The Evolution of Diabetes Treatment with Gary Taubes

Dr. Mark Hyman: Coming up on this episode of the doctor’s pharmacy.

Gary Taubes: What do you do if the drug helps 80% of the patients and causes intractable harm to 20% and you don’t find out for 10 years.

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Dr. Mark Hyman: Welcome to doctor’s pharmacy. I’m doctor Mark Hyman. That’s pharmacy with an F for place for conversations that matter. And if you have diabetes, you know someone diabetes or you have prediabetes or you’re overweight, which probably counts for 75% of you listening. You’re gonna love this conversation because it’s with an investigative journalist, Gary Taubbs, who has done a lot of work in trying to understand the nature of diabetes. He’s Hyman investigative science and health journalists. He’s the author of this new book, rethinking diabetes, which we’re talking about today. He’s also written the case for Keto, the case against sugar, Why we get fat? Good calories, bad calories, which is amazing. It was published in the UK as the diet delusion. He’s a former staff writer for Discover and a correspondent for the journal Science. His writing has also appeared in the New York Times magazine, the Atlantic, Esquire, and he’s been included in the numerous best of anthologies include the best of the best American science writing, and he’s received free science in society journalism awards from the US National Association of Science Riders And he’s a recipient of a very prestigious Robert Wood Johnson Foundation Investigator Award in health policy research. He went to Harvard. He’s got a master’s degree in engineering from Stanford, a journalism degree from Columbia, and he’s an incredible man who’s done a lot of work trying to understand why we are overweight why we have diabetes and what we can do about it. I know you’re doing this conversation because we got deep into the history of how we began to understand nutrition and nutrition therapy in diabetes.

Dr. Mark Hyman: And back in the day, we talked about in the 1700s and 1800s and early 1900s. We were using very high fat they called animal diets to treat diabetes. And we talk about how that all changed with the discovery of insulin when we loaded up people with carbohydrates and lots of insulin and how that has led to significant complications. We also talk about how some of the science that has been done is really not translated into the policies or the recommendations to the American Diabetic Association. We talked about some really fascinating research that’s been done by Sarah Hallberg and others looking at ketogenic diets to not just manage diabetes, but to reverse it. So I think you’re gonna love this conversation with Gary. Let’s jump right in.

Dr. Mark Hyman: Well, Gary, it’s great to have you back on the doctor’s pharmacy again.

Gary Taubes: Mark, it’s great to it’s funny. I just have to. The last time we talked, you were in Hawaii, and I was in Oakland.

Dr. Mark Hyman: And that was Oh, that’s right.

Gary Taubes: That was the COVID shutdown here. That’s right. Time before that, we were both in Geneva.

Dr. Mark Hyman: Yeah. That’s right in Geneva.

Gary Taubes: Was it Geneva? Wait. Geneva.

Dr. Mark Hyman: Yeah. It was a food conference. And, we were talking all about the things we’re talking about today, which is how food affects our health and the epidemic of diabetes and controversies about nutrition. And it was kind of the illuminata. I have, the diet nutrition

Gary Taubes: diabetes. That was a big day.

Dr. Mark Hyman: Yeah. It was I’m Zurich

Gary Taubes: now that I think about it wasn’t to me, but gotta get that.

Dr. Mark Hyman: That’s right.

Gary Taubes: That’s right. That’s right.

Dr. Mark Hyman: So, yeah, Gary, it’s so good to have you back. You know, for those who don’t know Gary, I did the intro, but, you know, he wrote this article that it kind of broke through the zeitgeist called, “what if it’s all a big fat lie” in 2002 in New York Times magazine? And I I didn’t even know who you were at the time. And I was like, wow, this really doesn’t fit with what I learned in medical school. And and it really started the conversation going about the quality of the food we eat, the quality of the calories we eat, and how they affect our, metabolism or hormones and how maybe weight loss wasn’t all about eating less and exercising more.

Dr. Mark Hyman: And you’ve been deep in this for a long time. You’ve written so many books about it. And your latest book, which is why we’re having the conversation today is called rethinking diabetes. And I have loved this book. I’ve just been savoring it every night. It’s like a mystery novel about the history of diabetes and what’s gone wrong in our approach to this condition. And it’s really the biggest scourge today on the planet. I would say diabetes, pre diabetes, metabolic dysfunction, is really at the root of so much of the suffering we’re seeing. Everything from heart disease to diabetes, obviously, to cancer, to dementia, even things like depression, and for utility, even acne can be related to the dysfunctions that we have with our metabolic health. And recent data from the NHHENS trial showed that 93.2 percent of Americans are metabolically unhealthy, which means there’s somewhere in the continuum of insulin resistance with a high blood pressure, high blood sugar, high cholesterol, have had a heart attack or stroke already.

Gary Taubes: 3%. No. 93.2%.

Dr. Mark Hyman: So, you know, 75% overweight. So this book has really kind of turned a lot of our ideas upside down about diabetes. And I I’ve been thinking about this for a lot. So I didn’t really have to do a lot of rethinking, but I I when I’m I think a lot of people are gonna read this book and go, Oh, boy. We got it all wrong about diabetes.

Dr. Mark Hyman: And, you know, you you kind of talk about how really this journey for you and now this quote you has said it begins with the regrettable observation that we are in the midst of a diabetes epidemic, a disease that was vanishingly rare in the 19th century that now affects 1 in every 9 Americans. And then all attempts so far to rein it in have failed, and it’s incumbent upon someone to ask the question why? So you took that upon yourself to ask that question, and I think we’re gonna get to the answer today. And did we fail because the current situation was inevitable? Meaning the result of a food industry out of control, perhaps, or a nation of individuals who can’t say no to what’s, next and tasty and the next ultra processed snack or maybe because we made them steaks and the diabetes specialist got it wrong and public health authorities maybe allowed this to happen. So we’re kind of in a disastrous situation where we’re 1 in 4 teenage boys has pre diabetes or type 2 diabetes. 1 in 9 now, you said have diabetes. Some populations have 1 in 4. The current view, and this is what I learned in medical school. Was this a progressive disease. It ain’t it ain’t going away. You have to quote, manage it. You have to manage it with medications and you have to do ever increasing amounts, dosages, and frequencies of medications, including insulin to control the disease. And yet there was a trial that happened that got me completely switched in my thinking. It was called the Accord trial. And this was a trial done many years ago on 10,000 diabetics. And what they said was, look, sugar is the problem. So if we really wanna fix diabetes and the complications from diabetes, we need to be very aggressive in controlling blood sugar.

So they use very aggressive insulin doses, very aggressive drugs called oral hypoglycemic, which raise insulin. And the consequences of that therapy were that more people died and more people had heart attacks than who didn’t have the intensive therapy.

Gary Taubes: The cord was one of 3 similar trials. All of them found the same thing.

Dr. Mark Hyman: So basically, we’re talking about a disease that we have been treating in the wrong way that has really been focused on trying to use more insulin to treat what has been thought of as an insulin deficiency, but in fact, it really isn’t. It’s a mostly disease of insulin excess in 95% of the cases, not if you’re type 1 diabetes. So maybe, Gary, you could talk about, this book from the beginning because I think that the history is really fascinating just to kind of give us a brief overview of the history of the thinking about diabetes. Because in the 19th century, it was like a rare disease. Like, if you had this in the hospital, all the residents, the medical and see attendings all come running. Oh, how does this rare case? And, like, we’d have syphilis now. I have never seen a case of syphilis in my life. Right? But but I read about it. You know? So Then it was it was rare, but it was happening. And so the doctors then had a very interesting approach that kinda happened upon the right answer in many cases. Using, a dietary approach that restricted carbohydrates and used a, basically, a ketogenic diet before they had insulin.

Dr. Mark Hyman: So can you talk about how that developed? And then what happened after insulin was discovered by Banting Invest in 1921?

Gary Taubes: Okay. And I’m happy to do that. Let me before we do, they’ll give you just a brief explanation for why this kind of research is necessary. And in the book and rethinking diabetes in the epilogue, I talked about the history of the evidence based medicine movement.

Dr. Mark Hyman: Oh, I wanna hear about that.

Gary Taubes: Yeah. So until the 1970s, basically, you know, what a doctor did with the the treated a patient was based on what he had learned in med school and what the authority figures in his life said, maybe what his textbook suggested, and maybe what his colleagues were doing, but there wasn’t really a lot

Dr. Mark Hyman: It was apprenticeship, basically.

Gary Taubes: Yeah. And now, in the 1970s, a few smart young doctors came along and they decided they would one of them, a guy named David Eddie, who at the time was had left medicine was getting PhD at the Duke, Stanford University in, oh, computational physics or something, and they had asked him to he was gonna give a talk on the why doctors were prescribing for something, and he looked into the pay chose mammography as a subject, then he went back and into the literature to look at the evidence space, why people recommend mammographies, and why the benefits of them are, and he thought this would explain various sort of operating systems, charts, and how you go through different branches to decide what to
do.
Dr. Mark Hyman: Algorithm. Right.

Gary Taubes: And he thought that he would find that this procedure was based in concrete evidence. And he said, instead what he found out was that it was based on Jell O.

Dr. Mark Hyman: Jello O?

Gary Taubes: There was just nothing there. It was just this technology that had come along that people thought might be beneficial, and they started to do, and the more they did it, the more other people did it, and they never tested it. Yeah. And this was the beginning of the evidence based medicine movement. So what you do when confronted with the as a journal Astra, a physician who’s interested in, you know, the bigger picture is you always ask a simple question.

What’s the evidence? Why do we do this? Why as you put it, you know, diabetes has exploded in prevalence, the increase just since 1960 is 600 or 700% increase. I mean, if this was any other

Dr. Mark Hyman: Not genetic.

Gary Taubes: Not genetic. Not some something about our lifestyles has made this explode. Still seen after, you know, 104 years, 103 years of pharmaceutical therapy, it’s still seen as a progressive chronic disease, the biggest challenge to success treatment according to an ADA panel a few years ago is the resistance of physicians to do what you said has to be done, which has continued to raise doses, add new drugs to the therapy.

