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February 6, 2024

Understanding the science and politics of diabetes treatment with Gary Taubes

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On episode 628 of the 40+ Fitness Podcast, we bring back Gary Taubes to discuss his new book, Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments.


Let's Say Hello

[00:01:25.040] – Allan

Hey, Ras.

[00:01:27.310] – Rachel

Hey, Allan. How are you today?

[00:01:28.930] – Allan

I'm doing all right. I'm doing all right. Things are busy at Lula's. We're getting into February here, and we're doing well now. But there's this couple of months where we weren't. It has its toll. You're running a business, and you're like, okay, what we would have had for a year would have been an awesome year. It turned out to not be such an awesome year. But that's fine. It's fine. It is what it is. We're running a business. We're going to keep running it the best we can. And my hopes are now we've got a good January, a good February going. So 2024, It looks like it's going to be a much better year.

[00:02:02.340] – Rachel

Awesome. That sounds great.

[00:02:04.490] – Allan

How are things for you?

[00:02:05.910] – Rachel

Good. Still cold up here in Michigan. Yeah. But we're doing well. I mentioned earlier, my daughter is engaged to be married, and we're making some good plans. We've got a date. It'll be in June. She's got her dress, and we're just ticking off all the boxes, getting stuff done. So that's pretty exciting.

[00:02:22.430] – Allan

Well, good. Good. Now, so you're going to hit this transition in life where you're not only an empty nester, but your daughter doesn't have the same last name anymore.

[00:02:29.880] – Rachel

That's right. I got to learn how to spell the boy's last name. It shouldn't be too hard, but it's different.

[00:02:35.150] – Allan

I'll tell this story. My daughter was getting married, and I had met her, her boyfriend, her fiance at the time. And so I go into the place. She wants all the guys in the wedding had to wear the same suit. This was the place that sold the suit. I'm going in to get the suit sized because it just happened to timing. So I think she was going to get married in. I think she got married in November, and this was August. And so I walk in and I go in and I say, okay, I'm here to buy a suit. And they're like, Okay, who's the wedding? I said, It's Becker. And she's, What's the groom's last name?

[00:03:04.180] – Rachel

Oh, my gosh. Did it take a minute?

[00:03:06.950] – Allan

Yeah, I was like, Oh, my God. I don't even know the guy's last… I knew his first name, but I didn't even know his last name. So I'm sitting there going back and forth. I'm like, It's Jay and Becker, Jay and Becker. And they were flipping through their papers, and they found it. Unfortunately, it was one of the largest orders because he had, I don't know, 13 groomsmen or something like that. That's a big order. And because of that, then because of that, Then she had to at least try to even it up so it didn't look like this weird flock of geese flying north.

[00:03:36.160] – Rachel

Oh, boy. That's awesome.

[00:03:38.340] – Allan

Anyway, so, yeah, I had to learn his name. And even today, I was sending something to her, and I had to write her name. I was like, Okay, this is the first time I've actually written that last name. The new last name. They've been married now for over a year. Oh, boy, oh, boy. But it's the first time I've had to physically write it down, which was interesting.

[00:03:54.460] – Rachel

Oh, my goodness. That is funny. Yeah, got to get used to that. Changes.

[00:03:57.900] – Allan

There's some new things coming on, but All right. So you're ready to talk to Dr. Ta… I mean, Mr. Taubes. I always want to call him a doctor because he is so smart. He does so much research that I just think of him as a doctor because- For sure. Of all the things he does. For sure. But no, it's Gary Taubes. You ready to have that conversation?

[00:04:18.450] – Rachel



[00:04:48.730] – Allan

Gary, welcome to 40+ Fitness.

[00:04:51.040] – Gary

Thank you for having me, Allan.

[00:04:52.750] – Allan

So your next book has to be on Stress Management now, right? We had so much trouble getting on this call. But today, the book we want to talk about is Rethinking Diabetes: What Science Reveals About Diet, Insulin, and Successful Treatments. When you started laying this out and saying this was a history book, I was a little like, okay, I just want Gary to tell me how to eat because I know he does his research. But I'm really glad that you did take the time to lay that out because there were so many layers to this that I went through a lot. I went through moments where I was just, okay, if I had I met that guy in person, I'd choke him out. And then there were moments where I want to shake someone's hand, and then it would flip. And then the person I wanted to shake their hand, now I want to choke them out. This whole convoluted story of science and medicine, food, diabetes, and treatment, it's a can of worms.

[00:05:51.310] – Gary

Yeah, that's a good way to put it. Let's talk about why I wrote a history of medicine book, basically on diabetes therapy. And how diabetes researchers… I'm going to refer to anyone who studies diabetes or medical practice specializes in diabetes as diabetologist, since that'll simplify everything. But one of The issue is with being a journalist and writing books challenge conventional thinking in medicine and nutrition is you have to establish on what basis you think you have a right to do that, that you think you know better. So my expertise throughout my career has always been the one subject I've studied, I've written multiple books on, and I think I know better than probably anyone else alive is good science and bad science. I mean, good scientists know that implicitly, but I have studied it explicitly. And when you look into the history of these fields, you could see why people came to believe certain assumptions were true. You could see whether or not they tested their assumptions to see if they were true, whether they adjusted their thinking when their assumptions failed the test, and whether assumptions were grandfathered into how we think about this disease and therapy without ever being tested.

[00:07:13.630] – Gary

And so when you do that, when you go back in time to look at the evidence base for what we believe about ideal therapies for diabetes, you end up telling a history. You say, look, this is what we believe that this point in time. This is why we changed our beliefs. This was the actual evidence on which the beliefs were changed. This was what happened when we tested them. So I end up in writing, rethinking diabetes with not just the history of the relevant diet, drug, disease relationship. But coming to conclusions about what perhaps these people should have concluded had they known then what we know now. We have the benefit of hindsight. And the benefit of doing this in the 2020s is that because of all these Internet repositories, you can basically get all this research, either downloaded or delivered to your doorstep, say, 90% of what should have been known about the science back when people were making decisions on 5 or 10 or 15%. The doctors would make decisions about diabetes therapy based on what they read in the journals that they got subscriptions to, in the languages that they could read, maybe what their local libraries had.

[00:08:38.630] – Gary

And now we can see almost all of it. And it's as though we have a thousand-piece jigsaw puzzle, and physicians and diabetologists were making decisions based on 50 to 100 pieces that they could access. And we can now see 950 pieces. We can and have a very solid idea about what image is on this puzzle when they were in effect guessing and then locking in their guesses over time.

[00:09:10.680] – Allan

Yeah. And then that's where personality gets involved and science can go out the door.

[00:09:17.010] – Gary

Yeah. One of the fundamental issues here is doctors are not trained to be scientists. They're trained to be doctors. They often look down on people with PhDs as FUDs. That's how they were called by my doctor friends when I was young. Being a scientist requires this very delicate balance between believing a hypothesis to be true or likely to be true and then being rigorously, extravagantly skeptical of your own thinking so that you can abandon that hypothesis if it's not true, even if you've built your career on it. And then doctors just say, you're confronted with Patients. Doctors are confronted with patients. They have to make decisions in the moment about what they think the best evidence shows. And the problem is, based on their decisions, they also come to conclusions about what they think the disease is, what it's telling them. Then, like I said, once you've made a decision, you've decided this is likely to be true, you lock yourself in after that, especially if you've acted on it, into believing it was true because you don't want to believe that you actually did people harm or that you made mistakes mistakes along the way.

[00:10:31.100] – Gary

And it becomes a can of worms, would be the phrase you use, the kind way to put it. So, yeah, the book is as much about the conflict between medicine and science and how doctors think versus how they should think to establish reliable knowledge and what happens when these assumptions are established as truth, as dogma, without really being rigorously tested. Not just being rigorously tested, surviving the tests.

[00:11:01.470] – Allan

Yeah. Well, and some of them were. I think that's one of the good takeaways here, where there were some really good doctors in this history. Diabetes started really hitting the scene around 100 years ago. And they were seeing a lot of type 1 diabetes, then type 2 was starting to come around. And so there was this, okay, what's going on here? This is different. And they didn't have exogenous insulin to shoot the folks up. They didn't really know insulin existed. And so they were, like you said, they were, I would say, practicing because they do call it a medical practice. But they would practice on a few patients and see what was happening and then adjust and adapt and come up with another way. They were sharing information with other doctors, which I was actually glad to see because I think that's how you learn how many cases you're going to see, how many they're going to see. And over time, you can build a body of experience that one doctor could never, never have experienced himself. So can we talk a little bit about treatments and things people were doing before exogenous insulin existed.

[00:12:06.250] – Gary

Okay. So apparently the first example, the first case in which a physician seemed to put a case of diabetes into remission was 1797. It was a British doctor named John Rallo. He's got a patient. He's in the military. He's got a patient in the military, Colonel Meredith. Meredith has recently lost a lot of weight. He's showing all the symptoms of diabetes, which are this extravagant hunger, thirsty all the time. He's peeing constantly. He goes to Rauh, Rauh. Back then, this is 1797, it was common for a physician to taste the urine, to make diagnosis. He tastes the urine, the urine's sweet, so he can diagnose his diabetes. And he decides that since the urine's sweet, it's got too much carbohydrates in it, too much that it shouldn't be there that's making it sweet. So carbohydrates from plants. And so he decides he's going to basically feed him a diet without a lot of plant matter. And he prescribes this diet, which is fatty, rancid meat, blood, sausages, and some green vegetables. And he's also giving him drugs. He's giving him… Morphine was a common treatment back then. And Meredith does better. His thirst goes away, his hunger goes away.

[00:13:26.810] – Gary

He gained some more weight back. And Raleigh writes a pamphlet about this. He also treats a general with the same diet, and the general seems to do better, but the general goes home, falls off the diet, and dies. So Rala decides if you stay in the diet, it'll probably cure diabetes. He writes a pamphlet, distributes it throughout the England, the United Kingdom, to physicians to suggest they try it on their diabetic patients, and it seems to work. And through the 19th century, the standard of care is what's called the animal diet. They drop the rancid meat, French doctor, Baudenaire, gets involved, and the Pollinaire, I forget his name at the moment, then brings a little French cuisine into it. By the end of the 19th century, they're realizing that they want to give their patients who tend to be losing a lot of weight, or if they have what we today would call type 1 diabetes, they're emaciated. And young, you want to build up their bodies. You want to give them as much calories as possible. So by the early 20th century, the idea of 1900, 1905. It's like, feed them as much fat as you can.

[00:14:34.470] – Gary

And Elliot Jocelyn, who starts the first diabetes clinic in the United States. He's a Harvard trained doctor. He specializes in diabetes in Boston. His clinic eventually becomes a Jocelyn Diabetes Center at Harvard, says, look, the secret to keeping these people alive is getting them to eat as much fat as they can. He actually learns that from the German diabetologist who have the most clinical experience in the world at that point. That's the diet. It's today we would call it keto. Back then, it was the high fat animal diet. Jocelyn is actually one of the reasons he's so interested. His mother has diabetes. And again, probably a type 2 diabetic whose pancreas eventually fails her, so she loses a lot of weight and is diagnosed. And she stays alive longer than any of her other family by rigid adherence to this high fat animal product-rich diet. And there's a brief interlude from 1914 to 1921, where another Harvard doctor, Fred Allen, decides the best way to treat patients is to semi-starve them. And you have this starvation therapy that takes patients who are… One of the diagnostic criteria of diabetes is ravenous hunger at the time, and then you starve them further.

