By Dr. Mercola
DM: Dr. Joseph Mercola
GT: Gary Taubes
DM: Welcome everyone. This is Dr. Mercola. We are honored today to be able to speak to Gary Taubes who is a prominent journalist. He has written a number of books. He has been featured in the New York Times. It‟s interesting that we both share very similar passions and have come to the same approach which is essentially we‟re both journalists in the health field. We‟re about the same age. Gary went to Harvard and Stanford which institutions I have enormous respect for and studied disciplines dear to my heart which is applied physics and aerospace engineering but you wound up getting a journalism degree and then shifted over to health and medicine and nutrition. We actually featured one of your articles nearly 10 years ago on our new site – “What If It‟s All Been a Big Fat Lie?” That was a phenomenally successful article when we had it. That‟s when I first became aware of your information. Welcome and maybe if you can expand on your journey in health education and understanding and how you came to do what you‟re doing.
GT: Thank you Joe. Thank you for having me. I started off as a science writer. In fact, right out of journalism school obviously because of my background. That‟s what I was most suited to do. I found myself in the 80s writing a lot about – my first book, I lived at the big physics lab outside of Geneva (indiscernible 3:26). I watched some very, very smart physicists discover non-existent elementary particles. They in effect screwed up while I was watching, writing a book about them. I got obsessed with this question of how hard it is to do science right, to get the right answer and how easy it is to be misled by your evidence. I wrote another book along the same lines about this scientific fiasco in the late 80s called Cold Fusion. I originally taken that book hoping to be able to whip it out in nine months and I became obsessed with this mess of a science. Afterwards, some of my friends in the physics community said, if you are interested in bad science you should look at public health. So I started doing that and I realized that a lot of the lessons I had learned from good experimental scientists in my other research about how carefully you have to control for variables and how meticulous you have to be with your experimental apparatus and how much attention you have to pay to negative results – the results that don‟t confirm your beliefs. I found were sort of just thrown out the window in a lot of public health research particularly this whole field of what‟s called observational epidemiology we hear a lot. It‟s constantly in the news. 2 Recently, there was just a study out of Harvard claiming that they can tell what foods make you fat by looking at, in this case, I think it was 70,000 nurses in the Nurse‟s Health Study and saying, the ones who got fat tended to eat these foods and the ones who stayed lean tended to eat these foods. That‟s a causal relationship. A lot of my writing in public health nutrition started off writing about this field of epidemiology. And then towards the late 90s, I kind of stumbled into first this controversy over whether salt is really the cause of high blood pressure and hypertension. That led me into the science of dietary fat and heart disease and whether a low fat diet is really a healthy diet. I would spend, for both the salt and hypertension story and then the fat heart disease story – both of them were from the Journal of Science – I spent a year on each of those stories.
DM: If I could just interject there because some of our readers are not literate with the scientific literature. The Journal of Science from which you have assimilated your publication is probably considered one of the most prestigious scientific journals in the world along with Nature. GT: Right. Science and Nature, the two in the harder sciences. That‟s where scientists ideally want to publish their work. Both these journals have news sections. Journalists who work for them and just get to cover science. I actually love writing for science because I could write a level that interests the scientists. I don‟t have to bring it down to a level that the lay public can understand. I have often been accused to failing to do that in my other writing anyway. One story just led to another. I was fascinated back in 2001 when our knowledge of the obesity epidemic was still relatively fresh. I pitched the story to the New York Times magazine about let‟s see if we can come to some conclusions about what caused the obesity epidemic and that‟s what grew into the story, “What If It‟s Been a Big Fat Lie”. I had two ideas about what might cause it both from my former research. One was the introduction of high fructose corn syrup in 1977 which pretty much more or less coincides with the beginning of the obesity epidemic. The other was this institutionalization of the idea that a low fat diet is a healthy diet because when you lower the fat content of the diet, as you know, you‟re going to replace the fat with carbohydrates. And until the 1960s, the conventional wisdom was that carbohydrates were inherently fattening. One of the articles I quote in my books was from the British Journal of Nutrition article in 1963 written by one of the two leading British dietitians. The first sentence was every woman knows that carbohydrates are fattening. What happened is we decided that dietary fat caused heart disease and started pushing carbohydrates as sort of heart healthy diet foods and this was institutionalized between 3 1977 and 1984 so that same time period. In that article, as you know, I kind of concluded that this indeed was the most likely explanation for the obesity epidemic that we took all these foods that everyone inherently believe were fattening and told everyone to eat as much of them as you could. Foods like yoghurt; we would remove the fat from the yoghurt and replace it with high fructose corn syrup in this case. So you take a little bit of fat out and you put a lot of sugar back. One thing led to another. That article, as you put it, was very controversial. It got me a big book advance and that allowed me to spend five years of my life working on my first book in this field Good Calories, Bad Calories. The most recent book “Why We Get Fat” is a kind of airplane reading version of Good Calories, Bad Calories. (indiscernible 9:22) produces 500 or 600 page book with notes and bibliography that was a history of the field in nutrition and chronic disease research and then a revision of science of the field saying this is why we came to believe what we believe today but here is this alternative hypothesis that the carbohydrates were to blame not the fats. Here is what the evidence showed. But what I didn‟t take into account is that the researchers and the physicians who I wanted to get this book to didn‟t have time or the interest to read a 600-page book suggesting that everything they believed was wrong. So I boiled it down and then made a more argumentative much more readable version which is the new book.
DM: Excelente. Uma das razões pelas quais eu entrei em contato com você é que li seu magnífico artigo no início deste ano no New York Times, que foi honestamente a melhor revisão abrangente do argumento da frutose. Foi simplesmente fenomenal. É claro que destacamos em nosso site. Eu gostaria que você dissesse algumas palavras sobre isso. Mas, antes disso, eu também queria comentar a afirmação que você fez sobre a transição do entendimento de que os carboidratos eram geralmente reconhecidos pela maioria dos especialistas e até leigos que estavam engordando. Essa transição ocorreu nos anos 70. Porque você estudou isso com muito cuidado e analisou a literatura há anos e esse tem sido seu trabalho em período integral. Entendi que Ancel Keys era como o culpado aqui. Ele fez uma pesquisa nos anos 50, que começou o processo de levar a comunidade científica a acreditar que as gorduras eram prejudiciais. É realmente uma crença perniciosa, já que ambos concordamos. Estou me perguntando se você poderia realmente comentar sobre isso. Porque isso é realmente central para todo esse ponto é como isso aconteceu para fazer a transição para esse absurdo de baixo teor de gordura que você eloquentemente desmascarou. E depois que você abordou isso, para dar a sua impressão de onde estamos dentro da comunidade científica, de não acreditar mais nesse absurdo. Realmente fizemos a transição ou ainda existe a maioria dos especialistas, por assim dizer, e dos cientistas que acreditam nessa loucura? GT: Deixe-me começar com o segundo, porque essa é a história mais curta. Se você olhar para o novo My Plate que acabou de sair, o substituto do USDA para a pirâmide alimentar, apesar de tudo ainda ser um prato com pouca gordura e alto teor de carboidratos. Talvez seja melhor que metade do prato seja de frutas e legumes, mas, por mais que você o interprete, a Pirâmide Alimentar. Eu lhe disse anteriormente, estava em Aspen no início desta semana no Aspen Ideas Festival, onde estava falando sobre a questão do açúcar. Havia muitos figurões. Eu gostaria de dizer que estava conversando com os bruxos superiores da estratosfera. Então eu estava conversando com Zeke Emmanuel, que é irmão de Rahm Emmanuel. O ex-presidente do presidente Obama – eu não sei qual posição ele ocupava – tecnicamente, ele agora é prefeito de Chicago. Zeke Emmanuel é um bioeticista muito respeitado no NIH. Ele estava me dizendo como o quanto esse My Plate seria esse grande sucesso. Ele estava combatendo a obesidade porque frutas e legumes eram metade do prato e essa foi uma grande mudança. Eu sinto como … como digo, mas ainda são principalmente carboidratos e a batata não é um vegetal na América. E isso é. É um vegetal rico em amido. Você ainda pode acabar com carboidratos de alto índice glicêmico como a maior parte da sua dieta e ainda vai tornar as pessoas mais gordas e não mais magras. Portanto, em geral, mesmo que agora haja muito mais nuances discutidas sobre as gorduras ômega3 e ômega-6 e sobre os diferentes tipos de gorduras monoinsaturadas, a mensagem geral ainda é uma mensagem com pouca gordura. É o que a maioria dos pesquisadores que eu diria neste campo, a maioria dos profissionais ainda acredita que é a chave. Eu acho que a maioria dos pacientes, se eles vão ao médico e estão obesos com excesso de peso, têm colesterol alto ou até síndrome metabólica, que nós dois sabemos que é um distúrbio na maior parte do metabolismo de carboidratos. Os médicos dizem reduzir a ingestão de gordura porque pensam que é assim que as pessoas são mais magras porque a gordura tem calorias mais densas. Como chegamos aqui? É fascinante que Ancel Keys, você está absolutamente certo, tenha sido o culpado. Ele era um nutricionista muito determinado e muito zeloso da Universidade de Minnesota que, desde o momento em que decidiu que o colesterol no sangue causava doenças cardíacas – ele pensava então no colesterol total, então entendeu errado. E essa gordura na dieta foi a causa do colesterol alto e ele provavelmente também entendeu errado. Ele só sabia que estava certo. Então ele começou a empurrar essa agenda, essa hipótese. Mesmo quando ele disse, Não fiz estudos para confirmar isso, mas ainda é por isso que todos devemos fazer dietas com pouca gordura. Isso foi no início dos anos 50. No final da década de 1950, a American Heart Association reuniu uma equipe de especialistas 5 para analisar os dados e disseram que você simplesmente não pode fazer essas afirmações. Não há experimentos para apoiá-lo. Você não pode falar sobre colocar os americanos em uma dieta com pouca gordura. Este foi um artigo importante publicado no American Heart Association Journal. A maneira de Keys contornar isso era entrar na American Heart Association junto com um cardiologista de Chicago, Jeremiah Stamler, que era igualmente zeloso com essa hipótese.
