Dr. Tro Kalayjian: Are You a Food Addict? The 3 Signs You Should Be Looking For

Are you stuck in yo-yo dieting, sugar cravings, or binge-restrict cycles—and blaming yourself for it?

 If food feels like it’s calling you, if one meal can spiral into weeks or months off track, this episode may change how you see your struggle forever.

In this powerful conversation, Dr. Tro Kalayjian, board-certified physician in internal medicine and obesity medicine, breaks down the 3 clinical signs of food addiction—and why willpower, discipline, and “trying harder” often make things worse, not better.

You’ll learn how compulsion, loss of control, and continuing despite consequences show up in real life, why so many people feel out of control around sugar and processed foods, and why shame and self-blame are not the solution.

This episode is for you if you’ve ever:

• Tried everything to lose weight but can’t keep it off
• Felt addicted to sugar, bread, chocolate, or ultra-processed foods
• Wondered why you have discipline in other areas of life—but not with food
• Experienced binge eating, emotional eating, or constant cravings
• Been told to “just eat less” or “have more willpower” and felt defeated

Dr. Tro also explains:

• The 3 C’s of food addiction (used clinically)
• Why one “off-plan” meal can trigger relapse for months
• The difference between obesity and food addiction
• Why some people need support, not restriction
• How metabolic health, insulin resistance, and blood sugar play a role
• What actually helps people achieve long-term weight loss without shame

If you’re a health professional, coach, or caregiver, this episode will also help you recognize food addiction in patients and loved ones—and respond with compassion instead of blame.

Chapters

• 0:00 Meet Dr. Tro And His Mission
• 2:56 From 350 Pounds To Physician Advocate
• 7:45 Building A Multidisciplinary, Data-Driven Clinic
• 11:20 The “Check Engine” Model For Health
• 15:20 Addiction, The Three Cs, And Real Help
• 19:24 Beyond Obesity: Screening Without Judgement
• 23:40 The Playbook: Repletion, Stability, Ketones
• 28:52 Using A CGM: Keep The Line Flat
• 33:30 Ketosis Without Dogma
• 38:40 Rigid Rules Vs. Smart Swaps
• 43:20 Portion Control And Volume Addiction
• 50:25 Bioindividuality And Practical Paths
• 54:05 How To Work With Dr. Tro

Transcript

FLORENCE: 0:01

Hello and welcome everybody to an interview today with Dr. Tro. Dr. Tro Kalagian, Kalasian, Kalagian. I always mess it up. What is it? No, Dr. Tro. That's it. Tro, just leave it at Dr. Tro, Florence. He is a born-certified physician in internal medicine and obesity medicine. His weight loss story began in his own childhood and he grew up in an obese family. And he personally and deeply understands the emotions and the struggle and the shame and the frustration that comes along with being overweight and following all the mainstream advice and not having it resolve. He has a private practice and he focuses primarily on reversing type 2 diabetes, obesity, and metabolic syndrome. They recently published a six-month medical weight loss program, but it's actually they have a year data now, and they're about to have two years of follow-up data. So, I mean, he is really tracking the long-term success of his program. And it's gobsmacking. It was so good it was published. What was it published in?

SPEAKER_02: 1:03

Published in MDPI, and we published in Frontiers in Psychiatry and Frontiers in Nutrition.

FLORENCE: 1:10

Amazing. And it yielded impressive results with an average weight loss of 38 pounds per person. They had significant reductions in cardiac risk, A1C levels dropped, blood pressure normalized, and of course they were able to get off medications, saving patients, you know, a lot of money and giving them back a lot of life. His practice is evidence-based. It's supported by seven publications showing the emphasis on metabolic health being the key driver of transforming our chronic health crisis. Welcome, Dr. Tro.

SPEAKER_02: 1:45

Thank you so much for having me. And guys, everybody who's here, this is day one of this amazing, amazing uh summit. And please, please, please, every single one of these uh speakers that you're gonna hear from today, and every single speaker you're gonna hear. Uh I know them personally. They are a wealth of information from Dr. Lustig on day two to Dr. Jen Unwen on day three. Um, it's an amazing summit, and watch every single one of these and and share it with everybody, please. We need your support, we need your help. We were just talking about that. Um, to spread principles of metabolic health, to spread the harms of you know, sugar and processed food and you know, healing, how to heal from the addiction to these is so paramount. And we need your help. So if you're watching this, go spread the word right now. Just hit the share button, send it to somebody, tell them about it. Um yeah.

FLORENCE: 2:42

Um thank thank you, Dr. Tro. Yeah. For those people who for whom you might be new to them, do you want to tell us a little bit about your own story, your own journey, and how you you landed here as an expert in this space?