Dr. Mark Hyman: So that’s what they’re saying. The problem is we’re not treating it aggressively enough.

Gary Taubes: you’re letting blood sugar rise out of control in patients. And so question I asked as a journalist was, you know, basically, as said, as you read in that quote from me, is it, you know, is this inevitable? And if it’s not, what’s the evidence base for the decisions? And when you start asking that question, you start going back in time. So you can start looking for clinical trials and the clinical trials you find will reference other clinical trials or other observational studies, and you just keep going back in time.

Gary Taubes: Yeah. And nowadays because of the internet, first of all, all these

Dr. Mark Hyman: It’s like a time travel going to reading that book.

Gary Taubes: I mean, everything’s available. Yeah. One way I describe this is 1920s when our philosophy of how to treat this drug was originally found in. It’s still with us today. The physicians who crafted that philosophy had imagined that the whole world of diabetes, therapy, and diet, and lifestyle like a 1000 piece jigsaw puzzle.

Gary Taubes: Hyman they had maybe 50 pieces. And they weren’t just 50 pieces in one corner. They were 50 pieces scattered throughout the jigsaw puzzle they that’s how they were making their decisions. Now you can go back in time and because of the internet and all these repositories of journal articles and documents and book Google Books allows you to find all the textbooks. If you can’t get them on Google Books, you can find bookstores that sell them.

Gary Taubes: My office is full with, like, you know, multiple additions.

Dr. Mark Hyman: Moldy books from 1925?

Gary Taubes: 80 year old textbooks and the 3rd edition and the 4th is you Anyway, now you can get, say, 950 pieces of that 1000 piece jigsaw puzzle. You can see everything they should have seen. But didn’t.

Dr. Mark Hyman: Hindsight is is

Gary Taubes: So you can go back and not only describe what they did, but what they missed. And you could say they did this because they saw that, or they had a patient that experienced this. They wrote about it, and they gave it talked about it in 1927 at this conference in New York to physicians, and here’s the talk. And it allows you not just to piece together the history of this field, and I think historically, the book is something that’s never been done or diabetes therapy, but also to see what was missed. Yeah. And how the thinking evolved considering what was missed.

So as you said in diabetes, you could go back 2000 years to when it’s identified in ancient texts or Indian texts, but modern history starts in 1797. Okay. A guy in British doctor named John Raulo working for the military has a patient named Colonel Meredith. Meredith has diabetes. He shows up, e’s lost a lot of weight. He’s hungry. He’s thirsty all the time. He’s peeing constantly. Back then, they would have their assistant taste the urine. This was a diagnostic technique.

Dr. Mark Hyman: For sure.

Gary Taubes: And if the urine was sweet, that was the identification of diabetes. And Rallows Isn’t

Dr. Mark Hyman: that what’s Melitis means is sweetness. Sweetness. Like, honey. Like, yeah. Right.

Gary Taubes: So Ronald thinks if there’s sugar in the urine. He’s not metabolizing the sugar properly. The sugar comes from plant foods. So I’m gonna feed him a diet of animal meat and recommend to see what happens, and he puts them on the calls of the animal diet. It’s actually fatty rancid meat—blood sausages. I mean, it sounds awesome. Disgusting. But Meredith gets better. And he ends up living for, I mean, at that stage in time. He probably had type 2 diabetes because he had been overweight and obese, but they don’t show up and that they don’t manifest the symptoms. 1 of the symptoms of being sick is losing a lot of weight. So at that point, his pancreas was failing, but he still lives 12 more years. Ronald tries it on different patient, a general He was in the army. That patient also gets better, but he doesn’t stick to the diet. He goes home. He eats what he wants and dies. So we’re all a public citizen.

Dr. Mark Hyman: That’s right.

Gary Taubes: Disseminates it throughout the United Kingdom and says to people, this is look, I seem to have come up with a way to cure this diabetes. If you’ve got any patients, consider trying it with them. This is medicine before clinical trials. Okay? And it’s still medicine where we don’t have clinical trials.

Dr. Mark Hyman: It certainly is. Yeah.

Gary Taubes: So few dozen physicians write back to him and almost uni I mean, the ones who write back at the diet works, they don’t understand it. Like, the patient will get better, and then they’ll let them eat whatever they want. Then the patient will get worse, and they’ll put them out. They’ll have kids. There’s a twelve year old girl who gets better, but she keeps cheating.

Dr. Mark Hyman: Oh, yeah.

Gary Taubes: And she knows she just can’t stop eating sweets and but the gist of it is works. And by the mid 19th century, This animal diet, they get rid of the rancid meat and the blood sausages and basically just becomes fatty meat and green leafy vegetables. So it is in effect ketogenic diet.

Dr. Mark Hyman: Paleo, keto ish.

Gary Taubes: And it’s a time where it becomes a standard of care for treating diabetes. So it could keep patients with type 2 diabetes alive indefinitely. Yeah. Their symptoms effectively go away if they don’t need carbohydrates.

And patients with type 1 who are insulin deficient, They delay their demise. Slow it down, but it’s not gonna stop it. And, no, you have no idea how much it slows because you don’t know how long the person would have lived anyway. The leading Italian diabetes specialist. He’s a guy named Catani. He’s locking his patients away for 2 months. To make sure they don’t need any carbohydrates, and they only eat this animal diet. The Germans are doing it. The French are doing it. The British. I mean, every major, basically, you can’t be a diabetes specialist. And, again, it’s a rare disease. There aren’t many of these guys without using this animal diet. As the 19th century turns into the 20th, it becomes richer and richer with fat. Because, again, patients show up in the doctor’s office having lost a lot of weight. And if they’re type 1 and they’re young, they’re emaciated. So the doctors thought we wanna put weight back on them. And we wanna feed them as much food as we can. And since you can’t give them carbohydrates, we can give them fat.

There’s a Swed named Petron, feeding patients 95% fat diets. Wow. I mean, the German comments that the diet unbelievably effective with his patients, but he can’t get Hyman to live on cucumbers and butter the way the Swedes were. I mean, Petron wouldn’t even let his patients eat bacon. Because there’s too much protein. And some of the protein gets converted into, I mean, amino acids get converted into glucose. So This is a standard diet. There’s a brief blip in from 1914 onward for 6 years when this, Harvard Harvard’s done a lot of damage in these worlds. It’s Harvard, doctor.

Dr. Mark Hyman: Doctor Gosslyn.

Gary Taubes: Now this is, Fred Allen. Oh, yeah. Friend of Gosslyn’s. Yeah. Starts advocating for this starvation diet.

Gary Taubes: So the idea turns out that with the young type 1 patients, if you starve them, you can keep them alive longer. Yeah. So this is standard of care.

Dr. Mark Hyman: So so basically, by accident, some observant physician made the conclusion. That that carbohydrates were causing sugar in the urine, and maybe we should not eat them. Yeah. And that became the standard of care until including with Doctor Jocelyn. And until 1921, when insulin was discovered.

Dr. Mark Hyman: Right.

Gary Taubes: So Jocelyn, just for background, Jocelyn is he’s a Harvard grad. His mother has diabetes. His aunt had diabetes and died from it. He’s assessed. Well, again, they were probably both type 2 because at the remember at that point in time, they were overweight.

Gary Taubes: Yeah. And then they you don’t they’re not getting blood tests, right, then nobody has any idea what their a one c is. Right. So they only manifest diabetes when they their pancreas starts to fail. And you get the weight loss and all these other Yeah. The hunger, the thirst, the peeing. So Jocelyn opens the 1st diabetes clinic in the United States in Boston dedicated to diabetes. So this is a period in time when

Dr. Mark Hyman: It’s still there. It’s the Jocelyn Diabetes Center at Harvard.

Gary Taubes: Eventually became the Johnson Diabetes Center. And because he’s got the only dedicated clinic, he’s seeing more patients than anyone else. So by 1916, when he writes the first edition of his textbook, it’s Jocelyn’s diabetes mellitus based on a 1000 cases. And no probably nobody else in the United States had seen more than 30 or 40. And then it’s 1970, and he’s got based on 1300 cases, and he just keeps releasing the textbook. And he kept his mother alive. And this high fat carbohydrate restricted diet she thrived longer than any of her other healthy relatives. Because he had gone to Germany, learned what the Germans were doing with all the butter and the meat and the no carbs and she was a stern New England stock, and she would do whatever he told her to do. And she thrived.

Gary Taubes: And then he buys into this Allen thing with starvation therapy. And the starvation therapy, you’re restricting not just carbs, but fat also.

Dr. Mark Hyman: And calories. Right.

Gary Taubes: And calories. So now he kinda begins to blame fat as Alan did for the disorders that would kill these diabetics. Because you’re feeding them high fat diets, and he thinks they shouldn’t die. Anyway, 1921 insulin’s discovered. First used therapeutically in January 1922, on a thirteen year old boy named Leonard Thompson. It’s a tremendous success. I mean, Thompson was so weak. He weighed, I think, £65. He was thirteen years old. His father had carry him to the hospital bed. Like, 50 years later, the med students and residents in this Toronto hospital said they were sure he was dead. Like, this was, you know, he had weeks to live. Insulin brought him back to life. I mean, just within days, It was a miracle cure. Eli Lilly begins to produce insulin, and they make it available to doctors around the US and Canada who had been treating a lot of diabetes patients. They were becoming diabetes specialists. And it’s a miracle.
Like, they’ve never seen these patients are resurrected.

Dr. Mark Hyman: But then what happened was it was something interesting, which is they somehow shifted from this idea that we should restrict carbohydrates that we should actually feed them a lot of carbohydrates and just cover it with insulin.

Gary Taubes: Well, so this is a extremely powerful drug. I mean, it’s a hormone. Right?

Dr. Mark Hyman: A peptide like Ozempic. We’ll talk about that in a minute.

