278 Pounds Of Fat Magically Disappears In Just One Year...On A High-Carb, Low-Fat, Sugar-Laden Diet?

In this episode of the Ben Greenfield.

Fitness show, you can't actually see the therapeutic effects of eating a very low fat diet until we're about 10% of calories is fat. So all these studies that are using 30% of the bar, they're completely missing what's going on at the actual low fat end of the spectrum. When people go into what I'm calling carbosis, which I'm identifying as a zone that starts at about 10% of calories from fat and lower and maybe 75 to 80% carbohydrate at the minimum. When people are in this zone, something equally fascinating happens where carbohydrate metabolism is optimized and insulin sensitivity improves.

Paradoxically, he's an expert in human performance and nutrition, voted America's top personal trainer and one of the globe's most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield.

Power, speed, mobility, balance, whatever it is for you, that's the natural movement. Get out there. You look at all the studies done, studies that have shown the greatest efficacy.

All the information you need in one place right here, right now on the Ben Greenfield Fitness Podcast.

Hey folks, it's Ben Greenfield. And a few days ago in podcast 335, if you took a listen, I mentioned that there was a very kind of controversial article that got published this week by Denise Minger in an apparent attempt to break the Internets, at least the Internets of the nutrition world. The article is called In Defense of Low, A call for some evolution of thought. And you've probably been hiding under a rock if you haven't seen all of the explosive responses, especially in those who live in the high fat, low carb or ketosis realm, when it comes to some of the potentially inflammatory statements that Denise makes in that article talking about how you can lose weight eating a bunch of sugar and starch and you can not just lose weight, but you can even do things like cure diabetes by eating a bunch of carbohydrates. And this is some really interesting information that a lot of people aren't talking about, but that Denise lays out quite extensively in an 18,000 plus Word article that I will link to in the show notes for this episode. So I have Denise on the call today to talk about this article. And actually, Denise has been on the Ben Greenfield Fitness website before. She hasn't been on the podcast. You haven't been on the podcast, right, Denise?

Not that I remember.

Not that I remember either. One of us would probably remember.

Probably, yeah.

Anyways, though, Denise wrote a book, really good book that I recommended about a year ago. It's called Death by Food Pyramid. Death by Food Pyramid. And we actually published an article last year that's kind of an anecdote from that book called how to figure out which diet is right for you. And I like Denise because, Denise, you're such a good writer.

Thank you.

Your writing is fun to read. But anyways, for those of you who aren't familiar with Denise, her blog is rawfoodsos.com and she spends about 5 hours a day reading and writing about nutrition. At least that's what the bio on her website claims. And Denise also speaks. I've seen her speak at the Ancestral Health Symposium. She does a lot of lectures on nutrition, and she's known pretty well for quite aggressively challenging conventional nutrition, wisdom and dogma. And she's perhaps most famous for a relatively thorough refutation of the China Study, which appears on her website and which I will also link to in the show notes for this episode. So before we dive in the show notes, you can get them@BenGreenfieldFitness.com High carb. That's high spelled with the ghost. BenGreenfieldFitness.com HighCarb with the gh. Not the way all the cool kids are spelling it with just the H I these days. Anyways, though, I'll put all the show notes, studies, articles, everything that we talk about over there. So, Denise, first of all, welcome to the show.

Why, thank you. And I must point out you forgot to mention that I don't like coffee.

You don't like coffee, and I don't like coffee.

This is very important.

Denise and I were having a chat just before we began recording. It is 10:00am here, Pacific Time in Washington state. And Denise, you just woke up.

I went to bed pretty late.

Okay, so you are a night owl.

Yeah.

We'll have to have a separate chat sometime about circadian rhythms.

And I'm not saying it's a good.

Chance and all that jazz. And you also are not a coffee fan.

I cannot stand it. It is vile to me.

Okay, I will try and ensure that this podcast is not sponsored by a coffee company, but I make no promises. And then finally, just out of curiosity, because I know that you are quite infatuated with nutrition and things diet related, tell me about what you ate yesterday.

Oh, my goodness. What did I eat? Okay, I found raspberries on sale and I ate an absurd amount of raspberries. I don't even know how much, but they were very delicious. Even this time of year is amazing. I actually can't even remember. Oh, I think I went out. Oh, I got sushi yesterday. I ate quite a few pieces of salmonigiri and some spicy salmon rolls and some. What did I get? Yellowtail sashimi, which was delicious. And I had a pretty big salad. And yesterday was pretty busy. I don't really remember. I think I was kind of eating distractedly, which is not a good thing. But it was a pretty. It was a pretty busy day. So that's not necessarily typical.

Well, I'm actually quite flattered that you two use the term big salad. You describe your daily. Well, for me it's my daily lunch. Now, you used to be. Did you used to be. Because your website's called raw food sos, did you used to be like a raw foodist? I guess the term would be.

I was. And I probably still qualify. Probably. My diet is about 75% raw. Not necessarily intentionally. It's just what I enjoy the best. And yeah, I started my website actually as an ex raw foodist to help struggling raw foodists. Hence the SOS on the. The title.

Gotcha. Now, what would a raw foodist struggle with?

Oh, everything. No, I think especially if you're a raw foodist vegan, you're going to run eventually into problems with fat soluble vitamins, in many cases vitamin K2, vitamin B12. A lot of people struggle to get enough protein. A lot of women end up not menstruating. There's problems with hair loss, extreme weight loss, occasionally weight gain, fatigue, dental issues. There's a very long list of things people can encounter. And I mean, not saying that everyone will encounter everything on that list or anything on that list, but my experience has been that there's generally a honeymoon period for people who go raw and that is followed by a period of crashing.

Now, you mentioned that you ate sushi yesterday. Would that be considered part of a raw food diet?

Probably. I mean, the rice wouldn't, but the fish sure would.

Okay, gotcha. So you were a raw foodie or a foodist for a while and now do you follow any type of specific, like dietary dogma or macronutrient ratio? Do you just kind of like eat raspberries and fish willy nilly?

I pretty much eat raspberries and fish willy nilly. Okay, well, I will say I try very hard not to identify with any specific group. I think a lot of them have things we can learn from, even the raw foodists, even the vegans. Even the very low carbons, et cetera, we can draw inspiration from all of those communities, but when we latch onto a single one is when things get dangerous.

So that means that your next book is not going to be the Denise Manger Diet.