DM: Stamler ainda está vivo?
GT: Stamler ainda está vivo. DM: Eu não sabia que ele era tão velho. Ele começou nos anos 50. Eu sei que ele está no noroeste.
GT: Quando eu estava fazendo a história do sal – Stamler é o principal defensor do sal. Se não fosse Stamler, a ideia de que o sal causa hipertensão nunca teria acontecido. Havia um cara em Brookhaven. Havia um cientista terrível chamado Louis Dahl. Ele faleceu nos anos 70. Ele havia feito o único trabalho significativo sobre o assunto e sua ciência é terrível. Stamler apenas pegou e abraçou e fez experimentos após experimentos ou estudos após estudos que não confirmaram o efeito. Ele é apenas um cientista terrível. Quando eu estava fazendo a história do sal, coloquei Stamler na linha e falei com ele por cerca de uma hora. Lembre-se, eu fiz um livro sobre fusão a frio e conversei com alguns dos piores cientistas do mundo. Eu sei como é um cientista ruim. Desliguei o telefone e liguei para meu editor na Science. Eu disse, Acabei de conversar com um dos cinco piores cientistas que já entrevistei em minha longa carreira. Ele não apenas recebeu crédito por fazer o povo americano comer menos sal. Ele assumiu o crédito por fazer os americanos comerem menos gordura e menos ovos também. Então, quando terminar a história do sal, vou fazer uma história gorda. Não sei qual é a história, mas sei se Stamler estava realmente envolvido de alguma maneira substantiva. Essa foi uma das lições que aprendi de minha pesquisa anterior. Os maus cientistas não conseguem a resposta certa. A natureza não é desse tipo. DM: Vamos voltar para onde fomos interrompidos. Então, quando terminar a história do sal, vou fazer uma história gorda. Não sei qual é a história, mas sei se Stamler estava realmente envolvido de alguma maneira substantiva. Essa foi uma das lições que aprendi de minha pesquisa anterior. Os maus cientistas não conseguem a resposta certa. A natureza não é desse tipo.
DM: Vamos voltar para onde fomos interrompidos. Então, quando terminar a história do sal, vou fazer uma história gorda. Não sei qual é a história, mas sei se Stamler estava realmente envolvido de alguma maneira substantiva. Essa foi uma das lições que aprendi de minha pesquisa anterior. Os maus cientistas não conseguem a resposta certa. A natureza não é desse tipo.
DM: Vamos voltar para onde fomos interrompidos.
GT: década de 1960, Ancel Keys, juntamente com Jeremiah Stamler, foram os primeiros adaptadores dessa hipótese, entraram em um comitê ad hoc da American Heart Association e surgiram com seu próprio relatório, que, se bem me lembro, talvez tivesse três páginas. Ele afirmou, com efeito, que havia evidências suficientes para dizer aos americanos pelo menos homens com alto risco de doença cardíaca que deveriam comer menos sal. Isso ganhou muita imprensa. Ancel Keys foi capa da revista Time como uma voz de sabedoria nutricional nos Estados Unidos. Naquela capa, Keys estava dizendo com efeito naquela matéria de capa 6 – não temos realmente nenhuma evidência, mas ainda assim todos os homens americanos deveriam reduzir a ingestão de sal para um número extremamente baixo. Mais uma vez, esqueço exatamente o que era. Portanto, a American Heart Association abraçou essa idéia antes que houvesse experimentos significativos. E, durante os anos 1960 e 1970, os pesquisadores começaram a fazer experiências em que levavam todos esses homens em diferentes populações. Havia um famoso, Hospital Veteran Administration, em Los Angeles. Houve um estudo de homens com alto risco de doença cardíaca em Nova York. Havia um em um hospital psiquiátrico finlandês. Eles colocariam um grupo em uma dieta baixa em gordura ou para baixar o colesterol, o que é realmente uma coisa diferente. Se você realmente deseja diminuir o colesterol, não diminui o teor de gordura. Se você diminuir o teor de gordura e aumentar o teor de carboidratos, isso aumentará os triglicerídeos na corrente sanguínea, que aparece como parte do número de colesterol.
DM: Se pudéssemos parar por aí. Talvez seja um pouco confuso para algumas pessoas ouvirem, você pode expandir isso – mas o conceito é que existem apenas três categorias de nutrientes; carboidratos, proteínas e gorduras. Se você está reduzindo a gordura, quase precisa reduzir a proteína, porque a proteína está quase sempre associada a gorduras. É comum que não seja. Há apenas um outro nutriente que você pode aumentar e isso é carboidratos e a maioria das pessoas não vai comer um monte de vegetais.
