Jan 18 2011
Why We Get Fat
Journalist Gary Taubes created a stir in 2007 with his impressive but daunting 640-page tome Good Calories, Bad Calories. Now he has written a shorter, more accessible book Why We Get Fat: And What to Do About It to take his message to a wider audience. His basic thesis is that:
- The calories-in/calories-out model is wrong.
- Carbohydrates are the cause of obesity and are also important causes of heart disease, type 2 diabetes, cancer, Alzheimer’s, and most of the so-called diseases of civilization.
- A low-fat diet is not healthy.
- A low-carb diet is essential both for weight loss and for health.
- Dieters can satisfy their hunger pangs and eat as much as they want and still lose weight as long as they restrict carbohydrates.
He supports his thesis with data from the scientific literature and with persuasive theoretical arguments about insulin, blood sugar levels, glycemic index, insulin resistance, fat storage, inflammation, the metabolic syndrome, and other details of metabolism. Many readers will come away convinced that all we need to do to eliminate obesity, heart disease and many other diseases is to get people to limit carbohydrates in their diet. I’m not convinced, because I can see some flaws in his reasoning.
He says that
[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.
This is simply not true. The laws of physics are unavoidable. His demonization of the calories-in/calories-out principle strikes me as a bit of a straw man argument. He says exercising and reducing total calorie intake don’t work; moreover, he says they can’t work. Most of us would argue that they can and do; the problem is not with the principle, but with its implementation. Simple physics requires that to lose weight, we must burn more calories than we ingest: that is indisputable. The devil is in the details. It takes a lot of exercise to burn off a few calories, so exercise is not a practical solution; and it has proved very difficult in practice to get people to reduce their calorie intake significantly over long periods of time. Weight loss is simple, but it is not easy; and those of us who rely on the calories- in/calories-out principle have never suggested that it was. We don’t just berate obese people for lack of will power. We try to understand why most people find it so difficult to lose weight. Perhaps the more intriguing question is why some people maintain a low weight throughout a long lifetime of varying food intake, including people who eat a lot of carbohydrates.
There are social and cultural influences and practical considerations; but the basic problem is that because of their genetic makeup, some people’s bodies are more efficient at storing calories. In a famine situation, they would be the survivors; in a world where abundant food is available, they are the obese. Taubes is correct when he says, “Those who get fat do so because of the way their fat is regulated.” But they still couldn’t get fat without eating too many calories for their particular metabolism, and if a way can be found to decrease their calorie intake to a level appropriate for their metabolism, they will lose weight.
Diets are just tricks to get people to reduce total calorie intake, and low-carb diets are no exception. A 2003 systematic review in JAMA showed that weight loss on low-carb diets was principally associated with decreased caloric intake and increased diet duration but not with reduced carbohydrate content.
Taubes says “In a world without carbohydrate-rich diets, obesity would be a rare condition.” That’s undoubtedly true. But is it the carbs or the calories? The two are confusingly intertwined. Carbohydrate-rich diets are high calorie diets. Cutting calories usually involves cutting carbohydrates, and cutting carbs usually results in cutting calories. On any weight loss diet, dieters avoid “empty calories” and try to pick foods that will satisfy their hunger better and for longer.
The diet he recommends allows unlimited amounts of meat, fish, poultry, green vegetables and eggs; limited amounts of cheese, cream, mayonnaise, olives, avocado, lemon, soy sauce and pickles; and no carbohydrates except for a few nutritionally dense, fiber-rich vegetables. A sample menu:
- Breakfast: bacon and eggs
- Lunch: grilled chicken and green salad
- Snack: pepperoni slices and a cheese stick
- Burger or steak, green salad, green vegetables
He advises that we protect ourselves from salt deficiency by drinking 2 cups of bouillon every day, which would not sit well with those who advise limiting salt intake to prevent high blood pressure. He recommends limiting coffee, but this doesn’t appear to be based on good evidence; in fact, a recent study showed that coffee improves insulin sensitivity, which is one of the aims of the low-carb diet.
He 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 it is a real challenge to overcome carbohydrate cravings, which amount to an addiction. He admits that high protein diets can be toxic. He also admits that people who restrict carbohydrates tend to eat less, and he says their energy expenditure increases. Wait! This sounds like support for very calories-in/out principle that he rejects.
He has an “out” to excuse failures: some people will only lose weight on a zero carbohydrate diet and “even this may not be sufficient to eliminate all our accumulated fat, or even most of it.”
Taubes says the high fat/cardiovascular disease hypothesis led the American public to replace fat calories with carbohydrate calories, thus causing the obesity epidemic. It seems to me that when we reduce carbohydrate intake, we need to make sure the carbohydrate calories are not being replaced by a worse option. Low carb diets cause ketosis; ketogenic diets have been used to treat epilepsy in children, but they can cause harmful side effects and they raise cholesterol levels by 30%. Meats, especially processed meats, have been associated with an increased risk of heart disease and cancer. In The China Study T. Colin Campbell argues that all animal products should be eliminated from our diet because it is animal products (not carbohydrates) that cause heart disease, cancer, and a host of other diseases. If he and Taubes staged a formal debate or both served on a committee to develop diet recommendations, there might be some spectacular fireworks. In the Middle Ages, disputes were sometimes settled by appointing two champions to duke it out. Interesting idea …. No, better stick to science to settle these differences of opinion, even though it may take a long time for a consensus to be reached and there will always be dissenters.
Taubes thinks that low-carb diets reduce cardiovascular risk and that low-fat diets don’t. He says a 2001 Cochrane review concluded that there is still only limited and inconclusive evidence of the effects of modifying total, saturated, monounsaturated, or polyunsaturated fats on cardiovascular morbidity and mortality. This is selective quoting. The conclusion stated in the abstract of that review was:
The findings are suggestive of a small but potentially important reduction in cardiovascular risk in trials longer than two years. Lifestyle advice to all those at high risk of cardiovascular disease (especially where statins are unavailable or rationed), and to lower risk population groups, should continue to include permanent reduction of dietary saturated fat and partial replacement by unsaturates.
He admits that studies show that low-carb diets tend to raise the level of “bad” LDL cholesterol, but he thinks that this is more than compensated for by rises in “good” HDL cholesterol and by lower levels of triglycerides. Published evidence suggests that he may be wrong. In a 2010 study, adherence to a Mediterranean-like dietary pattern reduced mortality but a carbohydrate-restricted diet appeared to increase mortality in elderly Swedish men. Another 2010 study showed that low-carb diets based on animal sources were associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.
What about weight loss itself? If Taubes’ thesis is correct, we would expect studies to consistently show a strong superiority of low-carb diets for weight loss. This 2010 study showed no difference in weight loss between low fat and low carb diets over a 2 year period, although low-carb dieters had more favorable changes in lipids. A 2009 study in NEJM compared weight loss from diets with different compositions of fat, protein and carbohydrates and found that low-carb diets were not superior, and that clinically meaningful weight loss results from weight loss diets “regardless of which macronutrients they emphasize.” An accompanying editorial suggests that behavioral factors are more important to weight loss than the type of diet, and that a total environmental approach is needed.
Taubes says right off the bat that “these competing ideas should be tested” and admits that such testing has not been done; but since obesity is such a serious problem, he says it is urgent that we institute his diet recommendations now, without waiting for the evidence. Yet he criticizes the low-fat diet campaign for doing just that: we went beyond the evidence and instituted society-wide changes based on inadequate data, with what Taubes considers to be disastrous results. How can he be so certain we should go beyond the evidence this time?
Has Taubes destroyed the old low-fat myth only to create his own new low-carb myth? Rather than jumping on the low-carb bandwagon before his ideas are properly tested, the precautionary principle suggests that it might be more reasonable to follow a moderate diet like the Mediterranean diet (or to follow Michael Pollan‘s stunningly simple advice to “Eat food. Not too much. Mostly plants.”), to limit “empty calories” from simple carbohydrates like sugar, to eat a variety of vegetables and fruits, to choose low calorie density foods that are more filling, to limit meat intake, to limit salt, and to keep looking for behavioral and environmental ways to change our calories-in/calories-out balance.
147 Responses to “Why We Get Fat”
All the way through this piece I’ve been itching to write a comment that would say essentially what’s written in the last paragraph.
Anecdotal evidence – I’ve tried the “low fat, low carb” diet consisting of mostly plants, very little animal protein (fish once a week) and very little calorie-dense carbs (piece of Pumpernickel once a day). I was very satisfied with the results – in six months I dropped from 200 to 160 pounds and kept the calory intake in the 1000-1200 range (I’m rather sedentary). The return into the 200 regions took me two years of pretty much unrestrained eating.
Now I’m trying to stay indefinitely on this diet with more (lean) meat but not more carbs. I think it’s doable.
Is it just me or does his diet plan (as so often with “carbophobes”) basically consist of normal meals without side dishes?
I am pretty sure that would work because it basically amounts to simply reducing calorie intake.
So many nutrition gurus use the example of low fat advice being correlated with the obesity epidemic, without asking how well the advice was followed (as well as whether it resulted in a lower energy intake).
While I think that lowER carb diets will become more important as we become even less active and insulin resistance/diabetes rises – Taubes like so many others simply cherry picks (pun intended) data to support his view instead of basing his opinion on the evidence.
It is interesting that he is vocal about how ineffective exercise is for weight loss while acknowledging how prevalent insulin resistance is becoming. So many people think of exercise only in terms of calories burned and not its direct, but acute effects on insulin sensitivity (including authors on this site). As insulin resistance becomes more prevalent, exercise (especially resistance training) becomes more important (not to mention its anti-depressive effects, another potential benefit towards weight loss!!)
Anecdotal I know. Changed jobs 4 years ago to a more active career and lost 15 pounds by moving all day. Exercise just laughed at the pounds. Calories in calories out worked for me.
I also recommend Dr. Yoni Freedhoff’s review:
http://www.weightymatters.ca/2011/01/book-review-gary-taubes-why-we-get-fat.html
Nice article. Thankyou.
Low carb diets may be a method of reducing calorie intake for some people because of the hassle or shock or I-m-getting-tired-of-eating-this effects. Randomly forbidding almost any set of items might work similarly.
I’m sticking with something like your last sentence.
I’m often struck by how little many people know about how many calories various foods have, despite many having labels, and I find US meat consumption astonishing. Tax it.
David: I have seen people on low fat diets over-consume carbohydrates. I don’t know how much of it is the SnackWell effect and how much of it is really related to the idea that fat makes you full. In the end, it does amount to calories in, calories out, but I think the correlation is real. I can certainly eat a lot more calories in the form of cookies or bread or pasta than I could in steak.
I know people who love low-carb. I can’t deal with it, or any diet that demands that I omit any category of food entirely. Sometimes it feels like all the diet experts fail to think about how their plans will work in the real world, where people have taste preferences and individual needs. Lean meats, whole grains, and lots of vegetables sounds like a great diet. In theory. But it’s very boring to eat (and no number of diabetic recipe books with cheerleader descriptions will conceal that), and the idea of “treats” or “indulgences” isn’t much of an improvement. I don’t want to be cheating because I have a potato and put a pat of butter on it.
Dr. Hall,
Did you read this new book?
You mention the “laws of thermodynamics” argument as though this were not addressed in detail. His point is that, while obviously caloric deficit is a prerequisite for weight loss, there are several different ways for a person to find themselves in a state of caloric imbalance. Because calorie expenditure (and, specifically, calorie expenditure from fat) is subject to several variables, that means that increasing physical activity and decreasing food intake are not the sole means of bringing about weight loss. Obviously, this is one such method, but it has limitations and drawbacks. The dogmatic insistence upon “eat less, exercise more” in all situations, and the subsequent yo-yoing that can result, might be misguided if there is an easier route for some people.
The other important thing I think you may have glossed over is that what gets called a “low-carb” diet in the literature is frequently still rather high in carbs; it is merely reduced in total carbs from the standard American diet. For example, in the 2009 NEJM study, the “low-carb” diet still represents 35% of calories from carbohydrates, which is more than three times the amount in ketogenic diets. There is not a simple linear correlation between carb intake and weight gain or its related problems — that is, if a person starts out eating 500g per day, and reduces it to 200g per day, the same underlying metabolic problems may still be going on. It may take a ketogenic diet before changes happen.
It is also non-trivial that low-carb diets help reduce appetite. Considering how hard it is to get people to adhere to calorie-restricted diets in the long term, I would expect doctors to look for an edge wherever possible.
Overall, why shouldn’t low-carb diets be included as one of many tools in a doctor’s arsenal of recommendations for overweight patients?
Regarding the “China Study”, how could eating meat be the cause of heart disease???Isn’t that our base state rather than eating grain? Eskimos don’t have heart disease.
Seems disingenuous to present “The China Study” as some equally worthy counterbalance to the work of Taubes.
Taubes did an exceedingly thorough job of exposing the “science” behind dietary recommendations. I don’t know if he has all the answers but I’m not sure cherry-picking a couple studies is much of a refutation of his thesis.
I think one of the obstacles to weight loss is the presence of dramatic claims (some true, some barely true, some false) about magically-bad food. All of that stuff can make a person focus on the less important (or even completely false) aspects of diet, and forget about the fact that they are eating too damned much.
A recent and clear example is when I read some health-related blog which suggested a home-made alternative to Egg McMuffins as a way to lose weight (something like “keeping your resolution to tighten the belt”). I actually checked the nutrition data for the ingredients they suggested, and the sandwich they had constructed was almost identical to a real Egg McMuffin–not just in total calories, but also very similar in the portions of fat, salt, etc. (either option was actually an OK breakfast if combined with OJ and nothing else, the problem is when you eat 3 of them instead of 1)
I posted a comment noting this, as well as all of the sources for my math, and they dismissed this by noting that McDonald’s uses whatever preservatives in their ham, and they think “ingredients” are more important than nutrition data.
Not everyone suffers from the delusion, but a lot of people do. People will declare that they don’t eat “unhealthy” fast food, and then consume the same, or even more, total calories minus the branded box.
very thorough review Ms. Hall.
Having read Gary’s GCBC, followed his lectures and writings on the subject and followed the ensuing debates in the blog-sphere it caused I can say this much:
if you sift through the abstracts of some of the studies cited in your piece you find that “low carb” is a catch all phrase which has been associated with very low carb diets and high carb diets alike depending on what they are being compared to.
there is no shortage of studies comparing “low carb” to “Mediterranean” diets when in fact neither mean any one thing, low carb could be <80 g per day or as low as <20 per day. a huge difference, and the same can be said for "Mediterranean" diets which in reality are diverse and bear no resemblance to the north American conception of how "Mediterranean" people eat. (speaking of which, southern france, southern italy, lebanon, algeria, tunisia, greece, croatia, albania, malta, and turkey all rest in the mediterranian, their cultures and foods are incredibly diverse, delicious and by no means matching the low fat/low carb ideals of diet guru's)
"Mediterranean" diets as a monolith are fantasy, peddled by hucksters trying to sell books. (i say this as i sit down to a lovely southern Italian breakfast typical of the region: 2 large almond biscotti, 1 potato fritter covered in icing sugar, 1 large coffee with milk -2 sugars)
there is a reasonable consensus among low carb folks out there that "low carb" is fairly less than about <50g per day, and that ideally for those trying to loose weight to attempt less than 20g per day (or VLC as its known).
among the Paleo movement which is growing the focus is less about reducing carbs and more about the type of fats, carbs and protein one is ingesting. this has led to considerable appreciation for diet composition as opposed to diet obliteration (good carbs in limited quantities vs. no carb militancy)
the principal difficulty in many studies is that the periods are short, or the "low carb" designation is not low enough. in addition the fats included can have considerable effect, ask anyone who eats principally vegetable oils and margarine as their fats on a low carb diet vs. one rich in saturated animal fats.
the suggestions of unlimited fats and meats and limited carbs made by taubes and others has been hijacked and misapplied in the same way people suggest that vegetarian diets are in effective because you can eat unlimited amounts of fries and smoke unlimited amounts of cigarettes.
comparing low fat vs. low carb is insufficient and inaccurate. comparison between say <20 grams of carbs per day, high saturated fat diet vs. low fat may yeild greater results.
ultimately Tabues work along with a growing list of other researchers is confirming other long held wisdom of our elders: too many sweets arent good for us. prior to WW2 the principal cooking fat of most people was a lard or butter. something changed over the past few decades where it was deemed these fats were bad and that new vegetable oils or olive oils were better. for people who want to harken back to a bygone era of simple folk wisdom or who quote Mr. Pollan's "eat what your grandmother recognized, no too much , mostly plants" must appreciate that part and parcel of our grandparents diets was not just ample whole foods but ample animal fats.
people seem to enjoy picking and choosing when approaching diets with a nostalgic confidence, just as was done with the once popular "Okinawan" diets they took what appeared to be a populace blessed with longevity, examined their diet, and removed the heavy pork content to proclaim it was a great diet to mimic if one wanted good health.
