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Gary Taubes and the Cause of Obesity

Gary Taubes has written two books explaining why people get fat and why a low-carb diet is the solution to preventing and treating obesity. He didn’t like what I had to say about his books on this blog back in 2011. I was not the only one to criticize. Another reviewer accused him of “abandon[ing] journalistic and scientific integrity in place of observational data, straw men and logical fallacy.” He says he agrees with Taubes’ premises but that his “arguments made me cringe,” and he goes into considerable detail to explain why. His analysis is worth reading.

photo by Fj.toloza992 [CC-BY-SA-3.0], via Wikimedia Commons]

photo by Fj.toloza992 [via Wikimedia Commons]

Rather than engaging in the Comments section, Taubes complained to me in a somewhat offensive personal e-mail, saying I had failed to understand what he wrote. Recently he e-mailed me again, condescendingly suggesting that I might understand his arguments better if I read an article he wrote last year for the British Medical Journal. I read it, and confirmed that I had understood perfectly well the first time around and that it was Gary Taubes who didn’t understand my criticisms. I pointed out some omissions and inconsistencies, but my major criticisms boiled down to two:

  1. The clinical evidence isn’t yet sufficient to convincingly prove his thesis. (He himself admitted this.)
  2. He strongly recommended that everyone adopt a low-carb diet, essentially insisting that we act on insufficient evidence. And this was after he had devoted whole chapters of his books to demonizing the low-fat diet advocates for doing exactly that: acting on insufficient evidence.

His basic thesis is that conventional wisdom is wrong when it says we get fat because we overeat, and that counseling patients on the basis of the energy balance hypothesis has been remarkably ineffective. He thinks we get fat not because we eat too much but because of carbohydrates.

He says:

What is wrong with the mechanism that normally adjusts appetite to caloric output? What part of this mechanism is primarily disturbed? Any regulatory defect that drove people to gain weight…would induce them to take in more calories than they expend. Positive caloric balance would be, then, a result rather than a cause of the condition.

I agree completely. I think we are talking at cross-purposes and getting hung up on semantics. It is obvious to me that “something” (likely more than one “something”) causes us to take in more calories than we expend. And then that positive energy balance is what causes us to gain weight.

Taubes says the real question is not why we eat too much, but why we store too much fat. The endocrinological hypothesis attempts to explain the root cause of obesity on the basis of insulin and/or the concept of lipophilia. Insulin is fattening, and since serum insulin levels are driven by the carbohydrate content of the diet, it seems only logical that a low carb diet would tend to reduce weight. Lipophilia (“love of fat”) explains that fat deposition is not uniform throughout the body and that must have a basis in biology; and that people who are constitutionally predisposed to fatten must have adipose tissue that is more lipophilic than that of lean individuals. The lipophilic tissue gloms onto calories even in the presence of under-nutrition and deposits them as fat, which deprives other organs and cells of energy and leads to hunger or lethargy. Withdrawing fat from the circulation after meals results in a delayed sense of satiety and a yearning for carbohydrates. This is supported by the conventional wisdom that carbohydrates are fattening.

But Taubes said in his book that simply restricting carbohydrates

…leads to weight loss and particularly fat loss, independent of the calories we consume from dietary fat and protein. We know that the laws of physics have nothing to do with it.

That is simply wrong. The only grain of truth is that a low-carb diet may result in decreased hunger pangs so that total calorie intake drops. The laws of physics tell us that if you ate 7000 calories of protein and fat during a period of time when you only expended 3500 calories, you would gain a pound, even if you ate no carbohydrates at all. There is no getting around the physics. If you expend more calories than you ingest, you will lose weight. No diet has ever been shown to produce weight loss without a reduction in calories. The problem is that reducing calorie intake is fiendishly hard to accomplish for many reasons, both physiological and psychological. No one has ever denied that.

Low carb diets came into fashion in the 1970s; and Taubes says they worked “remarkably well” but were criticized because they were rich in saturated fats, which the medical community believed caused heart disease. Sure, lots of people lost weight by controlling the quantity and quality of carbohydrates in their diet, but the evidence does not support the claim that these diets worked “remarkably well.” In comparative studies, people achieved sustained weight loss just as well on diets with different macronutrient compositions. Taubes concludes that there is little long-term compliance with any diet, which seems to me to undermine his recommendations.

He stresses that knowing the underlying cause of obesity is a different question from advising someone to follow a Mediterranean, low-fat, or low-carb diet. Yes it is! Which is exactly my point. There is no evidence that any diet works unless it results in lower total calorie intake. Does it really matter how that lowered calorie intake is achieved? Some people prefer one diet to another; if they are able to lose weight on a diet that includes carbs, why insist that they change their habits?

Taubes agrees with me that diet studies are inherently problematic (poor compliance, poor self-reporting of intake, etc.) and that rigorous studies are required to test hypotheses. He has cofounded a not-for-profit organization called the Nutrition Science Initiative to fund and facilitate rigorous well-controlled experimental trials carried out by independent, skeptical researchers. He says we must “refuse to accept substandard science as sufficient to establish reliable knowledge, let alone for public health guidelines.” I couldn’t agree more, and my criticism of Taubes is based on his track record of accepting substandard science and basing recommendations for public health on that rather than on rigorous science. Where we part company is that I am content to withhold judgment until the hypothesis is properly tested, while Taubes is so convinced that his hypothesis is right that he has urged everyone to change their eating habits before the test results are in. In his books, he says that obesity is such a serious problem that it is urgent that we institute his diet recommendations now, without waiting for the evidence. Which is exactly what he criticized the low-fat diet campaign for doing.

We need to understand why some people gain weight easily and others don’t. Taubes doesn’t have an answer for that: his “cause” of obesity is more of a “mechanism” that doesn’t really get at the underlying genetic, environmental, and behavioral causes. While we are waiting to understand that, we still have the practical problem that overweight people need to lose weight now. It is undeniable that if you can find a way to reduce total calorie intake sufficiently, you will lose weight. I maintain that there is more than one way to accomplish that, and that we don’t know enough yet to dictate one method. Most people find it difficult to reduce total calorie intake without restricting carbohydrate intake, particularly simple carbohydrates. But that doesn’t mean everyone must follow a strict low carb diet.

A 2003 systematic review found insufficient evidence to make a recommendation for or against low-carb diets, and found that weight loss on a low-carb diet was principally associated with decreased caloric intake.

The Swedish Council on Health Technology Assessment recently reviewed the dietary treatment of obesity. They said a low-carb, high-fat diet is the most effective for weight loss in the first 6 months and it improves health markers like HDL cholesterol. But they also said long term studies show no statistically significant differences among different diets, probably because compliance decreases over time. And they didn’t deny that other diets can also be effective for weight loss and can also improve health markers. And contrary to popular wisdom, they found that the benefit of adding exercise to diet is marginal or non-existent. Another 2014 meta-analysis found that the short-term benefits of higher protein, lower carb weight loss diets appear to persist to a small degree over a longer period.

My prescription for weight loss is this:

  1. Start keeping a food diary. Write down everything that goes in your mouth and track how many calories you are eating to maintain your present weight.
  2. Whatever number you come up with, cut it down by 500 calories a day; this should result in loss of a pound a week.
  3. If you are not losing a pound a week, cut down by increments until you are.
  4. Exercise will allow you to eat more calories but is not absolutely essential; those who abhor exercise or who are unable to exercise due to physical limitations can still lose weight.
  5. It doesn’t matter if your calorie estimates are inaccurate; reducing calories on the basis of inaccurate estimates will still result in weight loss.
  6. It is the average calorie intake that matters. If you are aiming for 1200 calories a day, you could splurge on a 2400 calorie Thanksgiving dinner or binge on 2400 calories of birthday cake and ice cream and make up for it by cutting down by 100 calories on each of 12 other days.
  7. There is no need to deny yourself anything you crave as long as you control total calories.
  8. Try to include a variety of foods to insure adequate nutrient intake. If you are concerned that you may have cut calories so much that good nutrition is suffering, it’s better to consult a dietitian than to rely on self-prescribed vitamins and supplements.
  9. Try to pick foods that are filling but low in calories (low calorie density foods). Use the diet diary to study your eating habits, identify situations or foods that particularly tempt you to overeat, and look for ways to outwit the temptations. You might want to try tricks like using smaller plates, eating more slowly and consciously savoring every bite, eating in the dining room instead of in front of the TV, etc. One of my patients would walk the dog whenever she felt hungry; when she got back home, the cravings had passed and she and the dog had benefited from the exercise.

I’m not claiming that everyone can do this successfully, but then Taubes admits that there is poor long-term compliance with a low-carb diet, too. He even admits that the diet can cause side effects, which he attributes to (1) eating too much protein and too little fat, (2) attempting strenuous exercise without taking the time to adapt to the diet, and (3) most importantly, to the body’s failure to compensate for the lower insulin levels. He admits that carbohydrate cravings can be difficult to overcome, and that high protein diets can be toxic.

Conclusion

Taubes’ hypothesis about the underlying cause of obesity may be right, and a low-carb diet may be best not only for weight loss but for disease prevention. I look forward to the results of rigorous studies. Meanwhile, I favor moderation: going easy on the carbs, especially simple carbs with low nutrient content, but not following a low-carb diet per se. The recommendations in Taubes’ books go beyond the currently available evidence. In his understandable enthusiasm for his attractive and plausible hypothesis, he has jumped the gun and committed the very sin he criticized in others. Perhaps he has reconsidered: the BMJ article is more about finding the underlying cause of obesity than about pushing a specific diet. Until the evidence is in, I see no compelling reason to prefer Taubes’ low-carb recommendations to the sensible advice of Michael Pollan to “Eat food. Not too much. Mostly plants.”

Posted in: Nutrition

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323 thoughts on “Gary Taubes and the Cause of Obesity

  1. Lacri says:

    “The laws of physics tell us that if you ate 7000 calories of protein and fat during a period of time when you only expended 3500 calories, you would gain a pound, even if you ate no carbohydrates at all.”

    No, they don’t. There is nothing in the laws of physics that requires all or any of those calories to be subjected to all or any of the chemical processes that allow the body to digest, utilise and ultimately store as fat the food that is eaten. The laws of physics don’t care if glucose remains in your bloodstream poisoning your organs, or is excreted into your urine, or if inadequately digested sugars result in digestive disorders or if gallbladder disease allows fat to travel undigested through your gut. The laws of physics don’t insist that the human body be able to metabolise every conceivable organic substance – the calories in cellulose, for example. They do not require chemical reactions to be initiated to rearrange the molecules of proteins and fats into carbohydrates or of carbohydrates back into fats, nor that any of those molecules be stored or remain in the body in any form whatsoever. The laws of physics would be entirely content if you ate a bar of chocolate and crapped it out whole again. Converting excess calories to fat and then storing fat is something the body must actively do, not something that will just happen automatically in the absence of anything else being done with those calories.

    1. Windriven says:

      Context Lacri, context. Dr. Hall’s point was simply that, all things being equal, 3500 kcal net of metabolism will hang a pound of fat where you need it least and a 3500 kcal deficit will remove it.

      And ultimately of course, Dr. Hall is quite correct. Biochemistry and molecular biology may not generally be thought of as subsets of physics but it is physical laws that govern the myriad biochemical reactions that turn that chocolate bar into man-boobs. Do you imagine it happens by magic?

      1. Lacri says:

        Of course the laws of physics apply to biochemistry. The point is that the laws of physics do not require calories ingested to be converted to fat. Invoking the law of thermodynamics is just a patronising way of telling people who struggle with their weight that it’s because they’re stupid and lazy and should stop making excuses.

        1. WilliamLawrenceUtridge says:

          The laws of physics require the energy to be consumed, excreted or stored. Stored energy is turned into protein, glycogen or fat. Fat is the only long-term storage for excess calories.

          The point isn’t to call people stupid or lazy – it’s to point out the fundamental reality. Losing weight is hard, but must always involve more calories being expended than are consumed. There are no tricks involved in this step – though there are ways to trick satiety, the sensations of fullness and hunger. Trick satiety and reduced consumption becomes easier. It may be possible to trick expenditure through means other than exercise – but this is a hypothetical, not a proven.

          This is where people seem to talk past each other. The equation is “calories in – calories out = net weight gain/loss”. Dr. Hall is talking about the overall equation, which is an unbreakable law of physics. She gives suggestions on how to modulate one of the parameters – calories in – in ways which require effort but little willpower. Most people who get upset about this seem to be talking about manipulations that involve hypothetical biological tricks that either up metabolism, or curb satiety without requiring any willpower. And, like all diets, this seems to not be a long-term strategy.

          The overall thrust is – people who want to lose weight should be realistic and invest in the long-term. They should recognize losing weight is difficult. And they should not be mislead into believing that there exists tricks to make it easy and sustainable over the long-term, or require no effort whatsoever.

          1. jay says:

            I think the low carb argument is that 7000 bomb calorimeter calories of legos metabolizes much more differently than 7000 bomb calorimeter calories of cake metabolizes much more differently than 7000 bomb calorimeter calories of steak.

            I am also not aware that humans are closed systems.

            These points make it hard for me to understand arguments that all else being equal 7000 calories is 7000 calories. All else is not equal. The metabolic pathways matter, otherwise we would all be so much dead rotting material and not commenters on blogs.

            1. WilliamLawrenceUtridge says:

              And the point that is missed here is that it doesn’t matter if the estimates given by a bomb calorimeter are 100% accurate to calories consumed and used by the body – if you are gaining weight, you need to reduce intake or increase expenditure. Counting calories is, as Dr. Hall’s fifth point says, to provide an estimate and make you aware of the calorie count of foods. The point is not to get an exact figure on the number of calories used. One doesn’t lose weight by counting calories, one loses weight by reducing calories stored. Counting calories is one way of measuring, estimating and guiding, a means to focus attention on habit.

              Bomb calorimeters are not an exact model of how food is processed by the body. That doesn’t matter. They do provide an order-of-magnitude standard that allows comparison.

          2. Chris says:

            “This is where people seem to talk past each other. The equation is “calories in – calories out = net weight gain/loss”. Dr. Hall is talking about the overall equation, which is an unbreakable law of physics. She gives suggestions on how to modulate one of the parameters – calories in – in ways which require effort but little willpower.”
            But this does nothing to address the fact that the body could choose to take energy from other sources (like breaking down muscles) to reserve the ingested energy for creating more body fat. Also, is it impossible that consuming 500 less calories could make your metabolism conserve energy by making your body use less? Has it been proven that a person can cut their caloric intake by a quarter and still have the same amount of excess energy to expend? So even though the “basic equation” may ultimately hold true, who are we to say that we have any direct control over this equation through the “simple” act of cutting calories?

          3. Razwell says:

            Please stop that nonsense. Many people misuse and abuse the PRINCIPLE of the conservation of energy- erroneously extrapolating it fat beyond ts scope and reach. The conservation of energy, while valid for life, says NOTHING about the regulation of fat cells SPECIFICALLY, how they hoard and can become dysregulated. I talked to 40 different scientists about this over the last 6 years and ALL agree that it is MISUSED.

            The commenter “Lacri” is COMPLETELY CORRECT that the conservation of energy does not at all care if we ate a chocolate bar and pooped it out . I APPLAUD HIM OR HER !

            By the way, humans WASTE energy by pooping up to 9 % total energy is lost as waste. Further, humans produce substantial amounts of DISSIPATED HEAT- LOST energy – up to 123 watts. NONE of this says anything about obesity. The conservation of energy is relevant and necessary BUT NOT NEARLY SUFFICIENT to explain obesity… Energy can be led to many pathways and there have been overfeeding studies of people eating 5,000 calories above normal amounts and gaining very little. Humans are open, non – equilibrium, dissipative systems.

            There is NO SUCH THING as a “scientific law”. NOTHING in science is immutable. Plenty of “laws” have been modified, amended or shown wrong in the past.

            They are useful and reliable – that is why we use them. Much remains to be learned about energy and matter. It is UNFORTUNATE they are called “laws.” They are NOT 100 % “immutable.” That is NOT what laws are or what they mean…. NOTHING is sacrosanct in science.

            Scientific PRINCIPLES is the accurate term.

            The conservation of energy is violated every single day, all the time in the quantum world. Tiny packets of energy pop into and out of existence- out of nothing- literally thin air- for a brief time and then disappear again.

            PLEASE STOP misusing the conservation of energy principle! Obesity is understood through the framework of BIOCHEMISTRY. TOP physicists specializing in non – equilibrium thermodynamics this told me this and stressed it. Scores of physicians are MISUSING IT

            1. AdamG says:

              Engaging with this individual, who self-identifies as “Razwell the troll,” is probably not a good idea.

              1. Razwell says:

                That is because you have NO ARGUMENT. It was SHUT down by my own efforts and the expertise of 40 world renowned physicists STRESSING the Internet gurus are MISUSING the conservation of energy principle.

                Relevant NOT SUFFICIENT. It does NOT address the REGULATION OF FAT CELLS SPECIFICALLY= which is why typical “successful” gastric bypass patients are still fat as hell and are STILL salami- only tinier pieces of human salami and cottage cheese legs. They are victims BO JACKSON WAS BIIIGGG LEAN pierce of sirloin.

                Energy balance does NOT address that!

              2. Razwell says:

                Lacri is CORRECT. I hope you realize that.

                That is because you have NO ARGUMENT. It was SHUT down by my own efforts and the expertise of 40 world renowned physicists STRESSING the Internet gurus are MISUSING the conservation of energy principle.

                Relevant NOT SUFFICIENT. It does NOT address the REGULATION OF FAT CELLS SPECIFICALLY= which is why typical “successful” gastric bypass patients are still fat as hell and are STILL salami- only tinier pieces of human salami and cottage cheese legs. They are victims BO JACKSON WAS BIIIGGG LEAN pierce of sirloin.

                Energy balance does NOT address that!

              3. Andrey Pavlov says:

                which is why typical “successful” gastric bypass patients are still fat as hell and are STILL salami- only tinier pieces of human salami and cottage cheese legs. They are victims BO JACKSON WAS BIIIGGG LEAN pierce of sirloin.

                Wow. I go away for a weekend and come back to some very interesting new trollery.

                I find you curiously creepy and disturbing. I have a feeling this will not end well and be another one of the rare bans we have around here.

          4. Razwell says:

            Losing “weight” and losing FAT are two entirely different things. Yu want MORE MUSCLE and less fat- but not too low. Body COMPOSITION. FORGET “weight” loss….

            I talk to actual scientists rather than hang out on these hokey blogs who want the STATUS of science. There are MANY, MANY PATHWAYS that energy can be led to. The first law does NOT address this. BIOCHEMISTRY AND PHYSIOLOGY are how we understand obesity. We are NOWHERE near solving it./

            Hawking himself said IT IS NOT basic thermodynamics. He replied after 4 tries and 1 year.

            1. Chris says:

              Obvious troll is obvious.

              1. Razwell says:

                NO, somebody who has actually RESEARCHED this non – stop for 6 years straight to DEBUNK articles like this…. PHYSICISTS SUPPORT ME.

            2. Razwell says:

              Obesity is NOT a matter of basic thermodynamics. TOP- TOP – THE VERY BEST in non – equilibrium thermodynamics TOLD ME THIS and stressed it. It is a BIOCHEMICAL MATTER.

    2. WilliamLawrenceUtridge says:

      If your body is excreting sugar in your urine, or fat in your feces – that usually means you’ve got a pretty serious medical condition you might want to get checked out. The body, under normal conditions, is quite good at absorbing anything it can absorb.

      Your point about cellulose is trivially true, which is a good reason to eat unrefined fruits and vegetables, as well as whole grains.

      I suppose Dr. Hall could have written it as “The laws of physics tell us that under normal health circumstances in the absence of diseases that cause the excretion of normally-absorbed nutriens such as sugars in the urine of a diabetic or fats in feces in cases of gallbladder dysfunction, if you ate 7000 calories of protein and fat during a period of time when you only expended 3500 calories, you would gain a pound, even if you ate no carbohydrates at all, ignoring any of such substances that were consumed by gut bacteria or parasites.”

      And I didn’t have to do much about the second half of the sentence, since it doesn’t talk about cellulose.

      But it doesn’t have quite the same pithy ring.

        1. Windriven says:

          “What are people’s thoughts on this article?”

          Not much. First, he takes so long to make his point I’ve lost track of what it is and interest in rereading it to find out. But it seems to be that fatties like to eat and that reducing caloric intake causes feelings of hunger. A secondary point seems to be that different people have different metabolic rates and that those rates can change in response to diet and exercise.

          Well no duh.

      1. Stella B. says:

        The human body is not a bomb calorimeter and there are metabolic differences in the way macronutrients are processed. I have to believe that those are second orde differences though. If you don’t eat the Twinkie, you don’t absorb the 170 kCals. If you do ewt the Twinkie, you may absorb 150, you may absorb 170. I know that I’m better off not eating the metaphorical Twinkie rather than trying to game out which calorie source is going to have the smallest effect on my weight.

        1. WilliamLawrenceUtridge says:

          The human body is not a bomb calorimeter, but if that Twinkie adds 150 kCal to your food intake for the day, rather than the 170 it says on the package, it will keep adding that 150 kCal every time you eat it. If you are gaining weight and you keep eating the same amount but not burning any extra – you will keep gaining weight. The exact numbers matter less than the trend. I don’t think there are many people sussing out the number of calories actually absorbed vs. the number of calories due to insoluble fiber.

          But realistically we’re arguing 80% of the same point – fruit > Twinkies, for myriad reasons, and people should eat way more fruit than Twinkies.

        2. Calli Arcale says:

          Exactly. While it’s an oversimplification to say that eating 750 calories but expending 200 will result in storing 550, since of course there are things that affect how our bodies decide to store fat and how much we absorb from the gut, it works well enough for most purposes. Like calling the Earth a sphere. It isn’t really a sphere (for instance, the equator is longer than the prime meridian)), but it’s certainly close enough for most purposes.

      2. Lacri says:

        “If your body is excreting sugar in your urine, or fat in your feces – that usually means you’ve got a pretty serious medical condition you might want to get checked out. The body, under normal conditions, is quite good at absorbing anything it can absorb.”

        Of course. But the laws of thermodynamics aren’t infringed. I used those examples because they are obvious, uncontroversial, well-known instances of calories ingested but not expended NOT ending up as fat stored, somehow without exploding the laws of physics.

    3. youcantbeserious says:

      If you crap out the calories, those dont count….

      1. Calli Arcale says:

        That is true. I have lost weight every time I’ve gotten diarrhea. I would not recommend it as a weight loss method, though. Rather unpleasant. ;-)

        1. n brownlee says:

          Many a woman has welcomed a bout of “stomach flu”.

          1. Calli Arcale says:

            Not me. Slight weight loss may be a brief silver lining, but I’d happily gain fifty pounds if it would guarantee never having to throw up again.

      2. Sean Duggan says:

        I have a friend who lacks much of her intestinal tract due to her body having rejected it (I’ll admit that I really don’t completely understand her condition, but it seems to have boiled down to her stomach starting to rot away and the doctors salvaging what they could over three operations in the last few years) and she suffers from an inability to get many calories from any food because it goes through her so fast. Essentially, she has an extreme gastric bypass.

        At first, she was happy that she was losing weight. Then, she realized that it wouldn’t stop. At all.

    4. John says:

      I tried to make some points in comments below but after a bit the reply function was turned off. Do you mind if I try again.

      I agree that low-carb lifestyle isn’t definitively supported by science to work for everyone.

      It definitely works for me, though, and, seems, many others. So I’m interested to see if there’s some fatal flaw – maybe I’m unknowingly killing myself.

      Most of the documented problems of low-carb seem to arise from excessive protein consumption (especially with Atkins).

      The References section of the 2013 Nature article (http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html) cites 109 papers, in medium or strong support.

      What I’d like is the counter-case to the Nature article. Best so far is one outdated (2007) Pubmed meta-analysis.

      In short, could anyone here direct me to some scientific research against low-carb.

      1. John says:

        Sorry – this came to the wrong place: I’ll repost – don’t respond here. Thanks.

  2. Jonathan says:

    Really good article, thanks for posting.

    I think you can summarise that he is over confident given the data but I second the other comment that calories are not all the same. It depends how the body processes them and it is worth noting but little remarked upon that the ‘calories’ in food are highly variable in their availability to the body. Raw sugar versus nuts for example. Former calories likely to be metabolised to higher potential than latter.

  3. Olli Kantola says:

    Hello,

    I’m a medical student from Finland and for years I’ve been inspired by the work and dedications you and your colleagues have give to this blog. Thank you for your efforts.

    Your major criticisms of Taubes’ are good ones and do expose a internal inconsistancy in his arguments. We have not reached a point where physicians would be able to recommend a low carb approach routinely to everyone. There haven’t been enough studies with normal weight individuals. With type 2 diabetics, I think we’ve reached the point where it is a valid recommendation.

    Taubes is a physicist by training not a physician. In that light he seems to get an awful lot of flak for supposedly not understanding the laws of thermodynamics. I think there are two points that we ought to take into consideration here:

    1) The thing with energy intake and expenditure is that they are not independent variables. Limiting the calorie intake could effect the expenditure by making one more tired for example. Conversily, exercising more surely does make one more hungry. Indeed, even cutting back on the much deplored carbohydrates could negatively effect ones ability to lift heavy weights and recover from such exercise.

    2) Your point about the ultimate causes stands. I think I remember Mr. Taubes restating the energy balance explanation in different terms. If we were to ask why there are 120 medical students in a lecture hall, replying that it is because of the laws of thermodynamics say that more students must have gone in than out. That doesn’t actually explaing why, it just restates the question in a different way. The actual reasons could be that there is an interresting or mandatory lecture held there or whatever. If people gain fat then they must have been in a positive energy balance, there is no way around that fact.

    That said, whatever interventions work, have to result in a negative energy balance. The thing that I feel that he is getting at is that even with that being the case, it not necessarily the best way to approach the problem, just as focusing on getting more people to enter the lecture hall and preventing on people getting out would not be an ideal way to approach the problem of boosting lecture attendance. ;-)

    . . .

    I wholeheartedly agree with you conclusions in the end, but would like to add something. The etiology of gaining excess fat mass is a complex tangle to unweave. For some people, low carb might be the right way, because their metabolomic makeup, while others will do well with other interentions. Gardner CD et al touched upon this in their paper “Adherence to a Low-Fat versus Low-Carbohydrate Diet Differs by Insulin Resistance Status”.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3504183/

    Let’s hope that we do get more good quality research about these matters. In 10-15 years I do feel that we will be able to choose more personal and a nuanced approach to these interventions and thus hopefully improve the success rate.

    1. Razwell says:

      Negative energy balances do NOT deal with FAT specifically. The conservation fo energy does NOT deal with WHAT form of mass is gained or lost, or even IF the conditions are present fro a gain or loss. IF THIS, THEN tat. And remember energy balance does NOT address body COMPOSITION SPECIFICALLY.

      I have talked to 40 different scientists from M.I.T. about this. The conservation of energy principle is being MISUSED by doctors all the time!

      “The first law of thermodynamics” says NOTHING about the regulation of fat cells specifically, nor why they can hoard and fail and become DYSREGULATED.

  4. CrankyEpi says:

    Dear Dr. Hall,
    OMG, I feel your pain. A few years back I submitted a paper to JAMA which was a response to Gary Taubes’ NYT article where he said that observational studies are riddled with errors while Randomized Trials Determine the Truth because they are experiments. One of my points was that certain types of randomized trials much more closely resemble observational studies than they do experiments. Guess who one of my reviewers was – Gary! Guess what – he didn’t like my paper! He said I was personally attacking him and I was twisting his words.

    It’s not for me to say whether the paper should have been published, but I do empathize with you as I have the similar experience of following his arguments for a certain time, thinking, “okay, okay” and then all of a sudden he makes some big leap that doesn’t seem to follow what he had been talking about. I think it would be very difficult to have a reasoned conversation with him.

  5. David Gorski says:

    This reminds me. Taubes sent me a review copy of his book. I’ve been bad and haven’t read it because things have just been crazy. Maybe I’ll go back and take a look.

    1. Windriven says:

      “Maybe I’ll go back and take a look.”

      Why? I love Dr. Hall’s reviews. She has directed me to some books that I’ve really enjoyed and learned from. She’s also saved me from wasting time on dross. So much to read, so little time.

      1. WilliamLawrenceUtridge says:

        I think Dr. Gorski might have something insolent to say about it, though in a respectful manner.

