Fast Carbs. Slow Carbs.

In Fast Carbs, Slow Carbs, David Kessler explains how eating refined grains such as wheat, corn and rice leads to a cascade of hormonal and metabolic issues that make it very easy to gain weight and nearly impossible to lose it. Worse still is how excess weight creates a very real link to diabetes, heart disease, cognitive decline and a host of cancers. We can no longer afford to dismiss the consequences of eating food that is designed to be rapidly absorbed as sugar in our bodies. Informed by cutting-edge research as well as Kessler’s own personal quest to manage his weight, Fast Carbs, Slow Carbs reveals in illuminating detail how we got to this critical turning point in our health as a nation—and outlines a plan for eliminating heart disease, allowing us to finally regain control of our health.

Dr. Kessler recently joined Joe Biden’s Public Health Advisory Committee and will also discuss how our collective behavior with be the primary determinant in dealing with the ongoing coronavirus pandemic.

David Kessler served as commissioner of the U.S. Food and Drug Administration under presidents George H. W. Bush and Bill Clinton. He is the author of A Question of Intent and The End of Overeating, a New York Times best seller. He is a pediatrician and has been the dean of the medical schools at Yale and the UC San Francisco. Kessler is a graduate of Amherst College, the University of Chicago Law School and Harvard Medical School.

MLF ORGANIZER
Patty James

Visit BarnesandNoble.com to purchase Dr. Kessler's book:https://www.barnesandnoble.com/w/fast-carbs-slow-carbs-david-a-kessler/1133320716?ean=9780062996978

Speakers:
David Kessler
M.D., Former Commissioner, the U.S. Food and Drug Administration; Author, A Question of Intent and The End of Overeating; Pediatrician; Dean of the Medical Schools, Yale and the UC San Francisco

In Conversation with Mark Zitter
Chair, The Zetema Project; Member, Commonwealth Club Board of Governors


This program is generously supported by the Chan Zuckerberg Initiative and a collaborative of local funders and donors. We are grateful for their support and hope others will follow their example to support the Club during these uncertain times.


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Subtitles and Closed Captions

Hello, welcome to today's meeting of the Commonwealth club's health and medicine forum. I'm mark slitter
Chair of the sedima project a member of the club's Board of Governors and your moderator for today
Presently the Commonwealth club has suspended all of its in-person programming for obvious reasons
But we are hosting a series of virtual events including this one. You can learn all about them
Some of them are code related some are not at our website
Www.prophecyinthenews.com
Burrup several times during the course this program for your convenience
And we also encourage you to like subscribe and share videos like this one with your families and friends
Announce time for me to introduce today's special guest. Dr
David, kessler author of the new book fast carbs slow carbs the simple truth about food weight and disease
Dr. Kessler served as commissioner of the US Food and Drug Administration from 1990 to 1997 under both President
George HW Bush and President Bill Clinton during his tenure
He helped design the Nutrition Facts label that appear on all packaged foods
After leaving the agency he served as the Dean of the medical schools at both Yale and the University of California, San Francisco
in
2009 he published the end of overeating a book that investigated how processed food companies
Design products that have powerful effects on the brain that lead people to crave. I consume them uncontrolled
He's a pediatrician by background and has published several recent New York Times op eds. ANCOVA 19
He also was named recently to Joe Biden's public health advisory committee
And today will talk both about diet and the pandemic so welcome. Dr. David Kessler nice to have you with us
Thank you so much for having me
We start with this
As you mentioned in your book more than two-thirds of Americans are either overweight or obese and only an astonishingly load
12% of us are fully metabolically healthy
Those are stunning statistics and sound like a crisis worthy of writing a book about
But of course there are many other diet books on the market including one that you wrote yourself
So what do you hope the readers will take away from this book? That's different
So, you know the question it's a fascinating question the way you phrased it
You think it's a diet book
Certainly talked about diet and health obviously, so most the time the reason I just smiled when you said that
Most I had books focus on weight
And the goal was to answer a very important question
And really was the role of diet and metabolic health and the health
Consequences now weight is key. I
Mean weight is central as much as I would like to say you could be
healthy of any weight the fact is when you age
It sort of catches up and it has consequences, but I was very interested
in
Understanding that that statistic that you excited
Why are?
87 88 percent of us. Why don't we meet you know basic guidelines for not only weight?
but blood pressure blood lipids blood glucose and
Why are our bodies in essence in metabolic chaos, and what's driving that and what's the relationship?
Of the foods we're consuming
to
Those diseases and the consequences of those diseases
So this was a follow-up to your previous book and something that struck me most about your book was for years
We've been hearing that a calorie is a calorie is a calorie and if you want to lose or maintain weight then what you need
To do is watch the number of calories you eat
But a central theme of your book is that you claim that what we eat is as important
Or almost as important as how much we eat and the two types of carbs is your prime example
So I guess this leads us to the title of your book what are fast carbs versus slow carbs?
so fast carbs
Include both sugars that you know many people have written about and talked about but it's also
starches its sugars and starches
that end up
being rapidly absorbed in our
gastrointestinal
tract and
For many people who are you know have to struggle with their weight or metabolically vulnerable that though at rapid
ingestion that almost had that
endless flood that streaming of this rapidly
digestible
glucose because all that sugar and starch
gets made into
Rapidly absorbable glucose what's the consequence of that?
That really was the central question and those are fast carbs
So it's it's all sugars
But it's also all starches that are rapidly absorbable now slow carbs
are those
carbohydrates
those fibers
Did you not get rapidly absorbed in our GI tract?
They don't get absorbed in the upper GI tract and they make it down to the lower parts. Where the bacteria
Are and also can stimulate other hormones satiety signals
so
vegetables legumes
Those are slow carbs
Well the most striking thing I took away from the book was about not only how quickly they're absorbed
but how much of them has absorbed so my understanding from your book was that the fast carbs get absorbed very quickly and
Pretty much completely. Whereas the slow carbs you mentioned about half of those calories
We actually never make that they actually never come into our body so they don't turn into weight
Exactly, you know, we don't know all the mechanisms
by which
These fast carbs have the consequences they do we know
For the for many people they can have, you know severe consequences both pre-diabetes
Diabetes they go on cardiovascular
Complications so we don't know all the science behind the effects of these fast carbs
But we know that you know, they affect I mean they're in essence predigested right so we eat them
Our eating rate is quicker with them. They go down go down in a whoosh they get all absorbed all those calories
There's effect certainly on insulin. They don't get down lower in the GI tract so they don't stimulate
Satiety hormones. So there are a lot of different mechanisms
right by which they act and we never you know, when we over the last hundred years as
We've created one of these great food processing bahamut's
You know in the United States
We never really ask the consequences what you know, what are the effects of?
processing of taking the structure out of much of the food and
With the end result that these fast carbs get so rapidly absorbed. What's the effect of this flood of glucose on our bodies?
Yeah, and your book maybe think about you know, one of the reasons we eat is because it tastes good
We like it. Certainly another one is that we're hungry
And these are related but not the same thing and I hadn't realized how the different types of carbs
Differentially affect our feelings of hunger and satiety. Can you see a little more about that so fast carbs get absorbed in the upper
GI
Tract as you stated, they virtually all get absorbed. They get absorbed very quickly
We know that they trigger blood glucose elevations blood insulin. We know that those
Hormones have effect on our brains
We know that that catches us in these vicious
Cycles, but one of the things that fast carbs don't do is they don't get down to the lower GI tract and it's the lower
GI crack also is where hormones get really their
Release and they can create signals of satiety of fullness
So I mean is it the fact that these fast carbs are not getting?
Down to the lower part of the GI tract not having these satiety signals
That's certainly one of the mechanisms that I think is in play
They catch us in this these endless cycles of overeating so we can eat these fast carbs
But still feel just as hungry as before you ate them anyway
absolutely, look, you know the the the fact is
That much of these fast carbs are also delivery vehicles
I you know the this starch I mean the read about a thousand
Calories of these fast carbs a day on average, you know starch itself
If you go back to kindergarten you'll remember, you know starch is this paste?
It's it's this bland, you know, you you won't want to eat it
But now when you realize that starch is a carrier for fat sugar and salt
That fat sugar and salt in that carrier also triggers
And makes food
Super palatable and I believe you say that starch actually is is is in the majority of these fast carbs, right?
well
That's exactly correct. We certainly we focused a lot, you know over the last decade a lot of good work on sugar
But the fact is that it's not just sugar. It's sugar and starch
and
You know while there's no doubt that the American diet contains a lot of sucrose
The vast majority of these processed foods the central component
Is starch so it's starch and sugar
Now, I'm sure that part of the reason you focused on this topic is you're a doctor. You're a scientist
You're former FDA head but you've also been public about some of your own struggles with weight and diet
So tell us how those things informed or motivated you to write this book
You know, so I mean I've have suits in every size I have
gained and and lost
weight
Repeatedly, you know, but the hard part is to be able
To keep it off
That's the the real struggle and when you study when you look at these studies
You find that almost any diet. People can lose weight in the short term
But it's around six months where weight starts creeping
Back up
And the fact is that in many of those studies where weight comes back after six months
You see that it's the introduction
People go back to what they used to be eating and much of that is fast carbs
So the diet works in the short term
But this notion that a diet you lose the weight and then you don't have to be on it
That's just not the way the thermodynamics work. Ya have to be on it. I mean for a lifetime because soon as you let up
and especially
For people who?
