Gary Taubes - 'The Quality of Calories: Competing paradigms of obesity pathogenesis'

thank you it's it's a real pleasure to be in Australia although I have to say every time I come here I get too sick so if I make those kind of sounds and when you're sitting on an airplane and the person next to you is sick and it drives you crazy just bear with me okay um let me give you just a little bit more of my background cuz um so I was a journalist I'm not a doctor I'm not a PhD I was I have a hard science background in physics and engineering and then I I learned at the beginning I started as a science journalist and I learned that there's terrible science out there just like there's terrible plumbing and terrible doctors and terrible tailors there are also some pretty bad scientists you don't know what they're doing and the scientists if they're not checked can infect an entire field so my first two books were about physicists and then chemists who discovered non-existent fundamental phenomena and I became obsessed with this question of how hard it is to do science right and how easy it is to get the right answer and I had a lot of fans in the physics community and after my second book the physicists my second book was called bad science and my physicist friends said if you're fascinated with bad science you should look at this stuff in public health it's terrible so I I moved into public health in the early 1990s and it was indeed as bad everything I had learned about how rigorous and methodical and critical and skeptical you have to be to even have a reasonable chance of getting the right answer in public health were considered luxuries didn't have time to do because people are dying out there and we have to act so by the late 90s I stumbled into nutrition um my first piece was on dietary salt and high blood pressure I spent nine months on this one article for the journal science I interviewed 85 researchers for one article and read all the relevant literature and while I was doing that one of the worst scientists I ever interviewed in my life and I thought I interviewed like the worst one of the five worst took credit not just for getting Americans to eat less fat but getting us our less salt but getting us on the low-fat diet as well and I literally got off the phone with this guy and I called my editor it's ion's and I said this is clearly one of the worst how you can tell a bad scientist if you're in the business just like if you're a reader you can tell a bad writer I said one of the worst scientists have ever interview just took credit for getting us eat this low-fat diet we've all been eating and I don't know what the story is but I'm gonna pursue it because if this guy was involved in any substantial way I know there's a story there yeah the method I had learned in the 80s from my physicist friends with a good time bad scientists never get the right answer it's just too hard to do and so I spent a year on that article and then I moved into obesity and everything that's followed um that's a set up so let me disclosures I get book royalties honorary and CrossFit movement the athletic movement supports me for reasons I don't quite understand but I'm grateful um no it's great they want to make people healthy athletically healthy nutritionally healthy intellectually healthy and so they've been supporting a lot of us the context is you know we talk about this like diets and we get confused and we think you know the arguments in the press or should you be on a low-carb diet or a low-fat diet but there is a much more profound context which is what Margaret Chan the former director-general of the World Health Organization of famous 2016 address called the slow-motion disaster of obesity and diabetes epidemics worldwide so these epidemics manifests themselves in every virtually every population in the world when they transition from whatever their indigenous diets are to Western diets and lifestyles and it tells us that there's something about these diets and lifestyles that are a B so genic and diabetes enik so in 1974 is Jan pointed out 105 million adults worldwide robeast and by 2014 40 years later the number had increased six-fold and it's probably doubled since then and was more interesting than this to me in this lecture which was so the National Academy of Sciences in the night States she gave a probability of keeping a bad situation from getting much worse to what she meant by that is a probability that health organizations like her own would not be able to reverse this epidemic but just curb it slow it down keep it stable and her answer was virtually zero she was predicting with almost complete certainty total failure into the future and with a scenario like this if this was any epidemic other epidemic situation where you would want is people saying to the public health you would want the public health authorities saying to themselves maybe we don't understand this disease state maybe there's something about obesity and diabetes that we got wrong you know if this was HIV and AIDS and you discover the HIV virus in 1984 and you can't curb the spread of the disease and the incidence increases six-fold in 40 years if people would be saying maybe it's not the HIV virus maybe we missed something right so this is what rod was talking about as a journalist I stumbled into this and I started basically being the person who said let's assess the underlying assumptions and I had a bias which was I knew these people didn't know how to do good science you know because they had I had been steeped in these bad scientists and then Nina ty Schultz came along after me asking the same questions with the same basic lack of bias going in we didn't have a you know a horse this race we just wanted to know what the truth is and we had a the journalists skepticism that maybe people screw up because people screw up all the time so the key thing here is this question what is it that causes obesity what's the you know and we've had this conventional wisdom now the fundamental cause of obesity and overweight sin energy and balance between calories consumed and calories expended and the medical community towards starts we know it's not that simple but the reality is they don't they'll talk about