The case for keto with Gary Taubes – Diet Doctor Podcast

[Music] welcome back to the diet doctor podcast i'm your host dr brett sher today i'm joined by gary taub so i should say rejoined because i was i had the privilege of interviewing gary to kick off the diet doctor podcast episode number one and now he he he is back for another episode thank goodness we didn't scare him off the first time that he was willing to come back for another episode um and it's such a pleasure to interview him because i mean let's face it if if you have any knowledge of low carb it likely has been traced back to gary tobbs in some way you know that you can think of the modern revolution of low carb started with dr atkins and then sort of fizzled out and then was reignited by gary tobbs with this 2002 article in the new york times magazine followed by his his book good calories bad calories and then other um very important books as well why we get fat the case against sugar and now he's back with another book the case for keto and we discuss about his his sort of rationale why he wrote this who he wrote this for and you can see it's sort of a it's a very personal journey but at the same time he really tries to to paint the picture of who this book is for and he interviewed 100 over 100 physicians and clinicians about this book to get their experience he knows the literature but he sees it from an outsider's perspective because he's not a scientist he's not a physician and some people are going to criticize him for that and some people are going to recognize that that's a strength of his because he's not um sort of entrenched in in the dogma the status quo and he doesn't sort of have a dog in the fight so to speak because of the way he's been practicing or doing his research instead he's trying to approach it with his inquisitive mind and he asks great questions and he brings up the point that probably within the traditional medical world we're not asking enough questions and that's part of the problem but we get into a lot of the concept of you know calories versus carbohydrates and insulin and not just what it means from a science perspective but what it means from a personal perspective from a hormonal perspective from a hunger perspective from a sustainability perspective and and we talk about um you know how people can walk away with information that could help them and that's really what this book is about you'll see how he describes um his book he wants us to be a book that you share with your family members that you share with your physician to make the case for keto maybe not for everybody but for the right person uh there's a case to be made so uh as always you know gary tubbs he's got great stories great anecdotes and a wonderful perspective so i hope you enjoy this interview with gary tobbs all right sorry for the interruption but just a quick break i just wanted to tell you about the new meal planner we have at diet doctor for all diet doctor members you now have access to our personalized meal planner so we had a pretty good meal planner before i gotta be honest maybe we have a thousand recipes um and it could come up with uh with a great set of meal plans and shopping lists for you but now we've made it even better by personalizing it so just a couple simple questions about who you are your age uh your height what your weight loss goals are if you have any medical conditions just a couple questions to better understand who you are then we can even better formulate the diet that's right for you pulling from our best recipes that are going to fit the profile that's going to impact you uh the most so uh if you're already a diet doctor member make sure you check out our personalized meal planner and if you're not this is a great opportunity to sign up to become a diet doctor members you have access to our personalized meal planner with the shopping lists and of course all the other benefits you get from being a diet doctor member and the first 30 days are free so you really have nothing to lose it's definitely worth checking out so go to dietdoctor.com to learn more all right now back to the interview gary tobbs welcome back to the diet doctor podcast it's great to have you back again okay bro thank you for having me it's so great to have you back i mean you helped us kick off the diet doctor podcast in episode number one and now you're back for another episode and i'm excited because you just now have the release of your new book the case for keto so i definitely want to get into the the details of this book but before just give us sort of a little background of what you're hoping to accomplish with this book who's it for and then we'll dig a little bit deeper into the specifics i'm writing it for those of us who are on that spectrum from overweight to obesity from you know metabolic syndrome pre-diabetes to diabetes like we are the people who fatten easily who can't control our blood sugar and for whom the conventional wisdom doesn't work right because if the conventional wisdom worked we wouldn't be here right and this is so and by the way the lean and healthy of the world i'm not counting them out as a potential readers i just figure by the time they become like us which many of them will over time then they can decide that they have to do something about it and they could go on this sort of down the rabbit hole where we've all gone to learn what the right thing is so um and then over the course of the past five to eight years mostly since my book why we get fat the world has changed dramatically so uh when i did why we get fat for instance i interviewed a half dozen physicians who were prescribing low carb high fat diets and these were the ones i knew out there who were doing it who had bought into it or had clinical experience and there were like six of them that i knew you know uh just six at that time mikey derek westman david ludwig a few others and even david ludwig was more less low carb high fat and more just restricted carbs so now by my estimate there's a few tens of thousands at least worldwide okay and now there are organizations like dietdoctor.com that have international reach and diabetes.com.uk and ditch the carbs and um so i wanted to find out i've always been obsessed with the problem without really long-term clinical trials the question is what works and what doesn't and i wanted to find out from these physicians what was working for them and when it didn't work why didn't it work and what the challenges were to the physicians and the challenges were to the patients and then i also want there was this sort of profound disconnect between what we believe and still what the authorities believe and this is represented by you know the sort of a u.s news and world report for instance which every year does they they have a committee of 20 or 30 authorities who decide what the healthiest diets are and invariably low carb high fat ketogenic diets are the least healthy of the 35 to 40 they include every year so we're committed to it they think it's an unhealthy unsustainable lifetime and i wanted to explain that disconnect and then i wanted to just i wanted people to understand there's so many misconceptions about diet and health and what it means to eat the low carb high the way diet doctor for instance prescribes and i wanted to address all of those i you know so that's it i want to put everything in context i wanted to write the book that sort of people could read so they would know that the lie the real logic behind what they're doing you can go to all these sites and they'll say look do this it'll make you healthy and i wanted to explain why we believed that and and what the conflicts were yeah that's one of the things i noticed about the book it does a really good job of explaining sort of the history i mean you're a journalist you're great at digging up history but it did a great job of explaining the history of how we think of obesity and when i say we i say sort of like the medical community and and how it became sort of ingrained you know that common word ingrained that it's it's really just a behavioral issue it's gluttony it's it's eating too much and all you have to do is is uh control yourself better and that will fix everything and sort of how we how we