Food as medicine – Healthy living through better nutrition ft. Dr. Molly Maloof

What you’ll learn
  • Why doctors should prescribe food as medicine
  • The power of continuous glucose monitoring
  • How to protect your mitochondria, gut and organ health
  • How to use fasting to improve your metabolic flexibility
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Read the transcript
Daniel

Today’s guest is Dr. Molly Maloof. Molly runs a concierge medical practice, which specializes in helping people optimize their health and longevity using food, lab tests, and self-tracking devices. She’s also a lecturer at Stanford University’s wellness department in the School of Medicine, where she teaches a course entitled “Live Better Longer: Enhancing Healthspan for Longer Lifespan”.

Previously, Molly was Head of Medical Science at Sano, a Silicon Valley startup, making a continuous glucose monitor. She’s a frequent speaker in health and wellness circles, and a passionate advocate for sustainable, healthy living.

Molly, thank you very much for joining us.

Molly
Thanks for having me!
Daniel

One thing that makes you so interesting is that you’ve come from the conventional medical world and you’ve crossed over into wellness, and really you’re in both now. So can you tell us about where you sit and how you found yourself making that journey?

Molly

Well, I have always been interested in health and performance, since I was a young child. Like I’m talking, I used supplements in eighth grade. That was not, I was not a normal person as a child. I basically found myself interested in understanding my body. And I remember very, very, very clearly when I was in sixth grade, when I hit puberty and I was like, “Someday I’m going to understand this body. This is so weird. I don’t know what’s happening, but someday I’m going to understand all this. I’m going to have an explanation for everything that’s going on inside me.” And the truth is, is that I’ve spent a lot of my life running self experiments to figure out how my body works, and to help it work better. And it’s funny that I’ve kind of become a leader in this space they call “biohacking”, when there wasn’t even a term for it when I was growing up, I was just trying to understand what was happening inside me.

And in medical school, I got particularly interested in optimizing my own performance because I was really unhappy, super stressed out, thought I was needing prescription medicine from a psychiatrist because I was so miserable. And so when I basically got to the point of getting professional help, because I was so burned out, they were like, “You’re not crazy, you’re just stressed out. You don’t take good care of yourself. Why don’t you try that?” And I said, “Oh my God, wow, that’s all I need to do is like take better care of myself? Like, this isn’t like a disease or anything?” And they’re like, “No.” So I thought it was a really good thing that that psychologist did for me, because a lot of people go to doctors and they just hand them drugs.

But this psychologist was like, “You don’t need drugs, you need to take care of yourself.” And it was the best gift anyone has ever given me because it gave me so much power to actually look at my life and look at how I was living and ask myself… I mean I was the picture, I was the exact like stereotype of a medical student who like sat in front of her computer, studied all day long, sacrificed her health for her grades. And really her grades were suffering because of her health. And when I connected that, I was like, “Oh, so what will happen if I take better care of myself? Let’s see.” So I started studying evidence-based lifestyle medicine, and I started looking into medical research on how do I make my body function better? And I realized I needed to meditate. I realized I needed to eat more regular meal times. 

I actually needed to eat more often. I was eating too little at the time. I needed to spend more time with my family and my friends. I was isolating myself because I thought all I had time to do was study. I mean, there was just so much information to learn that I didn’t really have time to do much else, I thought. So it turns out I was wrong. I actually had time to do it all. And in fact I also had time to sleep more, and I stopped drinking so much espresso, I stopped doing a lot of maladaptive behaviors that were causing me to not be in my best health. And surprisingly, I started getting really good grades. Like my grades went from average to outstanding, and my board exam scores went from literally average with test anxiety and not sleeping the night before, to getting a 99 percentile on my second board exam. And that doesn’t happen very often. 

So a lot of my peers found out and they said, “How’d you do this? This is weird. Like, what did you do?” I’m like, “I really just started taking better care of myself and I slept really well the night before, and I ate a healthy breakfast that day, and I went and I took the test.” And they were like, “No, no, no, no. Like, what else did you do?” And I’m like, “Well, I did this and that, and started eating regular meal times, and I started doing yoga. I started meditating, and I started spending time with my family again.” And they were just like, “Whoa, this is so crazy. Like you’re doing so well and you’re so much happier.” So I was kind of like generally ahead of the curve on a lot of things, but I really felt that this was important.