Well, that's kind of a good idea, but probably not.

Okay, gotcha. All right, let's jump into the meat here. Pun intended. So you say in this article about low carb specifically, or low fat, the article in defense of low fat, you say in the process of redeeming fat, we traded one form of oversimplified blame for another. Can you expound on that?

Yeah. So if we look historically at our beliefs about food, especially the ones that were given by the government, we can see that in the starting, kind of in the late 1970s, but especially in the 90s when the food pyramid came out, we had this anti fat movement arise in America where all of a sudden we were blaming the obesity epidemic on eating too much fat. Diabetes, all these chronic diseases. We were saying, oh, that's a result of people consuming way too much fat in their diet. So let's replace with some carbohydrates and put people on a quote unquote low fat diet. So what happened is America collectively reduced our relative intake of carbohydrate. We actually, or sorry, fat. We actually didn't eat less fat in absolute amounts. We just ate it, relatively speaking, because we were eating more calories in general. And so we had this low fat movement happen where the government was pushing us in that direction, nutritionists were pushing us in that direction. Most people believed it was the healthiest thing to reduce our fat intake. And lo and behold, especially the government version of what low fat was, which we can speak about later, it didn't produce the health outcomes that we were hoping for. People kept getting sicker. The obesity epidemic got even worse. And so then, lo and behold, about a decade and a half later, we started seeing books like Good Calories, Bad Calories, a resurgence of the low carbohydrate movement. And now today, 2015, there's a very strong movement trying to blame the obesity epidemic on the low fat diet, on eating too little fat, and by way of that, too many carbohydrates. So we've kind of swung from this extreme of believing that fat was the culprit to now believing that carbohydrates are the culprit. And in my mind, we're not learning from the history that we experienced with the low fat shaming, and we're starting to do the Same things with carbohydrate and in a way that is not scientifically founded.

Okay, gotcha. Now, you use the term carbosis in your article. What do you mean when you say carbosis?

So that's a word I made up. It's a word that is supposed to represent the opposite of ketosis. So when people go into ketosis, their fat metabolism is optimized, they're running on ketones. When people go into what I'm calling carbosis, which I'm identifying as a zone that starts at about 10% of calories from fat and lower and maybe 75 to 80% carbohydrate at the minimum. So when people are in this zone, something equally fascinating happens where carbohydrate metabolism is actually optimized and insulin sensitivity improves, paradoxically.

Really?

Yeah.

How does that happen? Biochemically?

Biochemically. So this is going to be the subject, part of it, of my second blog post on this topic. And in short, there's quite a few different things that happen that I'm still trying to condense into something that makes sense. But what we do know is that we have a lot of studies done on diabetics and normal people, you know, non diabetic people, where we'll feed them a potato. This is so interesting to me. I'm amazed by this kind of study. So we feed them a potato and then we measure their post meal response, blood sugar, insulin levels, et cetera, and then we feed them later on a different day under the same circumstances. A potato plus 10 grams of fat and then a potato plus 20 grams of fat. A potato plus 50 grams of fat. And contrary to what we might expect with normal people, people who are not diabetic, yeah, the blood sugar response is lowered, but the insulin response is actually the same the more fat you add, and even as the blood sugar response is diminished. So what that tells us is that we are secreting more insulin relative to the amount of glucose in our blood when we're adding fat to a meal. And in diabetics, it's even more interesting because adding fat to a carbohydrate meal does not lower the blood sugar response after the meal, and it actually raises the amount of insulin that is required. So with diabetics, we see an extreme reduction of insulin sensitivity after combining fat with carbohydrate relative to eating carbohydrate alone. And we see a somewhat similar but milder phenomena with non diabetic people. And the reason this is happening, as best I can identify, is There's a few different things going on. One is called the Randall cycle, which is not, for some reason is not discussed that much in biochemistry textbooks, but it's very prevalent in the scientific literature. It's basically this competition between glucose and fatty acids for oxidation. The two of them together tend to compete very viciously in the body. Fatty acids are going to actually inhibit glucose uptake, and glucose in some ways is going to inhibit fat oxidation. When we move to either being mostly glucose running or mostly fat fatty acid in the context of a single meal, it improves insulin sensitivity and basically makes metabolism optimized and more efficient.

So big picture is that if you eat a high amount of carbs, it's actually going to be more metabolically unfavorable to include certain percentages of fat with those carbs than if you have the carbs all by themselves.

Exactly. Especially for people who are already having health issues and who have metabolic damage.

Interesting. Now, as far as that combination of carbohydrates and fat, one of the things that you go into in the article is how what we would consider to be a high carb or low fat diet, specifically the low fat part of that, is actually flawed. What exactly do you mean by that?

Yeah, so Basically, since the 1980s, we've been defining low fat as anything that is 30% of calories as fat or less. Generally, not that much less, because it's really hard for people to go lower than that on a normal diet. And when we look at what the American Heart association recommends as a low fat diet, it's usually 25 to 30% of calories. Same with the American Dietetic association, the USDA, all of these large organizations that dictate dietary advice, they have set the bar for low fat as being 30% of calories. And what the problem is is that when we're conducting studies that move the macronutrient ratio from like 35% of Calor calories as fat, which I think is pretty standard in America, as the average right now, to 30%. We don't see any benefits, most of all, generally speaking, in these studies. And so we say, okay, well, low fat isn't doing anything beneficial. This must not be the right route for us to go. But something really fascinating happens when you push that fat limit even lower. And we can't actually see the therapeutic effects of eating a very low fat diet until we're about 10% of calories is fat. So all these studies that are using 30% as the bar, they're completely missing what's going on at that actual low fat end of the spectrum. And so I'm trying to communicate to people that when we're citing these studies saying the low fat diet did something really bad, or the low carb diet in this specific study beat the low fat diet in terms of weight loss and insulin sensitivity and blood lipids and so on and so forth, it's not actually a low fat diet that's being used 99% of the time.

When you go around the world and you look at, I guess what we would call like ancestral peoples or people who are living longer, hunter gatherer tribes, people like that, a lot of times you do see anecdotes that they're eating a high carb diet, right? Like they're eating lots of tubers, starches, bananas, whatever. What kind of percentages are they at?

There's quite a few that are. I mean, there's one that's even 3% calories as fat, but there's quite a few that hover between 10 and 15%. And what we should remember too is that here in America or in the west in general, we have access to a lot of isolated fats that are not that easy to obtain in non industrialized societies. And so if we take away the.

