Gary Taubes - 'The Qualities of Calories: lessons from the front line, Zurich & LCHF in practice'

thank you I want to start off by not have a black belt in Taekwondo but I was knocked unconscious boxing I may have CTE that remains to be seen okay this talk was actually written the first draft of this talk was written in Zurich at this meeting that the Swiss we hosted after we had a day-long meeting with the BMJ and I had listened to Derry dr. Moses Aryan speak and I thought in the course of this meeting he captured perfectly my thinking on nutrition he got closer than anyone else even the sort of ketogenic diet people in the world he said it's not about calories it's about sugar and refined grains right that was basically and I thought this amazing and yet you guys probably had the same experience there's so much of what he says that I disagree with and I sat down that night until about 3:00 in the morning that night was a Saturday night I was wrestling with this issue of why is it vici so close to the way we think on some things and so different from the way I think on others and put together this slide showed that I presented the next day the following fall is part of a research for my next book I interviewed a hundred plus physicians who prescribe low carb high fat diets to their patients who have converted for lack of a better word and so I got a viewpoint from the trenches so to speak from the frontline of nutrition science the people are actually stuck with trying to make their patients healthier trying to make themselves healthier so all of this is combined into this talk I'm going to give that tries to put everything in perspective to understand where we disagree and why we disagree and why it's so profound other than the bacon thing which you know he's just wrong okay my disclosures I get book royalties writing books that push people to not eating the single macronutrient I get honorariums for giving talks and CrossFit has been graciously supporting me lately um so let's just look at the state of affairs I wanted to put this also on a historical perspective so from my when I started in this field the very first article I ever wrote was for about the obesity that they for science it was 1986 1990 excuse me 1998 and at the time there were maybe a half dozen physicians in the US who were prescribing these low carb high fat ketogenic diets they were all sort of considered quacks half of them had probably written books and the authorities I interviewed at the time would acknowledge that this was a great way to lose weight and they used a diet but they thought it would kill them so you go in the diet do lose weight and then you go off the diet mean you gain the weight back and you psycho and this was sort of an the dogma at the time was that we should always low-fat calorie restrictive diet so a high-fat ketogenic diets gonna kill you if you want to lose weight you have to eat a calorie restricted diet and it's got to be low-fat to prevent heart disease I in 1998 Malcolm Gladwell wrote a piece called the Pima paradox for in The New Yorker on obesity and the obesity epidemic and it was really fascinating Malcolm almost got it right and I was gonna say the one thing that I did I came along three years later in wrote a similar piece of the New York Times magazine and want to change between 98 and 2001 and my research is I had clinical trials to look at by people like David Ludwig and Eric West men who were early adapters of carbohydrate restricted diets so when I did my research addressing the same program and when Malcolm said he said we've been told that we mustn't take in more calories when we burn that we cannot lose weight if we don't exercise but few of us are able to actually follow this advice is either our fault that the fault of the advice medical orthodoxy naturally tends towards the former position diet books tend towards the latter given how often the medical wertha Doxie has been wrong in the past that position is not in its face irrational it's worth finding out whether it's true and then what he did is he sort of did his research and bought - the medical orthodoxy I came along three years later and the first thing I did my research as I spent a few days with David Ludwig at his pediatric obesity clinic at Harvard and David's you know people at Harvard you respect them right given it's like bacon well not like bacon anyway so I had a different perspective I could be cynical and skeptical in a way that Malcolm couldn't because I had very you know academic research saying oh there's a different way to look at this and kind of agreeing with the diet books and now to tell this interesting story it talked about how diet books all have a same theme he said they have a conversion narrative in it so in this case Atkins is a conversion narrative at its finest hero dr. Atkins a humble corporate of physician as fatty begins searching for answers he tests his unorthodox views on himself as if by magic he loses weight he tests us unorthodox views on patients is it by magic they lose weight incredibly has come up with a diet that produces steady weight loss while setting