The Case for Keto by Gary Taubes - A Book Report
The Case for Keto by Gary Taubes
In the introductory chapter, the author, Gary Taubes, shares that though this book can help those who are naturally thin with a fast metabolism, it was written for those who truly need help losing weight for any number of health reasons, and for their doctors. It was written to help find a balance between the varying and oftentimes contrasting definitions of healthy. There exist conflicting definitions of what healthy eating is, one of which stresses the importance of limited calorie intake, a more plant-based diet, and regular exercise for preventing chronic disease. The other is in opposition to the advice of mainstream medicine, straying from the old school and offering their own advice on reversing chronic disease according to their own personal experiences. The common key is a low-carbohydrate, high-fat diet, known as LCHF/ketogenic eating. After lifetimes of attempting a mainstream diet and seeing its failure firsthand, some physicians have wholeheartedly embraced this new diet trend in a desperate attempt to reverse the obesity and diabetes epidemics. These physicians are turning the tide on modern diet regimens.
The introduction follows internal medicine practitioner at the Virginia Commonwealth School of Medicine Susan Wolver’s journey of discovering the LCHF diet and applying it to both herself and her patients. After spending two days in 2013 with Eric Westman of Duke University Medical School, she applied his dietary practices to her own patients, and for the first time in her career found long-term success. Her patients didn’t just lose weight, some were even able to get off their diabetes medications entirely, and word quickly spread. LCHF diets have become more widespread and commonplace in mainstream medicine, whereas once they were distrusted and mockingly called “fad” diets. Whereas old school dieting loses the weight, LCHF dieting keeps that weight off for good, and slowly but exponentially trust has been building in the so-called “fad” diets. Signs of chronic disease have dissipated in people utilizing the LCHF diet after years of struggling with how to be “healthy.”
Initial and longstanding preconceptions about chronic disease are now shifting alongside the shift towards diets that actually work, although there still exists plenty of opposition to these newfound diet trends. Particularly problematic is that the LCHF diet is rich in fats, and in no way emphasizes a diet dependent on plants, but rather includes animal and saturated fats as vital to its success, which is highly controversial. The LCHF diet doesn’t count calories or necessarily boast exercise, which makes it that much more unappealing to many in the medical field.
Of course, LCHF/ketogenic dieting is not a new concept, but has simply found its official name and gained traction in the past twenty-some years. This way of eating was discovered in France in 1825 and again in the 1920s in New York City, with slight variations on the same general idea. For sports and family medicine physician Robert Oh, the underlying theme is that LCHF dieting works, as he’s seen repeatedly with his very own eyes. For some people, it is indeed an internal struggle between believing the medical authorities and straying from what conventional medicine is saying and following the mounting physical evidence. This book is meant to “serve as both a manifesto” and an instruction manual to LCHF/ketogenic eating. This newfound way of dieting does not just shift one’s physical act of eating, but shifts the community’s way of thinking, which is a hearty task. In the case of mainstream dieting, it’s clear that something is broken, and this book intends to share the steps that can be taken towards fixing it.
Chapter one, “The Basics,” explains how society originally learned to look at obesity. In 1962, Tufts University Medical School professor Edwin Astwood sought to counter the previously existing theory of why obesity happens in people and what can be done to prevent it. Society had been going with the belief that obesity was a controllable disorder caused by a general over-eating. Astwood sought to refute this idea by suggesting that obesity had to do with the biology of a person and was a physiological disorder, not a psychological one. This then would explain while some people get fat eating while others simply do not.
For Astwood, obesity was a physiological, biological and genetic disorder, and certainly not one that was all “in the mind.” He argued that it had to do with the hormonal effects of consumption on the endocrine system, which he attributed to an eventual caloric build-up that stole energy from the body as it continued to feel hungry. In other words, something was going wrong during consumption and fat was incorrectly building up as the body kept requiring food. Simply put, the mainstream diet would naturally make any obese person, or any person for that matter, miserable as their body perpetually required nutrients. How much in common could obesity and type 2 diabetes have? Both seemed to Astwood to be caused by an endocrinological defect, and not some mental health epidemic that was then the common misconception. Unfortunately, Astwood’s own theories fell on deaf ears.
Now it is known how hormones and enzymes can go unregulated in the endocrine system to eventually lead to obesity, yet even today there’s overwhelming speculation. Today’s society is so consumed with blaming obesity on gluttony alone even when that’s been proven incorrect time and time again. What an LCHF diet does suggest is the negative impact of the intake of carbohydrates and goes as far as essentially excluding an entire food group from daily consumption. This carbohydrate-free lifestyle was newly introduced as part of the LCHF/ketogenic diet, an idea previously unheard of by researchers, though one physicians and dieticians were seemingly well-aware of. In 1963, anti-carbohydrate literature began circulating, and it was left to the doctors themselves to decide what to do with the information. What’s since been discovered is that these alternative diets not only lose the weight and keep the weight off, as is already known, but they also do so without literally starving the body. If this is really the case, then why the persistent and ongoing objection from medical authority? This is a question that chapter one leaves open-ended for later discussion.
Chapter two, “Fat People, Lean People,” opens with Taubes’ 2016 interview for a BBC documentary with a researcher from the University of Cambridge. As a journalist, Taubes had been granted access to interviews with the vast array of professionals involved in the study of obesity and the unending search for life’s healthiest diet, all of which accumulated in Taubes’ 2007 book, Good Calories, Bad Calories. The book brought in past context and present-day information and was met with both resounding agreement and aggressive opposition. In the BBC interview, Taubes was asked point-blank why “fad diets” were so popular in recent years. His answer was simple: what old-school diets were suggesting was eternal hunger, whereas said “fad diets” suggested an overall healthier and more positive lifestyle, and without the hunger. Why wouldn’t readers be attracted to the literature on alternative diets?
A main issue with conventional diet methods was that they came from the perspective of naturally lean people and didn’t apply to those suffering from the biological and genetic disease of obesity. This issue is rooted in the wildly presumptive and totally unfair idea that if lean people can maintain their physique, then overweight people should be able to reach that ideal weight as well. This leads to the harmful belief that obese people are lazy and unmotivated, and in turn leaves overweight people feeling desperately hopeless.