Butter, what does that mean?

Isolated fats?

Yeah, yeah.

Oh, so just basically fats that have been separated from their whole food source. Even things like olive oil in some regards, but definitely things like vegetable oils. Pretty much any plant based oil is going to be pretty hard to obtain without advanced technology. And when we take those kinds of foods out of the diet either because they are not highly obtainable elsewhere, even things like animal fats, you know, you're going to be limited in other areas that can't import large quantities of butter, of kerrygold butter and lard and tallow and all these animal fats, you're going to be limited to what an animal itself can produce. And oftentimes when you're relying on animals that have been captured from the wild, their fat deposits on their body are much, much, much lower than the fattened cattle and animals we have here in America. So if you look elsewhere in the world, there's a lot of lean animal products being eaten. There's a much lower intake of refined fats, isolated fats, and that doesn't necessarily mean you're at the 10% level, but you're going to be much lower than you are here in America. And there's quite a few societies that do hover around that 10%.

Mark, I want to jump into the research with you here in a little bit. But basically what you're saying is if you take an Okinawan who's eating not very much fat, or these folks in Papua New guinea who are eating 3% of their calories as fat, or the Tarahumara Indians or whatever, and you were to take their diet that's mostly carbohydrates and you were to say, okay, here's some butter, here's some nice extra virgin olive oil, here's some medium chain triglycerides and some coconut oil that theoretically what would happen would be when you introduce those quote unquote healthy fats into their diet, you would actually increase issues with metabolic syndrome or potential for issues as far as like pre diabetes, stuff like that, because you would actually be affecting this Randall cycle in their bodies and shifting them from be able to oxidize all this glucose and carbohydrate that they're eating towards having to kind of mix it with fats.

Yeah, I would say that would probably happen on a mild level. I don't think it would be anywhere near as severe as we see in developed nations just because we don't. Not only do we not have a base of whole foods carbohydrates here, we also have a ton of junk carbohydrates. A lot of food industries working in cahoots to make things really hyper palatable and addictive. And so that's also a factor here. And in these societies we might see a certain decline of health, but I don't think it would be as dramatic because there is a benefit still to eating whole food sources.

Yeah, there was actually a couple of years ago. I forget how theyyou may remember this, but they're called something like live cell carbohydrates or carbohydrates that are nutrient dense isn't the right word, but basically carbohydrates that come from living plant based sources versus starchy processed carbohydrates and the way that those are different metabolically in terms of the way that they're processed. I forget the term. I believe it was either Chris Kresser or Rob Wolf wrote an article about the difference in the actual cellular composition of carbohydrates when you're getting them from natural sources versus processed sources. I'll try and find a link to that to put in the show notes. But yeah, either. So not all carbs are created equal is basically what you're saying.

Yeah.

Okay, so I want to jump into some of these folks that you cite because a lot of people who have heard of the food pyramid and the whole, like, high fat, low carb, low fat, high carb controversy here in America. They think of this guy Ancel Keys. But you actually talk a lot about a lot of people who came before Ancel Keys. So first of all, can you kind of, kind of quickly review who Ancel Keys was and what exactly what we associate him with? And then I want to jump into some of these other folks.

Okay, well, Ancel Keys, depending on who you ask, was the devil incarnate? Which is not something I agree with. I think his story has been cartoonish, the way we've portrayed it. But anyway, he was a researcher who emerged in the last century. He was most famous for two things. One was the seven countries study. And a lot of people conflate the seven countries study with an earlier graph that he made, which was a six countries graph that basically just plotted six different nations in terms of their mortality and their fat intake and showed this perfect upward curve. And when you Google Ancel Key's name or whenever you see an article written about him, you'll usually see a representation of this graph posted with it. And a lot of times people assume that that graph was the thing that caused shock waves throughout the nation and changed our ideas about fat and convinced everybody. And in reality, he was actually. He was kind of ostracized based on his use of this graph initially, which started, I think, in the early 1950s. He presented it at a World Health conference or World Health Organization conference. And he was essentially laughed out of the conference for presenting this idea that fat could cause heart disease. And so I just wanted to take that moment. I always want to take the moment when I talk about Ancel Keys to clear up that myth, because a lot of people still repeat it. That was not the seventh country study. The seventh country study was a much larger undertaking that happened a couple decades later. But essentially, he is credited with the idea of, first of all, in some ways, inventing the idea that fat causes heart disease and modifying it later to say that it's really saturated fat that causes heart disease by way of raising blood cholesterol. And of course, as he got older, he actually adopted more of a Mediterranean diet where he didn't believe all fat was bad. It was mostly still just saturated fat in his mind anyway. He's often given credit for inventing the low fat movement. In reality, there are a lot of people, as you just mentioned, that came before him and were actually doing, I think, much more interesting work in terms of discovering what the effect of fat restriction can do on a human being. In my blog post, the first person I talk about is Walter Kempner. This guy, he was a German researcher who. He was Jewish. And so he fled Germany in the late 1930s as the country was getting very inhospitable to his kind. And he landed in Duke University where he started researching people with renal failure, kidney disease. He had put them on a special low sodium diet that was basically nothing. You know, this is kind of shocking. Nothing but refined sugar, fruit, rice, and fruit juice, and that was it. Occasionally some supplements, but that was the diet. His initial goal was just to treat kidney failure. But what he found happen over the years was that people who had diabetes, they would enter this diet because they had kidney failure. And he found that these people would start to improve in terms of their insulin requirements would go down, their fasting, blood glucose would go down, other people would lose weight, people would heal their psoriasis, all of the heart failure would improve. All of these various conditions that he did not even design the diet for would start improving when people went on it.

And these people are eating like 2000 calories a day from just refined sugar.

Yeah. The only form of his diet that was calorie restricted was the diet for extremely obese people. And so that one was calorie restricted, but for the rest of the people who had entered this diet, often he'd have to supplement their diet with more sugar to make sure that they didn't lose weight. And so he would feed people up to a pound of sugar a day of refined sugar, plus the sugar that was in the fruit and the fruit juice. So that is kind of shocking in many ways.

So he was looking at weight loss primarily, or was he looking at other metabolic factors?

