Ep. 137 – High Blood Sugar Levels And Its Long Term Damage with Gary Taubes

We are delighted to have Gary Taubes joining us today. Gary is an award-winning science and health journalist, and a co-founder and director of the Nutrition Science Initiative (NuSI). He is the author of The Case Against Sugar, Why We Get Fat, Good Calories, Bad Calories, and most recently, The Case For Keto. Gary is a former staff writer for Discover and correspondent for Science. He has written three cover articles on nutrition and health for The New York Times Magazine. His writing got featured in The Atlantic, Esquire, and numerous “best of” anthologies, including The Best of the Best American Science Writing (2010). 

As a science writer for Discover Magazine, Gary became obsessed with “bad science” and how hard it is to do science writing. After he had written his second book, a physicist friend suggested that since he was interested in “bad science”, he should look into public health because it was terrible. Gary then moved into public health, writing mostly for the Science journal in the early 1990s. By the late 90s, he had stumbled onto the world of nutrition and did a series of investigative articles. Gary found that the evidence supporting certain basic notions, like salt causing high blood pressure, and dietary fat being the cause of heart disease, did not pan out. That got him interested in obesity and what causes it, and ever since then has not stopped writing about nutrition.

Be sure to listen in today to hear what Gary has to say about why the established rules about eating healthy might be the wrong approach to weight loss, and how low-carbohydrate, high-fat/ketogenic diets can help many of us achieve and maintain a healthy weight for life.

“I can safely say that I am one of the world’s leading experts on ‘bad science’ or what physicists would have called ‘pathological science’.”

Gary Taubes

IN THIS EPISODE YOU WILL LEARN:

• Gary explains how after starting as an engineer, he ended up writing about science and health.
• Gary explains why calories are irrelevant.
• Gary discusses the roles of insulin in the body, and how it impacts your ability to utilize and store fat for energy.
• Looking at what leads to fat-shaming.
• Fat accumulation is caused by hormones.
• Gary gives his perspective on Ancel Keys’ policies.
• Gary talks about satiety and hunger.
• The health benefits of the ketogenic diet.
• The eating of carbohydrates after being on a ketogenic diet.
• Why certain carb-rich foods will cause cravings and spike your insulin significantly after you have been on a ketogenic diet for some time.
• Gary discusses the possibility of having long-term physical damage from your blood sugar levels going above 140.
• Gary explains the difficulties that surround writing a book about advances in nutrition.
• Gary discusses the reality of carbohydrate addiction.

Gary’s Links:

Visit his website, like him on Facebook, follow him on Twitter, connect with him on LinkedIn, and purchase his book, The Case for Keto!

Books mentioned: 

What We Don’t Talk About When We Talk About Fat by Aubrey Gordon

Calories Don’t Count by Herman Taller

The Atkins Diet by Robert Atkins

Protein Power by Mike and Mary Eades

Sugar Busters by Leighton Steward, Morrison Bethea M.D., Sam Andrews M.D., and Luis Balart M.D.

Connect with Cynthia Thurlow

• Follow on Twitter, Instagram & LinkedIn
• Check out Cynthia’s website 
• Check Out Dry Farm Wines: www.dryfarmwines.com/cynthiathurlow

About Everyday Wellness Podcast

Welcome to the Everyday Wellness podcast with Cynthia Thurlow! Cynthia is a mom of 2 boys, wife, nurse practitioner, and intermittent fasting and nutrition expert. She has over 20 years experience in emergency medicine and cardiology, but pivoted to focus on food as medicine. She loves to share science-backed practical information to improve your overall well being and is grateful to be interviewing leaders in the health and wellness field.  Her goal with Everyday Wellness is to help her listeners make simple changes to their everyday lives that will result in improved overall wellness and long term health.   

TRANSCRIPT:

Presenter: This is Everyday Wellness, a podcast dedicated to helping you achieve your health, and wellness goals, and provide practical strategies that you can use in your real life. And now, here’s your host, Nurse Practitioner Cynthia Thurlow.

Cynthia: I’m delighted today to have Gary Taubes. He’s an award-winning Science and Health Journalist, co-founder and Director of the Nutrition Science Initiative. He is the author of The Case Against Sugar, Why We Get Fat, and Good Calories, Bad Calories, and most recently, The Case for Keto. He’s a former staff writer for Discover and correspondent for science. He has written three cover articles on Nutrition and Health for the New York Times magazine, and his writing has been featured in The Atlantic, Esquire and numerous bests of anthologies, including the best of the best American Science writing. Welcome, Gary. It’s a pleasure to connect with you today.

Gary: Ah, thank you for having me.

Cynthia: I would love to understand and appreciate how an engineer got from doing an undergrad and graduate degree in engineering kind of heading up in science writing with that just a natural extension of graduate school, or how did that process actually happen?

Gary: Well, first of all, I was wasn’t very good, B student in physics and engineering. I even had an advisor who after I got a C minus in quantum physics and college suggested that I find another career path. I was always interested in journalism. So, I went to Journalism School of Columbia, and then when I got out, the jobs I could get were science writing. I wanted to be an investigative reporter. As a science writer at Discover magazine, it turned out that, there’s a lot of very questionable, poorly done science out there, and we see this condense now with the COVID debates. Back then, it was a little easier to get a handle on, and so, I started my first two books were about first physicists, and then chemists, and nuclear physicists who discovered nonexistent phenomenon. I became obsessed with how hard it is to do science right.

