Dr. David Ludwig is an expert in nutrition and obesity at Harvard Medical School. In this podcast, Dr. Ludwig gives an overview of the latest scientific literature on what it means to be overweight and ways to lose weight. On a typical day, Dr. Ludwig reviews the latest research and talks to other experts in the field so you can make the best decisions for you and your family. With this podcast, you can learn the latest and most effective strategies to reduce weight, improve health and prevent obesity.
Every third Wednesday of the month, Dr. David Ludwig joins guest host Dr. Dan Pardi to discuss a popular health topic. This month, Dr. Ludwig discusses the benefits and risks of intermittent fasting. Dr. David Ludwig is a Professor of Medicine at Harvard Medical School and Director of the Program in Obesity Research and Policy at the Boston Obesity Nutrition Research Center. He is also Director of the Optimal Weight for Life research program at the Joslin Diabetes Center. He is also the author of Health at Every Size: The Surprising Truth About Your Weight .
On this episode of the podcast, Dr. David Ludwig joins us to discuss his book The End of Overeating: Taking Control of the Insatiable American Appetite, his new research on the causes of overeating, and his latest findings on the benefits of intermittent fasting.. Read more about free podcasts and let us know what you think.
Dr. Ludwig has a lot of experience treating kids and keeping track of the pediatric obesity and type 2 diabetes pandemic. He’s also heavily involved in research, assisting us in better understanding the challenges and complexities of nutrition research, as well as shifting the paradigm of how we fund and design nutrition research to make it more valuable, rather than relying on poor epidemiological research or industry-funded research.
However, we will be able to answer that issue by attempting to bridge the gap between the food production sector and the industry that is not only concerned with the bottom line, in combination with research. Questions Is a calorie the same as a calorie? or the insulin-carbohydrate model. What does this imply for us as citizens of a free society, and how does it impact our health?
Finally, how will this impact our policies in order to assist us halt the diabetes, obesity, and chronic illness pandemic and reverse the trend? In today’s world, where there are so many opposites, where science is more like a religion, and where individuals are so wrapped up in their own views that they refuse to see the other side, David is a source of common sense. David attempts to bridge the divide by saying, “We’re all working for the same thing: greater health.”
How can we enliven this discussion so that we may have a more informed debate and a greater knowledge of the issue in order to find a solution? I hope you got it from his message and found it as valuable as I did. Dr. David Ludwig is interviewed in this video.
Before I continue with Dr. David Ludwig’s interview, I’d want to share some exciting news with you. We shot this interview on the first weekend of November, and his study was published in the BMJ two weeks later.
As a result, if you’re a researcher, you shouldn’t discuss your findings until they’ve been published. Unfortunately, we mentioned this research many times throughout the interview, but we couldn’t go into depth since it hadn’t been published yet. But now that it’s out, I’d want to offer you some background information so you can remember it while listening to this interview.
This is, in my view, one of the finest studies on the effect of calorie quality on energy intake. They studied 164 individuals with a BMI of 25 or more for two weeks, during which time they all ate the same diet and lost the same amount of weight.
He split them into three groups: 20% carbohydrates, 40% carbs, or 60% carbs, with the quantity of protein remaining constant. The only variables were fat and carbs, but here’s the best part: they supplied all of the food for the participants, totaling over $12 million in meals and snacks.
And I believe this is one of the study’s greatest strengths, since it removes one of the most important factors in nutrition research: what do the participants really consume. We may suggest anything, but what will they consume in the end? They provided the meals for this research, so we know precisely what they ate. It’s also an excellent illustration of how nutrition research should be done.
So, what did they discover? They discovered that the group that consumed the least amount of carbohydrates (20%) versus the group that consumed the most carbohydrates (60%) consumed 200-260 more calories over the course of the day, and that their energy expenditure increased without any additional exercise or physical activity.
Your energy bills have gone up. And if you look at the subgroup with the highest insulin levels, they gained more than 300 calories each day. As a result, the conclusion is self-evident. Your energy consumption is influenced by the quality of your calories.
Even cutting 300 calories from your daily diet may make a big impact in your total weight reduction. So, in my view, this is one of the finest studies, if not the best, that clearly addresses this issue. We may now go on to our interview with Dr. David Ludwig, given that we have these facts.
Thank you very much for joining me on the DietDoctor podcast today, Dr. David Ludwig.