GT: Certo. E mesmo na década de 1960, começando no final da década de 1950, os pesquisadores que estudavam isso sabiam que os carboidratos aumentavam as gorduras sanguíneas chamadas triglicerídeos, que também estavam ligadas ao risco de doenças cardíacas. Se você realmente deseja diminuir o colesterol, altera a proporção de gorduras na dieta. Você abaixa as gorduras saturadas e aumenta as gorduras insaturadas. Quando eles fizeram esses estudos, às vezes, eles poderiam mostrar que as pessoas tinham um pouco menos de doença cardíaca no grupo que consumia essa dieta para baixar o colesterol, mas tendiam a morrer exatamente como as suas – morriam na mesma idade ou até morriam um pouco mais cedo do que as pessoas que não estavam comendo as dietas para baixar o colesterol. Quando eles fizeram estudos epidemiológicos apenas olhando o que as pessoas estão comendo nas populações, eles encontraram os mesmos resultados incompatíveis. Como algumas vezes, a menor gordura estaria associada a uma vida mais longa, mas outras vezes, a maior gordura estaria associada a uma vida mais longa. Então, o que eles fizeram, que é um dos pilares dos cientistas ruins em todos os lugares, eles apenas prestaram atenção aos dados que concordavam com sua teoria e ignoraram os dados que não concordavam. Documentei isso com muito cuidado no livro Boas Calorias, Más Calorias. Como eles selecionariam aquele resultado e diziam que isso confirma nossa hipótese, mesmo que precisassem pular arestas para fazê-lo. 7 Por exemplo, em um estudo em Porto Rico, não houve associação entre o consumo de gordura em sua população e doenças cardíacas ou mortalidade. De fato, as pessoas que parecem comer um pouco mais de gordura parecem ter uma mortalidade um pouco menor. Eles parecem viver um pouco mais. Mas o conteúdo de carboidratos estava ligado. Quanto mais carboidratos algumas pessoas ingeriam, menor a doença cardíaca, portanto, isso confirmou sua teoria. Então, tudo foi visto como uma confirmação do que eles chamavam de teoria do coração da dieta. Isso continuou nos anos 70 e eles falaram sobre fazer o tipo de estudo definitivo que você precisaria para provar isso. Esse estudo realmente forneceria evidências convincentes, mas mesmo assim custaria cerca de um bilhão de dólares. Então eles apenas decidiram que não iriam fazer isso e isso poderia ter a resposta errada. Era disso que eles tinham medo, porque eles poderiam estragar o estudo. Na verdade, essa é sempre uma possibilidade legítima nos ensaios clínicos. E então chega ao ponto, por exemplo, o maior estudo realizado já foi conhecido como a pesquisa coronariana de Minnesota. Isso mostrou que as pessoas que fazem dieta com colesterol têm uma mortalidade significativamente maior do que as que estavam apenas comendo a dieta normal que todos nós comemos. Então eles simplesmente nunca publicaram o estudo. Ou melhor, o estudo foi concluído por volta de 1972 e eles o publicaram, o principal investigador o publicou, eu acho, em 1989 – 17 anos depois. Quando entrevistei esse sujeito mais tarde, por volta de 2004, e perguntei a eles por que você esperou 17 anos para publicar o estudo? Ele disse que não gostamos dos resultados. Ao selecionar a evidência que você gosta e ignorar o resto, e eu a comparei no meu livro, você pode provar que uma moeda tem um lado. Se toda vez que você o vira e cai no rabo, você diz, isso não conta. Deixe-me virar de novo. Isso é de fato o que eles estavam fazendo. Esse subcomitê ou comitê do congresso administrado por George McGovern se envolve e eles decidem que vão se envolver no assunto do que chamam de nutrição e doenças fatais, que são doenças cardíacas, diabetes e câncer. Eles decidiram que as pessoas que realmente sabem qual é a verdade são as que estiveram zelosamente por trás da hipótese gorda o tempo todo, embora haja uma enorme controvérsia na comunidade científica. É completamente polarizado se essa teoria está certa ou não. Eles decidem que vão dizer ao país inteiro para diminuir o teor de gordura. Isso foi em 1977. Por eles, eu nem me refiro aos congressistas, quero dizer aos jovens funcionários que trabalham para o congressista, que são uma espécie de advogados e jornalistas. Havia um jornalista que escreveu o relatório sozinho, que fora repórter trabalhista do jornal Providence Rhode Island. Ele foi demitido de lá. Ele foi trabalhar em Washington para um grupo de defesa do consumidor. Ele decidiu que queria ajudar a mudar o mundo depois de assistir a documentários sobre salmão na África. Ele conseguiu um emprego como escritor de oito membros desse comitê e, sozinho, com efeito, assimilou os dados como ele acreditava. Eu conheci esse sujeito várias vezes. Ele é um cara maravilhoso. Seu coração estava completamente no lugar certo. Ele realmente queria fazer uma boa ação. Ele não tinha um entendimento real da ciência. Nenhuma compreensão real da nutrição e saiu com este relatório que foi apoiado pelo comitê, grande conferência de imprensa, um grande negócio na época dizendo que todos deveríamos estar comendo mais carboidratos e menos gordura. Eles também disseram que também deveríamos comer menos açúcar e carboidratos mais complexos, mas a mensagem geral era de mais carboidratos e menos gordura. Isso foi apurado pelo USDA e, novamente, um administrador bem-intencionado lá com experiência em defesa do consumidor. Ela achava que qualquer cientista que discordasse dessa mensagem era basicamente um waffler. Você conhece esses cientistas, eles nunca dirão nada definitivamente. Eles querem obter mais dinheiro para eles – sempre lhe dirão mais dinheiro para pesquisas e temos que seguir o nosso melhor palpite. A única maneira de obter um palpite melhor foi ignorando o fato – havia um palpite de que a gordura da dieta não tem nenhuma influência significativa sobre as doenças cardíacas. Mas se você simplesmente ignora os cientistas e olha para o tipo de pessoas zelosas como Keys que estão fazendo essas declarações declarativas, sabemos qual é a verdade. É tudo sobre gordura, então você pode chegar a um consenso e foi isso que eles fizeram. E acabou de construir a partir daí. Eles financiaram alguns estudos enormes para tentar – não é tão bom quanto o estudo de bilhões de dólares que eles queriam fazer, mas alguns deles pensaram que os aproximariam de um estudo que custou US $ 125 milhões ou US $ 115 milhões. milhão. O estudo de intervenção com múltiplos fatores de risco em que eles tomaram novamente homens com risco muito alto de doença cardíaca e colesterol muito alto, como mais de 290, eu acho que sim. Eles os randomizaram em dois grupos. Um deles recebeu essa intervenção de múltiplos fatores de risco. Eles são aconselhados a parar de fumar, tomam um remédio para baixar a pressão arterial e recebem uma dieta que altera o colesterol. O outro grupo continua e vive a vida e administra o estudo por meia dúzia de anos. No final, verifica-se que o grupo com a intervenção, com os conselhos para parar de fumar e os conselhos sobre dieta para baixar o colesterol e a medicação para pressão arterial, na verdade, teve mais mortes do que o grupo controle. Eles disseram que devemos ter feito esse estudo errado. Lembre-se da chave com cientistas ruins para ignorar dados que refutam suas crenças. E eles tiveram outro grande estudo que foi um teste de drogas. A primeira grande – bem, ela quer o primeiro, mas o maior estudo já feito na época, analisando um medicamento para baixar o colesterol e lá eles viram uma pequena melhora na mortalidade. As pessoas que tomaram a droga viveram mais do que as que receberam o placebo. Eles apenas deram esse salto de fé. Eles disseram que se a droga para baixar o colesterol pode reduzir doenças cardíacas e levar as pessoas a viver mais, uma dieta para baixar o colesterol deve fazer o mesmo. Então, eles fizeram o teste com o medicamento 9 e disseram que isso também se aplica à dieta, e os americanos com mais de dois anos de idade devem seguir uma dieta com pouca gordura. Esta se tornou a famosa capa icônica da Time Magazine. Você provavelmente se lembra dele com um prato com dois ovos fritos para os olhos e o pedaço de bacon virado para baixo para a boca carrancuda. Eram cabeças cobertas com manchetes de colesterol e agora as más notícias. E boom, em meados da década de 1980, todos nós comíamos pouca gordura, dietas ricas em carboidratos e esperando desesperadamente prevenir doenças cardíacas. Em meados da década de 1980, os americanos começaram a ficar cada vez mais gordos e todo mundo estava dizendo que é um mistério que não entendemos por que essas pessoas gordas não nos ouvem. DM: Obrigado por essa história detalhada. Eu certamente fui pego nisso no meu treinamento educacional. Eu terminei meu treinamento de residência familiar em meados dos anos 80 e comprei todo esse argumento, linha e chumbada, porque esse era realmente o pensamento convencional da época. Eu pessoalmente cumpri isso. Eu baixei meu nível de colesterol para 70, acho que sem drogas. É por dieta. Eu estava louco. Eu estava me matando. GT: Todos nós fizemos. Mudei-me para Los Angeles em 1988. Nunca calculei qual é o teor de gordura da minha dieta porque não pensava assim, mas não posso dizer quantas claras de ovos, quantos ovos cozidos descasquei e joguei fora as gemas. Quero dizer, deve estar na casa de muitos, muitos milhares. Eu comia aveia, sem manteiga, sem leite e depois suco de maçã na aveia. Esse foi o meu café da manhã com essas claras de ovos. O almoço foi massas frescas com salsa fresca. Portanto, não há gordura lá. Quantos peitos de frango sem pele comi e jantares de massas comi. Você está com fome o tempo todo quando come assim. Lanches o tempo todo em arroz integral ou algum outro nutriente livre de gordura e o teor de carboidratos é enorme. Você fica cada vez mais pesado a cada ano. Eu morava em Los Angeles. Eu morava perto da praia. Eu estava malhando cerca de uma hora por dia, porque é isso que você faz em Los Angeles. Você não vai a cafés ou faz compras; você vai à academia ou sai correndo. Você está ficando mais pesado. DM: Obrigado por expandir isso. Não me sinto tão mal por sermos enganados por essa loucura, mas eventualmente, se você realmente busca a verdade, a verdade será revelada. A ciência, na sua fundação, descobre, mas o problema é como você definiu com muita eloquência é que há esse conflito de interesses e esse interesse próprio que leva as pessoas a ignorar descobertas negativas que realmente podem influenciar esses resultados.