Taubes goes as far as to suggest that had conventional dieting methods worked and had mainstream medical authority been correct, we wouldn’t be in the throes of national and global obesity and diabetes epidemics. Not every body is created equal, and it is the misconception that they are that seems like an excuse for having made no progress in neither preventing, nor slowing, nor reversing these global health epidemics. In 2016, the BBC interviewer posed the inane question to Taubes of why certain people eat more than others. Too many field intellectuals blame a mere lack of willpower in some, and an impressive display of self-control in others. This is all of its essence, modern-day “fat shaming.”
This then raised the question of why obese people lacked that imperative quality of self-control that seemed so inherent in others. Time magazine took this dangerous idea further with a 1961 feature on University of Minnesota nutritionist Ancel Keys who was quoted saying, “maybe if the idea got around that obesity is immoral, the fat man would start to think.” Taubes calls this logic circular and offers no explanation of the why and how of obesity.
The one undeniable truth here is that different people do need to eat differently. The difference between fat and lean people is their body’s response to food and how their bodies uniquely metabolize. The key is not to undereat, but rather to discover which foods the body responds to most positively. Different bodies utilize nutrients differently, and in that may lie the key for an effective and long-lasting diet. What food a body receives will have its own unique hormonal reaction, entirely independent from that of the next body, or the body after that. The bottom line? “Healthy” is a subjective term that changes from individual to individual.
Chapter three, “Little Things Mean a Lot,” starts off by raising the sketchy and not remotely correct question of how much food intake is too much? In the 1860s, German nutritionists made the relatively blind estimation that eating a simple two hundred calories more than “average” per day would become excess fat in the body. By their estimation, this would accumulate in an additional seventeen pounds in one year. And, furthermore by this estimation, just twenty calories per day “too many” would result in an additional two pounds of fat per year, which would result in obesity in twenty years’ time. Thus, our lives and our bodies exist in but a mere catch-22. So, while some bodies metabolize and excrete those additional calories, allowing the body to remain lean, it’s the apparently unlucky ones who don’t, and are doomed for obesity.
If that’s what’s really happening with the excess calories, then how is anyone supposed to know how much is too much? The revolutionary Eugene DuBois saw it differently and called out this over-simplified caloric equation as ludicrous. DuBois’ way of thinking reversed the question of why some bodies get fat and changed it to why some bodies don’t. Especially when cooking today is a booming industry, an art, a sport — shouldn’t we all eventually become obese? Because according to this estimation, the calories “in a single almond” or “one-eighth of a teaspoon of olive oil” is quite literally the physical and apparently fatal difference between obese people and their lean peers. Needless to say, that caloric equation was both painfully simpleminded and entirely nonsensical.
Taubes expanded on the absurdity of that caloric equation by using the example of a man he knew who had been obese from childhood. 380 pounds at the age of eighteen, with a
father and an uncle who were both obese, it was clear that genetics were at play. At 380 pounds and about 200 pounds overweight, by the same estimation above, this man was only overeating by 100 calories per day during his 18 years of life. Is it right to assume that had he just backed off each day by a mere 100 calories, this man would have grown up lean? And if it were that simple, wouldn’t any person on the fringe of barely overeating just simply, stop? While it’s clear that this just isn’t the case, the mainstream ideas surrounding obesity wrongly blame and shame larger people as self-inflicting losers. Take an acquaintance of Taubes’, a woman in her forties who, despite being a successful professional in a loving marriage, would first and foremost use the word “fat” when asked to describe herself. These outdated mainstream ideas of obesity are not only incorrect but are cruel and unusual psychological punishments inflicted upon lean and obese people alike.
Chapter four, “Side Effects,” offers the facetious answer to all of obesity’s problems. All one has to do to stay lean is to just not finish those last couple bites, right? By that logic, it would make sense for doctors to suggest that if their patients lay off precisely five hundred calories per day, then they’ll shed one pound per week. Problem solved, except that this logic doesn’t factor in the complexities of the human body.
Eating less on all accounts is what Taubes calls “semistarvation,” and determines that that’s all the mainstream diet really is at its core. However, when you starve an overweight person, they don’t become lean, they become “emaciated.” They’re thinner yes, but certainly not any healthier. And not only are they not any healthier, but the side effects of essentially starving oneself can cause great physical harm to the body. By literally eating less for the sake of losing weight, what must also be weighed are the pros and cons.
Predating his debut on the cover of Time Magazine, Ancel Keys conducted a weight-loss experiment on three dozen men, all of varying shapes and sizes. Having been fed a strict low-fat diet of 1,600 calories per day for six months, these men lost one pound per week for the first twelve weeks, which dropped to a quarter pound per week for the next twelve weeks. Their weight loss could technically be dubbed a success, but one that was vastly overwhelmed by its costs. Some suffered hair loss, others a drop in libido, while others underwent neurotic breakdowns that, for some, lead to hospitalization. Furthermore, these men were so malnourished once the trial was complete that in a desperate attempt to satisfy their appetites, they wound up on average 50 percent heavier than they were before the start of the study. What’s worse is that conventional medicine would jump to the conclusion that these men lost any self-control once the trial was over, and whatever had accumulated both before and after the trial was entirely their own fault.
With Keys’ study in mind, how can society honestly expect overweight people to quite literally starve themselves just to remain outwardly physically comparable to their leaner counterparts? Especially when evidence shows that overweight people are inwardly physically different than said counterparts.
Chapter five, “The Criticial If,” accuses just about every single group of thought in the history of medical authority as being not just wrong, but as coming up with easy answers to and mere excuses for the how’s and whys of obesity. These groups of thought can rightfully be called wrong, because they’ve never worked, which is why “fad” diets can be considered right — because for the most part, they work. Conventional ideas on diets have historically been one-sided and bias, coming from the perspectives of mainly, lean people and lean doctors.
In a French children’s book series, there are two young friends, lean Nicolas and fat Alec. In his analysis of Alec’s physique, Taubes finds fault with how Alec is portrayed as fat because he’s always eating and eternally hungry, when really Alec may be eternally hungry because he is fat. As it’s seen in both this French children’s book series and in mainstream medicine, hunger and eating cause obesity. For Taubes, hunger should be seen as the effect, and the phenomenon of unordinary fat accumulation as the cause. Proponents of LCHF/ketogenic eating have gotten on board with this not-so newfound theory of obesity’s cause-and-effect, and it is well past time that the rest of the medical authority got on board.
