Journalist Gary Taubes has written several books on diet, including “Good Calories, Bad Calories,” “The Diet Delusion,” “Why We Get Fat: And What to Do About It,” and most recently, “The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating,” which is the topic of this interview. For his most recent book, Taubes interviewed more than 120 physicians, plus a few dieticians and chiropractors and a dentist — about 140 medical practitioners in all — to understand the challenges that clinicians and patients face when trying to implement a ketogenic diet and lose weight. The first half of the book explains how carbs and fats affect your body, and why replacing carbs with healthy fats is so important if you’re trying to control your weight and/or blood sugar. The second half of the book is a review of the lessons he’s learned along the way. The Real Cause of ObesityAs noted by Taubes, on a global scale, the obesity epidemic can be linked back to a Western diet rich in refined sugars and grains. Whenever sugar and white flour are added to a population’s diet, regardless of what their baseline disease rate is, you eventually end up with an epidemic of obesity and diabetes. The idea that you get fat because your caloric intake exceeds your expenditure naïve, Taubes says. “That's not the cause of obesity. That's like saying we get rich because we make more money than we spend.” He also takes issue with the idea that obesity is a hormonal regulatory disorder.
Uphill Battle Remains Despite Strong Scientific EvidenceUnfortunately, Taubes estimates some 98% of conventional nutrition and obesity research community still approach obesity as an energy balance disorder. “They've been trained over their entire professional careers to think of obesity as caused by this imbalance in intake and expenditure,” he says.
On the upside, many physicians are now starting to understand the role of diet, processed grains and sugar in particular. Interestingly, the U.S. Department of Agriculture Dietary Guidelines Advisory Committee’s 2020 report claims there’s an insufficient amount of low-carb and ketogenic diet trials to suggest that this kind of diet would be beneficial for the American public at large. This despite the fact that hundreds of studies over the past two decades have consistently shown a ketogenic diet to be beneficial. “Name a disease state at the moment from Alzheimer's to traumatic brain injury, and you'll find somebody studying whether or not ketogenic or a low-carb/high-fat diet could be beneficial,” Taubes says. In 2018, the American Diabetes Association Nutrition Committee published a consensus report1 saying there was more consistent evidence for a low-carb or very low-carb diet being beneficial for Type 2 diabetes than any other diet tested, particularly ones that have been advocated by mainstream medical authorities, such as the Mediterranean diet and the DASH diet.
Not All Fats Are Equal MetabolicallyAn important side note here is that while processed sugars and grains are certainly a significant contributor to obesity and ill health, the types of fats you eat play an important role. Many are eating far too much omega-6 linoleic acid (LA), which appears to be even worse than excess sugar. In fact, I now believe an excess of LA in general is responsible for a vast majority of the damage and ill health we see in response to diet. I’ve reviewed this in several recent articles, including “How Linoleic Acid Wrecks Your Health.” Now, while most people will experience a significant improvement in their health when they cut down on processed carbs, replacing them with fats, the improvement is not universal. This paradox, I believe, is because they’re eating too much LA. Similarly, I think those who successfully use high-carb, low-fat diets to treat obesity, diabetes and coronary artery disease may be achieving these beneficial effects largely because they’re avoiding excess LA. Taubes is not entirely convinced, however, and goes into some of the details of his objections in the interview.
The Importance of Self-ExperimentationAs noted in Taubes’ book, at some point, you’ll need to be willing to self-experiment to determine your own dietary triggers and what works best for you. At the end of the day, it’s about how you feel, not how well you follow any given diet. Taubes recommends starting off rigidly abstaining from carbohydrate-rich foods, and then assessing what other problems you might have and make additional changes from there.
Why Restrict Carbs?So, just why is carb restriction such a key component? I was surprised to find that Taubes has not yet embraced cyclical keto (eating low-carb on some days and relatively higher amounts of carbs, maybe 200% to 300% more on others). Instead, he advises a more regimented and consistent carb restriction, i.e., a ketogenic diet that remains low in carbs continuously. The primary justification for this is because most obese and chronically ill people have an addiction to carbs. They are addicted to a certain way of eating, and the concern is that if you allow carbohydrates back into their diet they can trigger eating carbs without discipline.
That said, I, and nearly all of my clinical associates who see patients, especially those who are athletes, now personally use and recommend cyclical ketosis. Personally, I will eat 30 to 50 grams of carbs one day and then 100 to 150 grams the next day. I’ll alternate back and forth. To make sure you’re moving in the right direction, you can measure and monitor your ketones and blood sugar. The problem I've seen consistently is that if you restrict carbs continuously, your blood sugar tends to rise. The reason for this is because your body requires a certain amount of carbohydrates (glucose) to function. If you're not getting it from your diet, your body makes more of it in your liver to supply your needs. I hopefully catalyzed Taubes to seriously reevaluate his position as to one that is more consistent with our ancestral consumption of carbs. He responded:
How Excess LA Breaks Your MetabolismIf you’re like Taubes and are concerned about starting cyclical integration of carbs into your diet, I would recommend using a continuous glucose monitor like the Nutrisense device that allows you to measure your measure and record your blood glucose every five to 10 minutes. This will allow you to determine whether chronic low carb dieting is working optimally, or whether cycling higher and lower carb intakes might be better. Continuous blood glucose monitoring can immediately tell you how various foods affect your system. Cycling back to the issue of LA again, it’s important to recognize that excessive LA in your diet can cause extreme reverse electron transport flow through complex I in your mitochondria with the production of high quantities of superoxide and H2O2, which actually causes you to become insulin resistant. So, insulin resistance is not restricted to excessive carb intake. Limiting LA will also help reduce oxidative LA metabolites, which are the most pernicious sources of oxidative stress in your body. These oxidized LA metabolites (OXLAMs) prematurely destroy mitochondria and limit your ability to efficiently create ATP. When you eat an excessive amount of LA, the disruption it causes in your mitochondrial electron transport chain causes your fat cells to become insulin sensitive. This is the last thing you want. While you want your somatic cells to be insulin sensitive, your fat cells need to be insulin resistant.2 As explained by Dr. Paul Saladino in “The Case Against Processed Vegetable Oils”:
The take-home message here is that a proper ketogenic diet must be based on healthy saturated fats, not destructive vegetable seed oils or other common foods that are loaded with LA. Eating a high-fat diet, when the fats are primarily LA, is far worse than eating a chronic high-carb diet. The type of fat is of crucial importance, as it impacts your mitochondrial, cellular and metabolic functioning. I realize that this information likely leads many of you to many questions. The good news is I’m co-writing a new book on all of this with Chris Knobbe, who is a leading expert. We hope to have the book out by the summer of 2021. More InformationTo learn more about how carb restriction can improve your weight and health, be sure to pick up a copy of Taubes’ book, “The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating.” While I believe most people would benefit from additional dietary changes, such as implementing a cyclical ketogenic diet and limiting LA, the basic premise of carbohydrate restriction is certainly sound, and is likely to improve the health of virtually everyone. Then, as mentioned earlier, you may need to continue to fine-tuning and tweaking your nutritional choices to find just the right fit. You may also find that your body’s needs change with age. This is completely normal, and to be expected, so there’s no need to be dismayed if what you’ve done for a number of years no longer is working. from http://articles.mercola.com/sites/articles/archive/2020/12/27/the-case-for-keto.aspx
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