Full Senate Roundtable Speech

Thank you very much, Senator, and it is a pleasure and an honor to be here. I'm speaking today as a clinical research scientist. This is an endeavor with which I have some familiarity because I've conducted many such studies, and I'm aware of their difficulty. I'm also speaking as a clinician and a parent, and a sometime philosopher of science.

We'll start with the general in this discussion and move towards the specific. Generally, it's vital to understand that science itself is an ethical, even a philosophical, religious enterprise. Why? Because the scientists who advance humanity inevitably operate within a prior framework of faith.

What are the elements of that faith? Belief that the world is orderly in its foundation, its nature, and its spirit. Belief that such order is understandable to the mind of man and woman. Belief that the pursuit of such understanding is possible and laudable. And a belief that good itself will come of the pursuit of understanding.

There's a meta-principle that underlies these more explicit rules, and that is that the understanding—the understanding—that the scientific aim must be true for the truth to be revealed. This means that science aimed at career prestige, professorship, and funding, to say nothing of darker motivations such as pride, revenge, or the wish for destruction, is not science at all.

Much of what purports to be science now is instead the garnering of personal credit, career advancement, and economic gain that all derivative and essentially parasitic activity can temporarily produce. This does not result in truth. We should also not be confusing medicine, as currently taught and practiced, with science.

The education of modern physicians may familiarize them with the basics of physiology and biology and the details of their specific practice. This is by no means the same thing as teaching them how to conduct or evaluate scientific research, which is something that takes years of specialized training to manage.

Why am I making these points? So that we understand explicitly that aim and ethical orientation define the scientific pursuit and so that we pay enough attention here today to establishing that aim and ensuring that orientation.

When you're a scientist and you're doing statistical analysis, it's easy to believe, for example, if you don't know anything about science or statistical analysis, that the statistical process is a mathematics machine into which you pour data and crank out truth. That is just absolutely not how it works at all.

When you're doing statistical analysis, you're making a thousand micro-decisions, every single one of which is ethical. You have to decide which numbers to include and which numbers to exclude, and you have to understand why. You have to work against your own hypothesis and even against your own research interest to ensure that you're not deluding yourself in the public.

If you're a careerist or interested in prestige, then all of that goes out the window, and what you produce will be highly misleading to you and everyone else. It's very difficult to orient yourself so that you fight against that. You have to be terrified of the falsehoods that you might produce and where they might lead you and everyone else.

Now, having considered that, you have to start to understand what it is that should constitute your aim. What would require, in the case that we're discussing, to make America truly healthy again and to orient true scientists toward that aim?

It's a retooling of the research enterprise from the top down as well as the bottom up so that the goal would be clear, the incentives aligned, and the most productive actors identified, rewarded, encouraged, and capitalized. This could be facilitated politically by making a more specific goal clear.

We could begin that as we should by formulating an appropriate diagnosis. We need to get the problem right. What is the major problem? What are the major problems bedeviling the American people? One such is public health, clearly, and more so all the time, despite the extensive government spending in that domain and despite the negligible attention historically paid to the details of health research and practice by the political class.

American children are fat, diabetic, and increasingly miserable as they progress towards middle age. Those yet not captured in childhood by obesity, insulin resistance, high blood sugar, and inflammatory dysfunction are likely to suffer it then, with near certainty, by the onset of a declining old age, and expensively so.

What might we aim for instead? Slim, healthy, athletic, optimistic, and courageous children; strong, psychologically integrated, generous adults; resilient, active, productive seniors still contributing to their communities. Combined with either or both of much less spending or much better results for the cost, how could this aim be accomplished within the community of health-focused researchers and practitioners and incentivized politically?

America faces a multi-dimensional diagnostic conundrum. Its people suffer from a plethora of symptoms and syndromes—too high increasing body mass indices, rising blood sugar levels, associated risk for psychological disorder, immunological disregulation that increases risk of neurological degeneration, cancer, and heart disease, to name a few.

My daughter referred earlier to her terrible childhood experiences, inquiry and experimentation, communication of all that, and the social consequences among a multitude of people with various chronic health conditions. What was her prime scientifically relevant realization? The answer to this question: What do all fat, sick, unhappy people have in common? At least this: They all eat.

