I'm Gary Taubes, science/health journalist, author of the new book "The Case for Keto." Ask me anything!

Isn't this the Atkin's Diet 2.0 being sold as something new and interesting?

It explains the physiology behind Atkins - and other similar diets.

And, yes, Atkins was a ketogenic diet. Atkins was the first physician to play up ketosis as an important aspect of the diet -- how you knew it was working -- which is one reason he was criticized by the medical establisment. Medical professionals thought of ketosis as equivalent to diabetic ketoacidosis, which was naive then and is more naive now. I like to say that when I got into this business, keto was Atkins. The names change. It doesn't make it wrong.

Why does everyone think heart disease is something to worry about more than insulin resistance?

This is the history of the nutrition-chronic disease field. It starts, more or less, with Ancel Keys suggesting fat causes heart disease and since half of all Americans die of heart disease (or did then, in the 50s) they figured we should primarily eat to minimize heart disease. The insulin resistance story only kicked up a decade later, and by that time the cholesterol/hert disease thinking had saturated the available cognitive bandwidth. It's dominated ever since.

Ok, for those who stuck with me again, thanks. I'm signing off (for good) now. See you next time.

Hi Gary, thank you for this AMA! You talk a lot about bad science done in the health field, particularly around diet. What’s your advice to lay people who want to be able to discern “good” science from “bad” science?

As an aside, one thing I heard you say on a podcast once changed my life: I’m a sugar addict, and my greatest success in battling the addiction has been abstinence. That can be hard to explain to friends or family who think that you can just have something “in moderation.” You once said that you wouldn’t ask a smoker to have cigarettes in moderation or a recovering alcoholic to drink in moderation; I’ve used that comparison with people and it’s made a world of difference. Thank you for all you do.

I would be skeptical of all new results on principle. I would be skeptical of any authors who insist that what they're reporting is somehow truth and don't show that they're aware of the first principle of science (re Feynman): you must not fool yourself and you're the easiest person to fool.

Hi Gary! I was talking up your books way back before keto was keto. What are a few of the developments in nutrition and research that you’ve seen in the last few years?

I'd say a surge in physicians eating LCHF/keto themselves and prescribing it to their patients and their colleagues becoming more open-minded about patients who eat this way. Last I looked, there were 160 RCTs in progress on clinicaltrials.gov in which keto is a keyword. Surely a good thing. On the other hand, the vegan-vegetarian movement has also surged in popularity and some of the leaders of that movement seem intent on going after LCHF as either bad for the environment or for the people who eat it. Hence, the RCTs will continue to come in handy.

Thanks so much, this has been fun, I'm signing off now--see you next time! (And my apologies for missing some of the recent questions.)

I've now been told I can keep going, so I'll answer the questions I missed (in case anyone is still there).

Any thoughts on the carnivore diet?

I'd like to thank you for your effort. Your books have changed my life and given me the confidence to live low carb, and your continuing fight for spreading the low carb knowledge is helping countless people.

I find it fascinating. If nothing else, those folks who do it should be dead of scurvy after a few months, if the conventional thinking is correct. I'd try it myself but my family situation isn't conducive to that kind of experiment. If I were a nutritionist and considered myself a scientist -- i.e, naturally curious -- I'd certainly want to study folks like Sean Baker to understand what's going on and whether my preconceptions about vitamin C, particularly, could be so wrong.

Hi Gary, I've been following keto for a while with great results but I'm honestly afraid to talk to anyone about it because (like this thread demonstrates) it's often met with zealous resistance. How have you found it best to approach the topic with people so engrained in the standard way of thinking? I've recommended your books, but unfortunately a lot of my family and co-workers just aren't receptive.

Well, you can change how you talk about it, I suppose. Say you just don't eat sugars, starches and grains because you find you get fatter (or more diabetic, or whatever) when you do. So rather than play up the bacon and butter, just play down the carbs. It might work (although with the truly zealous, nothing ever really does).

What are your thoughts on intermittent fasting?

I have friends who get concerned and think its' not healthy if I go 40 hours or so without eating.

I think it's a useful adjunct to blood sugar and weight control.

Did Vihljalmur Stefansson really live without eating plants for years in the Arctic while studying the Eskimos?

He says he did and there's no reason to suspect otherwise.

What's your favorite example of an ethnic tribe picking up a Westernized diet and becoming chronically sick?

The Pima, because they're the best studied. But it happens to all of them. Or at least I don't know a counter-example.

I'm with you on recommending the keto diet for health. I'm a moderator on r/ketoscience and publish research daily from pubmed.

