.

So when you look at even fasting in people who have, you know, anorexia in the past, you don’t find an increased risk of anorexia when people are fasting. It’s, you know, fasting is what anorexics do, but it’s not what triggers them off. It’s just like washing your hands doesn’t make you obsessive compulsive, right? It just means you’re washing your hands, right? Whereas obsessive compulsive disorder, people wash their hands, you know, two, three hundred times a day sort of thing, right? But washing your hands, it doesn’t go the other way. Washing your hands doesn’t cause obsessive compulsive disorder. Obsessive compulsive disorders do make you wash your hands, right?

Same thing with the fasting.

Terry

52:04-52:15

Thank you for clarifying that. We are running low on time. And I’m wondering if you could just explain to us your three golden rules for weight control.

Dr. Jason Fung

52:16-55:01

So the golden rules really are very old rules that have been around for a long time. Number one is don’t eat ultra-processed foods to the maximum extent possible, right? And it’s a golden rule because it cuts across all three different types of hunger. The homeostatic hunger because these foods are processed to minimize satiety, because if you eat foods that make you full you’re not going to eat as much.

So when they engineer these processed foods they don’t want you to get full, so buy more and they make more money, but you gain weight. So that’s homeostatic hunger. They’re also engineered to maximize hedonic hunger. And because they’re so heavily advertised and so easy, right? Packaging, you don’t need to cook and all this sort of stuff. They’re very easy to build into habits. So you go in front of the TV, you’re not cooking a steak, you’re grabbing a pack of Cheetos or whatever.

So because it cuts across all the different types of hunger, that’s sort of the most important thing, the golden rule number one. And that’s really been identified in the most recent dietary guidelines as well. Eat real food. Number two is make sure you have an adequate fasting period. Because again, it really helps break some of those conditioned responses. And also is very effective for food addictions because food addictions have to be treated with abstinence. So again, as a rule, just don’t eat all the time. Make sure you have a good period of time where you’re going to burn off the calories that you ate, right? And that’s just natural and normal. And both of those have been around for a long time.

And the third golden rule is make sure you have the social environment that allows you to succeed. Because again, what you eat, how much you eat, how you eat, all of those things are influenced to a huge extent by the people you surround yourself with and the environment that you’re with. And, you know, people think it’s all about personal choice. But clearly, there’s a huge difference when you, you know, have a Japanese person in Japan versus a Japanese person in America. There’s a big difference. And the difference is not the person. The difference is the environment.

So I have to recognize that that food environment is different and plays a huge role. The social norms are different. And also, you know, people you surround yourself with. So you really have to make sure that you’re either leading your friends to good habits and explaining to them why you have to follow these habits, but creating that social environment that allows you to succeed. Everything is much more successful when you do it in a group and do it all together. Doing it by yourself is just very difficult. People generally don’t succeed like that.

Terry

55:02-55:08

Dr. Jason Jung, thank you so much for talking with us on The People’s Pharmacy today.

Dr. Jason Fung

55:07-55:08

Thank you.

Terry

55:09-55:42

You’ve been listening to Dr. Jason Fung. He’s a Canadian nephrologist and co-founder of The Fasting Method, a program to help people lose weight and reverse type 2 diabetes and obesity.

We conducted this interview before the recent publication of the Cochrane Review, showing that fasting is not more effective than calorie counting. His books include “The Obesity Code,” “The Diabetes Code,” and his latest, “The Hunger Code: Resetting Your Body’s Fat Thermostat in the Age of Ultra-Processed Food.”

Joe

55:43-55:52

Lyn Siegel produced today’s show. Al Wodarski engineered. Dave Graedon edits our interviews. B.J. Leiderman composed our theme music.

Terry

55:52-56:00

This show is a co-production of North Carolina Public Radio, WUNC, with the People’s Pharmacy.

Joe

56:00-56:16

Today’s show is number 1,463. You can find it online at peoplespharmacy.com. That’s where you can share your comments about this episode. You can also reach us through email: radio at peoplespharmacy.com.

Terry

56:16-56:25

Our interviews are available through your favorite podcast provider. You’ll find the podcast on our website on Monday morning.

Joe

56:26-56:55

At peoplespharmacy.com, you could sign up for our free online newsletter to get the latest news about important health stories. When you subscribe, you also have regular access to information about our weekly podcast. We would be so grateful if you would write a review of The People’s Pharmacy and post it to the podcast platform you prefer. If you find our topics interesting, please share them with friends and family. In Durham, North Carolina, I’m Joe Graedon.

Terry

56:55-57:28

And I’m Terry Graedon. Thank you for listening. Please join us again next week. Thank you for listening to The People’s Pharmacy Podcast. It’s an honor and a pleasure to bring you our award-winning program week in and week out. But producing and distributing this show as a free podcast takes time and costs money.

Joe

57:28-57:38

If you like what we do and you’d like to help us continue to produce high-quality, independent healthcare journalism, please consider chipping in.

Terry

57:38-57:43

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Joe

57:43-57:50

Whether it’s just one time or a monthly donation, you can be part of the team that makes this show possible.

Dr. Jason Fung

57:51-57:56

Thank you for your continued loyalty and support. We couldn’t make our show without you.