How could that brute and singular fact be varied and studied? It's a technical discourse on the formulation of adequate scientific hypotheses. Epidemiological studies associating any given dietary habit with some outcome of health inevitably fail, trying as they are to establish a correspondence between only two factors in a sea of causal possibility.

Science can only progress; genuine science can only progress when such inquiry is simplified radically so that single variables of interest can be assessed for causal significance. This is difficult to manage in the case of diet, but it no longer seems impossible.

The reason? Because of the actual possibility of radical simplification on the food consumption side. Elimination diets offer a potential solution to this problem. Most of them make little sense, however, conceptually or scientifically. They eliminate foods in an often random and fadish manner, often because of the spoken or unspoken ideological concerns of their proponents.

In addition, they're insufficiently simple. The range of foods involved, so that scientific analysis of causality can take place, must be reduced to the minimum. For genuine analysis of causality to take place, you're chronically ill. You have a plethora of symptoms; you eat a multitude of foods.

There's some relationship between the food and the outcome, at least in principle. How are you going to determine that? Well, no simple analysis is possible because of the multiplicity of factors both on the symptom side and on the dietary side. So you reduce the complexity of your diet optimally to a single variable. Well, that's what my daughter Michaela did.

Now we know some things about such reduction. These are things that are important to know. Ketogenic diets switch the body to fat metabolism, so they constitute a step in that direction. If you flip your body to fat metabolism and your symptoms decline, then you know that the metabolic illness that you're suffering from has some association with glucose metabolism.

Now, Michaela, I believe—or perhaps, yeah, it was Michaela—mentioned the fact that for a century, childhood epilepsy has been treated with a ketogenic diet because your brain won't go into convulsions if you're not feeding it sugar. That's a good example of simplification to a single variable.

Now, another alternative or associated issue with ketogenic diets is the restriction of carbohydrate and sugar intake. So they eliminate the contribution of the glucose-dependent metabolic pathway to obesity, insulin resistance, diabetes, and inflammation. Your body can burn sugar or it can burn fat, and in our society, we run primarily on glucose metabolism. But there's no necessity for that, not least because there is no recommended daily allowance for carbohydrate.

Right? You can live with zero carbohydrate, and zero is not a lot. So that's a remarkable fact in and of itself, given that the primary caloric source in our diet is actually carbohydrate. So that can be eliminated, and the consequences analyzed. And that can happen relatively quickly, and people can do it, and it's inexpensive, and it doesn't harm people. So those are all very good things from a research perspective.

The consequence of a ketogenic intake—switch to ketogenic intake—can be analyzed as well. You can monitor weight, blood sugar, and assorted symptoms of inflammation, including those associated with psychological disorder. The anecdotal evidence that we've picked up, because many, many people have communicated with our family, is that the typical obese person can expect to lose 7 to 20 pounds per month on a ketogenic or plant-free ketogenic diet, that that will continue month after month until virtually all of their body fat is eliminated.

That they can do that with no hunger, although there will be some cravings, which are not precisely the same thing, and that that's actually maintainable over the long run. With that reduction in obesity comes radical improvement in blood sugar, for example, and often an improvement in the kinds of psychological conditions that Dr. Chris Palmer, for example, has been studying.

It's a very remarkable concatenation of positive effects, some of which are quite unexpected, especially, I would say, on the depression and anxiety side, because those have been viewed for a very long time as, you know, consequences of life stress and trauma. And that can happen. But the fact that the psychological disorders seem amenable to treatment by ketogenic or plant-free ketogenic diets could be nothing short of a revolution because those are very intractable conditions and they're also sources of unbelievably immense suffering.

Plant-free ketogenic diets—that's a carnivorous diet, let's say—or even more restricted, a carnivorous diet that's restricted to ruminant animals. Push that simplification to its extreme. Well, why would you do that? Well, if you're trying to conduct a true scientific analysis, let's say, of the relationship between diet and health, you'd want to reduce the diet to the simplest possible underlying—what would you say? The simplest possible underlying maintainable structure.

And we know that that can be attained with a carnivorous diet. You can live on that for a very long time. In fact, whole societies have done that, like the Inuit in Northern Canada, when they've survived on primarily meat for well, their entire cultural history. So we know that that's possible.