        1. Zoe says:

          Dr. Hall should write her own book!

            1. Zoe says:

              Awesome!

  6. Windriven says:

    You have to love Taubes’ passion. We are, in fact, a nation of lardasses and it results in a variety of health risks and associated societal costs. But he has become a true believer in his embrace of the low carb diet and when belief trumps science, no good will come of it.

  7. Don says:

    I suspect that you are right about the flaws in Taubes’ theory but you may be wrong in your prescription for weight loss. Once of the reasons that Taubes and others arrived at conclusions was the observation that many people on LCHF diets are able to lose significant amounts of weight without counting calories. You allude to the possibility that restricting carbohydrates may decrease appetite yourself. Unfortunately, your prescription is that people simply count calories. For many, intentional calorie restriction is a prescription for constant hunger and weight loss failure. I, and many others, have found that changes in macro nutrients (primarily cutting sugar to almost zero and carbohydrates moderately or heavily) leads to substantial weight loss and a new set point without ever counting calories or restricting food amounts. In my case the loss took about 6 months (knocking off 30 years or slow gain) and has remained stable for 2 years. Anecdotal, yes, and not a prescription for everyone. But you would do better advising people to test dietary changes to see if they can cut consumption without counting and hunger.

    1. WilliamLawrenceUtridge says:

      Once of the reasons that Taubes and others arrived at conclusions was the observation that many people on LCHF diets are able to lose significant amounts of weight without counting calories.

      Dr. Hall discusses this – and notes that this drop doesn’t tend to last beyond 6 months because people can’t stick to the diet.

      You allude to the possibility that restricting carbohydrates may decrease appetite yourself.

      One of the biggest muddying issues in diets and diet is the effects of foods on satiety. People say “eating fats and proteins means you lose weight”, when what they should say is “it is easier to achieve and maintain satiety with a high-fat, high-protein diet than it is to achieve and maintain satiety through a high-refined-carbohydrate diet”. 100 calories from fat vs. protein vs. pure glucose, it’s all the same in terms of weight gain, but wildly, wildly different in terms of how hungry you feel and when you will open the fridge again.

      Of course, the same effect can be achieved through consuming fruits and vegetables, and whole grains.

      Unfortunately, your prescription is that people simply count calories.

      There are nine recommendations, the most crucial of which is found in number 7 – it is about controlling calories, and counting is one way to do so. And a pretty good one for some, since they don’t realize the calorie counts in many foods.

      For many, intentional calorie restriction is a prescription for constant hunger and weight loss failure.

      And for others it works.

      I, and many others, have found that changes in macro nutrients (primarily cutting sugar to almost zero and carbohydrates moderately or heavily) leads to substantial weight loss and a new set point without ever counting calories or restricting food amounts.

      So you’re kinda following recommendation 9 then, aren’t you? Avoiding low nutrient density foods. And how do you know you aren’t substantially restricting food amounts? Did you check? Because that’s a main finding of nutrition research – patients/subjects routinely underestimate not only their calorie intake but their food intake. They forget about snacks, they neglect to weigh or measure intake, they don’t count beverages, etc.

      If Dr. Hall’s recommendations don’t work for you, and you’ve found another way – great! I doubt she would object were you her patient (unless you completely avoided all fruits and vegetables). But her suggestions have also worked for some. And that’s again rather the point – many paths to the top of the mountain.

    2. Stella B. says:

      The problem is that I and many others have also failed to lose weight on LCHF diets. I was quite diligent for several months and gained 2-3 lbs. i also could not find a breakfast menu that did not leave me ravenously hungry all morning long, although I am nothing if not an adventurous eater. You may do well on the diet, but it is hardly a panacea. I found that Weight Watchers was the only thing that worked to rid me of my post-menopausal/orthopedic disaster weight (admittedly only 20 lbs. 100lbs might have been different.)

      One of Taube’ basic premisses is that the “low fat” campaign of the 70s and on has led to the steep ascent in obesity rates that began about that time. That may well be spurious correlation since there is little evidence that people actually decreased their fat intake and since multiple confounding factors also date to those decades. After criticizing others for cherry-picking, he then proceeds to cherry-pick to support his hypothesis.

      The plural of anecdote is not data, but I have worked with a lot of overweight people. Few of them lose substantial amounts of weight and keep it off, but I have seen it happen on rare occasion. The entire gamut of “diets” (mostly behavioral changes — what you are eating isn’t working so eat something different) has worked for somebody at sometime. Regardless of the diet, vegan to Atkins, even the ridiculous “Eat Right 4 Your Type”, lipids and A1C improve with substantial weight loss

  8. WilliamLawrenceUtridge says:

    Taubes increasingly sounds shrill and unpleasant the more I hear about him. The monkey in me* wants me to discredit him on this basis. But mostly I want him to read Mistakes were Made (but not by me) so he’ll start realizing he’s made errors and is retreating into self-confirmation, lashing out in the process.

    Making mistakes doesn’t make you stupid, but refusing to admit to them means people tune out (or become yesmen). Basic skeptical principles – admit when you make a mistake, and take criticisms as an opportunity to improve.

    *I know it’s an ape, somehow monkey sounds better, probably becuase it’s funnier.

  9. tw says:

    The article also failed to mention his partnership with Dr. Peter Attia and their project called NuSi which is designed to test various ideas and hypotheses regarding nutrition.

    I think this partnership demonstrates a real effort to address many criticisms of his past work.

    One would also be remiss without mentioning the kinds of recommendations provided by diabetes, heart associations, and other officialdom which appear to have resulted in an extraordinary increase in disease and girth. If Taubes is misguided then what are we to say about these “expert” organizations?

    1. JGoertzen says:

      “The article also failed to mention his partnership with Dr. Peter Attia and their project called NuSi which is designed to test various ideas and hypotheses regarding nutrition.”

      You mean when she said “He has cofounded a not-for-profit organization called the Nutrition Science Initiative to fund and facilitate rigorous well-controlled experimental trials carried out by independent, skeptical researchers.”? And when she goes on to say she’s looking forward to the results?

      Did you READ the article?

  10. steney01 says:

    We’re missing the big picture. Weight loss doesn’t reduce mortality! The current consensus is that if you’re healthy and overweight (and yes, you can be both, they aren’t mutually exclusive) it is not clear that you will extend your life by losing weight. In fact in some studies, mortality has actually been shown to increase with weight loss! Why are we indiscriminately telling everyone who is overweight that they need to be skinny and “normal” like us?
    Personally, I think there’s a significant bias against overweight people in american society that significantly clouds our understanding of this issue.

    1. Max says:

      “Weight loss doesn’t reduce mortality! The current consensus is that if you’re healthy and overweight (and yes, you can be both, they aren’t mutually exclusive) it is not clear that you will extend your life by losing weight. In fact in some studies, mortality has actually been shown to increase with weight loss!”

      This is a pretty bold statement to make and it is far from the current consensus! It flies in the face of the common consensus that the only way to increase longevity of life is to decrease caloric intake. The flaw in some of the literature you’re pointing towards could be that those who are pathologically losing weight may still part of the numbers. J-O diabetics, cancer patients, and the extremely malnourished all will have a decreased life expectancy by the numbers. To tell an obese person that they will be just as healthy staying overweight as shedding some excess pounds is a pretty irresponsible thing to do. I think you should show some of your research, and let it be examined, if you’re going to make a statement like that!

      1. steney01 says:

        There are many many studies that have looked at mortality and weight loss. I’m not even sure where to start, but here’s a link to a meta-analysis that can link you to many of the other studies.
        http://www.ncbi.nlm.nih.gov/pubmed/19555520
        “There was no evidence for weight loss conferring either benefit or risk among healthy obese. In conclusion, the available evidence does not support solely advising overweight or obese individuals who are otherwise healthy to lose weight as a means of prolonging life.”

        For sure, there are issues differentiating between healthy and unhealthy and deliberate and non-deliberate weight loss, but even when these have been controlled as best as possible, there is still no link.

      2. steney01 says:

        The reality is that high bmi correlates with mortality (in whites anyways) suggesting a link between weight and mortality. As a result we’ve decided if you lose weight you’re better off. But unfortunately it’s not that simple.
        This is suggested by the fact that in other populations, high bmi DOES NOT correlate with mortality. In other countries, diabetes rates are higher even though obesity rates are lower. This also plays out in studies that show that weight loss interventions don’t have an impact on cardiovascular related deaths in patients with type 2 diabetes, even despite an improvement in blood glucose, blood pressure and cholesterol levels.
        I don’t understand why we admit complexity with every disease except obesity. It’s not about just losing the extra pounds. That’s treating the symptom, not the disease.

        1. Greg says:

          Obesity is not a disease.

    2. Greg says:

      I think one could make an argument for quality of life as opposed to mortality. People who are obese or even moderately obese make life much harder for themselves. IMO quality of life is a much more important factor – after all nothing in life is particularly enjoyable without it.

    3. Dave says:

      This is only one study but with a fair number of people – from the NEJM in 2010:

      Body-Mass Index and Mortality among 1.46 Million White Adults

      Amy Berrington de Gonzalez, D.Phil., Patricia Hartge, Sc.D., James R. Cerhan, Ph.D., Alan J. Flint, Dr.P.H., Lindsay Hannan, M.S.P.H., Robert J. MacInnis, Ph.D., Steven C. Moore, Ph.D., Geoffrey S. Tobias, B.S., Hoda Anton-Culver, Ph.D., Laura Beane Freeman, Ph.D., W. Lawrence Beeson, Dr.P.H., Sandra L. Clipp, M.P.H., Dallas R. English, Ph.D., Aaron R. Folsom, M.D., D. Michal Freedman, Ph.D., Graham Giles, Ph.D., Niclas Hakansson, Ph.D., Katherine D. Henderson, Ph.D., Judith Hoffman-Bolton, Jane A. Hoppin, Sc.D., Karen L. Koenig, Ph.D., I-Min Lee, Sc.D., Martha S. Linet, M.D., Yikyung Park, Sc.D., Gaia Pocobelli, M.S., Arthur Schatzkin, M.D., Howard D. Sesso, Sc.D., Elisabete Weiderpass, Ph.D., Bradley J. Willcox, M.D., Alicja Wolk, Dr.Med.Sci., Anne Zeleniuch-Jacquotte, M.D., Walter C. Willett, M.D., Dr.P.H., and Michael J. Thun, M.D.

      N Engl J Med 2010; 363:2211-2219December 2, 2010DOI: 10.1056/NEJMoa1000367

      AbstractArticleReferencesCiting Articles (315) Letters
      Background
      A high body-mass index (BMI, the weight in kilograms divided by the square of the height in meters) is associated with increased mortality from cardiovascular disease and certain cancers, but the precise relationship between BMI and all-cause mortality remains uncertain.
      Methods
      We used Cox regression to estimate hazard ratios and 95% confidence intervals for an association between BMI and all-cause mortality, adjusting for age, study, physical activity, alcohol consumption, education, and marital status in pooled data from 19 prospective studies encompassing 1.46 million white adults, 19 to 84 years of age (median, 58).

      Results

      The median baseline BMI was 26.2. During a median follow-up period of 10 years (range, 5 to 28), 160,087 deaths were identified. Among healthy participants who never smoked, there was a J-shaped relationship between BMI and all-cause mortality. With a BMI of 22.5 to 24.9 as the reference category, hazard ratios among women were 1.47 (95 percent confidence interval [CI], 1.33 to 1.62) for a BMI of 15.0 to 18.4; 1.14 (95% CI, 1.07 to 1.22) for a BMI of 18.5 to 19.9; 1.00 (95% CI, 0.96 to 1.04) for a BMI of 20.0 to 22.4; 1.13 (95% CI, 1.09 to 1.17) for a BMI of 25.0 to 29.9; 1.44 (95% CI, 1.38 to 1.50) for a BMI of 30.0 to 34.9; 1.88 (95% CI, 1.77 to 2.00) for a BMI of 35.0 to 39.9; and 2.51 (95% CI, 2.30 to 2.73) for a BMI of 40.0 to 49.9. In general, the hazard ratios for the men were similar. Hazard ratios for a BMI below 20.0 were attenuated with longer-term follow-up.

      Conclusions

      In white adults, overweight and obesity (and possibly underweight) are associated with increased all-cause mortality. All-cause mortality is generally lowest with a BMI of 20.0 to 24.9.

      I don’t think the issue is with people who are modestly overweight and function well, and are happy and active, but so many people are morbidly obese and their health really suffers as a result. Their care suffers, too – an adequate physical exam may be impossible, IV access may be very difficult, they can’t fit into MRI scanners or weigh too much for the CT scan table, and it takes 3 nurses to turn them, etc.

  11. kevin says:

    Sadly, there are number in nutritional sciences who push Gary’s dogma. It leaves the realm of science for religion all too often. I have yet to see a LCHF diet that didn’t also reduce calories to lose weight. Their hypothesis can never seem to explain what happens to those extra calories, and why protein (lysine), which stimulates insulin release, is okay.

    And all of this is to just lose weight? LCHF has mostly been studied in relation to weight loss and CVD. As far as evidence-based nutrition goes, we know very little about it’s effect on other organ systems over time.

  12. goodnightirene says:

    Your plan for weight control is very sensible and is precisely the way I lost 45 lbs over seven years ago. The first step (food journal) is not only the most important in terms of a first step, but the one that I find people are the most reluctant to take. I think this might be because it will force them to admit how much useless stuff (can’t call most of it food) they consume. It is much easier, psychologically, to blame carbs, or gluten, or whatever.

    I have a number of fat (or cattish) friends who actually berate me for eating “so little”–actually just recommended serving sizes. They do not believe I can be healthy on 1200 calories/day (average, it certainly varies as I do not slavishly count them as so many people imply; it’s more of a serving size of real food is not going to exceed caloric targets). For example, a serving size of apple is usually given as a “small” apple. Most apples today are quite large except for the smaller ones that come in bags, so I cut my apples in half, which seems to shock people and cause them to accuse me of “starving”.

    People can continue to theorize about the value of “types” of calories, and they will continue to be overweight or regain lost pounds. Taubes has made a fortune from his books and will continue to defend his work. Dr Hall and I will continue to weigh ourselves frequently, and follow her list of sensible approaches.

    A book I highly recommend on the subject of calories is “Why Calories Count” by Marion Nestle and Malden Nesheim. Both are PhD’s, she in biochemistry with a Master’s in Public Health. She mentions Taubes briefly and when I asked her about this she said something to the effect that he is such a pain about criticism that she somewhat avoids it. The book is very science grounded, yet remains very readable–so of course, it will never be as well known as Taubes’.

    1. Denise B says:

      I gained 65 pounds over 15 years, then lost 40 of them over three years. It was all about appetite. I was uncontrollably hungry all the time during the time I was gaining. I didn’t even try to diet, because I was already using tremendous willpower to not eat 3000+ calories a day.

      For three years now, I have maintained my weight to the pound without any effort. I figure I have taken in over 2 million calories during this time. To maintain my weight, I must have taken in within .16% of the amount I expended.

      Now how, without making any effort, could I have hit the mark within .16%?

      Answer – I don’t know, but there’s certainly something going on that needs explaining. If I weighed and measured and counted every morsel that went into my mouth for three years and every calorie I expended and tried to match them, I couldn’t have done it with 99.8% precision. Yet my body knew how to do it – as it from high school to age 43, during which time my weight always stayed within 5 pounds up or down with no conscious effort.

      There are obviously some amazing feedback mechanisms at work here, and some things that can cause them to become deranged. We shouldn’t have to consciously control our caloric intake and expenditure any more than we should have to consciously control our body temperature.

      In my case, the period of time I was obese corresponded to the period of time I was taking various antidepressants. I started losing when I switched from Effexor to Wellbutrin. I can’t prove it was the cause, but it seems highly likely. And if a pill could do it, so could other environmental or genetic things.

      1. Angora Rabbit says:

        Increased appetite and weight gain are well-known side effects of many antidepressants including the SSRIs. And appetite is controlled by a series of peptide hormones and small molecules that communicate appetite and satiety between brain, gut, adipose, and liver. There’s some terrific review articles on this subject in PubMed and is intensely researched. There’s exciting work emerging about how appetite and the gut nervous system interact as well, with implications for the various forms of surgeries performed to help people lose weight.

        So your instincts are sound – it is definitely more than just counting, and by “listening” to your body, you were able to maintain your weight. Congratulations on losing those pounds!

      2. Xplodyncow says:

        Wellbutrin helped me lose weight by inhibiting my appetite (a known side effect), and then it took far less food to make me feel full. It’s so much easier to shed pounds when you aren’t hungry — but I feel like that’s cheating or something. :-)

    2. Iorek says:

      We need a word for things a person could eat, that won’t kill them today, but which has value only as calories. ‘Junk’ doesn’t really do the trick I don’t think.

      Also agree with you about the fruit. I have a hand of lovely bananas here fresh from the farm but they are each so big I can’t bring myself to start one. Maybe I’ll eat half and freeze the other half for a smoothie another day. The other good thing about small pieces is you can mix it up-a couple of small pieces is much nicer and more interesting than one monster piece.

      1. Kathy says:

        One way of using smaller amounts of large fruits like apples, bananas, oranges, etc., is to make a them into fruit salad and dish up just a little for yourself each time. It’s nice to eat instead of dessert, or as an alternative to lunch.

        1. Greg says:

          I often have fruit salad and cottage cheese for breakfast – delicious – cottage cheese goes with pretty much anything – I even put it in with oatmeal.

        2. irenegoodnight says:

          Yes, I do a lot of fruit salad with yogurt and a few nuts, but I only make small amounts and I MEASURE what I eat.
          ———–
          A lot is said here about hunger or feeling hungry–make no mistake, I am often “hungry”. I’ve learned to ignore it and only eat when I’m supposed to. I think that’s discipline, not torture. Who said you can never feel hungry?

  13. Angora Rabbit says:

    The problem with Taubes is the parable of the blind men with the elephant. He feels the animal’s skin and says, “Oh, it must be a rhinoX!” without considering the rest of the animal’s structure and thereby missing the trunk. He prefers to ignore the greater complexity of weight control and focuses entirely on one aspect. I just quizzed a colleague who is a leading expert on the subject, and his response was “Metabolic magic!”

    Yes, it is certainly true TO A POINT that reducing serum insulin through lower CHO intake can help reduce triglyceride synthesis and storage. But it is not the entire story. As I think William correctly pointed out, we must also consider metabolic set points and satiety issues. We must consider body composition – having greater skeletal muscle mass helps to burn free fatty acids at rest, because it is a primary fuel for skm. We must consider energy balance and intake vs. expenditure. We must consider fuel choice that the body is burning as these differ with rest and exercise.

    Taubes’ problem is that he’s half right and ignores what doesn’t fit into his simplistic little model. And he’s combative about it (hmm, wonder why), and thus has alienated himself from the very researchers who have tried to help him understand the complexity. I feel sorry for him because he could do so much to help people, but instead is focused on a partial story.

    I predict that many of today’s respondents will say “but it worked for me!” because those aspects of weight control were affecting them individually, to which I give a heartfelt “Hurrah and congrats!” But to then extrapolate, as Taubes does, that this must be a universal truth for all will do a disservice to those who have problems due to other issues and causes.

    To which I will just add that, for the typical adult American who gains a pound or two a year, we are talking about an average increase of just 10-20 calories per day above balance. I find this calculation to be very interesting because it is a manageable way to think about the problem.

  14. Angora Rabbit says:

    Steney, what you say can be true at the individual level,l but you are confusing individual risk with the public health question. Overall, when we consider a population’s health, obesity does increase overall risk for diseases such as osteoarthritis, type 2 diabetes, hypertension, and atherosclerosis. At the individual level, the statistics are definitely not in one’s favor, but one can roll the dice and there will be real statistical variation in there. So that individual may not be at risk because they have individual lifestyle practices and/or alleles that are helpful. It is the difference between population statistical risk and individual statistic risk.

    But it is not correct to then extrapolate that individual’s risk to the entire population and say, don’t lose weight, because the statistical risks are NOT in favor for the population. Think about seatbelts – on any given day, my individual risk for a collision is very very low, but I still buckle up anyway because I understand that the risk is not predictable. And at the population level, we can pretty much guarantee that wearing that seat belt today will save several thousand lives.

    Do you see the difference? It’s complex, I know. I think this lack of understanding the difference has created great confusion for the lay public (and professionals!) about this topic, and how we translate public health recommendations to the individual level.

    1. steney01 says:

      I don’t agree with your assessment (surprise). My basic premise is that it has not been shown that weight loss leads to a decrease in mortality. This is an observation derived from the population at large that can inform broad policy at the population level irregardless of individual variation. Namely, I believe our policy should be that we would stop pushing weight loss (and calorie counting) as the solution and instead focus on healthy eating in general whether or not that leads to weight loss at all. In other words, losing weight is not worthwhile in and of itself, or as a public policy since it does not improve mortality especially when you consider the tremendous toll it takes on people when you draft a blanket statement saying that they are unhealthy and costing society money if their bmi is over 25. I know that it’s just a lot easier to say to people, you need to get your bmi under 25, instead of, “you need to eat healthier”. Fortunately I think we can draft broad policy “eat healthier” that also accounts for differences in individual variation by not simply saying everyone has to lose weight until they hit a certain point that we’ve decided is “normal”.

      1. Sean Duggan says:

        Personally, I think it’s more likely that the figures showing that weight loss is not necessarily tied to lower mortality has to do with the fact that a “healthy weight” is at different points in the scale. Let’s take an analogy of blood pressure. My blood pressure figures run a little low, albeit in a healthy range. My brother, on the other hand, has elevated blood pressure, to the point where it is a healthy risk. It makes no sense to look at the situation and say that we both need to reduce our blood pressure, that lower is better. It also doesn’t make sense to say that high blood pressure is perfectly fine, since some people have unhealthily low blood pressure. Similarly, there are people whose bodies do just fine with them being 20-30 pounds over the “ideal” BMI and with a small ring of fat around their bellies and there are people who stay stick thin and are healthy. Being overweight or underweight is a data point, possibly a symptom, but it is not the story.

      2. MadisonMD says:

        I would add that mortality is not the only measure of health. What about quality of life and disease incidence?

        Mortality from diabetes and hypertension (with heart disease and stroke) has dropped precipitously over the past decades, due to effective medical therapies. Mortality from cancer has dropped a bit. However, the incidence has not. Wouldn’t it be best to avoid these diseases even if they do not shorten your life? A small stroke or diabetic retinopathy might not shorten your life, but wouldn’t you rather avoid them?

    2. egstras says:

      “But it is not correct to then extrapolate that individual’s risk to the entire population and say, don’t lose weight, because the statistical risks are NOT in favor for the population. ”

      Or think about smoking… I’m sure we all know someone who smoked X packs of cigarettes a day for 70 years and died at 100. That doesn’t negate the risks of smoking for the entire population.

  15. Bruce A. Hamilton says:

    I must agree with Lacri’s comment re: most popular discussions over-emphasize calorie intake as opposed to calorie absorption. What about resistant starch in foods like beans? Do most researchers claim that excreted stools have zero calories?

    1. WilliamLawrenceUtridge says:

      Do most researchers claim that excreted stools have zero calories?

      Of course not, researchers are not idiots – doubtless genuine experts’ understanding of the matter is far more sophisticated than that of anyone here bar probably Angora Rabbit. Have you ever actually counted up the number of grams of fat, protein and carbohydrate, multiplied the per-macronutrient calories by each subtotal then compared it to the total kCal? It’s possible the portion of indigestible fiber is already factored out (I genuinely don’t know, I’ve never undertaken the exercise). But it still muddies satiety with calories and basic physics. It doesn’t matter what it says on the wrapper, that’s at best a guide. If your current eating causes your weight to trend upwards, it doesn’t matter how many calories are pooped out.

    2. Angora Rabbit says:

      You’re right, Bruce, we do think about this and take it into calculations. You actually get, on average, about 10% of your daily calories from microbial fermentation of all the materials that enter your ileum and colon. Vegans generally get more because they eat a higher carb diet (gasp!) and will have more “digestible fiber” intake that reaches the colon. My bunnies get about 35% of their calories this way.

      Of course, your poo does actually contain calories, albeit in the form of microbes. Technically, they’re digestible. I can tell you about animal cruelty cases in which the animals eat their feces to try and obtain nutrients. And then there’s coprophagy, which is the “natural” feces eating that animals can practice, such as bunnies and rodents.

      If you read the professional diet tables, you’ll find that these break certain foods into “raw” and “cooked” forms when relevant to the diet. So one can see how calories, micronutrients, and fiber change with processing.

      And then you have to consider stuff like chewing, pancreatic sufficiency (like folks with cystic fibrosis, NOT the typical American), allelisms in digestion, and microbial composition. And then influences of genetic variation or processing of the absolute food. Professional nutritionists like myself view the tables as decent approximations but not absolutely what a person would experience. Calories in food have a specific scientific definition for that food being assayed. Those values are very helpful in developing diets (for example, in diabetics). But there will be individual variation on both the ingestor and the food, and that’s okay.

      It ain’t an absolute!

  16. Somite says:

    I don’t think we should discount the increasing body of evidence that fructose is probably toxic at the levels present in common diets

    http://www.nature.com/nature/journal/v482/n7383/full/482027a.html

    1. WilliamLawrenceUtridge says:

      The same could be said of nearly anything. Modern science and chemistry allows the concentration of nearly any substance on the planet. Consuming individual amino acids, or fats, to the degree with which we consume concentrated fructose would doubtless have consequences. People should eat fruit, not fructose.

  17. LucyDean says:

    I’ve lately heard a new-ish “theory” from my kids’ pediatrician who suggested I put my not-at-all-overweight 7-year old on a low-carb diet (for future purposes, not because she needs to lose weight now):

    Cutting calories doesn’t work because a reduced calorie diet will serve to “slow down” or “bottom out” your metabolism and your weight loss will plateau rather quickly; additionally, as soon as you increase your caloric intake even a little, you will gain it all back because your metabolism has become “inefficient.” Whereas, in a simple low/no carb diet, there is no calorie restriction and no opportunity for your metabolism to become inefficient.

    So, putting my, again, not even remotely overweight 7-year old daughter on a low carb diet will serve to continue keeping her metabolism “efficient.”

    Please confirm that I need to switch pediatricians :)

    1. Greg says:

      I would change pediatricians – a blanket statement that cutting calories reduces metabolism is categorically wrong. Starvation causes your metabolsim to slow but no one recommends a starvation diet as a sensible method to lose weight – too extreme and high risk.

    2. Raymond says:

      Wow. The pedestrian gave a load of misinformation/half truths.

      The only way to lose fat mass is to be in a negative caloric balance. Whether by decreasing input, increasing output, or combining both.
      Metabolism is going to slow when weight is loss. A 200 pound person just doesn’t need the energy of a 400 pound person.
      I’d fire a person who’s telling you to experiment with your child’s diet for no reason. Anecdote – I’ve read more about metabolism tanking on low carb than improving. Cold hands, lose of hair, poor sleep, ect.
      And lastly, the longest lived populations eat high carb.

    3. NotADoc says:

      Yeah, I’d get out of there immediately. Worrying about future weight in a healthy, beautifully proportioned 7-year-old girl, and putting her on a pretty restrictive diet, sounds like an eating disorder in the making to me!

    4. WilliamLawrenceUtridge says:

      The best way to ensure your not-at-all-overweight 7-year-old doesn’t need to lose weight is to expose her to some form of exercise that she likes, that she can do for years. Make her enjoy moving, for its own sake, for the competition of games, or even purely for health reasons. In addition to being an excellent way to maintain a reasonable BMI and body fat, it has its own benefits. Not exercising is, from my understanding, as much a risk factor as smoking.

      So – soccer, swimming, skating, strolling, it doesn’t matter – something to make her move and keep moving, and you’ll be doing massive favours to her adult self.

      1. mouse says:

        It better be a massive favor because my Memorial Day week-end fun is being scheduled around my daughter’s soccer tournament. (grumble, grumble).

        Oh – who am I kidding. I actually really enjoy the games and I enjoy watching a bunch of girls genuinely physically and mentally compete. I also enjoy hearing the supportive parents shouting things like “be aggressive, sweetie!” It makes the feminist in me happy.

        (That had nothing to do with diet-so I guess I should have inserted an off-topic warning- oh well)

  18. Don says:
    May 13, 2014 at 8:51 am
    “Once of the reasons that Taubes and others arrived at conclusions was the observation that many people on LCHF diets are able to lose significant amounts of weight without counting calories.”

