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You're at the right place, folks, if you're looking for Stay Off My Operating Table with Dr. Philip Ovadia. We are joined today by a returning guest, Craig Emmerich, and I'm i- I'm interested to see where this particular conversation goes, Phil for a lot of reasons. I think I should say right up front, Craig sent us a preview copy of the new book, and it is absolutely encyclopedic. Yeah. So I'm not sure I'm not sure how deep we get there, but Craig Emmerich. Hi. Thanks for having me on, guys. Good to see you again. Yeah. Great to be back with you, Craig. Always, I was just before we hit record, was just talking about how I got to see Maria, your wife, over the weekend. And whenever I get to see either, or preferably both of you it's always both entertaining and engaging and educational for me. I learn a lot from the experience that both of you have had now within this space. So maybe g- you, you can give the brief background, but we certainly invite people to go back to your first episode with us as to, your story behind this. But I think it's always good, maybe an update on your journey and your story, and then I think that leads into I suspect why, you and Maria decided it was time for another book, right? What- Yeah ... what really got you thinking about, what needed to be said on top of the already voluminous work, right? I think this is- Yeah ... book 9 or 10 between the two of you. Oh, yeah. It i- it's, Between... that we've co-wrote. I think we've got 25 books now total that are out there. Maria is a... y- she's a firecracker. She's always going. She's loaded with energy, and she's always pushing to, to help more people and get more information out there. Our history, we've been doing this for over 20 years, helping people with low carb diets and Maria herself, it's been over 25 years that she's been eating this way for her own health issues back then. And so we've got a lot of experience. We've seen just about everything when it comes to, people eating this way, whether it's low carb, keto, carnivore. And the last book we wrote on nutrition was our Keto: The Complete Guide, which is, we wrote it probably eight, nine years ago, and we've learned an awful lot since then. And especially in a couple areas that Maria really wanted to get in this book were a whole section on HRT bioidentical hormone replacement therapy. She's a big advocate for that for women. And then she also had a whole section, she's been doing a lot of research on peptides and so she did a whole section on peptides as well. Those are two of the new sections that she brought and make sure got in here. But in general, it's just, it covers... I mean, it's 400 pages and it's, like you said, there's a lot in here, but it, we tried to put everything we know about health and, environment, nutrition, all of it's in this book. Great. Yeah. I we'll certainly invite people to just, I mean, just the table of contents, for the book Jack said, it is encyclopedic and I think the writing style the way you laid out the book remains accessible, right? People shouldn't be intimidated by 400 pages. From my kinda overview of the book, I think there's a lot of... People will go to the sections that are gonna be relevant to them. One, one of the things that I pride myself in is being able to take pretty com- complex topics and breaking them down into easy to understand language. Like the biochemistry section in here, again, I think I broke it down. It's not a lot of complex stuff like a, textbook. It's more plain language, easy to understand language that really helps people understand the concepts without having to get into the big fancy words and, all that kind of stuff. Maybe talk about some of the challenges that you've ma- experienced personally and what you've seen, in your community now that really, again, I think a central theme of this book and, something we talk a b- lot about on this show as well, right? It's not as simple as just saying to people, "This is the one diet," right?"Go eat this." Yeah."And that's gonna fix all your problems." Yeah, absolutely. That was a big theme is that none of this is a one-size-fits-all. None of it. And I personally know that from my experience. I, I took about five, six years after Maria started eating this way for me to come around. I was a s- stubborn German. I like to brew my own beer and do my own thing and, But o- once I ate more and more of what she was making, I just felt better and better, and I just decided I wanted to do that. So I went probably 10, 12 years- I'd say 10 years of eating that way, feeling great. I never had any health issues. That's why it wasn't a big pressing urge for me to s- change my diet in the beginning. And then I started having health concern- or, my back started to get stiff and move up through my back, shoulders, neck. And initially I thought it was an old back injury that I had from high school, but it just kept going up and into my shoulders and neck, and it sounded a lot like Lyme disease to me. So I went and got the standard Western blot Lyme test, which I didn't know at the time, but I do know now is false negative like 70, 80% of the time. So it'll say you don't have Lyme disease when you really do. And so I went another year after that struggling and trying to figure out... And finally I just went to a doctor, got a bunch of tests done and I f- you know, my CRP was through the roof, very high inflammation. And then a friend of ours, actually our... the person who owned the company that published our previous books, had history with Lyme disease, and he said, "You need to take a better test IgeneX or Galaxy Labs." And it's expensive tests, but it showed I had Lyme and a couple co-infections. And so at that point I knew there's some people that had gone carnivore and I didn't eat a lot of plants to begin with, but, I- they went carnivore to help with their Lyme disease pain. And so I went full carnivore at that point while I tried these other treatment protocols. And