Between the raw food vegan folks and the low carb, high protein unrestricted fats folks, I’m beginning to wonder if anyone considers that not all people have digestive tracts of iron.
To many raw veggies and fruits through out the day gives me stomach pains. To much fatty meats or other oil rich foods makes me nauseous and my side hurt.
A good amount of fruits and veggies, (cooked on the harder stuff, like brocolli and asparagus, uncooked for salads, etc), some protein in the forms of nuts, beans, mostly lean meats, eggs and some fiber rich breads, pastas, etc seem to keep my digestive track happy. In my book, portion control and limiting empty calories to a small treat should be the way to go for weight regulation.
Of course staying committed to the portion control is my issue, but at least it doesn’t result in stomach pain or nausea.
I pretty much agree with ConspicuousCarl. In addition, I would say the Taubes, along with most low-carb enthusiasts, does not realize the importance of avoiding excessive omega-6 intake. It’s hard to do in a food culture that incorporates omega-6 seed oils into so much of its food and feeds huge amounts of omega-6 rich seeds to it’s livestock. Suggest readers Google “Susan Allport omega-6″ to learn what increased omega-6 intake does to a person who normally and prudently limits her intake of omega-6.
Dr. Hall, have you familiarized yourself with the body of research on omega-6 lenoleic acid? If not, I urge you to Google “1 of 4 Bill Lands” and “omega-3 omega-6 imbalance.”
No fruit? Really? How can any diet recommend cutting out fruit particularly given our inability to produce vitamin C, suggesting a high-fruit diet being part of our evolution. I’d love to see someone try to put on weight by increasing their fruit intake. Plus, good fruit is really, really tasty and has a low glycemic index. I don’t understand diets that cut out fruit (but getting good fruit is something else entirely).
Also, part of the reason why a high-protein diet is effective must be the energy expended to convert macronutrients into body fat – extremely efficient for fat (something like 97 calories stored out of a hundred), less so for carbs (I think it’s around 90 per 100) and least so for protein due to the biochemical cartwheels that have to be undertaken (I think it’s around 67 stored per 100 consumed). And in addition to that, protein is soaked up by the body to produce proteins, muscle fiber and nearly everything else that makes up our body.
And my final outraged comment is regarding exercise and weight loss. If nothing else, exercise alters where that fat is stored – moving it form the skin and viscera into the muscle where it is no longer a danger to health. But on top of that, it is effective at weight loss if you keep it up at a sufficient intensity. If my treadmill is right, I burn 2-3000 calories a week, which works out to a pound of fat; either 52 pounds per year I’m not putting on, or actively losing. If nothing else, exercise means you can eat foods that are bad for you without experiencing a slow (or fast) climb in body fat. And that’s completely discounting the beneficial effects of exercise independent of weight loss. “Don’t bother exercising” is incredibly bad advice and any weight loss consultant that doesn’t touch on the health benefits of exercise is doing something borderline unethical. Yes, exercise can be hard, but it also improves blood flow, increases the size and strength of the heart, improves bone density, maintains muscle strength and a host of other benefits. I get so annoyed when people discount exercise – not only for weight loss but for overall health.
First of all, I have to echo William Lawrence Utridge’s comments about exercise. Whether or not exercise can produce weight loss, its value to health is great enough that it should be strongly recommended anyway.
Second, this is probably just my ignorance talking, but I’ve just done some quick browsing through the Medline articles on the ketogenic diet, and seen some tantalizing hints of neuroprotective effects (in rodents, using measures like amyloid, apoE and caspase-3 expression, and brain oxidative stress responses). I know, I know… this doesn’t necessarily translate into actual clinical impact, but it’s enough to tempt someone into trying it, just for that reason.
On the other hand, what are the long-term risks of ketosis?
Taubes defense of low carb diets amount to special pleading. There is a range of how low is low carb in the various studies – but the studies do not show that any level of low carb diet has any benefit to weight loss beyond the reduction in calories.
Also, the decrease in hunger from low-carb appears to be a temporary effect, not long term.
And, people generally find very low carb diets unsustainable.
Bottom line remains – there is no evidence to support any weight control or overall health advantage to low-carb diets of any level.
Further, the focus on good vs bad food rather than lifestyle and behavior patterns appears to be a counterproductive distraction – so there is potential harm in taking Taubes advice.
Taubes argues that the low-fat diet craze led to the obesity epidemic, but he is rewriting history. The low-carb diet craze goes back to the 1970s with Atkins, had a resurgence in the 80s with the Zone diet, and Atkins became popular again in the 90s. Low carb diets have been there alongside low fat diets for the last three decades.
One could argue that it’s the diet craze (any diet) that is the problem. The problem is diets – when the focus should be on simple and sustainable behaviors.
There could be many reasons why the “calories-in-calories-out” model doesn’t work, and they need not violate the laws of physics. It’s a bit troubling that some find it so easy to toss out theories that happen to conflict with theirs because it’s convenient. The laws of physics have considerably more evidence than what we are talking about here.
But consider the poorly understood influence of gut bacteria. Perhaps a low-fat high carb diet causes them to extract more calories from the food you do eat, while a lower-carb diet causes them to reduce the number of calories extractable from the food you eat. It’s perfectly possible to have such mechanisms (or others) that that don’t have violate physics. There could also be indirect or psychological reasons (for instance, if it combats metabolic syndrome and diabetes, perhaps dieters just feel better and naturally engage in more activity than is involved in lying on the couch).
More research is definitely required, if for nothing else than to figure out why lower-carb diets are successful in doing what they do do. But, researchers really do need to get away from pretending there is any such thing as a magic bullet.
Oh goodness! I go to this blog to find elegantly formulated arguments on subjects that I’m nowhere near qualified enough to even comment on, and I always learn something.
I then I turn up today to find a post on a subject that I do know a thing or two about but I have to say I am more than disappointed!
I read Taubes book Good Calories Bad Calories back when it came out and was blown away by the level of detail. It began my own journey into researching nutrition. Although Taubes’ takedown of the hypothesis that saturated fat causes heart disease remains unparalleled in its rigour and detail, the idea that a macronutrient that we have been consuming for millions of years could all of a sudden be responsible for the obesity epidemic of the past 30 years just seemed to be implausible.
There are so many well-reasoned rebuttals to Taubes arguments that I am shocked that the author of this review has resorted to such shoddy reasoning:
“Meats, especially processed meats, have been associated with an increased risk of heart disease and cancer. ”
Processed meats indeed DO show an association with cancer and heart disease. When it comes to fresh meat the data is ALL over the place and definitely doesn’t support the notion that meat causes any ill health whatsoever. This throwaway line doesn’t inspire confidence that this subject was thoroughly researched. Not even mentioning the schoolboy error of confusing correlation with causation.
Also, the China Study? That was completely debunked by a college student with an interest in diet and statistics:
http://rawfoodsos.com/2010/08/03/the-china-study-a-formal-analysis-and-response/
Turns out that when you control for confounding factors such as infections known to cause cancer the association completely disappears. Dr. Campbell has dismissed Ms. Minger’s argument on an ad hominem basis, referring to her ‘lack of credentials’ but has to date failed to address any of her valid criticisms.
” Another 2010 study showed that low-carb diets based on animal sources were associated with higher all-cause mortality in both men and women, whereas a vegetable-based low-carbohydrate diet was associated with lower all-cause and cardiovascular disease mortality rates.”
This is embarrassing. Did you read the paper? Some of the participants in the low carb group were eating 60% of their calories from CHO! In fact the lowest CHO content was 37%, not ‘low’ carb by any accepted definition.
The supposed ‘low carb’ group also smoked more and had higher BMI’s, indicating that they were less health-conscious in general. Confoundersville. Also the group with the lowest risk (supposedly the ‘vegetable’ group) ate the same amount of red meat and almost the same amount of animal foods as the group with the highest risk!
” Published evidence suggests that he may be wrong. In a 2010 study, adherence to a Mediterranean-like dietary pattern reduced mortality but a carbohydrate-restricted diet appeared to increase mortality in elderly Swedish men”
Once again, correlation does not equal causation, and epidemiology is often a victim of self-fulfilling prophesies. The public health advice is to eat a low-fat high-carbohydrate diet, therefore why is it surprising that people who ignore this advice are often less health-conscious in general.
The only way to completely control these factors is a controlled trial:
http://www.nejm.org/doi/full/10.1056/NEJMoa0708681
More weight loss, better improvement in lipids compared to Mediterranean style.
“..it might be more reasonable to follow a moderate diet like the Mediterranean diet (or to follow Michael Pollan‘s stunningly simple advice to “Eat food. Not too much. Mostly plants.”)”
Why? Where is the long term evidence that this works? ‘moderate’ is a subjective and useless term, I’m sure the traditional Inuit diet of <10% carbohydrate is as moderate as a Japanese person's diet of 70% high glycemic white rice is to them. Both have low rates of heart disease and cancer compared to the West.
Also, no one in the mediterranean eats a 'Mediterranean diet', everywhere you go red meat is consumed liberally. From Iberia to Greece to Morocco. Their health has nothing to do with red meat consumption or lack thereof.
"to limit “empty calories” from simple carbohydrates like sugar"
Agreed!
" to eat a variety of vegetables and fruits"
Again, some controlled, rather than epidemiological trials showing the benefits of this would be nice, not saying it is incorrect, just that there isn't high quality evidence to make this assertion and in that instance, you're doing exactly what you critisise Taubes of trying to do, making recommendations without the proper evidence.
"to choose low calorie density foods that are more filling, to limit meat intake, to limit salt,"
Oi Vey! You can't fool the body into thinking that it has consumed more calories than it has. Again with the unfounded meat-bashing and on the salt front, show me a controlled trial that reduced salt and nothing else and lead to anything but a small reduction in blood pressure? I'll save you a google, that trial doesn't exist.
I was really looking forward to a proper skeptical look at Taubes' hypothesis, there really are massive gaps in his logic (for example protein stimulates insulin as much as carbs or the fact that many Asian countries exist on 80% carbohydrate diets and are leaner than americans who eat less total carbs) but all I can see to counteract the poor scientific reasoning is more poor scientific reasoning.
If you take Good Calories, Bad Calories as gospel truth, you can only come to the conclusion that eating fruit is bad for you, because it contains fructose. And so are non-green vegetables.
However, Taubes’ 2002 article in the NY Times, which kicked off the latest low-carb trend, was useful in getting lots of people to rethink what carbohydrates they were eating. There is a big difference between, say, whole grain bread and refined white bread. And as a direct result of his challenge to the high carb diets that were recommended, there was further study done on protein and why it has a satiating effect.
To ConspicuousCarl who says it’s all about calories and a home-made Egg McMuffin is as bad for you as the commercial one: being able to create the food at home is a marker for a healthy lifestyle. I guarantee you that someone who chooses to stand at a stove making their own Egg McMuffin will be healthier than someone who buys it at the drive through, EVEN IF the home made one has higher calories. Also the quality of ingredients most certainly does count (high fibre bread is better for you and more satiating than a McDonalds bun, for example).
Dr. Novella
regarding this comment:
“low-carb diet craze goes back to the 1970s with Atkins, had a resurgence in the 80s with the Zone diet, and Atkins became popular again in the 90s. Low carb diets have been there alongside low fat diets for the last three decades.”
this is true but wildly unrepresentative of the fact that “low-fat” has been the dominant theme of nutritional advice in both the mainstream media and medical fields for several decades now, we know that low-carb in addition to being subjective (how many grams of carbs per day constitutes low carb?) has been at best a fringe movement compared to the dominant low-fat theme.
the fact that people still consider “moderation” to mean ample veggies but limited quantities of meat (focusing on lean meats) shows us quite clearly the degree to which anti-saturated fat dogma is entrenched in our minds.
theres something that even a hardcore low carber such as myself feels when looking at a fatty steak that wonders how if im really wrong in thinking this could be better for me than a harmless pile of pasta…
i fail to see any clear evidence that a diet rich in saturated fat and low in refined carbs is unhealthy or at least worse than one that is simply low in fat and high in grains, beans and starches.
By the way, weight loss IS neither simple nor easy once the magic threshold into obesity has been crossed. The body begins to regulate fat in a different way, so ‘calories in/calories out’ simply fails as a solution at that point.
I echo SarahAnn on this: this is meant to be a science-based blog, so please don’t fall back into the prevailing ‘common sense’ wisdom – which is neither wise nor scientific – when dealing with topics like obesity.
Great post. I lived many years in Paris where people eat some of the most fattening foods, but remain fairly slim. They have almost the same genetic makeup than the Americans of European ancestry, some have African and North African backgrounds.
Their secrets: (1) they walk all the time, going up and down the stairs in the subway almost everyday, etc; (2) the meal portions are smaller, they do not eat at “all you can eat” restaurants; (3) it is not socially acceptable to eat at any time, outside of meal times; (4) being fat is not socially acceptable, people ostracize you if you are fat!
Therefore, it seems that intake amount, life style, and the social acceptance of being fat that are to blame, not the percentage of carbs or fat in the diet, or the genetic background.
Sarah – regarding the NEJM study you link to – the differences among the groups may have been statistically significant, but they were not clinically significant. The Low-carb diet has an extra weight loss of 0.3kg over 2 years compared to the Mediterrainian diet, and 1.7kg compared to low fat. What is remarkable is how badly all the diets worked, and the slight differences among them is largely irrelevant.
Also the study included diabetics, a population who do benefit from low cab/low glycemic index diet, and it is unclear how this affected the outcome.
Also – this is a bit of cherry picking. The review article Harriet links to is a better place to start. There have been some studies since, with mixed but generally unimpressive results. This one (http://www.ncbi.nlm.nih.gov/pubmed/19439458), which was carefully controlled for calories, had typical results – no difference between low carb vs low fat when calories are controlled, some benefit to glycemic control for diabetic on low carb, some increase in LDLs on low carb.
dr cosa – if you know of any good surveys on what people have actually been doing over the last 30-40 years, let me know. I honestly would like a good reference on this.
Absent that – we can argue endlessly about this point. My point is simply that in the dieting culture, the low-carb thing goes back to the 1970s, and therefore one cannot make simple assumptions about the relative roles of low carb vs low fat diets on the obesity epidemic over this time.
Regardless of the official recommendations, bookstore shelves have been filled with very popular (even if they were fringe within scientific circles) low-carb diets. My experience talking to people, especially over the last 20 years, about their diets is that low carb has been much more popular than low fat. This is anecdotal, but it has been fairly dramatic. I encounter many more people on low carb diets than low fat.
Bottom line – short of a good survey, you cannot assume that people have actually been following low fat diets to lose weight over the last few decades, and there is good reason to think that low-carb diets have been at least, if not more, popular. We know from other evidence that people listen to celebrities and friends more than experts – so it is not reasonable to assume that most people follow the official advice over the fad diets.
