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Chapter 6
Primary Switch Operations
The ecosystem involves hundreds of hormones and peptide chains. The Switch has four
main drivers, covered in the chart on the next page.
The Switch’s basic jobs are to:
stimulate release of fluids that break down food into usable nutrients;
set the pace for food to pass through digestion for optimal absorption;
trigger other hormones to act in the brain, letting the body know it is in receipt of
what it can expect to be useful resources;
ready the heart muscle to receive messages telling the heart that it has useful
resources coming in;
wake up and deploy insulin, the sugar-seeking hormone, to navigate blood, pick up
sugar, and deliver it to cells for use; and
optimize hydration by contributing to the amount of sodium eliminated via urine,
sending messages to the brain to trigger thirst, assessing dehydration in the colon,
and adjusting water and electrolyte levels accordingly (to improve cellular
hydration; this can lead to dried-out stool that is harder to pass).
These functions are carried out by the big-four Switch hormones, working in
collaboration.
Here are those Switch hormones’ individual tasks, lined up with their names:
GLP-1
GLUCAGON-LIKE PEPTIDE-1
WHAT IT DOES HOW IT WORKS
GLP-1
GLUCAGON-LIKE PEPTIDE-1
WHAT IT DOES HOW IT WORKS
Switches on insulin and leptin. Down-switches
glucagon and gastric emptying, which helps set
the pace of digestion and glycemic response.
Switches off bone formation. May impact fat
type, distribution, and metabolism.
Secreted from intestinal mucosal cells on receipt
of nutrient stimuli (carbs, protein, fats). Vagus
nerve fibers in the stomach send messages that
also trigger release. Travels via bloodstream and
vagus nerve to receptors.
PYY
PEPTIDE YY
WHAT IT DOES HOW IT WORKS
Helps set the pace of digestion. Helps switch on
satiety response (feel full). Increases water and
electrolyte absorption.
Gets messages regarding arrival of calories,
especially calories in protein and fat (amino and
fatty acids) lower in the small intestine. Exercise
can increase fasting levels. Caloric load and
medications impact the amount secreted.
Travels via bloodstream to receptors.
CCK
CHOLECYSTOKININ
WHAT IT DOES HOW IT WORKS
Switches on gallbladder and pancreas to release
digestive fluids (bile, enzymes) for the
breakdown of food into nutrients.
Released when amino and fatty acids arrive in
the small intestine. Stomach acid (hydrochloric
acid, HCl) levels and acetylcholine (from vagus
nerve) impact secretion. Travels via bloodstream
and vagus nerve to receptors.
GIP
GLUCOSE-DEPENDENT INSULINOTROPIC POLYPEPTIDE
WHAT IT DOES HOW IT WORKS
GIP
GLUCOSE-DEPENDENT INSULINOTROPIC POLYPEPTIDE
WHAT IT DOES HOW IT WORKS
Switches on release of insulin and glucagon
from pancreas. Switches on bone formation.
Impacts fat metabolism and inflammation.
Released when glucose and amino and long-
chain fatty acids arrive in the small intestine.
Travels via bloodstream to receptors.
That’s where we are today. And plenty TBD. We keep learning things about the
Switch and the weight-health ecosystem including the above.
THE SHOT IS NOT THE SWITCH; HERE’S HOW THEY’RE RELATED
The Shot, a game changer in weight loss, looks a lot like the Switch: GLP-1RAs, GLP-1
agonists, and GLP-1/GIP dual and forthcoming triple plus agonists, marketed under
brand names such as Wegovy and Ozempic, and delivered in pill form as well as via
injection. The Shot is hormone replacement therapy, substituting for the Switch
hormones. It has provided benefits to millions, from better blood sugar to weight loss to
reduced inflammation to even relief from sleep apnea. Its discovery, its mass adoption,
its trials and tribulations are something bigger than what it gets attention for most often.
The success and challenges of the Shot reveal an epidemic of suboptimal Switch
function.
The Shot’s achievement is making us aware that our weight-health ecosystem and
Switch exist, and that for most of us, they could really use optimization. It’s because we
have the Switch that science could invent the Shot, and now the Shot is helping bring the
Switch into the conversation.
