#176 – Why food cravings are killing us, and how to stop them | Mark Schatzker & Dr. Casey Means

Episode introduction

Episode Transcript

Mark Schatzker (00:00:00):

When the brain doesn’t get what it thought it was going to get, how does it respond? It’s almost like it gets a little ticked off. It says, “I really want that thing I didn’t get because I thought I was going to get it and this time I really want to get it,” so it’s going to work extra hard to get it.

Mark Schatzker (00:00:17):

So this is what evolution has given us. Evolution did not design us to want to stuff our faces, but it did design us to respond to uncertainty with excess motivation. Why? Because when something important like food becomes uncertain, well that whispers, there’s a possibility you might not get it and if that keeps happening, you’ll starve, you’ll die. So we’ve created this environment where there’s a lot of uncertainty in our food and I use artificial sweeteners as an example. People say, “Okay, well it’s like diet Coke and it’s a few things,” but that’s just one example. Uncertainty is baked into so much of the food we eat.

Ben Grynol (00:00:58):

I’m Ben Grynol, part of the early startup team here at Levels. We’re building tech that helps people to understand their metabolic health and this is your front row seat to everything we do. This is a whole new level.

Ben Grynol (00:01:24):

Why do we crave certain things and where exactly do these cravings come from? Well, neurologically there might be more to the picture than one would think. Mark Schatzker, an author and journalist based out of Toronto, Ontario, he sat down with Dr. Casey Means and they chatted about his new book, The End of Craving, Recovering The Lost Wisdom of Eating Well. He addresses what exactly cravings are from a neurological perspective and he dives deeper into why Americans have just recently in evolutionary history, developed an unprecedented and insatiable craving to eat. Well when you start to break down cravings, there’s some simple tactics that can be used to overcome these impulses.

Ben Grynol (00:02:07):

The episode was fascinating because Mark’s work presents a new model for the obesity crisis that is under recognized and it’s based on a concept of nutrient mismatch, whereby food is actually confusing our brains and driving us to eat more than we need by hijacking self-regulatory mechanisms. Casey and Mark also talk about why Mark doesn’t like alternative sweeteners, vitamins, or alternative plant based meats, all because they confuse the brain. Mark is also author of two other boats, Steak and the Dorito Effect. He’s also a writer and residence at the Modern Diet and Physiology Research Center, which is affiliated with Yale University. His writing has appeared in the New York Times, the Wall Street Journal and the annual review of Psychology. Anyway, no need to wait. Here’s the conversation with Casey and Mark.

Dr. Casey Means (00:03:01):

Mark, welcome to a whole new level.

Mark Schatzker (00:03:04):

Thank you so much for having me.

Dr. Casey Means (00:03:06):

So excited to dig into these questions. I was just truly blown away by the book and I told you before we started recording that this book was so impactful to me for a couple reasons. One, because it really made me think about things differently and some concepts that I’d never ever thought about or heard before, like nutritive mismatch, which we’ll talk about during this episode and what that means for our health and our obesity and chronic disease epidemic, but also because it’s just filled with so many amazing stories, some of which I’m sure we’ll go into in this episode.

Dr. Casey Means (00:03:44):

The book is called End of Cravings, so I think we should just start by defining what cravings actually are and really breaking down that concept. I think a lot of people have had that feeling of like, “I’m craving,” fill in the blank. For me sometimes it’s dark chocolate and almond butter, but what’s actually happening when we feel a craving and what’s the physiologic response happening in the brain?

Mark Schatzker (00:04:08):

So craving is very simply desire. It is, I guess, you could say desire at its most intense and it has a negative connotation. We think we’re victims of craving. To some degree that’s true, but it’s important to understand this is a natural thing. It’s there for a reason and if you look at humans or animals in a natural context, it performs a very important task.

Mark Schatzker (00:04:28):

If you think of starvation, what do people do when they starve? They crave food. They become absolutely fixated with food. The same is true if you’ve ever gone in a long run on a really hot day and you become really thirsty, you start to crave water, you can almost feel it, it just completely seizes your mind. We see when we look at the journals of British sailors who are suffering from scurvy, we hear in high school when they teach that, they had these swollen gums, and that’s true, they did have swollen gums, but the first symptom was a craving for fruits and vegetables. So the craving is the brain saying, “I need you to get something that’s really, really important for survival.”

Mark Schatzker (00:05:05):

So craving it comes from a good place, but that doesn’t mean in our modern world that it’s always a good thing and that became one of the focal points of this book because one of the most interesting things about obesity is that we tend to think the stigma is that it’s a disease of pleasure, that people with obesity lose themselves and the pleasure of the moment, they just don’t know when to say, “Enough is enough,” and that’s not what the neuroscience tells us. The neuroscience tells us that obesity is much like starving in the sense that it is a disease of craving.

Mark Schatzker (00:05:35):

So let’s just talk about two brains. If you think of a trim brain and an obese brain and they both… it’s time for a milkshake. Everyone thinks it’s when the obese brain takes a sip of that milkshake and it just loses itself. It lights up like a Christmas tree. That’s not what the neuroscience tells us. What the neuroscience tells us it’s upon seeing the milkshake, it is upon receipt of the cue as the psychologist would say, the trim brain says, “That looks like a nice milkshake.” The obese brain says, “I got to have that milkshake. That milkshake looks like the best thing ever,” and here’s even more interesting. When it comes time to actually sipping and tasting that milkshake, the obese brain, if anything, the pleasure response is blunted. So they have this massive craving for milkshake and yet the milkshake isn’t actually all that fulfilling whereas the trim brain says, “That looks like a next milkshake,” and they take a sip and they go, “Wow, that’s a great milkshake.”

Mark Schatzker (00:06:23):

So it really is a miserable condition. It is such a distorted and terrible relationship with food because people are tortured by a craving for an expectation of pleasure that is never really fulfilled.

Dr. Casey Means (00:06:36):

I thought something so interesting about the book was this idea that up until about 50 years ago, we were able to resist over consuming food. We may have had in an abundance of food, we had to store food for winter at times and we didn’t just go and eat all of it and now we’re in this situation where we literally can’t resist the food. There’s an insatiable craving and you talk about how obesity is actually a disease of craving. So what has changed over the past 50 to 100 years where we are no longer able to resist the food that is in front of us?

Mark Schatzker (00:07:18):

That is the nub of the question right there. It’s interesting you say we’re no longer able to resist, but maybe we weren’t resisting 50 years ago. Maybe we weren’t tempted in the same way. There’s this idea that we are wired to be obese, that we evolved in this environment where calories were unreliable, food could be scarce, so it just always made sense to eat a little bit more, and now in this modern food environment we’re surrounded by all these calorie rich foods, we’re sort of sitting ducks. I don’t think that makes sense and I think it’s really important to truly understand the nature of the brain and its relationship with food because it’s the only way we can understand this problem.

Mark Schatzker (00:07:58):

So here’s the reason I don’t think that makes sense. For one thing, in an evil extreme environment, if you’re carrying extra weight, it makes acceleration less efficient, more slow. It makes coming to a stop or turning quickly, much less efficient. You’re much less nimble. So it’s going to be much harder to catch prey and you’re more liable to become prey.

Mark Schatzker (00:08:18):

But I think this is the best argument as to why this doesn’t make sense. If you are carrying around extra weight, let’s say 20 pounds of fat as energy insurance in case famine comes knocking on the door, that is a really inefficient way to go about your life. It’s like driving a very big car. What is a big car need? It needs more gasoline. Well, a big body is the same way. So if you’re trying to navigate around a calorie scarce food environment, if you’re carrying extra calories, you have to eat lots more calories just to maintain those calories. So it’s a really bad strategy to use in a calorie scarce environment.

Mark Schatzker (00:08:55):

This whole idea that we are forged by the Stone Age to be hungry ogres, that the appetite is dumb, permanently hungry, always turned on, is just wrong. The brain, and we know this because of dieting, that the brain controls our body weight. When people go on diets, the diets work only for about six or eight months and this is part of the problem because people think the diet is working. Then around the six to eight month mark, the pounds start to come back on and people blame themselves. They say, “The diet was working, I failed.” That’s not what is happening. What is happening is the brain is intervening and the brain says, “I know you’re losing weight and I want you to gain it back,” and what happens is people snap back to their old weight.

Mark Schatzker (00:09:39):

So that might sound, on the surface like, “Well what are you saying that sounds like we’re wired to eat?” But it also works the other way. When scientists do overfeeding studies, they’ve been doing these since the 1950s, it turns out that getting people to eat too much food is nearly as miserable as starving.

Mark Schatzker (00:09:54):

The first scientist who did this, his name was Ethan Sims, he tries to do it to college. Everyone thinks college students are permanently hungry, always want to eat. He couldn’t get them to eat too much food. They just didn’t want to. He had to go to a state prison, and even there prisoners were dropping out of the study. It was so miserable to just literally eat yourself, to just stuff your face. And here’s what is so interesting is when that experiment came to an end, the pounds melted away. They snapped back to their old weight just the same way dieters do. So there’s this evidence that the brain has a pretty good idea of how much it wants you to weigh.