You know struggle with their weight who are metabolically vulnerable who have
Pre-diabetes. Once you start reintroducing these processed carbs. It's almost impossible to keep the weight off
So do you have any tips or things that have been successful for you in that regard?
You know I find you know for me
that
almost any processed carb
You know leads to more processed carbs lead to more processed carbs
you know, and I want to be careful mark, you know, this is
you know, we're
Still a lot of stress out there
people
a lot of anxiety
people
want
comfort
And the fact is these highly processed foods
You know, they taste great. I mean you you eat them
That starch is loaded with fat and sugar fat sugar and salt
And you eat it and you're in this momentary bliss and I don't want to take away that that comfort
There's also you know, the question of what you can get hold of what's in the house
What you can afford
But I think if you look from a health point of view
Certainly, you know my goal is once when this is over when we can
both come out of our houses and once
You know down the road we there's a semblance of normality
Whenever that is I think we want to emerge it would be nice to emerge healthier
and
I don't know any diet
That really is successful
That contains process cops'll you know, there's a lot of confusion out there. What's the best diet?
There is paleo
There is low fat there is Mediterranean there is keto
When you know when you really look carefully
all of them
Recommend taking out these fast carbs. Yes. That's something you have in common. So that's good
Let's get a very tactical for a second
Which carbs?
Should we eat more and less of and as you answer I want you to comment on two terms that I learned something from in
Your book about a little more about complex carbohydrates and whole wheat?
Both are very confusing and can be misleading
Terms, you know go back to the 1970s and 1980s
And the recommendations of the various government agencies
I
reduced total fat
Reduce saturated fat reduce simple sugars, but then they said, you know increased total
Ingestion of complex carbohydrates and no one distinguished when they use that term
And people follow those recommendations
No one distinguished fast carbs from slow carbs, so I think we should get rid of that term complex carbohydrates and
realize that its starch and sugar which can
Be rapidly absorbed and have consequences
Mm-hmm. So give us an example of the foods. We should definitely eat more of and eat less of
There's you know the slow carbs
Have I mean the key?
Aspect of them is they have this structure is intact. I mean, it looks like food
right, I mean and that's the key because
even in those vegetables and like use
I mean there is some starch in it, but it's relatively
Modest but the important part is that that I mean in that whole food
That food has not been processed to the extent. It's not
undergone
both the temperature the thermo and
mechanical the the pummeling of that that wheat that you know makes
those
That starch those grains
so rapidly absorbed so the key is to stay away from anything that
is
That is processed or certainly highly processed, you know
It's doing that pre processing for us now in the in this book
You take two tasks the food industry for promoting fast carbs that appeal to our taste buds
And they're cheap to produce but they're often appallingly bad for our health
So if you now are FDA Commissioner, would you recommend regulating those companies differently and if so, how?
you know, I'm not sure it's
Regulation, that's key. I think the key is
information
And
Be able to tell people
What's really in the food? You know, I mean, I have a habit of walking up and down
supermarket aisles and picking up a package and looking
You know below that nutrition facts panel
there's that ingredient panel and you see what the first item is and it sometimes
Says wheat or whole wheat?
and
It became very interested in
Really looking into what's in that food?
What's in that box? I mean is that?
We I mean or that whole week really whole wheat
Are in fact is it been so highly processed?
Yes, the the brand and the germ may be added back
But the starch part is so rapidly processed. It's the equivalent of any refined
sugar or starch
So you wouldn't deregulation but maybe some more education. Would you change the nutrition labeling on foods?
So I would certainly change the ingredient panel. I think that ingredient panel that lists the in very fine print
Which we didn't do when we did the Nutrition Facts that top part
I think we have to make that ingredient panel by either
To use, you know, when we did the nutrition facts panel that box that has calories total fat
Sugar carbohydrates, I think we did a good job with calories with fat
with sugar
But I don't think we did a good job when we just said total
Carbohydrates because that really doesn't give people a sense
That those total carbohydrates can be acting in essence like sugar
Would you recommend perhaps changing the nutrition guidelines of Dietary Guidelines? I?
I think there needs to be considerable thought about that. The nutrition guidelines are written
For
Menino I the person who is metabolically healthy
Yeah
And I think that the fact is that vast majority of us don't fall into
That ideal person with the physiology
That they're writing those guidelines for the fact is I mean the majority of us struggle with our weight
with
blood lipids with blood glucose, you know different
Various of a part and numbers of us have different
issues
But the fact is I think we need to be writing guidelines for not only the ideal
physiology but also for those who are most vulnerable and I think
allowing these fast carbs to be
Continued to be consumed in the quantities. They're consumed
For those who struggle with their weight
Have problems with their blood sugar
I think that's a problem. So I think
We have to recognize
we have to protect those who are
Most vulnerable and the fact is that's most of us. Yeah at this point. Well, it's always a challenge in public health
I know to
First of all for all of us know certain things we should do and it's a lot easier to know those things
Than to do them. So there's there's that challenge but along the way for died in particular
It seems like we've seen so much conflicting advice over time. It's hard for people to keep track. What have you found?
What has been the most successful public health campaigns about diet that have really gotten people to understand something new in a way
That's beneficial to them. Yeah, I think that's a key question. I think that you know the nutrition community in some way
We've added to the confusion
Because
You there's so many diets. Everybody has their parochial interest and that's in part why I wrote the book
I wanted to simplify
You know simplifying recommendations
and cut through
The noise and that's why and I came down to three things
That I think most people can agree on
One is to limit the amount of these for a scarves and I think almost every nutritionist would agree
With that too. We haven't discussed it but to lower our
LDL or our blood
Lipids to try to get that as low as possible because I think there's a potential to wipe out cardio that asterisk erotic
Cardiovascular disease in our lifetime not and the third is for everyone to engage in moderate intensity exercise
yeah, you know I think rather than
talking about all the different
All the differences and all the nuances and the fights between
Scientists, I think we have an obligation to play it straight
And say look these are the things we can agree on and that's why I did the book great. Thanks
We got a few audience questions. I want to address or have you addressed
one is about these are related sort of artificial sweeteners and
Related in terms of diet drinks diet sodas. I know for awhile people thought diet sodas are better because there's fewer calories
You don't have real sugar, but then there's some evidence that actually people gain as much weight with diet sodas and so forth
So what about the health of these artificial sweeteners at all?
And then also is it better to have died drinks than the non diet drinks?
Yeah, you know that's a question. We've been asking for the last three four decades
And it's not a clear answer
To that, yeah, I mean I certainly in the case of
the individual who's going to drink a
200 calorie soda versus a zero calorie soda
The answer is zero is better than 200
Compared to water and other beverages they don't have these sweeteners
if you can
Do that. That's obviously
better
But there's still not a clear answer a scientific answer that I can point to data
that show the diet drinks are
the driver of
increased
appetite, you know, the problem is that people who drink diet sodas, I mean also,
Drank sodas. They also
Like sweeteners so that a lot of that
Research is sort of confounder
I don't think it's the diet soda as much as getting the brain conditioned to like sweeteners because once you do that
once you use food for the reward
Pathways, you're sort of stuck. It's from yeah. Um
One question we got to is how does one an alcohol fit into the whole fast carbs low carb equation?
Yeah, that's also a great question
And I can answer that
From the reward pathways as much as from the metabolic pathways
Because whether it's alcohol or whether it's
sweetened
beverages
Or it's hyper palatable foods, they all
work on the same reward pathways
and
They all give us this momentary bliss
They all can trigger
An emotional reaction when we get queued
So they work on the same pathways
Again the metabolic on you know, the metabolic issues. I mean are less
A less important the fact that they all really focus on that reward pathway. Mmm-hmm
We got a question about something that's been in the news a lot lately in the medical journals intermittent fasting
What are your thoughts about that?