Whatever our relationship to the Shot, it will go down in history as the tool that
taught us about and allowed for deeper investigation into Switch function, and helped us
—me first, now you—devise a plan to optimize it now and going forward.
The big reveal within the reveal: Modern-day existence throws a whole lot at our
Switches, so much that we have an epidemic of suboptimal Switch function. This
epidemic makes Switch-hormone replacement therapy a helpful or even necessary
intervention for many of us. And it makes Switch assessment and optimization, as
indicated, mandatory for all.
The Switch-Shot relationship hinges on turning on and turning off.
Our natural Switch hormones turn on as needed, as indicated by various inputs, not
only nutrients; and they shut off pretty fast, within five minutes. The weight-health
ecosystem sends out enzymes that seek and break down the Switch hormones. It’s time
for rest-and-digest mode.
But how we live has changed, and rapid shutoff has some downsides.
The Shot’s synthetic hormones were engineered not to shut off in minutes. Or in
hours or even a day. They stay on for about a week. In the future, likely a month,
possibly longer.
Go-on-and-stay-on is the game changer. It’s what’s made the Shot heard round the
world.
What’s the trouble with quick shutoff? After all, it’s how the Switch is designed.
Let’s think of the Switch as a motion detector. A motion detector waits, alert but not
active, for a person, an animal, a robot, or any moving thing to pass. The device
receives data saying “motion” in its surroundings. It sends a message via an electronic
signal. That message triggers multiple actions:
A sound beeps or blips or rings and/or a light goes on.
A person in range of the sound or the light looks at a monitor.
Or no one reacts on site.
The device sends an alarm to the police or a security company.
By the time the reactions are happening, the initial action—motion—is often over.
There’s no longer motion out there to detect, so motion detection stops. Yet the light
stays on, the beep’s still beeping, and maybe the police are on their way.
The Switch detects food. It sends the message: “Food.” This tells our body to be
ready—to receive nutrients and for work to be done. The Switch sends those messages,
and it’s done its job. It shuts off.
That’s how the Switch was set up to work. In the highly regular and constant world
we inhabited until the industrial revolution, our weight-health ecosystem’s messaging
was in perfect sync. In that world, we hunted and caught our food, and in due course
mainly grew it; we slept and woke mostly by the rhythms of natural light; the messages
we sent and received were few, specific, and focused.
Fast-forward to today. Picture our motion detector—the Switch—with twenty-seven
dogs, three motorcycles, a trio of joggers, a drone, and a runaway hippo all charging at
it at once.
How can the motion detector send an actionable message? “All hell’s breaking
loose” is not much of an actionable message.
Modern living is subjecting our Switches to that kind of chaos.
There is nothing more chaotic than the bombardment we subject ourselves to—and
so our ecosystems—in the form of sugars and sweeteners. From recommendations
telling us to avoid all sugar to those saying replace sweeteners with nonnutritive ones,
on or off the Shot, we still impair our Switches. The results? Irresistible cravings, belly
weight, mood shifts, and energy and blood sugar challenges that so many of us battle
daily.
So here and now, let’s set the record straight on what isn’t and is better, as the sweet
stuff goes.
Sugar—being the basis of one of the three macronutrients, carbohydrate—is the
primary fuel the body is designed to run on. So optimally resourcing the ecosystem
naturally involves some nutrition in the form of sugar.
That’s a horse of a different color, though, from the inundation of added sugars and
nonnutritive sweeteners coming at us in food products, beverages, and supplements that
are engineered to cultivate a codependent relationship with the consumer.
That relationship damages our Switches and ecosystems in various ways, covered
throughout this book. While you have likely heard all you ever want to and more about
sugar’s negative impact on your body and its systems, you haven’t heard about its
impact on your ecosystem and the Switch, its regulator.
Here I will provide the CliffsNotes version and your first experiment. Later I will
go into more specifics.
Digestion + Hydration + Better Nutrition → Switch Function → Ecosystem Optimization
“I am drinking the iced tea that’s ‘just a tad sweet, and my blood sugar still goes
up?’”
“I gave up sugar and only use Brand Z nonnutritive sweetener—but I haven’t lost
any weight.”
“Ashley, can you help us with this article on which sweetener is better for anyone
trying to lose weight?”
