0:00 Introduction

0:18 Gary’s impact on low carb

1:30 Gary Taubes’ career

5:57 Rethinking Diabetes - new book

6:25 Historical perspective on diabetes management

13:00 The emergence of insulin therapy

14:01 Shift in treatment philosophy

15:55 Chronic complications

18:10 Evolution of drug therapy

19:39 Questioning assumptions

21:01 Early views on diabetes

26:58 Complexity of hormonal systems

29:45 Treatment dilemmas

30:00 The stickiness of beliefs

30:26 The Look AHEAD study 

31:09 Lack of mechanisms for investigation

32:22 Grassroots movement and patient-driven awareness

35:39 The clash of dietary and drug therapies

37:16 Misconceptions and resistance

39:29 Personal stories and transformations41:00 The debates lifestyle vs medication

46:03 Future of drug therapies

49:59 Gary’s writing process

51:54 Gary’s other projects

55:35 Cynicism and hope

Dr Peter Brukner (00:00.952)
Hello everyone and welcome to this Defeat Diabetes webinar. We're a little bit later than 24 hours later than we had hoped but these problems with international time differences is a bit of a nightmare but better late than never and welcome to you all and particularly welcome to our special guest Gary Taubes. It's great to have you with us Gary.

Gary Taubes
Thank you, Peter. I'm glad to be here, finally.

Dr Peter Brukner
I should start by saying Gary Taubes is a very important person in my life because his book, The Good Calories, Bad Calories, was the first book I ever read on low carb. So Tim Noakes had alerted me to the fact that maybe this carb thing was not what it was cracked up to be, or the fat thing rather. And so I went looking for a book and I found Gary's book.

Good calories, bad calories. That was, I often say this, I'm not just saying it because you're there, Gary, it was the book that changed my life and probably changed the lives of thousands of other people. it was a fascinating book because not only did it talk about the relative merits of fats and carbs, but it went through the politics and the history of how the low, know, fat movement had basically won out over the low carb movement back in the day, which I'd always assumed was due to, you know, good science and evidence and so on. But as Gary pointed out, had more to do with money and politics and ego than anything. that was really what got me going. let's start. So thank you once again. I thanked you previously, but I thank you again on behalf of everyone who's benefited from that. But take us through a little bit about your journey because you're not a doctor, you're not a dietician. How did you finish up in this space?

Gary Taubes (01:47.406)
I often wonder how that happened. No, was, well, I have a hard science degree, a physics degree, and I became a journalist and an investigative science journalist because my first two books were on very smart physicists and chemists who discovered nonexistent phenomena. So basically, I chronicled the research of these people as the non-technical term would be screwed up. And then learned how they screwed up with the help of the rest of the scientific community that was more than happy to help them understand that. So I became obsessed with this issue. This was going on 40 years ago and how hard it is to do science right and how easy it is to get the wrong answer.

And when I finished my second book, which was called Bad Science, some of my friends in the physics community said, if you're interested in bad science, you should look at the stuff in public health because it's terrible. And so I moved into public health and the research I was chronicling lived down to their predictions. And by the late 90s, I had sort of stumbled into the nutrition field. I was doing a story on the dietary approaches to stop hypertension. It was a new diet that was being written up in the New England Journal of Medicine because it could lower blood pressure. And in writing about this article, which I thought was a very simple story to do, I kind of stumbled on the reality that there was a very active controversy 25 years ago about whether or not salt caused high blood pressure. And this is sort of a bedrock belief in the

And when we define a healthy diet or when we did 25 years ago, a healthy diet was a diet that was low in fat and low in salt and rich in fiber and green vegetables. Turned out after a nine months investigation for the Journal of Science that the evidence linking salt consumption to high blood pressure was terrible. was basically it was an interesting hypothesis that had been tested and time and time again, it had failed the test. And yet the more money that was spent, the more investment and time that these researchers put in, the more they just insisted it was right anyway. And this was sort of classic bad science. And while I was doing that story, one of the worst scientists I had ever interviewed, and call my second book was called Bad Science. I thought I had interviewed the worst scientists in the world. One of them clearly took credit, not just for getting the world on this low salt diet that we were eating at the time, but on the low-fat diet that was so prominent that we all believed in in the 90s. And so when I was finishing up the salt story, I told my editor that I was gonna do fat next, because my experience, which was now going on 15 years, told me that whenever a bad scientist was involved in some kind of important endeavor, they were very likely to get it wrong. So I did a... spent a year on an investigation for the journal Science on dietary fat and heart disease and that evidence turned out to be bad. As well, sort of wishful thinking among the scientists. Again, you get this hypothesis that dietary fat, saturated fat causes heart disease because it raises LDL cholesterol and clogs our arteries. And then you test the hypothesis in clinical trials, which are the medical version of experiments.

And you fail to confirm it, but you insist it must be true anyway because you believe that so long it must be. Anyway, article in Science won national reporting awards. And a year later, I stumbled into the obesity world and started writing about obesity. And I've never really gotten away from that. And since obesity associates with every major chronic disease,

And it's clearly linked to diet somehow. It pretty much defined the next 24 years of my life until now.