no limit on the amount of food you clean I just it's dark in here so we can't really see this but how many of you in this room have had a conversion there it exactly like that like virtually everyone right and then one of my revelations was that in order to break away from a dogma you have to that Dogma has to fail you in some way and this is what I've learned interviewing these hundred physicians if your patients are getting heavier and more diabetic each year and you're telling them eat less exercise more eat mostly plants you're giving them the conventional wisdom and it's not working and they're just getting fed in the diabetes and obesity epidemics tell us it's not working there's getting fatter and more and more diabetic then you either have to blame them so you assume they're not trying which is what most of us would do there's not trying hard enough right that's where all the fat shaming comes in by the way there's from where I'm standing there's feedback and if we can get rid of that that would be nice or if the same things happening to you like Atkins if you're a humble corporate physician getting fatter you don't to be corporate and then you decide well I know I'm following my advice so maybe it's not my advice my my patients who are failing me maybe my advice is failing me and now you have a observation that is at odds with your expectation that's where science begin science begins with an observation that your expectations wouldn't have predicted so you do your homework you find a diet that seems to work it's the exact opposite of what we've been told to eat and now you try it on your patients and everything goes from there it's exactly what's happened to most of the physicians who have now come along to sort of convert to this way of thinking so if you look at the state of affairs in 2019 remember I said 1998 there may be half a dozen physicians in the country in America in thousands now maybe I'm estimating tens of thousands of physicians worldwide based on this number from Canada which is the Canadian women physicians low carb high fat Network and only women physicians their 30s almost 3,700 of them in Canada alone so if we assume there's a reasonable number of male physicians in Canada who have also converted we could estimate tens of thousands of physicians worldwide who are now eating a diet that is completely at odds and prescribing a diet that's completely at odds to what medical wertha doccy says they should do and 2017 there was this letter in the huffington post that was sort of organized by evelyn border a roy young physician in montreal it was over a hundred Canadian physicians co-signed it and this is what they said but we see in our clinics blood sugar values go down blood pressure drops chronic pain decreases or disappears lipid profiles improve inflammatory markers improve energy increases weight decreases sleep is improved IBS symptoms are lessened medication is adjusted down or even eliminated which reduces side effects for patients results we achieve with their patients are impressive and durable a phrase I heard over and over again from the canadian physicians i interviewed was they cannot unsee what they see in their patients this conversion experience is so powerful that it Trump's the dietary advice from the Health Organization's it trumps everything they've been told to do because what they're saying is I can make my patient healthy if I get him to eat this way so about three months after the Huffington Post letter comes out the US News and World Report does their annual Dietary Guidelines this is a 2009 version I've updated it but it hasn't changed much and this is the other conflict that I had in trying to write this report how can this be possible so you have a hundred plus physicians that's a lot out of it I guess you could have gotten 3,600 women co-signers if you're tried um who say look we put patients on this diet they get healthier but then you have the experts the authorities a committee of authorities for US News and report that will tell you the healthiest die in the world the best is a Mediterranean diet despite Preta men having been retracted the year that this came out then the next is - next is the flexitarian diet there are rich in fruits vegetables whole grains everything dairy thinks we should eat you do get to number 20 you get the sort of politically acceptable versions of Atkins so Atkins in South Beach are tied at 20th with the vegan diet which we have no idea of the long-term health benefits and then down at the bottom you get all the really hardcore ketogenic paleo is 33 it drops in 20 in 2018 and then Atkins Kido whole 30 and I have no idea what the body reset diet is um when you look at diets for weight loss it's the same thing Weight Watchers is number one buy you metrics and diet I do not think anyone has cared about for at least 20 years and to Barbara rolls presented it it's book is about that two million on Amazon there's number two and in the flexitarian diet um despite that he that was catching on so again we have this conflict between what the what we're being told to eat what the nutritional authorities