David Ludwig, Ph.D.: It’s wonderful to be here with you.
Bret: You were on the front lines of this growing tsunami of obesity and diabetes as a pediatric endocrinologist, and I’m experiencing it now as an adult physician, and it’s awful. However, as a doctor, you must find it very distressing to see this illness progress in front of your eyes.
David: That’s great. It is, in fact. This generation is more overweight than ever before, with devastating implications for both physical and mental well-being.
Bret: You’re correct.
David: Of course, type 2 diabetes in adults has received a lot of attention, but type 2 diabetes now affects children as well. This is unheard of. Type 1 diabetes accounted for 90% of cases while I was studying to be a pediatric endocrinologist, and I encountered a few instances of MODY – uncommon genetic causes of diabetes – every now and then. Type 2 diabetes, on the other hand, accounts for approximately a third of cases in teenagers. It’s possible that type 2 diabetes accounts for half or more of all new cases.
David: Consider this: It’s one thing if an overweight adult gets type 2 diabetes at the age of 50 and goes on to have a heart attack, stroke, or renal failure at the age of 60. When the clock begins ticking at the age of ten, though, we’re dealing with a very different scenario.
Bret: Yes. According to what I’ve read, a diagnosis of diabetes at the age of ten has a worse prognosis than a diagnosis of leukemia. That, at the very least, gives you a sense of how terrible it is. We might name a variety of causes, but processed meals, sugar, and just too much of everything seem to be the major culprits.
Many individuals are concerned with the sugar content, while others are concerned with the glycemic index. I don’t want to restrict you, but you seem to be a proponent of the glycemic index. Is that correct? Alternatively, tell us more about it.
David: That, however, would be too unusual. However, regardless of whatever side you’re on, there’s no agreement that sugar or processed carbohydrates are the reason. There is no agreement, at least in the traditional food community.
The fundamental concept is that all calories have the same metabolic effect. Obesity is the most serious issue. People will attain a healthy weight and the issue will go away on its own if they are just encouraged to eat less and exercise more.
Of course, this ignores the growing body of evidence that food, regardless of calories, affects our hormones, metabolism, and even gene expression in ways that can have a significant impact not only on our chances of losing weight and avoiding obesity, but also on our risk of developing type 2 diabetes, cardiovascular disease, and even cancer at a certain body weight.
Bret: It’s almost surprising that the nutrition world isn’t embracing this for those of us who realize that it’s not simply about eating less and moving more. Then we must look to science to see what it has to say.
You and your colleagues did a study to demonstrate the importance of calories, and you probably know more about the details than I do, but you had 21 overweight patients who lost 10% of their weight over a period of time, and then you offered them different isocaloric diets and a diet based on their percentage of carbohydrates, and you discovered that the diet with the lowest percentage of carbohydrates was the best.
That seems to be true. Your resting metabolic rate and isocaloric rate are affected by the food you consume, which means calories are not only put into but also removed out of the body. So, why hasn’t this research resulted in a paradigm shift?
David: First and foremost, no research is final and conclusive, as we’ll discuss later. But first, let me give you some background. The focus in the treatment of obesity is on the one hand on what is known as calorie balance. In any case, eating less and moving more is a significant emphasis for both public health and therapeutic treatment.
The carbohydrate-insulin model is another paradigm that we created with others. It now focuses on carbs and insulin since it requires a name, but it is not the assumption of a foodstuff or a hormone. That implies we’re on the wrong side of the world.
That overeating does not cause obesity in the long term, but rather that the process of becoming obese causes us to eat more. It’s a bit difficult to think about, but consider what occurs during pregnancy. Women consume much more than males. She’s hungry, wants to eat, eats more, and the fetus develops.
Which one, though, will be the first? Is there a link between excessive eating and fetal growth? Or does the developing fetus use more calories, making the mother hungry and driving her to eat more? We understand if you’re acquainted with the previous one. A developing adolescent is in the same boat. Unfortunately, no matter what we consume, neither you nor I can make our bodies larger.
A teenager’s growth spurt leads them to consume hundreds, if not thousands, of calories more than they would normally. So it’s obvious in instances like these.
Why not explore the idea that extreme hunger and subsequent overeating are caused by quickly increasing body fat caused by ingesting too many calories? It’s a model based on carbs and insulin.
