Robb Wolf - 'Will A Low Carb Diet Shorten Your Life?'

last year I ended up with food poisoning the night before giving this talk I was throwing up but both ends really were pretty pretty affected and I called dr. Gerber and I'm like hey I don't think I'm gonna be able to make it and then I've managed to rally and then I on my way walking to the talk I passed out and collapsed in the hallway got back up and managed to crawl into the the room apparently gave a phenomenal presentation I can't remember any of it literally so the fact that I actually slept well last night had no alcohol means that today is probably going to be absolutely wretched so this this talk arguably should be about two two and a half hours long we have a half hour so I'm gonna really try to boogie through this we don't have a lot of time for foreplay or cuddling so we're just gonna kind of launch right in so I've eaten a low carb diet ketogenic diet for 20 years and haven't died yet thank you we'll see you later yeah okay I I guess we probably need to give a little bit more diligence to it than that no disclosures no conflicts so do you folks remember last year when there was a pretty good buzz going around about low-carb diets are gonna shorten your life I mean everybody in their cat jumped in on this thing BBC CNN Newsweek everybody they quoted the study that really seemed pretty damning and and you know right up here at the front I have a lot of slides that contain a lot of text I try to avoid that like the plague but I'm actually pulling some really pertinent information out of these studies I'm gonna kind of glaze over some of that because you all are gonna get the slides later and you can go through someone try to provide value other than reading at you but some of the stuff just really needs to be read to you so we'll do a little bit of that but this is the the paper that came out it was published in The Lancet it was August 16 2018 dietary carbohydrate intake and mortality a prospective cohort study and meta-analysis the details on this this is basically coming from the you know how the study was put together there's this notion that low-carb diets which restrict carbohydrate in favor of increased protein or fat our popular weight loss strategies however the long terms effective carbohydrate restriction immortality is controversial apparently if dietary carbohydrate is replaced by plant-based or animal protein what might the outcomes be and I'll just this is exposing some of my own bias but I'm gonna go out on a limb and say that just that front part of this exposes some interesting biases potentially on the part of the researchers initially this study was really supposed to look at carbohydrate the protein carbohydrate fat content of the diet and then ultimately look at all cause mortality and a few other associations and then there's somewhere along the way we were going to start looking at plant-based vs. animal-based proteins and fat so it's kind of an interesting shift that occurred the way that they put this thing together they had 15,000 plus people aged 45 to 64 they completed a dietary questionnaire on enrollment and then in the atherosclerosis risk in community study they assess whether the substitution of animal or plant sources of fat and protein for carbohydrate affected all cause mortality sounds kind of cool they had this beautiful you curve which in in biology almost everything follows some sort of a you curb type distribution if we look at very low vitamin D level if we look at vitamin D in general very low levels tend to correlate with morbidity and mortality very high levels tend to correlate with morbidity and mortality and might actually know ok sorry guys so there's supposed to be this low add at approximately 50% of dietary intake of carbohydrates and then if you're very very low carbohydrate in theory then you're all cause mortality is dramatically increased it's a much flatter curve you can eat up to and Beyond 80% of your total caloric needs from carbohydrates in theory according to this study but have a much lower risk of all-cause mortality a in theory this actually looks a lot like the the curve that was produced in the sodium study in heart patients which is also an interesting study which presented the case that too low sodium was actually a much higher risk factor and more dangerous than too high of sodium so it's flatter on the on the increasing intake in theory with carbohydrate but when you really get in and dig into the details of this research it's a little bit perplexing and when these things pop up the folks in in the community we kind of get on an email chain and they're like are you gonna take this bullet are you gonna take this bullet yeah you know like who's gonna jump in and take the the week or month out of their life to fully unpack this stuff and and try to do something with it and Chris Kresser ended up drawing the short straw initially on this quite a few people jumped into this but Chris was kind of the one he's like okay I'll tackle this one so when Chris really jumped in and looked at this it was fascinating the subject diets were only assessed twice throughout a 25-year period separated by an interval of six years and it was a food frequency questionnaire which we're gonna dig into that a little bit more later and you know Gary Tops has been making the case for 20 years effectively that the research that comes out of these food frequency questionnaire are at best questionable and probably so misleading as to be worthless but that's kind of a another another topic and probably will be you know addressed later but again the study that got picked up by every media outlet on the planet was based around a food frequency questionnaire that was administered twice over a 25-year period and they actually didn't administer it over part of a 12-year section of that 25 year period so this is what we're hanging our hats on with this stuff if you want to read a really phenomenal take down on that Chris crecer did that and it's the same thing will low carb diets