    Conclusions not supported by the evidence.
    If weren’t counting calories, then they were performing uncontrolled observations, and they can’t really say whether they did or did not reduce calorie intake, right?

  19. Hi, Harriet,

    In response to this comment: “Taubes’ hypothesis about the underlying cause of obesity may be right”…

    It’s not right…not even close. Taubes gets so much wrong in regards to physiology and science of obesity. He completely ignores data that refutes and contradicts his “hypothesis” (I can’t even call it that because the science doesn’t even come close to supporting it). His GCBC book is full of misreferenced studies and incorrect statements regarding insulin and other aspects of physiology. I have criticized Taubes in a number of blog posts on my website http://weightology.net/?cat=79 . There are others who have done the same, such as Dr. Stephen Guyenet. I wish I could explain just how extensively wrong Taubes is in a comment here, but I can’t even do it justice here. Many central tenets of Taubes’s “hypothesis” are completely contradicted by published scientific observations, yet Taubes ignores all of this and continues to push his “hypothesis” (presumably due to extreme confirmation bias on his part, in addition to protecting his financial interest in selling his books and lectures).

  20. Oh, and I would like to add that sending somewhat offensive personal emails is not new to Taubes. He did the same thing to Evelyn over that the Carb-Sane Asylum blog, as well as sending one to me after I wrote this blog post: http://weightology.net/?p=265

    1. Razwell says:

      Stay out of this section, James. You are an irrational DOGMATIST. I have 40 different world renowned physicists on MY side about this issue. YOU ARE misusing the conservation of energy principle. It does NOT address the regulation/dysregulation of FAT CELLS SPECIFICALLY.

      ACTUAL physicists do NOT support what you are saying. They personally stressed to me. Obesity is NOT a matter o basic thermodynamics. it is NOT SUFFICIENT to epxlain this.

      Adam Kosloff and I are planing to publicly take you down with the backing of about 12 physicists.

      1. Windriven says:

        Which is it Razwell, 40 physicists or 12? I don’t have a dog in this fight but I’d like to see some consistency in the arguments. How many and who are they? Without names you’re just waving your hands.

  21. Yodel lady says:

    I think Americans won’t count calories because they simply can’t do the math. My science teacher in 8th grade taught me the formula, and it’s never failed me. Most of my friends are college educated, but tell them a pound =3,500 calories and you can sit and watch their brain cells start to die off. They cannot even think about it, let alone understand it or use the information. It’s much better to believe it works by magic, especially when magic requires no self-discipline.

    1. Windriven says:

      “Most of my friends are college educated, but tell them a pound =3,500 calories and you can sit and watch their brain cells start to die off.”

      I have witnessed this phenomenon and have come to understand that there is a difference between schooled and educated. One of the most ignorant and uncultured people I have ever met had an MBA from an OK school. Schooled he was. Educated, not so much.

  22. Frederick says:

    All those miracle solution are Malagasy BS, they always try to make people believe that the on answer to the problem. personally, I have been weight between 140-145 pound ( 5 foot 11) for like 15 years. I eat a lot, i eat every knds of food, ( vegan, meat, fish whatever I want), I’m one of those lucky person who is a living incinerator. I burn it all!

    The family on my father side is like that. Me and my little sisters are like that ( My older brother and sister are not that lucky, they are not obese, but they put on some weight, My brother a little bit more). My father is 64 and have the same shape as me. It is a good thing, because we have some heart problem ( some valve nor working properly), we all have it, mine is not bad, but i Might need surgery later. My father had one last year, My older brother had one a 8 years old, and his son will have surgery too. That and my eyes are my worst genetic flaws, and seriously I really happy to be this lucky. Of course that does not mean i cannot have blood problem.

  23. charles grashow says:

    http://www.nwcr.ws/Research/default.htm

    There is variety in how NWCR members keep the weight off. Most report continuing to maintain a low calorie, low fat diet and doing high levels of activity.

    78% eat breakfast every day.
    75% weigh themselves at least once a week.
    62% watch less than 10 hours of TV per week.
    90% exercise, on average, about 1 hour per day.

    http://www.nwcr.ws/Research/published%20research.htm

    1. irenegoodnight says:

      I never fit in!

      I never eat breakfast (not a morning person in general).

      I DO weigh myself regularly, and don’t own a TV–which is probably why I have time to read blog comments :-).

      I mow my own lawn (with a push mower), and do all my other yard work and home maintenance. I do less than I did in my prime, but I am more active than my friends. I don’t like formal exercise, but I make sure I move. I quit riding my bike after a very bad fall, but am thinking of a three-wheeler.

  24. Left Coast Bernard says:

    Dear Dr. Hall,

    Here is a link to a New York Times article about supposed weight loss misunderstandings that cites a Harvard researcher who denies that the First Law of Thermodynamics is correct as applied to dieting.

    The article touts another scientist, with a new book and a movie, who agrees, and argues that the secret to weight loss is to eat a high carbohydrate diet.

    http://well.blogs.nytimes.com/2014/05/09/fed-up-asks-are-all-calories-equal/?ref=health

    Bernard Leikind

  25. JLampen says:

    You say that “Taubes’ hypothesis about the underlying cause of obesity may be right, and a low-carb diet may be best not only for weight loss but for disease prevention”

    It seems there has been mounting evidence showing that high protein diets can be rather dangerous, such as this recent one:

    “Low Protein Intake Is Associated with a Major Reduction in IGF-1, Cancer, and Overall Mortality in the 65 and Younger but Not Older Population”

    http://www.cell.com/cell-metabolism/fulltext/S1550-4131%2814%2900062-X#Comments

    Maybe high protein can work for weight loss, but disease prevention (especially if its animal protein)? With a quick search I found many published studies showing possible dangers of eating meat (especially processed and red meat), here’s a few examples:

    http://www.nejm.org/doi/full/10.1056/NEJM199012133232404
    http://jama.jamanetwork.com/article.aspx?articleid=200150
    http://cebp.aacrjournals.org/content/10/5/439.short
    http://www.sciencedirect.com/science/article/pii/S0272638697900457

    There’s also this: http://www.health.harvard.edu/fhg/updates/Red-meat-and-colon-cancer.shtml

  26. dh says:

    The Taubes-style low carb diet that had me eating animal protein for 3 meals per day was extremely successful in several respects (weight loss, remission of metabolic syndrome), but extremely worrisome in another respect (severe hypercholesterolemia). Ergo I became a vegan and relatively high carb at that and still lost more weight. All of this without counting any calories but my guess is that caloric intake was the key determinant of success on both diets (by the way, the hypercholesterolemia remitted marvellously, and the metabolic syndrome is still gone). That was 2.5 years ago and the diet is sustained…

    n=1.

  27. Lytrigian says:

    I got into an argument with someone on the Sumo Forum the other day on this subject. Ironically the starting point was the plight of a sumo wrestler by the ring name of Takanoyama with precisely the opposite problem that most of us have: despite over a decade in the sport and a regimen which virtually guarantees weight gain in nearly all who follow it, he is simply unable to get fat. It’s made the sport rather difficult for him despite his high level of technical proficiency. When your opponent outweighs you by 50 kg or more, you have an uphill battle.

    It was revealed not long ago that he even tried insulin injections. So much for that theory.

    This didn’t stop one other commentor from invoking Taubes and his theories. Ironically — or maybe not ironically — he used exactly the same argument Taubes did with Harriet. I simply didn’t understand. In truth, I didn’t watch the YouTube video of one of Taubes’ lectures to which he’d kindly linked, proceeding instead on my own previous understanding. When clicked on it later, I realized my original decision was correct. He’s a dreary speaker and one much in love with the sound of his own voice, taking a great deal of time to say very little. It contained no new information. Some of it was positively faulty. He seems actually to not understand thermodynamics, despite his protestations to the contrary. When he asserts that a star can gain mass without “eating”, something has gone sideways in his mind.

    I linked to the previous articles here mentioning Taubes’ theory, but I doubt they were actually read.

    My own personal experience tallies with that of weight loss and fitness and health care professionals worldwide. When I watch my calories and get lots of exercise, I lose fat regardless of carb intake. Not necessarily weight, depending on the exercises I do. When I was in the best shape of my life I only weighed 5 lbs less than I do now, but my waist size was 2 inches smaller.

  28. Milwaukeegirl says:

    I started reading the comments but then got a sudden inexplicable craving for a Twinkie.

  29. healthnut says:

    Harriet’s advice is probably similar to the advice most doctors give their patients. And it is probably one of the main reasons there is an obesity epidemic, and a health crisis.

    Obesity used to be much less common. According to Harriet’s theories, it must be simply because people now eat more calories than they used to. Does that sound like a plausible explanation?

    The difference between then and now is that Americans (and others in similar societies) spend more time sitting in cars and in front of TV and computers screens. And because there is lots of convenience food available with very high levels of refined carbohydrates.

    Telling patients that exercise won’t make much of a difference is deadly advice. Exercise prevents the metabolism from slowing. It increases the size of muscles and that could be why it doesn’t seem to help much with weight loss. The goal should not be to lose weight, but to lose fat and increase muscled.

    Harriet’s advice has been around a long time and it is dangerous.

    Think of the people you know who are not overweight — do you ever see them writing down everything they eat in a notebook, or measuring food or counting calories? I doubt it. They probably just did not adopt the typical modern lifestyle. They don’t get giant soft drinks at fast food restaurants, and they don’t spend hours in front of the TV every day.

    The average American adult gets fatter every year, and it’s because of the typical modern lifestyle. It is not because they neglect to measure what they eat and count calories.

    Low carb diets may work for some, maybe not for all. The point is to break the carbohydrate addiction. Yes, refined carbohydrates are an addictive drug.

    Low fat diets are probably useless. Sadly, the grocery stores shelves are filled with non-fat yogurt that is full of refined sugar. Doctors like Harriet are not helping at all to change this terrible situation.

    1. Lytrigian says:

      Obesity used to be much less common. According to Harriet’s theories, it must be simply because people now eat more calories than they used to. Does that sound like a plausible explanation?

      Yes, actually. In 1970, it was pretty much impossible to find a 30-oz cup of soda. Now you can get that in any 7-11, and it’s not even the largest size. Calorie intake has increased dramatically since 1970, and people very likely underreport what they eat: http://health.usnews.com/health-news/blogs/eat-run/2013/03/11/accounting-for-calories

      I’m not sure how you missed Harriet’s recommendation to exercise, which she made at least twice in her article. The point of bringing up the Swedish study is that those who cannot exercise for this or that reason can still lose weight by controlling intake.

      1. Windriven says:

        “Now you can get [a 30 ounce soda] in any 7-11, and it’s not even the largest size.”

        I never go to fast food joints. But Mrs. Windriven and I had friends in town and we were on our way somewhere and the friends (both of Cold War-level throw weight) wanted to stop at Jack-In-The-Box for “a snack.” I ordered a large iced tea to be sociable. I didn’t know that I had done anything stupid until they brought the thing to the car with a forklift. It was big enough to end the drought in Sudan. Less than $2 as I recall.

        1. Lytrigian says:

          At least unsweetened iced tea has practically nothing in the way of calories.

          Jack-In-The-Box is one of those places where I can’t even fathom why anyone would buy food there.

          1. brewandferment says:

            it’s the jalapeno poppers. I don’t care how bad they are for you, since there’s no Jack in the Box anywhere near my normal range of travel, I only get to indulge once or twice every couple of years. And once or twice a year is usually all that I need to tide me over for the next couple…

            1. Windriven says:

              Brew, If it is the whap of the jalapeño and the soothing creaminess of the cheese that tickles you, split and seed the peppers, fill the halves with cream cheese, and pop them on the grill. They lack the crunch of the deep fried jobs but also some of the calories. And the grill adds a nice smokiness. Neufchâtel lightens the load a little further.

              1. brewandferment says:

                eh, too much work. If I don’t learn to make them at home then they remain the annual/biannual treat that I look forward to, gorge on once or twice and then put away the craving for another year or two. If only eaten on that frequency, calories and fat content are happily ignored, too.

                but thanks though!

          2. Windriven says:

            Local kids who work at Jack-In-The-Box have a nickname for the place that would get me banned for life if I repeated it here. But it sort of summarizes the way I feel about the place.

            Like you, I can’t imagine eating there. Though I must admit I haven’t had their poppers. There are enough bars around here that do them that I’ve never had the need.

            1. irenegoodnight says:

              Why would Jack-in-the-Crack get you banned?

              1. Windriven says:

                Hmmm … apparently it didn’t get you banned.

                After reading Gorski’s turd polishing entry I decided it was time to polish up my persona ;-) A kinder, gentler, less foul-mouthed Windriven.

    2. n brownlee says:

      “According to Harriet’s theories, it must be simply because people now eat more calories than they used to. Does that sound like a plausible explanation? ”

      I’m here to tell you it’s more than plausible. Whatever other contributing factors there may be- and lack of exercise is certainly one of them, especially for kids- American eating habits are nothing like they were forty years ago. We did not eat for entertainment. We did not snack non-stop, all day, at work, at our desks, at home watching twelve hours of TV every day- we simply did not. We did not watch television “gourmet chef” cooking shows and buy twenty thousand dollar kitchen stoves and show them off like Porsches, just for preparing four meals a week. Our children did not come in from school and eat Hot Pockets in front of the television a couple hours before a fast-food supper, then have a snack of chili cheese fries before bed, all washed down by soft drinks. Adults did not have 1500 calorie fast food lunches- we ate a tuna sandwich we brought from home. A restaurant meal was an occasion- infrequent, for most of us.

      We eat more. A LOT more.

      1. Windriven says:

        I love it when you get on a rant :-)

      2. Linda Ellis says:

        Your statement that people eat more calories today than n the past may be correct, but your examples are anecdotal.

        How far in the past are we willing to go back? 50 years? 100 years?
        We certainly have more prepared food higher in processed carbs and sugar in our current diet, and that is easy to document.

        But if you have documentation to support a claim that our current diet also contains a far larger amount of calories than in the past, that would be worth noting.

          1. Linda Ellis says:

            That report is good, and corresponds with my memory of food and drink sizes increasing in just my lifetime.
            But is it even possible to show what the components of the typical diet and caloric amount from 100 or 150 years ago?

            It looks like in this study, many items shown to increase in size are high in carbs (including sugar) which have a greater affect on raising blood glucose than proteins or fats, and thus more release of insulin to store it.

            I do not know how the percentage of carbs in the diet had changed over the last century, but I know the use of sugar in all forms has risen dramatically. I would more concerned about calories from refined carbs/sugars than from fats and proteins, as the body does not treat them all the same.

            1. Windriven says:

              “But is it even possible to show what the components of the typical diet and caloric amount from 100 or 150 years ago?”

              I doubt it. And levels of physical activity were much different.

              Much of the modern diet is packaged foods that are shaped more by marketing than nutrition. Grease, starch, sugar and salt – the four major food groups, right?

            2. Angora Rabbit says:

              Hi Linda, it is absolutely possible to get the information you are asking about, such as food consumption per capita, food composition, and thereby caloric breakdowns over the past 120 years, possibly back 150yrs. I have colleagues who do these calculations regularly; one has access to detailed government records on food production, for example. Researchers review the copious recipe and food preparation documentation for both homes and food producers and can calculate meal and food composition and how those change with time. There are also researchers who follow activity levels in volunteers and can determine how much energy expenditure has changed over the decades. They can compare expenditures for “labor saving” devices and develop pretty accurate estimates for their impact on expenditure. I can’t point you to those documents right now, but if you nose around the internet, you should be able to find them. USDA would probably be a great starting place for that information.

              Marion Nestle is an outstanding researcher and writes about these issues in her excellent books. You might also look at Brian Wansink’s work at Cornell on “mindless eating” and his research into food psychology – equally fascinating work! He has a book as well on “Mindless Eating” wherein he focuses on behavioral practices that have increased consumption; the restaurant plate size research is his, IIRC.

        1. Calli Arcale says:

          Wouldn’t that be a bit like backing up the claim that there are more cars today than there were in 1950? It’s sort of obvious. Documentation might be useful from a quantification perspective, but it seems obvious that we’re eating more now than we did before. Restaurant portions are clearly up, even from when I was a kid in the 80s, and snack sizes are up too. The candy bars have gotten bigger.

        2. Dave says:

          A few months ago on this website information was posted from the dept of agriculture about the amount of food produced/available per capita over the historical records. It didn’t specifically tabulate what people ate but there is far more food available per person now in the US than in the past and this probably correlated with consumption.

          I actually agree with some of the posters here about the importance of exercise. I think the problem is that the amount of exercise needed to lose weight is pretty substantial. If you study people whose exercise is walking an hour a day, which might burn 200-300 calories, the effect of diet overrides this, since a latte might exceed that amount. On the flip side, the men in the Lewis and Clark expedition reportedly consumed enormous calories, albeit mostly meat, on the order of > 5000/day, but they were hauling a keelboat upriver against the Missouri during spring runoff all day long. I haven’t seen any documentation of their weight but the screening for the expedition members filtered out all but elite athletes so I imagine they were pretty lean. We see similar losses in people who backpack the Pacific Crest trail, go on strenuous mountaineering expeditions, or go through the weeks of special forces testing. But who realistically can sustain those levels of activity in modern society?

          Anecdotal, which I know is not valid here, if I run more than 30 miles a week I can lose weight, 15-30 I maintain weight, if I can’t run I gain. This is without adjusting my diet.

        3. irenegoodnight says:

          Marion Nestle says (and documents) that there are twice the calories available in the US than there were in 1980. This is the fundamental problem, not food groups.

          If you don’t know who Marion Nestle is, take a look at foodpolitics,org

    3. weing says:

      “Telling patients that exercise won’t make much of a difference is deadly advice.”

      Do you mean I can eat 7000 calories a day and If I walk twice around the block I won’t gain weight? What if I jog 5 miles daily for an hour? I still won’t gain weight?

    4. Dave says:

      Actually the standard medical advice is to combine portion size restriction plus exercise. I recently posted the American Heart Associations exercise advice from their website a few weeks ago – basically about an hour a day of at least moderate intensity exercise on most days with strength training a few times a week. A few years ago there was a recommendation to increase exercise for weight loss to 90 minutes a day. I think it was realized that few people have that kind of free time and I’ve not seen that recommendation lately.

      I don’t think anyone feels that refined carbohydrates are good for you but I see this term “addiction” used a lot, and I think it means something different to different people. I frequently have patients who are hospitalized and unable to eat for periods of time. I’ve frequently seen withdrawal symptoms from narcotics and alcohol (sometimes quite severe) and some ssri’s in these circumstances. I’ve never seen withdrawal symptoms from sugar. Some of these patients are getting glucose in iv solutions but many are on normal saline . I think refined carbs are very habit forming but not in the same league as other substances we refer to as addictive.

      As an aside a few years ago a study came out about the diet of a team of Kenyan elite distance runners. Their average weight was 129 lbs, average height 5’9″. Most (76.5%) of their calories came carbohydrates and a significant proportion, about 20% or about 500 calories a day, was from sugar, mainly in tea. Of course they were running a lot also. Here’s a report on the article:http://www.active.com/running/articles/eating-practices-of-the-best-endurance-athletes-in-the-world

      Finally, studies have been done comparing dietary intake from a century ago and now. This was posted here a few months ago and there has been an increase. I’m old enough to remember the portion sizes in the 1950′s. It is also true activity levels were different. TV’s were not found in every home back then, and I remember as a child that we were able to watch tv one evening a week, at which night we also were allowed an evening snack (we referred to that day as “refreshment night”.

      Anecdotally, the thinnest I ever was was at less than 140 lbs (I’m 5 ft 11 inches) and I ate a ton of carbs. I was also running marathons.

    5. Raymonencq says:

      “The point is to break the carbohydrate addiction. Yes, refined carbohydrates are an addictive drug.” No, no they aren’t. There is nothing you could site to support this statement. We gotta stop with this “refined carbohydrates” talk. Most “refined carbohydrates” are 40%+ fat. Potato chips and some brownies are more fat than carb.

      “Low fat diets are probably useless.” Not at all. Low fat populations are common. They’re just low fat through the likes of tubers, grains, and legumes – not no fat cookies.

  30. Windriven says:

    “Does that sound like a plausible explanation?”

    Yup. That and less exercise owing to TV, internet, etc.

    The rest of your rambling and frankly pointless comment seems to go … nowhere.

    Dr. Hall didn’t discourage exercise. Her entire point was that when input is greater than output you gain weight. You can input less. You can output more. Conversely, when input is less than output you lose weight. How does that make her dangerous?

  31. mho says:

    One reason I ate less in 1970 was because I smoked. It was remarkable how much better food tasted once I quit.

    1. Windriven says:

      And eating gives you something to do with your hands and mouth. I’m fairly serious about that. I smoked very many years ago and I porked up when I quit. I decided it was a subconscious replacement strategy. So I stopped.

  32. Jamie says:

    1. Distinguish between fat gain/loss and muscle gain/loss.
    2. Hormones and other signaling matter.
    3. Macro-nutrient timing matters.

    1+2=the simplistic “thermodynamics” discussion above is absurd. Calories used to build muscle will lead to future fat loss. Restriction in calories that leads to muscle wasting will lead to future fat gain.

    3 is a factor in 2. For example, your body will use carbs differently after heavy weightlifting than after 10 hours of sitting; carbs in the morning while cortisol is high will tend to increase fat storage; ….

    1. Lytrigian says:

      Your problem is that no one has any good evidence that 2) is the main cause of obesity for most obese people, or even for a good proportion of obese people. You can repeat it until you’re blue in the face — and Taubes’ claque is perfectly prepared to — but he simply doesn’t have the evidence.

      I’d be perfectly prepared to believe that it’s the problem for some small number of cases of obesity, so you’ll likely be able to find specific examples if you cherry-pick carefully enough, but that’s not helpful for making general dietary recommendations.

    2. Catherine says:

      Thank you.
      I’m suspicious of any weight loss guideline that fails to differentiate between weight loss and fat loss. The difference between being fat or thin, for me, is entirely in the type and intensity of exercise. A 45 minute walk, repeated every day, simply won’t move fat off my waistline. It may be keeping me from adding more, but no loss happens. Contrast that with lifting weights for 45 mintues, 3x per week and working muscles to the point of fatigue and I get thin and stay thin in a matter of weeks.
      I’m disappointed by experts holding out their particular diet plan as superior with only a passing mention of exercise as though all manner and intensity of exercise were equal. Clearly they recognize a difference between low carb and low fat, why the blind spot on aerobics versus weight lifiting?

  33. Iorek says:

    There’s so much emotional stuff tied up in this too. I have a brother who weighs 150kg-that’s pretty big, in your money. He’s always been an anxious person and very emotional-easily upset, angered or frustrated.

    He has many metabolic problems and despite doctors offering bariatric surgery, he maintains that it would be a failure to make that choice, and he wants to lose the weight on his own so as not to be a failure. As he sees it, the issue is not his intake but that it doesn’t matter what he eats or doesnt’ eat, he can’t lose weight. He went to the dietician to talk about his eating habits and came back saying that he was sure she didn’t know her topic or ‘practice what she preached’ and that what she proposed was ridiculous. He then said I’d got lucky with my genes from our parents. So I asked him if he wanted to eat what I eat for a month-I’d buy, prepare and deliver the food for him, so long as he agreed to only eat what I ate. I’m under 60kg.

    No, no he wouldn’t put me to the trouble-and anyway, the surgeons were going to put him on those meal replacements to get him down to a weight at which surgery would be safe(r), which would show them once and for all that whatever he eats or doesn’t eat, he gains weight or at least can’t lose any.

    So he goes onto the shakes and loses 25kg in a couple of weeks. Then freaks out, cancels the surgery, goes back to his regular life and puts on 30+ kilos.

    Intensely frustrating to watch, I can only imagine what it’s like to live it. I fear he won’t see 50 and wonder whether there is anything that could unravel the complexities of what is going on in his head, hopefully before what he is putting into his body destroys it permanently.

    1. Dolph says:

      I share your concern for your brother. This story reminds me of a former classmate of mine, very similar mindset.
      I think in many cases it’s a kind of self-inflicted injury as a marker of a broader psychopathology aka a visible sign of suffering. Pretty clearly it’s less of a physiological problem or even “mystery”.

  34. John McGuinness. M.D. says:

    When in the 1860s Semmelweiss championed handwashing as a way to prevent childbed fever, he was run out of town by the medical establishment. This was in no small part due to the horror that very establishment felt at the idea that they or their advice was somehow responsible for the diseases they sought to cure. Perhaps Dr. Hall is suffering a mild case of this ailment. It is clear that the approach of recent medicine to obesity and diabetes has been an abject failure. It is easy to blame the patient for being too lazy or overindulgent but my years treating women who are beside themselves with frustration at the inability to control their weight speaks otherwise. For years I robotically repeated the calories in/calories out mantra and privately bemoaned the lack of willpower of my patients.

    Dr. Semmelweiss was also roundly criticized for his lack of direct evidence. History has shown us that his observations should have been compelling enough even if the germ theory hadn’t been completely worked out. Dr. Taubes presents equally compelling observations in his books, observations that when combined with the crisis of the obesity epidemic should spur robust discussion and research rather than smug dismissal.

    1. Sawyer says:

      *Sigh*

      Taubes may have evidence that is worth looking at. He may have a unique viewpoint on nutrition that merits further investigation. But he’s not freaking Ignaz Semmelweis. Let’s try turning the humility dial up a few notches.

      Why is this analogy so popular among health gurus? We’ve seen it brought up dozens of times on this blog, and I don’t think it has EVER properly employed. Like the Galileo Gambit in physics, the Semmelweis story relies on the lottery fallacy. Everyone that has a revolutionary idea thinks their work is incredibly important and that the mainstream scientific community is close-minded. Only a tiny, tiny percentage of those revolutionaries end up being right in the long run.

      The hardcore vegetarians that decry the fat and cholesterol from meat make the exact same pleas that mainstream scientists are ignoring their ideas. Why is the Semmelweis argument a valid defense for the LCHF crowd but not the HCLF crowd?

      1. John McGuinness, MD says:

        Sigh…
        Yes, Gary Taubes is not Ignaz Semmelweiss. Insightful.

    2. Windriven says:

      When Semmelweiss championed handwashing, medicine’s link with science was tenuous at best. The observations with which you are so enthralled can be useful pointers to areas of research. But at the risk of repetition to the point of nausea, correlation does not equal causation.

      Semmelweiss is the poster child for why science is the key to medical advance. It wasn’t science that ridiculed Semmelweiss, it was hidebound tradition, exactly the mindset that says ‘I believe it so it must be true.’ Science provides a form and structure for those who think they have a better answer. Instead of “bemoan[ing] the lack of willpower of my patients” bemoan instead those too indolent to use the powerful tool at their fingertips.

      1. John McGuinness, MD says:

        Correlation does not equal causation…except when it does. i agree that Taubes observations are useful pointers to further research and look forward to it. The fact remains, however, that in this situation there IS NO HARD SCIENCE that the thermodynamic theory is plausible. It is the product of it’s own logical fallacy and fails to consider hormonal regulation as a determinant of fat deposition. The only thing it has in its favor is that it is the incumbent “hidebound tradition”. It is easier for me to believe that a genetically determined variation in the sensitivity to insulin or insulin production leads a variation in phenotype given the same dietary and exercise habits than it is to believe that lean people are more disciplined in their eating and exercise habits than are fat individuals

        1. Battousai says:

          “The fact remains,however, that in this situation there IS NO HARD SCIENCE that the thermodynamic theory is plausible.”

          Sure – if you ignore every metabolic ward study ever conducted.

        2. Windriven says:

          Dr. McGuinness, I don’t think anyone is arguing that genetics and endocrinological variations play no role. But the energy has to come from somewhere before it gets stored as fat. And the energy that powers muscles has to come from somewhere during exercise. There are clearly differences in the trigger levels for, say, lipolysis but all of the relevant processes do occur.

          BTW – any relation to Jay McGuinness in NOLA? Great guy.

        3. WilliamLawrenceUtridge says:

          Hormone regulation probably impacts satiety, but it’s unlikely to impact thermodynamics in most cases. And there’s a reason that extremes of hormone levels are disease states. Whether one can reach these extremes through manipulation of diet is questionable. Whether one would want to is even more so.

          i agree that Taubes observations are useful pointers to further research and look forward to it.

          One must then conclude that you agree with Dr. Hall’s assertion that Taubes should not be promoting his ideas as if they were holy writ, unquestionable and above all absolutely correct, then.