Dr Peter Brukner (06:12.886)
That's been quite a journey and a number of books that you've written on the topic and all of which I've enjoyed. And we're really here today to talk about your latest book, which is this one here, "Rethinking Diabetes, What Science Reveals About Diet, Insulin and Successful Treatments", which I had the pleasure of reading. And what it does, you know, the interesting part about it really is sort of the history of... of diabetes and its management or lack thereof, take us back to say the 19th century, late 19th century Gary and just sort of take us through you know from there until the discovery of insulin and what how diabetes was managed and what people knew about diabetes at that time.

Gary Taubes
Okay, and let me just take one quick step back and say, answer the question, why do I approach these stories from a historical perspective? And when you're asking any and doing an investigation on any subject, basically you're asking the question, why do people believe whatever? And why do people believe that in this case, a disease of clearly defined by the inability to metabolize carbohydrates safely should be treated with a diet that's 50% carbohydrates. And so what you want to do is in order to answer the question, why do we believe this, you want to see what the evidence is. And the evidence requires that you look at the references and the studies and you go back and back in time trying to understand the evidence base of the belief system.

In this case, go back to the 19th century. the 19th century, only... So diabetes was a very rare disease, first of all. Nowadays, it afflicts like in the US, it's one in every 10 Americans is diagnosed with diabetes in the...

Dr Peter Brukner (08:12.212)
Similar in Australia.

Gary Taubes
Yeah... In the mid 19th century, major urban hospitals could go years without seeing a case. It was that rare. So there were maybe a dozen physicians around the world who specialized in diabetes therapy. And invariably, considered, they said, look, people can't metabolize the starches and grains and sugars in their diet, so they shouldn't eat them.

So the prescribed diet standard of care we would call it today in the US, in England, in Germany, in Italy, in France was what they called the animal diet, which was basically fatty animal meat and green vegetables. And this could... keep patients with what today we would call type two diabetes healthy. And it could slow the progression to death of patients with type one diabetes. So now we know that type one diabetes is a disease of insulin deficiency. These patients needed some insulin to survive. That part of the debate is how much. And back then, again, 19th century, they knew that

By the time somebody was diagnosed, the type 2 diabetes would look a lot like type 1, but it tended to be in much older patients, tended to be in patients who had at least been very heavy, although often they only showed up in the hospitals or the clinics after they had lost significant weight. So they had one lever to pull, which was diet. And the diet was, again, fatty animal meat and green leafy vegetables. Today we would call it keto.

Gary Taubes (09:54.226)
As the 19th century came to an end, the thinking was you want to get, since these patients showed up in the doctor's office or the clinic or the hospital emaciated or having lost a lot of weight, you wanted to put weight back on them. So you wanted as many calories as possible, but you couldn't feed them carbohydrates. So you fed them fat, butter, milk. There was a Swedish doctor named Petrin in Sw famous for became famous diet was probably 95 % cal and the German diabetes s wouldn't want to treat th having access this diet could take even a type one p you know, on the brink o them closely back to hea be willing to eat uh, butter. And the German diabetes specialist doubted that anyone but Swedes would be willing to do that. But if they did, they could be healthy. Again, diets of which virtually all the calories came from fat from butter.

Dr Peter Brukner (11:12.398)
So then, again, late 19th century, earlier 20th century, that was the way things were. And then something pretty dramatic happened in 1922, didn't it?

Yeah, the team of physicians and chemists at the University of Toronto isolate the hormone insulin from dog pancreases. And they begin using insulin therapy to treat these young patients at the brink of death. start with, mean, literally at the brink of death patients. The first patient ever then which they ever tried insulin was a young boy named Leonard Thompson. was 13. He weighed 65 pounds. So weak his father had to carry him to the hospital bed. after two weeks of insulin therapy, he appeared relatively healthy and immediately put weight back on. It was a miracle drug. the problem is that insulin is such a powerful drug. It's so good at lowering blood sugar that it actually created the condition of low blood sugar.

Technically called hypoglycemia, which itself can be fatal. So as soon as doctors started using insulin therapy to treat diabetes, again, a wonder drug for patients with type one diabetes of questionable efficacy for type two, but they really didn't distinguish between the two back then. They now have to get the patients to eat carbohydrates to prevent low blood sugar, not just to bail themselves out when they're having a hypoglycemic episode.