[00:15:57.490] – Gary

And again, with patients with type 1, these young kids, you could keep them alive longer by doing so. And then 1921, insulin is discovered. And insulin is the hormone that the pancreas should be producing. And University of Toronto researchers Discover it, purify it, use it as therapy, and find that they could basically bring these kids at the brink of death, emaciated 15-year-olds who weigh 50 pounds and could restore them to life. They would talk about it as almost literally a resurrection, like a biblical experience. And as soon as you start giving patients insulin, you create the disease of low blood sugar, hypoglycemia. And that can be deadly. That can be fatal, very quickly fatal. So you have to get the patients to eat carbohydrates so that they don't die of low blood sugar. So your cure creates a new disease. And simultaneously, you go from diets that basically had the patient abstaining entirely from carbohydrates to telling them to eat carbs, and telling them to eat carbs at regular intervals, and they should have them at breakfast, and they should have them at snacks, and they should have them at lunches. And that way, when the insulin covers them, you won't kill them with low blood sugar.

[00:17:25.830] – Gary

And as this is happening, physicians are making decisions visions about what this says about the diet. And the one thing they don't know is what the long term consequences of any of this are. So you imagine they created a drug like an anti-cancer drug that could cure some horrible cancer. And in the short run, it works tremendously. It keeps people alive, but you have no idea what the long term benefits of this diet is. And by the time those… Excuse me, not just the long term benefits, the long term risks. And by the time those risks and benefits start to wash over these patients, this wave of diabetic complications that we're so familiar with today, which are heart failure, atherosclerosis, nerve damage, amputations, and gangrene, and retinopathies, damage to the eyes, and blindness, kidney failure. You're so far along in treatment, 10, 15 years, that you don't know what's causing it. And that's what we've been living with ever since. These decisions made in the 1920s and '30s about how to treat the disease with no real understanding of how they affect these long term complications.

[00:18:44.690] – Allan

I've talked on here a lot about homeostasis and how our body likes to stay in balance. And it has all these, in some places, very complex relationships between things to help make that happen. And I think insulin Insulin and glucagon is maybe one of the easier ones to understand, but it is extremely complex when you get down to the true science of how it happens in the body. Could you just give us a little bit of a primer on insulin and glucagon and how the two of them, both coming from the pancreas, work together to keep us in a good place or should keep us in a good place?

[00:19:22.850] – Gary

Okay. There's, again, a lot to unpack and what you just said. So homeostasis is one of the most important Certain concepts ever discovered in medicine. Dates to, again, 1865, a French physiologist, very famous, named Claude Bernard. The idea is basically that everything our bodies do is to try to keep relatively constant. The conditions, he called it the milieu interior, the interior milieu, but the conditions right outside the cell walls because your cells are basically living in that environment. They have to stay alive. And all they're seeing are the the nutrients in that environment, the vitamins and minerals right outside the cell walls and the cellular fluids and the fluid circulating through the bloodstream. And they're seeing hormones and signaling molecules and inflammatory molecules. Our body is working through this system of hormones and the nervous system to keep that constant. One more message, and then I'm done. The hormone that's in diabetes in 1889, a German physician, a researcher named Minkowski realizes that the pancreus is a problem in diabetes, because when you remove the pancreas from dogs, if you keep them alive, they become diabetic. 1921, as we said, these University of Toronto researchers led by Banting and Best, realized that the hormone that's missing is insulin.

[00:20:51.760] – Gary

So the idea is that insulin controls blood sugar, and without it, you have high blood sugar and all the symptoms of diabetes. You give insulin, you lower blood sugar, as we discussed. And forever after, effectively diabetes is seen as a disorder, or at least for the next 40 years of insulin deficiency. While researchers are studying insulin and focusing on its effect on blood sugar. Other researchers have established that the pancreas actually seems to secrete two hormones that work together. And one of the messages was how our endocrine system, our system of hormones, controls homeostasis, keeps us in homeostasis equilibrium, is it does it by not just secreting hormones that have certain effects, but having those hormones in turn react with counter regulatory hormones that have the opposite effects. Anything that's working to do one thing, there's guaranteed to be another hormone that's working to do the opposite. And these hormones are going to be linked. And the idea was that as these researchers began to realize that blood sugar is controlled not just by insulin telling cells to take up blood sugar and use it for fuel. So insulin lowers blood sugar, and you get to utilize, but also this hormone glucagon, which is secreted by neighboring cells in the pancreas, that actually tells the liver to create and effect glucose, blood sugar, and secrete that glucose into the bloodstream to keep blood sugar up.

[00:22:30.710] – Gary

So we have this dual hormone system, insulin being secreted by cells called beta cells, glucagon being secreted by cells called alpha cells, which are right next to the beta cells. The mechanisms in the cells are very similar. Glucose stimulates insulin secretion and inhibits glucagon secretion. So glucose is blood sugar in effect. Insulin itself inhibits glucagon secretion, and glucagon inhibits insulin secretion. And these have to work perfectly. But diabetes researchers and physicians are so focused on insulin that they pay virtually no attention to glucagon. And glucagon, while secreted from the pancreas, is doing the bulk of its work in the liver, which is the organ that's secreting glucose into the circulation and working to rise blood sugar. So in an ideal world, glucagon and insulin are working together, and they're working to keep blood sugar stable, which is what is relatively stable in those of us who don't have diabetes. And if you don't have enough insulin, you're going to have too much glucagon. If you have too much glucagon, you're not going to have enough insulin. And if you have too much insulin, you're not going to have enough. It's hopelessly connected. And vitally important to this is that the insulin and the glucagon are both secreted by the pancreas.

[00:24:00.070] – Gary

So the highest doses in any cell's fee are in the pancreas, and the next highest doses are in the liver, down the portal vein. If you just inject insulin, as we do with insulin therapy, exogenous insulin, as you call it, you're putting insulin eventually into the circulation. So it has to, by the time it gets to the pancreas, it's seeing an entirely different dose. The pancreatic alpha cells are seeing a very different dose than they would if insulin was secreted from the pancreas. And these are all revelations that are made by really good researchers, physiologists studying these systems through the 20th century. And the implications are profound for how we treat the disease. And yet when you look back at this history, you see that the way we treat this disease never really changes in response to a changing understanding of the disease itself.

[00:24:52.150] – Allan

And even when it does, it's three decades later.

[00:24:55.490] – Gary

It's three decades later. But even today, we have these wonderful new drugs, GLP-1 agonists, Receptor agonists, that are used to treat both diabetes and are considered wonder drugs for obesity. And the way the researchers think about those drugs working is purely through the insulin system because they think, Oh, these drugs reduce, they bring blood sugar under control. Therefore, they must be stimulating insulin secretion. And in cell cultures, they will indeed stimulate insulin secretion. But when you actually… They are called glucagon-like peptides for a reason, because they are very much like a glucagon, and they're the proteins in their shape and configuration, and they have an effect on glucagon as well. And what you could be seeing is a glucagon-related effect, not an insulin-related effect. But that's not how people think about it. One of the messages with the research I've done is that when you talk about all the mistakes that were made in medicine along the way, they don't tend to become trivial. They tend to become compounded with time. They pollute the science ever after because people just embrace these things as the correct way to think about it.

[00:26:19.680] – Allan

I want to jump ahead a little bit here. Now, obviously, okay, so a wonder drug, if you will, or basically a hormone, is starting to help people live a lot longer than they would lived otherwise. And so as a result, now they're actually starting to see some of the downstream effect of folks with diabetes that live a little bit longer and or maybe even the effect of insulin itself when it's injected this way. And that's heart disease, atherosclerosis, and some of the other diseases that are out there. Can you describe why there's such a huge correlation between diabetes and heart disease and the other metabolic diseases?

[00:26:57.500] – Gary

Well, again, it gets As soon as we get into it, it gets complicated. So it happened, like I said, once insulin is discovered and insulin therapy is initiated almost exactly 100 years ago, you can suddenly keep patients with diabetes a lot longer. And this alive a lot longer than otherwise. So this includes not just young kids who are diagnosed with type 1 diabetes or at the brink of death, and now you can keep them alive indefinitely. But the folks with the chronic form of the disease that associates with obesity and aging, a type 2 diabetes who wouldn't show up into the doctor until they had lost a lot of weight and were clearly suffering insulin deficiency. So now you're giving them insulin, you're keeping them alive. And then by the late 19 '20s, early 1930s, you start seeing this wave of complications comes in the medical community. So all these… And kids who might have been diagnosed at age 12 and kept alive for 20 years by insulin, which is the miracle aspect of it, are now dying in their early, late '20s, early '30s of heart disease, kidney failure, blindness. They're getting all these awful complications.

[00:28:13.110] – Gary

It's still tragic. They're still dying way too young. It's as though they're aging too quickly because they're getting these diseases that strike the rest of us in our '50s, '60s, '70s, and '80s. They're getting them in their '20s and '30s. And the physicians are confronted with this now. And I should say, as this has been happening, the physicians have been liberalizing the diet evermore because they think of insulin as a miracle drug. And they think rather than tell people to restrict the carbohydrates they eat, and minimize your doses of insulin, they're saying, Why don't we let people, particularly kids, eat whatever they want and cover it with insulin? So the insulin doses get higher and higher. The drugs do a very poor job of controlling insulin, but the physicians can't. Excuse me, controlling blood sugar, but the physicians can't really measure. They can't measure blood sugar in any meaningful way, so they don't know that. And when these diabetic wave of complications washes over their patients, they don't really know what to do about it. They assume it's because their blood sugar is poorly controlled. They never think that it might be related to the insulin they're giving them as well.

[00:29:30.070] – Gary

It's hard for physicians to think that the drugs they're giving them are also creating complications. And by the time the medical community starts using randomized control trials to test drugs and diets to see what works and the long term risks and benefits. That's 1950s, 1960s. This belief system that we should let patients eat carbohydrate liberal diet. We should let them eat whatever everyone else eats. They have to count it. They have to count their carbs at breakfast, lunch, and dinner, so they know how much they're eating, so they know how much insulin to take. They have to take specific doses of carbs at snacks, so they cover that insulin. And the insulin covers the carbs, but we're not going to tell them they can't eat pasta, bread, potatoes, because they're not going to listen to us anyway. So these are all assumptions that are embraced. And this diet never gets tested. And through the 1970s and onward, as a diabetes community starts doing ever larger and more rigorous tests to test their assumptions about keeping blood sugar under control by drugs. The assumptions almost invariably fail to be confirmed by the study. So they find it's just harder.

[00:30:48.990] – Gary

And no matter what they do, the complications from the disease seem to be inevitable. And they never test the idea that one of the problems is the diet, that as long as you let patients eat whatever carbohydrates they want, they are going to get complications and these long term chronic effects. And that the other problem might be the insulin and the drugs they're giving as well. And that's never really embraced. When it's tested, the tests seem to demonstrate that that's what's happening, but that's not how these physicians are thinking. So you've got a situation. In fact, there's two ways to think about treating this disease. And there were two ways to think about it back in the 1920s. One is the symptoms only appear when people eat carbohydrate-rich foods. So I'm not talking green leafy vegetables, but starches, potatoes, grains. And if they minimize consumption of those or abstain from those foods, they either won't manifest symptoms of the disease or the symptoms can be controlled with very low doses of drugs. Patients with type 1 diabetes will always need a little some insulin, but they'll need a lot less if they don't eat carbs.