Alexis – the calories in – calories out is not “common sense wisdom”. It is solidly based in scientific principles – and further, it is also the overwhelming result of decades of clinical evidence which consistently shows that caloric intake is what determines weight loss, regardless of all other factors.
You can make elaborate and well-referenced arguments about many factors that influence weight – but no one has been able to consistently measure the net clinical effect of these factors. Therefore it is reasonable, based upon the evidence, to conclude that even if they are true, they don’t have a significant clinical effect. While calories in vs calories out has a dominant overwhelming effect.
You can quibble with her specific references, but Harriet’s bottom line interpretation of the basic and clinical evidence is spot on.
Steven,
If you read my post I was not quoting the study to prove that weight loss for carbohydrate restricted diets was superior (I did mention it but that was not my point) but rather to refute the low quality study Dr. Hall used to suggest that low carbohydrate diets lead to increased mortality. Unless you have a controlled study that shows this my point stands that this was a shoddy reference and a groundless assertion.
Also, I don’t believe at any stage did Alexie suggest that calories in/out do not determine weight loss/gain, but rather that the factors that control the energy balance are far more potent than consciously trying to control food intake.
Consciously controlling calorie intake as a strategy has little to no clinical effect the weight of obese subjects in the long term. If you have evidence to the contrary I’d love to see it.
And also by Harriet Hall: http://www.sciencebasedmedicine.org/?p=385
In your haste, you apparently misinterpreted Harriet’s point in citing it.
“He recommends limiting coffee, but this doesn’t appear to be based on good evidence; ”
Oh yeah, you must limit coffee, just for good measure…why do these diet promoters always say that? And no diet pop – why? What if it doesn’t have caffeine The “reason” is the author doesn’t like the stuff, and everyone *knows* Aspertame is bad for you!
The only rationale I can see, at least in my case, is that eating smaller dinners makes it a little harder to sleep well at night, especially when you are older and have other complications. When your body no longer clears caffeine quickly, excess only aggravates the problem. So why not say that?
Or is it just me – ?
CarolM – Because they are one trick ponies who thrive on rejecting every staple food a priori
I feel bad for making another Mitchell@Webb plug but it hits the nail on the head
http://www.youtube.com/watch?v=SavsJYXWgm8
Dr. Novella,
the mere fact that “healthy” choices, “lite” options on menu’s, the constant refrain to cut saturated fat from diets by most major medical associations, the term “artery clogging” for saturated fat not shared by vegetable fats, the school programs (at least in canada) that preach avoidance of excess meat, fats, and praise for grains, all point to the dominance in the mainstream of “low fat”.
its a fair bet to observe that given a plate of veggies and bread vs. a large steak smothered in butter that people would view the steak/butter as less “healthy”.
the whole reason people may point to being on a low carb diet because “low fat” isnt considered a diet as much as it is a lifestyle change due to its entrenchment in our psyche. how often do we see comments even in this website about “diets dont work, best advice is to eat sensibly” which more closely mirrors a low-fat, lots of veggies, lean meat approach than a low carb approach. (low carb is considered extreme for this reason)
“In your haste, you apparently misinterpreted Harriet’s point in citing it.”
How did I misinterpret it? I saw her point as, everyone thinks different things about diet and no one really knows anything about it, therefore Dr. Campbell’s opinion has equal validity to Taubes, despite the China Study being completely unscientific in method and conclusions.
I did read Dr. Halls review of it before but unfortunately comments were closed by the time I read it so included the rebuttal by Ms Minger here. It was rather restrained considering how easy Campbell’s argument is to dismantle.
Thanks, Dr. Hall, for calling Taubes on the carpet. Although his book is better researched than his previous one (that’s not saying much given the previous dearth), there are still many inaccuracies, gross and otherwise. His central problem is that he continues to ride the Insulin-is-Bad hobby horse at the exclusion of all other players and modifiers in energy/weight control. If his claims were true then we should all become Type 1 diabetes as this is the physiology he is promoting, and that is certainly not a healthy condition! He is typical of our first year grad students who discover some interesting fact and then decide that it must explain everything else as well.
Like so many CAM proponents, he is incapable of appreciating the subtler and critical points of his self-identified Area of Expertise, and instead can only focus on the One True Thing. He neglects entire bodies of research because to include them would make for a more complex argument that won’t sell books. Or make his head spin. Or something. It’s a shame, because if he bothered to get it right, then he might actually be able to have a real impact on human health. As a communicator he is in a good position to do so, but instead wastes the opportunity.
My colleague’s wife did read his book and her response was “Sure, if I followed Taubes’ diet I’d be at 1500 calories a day, and of course I’d lose weight.” No magic here. The reality is that the instant one goes on a diet, one is paying attention to what puts in the mouth, and for most people that means they eat fewer calories. This is why SBM practices and control groups are just as crucial for diet advice as for any other medical practice.
BTW, the dietary advice given in the 70s from the nutrition community was to “reduce saturated fat intake AND reduce caloric intake.” Alas, people did #1 and instead increased #2. Dropping saturated fats didn’t cause obesity, but it is not surprising that people might be misled into thinking that. The reality is that the US has experienced a steady increase in per capita food consumption since at least the 1960s. I think I posted these stats before, but honestly, these days I have a memory like a steel sieve.
Another issue that’s involved in the pro-meat diet is just the systemic investment to eat most of your calories in the form of high-fat, high-protein, low-carbohydrate foods. That’s basically meats and other animal products. For the world, or even America to eat this way would be extraordinarily expensive, require massive amounts of crops to raise the meat in the first place, faces numerous ethical questions, require huge investments of fossil fuels in the form of fertilizer and transportation costs, probably deplete most of the aquifers and rivers on the continent and just be generally wasteful. It takes far more water and energy (sunlight or hydrocarbon) to produce the equivalent number of meat calories compared to vegetable calories. Even if the evidence was solid that low-carb is a better weight loss approach, it’s still not practical when it comes to feeding a population.
The biggest confounds when comparing this is simple compliance – modifying diet and exercise is hard, it’s called a lifestyle change for a reason. You have to change how you think about your body, your leisure activities, your food, your eating, what food means to you, how you use it, how you transport yourself. It requires massive reflection on the fundamentals of how a life is lived. I can’t imagine how you’d get unequivocal scientific data outside of an institutional setting, and then do you have any external validity? We would have to give everyone aides.
Probably the closest meaningful comparison in terms of the energy you have to put into it and the impact on your life would be something like Alcoholics Anonymous or another addiction. This isn’t simple like taking a pill or even major surgery (which is itself not simple). It’s a huge number of intersecting factors, confounds, variables, motivations, etc. I wonder if we will ever have a scientific approach to weight loss that’s meaningful on a population level.
I’m giving myself bonus points for the South Park reference.
This “marker”, even if it is true rather than imagined, is merely an association. We (everyone but you) are talking about a person changing their behavior toward an end (eg, changing food intake to lose weight). Associations do not determine whether specific manipulation of a factor will produce a desired result. Maybe people who read diet books are more likely to be fat, but that doesn’t mean that “don’t read diet books” is good advice for losing weight.
This association might be real (provide your data, please), but probably only among people who falsely believe that doing so is going to help them lose weight. If you limit the scope to people who know better, you probably would not find such an association.
Fiber is a recognized nutrient which can, and must, be quantified by reading the nutrition data (you don’t know how much just by reading an ingredient list). As it happens, the Egg McMuffin has 2 grams and common wheat bread has that much per slice for 4 grams total. So your argument is that, in spite of everything else being the same, that extra 2 grams is where it all hinges. Note that neither of those numbers meet the RDA for a single meal, so the plan to trick your stomach into abnormal satisfaction is flawed anyway.
WilliamLawrenceUtridge, (say that 10 times fast!)
A low carb diet is not high protein, it is moderate-protein high-fat.
No need to consume any extra protein than recommended amounts.
Thanks Harriet. A very straightforward and reasonable piece. I shall post it on some site I commented on and received a deluge of abusive replies–all defending Taubes quite religiously.
Although I am only one person, I am prime evidence. In my fifties, with the onset of Type 1 diabetes–having been overweight for 20 years (obese toward the end), I decided I must deal with this NOW! I followed standard diet advice from a registered dietician. Yes, I reduced carbs, but most of all–I REDUCED CALORIES–DRAMATICALLY! I had no idea how much I was eating until I did the simple (but always avoided) exercise of writing down what I was actually eating. I, like most, had no real everyday working knowledge of a serving size and had to measure a lot for a while. One half cup of something is not much–sorry! Also, it is critical to know how much YOUR body can use up given YOUR level of exercise, a level that you can maintain long term.
To those who interpreted this article as not promoting exercise, I think you should re-read! Of course exercise is good and can HELP control weight, but as the critic pointed out, it amounts to a pound here and there over time and as Hall and others point out, it is over rated in the equation of calories in/calories out. If you eat too many calories daily, you will not be able to do enough exercise (most people) to get rid of it all.
At 61, I have maintained most of a 45 lb weight loss and my blood sugar is normal. I struggle every day to stay within my caloric limits. Age takes it’s toll on one’s ability to use up calories and to expend them, so it’s a constant battle to determine just what I can get away with without starting to gain weight.
NO ONE is going to stay with these extreme diets–all they do is give people who want dearly to believe they can eat all the meat or whatever food they love, that they want and lose weigh. There are arguments for all sorts of diets, but they rarely discuss portion size or calorie content. There are days when I talk myself into a wonderfully rich piece of flourless torte by not consuming anything else that day and half of the next, but then I get back to reality and try to do exactly as Mr. Pollan says–appropriate to my own personal caloric needs (the “not too much” part).
Another important factor is to EAT AT HOME. People have no clue as to the amount of fat in restaurant food. Even most Chinese stir fried food is swimming in oil–it will make you ill if you have been eating low fat for some time!
You can say all you want about “good fat, bad fat”, but you won’t get thinner by having too much of any of it. People keep telling me, “olive oil is ‘good’ fat”, well, yes, but that means one or two tablespoons a day, not a cup or more. All the fats have the same amount of calories! Yes, I use only olive oil (occasional pat of butter), but I USE IT SPARINGLY. I’m sure an athlete forty years younger than I can consume more olive oil than I can without gaining weight, but this difference fails to resonate with a lot of people.
Same with carbs: Whole grains vs. processed. Yes, I make my own 100% whole wheat bread (because most of what you buy is labeled whole GRAIN, which is mostly white flour with a bit of whole grain thrown in), but again, I only eat a little, because bread simply has a lot of calories when you are trying not to exceed 1000/day and I want my little bit to have some fiber and nutrients in it.
If you don’t like veggies, well, you’ll have to figure out how to get by on teensy portions of steak or whatever, but I’m glad I like them because they give me something to fill up my (small) plate and they take time to chew. I’ve found some dynamite recipes for kale, collards and other greens–IT’S TRUE! My family were very surprised at their versatility and they eat them now as well. Fruit is there, but measured for sure. I do fruit in halves–1/2 an apple, 1/2 an orange–calories add up people–very quickly! The sooner you face it, the sooner you can manage your behavior and achieve lasting weight control.
Oh yeah, my BP, triglycerides, and all lipid levels have improved dramatically. All meds were dropped except for very minimal BP. Had a stent at age 49–early onset runs in my chubby, apple-shaped, metabolic syndrome-prone family. Yes, I exercise, walking and x-country skiing, always take stairs (when I can find them!).
Now, none of this will sell any books, but it’s simple (not easy) and real.
Also…
In fact I specified that the similarities did not just stop at total calories (even though that IS the most important fact about losing weight) and extended to, and I quote myself, “the portions of fat, salt, etc.”
Here’s how: You were “shocked that the author of this review has resorted to such shoddy reasoning,” offering, as your second example of such shoddy reasoning, Harriet’s having named the China Study—a critique of which you then cited and discussed. A reader may reasonably infer that you were chiding Harriet for recommending the China Study, at least as a rebuttal to Taubes, and that Harriet must not have known that the China Study had been “completely debunked.” Neither of these interpretations is correct: Harriet was well aware of the weaknesses of the China Study, having provided one of its debunkings herself; and Harriet’s point was not that “Dr. Campbell’s opinion has equal validity to Taubes,” but that the opinion of each is invalid.
It is disingenuous of you now to state that you had read Dr. Hall’s critique of the China Study before you posted that comment. If you had read it, why cite another critique without acknowledging Harriet’s own critique?
Regarding weight loss recommendations of the 70s… I distinctly recall in the 60s and 70s (and I’m pretty sure it was true in the 50s and earlier) that the “common knowledge” was to eat protein and reduce carbs. But we didn’t call them “carbs” in those days. We just avoided bread, sweets, potatoes, etc.
I can’t be the only one who remembers the classic dieters’ plates at any restaurant:
Grilled plain hamburger patty (no bun), scoop of cottage cheese, some tomato slices. Maybe some celery sticks. (It seems like every stereotypical pop culture diet image included the ever-present celery sticks.)
My whole family struggles with weight issues. My mother is morbidly obese and has battled obesity her entire life. Weight Watchers was all the rage in the late 60s and early 70s, and she was a committed member who saw excellent results that lasted many, many years.
Our family ate dinner together, every night. We all ate whatever Mom fixed, and what she fixed was whatever fit her Weight Watchers plan. A meal of which I have very clear (unpleasant) memories was a big pot of yummy Italian-style meat sauce (made with lots and lots of cheap ground beef, canned tomatoes, peppers, onions)… and served over steamed bean sprouts instead of pasta. Covered with parmesan. Seriously.
And every dinner included salad. Unless the meal WAS salad. My mom would make these absolutely enormous chopped green salads (all vegetables) and would throw in a couple of cans of drained tuna and maybe a couple of chopped hard-cooked eggs. No croutons. No crackers. No bread and butter. We ate this at least once a week during the summer.
My point is, I don’t know what the medical establishment was recommending at the time, but this is the reality of what people were doing in the 60s and early 70s.
“Here’s how: You were “shocked that the author of this review has resorted to such shoddy reasoning,” offering, as your second example of such shoddy reasoning, Harriet’s having named the China Study—a critique of which you then cited and discussed. A reader may reasonably infer that you were chiding Harriet for recommending the China Study, at least as a rebuttal to Taubes, and that Harriet must not have known that the China Study had been “completely debunked.”
Neither of these interpretations is correct: Harriet was well aware of the weaknesses of the China Study, having provided one of its debunkings herself; and Harriet’s point was not that “Dr. Campbell’s opinion has equal validity to Taubes,” but that the opinion of each is invalid.”
It is disingenuous of you now to state that you had read Dr. Hall’s critique of the China Study before you posted that comment. If you had read it, why cite another critique without acknowledging Harriet’s own critique?”
It is now you who is misinterpreting me. My reference to shoddy reasoning was detailed thoroughly in my post. Namely not reading the full text of the supposed ‘low carb’ study, confusing association with causation and not providing adequate evidence to support her proposal of a ‘moderate’ diet (low salt, meat reduction).
Also I think my interpretation was reasonable. Comparing Campbell to Taubes is ridiculous and the comparison in the same sentence indicated that they both provided the same caliber of evidence.
The reason I did not reference Dr. Hall’s previous work is that I presume that people who read this blog have read it! Did you honestly think I was trying to conceal it or something?
But continue to labour on semantics if you think that’s the only point in my comment that was incorrect.
Anthro, you are my favorite student.
Seriously, you wrote an outstanding critique and you are exactly right. Congratulations on both the weight loss and for “doing your homework” on the subject. You’re right – it is simple but not easy, and I wish you all success as you continue your progress.
