Editor's note: Gary Taubes, the famous writer of Good Calories, Bad Calories: Challenging the Conventional Wisdom on Diet, Weight Control and Disease, answers the second round of your questions here. Check out the original posts here, and Gary's first set of answers here. Gary is still working on more of your questions, so check back in the coming weeks for more responses!
1. Good Calories, Bad Calories is a seminal work. It has become a touchstone in both my professional world and personal life. Your book should be required reading for all health care professionals, starting with diabetes educators.
I understand even more clearly now why keeping insulin levels low is primary to optimizing health and how to accomplish this. However, besides carbohydrates, there is another dietary source that also causes insulin resistance: high AGE foods. In researching this book, what did you find re: this subject?
I spoke with Helen Vlassara, a researcher at Mount Sinai School of Medicine, who has done much of the research on high -GE foods and I read half a dozen of her articles. I remain skeptical, however. One subtext of my book is that it's overly simplistic to think that some compound in our diet -- cholesterol, say, or saturated fats or salt -- is the cause of an excess of that compound in our circulation or our cells. Take, for instance, vitamin-deficiency diseases. I speculate that the problem isn't the dearth of the relevant vitamins in our diet -- B vitamins for pellagra or beri-beri, for instance, and vitamin C for scurvy -- but the effect of the diet itself on the mechanisms that work to conserve and metabolize these vitamins for use in our body.
Thus, we eat refined and easily digestible carbohydrates, these compounds require B vitamins to metabolize and cause a deficiency of this vitamin elsewhere in the body and so the deficiency disease. It's this kind of dysregulation of homeostatic control mechanisms that I think is most likely the fundamental problem. This is why I consider the AGE's that result from elevated blood sugar from high-carb diets to be a problem, but I suspect that we defend ourselves well against AGEs in the foods themselves. I'm just speculating but that what's I would believe until I had compelling evidence to the contrary and I just don't see that evidence.
2. I have been living on a low carb diet since being diagnosed with T2 diabetes 6 years ago. I have lost over 160 lbs and have the disease in very tight control with a usual A1c at 5% or close to it. I am still 30 lbs overweight at 5 ft tall & cannot lose any more no matter how low I cut carbs. I see no way around counting calories to lose these last pounds but my calorie needs are so low that I am intensly hungry all the time which is defeating me. What do you suggest?
All I can do here is speculate, as I have no clinical experience treating people with carbohydrate-restricted diets, I'm just an investigative reporter with a somewhat obsessive interest in the subject. That said, between 1956 and 1972, the British physician Robert Kemp prescribed carbohydrate-restricted diets to almost 1,500 patients. He concluded that a small proportion, particularly the most obese and those who had been obese the longest, often failed to lose weight on the diets even though they faithfully followed them. It is possible that if you were heavy for a long time, your fat tissue has accumulated chronic damage and so you're just stuck with those 30 pounds, and little or nothing you can do will change that.
Another possibility -- and this is really speculation, because as I've said I'm not a doctor -- is that the diet actually works best when it is a high calorie diet with a lot of fat. The idea is that we consciously or subconsciously try to restrict calories on the diet and so our body still thinks it's in starvation mode, even with the absence of carbohydrates, and holds on to the fat. I have no idea if this is the case -- it's the kind of thing that, in an ideal world, would be studied by obesity researchers.
Editor's note: If you're having trouble with your diet, talk to your doctor, dietician or CDE.
3. Dr. Richard K. Bernstein is the diabetes guru of low carb. I notice that you don't mention him in your book. What do you think of his recommendation that we limit our carb grams to 6 grams of slow-acting carbohydrates at breakfast, 12 grams at lunch and at dinner, plus 12 grams for a snack (Dr. Bernstein's Diabetes Solution,2007, p. 169 and 172)?I did not mention Dr. Bernstein in my book, but only because I was concentrating on making the argument that we should have known all along -- say for 40 years, at least -- that refined, easily-digestible carbohydrates and sugars are the cause of weight gain and the associated chronic diseases. When it comes to the best way to keep diabetes under control, however, I defer to Dr. Bernstein's clinical experience and his wisdom in these matters. You can't do better than reading Dr. Bernstein's books and following his advice.
5. EFAs and optimizing insulin sensitivity Did you find any research about essential fatty acids affecting insulin sensitivity?I did, but nothing convincing. The only thing I could suggest with reasonable certainty is that carbohydrates are the problem. Everything after that strikes me as guesswork.
6. My wife tells me that Overeaters Anonymous used to advocate getting rid of carbs (she still has the old recipe book) but now has allowed a variety of diets, including those that conform to the low-fat guidelines promoted by the government. Is there a story behind this shift?I didn't see the early advice from Overeaters Anonymous, but I do know that Weight Watchers used to advocate getting rid of the carbohydrates until the government shifted the playing field and the low-fat diets came into vogue. As for the Paleolithic diet, I agree with most of its principles. Fundamentally, it begins by getting rid of the carbohydrates. My only question is whether or not there is some "ideal" balance of nutrients and micronutrients that will maximize our health and longevity. The Paleolithic diet implies there is. As I have already said, I feel that the best we can say is to stay away from the kinds of carbohydrates we know for sure we didn't evolve to eat. After that, the Paleolithic diet depends on educated guesses. They may be very good guesses, but there's no way to tell for sure.
Also, everything you say about non-Western diets fits with the Paleolithic diet. Any comments on that diet?