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conversations that matter. And if you have

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diabetes you know someone diabetes or your

2:55

pre diabetes or you're overweight which probably

2:58

accounts for seventy five percent You listening

3:00

you're gonna love this conversation because it's

3:02

within Investigative journalist Gary Taubes who is

3:05

done a lot of work in trying

3:07

to understand the nature of diabetes his

3:09

and investigators size and health journalists. His

3:12

author this new book rethinking Diabetes which

3:14

are talking about today's also. Written the

3:16

case for key. the other case against

3:19

why we get sad good calories bad

3:21

calories which is amazing was posting Uk

3:23

as die delusion. He's a former staff

3:25

writer for Discover and a correspondent for

3:27

the Journal Science Is Writing is also

3:29

appear in the Earth Has magazines, The

3:32

Atlantic, Esquire and is be included in

3:34

the numerous Best Of anthologies including the

3:36

best of the Best American Science Writing

3:38

and he's received three Science in Society

3:40

Journalism awards from the Us National Associations

3:43

Science Writers and he's a recipient of

3:45

a Very Procedures. Robert Wood Johnson Foundation

3:47

investigate award in Health Policy research. He

3:49

went to Harvard, he's got a message

3:51

green engineer from Stanford, a journalism degree

3:53

from Columbia, and he's an man who's

3:55

done a lot of work and try

3:57

to understand why we are overweight, why

3:59

we have diabetes and what we can

4:01

do about. I know you know this

4:03

conversation because we had deep into the

4:05

history of how we began to understand

4:07

nutrition and it's recent therapy and diabetes

4:09

and back in the day we talk

4:11

about in the seventeen hundreds and eighteen

4:13

Hundreds. The early nineteen hundreds were using

4:15

very high fat with the called Animal

4:17

Diet's to treat diabetes and we talk

4:19

about how that all changed with the

4:21

discovery insulin or me loaded up people

4:23

with carbohydrates and lots of insulin and

4:25

how that has led to some significant

4:27

complications. He also talk about how some

4:29

the. Science that has been done in

4:31

such as I did into the policies

4:33

are the recommendations in American Dietetic Association

4:35

with Had to Buy Some really passing

4:38

research has been done by Sir Hallberg

4:40

and others looking at Td Jakes guides

4:42

to not just manage diabetes but reverse

4:44

at cyber your mother's conversation Gary and

4:46

let's jump right in. Bulgaria.

4:49

Great to have you back to the doctors

4:51

pharmacy again Mart it's great to It's funny

4:53

I just have says. The

4:56

last time we talked you are in Hawaii

4:58

and I was in Oakland over rise I

5:00

was covered shut down the line. Before that

5:03

we were both ends in a boss. Or

5:05

yeah that's right in Geneva as and either

5:07

way to name was a suit conference and

5:09

now we're talking all about things are time

5:11

out today which is how food affects our

5:13

house and epidemic diabetes and controversy about it

5:15

for sand and was kind of is illuminated

5:17

I have ah the died interest in thy

5:19

them use of the zebra all day I

5:21

was good officer acknowledge I think about yes

5:23

and to me but gotta get that says

5:26

right I know that are an afterthought the

5:28

Us to get Gary so good have you

5:30

vacuum for those do don't know Gary I

5:32

did the and show but you know he

5:34

wrote this article it broke. Through as a

5:36

dice cause one of it's all a

5:38

big fat lie in two thousand and

5:40

two in the or Time magazine I

5:42

read it and in new know your

5:44

it's times as I was really doesn't

5:46

fit with an island medical school assets

5:48

and and I really started the conversation

5:51

going about the quality of the food

5:53

we the cli the collar see how

5:55

they affect our. My. Com metabolism

5:57

nor hormones and how many

5:59

ways. Last wasn't all about eating

6:01

less and exercising more and you been

6:04

deep in this for a long time.

6:06

You've been so many books about and

6:08

your latest book I was were having

6:11

a conversation today's called Rethinking Diabetes and

6:13

and I have loved this book I've

6:15

I've had just been saving and every

6:18

night it's like a mystery novel about

6:20

the history of diabetes and and what's

6:22

gone wrong and our approach to this

6:24

condition And it's really the biggest scourge

6:27

today on the planet. I would say

6:29

diabetes pre diabetes. Metabolic dysfunction is

6:31

really at the root of

6:33

so much the suffering we're

6:35

seeing Everything from heart disease,

6:38

diabetes obviously to cancer, to

6:40

dementia, even things like depression

6:42

and fertility even actually. Can

6:45

be related to the dysfunction that we

6:47

have with our metabolic health and and

6:49

recent data from any Strauss So that

6:51

ninety three point two percent of Americans

6:53

are metabolic we unhealthy which means of

6:55

somewhere in the continue have been some

6:57

resistance with a high blood pressure, high

6:59

blood. Sugar High cholesterol, A

7:02

have high had a heart attack or stroke

7:04

already three percent know ninety three point two

7:07

percent off so in know seventy five percent

7:09

of or we'd So this book is really

7:11

kind of turn a lot of our ideas

7:13

upside down about diabetes and ice. I've been

7:15

thinking about this for lot so I don't

7:17

really have to lot a rethinking but I

7:20

do A success and I'm such a a

7:22

lot of people going to read this book

7:24

engulfs. A boy. We. Got it

7:26

all wrong about diabetes? And you know

7:28

you kind of talk about how really

7:30

this this journey for you in out

7:32

this quote you as has begins with

7:34

a regrettable observation that we're in the

7:36

midst of a diabetes epidemic, a disease

7:38

that was vanishingly rare in the nineteenth

7:40

century that now affects. One.

7:43

In every nine Americans and then all,

7:45

it's him so far to rein it

7:47

in have failed. and it's incumbent

7:49

upon someone to ask the question why are

7:51

you took that find yourselves das said questions

7:53

and i think we're going to get to

7:56

the answer next and did we fail because

7:58

the current situation was inevitable meaning the

8:00

result of the food industry out of control perhaps,

8:02

or a nation of individuals who can't say no

8:04

to what's next and tasty

8:06

and the next ultra-process snack, or maybe

8:08

because we made them steaks and

8:11

the diabetes specialist got it wrong and public

8:13

health authorities maybe allowed this to

8:15

happen. So we're kind of in a

8:17

disastrous situation where one in four teenage

8:20

boys has prediabetes or type 2 diabetes.

8:22

One in nine now, you

8:24

said, have diabetes. Some populations have one in

8:27

four. The current view, and this is

8:29

what I learned in medical school, was

8:31

this is a progressive disease. It ain't

8:33

going away. You have to, quote, manage it. You

8:36

have to manage it with medications and

8:38

you have to use ever-increasing amounts, dosages,

8:41

and frequencies of medications, including insulin, to

8:43

control the disease. And yet

8:45

there was a trial that happened that got

8:47

me completely switched in my thinking. It was called

8:49

the Accord Trial. And this was a trial done

8:51

many years ago on 10,000 diabetics. And

8:54

what they said was, look, sugar is

8:56

the problem. So if we really

8:59

want to fix diabetes and the

9:01

complications from diabetes, we need to be

9:03

very aggressive in controlling blood sugar. So

9:06

they use very aggressive insulin doses,

9:09

very aggressive drugs called oral hypoglycemics,

9:11

which raise insulin. And

9:14

the consequences of that therapy

9:16

were that more people died and more

9:18

people had heart attacks than who didn't

9:20

have the intensive therapy. So

9:22

the Accord was one of three similar

9:24

trials. All of them found the

9:27

same thing. So basically we're

9:29

talking about a disease that we have

9:31

been treating in the wrong way that

9:33

has really been focused on trying to

9:35

use more insulin to treat

9:38

what has been thought of as an

9:40

insulin deficiency. But in fact,

9:42

it really isn't. It's mostly a disease of

9:45

insulin excess in 95% of the cases, not

9:47

if you're type 1 diabetes. So

9:49

maybe, Gary, you could talk about this

9:52

book from the beginning, because I think

9:54

that history is really fascinating, just

9:56

to kind of give us a brief overview Of

9:58

the history of the thinking. Diabetes because in

10:00

the nineteenth century it was like up. A

10:03

rare disease or like if you had this

10:05

in the hospital all the residents the medical

10:08

school and see attending the i'll come running

10:10

a lot as is rare case and like

10:12

we'd have syphilis now I never see the

10:14

sick is a simple some my life I

10:17

by the floods i read about hating us

10:19

then it was it was rare but but

10:21

it was happening and so the doctors and

10:24

had a very interesting approach that can have

10:26

happened upon the right answer in many cases

10:28

using a died reproach that restricted carbohydrates and

10:30

use it basically cynic diet before they had

10:33

insulin. Cities like about how they

10:35

developed and then what happened after Islam

10:37

was discovered by Bending Invest in Nineteen

10:39

Twenty One. Okay, and I'm happy

10:41

do that. Let me, before we do,

10:44

they give you just a brief

10:46

explanation. For why this

10:48

kind of. Research. Is necessary

10:50

and embark and rethinking diabetes. And epilogue

10:52

I talked about the history of the

10:54

evidence based medicine movement own hear about

10:56

that yeah hello and till the Nineteen

10:58

seventies. Basically you know what a doctor

11:01

did with the did treated to pay

11:03

some was based on what a and

11:05

learn to med school on what the

11:07

authority figures in his life said may

11:09

be what is textbook suggested maybe what

11:11

his colleagues were doing but there wasn't

11:13

really a lot of as apprenticeship basic

11:15

with yes and Now and the Nineteen

11:17

seventies a few smart. Young doctors came

11:20

along and they decided they would

11:22

one of them again him David

11:24

Etti who at the time was

11:26

had left medicines getting his phd

11:28

it at Duke ah, Stanford University

11:30

and I'm oh computational physics or

11:32

something and they had asked him

11:34

to. He was going to give

11:36

a talk on. Why

11:40

doctors were prescribing for some any. looked

11:42

into the bay, chose mammography as a

11:44

subject and he went back and into

11:47

the literature. looked at the evidence based

11:49

why people recommend mob or fees and

11:51

what the benefits of them are and

11:53

he thought this would explain various sort

11:56

of operating systems charts and how you

11:58

go through different branches to decide what's

12:00

the ground or other my any a

12:03

thought that he would. Find.

12:05

That this procedure was based in concrete evidence

12:07

and he said it's what he found out

12:09

was at it was based on jello. Jello

12:12

says nothing. There was just as technology that

12:14

had come along the people thought might be

12:16

beneficial may started doing the more they did

12:19

at them. Your other people better than never

12:21

tested at the Up and this was the

12:23

beginning of the evidence based medicine movements. or

12:25

would you do when confronted with a dilemma

12:28

as a journalist or a. Physician

12:31

is interested in the end of the bigger

12:33

picture as you always asked. A simple. Question:

12:35

What's the evidence? Why

12:37

do we do this? Why use

12:39

you put a year? Diabetes is

12:41

exploded and prevalence increase to since

12:44

nineteen sixties six hundred or seven

12:46

hundred percent increase. Know if this

12:48

was any other not genetic match,

12:50

an addict, not some something about

12:52

our lifestyles and made this explode?

12:54

I'm. Still, Scene

12:56

After dinner: One hundred and four

12:58

years, hundred and three years of

13:01

of pharmaceutical therapy, it's still seen

13:03

as a progressive chronic disease. A

13:05

biggest challenge the successful treatment according

13:07

to an A B A panel

13:09

a few years ago as the

13:11

resistance of physicians to do what

13:13

you said has to be done

13:15

which has continued to. Farm.

13:17

Raised Doses add new drugs to the

13:19

therapy services after seeing the problem is

13:22

we're not treating an aggressive enough gear,

13:24

not treating it aggressively, him out, and

13:26

letting blood sugar rise outta control and

13:28

patience. and so. Question.