multifactorial complex diseases and they'll put up graphs with arrows going everywhere the society and such economic factors and personal factors and this is 2017 The Endocrine Society scientific statement was co-authored by more than a half a dozen researchers it was 31 pages long from a thermodynamic perspective it is clear that obesity is generally the consequence of small cumulative imbalances of energy and taken expenditure okay it's an energy balance disorders the phrase you hear in the medical literature calories in greater than calories out we overeat that's the biblical terms would be gluttony and sloth and a lot of the researchers by the way out there I would say virtually all of the research in the field is aimed at trying to figure out why we overeat so I don't try to figure out as rod said why somebody might have an affinity for accumulating fat and someone else doesn't they try to figure out why somebody has an affinity for eating too much or not being able to say no to doughnuts and somebody else does and it's a fundamental this is the Newton's law of obesity okay and this is what this hypothesis looks like too much food too little physical activity causes overeating energy and greater than energy and the result is the obesity and the obesity epidemic it's also the root of all fat shaming a lot of you said you lost a lot of weight right and so you're a heavier and the implication for why you were heavier is cuz you ate more and exercise less than your lean friends okay didn't matter how much you ate how little you ate or how much you exercise throughout your life the implication this hypothesis was you personally failed to be an energy balance when you're lean friends succeeded and that's the root of all fat shaming okay so Hans Krebs Nobel laureate and his memoir of his advisor otto warburg a Nobel laureate makes the same point I made he said students sometimes common that because of the enormous amount of current knowledge they have to absorb they have no time to read about the history their feel but a knowledge of the historical development of a subject is often essential for a full understanding of its present-day situation so on Thursday I gave a talk at the University of Sydney to about 50 we searchers and students and I asked them how many of them understood knew the history of their Newton's laws of obesity and not a single one raised their hand actually one did because she had read my books by the way I was from one thing I forgot to say I like to give both I think it's vitally important that we all give we pay attention to positive evidence of the negative evidence we have a tendency to only really want to pay attention to the evidence we believe when I made fun of the scientist it was the worst scientist who ever lived one of the five worst I'd ever interviewed who took credit for putting us all on a low-fat diet and he gets credit for it he celebrated his 100th birthday a few weeks ago and his mentor also lived to be over a hundred I mean you can't okay I just I forgot I wanted to say them I forgot okay so this is a hypothesis sets the point this is a hypothesis it's not chiseled on stone tablets and handed down from the mountaintop it's not a direct consequence of the laws of physics other people believe this hypothesis think it is and it has an origin and the origin is fascinating and you always have to understand the history because if you want to know what you're talking about in the subject you have to know the origin of the ideas that you're discussing and you have to know the competing hypotheses at the time because you have to know if the ideas that you've embraced were actually based on compelling evidence and what other ideas might have been based on more compelling evidence but were rejected along the way because polluting and this is always how I've approached my research you just keep going back in time so it's interesting is excuse me the birth of modern nutrition science begins in 1866 with it this machine this is a room sized calorimeter well it's a calorimeter in this case that's big enough to house a dog and a calorimeter is a device that allows you to measure oxygen consumption and co2 respiration and from that you can calculate how much energy the animal expended so a century earlier they figured out you could calculate the energy of food by burning it a bomb calorimeter and seeing how much it heats up and now they can calculate the energy expended by the animals that are eating the food and by doing so they can now measure energy in an energy out and for the next 60 70 years all of nutrition science is vitamin and mineral content protein content some discussion about insoluble carbohydrates fiber and energy and energy out calorimetry by the late 19th century early 20th century everyone is doing calorimetry that's the fad and one of the things you have to know about science in any subject is the technology available determines the questions you can ask if you can only measure one thing you can only ask a question about that one thing and you if you're good scientist you're aware that that one thing you're measuring might not be the key thing so you don't want to get locked into a hypothesis based on what you could measure because there might be other things you can't measure that are more important this is what they could measure so by the early 1900's they come up with a hypothesis promoted by carl van Norden who's a leading german authority and diabetes based on energy and and energy out they can you can't think of a way that vitamins and minerals and fiber and protein might relate to obesity but energion seems natural they've also worked out the laws of thermodynamics and this time they've determined that the laws of thermodynamics apply to humans as well as animals so more energy and so this is Van Orden statement of Newton's law this is called von Norton's law from here on n the ingestion of a quantity of food greater than that required by the body leads to an accumulation of fat to obesity should the disproportionate be continued over a considerable period okay and then Lewis Newberg comes along Lewis Newberg is a University of Michigan physiologist he is - von Norden what Huxley was - darwin if you guys know your evolution so