First some disclosures. As far as diets go, I’m egalitarian. I believe that the best diet for you may be the worst diet for someone else, and that all diets work by way of reducing caloric intake, but that calories from different foods will have differing impacts upon health and satiety. As far as Gary and Stephan go, I like both of them. I’ve had the opportunity to have a number of offline conversations with Gary over the years and though I’m guessing we generally spent the majority of our time in those chats disagreeing with one another (sometimes rudely), for reasons I find difficult to pin down, I’ve always enjoyed them. Stephan is someone whose work I’ve been reading for years and whose opinion I respect and value. And the 3 of us, in 2017, were involved with the Cato Institute for an online debate on sugar.
With those out of the way, onto the debate.
I certainly hadn’t planned on writing about it. And I won’t spend too much time nitpicking the discussion. Suffice to say, as many already have, it seemed that Gary the journalist relied on stories to make his points, while Stephan the scientist relied on studies. Gary constantly interrupted Stephan, and somehow also managed to recurrently mispronounce his name (despite corrections), and Stephan, perhaps as a consequence, at times treated Gary dismissively.
If you’re looking for a more detailed play by play of the entire 2 hours and 37 minutes, by all means, here’s Layne Norton’s fairly exhaustive (and even time stamped) coverage, but what I want to cover today are a few thoughts inspired by the debate rather than the debate itself.
Much of the low-carb high-fat (LCHF) (now in many cases interchangeable with #Keto) world has raged on for years about mainstream medicine and science’s disregard for their chosen diet and theories. An old photocopy of an American Heart Association pamphlet from 1991 that indeed promotes sugar consumption gets trotted out as some sort of gotcha for 2019. Young keto adherent physicians proudly tweet of the “torture” they experience reading opinions on diets other than their own (disclosure – including mine). Cardiologists with bestselling LCHF diet books write breathless articles in newspapers championing the idea that everything you’ve been taught about diet and heart disease is wrong and encourage the specific consumption of saturated fat. Self identified “science journalists” (note, this isn’t actually a dig at Gary but rather others) who purport to care about evidence embrace and amplify the most idiotic of theories, stories, or comments so long as it suits their narratives. And if a study contradicts any of the aforementioned folks’ belief systems, the fault is said to no doubt lie with the methodology, or the researcher being conflicted (as Gary repeatedly suggested in the debate when discussing the work of his former NuSi hire Kevin Hall, as well as Jim Hill and colleagues’ metabolic ward study that utilized direct calorimetry to show that people gained equal amounts of weight when overfed fat or carbs), or both. And of course pretty much all of the most vocal gurus, even the ones from prestigious institutions like Harvard, appear more than happy to extend their credibilities to prop up whatever medical quack (Mercola, Oz, Hyman, etc.) is willing to promote them.
For various reasons, listening to this debate reminded me of all of that.
Despite Gary’s very real comment in regard to diet related chronic disease and society that,
“Tragic shit is going on“
it would seem to me that the bulk of the energy spent by the loudest of the LCHF/#Keto crowd is mustered trying to prove everyone else is wrong or conflicted, and that there is only one, true, right, best, diet – a message that’s especially off putting when it comes from MDs, given every single day physicians are reminded that different treatments work differently for different people – sometimes predictably, and sometimes not so much – which is why for instance for hypertension there are at least 10 different classes of medications, and multiple options within each.
The starkest difference between Gary and Stephan I think comes at the 2:24:08 mark where Stephan details how much he loved Gary’s Good Calories, Bad Calories and how he found it so persuasive that he personally adopted a LCHF die, but that then he turned from the historical narratives conveyed in Good Calories, Bad Calories, to the science, and he found that the science told a different story. Not a story that suggested LCHF was a bad diet, or the wrong diet, or an unhelpful diet, but just that the science underlying Gary’s hypothesis doesn’t hold water for Stephan. And then over the course of the next few minutes, in what I can only assume is his rebuttal, Gary tries to narratively explain Stephan’s personal, subjective, experiences on LCHF diets, and then discounts the various studies Stephan mentions as being poorly designed while trotting out one study he does like from the 60s that to his reading, supported his assertions.
And I know this wasn’t the point of the debate – it was a debate after all – but wouldn’t it be grand if instead of the constant need of so many (and yes, there are definitely exceptions – see note at end) to promote LCHF/#Keto as the one right, best, only, diet, instead LCHF/#Keto, especially those who are themselves researchers and health professionals, took a deep breath and realized that if tragic shit is indeed going on, that perseverating on motives rather than data, and fanning the flames of online outrage mobs, and propping up of quacks like Mercola and Hyman, and promoting the worst examples of science and opinion so long as it suits their narratives, and fear-mongering around statins, and spreading the bizarre notion that there’s only one right diet and that anyone who suggests otherwise is wrong and likely conflicted, while providing fodder for online debates, is indefensible, unhelpful, and a very real reason why there’s far less embrace and research of a strategy that absolutely has a place in the treatment and prevention of diet and weight related diseases.
(And for an example of a keto adherent physician who bucks the aforementioned trend, look no further than cardiologist Ethan Weiss who just the other day penned this great post about keto, LDL, and treatment, all the while embracing science and reason)