          The absurdity of the whole thing is that ultimately there must be agreement on 90% of recommendations – avoid processed foods, eat fruits and vegetables and some meat. If Americans cut out soda, deep fried foods and refined carbohydrates, I would guess that the impact of the obesity epidemic would be blunted.

    3. weing says:

      “For years I robotically repeated the calories in/calories out mantra and privately bemoaned the lack of willpower of my patients. ”
      You worry too much about obesity. A few years of crop failures due to climate change will take care of the problem. Then you’ll see it’s not a willpower problem.

      1. Windriven says:

        Ah weing, you made me laugh out loud!

        Sadly, it isn’t a lard-butted westerner who will take the brunt of that catastrophe. Some 50kg Ethiopian will.

        In the early 50s Americans spent 20% of their disposable income on food. (Table 7) Today we spend half that. At the same time we consume 26% more aggregate calories than we consumed in 1957. It is cheap and easy to be obese. For now.

      2. Angora Rabbit says:

        Oh, yeah. For several years I’ve been sardonically saying that the rise in grain and commodity prices will be the real thing that curbs obesity, as commodities are used to make “biofuel” and animal feeds instead of food for humans. It’s ironic. And now we have last week’s report in Science about crop growth under increasing CO2.

        Windriven, you’re right about how will take the biggest brunt. It’s sad.

  35. Karen says:

    While I whole-heartedly agree with (practically) everything Harriet Hall posts…I take issue with her cavalier attitude about physical activity. There are only 2 ways to create an energy deficit—eating less and moving more. I agree that the majority of the deficit will likely have to be created via diet restriction, but I believe it’s a mistake to discount the importance of exercise. Increased physical activity must account for a portion of the caloric deficit—especially if the weight loss it to be maintained. Unfortunately, it’s a vicious cycle where the ability to increase physical activity can become increasingly grim. Even so, I think a strong case can be built for including increased physical activity, even if the increased caloric expenditure is only a small portion of the caloric deficit. A whopping 90% of those on the National Weight Control Registry use exercise. I understand that this is a self-reported reservoir, but 10,000 participants is worth noting. Plus, (personal opinion) we can’t keep lowering the “calories in” side of the equation. As some point—we’re gonna have to embrace increasing “calories out”. How much more sedentary can we possibly get?

    1. Harriet Hall says:

      “I take issue with her cavalier attitude about physical activity”

      I think you need to read my article again. Is it a “cavalier attitude” to cite a study (actual evidence) showing that the benefit of adding exercise to diet is marginal or non-existent? To say that exercise will allow you to eat more calories? To give hope to those who are unable to exercise? To even give an example of a woman who incorporated exercise (even if it was only walking the dog) into her weight loss plan?

      “Increased physical activity must account for a portion of the caloric deficit”

      This is simply not true. I have a counter-example from my immediate family. My husband lost 60 pounds in 5 months without exercising at all, simply by eating more sensibly (he didn’t even formally count calories). And he didn’t feel hungry.

      It takes a lot of exercise to burn off calories. Some people get very frustrated when they don’t lose weight by exercising, and some people have physical limitations that preclude exercise. I am only stating a fact when I say exercise is not absolutely essential for weight loss. I strongly recommend exercise for its many health benefits, and nothing in my article says otherwise.

    2. Windriven says:

      Exercise has many fine benefits to recommend it. But most people would be shocked to learn how much exercise they have to take to burn, say, 500 kcal. It would take a 150 pound woman an hour or so of jogging or a 200 pound man 45 minutes of swimming.

      A BigMac is 590 calories. Which is more likely for an obese person, running for an hour or having an apple instead of a BigMac?

    3. weing says:

      I don’t think Dr. Hall is cavalier about exercise. From what I recall, exercise is important and should be incorporated into a weight loss program to decrease loss of muscle mass.

    4. Angora Rabbit says:

      Exercise will help with a few things. It can counter the body’s natural metabolic shift to reduce expenditure in response to reduced caloric intake. It also helps increase muscle mass (to my knowledge, no change in calories will do this). Muscle mass is fat-burning as I said above, and it is a major organ for serum glucose clearance. Increasing the muscle mass can help both store glucose more efficiently (reduced insulin need and improving glucose tolerance) and can improve serum triglycerides. Exercise also suppresses immediate appetite.

      However, there is a big caveat in that the body will also naturally adapt to long-term exercise by increasing appetite to increase caloric intake. One needs to be aware of this and respond accordingly. Muscle is also denser than fat, and weighs more per volume. Thus in the short term exercise can increase body weight and body size (i.e. leg diameter), and people don’t always understand this shift, get discouraged because it’s not “working” and give it up.

      The exercise needn’t be vigorous. Changes can be small and cumulative – parking a bit further away in parking lots (most of my colleagues here do this at work), getting up to answer phones / change channels, taking stairs instead of elevators, taking a short walk during lunch or in the evening. Install a standing desk (I did this) or shift some tasks from sitting to standing (my lampworking friends now all stand at their torches). There have been multiple studies that show how minor shifts can add up to caloric expenditure in a big way. In general, Americans are expending fewer calories – 700 cal/d less since 1900 and 100 kcal/d since 1980. It adds up.

  36. Marion says:

    Far too much unfounded ALARMISM about obesity in the USA & UK.
    Yes, I see fat people. Yes, I am overweight by about 20 kilograms, too.
    Yes, I try to lose weight. I have had partial success.
    However, my personal method would NOT work for someone else.

    I gave up my car back in 2011 because of global warming & peak oil.
    That’s the only reason why. I ride a part manual part-electric cycle to get where I need.
    In 2012, I developed the worst case of eczema in my life.
    Prednisone was the ONLY solution. I quickly gained weight after that.
    The prednisone also nearly instantly stopped my colitis, chronic raging diarrhea, too.

    Well, as long as the eczema does not come back, I will keep off prednisone.
    Been off it since end of 2013. The diarrhea has come raging back.

    And that is how I lose weight: let the diarrhea rage. Don’t treat it.
    Let the extreme intestinal pain that comes from eating ANY amount of food, no matter how small, keep me from getting hungry. Also, I get no exercise, because of my moderate rheumatoid arthritis, and the diarrhea makes it unfortable to go out.

    I usually also let m y food run out, forcing me to go to the store to buy more.
    (I ride a free local bus to the food store each week, so I don’t have to cycle anywhere.)

    And I HAVE been losing about 1 pound a week using this method.

    Point is: it’s going to be different for everyone how they do it.

    Some people will consume a lot of drugs & alcohol to take their mind off the misery & constant hunger.

    I am vegan, for animal rights of course, as everyone should be. But, my veganism has NOTHING whatsoever to do, pro or con, with my health. Never has. It is neither helping me lose weight nor gain it, as I have done both while being a vegan, which is my whole life.

    So, yes – these scammers with their low-carb diet bullshit – are liars just trying to get rich. For those who need a lot of protein – and I am one of them – support the movement to grow cultured meat in a laboratory.

  37. healthnut says:

    [. Is it a “cavalier attitude” to cite a study (actual evidence) showing that the benefit of adding exercise to diet is marginal or non-existent?]

    It is wrong to cite a study that is stupid. Excerise decreases fat and increases muscle — if you don’t account for that you will misunderstand the results. We all know that muscle is heavier than fat.

    Exercise prevents the metabolism from slowing. If you go for years without regular exercise your metabolism will slow and you will get fatter without taking in any more calories.

    Dieting by restricting calories slows the metabolism.

    Telling overweight patients that exercise won’t help them lose weight — based on research that is stupid — is very damaging. They will not exercise if you tell them that. And they will get fatter and sicker.

    1. Windriven says:

      “It is wrong to cite a study that is stupid.”

      Wow healthnut, you must be a genius! Would you be kind enough to tell us how we can identify studies that are stupid? Or is this not something you can teach, something that only you can determine?

      You know sometimes it isn’t the study that is stupid but the studier studying the study.

      1. Harriet Hall says:

        Let me venture to translate: “a study that is stupid” = a study whose results I don’t like.

  38. karen says:

    Losing it and keeping it off are two different things. Again, the weight control registry sites 90% of those who keep it off use exercise. I agree that the obese are not capable of 45-60 minutes of conventional exercise (jogging, swimming). Still, there are ways to sneak physical activity in….physical therapy, water aerobics, recumbent bikes, sit-and-be-fit….basically adding any movement beyond sitting. I realize that this won’t burn significant calories, but even 2 minutes of sustained movement is better than zero. Of course it isn’t enough to lose weight. I just think it’s a mistake to “poo-poo” exercise during the weight-loss phase. Intake and expenditure are inter-related. The ROI of a large person exercising has more impact than a small one….as they become a smaller person the ability to increase duration and/or intensity will get easier—but only if they’ve been working towards improved exercise tolerance. Magnify this if the subject is older, and thereby more prone to sarcopenia. I cringe every time I hear someone adopt the “diet first, worry about exercise later” approach. Evidently your husband had a positive experience with the diet-first approach, but there are those who don’t share the same results. Lean body mass is precious tissue. Even modest exercise helps stimulate/retain lean muscle mass—with or without weight reduction. I realize that (almost all) of the caloric deficit will have to be created via diet, but I think we do a disservice if we don’t advocate that exercise (even if only 100 calories of the deficit) pays dividends. I don’t even know how many times I’ve seen (previously unsuccessful “calorie counters”) experience success only after exercise (albeit modest) was added to the equation. Perhaps, it is psychological. Perhaps they are (unwittingly) eating fewer calories because of the exercise. Who knows? Does it matter? I think it’s about presentation. When we “dis” exercise—it reinforces (already negative) notions about exercise. To the contrary. I think we ought to be encouraging every morsel of physical activity we can inspire. No, cutting 100 calories won’t off-set a cheeseburger. But, it is 100 calories…..in a month, it’s a pound. A large person is capable of increasing expenditure in small, do-able, bursts. I don’t deny that aren’t situations where increasing physical activity is moot. For most, however, increasing expenditure (even if small) is worth promoting—yes, as a weight loss strategy. …the “other” reasons are too many to list…(decreased insulin resistance, triglyceride uptake, improved blood pressure/heart rate, etc)

    1. healthnut says:

      There are various reasons why exercise helps prevent obesity, and why it helps in losing fat, and Karen mentioned some of them.

      We were not designed to sit all day everyday for years and decades, yet that is the typical modern lifestyle. Inactivity disrupts and damages the body.

      Harriet is somehow not aware of any of this. She cites one stupid study, and makes the dangerous mistake of informing her patients that exercise won’t help them lose weight.

      1. Windriven says:

        “Harriet is somehow not aware of any of this. She cites one stupid study, and makes the dangerous mistake of informing her patients that exercise won’t help them lose weight.”

        Healthnut, you seem to be quite an expert on stupidity.

        I can see how that happened.

  39. Harriet Hall says:

    Arrgh! I said “I strongly recommend exercise for its many health benefits.” How could I possibly make that more clear?

    1. healthnut says:

      You tell patients exercise won’t help them lose weight. They probably hate exercise in the first place, so you give them just another excuse to not do it.

      1. Stella B. says:

        Nobody is saying that exercise doesn’t help weight loss. Unhappily, it doesn’t help much. You have to walk about 45 miles to lose a pound of fat. Exercise is a vital part of a healthy lifestyle, but the vast majority of people don’t have the time to burn a significant number of calories through exercise. In order to lose weight at an appreciable rate, people have to restrict calories. Any diet that reduces calorie intake will do the trick. Taking the stairs regularly at work won’t cause weight loss, training for a triathlon will.

      2. Harriet Hall says:

        “You tell patients exercise won’t help them lose weight. They probably hate exercise in the first place, so you give them just another excuse to not do it.”

        No, I don’t. I tell them if they exercise they can eat more calories; and I tell them that if they are unable to exercise they can still lose weight. And they don’t need an excuse! :-) If they ask me whether adding exercise to a low calorie diet will increase their success in losing weight, I tell them the evidence shows it won’t make much difference for their weight, but it will make a difference for their health.

    2. Windriven says:

      “How could I possibly make that more clear?”

      You couldn’t, Dr. Hall. Healthnut and Beth are either cretinous trolls – or they play them on the internet. Healthnut is an expert on stupidity and Beth doesn’t concern herself with the meanings of words or with anything smacking of linear thought. Two simple minds caught in life’s little Osterizer.

  40. healthnut says:

    http://www.mayoclinic.org/healthy-living/weight-loss/expert-answers/weight-loss/faq-20058292

    “Studies show that people who lose weight and keep it off over the long term get regular physical activity.”

    The evidence is not clear and simple. Harriet is wrong. There are various possible problems with the research that shows no benefit for exercise.

    For example, having patients do intense workouts three times a week for six months, without modifying their diet. There are several obvious problems — intense exercise is exhausting especially for someone who is very out of shape. Of course they will pig out on ice cream as soon as they get back from the gym.

    Another problem — six months might not be nearly long enough to reverse the damaging effects of a lifetime of inactivity.

    Another problem — confusing weight loss and fat loss. Exercise increases the size of muscles, so exercise causes weight gain along with weight loss.

    That inactivity often leads to obesity is utterly obvious, and research showing otherwise must be full of stupid mistakes.

    I sort of wonder if the big drug companies are behind this — if Americans started exercising it could be disastrous for drug company profits.

    1. Dave says:

      Healthnut, people don’t need any help from the drug companies to not exercise and to eat poorly. Drug companies, like any company, are profit driven but they didn’t fund the fast food industry, etc. One of the major sponsors of a 15K race in my old home town was the makers of a popular bronchodilator. There’s a lot to despise about the drug industry but don’t get whacky here.

      1. healthnut says:

        I think that the recent articles saying exercise does not help in losing weight are going to have a very big influence. People would try to overcome their natural laziness if they thought exercise would make them look good at the beach.

        Now they are being told it won’t. So they will go back to sitting all the time and eating non-fat yogurt that is full of refined sugar, and their doctor will prescribe cholesterol and blood pressure lowering meds.

        Very good for profits. If Big Drug didn’t pay to have these studies turn out this way, then at least you know they are celebrating.

        1. weing says:

          “I think that the recent articles saying exercise does not help in losing weight are going to have a very big influence.”
          Don’t stop exercising just because of some articles. Exercise has many benefits. It’s just that, if you want to lose weight with exercise, you will also have to cut down you caloric intake. Diet and exercise go together like Laverne and Shirley.

          1. Richard Abbott says:

            On the runner’s forums I frequent, the common comment to beginners who took up running to lose weight is always:

            Weight loss starts in the kitchen.

            its trivial to “out eat” the mileage a beginner can run (or bike, or lift …)

        2. Dave says:

          We have numerous data that exercise is important for health and longevity. I happen to agree with you that exercise can help weight loss but the amounts of exercise need to be pretty high. Regardless of weight, I believe exercise is important for health. Not only that, it makes you feel so much better. It’s a sad state of affairs when people exercise solely to look good.

          Treating hypertension is a different subject. We know that hypertension increases the risks of strokes, heart attacks, congestive heart failure and kidney failure. We also know that lean exercisers can still get hypertension.. Don’t lambast doctors for trying to prevent these horrible outcomes. Lipds are yet another subject, which has been discussed ad nauseum in prior posts here, and I’m not going to open up that box.

    2. Harriet Hall says:

      “For example, having patients do intense workouts three times a week for six months, without modifying their diet.”

      The study I cited was about adding exercise to a low calorie diet, not about exercising without modifying their diet.

      “That inactivity often leads to obesity is utterly obvious”

      It’s also obvious that inactivity doesn’t lead to obesity in people with good genes who don’t overeat.

      1. healthnut says:

        “It’s also obvious that inactivity doesn’t lead to obesity in people with good genes who don’t overeat.”

        Yes Harriet, and there are people who smoke five packs of cigarettes every day for their whole lives and never get lung cancer.

        So tell your patients it’s ok to smoke.

        1. weing says:

          “Yes Harriet, and there are people who smoke five packs of cigarettes every day for their whole lives and never get lung cancer.”

          Citation, please?

  41. Vicki says:

    Or another reason to keep doing it.

    Consider two people. They’ve both just started exercising, at about the same intensity. Neither changes what they eat. One of them has a doctor who says “great, keep exercising and you’ll be thinner in a couple of months.” The other says “great, the exercise is good for your heart, and will help you live longer.”

    Six months later, neither of them has lost (or gained) any weight. The first person’s doctor says “clearly you aren’t exercising enough, or you’d have lost weight.” The second person’s doctor says “keep up the good work, your blood pressure has already improved.”

    Which one is likely to keep exercising, the one who has been told that they aren’t doing enough (and maybe accused of lying to the doctor about it) or the one whose doctor notices and praises their actual success?

  42. Vicki says:

    My comment above was supposed to be a comment to healthnut’s comment to Harriet’s comment 40. Sorry the threading didn’t work.

  43. Kirk says:

    What I don’t get is the fact that there are lots of people who can eat _anything_, and never gain weight. I was like this for a long time. My weight never fluctuated more than +/- 2 kg, regardless of how much I ate, or how active I was. This changed when I took gabapentin for a year for chronic pain from a compressed nerve in my spine. I put on about 1 kg a month until I stopped it.

    So I wonder: there’s something else going on beyond the calories-in-calories-out thing. Is it gut bacteria that gives some people the ability to burn all the extra calories they eat? If so, could the gabapentin have changed that? My GP at the time said that gabapentin “slows down the metabolism,” but what exactly does that mean?

    As for anecdote, I’ve been on a low-carb diet for about a month now, and have lost 2 kg. I’m eating much more than before overall; I snack on nuts a lot, which are high in calories. But I’ve drastically reduced my sugar intake.

    In addition, I had been having problems with bloating, and I’m not getting that very much any more. This leads me to wonder: is there a relationship between sugar digestion and gut bacteria?

    1. healthnut says:

      Of course it is not simply calories in and out. How could Harriet possibly believe that, when it is so obviously untrue?

      One factor, of course, is metabolism rate., which may be influenced by various things.

      1. Andrey Pavlov says:

        I’ve not been bothering to read much of the tripe healthnut puts out because it is so obviously tripe, but I love it when a troll/nut makes a comment that is only 3 sentences long, thinks it is so profound and obvious, and yet still manages to be completely oblivious and contradict him/herself:

        Of course it is not simply calories in and out.

        Oh, what else is necessary to consider, dear learned interlocutor?

        One factor, of course, is metabolism rate., which may be influenced by various things.

        Metabolism rate, you say? Gee, if only there was a way we could somehow quantify and measure a “metabolism rate” so we could stop being so dumb and factor it into our measurements and thus have a better understanding of weight gain and loss.

        It is so sad that science just can’t keep up with the brilliance of healtnut.

  44. Kirk says:

    I’d also like to comment on this statement, in recommendation 9 in the article:

    “Try to pick foods that are filling but low in calories”

    This sounds like a very unscientific thing to say. What is “filling?” To most people, it means something that takes up space. But I think what should be said is one should choose foods that are digested slowly. We know that hunger is not about how much food is in your stomach, but how quickly it’s digested, and when your blood sugar starts going down.

  45. Garuno says:

    @healthnut: “We were not designed to sit all day everyday for years and decades, yet that is the typical modern lifestyle. Inactivity disrupts and damages the body.”

    We were not “designed” at all. As a species, we have evolved, which is rather different. In addition, our individual lives and habits tend to be a product of our environment and culture, which obviously enough varies widely from one place to the next. For what it’s worth, my daily routine is fairly typical for someone of my age, economic situation, and cultural background. But it would not be particularly better or worse for me to be tending olive trees in rural Greece, that’s just a different form of human activity. We are not specifically meant to do either of these things (or come to that, meant not to do them).

    1. healthnut says:

      Oh please. We were designed by evolution, or whatever anyone happens to believe. Either way, we have been formed over extremely long periods of time.

      Sitting all the time causes muscles to atrophy, especially over many years. Health depends on healthy, non-atrophied, muscles.

      All too obvious to even have to say.

      1. WilliamLawrenceUtridge says:

        We aren’t designed by evolution. Evolution is blind, it merely cauterizes stumps of gene lines that cannot survive within a specific evironment (meant broadly, to include cultural, physical, behavioural – and in this case nutritionally). We are adapted, over long periods of time (and sometimes over short periods of time, such as the two-generation population bottleneck for disease tolerance experienced by aboriginal groups exposed to European diseases), to reproduce within specific environments. Evolution has driven gene adaptations to improve the ability to consume novel sources of food, such as lactose tolerance. Over a long enough time period given the current modern diet, we would adapt to this too – all the fat people who can’t get pregnant or deliver a baby safely would leave fewer descendants. Humans in general would evolve to tolerate obesity, inactivity and highly refined diets. This is indeed obvious. What you appear to be missing is the fact that this doesn’t help anyone alive right now.

        There are some people who suffer egregiously on a low-activity, high-calorie diet. There are others who do not. Over a long enough time period, not through any design, the people who suffer will die out and those whom can reproduce in these circumstances will populate the world. Whether our current nutritional environment will last long enough to cull those poorly adpated to it remains to be seen, and none currently alive will live to see it.

        No design involved.

        1. weing says:

          “Whether our current nutritional environment will last long enough to cull those poorly adpated to it remains to be seen, and none currently alive will live to see it.”

          I hope not. A few years of crop failures and we may just find that those that are poorly adapted are the non-obese.

          1. Dave says:

            I remember seeing an article in the NEJM several years ago linking the high rate of hypertension in American blacks to the possibility that only those predecessors who were able to retain sodium avidly could survive the horrid conditions and dehydration on the ships that transported them to America. What works in one environment might be detrimental in another.

            1. MadisonMD says:

              Ah, the slavery-hypertension hypothesis. I don’t think it ever got published in NEJM because, well, there was no good evidence supporting the hypothesis. In fact it has been largely repudiated. See here and here and here for examples.

  46. zcos says:

    Unless you are eating neurotically for some pleasure or satisfaction other than hunger, all else being equal, you will eat less calories on a very low carbohydrate diet. In addition, your body’s access to fat as a source of readily available energy is much higher when insulin is at a minimum. When you have access to energy, you will feel more energetic and be less hungry. It is hunger that generally drives us to eat, and if eating carbs spikes insulin and quickly drives our energy sources into fat and glycogen, then we will soon be in need of energy again and will feel hungry. The body cannot burn fat in the presence of insulin. It stores it. In addition, the insensitivity of Leptin and grehlin due to the repeated peaks of serum insulin cause a general ongoing craving for food. Once the leptin sensitivity is restored by keeping a low serum insulin, our hunger tends to be much suppressed and controlled. These are, as I understand it, the reasons low carb diets are effective. We not only burn fat more readily, but we are less hungry and generally eat less.

    1. Harriet Hall says:

      Yes, this all makes a lot of sense. But the fact remains: low carb is not much more effective than other diets in the short term, and is no better in the long term. Do you have an explanation for that?

      1. Kirk says:

        But you said above:

        “Another 2014 meta-analysis found that the short-term benefits of higher protein, lower carb weight loss diets appear to persist to a small degree over a longer period.”

        And, something I find interesting:

        “And contrary to popular wisdom, they found that the benefit of adding exercise to diet is marginal or non-existent.”

        So, calories-in, calories-out isn’t true…?

        1. Harriet Hall says:

          “short-term benefits of higher protein, lower carb weight loss diets appear to persist to a small degree over a longer period.”

          That’s the first study to say that; the evidence is not entirely clear. And “to a small degree” tells me low-carb is not as effective as Taubes’ hypothesis indicates it should be. And diets that are low-calorie but not low-carb are also successful in producing weight loss.

          “the benefit of adding exercise to diet is marginal or non-existent.”
          So, calories-in, calories-out isn’t true…?”

          That doesn’t follow. It only means that in practice, the contribution of increasing calorie expenditure is very small compared to the contribution of reducing calorie intake.

    2. Stella B says:

      “Neurotic” is a bit judgmental. I am aware right now that my husband put a couple of pints of Ben&Jerry’s in the freezer. I am not hungry right now, but I’m doing my best not to think about that frozen, chocolatey goodness. I know that if I tasted a spoonful, I wouldn’t stop until the better part of the pint was gone. If you read Mark’s Daily Apple comments, you will also find that a significant number of his true-believers fault themselves for being insufficiently pure and failing to avoid forbidden foods. Hunger? Not really. Neurotic? Nah. Enjoyment? You bet! My desire to eat that sweet, creamy, cold deliciousness is not driven by my insulin level, it is very clearly driven by my previous experience with New York Super Fudge Chunk (ice cream, because of its fat, actually has a pretty low glycemic index). My danger time for eating fattening sweets is actually after meals which is obviously not due to hunger but rather to the cultural conditioning that says that meals end with sweets.

      A lot of eating takes place in the absence of hunger cues. Often we have finished our meal before the sensation of hunger subsides, just because there is a time delay in the process.

      Macronutrients do influence satiety, but there are a large number of other factors that also enter into the obesity equation. Taubes’ model is overly simplistic.

    3. WilliamLawrenceUtridge says:

      Unless you are eating neurotically for some pleasure or satisfaction other than hunger, all else being equal, you will eat less calories on a very low carbohydrate diet.

      Humans “neurotically” will routinely eat for more than mere satisfaction and hunger. Humans eat for pleasure, to cement relationships, to celebrate, to mark religious occasions, etc. Claiming all consumption beyond mere satiety is neurotic dooms the entire human race to mental illness. This, I am pretty sure, includes low carbohydrate diets.

      Your speculations on hormones are speculation, not fact.

    4. john says:

      Well said, Zcos. That’s exactly how it works for me personally.

      And also for an awful lot of other people, judging by their testimonials.

      I agree, Gary Taubes is too prickly and overstates his case. There isn’t enough science to prove it definitively.

      Maybe such science will never appear. How likely is it that a sufficient sample could be assembled? You’d need thousands of people in various subcategories who you could rely on to stick to eating and exercise guidelines for a number of years – without fibbing!

      Which would mean that personal testimonies may be the closest we’ll get. That of course means that you have to be careful not to overstate the scientific basis for your position.

      Btw, this business of not continuing with weight loss after six months on a low-carb diet: speaking personally, after six months I had hit my ideal body weight, I didn’t need to lose more.

      Another point: low carb doesn’t mean high protein. I eat less protein now than in my pre-low carb days. The calories come from fat.

      Final point: food tastes much better on low carb – but you do need to do your own cooking.

      1. WilliamLawrenceUtridge says:

        And also for an awful lot of other people, judging by their testimonials.

        Of course, once you stray from testimonials and into scientific research, you find that low carb actually doesn’t work for most people over the long-term. It’s either too hard to adhere to, or people end up adjusting to it and simply eating more. That’s the thing about testimonials – it’s easy to find someone who says “it worked for me!” but it’s much harder to find that same person six months or a year later and ask them if it’s still working. Equally so for the person for whom it never worked.

        Btw, this business of not continuing with weight loss after six months on a low-carb diet: speaking personally, after six months I had hit my ideal body weight, I didn’t need to lose more.

        You can find this for any diet however – over six months people lose weight, then over a year, or two years, they will gain it back. Diets don’t work, permanent lifestyle change is what is required. And, of course, you’re only here commenting because it worked for you. If we could systematically poll all who try the diet, i.e. as scientists do, then we would find that for most it doesn’t work. And you can’t even claim it is superior to other diets because it worked for you, because for any other diet you will find someone for whom it worked for longer than six months – the real question is if it will work for most people for longer than six months. And most diets don’t work for most people over the long timeframe, low carb included.

        Final point: food tastes much better on low carb – but you do need to do your own cooking.

        You’ve never had my home-made bread, pie, pasta or potatoes. Well-cooked home-cooked food tastes good, it doesn’t have to be low carb, and by eliminating carbohydrates you are eliminating an enormous number of gustatory pleasures from your diet. That’s fine if it works for you – but you can’t generalize your statement to all low carb foods or all people.

        1. john says:

          So we’re in agreement. It seems no-one can ever say anything about any diet or exercise regime, other than “it worked for me (and apparently a lot of other people)”.

          Notwithstanding that, you appear to know that “if we could systematically poll all who try the diet, i.e. as scientists do, then we would find that for most it doesn’t work”. Maybe, maybe not. How many have tried? And many may give up for extraneous reasons, much as people give up on good intentions to exercise more.

          I agree with your point about lifestyle. I envisage being on low-carb permanently.

          If I felt like home-made bread, pie, pasta or potatoes I’d have them (occasionally). It’s interesting that they no longer seem appetising. I find that it takes no self-denial whatever to stick to low-carb.