But in effect to balance the insulin. So you go immediately from a diet that could be a disease that could be treated with diet, in which your understanding of the disease state is determined by sort of how it responds to diet and carbohydrates, fat and protein, to a disease that's now treated by drugs and diet becomes an adjunct to drug therapy. So now you're giving patients

Gary Taubes (13:18.52)
carbohydrates to consume because otherwise the cure insulin will kill them. And as the 1920s progresses, the physicians realize that it's extraordinarily difficult to balance this how much insulin they should be getting because the amount of insulin that they're taking is always dependent first and foremost on how many carbohydrates are eating, how carbohydrate rich their meals, but then on a whole host of other factors that can't be predicted. And they're trying to prevent their patients from dying from insulin therapy. And it turns out it's just a lot easier to tell them, allow them to eat whatever they want and give high doses of insulin to cover it. when the insulin therapies first initiated in 1922, the idea is, look, this is a dangerous drug. Let's use as little as possible. And we'll keep diet as strict as possible so that we can use as little insulin. And then as the years go by, it's like, well, you know, people like, they don't stick to the strict diet anyway. So let's let them eat whatever they want. And especially children, we don't want that diagnosis is bad enough for them. Let's just let them eat carbohydrate. This is just what their friends and families do so they don't feel birds.

Burdened by this disease in so many different ways and will give them higher and higher doses of insulin. And this could have been a perfectly appropriate way to treat the disease, except that by the 1930s, these patients start being overwhelmed by the sort of chronic complications that we now attribute to the disease. So this is just, not just atherosclerosis, which is coronary heart disease, arteriosclerosis, these atherosclerotic, these sclerotic plaques throughout the whole body, strokes, heart attacks, nerve damage, neuropathies, kidney damage, retinopathies, they're going blind. And these young kids who might have been saved from imminent death when they were eight, 10, 12 years old are now dying.

Gary Taubes (15:30.862)
15, 20 years later, still young, tragically young from the complications of what they think is living with the disease and poor blood sugar control, but could also be the complications of the insulin therapy and the diet. So you see how the decisions made in the 1920s about what's easiest for the patients may have backfired by the 1930s, but there was no way for the physicians treating the patients to know.

So they didn't, as you say, they didn't know and they continued on pretty much the same philosophy really, right through until almost modern. mean, nowadays things haven't changed that much, have they?

Yeah, no, the philosophy stayed almost invariably the same. was, we have these drugs, the drugs keep getting better. They had new insulins by 1937 or so, long lasting insulins that can be injected once or twice a day. They just really never crossed their mind that their approach to dietary therapy, which changed dramatically was the availability of the drug was the problem than the thing that was causing these complications. So it was always, we'll have new drugs, oral hypoglycemic non-insulin drugs became available after World War II. The drugs keep getting better and better. The latest ones, GLP-1 agonists have been in the news weekly and all around the world. I mean, it always seems like the next drug is gonna solve the problem or the next drug has solved the problem.

But what happens from the 1960s onward, the diabetes community to their credit starts doing these large, ambitious clinical trials to test their fundamental assumptions. So the first one in 1960s in the US is to test this assumption that these oral drugs, not insulin, drugs actually make people live longer when they take them. They control blood sugar, that's for sure, but do they make people live longer?

Gary Taubes (17:42.932)
Study takes 10 years and they find out it doesn't. And what's even weirder is when they look at the group just taking insulin compared to the group just taking diet, insulin also didn't make patients live longer despite controlling blood sugar. And then through the 1980s, 90s, 2000s, they do these series of big clinical trials and all their fundamental assumptions about the relationship between drug therapy and diabetes fail.

And throughout this, in this process, one of their major studies and that's confirmed in others concludes that the drug therapy never curbs the progression of the disease. So if you ask a doctor today, they'll tell you that diabetes, mean, doctors outside of our group will tell you that diabetes is a chronic progressive disorder, both type one and type two. So by that they mean it doesn't go away, it just gets worse. And I cite a...

2017 American Diabetes Association committee analysis that said the biggest obstacle to better therapy is the resistance of physicians to keep adding new drugs and new higher doses of the drugs they do have. So the idea is that the disease only gets worse. We're gonna put you on drug therapy. We're gonna tell you to eat 50 or 60% of your calories from carbohydrates, the one macronutrient, you cannot metabolize safely without drug therapy. And we're going to acknowledge that the drugs aren't going to stop you from becoming unhealthy and slowly developing the somewhat terrible complications of this disease. We're just going to hope as we go along that we have better drugs and that we could switch you from drug to drug like a... somebody jumping from one stepping stone to another in a river before they fall off and drown. nobody, takes a journalist basically to come along or a group of physicians like yourself to come along and say, wait a minute, maybe this whole thing started going awry when we decided that it's a good idea to tell patients with diabetes they can eat significant.

Gary Taubes (20:00.066)
carbohydrates when we know that they can't metabolize these drugs safely and that we know the drugs don't prevent the complications. They may delay them, but they don't prevent.

So why don't the drugs work to prevent the complicated because they do by and large to varying degrees control the blood sugar levels and we're always told you know, you control blood sugar levels You'll reduce the impact long-term impact of all those complications and yet the drugs which by and large, you know improve that the blood glucose anyway, if not perfect Don't prevent those those complications. Why is that?