[00:32:07.860] – Gary

Patients with type 2 diabetes might not need any drugs at all if they abstain from eating these foods. And then the other way to think about it is the way we did, which is you let them eat whatever they want. Although maybe you say you got to, again, rigorously count the calories, the carb calories in every meal so you know how much drugs you should be taking, and then you cover it with drugs. And we never actually… The point I'm making in this book is that when you look at these clinical trials and you look what was tested over the past 40 years, when we really started doing these tests, This is a degenerative chronic disease that requires more and more drug therapy as time goes on if you're eating a carbohydrate-rich diet. And it very likely is not, if you're not if you're abstaining from those carbs.

[00:33:02.310] – Allan

As you went through it in the book, it was one of those moments where I was like, there were doctors that got it with that minimum effective dose. Let's not give them more than they need. Let's put it together with eating That's a concept I haven't seen in medicine a lot at all. And particularly, start talking about heart disease, you start talking about other things. There really isn't enough conversation, at least in my opinion, about how food is medicine, even though that concept has been around for quite some time, it doesn't seem to be practiced as much. I saw a lot more of that in this book than I expected to see in the history. So let's say you happen to go to the doctor and they told you, Hey, Gary, your numbers are up. Your A1c is starting to hit that point. We're going to call this prediabetes. What are you going to eat from that point forward? You probably already eat that way.

[00:33:58.640] – Gary

I do already eat that way because one of the messages from all my books, and again, which is based on arguably doing more research in the literature than anyone alive up to a certain point in time.

[00:34:12.610] – Allan

I think you got the meta study down.

[00:34:16.000] – Gary

Yeah, it's a cluster of chronic diseases that associate together. And by that, I mean, they associate together in populations. They appear in populations together. They become epidemic together. And And they appear in patients. If you have one, you're much more likely to have the others. And this is obesity and diabetes and gout and heart disease, and cancer is one of them, and dementia is one of them. Basically, all the chronic diseases that are likely to shorten our lives and kill us and make our old age, our oldest age, very uncomfortable are diseases that are associated with Western diets and lifestyles. And when you look into the history of this idea and the research, And the conventional thinking is it's caused by eating too much and maybe being sedentary and maybe the fat in the diet causes heart disease and the salt in the diet causes hypertension. And so strokes, cerebrovascular disease, and maybe the red meat and the alcohol cause gout, and every disease has a different trigger. And the other hypothesis that was always out there is these are caused basically by the refining of sugar and grains. Highly processed grains and sugars. And once you live in a population where that's a staple of your diet, these diseases are going to manifest themselves, they're going to be passed on from mother to child in the womb, so they're going to get worse with each generation.

[00:35:46.740] – Gary

And it seems to be what we're suffering from today. And the dietary therapy that that hypothesis implied, and that had been in many ways, conventional thinking for 200 years, is that if you avoid these carbohydrate-rich foods, you will be relatively healthy. This isn't really food as medicine, so much as some foods are simply toxic to some ever larger proportion of the population. And if we want to be healthy, we can't eat them. The Atkins diet, beginning in the 1960s, was a carbohydrate-restricted high fat diet. The animal diet for diabetes that was used from 1797 till insulin came in was a carbohydrate-restricted high fat diet. It was considered a very effective treatment for epilepsy beginning around 1920. And there was always significant evidence in the literature that people, some people just couldn't tolerate the carbs in the diet, that for whatever reasons, probably insulin-related and glucagon-related. These foods, when they're refined and they're digested quickly, today, we call them high glycemic index carbs. Again, sugars could be particularly bad for us, that if we don't eat those, we'll be healthy. And again, if you want to keep your calories up, then you have to replace those carbohydrate-rich foods with calories.

[00:37:23.450] – Gary

And inevitably, it's mostly fat. Even sources of protein come with attached unless there's skinless chicken breasts, which I don't think anyone should ever have to eat. So, yeah, all these lines of thinking lead you to believe that we should eat, in effect, if we want to be healthy, a very low carbohydrate diet, replace those calories with healthy fats. And now you're reading something that looks a lot like keto or Atkins or carnival even. And one of the subtexts of everything I write about, it's in the diabetes book as well, is as soon as the medical organizations like the American Diabetes Association, the American Heart Association, and National Institutes of Health, and then the US Department of Agriculture get involved. Once they start taking the conventional wisdom and turning it into dietary guidelines that we should all follow, anything that is divergent from that is treated as a fad diet or a quackery. It's dismissed as dangerous or harmful or something that people won't adhere to because we know people won't stick to a diet. And so the medical community thinks of all ways to convince people not to eat a diet, that this alternative hypothesis, which is based on the literature and the history, says it's probably the healthiest way to eat. It's… And that's how I eat.

[00:38:51.720] – Allan

Okay. The sad story of all this as you go through is they come up with the concept with insulin that you can cover up the carbohydrates, the volume of carbohydrates, and particularly sugar, that the American or the Western diet starts taking on escalates. And so we're no longer covering up 30 pounds of sugar a year, 40, 45 pounds. We're talking over 100 pounds to 150 pounds of sugar that a lot of people are eating in a year. And if you're using insulin to cover that up, we're not talking about five units here, 10 units there. We're talking in terms of a couple of hundred units here and a couple of hundred units there. So I think that sometimes when we think we have a miracle drug that allows us to do things, then everything just flips the other way, which gets me concerned about this glucagon-like peptide stuff that's coming out is that a lot of people are looking at it and saying, oh, well, that's going to help me lose 30 pounds. I'm going to do that instead of eating a diet that's going to help my body naturally get rid of body fat and eat a little bit less, maybe.

[00:40:02.190] – Allan

They're looking to something like that to cover it off, if you will. What are your thoughts about these new wonder drugs? I got chewed a little bit by a doctor that prescribes these because he's like, These are peptides. These are not drugs. These are just natural occurring things, which is probably a little true, but not something you're going to inject. Yeah, not something you're just going to inject. Once you start injecting something, I'm going to call it a drug.

[00:40:27.020] – Gary

Yeah, I think that's it. These are pretty profound variations on the naturally occurring hormones. But I have the same worries. I mean, the good news would be that because one of the effects, whether it's direct or indirect, is to so powerfully inhibit appetite, people are going to be eating a lot less of the foods that I would argue they shouldn't eat anyway. And it may be that these particularly target sweets. So one thing that when they talk about cravings going away, the things we tend to crave are sweets. So I suspect that's a kind way of saying people aren't craving desserts all the time, and maybe they're drinking less sugar, sweetened beverages. So that could balance out. And it's one of the interesting benefits. I do think that the world is full of people who, even if they eat a carnivore diet, would still have considerably more excess fat than they prefer, and that if they want to take care of that, the drugs would be beneficial. But I do worry that insulin to me, reading the insulin story in the literature was horrifying because you see how it could take 10 to 15 years before you really understand the bad things that could happen.

[00:41:46.240] – Gary

And by that time, it's too late. And I keep hoping that maybe I'm just misunderstanding the level, the kinds of clinical studies that have been done today so that somebody could convince me that I shouldn't be anxious that as millions and tens of millions of individuals embrace these drugs, we're not going to see the tidal wave of complications that we couldn't imagine. There are all kinds of other issues, like With pregnancy, for instance, if a young woman goes on the drug like Wegovy and then loses 50 pounds and gets married and then wants to have children, does she stay on the drug while she's pregnant? If she does what happens to the fetus, to the child. And if she gets off the drug before she goes pregnant, she'll be gaining weight back at a very considerable speed while she's pregnant. And we don't know what will happen to the child. And it could take 20, 30, 40, 50 years before we actually know the long term consequences of what happened in the womb. And so there are situations that I don't think we're prepared to deal with. But again, I'm hoping that I'm just naive here, that this is an area I could find the authorities who could convince me that I don't know what I'm talking about.

[00:43:06.080] – Allan

I think just the lesson that I took away from insulin here was it's not a cover. It doesn't mean that you just go full bore and you're free. And you can do what you want to do and you just take more to cover off on it. I look at this the same way and say, what lifestyle changes can you be making to support a lower weight when you get there? And that this is just a helper to get you to a point, like the guy who comes in and he's going into a coma, and that kid's going to be dead in a couple hours if they don't get that shot of insulin. So you give them the shot of insulin, and it revives them, and now you can deal with it. But in this case, again, I hope there's some lifestyle changes that come along with these things.

[00:43:51.030] – Gary

That's a good man. And again, one of the reasons I write these books is history. I'm trying to reach the physicians and the researchers to say, look, I I think if you did what I did, you would come to some of the same conclusions. If you looked at these histories and you saw that when we think about obesity, it's not an over eating problem. It's an effect of carbohydrate and tolerance problem. So if you could use these drugs to lower your weight significantly, but if you have to go off them, you will be… You probably won't gain the weight back if you don't eat these foods that caused you to gain the weight to begin with. And the drug will probably work better. But we don't actually know because these drugs are not tested on those of us who eat low carb, high fat ketogenic diets or testing on people who eat the standard American crap. So we don't even really know if they're healthy for us or as healthy or maybe more healthy. We represent… Our metabolisms run different. We burn fat for fuel. Other people burn carbohydrates for fuel. So there's a whole world of problems that comes with relying on a drug when these chronic disorders might be solvable, might be able to be put into remission with dietary changes that we can be pretty confident, but not absolutely confident, do not have those long term effects because we're eating diets that basically we evolved as a species to eat.

[00:45:22.830] – Gary

Whatever you do once you start talking about long term, 10, 20, 30, 40 years on a drug or a diet, we don't really what's going to happen.

[00:45:31.560] – Allan

We'll get back together and we'll do that podcast episode, okay?

[00:45:34.100] – Gary

With luck. I think the odds are better for you than for me.

[00:45:39.410] – Allan

We'll see. You're going to write the book anyway. Gary, I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and stay well?

[00:45:51.140] – Gary

Now you're asking a journalist to give advice, and that's never a good idea. Eat the diet that makes you feel healthiest in the short run. So by that, I mean, if you suffer from a chronic disorder, which can be obesity or diabetes or heart disease, a little tougher. But let's stick with obesity diabetes, where you can actually experience the symptoms in the short term. If you can find a diet that makes those symptoms go away, which includes excess weight and high blood sugar and high blood pressure, then that's how you should eat. And in that case, you have to do your research so that you understand what the arguments are for eating this way, this eating pattern, and how to follow it. So that would be the first thing. I believe there's some foods we just shouldn't eat because they're bad for us, and that we'll get over missing them as we get healthy. The others become trivial to me after that. I mean, getting enough sleep and physical activity because I don't know if they'll make us live longer, but they tend to make people happier and emotionally balanced in the short run. So that's true.

[00:47:04.950] – Gary

My expertise is purely diet, and even there as a journalist.

[00:47:09.440] – Allan

Well, thank you. And they say that the value of history is to learn so we don't repeat it. So I'm glad you did take the time to write this book the way you did, because I do think that a lot of doctors can look back and say, okay, here's what we know, and here's what we've learned, and here's what we know we should probably should be doing regardless. And so I think it's a valuable book for anybody, including medical professionals that want to just know why we think the way we think when they really haven't seen any literature that proves what we think. So thank you for that. If someone wanted to learn more about you, learn more about your book, Rethinking Diabetes, where would you like for me to send them?

[00:47:46.640] – Gary

Well, Amazon to purchase a book. I do think it's a typical author. I think it's very much worth reading.

[00:47:54.640] – Allan

I do, too.

[00:47:55.270] – Gary

I have a website, garytaubes.com. I am I have a sub stack now with the wonderful journalist Nina Tysholtz called Unsettled Science, in which we discuss these issues of nutrition and chronic disease and the various influences in the science that perhaps shouldn't be there. And I tweet @garytaubes, although not as often as I should.

[00:48:23.240] – Allan

Well, thank you. Gary, thank you so much for being a part of 40 plus fitness.

[00:48:27.180] – Gary

Thank you, Allan.