Mark Schatzker (00:10:29):

Here’s the other thing that’s important to understand. We think of the sensation of eating, of flavor and taste, as this sort of frivolous thing, sweetness and flavor, this sort of gets in the way of nutrition, it takes me to a bad place. That could not be more wrong. It is your brain’s way of measuring the nutrients that come into your body and the brain is obsessed with measuring. I talk about one of the studies in the book, Scientists of the National Institutes of Health and Kevin Hall. He studied people taking a drug called Canagliflozin. This is a drug that diverts sugar into the urine, it’s used for diabetics. And this drug was diverting about 360 calories a day of sugar into their urine. And he noticed for every pound they lost, there was a commensurate uptick in their appetite until they were making up for this loss of 360 calories by consuming an extra 350 calories. That is such… I mean talk about accuracy, that is unbelievable. But these people had no idea. They didn’t know if they were taking a placebo, they were just taking this pill, this all happened unconsciously.

Mark Schatzker (00:11:37):

So this really reframes the idea of overeating and obesity because this isn’t just us falling into our natural inclinations as given to us by evolution. There’s something wrong where a brain that manages body weight and a brain that is obsessed with measuring with the nutrients that come in the body has basically made a kind of decision to say, “I need to eat more food,” and that is the question we need to ask. What could cause a smart brain to say, “I need to eat more food?”

Dr. Casey Means (00:12:07):

That really feels like the crux of the book and what you really answer in this book, which is that this may actually be caused by something that is very different than what we conventionally think about as part of the obesity conversation, which is actually maybe that there’s this… with the advent of a processed food and this totally new food environment that we’re living in, that our brain is really confused. This amazing measurer that is so finely tuned is not really sure what’s going on. So I’d love for you to dive into this concept and touch on how odd this time we’re living in is for our brain in the sense that it used to have these visual and sensory cues that gave it a good sense of actually what was coming in from the mouth to the stomach and now it’s completely lost. What’s going on there and what is happening physiologically with our brain and with our motivation mechanisms that are causing us to overeat through this way?

Mark Schatzker (00:13:21):

Let’s just first talk about how important this measuring of nutrients coming in is. We do that with our nose and mouth. We experience it as taste and flavor, but see, your brain, this is information and this is so important that if you think of your DNA as your instruction manual to make you, the thickest chapter is on making the nose and the mouth. So that is how important nutrient detection is to the brain. And it’s only really recently that we’ve started to mess around with those signals. They were always very stable.

Mark Schatzker (00:13:53):

So I want to talk about an experiment that was done at Yale University by a woman named Dana Small because I think once you understand this experiment, the pieces start to fall into place. She began the experiment by asking a simple but important question, which is, “Is it possible to create drinks that are just as rewarding as a sugary drink but pack fewer calories?” This is kind of the dream of things like artificial sweeteners, “Can I scratch this itch I have for sweet things but not get that big wall with calories in the gut?” And if it turns out that’s possible, isn’t that great? We can go around drinking all the sweet delicious things we want, but not pay for it in terms of all these calories that accumulate as body fat.

Mark Schatzker (00:14:31):

Well it’s a really interesting question, but how do you answer it? And this is what makes Dana Small such an interesting scientist. What she did is she devised five novel drinks. They all had a distinct flavor and color and they were all made equally sweet with an artificial sweetener called sucralose. So they all tasted equally sweet, they had about 75 calories worth of sugar. Then she used a tasteless starch called maltodextrin to give each of these drinks a different calorie payload. One had no calories, one had about 37, one had 75, one had 112 and one had 150.

Mark Schatzker (00:15:05):

She gave these drinks to subjects and they went home and they would drink these drinks and their brain, I told you, obsessed with measuring, so their brains drink, sipped, tasted, learned, and the brain doesn’t just measure what’s in the mouth, it also measures what’s in the gut. It’s called post ingestive learning.

Mark Schatzker (00:15:21):

So the brain gets kind of a case report on each of these drinks and then she invites the subjects back to the lab and she sticks them in the brain scanner and they sip each of these drinks.

Mark Schatzker (00:15:29):

So let’s ask ourselves, “How do we think all these brains are going to respond to these drinks? Are they going to like them all equally the same because they were all equally sweet and the brain just… we like sweetness, so if it tastes sweet, that’s all we care about or is the brain smart and it’s going to measure these drinks and it’s going to say, ‘I like the 150 calorie drink because I’m a calorie hog?’”

Mark Schatzker (00:15:51):

Well it was one of these two outcomes that Dana Small was expecting and it turns out there was only one drink that really generated a big brain response and that was the 75 calorie drink. It just didn’t seem to make a whole lot of sense. The one right in the middle, not the 150 calorie drink, not the zero calorie drink, right down the middle, it didn’t really make sense. So she did the experiment again and it happened again. So now she kicked things up a notch and she put her subjects in something called an indirect calorimeter. This is a device that measures what’s called the thermic effect of food. When you consume calories, the body starts to expand energy and we can measure that in terms of the heat that’s given off to process those calories. So the more calories you consume, the bigger the thermic effect.

Mark Schatzker (00:16:33):

So one day a female subject in her early twenties comes in and she drinks that 75 calorie drink and there’s this beautiful little plume of heat, just exactly like you’d expect, that’s what the physiology textbook say is going to happen. Everything’s going great. A few days later, she comes in and she drinks that 150 calorie drink. Well what do we know from what know about physiology and how the quality burns calories, there should be a bigger plume of heat, right? There’s no plume of heat. The metabolic response is flat. This woman has consumed 150 calories and it’s like she drank a cup full of air. What on earth could be going on? And Dana Small is flummoxed and then it hits her. It’s the number 75 because all the drinks tasted as though they had 75 calories worth of sugar, but only one drink actually had 75 calories worth of energy in it and that’s the drink that was metabolized properly and that’s the drink that got the brain excited.

Mark Schatzker (00:17:26):

This tells us something very important. That sweetness isn’t just this sort of frivolous sensation from the stone age that’s meant to pleasure us for no good reason. It is information and that the accuracy of that information is crucial because when everything lines up, when the sweetness matches the calories, the beverages metabolize properly and the brain responds to it properly. But when it’s mismatched, when the taste does not match the calories, everything kind of goes kapluey. It doesn’t get metabolized properly, the brain doesn’t respond to it. What happens to these calories? They’re floating around in the blood and the brain almost isn’t even aware of them. So this is kind of frightening because you’re dumping nutrients into your body and they’re not getting processed properly.

Mark Schatzker (00:18:10):

She did more experiments and she found that this brings about symptoms in the body that are metabolic disease. She did a study with adolescents and this is really important because adolescents are in a period of bodily growth. So that’s why a lot of teenagers drink juice, they drink pop, they eat chips, they eat pizza. They can really pack it away because they’re in a period of growth, the body does need energy. And she found that when she gave these adolescents mismatched drinks, they actually had to bring the study to a screeching halt because they drew blood from three subjects early on and they were already looking pre-diabetic. So this is like, “Okay, this isn’t good.”

Mark Schatzker (00:18:43):

Okay, so now let’s pan out a second and say this is disturbing because we see when you start to mess around with the sensory signals in food, food doesn’t get metabolized properly. But let’s ask a deeper question. Let’s talk about the fundamental nature of the brain itself. I told you how the brain loves to measure. Why does it love to measure? Because the brain loves to predict. A lot of neuroscientists are talking about the brain is a prediction engine. The reason we have the senses, the sense of sight, the sense of hearing, the sense of taste, the sense of touch is so we can draw a kind of map of the external world and so we can thrive in that external world. We drop a representation of it that lets us predict what’s going to happen.

Mark Schatzker (00:19:24):

Well we’ve created a situation where a signal, that for millions of years was stable, sweetness. Sweetness meant calories. The more sweet something was, the more calories it had. Well now we have this funny situation where maybe that’s not true. You could have a sweet drink on a Monday and you get a bunch of calories. You could have a similarly sweet drink on a Tuesday and get no calories or get a bit of calories and then a Wednesday you have the same sweetness and you get lots of calories. So this signal that was stable all through evolution very recently has become unstable.

Mark Schatzker (00:19:56):

What is this? Well, psychologists call this very simply uncertainty. There’s an even more technical phrase. Reward prediction error. Basically means the brain had to predicted reward in mind, that reward didn’t happen. How does a brain respond? And this is where things get really interesting. The brain responds with increased motivation. When the brain doesn’t get what it thought it was going to get, how does it respond? It’s almost like it gets a little ticked off. It says, “I really want that thing I didn’t get because I thought I was going to get it and this time I really want to get it,” so it’s going to work extra hard to get it.

Mark Schatzker (00:20:28):

So this is what evolution has given us. Evolution did not design us to want to stuff our faces, but it did design us to respond to uncertainty with excess motivation. Why? Because when something important like food becomes uncertain, well that whispers, “There’s a possibility you might not get it. And if that keeps happening, you’ll starve, you’ll die.” So we’ve created this environment where there’s a lot of uncertainty in our food and I use artificial sweeteners as an example and people will say, “Okay, well it’s like diet Coke and this and a few things,” but that’s just one example. Uncertainty is baked into so much of the food we eat. There’s not just artificial sweeteners, there’s fat replacers.