Well, it's hard to always answer a why question like that. But let's take type 2 diabetes. One of the issues I discuss in the book, and this speaks to my own obsession about good science and bad science. So researchers, physicians trying to come to conclusions about the disease they're studying and treating do it based on a very limited knowledge at the time.

And so in 1921, from 1889 to 1921, it was pretty clear that at least one type of diabetes is caused by some kind of pancreatic deficiency. That's because you remove the pancreas from animals, they'll manifest diabetes before they die. And then there's Toronto.

team comes along banding invest, they discover insulin, it's extracted from the pancreas has convinced everyone that diabetes is a pancreatic deficiency disease and it's an insulin deficiency disease. And if you just give insulin back, that'll solve the problem. So that seems pretty simple except that by the mid 1940s, it becomes pretty clear that type two diabetes, which constitutes 90 to 95 % of all cases is not really a pancreatic insulin deficiency disease.

Gary Taubes (21:58.738)
It's the primary organ that's dysfunctioning is the liver and it's probably dysfunctioning because of glucagon is not being inhibited, a counter regulatory hormone that's secreted with insulin and glucagon works to stimulate the secretion of glucose blood sugar into the liver and that should be shut down when we eat carbohydrates because you get the glucose you need from the carbohydrates if you need glucose at all, so you don't need this extra glucagon. Anyway, we learned that the liver is sort of the primary organ, that this hormone glucagon plays a major role. And then by the 1960s, physicians realized that insulin does very different things to the human body if it's secreted from the pancreas in response to the glucose, the blood sugar level and the circulation going up and down.

Or if it's injected into your thigh or your butt or your abdominal region and then goes directly into the general circulation. So the human body's all organisms are these very complex homeostatic organisms. You've got all these various.

Hormones determining how the body works, what every cell should be doing, responding to it every moment of the day. And these hormones are secreted in response to changes in factors in the circulation and they stimulate counter regulatory hormones which stimulate counter counter regulatory hormones. And there are these incredibly complex systems. I kind of think of them as multi-dimensional spider webs.

And you pull on the web at any one point and it reverberates throughout the entire system with these counter changes. And it turns out it matters tremendously where you put the insulin. Because if it comes from the pancreas, the cells that see the highest dose are the cells right next to the insulin secreting cells in the pancreas. And those cells that are secreting glucagon and the cells that see the next highest dose are in the liver.

Gary Taubes (24:19.392)
And 50% of the insulin doesn't get out of the liver. And then the rest of it goes into the circulation. If you put it into the circulation to begin with, you have to put in massive doses so that the amount that the pancreas eventually sees is high enough to inhibit this glucagon secretion. It's this crazy complication. But the message is that unless you can figure out a way to make the liver secrete insulin again naturally, particularly in type 1 diabetes, you'll never be able to use insulin therapy to prevent, you'll always have very low blood sugar as a side effect. And then there are all these other issues that insulin does a whole world of things in the, I mean, a whole body of things in the human body, it doesn't just control blood sugar. And yet if we have low insulin and type 1 diabetes, the therapy perhaps appropriately is to add insulin back, but type 2 diabetes, which is understood by the 1960s to be a disorder of insulin resistance. Again, the liver is the primary organ dysfunctioning, not the pancreas. And the insulin resistance means it's a disorder of too much insulin. But now we treat that by giving more insulin. And a comment made by a British diabetes specialist, Robert Tattersall, kept resonating with me as I wrote this book.

Every other hormonal disorder, if you diagnose it by the level of the hormone in the bloodstream, if that hormone is too high, you lower it, and if it's too low, you raise it. Diabetes, particularly type 2 diabetes, the hormone level insulin is too high, too much insulin is being secreted, but we're not treating it by the hormone level, we're treating it by the blood sugar level.

So the way the response is to give still more insulin to lower blood sugar when the rational thing to do would be to figure out how to lower insulin and simultaneously bring back blood sugar. And that's something you can do by diet. It's not something you can do by drugs.

Dr Peter Brukner (26:32.632)
So why do you think it is that the medical profession, which is supposedly full of smart people, it doesn't get it. It just doesn't see that, as you say, every other hormonal disease is treated by lowering the hormone. Why is diabetes treated differently? What's going on? Why can't the medical profession get their head around this fact?

Gary Taubes
Well, one of the lessons from this book and looking back at the history is that there's a disconnect between, so the diabetes specialists are physicians treating patients. They're not trained as doctors. I mean, they're not trained as scientists. They're not trained to think critically except about the diagnosis of their patients ideally. But they're treating patients. That's their primary job. They then... have very limited information and knowledge available about the sort of greater research speaking to the underlying mechanisms of the disease. So whatever journals they're reading, and one of the again revelations of doing this book is at a period when most of the best work in the field was being done in Germany and Austria and being published in German language medical literatures, which were the highest ranked to journals of the era, if you were an American physician and you didn't speak German or didn't read German, this knowledge was shut off to you. So there was very limited knowledge available. The revelations I'm talking about, about the liver being the primary source of dysregulation and the role of glucagon as opposed to insulin and then the even type 2 diabetes is disorder of insulin resistance, not pancreatic insulin.