Gary Taubes: For our intents and purposes, there was no such thing as high blood, excuse me, low blood sugar, hypoglycemia, until insulin was discovered. Now if you overdose, you’ve gotta balance the insulin to the carbohydrate. So there’s no way to know what the proper dose is. Everybody’s different. And insulin will control blood sugar. It’ll desugarize the urine, which was their target. Let’s get rid of the symptoms and get the sugar out of the urine, but we don’t know how much to give and how much we give depends on how many carbs they eat. And suddenly you’re having these patients are getting hypoglycemic episodes. They’re going into what they call, at the time, insulin shock or insulin overdose. Yeah. And that can be fatal. So the cure, the great miracle drug is a cure for a chronic condition or an acute condition type 1 diabetes, but the side effect is that it can be fatal within hours.

Dr. Mark Hyman: Right. So your side effects.

Gary Taubes: So Suddenly you have to feed patients carbohydrates. You have to make sure they eat enough carbohydrates to protect them from the treatment. That’s you know, protecting them from the absence of insulin or too much. Doctors realized pretty quickly this cocktail, trying to figure out how much insulin to give and how much carbohydrates to feed is really difficult. And with children, you know, this disease is when you’re diagnosed back. It’s bad enough diagnosis without telling kids they shouldn’t eat ice cream ever again.

Dr. Mark Hyman: Right. Right.

Gary Taubes: They can have cereal in the morning. Like, that’s why

Dr. Mark Hyman: you wanna restrict them.

Gary Taubes: So very quickly, they decide, look, it’s just easier to let the kids eat whatever they want. They’re gonna do it anyway. Mhmm. And we’ll cover it with insulin. And from the 19 twenties to the 1930s, doc it goes from children to adults. Both type 1 and type 2. And everyone just says it seems to work. The patient seemed to some patients at least seem to feel better. They don’t get fatter, which is the side effect.

Dr. Mark Hyman: Yeah. Yeah. People need to know when you start taking insulin, you gain weight because insulin is a fat storage hormone.

Gary Taubes: Insulin is a fat storage hormone. And some people knew that, and some people didn’t. Then we’ll talk about how that got confounded by the conventional thinking on obesity. I hope he will. What they didn’t know. This is a part of the issue with so evidence based medicine movement that I had mentioned in 1970s. The idea was if you wanna know if you’ve got a therapy and you wanna know whether it’s better than nothing, whether it’s better than what we’re already giving patients. You do a randomized controlled trial and you randomize patients, you give 1 of them the new therapy and 1, the old, and 1, the new therapy and 1 group, the placebo. And then you run them forward long enough in time, not just to see whether it’s more effective, but to see whether it’s safe or not. Or safe or and you go with enough patients and long enough so you could see whether they have more or less of complications, heart disease, cancer, dementia, pick whatever you might get. They didn’t have that in the twenties. Ran the concept for randomized controlled trial hadn’t been discovered till they developed this therapeutic philosophy for treating their patients. And then as you get about 5-10 years down the line, they start to see this they referred to as kind of tidal wave of diabetic complications. These patients whose lives might be saved by in on resurrected, brought back from the dead at 9, 10, 12 years old, are now 22, 25, 27, and suddenly, all the familiar complications of diabetes or atherosclerosis or arteriosclerosis are getting sclerotic plaques all through their body. They’re dying of heart disease and strokes they’re getting

Dr. Mark Hyman: Blindness and kidney disease. Right?

Gary Taubes: Kidney disease and neuropathy are having their limbs amputated. Yeah. And when you read the records, and there was a wonderful book by a pediatrician turned medical historian named Chris Foytner called bittersweet where he got a hold of Jocelyn’s records from his early years. And these patients would be thriving. And then over the course of a year or 2, their bodies would just fail them one day.

Dr. Mark Hyman: Was it because they were taking too much insulin or because they were eating too many carbohydrates or both?

Gary Taubes: Or They have no idea. Right? So their assumption is they’re trying to wrestle with these complications is that the patients aren’t doing a good enough job controlling blood.

Dr. Mark Hyman: So it’s the patient’s fault?

Gary Taubes: Possibly. Yeah. It’s, you know, the there Mark patients The patients who seem to take their drug therapy seriously and rigorously seem to do better. So the idea was the blood sugar control is the issue. And the answer again, when you think like that, is more insulin or more regular use of insulin or more. But what they didn’t know, they didn’t actually know if that was true. Because all they know is that it could have been the high uncontrolled blood sugar, which is what they assumed. It could have been the diet that they were allowing them to eat with the that was In part responsible for the uncontrolled drug threat, it could have been the insulin therapy. And you can’t differentiate with the information they had because they didn’t do the right clinic. They didn’t do any clinical trials. Their assumption was poorly controlled blood sugar. So you move into the 2nd World War with that as the assumption come out of the war and out of the war, you start seeing the first arrival of these hypoglycemic oral. The holy grail of the field is a drug that lower blinds and take it by mouth. You don’t have to use a damn needle. This catches on pretty quickly. As soon as they establish that it is safe and it lowers blood sugar. People start using these drugs.

Dr. Mark Hyman: And they raise they work by raising insulin.

Gary Taubes: But but it worked by stimulating insults.

Dr. Mark Hyman: But if you look at the the label, the morning that’s mandated by the FDA, It’s got a black box warning on these drugs. A black box warning is essentially, an alert that this has got serious side effects. And for oral hypoglycemics, the black box warning is: It’s gonna help your diabetes, but it’s gonna cause you to have a heart attack and stroke.

Gary Taubes: Well, so this is the very first randomized clinical trial they do in this field was called the, university diabetes program, and it starts around 1960. And it starts because there’s a congressman whose daughter is diagnosed with diabetes and she’s put on one of these oral hypoglycemic drugs and the congressman asks these in Ohio. So he asked the leading authority at Case Wester. You know, do these drugs, do they help? And he says, I don’t know.

Dr. Mark Hyman: Right.

Gary Taubes: Who knows? Maybe, yes, maybe no. So they actually get $30,000,000 together.

Dr. Mark Hyman: in 1960. It was a loaded.

Gary Taubes: was trying one for 10 years, and it was, these oral hype, this drug told you to mine and oral hypoglycemic and then insulin and then diet alone. And, they added fenn fenn. 1 of the fenns of the fenn fenns. Fiasco. I forget which one. Anyway, 1970, the results are leaked to, I think, was the Wall Street Journal at that. I mean, not only is the oral hypoglycemic agent, not do anything, not keep people alive any longer than diet alone, and the diet was a bad diet. And it was a carbohydrate rich diet they were giving them. Insulin doesn’t do any better either.
Okay. It’s completely useless. And this was a huge controversy.

Dr. Mark Hyman: When you say better either, do you mean in terms of, like, reducing death, heart attack strokes?

Dr. Mark Hyman: Whatever they looked at.

Gary Taubes: I forget what the endpoints of the study were, but the drugs didn’t help. And and, again, it it must have been it might have been mortality. They didn’t play up the insulin. They played up the, you know, for the oral hypoglycemia, but this is what doctor. This was what therapy was.

Dr. Mark Hyman: I mean, I went to medical school 1983. That’s what I learned how to do is give these drugs. And and then we we it was interesting. You’re, you know, I’m just reflecting back on my training and what I learned was, you know, I would see these patients come in who were were eating a lot of carbohydrates. They were taking a 100 or 200 units of insulin. And we thought that was fine to give him as much insulin as necessary to keep their blood sugar under control. But I never occurred to me was What was the normal amount of insulin that’s produced by the pancreas every day and someone who doesn’t have diabetes?

Dr. Mark Hyman: And it’s like 20 to 60.

Dr. Mark Hyman: It’s like depending

Gary Taubes: on how many Mark.

Dr. Mark Hyman: Depending on which we like we can be 10 to 20 or more units. So giving all this extra insulin can help control the blood sugar, but it’s actually having all these adverse effects

Gary Taubes: and weight gain inflammation. The reason I have to give so much is because

Dr. Mark Hyman: They’re in some resistant.

Gary Taubes: Back to the story. They’re in some resistant. The problem isn’t that they’re insulin deficient, which is type 1 diabetes. They too much insulin already.

Dr. Mark Hyman: And then there’s double diabetes.

Gary Taubes: Now you’re adding more. Yeah. What’s interesting, again, going back to the history, we were talking about Joss one. And when insulin first came in, this is really launched Jocelyn to his fame because he embraced it. He talked about chapters in his textbook on how to use it. Jocelyn thought the way to use it is you’ve gotta minimize doses. They started patients on one unit. Yeah. And then they went to 2 units and 3 units. And at 9 early 1920s, they might have been using 10, 20 units of insulin on patients. Then you have to strictly control their diet so that minimal insulin can can work and desugarize urine, which was there. And as time went on, other doctors were pushing for much greater doses. There was a Samsung and Santa Barbara who was pushing for 100 units, 150 units, and he would show. He said my patients are thriving. But in his patients in his papers, you could see his patients had gained £50, £80 in a year. You know? So they start off emaciated, and then they maybe put on £40 to get back to normal, and then the 40 is obese today. And there’s a British diabetes specialist, Lawrence who had type 1 diabetes himself and his life had been he was dying in Italy when insulin was discovered. His doctor back in the UK said if you can make it home, I can save your life. And he did. And he became co founded the British diabetes foundation with the HD Wells, famous science fiction writer who had diabetes. And Lawrence tried these higher doses, and he was like, this is crazy. You know, it’s like, I don’t wanna blow up like a balloon.

Dr. Mark Hyman: We know that if you if you start a patient on insulin, their blood pressure goes up, their weight goes up, their triglycerides go up, their cholesterol goes up, We know this. And so insulin is not

Gary Taubes: But we got drugs for everything. We got statin for the cholesterols. We’ve got

Dr. Mark Hyman: blood pressure. We call it comorbidities. Them all separately with drugs. He’s got a blood pressure drug, cholesterol drug, diabetes drug. Right?