Mark Schatzker (00:21:07):

Now what’s so amazing? Everybody knows about artificial sweeteners. Nobody knows about the fat replacer industry. Multi-billion dollar. If you’ve ever scratched your head and wondered, “Well just what the heck is light mayonnaise anyway? What is a light salad dressing?” It is technology that companies have created to create the illusion of rich fatty calories in the mouth and deliver just a dribbling of calories in the gut. This is a great idea if your brain’s just a hungry moron from the stone age, fool that brain. If your brain is smart, obsessed with measuring, this is a terrible idea because you’re fooling your brain and your brain will have the last laugh, it will have the last word and it’s going to say, “Don’t do that to me. I’m going to get what you tried to take away,” and this is what we see in neuroscience, is we see excess motivation. People with obesity crave food too much. We have incited this kind of artificial state of excess hunger by tampering with the sensory qualities of food.

Dr. Casey Means (00:22:03):

That is just such a mind blowing explanation that was so beautifully stated. I think two of the main points that I’m hearing is that the first is that when there is a mismatch between what the brain thinks the stomach’s going to be getting based on taste and other sensory cues and what it actually receives, it, first of all, actually changes the way we metabolize the food, which is really interesting and that experiment with the maltodextrin and the sweet drink, 75 calories versus 150 calories with the same sweetness is so interesting.

Dr. Casey Means (00:22:44):

I think I remember from the book that you said that with when the sweetness essentially equated to what 75 calories would be, the body metabolizes it properly and it is all the sort of cellular processes that break down carbohydrates and glucose and process this and form ATP and all this stuff were working, but then when it was the same sweetness, so we expected 75 calories, but it was actually 150 calories, literally the metabolic processes inside the body post digestion, the cellular physiology actually changed. Is that accurate?

Mark Schatzker (00:23:18):

Yeah, it just stops. It just comes to a screeching halt. It’s like if you invited 20 people over to a party and you open the door and 50 people are there and you just like, “Oh my god, I don’t know what to do.” You just freeze, you freak out.

Dr. Casey Means (00:23:30):

Call off the best party.

Mark Schatzker (00:23:31):

Exactly. Like, “Get away. I’m calling the cops.” It’s something like that. It really seems to throw things into disarray and we don’t actually know why that is. That’s an area of further study that might have to do with the rate of gastric emptying. There’s so much more to learn here, but what we do know is that we see that when the signal doesn’t match the nutrition, things don’t work.

Mark Schatzker (00:23:52):

One of the things I find so interesting about this is how surprising we find this because we’ve been so conditioned to think that taste and flavor is frivolous and unrelated to this important business of nutrition. Like nutrition is always from the neck down. We always think of nutrients entering the body, entering the stomach, carbs, protein, fat and it’s as though this whole experiential part that happens in the mouth is just frivolous and silly. And it’s like, well of course it isn’t. Of course there’s a reason we have this experience and of course it must mean something important for the way the body metabolizes and processes food, but I think we’ve been so conditioned to ignore it that when we actually have really good evidence saying, “Hey guys, look at what’s going on,” it becomes such a surprise to us, which I think in itself is so interesting.

Dr. Casey Means (00:24:42):

It’s almost like because we think of flavor as driving pleasure, we think we can really have our cake and eat it too by just getting as much flavor as we want and then totally not… like whatever the actual nutrients that are going in, it’s almost like an afterthought. We’ve decoupled these things and I think what you present as this model of how it’s really an integrated system of flavor and taste and all of the stuff that’s happening with the sensory cues of food is actually setting up a top down series of downstream effects that are going to be related to how we actually process and metabolize that food, which is one of those… This is why the book was, I think, so impactful was it’s like, “Well duh,” and yet we have really so, so decoupled those things in culture to our detriment.

Dr. Casey Means (00:25:31):

One of the second big things I was hearing from what you were saying is I think just so fascinating, which is that when you essentially have the taste and what your body is predicting that you’re going to get from a food, when that is mismatched with what the food actually provides, which is essentially the definition of processed food, it’s like changed and altered and very much modified to be something that’s not essentially, that that is actually going to drive us inherently to eat more and this is not necessarily about craving more of that flavor, it’s the fact that the brain is confused. There’s inconsistency between different iterations of what it’s getting. Like you might have a Diet Coke on Tuesday and then a Coke on Wednesday and a Diet Coke on Thursday and a Coke on Friday, so it’s getting the same flavor but different amounts of nutrients and it’s throwing the brain for a loop saying, “There’s inconsistent nutrition coming in. This is a time of scarcity and inconsistency and therefore I need to be driven to essentially consume more and eat more,” and that is just so fascinating to me

Dr. Casey Means (00:26:46):

You call it, I think, reward prediction error, could really be a link between the obesity epidemic, the chronic disease epidemic, and the processed food culture that we’ve been living in just for the last few decades. I wonder if you could share one of my favorite parts of the book, which was the gerbil experiment with the seeds because I think one thing-

Mark Schatzker (00:27:07):

Yes because this really…

Dr. Casey Means (00:27:08):


Mark Schatzker (00:27:11):

Yeah, no it’s a great one and this really brings to light how uncertainty works. So this is an experiment done with gerbils and they were put into two food environments. One was a very certain food environment. So in this food environment there was this big bowl just filled with seeds and next to it there was a bowl filled with sands and there were seeds buried in the sand. And it was just paradise for gerbils. They had all the seeds they could eat. And funny enough, they didn’t really overeat all that much. And it was kind of funny because even though they could go to this big bowl and just pig out on seeds, they seemed to enjoy digging around and pulling out these seeds from the sand and eating them at their leisure and so forth.

Mark Schatzker (00:27:46):

Then one day they go from the certain condition into the uncertain condition and now the big bowl is gone, there’s just the bowl with seeds and there’s actually not that many seeds in it. And then the next day, while the big bowl is there, there’s a few seeds and the bowl with the sand, there’s like hardly any seeds and then it was moved to the left side of the cage and just things keep changing and the stability is gone. And what do those gerbils do? Now they really start to pick out and guess what? They don’t seem to enjoy pulling the seeds of the sand. If they can get a free seat out of that big bowl, they will go for what is called the most profitable bowl, the bowl that gives them the most for the least amount of energy. So we see in this uncertain food environment, this whisper of a loss. The world is whispering to the gerbil, “You might not get enough to eat.” What do they do? They freak out and start stuffing their cute little gerbil faces.

Mark Schatzker (00:28:34):

Here’s the most interesting thing about that experiment. They always had too much food to eat. Even in the uncertain condition there was more food than they could have eaten, but it was because of this change in the way their expectation of food was framed that it instilled this panic in them. And this might seem odd and unusual, but it happens to us. If I told you you’ve got to catch a flight at five o’clock. It takes an hour to get to the airport. Your watch says it’s three o’clock. It’s either an hour fast or an hour slow. What are you going to do?

Dr. Casey Means (00:29:09):

50-50 chance that it’s early. So you’re like, “I’m going to the airport.”

Mark Schatzker (00:29:15):

“If I’m early, no big deal.”

Dr. Casey Means (00:29:15):

Yeah, exactly.

Mark Schatzker (00:29:15):

That’s right. Okay, so here’s another example. If your fuel gauge in your car was uncertain, it says it’s full, it says it’s half, but you actually don’t know, it’s just not working. What’s your response?

Dr. Casey Means (00:29:27):

To get more gas?

Mark Schatzker (00:29:29):

Yeah, you’re just going to be, “I got to…” you’re going to go to the gas station more often because you’re like, “I don’t know how much gas is there,” and running out of gas sucks, right? You got to call a tow truck. It’s a disaster. So you can suddenly feel, you just feel it’s like, “Yeah, if I don’t know how much gas in my car, of course I’m going to fill it up,” because running out would be a disaster. So this is an emotional response that we all have and this is a signal, an unconscious signal that our food is sending us now.

Mark Schatzker (00:29:55):

Here’s the thing. It’s not just artificial sweeteners and fat replaces. Those are the two big ones, which is the industry really trying to muck around with our sensory system, but there’s all sorts of other things like emulsifiers. There’s things they add to ice cream so that it doesn’t form ice crystals. Well that’s good if you want to get a longer shelf life out of ice cream, but it also adds the creaminess to it and this was noticed decades ago. So of course they’re going to use more of that if it makes it taste more creamy. They put things in chocolate milk, for example, so that it doesn’t separate into the chocolate in the milk because that’s unsightly, nobody wants to buy that.

Mark Schatzker (00:30:26):

So there’s all sorts of things they add into food. They put stuff in microwave pizza so that you don’t get this puddle forming when you microwave it. These are called modified starches. There’s a massive industry in modified starches. I call them stealth carbs because they are carbohydrates that have no flavor. They’re just there to perform a functional role in a processed food. So you’re putting these calories in your body and you can’t really sense them as they go in.

Mark Schatzker (00:30:50):

We’ve been so divorced from the importance of the sensory aspects of food that everyone thinks it’s no big deal because nutrition starts with nutrients in the gut being diffused in the body. That’s not how it works. The mouth and the nose, that is the gateway, that is where it all starts and we’ve ignored it, we think it doesn’t matter, and I’m saying it’s actually the most important part of nutrition.

Dr. Casey Means (00:31:12):

Yeah, I think it can be perplexing because we think like, “Oh.” We live in this environment now of such crazy food abundance. It’s everywhere. You go into the grocery store, you’re just surrounded. In most grocery stores, the shelves are full and shiny and all this stuff. So it’s like, “Okay, that’s the problem.” But to really start seeing your perspective of that’s not the problem, there’s too much food around, it’s what’s happening to our brains in that the way that food is processed is actually signaling to our brain when we eat it that there’s actually uncertainty and there’s potentially a survival risk because.