Van Orden put this idea out and then moved back into diabetes and Lewis Newberg took it and ran with in by 1929 Newberg wrote his first paper on obesity based on studies of four people and said beyond a shadow of a doubt that obesity is caused by excessive intake of food but he acknowledged that there could be people who don't eat excessive intake so they must have a lesson to have flow of energy okay so all obese people overeat there is no hormonal and de Crenn a cause of obesity it's always taking it more food than you expend but the problem with this hypothesis is simple there's a lot of them which I'm going to discuss but the first one is once you inform an obese person that they've gotten fat by overeating why don't they adjust okay clearly all they have to do is eat less and exercise more and we'll look at the size of that effect how little they have to adjust and you have to explain that Newberg knew we had to explain that so his answer to this question why don't obese people compensate by eating less or exercising more is because they suffer from quote various human weaknesses such as overindulgence and ignorant this is one of the kindest ways Newburg put it when you read the obesity literature from the 1930s 40s and 50s with our 21st century perspective it is shocking how condescending and sexist and I don't know pick your adjective they were because they always had this problem they knew what caused obesity and they couldn't get obese people to lose weight and I put this photo of newburgh in here because I think this is how lean people naturally think okay and it's one thing I'm going to try and do in my next book which is lean shame people well because here's the thing if you're lean and you know the secret to obesity and you're lean and you you write you eat in moderation you're not the glutton and you're not slothful you exercise back then he wouldn't walk to work faithfully your assumption is if everybody did what you did they would be lean to the famous cognitive behavioral economist Richard Kahneman had a concept he called what do you see is all there is why see a day and that's how we see the universe what we see determines how we think about it that's what I meant when I said the tech ecology of available determines questions you could ask so if you're lean and you know the secret to obesity and you tell people this is what they have to do and they fail you got to explain it right so clearly they don't care as much as you do or they're not listening to you or they pick your shameful characteristic okay so he took a problem that was based in the stomach this is what this full energy balance hypothesis does and it puts the ultimate cause of the problem in the bein and all of modern obesity research all of mainstream obesity research since the 1930s has been aimed at trying to find a way to explain why obese people eat too much without actually blaming them so you blame the socioeconomic status or you blame the food industry or you blame ultra-processed foods or you blame genetics for making them not have willpower you're trying to find some way to blame us without actually fat shaming of us but it's ultimately all fat shaming so why do they believe it well because they knew that people like Falstaff had this zest for life as he ate mrs. twombly out of house and home I mean this is this is the ultimate basis of their belief and they knew that if you starved people or rats or rodents you could get lean or people or rats rodents and I had multiple of these researchers tell me there is no there were no obese people in Auschwitz again even in that late 1990s early 2000 same things that made me want to stick needles in my eyes okay so the size of the effect how small is this cumulative energy imbalance it's vitally important also in science to understand exactly what it is we're trying to explain and to quantify it if possible it's one thing to say you should eat less the question is how much less so weight management you know this it's all about balancing calories in calories out as the CDC says when back in the old days when you went to the gym and you got on the elliptical machine you looked at how many like you do like 300 or 400 calories before you even allow yourself to get off right because you were trying to balance intake to expand a turn if you were like me you went outside drank a 32 ounce bottle of Gatorade because you were soaked in sweat and never lost a pound oh yeah so that's 20 we ask the question how many calories do I have to store my fat tissue every day to gain 20 pounds of fat years so if I mean 2 pounds of fat a year 20 pounds a decade so if in my early 20s I'm lean and by my early 40s I'm obese I'm 40 pounds overweight how many calories did I store in my fat tissue that my lean friends who remained lean did not what's the difference between us so we're storing 2 pounds of fat a year and it's found the fat is roughly 3500 calories and it's a very simple calculation it's 2 pounds times 3500 calories per pound of fat divided by 365 days and the answer is every day you were storing 19 calories of fat in your fat tissue that your lean friends weren't if you gained a hundred pounds in those 40 years you were storing 50 calories a day that your lean friends were not that's the difference okay so that's this is a bite of food it's to peanuts worth of fat for olives worth of fat to gummy bears in the u.s. we had an entire obesity epidemic is 30 pounds since 1960 per capita that's about 5 calories a day that's half a gummy bear okay that's what's been stored in our fat tissue every day everything else is irrelevant that's what we want to understand why is that some people store 2 gummy birds worth of fat in their fat tissue when they eat 2,000 3,000 calories a day at the point zero zero seven percent positive energy balance Eugene I first saw this calculation done by bun Norden 1905 then Eugene Dubois was a leading authority of metabolism in the US his seminal textbook basal metabolism and health and disease this says 1936 that since I wrote this slide I got the 1926 edition it's in there he does his calculation actually does a different version uh but he says if you want to remain lean you have to be in perfect energy okay you cannot air at all because