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hello and good afternoon i'm patti james of the
commonwealth club health and medicine member led forum it's my pleasure to extend a special
welcome to any new members who are here today in this digital program mode the
commonwealth club continues to be an organ a digital organization and we will be
for the coming months i encourage our viewers to become members of the commonwealth
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blue donate donate button on your screen one quick note before i introduce today's guests
if you have a question for our guest please post it in the youtube chat area those questions
will be forwarded to me during the program some of those questions i might ask as they
come in and but a good portion of them will be towards the end of the program and now it's my
pleasure to introduce gary tobbs gary tobbs is an investigative science and health journalist the
author of the case for keto the case against sugar why we get fat and good calories bad calories
gary is a former staff writer for discover and a correspondent for the journal science his writing
has also appeared in the new york times magazine the atlantic and esquire and has been included in
numerous best of anthologies including the best of american science writing 2010.
He has received
three science and society journalism awards from the national association of science writers
he is the recipient of the robert wood johnson foundation investigator award in health policy
research as well as the co-founder and president of the non-profit nutrition science initiative
gary lives in oakland california with his wife author sloane cannon and their two children
welcome gary patty thank you for having me yeah i know this is great i've obviously enjoyed
uh your book as you can see you have many notes but we won't be able to get to everything today
because for one thing we want people to purchase your book and really delve into it it's very
interesting so we don't know who's on this call today you know we might have we might have people
well-versed in keto who just want to hear what you have to say and want to ask questions because
they agree or disagree with you but we also have might have people who know nothing about keto
they are here to learn from you so with this in mind please tell us a brief history of the history
of the ketogenic diet for whom it was originally created and then explain what ketosis actually is
okay well let me also just say the book is called the case for keto but i'm not actually writing it
for people who are well-versed in the keto diet because they don't need it the argument i'm making
is why this diet never goes away why it's got such a long history what the mechanism behind it is and
why medical professionals and anyone who suffers from overweight diabetes obesity anything on
that spectrum should consider seriously consider these low carbohydrate high fat eating patterns
which i'm lumping together with keto uh the subtitle of this book is rethinking weight control
the science and practice of low carbohydrate high fat eating and that's more on point than
actually the title um so yeah the ketogenic diet i mean it's got a long and glorious history which is
one of the bizarre aspects of it you could go back to 1825.
So a ketogenic diet is essentially a diet
that restricts all the carbohydrate-rich foods and so you don't eat sugars you don't eat starches you
don't need grains then you replace those calories with fat and now give or take a few grams of
carbohydrates here you're either generating ketones making it a ketogenic diet or you're
just eating a low carbohydrate high fat diet as a weight control device you could go
back to 1825 you're probably familiar with uh jean on film briat savarance the physiology of
taste the most famous book ever written about food and in this book riyad savaron says he's
had conversations with 500 patients 500 obese diners over the years and they ask them
what they eat and what they crave and inevitably they crave carbohydrates potatoes rice bread and
he decides that if you but his diet for obesity is more or less rigid abstinence from those
foods and then you could eat as much as you want from anything else it resurfaces as in 1865
as the first most popular diet book ever written uh the first best-selling worldwide diet book
a pamphlet written by a a british undertaker formerly obese now long or no longer and the name
banting that and by the end of the 19th century it's embraced throughout europe as the primary
means to affect weight loss you tell people not to eat carbohydrates the theory is carbohydrates are
fattening so if you don't want to be overweight or obese you don't eat these foods prior to
insulin being discovered in 1921 the diet for uh the standard of care for patients with
diabetes was what they called the animal diet it was basically animal products and green leafy
vegetables boiled three times to get all the carbohydrates out of them the idea was diabetes is
a disorder of carbohydrate intolerance so people shouldn't eat that um it resurfaces in the 1960s
while it's studied in the 1930s 40s and 50s by physicians who are trying to figure out how to get
their patients and nutritionists and dietitians are trying to figure out how to get people to
lose weight without having to be to struggle with hunger constantly because the assumption is if
you're struggling with hunger you're going to lose that battle eventually uh in the 1960s it's reborn
first as a best-selling diet book called calories don't count by a brooklyn gynecologist named
herman talar and then most famously robert atkins and his atkins diet revolution and virtually every
other best-selling diet book is some version of a low-carb high-fat ketogenic diet so uh protein
power my mike and mary dan eads a physician couple that was a massive bestseller in the 1990s
sugar busters is the same south beach is a sort of politically friendly version of this way to eat
the paleo diet is a version of a low carb high fat diet one of the reasons again in the case for
keto i'm trying to get people to understand that for 195 years there has been a theory that
the way you lose weight is not by eating less and exercising more but by abstaining from
carbohydrates so that's that's the basis of it more or less rigid abstinence to carbohydrate-rich
foods which is how we add several phrases now isn't the atkins diet the keto diet is higher
in fat the and moderate in protein intake and the atkins diet is slightly higher in protein intake
and lower in fat am i correct no not really atkins just said don't eat atkins got in trouble the
reason he was uh excoriated by the uh the medical community was he was the first uh physician who
really embraced ketosis and and suggested that his readers measure their ketone levels during uh you
