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Episode 166
The Doctor's Farmacy

Who Should Eat Keto and Why?

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Chances are, you’ve heard a lot of buzz about the ketogenic (or keto) diet. This high-fat, low-carb approach to eating has become extremely popular in recent years for helping with everything from weight loss to cognition.

So is it worth the hype? Like any diet, keto is great for some people and not-so-great for others. Genetics, family history, personal health goals, and so many other factors tie into what type of diet will work for an individual. The one-size-fits-all approach to diet has led way too many people down the wrong path.

Today, I’m excited to chat with Gary Taubes all about the keto diet, it’s complexities and benefits, and who might want to consider it. 

If you’re not familiar, the keto diet is essentially 70% fat, with very little carbohydrates and moderate protein. This is a major shift from the low-fat craze, and though it was originally used as a therapeutic diet for epilepsy decades ago, many other health benefits have been discovered since. 

The calories in, calories out model of health hasn’t been serving us. Not all calories are created equal; healthy fats can be much more nutritive than non-fat refined carbs. One of the biggest failings of that energy-balance approach to eating is that it doesn’t take hormones into account—and hormones have a massive impact on our weight and our health. 

Gary and I talk about the problem with viewing weight loss as a math problem and why keto is a good example of stepping away from that pattern. We also talk about customizing keto to fit your individual needs. You might be surprised it doesn’t have to be meat-heavy, plus we discuss what kinds of issues some people might run into that signal keto isn’t right for them. 

Diet is not black and white. I hope you’ll tune in to learn more about keto and if it’s right for you. 

This episode is brought to you by Paleovalley, Joovv, and TrueDark.

Paleovalley is offering 15% off your entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal.

Right now, Joovv is offering Doctor’s Farmacy listeners an exclusive discount on Joovv’s Generation 3.0 devices. Just go to Joovv.com/farmacy and use the code FARMACY. Some exclusions do apply. 

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I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

In this episode, you will learn (video / audio):

  1. How an investigative journalism piece on salt and blood pressure led to Gary’s ongoing inquiry into the obesity epidemic
    (5:15 / 9:11)
  2. Why we get fat
    (10:02 / 13:58)
  3. Why science mistakenly began focusing on calories, instead of hormones, to understand obesity
    (14:02 / 17:58)
  4. The origin and perpetuation of fat shaming and obesity stigma
    (17:49 / 21:45)
  5. There is no one-size-fits-all diet
    (24:34 / 29:02)
  6. Using a keto (or low- carb, high- fat) diet to decrease insulin levels
    (32:54 / 37:20)
  7. How ultra-processed, starchy refined carbohydrates are driving most of our global issues
    (45:49 / 50:15)
  8. Would humans and the planet be healthier if we all stopped eating meat and became vegan?
    (48:07 / 52:34)
  9. Connecting what you eat with how you feel
    (53:31 / 57:57)
  10. Research on treating and reversing type 2 diabetes using a ketogenic diet
    (1:00:14 / 1:04:41)
  11. Using a ketogenic diet to treat cancer, heart disease, heart failure, dementia, epilepsy, and more (
    (1:12:38 / 1:17:05)

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Gary Taubes

Gary is an award-winning science and health journalist, and co-founder and director of the Nutrition Science Initiative. 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, and his writing has also appeared in The Atlantic, Esquire, and numerous “best of” anthologies, including The Best of the Best American Science Writing (2010). He has received three Science in Society Journalism Awards from the National Association of Science Writers, and is also the recipient of a Robert Wood Johnson Foundation Investigator Award in Health Policy Research. 

Show Notes

  1. Get a copy of his book, The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating

Transcript

Gary Taubes:
The obese and overweight, the 90%, 88% of Americans who are metabolically unhealthy are not sitting in lines at McDonald’s right now in their oversized SUVs with especially wide seats, waiting to get their triple cheeseburgers and super sized fries and huge cokes. I mean some of them are, but some of them are eating very healthy and doing their best to eat in moderation. They’re still overweight because they’re getting the wrong advice.

Dr. Mark Hyman:
Welcome to The Doctor’s Farmacy. I’m Dr. Mark Hyman, that’s Farmacy with an F, F-A-R-M-A-C-Y, a place for conversations that matter. And if you’ve heard the buzz about keto and are wondering what it is, if it works, if you should do it, or if it’s going to kill you this is the podcast you should want to listen to because it’s with my good friend, incredible award winning journalist Gary Taubes. He is one of my heroes. In fact, it’s one of his original articles that got me thinking about the whole idea of is a calorie a calorie and is sugar actually worse than fat. Back in 2002, when he wrote The New York Times magazine article, which was called Big Fat Lie. Wasn’t it called Big Fat Lie?

Gary Taubes:
What if it’s All Been a Big Fat Lie? Yes. [crosstalk 00:01:19].

Dr. Mark Hyman:
Yeah. Hi, Gary. Gary was a co-founder and director of the Nutrition Science Initiative or Nusi, he’s the author of many books, which are really deep dives into issues that we all care about. The Case Against Sugar, which I’m a huge fan of, Why We Get Fat, which is a very concise little book that explains exactly why we gain weight, and Good Calories, Bad Calories. Again, these are just in my mind, some of the top books in the nutrition health field, probably the most investigative books I’ve seen about the truth of the science without any filters or any sort of obfuscation through the ways that we usually get our data.

Dr. Mark Hyman:
He is also a contributing article writer for Discover, staff writer. He’s written many articles and cover articles for nutrition healthy in New York Times Magazine, he’s written for the Atlantic, Esquire and has been in many best of anthologies, including the best of American Science Writing. And he’s received lots of awards. Three Science and Society journalism awards, the National Association of Science Writers, he’s the recipient of the Robert Wood Johnson Foundation Investigator Award in Health Policy Research, which is pretty damn good for a journalist. He lives in Oakland, California, and he is one of the smartest guys I know. Welcome to The Doctor’s Farmacy.

Gary Taubes:
Mark, thank you. And thank you for that great introduction.

Dr. Mark Hyman:
Okay.

Gary Taubes:
Even me. Even I’m willing to listen to what I have to say now.

Dr. Mark Hyman:
Yeah, exactly. Well we’re in an interesting moment in society where we’re fatter than ever, we keep talking about it for decades. I have been you have been and it just keeps getting worse and worse and worse. Our government recommendations and policies don’t seem to be solving the problem. And certainly the advice we’re getting from our doctors and nutritionists often is not effective either, which is eat less and exercise more. It’s just calories in, calories out. You’ve written a lot about this in the past. And recently, there’s been a real movement to look at radical different ways of solving some of the biggest problems we have, which is diabetes and obesity using a ketogenic diet.

Dr. Mark Hyman:
And for those who are listening, a ketogenic diet, essentially a 70% fat diet, cuts out almost all carbohydrates, and has moderate amounts of protein. It’s definitely not exactly an Atkins diet, it’s a little bit different than that. And it’s been around for a long time in medicine, but it’s recently being used for all sorts of conditions, from cancer to diabetes to Alzheimer’s.

Dr. Mark Hyman:
And it’s been used for decades for epilepsy by neurologists. So you really become an expert on these issues. As a non-doctor scientist, you probably have read more of the scientific papers and more of the data on this than most doctors or scientists. And you’ve been busting a lot of the big myths that really we are facing in the world of food. And the first myth that you really took on back in 2002 with that article, What if It’s All Been a Big Fat Lie, was that we should all be eating a low fat diet to lose weight because fat has more calories than carbs. So if we all eat snackable cookies, we lose weight, except for one thing the opposite happened. So what led you in that whole trajectory of this sort of examination of the low fat movement to swing so far the other way to write a book called The Case for Keto: Rethinking Weight Control and the Science and Practice of Low Carb, High Fat Eating. What made you go I need to write a book about this.

Gary Taubes:
Okay, well when I first-

Dr. Mark Hyman:
By the way, this is the book, everybody should get it. It’s really, really awesome. It’s got a nice red color, you can’t miss it. And it’s beautifully written. It’s great prose. It’s just awesome.

Gary Taubes:
And thank you again. So yeah so that New York Times Magazine article was a third of my investigative reports on nutrition. So I started off just by chance writing about salt and blood pressure for the journal Science. And I had no idea that enormous, very vitriolic controversy in the field, the basis of which was that there’s surprisingly little evidence to advise us all to eat less salt. And while I was doing that work, I realized that one of the worst scientists I’d ever interviewed, had written a book called Bad Science, has taken credit, not just for the low salt diet, we were all eating in the 1990s, but the low fat diet as well.