An endless sea of questions pertaining to fat accumulation can be answered when you consider the hormonal and metabolic effects of food intake on weight gain. Men and women gain weight differently, people gain weight differently at different points in their lives, some people gain weight here while others gain weight there, etc. A study of just caloric intake alone wouldn’t explain the vast types of weight gain and loss upon individual and differing bodies. Referring back to Astwood’s failed persuasion upon the medical industry, this would require a lot more explanation than just counting calories. The correct question to ask is not why the obese person did nothing to stay lean, but rather why the body insists on hoarding fat cells.
It was physiologists alone that began uncovering the defects happening within larger bodies having to do with fat accumulation, and it was physiologists alone that seemed to care about said discovery. Hilde Bruch of Columbia University reported the blatant disinterest by medical researchers of any such discovery in her 1957 book, The Importance of Overweight, and their dumbing down of any explanation of obesity to an equation that looked no more complex than (more food=more fat). By putting herself in the frontlines as a pediatrician studying childhood obesity, Bruch was given the opportunity to not only learn about but care about these physiological truths. Following her patients throughout childhood and into adulthood, she witnessed firsthand the falsities surrounding obesity. Thankfully, others were slowly coming on to these discoveries as well.
Chapter six, “Targeted Solutions,” explains why “diet” is the wrong word to use for healthy eating habits. Taubes himself prefers the terms “lifestyle” or “eating patterns” over “diet.” This is because the term “diet” implies a temporary shift in behavior, whereas what’s required to maintain a long-lasting healthy weight is a permanent change to one’s daily eating habits. By definition, “diet” is meant to be a pattern, which helps to understand why conventional diets don’t last, while LCHF/ketogenic eating is much more physically and mentally sustainable. Why spend so much time starving oneself when an entirely different solution might be readily available and at your fingertips? Even if one loss some weight, is it really worth the abundant suffering one inevitably endures to lose it?
In a 2002 trial called the Diabetes Prevention Program, it was found that by utilizing calorie control and participating in regular exercise, one could “delay the onset of diabetes for two or three years.” For Taubes, a lifetime of counting calories for an extra two to three years before the inevitable adult-onset diabetes hits just didn’t seem worth it, and the whole idea behind diabetes prevention and control seemed relatively hopeless.
Opponents of “fad diets” don’t agree with the suggestion that overweight people avoid a certain food group forever, and in its entirety. However, all signs have pointed towards success when people cut out the specific foods that stack up as fat cells and eat otherwise completely normally. Sure, that creates an unbalanced diet, but only if the dieter makes it so. Certain foods are “bad” and should be labeled as such in order to re-balance a diet without including the most harmful and inefficient food group. Without that exclusion, the fat cells will continue to pile up, and the hunger will continue to persist. Better to cut out just the one bad thing, satisfy your hunger with everything that’s left, and come as close to naturally lean as is psychologically possible.
Author of The Importance of Overweight Hilde Bruch used her inspiration from physician Alfred Pennington’s research on LCHF/ketogenic eating to guide a patient to a healthier lifestyle. Most important was the relief Bruch’s patient felt switching from a life full of mainstream diet attempts that had her feeling ashamed and anxious about each single bite taken. Rather than feeling eternally hungry, the patient ate differently but in normal amounts that left her feeling satisfied. It was three meat-heavy meals a day with fruits and vegetables sprinkled in that caused this change, with calorie-counting a thing of the past. The true culprits were revealing themselves as starches, grains and sugars. What caught on in the 1950s was simple. Avoid starches, grains and sugars, and eat as much meat, fish, vegetables, fruit, eggs and cheese as your heart desired.
By the 1960s, LCHF/ketogenic eating was being taken more seriously across the board. In 1973, a conference on dietary therapy was held by the National Institutes of Health, where pro-LCHF/ketogenic rhetoric was finally becoming widespread and considered not just a solution but the solution to obesity and its accompanying mental health crises.
Chapter seven, “A Revolution Unnoticed,” details how the study of hormones and their effect on metabolism were deeply researched in the 1960s. The research and work of Rosalyn Yalow and Solomon Berson earned them the 1977 Nobel Peace Prize and was proclaimed a “revolution in biological and medical research.” Unfortunately, not many within the medical authority paused to take notice and thus this information didn’t reach the masses the way it needed to.
What researchers needed to be able to explain was the cause of the malfunction in the endocrine system that resulted in the accumulation of excess fat. The process of metabolism was nicknamed the “Krebs cycle” after Hans Kreb, who had fully grasped the metabolic process that turned the body’s intake of food into energy, or “fuel.” The summary of his understanding was that the fat cells generated energy for the body by burning carbohydrates, proteins and fats, and it was the endocrine system that made the initial the decision of how and when those carbohydrates, proteins and fats were burned. It’s precisely the hormones in the endocrine system that oversee the burning of fat cells into energy — they control the body’s response to the intake of food, just as they control the body’s responses to just about all external factors. However, Edwin Astwood took note of one particular hormone that was interrupting the metabolic process and essentially reversing the entire process of turning fat into fuel. Insulin was working towards the accumulation of fat cells, rather than towards the burning of them into energy.
When insulin was discovered in 1921, malnourished type 1 diabetes patients were administered insulin and were thus able to gain enough weight to be considered healthy again. The only issue with this revelation came with type 2 diabetes, where so many patients with adult-onset diabetes were overweight and obese. If insulin was a fat-hoarding hormone, like would seem true for those with type 2 diabetes, the deficiency of insulin in those with type 1 diabetes seemed contradictory. Yalow and Berson distinguished the differences in the two types of diabetes. Where type 1 meant an insulin deficiency, type 2 meant an insulin resistance, and it was that resistance that caused the body to hyper-produce insulin, and that insulin
would in turn store more and more fat. Furthermore, they found that those with type 2 diabetes didn’t necessarily need to eat less or exercise more, but somehow needed to lessen the amount of insulin in the body.