carnivore did reduce the pain somewhat. But, this is where I started to recognize that, food's not gonna change everything and fix everything. There's definitely massive improvements. I mean, w- I have a folder with over 5,000 testimonies from clients and people we've helped, and I can go in there and type any condition and see, half a dozen things, half a dozen examples of people who saw m- big improvements with this lifestyle. But one of the issues is you gotta recognize is y- you can see improvements, but if the source of the problem is not food related, then food's not gonna fix it. It may make it better, but you need to find other modalities to get rid of the source, which in this case was my Lyme disease, right? There's nothing about what I ate that's gonna get rid of the spirochetes out of my body, right? And so that's where, the carnivore harder just doesn't work in that situation. You do have to find other modalities. You ha- you do have to find supplements or, other traditional medicine antibiotics, other things to get rid of that problem. Real quick just because I'm not a medical professional, Lyme disease is caused by and is signified by? So Lyme disease is a ill- you get it from a tick a wood tick Right they bite you, and then the, it the the Lyme spiral key gets into you. It replicates. It causes all this inflammation in your bo- your immune system is constantly fighting this stuff, trying to get rid of it and that causes constantly elevated immune system. E- chronic Lyme is, has got some other ana- analogous things that are very similar, like chronic inflammatory response syndrome, SIRS. That's another, im- your immune system won't shut off. Chronic Lyme is very similar. Long COVID was very similar as well, where people, some people just had this, where their immune system wouldn't shut off. For whatever reason the body gets into that state, and you just have to find the modality. And it... The thing about chronic Lyme and some of these other things, what works for one person does not work for everyone. It works... It's... I tried... I spent probably a quarter million dollars on various treatment protocols, and of course, all out of pocket because, chronic Lyme in the traditional medicine sense, they, some doctors don't even believe it exists. So this, I tried everything. I mean, everything that you could imagine, everything the people out there would suggest to us that so and so got helped with this, so try that. And it to- it was a very long road to get around to where I am now. And about two, three years ago, I'm back to CRP below two. My inflammation's back under control. I don't, have to rely on painkillers just to function. And I haven't taken- ... a painkiller since I got my hip replaced two years ago. Definitely looking up. Real quick, because we didn't mention it, but Craig is not a medical professional. Maria is not a medical professional. These are people who have everything that they have learned has come external to the the medical education establishment. Now, I personally find that to be a point in your favor, or several points in your favor. Maria did go to college for nutrition and exercise science, but the nutrition stuff she got taught was basically food pyramid, so- Yeah everything's been outside of that. Yeah. All right. Y- you mentioned a couple of things right at the beginning that I would love to hear more about. But before, I d- I wanted to ask you about Maria's health. She's, she mentions in the book that, I don't have the page in front of me, I apologize. Yeah, she- But the gist of it was a friend said something to her about she looked like she was too skinny. Yeah. And that, that turned a light on for her. Yep. She- it's something she's been working on for a while and she's doing amazing. She's in that r- weight room every day building muscle. That was one of the big things for her is she had lost a lot of muscle because i- initially started quite a while ago where she was kinda getting caught up in the carnivore one meal a day kinda stuff. You like, you gotta eat like a lion and eat one meal, and- Yeah ... she could never eat enough protein in that one meal. And sh- she lost quite a bit of muscle during that time. So yeah she's doing great. She's building muscle like crazy. She's... Like I said, she's a firecracker. Whatever she puts her mind to, she's gonna do it. So i- is sh- is she one of those people who is capable of overdoing it regardless of how she's feeling? Is that what, She's the kind of person that does everything 110%. Okay. There is no halfway with her. I mean, it's... She does- She's literally the only person I've ever seen or ever met o- who's gone too far the other way. She... Like I said, I mean, we've published 25 books. Yeah. No, there's no breaks. It's all gas with her, so yeah. That's pretty good. All I guess, a high-level question that comes out of all of that, right? Your experience, Maria's experience, and again, all of the, thousands of people that you guys have helped through your community now. What maybe are some of the indicators that people should be on the lookout for as to changing your diet alone, is not going to be a complete answer to whatever you're struggling with? I think that's something that people don't know, quite when to look further, look beyond. Because lots of people, as you said and yourself and me and, lots of people get lots of great improvement from just changing the diet. Yeah. But then, when are those indicators, what are those indicators that you might need to start looking about some of the... looking at some of the other stuff. And again you guys do a great job of going through what some of that other stuff might be in the book. Yeah. It's, There's a lot of things. But, I would say one of the foundational pieces would be what's the root cause of this problem? If it is truly Lyme disease or, mold, if you've got mold exposure and toxicity going on. Those are factors that diet's really not gonna do anything. You gotta you gotta address that root cause. Beyond