@SarahAnn:
Dr. Hall also has written here about Denise Minger’s critique: http://www.sciencebasedmedicine.org/?p=6092
LMAO,
Back then it was “starch,” not “carbs.” Weight Watchers are still substituting veggies for carbs, but these days the favoured vegetable is cauliflower:
http://kitchen-parade-veggieventure.blogspot.com/2009/05/cauliflower-spanish-rice.html
ConspicuousCarl: re: cooking and weight. You may find this interesting:
http://www.economics.harvard.edu/…/cutler/…/Why%20Have%20Americans%20Become%20More%20Obese.pdf
Hi Kimball,
That I had not seen. I’ll retract that portion of my comment, though I still think that flawed in parts as Taubes argument is, he is leagues ahead of Campbell in terms of scientific rigour. No insult to Dr. Hall but I don’t believe that is a realistic comparison.
I have looked at the literature but can not find studies looking into efficiency of absorption of “calories in”. If you are going to balance calories in versus calories out it would be conditional on calories absorbed, not calories consumed. Nuts for example have very poorly digestible protein bodies, so the calories calculated from a bomb calorimeter would not give an accurate accounting of true calories in. I think it is biologically plausible that some foods that are less well digested or absorbed could alter the basic equation.
Granted. Immediately after that paragraph was this:
I hope you can see why I interpreted you the way I did, particularly when Harriet herself had previously cited the same “debunking” of the China Study that you did. BTW, of course I don’t think that you were trying to conceal Dr. Hall’s previous work. Rather, I think that you had either forgotten it or were not aware of it.
Regarding Harriet “not providing adequate evidence to support her proposal of a ‘moderate’ diet,” you missed her point: that in the absence of such evidence, “the precautionary principle” suggests moderation.
@SarahAnn:
Oops, cross-comment.
Anthro “I’ve found some dynamite recipes for kale, collards”
off topic – but I’d love some good recipes for kale and collards. When I was in Rome I had some unidentified greens that were incredible, but everytime I try kale or collard greens they take forever to cooks and then are a disappointing flavor.
Science based cooking, anyone?
@LMAO and Alison – HeHe, I can’t break myself of thinking of starches rather than carbs. I still have the traditional “balanced” meal mentality that says a dinner should be a protein, a starch and a veggie. Sometimes my husband tries to pass off a potato as the veggie, no, no, no. That’s a starch. My mom told me so.
@michele… hehehe… we must be about the same age!
@Alison… yes… cauliflower “couscous” anyone?
On topic, haven’t there been a number of these “diet” studies that found protein-intensive diets, without the intensive fat restrictions, to be easier to sustain over longer periods, ostensibly due to be satiety?
Don’t misunderstand. I’m not at all a fan of the so-called low-carb diet. Diets in general annoy the heck out of me. But I do find myself much less hungry, and therefore eating fewer calories, when I emphasize proteins and vegetables, minimize grains and starches, and don’t really think too much about fats.
Anecdotal… when his father died of a heart attack my dad became obsessed with his familial predisposition to CAD and his very high cholesterol levels. By the 1980s, he was the poster boy for the low-fat bandwagon. His cholesterol still wouldn’t go down enough. More drastic fat-cutting. Lipids still too high. Finally got the cholesterol down when he cut fat consumption to less than 10% of calories. Maintaining that 10% consumption is his obsession. Anything to avoid statins.
Interestingly, at the same time they went low-fat, my mother began really packing on the weight. Before that, on the more-protein/less-carb Weight Watchers model, she had maintained a reasonably healthy weight for 10-15 years. She has gotten fatter and fatter and fatter, probably weighing in currently at about 3x her appropriate weight. My father is very fat too, but his cholesterol IS at acceptable levels, as long as he continues his OCD extremism.
Why are they SSOOO fat? They eat lots of vegetables, very small amounts of the leanest protein (fish, chicken breasts), and loads of “good” carbs (brown rice, pasta, fruit). I mean LOADS of them. With plenty of “good carb” snacks between meals.
Bottom line: They eat WAY too much food (mostly “good” carbs) and way too many calories. They are always hungry. Their idea of a “normal” portion is absolutely mind-blowing to me.
I have to watch my weight, too. I also eat loads and loads of vegetables. I eat lots of protein (not necessarily meat). I eat very few grains/starches, and those are high-fiber (whole wheat bread, oatmeal). I eat very little fruit (doesn’t agree with me). I don’t worry much about fat — I don’t gorge, but I don’t really restrict it, either. I add olive oil and real butter at will. I drink wine. I rarely snack. If I really want a burger and fries, I don’t deprive myself. But I only indulge once in a while. And then I compensate.
The only real differences between my eating habits and those of my parents are portion size and ratio of protein to carbs to fats. We eat almost exactly the same foods, but I eat way more fat, very little grain/starch, and significantly more protein. We’re probably even on vegetables. Overall, I eat much less food and, therefore, a lot fewer calories.
They’re always hungry. I’m not. They’re obese. I’m mildly overweight (BMI=25.7). My extra weight is due to a recent drastic reduction in activity levels. Whenever I start moving around more, my weight improves.
Anecdotal, I know. But still. When I eat protein, I’m not hungry. When I eat carbs, I am.
LMAO – Yes, I wonder how different diet content effects appetite too. I have also heard that protein is a high satiety food. I have noticed when I eat something like cereal (even high fiber) in the morning I am starving by late morning, sometimes to the point of being shaky and irritable. Whereas if I eat a protein and carb, like a couple of eggs and a slice of toast, I don’t feel hungry til later AND it’s a more normal hunger.
I think this is pretty well understood by science, just not by me.
Somewhat unrelated, My husband and I had a discussion regarding low fat and flavor the other night. His mother is into low fat cooking due to his father’s heart condition (not high cholesterol, though). I joke a bit because some of the recipes seem somewhat flavorless. I often wonder if you eat one flavorless muffin, if you are more inclined to eat another, just because you haven’t really tasted anything?
On the other hand, as my husband said, some things taste so good they are too easy to over eat…potato chip syndrome.
I don’t know. I do have a feeling that appetite and satiety are an important part of the weight gain/loss puzzle, which seem hard to get a handle on.
Ketosis would have been the metabolic condition of most humans throughout history. Enough populations have been observed eating diets consisting almost totally of flesh (by credible scientific observers in the 19th and 20th centuries) to nail that fact to the wall.
Personally, my diet is much like the one described in the article and I find it it sustains my active and athletic life quite admirably, even as I approach 60.
Oh, I would add a half bottle of pinot noir and a large serving of freshly picked strawberries with whipped cream and cashews to that daily menu.
That is an interesting paper, particularly in the way they make formulas to describe availability.
But the key information appears to be this:
Page 100: “the 10- to 12-pound increase in median weight we observe in the past two decades requires a net caloric imbalance of about 100 to 150 calories per day.”
Page 101: “Reported consumption increased by 268 calories for men and 143 calories for women between the two surveys. This increase is more than enough to explain the increase in steady-state weight.”
So people ate more and got fatter.
There is a blog out there (http://carbsanity.blogspot.com/) that does the best job I have seen of really exploring the biochemistry and the actual references that Taubes uses in his Carbohydrate Hypothesis.
Even though the blogger is a low-carber herself, she thinks Taubes is a total fraud. She claims that many of Taubes references say the opposite of what he claims. Taubes emailed her, but he refused to debate her openly.
I think Dr. Hall’s mention of T. Colin Campbell may be very insightful. It appears that Taubes may well be the Campbell of the low carb movement – a guru obsessed with simplistic ideas backed up by numerous endnotes but not by the science.
It is shame that Taubes just didn’t stop after vindicating fats and saturated fats from demonization. He had to turn around and demonize another simple macronutrient. Maybe if he hadn’t decided to go after carbs, he could have looked more at omega-3/omega-6 balance and the case against excess omega-6 PUFAs.
Evvy Dense,
Nuts, butter, potatoes or carrots — the more you eat of whatever it is the more calories you’re getting. If you eat more ___ you’re eating more calories. Those calories can either be burned, stored or eliminated (through the urine in diabetes; through breastmilk; through donated blood; through the breath and urine in ketoacidosis; through steatorrhea; through plasma from burned skin; through a baby and placenta).
Not knowing exactly how many calories are in a walnut is not a really big problem given that we have only a very vague idea of how many calories we burn. We aren’t matching ins and outs consciously; our bodies do it while we aren’t looking and they don’t ask us to check their math.
If the balance is off, we’ll notice because we gain or lose weight. Then we know we have to change something. It doesn’t really matter what. If you’re eating walnuts and drinking soy milk and eating pasta with mushrooms and broccoli and eating oranges you don’t really know how many calories you’re taking in. If you’re gaining weight and don’t want to, cut back on something. (Not the mushrooms and broccoli, because we know they’re lower in calories than the others.) Or turn down the thermostat in the house. Or give away your car. Whatever, something. None of those actions has a precise number of calories attached to it that you can easily control and measure.
Fussing over exactly how many calories you’re getting from each walnut is tripping over the flowers in the carpet (as we say in Quebec). It’s a distraction.
I’m not getting into this argument this time,but I sure could have used some of yall’s help last week
micheleinmichigan said
“Anthro “I’ve found some dynamite recipes for kale, collards”
off topic – but I’d love some good recipes for kale and collards. When I was in Rome I had some unidentified greens that were incredible, but everytime I try kale or collard greens they take forever to cooks and then are a disappointing flavor.
Science based cooking, anyone?”
Collards, and/or chard, with chopped cabbage, golden raisins, onion, ginger, garlic, some spices if you like.
ghee or olive oil in the pan, minced onion/ginger/garlic, add spices if you like (I use a hot peppery mix, but sparingly), golden raisins, cabbage, let saute a while, add collards, or chard, add a bit of broth or water to keep things from sticking, let it get nice and soft and roasty-like, add a tiny dash of salt and you’re in heaven.
The science-based part is that you listen to nerdy science podcasts until it’s all done.
Interesting debates going on here. I quite enjoyed Taubes work. He wrote an entertaining book that was both educational in science/history as well as both friendly and entertaining to the layman, but not as watered down as Fast food nation.
However, I think a number of critical thinkers here give him both due and undue credit for the same principles, and fail to touch on the key point that GCBC was essentially an argument by verbosity.
Medical science has been preaching relatively consistent concepts for nearly a century, despite false dichotomies insinuating that the american heart association is trying to poison us with cheerios. Dr. Lipson’s piece on heart disease recently showed some of us, myself included, another mirror that let us see the backs of our own heads. Just as Taubes’s verbosity feeds the bias in our wishful thinking, Lipson’s statements challenged it. This is why I am a skeptic. To question my preconceived notions.
Lesson of the century?
Everything in moderation.
Take the myth of the thousands of doctors preaching tobacco-science. Its often forgotten that clinicians of empiric medicine were among the very first and loudest voices that raised the alarm against the detrimental effects of chronic smoking, with the final culmination into direct action by The General of Surgeons. (Though I am aware they were not all Surgeons, but doctors none the less.)
Despite this we are all so keen to leap on board any principle that feeds our confirmation bias.
Everything in moderation.
Macronutrition is begging us to find simple solutions to complex problems. Too much fat? Stress the liver. Too much protein? Stress the kidneys. Too much carbs? Stress the pancreas. Too much vitamins? Stress on the wallet and entertaining urine color.
One thing remains a fact:
If you don’t eat, you starve. If you don’t eat a balanced diet, your physiology will adapt in predictable ways, largely independent of your polymorphisms. Ask a veteran POW how to lose weight. They call it the thirty pounds in thirty days diet, coupled with slave labor, scientifically proven to work. (For a more recent rendition of this heinous methodology, check out “The Biggest Loser”© on NBC!)
Again, everything in moderation.
No amount of hindsight can argue that changing to a balanced diet and exercise was an erroneous recommendation. Taubes is a decent journalist, but his supporters do suffer from a seemingly religious vein of carb-hysteria devoid of some pretty macroscopic physiology and biochemistry givens.
Take a couple slow, deep breaths folks. When its over, you can have your cake and eat it too on your way back to the treadmill lardasses!
desta – yum, Thanks!
On a related topic, the accelerometry data is in from the Canadian Health Measures Survey.
Basically, the results show that we aren’t hitting the desired activity levels, and have high levels of sedentary activity.
Summary from the Daily, and links to the articles.
For years I weighed 72kg, very active (professional athlete till the age of 52), nearly invarient for decades, a kg or two more in the winter, a kg or two less in the summer.
After surgery and radiotherapy for cancer six years ago, I have been reset to 65kg. My diet seems to remain as before, my activity level slightly less but the weight still remains invariant with regards to periods of inactivity or or days of strenuous exercise.
I am connvinced that my body must subltly increase the use of food consumed in periods of less activity by ways other than exercise. Increase in the production of heat? Excretion of unused food? Feeding the myriad of bacteria in my body?
I am an engine, not a black box radiator in a vacuum.
micheleinmichigan:
And it could go the other way. Hubby’s Dutch grandmother’s recipe was to put the bits of kale where the ribs had been removed into the water with the potatoes and cook them together.
Then in another pan the sausage was cooked in a pool of butter, more than one stick.
When the potatoes were soft, that was drained and the butter from the sausage pan was poured over. The potatoes and kale were mashed together, then served with the butter poached sausage.
Every time I made this for Hubby I got ill to my stomach. I finally said I could not do it anymore. I think at some point I will do the Dutch mashed potatoes/vegies bit again, but without all of the butter and grease.
I believe everyone of her recipes started with “melt half a kilo of butter in pan.” When we stayed in his grandparents house north of Amsterdam ago she made us steak literally poached in a pool of butter. (note on a more recent visit to the Netherlands, her other grandchild, hubby’s cousin, does not cook that way!)
The worst part is that when we had our cholesterol done, half-Dutch Hubby’s levels were in the basement, and mine were high! When he gets a snack it is a plate of salami, cheese and some pickles… with me it is fruit or carrots (and an occasional bite of cheese). Life is unfair.
@Kimball
“Regarding Harriet “not providing adequate evidence to support her proposal of a ‘moderate’ diet,” you missed her point: that in the absence of such evidence, “the precautionary principle” suggests moderation.”
There is that word again. Moderation. That meaningless, vague, unscientific and subjective way of justifying whatever you want to promote as healthy with zero evidence to show that it is.
Most current nutrition recommendations are the result of industry influence and political agenda rather than any scientific consensus. It was repeated so often that it somehow became scientific gospel along the way.
That’s why I’m really surprised to see Dr. Hall rely on unscientific recommendations. No point extending skeptism only half the time.
SarahAnn on moderation: “That meaningless, vague, unscientific and subjective way of justifying whatever you want to promote as healthy with zero evidence to show that it is.”
Can you be more specific? I can’t tell what you’re referring to here.
For anyone interested in the comprehensive literature that makes up current (2010) USDA ‘Dietary Guidelines For Americans’, here is a wealth of information:
http://www.cnpp.usda.gov/DGAs2010-DGACReport.htm
No need to endlessly speculate about whether or not the current guidelines are evidence based or not..it’s all here.
Let me just say that it is so refreshing to finally read an article AND comments about what causes obesity that actually speculates, rationally, that calories in/calories might not be the whole story. I have been in and out of treatment to gain weight (eating disorder) and each time have had to have my calories increased at least every other week just to gain one or two pounds, at one point needing 4,000 kcal. Although my situation may be on the extreme side, it does go to show that the metabolism and other factors are in play here too, and everyone’s metabolism, gut bacteria and genetics varies. If calories in/calories out were that straightforward then I would have gained weight easily, especially considering that I could not excercise.
By the way, I have been taught that weight set point theory (hypothesis?) is another factor as to why some people are heavier than others, that some are genetically destined to be heavy – just like some people are destined to be short, tall, have green eyes or brown hair and so on – no matter how much the person eats in the first place. Do you think there is any truth to that?