Gary Taubes: And, I mean, it’s, you know, it sounds fascinating to say so, but, I mean, that basically, you’ve got a pharmaceutical industry that’s working hard to provide these drugs. And then, yeah, there are people with high blood pressure and high cholesterol. So you’ve got the drugs use them.

Gary Taubes: And nowhere along the line, do people say, wait. Wait. Why?

Dr. Mark Hyman: I mean, your book basically rethinking diabetes challenges all of our assumptions about diabetes?

Gary Taubes: It pretty much does, which makes it a difficult thing to swallow if you’re somebody who believes the assumptions. The oddness about that book is it’s basically written for precisely those people who won’t read it. It’s true.

Gary Taubes: The reason they won’t read it is because they’re convinced their assumptions are correct. And, you know, I have an odd sense of commercializing my intellect.

Dr. Mark Hyman: Yeah. I mean, you have to question your assumptions. And I think Ken and John F Kennedy had a great quote about this. I’ll see if I can remember. Essentially was, like, you know, most people are not willing to challenge their assumptions for the discomfort of thought.

Dr. Mark Hyman: Well, it’s also the question. Comfort of thought.

Gary Taubes: Challenging your assumptions, but it’s challenging your assumptions on which you have built your career. Yeah. So you get to the pinnacle of your career because you basically embrace the conventional thinking of the disease. As soon as you embrace, you know, an unorthodox approach, then you get excommunicated from your church. So the field selects out people who agree with the conventional thinking, they become professors, heads of departments, heads of associations. They serve on prestigious committees. They’re the people you go to in the New York time runs an article that the people who we consider experts and authorities

Dr. Mark Hyman: the guidelines.

Gary Taubes: and the same has been a set of me, and it’s true. It’s like at what point can you say everything, I believe, everything that not only made me the person, you received with that reason I’m on Mark Hyman’s podcast, but the people you like and respect all think the same way. Mhmm. It’s literally like a church. You all have a certain religion.

Dr. Mark Hyman: Kind of a cult.

Gary Taubes: No. It was interesting. I was interviewing a, the eighty year old nutritionist that Baylor University this past week. The interview very quickly deteriorated, just extremely pleasant to our discussion about good and bad science. But he used the phrase allegiance bias.

Dr. Mark Hyman: Uh-huh. Yeah.

Gary Taubes: And I said I stopped them. I said I’d never heard that for, but it’s exactly right. And so you have a certain allegiance bias, and it’s just not only does everyone you know and respect think like you do. But it’s, you know, it’s what made you the person you are today. And now you’re supposed to

Dr. Mark Hyman: It’s true. I mean, I, you know, I I think, you know, Chris Gardner’s a great scientist, but, you know, they have a plant based research

Gary Taubes: We have a different consensus. Okay.

Dr. Mark Hyman: Well, he’s he’s a Stanford. He’s a smart guy. He’s a good guy. He’s a nice guy. And, you know, he they have a plant based research institute, which seems ideologically biased, right, from the get go.

Gary Taubes: to Christopher’s defense. I assume what he’s trying to do is demonstrate that a plant based diet is not harmful. So what is the phrase they use in clinical trials in medicine for, non inferiority trials? You don’t wanna If you can demonstrate that it’s not inferior to ways of eating with, you know, animal products in it, then you can recommend that people do it they’re for ethical reasons or environmental reasons, they can eat this way and have confidence they won’t be harming themselves until they can feed it to their children. So I think that’s how he would defend it. I mean, okay.

Dr. Mark Hyman: But but, you know, is there a sort of meat based diet initiative?

Dr. Mark Hyman: There’s maybe a fake meat based diet initiative. But I, you know, I think I think you’re hitting on something really important, Gary, which is that the way we’ve done science is is really kind of skewed and biased in many ways. And we don’t challenge our assumptions, and we look at the world in a certain way through certain lenses, Artie Lang said this. He said, scientists can’t see the way they seeing. So when you look at the horizon, Renele, you go to Venice Beach, you look out, and the earth is flat. It’s you can confirm it with your own eyes. And there’s no doubt about it.

Gary Taubes: And not only that undeniably, the sun is revolving around the earth.

Dr. Mark Hyman: Absolutely. But neither of those are true. Yeah. And and until somebody started to question those assumptions, and some of them Mark called crazy or were put in jail or worse. You know, we didn’t really change our thinking. And what we have to do, and we must do because this disease is really going to decimate humanity. It’s decimating our children. It’s decimating our population. It’s crippling our economy. The federal deficit is in large part due to this phenomenon and insulin resistance and the consequences of it in our society, chronic disease that are just such a burden. And I think we have to get it right. And your book is about challenging our assumptions to get it right. And a lot of people would argue with you that, you know, No. No weight gain and obesity and diabetes, which is a consequence of obesity, are really simply the result of eating too much food. And not exercising enough. And, you know, you’ve you’ve talked a lot about this. You wrote about this in your book. Good calories, bad calories. You had a whole research initiative called Newsy about this where you funded large studies that David Litterig was a friend of ours, does a really powerful trials looking at do different calories matter and affect your hormones, metabolism, weight. And he found that they did, and there’s just a huge body of evidence around this Virta Health, which I I know you were very close to, and Sarah Halver, who’s a friend of ours recently died from breast cancer. She does really pioneering research looking you know, ketogenic diets and reversing types of diabetes. And yet the American diabetes association and and most endocrinologists are still saying you should have half of your diet as carbohydrates. So what is the truth about this? Like, are all calories the same? And is it just about energy balance?

Gary Taubes: funny when I first wrote about this. Well, I mean, the first book in good calories, bad calories, and it was critically reviewed in the New Yorker by their science health reporter Gina Kalata, who I knew well.

Dr. Mark Hyman: say no more.

Gary Taubes: You know, well, Gina made some interest. She said, first of all, you never know what I left out, which is true of all, Paul. You just never know what the alter

Dr. Mark Hyman: Selection bias, we call it.

Gary Taubes: It is selection bias. And when you’re running a book, you’re also selecting for story and you’re trying to select the most, the information that really you believe has to be in the book because a book can’t be 2000 words, pages long. And then she said that diabetologist, diabetes specialists had been, you know, proven that a calorie is a calorie. And when I wrote back in the times kind enough to run a lengthy letter of mind and response, which they don’t often do to book reviews. And I said, look, diabetes specialists of all people know that a calorie isn’t a calorie, except for Peter Attilia, who no longer knows that. But it’s, you know, you know, that every macronutrient, proteins, fats, carbohydrates, they prompt a different hormonal response in the body. And so a different metabolic response, and that the hormonal response includes a different, you know, different effects on fat storage and fat mobilization and fat metabolism, burning fat, whether you’re gonna burn fat or carbohydrates or whether you’re gonna use protein for fuel, which you could do or for tissue repair and cellular repair, which is how you’d like to prioritize it. All these things are determined by the hormonal response, which is different from all of them. And then so the argument I began making in good calories, bad calories, and as you point out, it’s been in every one of my books, and it’s in this one too, because it’s to me clear his day, and this was worked out beginning in the 19 teens, German and Austrian clinical investigators, researchers who were they were doing the best medical science in the world bar none until world war 2

You know, fat storage is regulated independently from how much you eat and exercise. You know, your fat cells that make up fat tissue. They can’t tell how much you’re eating or exercising. So they only see certain thing. They see the fats and the blood. I mean, c is a, you know, metaphor. They can. They’re aware of the fats in the blood and the hormones in the blood and the the glucose and the triglycerides and all kinds of other molecules, but it’s not not how much you’re eating and exercising. And by the 1950s, it was pretty clear that they were responding primarily to insulin. So you raise insulin. You drive fat accumulation. You inhibit primarily, you inhibit the escape of fat, the mobilization of that.

Dr. Mark Hyman: We call it lipolysis, the breakdown of fat. So, basically, it’s like one way turnstile in a in a subway where the calories get stored in the fat tissue, but they can’t get out.

Gary Taubes: They can’t get out. They need this process of repolysis. They need to be broken up into small pieces so they can get out of the fats. How an insulin prevents that from happening. Apparently, you know, someone in the body is a sensitive to insulin as a fat side. So there’s a tiniest bit of insulin in your circulation. It’s gonna shut down mobilization of fat.

Dr. Mark Hyman: for your fact. So Anyway, just to just to point out something that our friend David Ludwig said to me once, which really sort of highlighted It it’s more than just calories. He said in a type 1 diabetic, when they’re untreated and they’re first diagnosed, they could be eating 10,000 calories a day and losing weight.

Gary Taubes: Right.

Dr. Mark Hyman: So that’s because they have no insulin, and they can’t store those calories. They can’t get in the cells.

Gary Taubes: They can’t get in.

Gary Taubes: you know, there’s always 2 different ways to see everything. Yeah. So the way the community saw it is because they’re losing, they’re peeing away all those calories. That’s why they’re not gaining weight. So it’s still to them, it’s still an energy and energy out. They’re just losing all the calories in their yard. There are ways to study this and it was studied and to pick apart exactly what’s happening. And, you know, what’s happening is that without insulin, they can’t keep fat in the fat tissue. Yeah. So that’s the primary effect. What’s interesting, like I said, is they start giving insulin therapy, the more insulin you give the fatter patient if it became. And often they would become obese and then type 2 diabetes so closely associated to obesity, and they knew this even as the specialist a 100 years ago weren’t thinking of, but it’s type 2 diabetes. They didn’t want patients to become fat because they knew that made diabetes worse.

Dr. Mark Hyman: Worse. Right.

Gary Taubes: So you get massive doses of insulin. You tell them to get fatter, and then you tell them they gotta eat less.

Dr. Mark Hyman: Yeah. I think type 1 diabetics get also type 2 called double diabetes. So you you give them enough carbohydrates and enough insulin. They become insulin resistant. And so they need a massive dose of insulin. And it’s like they literally get double diabetes.