every day's air accumulates into excess fat and obesity and he says considering that fact alone there's no stranger phenomenon in the maintenance of a constant body weight under marked variation in bodily activity and food consumption how can we possibly do this by having our brain regulated and taken expenditure what is it measuring and by the way people think they they'll give you answers but they don't think in terms of how small this effect is the ideas were hormones like ghrelin and NP YY and leptin are singling to our brain how much fat we have and how much fat we're eating and then they're telling our body how much to expend to balance it out further shortcomings okay there are a lot of shortcomings it's not that first is genetics okay we've known forever that obesity is a large genetic component it was first documented in the 1930s by a austrian research arm to discuss or the the twin on the right is the pair of identical twins on the right are clearly obese and on the left hip lean para knee our energy balance hypothesis might tell us why the obese pair have a BMI over 30 because they ate too much but it tells us nothing about why the thigh they have the identical bodies okay right identical twins don't just have the same faces if they're raised in the same environment they have almost the identical bodies I mean they have the identical bodies if they're raised separately and adoption studies and almost identical bodies so what is it about our bodies that make us store fat in very specific ways that are independent of how much reading or exercising there are sexual variations and by the way I apologize for these photos these are from pre World War 2 European textbooks because the pre World War 2 European researchers thought it was very important to understand and really care that much why rats got fat so they didn't have pictures of fat rats they wondered why humans got fat and the one when you want to know something about a subject you want to know everything about that subject so they wanted to know when they got fat and where they got fat and actually having pictures in case studies they considered valuable because then they could start explaining um you know singular case ism from singular cases they could always forget if it's induce or deduced what's going on and general so men and women fatten differently okay men get fat above the waist women get fat below the ways the guy who got fat above the waist here doubled his risk of heart disease but our calories in calories out energy imbalance that has nothing about why this happens why did this guy get fat above the waist and why did he double his risk of heart disease when she didn't we need a theory that can explain that you can think of it as a theory of adiposity of fat accumulation rather than just obesity because if it's fat accumulation we want to know the where's and the when's of it as well as the whys if it's obesity you just want to know if somebody is a BMI over 30 so puberty is another example boys and girls enter puberty with roughly the same amount of body fat they both get bigger through puberty they both grow taller they both eat us out of house and home the boys lose fat and gain muscle or at least they used to and the girls gain fat and they gained fan very specific places okay and by the time the girls get out of puberty they have 50% more fat on their bodies than the boys do so puberty for a woman is in a deep oceanic phenomena if it stimulates fat formation and stimulates fat formation or very specific place where for men it's the opposite so clearly we know this is driven by sex hormones and they knew this a hundred years ago and if sex hormones are determining where and how you put on fat and muscle maybe they're determining how and where you put on too much fat or too little muscle so energy balance this is the key this is a mistake that was made that still stuns me I mean I cannot believe this and yet I've been writing about it for 20 years energy balance is a tautology not a hypothesis so what that means what a tautology is is circular logic okay so let me give you this example of circular logic why do we get fat because we're overeating that's what the hypothesis tells us the problem is there's nothing you can measure to tell someone they're overeating so how do you know they're overeating because they're getting matter in fact if you're 50 pounds overweight and you have been 50 pounds overweight for a hundred you for 20 years or ten years you're not overeating you're in energy balance so why do we get fatter overeating how do we know we're overeating because we're getting fat and why are we getting fatter because we're overeating at infinitum there is no explanation buried in here for anything there's a tautology if someone's getting bigger they're storing taking in more energy than they expend the question is why are they getting bigger so remember this is another way to think about the fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended imagine you came to the Gold Coast not to hear talks about low carb diets but to hear how to enrich yourself and I was a famous economist and I'm gonna give a talk about wealth and wealth disparity and how to beef up your pension plans and retire here instead of and this is what I said the fundamental cause of wealth is a money imbalance between dollars our and and dollars dollars in greater than dollars out if you make more money than you spend you'll be able to retire but you got to make a lot of more money than you spend you're not just a little and I can't tell you how to do that because my hypothesis doesn't include information on why Bill Gates got rich and we didn't okay but this is the exact same logic I mean I'm turning it into a joke it is the exact same logic and in economics it's a joke you're laughed out of the room and obesity it's the only allowable explanation it's surreal what happened every time I hate every time I hear the word overeating I reach for the knitting needles okay it's not a hypothesis it is nothing and they actually use it it's very hard not to use it cuz even in myself and my colleagues you find yourself talking about excess carbohydrates what are excess carbohydrates that's when you're eating too much of