Gary Taubes:
So then I did a investigative piece for Science, it took me a year, published, it was called the Soft Science of Dietary Fat. And it just turned out that again, the idea that dietary fat causes heart disease was an interesting hypothesis that was launched kind of in the beginning of the 20th century, and then took hold in the 1950s and never panned out. Experiment after experiment to try and test it and the experiments, sometimes they show that people who ate less fat live a little longer. Sometimes they showed that they died a little more prematurely.

Gary Taubes:
And scientists fell in love with the hypotheses as scientists often do. The public health establishment in this country’s started promoting it and we believed it ever since. So in 2002, when I did this New York Times Magazine article initially, the idea was that I just wanted to find out what started the obesity epidemic. Our awareness of it was relatively new, obesity rates shoot up in this country roughly in the 1980s. And it coincides with some shifts to nutritional advice, we go from eating sugar to eating high fructose corn syrup. So that was one hypothesis, Michael Pollan bought into that idea and was promoting it.

Gary Taubes:
And the other was just that we started promoting this idea that a low fat diet was a healthy diet, and that carbohydrates are heart healthy diet foods. When carbohydrates, it had always been perceived as kind of uniquely fattening. Starches, breads and sugars, the kind of thing that people would say they go right to my hips or right to my gut. So I was reporting that story for the New York Times Magazine. And while I was doing it, it turned out, I stumbled on five clinical trials, really the first five that had ever been done comparing an Atkins ketogenic diet to a low fat diet. The kind the American Heart Association was telling us to eat.

Gary Taubes:
None of these studies had been published yet, but they’d all been discussed in conferences, and they all found the same thing. That if you tell someone to eat a high fat diet, rich and saturated fat and animal products, but don’t eat carbohydrates, and you can eat as much as you want, so eggs and bacon for breakfast and T-bone steak was salad for lunch and a half a roast chicken with salads or green vegetables for dinner and you smother it in butter and oil. And all the things we were supposed to not do.

Gary Taubes:
And if you tell someone to do that, not only did they lose weight, but their heart disease risk factors improve. And all five studies showed the same thing. And they were from clinical trials up and down the East Coast, basically. And it suggested this is the joke, it suggested that everything we know about, or everything we’re being told about diet and health was wrong. Because the Atkins diet again was just basically was a ketogenic… It was a ketogenic diet. That’s why Atkins was crucified for promoting it. He got very wealthy, but the medical establishment didn’t appreciate him promoting a radical idea like ketosis.

Gary Taubes:
Yeah, so anyway, I wrote that article, I argued that maybe dietary fat wasn’t the problem, maybe carbs were. And I’ve been following that ever since. And I actually didn’t want to call my book The Case for Keto, because I didn’t want to distract from the major points. It was sort of the… Originally the book was called How to Think About How to Eat and then our mutual friend Mark Bittman came out with a book called How to Eat six weeks before mine was originally scheduled to be published. Theirs came out in mid March of 2020. So they got swallowed up by COVID. Mine was not scheduled until late April so we could delay it. And when we delayed it, we changed the title so they wouldn’t compete and it became The Case for Keto.

Dr. Mark Hyman:
Well, that’s amazing.

Gary Taubes:
I didn’t fight it because I’d basically been making The Case for Ketogenic diets since that original 2002 article.

Dr. Mark Hyman:
It’s a pretty profound idea. Yeah, go ahead.

Gary Taubes:
Yeah, I just wanted to put all this in context. And the context is carbohydrates are fattening, those of us who get fat easily can’t eat them. And then the extreme version of carb restriction is a ketogenic diet. But for 90 years people have been insisting we get fat because we eat too much. And you and I and others have been arguing you get fat because of the carbohydrate content of the diet. And some of us just if we want to reverse that process, we basically have to restrict or abstain from them entirely, and then you replace the calories with fat and now you’re doing a keto diet, and you’re [inaudible 00:10:44]. But it’s the same thing that you would have been told 195 years ago.

Dr. Mark Hyman:
Well, it’s true. I mean, this has been around for a while, in fact, in our good friend, David literally was a Harvard professor, and is a clinical trialist in obesity and insulin resistance. He says, “We don’t get fat because we overeat. We overeat because we’re fat.” And what he means by that is that when you start eating carbohydrates, you get hungry fat growing in your abdomen. And it’s not just fat there holding up your pants is actually hungry fat that makes you hungry, and eat more carbohydrates. It’s a vicious cycle and it causes fat storage, slows your metabolism, increases hunger and locks the fat in the fat cells. So it’s literally a one way turnstile once the fat gets in, which comes from the sugar is turned into fat, it can’t get out. So it’s kind of a disaster.

Dr. Mark Hyman:
And he said something to me once which just blew my mind and made it all makes sense to me. He says, “Remember your training about type one diabetics.” Type one diabetics is an autoimmune disease where the pancreas is damaged, and you cannot make insulin. These people have, we call it polydipsia, polyphagia and polyuria. So they’re constantly thirsty, because they’re peeing out all the sugar and salt and everything. But they’re hungry, they’re starving all the time, which is polyphagia. And that means that they can eat 10 or 20,000 calories a day, and they will not gain a pound. In fact, they will lose weight. So why is that? It’s because they have no insulin, and you need insulin to gain weight.

Dr. Mark Hyman:
And the whole key to keto is that it shuts off that insulin. And so one of the whole issues here is this whole calorie myth which you dissected in your book Good Calories, Bad Calories. Can you take us down a little bit of why we’re still so stuck on this. In fact, David Ludwig sent me a paper from the American, I think, Endocrinological Society that was relatively recent by a whole panel of experts on obesity, very renowned people. And they all came down and said, “It’s all about the calories.” And I was like, “Oh, I thought we were over that one.”

Gary Taubes:
It’s not about the calories because they’re willing to accept the counting calories doesn’t really help anyone anymore. It’s this idea that it’s all about energy balance. So what David Ludwig is saying, the idea is you have the different foods have different effects on our hormonal status, and whether or not we accumulate fat is determined primarily by hormones. Insulin, and glucagon. So insulin is the dominant one and glucagon is a sort of a counter hormone on it.

Gary Taubes:
So if some foods stimulate insulin, carbohydrate rich foods and protein to a lesser extent, carbohydrates only stimulate insulin, protein stimulates glucagon, which works against insulin, the fat tissue. So it’s sort of… The argument is obesity is a hormonal thing, you cause your fat cells to accumulate excess fat, and that in turn steals calories from the rest of your body that you would use for fuel and so you’re constantly hungry. And when insulin is elevated, the only calories you could burn for fuel carbohydrates, so you’re constantly hungry. So that’s part of a vicious cycle.

Gary Taubes:
Back at the turn of the 20th century, when nutritionists and doctors first started thinking about what the cause of obesity is. It’s funny, in science and my interest, even more than nutrition is how science progresses and scientific thinking. And in science, the tools you have available determine what you can learn. So in physics, you get a bigger accelerator, you can learn more about the universe in astronomy you get the telescopes that look in different wavelengths, you could learn different things about the universe, whatever you could see in that wavelength.

Gary Taubes:
And in nutrition, the only tool they had that seemed relevant to obesity was a device called a calorimeter, which could measure the energy expended by a human being or could measure the energy contained in a food that the human ate. So they created this theory that obesity is caused by energy in, being more than energy out. It seemed intuitively obvious because that’s all they could measure. They couldn’t measure-

Dr. Mark Hyman:
It’s a math problem. I mean, weight loss is a math problem, is basically what [crosstalk 00:15:05].

Gary Taubes:
Weight loss is a math problem. So [crosstalk 00:15:07] look it’s-

Dr. Mark Hyman:
Except it isn’t.

Gary Taubes:
… clearly a hormonal issue. It’s like you look at men and women fatten differently. That’s hormones. Boys go through puberty, they gain muscle and lose fat. That’s hormones. Girls go through puberty, they gain fat in specific places. That’s hormones. It’s all hormones. And it’s just some people, they’re going to get fat no matter how much they eat. Or the only way they’re going to stop themselves from getting fat if they starve themselves. And this was a German and Austrian clinicians who are doing the best medical science in the world at the time, argued this.

Gary Taubes:
It didn’t matter. An American came along guy named Louis Newberg, University of Michigan and claimed he had done the first experiment ever. This was 1930. And in this experiment, he proved once and for all, it was all about calories. It’s about how much you ate. And it was always about how much you ate. And no matter what the excuse, like women when they go through menopause, they gain fat. Now, animals, when they go through menopause, or if you remove the ovaries from animals, they’ll gain fat. And that was well known even in the 1920s. So it seemed to be a hormonal thing related to estrogen.