Post Show/Recap

[00:48:29.200] – Allan

Welcome back, Ras.

[00:48:30.360] – Rachel

Hey, Allan. That was a really fascinating discussion. There's so much to talk about the history of diabetes. It's just one of those things that I've always just known existed. But I didn't realize that insulin was only invented in 1920 or 1921, I think.

[00:48:44.930] – Rachel

That feels so recent.

[00:48:46.860] – Allan

They found it in the early '20s, 1920s. So it's just a little over 100 years old. That's crazy. And then because they understood what was happening, particularly with, at that point in time, type 1 diabetics, because there weren't that many type 2 diabetics. It just didn't happen as often. It was a type 1. And that's why it's called type 1. It was the first one. They like, okay, they don't have insulin. So what happens is they end up in a coma, and they bring them into the hospital in a coma. And in the past, they pretty much said they're just going to die. And so now they're like, okay, we inject them with this insulin. They didn't know how much. They didn't know anything. They was like, just- Try this.inject them. Yeah. So they injected in and some of them were recovering. And so like, oh, so they need this insulin to do the process. So now they didn't fully understand what all was going on with the process, but they could see the relationship between insulin and blood sugar. And so that's what they started working with.

[00:49:45.490] – Rachel

And it's interesting that they had some dietary protocols until they figured out of what insulin was and how it works. But in the beginning, they did have some very interesting dietary protocol.

[00:49:55.730] – Allan

Well, they did because they understood it was the sugar and not having insulin. So it was like, well, some doctors were, well, if they don't eat, then they should be fine if you don't ever eat. Don't eat. So they were. Some of them were on… They were putting… People were going on starvation diets, realized that the medical system was very different back then. So they could do experimentation on their clients with the patients without really worrying about it. They were just doing everything they could think of to solve a problem. Sharing information with other doctors. Like, I tried this with this client and it worked. This client, it didn't. So this is something to think about because it had worked. But dietary was one of the core ones because there weren't a lot. Metformin didn't exist. Other drugs didn't exist. So really, they didn't have anything. So that's all they could really do was change your behavior or change the way you eat, change your movement, change your output. And so they had done this. There was one doctor that speculated that you could just feed people fat to replace the calories. So protein and fat instead of a more balanced meal.

[00:51:02.480] – Allan

And that was working for a lot of type 1 diabetics. They were staying alive longer. They still would, at some point in time, potentially go into a coma and die because you can't change what someone's eating when they're unconscious and can't eat. And so that would happen. What was so weird, in my opinion, was that the instant we had access to this, we call it a drug, but it's basically a hormone, but a drug, since we had this thing, everybody dropped every every other protocol out there and just move on. Now, that was fine for a while, but the thing was people started living longer. And the other diseases of lifestyle that are associated with diabetes, like heart disease and kidney issues, they still came on. But now you saw them because before, the first time you maybe knew they had a problem was when they showed up in a coma, and then they died shortly thereafter. Here, they're living into their 40s and having heart disease, which compared to a normal average person, might be 10 to 20 years earlier. They were thinking, oh, the high fat diets that these folks are eating are the problem.

[00:52:12.290] – Allan

So we need to make sure they're eating a carbohydrate rich diet. They've got insulin to cover off on it. So don't worry about that. So it's this… And they're trying to solve a problem. So it's hard to look at them and say, you didn't know what you were doing. True, because they didn't know what they didn't know. But we're at a point right now where I just, other than the fact that compliance would always be an issue, it just chaps me that we don't go with medicine as a food first, lifestyle first approach.

[00:52:43.710] – Rachel

For sure. Well, towards the end of the interview, he mentioned the term dietary therapy. I feel like that's a great term because if you have a condition, especially diabetes, if there are certain foods that make that condition worse, why would you want to take them? Even though you have the insulin to cover them up, why put that fuel on the fire if you don't need it?

[00:53:04.180] – Allan

I like that term, too, because at this point, yes, it is effectively acknowledging that food is medicine. Someone said that a long, long, long time ago. So we've known that for a long time. We just ignore it most of the time because it's not cool and you can't sell that diet necessarily. Doctors can't sell it. Pharmaco companies can't sell it. What they want is like, Here's your shot. Go have at it. Do what you want to do. Here's a pill. Go have at it. That's why I wanted to talk about, even though he didn't do a lot in his book about GLP-1s, those are coming out now and they're so popular and it's like, Oh, I'm not hungry, and I lose all this weight, 15% of my body weight is gone. As long as I keep taking these shots, which are like a thousand dollars each, I do that once a week. Chepers. Yeah. So think about that's okay. That's a new car every year.

[00:53:57.810] – Rachel

Oh, my gosh.

[00:53:59.320] – Allan

You know? Yeah. And you're just doing that so that you can maintain a lifestyle that's not what it should be. And so that's where I really struggle with it. So I think you calling it a therapy is going to help some people probably turn on their brain. But then also the problem is, well, then after I'm cured, I stop the therapy, and that could fundamentally backfire as well. So yes, it's life-saving, and it's incredible that insulin was found and has saved lots of lives, extended lives a lot longer than they would have. But if you don't change your lifestyle, then all you've really done is just delayed it and changed the way you're going to die, what you may die of. So heart disease, kidney disease, gangrene, Alzheimer's, all of that. And you're not going to have it when most people would have it. So you're not like in your '70s or '80s or '90s dealing with this stuff. You're dealing with it in your '40s, '50s, and '60s. Too early. Yeah, way too early. So the instant you walk in and the doctor says your A1c is a little high, his next words that are going to come out of his mouth is, I'm not really worried about that.

[00:55:12.590] – Rachel


[00:55:13.380] – Allan

And the reason is, it's Because of all the patients that come in his office, the vast majority are. I read a survey this week, thing that said by 2030, now that date just sounds hugely far away, but it's seven years. I mean, it's not that far away anymore. Yeah, exactly. He'll be alive in 2030. I hope. But by that point in time, half of Americans will be obese.

[00:55:40.230] – Rachel

That's crazy.

[00:55:42.350] – Allan

Half of us.

[00:55:43.460] – Rachel

That's crazy.

[00:55:44.050] – Allan

Will be obese.

[00:55:45.990] – Rachel

Oh, my gosh.

[00:55:46.960] – Allan

At the current rate we're going. So if you're not going to change your lifestyle, if the doctor tells you, don't worry about it, you're close, you're borderline, it's time for you to implement dietary

[00:56:00.700] – Rachel

Well, that's the needle, okay?

[00:56:03.520] – Rachel

That's the needle. If your doctor says that you're looking at prediabetes, then you can either let that needle go forward straight into diabetes, or you can stop it there and go backwards and reclaim your health through all of the interventions that we talk about all the time. Better diet and exercise.

[00:56:21.180] – Allan

The cool thing about this is we're at a point in time with what they know about genetics and what they're learning and getting some of the judgment out of where things like AI will just go out there and say, if this, then that. And they'll do it at such a crazy level of what your gene expression is at any given point in time. Have these treatments that could extend life not just an extra few years, but like decades and decades. Sure. There's a theory that at some point we could basically almost become immortal. Anyone would want that, but basically that the medical establishment will get ahead of the curve. And with every year, they'll be able to add more than a year of life. So you start thinking about the ability of medical science to add to and extend life. The only reason that it's not going up drastically right now is because of the way we're living our lives with lifestyle things. So if we fixed our lifestyle, we would live much, much longer than our parents. Our kids will live a lot, lot longer than us.

[00:57:27.990] – Rachel

Longer is great, but I want to put in high quality. I don't want to just sit on the couch for decades. I want to be active and moving and being capable of living a high quality of life. I think with the metformin, which is often prescribed for prediabetics as well as insulin, when you get to that point of diabetes, if you're looking at type 2 and not born with type 1. But those are just the tools. That's not the answer. That is one thing that can help you live a healthier life. But I think we often We look at that as the answer, the end, the one thing to do to manage this illness. But it's not. We really need to go back, and like we say every week, Allan, get into an exercise program and eat way better foods to manage and be healthy.

[00:58:17.340] – Allan

And that's why there was the doctor, because so many people have high cholesterol, his solution was, just like we did with fluoride for dental cavities, was to put it in the water, put statins in the water.

[00:58:31.450] – Rachel

Oh, oh.

[00:58:34.110] – Allan

Okay. No, no. Because, again, they do not believe that you can do this. And what I can say is, even just the keto diet or people eating a lot more whole food. That is a fraction of the total way that people eat. But that's getting bigger every year. The number of people who try keto and are successful with it gets bigger every year. And so there is success here, but you have to make that choice. You have to make that effort to make that lifestyle change, or it won't happen.

[00:59:06.510] – Rachel

Yeah, that's absolutely it. Bottom line.

[00:59:09.170] – Allan

Yeah. All right. Well, I'll talk to you next week.

[00:59:11.560] – Rachel

Awesome. Take care, Allan.

[00:59:13.050] – Allan

You, too. Bye.

[00:59:13.940] – Rachel

Thanks. Bye, bye.

Music by Dave Gerhart


The following listeners have sponsored this show by pledging on our Patreon Page:

– Anne Lynch– Ken McQuade– Leigh Tanner
– Debbie Ralston– John Dachauer– Tim Alexander
– Eliza Lamb

Thank you!

Another episode you may enjoy


January 18, 2021

The case for keto with Gary Taubes

Apple Google Spotify Overcast Youtube

Few people put in the amount of research journalist Gary Taubes does when he's writing a book. In his new book, The Case for Keto, Gary really dives deep into the nutrition science to walk us point-by-point through determining if the ketogenic diet is the right way to eat.


Let's Say Hello

[00:01:48.020] – Allan
Raz, how are things going?

[00:01:50.540] – Rachel
Good, how are you today, Allan?

[00:01:52.340] – Allan
I'm doing okay. Working on getting the gym open. We got some space next door, so we've been able to spread the equipment out a little bit more, which should help when we go to the health department. And my goal is before the end of this month to have the gym open and now it's just some final cleanups and put together and things like that to get it all ready. And then I've got a crew scheduled to come in and help me do some deep cleaning. So we're going to get everything set up. And I had to pull everything apart and clean it all up and then put it all back in.

[00:02:24.830] – Rachel

Yeah, it's a lot of work. I've done it a few times myself over the years. And one of the things that I've come to understand is that you can't go 11 months without significant training. You know, I'm doing some training, but it's not like I was before. My strength has dropped. I'm not as strong. So I actually had to hire some people to help me move a piece of equipment today.

[00:02:49.940] – Rachel
Oh, boy.

[00:02:52.160] – Allan
I moved it all over the gym before, but it is really, really heavy. It probably weighs about 400 pounds. So it's not a light piece of equipment. But I used to be able to just drag it all over the gym. Not a problem that wasn't happening for me today. I gave it a tug. It moved about four inches. And I'm like, okay, I really have to move this about 20 feet. So, little four inch increments. That was a lot of polling. So I went out and I asked a couple of local guys that work at the water taxi across the street, and I said, you guys wanna help me out? And I said, I think I will need about two of you. And two of them came in. One of them came in and he's like, he was going to get underneath and lift it up. And I'm like, it's kind of heavy. He says “I'm really strong.” I said, “I am, too.”

[00:03:33.470] – Allan
And he went to make the tug and it didn't move at all. And his friends laughed at him. And then they went and got another guy in there to help us as three guys and myself. We got it. We got it moved.

[00:03:41.930] – Rachel
Oh, how wonderful. Gosh, how crazy!