Whatever people think of my nutrition and chronic disease writing, I think, it’s safe to say, I’m one of the world’s leading experts on bad science or what physicists would have called pathological science. After my second book, my physicist friends said, “If you’re interested in bad science, you should look at the stuff in public health.” It’s terrible. So, I moved into public health writing mostly for the Journal of Science in the early 90s, and by the late 90s, I had stumbled on the nutrition world, and did a series of investigative articles first on this question of, whether solid causes high blood pressure, which is still like just bedrock, conventional nutrition wisdom, and there’s just the evidence to support that belief is just at best ambiguous, and then, the issue of dietary fat causing heart disease, and again, interesting hypothesis that doesn’t pan out. The guy named Ancel Keys in the 50s has this idea that dietary fat causes heart disease, and the government funds a few hundred million dollars’ worth of studies, and the studies don’t actually confirm the hypothesis, but we’re so invested in it. When your government spends $200 million in this case, there was $150 million on one study, $112 million on another.

The assumption is, unless the study confirms the hypothesis, you wasted the money. It’s a very odd way to think about it. Anyway, that got me into obesity and what the causes of obesity is, and I had this first infamous New York Times magazine article, and then spent five years on my first book, Good Calories, Bad Calories, and I have not been able to get out. I’m like Al Pacino in Godfather III. I’ll be writing about this until I fall off the stool someday, hopefully, later rather than sooner.

Cynthia: Well, I’m so glad that you’re doing the due diligence, because as a clinician, my whole career was an ER medicine and cardiology versus a nurse, later as a nurse practitioner. And for me, so much of what I was telling my patients was what we were conventionally taught in school, which I even attended a top researching university on the East Coast. Even we weren’t getting it right in terms of what we were suggesting to our patients. I’m so glad that there are people like yourself that are doing the due diligence, so that it can help, shift perspectives, because obviously, with escalating rates of obesity largely tied into the foods that we’re choosing to eat, it’s really of paramount importance.

So, let’s focus first on why calories are irrelevant? I think that, this is probably one of the most common, I know you’re smiling. One of the most common questions I get from other women is, “Well, how many calories do you eat a day? How many calories do you suggest I eat?” I tell them, “I don’t track any of that.” I’m much more focused on macros, because that’s what our body recognizes as opposed to this unit of measurement. So, I would love for you– I know Dr. Fung dispelled this also when I interviewed him, but I’d love to get your take on it as well.

Gary: Yeah, so, the essence of how we think about obesity is, and then fat accumulation is caused by taking in more food with more energy than we expend, and then we get calories of the way we count energy. This idea goes back to the early years of the 20th century back when the only thing they could measure was, how much energy was in foods and how much energy people expended? So, they thought the difference might explain obesity. Again, it was an incredibly naive way to think about it. So, that’s medical research at the time in the 1920s, 1930s was going on in Europe, in Germany, and Austria. In Germany and Austria, the researchers say, “Look, we know that obesity, fat accumulation is controlled by hormones.” Men and women, fatting differently. We go through puberty; we lose fat and gain muscle. You guys gain fat and you gain fat in very specific places. You get pregnant, you put on fat, and you put on fat below the waist, because if you put on fat above the waist like men do with the babies, you would be unbalanced. So, evolution or nature, whatever designed it, so that you can add fat. When the baby’s born, you can feed the baby.

Even if there’s a famine when the baby’s born, you have fuel available that you’ve stored. So, you can feel and it’s– So, all this is controlled by hormones. But if you have excess fat, the idea is kept that way, just because you eat too much. Yeah, the argument I’ve been making and that Jason has been making is, look, clearly all of this is a hormonal problem. There are other ways to think about it. I do this in the case for keto to quantify how [unintelligible 00:06:51] this calorie problem is. For instance, if you’ve gained 30 pounds of fat between high school and say, 45 years old, and your best friend has remained lean, the difference is, is that you’ve stored 30 calories a day in your fat tissue. 30 calories a day that they didn’t. So, you’re overeating. However much you’re supposed to overeat or however much you’re supposed to control your caloric intake, the problem is that, your fat tissue is holding on to 30 calories every day too much. After you eat, the fat you eat gets stored temporarily. So, say, during the course of the day, maybe you eat 1,500-2,000 calories and half of that’s from fat. So, your fat tissue will store 750 calories.

At the end of the day, it’s only released 720 of them to be used for fuel and the 30 that’s left is a difference between you being overweight and your best friend being lean. Now, you can ask the question, “What controls whether or not those 30 calories get out or not?” That’s a hormonal question. It’s not how much you ate or exercise or counting your calories question. It is you could count your calories and your fat tissue will still trap that fat. So, if you think about it like that, and the medical community religiously refuses to do so, and then you’re asking what hormones connect what you eat to how much fat you accumulate in that. That’s been known for 50 to 100 years, depending on how you want to look at it. It’s primarily the hormone insulin. Now, we’ve gone from talking about calories to talking about hormones.

Cynthia: And it’s absolutely critical. Unfortunately, whether or not people want to change and shift the dogma that they grew up with, I’m a huge disrupter. I am someone that constantly is asking why, which sometimes gets me in trouble. But I think it’s really critically important that people understand that a lot of the fat shaming that we see here not just in the United States, I know that it was really prevalent when we’re traveling abroad, but when we’re thinking about how that actually takes place. It’s not about someone not having enough initiative, it’s not about someone being lazy, it’s really about this hormonal dysregulation that goes on in the body. You mentioned insulin, and unfortunately, I think insulin has gotten a bad rap. Insulin isn’t all bad. So, when you’re talking or you’re unpacking this whole concept of what’s driving obesity, let’s talk a little bit about insulin roles in the body and how it impacts our ability to utilize fat for energy and store fat for energy.