them how do you know you're eating too much long because you're getting fatter right so the tautology is everywhere and one of the things I try to do rigorously is never use that phrase but it's difficult but in this case it became the baseline hi Paula assistant field so there was an alternative this is what I learned during my research I had no idea this existed until about 2003 about a year into my work so in this alternative you start with first principles it's another lesson in doing good science you know you've heard that phrase never assume it makes an ass out of you and me well in science you can't assume either so if you call B city an energy balance disorder you're assuming that you know the cause of it if you say that if you're a physician and a obese person walks into your office and you just look at them and think these people have too much fat on them they have a fat accumulation problem or access for here we could use the word excess obesity is sort of excess fat accumulation its first principles and as I'll walk you through gluttony and sloth or compensatory effects this also had a history and very powerful in German Austrian hypothesis pre-world War two the leading authorities who would have known karl von nord by the way and von Norden actually talked about this hypothesis in one of his early books and kind of dropped it kind of forgot he ever raised it as far as I could tell so Gustav von Bergman was a leading German authority in clinical internal medicine pre World War two and the most prestigious award in the German society of internal medicine at clinical medicine is he gustav von bourbon medal still today and Julius Bauer was a pioneer in the field of endocrinology and chronic disease at the University of Vienna one of the great which is one of the great universities in the world pre-world War two and if you have any friends who are austrian biologists they probably know julius bowers name it was that respected so this is how bauer put it and to understand this phrase you have to see in the second sentence in the middle there's this weird lipophilic so lipophilic means love of fat and it was a word they needed to define a characteristic that they thought was important vitally important which was you could look think of the sexual variations men get fat above the waist but the world is full of men with pot bellies who have skinny little legs okay and women get fat below the waist and the world is full of women who have you know our overweight below the waist and I'm skinny little tops and there's clearly something about the tissue itself that determines whether or not it's going to accumulate excess fat and they knew this there was a case that Vaughn Bergman wrote up about a young girl had a bad burn on the back of her hand so they took a graft of skin from her stomach and put it on the back of her hand and then she grew up to be obese and she had a huge tough - fat on this hand and none on this hand so clearly there was something about the tissue that allowed it to accumulate fat when other tissue didn't and this they described as limp Ophelia so it's just a character just like we have some parts of our body that we grow hair and other parts we don't and we don't have a word for that but we should or maybe there isn't I don't know there was a there thought was there some parts of our body where we accumulate fat and some we know and they need that term so like a malignant tumor like the fetus the uterus of the breasts of a pregnant woman the abnormal lipophilic tissue seizes on foodstuffs even in the case of undernutrition it maintains its tock and may increase it independent of the requirements of the organism a sort of Anarchy exists the adipose tissue lives for itself and does not fit into the precisely regulated management of the whole organism a lipoma test subject may die of starvation and still remain lymphoma tests that's how they phrase it so some people are more lipophilic than others that's what he means by lipoma tests and we don't know what just is some tissues on when just as some people are hairier than others and we don't know what that is he didn't know what it was what was determining it but by the late 1930s his theory was catching on and required a textbook from Germany being translated into English in 1933 and once it did American thinkers could start thinking about a new bird didn't like it because he did his work in 1929 and had declared definitively that obesity was caused by eating too much so textbook comes along in 1933 that starts airing this idea Newberg's resistant but other researchers russell wilder was the leading authority on obesity and diabetes at the Mayo Clinic he said the effect after meals of withdrawing from the circulation even a little more fat than usual might well account both for the delayed of satiety and for the frequently abnormal taste for carbohydrates encounter and obese people a slight tendency in this direction remember like 20 calories a day 10 calories a day whatever profound the fact the hypothesis deserves attentive consideration and Hugo roni who was a Hungarian endocrinologist who came to the u.s. in the late 1920s and was working at I think was rush Medical School in Chicago or Northwestern wrote the first monograph on obesity in the American literature and he said it's now more or less fully accepted chiefly in Germany that was 1940 and the problem is 1940 was a very bad year particularly for German and Austrian researchers and this hypothesis vanished with the war so pre-world War two the lingua franca of medical sciences German if you want to be a serious medical research you have to at least read German ideally you speak in and have spent years studying men touring with German Austrian European researchers post-world War two the lingua franca becomes English in many fields of medical research a reconstituted from scratch by young American researchers who fought in the war America is the only country in the world that has the money to fund research the rest of the world is rebuilding and we recreate all these fields from scratch and Louis Newberg's work Louis Newberg was the American he was the only one whose ideas carried across the war and I could actually document that but the interesting