that, if you're just not feeling the benefits if you're sleep is bad, if blood markers, if y- if your blood markers are looking out of whack even though they... what you think they should look like when you're eating this way. For example, glucose is way too high still even though you're eating little to no carbohydrates, or triglycerides still staying high. Those kind of things can be indic- indicators of other things to address that might be going on. Ferritin being really low, if you've got some, that's gonna give you low energy and those kind of things. So blood markers can be powerful, I think, in, in understanding, what might be going on that's outside of diet. So let's talk about hormones. Hormones. I can't go super deep into a- HRT because that's Maria's chapter, and that's her chapter. Okay. All right. I saw that chapter- It- ... and I've, I, I- Well- ... made a note to myself What I do know is it's incredibly important to be discussed more. I think what is it? Like 8% of women th- are on hormone replacement. I mean, that's crazy. That's... it w- it all evolved from this scare of increased bre- breast cancer risk but that was using, not bioidentical hormones. The... it was using all these other things. She can explain it better, but it's those... that scare is not really valid in today's s- situation with the bioidentical hormones and all that. And what happens inside a woman when they don't have enough estrogen is crazy. The arteries stiffen, your bones deteriorate. There's all of these things when you don't have enough estrogen, and you can't f- necessarily feel that. People... and this is another example. In this community, people, there's... I know one influencer who says you don't ever need h- hormones, just eat lots of fat. No matter how much fat you eat, you're never gonna replace the estro- estrogen that's lost from menopause. And you might feel a lot better, and your symptoms of menopause may go down, which is what we see a lot when e- people eat this way, but internally, those, the bones, the arteries, you can't feel those changes happening, but they are. That's why h- heart attacks are one of the biggest killers of women. So she's a big advocate for this. One, one thing that- sh- she would say also is va- vaginal estrogen, women who have chronic UTIs, this would actually save millions of dollars in healthcare costs if they just gave them vaginal estrogen. And this... She was having them very frequently as well, and they always just give antibiotics. And she, once she started vaginal estrogen, she had a, hasn't had one since. Huh. It should be over the counter, I'm telling you. And it's one of those things that, if it was happening to men, it probably would be over the counter. But, it's just one of those situations where, I don't know, it's crazy. Is there... And I was looking for it, I'm not seeing it. Is there a section of HRT for men in the book? She talks about testosterone and stuff, but mostly in the context of women. But we do believe that, testosterone replacement for men in certain situations can be a very good idea. If you, if your testosterone's 200, even though you've changed diet and done, all the things, and whatever reason, genetics or your situation, you're, got low testosterone, could be really life-changing for men too to get it up to a normal range. Yeah. Okay. Well- What you talk about you have a section on supplements in the book. Yeah. And again, maybe, don't necessarily need to get into all the specific supplements. But again, I'd love to hear your framework, your thinking around on the one hand plenty of people are out there saying and, you should just get everything you need from your diet," right? Yeah."You shouldn't need supplements." And love to hear how you kinda think about when, again, when you might, what might be some of the indicators and why chose to make that such a prominent part of the book. Yeah. So we look at it as, we try to use every modality we can to help people. And we've seen some pretty amazing results with people with supplement, targeted, not necessarily long-term with certain ones, just, a few months to top up levels. If somebody's deficient, for example, in magnesium, mag- magnesium is one of the biggest deficiencies in the United States. 80% of people are deficient in magnesium. Part of the reason is we used to get a fair amount from our water supply but what's everybody drink now? Filtered city water, filtered bottle water. Everything's, all the minerals are filtered out. And so there when you're deficient in magnesium, topping up those levels with a supplement m- more quickly than you c- probably ever gonna get from food- Can be very beneficial, and you can see some really nice results from that. And, it... In general, what I would say about this too is, people, yeah, you- you're eating protein, which is one of the most, nutrient-dense foods you can eat and, whole foods, lots of vitamins and minerals. There's a study that I think it was from the '70s to the'90s, like 25-year period. They found that the vitamins and minerals in our food supply had gone down 50 to 70%. Our soils are being depleted with, the row crops and the- Yeah ... the cows are eating those crops or parts of those stalks and things from those crops, so they're, maybe they're likely going down in vis- vitamins and minerals too, right? Because their, the- their food that they're eating is going down. So if you look at it that, from that perspective too, our food supply is half as much vitamins, minerals, half as nutri- dr- nutrient dense as it was 25 years ago. There might be situations where you're even eating whole foods and all that, you're not getting what you need in certain vitamins and minerals. And then there's also ones that are just not eaten very much anymore because of modern situations. One example is vitamin K2. I think K2 is an extremely important vitamin. It regulates calcium metabolism. It gets calcium where it should be in the bones and helps keep it out of, kidney stones, arterial plaque, all