The Case for Keto with Gary Taubes
Gary Taubes is an investigative journalist who has written several books and articles about the science of nutrition, health, and obesity. His new book is The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating.
Several years ago, KAXE/KBXE staff member Maggie Montgomery read another book by Taubes, Why We Get Fat - a book that changed many people’s understanding of how our bodies accumulate and use fat.
In this interview, Maggie asked Taubes how things have changed in the field of medicine and nutrition between publication of Why We Get Fat and The Case for Keto:
NOTE- - audio of this interview is below the transcript - -
When I wrote Why We Get Fat, the last chapter was my sort of advice chapter, among other things. I interviewed a half a dozen physicians I knew - who were the only half a dozen physicians I knew - who were prescribing low carbohydrate, high fat, keto diets to their patients. And today I estimate that there's a few tens of thousands out there. There's a Facebook group in Canada for women physicians who eat low carb, high fat diets. This is just women doctors in Canada. And they have 4,000 members, which means one in every 10 women doctors in Canada are part of this Facebook group, and they're basically eating keto. So anyway, a few tens of thousands. And what was once known as the Atkins diet is now keto, but it's probably now the most well tested dietary pattern in history. And there's about a hundred clinical trials in the works presently. And think of any dietary pattern from any disease from Alzheimer's or, you know, anxiety disorders, to traumatic brain injury, and there's someone out there testing to see if a ketogenic diet will benefit because it seemed to make so many things better.
This book, it felt really personal and very compassionate. Who are you aiming to have read this book?
I guess I had two goals. One is I wanted people who are already eating carb-restricted diets. So again, it's not necessarily ketogenic, but low carb, high fat, or keto or some variation. I wanted them to understand fully why they're doing what they're doing, what they're accomplishing, how to think about it, how to pursue it, how these physicians out there think about it and the challenges that we all face and how to think about overcoming it. Originally, the book was actually called “how to think about how to eat.” (And I have to apologize for my dog barking in the background…life during COVID.)
But then I also wanted a book that would go beyond the people are already bought in. And so anyone who's ever said, “well, you can't eat that way. That's, you know, you're restricting a whole food group. You're going to get an eating disorder.” Or,” you can't eat that way, the saturated fat is going to kill you,” or “you can't eat that way because you're not going to sustain it.” Or “you can't eat that way because you should be eating a plant-based diet because it's better for the environment.” Or, you know, “I'll never be able to eat that way because I love my pasta too much. And so I'm going to just count my calories” or, you know, any doctor out there who says, “oh, keto that's fad. Nobody can sustain that. Why would anyone want to do that?”
So by writing The Case for Keto, I wanted to literally make that case so that this is a book people can read, and see this is why tens of thousands of physicians find this so compelling. One story I heard - I interviewed over 120 of them for the book - and the story I heard consistently was, I wanted to do medicine because I wanted to help people; I wanted to make them healthy. And what I ended up doing is managing chronic disease all day long. And the chronic diseases are all associated with obesity and diabetes and hypertension. And if I can get people to abstain from the carbohydrates in their diet and eat this low carb high fat keto thing, I can make them healthy and I can make them happy. And when I do that, my job becomes fulfilling. So that's what they do. And that's why they shift.
I can definitely see a doctor giving this book to one of their patients because it speaks to people respectfully. Part of what is so revealing in the book is how we come to the idea of diet with these preconceived notions. Even if we do understand the role of insulin and all that stuff in how diet works and how our bodies work, we have prejudices against people who tend to put on weight. And that's a big deal.
Yeah, one of the revelations to me was we have this idea. So the conventional wisdom, right, is you get fat because you take in more calories than you expend. So the difference between someone who remains lean – like I’d say, you and your best friend, when you were in high school, you both weighed 140 pounds. And 20 years later, she still weighs 140 pounds and you weigh 200 pounds. And the obesity research community - and I'm not kidding – thinks the only difference between the two of you is that you ate too much and she didn't - or vice versa, depending on how this weight differential went. And anyone who's had weight problem knows this is something that…by definition, when you have a weight problem, you can't control it. So this was always one of the theories of obesity. Some people just gain weight regardless of how much they eat. And if they try to stop the weight gain by starving themselves, they're just hungry all the time.
So the whole nutrition obesity research community embraces the sort of nonsensical idea that the only difference between lean people and people who suffer from obesity is how much they eat and exercise. And then they spun all these stories around that, as their nonsensical idea made nobody healthy. So there's no… you know, it's like people do not get lean and healthy by starving themselves or exercising themselves into exhaustion.