Those are just the tip of the tip of the iceberg.
Confronting nonpersonalized recommendations that fail my patients, my MO is to
devise experiments that show them why off-the-rack recommendations are unlikely to fit
them and then to give them something that can specifically reveal what their bodies need
to run better.
At a point, I realized I had one too many patients consuming more added sugar than
was better for their bodies at the same time that I had others who were doing the same
but with nonnutritive ones. I needed a way to show them both that what matters more
isn’t a set amount of either or that one was better than another. What matters is
something more physiological: how our sweet taste buds are working and the
information they’re sending to the rest of the ecosystem. Thus, assessment of sweet taste
bud function provides us a key performance indicator of Switch and ecosystem function.
That’s how this test came together.
To start your Switch Optimization, take it now.
THE SWEET TASTE BUD TEST (AND RESET)
You will need a few bites of an apple (a quarter or two slices). With the exception of a
green Granny Smith or candied or baked apple—which are not allowed—the type does
not matter that much. If you can choose one that isn’t advertised for being super sweet,
that is better. It is more important to use the same apple type—and about the same
degree of ripeness—so your test and retest get accurate results. If you cannot consume
apples, you can use a pear instead.
Consider previous bites and sips that are sweet to you and mentally develop a scale
—from 1 to 10—where 1 is not sweet at all and 10 is very sweet, the most sweet that
you can recall.
With a neutral palate (not following recent toothbrushing, using mouthwash, or
consuming coffee, alcohol, food, gum, or mints; if you have, you can eat a few slices of
cucumber or sip on some water), take two to three bites of your apple, chewing them
thoroughly.
As you chew and experience the flavor, score your bites on your scale from 1 to 10.
On average, what do your bites score?
Results
If your apple bites are greater than a 7, then your sweet taste buds appear to be
well-aligned with the natural degree of sweetness.
If they are a 6 or less, you will want to conduct a reset and retest your apple bites
every seven to ten days until you achieve a score of 7 or greater.
The Sweet Taste Bud Reset
Remember that this is for a set period of time, not a life sentence.
Remove all sugars and sweeteners—sugars, syrups, honey, and so forth—that you
add to your food and beverages. Remove all ready-made products containing them. This
includes all nonnutritive sweeteners . . . yes, even the natural ones. If your current
supplements—including fiber and protein powders—contain sweeteners or added
sugar, work with your practitioner or make replacement choices for the duration of the
reset. You may be onto something with your sweet taste buds if you discover these as a
source!
Yes, you can have foods that have naturally occurring sugars such as fruits and
vegetables—incorporating them into your overall nutrition plan may really help you
make it through the reset! Baking or preparing fruits and vegetables with a pinch of salt
or spices such as cinnamon may help bring out their sweetness to help satisfy you.
Herbal teas that have a natural sweetness can be consumed as well.
During your reset, document and experiment with strategies to address when you
experience sweet cravings.
Are you tired? Hungry? Thirsty? Emotionally high or low? Did you consume
something high in salt? Did you have a meal or snack that had protein and fat but no
carbohydrates? Was what you ate or drank not delicious to you in the moment? Maybe a
sweet craving hit post caffeine or alcohol? Any signals from your digestion—gassy,
bloated, constipated, or loose stools? These insights will help you optimize your sweet
taste buds and your ecosystem using the discussion points and additional experiments in
the book.
Redo the Sweet Taste Bud Test after seven days and continue the reset protocol if
you are not yet a 7. When you achieve a 7, you can experiment with bringing back
choices such as added sugar and sweeteners. Informed by your insights, experiments,
and the reset experience, the amounts that you add back should help you maintain
optimal sweet taste bud function.
Retest once a quarter or when you notice you are challenged by sweet cravings.