I’m a big fan of Dr William Davis, the Track your Plaque doctor (http://www.trackyourplaque.com/) whose program can slow down or reverse coronary plaque. Here are his thoughts on how to get diabetes:
“If you would like to become diabetic in as short a time as possible, or if you have someone you don’t like–ex-spouse, nasty neighbor, cranky mother-in-law–whose health you’d like to booby trap, then here’s an easy-to-follow 5-step plan to make you or your target diabetic.
1) Cut your fat and eat healthy, whole grains–Yes, reduce satiety-inducing foods and replace the calories with appetite-increasing foods, such as whole grain bread, that skyrocket blood sugar higher than a candy bar.
2) Consume one or more servings of juice or soda per day–The fructose from the sucrose or high-fructose corn syrup will grow visceral fat and cultivate resistance to insulin.
3) Follow the Institute of Medicine’s advice on vitamin D–Take no more than 600 units vitamin D per day. This will allow abnormal levels of insulin resistance to persist, driving up blood sugar, grow visceral fat, and allow abnormal inflammatory phenomena to persist.
4) Have a bowl of oatmeal or oat cereal every morning–Because oat products skyrocket blood sugar, the repeated high sugars will damage the pancreatic beta cells (“glucose toxicity”), eventually impairing pancreatic insulin production. (Entice your target even further: “Would you like a little honey with your oatmeal?”) To make your diabetes-creating breakfast concoction even more effective, make the oatmeal using bottled water. Many popular bottled waters, like Coca Cola’s Dasani or Pepsi’s Aquafina, are filtered waters. This means they are devoid of magnesium, a mineral important for regulating insulin responses.
5) Take a diuretic (like hydrochlorothiazide, or HCTZ) or beta blocker (like metoprolol or atenolol) for blood pressure–Likelihood of diabetes increases 30% with these common blood pressure agents.
There you have it! Perhaps we should assemble a convenient do-it-yourself-at-home diabetes kit to help, complete with several servings of whole grain bread, a big bottle of cranberry juice, some 600 unit vitamin D tablets, a container of Irish oatmeal, and some nice bottled water.
The low-carb diet craze goes back to the 1970s with Atkins, had a resurgence in the 80s with the Zone diet, and Atkins became popular again in the 90s.
Further. I seem to recall reading that Owsley was already pushing his own cosmicized version when he visited Millbrook in ’66 or ’67.
Xira on the first law of thermodynamics: “Let me just say that it is so refreshing to finally read an article AND comments about what causes obesity that actually speculates, rationally, that calories in/calories out might not be the whole story.”
Well, it is the whole story. If you know exactly how many calories go into a person (because you’re feeding them exact amounts of purified chemicals); you measure the number of calories they burn (by making them walk around breathing into a respirometer that measures their CO2 production); and collect all their menstrual discharge, urine, stool and sputum and measure the calories in that — the numbers will add up. Or rather, the difference between calories in (food) and calories out (everything else) will be body mass lost or gained. There’s no other option.
The problem is that in real life, controlling all these things is impossible. The closest we can come is to eat only measured amounts of synthetic food (even that may not be possible for everyone) and conscious control over output competes with the body’s unconscious homeostatic mechanisms.
One of the body’s homeostatic mechanisms is control of our appetite. The fact that most people’s weight fluctuates very little is testament to the astonishing effectiveness of our bodies in controlling our appetites so that our inputs (almost) exactly match our outputs even though what we eat is under conscious control.
If you think that “appetite” is something trivial that can be simply overriden by correct thinking, imagine taking a concentration camp survivor whose weight is down around 85 lbs, sticking them in a food court, giving them $50 and a carrot stick and telling them not to buy any food, that the food court stuff is not really very healthy, and that you will pick them up the next day to give them something that really is good for them.
Their appetite is going to override their intellect and they are going to buy food and eat it. We all know that — it’s obvious.
Appetite is not regulated by an intellectual part of the brain. It doesn’t care at all about what your doctor has told you is your ideal weight. Someone may be obese but still have the powerful appetitive drives of someone who is starving. Saying that someone in this situation “should know better” or that “knowing better” is everything we need to know about intake management is madly oversimplifying.
Assuming intake is managed apparently reasonably, within usual limits for someone of your target weight, output then has to be accounted for. Gut microflora and gut disorders can affect output even before the food is absorbed into the bloodstream. Exercise, sleep, temperature, fidgeting, smoking and disease all affect energy use. We can then run into a situation where we are controlling exercise (that we have conscious control over) but unconscious homeostatic mechanisms are tweaking the other forms of output to prevent (or slow) weight change.
However, these other homeostatic mechanisms all respect the first law of thermodynamics. Calories do not appear or disappear by magic. (Calories in) – (Calories out) = (Weight change). Always. There is no other option.
In addition to trying to manage the parts of the equation under conscious control, we also need to know how to override the other homeostatic mechanisms in a consistent way. We do know some things. It is possible. It’s not magic. But “knowing better” is not always enough.
Aw, c’mon, SarahAnn, lighten up a little. “Moderation” in this context may be inexact, but it certainly suggests limiting calories to the extent necessary to avoid obesity, and together with the rest of Harriet’s last sentence suggests avoiding extremes of either consuming or avoiding the various “food groups.”
Regarding evidence, it is certain that such moderation prevents obesity (duh), and it is likely that this would therefore diminish the risks of other outcomes for which obesity is a risk factor: Type II DM, hypertension, and obstructive sleep apnea, for example. Regarding evidence for other outcomes or other diets, that was Harriet’s point, and has been made all the more clear in this comment thread: the evidence is equivocal at best.
It sometimes seems to me that dieting really ought to be considered to fall under psychology. The really important question always seems to be “can this particular person stick to this particular diet?” The other details don’t have any effect that comes close to that.
Scott,
Dieticians do study a lot of psychology!
@Alison, I want to frame your last post!
@Kimball I know I come across as serious about this subject, but that’s because I’ve studied body-fat regulation non-stop for the past 4 years and to have a reviewer of Dr. Hall’s callibre resort to some platitudes about moderation is infuriating because it reaffirms to me that we are still stuck in the nutritional dark-ages.
Recommending reducing meat or salt has never been shown to reduce the incidence of any disease or obesity. You seem to think that advocating ‘moderation’ is bound to work, when it doesn’t because:
a) Everyone’s definition of moderation is inconsistent, even in the same person over time, to demonstrate this check out how bad the accuracy of 24hr food questionnaire recalls are.
b) that it only seems to applies to things deemed unhealthy with no evidence (meat, salt – unless you set out to poison yourself of course)
Even if the above interventions were benign (and I suspect that the law of unintended consequences always applies here – sometimes when people take things out of their diets they replace it with something worse), then it’s still a little rich to advocate them with no evidence, that’s what CAM supporter would do.
I have a feeling if you replaced the term moderation with homeopathy there’d be a somewhat different reaction.
SarahAnn,
Thanks for the vote of confidence.
I’m still not sure what your specific concern about the word “moderation” is. Is it simply that if your only lifestyle-change advice to someone is “be moderate,” that it won’t be helpful?
Below is a simple version for a cookbook with citations removed, but I’d have to agree with Taubs about white flour as being harmful for the reasons below
Food made with white flour is unhealthy
White flour has been stripped of nutrition. The bran and germ parts of wheat kernels have been removed, which contain most of the fiber, essential healthy oils, protein, vitamins, minerals, and ephemeral nutrients.
That leaves mainly the starchy endosperm which quickly converts to sugar – it’s one of the reasons so many people are overweight.
This isn’t going to change. Grocery stores, bakers, and the food industry like white flour because it can sit on shelves a long time. Millers love white flour even more, because they make twice as much money selling white flour for human food and the healthy bran and germ as animal feed. Your pets may be eating better than you are!
Rats fed on white bread have died, so the missing nutrition is a big deal. Bread used to be called the staff of life because you could live off of it. Not anymore.
According to Consumer Reports, eating whole grains is the #1 action you can take to improve your health (besides quitting smoking).
Repeated studies have shown these benefits from eating whole grains:
Disease Reduction*
Stroke 30-36%
Type 2 Diabetes 21-30%
Heart Disease 25-28%
* Source: http://www.wholegrainscouncil.org “2009 WGC Research Summary”
Whole grains also reduce asthma, lessen the risk of inflammatory disease, colorectal cancer, lowers blood pressure levels, and much more.
and so much more information that’s peer-reviewed, sorry I didn’t have the time to make this a better post
@SarahAnn:
Moderation defined as “limiting calories to the extent necessary to avoid obesity,” as I defined it and, as I believe, is a reasonable interpretation of Dr. Hall’s words, is, er, bound to avoid obesity. That’s hardly “advocating it with no evidence,” and is hardly analogous to advocating homeopathy. I am as annoyed as you and other commenters are at some of the common, arbitrary prohibitions or extreme limitations that are out there (salt, coffee, meat, etc.), but “moderation,” even if imprecise, can’t be accused of being equivalent to “prohibition” or “extreme limitation.” It may even be true that salt, for example, needn’t be moderated at all, at least for people with normal renal function. So what? The point is a small one.
None of this means that we are in the nutritional dark ages. We know a hell of a lot about nutritional deficiencies, which have constituted the vast majority of nutritional problems for most of our species’ time on earth, and still do for a large fraction of people. What we haven’t figured out to any substantial extent—other than applying “moderation” as defined above, of course—is how to proceed when the problem is not one of deficiencies but its opposite. That is the point of threads such as this one. If you know of science-based advice that you haven’t previously mentioned here, we’d love to hear it.
Rats fed on only unenriched white bread will die. Supplement with Four Essential Vitamins and Iron! (check out a package of Wonder Bread or white flour) and whey powder (just the Wonder Bread) and they’ll be just fine. That’s why enriching white flour is required by law.
If you’re relying on wheat flour (white or whole grain) for all your protein you’re going to have a problem. If you eat a mixed diet, you’ll be fine.
I’m not up on the latest on diabetes, diet and fibre so I won’t comment on the rest, but your cookbook is so woefully incomplete on these two points that I don’t trust it on the other ones.
(Disclosure: I do not have white flour in the house. I use whole-grain flour, pasta, rice, quinoa etc exclusively — an occasional exception for poppy-seed bagels.)
“Whole grains also reduce asthma, lessen the risk of inflammatory disease, colorectal cancer, lowers blood pressure levels, and much more.”
p-shaw – I eat whole grains almost exclusively in my breads and pasta and mostly in my rice and I still have asthma and inflammatory issues. But in spite of my trying to eat low fat, I do not have diabetes, regardless of Oderb’s plan…
It seems that particular foods have all these magical properties, which somehow just don’t apply to me.
Oh and I have a horrible memory, anyone want to tell me what wonder food I am already eating that cures absentmindedness.
“Most current nutrition recommendations are the result of industry influence and political agenda rather than any scientific consensus. It was repeated so often that it somehow became scientific gospel along the way.”
SarahAnn, as a nutrition professional I find this statement naive and inaccurate. Open your copy of the Dietary Reference Intakes – which are the dietary guidelines for Americans and Canadians for every macronutrient and micronutrient including energy intake – and the first chapters of each book detail the *scientific* criteria used by the Committees to evaluate the *scientific* literature and establish the recommendation. It’s all out in the open for everyone to read.
Second, read the list of committee members. Every one is a highly respected scientist knowledgeable in nutrition; nearly all are academics. Not an industry shill in the lot of them.
During the review process commentary is solicited from the general public. This includes everyone who wishes to comment. These can include industry representatives, interested parties, and even can include you the Taxpayer. All that testimony is made available for all to read. The list of people who testify and their affiliations is also publicly available.
The only myth being perpetuated is the one in quotes.
I think I understand your general distaste for that word, as I have heard it tossed around in this way. It can sound like the “gray fallacy” (in which one person says black, another person says white, and the audience assumes that the real answer is in the middle).
However, in the case of diets, the “moderate” range with a mixture of fat, carbohydrates, proteins, and a variety of vitamins within food sources is not some assumption, it has been fairly typical of most human eating for tens of thousands of years. Sure you can point at a few extremes, like people who only have seals to eat, but in general the “moderate” diets we refer to are an existing reality for most of humanity rather than a gratuitous interpretation.
And yes, those evil scientists have changed the recommendations for exact proportions, but compared to the absurd extremes offered by fad diets with weak or non-existent evidence (Only eat fat! No, only eat carbs! Do either, but consume 10,000 times the historical level of this vitamin!), all of those RDAs have been relatively moderate changes. All of the fad diets addressed are way outside of the typical range of nutrients with which we have roughly doubled the normal lifespan by adding good sanitation and medical care.
OK, here is where I need to open up a can. After your rant about a particular word being too vague and too easily used for almost any argument, you follow up with what is basically the old “It’s, like, the corporations doing it dude!” It comes up a bit short on the WWWWWH index. Who exactly? Why do you think it was corruption rather than honest advice? When did the corruption factor into the process, and exactly how did the responsible parties influence the educated people at the IOM?
Sadly for industry and diet gurus, there are no magical foods. (Though sometimes I think I should invent one just to get a cut of the gullible-i$m.) I enjoy t-bones, bacon, pasta and ice cream. I also adore veggies, fruits and small portions. I eat moderately, stop when I feel full and save the rest for lunch. I make time to cook so that I have control over what I eat. I don’t have diabetes, high cholesterol, or any of the other horrors that the diet gurus like Taubes would swear I ought to have.
The key *is* to eat moderately. What is that? To consume no more calories than you expend (less if you need to lose weight). I follow the US Dietary Guidelines of 10-12% calories as protein, no more than 30% calories as fat, and 55-60% calories as carbohydrate. I am lovely and slim and over 40.
Very few nutritionists I know use fad diets. Most follow the same guidelines as I do. I know of very few fat nutritionists and even fewer with chronic disease. But then since we clearly don’t know what we’re talking about, I wonder why that is???? (sarcasm off)
I don’t know this Dr. Davis.
The last person I knew that had at least real evidence of reversing heart disease was Dr. Dean Ornish.
His plan was mostly vegetarian, 10% fat (almost all from the mostly monounstaturated) with 9 mg of cholesterol.
It also included talk therapy, meditation, and exercise, so it was not just diet, and he only made claims about the program as a whole. not as individual items.
Anyway, IIRC, everyone on the diet had to *stop* taking their beta-blockers and or insulin.
Unless Davis has studies to back up his diabetes claims (and he may… I did not spend too much time with it), he is just spouting anecdotal evidence.
Allison: here’s what’s missing from white flour. Just adding a few vitamins back doesn’t work — which is clear from the many studies on vitamin pills that showed no efficacy.
Nutrients Lost when Whole Wheat Flour is Refined
Nutrient % Lost Nutrient % Lost Nutrient % Lost
Cobalt 88.5 Zinc 77.7 Copper 67.9
Vitamin E 86.3 Thiamin 77.1 Calcium 60.0
Manganese 85.8 Potassium 77.0 Pantothenic Acid 50.0
Magnesium 84.7 Iron 75.6 Molybdenum 48.0
Niacin 80.8 Vitamin B6 71.8 Chromium 40.0
Riboflavin 80.0 Phosphorus 70.9 Selenium 15.9
Sodium 78.3
SOURCE: Henry A. Schroeder, “Losses of Vitamins and Trace Minerals Resulting from Processing and Preservation of Foods,” American Journal of Clinical Nutrition 24 (1971)
Bran (Removed). fiber, niacin, thiamin, riboflavin, magnesium, phosphorous, iron, zinc & trace minerals.
Germ (Removed): Vitamins B1, B2, B3, B6, and E. 25% of the protein. phytochemicals (may protect us from disease), essential fatty acids, folates, magnesium, phosphorous, iron, zinc, anti-oxidants, calcium, copper, potassium, niacin, riboflavin, and pantothenic acid.