Gary Taubes:
But with women, it was about eating too much. They sat down with their lady friends and played bridge and ate bon-bons. I mean incredibly sexist explanations for why it’s never hormones. And just caught on, it caught on in part because World War Two came along and the German that Austrian researchers arguing the opposite, vanished. They evaporated with the war.

Dr. Mark Hyman:
So the Germans were the ones pushing that it’s not energy balance. And because they were German and Nazis we got rid of that theory.

Gary Taubes:
We got rid of that theory. And it sounds like we’re joking, but nowadays, it’s very easy to demonstrate in the history. It’s people cited Newberg, they didn’t cite the german. Actually the prime guy was an Austrian, he was a Jew named Julius Bauer. He fled to the US in 1938. But the only job he could end up getting was at the… He was one of the founders of the sort of endocrinology research in Europe, very well known pioneer in the field, flees the Nazis in ’38 when they attack, they move into Australia. He ends up going to Baton Rouge, Louisiana. He works at LSU for a year, and then he goes to LA and gets a job at the Hospital Medical Evangelist. And he publishes papers like Julius Bauer, Hollywood, California, and nobody pays attention. He’s not at Harvard, he’s not at Yale, he’s not at Columbia. He’s like who is this guy?

Dr. Mark Hyman:
We’ve had decades of other research since then. I mean, there’s been really well designed, well executed clinical trials by David Ludwig and others looking at this whole hypothesis of the carbohydrate insulin hypothesis of weight loss, which is a hormonal one. And what it really leads to in our thinking, and this is sort of striking to me and in researching some of my books, I discovered that if you’re a kid and you’re overweight, it’s more of a stigma than if you’re a kid and you’re in a wheelchair and are quadriplegic.

Dr. Mark Hyman:
And we basically blame the person is overweight, for being fat. It’s your fault, you’re fat, just eat less and exercise more. And otherwise, if you don’t, it’s just because you’re lazy and a glutton, and that fat shaming and that underlying approach is based on this idea of the calorie myth and that weight loss is just a matter of willpower. So why is willpower not the issue here?

Gary Taubes:
Well, again, it’s based on this energy balance idea. The obese child, maybe he’s 40 pounds overweight at age 12. That means his fat that he’s been storing 50 extra calories of fat a year in his fat cells. So why can’t they fix that? Why can’t they just eat a little less, store little less, or exercise a little more, store a little less? And it’s the answer that lean people come to is well, they must not care enough. If it’s about energy balance and I make this point in The Case for Keto, it’s about energy balance. Absolutely, that creates the concept of fat shaming in effect. Because the assumption is always if it’s about intake and expenditure, then you should be able to take in a little bit less, or expend a little bit more. It doesn’t take a world of effort. We’re talking about tiny numbers every day. So why can’t people do it? And then you end up assuming it’s because they don’t want to or they don’t have willpower you come [inaudible 00:19:54].

Gary Taubes:
And it’s interesting by the 1960s, obesity research in the US was dominated by psychologists and psychiatrists who were trying to figure out how to get those fat people to eat less. I mean, they didn’t care, the idea that they just have a fat storage disorder. We have a fat storage disorder just like if you saw somebody walking down the street who was eight feet tall, you wouldn’t think about how much they eat and exercise, you would think he’s got some kind of growth hormone dysfunction. Even if he weighed 400 pounds, which often if somebody is eight feet tall, they’re likely to weigh 300 or 400 pounds, you don’t care about how much they’re eating and exercising. You care about the growth hormone issue and growth hormone receptor.

Gary Taubes:
But here, they just didn’t think like that. And once they didn’t, and this is the danger in any sort of medical, scientific process. Once you assume something to be true based on an assumption, then it’s going to infiltrate everything you do and it’s going to affect everything you do. So David Ludwig does these terrific, very well designed experiments to suss out whether or not obesity is a carbohydrate insulin problem or a calorie problem.

Gary Taubes:
And for the most part, his work has sided with his own preferred hypothesis, carbohydrate insulin. But there are other people who think the opposite, who claimed that their experiments are just as well designed. And then you end up getting [crosstalk 00:21:18].

Dr. Mark Hyman:
They will remain nameless.

Gary Taubes:
Yeah, they will remain… And the problem is all we can do, you, as a physician, amaze, a journalist to say, look, “This works.”

Dr. Mark Hyman:
Well, Gary, I’m a practicing doctor. And I’m just humbled by seeing real patients in real time and not just looking at theory, or scientific articles or textbooks, but actually seeing what works and what doesn’t work, depending on the person. And this is really an important piece, in your introduction, your book, you say, “I’m not writing this book, for the lean and healthy of the world, I’m writing it for those who fatten all too easily.”

Dr. Mark Hyman:
And I think that’s the key line in the book. There are some people who can eat whatever they want and they’re fine, because they’re highly insulin sensitive. But when you look back, for example, at the Native Americans in this country, there was no obesity, there was no diabetes, there was no heart disease. And now, second to Samoans, they’re the fattest population in the world. Why? Because their diet changed from what they were adapted to a extremely high carbohydrate diet. They were great at starvation. They were magnificent at managing scarcity which hundreds and hundreds of genes do that.

Gary Taubes:
Oh, no, I don’t think… I don’t think the Native Americans dealt with a lot of scarcity in this country.

Dr. Mark Hyman:
Well, I mean, they might have had to deal with some scarcity, hunter gatherers they could get food. There was food, but it was tough. It wasn’t like you had periods of food-.

Gary Taubes:
It wasn’t that tough. When Lewis, Clark, I hate to… When Lewis and Clark crossed the country in 1805, they had to push the buffalo out of the way on the Great Plains, literally. You’ve got these herds of millions of buffaloes, they had to-

Dr. Mark Hyman:
But historically, we’ve gone through periods where it wasn’t always easy to go to the grocery store and get food. So we were really well adapted to starvation. And there’s a whole class of people that really this book is for. The Case for Keto: Rethinking Weight Control, and the Science and Practice of Low Carb, High Fat Eating, everybody should get a copy. You go into explaining why there’s a subset of people, which turns out to be probably the majority in America.

Gary Taubes:
Probably the majority.

Dr. Mark Hyman:
75% are overweight, 88% are metabolically unhealthy. So maybe there’s like one out of 10 that’s a lean, healthy person, they got lucky. But for the rest of us, carbohydrates make a difference.

Dr. Mark Hyman:
Hey, everybody, it’s Dr. Hyman. Thanks for tuning in to The Doctor’s Farmacy. I hope you’re loving this podcast. It’s one of my favorite things to do, and introducing you to all the experts that I know and I love and that I’ve learned so much from. And I want to tell you about something else I’m doing which is called Mark’s Picks. It’s my weekly newsletter. And in it, I share my favorite stuff, from foods to supplements to gadgets, to tools to enhance your health. It’s all the cool stuff that I use and that my team uses to optimize and enhance our health.

Dr. Mark Hyman:
And I’d love you to sign up for the weekly newsletter. I’ll only send it to you once a week on Fridays. Nothing else I promise. And all you do is go to doctorhyman.com/picks to sign up. That’s doctorhyman.com/picks P-I-C-K-S, and sign up for the newsletter and I’ll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer. Now back to this week’s episode.

Dr. Mark Hyman:
So what does it mean to fatten easily and why is this book so important for people who are overweight to really get understand in reading?

Gary Taubes:
We get it. If you’re one of these people who struggles with their weight. The conventional wisdom, the assumption the advice we get from everyone when it’s a calorie problem, you got to eat less and exercise more. The idea is if you’re still struggling with your weight, you’re not trying hard enough. Whereas the rest of us want to say, “Look, I tried that. I did the eat less, exercise more. I spent the decade of the 1990s hungry. Okay, I gained weight anyway.” This is what it means to… I restricted my calories, I ate in moderation. Michael Pollan, I tried my best to eat not too much, and I got fat anyway.

Gary Taubes:
So we’re different from the lean people. So a lean person comes along and they think, “Okay, I eat in moderation…” This is my issue with David Katz. And I hope David Katz someday reads the… Yale affiliated Doctor who has become a major spokesman for the sort of mostly plant movement. And the world is full of these healthy, lean, buff physical trainers and marathoners and they think “I eat in moderation, I’m lean, I eat in moderation, and I exercise. Therefore, if everyone else ate in moderation, exercised they would be lean too, which is not true. And if they don’t eat moderation, and exercise, or if they’re not lean, it means they’re not eating in moderation, and they’re not exercising enough, so I have to tell them eat in moderation, don’t eat too much. Eat a healthy diet, fruits, vegetables, whole grains.”