whether they're right or wrong are telling us to eat and what's actually happening out there and recently there was this article in CNN talking about how weight watchers stock is down and Oprah Winfrey's stock in Weight Watchers is down because keto was taking it over the world and Diet doctor calm is putting them out of business and she referred to she referred to keto is the kiyose surge I love that by the way the photo I'm glad that Weight Watchers is selling calorie restricted versions of ice cream cones Vanilla Fudge where I'm assuring I am assuming they're low calorie but they probably have points okay the conventional wisdom is on the defensive oh you don't actually see it happening so like this New York Times article which is about a study that new C funded the key to weight loss is diet quality not quantity and these study finds so we're moving into this thinking that it's about quality although to question whether we're defining what we mean by quality very well but then you still get the hardcore defense and this is I just had it I don't know if you guys saw this was an article New York magazine the last conversation you ever need to have about eating right by the Yale associated nutritionists David Katz and Mark Bittman a former columnist at the New York Times and you know if there's one thing I know for sure it's that carbs are evil and all plant foods are carbohydrates so that can't be true but yeah but carbs are evil everything from lentils to lollipops are different kinds of carbs sure but I should still avoid carbs right exactly the opposite is true you cannot have a complete or healthful diet without carbs why I've been led to believe that carbs are evil because reading Gary towns on no highly processed grains and added sugars are bad so again it's a nuanced message my friend is also talking about inducing ketosis what is he talking about is that healthy there's no evidence that such diets are conducive to good health in the long runs that's an interesting point okay because we've seen evidence we have clinical observations that they're conducive to good health in the short run so that's a point we're gonna come back to and then he says they say not everything that causes weight loss or a parent metabolic improvement in the short term is a good idea cholera for instance causes weight blood sugar and blood lipids to come down that doesn't mean you want it that's the only time I've ever used an emoji in a lecture okay so what's going on here how do we make sense of this and I'm gonna give Martin and drea a physician in Vancouver South African he's working north of Vancouver I'm gonna give him credit for putting some of these thoughts in my mind and I'm embarrassed at work on this field for 20 years I didn't think about it but Martin said you know what we have here is we've been telling we're telling people to prescribe by by hypothesis we have hypotheses of what constitutes a healthy diet that'll make them live long or and then we have clinical experience I put somebody on a low-carb high-fat ketogenic diet I see them get healthier so a lot of what dr. Mirza Farion is talking about is lecture two in my mind their hypotheses about increasing the length and health span and lifespan and you don't even know if they're true I mean even if we did a randomized controlled trial you wouldn't know if would be true for you because you'll get some probabilistic estimate of whether or not this diet is a good idea that you will live long or if you eat for instance plan oils instead of animal fats and then the contrary that what you can't unsee is what happens to yourself and what happens to your clinic I cannot unsee the fact that I'm 30 pounds lighter than I used to be effortlessly okay I may be killing myself and I worry about it daily because it would be a real blow hey I am unbiased I don't know so he has a contract one of the interesting things that was happening this was actually discussed in Zurich and one of the the members of the audience accused the discussion of being hijacked by discussions of the low-carb high-fat ketogenic diet because it was discussed for about the first time ever perhaps in a a mainstream nutrition lecture so here's the conflicts based on three hypotheses the first is energy balance and its implications and I speak about a little bit differently than dr. Moses if Aryan did but this was one of the Articles that came out of the the BMJ Swiss recon furan see and you'll see at the top right of the key message is imbalance between calorie and taking calorie expenditure determines body weight and body fat changes so this is that the most informed nutrition conference in the country and the authorities still were willing Michael lean and colleagues were willing to say that this is what determines intake and expenditure this sort of nine kids not even 19 2006 about 1860 zero science so energy balance this idea has interesting implications because what it means is this it means people prio beasts people people are lean ie you know us at one time and we were young our equal to the same as lean people - the ability to remain in energy balance