Regarding weight control I've assembled my own theory on how our weight is managed. A central element is the type of energy available in the blood and how it is sensed by the hypothalamus which then drives all other factors. In my article I show how it explains the observed effects of fructose, hypoglycemia, 2DG, anti-depressants, melatonin, GSD3, Inuit, high protein, perinatal protein restriction, transitioning into a ketogenic diet as reported by Kevin Hall, forced overfeeding, migraine and finally T1D. That is enough diversity of situations so I suspect I'm on the right track.

https://designedbynature.design.blog/2020/05/13/hyprocico-the-theory-behind-obesity/

Now for my question :) I haven't read your latest book so it is just a guess but I doubt it references anything related to the hypothalamus. If you look on pubmed there is a plethora of publications on how the hypothalamus is in control of hunger. Why isn't this referenced in your book? (if it is, I'll buy your book ;) )

if you search on google for "pubmed hypothalamus food intake" you'll get 680,000 hits

Read Good Calories, Bad Calories (The Diet Delusion in the UK). Here's how I think about it: simply put, obesity is a disorder of excess fat accumulation and fat accumulation is regulated primarily in the periphery by hormones dominated by insulin. The hypothalamus is involved, but it also stimulates insulin secretion, among other things, via the vagus nerve. There was copious research in the 1960s showing the first noticable response to hypothalamic lesions was hyperinsulinemia. That would cause excess fat storage, shut down fatty acid oxidation and that, in turn, would drive hunger. Read my first book. The VMH is discussed.

I see from your website you have degrees in applied physics, engineering, and journalism. What makes you qualified to write on the topic of diet and nutrition?

Smart guy. Twenty years of research into good and bad science.

Still have time for a few more questions.

Hi Gary, I am big fan of your books, and I am currently reading "The Case for Keto". I had a question about salt and blood pressure. My Doctor is convinced if you get too much salt consumption in your diet that it will cause hypertension. My question is with the Standard American Diet (SAD), is the elevated sodium content in high carb diets enough to really cause hypertension?

My take on this is that some people are salt sensitive and they're the ones who happen to be insulin resistance. Fix the carbs and the salt sensitivity should go away. I could be wrong, of course. I suggest you give your physician a copy of the very first investigation I did for the journal Science on this. Here's the link: https://garytaubes.com/wp-content/uploads/2011/08/science-political-science-of-salt.pdf

It won a National Association of Science Writers science-in-society journalism award, for what that's worth.

Thanks for doing this AmA!

One of the most important considerations when we start looking at scaling up food from "personal diets" to large scale cultural diets is the sustainability and long term impact of the food production on the environment. Considering how resource intensive meat currently is, how realistic is a Keto diet across the planet as we try to figure out how to feed our ever growing population? Do you think vegan keto is a realistic diet now or in the near future?

I think keto is only necessary for folks who are significantly overweight or diabetic. For the rest it's about improving the quality of the carbs consumed and avoiding sugar and sugary beverages. So the whole planet doesn't have to go keto. We just have to get people to stop eating and drinking sugar. IMHO.

What might be the best strategy for connecting in-practice doctors together to share knowledge on ketogenic diets?

Doug Reynolds of LowCarbUSA and Adele Hite have formed an organization with a standard of care document to do just this. Here's a link to membership: https://www.metabolicpractitioners.org/membership-account/membership-levels/?utm_source=Low+Carb+USA&utm_campaign=291881c32e-EMAIL_CAMPAIGN_2018_03_09_COPY_01&utm_medium=email&utm_term=0_e055f0e7be-291881c32e-223988665

Do Americans put too much faith in our dietary guidelines? I noticed you attacked the usage of faith a lot in The Case Against Keto.

Clearly.

Do diet soda's have any effect on Ketosis?

No idea. But I should look into it.

Is insulin the key?

I clearly think it is.

Love your books.

What do you make of the claim that humans in the wild have lower levels of cholesterol than domesticated humans? Does it matter?

I assume they have lower levels of all chronic disease risk factors, the question is why. I propose it's the absence of refined grains and sugars.

What's worse for you? Sugar or alcohol?

Depends how much you drink, I suppose. We all drank a hell of a lot of sugar. Those who drank that much alcohol, tended to know they were doing themselves no good.

I've seen you having discussions on Twitter with those who disagree with the carbohydrate-insulin-hypothesis. Have you been able to figure out what their arguments are? I find it difficult to steelman them and they are based on too much bad science or myth.

I understand their arguments (I think). The gist of them is that obesity is an energy balance disorder and so diets work when people eat less and people get obese when they overconsume calories and little else need be understood. I wrote my book, in part, to once again provide the reasons why we find this logic so uncompelling, but that then assumes that they're willing to read one of or yet another of my books.

Hi Gary, thanks for being willing to do an AmA.

I actually was about to make a YouTube video discussing this exact topic, along with intermittent fasting. While I'm not as researched as you, I have gone through various forms of weight loss on my own through exercise and dieting. In my experiences being calorie-conscious and creating calorie deficits is more tactful approach to weight loss than a trendy new diet. Would you say that this is a common theme in your experiences or would you find that most weight loss successes are unique to an individual?

Finally, if you were to give any sort of small piece of elevator pitch style advice to someone who wants to start the 2021 year with a New year's resolution of weight loss, what would you advise them?