Mark Schatzker (00:31:57):


Dr. Casey Means (00:31:57):

And that is just such a different paradigm that makes so much sense, and also I think, gets at this insatiable desire that we have. It makes sense that this is getting at this deep, visceral dopamine survival like neuro circuitry because like you said, when you look at the brain scans, it’s not actually generating maybe that much pleasure, and yet we are literally killing ourselves by eating so much of it. So to unlock this new way of looking things of like this is actually the survival brain being hijacked in a sense and then utilizing the dopamine reward pathways essentially to co-opt us, it puts a lot of the puzzle pieces together, I think in a really new and interesting way.

Dr. Casey Means (00:32:52):

I think also so much of what I think about and focus on as a physician and with what we’re doing with our audience and members at levels is fundamentally trying to move people towards eating a more thoughtfully grown, whole foods, unprocessed diet and have a better relationship with this incredible miraculous substance that creates our body and also dictates the functioning of our body, but motivating people to eat whole foods, it can be challenging, but I think understanding truly why unprocessed foods are actually what it’s physiologically doing to our brain, I think is a new level of motivation and understanding of why it’s important that could really have a huge impact if people could really adopt and incorporate this message that you’re talking about.

Dr. Casey Means (00:33:47):

So I’m very grateful for you putting this out there. I just think it’s all about… we think a lot about empowerment at levels and how do we empower people to live their healthiest lives? And I definitely believe that empowerment starts with understanding the reality of what’s going on and this is a whole, I think, broader reality. Why do you think that this perspective hasn’t really made it to the mainstream conversation? You’re bringing it to the forefront, but why do you think we’ve been lacking in having this understanding of our brains and what’s happening to our brains with processed food?

Mark Schatzker (00:34:19):

It’s a really good question because it seems clear to me and it’s been something that it’s like it was calling to me and certainly I talked to a lot of scientists about this and I think slowly the consensus will start to move in this direction, but I think it’s because part of the problem is that as North Americans, we are suspicious of pleasure. We think pleasure’s a bad thing. And there’s a big mistake we’re making, is that we’re conflating addiction with pleasure and we think that things that taste good are actually addictive. This is wrong.

Mark Schatzker (00:34:47):

Maybe the most important aspect of addiction is that pleasure is gone. When heroin addicts talk about using heroin or alcoholics talk about alcohol using alcohol, they seized by cravings for it as when they’re in the grip of the craving, they were convinced that it will bring them pleasure, but it no longer delivers pleasure and I think that’s important because we talk about whole foods and I agree, I think whole foods are the way to go, but there’s almost this idea that, “Oh, that’s boring.” It’s like going to church, community service.

Mark Schatzker (00:35:22):

The food that nature creates is the most delicious of all. Frito Lay and Pepsi and Coke, they don’t have anything on Mother nature if you’re going to talk about a strawberry or peach or an amazing steak or mushrooms or something like that, but we’ve been so conditioned to think of healthy eating as boring, like it’s going to suck. It’s going to taste terrible, and I think that’s part of the problem.

Mark Schatzker (00:35:41):

What’s so interesting to me is that when you look at the food cultures that have the highest standards for food, the three I think of are Italy, South Korea, and Japan. These are countries that where the food is of an incredibly high quality and they are very picky about what they eat. They are in far better shape in terms of obesity and metabolic health than we are. So I think that’s telling us something really important that we’re getting wrong, that food needs to taste good. Food tasting good naturally is not a bad thing, it’s a very good thing.

Dr. Casey Means (00:36:11):

Yeah, I’d love to chat a little bit more about the Italians, because you get into the Italians quite a bit in the book and when you look at the rates of global obesity, of course U.S. is right at the top by a huge, huge gap in between the other charts and then you’ve got Italy much lower down with only about 10% obesity, and then South Korea is way, way, way at the bottom near Japan, with like 3% or so obesity. So these are also modernized industrialized countries with tons of access to any particular product they want. So what is going on? Where did the trajectories go awry between the U.S. and these other countries that love food, are super modernized and yet have a fraction of the obesity that we do?

Mark Schatzker (00:37:02):

So I focused on Italy because Italy is a western culture. There’s many Italian immigrants in North America and I love South Korean and Japan, but I think they’re culturally more different. So I really focused on Italy and the most interested thing about Italy is I think it really explodes one of the myths about food, which is that delicious food takes us to a bad place.

Mark Schatzker (00:37:24):

Northern Italians… Italian cuisine is famous. Northern Italians in particular. The city of Bologna is where I really focused Bologna sounds like bologna or bologna. Well that’s where we get that kind of famous, maybe infamous luncheon meat, it comes from Bologna. There they call it mortadella. I would say it’s a finer creation. There’s a little more of a crafted artisanal product. But one of the biggest differences between the mortadella you get in Bologna and the bologna you find in supermarket shelves here is in Italy you see these cubes of white fat. They are not afraid of eating fat and Bologna.

Mark Schatzker (00:37:59):

They are obsessed with food. They have a repository in their chamber of commerce where they keep an official list of recipes that if you want to make something like lasagna, this is how you make lasagna. If you want to make tortellini, which is that wonderful little dumping that’s filled with pork and prosciutto and Parmesan cheese, this is how you make it and it must be served in a broth made with a farmyard chicken. They are really fastidious about it.

Mark Schatzker (00:38:22):

They have these two religious orders. One is the Brotherhood of the tagliatella. This is their favorite noodle. It’s made with the two nutrients we’ve been living in fear of, carbs and fats. It’s made with eggs and flour and they make this just fantastic noodle, which they use with their famous ragu in the Bolognese. This is not the Mediterranean diet, this is not fish, this is not olive oil, this is pork, cream, pasta, butter. It’s really rich food. Well, you’d think if rich, delicious food is what makes us fat, then the Northern Italians should be the absolute plumpest in the Western world.

Mark Schatzker (00:38:56):

What is so stunning is that not only are Italians thinner by a long shot than North Americans. Northern Italians are skinnier than Southern Italians. The rate of obesity in Northern Italy is less than 8%. The NHANES survey has been measuring obesity in the United States since the early sixties, it’s never been that low. As far as we’ve been measuring, we haven’t been as skinny as Northern Italians and they’re eating this absolutely fantastic, rich, delicious, amazing diet. It’s so good that people travel by plane loads just to eat what they’re eating.

Mark Schatzker (00:39:26):

So on the one hand I think this is actually really hopeful. It’s like, okay, so it actually is possible to literally not have your cake, have an amazing cake, have the world’s best cake and eat it too. That’s really exciting. But then I wanted to understand, okay, so what’s going on? What is it that makes Northern Italy different from us?

Mark Schatzker (00:39:42):

So I started to turn back the pages of history and what I found is at one time Northern Italy wasn’t so much different as it was similar, similar specifically to the American South. This is going back a little over a century ago and in Northern Italy there was an epidemic raging called pellagra. That word we get from an Italian dialect, it literally means rough skin, and the disease of rough skin started usually with farmers, farmers’ wives. It would start with a skin scale on their hand. It’d start in the spring, it would kind of go away later in the summer, but then it would return the next year and eventually it would overtake their whole body. Their hands would become these hideous appendages. They would get diarrhea, they would become demented and confused and eventually they would die. And they had no idea what was causing this. They thought maybe it had to do with if you live too close to a river, some people said there’s these spores that get into your blood and they ignite or it has to do with eating rotten food. It’s hilarious some of these old time medical explanations from centuries past.

Mark Schatzker (00:40:42):

Well in 1904, pellagra suddenly pops up in Georgia and just like in Italy, it’s an epidemic, it starts to spread from state to state and the American scientist, it’s very much reminiscent of our obesity debate because there’s all these experts and they’re just pounding their fists on the table saying that they have the answer. Some say it’s clearly a disease of infection, it’s like a virus or a bacteria. Some say it’s spread by flies. There was a sand fly contingent, there was a mosquito contingent, they would argue with each other.

Mark Schatzker (00:41:10):

Then one day this epidemiologist named Joseph Goldberger gets sent to a sanatorium Tennessee and everyone thinks this guy is nuts because he is like, “Don’t clean up the puke on the floor, don’t change the bedsheets. Keep everything as it is. I just want these people to eat different food.” And they started eating beans and cheese and milk and everyone’s like, “This guy is the total lunatic.” And it works. He gets there in the fall, by the spring there’s one case of pellagra left, but nobody believes him. No one believes him.

Mark Schatzker (00:41:39):

So then he goes to a prison in Mississippi and he creates pellagra. He gets permission from the governor. He says, “If I can do this experiment on these prisoners, will you let them go free?” He’s like, “Yeah. Okay.” So he gives them what’s called the pellagra diet. They’re eating a diet of grits, which is corn meal, which is what the Italians were eating, polenta, pork fat and molasses and he induces pellagra.