SPEAKER_02: 2:56

Yeah, so uh let's talk about, I guess, who I am. I am an internal medicine doctor, an obesity medicine doctor, a metabolic health practitioner. I lost 150 pounds. I did it by rejecting everything we've been told, eating, you know, six to 12 servings of grains, eating six to 12 servings of fruits and vegetables that went out the window, controlling my portions, controlling my uh carbon, uh sorry, controlling my calories. All of that went out the window, and that's how I reclaimed my life. I was a 350-pound father, I was a 350-pound doctor, I was a 350-pound uh uh husband, and I was suffering. And I was suffering like a lot of the people who are listening to this, every joint in my body hurt. It was, I had no energy, brain fog. I was living a shell of myself, a slave to food, blaming myself, riddled with shame and guilt. I was not living. I was trapped, and I was in prison, and it was a prison of my own making inside my own mind, and nobody else could see it. All they could see was a 350-pound guy, and all they could say was, why don't you count your calories? Why don't you just try harder? And it was not the advice I needed. I needed a different message. So um finally, 10 years ago or 11 years ago, my wife really inspired me to understand obesity, and I went into the literature. I found people like you and all of the different speakers that are here today inspired me. Nina Teichults, a big influence, Jason Fung, uh, and so many others, you know, Dr. Lustig, Dr. Ludwig, um, huge influences. I mean, Eric Westman. Uh, I read all of their books, all their work, and I said to myself, gosh, like we have this all wrong, right? Science, the science is all wrong. The government is all wrong. And um, I hadn't cooked the steak at that point ever in my life. I never cooked the steak. And so I drastically changed how I ate. And it wasn't, I started with a harm reduction approach. I I look listed all my cravings, I listed all the times I struggled, I listed all the different places I went where I still struggled to make good food choices, and I just came up with better options that were lowering carbs. So I started with a harm reduction approach. And after losing 80 pounds the first year, I felt amazing. I edged towards abstinence, uh, essentially eliminating a lot of the key ingredients that were causing me physical and emotional and psychologic distress. Namely, let's name them because everybody says ultra-processed food addiction, but let's talk about the ingredients sugar, processed carbs, processed fats, right? And essentially eliminated these things. And it's been over a decade I've been able to keep the weight off. Certainly, they've been ups and downs. You know, I had some injuries, I've been in chronic pain, I had stress, and my weight ebbs and flows. But for the most part, 150 pounds has been kept off. So that's my story in a nutshell. And now, you know, I have devoted my entire career. I left the Yale system where I was an internal medicine doctor, and I took out huge loans. And we were talking about this before you hit record, took huge risks so that I could uh create a medical practice that actually heals. And I've been working tirelessly. I started with just me and my office manager Tyleen, and that was you know eight years ago. And now we have almost 20 employees, you know, three providers, four health coaches, a personal trainer, a huge team and growing. Um, and we have you know 10 studies now, 10 papers. Um, and as you mentioned, we have one-year data showing 43 pounds off uh out average and an 80% reduction in binge eating symptoms. And the question is is how do we do this? Simple answer a multidisciplinary team, right? Coaches, trainers, doctors working together. It uses remote equipment, scales, blood pressure costs, CGMs. We have an app that provides a community with live meetings every day. And we have one-on-one visits with your health coach, frequent lab work, so you see your body heal. And uh we have even stepped into machine learning and AI tools to be able to predict relapse and to be able to predict weight regain and trying to intervene sooner. So it's a blend of empathy, technology, research, to honestly like to just do what medicine should have done maybe decades ago. You know, if our cars can have a you know, get service button on it, and if our cars can have a you know, check engine light on it, if we can't get our medical practices to do that around chronic disease and food addiction, then we have a problem. Right? Then we have a problem. Our cars do not matter more than our health. Our bank accounts that have real-time alerts do not matter more than our health, right? So our health should at least have as many systems around it, protecting it as our, you know, cars and our money. And that is my mission is to create systems around patient health.

FLORENCE: 8:55

So if I was to kind of understand that metaphor a bit better, what you're saying is that on our dashboard, I might get an alert saying it's time for an oil change or tire rotation or something like that. But they're early warning signs before the engine goes into a seizure or something bad happens. And that there should be people around monitoring for this early signs of metabolic syndrome and intervening before there's like a diagnosis of a disease. Is that what you're suggesting?

SPEAKER_02: 9:21

But even in the food addiction realm, right, we know right where we turn back to. If you've had chronic obesity yo-yo dieting your entire life, right, we know the potential harm. And we can use tools, we can see that uh maybe you're not stepping on the scale the way that you did. Maybe your blood sugar is fluctuating in a way that it hadn't before because you haven't slept and you're under stress. Maybe your blood pressure is up one point more than it usually is. Maybe your water weight's up because you're just having that extra meal, even if it's you know a healthy meal, that that extra little meal with that extra little insulin that we can detect before the handrails come off. And maybe all you need is somebody to say, hey, maybe it's time to check that engine, right? Maybe it's time to like just have a check-in. Right. So if a medical practice can't do this, like what are we doing? What are we waiting for you to gain 100 pounds a year later so that we can come back and shame you? Why can't we help in real time? Right. So, my vision, you know, for healthcare, it's a bit invasive, but it's simply to be as much as a service as your car is, right? As much as a service as your bank account is. Like your bank account's monitoring your bank. It's like, hey, I think there's fraud here. Like, do you want to talk to me and make sure this is you? Right. So why can't medicine do that? Hey, like you've had stable blood sugars and your blood pressure's been great, and all of a sudden we're seeing your water weights up and your blood sugars fluctuating. We know there's something going on. Do you want to talk about it? And it's not like uh to blame you or or to shame you. It's like, hey, we're here to help. And and maybe you want to talk about it, maybe you don't, but at least we asked, right? At least we were there, available, empathetic, and ready to help. So I'm hoping we can change the course of medicine. I really am.

FLORENCE: 11:23

Wow. I I see what you're saying. So it wasn't really about disease diagnosis. It's the early warning signs that someone's about to fall off the path that's gonna heal them. They're gonna go back, that gravitational pullback to the old, the old ways of eating that got them sick in the first place.

