Going Under: Anesthesia Answered with Dr. Brian Schmutzler
Going Under: Anesthesia Answered is a podcast with renowned physician and anesthesiologist Dr. Brian Schmutzler. Together with Award-Winning Co-Host and television journalist, Vahid Sadrzadeh, the podcast aims to answer not only your most pressing anesthesia questions but to provide the most up-to-date medical data available.
This weekly medical podcast will release a new episode every Thursday at 5 am. Thanks in advance for being a listener.
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Going Under: Anesthesia Answered with Dr. Brian Schmutzler
The Food Pyramid Was a Lie (And We’re Finally Admitting It)
In this episode of Going Under, Dr. Brian Schmutzler and Vahid Sadrzadeh unpack how the old grain-heavy pyramid collided with modern food engineering to fuel obesity and diabetes, then lay out a practical path centered on protein, natural fats, and fewer ultra-processed foods. We weigh policy shifts, GLP-1s, and the need to teach kids real-food habits early.
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This is going under Anesthesia Answer with Dr. Brian Schmutzer. I'm Bahid Soder's Dada, and we're brought to you by the Butterfly Network.
SPEAKER_00:Alright, I'm going to let you in on something that's completely changed the way that I practice. I've been using Butterfly Probes for years. It's a portable ultrasound that plugs right into my compatible smartphone or tablet, and I so I can start scanning at the bedside in seconds. If you you've used the older versions, uh, or even if you're new to the handheld ultrasound game, let me tell you why this IQ3 is a game changer and really impressive. First off, having an ultrasound that literally fits in my pocket means I can move faster, whether it's vascular access, procedural guidance, or just getting real-time insights for my patients. And the tech inside this tiny device is pretty incredible. Biplane imaging lets me see two axes at once, huge for procedural guidance, and honestly, a great tool for learners. The new needle at a plane preset even shifts the scan plane digitally, so I can see the needle tip sooner, which makes a real difference when precision matters. And the image quality, honestly, this IQ3 holds up to some of the high-end cart-based systems I use, which is impressive for something this portable. If you're looking for a device that supports your practice, I can't recommend the Butterfly IQ three enough. And right now, they're running a special offer. You can get$750 off the latest IQ3. Check it out at ButterflyNetwork.com.
SPEAKER_01:So thanks to Butterfly Network for sponsoring this podcast. And we're back at it. Uh season five is underway. Uh Brian, where's your hat? I thought you were gonna break, I thought you were gonna break out the IU hat today. There we go. Don't you worry about it. And don't you worry about it. We'll wait for final predictions uh coming up. And I was right in my semifinal predictions, by the way. You were, you were.
SPEAKER_00:I thought I was I thought I was gonna be right with that. It looked like old Miss was gonna win.
SPEAKER_01:And then yeah, you were on the right track there. Not a bad team. Um National Championship is Monday, a few days away, but I will talk about that later. What we do want to talk about is the food pyramid. It's upside, it's upside down now. Well, yeah.
SPEAKER_00:Sorry, sorry, I was I was doing the old pyramid. Yeah, the one we learned, yeah. Um just to point out to our to our uh listeners and viewers, we're uh remote this evening because we have like a foot of snow on the ground. So I'm comfortably in my house. Uh Vahid, I believe, is comfortably in his house as well. So we're uh we're remote this evening.
SPEAKER_01:Yeah, I I wasn't the smart one that brought my truck to to work this morning, so uh had to forfeit and do a remote podcast. But that's right. Um the the food pyramid, the food pyramid for years, right? I mean, we're talking about less fat, you know, the balance, blah, blah, blah. But then what happened, right? I mean, we're we're dealing with American society that's dealing with obesity, heart disease, diabetes, and now we're seeing the back end of that. And now all of a sudden we're switching it up, and we're like, oh, the people who back then said, Hey, maybe we should be following different guidelines were right.