Endosperm (KEPT) –three-quarters of the grain’s protein and carbohydrates and has small amounts of vitamins and minerals. Most of the endosperm, better known as white flour, is starch.
allison wrote: If you’re relying on wheat flour (white or whole grain) for all your protein you’re going to have a problem. If you eat a mixed diet, you’ll be fine.
reply: huh??? Is that a straw man argument, bringing up protein when I never mentioned that word in my post to discredit me?
Allison: I’m not up on the latest on diabetes, diet and fibre so I won’t comment on the rest, but your cookbook is so woefully incomplete on these two points that I don’t trust it on the other ones.
reply: What? Do you think I’m going to post an entire cookbook in a comment?
# micheleinmichigan: I eat whole grains almost exclusively in my breads and pasta and mostly in my rice and I still have asthma and inflammatory issues
Whole grains don’t cure or prevent anything, they help and reduce, there’s no nutritional magic bullet. But clearly a food at the base of the food pyramid that you’re supposed to eat the most of that’s been depleted of nutrition has caused some mental malfunctioning — I don’t understand why people aren’t mad about this…
But I’m wasting my time, I thought this was a critical thinking website
Angora Rabbit, food guidelines do get influenced by industry unfortunately. This isn’t to impugn dieticians but rather to point out that the government – particularly in the US – does manipulate what gets grown, sold and promoted (corn and milk being two obvious examples) both to the public and in government food guides and that big food corporations have a lot of power. Often to the detriment of farmers and food diversity, and to citizens who are being viewed first as consumers. Sometimes this is a good thing, such as supplementing folic acid via flour or vitamin D via milk, sometimes it’s not. That said, healthy eating is pretty straight forward really…eat a diversity of foods, more veg than anything else, and not to much (the Michael Pollen approach). That and knowing one’s own body and nutritional needs. As you say, there are no magical foods, just realistic eating and exercise habits.
Calories in/calories out has to work. It’s thermodynamics.
A lot of people want to believe that you can lose weight without cutting calories by tweaking the ratio of nutrients in their diets. Supposedly, this is possible because the magic formula stimulates your metabolism. Even if Taubes or a competitor found the magic formula, that wouldn’t invalidate the thermodynamic argument. Increased metabolism would be increased energy expenditure.
Maybe you’re maintaining your weight eating 2000 calories of Pepsi and Twinkies a day. As a result, you’re apt to feel sluggish and move as little as possible. However, if you switched over to a more balanced 2000-calorie diet, you might lose weight just because you’re feeling more energetic and moving more. That still doesn’t challenge the calories in/calories out principle. Moving around is energy expenditure.
Taubes is right that a rote calorie-counting approach to weight-loss is a very difficult way for most people to achieve the calorie deficit they seek.
Quite simply, if you eat significantly less of the same stuff, you are likely to feel very hungry. If you are hungry all the time, chances are, you won’t stick to your diet.
So, a lot of diet writers attempt to tweak the kinds of foods that you eat as well as the quantities in the hopes that you will feel more full with fewer calories. There are a lot of different ways to go about this. Many diets use a combination of strategies. For example, you can choose foods that provide a lot of bulk relative to their calorie content. You can load up on fiber. Some people find that a high protein diet is more satiating, at least in the short term.
None of this disproves the calories in/calories out principle. Anyone who tells you their diet defies the laws of thermodynamics is as much a huckster as someone who makes the same claim about their “perpetual motion machine.”
ardnassac – the U.S government in information explaining their food pyramid states “At least ½ of all the grains eaten should be whole grains.”
http://www.mypyramid.gov/pyramid/grains_amount.aspx
And no, I’m not mad about it. I’m mad about cholera in Haiti. I’m mad crazy people shooting up political gatherings, or kids or innocent people who get killed by IEDs. I’m mad about people having to go without insurance. Sometimes, I’m mad when people drive too fast through my neighborhood.
I am not mad about white bread.
ardannasac,
I have no issue with there being less of all those things in white flour than in whole wheat. I’m quite familiar with those facts: it was my field of study in university.
What you have not established is whether the missing (for instance) sodium in white flour causes a problem for a human being eating a mixed diet. Perhaps removing them is a good thing. For instance, more than 1.6 mg copper daily is associated with accelerating mental decline in people eating high-fat diets. If people who tend to choose white bread also tend to choose high-fat diets, then less copper may be a very good thing indeed.
You haven’t established that flour is an important source of any of these nutrients for individuals eating a mixed diet.
Compare: Water is essential. Grapes lose about 81% of their water content when they are converted to raisins. Raisins will always be popular because they are easier to store and lighter to transport than grapes. But we don’t go around fretting about the malicious motives of grocers who sell us raisins, thus dehydrating us, because grapes just aren’t that important a source of water for most of us. We go to the tap, or drink juice or soda or tea or coffee or soup…
So it’s not enough to say that X is different from Y. You also have to establish that the difference is a problem, which you haven’t done.
And yes, you most definitely did refer to protein. Go back and read your comment.
Bread used to be called the staff of life because you could live off of it.
Except for that wee problem of scurvy.
also @ ardnassac
Obviously I am not a critical thinker, because if I was I would have asked for your sources in the asthma and inflammatory disease claims.
@micheleinmichigan-
In December of 1972 (On a Wednesday,I believe) I ate a spoiled Brazil nut.It was positively the worst thing that I have ever tasted,and I have never forgotten that experience!
So I would suggest bad Brazil nuts for memory enhancement
tmac57 – HeHe – that’s a good one. I was thinking of more of a names, dates, to dos and those random words that are just on the tip of your tongue. But, if I ever need to remember an awful experience, I’ll be sure to turn to spoiled Brazil Nuts.
ardnassac: Your argument about white flour doesn’t stand up to history. There is a longstanding historical preference for white flour, because the bread produced with it is lighter and easier to eat. White bread used to be a luxury. Now it’s the norm (and we’re better at removing the bran and germ). It wasn’t foisted on us by millers seeking to make a profit. Even the Bible talks about “flour” vs “fine flour” (which, according to the explanation I was taught, means flour that was sieved).
As for protein content: Bread flour is 12% protein. If all or most of the protein were removed, you wouldn’t be able to make bread from it on its own. You’d have gluten free flour. The protein content is far more dependent on wheat variety than on white vs. whole. Most whole wheat flour is about 14% protein, but you can buy whole wheat pastry flour which is closer to 10%.
BTW, Anthro, I suspect you were on the verge of developing Type 2 diabetes, not Type 1. You can’t stop Type 1, which is an autoimmune disorder.
@Angora Rabbit
“SarahAnn, as a nutrition professional I find this statement naive and inaccurate. Open your copy of the Dietary Reference Intakes – which are the dietary guidelines for Americans and Canadians for every macronutrient and micronutrient including energy intake – and the first chapters of each book detail the *scientific* criteria used by the Committees to evaluate the *scientific* literature and establish the recommendation. It’s all out in the open for everyone to read.”
I quickly browsed through the DGAC guidelines the TMAC posted and easily found an error. They say that saturated fat in the blood stream down-regulates the LDL receptor, in vivo. This is true, but they neglect to consider that saturated fat in the diet does not completely control the amount saturated fat in the blood, most palmatic acid in the diet is converted from carbs in the liver! This lack of joined up thinking is what plagues nutrition science today.
As for RDI’s, these are merely enough to prevent the most obvious deficiences, and are called ‘minimum-wage nutrition’ in some circles. Believe it or not, nutrition is an incredibly young science and is not being aided by the reductionist approach taken by most scientists in the area. We don’t know as much as we think we do. Read good calories bad calories, ignore the part about carbs but do read the part about how saturated fat became demonised, then you’ll learn how the guidelines are influenced by industry.
But I’ll give you a chance to redeem the nutrition guidelines if you can find me one high-quality well controlled study that shows that increased saturated fat leads to an increase in heart-disease.
@ConspicuousCarl
I’ll bring it out of the realm of speculation then, moderation is defined as ‘less than 30% calories from fat’ & ‘less than 15% from saturated fat’ & ‘less than 6g salt a day’ and ’5 servings of fruit and vegetables a day’. What annoys me so is that they hide a common sense concept like ‘moderation’ (who can argue against moderation after all, it is the most coveted virtue of our age!) and use it to hide causation pulled from poorly interpreted observational studies, it is the lack of high quality RCT’s in nutrition that cause this over-reliance on observational studies. And a shocking amount of nutritional advice is based on a combination of bench research and epidemiology, and has led to some erroneous conclusions.
If anyone cares to show me a well controlled prospective long term trial that shows any of the above has a clinically significant improvement on health I’ll shut right up. Otherwise we are just making things up and calling it science.
SarahAnn- You seem very disdainful and dismissive of what mainstream nutrition science recommends,yet you seem all too willing to buy in to Taubes’s work.Why is that?Are his references the ‘good’ science?
The protien in flour causes autoimmune problems in a large proportion of its eaters. It probably adversely affects all of them. Wherever humans began cultivating grains for a living, their stature shrank about 15cm. The phytates in “healthy whole grains” inhibit the uptake of nutrients as they are meant to.
Grains have little to offer but calories.
AlexisT – You’re entirely right that many of our unhealthy eating habits are driven by a desire for foods that were once “luxury” foods. White flour, white sugar and steak/roast beef all used to be seen as “luxury” foods that mainly the wealthy or upper classes could afford. (Refined sugar was once considered so valuable/special that it was kept in specially designed furniture that locked.) The kinds of health issues that are now common – obesity, gout, diabetes, etc – used to limited to the upper classes that could afford to drink and eat “luxury” foods. People’s desire for steak and cake was driven by class/luxury more than anything else really. As America become more affluent, these became the norm. Ironically, the upper classes are now more likely to eat a more diverse diet since these things are longer seen as upper class and being able to afford fresh fruit and veg is a class issue (check out the difference between supermarkets in affluent and poor areas, there’s alway a bigger diversity of fresh produce in the affluent areas). This doesn’t mean that steak and cake aren’t still signifiers of class or sought after commodities, but they’re certainly more ubiquitous than they once were.
“Among the heirlooms reflecting a definite social and economic custom of the past is the sugar chest. A southern piece, made during the eighteenth and early nineteenth centuries, it was primarily a chest on legs, fitted with a bin for sugar, another for coffee, and quite often small drawers for spices.
Since these were all luxuries, the chest was therefore fitted with a lock. In the agricultural South, especially Kentucky and Tennessee, each plantation was self-sufficient as far as food products went; except for sugar, tea, coffee, and spices. Quite aside from the money value of these items, which was considerable, poor transportation made delivery possible only once or twice a year. Therefore, stern rationing was necessary on a plantation with numerous dependents. Sorghum, honey, and molasses were sweetening substitutes for everyday use.
Except for a limited amount of cane sugar grown in Louisiana, all brown and white sugar used in colonial America and later in the United States was imported and remained costly until nearly 1870. The less refined brown type was doled out by the housewife each day for cooking and ordinary use, white sugar which came in a cone, wrapped in a deep violet-colored paper, was for company. Cutting it into pieces for serving was not entrusted to servants, as precious grains of it might be wasted. There were special cutters or shears for the process which were wielded by the mistress of the house.”
FiFi”(check out the difference between supermarkets in affluent and poor areas, there’s alway a bigger diversity of fresh produce in the affluent areas)”.
Just to add, fresh fruits and vegetables also have a higher cost due to spoilage. That can be an inhibitor when shopping on a tight budget.
michele – Scarcity and the associated higher cost are some of the key elements that make anything valuable or a luxury item – whether we’re talking fois gras, gold or fresh strawberries in mid-winter. Often the sad end result of the drive to create “affordable” luxury items is really crappy food – whether that is bland, tasteless strawberries or candy bars masquerading as chocolate. It often also leads to a great deal of waste – if everyone’s eating steak that’s a lot of cows being killed mainly for certain cuts, which is one of the many drivers of factory farming.
However, luxury foods now often mean organic and less commercially available foods rather than the things that used to be considered a signifier of class when it comes to eating.
These kinds of eating habits are related to wealth, obviously, in poorer nations people are much more likely to be using the whole animals and a wider diversity of fruit and veg (ie. anything available).
Industrialization of food has also had a big impact upon regional foods and cuisines, not to mention learning to cook in and of itself. If processed, packaged foods are cheaper and more readily available, people simply don’t learn how to cook (the skills aren’t passed down through the generations). They may be a far inferior quality – and ultimately more expensive in the longterm – but for the working poor (who tend to work much harder than the working wealthy, particularly if we’re talking single parent families) the appeal is obvious. The very wealthy often don’t cook for themselves either but they tend to have an actual cook.
Our relationship to both cooking and eating has changed a lot. Cooking has in some ways become a hobby or craft rather than a basic life skill. Not only do less people know how to cook, despite all the cooking shows on TV (another signifier of cooking as a hobby), but we also tend to approach eating as less of a communal and shared experience. (As a gros generalization, obviously individual families and certain cultural/social groups fall outside of this generalization.)
“People’s desire for steak and cake was driven by class/luxury more than anything else really.”
Actually, they are driven by desirablility. We desire things that are hard to get to make sure that we get them.
We like sweet things — even newborns who have never been exposed to candy marketing. Ripe fruit is sweeter and more calorie-dense than unripe fruit and than vegetables. Starchy, high-calorie vegetables are sweeter than low-calorie vegetables.
We like fat. We like salt. We like umami. Meat is hard to get — it often runs away, may be dangerous, may be guarded by another carnivore or scavenger, and needs processing. We wouldn’t bother if we didn’t really like it.
We don’t stop really liking these things just because industrial agriculture and food processing and distribution have made them easy to get. We still really like them.
Of course there are wealth and class signifiers associated with food. Plenty of them. But we like meat and fat and sugar because we’re omnivorous animals. (Dogs find these things extremely desirable too, and it’s not because they signify wealth.)
“But we like meat and fat and sugar because we’re omnivorous animals. (Dogs find these things extremely desirable too, and it’s not because they signify wealth.)”
When I was a kid, my mom (I think) used to say that if you crave something, like liver, then that means your body is sending you a signals that it is low in that nutrient, like iron.
To a certain extent I don’t believe this. From what I’ve read, evolutionarily, we are inclined to crave scarcity, fat, high calories foods, to protect against times of famine.
But, when I was in Kazakhstan in the winter, when most of the diet was meat, bread, pasta, very cooked potatoes, onions and the occasional cooked vegetable, and candy (As a visitor, it’s difficult to eat fresh greens, veggies some fruits, due to contamination issues). I was really craving a salad or other green veggy. And oddly, after a few weeks, I looked like I needed a salad. My skin was dull. Of course this could have been my imagination or just that a change of diet is hard on your body, like it is for dogs, but since then, I’ve always wondered if there was some truth to the food craving/ low nutrient belief.
Just speculation
Alison – Certainly we enjoy fat, sugar, salt and caffeine (and cocaine, etc) for biological reasons. I didn’t mean to imply the only reason why we enjoy them is because of the status they convey, my main point (which I obviously wasn’t clear about so my bad) was that one reason why steak, sugar and refined flour is so ubiquitous is because they were historically viewed as a luxury item in the US and UK, which is part of what has led to them being marketed (often poorer quality versions with less of the obvious appeal).
Obviously there are a confluence of factors that range from biology and psychology to industrial farming (which gives us the ability to grow/raise larger quantities) and marketing but economic/social attitudes/beliefs do play a role in regards to what is considered desirable and what isn’t (this goes for other items too, for instance, Burberry stopped making a certain item because it had become to popular with Chavs in the UK). In other cultures the coveted foods are different because of different social beliefs and we quite often find these foods quite disgusting or boring (shark fins in China, sheeps eyes in some Arabic cultures, etc).
As for the fatty argument, there are plenty of fatty cuts of meat that are considered less desirable than a lean steak so it’s not just about fat. In fact, the trend has been towards leaner cuts of meat being the most desirable and expensive (though obviously they don’t taste as good so you’re going to find less of this in the top restaurants).
