Of all the dangerous ideas that health officials could have embraced while trying to understand why we get fat, they would have been hard-pressed to find one ultimately more damaging than calories-in/calories-out. That it reinforces what appears to be so obvious—obesity as the penalty for gluttony and sloth—is what makes it so alluring. But it’s misleading and misconceived on so many levels that it’s hard to imagine how it survived unscathed and virtually unchallenged for the last fifty years.
It has done incalculable harm. Not only is this thinking at least partly responsible for the ever-growing numbers of obese and overweight in the world—while directing attention away from the real reasons we get fat—but it has served to reinforce the perception that those who are fat have no one to blame but themselves. That eating less invariably fails as a cure for obesity is rarely perceived as the single most important reason to make us question our assumptions, as Hilde Bruch suggested half a century ago. Rather, it is taken as still more evidence that the overweight and obese are incapable of following a diet and eating in moderation. And it puts the blame for their physical condition squarely on their behavior, which couldn’t be further from the truth.

Gary Taubes from Why We Get Fat

While trying to catch up on my reading before piles of Financial Times, New York Times and Wall Street Journals consume our living space, I came across a review of Donald Rumsfeld’s book, Known and Unknown.  The title of which was taken from one of his orotund responses to a reporter about the various kinds of knowledge we have.  Said he:

There are known knowns. These are things we know that we know. There are known unknowns. That is to say, there are things that we know we don’t know. But there are also unknown unknowns. There are things we don’t know we don’t know.

Mr. Rumsfeld believes the last of the above, the things we don’t know we don’t know, is the most problematic.  I disagree.  I think the first gets most people in trouble most of the time.  And this includes Rummy himself.

It ain’t so much the things we don’t know that get us into trouble. It’s the things we know that just ain’t so.

So opined Henry Wheeler Shaw (AKA Josh Billings), who said it a lot more memorably well over a century ago in a quote often misattributed to Mark Twain, Will Rogers and others.
One of the things countless people ‘know’ that just ain’t so – or at least that ‘just ain’t so’ as they think they know it – is that people get fat because they eat too much or exercise too little.  In the minds of many, it’s all a matter of calories in versus calories out.  Which is a really meaningless statement of the problem, but which leads inexorably to the conclusion that people get fat because they are either gluttonous or lazy or both.  The so-called Gluttony and Sloth model for obesity.
Why is the calories in vs calories out notion so meaningless?  If more calories come in than go out, you gain weight, and if more calories are expended than come in, you lose weight.  Seems reasonable.  It’s a bewitching notion, because it is absolutely true but at the same time absolutely meaningless.  It tells us nothing.  Let me digress to explain using a painful example from my own past.
Almost 20 years ago I singlehandedly dragged my family into the restaurant business.  I bought a franchise for a Mexican food place. (If you’re interested, you can read more about it here.) I recruited (read: dragooned) all our children to operate it, and despite all our best efforts, the venture ended in disaster.  But during the run, I spent a lot of time in the restaurant.  And one of the constant conversational threads was why it was or wasn’t busy at any given time.  We would have a Saturday afternoon during which few people came in.  As a consequence, the next Saturday we would schedule a skeleton crew, and we would be slammed.  Then someone would realize that there was a Razorback football game in Little Rock that weekend, which would explain it.  Or so we thought. Sometimes for no apparent reason we would have people swarm in.  There would be a line out the door with more showing up by the minute.  We would all be working like dogs to get everyone served, all the while saying to ourselves and to one another: What the #$&**!!# is going on? Why are we so packed?
Now imagine if during one of these rushes, one of us had said, It’s really quite simple:  we’re so crowded because there are way more people coming into the restaurant than there are people leaving.  We all would have looked at the person uttering such nonsense as if he/she were the village idiot.  But the statement is absolutely 100 percent correct.  That’s why we were so busy.  More people coming in than going out.  But it doesn’t really answer the question at hand.  What we want to know is why so many people are coming in?  A Razorback game? A big sale at the department store next door? A good review in the paper that we weren’t aware of? A bus full of people broken down outside the front door?  Why are there so many more people coming in than going out? If we could figure out the why, then we would have an easier time scheduling staff.*
It’s the same with the calories in/calories out notion.  If you’re fat, you’ve been taking in more calories than you’ve been expending.  No one would argue that.  At least no one with good sense.  But the question is, why?  Why have you been taking in more than you’ve been expending?  That’s the question you want to have answered, because only when you discover the answer can you figure out why you’re fat and what to do about it.
Gary Taubes has done the figuring and writes about it in his new book, Why We Get Fat And What To Do About It (WWGF).  As most readers of this blog know, a few years ago Gary wrote a long, detailed book on what we can call the Carbohydrate Theory of disease, titled Good Calories, Bad Calories (GCBC).  Now he has come out with what many think is a slimmed-down version of GCBC, called by some GBGC-Lite. But it’s not really a lite version of GCBC – it’s something much different.  I call it GBGC-Fat.  I would append the term ‘fat’ because it’s about fat – adipose tissue – and why so many of us struggle so mightily to rid ourselves of superfluous wads of it.
WWGF is a great primer on fat gain, fat loss and just about everything having to do with obesity.  I read GCBC three times, starting with the first manuscript version and ending with the actual book.  I’ve done the same with WWGF, so I can assure you that it is not a rewrite of GCBC, but is mainly new material presented in a much easier to assimilate way.  As many people have discovered, trying to get their doctors or other non-believers to read GBGC is a tough sell.  Few, who aren’t already converts, can summon the will to dig in to a book that large.  The new book is much less intimidating than GCBC, but just as compelling.  Even the title is better and more seductive.  Who wouldn’t want to know why we get fat?
In his efforts to ferret out why we do get fat, Gary, an obvious follower of the Samuel Johnson admonition that we more often need reminding of old truths than instruction in new ones, looks to the pre WWII scientific literature for the ‘old truths’ that are still valid. One of which is that carbohydrates fatten both livestock and people.  If you think about it, it’s difficult for the current crop of academics to intuitively grasp this notion, because they have been inculcated from the time they entered kindergarten with the ‘dietary fat is bad’ mantra.  That kind of deep-seated learning is hard to shake.  Especially so, since when today’s academics were students, their mentors, who had built their own careers (all way post WWII) on the very same mistaken notion about fat, wouldn’t likely have provided much inspiration for their young charges to change.
So, why do people get fat?  Let’s look at it as Gary does and start from the beginning.
When we talk about obesity, we’re talking about the excess accumulation of fat.  The excess fat is stored in the fat cells (adipose cells), which, collectively make up the adipose tissue.  With that as our starting point, where do we go?
If we ask how the fat gets into the fat cells, we will discover that all the pathways of fat storage were worked out years ago and are so uncontroversial that they’re described in detail in every biochemistry and physiology textbook currently in use.  It’s well known that the metabolic hormone insulin stimulates an enzyme on the surface of the fat cell that moves the fat into the cell.
So if insulin moves fat into the fat cells, it would seem that a lot of insulin would move a lot of fat into the fat cells.  And indeed it does.  Given this, the rational person trying to figure out the previous step in our progression would ask What causes a lot of insulin?  Or the rational person, should he/she have been steeped for a lifetime in the marinade of ‘fat is bad’ might ask, What about fat?  If there is a lot of fat in the blood as a result of fat in the diet, wouldn’t that fat get into the fat cell?  If so, then doesn’t dietary fat lead to fat?
A good question, but the answer is no.  Type I diabetics can have a lot of fat in their diets and in their blood, but if they have no insulin, they can’t store that fat.  In fact, most pre-diagnosis type I diabetics lose enormous amounts of weight despite eating ravenously because without insulin they can’t store the fat.  So dietary fat itself – even large amounts of it – won’t find its way into the fat cell without the help of insulin.
When you hack through the thicket of all the biochemical pathways involved in the metabolic process, you find that insulin is the primary force involved in the storage of nutrients.  Insulin is the body’s storage hormone: it puts fat in the fat cells, protein into muscle  cells and glucose into it’s storage form, glycogen.  Insulin, along with its counter-regulatory hormone glucagon (the Yin and Yang of metabolism), are involved in nutrient partitioning – the process of stashing nutrients away in different parts of the body and/or harvesting them for the body to use as energy.
If we have a lot of insulin, the insulin dominant-pathways (the storage pathways) hold sway, and fat is partitioned away in the fat cells; if insulin is low, then the glucagon-dominant pathways (the energy-release pathways) take over and start moving fat out of the fat cells, so it can be consumed by the body as fuel.  This is how it is supposed to work.  We eat.  Insulin comes out and stores away the energy.  We go for a while without eating, insulin goes down and glucagon comes out to retrieve our stored fat so we’ll have a continuous energy supply.
Problems arise when this system goes off the rails, which most commonly happens when people develop insulin resistance, a problem of disordered insulin signaling.  Insulin talks, but the cells don’t listen.  So insulin keeps talking louder until the cells finally get the message. In other words, the pancreas keeps producing insulin and the blood levels continue to rise until the cells finally get the message.  But it’s a message that has taken a lot of insulin force to deliver.
If all the different types of cells developed resistance to insulin at the same rate, we wouldn’t have as much of a problem.  But they don’t. Different cells develop insulin resistance at different rates.  Typically the first cells to become insulin resistant are the liver cells.  The liver cells are continuously producing sugar and dumping it into the blood.  Insulin shuts this process down.  If the insulin level drops to zero, as it does in type I diabetes, the liver dumps a huge load of sugar in the blood causing all the blood sugar problems associated with this disease.  Under normal circumstances, just a little insulin stops the liver cells in their tracks.  But if these cells are resistant to insulin, much more is required to get them the message to turn off the sugar spigot.
In most people, the fat cells develop insulin resistance later, which creates the problem.  If insulin levels are high to control the liver’s sugar factory output, then these elevated insulin levels are sending a strong message to the non-insulin-resistant fat cells.  The message is take this fat and store it.  High insulin not only drives fat into the fat cells, it prevents it from getting out.  Fat is packed into the fat cells and kept there.
Between meals when insulin levels would normally fall, allowing the liberation of fat to feed all the body’s tissues, insulin remains high in an effort to keep the liver in check.  Fat can’t get out of the fat cells, and the tissues begin to starve.  Even though there is plenty of stored fat, the body can’t get to it because elevated insulin is preventing its release.
Starving tissues send a message to the brain, saying ‘we’re hungry.’  The brain responds by increasing the drive to feed.  We eat, and the carbs we eat are consumed by the cells for immediate energy, and insulin stimulated by the dietary carbohydrate drives the fat into the fat cells where it is trapped with the rest of the fat already there.  The fat cell mass gets larger and larger, and we become obese.
The above scenario explains a lot.  Why can some people eat like crazy and not get fat?  Perhaps because they develop insulin resistance in their fat cells just as they do in their liver cells.  They don’t get fat, but they typically have all the other insulin-driven problems of the obese: high blood pressure, elevated triglycerides, increased risk for heart disease, etc.  And all while staying skinny.
How about morbid obesity?  Easy.  Those people don’t develop insulin resistance in their fat cells until late in the game, if ever.  They continue to push fat into the fat cells and become more and more obese until they weight 400-500 pounds or even more.  The average person will finally develop fat cell insulin resistance before the morbid obesity stage.  When this happens, weight and level of obesity stabilize and stay the same, almost irrespective of how much is eaten.
We now know why we get fat.  Excess insulin drives fat into the fat cells increasing the fat cell mass, ultimately leading to the state we call obesity. If we keep walking this progression back, the next question has to be, Why do we make too much insulin?
We make too much insulin because we eat too many carbohydrates, especially sugar and other refined carbohydrates.  With that statement, we’re starting to edge into controversial territory, but it’s only territory populated by the ignorant.  The hard science is emphatic that carbs are a pure insulin play.  Eat them and your insulin goes up.
Some people with a little learning may be quick to point out that protein drives insulin up as well.  This is true, but with a catch.  Protein drives both insulin and glucagon up, so you don’t have the pure insulin effect.  Only carbs will give you that.  With carbs, insulin goes up while glucagon goes down.  With meat and other proteins, the effects of the elevated insulin are muted by the concomitant rise in glucagon. (Glucagon isn’t called insulin’s counter-regulatory hormone for nothing.)
As Gary lays out the progression, carbs increase insulin, excess insulin drives excess fat into the fat cells, the fat cell mass grows, and we become fat.  This chain of cause and effect leads to the ineluctable conclusion that excess carbohydrate intake leads to obesity.  And each and every link forged in this chain is scientifically unimpeachable.
So if you are fat and want this progression to reverse itself, wouldn’t it make sense to reduce your carbohydrate intake?  All the science is valid.  But don’t just take my word for it. Gary writes of a former Harvard professor responsible for much of the early work in the field of the regulation of fat accumulation who summed it up like this:

Carbohydrate is driving insulin is driving fat.

If you put that in reverse, you should cut the carbs, reduce the insulin and lose the fat.  Seems simple, but here is where all kinds of controversy rears its head. Even the very smart Harvard professor who did the original work and uttered the above quote, when asked by Gary why there is so much obesity, responded that people didn’t exercise enough. Which also proves true what Saul Bellow wrote years ago:

A great deal of intelligence can be invested in ignorance when the need for illusion is deep.

As I’ve written numerous times in the pages of this blog, food is made of three things: fat, protein and carbohydrate.  When you decrease one, you typically increase the other.  If you cut the carbs, you’re going to increase the fat and protein in your diet.  And it’s the increased fat in particular that leads to all the controversy.
The current zeitgeist is that dietary fat, especially saturated fat, is bad.  And not just bad, but extremely bad.  So, even though they may understand that carbs drive fat storage, the ingrained fear of fat keeps many otherwise smart people from accepting the merits of the low-carbohydrate diet.  To escape the cognitive dissonance, they default to the calories in/calories out argument, which, as we’ve seen, is meaningless.  But they feel safe taking refuge in what they believe is a known known. More’s the pity since it will end up doing them about as much good as it did Rummy in the Iraq war.
Most rational people will find the above argument understandable and be able to connect the dots showing that carb intake leads to excess insulin leads to obesity.  The difficult concept for many to grasp, however, is the other problem with too much insulin: it prevents the stored fat from being accessed for energy. Normally adipose tissue acts as a reservoir of energy.  We eat, we convert the food we don’t immediately use into fat, and the body – acting via insulin – stashes it away for later.  When later comes, insulin falls, glucagon rises, and the body starts harvesting it’s stored fat to provide energy for all the cellular functions.  Then we eat, and the process starts anew.
In obese people it’s different.  They eat, they use the food for immediate energy needs and store the rest away.  In other words, they store excess energy away in their fat cells just like non-obese people do.  It’s the second part of the formula that is different.  In obese people, insulin is almost always elevated – even when they haven’t just finished a meal.  These chronically elevated insulin levels trap the fat in the fat cells, and, in fact, turn the fat pathway into the fat cell into a one-way street.  Fat can get in, but it can’t get out. If the fat does get out, the excess insulin tells the mitochondria not to burn it anyway, so it just gets sent back to the fat cells.
What does this mean for an obese person?
Let’s look back at the non-obese person to explain.  A non-obese person eats, uses the energy from the food and stores the rest.  During the time between meals and during sleep, the non-obese person draws on the stored fat to provide energy.  When the fat cell mass decreases to a certain critical point, the body signals the brain that the fat cells need a refill, so the brain initiates the hunger response.  The non-obese person eats, uses some energy for immediate needs, fills the fat cells with the rest, uses the stored energy as needed, and then the cycle repeats.
It doesn’t work that way in the obese.  Obese people eat, use the energy required for immediate needs and store the rest.  But–and this is the extremely important ‘but’– during the time between meals and during sleep, obese people can’t access their fat stores because their baseline insulin is too high.  When they can’t get to their stored fat, the lack of access to energy sets in motion all the same biochemical signals in the obese person that get sent in the non-obese, who have depleted the energy storage in their fat cells.  And these signals are converted by their brains into the drive to feed, i.e., intense hunger.  They have to eat to provide for their immediate energy needs because, thanks to chronically elevated insulin levels, they can’t get into to their own stored fat, even though it’s there waiting in massive quantities.
To use an analogy, it would be like being out of cash when you desperately needed it yet having a huge amount of money in the bank.  You hustle to an ATM machine and find your card won’t work.  It’s the same with the obese – they have plenty of energy to go without eating for months, but their fat ATM cards don’t work.  And since their fat ATM cards don’t work, the only option they have for immediate energy is to eat.
So fat people are fat not because they overeat – they overeat because they’re fat.
A real debt of gratitude is owed Gary for combing the old literature and ferreting out this notion.  As early to mid-twentieth century, researchers both in Europe and America had determined obesity is a disorder of fat accumulation, not a problem of ‘perverted appetite,’ self control, or gluttony and sloth.  Louis Newburgh, Ancel Keys, Jean Mayer and a few others were responsible for turning the herd thinking of academia in a different direction, and the ‘eat less, exercise more’ paradigm has been with us since. It’s doubtless not a coincidence that the obesity and diabetes epidemics have flourished as a consequence.  As I say, Gary deserves a lot of credit for resurrecting this old work and starting to turn opinion in the other direction.
In addition to the chapters describing and discussing the mechanisms by which we get fat, Gary has included other important material in his book.  One of my favorite chapters is the one titled “The Nature of a Healthy Diet.”  Although you wouldn’t know it from this title, the chapter fairly presents most of the arguments against low-carbohydrate diets and refutes them.  I’m sure many will find these refutations helpful in their dealings with naysayers, who seem compelled to point out non-existent problems with carb-restricted dieting.  There is one in particular that I plan to deploy at the next opportunity.  Since I have my own arguments against the rest of the anti-low-carb idiocy, it annoys me greatly that I didn’t think of this one myself.
Here is a scenario I often endure at a party or other get together after my identity as a diet book writer and low-carb expert has been revealed:
Other person, OP (typically an overweight female): I tried a low-carb diet once.
Me: (Dreading what’s sure to follow.) Oh, really.
OP: Yes, and it worked for a while, but I couldn’t stick to it.
Me: Oh, really?  Why not?
OP: Well, I felt tired and spacey headed.
Me: People sometimes experience those symptoms early on, but they usually resolve after a couple of weeks.  And there are steps you could’ve taken to prevent or minimize them.
OP: No, I don’t think so in my case.  I know my body, and I know what it’s telling me.  I’m just one of those people whose body needs carbs.  As soon as I started eating carbs again, I felt much better.
Me: (Fighting down the impulse to point out that she’s still fat…) Hmmm.  Maybe so.
Now, thanks to WWGF, I’ll know just what to say.  I’ll leave you with the relevant paragraph from the book along with my highest recommendation to grab a copy and read it.  I can promise you won’t be disappointed.

The more technical term for carbohydrate withdrawal is “keto-adaptation,” because the body is adapting to the state of ketosis that results from eating fewer than sixty or so grams of carbohydrates a day.  This reaction is why some who try carbohydrate restriction give it up quickly. (“Carbohydrate withdrawal is often interpreted as a ‘need for carbohydrate,’ ” says Westman.  “It’s like telling smokers who are trying to quit that their withdrawal symptoms are caused by a ‘need for cigarettes’ and then suggesting they go back to smoking to solve the problem.”)

* Full disclosure:  In the first draft of WWGF I read, Gary had used the crowded restaurant example to explain why the calories in/calories out explanation was so ridiculous.  It reminded me of our dismal times in the restaurant business, and I thought it was a brilliant way to demystify the problem.  In one of the later drafts I read, the restaurant example was missing.  I asked Gary about it, and he told me he and his editor had decided it wasn’t the best way to describe the situation.  I disagreed (probably because my financial wounds from the restaurant biz, though long past, were still painful) and told Gary I thought it was a terrific way to explain it and that if he didn’t use it, I would rip it off and use it as my own.  Although he has used the examples in lectures, Gary didn’t use it in the book, so, true to my word, I ripped it off as my own.


  1. Thanks! I found your blog after your last post, and was wondering if I had missed all the fun.

    1. Nah, you haven’t missed it all. I’ve got more posts coming. I just had a long and very busy spell in my day job as an appliance salesman.

      1. I have read with interest all you have said about resistant starch and think it is a farce. If this is so how do you explain the success of The Rice Diet. I have lost 25 lbs in about 2 months following it. With not a drop of protein, other than what is in the beans.

        1. The Rice diet, if it’s the same one I know, starts week 1 with 4 and a bit cups of rice. That’s about 180 grams of carbs. You have to compare that to what you were eating before – how high was the carb before? Likely double, triple or more.
          When you reduce carbs from what you were eating before you will lose weight.
          Are you moving more (they do mandate exercise)? That will metabolise the carbs a bit more efficiently.
          It’s a low sodium diet. Your first phase of weight loss will include a lot of water-weight as well. You can also lose muscle mass on this diet.
          So, let’s see what happens in a year – can you sustain the diet? It looks a bit boring to me but each to his own. How much weight will you lose? If you can’t sustain it, how quickly will you put the weight back in by increasing your carbs back to where they were before?

          1. Sue, I think you are thinking of the Original Rice Diet. The Rice Diet Solution is what they now call it and you begin with Phase one which is 2 fruits and two grains for all three meals on the first day. The second day is 2 starch and 1 fruit for Bk.3 starch , 3 veg. 1 fruit for lunch.3 starch, 3 veg and 1 fruit for dinner. This is for one week. Phase 2 is, the first day( and after that one day each week) will be a repeat of 2 starch and 2 fruits for all three meals. (they call this a detox day) The balance of the week is 1 starch, 1 one non fat dairy and 1 fruit for bk, 3 starch, 3 veg and 1 fruit for lunch and dinner. You do eat relatively salt free. You may have meat or fish for dinner one day a week. I lost this 25lbs three years ago, I do not exercise (I know I should) and I am 75 years old. This is the healthiest diet I have ever been on. and it works! Of course the starch is all complex starch.

          2. Wow, must be nice to have pancreatic function. I would need 9 million units of insulin for that diet (I’m a type 1 diabetic) and my blood sugar would be peaking and valleying like a cyclist on the Tour de France. My feeling is that that diet would only work for someone with perfect insulin secretion and insulin sensitivity – and I think such a group is a very small minority of adults in the US these days.

          3. I’m with you Wendy! I’d need a gazillion units of insulin as well! And if I miss the timing, I’d feel absolutely horrid until I got all that glucose metabolised. Yuk!
            Rob, thanks for the explanation. Still sounds awful to me!
            I’m still asking the same question, Rob – how many carbs were you eating before the diet compared to how many during the diet? A high carb diet can be switched to a relatively lower carb diet and you’ll lose weight.

          4. It is not awful if you prefer carbs to protein. I was never much of a meat eater, but ate all the wrong carbs. To tell you the truth I have never counted the carbs as they do not tell you to do that and I just eat till I am satisfied. It is the type of food I prefer…..well actually I would prefer pie, cake and ice cream…
            But this is a great way to eat for me. I do not have diabetes either so do not know how those people make out on it.

          5. No, actually, that’s not a healthy diet. You are missing all sorts of nutrients and it will catch up with you later. I’ll be very surprised if by the time I post this six months after your post, you aren’t beginning to suffer from mental health issues at the very least.
            The folate in the veggies will mask the lack of B12 for a while but you won’t get away with it forever. Hope you’ve got good vitamin A reserves, too. Yeah, you’re getting beta carotene, but you have NO idea how well you convert it.
            Good luck to you.

          6. From what I read, phase one is fruits and grains? And no room for protein. PHASE TWO Galloway fish once a week etc etc… all that lack of protein tells your muscles, hey, there’s no need to keep much of you around so we aren’t going to spare you. Initial weight loss is most likely muscle.

    2. It’s just easy math, really. If you gain more calories than you burn, then you will inevitably get fat fast.

      1. The math is easy. The same math that tells you if more people enter a restaurant than leave, the restaurant will become more crowded. The hard part is determining WHY more people are entering the restaurant. Same for calories. Why do people consume more or burn fewer? The calories in vs calories out calculation is simplistic and provides no information as to what’s really happening.

        1. The math isn’t super hard but it more complicated than people think.
          It involved terms like
          Calorie sinks:
          CO(B) calories consumed by basal metabolism
          CO(A) calories consumed by baseline activity
          CO(E) calories consumed by “elective” activity such as exercise
          CO(F) calories required to add fat tissue
          CO(P) calories required to grow muscle
          CO(X) calories excreted (e.g. excreted ketone bodies)
          and for most of them there is corresponding calorie source
          CI(F) from food
          CI(P) calories provides by metabolising muscle tissue
          I may have missed a few terms. In any case what is super important (and
          why calories in/out is such an inadequate model) is that these
          terms are not independent of each other. They are also not indepedent of insulin levels (and the availability of carbs) affects most of them as well as your appetite and body’s innate physiological and behavioral responses.
          Sorry, George it really isn’t that simple.
          And as Dr E say points it is only a model of the constraints that have to be met in the process, not a explanation of causation. If your body put on fat it doesn’t happen automatically (it is a complex biochemical sequence that cause fat cells to take up fatty acids, it doesn’t always happen and there is always the possibility that ketones or sugar will be excreted instead, it all depends).

      2. That math is for robots. We are biological creatures and we do not burn calories like a stove, we process them like chemistry. Fat does not turn into fat. Protein does not turn into fat. Fat and protein have calories but our chemistry does not turn them into our own body fat. Better read up!

  2. Wonderful blog as usual. Thank goodness for this new Taubes book. I just didn’t have the time to dig into the first book nor the desire to try and understand. I am not very scientifically oriented. I am a musician and my time and efforts go into my music. I have had success with the low carb lifestyle but find myself having to constantly defend it. Think I will just print this and hand it to my naysayers instead of trying to explain. Thanks again!

  3. Thanks for the reminder about the crowded restaurant example. It’s an excellent simile. Gary may not need it, but it will be useful in casual exchanges.
    And, thanks also for the clear statement about insulin keeping the fat in the fat cells. As a solid low carber, it’s another thing I knew, but needed a clearer statement of.
    In defense of the “things you don’t know, that you don’t know that you don’t know” idea, I point out that “things you know that just ain’t so” fall into that category. That they just ain’t so makes them unknown, and that one thinks they are so makes the “ain’t so” an unknown unknown.

    1. I like to use the alcoholism example when talking about the calories in/calories out theory of obesity–saying that obese people are obese because they eat too much is like saying that alcoholics are alcoholic because they drink too much. Wel of course they do, but why does this happen, and what can we do to help them stop the cycle?
      FWIW I read GCBC and learned quite a bit but was glad to be finished with the book. I then bought WWGF and have read it cover to cover four times.

  4. Very clear and well phrased post, thanks. I have lately reviewed in detail the literature regarding Low Carb Diet and I’m convinced that for some it’s best possible diet. After testing the diet myself and hearing feedback from others,  I’m also convinced that the early symptoms of tireness and dizziness are a big obstacle for many. People should be well prepared to handle mood swing which will gradually resolve. 
    I’m intrigued about the insulin-glucagon interplay in storing fat. Your reasoning sounds solid, even if somewhat simplified. I can learn more on this from Gary Taubes, sure.  But would you be able to provide a scientific reference to the role of insulin-glucagon axis (a review paper)
    , or anything). I haven’t found a solid one. 
    If insulin is so central to obesity, how is it possible that difference in weight loss is not even more striking between LCD and Low Fat Diet?Take any long term (2 year) study or Hession et al meta-analysis for example, differences are tiny after a year. In my opinion this is an evidence that you taking the insulin argument too far. A simple message is always easier to sell. 
    I don’t argue that insulin does not play a major role hear. I just want to expand that there are many other factors that may explain the effectiveness of LCD. These also include: high satiating     
    and thermic effect of protein, ketosis’ effect on satiety, degradation of glucagon stores, sparing of lean body mass independent of insulin, cravings for sugary and starchy foods diappear. 
    In conclusion, Gary Taubes’ and your take on insulin is likely to be too simplistic. Anybody interested in more detail in the insulin argument should examine Shai et al paper (2008 NEJM) that showed that Mediterranean diet was better than LCD in reducing insulin levels at 2 years. 
    Reijo Laatikainen, dietitian 

    1. As far as I know, there isn’t really a review paper on the insulin/glucagon axis because it’s so mainstream and uncontroversial it’s in every biochemistry and physiology textbook out there.
      The problem in drawing conclusions based on long-term dietary studies arises because as the studies drag on, most participants tend to regress to their pre-study diets. Early on when it can be assumed that study subjects are at their most enthused, the majority of studies show a large difference in favor of the low-carb arm.

      1. I’ve been on a low-carb diet (10g a day) for 2 months. I’ve gone from 428lbs to 365lbs. I’m a 25 year old male, 6’2. This has been on little to no exercise. The “keto” diet I’ve been doing has been the most sensible, easy diet I’ve ever tried. Cravings are non-existant. I hardly ever feel the need to eat. Bloodwork showed my blood pressure is coming down, my cholesterol isfine, my triglycerides are “fantastic” and my blood sugar was 84 about an hour from a full stomach.

        1. Great Job, I am 36 Female and just lost 55 pounts but in took me 11 months, would you be interested in giving me more info on what you ate on a daily basis I need to lose about 60 more…thank you ….

        2. Tony, you rock!!! I’m sooo happy for you. Moving arount the planet will get so much easier for you. Taking a flight for a holiday will be an option and your life will never be the same.
          Keep putting one foot in front of the other. You are in my thoughts and I’m lighting a candle for both of us right now.
          Karen in CA

      2. Without question, Gary Taubes rocks!!! I love it that Andrew Weil, MD thinks so too, and so did Larry King when he had Gary on the show.
        Mainstream information, finally!!! Now let’s spread the word. My life was saved from mental craziness when I got of flour and sugar. It’s only gotten better over time. Not to mention a 68 pound weight loss.
        I love Gary Taubes and his courage to buck the cheap trends put out by the food industry. “Moderation” [of junk food] is a marketing trick and has no place in a healthy eating plan.
        Thank you, Mr. Taubes. I love ‘selling’ your book.
        Best and Happiness in 2012.
        Karen Ferguson, Ph.D.