SPEAKER_00:Yep. Yeah. So the food, the food pyramid, I think initially it came out in like the 80s or 90s when we were kids, and the recommendation was like nine to eleven servings of grains and and starches and carbs. Like, I don't know a day. A day, yeah. I mean, I that's a lot of carbohydrates. Um, and then, you know, less of whatever, um, less of these foods, less of these foods, and then like saturated fats was way at the top, and you shouldn't have any of that. They didn't really talk about sugar or processed food or any of that sort of stuff. And so I I think what um, you know, I I've looked a lot at this in the past. That there's a lot of stuff out there uh at the the food industry that really um I think kind of drove the food pyramid and has driven what we've been eating since like the 60s. Um, you know, that there's subsidies for corn, there's and we'll we'll get into some of this too. There's subsidies for sugar, there's a big sugar industry, and so um I think that was probably part of it. But yeah, so the food pyramid used to have all the grain at the bottom and all the meats and fat at the top. So then now we flipped it, and it's the exact opposite. So now you've got all the you know meats and and proteins and all that sort of stuff at the the highest amount, and then everything else less and less and less, and grains at the very bottom. And then they did take a stand on processed food, saying that you really shouldn't eat processed foods um and and pure sugars, and then um, you know, the they changed the recommendation on alcohol to uh to less than it was before. So all things that like any sane person pretty much knows, you know.
SPEAKER_01:Why did they so I mean I I know the answer to this question, or probably what you're gonna say, but why not consult biology? Why not consult medicine when they're building these food pyramids? Because back in the 80s, 90s, right? You gotta know as a physician, as an industry, too many carbs is gonna make you fat. Too many carbs make you gain weight, heart lead to heart disease, too many sugars. Uh-huh. But I understand probably why they didn't.
SPEAKER_00:Yeah, uh the the biology and medical industry doesn't have the money that the big ag industry has, right? So the again, the sugar lobby, the corn lobby, the wheat lobby, all these things that we subsidize and then pay a bunch of money to as a as a society, they they want their return on investment. So they're gonna recommend all these these things. And so, I mean, one thing, just just logically, right? You think about it. What's one of the most successful diet techniques out there? I mean, if you're asking me, yeah, keto. Yeah, keto, less carbs, protein. Almost no carbs, yeah. Almost no carbs, protein. So there's even data out there that if you do keto, it can help with seizures. Um, there are certain people who go pure keto when they're on, when they when they have seizures and it reduces the seizure, uh, the the frequency of seizures and the severity of seizures. I mean, that there's a just a ton of things that keto helps with. Um, but you you notice people lose weight on keto. Um and so the the theory, and again, I'm I'm not a dietitian, right? We get almost none of this in medical school, but the theory behind it is that fats and proteins, particularly fats, make you more full. They're denser, right? That they're they're just heavier. They they're not like carbohydrates, which you process quickly, spike, spike your blood sugar.
SPEAKER_01:Yeah, and it's not an instantaneous thing, right? Though it's like if you eat a bowl of rice, you're not gonna be full at that second. It's you're gonna take 30 minutes to whatever the time is to to um transition through your body to get your mind to say, I'm full.
SPEAKER_00:Right, right. Um, but but those fats and proteins, big, big heavy fats and proteins, they spend a little bit more time in your stomach. They're harder to digest. And so again, it gets your brain thinking I'm I'm more full, but also it doesn't spike your blood sugar. Just like, you know, rice, for instance, is a pure carbohydrate. So white rice goes into your goes into your stomach, all the carbs start to get processed, you get a huge spike in blood sugar, followed by a huge spike in insulin. And that's like basically the definition of what the cause of diabetes is, right? Now, you've got the flip side of people who say, you know, too much fat causes increased cholesterol, which can cause heart disease. Now, that there's some debate in the literature about that. Um, and you know, we we talk a lot about moderation on this on this uh podcast. So certainly moderate, right? I'm not suggesting anybody go out there and eat, you know, 200 grams of saturated fat, right? That does not make any sense whatsoever. And and it's not good for your body overall. But to have a higher fat, higher protein diet, lower carb diet is is a good recipe for losing weight. And there's some things about timing when you take in carbs, and you know, you need some carbs if you're gonna go, you know, run a marathon, right? You used to run marathons, I used to run marathons. You need some carbs for that sort of stuff. But just your average American who has a sedentary job and walks around very little all day long, that you probably don't need nine to eleven grams or nine to eleven servings of grains and carbohydrates in a day seems a little much.
SPEAKER_01:What's being done, I guess, um what's being done on a state level, what's being done nationally to balance out in terms of these are the guidelines. We talked a lot about guidelines last week, right? You know, the guidelines what's being done on state and and national political levels to counterbalance what we've been taught over the years, right? But still satisfy those industries that we've made promises to over the years.