know using the uh the the urine strips that uh that diabetics were using and those people with
diabetes at the time so um there are and again one of the points i'm trying to make in this book
is there always minor variations on this theme so if you're a physician and you're struggling
with and nowadays every physician is struggling with this particularly in family medicine and
internal medicine um your waiting room is getting is filling up with people who are in effect
suffering from the negative sequelae of obesity diabetes hypertension so they can't control
their weight they can't control their blood sugar they can't control their blood pressure
and the job of a physician is now basically managing these diseases with prescriptions yeah
and so you want people to be able to lose weight if you can solve the obesity problem if you could
solve the excess weight problem you could solve the blood sugar and blood pressure problems
with it and if the conventional wisdom doesn't work you look around you find another you and
nowadays the internet makes it possible to find any dietary approach you might and try them all
yourself too so you you try a vegetarian diet a mediterranean diet and a dash diet and a vegan
diet and eventually you come on some version of this and like i said there are all these
different versions but the problem is if you if it works and it works for your patients
and then you want to write a book about it because you want to tell other people
you've actually figured out weight loss and weight control that's called healthy
weight control but you can't just write a book saying atkins was right i can do that as
a journalist i can say i think atkins was right i think mike and mary dan eads were right i think
the sugar buster people were right and i think they got something and understood something that
the medical community in general missed but if you're a physician you can't do it so you write
your own diet book you put your own spin on it and then the media talks about how all these
diets are different so atkins is different from keto which is different from you know a protein
power all little bit subtle differences but the reality is they're all fundamentally bound by this
idea that the problem with modern diets is not how much people eat and how much they exercise or how
little they exercise but the carbohydrate content and the diet was originally uh created for
children with epilepsy correct it was well it was the given the ketogenic diet russell wilder who
developed that he was the uh endocrinologist at the mayo clinic back in the 1920s who pioneered
using this diet for pediatric epilepsy but the reason he used it for pediatric epilepsy is
because it was being used for diabetes first and he thought isn't this interesting maybe since
it seems so effective for at least most diabetes not what we would call type 1 today but type 2 the
kind that associates with obesity he saw reasons to test it on children i forget if you might
have seen a patient with diabetes who had had and epilepsy would have the epilepsy resolve on the
diet but that's why so it's talked about as though it was started as a pediatric epilepsy diet and
it was known the keto diet per se where you really you get the 85 90 of your calories from fat um it
was pioneered for pediatric epilepsy by research that at first russell wilder at the mayo clinic
and then researchers at johns hopkins but again i'm i am making the case for low-carb high-fat
diets and linking them with keto and that's uh that's that's the essence yeah thank you
now for those again since we're not really talking then to uh uh uh focusing as much on the
people who are well versed maybe an explanation for those who are just figuring trying to figure
all this out talk about insulin and your liver go through the physiology of this if you would
okay well the idea is um okay so let's talk about the conventional wisdom on why why people gain
weight okay so the uh what i think of is newton's laws of obesity is you get fat when you take in
more calories and you expend okay you could find a sentence like this on virtually effectively
every uh public health website in the world on their pages of obesity and this idea grew out
of uh research in the 1930s it's it's considered to be uh sort of such a truism it didn't it
didn't need a birth but it actually was a hypothesis that a researcher named lewis newberg
claimed to have proven in 1930.
So the idea is there's no metabolic defect in obesity you're
not there's no abnormal growth phenomena going on that's driving you to accumulate
fat when you're lean friends might not but it's all about how much you eat and exercise
in effect and the essence of this theory is the way i like to think of it is you know the comedy
team well we grew up with abbott and costello when we were very young uh it was uh laurel and
hardy and it's one thin guy and one person who we would say today is struggling with obesity the the
thin guy was usually the straight guy um and the idea is that there's no difference between abbott
and costello or laura and hardy except that the rda too much and costello away too much and okay
the other two did not heard that analogy but i can see the whole thing in my head so there you go
you could say the difference between roseanne barr for instance and twiggy by our current thinking
on obesity is that roseanne barr eats too much and twiggy didn't wiggy was a model when i was oh
yeah again i'm using uh kate moss and yeah um so these are the this is a conventional wisdom one
of the things i've done in my writing and other researchers have done and what my writing has been
aimed at and the case for keto is arguing is that we have a theory of obesity that completely
leaves out all physiological regulation of fat accumulation okay so just like your height is
determined by hormones and enzymes that you know secreted from the pituitary gland and um you know
everything in your body is very well regulated fat tissue is also very well regulated and this
science was worked out by the between the 1930s and the 1960s when the tools became available to
do it and what physiologists and biochemists and endocrinologists learned is that your fat
tissue is regulated by the hormone insulin okay so you secrete insulin your pancreas secretes
insulin in response to the carbohydrates you're consuming and then insulin keeps your blood sugar
under control it tells your muscle cells and your organs to to sort of facilitates the uptake of
glucose blood sugar so that they do a better job of keeping blood sugar under control but it
also tells your fat tissue to hold on to fat so while you're secreting insulin your fat
tissue is holding on to fat and as long as insulin stays elevated it's inhibiting
the release of fat familiar fat tissue and all of this has worked out pretty well by
around 1965.