    2. As far as I’m concerned, and I’m just a layperson so what do I know, any research study that speaks uncritically of “the” Mediterranean diet has automatically disqualified themselves from, well, anything really.
      There is no such thing as *the* Mediterranean diet. There are lots of Mediterranean people and they eat lots of different things. Also, anyone who attempts to speak of such a diet without also pointing out that Mediterranean people also eat copious amounts of pork (outside the Levant), lamb, and mutton is being ignorant at best and dishonest at worst. It’s like “the Okinawan diet” which is portrayed as all but vegetarian. Nope, sorry–Okinawans eat lots of pork too.
      Anyone reading this who is curious about traditional diets would do themselves a favor to start with Weston A. Price’s work rather than any number of these faddist diet writers indulging in wishful thinking about other cultures’ eating habits without actually having spent time around practitioners of those cultures. Price actually went and visited those people before industrial food had made serious inroads–his observations are priceless even today.

      1. @Dana, you’re right the Okinawans eat pork but they do boil off the pork fat before eating. I think it’s a whole combination of things that contribute to their longevity, which has declined in recent years.

    3. Shai et al (NEJM, 2008) shows conflicting evidence for diabetics vs non-diabetics. Fasting glucose was taken but the far more useful glycated hemoglobin was not. And since diabetics were not weaned off meds, fasting glucose and insulin numbers may be misleading for the diabetic group.
      The non-diabetics had DOUBLE the reduction in fasting insulin with the LC diet vs MED.
      Change in fasting insulin (in mU/ml):
      Low fat: -1.4
      Med: -1.8
      Low carb: -3.7
      In the absence of glycated hemoglobin numbers, I’ll go with the fasting insulin as the most likely to show a significant improvement in metabolism to prevent/reverse diseases of civilization.
      Looks like a clear win for LC over either LF or MED.

    4. “If insulin is so central to obesity, how is it possible that difference in weight loss is not even more striking between LCD and Low Fat Diet?Take any long term (2 year) study or Hession et al meta-analysis for example, differences are tiny after a year. In my opinion this is an evidence that you taking the insulin argument too far. A simple message is always easier to sell. ”
      Taubes addresses this in WWGF. When people go on a “low-fat” diet, what foods do they cut out? Were they eating pure fat? No, the foods they cut out are typically also high-sugar (and, though he doesn’t say this, also high-flour). So, the “low-fat” diet is also significantly restricting “added sugars” (and maybe also grain).

  5. Another great post Dr.
    I recommend that everyone follow you on twitter. I often have a hard time keeping up with all the interesting links you post. Thanks for everything.

  6. Oh yeah, one of my favorite quotes
    It is the tragedy of the world that no one knows what they don’t know. And the less a man knows, the more sure he is that he knows everything.

  7. Ahhhhhh you’re back!!!!
    Doc ,please keep writing. You make my life so much easier as I can just forward your posts to my highly educated sister and brother in law, instead of hours of conversations where I present all the facts…and I get told…”But Marc…EVERYONE knows it’s all about calories in calories out…..it doesn’t get any simpler than that does it?? We did go to school a bit more than you did you know?” oy vey! (oh, and they’re fat)
    To everyone; get the book! Especially if you had to read GCBC 5 times to truly understand it like myself.
    Thank you Doc.

    1. You should throw some John Holt and John Taylor Gatto at your sis and brother-in-law, too. Schooling != education.

      1. I totally agree, Dana! Some of the most intelligent people didn’t have much ‘formal’ education.

      2. Of course Dana, but you aren’t about to convince any highly educated person of that. How else could they feel superior to the unwashed masses. I’m not trying to be facetious, it’s the way it is. It’s part of our culture

  8. Thanks for a great read. Not only good information but your ability with the written word make this important subject readily accessible to a non-medical person like me.
    I wonder if you might have an opinion on the work of Barry Sears and his Zone dietary guidelines. He seems to have written about the insulin/glucagon axis and built his program around that concept many years ago but rarely gets credit for it. Does that imply that his program has obvious flaws or is it for some other reason? I did notice that he tries to avoid ketosis for some (for me) complicated reasons even though he admits that getting close to the “ragged edge” of ketosis helps maximize fat loss. I figure if anyone can write a clear, honest, fact based response to this issue that a lay person like myself could understand…it would be you.

    1. Barry Sears and I have been friends since long before either of us wrote books. We disagree on the structure of the optimal diet, but we’ve remained friends nonetheless. MD and I wrote extensively about the insulin/glucagon axis in Protein Power, but I don’t recall Barry writing about it much. He thinks too much protein over stimulates the production of glucagon, a notion I totally disagree with.

      1. I found & love your blog! I just started atkins and can’t find how much protein to eat? I went to the library and your book is very popular over here – I’m fifth on hold for it. is there a formula for protein to know how much is right to lose wt? Thanks fm D in GE

      2. When I read “Enter the Zone” back in the mid-90’s was the first time I ever learned there was such a thing as glucagon.
        Maybe if he’d made the 40% fat instead of carbs?…

        1. So.. Would glucagon supplements in people with elevated insulin be worthwhile, or would it be too dangerous? I wonder if more extensive blood monitoring for dieters would be worthwhile, and if there’s any weight-loss doctors that already do it..

  9. Ah we’ve missed you here SO much Dr. Mike — but your (fantastic!) “appliance” gets a huge amount of regular use in my house!! Please, please, you and Mary Dan move the mountains necessary to make the Ancestral Foundation Symposium in August. I’m flying out from Georgia in the mere HOPES of meeting y’all (and also Gary and Tom and Mark and Richard and and and….)

  10. “It’s well known that the metabolic hormone insulin stimulates an enzyme on the surface of the fat cell that moves the fat into the cell.”
    Hrmm first hiccup for me. Acylation stimulating protein (ASP) also stores fat into fat cells. ASP is stimulated by chylomicrons. Your statement is not incorrect, but it leaves out a point that I think is important for your lay audience. (ref: http://www.ncbi.nlm.nih.gov/pubmed?term=9034195)
    “We now know why we get fat. Excess insulin drives fat into the fat cells increasing the fat cell mass, ultimately leading to the state we call obesity.”
    I think insulin is more about preventing fats from leaving fat cells, than about driving them in there in the first place. But that’s mostly a quibble.
    “We make too much insulin because we eat too many carbohydrates, especially sugar and other refined carbohydrates.”
    I’m sorry, but you’re off the rails now. You just laid out an argument that an insulin resistant liver pumps glucose into the blood stream at too-high of a rate, causing the pancreas to release more insulin in an attempt to reign it in. And your non-sequitur is that somehow this whole scenario is caused by the insulin release triggered by a carbohydrate heavy meal.
    I wish you had instead said something like ‘fructose causes fatty liver, which causes hepatic insulin resistance.’ This is a known pathway.
    But I think what would be tough for you to say, given the foundation upon which you’ve laid this part of your life, is that dietary fat can also cause a fatty liver, and the consequential hepatic insulin resistance.
    Chris Masterjohn I think is the best diet-science writer out there right now (recently taking the lead from Stephan Guyenet, but Stephan is fighting back for the top spot). Chris wrote a series on fatty liver, here is a seminal post:
    In short, people can get a fatty liver, either through excess fructose or fat consumption, with choline deficiency.
    It has nothing to do with dietary (non-fructose) carbohydrates.
    Ok, now I’m ready to be beat up!

    1. If fructose causes fatty liver, it’s by being turned into fat in the liver, which is then trapped there for whatever reason. However, nonfructorse carbohydrates not absorbed by other tissue is also turned into fat in the liver, which will likewise be trapped there for the same reasons. So, nonfructose dietary carbohydrate can absolutely cause fatty liver just as much as fructose can.
      I would like to see more about the scientific evidence on choline deficiency preventing the fat from being released from the liver.

        1. Thanks. It was long, but worth the time.
          Looks like a good argument for getting one’s protein from meat, which has plenty of choline.

    2. You’re making it too easy for me.
      First, ASP is more or less a non starter. If you take a look at what the big names in ASP research have to say, you’ll find that Sniderman states clearly that rodents react differently than do humans and that you can’t apply rodent findings to humans. There is also controversy over whether ASP has anything to do with anything. And he also points out that ASP works with insulin (and although he doesn’t come right out and say it, the implication is that insulin is the primary factor at work). The other group working on ASP (Wetsel et al) have concluded that the ASP pathway isn’t physiologically relevant.
      Liver cells bathed in excess insulin can become insulin resistant. Once they do become insulin resistant, it takes more insulin to suppress their sugar-making functions. There’s nothing new and exciting about this – it’s pretty much textbook thinking on insulin resistance.
      I suspect that fructose does play a role in the development of fatty liver, but it isn’t the entire story. At this stage, I don’t think anyone knows for sure exactly what causes it, but based on a number of human studies in the literature, a low-carb diet treats it quickly.
      I would bet that the increase in fructose and vegetable oils along with a decreased intake of saturated fat exerts a significant effect on the development of fatty liver. Non-alcoholic fatty liver disease (NAFLD) is indistinguishable from alcoholic-fatty liver disease. The only way they can be differentiated is by the history of alcohol abuse or lack thereof. Researchers make lab animals develop fatty livers by dosing them with alcohol. A number of papers have shown that if these animals are given vegetable oil along with the alcohol, the development of fatty liver is accelerated. If, instead, the animals are given saturated fat along with the alcohol, it becomes difficult – even in the face of pretty hefty doses of alcohol, to cause fatty liver. Which leads me to believe that saturated fats are protective while vegetable oils are promoters.
      NAFLD is at epidemic proportions right now, and what have we (as population) been doing over the past couple of decades? Avoiding saturated fat, upping the vegetable oils and chowing down on fructose. Given the info above, it makes sense that there is a lot of NAFLD floating around. And it also makes sense that a low-carb diet high in saturated fat would reverse it in a hurry.

        1. I just note for other readers: less than 20g carbohydrates per day. It would be interesting to see some figures on low carb that aren’t very low carb, but it may be that people who already have metabolic syndrome problems may need to at least start with a period of very low carbs to break out of it.

          1. @Warren:
            re: “people who already have metabolic syndrome problems may need to at least start with a period of very low carbs to break out of it.”
            There is no breaking out of it. I stayed at 20/g/c per day for YEARS and I still have metabolic syndrome. Also have hypothyroidism and adrenal fatigue on top of it.

          2. I got rid of my metabolic syndrome. It may not work for everyone, but it works for some of us.

          3. @Laurel,
            I disagree and l’ll even wager you can find a way of breaking out of it. Eating low carbs helps and is essential, but not the only tool in the bag and not even the most powerful one.
            There are other natural interventions you can do that will work–and this means no drugs, no supplements. There are specific and periodic dietary actions you can take with rest that will work. Do them and vitality returns.
            Of course if you simply want to argue that any change for the better in your condition is impossible, then I’ll just surrender now and concede the point to your view. But I’d be happy to share some experience if you’re truly interested.

          4. @Rob – p.s. Your idea of recovery and my idea of recovery may be different though. I don’t think staying at 20gms carb per day for the rest of my life = recovery. I’d call that a very UNnatural way to eat. I don’t agree with the Paleo folks that our ancestors never ate starchy foods. On the contrary I think they would have valued them very highly.
            And I think there is a huge knee-jerk reaction against grains going on lately. Sure, some people are gluten sensitive or full-blown celiac, but my Polish ancestors ate tons of rye and ate lots of potatoes and the only thing that shortened their lives was the vodka. *smirk*
            Anyway, I’d love to be able to reverse my insulin resistance and have the occasional potato.

          5. Ok sure, how would you like to connect? Email or phone is fine with me.

          6. “I don’t agree with the Paleo folks that our ancestors never ate starchy foods. On the contrary I think they would have valued them very highly.
            And I think there is a huge knee-jerk reaction against grains going on lately. Sure, some people are gluten sensitive or full-blown celiac, but my Polish ancestors ate tons of rye and ate lots of potatoes and the only thing that shortened their lives was the vodka. *smirk*”
            Um, in the *PALEO*lithic time there was no “Poland.” You’ve got a very, very short time-frame if you’re thinking that way (and you clearly do not understand the idea of hominid evolution and the diet we’re built to eat, which is what lies behind the whole concept of “paleo” and “primal”). There were no farmed potatoes throughout the eons of time when our primate ancestors were becoming homo sapiens and then homo sapiens sapiens.
            (Doesn’t matter if they would have “valued starchy foods”; since agriculture wasn’t in place yet there were no fields of grains for them to harvest and process into bread.)
            This paleo stuff is NOT your granny’s granny’s granny — but your ancestors going back before the Ice Ages. Keep reading Laurel, you’re missing some of the fundamental and important bases for this stuff!

          7. @Rob
            Email is preferred, but I have no idea how to send you my email address without the world seeing it.

          8. @ Laurel, just click on my underlined name here in this or any other of my posts (and anybody else’s underlined names on their posts) and it should take you to my website. You can find my phone and email details there.

          9. Please Laurel — go and read up on the website “Stop the Thyroid Madness.” I, too, have (and am treating) hypothyroidism — and HAD adrenal fatigue before learning (what my doctor did not know!) how to treat it. My doctor was willing to go along with what I wanted him to prescribe (and the dosing schedules I suggested) — because I could show him studies and information (from the STTM site) that **far** exceeded his minimal knowledge. As with so many things, you have to do your own study and design your own health and wellness plan, because your doctor(s) just won’t know!
            (As this super-cool doc once wrote in his blog: “Here’s what you’ve got to learn. If the pilot make a mistake, the pilot dies; if the control tower makes a mistake, the pilot dies. Always check for yourself.”
            That’s from this … /drmike/cardiovascular-disease/you-bet-your-life-an-epilogue-to-the-cholesterol-story/)

          10. Been there, done that. I’m in recovery now, but still have a big ole goiter.

          11. @Elenor
            Um yourself. Just because they didn’t have “agriculture” doesn’t mean they didn’t have starchy foods!

          12. Elenor:
            It’s not so simple. Physiological adaptation is generally less about total time frame and more about selective forces over a time frame. Using the idea of a “paleolithic human” for generalizing a healthful diet is almost meaningless as there was both myriad food sources and environmental pressures in different places, and for different lengths of time, much of which there is no fossil evidence.
            Massai culture is frequently used as a reference for support for paleolithic diets. But much of what they (Massai) are demonstrating is not so much adaptation that occurred during paleolithic time frames, but relatively recently, and something convergent with Europe: http://www.nature.com/ng/journal/v39/n1/abs/ng1946.html
            Given that the majority of studies examining the benefits of ketogenic diets is performed on other animals, their findings suggest it’s a mammalian condition for the most part – there are exceptions, of course. A mouse doesn’t live longer on a specific diet because its the same diet its paleolithic ancestors ate. And diets aiding longevity and reproductive success are not equivalent. Caloric restriction has been shown to both increase longevity in mammals, while also reducing reproductive success. Evolutionarily, the differential representation we see today is due primarily to reproductive success.
            There is no need to attack anyone. And not all medical conditions can be reduced to diets, especially a diet.

          13. You seem to have some misconceptions about paleolithic diets. The Maasai are far from paleolithic, as they are herders, not hunters; domestication of cattle and consumption of nonhuman milk did not occur until relatively recently – perhaps 10,000 years ago – on the paleolithic time scale, which goes back about 2,000,000 years. Nor is there evidence for any broad variety of food sources for the bulk of the paleolithic; that appears to have come with the broad spectrum revolution.
            I would agree that unlike caloric restriction, there’s little evidence that a paleolithic diet will increase longevity. The primary benefits are in the areas of improved health rather than longevity. Most of those who us on a more or less strict paleolithic diet find numerous health benefits that make our lives more enjoyable.
            If you’re going to attack our diet, at least do the research to find out what it’s like first.

          14. @ Jeremy who wrote: Caloric restriction has been shown to both increase longevity in mammals, while also reducing reproductive success.
            Recent studies have shown that underweight and normal individuals survive into old age less well than people with slightly more weight going into that older age.
            It was part of two studies on humans and it found: the most unhealthy weight (in terms of mortality) was one that produced a BMI under 18.5. People with that weight were 73% more likely to die than people with a normal BMI. People with a BMI of 25-30 were 17% less likely to die than people with a normal weight. Even those classified officially as “obese,” people with a BMI of 30-35, had a 5% lower risk of death than normal people.
            Here’s the link for my friend’s take on the studies: http://diabetesupdate.blogspot.com/2009/06/more-evidence-that-overweight-is.html
            It’s worth a read.

          15. @ Sue – the NHANES III study showed excess deaths below a BMI of 18.5 and above a BMI of 25. Normal weight was best. Here’s the paper:
            Only the Canadian study showed that overweight was better. Possibly extra fat is more useful as you get further toward the poles, perhaps because the further away from the equater one gets, the more fat soluble vitamin D one needs to maintain healthy levels through the winter. That might also explain why the inuit tend to be fatter than most people.

          16. Warren:
            There’s nothing wrong with the diet. If fact, when I’m asked for basic diet advice from someone, I often recommend that they Google “paleo diet”, as I find it to be the most healthful as a generalized diet, and I eat this way for the most part.
            My issue is with the idea of “Paleolithic” being the entire basis, and with comments like those from Elenor being authoritative and overly pushy, when indeed we really don’t know much. There is some strong evolutionary support from that time that suggests we ate a lot of meat. For example, fossil evidence shows unequivocally that our guts have reduced in size. But to be sure, the anthropological literature is fairly limited in respect to diet during that time, much more so than what many ancestral diet books may leave one to believe. Over time, more evidence will come and that picture will be clearer.
            But even if we had the exact diet that Paleolithic humans ate 2MYA for a million years, that isn’t enough evidence to declare that is how we should eat. I think you misunderstood my comment about Maasai. I was demonstrating two points there. One, I’ve heard Maasai stated frequently as evidence for “how we used to eat”, which is not true, as you pointed out. And two, more importantly, adaptation (especially dietary) is nonlinear and punctuated over human history. There were periods of hard selection, where eating a certain way meant death or no reproduction in certain individuals. As I was pointing out, Africans and Europeans are examples of such pressures, which is seen as lactase persistence, the ability to digest milk as an adult. And even with those forces, it doesn’t mean milk is a healthful substance. It simply means it was there, and more people that could digest it reproduced. Further experiments have to be done to how it’s being metabolized and what the implications are to get a better idea.
            Thank you for the link. I must say that I take heed when looking at observational studies like this.
            A study came out a few years ago showing that Americans who sleep 6-7 hours live the longest. While that may be true, most healthy Americans feel they don’t have enough hours in the day, and tend to sleep less. Similarly, the average healthy American is overweight.
            I read the study, and there was no mention of why someone was underweight. It’s unlikely they were a healthy person practicing caloric restriction. There is probably another driver there.
            The first sentence in the concluding paragraph in the study is, “Care should be taken before extrapolating results on mortality to morbidity. Overweight and obesity have been clearly associated with morbid conditions like heart disease, hypertension, and type 2 diabetes (5,10).”

          17. Did you self diagnose your hypothyroidism and adrenal fatigue or did you have health care professionals test you? If so, what tests were done? I have both as well, but I have diagnosed myself based on the evidence and research I’ve done. I’ve had limited success with several low carb programs, but they eventually stop working. Is that normal? Anyone?

          18. synthetic T4 – the standard treatment – does not work for most hypo’s. Even Armour thyroid was of limited use to me. Finally found a holistic M.D., he put me on sustained release T3 from a compounding pharmacist. That’s what works for me.
            Also, look up Dr. Brownstein on iodine (I take one Iodoral 12.5 mg per day).
            re: adrenals. Pantothenic acid helps them (I found 250mg breakfast and lunch feels better than 500mg at one time), as do whole eggs.
            Also, lights out before midnight (no computer etc.), sleep in darkness and quiet, don’t get up til after dawn.

      1. Thank you for a very well-written and informative article.
        I have also reached the conclusion that the core of the issue is metabolic syndrome, caused by the liver becoming insulin resistant, with chronically high blood sugar as a result, not the fattening per se.
        Indeed, the fattening might even be seen as protective as it helps reduce blood sugar levels, hence pushing the onset off full-blown Diabetes type II a bit further into the future.
        This is why I believe that the focus of discussion should be on metabolic syndrome, and what causes it, not on fattening per se.
        It is however not obvious to me that it is merely carbohydrate consumption per se that causes metabolic syndrome. Although rat experiments should be treated with caution, I can´t help but note that there are two surefire ways to make rats diabetic: Feed them large doses of fructose, alternatively large doses of trans fats*. Some nutritional deficiencies promoted by sat-fat fear (I.e. choline deficiencies) might also play a role.
        This helps explain why there are many regions and peoples with relatively small problems with metabolic syndrome while maintaining a high carbohyrate consumption. Also, it tracks rather nicely with actual US consumption statistics during the obesity epidemic (more sugar, less meat, more industrial vegetable oils).
        Of course, once you have metabolic syndrome, eating a high-carb diet becomes a decidedly bad option. But that doesn´t mean that carbs per se are the culprit.
        *This is usually reported as a “high fat diet” causing diabetes. Wonderful. (I.e. see Axen & Axen´s papers, where they accidentally absolve sat fats from causing diabetes in rats)

      2. Hi,
        I was just wondering… you point out in your first paragraph here that using rats as a model for assessing ASP is dubious due to their different response to humans but then go on later in your comment to make use of animal models (of unnamed species) to study fatty liver induction. Is there any evidence, to your knowledge, suggesting that animal models can be used as an indicator of the likely human response to exclusive feeding with fructose, sat fats, vegetable fats (I’m assuming you mean non-hydrogenated, mono or polyunsatfats), alcohol, or a combination?
        Your post was successful in getting me intrigued about Taubes’ book, which I’d previously dismissed as yet another nonsense diet book! Thanks.

        1. I’m glad I at least encouraged you to read Taubes’ book. You’ll enjoy it.
          The animal model situation is a double-edged sword. I dislike relying on animal studies for anything because animals – especially rodents – are not just furry little humans. They are a different species. Procedures, drugs and diets that work for them, don’t always work for us and vice versa. But ethical considerations prohibit us from studying humans (other than after the fact) the development of fatty liver, heart disease, diabetes and all kinds of diseases by administering agents that we believe are the cause of those diseases. We can’t ethically load humans up with vegetable oils and fructose to see what happens to the fat content of their livers when we suspect those agents are what cause fatty liver. The best we can do is find humans who are already afflicted with fatty livers and inquire of them what they ate. Or we can load animals up with vegetable oil and fructose to see what happens. If they develop fatty livers – and they do – and if humans with fatty livers report eating a lot of fructose and vegetable oil, then we can cautiously say that maybe vegetable oils and fructose cause fat accumulation in the liver.

    3. You couldn’t have a ton of glucagon stored in your liver if you had not eaten the carbs to begin with. Your body does not make tons and tons of glucose just to make glucose–it maintains your fasting level at an equivalent of about two teaspoons for your entire body. If you can work out a way that two teaspoons of sugar would translate into an amount of glucagon in the liver that would possibly, say for instance, translate into a blood glucose level of 200 mg/dl, be my guest, we’re all ears. No? Right. You have to eat the stuff first.
      Also, there are quite a few people trotting out ASP. Except, why doesn’t that work to build lean tissues and store fat in undiagnosed, untreated type 1 diabetics? They waste away instead.
      Also, I have also read that bit about choline and fatty liver but as there’s no reason to eat copious amounts of fructose, and as it takes time to change eating habits (choline from food is infinitely better for you than choline in tablets) and the best low-carb sources are egg yolk and liver, two foods most of us have been trained into a pathological fear of eating, advising people with fatty liver to avoid fructose is still valid advice.
      (Hey Doc… This is probably why your advice in The 6-Week Cure to add a raw egg to the shake works so well to move fat out of the liver. Not the cholesterol in the egg so much as the choline!)

      1. <>
        Dana, I can very easily get to 200 mg/dl (11 mmol/L) if I’ve not eaten and do exercise. There’s no insulin in my body (Type 1 diabetes), so the liver releases the glucose for the energy I need, but it has no way of getting into my cells. I have learned to have some insulin before exercise plus a very measured amount of carb – straight glucose is best. On the other hand, 50% of protein and 10% of fat gets turned into glucose, there’s your glycogen storage without having eaten any carbs.

      2. “You couldn’t have a ton of glucagon stored in your liver if you had not eaten the carbs to begin with.”
        I think you mean “glycogen,” not “glucagon.” Glucagon is a hormone. Glucagon is actually a pretty good guy.
        In any case, glycogen storage in the liver (or anywhere else) is pretty limited in volume. It isn’t really bad for you to have some glycogen stored. What is bad is to have your glycogen storage stuffed full and still have lots of glucose circulating, looking for a home, with insulin knocking on all the doors and finding “No Vacancy” at every inn.
        Insulin sensitivity usually means that you are rebuilding glycogen stores. That’s why exercise lowers insulin resistance: by burning off glycogen, it leaves somewhere for the insulin to send the glucose for storage. Building and draining glycogen stores is supposed to be a dynamic process, and keeping glycogen stores full all of the time is a sort of metabolic constipation that we call insulin resistance..

  11. Excellent post! I will send my dad this link (he’s diabetic). One question though, you poo pooed the idea of exercising to lose weight and help control diabetes etc.. Will exercising enhance the effects of reducing carbs or just the opposite?

    1. Exercise will help. I’m not anti-exercise by any stretch. It’s just that no studies have ever shown that exercise works for significant weight loss. Doesn’t mean it’s not good for other things.

      1. Is Mr. Taubes’ new book suitable for someone who’s read GCBC probably 3-4 times? Also, do you know if he goes into more detail on the exercise/insulin response theories? I’m convinced that absent poor insulin response, the body should naturally balance calories in/calories out. However, I’ve also lost weight exercising many times throughout my life. At the same time, I can gauge an increase in calories during the days I exercise. So, I’m wondering if one of the reasons exercise might help some to lose weight is not based on calorie consumption, but on a modification of insulin resistance/sensitivity. If that was the case, this would make sense and also go a long way toward providing a reason some people can eat high carb if they exercise a lot.

      2. I am curious about your comment regarding the absence of studies showing that exercise works for significant weight loss. Is the science behind the book Body by Science merely theoretical?

        1. It seems counter intuitive but there is no real scientific evidence that exercise brings about weight loss. Dr. Doug McGuff, author of Body by Science, famously said in his lecture at the Ancestral Health Symposium, “You can’t exercise your way out of a bad diet.”

    2. Exercise allegedly increases insulin sensitivity. But if your dietary composition is not up to snuff and you go out and work out a lot, you wind up making your lean tissues clamor for more energy, and then when you turn around and eat more, your insulin skyrockets again and stores it all away. Even if you could stabilize your weight your body composition would suffer (loss of lean mass + increase of fat mass). That happened with the Twinkie Diet guy. So it’s important to look at both diet and exercise.
      Plus, dropping carbs has the eventual effect (at least in the people I’ve read and talked to) of increasing energy levels, making a person *want* to get up and move. There was this guy trumpeted all over the New York Times not long ago for showing that people who moved around less after an increase in calories had worse chronic disease markers and were more likely to become diabetic. But he failed to establish a clear cause and effect. I’m suspicious that the people in his study who moved around less were already on their way to health problems, and it wouldn’t have mattered what he fed them.

  12. Thank you for another well written, logical and interesting blog. I particularly love the comment about the Harvard professor who did the original work “Carbohydrate is driving insulin is driving is driving fat”. Despite this he thinks people are fat because they don’t exercise enough!

  13. Welcome back! Thanks for this post. It reminded me of some examples I *wish* I’d remembered during some presentations. Now *I* need to write an overdue post …

  14. any thoughts on the new irititoids and claimed benefits from Tahiti fruit ingredients in them? Lose weight naturally with Tahitian Noni

    1. Unfortunately, I haven’t had the time to read anything about them, so I profess total ignorance.

  15. Great review. Thanks for taking the time. I have finished wwgf twice now and truly believe in the message it is sending. This has changed my life.

  16. Hi Doc, always thoughtful and compelling posts. Thanks. (And I too suffered the restaurant gulag as a child, dragooned into service by loving parents; it is no wonder why you held to using the example, such experiences are forever seared in our minds if not etched from our bank accounts…)
    Now about fat and fat storage, of which you and Taubes are clear and concise and which I agree with totally, both in theory and from long practice, I’ve been finding even more interesting wrinkles to the dietary fat story. Those of us actually awake have known for sometime that dietary fat is so very important, and I imagine once we win this battle of cognitive resonance with all the naysayers about dietary fat, we might then have greater opportunity to explore the true merits of exactly what types of fat are so beneficial and why in more detail. But I’m already a believer and I’d love to know your opinion about the work Dr. Bill Lands of NIH. Like all that we’ve known about carbohydrates and fat for over 40 years, Lands has done the same regarding fat composition in the body regarding Omega 3 and 6 balance during this same period.
    Lands also has a great lecture that was video taped (available on YouTube) where he presented to Dept. of Defense concerning the health of US troops and the importance of recognizing there is competition in cells for the first dietary 1% of fat between storage and use of Omega 6s and 3s. The winning Omega fat in this competition (determined by what we eat) decides most of our hormonal potentials for producing prostaglandins and the overall sensitivity of our bodies to achieve effective immune response and resolve inflammatory conditions.
    So my question for you Doc, is have you seen or read about Dr. Bill Lands work? And if so, do you have any thoughts or comments concerning the composition of fats within our cells leading to benign or bedeviled hormone production and functional or faulty immune systems? Please wax on if you can here!
    And finally, being an appliance salesman is a pretty good gig if you believe in the product. And I think you do. Any franchise opportunities?