Mark Schatzker (00:42:02):

So eventually people start to realize that this guy knows what’s going on and this was led to a very important discovery, which is that of vitamins. Goldberger wasn’t the only one, but this research helped us understand that food isn’t just food, that there are vital elements within food that are necessary for the continuation of life, and if you don’t get these elements, you die. Well, early on they were called vital amines, we now called them vitamins. And where things get really interesting is if you look at how the American government responded to pellagra and how the Italian government did.

Mark Schatzker (00:42:33):

The American government did what you’d think you do. They put on their lab coat and they said, “If people need niacin, well, let’s just give them niacin. Let’s put niacin in white bread. Everybody eats white bread, let’s put niacin in white bread and let’s just not do niacin, let’s also do thiamin and riboflavin, and those are also two important B vitamins. Let’s also do iron.”

Mark Schatzker (00:42:50):

So that’s called enrichment and it started with white bread and then it spread to pasta. Now it’s in everything. It’s in donuts, it’s in basically all our processed carbs, also in breakfast cereals and it worked beautifully. Pellagra just like, poof, gone, just fell off a cliff. Over in Italy the response was almost like medieval. They could have added niacin to polenta, but they didn’t. They said, “We should bake bread and communal ovens, and you know what poor people should do? They should raise rabbits because rabbits are really economical form of meat,” and some people say, “Well, if you have pellagra, you know what you should do? Is you should have a glass of red wine,” which is so Italian, it’s so funny. Are you going to tell this person, they have a nutritional deficiency and you’re saying, “Have a glass of veno.” It actually wasn’t bad advice though. Not that anybody knew it, but the wines back then weren’t well filtered, they had lots of yeast and yeast is just super loaded with niacin. So actually, if you got pellagra, go get yourself a glass of red wine a hundred years ago, really good idea.

Mark Schatzker (00:43:53):

Here’s what’s also interesting. The Italian method also worked. It didn’t work as quick, but Italy literally ate its way out of a nutritional epidemic. Well now, let’s just fast forward the clock to the present because these two regions could not be more different. Northern Italy is the seat of Italian culture, fashion, Ferrari, Maserati. Northern Italy is this amazing place and the food is incredible. The American South, it graduated from one nutritional disaster to another. What was once upon a time, the pellagra belt is now the obesity belt. It’s also called the diabetes belt.

Mark Schatzker (00:44:29):

So if you look at the Southern U.S., it really confirms our deepest fear about food, which is that you’re either going to starve or you’re going to eat yourself to death, but Northern Italy says, “No, actually you can have this great relationship with food.” So then I ask this question, “Could enrichment have had something to do with this? Could putting vitamins in processed carbs there something to do with this?” I’ll be the first to say this sounds totally wacky. We’ve had every theory of obesity in the world, except now all of a sudden this idiot is coming along saying it’s vitamins? How dumb is this? There’s no calories and vitamins, right? There’s not any single calorie. You can have one ton of vitamin C, there’s no calories. So what could the connection be?

Mark Schatzker (00:45:10):

Well, here’s where things get interesting. Remember that diet that Joseph Goldberger created in that prison? What were they eating? They were eating grits, which is corn meal, pork fat and molasses, carbs, fat and sugar. It’s really hard to imagine a more calorie dense diet, yet these people were literally starving. How is that possible? Well, what that tells us is that our concept of calories equaling energy is wrong. We think of calories it’s like putting gas in your car or plugging your phone into the wall socket to get energy. Calories don’t equal energy because for the energy and calories to be released, they have to be metabolized and to be metabolized, you need certain vitamins, certain B vitamins like niacin, like thiamin like riboflavin.

Mark Schatzker (00:45:57):

Where things get really interesting and where I really became convinced is when I looked at pig farming in the 1950s, because this is where things really start to come together. The goal of the pig farmer is to get pigs big and fat as quick as possible. The faster they can turn over their pigs, the more money they can make. Well, back in the early 1950s, pig farmers knew if you want to get your pig big and fat really quickly, what do you do? You give them a diet of corn with some soy, that just packs in the pounds. But if that’s all you give them, they die. Their hair starts to fall out, they get diarrhea, they crater, they lose weight and they’re basically getting something like a pig version of pellagra. They knew that the diet was unbalanced. They didn’t really know why, but they said it’s really important to send your pigs out to pasture where they would munch on alfalfa.

Mark Schatzker (00:46:46):

So back then all pigs were pastured pork. That’s trendy and more expensive now, but that’s the way all pork was once upon a time. They knew that alfalfa was essential to balance the diet. Well the discovery of vitamins changed everything. We talk about K-Phos and confinement farming, vitamins made that possible because now you could take your pigs, you could crowd them all together in a barn and give them that rocket fuel feed of corn and soy and then dust in these B vitamins. They didn’t need to eat alfalfa anymore. And now their rate of gain just took off.

Mark Schatzker (00:47:17):

I found pamphlets from the University of Iowa from the late 1950s that would say the pig has a reasonable ability to balance its own diet, but there’s now a better way. There was now optimal weight gain. What was that? It was giving pigs corn and soy with the B vitamins dusted in. Well this is great. If you want to get your pigs big and fat quickly, that’s the way to go, but the problem we have as humans is that we get big and fat too quickly. And what did we did to our diet? We did something that resembles a whole lot about what we did to the pig diet and the chicken diet and the cow diet, the confinement diet, which is to give them processed carbs and dump in the B vitamins and they will get big and fat super quick.

Dr. Casey Means (00:47:59):

Oh my gosh, it’s so interesting. So many fascinating elements of it. One, is that it’s like good intentions gone awry. It’s like this seemed, I could totally see at the time when we’re fighting pellagra that like, “Oh, let’s enrich our flour and these staples and maybe it’ll help,” and to think that we’re now, I don’t know, 50-100 years later, whatever it is, and we are essentially potentially paying the price for this and it’s so hard to dig our way out. It’s just really, really fascinating to hear the full story.

Dr. Casey Means (00:48:37):

One thing that definitely got me head scratching during this part of the book was just reflecting on something I talk about a lot with the metabolic health, our community, which is the importance of micronutrients for optimal metabolism. And something I’ve said on many podcasts is that when I go to the grocery store, I’m on a micronutrient hunt. Micronutrients being vitamins, minerals, antioxidants, et cetera, that serve multiple functions. They can be lock and key cofactors for enzymatic process in the body, they can access antioxidants, they can be incorporated into proteins like selenoproteins, things like that and how all these things are really important for ourselves to function properly, and so just how important it is to get those. And then still trying to work through how to balance that with… and essentially saying for our metabolic machinery to function properly, we need proper micronutrients.

Dr. Casey Means (00:49:39):

We’re also living in this funny time right now while we are fortifying food with some vitamins, our whole foods are becoming less micronutrient dense as our soil becomes depleted and our farming practice has become worse in our mono cropping agriculture, and the average American is deficient in at least one key micronutrient. So that seems to me, in my mind, to be a big problem related to the fact that we’re not eating diverse omnivorous, nutrient dense whole foods and we’re stripping a lot of our foods of different things.

Dr. Casey Means (00:50:11):

So I’m trying to put this together in my head of how enriching foods with B vitamins or with these vitamins is actually helping our body much more quickly store it as fat versus this other reality that’s happening where people are becoming in some way vitamin or micronutrient depleted because of our processed food diet and our poor soil. How do you think through those different things going on?

Mark Schatzker (00:50:36):

Yes, I was tortured by the same thought and I thought a lot about it.

Dr. Casey Means (00:50:40):

Help me.

Mark Schatzker (00:50:42):

So let’s talk about it first in a philosophical level because what is so interesting is if you look at the American approach, the Italian approach, the American approach was to say, “We’re dumb. We don’t know what’s good for us and food is by its very nature, incomplete because it doesn’t always have what we need. So we will take the godlike hand of science to intervene and we’re going to put in food what doggone it, needs to be in there.” And the Italians, they took a very different approach. They didn’t see food as the problem. They saw food as the cure. They said that, “The problem with these poor farmers is they can’t afford good food.” That’s why they said grow rabbits. It’s like, “You need to eat meat, you need to drink wine, you need to eat all these good things.” It seems it has this folksy kind of old world quality, but they were right.

Mark Schatzker (00:51:23):

Here’s what the difference is. It comes down to complexity and simplicity. Nature is complex. Whole foods, there are so many compounds in whole foods. We talk about ingredient list being long. If you look at the ingredient list of strawberries or all the compounds in a strawberry, it be from here to the moon.

Dr. Casey Means (00:51:39):


Mark Schatzker (00:51:39):

Tens of thousands of compounds.

Dr. Casey Means (00:51:41):


Mark Schatzker (00:51:41):

The idea that we could enrich food to make it healthier it’s well intended. The problem is we are simplifiers, we just do a handful of things that we think are important. We can’t come anywhere close to achieving the complexity in the ones that nature does. This is why I’m such a critic of things like plant-based meat because there may come a time when we can equal the complexity of nature and create food that communicates with our body the same way actual food does, but we are so far away from that, and part of that is because of our reduction as simplistic thinking.