got to this position and and you pointed out very clearly how if it's a a thin doctor who or a thin scientist or mostly a thin doctor who never had trouble with their weight it just makes sense right it works for me and here we have some science to support it seemingly so it should work for everybody but that's but that's not the case and you wrote the book in a very sort of personal way there was a lot of people like us like we because you personally were in a position where you found yourself not kind of the the the paradigm from the the skinny healthy doctors wasn't working for you so i guess that kick-started this journey many years ago for you didn't it well it actually it's funny because i got into this um without any bias whatsoever i got into it because i was interested in good science and bad science yeah and i had reason to believe that the nutrition science had a considerable amount of bad science i didn't know what it was so i spent the 90s like everyone else eating low-fat diets and mostly plants than exercising an hour a day and not being able to control my weight but what i realized doing this is and a lot of this goes back oddly enough to malcolm gladwell so malcolm gladwell one of his first pieces he ever did for the new yorker in 1998 was um a uh called the pima paradox and was about obesity and the review of the obesity field very much the same subject that i took on for the new york times magazine three years later um but malcolm didn't have in those three years a lot happened like eric westman happened and david ludwig happened and steve finney and jeff boleck happened and so where i had authorities i could interview who were taking low carb high fat diet seriously and had tested them in clinical trials malcolm didn't um so he breaks down he parses diet books and he kind of makes fun of the fact that they all have the same structure and they start with the conversion experience of the physician the doctor says you know i was suffering from i was overweight or i was obese or i was suffered from this disease or that disorder i couldn't sleep or whatever it was and i tried everything that the conventional wisdom offered and it didn't help so i went down into the basement of the library medical school library and down there i found the tome that held the secret and i tried it it worked for me and it sounds you know like a sales job and that's kind of how malcolm intended it was to sort of suggest that this is part of the diet book con but what i realized in talking to over 120 positions first of all they they'd all gone through this you went through it i went through it if you're lean and healthy and you're doing what the conventional wisdom recommends there's nothing to learn there's no conflict between your experience and hypothesis so science starts with an observation of this is what i believe but it's not what i'm seeing and then from there you generate a hypothesis to explain what you're seeing and then you test the hypothesis and all of science goes from there but if you're lean and healthy and you're doing you know eating in moderation and exercise you have no reason to doubt those as weight loss advice and so that's what you tell your overweight ob subjects to do and even though even lean and healthy physicians have patients who get heavier with each passing year and more diabetic they just assume they're not taking their diet advice but then you get to the point where it doesn't work for you and so if you're actually one of these people and this is why you keep referring to us we're the people who can do the experiment ourselves to see if it works okay and you have to be willing to do that experiment yourself yeah being someone who's gaining weight year in year out regardless and i don't believe thin people can understand this because it's not within their life experience so they assume that they stay lean by eating in moderation everyone can they don't know that the world is full of people who if we try to eat moderation we get fatter anyway or we just get too hungry right and that's so important that we get too hungry to keep it up and that's a concept that is really i hate to say the word ignored but it sort of has been ignored by guidelines and and the common practice that um you know we're giving a diet that probably is going to stimulate hunger in 90 or more of the people who are going to do it but we expect it to be successful so you really focus on hunger in this book and you talk a lot about it well there's a misconception there as well because the community has thought of hunger as something independent of the physiology of the body so maybe it has they'll talk about satiety and um you know how quickly or not you digest the foods you consume so fats they're supposed to be satiating when they believe fats are satiating because they're slower to digest than protein or carbs the reality is you need a certain amount of energy to run your body and if some of that energy is being trapped in your fat tissue because you're accumulating fat or your fat tissue is trying to accumulate you're not going to have enough energy to fuel your body and that's going to spur hunger so it's sort of this concept of fuel availability in the periphery i don't go into this a lot of detail but you can't separate hunger from fat accumulation it's just right the two are are hopeful you know they're they're two sides of the same phenomena um so that's that that was one of the many misconceptions that's been out there i mean for 50 or 100 years right and this concept that hunger means we need nourishment that we're somehow missing food and nourishment is sort of the general conception but when we have all the calories and nourishment that we need in our stores we just can't get to them there's that disconnect you know it's funny i just saw a paper came out last week this week from the physicians committee for responsible medicine neil bernard is the last author it's published in jama it's a vegan diet for weight loss and so they randomized something like 250 subjects to eating a vegan diet and or just doing nothing so you either stay in the standard american diet with all its sugary beverages and all its beer and all its crap or you think and eat healthy and eat a vegan diet and they report that over the course of 16 weeks they lose like 12 pounds and so this is a good thing in their mind but they also report that they restrict their calories to 1200 calories a day in order to lose the 1600 pounds and we know from the most famous clinical trials ever performed ansel t's famous starvation study that people can't sustain 1200 calorie a day diets that that level of hunger eventually will drive them crazy they might be able to sustain it for 16 weeks but they can't sustain it forever and so you have this disconnect again one of the arguments against the low carb high fat ketogenic diet today and we should explain why i refer to it as low carb high fat ketogenic but we'll get back to that is it's unsustainable yeah but a diet that requires you to semi starve yourself while getting to have the occasional you know uh crackers and ice cream is considered sustainable on the flip side what we believe is a diet that doesn't make you hungry that doesn't make you hungry but does make you healthy will be sustainable effort easily because you want to sustain your good health any diet that makes you hungry is going to fail yeah and i think there is a that disconnect like you said and going back to dr keys study on the starvation study you know a lot of people think about him from from just a seven country study but the starvation study and the stories that you told about some of the reactions people had the the psychological reactions people had was mind-boggling i mean i never heard that i mean that's worth just reading the book in itself just to hear some of those crazy stories this is the you know early years of world war ii they want us they they know that when when if they would win the war in europe they're going to be facing major famine areas um with the liberation of europe particularly in eastern europe so they want to do a study to to understand starvation and famine so they know how to deal with it and then so anthocy's famous nutritionist this made him famous at the