    1. @Rob: I advise all to be highly skeptical & suspicious of people like Bill Lands & that whole contingent of morons with PhDs, bloggers, nutritionists & anybody with a website saying peanuts & omega 6 essential fatty acids are BAD!! because they contain high amounts of Linoleic Acid.
      Lands, et al apparently do not understand the HUGE difference between the toxic, TRANS configured O-6 LA as opposed to pure, fresh, organic cold pressed CIS configured O-6 LA, and therefore they cannot & do not ever make any distinction between the two molecules & thus continue to perpetuate the O-6 Linoleic Acid & Arachadonic Acid Myth & disinformation and attribute all the world’s health ills to an excess dietary intake of O-6 LA, again never mentioning the fact that is the toxic TRANS forms in processed vegetable oils used liberally in processed foods that do all the metabolic damage. Any nutrient can be problematic if taken in excess, but I can guarantee you that virtually no one on earth is taking excess levels of good CIS O-6 Linoleic Acid.
      A correct understanding of the properties of these essential fatty acids requires studying them properly, objectively & COMPLETELY. For a correct understanding see the writings & work of Patricia Kane PhD and Brian Peskin, two of the few researchers that teach the facts correctly.
      Here’s a snippet from Patricia Kane to whet your interest: “The frequency of omega 3 ALA is higher because it’s swinging a lighter load — simple. Swinging 3 carbons back and forth is easier than swinging 6. That gives the 3s an energy advantage. At a one to one ratio the 3s will win the metabolic race and subsequently suppress the 6s, which we see in the RBC Fatty Acid test results. The difference in activity level helps to visualize how life survives in extremely cold environments.”
      Here’s another Kane tidbit that counters the current conventional “wisdom” of taking LOTS of Omega 3″s: “Excess omega 3s will easily suppress the omega 6s, whereas the reverse does not seem to occur, 6s do not suppress the 3s.”
      http://www.bodybio.com/BodyBio/docs/BodyBioBulletin-TheInsideStoryof Omega3FattyAcids.pdf
      And here’s a snip from a Peskin article: “Omega-6 is the substrate for PGE1, the body’s most potent anti-inflammatory. Unfortunately, today’s physicians, nutritionists, and athletic trainers simply and naively “parrot” what they read. Yet, nowhere to be found in any of these articles is there a discussion about the adulterated, nonfunctional, non-oxygenating, destroyed omega-6 PEOs caused by food processing requirements, which stop oxygen transfer. That is the FUNDAMENTAL issue that Is completely overlooked.”
      Both Kane & Peskin are excellent in their understanding of EFA’s, & if you read even just a few of their articles you’ll have a better & more factually correct understanding than most people writing about them.

      1. @ cancerclasses
        “I can guarantee you that virtually no one on earth is taking excess levels of good CIS O-6 Linoleic Acid.”
        I don’t know about that. About 15 years ago I trashed my immune system by consuming too much mayonnaise and cold pressed soybean oil, ingredients in the salad dressings I concocted. The first indication that something was wrong was a leg ulcer that caused considerable discomfort over the 5 months it took to heal.”
        The story doesn’t end there. About 18 months ago, in the lecture Rob Hanna mentioned, I heard Dr. Bill Lands say, “Did you know that peanuts contain 4,000 milligrams of omega-6 in each 28 gram, one ounce serving of peanuts, and one milligram of omega-3?” When I heard that I realized my mistake. I’d been eating a peanut butter sandwich for lunch on work days for more than three decades. Except for the peanut butter, my otherwise healthy diet no longer contain a substantial amount of omega-6. Two months after I stopped eating peanut butter my leg pains subsided. I’ve been regaining mobility ever since. I’ve also been researching the omega-6 hazard. Both circumstantial and experimental evidence suggest that excessive omega-6 linoleic acid intake promotes, inflammation, abdominal fat accumulation, and free radical formation.

        1. @ David Brown & @ Cancerclasses,
          Thank you both for your posts. Helpful perspectives. It would be even more helpful if I understood exactly how good CIS O-6 can appear on my plate–what are the whole foods to eat that deliver, as well as my bloodstream? Are these EasyFAs I can eat from the grocery or farmers market?
          I’ll check on the authors cited for other details–thanks!
          When I look at what people eat in terms of actual foods, instead of the processed industrial foods that attempt to mimic real food, and then read the greco-latinate molecular structures and profiles of what constitutes these foods, and then further track these constituent factors into terms of daily intake from real diets, it appears more and more that focusing on such molecular issues are in and of themselves less helpful and less illuminating to our understanding than is clarifying the effect of our entire physiological environment that these molecules travel through. There appears to be a Goldilocks point for everything in the universe as it comprises our bodies at which on either side of Goldilocks amounts we have too little or too much of whatever it is we’re scrutinizing.
          And as all periodic table elements found in chemical actions in our body are governed as molecules, and all molecules must show up in the tissues as positive numbers, there must always be some sort of competition going on between all these positive numbers of molecular string flowing into and out of us.
          We know so very little about all the molecules that get to play, which ones should win the day and which ones should win every day.
          So, what should be in your bloodstream and tissues? And what shouldn’t be…?

          1. @ Rob Hanna: I disagree with your statement: “focusing on such molecular issues are in and of themselves less helpful and less illuminating to our understanding”
            There is a certain congruity that must exist between the “molecular issues” & the “physiological environment that these molecules travel through,” things are structured in a certain way for specific & definite reasons. When you understand the molecular properties is becomes easy to spot the vast amount of bullshit being pushed on the public by the so-called experts. The prescribing of statins as the medical & pharmaceutical industry’s “standard of care” for treatment of their completly mythical cholesterol issue is one example that comes to mind.
            I find Patricia Kane’s explanation of the wonders of the cell’s bi-lipid membrane structure EXTREMELY fascinating & clarifying to many questions, theories, suppositions & issues regarding the role & function of dietary essential fatty acids.
            Here’s one little molecular fact that exposes the mostly criminal deception of the entire processed oils industry: “Light is 1000 times more deleterious to the sensitive oils than exposure to air. They should also be kept cold (refrigerated) all along the process, much like the milk industry, immediately from the cow, to the homogenizing, bottling, trucking, and finally to the food store and into our homes to be stored in our refrigerators. We should treat our oils with affection; they are the beginning of life — our life.” http://www.bodybio.com/BodyBio/docs/BodyBioBulletin-4to1Oil.pdf
            But I really like how Mrs. Kane’s husband Edward phrases it in his brief description of the role & action of electrolytes in the body:
            “The list of functions that electrolytes control is endless but include; temperature control / fluid level / cardiac arrhythmia / respiratory rate / digestion / fluid transport across cells / ion transport / renal function (bladder control) / neurological function / signal transduction / thought / memory/ all the senses both gathering information and then transporting that message to the brain and to the muscles including the sense of touch / energy production / glucose metabolism etc. etc. It is easier to count the stars in the sky than to list all the functions in the body controlled by electrolytes. But the body, in its miraculous evolutionary way is structured to maintain it all in some combinatorial marvelous life-giving manner. The majesty of it all is so wondrous that the study of cells and of life can often leave one breathless. We frequently sit back in our research as the concepts unfold and are literally awestruck. The most one can attempt is to try and convey a small picture of this wonder.” http://www.crampnomore.com/sportshealth/default.html
            The secret of all life, the signalling of all molecular processes, resides within the cell in EFA’s & electrolytes. Study the cell & it becomes immediately apparent what we should & should not be eating for optimum health.

          2. @Cancerclasses
            Disagree all you like, but you’re not answering my question:
            “What’s for supper?”
            And I mean a supper that gives me all that I should be nourished by and nothing that’s going to bugger me later.

          3. @Cancerclassess
            I enjoyed Kane’s article on the link you provided above and the fascinating journey into EFAs in our cells, but I would have enjoyed it more if it she wasn’t pimping the 4:1 Omega Oil as referenced in the paper as a proprietary retail product on her Bodybio website.
            But everybody’s got to make a living somehow, and I can’t fault that.

        2. @ David Brown: You are right in saying “I don’t know about that.” As I said, & let me repeat since you also are unschooled in the difference and are confusing the two forms: I said “Excess levels of good, (UNADULTERATED, FUNCTIONAL) CIS O-6 Linoleic Acid.”
          The peanut butters & salad dressings you admit to eating to excess are LOADED with the TOXIC, adulterated trans configured soy & vegetable oils, NOT the good organic cold pressed CIS form.
          Virtually ALL commercially processed mayonnaise, salad dressings & also peanut butters list soy oil, soy proteins, soy lethicin and vegetable oils as their principle ingredient, just check the labels next time you’re at the store. And to top it all off you admit to also using soy oil it’s self.
          Here’s how to spot the toxic trans oils at the store: they’re stocked in open, unrefrigerated shelving, unprotected from light & heat & are typically packaged in CLEAR bottles. The good CIS O-6 oils are just the opposite because omega oils are very sensitive & degrade quickly (go rancid, biologically dead & toxic) under light, heat & oxygen exposure.
          Pure, cold pressed organic O-6 LA does not cause inflammation, it resolves it. The first clue that this is NOT what you were eating is when you say you trashed your immune system.
          Soy is a known immune, fertility, endocrine & hormone system disruptor. Many people have written extensively on the destructive effects that soy and it’s even worse cousin Trans fat soy oils, has on humans, Joe Mercola for one, as have Peskin & Kane. Purified pharmaceutical grade vegetable oils are so effective at immune suppression that they are routinely given to organ transplant patients to prevent foreign tissue rejection, FACT, look it up.
          As testament to their toxicity, the National Academy of Science & the Institute of Health have both stated publicly & on the record that there is NO SAFE LEVEL of trans fat ingestion. http://en.wikipedia.org/wiki/Trans_fat#Nutritional_guidelines
          In my opinion trans fats are worse than radiation because we are constantly exposed to them since trans fats are everywhere in all manufactured, processed & junk & fast “foods”, whereas until the Japan tsunami we are usually not constantly exposed to radiation.
          Kane: “The use of trans fats literally shuts down the fatty acid metabolism. These (good) fats must be supplied and trans fats avoided if modulation of the faulty metabolism is to be achieved.”
          Your and many other peoples experiences highlight the toxic properties of TRANS O-6 linoleic acid soy & vegetable oils, and I find it particularly notable that the human body can resolve the negative effects just by stopping the ingestion of these toxic substances. Your next step for optimum health & anti inflammation is to supplement your daily diet with 2 to 4 grams of the good organic omega 6 evening primrose, sunflower or safflower oil and 1 gram of omega 3 flax oil. http://www.brianpeskin.com/NEXUS-article.pdf

          1. @ cancerclasses
            “Your next step for optimum health & anti inflammation is to supplement your daily diet with 2 to 4 grams of the good organic omega 6 evening primrose, sunflower or safflower oil and 1 gram of omega 3 flax oil.”
            I would just as soon avoid supplements as much as possible. To me it seems like an artificial and problematic way to live trying to supplement one self out of a problem one ate one self into. Better to avoid sources of industrial fats and obtain high quality animal products and produce.
            I appreciate the advice, though. The peanut butter I consumed for many years was Adams Old Fashioned. It consisted of peanuts and salt, no soybean oil. The soybean oil I used for salad dressings was cold pressed but not stored in an opaque bottle. I kept in the refrigerator after purchase. The mayonnaise did not contain partially hydrogenated soybean oil. Still horrid stuff, though.
            I think I understand your point about industrial omega-6 seed oils being toxic due to the way they’re processed and handled. But instead of referring to Dr. Lands, Evelyn Tribole, Susan Allport, and Emily Deans as morons, why don’t you communicate with them and help them revise their opinions?

          2. On the subject of PUFA, I hope I can clear up a little of the confusion going on here. Cancerclasses, you are absolutely correct about the dangers of trans fats, but I’m afraid you are mistaken in thinking that all processed oils contain them. In fact only partially hydrogenated oils contain more than trace amounts of trans. It IS true that the highly refined heat processed/solvent extracted vegetable oils commonly used these days are damaged and unhealthy, but it is because they contain oxidized and rancid fatty acids (and therefore cause free-radical damage). They are not trans. Also since only a portion of the PUFA in these oils is rancid, people can and commonly do, obtain excessive amounts of O-6 LA from them. Which is also a problem because few people eat much O-3. Of course neither O-6 nor O-3 are “bad”, you just don’t want to overdo it. Too much of either will interfere with metabolism of the other, and too many total PUFA increase lipid peroxide levels and oxidative stress in the body even if the oils used are cold pressed and carefully handled.
            As for Rob’s question of what’s for supper, avoid hydrogenated and processed vegetable oils and “foods” containing them. You can get all the LA you need using EV olive oil in salad dressings and cooking. Preformed AA from animal sources like egg yolks, O-3’s from fish like salmon, tuna or sardines. You really shouldn’t need to supplement if you eat real whole foods. The actual quantities needed are quite small, and the fragile fatty acids are protected when they remain in the whole food.
            for a great overview of PUFA info check out this article by lipids researcher Mary Enig. http://www.westonaprice.org/know-your-fats/2021-precious-yet-perilous
            And for those wanting more in depth info on fats of all types I recommend Mary Enig’s book “Know Your Fats”.

          3. @Angela A.
            Thanks for answering my question. It’s funny how lost so many people can get in chasing information without finding a way back to a place where they can actually do anything with it…
            What you wrote here is also worth something and more people should pay attention,
            “…animal sources like egg yolks, O-3′s from fish like salmon, tuna or sardines. You really shouldn’t need to supplement if you eat real whole foods. The actual quantities needed are quite small, and the fragile fatty acids are protected when they remain in the whole food.”
            Sounds like breakfast, dinner and supper to me…
            And I agree Mary Enig’s a great resource. I visited her at her office in Silver Springs MD years ago and asked as much advice as I could get her to share about what to have on my plate. She’s a no-nonsense person and gives good advice too.

      2. I don’t care about that stuff. That overcomplicates what should be simple. Had we never moved away from animal fats in the first place we wouldn’t be arguing chemistry experiments to reduce inflammation–we would be avoiding it already.
        Eating animal fat is easy. Kill the animal, butcher the animal, cook the animal, and nom. You practically have to have the industrial food infrastructure to eat most plant oils in any significant quantities, though–and personally, I’d rather see us move away from that.

        1. I agree and am all for keeping it simple to what we can actually see on our plates and bring down, catch, trap, spear and shoot with our bare hands… Or ok, at least be able to pick it up at the local farmers market while balancing a cup of latte in the other hand.
          Not only do people not have any clue where there food comes from, they’d probably puke if they knew exactly what it went through to get to them. And that’s before the folks in restaurants and grocery stores start their various acts of fondling, storage and “sniff, seems good enough toe me” quality controls.
          Factory farms and factory ranches produce factory food for factory lived lives… fact.

          1. @Rob Hanna – yeah, if people only knew!
            On the other hand, eating low-carb (which I’ve done on and off for more then 10 years), can be hellishly expensive. I assume it’s the same in the USA. The bottom line is that I can’t always afford to do it. Put organic on top of that, which I’d like to do, and it’s out of reach of most people, including me. Feeding a family a lower-carb diet is often impossible for the average wage earner, let alone for millions who fall below that average.
            Our dollar is about the same as the USA at the moment. I’m shocked at our food prices spiralling out of control. Non-organic lamb at $50/kg! More in some places. Non-organic salad ingredients also incredibly expensive at the moment.
            A low-carb diet with only very average quality ingredients (let alone good quality) is out of the reach of average people. I recently travelled some distance to a wholesale butcher and found cheaper meat but it was awfully poor quality and smelled of chemicals. Not going back there anytime soon.
            While I do not spend the kind of money on myself that some women do (I do cheap clothes, hairdresser twice a year, do my own nails and so on) and we rarely spend money on restaurants or entertainment, I haven’t yet found a way to make the budget stretch to low-carb all the time.
            While I don’t need any convincing about why to eat low-carb, a higher carb diet will always be cheaper… much cheaper.

          2. In the U.S., commercial high fat ground beef is comparable to bread in price, so it is possible to eat low carb without much change in grocery bills. Higher quality meat, especially grass finished or organic, does make it quite a bit more expensive.

          3. @ Warren – Firstly, finding any meat with the fat on is near impossible around here. It has to be a ‘special order”. They’ve really swallowed the big fat lie in Australia, especially where I live. Secondly, as examples, ground beef is around $12 per kilo (and full of chemicals). Rib eye fillet is $38 per kilo. Lamb is about the same price, depending on cut. Some lamb is around $48 per kilo at the moment. None of these prices are for organic – you get the chemicals, full chemical growing and inhumane processing as a bonus. 120 gr of mixed lettuce leaves is $3.70. An avocado, $2.20. A dozen cage eggs (not my preference) is $2.99 – organic runs around $6. Try feeding 2 people a low carb diet for 21 meals a week, on those prices! I try to do it as much as possible, but sometimes it’s impossible. To minimise the carb impact on my T1 diabetes, plus buying insulin pump supplies and paying for petrol and other basic living, is very difficult. No room to grow vegetables here although I have lots of herbs on the balcony. Sounds like I should move to the USA!

          4. There is little question that if everyone today started eating only healthy, whole foods it would be impossible to commercially supply them (but a good start to prompt industry, government and farmers to do so). Immediate big shifts in demand would raise prices such that only the ultra rich (in US terms) could afford them.
            But it’s already a war right now and the wholesome-food-desiring consumer is not yet winning: the initial wave of demand we’ve seen growing by ~10% shift of consumers into preferring organic and natural foods to established factory crap have been pretty well co-opted and neutered by mainstream Big Ag industry. Most of them have only changed their packaging, marketing rhetoric and simply worked even harder to gut all regulatory language about what “organic” and “natural” etc. can mean. In addition, their influences have made it more expensive to become an organic producer or business than remaining a crap producer (nice to raise the cost of entry to competitors). In practice very little has changed with the largest producers and they will continue the fight to the death to keep it so unless we figure out a way to regulate them as polluters and impose costs on their excess food pollution to our society.
            Unfortunately this regulatory and political scenario is further complicated by the majority of the world’s food consuming population facing an even more beguiling problem that is related to this blog–insufficient protein. And so again this political agenda gets co-opted under the evil banner of Monsanto and all other Big Ag propaganda machines that try to justify RoundUp Ready GMOs, grain fed Tilapia and every other commercial sin committed in propagating more carbohydrates into our food supply. It is all being done under the sanctimonious screed that it’s the only response possible to feed these growing masses. And yet it’s not feeding them, it’s in fact even worse. Shhh, don’t tell anyone–because of the Food Libel Laws you can get sued into the stone age, just like Oprah did.
            Yet all of us here suspect our choices arriving from these macro economic forces and morally bankrupt influences come with either damning or being fully damned consequences: eat grain fed, antibiotic and hormone infested, factory feed lot beef for protein because you can afford it, or eat cheap carbs and the protein from freakin’ Franken’ foods they tout as being oh so good for you. Pump my stomach now, please.
            And whether you choose the lesser evil based on your bank account or your body, you still face challenges in doing your body good: low carb choices are fully reshaped by such nefarious influences that we no longer have any natural idea about how to achieve the entire nutritional quality or composition of foods that will feed what the hell our body needs. It’s not hyperbole to suggest that if you are not totally diligent in reviewing what you’re eating, something else that you don’t need to eat will be coming along for the ride and screwing you longer than the guest list at the Royal Wedding.
            And if you’re not sure our current food landscape is overrun by modern choices that are nothing like our grandparents’ choices, watch any movie or even TV show from the 70s, or any before then, and just look at all the extras (not the stars) in the background of any scenes–every one of them is skinny as a rail by today’s standards. How can you see these scenes and not realize “Of course it’s not only the composition of our diets, it’s what’s now in and not in our foods today!”
            At least if we acknowledge waking up into the twisted landscape of today’s foods, where we are badly shaken by being knocked on the head with lies from Big Ag, we can overcome the madness and begin the long adventure back through the low carbs diet. Eating low carb is our Yellow Brick Road and seemingly only path back to Oz… and perhaps the most wholesome way back home again.
            Clearly we’re not in Kansas anymore.
            PS I don’t mean to say that Dr Mike is Glenda the Good Witch, other than his offering a wise message that serves the same purpose.

          5. U.S. style factory farmed food is cheaper than fully healthy organic foods for a reason: it’s cheaper to make food out of oil than out of sunlight.
            The underlying problem is overpopulation. There are just a lot more people in the world now than a century or two centuries ago. I have no idea how to fix that, though, so I’m just happy I live in a part of the world where low carb is not yet impossible.

          6. @ Warren
            On your post below you wrote, “The underlying problem is overpopulation. There are just a lot more people in the world now than a century or two centuries ago. I have no idea how to fix that, though, so I’m just happy I live in a part of the world where low carb is not yet impossible.”
            The Population Bomb thesis has become a common shibboleth after it gained traction with Paul Ehrlich’s fantasy book of the same name in the 1970s, that we’d be eating our own young at this point in time for lack of food because of overpopulation. Well, it ain’t so. The facts of food production, human innovation and simple population trends never supported this at all and we’re now at a point where folks like Fred Pearce are writing the exact opposite: that many of the world’s populations are in decline, below their replacement rate in terms of new offspring, and we are facing an inevitable population CRASH. Wow-zah! Perhaps this is also likely to be a fantasy scenario when we’re 30 or so years from today, but who knows.
            Adding to this dizzy dance of Alabama left and Alabama right in intellectual prognostication is the observable fact that the physical capacity to produce more food than people need to eat on the planet has always been among us. If you wanted to prove this, you could start by noting a significant surplus of food stocks available in storage during periods of modern famine that just somehow never seem to reach the people in need. You also then might begin to surmise a different reality behind the scenes: one of intangible human lust for power, greed for money and abject control over those that can’t be bothered to fight back. In short, not a conspiracy at all, simply an unequal distribution of common humanity at the helm of extremely large enterprises that free one from impositions of personal consequences and bestow permission for rampant dissembling. And the ability to design your own platinum parachute comes to the winner take all expertise of exerting strategic control over the profits. It’s just the most ancient human game that nobody likes to play until they’re winning. And now it’s being played at the economic scale of nation states. Mores the pity for our food, 401ks and housing. It’s all the same: a big pro game being played everyday, though you might not want to connect those dots as it’s not a pretty picture.
            Finally, less apocryphally, Big Ag industry is uniquely smart in fully capturing the regulatory powers of US government, (they’ve even outperformed the up and coming Wall St duo of Dimon and Blankfein) as they long ago figured out how to annually profit from hundreds of billions in government subsidies. That’s some real gerrymandering brilliance: getting government to pay industrial farmers billions to not grow certain foods and even more money to take foods off market and into government storage facilities. And all the while pimping out such changes as being what’s good for the small family farmer, those without enough acreage to even qualify for these subsidies.
            It’s nauseating to listen to all the very plausible explanations for why the leaders of large, winner take all companies and the people that profit from them were forced to do what they did, and even more so because we’re only ever offered such explanations in their diminutive passive voice…

          7. I am guessing you are not old enough to remember agriculture before the green revolution, when crop varieties were developed with extremely high yield using fossil fuel inputs. Back then, there were times when total world food production really wasn’t sufficient to feed anyone.
            Pastured meat is still produced the same way as it has been for millenia; unlike factory farmed food, it hasn’t become substantially more efficient. That’s why grass finished organic beef is so expensive. There’s no need to conspiracy theories here, just the simple interaction between fixed supplies and increasing demand from the rapidly growing population.
            By the way, the population “crash” on a worldwide basis isn’t projected until after 2050. Until then, the world population will keep growing.

          8. @ Warren
            I was explicitly saying there was no conspiracy, just simple and natural human avarice competing for an edge in all the wrong places of industry and politics, or maybe that’s all the right places. I can’t keep up.
            We could quibble, but my main point was rising or falling global populations are not the problem or driving force of food prices or the rapid degradation of our food supply system here in the US. At least I don’t see many facts or even a compelling argument to support this claim outside of Big Ag industry propaganda, which has been around for centuries too. It’s just big business being business like.
            And as a former commodities trader for the nations oldest merchant bank, I can attest to the use of fossil fuels for agricultural commodities and also remark that agricultural commodities can not only go to a zero price because of oversupply, but even go to less than zero if you count storage and clean up costs assessed when they rot in rail cars because nobody would buy back the contracts and accept physical delivery. But that was likely back in the same days when food production wasn’t sufficient to feed the world’s population.
            I’m not sure being old has anything to do with what is and what isn’t observable as true… in fact, I’m rarely certain what is or isn’t true anymore with all the revisionist history taking place almost as fast as history happens. There’s just no place for irony anymore.

          9. Sorry to take issue with use of language, but
            1) That’s a really odd use of “shibboleth”
            2) “Alabama left”? Are you referring to square dancing, as in “Alaman Left”?
            3) “…intangible human lust for power…” It’s true, lust is intangible. So are comedy, and cyberspace, and spirituality.
            4) “Gerrymandering” refers only to the arbitrary drawing of the boundaries of voting districts and makes no sense here.
            5) “Finally, less apocryphally…” Sounds equally apocryphal to me. “Apocryphal” means “without any evidence or substantiation–a story or myth.” Are you intending to cast doubt on your previous paragraph.
            5) “…diminutive passive voice…” That’s a real headscratcher.

          10. @ David I
            Are you really sorry, or are you joking me?
            per your enumerations:
            1. Is there a really even use of shibboleth that I’m missing somewhere?
            2. Yes, thanks for clearing that up. It’s been decades since I’ve been on the farm.
            3. Ok.
            4. If you look definitions up to be nit picky, then read all of them, or even just the second one: Gerrymandering: 2. “to manipulate or adapt to one’s advantage”, which is the relevant usage here
            5. Yes. And I was being generous with such a term as to the literary stature of what most everyone exclaims about here, including myself.
            6. Haha, do you have an “unreal headscratcher” somewhere I can use? Perhaps if you ever watched corporate executives testify before congress and dissemble maybe you’d leave your head alone more or get a better shampoo for that itch, as such executives mostly speak in a diminutive, passive voice. Maybe they’re trying to emphasize their innocence in all things bad with such tropes as “things were done by others” and “mistakes were made…” I have no idea.
            How much do you charge an hour for editing? I’ve got plenty of work that needs it…

          11. @Rob – the green revolution started in about 1950. Were you a commodities trader before then? I don’t believe the near zero grain prices occurred until after the green revolution and fossil fueled crops took hold. We won’t see them again after the fossil fuel runs out, either.

        2. Cooking the animal is often optional or even detrimental, especially the bits high in delicate lipids like liver, egg yolks and most seafood.

  17. Dr. Mike,
    Great to have a new post. I’m relatively new to the whole low-carb thing, having been introduced by Gary’s book at the beginning of the year. After which I went back and read GCBC (twice) and wish I’d read it when it came out, and wish even more strongly that someone had given me all this information 20 years ago.
    I did buy a copy of Protein Power recently, not so much because I wanted a new diet to follow, but more as a means of thanking you for the blog, which I’ve read, well, almost all of at this point, and think contains a tremendous amount of valuable information. Thanks.
    As it is, I’m down about 60 pounds since the beginning of the year on fewer than 20 g of carbohydrates a day. I’ve been very low calorie, too, with frequent intermittent fasts, but the thing is, I could not survive (as I know from past experience) on my current intake in a low-fat, high-carbohydrate diet. I struggled to get by on 2500 calories a day of low-fat for more than a month or two. Since the third week in January, I’m at about 1725 calories per day, and not hungry. I was diagnosed with Type 2 DM about 10 years ago, and have been weaning off of my medications, while maintaining better blood sugar (essentially normal) than I’ve ever had since I started testing.
    So I wanted to thank you, because this blog has been a tremendous help and support to me, even though this is the first new post on it since I discovered it! (I got here from Tom Naughton’s Fat Head site.)
    (BTW, Gary did use that analogy, at least in the Kindle version of WWGF, but he just used a crowded room, as opposed to a restaurant. I agree that it’s a brilliant analogy…)

  18. I’ve just finished both of Taubes’s book, having ready many excerpts over the years. I’m a relatively low carber, with occasional treats. I also have Type 1 Diabetes and am in my late 50s. The weight has packed on thanks to insulin, and I find it incredibly difficult to lose (BMI at top end of ‘overweight’). I have a very small breakfast, a snack at 4pm and a regular 20-30 carb dinner (all fresh food, no packets, tins etc). I have learned to ignore hunger and it goes away. I can’t reduce my basal insulin because I want my A1C to stay in range, so what’s the solution? I bolus insulin for carb, protein and fat. I probably don’t do enough exercise (which can reduce insulin needs a little). Even doing extreme low-carb over 2-3 weeks, and swimming every day, recently, I didn’t lose an ounce. What am I missing here?

    1. I’ve had type1 for forty years. Switching to low carb has improved the numbers and somewhat reduced my need for insulin over the past year, and A1c has gone from over 10 usually to just over 6 nowadays along with a plummet in triglycerides and better cholesterol numbers, but I have gone from a peak of 271 lbs to oscillation these days between about 245 and 265. I eat a fatty breakfast and dinner each of 900 to 1000 calories, and usually can get by eating nothing else all day. Probably I too do not get enough exercise. More weight loss than that seems impossible. Maybe I need to drop the calories a bit further: I think I could do it with a little less insulin and a little more hunger (surprisingly little now). I have not seen any useful advice for long-time type 1 diabetics for losing weight, anywhere.

      1. As a Type1 myself, here’s something to think about. Cortisol is another hormone to consider. In the presence of cortisol, your body becomes naturally resistant to insulin. Less stress and some exercise = less cortisol. Age also increases insulin resistance, even in Type 1. The point of exercise in diabetes, particularly if you are carrying some extra lbs, is to reduce your insulin intake. Low carb does this, but exercise also does it. If I exercise, it’s not to burn off calories. As Dr Lustig says, it takes about 5-6 hours of intense exercise to burn off a BigMac. Equally, if your calorie intake is high from fat and protein (likely more than a BigMac just at breakfast), I expect the same might apply. Although exercise has its limits for me, if you’re doing none, take steps to reduce stress, get more sleep, and increase exercise if you think this could helnp.

        1. Also a type 1 here who is frustrated by weight gain despite eating low-carb. I feel that we are ignored when it comes to weight loss advice. Everybody writes us off saying ‘REad Bernstein.” I’ve read Bernstein but it’s really hard to figure out if you really need to follow his advice to the letter. Is it really horrible to work out in the morning? What if it’s your only time to work out? Does one really have to eat 6.0 g carbs at breakfast, 12.0000 g carbs at lunch, take only Regular insulin, etc.? Is it horrible to take Apidra? He also hates insulin pumps. Maybe I’ll have to write my own book. The only thing that will help me lose weight is significant amounts of exercise and as a working mom I have very little time to do that these days. I would so like to hear from doctors who help type 1s lose weight…or from type 1s who’ve managed it.