We’re concentrating on carbs because, in the age of the low-calorie diet, they’ve inundated our diet over the last 40 years. Carbohydrates, particularly processed sugars, but also, maybe even more so, refined starches, increase insulin levels, and insulin, which I refer to as “a growth miracle for your fat cells,” is not the miracle you want to see in your body.
Insulin is the most potent anabolic hormone, because fat cells do nothing until hormones tell them to. Promotes the formation of fat cells, the storage of calories in fat cells, and the inhibition of fat release from fat cells. Weight gain is always present in disorders in which insulin has an overwhelming impact, such as in the case of mutations that cause insulin overproduction, or in the case of type 2 diabetes. Once insulin has kicked in, there is always weight gain.
Conditions where insulin activity is inadequate, such as type 1 diabetes, are also true. Whether they consume 3,000, 5,000, or 7,000 calories per day, anybody who can’t generate enough insulin owing to an autoimmune assault on the beta cells will lose weight before therapy starts.
If you don’t have diabetes, changing the quantity and kind of carbohydrates you consume is the fastest method to alter your insulin levels. In addition to carbohydrates, proteins, the types of fats we consume, micronutrients, fiber, the state of our gut microbiome, and non-nutritional factors like lack of sleep, stress, and an overly sedentary lifestyle, there are also non-nutritional factors like lack of sleep, stress, and an overly sedentary lifestyle. All of this has an impact on fat cell activity and influences whether the calories we consume are utilized for storage or oxidation.
In ten years, a few additional grams of fat per day may be the difference between remaining thin and becoming substantially overweight. To return to the research, we lowered people’s weight in order to cause stress in their body’s adaptive systems. These were individuals who had a high body mass at the start of the study.
They lost at least 10% of their body weight before being randomly allocated to one of three diets: a low-carb Atkins diet, a high-carbohydrate diet (60 percent carbohydrate), or an intermediate diet, such as a Mediterranean diet with 40% fat and 40% carbohydrate. We assessed resting energy consumption and total energy consumption using a technique called double watermarking after each of these diets was given for a month. Despite the weight reduction, we discovered that the low-carb diet had no effect on overall energy consumption.
We know that your body adjusts to weight reduction by becoming more efficient, making it more difficult to lose weight. However, there was no such adjustment in the case of a low-carb diet, which may be a significant advantage for weight reduction.
The high-carbohydrate diet decreased daily energy intake by almost 400 calories. With no change in calorie consumption, this difference of 325 calories corresponds to a 35-pound weight reduction.
Bret: This is the difference between being thin and being fat.
David: It’s likely that this accounts for a significant portion of the disparity. And, as previous studies have shown, if your desires alter, if you feel less hungry and less hungry on a low-carb diet, the impact may be much larger. As a result, this research, which was published in the journal JAMA, has gotten a lot of attention.
You know the research has limits; it’s simply a study that has to be repeated, and then the NIH group came out with a kind of rebuttal, a counterattack to that hypothesis and study, looking at other studies on food composition and energy expenditure and concluding that there was no impact. And the NIH team’s meta-analysis was used to argue that the carbohydrate-insulin model proved them wrong.
Almost all of the studies included in this meta-analysis, with the exception of maybe three, were two weeks or less in duration. As a result, proponents of low-carb exercise will instantly see that reducing carbohydrates, particularly in the ketogenic range, as some of these studies have done, requires the body to adapt.
You’ve cut off carbs, which are a significant source of energy for the brain, but the ketone bodies haven’t stabilized yet. The ketone bodies were deprived of food as part of a complete famine in Cahill’s and others’ classic fasting experiments. To achieve a steady condition, it takes two to three weeks.
Bret: And how long did your investigation take?
David: He was a month old when we got him.
Bret: Okay, a month.
David: We have a long enough time period to see these adaptive modifications. Almost all other published investigations, on the other hand, have not. What happens if you’ve quit eating carbohydrates but haven’t yet transitioned to a high-fat diet? You’ll be exhausted. We have a term for it: keto flu. You know you’re physically weary and psychologically a bit sluggish.
There are hundreds of studies that indicate it takes a few weeks, and if you do research during that time, you will almost definitely not experience all of the advantages of a low-carb diet, and you may even see some bad consequences.
However, I would equate it to a scientist researching the effects of vigorous exercise on a sedentary population. You select a bunch of overweight 45-year-old guys who spend their days sitting in front of the television and offer them a six-hour training camp.