Okay so if you just ask the question what makes a fat cell fat so if you're overweight
they're obese your body is full of all these overstuffed fat cells fat cells that have taken
up too many calories and they won't give them off and you ask the question what makes the fat cell
do that the answer is basically elevated insulin so if you want to get fat into a fat cell and
keep it there you up regulate insulin if you want to get fat out of a fat cell you have to
lower insulin and this is textbook medicine but it's always been left out of all our discussions
on obesity because on obesity particularly by the 1960s the obesity community had decided that we
get fat because we eat too much and the field was dominated by psychologists and psychiatrists who
were trying to figure out how to get people who suffer from obesity to eat less they didn't care
about endocrinology they didn't care about the hormonal regulation of fat cells because that's
not their field they don't read the journals they don't go to the conferences their field is human
behavior that's all they cared about so we came up with an obesity theory dominated by this idea
that people who suffer from obesity behave badly they eat too much they exercise too little and
what i'm bringing back and others with our root work all those promoting these low carb high fat
diets is the idea that this is a physiological disorder of excess fat accumulation fat
accumulation is regulated by the hormone insulin and if you want to get fat out of your fat cells
and burn it which is what we all want to do you have to lower insulin and the way you lower
insulin is by abstaining from carbohydrates the way i said in my first book good calories bad
calories by mid 1960s a physiologist had proven that insulin was a principle regulator
of fat metabolism that's a quote from the new endocrine on two researchers rosanna and
solomon burst and yellow won the nobel prize later for the work that led to that so insulin's
a primary regulator of fat metabolism and the conventional wisdom was that carbohydrates
were fattening and we secrete carbohydrates and respond we secrete insulin in response
to the carbohydrates so in an ideal world the medical establishment would have said bingo we
figured out why people get fat and now we know what they have to do if they want to get lean
again which is they have to abstain from these foods that make us secrete insulin and they
just never did it they never did it in part because the world was full of thin doctors who
thought people get fat because they eat too much well i'm going to read you a thread that i just
happened to come upon on twitter yesterday so you know and and this is uh it was geared towards
those with type 2 diabetes but it it uh it's you know it's very much tied into
what you just said so the one person it was a discussion if you want
to call anything that happens on twitter or discussion sometimes it is but not
generally speaking it was about carbohydrates the one person who was a doctor stated that quote
type 2 diabetes is a chronic carbohydrate overload and the response from somebody who was not a
doctor but it said he was master's degree in something didn't say what and the response was
no it is not saying type 2 diabetes is a chronic calorie overload scientific studies were quoted on
both so back to that person you know who's trying to figure this out we hear what you just said
and then we see these two educated people who both have scientific studies one saying it's not
carbs it's calories one saying it's it's carbs so what's the average person it's like they're
getting pulled in every direction who do we who do they believe okay well it's a very good question
so one of the um and what's interesting about that debate and my next book is about diabetes only
and i'm now i'm obsessed with the history here and this exact same debate was going on and i could
read you a quote from a harvard diabetologist named fred allen circa 1919 saying all of the
discussion on diabetes comes down to whether it's a calorie problem or a carbohydrate problem
fred allen thought it was a calorie problem other researchers thought it was a carbohydrate problem
um yeah who do you believe so since the first time i got into this i'm an investigative
journalist why listen to a journalist when there are all these doctors out there but
the problem is well there's several issues one is obesity and diabetes rates keep going up okay
in this country and around the world uh the former uh head of the world health organization
a few years ago at a national academy of sciences meeting in washington said it was a it
was a slow-motion catastrophe what's happening worldwide this was before
covet a less slow-motion catastrophe on when covet passes the obesity and diabetes
epidemics will still be there wreaking havoc these all of these people have been bombarded with
the conventional thinking throughout their life eat less exercise more it's what they do so
if you suffer from this disorder if you're have trouble controlling your weight or your
blood sugar and you've never tried to eat less and exercise more um then i'm assuming i can't
reach you because you're not interested enough for those people who have gotten past that and
say well that doesn't work for me i'm hungry all the time i'm stu i you know i can keep it up for a
month or two and then i binge eat and fall off the wagon i yo-yo diet everything we do the argument
is pretty simple um when i started writing about this 20 years ago uh these again keto was atkins
then or atkins and sugar busters and protein power and even the zone a little bit um they
were uh the idea was they were fad diets they were quackery and they would kill you uh when i
first wrote about this cover story in the new york times magazine i decided i described my experiment
eating atkins and i sitting at a diner in new york where i lived at the time having eggs and bacon
for breakfast and waiting to have a heart attack that was the idea this would clog your arteries
and kill you in the 20 years since then there have probably been more studies done on low
carb high fat ketogenic diets in any diet pattern in history there's over 100 that have been
completed and another 100 or so that are in the works and the one thing we know for sure is it's
safe it's benign or beneficial it virtually every disease state to which it's on which
it's tested it has some benefit and when it's compared to other dietary
approaches it tends to do better than all of them not a lot better because in these studies people
don't stick to these diets but when they are told to abstain from carbohydrates and eat as much
calories as they want otherwise they tend to lose more weight and their heart disease risk factors
improve so getting back to your question who do you believe you don't have to believe any of us
you can try it yourself okay so that okay now then the next it's a series of four questions
you've actually answered a couple of them yeah i apologize you warned me about that before we
started okay i warned you that i'm bad at this i i talk too much all right because we have some
questions that have come in that are gonna uh so also the ketogenic diet has been voted
the worst diet three years running i'm sure you've heard that okay so i wanted to address