[00:03:47.420] – Allan
It is. But it was fun. It was fun. And I'm getting things in. It's lining up. And so I'm hopeful we can get the health department here in Bocas to see it as a good place for people to be and exercise. We'll have a clean up plan, have everything going. So a lot of moving and shaking there. And then, of course, started kind of launching a twelve-week program for my for my online trainee's and, you know, for people over 40.

[00:04:13.070] – Allan
And it's. Yeah. That's going really well. I'm super excited about the folks that are coming in. They're energized. You know, our private Facebook group is there where we're checking and everybody's everybody's getting really excited and doing some things here. So, you know, and even just the first couple check ins of folks coming through, I'm like, wow, you guys are just you're just flooringme. I've got some awesome people in there and it just everyday seems to be getting better and better.

[00:04:39.410] – Rachel
Isn't that exciting? I love to see when people get excited about trying something new, a new training program or something and really taking the reins on what they want out of their health and fitness. I love that.

[00:04:51.950] – Allan
Yeah, well, of course. Me too. That's why I'm doing this.

[00:04:54.800] – Rachel
For sure.

[00:04:56.070] – Allan
So what have you been up to?

[00:04:58.130] – Rachel
Actually, something similar myself. I love resolutions. I love making plans at the beginning of the year. I, I love the idea of settling in on a goal and I have some big running goals for myself this year. But in order to reach those goals, I know I need to branch out and do some other things besides running. So I've been putting together a body weight routine that I call the runner's workout. I'm putting the final touches on it and I hope to have it ready to share pretty soon.

[00:05:30.170] – Rachel
Cool. I'm looking forward to seeing that's going to be really good. That's really good. All right. So today our guest is Gary Taubes. And Gary, Gary is one of my favorite people because he thinks like a journalist, but he also understands health really, really well. And so he gets into these concepts of keto. So the book is called The Case for Keto. And I've had him on before The Case Against Sugar. And he sold me on that one for sure, because now, you know, I'm as against sugar as ever.

[00:06:06.200] – Allan
But his book The Case for Keto is really, really good. I was really excited to have him on the podcast again. So I guess let's go ahead and have that conversation with Gary.


[00:06:36.920] – Allan
Gary, welcome to 40+ Fitness.

[00:06:39.860] – Gary
Thank you for having me.

[00:06:42.080] – Allan
This is the second time you've been on the show. We had you on for The Case Against Sugar, which was episode 224, that was 245 episodes ago, and I still recommend people go read the book The Case Against Sugar. It's as relevant, if not more relevant today than it was then in 2017. And the book we're going to talk about today is called The Case for Keto: Rethinking Weight Control and the Science of Low-Carb High-Fat Eating.

[00:07:11.570] – Allan
And the thing I like, Gary, about the way that you approach these topics is that you put together a case which is what you're doing, and you're thinking in terms of how do I build up a body of evidence that really proves this. And it's not just you're going to go across and say, well, everybody knows and then stop and just use that as your anchor. You have no anchors. But the fact that you've done more research then probably anyone else in the field of nutrition, which is actually kind of sad considering you're a journalist and not a scientist, but you've done you've done more work in the nutrition field to understand why we think the way we do, why we do the things we do and why things work the way they do inside our bodies than maybe any any other human being on Earth. And it's just fascinating to read your stuff.

[00:08:07.470] – Gary
Thank you. You know, it's funny, as a journalist, you just keep asking questions until, well, I would like to say until there are no questions to be asked, but basically eventually you will reach a point of diminishing returns where your mathematicians are saying you're asymptotically approaching the endpoint. And yeah, I when I started this 20, almost 25 years ago, I had no biases. I was believe what we all believed about a low fat diet and then red meat being deadly.

[00:08:49.180] – Gary
And and then I but I was an investigative journalist with a science background. So I stumbled into this field. I wanted to know what the truth was. I just kept asking questions. I also hate writing. So research is a great procrastination tool as long as you keep doing research, you don't actually have to sit down and do the hard work of synthesizing it, making it reasonable.

[00:09:12.730] – Allan
Well, you did. And thank you for that, because you went through an entire history. And that's another thing. I mean, as we're talking about why we are where we are. We have to kind of understand some of the history, it's not if we try to put that anchor point in, this is the ultimate truth and we don't go back and at least understand where that truth came from and question that truth, which you as a journalist do, then there's a lot of things that can go wrong.

[00:09:48.320] – Allan
In a way, I kind of think about this is in terms of geometry. You know, you work as a kid, you work in the geometry problem and they make you show you work. And so you sit down, you prove that first thing and then therefore you can prove the second thing and therefore you can prove the third thing. And you have to do all three of those in that order or it doesn't work. And a lot of the science we have right now skipped through the first two proofs and now we're at the third proof.

[00:10:16.010] – Allan
This book doesn't do that. Why are we where we are? And what happened? What went wrong?

[00:10:22.460] – Gary
So this is what's happened to me. So my obsession has always been good science and bad science, more so than nutrition. It's just, the themes and bad science play out so well in nutrition and so continuously and obesity and diabetes research also. But one of the things that fascinated me is I grew up in the physics world and in physics. You learn the science, the history attached. Right. In part because as the history as you move forward in time, the science gets more complicated to start with, like Newton's laws. And you learn about Newton and you learn about the laws. And every law has a name attached to it. Every discovery has someone's name attached or whether it's, the variables, the units being teslas and gauses and ohms are people's names to learn who did the work, what they did, what they saw, what the alternative hypotheses were. You get to Einstein's theory of relativity. It's only when you get to quantum physics in the twentieth century that we tend to start using the name, leaving the names behind.

[00:11:28.250] – Gary
But any student of physics knows who did the work and what they did and what experiments were done to test it and what those experiments on. And I don't know, in medicine, you don't do that. The textbooks don't talk about the history. There's too much to learn. There's too much you have to digest in order to the theory goes to diagnose and treat patients. So maybe the ideas don't have time to learn it.

[00:11:52.830] – Gary
So as a journalist, when I got into this, I wanted to learn the evidence-based first behind the idea that salt causes high blood pressure. And that led me to the evidence behind dietary fat and heart disease, and that led me to the obesity story. So as a journalist, you start going back in time because we've accepted certain facts, dogma or consensus. So you go back in time to find out when they were still up for grabs, when there was still a controversy and no consensus formed over what we believe and see what the evidence was and what forged the controversy? Was it compelling evidence or was it political or sociological forces? And in nutrition, obesity was always the latter.

[00:12:44.460] – Gary
Go all the way back to the early 20th century for obesity and again, when we think of the obesity research community today, we think of hundreds, thousands of research around the world studying animals. Back then, obesity research constituted oh, I don't know, a dozen positions around the world, the German and Austrian clinicians with their schools of thinking and they had institutes with research physician, researcher in them. And these dozen people would write articles about obesity every few years.And in those articles, they might speculate as to what the cause was.

[00:13:21.910] – Gary
And there were two ideas of what the cause of obesity was. One is people eat too much: The gluttony idea. Sloth wasn't that much of an explanation back then, but you had Falstaff. A big, heavy set guy with a zest for living, sitting in a bar and he's got a leg of lamb with one hand and the tankard of ale in the other. And the reason he's fat is good. He's a glutton. And that was sort of the general thinking.

[00:13:49.950] – Gary
And then the other hypothesis was that obesity is a hormonal disorder that some people just put on weight no matter how little they eat. Okay? So some of us are predisposed to get fat, others aren't. The Germans and Austrians tend to embrace this hormonal predisposition idea, even though they didn't know how hormones regulated fat accumulation.

[00:14:13.110] – Gary
And in 1930, an American researcher named Lewis Newberg comes along the University of Michigan and he claims for the first time ever to have actually tested these two hypotheses experimentally. No one has ever done that before. And he claimed that the overrating hypothesis won, based on basically what he did, is he put some lean people on a semi-starvation diet and some obese people on a semi-starvation diet. And he said they kind of lost weight equally. It didn't matter whether they were obese. Therefore, the obese people didn't have some hormonal predisposition to make them trap fat. And nobody had ever done this so Newberg and the United States particularly has kind of embraced as getting it right.

[00:14:59.860] – Gary
And it fit preconceptions, right? Because lean physicians, because if you're lean it's easy to think fat people get fat because they too much. The Europeans, the Germans and Austrians kind of made fun of this energy balance idea, didn't explain anything. So if you want to explain like for instance, whether or not someone's obese or not, but why men and women fat differently, men put on fat above the waist, women tend to put on fat below the waist. So clearly hormones are involved, like why are there certain areas in our bodies we accumulate fat and other areas we don't? Why? There are things like lipomas, fatty tumors. All of these are independent of energy balance.

[00:15:44.500] – Gary
And you want a theory of obesity should be a theory of fat accumulation. So all of that is argued out in a few papers that go back and forth, the Austrian clinical investigator named Julius Bauer, the one of the leading figures in the field of endocrinology, says the energy balance thing is nonsense. The overeating hypothesis doesn't tell you anything. Newberg responds that the hormonal hypothesis doesn't tell you anything. World War II comes along. The European, German, Austrian schools evaporate. And post-World War Two, Newberg's overeating energy balance hypothesis is just embrace this fact.

[00:16:31.430] – Gary
Clearly fat people overeat and then for whatever reason, people start invoking the laws of thermodynamics as somehow relevant to this. And by the 1960s, you've got obesity research dominated by psychologists and psychiatrists who are trying to get fat people eat less.

[00:16:53.640] – Gary
And at the same time, you've got beginning in the 1930s, through the mid 1960s, a series of metabolism researchers, physiologists, PHds mostly rather than MDs to actually work out in the lab what regulates fat accumulation and the role different hormones play in regulating fat accumulation. And by the mid 1960s, it's clear that insulin dominates fat storage. The hormone insulin, it orchestrates partitioning in the body. When we burn fuels versus when we store them, use them for repair and regeneration. But it's the hormone that puts fat tissue and keeps it there. And so by the mid 1960s, you should have a hypothesis that obesity is a hormonal regulatory disorder, just like the Germans and Austrians had always said, where insulin dominates the length of diet.

[00:17:50.040] – Gary
And so all of this was just ignored, just ignored, because the obesity community has decided that fat people eat too much. Even when you look at the research in the field, they're not trying to explain fat accumulation. If you look at, for instance, the discovery of leptin, which is seen as a satiety hormone. The researchers are trying to explain appetite and hunger and why fat people might eat too much rather than why fat people might accumulate too much fat, which is an entirely different question.

[00:18:26.130] – Gary
So the latter is answered pretty much by elevated insulin and keep it elevated as it is in insulin resistance, and you're going to accumulate too much fat. But that's not even what we've been studying. And then the dietary implications, of course, are a disaster for 80 years, 90 years. Physicians tell their patients to eat less and exercise more because they think they're eating too much. And that's why they're getting fat.

[00:18:56.850] – Allan
When I was in high school, I thought I was going to be an NFL football player and offensive lineman, thought I was going to be this big, huge dude. I stopped growing in the 10th grade and couldn't put on any weight. I could eat and eat and eat and eat and in fact, really strongly believe that it was those eating habits that I developed when I was a teenager that set me up for having metabolic problems later because it was the type of food I was drinking a lot of milk, like a gallon of milk a day. I was eating loaves of bread because those were the things that put some weight on me. And so when I was younger, I was one of those folks that you would call just naturally lean. He can eat anything and everything and stay naturally.