You’re aware that they engage in 6 hours of athletics, gymnastics, and contact sports each day. After three days, you measure them again. So, what are your plans?
Bret: You’re going to be upset.
They’ll be weary, their muscles will hurt, and their physical skills will deteriorate. David: If you believe that exercise makes you lose fitness, you’re doing the same thing as individuals who follow a low-carb diet for a short period of time: you’re missing something.
That is why further research is required… Our research, as well as a few others performed over the course of a month, demonstrate the advantages of a low-carb diet. I believe we need lengthier research, and we have recently completed one. We’ll be the first… on November 14th, at the Obesity Society conference, we’ll reveal the study’s findings to the public.
The research, which cost $12 million, was funded entirely by charitable donations. Unfortunately, large-scale nutrition research is seldom funded by the National Institutes of Health. And following weight loss, the same setup as the first phase of weight reduction, in this instance we examined three diets in parallel, so you come on a diet with either 20%, 40%, or 60% carbs, a protein control, and the test phase lasted 20 weeks.
That’s four times as long as our JAMA study and ten times as long as the majority of the studies in the NIH meta-analysis. As a result, this research will be substantial and lengthy enough to test the carbohydrate insulin model conclusively.
Bret: That seems like a lot of fun.
David: We’re excited to present these findings in the near future.
Bret: You’re simply trying to irritate me; I’m looking forward to seeing the consequences.
David: They’re also released, and they’re published.
Bret: That’s all there is to it. That’s always an issue, as well. When a research is presented at a conference but we don’t know all the specifics and the media starts publicizing these incredible findings, the devil is sometimes in the details. And I enjoy how quickly it’s published.
David: We’re hoping to have them out at the same time.
Bret: You mentioned a few points that I’d like to discuss. Philanthropy is funding one of them. That’s a huge issue, because the issue isn’t that it was financed by help, but that it should have been funded by assistance, since there’s no financial difficulty with a drug study.
Even studies that show calories inside calories or attempt to establish this paradigm may be sponsored by the business, since Coca-Cola claims that all you have to do is exercise more and drink Coke, and everything will be great. However, it must be difficult to get financing for preliminary investigations of this kind, which is part of the reason they aren’t being carried out since doing so well is difficult and costly. Was this one of the toughest tasks you’ve ever faced? Are you receiving the money you need from the appropriate sources?
David: It’s incredibly short-sighted, and it’s unclear whether all drug trials will be funded, but if you’re a big pharmaceutical company with a new drug that you think will be useful for a single obesity-related complication, you can get hundreds of millions of dollars to get it into a phase 3 clinical trial.
You’re probably aware that the number of nutritional studies dedicated to a single nutritional theory that surpass a hundred billion dollars can be counted on one hand. It’s also very short-sighted, since we barely spend a fraction of a cent for every dollar spent on food-related disease in the United States and the rest of the globe.
We actually want the financing infrastructure to be suspicious of new ideas, since that is how science works. Because the state of science is an accumulation of many years of research, very few new ideas will eventually establish their validity, and therefore the next study will not statistically alter the paradigm. So we want skepticism, but not at the expense of new ideas, which is a problem because new ideas are clearly needed in the area of obesity and diet-related diseases, where recent data show that prevalence rates are still rising and that the current mindset of eating less and exercising more has failed miserably.
Despite this, it seems that dietary leaders are eager to attempt to disprove new concepts, such as the carbohydrate insulin model, using evidence that is obviously insufficient. We’d be shut down instantly if individuals on our side of the argument produced papers of that caliber, but these low-quality studies are being used to falsify the model.
As a result, it’s in no one’s best interests. Let us not be too eager to rejoice in triumph or decry loss; this is too binary. We want a more nuanced discussion in which we acknowledge that we have a public health crisis that is not being addressed by current thinking, and whether the carbohydrate insulin model is 90% accurate or 10% accurate, we need to understand what we can learn from it rather than dismissing new ideas so quickly.
Bret: As a result, food science is becoming to resemble a religion rather than a science, which is a concern.
David: This is true for both sides. People may be extremely discreet on social media, just as they can be with their calorie intake and consumption. The low-carb group has its own dogmas and communication techniques. Both sides, in my opinion, need to calm down and refrain from using ad hominem attacks.