Writing this book, I wanted people to understand that it was always very good scientists arguing that obesity is a hormonal regulatory problem. And there was always very good scientists arguing that - well, this is textbook medicine – the link between fat accumulation - your diet - goes through the carbohydrates you eat and the insulin you secrete in response. And that if you reduce the carbs and you reduce the insulin, you accumulate less fat. So by putting this all into context, it's a way for people to understand that this isn't - it's not a fad diet, it’s not quackery. It's just textbook medicine that the medical community ignores because they think obesity is caused by eating too much. And if you apply that textbook medicine, for most of us - well, all of us will get healthier - and most of us will be able to achieve and maintain a healthy weight.
This is the time of year when people are going to be making their new year's resolutions. And they're thinking about turning over a new leaf and maybe exercising more and losing weight and getting healthier. How does this keto thing work and why does it work? And why might people want to choose that?
The easiest way to think about keto is, carbohydrates are fattening. So if you're struggling with your weight, there could be a lot of hormonal reasons, but the dietary trigger - the link to diet - goes through carbohydrates. The carb-rich foods - sugars particularly, starch and grains, beer regrettably, because of the maltose, which is a carbohydrate. If you’re carrying around excess weight and you want to lose it, and you believe that human physiology is relevant, then you have to lower insulin. And the way you do that is by replacing the carbohydrates in your diet with fatty foods. So that sounds complicated, but basically it means, you know, you have whatever you had for lunch anyway, but without the bread and without the potatoes. So if it's a hamburger, you have a hamburger without the bun. If it was a chicken salad, you have the chicken salad without the bread.
If it was…for me, I always ordered…we'd go out to restaurants, I'd order half a roast chicken and I'd tell them to hold the potatoes and give me a double order of vegetables, because green leafy vegetables - broccoli, spinach - they have very low carbohydrate content. Dinner is the same thing. You just eat whatever you were going to eat and don’t eat the starch.
And then breakfast is always a sticking point. Breakfast, you get rid of all that crap we were told to eat - excuse the non-technical terminology - because it was low in fat. So the cereal and the fruit juice and the fruit and the toast and the skim milk - all that goes - and you replace it with exactly the foods we were told not to eat, which are, you know, eggs and bacon. If you don't want to eat eggs and bacon, you could eat leftovers from dinner the night before, or you eat…I dunno, kippers, salmon or pick your, you know, there's a whole host of things you can eat now. But basically what you're doing on these diets is you are not eating sugars, starches and grains.
Carbohydrates are everywhere and they're cheap. They're kind of pushed at us.
They are pushed. Well, this is what happened in America…coincident with the obesity epidemic…is basically the food industry made…took control of our diets from us by making these processed foods and fast food that we could give to our kids and we can eat ourselves, and you are guaranteed to like them. Whether it's sugary cereals or whatever you'd prefer - McDonald's or Burger King - or, you know, and then all the sodas and all the other crap we were supposed to eat in between meals. And in doing that, we stopped really thinking about what we ate and we just bought the convenient thing. So the world is full of people who don’t think very carefully about what they eat. And one of the arguments that these doctors made to me and that I'm reiterating in this book is that there's nothing more important to us and to our health than what we eat.
So it's as fundamental an act as we do all day long. This is as critically important as our work and how successful we are and how we parent and how we interact with our loved ones. And we have to put thought into it.
And the problem is that what we've been told to do for the past 60 years has been wrong. It's just…I don't know how else to put it. So we've been taught that we should eat low fat diets and mostly plant diets, and that carbohydrates are benign, and sugars are benign. And you know, all we have to do is eat in moderation and we'll maintain a healthy weight. And it's just…for those of us who gain weight easily - the old fashioned diet book doctors used to say “fatten” easily - and we all know who we are - for us, the conventional advice doesn't work. We try to eat the conventional, healthy diet. We stay fat or we get fatter and we get hungry. So for us, we have to…well, there was a French writer in 1825 who wrote the most famous book ever written about food, which was called The Physiology of Taste. It never went out of print. And he said for people to become lean and remain lean, they had to more or less rigidly abstained from carbohydrates. He didn't use the term carbohydrates at the time, but more or less rigid abstinence was necessary. It still is.
I had a coworker who used to have a saying, and he would say, “The more you eat, the more you eat.” And that was one of his truisms. Why is it that when we eat carbohydrates, we crave more?