Mark Schatzker (00:52:15):

So when we do things like enrich and fortify food, we’re not really trying to mimic the complexity of nature. People say that we enrich food to replace what’s lost in processing, that’s not true. The nutrient profile that’s lost in processing is nothing like what we add in enrichment. When we think of all the vitamins and minerals we need, not to mention all the phytochemicals, the antioxidants, all that stuff, the stuff that companies are dumping into Rice Krispies or Multi Grain Cheerios is nothing like what you actually see in a plant, it’s not even a vague resemblance. And one of the reasons companies do this is because unfortunately they have the advantage that most of us just don’t know a great deal about nutrition. So a parent looks at the side of the cereal box and say, “Well, look at all those vitamins. This must be healthy.” So what we’re getting wrong is it’s just not in the right amount, not the right diversity, not the right nuance and it’s tilted a certain way.

Mark Schatzker (00:53:08):

I think an interesting thing is a lot of people say that there’s too many empty calories in our food. If you think of something like sodas, well that is empty calories, that’s just sugar. But what’s really interesting, if we were really eating this empty calorie diet, we’d be just like those southerners, we’d have pellagra. So clearly we’re getting the vitamins we need to process those calories into fat. But I agree that I don’t think we’re getting a truly nourishing diet. I think it’s lacking in all sorts of ways.

Mark Schatzker (00:53:36):

So we’ve just sort of torqued it in this way and this way, but the diet we’ve created by doing that in no way fills in or can, in any way, equal what nature does when nature creates food. Maybe one day we’ll do that, but we’re not doing it now. I don’t even think we’re trying, to be honest. I think it’s a quick fix that’s meant to make people think food is healthier than it is.

Dr. Casey Means (00:54:00):

So I’d love to shift gears and talk about potential solutions here and some actionable things that people can do because it can seem pretty overwhelming.

Mark Schatzker (00:54:11):


Dr. Casey Means (00:54:11):

Our motivation circuitry at the most fundamental level is being hijacked by our food environment and whatnot. So I would love to talk about a vision that you see for moving forward and what we can learn from other cultures and what is your personal framework for how we should be approaching our diet and our food? Let’s maybe start with talking on the individual level and then maybe we can also secondarily touch on a systems level.

Mark Schatzker (00:54:42):

Well, I think the important thing is everybody’s after a quick fix and there is no quick fix. We’ve gotten ourselves into a bad place with food. It’s taken time, it’s going to take us time to get out of that bad place. I think on an individual level, I’m one of those very lucky people, I eat what I want and I maintain a healthy body weight. I don’t diet. I weigh myself and one day it’s a couple pounds up and one day it’s a couple pounds down, but I realize how lucky I am, but the relationship I have with food should be the normal relationship everybody has with food. So the question is how do you get back to that? I think one of the things to do when people say eat whole foods, eat real food, eat foods that your grandmother would recognize, that’s true, that’s not wrong. But what I would add to that is eat an Italian. Eating food isn’t doing community service. Nourishing the body isn’t meant to be boring or painful, it’s meant to be joyful. Food tastes good for a reason because it’s providing nourishment.

Mark Schatzker (00:55:40):

So every meal should be an opportunity to indulge and enjoy what nature gives us, but in eating an Italian, that means valuing food the way Italians do, which is honoring the goodness that we get from the land and the sea. Italians have all these funny food rules that if you want to call a San Marzano tomato a San Marzano tomato, it must be a certain type of tomato grown in a certain place. The reason they’re saying that is because that’s their guarantee of quality because we know when we grow this tomato, this variety here, it tastes really good. They have all sorts of rules all over the place.

Mark Schatzker (00:56:12):

We’re nothing like that. I think things are improving. Like you can look at things that we’re developing more sophisticated wine palate or you look at the growth of artisanal cheeses or craft beers, things are getting better, but we have to really make a big deal over flavor and celebrate it and be willing to spend a little bit more money on food that really does taste good the right way, not by cheating.

Mark Schatzker (00:56:35):

What I often tell people to do, this will sound weird, eat food that tastes like what it is. If you actually start to look at what’s in the ingredient list, you see things like artificial flavors and natural flavors, you see artificial sweeteners and fat replaces. These are foods that are engineered to create a flavor image that deviates from what they’re sending to your stomach. So eat food that tastes like what it actually is and I think that is doing your brain a big flavor and you’re just going to find by doing that you’re just eating foods that are automatically healthier.

Mark Schatzker (00:57:03):

I think also we have to develop a more sophisticated language about pleasure. I visited a clinic in Germany. I spent some time with a scientist there named Anja Hilbert, and she does what’s called hedonic therapy. That just means pleasure therapy. Hedonics means pleasure in sciences and she let me take part in this therapy and it was so interesting because it really made me realize how our brain can respond in two different ways to foods.

Mark Schatzker (00:57:26):

So one of the first things she did, this was an exercise in making me experience this wanting circuit, this craving circuit that can take us to a back place and she started with a bag potato chips. It was cheese and onion flavored. And she said, “Look at the bag, Look at the picture,” and she’s like, “Open it,” and it makes this pop and there’s this whoosh of aroma. She’s like, “Just smell it. Just inhale it deeply,” and then she said, “Take out two chips,” and she said, “You can nibble them but you can’t munch them.” She said, “You can sniff them,” and then she said, “Rub them together.” I thought, “That’s weird,” but I rubbed the chips together and it was really odd. I was absolutely seized by an almost angry desire, like I really wanted to eat those chips.

Mark Schatzker (00:58:04):

And then she said, “Throw them out. Throw them in the garbage.” I was like, “Are you crazy?” These two beautiful potato chips, I threw them out and then I took these two new beautiful pristine potato chips. I did it again and this craving is washed over me, like I really wanted to eat this so badly. I’m someone who has a good relationship with the food, but I was brought to this place of total craving. It was anger, I really wanted these chips.

Mark Schatzker (00:58:25):

Well then now we did a different experiment and this was opening my experience at my inner mind’s eye to the pleasure circuit, which is different than dopamine. Dopamine is craving, dopamine is desire. Pleasure is mediated by the opioid neurochemicals. This is true pleasure.

Mark Schatzker (00:58:43):

She gave me this little square of dark chocolate and she said, “Just put it in your mouth and just let it start to melt,” and nothing really happened at first, it was like, “Ah, whatever,” and then there’s just this little warmth and this cocoa aroma just starts to fill my mouth and then it starts to melt and then the drop was turned into a pool and then I crunched through this biscuit center and this was such a different experience because a few minutes earlier I was like hopped up, I was aggressive, everything was going quickly, and all of a sudden everything’s going slowly and I’m like the passenger in a boat and this chocolates taking me on a journey. And that is what true pleasure is. And I think we know that because there’s a reason we call junk food junk food because we know on an intuitive level, “This is crap. This is taking me to a bad place.”

Mark Schatzker (00:59:24):

I think of potato chips, everyone eats potato chips. No one ever talks about this legendary bag of potato chips they had on their honeymoon or their first trip to France. We talk about other things. We talk about mushrooms or great steak or great soup or great place of wine and that is how food is meant to pleasure us, and when food pleasures us in that way, I think it communicates to our body in a different way. But here’s what is so interesting about Anja Hilbert’s research. She has patients with binge eating disorder and these people are absolutely consumed by cravings. They eat themselves to the point where it’s painful in the stomach there’s so much food. Well when they get these cravings to stuff their faces, she says, “Just take a really fine chocolate and let it melt in your mouth,” and what she’s found is that the pleasure that chocolate can deliver can extinguish the craving. So I think that’s telling us something, that when you choose to eat food that delivers true pleasure, you start to develop a different relationship with food.

Dr. Casey Means (01:00:22):

Would you say that food that delivers true pleasure is going to be more beautifully grown natural foods filled with all the phytochemicals that are supposed to be in there.

Mark Schatzker (01:00:35):

Yes, I would say that.

Dr. Casey Means (01:00:36):

What would be defined as food that generates pleasure?

Mark Schatzker (01:00:40):

I would say in my experience, if I had to think of an example, I think dark chocolate is a really good example. I talked to one of Anja Hilbert’s patients actually, and she said dark chocolate was a transformative food for her because she didn’t like it at first, she found it bitter, but then she started to eat it and she started to develop a taste for it and then one day she put a square of milk chocolate in her mouth. She’s like, “I can’t believe I was ever eating this. It’s just so sickly sweet.”

Mark Schatzker (01:01:02):

She said the other thing with dark chocolate is you just can’t eat it too quickly. You would never stuff your face with dark chocolate. It’s something that is meant to be slow and slowly savored and you talk about things being beautifully grown. I would agree with that, not because out of some kind of snobbish sort talk about tarwar and rare this and rare that. It’s just that when food is beautifully grown, there’s a complexity that our brains can perceive in food and that’s what we’re perceiving and that’s why the Italians care about the way their tomatoes taste and they care about the varieties of grapes because they know that’s where the real joy is. So yes, I would agree with that.

Dr. Casey Means (01:01:39):

Yeah, it really resonates with my own personal food journey over the years. I was very, very overweight in my early teenage years and I ultimately was able to lose a lot of weight and really keep it off through learning how to cook and learning about food and moving away from the standard American diet towards really more of a, I would say, unprocessed diet but also appreciating food more. When I was in college, what really got me fascinated with the biosciences was the study of nutrigenomics. So how food compounds changed gene expression and I think it fed into what you’re talking about, which is a sense of awe and reverence for what food can do.