Certainly if you intermittent fast you're going to
Reduce the number of calories the question is how long can you
Do it
You certainly will
quiet down
the metabolic pathways you're not flooding your bodies for
Periods of time
Whether
It it offers any super advantage
Over just cutting out
fast carbs
Over the long term. I haven't seen any data to suggest that there's any super properties of
intermittent fasting, but obviously if you fast
Less fast carbs less metabolic chaos, and that's important
But it's not clear
That there's any real super benefits. Ok. Ok. We're in another question - about
Whole wheat bread, is it ok to eat them in moderation?
so, I mean I'm not going to in moderation anything is
Is sort of fine but just recognize that much of the whole wheat out. There is not holy. I
Mean it is processed
And it's been highly processed
And that label has to change
We have to have much stricter requirements
Because for many
products consuming that whole wheat
Yes, you're getting some brand. You're getting some germ added back and maybe some benefit on that from that fibre
But the other big component of that whole wheat that endosperm that's highly refined
And it's problematic. So we shouldn't assume that whole wheat means healthy, right? That's correct all the way to
Question about gut bacteria and how to what degree does that impact the way people respond to a diet or calories?
an emerging feel
field
You know, if you can get food down into your lower GI tract and let some of the bacteria
Do the processing rather than the food manufacturer do the processing? I think we're much
Better off. It's still a lot of science that we
Don't know
but I'm all in favor of
You know the slow carbs and letting them interact
With the micro biome, I think that's much better than the processed stuff
That gets rapidly absorbed higher up in the geography
We had a question about what if somebody is on snap meaning, you know, they have lower income and they've got fewer choices
What are the healthiest fast carbs that they can get if they if they need to use them?
You know, I think there's have been a lot of work with snap
being able to encourage and create incentives and
Allow some of those snap dollars
to buy more
healthy foods
And I know people have been working
on that you
Know III think that if the goal is if it doesn't look like food
I mean III would stay away
I I think you did that structure that natural structure
because once you alter that natural structure of the food and you destroy
The integrity of that food that's going to be rapidly absorbed and that's problematic
So so look with the snap dollars if it looks like food
That's where I would spend those resources
Great. Well, there's a question about I just heard a little piece of trivia that the only natural food
That doesn't spoil is honey. Not sure if that's true
I heard that but the quantity the question for you is what's your opinion about honey? Yeah
You know there
There are
Certainly cultures where honey is a large part of the diet
In
certain
Areas where the
There but you see in those in those communities
With more primitive
And a lot more fruits a lot more vegetables no processing
You know and a lot more physical activity. I mean to me a if you're a marathon runner
If you're in that
Hunter-gatherer mode if you're expending a lot of energy
Is honey gonna be fine? Sure because you're gonna burn at all
Before
You're going to store it. So I don't think it is problematic that the real problem is about honey. And
these fast carbs
in an environment of plenty of overabundance of excess
calories
of positive energy balance
And I think that's where you run into two problems
Thursday in well
Because of your expertise and your role and Joe Biden's public health advisory committee
I know that our listeners want to hear your thoughts about the pandemic. So let's let's turn to that
Almost exactly two months ago was March 13th. You published an op-ed in The New York Times saying that was quote
There is this is March 13th you saying there is no reason the testing infrastructure can't be up and running in seven days
So that every person in America needs a test can be tested the president should demand it unquote
Now that infrastructure still isn't in place, obviously
Why not?
You know, I think that if you look at the numbers today
The numbers have gotten better. I mean there are a total of eight nine million
tests totally about
250,000 a day
But certainly not enough by anyone's
Standards, it was a question of taking
responsibility and
Accountability
and
also, I think
of
Competence I think the administration chose to leave it to others
and
Didn't take primary
responsibility
for getting up in place
the systems necessary
to
Do what the president said, which was for every American who wants to test they can get a test. I mean
Regrettably, that's not been the case. I think we're gonna eventually get there. It's still gonna take time, but we have lost
very precious time look the fact is that
for every
day
Every week
right that
we
let people
People were out there
Conducting business as usual going around when that virus had a jump on us
every day in March
Costs us and cost us dearly and we didn't have the testing when we needed to test and it's a problem now
we're up to you save 250 or
270,000 when one Harvard paper said that we need to go up to 20 million and
The Trump administration says there's no way that's going to happen
Do you believe we need to get up to as high as 20 million?
And and where do you think you can reasonably get to an amid the near-term?
You know, there's a new antigen test out
I think that will add millions more availability
certainly
Each week
So we will see the numbers go up significantly
The problem is we have to identify the asymptomatic carriers. Mm-hmm
if I'm
Take somebody who's 65 in their house, and they're wondering can I go out again? Will it be safe?
I mean, that's the question people are asking
mmm, and
if you
the answer is you know, you could go out is
I mean if you you have to know what the how much of iris there is in your community
I mean the people you're interacting with
are they positive and the problem is they may be positive and
They don't have symptoms
And that's the only way you're going to be able to know whether the people you're interacting with are positive is if they're tested
Yeah. Yeah, right. So I mean let's I think we can all agree the more testing that we do
the safer we can be
And we lost mightily because we weren't able to
realize that for weeks and weeks
This virus was spreading exponentially and we didn't even see it. Yeah, cuz of a lack of testing, right?
Now you wrote another piece in The New York Times last month that our collective
Behavior will be the primary determinant of whether we can keep this virus in check
So I want to ask you what are the key behaviors and then do you think we actually will follow?
I am concerned I
Am very concerned
When I see
the key tools
that we have available to combat this virus now in the absence of a vaccine of
in the absence of monoclonal
antibodies in the absence of a prophylactic drug therapy
We all we have I
Mean really our masks and social distancing and the ability to reduce our our contacts
Look, this is now
This has reached the White House with all its testing
they're still having positive cases and that shows you the
Degree that this virus is still out there. It's transmitting. It's transmitting today
You know, there's some 20,000
Confirmed new cases in the country, you know you you that those are the confirmed cases, you know
And if you just think about how many are out there that if not, they confirmed you some multiple five ten twenty
There's still a enormous amount of virus out there
And I think that the tools that we have are masks social distancing. Um
Trying to reduce the effective contacts between people so the virus can transmit and it and I see it
Increasingly becoming a political issue the mask issue
the
and I don't get that I
Mean we hold each other's fate in our hands how I act
Right if when I go out, I mean affects you and it affects my neighbor
and I don't think this is about
You know
I don't think we should think about this in terms of laws and regulations
And these are things I am mandated to do. I mean this to me is one of the great
Moral questions, I mean, how can we act as
individuals as citizens
How do we protect each other and and I would hope that everybody can?
understand
That that's what's at stake. Yeah. Yeah. Well clearly we're seeing a tension between
public health
and civil liberties and
Unfortunately often that seems to be breaking down by political party
But I will say the people who are more concerned about reopening the economy and civil liberties will say that hey
California was the first state to issue
these statewide shelter-in-place orders and feels very proud of that and kept most of its hospitals from getting overwhelmed, but
our new case rates been pretty stable for the last five or six weeks and
And you know public health people said we have to do that to make it drop why hasn't it drop?
It hasn't dropped because there's still transmission
I mean we plateaued as a country, but we're still hovering
You know you are the reproductive level is pretty
country pretty close
to one and there's not a lot of
room for error
For error here. Look we're at
twenty figure in New York City's what 20 percent immunity twenty five percent
Population immune serological tests aren't perfect. But
Let's let's take that number, you know most scientists recognize that we're not going to be able to slow down
this virus until
That herd immunity number gets to 60 70 percent
So this virus whether we like it or not is going to run its course
Just because we have you know, many of us have stayed
Home and had the privilege staying at home. Others have had to be out there
They've come back home. This virus is still
very
The the transmissibility is very high
It's not gone
By any means and I just don't understand you phrased this as a choice
between public health and civil liberties
I mean ask anyone who cares about their civil liberties
You know, what's the civil liberties of?
That you know 80 year old in a nursing home that
meat packer that person who works in that meatpacking
Plant that prisoner that prison guard
everyone in those tight
Circumstances, you know, this is about how we're going to take care of each other ai
Ai ai
I don't understand why we can't come together
as a country
and say look, of course we have to
Open up
But let's do it as safe as we can
Let's have for those of us who can continue to work at home. Let that happen for those
Who have to get the economy going?
Let that happen, but let's provide them
With the tools they need to do it safely
I don't I don't think it's that hard to come together and I just I don't get the dynamic. That's at play
of why we're fighting with each other and
Why there's not a unified approach to deal with this virus, you know
But to leave there is to some degree but understand the consequences of that. Yeah
Yeah, right. We are about 4% of the world's population. Mm-hmm
25 percent
plus of the deaths
And cases that go midnight. I mean, how do you think the rest of the world is looking at us right now?
We can't get our act together. Hmm, I
Mean the the consequences of this
Are
Enormous, I mean how how we act how we deal with this are how successful we are. I
mean is gonna be with us for
not only six months or a year, but for years to come I mean, you know
America was always the place
American leadership was always a place that was able to certainly
Lead coordinate on the vaccine side on the drug side
The the the entire global public health community and I think in some ways we're abrogating that responsibility
And if we don't get these numbers down if we don't get off this plateau
Right and keep us off this plateau
We have another wave like this. We have a wave that's greater. We have multiple ways. Hmm
We're not going to be sitting here and having the luxury of having these debates
of
You know, I don't want to wear a mask. I want to wear a mask. Yeah, we got to keep each other safe
Well, yeah. Yes, and you'd mentioned that New York has perhaps 20 25 percent immunity
Are you do you feel pretty strongly that those who have had the virus have been infected our immune afterwards?