four concerns i was thinking about this like uh until like two in the morning last night i had
a phrase uh the last question in particular so you've already talked a little bit so they're big
one of their big concerns is the saturated fat and this kind of goes into one of our questions from
our from our um viewers here too so they're saying that it's too much meat too high in saturated fat
which raises ldl cholesterol and i know you're gonna and that's true right and but they also
say that's a marker for heart disease now you've covered a little bit about so that's the first
one so kind of briefly you've already talked about that but kind of briefly say answer that question
um saturated fat ldl cholesterol heart disease and if you would being a nutritionist like i'm
always having this conversation with my doctor about why do they check ldl and not see reactive
protein you know inflammatory markers for heart disease are probably better markers but but
tell us about um heart disease and saturated fat uh okay so i got into this field in the 90s and
my expertise my background is physics my first two books were about physics and nuclear chemistry
and researchers who got the wrong results okay researchers who screwed up publicly lived to him
and i got to document how they screwed up and why they screwed them my second book was called bad
science and i like to think if nothing else no matter what people think about my nutritional
wisdom i know more about bad science than any human being alive okay by virtue of having to
have written two detailed case studies um i got into nutrition because my friends in the physics
community who of whom i had many said that if i was interested in bad science i should look
at the stuff in public health so this was the early 90s they said the stuff in public health is
terrible and they were right it turns out it is and by terrible i mean it's in order to get the
right answer in science is what i learned from my first two books you need a certain rigorous
critical skeptical approach to the research a relentlessly honest rigorous skeptical approach
uh in virtually all of my books i quote the nobel laureate richard feynman who said the first
principle of science is you must not fool yourself and you're the easiest person to fool so i started
writing about public health issues for the journal science as a correspondent in the 90s and by
the late 90s i had stumbled serendipitously as it seems into nutrition first with this idea that
we get hypertension because of the salt content of our diet and i spent nine months working on
a story in which i interviewed i think it was 85 researchers for one magazine story and then while
i was doing that one of the worst scientists i'd ever interviewed and remember my second book was
called bad science i thought i had interviewed the worst scientist in the world one of the worst
scientists i ever interviewed took credit not just for getting americans to eat less salt but
for putting us on the low-fat diet that we were all eating through the 90s and many of us are
still eating so i spent a year working on that one magazine article one entire year for science
140 researchers and administrators interviewed i read stacks and stacks of documents i even
hired epidemiologists researchers who had never stepped into this quagmire before to read
documents for me and the reality is the science is terrible this belief that saturated fat causes
heart disease is not supported by the evidence okay i'm going to leave it at that that was that
was the the sound bite i was looking for let me just say back then i had no bias other than i was
skeptical of bad science but i i ate what everyone else ate i had no book deals i wasn't looking for
book deals all i wanted to do was find the truth and it turned out i'm just going to
finish it comes down to five six maybe trials done in the 1960s and 1970s that were
ambivalent and everything after that has been the sort of public health establishment saying
we've been saying it all along it must be right yeah yeah yeah i remember the whole low-fat
thing in the 80s when my kids were little and i i i didn't i didn't buy into it i'm rather
proud of myself you shouldn't you know and so let's put and and we have some questions
here but i want to get through my four points first before we go to these questions instead and
there's their second point is it's insufficient in dietary fiber which is needed for gut
health and you know health in general so briefly uh talk about dietary fiber and
the keto well is it needed for gut health how do you know that biome uh well there
is a gut biome but there are populations that seem to thrive eating virtually
no dietary fiber at all the that's true yeah these debates were had in the 1920s and
1930s that's one of the issues that's when you know you've got a problem with the science when
the same debates the same experiments even are done over and over again but researchers actually
did experiments where they they locked away two explorers for well they had to meet a fiber-free
diet for a year a guy named stefansson famous arctic explorer and his partner anderson so
they lived for a year on meat only zero fiber and then 10 of the leading nutritionists in the
world published a report on this was in 1928-29 literally 10 of the leading research in the
world published i think was from 8 to 12 reports total i forget and after a year without
fiber these guys were healthier than they'd ever been in their lives okay wouldn't be me i need
i like well i just love this well you like it everybody here's the other issue which is nobody's
saying don't eat green vegetables oh i know i'm just one image isn't i'm not advocating carnivore
i'm just being uh intellectually honest enough to admit that yeah the carnivore diet fascinates
me there are these guys walking around out there who eat zero vegetable matter they're supposed to
be dead from scurvy let alone whatever's going on with and they are in extraordinary health i've
met some of these people okay and actually yeah that's okay i know i know the other thing is
classic low-carb high-fat ketogenic diet lots of meat on for for ethical reasons people
have problems with that for environmental reasons it could be a problem but that's number
four don't go into that right now okay okay spend you basically you're still eating plenty of
green leafy vegetables you're eating your broccoli you're eating the vegetables you like you're
eating salads sure you're just not eating potatoes grains sugars yeah oh yeah okay third point and
um and again i'm i please uh do this as briefly as you can because the point four is important
and before we i take these in and that is an endless people saying it's not sustainable
you can't do it there's no air around you you can't go out to dinner you can't do this you so
what about the sustainability asset and i have a good friend jd griffin i think i introduced
him to you he's been keto and he teaches it uh you know he does um though he sustains it he
sustains it so it's sustainable really well you know so here's let's go back to the basis
of keto the basis of keto is carbohydrates are for those of us who fat and easily a term i admit