those kind of things. It mainly comes from things like, organ meats, which people don't eat much anymore. Naturally fermented vegetables, which, the pickles in the store aren't naturally fermented anymore. You don't have that, So you're not getting that K2 as much anymore in the food either. So that's where supplementing can really help. So I think it, I think they have their place, and when used appropriately we diagnose by symptoms. You've got these issues, these GI issues, whatever. She's m- creates a protocol for them of supplements to ch- to take for a period of time and improve their health. When I read these... i'm currently reading a book that I'm almost embarrassed to admit I'm reading. But my wife found it on a discount store shelf, and I picked it up, and it's actually interesting.... It's a, it's chick flick, so I'm... But it's well-written. But it, there's a general store in the '20s in the South, and they talk about a pickle barrel. Is- Yeah ... was that what, how they naturally fermented stuff? Was it, that's just... I'm confused about what makes natural fermentation natural. That's... It's like the lacto-fermented vegetables. That's how we used to do it, today it's like sodium bi- what do they use? It's different. You're not getting the pr- prebio- probiotics and all the stuff that's coming from the natural fermentation process. Again I don't know the exact specifics of what they put in it, but to make it happen, but it's a different process. Is it done that way because it's faster or controllable- Faster, cheaper or what? Yeah. More controlled.'Cause you're actually getting... There is... You can get Bubbies Pickles are naturally fermented, lacto-fermented, so you can actually get those still today. But they're, like a more high-end pickle, it's... You can only find them in certain places, that kind of- Yeah. Bubbies Pickles. All right. I'm gonna put that in the show notes. They're good. I've had them. They're good. I can vouch. I've had them as well. They are pretty good, and you can find them in the supermarkets. But yeah, it again, it remains a challenge around our food in general, right? Because even things that are, purported to be healthy, right? It I guess I would say it this way. Almost anything that's thought to be healthy in some way these days has a bastardized version of it, right? That the food companies are trying to- Yeah ... do it at scale and do it cheaply. And for the most part, you're probably not going to see the results that you expect from those versions versus the natural things that certainly may be healthy on their own. Yeah, for sure. And I guess I'm gonna have to find out w- what natural fermentation is as opposed to... it never occurred to me there was- A difference? No. Yeah. I just, I assumed fermented was fermented. Yeah. Not all And this goes for the kimchi and the- Yeah ... even like Japanese stuff like miso, tempeh, those are- Yeah fermented. It's a different process, yeah. Yeah. Sauerkraut, most of the sauerkraut that you buy in the stores is really not fermented. It's just soaked in vinegar and some other- Yeah ... chemicals to give it the taste, but not getting those benefits from it. Yeah. For sure. Well- In the food supply. Yeah. What are your thoughts on what we're seeing in the changing food environment these days, right? So we have, and again, putting the politics of it aside, right? We have the MAHA movement. We have a brand-new food pyramid that was released. What's your perspective? Like you said you and Maria, you've been at this for a long time now. Do you think that we're starting to see some actual meaningful change in terms of our food environment and how we talk about food overall? I hope there is. The... anytime you change to prioritize more protein, I think we're going in the right direction for health. And not just protein, but, complete proteins like animal proteins. There's so much misconception on protein too of, bioavailability and how much amino acid profiles and everything. Y- the old, I think it's a vegan chart of broccoli versus steak showing how broccoli has, like X protein versus this. And it's if you actually take into account the bioavailability, the l- lack of leucine and how much you have to eat to get enough leucine to actually build muscle, it's like crazy. The I think I did the math once. It's nine entire heads of broccoli to equal a, four ounce steak of protein. It's who's eating that? Yeah. But yeah I think that's really important too, that they're focusing on that as well. It's a little tough, I think, in the general population because, I mean, prior to this, how many people out there would you say are loyally following the food py- pyramid the way it was? Yeah. I mean, who really pays that much attention to it? I don't know. If it can m- maybe make some s- slight changes of people not being afraid of like animal proteins or that kind of thing, I think that would be very valuable. I'd love to hear you... I'd love to go, I'd love to have a deep dive on peptides. I, that's really what I'm trying to say. I realize the book is designed to be a guide for a user like me. And I'll confess, I haven't read that chapter yet. But I'd love to hear anything and everything you have learned about peptides what you've personally experienced and what you've seen work- For people in the kinds of situations our listeners might get into Yeah, so unfortunately that's another one that Maria wrote. Oh, come on. You gotta have Maria on and talk about peptides and HRT and- Ah ... talk your ear off. But, there's so many peptides out there, and peptides in general, I mean, it's a protein-based signal- signaling molecule that the body naturally has, and these peptides are just increasing levels externally. Insulin is one of the first peptides ever created, external. Saved tons of lives. Peptides, ob- obviously today in the news are, and the GLP-1s are all the rage and all over the place. That's another peptide. And then there... but there's lots of other ones that m- people have used and