Gary: Yeah, I want to get back to one point, though, you made about fat shaming. Because one of the problems, and this is an argument I also make in the book. Once we decided that obesity is caused by eating too much, and then you quantify the number. Like I said, you’re 30 pounds overweight, your best friend’s lean, you stored 30 calories a day in your fat tissue that he or she didn’t. That’s like three bites of food. It’s too [unintelligible 00:09:58] teaspoon of olive oil, it’s a tiny amount of food. Then the natural thing to ask is, why did you store it and somebody else didn’t? If you think it’s caused because you ate too much, then clearly you just don’t care enough to eat less or you’re too ignorant to realize. There’s no way to explain that without shaming the person who’s got the excess weight.

If you think, yeah, there’s this counter argument that it’s a hormonal issue, then while some people are predisposed to get fat and other people aren’t. There’s just no way to get around that. I had a brother. I have a brother who was always lean, I was always thick. We were built differently. There’s a wonderful new book out, a heartbreaking book called What We Don’t Talk About When We Talk About Fat by a young woman, Aubrey Gordon. She suffers with severe obesity, and she says like, “Some people are just built fat.” That’s all there is. It’s not that nothing in almost any food environment. Any modern food environment, they’re going to have excess fat. It’s not about, yeah, as you put it, it’s not that they’re lazy, it’s not that they’re gluttons, it’s not that they don’t pay attention to how much they eat.

Usually, people who suffer with obesity, pay more attention to what they’re eating than the rest of us, because they have to. Roxane Gay writes about this in her memoir, Hunger, when she’s going on a plane. When the officers say, you want to– Yeah, potato chips go on the plane, and Roxanne weighed over 300 pounds. She said, no, you don’t understand people like me can’t– We can’t be seen eating in public, because then people draw conclusions. The very nature of this idea that obesity is caused by taking too many calories and we expend leads to all the fat shaming, whereas if we had accepted this idea that it’s a hormonal dysregulation, then the job is to understand what hormones regulate fat accumulation. Now, we’re back to insulin, which was your question.

I think in an insulin, a hormone that regulates your partitioning in the body. You eat mixed meal with fats, carbohydrates, and proteins, and your body wants to maximize utility of all those macronutrients and fats, terrific for storage, because it’s dense as calories. Protein is used for repair and growth of cells, and tissues, and membranes, and carbohydrates have no use in the human body except for energy. When your carbs are high, blood sugar is high. That’s toxic state that most of the damage done in diabetes is done from high blood sugar. So, your body is working very hard to keep blood sugar under control, which means the insulin is telling your fat to store the fat you’ve consumed.

Remember, I said that virtually, all and most of the fat you eat during the day gets stored for the short-term immediately. Then it’s telling the protein to be used for growth and repair. So, it’s serving as a growth factor, and it’s stimulating other growth factors in something like growth factor. Then it’s telling the body to burn carbohydrates. The problem, when it becomes a negative thing is, when we have to and when we’d become insulin resistant, and we have too much insulin elevated in our bloodstream, and then it’s constantly telling your fat to hold on to fat cells and burn carbs for fuel in a mode where you’re storing fat from far more of the day than you normally would. So, it’s a hormone that we can’t live without clearly is in type 1 diabetes. It’s extremely beneficial. But when it’s dysregulated, then it starts to do damage, and that damaging fluid excess fat accumulation, and eventually, manifests as diabetes, type 2 diabetes.

Cynthia: Do you think a lot of this shift here in the United States was a direct result to the methodologies of Ancel Keys? I know that we’ve had several guests that have touched on Ancel Keys including Nina Teicholz, whose podcast will be released tomorrow. But I reflect back on how much his perspectives and policies really have been profoundly detrimental to the health of us here in the United States. So, I would love for you to touch on his shift on not wanting to focus on sugar being this profoundly inflammatory substance, and instead wanting to bastardize fats. Let me be very clear to all the listeners, I always feel like I have to say this. I was schooled in the 90s, and started practicing as an NPin the 2000s, and we were still at that point in time, especially, in cardiology saying, fats bad, you have to use all these fake fats.

Now I know better, but I think it’s really important, because those changes, shifting focus from sugars to that bastardization has forced the processed food industry and forced all of us to think of fat as a bad thing. In many ways, when I reflect back on 1980s, 1990s, and beyond the start of a lot of these policy changes where they want us eating heart healthy grains, and people are hungry all the time, because they’re not eating much fat in their diet, its very carbohydrate focused. So, I would love to get your take on perspective on what you think of Ancel Keys policy.

Gary: This is what got me into obesity. While I was doing this article on dietary fat, which took me the better part of me, it took me a year. In fact, I interviewed 145 researchers and administrators for one magazine article in the Journal of Science, and realized as I was doing this began to learn about the influence of Ancel Keys and others, that there was again the idea that dietary fat caused heart disease, and saturated fat raises LDL cholesterol, and that causes atherosclerosis was an interesting hypothesis that had been tested in numerous trials.

A few of the trials suggested that people ate a lot of saturated fat compared to unsaturated fats had more heart disease, but they also tended to have less heart disease. Anyway, some of the studies confirm this idea that saturated fat was bad, and some of them refuted the idea that saturated fat was bad, but the government was so invested. As I was doing that there was a researcher and administrator at the National Institutes of Health who told me, we were actually having coffee at the Starbucks at the corner of Falls Road and River Road in Potomac, and then the Washington DC suburbs, and he said, “Look, we thought when we put the country on a low-fat diet beginning in 1984, we thought if nothing else, we would solve the obesity problem.” Because we’re putting them on the least, the fat is a dense as calories in the diet. They’re nine calories per gram of fat compared to four. So, if you eat less fat, we’ll consume less food and you’ll weigh less.