university of minnesota recruits i think it was 25 or 32 conscience subjectors young men who are from you know lean to what they considered overweight back then which is a lot different than what we consider overweight today and then they put them on what they described the sort of the eastern european diet but 1600 calories so it's basically a little bit of lean meat green vegetables and starchy vegetables and very low fat and it would be considered a very healthy diet today in our sort of low fat low saturated fat oriented world and these young men go crazy to the point that the few of them they called it the i think the term was starvation and psychosis and one of them tries to cut off his fingers to get off the study and then he eventually succeeds one of them gets hospitalized and they thought about food constantly they dreamt about food at night one of them took to chewing 40 pieces of chewing gum during the day to make up for his hunger and it was that the starved was a you know the minnesota starvation experiment but starvation was sixteen hundred calories a day which is what the conventional wisdom the nih since the cdc or the american heart association will prescribe for any for men in a weight loss stock women and weight loss diets are often prescribed twelve hundred fifteen hundred calories so again it's clearly when they give this advice the idea is those of an obese we're just supposed to be able to deal with the hunger right as if it exists in a vacuum you just put the advice out there and people do it and comply with it and there are no other factors to consider but clearly clearly there are the people fail it's clearly because they're not following the advice and then they come up with the theory that nobody follows a dietary advice so one of the misconceptions i would like to erase from the world forever and i discuss in this book is the idea that the diet that works is the diet you'll sustain so you don't actually define any criteria by which the diet works like does it actually make you healthier or you know improve your lipid profile or reduce your weight significantly or make more energetic or happier or do you sleep better none of that if you can sustain it then that's a good diet right the america i didn't mention this in the book but i noticed this recently i'm my next diabetes i've been reading all the diabetes literature the latest uh lifestyle guidelines from the american diabetes association actually recommend that physicians with diet patients with diabetes advise the patients to eat exactly how many carbohydrates that they've always been eating because that way they know they'll take their advice oh god that's just and then we're laughing um i could actually pull it up i've gotta i had to put in the book where i mentioned this in my book and the draft i have a footnote because i know nobody's going to believe that this is what they really say and then the footnote quotes it exactly which is you know the diet that works is a diet that they adhere to so therefore tell them to do what they've always been doing and what all their friends are eating and that way we can have confidence that they'll they'll they'll adhere to that diet advice that's disturbing well and then this gets to one of the other disconnects that you bring up in your book is is the disconnect between what the obesity textbooks say and what the biochemistry books say so what is sort of the biochemistry of of fat gain and then what do they clinically tell us to do and i thought that was a really good uh i was really good the way you pointed out the difference so tell us a little bit about about that difference because i think it's so important okay so the conventional wisdom right is you get you get fat because you take in more calories and you expand so you overeat uh the biblical term would be gluttony and sloth but the um and then if you look at the textbooks the textbooks will tell you that the the diet that works is diet that reduces calorie intake because these people believe you get every diet has a theory attached to it where implicitly or explicitly and that theory is about what the cause of the disorder is that the diet's supposed to be fixing so if you have uh you know any the diet that works the one that you adhere to that supposedly thinks that you get factors you eat too many calories and you're gonna eat less on this way of eating um so the textbook of obesity the last the edition the only edition i think was published was in 2012 says you know the diets work when they reduce caloric intake um if you actually look in endocrinology textbooks or metabolism textbooks or even medical textbooks under you know the regulation of fat storage and fat cells you can go to the index and look up the word adipocyte which you know is a technical term for fat cell or um fat metabolism is another one that'll tell you that fat cells get fatter when they insulin levels are elevated so one of the many things the hormone insulin does it tells your fat tissue to take up fat and it inhibits the enzymes that release fat out into the circulation and again use for fuel so if you pay attention to what the textbooks say about fat cells fat cells get fatter because we secrete too much insulin our insulin levels stay elevated too long the fat cells are exquisitely sensitive to insulin so even the littlest bit of insulin in your fat cells are being told to hold on to the fat they've accumulated but the same textbooks will say that obesity is caused by eating too much and completely ignore this sort of biological endocrinological knowledge about what's happening to the fat cells themselves and all we've done is say look we're we are the accumulation of all our fat fat cells so if we're overweight or obese you know we have either too many overstuffed fat cells or we've got two overstuffed fat cells and the way you get the fat out of the fat cells is by lowering insulin minimizing insulin ideally and the way you do that is by avoiding carb rich foods and sugars so starches grains and sugars and if you do that we have copious anecdotal evidence and some pretty good clinical trial evidence that solves a problem it certainly makes sense now but i guess you could say part of the problem is is how good ketogenic diets are at reducing appetite and having people naturally reduce their calories which then leads sort of some of the um the detractors to say well it's only because you reduce your calories that it's working because it's it's it's hard to find a study at least in sort of free living people where you don't purposely restrict or mandate their calories it's hard to find a study where someone who starts a ketogenic diet doesn't reduce their calories naturally so it's almost like yeah except that we all went through periods and again this is where it gets confusing because often when i talk to the critics they'll say well this is all you've got is anecdotes that it works better than other diets so on one level and again there are a lot of issues to unpack just with the sentence like that but um not everyone eats less when they go on these diets we all know what it was like to try and lose weight the conventional way i mean i would do it every six months to my 20s i was a football player in college football i was a defensive lineman so i was not very good but i was the kind of guy who got heavier when he got older and my playing weight was about 238 pounds which was the heaviest i could get when i was 21 years old and then when football ended i dropped down to 210 by basically eating less and eating a lot less crap drinking diet cokes instead of coke stuff like that um and then you start gaining weight two pounds a year and i would you know every few once a year i would go on a diet try and bring you remember what it was like the small portions of food you ate the the you know palm sized portion of tuna fish on a lettuce cup that would be your my lunch um i once got accused actually a woman in a cafe in a midtown in new york while i was working got mad at me because i had finished my my ice cream scoop worth of uh tuna fish and i was she was sitting at the table next to me and i was staring at her plate because you're so hungry still yeah and then you compare this to and then in between meals