i'm borrowing from the 1950s diet books some of us fat and easily some of us don't some of us can eat
whatever they want however much they want they'll stay lena's west kansas coyotes was a phrase that
was like quote my book right out of congress in 1967 the rest of us you know we look at a piece
of bread it goes right to our hips that's another expression from the 1960s so for those of us
who found easily carbohydrates are the problem and the mechanism goes through the hormone
insulin other hormones as well but primarily insulin so if we don't want to gain weight or
we want to be at a healthy way we want to be at the healthiest weight possible for us we can't eat
these foods in the same way if i don't want to get lung cancer i a former smoker cannot smoke
cigarettes there was a period in my life where i would have told you smoking on not
smoking is unsustainable i lived in new york the world was full of smokers everywhere i went
but if i wanted to be healthy i had to abstain from cigarettes the argument here is those
people who suffer with you know overweight will be who have trouble controlling their blood
pressure their blood sugar and their weight not do more or less rigidly abstain from carbohydrates
and then they're not sustaining their diet they're sustaining sustaining their health
yeah and jd wants to stay healthy that's why he actually competes in physical stuff
and there are people that say this i remember what it's called yeah i don't yeah
because we've all done the other diets we've all spent years trying to eat less and exercise
i used to go on sushi diets when i was younger um i mean i you know we anyone who struggles with
their weight basically spends their adult years trying to diet if you find something that works
by which i mean you lose excess weight easily and you're not hungry i can guarantee you
that if you understand it you'll sustain it okay i can go down a rabbit hole here but when
we don't have time to do it about you know when i grew up um there there were no fat kids there were
no obese children no well there were a few but i don't remember any of them but then i grew up in
the country and there might have been a couple um but but it wasn't you know anyway i'm getting
i don't want it so something has changed that's another way to look at it something has changed
dramatically and the question is what well so it's the conventional wisdom is the the food industry
made more food available and it's very tasty food and people just ate too much and those of us who
struggle with obesity can't say no so we have a willpower thing and the conventional wisdom by the
way is the invention of it's the reason why fat shaming exists because those of us who gain weight
easily apparently just can't control our appetites whereas lean people can that's the thinking the
can the alternative hypothesis the basis of books like the case for keto is that we change the type
of carbohydrates we consumed yeah you going to the nation in sugar as your friend robert lustig will
tell us yeah i know he's speaking for me when his new book comes out in may by the way yeah and
refined flowers and processed carbohydrates and that and our brilliant uh public health
administrators started telling the whole nation that the reason we get fat is because of the fat
in our diet not the carbohydrates yeah yeah so one of the things that shifted between them from
when we were kids to now is when we were kids the conventional wisdom was a carbohydrates for
fattening bread pasta potatoes beer i'll make you fat if you don't want to be fat you don't eat
them and then by the 1980s carbohydrates had been transformed into heart-healthy diet foods
so now if you had a problem with your weight which much of the nation started to have you did
exactly the opposite of what our parents would have done our mothers would have done so in 1960
say if you have a problem with your weight you don't eat potatoes or pasta or bread in 1985 and
onward if you have a problem with your weight you don't need you know butter and animal products and
saturated fat rich foods instead you eat potatoes pasta bread yeah and we just got fatter and fatter
so those are sort of another way to look at the calories versus carbohydrate issue on a historical
scale okay and one question and um this might come as a little harsh but i have to ask it and then
we have to hit these questions and i if we have time i'd like to go back into the willpower
a little bit and um okay for me maybe just and i think for other people too um they're you
know the biggie is that and you reference it in your book but it's the it's the environmental
impact of this and and you say and i i didn't i should have i don't know i'm paraphrasing
you here now but you basically say that what you that um you can't tell somebody what they can
eat or not eat it's really up to them and how they feel and i agree with that however we're in the
middle of a climate catastrophe right now it's not climate change the climate has always changed
we have global warming issue and agriculture is part of that i mean my niece and her
husband are farmers and but but they have they're very much into carbon sequestering
you know and i and i follow um the savory institutes all their articles on grass-fed beef
and carbon sequestering but let's be real here the the beef in our food supply is not from
that it's feedlots and this horrible and it's without anything just a second almost
done without even getting to i just got to finish my preamble it's not it's not only the
animals but it's it's the people who work there and uh and then we have you know pigs who never
get off the cement and and you know just this horrible um wouldn't we be better and in fact
it was really interesting that um i subscribed recently to mark bittman's uh his new thing the
bittman project he said legumes are the world's most important source of protein bar none that's
quote grains are the staple of humanity and have been for ten thousand years rice and beans
could save the world so that person's choice to eat all this meat all this bacon all this
dairy those there's nothing in my book saying okay new issues that we're conflating here i am
arguing that carbohydrates are fattening okay yes and that for many americans from say 30 to 88
of them they have to dramatically restrict the carbohydrate content of their diet if they want
to be healthy yeah okay okay so that's the context when people argue about the environmental impact
of beef they're assuming that people again it's a kind of fat shame the assumption is people who
get obese get that way because they eat too much they could eat less of anything this
is what mark bittman's saying and i know mark and i like him immensely but he's
basically saying look if i can maintain my weight eating rice and beans so can anyone so
that's what they should eat and i'm arguing that's not true the foods that lean people can
eat to stay healthier foods that will make me hungry fatter and unfortunately
let's not get into legumes um the uh but it's sort of so the issue is let's
just put it this way let me phrase it for you as a question i know you've got children let's
say one of your children struggles with obesity so they're 12 years old they struggle with obesity
okay and they're going to be diabetic by the time they're 16.