That was our fallback position. We didn’t know what it would do for heart disease. We were clear about the studies being ambiguous, but we figured it’ll make people leaner, and if people get leaner, they’ll have less heart disease. Instead, we have an obesity epidemic. People eat more carbs. They replace their fat with carbs, and they got fat. When I started this New York Times magazine story, that was one of my hypotheses. The idea was, what’s the cause of the obesity epidemic? Here, I had this administrator, the National Institutes of Health suggesting to me that, it was their policy to tell the whole country. What had happened in the US, and there’s the Ancel Keys story is Ancel Keys, the University of Minnesota Nutritionist comes along in the 1950s with this hypothesis, that dietary fat causes heart disease. It’s based on work that he and his wife had done in Naples sort of very amateurish study, where you look at people with heart disease and people with that, and you measure their cholesterol, and you get some idea what they’re eating, and decide this an interesting hypothesis.

Ancel Keys a very energetic, motivated man who wouldn’t take no for an answer. He’s the kind of man that would be described as not suffering fools gladly, and he would define a fool as anyone who disagreed with him. He just through force of will convinced the government and the research community that this hypothesis was almost assuredly right, and they just had to do the right clinical trials or studies, and they could demonstrate that it was right, and it turned out that it inflicted in time with the British hypothesis, which is that though, it’s interesting way to look at it. In science, I would someday like to write a book about ‘Good Science and Bad Science.’ In science, the critical thing to do is to ask the right question, because the question you asked determines the answer you get.

What Ancel Keys wanted to know is, why was there so much heart disease in the United States and Minnesota, where he was practicing medicine as well as being a nutritionist, and then may be in Italy, why did the rich people have more heart disease than the poor people? So, this is the question he asked, and the answer was, well, because we eat too much saturated fat in dairy and meat, and so, and that raises our cholesterol. But simultaneously, that was a British hypothesis, and the British had the British Empire. So, they had colonial and missionary hospitals all around the world. All around the world, they were seeing the same thing, which is regardless of the population that was being served. So, it could be agrarian populations in Asia or pastoral populations living on cattle in Africa or Inuit populations living on whale meat, and caribou, and seal, and wherever it is. They were healthy until they transition to the Western diet.

Then, once, they have the Western diet, then, they start manifesting heart disease, obesity, diabetes, cancer, this whole cluster of chronic diseases. The transition to the Western diet was basically you add sugar and white flour to whatever their baseline diet was. So, their baseline diet could be very high in saturated fat like the pet store or less. It could be high in unsaturated fat like the Inuits, it could be relatively low in fat like the Southeast Asians, and you add sugar and white flour, and you get obesity, diabetes, heart disease, and a whole cluster of chronic diseases that became known as Western diseases. So, the British have this theory that the problem is sugar and flour.

The first by a US Naval researcher named Peter Cleave a British naval researcher and then John Yudkin, the most prominent British and European nutritionist, took it up, and pushed it as a sugar only, pissed because Cleave, he was testifying to the US Congress. He said, I could pick [laughs] this man in a five-block neighborhood of US Congress, and there wouldn’t be a sugar eater among them. They’d all be beer drinkers. So, we can’t just blame sugar. Anyway, so that was a British hypothesis pushed by Yudkin saying, it’s sugar, and maybe white flour. Keys in the US is pushing the fat hypothesis. The US had all the money, that Europe was still digging out of the Second World War, and they had other things to worry about still in the 1960s. So, funding was much lower.

Keys did the biggest studies. It was a political social conflict. There wasn’t based on the data, and then in the US, there was a very active sugar lobby that I’ve written about in my books, and the sugar lobby was pushing the fat hypothesis. Clearly, if everyone thinks it’s fat and sugar must be benign. By the 1970s, the fat hypothesis had worn out. That was it. The sugar hypothesis fell into the hibernation, went into remission for 30 years until people like myself, and Dr. Robert Lustig at the University of California, San Francisco started saying, maybe, it’s sugar and not fat. But none of us knew this. When I was growing up, when I was eating a low-fat diet to the 90s, I had no idea about any of this. I was consuming an awful lot of sugar on a very healthy, mostly planned low fat diet, because like all of us, we thought the problems, saturated fat and salt, and as long as we avoid those will be healthy.

The interesting thing is, books now come out what happened– When I wrote my investigative articles in the New York Times magazine piece of my first book, this was kind of news, and then Michael Pollan picked up on it a little bit even and said, this is important stuff, and then Nina took it even further with her book, The Big Fat Surprise, and got accolades that I couldn’t get seven years earlier, because what I was saying was too controversial. So, we’ve managed to shift the thinking. So, nowadays, the conventional wisdom right is the problem is processed foods, which means processed grains, and vegetable oils, and sugars. That’s the zeitgeist. But the establishment still is pushing low fat, low saturated fat diets as Nina will have said, and the dietary guidelines is still pushing those, and the American Heart Association, the public is still afraid of fat. They don’t know what we know.

Even though, they’re in books now, on multiple books, and they said, world of low carb and ketogenic diet books that are out there, and new ones coming out every month, and they’re all saying the same thing, but this history just fades back into the history, and people think this is an interesting opinion. But they’re still going to worry about the saturated fat in their diet, because that’s what they’ve been told their whole life.

Cynthia: Well, there’s not a day that goes by that I don’t get a direct message on Twitter, or Instagram or Facebook. Someone’s fearful of my life, because I’m eating butter or I’m eating steak, but admittedly, I have a house full of all boys. So, there’s a lot of meat consumption in my home. But I think you bring up such a great point that it takes a long time for dogma to shift, and it takes a long time, if the conventional wisdom has been for 20, 30 plus years that fat is bad, people are afraid of eating fat. And I know this, because I have conversations with my own family members. My mother who’s Italian, trying to convince her that she needed to liberalize her avocado use, and not be afraid to eat some nuts, and not be afraid to use coconut oil or MCT oil. It completely blew her mind.