shorten your life Chris cress or do a little search on that and you can find massive amount of detail but something that was really interesting that was missed is in the exact same Journal on the exact same publishing date was this article also in the lancet evolving evidence about diet and health and this is where I'll have to do a bit of reading to you folks and I apologize for that but dr. Yusef if you I really do encourage folks to read thoroughly both of these studies are actually quite accessible this one in particular so if you look at Lancet dr. Yusef or evolving evidence about diet and health and again you guys will get all these slides after the conference but from dr. Yusuf's comment nutrition research initially focused entirely on conditions of deficiency but by the 1950s with the increase in coronary heart disease in the high-income countries attention shifted to a range of so-called diet heart hypotheses you guys were all familiar with that who's at the cornerstone of that story until Keyes sure sure these included the putative and harmful effects of fats especially saturated fats and the protective effects of so-called Mediterranean diets to explain why individuals in the US Northern Europe and UK were more prone to coronary heart disease some of the initial studies were enormously influential while undergoing limited scrutiny as to the rigor of their methods the lack of replication these early claims should have prompted caution and re-examination of whether fats especially saturated fats were indeed harmful so not really not surprising stuff to this audience right but again this is interesting all none of not a single news outlet covered any of this piece which appeared in the same issue of the original publication suggesting that low-carb diets are going to shorten your life based on first principles that you shaped association is logical between most essential nutrients versus health outcomes although carbohydrates are not technically an essential nutrient unlike protein and fats and then it goes on a little bit to talk about well I don't know maybe when you exercise unique carbs but I think that we're pretty well steeped in the idea that that's generally not true and if you do need some it's probably not all that much in a very targeted fashion and whatnot but really making the kind of poking holes in this notion that there's any substance to this you curve that's been derived trying to suggest that low-carb diets are going to shorten one's life the findings in the meta-analysis should be interpreted with caution given that so-called group thinking can lead to biases in what is published from observational studies and the use of analytical approaches to produce findings that fit in with current thinking basically you can lie damn lie and statistic your way to any type of outcome you want particularly in these kinds of epidemiological research scenarios so again you know this you curve is really compelling and also again there the authors are trying to make this case that when we get below at or below 20% of calories coming from carbohydrates according to their study which is a food frequency questionnaire collected twice over a 25-year period that there's something really injurious that we're going to experience in this but wait when I was looking at this I was kind of reflecting on a lot of the research that has been done and in a much more rigorous fashion and it was interesting because I just couldn't find evidence of who the hell was eating carbohydrate at that lower level now in this group of people it's probably a pretty good assumption that we have a lot of folks that are at that point but none of those none of us none of those people were captured in this study so who are these low-carb eating people and so when I got in and started looking at some of the better research that's been done this is a great paper it's called the the a dizzy study it looked at Atkins own Ornish learn diets for change in weight and related risk factors among over weight people any positive women the learn program is just like its Dietetics gets bumped on the head and then goes to hell and then it produces a dietary intervention lifestyle exercise attitudes relationships nutrition again that's opposing my own bias but so the the learn program was lots of carbohydrates at least 60% of your your daily in taking calories should come from carbohydrates fat should be limited to below 10% you must focus on portion control there are no forbidden foods because man we don't want to create disordered eating and count calories and calculate daily requirements based on your activity level because that's super easy and intuitive you know I mean you know the my physiology versus your physiology running up and down a flight of stairs I slept last night you didn't sleep last night so that's super easy to keep track of all that stuff and that's the recommended intervention to duce person made and so my point about like bumped on the head gone to hell nutrition but so within the study they they basically compared the Atkins diet zone Ornish learn and they were looking at weight loss and a number of pretty pretty solid cardio metabolic outcomes they looked at weight loss at 12 months secondary outcomes include lipid profiles percent body fat waist-to-hip ratio fasting insulin glucose levels these folks were were instructed and how to eat these diets they had a dietician or health coach that checked up on them if frequent intervals so I mean this thing wasn't a metabolic ward study but it was pretty darn good like they they went through pretty good lengths to teach these people how to do these interventions then they provided continuing support to make sure that they were on track and kind of monitoring what they were doing but what was interesting is a weight loss was greatest for the women in the Atkins diet group they lost on average four point seven kilograms everybody else was pretty unimpressive and not statistically significantly different within all the rest of the groups pre menopausal