All those were made by physiologists and laboratory researchers, not doctors interested in diagnosing patients. So there's really no mechanism by which these fundamental revelations about the disease state cross over into having an effect on therapy with the patients. And these clinical trials I talked about often take 10 years between initiation and conclusion. So even if researchers decide, look, maybe there's a better way to test this. Okay, we know type two is an insulin deficiency disorder. Maybe we should stop treating it with insulin therapy and try dietary therapy instead. It could take 10 or 15 years to set up a trial, get enough patients, run the trial through for five, seven years to have some idea of the long-term effects and then publish the results.

And throughout that period, the entire period, the field is continuing to believe that they're doing the right thing and that in fact they're doing no harm, which is the fundamental, you know, Hippocratic pattern of medicine. And so even if the results of the trial are that, well, whoa, we may be doing harm here. Maybe we're doing the wrong thing. It's very hard then for the physicians to accept that it's true because they've spent so long doing the opposite. So you just find that

There's sort of the belief systems, the term Malcolm Gladwell would have famously is it's incredibly sticky. Once it sets in, it's virtually impossible to get it out. It's like you can fill the vacuum of a belief about the, you know, mechanism of disease and the best way to treat it. Once you fill that vacuum with a hypothesis, even if that hypothesis is wrong, replacing it is much harder to do. So we end up with the sort of the same philosophy, the same dietary approaches, know, slight variations on drug therapies. I remember there was a famous study called the Look Ahead Study, which was a $200 million study that was testing this absolutely fundamental belief among diabetes specialists, the type two diabetes that you could prevent chronic disease endpoints could lower heart disease rates in these patients if you get them to lose weight. And 10 years into this $200 million study, they closed the end of the study, what's called for futility, because it was clear that the weight loss wasn't reducing heart disease risk. And a doctor at Harvard, David Nathan, famous Harvard diabetes, specialists is quoted in the New York Times saying we have to have an at all conversation about this. But the reality is they never do. They just keep doing what they've always done because they do doing anything else is to acknowledge. Well, first of all, you need a mechanism by which you could sort of investigate whether or not you made huge mistakes. And diabetes associations in Australia, the US, UK, Europe, they don't have those kind of mechanisms.

They don't have a way to bring in independent investigators like a corporation might do. Like if a company is behaving badly, a reasonable thing to do is to bring in a consulting crew to investigate what you're doing and what has to change. And then you listen to these independent individuals tell you what you might be doing wrong and you change it because your company depends on it. That kind of thing never happens. Diabetes associations don't have that mechanism.

Dr Peter Brukner
So where do we go from here? I think, I mean, this is largely being this movement towards more awareness of the role of diet is largely being driven by patients rather than doctors, isn't it? The patients are educating their doctors.

Gary Taubes
Pretty much. So what happens is you have these failed approaches. You have patients who are doing poorly. have patients who are, particularly with type 2 diabetes, who are being told, look, take these drugs, take insulin. But if you're getting fatter, you've got to control your weight. And nothing works except basically the diet that was used prior to insulin's discovery. Very low carbohydrate, high fat diet, the animal diet, is what's called the 19th century. So and by the end of the 20th century, you've got diet book authors, most famously Robert Atkins and then Richard Bernstein, a patient with type one diabetes who comes upon this technique himself and sort of begins a revolution in type one diabetes, but doesn't can drive it as far as it should have gone.

And patients realize they read these books or they go on the internet and they say, can I lose weight? And they find low carbohydrate ketogenic diets, keto or carnivore today, and they try it and it works. And then they tell their doctors and their doctors ideally pay attention. They don't always, I don't know what percentage of them do, but a significant amount might pay attention and that's really interesting.

What happens by the late 1990s is you have physicians confronted with patients like that, most notably Eric Westman at Duke University in North Carolina. And so you have a patient do exactly the opposite of what you've been telling them to do. They go on a diet where they're living on steak and eggs and all these high fat, high cholesterol foods, and they lose weight. And you run blood tests, and they seem to get definitively healthier.

And in Westman's case, he said, this is fascinating. I don't believe what just I'm seeing. I'm going to study it. So then you do a clinical trial. And he did, and the clinical trial confirmed that this is a common response to this kind of diet. And then other people see that clinical trial, or they have patients like David Unwin is another example in the United Kingdom, who's kind of famous, and has one patient who does the exact opposite of what you tell them to do. And finally, you see somebody succeed to to lose weight and put their diabetes in remission. And so now we have this sort of grassroots movement that's built on more clinical trials than have ever been done on any single diet. Effectively, all of them showing that this is an extraordinarily healthful way to eat, beneficial way to eat, and certainly demonstrating that it can.


Do something that diabetes specialists never believed was possible, which is put type 2 diabetes into remission, by which I mean drug therapy is no longer needed and you don't manifest symptoms of the disease. And that's a very powerful observation. The problem is every time a new drug comes along, it just reaffirms to the 98 or 99 % of the community that they will now solve all problems.