In 1963, it was stated by researchers from the University of Wisconsin in the Journal of the American Medical Association that obesity could not occur without insulin, that the accumulation of fat relied on the existence of insulin, at some level. To take it one step further, they reported that obesity relied on the intake of specifically carbohydrates, also known as glucose, to stimulate that insulin production that then caused the accumulation of fat. At this point, there existed two very opposing groups of thought pertaining to diet and weight loss. One stated that to lose weight, there requires a reduction in calorie intake, and the other stated that to lose weight, there requires a reduction in insulin. At the heart of this contradiction was the argument of physics versus biology.
In chapter eight, “The Body’s Fuel,” the body is given its due credit for the millions of tasks it completes during its lifetime in order to keep itself not just living but thriving. Specifically credited, in this case, is the body’s task of breaking down all of the food it has received and utilizing it as energy, as fuel to consistently thrive on. When the body receives too much or too little of any certain nutrient, the body has the more difficult task of adapting or configuring itself in order to continue thriving, and it is this more difficult tasks that pertains to carbohydrates. Carbohydrates are known to increase blood sugar levels, which then have to be regulated within the body, and if needed, with the help of medication before those levels reach toxicity.
Carbohydrates burn first in the body, and once they’ve dissipated, the body begins to burn fats, saving the proteins for cell and tissue repair. Keep in mind here that the body has a significantly lower threshold for carbohydrates than fats or proteins. Insulin is tasked with the job of making sure the carbohydrates get burned first in order to avoid a toxic blood sugar level. The number of carbohydrates in circulation and the amount of insulin in circulation should drop simultaneously as those carbohydrates are burned. Once the insulin levels lower, the fats are free to begin burning to create energy. This entire process is referred to as the Randle cycle, and mainstream medicine argues that the body needs the carbohydrates to burn first.
Since the body’s threshold for carbohydrates is significantly lower, the body braces for the intake of carbohydrates well before the act of eating is occurring in order to prepare to immediately begin breaking them down. It does this by prematurely releasing insulin, which is ready to start immediately burning carbohydrates while forcing the fat cells to stay where they are. This is the first step of the Randle cycle, and the next steps are the decrease in insulin and the release of fats that allows them to begin breaking down. A lean, healthy body can flex back and forth between breaking down carbohydrates and breaking down fats.
The issue occurs when insulin levels fail to decline as carbohydrates burn off. When this happens, it’s called insulin resistance, and the fat begins accumulating rather than breaking down. The malfunction that causes insulin levels to remain higher than necessary will increasingly store fat on the interior, and increasingly grow fat on the exterior. Yalow and Berson noted that even a lower, nearly immeasurable level of insulin resistance paired with a few extra calories per day could quite easily become accumulated internal fat cells and external weight gain. Overall, it’s quite easy to set oneself down the path towards obesity.
Chapter nine, “Fat vs. Obesity,” explains how by the 1970s, the research on metabolism had found its way into textbooks and medical journals. Medical literatures as a whole were finally including terms like “metabolism,” “insulin” and “adipocyte,” which is the technical name for a fat cell. This literature would include the summarization of how insulin promotes the storage of fat due to one of two reasons, either the heavy intake of carbohydrates or type 2 diabetes. These processes were summarized in the highly accredited Lehninger Principles of Biochemistry, which offered the more complicated version of this simpler explanation — high blood sugar is caused by either carbohydrates or type 2 diabetes, the pancreas produces insulin, the carbohydrates burn, the glucose is stored as fat and the preexisting fat is accumulated further. A huge oversight within this book is that in an entirely separate section, it is stated that an overabundance of calories causes obesity. However, it is recognized that there is some logic to assuming that the factor that adds fat to our bodies is the same factor that adds fat to our fat cells, however incorrect that logic is.
A diagram is shared from the 2019 version of Oxford University Keith Frayn’s Metabolic Regulations in Humans, which shows how fat cells are regulated. In the diagram, insulin is the driving force anywhere that there is fat buildup. Furthermore, it’s seen that insulin is the roadblock found anywhere that fat is failing to break down. Frayn’s diagram understood that the factor adding body fat is not the same factor accumulating fat cells. If it weren’t for carbohydrates, insulin wouldn’t hyper-produce, and fat cells would be free to burn and break down. To allow fat cells to dissipate, insulin levels need to be kept low. This emphasizes the point that physiology and specifically endocrinology is imperative to be considered when questioning obesity.
Obesity could be a relatively uncomplicated matter if it weren’t for the lengthy history of so many people in its related fields of study getting the matter completely wrong. Assumptions were made and never questioned, creating an entire school of thought that was based on incorrect information. In 1965, Harvard’s Jean Mayer was quoted by The New York Times saying that these newfound fad diets would lead to “mass murder,” and while he may have understood the role of insulin in the body, he couldn’t drop the ideas of a conventional diet. It seemed as if like-minded medical authorities would rather have accepted the successes of LCHF/ketogenic diets as “if by magic” than dive deeper into how and why these diets were successful at all. It was easier to run with the theory that “the fat we eat is the fat we store,” which is true in essence, and then guide people to quit eating fats. While fats were being excommunicated, carbohydrates and sugars became welcome guests in the eating patterns of obese patients. Robert Atkins himself, while finding personal success with LCHF/ketogenic eating, gave credit to the hormones burning fats, and ignored the now obvious fact that it was the lack of insulin that deserved that credit. Atkins received well-deserved criticism for his misleading naivety, despite how much fame and success the Atkins diet earned.
Chapter ten, “The Essence of Keto,” touches on the history of the Atkins diet, and the criticism it was receiving from both sides. While some were criticizing Aktins for not understanding the role of insulin in the LCHF/ketogenic diets, many on the opposing team were criticizing his widely successful promotion of LCHF/ketogenic eating. The low-carb, high-fat Atkins diet scared medical authority for not only its main tenets, but for how widespread its popularity had become. Not only was Atkins suggesting cutting carbohydrates completely, but he was also suggesting fats as their replacement. By introducing the state of ketosis, Atkins was playing a very dangerous game with conventional medicine and patients worldwide.
Ketones are molecules that are synthesized by the liver during fat-burning and can be used by the brain as energy when there are no carbohydrates to be found. Not only are ketones a possible alternative to carbohydrates, but studies show that ketones are actually more efficiently utilized by both the brain and the heart. The state of ketosis is reached when the liver is synthesizing above-average numbers of ketones. Atkins used ketosis to put a name to the idea that carbohydrates were “bad” and sought to a capitalize on a self-proclaimed “revolutionary” idea that was based on the long-since discovered science behind LCHF/ketogenic eating.