Gary Taubes: Yeah. No. And it’s it’s along this way, I mean, one of the other things is having the whole science of well, it’s called endocrinology hormones and the hormone related diseases, and it’s also sort of born in the late 19th century, but it’s very primitive, and it’s it’s growing and then evolving through 20th century, and these doctors are realizing that they’re diseases of, you know, excess hormone. And if you have too much of a hormone, then you gotta lower it. And if you have too little, you gotta add it.

Gary Taubes: But the problem is they can’t really measure hormones from the bloodstream accurately until 1960. So we’re giving insulin to everyone where they have too little insulin or too much. Because all we’re trying to do is lower blood sugar. And then if patients have side effects or complications, they get all the diseases that associate with it. You say, well, the problem is uncontrolled blood sugar. But you’re giving the problem in type 2 is insulin resistance and hyperinsulinemia. I mean, it’s too much insulin, and you’re treating it with more insulin.

Dr. Mark Hyman: It’s like the boy who cried wolf. He kept knocking at the door and tried to pick get someone to pay attention, but it doesn’t actually work. Right?

Gary Taubes: Doesn’t actually work. So what you do, you have more boys banging it on the door.

Dr. Mark Hyman: So, Gary, You know, we’re in this moment now where, you know, we really, I think, have begun to really understand the biology of diabetes and the biology of insulin resistance and poor metabolic health and more people than ever are suffering from this. And we now have this drug, Ozempic. Right. So is obesity and Ozempic deficiency?

Gary Taubes: Quite possibly. No.

Dr. Mark Hyman: mean, what’s going on here?

Gary Taubes: The issue with the drug is fascinating because part of the thinking here. So one of the ways this was captured, this was originally an epigraph in the beginning of the book. And then I decide if I put in the beginning of the book, I’m giving the whole book away. Nobody has to read. I took 2 epigraphs out.

Dr. Mark Hyman: That’s too bad. So what were they?

Gary Taubes: One of them was from 1870s is British physician was talking about a patient who came in a woman in her seventies, very healthy plump, robust, and she came to see him a good type 2 diabetes, and she had it completely under control by diet. And he thought this is terrific. Why are you seeing me? And because she didn’t wanna be on a diet anymore. And he’s like, are you crazy? You know, you’re as healthy as can be with the disease that for other people is chronic. I forget why we took that one. The other one was a story that was told to me by, well, from my perspective, a young man, he was diagnosed with diabetes in his thirties. This was, like, 2017. He was a chef. He became a journalist. He actually interviewed me for my sugar book. Told me at type 1 diabetes. And I said, I gotta interview you for my diabetes book. So he’s when you’re diagnosed with diabetes, particularly type 1. It’s like you go from maybe never having thought of this disease in your life unless a friend or relative had it to being dropped into this world where now you have to learn as much about it as you can, as quickly as you can, because you’re gonna pretty quickly. Like, within a day, you’re gonna be injecting insulin. And the doctor is briefing him. And he says, so what we’re gonna do is, you know, you’ve insulin deficiency disease. It’s type 1, and so we’re gonna give you insulin. And you can no longer metabolize carbohydrates safely. So in order for you to do that, we’re gonna give you insulin.
And then you’re gonna eat, you know, get 50% of your calories from carbs, and you gotta regiment them, certain amount for breakfast, certain amount for snacks, certain amount. And he says to the doctor, well, well, wait a minute. Let me get this straight. What you’re telling me is that carbohydrates are now toxic to me. And insulin is the antidote. And you want me to eat the toxin and take the antidote.

Dr. Mark Hyman: That’s right.

Gary Taubes: Why don’t I just not eat the toxin? And of course, the doctor has never thought about it this way. Like, he’s like, there’s gotta be a reason. Right? And the reason is, well, that’s too hard to do or, you know, it’s and he actually says, well, wait a minute. If I told you I was gonna now exercise an hour a day, you would you would say that’s terrific, even though the hour a day is gonna be, like, 30 getting to the gym and, you know 30 minutes taking a shower. But as I tell you, I don’t wanna maybe I shouldn’t eat the toxin. That’s gonna be too difficult to do. Right. What’s the problem?

Gary Taubes: So

Dr. Mark Hyman: That’s very funny.

Gary Taubes: As soon as we had insulin, we had the idea to eat the toxin and take the antidote. And if the antidote didn’t work well enough for there would always be a new antidote also. 1937, do you go with long acting insulin as discovered and, noble Nordisk in Copenhagen was the beginning of the

Dr. Mark Hyman: now making Ozempic. It was

Gary Taubes: now making Ozempic. And so this is the long acting insulin generation. Then post World War 2, you have the oral hyporglycemics. And then by the 1970s, you’ve got insulin pumps. And now you’ve finally got blood sugar monitor. So you can monitor blood sugar, and there’s always a new drug. And then we have, you know, the trans insulin made from, molecular biology, they did. Recombinant. Yeah. Recombinant DNA and and so there’s always a new drug.

Dr. Mark Hyman: So the idea is, yeah, sure. Pagan, beef, insulin. We were before. So now we had hue, human insulin. We could synthesize it.

Dr. Mark Hyman: Yeah.

Gary Taubes: We’re gonna need vegan insulin.

Dr. Mark Hyman: Gosh. If you’re a vegan, and have type 1 diabetes, then they have Hyman insulin. What’d you do?

Gary Taubes: Anyway, but the idea is always like, yeah, well, acknowledge that therapy isn’t great now, and there’s room for improvement. It’s always better than it was, which is true. But we also see other drugs coming down the pipeline, and there’s always other drugs coming down the pipeline. So now the latest drug, the GLP 1 agonist, again, that Ozempic will go be Munjaro. Terrific drugs.

Gary Taubes: I mean they seem to be the solution? Wonderful things. No. Why? I mean, they’re still treating that they’re still treating the symptoms. Yeah. As you put it, it said we don’t have a GLP 1 agonist deficiency disease with obesity. I mean, maybe we do on some level, but who knows? Yeah. Certainly you can treat it.

Dr. Mark Hyman: A lot of actually a lot of the ways we eat in the process where we actually lowers GLP 1. GLP 1 is something our bodies make. It’s peptide. It’s a natural thing like insulin.

Dr. Mark Hyman: And we’re just making something that acts more than our body connect she produce and make. Like, it’s

Gary Taubes: And accents slightly, you know, it is kept alive in the circulation, so it’s not degraded as quickly. And but so this is always the issue is we can treat the symptoms. We don’t have to people don’t. So along the way, as the obesity community was failing to treat obesity, failing to understand obesity, and failing to to provide a dietary therapy that worked. This is the convention of the establishment, not the diet doctor world because it’s, you know, we think they got it right, but they created all these mindsets and belief systems that would allow them to continue doing what they were doing without feeling that. Ultimately, they blame the patient, but the idea was nobody wants to be on a diet. That was a message from the kids from their early 19 twenties. Nobody wants to be on a diet. They’re not gonna stick with a diet.

Dr. Mark Hyman: Fair enough. But people would if you give them a chance.

Gary Taubes: Well, it’s gotta be the right diet, and that’s the point. So if you give them the wrong diet, why would they stick with it? Or if you’re giving them a diet just to prevent the appearance, delay the appearance of a disease, 10, 20 years down the line. Like, if I tell you eat a low fat diet to delay heart disease, prevent heart disease, assuming it works, you don’t ever actually see prevention happening. You don’t experience the prevention of a disease.

Dr. Mark Hyman: Right.

Gary Taubes: And when you get the disease, 30 years later, you don’t know that maybe you would have gotten a 10, 20 years later if you had eaten the way you used feed, or maybe you’d get a 40 years later. I have no idea. There’s no feedback on prevention. It’s one of my issues with the whole longevity world.

Dr. Mark Hyman: Yeah. How do you know?

Gary Taubes: Even if you have a drug that keeps dogs alive longer, like, maybe Well,

Dr. Mark Hyman: if I live to a 120, Gary, I think that’ll prove a point.

Gary Taubes: If I think that would be if you see a strong enough signal. Like, suddenly, there’s a whole world of people who have been taking a drug and live to be 120, but

Dr. Mark Hyman: It’s gonna take a minute.

Gary Taubes: It’s gonna take a while to establish that observation. It’s better be clear. Because those same people are probably doing a lot of other things too. So anyway, but that’s that’s the issue. So nobody sticks with the diet. And as long as nobody sticks with the diet, drug therapies always better.

Dr. Mark Hyman: But it but it’s not really because it ends up causing other complications.

Gary Taubes: Well, and this is what you have to find out. Again, I have, essay sitting at the Atlantic that I hope by the time this is aired, maybe we’ll have made it.

Dr. Mark Hyman: About Ozempic? And it’s, you know. So what’s your take on it?

Gary Taubes: Well, this is what scared me. They wanted we talked about the history and the tidal wave of complications. If you think of insulin, 1922, it’s a lifesaver. It’s a miracle drug. 1st miracle drug, undeniable. I mean, people at the brink of death and it brings you back and takes this intractable disease and it makes it tractable.

Dr. Mark Hyman: like ozempic in obesity.

Gary Taubes: Patients do better. They clearly live longer. It’s clearly minimizing diabetic combo. I mean, the complications for the 1st 5 or 10 years.

Dr. Mark Hyman: The acute complications.

Gary Taubes: Yeah. But then you get to see the long term complications of people, not just living with this disease. It used to kill them, but living with the disease and the drug therapy and the dietary approach that had been adopted along with it. And you cannot separate them out. And by the 1930s, you’re seeing these people suffering the tragic consequences that they might not have had to suffer. People really understood what’s going on now. And so the question is, you take

Dr. Mark Hyman: is that happening with Ozempic? Are we now in this in this golden era of Ozempic like we were with insulin and giving it to everybody without really any kind of thought about it. It looks like

Gary Taubes: insulin, they’re gonna have to be on it for the rest of lives. So it’s not just you’ve got some clinical trials that have tracked people out 3, 5 years and looked at specific complications that might stand out from the background.

Dr. Mark Hyman: Pancreatitis, balance structure.