you think about food constantly yeah and then dinner the same thing it's just this constant steve finney would call these sort of constant thoughts of eating and food that you have um and then on this diet you have a nice this way of eating you have a nice big breakfast eggs bacon you know if you want five eggs three pieces of bacon sausage and then it's true you don't need a snack so you lose those calories and you might not have the coca-cola you might otherwise have in the middle of the day or the sugar in the coffee you might otherwise have but then you get to lunch and you have a nice big lunch half a roast chicken with a salad or you know and when i first tried this as an experiment i would have a big steak for lunch because there was restaurant nearby an argentine steakhouse where i could get cheap cuts of meat and then you go to dinner and the same thing happened so you're missing out on the snacks because you're not hungry for reasons we pretty much understand um but you're having large portions of food for breakfast lunch and dinner there's no sense so it is possible that you actually do restrict calories but when you look at the studies closely most of them don't talk about how they measured caloric consumption so they kind of assume that if somebody lost weight because they they're programmed to think in terms of energy balance if someone lost weight often what they'll do is kind of assume that somebody lost weight they must have eaten less so you get i believe people have to eat less to lose weight if not it's against the laws of thermodynamics which is nonsense but they don't understand that um and since i believes you have to eat less to lose weight and my subjects lost weight therefore they must have eaten less and this confirms my belief that you have to eat less to lose weight it's complete the whole idea of energy balance has circular logic built into it all along the way so and then again in simple language i'm trying to explain that to people yeah right right and i think i think that does make it challenging um because we get into these camps of calories versus carbohydrate insulin and and when you sort of when people dig into their camp it makes them so open to just confirmation bias and sort of like you're saying the circular logic and it makes it much harder to see that disconnect like you pointed out about the biochemistry of getting fat versus sort of the recommendations for getting thin but this is you know what i mean about even um how people interpret the studies to confirm their um prejudices or where they stop you know i said these people have no curiosity about the implications so and when i was you know when uh my not-for-profit nucia the nutrition science initiative was viable and we were having quarterly meetings with these leading obesity researchers and they would say you know and again well ketogenic diets work because they inhibit appetite okay well then how do they inhibit appetite because then you've got two different hypotheses there one is they just make fuel available to be burned all day long because you're not trapping your fat in your fat tissue you have it available to use for fuel the other is something magical that's happening in the brain you have to differentiate that but it's not enough to say the diet works because people eat less now you have to say why aren't they hungry right okay okay and i said this in my very first book good calories bad calories if they the diet works because they eat less and why aren't they hungry and if they don't eat less why do they lose weight right and you cannot get around those questions it's like a whack-a-mole when you whack at one place it's gonna the only explanation that really the simplest explanation is they lower insulin and insulin allows fat to flow out you know the with the phrase i use which came from a nobel laureate 19 she hadn't won the nobel prize in but this negative stimulus of insulin deficiency if the fat cells are sensitive to insulin they lower insulin enough fat's going to come out of the fat cells that's going to be burned and so the the fat cells are sort of waiting to see that no insulin signal it's like the green light for them is we got insulin low and now they can dump their fat you could burn the fat and the body works the way it's supposed to work yeah i think that's a great point about just sort of the scientific curiosity to keep asking why rather than just sort of pick a pick a reason that fits your bias and and then kind of run with that as a reason why now that we're having a pretty a big surge of of science and literature sort of supporting low-carb diets a lot of it comes down to this question of sustainability which you talk a lot about in the book but sort of how the message is crafted for sustainability like some of these studies like the diet fit study that says okay we're going to start you on a very low-carb diet for the first i forget like six weeks i think it was and then after that we're going to have you add back carbs because we know you can't sustain that level of carb restriction for that long or that's the way sort of the atkins program was set up an initial keto diet and then you add carbs in sort of like setting up from the beginning that it's not sustainable so so what do you think about just how we counteract that message because if someone starts a diet thinking it's not sustainable it's going to be a self-fulfilling prophecy well that yeah and if they start thinking that it's some kind of magical diet that they could go on and then they'd lose the weight and then somehow go back to the way they've been eating and keep the weight off so and this is one of the misconceptions that i find really silly and that i i you know it strikes me as bizarre that i have to clear up and that needs to be cleared up in 2020 but the idea is you know diets work when they remove the cause of the problem okay and i use a very simplistic banal example which is when i was a kid i had a corn allergy i still have a corn allergy but i couldn't eat any food with corn in it without having serious gastrointestinal problems and my that was always you know my stomach always hurt and so my mother drags me off to the allergists they run allergy tests they say hey kid you're allergic to corn don't eat these foods and i never eat these foods again i mean again i or when i do i get gi problems even 55 years later and i know what the cause of them are right it's like okay um i miss popcorn i miss corn on the cob when people sit down to dinner and they have spring corn is there and i look at it and i finally i'll say okay look i'm going to have a bite and i'm going to have gi issues but i'm going to deal with this but the idea is it works when you remove the problem if you think the problem is too many calories the diet works when you eat fewer calories if you think the problem is carb so you remove it and the message should be and i thought about this with diet fits and i would like would you know again my non-profit help fund that study um we didn't know about the way they were encouraging people to eat carbs it wasn't like if you're having trouble with sustainability right add carbs back it's we are afraid you are going to have trouble in the future add carbs back now and the story i tell in the book is i was at a diabetes conference in aspen colorado and i'm talking to a young woman who had been a subject in that study she'd been a student at stanford and she had been always obese suffering struggling with obesity and she was 240 pounds and she was randomized into the low carb arm says a low carb arm and a low fat arm and those that's another story so in the first six weeks she loses 30 pounds strict adherence to carbohydrate restriction and then they recommend that she add carbs back healthy carbs so berries so she adds berries back at six weeks and in her three months excuse me in the next three months she loses five pounds so she goes from losing 30 pounds in the first three months to five in the second at the six month point they encourage her again to add healthy carbs back and now she never loses another pound so to this woman the diet didn't work all that well for her because she only lost 35 pounds out of 240 and the point i was making is had she remained