I got to my residency, found that the workload combined with the culture of medicine was just super maladaptive to health. And so I decided to get my medical license and to take a jump into the tech scene, and started working with companies, started working as an advisor or consultant to that early stage startups, and then also started my own medical practice because I had a fairly strong belief that if I were to go out and try to help people become as healthy as possible, that even if I wasn’t a board certified physician, that I could make a difference in the world. And so that was really my intention is, going out and teaching people about health through lifestyle. And that’s where I am today.

Daniel

That’s awesome. So you said that health happens between office visits. So, I guess, most patients you could say they’re taking snapshots of their health rather than a movie. Right? So in your practice, how do you help people take movies of their health? How do you interpret the picture that you see?

Molly

I mean, the best tool that I use for clients is the continuous glucose monitor, because this device has traditionally been used for diabetics to manage their disease. But the reason why a person is diabetic is because they’re not healthy. So the thing is, is that diabetes is just a symptom of an unhealthy organism that’s not adapting to its environment or its food supply.

So you put a glucose monitor on someone before they even become diabetic, and it reflects how they eat, and when they eat, and where they eat, and how stressed out they are when they’re eating, and how much they move, and how they sleep, and how their liver’s functioning, and how their muscles are processing glucose. And it’s just such a beautiful picture into a lifestyle.
Dr. Molly Maloof

So I love that tool. I mean, I discover things every day putting these on clients, whether it be certain programs I thought were healthy that aren’t. Like I put a client on a fasting mimicking diet and she was wearing a glucose monitor, and lo and behold, the food products she was eating were spiking her blood sugar, and we would’ve never known that.

And it’s surprising that there’s things that are sold as healthy that may actually not be perfectly sound scientifically, even though they may have tons of research behind them. If you don’t look at the real world use case of these products, you don’t actually find out how they work in the real world, really. So, that’s always interesting.

And then you can also use these tools to help people course correct in the moment. So if your blood sugar is spiking, you can go do some exercise, and you can get it to drop very quickly. And so I can’t wait for getting an implantable glucose monitor. I’m sure I’m going to get one before the next year or so, because they just came out with these clinical tools doctors can prescribe and actually learn through in certain people. So I’m very close to becoming a cyborg, but it’s really just about gathering as much data as you can on a person. And I do check in with some of my clients every week, and that provides me with a really in-depth perspective on the problems in their life. And not every doctor gets to do that. But I have a very small panel because I have high-touch care.

Daniel

That’s awesome. It sounds like you’re also trying to strike the balance between health tracking that’s natural but not neurotic, right? So there’s so many devices you can choose from, but you want the right balance of minimum pain, reasonable time, decent cost, also things that just are actionable. If you had to choose one biometric for general health, glucose is obviously a great place to start.

Molly

Yeah. Glucose and heart rate variability are both really important. I mean they’re real time.

Daniel

So you specialize also in helping people to extend their health span, to maximize their healthy life expectancy. What things do you look at when you’re helping people to make changes and really the key factors that they should look at to help extend that?

Molly

I mean a big thing is I look at a lot of labs first and foremost, to get an idea of where their baseline health is at. So I want to know, what is their iron metabolism? What is the white blood cell count? If it’s high, that’s a big, big red flag. What is their CRP level? If that’s high, another big red flag. What’s their vitamin D? If that’s low, then their immune system’s compromised. That’s a problem. What do their minerals look like? What does their comprehensive metabolic panel tell me about their kidney function, their liver function? And what is their fasting glucose, hemoglobin, A1C, fasting insulin. You know, I want to see their lipid metabolism, their lipoproteins. I want to see their hormone metabolism. And all of these things tell me like what are these different systems doing? Are they functioning at their best, or do they need to be optimized?

And a lot of these tools and these labs give me very specific recommendations for patients, whether it be a custom supplement protocol, or a custom fitness protocol, or a custom nutrition protocol, or stress management recommendations or even environmental changes. Like one of my clients had significant levels of mold mycotoxins in his urine and he has to move, he has no choice. Like, his home is poisoning him. So, I used to think some of these things were not real, but then you start measuring them and then you’re like, “Well if you can see it on the wall and you can see it in the urine, you’re probably going to have mold mycotoxicity.” So you know, it’s not the first thing I look at, but environment really matters, you have to pay attention to that.