13:30

I ask his job losses Vienna

13:32

basically as I said as as

13:34

you read med quote from his

13:36

as you know is is an

13:38

avid a bonus. It's not about

13:40

what's the evidence base for the

13:42

decisions and when you start asking

13:44

that question you start going back

13:46

and time. So you the start

13:48

looking for clinical trials and the

13:50

clinical trials, you final reference other

13:52

clinical trials or other observational studies

13:54

and is just keep going back

13:56

in time now and nowadays because

13:58

of the internet. First of

14:00

all being like a time travel

14:03

gone dream episode I mean everything's

14:05

available. Yeah I have one way

14:07

I describe this is nineteen twenties

14:09

when I met our philosophy of

14:11

how to treat this drug was

14:13

originally sound them that still with

14:16

us today the physicians who crafted

14:18

that philosophy had imagine that the

14:20

whole world of diabetes therapy and

14:22

diet and lifestyle like a thousand

14:24

piece jigsaw puzzle and they had

14:26

may be fifty pieces. And

14:29

they want to. fifty pieces in one

14:31

corner. There were fifty pieces scattered throughout

14:33

the jigsaw puzzle. and they, that's how

14:35

they were making their decisions. Now you

14:37

can go back in time. And because

14:39

of the Internet. Know these repositories of

14:41

journal articles and documents and books. Google

14:43

Books allows you to find all the

14:45

textbooks. Smile! can. Get. Them

14:47

on Google books you can find bookstores

14:50

and sell them my offices for with

14:52

like. You know, multiple additional the

14:54

books from Nineteen twenty five years

14:56

back. out of unless the third

14:58

edition and the point of view.

15:00

Anyway, married gets a nine hundred

15:02

and fifty pieces and that thousand

15:04

be stick. Suppose you can see

15:06

everything they should have seen. But.

15:09

Didn't Hindsight is is so loyal back

15:12

and not only describe what they did

15:14

but what they've missed and he could

15:16

say they did this because a saw

15:18

that are they had a patients that

15:20

experiences they wrote about made him a

15:23

talked about at Nineteen Twenty seven at

15:25

this conference in New York. The Physicians

15:27

and mirrors would talk and is a

15:29

lousy not just a piece together the

15:31

history of this field and I think

15:34

my historically this book is something that's

15:36

never been done now diabetes therapy but

15:38

also to see what was. Missed

15:40

yeah and how. The

15:43

sinking of valve considering what was

15:45

mess soaks as you said. In

15:48

diabetes you could go back to

15:50

thousand years to one. it's the

15:52

down a flight and ancient tax

15:55

or Indian tax fraud. This monitor

15:57

history starts and seventeen Ninety seven.

16:00

Okay guy. British doctor named John Rollo

16:02

work and for the military has a

16:04

patient named Colonel Meredith. Meredith has diabetes.

16:06

He shows up east, lost a lot

16:09

of weight, is hungry thirsty all the

16:11

time is being constantly. Back then they

16:13

would have their assistance taste the your

16:16

and this was a. Diagnostic.

16:18

Tech measures and of the earn

16:21

was sweet that was it down

16:23

of occasion of diabetes and Rollo

16:25

salads lightest means of sweetness, sweetness

16:27

or honey like on young as

16:29

so. Rollo. Thanks. If

16:32

this sugar in the earn his

16:34

up metabolizing the sugar properly. The

16:36

sugar comes from Try and Foods

16:38

Summerfield Diet. Of Animal made

16:41

me and recommend the see what happens

16:43

any put some on they cause of

16:45

the animal diet it's actually Sadie Ryan

16:48

meet Blood sausages or cells are disgusting

16:50

but Meredith gets banned worked. And.

16:52

He ends of living for i'm in bed

16:55

that stays in time. He probably had type

16:57

two diabetes cause he had been overweight and

16:59

obese but they don't show up and that

17:01

that manifests as symptoms. One of the symptoms

17:03

of being sick as losing a lot of

17:05

weight. so at that point his pancreas was

17:07

failing but he still lives twelve more year.

17:09

Amazing! Rollo tries it on different pace in

17:11

a general he was in the army. That

17:13

patient also gets better but he doesn't stick

17:15

to the died. He goes home. It's what

17:18

he wants and dice are all a problem.

17:20

Was a train. Disseminated.

17:22

Throughout the United Kingdom and says the

17:24

people this is look I seem to

17:26

have come up with a way to

17:28

cure this diabetes if you've got any

17:31

patients. Consider trying it

17:33

with them. This. Is Madison

17:35

before clinical trials? Okay and

17:37

it's still medicine where we

17:39

don't have clinical trial is

17:41

certainly is on a so.

17:44

Few. dozen physicians right back home and machine

17:46

of i mean once you're right back it's

17:48

a diet works and then on understand it

17:50

like that patient will get better and then

17:52

they'll let me whatever they want and the

17:54

patient get worse and i'll put a martyr

17:56

they'll have kids is a twelve year old

17:58

girl gets better but but she keeps cheating

18:01

and she knows she's here. She just can't

18:03

stop eating sweets. But the

18:05

gist of it is it works. And by the mid

18:08

19th century, this

18:10

animal diet, they get rid of the

18:12

rancid meat and the blood sausages and

18:15

basically just becomes fatty meat and green

18:17

leafy vegetables. So it is in effect

18:19

a ketogenic diet. Paleo, ketone-ish. And it

18:21

becomes a standard of care for

18:24

treating diabetes. So it could keep

18:26

patients with type two diabetes alive

18:28

indefinitely. Their symptoms effectively

18:30

go away if they don't eat carbohydrates.

18:33

And patients with type one who are

18:35

insulin deficient, they don't

18:38

delay their demise, slow it down, but it's not

18:40

gonna stop it. And you have no idea how

18:42

much it slows it because you don't know how

18:44

long the person would have lived that way. The

18:47

leading Italian diabetes specialist, he's a

18:49

guy named Cantani. He's locking his

18:51

patients away for two months to

18:54

make sure they don't eat any carbohydrates and

18:56

they only eat this animal diet. The Germans

18:58

are doing it, the French are doing it,

19:00

the British, I mean every major, basically you

19:03

can't be a diabetes specialist. And again, it's

19:05

a rare disease. There aren't many of these

19:07

guys without using this animal. As

19:11

the 19th century turns into the

19:13

20th, it becomes richer

19:15

and richer with fat. Because

19:17

again, patients show up in the doctor's

19:19

office having lost a lot of weight.

19:21

And if they're type one and they're

19:23

young, they're emaciated. So the doctor

19:26

saw we wanna put weight back on

19:28

them and we wanna feed them

19:30

as much food as we can. And

19:32

since you can't give them carbohydrates, we

19:34

can give them fat. The

19:36

Swede named Petrin feeding

19:39

patients 95% fat diet. I

19:42

mean the German comments that the diet

19:44

is unbelievably effective with his patients, but

19:47

he can't get Germans to live on

19:49

cucumbers and butter the way the

19:51

Swedes, I mean Petrin wouldn't even let his

19:53

patients eat bacon because there's too

19:55

much protein. Some of the protein

19:57

gets converted into amino. The

20:00

no assets get converted into Glucose

20:02

so. This is

20:04

the standard diet them brief blip

20:07

to in from nineteen fourteen onward

20:09

for six years when this a

20:11

Harvard, Harvard's done a lot of

20:14

damage and the world's as Harvard.

20:16

Dr. Dr.advocate. Now this is Fred

20:18

Allen or your friend a job

20:21

violence and starts advocating for this

20:23

starvation diet. So the idea turns

20:25

out that with the young type

20:28

one patients, if you starve them,

20:30

you can keep them alive longer.

20:32

Yeah, so this is standard of

20:34

care. So so basically. I.

20:37

Accident. Some. Of

20:39

my Boxer and physician made the retail

20:41

my oh an error in the carbohydrates

20:43

were causing cigarette the or and and

20:46

maybe we should not eat them. Cms

20:48

became a standard of care until including

20:50

would Boxer Jocelyn and and only nineteen

20:53

twenty one when in some was discovered

20:55

writing So Johnson just for back on

20:57

Joslin as is a Harvard grad his

20:59

mother has diabetes is and had diabetes

21:02

and died from a season high pass.

21:04

Well again they're probably both type two

21:06

because of the remember that. Point in

21:09

time there are overweight. Yes, I'm amazed.

21:11

The. You don't speak at as an

21:13

American in blood tests right or nobody

21:16

has any idea what they're it or

21:18

a one. See is my so they

21:20

only manifests as diabetes when they stare

21:22

Bankers starts to sound and to get

21:24

the weight loss and other the up

21:27

the hunger, the thirst, the paying so.

21:30

Joslin opens the first Diabetes flag

21:32

and the United States and Boss

21:34

and dedicated to diabetes. So this

21:36

is a period and time and

21:38

so there's just the Navy Center

21:40

Hundred offensive became the Josten Diabetes

21:43

Center. And because he's got the

21:45

only dedicated clinically seem, more patience

21:47

and anyone else. So by nineteen

21:49

sixteen when he writes first edition

21:51

of is textbook it's Johnson's Diabetes

21:54

Mellitus based on a thousand cases

21:56

and know probably nobody else in

21:58

United States had seen. More. than 30 or 40. And

22:02

then in 1917, he's got based on 1300 cases and he just

22:04

keeps releasing

22:08

the textbook and his,

22:10

he kept his mother alive and

22:13

this high fat carbohydrate restricted diet.

22:15

She thrived, lived longer than any

22:17

of her other healthy relatives because

22:20

he had gone to Germany, learned what the

22:23

Germans were doing with all the butter and

22:25

the meat and the no carbs. And she

22:27

was a stern New England stock and she

22:29

would do whatever he told her to do. And

22:32

she thrived. And then he buys

22:35

into this Allen thing with the

22:37

starvation therapy and the starvation therapy

22:39

are restricting not just carbs, but

22:41

fat also. And calories, right? And

22:44

calories. So now he kind

22:46

of begins to blame fat as Allen

22:48

did for the

22:50

disorders that would kill these diabetics

22:53

because you're feeding them high fat

22:55

diets and he thinks they shouldn't

22:57

die. Anyway, 1921, insulin

22:59

is discovered first

23:02

used therapeutically in January, 1922. I'm

23:05

on a 13 year old boy named Leonard

23:07

Thompson. It's a tremendous success.

23:11

I mean, Thompson was so

23:13

weak. He weighed, I think 65 pounds. He

23:16

was 13 years old. His father had to carry him to

23:18

the hospital bed. 50 years

23:20

later, the med students and residents in

23:22

this Toronto hospital said they were sure

23:24

he was dead. Like this was, you

23:26

know, he had weeks to live. Yeah.

23:29

Insulin brought him back to life. I

23:31

mean, just within days, it

23:33

was a miracle cure. Eli Lilly

23:35

begins to produce insulin and they

23:37

make it available to doctors

23:40

around the US and Canada who

23:42

had been treating a lot of

23:44

diabetes special patients. They were becoming

23:46

diabetes specialists and it's a miracle.

23:48

It's like they've never seen these

23:50

patients are resurrected. But Then

23:52

what happened was it was something interesting, which is

23:54

they somehow shifted from this idea that we should

23:57

restrict carbohydrates, that we should actually feed them a

23:59

lot of carbohydrates. The grades. And. His

24:01

cover it with insulin. Well the

24:03

So this is a extremely powerful.

24:06

Drug and minutes A hormone riot or

24:09

a peptide like those Mp Ty was.

24:11

I have my dad a minute we

24:13

were thrown hunting purposes. There was no

24:16

such thing as I blood us. she's

24:18

me. Low blood sugar, hypoglycemia, intel and

24:20

some was discovered. Now if you overdose

24:23

you've got a balance insulin to the

24:25

car behind and so there's no way

24:27

to know what the proper doses each

24:30

everybody's different. And install

24:32

control blood sugar a d sugar eyes

24:34

the urine which was their target. Let's

24:36

get rid of the symptoms and get

24:38

the sugar out of the or and

24:40

for we don't know how much to

24:42

give and how much we give depends

24:44

on how many carbs, a yacht and

24:46

suddenly you're having. These patients are getting

24:49

hypoglycemic episode to going into what they

24:51

called it's Time insulin, soccer, a Iceland

24:53

overdose Yeah that can be said on

24:55

the I can see. The

24:58

Cure the Great Miracle drug is

25:00

a cure. For a chronic condition

25:02

or an acute condition type one

25:04

diabetes but the side effect is

25:06

at it's can be say the

25:09

like than ours right Syria If

25:11

I so suddenly you have to

25:13

see patients carbide it's have to

25:15

make sure they eat enough carbohydrates

25:17

to protect them from the treatment.