Gary Taubes:
And the point is, we all did that. The obese and overweight, the 90%, 88% of Americans who are metabolically unhealthy are not sitting in lines in McDonald’s right now in their oversized SUVs with especially wide seats, waiting to get their triple cheeseburgers and super sized fries and huge cokes. I mean, some of them are, but some of them are eating very healthy, and doing their best to eat in moderation and they’re still overweight, because they’re getting the wrong advice. And that’s what I’m trying to communicate.

Gary Taubes:
We’ve been getting the mean person’s diet advice for the past century. And this is I what I eat. Therefore, this is what you should eat. And what I’m arguing is that those of us who fatten easily, if we eat what they eat, we’re going to be either fat or hungry. Those are our two choices. And possibly both. Often both.

Dr. Mark Hyman:
Yeah, that’s right. As a practicing doctor, I see this in real time by looking at people’s hormones and their metabolism and their insulin levels and their lipids and their inflammation. I can tell often just by looking at somebody, because I had so much experience, but just looking at their lab test, which type of metabolism they have. And the truth is, and I often I feel bad. And I apologize to my patients, because I say, “Listen, I didn’t design this, I’m not the creator of your biology. I’m just the interpreter. But I’m telling you if you really want to stay healthy and avert all the diseases of aging,” because they’re all connected to this mechanism of high insulin, heart disease, cancer, diabetes, dementia, depression, I mean, I could go on and on.

Dr. Mark Hyman:
If you don’t pay attention to this, you are going to be in trouble. And the truth is, like you were saying, what do these lean people have in common? They’re insulin sensitive. I don’t know if Jorge Plutzky. He’s a cardiologist at Harvard, a preventative cardiologist. He said, “Mark, if you were to take a group of 100 year old people who had absolutely clean arteries, they’d have one thing in common.” I said, “What’s that.” He said, “They’ll be insulin sensitive.” Meaning they are very good at producing very low levels of insulin that are extremely effective in the body that don’t require them to produce more and more to get the same benefit. And sort of like that’s what insulin resistance is. Essentially, when your cells become resistant to the effects of insulin. So you produce more and more and more and more to keep your blood sugar normal. But eventually that burns out and you get diabetes, but even before you get diabetes, it just causes the weight to pile on all the metabolic issues.

Gary Taubes:
Yeah, and those people who… I mean, you can guess, if you’ve got a weight problem, this is right, though, the first symptom a doctor is supposed to look for to diagnose metabolic syndrome. Which is we could call insulin resistance or hyperinsulinemia syndrome. And the first symptom you supposed to look for is your waist size is increasing, you’re getting fatter. And then it’s high blood pressure and low HDL cholesterol and high triglycerides and glucose intolerance, you’re becoming diabetic, all those things are happening. And the way you fix it is remove the cause of it. And the cause is, first the highly refined grains and sugars. But then for many of us, and this is where you start going into sort of the keto diet land, for many of us, it’s all carbs. All carb rich foods other than-

Dr. Mark Hyman:
You mean grains and beans and fruit.

Gary Taubes:
… Green leafy vegetables, grains, beans, starches. Yeah, it’s because our bodies can’t tolerate it. And this is just not the message we get. And it’s a strange time we live in because often I feel like we were making a lot progress getting the nutrition community to pay attention. But now we live in the age of fake news. So it’s easy to write off alternative perspectives as fake news. And I wander around thinking, “Wait am I a purveyor?”

Dr. Mark Hyman:
Are you a fake news purveyor?

Gary Taubes:
Am I a fake news… Because I disagree with the establishment, but again, the argument we’re making and what you’re telling your patients. What I’m telling readers is “Look, try this.” The one thing we know for sure is low carb diets are safe. And when I first wrote The New York Times Magazine article 18 years ago, the assumption was that these… 19 years ago, the assumption was these diets would kill you. I mean, I described sitting… I had tried Atkins as an experiment I described sitting in my diner in New York having my morning eggs and bacon and waiting for my heart to blow up. Because it’s high in saturated fat, Christ it’s high in bacon, I should have died of colon cancer decades ago. knock on wood. We know they’re safe now. We know they’re benign.

Dr. Mark Hyman:
That’s true.

Gary Taubes:
We know for sure now, people can try them without being afraid that they’re going to somehow blow up their hearts and they can see the benefits.

Dr. Mark Hyman:
Yeah. And I think that what happens is that in medicine, we tend to be lumpers not splitters. We lump everybody into one group saying, “All you humans are the same, you’re all metabolically identical. You all need to follow this same monotonous advice. And you’ll all be fine.” And it’s absolute nonsense, because as we’re learning, there’s a large heterogeneity or variation of the population according to their genes, their metabolic issues, their family histories, and so forth. And their need for different types of diets and foods. There’s no one size fits all diet. So for me, and for you, maybe we are relatively lean guys. And maybe it’s just because we follow this advice. But….

Gary Taubes:
In my case it’s because I follow this advice. Right or wrong, I may be killing myself but-

Dr. Mark Hyman:
So I’ve gained 15 pounds by eating more carbohydrates. I went through that period. And I’m now down. And I think that… But keto isn’t, I think universally effective for everybody. Because I think some people, and I’ve seen this in my practice, if you’re wanting to, for example, optimize your health, and people are trying keto as a health kick. And you’re one of those people, for example, like me, who when you eat excess fat, it actually can screw up your metabolism in the sense that it can cause really worse lipid profiles and all sorts of abnormalities that you wouldn’t necessarily see.

Dr. Mark Hyman:
So I think there’s still a lot to learn about who’s the right person for this? And I think we’ll be able to sort of discern this through both hormonal metabolic testing and genetic testing.

Gary Taubes:
The question would be… Yeah. And I and I agree with you. The question would be, though, if you’ve got a patient, the obese diabetic patient, someone who struggled with their way, their whole life.

Dr. Mark Hyman:
There’s no doubt.

Gary Taubes:
We agree we’re going to agree that we have to get their insulin down.

Dr. Mark Hyman:
Yes. 100%, 100%.

Gary Taubes:
Fundamental, and so then the question is, how do you do that in a way that maximizes their benefits and in a way that they can maintain it for the rest of their lives? And those are sort of different questions. So for the most part, we talked about it… Because even though again, this book, it’s called The Case for Keto, but the book is about the subtitle. It’s re=thinking weight control, and the science and practice of low carb, high fat eating. And throughout the book, I use the term low carb, high fat slash keto, or ketogenic eating. I admit that this is… There’s nothing catchy about it. Nobody’s going to say, I’m doing Taube’s LCHF slash keto. But I’m trying to be inclusive.

Gary Taubes:
At some level, I just try and hammering on this. And people say, “Well, Taubes keeps writing the same thing over and over again.” It’s because we have to get more and more people to accept that this is a carbohydrate problem. It’s not a fat problem, it’s not a… It’s funny, even what you just said. So my next book is on diabetes, and specifically diabetes, and I’m obsessed with the history. And I’m going to apologize for-

Dr. Mark Hyman:
But wasn’t that The Case for Sugar. That was sort of talking a lot about the history of diabetes.

Gary Taubes:
That was diabetes on a population wide base. This is individual… What’s the dietary treatment of diabetes, how we got into this world where the ADA is prescribing high carb diet.

Dr. Mark Hyman:
Well, it used to be… I mean, the treatment for diabetes used to be back in the 1920s a 70% to 75% fat diet and low, very, very low carbohydrate ketogenic diet. That was the treatment before we developed insulin.

Gary Taubes:
That was from the 1780s till 1914.

Dr. Mark Hyman:
This is Harvard’s Joslin Diabetes Center. This is not some radical clinic in Topeka, Kansas.

Gary Taubes:
No, I know, I know. So that’s the…

Dr. Mark Hyman:
No offense Topeka.

Gary Taubes:
Anyway, the point is once you restrict carbs, once you restrict carbs, and you still have problems and people start talking about what else should I restrict? Do I have to restrict fat also. Do I have to… And we’re saying on some level, how do you fix these people? Everyone’s going to be different, lipid profiles. I’m a little less sanguine about what we really know about the connection between lipid profiles and long term health.