Definitely other metabolic factors. I mean, again, his original goal was kidney disease and high blood pressure. Those two things ended up being probably what his diet was most known for, at least initially, because it was, you know, back at the time, we didn't have these blood pressure medications, we didn't have a lot of medical therapy for kidney disease. And so people who were diagnosed with these conditions back in the 1930s and 40s, it was almost a death sentence. And often people were not expected to live more than a few years after the diagnosis. But he gave them decades and decades and decades of extended life, basically. And so he actually, the rice diet program ended up being more of a weight loss thing. As the years rolled down, he ended up switching. I guess he backed down from the program eventually in his old age. And some Other people took it over and continued it. Mostly an in house weight loss clinic. But the fact remains that some of his early papers demonstrate pretty convincingly that diabetics, and this is the part that interests me the most, diabetics would be eating a diet of basically almost pure sugar. Pure sugar and refined carbohydrates. And they would get better. 58% of them would reduce their insulin requirements and about 25% could go off insulin entirely. Eating a diet of almost nothing but sugar, that's crazy.

So do you think that, I guess you're writing a part two on this? But as far as Walter Keppner's research and these people who are literally beating diabetes and losing literally hundreds of pounds eating a bunch of rice and sugar, you think it has to do with this cycle that you talked about? What was it called again? The Randall Cycle?

Yeah, the Randall cycle. I mean that's just one component of it. I think there's a lot that happens immediately after a meal too that can inhibit insulin sensitivity. I'm still, I don't want to say too much because I'll probably be like, oh, I just misspoke. And now I'm embarrassed. So I'm still working on it and that's why my part two isn't out yet. But yeah, I think a big part of it is the dramatic increase in insulin sensitivity that comes through reducing fat intake to rock bottom levels.

Now I know some people are going to be screaming through the podcast right now asking about confounding variables. Was there like exercise introduced? Did they quit smoking? Did they move to pristine Himalayan mountaintop? Were there other things going on?

I would say the biggest confounder was just the fact that they were in an in house environment where there is more support for staying on the diet. Walter Kemptner, for his severely ill patients, the ones who if they went off the diet would probably die, he would whip them, which is obviously a big issue of controversy.

He would whip them?

He literally whip them? Yes, he said that they wanted to be whipped. So there was some shady business going on with that. I mean, there's definitely some weird stuff that was going on, but for the most part, the fact that the diabetics in his program responded the way they did, and I don't think they were whipped. I think it was mostly the people who had extremely severe blood pressure issues and kidney disease, where literally they were on their deathbed, he would try to whip them to make sure they complied with the diet, which I'm not excusing as a practice. I'M just saying I think he did it only in the most extreme cases. That's obviously a confounder, because if we put these people in a real world environment and told them to eat this diet, probably most of them would not be able to stick to it. But for the purpose of what I'm trying to explore with my blog posts here, I'm more interested in understanding the mechanisms that are underlying these results. Not so much is this specific diet real world applicable, because I think that's a separate issue that was a confounder. But. But this is the 1930s and 1940s. Smoking was not considered a huge health hazard, yet he didn't pressure people to stop smoking. Exercise, as far as I know, was not a large component. In fact, I think for the first few weeks of the program, people were expected to be pretty sedentary because the diet was so low in salt and had a very potentially deadly mix of electrolytes that were very low. He had to restrict water intake because the salt intake was so low. People were at risk of suffering from problems with electrolyte imbalance, and so they weren't supposed to exert themselves. So I don't think that was a confounder. I think really the only things that could be considered really problematic in terms of the outcomes were the fact that people were monitored in house, not set to do their own thing, and perhaps also, of course, his diet eliminated so many different foods. You can make the argument that, oh, maybe it was the gluten he eliminated, or maybe it was the dairy that was eliminated and that sort of thing.

Yeah, they're still eating craploads of sugar. It's crazy. And if you look at the photos, and I'll publish some of them in the show notes over@BenGreenfieldFitness.com HighCarb but you've got people who are literally dropping over £250 in a year eating essentially pure sugar and rice. It's kind of nuts. Okay, so you got this Walter Kepner dude at Duke who puts people on the rice diet and fixes a bunch of issues. Weight loss, diabetes, insulin resistance, et cetera. And then you talk about this guy, Roy Swank. Who is he?

So, Roy Swank. He's pretty awesome. He's from where I'm currently living, Portland. And he. So his whole thing was multiple sclerosis. When he was younger, he was invited to start researching Ms. Because at the time, people really did not understand what the condition was and why it was occurring and why it was clustering around certain Geographical locations. And for anyone who doesn't know, Ms. Is a pretty crippling autoimmune disease or a neurological disease that over time, pretty much, if untreated, will leave people incapacitated and eventually dead. So this was back in the 1940s as well. 1948, he got invited to Montreal to start researching this condition. And one of the first things he noticed was when he conducted surveys of geography in terms of correlating with the disease, he would find that the mountainous farming regions in certain areas were experiencing much higher rates of multiple sclerosis than the lowland fishing areas where fat intake was lower, especially saturated fat. People were perhaps eating more carbohydrate foods. But in general, the big difference here was saturated fat intake, at least according to what he saw. Of course, we could also make the argument there's a lot of confounding variables geographically, too. But this was what he had to work with at the time because really, nobody knew anything about the disease. His first hypothesis was that it might be saturated fat contributing in some way to multiple sclerosis. He designed this diet that was, again, he didn't limit white sugar or refined grains, and he didn't tell people to eat a whole bunch of vegetables and fruit. He didn't tell people to stick with only whole food sources. The only thing he did was reduce people's saturated fat intake, and he reduced it pretty dramatically. The average saturated fat intake, according to some of his papers of his patients at the time of the study starting, was about 125 grams a day. And he ultimately lowered that to about 15 grams. Maybe 10 to 20 is the flexible range.

So they were eating 125 grams of saturated fat. Just to put that in context, like, what would that look like if you were looking at butter and coconut oil and stuff like that?

Oh, gosh, that's a lot. I don't know, actually. I don't really. How much?

125. You said 125 grams, right? Yeah, it's a pretty decent amount. That would be. It's basically nine calories per gram. So we're looking at over a thousand calories of saturated fat per day.

Yeah. And keep in mind, too, back then, since there was not this big movement towards vegetable oils, a lot of people, if they're eating fat, it was going to be mostly saturated. So especially if you're cooking with animal fats and butter and that sort of thing. So this was the average for his patients, which might not be representative of they were eating about £3,000, basically.

