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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.

Posted in: Book & movie reviews, Nutrition

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147 thoughts on “Why We Get Fat

  1. hat_eater says:

    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.

  2. xwolp says:

    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.

  3. 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!!)

  4. jdifeo says:

    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.

  5. rork says:

    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.

  6. AlexisT says:

    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.

  7. zoe says:

    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?

  8. petertemplar says:

    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.

  9. ConspicuousCarl says:

    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.

  10. dr.cosa says:

    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.

  11. 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.

  12. David_Brown says:

    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.”

  13. WilliamLawrenceUtridge says:

    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.

  14. Gregory Goldmacher says:

    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?

  15. 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.

  16. theonides says:

    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.

  17. SarahAnn says:

    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.

  18. Alexie says:

    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).

  19. dr.cosa says:

    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.

  20. Alexie says:

    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.

  21. Ben Kavoussi says:

    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.

  22. 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.

  23. 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.

  24. 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.

  25. SarahAnn says:

    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.

  26. Also, the China Study? That was completely debunked by a college student with an interest in diet and statistics…

    And also by Harriet Hall: http://www.sciencebasedmedicine.org/?p=385

    In your haste, you apparently misinterpreted Harriet’s point in citing it.

  27. CarolM says:

    “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 – ?

  28. xwolp says:

    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

  29. dr.cosa says:

    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)

  30. SarahAnn says:

    “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.

  31. Angora Rabbit says:

    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.

  32. WilliamLawrenceUtridge says:

    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.

  33. ConspicuousCarl says:

    Alexieon 18 Jan 2011 at 10:53 am
    being able to create the food at home is a marker for a healthy lifestyle.

    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.

    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.

    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.

    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).

    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.

  34. SarahAnn says:

    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.

  35. Anthro says:

    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.

  36. ConspicuousCarl says:

    Also…

    Alexieon 18 Jan 2011 at 10:53 am
    To ConspicuousCarl who says it’s all about calories

    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.”

  37. 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.

    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?

  38. LMAO says:

    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.

  39. SarahAnn says:

    “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.

  40. Angora Rabbit says:

    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.

  41. @SarahAnn:

    Dr. Hall also has written here about Denise Minger’s critique: http://www.sciencebasedmedicine.org/?p=6092

  42. 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

  43. Alexie says:

    ConspicuousCarl: re: cooking and weight. You may find this interesting:

    http://www.economics.harvard.edu/…/cutler/…/Why%20Have%20Americans%20Become%20More%20Obese.pdf

  44. SarahAnn says:

    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.

  45. Evvy Dense says:

    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.

  46. 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).

    Granted. Immediately after that paragraph was this:

    Also, the China Study? That was completely debunked by a college student with an interest in diet and statistics (etc.)

    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.

  47. @SarahAnn:

    Oops, cross-comment.

  48. 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?

  49. @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. :)

  50. LMAO says:

    @michele… hehehe… we must be about the same age! :D
    @Alison… yes… cauliflower “couscous” anyone? :P

    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.

  51. 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.

  52. sandra says:

    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.

  53. ConspicuousCarl says:

    Alexieon 18 Jan 2011 at 3:05 pm

    ConspicuousCarl: re: cooking and weight. You may find this interesting:

    http://www.economics.harvard.edu/…/cutler/…/Why%20Have%20Americans%20Become%20More%20Obese.pdf

    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.

  54. CPM says:

    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.

  55. 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.

  56. tmac57 says:

    I’m not getting into this argument this time,but I sure could have used some of yall’s help last week :(

  57. desta says:

    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.
    ;)

  58. Reductionist Nurse says:

    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!

  59. desta – yum, Thanks!

  60. Epinephrine says:

    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.

  61. sandra says:

    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.

  62. Chris says:

    micheleinmichigan:

    off topic – but I’d love some good recipes for kale and collards.

    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.

  63. SarahAnn says:

    @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.

  64. 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.

  65. tmac57 says:

    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.

  66. Xiira says:

    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?

  67. oderb says:

    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.

  68. Narad says:

    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.

  69. 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.

  70. 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.

    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.

  71. Scott says:

    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.

  72. Scott,

    Dieticians do study a lot of psychology!

  73. SarahAnn says:

    @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.

  74. 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?

  75. ardnassac says:

    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

  76. @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.

  77. 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.)

  78. “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. ;)

  79. Oh and I have a horrible memory, anyone want to tell me what wonder food I am already eating that cures absentmindedness.

  80. Angora Rabbit says:

    “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.

  81. ConspicuousCarl says:

    SarahAnnon 19 Jan 2011 at 2:51 pm
    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.

    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.

    Most current nutrition recommendations are the result of industry influence and political agenda

    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?

  82. Angora Rabbit says:

    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)

  83. mas528 says:

    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.

  84. ardnassac says:

    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

  85. Fifi says:

    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.

  86. 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.”

  87. 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.

  88. 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.

  89. Narad says:

    Bread used to be called the staff of life because you could live off of it.

    Except for that wee problem of scurvy.

  90. 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. :)

  91. tmac57 says:

    @micheleinmichigan-

    Oh and I have a horrible memory, anyone want to tell me what wonder food I am already eating that cures absentmindedness.

    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 ;)

  92. 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. ;)

  93. AlexisT says:

    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.

  94. SarahAnn says:

    @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.

  95. tmac57 says:

    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?

  96. sandra says:

    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.

  97. Fifi says:

    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.”

  98. 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.

  99. Fifi says:

    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.

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