Okay then they're going to be on
insulin for the rest of their life okay we could probably control it maybe bariatric surgery will
solve it you know as a mother yeah then you could make them healthy right by eating a low-carb
high-fat ketogenic diet what are you gonna do absolutely i'm not arg and okay so all i'm arguing
is that that mother whoever every mother out there should know that this is the possibility that
this is what their kids need to be healthy you can't tell them not to eat meat because of the
environment they can give a they can buy carbon offset i mean that you know they can walk to
work you can sacrifice you can bring bring your footprint down other ways but for some of us we
may have to eat like this but who don't have to eat like this i mean i went in to the bookstore
the other day and there's so many books on keto by far so not everybody needs to be on it so i'm just
saying for those who whose health relies on it absolutely again well but again we don't we
don't know what proportion of the population that that's what i was going to ask you so this is what
and again it's way if you look at the number of americans who are um metabolically you know have a
metabolic disorder so it's again they have trouble controlling blood pressure blood sugar and obesity
we're talking close to 90 percent yeah okay now many of them again when i talk in the book about
more or less rigid abstinence from carbohydrates some of them just improve the quality of the
carbs like rob lustig thing gets rid of the sugar yeah yeah everyone will be healthier stop
drinking sugary beverages cut back on the beer you know that'll solve a lot of problems but
it's not enough for many people yeah and that's the issue and it's sort of you know a lot of
our thinking about the environmental issues and the ethical issues are based fundamentally on
this idea that this is the healthiest way to eat so people like peter singer the princeton
philosopher argues against you know the the ethics of animal agriculture and and you
know the utilization of animals for for human needs and pleasure i mean peter singer's a
very smart guy peter singer thinks that the healthiest diet is a diet that's plant-based and
that's a conventional that thinking it's very ingrained out here in the bay area it may indeed
be wrong for most of us so i'm in a very awkward position right because i now spend on you know
i've stumbled into this career where i'm the boy saying look we're telling everyone to eat
plant-based diets and it is not necessarily benign they've never been tested the way they should be
and then we back it up by saying you're doing you know you're you're singling your virtue with
the environment if you're eating this way and you're singling your virtue with the ethics if
you're eating this way but my primary concern is that people get to be healthy and they get the
right advice to be healthy and the reason i wrote this book is so that they could read it and say if
this is true i can try it i could see what happens and then i can decide for myself what kind of
sacrifices i want to make for the environment yeah because we all need to right we all need
to we're completely in agreement there we have a produced and we have a problem yeah yeah yeah
right okay so let um so anyway i knew that that that's a tricky subject and i i understand that
because i want people to feel good strong healthy but i also have major concerns about my own
grandchildren and what their world is going to be like in 50 years so as as do i yeah i'm
more worried about artificial intelligence yeah okay so i'd like them to have jobs yeah yeah
that would be nice i have more things they enjoy that they enjoy there you go um so um
i think you answered the first question about for those of us who do better without carbs are
we missing anything or should we be concerned about anything any life expectancy changes
you you went into depth about um i think and since this question came in
way in the beginning i think you've you know and let me say just quickly okay
it's an interesting question the argument the case for keto here is that if you abstain
from carbohydrates and replace those calories with the healthy fats you'll be healthier it might
take you a while to make the transition because you're transitioning your body from running on
glucose or carbohydrate to running on fatty acids but eventually you'll be healthier maybe then
you'll feel better and you'll have more energy and your weight will come under control but
i can't tell you that you'll live longer yeah nobody can tell you that you'll live longer
because those trials those experiments don't exist right so all we could say is
you'll feel healthier and if you do you know i want you to understand that
there are risks and benefits involved with anything you do an example i use is
if somebody tells you to go running yeah to get healthier which is a universally accepted as
good advice doesn't mean you're not going to end up needing a knee replacement 10 years sooner
because you're a runner than if you weren't so they're always what we know is that you should
there's copious clinical trials saying this will make you feel better it'll help you control
your weight your blood sugar your blood pressure they'll all get better will you live longer geez
i hope so yeah right these all this longevity stuff now it kind of makes me nuts actually it
makes my notes awesome oh good good because it's like you know let's live our time on this earth
as healthy as we can and then leave this earth when we're supposed to and you know leave all the
the resources it's how it's how 40 year olds are 20 year olds 30 year olds and 40 year olds think
before they get to be 80 and 90 year olds or 63. 64 and a half okay the next question what about
hydration issues with keto briefly because we have quite a few more questions uh yeah when you give
up when you're abstained from carbohydrates well when you go on any diet your body will you'll lose
water weight uh that's your body burning through glycogen stores and the liver and the water that's
stored with it um it helps to drink a lot of water uh clinical experience and clinical trials
over the years suggests that it helps to drink broth um and even salty broth because you use
a lot of you lose a lot of salt with the water that you're losing yeah urine your kidney flushes
away uh sodium it's cramping often tends to be a problem when you eat this way but so you replace
sodium magnesium drink broth drink water okay um is there a relationship and by the way
before we go on one thing and we won't talk about it now because this is uh you talk
about the keto flu and uh you know some of the some of the reactions that people might
have when they first start the keto diet but um you anyway so okay is there a relationship
between keto and brain functioning memory uh people say there is um hard to tell
you know i mean my memory stinks but i've had multiple concussions in my youth so it
would it be worse if i was eating differently there's no way to tell um there's a lot of
research in these areas there's a lot of theories everyone's got a mechanism to explain
why memory could be better or this could even you know the clinical trial was just published