strict she might have found that instead of only losing 30 pounds in three months she might have lost him on 90 pounds in a year she might have gone from 240 to 150 i i don't know we don't know maybe she would have peaked at 30 pound weight loss anyway but if she had lost another 50 pounds she might have decided that a life without blueberries and healthy carbs was with it because she gets to be relatively lean and healthy for the first time in her life she was healthy anyway now she gets to be laying right in a way that that's almost though a backwards success story because she didn't put back on the initial weight that she lost and the other thing clinicians have to realize is when you start to liberalize the carbs it can be a slippery slope because there are cravings you know the sugar the even the sugar in fruits and healthy carbs can trigger other cravings so she was fortunate that she could add those carbs and stay at those carbs and not start adding more and more and more and that's the other in all honesty i never asked her how much she weighed when i was talking to her about two years after the end of the study so she might have drifted back to 240. okay the uh and that's and of course that's the problem because then you think well i tried carbohydrate restriction it didn't work it didn't work yeah yeah and the point is she never really gave it a try and so i always wondered that look the message and i hammer on this in the book we talked about ketogenic diets and ketosis and satiety and hunger but the message ultimately is you know our carbohydrates fattening or not because if carbohydrates are fattening then those of us who fat and easily can't eat them and that's it that's it just like i can't eat corn because i get gastrointestinal distress i can't eat carbohydrate and then when i talk to people about it that's my message they say what diet are you on why i don't eat sugar starches and grains because they make me fat and they make me hungry right you know together those two go together right and but it's worth recognizing that it's not a universal phenomenon and i think that's sort of where some of the critics would say see here are some examples where that's not the case so it must not be true when the people on keto might say well here it works so it must be true but it's not necessarily true for everyone you see people in the blue zones you see catawbans or you know you can pick your example where people are eating a high carb diet and are metabolically healthy but that's very different from our current society and the way we eat carbohydrates in our current society well that's the thing so it's um there's a couple issues there too we can unpack one is clearly the world is full of people who can tolerate high carb diets the question is is the world full of people who can tolerate standard american diets and we don't actually have any evidence that's the case because as populations become westernized which includes you know primarily the addition of like refined highly refined grains and sugars and sugary beverages like the coca-cola effect you know um those populations get obese and diabetic and then once you're there how do you fix them how do you fix us because we're very different a population that's been consuming high sugar high processed grain maybe high vegetable oils i'm a little more agnostic about that for a century is a very different population like each child who's born is born physiologically different than the catavins with their sweet potatoes so it's sort of you know again there's a lot of sloppy thinking and we're always in the position of saying one reason i wrote another book is because it's sort of my old books are four and nine years old and we haven't won yet you know so you have to keep repeating the arguments and clarifying the arguments and seeing how people are misconceiving them i thought of you know dedicating this book to some of my most outspoken critics so because i'm basically writing to them this is i'm not saying this i'm saying that i'm not saying everyone should eat a ketogenic diet but i'm saying to everyone who fans easily the link to diet goes through insulin and insulin is responding primarily to carbohydrate content so it's a different way you know i think of um every time i wrote a piece on uh for the nature or the british medical journal which i've done on this different way thinking about obesity as a fat accumulation disorder instead of an energy balance disorder there's a this young neurolog neuroscientist in seattle with whom i had a fiasco of a debate on the joe rogan show who would write an article saying you know towns he would write a letter saying palp says obesity researchers don't think in terms of hormones and we do i mean look at leptin and so in this book i'm saying look first of all we misconceived leptin i don't get into that but that's a problem and then second of all we're talking about is hormones that regulate fat accumulation not hormones and fat metabolism not hormones that might be regulating you know hunger and eating behavior even though i think they're all hopelessly linked but it's a different paradigm right and it shows you the paradigm like so much research now is being done on leptin to say well what if we had a drug that could affect leptin then we can eat however we want and not be hungry as opposed to why don't we find a diet that just makes us less hungry so we don't have to worry as much about leptin you know it's funny i'm working on this book on diabetes and the diabetes story's interesting i'm sure you know it pretty well but it's it's until insulin came along basically it was a it was a low-carb high-fat ketogenic diet that's what you got so they called it an animal diet because it was animal products and green vegetables and you actually boiled the green vegetables three times to get all the carbs out of them so and preferably fatty animal food not lean animal food no milk because that had lactose in it so that was that was a treatment [Music] and then they get insulin and you start giving insulin and now you need to balance the insulin with carbohydrates because hypoglycemia doesn't actually exist until you have insulin therapy there's no such thing as hypoglycemia until actually banting invests to invented insulin uh create the first case of hypoglycemia while they're testing their experimental insulin on one of their dog models so they get like the dog starts shaking and heart is palpitating and he's sweating and you know um she said i need to give carbs but then the idea is they have all these different theories now about how to deal with diabetes in order to control blood sugar and then once we start giving insulin through injections so we're not even not the pancreas pumping out insulin and inhibiting glucagon and doing all the things that it does when it's vein sun's going straight into the liver you're injecting the insulin into the circulation um there's this really incredibly sort of remarkably complex homeostatic system and what people try to do is say if we just add this drug or this device or this diet we can fix the system rather than remove the problem that's just regulating it and what's interesting is going even back to the pre-insulin era they they would say look you know we know people can survive on these animal diets because the inuit do it and argentine cowboys do it and you know and so the very same arguments we've been having today but it's like and there are animal studies showing that if you just remove the carbohydrates and the diabetic wrath they appear to be healthy rats because their bodies work perfectly fine the homeostasis works when you remove the cause of the problem rather than try to keep the cause but add other you know monotherapies on top of that to try and deal with all the side effects you get because you haven't removed the cog right and that also sort of brings back the another concept about sustainability is like do you think it's do you think it's healthy and if we're taught that it's not healthy it doesn't matter what all these science of the science says so you talked about how eating this way being afraid you're going to have a heart attack at any moment i'm sure like when you were interviewing all the all the doctors and