This is what's so fascinating, because the idea is, if I tell you to eat less, that's somehow sustainable. Because even though you'll be kind of starving yourself, you'll get to eat whatever you want to eat. So you'll be hungry all the time. You'll think about food all the time. And this has been demonstrated in some of the most famous experiments that were done in the nutrition world. And ultimately you'll fail. But if I tell you don't eat the carbs, you'll lower your insulin. And when you're lowering your insulin, your fat tissue can mobilize all that fat is stored. So insulin tells the fat tissue to hold on to fat. And if you lower insulin and you get it low enough, which is what happens in a keto diet, then you mobilize the fat. You can burn that fat for fuel. And now all that fuel that you've stored away as fat that's such a burden in your life, you're now doing what you're supposed to do with it, which is burn it for fuel. You won't be hungry because your body's getting a steady supply of fuel. The technical term is, it’s endogenous. It's already inside your body. You don't have to eat it from the outside.
And a very common observation, whether in the clinical trials or anecdotally is people who eat these low carb, high fat keto diets are just not hungry. So they have a nice healthy breakfast. And then they realize, instead of being hungry, two hours later, like you are with the carb-rich sort of traditionally healthy diet. And so instead of meeting to snack at 10 o'clock, you suddenly find it's 1:30 or 2 o'clock and you haven’t eaten lunch. And then you go to dinner without snacking. And it's all because your body is now working the way it's supposed to work. It's burning the fat that you've stored rather than keeping it locked away in your fat tissue. And like I said, that this should happen is textbook medicine. It's just that nutritionists and the obesity researchers have been so locked into this idea that those of us who are fat just eat too much that they haven't paid attention to what their own textbooks say about fat accumulation.
You had two charts in this book. And one of them showed how few carbohydrates we can eat before the insulin kicks in. It was a little bit dismaying. We really, we really have to be careful about that, don't we?
Well, and that's the kicker. So this is more of the textbook medicine. This is true of healthy people or lean people also. So when I interviewed the metabolism researchers who studied fat metabolism. These are not medical doctors, they're PhDs working in the laboratory. They would use this phrase that the fat tissue is “exquisitely sensitive to insulin.” So that means if your pancreas is screening, even the littlest bit of insulin, your fat tissue is going to recognize that it's there and hold onto the fat that it's stored. And when researchers have looked to see how low you have to get… as insulin comes down, it's as though you’ve flipped a switch.
So if you can get your insulin levels low enough, this switch flips and suddenly your fat cells just say, hey, there's no insulin there. We can now dump the fat into the bloodstream. We can mobilize it. Now the rest of the cells in the body can burn that fat for fuel, which is exactly what you want to happen if you're dieting. So the bad news is that for those of us who gain weight easily, we can know that that level of that, that switch is flipped at a very low level of insulin. So basically that's the argument for a ketogenic diet is you're minimizing insulin secretion. If you're in ketosis, which means your liver is taking the fat that you're mobilizing and synthesizing it into these molecules called ketones, and the ketones are being secreted into your circulation, where your brain, for instance, uses them for fuel… If you're at that level, you know you're mobilizing your fat, you know you've got your insulin low enough. So the bad news is that level is low. The good news is that we basically know how to get below it, which is with this very low carb high fat diet. So you just, you don't eat the carbs. They’re fattening. You can never go back to eating them, by the way. That’s also the bad news.
But it's kind of like when you quit smoking, you don't quit smoking cigarettes to lower your risk of lung cancer so that you could then go back to smoking three years later. Because you know, as soon as you go back, your risk is going to go back up. And the idea here is that these carbs, for us - not for our lean friends - but for us, they’re literally fattening. So we can't eat them. If we don't eat them, we'll lose the fat we've accumulated. But if we ever go back to eating them, then they'll be fattening then too. And we'll gain the fat back. The other good news here is that when you shift your body over... So when insulin is elevated, you're burning carbohydrates for fuel. So you're a carb burner as the diet book doctors would say. When you're lowering insulin you're burning fat; now you're a fat burner. The reason you crave carbs now is because carbohydrates are your fuel. If you shift over to burning fat by keeping carbs low, and this was shown first in animal experiments in the 1930s, then you'll develop a craving for fatty foods. Your palette will change. You'll learn to like foods with fat in them, rather than carb-rich foods.
One of the things that you tell readers to do is maybe experiment and see what works for them, and try something for a couple of months. What might one of those experiments look like?
Well, I do think people should just experiment with keto. You know, when I first started reporting on this 20 years ago, there were only, uh, actually, as I was reporting, I learned about a handful of studies that were being published. And those are in effect the first ever that were done on anything other than childhood epilepsy for these diets. We now know that this is a safe way to eat. It is undeniable. In fact, you know, arguably from the clinical trials that have been done, we know that this is the best way to eat for at least a year or two for most people. And that it'll make them healthiest. So now the thing is, can you experiment with this and see how your weight responds, if that's what you're interested in, or your diabetes status responds. Although if you're diabetic, you’d better be working with a physician because you're going to have to lower your medication almost immediately.