You know immune for how long what do we mean by immunity?
There's no reason to doubt. I mean the general assumption that is held
For almost every other
You know virus is that the presence of neutralizing antibodies
Do confer some benefit now how long?
They confer that benefit how strong that benefit that remains to be seen but there's no reason to assume that
That immunity won't be there at least to some extent still more questions to be answered
So we're hopeful that you can't catch Co but a second time at least not very soon afterwards
but I mean, it's it's it's it's
That's a key. Look. It's a key question
Right, not only for whether you can catch. Yeah the second time that's not what I mean. That that's certainly going through my head
The real question is is a vaccine going to be effective. Mm-hmm
I mean because you have to make antibodies but you got to make the right antibodies. We've seen in certain cases
We've seen back in the 70s with RSV. We've seen with dengue fever more recently, but sometimes you make antibodies
To a vaccine and you can have you can make the infection even worse in certain populations. Mm-hmm. I
mean so that the basics of a vaccine we got to be able to
Hope that neutralizing antibodies or certainly a cell response and immune response along with those antibodies are
The immune faculties in our bodies the vaccines kind of work
We got to make sure I mean those antibodies and those immune cells have to work. Right right. Um
One more question on on this in this area is there seems to be a lot of different estimates of the percentage of Americans who?
Have been infected as well as what the death rate is for those infections a lot of controversies even two orders of magnitude difference
What are your thoughts about that?
So I can tell you if you look at the New York numbers I try to calculate it yesterday. I got a
infection fatality rate of
About point eight two point nine. There's a health affairs article that came out
About a week ago that had the case the infection fatality rate of one point
three
There's a meta-analysis where it comes out to 0.75
Take all those numbers
Together and you know assume it's point seven point eight percent. We will get better data
is
Compared to flu which is point one
There's no doubt that
The lethality of kovat is several multiple fold greater than flu
also just back at the envelope if
We went for hurt immunity and that took 75 percent of the population to get there and we have a roughly 1 percent
Point 8 percent mortality rate you're talking about maybe a million Americans who died
That's an awful lot of people
so
It is all
I mean, this is all a race. Yeah, right. Yeah between keeping people safe
Until that time when we can get either convalescent plasma monoclonal antibodies to give people
The
Antibodies, they need to prevent or to treat or a vaccine
Look, we just have to we just have to keep these big waves
From reoccurring yes. Let's look. Let's slow that down
Until we can get better therapies. You know, what's key here, and that's progress
I mean we're taking I mean, I I see a way to take the lethality out of this virus you saw positive
Results with REM dis aveer doesn't for the viral phase. There's an inflammatory phase, you know a second phase where people crash
and get this a RDS pattern there are
Anti-inflammatory drugs for which this clinical effect. We're going to be able to put together different
combination therapies
That will reduce the fatality and by reducing the fatality associated with this we can at least manage
this disease without the threat of
the death rate
Being what you suggest
Great, whatever as important as this issue is people on the who are watching want to get back to talk about carbs
so I have another couple questions for you about that and one is about the relationship between
Carbs and glycemic indices. I know you talked about this in the book is the same thing
yeah, so their glycemic index is
one measure of carbohydrate
rise
in blood
Glucose and you can think about it that way
The problem is glycemic index for a number of reasons is not a perfect test
So I think that certainly fast carbs
do correlate
with higher
glycemic index
The problem is sometimes you can have foods that are low glycemic index and for certain
Aberrations there are also fast
Carbs, there are some other research measures how quickly the starch is absorbed
but there certainly
It's one metric that can be used
What's the best way here's another question to overhaul a diet to get rid of the fast carbs
Cut out processed foods, but it's pretty pretty simple overall there -
And here's a question that sort of bridges the two topics
So it's not quite about carbs and it's about vitamin D that most people who die from COBIT
Coordinate this audience member have been found to be low in vitamin D
So if that's the case which supplements reduce the risk of getting sick or ill from phobic
Yeah, I haven't seen that data and I need
To look at that data in a will
But just without seeing that data I can't comment
okay, how do you plant based diets relate to your recommendations regarding clothes, so
Plant-based diets
Again can be good but I mean, you know plants produce a lot of starch
That's a fast
carb, so the real question
Is what kind of plant-based?
Diet
I
Think is is key. So
again
One can't just generalize and say all plant-based diets heavy starch
rapidly absorbed
Just course it's plant
is not going to
Get you to where you you want I think that whole plant diets, you know non-processed foods
Plant diets and I think that's probably the intent of the question
No, no doubt that if one's looking for the optimal diet certainly both to reduce fast carbs
As well as to reduce LDL
We haven't spent any time doing that
Plant-based diets can be very effective in
Doing it you can get a reduction of as much as 40 percent in your LDL
Which we know is positive with asters chronic heart disease by a plant-based diet. At least many people
It's not going to be as powerful as some of the drugs out there
But certainly a major advantage in lowering your LDL. Yeah, I know
she was interesting what your second major recommendation about reducing LDL said
You know do it via a plant-based diet or medication and talk about the differences or why you would want both of those?
so
No doubt that if we can get LDL down in this country
You know, we now know that LDL is elder the number of LDL particles
Let me be exact for the scientists who are listening the number of LDL
particles
Is causal certainly on the causal chain?
Right and if we can reduce on a popular a population wide basis everyone's LDL
significantly, we can wipe out 70 to 80 percent of
Cardiovascular after Estrada cardiovascular disease we can have as big effect on our health as we had on tobacco
If we can reduce that
LDL and the easiest way to do that is with a plant-based
Diet now drugs you can get there and in some ways you can get there faster and you can reduce your LDL
stronger, but I didn't want to just focus on
Drugs, I mean, I think that would be a mistake
I think diet is a big part of that
You know, I asked the great cardiologist Jean Brown wall, you know
If drugs work so effectively do you just say let's forget about diet
and he said no, I mean it is the first
thing that we should all
focus on because medicines do have
Some side effects they are not
the perfect
Answer and if you can get your LDL down and we all do that we can wipe out much of cart disease, you know
certainly a thorough sporadic heart disease in our lifetime terrific
Well, I have a specific question about the humble potato
Our potatoes faster slow carbs and the aren't process but aren't they full of sugar? Should we need more potatoes? The fact is that
When you cook that potato you gelatinize that potato and it becomes a fast
car I
Mean can you have the structure the potato maintained?
So it's less rapidly absorbed sure certain boiled potatoes do not
have the same effect the vast majority of these potatoes are processed and they are you know,
It's just it's like eating any other sugar. No see you wouldn't prescribe french fries. Yes
that's
That's clear and difference between white potatoes versus sweet potatoes or yams
So a great question, right?
Different kinds of starts certain starches are resistant starches
In the in the sweet potatoes and others so they don't get as rapidly absorbed
It's a good question. Right? So tactically someone asks what are five plants that we should eat
Five plants my plan on that. Well, you know the question is also what five five grains
We should eat and there are certain grains
Such as
Buckwheat
pumpernickel
Certain kinds of flowers that are more resistant
starches
The answer is any plant
Whose structure is intact?
Right or essentially intact and has not been pulverized and not subjected
to the thermo mechanical forces
That food processing. So any plant whose structures intact, that's probably how we make them
Okay, and then here's the reverse type of question. What are the very worst processed foods?
Anything that takes
that wheat kernel
subjects it to intense heat
intense shear forces
and makes it into something that
Doesn't look like food, you know
I'm so it's anything that has been subject to that intense heat and those attendants shear forces that's going to destroy
the starch molecules
Increase the surface area increase the rates of Y which we digest them
And if I'm not a scientist and I want to understand how much things have been pulverized or processed
Is there a way I can tell that from the label on the package?
FairPoint no
You can look in the box and say does it look like anything like food that anything that's grown so you can have a sense
If it's not growing in that form in that field
If you haven't seen it in nature like that
It's going to be have been
subjected to pretty intense heat pretty intense shear forces and
Some one last question you see function if food is intact what what has really intact mean in this context? So
What you want?
is
The food just not
The membranes
the the structure the way the starch molecule is even packed together once you destroy
That by intense heat by intense shear forces you're going to increase the surface area
And you're going to increase the ability of our enzymes, you know
You know that justice system to quickly absorb those molecules
So, I mean it's it's a question of literally pummeling that food, which is what food processing does. Yeah
Yeah, I remember when I was a kid. I used to love orange juice
I thought it was so healthy for me and I later learned that just drinking the orange juice by itself was a very high
Percentage of sugar whereas eating the orange is much healthier
You have the structure. You have the fiber. I mean sure you some of the juice
that
is still there, and it's there's still
some sugar, but you have a greater chance of
Because of that structure that food because of that fiber
of much of that orange make eating into the lower part of your GI tract and it's not going to be as rapid or
And do you worry it can some weight can one eat too much fruit
Sure, I mean, but I mean, you know terms of getting too much sugar from free if you're just eating regular fruit
Yeah, look, I mean you asked me the question about could I you know in moderation?