GT: I also think what happens here is there is a sort of mentality – I often call it the Jurassic Park mentality. I don‟t know if you remember the first Jurassic Park movie but about every 10 minutes they would go, “But people are dying out there.” People are dying out there. As we‟re talking, I don‟t know, another 100 Americans have dropped dead from a heart attack. So you got to move fast. You can‟t wait for the definitive evidence to come through. I would look in the literature and I was always told this by the research. We can‟t dot every I and cross every T. We‟re not like the physicist who studied who wanted to have the time and the patience to reproduce the experiment and make sure they controlled 10 for all the variables. I said, basically, what you‟re saying is you don‟t have the time to figure out whether you‟re really right or not. Because if you don‟t dot every I and cross every T, you don‟t know. That‟s how cruel science is. But because people are dying out there, we have to move fast. We have to take leaps of faith. We have to jump to conclusions and we have to hope that we‟re right. Unfortunately, all too often, some huge proportion of time when people do that they‟re not right. We‟ve been living with that ever since. And then what happens is nutritionists embrace it, dieticians embrace it, personal trainers embrace it, people standing on the checkout line next to you have embraced it. It becomes this huge sort of all pervasive dogma. Now it‟s not like – it‟s hard enough if you read the history of science for say 200 physicists to change their mind. But now you‟ve got enormous institutions that have been pushing this dogma. The American Heart Association, imagine if the American Heart Association, imagine when they decide they were wrong, what do they do? You can‟t just put out a press release saying we apologize for the last 40 years of advice we‟ve been giving you. We apologize if we got a lot of stuff wrong and we killed a lot of your loved ones. We haven‟t killed you yet obviously because you‟re reading the press release but we will. Now, we‟re going to tell you what the real answer is and we have confidence in this one and trust us, we‟re a good source of advice. It just can‟t be done. All that stuff is institutional self interest as well too. The people in those institutions presented with what psychiatrist would call cognitive dissidence, you know, I‟ve been paying this, I‟ve been believing this for 30 years and now you‟re telling me not only that I was wrong but it‟s the exact opposite and I may have done more harm than good. Most of us when confronted with that situation just say, you know, our brains figure out a way to convince ourselves that we were right all along. So there are all these perfectly human well meaning beliefs that worked in this situation to keep the truth isolated and walled off in this little corner of the world where you and I live. It may be a little more than you. It‟s a tricky business.
DM: Sim, eu não poderia concordar mais e realmente agradeço por essa explicação, porque isso não é apenas verdadeiro para nutrição com os problemas que você está descrevendo, mas também em outras áreas da saúde ou da saúde pública, especialmente aquelas que tem interesse específico em amálgamas de fluoretação e mercúrio e questões de vacina. Essas são todas as áreas que realmente têm as mesmas variáveis que você acabou de abordar que contribuem para uma mudança na consciência e no pensamento que realmente perpetua esse mito.
GT: Sim, e então você tem os mecanismos de financiamento perpetuados. Eles tendem a financiar pessoas que concordam com a sabedoria convencional. Se eu estivesse dirigindo o universo, jogaria fora todo o sistema e começaria do zero com um método de financiamento e abordagem de controvérsias que realmente funcionam para fazer exatamente isso. Essa é outra hora de conversa. 11 Devemos falar um pouco sobre o argumento fundamental que venho apresentando no meu último livro, “Por que engordamos” e que permeia a segunda metade do meu primeiro livro, é a idéia de por que engordamos. Ficamos gordos porque comemos muitas calorias e somos apenas glutões e porque somos sedentários?
DM: Eu definitivamente queria que você entendesse isso e essa é uma das perguntas que gostaria de fazer, porque parece que parece ser o meu entendimento de revisar a literatura – estou muito curioso para saber o que você pensa sobre isso. Uma das questões principais é essa frutose. É apenas o senso comum básico, é o número um da fonte de calorias nos Estados Unidos, por isso tem que ser um problema.
GT: Certamente é. O argumento que tenho apresentado é que estamos cometendo um erro fundamental, mesmo pensando em termos de calorias. Este é um dos lugares onde a obesidade … bem, é o lugar para a comunidade de pesquisa sobre obesidade ter saído dos trilhos. A pesquisa de doenças cardíacas fez isso com gordura na dieta e depois se espalhou e afetou todo o resto. Antes da Segunda Guerra Mundial, os pesquisadores médicos europeus tinham uma concepção diferente do que causava a obesidade. Eles disseram que o corpo humano em essência é muito bem regulado. Todo sistema no corpo é muito bem regulado. As células não absorvem excesso de energia, a menos que sejam sinalizadas para isso. Se você pensar bem, é isso que a insulina faz. A insulina diz: ei, há muito açúcar no sangue. Temos que dizer às células para absorver mais do que queriam. Então é isso que a insulina faz. Ele diz às células para absorver os nutrientes em efeito, porque há muito na corrente sanguínea, e queimaremos alguns deles no tecido magro e armazenaremos alguns deles no tecido adiposo. Mas você precisa de moléculas únicas. Os hormônios estão lá fora para dizer, pegue isso, pegue isso porque há muito disso. Então, se houver muita gordura acumulada no tecido adiposo, é porque os vários fatores no corpo, os hormônios, as enzimas, o sistema nervoso central que regula a captação de gordura pelo tecido adiposo e a liberação de gordura está dizendo à gordura a ser absorvida e temos que descobrir o que é isso. Infelizmente, esta escola européia desapareceu com a Segunda Guerra Mundial. Ao contrário da física, onde abraçamos pesquisadores alemão-austríacos porque tivemos uma – houve uma corrida armamentista com os russos. Tivemos que construir armas nucleares e construir foguetes. Então, nós realmente não nos importamos com o idioma que alguém falou ou com o sotaque que eles tinham, em alguns casos, mesmo que fossem nazistas. Nós os abraçamos e aprendemos com eles como fazer ciência. Na pesquisa médica e na saúde pública, em nutrição, essas pessoas não foram acolhidas. Eles conseguiam empregos onde podiam e realizavam trabalhos domésticos em hospitais. Então essa teoria meio que desapareceu. Foi substituída por essa idéia de que é apenas o quanto você come e se exercita. 12 E, a partir do final dos anos 50, início dos anos 60, os pesquisadores finalmente tinham as ferramentas necessárias para descobrir o que regulava o tecido adiposo e perceberam que era fundamentalmente o hormônio insulina. Quando o nível de insulina sobe, você armazena calorias como gordura e, quando diminui, libera essas calorias e diz ao músculo magro, aos tecidos musculares, aos órgãos, para queimar gordura nas costas. Nós secretamos insulina em resposta a – para todos os efeitos – em resposta ao conteúdo de carboidratos da dieta. Você poderia dizer que o tipo de carboidratos e a quantidade de carboidratos regulam mais ou menos nossos níveis de insulina. Então isso levou ao conceito de dieta restrita a carboidratos. Mas, como conversamos anteriormente, se você vai cortar gordura, precisa adicionar carboidratos.
DM: Really no other way around it.