On Twitter, it’s all too usual to accuse our opponents of intentional obstinacy, which I don’t believe is accurate; I believe they may be incorrect, but they promote ad hominem assaults, which I’ve been the victim of. Ad hominem attacks are usually a waste of time when it comes to science. Let’s concentrate on science, public health, and dealing with your annoyances.
People aren’t always understanding. Consider the history of science: some good ideas took decades or centuries to be proved definitively. Let’s be mature, because even if you’re right and the world doesn’t recognize it, attacking the other side won’t help.
Bret: They are unquestionably the voice of reason in a society obsessed with polarity, which sells, generates clicks, and generates views.
David: There are no polarity issues. What we actually need is a more spirited discussion that explains the polarization. One of the issues I have with the conventional worldview is that it is ever-changing. Every time a new discovery is made, it evolves in a manner that attempts to fit that finding without reevaluating the fundamental concept or assumptions. So, sure, a strong light is required. Let’s have a discussion that explains the polarization, but don’t become personal.
Bret: All right, now I appreciate what you mentioned about the carbohydrate-insulin hypothesis being around 90% or 80% accurate.
David: Or, to be more precise, 10%.
Bret: That’s correct; it doesn’t have to be all or nothing, and some people still believe that calories don’t matter when it comes to carbohydrates and insulin. Calories are essential, to be sure. You won’t lose weight if you consume 10,000 calories on a low-calorie diet because you’ll overeat.
On the other hand, if you consume 800 calories while on a low-carb diet, your resting energy expenditure and metabolic rate are likely to be affected. So it’s difficult for me to say it needs to be one or the other. However, several important figures in this area continue to believe it is either one or the other. How can we address this issue and demonstrate that not everything is black and white?
David: We must keep in mind that science is not a religion. You’re discussing weight management, which is one of the most difficult and multifaceted clinical issues we encounter. Diet, exercise, stress, sleep, family dynamics, neighborhood, food supply, and political and policy choices are all known to have an impact. We may all fool ourselves into thinking we know the entire image by looking at a tiny section of the elephant.
A little humility is in need here, because as you point out, the carbohydrate-insulin paradigm doesn’t seem to work against the caloric balance. In a recent review paper for JAMA Internal Medicine, I attempted to make this point apparent. It’s only a reinterpretation of the first rule of thermodynamics based on biological facts.
Humans, on the other hand, are not toasters. Changes in caloric balance cause us to react in a dynamic way. Unfortunately, although this phenomena has been extensively documented in the laboratory, it has largely gone unnoticed in medical and clinical settings.
Bret: And now comes the tricky part: how do you construct a research to assess that? Is this the real world, with free people? Is he encased in a metabolic chamber? Is it just capable of measuring double-marked water?
David: That’s all there is to it.
Bret: Right, a little bit of everything is required.
David: Of sure, we must comprehend this. The issue is that we have hurried into effectiveness trials in which huge groups of individuals are placed on various diets, given nutritional advice (sometimes of low intensity), and then required to follow it. And if you’re fortunate, they’ll modify their diet for a few weeks or months, but after a year, nearly everyone eats about the same.
It’s unsurprising that their weights and other health markers are almost similar, but does this imply that diet is unimportant and compliance is all that matters? No, it is a clumsy idea. In another area, such as biomedical research, we would never undertake such a thing.
Consider a potential new cancer treatment that may cure children’s acute leukemia. One group received a medication, while the other received a placebo. The youngsters in the therapy group, on the other hand, never got the medication in the appropriate dosage or at the right time.
Perhaps they were given incorrect directions, many families couldn’t afford the medication, or there were minor and transitory side effects that might have been avoided with proper guidance but weren’t. This indicated that the medication was not taken as directed and that no statistically significant difference in cancer outcomes existed.
Would you come to the conclusion that the medication was unsuccessful or that the study was a failure? More qualitative research is required to answer these basic issues. This is a common dietary blunder. We were missing the mechanisms and, more importantly, the efficiency. What occurs under perfect circumstances? What happens in the actual world, particularly when the real world comes in the way of good conduct, when we withdraw prematurely into efficiency?
If we learn that a low-carbohydrate diet is best for a third, half, or two-thirds of the population, we’ll be able to create behavioral and environmental treatments that are more successful. Understanding that smoking causes lung cancer is not the same as establishing environmental policies, basic environmental laws that really assist people quit smoking.