          1. I think the issue is that, for anyone except type 1s, as insulin sensitivity improves on low carb, production naturally falls by the appropriate amount. For type 1s, you have to adjust your insulin manually, and there’s a tendency to err on the high side to avoid excessive blood sugar. Unfortunately, erring on the high side means you keep your fat – especially if you use an insulin pump, which means you may not have periods of very low levels of insulin to allow your fat cells through lipolysis.
            Here is a link (if it works) to a post from a type 1 who had success with one type of low carb diet.
            This was her intro post but you could look up her post history through her profile information for more data. She eventually found that 2-3 units per day of lantus, without any other insulin, was sufficient for her.
            I’m not saying to drop your own insulin to that level right away, of course. I do suspect, though, that to have a chance of losing weight you need to keep your insulin adjusted to the bare minimum needed to control blood sugar, and that example might give you an idea of how low that might eventually be, once you’re fully adjusted to the diet.

          2. Wow, do I appreciate this. Thank you for responding to my post Mr. Warren Dew. You are my new best friend. Usually no one pays attention to my concerns. I am going to give it a try. I did mention my problem losing weight to Dr. Eades once and he said I probably just had too much insulin. I gained this weight when I went on the pump and I’ve always suspected that the constant drip of insulin was preventing weight loss. It’s weird though to think that my blood sugar could get high in the meantime. Now that it’s the summer and my one-year-old is slightly more independent, I might be able to use exercise to keep blood sugar down and less insulin to help weight loss. It could be an interesting experiment!

          3. I read greenrosa’s post though and there’s no way in the world that I could get by with 3-4 U insulin/day. I’d die. And there’s no way that I could do it with 100 g carbs/day like she’s doing. I’ve been eating mostly low-carb for years (with occasional cheats of chocolate or too many nuts) so there’s no adjusting to low-carb to do. The only diet advice that I can find for type 1 diabetics is on bodybuilder forums and they advocate fruit, oatmeal, etc. Maybe I should switch to that.

          4. Greenrosa had been on the diet for a while before she posted, and she had probably been gradually reducing her insulin during that time. As I mentioned, that doesn’t mean that people should reduce their levels to those levels right away. And of course, she was young; older people who have had more time to develop insulin resistance might need a lower level of carbohydrates and more time to make it work.
            If you gained weight when getting on the insulin pump, it sounds like the pump should be the first thing to go. Let the basal insulin get lower between meals. Exercise might be good too. A few squats each day carrying your baby may help, as anaerobic exercise does much more for insulin sensitivity than aerobic exercise. Also, find low carb foods that you like to eat, so you’re not tempted into cheating.

          5. @Warren, I’m extremely skeptical about only needed so little insulin. She was already not using that much (16 units per day). She also doesn’t state how much exercise she does (reduces need for insulin). I have kept my carb consumption under 100g/day for quite a few years, often much less, and I’ve packed on about 20 kilos. Some T1s still produce some insulin and especially if they are Mody or LADA, which require very little insulin in the beginning. Mody often requires very little insulin – life-long. When you severely reduce your insulin so you can loose weight, it’s called Diabulemia. People who do this always run high blood glucose. So, I think there’s lots this girl isn’t telling if her blood glucose is always normal. When and how often is she testing? What’s her HbA1C? What type of diabetes does she really have? I’d like to see if she can still do this in 10 years time.

          6. MODY isn’t type 1 diabetes; it’s a pure genetic disease, not an autoimmune disease, so it’s not what we’re talking about here.
            With respect to the 16 units a day, this person was already on a low carb diet when she was using that level of insulin. It’s possible that her switching to a paleo diet had additional beneficial effects beyond the effect of low carbohydrates. Paleo diets tend to be antiinflammatory and often reduce autoimmune effects, and she noted that her beta cell antibodies disappeared after six months. If the type 1 diabetes hadn’t yet killed off all her beta cells, she might have managed to regrow enough to provide some low level of insulin.
            Perhaps the 16 units a day is a more realistic benchmark for a generic low carb diet without antiinflammatory effects.
            As with most people and message boards, this particular poster didn’t stick around forever, so she’s not available for questions as far as I know. Wendy asked a question, and I thought this particular example might provide some useful information. Whether you find it useful enough to act on is up to you.

          7. @Warren; Yes of course, Mody isn’t Type 1 and not autoimmune. Nevertheless, a honeymoon in a teen can be up to 5 years, so this may, along with low-carb, explain the need for so little insulin. Apparently, from 15-40% of beta cells can remain active. Some antibodies disappear, some, like GAD don’t.
            I was first diagnosed with diabetes when I was 25 years old. When in my early 50s, I began insulin (apart from pregnancy 22 years ago). I am highly GAD Positive (on 2 separate tests). C-Peptide was zero when last tested 12 months ago.
            I definitely don’t need convincing about the benefits of low-carb (I believe it stretched my LADA honeymoon longer than most, however, the minimum basal I can use (and remember I’m at the far end of overweight with BMI) is 23 units. Then add bolus insulin for food, and I bolus for protein and fat as well as carbs.
            It’s a very fine line between keeping my blood glucose at the high end of normal and still risking complications (or making the ones I already have, worse), or keeping the BGs lower to minimise complications. My doctors are very happy with my A1C (6.8) but I am definitely not! Too much evidence of complications at that number. Max I can turn off my pump is around 2-3 hours. If you are T1, then you’ll usually have some basal insulin working, whether you’re pumping or injecting. Then there are other times when my BG goes high – stress and lupus, plus anti-thyroid antibodies, which haven’t turned into anything detectible for the last 20 years. Could it be low-carb? I sure think so.
            How does one balance the complications risk with keeping the BGs at the high end of normal? Even Bernstein wants A1Cs in the “no diabetes” range. That’s pretty darn hard to do without insulin. He’s anti-pump because he says they don’t work to keep the BGs low because they are too unpredictable – huge numbers of us disagree.

  19. I’ve been worried that you would never blog again – it has been a long dry spell.
    But…….. you’re back! And in great form as always! That book has been in my Amazon wish list since long before the release and thanks to you, I’m ordering now.
    I loved GCBC but understand why it isn’t for the masses. Hope this one makes into a lot more personal libraries – Taubes is one of my heros!

  20. I wish that someone would spend some time and research money on helping post-menopausal low-carbing women get and stay thin. I am appalled at what’s happened to me. Maybe a possible topic for Mr. Taubes’ next book?

    1. I think it will help to remember that post-menopause is not pre-menopause and that your hormonal profile is going to be different and, as a result, your weight set point too. To a certain extent this will actually be to your benefit; older people who weigh a little more also tend to live a bit longer.
      I’m 37 so I do not say this idly. I get to deal with it in the next decade or so. But I don’t expect to look like I did at 20 at *this* point, much less will I expect it on the other side of “the change.”

  21. Elevated insulin causes obesity, this I believe. My question is this: What, besides eating carbohydrates, keeps insulin levels high?
    Despite adopting a low carb diet, my fasting insulin is still pretty high, and as would be expected, I still have extra weight to lose. I’ve added a high intensity weight training program to increase insulin sensitivity, and that has helped some, but I still have a tough time losing weight, even though I am committed to a no grain, no sugar, no fruit, high fat, moderate protein diet.
    My current goal in life is to find out:
    *What elevates insulin when the diet is already low in carbohydrates, and exercise is included?*
    I think this is the central question for people who already eat a low carb diet, but don’t lose weight.
    What elevates insulin in the absence of high carb intake?
    Peter over at Hyperlipid wrote a post on this once and suggested that people who had trouble losing add resistance training and follow this advice:
    “If you want to adjust your weight downwards to where you would like it to be, you are stuck with a pretty extreme version of the Optimal Diet, low but adequate in protein, low in carbs, probably eaten as starches as part of the evening meal, fine tuning your thyroid meds and replacing coconut oil with lard.”
    I would love to know your thoughts on this perplexing issue.

    1. Insulin resistance in the liver keeps insulin high. The liver loses its ability to listen to insulin to shut the sugar dump off. Therefore the liver continues to dump sugar which keeps insulin high.
      Seems to be an argument for Intermittent Fasting, doesn’t it?

    2. Related to another comment way up the page, how’s your choline intake? It’s supposed to be between 400-500mg for adults. Do you eat liver or eggs? About four egg yolks would do it, or a few ounces of liver. The supplements are not so great.
      Choline’s shaping up to be really important for liver health.

      1. I’m good on choline, eat at least 3 egg yolks a day, plus liverwurst at least 3-4 times a week. That’s why I ask the question.. my liver is in great shape, enzymes are perfect, my diet is high in saturated fat, blood work is as would be expected.. high HDL, low Trigs, normal LDL. Why should insulin still be high? It’s a million dollar question to which I hope to find the answer.

  22. Would it be possible for you to someday provide advice to a person who is both morbidly obese and a sufferer of Crohn’s Disease? Can a person in that situation use a low-carb WOE to lose weight?
    Would appreciate your insights!

    1. I’ve been working on writing a book on the subject (Crohn’s and diet, not so much weight loss), so bear with me as I’ll probably skip around a lot.
      1) Assume the low-carb diet is good for you. Let’s run with that.
      2) Read the work by Ebringer et al. suggesting that Crohn’s disease (CD) is caused by an organism called Klebsiella pneumoniae. Here’s the hard part to wrap your head around: it’s not a pathogen. This is to say, while Kp *can* be pathogenic (it’s very nasty once it gets in the lungs), in Crohn’s it’s not acting as a pathogen; instead, it’s living as a commensal organism, just hanging out in your gut, living life. The problem is that, with Crohnies, the body has been sensitized to a protein produced by Kp in order to digest starch- specifically, amylopectin starch. In reality, there’s more to it than Ebringer suggests, and I’m busy keying this out on my own. Long story short: don’t eat sugars, the disease goes into remission. Takes about 1-3 years for full effect, but it’s worth it.
      3) Read “Life Without Bread” by Lutz (just died in late 2010 at the age of 99). Focus on that chapter on Crohn’s and ulcerative colitis. Note the chart that shows that ~85% of Crohnies will be in remission on “his” diet (<72 g/day carbohydrates) at up to three years out. Now show this to your doctor, who will immediately reject it because if it were that good, EVERYONE would be doing it. The next lecture you'll get is how wonderful TNF-alpha inhibitors are. Right.
      4) Eat meat. Maybe not immediately; I haven't decided what's best for the individual with a weakened bowel. I would *start* with what Elaine Gottschall has to say in "Breaking the vicious cycle." That gets rid of all your grains- and the starches (!) and lectins that go with it. Gottschall is NOT a low-carb diet, but it can be adapted as such. Combine Gottschall with Lutz (no more than 72 g/day carbohydrates), and start dialing back the vegetable matter; there's something to cellulose- I haven't figured out what yet- that also inspired the badness of CD. Maybe Kp kicks off the enzyme to digest cellulose, thinking it'll attack those beta 1,4 glycosidic bonds, I dunno.
      5) Eat more meat. Eggs, bacon, fat. Hang out at Dirtycarnivore and so forth, pick up the tips of ultra low carb living.
      From this, I would opine that you could use a low-carb diet to shut down Crohn's as well as potentially fix your weight. Of the 6 people I have "coached," 5 are in remission from their Crohn's using these techniques. Good luck to you.

      1. @ Thor2202 I would be interested in a book if you write one. Also do you have a blog or website. I have had terrible IBS for 50 years and am 18 months into low carb. How ever I just started Niaspan for TC of 348, HDL 87, TG 40 & calculated LDL 252.

        1. Hi, BR. It’ll probably be another few months to a year before I’m done; I have so many books and references to read. I would recommend “Life Without Bread,” however. It’s probably the single most useful book for IBD, as above. Wish I could speak more intelligently to IBS- sorry.

  23. Hi Mike,
    Good to see you back again!
    Having said that (ah, here comes the “but”), as you know I get a bit frustrated with this black and white approach to the ‘why we get/stay fat’ question – and that may explain why Gary’s book is one of about 8 half read books on my bedside table right now.
    Don’t get me wrong, I have been eating a very low carb diet for over 8 years now, and I can’t thank you, Mary Dan, Gary and a host of other luminaries for the transformation that has brought to my health. Whilst the n=1 qualification of course applies, it certainly is getting ever harder to think the ‘not so much as a cold’ in all that time (amongst many other benefits) is in any way coincidental.
    But I still have a battle to keep my weight in check. I still eat too much … maybe not all the time, but more often than I should. I’m sort of happy to call part of that gluttony (if you can be ‘happy’ about one of your failings!). I’m also aware of the many other factors that can influence eating behaviour other than the purely physiological that you and Gary would have us believe (or so it seems) is the only game in town.
    I know I’ve said this before.
    What I guess I find hardest is that I think you guys are making it harder to fight the fight needed to be fought on the nutrition side … by failing to acknowledge that it is only part of the solution. Again, don’t get me wrong, I can absolutely understand why you might not want to write a book dealing with these other issues (by the sound of it, both the writing and the promoting are pretty painful so you may never want to write another book!) – but please give some thought to saying something along the lines that controlling carb intake and therefore insulin is the first and most important step … but, at least as far as weight loss/maintenance is concerned, it isn’t the whole journey. for. some (and yes I would say most) people.

    1. Psychological issues are physiological in origin, though. Your brain’s an organ in your body.

      1. They are? Wow, thanks for that insight.
        I suggest you work with trauma victims and tell them there is a simple physical cause for all that ails them … if only they were eating right …

  24. The root cause of the problem seems to be the Lipid Hypothesis. Let’s replace it with the Ravnskov Hypothesis (“Fat and Cholesterol Are Good For You”), by Uffe Ravnskov. It says:
    1. Artery disease is caused by at least 50 varieties of micro-organisms.
    2. LDL particles are part of the immune system, able to capture microbial toxins.
    3. LDL enters the arterial wall from the outside, through vasa vasorum.
    4. LDL particles with captured toxins are oxidized by white blood cells (phagocytosis).
    The Ravnskov Hypothesis is the only one I’ve found that explains why arteries get plaque formations and veins don’t. (The pressure gradient and greater wall thickness impede the radially-inward travel of LDL particles in arteries.)
    The Ravnskov Hypothesis also explains how LDL particles ger oxidized and why LDL particles are not found immediately outboard of the endothelium.

    1. There is other hypothesis. Pauling/Rath:
      “A Unified Theory of Human Cardiovascular Disease”

  25. Glad you are back, as I need some reinforcement to keep the carbs from creeping back into my diet. Thanks!

  26. II’m unconvinced.
    When is all this Taubes stuff going to stop sounding like a total crock? (Anyone notice that Dr. Eric Westman very publicly says that Atkins works because people eat fewer calories?)
    Eat less and move more – it works.

    1. Westman helped write the new Atkins book. I respect that he’s willing to help his patients do low-carb, which places him at a higher caliber than too many other doctors out there, but I’ve looked through the new Atkins book and I’m not impressed. The Atkins company is now trying to bring vegans into the fold, and Westman’s part of that. Anyone approving of a diet that solidly results in malnutrition has lost some credibility with me in terms of telling me why Atkins works.
      In any case, there’s a difference between deliberately eating fewer calories and feeling like you are starving all the time, and going into ketosis and therefore not NEEDING to eat more calories. And that vindicates Taubes as far as I’m concerned.
      I should add that I have some personal experience with this and that while it is pleasant to not crave carbs all the time, I find myself falling on my face with weight loss because it *isn’t* all about the calories. Nutrition is important too. And there is a danger, when one is low-carbing and in ketosis, of NOT EATING ENOUGH in a day, and therefore not getting enough of the necessary micronutrients. That can also affect weight loss, because everything that drives your metabolism depends on those micronutrients for proper function.
      Any diet calling for 1800 calories a day or less is a diet that will eventually fail in one way or another, not because the dieter can’t maintain that intake–on ketosis, they most certainly can–but because eventually they’ll suffer from deficiency and “fail” that way.

      1. So what do you suggest is sufficient here:
        Please share what daily or weekly feedings of a variety of foods would result in sufficient array of micronutrients not to end up in a long term fail?
        I’m sincerely interested in this and have been refining my eating over 10 years now in low carb land and would like to compare notes.

    2. As someone who has worked out like a demon and gotten fat while doing it and been unable to workout and seen the weight just melt off from going low carb. I can’t agree with this. Working out has been a large part of my life for 30 years, but the hypothesis that I work out because I feel good makes as much, if not more sense to me, as the hypothesis that I feel good because I work out. There are important health benefits to exercise, fat loss isn’t one of them.

      1. Agreed! I ate low-cal (1200 a day, as recommended for weight loss) high carb low fat diet for a long time while lifting and doing cardio and didn’t lose weight. I had better muscle tone but still too much fat. Eating high fat low carb the last 3 years has helped me drop alot of fat and keep muscle, and exercising now is not part of that equation. I still do it, but for non fat loss related reasons. I realized–before Gary suggested it–that there are health benefits to exercising but losing fat doesn’t top that list. I think that the reason people think fat loss is helped by exercise is because exercise done right makes us feel good, and feeling good helps us want to keep eating right (HFLC). I’ve tried everything to lose fat (was a dancer from age 5 through college) and the high carb low fat diet just doesn’t work, no matter how much I exercised, which was plenty. And I’ve never met a more determined person than myself, so I tend to really commit to my goals.

  27. So glad you’re back to find the time from your (hopefully thriving) busy day job to write another informative and easy to understand article!
    I see I’m not the only one who has missed you posting. 😀
    I’m currently going through carb withdrawals and it ain’t fun but I’m excited to get to the other side and finally, FINALLY, rid my poor body of this excess fat accumulation.
    Reading WWGF and your excellent summarization of it, has finally helped me to understand what the problem has been all along. I don’t feel like such a failure now, either. I see now that I was operating with false information that was helping to keep me fat while making me feel as though there was something almost morally wrong with me that I couldn’t lose weight.
    To quote Maya Angelou … “When you know better, you do better.”
    Thank you for helping me to “know better.”
    All the very best to you.

  28. Excellent summary! Thanks for this.
    There’s a little typo:
    “Fat can get it, but it can’t get out. If the fat does get out, the excess insulin tells the mitochondria not to burn it anyway, so it just gets sent back to the fat cells.”
    Should be “Fat can get *in*…”.

  29. Isn’t the problem really that multiple generations of people have had access to an abundance of food AND have not understood how to eat properly in that abundance? For the majority of us, common wisdom is the problem. We are all capable of learning appropriate eating techniques (with proper training); however, we need a conventional wisdom that is closer to the truth.
    In my opinion, “calories in / calories out” is a fact that explains everything with regard to maintaining weight. The observation that in given society, some individuals are underweight, some are overweight and some are obese is a different and multi-faceted issue. I think vilifying facts is an awkward way to attack the problem.

    1. Do you really think people would get fat with an abundance of meat, animal fat, fruits and vegetables? That’s not all that is available to us, though, is it?
      As both Taubes and Eades have pointed out, of course more calories being stored than burned is the problem. The question is WHY more calories are being stored than burned. I know a fat person who runs marathons. I have also encountered a fat triathlete. Why are those women fat?

      1. Dana-this is something I’m always trying to explain to my hard-head body building bro who’s always trying to get leaner. He eats lean meat and carbs like pasta and can’t understand why his nearly fat-free diet doesn’t help him get to that single digit body fat. He’s eating the way “they” say and just won’t even consider that the kinds of cals make a world of difference. I loaned him GCBC at Xmas and he hasn’t read it yet–so indoctrinated into one way of thinking and thinks his lifting experience means he’s got the answers to it all… and yet, he struggles.
        Same with most people, I guess. We think because it’s a popular opinion that it’s true. Now that I’ve taken control of my health my life is forever improved, as well as the lives of those loved ones that have done the same. I’ve got friends I’ve finally gotten to eat lower carb, but one’s just been diagnosed w NAFLD (she’s 30 and always skinny) and one’s 31 and is obese with a liver that’s currently shutting down. Doc put her on low carb and already her liver function is improving. All this stuff in such young people!
        By the way, I enjoy reading your comments, Dana! I tend to see eye to eye with you on just about everything, and I always appreciate your take on things.
        And I’m grateful for both Taubes, the Dr’s Eades, Tom Naughton and a whole mess of other bloggers for improving my life! I will keep doing what I can to help those I meet to step out of the mainstream and forge their own path towards wellness.

        1. It used to be said one was able to at least lead a horse to water… now we can’t even do that–people are so fearful of changing their opinions these days.
          And diet and nutrition has everything to do with that! It’s a vicious circle..

      2. Do you really think people would get fat with an abundance of meat, animal fat, fruits and vegetables?
        >>> Yes. I am quite sure that people can overeat on ANY diet.
        That’s not all that is available to us, though, is it?
        >>> no comment
        The question is WHY more calories are being stored than burned. I know a fat person who runs marathons. I have also encountered a fat triathlete. Why are those women fat?
        >>> because they eat too much. The question is why do they want to eat so much? Given an abundance of food, the majority of the population finds it easy to overeat. Can they be trained to (easily) eat and maintain proper weight despite the abundance? Yes! Will they be? Probably not because the eating pattern prescribed by “common wisdom” is incorrect for most.

        1. Ray,
          You obviously didn’t assimilate the material you presumably read. It’s not because they eat too much, it’s because they eat the wrong foods. Do you challenge all the studies that prove Gary Taubes’ and Dr. Eades’ points? There are myriad examples of people who don’t eat too much, but eat mainly carbohydrates, and remain fat or gain weight.
          And there are people like me who can eat virtually all they want, provided what they want doesn’t include high carbohydrate foods such as fructose, dextrose, wheat, barley, potatos, rice, etc., etc., particularly the processed versions of those and other foods.
          You seem to be an excellent example of the millions who have been brainwashed by mainstream medicine into believing the calories-in, calories-out fabrication. It’s the KIND of calories, not the calories themselves, that result in the gain or loss of stored fat.

  30. Thank you for explaining the benefits of low carb eating so fully and clearly. I have been eating low carb (and high good saturated fat) for about a year now and will continue to do so. I have certainly lose some excess weight by doing so.
    I also eat no processed food, no bread or flour and no added salt/sodium at all. I have been doing this for over then years. This has been the main way that I have lost weight, and that is because I have steroid-induced obesity from taking inappropriately prescribed and poorly monitored steroids. Excess weight gained in this way is largely fluid retention, and is easily and rapidly reduced once you know that it is nothing to do with calories, and the main course of action needed is as far as possible to avoid salt and salty food.

  31. It’s nice to see you posting again; I’ve greatly missed your writing. I think the carb withdrawal may more accurately be wheat withdrawal. I can go for long periods of time very strictly adhering to low carb with the occasional piece of chocolate as a treat, but it I so much as nibble a cookie I’m sunk. Just the thought of eating bread or pasta still gives me an immediate and strong physical response. I find the feeling very similar to when I was eliminating diet soda containing aspartame from my diet after reading Dr. Blaylock’s Excitotoxins book. I switched to diet sodas with splenda and coffee with splenda, and my body still intensely craved aspartame diet sodas. It took a good 6 months to clear that feeling, and now if I have aspartame, I get a terrible shaky feeling for hours. I understand the insulin reasoning, and avoid all starches as a result, but I just think that maybe if people resistant to the idea of adapting to low carb switched to gluten free for 4-6 months to detox from wheat and then started reducing the remaining carbs they are eating they might be more successful. Going through withdrawal from wheat and going through keto-adaptation at the same time might just be too hard for many people.

  32. Hi Mike:
    Off topic, but I think you will find it interesting nonetheless. It was found recently that astrocyte-neuron lactate transportation is necessary for long term memory formation via MTC-2. Since it has been known that MTC-2 is responsible for ketone uptake, there is more support that a diet giving higher concentrations of ketone bodies could increase memory formation.

  33. My 1st post has disappeared……………
    To repeat – love your posts, have been a low carber for nearly three years. Would like your opinion regarding a person who is morbidly obese and dealing with Crohn’s Disease. Is that a safe way for them to drop the weight? Where could they go for information?

    1. @Squirrel: The Drs. Eades covered this in “The Protein Power Lifeplan”. In summary: Yes, it’s safe. Intestinal disorders are often caused by anti-nutrients in grains/legumes, so avoid grains/legumes for a while. You may need some additional supplements to support intestinal healing – especially L-glutamine.
      Dr. Lutz mentions Crohn’s Disease in “Life Without Bread”. He says “Crohn’s Disease […] heals with great probability from a low-carbohydrate diet within six monthis to one year, and usually without complications.”
      I highly recommend both of these books, even for those without Crohn’s Disease.

    2. Conventional medicine’s answer to constipation and all other digestive problems is “more fiber”, specifically “whole grains.” More fiber is not necessarily the answer.
      Cut out the grains, yes, but also add: water, walking, magnesium, digestive enzymes, and probiotics.

  34. I accidentally ran across this blog article and couldn’t stop reading it! Wonderful information. I will get the book and start it this week. I hope you won’t mind me quoting you in my own blog. You have such a wonderful way of explaining things and pulling the reader along with you (much more than I).

  35. So I stay fat on my low carb diet because I eat to much fat, my calorie intake is to high so I dont lose weight.
    I only eat meat, green vegetables, a hand full of nuts, and the occasional tomato (95% of the time). Occasionally I lose control for one meal but return to my usual regimen the next day.
    What should happen though is that I will have all the health benefits of being on a low carb diet, while continuing to be heavy.
    Is that right?

    1. Where’s the fat? You’re eating muscle meats, vegetables (including the tomato) and a handful of nuts. You must be ravenous.

  36. Dr. Eades,
    Just a quick note to say thanks for sharing your brain with us. You are my most-trusted source of health and nutrition info – and that’s quite a compliment to you, considering how widely-read and skeptical I am.
    I know that your insights have made a difference in my life, and I am always passing your posts on to my fat lipophobic friends. Please keep those posts coming – you are helping a lot more people than you may think.

  37. Thanks for another post, Doc. Would also like to add my kudos regarding your Twitter feed … always great reading. You do lots of reading and pick out the good stuff, so I don’t have to. 🙂

  38. Hi, Dr Mike,
    I’m trying to learn as much as I can about low carb / high protein diets and I find your posts very informative. The biological mechanics have me convinced that it’s a logical way to lose / maintain weight. I do have one question though.
    You stated in this post that ‘insulin is the body’s storage hormone: it puts fat in the fat cells, protein into muscle cells and glucose into it’s storage form, glycogen’. If insulin production is all but halted due to restriction of carbohydrate in the diet, how does protein get into the protein cells? Does the 30g of carbs provide just enough insulin to do this but nothing else?
    Forgive me if I’m being dense.
    Kind regards,

    1. Glucose is made by the body from about 58% of the protein you eat and about 10% of fat. Having Type 1 diabetes, I have to take insulin for a protein/fat-only meal or my blood glucose goes up. The percentages do vary with different proteins but it makes no difference if you have diabetes or not. I’m just mentioning it as a way of anecdotal proof.

    2. I’ll give this a quick answer in case Dr. Eades doesn’t have the time.
      As Dr. Eades’ post pointed out, dietary protein also stimulates insulin production. That insulin should be sufficient to get the protein into the cells that need it.

  39. It’s going on my Amazon wish list NOW. When I get all my bills paid off, I am going to have a great time ordering at least some of the books you’ve reviewed on your blog. But this one is first in line!

  40. Here’s a request, Dr. Mike… is there a way to see a list of books you’ve reviewed without having to slog through all of your blog articles? I’d like to put many of those books on my Amazin wish list. Thanks.

    1. Pam: at Tom Naughton’s Fathead blog he’s got a good list of books to read…there’s a tab at the top for recommended reading. You might check it out while waiting to hear from Dr. Eades.

  41. In the literature, the ability to switch back and forth between glycolysis (burning sugar) and beta-oxidation (burning fat) is called “metabolic flexibility”.
    Keto-adaptation is the extreme case of adaptation to a low-carb diet, and is only part of the story. You don’t have to be in ketosis to access your fat stores, and you don’t have to be insulin-resistant to have trouble accessing your fat stores (known as the “low carb flu”). I talk about metabolic flexibility at length here, and would appreciate any input anyone cares to provide on the matter.
    Great to hear from you again, Dr. Eades! “The fat is still listening to insulin but the liver isn’t” is such a great, concise explanation of how T2D develops.

  42. I wonder where I fit into this: mid sixties female, slender all my life, pre-diabetic range for last 10 years, normal to low blood pressure, low triglycerides (50-70) eating low-carb (but 100g or more to keep from losing weight)….I’m still waiting for the ‘middle age spread’ to arrive!

  43. Just read WWGF – has rocked my world. I’m a total believer. It really is a true paradigm shift – this must be what it was like to learn that the earth was round. I’m a family doc, and finally have the answer for all my young, obese patients who SWEAR they count calories and exercise extensively and still can’t lose weight.

  44. Gary Taubes and the insulin-fat connection sounds very logical. Reading your post made me think of Jimmy Moore who lost a whole lot on low-carb, put quite a bit on again and is now desperately trying to get back from 280 or so to 230. Presently he eats almost nothing but eggs, coconut oil and meat, very few veggies, has come down to the 250 range and can’t seem to go any further. I wonder why – after losing the initial weight – , he put some weight back on even though he is ketoadapted and stuck to low-carb all the time and why he finds it quite difficult to lose more weight now? There must be something else at work. Besides, there are many examples out there where people put on weight on a low-carb diet. Even Dr. Atkins is known to have advised people to count their calories – or so a friend of mine, who consulted him, told me.

    1. @mezzo, Jimmy Moore is still eating Frankenfoods. Daily. He has tried it all including a week long fast.
      He has spent time eating only eggs with coconut oil. He eats at restaurants a lot so gets their highly processed and heaven only knows what kinds of oil they use to cook with.
      He cannot get past his carb cravings because he will not eat only real food and enough calories a day for his body. He tends to over exercise as well. Chronic cardio.