I don’t much about food, but I think that once one is too fat, one needs a lot of energy to haul around that extra weight. For example a person of 1.70 meters (that is 5 foot 7 inches in prehistoric units) having a BMI of 24 weighs just over 69 kilogram (152 prehistoric pounds). If the same person is obese (BMI 31), s/he carries 24/7 the weight of a standard suitcase of the maximum weight you can take with you on an airplane.
That takes extra energy so makes you want more food. If such a person want to lose weight she’ll have to get used to feeling hungry all the time.
@tmac
“SarahAnn- You seem very disdainful and dismissive of what mainstream nutrition science recommends,yet you seem all too willing to buy in to Taubes’s work. Why is that? Are his references the ‘good’ science?”
I’m not dismissive of all ‘mainstream’ nutrition science (whatever that is) I agree with a lot of the current recommendations (avoid trans fats, eat oily fish, low refined sugar), don’t try to make me out as some alternative kook.
I don’t ‘buy’ into Taubes work either. I stated in my first comments that his carbohydrate hypothesis is most likely false and that there is plenty of better critiques of his work than this one. But on the saturated fat front and how the current recommendations were formulated I see a well referenced position that has since been backed by high-quality systematic reviews of the current science:
http://www.ajcn.org/content/early/2010/01/13/ajcn.2009.27725.abstract
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7930322&fulltextType=RV&fileId=S0007114510004010
The McGovern report in 1977 is largely credited with forming the current guidelines wrt restricting fat in the diet. They stated that dietary cholesterol needed to be restricted in order to reduce blood cholesterol. Every single controlled trials since then has been shown this to be untrue, dietary cholesterol has no influence on blood cholesterol, and yet the AHA still recommendations to restrict eggs to 3-4 yolks per week. Why?
The problem with pushing the Mediterranean diet as a being “scientifically proven” (as opposed to just a diet high in fruit and veg) is that uncritically doing so actually ignores a whole slew of factors. This isn’t saying that rigorously adhering to the diet isn’t going to be good for your health, it’s just to point out that rigorously adhering to any diet high in fruit and veg, when combined with exercise, has this effect. There’s a somewhat faddish focus on calling it a “Mediterranean diet”(and, of course, there was a populist book accompanying it) and lots of guesswork around why it’s protective (ye olde correlation isn’t causation issue, as well as the effect of carefully monitoring diets on how people eat combined with a switch from a high fat, high sugar diet with no exercise to a diet high in fruit and veg and starting to exercise). The Mediterranean Diet has it’s own faddish “miracle food” aspect too (in this case olive oil). This is not to say it’s not a healthy diet, it’s just to say that any diet high in fruit and veg, when combined with regular exercise, seems to be a healthy diet. Particularly if you live in a nice sunny country, eat fresh local produce and walk everywhere.
“Mireille Guiliano credits the health effects of the Mediterranean diet to factors such as small portions, daily exercise, and the emphasis on freshness, balance, and pleasure in food.[21]
Dietary factors are only part of the reason for the health benefits enjoyed by certain Mediterranean cultures. A healthy lifestyle (notably a physically active lifestyle or labour) is also beneficial.[22] [23] Environment may also be involved. However, on the population level, i.e. for the population of a whole country or a region, the influence of genetics is rather minimal, because it was shown that the slowly changing habits of Mediterranean populations, from a healthy active lifestyle and Mediterranean diet to a not so healthy, less physically active lifestyle and a diet influenced by the Western pattern diet, significantly increases risk of heart disease.[24] [25] [26] There is an inverse association between adherence to the Mediterranean diet and the incidence of fatal and non fatal heart disease in initially healthy middle aged adults in the Mediterranean region.[27]
A 10-year study published in the Journal of American Medical Association (JAMA) found that adherence to a Mediterranean diet and healthful lifestyle was associated with more than a 50% lowering of early death rates.[28]
The putative benefits of the Mediterranean diet for cardiovascular health are primarily correlative in nature; while they reflect a very real disparity in the geographic incidence of heart disease, identifying the causal determinant of this disparity has proven difficult. The most popular dietary candidate, olive oil, has been undermined by a body of experimental evidence that diets enriched in monounsaturated fats such as olive oil are not atheroprotective when compared to diets enriched in either polyunsaturated or even saturated fats.[29][30] A recently emerging alternative hypothesis to the Mediterranean diet is that differential exposure to solar ultraviolet radiation accounts for the disparity in cardiovascular health between residents of Mediterranean and more northerly countries. The proposed mechanism is solar UVB-induced synthesis of Vitamin D in the oils of the skin, which has been observed to reduce the incidence of coronary heart disease, and which rapidly diminishes with increasing latitude.[31] Interestingly, residents of the Mediterranean are also observed to have very low rates of skin cancer (which is widely believed to be caused by over-exposure to solar UV radiation); incidence of melanomas in the Mediterranean countries is lower than in Northern Europe and significantly lower than in other hot countries such as Australia and New Zealand. Its been hypothesized that some components of the Mediterranean diet may provide protection against skin cancer.”
http://en.wikipedia.org/wiki/Mediterranean_diet
Just to say, if we’re going to blast other faddish “brand name” diets for things such as being easier to adhere to under observation, mainly being effective because the person switches from an unhealthy diet and no exercise to more fruit and veg and exercise, and your basic correlation isn’t causation miranda warning, the same needs to be applied to the Mediterranean diet.
We’re still really in the infancy of both nutritional and exercise science, which is one reason why there’s so much quackery around both diet and exercise. I don’t really see a huge difference between someone getting healthy and losing weight on a Mediterranean Diet 9which is high in salt so not for everyone), a low carb one or Michael Pollan’s very sensible but hardly scientific “eat food, not too much, mostly plants” (Pollan, incidentally, also writes “the whiter the bread, the sooner you’ll be dead.”) In the real world, cutting out white bread can be a very effective way to lose weight. In the real world, it seems like a diversity of approaches for a diversity of people is what’s needed and is the most practical.
http://en.wikipedia.org/wiki/Michael_Pollan
“This is not to say it’s not a healthy diet, it’s just to say that any diet high in fruit and veg, when combined with regular exercise, seems to be a healthy diet. Particularly if you live in a nice sunny country, eat fresh local produce and walk everywhere.”
I would just add that another additional aspect of the Mediterranean cooking (I can’t speech to the diet, I haven’t read up much on that.) is the use of different beans as protein. You see this quite a bit in Italian and Mediterranean/Middle Eastern food. If one is cutting back on meat or just wants to add more variety to their cooking, beans are a nice way to go.
Also soup, lots of soup in Italy. Which I think is quite healthy, a filling way to limit portion size.
Also, I find Mediterranean foods (more of the Italian variety) and or rustic french (well that’s what the cookbook I have calls it) easier to prepare than french cuisine (which is apparently only healthy to the french and will kill anybody else on sight
, but also most Asian recipes I’ve come across, which are complex. This is, of course, if you can steer away from the recipes calling for boar and squids ink…which are a little difficult to obtain in the States.
So, nothing glaring wrong with the content, lots of fruits and veggies, good meat alternative using easy to moderate preparation. Those are the reason’s that I think Mediterranean cooking may be a healthy approach for a typical American. But, I really think it depends on the individual and their taste preferences.
The whole fat debate in the US is suffering from “navel-gazing,” meaning “self-absorption.”
One has to go other countries to realize it. By traveling outside of US, you will realize that it is not WHAT we eat, but HOW MUCH eat that determines if we can fat or not.
Gluttony was once considered a sin. We now think it is OK, and being fat is also socially acceptable. It is embedded in our culture.
Ben – Maybe it’s a case of just being very, very occupied with trying to actually find their navel to gaze at….
Ben Kavoussi
“Gluttony was once considered a sin. We now think it is OK, and being fat is also socially acceptable. It is embedded in our culture.”
Well lots of things were once considered a sin… sex*, loaning money, homosexuality, and now to a certain extent they are all embedded in our culture. I would point out that we no longer put adulterers in the stocks anymore.
I’m curious though, if being fat is so socially acceptable, what’s up with bulimia and anorexia? Also why are all the models size 00 these days?
*The Shakers didn’t have much luck with forming a religion that preached complete abstinence from sex…but they did make some lovely furniture.
micheleinmichigan-You can talk about bulimia,anorexia,and fashion models all you want,but one trip to Wal-Mart,will tell you who is winning the battle of what is socially acceptable when it comes to weight is the U.S.A.
That’s absurdly naive. It merely means that the outgroup is growing in number, not that they’re becoming more socially acceptable to the dominant culture.
Mandos-What you are referring to as an ‘out group’, is a majority of U.S. citizens. The numbers range from about 55%-67% as overweight with about 20%-30% of those falling into the obese category. I personally find overweight people to be socially acceptable.Most people that I know are overweight.I don’t think that they are making the best health choice,but that is not the same thing as condemning them socially,and they seem to be functioning quite well in society.They have good jobs,spouses,friends,family,pets,etc. Where is the social stigma?In short,they ARE us.
You do realize that outgroups and underclasses can be majorities, right? That they live among one another, etc, etc. And that they appear on TV less often, except in negative contexts.
tmac57 “Most people that I know are overweight.I don’t think that they are making the best health choice,but that is not the same thing as condemning them socially,and they seem to be functioning quite well in society.They have good jobs,spouses,friends,family,pets,etc. Where is the social stigma?In short,they ARE us.”
Ask them how they feel about their weight. Most people don’t shed tears of shame, have surgery or spend lots of money to get rid of something they feel fine about.
But true, I see very little social stigma over people being unhealthy…it’s just being unfashionably fat. Athletes who are basically wrecking their body (and setting themselves up for chronic lifelong pain) to become competitive in their sport are admired by the general public.
Ahh, I’ll just blame the media. It’s so much easier to sell stuff when you can set the bar at an unattainable level…people who feel like sh*# about themselves buy more sh*# in the attempt to make themselves feel better.
tmac57 “You can talk about bulimia,anorexia,and fashion models all you want,but one trip to Wal-Mart,will tell you who is winning the battle” etc
Also, I’m not buying the logic. Just because a particular trait is on the upswing, does not mean that it is considered good, acceptable, admirable, etc. You are making a leap in reasoning without supporting you point with actual evidence.
FiFi – “Pollan, incidentally, also writes “the whiter the bread, the sooner you’ll be dead.”
HeHe, I missed this line before. My BIL sometimes says “Cotton Kills”, somehow they have the same ring to them. Of course the “Cotton Kills” is actually supported by a lot of evidence (in the mountain climbing context).
@Mandos – outgroup as majority – that is a powerful concept. You’ve just changed my whole understanding of American culture.
I stopped thinking about which foods to include or avoid in my diet years ago when I realized that people around the world survive on an incredible range of foods – some eating only meat, some eating none, many vegetables, few veggies – and most consume much less than I do. My Western lifestyle is quite sedentary in any historical context; so I try to balance my desire for nutrient dense foods with a high percentage of low calorie foods – fresh veggies and fruits.
If people in Asia can live on three meals a day of rice and a few occasional vegetables, I think I’ll do all right on the most widely varied diet in human history, as long as I don’t eat too much.
An article on an interesting look at a healthy and sustainable diet as proposed by UK academics that also mentions how beef is a status commodity in China …
http://www.guardian.co.uk/environment/2011/jan/30/livewell-plate-diet-nutrition
Considering that the current UK government has turned to industry instead of academics and scientists to create nutritional guidelines and to guide policy for the UK, it’s nice to see that researchers are producing their own guidelines (and considering the health of the planet/environment as a factor in general human health)…it’s naive to think that the food industry has no influence on government created guidelines in any country where corporations and lobbyists have more power and are considered more important than citizens (or where a government sees the people as consumers not citizens).
http://blogs.plos.org/speakingofmedicine/2010/07/08/uk-government-and-food-industry-in-bizarre-alliance/
People need to read the book to understand his points. Taubes studied physics, he understands the importance of the first law of thermodynamics. He states in the book that for someone to lose weight they need to consume less calories than they expend.
His point however, is that our approach to dietary advice shouldn’t rest on that fact. He points out that that fact says nothing about *why* someone is gaining weight/eating more and only says what is absolutely necessary to happen *when* someone does.
He argues that (for example) a tiger doesn’t get fat, even with excess environmental food, so why would a human? He is then arguing that it is the presence of (mostly high-gi) carbs in the diet that leads to the weight gain, and due to the effect on insulin of carbs, more of that energy is stored in the adipose tissue, unavailable to the muscles for energy so appetite rises, more calories are consumed.
The reason why people spontaneously eat fewer calories on a low-carb diet *isn’t* because they avoid the bread but because their body for once can actually regulate it’s own energy intake. Our appetite and our adipose tissue is being hijacked by carbs.
He also points out that some people eat lots of carbs and are fine. It seems very apparent that the environment of the genetic heritage plays a large part. Cultures that spent 1000s of years living on pacific islands eating fish and coconuts (high fat low carbs) tolerate carbs extremely poorly and not surprisingly are over-represented in obesity statistics in the west, while populations that spent 1000s of years eating carb rich diets are not affected to the same degree.
If the claims that animal fats are not the cause of heart disease, and knowing that fat does not induce an insulin response, we should not be afraid of fat in the diet. Instead I read magazines where a pizza is made “healthy” by changing the meat from a fatty meat to a lean one and reducing cheese, so overall reducing calories and lowering fat.. No mention whatsoever that a serving of the pizza is half a cup of white flour!
Challenge all your preconceptions! His primary claims are that refined carbs, sugar and starches are the primary evils. If someone wants to lose weight drop these and the rest will follow.
It’s also worth noting that here http://www.garytaubes.com/2010/12/calories-fat-or-carbohydrates/ Gary argues that any dietary regime that can induce weight loss is based entirely on carbohydrate restriction. I’m not going to repeat the argument but it seems clear that the single most important factor in weight gain/loss is to do with how much insulin is secreted. This may change due to genetics or diet/amount or both.
The point is that for a intake of calories (say 2000) either a lot can be stored as fat (making a person tired/lazy/hungry) or burnt (making a person energetic, not hungry) and the energy expenditure in a large way depends on the insulin effects of the food. 2000 calories is 2000 calories but 2000 white carb calories will leave someone tired hungry and slightly fatter while 2000 fatty meat calories will not leave someone tired and hungry. Out of those two extremes it’s easy to see why carb restriction facilitates all the other aspects of weight loss (energy expenditure and not hungry) and a carb rich diet (may) leads to lazy and hungry people.
FiFi – I like the ideas behind of your livingwell link, but I will note that the recommendations have been developed using foods that are typical to the UK.
We’d definitely need a different menu selection in the U.S., seeing as how items like baked potato with baked beans are probably not going to fly here.
echinopsis,
Your explanation makes a lot of sense. Thank you.
Trials comparing high-protein and high-carb diets show little or no difference for weight loss. This suggests that Taubes’ thesis is an interesting hypothesis but not borne out by facts.
Alison, I’m glad I could help make it clearer.
But, I think you need to increase your critical understanding of those kinds of studies. Have you read Taubes book? People bring up issues about his hypothesis that he addresses in the book. And he freely admits all along that this is what the science points to currently and his general argument is that nutrition has been stuck in a confounding mindset that has a lot of trouble looking at itself objectively.
It’s doubly difficult because unlike most modern health treatments the result really affects the public. The public believe that fat is an evil, and that a diet high in omega-6 polyunstaturates and “moderate” with refined carbohydrates and replacing fat with them. The public don’t follow nutritional regimes like studies test for. Why is still so much bread sold white? Not that I really think wholegrain bread is much better
* sorry
The public believe that fat is an evil, and that a diet high in omega-6 polyunstaturates and “moderate” with refined carbohydrates is ok despite how terrible we know it is for someone
I missed the “how bad” sorry again..