Gary Taubes: Yeah. There’s a there’s so the question is, what happens after 10 years 20 years? And what happens when people try to get off? We also have clinical trials that show that after a year or 2 people get off these treatments, the weight comes back, if you do it for weight. So we know that. But what happens if try to get off after 10 years or 20 years or 30 years. What happens if somebody does these drugs? You know, I obesity is, for most people, is an intractable condition. I mean, we both think that that very low carb, high fat ketogenic diets will do this is probably the best approach, the most effective approach dietary approach for treatment, but we really have no idea for how many people.

Dr. Mark Hyman: Yeah. It may work for some and may not for others

Gary Taubes: And, you know, I mean, I just don’t know. The studies have never been done. So for many people and for children, obesity can be an incredible burden.

Dr. Mark Hyman: five year olds and twelve year olds on Ozempic.

Gary Taubes: Yeah. So but now you

Dr. Mark Hyman: That’s what the American Academy Pediatrics is recommending. Yeah.

Gary Taubes: Now you’re gonna have kids gonna be on these drugs for 40, 50, 60 years. And what about the girls who then get married in their twenties and wanna get pregnant? So what do these drugs do? We know there’s this concept of fetal programming in which basically the mother’s metabolic health is passed on to the child through the womb and that’s an effect that you I mean, it’s manifest itself as larger babies. But for the most part, you can’t really see the effects for gender literally generations until these kids are middle age and adults. And then you see the explosion of diabetes and obesity.

Dr. Mark Hyman: the epigenetic changes that are programmed for disease in utero for obesity that

Gary Taubes: Now you’ve got this very powerful drug that far, we know my reverse. This. I mean, maybe it’s a godsend. Kids, you know, mothers take this drug during pregnancy. The kids, maybe it’s not, here’s no way to know. And if the mother goes off the drug to get pregnant, that means she’s gonna be gaining weight back while she’s pregnant, which we know is a problem for fetal programming.

Dr. Mark Hyman: Unless people change what they’re eating. Like, right?

Gary Taubes: So, you know, I think about the way Jocelyn thought about insulin in the early years. What if he used the lowest doses? And this was Richard Bernstein’s revelation and type 1 diabetes in the 70s. Let’s use the lowest doses and craft a diet that allows those lowest doses to be effective.

Dr. Mark Hyman: Which is basically lower starch and sugar and higher fat. I mean, you know, we have a friend in the comment who, is a type 1 diabetic who’s a doctor who basically uses 1 or 2 units of insulin a day because she’s on a ketogenic diet. So she needs very, very low doses. She needs a little, but not that much.

Gary Taubes: Yeah. And then we know it can be done with that, and it can probably be done with these drugs. Maybe and it’s quite possible that with the right dietary approach and those, maybe people can get off the door, get to a maintenance weight, the weight they’re comfortable with.

Dr. Mark Hyman: I mean, I think it’s possible. It needs to but, really, that’s not what’s happening with the drugs. They’re just being described with no lifestyle change, no dietary advice, no regimen of exercise to prevent muscle loss.

Gary Taubes: the question is Mark people know, if you don’t need the diet advice, I was just with Oprah just had her special on Ozempic and how it’s changing obesity. And, I haven’t checked a ally out there emailed me and said, you should watch and see if the word sugar is ever mentioned.

Dr. Mark Hyman: Yeah. Right.

Gary Taubes: So if you can, I mean, again, apparently, in any of these drugs do inhibit appetite, that’s an effect? I don’t know if it’s a direct effect or an indirect one, but, and they might inhibit specific taste for carbohydrates and sweets.

Dr. Mark Hyman: which is the drug. Right? And they get nauseous.

Gary Taubes: Yeah. But it’s you know, to have a drug just explode like this. And our history of pharmaceutical therapy is full of examples of drugs that were wonder drugs, that ended up you know Delinamide. Well, thalidomide was an extreme example because you could see it, but, benzodiazepines, for instance. I mean, the world is full of people who took them on prescription as prescribed and got to the point where either the complications became unbearable or they became annoyed to the dose, and they didn’t do anything anymore and then couldn’t get off it. And then you have nightmares here. I actually had a tenant who was sent off to a rehab center for a month to break his Klonopin habit. Wow. And, had a mental breakdown afterwards. You know, it’s the what do you do if the drug helps 80% of the patients? Yeah. And causes intractable harm to 20% and you don’t find out for 10 years. Percent of the 20%.

Dr. Mark Hyman: We’re gonna see that. I have no doubt. I mean, I think there’s gonna be a boon to some people, and I I think it’s not a bad drug like any drug. It’s how choose who it’s used with, how long it’s used, what does it choose, and and also

Gary Taubes: And the extent of the problem that you’re using it for.

Dr. Mark Hyman: Right. But I’ve had so many patients, Gary, who’ve lost a £100, £200 without that by just giving proper nutritional advice and in many of these cases, restricting carbohydrates.

Gary Taubes: But can we have a world of ways to think about it? I mean, the one of the diagnostic criteria of an eating disorder is not eating an entire food group. Yeah. And there are other people you and I saying, well, the problem is the carbohydrate content of the diet. So we don’t need carbohydrates. We don’t have there are no essential carbohydrates. Don’t eat them. You’ll be fine. That was basically what I’m arguing for diabetes. You don’t need to take all the medications of pharmaceuticals that are prescribed to you to treat the symptoms that come from eating them. Yeah. I just

Dr. Mark Hyman: I just wanna stop you there for a sec because what you said is really important. There are essential fatty acids. There are essential amino acids. There are no essential carbohydrates. Right. So the body she does not need them biologically to thrive even though it’s our main fuel source. So historically, we’ve been adapted a whole range of diets from the Inuits and the basic ketogenic diet. To, you know, the Pema Indians who were 8.80 percent carbohydrates, but it was all high fiber plant, you know, based carbohydrates that were were really nutrient dense. So, you know, the body can survive and thrive on many different things. And the quality of the calories matter, which is really the thesis of your book, good calories, bad calories. And I think you know, most people don’t understand that they actually can regulate their biology if they figure out what their particular metabolic type is because everybody’s different. And for example, I need a little more carbohydrates because I’m kinda thin. And if I don’t eat them, and I go keto, I’ll lose too much weight. Right. But if I take a patient who’s overweight and type 2 diabetic, they’re gonna do really well if I do that.

Gary Taubes: And a little bit of carbohydrates might prevent them from doing really well. Yeah. That’s that’s the, I think one of the points that I’ve made in my other book is we do think everybody is different. And we definitely evolved to cope with the proteins and fats in our diet that the idea that the foods that we didn’t, the new foods of modern life.

Dr. Mark Hyman: Ultra-processed food. That’s not even food.

Gary Taubes: I’m not wild about the term Ultra process because it sort of like the miasma theory of all these kind of vague things that we’re gonna throw. And, you know, Michael Pollan called them food like substances, and I prefer that. It’s more to the point.

Dr. Mark Hyman: But they don’t need to actually criteria the definition of food if you would like.

Gary Taubes: We didn’t have time to adapt to high levels sugar in our diet and and sugary beverages in our diet. These things didn’t exist. We didn’t have time. I mean, I’m agnostic about the seed oil issue. I don’t find the evidence. I can easily believe that these things are toxic, but I

Dr. Mark Hyman: Yeah. I mean, it’s just confusing for sure.

Gary Taubes: There’s a certain absence of human clinical trials.

Dr. Mark Hyman: Just like sugar, you know, when you think about sugar, we never had exposure to the amount of sugar eating that historically as species. We never had 10% of our diet being refined soybean oil before. It’s a new phenomena for humanity. And, yeah, maybe it’s okay. Maybe it’s not, but I think it should be questioned.

Gary Taubes: Yeah. It certainly should be questioned. And that’s the thing. Those you so you can propose that those are problems. And with the sugar and refined grains, you could see what happens when you take them out of people’s lives. I mean, and we have clinical trials such as.

Dr. Mark Hyman: Can you talk about that? Like, you talk about the Verta health work and, sorry, how books work and the sort of work on advanced type 2 diabetes where they actually were able to reverse it, not just slow it down or delay the complications or to manage the disease, but literally to reverse it.

Gary Taubes: Yeah. Well, so this is, you know, getting back to the history a bit. We get to the 19 seventies eighties as the diabetes community, their credit, did some really ambitious clinical trials. And what they find out and the fact is that this disease has, by their treatment, as a chronic progressive disorder, it just gets worse. Hyman famous British trial where they just they show they start people on diet only, and then they add one drug and then they go and they see how many pay patients diagnosed with type 2 diabetes can stick with 1 drug monotherapy, and the answer is, like, 10%. So as time goes on, you keep on having to add drugs to keep the blood sugar under control. They do these we set a cord and, I forget the other names of the other 2 trials. Looking at intensive insulin therapy and they find that it does more harm than good at the very best. And then they do this huge look ahead trial, $200,000,000 to demonstrate that if you lose weight, you’ll reduce diabetic complications. That fundamental pillar of thinking with diabetes. Just get your patients to lose weight. They’ll be fine. Yeah. Again, to lose weight, and it doesn’t make a damn bit of difference. A trial has ended for futility, a $200,000,000 trial, and it’s great quote in the New York Times from a Harvard Diabetes specialist named David Nathan who says we have to have an adult conversation about this, and they never do.

Dr. Mark Hyman: is an important point, they lost weight and they got worse. So they lost weight and they didn’t get better. So they lost weight.

Gary Taubes: The idea was you lose weight, you know, have fewer complications, you reduce heart disease, you reduce strokes, you reduce mortality from this disease.

Dr. Mark Hyman: Was it because of how they lost weight?

Gary Taubes: Well, it could have been because of how they lost weight. And in fact, back around 2003 when I first heard about this trial, from one of the principal investigators. I was in a conference invited me to talk in Houston. I remember saying to him, look, are you doing a low carb Mark? Okay? Just do a low carb arm. Make it not just low calorie, low fat, fruits, vegetables, whole grains, the usual

Dr. Mark Hyman: Mediterranean diet. Right?