Bret: You have to prove it in a perfect test first, then find out how to use it in the actual world.
David: These are two different problems, two different scientific truths, and they’re still blending together.
Bret: One of the unique aspects of your research is that you provided food rather than telling them to eat. Is that what you’re going to do in your future research?
David: Yes, we just finished a research called the Framingham State Nutrition Study, in which we were able to enroll students, employees, professors, and community people and feed them via the university kitchen, a commercial nutrition service, in collaboration with Framingham State University.
So we took use of the fact that the restaurant business understood how to provide great meals in big numbers and at a profit. We were able to test the mechanistically oriented hypothesis by controlling the quality of these meals. Is there a difference in metabolism if individuals eat very differently?
Bret: Yeah, this demonstrates a novel approach to doing research….. I recall you mentioning something on Twitter about a new paradigm for bringing academics and industry together to help discover solutions, and that this requires money.
David: True, however in this instance we’re utilizing the industry to avoid any conflicts of interest. Working with a nutrition service provider that isn’t interested in a certain diet but can offer high-quality food that is much more appealing than metabolic hospital fare is something completely different.
Working with them as a pair is one thing. The other is collaborating with Coca-Cola on a research to explore whether sweetened beverages may help youngsters avoid dehydration.
Bret: Nonetheless, it occurs often. This kind of collaboration and financing, and you know….
David: That’s why we’re here… The National Institutes of Health, in my view, has failed to finance high-quality nutritional research on a large enough scale to conclusively resolve the issues that have plagued us for millennia. To fill the void, philanthropy has to come in.
And I believe that if any billionaires remain, they should come to Harvard, where we will try our best to provide definite solutions to some of these long-term issues.
Bret: There was a philanthropy-funded research headed by Gary Taubes – well, not led by Gary Taubes, but a sort of long-awaited public study with Gary Taubes.
David: Nucy, nucy, nucy, nucy, nu
Bret: I’m using NuSI.
David: As a result, NuSI provided us with funding. One of the first three significant investigations is this one. A pilot research, really a non-randomized pilot trial with the NIH and several co-authors, was published in the AJCN journal, and it indicated a benefit of the ketogenic diet despite some bias…..
Bret: See, this is precisely what I was referring to.
David:…the ketogenic diet provided a metabolic edge thanks to double-labeled water and the metabolic chamber. It wasn’t a big difference, but it was statistically significant in a pilot trial that wasn’t large enough to provide an exact estimate and wasn’t randomized, both of which indicate against a low-carb diet.
Why? Because they all maintained a normal diet for a month before switching to the ketogenic diet in a nonrandom manner, yet the experimenters underestimated the energy. They intended to do this to maintain weight stability, but they miscalculated the computations, resulting in a substantially negative energy balance among the individuals.
They ate approximately 300 calories per day or more and lost weight steadily. This is why we use randomization to conceal errors like this. In this instance, since they were not randomly assigned to the normal diet, their mean weight was substantially greater than on the ketogenic diet, skewing the total energy expenditure statistics. Despite these and other biases, the low-carb diet has proved to be a success, and I believe it has successfully exhibited its claimed benefits.
Bret: That’s true, as you said, prominent experts have stated that this disproves the carbohydrate-insulin hypothesis.
David: According to the register, this research was classified as an observational pilot study. By definition, a pilot study cannot confirm or reject a claim. Its purpose is to assess research techniques and provide broad impact estimates that may be used to validate them. So, if you reinterpret the NuSI research, as we did, the advantage of a low-carbohydrate diet is approximately 200 to 250 calories per day when mistakes are taken into account.
And that aligns with our JAMA findings, which we’ll be able to compare to the findings of the new Framingham research. A nutrition research performed at Stanford and just published in the Journal of the American Medical Association, or JAMA, is the third NuSI-funded study.
This research discovered a tiny, statistically insignificant advantage of a low-carbohydrate diet over a low-fat diet, but low-fat dieters should restrict or eliminate all processed foods, particularly refined grains and added sugars. As a result, the combination of the glycemic index and the quantity of carbohydrate produces the glycemic load that best predicts blood glucose and insulin levels after a meal.
In fact, in the low-carbohydrate/low-glycemic load group, this rate dropped as much as in the other clinical studies. In other words, if you avoid processed carbohydrates, you may likely succeed on a diet that includes other macronutrients: more carbs and fat. The other is if you have type 2 diabetes, however this research did not cover type 2 diabetes patients.