And then beyond that, I’m also looking at the history, right? Like the history is as a big picture of a person’s health and their life. It is the movie of their life. So I’m asking them questions about their childhood medical history, what it was like for them in utero. I’m asking them about their family history. I’m asking them about their relationship with their parents, with their partners, with their environment, with their food, with their fitness. And I’m really getting the qualitative markers about their health. And then from there, you can take the quantitative markers from urine, blood, stool, saliva, and layer that upon the qualitative markers, and now you can start seeing these patterns of expression of health or disease.

Daniel

Absolutely. You’ve also talked about something called organ reserve when you look at people’s health. Can you tell us what that actually is and why it’s important?

Molly

So every time we tax our organs with work to do, it wears out the organ, okay? And so if you think about a person’s life, their organs are only going to last as long as they are taken care of. So if you look at these organs and their capacity to do their job, if we tax them over time, we lose their reserve. And another facet of organ reserve is this concept of bioenergetic capacity. So your cells can only work as long as they are energized to have the ability to run the function. So if you think about the body and the organs, if they don’t have enough power to do their job, they’re not going to work, right? They’re not going to do work. Like you need energy to do work. So part of organ reserve is literally having the energetic capacity to do the work, which means that as we get older, if we lose bioenergetic capacity, and you’ve talked to anybody who’s in middle age, who tells you, “Yeah, I don’t have the energy I had when I was younger,” that’s a sign of lost capacity.

So that’s when you start seeing biomarker shift. You start seeing the end organ reflection of the shift in the body on the biomarkers, which the numbers change because they’re no longer able to maintain homeostatic capacity, which means they’re no longer able to maintain the normal range of function. So they’re starting to shift their normal range into the abnormal range. And that’s when we start seeing things like hypertension, which is high blood pressure, the inability to maintain proper blood pressure, or we see high cholesterol, or we see high blood sugar. And we call these disease states, right? But they’re actually just symptoms of a body losing organ reserve, and losing its ability to maintain bio-energetic capacity.

Daniel
Okay. So when you see those things happening, are there ways to make changes to limit that degradation?
Molly

The first thing you have to do is you have to send the signals to your body to make more energy. And the one thing that people do as they get older is they slow down. And as you slow down, that’s sending the signal to your body to make less energy. Because it says, “I don’t have a demand, so it means I don’t have to do the work, which means I’m not going to make the energy organelles. I’m not going to make more mitochondria if I don’t have the demand to make more mitochondria.” So energy demand is a signal that tells the mitochondria to make more. But the problem is that, if you slow down and you sit in front of the TV and you sit in front of a desk for 16 hours a day, or 12 hours a day, and you don’t move your body, your body never gets the energy making signals.

And so this is the adaptive capacity model. And I really believe it’s true, because I have found that just standing during the day, which I’m doing right now as we’re on this podcast, totally shifts my energy level because my body is saying, “Oh, you’ve got a demand to stand up? Great, we’re going to provide you with more energy to stand up.” The same thing goes with movement. So weightlifting and high intensity interval training, even if it’s a few sprints, that sends potent signals to make more mitochondria. So you’ve got to send the signals if you want to make more energy, but you also have to have the fuel, the fuel to run the power plants.

You have to put the right fuel into the body. And unfortunately most people are putting really dirty fuel into their gas tank and they’re ruining the engines. And that’s what’s happening when you eat packaged, processed food, or gas station food, or anything you find at the cereal aisle of a grocery store. All of that stuff is garbage, and no one should touch it because it’s not good fuel.

Dr. Molly Maloof

So the kind of fuel that I eat is, I eat lots and lots of vegetables, a little bit of fruit. I eat lots of healthy fats, lean protein, sometimes fatty proteins depending on how I’m feeling. Lots of fish. Colorful vegetables is the core of my diet. And the reason why is you get fiber, you get heavy water from inside those cells, which is really good for maintaining that, basically maintaining your own hydration levels, which you need really proper hydration and minerals to drive these gradients, which are basically the batteries of ourselves. So it’s all about getting the pigments, getting the phytonutrients, getting the fiber to feed the microbiome, getting these structural components from amino acids, getting the fat to fuel the mitochondria, and not overdoing carbohydrates, not abusing the refined carbs and sugar.