SPEAKER_00:Yeah, um, I mean, so if you think about the sugar industry, there's some other things that that goes into the corn industry for sure, uh, ethanol that goes into uh to gasoline and that sort of stuff. So um I, you know, I I I'm not sure exactly because I'm I'm you know not anyone who negotiates these deals with these companies, but um, you know, I'm not sure exactly what they're doing to placate them, but I think um, you know, from top to bottom, the the current administration and HHS are really pushing these these changes. So, like better diet, less processed foods, more exercise. And I think that's trickling down to a lot, a lot of states. Um, I know there's several states that are looking at um taking things like sugary candies and sodas off the snap benefits. Like you you have to buy healthier food on snap benefits. There's there's a lot of things I think that are happening nationally, and and you know, we we talk a little bit. I used to watch The Biggest Loser. So Gillian Michael. Of course, yes. She's become a huge advocate. I mean, she was a big health person anyway, but she's become a huge advocate for a lot of this stuff with diet and exercise. And you know, she's got her own a big podcast now and stuff. And this is stuff she's been saying for a long time. Um, you know, and I and I've read a ton of books in the past about uh, you know, what what sugar does to your body, what carbohydrates do to your body versus what what proteins and even keto diet. You know, there's a guy named Jason Fung, I think is what his name was, who wrote several books about keto and intermittent fasting, um, all as a way to get your body in a caloric deficit and to sort of start you know processing itself, eating away at the glyco uh at the uh glycogen, and then after that eating away at the fat.
SPEAKER_01:So let's look at from both sides of this coin, right? Like the the government didn't actually admit they were wrong, right? They just said we're moving on from this. Yeah. Um, over the years, meaning like they didn't say like this initially was wrong, they just said, hey, we're changing the guidelines, we're moving on. This is what we recommend now. As a society, though, maybe this fits our society better from our human biology more than it did in the 80s, right? I mean, like, from a medical perspective, do you think our biology changed? No, right, that much.
SPEAKER_00:I I think what what adding a bunch of carbohydrates and processed food did is make us fatter and sicker. Um, and and you know, now we're now there's no way to deny it, right? Maybe you could deny it in the 70s and 80s. Oh, yeah, people are more sedentary because they're watching more TV or you know, they have more desk jobs, but I think it's very clear now that you know not much has changed about our society's movement and exercise in the last 30, 40 years, but a lot has changed with our diet. There's no there's no real food in our food anymore, right? Our food is is poison, basically. So yeah. Yeah, well, and well, and I think a lot of that comes from the carbohydrates, right? The the what is it that they say that the the closer to the um the closer to the ground or the closer to the original animal or or plant that it is, the healthier it is for you, right? So you think about it like a um a strawberry is much more healthy for you than strawberry cola that has like that much strawberry left in it. Um so you know, and and carbohydrates, uh, you know, aside from and you can make all kinds of arguments about wheat, but aside from like wheat directly eating wheat or corn, which I mean who who eats direct wheat or corn? Everything's processed, right? Most you eat bread, which is processed wheat, right? You eat um, you know, uh corn-based things, but it's not a lot of people are sitting down and eating like corn on the cob and you know, that sort of stuff. So um I think you go to meats and fats, you're getting much closer to the source as opposed to the carbohydrates.
SPEAKER_01:So carnivore diet, I think I think of the carnivore diet, right? I mean, like it's another diet terminology. Yep, yep. But speaking of the things that you put in your body and you feed, I mean, if we go back to the our our ancestors, our way back when, yeah, way like the Mesozoic era, whatever, right? Probably getting my errors wrong, so don't come at me at the comments. But going back to when civilization was bare bones, right? They weren't having 10 meals a day, they weren't having seven meals a day. It was hunter-gatherer, you get the food, and the food was protein, right? I mean protein fat. Right. They they didn't have, I mean, it wasn't even until when, like the 12th, 13th, 14th century. They didn't have starches, right? No, I mean, yeah, I don't know when all that came about.
SPEAKER_00:I mean, I mean, I you know you could pick you could pick berries or something like that off of trees, but you're not getting large amounts of that. Yeah, the majority, you would the the the um humans would hunt some sort of animal, a buffalo or whatever, right? Kill the buffalo, and they'd they'd eat for three or four days, and then they might not get anything to eat for another week until they went and killed another buffalo. So, I mean, that could get kind of gives you the idea of the intermittent fasting as well. Like, were we naturally designed to intermittently fast? Um, there's some some literature out there that says that a 72-hour fast is like kind of the sweet spot of fasting where you don't don't go into true starvation where you're like eating muscle, um, but you get all the benefits of a fast. So, and and that would make sense, right? I I would imagine that if you're a hunter-gatherer, you're probably not eating any significant calories except every three or four days.