Based on Dr Hall’s excellent book review, it sounds like Taubes has lifted much of his material directly from Atkins. Wonder if anyone at Retraction Watch might be interested, or if Atkins’ widow will sue for plagiarism?
Disclosure: Tried the Atkins diet many years ago, found I lost some weight because the allowed foods got boring quickly, and I missed fruit, vegetables, and bread far too much.
The thing that strikes me about this thread is that the fact that people benefit tremendously from a low-carb diet has been lost in the argument over whether Gary thinks the First Law of Thermodynamics applies to humans or not (he does) or whether he has accurately reflected the science (he has), etc etc. In my experience, if you have someone with insulin resistance, this is the first line therapy, end of story. I have seen amazing reversals of metabolic syndrome and type 2 diabetes. I have one case where the fellow had type 2 and MetS, had been on insulin for 17 years, poorly controlled, hypertension, dyslipidemia, Hx of stroke, obese, and after 2 weeks was recording normal sugars on no insulin and at 18 weeks was metabolically normal on no meds with a weight loss of 50 lbs. That was 6 years ago. Since then he has maintained those benefits as long as he stays on the diet. When he goes on a “carb binge”, which he has a few times, all the problems come back. His is not the only case like this. My quest over this period has been to understand why this works so darn well and why it isn’t the accepted first line therapy. The rest of it is just the same as arguing over the number of angels on the head of a pin, IMHO.
@ Jay:
I think you’re missing part of the point. Everybody knows that diet and exercise are the best ways to deal with such issues. Gary is making a far more specific claim, that a low-carb diet is the most effective kind of diet, as opposed to any more general calorie restriction diet. The current evidence does not seem to demonstrate that this is the case.
Also, as an MD you should know that what you personally have seen means very little; it’s just a collection of anecdotes. The only robust way to answer the question of whether low-carb is better than any other calorie-restricted diet is with well-designed clinical trials.
What’s that old saying about a physician who proclaims “In my experience…”?
Scott,
I do read the literature and am familiar with the clinical trials in this area (and have been involved in some, too). The studies that people reference to make the claim that it isn’t about carbs, it’s about calories are, without exception, effectiveness studies. You have to be very careful in drawing conclusions about efficacy from effectiveness data. This distinction is routinely ignored, often by the authors themselves, and then by others who propagate this argument. To appreciate the efficacy of this diet, you can look at case studies and you can look at trials where compliance was high. The recent trials, like Sachs et al and Foster et al, had major compliance issues, yet they concluded anyway that low-carb was no more beneficial than calorie restriction for weight loss. These researchers and many others do not know how to properly administer a low-carb diet. In Foster’s case, subjects were told to restrict salt and drink lots of water. He apparently didn’t know that when you restrict carbs you experience natriuresis. This advice would exacerbate sodium depletion and lead to the typical adverse effects reported in these kinds of studies: headache, constipation, weakness, fatigue, etc. with attendant high drop-out rates (I suspect Sachs used this approach, too, given his role in DASH). In Sacks case, he gave me a severe public tongue-lashing at a meeting when I suggested there was some merit in low-carb dieting at a time when he would have been doing the trial where he discovered carb restriction was not effective. My point is that you can find lots of poor quality evidence out there to argue your point in the RCTs. There are some good quality RCTs like the ones done by Volek et al at UConn where the compliance rates are high. In these studies, the low-carb arms outperform the “prudent diet” in every measure. And, I will continue to maintain that, in terms of understanding the efficacy of this therapy, witnessing what happens to a compliant patient is also valid evidence.
Jay
@ Jay:
If you’re familiar with the literature and want to argue your point on that basis, fine. But you should have started there, not by essentially saying “I’ve seen some success stories in my practice therefore this is true.”
I also would point out that compliance shouldn’t necessarily be labelled as a problem with the trial. If we know one thing for sure, it’s that compliance with ANY restrictive diet is extremely hard. How easy a diet is to comply with therefore an extremely important characteristic.
@ Scott:
Compliance is a big part of what an effectiveness trial looks at and that is a valuable thing to study. However, if you want to know about efficacy, compliance is essential. You learn nothing about efficacy if subjects are not compliant. My point is that in the absence of good efficacy trials, one must fall back on case studies to understand the efficacy of this approach. In my experience, and in sharing with colleagues who use this approach, I find there is a tremendous benefit for people with any degree of insulin resistance if they use this diet. Of course there are compliance issues but I compare it to smoking cessation. We know it is the most efficacious way to avoid the harm of tobacco use but it is not highly effective because of poor compliance. Does this stop us from using this approach. No, of course not, because we understand the efficacy, we push on and try to address the compliance issues. With ketogenic diets and insulin resistance, we have a similar set of circumstances except that there are a bunch of nay-sayers out there who use effectiveness data to question the efficacy and who argue that the diet has no merit because nobody can comply. To make matters worse, some of them do their own studies in which the diet is administered poorly to provide more fodder for the argument. Meanwhile, in the clinical setting, where competent practitioners apply the diet, people lose excess weight, normalize their cardiometabolic markers and get off their meds. What’s wrong with this picture?
@Scott
If you read the book you’ll see that Gary points out that the only way to lose weight is to reduce the insulin secreting effects of food. Restricted calories may achieve this, because they will reduce carbs and most diets like that also try to improve what kinds of carbs.
One thing to remember is the shocking real world efficacy of restricted calorie diets, if people are consistently hungry the diet will fail sooner or later.
Have you read the book, or GCBC?
No, nor is that relevant. I was responding specifically to Dr. Jay’s inappropriate use of personal experience to attempt to prove the point.
@ Jay Wortman,
What’s wrong with this picture? There’s nothing wrong with the outcome for patients. What is wrong is using “in my experience” arguments to claim that one diet is superior to others. How do you know that “where competent practitioners apply OTHER diets, people don’t ALSO lose excess weight, normalize their cardiometabolic markers and get off their meds.”?
@ Scott and Harriett
I guess we are just going to have to disagree on whether clinical experience has any merit in assessing the efficacy of a therapy.
I also lecture to physician audiences about this and “in my experience” doing that, there is quite an appetite for this approach because the “OTHER diets” you refer to don’t seem to be doing the trick.
@ Scott and Harriett
I would also suggest that you read “Good Calories, Bad Calories”. Gary does a better job of reviewing the nutritional literature in that book (I believe there are over 1200 citations). He wrote “Why We Get Fat” because GCBC was too hard to read for most people, including a lot of our colleagues. I think it is a little unfair to harshly criticize him for WWGF, which was purposely dumbed down for a wider audience when his opus is really GCBC.
@ Jay Wortman,
I read GCBC before I read WWGF.
In his book, Taubes himself calls for proper studies to test his ideas.
Clinical experience is very valuable in guiding research, but it can never be a substitute for actually doing the research. As Mark Crislip says, the 3 most dangerous words in medicine are “In my experience.”
Throughout history, there have been sincere clinicians whose experience convinced them a certain therapy worked; many of them were subsequently proven wrong. Our experience frequently misleads us: that’s why we do science.
@ Harriett
No argument. However, I would venture to say that I have learned about as much from the shared experience of colleagues as I have from the literature. There is merit in both. In my own case, what I observed clinically with this diet led me to the literature and then to getting involved in the research myself. The case I mentioned was not a patient of mine, he was someone who heard me speak on this topic and then proceeded to implement the diet with no particular help from his physician. I was an arms-length observer and was so impressed with what he did that I have been compelled to pursue this. Full disclosure – I corrected my own type 2 and MetS this way, too, and have adhered to a very low-carb ketogenic diet for over 8 years now and I have no intention of going back.
Yes, Gary calls for studies. I actually discussed this with him last week over dinner. He would like a non-weight loss eucaloric feeding study comparing a low-carb diet to a prudent diet. It would not be that hard to do and it would put to rest the debate about his ideas. He reckons it would cost about $1.5 million. This level of funding would have to come from NIH or a similar source. Why is it, do you suppose, that it has not been done?
“He reckons it would cost about $1.5 million. This level of funding would have to come from NIH or a similar source. Why is it, do you suppose, that it has not been done?”
Am I missing something here? On the basis of Gary Taubes’ books, some personal anecdotes and your criticisms of studies that have failed to show superior effectiveness of this diet, you want to ask for $1.5M? Or rather, you want some other, real scientist out there to ask for it?
I dunno. On this basis I might think of giving you $15k, if I had a lot of money and there weren’t too much competition.
Isn’t the usual procedure to start with small trials, demonstrate that it’s possible to get positive results, and then scale up to progressively larger trials? Because from what I’m understanding, the first step has not yet been achieved.
I’m not sure I understand what you’re proposing.
@ Allison Cummings
I’m not proposing anything. Gary is proposing that a trial should be done. I agree to the extent that if it were done properly it might influence people who have so far been able to ignore the existing evidence.
The small trials you suggest have already been done. There are a number of RCTs out there, most of which did a poor job of administering the low-carb arm and virtually all which still demonstrated better results for low-carb when compared to low-GI, low-fat, low-cal, etc. Better weight loss, better cardiometabolic improvements and better compliance in most cases. The worst thing that anyone has been able to conclude from these trials is that the low-carb diet was no less effective than the control diets. Among these are a couple of well executed studies that give us a glimpse of the true potential of this approach. If you are interested in reading them, find the recent papers by Jeff Volek or his grad student, Cassandra Forsythe in Lipids.
The low-carb approach represents a major paradigm shift. This kind of tectonic change is never welcomed. Researchers who work in this area, unless they are card-carrying defenders of the current paradigm, find it very difficult to get funded. People like Sacks and Foster, whose support of the calories in/calories out paradigm is well established, get funded to do low-carb trials, do them badly and produce equivocal results that don’t challenge the paradigm. Researchers like Volek et al, who know how to do a proper low-carb trial get amazing results but can’t get them into high-impact journals and are discounted because of small size, short time-frames, etc etc. all of which are functions of a lack of funding. This is how the paradigm is defended.
Consider Chris Gardner at Stanford. Nice guy, vegetarian, very bright, believed that low-carb was harmful and did the A to Z trial looking at four diets with varying amounts of carb and fat. After he published his findings in JAMA which showed better performance by the Atkins arm he did some subsequent analysis of his data which showed that the subjects who had insulin resistance did exceptionally well on a low-carb diet and may actually get worse on a low-fat diet. He was unable to get funding to pursue this further and, as far as I know, he hasn’t been able to get those findings published, either.
Throughout medical history we have defended our cherished paradigms, even in the face of compelling evidence they are wrong. Have a look at the Wikipedia biography of Semmelweis for a classic example. I think this is human nature and I don’t think it has changed in the intervening 150 years.
Silly, really, to argue with people who haven’t read the book and don’t understand what (who) drives food production.
The latter certainly isn’t (aren’t) scientific scepticism (sceptics).
Dr Novella asked for evidence that eating low fat was the emphasis in the last 30 years. According to NHANES surveys (at least between 1974 and 2000 when obesity rates doubled), the extra 500 calories a day that Americans were eating on average compared to before we started preaching low fat in the late 70s was all carb calories. Fat consumption actually stayed the same or decreased a bit. I know as a physician that the medical community demonized low carb diets. A JAMA editorial labelled them “bizarre concepts of nutrition and dieting”.
…here is the reference:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm
Excerpt:
“During 1971–2000, a statistically significant increase in average energy intake occurred… For men [and women] the percentage of kcals from carbohydrate increased between 1971–1974 and 1999—2000.
The percentage of kcals from total fat decreased .. for men and for women. In addition, the percentage of kcals from saturated fat decreased for men and for women. A slight decrease was observed in the percentage of kcals from protein,
The decrease in the percentage of kcals from fat during 1971–1991 is attributed to an increase in total kcals consumed; absolute fat intake in grams increased. USDA food consumption survey data from 1989–1991 and 1994–1996 indicated that the increased energy intake was caused primarily by higher carbohydrate intake (6). Data from NHANES for 1971–2000 indicate similar trends. The increase in energy intake is attributable primarily to an increase in carbohydrate intake…Total fat intake in grams increased among women by 6.5 g (p<0.01) and decreased among men by 5.3 g (p<0.01).
…
The latest national dietary data available indicate that the previously reported increase in energy intake has continued, reflecting primarily increased carbohydrate intake."
I have to laugh at all this Gary Taubes bashing because the guy is, if anything, panic-stricken about putting out evidence-based science, and “Good Calories, Bad Calories” is so dense with evidence that it’s hard for anyone without a science background to read.
I’ve known Taubes since around 2000, and it’s a lucky thing, because I have been following his work since we met — and changing the lives of my readers because of it. (I’m a syndicated columnist and blogger — and usually a fan of this site and Harriet. This is a big miss from her — and I’m not going to repeat what’s already been said above about where she’s gone wrong.)
I get about five letters a week from readers who got so bored with my frequent mentions of Gary Taubes and the (too few) others who recommend a diet based in science rather than the “science” reccomended by government and many or most doctors. These readers finally bought Taubes’ book and checked out the other sources I recommend, and ate accordingly, and dropped pounds like stones falling off a truck.
Yeah, I know…the plural of anecdote is not data. But, will you take a photo?
http://www.advicegoddess.com/archives/2010/06/28/la_press_club_a_4.html
I used to diet — to eat this ascetic diet (fruits, vegetables, high-carb, low-fat…just like the doctor ordered — based on Ancel “Selection Bias” Keys’ crap research). I used to run seven miles a few times a week — wasting time I could’ve spent reading and killing my knees. Ridiculous.
I am now EFFORTLESSLY THIN thanks to Gary Taubes’ work — laying out what evidence-free science the government and doctors and media have been promoting for decades. I now eat bacon, eggs, butter, greens, steak, steak, steak, chicken, pork chops, green beans drenched in butter, and sauteed Italian parsley. And cheese and salami.
I’m never hungry, I now need very little sleep, and I sit at a keyboard all day and barely exercise (I do 100 lifts with weights every other day and try to remember to do an hour on the bike every week…which I haven’t been doing lately). I weigh what I did in high school — and I was slim then — without dieting. All I did was cut out carbs — flour, sugar, starchy vegetables like potatoes, and fruit.
Pssst to the person above mentioning George McGovern: Taubes notes in “Good Calories, Bad Calories” that the food pyramid was created by an aide to McGovern with ZERO science experience.
Oh, and P.S. I know a lot of writers, and a number of science writers and researchers, and simply knowing somebody doesn’t make me respect their work. The level of evidence behind it does. Which is why I respect the hell out of Gary Taubes, and see it as my mission to put the word out about his work.
Here’s just one of the numerous e-mails I’ve gotten about how he’s changed the lives of my readers:
“Dear Ms. Alkon,
I know your time is precious, so I will keep this e-mail short and to the point. I would like to thank you for using your blog as a forum to talk about low carbohydrate diets and introducing me to the work of Dr. Eades and Gary Taubes. After two pregnancies I was seriously overweight and struggling with losing the excess pounds with no success. After reading your blog posts about low carbohydrate diets, I listened to the YouTube lecture about sugar that you linked to and did some extensive literature searches about the science behind the effects of carbohydrates and sugar on metabolism. Much to my surprise (since this is not my field of research) these studies were more scientifically sound and made much more rational sense than any of the nutritional studies that we are normally told about through the media. After this research, it was not a hard decision to cut out all sugar, grains, and processed food from my diet. The results were spectacular. In a period of a little over three months, with very little effort (for example, I never went to the gym during this time), I was able to lose over 45 pounds and am now actually below my pre-pregnancy weight. Of course, this was all without ever
going hungry and being able to eat delicious meals filled with meat and buttered vegetables.
Once again thank you. The information that you provided on you blog has truly changed my life.
Sincerely, Name Withheld”