25:19

Yes that's. You

25:21

know protecting them from the the

25:24

depends on are too much. doctors

25:26

realize pretty quickly this cocktail trying

25:28

to figure out how much since

25:30

on to given how much carbohydrates

25:32

fits really difficult and with children

25:35

and was. This. Diseases when

25:37

you're diagnosed back it's it's bad enough.

25:39

Diagnose me about telling kids they should

25:41

need ice cream every down or my

25:43

friend they can have zero in the

25:45

morning like don't really want to restrict

25:47

them so very quickly they decide like

25:49

this is easier to let the kids

25:51

he whatever they want a gonna do

25:53

it anywhere and and will cover it

25:55

with insulin. Yeah and from the nineteen

25:57

twenties to the nineteen thirties, die goes.

25:59

from. Going to adults both type

26:01

one and type two and everyone says

26:03

it seems worth the price and seem

26:06

to some patients ugly seem to feel

26:08

better yet they'll get sadder which is

26:10

a side effect out the i people

26:12

didn't know when you start taking his

26:15

when you gain weight because insulin is

26:17

a fat storage hormone as of sad

26:19

or harm on and and. Some

26:22

people knew then some people didn't than will

26:24

talk about how that God can found that

26:26

by the conventional thinking on a beach. I

26:28

hope he will. What they didn't

26:30

know. This is a. Part.

26:33

Of the issue with. So. Evidence

26:35

Based Medicine movement that I had mentioned

26:37

the nineteen seventies. The idea was it's

26:39

the wanna know if you've gotta therapy

26:41

and want to know whether it's better

26:43

than nothing and whether it was a

26:45

them over already giving patients. You do

26:47

a randomized controlled trial and you randomized

26:50

patients. you give one of the new

26:52

therapy and one the older one, the

26:54

new therapy in one group, the placebo

26:56

and then you run them forward long

26:58

enough and time not to see whether

27:00

it's more effective but to see whether

27:02

it's safer, not yeah or say far

27:04

and you go with enough patience and

27:06

long enough so you could see whether

27:08

they have more or less and complications.

27:10

heart disease, cancer, dementia, pick one you

27:12

might didn't have that in their twenties.

27:14

I ran the concept. randomized controlled trial

27:16

had been discovered to they develop this.

27:19

Therapeutic. Philosophy for

27:21

treating their patience. And then as

27:23

you get about five ten years

27:25

down the line they start to

27:27

see this. They. Referred to as

27:30

kind of tidal wave of diabetic

27:32

complications Yes, these patients whose lives

27:34

might be saved by insulin resurrected

27:37

brought back from the dead at

27:39

nine ten, twelve years old are

27:41

now twenty two twenty five twenty

27:43

seven. And suddenly all the familiar

27:46

complications of diabetes or atherosclerosis or

27:48

arteriosclerosis are getting sclerotic plaques all

27:50

through their body. on their dying

27:52

of heart disease and stroke, said

27:55

getting blindness in line or user

27:57

a kidney disease and. iraq the

27:59

season having their limbs amputated.

28:02

And when you read the records, and there's

28:04

a wonderful book by a pediatrician

28:07

turned medical historian named Chris Feudner

28:09

called Bitter Sweet, where he got

28:11

a hold of Jocelyn's records from

28:14

his early years. And

28:16

these patients would be thriving. And

28:18

then over the course of a year or two, their bodies

28:20

would just fail them all.

28:22

And was it because they were taking too much

28:24

insulin or because they were eating too many carbohydrates

28:27

or both? They have no idea, right? So

28:29

their assumption, as

28:32

they're trying to wrestle with these complications,

28:34

is that the patients aren't doing a

28:36

good enough job controlling blood sugar. So

28:38

is the patient's fault? Possibly,

28:41

yeah. There

28:45

are patients, the patients who

28:47

seem to take their drug therapy

28:49

seriously and rigorously seem to do

28:51

better. So the idea was

28:53

the blood sugar control is

28:56

the issue. And

28:58

the answer again, when you think

29:00

like that, is more insulin or more

29:02

regular use of insulin or more. But

29:07

what they didn't know, they didn't actually know if that was true.

29:09

Because all they know is that it

29:12

could have been the uncontrolled blood sugar, which

29:14

is what they assumed. It could have been

29:16

the diet that they were allowing them to

29:18

eat with the, that was in part responsible

29:20

for the uncontrolled drug therapy. It could have

29:23

been the insulin therapy. You

29:25

can't differentiate with the information they had

29:27

because they didn't do the right clinical,

29:29

they didn't do any clinical trials. Their

29:32

assumption was poorly controlled blood sugar.

29:35

So you move into the Second World War

29:37

with that as the assumption, come out of

29:40

the war, and out of the war you

29:42

start seeing the first arrival of these hypoglycemic

29:44

oral, the holy grail of the field

29:46

of the drug that could lower blood sugar. Like

29:48

guanide, yeah. And take it by

29:50

mouth, you don't have to use a damn needle.

29:52

This catches on pretty quickly. As soon as I

29:55

established that it's safe and it lowers blood sugar,

29:58

People started using it. The drugs

30:00

and I'm a raise. They work by

30:02

raising insulin but but he worked by

30:04

simulating sunscreen as you look at the

30:06

the label the if the morning its

30:09

managed by the cia is got a

30:11

black box warning on these drugs A

30:13

black box warning essentially an alert The

30:15

dishes got serious side effects and for

30:17

all have of I see makes the

30:19

black box warning is. It.

30:21

Going up your diabetes but for the cause

30:23

you have heart attacks. try of this and

30:25

us that very so. I waited at. The

30:29

very first randomized clinical trial they do in

30:31

this field was called the Our. Our

30:34

University Diabetes Program And that starts

30:36

from Nineteen sixty. And

30:39

it starts because there's the Congress man

30:41

whose daughter is diagnosed with diabetes and

30:43

she's put on one of these horror.

30:45

I built my Simic drugs and the

30:47

Congressmen aussies in Ohio so we ask

30:49

that leading authority a case western yeah

30:52

no duh, these drugs by the do

30:54

they help and he says. I.

30:56

Don't. Write

30:58

for who knows? Maybe yes maybe now.

31:00

So they to actually get thirty million

31:02

dollars together do a clinical trial, a

31:05

million dollars and his excuse a low

31:07

damn dragons try one for ten years

31:09

Into his eyes these oral have this

31:11

drugged hope you the mine and are

31:14

hypoglycemic and then insulin and and diet

31:16

alone and on They added. Sense

31:19

and one that one of the sense of

31:21

the fence and the a fiasco. i forget

31:23

which ones anyway. Since. Nineteen Seventy. The

31:25

results are leads to I think was

31:27

Wall Street Journal instance or hunt I

31:30

mean none on his the or hypoglycemic

31:32

age and not do anything not keep

31:34

people live any longer than diet alone.

31:36

And the diet was a bad guy

31:38

in a minute was a carbohydrate rich

31:40

diet. they were given up Insulin doesn't

31:42

do any better either. Yeah I can.

31:44

completely useless and this was a huge

31:46

controversy. Of course half the most of

31:48

the we use a better either you

31:50

mean in terms of like reducing death,

31:52

heart attack stance, heart attacks in whatever.

31:54

They looked at every door with the

31:57

endpoints the study were but. The.

31:59

Drugs. and again, insulin, it must

32:01

have been, it might have been mortality. They

32:04

didn't play up the insulin. They played

32:06

up the, you know, for the oral

32:08

hypoglycemia, but this is what

32:11

doctors, this was what therapy was. I

32:13

mean, I went to Medical School in 1983, that's what

32:15

I learned how to do, is give these drugs.

32:17

Yeah, so you give them drugs. And then, what's

32:19

interesting, Gary, I'm just reflecting back on my training,

32:21

and what I learned was, you know, I was

32:23

seeing these patients come in, who were eating a

32:26

lot of carbohydrates, and they were taking 100 or 200 units of insulin,

32:30

and we thought that was fine, to give them as

32:32

much insulin as necessary to keep their blood sugar under

32:34

control. But what never occurred to

32:36

me was, what was the normal amount

32:38

of insulin that's produced by the pancreas every day,

32:40

in someone who doesn't have diabetes? Yeah, and it's

32:43

like 20 to 60 units, depending on how many

32:45

carbons. Yeah, depending on which we eat, like we

32:47

can eat 10 to 20 or more units. So,

32:51

giving all this extra insulin can help control

32:53

the blood sugar, but it's actually having all

32:55

these adverse effects of weight gain, inflammation. When

32:57

you're giving in, the reason you have to

33:00

give so much is because, again, it gets

33:02

back to the story, they're insulin resistant. The

33:04

problem isn't that they're insulin deficient, which is

33:06

type one diabetes. They have too much insulin

33:08

already. And then there's, how about double diabetes?

33:11

Now you're adding more, yeah. What's

33:13

interesting, again, going back to the history,

33:15

we were talking about Jocelyn, and when

33:17

insulin first came in, this was really

33:19

launched, Jocelyn was famed, because he embraced

33:21

it, he talked about, in

33:24

chapters in his textbook, on how to use it,

33:27

and Jocelyn thought the way to use it is

33:29

you've got to minimize doses. They started patients

33:31

on one unit, and

33:33

then they went to two units and three units,

33:35

and in the early 1920s, they

33:38

might have been using 10, 20 units of insulin

33:40

on patients. Then you have to strictly control

33:42

their diet so that minimal

33:44

insulin can de-sugarize urine,

33:49

which was there. And as

33:51

time went on, other doctors were

33:54

pushing for much greater doses. There was

33:56

a Samsung and Santa Barbara who was

33:58

pushing for 50. 150 units and he would

34:00

show, he said, my

34:04

patients are thriving, but in his

34:06

papers, you could see his

34:08

patients had gained like 50, 80

34:10

pounds in a year. So

34:13

they start off emaciated and then

34:15

they maybe put on 40 pounds to get back to

34:17

normal and then the extra 40 is obesity. And

34:20

there's a British diabetes specialist,

34:23

Lawrence, who had type

34:25

one diabetes himself and his life had

34:27

been, he was dying in Italy when

34:29

insulin was discovered. His doctor back

34:31

in the UK said, if you can make it home, I

34:33

can save your life. And it did.

34:36

And he became, he co-founded

34:38

the British Diabetes Foundation with

34:41

H.G. Wells, famous science fiction writer

34:43

who had diabetes. And Lawrence

34:46

tried these higher doses and he was

34:48

like, this is crazy. You

34:50

know, it's like, I don't wanna blow up like a

34:52

balloon. I don't, you know. We know

34:55

that if you start a patient insulin, their blood

34:57

pressure goes up, their weight goes up, their triglycerides

34:59

go up, their cholesterol goes up. We know this

35:01

and so insulin is not. But we got

35:03

drugs for everything. We got the standards for the

35:06

cholesterol. We've got blood pressure, blood pressure, blood pressure,

35:08

we call it comorbidities. We call it comorbidities. Like

35:10

treat them all separately with drugs. You get a

35:12

blood pressure drug, cholesterol drug, diabetes drug, right? And

35:15

I mean, it's, you know, it sounds facile to

35:17

say so, but I mean, that was basically,

35:19

you've got a pharmaceutical industry that's working hard to

35:21

provide these drugs and then, you know, there are

35:23

people with high blood pressure and high cholesterol.

35:25

They don't have diabetes. So you've

35:28

got the drugs, use them. Yeah. And

35:30

nowhere along the line do people say,

35:32

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37:07

Me your book busy Rethinking diabetes

37:09

challenges Oliver Assumptions about diabetes I've

37:12

pretty much does, which makes it

37:14

does a difficult. Thing

37:16

to swallow of her somebody believes

37:18

is some sense that they the

37:21

oddness about that book is of

37:23

basically written for precisely those people

37:25

who won't read it just not

37:27

as there a reason they will

37:29

read it is because they're convinced

37:31

their assumptions are correct and dinner

37:33

the outer I have an odd

37:35

sense of fun. Commercializing.