Especially, I think women of a certain age in particular, they’re already very focused, pre-occupied with weight gain, and so they fear that if they eat fat, they’re going to get fat. But let’s pivot a little bit, and talk about, you know when we’re talking about these carbohydrate focus diets that have low fat, one of the reasons why people continue to overeat carbohydrates is because they’re not satiated. So, let’s pivot and talk about the foods that we know are most satiating, and then jump into talking about ketogenic or lower carbohydrate diets and some of the health benefits, because I think that keto also gets a bad rap, because so many people do it wrong. There’s junk food and every nutritional focus that’s out their vegan, probably, not carnivore, but just about everything else. There’s vegan junk food, there’s paleo junk food, there’s primal junk food, there’s keto junk food, it’s all out there. People capitalize on that.

Gary: Yeah, there’s a lot of issues wrapped up in that. When we talk about satiety, well, first I was going to talk about the fear of fat. I’ve been doing this– I first experimented with keto, which in 2000, we still called Atkins. So, 21 years ago, and when I first wrote about this for the New York Times magazine, I described sitting down at my breakfast looking at my bacon and eggs, and waiting for the heart attack or the rebound obesity, or whatever it was that was going on– 20 years later, I still worry about it. I programmed. It can’t possibly the amount of butter I eat. It can possibly be good for me. Bacon cannot possibly– Then you see this. It’s funny.

The most uninformed the nutritionists are, how can this diet possibly be healthy, if they allow you to eat bacon? Can you actually show me a study, a clinical trial within, without bacon in it, where the people not eating bacon are healthier? It’s kind of a disingenuous question, because nobody’s ever going to do that kind of trial. But that’s what you actually need to do to know if bacon is bad for you. It’s always been associated. There are certain foods that became associated with an unhealthy diet. So, instead of it being a Coca-Cola, and McDonald’s French fries, it was always the burger. Whenever you have a picture about the unhealthy diets or the American diet being bad for you, they will show you a hamburger photo along with photos of 400 pounders in bad clothes at Disney World taken from the back.

The idea being made to hamburger and that’s what made them. We are programmed at this point, and the younger the generation, and I’ve spoken to a lot of pre-COVID, but I talked to a lot of dietician classes, and nutrition classes, and I had the–growing up my mother in the 60s believed that meat, fish, and fowl are integral to a healthy diet. So, that’s just what we ate with the green vegetable and a starch at every meal, and an appetizer, and a salad. Very lucky to have a mother who was very health conscious. But then by the 90s, mothers had been convinced that they should be avoiding fat and red meat. Now, you have a generation of people who have been taught that from birth. It’s much, much harder to end. If you can give that up, and eat instead doughnuts, and bagels, and soy, cream cheese, and McDonald’s French fries, and feel like you’re being virtuous, because you’re not eating meat, that seems like a good trade off. If you are 50 or 100-pounds overweight, that seems like the best you can do, because you’re still trying to eat not too much, and you end up with this perfect storm of bad dietary advice combined with the physiology, that’s now programmed to gain weight.

Satiety is an interesting issue. I don’t actually think in terms of satiety and hunger. Part of my research, part of the advantage I had as a journalist when I wrote my first book, Good Calories, Bad Calories, I wasn’t locked into a particular discipline. The way obesity researchers have thought about fat accumulation for 50 years is that people get fat, because they eat too much. If they eat too much, that must mean that they’re either too hungry or the foods they’re eating aren’t satiating enough. So, they continue eating after the point that they’re full or they don’t know that they’re full. They’re all these concepts that are based on the idea that you get fat because you eat too much as opposed to you get fat, because your body is storing too many calories as fat.

There was a field, a discipline known as physiological psychology, which dates back to Pavlov and Pavlov’s dogs’ assumption of that research being that underlying physiological states. That fundamental behaviors are determined by underlying physiological state. So, if you’re hungry, it’s not because your brain is being failing to get some satiety hormone or something, it’s because the cells in your body are not receiving enough fuel. If they’re receiving enough fuel, then you won’t be hungry and you won’t go through, and that whether or not your cells are receiving enough fuel is thehormonal issue in the body. Again, it’s the same hormones, insulin, and glucagon, and growth hormone, and these hormones that determine whether you burn calories for fuel.

The way I think about it is, when you’re in a condition where you’re storing calories as fat. When insulin is elevated, that’s going to make you keep eating, because body, basically you’re on what the bodybuilders would call an anabolic state, where your body is trying to grow. So, the foods that stimulate insulin secretion are going to be the foods that make you hungry, and the foods that you can eat without stimulating insulin are going to be the foods that seem more satiating. But even then, it’s more complicated. I don’t like the term overeating on carbohydrates, because for the person who fattens easily, then there may not be almost any amount of carbohydrates that won’t trigger that fat deposition.

So, it’ll be hard to find the point at which we can eat carbs without our body still wanting to store fat. If we’re not getting enough calories, and we’ll just be hungry, and we’ll keep eating, and if we are getting enough calories in our bodies will store the fat and despite the carbohydrate. So, there’s a lot of ways we’ve been trained to think about this that are based on this initial belief that we get fat because we eat too much. If the obesity researchers had gotten that right, we’d have been thinking about all of this differently. So, it wouldn’t be that some foods are satiating like protein and fat. It would be that some foods literally make us hungry or like the carbohydrates we consume.

