In this episode of True Health Revealed, THR co-host Tom Rifai, MD FACP, interviews nationally renowned low carb advocate and author of the 2020 book, The Case for Keto, Gary Taubes. Here are Dr. Tom’s notes from their interview.

Flexitarian Meets the Case for Keto

Despite many likely thinking we might be diametrically opposed, Gary Taubes and I had a very comfortable discussion reverting back and forth from personal experiences (including his addiction to smoking and my binge eating disorder) to discussing randomized controlled trials of nutrition, including the renowned DIETFITS trial of healthy low-carb versus healthy low-fat diets, led by Christopher Gardner at Stanford.

Not only did I not find Gary to be “scary.” I found a humble, at times charmingly self-deprecating man who is, dare I say, flexible! For instance, he rightly pointed out that the maintenance phase of the Atkins diet has many similarities with plant predominant Flexitarian eating, whereas most people only focus on Atkins’ initial, ketosis inducing, “induction phase.”

Gary is also particularly curious. For instance, he found fascinating and would like to see more quality research on the nothing-but-meat “carnivore diet.”

And I heard no outright denial of the fact that a plant rich, flexitarian or even vegan approach (keeping in mind his wife, he makes clear, is close to plant pure) isn’t appropriate and healthy for many.

To be clear, he absolutely believes that controlling insulin via a low carb approach and titrating (adjusting) carbohydrate was key to managing insulin resistance and weight control.

Now, I don’t fully agree with the CIM (carbohydrate insulin model) obesity paradigm. Yet I saw no reason not to look at the mass majority of where we agreed… And yes, we could meet and “break bread” (minus the bread of course) over a fresh bed of vegetables and sustainable fish. In the spirit of the words he wrote to me in a personally signed copy of his newest book, “Here’s to Switzerland…!”

Some of Gary’s summary points in making the case for Keto:

• Colorful low starch vegetables are healthy! He never ate more before going low carb.

• Low-carb/keto is for metabolic correction in the insulin resistant and certainly is compatible with transitioning to a Flexitarian type eating pattern. But if weight gain/insulin resistance recurs…titrate back on carbohydrate, especially CRRAHP™ (calorie rich, refined and highly processed) carbs, but also whole grains, legumes, starch based vegetables and most whole fruits.

• Foods containing CRRAHP™ carbs add addictive qualities and many people, though not necessarily all, may need to consider them like an addictive drug to be “dosed” carefully and with honest personal admission to susceptibility for drug like dependency.

• Gary’s approach to low-carb and ketogenic diets is about personal experimentation and finding what works best to achieve metabolic health, unlike caricatures of him as someone who believes in absolutism.

• Healthy populations such as Blue Zones and the Bolivian Tsimané tribes are different from westernized populations, particularly the United States with our insulin resistance and obesity epidemics. Traditional (e.g., Blue Zones) and forager-horticulturalist based populations (e.g., the Tsimané of Bolivia) have never experienced the metabolic disruptions that drive our obesity epidemic, nor the epigenetic pressures that come from such, including those that occur in utero (e.g., upon unborn children to mothers who are insulin resistant). Healthy populations’ eating patterns that include high intakes of legumes, root vegetables, whole grains, whole fruits and vegetables are quite justified even to Keto expert Gary Taubes, considering the difference in their current and historical metabolic health (including lots of natural movement). The US population, which has been “raised” on the CRRAHP-SAD (SAD = Standard American Diet), is a different animal (no pun).

• Social support is critical for any substantial transformational lifestyle change based on food behaviors, particularly in the inner circle of our lives such as life partners/spouses. Without such support, any eating pattern much different than the CRRAHP-SAD would be a struggle of a potentially insurmountable nature.

• Gary is as human as anyone else when it comes to binge tendencies (like yours truly), and isn’t averse to the occasional slice of pizza or a dessert, although he, as do I (more in common!), probably fight the urges more so than most.