clinicians for this book did they have sort of similar experiences that they personally had to get over that hurdle of thinking they were going to kill themselves and then do they have to address that with all their patients as well to get over that hurdle that you're not going to kill yourself by eating this way even though you're sort of led to believe you might you know we've been we've been indoctrinated to fear fat to think that high fat diets are going to kill us um i was just asked today is uh uh promo for the the book uh there's a journalist at u.s news and world report who's writing an article about healthy fats and if i could suggest a couple and why they were hell healthy fat high-fat foods and i could suggest a couple and why they were healthy he would include me in the article with my name and the case for keto and i might sell three books [Laughter] so the and they they sent along what he had so far and it was you know avocados salmon extra virgin olive oil and i said to the publicist look if i say bacon and butter he's not going to use it he can't use it right he's a cognitive dissonance we're living in different areas in different paradigms and yet i actually believe bacon and butter are benign let's put it that way i don't know if you noticed i use the word benign a lot because i think there are harmful foods yeah sugars refined grains for those of us who fat and easily starch and then there are foods that don't cause any harm and our body works perfectly you know i don't know if i'll live longer if i eat a lot of butter or little butter i'm programmed to think a little butter is better but i have no idea right i think it's good to use benign or neutral as as a term i mean is is really as good as you can get in most cases in nutrition yeah and then our bodies will work the way they're supposed to work right and you know ideally we'll cook along for seven whatever it is three score years and 20 at this point so four score years um so you because the nutrition obesity community embraced beginning around 1930 this idea that obesity is an energy challenge problem that the only difference between fat people who get fat and people who stay lean is how much they eat and exercise which is when you think about it again almost insane um i i wonder have these people ever known somebody like a child or a sibling or a relative who had a weight problem did they really think that the only problem with these people is that they ate too much that their bodies weren't trying to do something differently and then their bodies were but once they embraced that now they've got a well first of all kind of a meaningless paradigm it's taught logical we get into that but it doesn't explain anything and clearly it doesn't lead you to a cure because eating less and exercising more doesn't work just makes people hungry so then they start adding layer and layer and layer of what the philosophy of science we call epicycles so you've got an underlying theory that doesn't work and then you've got to keep explaining why it doesn't work so well the diets don't work because people don't stay on the diet and the diets that do work are the people who stay on them and you know yeah you won't really lose any weight by exercising but maybe if you exercise an hour and a half a day you'll maintain your weight loss even though who has time to exercise an hour and a half a day be nice be nice yeah yeah well so and one of the other topics you bring up in the book is is this concept of a well-formulated ketogenic diet and i'm quoting steve finney for that but if there's a well-formulated ketogenic diet it seems to imply that there is a poorly formulated ketogenic diet so again just saying reducing the carbs works there's more nuance there as well right so there you can do it properly or improperly just like healthy fats implies there's unhealthy fats although there's a big argument for that so how would you describe well-formulated versus poorly formulated ketogenic diets a well-formulated ketogenic diet is more or less rigid abstinence to the carbohydrate-rich foods and then replaces those calories with healthy fats which are naturally occurring fats that we've been consuming for thousands to millions of years as a species um the poorly formulated ketogenic diet could be a personal thing so this is one of the things we don't actually know um a we don't know how important it is to actually be in ketosis that's why i refer to low carbohydrate high fat slash ketogenic diet the idea is and i come back to this over and over again it's a phrase that was used in the physiology of taste which was written in 1825. frenchman antoine briatzavron it has never been out of print which i don't think many non-fiction books can claim other than the bible and briat savaron said the way you lose your excess weight is more or less rigid abstinence to the starches and grains and sugars in the diet so again get rid of those add back mostly fat because proteins some 60 of the amino acids and protein will get converted to glucose and that will stimulate insulin secretion so you don't actually want a low-fat diet you want a higher fat diet and i know even this is um there are physicians out there who are now advocating more protein rather than less and i go through this the advantage of interviewing 120 positions including most of the you know our peers is you get a lot of different perspectives on what well formulated means ultimately it means you've gotten healthy and you've gone relatively lean so the effects tell you you're doing it right uh you have energy your head is clear and if it you're sleeping well and if you're not you want to start experimenting with how to modulate the diet they're the components in the diet to see what works and what doesn't maybe if you're not losing enough weight maybe you're not getting enough maybe you're eating your protein too lean so maybe you need more fat and less protein or maybe you're eating uh too little protein ted naaman would say you need more protein and less fat right i i think that's a great point though because it points out that there isn't one keto diet and and that's sort of the point i i was hoping to make karen you made that very well that there isn't one keto diet and there are lots of variations and for for you know the other concept of protein how much protein like what we consider moderate protein other people think as high protein and it's just the label you put on it but if you're getting you know 20 to 30 percent of your calories as protein the clinical trials show there's really no clinical meaningful response to your blood sugar and your insulin levels in that level for most people now if you're eating more than 30 percent or you know more than maybe 150 grams and you're insulin resistant and obese okay maybe that's going to be an issue but that gets boiled down to make sure you have low protein well well you know so for some people that that's not going to work and the terminology can be confusing and the same for high fat like you know for some people 40 of their calories is high fat but that's probably not going to be enough on a keto diet and for other people you can overeat fat because in your body yeah it also means if the 40 of the calories are fat that leaves 60 percent between protein and carbs right so you're either getting too much carbs or you're getting too much protein or you are eating so few calories that you're going to be hungry all the time so people often so there's two places in the book i address this because you raised one my favorite one of the things i did at the end again the advantage of interviewing so many physicians and you see this getting to do these podcasts is we have some really smart friends out there and allies and they have wonderful ways to think about this and to phrase this and so there's a at the end i go through sort of the major like how to think about how to eat a low carb high fat diet how to think about how to eat if you're overweight obese diabetic um how to approach the problem and i use uh quotes from various of our peers out there that i thought really did the best job of capturing it my favorite one is was from carrie doulas who's a spine surge he's a spine surgeon who used to work at the cleveland clinic