SPEAKER_01:I I want to throw a wrinkle at you because um the introduction of GLP1s have made things a little made things a little bit interesting, right? Because the whole point of a GLP one, as correct me if I'm wrong because you're the physician, is that it basically takes this intermittent fasting idea to another level, right?
SPEAKER_00:It makes you think you feel full.
SPEAKER_01:Um, so whatever the drugs they're using now, yeah. Does this change our biology? Does this change our DNA? Does this change how we as a society, you know, look at food and what we eat and how we eat it?
SPEAKER_00:So it may change the expression of genes for certain things. So does it change our biology? Probably. I don't think anybody's done those studies. I don't know if they've been out long enough, but there's probably some change in biology. Um, but I mean, you still come out with the same problem. If you eat, even if you're on a GLP1 and you eat too much sugar, you can still end up diabetic, right? Or or worsening your diabetes because of the spike in in blood sugar and the spike in insulin. The other thing is the whole idea of the conversion of these things to fat, right? So um uh, you know, most of the cholesterol you eat gets or the fat that you eat at some point can get converted into that LDL or HDL cholesterol, fine. But one of the worst cholesterols for you is is uh triglycerides. And triglycerides are made primarily from excess sugar in your body, right? So you get all these triglycerides from eating sugar. A lot of people have major issues with that. Now, I'm also not saying, like we said, if if you have a that there are certain genetic disorders and there are certain um lines of population where if you eat too much, if you get too much LDL cholesterol, you're gonna be at high risk for a heart attack. So there's a certain percentage of the population, you you probably need to be a little bit more balanced. But for the majority of the population, it is probably better to eat more fats and proteins than it is to eat all those carbohydrates. What happens with the GLP1s? I guess we'll see. Um, I mean, you you can take them as lifelong drugs. That probably helps stave off some of those effects. But again, if you're if all you're eating with your GLP1s is a thousand calories a day of carbohydrates, you're not getting, you're not gonna build any muscle. That's a big thing, right? We talked about this before that if you don't exercise any protein on the GLP1s, you're gonna lose muscle mass as well as fat. If all you're eating is is starches and sugars and carbohydrates, you're still gonna cause problems.
SPEAKER_01:It's interesting with the GLP ones because I don't I just don't think there's been enough research done, right? I mean, probably not. And and it'll be another generation before a lot of that stuff comes out, you know. Like, is there drawbacks to it? We we've kind of done podcasts on that in the past where we've asked those questions. Um looking at all of these parameters, right? You're looking at the inverted pyramid.
SPEAKER_00:You're also the memes on that were great. Yeah, if they were with all with all these all these scientists sitting around going, how are we gonna fix the pyramid? And then uh, I can't remember who it was. One of one of the one of the politicians goes, just flip it upside down, and all the all the scientists laugh, and then they do it, and they're like, Oh yeah.
SPEAKER_01:Um with this inverted pyramid with um all the diet trends that have come out with the GLP ones, as a physician, what is the right method? What is the right way to do things? What are the right guidelines in your estimated opinion?
SPEAKER_00:In terms of how to lose weight, you know, I I think there's study and study and study that comes out, and I get them across my email all the time, um, of the combination for for severe morbid obesity, the combination of a GLP one and one of the one of the surgeries, one of the weight loss surgeries, oftentimes it's the sleeves, the gastric sleeves, that's probably the best long term outcomes, is doing both. So you pre treat with a GLP one, lose a little bit of weight that way, have a gastric sleeve, lose a lot of weight that way, and maintain it with a GLP 1. That's probably what what the long term protocol will be for morbid obesity or ultra morbid obesity. But what's even better is Let's not all get obese to begin with, right? I mean, let's take the next generation and instead of our kids starting to get obese when they're four, five, six years old, let's have them eat real food, limit the sugars, limit the processed food, make them exercise a little bit and run around, kind of like we did in the 80s and 90s, and then stave off them because there is data that says that if you aren't overweight by the time you're like, I can't remember what the age is, 12 or 13, that your likelihood of of being obese and having major weight issues later on is infinitesimally small. So if you if you can keep kids healthy to that 12, 13, 14 age range, their risk in the future is is less. So I mean the key really, I think, is the kids at this point. I mean, I think we need to treat the adults, but we need to prevent it with the kids. Awesome. Yeah.
SPEAKER_01:Is there anything else for the good of the order?