Drugs and then anyone who talks about diet is diluted because their patients don't want to go on diets. That's the story they hear and the story they tell themselves.

It's interesting, it? That constantly comes from diabetes specialists, that patients won't stick to a low-carb or a ketogenic diet and it's not sustainable. It always amuses me because it's always the people who never tried it that say that.

The most virulent critics of my books are invariably the people who don't read them. Because they're so convinced I must be wrong that it would be a waste of time to read the books. And therefore, because they have no idea what I'm actually arguing, there are evidence on which I'm basing my arguments. And yeah, you find the exact same thing. The world is full of lean people who are lean naturally.

and they exercise and they eat in moderation. So they somehow assume that they're lean and they're healthy and they exercise and eat in moderation. Therefore, anyone would be lean and healthy if they exercise and eat in moderation. So they only have to tell other people to do exactly what they do. What makes diabetes so interesting as a disease state in this sort of conflict between types of dietary therapy and dietary therapy versus drug therapy is that everyone acknowledges that carbohydrate rich diets are a particular problem for diabetes, people with diabetes. These are the foods they can't metabolize without drug therapy. And yet the community has trouble accepting that the alternative to, actually let me tell you a story. This I think is the best way to phrase it. One of the interviews I did for my book, it was interesting because one of my previous books was The Case Against Sugar, which was a sort of history and analysis of the sugar science. And I got interviewed by a young man who had been a chef and became a journalist and had been diagnosed with type 1 diabetes. So he was interviewing me about my sugar book. And I said, yeah, when we're done, want to interview you about your experience with diabetes. And I did. And so he was diagnosed in 2017. And when you're diagnosed with diabetes, as you know, you go in without preconceptions. And then you're suddenly thrown into this world of the diabetes land, you could call it where.

You have to educate yourself in the nature of this disease and the best way to treat it. And the physicians are telling you what to do when you've got no preconceptions. And the doctor says to them, look, because you don't make enough insulin anymore and you're going to make less and less as time goes on, we're going to have to give you insulin therapy. But then we want you to get the significant proportion of your diet from carbohydrates. You can't metabolize those carbohydrates safely anymore.

So we're going to give you insulin therapy and then you're going to use that to cover the carbohydrates that we're going to have you eat. And he, without preconception, says to this doctor, wait a minute, what you're telling me is that carbohydrates are now toxic to me now and insulin is the antidote and I should eat the toxin and take the antidote rather than just not eat the toxin.

Gary Taubes (39:26.062)
And he said that my doctor just wanted me to be healthy. And he said, well, if you don't eat the carbs, that's very hard to, you can't comply to that. That's a ketogenic diet that you can't stick to. And he said, basically, well, look, you're telling me I should exercise an hour a day. You don't tell me I'm not gonna be able to adhere to that, even though I have to, I should have said he didn't, is if I go exercise an hour a day, it's a half an hour getting to the gym and changing into my gym clothes and then, you know, after exercising another half, that's two hours a day I'm spending on this. And the alternative, not that I don't think exercise is good for you, is I don't eat the bread, the pasta, and the potatoes, and I stay away from sweets. How hard is that? And that's kind of the issue, but the diabetes and the obesity community, the nutrition community have created this whole mindset that abstaining from these foods is too difficult. It's imagine if you wanted to prevent lung cancer and you said, well, the way to prevent lung cancer is to stop smoking. But we're never going to be able to convince you to do that because it's really hard to do. And nobody complies to smoking cessation problems since they're going to give you a drug and you should keep smoking and the drug hopefully will delay your lung cancer. And we would say that's absurd and yet it's not a dissimilar situation to the way we're treating diabetes today.

There's often a lot of parallels made between the diabetes and the tobacco story and the sort carbohydrate story really. There lot of similarities and it took what 30 or 40 years really to convince people of the tobacco story because of the vigorous defense made by the tobacco industry and I guess it's a little bit similar in the carbohydrate story. Food industry, the pharmaceutical industry, there are a lot of people who have a vested interest in it not working.

Gary Taubes (41:26.506)
And pretty much. it's, you know, clearly it's easier for the doctors. Let's be serious. To just write a prescription is a lot easier than trying to convince someone to change their diet. But I think if the, and this is what I'm arguing for in the book is doctors who are well enough informed in the principles of low carb ketogenic diets and why they work, why they should work, the clinical trials.

The advice necessary to give to patients, how to guide and counsel patients so that they could say to patients when they diagnose them, look, there are two ways to treat this. OK, we can, you know, if you just keep eating bread, pasta, potato sweets, and we'll give you drugs and the drugs. I'm going to try and do this in a way that doesn't sound biased towards one, but it's almost impossible. The drugs will keep your disease under control.