the other day suggesting that a ketogenic diet helps some restore some cognitive function
and alzheimer's disease i see that there's i saw that yeah there's a lot of can you pick a
disease state and somebody is trying a clinical uh ketogenic diet to see if it makes it better
yeah and it's an interesting experiment because like i said you're changing the fuel your
body runs on and your use is so uh uh yeah integral to all human functions that
it's sort of like ah let's see what happens change my brain from running on glucose to running
on fatty acids and ketone or ketones and glucose maybe that'll help my memory okay i can't tell
you that it helped mine but like i said so has the food pyramid impacted our understanding
of these issues oh my goodness so okay i won't answer that what do you think okay uh you read
my first book good calories bad calories or the articles i did for science um nina ty schultz's
uh wonderful book the big fat surprise um you know the story the gist of the story is i
have trouble telling a short story um nutritionist woman from studying deficiency diseases that they
could test right if somebody's suffering from the absence of a vitamin b and they've got berry
berry or pellagra you can give them the vitamin and see what happens they went from doing that to
post-world war ii studying chronic diseases which where you look to see maybe something you're
eating instead of something absent in your diet something present in your diet is causing a
long-term chronic disease state and they couldn't test that so they did some pretty poor studies i
guess these are the five or six clinical trials i mentioned short term and then they embrace the
idea that dietary fat was bad for us and then they enshrined that in a series of government documents
in the 80s the usda and its dietary guidelines and then the food pyramid and all of this pushed
us to a diet if you remember the food pyramid the base of the diet whether pasta bread rice
grains all the foods that i'm saying are uniquely fattening so if i'm right the food pyramid was a
public health disaster of perhaps unprecedented um experience i could be wrong yeah there's lots
of pyramids i mean there's old ways you know the the old ways they have their for for different
um native populations there's a mediterranean diet there's well even old ways with their native
populations they never picked the plains indians or the messiah or yeah yeah right no no they
didn't know so okay um we look at all the evidence and not just the evidence that support when i
talk about bad science one of the characteristics of bad science is you select out only the evidence
that agrees with you when you ignore the rest sure cherokee well and the funny thing
is every scientist has to do that but it's to the extreme and bad science okay so
please speak to the pathway from dietary fat to stored fat and then two more questions after
that one and then another one dietary fat we actually store the fat we eat this was one of the
things that drove oddly enough the wrong dietary approach when you eat a mixed meal the fat you eat
is stored in your adipose tissue while your body and the protein ideally is used to rebuild tissues
and cells um and the body struggles to deal with the carbohydrates you know you know the difference
between this was a number that stunned me um when you uh somebody with a healthy blood sugar
has something like i hope i'm remembering this correctly a teaspoon worth of glucose in their
blood at any one time and then a diabetic blood sugar is like a teaspoon and a half so that's
a difference between about you know 16 and 24 calories worth of carbohydrates and you might eat
at a meal between the bread and the potatoes and the orange juice say 400 or 500 calories so
that's a kind of metabolic tsunami for your body that has to deal with it somehow so it
prioritizes burning through the carbohydrates and that's what insulin does it you secrete
insulin the insulin tells your cells take up the carbs and burn them burn them burden them
because high blood sugar is toxic and dangerous and while it does that it tells your body to hold
on to dietary fat so back in the 60s and 70s as researchers were realizing that we store the fat
we eat they thought well that makes sense so if we tell people to eat less fat they'll store less fat
but it's actually the wrong problem the problem is it's the carbohydrates that regulate the storage
of the fat that we eat through the hormone insulin so the way to have less fat stored is to eat less
fewer carbohydrates and have less insulin and then again that was the exact wrong advice we gave
people yeah okay um this next one's interesting um i don't know i guess i think the first one i did
on food addiction was in 2009 with dr vera tarman you know dr tarman and and dr nicole lavina and of
course dr robert lustig and and it was all kind of based on michael prager's book um uh uh fat boy
thin man and it was on food addiction and and they're all very into this world um as michael
tells the story and he's he said you know he's just a person he's not a scientist but he tells
a story about just being absolutely hooked on popcorn lots of butter lots of salt popcorn and so
he told himself he was only going to have popcorn when he went to the movies well guess what
he started going to the movies every night i know so his point is is food addicting for him
absolutely so there's a lot of people in this world but the question was not to me it was for
to you is sugar and then she has or he has in parenthesis carbs addictive uh my answer is
if you actually look at the science i don't find the evidence very compelling um it wasn't
studied this is one of those issues that simply wasn't studied for 30-40 years because
we had established that dietary fat was a problem and heart disease and people ate too
much that was why they obesity was about so um there was one group at princeton in the united
states studying the possibility that sugar was addicting art hopeless group and uh nobody
else for the most part there's a group in france i think there was a canadian researcher the
french research was interesting because i think they demonstrated beyond a shadow of a doubt that
sugar is more addictive than heroin or cocaine or rats okay but we're not rats yeah so literally
the the research just wasn't done but here's one of these areas where i think geez if you have
kids or you have a sweet tooth do you really need some scientists to tell you whether or not it's
addictive or not no i mean i think it's pretty clear that you know some people just can't handle
sugar they can't have one cookie they're going to need a dozen of them exactly by the way i'm one
of them um what you need the the addictive signs for is if you want to regulate against it if
you want to go after it like we went after the cigarette industry then it helps to know beyond
a shadow of a doubt scientifically you know with copious rigorous evidence that it causes addiction
and if you know how to do it that'll help as well but for the rest of us it's like you know
you know or you don't and if you have kids you don't need the science yeah yeah and i think