I mean that’s the number one thing I tell people is just minimize the sugar because it’s in everything. And if you minimize all the things that it’s in, you’re basically left with whole food, and real food instead of processed food. And if you can do that, then you’re going to be way healthier for longer, and you’re also going to look younger. I mean the less sugar you eat, the less you glycate yourselves, the proteins of your cells, and the less you age, the less you literally cook yourself.

Carbohydrates burn hot and also glycate, so they attach these carbohydrate residues to proteins that literally… It’s like the browning reaction when you take a steak and you put it on a hot pan and it turns brown, that’s a Maillard reaction, and that is happening in your cells when you eat carbohydrates. So you don’t want to overdo the carbs. You want to have the right amount of carbs, preferably ones that are bound to lots of water, and not too much of them and not too much at the same time, especially not too much with fat at the same time. But these are some basic rules that you can follow and you’ll be a lot healthier.
Dr. Molly Maloof

Daniel

Mm-hmm (affirmative), okay. So you talked about the importance of high quality food, whole foods, minimizing sugar intake, having good carbohydrates. What’s your view on fasting and calorie restriction? Is that something you think is important? Do you practice it yourself at all?

Molly

So lately I’ve been doing intermittent fasting because I have found that, that’s the thing that I can most consistently do. So I’ll do 14 to 16 hours, typically. Ideally 16 hours is ideal for me, but sometimes I manage 14 hours if I really…I just love breakfast. And usually it’s because I’m socializing that I’m having dinner, but I really like to eat earlier in the day and stop eating earlier in the night. And it seems like a lot of the evidence is starting to suggest that, that’s the best time to eat anyway. So I’m not a big believer in late eating at all, unless you’re going to be socializing with people, and you basically need social interaction, which is super nourishing for the body. But I also do an occasional extended fast, and I always fast on flights, so anytime I’m traveling I’m fasting, just because it helps you reset your circadian rhythms. And a good 24 hour fast here and there is also a great thing to do.

I used to be a little bit more rigorous with fasting, but I’m really at a place where it’s really about fitting into my lifestyle and being realistic with it. And I do think it’s good to empty your glycogen stores periodically, but I’m doing a lot more weight lifting right now. And one of the things that you have to learn about with fasting is that it does improve muscle quality because it reduces the muscle fat, but it also makes…like when you’re exercising more, you also want to eat more, so you have more eating signals. So it makes it a little bit more difficult to fast. But I do think it’s possible to do both. And I do recommend doing both.

So it’s just really the key is, you have to modulate the stress. And if you’re under an enormous amount of stress, that has got to be your main priority, not fasting. Fasting comes from when your body is in a place of being able to be challenged. And if your body cannot handle that challenge, then you shouldn’t do it. So you have to build your body’s capacity to handle that kind of metabolic training.

Daniel

Okay. So let’s say, for example, you’re doing weight training in the gym, but you’re also fasting. You might wake up, have something very small pre-training, have your workout, then a fairly large post-workout meal, and then be fasting the rest of the day, right?

Molly

Yeah. Or like eat two meals a day and then maybe have that one snack before you start lifting. But just ending eating early. So I like to work out in the morning preferably. I’ve really noticed through self-experimentation that if I work out in the morning, the rest of the day is easier. And so it’s almost like I’ve gotten the hard thing out of the way. And so if I can fast and I can work out in the morning and I can get a nice meal in around five, it’s a lot easier for me to fast from 5:00 PM to 9:00 AM than it is from like 7:00 PM to 11:00, personally. I just find that I just like breakfast and I like working out in the morning and I like having some food around weightlifting.

There is some benefit to fasted exercise. You don’t get as much performance on those days, but you are actually getting a conditioning effect. So there is benefits to doing some fasted cardio. It’s kind of like wearing a weighted vest.