GT: Yeah. Beginning actually the late 1940s and before they unraveled this regulation, they elucidated what regulates our fat accumulation. Physicians started looking at what happened when they put their patients on very carbohydrate restricted high fat diets and they lost weight effortlessly. And then some very successful books were written on this. The most famous was in 1960-61 was Calories Don’t Count by a European-born OBGYN working in Brooklyn named Herman Taller. And then 11 years later, the Atkins Diet revolution. They‟re pushing high-fat diets when we‟re beginning to think that dietary fat cause heart disease and the nutrition and heart disease community comes down on them like a ton of bricks saying you guys are killing people. Actually, there was a quote in 1965 New York Times article in which (indiscernible 9:48) the most influential nutritionist of that era in the 1970s says that to recommend a carb restricted diet to patients is equivalent to committing mass murder. That‟s a direct quote. This was the exact same time actually that researchers had realized that insulin causes fat accumulation. If you want to lower insulin level the way you do it is cut the carbs out of the diet. We got in this conflict where one of the two hypothesis had to go and like I said, the interesting thing is up until the 1960s for the 150 years previously, the conventional wisdom was that carbohydrates made you fat. One of the things I did in the book – because I read all of them. I probably read 95% of the (indiscernible 10:35) literature from the 1980s back to the 1890s. You could find articles published in the major medical literature in 1940s and early 50s from doctors at Harvard, Stanford, and Cornell talking about the diet for obesity they used in their hospitals. The first thing you get rid of starches and anything made from flour and sweets and anything made from sugar. And they said you could eat as much as you want of the animal products, you know, meat, fish, fowl, eggs, cheese. 13 Basically, what they were saying is get rid – they didn‟t realize it in the 40s and 50s but get rid of the foods that stimulate insulin secretion because those were the foods that make you fat and keep the foods that don‟t stimulate insulin secretion, not a lot, considerably less and at a slower rate because those aren‟t fattening. It‟s like if you want to prevent lung cancer you get rid of the cigarettes because they cause lung cancer but you could do anything else you want because it doesn‟t except work around asbestos I guess. Anyway, this is the alternative hypothesis. It‟s not about how much we eat or exercise. If you‟re getting fat or you have to take in more calories and you expand that. It‟s what the laws of thermodynamics tell us. That‟s always true but certain nutrients affect the hormone insulin that fundamentally regulates fat accumulation and that‟s the carbs. Getting back to fructose. This is the issue I talked about and that sugar story is the worst that people have been allowed more or less to say about sugar is maybe is it‟s empty calories. White sugar (sucrose) is half glucose, half fructose. And high fructose corn syrup is 55% fructose, 45% glucose. It might actually be a little more. It‟s supposed to be 55-45. Most human studies have shown, all human studies have shown that the biological effects of these two seem to be identical. So when I talk about sugar I‟m talking right now about both the sort of sugars we use it in, you know, we put it in our tea and our coffee and also high fructose corn syrup. The glucose molecule goes into our blood steam, simulates insulin secretion and is oxidized and used for fuel by virtually every cell in the body. The fructose is mostly about 90-95 percent metabolized in the liver. It‟s fundamentally different. The pathway by which it‟s metabolized is fundamentally different. The place at which it‟s metabolized is different. It makes the liver do more work than just eating a starch which will break down to glucose only. The idea and I quote Dr. Robert Lustig who was at the University of California, San Francisco in this lecture he gave at Sugar: The Bitter Truth which was viewed at the time I wrote the article about 900,000 times and the year and a half since it came out. I think now that number has probably close to doubled. The phrase that Lustig uses is isocaloric but not isometabolic which means you can have the same amount of calories from fructose or glucose, or fructose and protein, or fructose and fat but you‟re going to have an entirely different metabolic fate. And that metabolic fate is going to determine the hormonal response and that hormonal response is going to determine among other things how much fat you accumulate. So this idea that it‟s only about calories that it‟s just all calories are created equal. Well, yeah, in terms of the energy in the calories, yes. That has to be. But in terms of the fate of the nutrient downstream entirely apart from the caloric content, the same amount of calories of different nutrients will have a dramatically different effect. 14 Fructose, in it‟s way, seems to be the worst carbohydrate because of what it makes the liver do which is convert it into fat. And then you get fat accumulation in the liver. The latest data suggest – I believe it but you really need far more definitive tests than we‟ve seen so far that the fructose content in sugar and then the sugars because of that are the fundamental cause of this condition called insulin resistance. That‟s where you become resistant to the insulin you secrete so you have to secrete more and more insulin. Insulin resistance is at the heart of this metabolic syndrome and that could be called sort of a paradigmatic disease of Western civilization. It‟s the pathway home. The metabolic syndrome can be perceived as sort of the step on the way to obesity, the diabetes, the heart disease, and probably even to cancer and likely even to Alzheimer‟s disease. All of these diseases are associated with metabolic syndrome. You‟re at a higher risk if you have metabolic syndrome or you‟re obese or you‟re diabetic. It looks like sugar could be in effect the fundamental problem with Western diets. I‟m not going to absolve the other refined carbohydrates because I think they can play a role too but it‟s possible that if we never had sugar in our diet – you could go back in history and remove refined sugar. I‟m not talking the small amounts you find in fruit. I don‟t know what the reality is with things like honey and maple syrup because it‟s complicated but just refined sugars where you take the starches in sugarcane or beets or corn and refine and distill them down to all kinds of wonderful chemical process until you have this sort of refined little piece of sweeteners so those refined sugars are the cause of all the chronic disease, the major chronic diseases that kill us in the United States today. And it‟s possible. DM: It sounds like you‟re in agreement that fructose maybe the single biggest culprit which is Dr. Lustig‟s contention.
GT: Yeah. Although the place where I disagree with Rob and we‟ve talked about it is we never really get fructose alone.
GT: We always get it with glucose attached. That‟s the system you‟re looking at. The glucose stimulates insulin secretion. The presence of the glucose also affects the way we metabolize the fructose in the liver. What differentiates the whitest flour from sugar is the fructose molecule and it‟s the fructose that makes it worse but then you have to ask the question – and this is where these scientists get complicated – what about fructose alone? What if we just use fructose as a sweetener? There is a line of products in Australia now pushed by Jennie Brand Miller who is one of the leading proponents of this idea, the glycemic index. They use fructose as a 15 sweetener. Because fructose doesn‟t stimulate insulin secretion it has virtually no glycemic index. So it‟s the lowest glycemic index carb you can find. But the only way you would ever get it where you didn‟t have other carbohydrates attached is if you used it to sweeten butter or the meat products, something that didn‟t have other carbs in it. If the product has other carbs even using fructose as a sweetener you‟re still going to get it with glucose that stimulates insulin secretion. It‟s complicated. But one way or the other, it‟s the sugars that are the problem and the fructose that makes those sugars different from other refined carbohydrates. DM: Sure. You just touched on it. It is a confusing part of the equation is that there is – I think Jenkins is the guy that popularized in the 70s is the glycemic index. He‟s out of Canada. I think there is probably some value to it. I believe you‟re not in favor of that for just the reasons you mentioned. Even though it doesn‟t cause insulin to be secreted, it increases insulin resistance maybe not immediately but certainly down the road with prolonged use. GT: With the fructose, yeah. That‟s the issue. I talked about this in Good Calories, Bad Calories because this glycemic index which – just to define it briefly is a measure of the blood sugar rise and effect after consuming a set amount of a food, a hundred grams of usually a carbohydrate rich food. That‟s the reason you don‟t want your blood sugar to rise is you don‟t want the insulin secreted afterwards. Fructose doesn‟t count in blood. It doesn‟t go into the bloodstream. It goes directly to the portal vein into the liver. It doesn‟t raise blood sugar. It doesn‟t stimulate insulin. It‟s got this very – in the short term, as you pointed out. It‟s got very low glycemic index. When this concept came down in the 1980s it was popularized, the American Diabetes Association immediately said, then fructose is good and sugar is good for diabetics because of the relatively low glycemic index since half the carbohydrates in sugar are fructose. The corn refiners producing high fructose corn syrup sort of pounced on this and used it – they talked about high fructose corn syrup as though it was only fructose to give the impression that it was something entirely different than sugar (sucrose). To portray it, they would talk about fructose as fruit sugar. Fructose is found naturally in fruits and vegetables in small amounts. So they made high fructose corn syrup look like this healthy product that was entirely different from sugar. I believe the reason we started consuming more and more of what the USDA calls caloric sweeteners which is sugar and high fructose syrup total in the 1980s was because the corn refiners did a very good job of never having us realize that they were marketing another kind of sugar so we just ate more and more of it. Like I said, foods in which fat was removed and high fructose corn syrup put in to replace it like the low fat fruity yoghurts were portrayed as health foods. They still are today. 16 You can take a little out of a food, put in some sugar and you have what the U.S. government considers a health food because it‟s low fat. So we ate more and more sugars total. We got fatter and fatter. We got more and more diabetic. What I pointed out in this New York Times magazine story and in my book is one of the disorders that‟s associated with being obese or diabetic having what‟s called insulin resistance, high levels of insulin is cancer. It‟s clear that the hormone insulin actually promotes cancer growth as does insulin-like growth factor. I interviewed some very prestigious researchers including the president of Memorial Sloan-Kettering Cancer Research Hospital in New York. It‟s probably the most prestigious cancer research hospital in the U.S. if not the world and these people don‟t eat sugar because they don‟t want to get cancer. The idea if it‟s a sugar that causes insulin resistance and that‟s what causes your insulin levels to go up. It doesn‟t matter if the fructose doesn‟t stimulate insulin in the short term it causes the elevation of insulin in the long term. The more insulin you have in your blood stream, the more an incipient tumor cell is going to be driven to becoming a full blown malignant mess. DM: Thank you for explaining that. Let me just comment on that. I really appreciate your insights on the medical scenario that the researchers are saying that people are dropping very rapidly and we really don‟t have time to look at this really carefully. I think when you commented on it you mentioned that it really wasn‟t justification to not do the research and I agree but at some point you can rely on earlier research. Some of which you quoted like that was done in the 40s and before that really purport to what appears to be the truth and worked on some evidence. As you also mentioned a lot of the studies haven‟t really been done definitively to prove this fructose hypothesis. One of the researchers on this area is Richard Johnson. I‟m sure you‟ve interviewed him in the past. He‟s out of Colorado. His hypothesis is that it‟s the total grams of fructose. The reason I‟m mentioning this is that I‟m kind of buying this hypothesis hook, line and sinker and I think it makes a lot of sense and we‟ve got a lot of historical evidence to go forward with it and really promote and educate people on it and that to really limit our fructose because if you go back a hundred years the average person was rarely consuming more than 25 grams of fructose and probably closer to 15 and now the average person is consuming 75 grams. So all this lead into the comment which and I get a lot of opposition on it on my site from people who think that fruits are healthy because they‟re natural and you can have as much as you want. My conclusion is and I agree with Johnson on this is that fruits are okay but it‟s only in a person who is eating a healthy diet. 17 So if you‟re a typical American, you‟re consuming 75 grams of fructose or a teenager who is consuming 150 grams, the last thing you want to do from my perspective is add more fructose in the form of fruit even though it‟s healthy and the absorption is slowed somewhat by the pectin and fibers in there. It‟s still going to contribute to the total fructose load. I‟m wondering from your review of the literature and your perspective on it what your thoughts are on that.