Like three sticks of butter.

Yeah, so that's the equivalent. So there is very animal heavy animal food heavy population that he was studying. So he took these people and he did not, again, he didn't reduce their sugar intake, he didn't reduce their refined carbohydrate intake. He just made them switch from the fatty animal products to extremely lean animal foods if they're going to eat animal foods. And so things like skim milk were fine. Chicken breast, turkey, that was very lean, very lean cuts of meat, those foods, very lean fish, I think even fatty fish was limited. So all these foods were fine. It wasn't a vegan diet, it wasn't a refined sugar free diet, it wasn't a refined grain free diet. And what he did was he tracked these people for up to 50 years eating this diet. And during the first few years, of course, he was very vigilant about checking in with them and making sure they're sticking to the diet, giving them food frequency questionnaires on a very rapid basis, having them come up to his clinic in Montreal to get assessed and have their disease progression monitored. And what he found was that first of all, not all of his patients were able to adhere to the very, very low saturated fat diet. So he divided up the group into people who were, he called them good dieters, which means they were eating less than 20 grams of saturated fat a day. And then he divided everyone else up into a group called poor dieters and the people who were eating more than 20 grams a day. So what he found over the course of literally decades was that the mortality rates and the disease progression for the people who were eating the low saturated fat diet successfully were much, much, much, much lower than the people who had even marginally fallen off the diet. And again, this is, it's not a matter of people who are eating more saturated fat, were also eating more vegetable oils, or they're also eating more refined grains, because that was not even part of the program. What's very ironic in my mind too is he eventually, after the first few years of his study being started, he let people start eating a little bit of about 10 to 40 grams a day of fluid vegetable oils, which include the really high PUFA stuff that most of us completely loathe. He found that this did not harm the progression of their disease at all. Essentially, he boiled down the factor here to the differences in people's saturated fat intake. This was a struggle for me to read because I'm so anti refined vegetable oil and I'm a much bigger proponent of natural fats, if they're. They're probably going to be saturated if they're from animal sources. So it was really disturbing to kind of see the results of this study. And I think we would need much, much more detailed documentation of exactly what people were eating to rule out all confounders. But what also intrigues me is another thing I'll be posting about in my next installment in the series, which is a lot of research he did on saturated fat intake and blood circulation and tissue oxygenation. And I'll spoil. I'll give a small teaser right now. I don't want to spoil the whole thing. I do want to wait for that blog post to come out. But what he found essentially was that even in a single meal of. Not even a bad saturated fat meal like carrot cake and milkshakes, but having people drink a glass of pure cream, that's. That's the kind of thing we're talking about here. They drink a glass of pure cream. And the results for the next eight hours would show that as that fat was entering the bloodstream, people would suffer from severely reduced blood oxygenation. Their capillaries would start clumping the blood cells as they were passing through capillaries would start clumping, and even circulation would get cut off in many different parts of the body. And what he decided, and what he concluded eventually was that saturated fat fat for susceptible individuals was having an effect where it was basically after consumption was starving different tissues in the body of oxygen. And I'm still kind of working on going through all of the research that he cited and worked on showing how this happens. But it does seem like in certain people, I won't say everybody, but certain people, there is a really negative effect of saturated fat intake.

Do you think at all, like, part of that could be from the source of the saturated fat? Like you look at heavy cream, for example. Some people just do not do freaking well. Like, I. I do horrible with heavy cream, but I also get bloating and gas and stuff from it because I've got some cow's milk allergies and also lactose intolerance. Right. So for me, I've. I've always wondered, like, is it the fat or is it being allergic to something that's coming in along with the fat?

Right. That's a great point. Especially with dairy fat, because that is a special case. I will say, for Swank's research, he did use other forms of fat, including fluid oils. And I think he used lard in one of his studies, too. And it showed pretty much the same thing. It did seem like dairy fat was the worst, but it was not the only type of fat that was eliciting these effects.

Interesting.

Yeah.

Okay, so basically the big picture though is that people who had ms, they seem to respond very, very well to lowering their fat intake and even in many cases, increasing their intake of just straight up freaking vegetable oil.

Right.

Okay.

Yeah.

Now, what about this next guy that you talk about, Lester Morrison? He's kind of like the next piece of the puzzle. Who is he and what did he find?

So Lester Morrison, he was kind of hard to research because there's not a lot of info out there on him. But the short story is that he was a doctor that was researching heart disease and probably one of the earliest, more well known physicians who is putting patients on a low fat diet as a way to treat their heart disease. So for him, he started his work Also in the 1940s, in 1946, it was actually that he launched his first study using 100 people who had had a heart attack. And so they clearly already had heart disease. And he set up an intervention group and a control group, the intervention group. He had 50 patients, left their menu. He took all the, basically getting all the fat out of the menu. And I'll say to you, a lot of these men, they were inspired by seeing the results of World War II, where rationing in certain areas was corresponding with a reduction in cardiovascular disease mortality. And so this was a big thing back then because, you know, in 1940s, late 1940s, a lot of people were seeing these same statistics and thinking, wow, I wonder if the meat and the dairy that were being rationed and seemed to be improving health by their absence. Maybe that has something to do with it. So again, this is a time before we had a lot of the current understanding that we do.

So it was meat and dairy that was being rationed. It wasn't just food in general. So you couldn't just say it was calories in general that were being lowered. It was meat and dairy specifically that they were getting less of.

Well, that's actually a point of contention I have with that data because a lot of different things did change in a lot of places. Fish intake went up, refined sugar went down, refined grains went down. Food in general, as you just mentioned, probably was restricted in general. People had to start foraging for wild foods. There was a ton of stuff that happened. If I was looking at that day to day, I would never look at it and say, oh, gosh, I wonder if it was Meat and dairy. But the men back at the time who were doing this research, that's what they had to work with. That was the first thing that kind of pinged on their radar. I won't agree with their methodology for reaching the idea that low fat could have some merit, but I will say that their results from putting that into practice with their patients did have very interesting outcomes. So, yeah, I wouldn't say that that World War II data is really a good thing to look at in terms of trying to figure out what factor there was important. But anyway, so with Morrison, that was kind of the thing that tipped him off to the idea that, oh, maybe we should take out the meat heavy or the fat heavy meat and dairy from people's diets and see if that improves their cardiovascular outcomes. So 50 people, he left their menu as is 50 other people. All he did was he took out all the really high fat foods and didn't tell them again to eat less sugar, didn't tell them to eat less refined grains, didn't tell them to stop smoking, anything like that. And his results were essentially the same as what I've been talking about for all these other people too, which is that the control group had much, much higher mortality for the next 12 years than the intervention group did.