SPEAKER_02: 11:39

Well, yeah. Well, then we get the families recruited and do all the prevention, right? Because the same struggles you have are the same struggles, my the same struggles I have, my kids are gonna struggle in the same way. We've seen it. Okay. Obesity spreads in social networks, depression spreads in social networks. And guess what? The reverse is true. Happiness spreads in social networks, thinness, leanness, good metabolic health spreads in social networks. So we can, we absolutely can prevent, and it's by accessing the families and doing good screening, like checking a fasting insulin and checking a triglyceride and HDL level to get to disease beforehand. So we can do what you're saying, and we will do those things, but can we even start with helping those who need us, who need us the most, right? Instead of relegating them to surgery and injections, they're gonna fail them in two years.

unknown: 12:37

Totally.

FLORENCE: 12:45

It doesn't feel aggressive. It feels like a big giant hug. There was there's a documentary out on Netflix called Fit for TV. Have you seen it?

SPEAKER_02: 12:56

Tell me about it.

FLORENCE: 12:57

Watch it. Like, watch it. You're gonna love it. Anyone who's listening to this interview, watch it. It captures so brilliantly the desperation, the pain, the despair, the frustration of millions of people who are overweight and can't quite seem to get that sorted for themselves. And they've tried everything and they've done desperate things like surgeries. But for 16 years, the show, The Biggest Loser, ran, and it was one of the all-time most popular shows on TV. I think there was like 15 million viewers at the end of the 10th season, like huge. And one of my dear friends, Debbie, actually, she used to pray that she'd get picked to go on the show because she just felt like if she could get on the show, they were gonna help her sort the problem. But we know, we know what happened. They lost weight on the show and they went home to gain it all back, if not more. And there were only two people that they had followed up with that had kept their weight down-ish. And both of them were on GLP1s. Um, it just was glaring that the piece that they were missing was maintenance. The piece that they were missing is how to do exactly what you're doing. How do you catch the early warning signs that they're about to go back to what's familiar to the body, familiar ways of eating, familiar ways of thinking, feeling, behaving with food and their self-care. So, I mean, that was the missing piece. That was the missing piece. And these people went back to lives of despair. And so I feel like you are passionate about this because you're right that the absolute pain that this problem is causing, metabolic syndrome, obesity, diabetes, is it's a tremendous kind of suffering.

SPEAKER_02: 14:38

Yeah, so let's let's describe that so the listener understands, right? Because um, sometimes it's tough. I'm gonna talk about it from the clinical sense in a minute, but I'm gonna talk about it from what the person is thinking, feeling, okay. If you're out there and you are yo-yo dying, okay, if you are if you are somebody who says, why can't I keep this weight off? If you are somebody who says, you know, I'm a chocolate, I'm a Bretaholic, I can't seem to stop. If you're like, if you're saying, I need more willpower, I need more discipline, I need, if you're stuck in self-blame, if you're ever wondered why one little meal can set you off for months, right? This is the lived experience of somebody with addiction, right? This is what's going on in their head. I just can't seem to figure it out. I don't know why. I have discipline in other things. I'm a breadholic, chocolate, it's in my family. I can't, I just can't seem to do it. This is what people say. From the clinical side, you know, what you should be looking out for if you're a doctor or a coach or or a you know a nurse out there who's seeing this, you want to think of the three C's. Right? One is compulsion, you feel compelled, right? The food calls to you, right? Two, loss of control, right? Loss of control is a very characteristic feeling. You feel like you just can't control yourself, right? And the last C is consequences, right? You're eating despite poor consequences, consequences you're not happy with. And so if you are experiencing this as a person, or seeing a patient experience those things, or saying the things, you know, doc, I just need to do better. Doc, I can't figure out why, right? You need to be alerted to the fact that this person is struggling and they need serious help. And that shaming and blaming them and telling them to just pick themselves up by the bootstraps, this is not the messaging they need. You have a problem, there's loss of control, there's consequences, you're using this substance despite poor health, and you need help. And I want to help you, right? I want to help you. This is the way you should be thinking. And if you can't help that person, if you have no track record in helping that person, please send them to Tort Health, right? Or nationwide medical practice, right? Because we have a track record, right? We know how to reach these people. If you can't do it, don't be ashamed. Like I'm not an interventional cardiologist. I don't know how to put a stent in you. I'm not Philovedia. I don't know how to take your heart out and bypass it, right? I'm certainly, you know, I'm not Eric Berg. I don't know chiropractic. I don't know how to change my, you know, to realign my back as well as he does. So if you're a provider out there or a coach out there, and and or if you're a person suffering out there, you know, and you're like, I can't do this, well, you're not the only one. Right? We have 15,000 people using the Torred Health app who are just like us, who are struggling every day. But if you're a doctor out there or a or a or a family member and you're so just frustrated, why, well, why can't they seem to do it? Well, send them to somebody who can do it. Right, send them to somebody who's experienced with this. Because unfortunately, the modern world is going to do two things. They're gonna set you up for an injection or they're gonna set you up for surgery, right? Which is an unfortunately uh they're immensely helpful interventions. I will acknowledge that. But they're only one part of the toolbox, and there are other ways to do this. So um look out for loss of control, compulsion, and a consequence, somebody using despite consequences of three Cs. Uh I think that's very critical if you're out there listening to this.