GT: People are horrified, as you know, if you go against fruit in this climate. I try not to – what I want to say would you just show me one randomized control trial where people are randomized to more fruits and vegetables versus X whatever they‟re replacing it with. And they actually lose significant weight or any weight. It‟s a belief almost like a religious belief. We think that if Adam and Eve ate fruits and vegetables, they have to be good for us. I eat a lot of green vegetables more than anything because my mother told us back then, told me to eat my green vegetables in the 1960s so I‟m going to do it. The fruit, you compare an apple and I do this Why We Get Fat, you compare an apple to a potato of roughly the same weight and the potato has a little more glucose, the apple has more water, but the apple has more fructose. If I‟m going to say the potato is fattening it‟s quite likely that apple is just as fattening. It‟s not a little more. The difference between I think what you guys are saying and what I believe – I know Rick well. I‟ve had dinner with him in Denver. He‟s a very smart erudite guy. He‟s really been doing some good research. Once you‟re hyperkalemic, once your insulin levels are elevated and you‟ve got insulin resistance, you‟ve got metabolic syndrome, you‟re overweight or obese and now we‟re talking about two-thirds of Americans. I think you‟re better off if you get rid of, you know, you‟re probably better off eating the apples, oranges, etc than white bread but the question is are you better off – will you lose significant weight if you‟re still eating for instance low fat relatively high carb diet even if the fruit is coming from – you‟re not drinking the Cokes and any other sources of fructose. Is a fruit smoothie – let‟s say the only thing you do all day long is have a fruit smoothie in the morning. Are you going to be able to lose weight? Even if you‟re trying to cut calories because you‟re still getting – it‟s a fairly dense source of carbohydrates and as you put it, there is fructose in it. It‟s going to increase your fructose load. The question, I don‟t know. I have reason to believe from my research tells me especially for obese individuals they‟re probably better off getting rid of most fruit. You know the Paleo people and the carb restriction people, we end up with berries because they have a low fructose content. They have a lot of fiber so they have a low GI. These fruits are good. One of the arguments, yeah, we evolved eating fruits but the fruit we evolved to eat is entirely different than the kind of fruit we eat today. 18 I talked to Nassim Taleb, a financier who wrote the great book The Black Swan who is a big believer now in carb restricted diet. Nassim grew up in Lebanon. The fruit he had in Lebanon growing up was sour. Even the oranges were kind of sour. What we‟ve done is we have bred them to be sweeter and juicier and that means increase their fructose content. We make them available all year round instead of seasonally when they would have been available in the Paleolithic era. We don‟t have to compete with birds and other animals for the fruits so we can get it when it‟s at its ripest and not worry about somebody else having to eat most of it, some other species having consumed a lot of it first. So we get the much greater amount of fruit than we used to. We get it juicier and sweeter with more fructose. Again, I think, on some level it‟s going to stimulate insulin secretion and that‟s going to make it more difficult – that‟s going to push you towards storing far rather than burning it for fuel. I‟ve been pilloried for saying this as well. No matter how carefully I try to couch it.
DM: I routinely get significant numbers of individuals who strongly and vehemently disagree with me and post their comments on the board of my site. I don‟t feel too bad if they‟re also (indiscernible 30:01).
GT: The problem is that people are disagreeing. This is another phenomenon. The world is full of these lean, healthy, muscular, marathon running, bike riding, century riding athletes or exercise physiologists who think, first of all, that fat people are fat because they just don‟t have the willpower to workout as much as these people as I do. That‟s what they‟re saying. They think whatever I can do, overweight and obese people can do. Whenever I‟m out – again, I was in Aspen at this Aspen Ideas festival. There are all these (indiscernible 30:37). I was talking about sugar. I have been invited because of the Times Magazine cover but it‟s full of all these – I tell my friends I‟m hobnobbing with the upper wizards of the stratosphere. Sandra Day O‟Connor is there and columnists from the New York Times, Obama‟s chief strategist. I thought I was approaching different policy people trying to get them – and luckily some of them had come to hear my sugar talk and then I was approached and I was trying to get them to understand the arguments I have been making because I think they‟re crucially important to getting a handle on both personal obesity and the obesity epidemic. Whenever one of them was like lean and fit – I knew that they were going for a hike later in the day or a run or a bike ride. I‟m going to have more trouble because these people are inherently going to believe that what they do is what everyone should be doing and if everyone did it nobody else would be fat either. It‟s just the human 19 perspective. So the people I bet who are commenting, they‟re probably the same people who attack me for saying this and they‟re not people with weight problems. One of the arguments that I‟ve been trying to make is that people are predisposed to store excess fat on their bodies, are different than people who aren‟t. And that lean people have to understand that. Because until they do, they‟re going to be giving the obese people the wrong advice and nobody wants to take advice from obese people. It‟s sort of I get this on – there is a photo on the internet if you search me where this blogger from New Jersey who works for – I forget the fellows name but he‟s a vegetarian diet doctor. I was lecturing in New Jersey and there was a photo on the web where he circled my waist and written „doughy!‟ because he believes I‟m doughy which I wasn‟t. Therefore that means I don‟t even have the right to talk about this stuff. I could have weighed 400 lbs and reduced down to 220 and still been heavy in which case I would have more right to talk about this than any human being alive. So it didn‟t even matter. The question isn‟t whether I‟m doughy then, it‟s how much doughier I would have been had I not changed the foods that I eat so that I‟m not eating the fattening ones anymore. Those of us who store calories as fat are different than those of us who can remain lean effortlessly. DM: It really is great to have individuals like you who are so committed and sincerely finding out the truth and taking the time, effort, and energy to review the research and talk to the people who are doing the research and really come up with some solid advice to guide us with reasonable and rationale recommendations. It‟s a useful component. I think we‟ve hit the fructose and the sugar one well. It‟s sort of an extension when you were previously talking about fat, is the saturated fat. I‟m sure you‟ve looked at that. Actually, before we go into the saturated fat, I‟m wondering if you believe the total fat myth is actually starting to wane. Obviously, it still persists as best exemplified by the recent food dietary guidelines but do you think we‟re making improvement? Is it more and more of the experts or the researchers or the media is starting to hold credence that it may not be this low fat approach that‟s the most helpful. GT: Yeah I do. I‟ll give you an example first that delighted me this past week. Again, there I am in Aspen at this Aspen Ideas Festival. It‟s held at this glorious think-tank called the Aspen Institute. They have this place where you check in. They have coffee laid out in the morning and tea. They had cream and milk. No low fat milk, no reduced fat milk and they didn‟t even have half and half. I thought, My God this is the best…I took a photo and I put it on my blog. If we‟ve gotten to the point that we‟re getting away from reduced fat milk then the idea that a low fat diet is a healthy diet is beginning to wane. I do think that‟s the truth. Like I 20 said the problem is that the government is still stuck in this position where they don‟t believe that, you know, it gets too complicated to tell people you can eat more saturated – less saturated, they still think saturated fats are killers so we want to get saturated fat down and monounsaturated fats and polyunsaturated fats up. We don‟t want to tell people to eat less of any food because that alienates constituencies of whoever produced that food. So we can‟t say eat less butter. As I have pointed out, most animal products, the primary fat in animal products is actually oleic acid. The same monounsaturated fat in olive oil that we‟re telling people to eat so that gets complicated. So instead, we just say eat less fat. If we eat less fat and there is a sort of general kind of anti-meat-egg message then people will cut their saturated fat because of it. Michael Pollan, I disagree with him on much of what he says but he‟s got a long way to getting the intellegentsia to accept that the lipid hypothesis is simply wrong and he gives me credit for that which is nice. So yeah, I think the low fat message in general is spreading but that‟s also different than believing that a high fat diet is a healthy diet. DM: Sure. Well, it‟s a step in the right direction.