So that means that the control group, which was the group that wasn't eating a low fat diet, they were dying much earlier and the low fat group was actually living longer.

Right, exactly. And by the end of 12 years, 34% of the people who'd had heart attacks but were put on the low fat diet, they were still alive, whereas every single person in the high fat group had died.

Okay, got it. Interesting. Now, this result from the Lester, his name was Lester Morrison, is that right? Yeah, that's right, Lester Morrison. Okay, so as far as his results go, with these fat restricted patients living longer, do you think that there were other variables that could have been at play?

There could have been. I mean, one confounding factor is the fact they were eating a bit more protein relative to what they were eating originally, largely because they were switching to lean animal products. So, you know, they were trying to establish an equal calorie balance and taking out the fat meant replacing it with something else. So we could say, oh, well, maybe there's an effect of increasing protein intake on heart disease survival. A lot of them initially in the first year lost a significant amount of weight, although that stabilized for the next 11 years. And we could also say, well, maybe the weight loss had something to do with It. So there's a lot of what ifs that. If I was looking at his study in isolation, I might say, well, we can't really use this as evidence for anything. It's only the fact that his results corroborate what all these other researchers were also finding using similar methods, that I find it has merit.

Yeah, well, that's the thing. You talk about another researcher who's a little bit more famous, who had a bunch of results that kind of backed up what this guy Lester Morrison studied. Nathan Pritikin.

Yeah. So Pritikin. I think a lot more people are familiar with his name. So what's funny here is that Pritikin was actually kind of a patient of Lester Morrison. And this is at the time Pritikin, he actually did get diagnosed with heart disease in his younger years. And at the time, he didn't really pay much attention to his high cholesterol until he went in for an electrocardiogram, and the results came back pretty abnormal. And he's like, oh, I really got to. I gotta do something to fix my own health. And Pritikin was an engineer by trade, and so he had this really mechanical mind where he loved to test variables and take meticulous documentation of things. And what he did was he ended up spending a really long time experimenting on himself, trying to get his cholesterol lower, because I think it was in the. It was close to 300, I believe, when he had it tested at Lester Morrison's office. So he ended up trying things like experiments of using, like eating nothing but legumes and some beef or some dates after dinner and just various combinations of food. And each time he would try a certain dietary experiment for a couple weeks and then go back to the doctor and get his cholesterol retested. And he. Eventually he was able to pound his cholesterol down below 150, total cholesterol. And at that point, his electrocardiogram, to the shock of his doctors, ended up coming back normal, meaning that he had done something to essentially fix the state of his heart. So at that point, he started counseling other people for free, saying, hey, this is what I did. The diet that ended up working for me was extremely low fat. I kicked out almost all the sources of fat from my diet, except for very occasional chicken or fish. He started putting people on the same program he had tried, and he ended up just accumulating this huge group of people who wanted his information and his help. And it led to him eventually starting a longevity center in California where it was Designed specifically to bring people in who had heart disease or even had other health conditions, who needed to lose weight, who had diabetes. He would bring them into his clinic and put them through a 28 day program where they would learn how to eat his diet. The only exercise that was added was some walking each day, which he was actually a really big fan of people walking for about an hour each day. And apart from that, he would just bring them in, put them in for 28 days and. And a lot of times, I would say the majority of the time they would rapidly improve their conditions.

Now, what about with the Pritikin thing? The way I understand it is they were eating a lot of vegetables and fiber and stuff like that, right?

Yeah, he was a very big proponent of fiber. I think he believed that there was an independent effect of fiber that really helped lower people's triglycerides and improve their cholesterol profile, which is true. I mean, if we look at the progression of results from Walter Kempner, yeah, he had some really amazing results with diabetics, but it was much improved with Pritikin's diet when the diet was shifted to a whole foods form. So diet. Over 200 papers have been published on Pritikin's results, largely from a researcher who is James Bernard, who is the medical director for a while. And it's really fascinating to me, when I was writing this blog post, I was just reading through all these studies thinking, wow, there's so many people out there saying that low fat has never been proven and that it's never had any good results in studies. And here I'm looking at hundreds and hundreds of papers showing people again reducing their diabetes, going off insulin entirely after just 28 days on this diet. And Pritikin, he even had some longer term studies lasting for several years that showed people could maintain the diet and maintain their health improvements.

Interesting. But with Pritikin, isn't there like an issue with him dying horribly of some kind of disease or something like that related to this diet?

Yeah. So I was inspired to write about this in my blog post because I gave a talk on the same subject at the Ancestral health symposium in 2014. And somebody in the audience brought up a good point, which is something I think a lot of people believe, which is that Pritikin committed suicide. He committed suicide. I think he was 69. He's in his late 60s, so still relatively young. And he also had either a form of leukemia or lymphoma, depending on who you ask about the diagnosis at the end of his life. And so what a lot of people see is, okay, well, he was on the super low fat diet. We already suspect that that kind of diet can impair neurological function and cause people to be depressed and have mood disorders. And he had cancer, so, wow, it must have been all the carbs turning into sugar in his body feeding the cancer cells. And so I see that argument made a lot as a reason that Pritikin failed on his own diet. And, and what a lot of people don't know is that before he ever started his low fat experimentation, Pritikin was blasted, just blasted with radiation due to a skin condition he had. And he was given this huge dosage of radiation trying to fix the condition. I can't remember what I did the calculation. It was just likeit was the equivalent of so many thousands of chest X rays. It was just like a ton of radiation. And immediately after he had this happen, and basically his white blood cell count never came back. Normal people would take his blood work and be like, wow, something's really, really wrong with what's happening in your blood. And shortly after that, it progressed into again, a rare form of either leukemia or lymphoma. And so he actually had this cancer before he started the diet. And it was a cancer that people did not expect he was going to be able to live with for more than a few years at the time of his diagnosis. So he had a very grim prognosis. It was before he started the low fat thing. And are we going to argue that it was his low fat diet that failed to cure this disease? Or could we argue that it gave him 30 years of basic remission to be experimenting with his diet and eating something that was healthy for his body? The reason he committed suicide too, is that at the end of his life, he had all of a sudden, his disease went out of remission. It became much more severe. He had legs swelling so bad that he was no longer able to jog, which is one of his passions in life. And he was so depressed about that fact that he actually let doctors give him some chemo, which at the time he was actually not really a fan of. He wanted to cure his conditions with food, so he ended up getting chemo. The chemo completely destroyed his body. He ended up being super anemic, lost 30 pounds, even though he was super slender already. And the tipping point for him came when he was told by a doctor in Albany that, hey, have less than six months to live. You're going to be out of this world within six months. And he took his own life at that point.