okay I'm in dead serious about this hypothesis means that the difference between you mean like when I was in high school my senior in high school I weighed 195 pounds I was 6 feet 2 and I played football my brother he is senior in high school weighed 195 pounds was 6 foot 4 and he played football and he never got over 195 pounds in his life whereas I went up to 240 and according to this energy balance Theory the difference between us the only measurable difference was that I couldn't control my energy balance and he could today I probably weigh 70 pounds more than him and it still says nothing about whether we're just physiologically different it just says that he could control his energy balance I can't or I couldn't so pre obese people are lean people - willpower that's what the theory that's where the fat shaming comes from and then pre obese people we equals lean people plus gluttony and sloth it depends how you want to look at it again it's all fat shaming this is the direct implication of this caloric balance idea that energy balance is determined by our intake and our expenditure so the implications for diet for obesity are fascinating ok a healthy diet minus the excess calories is what we should be eating because again we're the same as lean people plus excess calories of so plus willpower's this is where you get ideas like not too much some diet guru says 'hey not too much that's what they mean they mean you eat what healthy people eat but you eat not as much of it or not too much of it you won't get fat that's the theory so what do we mean by healthy and that's where nutritional epidemiology and its implications come in and this is where dr. Mirza Farion and I have conflicts you get studies like this from the Harvard School of Public Health both low and high carb diets can raise risk of early death I should have replaced this with the recent study showing that low claiming that low carb diets can raise risk of atrial fibrillation although what they mean is that the increased risk of atrial fibrillation and there's no causality there and then you end up with conclusions like dairy publish which is I'm going to show this sort of definition of a healthy diet I'm gonna use this to more or less define the conventional thinking it Tufts in most places on a healthy diet and their foods are good for us and foods that are not good for us and then there are some foods that we you know are in between so what's interesting is my understanding of Epidemiology and I hope we can clarify this and again this is so simple that I think it must be wrong so feel free at our discussion to explain why it's wrong I do want to ask you about this is you look and see what healthy people eat compared to what unhealthy people eat they said its simplest level and then you assume that if we all ate like the healthy people we'd be healthy too is that kind of No ok so we're going to discuss this later so because we're concerned with this sort of metabolic syndrome cluster obesity diabetes metabolic syndrome these diseases that we think of as diseases of Western diets and lifestyles that are epidemic all around the world today as our Western diet lifestyle spread all around the world we're looking at healthy people compared to people who aren't obese and aren't diabetic and don't have metabolic syndrome so that's kind of the comparison that's how I see it and the hypothesis is it foods that healthy people tend eat are better for all of us than foods and unhealthy people tend to eat and so the benefit the good foods the foods that dr. maté most of hearing defined as being good for us is you know unequivocal evidence are foods that health we know these are what healthy people eat therefore they're good for us and the foods that are at the bottom are things that we know unhealthy people eaten and then are some nuances so you end up with this kind of thinking where we're all being told to eat food mostly plants not too much because this is what healthy people do everything in moderation they send everyone in the world who's lean and healthy thinks they eat in moderation except maybe some 17 year-olds who know better but will regret it later Blue Zones look around the world find the people are the healthiest people they'll oldest living people in the world and tell us to all eat exactly like they do as though there's no difference between them and us ordinary vegan whole food vegan plant-based diets the same thing the healthy eating plate it's the same thing it's let's look at what healthy people eat and tell us all to eat that way or look at people who stayed and if we're over waiting obese eat like healthy people eat but less of it that's what we're being told by our nutritional government I think it's lean people's diet advice so many people think I eat healthy and I exercise regularly and I remain lean therefore I can tell other people to do that and they will remain lean also and what they don't understand is we are not them we are people who get fat and sick eating the foods that they eat my take on it so the conflict the ironies who needs dyin nutrition advice I don't think healthy people need it