Maria has used herself whether it's things like BPC 157, which is a really good one for healing and it actually increases vascular growth around areas to help them heal. There's, th- that one has been on some channels, like I think on Rogan there's these fighter, ultimate fighters that have used it to, in their joints or- Yeah ... places where they've had injuries and saw- seen some pretty impressive results. One of the things about it in general is that it's it's a little tough because, right now the FDA hasn't really jumped in too much on it, and so you kinda gotta be careful where you source things. You gotta make sure they're reputable, make sure they're high quality, and all that kind of stuff. There's... You can go out there and get, a peptide or a GLP-1 from China, and you don't even know what's in that thing. I'd be careful about injecting that into my body, but if you find a quality source and a quality product, they can be really helpful. Yeah. It's certainly a topic that I've become interested in as well and have gotten a fair amount of education around done some training and something we're starting to integrate into our practice as well and seeing, people derive great benefits from this. And, it brings up the interesting again, what we were talking about earlier, right? That there are many people out there that are, dogmatic about, you know- It should be your food and only your food, right? And whether we're talking about supplements or pharmaceuticals, and peptides fall somewhere in a gray zone between those two, right? But, no reason that we should be using these or considering them or but realistically, I think those of us that work with a lot of people, we do recognize and we do see, the practicality of bringing these tools in, using them smartly, right? Yeah. I think many of us have criticisms of, the kind of mainstream approach of the pharmaceutical or the peptide is the solution to your problem. And you don't have to worry about what you eat, or you don't have to worry about any of that other stuff, right? We can fix it with the medicines. And but I think most of us that are reasonable, have come to the conclusion that all of these things are tools. The food that we eat- Yeah is a tool. The habits that we live, exercise, sleep, all of that, these are tools. And things like peptides and supplements and even some pharmaceuticals they can be tools that if you use them in the right way, you're gonna get good results from. Yeah, for sure. And, again, very context dependent too. I agree that I do not like the, blanket of the, GLP-1s, the way that it's being pr- promoted, especially, somebody who's 10 pounds from goal weight, something like that. I don't think that's should be used in that s- situation ever. I mean, get i- get in the weight room, g- start working out. That's not the tool for that. It's the, person 100 pounds overweight with, all these health issues who is trying and d- struggling with the food noise to stick to their l- this l- diet. And, it's a, can be a tool to get them through that phase and get that get them healthier quicker. And then, look at, focusing on the other things once that's all taken care of. But yeah, it's... I think there's a... Everything's a tool. E- you gotta use them strategically and smart and in the right situations. What has changed for you in terms of how you eat?'Cause this is primarily about nutrition but in, in how you care for your health since you first started followed Maria down the carnivore path. What worked that stopped working or didn't work as well as you needed to and changed, and what triggered those changes? I'm asking you to look back years, I understand. Sure. First of all I just remembered, we have a... Maria's doing a peptide class, so if you wanna get the deep dive on peptides, she's got a class coming up in June. Ketomaria.com, you can get access to that. But over the stretch of, again when she was doing this, she was doing it 'cause she had PCOS, IBS, acid reflux, extra weight that even though she's running marathons she couldn't get rid of, following the, low fat, a healthy whole grain approach that she was taught. She was trying to address her s- her own issues. And a- at that time, I didn't, I probably lost, I don't know, maybe 30 pounds total in the journey. But I wasn't super concerned about it at the time. And I just didn't have any health issues, so it wasn't a pressing need. But what I did notice is she would always make my lunches when I go to work, and I'd eat, for the most part eat her food all week. And then the weekends I would have whatever. And I just kept noticing how crappy I felt on the weekends. But during the week and I'd have that, nice stable energy and focus all week. And it just finally dawned on me that it's just not worth it, and so I just started eating this way all the time, and I felt, r- reaped the benefits of the, mental clarity and able to focus on projects, all that stuff. And so that's kinda what started it. The transition of that to, getting to my condition with Lyme and everything, I did transition then to carnivore. And again, pain did go down some, and so that was another transition I made based on my situation. Now that my inflammation's back under control, I actually have switched a little bit towards more keto and eating more variety of foods and plants and that kind of thing. And, Sorry. Thank you. My, my puppy's going crazy. Maria just got home, so Oh. Dog is going nuts, wanted to go out. But yeah I've been moving and based on my situation, my body, how it's feeling, moved to different protocols or different, diets across this, what we call in the book a diet spectrum based on my preferences and my goals and situation. And I think one of the things, I'm sure you under- you know that the number one failure of any diet is noncompliance. And so you gotta find something that's gonna work for you long term. And if it's eating beef and salt and that's it- All the power to you. Lot of people can't do that, and a lot of people need more variety