So he probably didn't die from a low fat, high carb diet. He probably died from radiation.

I really don't think it's fair to say that. And I think if we're going to make that claim, there's a lot of people who've died fairly recently within the high fat world, like Barry Groves, Robert. I think Robert sue, who wrote a book called Carbohydrates Can Kill these men also died fairly recently at what we might expect to be not their full lifespan. And if we're going to say that about Pritikin, shouldn't we be saying that about everybody? And I don't think that's fair either. But it's like, you know, keep it balanced here.

So I've got a question for you. But prior to this point and kind of digging into this topic with you, I've mostly been under the impression that some people do okay on a high carbohydrate diet based on their genes, right? Like whether it is less of an insulin, insulin response to carbohydrates or greater insulin sensitivity or more production of the enzymes responsible for digesting starch in the mouth. Like a Kenyan marathoner being able to handle that more from their genetic intake traditionally of a high carb diet versus say a Northern European who would do things like lose salt better because they're used to having a higher amount of salt, which with curing and food preservation methods or doing okay with higher amounts of fat because that's what their genetic ancestors would have traditionally eaten. And even this, there was a really recent study that just came out. I don't know if you saw this one. It was in the Journal of Clinical Nutrition out of Asia Pacific, and this one was actually in Chinese and they found that there were people with specific genetic polymorphisms within what's called the lipoprotein lipase enzyme that would allow some people to develop insulin resistance in response to carbohydrates and then some people to be just fine with carbohydrate intake. Showing that maybe part of this is genetics. But what kind of got me scratching my head was a lot of these people who are being studied by Pritikin and Lester Morrison and all these other folks that you've been talking about so far like these, these were people from a, from kind of a genetic melting pot, right? Weren't they, weren't they studying mostly just average people from America, like fat people or people with diabetes or multiple. Multiple sclerosis or whatever?

Yeah, it was a pretty diverse population. I Believe, I mean, diverse for America. But yeah, there was. I mean, it wasn't like a specific ethnic group. We could probably say that people who ended up with diabetes or heart disease, disease maybe had other genetic predispositions that clustered them in terms of commonality. But that's actually really interesting. I'd love if you could send me that piece.

Yeah, I will. I'll put a link to it in the show notes. I actually talked about that particular study in my last podcast episode. But kind of following that train of thought, let's just say that genetics aren't responsible for some people being better adapted to a high carb diet versus a high fat diet, at least in these studies that you've been talking about so far. Could you safely say, do you think that you've basically got two extremes, right? You've got carbosis, where people who do like whatever, like the fruititarian or the 80 to 90% carb based diet in, in relative absence of fats, aren't subjecting themselves to a situation where fats can I guess, like do damage to the high carbohydrate state. And then on the completely opposite end of the spectrum, you have a bunch of people doing well with ketosis, high fat carb restriction in a very appropriate sense of the word, like 5 to 10% carbohydrate intake, and they're doing well on that higher fat intake. And all this could be due to this Randall cycle that you talked about where you could either do really well on high amounts of fat, you could do really well on high amounts of carbs, but playing in the in between land could be dangerous.

Yeah, I would say that's pretty on target, I do think. I mean, because even if the. In the studies that I've discussed here, even when the majority did benefit from the dietary intervention, there's always a certain percentage of people who got worse. And I think we do see the same thing with the very low carbohydrate diet too. There's going to be a lot of people who excel and who have a lot of great health benefits, especially initially. But long term, I see a lot of women who have problems. Long term, I see a lot of people who go onto those diets and they maybe experience great benefits initially, but after the fact they're running into issues with stress hormones and whatnot. I think there's a range of response to both ends of the spectrum that probably is dictated by genetics, maybe early health history, other issues that people are entering the diet with already. And so I don't Think it's a matter of saying everyone can do well on this end and everyone can do well on this end. I think there's going to be people who respond much more favorably to one end or the other. And quite frankly, I have no idea why at this point.

Okay, I want to ask you a couple of other things. I want to ask you about Esselstyn, because you actually talked about Forks Over Knives on your website. You critiqued it kind of harshly. You criticized his fat shunning program because of some of the issues that you had with it. What do you think about Esselstyn now, now that you've dug into some of this stuff?

So my big point of contention with Forks Over Knives was actually what I mentioned earlier about looking at The World War II statistics and the corresponding drop in cardiovascular disease, plus the food rationing. That was actually something that was a big central point for Forks Over Knives. And I was actually dug into the data there. I was like, no, we can't use that to say that it was the fat that caused a problem. But with Esselstyn, I've actually always been pretty impressed with the kinds of results he's achieved. The study that I wrote about in Forks Over Knives was, I think, using 18 people who stuck with his diet and who were all able, basically, to reverse or arrest their heart disease. And so at the time, I was thinking, yeah, that's pretty impressive, but look at their hdl. It's really low. Look at their triglycerides. They're kind of super high. He might have been using statins for a lot of these people, and it was only a group of 18. You know, what would happen when he. We tried this diet on a much larger sample size. Would it still have these great results? And so that was kind of the question mark I left off on my Forks Over Knife post. And I don't want to say that I just completely wanted to discredit Esselstyn. I just wanted to point out that his results really needed to be replicated, and we needed to understand further what was going on with his patients. Lo and behold, in 2014, I believe it was. I think it was in July, he actually released another study using about 200 people. And his results were just as profound, if not more so, than his study of 18. So when I was reading this more recent study, and I was thinking, wow, there's definitely something to this. He has probably, this is the most successful study that I've seen, even with Ornish. I mean, Ornish did well, too, but he used so many different other factors in his lifestyle program, like stress reduction, meditation, social support, smoking cessation, exercise. He had a lot of different things going on besides diet. So he's known, too, for reversing heart disease. But it's harder to blame that on diet specifically. But with Esselstyn, he didn't have all those confounding factors. He basically just used diet. And I think he did use statins for people whose cholesterol would not go below 150 with diet alone. But there were a lot of people who did not even use statins in his program. And again, it was this. I think only one person out of his. The group of adherent patients to his diet in this larger study saw any type of adverse cardiovascular event that was due to the diet, which is pretty profound. And most of them, these are people who are basically on their deathbed when he got a hold of them, and decades later, he was able to keep them alive.