Dr. Molly Maloof

Daniel

Okay. So just to get a little bit more technical. We know that calorie restriction generally promotes life expectancy, all things being equal. And there’s some evidence, particularly in mouse studies, that fasting promotes something called autophagy, or cell renewal. And of course because of the restricted or no carbohydrate intake, it can improve insulin resistance and so on. But is it enough to just simply spend periods of time not eating when fasting, or do we actually need to be in a caloric deficit to get those benefits? You know, could it be an association or causation of fasting, right? But I want to understand, is it about the not eating part, or is it about the calorie restriction as well?

Molly

I mean, so there’s two camps of calorie restriction, right? There’s the continuous calorie restriction, and then there’s intermittent. And intermittent would be fasting and continuous would be the people who just eat less per day, but they don’t care about when they eat. So it’s like time course shifting or just overall shifting. So the body very, very quickly adapts to the change of calories. So if you eat less per day, the body turns down metabolism like a thermostat. And by doing so, you’re literally turning down heat production in the body. If you look at people who do continuous calorie restriction, they actually do look younger, but they also are very skinny. There is some evidence in animals that if you do more intermittent fasting, what you’re doing is you’re flipping the metabolic switch, and so you’re shifting from carb to fat metabolism. And doing that trains your metabolism to basically shift gears more effectively.

And so it seems like that calorie restriction through fasting can have similar benefits, if not more benefits, because of tapping into ketosis. So to me it’s probably more optimal, but you know what? We don’t really know. It’s more of a hypothesis. I think the key is, is if you’re going to do continuous calorie restriction, to make sure you exercise to drop into those levels of ketosis. I know when I’m in ketosis because I can smell when it comes on, and I tend to drop in when I’m on a low carb diet or if I’m intermittent fasting. But I used to do continuous calorie restriction for years, and don’t get me wrong, it works. It’s just I kind of like eating. So I think that, you know, I just kind of like fasting because I just think it’s a little bit easier to limit the timeframe versus limit the calories.

But that being said, like I am actively always seeking ways to trick my body into thinking that I’m eating more food than I’m eating. So that’s why I eat tons and tons of vegetables. But I have a tendency to want to eat higher calorie dense foods. I love nuts and seeds. I love a good steak here and there, and I’m not a believer that there’s any food that’s off limits per se, aside from like trans fats and processed foods. So I’m kind of in the world of, we need to kind of move away from restriction patterns because it’s causing disordered eating and orthorexia, and we need to move towards actually living our lives and finding a lifestyle that works for us and that we enjoy. Because you can’t just wake up one day and be like 85 and bored and alone at your table with your like crappy dinner that you’ve been eating for 50 years that you don’t even don’t like. That’s not living.

You want to be surrounded by people you love, enjoying the foods that you eat, enjoying the life that you’re living. Having times of feasting balanced with times of fasting, and following the rhythms of the environment. If you look at the environment, there are times of abundance and there are times of land going fallow. And that’s part of the natural cycle of life. And I think that that should be our goal is just aligning ourselves with the natural patterns of nature.
Dr. Molly Maloof

Daniel

Yeah! So that leads me to another question. I know you’ve experimented with keto, you’ve been on and off it, also a low-carb diet. It feels like in the keto world some people are still very much on pure keto, but there’s more interesting cyclical keto or improving metabolic flexibility by switching diets. What do we know now about the effects of being on keto long term? Are there any potential health downsides to that, or is that unclear right now?

Molly

I’m pretty sure that the biggest downside is that your microbiome adapts to whatever diet you’re placed on. And right now I’m in this like practice of trying to figure out how do I get as much fiber as I can into my diet. And the problem with keto is that it’s a really low fiber diet. And so you’re not feeding the microbiome the things that it needs to thrive and flourish. And so that can be a problem, right? Like you need a strong and healthy microbiome to protect your mucosa, and to have a strong immune system. So we’ve got to find balance. And I’m actively looking at figuring out how to create my own food products and produce food products that are low carb, that have high fiber, that don’t cause gastrointestinal upset, and that enable a person to thrive on this kind of dietary style.