The first step in the Atkins diet was to cut out all carbohydrates, aside from green vegetables and the glycogen in meat. The recommended diet of meat, fats and green vegetables not only maintained low insulin levels but promoted the production of ketones, the goal being to leave dieters remaining in a state of ketosis. Dieters could test their ketone numbers with strips bought at any pharmacy, strips that were already available for diabetes patients who had to self-test to prevent diabetic ketoacidosis. After some time, some amount of beloved carbohydrates could be integrated back into the diet, as long as ketone levels remain within ketosis.
Since ketones were found in the urine of diabetic patients dying from diabetic ketoacidosis, ketones were seen as the villain. However, in a normally healthy body, ketones are friend, not foe. The liver won’t synthesize ketones without the accompaniment of certain simultaneous bodily functions — specifically low insulin and rapid fat-burning — because insulin prevents ketone synthesis. Ketones are irrelevant while insulin is secreting, and a high level of carbohydrates are being burned and broken down. When there’s only fat to burn, the liver will burn that fat and produce ketones. Even after a night’s sleep, exercise, fasting, or any other activity that would deplete carbohydrates and instigate high ketone production, your ketone level will still be significantly lower than the number of ketones reported during diabetic ketoacidosis. This fear of ketones is relatively unmerited, when in reality “nutritional ketosis” means that fat is being burned and utilized, rather than hoarded.
Each individual body reacts to carbohydrate differently, and at different rates, while individual tissues and cells themselves respond to insulin differently, and at different rates. Fat cells in particular are significantly more sensitive to insulin than other tissues and cells in the body. A researcher from the University of Texas, Ralph DeFronzo, was able to distinguish the so-called insulin “threshold” for fat cells and create a diagram that Taubes calls the “single most important figure in the whole discussion.” The figure shows that for most of the “range of insulin in our bloodstream,” fat cells are sensitive to it while other cells are desensitized. Above the threshold, fat is hoarded, and below the threshold, fat is broken down. Surprisingly, this threshold is extremely low, even amongst lean and healthy bodies, and it is both easy to climb above it and challenging to fall below it. The Atkins diet was essentially guiding its patients to remain below this threshold. However, each body has a different threshold, a threshold that has the ability to change over time, and it might be this internal and individualized threshold that makes it so easy for some people to eat carbohydrates and stay lean, and so hard for others to eat at all.
Chapter eleven, “Hunger and the Switch,” questions whether cutting out an entire food group from one’s diet is altogether necessary. Looking at the healthy body’s insulin threshold as a switch, where on means fat hoarding and off means fat burning. In an overweight and thus insulin-resistant body, that switch is on more often than off, and the body is craving the carbohydrates that it’s expecting to receive. When there’s no carbohydrates, the body can run on fats alone, those cravings disappear, and weight loss occurs. When the body stops receiving carbohydrates, it’s not starving, but rather at a tug-of-war with itself over natural weight loss. By replacing carbohydrates with fats, the body is feeling satisfied rather than starving.
Working with obese children, Duke University pediatrician James Sidbury fed his patients 300-700 daily calories worth of only fats and proteins. Their insulin levels lowered, they lost weight, and they felt satisfied throughout the process. Working with obese adults, Harvard Medical School’s Bruce Bistrian and George Blackburn fed their patients 650 to 800 daily calories worth of fish, meat and fowl. These patients reported feeling satisfied, and on average they lost at least forty pounds. Unfortunately, both studies incorrectly treated calories as the villain. Both sets of patients could have increased their daily calorie intake but continue to avoid carbohydrates, and insulin levels would remain low, allowing natural weight loss to occur.
Critics of LCHF/ketogenic eating went from naïve to desperate when claiming in 1973 that a loss of appetite was a side effect of the diet trend. They claimed that the diet being suggested was “so boring or so nauseating” that dieters simply wouldn’t or couldn’t eat to their heart’s content. This criticism completely ignored the high efficiency of a body running on its own fat, rather than on carbohydrates.
The important stipulation of a LCHF/ketogenic diet is that it needs to be maintained over the course of a lifetime, which means that a “cheat” meal will flip that switch to on and will again cause cravings and hunger. Even thinking about carbohydrates will cause insulin to begin producing in hopeful preparation of the next meal. When a body is insulin resistant, it’s that much harder for it to resist the urges felt from cravings and hunger. Larger people have a harder time avoiding the foods that are fattening to them, and the hard time is occurring physiologically, not psychologically.
Carbohydrates therefore have an addictive quality, and just one is too dangerous to the natural weight-loss process. What so many medical professionals don’t have is the perspective of being someone who’s physiologically addicted to carbohydrates, which may be why LCHF/ketogenic eating has been so misunderstood. For lean people, carbohydrates are a choice, but not so for overweight people. Thankfully, overweight bodies can rely on fat to replace the carbohydrates, once the addiction has been broken.
Some loopholes have been found that offer patients a successful low-fat, high-carbohydrate diet, especially for those trying to prevent heart disease. These patients may have such little available fat in their bodies that it’s the carbohydrates and only the carbohydrates that are burning and breaking down. Or the carbohydrates being consumed are non-processed, high-fiber and slow-moving, which are better than their sugary and processed counterparts. Another loophole is exercise, although the science behind that all relates back to insulin. Exercise could be extending the time of “fasting” between meals, where the body remains below the insulin threshold, or exercise is depleting the body’s glycogen, and therefore requires some carbohydrates. With any loophole, however, no carbohydrates are the best bet.
Chapter twelve, “The Path Well Traveled,” questions whether losing excess weight is ultimately healthy. In considering this question, the how of the weight loss occurrence has to be considered as well, whether eating less carbohydrates or less fats is what’s healthiest. What will be the long-term effects, both negative and positive, of any diet? As of now, most speculations on these unknown long-term effects are just that — speculation. In 1981, the British epidemiologist Geoffrey Rose proclaimed that the best way to avoid chronic disease later in life caused by eating patterns was to remove anything unnatural from them, for instance, processed grains and sugars. These food groups are relatively new to human eating patterns, and therefore it can be said with somewhat certainty that they do more harm than good. On the other hand, the LCHF/ketogenic can safely say that fats from animal products can’t be all that harmful since they’ve been a part of eating patterns since more or less the dawn of man. Unfortunately, natural and unnatural are subjective terms, up to interpretation and further muddled by mainstream media.