If your symptoms don't resolve in consequence, well, then there's no loss, except that it's a difficult diet to attempt. And if they do resolve, well, that's a pretty good deal for you. And then it's inexpensive, and there's going to be all sorts of corollary benefits. And then, with any luck, if your symptoms do resolve and you find the diet too restrictive, you can start by introducing one food category at a time and carefully, and so with any luck, you'll be able to get back to something approximating, hopefully not a typical American diet that's sugar and carbohydrate loaded, but at least one that's varied enough to maintain your interest.

None of this seems impossible. The more I've thought about this as a scientist, and I came to these conclusions with great hesitancy, by the way, because I know it's quite a radical solution, but as I was thinking it through as a scientist, it just became more and more obvious. It's like you don't want to hurt people when you're attempting to generate a solution to a health problem that they have.

A ketogenic diet certainly won't hurt them; it might help. If it doesn't, well then you can stop doing it. It's very inexpensive; it's within, at least in principle, within the behavioral realm that people can manage. And it's simple enough so that you can actually do a causal analysis. Plus, the results appear quickly enough so that that's maintaining and rewarding in and of itself.

That's a pretty good list of positive possibilities. And so there's another advantage as well with regards to ketogenic or plant-free ketogenic diets: that the people on them don't have to be hungry. So most of the time when people are considering something like weight loss, they think they have to go on a diet. So they need to go on a diet; they need to lose 30 lbs or 40 lbs or 50 or 100 lbs.

And then the theory is they've lost the weight and they can go off the diet, which they want to do because they're always hungry on the diet, and no one can maintain that. And then they go off the diet, they go back to their old eating habits, and bang, they weigh exactly what they weighed or more because that's the typical pattern as a consequence of overeating in relationship to the food deprivation.

On a ketogenic diet, you don't have to be hungry. You can eat as much as you want, and they're very satiating, and so that doesn't seem to be a problem and something that's sustainable in the long run. The most important thing, however, as far as I'm concerned from the scientific perspective, is the radical simplification of the causal analysis.

Right? If you go on a ketogenic or plant-free ketogenic diet and your symptoms remit, you know that there's some relationship between what you're consuming and the health outcome. And so that's exactly what you want to know if you're chronically ill. And maybe, well, then you're fortunate as well because it's remitted. You can start to experiment and see if you can find out the actual cause.

And that opens up the scientific endeavor in a much broader way because that would mean that we could reduce the typical chronically ill person's diet to a ketogenic or plant-free ketogenic diet, and then we could do causal analysis with different classes of food to see which classes of food were contributing to which downstream illnesses. So that would be a real good deal for everyone too.

This sort of scientific endeavor is certainly technically possible. It's difficult to find participants, and clinical research is a difficult endeavor, but none of this is impossible. The additional advantage also is that it's not going to hurt people.

Okay, so we'll close with this: What is the most logical upward aiming scientific approach to the problem of American health? Identification of diet as the potential common mechanism, radical simplification of that diet, analysis of programmatic variation of that simplified diet as food items are added in, by category, one by one. Those with chronic andrac illnesses could thus well be placed by default on a plant-free ketogenic diet for the several mere months that it would take to assess the consequences.

This is a revolutionary but manageable proposition. Before it becomes a generalized standard of care, however, the relevant studies should be done. We have more than sufficient anecdotal data pertaining to the positive effect of such simplified diets, the testimony of thousands of people, which is not sufficient to constitute proof but is certainly sufficient to justify hypothesis.

The goal is health; the approach is generally of upward aim and commitment to the truth. The specific strategy is restriction of all extraneous dietary variables, analysis of the consequences of that restriction, and then systematic variation with the return into a more varied diet. Simple, elegant, implementable, necessary.

The alternative, given the crisis that confronts us on multiple health fronts, is dreadful: the continued sickening of the American people with all the unsustainable economic burden that sickening is and will continue to produce—demoralization, decline in productivity, and spiraling health care costs that are already mounting to the point of unsustainability.

When we could replace that miserable future with something much brighter and healthier if we had the moral and political will to do so. Thank you very much. [Music]