FLORENCE: 18:48

There are lots of there's there's evidence to suggest that there are people who are obese that don't fall on the food addiction, ultra-processed food addiction spectrum. And there are people who are normal weight or underweight that also do, you know, qualify for for the, you know, I'm on the addiction spectrum, food addiction spectrum. So if someone doesn't have addiction, can you still help them? I mean, I'm assuming talk to us a bit about how how you can reverse obesity, even if you don't identify with the three C's.

SPEAKER_02: 19:22

Yeah, so that's a that's a great question. Uh there's not a one-to-one overlap, right? So, so just imagine I'm I was a 14-year-old kid. I was struggling with all the symptoms that I just described, okay, but I compensated for it with uh being vegan and anorexic. Right. So you didn't see the obesity, but you fundamentally saw somebody who didn't eat for a month, right? Because I was struggling with something I did not understand, and I was looking to grit and starve my way to still solve the problem, right? So you're absolutely right. You would have looked at me at 14 and said, Oh my God, this kid lost weight. Right. And so you can miss the problem. You're absolutely right. It's important, you know, a lot of times bulimia is a great example of this, right? There's a huge loss of control, but there's normal weight. And some of the telltale signs are poor dentition, bad breath, right? Because they're purging so that there's no consequence on their weight, or less consequence on their weight. And you're absolutely right. There's also certain populations, the French, you know, Asian, sub Asian populations that also don't show obesity. They may have some uh intra-abdominal obesity. You could you could tell if you look closely, but they don't appear obese. They they're not gonna be certainly like me, that was 350 pounds. So you can't judge a book by its cover. You're absolutely right. The internal journey somebody is going through is different than the external journey. So um I think it's important to screen for this in the clinical setting. Uh, we use a modified cage questionnaire. We also use the binge eating scale, we also use, you know, the food addiction questionnaire. And these are tools, you know, certainly Jen Unwin, who you you all will hear from, and Bitten Johnson, who you'll hear from today, uh, will talk about their screening strategies. And any one of these is a great way to screen for this with or without obesity. There's some estimates, Ashley Gerhart estimated that this may be up to 60% in the obese population, and about 30% of adults may have food addiction. So those are just some things to look out for. Certainly not everybody. Um so I think you bring up an excellent point to for the clinician out there to just know, you know, uh, oh, who who would There's a great speaker from South Africa, Karen Thompson, who talks about her. You know, uh, she was a model, but she suffered from addiction and she had to restrict and and uh to sort of compensate for this. So um you're absolutely right. Don't judge a book by its cover. If you're a clinician out there, be alerted to the fact that you can be thin and have these symptoms. Um, you know, there's certainly things called exercise bulimia, for example, which is you know, eating and and over-exercising to compensate. And it's a very tortuous cycle. It's it's no less tortuous, right? Sure, you have the the less stigma because of the way you physically appear, but the internal trauma of losing control and having to compensate with exercise, it's basically a form of self-punishment that just cycles back and forth. So it's a it's a tough concept for for many, I think, to envision and understand. But hopefully now with with this question, they'll be alerted to it. Now, people with obesity who don't have food addiction can often follow a very simple nutritional plan. You know, it could be just lower your carbohydrates, just keep a stable CGM, just fast if you're not hungry, right? Like it could be really simple food rules and consistency and support that get them down. So I think absolutely, you know, not everybody who's who has obesity has food addiction, and not everybody who's without obesity, you know, is without food addiction. It's an excellent question and an excellent point.

FLORENCE: 23:39

So let's get practical. Someone might be listening to this going, Dr. Tro, I'm obese. I've tried everything, everything. Like I'm so insulin resistant now. I just look, I just look at a single blueberry and I, you know, I gain 10 pounds. There's that they've, you know, there's people that are doing, feel like they're doing everything right. So tell us what gets the results that you get. You've cracked the code, you know what you're doing, you're getting the results. What do people need to do?

SPEAKER_02: 24:06

The first and foremost, if I have a product AO dieter, we've done the labs, we know this. 90% of people in my clinic come in with nutrient deficiency. Vitamin D is low, vitamin C is low, folate, B12, run down the line. All the minerals are low, magnesium is low, potassium is low, right? Everything is low. So that person will not lose weight. You can start yourself, you will not be able to win, you will not win, okay, because your mind in that nutrient deficiency, that mineral deficiency will win and you will lose control. So, first and foremost, somebody must be nutritionally replete. So, a lot of times we recommend no weight loss, and we don't even care if you gain weight for the first two to four weeks, often longer. Right? Uh, just eat proper food. And this is a hard concept. Well, doc, I came to you to lose weight, and now you're telling me to gain weight. Yeah, I'm telling you to eat more, gain weight, become nutritionally replete. Right. So that's step one, right? I think step two is stable glycemia. Stable glycemia and ketones predicts weight loss in our clinic. So if you need a goal, it should not be weight loss, it should be stable glycemia and ketone production. Um, and if you're not able to do that, sometimes you will need to fast. Okay. And that means fasting is a ketogenic intervention, is not a deprivation. Or exercise as a ketogenic intervention, not punishment. Right? You know, we have people who've been low carb and have an insulin level of 20. Stable blood sugar, high blood sugar, still with an insulin level of 20. And sometimes there's stress, sometimes there's inflammation, sometimes there's other things that need to be uncovered. But for the most part, uh the the blood sugar's got to be stable, ketones need to be produced. So if you have a nutritionally replete person, psychologically addressed person, right? Stable glycemic, ketones, this is a recipe for somebody to lose weight. If they are in control of their appetite, if they're nutritionally replete, fasting is easy. It's a it's a pleasure. You know, I went to a food addiction conference I didn't eat for three days. I felt amazing. I didn't feel poor. I felt amazing.