Medical authority views the fats that are vital to an LCHF/ketogenic diet as unnatural and will certainly have negative effects later in life. In short, just because it sheds the weight doesn’t make it healthy, and a quick fix doesn’t necessarily make it the right fix. Whether any diet is both safe and a fix is the important question. From there, the most viable option can be explored by each individual body, taking into account both long-term and short-term effects, and seeking to find a balance between the two. So, while a low-fat, high-carbohydrate diet might help prevent heart disease, is it worth it? Studies show that drastically slashing fat intake only adds an average of a few days to a few months onto one’s lifespan, meanwhile the positive effects of LCHF/ketogenic eating are endless, many of which are long-lasting and include surprisingly improved heart conditions. While the long-term effects of LCHF/ketogenic eating remain unknown, so do the long-term effects of mainstream diets, yet these fad diets disprove mainstream diets time and time again. Inspired by Rachelle Ploetz, Taubes asks what’s worse, eating more bacon or being 120 pounds overweight?
Regardless of a plethora of growing evidence in favor of LCHF/ketogenic eating, in 1988 the U.S. surgeon general blamed roughly 65% of deaths each year on fats, the federal government moved on campaigns that instilled widespread fear of fats, and society has never been fully able to shake that fear. Since all medical authority believe in a low-fat diet, then inevitably all medical authority continues to believe in a low-fat diet. Furthermore, they have a one-sided concern for just heart disease and LDL cholesterol alone, LDL cholesterol being “bad” cholesterol, and disregarding any number of other chronic diseases that ail humanity. Ironically, further probing into high LDL cholesterol leads back to insulin resistance and the metabolic syndrome caused by insulin resistance that then causes fatal heart conditions. Each and every one of the ailments that accompany obesity and type 2 diabetes are all, in fact, associated, including high blood sugar, high LDL cholesterol and high blood pressure. Since many of the short-term positive effects of LCHF/ketogenic eating lead to long-term positive effects, then it must be worth giving a try.
Chapter thirteen, “Simplicity and Its Implications,” drives the previous chapter’s point home by declaring that carbohydrates are what are so fattening. And the higher the sugar content of a carbohydrate, the more fattening that carbohydrate will be. First fructose, then the beet sugar industry, then the cane sugar industry, and then high-fructose corn syrup has pushed onto society an influx of sugar and increased the supply of sugar thirty-fold. Different from glucose, fructose is metabolized in the liver, a task that the liver has a difficult time of, and much of that fructose becomes fat. What biochemists have come to believe is that the accumulation of fat in the liver from an abundance of fructose is what initially causes insulin resistance. While fructose is causing insulin resistance in the liver, glucose is jump-starting insulin production from the endocrine system. Any level of abstinence from sugars and carbohydrates is recommended, depending on each individual and their size, but whatever that level may be, a strict commitment is vital to any long-lasting success. Changing one’s diet will change the body’s physiology, and eventually the body will no longer crave the fattening foods it once did so desperately. As the bariatric surgeon running a Florida-based weight lost program so perfectly put it, “we are a carbohydrate abuse program, not a weight loss program.”
Chapter fourteen, “Defining Abstinence,” consists of a comprehensive and definitive rundown of the rules, the do’s and do not’s, of LCHF/ketogenic eating. The first rule is to avoid all grains, including rice, wheat, corn, quinoa, millet, barley, buckwheat, pasta, bread, bagels, cereal and anything that uses cornstarch. The second rule is to avoid all potatoes, sweet potatoes, parsnips and carrots. The third rule is to avoid all fruit, aside from avocados, tomatoes and olives. The fourth rule is to avoid all beans and legumes, including peas, lentils, chickpeas and soybeans. The fifth rule is to avoid all sugary foods and beverages, and the sixth rule is to avoid milk and sweetened yogurts. Fiber is boasted as overwhelmingly beneficial to and productive towards an LCHF/ketogenic diet. Permitted foods are meat, fish, shellfish, eggs, butter, olives, avocados, tomatoes, cheese, cream and unsweetened yogurt. Permitted vegetables are kale, spinach, lettuce, cabbage, broccoli, cauliflower, asparagus, Brussel sprouts, mushrooms, cucumbers, zucchini, peppers and onions. Lasty, foods that are permitted in moderate amounts are low-sugar chocolates, berries, nuts and seeds. The last category comes with the warning that if there’s no visible weight loss following these rules, then the foods listen in the last category might be the problem and should be avoided as well.
Chapter fifteen, “Making Adjustments,” concedes to the fact that whichever diet works the best for the individual person over the course of the lifetime, and is therefore most sustainable for them, is their best option. To fit these criteria, the diet needs to keep the dieter fully satisfied and satiated while also seeing significant and satisfactory weight loss. The diet allows the dieter to eat when hungry and until reaching the feeling of fullness. If carbohydrates are prohibited, then fats are relied upon to replace them in order to keep the dieter feeling satisfied. The only thing to be wary of is replacing these carbohydrates with too much protein, which can be “converted to glucose in the liver,” thus setting another bad cycle in motion. Fats are the only “macronutrient” that won’t instigate the production of insulin at all.
Taubes uses photos in this chapter to give visual representation of what meals should and should not look like during LCHF/ketogenic eating. For instance, the dinner plate one should eat has roast chicken thighs and broccoli with butter, whereas the dinner plate one should not eat has roast chicken breasts, broccoli and potatoes. They’re a simple variation of each other, with a higher calorie count in the former, but still much less fattening than the latter. The next example is the lunch plate, one which is a McDonald’s cheeseburger with fries and a soda, while the other is a Double Quarter Pounder with no bun, no fries, no soda, with a side salad with ranch dressing. Same calorie count but an aggressively different carbohydrate count. For breakfast, there’s either the cereal-banana-toast-juice combination or the eggs-cheese-sausage-bacon-avocado combination. The first will have the brain and the stomach fiending for a mid-morning snack, while the second will keep the body fueled until an appropriate lunchtime. This can feel confusing, because all three “bad” meals are staples of an American diet, but they’re also what have been packing on the pounds for our lifetime. As is displayed in these examples, calories have proven wildly unimportant for healthy weight loss.