37:38

My. My. Intellect the i mean you

37:40

have to question your assumptions are and I think Can

37:42

and John of can. We had a great quote about

37:44

the censoring. remember as a she was like in a

37:47

most most. With. are not willing

37:49

to challenge their assumptions oh it's

37:51

also a concern of thought challenging

37:54

your sampson but salinger some since

37:56

on which have built your career

37:59

now so you get to the

38:01

pinnacle of your career because you

38:03

basically embrace the conventional thinking of

38:06

the disease. As soon as you

38:08

embrace an unorthodox approach, then you

38:11

get excommunicated from your church. So

38:13

the field selects out

38:15

people who agree with the conventional

38:17

thinking. They

38:19

become professors, heads of

38:21

departments, heads of associations. They serve on

38:24

prestigious committees. They're the people you go

38:26

to when the New York Times runs

38:28

an article. They're the people who we

38:30

consider experts and authorities. The guidelines. And

38:33

the same has been said of me,

38:35

and it's true. It's like, at what

38:37

point can you say

38:39

everything I believe, everything that not only

38:42

made me the person

38:44

you receive for that reason I'm on Mark

38:46

Hahnman's podcast, but the

38:49

people you like and respect all think the same

38:52

way. It's literally, it is quite

38:54

like a church. You all have

38:56

a certain religion. Kind of a cult. I

38:59

was interviewing the

39:02

80-year-old nutritionist at Baylor

39:04

University this past week. They interviewed

39:07

very quickly, deteriorated in just

39:09

an extremely pleasant two-hour

39:11

discussion about good and bad science.

39:14

But he used the phrase, allegiance

39:16

bias. And

39:18

I said, I stopped him. Which camped you

39:20

belonged to, right? Yeah, I'd never heard that

39:22

before, but it's exactly right. So

39:25

you have a certain allegiance bias, and

39:27

it's just not only

39:29

does everyone you know and respect think like you

39:31

do, but it's

39:34

what made you the person you are today. And

39:37

now you're supposed to say, oh. It's

39:40

true. I think Chris Gardner

39:42

is a great scientist, but they

39:45

have a plant-based research. We have a

39:47

different concept. Okay, okay. Well, he's

39:49

a stand-in. He's a smart guy. He's a good guy.

39:51

I like him. He's a

39:53

nice guy. And They have

39:55

a plant-based research institute, which

39:57

seems ideologically biased right? from.

40:00

Go! Yeah! Although I was like

40:02

to Christopher's. The. Sense I assume

40:04

would is trying to do is

40:07

demonstrate that a plant based. Diet.

40:10

Is not harmful. So

40:13

what is the phrase they use

40:15

in clinical trials and medicine for

40:17

Ahmad not inferiority trial vs you

40:19

don't have if you can demonstrate

40:22

that is not inferior to ways

40:24

of eating with. The. No

40:26

animal products and then you can recommend

40:28

that people do it. It served for

40:31

ethical reasons or environmental reasons. they can

40:33

eat this way. I have confidence they

40:35

won't be harming themselves naming to their

40:37

children so I think that's how he

40:39

would defend it. I mean okay bye

40:41

by now still Wizard of meat based

40:43

diet mission over here now I sat

40:46

here How high I say there are

40:48

as it may be a faith me

40:50

based I his spare your I see

40:52

I see you're hitting on something really

40:54

important Juri which is that the. Weird

40:56

and sciences is really kind of skewed and

40:59

bias in many ways and we we don't

41:01

sound your assumptions and we we look at

41:03

the world and a certain way to certain

41:05

lenses and game. Artie Lange said that he

41:08

says scientists can see the way they see

41:10

with the way of seeing. So when you

41:12

look as the horizon runaway go in Venice

41:14

Beach, look out and the earth is flat.

41:17

As Elo can confirm it with your own

41:19

eyes and there's no doubt about it. And

41:21

now he's at the undeniably the sun. Is.

41:24

Revolving around the are absolutely but neither

41:26

those are true and and until somebody

41:28

started question those assumptions and some of

41:30

them are called crazy or put in

41:32

jail or worse in hopes with we

41:35

didn't really change or thinking and what

41:37

what we have to do and we

41:39

must do because this disease is really

41:41

going to decimate humanity. It's decimating our

41:43

children, it's decimating our population is is

41:45

crippling our our economy. The federal deficit

41:48

is in large part due to this

41:50

phenomena of in some resistance and the

41:52

consequences of it in our society. from

41:54

chronic disease that are just such a

41:56

burden it's i think we have to

41:58

get it right and And your book

42:00

is about challenging our assumptions to get it

42:02

right. And a lot of people would argue

42:04

with you that no weight gain and

42:07

obesity and diabetes, which is a consequence

42:09

of obesity, are really simply the result

42:11

of eating too much food and

42:14

not exercising enough. And

42:16

you've talked a lot about this. You wrote

42:18

about this in your book, Good Calories, Bad

42:20

Calories. You had a whole research

42:22

initiative called Newsee about this, where you funded

42:24

large studies. David Ludwig, who's a friend of

42:27

ours, does some really powerful trials

42:29

looking at do different calories

42:31

matter and how it affects your hormones, metabolism,

42:33

weight. And he found that they did. And

42:35

there's just a huge body of evidence around

42:38

this, Virta Health, which I know you were

42:40

very close to. And Sarah Halberg, who's a

42:42

friend of ours, recently died from breast cancer.

42:44

She does some really pioneering research looking at

42:47

ketogenic diets and reversing types of diabetes. And

42:50

yet the American Diabetes Association and

42:53

most endocrinologists are still saying you should have half of

42:55

your diet as carbohydrates.

42:58

So what is the truth about this?

43:00

Are all calories the same? And is

43:03

it just about energy balance or? Funny, when

43:05

I first wrote about this, I

43:08

mean the first book in Good Calories, Bad

43:10

Calories, and it was critically reviewed in the

43:12

New Yorker by their science health reporter, Gina

43:15

Colada, who I knew well. And,

43:19

you know, when Gina made some interesting, she said, first of

43:21

all, you never know what I left out, which is true

43:23

of all books. You just never

43:25

know what the author, yeah, sure, selection

43:27

bias, we call it. It is selection bias.

43:29

And when you're writing a book, you're also

43:31

selecting for a story and you're trying to

43:33

select the most, the information that really you

43:35

believe has to be in the book, because

43:37

the book can't be 2,000 words, pages long.

43:40

And then she said

43:42

that diabetologist, diabetes specialist had

43:44

been proven that

43:47

a calorie is a calorie. And when I wrote

43:49

back in the Times was kind enough to run

43:51

a lengthy letter of mind and response, which

43:53

they don't often do to book reviews. And I

43:56

said, look, diabetes specialists of all people know

43:58

that a calorie is in a calorie. except

44:00

for Peter or Tia, who no

44:02

longer knows that. But

44:04

it's, you know, you know that every

44:07

macronutrient, proteins, fats, carbohydrates,

44:10

they prompt a different

44:12

hormonal response in the

44:14

body. And

44:16

so a different metabolic response and that

44:18

the hormonal response includes a different effects

44:21

on fat storage and fat mobilization

44:24

and fat metabolism,

44:26

burning fat, whether you're going to

44:28

burn fatter carbohydrates or whether you're

44:30

going to use protein for fuel,

44:33

which you could do, or for tissue

44:35

repair and cellular repair, which is how

44:37

you'd like to prioritize it. All

44:39

these things are determined by the hormonal response, which

44:41

is different from all of them. And

44:43

so the argument I began making in

44:45

Good Calories, Bad Calories, and as you pointed, it's been

44:48

in every one of my books and it's in this

44:50

one too, because it's to me clear

44:52

as day. And this was

44:54

worked out beginning in the 19 teens,

44:59

German and Austrian clinical

45:01

investigators, researchers who were, they

45:03

were doing the best medical science in the

45:06

world, bar none, until World War II when

45:08

they're, they worked all this. Things

45:10

went south a little bit. Yeah.

45:14

Um, you know, fat storage is regulated

45:17

independently from how much you eat and

45:19

exercise. Your fat cells that make up

45:21

fat tissue, they can't tell how much

45:23

you're eating or exercising. So

45:26

they only see certain, they see the

45:28

fats in the blood. I mean, C

45:30

is a metaphor. They're

45:33

aware of the fats in the blood and the

45:35

hormones in the blood and the glucose and

45:39

the triglycerides and all kinds of

45:41

other molecules, but not

45:44

how much you're eating and exercising. And by

45:46

the 1950s, it was pretty

45:48

clear that they were responding primarily to

45:50

insulin. So you raise insulin, you drive

45:53

fat accumulation, you inhibit primarily, you inhibit the

45:55

escape of fat, the mobilization of fat. We

45:57

call it lipolysis, it's a breakdown of fat

45:59

cells. So basically it's like a one-way turnstile

46:02

and in a subway where the calories

46:04

get stored in the fat tissue, but they

46:07

can't get out. They can't get out. They

46:09

need this process of lepolysis. They need to

46:11

be broken up into small pieces so they

46:13

can get out of the fat cell and

46:15

insulin prevents that from happening. Apparently

46:18

no cell in the body is as sensitive

46:21

to insulin as the fat cell. So if

46:23

there's a tiniest bit of insulin in your

46:25

circulation, it's going to shut down mobilization of

46:27

fat for your fat cell. It's interesting. Just

46:30

to point out something that our friend David Littewick said

46:32

to me once, which really sort of highlighted that it's

46:34

more than just calories. He said

46:37

in a type 1 diabetic, when

46:39

they're untreated and they're first diagnosed,

46:41

they could be eating 10,000 calories a

46:43

day and losing weight. So

46:46

that's because they have no insulin and they can't

46:48

store those calories. They can't get in the cells.

46:50

They can't get it. So

46:52

the problem with this, you know, there's always two

46:55

different ways to see everything. So

46:57

the way the community saw it is because

46:59

they're losing, they're peeing away all those calories.

47:03

That's why they're not gaining weight. So it's still

47:05

to them, it's still an energy in, energy out

47:07

thing. They're just losing all the calories in their

47:09

urine. There are ways to

47:11

study this and it was studied and

47:13

to pick apart exactly what's happening. And

47:15

you know, what's happening is that without

47:18

insulin, they can't get fat in the fat

47:20

tissue. So that's the primary effect. Yeah, what's

47:22

interesting, like I said, is they start giving

47:24

insulin therapy. The more insulin you give, the

47:26

fatter patients you became. And

47:29

often they would become obese and then type

47:31

2 diabetes is so closely associated to obesity

47:34

and they knew this even as the

47:36

specialist 100 years ago weren't thinking of it

47:39

as type 2 diabetes. They didn't want patients

47:41

to become fat because they knew that made

47:43

diabetes worse. Worse, right. So

47:46

you give massive doses of insulin, you tell them

47:48

to get fatter and then you tell them they

47:50

got to eat less. Yeah. So you type 1

47:52

diabetics, you get also type 2

47:54

called double diabetes. Right. So

47:57

You give them enough carbohydrates and enough

47:59

insulin. They become insulin resistant.

48:02

And so they need a massive dose of

48:04

insult him as like the get by living a

48:06

double diabetes. Yeah, I know, and it's it's.

48:09

The longest Why? I'm in one

48:12

of the of thing seminal sciences

48:14

or and love Scott Endocrinology, hormones

48:16

and norm related diseases and it's

48:18

also sort of born in the

48:20

late nineteenth century but it's very

48:22

primitive and it's it's it's growing

48:24

and then evolving to the twentieth

48:26

century and these doctors are realizing

48:28

they are diseases of yeah no

48:30

excess hormone and of you have

48:33

too much of a hormone then

48:35

you. Gotta. And lower it. And.

48:37

If you have to little he got

48:39

Anna May up. The problem is I

48:41

can't really measure hormones and the bugs

48:43

from accurately until nineteen sixty six so

48:45

we're giving insolent every one where they

48:47

have two little insulin or too much

48:49

because all were try to do is

48:51

lower blood sugar and then with patients

48:53

have side effects or complications again all

48:55

the. Diseases that

48:58

associate with it you say? Well, the

49:00

problem is on patrol Blood sugar enough.

49:03

But. You're giving the problem of

49:05

and tied to his insulin resistance

49:07

and hyper in Salome Me and

49:09

yes, too much insulin and you're

49:11

treating it with more insulin. Sector.

49:14

The boy who cried was knocking at the

49:16

door to try to pay. get some underpaid

49:18

consumer doesn't actually work for it doesn't actually

49:21

work. So it's A D M more boys

49:23

paying and on the door. So Gary's you

49:25

know where? Where did this moment? Now we're

49:27

in a we we really I think have

49:29

begun the really understand the biology of diabetes

49:31

and the bows even resistance in for metabolic

49:34

healthy and more people than ever are suffering

49:36

from this and and. We. Now have

49:38

this drug of them. pick nine

49:40

So. Is. Obesity, Sonos

49:43

and pick deficiency. Nothing

49:45

on a high price. I'm not, I'm

49:47

I'm envious. What's going on here I

49:49

am in. The issue with the drug

49:51

is fast and it is part of

49:54

the thinking here. So. One

49:56

of the ways this was captured.