Earlier absolutely, I think the fruit has there's no doubt that
As long as that structure is intact are there sugars in that fruit, yes
but that doesn't concern me as much as
When that fruit has been processed and it all has been transformed into a fast car. Gotcha, okay
Well, we are just getting to the end of our time and we spent the majority of it on on carbs
But I did want to get you a chance since he didn't say everything you may have wanted to say on the pandemic
For one last question. And the question is this what's the one piece of advice? You would give the Trump administration?
About managing the pandemic at this point
Let the scientists go out front and let the politicians
Recede into the background
We're only going to get through this
if we trust
Our public officials because they again we talked earlier
This is not going to be we're not going to get through this because of laws or regulations. We're going to get through this
because we have the
the moral sense of we each are going to do what's right, and if people can galvanize
That collective sense and we all feel that we're being played straight. Just give us the facts
the American people can handle
The facts we will get through this. It's the mixed messages. It's the spin
It's the promises
that will never be
fulfilled
That just is making this as hard as this is
It's making this even more difficult
Okay, well thank you for that I want to give a big thank you to dr
David Kessler the author of the new book fast carbs and slow carbs
we encourage you to order your copy today through your local independent store or
Noble.com I also want to thank all of the visitors and viewers viewing us online. I
Want to remind you the club has a wide range of virtual programming both koba and non Kovach related
Not that many more things on carbs, but but but some good content nonetheless, and if you enjoyed today's program
Please consider supporting our our organization though the oldest and largest
Public affairs forum in the country you can donate online at www.norfolk.gov
You

Transcript

Hello, welcome to today's meeting of the Commonwealth club's health and medicine forum. I'm mark slitter Chair of the sedima project a member of the club's Board of Governors and your moderator for today Presently the Commonwealth club has suspended all of its in-person programming for obvious reasons But we are hosting a series of virtual events including this one. You can learn all about them Some of them are code related some are not at our website Www.prophecyinthenews.com Burrup several times during the course this program for your convenience And we also encourage you to like subscribe and share videos like this one with your families and friends Announce time for me to introduce today's special guest. Dr David, kessler author of the new book fast carbs slow carbs the simple truth about food weight and disease Dr. Kessler served as commissioner of the US Food and Drug Administration from 1990 to 1997 under both President George HW Bush and President Bill Clinton during his tenure He helped design the Nutrition Facts label that appear on all packaged foods After leaving the agency he served as the Dean of the medical schools at both Yale and the University of California, San Francisco in 2009 he published the end of overeating a book that investigated how processed food companies Design products that have powerful effects on the brain that lead people to crave. I consume them uncontrolled He's a pediatrician by background and has published several recent New York Times op eds. ANCOVA 19 He also was named recently to Joe Biden's public health advisory committee And today will talk both about diet and the pandemic so welcome. Dr. David Kessler nice to have you with us Thank you so much for having me We start with this As you mentioned in your book more than two-thirds of Americans are either overweight or obese and only an astonishingly load 12% of us are fully metabolically healthy Those are stunning statistics and sound like a crisis worthy of writing a book about But of course there are many other diet books on the market including one that you wrote yourself So what do you hope the readers will take away from this book? That's different So, you know the question it's a fascinating question the way you phrased it You think it's a diet book Certainly talked about diet and health obviously, so most the time the reason I just smiled when you said that Most I had books focus on weight And the goal was to answer a very important question And really was the role of diet and metabolic health and the health Consequences now weight is key. I Mean weight is central as much as I would like to say you could be healthy of any weight the fact is when you age It sort of catches up and it has consequences, but I was very interested in Understanding that that statistic that you excited Why are? 87 88 percent of us. Why don't we meet you know basic guidelines for not only weight? but blood pressure blood lipids blood glucose and Why are our bodies in essence in metabolic chaos, and what's driving that and what's the relationship? Of the foods we're consuming to Those diseases and the consequences of those diseases So this was a follow-up to your previous book and something that struck me most about your book was for years We've been hearing that a calorie is a calorie is a calorie and if you want to lose or maintain weight then what you need To do is watch the number of calories you eat But a central theme of your book is that you claim that what we eat is as important Or almost as important as how much we eat and the two types of carbs is your prime example So I guess this leads us to the title of your book what are fast carbs versus slow carbs? so fast carbs Include both sugars that you know many people have written about and talked about but it's also starches its sugars and starches that end up being rapidly absorbed in our gastrointestinal tract and For many people who are you know have to struggle with their weight or metabolically vulnerable that though at rapid ingestion that almost had that endless flood that streaming of this rapidly digestible glucose because all that sugar and starch gets made into Rapidly absorbable glucose what's the consequence of that? That really was the central question and those are fast carbs So it's it's all sugars But it's also all starches that are rapidly absorbable now slow carbs are those carbohydrates those fibers Did you not get rapidly absorbed in our GI tract? They don't get absorbed in the upper GI tract and they make it down to the lower parts. Where the bacteria Are and also can stimulate other hormones satiety signals so vegetables legumes Those are slow carbs Well the most striking thing I took away from the book was about not only how quickly they're absorbed but how much of them has absorbed so my understanding from your book was that the fast carbs get absorbed very quickly and Pretty much completely. Whereas the slow carbs you mentioned about half of those calories We actually never make that they actually never come into our body so they don't turn into weight Exactly, you know, we don't know all the mechanisms by which These fast carbs have the consequences they do we know For the for many people they can have, you know severe consequences both pre-diabetes Diabetes they go on cardiovascular Complications so we don't know all the science behind the effects of these fast carbs But we know that you know, they affect I mean they're in essence predigested right so we eat them Our eating rate is quicker with them. They go down go down in a whoosh they get all absorbed all those calories There's effect certainly on insulin. They don't get down lower in the GI tract so they don't stimulate Satiety hormones. So there are a lot of different mechanisms right by which they act and we never you know, when we over the last hundred years as We've created one of these great food processing bahamut's You know in the United States We never really ask the consequences what you know, what are the effects of? processing of taking the structure out of much of the food and With the end result that these fast carbs get so rapidly absorbed. What's the effect of this flood of glucose on our bodies? Yeah, and your book maybe think about you know, one of the reasons we eat is because it tastes good We like it. Certainly another one is that we're hungry And these are related but not the same thing and I hadn't realized how the different types of carbs Differentially affect our feelings of hunger and satiety. Can you see a little more about that so fast carbs get absorbed in the upper GI Tract as you stated, they virtually all get absorbed. They get absorbed very quickly We know that they trigger blood glucose elevations blood insulin. We know that those Hormones have effect on our brains We know that that catches us in these vicious Cycles, but one of the things that fast carbs don't do is they don't get down to the lower GI tract and it's the lower GI crack also is where hormones get really their Release and they can create signals of satiety of fullness So I mean is it the fact that these fast carbs are not getting? Down to the lower part of the GI tract not having these satiety signals That's certainly one of the mechanisms that I think is in play They catch us in this these endless cycles of overeating so we can eat these fast carbs But still feel just as hungry as before you ate them anyway absolutely, look, you know the the the fact is That much of these fast carbs are also delivery vehicles I you know the this starch I mean the read about a thousand Calories of these fast carbs a day on average, you know starch itself If you go back to kindergarten you'll remember, you know starch is this paste? It's it's this bland, you know, you you won't want to eat it But now when you realize that starch is a carrier for fat sugar and salt That fat sugar and salt in that carrier also triggers And makes food Super palatable and I believe you say that starch actually is is is in the majority of these fast carbs, right? well That's exactly correct. We certainly we focused a lot, you know over the last decade a lot of good work on sugar But the fact is that it's not just sugar. It's sugar and starch and You know while there's no doubt that the American diet contains a lot of sucrose The vast majority of these processed foods the central component Is starch so it's starch and sugar Now, I'm sure that part of the reason you focused on this topic is you're a doctor. You're a scientist You're former FDA head but you've also been public about some of your own struggles with weight and diet So tell us how those things informed or motivated you to write this book You know, so I mean I've have suits in every size I have gained and and lost weight Repeatedly, you know, but the hard part is to be able To keep it off That's the the real struggle and when you study when you look at these studies You find that almost any diet. People can lose weight in the short term But it's around six months where weight starts creeping Back up And the fact is that in many of those studies where weight comes back after six months You see that it's the introduction People go back to what they used to be eating and much of that is fast carbs So the diet works in the short term But this notion that a diet you lose the weight and then you don't have to be on it That's just not the way the thermodynamics work. Ya have to be on it. I mean for a lifetime because soon as you let up and especially For people who? You know struggle with their weight who are metabolically vulnerable who have Pre-diabetes. Once you start reintroducing these processed carbs. It's almost impossible to keep the weight