          Just my personal contribution to the debate, nothing more.

          1. KayMarie says:

            Well there was that one study that basically showed that all the various diets, all the ones that completely contradict the premises of each other, all work equally well and equally badly.

            For the few people that find that particular diet is one the can sustain for a lifetime keep the weight off. Those that cannot tolerate eating that way for the rest of their life gain the weight back because after about 6 months they just can’t eat the way the diet requires anymore.

            So every diet is going to have a bunch of people saying it worked great for me and I can eat this way the rest of my life. But every diet is going to have a lot more people that failed.

            Low carb is not unique in any way by having a small group of enthusiastic people who can maintain it for years on end and keep the weight off.

            The research seems to show that once you find what works for you, do that. There is my Dad’s famous diet. Do not change a single food you eat, just put 2/3 of what you usually eat on your plate and don’t go back for seconds. Never needed to exclude anything to lose weight and he did very well on it. But portion control doesn’t work for everyone as a lot of people can only keep it up for a few months like some people can only do low carb, or low this or low that for a few months.

          2. Windriven says:

            “So we’re in agreement.”
            I’m betting against.

            “no-one can ever say anything about any diet or exercise regime, other than “it worked for me”

            Really? Pubmed shows 5676 entries on low carbohydrate diets alone, including their effect on lactating Holstein cows. Beyond that, anyone can say with no fear of correction, that a balanced diet and moderate exercise that supplies fewer calories than those expended will, over time, result in weight loss. Modifying one’s behavior to adhere to that simple construct is the key to weight loss and subsequent maintenance.

            “Just my personal contribution to the debate, nothing more.”

            An anecdote is an anecdote is an anecdote. It really adds nothing to the debate. I have brown hair. So what? That doesn’t say anything about hair color in the population. I prefer Scotch to bourbon. So what? That adds not a lick to understanding consumption of spirits in our society. You prefer your diet to be largely sans carbohydrates. I prefer a Mediterranean diet that includes pasta, bread, fish, vegetables and damned near every edible part of the pig.

            There is a huge difference between our personal preferences and scientific evidence. This site is about science.

            1. WilliamLawrenceUtridge says:

              I’m betting against.

              You are correct, sir, and I’m amazed I managed to convey my feelings on the matter without the use of profanity.

              1. Windriven says:

                You’re amazed. I’m disappointed. Well-crafted profane invective can be a joy to behold, especially when so richly deserved.

              2. WilliamLawrenceUtridge says:

                Well you’ll enjoy my next comment when it gets through moderation then.

          3. simba says:

            You can study these things with science. Four hundred years ago the only way to decide whether or not something was good for lung disease was to see if hey, it worked for me/ my patients. Now we can actually study it systematically.

            I lost a stone and have kept it off for five years (as I’ve mentioned here before). How? Well, the only intentional change I made in my diet was that I started eating a chocolate bar (or some form of candy) at least once a day- my diet is lower in protein than the average, I eat/ate mostly carbs, general junk food, and vegetables. But I happened to reduce my calories somehow without noticing it, over time my idea of portion sizes got smaller, and I lost weight and kept it off. That does not mean that The Chocolate Diet is effective. Anecdotes are just that, and not proof (or even good evidence) of anything.

          4. WilliamLawrenceUtridge says:

            So we’re in agreement. It seems no-one can ever say anything about any diet or exercise regime, other than “it worked for me (and apparently a lot of other people)”.

            That’s not at all what I said. Not even a close approximation. In fact, that’s essentially the opposite of what I said. If you re-read my comment with even a modicum of attention you’ll note that I pointed to scientific research finding most diets don’t work. I was mostly pointing out that your confidence in your anecdote was misplaced because it was contradicted by the scientific literature.

            Seriously, bad faith, or do you have comprehension problems? I feel like I was dry-humped by someone grinding an axe.

            Notwithstanding that, you appear to know that “if we could systematically poll all who try the diet, i.e. as scientists do, then we would find that for most it doesn’t work”. Maybe, maybe not. How many have tried? And many may give up for extraneous reasons, much as people give up on good intentions to exercise more.

            Pubmed. Meta-analyses. Scientific literature > your self-confirming biases, goalpost-moving and special pleading.

            If I come across as rude, it is deliberate as I object to having words I say forced into my mouth in a deceptive effort to create agreement where none existed.

            1. John says:

              Yes, you do come across as rude, as do a lot of the comments on this site. Calm down, everyone, enough already of the virulence and ad hominem attacks.

              Thanks so much for referring me to the Pubmed meta-analysis dated 2007. That was before low-carb diets attained critical mass (ahem). I’d be interested (genuinely) in something that has significant low-carb exposure.

              Meanwhile I keep posting http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html – I’d be interested in responses to that too.

              The reason I think low-carb diets are different from other fads is that it explains fat creation, and also why for many people including me I could do a lot of exercise and carry a lot of fat. Laws of thermodynamics don’t capture the metabolic dynamics.

              1. Windriven says:

                “– I’d be interested in responses to that too”

                Did you actually read it? It is the Seifeld of journal articles, a paper about nothing. Well, not about nothing. It does describe ketosis. It then goes on to suggest possible value for VLCKD in a variety of diseases. That is to say, it is a couple of paragraphs on ketosis set inside a blizzard of speculation.

                Is this the kind of paper that sets you heart aflutter?

                Just as an aside, I don’t recall ever having read a journal paper before that cited the bible. What next? Believe unto my words or I will smite thee with a stick?

                “why for many people including me I could do a lot of exercise and carry a lot of fat.”

                Yeah, the secret is fewer push-ups and more push-backs … From the table. That has been covered at SBM before. You can run a triathlon every week but if you eat like you’ve got two a-holes you’re gonna carry some fat. Calories go in a lot easier than they come out.

                “enough already of the virulence and ad hominem attacks.”

                I reread William’s comment. I don’t think you understand what an ad hominem is. “You have a simpleton’s understanding of science”, for instance, is not an ad hominem when it reflects facts in evidence. As to virulence, he struck me as reasonably restrained.

              2. simba says:

                Exercise doesn’t actually burn off as many calories as people think it does, unless you’re an olympic athlete in serious training. Hence the phrase ‘you can’t outrun your fork’.

                The link you posted is interesting but if you read it it doesn’t contradict any of the ideas posted here, at least not with solid evidence. It says that people on low carb diets lose weight in the short term, and that this is probably due to satiety but there are other possible (but unproven) hypotheses.

                You still haven’t explained how, if carbs are the important factor, people like me can lose lots of weight and keep it off happily on carbs. That suggests to me that different diets will work for different people, and that the ‘carbohydrates cause you to put on more fat’ idea is wrong. In the end you need to study diets to figure out what ‘works’ and what doesn’t. Otherwise the people who ‘fail’ on the diet won’t get counted.

              3. WilliamLawrenceUtridge says:

                Don’t facefuck your opinions into my mouth and I won’t be (as) rude.

                Do you have a meta-analysis that demonstrates low carb is superior for short-term weight loss and long-term maintenance? Because that’s really the point – any diet can reduce weight over the short term, that’s not special. Special would be reducing weight (and ultimately all-cause mortality) over decades. Until that happens, and it hasn’t happened yet, I continue to think low carb is just another diet.

                Your nature article discusses mostly non-obesity conditions, none of which I have. If a low-carb ketogenic diet is effective at treating them, hooray! I just hope that it’s easier to follow than the diet used for epilepsy, which can lead to children eating dog food or dropping out of ketosis because of toothpaste.

                The reason I think low-carb diets are different from other fads is that it explains fat creation, and also why for many people including me I could do a lot of exercise and carry a lot of fat.

                As-yet unproven, Taubes and other proponents have not yet convinced their peers – and not out of mere spite. The evidence just isn’t in yet.

                Laws of thermodynamics don’t capture the metabolic dynamics.

                Yes they do – calories in minus calories out equals weight gain/loss. What you’re confusing is satiety and possibly metabolic changes. Fat and protein have high satiety indexes, making it theoretically easier to eat fewer calories due to pure hunger. Metabolic changes may increase calories out, but I believe careful testing has shown it’s not much of an increase, if it exists at all.

                Look – eat whatever you want, that’s fine. Believe what you want, that’s fine too. But don’t claim science supports low-carb or ketogenic diets as an easy way to lose and keep off weight over the long-term. The evidence does not support it (and there’s still concerns over its effects on the cardiovascular system, kidneys and liver). Accept that there is ambiguity and flawed evidence.

  47. Grumpy Old Man says:

    Taubes might be on to something, but I smell cult.

  48. Sawyer says:

    After enjoying a meal at my favorite Chinese restaurant (with both evil meat and evil carbs), I discovered the only sage fortune cookie quip I have ever encountered:

    “A diet is a selection of foods that makes someone rich.”

    This seemed like an appropriate place to share.

  49. Eli says:

    What intrigues me most, is why is there such a huge double standard.
    Dr. Hall can dispense her theory on the cause of obesity (i.e. simple physical energy balance – “There is no getting around the physics”, H. Hall May 13, 2014) without any proof, and later opine on how best to loose and maintain weight, also without any scientific support whatsoever. Yet Taubes writes an exceptional book, with a wealth of historic, anecdotal, circumstantial, logical and theoretical I might say overwhelming support – and he is supposedly the quack.
    I have to say, what kills me most in these debates over Taubes’s GCBC book is the childish unsupported and biased drivel that passes as a “scientific” critique, certainly in comparison to Taubes’s work (Hall, Novella, Carbsane, Wheatology etc…)
    It doesn’t matter if Taubes convinced you or not (I certainly have some doubts in some portions), he had introduced a new standard to the debate and nonsense such as “There is no getting around the physics” is not good enough anymore.

    1. Harriet Hall says:

      If you actually read my article, you failed to understand it. Try again.

      1. eli says:

        I really read it, I’ll focus on main issue, my point is that you have a glaring double standard, I think the key paragraph in this article is the following,:

        “That is simply wrong. The only grain of truth is that a low-carb diet may result in decreased hunger pangs so that total calorie intake drops. The laws of physics tell us that if you ate 7000 calories of protein and fat during a period of time when you only expended 3500 calories, you would gain a pound, even if you ate no carbohydrates at all. There is no getting around the physics. If you expend more calories than you ingest, you will lose weight. No diet has ever been shown to produce weight loss without a reduction in calories. The problem is that reducing calorie intake is fiendishly hard to accomplish for many reasons, both physiological and psychological. No one has ever denied that.”

        This is a concise statement of the conventional view, this is in my eyes the root of the disagreement, everything else are mere details, that flow from this belief.

        What I think need to be reminded that your statement is a hypothesis that had never been proven (and I personally think it is contradicted by many observations, clinical experience, my personal experience and common sense) and I find it is a huge double standard that you feel you can state this without ANY support at the same time that you demand watertight proofs from Taubes.
        Taubes on the other hand had produced wealth of evidence and arguments for the alternative view, I also think that the lack of definitive evidence is really not that surprising in view of the vilification and marginalization of anyone that tried to even touch the alternative view .

        You should stop assuming your views simply true, and try to amass equally good amount of historical, epidemiological, biological, experimental, theoretical and clinical evidence like Taubes, and then we will try to judge which one has the better case – for now, it is simply premature to take your case seriously since you haven’t supported it at all, and certainly dispensing diet advice on the basis of mere baseless statements is a double standard.

        For example, I think one of the points that Taubes showed unambiguously, is that people can get obese without overfeeding in an impoverished environment – this observation completely contradicts your hypothesis and explains why “reducing calorie intake is fiendishly hard” as you write, and why your diet advice might be harmful, and again even tough your diet advice was shown to harm most people (loose->regain more etc…) you do not feel any urge to substantiate your advice while at the same time chastising Taubes, who in comparison to you is a saint in this regard.

        An example:
        http://medicalxpress.com/news/2012-10-obesity-under-nutrition-prevalent-long-term-refugees.html
        Both under-nutrition (lack of calories, not only malnutrition – i.e. lack of nutrients) and obesity prevalent in the same families in extremely poor refugee populations.
        As Taubes asks in WWGF: Do you believe the mothers steal food from their undernourished babies in order to overfeed themselves into obesity?

        1. Harriet Hall says:

          There is no double standard. My “case” as you call it, is that there is no evidence that any diet is successful in reducing weight without reducing calorie intake. If you think there is evidence, it’s up to you to show it.

          You say “people can get obese without overfeeding” but that hinges on your idiosyncratic definition of overfeeding. If they get obese, the calories had to come from somewhere. The same number of calories might not be overfeeding for another person, but they were for the person who got obese. Obviously, some people have a propensity to gain weight; we don’t know why, and Taubes has not even begun to explain why. He blames carbohydrates, but some people become obese on a diet low in carbohydrates and some people lose weight successfully on a diet high in carbohydrates. If Taubes’ hypothesis were correct, I would expect to see his diet show much more impressive results rather than just a small short-term advantage over other diets. His marshaling of evidence is impressive, but he himself admits it is not the kind of clinical evidence of diet and health successes that would justify policy recommendations.

          1. eli says:

            No, you have a hypothesis that a simple energy balance is what lies at the root of obesity and that that the way to solve it is to reduce calories, and this is the basis of your dietary advice, but a lot of evidence exists that this advice (and the theory that underlines it) might be extremely harmful, and according to Taubes (and it seems likely to me) it is manifested in the current obesity epidemic (you might not agree, but it is a troubling coincidence).
            Yet still as many dietary “experts” in the past you simply deny your’s is a hypothesis on the mechanism of the control over energy in the body, you simply state it is the “common sense” and that you need not proof anything and you immediately going on to dispense your advice – this is the a double standard, this is exactly the bias.

            Again it doesn’t matter how you say it, how you state it, or what syntax you use, you have a hypothesis, and you have an intervention that is based on it, and you do not bother to substantiate it all – this is I think one of the main points of GCBC, I’ll borrow from Taubes (on the medical obesity research community, seems very fitting):

            “The result is an enormous enterprise dedicated in theory to determining the relationship between diet, obesity, and disease, while dedicated in practice to convincing everyone involved, and the lay public, most of all, that the answers are already known and always have been—an enterprise, in other words, that purports to be a science and yet functions like a religion.”

            Regarding your criticism of Taubes’s hypothesis, it is fine I agree with some of it.
            Some of what you say is simply wrong.
            And some, like:
            “If they get obese, the calories had to come from somewhere. he same number of calories might not be overfeeding for another person, but they were for the person who got obese.”
            It is simply circular logic, if you hypothesize that a simple energy balance is the cause then you can go on to conclude that if they are obese they overate.
            You completely disregard that those are not independent variables –the obese person might also be under-nourished (as manifested by other development markers).

            Also the lack of clear results is I think not surprising in view of the overwhelming decades long institutional bias. Taubes at least tries to get the results with Nusi.
            This is the main Taubes’s accomplishment (I think) is to expose the bias, the double standard, the lack of minimal scientific standards and plain nonsense that passes for obesity research.

            1. Harriet Hall says:

              Apparently I’m not getting my point across. How can I make this more clear? I don’t think excess calorie intake is the underlying cause of obesity; I think we don’t know the underlying cause, and Taubes’ speculations may help point us in the right direction. I think there are probably a number of underlying causes. All I’m saying is that whatever the underlying cause(s), obesity cannot possibly develop without the ingestion of more calories than that individual’s body needed to maintain a steady non-obese weight. I don’t need to prove that; it’s self-evident. And whatever the underlying cause of obesity, a fat person will necessarily lose weight if calorie expenditure exceeds intake. I fully recognize that that is extremely difficult for some people but that calorie intake is naturally limited by the body in other people.

              Our apparent disagreement is only semantics: different concepts of the meaning of the word “cause.” A car is “caused” to run because energy is produced by its internal combustion engine and transmitted to the wheels; but the car won’t run with an empty gas tank, and putting gasoline in the car will “cause” it to run, and when the gas is used up, the car will stop. The physics of gas mileage is not the same as an explanation of the internal combustion engine.

              If this is still not clear, perhaps other commenters who understand me can express it more clearly.

              1. eli says:

                The alternative view would be that I am not making my point across.
                I first would like to rest your mind that I completely understand your point, I simply disagree.
                You contend that no matter what is the mechanism behind weight management ultimately what it does, is simply controls hunger, hunger influences feeding behavior and hence until we find out exactly who is right we can concentrate on reducing calorie consumption through manipulation of feeding behaviors using all kind of behavior “gadgets” and mind tricks (food-log, high bulk/low kcal foods..etc), all with the goal of tricking us to eat less.
                If you agree that I basically understand your point we can move on to my points of criticism and away from just trying to explain to me your article.

                First, even if you are correct and calorie reduction is the only thing (until ultimate resolution of this debate) that will cause weight loss, it doesn’t follow that your intervention is not harmful or that it is effective in long term, as any other intervention it’s efficacy and safety has to be PROVEN, it is logical and even probable that undercutting the hunger mechanism by short term tricks might cause harm in long term, moreover there are observations like yo-yo dieting which suggest that when the “tricks” ultimately loose to hunger, the weight returns with a vengeance – and harm results (I think it is the commonest observation of all), hence, again the fact that you do not even feel the urge to prove your intervention is a bias and a double standard. Moreover the efficacy of this intervention is also dubious.

                Secondly, unlike what you write, the notion that all there is about energy control mechanism is hunger, and ultimately hunger controls intake and it is all calories behind the scenes (while an advance over the past), it still a hypothesis (an unlikely one IMHO) that also should be proven.
                Since it is known that the body has control over te following variables that directly affect weight:
                1. Input of energy (by controlling hunger, satiety and all other urges and food cravings),
                2. It controls the source of energy i.e. whether to take from fat tissue, from glycogen, from muscle or from ingested food, it also controls the type of food by specific cravings which is a documented phenomenon.
                3. It has control on the storing of energy by routing calories to fat cells, to glycogen in liver and muscle, and the building of muscle tissue, also hoarding of food externally can count.
                4. It controls the output of energy, by up/down regulating metabolism, by controlling excretion of energy (ketones and sugar in urine, and unused nutrients in stool), by controlling the urge to exercise and energy levels that controls general activity level, also nervousness, agitation and shivering.
                There are probably others levers of control the animal has to regulate it’s energy and weight (which seems to me like an important variable to control evolutionally) hence it would be extremely unlikely that the only lever that is actually used is hunger.

                You write:
                “No diet has ever been shown to produce weight loss without a reduction in calories.”

                ” If they get obese, the calories had to come from somewhere. The same number of calories might not be overfeeding for another person, but they were for the person who got obese.”

                Let’s look at the obese women refuges that are holding undernourished children in light of your logic, according to you the case is clear and we can rightfully approach those mothers and demand them to stop gorging themselves and leave something to their undernourished babies, do you really think your hypothesis really explains this observation? Do you believe that although they consumed extremely low calorie diet by any standard (the family is chronically undernourished – this a fact proven by the state of the children), they still are overeating and this is proved by the fact that they are obese? And they are depriving their babies for becoming obese. Your logic doesn’t allow you to exit the following circle:

                Obesity caused by overeating, they must have overate since it is evident they are obese, hence nobody proved weight can be lost without undereating, since if they lost weight they must have underate.

                Another example, up until 5 yrs ago I ate basically according to the common prescription “mostly plants, not too much”, I had good gains (i.e. weight losses), but I stalled and started to regain on what was a very low calorie diet and I was constantly hungry, after I read GCBC I switched to LCHF and dramatically increased the calories, really increased, coffe with 38% fat cream, organ-meats, fat laden ribs etc… – yet I started to loose again..
                Consider this, how would I prove to you that I had not lost the weight through calorie reduction? you and your logic wouldn’t accept this, you would say: the mere fact that you lost the weight, proves that you under-ate, maybe at some other times this amount was too much for you, yet today this amount is too low – this is proven by the weight loss itself – circular logic that which can’t be escaped.

                Another example, in the WHI study, women reduced their intake by a considerable amount according to the study’s measuring methodology, yet they lost no weight, and increased their waist circumference (basically following your recommendations).
                According to your logic those women couldn’t have reduced their calorie intake, the weight being constant categorically proofs they haven’t reduced the intake.

                Another example, the A-Z study from Stanford, people on LC ad-lib unrestricted diet lost more (twice as much) than other various popular calorie restricted diets, note that it is highly unlikely that without any restrictions and considering the foods mandated by LC it is unlikely they ate less than in the restricted and low-fat diets, yet you would say: the fact that they lost more weight proves that they underrate more i.e. nothing is able to prove to you the reverse.

                Again, your hypothesis is not a law of nature that you do not need to prove it, it is exactly the thing to prove!!!

              2. Harriet Hall says:

                We are still not communicating. I am not saying obesity is caused by overeating. I am saying that whatever the causes of obesity, the calories to build that fat had to come from somewhere. THAT does not need to be tested. I certainly agree that we don’t have evidence about the safety of “tricks” to decrease calorie intake, and that every intervention needs to be tested. Most of the studies on diet go by self-reported intake, notoriously unreliable. We just don’t know, and when we don’t know, I think a moderate approach is more sensible than pushing everyone to go on one specific diet. You believe in LCHF because it worked for you; others believe in calorie restriction because it worked for them. You think you lost weight without decreasing calorie intake, but controlled studies don’t bear that out. Success on low-carb diets correlates with decreased calorie intake.

              3. eli says:

                I’ll reply here because you seem to closed the “reply” option below.
                Obviously “whatever the causes of obesity, the calories to build that fat had to come from somewhere” yet, if they came preferentially by the slowing down of metabolism, by slowing down of maintenance and repair function of the body, by obliterating the sex drive, and by feelings of low energy (thus precluding normal physical activity- turning people into couch potatoes) (all phenomenons well documented) than your “moderate” intervention will exacerbate the condition and will not help it.
                Really, I do not get the concept of “moderate”, it either helpful or harmful, effective or not, you can’t just conclude on theoretical and logical grounds (without any proof) that due to the law of conservation of energy (which is not helpful in this context) that your intervention doesn’t need any proof because somehow it is all calories behind the scenes.
                The system is a complex control loop with multiple feedbacks and many probably unknown hidden connections, it doesn’t react well to arbitrary forcing of one variable, considerable harm might occur (I think it already did) – hence the fact that you do not bother to prove your intervention is a double standard.

                Again, irrespective of what you say, yours is a hypothesis on how the body works, It is also the regular hypothesis we were given for decades, you simply qualify it to be an intermediate and not the ultimate mechanism, I guess due to Taubes’s strength of evidence, and the prospects of your intervention is based on this hypothesis being true, and this is my point: When you require Taubes to provide good evidence, since his ok evidence is not enough, yet you do not bother to give any evidence at all – you have a double standard.

              4. Harriet Hall says:

                Your are still misunderstanding what I’m trying to say. I’ll try one more time, then I will have to give up in despair. The calories to build fat come from oral ingestion. The way those calories are used in the body depends on all the things you list, but the body can’t use them unless they are ingested. Ergo, reducing ingested calories will necessarily have an effect on whatever processes are going on in the body. Successful weight loss has been demonstrated to alter the calories in/out equation. Diets that don’t decrease total calorie intake have not been shown to produce weight loss. The success of the low-carb diet is far less than expected if Taubes’ reasoning is correct. I am not hypothesizing about “how the body works,” I’m simply stating an incontrovertible fact: to store calories, we must first ingest them; obese people will necessarily lose weight if they ingest fewer calories than their body uses up.

                By “moderate” I mean not making extreme or dogmatic recommendations in the absence of evidence. I advocate a conservative approach that allows different people to adopt different strategies while we wait for better evidence. I’m all for a moderate decrease in carbohydrate intake; I just think Taubes’ recommendations are too extreme. And even he admits that he has gone beyond the evidence; that’s why he’s supporting research.

              5. weing says:

                @ eli,

                You will have to produce extraordinary evidence to show me obesity is not the result of excess calories in to calories out. Food is swallowed and digested and absorbed. You can interfere with intake, digestion, and absorption, either increasing or decreasing them and you will affect weight. Some foods will affect the metabolic rate, so can some diseases , and so can exercise. You can try to quantify each of these effects. It will still come to the difference between calories in and calories out.

              6. eli says:

                @weing
                Why to I have to produce extraordinary evidence? i am not even advocating anything, I have my beliefs, yet what I am pointing out that there is a double standard against Taubes.
                He has to produce great evidence, his “ok-evidence” is not enough yet the proponents of the simplistic and highly unlikely energy balance theory has to prove nothing.

                As I tried to explain, fat cells releasing their stores is a biological process involving signaling and chemical paths etc… there is no apriori reason to think this process is caused by the stimulus of the reduction of ingested calories, to say so is a hypothesis, like Taubses it needs to be proven.
                Body has many various stores that can deliver calories and energy users that can economize to make up the difference when you reduce input – this is exactly what seem to be happening and why it is so hard to loose fat weight.

                Moreover much evidence exists some I brought in this discussion that this is exactly the case.

                Acting on a unproven hypothesis might cause considerable harm, this is I think what exactly is happening.

              7. weing says:

                “He has to produce great evidence, his “ok-evidence” is not enough yet the proponents of the simplistic and highly unlikely energy balance theory has to prove nothing.”

                Not sure if I understand you correctly. Are you saying the law of conservation of energy has not been proven? That it is dubious, simplistic, and highly unlikely?

                “As I tried to explain, fat cells releasing their stores is a biological process involving signaling and chemical paths etc… there is no apriori reason to think this process is caused by the stimulus of the reduction of ingested calories, to say so is a hypothesis”

                Who is saying that reduction of ingested calories is a stimulus to fat cells to release their stores? That is a hypothesis. My understanding was that if you stop eating, after glycogen is used up, in order to meet its energy needs, the body starts to release the energy stored in muscles and fat, and without exercise you will have more muscle than fat loss. But it’s been years since I went over this. Feel free to present more recent research, if you have it.

              8. eli says:

                Weing
                I do not doubt the law of the conservation of energy.
                It simply has nothing to do with the issue at hand.
                What the 1st law of thermodynamics says is that if you would measure all the energy that entered and exited and that stored in the body from the moment of inception until today then the “in” would be equal “out+stored” – nothing more, this doesn’t explain why one becomes obese and Schwarnegger got to be a mountain of muscle with 7% fat.

                (obviously this is practically impossible, you have to measure all bodily fluids for unused calories, heat and kinetic energy that exits etc.. also all the heat that absorbed etc.. )

                What we are talking about here on the other hand, is whether the fat tissue will release stored calories as a response to the stimulus of reduction of total calories – which is a highly complex biological question that probably behaves very differently in different situations, and there are many observations that contradict that this is indeed the case (some I brought here above).

                You can just pretend (as Dr. Hall does) that this is just simple “physics”, and that this is not a hypothesis about how the body works, or it is somehow “incontrovertible” and than just go on to give an intervention based on it, without any proof whatsoever, and at the same time chastise others that actually try to justify their hypothesis with evidence, and are trying scientifically to amass more evidence with Nusi.

                Again, this my point, I am not now advocating LCHF (although there is no reason someone shouldn’t try it – it certainly helped me) I am pointing out that Dr. Hall has a bias and she applies a huge double standard against Taubes.

              9. Harriet Hall says:

                Why are people continuing to misrepresent what I wrote? I said we don’t know the cause(s) of obesity, but that whatever the cause, if an obese person reduces calorie intake sufficiently, he WILL lose weight. As an extreme case, people lose weight and die in concentration camps and famines. And there is no evidence that anyone has ever lost weight WITHOUT changing the calories in/out equation. The point about “evidence” is that most of what Taubes offers is pre-clinical. Taubes himself is supporting research precisely because he recognizes this. We both agree that we need to do something NOW. Taubes advocates a specific diet before the evidence is in; I was merely trying to offer a plausible, practical, flexible, conservative stop-gap approach while we wait for evidence. I don’t claim that my approach is supported by any evidence from controlled scientific studies, only that it is consistent with all the studies of successful weight loss because they have all demonstrated lower calorie intake. And I most certainly have never “chastised others that actually try to justify their hypothesis with evidence, and are trying scientifically to amass more evidence with Nusi.” I have only criticized others when they go beyond the evidence and make strong recommendations based on insufficient evidence. Which is what we consistently do on the Science-Based Medicine blog. My only “bias” is that I have repeatedly and consistently seen calorie reduction work (in my patients, my family, animals, and myself) to reduce weight without a formal low-carb diet. Weight Watchers is not a low-carb diet, and I had a patient who lost 100 pounds in a year on Weight Watchers, didn’t feel hungry, and sometimes was unable to eat all she was allowed. Keep in mind that Taubes is a journalist with a background in physics and aerospace engineering whereas I am an MD with actual experience working with overweight patients. I suggest Taubes and his supporters may be the ones with bias. And I think the low-carb diet is one good way of reducing calorie intake and achieving satiety and that approach has worked well for a lot of people. I have never advised anyone NOT to follow a low-carb diet, but it is not the only approach that works, and its superiority has simply not been convincingly demonstrated in well-designed studies.

