The Case for Keto

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 
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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 and now the 
meeting of the commonwealth club of california   commemorating the 118th year of 
enlightened discussion is adjourned you

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