overweight and obese women who were assigned to follow the Atkins diet had the lowest carb intake lost more weight and experienced more favorable overall metabolic effects for the twelve months than the women assigned all the other groups the conclusion the low carb high protein high fat diet may be considered a feasible alternative recommendation for leg ones maybe maybe you could also just cut your leg off and you'll lose weight pretty rapidly too so uh some important things to kind of take out of this though is that as folks kind of acclimatize to what they were doing the Atkins diet really wasn't quite the Atkins diet people actually shifted to effectively what would be zone ratios in their macronutrients and and that that's just a theme that we see that pops up again and again we try to start folks at these somewhat extreme edges and the tendency is to slide towards more of a middle ground so we start people either low carb or low fat and then they tend to slide into middle ground and if you read my second book wired to eat I would make the case that the middle ground this area where we combine fat and carbohydrates and hyper palatable food combinations is really where the rubber hits the road with regards to our major food problems and then if we also look at metabolic flexibility in the loss of mitochondrial function this is probably an argument why low carb and ketogenic diets are so darn effective for westernized populations because we may have largely lost the ability to be effective at carbohydrate metabolism perhaps in our ancestral genetic makeup we should be able to handle carbohydrates better but because of a variety of factors where we're not that adept at doing it but so the Atkins diet wasn't quite really the Atkins diet but it still performed better than all the other diets this was generally a well-designed study despite the efforts folks tended to slide to the middle but according to the current study they're recommending that we be in that middle ground at a minimum that 50% of our our calories come from carbohydrates and so we're gonna have a very mixed macronutrient bag which seems to be the place that bad things happen when you think about any type of processed food story and again if the folks in this study that were trained in how to eat a low-carb diet generally couldn't or didn't maintain that low-carb diet over the course of time again with this you curve who were the 20% you know the people eating below 20% car behind level it just doesn't make any sense at all like it's hard to get people to do this under a metabolic ward setting so how did we discover this in a again food frequency questionnaire twice administered over a 25-year period so another kind of interesting piece to maybe look at what this is a paper the the diet fits randomized clinical trial where folks were instructed to eat either a low-carb whole food diet or a low-fat whole food diet it was again really quite well designed and at the end of the day the macro level differences weren't that great both groups tended to lose weight both groups tended to improve cardiometabolic risk parameters within each group some people failed miserably and this may be some of those outlier scenarios in which some people may not be that well suited to a low-carb diet and conversely some people may not be that well suited to a low-fat diet but at the end of the day what they found in this study was that folks who are a large leading whole unprocessed foods tend to do quite well they tend to have fewer problems but then as things slide to a middle where we have both high carb and high fat than we tend to see some pretty significant problems um this is an important slide to take a peek at it and there's all kinds of contention and pissing matches around well we're eating more carbs now no we're eating more fat now the the realities were eating more now period and the more and this is also where it gets super annoying they have this labeled under grains is that what it is added greens flour cereal products and then added fats oils and dairies people are not eating pearl barley with a dash of you know key that was milked by the Dalai Lama and blessed this is what they're eating this is what folks are eating when we see increased grains and increased oil consumption and how many folks have heard me talk about this Doritos roulette bag anybody a couple of people how much time on my 15 minutes in I have 10 minutes okay I'm gonna die literally could do what an hour on on this slide alone it's kind of crazy so on the bag and again this laser pointers not fantastic but it says attention some chips are extremely hot so what they've done with in this bag is they have a mix of extremely high medium and mild chips and again if you followed any of my work any of stephane DNA's work and you think about hyper palatability palate fatigue what these folks have done in one bag has created a randomized stochastic distribution in palate experience which makes the product more addictive so I was checking this out I was like wow this is really interesting so I tracked down who the manufacturer was and it's kind of like a coca-cola owned company or something like that they had a contact page and so I shot them in the email never expected to hear anything back and I said hey I'm a food researcher I'm just really curious um by chance does the distribution of hot versus medium versus mild follow a power-law distribution and I had a couple of other questions fired it off never expected to hear anything two days later I got an email back in the Gelle said hey Rob it's great to hear from you fantastic questions the scientists in the lab are huge fans they love all of your work and I was like and they were so tickled that yes the distribution of these things follow a power-law distribution so what the food manufacturers are doing they are exceptionally well steeped in evolutionary biology evolutionary psychology chaos mathematics as it applies to habituating someone to an addictive substance if you wanted to get a mouse or a human