            2. eli says:

              I am sorry you are despairing, as they say, when the going gets tough….etc
              Note that this is a symmetrical situation.
              I also understand your position perfectly, I held it not so long ago, I changed mine due to preponderance of evidence.
              I simply disagree with you.

              You say:
              ” The calories to build fat come from oral ingestion. The way those calories are used in the body depends on all the things you list, but the body can’t use them unless they are ingested. Ergo, reducing ingested calories will necessarily have an effect on whatever processes are going on in the body. ”

              This is a correct and neutral statement, yet what you actually mean is that reducing ingestion of calories will cause the body to release the fat stored in fat tissue and not effect some unknown neutral “processes in the body” (we all believe something is affected by a reduction) – and hence it will ameliorate obesity. This is your hypothesis about the ultimate cause of obesity, it flows directly from what you write, otherwise what you write and your diet advice doesn’t make sense.
              And it is a hypothesis like any other which you need to substantiate.

              There is no particular apriory reason to think as you do, if for example obesity is a dysfunction of the control mechanism, let’s say hypothalamic injury or for example the body is unable to release calories from fat tissue due to chronically high insulin levels, the reduction of intake will cause:
              slowing of metabolism,
              loss of lean tissue
              loss of energy and lethargy,
              lack of body heat and constantly feeling cold
              loss of sex drive
              unhealthy hair and nails.
              etc… all are well documented effects of low calorie diet.

              Again, there is no reason to think reduction of intake will cause specifically the fat tissue to release it’s stores – this is a hypothesis.
              the reduction can be compensated by any other store of calories (like lean tissue, liver) or some other energy user in the body or all of them can economize on calories – the only reason there is to think fat cells will release their stores preferentially is only if you hypothesize that calories in/out are the only control over weight and fat tissue, and reversing it will cure obesity, i.e. it will cause fat cells to release the fat – - this is a biological process and not physical balance, some signaling in the body needs to signal that to the fat cells (like lack of insulin between meals) this a clear hypothesis on how the body works and you have to prove it, like any other hypothesis – there is nothing magical about it that makes it true by default .

              You write:
              “By “moderate” I mean not making extreme or dogmatic recommendations in the absence of evidence.”
              ” I just think Taubes’ recommendations are too extreme.”

              “moderate”, “extreme” and “dogmatic” are just name calling, he simply advocates according to what he thinks is the ultimate cause of obesity (chronically high insulin and insulin resistance), and you advocate according to what you think is the ultimate cause (in/out disparity – you obscure it a little), the main difference is that he substantiates his causation hypothesis as much as possible in view of the existing data, and works to achieve additional evidence and you do not. You had pronounced your way a truism by definition and feel no reason to substantiate it.

              1. Dave says:

                I wish Angora Rabbit would reply to this. I believe there is some knowlege about the loss of fat stores vs lean tissue with calorie deprivation. I was taught in medical school that one of the reasons for adding some glucose to the IV’s was to prevent lean tissue loss in patients unable to eat. I don’t know whether this is true or not but that was given as the reason to do it. We also did metabolic experiments, one of which was to have some of the class eat a ketogenic diet with no carbohydrate for several days (others ate a high carbohydrate diet, and still other brave souls (all volunteers) had no calorie intake for several days).A ketogenic diet resulted in ketonuria and a decrease in appetite, but was not very sustainable longterm. We didn’t have the ability to measure lean vs fat loss in these exercises – just chem profiles and urinalyses.

                It’s obvious this is a complex issue. One peoblem I have with attributing the rise in obesity purely to a change to a higher carbohydrate diet is that it downplays the other behavioral changes which have occurred in the last 50 years. It also ignores populations who eat a high carbohydrate diet and remain lean. The genetics have not changed in that time, but we know people are consuming larger portions and are spending more time in sedentary pursuits. I also think we eat a LOT now when we aren’t hungry. Cars in the 1950′s did not have cup holders. I never saw my parents or anyone else eat in their vehicle, aside from stopping at a drive-in, in which case you ate at the drive-in place. A few fast food joints were present, like White Castles (but the hamburgers were quite small by today’s standards) but they weren’t on every corner. It was rare that we had evening snacks – almost all food was consumed at mealtimes. Not watching much tv, we didn’t get exposed to a continual stimulus of food commercials. Lacking microwave ovens, preparing food took more effort and was probably done less frequently. Surely these changes have played some role in the rise of obesity. We also have studies, such as the JAMA article previously quoted, showing equivalent weight loss with calorie restriction regardless of the dietary components. There may well be validity behind the type of food causing different insulin secretion and appetite response but I doubt that’s the whole story for the rise in obesity.

              2. eli says:

                @Dave
                1. Why wasn’t ketogenic diet “not very sustainable long term”? I seem to be ok and also others, it is well known that initial few days maybe a week is required for some metabolic adjustments, yet as it settles, I and others found no fault with it.

                2. It is certainly possible that ketogenic diet subdues hunger, not because it directly affects hunger but rather because body “runs” partially on internal stores of fat, now became available due to lower insulin level, in short preferentially fat is lost (had been shown) and you are less hungry, seems reasonable – just a hypothesis.

                3. There were huge behavioral changes relating to eating and activity as you enumerated, but there is no reason to draw the causality from behavioral changes to obesity, it is reasonable (and I think more so) that the causality is reversed, what I mean is that first diet shifted to more sugary and refined carb based diets (this is undeniable), which caused increased hunger, specifically to refined carb reach foods (as you noted diet lesser in carb subdues hunger, ketogenic diet is an extreme case), and it also caused lack of energy, for example like when teenagers have their growths jumps they are lethargic and hungry, here we are talking about growth in fat tissue – but the concept is the same, calories are diverted by hormonal signaling to fat tissue – the organism is hungry and lacks energy – and turns to less vigorous activities – hence the behavioral changes.

                Again all of this is far from known, yet i am sure no side in this debate can just pronounce it’s hypothesis proven by default, and directly jump to devising an intervention based on it (and chastising the other side for trying to amass arguments and evidence), certainly not if decades long insistence on this hypothesis and roughly the same intervention only saw a catastrophic deterioration in the rate and severity of obesity in the population.

              3. Dave says:

                Eli, for decades the endurance athlete community has generally been told to eat a high carbohydrate diet, the purported reason being to replace the glycogen stores lost in training. The standard traditional pre-marathon meal was a spaghetti dinner. There used to be a lot written about glycogen loading before such an event. I posted an article here referencing a study on Kenyan elite distance runners, whose diet consists of 76% carbohydrates, with 20% being sugar. These people are hardly lethargic. If you want an irritable person on your hands take an avid endurance athlete and prevent him/her from running or biking for a few days. They go stir-crazy. I’d say this is pretty good evidence against the postulate of carbs causing lethargy and thus weight gain. The flip side is that some people perform vigorous activities on a mostly meat diet, such as the Inuit and historically the men on the Lewis and Clark expedition.

                A ketogenic diet such severely restrict carbs to the point most people won’t follow it. If you think you are on one do a urinalysis and see if you’re spilling ketones. If not, you’re not on the kind of restriction I was referring to.

              4. weing says:

                “It is certainly possible that ketogenic diet subdues hunger, not because it directly affects hunger but rather because body “runs” partially on internal stores of fat, now became available due to lower insulin level, in short preferentially fat is lost (had been shown) and you are less hungry, seems reasonable – just a hypothesis.”
                So prove it. Number 3 is also just a bunch of unproven speculation. Who knows if it’s correct? We do know that fatty foods decrease gastric emptying. That may work in some people to prolong satiety and a net decrease in consumption of calories. How long can they do this for? Studies of people on these diets for over a year haven’t been that great.

              5. eli says:

                Weing
                you write:
                “So prove it. Number 3 is also just a bunch of unproven speculation”

                I remind you that I am not peddling a hypothesis and an intervention here, my point is, and always was, that Dr. Hall has a severe double standard and a bias, I am pointing possible scenarios that underline the fact that this is biology and mere correlations and certainly not simple physics and causation – I am the one that insisting that the hypothesis should be substantiated before intervention is proposed, I completely agree that those are speculation, this is why I wrote “It is certainly possible” and “but there is no reason to assume” etc… and the like, just note that Dr. Hall’s (and yours) are also mere speculations, the difference is that you and her are pretending it is all simple truths of physics that require no substantiation, and directly you jump to both, and at the same time 1. chastising Taubes for trying to prove and substantiate his point and 2. to propose an intervention – that is noted for it’s ineffectual nature and proven harm.

              6. eli says:

                Dave
                It is an observation, Taubes has a section devoted to this you should try to look it up, I think it doesn’t deny the main premiss, the main issue according Taubes is insulin resistance and the difference between insulin resistance of the muscle vs. fat tissue.
                if due to extreme activity and natural variability (that drives people to being endurance athletes) the do not develop insulin resistance and do not have chronically high level of insulin in the system – than they are not susceptible to lethargy.
                High chronic level of insulin disables the possibility to get calories from fat stores (this is a basic fact – see wikipedia) hence he directs calorie to fat stores yet can’t mobilize them – which causes hunger and lethargy, if a person burns all he’s glycogen and glucose, and doesn’t have elevated insulin – he wouldn’t suffer from that.
                Yet again, this is all hypothesis, I just brought alternative views to show that Dr. Hall’s explanations is not the only one possible and that she has a double standard and a severe bias when she doesn’t bother to substantiate her’s, pretending her’s is “just physics”.

                It would be instructive for you to look at Pater Attia blog who is an endurance athlete (and Taubes’s collaborator) about this issue, he discusses it at length.

                Regarding ketogenic state, I used stirps to test it in the beginning, but now I just know when I am according to general wellness, there is nothing harmful or abnormal in this state, I think you might again look in Pater Attia’s blog he done many self experimentations with keto while in extreme (really extreme) endurance training, and also there is much more literature about this. I found no adverse effects.
                Moreover, this is a bit hair splitting, why does it matter if your diet is 20gr of carbs and you have ketones in urine or 60gr carbs and you have only trace amounts of ketones, the main thing I think is avoiding sugar and refined carbs like the plague, this is much much easier and much more delicious when you have no fat/meat phobia.

              7. weing says:

                “1. chastising Taubes for trying to prove and substantiate his point and 2. to propose an intervention – that is noted for it’s ineffectual nature and proven harm.”

                I have never noted Dr. Hall to be chastising Taubes, or anyone for that matter, for trying to prove or substantiate points. The more research the better, as far as I am concerned. I remain confident that calories in to calories out will remain as the bottom line determinant of weight gain or loss.

                What intervention has been proven effectual over the long term? What proven harm are you talking about? Is it possible you suffer from a carb phobia? And you think anyone who disagrees with you has a fat phobia?

        2. Andrey Pavlov says:

          @Eli:

          I’ve skimmed your plethora of comments and Dr. Hall has responded admirably (which is absolutely no surprise to me at all).

          There is little I can add since you are clearly already set on your ideas and either unwilling or utterly incapable of understanding the truly straightforward message Dr. Hall is presenting.

          However, you say this:

          You should stop assuming your views simply true, and try to amass equally good amount of historical, epidemiological, biological, experimental, theoretical and clinical evidence like Taubes, and then we will try to judge which one has the better case – for now, it is simply premature to take your case seriously since you haven’t supported it at all, and certainly dispensing diet advice on the basis of mere baseless statements is a double standard.

          You completely fail to recognize that there is a huge amount of relevant data to inform Dr. Hall’s thoughts and she is in perfect nuanced concordance with that. You try and argue that a calorie is not a calorie and she even (and I as well) admit that there is a slight difference in how different calories are metabolized (that is painfully obvious to anyone who has studied the matter). The key is that the difference is ultimately of absolutely no clinical significance. You further assert that carbs are the enemy, as per Taubes. And that a carb calorie is somehow more obesogenic than a fat or protein calorie. Yet, there is a black swan flying directly in your face, ready to break your nose just like Fabio and the goose. It has been documented that a man has lost significant weight eating nothing but twinkies. And that many of his relevant biomarkers improved as well. Doing absolutely nothing but strictly managing his caloric intake based on his calculated metabolic rate.

          So it is not Dr. Hall who must explain why human beings still must obey the fundamental laws of thermodynamics, but you who must somehow explain how a 100% carb diet where the caloric intake was less than the output not only led to precisely (within measurement error) the weight loss predicted by the calculated calories in/out but also improved cholesterol, hypertension, etc.

          The point being is that if there is truly a difference in calories it must necessarily be extremely small. And that is precisely what the various converging lines of evidence show.

        3. Andrés says:

          Welcome back, Dr Pavlov. I will complete my response addressing your other points as soon as I have enough time.

          But now just a (almost) quick comment.

          Dr. Pavlov said:

          It has been documented that a man has lost significant weight eating nothing but twinkies.

          but you who must somehow explain how a 100% carb diet where the caloric intake was less than the output not only led to precisely (within measurement error) the weight loss predicted by the calculated calories in/out but also improved cholesterol, hypertension, etc.

          It wasn’t only twinkies. It wasn’t a 100% carb diet. It didn’t drive only improved health measures.

          There are those who have taken the time to compute Haub’s twinkies diet daily average macro composition: 61g of fat (38% of calories), 173g of carbohydrate (47%), 54g of protein (15%).

          It seems that Haub lost 6 pounds of lean mass. I don’t think anyone considers that healthy.

          Paul Jaminet defends a 150-200g of carbohydrate as matching the daily glucose requirements) and hence neutral. That should be considered either the higher end of low carb or a moderate carb diet. Certainly it is not a high carb diet.

          There has been other supposedly high carb diets that just fall lower than 200g/day.

          Not that it isn’t possible (and logical) to lose weight on a high carbohydrate diet though.

          PS: Since I haven’t found the twinkies diet paper I haven’t looked for any supporting my points either.

          1. Andrey Pavlov says:

            Hello Andres,

            Firstly I will indeed admit my error – there were fat calories involved. For some reason the link your provided as to the breakdown of daily caloric intake is not loading for me, no matter how many times I try. However, if you look at the direct dietary information for twinkies you will find that each twinkie contains only 1g of protein. He limited his diet to 1800kcal and, it says, augmented it with the occasional “Doritos chips, sugary cereals and Oreos”. If one assumes roughly 10 twinkies per day (for a total of 1,500kcal) then according to the math you provided he would need to eat another 44g of protein which seems rather difficult considering that a serving of Doritos and Oreos each contain only 2g of protein for roughly the same calories as each twinkie. So even if he at only Doritos, for example, which would double the protein intake he could only have maxed out at roughly 20g of protein per day, not 54g. It does say that he did add in a protein shake per day, but it does not specify which one. However, in looking it over, at most a standard protein shake has 18-20g of protein.

            Additionally, the numbers you provide add up to a 1,500kcal diet, and it states that he was shooting for a roughly 1,800kcal diet. In other words, while you are correct in my error in saying it was a pure carb diet, the numbers you are providing simply don’t quite add up. Plus the source seems dubious to me and I would aver that there was some fancy footwork with the numbers to try and make some point the individual already had in mind.

            Haub weighed 201lbs at the start and ended at 174lbs (a total weight loss of 27lbs). It was also noted that his body fat % went from 33.4 to 29.4%. That means he had a total of 67lbs of fat to start and ended with 51lbs, for a total loss of 16lbs of fat. That leaves 10lbs, not 6, of lean muscle and water weight to account for, once again calling into question the numbers you provide.

            Next, it was also noted that his diet specifically restricted calories from 2,600 to 1,800 for a net deficit of 800kcal per day. Over the course of 10 weeks, that amounts to 56,000 calories. At 3,500kcal per pound of fat, that is precisely 16lbs of fat, which is in concordance with his measured fat loss. The remaining 10lbs is not entirely addressable given the circumstances. It could have been mostly water weight or lean muscle from catabolic processes or from a lack of anabolic processes. Likely all three.

            Regardless, it does not at all obviate my point to Eli.

            I also did not assert that it was a healthy diet nor that it only improved biomarkers. I would certainly not recommend this diet to my patients. The point is that Taubes’ ideas about carbs and the assertion that a calorie is not a calorie and different macronutrients are (significantly) differently obesogenic is not supported and this anecdote highlights that.

          2. WilliamLawrenceUtridge says:

            This doesn’t really do much to refute Andrey’s core point – that calories matter, not the origin of the calorie, and that Taubes’ assertion that carbohydrates are the enemy doesn’t seem to be backed by sound science.

            1. Andrey Pavlov says:

              Thank WLU. I guess I find Andres’ silly pedantry stimulating to my own silly pedantry, when your comment would have sufficed. :-)

          3. Andrés says:

            Well, it seems that the link is censored from your site since I have no problem from here.

            Nevertheless, Haub kept a food log during the experiment. I have downloaded it from August 25th 2010 to September 25th 2010 (it doesn’t export if too much days are selected) and check average consumption of carbohydrates those 32 days: 171g/day.

            It seems his message got a little sensationalize by the media.

            Dr. Pavlov said:

            That leaves 10lbs, not 6, of lean muscle and water weight to account for, once again calling into question the numbers you provide.

            Initial water (and glycogen) loss when depleting glycogen is usually cited as 4lbs. I may try to look it up if you want. So I think 6lbs of muscle loss is a generous (low) estimation.

            Dr. Pavlov said:

            The point is that Taubes’ ideas about carbs and the assertion that a calorie is not a calorie and different macronutrients are (significantly) differently obesogenic is not supported and this anecdote highlights that.

            This anecdote doesn’t because it is not a high carbohydrate diet. The twenty potatoes a day anecdote approaches more to highlight that the subject at hand is not simple. I think that the hormonal view of it is more enlightening than calorie counting though.

            WLU said:

            This doesn’t really do much to refute Andrey’s core point – that calories matter, not the origin of the calorie, and that Taubes’ assertion that carbohydrates are the enemy doesn’t seem to be backed by sound science.

            Perhaps they are not the enemy but there are those who get to control their blood glucose through carbohydrate restriction when the damage is already done. Of course there are people with perfect blood glucose control on high carbohydrate diets as for example the Kitavans or even most Mexican Pima (very unlikely that they are eating the same food than U.S. Pima). I don’t have any interest on focusing on losing weight as the primary goal of anyone. I don’t think that focusing on counting calories instead of counting carbohydrates does any good to someone with pre-diabetes, diabetes or metabolic syndrome either.

            Certainly I am biased. I find absurd not using our evolutionary design as hormonal machines in order to improve satiety (fat and protein certainly drive more than empty-time) instead of a calculator. I like to check my blood glucose though.

            1. Andrey Pavlov says:

              Nevertheless, Haub kept a food log during the experiment.

              Fair enough. I shall concede that my example is not quite as strong as I had thought it to be. Regardless, as WLU said, it doesn’t obviate my point to Eli.

              Initial water (and glycogen) loss when depleting glycogen is usually cited as 4lbs. I may try to look it up if you want. So I think 6lbs of muscle loss is a generous (low) estimation.

              Not entirely unreasonable. But you are assuming those are the also the only two losses possible. Regardless, it is not a critical point either way.

              This anecdote doesn’t because it is not a high carbohydrate diet. The twenty potatoes a day anecdote approaches more to highlight that the subject at hand is not simple.

              Perhaps an even stronger anecdote to rebut Eli’s point. I’ll keep it in mind for the future. However, it also supports my main point – a calorie deficit leads to weight loss regardless of what the macronutrient composition is.

              I think that the hormonal view of it is more enlightening than calorie counting though

              I disagree – and so would, I believe, Dr. Hall – that a hormonal view is predominant. I’ve pointed out before that one can use different macronutrient compositions to alter the GI hormone balance to improve satiety before. That is obvious and well known. The point at the end though is that this is simply yet another means by which to achieve calorie reduction. Which is, once again, the point.

              Perhaps they are not the enemy but there are those who get to control their blood glucose through carbohydrate restriction when the damage is already done.

              A non-sequitur.

              Of course there are people with perfect blood glucose control on high carbohydrate diets as for example the Kitavans or even most Mexican Pima (very unlikely that they are eating the same food than U.S. Pima)

              The Kitavans were written about before by Dr. Hall. Suffice it to say the evidence one can glean from them is minimal and certainly not sufficient on which to base dietary advice. But thin data has never stopped you from drawing firm conclusions in the past.

              And also a non-sequitur.

              I don’t have any interest on focusing on losing weight as the primary goal of anyone.

              Then why are you even engaged in the conversation? That is the topic at hand.

              I don’t think that focusing on counting calories instead of counting carbohydrates does any good to someone with pre-diabetes, diabetes or metabolic syndrome either.

              Once again, a non-sequitur. Individuals with special metabolic demands and conditions are not the topic of conversation. Regardless, both calorie counting (or, more pointedly, restriction) combined with carbohydrate monitoring is necessary for optimal dietary control of diabetics.

              I find absurd not using our evolutionary design as hormonal machines in order to improve satiety (fat and protein certainly drive more than empty-time) instead of a calculator.

              A point I have made many, many times here. And not at all what Taubes or Eli are trying to assert in their discussions of the matter.

            2. WilliamLawrenceUtridge says:

              Someone who is getting control of blood glucose through carbohydrate restriction is a significant step away from the average person, or even the average obese person.

              I continue to doubt that there is merit in trying to trick the body; calorie restriction to lose weight, exercise to maintain health, and in general diverse unprocessed foods seem like a sound approach to nutrition that doesn’t pretend there are magical foods that are obesogenic beyond their calories or will work some sort of metabolic magic. I find it absurd to think that given our dentition and GI tract we are anything but diverse omnivores capable of thriving on a wide variety of diets.

  50. Matt Brown says:

    Here is a related opinion piece (based on two JAMA articles) that repeats Taubes’ ideas. It might be worth a look as well.

    http://www.nytimes.com/2014/05/18/opinion/sunday/always-hungry-heres-why.html

    1. Zoe says:

      I read this article as well in the NYT. I don’t want to believe it, I’d rather trust Dr. Hall. And yet, there is something pretty compelling about the argument. I just can’t believe it as simple as a calorie equals a calorie. But, I whole heartedly agree with the advice at the end of the article.

    2. Zoe says:

      Hmm, I’m not sure why my comments appear and disappear. I assume mine will reappear so I’ll add to it. It seems like Dr. Hall is open minded to the possibility that some of Taubes’ ideas may be correct, but that they haven’t been proven yet. I appreciate the skepticism and also the discussion of the probability of multiple causes of obesity. I do happen to think its smart to restrict simple carbs and simple sugar, but pure insanity to eat lots of bacon and meat in its place. People like extremes and simple answers and to jump on bandwagons.

  51. l. ross says:

    Some years ago, with no change in physical activity, my body “demanded” a doubling of caloric intake over the course of ten days or so and then “demanded” a second doubling shortly after that; all with zero weight gain. Several weeks later I was in a deep malaise, with little physical activity, high caloric intake, and no weight gain. This persisted for several months; at which point I developed what I thought was a migraine headache, and treated it as such. When the migraine didn’t respond to medication, I realized I had meningitis and called an ambulance.

    Turns out the increase in caloric need followed by malaise, most likely coincided with contracting Lyme disease, which then developed into meningitis (never fully recovered).

    My question is: Is it possible for an infection, perhaps subclinical, to be an underlying cause of extreme hunger with the infection resolving over time but the hunger continuing. In my case, the hunger continued and there was no weight gain for another six months after the meningitis was resolved, then the weight gain began.

    Just to be clear: I did see a physician when my metabolism went berserk. It was both deeply troubling and expensive to have to eat a family size frozen entree and still be hungry. But I had no temperature, and the doc just said to stop eating so much, and was too busy typing to listen.

    1. Harriet Hall says:

      “Is it possible for an infection, perhaps subclinical, to be an underlying cause of extreme hunger with the infection resolving over time but the hunger continuing.”

      An interesting question. I don’t have an answer. Hunger is affected by many factors, one of which is the hormone ghrelin. Damage to the hypothalamus can cause increased hunger, and hunger is one of the 3 classic symptoms of diabetes (polyphagia, polydipsia, and polyuria) along with paradoxical weight loss. Certainly your experience is unusual. Strange things happen. I know a woman who was obese as a teenager and at the age of 18 spontaneously lost the excess weight and remained thin for the rest of her life. I could speculate about how your infection might have triggered your hunger, but I won’t. Unusual cases like these might provide clues to the basic underlying mechanisms that lead to excess calorie intake and obesity. A better understanding of the basic science will surely lead to better clinical solutions for weight control. One of the many reasons we should be devoting our limited research funds to solid research based on scientific merit instead of tooth-fairy NCCAM studies based on politics and popularity.

    2. Andrey Pavlov says:

      @I. Ross:

      As Dr. Hall said, it is indeed possible. We know from critical care medicine in treating sepsis that caloric demand from a significantly ramped up immune system can be extremely high. The question as to whether this can somehow have a lasting effect is, to the best of my knowledge, unanswered. Based on prior plausibility and physiology we do know, the best answer is likely that it is possible though uncommon if it does happen.

  52. Kirk says:

    Ms Hall, I would be interested in your opinion on this recent book:

    The Big Fat Surprise: Why Butter, Meat and Cheese Belong in a Healthy Diet Hardcover
    by Nina Teicholz

    I heard an interview with the author, and she essentially takes Taubes’ ideas a bit further, examining fats, and discussing why they are not unhealthy.

    1. Harriet Hall says:

      I have not read the book, but the evidence doesn’t indicate that butter, meat, and cheese are unhealthy. The only evidence is against trans fats. There is some evidence that large amounts of meat, especially processed meats, may be harmful, but no clear evidence that small amounts are harmful, and meats and fats contain nutrients that are not as readily available elsewhere. The whole problem with diet advice is that we have no compelling evidence, and in the absence of evidence surely moderation is the safest approach. One reason to moderate fat consumption is that fat contains more than twice as many calories per gram as protein and carbs; so moderating fat intake will help moderate calorie intake. I love cheese, I eat butter, and I eat some red meat but much more chicken, fish, and other sources of protein.

  53. Spectator says:

    “the benefit of adding exercise to diet is marginal or non-existent.”

    Perhaps for people who hate exercise, and thus do rather little of it.

    Try training for a half or full length triathlon and see how it effects your caloric balance. Exercising ten hours per week at an adequate pace will cut the amount of time you have to sit around and eat, raise your base metabolism and also burn 7-12 thousand calories per week directly… more you also do weight training to avoid the upper body atrophy which can happen from high running mileage.

    Go hang out an any qualification triathlon (one where a high enough finish gets you a spot in the Hawaii Ironman), and check the contenders for obesity. They eat more than average, but I suspect you’ll see they are a standard dev or three below average on the obesity scale.
    Of course, since exercise doesn’t work, it must be their stretchy outfits causing them to appear lean.

    1. Windriven says:

      Do you imagine that the average person trying to lose 20 or 25 pounds is going to train like a triathelete? For the average person a 500 calorie workout is a huge commitment.

    2. weing says:

      “Go hang out an any qualification triathlon (one where a high enough finish gets you a spot in the Hawaii Ironman), and check the contenders for obesity. They eat more than average, but I suspect you’ll see they are a standard dev or three below average on the obesity scale.”

      They sound like very motivated people. You mean to tell me that after sitting at a desk job, or driving a truck for 40+ hours a week, shopping, household chores, they then go and exercise 10 hours a week? That’s impressive, I can only get in 4-5 hours.

      1. Dave says:

        Weing, I know some of these people. They do indeed work 40+ hours a week, run before work and swim or cycle after work. The remainder of their free time is spent recovering from workouts with little left over. It’s an ascetic, disciplined lifestyle, and something most people cannot do, should not do because of family and other commitments, or have no desire to do. I think Spectator is making the point that a lot of intense exercise sustained for long periods can cause weight loss. I believe this to be true, but beyond the scope of the average person, the kind of person we see in our pracrices. Let’s face it, doctors waiting rooms are not populated by triathletes or marathoners.

        1. weing says:

          “I know some of these people. They do indeed work 40+ hours a week, run before work and swim or cycle after work. The remainder of their free time is spent recovering from workouts with little left over. It’s an ascetic, disciplined lifestyle, and something most people cannot do, should not do because of family and other commitments, or have no desire to do.”