Gary Taubes:
There’s so much confusion there and so few diet related clinical trials that would actually tell you once you sort of fixed your metabolic syndrome, once you’ve lowered insulin and got your weight under control, what do the other lipid markers mean? Because we decide based on people, the standard American diet, that’s how we decide what the association between these risk factors and disease are. But you’re not advocating a standard American diet to your patient, and I’m not advocating it. So once you fix your obesity and your blood sugar levels, issues with carb restriction of some form, from moderate to severe. Improving the quality of the carbs might be enough for people. But even then it’s sort of, everyone’s different, everyone’s going to be able to tolerate a different level of carbohydrates. But on some level that’s-

Dr. Mark Hyman:
What you’re saying is so important, Gary, I want to stop you because I think what I’ve learned is that there’s a continuum. There are some people who can’t even look at a bagel, because if they do, they’ll have a cephalic, insulin phase response. Meaning they’ll think about the bagel, it’ll make their insulin go up, and they’ll gain weight without even doing anything. That’s the one extreme, and those people I would say, they’re like celiac disease. They need to be considering themselves carbohydrate intolerant.

Dr. Mark Hyman:
And then there’s a continuum of people who were sort of somewhere along that spectrum. And the question is what is right and do you need to be full keto? Can you just be lower starch and sugar, more higher fat without being keto? Because keto is a very specific type of metabolic framework. And I think maybe we should take a little time to dissect what happens when you eat keto and what the benefits and slash potential risks are, and particularly how keto can be monitored in a way that makes sure you’re doing it. So tell us about what is actually keto? And how do you know you’re keto? And how do you do that?

Gary Taubes:
Yeah, and again, remember, despite the title of my book, which is The Case for Keto, it’s not actually about keto. So keto, to me is the extreme of carbohydrate restriction where you replace the carbs with fat. And Atkins was keto. The way I refer to it is back when I was young that’s what we call it a ketogenic diet was Atkins and Atkins got in trouble because he was advocating a ketogenic diet. So we can talk about… I mean, there are different definitions for how much carbohydrates people can tolerate in order to get into ketosis.

Gary Taubes:
But one of the things I did in this book is I interviewed 120-odd physicians from around the world who had converted to our way of thinking. And I wanted to know what they were trying to communicate to their patients and what the challenges were. And surprisingly, I don’t think there was a single one of them that actually had the patient’s check for ketones. They just wanted to get their patients off carbs, it’s like, “If I can get them off carbs, if I can get them to accept that dietary fat is benign, that it’s not going to kill them, then we’re going to be fine. And that’s what they’re going to eat.”

Gary Taubes:
As soon as you start thinking of it as a specific diet. I am doing keto. And I’ve had people say to me, “Well, I don’t know if I’m doing keto, because I don’t have a bulletproof coffee more than twice a week.” And then Ted Naiman’s got a new book out called the, I think PE Diet, which is probably protein energy ratio. And does Ted think of his diet as a keto diet, because he’s advocating for higher protein and lower fat.

Gary Taubes:
And I’m saying on some profound level, again, individual variation is going to play a huge role, but we don’t know the answers to what the level of protein should be to maximize this and there’s probably not one level of protein for any… Because everyone’s a little bit different. Some people are going to run into trouble because they can’t tolerate the amount of fat they’re eating. Some people are going to run into trouble because they can’t tolerate the amount of protein they’re eating. Some people are going do fine and never have measurable ketone levels. And some people may be in a brain fog because they don’t have measurable ketone levels.

Gary Taubes:
I’ve discussed this endlessly with Steve Finney, who’s done as much work on ketosis as any human alive. And Steve thinks if you’re not… I mean, Steve’s the guy to really talk to about… How does he, what’s the… Well formulated ketogenic diet, if you’re cutting carbs, but you’re not cutting them enough and you’re not being enough and your ketone synthesis isn’t high enough, then you’ll never feel good. You’ll never have energy. He talks about it like an island, you have to hit the ocean.

Gary Taubes:
And that could be true, but I don’t… Most people don’t think so. I think most people benefit from these diets without ever measuring ketones. They just…

Dr. Mark Hyman:
Yeah, I think that’s right. I mean, I’ve, as a physician learned to sort of pick the right person. I think diet… Well food is medicine. So if food is medicine, then what is the right medicine for each person within food. And I think it’s different. And I wish we could all say we’re all the same, but there’s tremendous variation in the population. We’re learning more and more about personalized nutrition, precision nutrition, personalized medicine, that’s what I do. That’s what functional medicine is. And it’s very humbling when you start having a grand theory. Everybody should be vegan. Everybody should be keto, everybody should be blah, blah, blah. And all of a sudden, it’s like, wait a minute it’s more complicated than that.

Gary Taubes:
Yeah, but remember, we’re still saying if you struggle with your weight, and you struggle with your blood sugar-

Dr. Mark Hyman:
Yes, yes.

Gary Taubes:
You got to… Everybody who does that should cut back on carbs.

Dr. Mark Hyman:
Well, here’s the thing. Yeah, I agree. Here’s the thing, everybody is going to get in trouble when they eat sugar and starch, whether you gain weight or not, because it creates metabolic changes that might not make you fat, but make you sick. And that’s important to remember.

Gary Taubes:
And so that’s the… And I again, the reason I wrote this book is to try and clarify some of this and put it into context. Because people hear the everybody’s different. It’s funny, I have an interview, I’m going to talk to a woman this Saturday. Well, by the time this airs, it will have been several Saturdays ago, who’s an advocate of plant based diets and think it’s very important for her to get her patients on plant based diets. And she herself consumes, I think, a vegan diet. And I want to understand what her conversion experience is.

Gary Taubes:
So again, one of the points, one of the one of the advantages of being a journalist when you can interview so many people. Back in 1998, Malcolm Gladwell, one of the first pieces he ever wrote for The New Yorker was called the Pima Paradox and was about obesity and fad diets. And Malcolm kind of made fun of how diet books are written. So he made fun of diet book authors, he said, it’s always the same. There’s a formula, they’re getting fatter, or they’re getting disease X, and they try the conventional wisdom, and it doesn’t work. And then they get frustrated. And they go into the bowels of the medical school library. And in some dusty tome of medical knowledge, they find something they try and it works for them. And then they try it on their patients, and their patients get healthier.

Gary Taubes:
And then they write a book about it and try to cash in. And so the idea is that this is something… The implication is this is all part of the job of being a snake oil salesman, you have to come up with a story, a pattern that you could sell and part of the pattern is look what happened to me. But the truth is, if you’re lean and healthy, and you’re eating a conventional diet, there’s nothing you can learn from your experience.

Gary Taubes:
And there’s no reason to change what you’re doing. Because what you’re doing seems to be working for you. And if your patients are lean and healthy and you’re telling them to eat the conventional wisdom with David Katz and Mark Bittman promoted in their last book, and their patients stay healthy, you don’t learn anything. It’s only those of us who are getting fat or who can have what Gladwell called this conversion experience. If you’re getting fatter yourself, or your blood sugar’s out of control, like Sami Inkinen the founder of Virta Health a world class… Literally a world champion triathlete.

Dr. Mark Hyman:
And he would roll his boat California to Hawaii, that’s the kind of guy he was.

Gary Taubes:
With his wife. Yeah, that’s the kind of guy.

Dr. Mark Hyman:
Rowing a boat.

Gary Taubes:
And yet he was pre-diabetic. [crosstalk 00:44:34].

Dr. Mark Hyman:
Why, why?

Gary Taubes:
Why? So what’s going on? So once you have a problem-

Dr. Mark Hyman:
He was eating all the goos, all the sports goos. The gels which is pure sugar, that’s why.

Gary Taubes:
Despite the incredible physical activity, he’s poisoning his body. I’m not so sure food is medicine. It could be. I use the word benign a lot. [crosstalk 00:44:57]. But I do think food can be poison. And our job is to identify what the poison is. But the problem is if you’re not being poisoned, if you’re not getting fatter, or getting diabetic, then you can’t learn from your experience, there’s nothing you can do that will tell you that the conventional wisdom is wrong. So again, it’s people like us, we go through this… All these physicians went through this conversion experience, every last one of them.

Dr. Mark Hyman:
Yeah. And I would say the smartest doctor in the room is your own body. Like you have to see what affects you, which foods make you feel good, make you feel bad, which foods actually make you gain weight or lose weight. And pay attention, because smarter than any lab test or doctor is your own body’s response to the food you’re eating. And I think if it’s not working, then you have to say, “Well, why isn’t it working? And what do I do?” And I think your book really outlines a different way of thinking that is really the key to not just solving weight and obesity, Gary, it’s the key to solving most of our global issues.

Dr. Mark Hyman:
Because food and the food we’re eating at 60% ultra-processed food and mostly refined, starchy carbohydrates, it’s driving this pandemic of obesity, it’s also driving the pandemic of chronic disease, heart disease, cancer, diabetes, dementia and more, it’s literally killing 11 million people a year around the world and we think COVID is bad, but there’s far more people that die every day from eating the wrong food than from COVID or any other disease combined. And it’s all related to this underlying mechanism of high levels of insulin sustained over a lifetime that drives aging.