However, this is in line with the carbohydrate-insulin hypothesis once again. It concentrates on refined carbs. This isn’t to say that the issue is caused by the typical Okinawan diet of fruits, vegetables, and starchy tubers.
It targets the refined carbs that have inundated our diets as a result of years of low-calorie eating, producing an insulin surge. I may not be able to reveal the outcomes of our research, but I believe we will find that the findings of the NuSI-funded studies are consistent.
Bret: And I believe it’s great that you emphasized that you weren’t thinking about type 2 diabetics, since fruits and tubers may produce too much glucose load and insulin response in such individuals. However, it is not the evil we’ve been discussing for the general population, which is metabolically healthier.
So it’s obvious that the planet can’t live without all carbs, all grains, i.e.
Bret: Sure, why not.
David: There will be ten billion of us, yet there will be insufficient animals to feed ten billion humans. To feed so many people, grain is required. We’ve evolved from our hunter-gatherer ancestors. What exactly are these grains, exactly? Are they being handled as little as possible, and may we, too…?
Because you already know that traditional bread, such as sourdough bread, is prepared with less finely ground wheat and ferments for a long time, allowing numerous easily accessible carbs to be digested and transformed into extremely beneficial organic acids. We may also look to agriculture for additional healthy fats such as avocados, almonds, and dark chocolate. They’re all tasty and healthy, and they can help feed the world’s 10 billion people.
Bret: How can we get there, given the present status of farm bill legislation, its benefits and drawbacks, the current structure of our business, and our medical community? There seem to be many roadblocks. They were politically engaged and attempted to make a difference. What are the following measures, in your opinion, that should be taken?
David: First and foremost, we must comprehend what science is teaching us. About the human body’s functioning, and how to care for and nourish it so that it doesn’t suffer from these metabolic abnormalities as often as it does now. They’re in their 50s and 60s, or, as we mentioned at the start of this session, they’re occasionally in their teens.
So we need to study the science to see if there is a propensity, if there are variations owing to our genes or other biological variables, and we’re very interested in insulin secretion, but that’s a different tale.
So, what is acceptable for the general public, and are there any bigger subgroups that need particular attention, such as B. People who suffer from type 2 diabetes, which is very prevalent. As a result, it’s a public health concern. Then, I believe, we start searching for common projects that we can work on together. One of the first industries to express interest is the insurance sector.
They spend a lot, and they continue to do so. Preventable diseases: If a $10 investment in good nutrition or a change in infrastructure or policy can generate $100 in economic benefits, reduce medical costs and increase worker productivity, and reduce the number of days lost to diet-related diseases, I believe you’ve suddenly leveled the playing field between Big Pharma and the food industry.
As a result, we must begin forming coalitions. They will assist us in developing policies that benefit society as a whole, rather than simply privileged interests with disproportionate access to politicians and power.
Bret: Yes, it is an excellent point. Some have argued, for example, that the expense of particular meals is the cost of bad health. I’m not sure whether it’s feasible, but it’s a valid point of view.
David: This is known as the Pigovian tax, and it is a widely accepted capitalist concept. You can’t create a product that, let’s say, pollutes the environment. You have a pig farm that generates massive lagoons of hazardous waste; you can’t expect someone else to take up the environmental catastrophe that is that lagoon by selling the product at a cheap price.
He’s lightening the burden on this investigation. For example, the Pigov tax, which is now being implemented throughout the nation to cigarettes, shows that we need to pass on some of the product’s long-term expenses, such as emphysema or lung cancer treatment, in the price so that they are not passed on to the public. You may have a capitalist notion of market responsibility. However, more is required.
Bret: Yes, and I agree. But if it’s done correctly, and there’s a caveat here: There are so many epidemiological and observational studies on which such a tax would be based, and so many research that show that eating more meat raises the risk of heart disease and cancer. The Harvard School of Public Health often sponsors them.
This ignores the fact that scientific quality is deteriorating. The research we’ve discussed thus far are controlled, prospective trials, not retrospective studies featuring businesses with healthy customers, confounding factors, and risk ratios that are too low to make general conclusions from. As a result, I am concerned that if we continue down this path, we may end up with a meat tax based on the findings of these low-quality epidemiological research.