Consider the possibility that carbohydrates really are fattening -- sweets, starches, grains and, well, beer -- and if you want to be as lean and healthy as you can be, don't eat them.

Is the ketogenic diet for everyone (i.e. should it be avoided by people who suffer from certain illnesses or heart problems/high blood pressure)?

These are the people it might benefit most, but they should certainly find a keto-informed physician to work with closely.

Have you ever heard of Brad Marshall’s SCD1 theory of obesity ? https://fireinabottle.net/

A lot of what he saying makes sense but I’m a still skeptical considering he said he only ate croissants with steric acid added to the butter that causes his weight loss.

Would appreciate any of your opinions on this . Thanks

Highly speculative based on an n of 1 uncontrolled experiment. Doesn't mean he's wrong, but he's a long way away from getting me to take it seriously.

Why are some people so anti keto? Are there studies somewhere that says it going to kill you? What am I missing?

They think of it as a fad diet and a radical diet and think if we were all eating just like they do, we'd be lean and healthy, too. I think of this as lean people thinking. They can't imagine that we might have to avoid foods to be healthy that they can eat with impunity.

I have had a total thyroidectomy and therefore no natural metabolism. How will keto work for me?

I suspect it would help, but this is the kind of thing you need to work with a physician on, ideally one who has done his or herhomework on keto.

If you had to come up with a meal plan for just one day, what would you pick?

It wouldn't include sweets, starchs, grains, legumes or pulses. It would include (for me) lot's of green vegetables and fish, fowl or meat, plus butter and olive oil. I also like pork rinds, but that's just me.

I've often thought about creating a routine which involves eating the exact same meals every day with no/little variance. Because of this I've always been interested in meal replacements like Soylent.

Do you think there is an effective way to build out a meal plan of the same food every single day that works to keep the body in a ketogenic state?

I think it can clearly be done. I knew at least one Berkeley resident who was living on rib eyes and only rib eyes and, well, still living, last I heard. (Although it would have to be his next of kin to alert me if he wasn't.) He had elevated LDL particle number but seemed healthy otherwise.

Do you think type 2 diabetes is a curable (vs. treatable) disease?

I think you can put it in remission by not eating carbs.

Hey Gary I did keto and loved it but lost muscle, so now I’m im on carnivore and loving it, do you see any negatives from carnivore diet?

Not yet. No. Although I have friends who eat vegan/vegetarian and say they just can't tolerate the animal products in the diet. And some folks clearly see ethical negatives and environmental negatives, although I think these issues have to be separated.

If i am consistently in mild ketosis, can I forget about my insulin levels? I achieve mild ketosis on 60g carbs a day, which is unusual. Should I strive to lower the insulin my body produces further, or should I just get on with my life?

Depends whether you're healthy and happy with your weight. If so, the if-it-ain't-broke-why-fix-it? rule applies. Otherwise, yes, sure, why not experiment to see if your health problems improve with still fewer carbs?

What's the best way to convince family (particularly obese parents, rapidly aging grandparents, and/or other sick relatives) that they should go keto?

Lie to them and ignore all a nutrition and diet science of the past 100 years

I understand the urge to ignore books that you're convinced are quackery. You can get it out of a library, though, and I won't make a penny from it. Then I suggest you test whether you really are open to new, perhaps uncomfortable thoughts, by trying to read it. Just saying...

My husband swore he could not live without toast. Then he saw me drop a dress size in a month & decided maybe he could eat sausages for breakfast after all.

Give your husband my fond regards. He made my day.

I suppose I have to say give them a copy of The Case for Keto. It's why I wrote it.

One time i ate a carb and now i am paying the consequences. How do i forgive myself? Also how do you make a keto tuna melt

Significant charitable contributions always help. Otherwise, enjoy.

Hi Gary. Thanks for your tireless journalistic resolve to keep us informed on actual nutritional science.

In your investigations, how obvious is it that the big grain industrial complex is influencing the dietary guidelines? Is there direct lines that can be drawn from the grain industry to the people who are making the unscientific guidelines?

Could you argue the same thing about the meat industry? They also have something to gain by convincing you to eat essentially only meat.

My interactions with the meat industry suggest that they're not as insidious for a simple reason: they can always produce low-fat cuts of meat and meat with better lipid profiles, which is what they've tried to do since the first guidelines. It's hard to produce low-carb grains and it's harder to produce low-sugar sugar. So those industries are threatened more by LCHF/keto thinking than is the meat industry by the low-fat movement. As the guidelines become more and more plant-based, though, this could clearly shift.

This isn't my area of expertise. I worry more about the cognitive dissonance and group think on the guidelines committee more than I do industry influence. But I also trust Nina Teicholz on this, and she would argue (I think) that I'm naive.

Either way, group think is a problem. The people chosen to head these committees are invariably leaders in the field and they became leaders by believing in and promoting the conventional wisdom. They then choose people who they are smart and the people they think are smart are people who believe what they do. That's classic group think. It happens in the low-carb/keto community, too, although I (of course) think we are all smart and right.