Cynthia: And that can be hugely problematic. I think as people if they’re open to it, if they’re open to shifting, I always say the end of one of experimenting with what works best for your body. I think it can be profoundly interesting, and I know before we started recording, we were talking about CGMs, Continuous Glucose Monitors, and how surprised I had been despite being low carb bordering on ketogenic, how surprised I have been that certain foods that I thought were probably not all that bad for me really spike my insulin. So, is it any surprise that yesterday when I tried to eat some berries, that it spiked my insulin significantly, and the whole rest of the day, whether it was like a psychosomatic situation, but the whole rest of the day, I was like, “Wow, I don’t normally have cravings, and here I am having cravings,” and isn’t that interesting that we’re talking today, whereas today, I made sure everything I’ve done has been protein and fat focused. I’m full like there’s no desire to eat more food and my CGM data completely aligns with that.

Gary: Yeah, and it’s hard to tell notwith analog ones, it’s hard to tell what’s kind of a placebo psychological effect. I have all kinds of responses to Corbridge foods that I can almost get, hang, well, I get the equivalent of hangovers now if I have a Corbridge dinner, and the next day, I’ll feel awful. Honestly, I have no idea if that’s a real phenomenon or if that’s somehow psychologically prompted, and if there’s even a difference between the two. The other thing that happens is, when you’re keeping low carb for a long time, your body loses the ability to– It doesn’t lose your– It’s like your pancreas decides that it doesn’t have to secrete insulin every day. It’s not going to get carbs, so you don’t have to worry about it, and this is a common phenomenon. It’s been known since [unintelligible 00:35:36] that if you want to test glucose tolerance after a ketogenic diet, you’ve got to re-feed carbohydrates for a few days to get the pancreas used to eating them.

Then, so, if you were eating the berries regularly, your blood sugar might have stayed better under control you’d have gotten more insulin secretion. By doing the experiment like this, you may be seeing anomalous short-term effect. Every once in a while, to decide the paleo people, maybe they know what they’re talking about, and I should be having sweet potatoes or yams every day, because whenever I give a conference, I give a talk, and somebody asked me about sweet potatoes. I immediately think that this is a paleo person. So, I’ll cook dinner for my family. My kids get a healthy conventional American diet, and my wife is mostly vegetarian. So, she’ll get what we’re eating minus whatever the meat, fish, or fowl is.

Every once in a while, I’ll make them sweet potatoes, and I’ll try the little piece of sweet potato, and then after dinner, we get cleaned up. My wife and I usually watch an hour of Netflix or Amazon Prime video. That’s great age oftelevision, and I will fall asleep on the couch religiously.Just as in high school, Thursday night was pasta night, and I used to go on these carb comas after the pasta meal, my mother would have to almost drag her 190-pound son from the living room couch to his bedroom. Now, the same thing happens from a little piece of sweet potato, and I keep thinking. If I continued to eat it, maybe my body would adapt, but I don’t feel well. So, I don’t want to continue to eat it.

Cynthia: Which makes complete sense. Although, it’s interesting, because I feel like there’s this conventional dogma that we need to boot ourselves out of ketosis, episodically, if we’re doing low carb or ketogenic diets for a period of time, so that our bodies aren’t– Well, the conventional wisdom that was shared with me was, we want to remind our bodies, we’re not starving. We want to much like anything, it’s some variability in our diets. I just don’t know where I fall with that right now, because I was so surprised at how high my blood sugar went when it has been in the 70s and 80s coasting along. And I know when I was talking with Ken Berry, he was saying, “Anytime your blood sugar goes over 140, you’re damaging the interstitial lining of your blood vessels, you can be damaging your kidneys and your eyes.”

Being the good soldier, being the obliger, I hear that I’m like, “Okay, well, I probably need to be more conscientious.” I’m not sure what the right answer is, and I know that, listeners will be curious if there’s any research that’s been done on this at all.

Gary: Yeah, and the answer is no. Because what you want to know long-term harm. You can make the argument that a liver damage is a good thing, because it keeps your defense mechanisms working. The worldis full of hypotheses. One reason I wrote, The Case for Keto, I kind of want to say, look, this is how originally it was called, how to think about how to eat, and we had to change that title. But that’s what I wanted it. For those of us who fatten easily, a term I picked up from the 1950s diet books, and we all know who we are. For those of us who put on weight easily, we have trouble controlling our weight in our blood sugar, and now we’re bombarded by inflammation, and this is how I think we should approach this and think about it andmight be right.

But even if he’s right, that you’re doing long-term damage, and you’re doing this two or three times a week or once a week, are you shortening your life by five years or you’re shortening your life by five minutes? We don’t know. When these studies were done in the late 1980s to test the idea that we should all keep our cholesterol or LDL cholesterol, the answer for that assuming that everything the establishment said about the evils of cholesterol was right, was that we would live a few weeks to a few months longer by restricting that saturated fat in our diet significantly. All of our fear of fat was about maybe, key word, maybe lengthening our life by a few weeks to a few months.

One of the researchers who did this, and he did this study at the behest of the Surgeon General’s office. When he got his results, the Surgeon General’s Office tried to prevent them from publishing it. It actually reached out to the editors in JAMA, the journal that it accepted and said he couldn’t publish this, because if he published it, nobody would eat a low-fat diet. When I interviewed him, he was here in San Francisco, he said, aside from sharing with me the letters and went back and forth with the Surgeon General’s for which I was always grateful, he said, you can live two, three months longer. It’s not on your honeymoon.

