17. Why Your Diet Isn't Working (And What Actually Does)

Are you trapped in the cycle of endless dieting and calorie counting? For years, we've been told that weight loss is as simple as "calories in, calories out," but if that's true, why do so many of us still struggle? What if the problem isn't just the numbers, but how we think about them? In this episode of theExtend podcast, I take a closer look at why the traditional approach to calorie control fails—and what you can do instead. From the science behind metabolic rate to the surprising impact of ultra-processed foods on your hunger and hormones, I'm going to break down the three key levers for weight management: calorie restriction, dietary restriction, and time-restricted eating. I also reveal why most diets are destined to fail and how small, sustainable changes can transform not just your weight, but your overall health and energy levels. If you're ready to break free from ineffective methods and embrace a smarter approach, this episode is packed with insights you don't want to miss. Tune in to discover how you can not just lose weight but feel better in your own skin. We Also Discuss: (01:51-02:58) Not All Calories Are Created Equal (03:31-04:20) The Japanese Secret to Mindful Eating (06:50-07:28) Where Your Calories Go: Total Energy Expenditure (08:58-09:38) Why Diets Fail 90% of the Time (10:22-11:37) Time-Restricted Eating: Is Fasting for You? Thank You to Our Sponsors: TruNiagen: Whether you are looking to stay sharp, feel more energized or simple age better, go to https://www.truniagen.com/ Learn more about Dr. Shah: Website: https://www.drshah.com/ Clinic: https://www.next-health.com/ Instagram: https://www.instagram.com/darshanshahmd/

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:03Dr. Darshan Shah?

  Welcome to Extend with me, Dr. Darshan Shah, a podcast dedicated to cutting-edge science, research, tools, and protocols designed to help you extend your health span. Having become one of the youngest doctors in the country at the age of 21, and trained and board-certified at the Mayo Clinic, I've accumulated three decades of practice as a board-certified surgeon and longevity expert. Over that time, I've discovered that a mere 20% of health knowledge yields 80% of the results when it comes to your health span. We're living in a new era where we are creating a new healthcare system, no longer focused on disease management, but achieving optimal health and vitality. Join me as I interview world-renowned experts, offering you a step-by-step guide to proactively avoid disease, and most importantly, extend your health span.

• 0:50Dr. Darshan Shah?

  Hello, everyone, and welcome back to the Extend Podcast, where we explore the 20% of insights that drive 80% of our health, wellness, longevity, and mindset. Today, we're diving into a topic that stirs up a lot of discussion, and sometimes confusion when it comes to our health: calorie control. We often hear that controlling calories is key to weight management, but is it really as simple as calories in and calories out? And does this principle apply universally? Or are there nuances that make all the difference? So let's break it down. First, let's address the elephant in the room: is it all about the calories? The answer is both yes and no. Yes, because the laws of thermodynamics are immutable. To lose weight, you need to consume fewer calories than you burn.

• 1:35Dr. Darshan Shah?

  That's science. But no, because not all calories are created equal. The effect those calories have on your metabolism, insulin levels, and overall health depends on their source and nutrient density. For example, 200 calories from a sugary soda impact your body very differently than 200 calories from a salmon filet. One spikes your insulin and adds empty calories, while the other provides protein and omega-3s that fuel your body, stabilize your metabolism, and cause you to feel satiated. It's not just about the numbers, it's about the impact. Let's now explain. Explore the three methods that people often use to control their weight that Peter Attia actually does a really good job talking about in his book Outlive.

• 2:18Dr. Darshan Shah?

  These are calorie restriction, dietary restriction, and time restriction. Each approach has its pros and cons, and it's crucial to figure out what works best for you. As Dr. Attia says, you should always be pulling one of these levers, often pull two of these levers, and sometimes pull all three. Let's talk first about overall calorie restriction. This is the simplest understand, basically, because it's just basically just you eat less. Many people use apps like MyFitnessPal or Chronometer to track their daily intake, and these tools can be incredibly effective. The Japanese call this method of eating until you're 80% full, hara hachibu. This practice originates from Okinawan culture, which is a common saying, and is an approach to mindful eating.