FLORENCE: 26:41

That's not everyone's experience, though.

SPEAKER_02: 26:44

Certainly it's not. You have to, you know, I'm I'm nutritionally replete. I have proper electrolytes, right? I hydrate, I'm in control. I'm not suggesting that that you start that way, particularly if you've been yo-yo dieting and suffering. But my point is that not eating is an expression of being nutritionally replete, of having stable glycemia, ketones, and understanding fully, you know, what are your hunger signals, what are your triggers, and what you need to do. Right. So I not ate almost effortlessly, and I came back and I ate in a way that I was happy about. And I didn't feel restriction. I didn't have this thing. So I think fundamentally, when somebody starts with me, it's just eat real food, nutritionally filling food for a long enough time without caring of weight, without the PTSD of weight loss, not losing weight, without the PTSD of the scale, without the drama of I didn't gain weight, I didn't lose weight, none of that. Just eat, nourish your body in a way that you're proud about, happy about, in control. Then start to exert your control through stable glycemia and ketones. Then address the psychologic factors, the emotional factors that lead to eating. Then go not eat effortlessly, right? Move your body because it gives you joy. Right? So it's tough to explain, you know, I think in an abstract way, and it sounds maybe too good to be true, but this is a recipe you can go and recreate. It's eat low carb until your hunger, you know, like settles down. When you're not hungry, don't eat. If you are hungry, analyze why. You know, I don't get hungry now. I get hungry when I'm stressed out or when I'm in pain or when I haven't slept. Tell the time I get hungry. Right? So, you know, I certainly get cravings. Sometimes I see food, and and of course, when you see food, you want some. Right? But I'm not a slave to food. I'm not, you know, I'm not sneaking my, you know, my uh colleagues' chocolate at the workplace and stuffing my face before somebody comes into the to the room, hiding my wrappers because I'm ashamed of what I just ate. You know, I'm not in that place anymore uh because of these things. I'm nutritionally replete. My minerals are repleted, I've addressed my psychologic issues, I'm hormonally and metabolically, physiologically stable. And uh not eating or eating less or moving my body or having increased energy expenditure effortlessly, which is what low carb does, all of these things make it easier for somebody who struggled. I don't know, is that too much? Too essentially.

FLORENCE: 29:45

Oh, it's super clear, super clear. Um, when you talk about stabilizing, uh, basically saying stable blood sugars, and obviously a CGM is essential for being able to be honest, like know for sure if the the blood sugars are stable. Tell us the best way for people to start on that step. How do we know? How do we use a CGM? How do we know what is the right number? What does stable mean?

SPEAKER_02: 30:10

Yeah, so so uh I think we have to separate the conversation for the person struggling or the clinician monitoring, or or maybe both. If you're gonna prioritize, prioritize the person, probably. Okay, person struggling. Keep the line flat. Okay, keep the line flat. You generally want to be between, let's say, 70 and 140 and as flat as possible. Now you can't uh you can't be beholden to a number. Remember, like you don't control this. You don't control your stress hormones, you don't control if you had sleep disturbance, you don't control your morning rise of cortisol, you don't control that exercise may increase your blood sugar, right? So there's a lot you don't control, right? So you can't like get bogged down by numbers, right? But generally as flat of a line as you can, right? Between that 70 to 140 range. And when you eat a food, when I eat a food, if it raises more than 20 or 30 points, I don't eat it. Right? Uh, and certainly if it goes up 100 points, I don't eat it. And to give you an idea of the things that go up 100 points in me, you know, a banana and berries would raise it up 100 points. If I had a banana and berries, if I had a bowl of cereal, it would go up 100 points. Um if I had a cup of orange juice, it would go up 100 points, right? Uh, if I had uh whole grain uh oats or whole rolled steel-cut oats, it would go up a hundred points. So I avoid this and and this this uh extreme excursion and the bounce back, uh, the the the delta in your in your blood glucose levels is what predicts hunger and predicts weight gain. So if you're a person who went to Tor Dot Health, got a CGM from us for 50 bucks, which is pretty darn cheap, um, and you put it on, you want to, sorry for the shameless plug, but uh you want to keep that blood sugar as stable as possible. And you want to monitor for the things for the foods that cause a 20 or 30 point fluctuation. Now, if you're the clinician out there, you want the glycemic variability to below 12%, right? Which is the coefficient of variation of uh blood sugar. And uh it's not always food that does it, certainly like stress, infection, sleeplessness, pain can modify that. But you want to aim for a coefficient of variation of under 12%. Um and uh what that does is it just removes a hunger, a delta drastically falling blood sugar removes a main drive of hunger in our modern-day lives. It just makes like this lifestyle easier, right? So that's the purpose of keeping that blood sugar stable. There are other theoretic benefits, you know, the blood sugar excursions attack every blood vessel in the body, eyes, kidneys, every artery in the body, nerve, arteries, right? Uh they they um it's a it's a you know, it's sort of like the smoke, it's sort of like smoking, it causes an oxidative stress. Um but uh but for appetite and weight, that stability predicts weight loss and decreased appetite.

FLORENCE: 33:47

And the third, the third third phase was uh uh you know making ketones. Do you have to be continuously in ketosis? Can you talk about that? Or can people move in and out?