and want more variety. And so keto or even into a more low-carb kind of space, low carb, high protein that is, we give that as an option, and find where you're comfortable, find what works for you, what is... enables you to maintain your successes, the weight you lost and the health improvements, while having the variety that you can stick with for life. In other words, it's not a religion with you. Exactly. We're not in a silo. We're not dogmatic about any approach. In, protein sparing modified fast, we haven't talked about that. That's another tool that we have that we use where you basically eat your same protein goal, almost no carbs, and only 20 or 30 grams of fat for a day. And it mimics w- it... The technical the term comes from studies and science that that you're sparing your body's protein by modifying a fast. It's they found that they were doing these studies on extended fasting, and they would always find nitrogen loss and that you're losing some lean mass some muscle while you're doing ex- extended fasting. So they tried to modify the fast to spare the body's protein. S- so how do you do that? You just eat basically protein and nothing else. Just enough fat to absorb fa- fat soluble vitamins and hor- hormones and that kind of thing. And it's a really great tool for rapid fat loss. It mimics a lot of the things you get from a extended fast without the negatives of losing muscle.

And for us, two things: 35:35

protein is always a priority, and your muscle on your body is never anything to take for granted or lose or, you want to maintain as much as possible, especially as you're younger, so that when you do get older and that leucine curve shifts and you start to be harder to maintain and build muscle, you've got that storage or that, muscle built up that is a bank, if you will for later in life. Did you... What'd you say? Leucine shift? Leucine. Leucine's amino acid. Oh, leucine. Okay. Yeah. That is one of the primary triggers to tell the body, "Okay, we're gonna build muscle," 'cause we have a complete pr- complete amino acid, complete protein coming in. Gotcha. And the threshold where that triggers, if you will, in the body, it shifts with age. And so you actually need more and more leucine as you get older just to build muscle, and that's why it's so hard for older people. It's a lot of time, older people eat even less protein, and then this leucine shift is happening on top of that, and that's why you get so much sarcopenia. And what kind of- I guess why do you think protein is so important ultimately? The protein sparing modified fast is something, I know you've been a big proponent of for a long time now. And just talk about... I think this is, this, like you said, is in the conversation now, right? And part of the revised food guidelines were around increasing, the definition of what is adequate protein. But maybe talk a little bit more about why protein in particular is so important and what maybe you think the right levels that people should be targeting are. Yeah. So one of the things, when you look at, there's fat, protein, and carbohydrates. Carbohydrates and fat are primarily fuel sources. Protein isn't really a fuel source. Yeah, the body will turn a little of it into glucose through gluconeogenesis. It's gonna take some protein to make glucose from it. But it's primarily gonna take that protein and use it for the amino acids to build h- the stuff you're losing every day, hair, skin, nails. That's all protein that has to be replaced every day. Muscle and rebuilding and build, trying to build muscle. You need a lot of amino acids for that. Autophagy. Autophagy is this process where the body breaks down cells that are a- aging and failing and builds them back up with some new amino acids to have new healthier cells. Autophagy is happening all the time, and that needs a supply of amino acids to help fuel that process. The Nobel Prize winner for autophagy I can't pronounce his name, the Japanese man he estimated that every three to four months we turn over all our protein cells through autophagy in our body. So you need a steady supply of amino acids, and the body really wants that steady supply, and they, and it's always best if they're complete 'cause then you can do the muscle building and all of the things. And so when we look at it, and then, and secondary to that we talk about, animal proteins in our... Eight, 10 years ago when we wrote the keto book, I put a whole chapter in there on where our vitamins and minerals are coming from because at that time I'd researched quite a bit and I didn't even realize, it wasn't talked about much in this community or anywhere, where are your vitamins and minerals are really coming from. And it's primarily from your animal proteins. If you stack up kale and blueberries and steak, it, 10, 15 years ago people would say, oh, even in this community, vitamins, minerals are probably coming from the kale or maybe the blueberries. No, it's the steak. That's where all your vitamins and minerals are coming from. Th- and- When you break that down within the steak, when you look at the fat of the steak and the protein of the steak, the protein is where all those vitamins and minerals are. There's very little maybe some vitamin A, vitamin D in the fat part, and m- a vast majority of those vitamin- minerals are in the protein part of the steak. And so that's why in general, we, always prioritize protein to n- not only for the amino acids, but for the vitamins and minerals. A good... There's several ways you can look at how much protein you wanna eat. I've got two or three real simple off, off-the-cuff ones. One is for a man at five feet tall, eat 100 grams of protein, and i- for e- each inch above that, add another five grams. So if you're 5'6", eat at least 130 grams of protein. Another way to look at it in a kind of a weight loss setting is eat one gram of protein per pound of ideal body weight. So if you wanna get to 150 gram, or 150 pounds, eat 150 grams of protein. Or a woman, 120 pounds, 120 