Dr. Mark Hyman:
It’s really the fundamental mechanism of aging and reversing it is the fundamental strategy to longevity, well being, weight loss, solving all of our chronic problems and other downstream consequences of… The economic impact of climate change, of social injustice. So many things are connected to this. And I think if you hit on this key idea that we need to get rid of these starchy, refined calories that are causing high insulin, we literally pull the thread that’s connecting everything that will literally unravel our current metabolic, economic and environmental catastrophe.

Gary Taubes:
Yeah, and again, it’s I mean, there are huge issues to doing this because again, what does the food industry produce which are exactly the foods that we’re going after and saying people can’t eat. I dropped my son off at the school bus thank god this morning at 7:00 in the morning. And I stopped off at Safeway to pick up some butter and I’m walking down this aisle and I want to call it the diabetes aisle. It starts with this… It’s not the sports thing, it starts with the high caffeine, high sugar drinks on the left and it’s got the chips going on the right and the chips on the left and then I move down to the sodas and then I go to the sports drinks and the chips go to from potato chips to the [crosstalk 00:47:57].

Dr. Mark Hyman:
I love it. I mean, you could have a cancer aisle, a heart disease aisle, a dementia aisle, a diabetes aisle. It would be great.

Gary Taubes:
Seriously.

Dr. Mark Hyman:
I love that.

Gary Taubes:
And that’s the thing is the world doesn’t have to go keto. And one of the things that runs in that the low carb movement has run into lately is the idea that livestock is bad for the environment. Livestock, a significant producer of greenhouse gases and I don’t know enough about this science to comment. So I’m willing to assume that for sake of argument that this is true, and it’s a problem and it’s got to be dealt with.

Gary Taubes:
But the underlying assumption is that if we all go plant based will all be healthier. The phrase used by this Eat Lancet Commission that was headed by Walter Willett, at Harvard, has made such inroads into pushing this plant based movement for everyone is, it’s a win-win situation. We know that if we eat a plant based diet, we will be healthier. We know if we eat a plant based diet, the climate, world will be healthier. And again, the point is we don’t know that.

Gary Taubes:
The lean people of the world they can eat a plant based diet, they’re fine. All of us can improve our diet and be healthier by getting rid of the refined sugar and the stuff in the diabetes aisle in the supermarket. All of us will be healthier, but some of us have to go further. We just have to cut out carbs. And then plant based foods come with carbs attached. With the exception of olives and avocados.

Dr. Mark Hyman:
It’s challenging. And if anybody wants to dig into the whole meat, no meat climate change health issues I we’ve done a lot of podcasts on this, but the short answer is it’s not the cow, it’s the how. And if you grow factory farmed animals, yes, they’re an abomination. They should be outlawed and they’re devastating human health, environmental health, animal welfare and destroying our soils and polluting our waters and poisoning us with chemicals. So that there’s no doubt about that or disagreement.

Dr. Mark Hyman:
However, there’s a movement of regenerative agriculture, which has the hypothesis that you can actually raise animals and integrate an ecosystem of a farm that builds soil, that conserves water, that eliminates the need for chemicals and produces healthier food, more food more profitable for the farmers, and actually may be healthy. In fact, some guys like Fred Provenza, I don’t know if you’ve heard this research, Gary. But Fred Provenza is originally a scientists from University of Utah, or Utah State, who is now working with folks at Duke and finding the animals that are allowed to forage on a wide variety of plant foods actually uptake all these phytochemicals and have much different nutrient profiles, much different metabolic profiles when you eat them.

Dr. Mark Hyman:
The one favorite study, I always quote is the kangaroos study in Australia, because you can get kangaroo meat there. And they fed them gram per gram protein, the same amount of feedlot feed for kangaroo meat, and the feedlot group had increased inflammatory biomarkers, and the kangaroo eaters actually got better, they were healthier, they had lower inflammation as a result. And this is taking a chunk of meat exactly the same amount and feeding based on what they ate. So this is a different topic, and I don’t think a ketogenic diet is a high meat diet, either. It’s not necessarily a high meat diet.

Gary Taubes:
It doesn’t have to be.

Dr. Mark Hyman:
Yeah. Yeah. And I think some people can tolerate some level of whole grains or beans, some people can’t. And often the argument is “Well when I switched to vegan I lost weight, I got healthy.” And I think if you’re eating the standard American diet, the absolute answer is yes, you will be much better off if you switch to a lot of plants and whole foods and get off all the crap. And it may not be the vegan diet, it may be just getting off the crap. And then the question is long term, what happens to these people?

Dr. Mark Hyman:
And if you start looking at a lot of these situations, you see this increasing creeping insulin. Even if you’re eating whole grains and beans, some people are just that carbohydrate intolerant. So I think there’s a continuum we have to understand. And I think that’s what you’re saying with your book. It’s not just one size fits all, everybody in the world should be keto, because I don’t think that’s true. You’re talking about this spectrum of eating styles, depending on your metabolic type and your response to the food you’re eating.

Gary Taubes:
Right, and that’s it. So we’re cutting carbs, and we’re adding fat at some level. And if you prefer, just animal protein and animal fat, you can make it work. My favorite part of the book, so at the end of the book, I have lessons that I’ve learned from the physicians I’ve interviewed and I sort of encapsulate, it’s the key lessons and how to think about progressing to a low carb, high fat ketogenic diet. And so Carrie Diulus. I’m sure you know Kerry, Carrie Diulus because she’s Cleveland, and formerly Cleveland Clinic. So Carrie’s a spine surgeon formerly at the Cleveland Clinic now in private practice in Ohio, and she comes from a family history of obesity, she had a weight problem.

Dr. Mark Hyman:
So she was 300 pounds, she was 300 pounds.

Gary Taubes:
300 pounds. Yeah.

Dr. Mark Hyman:
She’s a good friend of mine.

Gary Taubes:
She also has type one diabetes, and she can’t tolerate animal products. She just can’t do it. Her body can’t do it. So she has moved to eating a vegan, ketogenic diet. And she said to me, and this is the quote that I lead off the section with, “It’s not a religion, it’s just about how I feel.” And then it’s a thing we’re all doing. It’s about how we feel. And again, it’s part of the learning process and learning how to do these experiments.

Gary Taubes:
I mean, you and I probably do it naturally. It’s like some issue comes up in your life. My wife always gets… She’s been living with this for far too long, but I’ll make some comments about how I feel. And I go, I can’t understand it. And she says, “You always say that.” And I go “Well, what I can’t understand is why I feel like this today.” So I’m trying to understand it in terms of what I ate yesterday or the day before that, because I think it’s related. And can I change my diet in such a way that I don’t feel like I do today in the future? And what do I have to do?

Gary Taubes:
And over the course of… Among the vices, we talked about, before we get started all the vices we’ve given up. Part of the reason we’ve given up these vices is because they don’t make us feel good. I no longer drink alcohol not because I have any moral or ethical issues with alcohol, quite the contrary, it’s just the next day I tend to feel like crying all day long.

Dr. Mark Hyman:
Oh, Gary, I’ll give you a hug. Don’t worry.

Gary Taubes:
There we go. So yeah a hangover you can fix with aspirin, depression, you can’t. So eventually, slowly over the years, it’s become… No, but because I’m paying attention to how I feel the next day and in my case, it doesn’t need a lot of attention to be paid to notice it. But these are the kinds of things you can do with all issues of your diet.

Dr. Mark Hyman:
Well, you’re right.

Gary Taubes:
When I start adding beans back to my diet and I gain 10 pounds, and I find that I’m craving beans. Black beans doesn’t matter healthy beans just like they might eat in the Blue Zone. But when I add it back to my diet, I gain weight. I don’t like the weight and I don’t like the fact that I’m now craving the beans. Maybe it’s better that I don’t need them. They’re bad for me. They might be fine for David Katz or Mark Bittman.

Dr. Mark Hyman:
That’s right.

Gary Taubes:
But they’re not fine for me.

Dr. Mark Hyman:
We’re all different.

Gary Taubes:
That’s what we’re trying…

Dr. Mark Hyman:
Yeah, I think we have this amazing opportunity now to start to teach people about personalized nutrition and food as medicine. I think one of the things that people don’t understand, and you sort of highlight this with what you said, I think it’s important for people to really get this. Most people don’t connect what they eat, with how they feel. And food is the single biggest modifier of your biology every day. There is nothing that influences your biology in terms of hormones, the microbiome, your immune system, your detoxification system, your brain chemistry, your metabolism.