      1. FWIW, I saw Jimmy Moore last week on the low-carb cruise, and he looked great. So what if he weighs 250; he’s a big-boned, broad-shouldered guy, and at least 6’4”–if not taller. I wish I had half his energy. 🙂

      2. Thanks for answering my question – I had similar suspicions. I noticed this habit and pointed it out on the comments of his blog – told him to lose the Atkins bars. I had a similar comment several years ago when he was still drinking gallons of diet sodas and adding some sort of wonderful fat- or calorie-slashing pills to this diet. Those comments were not well received. I also noticed that he was starving himself on the meat and eggs diet – barely 1500 kcals a day has probably shot his metabolism into outer space. This is so sad

        1. The big question for me is… how do your normalise what is likely a shot metabolism? I’ve got to the point of eating little (not hungry, despite the insulin I take) and not losing weight on low carb. Any hints on how to kick-start the process?

  45. I think a distinction must be made between refined and healthy carbs. Kitavans consume high carbs, high fructose diet and have no obesity or other diet-related diseases.
    They get 69% of their calories from carbohydrate (10% from fruit), 21% from fat, (17% saturated) and 10% from protein.
    According to the insulin theory they should (at least some of them) become insulin resistant and obese.
    Similarly, Japanese consume high carb diet and have very low rate of obesity and disease.
    Blaming obesity on carbohydrate wihtout any distinction where these carbohydrates come from is simply not true and contrary do the obvious evidence we have based on Kitavans or Japanese diets. High carbohydrate diet may be in opposite very healthy as Japanese and Kitavans prove.

    1. @Rudolph put those Japanese on a western diet and you get the obvious result. But remember, the bulk of the traditional Japanese diet doesn’t include loads of fruit, dairy or refined carbs. Just rice (yes a refined carb), vegetables, soy (another issue entirely), meat and lots of fish, and yes some sugar in a few of their dishes. It’s a nutrient-rich diet of very fresh food. Their portions are also a lot smaller and they are probably more active too. The Okinawans, in particular on Ryuku Island, according to what I’ve read, have a diet 25% lower in sugar than other Japanese and 75% less carbs. It’s considered to be quite low in calories (which if they ate tons of rice, then couldn’t be). So no, the diet everyone talks about isn’t high carb.

      1. I think the fact that the main carbohydrate in the Japanese diet is white rice, which is considered highly refined, kind of shows the error in the “refined” versus “unrefined” carbohydrate argument.
        What’s common between the Kitavan and Japanese carbohydrates is that they are cooked and eaten hot. That means they’ll be eaten primarily at meals, not as snacks, giving insulin levels a chance to subside and fat to come back out of the fat cells between meals.

    2. Rudolf,
      I think that the main reason that the Kitavan’s diet is healthy & the Japanese diet used to be ( they have a fat problems now especially in children ) is the one mention in Rob Hanna’s post:- complete absence of refined vegetable oils.

  46. “So fat people are fat not because they overeat – they overeat because they’re fat.”
    I thought fat people didn’t overeat. Didn’t Gary say that most overweight or obese people eat the same amount of food as others?

  47. It’s not carbs in general that are the problem, but highly-refined processed carbs. If you are raised on corn syrup, white flour, and ice cream then your metabolism is permanently messed up.
    Those famous Kitavans, grow up eating a 90% carb diet, but they are unrefined and unprocessed carbs.
    The big question is “How to reverse insulin resistance in the liver and/or induce it in the flat cells?”
    This is the $64,000 question.

  48. Dear Dr. Mike,
    It was surely providence that I read your blog, since I rarely go into low carb blogs anymore.
    I’ve been trying to low carb for a while now, but the first few days are so horrible, I always give up and eat carbs like fruit and popcorn and feel better. But in the long-run I know that eating too many of those is damaging to me.
    I give up low carb because I feel so tired, my thinking is clouded, leading to depression, and I feel that “this is no way to live.” Of course in my muddled thinking, I can’t see the bigger picture. I have metabolic syndrome, so I know low carbing is best for me.
    In your article you mentioned there are things we can do to help those first few days of “carb hell.” Please Dr. Mike, can you share some techniques that may help us? I know I can’t be alone in needing advice. Thank you Dr. Mike.

    1. The best thing you can do is tough it out. Your body is going through a metabolic changeover and that has an effect on your mental status, cravings, etc. But it does pass, which takes anywhere from a couple days to a week or two. Dr. Mike likely knows of tricks that make the process easier, but bottom line is you have to stick with it.
      I will say that if you’re trying to do a low-fat version of low-carb then you’re not going to get to the point of feeling better. Some people trip up because that’s what they’re trying to do, and it doesn’t work. Best of all, make sure most of the fats you get are animal fats of the majority-saturated variety (there is no pure saturated fat that occurs in nature–coconut oil is probably closest and that’s not animal, obviously).

    2. Google “eades ketosis” and you should find a good article on what happens dring entry into ketosis and why it’s temporary. And as Dana says, eat more fat.

    3. Jane- for me, eating lots of saturated fat makes it all too easy and helps with the few days in the beginning. Bacon and eggs for breakfast, roasted chicken on salad with avocado and olive oil for lunch, beef or pork and roasted veggies smothered in butter for dinner, LOTS of water…this is what worked for me and what I recommend to new low-carbers. Just remember that carbs are as an addiction, and you can’t break an addiction by having the substance regularly again. Even 3 years in if I have pizza with the crust I start down that nasty spiral of carb cravings again. I still do it occasionally, but it always takes about a week to get my body back into fat burning and also for the addictive need for carbs to pass.
      Personally, I think alcoholism is just another version of carb addiction. I could go without drinking but could never go without sugar and bread. After breaking the cycle my body I’d finally in tune with its actual needs instead of the needs of the addiction that used to control it.
      Don’t give up! It gets easier, and there’s quite an amazing support system here to help you. The benefits far outweigh the short-term discomfort. Have faith in your strength!

  49. “If all the different types of cells developed resistance to insulin at the same rate, we wouldn’t have as much of a problem.”
    Well, we would, though. We’d go diabetic immediately.
    I keep saying (elsewhere; I should probably say it here too) that fat people are immeasurably lucky. Anyone can become metabolically deranged, insulin-resistant, what-have-you. (And here I mean the pathological form of insulin resistance–you can become IR for legitimate health reasons, i.e. pregnancy, but try explaining that to most folks who are just now learning about IR and their brains will go asplodey.) But the fat people get a visual cue. We receive a clear warning by way of fat gain. Slender people who go pathologically IR do not get that warning. Instead they come down with a whole host of health ills, such as high blood pressure and low HDL, that they write off as “hereditary” and for which they opt to go on meds.
    If I could wish for anything in life where public health is concerned I’d love to see the public finally figure out that the problem isn’t obesity but poor nutrition, and anyone can be a victim/survivor of poor nutrition, and anyone can suffer poor effects from it. No one is immune, no matter how normal their BMI is.
    I did not start out overweight and looking back now, I’m suspicious I was suffering from reactive hypoglycemia and all the fun little mental health problems that come along with that from my early adolescence onward. My grades suffered and that had a far-ranging effect on my adult life as well. People’s lives are being played with here–and I was lucky; had I gone to school just ten years later, some wit in the school system would have been trying to put me on Ritalin. My stepmother, not knowing any better and possessing of an inordinate trust in the system, likely would have complied in my dubious behalf.

  50. @ Jane–Ditto! I give up LC too easily for the same reasons. Yes, Dr. Eades, can you mention things to do to get through the cloudiness? I’ve read “Protein Power”, but I don’t recall reading it in there.
    I ordered WWGF by clicking on one of the links in this blog, so you’ll get a bit of credit through Amazon.
    Thanks for blogging again. As always, a huge wealth of information, and I plan to stick with LC this time.

  51. Hi Dana, thank you very much for your feedback. Yes, Pam and I will have to tough it out. Thank goodness the coming week (I started back on low carb yesterday) I can just sit around and be a vegetable if I need to; not much to do.
    I am hoping the “symptoms” do not last any longer than a week. The particular plan I’ve decided to follow says they will vanish by the fourth day. We’ll see.
    Pam, what is WWGF that you ordered?

  52. Thank you Dr Eades, I’ve bought your books and Gary’s. We cannot begin to describe how important this information is, and consider them a “re-awakening” and advancement of scientific facts that were buried in the 1950’s and 60’s but now are back on track to help our society to become healthy once again.

  53. Excellent article , Dr. Eades. 🙂
    Gary Taubes delivers another great book.
    I am linking this article to my own blog, because I support the both of you 100 %.
    Gary has gotten the ball rolling in the right direction, and I will be the first to applaud him. He sparks interest in fat cell behavior, something essential to understanding morbid obesity, and something ignored by the mainstream.
    Fantastic journalist.
    Take care,

  54. I really cannot thank you enough for your tireless research in this field, and all the (free) information you’ve made available on the Protein Power lifestyle. The rational breakdown of the lowcarb life and its innumerable benefits, as well as the extensive scientific data you dissected both thoroughly and in an easy-to-digest fashion were what hooked me on your blog.
    I was introduced to you and your wife via the film Fat Head, which I watched (having no prior knowledge of its contents, just bored and happened across it as something to watch on a day off of work) while I was on a low-fat, high-carb diet the likes of which I found touted by “nutrition experts” all over the world. I had been on that mobius strip of misery for a few weeks at that time. I am a 6’0″, 25 year old male who weighed 365 pounds when I decided to cut out soda, junk/fast food, and fatty meats to lose weight – as well as upping my intake (from zero, let’s be honest) of fruits and vegetables. I did the math and found I was eating about five thousand calories a day before I made the change. Eating lean meats sparingly, a lot of fruits and vegetables, and a lot of granola as my daily fare; I cut calories to about 1200. Needless to say, the weight flew off! I lost an amazing amount of weight. I couldn’t move as much poundage when I went and lifted weights, which naively I attributed to simply not having as much fuel – nothing to be concerned about.
    But oh… the depression. I’ve never had problems with that (not since typical teen angst anyway, which being obese compounded). But for those few weeks on the high-carb/low-fat diet, I was feeling lost and hopeless and empty inside – in more ways than just the hunger. I wouldn’t say I wanted to die, but I wouldn’t call my emotional state at the time anywhere in the same ballpark as “healthy”.
    And then, Fat Head. I watched it all, mouth agape most of the time. I thought it was cute and clever at first, but when he (along with yourself, your wife, and many others) began explaining the science of fat retention and loss, I was definitely intrigued. But skeptical! And so I finished watching the movie, and started looking into the credentials of the people he interviewed. Scam artists can slap on white coats too, I thought.
    My research led me to your blog. Your insightful, witty, and THOROUGH blog posts impressed me. That you had done the research was readily apparent. Your passion and your intellect and your mountains of corroborative data won me over. I will, I told myself, at least give it a shot. When you’re over 350 pounds, it’s time to take a chance or two on fixing what’s broken.
    I’m not a sappy kind of guy, and short of getting a knee to a certain part of the anatomy during a football game, I have cried twice that I can remember in my adult life: Once when my father had his stroke, and – most recently – when you showed me incontrovertibly the lies and misinformation surrounding weight loss that led to his obesity and ultimately the stroke. The lies that led to my obesity, depression, frustration, etc. And the obesity, depression, and frustration of MILLIONS of Americans.
    I have read every single one of your blog posts, and every comment on them (because there’s gold in them thar comments, especially when you reply). Thanks to you I’m down to 295 pounds. Furthermore, my ability to lift weights has increased, even more than before that awful, awful low-fat diet made me weaker. This leads me to believe that I am preserving more lean muscle mass, and I’m noticing definition in some muscles I haven’t seen clearly-defined in quite some time. Sickening, when I think of what I was doing to myself on that death spiral diet I had been on.
    Oh, and depression? Ha. I haven’t been this happy or energetic in years. I eat about 1400 calories of meat (beef, fish, pork, chicken, etc.) and cheese a day. Only about an ounce of cheese a day, I know what you’ve said about it sabotaging weight loss efforts. I went zero-carb the first week, now I’m keeping it under ten per day. No HFCS, as little diet soda as I can stand, etc. I’m doing my best with the WEALTH of free information you’ve provided.
    But I got paid yesterday, so now it’s time to order your books. I want more information, as much as possible.
    I’m sure you’ve heard this a thousand times, but I’m going to make it 1001: You saved my life, Dr. Eades. My life, and my sanity. You’ve made my short list of heroes, and I couldn’t be more thankful for everything.

  55. I have a question. I went from eating a high carb (200-250gms)/ low fat diet to a low carb (75-100gms)/high fat diet with calories remaining roughly the same. I have been lower carb for about a year now. I have lost no weight. If this theory holds good , I should have lost atleast a few pounds. But I weigh exactly the same. Even if that many carbs does not take me into ketosis, shouldnt it have affected my insulin levels a little ? Is this what Dr Atkins talks about….that even a few extra carbs are the “kiss of death” on this diet ?

  56. Hi Gary – Been on a low carbohydrate/paleo diet for the last two years. I quickly dropped down 25 lbs but have been largely unsuccessful to loose anymore despite being true to the low carbohydrate/paleo diet. I still have about 10-25 lbs more to loose and am wondering if part of it is due to potentially insulin sensitivity.
    Am wondering, do you have any tests you could recommend I can discuss with my Physician on taking to test for that?
    I also find that if I drink alcohol, I seem to gain weight very quickly – even if I eat cleanly before/after I have a few drinks. I’m concerned that it may be an issue with insulin resistance in my fat cells similar to what you indicated in your article.
    I know that you do not diagnose/treat via comments and I’m not asking you to. Just wondering if you could point me in any direction to identify how I could determine if that is what is causing my weight loss stalling and any topics that I can research for myself on how to correct that from your opinion.

  57. Okay, so I’ve read the blog in its entirety and applaud both Gary and Mr. Eades, however, as someone with extremely low core body temp (!n indicator of hypothyroidism) I find that even when following a low carb diet it is rather difficult. Short of taking synthetic hormones, what can I do to shed the last ten pounds?
    In addition to that I have a question regarding exercise timing….in the event of consuming a high carb meal…what would be the best way to counteract or prevent the insulin highs and lows? Could I exercise my way out of it so to speak?? I mean it happens on occasion and exercise has to play a part somehow.

  58. Hi Dr. Eades
    I switched my diet to low carb after i saw the film Fat Head and I was just wondering if I can continue with this eating style when I become pregnant? Meaning, is it healthy for unborn children or is it better to consume more complex carbs? Of course i will have to increase my calories but limit my carb intake.

    1. My wife was on a high carb diet when pregnant with our first child and on a low carb diet when pregnant with our second. The main difference was that, as with most newborns, our first child had to have her head supported when we held her for the first couple months, while our second could hold his own head up immediately upon birth.
      They both seem to be progressing fine. At the second child’s 15 month checkup last week, the doctor expressed surprise as how good his pronunciation was, though I don’t know that low carb is the explanation for that.

      1. I ate high carb low fat diet with my 1st child. He was almost 12 lbs and was having low blood sugar issues after birth. He was insatiable.
        My second child, I ate low carb, she was 6 lbs 8 oz and had no problems at all. Now I believe it is not just the difference between boys and girls. He was almost twice her weight!!!
        Good Luck and I wish you a healthy pregnancy!!

  59. Hi, I have a question.
    If the level of insulin is generally low so you don’t store the calories as fat, and you also don’t burn them through physical activity, what happen to those calories? Does the body somehow dispose of them in a way that’s neither fat storage nor energy creation?
    I wouldn’t be surprised if it does, I never understood why the calorie theory people assumed calories only can end up as fat or energy, but I still don’t know anything about the bioprocess of this.

    1. I believe Eades feels more are burned for energy, in the form of “futile cycles” that increase the metabolic rate – google “eades futile cycle” to find some previous posts on the issue.
      Personally, I believe with sufficiently high fat intake some passes through the gastointestinal tract undigested.

    2. John lll asks, “Does the body somehow dispose of them in a way that’s neither fat storage nor energy creation?”
      Yes. The digestive tract harbors trillions of gut microbes that feed and multiply. They eat what you eat and they produce heat as they multiply. About half of the solid waste that exits your body consists of dead gut microbes. For more info on this Google “Gut microbes caloric apportionment.”

      1. David Brown: “The digestive tract harbors trillions of gut microbes that feed and multiply. They eat what you eat and they produce heat as they multiply. About half of the solid waste that exits your body consists of dead gut microbes.”
        Okay. Isn’t that alone evidence that the calorie theory of weight loss is wrong, because it blatantly means that calories don’t have to end up as either fat or energy (which is the basic premise of the calorie theory, that anything that isn’t burned end up as fat.)
        Calories being consumed by microbes, is that the main explanation to what happens to those calories that aren’t burned or stored as fat? For example, is that what happens to the “superfluous” calories in people who eat, let’s say, 5000 calories a day without exercise or fat gain? (Assuming no extreme circumstances like a lot of freezing or the like.)
        Or are there even more ways the body can dispose of superfluous calories? Even if we don’t know of any other way, couldn’t there be some way we haven’t identified?
        Again, it just never made sense to me calories has to be either stored or burned and absolutely can’t end up in any other way, and equally silly to assume that the people who reject this view are rejecting the law of thermodynamics rather than rejecting that these two are the only options.

        1. There are so many ways the calorie theory is wrong, but who has enough time or energy to document them all?
          How about just two obvious ones, for giggles:
          1. the thermogenic effect of eating foods differs depending upon what you eat, digesting proteins expends about 30% of its potential caloric energy in digestion alone… or so they say
          2. irritable bowels, coffee, red bull and just plain old fast peristalsis (the transit time of foods digested) can move food too quickly for full caloric absorption… or so you can prove it for yourself: ever poop after eating and see stuff in your toilet that looks like you should be chewing your food better?
          So who knows for sure, etc. What some know they don’t know is often discussed or acknowledged in humility to inspire contemplative and rhetorical caution, but that most don’t know what they don’t know is gleefully estimated at zero and commonly ignored with impunity…

          1. @ Rob Hanna…you have a way with words….LMAO! Enjoy all your posts. They are very informative and written with humor.

        2. John III
          Faeces can contain a lot of fat/calories, which is why animal dung is used as fuel in many countries.
          See http://www.bbc.co.uk/sn/humanbody/truthaboutfood/slim/calcium.shtml where you will read: “a high calcium intake increases the excretion of fat in the faeces”. – Danish researchers had found that twice as much fat was excreted on a high calcium intake as on a low calcium intake – and this was independent of calorie intake. – They also found that dairy calcium (they suggest yoghurt) is a particularly good source for this extra calcium.
          I have written more fully about this on the Fat Retention page of my website.

  60. As Laurel says, “The big question is “How to reverse insulin resistance in the liver and/or induce it in the flat cells?” This is the $64,000 question.”
    As a T2, I have been doing extreme LC (20 – 30 grams/day) and very high fat (@ 70% of my calories) including plenty of saturated fat. I am always in ketosis. At first, it seemed astoundingly successful — I lost 30 pounds in no time, my BGL dropped to pre-diabetic range from the 300s post-meals even faster than the weight loss occurred. Then, a couple of years ago, my “success” began to fluctuate: my weight and my morning fasting BGL began to go up and down for periods at a time. At first I thought it might be seasonal but discovered later it wasn’t. I now think it is more a cause of becoming more IR at times or less IR at times. But, what causes these fluctuations that have nothing to do with my diet?
    The mention that the liver could be IR while the fat cells aren’t got me to thinking that there might be something here that has to do with my T2 and IR. Obviously, when I am in a weight gaining period, my fat cells are functioning very well… too well. They are quite insulin receptive rather than resistant. This weight gain appears to happen independent of what goes on with my BGLs however — they could be in a higher than usual period or in a lower. When my BGLs are running in a lower range, is my liver less resistant or is it merely my fat cells clearing out the glucose with the help of insulin? When my BGLs are running higher, is it the opposite? This is quite confusing but if I could understand a little more, I might be able to exert some control over my unstable situation.

  61. I’m new to this, but this article makes a whole lot of sense. I would like to start a low-carb diet, but would appreciate some suggestions on a particular program. One that can help me deal with carb withdrawal would be nice. Thanks for the help.

    1. Dr. Eades book ‘The 6 Week Cure For The Middle Aged Middle’ is a vastly underrated gem. It will provide all the help you need in a very easy to follow program. You’ll enjoy the shakes (protein, not withdrawal) and come to understand what you need to do once you finish the program.
      This blog, and perhaps that of Dr. Kurt Harris, should provide you with tons of info as you move on. Keep an eye out for links from here to other blogs, and learn from those that interest you. It’s fun journey, and if temptation should arise, there’s plenty here to reinforce what you’ve learned and help you get back or stay on track.

  62. We chemists are doing an inadequate job of explaining the laws of thermo and to what variable limited (reductionist) systems they can be reasonably applied to to make them understandable. It’s not that they are not in effect in more complex systems, it’s that no simple (reduced) explanation will suffice. If you wake up one morning and discover you are fat, I can tell you with thermodynamic certainty that you ate more than you expended. Hohum. You are not a closed system at equilibrium- when you do reach equilibrium you’ll be dead. You are an alive, non-equilibrium system for which the reaction quotients (reactions in progress) of literally hundreds of trillions of thermo reaction equations of the Gibbs free energy would have to be manipulated and calculated AND interconnected (and resultant wild card emergent properties would no doubt emerge to complicate even further) for any valid thermo conclusions to appear. So ‘calories in calories out’ is helpful after the fact only. Fueling is not the only reason we need to eat. We evolved our big complex brains, that are made of animal cholesterol and fat, by not burning everything that came in. And to this day, not everything we eat is used for fuel.
    If your car is performing poorly and you were feeding it low quality fuel and oil to begin with, try reducing the amount of fuel and decreasing the oil stock further and see how that works out for your car. And your car doesn’t replace its components persistently and/ or protect itself from infection continuously or constantly with an immune system. Your car doesn’t support 1000 trillion continually turning over symbiont bacteria either, whose health and community composition are vital to the car’s performance and mental health either. So go ahead and stick your head in the sand and say it’s calories in calories out all you want and continue to eat sugar, cereal grains and vegetable oils and low-fat, vegan, low-salt diets. If we can’t explain it better, as the good scientists we aspire to be, I guess it’s hopeless.

    1. “So go ahead and stick your head in the sand and say it’s calories in calories out all you want and continue to eat sugar, cereal grains and vegetable oils and low-fat, vegan, low-salt diets. If we can’t explain it better, as the good scientists we aspire to be, I guess it’s hopeless.”
      A little harsh and judgmental don’t you think? When you actually understand the complex system you attempt describe, you will be in a position to make definitive recommendations. Until then, we will all continue to wonder how it is that people eating “cereal grains and vegetable oils and low-fat, vegan, low-salt diets” can do quite well. Something else is going on.

    2. Thanks Laurie,
      I’m always muttering at my computer screen when the discussion of the first law of thermodynamics goes on withput a mention of a closed system.. In my engineering based thermodynamics class, the test include about one question on energy in equals energy out. Because, as you said, hohum….snore. But there were several questions about what is a closed system. The problems with friction, heat, heavier weights, longer fulcrums, chemical reactions, phase changes, etc can be somewhat tricky. But, the human body as you point out is way be gone not a closed system.
      There are so many ways that the body can burn more or less energy. For example, gluconeogenesis takes energy to create the carbs that the nervous system needs from protein. So, if I’m playing a difficult game of chess while on a low carb diet, am i burning more calories than I would be doing the same on a high carb diet?

  63. “Me: People sometimes experience those symptoms early on, but they usually resolve after a couple of weeks. And there are steps you could’ve taken to prevent or minimize them.”
    Could you point me to where I might read about these steps please.
    Thank you, welcome back and a wonderful and informative post.

  64. eks wrote:
    I was just wondering if I can continue with this eating style when I become pregnant? Meaning, is it healthy for unborn children or is it better to consume more complex carbs?
    Dr. Jay Wortman, whose T2 diabetes resolved with low carb, comments in the interview below on his two children, both of whom are low carb (and whose wife was low-carbing during pregnancy.)
    He says both kids are happy, healthy, calm and never get sick. Interestingly, his kids are at the 95th percentile for size for their age.
    (It makes you wonder if we’re all stunted because our mothers were on wheat and sugar while they were pregnant with us.)

    1. Hi, Joe. I’ve got a 6 month old son and I eat high fat and low carb. I did this, for the most part, while pregnant but had a harder time eating enough meat and fat and tended to crave bread, sugar and fruit. I ended up gaining 38 lbs (about 15 of that during first trimester carb binge) but tried hard to keep the gain at a slower pace by not eating too much grain or sugar. The blood glucose test I took while pregnant went very well–my blood sugar still recovered very fast, presumably from my 2 years of low-carb eating prior to pregnancy.
      There aren’t any real studies done on safety of bring in ketosis while breastfeeding, but I’ve already managed to effortlessly drop all pregnancy weight. My son is just now having some solids, and I’ve no intention of giving him grains, as they’re very nutrient-poor. Poor man’s baby food, some call cereals and grains. He’s been eating avocado and soft cooked egg yolk along with breastmilk and he’s one of the strongest and brightest babies I’ve ever met. Never been sick, either. I’m convinced that what’s good for adult humans is good for little ones, though I’ll probably let him have more fruit and maybe the occasional sweet potato, as he’s not trying to lose weight like his mommy! He’ll always get full fat raw dairy, too. I’m fairly convinced it’s the low-fat diet that’s at least partially responsible for all the ADD and possibly autistic disorders in kids. I wish they’d do more studies on this instead of just continuing to cut more and more of the fat out of those poor kid’s diets. You build brains on fats…NOT grains:)
      Recommended reading: Real Food for Mother and Baby by Nina Planck. This book is still a daily lifesaver for me. Covers pre-pregnancy diet as well as pregnancy diet and first foods.

    2. Thanks for the website to Dr. Wortman.
      My mother loved Coca-Cola way back when it came in 8, or was it 6, ounces bottles. (for the younger audience that was in the 1940’s) I came out of her womb as nearly a 12 pound baby.
      I loved Cheerios with lots and lots of added sugar. Needless to say I was a hyper kid. But what was sadly interesting is that i was very skinny and small from the age of 10 or so until I was 15. I developed T1 at 15 and, with the addition of insulin, went from a 90 pound weakling to a 165 pound defensive tackle in two fast growing years.
      The consequences of sugar and refined carbs on the embryo and developing child are many and sad.

  65. What is the real difference between a Keto diet and a low-carb diet. I am currently on a ketogenic diet, but I’, wondering if I can get the same results by eating low carb. Currently I’m eating between 10-25 grams if carbs a day, but if I increase that to say 50 grams a day am I going to experience fat loss?

    1. A ketogenic diet is just a very low carb diet (VLC, sometimes called). Usually 20-30 or less. Adkins called it the ‘induction phase’. Some call it a zerocarb diet, as it’s so low that it usually means no fruit or starchy veggies at all. Most people do this for the faster weight loss phases, though some try to stick with this indefinitely. Some feel great eating this way all the time–others eventually find they want to add back squash and berries and the occasional glass of wine and find a bit more carbs more managable. Just depends on the person’s body and their health goals and health history.
      I’m sure some people can be in ketosis on more than 30 carbs, but really, ketogenic just means being in a more or less continual state of ketosis.

      1. I can have some fruit – the equivalent of one normal sized piece per day – and stay in ketosis, and below 30g carbohydrates. Very low carb is lower than low carb, but it is not the same as zero carb.
        The zero carb folks generally eat no vegetables at all, just meat. If a vegan can eat it, they don’t.

        1. I agree that 20 and under isn’t actually zero carb. I just meant I’ve read that some consider 20 or less carb to be a zero carb or no carb diet, since it’s quite low. There really isn’t such a thing as a true zero carb diet as meat has at least a bit of carbohydrate in it…at least, so I’ve heard. And some people consider a ketogenic diet to be a zero carb diet, even though it’s most likely not.

  66. The crowded restaurant example is brilliant. I truly enjoy reading your posts, Dr. Eades, and look forward to more. I appreciate you!

  67. So many posts! But up there, somewhere, a person wanted to know how to get through the carb withdrawal. In WWGF, Taubes includes Dr. Westmun’s (sp?) diet. He recommends having some beef bouillon because blood pressure drops when you drop carbs (which make you retain water). I don’t know if that will help with the “carb withdrawal”. I had a friend who tried Atkins and felt sick to her stomach and therefore, found that as “proof” that her body was “different”. I wish I’d known about the beef bouillon trick.
    When I felt a craving, I would eat something high in fat. I knew that I would feel better after I ate fat, so that knowledge alone helped me avoid stuffing myself with something carby. I’d never been able to follow a “diet” before because I think there was a sense of panic when I knew that nothing I would be allowed to eat – when I could eat – would satiate me. Knowing I’d feel better after having something with fat got me over the hump.
    Now I maintain my weight easily, but if I get silly and we have too many celebrations around here, I’ll start to crave sweets again. Once I get back to a certain proportion of fat to muscle in my body, I can indulge once in a while without having carb cravings rule my life. Hunger for carbs is so different than what I call *real* hunger!
    (BTW, via Mark’s Daily Apple, there’s a link to a Hawaiian guy who is totally raising his baby Paleo. Interesting read.)