GT: It is a step yeah. DM: Along those lines is the saturated fat component because there is – I really appreciate your comments on this because you‟ve looked so carefully at the literature that there seems to be some fairly compelling scientific support for the assertion that saturated fat will increase your risk for all sorts of diseases including heart disease. So there is a strong – even stronger than it appears to be that people should lower their fat intake in general is that saturated is just vilified.
GT: That‟s the latest dietary guidelines is lower your saturated fat. We‟ve told you 10%, now make it 7% of all calories. DM: It‟s even getting worse. I‟m wondering if you disagree with that concept and if you do, what your explanation for it and how this scientific finding could be off. My take on it was that they had never separated the reasons that when they looked at saturated fat analysis or dietary analysis they never separated the trans fat and some of the other damaged fats that occur when you heat these oils. GT: That‟s possible but I think – first thing, it‟s the thing that the establishment, the American Heart Association, the USDA can hold on to. Particularly if they don‟t do any good studies to establish whether or not it‟s true or not then you can always hold on to this belief. So they could always say it‟s saturated fat. I don‟t know, if you remember the Women‟s Health Initiative. This huge 49,000 women randomized to low fat diets versus conventional diet. It runs for seven years. It cost 21 about half a billion dollars. No effect – the low fat diet had no beneficial effect on weight, on heart disease, on diabetes, on cancer, on anything. So the response was well, we just told them to eat less fat. We didn‟t tell them as we now would to eat less saturated fat and more monounsaturated fat to get more omega3. So it was a very nuance study and we don‟t have to pay attention to the findings. So this is one way they could hang on to it and they are. The other thing is if you do an observational study, remember this is what got me into this, you follow some huge population of people and one of the biggest ones now being done is a joint study between the American Association of Retired Persons, The National Cancer Institute, 500,000 retired Americans. They probably have been followed going on 20 years now and you look at what these people are eating and then you look at their mortality and their disease rates later. What you find is that the people who eat – the more vegetables and the less meat you eat, the longer they lived and the less disease they get, the less heart disease, diabetes and cancer. If the protein sources come from vegetable sources instead of animal sources, you‟ll find the same result. This is used to support the belief that for heart disease, the least of the problem is these saturated fats in the animal products as opposed to the mostly unsaturated fats in the vegetables. This is what we do these days. These studies make the front pages of newspapers. They‟re out there. They‟re coming out every week. And we do these studies because they‟re relatively easy to do. And they‟re relatively inexpensive. They don‟t cost half a billion dollars like the Women‟s Health Initiative diet trial did. They only cost a few tens of millions. The problem is they tell you nothing about what‟s cause and what‟s effect. In effect, the more vegetables and less meat you eat associating with lower mortality less disease – as one friend of mine put it, it is as though they are comparing – I live now in the Berkeley area in Northern California. It says, as though they‟re comparing vegetarians at Berkeley who eat at (indiscernible 40:40) everyday and go for a hike, you know, every other day in the mountains to rural truck drivers from West Virginia whose idea of a gourmet let‟s go out to eat tonight meal is Denny‟s because that‟s all they‟ve got. Over the last 30 years, people who tend to eat more vegetables products – let‟s say, people tend towards vegetarianism are more health conscious. They‟re better educated. They are a higher socio-economic status. They‟re probably healthier to begin with. They have a whole slew of healthy behavior. So not only do they eat more vegetables and less meat. They basically do what they have been told to do since the late 1970s but they do that in a lot of ways. So they eat less sugar and they eat less refined carbs. They‟ll eat whole wheat bread instead of white bread. They‟ll brown rice. And all these little effects. Some of them could be big effects like the sugar, are going to add up so that by the time you look at 22 the end result these people are healthier. They started out healthier. They have better doctors along the way too and they end up healthier. And then what the researchers do is they say, well it‟s the meat and the vegetables that are causing the effect we see. The other thing you could do is do an experiment. This is an observation. Again, I think of myself as a kind of big fan of good science. So I like experiments. Actually, one of my favorite books on science was a book written in 1865 by the great French physiologist Claude Bernard. He says look you have these observations, if you want to find out – and you form hypotheses based on the observations. So I see this in nature and then I want to come up with an experiment that will confirm whether what I think is happening is really happening and establish what the causes of what I see. You could say here and what do observational studies do? They‟re observations so they allow you to form hypothesis. The better researchers in the field refer to these studies as producing hypothesis generating evidence. So my hypothesis is that if you eat more vegetables and less meat and less animal fat and less saturated fat, you‟ll have a low rate of heart disease, a low rate of diabetes. So now we could do an experiment. An experiment is a randomized controlled trial. So I‟m going to take some group of overweight and obese subjects and I‟m going to randomize them into two groups. One group is going to get a very healthy high carbohydrate diet with fruits and vegetables and whole grains and skinless chicken breasts. It‟s going to be low in fat and low in saturated fats. The other group is going to get a high saturated fat diet with very low carbohydrates. When we do that and those experiments have been done and they have been done for as long as two years. My hypothesis is that the group getting the high saturated fat, high animal product diet is going to drop dead right? When you do that study what you find is not only do they lose weight even though they are told to eat as much as they want. Their heart disease risk factors improve. Their diabetes risk factors improve and they improve far more than the people eating what we think of as a healthy diet which is rich in carbohydrates and starches and low in fat and low in saturated fat. This is what got me into this crusade which is if you just look at the experiments which we can have some faith in. I mean they could be done wrong too and I would do them differently if I did them but if you look at the experiments, a high saturated fat diet is a healthy diet. That‟s the best evidence we have. It doesn‟t matter if it contradicts what you have been saying for the past 40 years. If you don‟t like it, do a better experiment. Don‟t ignore the results. DM: How do you account for the decades of previous studies which seem to provide fairly clear substantiation for the saturated fat as harmful hypothesis? 23 GT: Remember, there actually weren‟t. Those previous studies never actually confirmed the hypothesis. DM: Okay so there is a confusion. So it just continues to be held as this belief that‟s referenced in these journals but there is really no good support for the whole hypothesis to begin with.