grams of protein. So it's a real easy way to look at it. There's more complex ways of looking at .8 or .8 to maybe one or 1.2 times your lean body mass. A little more technical approach that can get you a number, but those those easy ones are pretty accurate too. I just did a quick, did the math real quick in my head, and I should be eating 180 grams based on the 100 grams at five feet. And I think my ideal weight's probably 185. So I'll add another five grams. In a weight loss setting, I think more protein is better. It's, again, not used as a fuel, so you get that benefit. It's very satiating when you look at it per energy,'cause it's not, again, really used as a fuel. It's, but it's very satiating. I... if you sit down in front of a bucket of shrimp, okay? A pound of them, and you can't use any butter, you're gonna, you're gonna stop eating them because it's just... it gets to a point where you just can't eat... Or, a chicken breast with no skin, no sauce it's one of those things that you just can't eat a ton of by itself. So it's very satiating too. So it really helps if you up your pro- Is that your protein to energy ratio there that you're- Yeah. That's part of it. And the thing is, people will say fat's more satiating." Yeah, but fat is, over t- twice the energy and protein, again, isn't really used as energy. And if you ate, somebody will substitute, you know- 100 grams of protein with 100 grams of fat yeah, you're gonna be more satiated on 100 grams of fat because it's, t- more than twice the calories. If you ate 200 grams of protein versus 100 grams of fat or 80 grams of fat and look at the satiation difference, it's probably gonna be different. Yeah. Exactly. The what you said about if you're trying to lose weight, you probably wanna eat more protein- Yeah ... I think is one of, is- is very counterintuitive to most people and counterintuitive to what our traditional dieting and weight loss, strategies have been. But I- I agree completely and- and see it work over and over again with people, even- Yeah... and even people, again, that are already in that sort of keto carnivore framework that are hitting these stalls or these, plateaus with their weight loss. One of my common recommendations is gonna be eat more protein and- and- and moderate fat a little bit. Yeah. And that's one of the things, Maria talked about this in her presentation, but, we get constantly get people who, you know, in the, in... especially I think in the carnivore kind of silo, there's this only eat the fattiest cuts of meat and add some butter to your steak, and this is the only way to do it. And we get especially post-menopausal women, it's very common, we get almost daily people coming to us saying, "I'm not losing weight," or, "I'm gaining weight following this advice. What am I doing wrong?" And again, w- we're not talking zero fat here. We're just talking, moderate it a little bit, instead of having two extra fatty ribeyes with butter for your day's meals, make one of them a leaner cut. Make it a tenderloin, it- it doesn't have to be drastic. It's just, doesn't have to be all super high fat. Yeah. And, to be fair there are some situations where more fat is the answer as well, absolutely. Yeah. And that's- that's again, n- not a one size fits all. Yeah, exactly. If it's somebody's dealing with seizures or dementia, Alzheimer's maybe bipolar, a lot of different brain conditions, you want more fat to elevate those ketones to help the brain. So yeah, it's- it's very individual. Yeah. I think that, really comes back to the nuance and- and, again, understanding who, who you are, what your goals are, where you're coming from, right? Where you're starting from. These are all things that are going to help guide you as to where within the nuance you ultimately fall. Yeah. And again, I think this book does a very good job of helping people- That's why it's 400 pages ... about that. Yeah, exactly. Was there one section that was particularly difficult to write? Oh, boy. I want- I don't know if it was difficult, but I wanted to give it the attention it needed. And that was just the, what's the actual title of it? Understanding how we process fuels. And for me, that was a chapter that I really enjoyed writing, but it took a long time to really not only come up with ways of explaining comp- complex biochemistry in easy to understand ways but bringing it in with graphics too. Putting up, different graphics and things that can help understand these thing, these very complex processes putting them together and putting them in here. I- that was very, Took a lot of time, and I'm trying to find a page here. I also included... One of the things you'll notice in this book too, which I really enjoyed doing, was we've got, a- again, over 5,000 testimonies of... In this folder I started keeping when people would send us these testimonies. And so I wanted to get some of that out there so people can see these N equals ones, because- ... yeah, it's not a randomized controlled trial, but you know what? N equals one testimonies, when there's 10 of them or 20 of them, become a powerful, thing that can motivate people. And so basically every square inch of white space in this book , I just threw a testimony in there wherever I could. And so it's loaded with hundreds of testimonies too. But this one is one that I really think I enjoyed. This was Tyler. And this is in the section that's talking about personal fat threshold, which is an important concept, I think for people to understand if they have insulin resistance. And this example really almost proves by itself personal fat threshold, because what personal fat threshold is when we're young, we are able to make lots of new fat cells. Hyperplasia, that's where you can make n- new fat cells. And then we get to a certain age, the vast majority of people stop having that ability to make lots of new fat cells, and you just fill up and empty the fat cells that you have primarily. And what happens is you get a... You, I have so many fat cells, and the fat