off So do you have any tips or things that have been successful for you in that regard? You know I find you know for me that almost any processed carb You know leads to more processed carbs lead to more processed carbs you know, and I want to be careful mark, you know, this is you know, we're Still a lot of stress out there people a lot of anxiety people want comfort And the fact is these highly processed foods You know, they taste great. I mean you you eat them That starch is loaded with fat and sugar fat sugar and salt And you eat it and you're in this momentary bliss and I don't want to take away that that comfort There's also you know, the question of what you can get hold of what's in the house What you can afford But I think if you look from a health point of view Certainly, you know my goal is once when this is over when we can both come out of our houses and once You know down the road we there's a semblance of normality Whenever that is I think we want to emerge it would be nice to emerge healthier and I don't know any diet That really is successful That contains process cops'll you know, there's a lot of confusion out there. What's the best diet? There is paleo There is low fat there is Mediterranean there is keto When you know when you really look carefully all of them Recommend taking out these fast carbs. Yes. That's something you have in common. So that's good Let's get a very tactical for a second Which carbs? Should we eat more and less of and as you answer I want you to comment on two terms that I learned something from in Your book about a little more about complex carbohydrates and whole wheat? Both are very confusing and can be misleading Terms, you know go back to the 1970s and 1980s And the recommendations of the various government agencies I reduced total fat Reduce saturated fat reduce simple sugars, but then they said, you know increased total Ingestion of complex carbohydrates and no one distinguished when they use that term And people follow those recommendations No one distinguished fast carbs from slow carbs, so I think we should get rid of that term complex carbohydrates and realize that its starch and sugar which can Be rapidly absorbed and have consequences Mm-hmm. So give us an example of the foods. We should definitely eat more of and eat less of There's you know the slow carbs Have I mean the key? Aspect of them is they have this structure is intact. I mean, it looks like food right, I mean and that's the key because even in those vegetables and like use I mean there is some starch in it, but it's relatively Modest but the important part is that that I mean in that whole food That food has not been processed to the extent. It's not undergone both the temperature the thermo and mechanical the the pummeling of that that wheat that you know makes those That starch those grains so rapidly absorbed so the key is to stay away from anything that is That is processed or certainly highly processed, you know It's doing that pre processing for us now in the in this book You take two tasks the food industry for promoting fast carbs that appeal to our taste buds And they're cheap to produce but they're often appallingly bad for our health So if you now are FDA Commissioner, would you recommend regulating those companies differently and if so, how? you know, I'm not sure it's Regulation, that's key. I think the key is information And Be able to tell people What's really in the food? You know, I mean, I have a habit of walking up and down supermarket aisles and picking up a package and looking You know below that nutrition facts panel there's that ingredient panel and you see what the first item is and it sometimes Says wheat or whole wheat? and It became very interested in Really looking into what's in that food? What's in that box? I mean is that? We I mean or that whole week really whole wheat Are in fact is it been so highly processed? Yes, the the brand and the germ may be added back But the starch part is so rapidly processed. It's the equivalent of any refined sugar or starch So you wouldn't deregulation but maybe some more education. Would you change the nutrition labeling on foods? So I would certainly change the ingredient panel. I think that ingredient panel that lists the in very fine print Which we didn't do when we did the Nutrition Facts that top part I think we have to make that ingredient panel by either To use, you know, when we did the nutrition facts panel that box that has calories total fat Sugar carbohydrates, I think we did a good job with calories with fat with sugar But I don't think we did a good job when we just said total Carbohydrates because that really doesn't give people a sense That those total carbohydrates can be acting in essence like sugar Would you recommend perhaps changing the nutrition guidelines of Dietary Guidelines? I? I think there needs to be considerable thought about that. The nutrition guidelines are written For Menino I the person who is metabolically healthy Yeah And I think that the fact is that vast majority of us don't fall into That ideal person with the physiology That they're writing those guidelines for the fact is I mean the majority of us struggle with our weight with blood lipids with blood glucose, you know different Various of a part and numbers of us have different issues But the fact is I think we need to be writing guidelines for not only the ideal physiology but also for those who are most vulnerable and I think allowing these fast carbs to be Continued to be consumed in the quantities. They're consumed For those who struggle with their weight Have problems with their blood sugar I think that's a problem. So I think We have to recognize we have to protect those who are Most vulnerable and the fact is that's most of us. Yeah at this point. Well, it's always a challenge in public health I know to First of all for all of us know certain things we should do and it's a lot easier to know those things Than to do them. So there's there's that challenge but along the way for died in particular It seems like we've seen so much conflicting advice over time. It's hard for people to keep track. What have you found? What has been the most successful public health campaigns about diet that have really gotten people to understand something new in a way That's beneficial to them. Yeah, I think that's a key question. I think that you know the nutrition community in some way We've added to the confusion Because You there's so many diets. Everybody has their parochial interest and that's in part why I wrote the book I wanted to simplify You know simplifying recommendations and cut through The noise and that's why and I came down to three things That I think most people can agree on One is to limit the amount of these for a scarves and I think almost every nutritionist would agree With that too. We haven't discussed it but to lower our LDL or our blood Lipids to try to get that as low as possible because I think there's a potential to wipe out cardio that asterisk erotic Cardiovascular disease in our lifetime not and the third is for everyone to engage in moderate intensity exercise yeah, you know I think rather than talking about all the different All the differences and all the nuances and the fights between Scientists, I think we have an obligation to play it straight And say look these are the things we can agree on and that's why I did the book great. Thanks We got a few audience questions. I want to address or have you addressed one is about these are related sort of artificial sweeteners and Related in terms of diet drinks diet sodas. I know for awhile people thought diet sodas are better because there's fewer calories You don't have real sugar, but then there's some evidence that actually people gain as much weight with diet sodas and so forth So what about the health of these artificial sweeteners at all? And then also is it better to have died drinks than the non diet drinks? Yeah, you know that's a question. We've been asking for the last three four decades And it's not a clear answer To that, yeah, I mean I certainly in the case of the individual who's going to drink a 200 calorie soda versus a zero calorie soda The answer is zero is better than 200 Compared to water and other beverages they don't have these sweeteners if you can Do that. That's obviously better But there's still not a clear answer a scientific answer that I can point to data that show the diet drinks are the driver of increased appetite, you know, the problem is that people who drink diet sodas, I mean also, Drank sodas. They also Like sweeteners so that a lot of that Research is sort of confounder I don't think it's the diet soda as much as getting the brain conditioned to like sweeteners because once you do that once you use food for the reward Pathways, you're sort of stuck. It's from yeah. Um One question we got to is how does one an alcohol fit into the whole fast carbs low carb equation? Yeah, that's also a great question And I can answer that From the reward pathways as much as from the metabolic pathways Because whether it's alcohol or whether it's sweetened beverages Or it's hyper palatable foods, they all work on the same reward pathways and They all give us this momentary bliss They all can trigger An emotional reaction when we get queued So they work on the same pathways Again the metabolic on you know, the metabolic issues. I mean are less A less important the fact that they all really focus on that reward pathway. Mmm-hmm We got a question about something that's been in the news a lot lately in the medical journals intermittent fasting What are your thoughts about that? Certainly if you intermittent fast you're going to Reduce the number of calories the question is how long can you Do it You certainly will quiet down the metabolic pathways you're not flooding your bodies for Periods of time Whether It it offers any super advantage Over just cutting out fast carbs Over the long term. I haven't seen any data to suggest that there's any super properties of intermittent fasting, but obviously if you fast Less fast carbs less metabolic chaos, and that's important But it's not clear That there's any real super benefits. Ok. Ok. We're in another question - about Whole wheat bread, is it ok to eat them in moderation? so, I mean I'm not going to in moderation anything is Is sort of fine but just recognize that much of the whole wheat out. There is not holy. I Mean it is processed And it's been highly processed And that label has to change We have to have much stricter requirements Because for many products consuming that whole wheat Yes, you're getting some brand. You're getting some germ added back and maybe some benefit on that from that fibre But the other big component of that whole wheat that endosperm that's highly refined And it's problematic. So we shouldn't assume that whole wheat means healthy, right? That's correct all the way to Question about gut bacteria and how to what degree does that impact the way people respond to a diet or calories? an emerging feel field You know, if you can get food down into your lower GI tract and let some of the bacteria Do the processing rather than the food manufacturer do the processing? I think we're much Better off. It's still a lot of science that we Don't know but I'm all in favor of You know the slow carbs and letting them interact With the micro biome, I think that's much better than the processed stuff That gets rapidly absorbed higher up in the geography We had a question about what if somebody is on snap meaning, you know, they have lower income and they've got fewer choices What are the healthiest fast carbs that they can get if they if they need to use them? You know, I think there's have