SPEAKER_02: 33:58

Yeah, so so I think that there's something uniquely healing about ketones. Um, you know, there's there's I don't think like again, any number, like in including weight, right? I had a gentleman who um gained 20 pounds in three days. Okay, like if I if he's beholden to that number, if he doesn't have a good understanding that this is just water weight, it's not real weight, right? And he and he makes it a moral failure that he put on 20 pounds of water, right? He's a very large gentleman, and this sort of fluctuations are normal, it can really be devastating. So blood sugar fluctuations, weight, ketones, these are all, you know, uh uh surrogate markers, and they're not our moral compass. So first and foremost, but I do think that being in ketosis is healing. There's good data suggesting that ketones predict all disease, right? There's a linear relationship between claims, insurance claims, and ketone levels. So I think there's something uniquely healing. I think it has to do uh with the mental health impacts, um, but it's not exactly clear. So I think in our clinical practice, people move in and out of ketosis. We use it as a general barometer. When people's insulin resistance is stubborn, meaning their triglycerides are still high, their insulin levels are still high, their inflammation is still high. Oftentimes we'll begin to track ketones just a little bit more, and we'll look for interventions beyond diet, like fasting and exercise, to see if we can adjust those hormones and promote ketogenesis even more. Um, but it's not a be all and all. But you know, I've gained weight in ketosis. So um, you know, um I don't think uh I don't think any, I think all of these rules can be, you know, I've gained weight with a stable blood sugar, right? So it's so much harder to do. It's incredibly hard to have a ketone level of three and a stable blood sugar and gain weight. I would say you are less than a 1% chance of achieving this. It doesn't mean it's not doable, it's just incredibly hard, right? It's incredibly hard.

FLORENCE: 36:30

Sorry. Yeah, I guess. I th I I was just thinking of the individuals who's like, oh no, I'm not another keto guy. Everyone's just telling me I have to do keto, and I don't want to do keto, I don't feel great on keto, or I don't think it's important, I don't think it's good to always be in ketosis. So I was speaking, I was asking a question for those those those people.

SPEAKER_02: 36:50

Yeah, yeah. I mean, my average ketones are probably 0.3 to 0.5, which is like not even, you know, ketosis.

FLORENCE: 36:58

Yeah.

SPEAKER_02: 36:59

Uh uh, for me to get my ketones high at this point, I have to fast for two to three days. Um yeah, so um, yeah, but but I mean it's it's I I think it's a silly to be ketophobic, also, you know, like my nine-year-old son, he wakes up in ketosis, like, you know, just by sleeping and waking up and having a small tiny liver, you know. Um, so I think that, you know, it's a just a data point. It's not a moral failing, you know, it's not a um I don't, yeah. I I you know it's it's just a data point to track, just like weight is, you know. Do I really care about my weight? No. If I gained 10 pounds of muscle and lost 10 pounds of fat, I would be happy and I would have no weight difference, right? If I gained 10 pounds of muscle and didn't lose any fat, would I be happy? I should be. Right? I should be so no, you know, if I'm in ketosis and I feel miserable, like who cares? You know, like why am I I shouldn't chase that, you know, if I feel unwell, you know. So I I don't know. I think it's um it's tough to deal with the psychology sometimes.

FLORENCE: 38:16

Yeah. And I think that it's it's really helpful for people to hear that people move in. It's normal to move in and out of ketosis. All of our ancestors moved in and out of ketosis, especially in northern climates during winter, more likely to do ketosis, spring, summer, fall, maybe you know, more curbs come in, we're in and out. It's a normal state. It's not this extraordinary state that we have to work really, really hard and deprive ourselves and go really low carb and fat. It just naturally happens as we sort of ebb and flow with fasting and appetite and let me tell you, if you are time restricted eating like our ancestors did, right?

SPEAKER_02: 38:54

Uh, and you are uh moving your body, you're in ketosis when you wake up.

unknown: 38:59

Yeah.

SPEAKER_02: 38:59

You know, you're in ketosis. If you are moving your body and just doing like just eating two meals, let's say, you're gonna be in ketosis. You don't need to work for it. Your body's doing it.

SPEAKER_01: 39:11

Yeah, right.

SPEAKER_02: 39:12

So there's no, there's no work required. If you forget about a meal, you're in ketosis, right? So, yes, it's not a it's not about deprivation. And yes, there are whole populations, specifically the tropical, that are higher in carbohydrate, right, and still maintain some degree of you know teogenesis, they're typically more active and typically uh uh a little bit, you know, they they uh their food supply was very unique, not like our modern food supply. Um, so yeah, no need for no need for deprivation. Right. Or or or I think that deprivation mindset is is just it's the rigid deprivation mindset. I'm so glad you brought it up because I think it's another topic. Sorry to my ADHD is flaring. So you're good, you're doing great. Just go. Yeah, so so that rigid mindset and the uh I think it's one of the most harmful things. Like you don't need to do anything. The question is, what do you want? Right? How do you plan on achieving it? Right. So a lot of people I see fall into the trap of I must lower my carbohydrates or I must fast or I must this, and and then they don't get their results, maybe they were looking for in the time frame they were looking for. And they're they're they're so rigid about I'm never gonna eat pizza. I'm never like if I wanted to eat pizza, there's nobody in the world that would stop me. If I wanted to have a cookie, I haven't had pizza in 10 years. Right? If I wanted a pizza, there's nobody in the world that would stop me. It's my choice. I choose to. Right? If I wanted pizza, I know how I would make it. Almond flour crust, you know, low, no sugar sauce, you know, pizza seasoning and mozzarella cheese. Right? I know how I would make it. Why would I make it like that? I want to enjoy my food and I want it to taste good, and I want it to be as low glycemic, low in process carbohydrates as possible, so I don't get that rebound hunger. Right? But I'm not deluding myself to think eating low-carb pizza is gonna help me lose weight. No, it's helping me, you know, get the foods I want and I enjoy, not deprived, like so I'm not deprived, and it's doing it in a way that's a little less harmful than our modern food environment. Right? With the glyphosate flour and the you know, three packets of sugar per ounce of pizza sauce.