• 3:03Dr. Darshan Shah?

  It encourages stopping eating before feeling completely full, which helps prevent overeating and supports better digestion and long-term health. The reality is that most Americans consume way too many calories. Did you know that the average adult in the US eats about 3,600 calories a day? That's well above the recommended levels for most people, especially considering that most people are sedentary almost all day long. Cutting down even slightly can have a significant impact on your health. The calorie restriction isn't just about eating less, it's about eating smart. Prioritizing nutrient-dense foods, so you're not just reducing calories, but also fueling your body with what it needs to thrive, is what automatically will result in less intake and more satiety.

• 3:49Dr. Darshan Shah?

  This is basically the opposite of what ultra-processed foods do. They make you more hungry because they have very poor nutrient density. So how many calories do you really need every day? And how does caloric deficit lead to weight loss? Understanding this, how many calories you need each day, really depends on your age, gender, weight, height, and activity level. Your basal metabolic rate, or BMR, the calories your body burns at rest, forms the foundation of this, which is then adjusted based On your activity level. There's a formula for this that helps you figure this out. For example, a moderately active 180-pound man might need about 2,790 calories a day,

• 4:32Dr. Darshan Shah?

  while 150-pound woman might need about 2,170 calories a day. Creating a caloric deficit, eating fewer calories than your body needs, leads to weight loss by forcing your body to use stored fat for energy. Since one pound of fat equals about 3,500 calories, a daily deficit of 500 calories can result in about losing one pound a week. However, as we talk about all the time, not all calories are created equal. A doughnut and salmon filet might have similar calorie counts, but their effects on your metabolism, hunger, and overall health are worlds apart. Also, remember that drastic deficits can backfire, so aim for a balanced gradual change that supports your long-term health goals. It's also beneficial to understand

• 5:16Dr. Darshan Shah?

  how the human body uses calories on a daily basis. This concept is called total energy expenditure. Total energy expenditure, or TEE, is a total number of calories your body burns in a day and is divided into three main components: BMR, NEAT, and TEF. First is basal metabolic rate, BMR, which accounts for the largest portion, 60 to 70%, and represents the energy used for basic functions like breathing and maintaining body temperature. You don't have much control over your BMR other than by staying active and having good overall metabolic rate.

• 5:54Dr. Darshan Shah?

  I've been dissecting the science of NAD for over three years now, and I want to tell you what I use for optimizing my own mitochondrial health. If you want to support healthy aging at a cellular level, True Niagen's NR is scientifically proven to increase NAD plus levels, a critical coenzyme for energy production and overall cellular health. It's my favorite supplement for boosting NAD+ improving how your body handles stress, optimizing your recovery, and supporting longevity. Whether you're looking to stay sharp, feel more energized, or simply age better, True Niagen NR is my go-to solution.

• 6:32Dr. Darshan Shah?

  Next, let's talk about non-exercise activity thermogenesis, or NEAT, which is about 15% of your energy expenditure. This includes calories burned through everyday activities like walking around, fidgeting, or doing chores. This is why it's incredibly important to get in those 8,000 steps a day. Finally, there's a thermic effect of food, or TEF. This is the energy required to digest, absorb, and process food. And believe it or not, this is actually 10% of your daily energy expenditure. Finally, you can add on exercise activity thermogenesis, or EAT. This refers to the calories burned through intentional exercise, such as running or lifting weights.

• 7:15Dr. Darshan Shah?