Cynthia: [laughs]

Gary: It’s at the end of your life. So, somebody who is going to die of 75 years old in March, who avoids saturated fat his whole life, eats like skinless chicken breasts, and seed oils, or pick your oils instead of butter, and chicken thighs, and instead of eating like the French, they eat like the Mediterranean’s, even though, we know the French live a very long time. Anyway, you make all these sacrifices, instead of dying in March at 75, you die in late April. These aretimingon the nursing home. It’s like another [unintelligible 00:41:04]

How much of a difference is going to possibly make? That’s the question. So, in this book, there’s a good argument we made that, if you’re on the borderline, it could toast us. Maybe your brain isn’t getting enough ketones for fuel and brain fog that people often feel, but they feel this on every diet. Just the brain fog that you might feel on a keto diet might be better if you religiously stayed in ketosis. That’s quite possible. I don’t know if it’s true or not. It’s also like I said, Ken’s argument is quite possible and I don’t know if that’s true. But even if it’s true, the question is how much do we–

I often wonder like, if I’m right and you give up sugar, and flour, and grains, and starches, and don’t even eat legumes, because they have a high carb content, and you go carnivore for instance, and then what’s going to kill you? Now, we associate all the chronic diseases that we suffer with basically overweight, and obesity, and diabetes, and high blood sugar, and high blood pressure, and those are all carb related, so, you’re going to minimize the risk of all those chronic diseases including cancer and Alzheimer’s. What do you die of and my theory is, you’re 80 years old, you’re in perfect health, you go to your grandson’s first birthday party, you have an ice-cream cone, and your heart blows up. Everybody blames it on the ketogenic diet you’ve been eating for the past 40 years instead of on the ice-cream cone that raised your blood sugar and blew up your heart. A lot of complicated–

One of the problems, and I discussed this in the case for keto is because the obesity in Nutrition Research Establishment completely failed to– They came up with this idea that people get fat just because they eat too much, so they tell us how we got to eat less and exercise more, we have obesity and diabetes epidemics. The whole nation is getting fatter. They have completely and utterly failed to handle this. So, they’ve left it up to the physicians like yourself to figure it out, and over the decades, physicians did. People like Albert Pennington in the late 1940s, who worked in Pennington or worked at the DuPont, Hermann Taller wrote a book called Calories Don’t Count, or Robert Atkins and the famous Atkins Diet, and Michael, Mary Eades, who wrote Protein Power, and a group of Tulane physicians who wrote Sugar Busters. And then people like Nina and Heidi Shelton, I came along, and we established through our journalistic research that these diets are healthy and not going to kill you.

While we were doing that work, people are actually doing clinical trials establishing that rigorously. But now, you’ve got this world of theories, and hypotheses, and diet books, and everyone’s got to say something new. You can’t write a diet book and say, just do what Adkins said. I can because I’m a journalist. The physicians can’t. So, as soon as you decide I’m going to write a book, you’ve got to write something different than everyone else. You’ve got to have a different hypothesis, or timing, or so, now, you’re pushing. There are all kinds of variations on it. Some of them may be important advances, but there’s no way to know. Some of them may be important observations. Maybe just a little bit of elevated blood sugar is going to shorten your life by five years, not five weeks, but maybe five years. Maybe it’ll be the difference between what cancer diagnosis or not. I don’t know. Not one in 10,000 people, but one in 10 people. But there’s no way to know, because the mainstream establishment has failed at their job.

Cynthia: Such important points. I definitely want to at least be mindful of your time, but one of the questions that came up with some frequency, when I mentioned that we were going to be connecting was carbohydrate addiction. Obviously, I know that there is this is real. This is not something that’s just contrived, just based on certainly what I have read. So, for people who are unable to control their consumption of carbohydrates, meaning, they can abstain from eating a cookie or ice-cream, but as soon as they have one or a scoop, it puts them in a position where they then slide down the path of overconsumption, and then they’re back to this kind of powerfully addictive qualities. What has been your experience, when you’re talking and doing research on carbohydrate addiction? Because I do believe that it’s a real entity much to the point you were making earlier about the profound hormonal impact of having elevated insulin levels amongst a myriad of other hormones that get activated.

Gary: Well, one of the things I did in this latest book, The Case for Keto, so, I’ve interviewed 120 plus physicians who out of what I estimate is a few tens of thousands in the world who now think like we do. And I wanted to understand that what we’re beginning to see is enough clinical experience that people can start talking about what works from the physician perspective, and what doesn’t work, and the challenges to the patient. Many of these physicians thought of what they did not as we’re describing their clinics, not as weight loss clinics or family medicine clinics, but as carbohydrate addiction, rehab clinics. How do you get people off carbs?

There’s a very good physiological explanation for the craving and the love we all have of carbs, which is when you start thinking about eating carbohydrates, your body will secrete insulin in response. It’s like a Pavlovian thing I talked about, just as Pavlov’s dogs would salivate when he rang a bell, I can sayhot fresh donuts, and I’ll start salivating. But it means my pancreas also just secreted insulin, saying, “Oh, this guy is about the carbs and we got to get insulin in the bloodstream in advance,” and what insulin does is, it tells the lean tissue to take up the blood sugar, the glucose. So, your blood sugar is going to start dropping once you start thinking about eating, and it tells your fat tissue to hold on to the fat because it’s preparing for the food that’s coming.