she now has her own practice in ohio she's got type 1 diabetes herself since she used to weigh 300 pounds so there's no way in the world this should be a healthy woman and that she has her diabetes and her obesity under control and she's a vegan ketogenic diet and the reason she does is because she slowly realized that her body doesn't tolerate animal products so the fewer she consumes the better she feels and the quote the chapter section starts off with a quote from her which is it's not a religion it's just about how i feel it's not a religion you know it's about and i play off carrie with georgia eads who's a psychologist who works in western massachusetts now she used to be at harvard um georgia slowly became a carnivore and she eats a carnivore ketogenic diet because her body can't tolerate animal products i mean vegetable mat right so it's already we've got two people are both eating ketogenic diets one is eating all animal products the other is eating all all plants they're completely in alignment about what they believe and they do it because that's what their body will tolerate so they're both eating well-formulated ketogenic diets even they're entirely different well-formed related ketogenic diets and as georgia said it's just not a religion it's about how you feel i don't like in an ideal world i would love to be able to be happy and healthy not eating animals you know i understand the argument of the vegetarians and the vegans the ethical arguments and i sympathize with them but i don't think i can be healthy doing that and i'm pretty damn sure i can't be happy even though i realize that my eating habits probably don't make the animals all that happen i think that's a good perspective and a good way to think about it for sure yeah one of the other phenomena is another quote in there ken berry who said this is them what you're going to do this is what you're going to become okay and the idea is eating healthy required it's about the most fundamental thing you can do in life i mean you've got your relationships and your children and your jobs and sustaining yourself is at the heart of all of that fueling your body allows all of that to happen and it should take it shouldn't be easy it shouldn't be something you do you know without a lot of thought you should put a lot of thought into it and if you another quote from uh susan wolver on uh associate professor and i think was virginia commonwealth university who said it takes practice like everything else the more you do it that you know you think about it you read about how to do it well just if you were a local boar or an omnivore michael pollan like omnivore you were just a foodie you know you would put an awful lot of work into thinking about what you were eating vegetarians and vegans put an enormous amount of work into thinking about what they're eating i do yeah and i i like that perspective in the book about how there are different ways to do it but yet there are still underlying principles that to adhere to and that's why a diet doctor we say you know limit your carbohydrates prioritize your protein and then you add fat for satiety and taste because fat makes the meals more enjoyable and you know that can be extra calories that you add to stay so you're not hungry or you take away so you burn more of your own fat so i i really like that message in the book um now one of the other things though is that you said in the book you say it's not doing keto it's understanding how to eat correctly for your weight and health and in a way that works with your physiology and i really like the way you worded that but yet the title is the case for keto and i i my guess is the publishers didn't want the title understanding how to eat correctly for your weight in your health and and how to work with your physiology it's not as quite as gripping of a title but but the point i'm trying to make here though is the word keto in the title is a polarizing word and i'm trying to think you know back to when dr atkins was doing this and back when when you sort of um i guess you could say reignited the fire of keto back in 2002 with your big fat lie article and then good calories bad calories i'm not as aware of what the atmosphere was like in terms of polarization then but it certainly seems to be incredibly polarizing now especially with the rise of social media so i guess i just want to get your perspective what is life like now in terms of the battle and the and the polarization i can't think of a much better word now versus what it was then okay so first of all i want to say you almost got it the original title of this book well first i wanted to call it in praise of bad diets okay because i i had this revelation when i was being interviewed for a bbc documentary they never used my spot and i'll tell you why because they wanted they had recruited me because i'd written the only sort of history of obesity nutrition science and they knew that and they wanted me to answer the question why do so many people read fad diet books why are the books so popular why are there so many fad diet book doctors and the interviewer was this you know university of cambridge or oxford i forget which a geneticist who studies like the genes related to obesity and i was thinking about they asked this question i'm going jesus there's so many fat diets because the conventional wisdom doesn't work yeah you know that you get told to eat less and exercise more and eat low-fat diets and mostly plants and it doesn't make anyone thinner so those of us who struggle with our weight look for alternative to something else to try and the people who are promoting something else or by definition fad diets but i knew my editors would never go for an appraisal bad diets and then i would have say in praise of some fad diet because some i think are clearly insane and dangerous so the next title which my wife suggested was how to think about how to eat all right that was that was a working title until about this time last year and then we realized that david katz and mark bittman two of the greatest promoters of the sort of conventional healthy diet being you know fruits vegetables whole grains beans legumes like tiny little pieces of meat they had a book coming out in march called how to eat yeah and mine was going to come out in april called how to think about how to eat and this clearly wouldn't work so they suggested the publishers i had written a case against sugar so they liked the case for keto um it kind of gave me the willies but um i realized i've been making the case for keto since a 2002 new york times magazine article one way or the other and i might as well live up to it what i don't like about it is probably what you live up there it's not just that keto is polarizing but it's something of a fattish term i was thinking i don't even know when it became keto it used to be atkins right okay but you couldn't if you were going to write another book advocating for the atkins diet you couldn't call it the atkins diet so then it became you had to call it something else so somewhere in the last six seven eight years it became keto and it's likely to morph again in the next 10 years so by 2030 i don't know what it'll be called maybe we'll go back to the animal diet that it was 100 years ago who knows although then you can't have a vegan version of them when i started this it was atkins and atkins was incredibly polarizing um when i wrote good calories bad calories it was still atkins but atkins was a ketogenic diet i actually have a friend out here in oakland who's been working on a book on the ketogenic diet for um epilepsy on the history and the science and he never actually thought of atkins as a ketogenic diet and i had to give him a copy one of my copies of the original atkins and say well the reason he got pilloried was because he was advocating a ketogenic diet when physicians still thought of ketones as you know keto diabetic ketoacidosis and dead life um so yeah today there are a lot of changes and i talked about this in the book again i said you know when i wrote why we get fat i found a dozen physicians i could interview had clinical experience prescribing these diets for this book i interviewed 120 and i'm sure i could have found a lot more thousands