I think in the past, what happened is, people would think about doing carb restricted diets, and the first thing they would ask me or their doctors, well, what can I eat? Can I eat potatoes? Can I have a piece of bread every day? Can I have some ice cream once a week? What I think people should do is they should treat this like - and a lot of the doctors I interviewed, by the way, said this is how they think of it when they communicate to their patients - imagine you have a carbohydrate addiction, like you have a cigarette addiction or an alcohol problem. Try going cold turkey for three weeks. Set a time. So I'm going to follow this. I'm going to do it right. I'm going to have my eggs and bacon for breakfast because I now have faith that it's not going to kill me.
I'm not going to eat my starches and my grains. Then let me go three weeks on a very low carb, ketogenic diet. That's almost enough time to sort of adapt to ketogenesis. There's some things you might want to consider doing, like taking magnesium supplements or drinking broth; beef broth or chicken broth, so you get the electrolytes you need. And at the end of three weeks, now you can say, hey this is interesting, I've lost eight pounds. A lot of it's water, but geez, I feel good. I like the way I look, I'm sleeping better. So let's try another three weeks. Again, the doctors I interviewed, they thought if they could just get their patients to try it. Their patients will feel better. And as soon as they feel better they’ll want to sustain it. Then if they understand that this is something they could sustain for life… Again, it's basically, you know, don't eat potatoes, don't have the bread. It's not that difficult.
It's pretty simple. When you lay it out like that, it's just knowing what is a carbohydrate, and don't eat it
And don’t eat it. Yeah. And again, I’m mystified because I'm constantly reading or hearing mainstream nutritionists saying, well, I'm not going to tell anyone to do keto. That's unsustainable. When there are, again, millions of us out there eating this way for years or decades. You could just as well say I'm not going to tell my patients to quit smoking because I think quitting smoking is unsustainable. You know, 95% of the people who try fail at first. So you try and you try and try and eventually you succeed. This is sustainable because you feel good. And now the world is full of sort of keto friendly foods. You can buy keto pizza crusts and keto snacks and keto sweets, and, you know, go on Amazon. There's a zillion of them. I'm a little leery about some of them, but they're there if you want them.
So it's become much, much easier to do. There are wonderful cookbooks supporting this way of eating. There's some great websites with all the information you need. I hate to even say it because it makes my book irrelevant, but dietdoctor.com, which is run by a Swedish doctor out of Stockholm; tremendous website. Diabetes.co.uk, which was founded by a young man in London who was studying artificial intelligence. And his grandfather who lived in the States was diagnosed with diabetes and he wanted to know what his grandfather should eat. So he thought, I can use artificial intelligence techniques to kind of crowdsource advice on the internet. So he set up this bulletin board basically to ask people what they were eating that worked and his artificial intelligence settled on very low carb, ketogenic diets. That's what worked for people. Now they have 1.7 million people using their tools to eat this way. And it was all just because one computer researcher wanted to know what his grandfather should eat to keep him healthy. And his grandfather was still alive and doing fine.
Your book is not full of recipes or anything like that. Really your book is about the science behind it and the attitudes and the history. And that's the kind of thing we need to know. And then you can, like you say, search some of those other things in other places.
I wanted it to teach people how to think about this; guide them in how to think about this and how to think about being healthy. Even if it ends up that keto doesn't work for them. The way of thinking about our health…my favorite quote in the book is from a spine surgeon in Ohio named Carrie Diulus. Carrie has type one diabetes, her family has a history of obesity and she's a vegan. Her body does not tolerate animal products. She just can't eat them without bad things happening. So she eats a vegan ketogenic diet. It takes work. It can be done. There are Facebook groups that advise how to do this, and they have a few tens of thousands of members. And she said about her diet, “It's not a religion. It's just about how I feel.” And she feels good. And she feels healthy when she seats this way. I think that's how we have to think about this. It's not a religion. We're not proselytizing anything other than the fact that we think that if you eat this way, you too will feel healthy.
The book is available at your local independent book seller, if your local independent book sellers is still available. And, you know, Amazon will deliver,
There is a pandemic going on.
There is a pandemic going on. But when the pandemic is over, there will still be the public health crisis of obesity and diabetes. And those “epidemics,” is what we used to call them, those haven't gone away. And we know actually that if you suffer from obesity, suffer from diabetes or metabolic syndrome, it's called, then you are at higher risk of bad outcomes from COVID. So all the more reason to get your health under control.
Audio of this interview follows:
Gary Taubes’ new book, The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating is available through your local book seller, or at Amazon.