been a lot of work with snap being able to encourage and create incentives and Allow some of those snap dollars to buy more healthy foods And I know people have been working on that you Know III think that if the goal is if it doesn't look like food I mean III would stay away I I think you did that structure that natural structure because once you alter that natural structure of the food and you destroy The integrity of that food that's going to be rapidly absorbed and that's problematic So so look with the snap dollars if it looks like food That's where I would spend those resources Great. Well, there's a question about I just heard a little piece of trivia that the only natural food That doesn't spoil is honey. Not sure if that's true I heard that but the quantity the question for you is what's your opinion about honey? Yeah You know there There are Certainly cultures where honey is a large part of the diet In certain Areas where the There but you see in those in those communities With more primitive And a lot more fruits a lot more vegetables no processing You know and a lot more physical activity. I mean to me a if you're a marathon runner If you're in that Hunter-gatherer mode if you're expending a lot of energy Is honey gonna be fine? Sure because you're gonna burn at all Before You're going to store it. So I don't think it is problematic that the real problem is about honey. And these fast carbs in an environment of plenty of overabundance of excess calories of positive energy balance And I think that's where you run into two problems Thursday in well Because of your expertise and your role and Joe Biden's public health advisory committee I know that our listeners want to hear your thoughts about the pandemic. So let's let's turn to that Almost exactly two months ago was March 13th. You published an op-ed in The New York Times saying that was quote There is this is March 13th you saying there is no reason the testing infrastructure can't be up and running in seven days So that every person in America needs a test can be tested the president should demand it unquote Now that infrastructure still isn't in place, obviously Why not? You know, I think that if you look at the numbers today The numbers have gotten better. I mean there are a total of eight nine million tests totally about 250,000 a day But certainly not enough by anyone's Standards, it was a question of taking responsibility and Accountability and also, I think of Competence I think the administration chose to leave it to others and Didn't take primary responsibility for getting up in place the systems necessary to Do what the president said, which was for every American who wants to test they can get a test. I mean Regrettably, that's not been the case. I think we're gonna eventually get there. It's still gonna take time, but we have lost very precious time look the fact is that for every day Every week right that we let people People were out there Conducting business as usual going around when that virus had a jump on us every day in March Costs us and cost us dearly and we didn't have the testing when we needed to test and it's a problem now we're up to you save 250 or 270,000 when one Harvard paper said that we need to go up to 20 million and The Trump administration says there's no way that's going to happen Do you believe we need to get up to as high as 20 million? And and where do you think you can reasonably get to an amid the near-term? You know, there's a new antigen test out I think that will add millions more availability certainly Each week So we will see the numbers go up significantly The problem is we have to identify the asymptomatic carriers. Mm-hmm if I'm Take somebody who's 65 in their house, and they're wondering can I go out again? Will it be safe? I mean, that's the question people are asking mmm, and if you the answer is you know, you could go out is I mean if you you have to know what the how much of iris there is in your community I mean the people you're interacting with are they positive and the problem is they may be positive and They don't have symptoms And that's the only way you're going to be able to know whether the people you're interacting with are positive is if they're tested Yeah. Yeah, right. So I mean let's I think we can all agree the more testing that we do the safer we can be And we lost mightily because we weren't able to realize that for weeks and weeks This virus was spreading exponentially and we didn't even see it. Yeah, cuz of a lack of testing, right? Now you wrote another piece in The New York Times last month that our collective Behavior will be the primary determinant of whether we can keep this virus in check So I want to ask you what are the key behaviors and then do you think we actually will follow? I am concerned I Am very concerned When I see the key tools that we have available to combat this virus now in the absence of a vaccine of in the absence of monoclonal antibodies in the absence of a prophylactic drug therapy We all we have I Mean really our masks and social distancing and the ability to reduce our our contacts Look, this is now This has reached the White House with all its testing they're still having positive cases and that shows you the Degree that this virus is still out there. It's transmitting. It's transmitting today You know, there's some 20,000 Confirmed new cases in the country, you know you you that those are the confirmed cases, you know And if you just think about how many are out there that if not, they confirmed you some multiple five ten twenty There's still a enormous amount of virus out there And I think that the tools that we have are masks social distancing. Um Trying to reduce the effective contacts between people so the virus can transmit and it and I see it Increasingly becoming a political issue the mask issue the and I don't get that I Mean we hold each other's fate in our hands how I act Right if when I go out, I mean affects you and it affects my neighbor and I don't think this is about You know I don't think we should think about this in terms of laws and regulations And these are things I am mandated to do. I mean this to me is one of the great Moral questions, I mean, how can we act as individuals as citizens How do we protect each other and and I would hope that everybody can? understand That that's what's at stake. Yeah. Yeah. Well clearly we're seeing a tension between public health and civil liberties and Unfortunately often that seems to be breaking down by political party But I will say the people who are more concerned about reopening the economy and civil liberties will say that hey California was the first state to issue these statewide shelter-in-place orders and feels very proud of that and kept most of its hospitals from getting overwhelmed, but our new case rates been pretty stable for the last five or six weeks and And you know public health people said we have to do that to make it drop why hasn't it drop? It hasn't dropped because there's still transmission I mean we plateaued as a country, but we're still hovering You know you are the reproductive level is pretty country pretty close to one and there's not a lot of room for error For error here. Look we're at twenty figure in New York City's what 20 percent immunity twenty five percent Population immune serological tests aren't perfect. But Let's let's take that number, you know most scientists recognize that we're not going to be able to slow down this virus until That herd immunity number gets to 60 70 percent So this virus whether we like it or not is going to run its course Just because we have you know, many of us have stayed Home and had the privilege staying at home. Others have had to be out there They've come back home. This virus is still very The the transmissibility is very high It's not gone By any means and I just don't understand you phrased this as a choice between public health and civil liberties I mean ask anyone who cares about their civil liberties You know, what's the civil liberties of? That you know 80 year old in a nursing home that meat packer that person who works in that meatpacking Plant that prisoner that prison guard everyone in those tight Circumstances, you know, this is about how we're going to take care of each other ai Ai ai I don't understand why we can't come together as a country and say look, of course we have to Open up But let's do it as safe as we can Let's have for those of us who can continue to work at home. Let that happen for those Who have to get the economy going? Let that happen, but let's provide them With the tools they need to do it safely I don't I don't think it's that hard to come together and I just I don't get the dynamic. That's at play of why we're fighting with each other and Why there's not a unified approach to deal with this virus, you know But to leave there is to some degree but understand the consequences of that. Yeah Yeah, right. We are about 4% of the world's population. Mm-hmm 25 percent plus of the deaths And cases that go midnight. I mean, how do you think the rest of the world is looking at us right now? We can't get our act together. Hmm, I Mean the the consequences of this Are Enormous, I mean how how we act how we deal with this are how successful we are. I mean is gonna be with us for not only six months or a year, but for years to come I mean, you know America was always the place American leadership was always a place that was able to certainly Lead coordinate on the vaccine side on the drug side The the the entire global public health community and I think in some ways we're abrogating that responsibility And if we don't get these numbers down if we don't get off this plateau Right and keep us off this plateau We have another wave like this. We have a wave that's greater. We have multiple ways. Hmm We're not going to be sitting here and having the luxury of having these debates of You know, I don't want to wear a mask. I want to wear a mask. Yeah, we got to keep each other safe Well, yeah. Yes, and you'd mentioned that New York has perhaps 20 25 percent immunity Are you do you feel pretty strongly that those who have had the virus have been infected our immune afterwards? You know immune for how long what do we mean by immunity? There's no reason to doubt. I mean the general assumption that is held For almost every other You know virus is that the presence of neutralizing antibodies Do confer some benefit now how long? They confer that benefit how strong that benefit that remains to be seen but there's no reason to assume that That immunity won't be there at least to some extent still more questions to be answered So we're hopeful that you can't catch Co but a second time at least not very soon afterwards but I mean, it's it's it's it's That's a key. Look. It's a key question Right, not only for whether you can catch. Yeah the second time that's not what I mean. That that's certainly going through my head The real question is is a vaccine going to be effective. Mm-hmm I mean because you have to make antibodies but you got to make the right antibodies. We've seen in certain cases We've seen back in the 70s with RSV. We've seen with dengue fever more recently, but sometimes you make antibodies To a vaccine and you can have you can make the infection even worse in certain populations. Mm-hmm. I mean so that the basics of a vaccine we got to be able to Hope that neutralizing antibodies or certainly a cell response and immune response along with those antibodies are The immune faculties in our bodies the vaccines kind of work We got to make sure I mean those antibodies and those immune cells have to work. Right right. Um One more question on on this in this area is there seems to be a lot