thing is beginning to late 1930s researchers created animal models of obesity and in every single one of these animal models it supported this idea that obesity is a hormonal regulatory defect this picture is not one of Joel my ears might show my ear was the leading nutritionist in the u.s. in the 1960s he was at Harvard the 1950s he worked on a fad strain of mice he knew they were genetically predisposed to gain fat and he said these mice who make fat out of their food under the most unlikely circumstances even when half starved so they don't get fat because they eat too much they get fat if they eat at all and when if you remember bauer talked about independent of the nutritional state of the ant so even if you have Sardis anima every animal model of obesity shows us the researcher has to be smart enough to think okay I see the animal getting fatter and I see the animal wanting to eat a lot but what happens if I control for its overeating and I don't let it eat any more than lean animal I basically do to the animals what we did to ourselves growing up when we were 30 or 40 or however many pounds kilograms heavier and they find that the animals get fat anyway it's it's built into their genes and that's endocrinology so if obesity is a sort of excess accumulation of fat a hormonal regulatory disorder the question is what regulates fat accumulation this is what Bower didn't know he didn't have the technology to do it once again the technology allows you to ask different questions so 1960 this by the way is how held a Brook raised that same thought Hilda Brook was a leading American authority of the leading American Authority and pediatric obesity in the mid 1920s she said looking at obesity with our preconceived ideas one would assume that the main trend of research should be directed towards an examination of abnormalities that the fat metabolism since by definition excessive accumulation of fat is the underlying abnormality first principles it so happens this is the area in which police work has been done so in the nineteen 1960 Rosalyn Yalow a physicists and Solomon Burson a physician published the details of a new assay a new technology called the radium you know AHA say that for the first time in history allows researchers medical researchers to measure accurately the levels of hormones in your bloodstream yellow in 1977 wins the Nobel Prize for it and she's the Nobel person has died by then so he can't share with her and the Nobel Prize gives him credit for creating a revolution in medicine and a revolution endocrinology that passed the field of obesity research by because the obesity research by 1960 was dominated by psychiatrists and psychologists who are trying to teach fat people how to eat less okay and they didn't care about endocrinology but between 1960 in 1965 we worked out what a more moans this process of fat accumulation and it turns out to be insulin as yellow and Burson said insulin is a principal regulator of fat accumulation and inhibits fat mobilization it's a principal regulator inhibitor of fat mobilization so when you raise insulin levels you store fat that's what insulin does it's actually it's telling you lean tissue to burn carbohydrates and it's telling your fat tissue to hold on to fat and the release of fatty acids from fat cells requires only the negative stimulus of insulin deficiency that's a phrase I'm going to come back to if you want to get fat out of your fat cells according to endocrinology you got to get insulin down so this is our yellow inverse and put in 1965 this is a hypotheses we generally accept that obesity predisposes to diabetes but it's not mild diabetes predisposed to obesity since insulin is a most lipid genic agent they could have said the most lipid genic but they didn't weren't sure about that then chronic hyperinsulinism would favor the accumulation of body fat and in yellin Burson's very first paper they demonstrated that obese people in type 2 diabetes people with type 2 diabetes all had elevated insulin they identified insulin resistance and once they realize they had elevated insulin they said well if their insulin is elevated all the time they're storing fat all the time maybe that's why they're obese okay here's the key points of fat cell regulation when insulin is secreted I'd chronically elevated fat accumulates in the fat tissue when insulin levels drop that escapes from the fat tissue and the fat Depot's shrink that's textbook medicine and we secrete insulin primarily in response to the carbs in our diet that's also textbook medicine and one of the people I interviewed for this with George Cahill who did some of this work in the 50s and in 1965 co-editors 600-page American Physiological society handbook on fat tissue metabolism and I called him up in 2005 and I said look at all these things true and he said yeah carbohydrate is driving insulin is driving fat that's true and the interesting thing is so that's textbook medicine but if you take out the word is driving if carbohydrate is driving fat and now you have quackery because the calorie is a calorie we all get factors we eat too much and it doesn't matter what we eat too much up so you have something that's all textbook medicine each step along the way and you take out three words and you end up with quackery even though it's the logical equivalent here's how it looks in a textbook lenninger z' is the most authoritative biochemistry textbook in the u.s. if you go to the index and they look up fat accumulation and adipocytes which are fat cells it tells you that high blood glucose which you get from a carb rich me or being a insulin resistant elicits who release of insulin which speeds the uptake of glucose by tissues favors of storage of fuels as glycogen which is a storage form of carbs and try glycerols while inhibiting fatty acid mobilization and adipose tissue so if you want to get a fat cell fat you raise blood sugar and raise insulin if you want to make somebody fat there's a section on obesity in this book they eat more than they expend this paradigm is so powerful it's so wrong that even people who understand the biochemistry and then the chronology still think in terms of people get fat because they eat too much so here's the alternative