49:59

Sewage. The an epigraph in the beginning

50:01

of the bark and then I decided I

50:03

put in the beginning the book. I'm giving

50:05

the whole book away, nobody has to read.

50:07

I took to Epigraph South on the too

50:09

bad that. So

50:11

us lower a. Lot

50:14

of them was from eighteen Seventeen eighteen

50:16

seventies is a British physicians talk about

50:19

patient. Okay man and woman in her

50:21

seventies. very healthy. Plum for busts and

50:23

came to see if it has type

50:26

two diabetes and she had a completely

50:28

under control by Die At. Any

50:31

such as is terrific. Why you sing

50:33

means his she didn't want to be

50:35

on a diet anymore and he's like

50:37

are you crazy You know years as

50:39

healthy as can be with a disease.

50:41

That for other people's chronic I forget why we

50:43

took our the other one was a story that

50:45

was told to me by a. Mile.

50:48

From my perspective young man who is

50:51

he was on diagnosed diabetes in his

50:53

thirties. just like twenty seventeen. He was

50:55

a. Sassy. Became a

50:57

journalist he se interviewed meat from

50:59

my sugar boss tough and Tommy

51:01

had type one diabetes. I said

51:03

I got interview you for my

51:05

diabetes box own hands so he's

51:07

when you're diagnosed with diabetes particular

51:10

type one it's like you go

51:12

from. Maybe never having thought of

51:14

this disease in your life unless a

51:16

friend or relative had to being dropped

51:18

into this world where now you have

51:20

to learn as much about it as

51:22

you can as quickly as you can,

51:25

physique and pretty have if is die

51:27

like within a day or can be

51:29

injecting insulin and the doctor to houses

51:31

briefing him and he says well we're

51:33

going to do is you know you've

51:35

got the sense on deficiency disease type

51:38

one and so we're going to give

51:40

you insolence and you can no longer

51:42

metabolize carbohydrate safely So notify you do

51:44

that we're going to be and so

51:46

on. And. Then you can eat. you

51:48

know, get fifty percent of your calories from

51:51

carbs inning and a regiment them so said

51:53

in a certain amount for breakfast. Son loves

51:55

Jackson and he says to the doctor, move

51:57

wait him and let me get this. What

52:01

you're telling me is that carbohydrates

52:03

are not toxic to me and

52:06

insulin is the antidote and

52:10

you want me to eat the toxin and

52:12

take the antidote. That's right. Why

52:14

don't I just not eat the

52:16

toxin? And of

52:18

course the doctor has never thought about it this way.

52:20

Why? He's like there's got to

52:22

be a reason, right? And the reason is well

52:24

that's too hard to do or you know. And

52:27

he actually says well wait a minute if I

52:29

told you I was going to now exercise an

52:31

hour a day you would say that's terrific even

52:33

though the hour a day is going to be

52:35

like 30 minutes getting to the gym and you

52:37

know 30 minutes taking a shower. But

52:39

as I tell you I don't want to maybe I shouldn't

52:41

eat the toxin that's going to be too difficult to do.

52:44

What's the problem? That's very

52:47

funny. As

52:49

soon as we had insulin the idea was eat

52:51

the toxin take the antidote. And

52:53

if the antidote didn't work well enough there

52:57

would always be a new antidote also. So

53:01

1937 long acting insulin

53:03

is discovered in the noble Nordisk and

53:05

Copenhagen and that was the beginning of

53:07

the… We're now making ozempic. We're now

53:09

making ozempic and so this is the

53:11

long acting insulin generation. Then

53:13

post World War II you have the oral

53:16

hypoglycemics and then by the 1970s you've got insulin

53:18

pumps and

53:22

now you've finally got blood sugar

53:24

monitors so you can monitor blood

53:26

sugar and there's always a new

53:28

drug and then we have the

53:30

trans insulin made

53:32

from molecular biology.

53:35

Recombinant. Yeah, recombinant DNA insulin and

53:37

so there's always a new drug.

53:40

So the idea is… We were using

53:42

pig and beef insulin we were before.

53:44

So now we had human insulin we

53:47

could synthesize it. We're going to eat

53:49

vegan insulin. But

53:51

the… Gosh,

53:53

if you're a vegan and you type 1 diabetes and have human

53:55

insulin what would you do? Anyway,

53:58

the idea is always… like, yeah,

54:00

we'll acknowledge that therapy isn't great now

54:03

and there's room for improvement. It's

54:05

always better than it was, which is

54:07

true. But we

54:09

also see other drugs coming down the pipeline

54:11

and there's always other drugs coming down the

54:14

pipeline. So now the latest drug, the GOP

54:16

one agonist, again, goes Zempik,

54:18

Wogove, Manjaro, terrific

54:21

drugs. I mean, You

54:24

being facetious. I mean,

54:26

they seem to Are

54:29

they just solution? Wonderful things. No. Why?

54:33

Because they're still treating the symptoms.

54:35

As you put it, it said we don't have a GOP

54:38

one agonist deficiency disease with obesity.

54:40

I mean, maybe we do on some

54:42

level, but who knows? Yeah. Certainly you

54:44

can treat it. A lot of

54:46

actually a lot of the ways we eat in the

54:48

process of we actually lowers GOP one GOP one is

54:51

something our bodies make. It's a peptide. It's a natural

54:53

thing like insulin. Right. And making

54:55

something that acts more than our body

54:57

can actually produce and make. Yeah. And

55:00

acts in slightly, you know, is kept

55:02

alive in the circulation. So it's not

55:04

degraded quickly. But so this is always

55:06

the issue is we

55:09

can treat the symptoms. We

55:11

don't have to have people don't. So along the

55:13

way, as the obesity

55:17

community was failing to treat

55:19

obesity, failing to understand obesity

55:21

and failing to provide a

55:23

dietary therapy that work.

55:25

This is the convention, the establishment,

55:28

not the diet

55:30

doctor world because you know,

55:32

we think they got it

55:35

right. But they

55:37

created all these mindsets, belief

55:40

systems that would allow

55:42

them to continue doing what they were doing

55:44

without feeling it. And ultimately they'll blame the

55:46

patient. But the idea was nobody wants to be on

55:48

a diet. What was the message from with the kids from

55:50

their early 1920s? Somebody wants to be

55:53

on a diet. They're not going to be on a diet. Fair enough. Fair

55:55

enough. But people would if you give them a

55:57

chance. Well, it's got to be the right diet.

56:00

And that's the point. So if you give them

56:02

the wrong diet, why would they stick with it?

56:04

Or if you're giving them a diet just to

56:06

prevent the appearance, delay

56:08

the appearance of a disease 10, 20 years down

56:10

the line. Like if I tell you eat a

56:12

low fat diet to delay

56:15

heart disease, prevent heart

56:17

disease, assuming it works, you don't,

56:19

I never actually see prevention happening.

56:21

You don't experience the prevention of

56:23

a disease. And when you,

56:26

if you get the disease 30 years later, you

56:28

don't know that maybe you would have gotten the

56:30

10, 20 years later if you had eaten the

56:32

way you used to or maybe you'd

56:34

get a 40 years later, you have no idea.

56:36

No feedback on prevention. It's one

56:38

of my issues with the whole longevity world.

56:41

Yeah. How do you know?

56:43

Even if you have a drug that keeps dogs a

56:45

lot longer, like maybe. If I live

56:47

to 120, Gary, I think that'll prove a point.

56:51

If, I think that would be, if you see

56:53

a strong enough signal, like suddenly there's a whole

56:55

world of people who have been taking a drug

56:57

and live to be 120, but. It's

57:00

gonna take a minute. It's gonna take

57:02

a while to establish that observation. It's

57:04

better be clear. Yeah. Because

57:06

those same people are probably doing a lot of other things too. So

57:09

anyway, but that's, that's the issue. So nobody

57:11

sticks with the diet. And as

57:13

long as nobody sticks with the diet, drug

57:18

therapy is always better. Yeah, but it's,

57:20

but it's not really because it ends

57:22

up causing other complications. Well, and this

57:24

is what you have to find out.

57:26

Again, I have a essay sitting at

57:28

the Atlantic that I hope by the

57:30

time this has aired, maybe we'll have

57:33

made it. About Ozempic. And

57:35

it's, you know, so. So what's your take

57:37

on it? Well, this is what scared me.

57:40

They wanted, we talked about the history and

57:42

the tidal wave of diabetic complications. If you

57:44

think of insulin, 1922, it's a lifesaver. It's

57:48

a miracle drug. First miracle drug, undeniable.

57:51

I mean, people at the

57:53

brink of death and it brings you back.

57:55

Takes its intractable disease and it makes it

57:57

tractable. And. obesity.

58:01

Patients do better. They clearly

58:03

live longer. It's clearly minimizing

58:05

diabetic complications. I mean the

58:07

complications for the first five

58:09

or ten years. The acute complications. Yeah.

58:12

Yeah. But then you get to see

58:14

the long-term complications of people not just

58:16

living with this disease. It used to

58:18

kill them, but living with the disease

58:20

and the drug therapy and the dietary

58:23

approach that had been adopted along with

58:25

it. And you cannot separate them out.

58:27

And by the 1930s,

58:29

you're seeing these people suffering

58:31

the tragic consequences that they might not

58:34

have had to suffer. Yeah. People really

58:36

understood what's going on now. And so

58:38

the question is, you

58:41

take- Is that happening with Ozempic? Are we

58:43

now in this golden era of Ozempic like

58:45

we were at insulin and giving it to

58:47

everybody without really any kind of

58:50

thought of what's going to happen next? And these people are going

58:52

to have to be honored for the rest of their lives. So

58:56

it's not just you've got some clinical

58:58

trials that have tracked people out three,

59:00

five years and looked at specific complications

59:04

that might stand

59:06

out from the background. And

59:10

we're seeing pancreatitis, bowel obstruction. Yeah. So the

59:13

question is what happens after 10 years and

59:15

20 years? And what happens when people try

59:17

to get off? We also have clinical trials

59:19

that show that after a year or two,

59:21

people get off these treatments. The weight comes

59:23

back if you're doing it for weight. So

59:25

we know that. But what happens if you

59:27

try to get off after 10 years or

59:29

20 years or 30 years? What

59:32

happens if somebody does these drugs?

59:35

Obesity

59:38

for most people is an intractable

59:40

condition. I mean, we both think that

59:43

very low carb, high fat ketogenic

59:45

diets will do probably

59:47

the best approach. The most

59:49

effective approach, dietary approach for

59:51

treatment, but we really have

59:53

no idea for how many

59:55

people. Yeah. It may work for some, may

59:57

not work for others. Yeah. And yeah, I mean. I

1:00:01

just don't know. The studies have never

1:00:03

been done. So for many people and

1:00:06

for children, obesity can be an incredible

1:00:08

burden. So she was winning five-year-olds and

1:00:10

12-year-olds on Ozepi? Yeah. So, but

1:00:13

now you've got- That's what the American Academy of Pediatrics

1:00:15

is recommending. Yeah, and now you're gonna have kids who

1:00:18

are gonna be on these drugs for 40, 50, 60

1:00:20

years. And what about the

1:00:22

girls who then get

1:00:24

married in their 20s and wanna get pregnant? So

1:00:27

what do these drugs do? We know

1:00:29

there's this concept of fetal programming

1:00:32

in which basically the mother's metabolic

1:00:35

health is passed on

1:00:37

to the child through the

1:00:39

womb. And it's an

1:00:41

effect that you, I mean, it manifests

1:00:44

itself as larger babies. But

1:00:47

for the most part, you can't

1:00:49

really see the effects for generations,

1:00:51

literally generations until these kids are

1:00:54

middle-aged and adults, and then

1:00:56

you see the explosion of diabetes and

1:00:58

obesity. The epigenetic changes that are the

1:01:00

appropriately programmed disease in utero for obesity,

1:01:02

diabetes, heart disease. Now you've got this

1:01:04

very powerful drug that for all we

1:01:06

know might reverse this. I mean, maybe

1:01:08

it's a godsend. Kids, mothers

1:01:11

take this drug during pregnancy, the kids,

1:01:14

maybe it's not. There's no way to know.