Dr. Mark Hyman:
I mean, there’s nothing besides food that has that impact. And when you… The underlying subtext of what you’re saying, and that we talk about in functional medicine is that food isn’t just calories, it’s information. It’s instructions that regulates your biology with every bite, and can turn on or off hormones, genes, and immune function, literally in minutes. And I think most people if they started to pay attention, like you did. When I drink alcohol, I cry the next day, or when I eat a bagel I don’t feel good. Or I take a nap.

Dr. Mark Hyman:
I went to visit some friends over on Maui. And I went to visit some friends on this island who are pretty much vegetarian vegan, and they have lunch. And I’ll eat anything I’m not religious, and I normally don’t eat a lot of beans or grains. I don’t have a thing against them. I just feel better without them. And she had a big bowl of grains and beans for lunch. And then I literally that afternoon, we went down to the ocean, there was this place where the river comes to the ocean. It’s like really like rocky beach. And I literally was in a food coma, I lay down on my stomach. It was like on a bed of nails, like this really uncomfortable rocky thing was like rock sticking everywhere in my body. And I literally fell asleep with all these rocks sticking in me, because I was in this coma from what I had for lunch. Now that’s not true for everybody. But for me, that was true. And I think I just-

Gary Taubes:
Well part of my part of my conversion experience, is I used to say back prior to 2000, I didn’t take naps, naps took me. So I’m a science journalist, I would be interviewing some Nobel Prize winner over the phone at 2:00 in the afternoon at lunch, and I would have to get off the phone. Before I fell asleep, I would have to think of some excuse. I used to have notebooks back in the days when we would take notes on the notebooks. And I’d go back and look at them and my pen would just fall off the page because I’d have fallen asleep while I was taking notes. Yeah, I gave up carbs that stopped.

Gary Taubes:
Actually, one of the things that triggered this is I was doing the first piece ever did on dietary fat for Science. I was interviewing a guy at Yale who’s an authority on carbohydrate metabolism. And I said to him, “Why is it I fall asleep every afternoon after lunch, religiously?” And he said, “Well, we don’t know.” It’s like, “How could you not know that?” I mean, “It’s such a profound phenomenon, there’s whole cultures that have siestas in the afternoons because they have hard rich lunches.”

Dr. Mark Hyman:
And wine.

Gary Taubes:
And wine and then they go to sleep anyway. And then you give up the carbs, it just stops happening. I often wonder, do we get a message nowadays, we should all sleep eight hours a night, it’s vitally important, we’ll control our weight better if we do it, we’ll control our blood sugar better if we do it. But one of the things that happened when I cut out sugars, starches and grains, is I stopped needing to sleep as much. So I can get by on five, six hours of sleep. And I constantly have the struggle that I should be sleeping more.

Dr. Mark Hyman:
Well you may not need it.

Gary Taubes:
And if I sleep more I’m actually less alert.

Dr. Mark Hyman:
Yeah, you may not need it.

Gary Taubes:
So it’s sort of, again, individual variation and being aware of your body because we don’t need a clinical trial. And it’s the point I make in the book.

Gary Taubes:
We’re taught well you don’t know if these… And again, people, we don’t have enough clinical trial to know if this is good for you. Well, we do have the 100 plus completed clinical trials of ketogenic diets and it’s undeniably beneficial over the course of at least a couple years and then it’s hard to imagine that somehow it all goes bad the longer you do. But people who don’t like this message can imagine anything so I’m not going to… But you don’t need a clinical trial to tell you if this will change your ability to control your weight and blood sugar. In particular weight. It’s just do it, but do it right.

Dr. Mark Hyman:
Well, that’s the thing. I mean, I think how… Let me just sort of share some of the clinical trials that have been recently done around diabetes, because I think the data is so striking, that it’s really worth talking about. Because we are now facing a pandemic of obesity and diabetes. In fact, one out of two Americans is pre-diabetic or type two diabetic, it’s the number one driver of our economic costs within Medicare, which is… If Medicare was a company would be the biggest Corporation in the world with a budget of over $1.3 trillion a year. And it’s a good third of that, and probably more if you include pre-diabetes.

Dr. Mark Hyman:
So talk about what we’ve learned from these rigorous clinical trials using ketogenic diets on type two diabetics who are actually on insulin, on medications severely overweight, and how it compares to sort of other trials and treatments for diabetes.

Gary Taubes:
Well, the story with diabetes has always been the same, is it the carbs or is it the calories? Okay, this is the recurring theme going back to 1913. So today you do a clinical trial. So the conventional wisdom, the ADA tells their doctors “Just tell the patients to keep eating however many carbohydrates are eating, we don’t want to disturb them, we don’t want to give them any advice they can’t follow. And then we can cover that with insulin.” And the insulins we have are so fancy and so exotic these days. So high tech that this won’t be a problem except that when they look at population wide insulin control, you find out that it’s actually worse than it’s ever been.

Gary Taubes:
So both type one and type two diabetics are doing bad jobs at controlling their insulin, at controlling their blood sugar. So now you put them on a ketogenic diet. And the best study we have is Virta, and it’s criticized because it’s not a randomized control trial. But you don’t actually need a randomized control trial for chronic degenerative condition that never gets better because people serve as their own controls.

Gary Taubes:
So they have smartphones and telemedicine and they prescribe the well formulated nutritional ketosis, ketogenic diets. And over the course of five years, they have… I think, their five year data is now available in abstract form, they have tremendous maintenance of the diet, and virtually all of the people who are on insulin, get off insulin, and most of the people get off their oral medications and they lose weight, even when they’re not trying to lose weight. This isn’t prescribed as a weight loss diet, and they get healthier.

Gary Taubes:
And they sustain it because they’re sustaining their health. On the flip side, you’ve got that trial in England that got a lot of attention where you put people on, I think it was 600 calories a day, semi-starvation diets, they’re all…it’s even more than semi-starvation that also will lower insulin levels, and we’ll put the diabetes into remission. But now you have a problem with what do you do when the people go back to eating the way they used to?

Dr. Mark Hyman:
Yeah, because you can’t eat 600 calories your whole life.

Gary Taubes:
You can stay on 600 calories, you’re… And one of my issues with the nutrition, diabetes and obesity research community to begin with is they just keep reiterating the same thing. A sign that a science is pathological is they keep saying the same thing over and over again, doing the same experiments over and over again, and they never make progress. And so what we know from these trials is you advocate abstinence from sugars, grains and starches and beans, and people get healthy. They’ll get off… The type two diabetes will go into remission and they knew that pre-insulin as you said. Pre-insulin it was known as the animal diet. And type two diabetics, we didn’t use that terminology back then. But the physicians in the 19th century knew that people got their diabetes older and heavier had a less acute chronic form of the disease and they can put it into remission and basically live perfectly healthy lives so long as they didn’t eat carbohydrates. Don’t eat the foods that you can’t tolerate. How difficult is that?

Dr. Mark Hyman:
And what struck me was the Virta trials, which essentially is an online digital, disruptive healthcare delivery system using coaches and high touch points with pretty advanced diabetics. And our friend Sarah Hallberg and this is some of the data you’re talking about, were able to see within a year two years 60% reversal. Not just improvement, but reversal of diabetes with normalization of glucose, lipids, A1C without medication. A 90 plus percent reduction in insulin, 100% elimination of some of the key diabetes medications and a 12% weight loss, which may not sound like a lot to people. But if we see a 5% weight loss in a weight loss trial, that’s dramatic.

Dr. Mark Hyman:
The results seem to be sustained at two and even longer, now, years. And they did a follow-up study looking at all the biomarkers around heart disease, which was fascinating. So the concern that people have is “Oh my God, if I eat fat, what about my cholesterol?” Cholesterol is causing heart disease, it’s going to get bad. Can you talk about how you would address these concerns about eating a high fat diet and lipids and heart disease. And what this trial showed that was the impact on lipid profiles.

Gary Taubes:
The issue with LDL cholesterol has always been the problem with these low carb, high fat diets. When I was doing my first piece for Science one of the researchers I interviewed was a guy named Pete [Arons 01:06:07] at the Rockefeller Institute in New York, and Arons was probably the best scientists in the field, in the 1950s, 1960s. And he told me the story of a young woman, a Broadway actress who came to see him. She had gone on Atkins to keep her weight under control. And her cholesterol went up to 600. You have to get her off the diet because diet’s going to kill her. That’s the idea.