cells themselves can only get so big because their their membrane actually you can only get three or four times the di- diameter and then it's gonna burst. So the fat cell itself says,"Nope, no more fat in my, in me. I'm full." If you only have a few fat cells, not a lot of fat cells compared to the next person, and they're all full, where does the fat go? So the fat starts to accumulate in your liver, fatty liver, fatty pancreas, sky-high triglycerides. This is me- this is type II d- diabetes, insulin resistance. That's one of the root causes of insulin resistance. On the other end of the spectrum, there... I said almost everybody, and there's rare cases where there are some people who can continue to make new fat cells as they are, 30, 40 years old. Tyler's one of them. Tyler is i- when we, he met him, he was 645 pounds. Oh, man. He lost 75 pounds per- very quickly working with us. I think it was a little over a month. And we asked him to get these blood tests done at that point. And at 575 pounds, his... I'm gonna read them off here. His fasting glucose was 50. He, It was oddly low. He's usually around 90. I'm not sure what happened that day, but his fasting insulin is 3.5, his triglycerides are 77, HDL 42, A1C 5.6, HOMA-IR 0.4. He's completely insulin sensitive. Why? Because his fat cells are small and happy. He keeps making new ones instead of filling them up and getting them stuffed. His body's able to keep creating new fat cells as he gains weight, so they stay small. And he's... I- if he, if his body keeps doing this, he could probably gain unlimited weight and never become insulin resistant. And so this just shows the power of that concept and how you had to look at, When we... On the other end of the spectrum, we've had, women that are 120 pounds and type 2 diabetic because they have very few fat cells, but they're stuffed. And so e- in those cases, even though they're 120 pounds, they need to lose a little bit of body fat to get back down below that threshold and make the tri- triglycerides go down and all that. It might be just a couple pounds of body fat, but they do have to shrink those fat cells a little bit. Phil, have you ever run into that? Oh, yeah. Yeah, we see it all the time, and I mean, again, in heart surgery world we know we know that there are plenty of people that get rip-roaring heart disease and, full-blown diabetes without getting obese. Yeah. And then you can... Yeah, you can see these massively obese people, and their coronary arteries are s- are sparkling clean, right? And they're not diabetic. And, Yeah ... definitely something that we see in practice all the time. And we, I think Maria talked about in her presentation too y- we see this even in the carnivore space where this phenomena can be... A- and going back to like you're saying, how do you diagnose some of these things? By looking at their labs. We had a couple people that they were g- doing the super high fat and, adding lots of butter and all that when they were diabetic and at that fat threshold, and were overdoing it and eating too much. Which by the way, the eat till you're satiated doesn't work for everyone, because guess what you usually have when you're obese? You usually have leptin resistance, so you're not getting the I'm full signal like you should be. But they were overeating fat and actually making it worse. Their triglycerides shot through the roof, their blood glucose shot through the roof, fasting glucose, eating zero carb carnivore, because the fat cells were stuffed. And ins- and pancreas, without this extra fuel coming in, just couldn't control it. I've heard several things on here today I've never heard before. I don't- Greg is usually good for that. Awesome. Well- Just- ... yeah, let's let's let people know again, the name of the book is The Art of Metabolic Health. Yeah. And I think that's a great title for it. There we go. Tell people where they can get it, and where they can find out more about what you and Maria are always up to. It's always great talking with you guys, and i- I actually have created this website, ketomaria.com, where you can get to buy the book, you can get to, all our social media accounts at the bottom. It's all in one place. So just go- Nice ... you can find everything. I love it when guests do that. Makes it easy. Oh. But yeah, we, I did a lot of speaking last year San Diego Cape Town with Dr. Noakes' event. We were sp- I was, Tennessee, s- doing a lot of travel and speaking. I'm actually taking a little time off this summer. I don't have any speaking things going on this summer. I'm a... After this book which by the way, not only did we write 400 pages over two years I did all the layout in InDesign. I spent three months laying it out, putting the graphics in, the colors. It's all done by Maria and I. Then reading the- I'm impressed. I was actually looking at it, and one of the thoughts I had was, wow, this is a really beautiful book. Oh, thanks. It does... it's not, My first book was self-published and it looked like it. It, this might be my last I never wanna say never, but this might be my last nutrition book I ever write'cause it is a lot of work. Not just the writing, but having to do it all ourself with all the layout and- Gosh, yes working with a printer to print the books and doing the audiobook and all that stuff. It's... i'm ready for a little time off from all that. I can totally understand that. Our guest has been Craig Emmerich. The website is ketomaria.com. The book, The Art of Metabolic Health. I'm probably going to keep this one pretty close to me just as a reference. It's a really just in the little time I've spent looking at it, Thank you ... it's a, it's almost... I said it was encyclopedic in size, but it's almost encyclopedic in terms of how to find information as well. I'm... It's a good one, folks. Thank you. I recommend it. Thank you so much. I appreciate it. All right. For Dr. Philip Ovadia, this has been Stay Off My Operating Table. Thanks for joining us, and we'll talk to y'all next time.