addicted on cocaine you wouldn't give the individual the same dose every time one time it would be a big dose the next time you have small dose the other time there would be no dose because the anticipatory nature of what's gonna happen next heightens that dopamine response so the level that these folks are operating on is so sophisticated kated so dialed in it is absolutely jaw-dropping and on the standard medical model if you were to even try to talk about hyper palatable foods optimum foraging strategy palate fatigue they look at you like you have three heads but the folks that are profiteering from our health crisis are probably better steeped at evolutionary evolutionary biology than we are so that's something to noodle on and it's also something to noodle on just as a side note when we get into pissing matches about is 30 grams of carbohydrate versus 50 grams of carbohydrate a ketogenic diet we are really missing the boat like we have so lost the narrative it's almost painful because this is what we're competing against and and they are absolutely kicking our asses I'm gonna skip this one it's a piece from Marty Kindle which is phenomenal but it talks about satiety relative to different macronutrients and it really deserves a thorough unpacking and I don't really have time to super thoroughly unpack it but does everybody follow Marty Kendall's work at nutrition optimizer its outstanding really cannot recommend it enough but there's another paper that I want to consider when we're thinking about this whole story of high carb versus low carb and whatnot and really try to to make a case that it again it's this middle ground of fat carbohydrate combinations that I think are really the most dangerous this again is a fascinating paper or super additive effects of combining fat carbohydrate on food reward what they did is they they trained people in approximately the caloric and kind of dollar value of various foods as carbohydrates as fats individually and they would do brain imaging on these folks while they were going through that then they expose them to pictures of fat carbohydrate combos or not pictures but actual meals and what happened is that and I think that I actually mentioned this in brief it all show that foods containing fat and are more reinforcing than equal caloric foods containing primarily fat or carbohydrate this effect is independent of liking and is reflected by the Supra additive responses in the striatum during food valuation this may be one mechanism driving over consumption of high fat high carbohydrate processed foods so it's interesting we have a pretty good ability to look at and assess both the value and the relative caloric content of carbohydrates of fats once we combine them it's like we're drunk at a casino and we've been on a winning streak that turns into a losing streak we we lose all ability to distinguish what is really going on with those foods and then this is above and beyond even the palatability factor so again when when we're in these kind of battles over is it high fat is it low carb I think we really need to keep an eye on the fact that these hyper palatable refined foods are arguably from my perspective probably the place that we need to focus the most attention to and this is another piece that came out just on the heels of the original paper that was suggesting that low-carb diets will shorten your life and this this is from a absolute hero of mine dr. ayan itis he has been critical of the nutritional research community and really the scientific research community at large for a long time has taken a lot of heat for his positions but he really makes some amazing cases some nutritional scientists and much of the public often consider epidemiological associations and nutrition to represent causal factors the emerging picture of nutritional epidemiology is difficult to reconcile with good scientific principles so he makes a case that if we really hold a standard of what scientific practice is that the current iteration of epidemiology really doesn't fit within that very well often authors often use causal language reporting the findings of these studies and again you guys can look at some of the the details on this I'm not just going to try to hit the high points these implausible estimates of benefits or risks associated with a diet probably reflect almost exclusively the magnitude of the cumulative biases of this type of research so you remember that first paper where they brought up is it we're gonna consider plant versus animal-based proteins there's a massive bias exposed there right right out of the gate with extensive residual confounding and selective reporting disentangling the potential influences of health outcomes and a single dietary component from other variables as challenging if not impossible similarly limited self-reported nutrition data this is the food frequency questionnaire is etc ascertain with a handful of questions and self-reported items failed to acknowledge or accurately measure a system that matches or exceeds the genome and complexity so what he's saying is that we're we're basically taking two snapshots out of time but this is frequently the way it happens we use a fruit frequency questionnaire we know that people lie like crazy they have terrible memories and we're relying on this to provide a data signal in a system that the nutritional interaction within our bodies between the gut microbiome our hormonal state and whatnot is arguably orders of magnitude more complex than the totality of our genetics and this is what we're hanging our hats on this is what we're hanging public policy on it's absolutely ridiculous but it's so entrenched in the the kind of scientific culture in academia that nobody is other than a few people are really calling to question this whole story and again if I had a bit more time this is an amazing paper like if you guys want to go dig into a paper it's called caloric restriction does not enhance longevity and all species and is unlikely to do so in humans this is I want to try