Dr. Casey Means (01:02:24):

So it was this journey that was a combination of wanting to lose weight and then for me that was learning how to cook and learning how to actually prepare foods and engaging with foods so much more than I had as a child where you’re just wolfing down food and it was slower and took more time and I appreciated the food more because I was actually cooking it, coupled with this more science based sense of awe over the power of food and what it can actually do and that together really set me personally up for a long term sustainably positive relationship with food where, what struck me so much, and I think it’s so easy to say when you’re at this place and it’s harder to, because I’ve been on both sides of this, I know how severe craving can be.

Dr. Casey Means (01:03:11):

I’ve been there. As a child I literally hid Nutella containers in my closet. So I get it very much, but now I just would never… I have no risk for that right now and I think it is really what you talk about, which is that pleasure has overcome that in a lot of ways, to the extent where now I really think about and dream about more healthy foods like a cauliflower rice stir fry. I’m like, “Oh god, that sounds so good. I love to eat that,” or something that I’ve really taken an hour to cook or something like that.

Dr. Casey Means (01:03:47):

I used to think, before reading your book actually, that I changed somehow the dopamine reward circuitry in my brain to want healthy food now. So I have a reward pathway or a motivation pathway towards healthy food, but what I kind of hear you saying is that it might actually be more that the pleasure associated with that stuff, which maybe is more opioid driven or something like that, is actually stifling some of the other cravings that could be there and less so that I’ve replaced one craving with another. Is that… how do you think through that?

Mark Schatzker (01:04:22):

I think it’s both. I think you do kind of overwrite those cravings because it’s like you do get hungry, you do want to eat. And I’m similar to you, I remember as a teen I’d crave crappy pizza or McDonald’s or something and that’s just gone for me now.

Dr. Casey Means (01:04:33):

Yeah, sensation, yeah.

Mark Schatzker (01:04:33):

It’s foreign to me and if I’m stuck in an airport and I eat that, rarely when that happens I’m just like, “Wow. This is just hot grease. There’s just nothing there.” I was actually really proud today. My daughter got braces and she said, “Daddy, can you make chicken soup?” And I was like, “Oh, I’m really busy. I got a podcast I got to prepare,” and then so I found a can of Campbell soup. She’s like, “No, no, I don’t want that. I want you to make chicken soup,” and I’m like, “You know, you’re right.” So I made her chicken soup and she followed along with me and we got herbs out of the garden and we got a shiitake mushroom because that adds this beautiful kind of [inaudible 01:05:08] and I thought, “This is great.” I’m not trying to congratulate myself as a parent or anything like that, but I was like, “This is how you do it,” and I’m glad she caught me. She didn’t let me take the easy way out.

Mark Schatzker (01:05:16):

I think what’s also really interesting is that people don’t realize the degree of processing. When you start to know what to look for. Some of these [inaudible 01:05:27] they have names like carrageenan. That’s actually, I think it’s an algae or something, I can’t remember, I get them confused. People don’t realize how much is going on. They’re actually putting these things in cream now. If you look at the whipped cream topping you get on coffees and things like that, everyone thinks it’s whipped cream, it’s not… Well, most of the time it’s not. It’s these confected fake whip creams that have fewer calories in them. So it’s really everywhere in the food environment. I don’t want to be one of these weirdos that it’s like if it didn’t come out of your garden, don’t eat it, but it does frighten me when I see my kids are up against.

Mark Schatzker (01:06:02):

My other daughter brought home an energy drink from Starbucks. It was mismatched, it had sugar and it also, I think it had sucralose in it, so it was a Dana small experiment. It also had 200% of, I think it was vitamin B6, and I’m sitting there going, “Why would anybody need 200%?” Nobody does. But in our silly way we think, “Well if 100 percent is good, 200%… This is an energy drink, this must be really good. It’s packed with nutrients,” and this is just the way we’re designing foods that really screw things up. So I think it’s more important than ever to just as simple as it is, eat real food.

Dr. Casey Means (01:06:37):

Oh my gosh. The part of your book around all this stuff that’s put in our food was mind blowing. You’ve touched on it a bit in this episode, to make something taste like fat, we’re actually using microparticles of protein globs, you talk about-

Mark Schatzker (01:06:50):

Yeah, that’s a good one.

Dr. Casey Means (01:06:51):

Ugh. it’s revolting but like that-

Mark Schatzker (01:06:55):

It is. No, but here’s the best part. So that’s a product called Simplesse. And I’m Canadian, that was discovered here in Canada. It was a scientist working for a brewery. This is, I think, it’s 1978. He tried to turn whey, that’s that liquid that’s left over when you make cheese, you got your curd that becomes the cheese and you got this liquid. He tried to turn the whey into a gelatin and he got this styrofoam thing that sort of tasted like cream cheese. That was eventually sold to NutraSweet and they marketed, I think in 1988, as a product called Simplesse, and what it was is a micro particulate protein, tiny little balls of protein that were just tickling the tongue, which created this experience of fat even though it wasn’t fat.

Mark Schatzker (01:07:34):

Here’s what’s interesting. When they put this stuff in a product, if you look at the ingredient label, you don’t see micro particular protein. You don’t see the word Simplesse. You’ll see whey protein or milk protein. That doesn’t sound bad, right?

Dr. Casey Means (01:07:46):

It sounds benign, yeah.

Mark Schatzker (01:07:48):

It just sounds like, “Oh this is concentrated milk. That sounds great.” So that’s just one of the ways that… Here’s the other thing. Scientists aren’t studying that. I talk to all these sensory scientists who are study artificial sweeteners. They don’t know about fat replacers because they’ve also been fooled because the fat replacer industry has been really smart. They just lurk in the shadows. They put this stuff in your food, but they give it all these nice sounding names so people don’t realize that this stuff is getting put now in everything because it brings the calorie count down.

Mark Schatzker (01:08:17):

It’s odd, but one of the reasons this is happening is because the new nutritional info panels, everyone turns over the package, they see calories, they’re always picking the one that has fewer calories. So the companies are saying, “Well we’ve got a lower calories. Let’s use artificial sweeteners, let’s use fat replacers, they bring that calorie count down.” Every time we do this we’re just baking in uncertainty into our food. So it’s really… it spread it, which I think is the scariest thing for me.

Dr. Casey Means (01:08:40):

Oof. I love that just by baking in uncertainty into our food with these replacers and ultra processing, we’re literally driving our motivation to eat more. I just think that’s so fascinating. Okay, a couple wrap up questions for you. The first is still one of these other things I’m still working through, which is this concept with the Italians. They eat a lot of pasta and you talk about pasta a lot in the book and ravioli and pasta is not found in nature. It’s a ground grain and water and maybe egg and stuff like that. It’s a combination food. The brain, I would assume, doesn’t really know or is able to predict what that’s going to do to the body. So how do you look at something like that? Like technically a somewhat processed food that Italians seem to be doing fine with, how does that fit as not causing some sort of mismatch situation because how does the brain even know what something like pasta or bread actually is or is supposed to be in terms of nutrients?

Mark Schatzker (01:09:50):

Yeah, it’s a great question and the answer is it doesn’t initially. When you’re born it doesn’t… Well, actually you’re subject to flavors in amniotic fluid, so maybe it does a little bit. It’s very complex. But the truth is we’re not born with a hardwired kind of menu of things. We have a brain that’s capable of learning. So the brain learns what pasta is and it learns that it contains carbohydrate and it learns that it contains, if you’re eating Italian pasta, that it might contain some fat and it’s really smart that way. The Italian pasta isn’t enriched or fortified, so that’s also a big difference. But here’s the difference. Pasta tastes like what it is. So it’s not trying to fool you and like I said, the Italian version isn’t torqued with B vitamins the way ours is. You could say the same thing about rice noodles in Japan. Caveman didn’t eat rice. Caveman certainly didn’t eat sushi. But I like sushi and I don’t think it’s driving people into a bad relationship with food the way processed foods are.

Mark Schatzker (01:10:53):

I think there’s an important distinction between processing and ultra processing. All foods are to some degree processed.

Dr. Casey Means (01:10:58):


Mark Schatzker (01:10:58):

Raisins are processed, right?

Dr. Casey Means (01:10:59):


Mark Schatzker (01:11:00):

Wine is a processed food.

Dr. Casey Means (01:11:01):


Mark Schatzker (01:11:03):

When you cook food, you’re processing it.

Dr. Casey Means (01:11:05):


Mark Schatzker (01:11:06):

People say that where things are a problem is when sense nutrition deviates from actual nutrition and you don’t see that in something like pasta. What you taste is what you get, if you’re eating real pasta and that’s the pasta you grew up with as a child and stuff like that. It’s when you start to tinker with things and start to try to fool the brain, I think that’s where we get into trouble.

Dr. Casey Means (01:11:27):

It’s when we try to fool the brain. So it’s like if you took a pasta and added some flavorings or cut out some element to decarb or who knows? Just like [inaudible 01:11:41]

Mark Schatzker (01:11:40):

Yeah exactly. If you created some pasta that-

Dr. Casey Means (01:11:43):

Low carb, yeah.

Mark Schatzker (01:11:44):

… had the flavor and sensory experience of pasta, but half the calories, I think that would be a bad idea.

Dr. Casey Means (01:11:49):

Yeah, that makes a lot of sense. Very interesting. And I guess the same would be true of bread because there’s so many different varieties of bread at this point. We’ve got what bread used to be, which is flour and water and salt and then we’ve got what bread is now, which you mention in the book, there’s a lot of breads now that literally have sugar and sucralose in them.