Gary Taubes:
So a lot of people we eat this high fat, high saturated fat diet, the phrase now thrown around the communities that they’re hyper responders in their LDL cholesterol goes up or their LDL particle number goes up. The good news is it used to be that would happen, the doctor would say you’re going to kill yourself, you can’t eat this way anymore. Now, an improvement, they’ll say “Well look, since you’ve dropped 50 pounds, and you’re A1C is coming down from like 10 to six, and we’ve gotten you off your medications maybe you should continue to eat this way. But let’s monitor that cholesterol, let’s put you on some low dose statin to try and control cholesterol.” And everyone feels differently about statin, so I’m not going to…. I don’t know what the thing is, I have friends I respect on all sides of this.

Gary Taubes:
For the most part, the Virta study showed us, and these are people who really are metabolically disturbed in that they have type two diabetes, they looked at 26 risk factors for heart disease, 22 of them improved on the nutritional ketosis.

Dr. Mark Hyman:
Improved, improved.

Gary Taubes:
22 got better, three stayed the same. And LDL cholesterol occasionally got worse. And of course-

Dr. Mark Hyman:
Sometimes it can get better too.

Gary Taubes:
Sometimes it can get better. And the cosmic joke right is that LDL is the only thing that conventional medical establishment cardiology community has paid attention to. And then when they look at overall risk factor, you can do an overall risk factor assessment from these numbers, and it clearly got better. And that’s with these people getting off drugs. So the comparison are diabetics who are getting standard of care diabetic therapy in Indiana.

Gary Taubes:
I talk about in the book, I just talk about my own experience, my LDL was fine for about a decade on this diet and then the last time it was measured, well it got higher the one time and that measured. Not just LDL cholesterol, but LDL particle number. Which is a much better predictor of risk. Still not as good as HDL over triglycerides, which always improves on this diet or total cholesterol over HDL, which always improves when you eat this way. Or almost always, nothing’s universal.

Dr. Mark Hyman:
Well it’s powerful. It’s powerful when… And again, it’s really like I just recall a patient who I had, it was a woman struggling with weight loss for years. Her total cholesterol was over 300, her triglycerides were well over 300, her HDL was terrible, 30 something. Her blood sugar was high, her insulin was high, she had small particle. I mean, she had the worst metabolic profile. And I said, “Listen, eat coconut oil and butter and get off of all the starch and let’s see what happens, I don’t know let’s try it. Six months, six weeks, two months.” There’s no harm in a short term job and then I measure. Trust but verify, as Reagan said.

Dr. Mark Hyman:
And then I checked her lab tests, her cholesterol dropped 100 points, her LDL dropped almost that, her HDL went up 25 points, her triglycerides drop 200 points and she lost 20 pounds. Another guy was a skinny little biker who wanted to try keto for performance and athleticism. And he was in his 50s, and he just was biking four hours a day and just doing all… And his numbers just went through the roof.

Gary Taubes:
Just LDL, though I assume.

Dr. Mark Hyman:
No, his particle number, his small particles, I mean, everything went haywire. And I noticed the same thing for me. I’m one of those lean mass hyper responders, I probably shouldn’t announce that, because people will send me all kinds of hate mail or hate messages on social media. But if I don’t eat a little bit of carbohydrate, like a sweet potato or winter squash, I will tend to lose too much weight, but also my lipids will go crazy if I’m eating just too much saturated fat. So I can modify it, I can eat more avocados and more olive oil and more nuts and seeds and other different fats.

Gary Taubes:
Even then the assumption is always that what you’re doing is going to make a significant difference in your long term health. And this is the issue that, again, I discuss in the book. We’ve been taught to whenever you’re doing preventive medicine, it’s hypothesis based medicine, if I get you to do this, I add the little bit of sweet potato, winter squash back and I get my LDL down, I’m going to minimize my risk of heart disease, and I’m going to live longer. And this is a probabilistic assessment, doesn’t mean you’re not going to have a heart attack, you’re just going to lower the chance of having a heart attack.

Gary Taubes:
And the flip side is if I get you to eat the coconut oil and the butter and get rid of the carbs, I could watch you get healthier. So not only will your lipid profiles get better, but I could literally watch you get healthier. I could watch your weight come down and your sleep disturbances improve and your mood will improve and your energy will improve. And you’ll walk in the office three months from now, this is why people like us can sound a little quackish, and you’ll be a different person.

Dr. Mark Hyman:
Yeah, absolutely. Your book is such a brilliant analysis of the science. But it’s also got a lot of practical aspects that you call the plan, where you go through a number of principles of how to think about doing this, how to work with a doctor, and how to get started. So it’s not just an abstract theoretical, historical analysis is actually very practical. And I really encourage people to get a copy of The Case for Keto Rethinking Weight Control, and the Science and Practice of Low Carb, High Fat Eating. Because if you are one of those people who are metabolically unhealthy, the 88% of us, it’s now more important than ever to really get this right and get your insulin down.

Dr. Mark Hyman:
Because COVID-19 disproportionately affects those who have poor metabolic health, including obesity, overweight, pre-diabetes, diabetes, and chronic disease, which is all connected to insulin. And Gary, what’s exciting is in your book you book focused on weight. But keto is being researched for cancer, for improving, for example, responses to chemo and radiation. Obviously, reversing diabetes, for heart disease for dementia. It’s now becoming a standard recommendation. I had a patient, was at Stanford and they were like “Yeah, I’ve got Alzheimer’s, they told me to be on a keto diet, or epilepsy or other conditions.”

Gary Taubes:
This is what’s so amazing, because the conflict we’re up against. We’ve got US News and World Report every year they give their diet ratings. And every year they tell us the Mediterranean diet’s the healthiest and then the DASH diet, which is supposed to lower your blood pressure. And they’ll look at 35, 40 diets in the worst are always low carb, high fat ketogenic diets, always. The least healthy around. And yet, if you go to clinicaltrials.gov, which is the website that the government has to register clinical trials and stick in ketogenic as a keyword you’ll pull up, as of last week, about 250 different trials, 100 of them have been completed, the others are still in the works. And it’s basically you name a medical condition, somebody is testing a ketogenic diet somewhere in the world to see if that will make it better.

Dr. Mark Hyman:
Yeah, but I use it for heart failure patients and the results are amazing, because it improves mitochondrial function. And we didn’t really talk about it, but your body has two… It’s like AC/DC, it’s like an electric-hybrid, Prius. It can run on carbs, or run on fat or run on both. But if you actually switch to just running on fat, it seems to burn cleaner, it seems to have all these downstream metabolic effects. And something that we really didn’t talk about was aging and insulin aging. And when you look at the, whether it’s a ketogenic diet or a high fat, low carb diet, or whether it’s a diet, that’s intermittent fasting or time restricted eating or any of these kinds of approaches, they all do the same thing. They all reduce inflammation, they reduce belly fat, they increase muscle mass, they increase bone density, they improved cognitive function. They improve stem cell production. I mean, they have all these downstream effects that are promoting aging and healthy aging. So this is really the key to everything.

Gary Taubes:
Yeah, or another way to put it as they’re removing the thing that accelerates aging. Because remember, even diabetes is a kind of accelerated aging, all these symptoms of aging are basically driven by glucose oxidation in the cells. You raise blood sugar, your body kicks into overdrive, the attempt to burn it off. And you do that, you generate reactive oxygen species, you generate… I mean, it’s just all the major manifestations of aging are accelerated by the same foods we’re telling people not to eat on these diets. So it’s sort of… But again, that’s the issue we’re a minority.

Dr. Mark Hyman:
Oh it’s getting out there. I think it’s getting out there.

Gary Taubes:
Well, the idea that…

Dr. Mark Hyman:
We’re talking about it here on The Doctor’s Farmacy, and, again, I want everybody right now to go out and get a copy of The Case for Keto Rethinking Weight Control and the Science and Practice of Low Carb, High Fat Eating. Not just for weight loss, but for longevity, for well being. To understand these concepts is so key to overall health, and it is probably the single biggest thing I do everyday in my practice has helped people understand this, implement it, and the results are profound.

Dr. Mark Hyman:
Gary, you are a tireless investigative journalist, you are a rare breed. There are not many left who are willing to do the hard work and look at the data and talk to hundreds of people and really be an investigative journalist. We now have sound bites and just short form memes that actually are confusing the heck out of most of us, and I’m just so glad you wrote this book. And I want everybody to get a copy and get it right now, it’s out.

Dr. Mark Hyman:
And again, Gary, thank you so much for being again a guest on The Doctor’s Farmacy podcast. If you all listen in and you love this podcast and you want to know more about how this affects you get the book and also leave a comment about how your diet has affected you and subscribe wherever you get your podcasts. And make sure you share this with everybody you know on social media because they need to hear it too because we are a metabolically unhealthy country. And we’ll see you next time on The Doctor’s Farmacy.

Gary Taubes:
Thank you.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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