SPEAKER_00:Good of the order. Uh I'm trying to think. Yeah, I mean, I think I think it's really interesting. Um, that, like you said, the government didn't say, hey, we've been wrong all this time. They just said, Yeah, we've decided. And there's no new research on this, right? I mean, I don't think that the government went and said, let's look at all the research and then figure it out, right? I literally think that they it was probably something like the meme where they're just like flip it upside down. Um, but no, I mean, you know, I I think I think we've talked about this exercise. We've talked about there's not real food in our food. I think the other thing that's tough is convenience, right? We're all in a hurry now. And the convenient food is the processed food. It's not super easy to be like, yeah, I'm gonna go make myself a steak right now. It's much easier to go to McDonald's and get a burger that has hardly any meat in it.
SPEAKER_01:I literally went to McDonald's like three weeks ago, and I'm like, Do you guys have salads?
SPEAKER_00:And they're like, No, like, no. You know, McDonald's put sugar on everything. There's sugar on the salads, they have salads, I think. And it's probably a specific type of sugar, so you crave only that. Well, and we didn't even talk about this, right? Foods are designed now to be ultra palatable, meaning that they are designed to make you eat them. They they they expand on what the natural taste would be, right? Like the Dorito is a prime example. Like Dorito has so much flavor that you would never get in nature, ever, right?
SPEAKER_01:So they're designed to be a Swiss char that's in the vending machine, you know what I mean?
SPEAKER_00:Like so, so they're designed to make you eat, they're also designed to be um uh easy, easy to digest quickly, so that you eat more of them, and they're designed to be very, very salty because salt makes you want to eat and drink even more. So our food is designed to make us fat. Now, I get it from a business perspective, you want people to eat more and buy more of your food, of course. But we have to realize as a society that you know eating these ultra palatable, ultra-processed foods is gonna lead to a lot of complications.
SPEAKER_01:Cue up the song, beer and pretzels. That's why the song's called beer and pretzels, it's not called light beer and broccoli.
SPEAKER_00:You know what I mean? It was we were at an event on Friday night, and uh, and and somebody was talking about the difference between broccoli and I think he said like a piece of candy. It's like, yeah, we we're trying to sell people broccoli. Nobody wants to eat the broccoli, even though they know that it's better for them long term. They're gonna live longer, they're gonna feel better, they're not gonna have digestive problems, they're not gonna get fat, they still choose the candy over the broccoli, even they know, even though they know it's better for them. So, you know, we we have to be we have to be better at figuring out how to teach our kids. The big thing is teach our kids how to eat well on the front end so that that there's less risk in the future.
SPEAKER_01:Before we wrap up, who do you got on Monday?
SPEAKER_00:What is it? Whoo-hoo-hoos. What's final score? Uh I think they win by two touchdowns. 28-14, 35, 35-21, something like that. They're like a nine-point favorite. Nine? I think they were eight. They were eight and a half. Um they may be nine by this point. Yeah. They started out at five and a half. So right, right, right before they right before they won the game, they were five and a half point, then seven and a half, and then eight and a half. Now they're I think they're nine. You're gonna what? Don't tell me you're gonna you're gonna pick Miami.
SPEAKER_01:You're not gonna like my prediction. I just think that defense is pretty darn good. I think the defense is now we're all waiting. We're all waiting to put eleven to throw some interceptions.
SPEAKER_00:Yes, we are waiting for Carson Beck. Yeah.
SPEAKER_01:Who's had an entire career of not being able to win the big I would like to see nothing more than IU hoist that trophy on Monday because I think it's pretty special going from worse to first, right? I mean, you could say from going from worse to first. That stadium's tough. I I've seen a lot of teams go down in that stadium over the last 24 months in person. And I know so you said something very interesting earlier that they're trying to ban, like get more uh uh UM fans, Miami fans, to buy tickets so that they get those IU fans out of there because it's a home game. Yep. Um my heart says IU. My mind says Miami by three. 20 to 17.
SPEAKER_00:Last second field goal. You're they're gonna hold they're gonna hold IU to 17 points. I would take that bet. I would take that bet any day. There's no way they're holding IU to 17 points. I hope I'm wrong. I'm hoping I'm wrong. All right. So what what am I gonna? I'll I'll say I'll say uh 2814 IU. You're saying 20 to 17 Miami. Miami. All right.
SPEAKER_01:Did you see the little by the way, before we close, did you see the map of like the United States and who is for the Hoosiers and who's for Miami? It literally had the 305 area code was for Miami, the rest of the country was for IU. Sounds about right. Sounds about right. All right, we are brought to you by the Butterfly Network. Uh, for Dr. Brian Schmutzler on Vahit Sadrazani. This has been Going Under Anesthesia Answered. Go Hoosiers. We'll uh Hoosiers. We'll see you in the next one.