Mark Schatzker (01:12:09):


Dr. Casey Means (01:12:09):

We’ve got all these modifying things in there and it’s just, oh, it’s 15 ingredients. So it’s actually quite a liberating point, I think, because I think some people are like, “Oh gosh, can I never eat pasta again? Can I never eat bread again?” And I think what I’m hearing is to really focus on simplicity of ingredients and quality and nothing that’s fake or fooling in the product is a really good start in terms of how you shape your diet.

Mark Schatzker (01:12:39):

Yeah. Absolutely.

Dr. Casey Means (01:12:41):

Yeah. Very interesting. So in terms of practical tips, I think one thing that I’m hearing is for people… because I think people, and a lot of what we hear from our community is like, “Where do I start? What’s the first step? I am eating a lot of this stuff and I do have a huge craving for it, so what am I supposed to do? I’m not just going to become a whole foods regeneratively grown meat person tomorrow, so where do you start?” And what I’m hearing, one tip I heard you say was that maybe take something like dark chocolate or some really gorgeous strawberry or beautiful heirloom tomato from the farmer’s market and sit with it and just as almost an experience, put it in your mouth and just chew it, let it melt, whatever, and just start to engage with some of those pathways. Is that a technique that people should do?

Mark Schatzker (01:13:28):

Yeah, I would say it is. I think the palate can change. I used to drink soft drinks like most teens did. I used to drink Coke. I drink it now and it’s just like bubbly syrup and I’m like, “I can’t believe I ever drank this.” So I think the palate can change. It takes time.

Mark Schatzker (01:13:43):

I’ll say, the funny thing with me is this all started for me with wanting to eat good food. This is not a nutrition thing for me. I mean I guess it is, but the way this started for me was I wrote a book about steak. That’s where it started. I love to eat steak. I love to eat good food. Right now that the plums are in season, the nectarines are in season, I’m in heaven. It’s so delicious. Nature can pleasure us in a way that the food companies, they’re centuries away from doing what nature can do.

Dr. Casey Means (01:14:09):

Yeah. I think the baby steps to get there are so helpful and you give some of those in the book, which I think is really, really helpful. For me slowing down, you talk about in the book, really experiencing meals. I think trying to build in cooking into our lives can help with that because you start to have a bit of a more complete sensory experience with food, so even if it’s cooking something really simple I think can be-

Mark Schatzker (01:14:33):

Yeah. Well, and the other thing too is people are afraid of cooking. So the one thing I’ll say, I love to cook. You’re going to screw up, don’t beat yourself up if you screw up. No dishes ever perfect. My wife’s always like, “Oh you’re so critical.” It’s like, I’m not critical, it’s just every time you cook something, you learn something new about that dish, so I’m always making notes and all that. People shouldn’t be afraid to cook because you’re probably going to screw it up your first time.

Dr. Casey Means (01:14:52):


Mark Schatzker (01:14:53):

And if you have a dinner party, don’t cook something you’ve never cooked before for a dinner party.

Dr. Casey Means (01:14:58):

Good life lesson right there.

Mark Schatzker (01:14:59):

[inaudible 01:14:59]

Dr. Casey Means (01:15:00):

Okay, lightning round. Last three things. I would love to hear a yay or nay of what you think about them. I think I know the answer to a couple of them. So people taking vitamins, yay or nay?

Mark Schatzker (01:15:15):

I would say unless your doctor has told you. Like some people, for example, aren’t very good, as they get older, they don’t absorb vitamin B12 efficiently, so they get a blood test. It’s like your B12 levels are low. If your doctor told you to take B12, take B12. But just to go and buy vitamins and take them? Nay. No, get your vitamins from food, that’s where they should come from.

Dr. Casey Means (01:15:35):

Okay. And what if people are eating a very ultra processed diet where really they’re just getting the B vitamins and the fortified vitamins, but they might not be getting any zinc, selenium, manganese, chromium, choline, what about that situation?

Mark Schatzker (01:15:48):

I think they should, if they realize that, that the solution is to change their diet, and I don’t think taking vitamins is a wise course of action.

Dr. Casey Means (01:15:58):

Very interesting.

Mark Schatzker (01:16:01):

I also don’t think there’s any evidence that shows that vitamin supplements… There’s some evidence I talk about in the book that especially with pregnant women, that vitamin supplements could actually be contributing to the fact that so many pregnant women have difficulty losing the weight that they gain in pregnancy.

Dr. Casey Means (01:16:15):

That was super interesting.

Mark Schatzker (01:16:17):

Yeah, no it’s really… Here’s the thing. Vitamins are the forest elves of nutrition. They always do good, they’re pure and wonderful. Nothing is that simple. You can poison yourself with water. We have antioxidants because oxygen, which is necessary for respiration, also can cause cellular damage. So biochemistry is all very complex.

Dr. Casey Means (01:16:43):

It is. Yeah, I think there’s very specific type of supplementation that there is some clinical backing for, but I think again, it’s in conversation with the doctor, for instance, for hypothyroidism, like 200 micrograms of supplemented selenium has been shown for certain patients with autoimmune [inaudible 01:17:00]

Mark Schatzker (01:17:00):

I have no issue with that at all.

Dr. Casey Means (01:17:03):

Yeah, but it’s just what you’re talking about, that’s a clinically indicated discussion. You’re using a potentially therapeutic or super therapeutic level to drive a particular outcome, but that’s interesting. Two is alternative meats. So things like Beyond Burger, Impossible Burger?

Mark Schatzker (01:17:28):

Hard no. That to me is the absolute apotheosis of this kind of North American approach that we can do better than nature. And these are foods, their entire purpose is to fool you. We’re taking something and trying to make you think it tastes like something that it isn’t. So on some level I think it’s well intended, but I don’t think it’s the way to go.

Mark Schatzker (01:17:49):

The other thing is I don’t like people calling them plant based because it makes it sound as though they have all the things in plants that make plants good. The fiber, the micronutrients, the phytochemicals, they have none of that. If plant-based meat is plant-based, Coca-Cola is plant-based, Doritos are plant-based, potato chips are plant-based. I think it’s misleading people.

Dr. Casey Means (01:18:08):

Yeah. There’s a company that’s trying to fight back against this called Actual Veggies, which it’s in the exact same container as the Impossible and Beyond, like very similar packaging, down to the shape of the plastic insert. but it’s literally just organic vegetables that have been basically blended together and nothing else. I think the binder is flax seed or something. So anyways, still not a whole food, but certainly trying to do something a little different than this idea of Beyond Burger as if it’s something better than what nature could [inaudible 01:18:40].

Mark Schatzker (01:18:40):

Exactly. Yeah.

Dr. Casey Means (01:18:43):

Okay, last one. The entire category of non-nutritive sweeteners. So just like non-nutritive sweeteners as an umbrella term, yay or nay?

Mark Schatzker (01:18:54):


Dr. Casey Means (01:18:56):

Yeah. So this is one that I know our listeners are going to be really interested in. So I would love your take on this. A lot of people will talk about that aspartame, sucralose, sugar alcohols, what else? Some of them are essentially worse offenders than others and then you often hear monk fruit, stevia and allulose being put in a category of these are actually better and okay because they don’t seem to cause an insulin response, they don’t seem to perturb the microbiome, they don’t seem to change digestive or satiety hormones. But after reading your book, I’m like, “I can’t imagine Mark’s going to say that these make sense because they’re a total nutritive mismatch situation.” So do you see a difference within the category or from your perspective, is it they’re all a problem because of the way they fool the body?

Mark Schatzker (01:19:47):

Well, I think anytime you’re trying to pull a fast one on your brain, it’s probably not going to work out. Yes, these things are different. There was just a study that came out a couple days ago in Cell that looked at the microbiome and I think they looked at aspartame, sucralose, stevia, and maybe there was one other, and they had had different effects, but they all had an effect.

Mark Schatzker (01:20:11):

I guess the other thing is if you look at the RCTs, a lot of the RCTs, they don’t look that bad. But here’s the thing, they never look that good either. They seem to show that people lose like a half a pound or a pound. You’re like, “Come on, it’s nothing.” I think it’s the wrong direction to go. I think the direction to go is in real food. And if you have a tortured relationship with sweet foods, maybe just get away from them from a while and reintroduce yourself to sweet fruit and things that are kind of sweet the old fashioned way and repair your palate rather than to further deceive it. That would be my approach. Yeah.

Dr. Casey Means (01:20:48):

Yeah. Okay. Well, any last final words of wisdom or anything else you’d like to share that we did not cover on this podcast?

Mark Schatzker (01:20:56):

No. Wow, we covered a lot. So I guess I would say it, we’ve gotten to this point where food is almost like a poison, and I think food can be so wonderful. It nourishes us and it pleasures us and I think we can get back to that. So I think there’s reason to be hopeful and I think we can get back to a good place.

Dr. Casey Means (01:21:11):

I love that. Where can people find you?

Mark Schatzker (01:21:14):

I’m on Twitter, I’m on Instagram. I’m not all that active on social media. I think the reason I wrote books is because if you have an important message, there’s a lot to it, a book is the best way to express it. So I would encourage people to read the books and if they ever want to reach out to me on any social media platform, they’re welcome to.