Here’s an overview of some of the additional problems in which Switch issues and
suboptimal Switch function are implicated:
SWITCH ISSUES AND SUBOPTIMAL FUNCTION
Disease s and syndromes: Crohn’s disease, ulcerative colitis, celiac, Hashimoto’s disease, Graves’ disease,
scleroderma, rheumatoid arthritis, psoriasis, psoriatic arthritis, prediabetes, diabetes (gestational, type 1, type 2),
polycystic ovarian syndrome (PCOS), metabolic syndrome, obesity, cancer, multiple sclerosis, epilepsy, gout,
irritable bowel syndrome (IBS)
Disorders, conditions, exposures (or symptoms): leaky gut/intestinal permeability, gas, bloating,
constipation, reflux/GERD, gastritis, gastroparesis, high cholesterol, high blood pressure, migraines/frequent
headaches, small intestinal bacterial overgrowth (SIBO), H. pylori/ulcer, diverticulosis/-itis, chronic fatigue,
chronic pain (joint, back, overall body), fibromyalgia, premenstrual cramps or disorder, sleep apnea, low
testosterone/estrogen/progesterone, adrenal insufficiency, elevated cortisol, insulin or leptin resistance,
depression, anxiety, seasonal allergies, histamine intolerance, mold exposure, elevated heavy metals and toxins
(glyphosate, etc.), food allergies or intolerances
As if to make things harder for our Switches and weight-health ecosystems, we’ve
cooked up “solutions” for nonproblems and dreamed up products to satisfy invented
needs. We’ve made conveniences, desires, and whims necessities. And, of course,
we’ve repurposed sedentary living as leisure and a luxury. Which is why we need more
than a motion detector.
These days, we need a force field.
A force field wards off attacks and intrusions. Better than a motion detector, which
just alerts us to things that aren’t stationary, a force field fends off inputs and stimuli that
cause interference. This protective barrier will help you avoid the onslaught of
unrecognizable, confused, inaccurate, even batshit-crazy information—all day, every
day; at the grocery store, on social media, while dining out, and even while you sleep.
The Shot can put up a temporary force field that deflects a variety of things, mainly
calories and food noise—and deflects them hard. The force field we’ll build in
optimizing Switch function does those things and more. It stays on as long as you
continue to optimize, and it supports the whole ecosystem—a true fix that optimally
resources your body.
Now our mission vector looks like this:
Plan → Assessment → Optimization → Your Force Field = Your Best Shot
The medical, nutrition, and health-care industries, and armies of influencers, have
dished up countless plans. They’re in business to keep coming up with more. The
trouble with most plans? Not that they go wrong so much as that they go nowhere. Or
they go in circles.
Go keto.
Did it work?
No.
Okay, try vegan.
Did it work?
No.
Try fasting . . .
Try a statin.
Did those work?
No.
So try Repatha . . .
As Jay Z sings, “On to the next one.”
It’s a cascade. And the basic nature of a cascade? It goes downhill.
All these plans are different, and yet these plans are all the same in at least one way:
They’re all sold as one size fits all.
We need more than a plan. We need a mission. I learned the difference from The A-
Team. As a kid, I was hooked on it. A bunch of unlikely military pros impressively and
hilariously take on the most incredible assignments and get the job done with flair and
exaggerated drama. Based on one set of mission specs, the A-Team determines the right
tactic is to night-parachute into the jungle and catch the bad guys by complete surprise,
free the hostages, and air-extract out.
All goes per plan. Until a rocket-propelled grenade hits the plane, forcing an
emergency landing in a clearing peppered with landmines. Or until it turns out, mid-
flight, that their pilot is on the bad guys’ payroll.
So, change tactics?
No way. We’re 2,500 miles from base, over territory dense with hostiles! The
answer is to modify and tweak and torque this plan. The one we’re in the middle of
executing.
The A-Team’s commander, John “Hannibal” Smith, portrayed to deadpan perfection
by George Peppard, supplied me with one of my main mantras. Once the A-Team
secured the episode’s win, Smith reappeared, sitting or leaning back with his trademark
cigar and grin. “I love it,” he’d say, “when a plan comes together.”
When a plan comes together, it’s a mission.
Thwarting terror attacks and rescuing hostages held in steamy jungles may not seem
to have much to do with our Switch Optimization mission, but stick with me.
Here’s another thing we can learn from the A-Team: Do a situational assessment.
The assessment tells us the mission’s actions, the order, and what tools the mission calls
for. Set out on your mission and do a situational reassessment to ensure your plan comes
together.
Mission-critical equipment is key. When a force field is what you need, a motion
detector isn’t gonna cut it.