The Exchanges

Q And this is the glycemic index, kind of like the response?

A When we talk about the glycemic index, exactly, that's the response of your blood sugar. To the foods you're consuming. So if you're consuming a food that's almost pure glucose and is easy to digest, like white bread, you will have a quick rise in blood sugar. And it's one reason why white bread was usually considered sort of the standard by which you would then compare other foods to in the glycemic index. But there's another half of the sugar molecule, or in the case of high fructose corn syrup, another 55% of it, which is this molecule fructose. So any molecule that ends in OSC is a carbohydrate. So fructose is the sweetest of the carbohydrates, so it's what makes sugar sweet. But the fructose is metabolized not by every cell in our body. It's transported through the portal vein to our liver, and some huge proportion of it is metabolized by liver cells. And, you know, this stuff was worked out by biochemists back as early as the early 20th century, but biochemists weren't doctors, and they weren't studying, treating diabetes or obese patients, and the doctors Even if they were getting biochemistry, might not have gotten this level of biochemistry. So the physicians treating diabetes never really understood what sugar was or what made it different than other starches. So when you began to have debates about whether sugar was a cause of diabetes, the diabetes specialist tended…

AI assessment note: “When we talk about the glycemic index, exactly, that's the response of your blood sugar.”

Q You've written about the history of nutritional sciences, about alternative hypotheses of obesity, and why we get fat, about the harms of sugar. What's the next thing you're writing about?

A Well, I have to write, uh, I, again, I'm interviewing practitioners around the world who, uh, you know, have transitioned to using low-carb, high-fat, or paleo diets to, uh, you know, prescribe to their patients for obesity or diabetes or other disorders, so that's going to become a book, although I have no idea at the moment how I'm going to write it. It's been fascinating talking to these And I would also like to, if there are any listeners, I would like to talk to doctors who are prescribing vegan and vegetarian diets now or Mediterranean diets to try and understand their, what they're seeing with their patients and the feedback they're getting and try to take care of the sort of selection bias of, you know, me interviewing people who follow my Twitter feed, kind of that kind of stuff.

AI assessment note: “I'm interviewing practitioners around the world... so that's going to become a book”

Q Why do you think nutritional science is in such a poor state compared to other areas of medical science? Like, what is it about nutrition that's led to such vast misunderstandings?

A Well, first of all, we don't know that it's actually better than other areas of medical science. One of the questions I'm always, we know what we see, right? So I study nutrition science. I write about nutrition science. I know nutrition science is, to me, almost not a functional science, but I've never had the opportunity to put that effort investigation into other areas of medicine or other areas of science. You just hope they're better. My take on this is sort of historical, and I'm gonna, the way I see it, science was sort of honed to a very fine edge as a, you know, methodology for establishing reliable knowledge. The universe in Europe, it's, By, you know, was at its height in Germany and Austria pre-World War II, and the sort of, these people really understood the rigor necessary to do good science, the skepticism necessary, this idea that Richard Feynman later encapsulated by saying, you know, the first principles of science is you must not fool yourself, and you're the easiest person to fool. And this culture of science Began to evaporate with World War II, and it crossed the Atlantic in fields like physics because we embraced these European researchers, many of whom were Jews, um, and the leading scientists in the world, the leading physicists in the world post World War II in the U.S. tended to be these European emigres or their students, um, and many of the Key play…

AI assessment note: “Well, first of all, we don't know that it's actually better than other areas”

Q Can you quickly walk listeners through, uh, your beliefs on what is causing this?

A Okay, so again, if you think of it as a criminal case, the first question is what's the crime being committed? And in this case, it's, it's like I said, it's obesity and diabetes epidemics showing up everywhere in the world after they transition to a Western diet. So that's, that's, that's the crime. That's what we want. We want to find out who the perpetrator is. We know what the agent, what the, the vector is. The vector is the Western diet and lifestyle. You know, it's commercialism and urbanism and, and maybe it's processed foods. These are all sort of vectors of the disease, but what's the agent in the vector? And, um, yeah, the point I make in my book is you can chart these, go back in time and, and actually, which you would do if, again, if it was a criminal case, you would, you would want to know, you know, when the crime was committed, when it, the earliest Sign of the crime, and, and so you could do this using, ah, hospital records and the medical literature, and you find out, for instance, in the U.S. that diabetes rates, ah, in, were virtually nonexistent, even though it was a very, a relatively easy disease to diagnose, um, You saw very little sign of it pre-eighteen 50, and even, for the most part, pre-eighteen seventies, and then the numbers in hospitals, and you could see this in hospital records, and in Boston, and Mass General, or in Philadelphia, Pennsylvania…

AI assessment note: “The vector is the Western diet and lifestyle. You know, it's commercialism and urbanism”

Q A lot of people seem to think it's just simply a matter of calories in, calories out. What, what do you say to that argument?