because they're already eating healthy the people who need it are us the ones who are not lean and not healthy this is what the kind of waiting rooms of many doctors in America look like today and they're people who are obese and overweight who suffer from diabetes and or getting the chronic complications of these diseases and they're not lean people so maybe they need different advice that's the hypothesis so those were the obesity diabetes hypertension etc and you can think of them and these are people that the insulin resistant hyperinsulinemia phenotype okay if we use genetic terminology what's happened in the world over the past hundred years is this huge explosion in this insulin resistant hyperinsulinemia obese diabetic hypertensive phenotype and something in the Western diets driving it these people us are not just like the lean and healthy - willpower okay we're physiologically different we respond to what we eat differently than they do that's this alternative hypothesis so the healthiest diet for this phenotype for us is a diet in which our phenotype is not manifest itself so if you can put someone on the diet whose guy has obesity or type 2 diabetes or hypertension you could change the way they eat in a way that it's not a struggle so I'm gonna roll out starving them that's probably a healthy diet so you could think of the conflict as being a conflict between the definition of a healthy diet which is what lean people eat and the diet that makes people are not lean who are not healthy healthy again which is what the conversion experience the where you end up in the you know at bins and ketogenic diet I'm an argue that that's the diet that minimizes insulin secretion and which is why ketogenic diets have become so popular you've heard me speak about the role of insulin on fat accumulation what I've never really talked about a lot is something I learned doing my research when you talk to found the tablet some researchers they would use a phrase they would say that fat cells are exquisitely sensitive to insulin okay so if you want to get fat out of fat cells if you want to mobilize fat from fat cells unamusing excess fat now is a proxy for all of this phenotype because again I think of it differently as we become you know the obesity diabetes hypertension is all manifestation of this insulin resistant hyperinsulinemia phenotype and we can see it in ourselves when we're getting fatter so that tends to be what if we can take care of the excess weight we can probably taking care of the rest of the phenotype as well so as instant levels come down it turns out that if you want to get fat out of fat cells you have to they have to see what Rosalyn Yalow the Nobel laureate called the the negative stimulus of insulin deficiency and as it turns out this was measured this negative stimulus concept was measured by Ralph de Franz och and his colleagues at UT San Antonio and de France who was in the newspapers today for taking six million dollars from industry so maybe it corrupted this study I don't know but fairness requires that I say that when incent levels drop the insulin is so sensitive that there dipa sites are so sensitive Benson that they hold onto fatty acid to anyway and you have to get bellezza threshold it's almost like a switch and if you believe beneath the threshold is you can see on the left in the in the purple circle that's below the threshold now the the dip besides dumb fatty acids into the bloodstream and the fat cells will burn alive burn them so you'll get much higher rates of fatty acid turnover which is what this is measuring and in the paper that the fronds were there's an insulin regulation of plasma free fatty acid turnover oxidation is maximally manifested low physiologic plasma insulin concentrations and they describe the most striking finding in their studies that adipose tissue is exquisitely sensitive to be an inhibitory effect of insulin on free fatty acid release so basically the whole idea of a ketogenic diet and my take which is the journalists take not the practitioner take is that if you're in ketosis you know that you're below that threshold pretty much what you have to do is be below that threshold and the longer you below that threshold more you're mobilizing fat and burning it oxidizing in the lower you're storing it so you end up with this clinical and anecdotal observation this idea that those of us who keep our insulin resistant hyperinsulinemia you know obesity hypertension cetera in remission by diet and so stay healthy do so by minimizing insulin secretion and maximizing the time we spend below that threshold prolonging the time so we end up with this conflict okay we're back to the ground so what we need to get healthy this is what those of us who follow low-carb high-fat ketogenic diets eat for the most part okay because they kid we can eat these foods and we can eat them in quantity for the most part we can eat to say tidy and we can keep our insulin low and we could not be obese and diabetic and hypertensive etc and they're not fish vegetables so these are on you know good foods yogurt cheese eggs poultry butter unprocessed