  This is the lowest portion of all caloric expenditure for most people. It's also the reason that spending countless hours on a treadmill often doesn't result in weight loss for so many people. So what's the main message here? Make sure you're staying active, take in less calories overall on a daily basis, and keep moving throughout the day. Maintain your muscle mass as a priority to have long-term fat mass control. Next, let's talk about the other method of caloric control called dietary restriction. This method involves cutting out specific types of food or food groups. Think keto, vegan, paleo. These are all different forms of just dietary restriction. At their core, they're just another way to reduce calories. For example, by eliminating carbohydrates on a keto diet,

• 7:58Dr. Darshan Shah?

  you're naturally reducing your caloric intake. Dietary restrictions can work for many people because they provide a structured framework. But they aren't a one-size-fits-all solution. The key here is sustainability. Find a dietary pattern that fits your lifestyle and aligns with your health goals. In reality, massive studies have shown that most people cannot follow a named dietary pattern for more than 12 months, and most will gain all the way back that they've initially lost. My personal feeling about named diets, as many of you might know from my previous episodes, is that I actually dislike all of them. I prefer to have my patients stick to a diet that prioritizes real food and simply pick an eating pattern that provides nutrient density while minimizing Blood glucose spikes.

• 8:42Dr. Darshan Shah?

  Lastly, let's talk about the last method called time restriction eating. Time restricted eating, often referred to as fasting, is another popular approach to control calories. The most common method of these are the sixteen eight dietary pattern. This involves eating during an eight hour window and fasting for the other sixteen hours. Research shows that time restriction, especially early time restricted feeding, where you delay breakfast and stop eating earlier in the day, can improve insulin sensitivity, metabolic health, and even inflammation. But fasting is not for everyone. For example, many women, especially postmenopausal or menopausal women, may experience hormonal and stress imbalances if they fast too long.

• 9:26Dr. Darshan Shah?

  Dr. Mindy Pels, in her book Fast Like a Girl, offers tailored strategies for women navigating fasting. Also, fasting is not ideal for pregnant or breastfeeding women and those engaged in intense training like for a marathon or triathlon. And let's not forget, inadequate protein intake during fasting can in some people lead to muscle loss, which is the opposite of what we want. So when you're fasting, please make sure you're maintaining adequate protein intake. Start with protein. As with everything in medicine, there's no universal answer. You have to experiment and see what works for you. Some tools that I have all my patients use to guide their journey are a bioimpedance scale to track their muscle mass and fat mass, a continuous glucose monitor to understand how your body reacts to different foods

• 10:11Dr. Darshan Shah?

  and different eating patterns, and also wearables to monitor factors like HRV, heart rate variability, and overall recovery as you test these methods. If you tried all the methods above, calorie restriction, dietary restriction, and time restricted eating, and nothing seems to work despite doing everything right, like exercising and getting good sleep, it might be time to consult a doctor. For some, modifying GLP-1 receptors with medications like semaglutide might be an option. These medications can help regulate appetite and metabolism for those who struggle with weight loss due to genetic or hormonal factors. So is calorie control important for overall health? Absolutely. But it's about so much Much more than just counting numbers.

• 10:52Dr. Darshan Shah?

  It's about understanding how those numbers interact with your body and your unique physiology. As always, you must always be your own best advocate. Experiment, track your progress and find out what's working for you. No one is going to care more about your own health than you do. So commit to taking personal responsibility for your caloric intake, your glucose curve, and trying different dietary patterns until you find one that works. If you enjoyed this episode, please share it with someone who might find it helpful. And don't forget to leave us a review. Your support helps us bring more health transforming conversations to light. See you next time on the Extend Podcast.

• 11:31Dr. Darshan Shah?

  Thank you so much for listening to the podcast today. Please remember to subscribe if you liked this episode and give us a good review and share a link with your friends. It really helps us support all of our efforts. I also want to remind you that the information shared on this podcast is for educational purposes only and is not intended to replace professional medical advice, diagnosis, or treatment. Please consult with your healthcare provider or physician before making any decisions or taking any action based on what you hear today, especially if you have any underlying health conditions or on any medications. Your doctor knows your personal health situation the best and it's always important to seek their guidance.