Carbohydrates happen to be the food group that also provide the body with the least number of vitamins and minerals, which is why they’re known as “empty calories.” Sugar, too, offers nothing to the body except short-lived energy, and both put the body at too great a risk. It’s just a matter of accepting and allowing fats to replace carbohydrates and sugars in one’s diet, for the sake of now and very likely the future.
Chapter sixteen, “Lessons to Eat By,” shares Taubes’ experiences from a lifetime of speaking with patients and doctors who utilize a LCHF/ketogenic diet. Some doctors and physicians that were spoken with have gone so far as to establish their entire careers on the practice and success of this way of eating. One in particular, Sean Bourke of JumpstartMD, emphasized that the most important factor of any successful diet is that the patient embraces it. On that note, Taubes continues on to share six lessons that “capture the essence of the practice of LCHF/ketogenic eating.”
The first lesson comes from Michael Pollan’s In Defense of Food, which addresses the relative inconvenience of healthy eating and how it takes a good amount of effort, thought, time and oftentimes, money. And like any addiction, it requires a lifelong commitment to abstaining from something and resisting any and all and the often-overwhelming amount of temptation. The second lesson comes from physician and author Ken Berry, whose advice stated that “this is what you are going to become.” Meaning, these new eating habits will become so ingrained within the psyche that it stops being something one does or practices and becomes a part of one’s being. That shift happens with care and motivation, two qualities Berry finds vital for the sustainability of healthy eating. The third lesson comes from Pittsburgh dentist Nick Miller, who was quoted saying “you don’t get cake and ice cream when you’re finished,” referring to healthy eating’s lifetime commitment. As a dentist, he’s shared the reality of how harmful carbohydrates and sugars are to the teeth as well as the internal body. One “treat” or celebratory dessert or meal will send any dieter too many steps back.
The fourth lesson comes from family medicine doctor Katherine Kasha when discussing addiction and understands how any dieter can always start again from scratch once they’ve fallen off “the wagon.” It’s a matter of cognition versus desire, and there’s always another chance to quite again. The fifth lesson comes from spine surgeon Carrie Diulus, who has celiac disease and is genetically susceptible to obesity. Her lifetime has been a series of ups and downs concerning her health and weight, from reaching obesity to running marathons. During her lifetime, she’s adjusted her eating regimen to fit what felt good and healthy at the time, what made her feel her best — “If that changes, I’ll adjust. It’s not a religion.” Every body is different, and no two can follow the exact same diet rules. The sixth lesson comes from Sue Wolver who emphasizes to her patients that with LCHF/ketogenic eating, “practice makes perfect,” both mentally and physically, just like anything else worth striving to achieve.
Chapter seventeen, “The Plan,” maps out a simple and easy-to-follow plan for LCHF/ketogenic eating — the basics of the diet, with each dieter meant to fine tune the plan as time goes on so that it becomes less of an LCHF/ketogenic diet and more of one’s own personal diet/healthy eating plan. There are many key points to consider when cultivating a personal diet, the first of which is to find a doctor that understands. It goes without saying that this doctor will need to agree with LCHF/ketogenic dieting at its core for the partnership to succeed. The doctor can take into consideration all other health conditions one may have in order to help personalize the patient’s diet. With the help of a doctor, achievable and realistic goals can be set, which is the second key point. Find a balance between what works and what maintains overall happiness. According to these established goals and objectives, outline how to begin the abstaining process, i.e., cold turkey or weaning. Weaning is usually more effective and much easier, whether it be slowly lessening carbohydrate intake or removing certain carbohydrates one-by-one. From there, the next key point is to understand that life happens, and to be prepared for those one-offs. Be prepared for initial withdrawals, which can be somewhat combatted with extra sodium intake and taking magnesium supplements, along with multivitamins to help reach a balance in a newly transitioned internal system. The only highly concerning possible side effect is high LDL cholesterol, which a physician will be able to monitor.
The fifth key point is adhering to the rules, especially in a society that promotes all of the least healthy food and drink. It’s difficult when at a party, or on vacation, especially when most people are eating and drinking more poorly than the LCHF/ketogenic diet recommends. At home, get rid of all carbohydrates and sugars so that they’re out of sight, out of mind. Join a support group if needed. Figure it out mentally, and then perfect it physically with experimentation, the next key point. If the results aren’t satisfactory, “find your triggers” and edit the diet. Maybe what was thought of as a “healthy snack” really isn’t when one reads the fine print. Too much of anything can be harmful, which includes fats and proteins. The effects of different kinds of alcohol should also be considered. The less sugary, usually the better, but again, everything in moderation. Exercise can be helpful not for burning calories, but for the sake of building muscle, which can boost insulin sensitivity. Intermittent fasting might help in the process of burning fat. But as time goes on, bodies change, and the diet will require an update.
Chapter eighteen, “Caution with Children,” asks if the overarching theory surrounding LCHF/ketogenic eating can apply and should apply to children. First and foremost, it’s imperative to avoid allowing a child’s diet to turn into a full-blown eating disorder. James Sidbury’s 1975 study on obese children following a LCHF/ketogenic diet did prove successful, although there is much more to consider when it comes to youth dieters. Children don’t have the same willpower as their adult counterparts, so it might make it easier for a younger dieter to be surrounded by adults who are following the same eating regimen.
Through the Healthy Lifestyles Program at Duke University Medical Center, Jenny Favret and Sarah Armstrong created an LCHF/ketogenic-inspired eating plan for obese children, and even provided families with recipes. They also emphasized the importance of helping children recognize when they’re full and to become more in tune with their hunger and satisfaction. The former director of Boston Children’s Hospital’s Optimal Weight for Life clinic David Ludwig saw most success with a step-by-step approach towards children, who were generally more averse to changing the way they ate and who too often saw sugary foods as a reward. With an obese child, the best a parent can do is to inform themselves on the physiology of obesity and metabolism in order to understand what’s happening, both physically and mentally. And this sentiment applies to all people struggling with weight — to learn about it, to stop blaming oneself, and to quit starving for the sake of being lean.