hypothesis like any growth defect obesity is a hormonal regulatory disorder so like any growth defect if you saw somebody walking in the room it was eight feet tall you don't care how much they eat an exercise regardless of how heavy they are or thin your concern that they have a tumor in their pituitary gland that's making them over secrete growth hormone and if this person sister is only 4 feet tall full out on height you know they've got a growth hormone deficiency or a growth hormone receptor deficiency they're very simple problems ok and they could be sudden they may or may not be solvable but you know that there's one fundamental hormone and this hypothesis the same thing happens when you're getting too heavy so like type 2 diabetes and it's association it's so close to type 2 is that some people like me think of on this two sides of the same coin it's fundamentally the sort of insulin signaling there are other hormones involved sex hormones like I said glucagon growth hormone they'll all tell you something about the problem but you could get about 80 to 90 percent of the understanding by focusing on insulin and it's triggered by the carbs so it's not all carbs it's not green leafy vegetables which are actually very low in digestible carbohydrates but sweets which are half glucose have fructose of fructose is metabolized particularly in the small intestine the liver and we've made our small intestines and livers take on the job of metabolizing huge amounts of fructose all day long which they didn't evolve to do and then if my belief is that's the cause of insulin resistance that suspect you how hypothesis but if your insulin resistant you over secrete insulin to all the carbohydrates at the base of this food guide pyramid which are all the foods we were told to eat in the 1980s and 1990s because we were avoiding saturated fat so that could explain the obesity epidemic so here's a hypothesis for fine-grained starches and sugars cause dysregulation of insulin signaling excess fat accumulation of beating the obesity epidemics at very simple hypothesis the implications are interesting the conventional wisdom is that all diets arizona weight-loss news on one basis on one basis only they reduce total calorie intake and the alternative hypothesis is they do so on one basis one base only they reduce circulating insulin they create the negative stimulus of insulin deficiency and the only way to do that is restricting carbs or not eating at all which we're all pretty good with I said any of this be surprising and again the conventional wisdom into the 1960s was this farinaceous and vegetable foods are fattening and saccharine matters are especially so farah nation is old-fashioned word for starchy okay this is line like this is in virtually every medical textbook from the late 19th century through the early 20th including some of the most famous medical texts books this is a line I use in every one of my books it's from the British Journal of nutrition first sentence co-authored by one of the two leading British dietitians every woman knows that carbohydrates are fattening this is a piece of common knowledge which via nutritionists would dispute to what our medical community did with their belief that saturated fat causes heart disease and their fear of heart attacks is a transform the carbohydrate from something that was inherently believed to be fattening that every woman knew went right to her hips and they turned it into a heart-healthy diet food in the course of many of our lifetimes so when I grew up Thursday night was pasta night in my family my mother was born in Brooklyn New York and she was a Jewish but you might as well been Italian and we had wonderful pasta only on Thursday night because it was fattening by 1988 or so pasta and I was every night bagels were Sunday bagels were every day it's just how we change I mean there's a New York Times that a food writer named Jane Brody famous food writer she's still working today and her 1985 best-selling book was the good food Booker T was that subtitle was living the high carb lifestyle is fattening now we know it's a heart-healthy diet food so and then they were you could find diets I went back you can find diets in the literature dieter obesity I found five of them in the late 40s and early 50s published from Harvard Medical School Cornell Medical School Stanford Medical School Russia in Chicago and this one Raymond Green was the most that the leading endocrinologist in England in the mid 19th century mid 20th century was a brother of the novelist Graham Greene for what it's worth and this is I find this fast because foods to be they were all this variations on this but mostly there's foods to be avoided this was before understanding of insulin and fat accumulation bread cereals potatoes foods containing sugar and you could eat as much you like to the following foods meat fish birds all vegetables eggs cheese fruit except with the exception of some of the fruit this is the Atkins diet this is Kido and what I find interesting is he's not talking about of this or percentage of that the foods on the left are fattening don't eat them okay and this is a message we've haven't given anyone from the 1960s if you're predisposed to get fat these are the foods that trigger it may not be able to stop entirely there may be other hormonal influences that are but these are the foods that trigger it they are literally fattening and if they're making you fatter you will crave them and then you'll be hungrier and the other foods are not fattening you can eat as much as you want it's like you know I can eat an apple well I'm not going to eat an apple I can you know chew on a coffee stirrer and now worry about getting lung cancer I don't smoke cigarettes because cigarettes are carcinogenic that's a lousy metaphor beef I do chew on coffee stirrers because I used to smoke cigarettes okay the catch and then we're done why kedo the medical community is legitimately afraid of extreme dietary interventions okay ketosis ketones were first ketones were first identified in the urine of uncontrolled diabetics who were dying of their disease in the 19th century this scares medical researchers in any extreme intervention seems come with more risk than a more