So, it’s very possible that we’re going to see a lot more data come out around the keto diet consistently – and especially the carnivore version of this diet – like super problematic. I just cannot imagine how microbiome can thrive on just the…like nobody grows a garden with dead meat, no one. And so I’m just not convinced, I’m just not. So maybe I’m wrong, maybe I’m wrong, but I think people go carnivore because their microbiomes were disrupted and their mucosa is no longer functioning adequately, and they have leaky gut and the only thing their body can tolerate is meat. Meat is a really low allergenic food. So I honestly think that, that’s the explanation why some people thrive on a carnivore diet, but I think that the optimal diet is a diet that’s high in fiber. And so as somebody who tracks things like this, like I recently tracked, tried to see how many grams of fiber I was eating one day, and I was like really astonished that I wasn’t even meeting my goal. And a lot of that has to do with dropping into ketosis. And so we have to realize that there’s this relationship.

Daniel

Mm-hmm (affirmative), that makes sense. Another topic we mentioned just now was metabolic flexibility. What actually is metabolic flexibility? Is it just about insulin sensitivity by switching substrates [type of fuel used e.g. glucose or fat], or is it something else?

Molly

So metabolic flexibility is largely the measurement of how quickly you can shift from carbohydrate to fat metabolism and back, or from carbohydrate to fat metabolism, or from fat metabolism to carbohydrate metabolism. So it’s through things like, for example, fasting. From eating to fasting would be one measurement, or from fasting to eating would be one measurement. So going from ketosis to carb metabolism, and how quickly you shift the respiratory quotient, which is basically an equation that reflects the shift in carbon dioxide and oxygen that you’re producing in metabolism. So in oxidative metabolism and cellular respiration. So if you think about it from a basic perspective, you can also measure respiratory flexibility by giving a body a stimulus. So you can give a body a large amount of fat to see how quickly it starts metabolizing fat.

You can give the body a large amount of carbohydrate to see how quickly it starts metabolizing carbs, and what happens to it when it does that. So if you give a body a large stimulus of carbohydrates or fat, does the body have super normal levels or is the body able to handle that load? So, that’s the flexibility of metabolism. It’s literally how can a body respond to these demands? And the thing is, is that in ketosis, the body is going to have this carb sparing mechanism that basically means that typically what happens naturally is your glucose levels are going to go up, but then they’re going to stabilize. And if you’re moving, and if you’re moving as you’re eating these carbs, you’re not going to see a giant spike because you’re actually going to be using that fuel.

The problem is, is that in modern life we’re eating carbs and fats together all the time, we’re not fasting really ever, and we’re not moving our bodies while we’re eating those carbs, unless you’re a marathon runner or a cyclist. And what’s happening is, you’re not metabolically flexible. So you start seeing your blood sugar rise when you eat the candy. And you start seeing the lipids rise because you’re eating popcorn with all this butter flavor, canola oil poured all over it. And the body’s starting to lose its ability to shift between carb and fat metabolism, and so it just starts having high blood fats and high blood carbohydrates all the time.
Dr. Molly Maloof

And so you’re losing that capacity to maintain homeostasis. And that is [lack of] metabolic flexibility right there, is your body just cannot maintain normal blood sugar, your body cannot maintain normal blood fats, and your systems are no longer able to adapt. Does that make sense?

Daniel
Yeah it does! So what’s next for you? Where are you going from here?
Molly

Well, I teach a course at Stanford – Live Better Longer: Enhancing Healthspan for Longer Lifespan. So I’m going to repeat teaching that course this spring. I’m starting to do retreats with some really cool places like Canyon Ranch, and this place called Calavi in Arizona. So I’m working with retreat companies like Chosen Experiences, Calavi, and Canyon Ranch, to bring my health span and protocols into the retreat format. And then I’m writing a book, and I’m working on getting it ready to sell to publishers. And then I’m also going to turn my course at Stanford into an online course. And I’m building a YouTube channel. So I’m getting really moving into media, and I’m partnering with companies and startups like Bisu to promote their products and to promote the science behind their products. So I’ll be doing a lot of content creation and a lot more media.

Daniel

That’s super exciting. That just leads me to say, thanks again Molly – thank you for joining us and really excited to see more of the great things you’ll be doing soon.

Molly
Thank you so much. This has been wonderful.
You can follow Dr. Molly on her Twitter and Instagram.
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