  68. Another point: in these discussions, someone inevitably trots out the ol’ “Japanese and their rice” example.
    From what I understand from people who travel extensively in Asia, Asians don’t eat as much rice as we think they do (and for much of their history, it hasn’t been refined). Or they didn’t. More Western-type foods are showing up there and expanding waistlines as well.
    Western people also didn’t become obese eating some carbs regularly until recently either. When I was a child in the 60’s, we’d add sugar to our sugary cereals! Yet, it was rare to see a kid who was obese. In the last 30-40 years, high-carb foods, easy and cheap and their consumption supported by the low-fat diet “wisdom”, have dominated the Western diet. I wonder if we all started slowing down – watching TV, driving instead of walking, sitting at the computer – as we started to eat more and more carbs, hm. Perhaps we have carbs to thank for our technological innovations. 😉

  69. Hi, I have been reading lots of articles here and found it very interesting.
    I am just an ordinary guy searching for truth.
    I am not an academic in nutrition, but recently found the paleo diet and thought “yes I could do that for life”. I read the paleo diet and went looking for proof and rebuttals. Then came The china study and then Cordain’s how to get rid of acne via diet. I then read many blogs, web articals and the excerpt from “Why we get fat” found here. I read the post debate documents between Dr’s Campbell and Cordain on protein consumption as well as many blogs discussing the review. I then read from “stop the thyroid madness”. It was all really interesting stuff and some of it seems to fall into the category of “common sense when you think about it”. I take everything into consideration and try to employ my common sense as I can. I enjoyed finding this blog and what it has to say – it’s fascinating reading.
    Whilst trying to stay objective and open minded – I find Dr. Cordain’s ideas logical and semi well proven, I find Dr. Campbell’s ideas profound, but I wish he had done studies on other animal proteins than casein to prove his point – it’s hard to judge or form a balanced opinion without that. I find the findings of Gary Taubes in “why we get fat” to be extraordinary. If true they explain a lot. Of course, I question and take things with a pinch of salt (although since starting the paleo diet, I don’t take very much salt if any these days) but for an average person in an average life, I want the truth! I know scientific proof and being right or wrong is almost an impossible goal but I feel like the people need it. They deserve it. I feel like Dr’s Campbell and Cordain should be given the money to sit in a room for five years and work out scientifically who is right and who is wrong on their fundamentally opposed ideas on protein. I feel they are close to the truth, but it still eludes them.
    Me myself, I have been on the paleo diet 2 weeks and am trying to get used to eating so many vegetables – not easy but I am sticking to it. Gains so far (trying to remain objective here)- 8 kg lost, feel much better generally, acne reducing and going away (something I have suffered with from the age of 12 to 38 – I used to drink milk in copious quantities when younger, several pints a day, but since off dairy I feel soooo much better), more zen, sinuses are de clogged totally (suffered from many sinus infections – I feel I can breath much more easily than any of the past 15 years I remember). I can honestly say that on the paleo diet I have never felt more alive and vibrant and I am trying to be as objective as possible here.
    One comment I do have however in general to the nutritionists is this, BMI. It’s a height vs. weight ratio thing and this seems unprecise from my point of view. I’m a pretty big bloke. Surely it should take into account how wide you are and how big boned you are ? Being someone of 197cm tall (77.6 inches or 6.5ft for my american cohorts) and extremely wide girth (I am about 62cm across the shoulders 2 ft!) shouldn’t this have an impact on my ideal body weight. I think it should. Curse those online BMI calculators. I propose the TBMI – true body mass indicators that takes this into account.
    Anyhow, have enjoyed reading here and am enjoying trying to do the best for my body, even though it may be write or wrong (when will you medical folk get together and finalise what we should be eating!)
    Nick Kent
    UK ex pat living in Belgium for the last 15 years.

    1. Many have thrown the whole BMI thing out the window as a load of nonsense for the exact reasons you point out. It is just not a valuable measurement.
      To me, weight loss itself is not a valuable measurement either. Fat loss is.

    2. Nick- I’ve also always found BMI to be the biggest crock since the ‘saturated fat is bad’ theory cane around. It’s ridiculously simplistic to lump all people into categories based on their height, since some people lift weights and others are skinnier with little muscle. Dr. Eades did a great blog about this a few years ago…comparing a 6 foot 200 lb weightlifter with a 6 foot 200 lb overweight person (the illustration at the top of that blog is very telling).
      Body composition is much more important, as having good lean mass tends to make a person healthier in most ways than an equal weight skinny-fat person. I say find out body composition and focus on that and ignore the pointless BMI. It says just about everyone is fat…could BMI be the reason for the so-called ‘obesity epidemic’? Just an inaccurate way of categorizing otherwise normal weight people?

    3. Forget Campbell, he’s at best wrong, at worst a fraud. He’s been completly refuted by smart bloggers like Chris Masterjohn, Denise Minger and others. Even the Cordain/Campbell debate should have clued you in as Campbells points are really vague and “new-agy” while Cordain brings a lot of research references and reasoning in the conversation.
      Here some links of Campbell debunkers
      Denise Minger showing that the raw data of the chinese study doesn’t show what Campbell claims it shows.
      Ned Kock who has collaborated with Denise on the stats
      Chris Masterjohn demonstrating brillantly that Campbell lies even about the results of his own studies (they don’t show what he claims they show)
      Dr.Eades himself had a take on it

    4. Hey Nick, before reading anything more from Campbell you should go over to rawfoodsos.com and click on the China Study link. Denise Minger, a very talented writer with a solid grasp of statistics used Campbell’s own data and found huge holes in Campbell’s conclusions. The best part, is if you don’t know anything at all about statistics Denise provides an easy walkthrough and makes it simple to understand for everyone.

  70. Hi, Mike
    Thank you very much for a very informative article
    I’ve loose about 15 pound of fat after starting to read you blog.
    Kveta Parfemy
    P.S. I like the crowded restaurant analogy.

  71. It seems almost too simple to be true. Too much free floating insulin and you’ve lost your ability to access the stored fat. So was Keith Frayne wrong:Adipose tissue and the insulin resistance syndrome (Proceedings of the Nutrition Society (2001)).”..NEFA release from adipose tissue is suppressed by insulin in both lean and obese individuals, but in obesity the process is ‘insulin resistant’ in that the dose–response curve is shifted to the right. NEFA release per unit fat mass is actually less in obese subjects than in lean subjects (effectively, it is down regulated by the fasting hyperinsulinaemia). However, because of the increased fat mass, total NEFA delivery to the circulation is increased in obesity.Furthermore, if ‘lean body mass’ (including skeletal muscle and liver) is used as the denominator for NEFA turnover, then NEFA delivery to the consuming tissues is clearly increased in obesity. The ‘insulin resistance’ of adipose tissue lipolysis may be particularly relevant in relation to the delivery of NEFA in the postprandial period. Despite high plasma insulin concentrations in response to a standard mixed meal, obese subjects fail to suppress NEFA release from adipose tissue at a time when it is completely suppressed in lean subjects…” I think Gary is in the vicinity of where it is happening, but I am missing something. Why does the thing go off the rails in the first place?

  72. I’d be very interested to see a study that looked not just at insulin levels of high-carb/low-fat vs low-carb diets, but also C-peptide levels. Seems to me that the C-peptide levels would give a more complete picture of insulin production in response to different diets than the point in time snap-shots that direct insulin testing does.

    1. @Noah, I’m not sure how well that would work because as we get older, we naturally become a little insulin resistant. So, the same diet in different people would look different. Even in Type 1 diabetes, where there is supposedly no insulin production and of course no corresponding c-peptide, that’s not always so. Does it matter whether it’s a measurement of insulin or c-peptide, which is only produced in response to natural secretion of insulin? Injected insulin is already “c-peptided” so the body does not produce more in response. Even for injected insulin, one person needs a different amount to another for the same carbs, same food.

  73. Amen & thank you! Had a hunger for nutritional knowledge since a very young age…Just finished reading Dr. Fuhrman’s book Eat to Live, which also describes the keto-adaptation. Afraid that most people will continue to choose for the bliss of ignorance. Sometimes it is just easier to “not know” and just continue to do what you like, instead of becoming knowledgeable and act upon that…Guess I have another book to read!
    Namaste, Monique

  74. Forgot: so what is recommendation for the overweight? Or people with insulin problems? Referring to our primate ancestors seems a little odd since their life expectancy was on average 15 years till 30 years at the most…What I’ve figured out with the little knowledge I’ve gained in my 46 years is that you have to find the best diet (meaning: way of eating, not meaning: losing weight) that makes you feel and function at your best. For me as European is seems a little more easier, since I grew up without the processed, fat, and sugary “stuff”. You are responsible for your own well being, so try to figure it out and use your common sense. Be well, Mo

  75. Dr,
    I purchased Good Calories before going to Vegas in April, but haven’t finished it yet. As a RN, I went for the more “clinical” book. Is there new info in Why We Get Fat that I won’t get from his earlier book? Trying to watch my every dollar!

  76. Lisa-there is some new info in the WWGF book. And it’s an easier read to recommend to others.

  77. “comments like those from Elenor being authoritative and overly pushy,”
    (I’m not sure I can be both authoritative AND overly pushy, unless you’re saying I’m correct, but too enthusiastic in expressing the correct information…) (I’d also ask you to perhaps see a difference between enthusiasm and “pushing,” although I acknowledge that it hard to differentiate the two in emails; I shall try to *push* the enthusiasm more clearly in future… {wink})
    I was answering Laurel about her very short time frame — I do not think there has been all-that-much biological adaptation in humans since Poland came into existence! And in the Ice Ages (and before), and in the northern climes, there were not lots of veggies and fruits (and certainly no ‘lots of grains/starchy foods’) growing so that humans could have a varied diet (any more than the Inuit did till the Europeans showed up).
    I’m not suggesting we all emulate cavemen (although we could do worse!). I’m suggesting (or trying to suggest) that looking back just several generations as a basis for ‘human food groups’ is probably not sufficient.

    1. Elenor:
      I see your point; it’s hard to interpret text, but sometimes enthusiasm in that way can come off as condescending.
      And you’re right, not much is likely to have happened in the 500 years since Poland was formed. But a lot can happen genetically in 5000-1000 years given sufficient environmental pressures. These changes would be hard to see in the fossil record because most change would be gene regulation, enzymatic, and adaptation in our gut microbes. Taking epigenetic factors in to account, this is accelerated.
      Thinking in evolutionary terms is important. But these assumptions need to be tested experimentally. There seems to be a notion that because adaptation occurred, due to a lack or existence of something, that those conditions are desired; that isn’t always the case.
      And you’re right, we could do worse. We can also do better.

      1. The fossil record is not the only record available. We now have a lot of information from the DNA record as well, with dating that is nearly as good as for the fossil record.
        The two most important changes that have happened since the paleolithic, in the last 10,000 years or so are well known: adult lactose tolerance through knockout of the suppression area for lactase production in adulthood, which has as you pointed out occurred multiple times in at least two populations, and increases in the copy count of the amylase gene for digesting starch, from 1 – or 2 in the very late paleolithic – to various numbers in the range of half a dozen with a dependency on population location at present. These occurred as a result of gross advantages for extracting energy, from nonhuman milk and from starchy agricultural products, respectively.
        That obviously means some postpaleolithic adaptation has occurred. However, it also gives us an idea of the limits of those adaptations. These particular mutations are the fastest types of mutations to happen. That they are gross changes – a complete knockout of a gene expression regulatory area, and a copy count increase – kind of indicates that finer modifications of regulatory areas are likely to require longer periods of time. Likewise, it probably means that the subtler changes that would be required to fully adjust to the proteins in milk and agricultural products have probably not had time to occur.
        Personally I suspect the most adaptation we can expect to have happened is something like the following:
        – industrial (past 200 years): virtually nothing
        – neolithic (past 10,000 years): simple changes for energy extraction, such as the lactase and amylase mutations listed
        – paleolithic (past 2,000,000 years): adaptations for changes in proportions of different foods, consisting of gene expression modifications affecting gut and other organ sizes
        – prepaleolithic (>> 2,000,000 years): adaptation to entirely new food sources requiring new enzymes to digest

        1. Warren:
          I agree without your outline; I’d define the period <10kya as well. Though, I'd also consider Mesolithic and Epipaleolithic period. These, I think, are more relevant to the discussion – which is less about consuming meat or cellulose, and more about what micro-/macronutrient is most healthful – as it was both a transitory period climatically as well as a sufficient time frame for significant adaptation. There was also substantial divergence (and diversity) here in human trends, with the warming climate.
          Information from molecular clocks is useful for building relationships, but it doesn't give us much data about what is being expressed in an individual, and when. Alternative splicing and ncRNA regulation amounts to over 75% of our genetic diversity. These modifications can happen rather rapidly, as basic changes need not occur.
          Cell per body, we are about 10% human. The rest is our hosting of trillions of microorganisms that have a huge influence on our function. There is little to no fossil record here, and not much in respect to molecular dating, except between living individuals. They adapt much faster than we do, and their change is significant.
          There was a textbook study 20 years ago where two fruit flies of the same species were reared on two different cultures for several generations. While it was not long enough to see physiological change, it was used as a model for behavioral discrimination (non-biological speciation) between the two groups as the wouldn't mate with each other. Last year, researches found out why. The gut bacteria in the insects adapted, and they were modifying toll receptors in the fly, which altered its brain chemistry enough to cause discrimination of one group when in search for a mate.
          Similarly, we have toll-like receptors in our small intestines, and our bacteria and archaea seem to play strong roles as well. Kwashiorkor, a type of protein malnutrition, seems to be caused by variation in these bacteria.

          1. @ Jeremy Teman
            The simple facts of our biological basis being only 10% begs the question of who is hosting who?
            What you write about here is precisely the areas of intelligence where I would love to find more information and studies relevant to human biology–even just learning more about our possible gut bacterias would be great.
            And if we could begin to reassess our many bald assumptions using this simple insight then perhaps the whole sum of human knowledge about our individual and collective species evolution could develop a more accurate and perhaps even precise understanding that each of us could use at the dinner table and beyond.
            I’m so tired of all the blind blah blah blah speculation about this or that human cell expression being the primary factor for everything that ails us. We really don’t know shit, even though some people do culture stools to get a better picture of our gut’s working ecosystem…
            But I too speculate and am just like everyone else I might bitch about: I suspect we humans each individually are an entire emergent ecosystem that few have even been able to consider in such potential entirety, let alone successfully parse out and understand the molecular and chemical parts and why they work or don’t in seemingly contradictory ways for some and others: it’d be darn interesting to find out I ended up choosing a mate based on how much lactobacillus we both ate.
            Any study references or books you can share that get us deeper into revealing the other 90% of us would be much, much appreciated. Thanks for your post.

          2. Rob:
            There is some discussion as to whether natural selection acts on holobionts (a host and its symbiotic microbiota), rather than a specific individual species. Under this definition, Lamarck’s “inheritance of acquired characteristics” holds merit because what the host does throughout its life will affect the genome of this unit, or hologenome, and will be past on from the mother. Epigenetics is also giving Lamarck’s ideas validity, in this way.
            Another textbook model worthy of noting is the ecological predator-prey (Lotka-Volterra) model of the lynx and hare. Theoretically, these models were constructed using second order differential equations showing a periodic trend whereby as the hare population increased, so followed the lynx population with a subsequent reduction in the hare population, and a later a reduction in the lynx population, which caused the hare population to rise again. These equations were pretty and all, but empirically, they didn’t hold up with these animals. The hare population stayed stunted for several generations more than expected. This was recently explained by determining the epigenetic factors. What was happening was that the mothers in proximity to the lynx were stressed, and this stress was literally passed on in the offspring causing a reduction in reproduction of future generations even with the lynx out of the picture. Here is an article: http://www.esajournals.org/doi/abs/10.1890/09-1108.1?journalCode=ecol
            Similarly, there is increasing evidence that diet can cause epigenetic change: http://www.ncbi.nlm.nih.gov/pubmed/21401888?dopt=Abstract
            As for microbes, I don’t think we yet know the extent to which our gut flora interact with our physiology; who knows if it’s as science fiction as us existing as vehicles. Here is the fruit fly study I mentioned: http://www.pnas.org/content/107/46/20051.full
            Here’s a news article you might enjoy. It highlights their contribution to our immune function: http://www.the-scientist.com/news/display/58050/
            I could point to more primary articles, but it might be more useful to search for news articles – (google: “nature news gut bacteria”, e.g.) – which often help to put things into perspective, and many readers won’t have access to the primary literature anyway.

          3. Epogenetics sounds suspiciously like dauer modifications.
            The final paper, a new one hitherto not published, deals with the question of how fitness of living things is constantly adjusted to a changing environment. Is this due to chance improvements arising from mutations that happen to be beneficial (as current evolutionary doctrine requires); or the inheritance of acquired characters by the conventional route as proposed by Lamarck (which is now entirely out of favor); or an immanent divine intervention, adjusting every element in the web of nature as required? Or is there after all some built-in mechanism of self-adjustment which operates as a kind of Lamarckianism but not via nuclear genes?

    2. I don’t think she was saying that Poland 500 years ago was Paleolithic, though. She was just pointing out that they didn’t have the metabolic derangement, *despite* eating Neolithic, carb-laden foods. (In fact that is true of cultures all over the world.)

  78. * I didn’t complete my sentence above: I’d define the period <10kya as well as being more significant.

  79. The most well-written review of WWGF I have read to date. I’ve given this article to several people already whom I thought would benefit from the book, and it serves as a great introduction, synopsis, and evaluation of what Taubes is saying.
    I really appreciated the extra material you added on how obese idividuals differ from those whose metabolism is functioning normally, providin an overview of the mechanisms driving frequent hunger, or as I often hear it, “low blood sugar”. I think Taubes’ book would have been even better if something like this explanation were included.
    Thanks for a great article.

  80. Thanks for Warren Dew and Joe for responding directly to my question and thanks to those who also shared their stories on pregnancy and low carb.
    I will probably slowly up my carbs prior to pregnancy, incorporating more veggies and fruits and limit the starchy carbs. I seem to have side effects to this low carb diet. I have recently started supplementing with potassium pills because I have terrible aches behind my neck and upper back. Im worried because I’m probably deficient in other vitamins and minerals too. I do take a multi vitamin, salmon oil, folic and occasionally probiotics but am not sure if it’s enough.
    That’s my main concern when becoming pregnant, getting all the necessary vitamins and minerals I need to sustain a healthy pregnancy and I believe in getting them in a natural way in fruits and veggies rather than taking a pill/s.
    I’m also sluggish, not necessarily tired. It’s great effort to lift groceries or do laundry- not sure if that’s because I’m eating 500+ fewer calories or because I am eating between 20-35 carbs a day.
    Any input would be greatly appreciated.

    1. Do you eat your meat well done? Meat loses potassium when cooked, so that may be why you need a supplement. Unfortunately many forms of meat that go through the modern distribution system are not safe to eat rare.
      A folic acid supplement is almost certainly a good idea when pregnant, as may be salmon oil if you don’t get enough DHA – an omega 3 fat – in your food. You’ll continue to need enough omega 3s while breast feeding. Fruit is in my opinion also fine; it really doesn’t have that much carbohydrate in it compared to things like bread or potatoes, and it will help with the potassium.
      Sluggishness may be ketosis induction, in which case it will pass in a week or two, or it may simply be inadequate calories. If the latter, eating somewhat more fat may help.

      1. Hi Warren
        I do eat meat well done- for the last two weeks or so it was more chicken based and this week much more red meat based. I started these feelings this past weekend.
        I believe I eat enough fat in a day around 50-70 grams a day. I’m hesitant to eat more than one piece of fruit a day so I stick to berries and occasionally some pineapple or a half an apple. Most of my carbs come from veggies and fruit and in a day it adds up to 30 or so. I do not eat any pasta, bread, rice or flour.
        I will continue with my supplements, increase leafy greens and maybe add another serving of fruit in the morning.
        Thanks for your response.

    2. Are you supplementing with magnesium? Potassium and magnesium work together, so you won’t be able to correct a potassium problem if you’re deficient in magnesium. Magnesium deficiency is one of the most common nutritional deficiencies in the US.

    3. Hi eks,
      Have you ever heard of The Primal Blueprint by Mark Sisson?
      It’s a low(ish) carb diet/lifestyle of the Paelo/Caveman variety.
      Get yourself over to the forum as there are women there who have done the diet while pregnant and people raising their kids paleo. Should be lots of advice for you there.

  81. “Insulin is the body’s storage hormone: it puts fat in the fat cells, protein into muscle cells and glucose into it’s storage form, glycogen.”
    Just wondering what recommendations you would give if an athlete was trying to add lean muscle mass and gain weight. Would it require a high-carb diet?
    Love the post.

  82. Dr. McDougal and other vegan advocates claim to reverse or cure type II diabetes just by eliminating all animal products. Is this at all possible? Or are they leaving something out? A friend of mine who went to McDougal keeps saying my low-carb diet with animal fats and protein will lead to all sorts of health problems.

  83. Dr. McDougal and other vegan advocates claim to reverse or cure type II diabetes just by eliminating all animal products. Is this at all possible? Or are they leaving something out?
    They’re leaving out the part that isn’t BS.

  84. @Terlin – What McDougal and others won’t accept because they are animal rights dogmatists is that it’s quite possible that their diets get the results they claim for many of the same reasons low carb diets get good results-elimination of sugar, processed foods, improved omega 3:6 rations, etc. etc. And that we humans can get the same results, and probably better results, on a diet based on animal fats and protein.

  85. Great article Dr. Mike!
    I do have two problems with Taubes:
    1/ In WWGF (unlike GCBC) he talks almost exclusively about “carbohydrate”, whereas in GCBC he pointed out that 100% of the increase in calories from 1970 til now was from two sources – grains and sugar. For people who aren’t already converts, I think that is an important point; we need to start telling them “severely restrict grains and sugar” (perhaps pointing out that “liquid fruit is liquid sugar”). Then, once they’ve got some fat loss, try to get them to go a little further. Baby steps to the car.
    2/ Most people are never going to go ketogenic (were most people in USA keto 50 yrs BP, when there was no obesity epidemic?). But Taubes will only say “60 grams of carbs per day”. We need a non keto way to reverse the obesity epidemic.
    May I humbly submit my 50/50/50 diet? 50 grams of protein, fat, and carbs each at breakfast lunch and dinner. It’s scalable!

    1. The reason it’s important to talk about “carbohydrate” rather than specific sources of carbohydrate is to avoid people’s say, “oh, I can’t eat sugar and bread, I’ll switch to french fries and potato chips” – which the evidence suggests would be just as bad.
      As for ketogenesis, regular low carb on a lifetime basis – with the right kinds of protein and fat – is probably fine for preventing getting fat in the first place, but frankly, most of the people buying his book will be people who are already fat, not people who aren’t fat yet.

  86. @Terlin
    The key point in the McDougall diet is that it is the COMBINATION of eating high fats/animal foods WITH high carbs that does the damage. If you don’t do that then both low carb and high carb diets work for many diabetics. In his diet you don’t add ANY oils or fat to your diet. You get enough in the veggies (both starchy and others), grains, legumes you eat. Check out his site for more detail if you’re interested. The main stay of his diet is ‘starch based’ which I know sound absurd but it works for many of his followers.
    You might find the following link very interesting. And he does supply references in all his articles.

    1. I find it most ludicrous that McD would actually use a reference from the Sugar Association, as if they tell the truth. What is this man thinking??
      Needless to say, after 30 years of following the low fat dogma rule of the day, I’ve thrown the towel in and now I’m an advocate of the Weston Price way and those who are of “similar/like mind.” On top of which, I don’t ingest sugars w/ many names, nor flour.
      Gimme a steak.
      Formally starving and fat vegan,
      Karen….Dr. Eades ROCKS big time!!!!

  87. Dr. Eades,
    Thank you for this amazing review. I bought the book immediately and finished it earlier this week. I was previously on Weight Watchers and exercising about 5 days a week. I think i lost 5 lbs. (but probably because I was reducing carb intake). However, I just hated it because I always found myself hungry! Anyway now I’m doing the low carb thing.
    Do you (or anyone else) think that the Atkins Diet is something to follow? I’ve been reading these comments and looking at other posts of yours, but I haven’t found much on the Atkins diet. Mainly, I am a bit confused on Atkins’ take on carbs. The diet suggests I start in the 2nd phase and have a net carb of 25 grams a day. So I bought a couple of their bars and shakes for snacks, but I’m worried that because they actually have a high carb count (low net carb count), I will not lose as quickly as I would like. I have 10 lbs to go.
    Please advise.
    Again, thank you for the truth! I’ll continue to read and peruse your blog.

  88. The Atkins diet is great. Look on Amazon for a used one of the older Atkins diet books. He would probably roll over in his grave if he saw how they’ve changed it.
    Don’t confuse the diet with the company.
    The Atkins junk food you should probably stay away from if you want to lose weight. If you read the ingredient list there is lots of stuff in there that is not on the carb ladder. Don’t go by the net carb on the front of the box. Eat real food, meat, eggs, salad to start with.

      1. The whole “net carbs” thing is not fishy, it’s a pretty part of Atkins and Protein Power and a number of other carb restricted ways of eating. At its most simple, you arrive at net carbs by subtracting the grams of fiber in a given food from the grams of carbs. The theory being that the fiber (which is counted in the carb count) has no real affect on your insulin and should not count against you. Where it gets wonky is in sugar alcohols and glycerin. Some say subtract all of the from your carb count, some say subtract a portion, if you want ti be safe, just do what I do, avoid them.

  89. Ive read similar stuff that it is the leptin, and not insulin that finally decides the amount of fat to keep in the tissues. I know Guyenet and Taubes share different opinions about the whole issue.
    My question is, what do the studies show?
    Is the fat amount in the adipose tissue more correlated to the leptin levels or insulin levels? And what about leptin and insulin resistance values in these cases.
    My second question would be, what would constitute as an evidence against the insulin hypothesis? In other words, what should be measured in the studies and what should the results be, if the insulin hypothesis would be wrong after all?
    Anyway, a really good article and I might have to buy WWGF even though i already have GCBC ( I’ve got the brit version, called: Diet Delusion)

  90. I was always a “needs carbs” person, until Dr. William Davis’ Heartscan blog mentioned fasting to increase HDL (I think, it’s been a while). Anyway I commented that I couldn’t fast very long because I’d develop symptoms of hypoglycemia, just like my mother and maternal grandmother (none of us were diabetics).
    Dr. Davis commented back to keep trying.
    So I came up with only eating (low-glycemic, no starch/grains – I was drinking tea with stevia, so no beverage calories either) whenever hypoglycemic symptoms appeared, ignoring hunger as my signal to eat.
    The first few days I pretty much ate like I had all my life, every 3-4 hours. Then after about 4 days, I noticed I went 6 hours without hypoglycemic symptoms – I was excited, so ignoring hunger became easier, because maybe I finally figured out how to kick the dreaded family curse of hypoglycemia!
    After about 10 days, I actually went 12 waking hours with no food!
    So it took almost 2 weeks for me to wean my body’s dependence on quick carbs, but I’m very pleased to have finally figured out why our family was plagued with hypoglycemia – we ate too much bread and biscuits!
    Now if I’m not paying attention, and notice hypoglycemia rearing it’s ugly head again, I drop sugar/starches/grains for a week, and no more hypoglycemia symptoms until the next time I don’t pay attention (it happens about 2-3 times a year).
    As far as the hunger pangs, I tell myself ignoring the pangs not only benefits my vanity, but also my health.

  91. RE: calories in / calories out
    I did a couple of overeating and weight gain experiments at home a few weeks ago:
    A) I couldn’t get more than 3 pounds of extra weight overeating on a very low carb diet for almost two weeks
    B) I lost weight overeating fat on a VLC diet the next day after I gained weight overeating sugar for a couple of days. Same calories, different results.
    I’ve been eating ‘paleo’-style and no more than 2 meals a day (often only one at the end of the day) for more than a year and I work out (muscles, not jogging) at least once a week. I was 30 pounds overweight 2-3 years ago back when I drank orange juice a couple of times a day and often ate pasta.
    the real test for the calorie balance theory is weight gain, not weight loss. It’s obvious and yet the calorie counters keep on focusing on weight loss as proof that the calorie balance thing is the real deal.
    take two groups of normal lean individuals and try to make them fat overeating the same amount of calories: 1st group High-Fat/VLC, 2nd group High-Carb/VLF. The same calories will have different results. This point of debate should have been settled already.

  92. Hello All
    Thiis is my first time posting after years of reading.
    First, thank you, Dr. Eades, for returning. I missed you.
    Second, if anyone–Rob Hanna, perhaps?–can assist me, I would be eternally grateful. Low carb healed 90% of my terrible GI problems and saw me lose 50 pounds a decade ago. Love this WOE, have read Taubes, Sisson, Atkins, Keith, Eades, etc. I believe in paleo completely. But 5 years ago, I started gaining weight and it will not stop, no matter what I do. Very low carb, protein shakes, high fat, IF, grass fed, organic, strenght training, supplements…you name it.
    My health/quality of life is now suffering because of my weight. I am 49 and don’t plan on spiralling down into physical decline with 40 years to go, so I need to fix this. Two years of intense research and effort has me stymied on what to do to get my metabolism working again. My lipid profile is great, fasting insulin is good, TSH is 1.2, fasting glucose a little high but not worth meds and still in the ‘normal’ range.
    I live in Canada and can’t find a low carb doctor to help me. My doc just seems to throw up his hands and tell me I’m an ‘efficient fat storer’ and would survive a famine. He has given up. If anyone has ideas, suggestions or links, I would be ever so grateful.
    Thanks to all for great reading, discourse and sharing.

    1. Hi Barbara, happy to share what I’ve found and be helpful if I can, just click on my underlined name on this posting and then shoot me an email. Cheers! Rob

    2. Barbra — please let me urge you to reconsider your thyroid. The TSH test is a pituitary test, NOT a thyroid test.
      I analogize it this way: the TSH test = the doctor testing to see if the farm wife has fed the farmhands their lunch. His test? He listens to see if she has called them (checks (only) your TSH: did the pituitary send out thyroid stimulating hormone towards the thyroid?) The doctor concludes, **because he heard her yell**, that the farmhands have been “fed” (he believes your thyroid has been stimulated into action by the pituitary) because he ‘heard’ the farm wife call them (there is TSH in your blood). But the TSH says nothing at all about whether or not your “farmhands” (the thyroid) *heard* the call (got the pituitary’s message), or actually “came in for lunch” (produced the hormone needed to speed up your metabolism).
      The TSH test completely insufficient to determine how your thyroid is doing. Please go to the website: Stop the Thyroid Madness and embark on a amazing journey. You can start with the page called: “Long and Pathetic list of Hypothyroid Symptoms.”
      You have to educate yourself, because, alas, most doctors do NOT know nearly enough about thyroid problems, and because most endocrinologists know only what Big Pharma tells them. (Gee, sound anything like the nutrition field?!)
      Good luck, and good learning at STTM — I am a million times better than I was, once I learned how to ACTUALLY treat my thyroid, and not just believe the results of the wrong test.