red meats processed meats and high sodium foods are also included in the foods we'd because when we eat them we don't get noticeably unhealthy now there might be a prediction that I'm getting unhealthy because I'm eating too much bacon and my favorite statement on that was from Michelle plotz who had a Instagram account called eat the bacon and she was 390 pounds when she started to ketogenic diet and when she was down to two thirty one of her colleagues said expressed concern that she was eating too much bacon and she said dude you never questioned my diet when I was 380 clearly I'm healthier at 2:30 unless I've got cholera so we have two different definitions of the word healthy the diet that gets a woman like Rochelle from 380 down to 230 without being hungry that she could sustain for the rest of her life she's clearly healthy or at two-thirty and they were all others you know or I mean there anyone sees lower triglycerides are lower HS there's all kinds of signs of good health that have erupted in this person and then we have the conventional thinking which is she's killing herself by eating bacon the constituents of a healthy diet here's what healthy people eaten it's different so now you've got people eating fruits and vegetables and whole grains and beans and the ideas were supposed to eat them because they're good for us they're actually beneficial instead of removing the foods that are deleterious which is what we do in our world you add foods that are somehow good for you and then you don't eat some foods that we think are bad for us that we find that we can eat and still remain apparently healthy so the conflict is the way we can think of it as corrective or therapeutic nutrition we remove the foods that are making us unhealthy and we replace them with fats and we get healthier we see we get healthier we have this unsee phenomenon so it's hard for us that's one of the reasons why we all sound like zealots right because you go through life struggling with chronic disorders and then you change your diet and they seem to go away it seems to demand a certain amount of zealot ROI three minutes three minutes it's more Brown and the opposite is preventive nutrition and I think this is a vitally important fact that we're dealing with one night a con what dr. Moser Farion is saying is that you are trying to prevent chronic diseases and if you eat this way you will live longer and live healthier and again there are hypothesis-driven prevention nutrition so when we argue about the value of clinical trials we're arguing about the value of studies that can tell us whether this is a good gamble whether I should really change my diet in a way that I don't notice there's nothing I have to unsee I don't notice if my LDO it's down and you're telling me I'm gonna live longer but I have to take your word for it if I left in ninety I don't know if I've lived to ninety because of your diet or I would have lived to 100 if I hadn't switched my diet there's no we have no input we have no there's no way God doesn't give us the information so we have to trust the hypotheses and again a lot of our differences are about how much we're supposed to trust hypotheses so again the conflict in perspective you've got this ayah insulin-resistant hyperinsulinemia phenotype people like us who go on a particularly unhealthy version of a healthy diet and we get healthier and then you've got the healthy phenotype telling us how we should eat so what they believe and this when it comes to obesity is a very simple this is from the textbook obesity all diets that result in weight loss do so on one basis and one basis only they reduce total calorie intake our alternative fad textbook of obesity would say all diets a result in weight loss do so on one basis or one basis only they reduced total carbohydrate intake or improve the quality of the carbs consumed they lower insulin and prolonging the time we spend below the threshold so there are two fundamentally different concepts different hypotheses the reason I started new C and we have not succeeded yet is to test these different ideas and then how does it work by the alternative hypotheses fewer the carbs the longer the time between meals so carne every in them and fasting time restricted feeding all work to keep you below that threshold keep insulin low and blood sugar low and prevent this hyperinsulinemic insulin resistant phenotype from manifesting itself and the key to success and that's another talk is commitment thank you [Applause]

Channel: Low Carb Down Under

Views: 61,662

Rating: 4.8848743 out of 5

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Id: 5hGyKbsQCuk

Length: 30min 58sec (1858 seconds)

Published: Sat Mar 23 2019

Reddit Comments

[u/carmkboss]

Thanks for sharing

[u/unibball]

That was a refreshing palette cleanser after the Mozaffarian video.

[u/Swimming_in_it_]

Why are vegetable oils bad on a keto diet?

[u/TomJCharles]

Heard him on Joe Regan recently debating someone. Every time Gary would interrupt, the other guy was all like, "Gary, let me finish."

Gary takes his turn and the other guy interrupts him all the time 😂.