Gary Taubes: Well, this was pre Mediterranean. I mean, this was, yeah, it was just classic, low fat. But in low fat, they’re also saying you’re eating fruits, vegetables, whole grains, you know, cut back on meat. Exercise. They no. They never crossed their mind to do a low carb diet because that was still considered quackish, but as the diabetes community keeps learning about how ineffective their treatments are and how their belief system is falling apart on top of them and not having an adult conversation about it, which is maybe we’re making some mistakes here. Other physicians coping with this increased obesity in their patients, are confronted with patients who don’t take their advice and instead, like, buy Atkin’s Diet Revolution book and lose £40 on Atkins. And a few of these doctors are open minded enough, Eric Westman and David Ludd would go to this. I’m gonna look into this. I’m gonna actually do a clinical trial. So they start doing clinical trials. It’s a big study at the Philadelphia VA. And there, the woman named Linda Cern is frustrated by how much her inability to help her patients. So she literally goes to, like, a Brentano’s bookstore, and she sits down in the diet section. She starts reading diets,

Dr. Mark Hyman: and I’m just going to the book starter read health self help books because it’s not in the textbooks.

Gary Taubes: You know, it’s not not not not today. Definitely don’t get grades. Good grades for this in med school. Anyways, I think she found protein power. And so she tries it on herself, and it’s effortless to lose weight. So they put together a clinical trial, and this is a veteran’s administration’s hospital. So there are a lot of vets. They’re not just obese. They have metabolic syndrome and type 2 diabetes. And instead of cutting them out of the trial, as you would, you know, the inclusion criteria in a pharmaceutical trial is gonna say we’re gonna not take these patients because they’re ill.

Gary Taubes: She says since this so associates with obesity, let’s do it. And not only do these patients lose a lot of weight on the diet, but their type 2 diabetes gets better on this high fat, low carb, back in small protein power diet. So if you start getting this groundswell, this is this movement of doctors who are reading these articles in the literature, And, saying, look, you know, diet really seems to help. They don’t know this deeper history, Mark Westman at Duke is looking into it. It’s just patients do well if you don’t feed them carbs. Isn’t that weird as bad. It’s a disorder of carbohydrate metabolism. If you don’t tell them not to eat it, they do fine.

Dr. Mark Hyman: You don’t take the toxin. You don’t need the antidote.

Gary Taubes: So Steve Finney and Jeff Volk too. Yeah. Steve is a PhD nutritionist. Yeah.

Dr. Mark Hyman: I’ve had them on the

Gary Taubes: pipe too. Is out at UC Davis, and he’s been he had studied ketogenic diets and Jeff Volek as an exercise physiology PhD, then at the University of Connecticut. They’d start working together and, publishing on this, and they help start this company, Verta Health. I remember Steve’s idea. I think it was. It was we could just convince insurance companies and employers that they could save money as diabetes is an expensive disorder. It’s costing a

Dr. Mark Hyman: It’s the most expensive

Gary Taubes: disease. Yeah. Go bills. If they could save 80% of that by getting these people on a diet, wouldn’t they wanna do that? So they’d become the client. Not the patients. We’ll go after the payers of the insured Yeah. The Kaisers and Blue shields of the world. And they create this company. They get this brilliant CEO, Sammy Inkannen, who is a world class Stanford MBA. Made millions creating the website. I always forget whether it was Trulia or, one of the real estate websites. A world class triathlete. Who’s was diagnosed with prediabetes Yep. Despite having coming first in his age group in the iron man triathlon. And Sammy goes to Steve and Jeff for advice on how to treat the prediabetes and also how he wants to this is Sammy and Kenny wants to row to Hawaii from San Francisco to Hawaii with his wife, Meredith, and he thinks they could do it. Jeff and Steve can coach him and they start talking about this idea and they start this company, Verta Health. Meanwhile, by the way, Sammy and Meredith do row to Hawaii. And they break the record, and they don’t need any carbohydrates on the whole trip. I think it’s 24

Dr. Mark Hyman: miles. And how he how he got the prediabetes was he was using all those goos and energy things that athletes use to fuel body.

Gary Taubes: That Sammy believed that a low fat diet was the healthiest way to eat. He had been told that. And Sam is, I think, he’s Norwegian. And does he put it? Not that being Norwegian matters, but if he’s Finnish, I apologize. He’s just got the best, you know, if somebody tells him not to eat fat, he doesn’t eat fat. It’s, I mean, this is an extraordinarily, the man has an extraordinary, you know, strength of will. And then he’s diagnosed with prediabetes. So there’s something wrong. This is a common phenomena that happens to many people in our world. Right? You’re doing what’s supposed to be the right thing, and it doesn’t work for you. And then you do the wrong thing, which in this case is it’s low carb, high fat ketogenic, animal diet. And you get better. And you say, wait a minute. If it’s wrong for me, maybe it’s wrong for a lot of people, if not everybody. So they start this company Verta Health. They realize they need a clinical trial to convince the and they meet Sarah Hallberg, who is a physician in Indiana, an amazing woman to whom the book is, dedicated, who has been asked to run an obesity clinic Indiana Health and has to learn everything she can about obesity. And she starts to reading all the literature, and she goes down the rabbit hole and she experience is this, you know, based on Jell O revelation. And she realized that the only people who seem to be having effective who seem to be effectively getting their patients to lose weight of these people like Westman who are advocating for these Atkins, low carb, keto diets. And so she goes and spends time with Westman. She goes and starts you know, advocating for this at her obesity clinic, and she meets Jeff and Steve, and they put together a clinical trial. Where they’re gonna randomize people for type 2 die people with type 2 diabetes side of this nutritional ketosis, keto with, smartphones, and personal, coaching and support, and telemedicine.

Dr. Mark Hyman: Adjusting their medications if they need to.

Gary Taubes: Right? Yeah. Because you’re gonna have to adjust medication. If you stop eating the talks and you’re gonna have to lower the dose of the antidote. And they it’s either that or the American Diabetes Association standard of care, which is drug therapy. And they do the trial. And after a few years, they report 1 year results, and after 3 years, they report 2 year results. Yeah. And for patients who comply with the diet, they seem to put this progressive chronic disease into remission. So it’s not a progressive chronic disease. It’s only a progressive chronic disease if you’re eating the toxin. Yeah. If you’re not eating the toxin, you don’t manifest the symptoms and it’s not the ideal clinical trial. There’s all kinds of their problems with it. Wasn’t randomized. Actually, I probably said randomized, and I should not. They let patients choose whether they wanted the diet or the ADA standard of care. But even on with those constraints, it demonstrated beyond a shadow of a doubt that a disorder, which is considered chronic and progressive is not necessarily chronic and progressive and that the defining factor is the diet. Again, whether you eat the toxin,

Dr. Mark Hyman: It’s true. I mean, in our practice, the ultra wellness center, I’ve seen that over and over again. People just don’t, on insulin, get off insulin, on meds, get off meds, normalize their weight, normalize their metabolism. The A1c goes down, they went from 11 to 5.5 in a few months. I mean, it’s quite remarkable.

Gary Taubes: by the end of the book, my employer, I mean, again, I this book does not advocate. It’s a it’s a dense historical.

Dr. Mark Hyman: Yeah. It’s like a mystery novel.

Gary Taubes: And a mystery novel.

Dr. Mark Hyman: Who done it and who didn’t do it?

Gary Taubes: Yeah. I think it’s a very good book. The question is imagine a scenario where everybody, every physician was taught not just the proper drug therapy. But how effective this dietary therapy was. Because there always been 2 levers to pull to keep blood sugar under control. There’s diet or drugs. Until 1921, we only had diet and for patients with type 2 diabetes, it was effective. Yeah. If you don’t eat these foods, you’ll be fine. Yeah. Once we had drugs, you had 2 lovers, and the idea was use the drugs. Give the drugs. You know, we’re gonna say the guy who’s integral, the cornerstone of therapy, but we’re gonna pay lip service to it because we got the drugs. What if confronted with a new patient? You give them the diagnosis. You have type 2 diabetes or type 1 diabetes. And you say, look, we can do this. We can treat your symptoms with drugs. You can continue to eat exactly the way you want. Or if it’s type 1, we’re gonna you’re gonna eat, you know, it’s specific interval, specific amounts to allow us to maximize your, you know, craft the diet to maximize efficiency of the drug therapy. And there’s all these complications we know are gonna ensue. So you’re gonna have an increased risk of heart disease and stroke and dementia and, blindness and retinopathy. And for some of you, no matter how well you manage your blood sugar with these drugs, those complications are gonna happen anyway. Yeah. At which point, we’re gonna blame you. But.

Dr. Mark Hyman: It’s a big fault.

Gary Taubes: you can do this diet. Now what it means is no more bread, potato, sweets.

Dr. Mark Hyman: Yeah. Wish people beverage. Which people crave it. It’s hard because they crave those foods when they have insulin resistance.

Gary Taubes: Yeah. Which is fascinating. If you eat this way, as far as we can tell, you’ll be fine. No drugs. No complications of drugs. No needing more doses or new doses, no waiting for new drugs to come along. No dialysis as far as we can tell. If you eat this way, you’ll be fine.

Dr. Mark Hyman: Amazing. I mean, we spent $1,000,000,000.

Gary Taubes: Probably take 2 or 3 months. It might take my you might love it immediately. It might take 2 or 3 months to get used to it. In which case, you know, like somebody who’s quit smoking, you won’t miss cigarettes after a while.

Dr. Mark Hyman: Right.

Gary Taubes: You will at first. You won’t after a while. It’s your choice. Yeah. We’re happy either way. Okay. Because we want you to be healthy. But this way, chronic progressive disease, diabetic complications, more and more drugs, complications of drugs. This way as far as we can tell, and we can’t, you know, there are unknown unknowns here. As far as we can tell, if you eat this way, you’ll be fine. Yeah. You choose. And if you do eat this well, let’s make sure you do it right.

Gary Taubes: Yeah. And if you choose the drugs, we’ll make sure you do it right.