David: As a result, I believe you are conflating two key problems. One issue is whether, based on the scientific evidence, taxes or subsidies that fairly balance the long-term costs of commodity prices are an acceptable policy tool. And I believe the answer is yes, and we seem to agree.
Bret: I concur.
David: The second question is: Why do you need a sufficient knowledge foundation to carry out your actions? So that’s an other topic altogether. There are issues with observational research, just as there are with clinical investigations. Did you know that no scientific study has yet proven that quitting smoking reduces the risk of lung cancer?
Nothing like this has ever occurred before. Nonetheless, we can all agree that there is a cause-and-effect connection here, and it is a significant one. So, despite all of the research, why hasn’t it been discovered in clinical trials? These are the clinical trial’s limitations. They haven’t met all of the requirements. You’ll be thrown about and see impacts that will take decades to manifest in certain instances.
So just because a clinical trial doesn’t demonstrate it, or vice versa, doesn’t imply it’s true; there are limits on both sides, and I believe it’s become trendy in the low-carb community to concentrate only on observational study constraints rather than intervention study limitations.
Both have a place in the world. There are many questions that clinical studies will never be able to address. It’s enough to know the difference between a good ATBI and a poor ATBI. As previously stated, we differentiate between excellent clinical studies and poor clinical trials.
Bret: As a result, since the risk ratio is higher than three, three and a half, smoking is regarded a good ATBI. If one of the explanations is that there is a dose-response effect, you know that it satisfies the Bradford-Hill criteria. Although saturated fats, red meat, and many other foods have much less ATBI than this, the Harvard School of Public Health has repeatedly publicized these findings, possibly misrepresenting what they can show. Is this anything that bothers you?
David: Well, I would say that all of the evidence should be interpreted reasonably. I’d also want to point out that Harvard does not have a single school of public health.
Bret: That’s a good point.
Some academics, including those who openly declare in their papers that earlier saturated fat guidelines were overstated and that saturated fat in a regular diet does not raise the risk of cardiovascular disease, have a different viewpoint.
I work at a public health school, and I’ve publicly said that when white bread and butter are compared, butter is the healthier option. Even while you claim that it causes a slew of issues that we wouldn’t have today if it weren’t for saturated fat, I believe saturated fat is a major issue in the context of a high-carb diet. I believe ATBI demonstrates this all of the time, and I believe there are genuine connections.
This isn’t to say that saturated fats don’t have an effect on a low-carb diet. In fact, I believe you’ll need to eat more saturated fats on a low-carb diet – you can vary the amount of saturated fats you eat on a low-carb diet, but it will inevitably be higher; however, if you’re not eating a lot of carbs, those saturated fats, as Steve Finney puts it, “go to the top of the oxidation,” and they don’t stay there very long.”
You also have triglyceride and HDL abnormalities, as well as chronic inflammation. So, even in the low-carb community, I believe we do both sides a disservice if we totally ignore any detrimental impact of saturated fat in a traditional high-carb diet. This, I believe, is a mistake.
Bret: Well, I appreciate your perspective as always, and you’re able to see both sides of the coin and try to bring them together to make a reasonable decision and move science forward in a way that helps answer these questions, not that it has to be one or the other, but we need a truthful answer to help our patients and understand the complexity of this issue. As a result, thank you.
David: I simply want to say that it’s fantastic that you’re working so hard on these problems as a cardiologist. Congratulations for getting started. I believe you can do it with a perspective and authority that is frequently missing.
Bret: Thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, thank you, you you, thank It is much appreciated. So, where can folks find out more about you and hear your thoughts?
David: If that’s the case, I’m not sure when it’ll be released, but you may attend the Obesity Society conference in Asheville in mid-November. We want to meet you at our next data presentation. Otherwise, you may find me on Twitter and Facebook. My Twitter handle is @davidludwigmd, and you can find all of my links on my website, doctordavidludwig.com, or drdavidludwig.com.
Bret: Dr. David Ludwig, thank you so much for taking the time to speak with me today; it was an honor.
Hey guys, you know how I love bringing you the latest in health-related news, so why not also give you the latest in health news? Dr. David Ludwig, an obesity researcher at Boston Children’s Hospital and Harvard Medical School, today is discussing a study he conducted that suggests the best way to lose weight may be to not eat at all.. Read more about podcast app and let us know what you think.
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