          Yeah, I know. But I feel better with my 4-5 hours a week after reading this

    3. Harriet Hall says:

      The fact that adding exercise to diet is of marginal or non-existent benefit does not mean that exercise “doesn’t work.” It only means that the typical dieter in a research study gets a lot more bang for his buck from reducing calorie intake than from exercise. Triathlon training controls weight for those who do it, but obese people are not likely to do it. It’s not something doctors could recommend to most patients or something that most patients are willing to do. I pointed out that exercise will allow dieters to eat more calories. Intense physical activity helps some people; low carb diets work for some people; other diets work for other people. Anything that alters the calories in/out balance will work if the math comes out right.

      1. Sean Duggan says:

        I would not be in the least surprised if there’s also a degree of correlation going on here. People who maintain a consistent exercise program are often also already watching their diet and both groups are likely to have a high degree of stick-to-it-tiveness when it comes to choosing a course of action and keeping with it.

        I actually saw an interesting study indicating that exercise, without a specific diet plan, typically leads to more calories consumed, even when accounting for the number burned in exercise. The researchers posited, based on the results, that it’s a matter of humans being very bad at judging how many calories we’ve consumed and we seem to subconsciously adjust our eating to consume the calories we’ve “lost” through the exercise and we overdo it.

        1. kevin says:

          Gary Taubes has opened provocative avenues of discussion on perhaps the most important health issue of our time. Sorry you felt slighted in an email he sent you Dr. Hall.

          1. Harriet Hall says:

            He has provoked others to discuss, but he seems more prone to make bold claims and prescribe solutions than to engage in productive discussions.

      2. Gibbon1 says:

        What freaks me out with this whole discussion over the effects of exercise and nutrition on weight is the ‘Simpson’s paradox’. it’s quite possible that when you’re dealing with over-wight people and people of normal weight your actually lumping in a bunch of sub-populations together.

        You can say that perhaps, some percentage of over weight people have a genetic or developmental issue that causes them to be over-weight. Changes in nutrition or exercise probably won’t do anything in this population.

        Other over-weight people may have some sort of syndrome or disease that causes them to gain weight. Certainly possible that removing the cause of a disease won’t necessarily cure it. Exposure to certain chemicals can cause Parkinson’s like disease. Removal, doesn’t reverse the disease because the many of cells in the substantia nigra that produce dopamine are dead.

        Which is some of my fear, once people become over weight, excepting those with an underlying genetics, it’s too late. It’s like blaming people with cancer for not getting well (It’s your fault for not beating cancer because you aren’t eating a macrobiotic vegetarian diet)

    4. Andrey Pavlov says:

      @Spectator:

      Perhaps for people who hate exercise, and thus do rather little of it.

      Try training for a half or full length triathlon and see how it effects your caloric balance.

      You’ve missed the point. And I can speak from experience. I used to weigh around 265lbs and am now currently out of shape at 190lbs. But at one point I was a lean and mean 175, exercising – on average – 35 hours per week. Yes, 35 hours per week. I needed to eat over 5,000 calories a day just to not lose weight.

      So yes, it is beyond obvious that exercise can affect your caloric balance and is extremely healthful beyond that as well. The problem is, which Dr. Hall is attempting to explicate and you are utterly missing, is that for the most part it is vastly easier to eat more calories than you can possibly expend exercising. Yes, you can point at extreme outliers like myself, where I had training days that left me with a 14,000 calorie deficit on the day and I had to eat 2 dinners, a midnight snack, and 2 breakfasts just to catch up. But it is impossible to just do that – I couldn’t do those kind of days right now even if I had the time. It takes significant time, effort, and consistent training to even get to the level where one can physically do that. I did not hop on a bike at 265lbs and magically start doing century rides with 7,000 feet of vertical ascent followed by a 10k run.

      So when one is talking about the idea of losing weight and exercise it is nothing short of asinine to start talking about Micheal Phelps and his exercise regimen. And it misses the stupendously obvious fact that it is incredibly easy to completely obviate the exercise one does. For example, take a moderately obese 220lb man, running an 8 minute mile for an hour (which, you must admit is extremely ambitious if you have ever run, but I’m being extremely generous here). You find that it burns roughly 1,300 calories. And a single Honey Bun from a vending machine is 440 calories, a single Krispy Kreme plain glazed donut is 190 calories, and single can of cola is 180 calories. In someone who is already overeating it becomes much too easy to negate the caloric benefits of exercise, even if it is a rather strenuous one like running 8 minute miles for an hour, something which even I couldn’t do right now without taking a couple weeks to train myself back up.

  54. ug says:

    To me, the 5/16 NYTimes article “Always Hungry? Here’s Why”, by a respected researcher like D.S. Ludwig very much vindicated Taubes’ thesis. What do you think about it? Ludwig also points out his recent JAMA paper “Increasing Adiposity
    Consequence or Cause of Overeating?” where he gives lots of evidence.

  55. Tammy Skerston says:

    Your Protandim story website would not let any more comments in. it took me to this website. whatever it is. just one question. harriett, have U tried Protandim?

  56. Andrey Pavlov says:

    I am making this a separate comment on the most recently commented thread so that those who are interested may be more likely to catch it.

    I just returned from 10 days back home in California followed by 8 days in Costa Rica (my first time there and absolutely loved it. I highly recommend visiting if you have the chance, though now I am convalescing a bit as I got a little whalloped surfing overhead waves for 3 days in Santa Theresa) and found my RSS reader with some 580+ comments. I skimmed through them all, thankfully skipping the plethora of SSR’s comments, but found some I’d like to respond to, including a few that mentioned me by name. If I missed anything particularly pertinent and thus my response is not entirely on point I apologize. If I missed any that mentioned me by name asking for a response, please feel free to bring it to my attention. If it seems I am necromancing a bit, my apologies for that as well, and I will try and keep things as brief as I can.

  57. oderb says:

    http://www.sciencedaily.com/releases/2012/06/120626163801.htm

    Here’s a study from 2012 that clearly demonstrates that a calorie is not a calorie.

    Those eating a low glycemic or low carb diet burned 300 more calories a day than those eating the same number of calories derived from a low fat diet.

    1. WilliamLawrenceUtridge says:

      Actual study.

      Interesting. I’ve only skimmed – did they control for the amount of weight lost? Comparing pure calories can mask the fact that simply being heavier can result in increased energy expenditure. Presumably a cross-over design would help control for that. Also interesting that they assessed body composition before and after weight loss, but not during each of the three phases. I’d love to see Angora Rabbit’s assessment, I’m having a hard time wrapping my brain around all the complexities.

      Did anyone else’s eyes bug out at the $52,000 in patient reimbursement fees alone?

      1. Andrey Pavlov says:

        Agreed. Can we have an Angora Rabbit signal kind of like the bat-signal? Or can I stand in front of a mirror and say “Angora Rabbit” 3 times and summon her?

        In any event, my take on this.

        First and foremost, a single study never “clearly demonstrates” anything. Particularly a study with an n=21, no matter how robust it is. That said, this study is interesting indeed, but here is what I am seeing (I’ll be quoting extensively from the study).

        An alternative explanation is that weight loss elicits biological adaptations—specifically a decline in energy expenditure (adaptive thermogenesis) and an increase in hunger—that promote weight regain… Acutely, reducing dietary glycemic load diet may elicit hormonal changes that improve the availability of metabolic fuels in the late postprandial period, and thereby decrease hunger and voluntary food intake

        So their premise and rationale for this study seems sound and in concordance with what I, and others here, have been saying. Basically that the different macronutrient components can alter the satiety and hunger levels of an individual based on hormonal responses. This goes both ways – the body wants to maintain fat reserves, so when they go down, hormonal signals increase hunger. When you eat fat and protein hormonal signals decrease gastric emptying and increase satiety.

        We enrolled 32 participants, including 17 men and 15 women. Of these, 11 participants did not complete the study… Noncompleters did not differ from completers with respect to any of these characteristics.

        They had a pretty high drop out rate. But at least there didn’t appear to be any noted differences, though I would argue that in studies like these there are likely to be at least a few non-quantifiable or identifiable differences that could be important, since they were only looking at demographic data as a comparison.

        I also give them credit for adding in a Bonferroni correction for multiple comparisons.

        The decrease in REE from pre–weight-loss levels, measured by indirect calorimetry in the fasting state, was greatest for the low-fat diet (mean relative to baseline [95% CI], –205 [–265 to –144] kcal/d), intermediate with the low–glycemic index diet (–166 [–227 to –106] kcal/d), and least for the very low-carbohydrate diet (−138 [–198 to –77] kcal/d; overall P = .03; P for trend by glycemic load = .009).

        Now here is the main issue I am finding – the differences are indeed statistically significant. But are they clinically significant? The maximum absolute mean difference is only 67 calories. I also note that they powered their study to detect an 80 cal difference and had dropout after enrollment, and the CI’s for each group overlap, even from highest to lowest.

        The most charitable interpretation I can come up with (and once again, Angora Rabbit! Angora Rabbit! Angora Rabbit!) is that there is indeed a difference in how different macronutrient compositions affect overall metabolism but that this difference in effect is pretty darned small and at 67 calories clinically insignificant (considering that a single apple has 95 calories….). But this does not mean that the calorie itself is somehow different – but that the hormonal milieu a specific macronutrient composition will generate is creating a slightly different metabolic state.

        The less charitable interpretation is that there really is no difference and that this falls within the noise of data, which is also distinctly possible, since the actual effect size is pretty darned small (a 67 cal difference amounts to a ~4% difference in caloric expenditure). Additionally if you look at the graph in Fig 3, you will note that some of the participants had an changes in REE counter to the general trend seen and the average described in the results.

        In any event, none of this is counter to anything I or Dr. Hall have been saying – that there is likely a slight difference because of different metabolic pathways but that if there it is clinically insignificant. Additionally, hormonal changes can elicit differences in metabolic state which is different to saying that “a calorie is not a calorie” and even then that difference is very small, if it exists.

        I won’t delve into the secondary outcomes because they are all surrogate markers which may or may not indicate anything particularly relevant, although these data do provide a hypothesis generating outcome to be evaluated in future trials. That, and they are irrelevant to the actual question at hand of “a calorie is a calorie.”

        I will add, however, that the authors explicitly stated:

        In view of the mechanistic nature of this study, relying on a feeding protocol, we did not design the diets for long-term practicality…. In particular, the very low-carbohydrate diet involved more severe carbohydrate restriction than would be feasible for many individuals over the long term. Therefore, the study may overestimate the magnitude of effects that could be obtained by carbohydrate restriction in the context of a behavioral intervention.

        Meaning that for these small changes in metabolism, the changes in diet and behavior are drastic enough that they are likely unsustainable and already clinically insignificant differences are even more likely pragmatically zero.

        The discussion is also telling, basically saying that they can’t really explain the differences and that some of the differences were paradoxical to what would be expected. It was also a short duration trial and it stands to reason that acute changes in dietary composition would yield larger fluctuations in measured variables which would even out and return closer to baseline in the long term, making an effect even smaller. They also noted that this trial was rather rigorous in terms of dietary restriction and weight loss/maintenance requirements and thus may reflect selection bias in terms of study participants, particularly given the background of a ~33% dropout rate. They also did not actually measure adherence to the diet and instead used RQ measurements and assumed weight maintenance indicated adherence. While this is not at all unreasonable it certainly adds some room for error, which could easily be significant given the most charitable interpretation is still a rather small effect size. Of note the study authors also say:

        In addition, we did not assess physiological differences among participants (for example, involving insulin secretion40,41) that might influence individual responses to the test diets.

        They do discuss how the crossover nature could lead to confounding and do reasonably say that these are accounted for in statistical modeling, including the randomized order of diets, these are still a lot of comparisons for a small n and is still a possibly big confounder.

        All of this does not at all invalidate the study, but it certainly makes it far from “clearly [demonstrating] that a calorie is not a calorie.” At best it merely suggests that there is a small difference.

        Also, WLU, it was not $52,000 in patient compensation. It was $500 and then $2,000 for a total of $2,500.

        1. Harriet Hall says:

          Thanks, Andrey. I was going to respond similarly but you saved me the trouble. There were a couple of other things in that study that I found interesting. They said there was no difference in satiety between the different diets, and they pointed out some adverse health consequences of the low-carb approach, saying that it might actually increase cardiovascular risk.

          1. Andrey Pavlov says:

            My pleasure Dr. Hall. I doubt I’ll have time to do such analyses in the not too distant future since although I am fast, they do take some time still. But I’ll do it while I can, particularly since I am genuinely interested in the topic and practicing dissecting a study is never a bad thing.

            And you are correct about the other things noted – I just didn’t want to get into them because I was trying to stay focused and it was already a long post. Plus, my cat decided to do barrel rolls on my keyboard signalling it was time to move on.

            Another analogy occurred to me in these discussions – that technically, one does age more slowly when driving a car and even more so when flying in an airplane due to relativistic and gravitational effects. But I doubt I’ll be telling my patients to live in an airplane to stave off senescence any more than I would be advising them to adopt a draconian low carb diet in order to achieve and maintain a healthy weight.

          1. Andrey Pavlov says:

            Danke.

        2. MadisonMD says:

          It’s funny folks keep going on about a calorie isn’t a calorie. No kidding. Put some cellulose in a calorimeter and you will discover many more calories that your body could possibly absorb in its absence of cellulase. Lactose intolerant? Drink lots and lots of no-fat milk and the pounds will melt away. Short gut syndrome? Yeah, a calorie certainly isn’t one for you.

          The point is, if you eat the same things you are currently eating, but take in 20% less, you will lose weight. All the rest is quibbling about what provides the best satiety, tweaks the basal metabolic rate, etc. etc. As Andrey points out, this all seems to be founded on preliminary evidence. All of which is exactly what I understood Harriet to say in the first place.

        3. WilliamLawrenceUtridge says:

          Also, WLU, it was not $52,000 in patient compensation. It was $500 and then $2,000 for a total of $2,500.

          $2,500 per patient, 21 patients, $52,000 total with generous rounding :)

          Interesting analysis, I’ve had a pet hypothesis for years that the biochemical processing of specific calories from raw ingredients into fat having different efficiencies could mean a high protein diet would lead to more thermogenesis, calorie for calorie, versus carbohydrates, in turn carbs being “better” than fat.

          Your point about clinical vs. statistical significance is well-taken. Particularly given patients saying “well, my diet means I burn more calories, so I can totally have an extra piece of cake for dinner”.

          I’m lazy, how did they measure REE and TEE?

          1. Andrey Pavlov says:

            $2,500 per patient, 21 patients, $52,000 total with generous rounding

            Ah. Touché. I suppose I just don’t bat much of a lash at a study having that much cost associated with it, so I didn’t think twice. Mea culpa.

            Interesting analysis, I’ve had a pet hypothesis for years that the biochemical processing of specific calories from raw ingredients into fat having different efficiencies could mean a high protein diet would lead to more thermogenesis, calorie for calorie, versus carbohydrates, in turn carbs being “better” than fat.

            Could be. And from an academic standpoint could be a useful distinction. We actually use RQ quotients in critical care medicine to determine the metabolic state of our patients (at least, they ask that on boards anyways). Point being that it could lend itself to finer tuning of critical care in people with highly aberrant physiology. Of course, in otherwise relatively healthy people (which in this case basically encompasses anyone who can walk around of their own accord) and those without extreme physiologic needs (like Micheal Phelps) those sorts of differences are likely swamped out by the rest of our physiology.

            I like my aging more slowly on a jet plane analogy here.

            Your point about clinical vs. statistical significance is well-taken. Particularly given patients saying “well, my diet means I burn more calories, so I can totally have an extra piece of cake for dinner”.

            Or even just an apple.

            I’m lazy, how did they measure REE and TEE?

            That was one of the strengths of the study, and a weakness, actually. From the supplemental data:

            REE:

            We measured REE by indirect calorimetry using a dilution canopy system (VMAX, Encore 29n, Viasys Healthcare, Inc., Yorba Linda, CA). The system was calibrated according to the manufacturer’s specifications. Room temperature was set at 21C (70F), and lighting and noise were minimized to limit variability in measurements. Oxygen consumption and carbon dioxide production were measured for 30 minutes, and REE (kcal/d) was calculated using the Weir equation9 with data averaged over the last 20 minutes

            The limitations are the time frame and the assumptions inherent to the Weir equation, which they adequately address in the discussion.

            TEE:

            TEE under free-living conditions was measured using the doubly labeled water (DLW) method. Following oral administration of the stable isotopes of hydrogen (2H) and oxygen-18 (18O) in the form of 2H218O, the 18O is eliminated from the body as both carbon dioxide and water, and the 2H is excreted exclusively as
            water. The difference between the urinary elimination rates of 18O and 2H provides a measure of carbon dioxide
            production (rCO2) which is used to estimate TEE… TEE was
            calculated from rCO2 using the equation of Ravussin et al,16 with the food quotient (FQ) as an estimate of respiratory
            quotient (RQ)

            They used FQ and RQ to sort of check each other, which is why I mentioned it as a potential confounder in my original comment. They did actual RQ measurements to determine if the basic macronutrient consumption was in line with the diet they were supposed to be on as a spot check. But for the actual calculation of the TEE and REE they used the FQ as the variable inserted. This is not wrong to do, I think, because the RQ can vary within expected parameters and was merely used to check and see if the study participants were sticking to the diet. Using a spot RQ could over or under estimate the value necessary for the equations and since the expected average RQ’s (had they done enough) should equal the FQ, if they assume the participant is sticking to the diet (reasonable) then the FQ is a better number to use.

  58. gary luzio says:

    Unless you walk the walk, it is hard to criticize Taube’s logic. His evidence is far stronger than that which supported a high carb low fat diet in the 50′s. The high carb diet is continuing to fatten people and cause heart attacks. I had metabolic syndrome and my blood chemistry was very bad on a high carb 2000 kcal per day diet. I lived with 26 percent body fat, Tri’s over 300 and low HDL. I had a heart attack which came within SECONDs of killing me. Calorie counting never worked for me and I was always hungry. Exercising would not reduce my body weight even though I burned 700 kcals per day on the tread mill. I switched to a low carb diet with no sugar, flour or starches. My blood chemistry is now in the best quartile with a very low apoB/apoA1 ratio, low trigs and high HDL. My ejection fraction went from 40 percent to 57 percent. In the stress test they had me RUNNING up an 18 percent incline before they got my heart rate to 141 with no chest pain. My cardiologist was amazed. I lost 30 pounds fat and gained 10 pounds of muscle in 6 months. I no longer take any heart meds. My blood pressure today is 110 over 65. Finally my diet is very easy to maintain. I have no hunger pains and I am completely satiated. In fact I have to remind myself to eat. Those people who say that Taube’s does not have every letter T crossed before we try his approach, miss the point. If I followed their advice I probably would be dead by now with my second heart attack caused by carbs and trying to count kcals. I recommend you try it and watch your blood chemistry. If it works for you stick with it. There is absolutely no doubt in my mind that the over consumption of carbs in this country is going to end up killing a lot of people. Eat fat (no trans) to satiety, eat protein and greatly reduce the carbs. No sugar, no starches, no wheat. I totally ignore how many kcals I ingest each day except I closely watch my carb intake. I eat less than 3 grams of sucrose a day. The only life it might save is yours. I walked the walk and I am alive and well at 63 years old with my body fat reduced to 15 percent today by just changing diet composition. .

    1. Harriet Hall says:

      Since you “totally ignore” the calorie count, you have no way of knowing whether you lost weight because Taubes is correct or whether you found reducing carbs was a more effective way for you to reduce calories than whatever you had been doing to “count calories” in the past.

      “There is absolutely no doubt in my mind that the over consumption of carbs in this country is going to end up killing a lot of people.” I agree. But there is doubt in my mind as to whether it is the overconsumption of carbs or the overconsumption of calories that matters most.

      1. Nathasha J says:

        I don’t think it’s overconsumption of carbs alone or overconsumption of calories alone. I think it’s a combination of both but mainly to do with overconsumption of carbs as even the consumption of water is calculated as calories. But does the consumption water really cause obesity?

        1. WilliamLawrenceUtridge says:

          I think it’s a combination of both but mainly to do with overconsumption of carbs as even the consumption of water is calculated as calories. But does the consumption water really cause obesity?

          It is? On what basis do you make this comment? You might be confusing the weight of a product versus the weight of the carbs in a product. But nobody counts water as calories.

    2. Andrey Pavlov says:

      Well, I’ve walked the walk Gary. I used to weigh 265lbs, had a body fat percentage of well over 40, had hypertension high enough that I needed medical treatment for 6 years (180′s/100′s), a waist of 42-44inches, and so on.

      I switched to a lower calorie diet, eating everything, including a fair number of carbs and exercise regularly. Depending on the rest of my life I have been fluctuating between around 180-195lbs for the past 7 years and a waist between 31-34 inches (I inevitably bump up when I am extremely busy and/or around the holidays). Last year I dropped that 15lbs in 2 months, once again eating a completely normal and varied diet including plenty of carbs (in fact I actually ate more carbs than normal during that time period) and exercising back at my usual levels.

      Just recently I dropped about 7lbs in a months and an inch off my waist doing absolutely nothing but decreasing my caloric intake. Once again, eating a varied diet with plenty of carbs, but mostly plants, with lean protein. Nothing specific, just less calories.

      That’s the thing with anecdotes. There’s always someone out there with a better one. That’s why we do science. And Taubes does not have the science to back him up.

      Now, to eat my breakfast burrito with a nice flour tortilla and beans and rice :-D

    3. Andrey Pavlov says:

      Oh, I can also add – for the fun of the anecdote – that I used to cycle centuries (that’s 100 miles in a go) with over 7,000 feet of vertical ascent, with my record being 5h34m. And then go run 8 minute miles after that. I also ran a half marathon at an average sub-7-minute mile pace. I no longer need blood pressure meds and am comfortable resting at around 130/75. My resting heart rate went from 80′s to low 50′s and sometimes 40′s (though now that I am deconditioned, it is mid 60′s).

      And I should add that I went from 265lb and never having been able to run a mile without stopping, never having been able to do a pull up, to 175lbs and all of that in less than 12 months, with the entirety of the weight loss in less than 6 months (March 25, 2007 until September, 2007, at which point I was cycling 60-80 miles at a time. I was cycling centuries in well under a year, and hit my record of 5h34m at right around the year mark). And I did it all while working full time as an ER trauma and ortho tech and taking coursework and doing research in molecular pharmacology.

      Seems to me you did great on your low carb diet, but based on my anecdote you could have done even more if you tossed in some carbs ;-)

      1. Sean Duggan says:

        … Man, now I’m really depressed about the shape I’m in. I’m just going to go drown out the pain with a twinkie binge…

        Honestly, I consider myself to not be in horrible shape. My BMI is in the healthy range. My blood pressure is good. My cholesterol is almost a little too low despite eating a relatively unhealthy diet. But I’m just not in the sort of shape you guys are in. I’m working at it, alternating C25k and the 100 Pushup program right now, but it’s small potatoes.

        1. Andrey Pavlov says:

          Haha… I wish I was still in that kind of shape, Sean. Then med school happened. Then the holidays. Then lots of travel. I’m currently back up at around 190ish lbs and can probably only cycle 40-50 miles if I really push myself. The nice thing about being relatively fit though is that you can rev back up again pretty quickly with just a couple weeks back at it. When I was in Costa Rica I was surfing in overhead waves for 4-6 hours a day, but I had to take breaks periodically. Back when I was cycling centuries in less than 6 hours I was working out (cross training with cycling, running, lifting, swimming, and surfing) for an average of 35 hours a week. Which is precisely why exercise is not the best means to actually lose weight. Who the heck has 35 hours a week to exercise??

    4. WilliamLawrenceUtridge says:

      Methinks you are confusing alleged metabolic magic with satiety. Carbs didn’t fill you up but fats did? Unsurprising, and implies you merely ate less.

  59. Rich says:

    Have you seen the lectures by Dr. Lustig, of U.C.L.A., on youtube? A good one on Youtube is “The Skinny on Obesity.”

    I personally lost 60 pounds following a low-sugar diet and including moderate exercise. It’s worth a view!

    1. Harriet Hall says:

      And my husband lost 60 pounds just eating sensibly and being more aware of total calorie intake and not exercising at all. Should I be more impressed by your experience than by my husband’s? We shouldn’t be going by anecdotes and videos, but by good scientific clinical evidence.

    2. Andrey Pavlov says:

      Funny that. Sugar = calories. Less sugar = less calories. You lost weight eating less calories? Color me shocked.

      Also, see my own anecdote above in response to Gary.

  60. John says:

    I tried to make some points in comments below but after a bit the reply function was turned off. Do you mind if I try again.

    I agree that low-carb lifestyle isn’t definitively supported by science to work for everyone.

    It definitely works for me, though, and, seems, many others. So I’m interested to see if there’s some fatal flaw – maybe I’m unknowingly killing myself.

    Most of the documented problems of low-carb seem to arise from excessive protein consumption (especially with Atkins).

    The References section of the 2013 Nature article (http://www.nature.com/ejcn/journal/v67/n8/full/ejcn2013116a.html) cites 109 papers, in medium or strong support.

    What I’d like is the counter-case to the Nature article. Best so far is one outdated (2007) Pubmed meta-analysis.

    In short, could anyone here direct me to some scientific research against low-carb.

    1. Andrey Pavlov says:

      @John:

      It isn’t that there is evidence against a low carb diet. If it works for you and you like it then go for it! I also lost a whole bunch of weight on a low carb diet. But I don’t adhere to it anymore (and I still have the weight off 7 years later).

      Just like any diet if taken to extremes it can have negative health consequences. The extremes of each diet will tend to lead to some differences in these negative consequences (veganism and macrocytic anemia vs low carb and kidney damage for example).

      But the real point is that the evidence shows us that the diet itself doesn’t really particularly matter. It is the calories in and calories out that are ~99% of the equation. And if you can get the calories in decreased on a specific diet and sustain that, then that is a great diet for you. It is just not something special about that specific diet beyond the fact that it is amenable to your tastes and facilitates your decrease in caloric intake.

    2. Windriven says:

      John,
      I pointed out elsewhere that the paper you linked contains nothing more than an explanation of ketosis embedded in a sea of speculation that the authors, for reasons I certainly don’t understand, label as “strong evidence.” The only area where there seems to be evidence that one could label “strong” is the management of type 2 diabetes and the reasons for that should be abundantly obvious.

      Moreover John, the study isn’t in Nature, and referring to it as the “Nature Study” is disingenuous. It is a study in the European Journal of Clinical Nutrition, a low impact journal (2.76), one of dozens of journals owned by Nature Publishing Group. The impact factore of Nature, to give you a frame of reference, is 38.6.

      There is a 2014 study in Nutrition that you should read. In it you will find a more balanced view that discusses both the benefits and the dangers of carbohydrate restricted diet.

      This is the last polite response you will get from me to comments that artfully work to mislead. I’ve made the generous assumption that you are out of your depth and not consciously working to create the illusion that there is powerful evidence suggesting ketogenic diet as the one true cure for all that ails you. If you do it again, everyone will know it is neither accident nor ignorance and the responses will be appropriate.

      1. John says:

        Apologies for the confusion about Nature, which I (lazily) took from the root of the link.

        I’m wasn’t working to mislead, certainly not artfully. I’m trying to get a balance. People for whom low-carb works well (like me) can easily overevangelize. Eg over-excited claims about curing cancer; it works for everyone; suchlike. These claims over-reach badly and bring the whole thing into disrepute, as evidenced by the tenor of comments here.

        What I’m looking for is countervailing scientific evidence. So thanks for your link to the 2014 Nutrition Study, greatly appreciated, exactly what I was trying to find. If anyone has any other links, similarly appreciated.

        1. KayMarie says:

          There is evidence low-carb works for the reasons any diet works. I’m not sure what you are looking for.

          If this is a diet that works for you and all your health indicator numbers are good, then I don’t think anyone is trying to convince you not to eat that way.

          Basically the data from most of the comparative effectiveness trials show any diet you can stick to (weight watchers, low carb, low fat, ethnic group’s diet, etc) will work better for you than a diet you hate or that doesn’t control the amount of food you put in your mouth. Something like 5% of people on any diet (including some of the really fad diets) will lose the weight and maintain the weight loss. Some percentage of people won’t lose weight at all (especially wild humans in their natural environment) and most people will lose some weight then gain some or all of it back.