  93. Maybe this is an oversimplification, but it seems to me that regulating insulin optimally would be a wonderful thing. If a company could develop a drug or supplement that kept insulin levels within a particular range depending on dosage, and if it wasn’t rejected by mainstream medicine, and if it didn’t have horrid side effects, many problems would be solved.
    But what do I know…
    I am a former diabetic and CABG patient who has eliminated all medications except BP pills. I’ve done this and obtained good test results for several years simply by eating VLC. Aside from a large garden salad each evening prior to my steak, I eat almost no carbohydrates. No sugars, no grains, no soft drinks. My blood glucose stays in the 100-120 range and my hgA1C in the 6.4-6.7 range. I’ve kept my weight constant at about 163 on a 6′ frame, and I have never had any symptoms of any kind while following this diet. I kept waiting for the ketosis effect, but have never experienced it. I wonder if I’d feel this good at 75 had I not become a convert to VLC eating.
    I second the mention earlier of Chris Masterjohn’s excellent site as a (mostly) unbiased place to get more information regarding lipophobia and for fine book reviews.
    But nobody does a better job than Dr. Mike…

    1. @ TexasRoger… not sure where you’re getting your numbers from. Sorry, but if your blood sugar stays in the range you stated (100-120) then your HbA1C would be in the mid 5.0 to 5.5. If your HbA1C is 6.4 – 6.7, your average blood sugar (and remember that’s AVERAGE, which means that it would be higher at times) is151-161. My reference is: http://www.rajeun.net/HbA1c_glucose.html – perhaps that reference is wrong. My last Hb1C was 6.8 (Type 1) and I know I got to that with a few pretty astronomical readings (pump site failures, illness, moving house, and 6 months of stress which makes insulin mostly useless when in high stress situations, etc). Even though doctors say an HbA1C under 7 is great, studies have shown that long-term damage still occurs at the high end of “under 7′, which is why I’m working to get my HbA1c down much more.

      1. Don’t know which conversion numbers you’re using, Sue, but my chart says an hgA1C range of 6.4-6.7 converts to a blood glucose equivalent of 137-146. That may not be optimal, but it’s good enough to suit me. I am determined to live without diabetic meds, and since I feel fine and my other test numbers are good, I’m not changing anything.
        I’m also convinced that between mainstream medicine and the pharmaceutical companies, there’s been a concerted effort during the past few decades to ratchet down all the so-called “acceptable” levels we slavishly attempt to adhere to, such as blood glucose, total cholesterol (a meaningless number; remember when the target was 300?), blood pressure, etc. So I pay attention to how I feel, not some arbitrary number established by the pro-prescription-drug medical profession.

        1. @TexasRoger – I understand what you’re saying. The link to the conversion chart I use is in my post. Unfortunately, mainstream does think those numbers you quoted acceptable. You can feel fine at numbers even higher because that’s what your body gets used to. It’s not even the day-to-day, it’s the long-term, often very-silently-approaching complications that are a worry for me – cataracts (which, after 33 years I already have), nerve damage (have some), kidney damage and so on. All these started to happen many years ago, when doctors told me to ‘just keep the numbers under 180’, and ‘near enough is good enough’, and complications continue to appear and deteriorate (although not so alarmingly fast) with an A1c of 6.8! In fact, doctors I see are mostly ignoring the studies I’ve come across that say 6.8 isn’t ok.
          I suspect that the reason most (not all) doctors seem complacent is one of making patient compliance even more impossible on the recommended ADA high carb diet, for starters, plus the sheer amount of patient education required to achieve lower A1Cs. Recent studies do show that a lower A1C is much better for avoiding long-term complications.

          1. Sue,
            Here’s something I just learned about. The Lancet had this quote on its cover several months ago: “The most entrenched conflict of interest in medicine is a disinclination to reverse a previous opinion.” And inside was an article by three physicians concerning a 27,000-person study that clearly demonstrates that “tight” glucose control has no effect on stroke, blindness, kidney failure, or death from cardiovascular disease or other causes. They also noted that intensified therapy is linked with weight gain, hypoglycemia, and impairments in quality of life “equivalent to a diagnosis of angina.”
            The study was titled “Intensified glucose control in type 2 diabetes — whose agenda?” The authors place much of the blame on the “synergy” and financial ties between the physician organizations that set treatment guidelines and the pharmaceutical companies.
            Now the question is, “How many physicians will heed the outcome and change their diabetes treatment protocols?” My prediction: Very, very few at first. After all, statins are of questionable value at best, don’t prolong life, and have serious side effects for tens of thousands, and they’re still prescribed at the rate of tens of billions of dollars per year.
            I know nothing about the study at this point, but it’s clearly been out for at least several months, and I’ve read nothing of it until now, in a newsletter.
            It should give every type 2 diabetic on medication pause, as should the side effects of the medications. I took Januvia for only a couple of months, and after reading about it, abandoned it and my former physician and began doing what has proved highly effective: very low carb diet and moderate exercise.

          2. Correction: The PAPER was entitled “Intensified…”, not the study. The study’s title is “The Diabetes Control and Complications Trial.” Sorry.

          3. Correction #2: Now I find that a previous reference was in error. I can’t find a name for the study that yielded the results for the paper. I’m not a Lancet subscriber, and that’s the only way it’s accessible now. The DCCT was a mid-90s study, and a UK study which yielded similar results (UKPDS) was in 1999. But the recent study’s outcome has called current diabetes treatment into question – at least in the minds of the study’s principals. Sorry for the confusion.

          4. @TexasRoger – tight glucose control for most mainstream is low-fat and lots of insulin for the high carb. It’s the wrong protocol for tight control with the right conclusion – yes, we already know that a regime like this doesn’t prolong life – diabetes or not. What I’m talking about is long-term complications of diabetes including, cataracts, retinopathy, kidney disease, neuropathies, blood vessel damage, thrust, healing problems, gastroparesis, and so on. And of course in pregnancy the risk is higher to the unborn child, the higher the BG. These risks are minimised as much as possible with a lower A1c. I’ve now read many, many studies that show that tight glucose control DOES have an effect.
            The study you quote – I’d want to see it. I’m sure i could poke holes in some of it, including the length of time the subjects did the tight control, what they did prior to that and more. Only studies of life-long tight control would surely be more accurate in terms of conclusions.
            My feeling is that the method of getting that lower A1c is very important – ie, low-carb. This is now common sense, and for people who understand the protocol, many are doing it against their doctors’ wishes. More power to them! There’s definitely an agenda in a multi-billion dollar diabetes industry. Few would argue with that. As for statins – I should have been long dead by now, I have such an incredibly high cholesterol – for as long as it’s been measured. My daughter at 13, also was high back then – it runs in the family. We might well have genes that favour high cholesterol. I flatly refuse to take a statin – when I took one many years ago, the results were a disaster. I could barely walk and I had a raised CPK.
            Educating ourselves can now happen independently of Big Pharma in wonderful mediums like this. If I could give every newly diagnosed Type 2, several books on eating lower carb, I dare say they’d be doing so much better, and would most certainly be doing their beta cells a favour. But it’s a large learning curve (including doing the research), and there’s no money in it – only better health, which… well, draw your own conclusions!

          5. Fine post, Sue. I’m assuming “tight control” is a euphemism for medication use to keep BG levels low. I too would like to see the study. But a huge government-sponsored study of type 2 diabetics a few years ago was abandoned because it became clear that type 2 could be controlled by diet and exercise alone. The UK study appears to confirm this. And irrespective of both studies, we know what works for us. But for the diabetes-ignorant, who elect to be totally dependent on their physician for type 2 diabetes care, such studies will only have impact if and when physicians stop reaching for the prescription pad as a reflexive response to most health problems. And that isn’t going to happen anytime soon…

          6. LOL no, @TexasRoger. Tight control means achieving it – not the method, which may or may not include medication, education, a lower-carb diet and so on. You can’t assume that all T2s don’t need medication. Many do, despite eating low-carb (and this requires a much longer explanation). And in terms of T1s (and anything in between), we’re often talking a life-long condition that requires insulin and later. There are certainly, some well-proven older meds like Metformin, which seems to be the most protective and least harmful (if one doesn’t get the belly problems) of all currently on offer, that may well have an appropriate place in treatment for some T2s. In my opinion, what you don’t want is meds that hasten beta-cell burnout, which many of the current ones do.
            As an aside, one can reverse (to an extent) long-term complications of diabetes, with tighter control, particularly with low-carb. I’ve done it, especially the neuropathy, and I’ve halted kidney issues, but that’s another long story about misdiagnosis and diabetes burn-out several years ago (when I did know better about low-carb, and threw in the gauntlet back then anyway).
            Would be happy to discuss further, but I think we should take this off here because it’s no longer all that relevant to the original post, unless we’re talking about what I think should be mandatory reading of Taubes’s books for every newly diagnosed T2. It would go a long way to helping the newly diagnosed, and would, in part, make up for the lack of education available from the medical community, some of whom tend to wave a pharma-logo pen across a prescription pad as a panacea for all, and then recommend a high-carb ADA diet, which we know is wrong, wrong, wrong on almost every level possible.

          7. Sue,
            I agree. But I’d like to continue this. My email address is proggey@valornet.com. And I should have made it clear that my definition of “tight control” was the way they used it in describing the study, not what it means generally.

  94. The primary function of carnitine in the body, is to regulate fat oxidation (burning). L-Carnitine is responsible for transporting fat to the fat furnace in our cells called mitochondria. Unless fat makes it to the mitochondria, it cannot be oxidized, no matter how much you exercise or diet. L-Carnitine is found predominately in meat and animal products. Red meat is the best source.
    Chicken and turkey also contain carnitine.
    Dairy and milk products contain small amounts.
    L-Carnitine works best with a diet low in sugars and starches (carbohydrates)
    So there you have in a nutshell why protein is needed if you want to make proper use of fat

    1. Red meat intake has its own share of problems. Parasites, viruses and bacteria come to mind. The debris from the digestion of red meat causes other problems like high cholesterol and faster aging.

      1. I would be interested to learn what parasites, viruses and bacteria you have in mind. The notion that there exists debris from the digestion of red meat is total and complete nonsense.

      2. @Rajiv
        I’m hoping your are not simply parroting some dogma or ideology for lack of hard facts about, or personal experience with, “red meat”. And if we are discussing red meat I will presume we mean the good stuff, being grass fed beef, bison, lamb and goat as dietary options.
        Such red meats are, here in the first world, particularly free of harmful parasites, viruses and bacteria compared to the track record of other food stuffs. Especially true if we’re talking about animals raised for harvest on small ranches and farms with any degree of tradition and skill in good animal husbandry practices.
        For instance, when I went with a friend of mine and harvested a bison (shot it with a rifle) here in Texas off a friend’s ranch I did so to put food on my own table. The USDA agent was present during our kills and took blood samples from each animal to ensure their quality and condition. We then took the animals directly to the processing plant (my friend wasn’t certified to process onsite) and ordered the type of cuts and holding periods we preferred (most red meat carcasses are actually hung and aged for at least several days before butchering, packaging and then consumption). No problems there. We enjoyed delicious fresh bison and then fresh frozen for months later. And since a single bison put about 250 lbs into my hands in one shot, I shared my harvest with friends. The entire animal averaged out to about $6 per pound on dressed meat and organs (heart, liver, kidneys, etc.). This was not only a better price than store bought or farmer’s market, I also knew exactly where my dinner came from. I also even looked the living animal in the eye and accepted any emotional and spiritual consequences of my act at the time. So please note I’ve no sincere interest in debating the kill to eat perspective and unbroken history of humans eating animals throughout our entire geologic record from any angle, whether the modern autism of political correctness or the primal, chest-thumping of modern hairy man-ism. Look people, it’s just dinner the old fashioned way–get over it.
        And though I can’t speak for third world red meat husbandry and harvesting practices, I can offer a little professional insight regarding contaminated foods here in the good ole US of A because I’ve owned restaurants, been an executive chef and had many interactions with food safety and government standards. You and all others might note that if you go looking for food problems in this country that the majority of contaminated food recalls have been for vegetables (remember that Spinach in CA?), and most of the contaminants here are good old e.coli among several other common pathogens.
        And to all others unconvinced about the factual record, a little research will show many of these pathogens exist in agricultural soils, or cross contaminate our foods through human incompetence and errors in harvesting, processing and packaging. If you might pause a moment to imagine being a migrant worker picking vegetables all day long, deep in the interior row of a monocrop farm, sweating under the hot sun… can you quickly realize it’s highly unlikely you can take five and hit a Starbucks for a latte and a bathroom break? If you do, you’re right. And many field workers realize the same thing you do and often just relieve themselves right in the rows of the vegetables and fruits they are picking. And that’s quite all right with management too, as long as productivity keeps up to the pace that’s needed to get the crops in on time.
        Now perhaps you and all others might not like to think about this type of “natural” and certainly “organic” human fertilizer when you hit your Sysco salad buffet, or frozen food aisle for that spinach… and maybe instead you’ll head over to the meat counter and get a little more red into your diet from a butcher you can trust.
        And to all others that are still wanting to argue the point, I hear red meat does wonders for cognitive reasoning and memory, which are becoming more ignored as the minimum prerequisites for debating any topic these days.

  95. Sue,
    Don’t get me wrong. While I’m feeling as well as I’ve ever felt, and have no symptoms, I’d be happier if my A1C was lower. But I know I’m doing the right things, and I assume I’m just insulin-resistant to a degree.
    By trial and error I’ve proved to my satisfaction that, after a BS reading of, say, 115, I can exercise for ten minutes and drop the reading by 10-12 points. So I’m sure my A1C would be somewhat lower if I exercised more. And if my results worsen that’s what I’ll do.
    And I apologize; I failed to notice the link to the chart you used. Apparently there are charts and there are charts. Since I first emailed you I’ve found four different charts — all somewhat similar, but all with differences.
    I am so convinced that most of mainstream medicine is in the pocket of Big Pharma, whether they realize it or not, that I’m skeptical and leery of any and all pronouncements by the FDA, AMA, ADA, NIH, etc. They’ve been so very
    wrong on so many topics (including off-label meds, for which BP has been fined many billions in the past few years) that I simply have no confidencein them. I have taken responsibility for my health, and my physician serves
    only as a prescriber and referrer for the most part.
    Finally, I like the name “Sue” so much that I named one of my daughters Susan.

    1. @TexasRoger – Isn’t it amazing how just a little bit of exercise can drop you like that? I hate exercise with a passion but it’s the only thing I can do to use less insulin – and even then that’s a juggle. If you have no insulin and your liver releases glucose because you’re exercising, you need insulin, otherwise your blood sugar can go high.
      And yes, doctors are too swayed by BigPharma, but there are also doctors who recognise that and go against mainstream.
      Funny, I’ve hated my name since I was little (actually Susan). Each to his own.
      Fact is, if you want your A1C lower, then you clearly recognise the benefits. Along with everything else you’ve done to ‘make it right’, you’re clearly going in the right direction!

  96. Very interesting article. India and Ayurveda has a take on it that explains what has been mentioned here but in a different way. Our ways of tackling obesity are also different but very effective.

  97. “… vegetarians, in a study of overall nutrition, scored significantly lower than nonvegetarians on the USDA’s Healthy Eating Index, which compares actual diet with USDA guidelines…”
    “…A Queens, N.Y., couple were indicted last May for first-degree assault, charged with nearly starving their toddler to death on a strict diet of juices, ground nuts, herbal tea, beans, flaxseed and cod-liver oils. At 16 months, the girl weighed 10 lbs., less than half the normal weight of a child her age. Their lawyer’s defense: “They felt that they have their own lifestyle. They’re vegetarians.” The couple declined to plea-bargain, and are still in jail awaiting trial…..” Time Magazine
    I thought it was a UK study that found that vegans actually have a shorter life expectancy.

  98. I have only today come across your blog. I am a Gary Taubes “disciple” and a reformed carb eater (with the same zeal as a reformed smoker!). I applaud you and Gary all the way from the UK! I am now on a mission to convert my friends and family.
    Thanks, Ann

  99. Not so negative, or pessimistic Rob. The tide might be turning. I am a regular participator in the the Dutch Foodlog.nl where the general trend is quite favourable towards a modified paleo version. Dr. Frank van Berkum has been treating obese and diabetic patients quite successfully with a protein diet. Melchior Meyer is the Dutch version of Michael Pollan and Gary Taubes. Professor Frits Muskiet (Groningen University) has written an introduction for his students on the value of a paleo oriented diet.
    And -get this- prof Martijn Katan (yes from the Katanic lipic verses) at his retirement speech admitted that he has come to the conclusion at the end of his career that he really doesn’t know anything, and that maybe there might be some truth in what the paleo side of things. I am in contact with dietitians who don’t adhere to the established truths anymore.

    1. @ James Pott,
      As you report such, these developments from the Netherlands are worth taking into mind and celebrating, and perhaps the same is true in the UK or elsewhere.
      My pessimism here is about the good ole US of A and how we seem… well, not so enthralled by people trying to convert us when it comes to personal behavior patterns and dietary choices. But maybe I’m wrong here… and perhaps should get out more.
      I just hope the conversion process doesn’t happen too quickly because I’m darn tired of paying so much more for my grass fed beef and other pure, unadulterated foods… the last thing I need is an avalanche of demand for these good things driving prices out of my reach… but perhaps I’m being too selfish on this perspective.
      Let them not eat cake…

  100. Dear Sue,
    With respect to your quote:
    “You can’t assume that all T2s don’t need medication. Many do, despite eating low-carb (and this requires a much longer explanation). ”
    I am very eager to hear your explanation. Could you please elaborate, I’m certain the information would be very helpful.
    Thank you,

    1. So am I, Suzanne. A few years ago the Diabetes Prevention Program, a huge study of pre-diabetics, was abandoned when it became obvious that diet and exercise beat metformin by nearly 2-1. Metformin was even less effective for people over 45. Find the results here: http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/#results
      Of course preventing isn’t reversing, but it’s also been proven, at least to my satisfaction, that T2 can be controlled, if not reversed entirely, with diet and exercise. I’m doing it. And the fact that a low-fat diet was used in the study simply means it should be even easier with a saturated, rather than vegetable, fat diet.

      1. @TexasRoger – metformin, if used at all, should be used in conjunction with a low-carb diet. It does help with weight-loss and from the studies I’ve seen it’s way more protective than statins (which we both hate).
        For me, a T1 with weight problems, metformin is an ugly, wicked drug, and half a long acting dose can make me end up in the ER with severe belly cramps. I really wish I could take it. I would in a heartbeat!
        I think one would have to take a holistic approach because everyone is different.
        As you no doubt know, there are morbidly obese people who will never get diabetes because they don’t have the genetic load for it. And there are thin T2s as well (with no antibodies, so they’re not, as far as we know to date, T1).
        If you’re going to get diabetes, you often start packing on the weight long before diagnosis. See Jenny Ruhl’s: You did not eat your way to diabetes – one of the best articles I’ve ever seen on the subject.
        It’s precisely this propensity to pack on the weight, that makes it very hard to lose. Some people are helped very much along the way with metformin, which also will lower that resistance. If someone’s going to take a year to lose the weight, you don’t want them with elevated blood glucose along that journey, surely?
        For some T2s diabetes is progressive, for some just weight loss will help enormously and they can stave it all off and come off medication. But who can predict how much beta-cell damage any one person will have and at what rate?
        There’s such a huge range of when people get diagnosed, what weight they are, how long it takes to lose and so much more that surely a “one way is the only way” just doesn’t fit everyone.

    2. Suzanne, do searches on beta-cell burnout, which begins to happen at relatively low increases in blood glucose, and look at the link here to several studies: http://www.phlaunt.com/diabetes/14045678.php.
      People with conditions including PCOS that is associated with insulin resistance often need insulin. T2’s in pregnancy. T2s who are very insulin resistant often need medication. i know of thinner T2s who have no antibodies and who do need insulin. We don’t yet know enough about all the variants of T2. People who have been undiagnosed for a while will need some assistance but can come off medication later with weight loss and low-carb. Often the point of medicating in Type 2 with insulin (not with other drugs that hasten beta-cell burnout) is to provide some respite for overworked beta-cells, which is mostly the case in T2 (measured as a high c-peptide). Everyone is different in this regard according to their situation.
      There’s no doubt, however, that even T2s on low-carb often need some assistance if they want to keep their blood glucose in a normal range. Not to forget that glucose is also available from protein (about 50%, depending on the protein) and bout 10% of fats. What you don’t want in T2 is any kind of elevated blood glucose, and that can be hard to achieve if you are very insulin resistant or if there is other beta-cell dysfunction.
      I’m not sure why you’re asking but I hope that explains it for you.

  101. “Why can some people eat like crazy and not get fat? Perhaps because they develop insulin resistance in their fat cells just as they do in their liver cells. They don’t get fat, but they typically have all the other insulin-driven problems of the obese: high blood pressure, elevated triglycerides, increased risk for heart disease, etc. And all while staying skinny.”
    I seriously disagree with this…. at least in my case. I am a 23 year old man who has always been terribly underweight all my life and has tried to gain weight numerous times in my life – even eating over 4,000 calories per day to try and gain weight. I never exceeded 134lbs. I am 6’4″ tall.
    I have always had very low muscle and fat since I was a boy. However, my blood pressure is low at 90/60, still is, my cholesterol levels less than 3.9, and my triglycerides were 0.4 (using English measurements, would be about 35 in US units), which is one of the lowest my doctor had ever seen. And this was measured after a surprise blood test where I hadn’t fasted, I’d just eaten a very fatty meaty lunch washed down with fruit juice. So that’s my triglycerides on a “bad” day. Somewhat lower otherwise….
    I definitely do not have any kind of insulin resistence, as all my blood tests to investigate why I don’t put on weight have indicated. How can you explain why I never gained weight on 4,000 calorie diets then? And have an extremely good metabolic profile? Low blood pressure, very low insulin levels, very low trigs and cholesterol, well controlled blood sugar?
    I believe some people are genetically gifted to not put on weight at all and still be very healthy even if they eat a lot. I keep hearing this rubbish about skinny people (who are naturally that way) being told “oh you skinny people are more likely to get a heart attack/high cholesterol etc” and, but you see, I have a long line of family members who were extremely skinny and lived into their 90’s, very fit and healthy til the day they died.
    And my blood test results along with other people who are naturally thin (eat all they want and don’t gain weight) prove quite the opposite, they all have exceptional metabolic profiles. Unless the repeated blood sugar, insulin level, cholesterol and triglyceride level blood test lied every time.. haha.

    1. You have to remember that fat does not make you fat. Fat also does not constitute triglycerides. While doctors will tell you that triglycerides are “fat in the blood”, the truth is that what increases triglycerides is carbs and alcohol, not, for example, a steak dinner.
      One of the greatest confusions to nutrition is that dietary fat and body fat are two different things. Dietary fat must go through a lot more bodily processing to become body fat, whereas carbohydrates and even protein are relatively easy to store as body fat.
      All of that aside, you can’t judge the validity of the science being discussed by your own experiences when your body type is obviously an extreme circumstance (you are not and “average” example…you are, in fact, the polar opposite body type from an obese person).
      I myself have always been a “hard gainer” my entire life. The only way I’ve ever been able to gain good lean mass – and to do so quickly – was to adjust my calorie intake to trick my body’s anabolic hormones into doing the work for me. Simply eating more won’t provide you with good weight, only fat storage (and that can be poor if your hormones are out of whack and won’t allow it). By alternating caloric intake from very low to very high in set periods, you can cause a rise in anabolic hormones, which you can take advantage of via exercise. Do a Google search of the ABCDE Diet for more information.

  102. I just read this wonderful article. I had a question about this paragraph.
    You wrote in your article “you find that insulin is the primary force involved in the storage of nutrients. Insulin is the body’s storage hormone: it puts fat in the fat cells, protein into muscle cells and glucose into it’s storage form, glycogen”
    If carbs drive insulin and insulin deposits protein, then how many carbs do you need to make sure that you get enough protein to build muscle?

  103. Hi Dr. Eades,
    Thanks for your great post. I agree that easily-digested carbohydrates like white flour, sugar, and alcohol are heavily to blame for the diabesity pandemic.
    I take issue, however, with the idea that these foods are entirely to blame for causing diabesity. What about other foods with established harmful properties, like industrial seed oils, reduced-fat dairy, powdered dairy products and food additives? And how about the contribution of vitamin D deficiencies and emotional stress?
    Dr. Chris Kresser presents compelling evidence that micronutrient deficiency, especially magnesium and vitamin D, contribute to diabesity.
    Dr. Stephan Guyenet at Whole Health Source and the folks at the Weston Price Foundation have reported on how excess omega-6 (or any polyunsaturated fat, for that matter) fats can disrupt thyroid signaling, cause premature aging, and lead to the diseases of civilization, including diabesity.
    I appreciate your feedback, Michael and others.

    1. Uh…The issues you raise are valid, but compared the vast quantity of carbs that the average American diet introduces into a body, they are much more minimal influences. Fat, protein, and carbohydrates are macro nutrients, Vitamin D and the other issues you mention are micro nutrients. They received those names for a reason. 🙂
      I dealt with my carb issues first and tweaked my health later by taking more Vitamin D and fish oil. Lowering the carbs got me about 75% of the way there.
      The sad part is I know from personal experience that many people would much rather pop a few Vitamin D/fish oil pills inconsistently rather than address their intake of carbs. Like your post, let’s talk about ANYTHING but cutting out my beloved bread, dessert, etc.

  104. Doctor Mike,
    Great site. I’m reading Gary Taubes Why We Get Fat book now and am having a hard time accepting some of his reasoning. Maybe you can address.
    He goes on to conclude that exercise doesn’t really work because it doesn’t burn very many calories, and it simply makes one hungrier, therefor you’d just eat more to compensate for those tiny amounts you burned off. Then he compares how many calories a lumberjack eats vs. an accountant, something like 5000 to 2500 respectively. Obviously then, exercise DOES burn off a lot more calories if these lumberjacks consume 5000 calories to meet their energy needs.
    Second, let’s just consider a reality tv show called The Biggest Loser. That’s ample proof that exercise and caloric restriction work, and work far greater than I think Gary would ever give credit for. And they aren’t all using carb restricted diets either.
    Another quibble I have is the idea that exercise makes one hungrier. It may be anecdotal, but I find exercises suppresses my appetite. I find being bored or something might one associate with a sedentary lifestyle (watching TV) causes me to eat far more than exercise. Are there no hormonal changes brought about by exercise that may decrease appetite?
    It’s still an interesting read but not overly compelling, imo. And I have one other niggling question. Why is it that Asians that subsist on rice (talk about a high carb diet) are far leaner and healthier than we are? Doesn’t the sort of destroy most of the ‘carbs are bad’ argument right there and lend far more credibility to the calorie in/calorie way of thinking?
    Oh, and I wanted to ask these questions in the Forums section but haven’t been approved by moderators since I joined over a week ago. How long does it take?

    1. Thanks for writing. I actually used your question about the Asians in a slide presentation I gave recently. I’ll post the entire slide show on this blog in a week or two after I teach myself how to format it and get it up. Then you can see the answer to your question.

      1. Exercise does suppress appetite. It’s part of the sympathetic nervous system which every human has. You don’t eat more after you exercise unless you have no discipline and you’re stupid. Or better yet… what if you already have a planned diet that matches your BMR? If you stick to it, AND exercise, how exactly are you going to over-eat? Oh yeah, by uhhh… not sticking to it. Ridiculous. Gary is just making excuses for undisciplined fat people.

  105. This is a great blog post. I’ll have to go out any buy Gary’s book now.
    What you described helps explain what I’ve noticed during several years of off and on low carb dieting. That is: When I consume lower carbs, I crave less carbs. But when I increase carb intake my cravings for carbs go through the roof. If carb intake increases insulin which prevents the body from burning fat for energy then once those consumed carbs are burned, stored, or excreted if the insulin levels do not drop off much then the body requests more carbs to boost energy. It’s a vicious cycle that I have only been able to avoid by eliminating most carbs from my diet.
    The obvious solution is to keep carb intake low. But, as the typical American, looking for a quick fix in the form of a pill… is there some other fix to control insulin levels besides avoiding carbohydrates? Especially in between meals?

  106. Dr. Eades –
    I’m a little late to the party, but I just got WWGF from the library and wanted to see what you thought. Glad to see you were part of the process. 🙂 I thought the book was great. I actually flipped back before I started to the Duke University Diet section and thought – hey, this is the Atkins diet plan. Finished reading the book and discovered that it was. 🙂
    What I really like about the book, too, was that he addressed how Weight Watchers type plans create weight loss. In my mind, it’s really important to explain how diets seemingly only based on calorie-in/calorie-out theories are actually back door carb reduction schemes.
    My sister has done WW since she was 22 or so and for the most part kept it off. Even at the height of low fat, there was an incredible amount of overlap in the foods that were “high points” and not permitted in the diet plan I was following (Atkins – sorry about that…). Interestingly WW appears to be backing into a low carb type scenario although they still doggedly hang onto low-fat, too.
    She’s still on the plan and although she is a normal weight, I cringe when I watch her avoid “high point” meats and fats in favor of empty “low point” carb based food. The worst of it is, she’s only 35 (younger than me) and she was put on high blood pressure this year. She also suffers from frequent sinus headaches, dust allergies (she never had that growing up) and occasional hives (also not something she suffered as a child and is not in the family.) She’s only been told she needs to exercise more to bring the blood pressure down. 🙁
    I’ve done low carb since I was 30 and my health is better then ever. (Baby #3 due in December at 37!). It’s a bit painful when you’ve got some idea you could at least help a close family member be in better health but you’re the one on the “crazy fad” way of eating that will be fat by forty and suffering heart attacks by 45. 🙁
    I’ve had the exact same conversations you had with family members and strangers when they’ve found out I’ve been on low carb so long. It makes me much less upset than it used it but encounters like that are not exactly restorative in feeling good about humanity in general. 😉 I had my FIL tell me that by next child wouldn’t have a brain because I wasn’t eating enough carbs. (Really!) I just wanted that conversation to end…
    Phew! That was the long way to say thanks for this blog and being part of WWGF. 🙂

  107. I read 80% of these comments while fasting. Fasting is what led me to the site, googling around. I fast every Friday. Fasting is a Catholic practice from old school, and I, too, want to offer a sacrifice for our poor world. But of course, I had assumed there would be health benefits, although I’m not overweight except for a little gramma belly. It was a little shock, then, to read a post that suggests fasting might actually be bad for you. However, after some thought, I’ve concluded it just makes fasting a better sacrifice.
    The benefit to deliberate sacrifice is that one feels closer to God. Hunger being a constant presence in short fasts, which I’m thinking that a 36 hour fast is, compared to the fasts of the saints, one can feel closer to God all thirty six hours. I’ve never found that feeling to be for sale, trade, or barter.
    Might I also say that unfortunately the diet recommended now in schools, hospitals, and in the popular media produces the cheapest human cog in their machine, maximizes profits, and lives just as long as they want *it* to. Which isn’t as long as we could. We just aren’t valuable enough for them to get nutrition straight. But many thanks to those who try.
    I might feel that no one will ever read this comment, after the–what?–hundreds of others! Don’t you think that’s a lot like prayer? And yet you are reading it, just as God hears us.