FLORENCE: 41:46

Wow. Right, it's a smart, it's smart, a smart swap. What about weighing and measuring? I'm sure you've had people come into your practice that come in come from backgrounds where we're encouraged to be precise with our portions. What are your thoughts on that?

SPEAKER_02: 42:02

It's a last line intervention for us. It's a last line intervention for us.

SPEAKER_01: 42:07

Yeah.

SPEAKER_02: 42:07

So if all else, so I think it's uh it makes no sense. You know, my nine-year-old kid who my my 13-year-old kid who when I was his age, I was 210 pounds. He is 100 pounds lighter than I was. Okay, he eats four hamburger patties, maybe six eggs, and he snacks on sardines. Right? Okay, so should I tell him not to eat? Was that too much? Right? Who am I to judge how much is right for him? Right? Who am I to tell him that's not good for him? So I'm not sure how to answer that question for most people. I I just simply ask them, well, what amount does it take for you to get full? Right? And my my daughter, who's 11, she has three to four, she has almost a pound of meat. I mean, how many women, Florence, do you know that eat a pound of meat? Not many. She is a healthy 11, she's gonna be 12-year-old girl who plays basketball, has fun, goes to school, chills out all day. I mean, she is an amazing person and she's eating a pound of meat. Is that not ladylike? Should I tell her that you know, good girls don't eat that much? Right? So, you know, so I find the discussion a bit preposterous, right? Like how much who decides what a portion is? Right. So I think ultimately we have to ask ourselves is your food behavior getting you the results you want? If you've addressed food quality, if you've addressed your relationship to food and you still struggle, well then. the last line would be looking at portions right for for us and honestly we keep it very simple take a picture send it in take a picture I think some people and I'm speaking from experience can become volume addicted totally I that's the reason the portions people can think I'll never overeat chicken I could never overeat broccoli and then they get rid of the processed stuff and they're like what I'm overeating chicken and salad now yeah so 100% uh I haven't I have not eaten any processed carbs and sugar I can overeat you know I can eat four pounds of meat easily yeah your jaw dropped so but yeah four I can eat four pounds of meat wow you know so you know am I that that's what it takes for me to feel uncomfortable right I'm full after one pound if you give me a pound and you tell me Tro go outside for a walk I'm full if you give me two pounds and you go tell me you go outside for a walk I'm full if you give me three pounds same thing right so the question is is what makes me eat from one pound to two pounds to three pounds right so um yeah I think most people that's unheard of like you know I I should have been a professional eater and you know I should have been like you know there's a hot dog eating contest I think I would have won um I just that's my natural ability right that's the size of my but but to answer your question I think the idea of portion control is probably a last line uh intervention for us if we suspect somebody's volume addicted we we we would offer maybe two options one would be gated eating which would be like you leverage fasting like maybe you want to have a big portion and you like the feeling of feeling full and you want that well then you have to give somewhere right so maybe you gotta lower the insulin on a fasting day or something like that. Or um you know I gotta be honest I had a patient who literally said I think I'm eating too much and I was like well what do you want to do about it we came up with the idea that his wife is going to set his portion so his wife was super supportive lady set his portion you know for dinner and he lost like 30 pounds just by letting his wife set his portion right he was full he was fine he was good his wife just set his portion right um so I think um it's an intervention that works you know sometimes we do like uh controlled eating so we'll recommend like a you know like a a keto or low carb or high protein meal uh that's pre-made you know or maybe they have a little time to work or something like that it's like a pre-packaged thing they could just heat up um you know I'm I'm happy to to say the name no sponsors or no relationship but we use factor uh we use factor meals so uh that's an option that works for some people like maybe one meal is unconstrained and one meal is very you know sort of portioned um but that would be a a last line thing intervention for us uh portion control unless we upfront thought that volume addiction was the as a key factor at play.

FLORENCE: 47:34

Got it okay that's helpful because I I know that you're not always assessed as to whether or not you you have a volume issue when you are you go into some programs, particularly 12-step programs for food addiction you just are assumed that you you're gonna have an issue with volume. And so everyone gets on the same plan and you weigh and you measure and some people love the scale and some people just it really it's just a struggle to to make peace with it. They don't want to have to bring it to restaurants it every day that they don't get it perfect. They feel like psychologically off like there's pros and cons to the scale and I was just curious to see where you you landed on it.

SPEAKER_02: 48:09

I think it's more of a con to be honest uh I think that you know from my uh from my perspective it's unnecessary for most people I think if you know you simple question the screen for it if I were to put out uh quarter pound hamburger patties in front of you how many can you eat until you're full? Right?