And we'll monitor your blood sugar regularly and we'll have you come in for checkups. And as you start to get the other chronic disease that associated with this, as your blood pressure starts to go up, we've got drugs for that. And we've got drugs to prevent your risk of heart disease and stroke. And if things get really bad, there's always kidney dialysis and we can amputate your limbs if you get gangrene. Or they could say the alternative is look,

These foods, life has dealt you a bad hand, but you can't eat these anymore, unless you want to do the drug thing. But it turns out that there's a whole world of people who have found ways to have wonderful diets that they actually prefer. One of my favorite quotes in the book is from this British diabetes specialist, Frederick Pabian, the 1860s, in his book on diabetes. And he's advocating for this animal diet. And he says, he's got patients who after a couple of months prefer to eat that way than the way they used to eat. And we all know people like that today. So we just said, look, it's not that hard. Here's the principles of it. You're just not eating these foods. can eat as much as you want of those foods. And we all know those foods. Most of us really like them. We've been brainwashed into thinking they're going to give us heart disease. They won't. And see how that works.


Quite likely, you know, come back in six months, you'll have no signs of diabetes.

Dr Peter Brukner
You mentioned constantly there being new drugs. Obviously, we've been overwhelmed by the Azempic saga for the last 12 months or so. What do you think that's going to go the same way as all the other drugs? Initially, everyone gets excited and then turns out to be not quite as good as people thought?

Gary Taubes
Yeah, you know, I hope not. I hope I'm wrong. I they're miracle drugs. But again, one of the things when you study the history of pharmaceutical therapy for any chronic disease, invariably you find a world of people who thought this drug had changed their life. Certainly this was the case with insulin and then learned 10, 20 years later. Had come to regret ever going on.

You know, know people already on semaglutide, on ozempic and mcgoby. They love it. It's changed their lives. Clearly in the short term, it makes them healthier. I believe the studies that show heart disease risk comes way down with these drugs. I worry about long-term use. What happens when people get in there? The longer you're on the drug, the longer time you have for side effects to manifest themselves. What happens?

When you, if and when you have to go off of them. And again, the assumption is, we'll have better drugs. There's so many new GLP-1 drugs and JIP drugs coming down the pipeline that we'll find a better drug. If it's a disease or a disorder that can be controlled by diet, it can be put into remission by diet. My bias is that's always a better way to do it, but everyone has a different...balance in a different perspective on how they want those are sort of personal decisions so i want to make it as easy as possible with drug therapy and treat whatever complications or consequences come down the road hope that we have better drugs or other drugs that can deal with those or do i want to try and basically put this disease into remission, whether it's obesity or diabetes, by a dietary approach and live with that. And everyone's gonna see that decision differently. But I think it should be that what we need is a medical community and a diabetes community and diabetes educators who understand that these are valid decisions and that patients should be given the opportunity and counsel if they choose to go the non-drug route.

Which clearly works. think it's been shown the Virta group in the US, low carb program in the UK and our own Defeat Diabetes program have all shown very clearly that you can put type 2 diabetes into remission through diet and that seems to be the way to go.

Gary Taubes (47:00.642)
The is... I was gonna say the joke is they knew this in the 19th century.

There's nothing more bad. You can put this disease into remission if you just don't eat the macronutrient foods, then you can't safely metabolize. Seems obvious to everyone but the diabetes specialists. As I said, running out of time, there's lots of questions. But before I do, your next book, what's that one?

I want to do a similar history. In all my books, talk about, all my books, one of the fundamental tenets of all nutrition science is that we get fat because we consume more calories than we expend. That somehow it plays a role.

It's this incredibly naive concept that lies at the very center of all of our thinking about nutrition and obesity and diseases associated with obesity. So I want to just do a history of that thinking and in effect how we came to believe something so biologically naive and physiologically naive and the implications of that, both on the science of obesity. And again, you see it today, even how people interpret the, the, Zempik-Wagovia science. and then also on, on things like the concept of fat shaming. You know, the reason we fat shame obesity is because we assume these people somehow earn their conditions by eating too much. That it's a behavioral problem. and then you have this huge industry of obesity researchers saying it's not a behavioral problem. It's got nothing to do with well power, but it's still caused by taking in more calories than we expend, which means that people who get obese can't stop themselves from eating too much, which sounds a hell of a lot like well power and a behavioral problem. So I want to write about that whole history. It's like I said, it plays a major role in every book I've written. It's always ignored.

I think because reviewers and the people who don't like my arguments have trouble dealing with this. It's sort of the energy balance idea that obesity is caused by eating too much is it's like too big to fail. So.

Dr Peter Brukner
Yeah. Right. Well, we'll look forward to that. How long does it, I mean, there's a massive undertaking, there's all the research, I mean, the number of, you must literally read thousands of research papers and articles and so on. So how long does it take you to sort of research this sort of and write something like this?