Overview of The Case for Keto
The Case for Keto: Rethinking Weight Control and the Science and Practice of Low-Carb/High-Fat Eating shares the positions of primarily physicians when it comes to LCHF/ketogenic and seeks to refute what society thinks about traditional diet methods. Using twenty years of investigative research and accompanying testimonials, LCHF/ketogenic eating is defended as the most effective and productive diet on the market currently and boasted as doing far more work in treating chronic disease, specifically obesity and diabetes, than all of its predecessors. What society thinks it knows about weight control and the chronic diseases related to one’s diet is rejected, and simultaneously studies are used to support the efficacy of LCHF/ketogenic eating. While these so-called “fad” diets are in no way revolutionary, having been around for centuries, the author strives to revolutionize the way society treats these vastly successful diets and to show doctors and patients alike just how important they can be in not only slowing, but counteracting obesity, diabetes and other chronic diseases in relation to weight.
Background on The Case for Keto
Author Gary Taubes credits one serendipitous breakfast meeting for jumpstarting the creation of The Case for Keto, when a friend with type 1 diabetes nearly begged him to finally publish his research in the form of a book. The book is the culmination of twenty years of not just research, but collaboration with other like-minded people in the field who were more interested in finding real success than sticking with the status quo. Though he graciously acknowledges the fluctuating support surrounding his work, in particular Taubes mentions the more than 140 interviews and interactions he had with “physicians, dieticians, health coaches and parents” that went into writing the book. Further gratitude is shared for the three intuitions that Taubes says made the book possible — The Robert Wood Johnson Foundation, the Laura and John Arnold Foundation and CrossFit Health.
About Gary Taubes
Gary Taubes has three prior published books on health and nutrition — The Case Against Sugar (2016), Why We Get Fat and What to Do About It (2011) and Good Calories, Bad Calories (2007) — that preceded The Case for Keto (2020). He is a Harvard College graduate who earned his S.B. degree in applied physics in 1977, and then went on to earn an M.S. in engineering from Stanford University in 1978 and an M.S. in journalism from Columbia University in 1981. An investigative science and health journalist, Taubes has won a number of awards for his work, including the Robert Wood Johnson Foundation Investigator Award in Health Policy Research, the International Health Reporting Award from the Pan American Health Organization and the National Association of Science Writers Science in Society Journalism Award, the last of which he won three times over, in 1996, 1999 and 2001. He is the co-founder of the Nutrition Science Initiative, a non-profit organization that conducts medical research in order to combat obesity, diabetes and other metabolic diseases.
Trivia Questions:
1. Who was the professor that couldn’t find a receptive audience to his theories on obesity? What was his general theory that he tried to share with peers and skeptics alike?
2. What was obesity described as in a 1961 feature story in Time Magazine, and why was this so inherently dangerous for us as a society?
3. How few additional calories would one need to intake each day to gain seventeen pounds in one year? How many calories to gain just two pounds in one year, and how long would it take this pattern to bring the body to obesity?
4. Once Key’s trial had ended, what percentage heavier did his test subjects become once they had begun eating of their own free will?
5. What truly is the cause and effect of obesity?
6. Should diets be seen as temporary or permanent, and why?
7. Which particular hormone was found to be reversing the metabolic process from within the endocrine system?
8. In your own words, what is the Randle cycle, and what are the basic steps involved in the cycle?
9. What did Robert Atkins get wrong in his explanation of why LCHF/ketogenic eating worked?
10. In your own words, explain ketosis and the essential difference between ketosis and diabetic ketoacidosis.
11. What is the addiction to in overweight and obese bodies?
12. What did Geoffrey Rose suggest as the best way to correct our diets?
13. What is the still unproven but very possible role of fructose when entering the body?
14. What foods should be further restricted if strictly following the rules does not give you your desired weight loss results while on a LCHF/ketogenic diet?
15. What are the two most important and overarching criteria for one’s “best” healthy diet?
16. What’s one quote from any of the six lessons of LCHF/ketogenic eating that you can recite?
17. What are the six key points of LCHF/ketogenic eating?
18. Science aside, what should be the tried and true goal of reaching a healthy weight?
Discussion Questions:
1. Why do you personally believe it’s been so difficult for skeptics to accept these alternative diet solutions?
2. In your own lives, how have you noticed the differences between what you eat and what your peers eat, and what effects might you have noticed?
3. Until this point, how had you viewed the psychological differences between people of different body shapes, and did you ever believe the psychological causes to be related to the physiological effects?
4. How do you feel both your body and mind would react after enduring a strict low-fat diet like the one Key’s test subjects had to live by for six months?
5. Have you every personally attempted a diet, whether that be the mainstream diet or a LCHF/ketogenic diet, what were your results, and how would you compare your results to that of the ideas expressed in this book?
6. Why do you think it took so long for medical authorities to jump on the LCHF/ketogenic eating train? Why do you think they were so averse to its benefits for so long?
7. Do you feel particularly strongly about either of the two groups of thought surrounding diet and weight loss?
8. Having learned about how easy it is for the body to gain weight because of some possibly infinitesimal defect within the endocrine system, does this make you begin to rethink your own eating habits?
9. While doctors are known to be well-informed and exceedingly knowledgeable, why do you think so many didn’t stop to second-guess the information surrounding obesity and diabetes that they were receiving? Especially when most were seeing only short-term or no success at all in their obese patients?
10. How does the science thus far make you feel about how each individual is born and exists? In the biological sense, can the idea that all people are created equal ring true?
11. At whatever size you are, have you ever felt cravings just by thinking about a certain food? How would you describe the perspective you’re sharing?
12. Do you feel the unknown long-term risks of LCHF/ketogenic eating are worth the overwhelming short-term benefits?
13. Would you consider yourself addicted to any one food or food group?
14. Which of the six fundamental rules of LCHF/ketogenic eating would you have the hardest time with? Which would be the easiest rule for you to follow?
15. Reflecting on your own diet, does it align more so with the traditional “American diet” or with the suggested meals for LCHF/ketogenic eating?
16. Which of the six lessons of LCHF/ketogenic eating stuck out most to you?
17. With everything we’ve learned, how would you describe your ideal weight loss diet?
18. How do you feel about children following an LCHF/ketogenic diet? What about instead of conventional dieting?