1:01:16

Yeah, we don't know. And if the mother

1:01:18

goes off the drug to

1:01:21

get pregnant, that means she's gonna

1:01:23

be gaining weight back while she's pregnant, which we

1:01:25

know is a problem for fetal programming. Unless people

1:01:27

change what they're eating. Like, right? Unless

1:01:30

they change. So, you know, I

1:01:32

think about the

1:01:34

way Jocelyn thought about insulin in the

1:01:36

early years. What if you use the

1:01:39

lowest doses? And

1:01:41

this was Richard Bernstein's revelation and

1:01:43

type one diabetes in the 70s.

1:01:46

Let's use the lowest doses and

1:01:49

craft a diet that allows those

1:01:51

lowest doses to be effective. Which

1:01:53

is basically lower starch and sugar

1:01:55

and higher fat. Yeah, I mean, we have

1:01:58

a friend in the comment who... as a

1:02:00

type one diabetic who's a doctor who basically

1:02:02

uses one or two units of insulin a

1:02:05

day because she's on a ketogenic diet. So

1:02:07

she needs very, very low doses. She needs

1:02:09

a little, but not that much. Yeah,

1:02:12

and we know it can be done with, and

1:02:14

it can probably be done with these drugs, maybe.

1:02:17

And it's quite possible that with

1:02:19

the right dietary

1:02:21

approach and dose, maybe people can get

1:02:23

off it or get to a maintenance

1:02:27

way to wait and get comfortable with, and then.

1:02:30

I mean, I think it's possible. But

1:02:32

really, that's not what's happening with the drugs.

1:02:35

They're just being prescribed with no lifestyle change,

1:02:37

no dietary advice, no regimen

1:02:39

of exercise to prevent muscle loss. And

1:02:42

then the question is, are people, if

1:02:44

you don't need the diet advice? I was just,

1:02:47

Oprah just had her special on ozmpic

1:02:50

and house-changing obesity, and

1:02:53

I haven't checked. An ally

1:02:55

out there emailed me and said, you should watch

1:02:57

and see if the word sugar is ever mentioned.

1:03:00

Yeah, right. So if you

1:03:02

can, I mean, again, apparently, these drugs

1:03:04

do inhibit appetite. That's an effect, I

1:03:06

don't know if the direct effect or

1:03:08

an indirect one, but, and

1:03:11

they might inhibit specific tastes

1:03:14

for carbohydrates and sweets. I

1:03:17

wouldn't be surprised. People feel full on the drug, right?

1:03:19

And they get nauseous. Yeah, but

1:03:21

it's, you know, to

1:03:23

have a drug just explode like this.

1:03:25

And our history of pharmaceutical therapy is

1:03:28

full of examples of drugs that were

1:03:30

wonder drugs that

1:03:33

ended up, you know. Delinamide.

1:03:36

Well, delinamide was an extreme example. Prevented. Because

1:03:39

you could see it, but benzodiazepines, for

1:03:41

instance. Yeah. I mean, the

1:03:43

world is full of people who took them

1:03:45

on prescription as prescribed and got to the

1:03:48

point where either the complications became unbearable or

1:03:50

they became a nerd to the dose and

1:03:52

they didn't do anything anymore and then couldn't

1:03:54

get off it. And

1:03:56

then you have nightmares here. I actually had a

1:03:58

tenant who was, sent

1:04:01

off to a rehab center for a month

1:04:03

to break his Klonopin helmet. Wow. And

1:04:08

had a mental breakdown afterwards.

1:04:10

You know,

1:04:13

it's the... what do you do

1:04:15

if the drug helps 80% of the patients? Yeah.

1:04:18

And causes intractable harm to 20%

1:04:22

and you don't find out for 10 years. Yeah. Whether

1:04:25

you're in the 80% of the 20%... We're gonna

1:04:27

see that. I have no doubt. I mean, I think,

1:04:29

there's gonna be a boon to some people and I

1:04:31

think it's not a bad drug

1:04:33

like any drug. It's how it's used, who it's

1:04:35

used with, how long it's used, what

1:04:37

does it use... And the

1:04:41

extent of the problem that you're using it

1:04:43

for. Right. But I've had so

1:04:45

many patients, Gary, who've lost 100, 200 pounds

1:04:47

without that by

1:04:50

just giving them proper nutritional advice and

1:04:54

in many cases restricting carbohydrates. But

1:04:56

can we have a world

1:04:58

of ways to think about it? I

1:05:00

mean, one of the

1:05:03

diagnostic criteria of an eating disorder is

1:05:05

not eating an entire food group. Yeah.

1:05:07

And there are people, you and I,

1:05:09

saying, well, the problem is the

1:05:11

carbohydrate content of the diet. So we

1:05:13

don't need carbohydrates, we don't... there are

1:05:15

no essential carbohydrates, don't eat them. Right,

1:05:18

right. They'll be fine. That was basically

1:05:20

what I'm arguing for diabetes. You don't

1:05:22

eat these foods. So you don't need

1:05:25

to take all the medications, the pharmaceuticals that are prescribed

1:05:27

to you to treat the symptoms that come from eating

1:05:29

them. Yeah, I just want to stop you there for

1:05:31

a second because what you said is really important. There

1:05:34

are essential fatty acids, there are essential

1:05:36

amino acids, there are no essential carbohydrates.

1:05:39

So the body actually does not need

1:05:41

them biologically to thrive even though it's

1:05:43

our main fuel source. So historically we've

1:05:45

been adapted to a whole range of

1:05:47

diets from the Inuits and the basically

1:05:49

ketogenic diet to the Pima Indians who

1:05:52

were 80% carbohydrates but

1:05:54

it was all high fiber plant based

1:05:56

carbohydrates that were really nutrient

1:05:58

dense. The

1:06:00

body can survive and thrive on many

1:06:02

different things and the quality of the calories matter, which

1:06:04

is really the thesis of your book, Good Calories, Bad

1:06:06

Calories. And I think most people

1:06:09

don't understand that they actually can regulate

1:06:11

their biology if they figure out what

1:06:13

their particular metabolic type is because everybody's different.

1:06:16

And for example, I need a little more carbohydrates

1:06:18

because I'm kind of thin and if I don't

1:06:20

eat them, and I go keto, I'll lose

1:06:22

too much weight. But if

1:06:25

I take a patient who's overweight and type

1:06:27

2 diabetic, they're gonna do really

1:06:29

well if I do that. And a little bit

1:06:31

of carbohydrates might prevent them

1:06:33

from doing really well. Yeah, yeah.

1:06:37

I think one of the points that I've made

1:06:40

in my other books is everybody

1:06:42

is different. And

1:06:44

we definitely evolved to

1:06:47

cope with the proteins and fats

1:06:49

in our diet. The idea

1:06:51

that the foods that we didn't have,

1:06:53

the new foods of modern life. Ultra-prostitute,

1:06:55

that's not even food. Yeah,

1:06:57

I'm not wild about the term ultra-process

1:07:00

because it's sort of like the miasma

1:07:02

theory of all these kind of vague

1:07:04

things that we're gonna throw. And Michael

1:07:07

Pollan called them food-like substances. I

1:07:10

prefer that, it's more to the point.

1:07:12

But they don't meet the actual criteria

1:07:14

of the definition of food. We

1:07:16

didn't have time to adapt to high levels of

1:07:19

sugar in our diet and sugary

1:07:21

beverages in our diet. These things didn't

1:07:23

exist. We didn't have time. I'm

1:07:26

agnostic about the seed oil issue. I

1:07:29

don't find the evidence. I can easily

1:07:31

believe that these things are toxic. The

1:07:34

evidence is confusing for sure. There's

1:07:36

a certain absence of human clinical

1:07:39

trial. Just like sugar, when you

1:07:41

think about sugar, we never had exposure to the

1:07:43

amount of sugar we're eating historically as species. We

1:07:45

never had 10% of our diet being

1:07:47

refined soybean oil before. That's gonna be a

1:07:49

new phenomena for humanity. And maybe it's okay,

1:07:51

maybe it's not. But I think it should

1:07:54

be questioned. Yeah, it certainly should be questioned.

1:07:56

And that's the thing, so you can propose

1:07:58

that those are. problems and

1:08:00

with the sugar and refined grains, you could see what

1:08:02

happens when you take them out of people's lives. I

1:08:05

mean, and we have clinical trials. Can

1:08:07

you talk about that? Like you talk about

1:08:10

the Virta Health work and Sarah Halberg's work

1:08:12

and the sort of work on advanced type

1:08:14

two diabetes, where they actually

1:08:16

were able to reverse it, not just slow

1:08:18

it down or delay the complications or to

1:08:21

manage the disease, but literally to reverse it. Yeah,

1:08:24

well, so this is, you know, getting

1:08:26

back to the history a bit. We

1:08:28

get to the 1970s, 80s, the

1:08:31

diabetes community, their credit did

1:08:33

some really ambitious clinical trials.

1:08:36

And what they find out in the

1:08:38

fact is that this disease has, by

1:08:40

their treatment, is a chronic progressive disorder.

1:08:42

It just gets worse. A

1:08:45

famous British trial where they just, they show

1:08:47

they start people on diet

1:08:50

only and then they add one drug and then

1:08:52

they go and they see how many of the

1:08:54

patients diagnosed with type two diabetes can

1:08:57

stick with one drug, monotherapy, and the

1:08:59

answer is like 10%. So

1:09:02

as time goes on, you keep on having to

1:09:04

add drugs to keep the blood sugar under control.

1:09:06

They do these, we set

1:09:09

a chord and the, I

1:09:12

forget the other names of the other two

1:09:14

trials, looking

1:09:16

at intensive insulin therapy and they find

1:09:18

that it does more harm than good

1:09:20

at the very best. And then they

1:09:23

do this huge look ahead trial, $200

1:09:25

million to demonstrate that if

1:09:27

you lose weight, you'll reduce

1:09:30

diabetic complications. It's a fundamental pillar

1:09:32

of thinking with diabetes. Just get

1:09:34

your patients to lose weight, they'll

1:09:36

be fine. And they get them to

1:09:38

lose weight and it doesn't make a damn bit of difference. The

1:09:40

trial has ended for futility, a $200 million trial.

1:09:43

And it's a great quote in the New

1:09:45

York Times from a Harvard diabetes specialist named

1:09:47

David Nathan who says, we have to have

1:09:49

an at-all conversation about this. And

1:09:52

they never do. But it

1:09:54

is an important point. They lost weight

1:09:56

and they got worse. So. No,

1:09:58

they lost weight and they didn't get. better. So

1:10:02

the idea was you lose weight, you'll

1:10:04

have fewer complications, you'll reduce heart disease,

1:10:06

you'll reduce strokes, you'll reduce mortality from

1:10:08

this disease. It didn't make any difference.

1:10:10

Was it because of how they lost

1:10:13

weight? Well, it could have been because

1:10:15

of how they lost weight. And in

1:10:17

fact, back around 2003 when I first

1:10:19

heard about this trial from

1:10:21

one of the principal investigators, I was in a conference,

1:10:24

he invited me to talk in Houston. I

1:10:26

remember saying to him, look, are

1:10:28

you doing a low carb arm? Okay,

1:10:31

just doing low carb arm. Make it

1:10:33

not just low calorie, low fat, fruits,

1:10:36

vegetables, whole grains, the usual story. Mediterranean

1:10:39

diet, right. Well, this was

1:10:41

pre-Mediterranean. I mean, this was, yeah,

1:10:44

it was just classic low fat. But

1:10:46

in low fat, they're also saying you're

1:10:49

eating fruits, vegetables, whole grains, you know,

1:10:51

cut back on meat, exercise. They,

1:10:55

no, they never crossed their mind to do

1:10:57

a low carb diet because that was still

1:10:59

considered quackish. But as

1:11:02

the diabetes community keeps learning about

1:11:05

how ineffective their treatments are and

1:11:07

how their belief system is falling

1:11:10

apart on top of them and

1:11:12

not having an adult conversation about

1:11:14

it, which is maybe we're making

1:11:16

some mistakes here. Other

1:11:19

physicians coping with this

1:11:21

increased obesity in their patients

1:11:24

are confronted with patients who don't

1:11:27

take their advice and instead

1:11:29

like buy Atkins' diet

1:11:32

revolution book and lose 40

1:11:34

pounds on Atkins. And

1:11:38

a few of these doctors are

1:11:41

open minded enough, Eric Westman and

1:11:43

David Ludwiger, they say, I'm going

1:11:45

to look into this. I'm going

1:11:47

to actually do a clinical trial.