Once your insulin is elevated, it’s telling your fat tissue to hold on to fat and your protein. The protein you consume to be used for cell repair, and growth, and carbs. It’s telling actually the mitochondria in your cells, the energy factories in your cells to burn carbs, not fat or protein. So, carbohydrates, literally become your fuel. If you’ve got this condition called insulin resistance, which if you’re overweight, obese, pre-diabetic or diabetic, you’re a type 2 diabetic, you are insulin resistant. Then for most of the day, probably, except for a little window while you’re asleep, your body is looking to burn carbohydrates. As your blood sugar comes down, you’re not getting the access to the fat to replace it, because your insulin is high. So, you’re going to crave carbs. You drink sodas all day long, because you’re basically feeding your body a little bit of carbohydrates and feeding your liver specifically all day long. You snack on carbs, because the idea of having cheese and a meat plate at 10 in the morning two hours after breakfast is like most people are going to be put off by that.

One reason they’ll be put off by that is because your body doesn’t want to burn fat and protein, and it wants to burn carbs, even the crackers, the doughnuts. Again, part of the way I think about this now is, once your body is dependent on carbs for fuel, your brain will respond with these markers of addiction. When you eat carbs, you’ll get the reward the dopamine response that you get from other addictive foods.

We all know who we are. My wife can have, she can go to dinner, order a dessert, have two bites, and then push it aside, not think about it again. I’ll go, I’m with her. I don’t order dessert because I’m virtuous. I don’t eat carbs. Then, I start staring at her dessert, then I have a bite of her dessert, and then I stare at her dessert, and then she’s pushed to the side, and then I just grab it and put it in front of me and I’m going to finish it. That bite makes me crave. There’s no way that sugar satiate me. When I’m done with that dessert, I don’t crave sugar any less than I did when I started. I just realized that I can’t have two desserts. That would be foolish. But that kind of urge, that kind of craving is magnified. It would be magnified the heavier I am, and it’d be magnified the more insulin resistant I am. It’s hard for a lean, healthy person to imagine the carb cravings of someone who’s not. How do you break it?

Well, telling people to eat in moderation is not the solution anymore than it is telling an alcoholic to drink in moderation, or cigarette smoker to smoke in moderation, or a heroin addict to only shoot up in moderation, and this is when these people think about rehab. You need to go probably cold turkey. The good thing is, we know physiologically, if you get rid of the carbs or replace them with fat, then your body will switch over to become what’s called fat adapted, and now, you’re burning fat for fuel. You will start craving that rich foods instead of carb rich foods, and this was demonstrated in rats in the 1930s.

Again, in this field of physiological psychology, you hear it all the time in the anecdotal world. But you have just like it takes you three weeks to get through the worst of alcohol addiction and smoking addiction. That’s why alcohol rehab is 28 days, because by 28 days, you’re over the worst of it. It probably takes that long for at least some people to convert in our world to get rid of the carb addiction, and then it’s something you fight for the rest of your life. The only reason I’m skeptical of the keto, low carb-high fat, processed food industry. But a lot of people, they’re going to foods who replace the junk they’re eating now. We’ve helped them get through the carb addiction. I know honestly, there are still times I crave a good candy bar and Suzie’s good fats will do it for me. But anyway, that’s the issue.

These physicians I spoke to they often they said, “Look, we know we have all these lessons we learned about in the addiction world and about how to deal with addiction.” If you’re an alcoholic, you don’t get a job in a liquor store. You don’t get a job as a bartender. Maybe you want to challenge yourself, but for most of us, it’s a foolhardy thing to do. You don’t have alcohol in the house. if you’re a smoker when I was a smoker, I tried to quit smoking. It wasn’t enough to just throw out the pack of Marlboro Lights that I ate or to break it up, because if I put in the trash and broken up three hours later, I would be able to find a half of one that I could still smoke. So, I had to put water in it. Because otherwise I was going to smoke and you’d learn those tricks. This is advice I got from physicians. It takes practice. The longer you do it, the better you get at it.

Things that seem unsustainable. Quitting smoking seemed unsustainable to me for 10 years before I finally succeeded. I learned tricks. Don’t go to a club with my friends Friday night. If they’re smoking and think that I cannot smoke, so, I just can’t do that anymore. Because I don’t want to become a smoker. Now, I can because no one’s allowed to smoke in clubs. Now, I don’t go to clubs because I’m 65-year-old man. Again, what I’m trying to communicate in The Case for Keto is, you learn to think like this. And you take it one step at a time, so, it’s not as hard as you think. What next thing, it’s been six months, you are pretty happy living without carbs, and you’re very happy that you’re now healthy. That your body have shed 20, 30, or 40 pounds. Your blood sugar is under control, your blood pressures, if you’re a type 2 diabetic, you’re off your medications. These have all been shown in clinical trials. This is what happens when you give up these carbs.

Cynthia: Well, slow and steady absolutely wins. I want all my listeners to know The Case for Keto is the first book I’m recommending for 2021. I’d love for you to share with the listeners. What are you doing next, and what’s the easiest way to connect with you on social media or on your website?

Gary: My next book will be on diabetes specifically, and I have to admit, all my books have taken a historical perspective. I work under the assumption that if you don’t know the history, have your beliefs, you don’t know whether they’re true or not. So, literally, to know what you’re talking about, I’m become obsessed with the history of dietary therapy for diabetes. I hope I don’t lose too many readers. So, apologize in advance. I’m active on Twitter. Not active enough that Twitter is another addiction. I’m not sure anyone is healthiest with and my website is garytaubes.com and people can reach me through the contact slot on my website. The book is available wherever fine books are sold. If you have an independent local bookstore that’s still open, please buy it there.

Cynthia: All right. Well, thank you so much. I look forward to having you back when your new book comes out. I do think that people are curious to understand more about this whole concept of blood sugar dysregulation largely because so many of us are insulin resistant, if not diabetic, and unless we start changing our choices, more and more of us will end up in that direction. So, thank you for your time today.

Gary: Okay. Thank you very much, Cynthia.

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