GT: What happened is, again, I lectured at the NIH a couple of years ago and afterwards I had – just talking to a guy who ran a childhood obesity program at – NIA funded childhood obesity research and program. He said their primary concern with obese kids is to keep their saturated fat content down because these kids are going to be at high risk of heart disease as they get older. He said there are thousands of studies showing that this is the thing to do confirming the evils of saturated fat. I said to him, the difference between you and I is I actually spent a significant portion of my life reading those studies and getting them all. In 1984 when there was a consensus conference by the NIH saying every American over the age two should eat a low fat diet. There were actually about eight or nine studies and we discussed six or seven of them earlier in our interview. They could never show that eating a reduced saturated fat diet would make you live longer. It might reduce heart disease rates. It did in some studies but it increased cancer rates. And then since 1984 there have been about another dozen that are relevant on – I mean often they‟re done – people are put on low fat diets not because they‟re looking at heart disease risk factors because even the researchers who did the studies assume that these people are going to be healthy. But they might be looking at something else like cancer. When you look at the meta analysis that have been done looking at these issues and a couple of them came out in the last two years, the results is always the same. There is not enough evidence to say that saturated fat is bad for you and there has never been that evidence. DM: That‟s a very powerful statement. Most of us don‟t have the scientific training and education and the time which is probably the most crucial variable to really sit down there, read and digest it and come to that conclusion. I mean there are very few people who really have that opportunity. You‟re clearly one of them. To hear your analysis of all those thousands of hours you‟ve put in to doing this evaluation is greatly appreciated.
GT: Thank you. You know, I hate writing, research I enjoy. Research is a great procrastination tool. As long as you keep reading papers and interviewing people, you don‟t actually have to sit down and write.
DM: There you go. I really thank you for all you‟ve been able to share with us. Are there any other items that you would like to expand on or mention? Actually, there is one before you answer that one that I just kind of expanded because you alluded to it with 24 your comments on Stamler from Northwestern in Chicago in addition to being a proponent of this low fat hypothesis. He also proposed this low salt approach which I believe preceded your work on the low fat. I‟m wondering if you could comment on that and also the current state of low salt being healthy. Is it a similar state that we are with low fat? In other words, there is a progression towards realizing this was a myth and a mistake and that we actually need salt. I‟m wondering if we can dialog about that.
GT: It‟s funny because – again, I was in Aspen. I was talking about sugar and my session was Sugar: The New Killer Nutrient. There was a session that I wasn‟t speaking at. Salt: The Deadliest Nutrient or the deadliest dietary factor? What I was trying to explain to the fellow who was actually moderating the salt session is Ezekiel Emmanuel, this bioethicist, is that the data on salt has always been terrible. Basically one study has managed to show that a salt restricted diet will lower blood pressure by any significant amount. It‟s called DASH sodium and a DASH diet which they used which everyone pushes now will say is that I think maybe it was U.S. News and World Report that recently pushed DASH as a sort of the healthiest weight loss diet according to nutritionists even though it‟s not a weight loss diet. The DASH diet is very low in fructose. This is something I pointed out to Rick Johnson because Rick is a nephrologist. His interest has always been hypertension. I pointed out to him about four years ago, I said, you should look at the DASH results because DASH is a low sugar diet. It‟s a low fructose diet. That‟s what it fundamentally is. So after 40 years have come to this, basically one study in which they refused to release by the way all of the data on the study. They were challenged. They were even sued to release it. One study suggesting that salt is the problem. One of the things people talk about it enough such as (indiscernible 50:33) like this fellow Stamler, failed in study after study after study to link salt to heart disease but eventually it becomes the conventional wisdom. The NIH, the USDA gets on board. Other government agencies get on board so it becomes sort of the deadliest nutrient with no evidence, no meaningful evidence to support it. It directs attention away. Something causes high blood pressure and hypertension. The point I point out in my book is that hypertension is associated – obesity, if you look in the textbooks, they refer to it as a hypertensive state. Gout is a hypertensive state, heart disease. So that‟s why we want to avoid hypertension because of heart disease and stroke. They‟re associated with hypertension – diabetes, high blood pressure, hypertension. The simplest possible hypothesis is whatever causes all these diseases causes hypertension too. The way we think about it now is you get fat because you eat too much. You get heart disease because of saturated fat. You get diabetes because you‟re 25 sedentary. You get hypertension because of salt and you get gout because of meat and alcohol. Yet hypertension is a common condition on all of them so maybe it‟s something else. Rick Johnson has been pointing that uric acid that he thinks is the fundamental sort of defect in this system which I won‟t get into on that. Gout is an accumulation of too much uric acid in the blood stream but insulin, the hormone insulin regulates all of these things including having a fundamental effect on blood pressure. So you raise insulin levels, you raise blood pressure. So your simplest possible hypothesis is once again it‟s the carbohydrates from the diet and the sugar and the refined carbohydrates that raise insulin and in turn raises blood pressure, causes hypertension, causes obesity, causes diabetes, causes heart disease. The funny thing is the research community doesn‟t like these sort of unified theories because it makes you sound like a quack. And yet, if you put – remember these clinical trials where you put somebody on a high fat, high saturated fat but low carbohydrate diet without sugars and not only all their heart disease risk factors improve and their diabetes risk factors improve but their blood pressure drops. It drops just as much on those studies as it does in this DASH-sodium study. It‟s kind of a crazy situation like my job – what I‟m trying to do is to get the medical research community and these public health authorities is look at this evidence and look at it in this unbiased perspective. If you do that everything implicates the carbohydrates. DM: Yeah. So do you think you‟re making progress on that and you‟re being invited to more and more influential committees and researchers and they‟re listening to what you‟re saying and your analysis of the literature? GT: Weirdly enough yes. I mean does this mean I‟m going to succeed? I‟m still pessimistic. It‟s funny, they are the biggest online publisher of scientific journals has been putting together a conference based on my research, on my ideas. I don‟t even know how many of the people involved in the conference now know what stimulated it. But they read my book and said this is amazing. We‟d like to have a conference. What can we do? We‟ve discussed the executive committee was, you know, a couple of Nobel Prize winners on the executive committee. These people are people who think it‟s important and they want to be able to link – go for it, have a conference that goes everywhere from the diet through insulin and insulin resistance through all these diseases that are associated with heart disease, cancer, Alzheimer‟s. So you get the whole link instead of just the disease or just the mechanisms of insulin resistance. People, slowly but surely, I hear from researchers who have read my books. Who say, I think you‟re right. I have changed the way I eat. Even in Aspen, I had people come up to me and say, I just want to say you changed the way I eat. I believe you‟re right more 26 than I believe my doctor. But that‟s still a long way from getting these huge institutions to shift.
DM: Well they have so much control over the social consciousness because that‟s what they‟re being bombarded with on the news or any magazine they pick up. It‟s the same messages that are being repeated continuously and reinforced. GT: That‟s the things with my plate. They have fruits and vegetables. I think is maybe a quarter, you know, whole grains and then a quarter protein they call it. It‟s a low fat, high carb plate, USDA dietary guidelines. These people have much greater effect. The sugar message, the fructose message will probably get across more. The sugar industry will do everything they can to try and keep it from ever being an official government message. But people don‟t mind when you go after sugar. They mind if you start telling people that fat is good or animal products are good.
GT: They can believe that sugar is bad regardless. People can get behind that regardless of their beliefs on these other issues. DM: Terrific. Do you have any other comments you would like to make on that or you provided a very comprehensive analysis of your work and I really appreciate that. GT: This has been great. Probably an hour from now I‟ll go, I wish we had talked about this.
DM: We can always do it again. I‟m going thank you very much for this interview. I really appreciate and want to thank you personally not only for myself but for the impact you‟re making and influence on the culture and really pushing us in the right direction. You know, I have been passionate about health for over three decades. I went to medical school to try to understand it better. There is no doubt in my mind that one of the most profound physical impacts you can have on your health is the food you eat, far more than exercise. I mean not that you shouldn‟t exercise but clearly it‟s the diet that‟s the chief criteria. You‟re really doing a lot to help really eradicate some of the destructive myths that have been permeated for the reasons you mentioned in the interview so thank you for that.
GT: Thanks. And yeah, I agree with your by the way, that‟s the one point we didn‟t talk about. But you put it beautifully which diet has such a huge effect. I think the basic thing, my beliefs about the real benefit, you know, it makes you feel better. I do it religiously. It makes you look better to some extent but I think really the real benefit of exercise is if there is one in terms of chronic disease and mortality is protecting us from the damage, ameliorating the damage we‟re doing with the diet.
DM: Yes, absolutely. 27
GT: So if we get the diet right, the benefits of exercise are much much smaller because you don‟t have to ameliorate all these damage. It‟s just not being done to begin with.
DM: Absolutely. Thank you for that.