And so just to clarify, this is a study that was just published last year at the time of this recording. And this is the whole Esselstyn forks over knives, oil free animal food free plant foods type of record measurement.

Exactly. Yeah. His initial program, I think, originally allowed for skim milk, but after he became buddy buddy with Colin Campbell, he decided that animal protein was really bad. And so he stopped letting people drink milk, even.

And it's. And it's like a full on, like heart disease reversal in this.

Oh, yeah, yeah.

Interesting. Now, another kind of like, devil's advocate question for you. What about, like, if you. If you look at stuff beyond just like, mortality or like, absence of heart disease, one thing that you hear, let's say Nora Gidgaudis, she's someone who's famous for saying your IQ drops and you start to become stupid and you get a cognitive decline when your cholesterol falls below 200. And I believe she may not be quite this blunt, but it's something along the lines of. And that's why vegans and vegetarians are more stupid or something like that. But what about some of the other things? Things, right, like cognitive decline or thyroid or like libido and sex function and all this kind of stuff. Like, do they track those kind of things or are they mostly looking at heart disease? Are you fat or not? And how long do you live?

I think for most of the studies, there is a primary outcome that they're trying to measure, and it usually is some chronic disease. I've seen a few studies that do comment on people's sense of well being and just their physical youthful looks and that sort of thing. Especially back in the night 1940s, where I guess it was more acceptable to comment on whether someone still looked vigorous and youthful. But for the most part, that is a concern and it's one that I believe needs to be addressed because I believe it's much more due to the vegan component of a lot of these studies rather than their low fat component.

Yeah, that's kind of like my thing that I always think about with this stuff is like, I want to live a long time, but I want to live a long time and be really smart and be a sex machine. And I'm not saying that that's not the case, that you can't achieve that with a plant based diet or, I mean, heck, even looking at some of these studies, like a white rice and sugar based diet, I just still question whether or not you can achieve total health on these diets or if. Yeah, we've just shown that basically they can help decrease heart disease and increase longevity and decrease some of the symptoms of Ms. And stuff like that.

Right. Yeah. I think it's important to look at the very extreme versions of these kinds of diets as therapeutic things that will help treat and reverse diseases that have already occurred or that are in the process of forming. And for somebody who's just trying to maintain their health, I don't think that going to a macronutrient extreme is the best plan of action because I think the negative impact will be greater than the positive impact in those cases, if that makes sense. And my whole thing with this is I think we can find ways to combine the benefits of carbosis and ketosis and all these different dietary theories that we have and compile them into an eating plan that's probably pretty flexible for most people, but that will, I guess, draw from the results and the benefits of all these different eating styles and obtain kind of a maximum benefit without as much harm.

Yeah. And you, at the end of your article, you apologize. Why do you apologize?

Yeah.

So.

Well, my whole thing with having a blogging platform is I never set out to be a blogger. When I started my blog, it was just a personal project. And I feel like it was a real gift and a real honor to be given a platform where people will listen to me and people will sometimes even follow my advice and ask me questions and listen to what I say, and it's just kind of still amazing. But because of that, I. I consider my duty for accuracy to be very high and I hold myself to very high standards of accuracy, of preventing my own ideas from falling into different forms of biases and dogma. And I feel that with the low fat thing, especially the plant based diet doctor squad as I like to call them, people like Ornish, McDougall, Esselstyn, Furman, Neal Bernard, all those people, I feel like I unfairly dismissed their results in a way that prevented my own knowledge from growing. And I feel like I disseminated certain pieces of information about their programs that were not complete and maybe not completely accurate. So I wanted to apologize just because I feel like again, I have this great platform and I hold myself to very high standards in terms of what I tell people and what I tell people especially. I want it to be filtered through all of my different analytical criteria before I really make a statement about anything. And so I just feel like I shortchanged myself and my readers in a certain area here and I wanted to apologize for that.

Well, you do realize it's kind of weird for someone in the nutrition industry to apologize that they were wrong about something or misled or for you to even change your mind. That's pretty weird. Most people are tied down to their URLs these days.

I guess that's true. I mean, it helps that I don't. I'm not promoting and eating my life.

Yeah, it helps that you don't have a diet book that's, that's always come back to bite me too. I don't really have a diet book. And so I'm, I'm always kind of like open minded when it comes to research and changing my philosophy. And a lot of people get pissed because they want, they want to be able to follow like a dogma and sometimes it's not that simple, so. Well, well, good on you for publishing this because it's actually, it's really informative and I would recommend. Again, I'll link to this and some of the other stuff Denise and I talked about in the shownotes@bengreenfieldfitness.com HighCarb H I G H Carb Denise, I know part two hasn't come out yet, but it sounds like you're gonna kind of expand on the biochemistry and the Randall cycle and all that jazz.

Yeah, it's gonna be pretty meaty.

I love it. I'm gonna get my propeller hat out to get out of the closet to get ready for part two. In the meantime, thanks for, thanks for your time and for coming on the show to talk about this stuff for all the people who don't want to go read the big long article.

Thank you so much for having me on. Yeah, cool.

Well folks, thanks for listening in and I know that you'll probably have your own comments, your thoughts, your questions, etc. I can promise that Denise is going to come over to the comment section and reply to all your comments because I know she has plenty of comments to reply to on her own site. But feel free to leave your feedback over on the show notes for this post anyways and I promise I'll go read them and jump in and respond where I can. And in the meantime, also keep your eye on Denise's site rawfoodsos.com for part two of this series. Thanks for listening in, Denise. Thank you.

Thank you, Ben.

All right folks, have a healthy week. I'm Ben Greenfield signing out from BenGreenfieldFitness.com.

You'Ve been listening to the Ben Greenfield Fitness podcast. Go to BenGreenfieldFitness.com for even more cutting edge fitness and performance advice.

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