1:11:49

So they start doing clinical trials.

1:11:51

There's a big study at the

1:11:53

Philadelphia VA and there the woman

1:11:55

named Linda Cern is frustrated by how much

1:11:57

her inability to help her patients. So she

1:12:00

literally goes to like a Brentown's bookstore and

1:12:02

she sits down in the diet section and

1:12:04

starts reading diets. The doctor's going

1:12:07

to the bookstore to read self-help books because

1:12:09

it's not in the textbooks. You know, it's

1:12:11

not, not, not, not. They definitely don't get

1:12:13

grades, good grades for this in med school.

1:12:15

Anyways, I think she found protein power and

1:12:18

she found some things they might get married

1:12:20

and she tries it on herself

1:12:23

and this is effortless to lose weight.

1:12:25

So they put together a clinical trial

1:12:27

and this is a veteran administration's hospital.

1:12:29

So there are a lot of vets.

1:12:32

They're not just obese, have metabolic syndrome and

1:12:34

type 2 diabetes. And instead of cutting

1:12:38

them out of the trial as you would, you know,

1:12:40

the inclusion criteria in a pharmaceutical trial is going to

1:12:42

say we're going to not take these patients because they're

1:12:44

ill. She says since this is

1:12:46

so associated with obesity, let's do it. And

1:12:50

not only do these patients lose a

1:12:52

lot of weight on the diet, but

1:12:54

their type 2 diabetes gets better on

1:12:56

this high-fat, low-carb, Atkins, small protein power

1:12:58

diet. So you

1:13:01

start getting this groundswell, this movement

1:13:03

of doctors who are reading these

1:13:05

articles in the literature and

1:13:09

saying, look, you

1:13:11

know, diet really seems to help.

1:13:13

They don't know this deeper history. Alorich

1:13:15

Westman, a Duke is looking into it.

1:13:19

It's just patients do well if you

1:13:21

don't feed them carbs. How weird is

1:13:23

that? It's a disorder

1:13:25

of carbometabalism. Tell them not

1:13:27

to eat it. They do fine. You don't

1:13:29

take the toxin. You don't need the

1:13:32

antidote. So Steve Finney and Jeff Volek

1:13:34

too. Steve

1:13:36

is a PhD nutritionist. I've

1:13:38

had him on the podcast. He

1:13:40

trained at MIT and is out

1:13:42

at UC Davis and he had

1:13:44

studied ketogenic diets. And Jeff Volek

1:13:46

is an exercise physiology PhD then

1:13:49

at the University of Connecticut. And

1:13:51

they start working together and publishing

1:13:55

on this and they help start this

1:13:58

company, Virta Health. I

1:14:00

remember Steve's idea, I think it was, is we

1:14:02

could just convince insurance

1:14:06

companies and employers that

1:14:08

they could save money as

1:14:11

diabetes and expensive disorders. It's costing them 12,

1:14:13

$15,000 a year in medical bills. If

1:14:17

they could save 80% of that by

1:14:19

getting these people on a diet, wouldn't they

1:14:21

wanna do that? So they'd become the clients,

1:14:25

not the patients. We'll go

1:14:27

after the payers of the insurers, the Kaisers

1:14:29

and Blue Shields of the world. And

1:14:32

they create this company, they get

1:14:34

this brilliant CEO, Sammy Inkenen,

1:14:36

who is a world-class Stanford

1:14:38

MBA, made

1:14:40

millions creating the website. I always

1:14:42

forget whether it was Trulia or

1:14:46

one of the real estate websites. And

1:14:48

if a world-class triathlete who

1:14:50

was diagnosed with prediabetes, despite

1:14:54

having come in first in his

1:14:56

age group in the Ironman triathlon,

1:14:59

and Sammy goes to Steve and Jeff for

1:15:01

advice on how to treat the prediabetes and

1:15:04

also how he wants to, this is Sammy

1:15:06

Inken, he wants to row to Hawaii, from

1:15:08

San Francisco to Hawaii with his wife, Meredith,

1:15:10

and he thinks they could do it with-

1:15:13

It was like a fun- On a ketogenic

1:15:15

diet. Jeff and Steve

1:15:17

can coach him and they start talking about

1:15:19

this idea and they start this company, Virta

1:15:21

Health. Meanwhile, by the way, Sammy

1:15:23

and Meredith do row to Hawaii and

1:15:26

they break the record and they don't eat

1:15:28

any carbohydrates on the whole trip. I think

1:15:31

it's 24 in the whole pile. How he

1:15:33

got the prediabetes was he was using all

1:15:35

those goos and energy things that athletes use

1:15:37

to fuel their bodies. Not only that

1:15:40

Sammy believed that a low-fat diet was

1:15:42

the healthiest way to eat, he had

1:15:44

been told that. And Sammy is, I

1:15:46

think he's Norwegian, and as he put

1:15:49

it, not that being Norwegian matters, but

1:15:52

if he's Finnish, I apologize.

1:15:56

He's just got the best, you know, if somebody tells him not

1:15:58

to eat fat, he doesn't eat fat. I

1:16:01

mean, this is an extraordinarily, the

1:16:05

man has an extraordinary strength of

1:16:07

will, and then he's

1:16:09

diagnosed with prediabetes. So there's something

1:16:11

wrong. This is a common phenomena that

1:16:13

happens to many people in our

1:16:15

world, right? You're doing what's supposed to

1:16:18

be the right thing, and

1:16:20

it doesn't work for you. And then

1:16:22

you do the wrong thing, which in

1:16:25

this case is this low-carb, high-fat ketogenic

1:16:27

animal diet. And you

1:16:30

get better, and you say, wait a minute,

1:16:32

if it's wrong for me, maybe it's

1:16:34

wrong for a lot of people, if

1:16:36

not everybody. So they start this company, Virta

1:16:38

Health. They realize they need

1:16:41

a clinical trial to convince, and

1:16:44

they meet Sarah Halberg, who is

1:16:46

a physician in Indiana, amazing woman,

1:16:48

whom the book is dedicated,

1:16:52

who has been asked to run

1:16:54

an obesity clinic at Indiana Health

1:16:56

and has to learn everything she

1:16:58

can about obesity. And she starts

1:17:00

reading all the literature, and she

1:17:02

goes down the rabbit hole, and

1:17:04

she experiences this based

1:17:07

on jello revelation. And

1:17:10

she realizes that the only people

1:17:12

who seem to be having effective,

1:17:15

who seem to be effectively getting their patients to

1:17:17

lose weight are these people like Westman, who

1:17:20

are advocating for these Atkins low-carb keto

1:17:22

diets. And so she goes and spends

1:17:24

time with Westman. She goes and starts

1:17:28

advocating for this at her obesity clinic, and

1:17:30

she meets Jeff and Steve, and they put

1:17:32

together a clinical trial, where they're

1:17:35

gonna randomize people for type two diabetes,

1:17:37

people with type two diabetes, type

1:17:40

of this nutritional ketosis, keto

1:17:43

with smartphones and

1:17:45

personal coaching, and

1:17:48

nutrition, telemedicine. Adjusting their

1:17:51

medications if they need to. Yeah, because you're

1:17:53

gonna have to adjust medication. If you stop

1:17:55

eating the toxin, you're gonna have to lower

1:17:57

the dose of the antidote. And.

1:18:00

It's either that or the

1:18:02

American Diabetes Association standard of

1:18:04

care, which is drug therapy.

1:18:07

And they do the trial

1:18:09

and after a few years they

1:18:11

report one year results and after three years they

1:18:13

report two year results. Yeah. And

1:18:16

for patients who comply

1:18:18

with the diet, they seem to

1:18:20

put this progressive chronic disease into

1:18:22

remission. So it's

1:18:25

not a progressive chronic

1:18:27

disease. No. It's only

1:18:29

a progressive chronic disease if you're

1:18:31

eating the toxin. If

1:18:33

you're not eating the toxin, you don't

1:18:36

manifest the symptoms. It's not

1:18:38

the ideal clinical trial. There's

1:18:40

all kinds of problems with

1:18:42

it. It wasn't

1:18:44

randomized. Actually I probably said randomized and

1:18:47

I should not. They

1:18:49

let patients choose whether they wanted

1:18:51

the diet or the ADA standard

1:18:53

of care. Even

1:18:57

with those constraints, it demonstrated beyond

1:18:59

a shadow of a doubt that

1:19:01

a disorder which is considered chronic

1:19:03

and progressive is not necessarily chronic

1:19:05

and progressive and that the defining

1:19:07

factor is the diet. Again whether

1:19:09

you eat the toxin. That's true.

1:19:12

We never practiced the Ultra Wellness Center. I've seen that

1:19:14

over and over again. People

1:19:17

just don't get off insulin, get off meds, get off

1:19:19

meds, normalize their weight, normalize their metabolism.

1:19:21

Anyone who goes down and went from 11 to

1:19:23

5.5 in a few months,

1:19:26

it's quite remarkable. It's quite remarkable.

1:19:29

By the end of the book, my

1:19:32

book does not advocate. It's

1:19:37

a dense historical, critical and a

1:19:40

mystery novel. Who

1:19:42

done it and who didn't do it? I think it's

1:19:44

a very good book. The

1:19:47

question is imagine a scenario where

1:19:50

everybody, every physician was taught

1:19:53

not just the proper drug

1:19:55

therapy but how effective

1:19:57

this dietary therapy was because there are

1:19:59

always There's always been two levers to

1:20:01

pull to keep blood sugar under control. There's

1:20:03

diet or drugs. Until

1:20:05

1921, we only had diet and for patients

1:20:08

with type 2 diabetes, it was effective. Don't

1:20:11

eat these foods, you'll be fine. Once

1:20:13

we had drugs, you had two levers and the

1:20:15

idea was use the drugs, give the drugs. We're

1:20:18

going to say that diet is integral, the cornerstone

1:20:21

of therapy, but we're going to pay lip service

1:20:23

to it because we got the drugs. What

1:20:25

if confronted with a new patient,

1:20:27

you give them the diagnosis. You have type

1:20:30

2 diabetes or type 1 diabetes. You

1:20:32

say, look, we

1:20:35

can do this. We can treat your symptoms with

1:20:38

drugs. You can continue to eat exactly the way

1:20:40

you want or if

1:20:42

it's type 1, you're going to eat

1:20:45

at specific intervals, specific amounts to

1:20:48

allow us to maximize. You don't

1:20:50

craft the diet to maximize efficiency of

1:20:53

the drug therapy. There's

1:20:55

all these complications we know are going to

1:20:57

ensue. You're going to have an increased risk

1:20:59

of heart disease and stroke and dementia and

1:21:03

blindness and retinopathy. For some of you,

1:21:05

no matter how well you manage your

1:21:07

blood sugar with these drugs, those

1:21:10

complications are going to happen anyway. At

1:21:12

which point, we're going to blame you. But

1:21:15

you don't have to say that or you

1:21:18

can do this diet. What it

1:21:20

means is no more bread, potatoes,

1:21:23

sweets, sugary beverages. It's

1:21:26

hard because they crave those foods when they

1:21:28

have insulin resistance. Yeah, which is fascinating. If

1:21:30

you eat this way, as far

1:21:32

as we can tell, you'll be

1:21:35

fine. No drugs,

1:21:37

no complications

1:21:40

of drugs, no needing more doses

1:21:42

or new doses, no waiting for

1:21:45

new drugs to come along, no

1:21:47

dialysis. As far as we can

1:21:49

tell, if you eat this way,

1:21:51

you'll be fine. It's amazing. It'll

1:21:53

probably take two or three months.