Dr. Mark Hyman: you do it right. I mean, it’s it’s such a it’s such a simple notion. And yet it’s it’s it’s, you know, bucking against the establishment paradigm that we should be using drug therapy and high carbohydrate dyes in diabetics. Mean, I think the ADA is starting to come along, American Diabetic associate, but it’s really tough.

Gary Taubes: Well, they’re starting to come along, but if you see how they do it. So they put out these standard of care documents. And every year, every January, and, there’ll be, like, 8 or 10 of these documents, and they what they do is they revise based on what research came out in that past year. So they really have no mechanism by which you say, let’s just rethink this.

Dr. Mark Hyman: Everything.

Gary Taubes: And then when they’re revising it, the discussion of diet is buried is inside in this document where it’s sort of you can do this or you can do that or you can try this diet. We have this research for this or this research for that. They don’t have any mechanism to say, can we just try? Let’s try a different approach. Let’s divide the world up. Let’s say this is what can be achieved with diet, and this is what can be achieved with drug therapy. And this is a complications that we know of with diets. Not many. And these are the complications we know with drug therapy, chronic progressive disease. Many people might choose drugs.

Dr. Mark Hyman: I mean, I don’t know. I mean, I think, you know, when you look at the data to me, it’s pretty clear that if you use drug therapy, that it is a progressive chronic disease, and you can mitigate or slow the complications, but it’s not gonna prevent them.

Gary Taubes: Well, this is

Dr. Mark Hyman: And then if you use the dietary therapy, it goes away. And and and, you know, I think people might be listening going, what do you know, Gary? We you’re giving these people a ketogenic diet with 75, 80% of their fat. What about their heart? And, you know, maybe say they’re diabetes, but, actually, they looked at over 20 cardiovascular biomarkers as part of the Verta study.

Dr. Mark Hyman: Part of the verte study. And and they were all improved. Actually, they got better. Right. You know, and I’ve seen this overnight. I had a patient, which was really struggling with with weight loss and she had pre diabetes, she had triglycerides of 3 plus 100 or HGL was very low, and her total cholesterol was over 300, very high insulin levels, rising blood sugar. And I’m like, why don’t you try a ketogenic diet? She did it. Not only did she lose £20, but her cholesterol dropped a 100 points. Her triglycerides dropped 200 points. Her HTO went up 30 points. Her blood sugar normalized. Now that may not work for somebody else who’s a thin guy who is an athlete, and I’ve I’ve seen people who use this ketogenic diet like that who actually don’t do well. And I’m one of those guys. If I eat too much of the wrong fats, my cholesterol goes off off the rails.

Gary Taubes: But we don’t know how harmful that is.

Dr. Mark Hyman: We don’t. We don’t unless we look in look inside your arteries, and then we can do. So it’s just fascinating. I think this is really a really important moment in history because we have this is a craze of Ozempic and Magawi. It’s the the, you know, golden child at the moment of Mark pharmacology, and and nobody’s really talking about the issue that matters, which is what we’re eating and and why we’re eating what we’re eating. And then

Gary Taubes: And that’s because we have this mindset that you know, the people with obesity, we’re not gonna blame it on willpower. We’re not gonna acknowledge that it’s a disease now. This is what Oprah was saying. But we’re also going to assume that they won’t change their diet. It’s really complicated. I’ve read the literature of most with obesity. They’re so confused. Yeah.

Dr. Mark Hyman: They know it’s not a willpower problem. No. It’s not a

Gary Taubes: willpower problem. And often, these authors will say I tried every diet. None of them worked. And I wanna reach out to them say, well

Dr. Mark Hyman: You didn’t try the right one. Oh, where did you because they always include Atkins in the list. They did not work for you, or are you something? But then they’ll say, you know, it’s just one of these books I read recently, it’s, you know, I don’t wanna go through my life, not eating a doughnut.

Dr. Mark Hyman: Right.

Gary Taubes: Well, I I understand.

Dr. Mark Hyman: I get that.

Gary Taubes: I get that. But, you know, I was, I’ve been biased by my history as a cigarette smoker. It was a period in my life where I couldn’t imagine going through my life without a cigarette. Yeah. And in fact, my next cigarette was what pulled me forward into the future. Maybe it’s an inappropriate metaphor. I’m not sure it is or not.

Dr. Mark Hyman: Well, no. And we know that, you know, there’s real addiction with these foods that particularly the, what do we call them? Food like substances or ultra processed food or high starch insurance, foods, they activate the brain centers for pleasure. And we can map that on brain imaging studies. So there’s no doubt that that these have biological effects on the brain that drive our our behavior, our cravings, our appetite, But but I think what it what’s really remarkable as a doctor treating these patients is that when you do the right thing, their brain chemistry changes, their hormones change metabolism changes, and they don’t actually have those cravings. It’s not like they have to use willpower to fix it. You science. And this is really what your book is about. It’s challenging the orthodoxy, challenging the science, making us rethink diabetes and come up with a new vision for how we can deal with this obesity crisis rather than spending $5,000,000,000,000 on Ozempic for the population, which is what it would cost if if we gave everybody who was overweight Ozempif.

Gary Taubes: Well, this is the idea that this will somehow impact the obesity epidemic is insane, right, because oh, I suppose if it gets off label and people can buy, you know,

Dr. Mark Hyman: a month’s cheap, even if it’s cheap, is it safe?

Gary Taubes: But then then, yeah, then the question is what are the side effects? What are the complicated part? Will there be a tidal wave or, you know, a wave of complications down the line that are gonna make a whole host.

Dr. Mark Hyman: I I think there is. I mean,

Gary Taubes: they wished they had never started.

Dr. Mark Hyman: I mean, I think the data is already coming out that the longer you’re on it, the more likelihood you’re gonna have complications. Not everybody will, obviously, but

Gary Taubes: What’s interesting is even these studies, the studies that looked at, that looked at, long term use. And again, they went out about they had patients in them who had been on the drugs for, like, 5 years, and they were looking at specific possible complications, but they would also say these were for lower doses. And as for diabetes, not for obesity, and then they say, well, with 60% of the patient’s discontinued use.

Dr. Mark Hyman: Yeah. Because they’re nauseous or

Gary Taubes: Yeah. Why did they discontinue? And what happened when they did? Because if when they did. They then fell out of the system. They were no longer in the clinical trial, so nobody has any idea. Was it difficult to discontinue use? Did things get worse? That then had to be treated with other.

Dr. Mark Hyman: Well, what happens when you take these drugs is you lose muscle and fat and you gain back the weight, usually gaining back fat. And so your metabolism is slower at the end of the process than at the beginning. And you need to eat less food in order to just maintain the same weight.

Gary Taubes: And this it’s a real problem.

Dr. Mark Hyman: Unless you unless you eat a protein and do a lot of strength training while you’re taking these drugs. You’re gonna be in trouble.

Gary Taubes: You know, I’ve been an athlete that jock my whole life, and I you know, I’ve lifted weights my whole life and the idea that you can solve the muscle loss problem by going into the gym eating protein and lifting weights. It’s like do you have any idea how hard that is? Well, you can do it. You can do it. But then

Dr. Mark Hyman: I can see your buff and your 67.

Gary Taubes: You know, yeah, but it’s it’s It isn’t the muscle that comes off easy with the drugs is not gonna be put back.

Dr. Mark Hyman: No. No. That’s right. That’s that’s important point. It’s hard. It’s easy to lose, hard to gain.

Gary Taubes: You know, and as people get older.

Dr. Mark Hyman: Yeah. That’s even harder.

Gary Taubes: The gaining is also dependent on hormones and wane with time.

Dr. Mark Hyman: Totally. Well, Gary, this has just been such a fascinating conversation. I think your book is a, you know, kind of a pivotal book in helping us literally rethink diabetes and challenge our orthodoxy, challenge our assumptions, poke the bear a little bit and say, hey, let’s let’s get real with this and let’s look at the data. Let’s look at the science and not go along with the current recommendations, which are, in many ways, I believe are harming people. And I think I think we have a moment, to change that. So thank you for writing it. It’s a beautiful book. It’s beautifully written. It’s very entertaining. It doesn’t it’s not a dense medical book like mine, so I think you’ll all like it. I encourage you to get it. It’s called “rethinking diabetes”. And, also, I would encourage you to check out his newsletter called “unsettled science” on Substack because writes it with Nina Tichols who wrote a book called the Big Fat Surprise, also another great book. And, and it’s really a great way to sort of get another point of view about nutrition that you might not be hearing to conventional channels.

So, Gary, thanks for being on the podcast again. Thanks for what you’ve done. Thanks for having the patience to weed through all those thousands of pages of historical data and limiting us with the history of diabetes and hopefully paving way toward a future that is much better than what we’ve had in the past.

Gary Taubes: Thank you, Mark.

Dr. Mark Hyman: Thanks for listening today. If you love this podcast, please share it with your friends and family. Leave a comment on your own best practices on how you upgrade your health and subscribe wherever you get your podcasts. And follow me on all social media channels at Doctor Mark Hyman, and we’ll see you next time on the doctor’s pharmacy. I’m always getting questions about my favorite books, podcasts, gadgets, supplements, recipes, and lots more.

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Dr. Mark Hyman: This podcast is separate from my clinical practice with Delta center and my work at Cleveland Clinic And Function Health, where I’m the chief medical officer. This podcast represents my opinions and my guest opinion and neither myself nor the podcast endorsement of views are statements of my guests. This podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice services.

Dr. Mark Hyman: Now if you’re looking for your help in your journey, seek out a qualified medical practitioner, you can come see us at the UltraBonus Center in Lenox Sachusetts. Just go to ultrawellnesscenter.com. If you’re looking for a functional medicine practitioner near you, you can visit ifm.org in the search find a It’s important that you have someone in your corner who is trained, who is a licensed health care practitioner, and can help you make changes, especially when it comes to your health. Keeping this podcast free is part of my mission to bring practical ways of improving health to the general public.

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