          There is no magic diet or magic mechanism that will allow you to eat several thousand calories a day more than you burn off with exercise and basal metabolism and still lose weight. Generally every “eat all you want” diet has something about it that tends to make people eat less than they were before. Some of the “eat all you want” plans if you look at the meal plans in the books generally are 900-1200 calorie a day diets, which will cause anyone to lose weight the first few weeks they do that.

          I don’t think anyone is saying that different diets may have some slightly different metabolic ripples that are of small differences in basal metabolism, but the biggest factor from the studies is if that particular diet tends to make you put fewer calories in your mouth. For some people that is eating the same three meals every day without varying anything they eat. Generally if you eat the same thing day after day after day after day you will over time eat less of it, eventually. For some people writing down or photo-documenting each meal is enough to make them eat fewer calories.

          I get the enthusiasm, but what most people here, I think, object to is the torturing of science to make claims for any given diet. Just because you use a lot of science words doesn’t mean that much. Too many people making huge sums of money when they keep on saying things that make me quote The Princess Bride.

        2. WilliamLawrenceUtridge says:

          John, it worked for you, so far. If you can eat the way you are for the rest of your life and maintain a consistent weight, great. But most people who try to eat a ketogenic diet fail, and regain the weight. And most people miss carbohydrates so much, as they are a great source of gustatory pleasure in life, that they end up going off the ketogenic diet and dropping out of ketosis which may have miraculous benefits as stated in your article.

          Ketosis is much like the low-calorie for life extension diet, both have miraculous health benefits ascribed to them – and both are so incredibly difficult to follow that these benefits are essentially illusory. The vast majority of people simply can’t willingly maintain ketosis over the long-term.

    3. John says:

      Thanks all, we part as friends (sort of). Civilised discourse, a part of science.

      Our main difference is that I seem to give more credence to the papers cited in the EJCN article (more the papers than the article itself).

      If the editors get the chance it would be good to see a critical article on the EJCN papers. If they’re happy to take a shot at Gary Taubes, why not? It’s too big a thing to resolve in comments here.

      Btw I’m an actuary, and therefore have some passing interest in mortality and morbidity studies. These affect rate-setting and policy exclusions, so it’s good to get a handle on the practical science. (But my primary reason for visiting this science is personal.)

      1. Andrey Pavlov says:

        @John:

        Firstly, you never addressed my original comment to you when you first asked for “evidence against low carb diets.” You have to realize that in science the hardest part is not finding the answer, but asking the right question. In other words you are believing in the intrinsic and unique benefits of a low carb (specifically ketotic) diet and asking for evidence against that position.

        That is not the way science works. You are (in this case) the proponent of something and therefore the burden of evidence is on you to demonstrate it. You can’t just say the evidence is settled, low carb diets work, now try and disprove me. You can only say “here is the proof that low carb diets work…” and give us evidence.

        Our main difference is that I seem to give more credence to the papers cited in the EJCN article (more the papers than the article itself).

        Really? Have you actually read through all the papers and judged them for yourself? Because that would take me weeks of dedicated work to get through all of those and even begin to form a solid appreciation for all of them (and I am really fast at reading scientific literature, particularly in the field of medical science). It seems to me more that you like the conclusions drawn from the editorial piece you linked. Which, btw, is not concordant with your level of confidence in the matter.

        If the editors get the chance it would be good to see a critical article on the EJCN papers.

        Actually it is not. The article you linked in the EJCN is basically just a selected review of the literature on all topics related to ketosis and low carb diet. It is not a systematic review. I’ve written a selected review before. The idea of them is to give a general overview of the literature on a topic to sort of piece together what the author thinks the literature tends to point to. But it cannot ever be anything definitive to hang your hat on. It does not “prove” a point, nor does it establish any sort of scientific causality, nor can it synthesize new knowledge. Did you read the (small) section on ketosis for weight loss? There are some very key points in there you need to focus on:

        There is no doubt that there is strong supportive evidence that the use of ketogenic diets in weight-loss therapy is effective; however, there are contrasting theories regarding the mechanisms through which they work. Some researchers suggest that there are not in fact any metabolic advantages in low-carbohydrate diets and that weight loss results simply from reduced caloric intake, probably due to the increased satiety effect of protein.12 Others instead promote the hypothesis that there is indeed a distinct metabolic advantage, which has recently been explored in more detail, raising interest in the role of VLCKD in weight loss and effects on metabolism in general.13 The first law of thermodynamics, also known as the law of conservation of energy, has in effect controlled the concepts for the basis of weight loss for over a century—resulting in a difficulty in accepting other ways of thinking. Adhering to these traditional concepts the US Department of Agriculture has concluded that diets, which reduce calories, will result in effective weight loss independent of the macronutrient composition, which is considered less important, even irrelevant.14 In contrast with these views, the majority of ad-libitum studies demonstrate that subjects who follow a low-carbohydrate diet lose more weight during the first 3–6 months compared with those who follow balanced diets.15, 16, 17 One hypothesis is that the use of energy from proteins in VLCKD is an ‘expensive’ process for the body and so can lead to a ‘waste of calories’, and therefore increased weight loss compared with other ‘less-expensive’ diets.13, 18, 19 The average human body requires 60–65 g of glucose per day, and during the first phase of a diet very low in carbohydrates this is partially (16%) obtained from glycerol, with the major part derived via gluconeogenesis from proteins of either dietary or tissue origin.12 The energy cost of gluconeogenesis has been confirmed in several studies7 and it has been calculated at ~400–600 Kcal/day (due to both endogenous and food source proteins.18 Despite this, there is no direct experimental evidence to support this intriguing hypothesis; on the contrary, a recent study reported that there were no changes in resting energy expenditure after a VLCKD.20 A simpler, perhaps more likely, explanation for improved weight loss is a possible appetite-suppressant action of ketosis. The mechanism for this is not established but evidence supports direct action of KBs together with modifications in levels of hormones, which influence appetite, such as ghrelin and leptin.21 Here we can summarize (listed in order of importance and available evidence) that the weight-loss effect of VLCKD seems to be caused by several factors…

        So you see that they are not – and cannot – assert that there actually is a metabolic advantage of low carb over other diets. In fact they clearly state that they cannot do this despite the fact that the authors are obviously enamored with exploring the idea (nothing wrong with that – I think their take on it is a tad overzealous, but not at all out of line; but your read of it is even more overzealous than theirs). Note that they explicitly say that there is no evidence to directly support the idea of intrinsic metabolic benefit of low carb diets. They posit the hypothesis that there is hormonal signalling modification of satiety from high protein diets, which is not at all unreasonable to think, and in fact is something that we here (myself included) have argued as part of the mechanism of weight loss in low carb diets. But it all still boils down to calories in vs out, precisely as I said in my original comment to you. They even say quite clearly that this is the “perhaps more likely” explanation! It is also noteworthy that they clearly state that it is the majority of ad libitum studies which support the idea of intrinsic metabolic benefit of low carb diets. That is the fancy way of saying one-off less rigorously designed studies in lower impact journals. Basically, a euphemism for lesser quality evidence.

        So not only are you unfairly shifting the burden of proof, not only are you ” [giving] more credence to the papers cited in the EJCN article,” but I would be willing to bet you haven’t even actually read the papers cited in the article and are instead overblowing the EJCN article itself beyond what even the authors are trying to claim.

        You need to temper your enthusiasm, stick with what the science actually says, and realize that the EJCN article is pushing the limits of the interpretation of that data and that even that article does not support – or even claim! – as strong a position on the topic as you have.

        And then you need to look at broader data that looks at actual human trials of dieting and weight loss and see that while different diets will have some differences in initial weight loss, that over periods longer than a few months they all basically come out to be the same.

        So if you really wanted to you could claim that a very strict low carb ketotic diet will help you lose a few extra pounds a little faster so that if you are trying to look good for bathing suit season or a wedding or something that it may be the preferred diet for that specific goal. I would have a hard time arguing against that position partly because in those situations and extra couple of pounds in the first month or two has some clinical significance (so to speak) even though it won’t matter in the long run.

        But that is a far cry from what you are trying to claim.

      2. Windriven says:

        ” It’s too big a thing to resolve in comments here.”

        But it isn’t really John. Low carb diets work for some people though over long periods of time, perhaps not so much. They come with other costs, for instance risk to kidneys.

        “I seem to give more credence to the papers cited in the EJCN article”

        I can’t imagine why except that apparently you have had a good experience with a low carb diet and it has captured your imagination. Don’t let that cloud your analysis of the literature.

        1. KayMarie says:

          I can imagine why. He is a bog standard human being and we generally have brains built to believe the evidence that agrees with our belief system.

          To misquote Talking Barbie, “Objective analysis is hard.” It seems to take a lot of training and effort before one can learn how not to fool oneself into seeing what they want to see. Sometimes I equate the medical lit to the bible. If you have a belief you can find one verse in the bible, or a paper in the medical lit to back that up and be all the evidence you need that God/Science is on your side and you have found the one true thing in all the world.

          With both these the thing that seemed so amazingly obviously true in complete isolation may not be as obvious or amazing or will be seen as inaccurate and wrong when judged against the wide range of verses and papers out there.

          In the brief stint in cytogenetics there was data that explained why we were so obsessive about blinding the experiments. With the same set of slides humans reliably produce statistically significant data if they score them one time knowing they are control slides and a second time knowing they are slides from something treated with DNA damaging energy or substances.

          It is great John found something that worked for him. It is nice that there is some evidence in the lit that suggests that it does at some frequency work for others. Just be careful in generalizing the data from a few (as even n of 1 experiments generate data) to everyone, or feeling you need extraordinary mechanisms that can’t possibly apply to anything else in all the world. Most things are not that special that they have their own unique physics, chemistry or biology that is radically different from all other similar things.

          I think that is human, too. To want to make our something completely different from all the other things out there. We don’t stop being human when we start trying to be scientific about things, or even after doing that for a long time. Reminds me of a cartoon where two identically dressed hippies are looking at a pair of identically dressed businessmen and say how they are so glad they don’t have to dress like anyone else. I think we all want our pet viewpoints to be more special than anyone else’s, and really working through that to get to an objective view of the data can take far more work than our special unique selves think it is going to be. After all as soon as I believe I am objective in my analysis I then only see the evidence I am objective in my analysis and all the other data coming in saying subjective bias is at play becomes invisible to me unless I can be very rigorous in making sure I force myself to see it.

  61. John says:

    Another piece of interesting research floating around recently, just to add to the mix.

    http://www.news-medical.net/news/20131107/Diets-and-the-famine-reaction-an-interview-with-Associate-Professor-Amanda-Salis-University-of-Sydney.aspx

    Emerging evidence (provisional, sure) for a mechanism by which some diets/lifestyles might be more effective than others.

    1. KayMarie says:

      But again the big thing is the very low CALORIE part of her diet which requires medical supervision to be done safely.

      She isn’t saying calories don’t count. Manipulating what you do with calorie restriction (how much restriction, how long, managing how you go back to normal eating that doesn’t require doctor’s supervision, etc) certainly should have some effect on if people keep the weight off. And again, there is likely no one size fits all, everyone must do this one diet and this one diet only. After all part of why humans are an invasive species all over the planet in a wide variety of ecological conditions is our adaptability. If one and only one thing worked for all humans we’d be living in one spot on the planet where the one food in all the world we can eat grows.

      Usually losing the weight isn’t the problem, it is maintaining the weight loss, and many people cannot maintain restrictive diets in the longer term which is why on any diet the vast majority of people gain the weight back.

    2. WilliamLawrenceUtridge says:

      Emerging evidence (provisional, sure) for a mechanism by which some diets/lifestyles might be more effective than others.

      Sure, as long as you can resist the urge to eat dog food or avoid swallowing toothpaste that throws you out of ketosis.

      Ketogenic diets are hard to maintain. If you can stay on it, and avoid the temptation to eat the many delicious foods that are rich in carbohydrates (breads, pastas, pastries, fruit, carrots, plain ol’ sugar, chocolate, ice cream, barbeque sauce, peanut butter, jam, potatoes, juice, milk, cream, flan, cake, pudding, candy, corn, honey, cookies) for your entire life, great. But generally hunger is only one part of maintaining a restricted food-type diet. As long as the monotony of eating from the same flavour palette for the rest of your life doesn’t bother you, great, stick with it. But don’t proclaim it a cure-all if only everyone would try it. People have tried it, and they’ve had an incredibly difficult time sticking to it. And I don’t blame them – eating is one of life’s great pleasures, and I wouldn’t want to cut out “sweet” as a flavour for the rest of my life.

      1. n brownlee says:

        “I wouldn’t want to cut out “sweet” as a flavour for the rest of my life.”

        Yep. It’s a stone drag.

      2. Windriven says:

        Beer, William. You forgot to include beer.

        1. WilliamLawrenceUtridge says:

          No, because beer is gross and I’ve gone my entire life using it essentially only for bread.

          1. Windriven says:

            Coors Lite is gross. But then Coors Lite isn’t beer, though I’m not quite sure what it is. Beer, real beer, is as perfect as real bread. Less than a handful of ingredients and the skill of the brewer or baker. Nowhere to hide.

            All that aside, I’ve made bread using beer and have never been especially happy with the result. If you have a recipe you think highly of, how ’bout moving it my way?

            1. n brownlee says:

              Unless you disdain quickbreads:

              Self-rising flour

              Beer

              Mix together into a stiff batter; pour into loaf pans. Bake. Eat.

              I use a blue bowl half full of the flour; don’t know how much beer because I was drinking it, too. Usually Shiner bock. or Tree Frog.
              This is perfectly good campfire bread as is, but better of you mix grated parmesan, garlic (powder or pressed fresh), herbs rubbed or fresh to taste, a little bit of cayenne, a whole lot of excellent quality sweet paprika, chopped calamata olives, whatever. Some fat doesn’t hurt, either. Olive oil, usually, or grapeseed. Also fine if you use the batter to make drop biscuits and bake on the back of the grill when barbecueing.

              Doesn’t it sound ridiculous? It’s quite good, really.

              1. Windriven says:

                No salt?

                Amazingly simple. I use waaaay more stuff just in my pancakes. Flour, baking soda, baking powder, sugar, salt, egg, buttermilk, vanilla. I guess self-rising flour already has the leaveners in it. And the beer covers the sugar.

                I’m going to pick up some self-rising flour and try it. But I’ll probably add some salt ;-)

              2. n brownlee says:

                I think the self-rising has some salt in it… but feel free. It’s a pretty free-form recipe, after all.

                The same principle works for quick savory biscuits: Self-rising flour, stir in garlic, freeze-dried chives and parmesan or other grated cheese, mix in buttermilk to a sticky dropping consistency. Roll each drop biscuit in melted butter, bake, serve with some good homemade soup or stew.

                Calorie bombs, guaranteed to fill up a table full of teenagers. Temporarily.

              3. n brownlee says:

                PS again
                I think it’s about 3 or so cups of the S-R flour and a bottle of beer. A lot of people put a little sugar in it- a couple teaspoons. I don’t.

                Also, I usually bake in a cake pan- for a round loaf.

              4. Windriven says:

                “I think it’s about 3 or so cups of the S-R flour and a bottle of beer.”

                Whatevs. I’m comfortable with going by the terminal consistency. Like you, I’ll probably pass on the sugar, the beer should have enough. I’ll probably use a pale ale or maybe even a stout.

            2. WilliamLawrenceUtridge says:

              America’s Test Kitchen has a recipe for almost-no knead bread involving beer, but I don’t know if it would be considered “beer bread”. I use talls of Molson, and one tall lasts for three loaves, I have to re-package it into a bottle with a snap-top I can close again, because I’m not going to drink it. A caveat is that you’re not supposed to use much beyond a Molson-type beer, otherwise it tastes boozy and hoppy rather than bread-y.

              http://www.cooksillustrated.com/recipes/4028-almost-no-knead-bread

              Also, the ATK bookstore is having a sale on their CI annuals, only $10 each if you order three or more.

              There, now people can call me a shill.

              1. n brownlee says:

                You’re welcome to ‘em, William.

                “Peanut butter and jelly! This week we test America’s favorite!” “Whatever you use, do NOT use supermarket bread! We found that French baguettes were the ultimate bread for pB&J, but not the kind from the supermarket! We used baguettes baked from our own ultimate baguette recipe, available from our bread book- or you can simply order direct from France, of course.” “First, heat the jelly slowly over- not in!- water testing between 120 and 125 degrees, until it’s melted. It will take about a week. Stir in a sixteenth of a teaspoon of fresh grated citron, a half gram of scraped vanilla bean, and a single blade of mace. Remove from heat and refrigerate overnight, or up to three days… we’re not picky…”

                For Christ’s sake.

              2. WilliamLawrenceUtridge says:

                Ha! Nailed it :)

                But for a novice chef with a large budget and a digital thermometer, that’s solid gold, that thar is. That’s exactly how I would make my PB&J every single time.

                Chris Kimball once said “why you would you stray from the recipe? We’ve tested it, it’s like taking a 747 off of autopilot”. That’s a bit of an exagerration regarding cooking, but as someone who came into cooking with few skills, the autopilot has been extremely handy. I can now start improvising somewhat, but I still prefer the comforting straightjacket of their recipes.

                But admit it – ADMIT IT – every so often you try one of their tricks, or adapt one of their recipes, or secretly in your deepest, darkest heart you flip through the equipment reviews when looking for a new skillet. You have to admit, even begrudgingly, that they are a useful source of information about cooking.

                ADMIT IT!!!

              3. n brownlee says:

                No, I absolutely do not! BUT- I do see the television show occasionally, while I’m waiting for a better cooking show Ina Garten, et al) on the Saturday afternoon PBS lineup. The thing that, for me, put the ultimate kibosh on their recipes was a chicken pot pie recipe that they promised was the absolute best version EVAH! Okay, I thought. It took a half a day and an extra trip to the supermarket and tasted exactly like every other crappy, mediocre chicken pot pie I’d ever had, only more bland. They are the Minnesota Church Pot Luck Supper of cooking shows, and that “why should you stray from the recipe?” quote shows exactly why.

                I grew up amongst people who cook. In my Southern American Austrian/German/French Texas-Louisiana) family, if you want to eat, you cook – and we are adventurous eaters. We didn’t have recipes, except maybe for cakes. Then in the ‘sixties-’seventies, Jacques and Julia came along and I learned about homestyle French cooking. I got an old Joy of Cooking when I was about 20 and it introduced to me the great flexibility that learning cooking methods and basic chemistry can give you. I learned about all modes of food preservation from Putting Food By.

                As far as I’m concerned, recipes are just starting points.

              4. WilliamLawrenceUtridge says:

                As far as I’m concerned, recipes are just starting points.

                Here is where we part ways, because in the absence of a recipe, everything I make is inedible. Even my sandwiches are mish-mashes of ingredients that shouldn’t be combined, a fact I only realize when I bite into my sundried tomato, pesto, mustard, mayonaise, cheddar cheese and tuna fish with pickles and wasabi on a kaiser. In Paris I bit into a demibaguette with nothing but pate on it and it was a revelation.

                But following ATK, I get praise.

                Yeah, the hyperbole that leads into the recipes is a bit much, particularly given his primary-but-not-target audience (revealed in the recent NYT article where Kimball discussed how many middle-aged white men have come up to him and sweatily thanked him for allowing them to produce edible food). But when you lack three generations of teachers and a youth spent learning how to prepare okra, it’s nice to have somewhere to go.

                If you have a chance, you might want to take The Science of Good Cooking out of the library, since it distills down 50 principles. You might find it disappointing though! And Harold McGee’s On Food and Cooking is invaluable, even just to read for pleasure.

              5. WilliamLawrenceUtridge says:

                Also, I like their equipment reviews, and their taste tests will often reveal some general principles that can be handy for picking out ingredients if you don’t have their favourite in your local stores.

                And finally – if I could acquire your cooking skill by eating your brain, I totally would. Sorry.

              6. n brownlee says:

                Your cooking sounds like my husband’s. He just grabs every shaker can, bottle, and bunch of dried stuff in the pantry and lobs it into the stew. My boys can both cook, though, and pretty well. You know how offspring are- they figure if their parent can do it, how hard can it be? Seems to apply equally to cooking, novel writing, and cost accounting.

                For me, you can prepare okra by throwing it out into the backyard. I think it’s one of the things that people ate because they didn’t have anything better. Like collard greens. And lizards.

              7. Windriven says:

                “Then in the ‘sixties-’seventies, Jacques and Julia came along”

                Jacques Pepin changed my life with a series he called, as I remember it, “Everyday Cooking with Jacques Pepin.” I love Julia but it was from Pepin that I really learned technique and the art of disciplined improvisation.

                “But when you lack three generations of teachers and a youth spent learning how to prepare okra”

                Okra has all the appeal of horse snot. It is that snottiness that makes it work in gumbo. It can be made less disgusting by pickling it or deep frying it (but why?). And the plants themselves are about as ugly a thing as can sprout leaves. I love so much of Southern cooking but okra hasn’t been a keeper for me.

  62. simba says:

    Any particular type of beer needed?

    Flour, egg, and milk is the only pancake recipe I make. Sure, I’ve tried others (with blueberries, butter, sugar, buttermilk, chocolate chips, peanut swirls etc). But I know which one is my favourite. Flour (self-raising better but plain will do), milk, and egg mixed together and topped with lemon juice and sugar, fried in oil and butter preferably.

    1. n brownlee says:

      On the (now very infrequent) occasions of my pancake making, I use an old Joy of Cooking (first edition, flea market prize) recipe- the one that requires beating the egg whites separately then folding them into the batter. SO good. I used to make buckwheat cakes, too, and loved them with honey and butter. My carbs are quite restricted, now- thank you, John Bernstein, for an H1C of 6.2 in spite of being ten years into (Sandostatin caused) Type !! diabetes.

      Miss it, though.

    2. Windriven says:

      I’m with you on the lemon and sugar. But I don’t fry mine, I bake them on a griddle. And I do like the tang that buttermilk brings to the party.

    3. n brownlee says:

      This quick bread is good with any old beer that’s around the house, super easy- and rounds out simple one-dish suppers – especially in the cold months. I used to bake a lot of ‘real’ bread, too- that is, yeast breads, when I had kids around. I kept 2 bread machines busy. But the beer bread is fast.

    4. WilliamLawrenceUtridge says:

      Apparently lighter beers (mild-flavoured lagers) are recommended, including nonalcoholic lagers, and the alcohol itself boils off (though yeast fermentation does create its own alcohol). Stouts or more strongly flavoured beers make it taste more like the beer and less like bread. The whole point of the beer is to ehnance the flavour so you get something closer to what you would with a lengthy pre-ferment. So if you’ve got a couple days and don’t mind planning, just make a bigga or poolish instead.

      The main advantage of the recipe I linked to above is that you barely have to knead it, compared to pre-fermented bread which requires a lot of arm strength or a stand mixer. Though not all require a lot of kneading.

      I find it delightful that a discussion of Gary Taubes and low-carbohydrate diets has turned into a discussion of breadmaking. It suits my definition of irony.

      1. simba says:

        I am becoming a shill for a minute to recommend http://www.northsouthfood.com, particularly their Brixton banana bread. The blog’s a good mix of the weird (African land snails?) and the doable.

        I have never heard of baking pancakes on a griddle. Hmmm, must find a friend with a griddle. I love the lacy crispy edges they get when you fry with butter.

        1. Windriven says:

          “I have never heard of baking pancakes on a griddle. Hmmm, must find a friend with a griddle. ”

          Astonishing! I’d never heard of frying them though I can see how the textural juxtaposition would be nice: crunchy outside and tender inside.

          1. KayMarie says:

            Baked? So you put the dough on the griddle then put the whole griddle in the oven?

            Because I usually use my griddle on the stove top with the heat from one side (but only a thin layer of fat so they don’t stick when you flip them)

            I’ve never deep fat fried pancake dough, but I’m sure I could get some at the county fair, they’ll deep fat fry anything ’round ‘ere.

            1. Windriven says:

              No, baking doesn’t necessarily include an oven. Cooking on a heated surface without benefit of a little fat (sauteing) or a lot of fat (frying) is still considered baking. What you are doing, I think, is baking despite the film of oil that you use. I incorporate 1.5 Tbsp of melted butter in my batter but use no oil on the surface. Sometimes I use a cast iron comal, sometimes an electric griddle.

              I understand that early flatbreads were baked on heated flat rocks. A fire was built on top of the rock and fed for some period until the rock was … hot. Then flatbreads would be baked serially until the rock no longer held enough heat.

              I don’t think that Simba is talking about deep frying, probably more like sauteing but with perhaps a tad more oil.

              1. simba says:

                Yes,that’s it exactly. Butter and oil into a frying pan, just enough to coat the bottom when you roll and shake the saucepan from side to side. Cook until bubbles form and colour changes on the top, then flip.

                I suppose deep fried pancakes would be fritters. Or possibly a variant of churros?

                I had my first ever corn dog on the 4th of July this year. Why did no-one tell me that the uninspiring name actually came with delicious food? It was like a battered sausage but different spices and a different texture of the batter.

  63. John says:

    I couldn’t find anywhere on this website setting out how it is funded, nor whether there are any conflicts of interest by contributors. I’m sure that everyone’s spotless, but it’s surprising that more prominence isn’t given to this. Medicine, pharmaceuticals and nutrition are notoriously conflict-ridden, and claims to be science-based surely rest on clear confidence here. (PS Declaration: I have no conflict of interest.)

    1. KayMarie says:

      The Pharma-Shill gambit, really? That old tired trope? I hope you don’t think you are being original with that.

      Why do people always assume the one and only reason that anyone could possibly disagree with them is that they are being paid by someone to be disagreeable. I really don’t think my opinions are so magnificent that no one in all the world could possibly just have a different viewpoint unless a conspiracy is going on.

    2. Windriven says:

      “whether there are any conflicts of interest by contributors”

      Caught in the act! Everyone is clean except Crislip. Someone had to discover the truth sooner or later. Dr. Crislip once accepted a Fleet’s Enema kit from a pharmaceutical salesman. It is true. He’ll admit to it if you shine one of those bright lights in his face. Or if you don’t.

      ” (PS Declaration: I have no conflict of interest.)”

      Thanks for that. Now I’ll be able to sleep at night.

    3. weing says:

      “(PS Declaration: I have no conflict of interest.)”

      Good enough for me.

    4. WilliamLawrenceUtridge says:

      Dear John,

      Go fuck yourself and your “just asking questions” insult to the science, discussions and thought process that go into each post and comment. I particularly love your inclusion of certainty regarding spotlessness, an apparent nod to reasonableness and pretend recognition of fairness in an effort to give your credibility-attacking comment more emotional appeal. Please note that your own declaration of a lack of conflict of interest is a bullshit waste of time since we have no way of verifying it. I will take one further moment to insult your inability to form a cogent argument and defaulting instead to an ad hominem effort to smear the contributors, thusly:

      By failing to provide a cogent argument, or even an interesting or amusing one, and instead substituting an insulting ad hominem, you are a douchebag.

      The website is currently funded by the ads you see just below the post itself, as well as the money and time of the individual contributors.

      Your claims lack any merit because you failed to identify any specific flaw in the post’s sources or analysis and instead lazily dropped in a generalized comment as if it were somehow relevant to this post and website specifically. Discussion of the blog in general can be found here, and discussion of Dr. Hall specifically can be found here. In case you are too lazy to actually read the pages linked, Dr. Hall is a retired family physician and flight surgeon, whose retirement is doubtless substantially funded through a military pension.

      Sincerely,

      Go fuck yourself

  64. John says:

    So what’s the answer? Who’s funding?

    1. Windriven says:

      Donations and advertisements. The editors and contributors are volunteers. Think Wikipedia. Go to the title screen of any post and move your eyes to the right and you will see a big GOLD button helpfully titled ‘donate’. Move now to the end of the post, the area before comments begin, and you may find a group of ads that have nothing to do with anything but that some weasel is willing to pay to have placed.

    2. WilliamLawrenceUtridge says:

      The answer is in the comment where I told you to go fuck yourself. Go read the whole thing.

      1. Sawyer says:

        To John’s credit there isn’t anything in the “About SBM” link about where funding comes from. Granted it takes about 30 seconds of detective work to find out the answer, but for the sake of clarity maybe Dr. Gorski/Dr. Novella/Paul can throw in a sentence describing funding sources.

        Might reduce the Pharma Shill accusations from twice a day to once a day? :)

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