That changed drastically after I turned 30, which again, is about the same time that certain hormones like testosterone. I was obviously I was working in corporate so my cortisol levels. I wasn't the carefree teenager anymore. My cortisol levels were obviously a lot higher. So I moved into that category in the book that you call fat and easily. And I think people who see this and they know this intrinsically. I'll have male clients and female clients and the male clients, if they really start working on the right things and do the things that are improving their overall health, they bounce back and they start losing weight a lot faster than females do. So a woman moves into menopause. And because her hormones change the structure of how and where she stores fat changes. So to sit there and completely poo poo hormones as having any involvement in this. I don't quite get it.

[00:20:49.010] – Gary
And this is what's so fascinating. On one hand, I mean, it's an interesting dynamic where. So Newberg did this. Because he had to answer questions after he said, as always, eating too much obesity always caused by eating too much. And so people said, what about menopause? You know, if you look at and I did and even into the literature on animal literature in the 1920s, you can find and endocrinologies saying, well, you know, animals get when you remove the ovaries and a female animal, that animal got fatter. And so clearly what we're doing is removing it's not secreting estrogen anymore and estrogen inhibiting fat accumulation.

[00:21:26.100] – Gary
And I think it was in the case against sugar. I had a reference from 1927 making that point. And I mean endocrinology as the term has barely even been coined by that time. They're still calling glands ductless glands and the researchers studying animals know that female animals will get fat or if you remove their ovaries. But still what's happening in humans in Newberg's says, well it's got nothing to do with hormones, even in women going through menopause.

[00:21:56.790] – Gary
They're saying what happens is they their kids are grown, they're out there, they're bored with their husbands. I'm an incredibly sexist discussions going on and they don't really care how they look anymore. And they're playing bridge with their lady friends all day long and eating bonbons. So it's still overeating. And they said, well, what about children of obese parents? Because he, you know, Julius Bauer had done some of the first research showing that, you know, we had 500 obese patients and 400 of them had at least one obese parent. I forget the exact number. So clearly it's genetic. And why wouldn't you expect it to be genetics? No, it's not genetic. And, you know, children with obesity learn to overeat from their parents with obesity. The groaning board, they called it, they just put too much food out on the table and they don't learn to control their appetites.

[00:22:50.010] – Gary
So they had an argument that everything. Nothing could be hormonal, and when Bauer attacks Newberg and you see this today with bloggers and everywhere and politicians, rather than ease off the argument a little, Newberg hardened it. Nothing can be hormonal because of anything, could be hormonal. Perhaps it could all be hormonal.

[00:23:17.630] – Gary
And then the idea of hormones were easily accepted as an excuse when that's what fat people was trying to understand. The AtMe movement or even the Black Lives Matter movement, because as a older white male, I'm being told that I can fundamentally cannot understand their perspective. And they're right. Okay, they're just right. I can't. And then it struck me that what we've got is lean people who are giving us diet advice, right?

[00:23:47.140] – Gary
The idea is if it's eating too much, the difference between if you take two 18-year-olds, say. A good example, my brother and I, when we graduated from high school, he was two years older. But his senior year, he played football. He was six feet tall and 190 pounds, six foot five and 190. And I was six foot two and 190 or 195. We both played football. We were both pretty good. He never got over 195 pounds and I went up to 240.

[00:24:17.450] – Gary
He couldn't. And he had more than I did. We would both accept that the difference was the idea the reason I went to 240 is I ate too much. And the reason he never went over 195 is he didn't, even though he ate far more than I did. So you've got these lean people giving this advice and they don't know what it means. They don't understand what it's like to slowly get fatter year in and year out no matter what you do. Right?

[00:24:48.680] – Gary
So we've all been through this. You restrict what you eat, you give up sweets, you do your calorie counting and no matter what you do and this is why I use that phrase fat and easily. It's like 1950s diet book terminology, but some of us fatten easily. And if you're not one of us, you can't understand what that's like. And you can't just say, well, you got to eat less, dude, or get out and run around the track, because that doesn't stop our bodies from wanting to fatten easily.

[00:25:21.610] – Gary
And we have to understand why our bodies are doing that. You're lucky your body doesn't do that. Just like somebody who wants to play basketball is lucky if they grow to six foot eight rather than six feet tall. And we know that's hormonal.

[00:25:35.960] – Allan

[00:25:36.380] – Gary

[00:25:38.480] – Allan
Because they too much.

[00:25:39.890] – Gary
Not because they eat more than the six foot guy. And it's funny. That's what the first guy, a German, Gustaf von Burgmann, who sort of wrote up this hormonal idea and made fun of this eating balance/energy balance idea said you know, a growing child is hungry all the time. That's not why it's growing. And you would never tell the child, look, if you would just eat less, you won't get so tall because we know they're not related.

[00:26:12.260] – Gary
And yet they turn this into obesity. They're growing outward instead of upward. And suddenly you flip all the causality in telling them to eat less is somehow a solution. And it's just not.

[00:26:24.770] – Allan
You said something in the book that just kind of resonated with me, probably something I should just actually just have posted somewhere for people to read whenever we're talking, particularly when they're dealing with hunger, is that you indicated in the book hunger is a response, not a cause.

[00:26:45.380] – Gary
Right. If you look at any biological system other than obesity, hunger is a response to a calorie deficit. Basically, you burn more calories, you're growing. You're going to be hungry because your body needs is building is in positive energy balance. It's building bones and muscles and connective tissue. And it needs the energy to do that and it needs the resources to create that that new growth and the response is you're hungrier than you are if your body isn't growing.

[00:27:18.170] – Gary
The examples I used and why we get fat. My second book was, you know, an elephant eats more than an armadillo because it's and it eats and several orders of magnitude more food because it's several orders of magnitude bigger. We never have a system where the amount consumed drives the growth of the system. It's always the growth process that determines the amount consumed. And what's fascinating is in nutrition. So remember, we've got these lean people. Newburg, by the way, was pencil thin. We've got them saying, look, fat people get fat because they eat too much, so they should eat less. And if they eat less, they'll lose the weight and everything will be fine, but we actually had an experiment to look at what happens when lean people eat less. And that was his famous experiment, Ancel Keyes, who in the early 1940s was a relatively young, ambitious nutrition researcher at the University of Minnesota.

[00:28:20.830] – Gary
This was before his dietary fat work. And he did an experiment, a famous experiment on starvation. And he published two books, two volumes of the biology of human semi-starvation. And this was a it was a semi-starvation experiment. So we got thirty two or thirty four conscientious objectors. And the idea was to understand the physical and psychological consequences of semi-starvation because when we won the war in Europe, the assumption was we would be confronted with famine conditions and particularly Eastern Europe, and we would have to know how to treat these people. We'd have to understand medically what they're going through.

[00:29:08.200] – Gary
So the diet that Keyes fed these conscientious objectors was similar to what they expected they would see in Eastern Europe. So it's tubulars like potatoes and turnips and little green vegetables and some very lean, small portions of meat. So it's a low-fat, low calories, about 1600 calories a day, even though it's referred to as a semi-starvation diet. That's what men are told to eat if they want to lose weight at the rate of a pound or two a week. So 1600 calories a day of a low fat, mostly plant diet, a very healthy diet by today's standards and the obvious consequence of this diet, not surprisingly, if you feed someone a semi-starvation diet, they get exceedingly hungry because they're only eating half the calories that they need.

They thought about food constantly. They obsessed about food. They wrote about food in their diaries. Tf they had gum, they chew gum constantly. They dreamt about food at night. They weren't allowed out of the lab to walk around town without a buddy system because they couldn't be trusted not to cheat if they were allowed out of the confined area where the study was going on. Several of the subjects suffered what Keyes and his colleagues called, I think they call it semi-starvation neurosis or psychosis, they had mental breakdowns. One of them tried to mutilate himself, actually successfully cut off several fingers with an axe, claiming that an accident so he could get out of the study.

[00:30:57.540] – Gary
The assumption is a lean person can tell a person who suffers from obesity to eat less and maybe 1600 calories a day, and that person won't be able to just lose weight, that's all. The fat tissue will get about the excess calories and they'll be fine. But the reality is, we know that if a lean person were to eat 1600 calories a day, they'd be starving and unable to sustain it.

[00:31:21.810] – Gary
By the way, the other thing that happened at the end of this trial, they lost 15 pounds in the first three months and then weight loss slowed down and sort of ground to a halt. So eventually their weight loss was not all that meaningful. They didn't have a lot of extra fat to lose. Then they start refeeding them. Okay, so now you're feeding semi-starved individuals and they're voraciously hungry and they had to slow down the feeding so they wouldn't get sick, but they still could eat like 10000 calories a day and they ended up all putting on more fat than they lost, which Keyes and company called post-starvation obesity.

[00:32:05.100] – Gary
The comment in the book, because we've all been there, right? We've all tried to starve ourselves, lose the weight, and then eventually you end up with binge behavior because you can't sustain it and you end up fatter than you started. All of this had been documented in lean people, and yet that's still the advice. And then lean people, conceivably the most famous nutrition experiment in history. And yet the lean people who tell us to eat less don't pay attention to that, because if they did, they would have to figure out something else to tell us.

[00:32:38.730] – Allan
When I was in the army, in the infantry, and so we're training and the way they would work is they had these meals ready to eat, MREs. That they would give us. And each one was 1000 calories and we were allotted three of them in a day. So, you know, I'm a young, healthy male, too, you know, 20 years old, 21, 22, and they're giving me three thousand calories a day and I'm losing a pound a day, so if I went out for two weeks, I'd lose 14 pounds and I didn't really have that much extra body fat to lose at that point in time, because I was at the time, I was about 185 pounds, maybe one 195 relatively lean.

[00:33:22.830] – Allan
But I would lose a pound a day if I was out and I was doing everything I could to find calories. So there were people who liked coffee at the time. I wasn't interested in coffee. I would trade my coffees for their cocoas. I would say, are you eating your creamer and your sugar? And if they weren't going to use their creamer and sugar, I would barter for that and I would take those to make little sugar cookies.

[00:33:47.880] – Allan
And so I was learning all of these little tricks on how I could get more food. And in fact, we were going in an exercise and this other group came in and our job was just to disrupt them. And when they came in and drop their packs off, we ran them off with their packs. When we came back through, we realized they had food in their packs, so we stole all their food.

[00:34:11.070] – Gary
This is a funny thing because you were lean, right? It's not funny. It's tragic because you were lean. Nobody judged you.

[00:34:19.170] – Allan

[00:34:19.830] – Gary
As though you are a glutton or a sloth or you lacked willpower or anything like that. You were just hungry and you were doing what you needed to do to get the food you wanted. But had you been overweight or obese and someone had seen you stealing that food, they blame your lack of willpower for being overweight or obese. I had a conversation with excuse me, the nutritionist at NYU recently through email has been arguing for decades that it's all about calories and she told me that her father had been obese and he definitely had a voracious appetite. And I said, but look I've eaten dinner with her over the years. I once took her out to a wonderful, amazing Italian restaurant in Greenwich Village to thank her for being a source for one of my very first article on dietary fat. And I said, you've seen me eat right. I am twice your size. I eat more than twice the amount of food you eat and I will leave the table hungry. But you don't judge it because I'm not obese, right?

[00:35:33.390] – Gary
The reason they twice as much as you do is because I'm twice as big as you are. It's that simple. And if my body was trying to get bigger still by putting on fat, I'd be hungrier still. And she may have actually gotten that. Again, in this world, people very common phenomena, when you can when you try to get people to shift paradigms literally from this energy balance, thinking and gluttony and sloth to hormonal regulatory thinking and insulin and carbohydrates. You can get them to shift momentarily, but inevitably they snap back to the way they always believed.