moderate intervention the first law of medicine is do no harm not do good by your patients it's do no harm so the medical community is absolutely right in being scared of our message okay so why do we believe this is necessary and maybe even unavoidable for many people so back in the 1990's 1990 a group of the University of Texas Ralph - Franz OHS team Ralph the Franz it was the only research or one of two research groups in the world that could do this measurement again the measurement is crucial what they wanted to know was how in fat accumulation fat storage and fatty acid oxidation responds to the hormone insulin so what they knew is a phrase I heard all the time that fat cells are exquisitely sensitive to insulin and what I'm going to tell you is what does that mean to be was at least sensitive to insulin that means through the whole range of fat so here's insulin going up and throughout this whole range of insulin secretion the fat responds to the insulin and holds on to fat and the lean cells respond to the insulin and burn carbohydrates so remember the insulin is in the bloodstream to tell the lean tissue to burn carbs and the fat tissue to store fat and the fat tissue even after the lean tissue becomes insulin resistant the fat tissue remains sensitive to the carbon in fact one argument is it's only when the fat tissue becomes enzyme insulin resistant itself does your weight Plateau but from here on up you're storing fat because you're burning carbohydrates so this is going down from high insulin and then you get to a threshold and it's like a switch has been flipped and many of us have experienced this in our lives when we've gone to ketogenic diets so below this point your fat tissue starts dumping fat into the bloodstream and your lean tissue starts burning it for fuel because meet that threshold you are burning fat for fuel and in theory there's no carbs in your body to burn if you're a type 1 diabetic regrettably or below that threshold all the time and that's why if you didn't take insulin you would be starving and emaciated because you'd have no insulin to secrete so the message of this is if you want to get fatter and any fat tissue below that threshold is a negative stimulus of insulin deficiency that's where you have to be in the longer in the day you're below the threshold the more fat you're burning and the less fat you're storing and you can think of it as a sort of 24-hour balance so during the day when we're eating we're above the threshold we want to be storing fat because we're going to burn it at night when we're sleeping so I don't have to get up to eat as our insulin levels go up we shorten the time that we're burning the fat and we lengthen the time they were storing and we start accumulating fat every day a little bit at the time accumulated and depending on our predisposition it could be 20 calories a day it could be 50 it could be a hundred so we have to be below that threshold the only way you really know you're below the threshold is if you're in ketosis you could be below it anyway but the sign that you're below does ketosis that's the logic for the ketogenic diet getting under that threshold and staying under that threshold if you do intermittent fasting my feeling is you're just extending the period you're under the threshold that you're burning fat whether that's you know the 18 hours a day or over the course of 48 hours so what's interesting just to tell you the end of this by the 1960s diet doctors got on to this particularly Atkins and they weren't diet doctors there were people like us who were struggling with their weight and eating less exercising more didn't help and actually did some research to see if there was something they missed and stumbled on this same science and so Atkins was the most prominent he found that he lost way when he restricted carbs he recommended to his patients he went through the same conversion experience and many of us do which of course bias the medical community against in forever and he became very popular and very rich with his book in the medical community went after not the whole medical community was a group of obesity researchers that controlled the field on the east coast of the US who tended to no Afghans so this paper was actually written by his chief resident as a cardiologist who knew Atkins and didn't like him okay and then a nutritionist at Harvard and the people at Harvard don't like to think they don't know everything it was published under the auspices of the Council on foods and nutrition the American Medical Association the Harvard nutritionist was working for them at this point is their nutritionist and it was a critique of low-carb ketogenic weight reduction regiments and it said low carbohydrate diets I'm going to read from the bottom up or bizarre concepts of nutrition that should not be promoted to the public is that they were established scientific principles and yet that is mobilized when insulin secretion diminishes and what they didn't say is that ketogenic diets low-carb guys are the ones that do the best job possible diminishing insulin secretion because that would be an argument to continue studying this and promoting it and perhaps making it mainstream so from the 1973 to the end of the decade the goal was to get rid of Atkins who they legitimately thought was killing people because he was advocating a high-fat diet so Atkins was the bathwater and the science at all the endocrinology the hormonal enzymatic regulation of fat accumulation had to be tossed out with it because if we paid attention to it you led to eating less carbs and more fat if you don't want to be overweight okay thank you [Applause]

Channel: Low Carb Down Under

Views: 73,555

Rating: 4.9005942 out of 5

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Gold Coast 2019, #LowCarbGC, Gary Taubes, We We Get Fat, The Case Against Sugar, Good Calories Bad Calories, Obesity, Low Carb High Fat, LCHF, Ketogenic Diet, Insulin Resistance, Carbohydrate Restriction, NUSI, Fat Metabolism, Hormonal Theory of Obesity, Diabesity

Id: DFY0iPmzNqU

Length: 51min 46sec (3106 seconds)

Published: Sat Nov 02 2019

Reddit Comments

[u/Ricosss]

Always fun to hear him present.. a bit of sarcasm here and there is good :)