Ken starts part two of our interview with Gary by mentioning that there is now substantial evidence supporting the efficacy and safety of low-carb diets. Ken mentions more and more physicians are prescribing this way of eating to their patients and large numbers of people are having success losing weight and managing type-2 diabetes using ketogenic diets. In light of that information, Ken asks Gary for his thoughts on why the U.S. News and World Report annual diet ranking stubbornly continues to describe the ketogenic diet as a detrimental way to eat.

Ken asks Gary to respond to some of the common arguments against the ketogenic diet ranging from human health and safety to climate change.

Ken asks about the claim that people on a ketogenic diet might lose a lot of weight in the short term but gain that weight back in the long term.

Gary tackles the criticism that ketogenic diets do not work for women.

Ken asks Gary to address concerns about the supposed unsustainability of ketogenic diets, noting how it is possible some people might have difficulty maintaining the diet for long periods of time.

Ken supposes that perhaps some of the anxiety surrounding a low-carb/high-fat diet has to do with LDL cholesterol. Ken mentions that some people on the diet, often referred to as hyper-responders, experience elevated levels of LDL and are warned by their physicians that this increases risk for heart disease. Ken asks Gary what he thinks the road forward should be for hyper-responders and others who are anxious about their LDL levels.

Dawn mentions that in 2018, Lancet published a study that aimed to make sense of the increasingly crowded world of low-carb diets. The authors, a team from Harvard, studied more than 15,000 American adults (aged 45-64) from four different communities over a 25-year period using dietary questionnaires. Dawn goes on to explain how these questionnaires revealed that consumers of both extremely low-carb diets and extremely high-carb diets had higher death rates over the course of the study. The lead author of this study was quoted as saying, “Our findings add to the growing evidence that animal-based low-carbohydrate diets are associated with increased mortality and therefore should be discouraged in the long term.” The last line of the paper reads, “Alternatively, when restricting carbohydrate intake, replacement of carbohydrates with predominately plant-based fats and proteins could be considered as a long-term approach to promote healthy aging.” News outlets described this paper as “the most comprehensive study of carbohydrate intake done to date.” She asks Gary to respond to this study and its conclusions.

Dawn asks what Gary’s ideal study design would look like to examine the safety and efficacy of the ketogenic diet.

Considering the recent birth of initiatives like EAT-Lancet, Dawn asks Gary if he sees the diet-science world moving in a more positive direction.

Ken asks Gary to elaborate on his view that the tools and equipment we use in science often shape the way researchers perceive the phenomena they observe.

Dawn asks Gary what it’s like being married to someone who prefers a mostly vegetarian diet.

Dawn mentions that even more than nutrition science or public health in this country, Gary’s interest has always been understanding the difference between good science and bad science. Dawn asks when Gary will write a book on that topic.

Ken mentions how the media often promulgates the notion that “science proceeds by consensus,”and that if the majority of scientists agree on a topic it is societally decided to be true. He goes on to say that this, of course, is not how science works, and the increasing attempts to squash criticism of established thinking parallel Gary’s career since the early 2000s. Ken asks if Gary has any more thoughts on this phenomenon.

Dawn closes the interview by asking if it is true that Gary had a high school guidance counselor who tried to put Gary in his place by saying Gary was “no Einstein.”