1:21:57

You might love it immediately. It might take two or three

1:21:59

months to get you. to it in which case,

1:22:01

you know, like somebody who's quit smoking, you won't

1:22:04

miss cigarettes after a while. Right. You

1:22:07

will at first, you won't after a while. It's

1:22:09

your choice. Yeah. We're happy

1:22:11

either way. Yeah. Okay, because we want

1:22:13

you to be healthy. But this

1:22:15

way, chronic progressive

1:22:17

disease, diabetic complications,

1:22:21

more and more drugs, complications of drugs,

1:22:23

this way, as far as we

1:22:25

can tell, and we can't, you

1:22:27

know, there are

1:22:30

unknown unknowns here. As far as we can tell, if

1:22:32

you eat this way, you'll be fine. Yeah.

1:22:35

You choose. Yeah. And

1:22:37

if you do eat this way, let's make sure you do it right. Yeah.

1:22:39

And if you choose the drugs, we'll make

1:22:42

sure you do it right. I mean, it's

1:22:44

such a simple notion. And yet, it's, you

1:22:46

know, bucketing against the establishment paradigm that we

1:22:49

should be using drug therapy in high carbohydrate diets

1:22:51

and diabetics. I mean, I think the ADA is

1:22:53

starting to come along, American Diabetic

1:22:55

Association, but it's really tough. Well, they're starting to

1:22:57

come along, but if you see how they do

1:23:00

it, so they put out

1:23:02

these standard of care documents, and every year,

1:23:04

every January, and there'll be

1:23:06

like eight or 10 of these documents,

1:23:08

and what they do is they revise

1:23:11

based on what research came out in

1:23:13

that past year. So they really have

1:23:16

no mechanism by which to say, let's just

1:23:18

rethink this. Everything. And

1:23:21

then when they're revising it, the discussion of

1:23:23

diet is varied, is inside in this document

1:23:25

where it's sort of, you can do this,

1:23:27

or you can do that, or you can

1:23:29

try this diet. We have this research for

1:23:31

this, or this research for that. They don't

1:23:33

have any mechanism to say, can we just

1:23:35

try, let's try a different approach. Yeah. Okay.

1:23:38

Let's divide the world up. Let's say this is what we can

1:23:41

be achieved with diet, and this is what can be

1:23:43

achieved with drug therapy. And

1:23:47

this is the complications that we know of

1:23:49

with diets. Not many. And

1:23:51

these are the complications we know of

1:23:53

with drug therapy, chronic progressive disease. Many

1:23:59

people might choose drugs. Yeah, maybe

1:24:01

they're right. I mean, I don't know. I mean,

1:24:03

I think, you know, when you look

1:24:05

at the data, to me, it's pretty clear that

1:24:07

if you use drug therapy, that it is a

1:24:09

progressive chronic disease, and you can mitigate

1:24:11

or slow the complications, but it's not going to prevent

1:24:13

them. Well, this is... And if you

1:24:15

use the dietary therapy, it goes away. And, you

1:24:18

know, I think people might be listening, going, would

1:24:20

you know, Gary, you're

1:24:22

giving these people a ketogenic diet with 75, 80% of their

1:24:24

diet is fat. What about their heart? And,

1:24:26

you know, maybe you say they're diabetes, but actually they looked at over 20

1:24:29

cardiovascular biomarkers as part

1:24:31

of the Virta study, and they

1:24:33

were all improved. Actually, they

1:24:35

got better. Right. You know, and

1:24:37

I've seen this over, no, I had a patient which

1:24:39

was really struggling with weight loss,

1:24:42

and she had pre-diabetes, she had drugless rides of

1:24:44

3 plus 100, or HDL was

1:24:48

very low, and her total cholesterol

1:24:50

was over 300, very high

1:24:52

insulin levels, rising blood

1:24:54

sugar, and I'm like, well, I'm

1:24:56

going to try a ketogenic diet. And

1:24:59

she did it. Not only did

1:25:01

she lose 20 pounds, but her cholesterol

1:25:03

dropped 100 points, her triglycerides dropped 200

1:25:05

points, her HDL went up 30 points,

1:25:07

her blood sugar normalized. Now, that

1:25:10

may not work for somebody else who's a thin

1:25:12

guy who is an athlete, and I've seen people

1:25:14

who use the ketogenic diet like that who actually

1:25:16

don't do well, and I'm one of those guys.

1:25:18

If I eat too much of the wrong fats,

1:25:21

my cholesterol goes off the rails. But we don't

1:25:23

know how harmful that is. We don't, we don't,

1:25:25

unless we look inside your arteries, and then we

1:25:27

can... Well, you can,

1:25:29

yeah, then... Yeah. So

1:25:31

it's just fascinating. I think this is

1:25:33

really an important moment in history because

1:25:35

we have this craze of

1:25:38

Ozempe, and Wagoi, Manjaro, it's the golden

1:25:40

child of the moment of pharmacology,

1:25:44

and nobody's really talking about the issue that matters,

1:25:46

which is what we're eating, and why

1:25:48

we're eating what we're eating. And that's

1:25:50

because we have this mindset that, you

1:25:52

know, the people with obesity, we're not

1:25:55

going to blame it on willpower. We're not,

1:25:57

we're going to acknowledge that it's a disease

1:25:59

now. This is what Oprah was saying.

1:26:03

But we're also going to assume that they

1:26:05

won't change their diet. And

1:26:09

it's really complicated. I've read

1:26:11

a lot of the

1:26:14

literature of mostly women, but

1:26:16

not entirely women with obesity.

1:26:19

They're so confused. They

1:26:21

know it's not a willpower problem. No, it's not

1:26:23

a willpower problem. And often these

1:26:26

authors will say, I tried every diet. None of

1:26:28

them worked. And I want to reach out to

1:26:31

them and say, well, they didn't try the right

1:26:33

one. Well, where did you, because they always include

1:26:35

Atkins in the list. Did it not work for

1:26:37

you? Or are you some, but then they'll

1:26:39

say, you know, it's just one

1:26:42

of these books I read recently. It's, you know, I

1:26:44

don't want to go through my life not eating a

1:26:46

donut. Right. Well,

1:26:48

I understand. I get that. I get that.

1:26:51

You know, I was, I mean, I've been biased

1:26:53

by my history as a cigarette smoker. It

1:26:55

was a period in my life where I

1:26:57

couldn't imagine going through my life without a

1:26:59

cigarette. Yeah. And in fact,

1:27:02

my next cigarette was what pulled me forward

1:27:04

into the future. Maybe

1:27:08

it's an inappropriate metaphor. I'm not sure it

1:27:10

is or not. Well, no, I mean, no,

1:27:12

there's real addiction with these foods. The,

1:27:15

whatever you call them, food-like substances or ultra-processed food

1:27:17

or high starch and sugar foods. Like

1:27:19

I said, they don't actually activate the brain centers for pleasure. And we

1:27:21

can map that on brain imaging

1:27:24

studies. So there's no doubt that these

1:27:26

have biological effects on the brain that

1:27:28

drive our behavior, our cravings, our appetite.

1:27:31

But I think what's really remarkable as a doctor treating

1:27:33

these patients is that when you do the right thing,

1:27:36

their brain chemistry changes, their hormones change,

1:27:38

their metabolism changes, and they don't actually have

1:27:40

those cravings. It's not like they use willpower

1:27:42

to fix it. Use science. And this is

1:27:44

really what your book is about. It's challenging

1:27:46

the orthodoxy, challenging the science, making us rethink

1:27:48

diabetes, and come up with a new

1:27:51

vision for how we can deal with this obesity crisis

1:27:53

rather than spending $5 trillion on those ZMPIC for the

1:27:55

population, which is what it would cost if

1:27:58

we gave everybody who was overweight a ZMPIC. Well,

1:28:00

this is the idea that this

1:28:03

will somehow impact the obesity epidemic

1:28:05

is insane, right? Because,

1:28:07

oh, I suppose if it

1:28:09

gets off label and people can buy, you know,

1:28:12

a supply for three dollars. Yeah,

1:28:14

even if it's cheap, it's safe. Right? But then, yeah,

1:28:16

then the question is what are the side effects? What

1:28:18

are the complicated, will there be

1:28:20

a tidal wave or a, you

1:28:23

know, a wave of complications down the line that

1:28:25

are going to make a hole? I

1:28:27

think there is. I mean, they had never started. I

1:28:29

mean, I think the data is already coming

1:28:31

out. The longer you're on it,

1:28:33

the more likelihood you're going to have complications. Not

1:28:35

everybody will, obviously, but... What's interesting is even these

1:28:38

studies, the studies that looked, that I looked at,

1:28:40

that looked at long-term use, and

1:28:42

again, they went out about that. They

1:28:44

had patients in them who had been on

1:28:46

the drugs for like five years, and

1:28:48

they were looking at specific possible complications. But

1:28:50

they would also say these were for

1:28:53

lower doses and for diabetes,

1:28:55

not for obesity. And

1:28:57

then they would say, well, 60% of the

1:28:59

patients discontinued use. Yeah, because they're nauseous or

1:29:01

vomiting. Any questions, yeah, why did they discontinue?

1:29:04

And what happened when they did? Because if,

1:29:06

when they did, they then fell

1:29:08

out of the system. They were no longer

1:29:10

in the clinical trial, so nobody has any

1:29:13

idea. Was it difficult to discontinue? Did things

1:29:15

get worse that then had to

1:29:17

be treated with other drugs? Well,

1:29:19

what happens when you take these drugs is you lose

1:29:21

muscle and fat, and you gain back the weight, usually

1:29:23

gaining back as fat. And so your metabolism is slower

1:29:25

at the end of the process than at the beginning,

1:29:27

and you need to eat less food in order to

1:29:29

just maintain the same weight. And this is... It's a

1:29:31

real problem. Unless you eat a lot of protein and

1:29:33

do a lot of strength training while you're taking these

1:29:35

drugs, you're going to be in trouble. You know, I've

1:29:38

been an athlete, a jock my whole life, and I,

1:29:40

you know, I've

1:29:42

lifted weights my whole life. And the idea

1:29:44

that you can solve the muscle loss

1:29:46

problem by going into the gym eating protein

1:29:48

and lifting weights, like, do you have

1:29:50

any idea how hard that is? Well,

1:29:53

you can do it. You can do it, but... Look at you,

1:29:55

you're buff and you're 67. You

1:29:58

know, yeah, but it's... It

1:30:02

isn't, the muscle that comes off easy with

1:30:04

the drugs is

1:30:06

not gonna be put back on. No, no, that's right.

1:30:09

That's an important point. It's easy to lose,

1:30:11

hard to gain. And as people get

1:30:13

older. Yeah, it's even harder. The

1:30:16

gaining is also dependent on hormones

1:30:18

and wane with time.

1:30:20

Totally. Well, Gary, this has

1:30:22

just been such a fascinating conversation. I

1:30:25

think your book is kind of a

1:30:27

pivotal book in helping us literally rethink

1:30:29

diabetes and challenge our orthodoxy, challenge our

1:30:31

assumptions, poke the bear a little

1:30:33

bit and say, hey, let's get real with this and

1:30:35

let's look at the data, let's look at the science

1:30:38

and not go along with the current

1:30:40

recommendations which are, in many ways,

1:30:42

I believe harming people. Yeah, I agree.

1:30:44

I think we have a moment to change that.

1:30:46

So thank you for writing it. It's a beautiful

1:30:48

book. It's beautifully written. It's very

1:30:51

entertaining. It's not a dense medical book like

1:30:53

mine. So I think you'll all like it.

1:30:55

I encourage you to get it. It's called

1:30:57

Rethinking Diabetes. And also

1:31:00

I would encourage you to check out his

1:31:02

newsletter called Unsettled Science on Substack. He's

1:31:05

right there with Nina Teichel who wrote

1:31:07

a book called The Big Fat Surprise,

1:31:09

also another great book. And

1:31:11

it's really a great way to sort of

1:31:14

get another point of view about nutrition that you

1:31:16

might not be hearing through a conventional

1:31:18

channel. So Gary, thanks for being on the podcast

1:31:20

again. Thanks for what you've done. Thanks for having

1:31:23

the patience to weed through all those

1:31:25

thousands of pages of historical

1:31:28

data and illuminating us

1:31:30

with the history of diabetes and hopefully paving the

1:31:32

way toward a future that is much

1:31:34

better than the one we've had in the past. Thank

1:31:37

you, Mark. Thanks

1:31:39

for listening today. If you love this podcast,

1:31:41

please share it with your friends and family.

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1:31:51

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1:31:54

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1:32:20

Thank you again and we'll see you

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1:32:27

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1:32:29

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1:32:31

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1:32:33

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