or tens of thousands um my estimate that there are at least a few tens of thousands is based on the fact that there's a facebook group in canada for women physicians eating low carb high fat diets and there are 4 000 women physicians on that facebook group wow just on one facebook group in canada that's amazing and so i'm assuming maybe 4 000 mana physicians as well now we've got 8 000 in canada and we haven't even gone to the united states where there's an order of magnitude more positions so um the world has changed but we're up against the very powerful vegan vegetarian movement that advoc that argues that the other well essentially the primary problem with modern diets is the meat the animal products um although they admit that a healthy vegan or vegetarian diet is a diet that's also absent sugar and refined but um and because of the their ethical arguments and the environmental issues which i'm not sure what to make of i i they're certainly serious and need to be considered but i'm not the you know i'm sure the science is as flawed there as it is in the nutrition world um so there's a very powerful movement pushing towards mostly plants a lot of the journalists papers you know the new york times is often advocating for mostly plant diets for environmental reasons so here you are here you are a journalist not a physician not a scientist countering that argument so you sort of paint a target on your chest uh certainly on social media but sort of that's what we've sort of proven that we need is sort of someone from the outside looking in to say well hang on a second this might not be right whether it's an engineer or whether it's a journalist but now now that you've had that target for so long and you're getting all slings and arrows all over social media and twitter like what is your thought about just the current state of of nutritional warfare and nutritional social media and and you know is there some good to it is it all negative attacking where can we go how do we improve it i mean that's a huge topic in and of itself but i'd love to just get sort of like your your opinions on that okay i try not to look at twitter because whenever i do i it's it's it brings out the worst in humanity and there's always somebody out there who's willing to say something that i wish i hadn't read although my favorite at this point was my wife is a is an author and she's an instagram page she wrote a wonderful novel called there must be a word for that i had recommend everyone reading it um so she gets a comment on our instagram page from someone who says yeah and i hear the pearl girl is married to gary towns can you imagine being married to that oh my god who says that not even to him and my wife said she was being funny it's like that you're always telling people not to eat carbohydrates i said i'm not i'm saying if you're worried about your weight if you're trying to control your weight stop screwing around and fix it the correct way don't try to fix it by eating a mostly plant diet or uh you know um anyway the it's just um it's a shame that you have to get your diet advice from journalists or websites or anything else but people are getting the right advice from their physicians now as this message spreads not enough of them but some of them the key here is you can try it for yourself so you know if a vegan diet works and you can eat a well-formulated vegan diet and you're not getting you know vitamin and mineral deficiencies and you feel good and you're healthy and then i'm all for it and the same with the vegetarian or pescatarian or fruitarian i mean again those of us who struggle with their weight tend to try a lot of different things right many of the physicians i interviewed had gone through periods where they were vegans and periods where they were vegetarians i spent 10 years eating a low-fat mostly plant diet but when i switched i got healthier quickly and you could see it happen this is the thing you don't you know and this is the point that martin andre made this physician from vancouver whom i interviewed the idea that um physicians have been taught to prescribe diet by hypothesis same hypothesis feed a low-fat diet or mostly plant diet or a you know high-proof a diet that you'll live longer and it'll reduce your risk of heart disease but you have no idea if it's really going to work you don't actually see any meaningful changes other than maybe your ldl goes down and your tmao goes down or something when you switch but you don't feel different you'll look different your weight for the most part doesn't change a hell of a lot unless you're willing to starve yourself so the alternative is you try the low carb high fat diet and eventually you might go through again people cycle through the vegan diet the vegetarian diet they tried this many of these people were fanatic exercises some of the people i interviewed were world-class athletes olympic athletes who were physicians eventually they got to the diet that physiologically makes sense which is remove the carbs and their their weight columns went away and their blood sugar came under control and their blood pressure came they everything worked properly when they did this so you can try everything and my fear is people who will try sort of vegetarian or vegan diets and get a little bit healthier because they're not consuming you know the sugary crap that they were consuming when they ate the standard american diet and they'll never realize that they could do much better yeah that that they're sort of they're missing the point and the point is this more or less rigid abstinence to carbs right and that's the case for keto it sums it up very nicely yeah as as does the book i think it walks walks through very well sort of where the misconceptions are and and makes a very good case for keto and again not necessarily for everybody but for the right person it's going to do great so i assume it'll be it's available wherever books are sold and how can people learn more about it and you where would you direct them to go yeah okay so wherever books are sold we don't know where books will be sold anymore uh if you have an independent bookstore by all means plea that's still open and still selling books by all means please uh it'll you know it's on amazon it comes out december 29th going to make the first chapter available on my website shortly but i guess this will come out in a after that happens so uh website is gary talbs.com i think it's an important book i know we all do authors always think their books are important but um otherwise you wouldn't write it but otherwise you wouldn't write it the other well the other thing i want to do is i wanted to write i do want people to have a book they can give to their doctors yes you know and say look you're against me doing this i want to try this and you're against me doing it well here's why i find this compelling so if you take your medical degree seriously spend you know a few hours and read this book and then go to dietdoctor.com and look at their videos and then tell me that you then then support me through this you know let's give it a try i could be your test case and let's see what happens and meanwhile you can test my lipids and you could you know we could i could see you regularly so we can make sure this isn't doing harm and um you know you need that kind of well you need the book you can give to your siblings who don't listen to you who say i'm not going to do that keto it's so fatish well they're not going to do the keto try the case for keto and let him make the case and if you still think it's not worth trying then i'll back off but i think you could be i think you know you can be healthier that's a great perspective and i hope people use this book in exactly that way so thank you thank you for all your work and your advocacy and for just good science and trying what works i i really appreciate that thank you very much thanks brad [Music] [Music] [Music] you

Channel: Diet Doctor

Views: 54,862

Rating: 4.9500566 out of 5

Keywords: keto, low carb, diet doctor, gary taubes, the case for keto, taubes, taubes podcast, the case against sugar, weight loss, losing weight, gary taubes podcast

Id: mTPFyJLiI6k

Length: 70min 11sec (4211 seconds)

Published: Wed Dec 23 2020