part of this it's crossed my mind this whole time we're talking is that you know when people are if
people is are going to try this on themselves and i told you the other day gary that i tried
it because i try everything for three weeks i mean i try every because i want to be three
weeks isn't long enough i know it's not i know but but i i mean i know but i i've tried
everything just to have some sort of semblance of of of what people might be might be going through
i i did vegan somebody got me um some book anyway i did vegan for about two and a half weeks
and then and i ain't vegan a lot of the time quite frankly but not all the time so when
um when i dreamt of a tuna fish sandwich my body was telling me okay that's it and so
i i was done but people have a little bit lost the ability to get the cues from their body you
know uh are you bloated how's your skin you know whatever how do you feel do you have energy
you know just be just being able to tune in to how your body feels i think if people would
really kind of just not like like the book i was telling you about that um michael prager he would
just stuffed up stuff stuff food in his mouth um and not even know he was full for a long
time and then he would lay on the ground and keep stuffing because he could stuff more in
i mean it's there are people who are like that but michael overweight i'm not anymore that's
why his book was called um a fat boy thin man but he still has to watch what he you know
so um okay so those are the questions but one more we've got a few more minutes um i i'd
like to talk because we we've covered a little bit about willpower and i go back to you know the
stanford study with the kids in the marshmallows what was that in the 50s or 60s and you know the
kids and i think everybody's heard this and one day i'm going to get a t-shirt that says don't
eat the marshmallows i know they're out there but the kids were given a marshmallow and they
were told you know don't eat the marshmallow if you don't eat the marshmallow you can have
a second one when we come back in 15 minutes and then you know and then that's
delayed gratification it's willpower and then um they tracked these kids
and found out the kids who who who left the marshmallow there and waited to the
second one did better in a lot of aspects of their life so that is the long preamble for
willpower willpower somebody told me once willpower is like a muscle the more you you use
it the stronger it gets and then you're blocking that was a thin person well i don't remember it
was a long time ago but you talk about the two friends walking down the street and going by
the bakery and oh my gosh it smells good the the one friend just says yeah it does and kept
walking the other one is just you know nobody got a hook and pulled him in the bakery but he
walked in and he ate however many and so willpower is there's is um and i'm you know i'm just
throwing this out there have we lost a little bit of willpower or is it almost impossible with the
junk that is in our food system now um so the idea and again uh you know one of the problems with
what i and others have been arguing for the past 20 years is that we're basically saying that the
obesity research community went off the rails just as the heart disease people went off the rails
with saturated fat and heart disease the obesity people went off the rails when they decided
obesity was caused by eating too much because the concepts like willpower are concepts that
exist only in the sense of people eating too much so um if you have a theory that says
obesity is a physiological disorder that's a fat accumulation disorder that's centered
around the hormone insulin in which insulin is a principle regulator then you could explain
phenomena like willpower as being the result of basically insulin signaling issues in the body
and this is the reason i use that example in the book so it's a person with obesity and a lean
friend walking down the street and they smell through the airport they smell the
cinnamon stores and i'm sure cinnabon like absolutely yeah so the the fellow has obesity
is insulin resistant that means his cells are resistant to the hormone insulin so he's over
secreting insulin in response to stimuli from the environment and if he smells something that
tells him that there's a carbohydrate out there just to be eaten yeah his pancreas will respond by
secreting insulin in preparation for the carbs to be consumed it's called the cephalic phase insulin
response if i start talking about hot doughnuts beignets i used to eat these when i lived in
france i will not only start salivating which i'm doing i will start secreting insulin a response
the insulin tells my fat tissue to hold on to fat and it tells the blood sugar to take up the liver
to take up any glucose and stored as glycogen and so it empties the circulation of available fuels
and it creates hunger you know the french have a phrase that the uh hunger begins with the meal um
hunger is the best sauce there's another one that comes from uh don quixote yeah um you know you
it'll make you hungry so the the fellow with obesity who's insulin resistant will instantly
get hungry upon smelling the cinnabon in a way that his lean friend will not yeah so now you've
got the equivalent of two people walking down they both might have eaten two hours before but
it's as though the person with obesity hasn't eaten in 12 hours or 24 hours and now he knows
there's food in there right and food that his body wants to metabolize because when insulin is
elevated you're only metabolizing carbohydrates so the idea is he goes in to that store because of
what's happening physiologically in his body not because he lacks willpower yeah the lean person
can't imagine how hungry that person with obesity has just become and if as i said in the book the
lean person goes into the store and has a cinnamon bun nobody judges him right because he's lean yeah
don't say he lacked will power because he's lean you only say the obese person did yeah so again
it's the whole concept of willpower and this is my problem with books like michael prager's
or on david kessler's the end of overeating um it's based on uh concepts that unfortunately i
don't believe were correct when they were embraced and it left out entire fields of science a field
of physiological psychology which studied how fundamental behaviors pavlov was
one of the founders of that field how fundamental behaviors are caused by underlying
physiological states and you could explain all of this with that science but we didn't want to
explain it because we knew that fat people ate too much and that's all we needed to say yeah well
i think um we for all that discussion we've only really scratched the surface of all the
information in here so i recommend everybody read this um and because it is fascinating uh
there's lots of uh room for well conversation so uh so with this um our thanks today uh to
gary for his comments here today as well as for those listening to the recording this program
and more like it will soon be posted on the club's website at commonwealthclub.org and now the
meeting of the commonwealth club of california commemorating the 118th year of
enlightened discussion is adjourned you