  108. Dr. Eades,
    This is a great explanation of the insulin resistant cycle making people fatter and why typical calorie restriction and exercise wouldn’t be effective. With all respect however, the cause of the insulin resistance is from overeating, even if it from overeating carbs in particular. And fasting and exercise do improve insulin sensitivity:
    If they “overeat because they are fat” then fat would have to cause insulin resistance, rather than the other way around. And then again, why are they fat?
    While some may be more predisposed to insulin resistance, lifestyle would have to be the dominant factor which is calories in, calories out. That may be too simple of an explanation to effect a change, it is the cause of insulin resistance. If not, we would see endurance athletes who eat 60-70% of their calories from carbs with insulin resistance and storing fat that they can’t access.
    Many obese are emotional eaters, who when they get upset will dive into a pizza, carton of ice cream, fried chicken, etc and eat way too much of it. I had one client who would get a bucket of KFC on his way home with the pizza. Or eat half a jar of p-nut butter at night, after eating great all day. Excessive calories of any kind will cause fat storage.
    So please help me understand why calories in, calories out isn’t relevant. Are you saying that eating maintenance calories, even at a level that would maintain an obese person’s current weight, will improve insulin sensitivity and eventually allow stored body fat to be used, as long as they are eating low carb?

    1. Excessive caloric intake will lead to excess fat accumulation. Of that, there is no question. The question is, Why are people driven to consume the excess calories? If the body sequesters all its fat in the fat cells and prevents the fat from coming out when the body needs energy, this deficiency of available fuel (even though there is plenty of fat stored in the fat cells) drives the hunger response and, consequently, drives people to consume too many calories.

  109. I lost 50 pounds on Optifast a few years ago and I have managed to keep most of the weight off. I don’t journal or exercise regularly, so taking the weight off was a slow and arduous process. I agree with your science and have decided to try Protein Power to lose the 10 pounds I have gained.
    Maybe I’m wrong, but I believe that obese people are obsessed with food. I know I was before I lost weight. My whole life revolved around what I would eat now, and what I wanted to eat later. I watched Food Network, spent time on the internet downloading and testing recipes, and then staring in the mirror at night and looking at my stomach hating myself for what I ate that day, and chiding myself because I was incapable of changing my circumstances. Needless to say my self esteem was very low. When I decided to lose weight, I found that I had to change not only my eating habits but my computer searches and general lifestyle. I convinced myself that I really didn’t overeat and would hide my eating from friends, family and myself. All this stuff I was doing was to appease me. No one else really cared about my weight issues. Regardless of who or what was at fault that I was fat, my own habits and feelings of self worth really kept me fat. I think obese people need to take responsibility for getting fat and staying fat. Blaming science and fast food may be comforting, but it doesn’t help get the weight off.

  110. Just found my way in to your blog… very interesting:) In Sweden we call this LCHF (Low Carb High Fat)… Been eating like this since April this year and life is GOOD!!!! I will for sure follow your blog and try to read through it all to see what more of interest you have been writing on.

  111. First of all, a much-belated ‘thank you’ to the doctors Eades. Their book, Protein Power, literally saved my life almost a decade ago. I could, but won’t, itemize all the gifts their advice provided. I know the details would be redundant, oft-repeated elsewhere.
    I’d just recently finished Gary Taubes’ WWGF book and had been recommending (and loaning) it to the people who constantly complain about the “intractability” of their weight problems.
    It’s extremely perplexing to me how FACT resistant many people are to this messages in this book. I’m glad the Eades juggernaut has put the force of its authority behind it.

  112. What is your opinion then on the 80/10/10 Diet by Dr. Doug Graham who recommends eating raw foods, with 80% carbs, 10% protein and 10% fats? Would a fat person benefit from this type of split? I am sure that Dr Graham has seen many people lose weight on his plan! I am not questioning the raw versus cooked, I am just questioning what’s out there concerning confusing, mind boggling, mixed messages nutritional information. I am a health care professional and I no longer know what to eat, nor what to recommend to my patients.
    Thank you.

  113. Potentially off-topic: The assault on the “insulin theory”
    I’ve been seeing posts by Chris Masterjohn etc. (one of these by another author has link on the latest Gary T. blog post) about the criticism of insulin/carbs as the source of obesity. CM talks about the role of leptin and hepatic damage.
    To my mind some clarification seem to be in order and I thought I would run it by you.
    1) An “insulation theory of obesity” is not the same thing as the more solidly supported statement that it is impossible to get fat without carbs. (iirc, triglycerides transport fat from blood into fat tissue cell and dietary carbs are the virtually exclusive source of these). So whatever biochemical, hormonal, psycho-behavioral pathways are active in obesity (which more than likely has more than one etiology, even if there a prevalent one) carb metabolism is a necessary condition, which -of course- does the negate the possibility of other necessary conditions.
    Also, I notice that the piece Taubes links to has the author admit low carb diets are effective even if thinks the reason is “mysterious”. Are both CM and this guy unduly influenced by the “whole foods” mindset
    (which do I think can be an useful working hypothesis)?

  114. I have struggled with what has been called ‘food addiction’ all of my life to sugar/carbs/junk. My Mother in her 70’s, was and still is a huge sugar addict (in denial). My sister was a meth addict, almost died of Hep C, but got clean and made it through the horrific Interferon. All past relatives were addicted to booze. Of course I, like many others, have tried every diet and diet drug under the sun. I did not succumb to gastric bypass and over the years I have come to know beyond a shadow of a doubt that this issue/problem, with me, is physiological.
    My dis-ease had progressed to the taking me to 226 lbs, stuffed, bloated swollen, desperate and feeling the push and pull of the OA meeting information I was getting, that my problem was of a spiritual basis. Hence I began to avoid trying any eating regime except for trying time after time after time to adhere to the 3 moderate balanced meals per day and working ‘the program’ as the OA literature suggests. (not avoiding any particular food group).
    However, in my continual struggle to find balance and feeling like a failure at every OA meeting in regards to the eating part, I began to look back at my history of controlling my weight and fearing that many disease processes were slowly being activated in my body from my bingeing and weight issues, I decided to try some type of diet routine once again. It took a lot to get me to this point as I did not want deprivation, starvation, and cravings which I ALWAYS had on previous diet routines including the Optifast regime. I never went into Ketosis on any Low Carb/High Protein routine and decided it took extreme low carb diets to get me into that state and that I just couldn’t go that low.
    So I went to a medical doctor who specialized in helping patients with their ‘addiction’ to food issues and guiding them back to sanity through losing weight and getting their health back on track, working one on one with each patient. This ‘one on one’ was what I felt I needed.. someone to be there for me through this time of confusion with my eating and help me find myself again.
    So I went in and she put me on a VLC, High Protein, Low Carb eating regime of approximately 800 calories a day telling me when I get hungry to have an egg or two. She also talked extensively to me about my issues and struggles and during the course of our conversation she handed me Gary Taubes book and suggested I take a read.
    The first week on the regime, we had to travel out of town with me driving in a mad rush to find another home to live as we are moving out of the State we currently live in. I don’t do well driving and so I drank quite a bit of coffee and used half and half. Beyond that, I stayed on the regime, and ended up eating a few eggs and my shakes but that was it. By weeks end when I went back to the doctor, all my numbers had drastically improved with my weight dropping 12 lbs. This fascinated me because of all the half and half I had used in my coffees but then while reading through this blog I found a reference to coffee moving fats out of the body. So maybe there is a connection there, maybe not. But I can tell you that on every other VLC, HPLC diet I’ve been on, I have always only lost a total of 10lbs the first week. So something was at play there. And I know as well that a lot of that first weeks loss is water, or so they say.
    After we got home from our trip which was 5 days into the first weeks eating regime, I began to pick up Gary’s book flipping through, reading this and that, and my hope that there was a true science being revealed behind my cravings, sugar/carb/junk addiction and desperation, began to take grow in leaps and bounds with every paragraph I read.
    Could it be true, that I could eat like that and gain my health and sanity back and loose the excess weight that kept me in bondage and a certain amount of shame and disgust?
    I’m in the 2nd week of the regime the doctor put me on now… and I’ve been venturing out of the ‘diet rules’ when I get hungry and adding protein in between the shakes as needed. I’m using myself as a test subject this week in that regard, and when I go in for my blood work, body fat measurements, weight, blood pressure, etc., I will be anxious to see how it went this week. I’m sure it will be fine. My plan is to tell the Doctor, I want to move onto Gary’s plan following his suggestions in the WWGF book and maybe combining that with suggestions from Protein Power, which I find has a common respect in this blog thread.
    My questions are as follows:
    I’m feeling quite edgy physically.. is this from too low of a calorie regime? I’m sure I’m not eating enough due to the diet she has me on even with adding the protein I’m adding…. because I’m not adding much at this phase.
    Or is the edgy feeling what it feels like to be in ketosis? Since I’ve never known what that feels like, I’m wondering.
    How much water should one drink as one moves into following Gary’s Taubes eating suggestions, and what about supplements due to the low carb intake? I will be starting out at the VLC amount due to the weight and health issues I have and as well, and more importantly, I want to move cautiously in adding too many carbs too soon due to my sensitive brain chemistry to sugar, and carbs in general, which if I add too many could cause a spike, cravings and a potential binge. There is nothing like the horror of trying to battle off those cravings! I have read several comments here about folks who have eaten a bit too many carbs and have had to take a week to rein themselves back in!! I don’t want to go through that! I’ve had 45 years of struggle with excessive sugar and carbs and almost every physical and emotional struggle that goes with those demons and I am beyond willing to walk carefully through the carb minefield!!! LOL
    Right now I’m down to below 20 carbs per day – I’d say coming in at 10-15 max.
    And one last question for now.. I’m a bit concerned about some of the posts I’ve read here about how folks have good success for awhile on this and then it stops. I’d love to hear what the medical folks on this thread think/feel or rather ‘know’ about this potential situation occurring down the line with any LC/HP eating regime.
    I most likely will have more questions but I would absolutely love to hear from others who have climbed on board here to gain back their life and health through finding Gary’s book and following his suggestions.
    I’m so grateful for Gary’s book thus far and this thread!!! So many professionals chiming in with great scientific info. mixed with lay people like myself working to find a way back to health and sanity!!!
    Thanks everyone. 🙂

  115. Ok.. I already have another question..
    I went to look for Protein Power and found so many of Dr. Eades books to choose from including the new Middle Aged Middle book. w
    Which one is a good one for me to start with that will provide solid basic information on this way of eating? I’m 53 and my husband is 57.
    thanks in advance.

    1. I found “Protein Power Lifeplan” to be the most informative, but there is some info in “Protein Power” that’s not in PPLP. The “Middle-Aged Middle” doesn’t have the background info that’s in the other two books. Start with PPLP, then read the blogs here to find some info that hasn’t made it into any books. If you’re interested to know some of the biochemistry behind how this all works, get the original PP to round out your education.

  116. I have a few comments about your post and specifically the questions:
    1) Don’t worry about calorie counting. Focus on CONTENT counting – specifically, grams of carbs. Everyone is different in how much carbohydrate they can tolerate and still get the results they’re looking for. Below 20 grams/day you should be guaranteed ongoing results.
    2) I doubt that ketosis “feels” like anything in particular. You just notice ongoing weight loss. But the key point about the loss gradient is that it’s not smooth – it “bumps” down in stages as your body adjusts to the new eating regime. Sometimes, if you’re meticulous about monitoring your weight, you’ll think you are “stalled”. Don’t worry about it. A week or two later, you’ll experience another “bump”. DON’T starve yourself.
    3) Drink enough water to keep from being thirsty. That’s it. If you want to “overdo” it with water (just to be on the safe side), you really can’t “over-hydrate” – you’ll just go to the bathroom more often. ( I swilled water like crazy for a while and found my measured hydration levels remained about the same with high or moderate water intake, so I think being thirsty is an adequate way of controlling intake. The key is the choice of beverage. DON’T substitute diet beverages for water if you’re looking to lose weight. You CAN experiment with them after you’ve reached your goals.)
    My thoughts on your journey. Good luck.

  117. What’s hilarious about this whole article is that Mike goes on a rant about how “It ain’t so much the things we don’t know that get us into trouble. It’s the things we know that just ain’t so”.
    Yet, he’s making exactly the same mistake with his recommendations here.
    Every douche bag out there trying to sell a book and who has a site littered with affiliate links and books, LIKE THIS SITE, is full of bunk bullsh*t information.
    This guy isn’t doing anything but running his mouth over correlation studies. OMG, PEOPLE ATE BREAD AND GOT CANCER!? CARBS MUST CAUSE CANCER!
    It ought to be a law that if somebody publishes a book with information that turns out to be highly inaccurate, it is legal to execute the author.
    Knowing this jerk, he probably lives in a rich community far away from the “normal” people he is peddling his books to. His high-priced lifestyle (typical of all douche bag doctors) is likely why he has to supplement his income with book sales.

    1. Where do these people come from? It’s always depressing to see the quality of the minds out there. And it’s always great to come across someone who is willing to call someone else whom hes never met a ‘douche bag’ based on the fact that he disagrees with an opinion.

  118. what a load of bollocks, if you are fat and dont eat as much as you normally do you will lose weight, it is not a magical phenomena that keeps you fat its eating too much

  119. I read this entire post and it’s nonsense.
    Yes, all your points about insulin are true.
    It doesn’t matter how high your insulin is, if you don’t eat when your body tells you to eat… guess what… YOU DON’T GET FAT.
    Wahhh wahhh insulin is high so I can’t release my stored fat and my body triggers hunger responses.
    You fat people have no discipline, that’s why you’re fat. Utter nonsense.

    1. I thought long and hard about whether to post your comment or not. Over the many years this blog has run, I’ve refused to put up only a few comments – maybe fewer than five. Those were vulgar and offensive. Yours is simply offensive to many people. But it has inspired me to write a post in the near future, so it does serve some value. I don’t know you so I don’t know if you are simply ignorant or breathtakingly callous, but I do know you had an improper upbringing (or you had a good one and it didn’t take) or you wouldn’t purposefully have written something so hurtful to so many people.
      I post this only because in my own ignorance many years ago, I felt the same way. But since I did have a proper upbringing, I didn’t feel compelled to display my ignorance to the world in such an obnoxious fashion. I didn’t sin publicly as you have done, but, like Jimmy Carter in his famous Playboy interview, I sinned in my heart.
      Until I reached my mid 30s, I was thin. I was involved in all sorts of athletics at both the high school and college level, and I always wanted to gain weight, especially for football. I ate and ate and ate but never seemed to gain the weight I wanted to gain. When I was in medical school and during my residency, I ate every day in the medical center cafeteria, and I ate whatever I wanted. As I went down the line, I never thought about health implications, I simply picked what looked good and added it to my tray. No matter what else I ate, I always had a piece of some kind of pie for dessert, and I always had them add a scoop of ice cream on top of it.
      If I were to go down the serving line behind a fat person, and I noticed said fat person carrying a piece of pie, or, God forbid, a piece of pie with added ice cream, I always felt this frisson of scorn that a fat person could be eating pie and ice cream. I never once wondered why it was that the fat person and I could both eat the same things and yet the fat person was fat and I was thin. What was a normal diet for me was overeating for them. When I was hungry, I ate until I wasn’t hungry, but I held contempt for fat people who did the same thing. I’ve always considered myself a critical thinker and one who ponders on all kinds of conundrums to try to make sense of them, yet this ‘fat vs thin on the same diet’ paradox never impinged on my brain then. All I did was felt some level of disgust that someone so overweight would publicly eat pie and ice cream. I maintained this mind set until I gained weight myself.
      Once I did gain a substantial amount of weight, my perspective changed. It wasn’t nearly as easy as I thought it would be to simply cut back, which was the recommendation I had given to my own patients who were struggling with obesity. The same amount and the same types of food that had previously kept me stable at my thin weight now made me obese. Was I disciplined before and undisciplined later? I don’t think so. I didn’t eat any more. The foods I ate hadn’t changed. But something in me had changed. I had become insulin resistant. And, as I discovered to my chagrin, once insulin resistance sets in, it’s a whole new ballgame metabolically. The situation can be controlled with a low-carb diet, but the underlying problem is always there laying in the weeds waiting to strike.
      Whereas before, I could have eaten anything and been fine, now, I have to watch what I eat constantly or the obesity returns with a vengeance. Now I’m the one who gets to watch thin people eat the pie and ice cream and stay thin while I have to forgo it or pay the price.
      In my experience, it is people yet to become insulin resistant who typically make ignorant comments about those of us who are insulin resistant. So keep eating my friend and feeling smug because your day will probably come, and you will then, like I, feel nothing but remorse for ignorant comments such as the one you just wrote. Assuming, of course, that you had any raising at all.

      1. Well said!
        Much of what’s in this post is supported by many scientific studies, and more to come. We with Type 1 diabetes and on insulin for years, know first-hand what effect that insulin has when we start to become even slightly insulin resistant, which many normal people become to some degree after age 35. We also know first hand that insulin is hunger-promoting. People with Type 2 Diabetes get ravenously hungry way before the diabetes is ever diagnosed because they are beginning to produce way more insulin than the average person. Such is the nature of Metabolism 101 and an incredibly oversimplified explanation in my response.
        The refuting of nonsense comments is sometimes such a pointless time-suck because that body of evidence can’t always be shown in a few short lines of a response. It does sometimes take books and references to other books and studies.
        Some of us who live the evidence every day, also understand that there will always be people who think what they think and will always say the sky is green with no possibility of convincing them otherwise. Sadly, such is human nature.
        In the 1970s I met one of the two Australian researchers involved in the discovery that helicobacter was the cause of stomach ulcers, and heard the story of how hard they were fighting to get their research accepted. Some 20 years or so later a Nobel prize came their way. That was a mighty long and hard fought-for mainstream acceptance, despite its simplicity. It can take a lot longer with a subject as complex as the one at hand.

    2. Trolling, no doubt. No one can be so shallow, can they? *chuckle….wonder what he’d say to his wife if she gained a few pounds. Actually, I can’t imagine him married…. Rather a sad little “army-like brat” eh?!
      I actually feel some pity for him: must be hard to be so ‘not-in-the-know.’

  120. Gary T. said it well when he said [probably paraphrasing] the dominant medical paradigm is calories in, calories out and judgemental-ness for “lack of discipline”. Which is to say, the dominant paradigm is not just wrong but also stupid and mean.

  121. Here, here. The real practical difference between low-carb eating and other diets (and there are many other health-related differences) is that low carb is the only approach to weight loss that gets an handle on your impulse to eat, i.e., it does not rely primarily depend on will power (which the research has questioned is every really effective over the long term).

  122. I monitor this conversation because my daughter-in-law, frustrating the religious impulse that so correctly accompanies the typical pregnancy, embraced vegetarianism with a vengeance, developed pre-eclampsia, the baby was hence induced, and had a few days of struggle. One correspondence with this scenario is insulin resistance on the part of the baby, which is not apparent at birth but develops over time. Or so I am given to understand, which is precious little due to the resistance of the medical establishment in service to the oligarchy to any possible fissure in their vegetarianism, the corner stone of their entire agenda to completely strip the poor of everything, including protein.
    That being said, gluttony is real. A woman I often commiserated with before work in the morning over the injustice of her overweight thought she’d be safe shopping at the supermarket in my rundown neighborhood, I suppose, rather than her uptown address, and I ran into her with an entire shopping cart full of Dove bars. They may have been on sale. Some of the posters are probably just communicating similar experiences of their own, although it’s never okay to be unloving about it. We can’t overeat anything, including protein of course. It is forbidden. We have to be hungry sometimes–*usually,* in fact. That’s one more reason to love Christ’s Church, because fasting is an integral step of penitence for sin. (St. Catherine of Siena was an anorexic, for example, and she used it as a tool against some mistakes of the popes, and also against some mafioso bad guys in the area.) Like Catherine, I will do it for Christ when I would not do it for vanity or even health. Anyway. This has been an interesting wakeup of the thread this week. Merry Christmas.

    1. Gluttony may be real, but there are different kinds of hunger. I weigh over 300 pounds, and I used to weigh quite a lot more. I’m losing 2/3 pounds a week now, and I should break 300 soon. So let me give you my perspective.
      Before I went on this low carb diet, there were times that I would have a hunger that was physically painful. A gnawing pain in my stomach, consuming thoughts of food, dizziness and weakness. This kind of hunger was impossible to ignore. It was suffering and could make me whimper in pain. I think now that it WAS a form of pain.
      The hunger I have now is nothing like it. Now, I just get a mild feeling for a nibble that I can ignore for hours, if I choose to. And the craving can be satisfied with nothing but a salad and a few sardines. That would NEVER have been enough before! I am always a little hungry now, but it’s an almost pleasant sensation, not pain.
      I think you should keep in mind that people who have this fat problem, which causes starving tissues, have a hunger unlike normal hunger. Telling them to just ignore it is useless.

    2. Jan Baker, I’m going out on a limb and say that you are not following a Low Carb High Fat diet. If you are forgive the assumption. I am following a LCHF diet and find that quite the contrary to “usually” being hungry I hardly ever feel hungry. I usually eat 3 meals a day and find that I rarely feel hunger. I sometimes have to remind myself to eat. My meals are not huge, but do contain a large amount of fat. When I was eating a High Carbohydrate I was hungry ALL the time and I believe my cells were starving and demanding quick energy,which made it hard not to eat binge amounts of carb most days. Now I still desire sweets because they are a pleasurable experience, but without the physiological drive behind the craving I find it quite easy to resist.

  123. To all you yahoos and yokels raised by wolves, Dr. Mike’s advice is borne out by testing it. My condolences if your parents were absent, didn’t tell you much or you simply weren’t listening, but there’s still enough common sense floating around at large, even at a level of explicit, hooked-on-phonics digestible portions, that you could grasp and use some of it and still not upset your thimble sized brains. Like this gem:
    “If you test any prescriptive advice by doing the work and then you get the promised results repeatedly with monotonous regularity, the advice is true.”
    And what Dr. Mike is saying is true about eating low carb to reduce your body fat composition and break the vicious cycle of insulin resistance at every meal. This is proven with monotonous regularity for a wide variety of people, ages and conditions. Not much else to tell all you Mowglis out there and I don’t know how to bark it so you’ll understand.
    What might be fuzzy is if we dwell on optimal health as only being indicated by weight, as a highly muscled and athletic individual can weigh much more than a fat couch potato. But weight is a fair enough proxy for most people to talk about regarding getting “back” to where they want to weigh after going so far down the insulin resistance inducing, body-bloating carb buffet.
    Even if you are not insulin resistant, are thin and can eat all the carbs you like there are many more benefits of experiencing a low carb diet before you get to insulin resistance, especially if you’re athletic and young and are seeking optimal performance, less inflammation and more rapid recovery from competitive events.
    But that’s a different conversation best saved for people with disciplined, mature and open minds interested in achieving an above the mean experience. That wisdom just won’t fit into a thimble.

  124. I believe taubes may be on to something, another good article is the obesity epidemic is the metabolic syndrome a nutritional deficiency. it is free to read just google the title or stephanie seneff.
    by the way there is one way your body can release fat when insulin is high, it is called adrenalin, it forces fat out, that is why you wake up in the middle of the night kind of nervous and tense. if you have high insulin really bad (like I used to) you get very hungry too. same symptoms as hypoglycemia. the nervousness ends when you eat.
    also the article explains why cells become glucose intolerant, or insulin resistant and it is not because insulin is too high after all if the cells are empty and crying out for food then why would theyresist? awe unless the can’t access it due to nutritional deficinecy. this is also why your accumulate fat around your organs they get direct access fo fat when insulin is high.
    I have to say reversal for me of insulin resistance has been very slow, I see signs of reversal over time, but it is so stinken slow!!!
    I looked at myself in the mirror yesterday at the doctors and I was appauled at myself. sure why do people stay fat if they don’t want to be, seems simple to lose it if they truely want to, so much for people looking beyond the obvious. ass/ume you know why people are fat and you know what happens. it is time for people to step outside the box.

  125. I’ve had a little read of Dr Jack Kruse’s website, which focuses on leptin resistance, which is also an interesting subject, to me. Cure: paleo. The two seem so intertwined – insulin resistance and leptin resistance. More interestingly to me, he explains that once that leptin resistance is gone, those people can add some “safe” carbs and not gain fat.
    Some people certainly can eat a high carb diet and stay normal weight. The rest of us can’t or don’t want to for all the reasons this site talks about.
    To all the doubters, all you have to do is try it. You don’t have to understand or believe the science for something to work. Give it a go! It’s such a wonderfully holistic approach that you’ll marvel at all the other health benefits that result.

    1. @Sue
      Thanks for posting up and sharing Kruse’s work, he’s pretty interesting. If you are also interested about cell terroir you could also check out one of my favorite explainers about the importance of tissue composition, especially the Omega 3 to Omega 6 dietary competition–this competition sets the stage for favorable and unfavorable responses under stress (crisis).
      You can watch Dr. Land’s address to the Department of Defense on the matter here http://youtu.be/dgU3cNppzO0 and the slides to his lecture can be found here http://bit.ly/xwFpRa
      Land’s offers some very pragmatic approaches to preventing and reversing many health problems that are well aligned with Dr. Mike’s insights.
      Hope you find this interesting.

  126. I found this blog by googling reviews for Taubes’ WWGF, which I have just finished reading. It is an accessible, relevant and fascinating explication of the whole messy question, which I have been struggling with since I was made aware that I should “diet,” and how immoral I was for not being thin. (fat since age 2, back when only 6% of kids were overweight.) Now I am age 67, fatter than ever, and of course have T2.
    In the past I have done low carb on many diets, thinking of it as a temporary regime for weight loss, but basically unhealthy. To read about it as Taubes explains it in relationship to insulin resistance and the real body purposes of fat storage and fat release from the cells has been a revelation. So! I actually have always had a medical condition, called obesity. I am fat because my body was/is out of whack, not because I was immoral. What a relief! (I always suspected it was so!)
    Speaking of morality, I AM an animal rights believer, and feel the best way for people to live is Vegan, but I will be selfish here and indulge in meat-eating.
    BTW, I started eating VLC 3 days ago, and immediately felt better, not worse, and have not had any withdrawal symptoms, or problems with hunger, and only passing nostalgia for carbs. Hope these responses continue. And I sure do hope I will be losing mass quantities of weight. OK, fat!!!
    I loved the dialog between Texas Roger and Sue. They disagree to prove their basic agreement and back and forth to reveal the truth shared by both, and in the process, provided immensely helpful information.
    Thank you very much for publishing this blog.
    P.S. My grammar pet peeve: the word is “its” as a possessive pronoun (think “his” and “hers”—note no apostrophe.) “It’s” means “it is.”
    pps to blog keeer—-do you need my last name, glad to provide if so.

    1. Did I use ‘it’s’ where I should have used ‘its’? If so, let me know so I can change it. I’m aware of the difference, but sometimes typos slip in. I also know the difference between ‘their’ and ‘there’ but every now and then while typing quickly, the wrong one slips in.
      I am the blog keeper, and I don’t need your last name.

      1. Thanks much for grammar response. You only did it once, mostly it is others’ usage. I think i made a bigger usage mistake. VLC—does it mean very low carb (what I inferred as its meaning from previous entries) or does it mean very low calories (which I see today on further internet searches)? Pretty significant difference.
        Thanks again for your wonderful presence; I am so grateful to have found your blog.

  127. I just found your blog. I am half way thru this WWGF book. I hate that it wasn’t written 10 years ago. ( I am Type II). I have committed to the cave man diet after reading this book and since my need for insulin shots have dropped drastically. It is a way of life for me now.
    The big scam is BigMart and their “Sugar-Free” Cookies, Ice Cream, Cakes etc. I was in denial when I ate Sugar-Free Oreo’s as to why I still needed a high dose of insulin.

  128. Hi,
    can you give any resource to verify that
    “It ain’t so much the things we don’t know that get us into trouble. It’s the things we know that just ain’t so.”
    is a quote by Henry Wheeler Shaw.

    1. Here is an excerpt from the excellent book The Quote Verifier:

      It AIN’T so much the things we don’t know that get us into trouble. It’s the things we know that just ain’t so.” In various forms this popular observation gets attributed most often to Mark Twain, as well as to his fellow humorists Artemus Ward, Kin Hubbard, and Will Rogers. Others to whom it’s been credited include inventor Charles Kettering, pianist Eubie Blake, and–by Al Gore–baseball player Yogi Berra. Twain did once observe, “It isn’t so astonishing the things that I can remember, as the number of things I can remember that aren’t so,” but biographer Albert Bigelow Paine said he was paraphrasing a remark by humorist Josh Billings. (In Following the Equator Twain also wrote, “Yet it was the schoolboy who said, ‘Faith is believing what you know ain’t so.'”) Billings, whose real name was Henry Wheeler Shaw, repeated this theme often in different forms. On one occasion Billings wrote, “I honestly beleave it iz better tew know nothing than two know what ain’t so.” A handbill for one of his lectures included the line “It iz better to kno less than to kno so much that ain’t so.” Across this handbill Billings wrote longhand, “You’d better not kno so much than know so many things that ain’t so.” Apparently the humorist considered this his signature “affurism.

  129. I’m thinking the so called studies that Fork over Knives touted, claiming fat surrounds the cells and gums them up, causing insulin resistance and type 2 diabetes were all done without restricting carbohydrates.

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