FLORENCE: 48:31

And if the answer is eight nine 10 or more well that's somebody who's got a huge volume capacity right if it's less than that then it's not something you have to worry too much about um so I so in terms of like using the scale I just am not sure how many we we haven't done it haven't done it you know we haven't used the scales I think it's just a lot easier to take a picture and send it to your coach like take a picture send to your coach you know and and uh you know if it gives somebody uh some peace to use a scale by all means use it but it's not something we use okay okay I I think it's really helpful for people to hear that because there's a lot of people coming out of 12 step programs who aren't aware that there's other ways that there's other options there's lots of right ways of doing this and yours is really unique and highly effective and I think it's gonna be really encouraging for people who don't want to have to weigh and measure everything.

SPEAKER_02: 49:29

Some people love it or some people it's it's a two I'm gonna say I'm gonna just take a step further and sorry to do this. No telling somebody to eat four ounces of meat I think is malpractice. Okay telling somebody to eat four ounces of meat and not to eat any more than that is malpractice. I don't my my my when my kid was six when my youngest kid was now nine and was six he ate well over that right well over that just to be reasonably full right and these are not overweight food addicted people right so eating telling somebody to have four ounces of meat or four ounces of fish or four ounces of chicken or four ounces of satiating food is malpractice.

FLORENCE: 50:17

I'm guilty of malpractice just for the record oh my god I'm sorry it's not it's not don't think of my like you know well maybe if I I'll well let me clarify that unless there's a serious volume issue at play or unless the person wants it yeah I mean I usually say between four or five ounces is a pretty decent size of protein for a woman like just kind of start there make sure you get at least that um but I'm aware at least that at least that so now we're saying you know at least that fine I'll take at least that sure you know but um I don't know I I don't know how I don't know how like I could I I would never tell my daughter that I would never say have one hamburger pattern right which is four ounces of meat I I can't you know I can't say that to her I just I would like literally be depriving her. Yeah and I love that she can break it down there's lots of us that have very damaged metabolisms and gallbladders and liver issues and right like it's you're absolutely right yeah it's not even possible I could never eat more than a patty of meat not a chance not a but I'm you know I'm a 50 plus menopause stable it's worked for you you know but you maybe you eat more frequently maybe you just can't stomach it right like so that's so there's there's always that individuality.

SPEAKER_02: 51:45

Yes but I don't you know so I but generally in my practice I don't have I have people who have been told um you know have been told to limit satiating food and it it's I I think it's a setup to fail.

FLORENCE: 52:03

So oh my gosh I'm sorry Florence no it's okay I'm embarrassed I'm like yeah no not at all I think this is the beauty of of acknowledging bioindividuality there's some people that can break down a pound of meat and there's some people who could not it would sit in their stomachs they don't have enough hydrochloric acid or whatever whatever and then we get to we get to be bioindividual.

SPEAKER_02: 52:25

Yeah well certainly there's there we you know every every patient is treated individually I haven't met anybody who couldn't accept my I'll tell you I'll I'll tell you I've met one person in my life who can't do more than four ounces of meat and it's my wife oh yeah I know it's my wife you know is she a bloody blood type A I have to go check what blood type she is you're a blood type O.

FLORENCE: 52:50

Yeah I have to go check what blood type she is um I don't I honestly I don't know but she's the only person I met she cannot you could not force her to eat you know more maybe like if you go to yeah you're unique though I thought yeah there's a few more of us out there and some of us sort of gravitate more towards the omnivore vegetarian whole food like because we do better with vegetables and lighter proteins and there's only so much stomach acid we have my understanding and I know people look at me like never say that publicly Florence you are professionally embarrassing yourself but I swear to you there's something to the blood type diet a little something because I can tell I think there is because my blood type A's you ask them they will gravitate to lower meat and they like their vegetables especially leafy greens and my blood type O's just give me steak just give me beef give me give me meat they love it and they can they can process it no problem they can eliminate it no problem it's it's a miracle to me I think wow how do you do that I'm a blood type A totally but anyways anyways absolutely could be so I'm gonna eat my words now I should I shouldn't be this angry New Yorker. Nah not at all yeah Dr. Trow how can people work with you?

SPEAKER_02: 54:08

How can people find you um so I'm on the board of the Society of Metabolic Health Practitioners I also uh am a member of the Coalition of Metabolic Health so if you're out there if you're a physician nurse PA health coach and you're looking for help to get the education or the resources to to and sort of be a part of a broader community I'm a part of these two organizations uh the Society of Metabolic health practitioners uh with Rob Syvis who'll be talking later this this week and Mark Tubazella and and so many others uh Doug Reynolds and Eric Westman and Laura Buchanan uh um and then uh the the coalition I think is a great resource for everybody who's is just looking for the coalition on metabolic health um you know really spearheaded by the bazookie group so um look out for more work from them and uh if you're looking for nationwide medical practice uh you know it's Tor.health uh Torred Health is the name of the practice uh we need people if you're interested in what I just said if you know we need we need to grow our medical practice Florence and I were talking about it um you know we have about 1500 people in the app it needs to be 150 000 you know we we need to uh we need to expand with three doctors four coaches a personal trainer and we are looking to help people make permanent changes uh we're we're a medical practice so we can help you know taper and titrate medications and that's toward dot health and then all social media if you really want to do that if you want to but I recommend against it but Dr. Tro at Dr. Tro um yeah hopefully come interact.

FLORENCE: 56:08

Yeah yeah beautiful thank you so much for the work that you do for this interview today for your passion for living proof that obesity can be reversed and there's life after it and it's so it can be so good that never lose hope. Reach out for help Dr. Tro will hold your hand and walk you through thanks everybody for tuning in today.