Gary Taubes
Well, the research has been accumulating for 20 years, but I probably did another year of article reading. In this case, I was able finally to get all the German literature. Again, as I said, prior to World War II, Germans and Austrians, well, the Germans and Austrians did the best science in all sciences. That's why like physics, for instance, the names are Einstein, Heisenberg, Schrodinger, they were all Germans, Austrians, or Danes, or Italians. I finally got a hold of that literature. And so I could finally piece together the whole story. So I'm very excited. The problem is I've had to put the writing on hold for a few months while I get the diabetes book out and do a few other things. I have a sub stack I'm now doing with Nina Teichelt's Unsettled Science that we're very excited about.

I hope within the next month to get back and start writing the book. So maybe another year to two years of writing, depending on how productive and efficient I can.

Dr Peter Brukner
Well, we look forward to that. Just in the remaining time, we've had lots of questions. So let me just grab a couple of them. And there's one from Chris who says, I lowered my HbA1c with low carbs and fasting. The doctor still won't take me off Metformin. She says, my beta cells are probably damaged. Is there a test I can have that shows where my beta cells are at? So the beta cells recover.

Gary Taubes
Not that I know of, but again, there's so many misconceptions in this field and so many things, so much research that can't be trusted that the fact I don't know it doesn't really mean that they can't. As for the test, I would talk to you, Peter, before I would talk to me as a journalist.

Peter Brukner
Okay, now this is a good question. We talked before about people of influence and who convinced everyone to go low fat and Sharon wants to know what would you say to Ansel Keys if he was in front of you right now?

Gary Taubes (52:11.63)
Okay, yeah, Ansel Keys was the primary proponent, the man most responsible, and then from the 1950s onward, getting us on a low-fat diet and then a kind of a Mediterranean diet, this idea that saturated fat caused heart disease and it did so by raising cholesterol. So one thing I would ask Keys is, in 1986, he's actually quoted in the New York Times as saying he's come to realize that cholesterol isn't that important.

And it sounds like he's talking about blood cholesterol, which is exactly the point that I concluded in my research. And I would like to ask him to explain that comment that the New York Times quote him correctly and what did he really mean. The other thing I would ask him is he fancied himself to be a great scientist. He had two PhDs. He was not a medical doctor. And yet he managed to convince the whole world to go on a low-fat diet based on these observational studies. So he didn't actually test his hypotheses and experiment. So he didn't really, he just kind of threw the scientific method away. And I would say to him, why would you of all people not want to see your hypotheses rigorously tested? As you know, science requires, before we believe anything, and do so before you start changing the diets of an entire nation or world ultimately. So that's what I would say. And I would have to look down a bit to say it because he was height impaired.

Peter Brukner
Right. I mean, it's funny, isn't it, that the low-fat diet, if we call it that, has never been proven scientifically. And yet, are the first people to criticize the low-carb diet for their lack of science.

Gary Taubes (54:04.77)
The funny thing, like I said, the low fat diet was tested. In clinical trials, probably close to a billion dollars was spent testing the hypothesis that if you eat less fat, you'll live longer. And it failed the test. The studies could not show that that was true. yeah, actually the other thing they say is, well, we don't want to take a reductionist approach anymore because we admit that we might have been wrong about fat. So now you're going after carbs. That's reductionist when you're just focusing on macronutrients. Instead we're going to tell you don't eat ultra processed foods and we're not going to define ultra processed foods. So by that we mean anything that we vaguely think might be unhealthy and then you've sort of thrown science aside entirely and now you've got I don't even know what to call it but it's it's a

I mean, one of the problems with getting older, you know this, this is why people get tired of, you know, you get cynical because you've seen so much crap over 10, 20, 30, 40 years that it's hard to imagine things getting better. On the other hand, we have this wonderful, we have this dietary therapy that works. It's like that simple. You eat this way, people get healthier.

And some huge proportion. mean, we don't even know how great it is, but clearly some huge proportion of people when they just abstain from eating carbohydrate rich foods will get healthier. So you don't really need the science, although it sure help.

It will help with some of those skeptical medical people who use that as an excuse really. as we said, this is a patient-driven campaign really. The patients are educating their doctors and as you say, some of the doctors are prepared to listen. David Amon was a classic example. One patient changed his whole attitude. We had David on this webinar before. He was about to retire because he was

Dr Peter Brukner (56:16.302)
Hating medicine, not enjoying it, didn't feel he was doing any good. And all of a sudden one patient changed that and he was prepared to listen. But so many others, I hear the story of someone who wants to go low carb and goes to their doctor and says, you can't do that, you'll drop the end of a heart attack and sort of stuff that they come up with. So yeah, it's certainly a challenge. Well, Gary, look, we've run out of time. I could talk to you for hours, but we really appreciate.

You're spending the time. I would thoroughly recommend this book if you really want to do a deep dive into diabetes. It's a fascinating story that evolves over 150 years and hopefully, maybe in another 20 years, you'll be able to write a book about how we finally conquered type 2 diabetes through a diet. maybe that's wishful thinking. Gary, all the best with the book. I'm sure it'll be very successful.

And on behalf of all the people in Australia and elsewhere who are listening, we want to thank you very much for your time.

Gary Taubes
And Peter, thank you. Thank you for having me.