[00:36:15.860] – Allan
There's a little bit of data there and, when you're when you get into a study where they'll do a well, they'll do a low-carb versus a high-carb switch but typically when they do that, they're really not going low-carb. They're they're going more of a moderate-carb kind of thing. And what they typically will show is for the first six weeks or so, these individuals that are on a low-carb diet lose more weight, but then they'll say six months later everything's pretty much even.

[00:36:47.420] – Allan
And I'm like, well, most of them weren't trained. That's how they were supposed to keep eating. So they went back to their old way of eating. And basically all you did was really. Yeah. Gave them a short term thing. And then you didn't pay attention to the fact that if they'd continue doing that thing for six months, it probably would have made quite a bit of difference.

[00:37:07.940] – Gary
The nutrition community has all kinds of excuses for why they can do bad experiments. So when they do those experiments, they don't test, for instance, whether a ketogenic diet leads to more weight loss than a low-fat or mostly plant diet. When the diets are sustained, they test the intervention. So they say, well, we've told people eat a low-fat diet and we told people to eat the ketogenic diet. And we gave them, you know, Atkins' book and Ornish's book or something like that. And then, you know, we just had them come in. We wanted to they they won't write it up like this. So they'll assume that they'll write it up as other people stayed on the diets. And then if you criticize and say, well, clearly from the data that people and stay on the diet and they say, then we know the diet to unsustainable. I co-founded a not for profit to try and improve the quality of nutrition science. We did some interesting experiments, but we did not succeed at improving the quality of nutrition science.

[00:38:18.690] – Allan
I guess the point I'm trying to get to is we're responsible for ourselves. And if we really want to get to the bottom of rather than most of us, I think we're listening to this and thinking we need to lose some weight. We probably fatten easily. We're probably not naturally lean. So we need to do something different than what is there, something different than what we've done? And if you've been concerned about the keto diet, just try and experiment.

[00:38:47.460] – Allan
And the experiment is to work with your hormones, looking at your carbs and your protein and your fat. And so, Gary, if someone was going to sit down and say, okay, I'm going to do an experiment, the subject is one. So my N=q and I'm going to do this experiment, how should they structure their experiment?

[00:39:06.720] – Gary
OK, so and this is why I wrote the book, by the way, among other things. So people know that they can do this. It's not going to kill them. Twenty years ago, you would have when I first did this as an experiment, I kept waiting for my heart attack. And then they have to understand how to do a right. Like any experiment, you have to get the methodology correct. So what we're doing with a low-carb, high-fat ketogenic diet. So remember, we broach this idea, the hormone insulin regulates fat accumulation. Insulin goes up, we store fat, insulin comes down, you start to mobilize and oxidize it. What's often not discussed is when insulin comes down, there's a threshold effect. So when I interviewed the researchers who studied fat metabolism, a phrase they often used was that fat cells are exquisitely sensitive to insulin. So if you're secreting even a little bit of insulin, your fat cells are detecting that. And that insulin is inhibiting what's called lipolisis, which is mobilization of fat from the fat cells.

[00:40:11.090] – Gary
So when you want to do if you're overweight or obese, you want to get fat out of your fat cell. So the fat cells, lipolisize fat, it's stored so it can come out and then you want to burn it for fuel. And what to do that you have to minimize your insulin levels, probably.

[00:40:29.310] – Gary
So ketogenic diet minimizes insulin. That's what it does. And it does that by replacing the carbohydrates, you consume all the carbohydrate rich foods. So everything other than green leafy vegetables and so on. It's a high-fat diet. So you're not eating grains, sweets, starches, legumes, because they're all carb, relatively carb rich. You're eating green leafy vegetables, eggs, meat, fish, fowl, butter. Animal sources of fat. In practice, it's actually very easy to do, it sounds complicated, but breakfast, if you eat breakfast and most of us in this world are many of us are now doing the intermittent fasting as well as our time-restricted eating. We just don't eat breakfast anymore. But if you do, instead of your usual carbs sources, toast, cereal, juice, skim milk, fruit, you're eating eggs and bacon.

[00:41:34.680] – Gary
It's the hardest thing to get over is the belief that eggs and bacon are going to kill you or eggs and sausage or kippers and sour cream, trout, leftover food from dinner. And then your lunches. I don't know. I lived in New York when I first came to L.A. when I first did this as an experiment. And I was a writer and I was unmarrieds. You tend to eat out every meal and inexpensive restaurants. And so I'd go out and instead of getting half a roast chicken with French fries and broccoli, I would order that roast chicken, say, hold the fries, give me a double or broccoli or, you know, hold the fries or the baked potato, give me an extra order of salad. And so you end up eating more green leafy vegetables than you ever did. Some vitamin deficiencies are not an issue.

[00:42:28.450] – Gary
Same for dinner. Dinner was instead of steak and potatoes and broccoli, it was steak and broccoli. You're just not eating the starches, the grains and the sugar, basically. and most people who do this and do it right. So the idea I remember is also so insulin dominates fat accumulation, carbohydrates dominate insulin regulation. So the simplest way to think of this is carbohydrates are fattening. That's what our parents generation grew up believing anyway. And so if carbohydrates are fattening and you don't eat them. Because at any time and what you eat them, they will work to make you fat or and if you try to prevent yourself from getting fat, it just make you hungry.

[00:43:21.640] – Gary
So you abstain from carbs. You replace it with fatty sources of food. You don't worry about the fat content as long as it's coming from sort of naturally occurring foods and people get healthier, they just they do. In the book, I describe this sort of cognitive dissonance between two conflicting definitions of a healthy diet. One is what we're told to eat fruits, vegetables, whole grains, legumes, lean meat in moderation.

[00:43:57.610] – Gary
And the other is what actually makes people like you and me healthier, which is green, leafy vegetables and meat, fish and pound dairy and eggs.

[00:44:09.370] – Allan
Yeah, it was interesting because someone posted on my Facebook group. They were looking they were struggling with keto. They had some struggles with keto diet and they wanted a balanced diet. And then, of course, there was another person that responded. Isn't that an oxymoron? And I had to respond and say, absolutely not. I mean, I probably eat. I would say ounce for ounce more vegetables because they're leafy green than I do eat meat when it's all said and done.

[00:44:40.390] – Allan
And yeah, there's some fat in there to make it actually taste delicious. But, you know, is just because everybody wants to nitpick and, you know, they're like, oh, it's the bacon diet. I'm like, well, they have a little bit of bacon. It's condiment. It's it's an aside, you know, it's like that's not their main protein. We're not all sitting around running around eating pounds and pounds of bacon. Now, yes, there are some people that are doing that, but in a general sense, you can have a balanced, fully nutritious diet. You have to have the understandings of what your body needs with regards to vitamins, minerals and particularly electrolytes. If we're going to go into ketosis because we're going to flush some water and just understanding those basic things is just a function of knowing how your body responds to food and eating appropriately.

[00:45:30.880] – Gary
And that's it. It's unlearning a lot of the simplistic crap we were taught. And then basing thinking about your diet in terms of human physiology instead of some, you know, like we're thermodynamic experiments. My favorite part, so part of what I did in this book, I interviewed over 120 odd physicians who had converted to this way of thinking. I estimate there are tens of thousands now worldwide at least to do this, but who now eat this way themselves and prescribe it to their patients. And by interviewing all these physicians, I could understand the challenges to them and to their patients and how they overcame those challenges. And at the end of the book, I give advice based on and ways to both think about this and do this, so that the eating a low-carb, high-fat ketogenic regime is something they can do for a lifetime.

[00:46:31.800] – Gary
But my I think my favorite chapter is. I start with the quote from a woman named Doctor named Carrie Doulos, who's a spine surgeon in Ohio. And Carrie comes from a family with a history of obesity and says without understanding her diet, she'd be 300 pounds. She's also a type one, has type one diabetes now, and she's a vegan. And she used to be a ketogenic diet. And she does so because she can tolerate animal products. So she would have she always had some ethical issues with them and she grew up ethically opposed to eating them. But she would do it if her body tolerated.

[00:47:13.260] – Gary
It just doesn't seem to do it. And she said it's it's not a religion. It's just about the way I feel, about how I feel. And to me, ultimately, that's kind of what we're doing here. And I play Carrie Doulos off against Georgia Edes, who's a psychologist, psychiatrist in western Massachusetts whose body doesn't seem to tolerate plant foods. And so Georgia is now a carnivore. All she eats exclusively is meat. And that's what makes her feel healthy and able to achieve a healthy weight. And as long as you know that you don't have any vitamin and mineral deficiencies and that you know your lipids are not insane, whatever that means is.

[00:47:58.220] – Gary
Of self-experiments until you found dumping crap food on us. And so we didn't really have to think about what we ate anymore. So you could give your kids sugary crap for breakfast and they'll eat it because it's full of sugar. And then you can give them take them to McDonald's or fast food restaurants and buy them a Coca-Cola and get them crap for lunch. And they'll eat that because the food industry did such a good job of making it palatable and the same for dinner and nobody had to think about it anymore. But there are people who think about it all the time or that the vegetarians and vegans have to think deeply about what they're eating and daily about making a healthy diet.

[00:48:38.210] – Gary
And anyone who is a foodie does it naturally and there's nothing more important to us. That's the fascinating thing. It's at least tied for being the single most important thing we can do in our lives, which is eat healthy. And it just requires some thought and practice to do it right? Nobody gets good at anything with that practice. The longer you do it, the easier it becomes. And meanwhile, we've been getting these messages from the nutrition community, don't even think about doing it. If you abstain from a if you don't eat the entire food group, that's an eating disorder. If it's unsustainable, don't try it anyway. Nobody can eat this way.

Even though it'll make you healthier, we're not going to tell you to do it because we don't believe you'll sustain it. I mean, sort of insane logic from the nutrition community. Whereas what they should be saying is being healthy takes work, you know, and so eat a diet that's designed physiologically to make you healthy, which this is, and then work at it so it gets easier. And now, of course, the food industry has settled. And so there are sort of you know, you can go on Amazon and buy a gazillion, you know, keto-friendly snacks and drink and God knows what they're doing for us.

[00:49:59.270] – Gary
But there they are. I was confronted yesterday with keto macaroons, I was always a big macaroon fan, I said I'm staring at the Amazon and blowing up the nutrition profile so I could see it going, wait a minute, wait a minute. They say it's keto-friendly. It's still like 14 grams of carbs.

[00:50:21.330] – Allan
You could probably tolerate two, maybe three of those.

[00:50:27.660] – Gary
You know, I mean, I could probably be very happy eating them, but I'm also very happy without eating them.

[00:50:32.740] – Allan
Yeah. Yeah.

[00:50:34.050] – Gary
And so ultimately, I passed.

[00:50:37.200] – Allan
Good for you, Gary. I define wellness as being the healthiest, fittest, and happiest you can be. What are three strategies or tactics to get and stay well?

[00:50:47.340] – Gary
OK, well, I'm a big fan of telling people what not to eat, okay? I know other people don't like negative messages, but don't eat sugar, starches, and grains.

[00:50:58.860] – Gary
Wear a mask.

[00:51:01.410] – Gary
And, you know, I don't know if I got a third. I'm a writer. We're tortured. Right. So telling people how to be happy, I feel like I'm not sure I'm certified to do that. But, get outside.

[00:51:17.340] – Gary
And one of the things that we used to be so part of the logic of the nutrition world is do you tell people to exercise? Because if you exercise, maybe they'll burn off calories. And I think of this as like a greyhound, the greyhounds of the world figuring if they can just get the bastard hounds to run around the track enough, they could turn the basset hounds into greyhounds. And what they end up doing is torturing the basset hound. And you end up with emaciated, starving, exhausted basset hounds.