of different estimates of the percentage of Americans who? Have been infected as well as what the death rate is for those infections a lot of controversies even two orders of magnitude difference What are your thoughts about that? So I can tell you if you look at the New York numbers I try to calculate it yesterday. I got a infection fatality rate of About point eight two point nine. There's a health affairs article that came out About a week ago that had the case the infection fatality rate of one point three There's a meta-analysis where it comes out to 0.75 Take all those numbers Together and you know assume it's point seven point eight percent. We will get better data is Compared to flu which is point one There's no doubt that The lethality of kovat is several multiple fold greater than flu also just back at the envelope if We went for hurt immunity and that took 75 percent of the population to get there and we have a roughly 1 percent Point 8 percent mortality rate you're talking about maybe a million Americans who died That's an awful lot of people so It is all I mean, this is all a race. Yeah, right. Yeah between keeping people safe Until that time when we can get either convalescent plasma monoclonal antibodies to give people The Antibodies, they need to prevent or to treat or a vaccine Look, we just have to we just have to keep these big waves From reoccurring yes. Let's look. Let's slow that down Until we can get better therapies. You know, what's key here, and that's progress I mean we're taking I mean, I I see a way to take the lethality out of this virus you saw positive Results with REM dis aveer doesn't for the viral phase. There's an inflammatory phase, you know a second phase where people crash and get this a RDS pattern there are Anti-inflammatory drugs for which this clinical effect. We're going to be able to put together different combination therapies That will reduce the fatality and by reducing the fatality associated with this we can at least manage this disease without the threat of the death rate Being what you suggest Great, whatever as important as this issue is people on the who are watching want to get back to talk about carbs so I have another couple questions for you about that and one is about the relationship between Carbs and glycemic indices. I know you talked about this in the book is the same thing yeah, so their glycemic index is one measure of carbohydrate rise in blood Glucose and you can think about it that way The problem is glycemic index for a number of reasons is not a perfect test So I think that certainly fast carbs do correlate with higher glycemic index The problem is sometimes you can have foods that are low glycemic index and for certain Aberrations there are also fast Carbs, there are some other research measures how quickly the starch is absorbed but there certainly It's one metric that can be used What's the best way here's another question to overhaul a diet to get rid of the fast carbs Cut out processed foods, but it's pretty pretty simple overall there - And here's a question that sort of bridges the two topics So it's not quite about carbs and it's about vitamin D that most people who die from COBIT Coordinate this audience member have been found to be low in vitamin D So if that's the case which supplements reduce the risk of getting sick or ill from phobic Yeah, I haven't seen that data and I need To look at that data in a will But just without seeing that data I can't comment okay, how do you plant based diets relate to your recommendations regarding clothes, so Plant-based diets Again can be good but I mean, you know plants produce a lot of starch That's a fast carb, so the real question Is what kind of plant-based? Diet I Think is is key. So again One can't just generalize and say all plant-based diets heavy starch rapidly absorbed Just course it's plant is not going to Get you to where you you want I think that whole plant diets, you know non-processed foods Plant diets and I think that's probably the intent of the question No, no doubt that if one's looking for the optimal diet certainly both to reduce fast carbs As well as to reduce LDL We haven't spent any time doing that Plant-based diets can be very effective in Doing it you can get a reduction of as much as 40 percent in your LDL Which we know is positive with asters chronic heart disease by a plant-based diet. At least many people It's not going to be as powerful as some of the drugs out there But certainly a major advantage in lowering your LDL. Yeah, I know she was interesting what your second major recommendation about reducing LDL said You know do it via a plant-based diet or medication and talk about the differences or why you would want both of those? so No doubt that if we can get LDL down in this country You know, we now know that LDL is elder the number of LDL particles Let me be exact for the scientists who are listening the number of LDL particles Is causal certainly on the causal chain? Right and if we can reduce on a popular a population wide basis everyone's LDL significantly, we can wipe out 70 to 80 percent of Cardiovascular after Estrada cardiovascular disease we can have as big effect on our health as we had on tobacco If we can reduce that LDL and the easiest way to do that is with a plant-based Diet now drugs you can get there and in some ways you can get there faster and you can reduce your LDL stronger, but I didn't want to just focus on Drugs, I mean, I think that would be a mistake I think diet is a big part of that You know, I asked the great cardiologist Jean Brown wall, you know If drugs work so effectively do you just say let's forget about diet and he said no, I mean it is the first thing that we should all focus on because medicines do have Some side effects they are not the perfect Answer and if you can get your LDL down and we all do that we can wipe out much of cart disease, you know certainly a thorough sporadic heart disease in our lifetime terrific Well, I have a specific question about the humble potato Our potatoes faster slow carbs and the aren't process but aren't they full of sugar? Should we need more potatoes? The fact is that When you cook that potato you gelatinize that potato and it becomes a fast car I Mean can you have the structure the potato maintained? So it's less rapidly absorbed sure certain boiled potatoes do not have the same effect the vast majority of these potatoes are processed and they are you know, It's just it's like eating any other sugar. No see you wouldn't prescribe french fries. Yes that's That's clear and difference between white potatoes versus sweet potatoes or yams So a great question, right? Different kinds of starts certain starches are resistant starches In the in the sweet potatoes and others so they don't get as rapidly absorbed It's a good question. Right? So tactically someone asks what are five plants that we should eat Five plants my plan on that. Well, you know the question is also what five five grains We should eat and there are certain grains Such as Buckwheat pumpernickel Certain kinds of flowers that are more resistant starches The answer is any plant Whose structure is intact? Right or essentially intact and has not been pulverized and not subjected to the thermo mechanical forces That food processing. So any plant whose structures intact, that's probably how we make them Okay, and then here's the reverse type of question. What are the very worst processed foods? Anything that takes that wheat kernel subjects it to intense heat intense shear forces and makes it into something that Doesn't look like food, you know I'm so it's anything that has been subject to that intense heat and those attendants shear forces that's going to destroy the starch molecules Increase the surface area increase the rates of Y which we digest them And if I'm not a scientist and I want to understand how much things have been pulverized or processed Is there a way I can tell that from the label on the package? FairPoint no You can look in the box and say does it look like anything like food that anything that's grown so you can have a sense If it's not growing in that form in that field If you haven't seen it in nature like that It's going to be have been subjected to pretty intense heat pretty intense shear forces and Some one last question you see function if food is intact what what has really intact mean in this context? So What you want? is The food just not The membranes the the structure the way the starch molecule is even packed together once you destroy That by intense heat by intense shear forces you're going to increase the surface area And you're going to increase the ability of our enzymes, you know You know that justice system to quickly absorb those molecules So, I mean it's it's a question of literally pummeling that food, which is what food processing does. Yeah Yeah, I remember when I was a kid. I used to love orange juice I thought it was so healthy for me and I later learned that just drinking the orange juice by itself was a very high Percentage of sugar whereas eating the orange is much healthier You have the structure. You have the fiber. I mean sure you some of the juice that is still there, and it's there's still some sugar, but you have a greater chance of Because of that structure that food because of that fiber of much of that orange make eating into the lower part of your GI tract and it's not going to be as rapid or And do you worry it can some weight can one eat too much fruit Sure, I mean, but I mean, you know terms of getting too much sugar from free if you're just eating regular fruit Yeah, look, I mean you asked me the question about could I you know in moderation? Earlier absolutely, I think the fruit has there's no doubt that As long as that structure is intact are there sugars in that fruit, yes but that doesn't concern me as much as When that fruit has been processed and it all has been transformed into a fast car. Gotcha, okay Well, we are just getting to the end of our time and we spent the majority of it on on carbs But I did want to get you a chance since he didn't say everything you may have wanted to say on the pandemic For one last question. And the question is this what's the one piece of advice? You would give the Trump administration? About managing the pandemic at this point Let the scientists go out front and let the politicians Recede into the background We're only going to get through this if we trust Our public officials because they again we talked earlier This is not going to be we're not going to get through this because of laws or regulations. We're going to get through this because we have the the moral sense of we each are going to do what's right, and if people can galvanize That collective sense and we all feel that we're being played straight. Just give us the facts the American people can handle The facts we will get through this. It's the mixed messages. It's the spin It's the promises that will never be fulfilled That just is making this as hard as this is It's making this even more difficult Okay, well thank you for that I want to give a big thank you to dr David Kessler the author of the new book fast carbs and slow carbs we encourage you to order your copy today through your local independent store or Noble.com I also want to thank all of the visitors and viewers viewing us online. I Want to remind you the club has a wide range of virtual programming both koba and non Kovach related Not that many more things on carbs, but but but some good content nonetheless, and if you enjoyed today's program Please consider supporting our our organization though the oldest and largest Public affairs forum in the country you can donate online at www.norfolk.gov You