A Um, this is, this was, this is the most common thing I read, right? So when I started my research, okay, journalistic research on this subject, and if you go back to the very first The infamous New York Times Magazine cover story I had in 2002 that was called What If It's All Big Fat Lie. I had a line in there where I said, you know, I was speculating that dietary fat doesn't make people fat and it's carbohydrates that do, but so I had a line where it said clearly it's excess calories that cause us to eat too much. And then I actually, you know, I get a big book advance, and now I could spend five years of my life Doing research, and the internet at this point in time made it possible for me to learn, you know, to, it was like a new technology had come along, and suddenly I can, you know, sit in my office, which was then in New York, and I can get every primary source on obesity, whether it's in the academic literature, or books, or conference proceedings, um, you know, going back to the 19th century, and, um, I mean, back then, nowadays, you could virtually download them. Back then, 2002 to 2006, you could, I had students all around the country whose job was to go to their local medical libraries and, you know, make copies of the 50 or a hundred references I would send to them, and then I would buy books. So, I, I actually started doing my research, and I realized that this, t…

AI assessment note: “It's logically equivalent to saying, you know, excess money makes us rich.”

Q So what do you think about, like, the Mediterranean diet and the French diet and all of this stuff? Like, are there diets suited to cultures or types of people that grow up in a certain region or...

A The Mediterranean diet may or may not be healthier than, for instance, an Inuit diet. Um, like if you took the Inuits and gave them a Mediterranean diet, they may do just as well as the Greeks do, or they may do more poorly because they haven't had time to adapt to, I don't know, olive oil, or a lot of green vegetables, or, you know, whatever the grains they're consuming in this diet. It's sort of Um, you know, it's one of the ways people tend to confuse the fundamental issue. So to me, the, the really important issue, the critical issue is these epidemics. And the numbers are just out of, I mean, almost unimaginable. In the U.S., and according to the Centers for Disease Control in the U.S., since the late 19 fifties, diabetes prevalence has increased 700%. Ok, so one in 11 Americans now had diabetes when the number might have been closer to one in a thousand or one in 3000 at the beginning of the 20th century. That's almost incomprehensible, and nobody really, I mean, the fact that there aren't sort of teams of investigative scientists, you know, and then task force on every street corner walking around with, you know, I don't know, detectors of some sort trying to figure out what the cause of this disorder is, You know, why we have this out of control epidemic is, is another question, but that's the question you have to keep on asking yourself. What's causing these epidemics?…

AI assessment note: “it's one of the ways people tend to confuse the fundamental issue. So to me”

Q you think it's gonna take for the, like, nutritional research community to get a lot more rigorous? It seems like, I mean, the influence of the Uh, epidemiology makes this difficult. Such a large percentage of nutritional studies are based on correlative measures rather than causative ones, leading people to believe that, you know, just about every food either causes or prevents cancer. Um, like how does this get fixed?

A Well, that's, that's the question. The, um, I'm involved now. I'm supposed to be co-authoring an article with the, for the British Medical Journal on nutrition policy. They're running a series on nutrition policy, so one of the articles on dietary fad, and I'm honored that they think enough of my work that they've asked me to be a co-author. With two epidemiologists. One of them is at Harvard and has not liked my work for 10 years since I wrote a New York Times Magazine cover article about the science of epidemiology using the Harvard cohort study as a case study of a pseudoscience, so I can understand why he might be angry at me and disagree with my way of thinking. So the conflict in this article is that the nutrition community, driven by these epidemiologists, think in the context of saturated fat, that if all of us out there in the lay population were to replace the saturated fats we eat with polyunsaturated fats, we'll live longer and be healthier. We'll have less heart disease, less diabetes, maybe less obesity, less insulin resistance. So this means, in effect, replacing, I don't know if they think this far into advance, but it means, in effect, replacing foods we've been consuming for millions of years as a species, so, and mostly animal fats, with vegetable oils that are relatively new to the human diet, and particularly like soy oil and canola oil and corn oil. And wi…

AI assessment note: “Well, that's, that's the question. The, um, I'm involved now. I'm supposed to”