to wrap this all into the context of okay well what what would go into effective health and longevity and this paper is really amazing in it it kind of is a a reality check for what I consider to be some over-the-top kind of extreme activity that people are undertaking in the the name of longevity how many people are concerned about mTOR for example just show hands don't lie you guys are concerned about mTOR how many of you know that you need to have mTOR complex one activated to turn on the t cells that fight cancer yeah so there are people out there that are advocating these room art even in the ketogenic community advocating these remarkably low protein diets they are terrified of mTOR but yet you need mTOR activity for a whole host of processes not the least of which is proper activation of the immune system for both preventing cancer and autoimmune conditions so a lot of the recommendations that are being made around fasting and super low protein intake they are a tool they have utility but people have gone to crazyville on this stuff and probably next year this is gonna be the talk that I'm gonna do and I'm if I'm gonna do it I really want like an hour and 15 minutes to fully unpack that one just sayin so some thoughts on health and longevity don't over eat that is so trite to say in a world of hyper palatable highly processed foods but in general if folks just don't overeat things go generally pretty darn well my dear circadian biology I think the wake sleep cycle is possibly as important as sleep find an appropriate glycemic load that's kind of my case around the seven-day carb test some teeth will do better with some carbs some some fewer some types of carbs work better for folks and others do a little bit of tinkering around that be mindful of immunogenic foods to the degree that the Paleo diet concept has any value I really think it's in this immunogenic food story looking at grains legumes dairy possibly nightshades FODMAPs things like that like that was really a powerful contribution that Paleo diet made to this story but at the end of the day if we were to focus on a low carbohydrate diet and then just give a little bit of a wink and a nod to immunogenic foods we're done and then you don't need all the kind of crazy religious type stuff that goes on with the Paleo diet concept lift some weights use asana find some meeting and social connections what does meaning and social connections really boil down to coffee beans coffee also coffee stimulates autophagy on a global level lifting weights simulates otology and muscles and also activates him tor in an appropriate fashion so this is a game where people are making this all too damn hard okay so I think I'm really close to running out of time at the end of the day markets are gonna figure most of this stuff out like markets and I'm one of those crazy libertarian people so I lost credibility with now 99.9% of the people in this room but I really believe in the power of markets when they're allowed to look at a situation and analyze it how many people have heard Swiss Ray okay cool cool awesome awesome usually generally the nobody's familiar with this if you have some sort of life insurance it is likely underwritten by these folks and they do a remarkable amount of research in a just jaw-dropping number of different verticals but they are very interested in this topic of nutrition because if people live longer they win bottom line so they're looking at this and as dispassionate no dog in the fight away as they can and they really like what I&I tiss is saying with regards to how broken nutritional research is and then they've hosted a number of conferences and they are not inviting the vegans to these things they're inviting to low carb thought leaders to these events because when they have put research teams out to critically assess what do you think is going to allow people to live longer and healthier what they're coming back with is something that looks like a probably a peri ketogenic diet so in the meantime with all that like we need to really keep our feet on the ground help educate people and I will go out there on a limb and say we collectively need to really rally behind the concept of sustainability I don't know if folks have followed Diana Rodgers work but the vegans are basically slicing and dicing dividing and conquering they're trying to impose taxes on meat they are trying to make it illegal to grow meat on your own land I own three acres of land and I have had sheep and goats they want to make that in a legal process they want to out lawn meet in school lunches and they are incredibly well organized incredibly well-funded the film what the health raised a million they're almost a million dollars in two days of crowdsource fundraising Diana's been trying to crowdsource fund raise her film for going on a year and a half now and we collectively kind of suck it supporting stuff like that and that is the beachhead that we have to defend whether you're Western a price or straight up Quito or or whatever if you want the freedom to be able to eat the way you want to eat and feed your family the way you want to feed them and if you want a medical system that gives a hat tip towards the notion that an appropriate glycemic load diet and and a highly nutrient-dense diet based around meat and animal products is the way that we should go we need to fight these folks because they are not interested in happy collaboration they want to make it impossible for us to live the lives that we want to live so thank you guys it's huge honor for being here [Applause]

Channel: Low Carb Down Under

Views: 140,061

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, Low Carb Denver 2019, #LowCarbDenver, Low Carb High Fat, LCHF, Ketogenic Diet, Carb Intake Mortality, Wired to Eat, The Paleo Solution, Chris Kresser, Atkins Diet, Zone Diet, Ornish Diet, L.E.A.R.N., The A-Z Study, DIETFITS, Nutritional Epidemiology, Health and Longevity, John Ioannidis

Id: reBRMw0BeEk

Length: 32min 18sec (1938 seconds)

Published: Sat Sep 14 2019