[00:51:43.980] – Gary
But if you can make those basset hounds healthy with the right diet, if that diet sort of reregulates their fat metabolism such that they're mobilizing fat from their fat tissue and burning it rather than storing it to excess, they'll have energy. And if they have energy, they want to exercise and they want to burn that energy off, which lean people do naturally. And then they'll want to go for walks and go for hikes and go to the gym and all those great things and get outside because of the energy to do it.

[00:52:15.850] – Gary
And so you don't exercise or get physically active to lose weight, if you fix your fat accumulation problem, you will want to be physically active. So do the former and then enjoy the latter.

[00:52:32.350] – Allan
Excellent. Gary, if someone wanted to learn more about you and or the book The Case for Keto, where would you like for me to send them?

[00:52:41.080] – Gary
OK, my website is garytaubes.com. I don't keep up with blogging, but it's there. Twitter is @garytaubes. The book is available. If you have an independent bookstore in your neighborhood that's still open, please buy it there. If not, Amazon will deliver.

[00:53:00.460] – Allan
Absolutely. Well, Gary, thank you so much for being a part of 40+ Fitness.

[00:53:04.750] – Gary
Allan, thank you for having me.

Post Show/Recap

[00:53:11.150] – Allan
Rachel, welcome back.

[00:53:13.010] – Rachel
Hey, Allan, wow, that was a really fascinating interview. There's so much to talk about.

[00:53:17.990] – Allan
Yeah, like I said, I really like Gary and I like his approach in his books predominantly because he doesn't take anything as fact. At first, you know, it's not like he's going to follow and say, okay here's here's our belief system. So I'm going to rest all of my argument on that thing. And a lot of people will do that. They'll say you don't need to do keto because it'll raise your cholesterol.

[00:53:41.630] – Allan
Some people get on keto and it lowers their cholesterol. Keto definitely lowers the triglycerides. It does a lot of other things that are really, really good for you. But it's not for everybody as Gary mentioned in the podcast. But, you know, if you're thinking about going to your doctor and you're thinking about doing keto or you're doing keto and you go to your doctor, your doctor says, oh, my God, get off that, you're going to die.

[00:54:03.410] – Allan
just realize that doctors are not infallible. And I don't mean for you to completely question your doctor, but realize at one point doctors were recommending cigarettes. You had advertisements, nine out of 10 doctors prefer a particular brand of cigarette.

[00:54:19.700] – Allan
Now, they didn't know they were not told in medical school that the tobacco was bad for them. And in fact, the tobacco companies went out of their way to make sure that that information was not available to your doctor. So doctors were recommending cigarettes. Now they're recommending different things. But some of our doctors went to medical school 15, 20, 25, 30 years ago. And a lot of them are still relying on the same things they were taught then, or they're relying on the things that they get at their conferences.

[00:54:52.370] – Allan
They have to do their continuing education. I don't know what they call it. You know, we call it CEUs use in a personal training space. We used to call it CPE when I was an accountant. But they have to get they have to go back and get education. Now, these educations are typically conferences and these conferences are typically sponsored and run by drug companies. So most of the science, most of the things they're hearing are not food can make you healthy. It's you need this medicine to be healthy and we don't have a deficiency of medicine. We have a problem with our food and Gary does an excellent job of kind of walking us through step by step, the Case for Keto. And so if your doctor is saying maybe you shouldn't be on that on that diet, highlight his objections, highlight them in your book, take the book to your doctor and have him read that section. You know, you need to do some stuff.

[00:55:49.620] – Allan
I remember when I was going through my first divorce. It sounds terrible, doesn't it. I was going through the process of the settlement and everything that happens. And, you know, she was going to get half of my 401k. And so it happened at that point in time to be reading a lot of things about divorce and about, 401ks and all that other stuff. And it said, you need this document called a QDRO, it's qualified something, something, something. Basically, it's where you're redeeming your 401k, but you're not taking the cash. So you do the form. And that way for your taxes, you don't have to pay taxes on the money you withdrew. Otherwise you do. And then the story was about a doctor who took a million dollars out of his 401k and basically had to pay five hundred thousand dollars in taxes because he didn't do this one document. So I went to my attorney and I said, well, have you drawn up a QDRO?

[00:56:46.200] – Allan
And he's like, What's that? So I showed him my research and I went to another law firm, a friend at another law firm, and requested a boilerplate for one and gave it to my attorney and he charged me my hourly rate for his time to read my research and do the form, which I thought was really, really not cool. But at least I saved myself a ton in taxes because I was aware of the situation. And I was a part of my own legal team.

[00:57:17.340] – Allan
I didn't just depend on the opinions and requirements that are put forward by my attorney. I made sure I understood the process as well as I could. So that I could be a part of the team and you really kind of have to do the same thing with your medical, because doctors are not infallible. They're human beings just like us. They're very intelligent human beings and they're fairly diligent because they did go through medical school. But at the same time, they're not doing the research specific to you every single day. You have to do that research.

[00:57:51.340] – Rachel
That's right. And you need to take your own reins of your own nutritional choices. And it's good to ask questions. It's good to question the doctor and help them or they can help you better once they know what you're trying to find out. But yeah nutritional guidance has changed so much. But the problem is that it hasn't been reflected in our country for anyway, in our guidelines, the food pyramid, as as we knew it growing up, was like that for probably 15 years and know that there were changes in the food pyramid. If it wasn't, last year was the year before, and it had been literally ten years in between. Any additional changes to what we know and it's only one dietary example to live by and it's not the right dietary example for everybody.

[00:58:42.610] – Allan
Yeah, well, one of the things is realized, that's a very politicized environment, Nina Teicholz wrote, The Big Fat Surpise, I believe, is the book she wrote. And she's been an activist on this thing the whole time. And the reality of it is when they get the people together in the room, the scientists, they're supposed to go through these studies. They sit down and they look at all the studies and then they start throwing some of them out as irrelevant or not valid. And all of the high-fat, low-carb diets, every single one of them was excluded from the study. And so, she's part of an organization that's out there trying to fight this, but they're moving forward with nutrition guidance.

[00:59:27.700] – Allan
And, basically probably for a generally healthy person that doesn't need that doesn't have metabolic problems, is not obese or overweight, those guidelines might work just fine. But for a lot of us that are I guess what I was with was is easily fat, I think was one of the terms I heard recently in an interview that that interview is coming up, guys, but easily fattened us easily fat and people. We can't eat that way. We can't feel that way. And unfortunately, that's not going to be a part of the guidelines. I was talking to a nutritionist out of Canada and she'll be on the show soon. And it was kind of the same thing. We were talking about the nutrition guidelines. She says, yeah, Canada has changed their guidelines. They don't have all of the grains and all that stuff anymore. They've lowered that down and they've got it a little bit more balance.

[01:00:16.450] – Allan
And I said United States is still charging forward with 11 servings of grain. She's like she's like, that's insane. And like, it's politics. And so, again, your doctor doing the best he can with his standard of care and his education. So just recognize you have to be a part of these decisions. You know, if you know that you need to go in for surgery and they're going to put a magic marker mark on the leg they're supposed to operate on, you check that mark.

[01:00:46.700] – Rachel

[01:00:47.470] – Allan
Don't just assume that they marked the right leg, you know, and when it was maybe it was supposed to be the left leg. Make sure that they marked the right leg. Make sure that the information your doctors giving you now, you do need your doctor to be involved. And here's one of the core reasons. If you're on metformin, some other blood sugar lowering medication or you're on insulin, your medication is very likely going to change if you change what you eat.

[01:01:14.860] – Rachel
That's true.

[01:01:16.150] – Allan
So a significant change in your diet is something you do need to talk to your doctor about. Like I said, he or she may object on the grounds that they don't believe that's a healthy, sustainable way of eating. But if you went in there and said, I'm going to go vegan or vegetarian. They'll be like okay, that's great. And it's like and keto.

[01:01:41.950] – Rachel

[01:01:42.230] – Allan
Yeah, crickets, but it's possible. And we've had we've had them on, too. So, you know, I think I think the key of this is of this whole thing is if you really want some support, when you're talking to family members, you want some support when you're talking to doctors. The only thing that I wish Gary was a doctor, he's a journalist, but he did take the time to get to the root cause he did go take the time to put together the history, to put together the case. And so to me, this book is is like gold. If you're trying to explain to someone why you're doing what you're doing.

[01:02:20.590] – Rachel
I think it's worth reading and experimenting. After listening to your podcast for a couple of years, you talked about keto for quite a bit, and I wasn't ready to accept that keto was a healthy diet to follow or lifestyle to follow. I had a hard time unlearning all of the things that I knew for a fact that that was bad for you. I mean, really, I had to really come off of all of those things that I had just tooken for a true science.

[01:02:50.410] – Rachel
But so much has changed. And and but I knew that if I didn't do something different, that I wasn't going to get where I wanted to be. And so I just like Gary had mentioned, like, I just did an experiment and I I told Mike,my husband I said, okay,I'm going to try this and see how it works. If it doesn't work, I'll try something else. But two years, almost three years later, I'm still basically following the keto lifestyle because it is working for me. Everybody needs to try that. Something different.

[01:03:23.140] – Allan
Yes. If what you're doing is not working, you've got to do something different if you expect a different outcome.

[01:03:29.630] – Rachel
Yep. And I know some people can be vegan or vegetarian. I know, like Gary had mentioned, he's got a friend who is a vegan, keto, and another friend who's Carnivore. It really is such an individual thing. And I respect anybody who can be vegan just as much as I respect anybody that can be keto. The fact is, is that they found something that works with the way that their body works and that's exciting.

So in the show notes, I'm going to make a point to I've had a carnivore on me, I've had a vegan keto on and I've had Dr. Will Cole on where he was pretty much somewhere in the lines between vegan and pescatarian. And so I'm going to link to those. So those are ways of eating that you're wanting to do. And then you're also want to consider trying keto or at least a low-carb version of those diets. I'll put the links in there for you to check those out, because there's a lot of good information in those episodes to just kind of give you an idea of what's possible.

[01:04:32.290] – Rachel
Perfect, I think that be so helpful.

[01:04:35.230] – Allan
All right, Rachel, I'll talk to you next week.

[01:04:37.840] – Rachel
Great. Take care.


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The worst part of a western diet | Gary Taubes

Gary Taubes is a well-known science writer and the author of a new book called The Case Against Sugar.

In this book, Gary examines why sugar is perhaps the worst aspect of any western diet. He explains that this is a relatively new stance, as nutrition policies from the 1970s and onward instead targeted fat content. The popular implication was that sugar was largely benign.

Conventional thinking on sugar is that it’s empty calories. It was often said that people get fat because they consume more calories than they expend. In actuality, different foods cause different hormonal responses, which can impact the storing of fat. The unique metabolism of a glucose and fructose combination can cause an endocrine response and lead to health issues.

Gary also speaks about the link between cancer and sugar. Research has shown that insulin stimulates tumor growth and metastases. Elevated blood sugar and insulin levels will fuel tumor progression and metastases. Whatever causes this insulin resistance will exacerbate existing cancer, and could possibly promote it. The best response is to prevent insulin resistance by removing the sugars and white flours from one’s diet, thus minimizing the risk of cancer.

Alzheimer’s disease is also being linked to sugar. The primary argument states that whatever causes insulin resistance will increase the likelihood of manifesting dementia of any kind.

In the end, we must weigh the risk and decide for ourselves how much sugar we consume. We must balance the desire to enjoy our lives, while also living long, healthy lives. For many of us, it may be easier to avoid sugar than to try and consume it in moderation.

To connect with Gary Taubes or to learn more about The Case Against Sugar, visit www.garytaubes.com.

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